[Recommendation on standardization of radionuclide imaging. Subcommittee for Standardization of Radionuclide Imaging, Medical and Pharmaceutical Committee (author's transl)].
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Brain↗
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Imaging: radionuclides in renal imaging.
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Chromium Radioisotopes↗
Implementation of a digital image superposition algorithm for radionuclide images: an assessment of its accuracy and reproducibility.
An operator-interactive algorithm to achieve superposition of organ images has been used with a dedicated nuclear medicine computer system. Its purpose is to achieve organ registration in 128 X 128 digitized images before a direct numerical comparison of the regional distribution of a deposited radiotracer is performed. The accuracy and reproducibility of the algorithm for myocardial images has been tested by four operators, using a set of 28 image pairs in which the relative position of the heart differed by more than 10 mm for each pair. Comparing their results with the known displacements on two occasions provided an assessment of these two important parameters. The accuracy and reproducibility for superposing myocardial images by this digital technique are found to be well within the spatial resolution (FWHM) of the imaging system of the Tl-201 tracer studied.
Computers↗
The lateral view in radionuclide imaging of the sacrum.
Radionuclide bone images in the anterior and posterior views failed to demonstrate a large metastatic tumor involving the sacrum which was obvious on the lateral view. Evaluation of the sacrum by radionuclide imaging may be incomplete without the lateral projection, particularly when there is a question of false-negative anterior and posterior views or difficulty in interpreting the radionuclide images.
Adult↗
The complementary role of computerized axial transmission tomography and radionuclide imaging of the brain.
Computerized axial transmission tomography and radionuclide imaging are complementary procedures, and the following recommendations are made as to their use. Where there is no real clinical suspicion of intracranial disease, either modality can be used for "rule out" screening; the choice can frequently be made on the basis of which modality is cheaper or more quickly available. It should be remembered that "quicker" is often "cheaper". Total cost is determined, not only by the cost of the procedure, but also the per diem costs incurred in waiting for that procedure. Thus the more expensive modality may, in effect, be cheaper if delays are shorter. Screening of the elderly patient, particularly when atrophy or communicating hydrocephalus is of clinical concern, should be by the CT method because of its ability to visualize cerebrospinal fluid spaces. When clinical signs and symptoms point to intracranial abnormality, both modalities should be utilized. If either study done first is normal, use of the other modality is mandatory. When the first study is positive with pathognomonic findings for a specific disease, which totally explains the patient's neurologic problems, the second study need not be employed. Such examples might include the fresh cerebral hemorrhage demonstrated by CT imaging, the AV malformation defined by dynamic-static radionuclide imaging, or multifocal metastatic lesions defined by either. However, when the clinical picture is not totally and satisfactorily explained by the demonstrated disease, the other modality should also be employed. Under many circumstances, neither study will be so reliable, specific, and free of false-negative or false-positive findings as to warrant ignoring the additional information potentially available from the other study.
Astrocytoma↗
Radionuclide imaging in the assessment of primary chronic pyelonephritis.
The diagnostic value of radionuclide imaging as a supplement to excretory urography was assessed in 33 patients with primary chronic pyelonephritis. Both 99mTc-glucoheptonate and 131I-Hippuran were used. Radionuclide imaging did not improve the sensitivity of detection by urography alone (31 of 33 patients). Nevertheless, in one third of cases the radionuclide studies demonstrated certain abnormalities more readily, including focal parenchymal damage, renal functional impairment, and decreased renal perfusion. Radionuclide imaging is useful when minimal or no abnormalities are observed on the excretory urogram or nephrotomogram.
Adolescent↗
Radionuclide imaging and echography of thyroid nodules.
The usefulness of grey scale ultrasonography in association with radionuclide imaging in the evaluation of thyroid nodules is discussed. Nodules were classified in five categories, according to the magnitude of the internal echoes (echogenicity). The assessment of neoplasms in each of these categories is reported in 143 cases in which radionuclide imaging disclosed nonfunctioning or cold nodules. In this study, echography is used principally to clarify the nature of nonfunctioning or cold nodules found on radionuclide imaging.
Adenoma↗
Correlation of computed tomography, gray scale ultrasonography, and radionuclide imaging of the liver in detecting space-occupying processes.
The abilities of computed tomography (CT; scanning time=2.7 min), gray scale ultrasonography, and radionuclide imaging to detect and characterize space-occupying processes in the liver were compared. A numerical rating scale which emphasized detection abilities resulted in ultrasonography scoring 3.5 CT 3.2, and radionuclide imaging 2.9. CT resulted in no false positives and 6 false negatives, caused mainly by motion artifacts. The simplest technique, radionuclide imaging, also had the smallest number (2) of false negatives; it is therefore recommended as the screening procedure of choice. Sonography or CT should be done for those patients with a prior suspicious finding.
Carcinoma, Hepatocellular↗
A comparison of gray scale ultrasound and radionuclide imaging for the detection of focal hepatic lesions: open shutter technique.
A conventional B scan ultrasound unit was modified by the addition of a specially built logarithmic amplifier and a high resolution nonstorage oscilloscope, as suggested by Taylor and Carpenter. One hundred five consecutive patients submitted for radionuclide imaging of the liver were examined with ultrasound using a standardized scanning system. The ultrasound technique produced scans that were technically poor or inadequate in 37 per cent of the patients studied. In the studies in which there has been confirmation, the ultrasound diagnosis was accurate in 73 per cent and the radionuclide diagnosis was correct in 83 per cent. The combined accuracy of the two studies was 93 per cent. In 11 patients, ultrasound more clearly defined the lesions that were demonstrated by both techniques or demonstrated the nature of suspicious or equivocal areas on the radionuclide images. In 48 patients, the radionuclide scan imaged the liver more completely or demonstrated lesions more clearly than did the ultrasound examination. This specific approach to ultrasound gray scale imaging appears to be a valuable supplemental tool to radionuclide imaging, but at its present stage of development cannot replace it as a routine screening technique for hepatic disease.
Diagnostic Errors↗
Bone stress: a radionuclide imaging perspective.
Thirty-five college athletes with lower leg pain underwent radiography and radionuclide studies to rule out a stress fracture. Their asymptomatic extremities and 13 pain-free athletes served as controls. Four main patterns were observed: (a) sharply marginated scintigraphic abnormalities and positive radiographs; (b) sharply marginated scintigraphic abnormalities and negative radiographs; (c) ill-defined scintigraphic abnormalities and negative radiographs; and (d) negative radionuclide images and negative radiographs. Since the patients with the first two patterns were otherwise identical medically, the authors feel that this scintigraphic appearance is characteristic of bone stress in the appropriate clinical setting, regardless of the radiographic findings. A schema is proposed to explain the occurrence of positive radionuclide images and negative radiographs in the same patient, using a broad conceptual approach to the problem of bone stress.
Adolescent↗
Computed tomography and radionuclide imaging of the liver: a comparative evaluation.
The authors retrospectively analyzed the results of radionuclide imaging (RI) and computed tomography (CT) of the liver in 174 patients. RI correctly identified 90% of patients with focal hepatic lesions while CT identified 85%. CT was capable of differentiating tumor, abscess/hematoma, and cyst while RI was more sensitive in the detection of hepatocellular disease. CT distinguished regenerating nodules from other focal lesions. Radionuclide imaging remains the preferred initial screening examination in patients with suspected focal liver disease, while CT is the examination of choice to distinguish obstructive from nonobstructive jaundice.
Diagnostic Errors↗
Computed tomography and 67Ga citrate radionuclide imaging for evaluating suspected abdominal abscess.
A retrospective analysis of the results of 67Ga citrate radionuclide imaging and computed tomography (CT) in 45 patients with suspected abdominal abscess was conducted to determine the mertis of each method. Both techniques were highly sensitive in detecting abdominal abscesses, and often provided complementary and supplementary diagnostic information; their combined use many times offset the limitations of each method used alone. Guidelines are suggested that permit rapid evaluation, while limiting diagnostic errors, when using 67Ga citrate radionuclide imaging and CT in the presence or absence of localizing symptoms and signs.
Abdomen↗
Radionuclide imaging of intestinal infarction.
An acute small bowel infarction in a 57-year-old male alcoholic produced a dense positive image on a gallium-67 citrate scan. Radionuclide imaging may be useful in the diagnosis of this condition, which has a high mortality rate and is not often diagnosed premortem.
Humans↗
Radiography, radionuclide imaging, and arthrography in the evaluation of total hip and knee replacement.
Twenty patients with 21 total joint replacements including 17 hips and 4 knees were studied by plain film radiography, radionuclide imaging, and subtraction arthrography to evaluate these procedures for assessing prosthetic complications. Surgery was performed in 14 patients and confirmed loosening of 8 femoral and 7 acetabular hip prosthesis components and 1 femoral and 4 tibial knee prosthesis components. Plain films suggested loosening of only 9 hip components and no knee components. In contrast, radionuclide imaging and subtraction arthrography were considerably more effective in demonstrating loosening as well as other causes of the painful total joint prosthesis.
Hip Joint↗
Computerized cranial tomography and radionuclide imaging in the detection of intracranial mass lesions.
Computerized cranial tomography (CCT) and radionuclide imaging (RI) of the brain are both accurate techniques for detecting intracranial mass lesions. CCT is superior in detecting low-grade gliomas, cystic lesions, parasellar tumors, and brain stem lesions. Overall, CCT detection rates are slightly higher than those with RI, but the use of iodinated contrast media with CCT increases the risk of this examination. There is a significant difference in the generally binary (positive/negative) type of information offered by RI and the more specific information offered by CCT about the pathologic nature of a lesion and its precise location. In the evaluation of patients with suspected intracranial mass lesions, CCT is generally the preferable initial diagnostic test. However, RI may still serve as a satisfactory screening examination in certain well-defined clinical situations.
Brain Abscess↗
Mycotic aneurysm of the hepatic artery. Case diagnosed with radionuclide imaging and ultrasound.
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.
Adolescent↗
201Thallium scintigraphy--a new method for radionuclide imaging of the uterus.
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.
Adult↗
Radionuclide imaging. Use in diagnosis of osteomyelitis in children.
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.
Bone Diseases↗