Biomedical subjects
Publications and source records attributed to F I Jackson.
We have treated 16 patients suffering from recurrent malignancies who were unsuitable for any other form of treatment with local radiofrequency (RF) hyperthermia. Relief of pain as a major symptom occurred in six patients and reduction in size of tumor occurred in 13 instances.
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Mastocytosis (urticaria pigmentosa) was proven in a patient suffering from severe back pain. A bone scan showed diffusely increased bone activity. Count rates were also abnormally elevated over several areas of the skeleton. Radiographs were consistent with mastocytosis in bone.
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A patient is described in whom the postoperative management after renal transplantation was complicated by a wound discharge. A radionuclide technique of solving the clinical dilemma is discussed, using scintilymphangiography and qualitative assays.
The biodistribution of radiotracers used in diagnostic imaging is grossly and recognizably altered by a wide variety of drugs and other treatment modalities, such as surgery and radiotherapy. Knowledge of such altered biodistribution is important both in making diagnostic inferences from scans and in dosimetric considerations.
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A family of four patients suffering from Nonne-Milroy disease has been examined by pedal scintilymphangiography. Lower limb edema was present in three patients and was bilateral in two instances. Scintilymphangiographic abnormality was invariably present, ranging from almost total obstruction of lymphatic flow to lymphatic pooling. The inguinal, iliac and para-aortic nodes on the affected sides were also noted to be small and few in number. The examination is safe and simple and may be used to distinguish Nonne-Milroy edema from edema due to other causes.
In a prospective study of 500 consecutive patients, the addition of oblique scans increased the accuracy of the colloid liver scans used to detect metastases. The oblique views changed the interpretation in 12 (2.4%) patients; objective evidence to support this change was obtained in 11 of the 12. The addition of at least a right anterior oblique scan should, on this evidence, form part of the radiocolloid evaluation of the liver for the presence of metastatic disease.
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In a prospective study of the value of gallium-67 scintigraphy in cases of multisystem malignant melanoma, 69 scans were obtained for 36 patients. No abnormality was found in 18 scans; in only 3 was there other evidence of disease. Of 54 sites of disease demonstrated by scintigraphy, 40 were correlated with other investigations: biopsy (5), surgery (7), autopsy (7), radiographic (13), or clinical (8). Metastatic melanoma was found in 37 (69%) of the sites; no such disease was found in 3 (5.7%). The life expectancy of patients with an abnormal scan was shorter than that of patients with a normal scan. Gallium studies reliably indicated the extent of multisystem melanoma, and are of value in clinical management.
Bone scintigraphs obtained with both Technetium-99m polyphosphate and Technetium-99m pyrophosphate have been abnormal at the sacroiliac joints of 44 patients with definite ankylosing spondylitis (AS). Because of the normal registration of the sacroiliac joints on bone scintigraphy, it has been necessary to develop a profile-scan technique to quantify the abnormality that proves to be significantly different from the normal finding. In 17 patients with a strong clinical suspicion of AS but normal radiographs, the sacroiliac joints have frequently been abnormal. This finding is meaningful because there is a common occurence in this group of the histocompatibility antigen HL A-B27, known to be a marker of AS. We also note the frequency of abnormal sacroiliac scinitigrams in 26 patients with rheumatoid arthritis and in a group of other diseases-Crohn's disease, uveitis, psoriasis, ulcerative colitis, and Reiter's disease-all of which share some of the manifestations of AS.
A prospective study of bone scintigraphic findings has been carried out in 63 patients, firmly diagnosed as having ankylosing spondylitis. In addition to abnormal uptake of the radiotracer at the sacroiliac joints, a peripheral arthropathy has been a common finding, particularly in the proximal joints, occurring in up to 50% of patients. Increased uptake of radiotracer in the spine has also been found both diffusely and focally. Focal increases have been noted at the apophyseal joints in 40% of patients and in three patients with a sterile intervertebral diskitis, an unusual complication of this disease only diagnosed in two patients after bone scintigraphy.
Fifty consecutive patients in whom occult primary malignant disease was suspected underwent scintiscanning of the head, neck and trunk with gallium-67-citrate. In 17 patients a carcinoma was correctly identified as to presence and approximate location. In another seven patients the site of the primary tumour was identified from the scan and confirmed by radiologic study but no histopathological diagnosis, except for metastatic anaplastic carcinoma, was made. In another five patients the many abnormalities on the scan did not permit identification of a possible site of the primary tumour. Eleven patients had normal scintiscans and no evidence of malignant disease on follow-up. In seven patients with proven carcinoma false-negative results were obtained: no uptake of the radioisotope was detected, even at the sites of known disease. In three patients false-positive uptake of the radiotracer was observed; two had benign disease and one had a malignant tumour remote from the scan abnormality.
Use of modern materials and methods has given bone scintiscanning a larger role in clinical medicine, The safety and ready availability of newer agents have led to its greater use in investigating both benign and malignant disease of bone and joint. Present evidence suggests that abnormal accumulation of 99mTc-polyphosphate and its analogues results from ionic deposition at crystal surfaces in immature bone, this process being facilitated by an increase in bone vascularity. There is, also, a component of matrix localization. These factors are in keeping with the concept that abnormal scintiscan sites represent areas of increased osteoblastic activity, although this may be an oversimplification. Increasing evidence shows that the bone scintiscan is more sensitive than conventional radiography in detecting focal disease of bone, and its ability to reflect the immediate status of bone further complements radiographic findings. The main limitation of this method relates to nonspecificity of the results obtained.