Tc-99m sestamibi uptake in a patient with gynecomastia: a potential pitfall in the diagnosis of breast cancer.
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Breast Neoplasms, Male↗
Biomedical subjects
G C Vivian
Publications and source records attributed to G C Vivian.
Quality assurance in myocardial perfusion tomography: a collaborative BNCS/BNMS audit programme. British Nuclear Cardiology Society/British nuclear Medicine Society.
The aim of this study was to assess the status of acquisition and reporting of myocardial perfusion tomography in the UK. Centres were asked to provide an expert panel with clinical and technical information, digital and hard copy of raw data and reconstructed tomograms, as well as their report (optional) for five randomly selected studies. Ninety studies were received from 18 centres; report text was provided for 66 studies. Six parameters (stress technique, radiopharmaceutical usage, image acquisition and processing, report images and text) were scored as good (2), adequate (1) or poor (0) by consensus. Centres received the quality scores for each study and a consensus clinical report from the panel. Stress technique was scored as inadequate in 10 (11%) studies, radiopharmaceutical usage and image acquisition as inadequate in 5 (6%) studies, image processing as inadequate in 8 (10%) studies and report images as inadequate in 2 (3%) studies. Report text was felt to be inadequate in 21 of 66 (32%) studies; in 11 of these (52%), the report text was judged to be incorrect and in 10 (48%) it was essentially correct but misleading because of poor phraseology. The mean quality score per study was 1.3 (range 0.5-2.0). Seventeen of 88 (19%) studies scored less than 1.0 and were considered to be of poor quality. In conclusion, a large variation in standards of myocardial perfusion tomography was seen. Data acquisition was generally satisfactory, but 32% of reports were inadequate.
Coronary Disease↗
Radionuclide developments.
This review considers a number of recent important developments in nuclear medicine, and possible future introductions, priority being given to those products which are most likely to find a place in clinical practice. This includes both novel radiopharmaceuticals and progress with new types of imaging equipment. Three areas are chosen as being of particular importance: brain imaging, heart imaging, and diagnosis and therapy of cancer. In the brain, the clinical value of imaging regional cerebral blood flow and certain aspects of the neuroreceptor/neurotransmitter system are discussed. Cardiac imaging is considered in the light of recent work on diagnosis and risk assessment, investigating the hibernating myocardium, and the possible place of fatty acid imaging. Both diagnosis and therapy of cancer are increasingly important, and the use of radionuclides in these areas in considered.
Bone Neoplasms↗
99Tcm-mercapto acetyl triglycine in paediatric renal tract disease.
The use of 99Tcm-mercapto acetyl triglycine (99Tcm-MAG3), a new hippuran substitute, has been reported widely in adults but not in children. Our experience of its use in 100 infants and children for renography and indirect micturating cystography (IMC) is reported. The average age was 5.6 years. 65 patients completed IMC studies and nine patients had 99Tcm-dimercaptosuccinic acid (99Tcm-DMSA) scans performed on the same day. The majority of patients were referred for the investigation of urinary tract infection. 32 kidneys were found to be scarred on 99Tcm-MAG3 scans, 17 kidneys and ureters refluxed on IMC and 14 kidneys were obstructed. The results of 99Tcm-MAG3 scans were compared with those of other urinary tract investigations including ultrasound, micturating cystography (MCUG), intravenous urography (IVU) and 99Tcm-DMSA scintigraphy. No kidney which was scarred had a normal 99Tcm-MAG3 scan. All significant degrees of dilatation or obstruction on IVU or ultrasound were also detected by 99Tcm-MAG3. 99Tcm-MAG3 gave more information than any other single imaging modality and we believe it represents an ideal initial screening test in the investigation of urinary tract infection in older toilet-trained children.
Adolescent↗
Spinning top urethra: not a normal variant.
Spinning top urethra (STU) is a term used to describe a widened posterior urethra seen mainly in girls. It is commonly regarded as a normal variant. The authors studied 30 girls with STU using videourodynamics. Twenty-eight showed bladder instability; 21, a congenital wide bladder neck anomaly; and 20, both instability and a wide bladder neck. One patient had a sensitive bladder. All patients had a urodynamic abnormality. The authors believe that the STU is nearly always an indication of bladder instability or wide bladder neck anomaly. The most common mechanism for the dilatation of the posterior urethra is that unstable contractions are resisted by a voluntary increase in distal sphincter tension so as to prevent leakage of urine. The resulting pressure rise produces distention of the posterior urethra, which will be maximal in subjects with a weak bladder neck mechanism as in the congenital wide bladder neck anomaly. The authors believe that STU is seldom if ever a normal variant.
Adolescent↗
Effect of volume expansion and urinary obstruction on the renal transit time of 99mTc-DTPA.
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Child↗
Renal parenchymal determination and analysis during dynamic 99Tcm-DTPA scans in children.
Twenty-six children underwent a total of 75 99TCm-DTPA scans. Two experienced operators, using different techniques were able to identify parenchyme in 77 of 111 kidneys. Parenchymal regions of interest were drawn by an entirely operator dependent and a relatively operator-independent technique. Transit time analysis, using a matrix algorithm, through the parenchyme of both normal and abnormal kidneys showed a high degree of correlation (tau = 0.595, P less than 0.001). The technique concurred in the studies for which the analysis could not be applied, generally due to poor technical factors or gross hydronephrosis with insufficient parenchyme to generate a time activity curve. Either technique may be used in clinical practice to identify renal parenchyme for further analysis.
Adolescent↗