SPECT versus planar liver scintigraphy: is SPECT worth it?

Five hundred three planar and SPECT hepatic studies were reviewed separately by two experienced observers looking for focal disease. An equivocal reading meant referral to ultrasound or computed tomography (US/CT). The increase in correct readings and decrease in US/CT referrals per 100 positive and per 100 negative SPECT readings were calculated, then the increase in correct readings and decrease in US/CT referrals for various positive rates of liver involvement determined. At our institution, the overall positive rate is approximately 13% yielding 1.1 and 0.83 more correct readings and 1.8 and 2.0 fewer US/CT referrals per 100 cases for each reader, respectively; a marginal benefit for SPECT over planar scintigraphy.

Indium-111 chloride imaging with ununited fractures.

Twenty patients with ununited fractures and a suspicion of infection had In-111 chloride imaging. Surgically obtained cultures were positive for infection in 12 and negative in eight patients. In-111 chloride images were positive in all 12 patients with infection but also were positive in six of the patients with negative cultures. It is not possible to differentiate infected from noninfected ununited fractures by In-111 chloride imaging.

Hyperthyroidism and the single lobe.

A practical approach to the hyperthyroid patient with a single lobe visualized on thyroid scintigraphy, and its impact on therapy is discussed. An illustrative case is also presented.

Indium-111 chloride imaging in the detection of infected prostheses.

Thirty-three patients with painful joint prostheses and a suspicion of infection were imaged with [111In]chloride. A final diagnosis was established by culture in 19. Of these, 12 were categorized as true positives and three as true negatives. There were two false-positive studies, occurring in patients with knee prostheses. In both, the culture was obtained by aspiration. Two false negatives were in patients with hip prostheses, one of whom had been on long-term antibiotic suppressive therapy. The sensitivity was 86%, specificity 60%, and accuracy 79%. Seventeen of the proven cases had bone imaging prior to [111In]chloride imaging. All 17 static images were positive and were not helpful in differentiating loosening from infection. Using increased uptake on the blood-pool image as a criteria for infection, the sensitivity was 89%, but the specificity was 0. Adding flow studies made little difference in interpreting the blood-pool images. This study shows that [111In]chloride accurate in evaluating infection in prosthesis than bone imaging.

Indium-111 chloride bone marrow imaging in chronic renal disease.

Eight patients with anemia and chronic renal disease being maintained by chronic hemodialysis were evaluated with In-111 chloride bone marrow imaging and bone marrow core biopsies. There was no correlation between the erythrocyte cellularity of the marrow and the indium bone marrow scan grade in any patient. Bone marrow imaging can not be used as an indicator of the presence of erythroid marrow in these patients.

Indium-111 chloride for detecting suspected hepatomas in patients with focal defects on technetium-99m sulfur colloid liver imaging.

Twenty-three patients with hepatic cirrhosis and focal defects on Tc-99m sulfur colloid (SC) scintigrams were restudied with In-111 chloride to determine if indium localization in the focal defect is indicative of a hepatoma. Seven of eight patients with proven hepatomas had positive studies; however, six of 15 patients without hepatomas also had studies interpreted as positive. Thus, In-111 chloride is highly sensitive for the detection of hepatomas, and a negative indium study would militate against this diagnosis. The high false-positive rate found may be due to technical factors rather than a lack of specificity of localization; the experience of others seems to support this impression. At present, In-111 chloride scintigraphy for focal hepatic defects appears to be useful in ruling out hepatoma.

Indium-111 chloride imaging in chronic osteomyelitis.

Sixty-eight patients with clinically suspected chronic osteomyelitis were studied with [111In]chloride. Fifty-four images were categorized as true positive; seven were categorized as true negative. There were four false-positive studies, two of which were associated with healing cancellous bone grafts. There were three false-negative studies in patients previously treated with long-term antibiotic therapy. Images in eight noninfected healing fractures 3 to 8 mo old were normal. Three patients with infected total hip prostheses had positive images. Two patients with loose prostheses had negative images. This study shows that [111In]chloride imaging is an accurate way to localize chronic osteomyelitis and may overcome some of the disadvantages of [67Ga]citrate such as localization in noninfected healing fractures and in some loose [67Ga]citrate such as localization in noninfected healing fractures and in some loose prostheses.

Indium-111 chloride imaging in patients with suspected abscesses: concise communication.

Two hundred and fifty-eight patients with clinically suspected inflammatory processes were studied. Seventy-two images were categorized as true positive; 211 as true negative. There were nine false-positive studies, four of which were due to activity in beds of excised organs. There were six false-negative studies, four of which were due to walled-off abscesses found either at surgery or biopsy. The sensitivity was 92%, the specificity 95%, and the accuracy 94%. This study shows that indium-111 chloride imaging provides a reliable way to locate inflammatory processes and overcomes the disadvantages of other imaging agents, for example gastrointestinal activity or the demonstration of healing surgical wounds with gallium-67, and the false-positive images due to cystic fibrosis and other respiratory diseases, or accessory spleens as seen with In-111-labeled white cells.

Bone-marrow imaging with indium-111 chloride in aplastic anemia and myelofibrosis: concise communication.

Twenty-nine patients with aplastic anemia and 11 patients with myelofibrosis were evaluated with indium-111 chloride bone-marrow imaging, ferrokinetics, and bone-marrow core biopsies. There was good correlation between the erythrocyte cellularity of the marrow and the In-111 bone-marrow scan grades in most patients. In some, the overall scan grade tended to underestimate the erythroid elements because the core biopsy had been taken from the area of the greatest radionuclide concentration on the scan. In patients with aplastic anemia, there was good correlation between the plasma iron clearance t1/2 and the scan grade. Less agreement was found in the comparison between the Fe-59 sacral and organ counts and the red-cell iron utilization. In patients with myelofibrosis, there was poor correlation between the surface counts over the sacrum and the red-cell iron utilization. Plasma iron clearances were abnormally short and were unrelated to the transferrin saturation levels. Eighteen patients were studied several times to evaluate their responses to steroid therapy. In all, there was good correlation between the bone-marrow imaging, the erythrocyte cellularity, ferrokinetics, and the patient's response to therapy. Indium-111 bone-marrow imaging is useful both in evaluating marrow erythroid activity and in following the response to therapy in patients with these diseases.

Value of thyroid carcinoma imaging after therapeutic doses of radioiodine.

Thyroid carcinoma scans in the immediate post-therapy period after therapeutic doses of I-131 for well-differentiated thyroid carcinoma showed additional lesions in ten of 24 (42%) patients or on 13 of 42 (31%) occasions, whereas the corresponding pretreatment diagnostic scans done with a small test dose failed to reveal the lesions. In four patients, lesions were only discernible on the regional rectilinear scan views and not on the total-body images. The value of post-therapy scans and the importance of obtaining the regional views are emphasized.

111In chloride bone marrow scintigraphy and ferrokinetic studies in a case of sickle cell anemia with transient erythroid aplasia.

A patient with sickle cell anemia was hospitalized because of an acute erythropoietic aplastic crisis. 111In chloride bone marrow scintigraphy performed during the aplastic crisis showed markedly impaired uptake of the radionuclide and simultaneous 59Fe clearance T 1/2 studies were prolonged (420.9 min). Following recovery from the aplastic crisis 111In scintigraphy revealed an expanded marrow and the radioiron clearance T 1/2 was accelerated (20.9 min). The clinical course, hemograms and bone marrow aspirations correlated with marrow scintigraphy. 111In appears to be a valuable marrow scanning agent for assessing the presence of intramedullary erythropoietic activity.