Andrew F. McLaughlin

Gallium scanning in the management of mediastinal Hodgkin's disease

Gallium‐67 scanning was performed pre‐ and post‐therapy in 25 patients with Hodgkins disease and a mediastinal mass. At restaging after therapy, radiographs (or CT scans) did not predict the presence of active disease whereas gallium scans did with a high degree of accuracy. Gallium‐67 determined disease activity in those patients who had a residual mediastinal mass predicting outcome in 11 out of 12 patients; one had a late relapse at 7 years. In patients without a residual mass gallium scanning was again accurate, predicting outcome in 11 of 13 patients. Two patients with negative gallium scans but subsequent active disease were scanned too soon after chemotherapy. The results suggest that gallium scanning has an important role in the mangement of mediastinal Hodgkins disease and is superior to all current methods of assessing disease activity irrespective of the presence of a residual mediastinal mass.

Current role of gallium scanning in the management of lymphoma

Gallium 67 scanning in the malignant lympho mas has been done, with variable success, for over 20 years. After initial enthusiasm, the technique fell into disrepute and it was not until the early 1980s that it enjoyed a revival. There have been many major contributions to the literature, both favourable and unfavourable. The reasons for the latter include: poor instrumentation (only single-pulse height analysis), low gallium 67 doses, impatient and careless scanning techniques, timing of the study after treatment (chemotherapy, radiation) and insensitive methods of confirmation of the presence or absence of disease (“truth”). Anatomical diagnostic techniques (computed tomography, plain X-radiography, magnetic resonance imaging and others) are incapable of distinguishing viable tumour in normal size lymph nodes or necrotic/fibrotic residual masses. With improvements in instrumentation (triple-pulse height analysis, gamma camera resolution and tomographic techniques) gallium 67 can detect active tumour in residual masses and in normal-size nodes. This is due to gallium 67s unique ability to localize in viable tumour cells. It has greater than 90% sensitivity, specificity, accuracy and positive predictive value in patients with lymphoma. Its major contributions are in: staging (changing management of mediastinal disease, obviating the need for a laparotomy and clearlyidentifying stage IV disease); detecting relapse or residual, progressive disease (it establishes true complete remission and is often the first and only evidence of relapse before clinical evidence); predicting response to therapy (failure to convert to a negative scan post-treatment signals a poor prognosis and alternative therapy is required); and predicting outcome — prognosis (it is the only diagnostic modality to predict outcome accurately).

Normalised radionuclide measures of left ventricular diastolic function

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish this, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate, when normalized to end diastolic volume, correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patients ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function or if age corrected, to screen for diastolic dysfunction.

Differentiation between right and circumflex coronary artery disease on thallium myocardial perfusion scanning

Abstract Thallium defects in the inferior and lateral walls of the heart were correlated with right and circumflex coronary artery disease (CAD) in 405 patients who underwent coronary arteriography. In the 102 patients with either single right or left circumflex (LC) CAD, inferior segment defects (anterior view) were associated with right CAD, and both lateral segment defects (40 ° left anterior oblique view) and posteroinferior defects (60 ° left anterior oblique view) were associated with LC CAD. In all 405 patients, inferior segment defects had a sensitivity of 65%, a specificity of 92%, and a predictive accuracy of 89% for right CAD, and lateral segment defects had a sensitivity of 52%, a specificity of 96%, and a predictive accuracy of 90% for LC CAD. Posteroinferior defects had a low predictive accuracy for narrowing in either artery. The presence or absence of concomitant anterior defects did not alter these results. Narrowing in both right and LC coronary arteries was best identified by a combination of inferior and lateral segment defects (sensitivity 30%, specificity 96%, predictive accuracy 72% ). Narrowing in only 1 of these 2 arteries was best identified by a combination of inferior segment without lateral segment defects for right CAD (sensitivity 63%, specificity 86%, predictive accuracy 55%) and lateral segment without inferior segment defects for LC CAD (sensitivity 45%, specificity 92%, predictive accuracy 57%). Thallium scanning identifies significant narrowing in the right and LC coronary arteries, and these may be separated by the pattern of defects.

Early supradiaphragmatic Hodgkin's disease. High-dose gallium scanning obviates the need for staging laparotomy

Experience with 16 sequential patients with Stage IA/IIA Supradiaphragmatic Hodgkins disease who had no evidence of intra‐abdominal disease using high‐dose gallium and computerized tomography scanning is reported. Subsequent staging laparotomy also was negative in all these patients and did not alter management decisions. It is suggested that high‐dose, whole‐body gallium scanning and other noninvasive staging procedures give reliable data for therapeutic decisions.

Tc-99m white cell scintigraphy in suspected acute infection

The usefulness of ln-111 labeled white cells in acute infection is well documented but the role of Tc-99m labeled white cell scintigraphy (WCS) has not been as clearly established. Using stannous fluoride colloid and a simple labeling procedure with 20 ml of autologous whole blood, three cases are presented in which Tc-99m WCS established unexpected diagnoses in patients who had remained undiagnosed despite extensive investigation.

Correlative Imaging in an Atypical Case of Mazabraud Syndrome

WEB This is a Web exclusive article. azabraud syndrome is a rare phenomenon that reflects the association between intramuscular myxoma and fibrous dysplasia, which is usually polyostotic. Approximately 40 cases have been described in the literature since the initial report by Henschen [1] in 1926. Mazabraud et al. [2] in 1967 emphasized the association as part of the spectrum of fibrous dysplasia. We present an atypical example of the syndrome and the characteristic difficulties encountered in interpretation of correlative images that necessitated biopsy of the bone and soft-tissue components for a firm diagnosis. Case Report A 53-year-old woman presented with a hard painless mass in the left deltoid muscle that had been noticed by her daughter. The patient had no symptoms, and the age of the mass was indeterminate. Sonography revealed a 51 × 46 × 48 mm oval hypoechoic soft-tissue mass within the deltoid muscle of the left arm. There was no involvement of the adjacent humerus. Radiographs of the humerus and forearm (Figs. 1A and 1B) showed multiloculated radiolucent expansile intramedullary masses involving the entire length of the left humeral shaft and most of the radius. There M

Appearance of Ga-67 citrate scanning in a patient with Mikulicz's syndrome associated with non-Hodgkin's lymphoma. A case report

The case of a patient with Mikuliczs syndrome and associated non-Hodgkins lymphoma is described. Description of the Ga-67 scan in Mikuliczs syndrome is presented