Graphic user interface-based nuclear medicine reporting system.

A graphically based, computerized report generation program has been developed and deployed at a dozen nuclear medicine facilities. The system is based on the Macintosh graphical user interface (GUI) and has been designed to be easy to learn and use. The system allows the nuclear medicine practitioner to generate reports for any nuclear medicine or nuclear cardiology procedure without transcriptionist support, dramatically decreasing report turnaround time. The system includes a relational database engine that allows cost-effective storage and rapid retrieval of final reports and also supports facsimile transmission of reports directly to referring clinicians' offices.

Graphical interface for medical image processing.

We have developed a graphical interface which allows users of varying levels of computer experience and proficiency to manipulate medical image-processing data with "point-and-click" ease. The power which had formerly been associated with protocols and shell scripts has been combined with the flexibility and "user-friendliness" of buttons and dialog boxes.

An integrated approach to biodistribution radiation absorbed dose estimates.

An integrated approach to existing methods of extracting biodistribution data, pharmacokinetics and radiation absorbed dose estimates from serial scintigraphic images is described. This approach employs a single computer-generated user interface to reformat planar scans into a standard file type, align conjugate (anterior and posterior) images, draw regions of interest (ROIs) over selected organs and lesions and generate count data for anterior and posterior views and calculated geometric means. Using standard correction methods, the fraction injected activity is obtained for all ROIs and total body. This methodology has been applied to the analysis of indium-III-labelled breast-cancer-directed antibodies and technetium-90m-labelled CEA-specific antibody fragments in non-small-cell lung cancer. It is anticipated that this approach will be useful for evaluating the dosimetry of other radiolabelled monoclonal antibodies, as well as other radiopharmaceuticals.

Anomalous origin of the left coronary artery. Use of thallium perfusion scans in the evaluation of successful revascularization.

Thallium imaging was performed on a 2-month-old infant with a left coronary artery originating from the pulmonary artery. Imaging was performed before and after corrective surgery, which involved creating a new left coronary osteum from the ascending aorta. The radionuclide study documented successful revascularization postoperatively.

Radionuclide quantitation of renal function.

Quantitation of renal function may be performed with a variety of radiopharmaceuticals which reflect slightly different renal functions. Plasma sampling techniques and imaging techniques have been used to derive absolute measurements of renal function. The addition of imaging permits the determination of relative or "split" function. Time-activity curves from renal studies provide other quantitative parameters of function reflecting arterial supply, renal cortical function, and patency of the renal collecting system. Quantitative radionuclide studies of the kidneys provide comprehensive, reproducible, and objective assessments of renal function.

Hepatic hemangiomas: diagnosis with fusion of MR, CT, and Tc-99m-labeled red blood cell SPECT images.

A method of image analysis was developed for correlation of hemangiomas detected at computed tomography (CT) and/or magnetic resonance (MR) imaging with increased blood pool activity evident at single photon emission CT (SPECT) performed after labeling of red blood cells with technetium-99m. Image analysis was performed in 20 patients with 35 known hepatic hemangiomas. After section thickness and pixel sizes of the different studies were matched, intrinsic landmarks were chosen to identify anatomically corresponding locations. Regions of interest (ROIs) drawn on the CT and/or MR images were translated, rotated, and reprojected to match the areas of interest on the corresponding SPECT images by means of a two-dimensional polynomial-based warping algorithm. Analysis of ROIs on 30 SPECT-MR and 20 SPECT-CT pairs of registered images provided absolute confirmation that 34 suspected hemangiomas identified on SPECT images correlated exactly with lesions seen on CT and/or MR images. Accuracy of fusion was within an average of 1.5 pixels +/- 0.8 (+/- 1 standard deviation). The technique enabled diagnostic confirmation of hemangiomas as small as 1.0 cm and proved useful for evaluating lesions located adjacent to intrahepatic vessels.

Brain imaging in acquired immunodeficiency syndrome dementia complex.

Human immunodeficiency virus (HIV) infections are accompanied by many different types of neurological complications. Opportunistic infections and neoplasms, particularly lymphoma, are often an underlying cause for these complications in patients with acquired immunodeficiency syndrome (AIDS). Frequently, these can be detected by cerebrospinal fluid (CSF) examination, double-dose contrast transmission computed tomography (CT), and/or magnetic resonance imaging (MRI). It has become apparent that the HIV itself is responsible for a significant percentage of neurological disease in the HIV-seropositive individual. The onset may be subtle and may occur before the onset of frank immunosuppression. Diagnosis of HIV encephalitis or AIDS dementia complex (ADC) is complicated by the frequent coexistence of opportunistic infections. Structural neuroimaging (CT or MRI) shows atrophy and in some case white matter abnormalities, but imaging-pathological correlation suggests that these modalities are relatively insensitive to the presence of HIV brain infection. Functional neuroimaging, both 18fluorodeoxyglucose positron emission tomography (PET) for evaluation of glucose metabolism and 123I iodoamphetamine or 99mTc-HMPAO single-photon emission computed tomography (SPECT) for evaluation of cerebral perfusion, can demonstrate abnormalities in the subcortical gray matter structures and the cerebral cortex in patients with ADC. These abnormalities may be observed early in the course of ADC even when MRI is negative and the patient is relatively asymptomatic. Also, PET and SPECT may be useful to follow progression of the dementia or response to therapy.

Definitive diagnosis of hepatic hemangiomas: MR imaging versus Tc-99m-labeled red blood cell SPECT.

Thirty-seven patients with 69 suspected hemangiomas found by means of computed tomography (CT) and/or ultrasound were studied with both 0.5-T magnetic resonance (MR) imaging and single photon emission CT (SPECT) with technetium-99m-labeled red blood cells. Using a criterion of "perfusion-blood pool mismatch," SPECT readers diagnosed 50 of 64 hemangiomas and all five "nonhemangiomas" (sensitivity, 78% [95% confidence interval, 0.664 - 0.864]; accuracy, 80% [0.69 - 0.877]). Qualitative analysis of lesion signal intensity on T2-weighted spin-echo MR images allowed readers to diagnose 58 of 64 hemangiomas and four of five nonhemangiomas (sensitivity, 91% [0.814 - 0.96]; accuracy, 90% [0.807 - 0.951]). Because of the significantly higher cost of MR imaging and its inability to categorically differentiate hemangiomas from hypervascular metastases, the authors consider SPECT to be the method of choice for diagnosing hepatic hemangiomas. MR imaging should be reserved for the diagnosis of lesions smaller than 2.0 cm and for those 2.5 cm and smaller adjacent to the heart or major hepatic vessels; in such cases MR imaging was found superior to SPECT.

Detection of thoracic infections by nuclear medicine techniques in the acquired immunodeficiency syndrome.

The challenge of the acquired immunodeficiency syndrome (AIDS) for nuclear medicine has been the early detection of related intrathoracic opportunistic infections, inflammatory conditions, and neoplasms. Gallium-67 citrate scanning has proved a sensitive test not only for Pneumocystis carinii pneumonia but for many of the other opportunistic infections and malignancies, including mycobacterial infections and lymphoma. Patterns and intensity of gallium uptake may suggest more specific diagnoses. Indium-111-labeled white blood cells may also be a valuable diagnostic tool in the AIDS patient.

CT-SPECT fusion to correlate radiolabeled monoclonal antibody uptake with abdominal CT findings.

To enhance the information provided by computed tomography (CT) and single photon emission computed tomography (SPECT) performed with radiolabeled, anti-carcinoembryonic antigen monoclonal antibody (MoAb), the authors performed fusion of these types of images from eight subjects with suspected colorectal adenocarcinoma. Section thickness and pixel size of the two studies were matched, coordinates of corresponding points from each study were identified, and CT sections were translated, rotated, and reprojected to match the corresponding SPECT scans. The CT-SPECT fusion enabled identification of anatomic sites of tumor-specific MoAb accumulation in four cases, showed non-specific MoAb accumulation in two, and helped confirm information only suggested by the two studies separately in one.

Contribution of SPECT to imaging of gastrointestinal adenocarcinoma with 111In-labeled anti-CEA monoclonal antibody.

Fourteen patients with suspected adenocarcinoma of the gastrointestinal tract received 1 mg of 111In-labeled anticarcinoembryonic antigen monoclonal antibody type ZCE025 combined with 40 mg unlabeled antibody of the same type. Planar and single-photon emission CT (SPECT) imaging studies were performed 3 days after infusion and, when possible, 7 days after infusion. Scan findings were correlated with the findings at surgery when possible. Tumor was detected by day-3 planar imaging in eight of 13 patients in whom tumor was documented histopathologically. Day-3 SPECT allowed demonstration of tumor in 11 of these 13 patients. In another patient whose scan was negative, no residual tumor was found at surgery. SPECT was particularly helpful in identifying small and midline tumors. In two cases, localization on SPECT helped identify the tumor mass on CT. Two primary tumors weighing less than 5 g could not be detected on either planar or SPECT scans. Histologically positive, normal-sized lymph nodes were not seen by planar imaging or SPECT. SPECT increased the detection rate over that achieved with planar imaging, helped to better localize scan abnormalities, and afforded more useful comparison between the monoclonal antibody study and CT.

Aortic aneurysm dissection causing V/Q mismatch.

A case of unilateral mismatch on a ventilation/perfusion lung scan due to aortic aneurysm dissection is presented. Pulmonary embolism should not be considered the sole cause of unilateral lung mismatch. Clinical evaluation and pulmonary angiography should be used for a definitive diagnosis.

Gallium-67 scans of the chest in patients with acquired immunodeficiency syndrome.

Eighty-six [67Ga]citrate chest scans were performed in 71 adult patients with the acquired immunodeficiency syndrome. Forty-five of these patients also had Kaposi's sarcoma. Only 29 of 57 abnormal scans were correlated with abnormal chest radiographs. Chest radiographs were negative for 27 scans and unavailable for one. Several scan patterns were seen. Diffusely increased lung uptake was seen most commonly with Pneumocystis carinii pneumonia, but also other infections and noninfectious inflammatory conditions. Focal uptake corresponding to regional lymph node groups occurred most often with Mycobacterium avium-intracellulare but aslo with lymphoma. Localized intrapulmonary uptake was seen in bacterial pneumonias. Perihilar activity occurred in two cases. When chest radiographs were abnormal and 67Ga scans negative, the most common diagnosis was pulmonary Kaposi's sarcoma.

The impact of intradermal lymphoscintigraphy on surgical management of clinical stage I truncal malignant melanoma.

Lymphoscintigraphy results in 35 stage I melanoma patients were compared with primary location and surgical management. Six of 25 primaries with potentially multidirectional lymphatic drainage had drainage to one regional node group. Three of 10 with expected unidirectional drainage showed multidirectional drainage. With unidirectional drainage, decision concerning lymphadenectomy was simplified.

Breakdancer's pulmonary embolism.

A case of pulmonary embolism caused by breakdancing is reported. There was no clinical suspicion of pulmonary embolism.

"Supernormal" bone image in a case of Waldenström macroglobulinemia.

A case of Waldenström macroglobulinemia, a rare cause of diffusely increased skeletal uptake and relatively diminished renal uptake of bone seeking radiopharmaceutical, is presented. This pattern has been described in a variety of disorders. An important observation to be made in these cases is the skeletal distribution of the radiopharmaceutical. In diffuse bone metastases from carcinoma, which is the most common cause of these findings, the increased activity is primarily in the axial skeleton. In some of the more uncommon causes, including certain hematologic disorders, however, the increased skeletal uptake is more homogeneous in distribution, with prominent uptake in the skull and distal extremities.