Squamous cell carcinoma of the lung mimicking an ectopic mediastinal parathyroid adenoma demonstrated by Tc-99m sestamibi in a hypercalcemic patient.
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Adenoma↗
Biomedical subjects
K Y Tzen
Publications and source records attributed to K Y Tzen.
Value of Ga-67 SPECT in monitoring the effects of therapy in invasive aspergillosis of the sphenoid sinus.
PURPOSE: We report a case of invasive sphenoid sinus aspergillosis clinically presenting as a pituitary mass. METHODS: After exploration via the trans-sphenoidal approach and subsequent treatment with amphotericin-B, Ga-67 brain SPECT was performed twice to monitor the therapeutic effect. RESULTS: Three months after antifungal treatment, Ga-67 brain SPECT showed partial resolution of the lesion in the sella turcica region. The patient continued with fluconazole treatment for another 2 months and received another Ga-67 brain SPECT, which showed complete clearing of the previous lesion. CONCLUSION: Ga-67 brain SPECT may play a potentially useful role in monitoring the therapeutic effect of treatment of invasive sphenoid sinus aspergillosis.
Aged↗
Multiple pyogenic granuloma demonstrated by SPECT using 99Tcm-labelled red blood cells.
Pyogenic granuloma is a polypoid form of capillary haemangioma that occurs on the skin and mucosal surface. The eruption of multiple pyogenic granuloma is a rare phenomenon. We report the case of a 73-year-old male with a 2 year history of intermittent lower gastrointestinal bleeding. 99Tcm-labelled red blood cell scintigraphy was performed to rule out the possibility of capillary haemangioma on the mucosal surface of the gastrointestinal tract. The images showed disseminated haemangiomas involving the skull, abdominal wall, intestine, scrotum and right leg. The final diagnosis of multiple pyogenic granuloma was made by skin biopsy. To the best of our knowledge, this is the first case using 99Tcm-labelled red blood cell scintigraphy to demonstrate multiple pyogenic granuloma.
Aged↗
Complementary role of dual isotope in non-bacteriuric renal infection--a case report.
To detect non-bacteriuric renal infection in a diabetic patient, though difficult but is very important because early diagnosis and early treatment can prevent later complications such as renal abscess, renal hypertension or even end stage renal disease. Herein, we presented a case of diabetic patient with septicemia whose urine culture and renal ultrasonography were negative initially. By using a combination of dual isotope images and single photon emission computed tomography technique, an infectious lesion in the upper pole of left kidney was revealed, which was identified as acute focal bacterial nephritis by computed tomography four days later. This case report showed that 67Ga plus 99mTc dimercaptosuccinic acid images are useful in patients under clinical suspicion of renal infection, especially for those with negative urine analysis and/or urine culture initially.
Acute Disease↗
Development of a device for immobilization of head and correlation of functional-anatomical brain images.
BACKGROUND: The excellent resolution of brain imaging modalities has important contributions in the diagnosis of brain diseases. However, involuntary movement by the patient may cause poor image quality. In this study, we developed a device to help keep a patient's head immobilized during brain image acquisition, for comparison between each follow-up study, and for functional-anatomical image correlation. METHODS: This device includes an acrylic material head supporter and a thermoplastic material facemask. The head supporter and the facemask can be firmly attached as a whole to support the head in a fixed position. Two capillary tubes filled with technetium-99m solution were placed perpendicularly on one side of the facemask as fiducial for imaging correlation between different studies. Ten patients, who each had two technetium-99m hexamethyl propyleneamine oxime (99mTc-HMPAO) brain single photon emission computer tomography (SPECT), were tested with this device for imaging. RESULTS: Three-dimensional cine motion and sectional imaging were displayed and confirmed head immobilization in all of these studies. In addition, the 99mTc fiducial were useful in the comparison of head positions among the different studies. In five subjects, the device also proved to be useful in functional-anatomical correlation among SPECT, magnetic resonance imaging (MRI), and computed tomography (CT) images. CONCLUSION: In conclusion, this device has been developed and found to be useful in (1) keeping patient's head immobilization, (2) keeping consistent head position for follow-up studies, and (3) SPECT, MRI and CT functional-anatomical imaging correlation.
Brain↗
The specific gallium-67 scan uptake pattern in psoas abscesses.
A psoas abscess is a rare clinical entity that presents diagnostic and therapeutic challenges. In this retrospective study, we reviewed gallium-67 scan findings in cases of psoas abscess to determine the specific uptake pattern and the usefulness of 67Ga scans in diagnosis and management. Fifteen psoas abscess lesions in 13 patients who had undergone a 67Ga scan during an 8-year period were found in the hospital computer. All but two of the patients had been diagnosed as having fever of unknown origin, urinary tract infection or another irrelevant disease prior to the 67Ga scan. Of the 15 psoas abscess lesions, 12 (80%) could be clearly diagnosed on the basis of the specific 67Ga uptake pattern, in which: (1) the oblique direction of the 67Ga-avid lesion correlates with the orientation of the psoas muscle from the lumbar region to the hip joint region; (2) the lesion does not cross the abdominal midline; (3) the lesion goes through the inguinal region; and (4) the lesion involves at least two-thirds of the whole length of the psoas muscle. The specific features may help in the differentiation of psoas abscess from other intra-abdominal lesions or normal bowel distribution, especially with single-photon emission tomographic images. In 7 of 13 patients (53.8%) the 67Ga scan findings contributed to the clinical management of the patients by first detecting the focus of the infection. Multiple concomitant 67Ga-avid lesions were found in ten patients. In conclusion, the specific features as well as the whole-body survey with 67Ga scan are useful and important in the diagnosis of psoas abscesses and the detection of unexpected concomitant multiple infectious foci in clinically suspicious infectious disease patients.
Adult↗
Use of radioactive iodine for thyroid remnant ablation in well-differentiated thyroid carcinoma to replace thyroid reoperation.
Complete thyroidectomy was recommended for patients with well-differentiated thyroid carcinoma to remove any potential residual contralateral cancer tissue and to facilitate detection of metastatic lesions by radioactive iodide (131I). Unfortunately, 8-32% incidence of severe complications were noted after reoperation. At present, there are still not enough data about the ablative effect of 131I for such conservative surgical treatment of well-differentiated thyroid cancers. The major goal of the present study was to examine the effects of 311I for ablation of thyroid remnants in order to obviate the severe complications associated with reoperation. From January 1977 to December 1995, 210 papillary or follicular thyroid carcinoma patients received subtotal thyroidectomy or lobectomy. After the operation, 46 of the 210 patients received 131I for remnant ablation. At doses of > or = 30 mCi 131I, 38 thyroid remnants were successfully ablated; 25 of 38 (65.8%) patients successfully ablated patients received 30 mCi 131I one-four times. Five patients expired during the follow-up period, including two follicular carcinoma patients who were misinterpreted as having benign lesions in the first operation. Patients in the overall failure versus success group for thyroid remnant ablation revealed increased age, histopathology of follicular carcinoma, higher postoperative 131I uptake in the neck bed, higher postoperative thyroglobulin levels, bigger tumor size, and higher mortality. In conclusion, repeated 30 mCi 131I treatments were adequate for most thyroid remnant ablations following subtotal thyroidectomy or lobectomy in well-differentiated thyroid cancer patients. Misinterpretation of follicular cancer as benign lesions and unresectable tumor comprised the main reasons for mortality.
Adenocarcinoma, Follicular↗
Identification of new renal scarring in repeated episodes of acute pyelonephritis using Tc-99m DMSA renal SPECT.
PURPOSE: This prospective study compared the value of Tc-99m DMSA renal planar scintigraphy with SPECT to detect new renal involvement in patients with repeated episodes of acute pyelonephritis (APN). MATERIALS AND METHODS: Children with suspected APN were transferred to our department for DMSA renal scans. Seventy-two children (ages 1 week to 15 years) had DMSA planar and SPECT imaging performed twice because of clinical or laboratory suspicion of repeated APN. In addition, radiographic voiding cystourethrography was also performed in all cases. The presence of vesicoureteral reflux (VUR) was graded on a scale of 0 to 5. RESULTS: New lesions were observed with SPECT in 56 kidneys and with planar scintigraphy in 38 kidneys. No patients had a negative result of Tc-99m DMSA renal SPECT who also had a positive Tc-99m DMSA planar result. The degree of VUR as related to APN was diagnosed better with SPECT than with planar scintigraphy (46 compared with 30 and 10 compared with 8, respectively). There is a significant difference (P < 0.05) between the diagnostic ability of these two methods to identify the increased tendency of repeated APN to occur with high-grade VUR compared with low-grade or no VUR. CONCLUSIONS: High-grade VUR is more commonly associated with renal injury than is low-grade or no VUR. If only Tc-99m DMSA renal planar scintigraphy is performed, renal scarring may be underestimated. Our results suggest that Tc-99m DMSA renal SPECT, rather than planar scintigraphy, should be used routinely in children with a clinical suspicion of APN, especially for those with scarred kidneys and high-grade VUR.
Acute Disease↗
Biliary and liver abscesses demonstrated with Tc-99m DISIDA and Ga-67 imaging.
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Abscess↗
Uterine blush mimicking a hypervascular tumour in the pelvis as demonstrated by a triple-phase bone scan.
Transient visualization of the uterus, mimicking a hypervascular soft tissue tumour in the pelvic region, in the blood flow and blood pool phases of a triple-phase bone scan, was seen in 78 of 91 females of reproductive age. It was noted in all cases of menstrual (n = 15), early proliferative (n = 9) and secretory (n = 42) phases of the cycle, but in only 12 of 25 subjects studied in the late proliferative phase. This observation differs from previous reports of uterine uptake only being seen in the menstrual and secretory phases, or in all menstrual cycle phases. None of the 58 control patients (20 males, 16 pre-menarcheal females and 22 post-menopausal females) had such uterine uptake in either the blood flow or blood pool phase in the pelvic region. We suggest that this normal physiological phenomenon, mimicking a hypervascular soft tissue tumour in the pelvis, occurs in the menstrual, early proliferative and secretory phases of pre-menopausal females and in all phases of the cycle in younger females of reproductive age.
Adolescent↗
Quantitative cerebral perfusion SPECT in systemic lupus erythematosus with severe central nervous involvement--before and after methylprednisolone pulse therapy.
Severe cerebral involvement may occur in patients with systemic lupus erythematosus. Methylprednisolone pulse therapy is a management choice for those with severe cerebral involvement. However, its effectiveness is uncertain. This article describes Tc-99m HMPAO cerebral perfusion single-photon emission computerized tomography to document the restoration of cerebral perfusion after methylprednisolone pulse therapy in a case of systemic lupus erythromatosus with severe cerebral manifestations.
Adolescent↗
Rectus abdominis rhabdomyolysis after sit ups: unexpected detection by bone scan.
Uptake of technetium-99m methylene diphosphonate by the rectus abdominis muscle was unexpectedly found in a 29 year old man who had started to perform 30 to 40 sit ups a day for five days before the bone scan. After a week of rest, serum creatine kinase activity was still abnormal but muscle uptake of technetium-99m methylene diphosphonate had ceased. This specific muscle injury after short term sit ups as well as the resolution of the phenomenon within a week are of interest.
Adult↗
Development of a dual-probe detection system for positron emission radiotracer detection.
BACKGROUND: Positron emission radiotracers are very useful in biochemical and pharmacological research. The purpose of this work was to develop and build a simple and inexpensive dual-probe detector system (DPDS) for detecting the activity of positron emission radiotracers. MATERIALS AND METHODS: The design of the DPDS was based on the coincident detection of two 511 KeV annihilation gamma-rays, which determined the positron activity in the body. A pair of sodium iodide (NaI) scintillators coupled to a photomultiplier tube (PMT) were positioned face-to-face as in a dual-probe system. The signals from each probe were then sent to a preamplifier, a linear amplifier, a single channel analyzer (SCA), and the primary and secondary coincidence units, respectively, to determine the number of total coincidence events and random events. Validation of basic characteristics, including stability, sensitivity, linearity and geometric counting efficiency, were tested. RESULTS: The sensitivity and linearity of the DPDS worked well in detecting radioactivity within 100 microCi. The DPDS was very stable in continuous counting for more than 2 hours. The geometric counting efficiency changed less than 5% when the source was placed 2 cm from the central coincidence line. CONCLUSION: This DPDS is a promising tool for positron emission radiotracer detection. It may be helpful in future in both clinical and basic biomedical research, such as neuroreceptor occupancy or glucose metabolic studies. Eventually, we will be able to use the DPDS in the human or animal body for evaluating position emission radiotracer metabolism and distribution.
Humans↗
Radionuclide inferior venocavagraphy in Budd-Chiari syndrome before and after angioplasty.
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Angioplasty, Balloon↗
99Tcm-MDP scintigraphy in high-voltage electrical burn patients.
In high-voltage electrical burn injuries (> 1000 V), it is difficult to identify the site and extent of non-viable deep tissue damage for debridement to avoid further tissue injury from wound infection and the risk of sepsis. This prospective study was designed to evaluate the usefulness of 99Tcm-methylene di-phosphonate (99Tcm-MDP) scintigraphy in detecting the extent of tissue injury and determining the level of amputation required for electrical burn patients. Over a 5 year period, 33 high-voltage electrical burn patients were studied. Blood flow and blood pool studies revealed absent perfusion in 37 limbs, all of which eventually were amputated. In addition to a routine three-phase bone scan, images were obtained at 30-60 min (early images) to evaluate whether soft tissue injury could be detected better at that time. For comparison of the detection rate from the early images and bone (delayed) images, 164 corresponding spot views of both images were reviewed. Eighty-three and 125 tissue necrotic lesions were demonstrated by the early images and bone images respectively. All of the 83 lesions found by the early images were more clearly identified by the bone images. All but one of the 125 lesions underwent surgical debridement or amputation. We concluded that the blood flow and blood pool images correlated well with the level of amputation required. The site and extent of tissue necrotic lesions can be clearly identified on 99Tcm-MDP bone scans. Because the early images were less sensitive in detecting tissue necrosis, we suggest that early imaging is not necessary.
Adolescent↗
Diuretic renography findings in enterovesical fistula.
A 73-year-old male presented with a 2 week history of gross haematuria and faecal material in the urine. Bone scan for cancer work-up showed 99T(cm)-MDP radioactivity accumulation in the transverse and descending colon. A 99T(cm)-DTPA diuretic renogram was arranged to study renal function and to determine the location of the enterovesical fistula. Diuretic renography demonstrated extraurinary tract radioactivity in the sigmoid colon in the early images, extending to the descending and transverse colon in the subsequent dynamic images. A sigmoid colon adenocarcinoma with bladder wall invasion and fistula formation was confirmed at surgical operation. The impressive dynamic diuretic renography study in this patient was helpful in determining the location of the fistula and in planning surgical management.
Adenocarcinoma↗
Cerebral sparganosis: increased uptake of technetium-99m-HMPAO.
Cerebral sparganosis is an extremely rare intracranial parasitic infectious disease. We report findings of 99mTc-HMPAO cerebral perfusion SPECT in a case with cerebral sparganosis. SPECT revealed an irregularly shaped area with markedly increased 99mTc-HMPAO uptake in the parasitic infectious region of the cerebrum. Both white and gray matter was involved, the white matter involved predominantly. Decreased perfusion to the right cerebellum, suggesting cross cerebellar diaschisis, was also demonstrated. This article illustrates that cerebral sparganosis is one of the causes of increased 99mTc-HMPAO uptake in the cerebrum and should be considered clinically if present.
Aged↗
False-positive whole-body iodine-131 scan due to intrahepatic duct dilatation.
Focal retention of radioactivity in the liver on whole-body 131I scan was interpreted as a metastatic lesion in a patient with well-differentiated thyroid cancer. Intrahepatic duct dilatation, usually resulting from biliary tract obstruction by bile stone, is a common disorder and may cause bile stasis. A patient with papillary thyroid cancer and a previous history of biliary tract stones had focal retention of radioactivity in the liver on whole-body 131I scan. Abdominal CT, endoscopic retrograde cholagiopancreatography, radionuclide cholangiography and sequential 131I scans demonstrated that this focal retention of radioactivity was caused by intrahepatic duct dilatation. Focal retention of radioactivity is visualized on delayed images but not on early images. The radioactivity initially increases and then decreases on following days.
Bile Ducts, Intrahepatic↗