Biomedical subjects
Publications and source records attributed to H A Goldstein.
This case report demonstrates the usefulness and limitations of technetium/thallium scintigraphy in the diagnosis of parathyroid hyperplasia. In addition, discordant thyroid tracer uptake (Tc-99m but not TI-201) due to colloid cysts is described. Another perspective in the controversy over which radiopharmaceutical, Tc-99m or TI-201, should be injected first also is presented.
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Numerous radiographic and scintigraphic imaging modalities are now available for evaluating the gastrointestinal system. With a well-formulated plan based on patient history, physical examination, and laboratory values, together with knowledge of patient preparation techniques and consultation, an efficient customized approach to gastrointestinal disease can be accomplished.
The ratio of splenic to hepatic activity in the posterior view of a Tc-99m SC liver-spleen scan has been used as an indicator of parenchymal disease. Analysis of liver-spleen scans from a series of patients acquired in both the supine and erect positions revealed that the spleen-liver ratio varied considerably with a change in the patient position. Qualitatively there was a shift of colloid from the liver to the spleen in five of 18 supine views and ten of 18 erect views. Quantitative analysis of 37 cases showed that the median erect spleen-liver ratio was 20% greater than the spleen-liver ratio observed in supine patients. Criteria for an abnormal spleen-liver ratio need to be established in each position.
Technetium-99m phosphate compounds may occasionally accumulate in malignant pleural effusions. A case of metastatic pleural effusion first diagnosed by bone scan, prior to its clinical or roentgenographic detection, is reported.
Two cases of benign cortical irregularity of the distal femur ( BCIDF ), which radiologically simulate malignancy, are presented. The use of bone scintigraphy in differentiating this entity from malignancy is described.
We have developed a computer method which by automatically locating the border of the gallbladder in each image and subtracting a varying location-dependent background corresponding to the gallbladder border overcomes the difficulties associated with quantitating gallbladder contraction. These difficulties are attributable to significant and changing background activity, imprecise manual delineation of the gallbladder, and the changing position and shape of the gallbladder. Validation studies using a gallbladder phantom showed the method to be very accurate. No significant difference (P greater than 0.05) was observed between the expected and calculated ejection fractions. Ten patient studies were analyzed, with a resulting range of gallbladder ejection fractions of 22-79%. Excellent reproducibility was obtained with an average intraobserver coefficient of variation of 3.5%, and no statistically significant difference in interobserver measurements (P greater than 0.05). The regression line for interobserver measurements had a slope of 0.96 +/- 0.08, an intercept of 1.6 +/- 4.0%, and a correlation coefficient of 0.99. From these preliminary results we conclude that this method offers a reliable means of quantitating gallbladder contraction.
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A lesion was identified on the late images of a hepatobiliary scintigraphic study, but was not detected on the very early images, due to its enlarged blood pool. This combination of scan findings has not been previously described. The implication of the observation is that one must examine all the images of the hepatobiliary study in an effort to detect space-occupying lesions of the liver.
The stroke-volume ratio determined from the equilibrium gated blood-pool study has been utilized to assess valvular regurgitation, but it is difficult to get reproducible results using generally available equipment. We have developed a new approach utilizing the Fourier amplitude ratio of the left and right ventricles, which is easily implemented and reproducible. Initial clinical experience shows that 17 patients with valvular regurgitation were clearly distinguished from 30 patients without valve disease.
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Ten patients with diabetic gastroparesis were selected for a randomized, double-blind, controlled trial of metoclopramide. Each patient had longstanding insulin-requiring diabetes mellitus and symptoms of gastric stasis. The patients were evaluated for the symptoms of gastric stasis and radionucleotide gastric emptying was measured before the patients entered the study and after they were given either metoclopramide or placebo treatment. Metoclopramide, 10 mg orally, stimulated an increase in the rate of gastric emptying (56.8% +/- 7.4%) in contrast to the response to placebo (37.6% +/- 7.7%) (p less than 0.01). The overall symptoms and symptoms of vomiting were markedly reduced during metoclopramide treatment in contrast to those during placebo treatment. Before the study five patients were constipated (less than three bowel movements per week); during metoclopramide treatment the patients' bowel habits were improved. There was a poor correlation between improved gastric emptying and decreased symptoms. Metoclopramide may improve symptoms of diabetic gastric stasis through two mechanisms: its peripheral effect on gastric smooth muscle, which increases gastric emptying; and its central effects on the chemoreceptor vomiting zone, which decrease nausea.
Thirty-eight patients (28 boys and 10 girls) with hip pain were referred for bone scans. In 7 of 8 with Legg-Calvé-Perthes disease, there was decreased uptake of the radiopharmaceutical in the proximal femoral epiphysis; the other had radiographic evidence of joint destruction and showed increased uptake. Three patients with abnormal scans had normal x-rays with Gaucher's disease, toxic synovitis, and Legg-Calvé-Perthes disease, respectively. One patient with avascular necrosis associated with steroid therapy had increased uptake, possibly due to revascularization. Those with toxic synovitis had either normal bone scans for showed a slight generalized increase around the hip joint. It is speculated that the latter may represent those who later present with Legg-Calvé-Perthes. The bone scan is useful for the early detection of Legg-Calvé-Perthes disease in patients with hip pain.
Nine patients with facial pain were evaluated with limited bone scans. The scintigrams correlated with microscopy in all patients (eight positive, one negative), although radiographs correlated with microscopy in only five patients (four positive, one negative). The degenerative disease process in the temporomandibular joint was more extensive in the patients with radiographic and scintigraphic abnormalities than in those with scintigraphic abnormalities alone. The limited bone scan appears useful in detecting early degenerative changes in the temporomandibular joint.
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Osteoid osteoma is a painful osteoblastic process. The pre-operative diagnosis is usually made by roentgenogram. Four surgically confirmed cases are examined where the preoperative diagnosis was clarified by bone scintigraphy. The clinical indications, the diseases process, the literature are reviewed.