Bone scan as a stratification variable in advanced prostate cancer.

The serial technetium 99 (99Tc) bone scans of 76 patients with Stage D-2 prostate cancers were reviewed. Sites of metastases in skeletal areas in decreasing order were vertebrae, ribs, pelvis, long bones, and skull. Patients with one or two involved skeletal areas had a significantly longer progression-free interval and survival time than patients with three or more bony areas of uptake. Bone scans might be used as a stratification variable in future prospective clinical trials of Stage D-2 prostate cancer.

Facial bone infarcts in sickle cell syndromes.

Bone infarction in the sickle cell syndromes (sickle cell anemia, sickle beta thalassemia, and sickle C disease) is common in the long bones, but the facial bones, particularly the orbits, are infrequently involved. In a review of the literature, only 13 cases of facial bone infarcts in sickle cell syndromes were found. Seven episodes of facial bone infarcts--four orbital, two mandibular, and one in the zygomatic arch--in six patients encountered at the authors' institution are reported. Five patients had hemoglobin SS, and one had hemoglobin SC. Bone marrow scans were positive for infarction in five of the six episodes during which they were obtained, which highlights the usefulness of this technique in the diagnosis of facial bone infarction.

Nuclear medicine in the diagnosis of cardiac contusion.

In 16 patients with blunt trauma to the chest, the role of cardiovascular nuclear medicine was evaluated using anterior chest flow assessment, with first-pass ejection fraction of left and right ventricles and 99mTc-pyrophosphate scintigraphy. The radiopharmaceutical used was pyrophosphate, labelled with approximately 20 mCi 99mTc. The anterior chest flow and first-pass ejection fractions were initially obtained during the injection of 99mTc-pyrophosphate and were followed up 3 h later by anterior, LAO 45 degrees, and left lateral views of the chest, using an LFOV gamma camera with a data processor. The results were compared with serial cardiac enzymes studies, electrocardiograms and echocardiograms. Of the patients, 77% showed scintigraphic evidence of cardiac contusion. The intensity of activity varied from grades I to II; five patients had abnormal echocardiographic findings. Only two had abnormal ejection fractions, and one patient had evidence of left ventricular aneurysm along with poor ventricular performance. Cardiac enzymes were found to be the least helpful. Electrocardiograms, though non-specific for myocardial damage, were abnormal in 62% of the patients. Eleven of our patients had both abnormal ECG and increased PYP uptake. Even though there is no agreement as to which noninvasive parameter is more sensitive in the diagnosis of myocardial contusion, 99mTc-pyrophosphate scintigraphy, in conjunction with ECG, seems promising in this respect.

Indications for Gallium 67 in surgical oncology.

Until recently, the diagnosis of primary neoplasms and metastasis required different and complicated tests, many of which were invasive. Several radiopharmaceuticals have been tried in the diagnosis and management of neoplasms, but so far, the only radiopharmaceutical which gives satisfactory results is Gallium 67. Scintigraphy with this compound allows localization of the primary neoplasm and metastasis. It is also useful in the staging and follow-up and, in particular, in ascertaining the efficacy of treatment. Gallium scintigraphy is a very sensitive procedure, but not very specific; active inflammatory processes can produce an abnormal localization of the Gallium 67 in the infected area.

Gallium-67 uptake in cutaneous sarcoidosis.

A case of abnormally increased gallium-67 uptake by cutaneous lesions in sarcoidosis is reported. The patient also had active sarcoidosis in lungs, periaortic lymph glands, salivary, and lachrymal glands.

Bilateral pulmonary 67Ga uptake in a patient with a benign monoclonal gammopathy.

Bilateral pulmonary uptake in an asymptomatic patient with normal chest X-rays and a monoclonal gammopathy is described. At the 11-month follow-up the patient is asymptomatic and chest X-ray remains normal.

Bone scintigraphy in drug addiction.

In 22 drug addicts, the clinical diagnosis of osteomyelitis and/or septic arthritis was suspected because of symptoms of sepsis and pain in various locations. All patients underwent bone scintigraphy with 17-20 mCi of 99mTc labeling either pyrophosphate or methylene diphosphonate. Whole body and spot scans located the area of disease in most patients. This permitted biopsy of the affected area when the pathogen recurs. One of the two patients whose scintigrams were normal was on adequate treatment before the bone scintigram and the other was on oxacillin. Radiographs of the affected areas were normal, which indicates bone scintigraphy should be preferred to radiography in the early diagnosis of osseous infections.

Gallium 67 scintigraphy in abdominal diseases.

An abnormal localization of radioactivity from gallium 67 in the left upper quadrant of abdomen was found in a pancreatic abscess with invasion of adjacent structures.

Radionuclide angiocardiography in tricuspid atresia.

In two cases of tricuspid atresia and one of severe tricuspid stenosis the Glenn and Fontan operation was performed. These patients were evaluated post-operatively by studying the distribution of the ventilation with Xe-133 on a gamma camera; the pulmonary circulation was evaluated by injection through antecubital and pedal veins of TC99mMAA and angiography was performed by "in vivo" tagging of red blood cells with TC99m04 preceded by the administration of stannous pyrophosphate. The scintigraphic findings in two cases consisted of decreased ventilation of the left lung and grossly normal perfusion of both lungs. In one case there was abundant collateral because of partial occlusion of the anastomosis between the superior vena cava and right pulmonary artery. The patients also had angiocardiography with contrast medium; the correlation between the scintigraphic and angiocardiographic findings was excellent.

Thrombosis detection using radionuclide techniques.

Radionuclides have been used in the evaluation of intravascular thrombosis for several years. The most widely accepted nonimaging technique is I-125 labeled fibrinogen. It is commonly used for patients who have a high probability of developing a thrombus (e.g., those undergoing surgery). Other techniques are emerging as having value in thrombosis detection. These techniques include radionuclide venography and clot localization scanning techniques utilizing the affinity of clot for small radiolabeled particles, as well as imaging techniques using I-131 labeled fibrinogen. More recently, a number of the above-mentioned techniques have been applied to patient problems. The FDA ban on commercial radiolabeled fibrinogen in the United States has promoted the development of alternative techniques and the use of autologous fibrinogen. A number of other techniques for thrombosis detection have also been explored on a more experimental basis. They include the use of thrombolytic agents such as streptokinase, urokinase, and white blood cells, as well as platelets. The common lung or pulmonary perfusion scan using macroaggregates of albumin or microspheres radiolabeled also gives information as to the presence of thrombosis of embolus within the pulmonary arteries, by showing the effect upon the perfusion pattern. This review will explore in detail the principles, as well as the present and prospective usefulness of the techniques currently available.