Brain SPECT, MRI, and CT in a closed head injury induced intracerebral hematoma.
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Adult↗
Biomedical subjects
W J Shih
Publications and source records attributed to W J Shih.
Reverse redistribution on dynamic exercise and dipyridamole stress technetium-99m-MIBI myocardial SPECT.
Reverse redistribution on 201TI-chloride stress-redistribution myocardial scintigraphy has been associated with coronary artery stenosis. We report a patient whose two separate 99mTc-MIBI myocardial SPECT stress studies (dynamic exercise and dipyridamole) showed septal reverse redistribution and fixed inferior defect. Echocardiograms showed left ventricular (LV) hypertrophy and diffuse hypokinesis, especially in the inferior wall, and EKG showed LV hypertrophy and strain and inferior infarct. Coronary angiogram confirmed two-vessel disease involving 80%-90% stenosis of the proximal second diagonal branch of the left anterior descending artery and 75%-90% stenosis of the right coronary artery as well as global left ventricular dysfunction. Reverse redistribution on 99mTc-MIBI myocardial SPECT occurring on dynamic or dipyridamole stress may indicate damaged but viable myocardium.
Coronary Angiography↗
Technetium-99m MIBI uptake in recurrent parathyroid carcinoma and brown tumors.
Demonstrable parathyroid adenoma in delayed (3-hr) 99mTc-MIBI neck imaging and localization of 201Tl-chloride in brown tumors mimicking skeletal metastases have been reported. Technetium-99m-MIBI scintigraphy is currently the imaging modality of choice for localizing parathyroid tumors in patients with recurrent hyperparathyroidism. This report is a good example of the use of 99mTc-MIBI in the diagnostic work-up of a patient with recurrent hyperparathyroidism, which turned out to be due to parathyroid carcinoma rather than the initial histopathologic diagnosis of parathyroid adenoma. Additionally, the patient's total body 99mTc-MIBI and 99mTc-MDP bone images showed multiple focal lesions in the bone-mimicking metastases.
Adenoma↗
99Tcm-MIBI mammoscintigraphy of breast masses: early and delayed imaging.
Forty patients with breast mass and 10 female controls underwent double-phase (15 min and 3 h) 99Tcm-sestamibi (MIBI) imaging. Another four post-mastectomy patients with suspected metastases underwent total body imaging at 15 min. The 99Tcm-MIBI images of all 10 female controls showed symmetrical homogeneous radioactivity in both breasts. A focal area of increased 99Tcm-MIBI uptake in the breast tumour is considered as positive. Eleven breasts of 10 patients underwent total mastectomies with lymph node dissection, with one patient having bilateral mastectomy. These 11 breast tumours were confirmed to be infiltrating ductal carcinoma. All 11 breast carcinomas had positive early and delayed phase results with the exception of one patient who had only a focal increased uptake in early phase which happened to be the smallest size of carcinoma. Focal areas of positive MIBI uptake in the axillae in 4 of 10 patients were confirmed to be metastatic carcinoma of the breast. One patient with breast carcinoma underwent mastectomy whose 99Tcm-MIBI imaging was negative. Twelve patients undergoing excisional biopsy or lumpectomy of breast resulted in 7 fibroadenomas, 2 papillomas, 1 abscess, 1 granuloma and 1 chronic inflammation. Four of 7 fibroadenomas having hypercellularity histopathologically exhibited a focal MIBI uptake on double-phase imaging. One granulomatous disease had positive early phase but faded on the delayed image. The patients with absence of MIBI uptake included 3 fibroadenomas, 2 papillomas, 1 abscess, 1 chronic inflammation and 17 fibrous hyperplasia.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Reversible hypoperfusion of the cerebral cortex in normal-pressure hydrocephalus on technetium-99m-HMPAO brain SPECT images after shunt operation.
A man with dementia underwent radionuclide cisternography to establish the diagnosis of communicating hydrocephalus. Technetium-99m-HMPAO brain SPECT images showed marked hypoperfusion of both posterior cerebral cortices and three-dimensional displays that demonstrated perfusion defects at both of the posterior parietotemporal regions. A successful ventriculoperitoneal shunt operation was performed. Five and one-half months later, repeat three-dimensional display showed that the perfusion defects had resolved and a repeat brain SPECT image showed marked improvement of the hypoperfusion. This concurred with postoperative clinical improvement. Technetium-99m-HMPAO brain SPECT, which provides objective documentation of clinical recovery after surgery, could be routinely used to evaluate patients with normal-pressure hydrocephalus.
Cerebral Cortex↗
A geometric approach to the analysis of physiological flow data.
Physiological flow data are common in various medical fields. Examples include urinary, blood and expiratory flows. They are widely used in assessing functions in the urinary, circulatory, or pulmonary systems, respectively. Current statistical methods for analysing these flow data in clinical trials are either univariate analyses, which do not utilize all the information together, or some conventional multivariate methods (such as regression analyses) which yield results that do not render clear medical interpretations. This paper presents a new approach to analysing the flow data, using urinary flow as the primary focus. The basic idea and technical steps are applicable to other flow data as well. The proposed method aims to transform the flow measurements back to the shape of the flow graphs. Since the whole geometric pattern of the flow graph provides more information about the patient's flow condition than any individual flow parameter alone, the method is a meaningful way of combining and analysing the flow data in both statistical and clinical senses. The method is a three-stage procedure. Patients are classified into three classes in the first stage and then ranked in sequence in the second stage, according to the geometry of the shape pattern and some clinical criteria. The classification procedure is shown to be very reliable when compared with the clinician's visual evaluation, and hence can be implemented by computer programming to aid clinical trials involving many patients. The whole ranking score is then readily analysed at the third stage for comparing treatment effects by the analysis of covariance method based on ranks, with the post-treatment score as the response variable and the baseline score as the covariate. An example of a urinary flow data set is provided to illustrate the use of the procedure.
Analysis of Variance↗
The biodistribution of technetium-99m-hexamethylpropylene amine oxime.
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Adult↗
Duodenogastric reflux demonstrated by cholescintigraphy in peptic ulcer disease and chronic gastritis.
Duodenogastric (D-G) reflux is commonly associated with peptic ulcer disease and chronic gastritis. To determine D-G reflux in association with each disease entity, we studied 43 chronic gastritis patients and 21 peptic ulcer patients with cholescintigraphy. Scoring (0 to 3+) was judged by the amount of Tc-99m diethylacetanitanilido-IDA (EHIDA) in the stomach. In the chronic gastritis group, 5, 16, 10, and 12 patients scored 3+, 2+, 1+, and 0, respectively. In the peptic ulcer disease group 6, 2, and 13 patients scored 2+, 1+, and 0, respectively. Thirty-nine of the 64 patients (60.9%) were positive for D-G reflux. D-G reflux occurred in 31 of 43 (72.09%) of chronic gastritis patients and in 8 of 21 (38.1%) patients with peptic ulcer disease. D-G reflux was significantly higher in the chronic gastritis group (P = 0.0009). Chronic gastritis patients were more likely to have more marked D-G reflux than peptic ulcer disease (P = 0.048). The authors conclude that cholescintigraphy is noninvasive and objectively demonstrates D-G reflux in chronic gastritis and peptic ulcer disease and that chronic gastritis is more closely associated with D-G reflux than peptic ulcer disease.
Adult↗
Diffuse and intense Tc-99m HMDP localization in the liver due to hypoxia secondary to respiratory failure.
After left lower lobe lobectomy for lung carcinoma, a patient had acute respiratory failure secondary to pneumonia and pulmonary embolism requiring a ventilator. Tc-99m HMDP bone scan showed diffuse, intense hepatic uptake. Concurrent liver enzymes indicated hepatic necrosis. Two weeks later the patient died and a limited chest autopsy confirmed acute adult onset respiratory distress syndrome. Etiologic factors of massive hepatic necrosis in relation to hepatic localization of bone imaging agent and its prognostic outcome are discussed.
Aged↗
Demonstrable photopenic lesion in Tc-99m pertechnetate thyroid imaging after recent contrast radiographic procedure.
Iodine-contained contrast media of a recent arteriogram can block normal thyroid uptake of Tc-99m pertechnetate or radioiodine, resulting in virtual nonvisualization of the thyroid gland and showing a prominent salivary activity. In Tc-99m pertechnetate thyroid imaging, however, diffuse soft-tissue uptake in the anterior neck surrounding a fluid containing (cystic) lesion may standout as photopenia. The authors present two patients with recent contrast radiographic procedures who underwent Tc-99m pertechnetate imagings that demonstrated photopenic lesions: one was a thyroid cyst and the other confirmed an abscess.
Abscess↗
Abnormal scrotal finding on bone imaging. Increased radioactivity in a hemi-scrotum due to malignant lymphoma.
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Aged↗
Matched ventilation-perfusion becomes mismatched ventilation-perfusion lung imaging after resolution of carcinoma of the bronchus.
Airway occlusion results in regional alveolar hypoxia followed by reflex hypoxic pulmonary arterial constriction. Ventilation-perfusion imaging demonstrates matched defects. In the two patients reported, occlusion of the main bronchus by bronchogenic carcinoma was resolved--in one case by radiation therapy, and in the other by removal of the tumor mass in the bronchus by bronchial slitted biopsy. The initially matched ventilation-perfusion findings became mismatched. While ventilation was presumed to be normal, pulmonary perfusion was not completely reversed.
Aged↗
False-positive I-131 uptake at a tracheostomy site. Discernment with Tl-201 imaging.
I-131 whole-body imaging is used in the follow-up evaluation of differentiated thyroid carcinoma. The authors report a case of spurious I-131 localization at a patient's tracheostomy stoma. Demonstration of this I-131 uptake as false positive was achieved by showing no Tl-201 localization at this site and a low thyroglobulin while the patient was hypothyroid. This strategy may discern spurious I-131 uptake and help avoid unnecessary I-131 therapy.
Carcinoma, Papillary↗
Meperidine in conjunction with cholescintigraphy to diagnose acute cholecystitis in a patient allergic to morphine.
Cholescintigraphy with morphine augmentation is used routinely to expedite the differential diagnosis of acute from chronic cholecystitis. A patient with hepatic dysfunction and an allergy to morphine received intravenous meperidine in conjunction with cholescintigraphy. The gallbladder was not visualized 30 minutes after administration of the drug. However, the activity accumulated in the initial photon deficient gallbladder at 4 hours after meperidine administration (6.5 hours after radiopharmaceutical administration). These findings may be explained in part by prolongation of meperidine bioavailability because of impairment of hepatic function.
Acute Disease↗
Comparison of new biochemical markers of bone turnover in late postmenopausal osteoporotic women in response to alendronate treatment.
To evaluate the clinical utility of recently developed biochemical markers of bone turnover to monitor the response of osteoporotic patients to antiresorptive therapy, we compared the results of three advanced assays for markers of bone resorption and four of bone formation to high pressure liquid chromatography (HPLC)-fluorometric assays for urinary pyridinoline and deoxypyridinoline. These assays were also used to resolve the uncertainties concerning the rate of bone turnover in late postmenopausal (late-PMP) osteoporotic women. The rate of bone turnover in 85 women (mean +/- SD age, 63 +/- 6 yr) with low bone mass and all more than 5 yr postmenopausal (mean +/- SD yr PMP, 16 +/- 7 yr) was compared to that in 46 premenopausal women (mean +/- SD age, 40 +/- 5 yr) randomly selected from a large cohort and all having a normal spine bone mineral density (BMD). The late-PMP osteoporotic patients were a subset of patients enrolled in a double blind, placebo-controlled, randomized study comparing the effects of several doses of oral alendronate, a potent and specific inhibitor of bone resorption. Periodically during the 2-yr study, the women's spinal BMD and the level of several markers of bone turnover were measured. Serum total and intact osteocalcin, bone-specific alkaline phosphatase, and carboxy-terminal propeptide of type I collagen measured by RIA were used to assess bone formation. To assess bone resorption, we measured the urinary excretion of total pyridinoline (HPLC Pyr) and deoxypyridinoline (HPLC D-Pyr) by HPLC, type I collagen cross-linked N-telopeptide and urinary free PYR (F-Pyr) by enzyme-linked immunosorbent assay, and the serum concentration of type I collagen cross-linked C-telopeptide (ICTP) by RIA. All bone formation markers, except carboxy-terminal propeptide of type I collagen, and all bone resorption markers, except ICTP, were significantly increased above normal (33-171%; P < 0.001) in late-PMP osteoporotic women. The long term within-patient variability assessed over a 15-month period in the placebo group was low and was somewhat lower for serum markers (12.5-17.4%) than for urinary markers (24-29%). Under treatment with alendronate, resorption markers decreased earlier than markers of bone formation, consistent with a direct action of the drug to inhibit osteoclastic bone resorption. With the exception of F-Pyr and ICTP, the levels of bone markers were reduced to the normal premenopausal range, and this steady state was maintained from 6-15 months.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Large eccentric mural thrombus of abdominal aortic aneurysm: demonstration by aortography and radionuclide angiography.
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Aged↗
Serum PSA and PAP measurements discriminating patients with prostate carcinoma from patients with nodular hyperplasia.
Prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP) are the tumor markers for monitoring disease progression or improvement in patients with prostate adenocarcinoma. The clinical utility of PSA and PAP for early detection of prostate adenocarcinoma, however, requires distinction between prostate adenocarcinoma and prostate nodular hyperplasia. The serum PSA and PAP levels were measured in 20 men with histologically proven prostate adenocarcinoma and 28 men with histologically proven prostate nodular hyperplasia. Patients' blood samples were collected 1 to 7 days prior to the prostate examination, which included a rectal digital examination, transurethral resection, cytoscopy, and prostate biopsy. Sensitivity, specificity, and predictive values of positive and negative results for the discrimination of prostate adenocarcinoma from prostate nodular hyperplasia were 85%, 89%, 85%, and 29%, respectively, for serum PSA (cutoff level: 10 ng/mL) and 40%, 96%, 89%, and 69%, respectively, for serum PAP (cutoff level: 10 ng/mL). Results indicate that marked elevation of serum PSA suggests prostate adenocarcinoma and that serum PSA can discriminate prostate adenocarcinoma from prostate nodular hyperplasia better than serum PAP.
Acid Phosphatase↗
Monitoring of clinical trials and interim analyses from a drug sponsor's point of view.
This paper illustrates aspects of data monitoring of clinical trials in the pharmaceutical industry. Formal interim analyses are performed at least in part to address the question of whether the trial should proceed or whether there should be an early termination of the trial. For formal interim analyses, frequently independent data and safety monitoring committees are utilized for monitoring clinical trials, and adjustments to nominal significance levels for test statistics are required. Various statistical methods developed during the last fifteen years are utilized. Administrative interim analyses are those analyses that are performed without any intention to stop the trial as a consequence of those analyses. For administrative interim analyses, adjustments to significance levels may not be required, but results must still be carefully interpreted. Regardless of the interim analyses performed, it is critical that the plans for interim analyses be identified in the study protocol, and the dissemination of interim results be carefully restricted. The following clinical trials sponsored by Merck Sharp and Dohme Research Laboratories (MSDRL) will illustrate these points: CONSENSUS; CONSENSUS II; 4S; Haemophilus influenza type b efficacy trial; famotidine in upper gastrointestinal haemorrhage, and a phase II analgesic study. It is anticipated that data monitoring and interim analysis activities will increase for future clinical trials due to the availability of appropriate statistical methods and improved data management systems.
Clinical Trials as Topic↗