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The authors report a case of hepatic mycotic aneurysm following Staphylococcus aureus septicemia and subsequent bacterial endocarditis. The diagnosis was made preoperatively using serial radionuclide imaging and ultrasound and confirmed by angiography and surgery.
A new radionuclide method for uterus imaging is described. After intravenous application of 201Tl chloride the myometrium can be displayed by means of a gamma camera and a small digital computer. Early results suggest that Tl accumulation by the uterus depends on its histopathologic structure. After intra-uterine injection of 133Xe in saline demarcation between myometrium and uterine cavity is possible.
Forty-four children were studied for the presence of osteomyelitis by scintigraphy using Tc 99m etidronate tin complex. Evidence of osteomyelitis on radionuclide images was found in 16 of 19 patients considered to have osteomyelitis by their attending physicians. Bone scintigraphic changes were noted prior to or in the absence of roentgenographic abnormalities in 10 of 19 patients. Cases of acute hematogenous osteomyelitis, chronic osteomyelitis, and osteomyelitis caused by penetrating trauma and contiguous infection were identified. Three bone infarctions were correctly diagnosed.
The clinical, surgical, and pathologic findings in a five year prospective study of 192 patients referred with a high probability of pancreatic cancer are reported. We have defined the requirements of any pancreatic imaging procedure as its ability to distinguish a normal pancreas from pancreatic cancer or chronic pancreatitis and the capability of detecting tumors less than 5 cm in diameter. There was a 47 percent incidence of pancreatic disease (27 percent pancreatic cancer and 20 percent chronic pancreatitis). Prospective radionuclide imaging as routinely performed was found to be of little clinical value in this patient population; it was neither specific nor sensitive to pancreatic cancer or chronic pancreatitis. Preliminary data with longitudinal multiplane emission tomography show an improved diagnostic accuracy and the ability to detect resectable tumors, but its efficacy needs to be prospectively compared with other screening tests on a carefully defined patient population.
99mtechnetium diphosphonate was used in 81 patients for myocardial imaging. 46 of the patients suffered, 2-6 days prior to the test, from an acute transmural infarction provided by clinical, ECG, and enzymatic evidence; the scintigram was definitely positive in 43, equivocal in 2, and negative in 1. In 16 patients with subendocardial infarctions, in 9 the scintigram showed a positive result, in 1 it was equivocal, and in6 patients negative. In 6 other patients who suffered from acute chest pain, followed by enzyme changes, but no ECG evidence of infarction throughout the hospitalization period, the scan was positive in all. In 13 patients with acute ischemia (unstable 'crescendo' angina), 9 had a positive, 1 an equivocal, and 3 a negative scan. We conclude that radionuclide imaging is a valuable addition to the methods already available for diagnosis of myocardial infarction. With the use of diphosphonate as the tracer, we found that acutely ischemic myocardium that later may recover, gives also positive imaging.
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Radionuclide studies in a renal-transplant patient with congestive heart failure suggested vascular steal from the renal allograft by a contralateral femoral arteriovenous fistula. These reliable, noninvasive diagnostic procedures have potential use in similar settings to evaluate allograft perfusion and function. Correction by removal of the fistula was demonstrated.
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An improved means of detecting upper abdominal abscesses using the dual radionuclide subtraction technique was applied to 51 patients. 67Gallium citrate was used in the localization of the lesion and 99Tc-labeled human albumin microspheres and 99Tc sulfur colloid were used for subtracting out the interfering background from normal organ concentrations. The procedure provided the parameter capabilities for localization of the abscesses as well as information on their shape and size. Compared to nonsubtraction Ga procedures, 53% more abscesses were diagnosed using the subtraction technique.
Tc-99m colloids are the pharmaceuticals preferred in the radionuclide diagnosis of splenic rupture. Spleen scintigraphy is also the preferred diagnostic method. It is rapid, safe, and reliable and should be recommended in all clinical situation where diagnosis is in doubt. A most important point is its value in following the healing of a splenic rupture managed nonoperatively or by suturing or resection, treatment modalities which are increasingly used at the present time.
Normal radionuclide patterns of the hand obtained with 99mTcO4 and 99mTc-Sn-EHDP are described and their validity supported by clinical, radiographic, and laboratory examinations performed to exclude articular disease in the control group. Comparison of the 99mTcO4 and 99mTc-Sn-EHDP images in patients with various articular diseases demonstrated higher sensitivity of 99mTc-Sn-EHDP in detection of involved joints; this was also true when the radionuclide images were compared with fine-detail radiographs in patients with rheumatoid arthritis.
Eight patients with herpes simplex encephalitis among the 10 cases diagnosed at the University of Kansas Medical Center from 1966 to 1976 were studied with 99mTc early in their diagnostic work-up. The images were unilaterally positive in the temporal lobe area in all 8 patients. Radionuclide studies can suggest herpes simplex as the specific etiology in cases of encephalitis and can also indicate the best site for brain biopsy to confirm the diagnosis by fluorescent antibody techniques. Appropriate antiviral therapy should be instituted as soon as possible to alter the course of this destructive form of viral encephalitis.
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Three patients with subacute sclerosing panencephalitis (SSPE)--two with acute disease and one with an exacerbation--had abnormal radionuclide brain scans during periods of rapid neurologic deterioration. In two of the three patients radionuclide brain scan showed lesions of both cortex and deeper structures, indicating the panencephalic nature of the disease. There was no contrast enhancement on computerized tomography (CT) in the areas of radiopharmaceutical accumulation in the two patients studied. We feel that delayed radionuclide scanning is more sensitive in detecting acute SSPE than routine contrast-enhanced CT, because more time is allowed for tracer accumulation in lesions and for background activity to decrease.
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