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Biomedical subjects

Alan Siegel

Publications and source records attributed to Alan Siegel.

9 recordsLinked to original sources
PubMed2006

Parameters in the prediction of the sensitivity of parathyroid scanning.

OBJECTIVE: Although parathyroid scintigraphy with technetium-99m sestamibi has been shown to be a sensitive and specific test for the detection and localization of parathyroid adenomas in patients with primary hyperparathyroidism, false-negative studies occur. Our goal was to determine whether the presurgical parathyroid hormone level could be used to predict whether a scan would be positive or negative. MATERIALS AND METHODS: A retrospective review of parathyroid scans was performed. Analysis included patients with surgical confirmation of a parathyroid adenoma and a documented parathyroid hormone (PTH) level obtained within 6 months of the scan. Patients with secondary hyperparathyroidism were excluded. A true-positive study was defined by the surgical finding of an adenoma on the side indicated by the scan. A scan was false-negative if it did not detect the adenoma found at surgery. A scan was false-positive if an adenoma was identified in the wrong side of the neck or if an adenoma was called but not found. RESULTS: Of 166 scans, 83 met the criteria for inclusion. There were 56 true-positives, 21 false-negatives, and 6 false-positives. The mean PTH in patients with true-positive scans was 367 pg/mL (range, 46-3231 pg/mL) and with false-positive and false-negative scans was 148 pg/mL (range, 46-390 pg/mL). The difference was statistically significant. CONCLUSION: There is a correlation between the sensitivity of parathyroid scintigraphy and presurgical PTH. The overlap, however, of parathyroid hormone levels in positive and negative scans does not allow one to confidently preselect candidates for preoperative scanning.

Adenoma↗
PubMed2004

Clinicians' perceptions of the value of ventilation-perfusion scans.

RATIONALE: The goal of this investigation was to understand clinicians' perceptions of the probability of pulmonary embolism as a function of V/Q scan results of normal, low, intermediate, and high probability. METHODS: A questionnaire was developed and distributed to 429 clinicians at a single academic medical center. The response rate was 44% (188 of 429). The questions included level of training, specialty, probability of PE given 1 of the 4 V/Q scan results, and estimations of the charges for V/Q scanning and pulmonary angiography, and estimations of the risks of pulmonary angiography. RESULTS: The medians and ranges for the probability of pulmonary embolism given a normal, low, intermediate, and high probability V/Q scan result were 2.5% (0-30), 12.5% (0.5-52.5), 41.25% (5-75), and 85% (5-100), respectively. Eleven percent (21 of 188) of the respondents listed the probability of PE in patients with a low probability V/Q scan as being 5% or less, and 33% (62 of 188) listed the probability of PE given an intermediate probability scan as 50% or greater. The majority correctly identified the rate of serious complications of pulmonary arteriography, but many respondents underestimated the charge for V/Q scans and pulmonary arteriography. CONCLUSIONS: A substantial minority of clinicians do not understand the probability of pulmonary embolism in patients with low and intermediate probability ventilation-perfusion scans. More quantitative reporting of results is recommended. This could be particularly important because VQ scans are used less frequently but are still needed in certain clinical situations.

Angiography↗
PubMed2003

Validation of ictal single photon emission computed tomography with depth encephalography and epilepsy surgery.

Many centers have reported that ictal single photon emission computed tomography (SPECT) localizes regions of seizure onset with greater sensitivity and specificity than interictal SPECT. Here we report interictal and ictal SPECT scan results in both lesional and nonlesional cases. Using technetium hexamethyl propylamenamine oxide (HMPAO) or ethyl cysteinate dimer (ECD), these scans were done in 52 patients with partial and secondarily generalized seizures. Twenty-five had normal MRI and 27 showed structural lesions. None had mesial temporal sclerosis clearly identified on MRI. All 52 subsequently had interictal and ictal intracranial EEG studies that appeared to localize the seizure focus. Thirty-nine patients had surgery and have been followed for 2 or more years. Interictal SPECT scans showed focal hypoperfusion consistent with intracranial EEG localization of the seizure focus in 29% of patients. In another 13%, there was correct lateralization but not localization. Ictal SPECT scans showed focal hyperperfusion consistent with intracranial EEG localization of the seizure focus in 52% of patients. In another 25%, there was correct lateralization but not localization. The presence or absence of structural lesions on MRI did not affect ictal hyperperfusion or its correlation with intracranial EEG. Thirty-nine patients had resective surgery, of whom 62% had class I outcomes. There was a trend towards better outcome when ictal SPECT data were concordant with intracranial EEG data. The presence or absence of structural lesions on MRI did not affect the likelihood of class I outcome. Ictal SPECT is superior to interictal SPECT in localizing and lateralizing seizure foci. Its results correlate well with intracranial EEG, but in more than one third of cases, the latter shows focal seizure onset in areas that do not show focal hyperperfusion. Surgical outcome tends to be better when the two modalities give concordant results.

Adolescent↗
PubMed2002

The value of interictal brain SPECT in epilepsy patients without mesial-temporal sclerosis.

PURPOSE: Most of the literature concerning interictal SPECT brain scanning in patients with seizures has involved the evaluation of those with temporal lobe epilepsy. The authors' aim was to determine the utility of interictal SPECT in patients with neocortical epilepsy. MATERIALS AND METHODS: Eighty-four patients with neocortical epilepsy were evaluated with 95 interictal SPECT scans and magnetic resonance imaging (MRI). RESULTS: Fifty-four percent of studies with normal MRI findings had SPECT images without regions of hypoperfusion. Sixty-one percent of patients with abnormal MRI results had matching defects visible on SPECT images. Fourteen scans (only 24%) had focal hypoperfusion by SPECT and no obvious matching MRI finding. CONCLUSIONS: Interictal SPECT, without a comparison ictal study, is of potentially limited value in localizing neocortical seizure foci. SPECT findings usually match MRI findings. Interictal SPECT, however, may still be of value in confirming abnormalities detected by ictal examination.

Adolescent↗