Arnold M. Strashun

Noninvasive detection of left ventricular dysfunction with a portable electrocardiographic gated scintillation probe device

A comparison of left ventricular function data derived from a low cost, portable electrocardiographic gated scintillation probe (nuclear stethoscope) with conventional scintiangiographic data was performed in 68 patients. Ejection fraction correlation (r = 0.86, p less than 0.005) was better in patients with uniform wall motion than in those with regional asynergy (r = 0.68 p less than 0.01). Probe variables reflecting systolic emptying rates, diastolic filling rates and timing intervals, and relative volumes analyzed in combination provided 100 percent sensitivity, specificity, and predictive value in detecting abnormal left ventricular performance. The results suggest that radionuclide angiography with an electrocardiographic gated scintillation probe is a sensitive, rapid and relatively inexpensive portable method of screening for cardiac dysfunction with a yield similar to that from the more costly gamma camera derived scintiangiogram.

A Reduced Role of V/Q Scintigraphy in the Diagnosis of Acute Pulmonary Embolism

Ventilation/perfusion (V/Q) lung scintigraphy, when used for the clinical determination of the presence or absence of pulmonary embolism, has been much studied by medical imagers. Inherent to a ‘‘cold-spot’’ scan targeting the normal pulmonary tissue, the deck has always been stacked against us and our specialty frequently maligned by the referring physicians as practicing ‘‘unclear’’ and not nuclear medicine. The nonspecificity and, at times reputed, nonsensitivity of the V/Q scan for embolism as imaging protocols evolved led to a probability scheme (1) of reporting positive or negative findings in shades of gray rather than as

Preoperative parathyroid adenoma localization by the technetium‐thallium subtraction scan

The technetium‐thallium subtraction scintigram was utilized preoperatively in 14 consecutive patients explored for primary hyperparathyroidism. The scintigram accurately identified the site of a parathyroid adenoma in 12 of 13 patients.

Improved renal screening on bone scans.

Intravenous injection of Tc-99m-labeled radionuclides permits angioscintigraphic and blood pool visualization of both supra- and infradiaphragmatic organs. By adding this procedure to routine bone scans an improvement in the diagnostic yield of incidentally observed renal abnormalities was achieved. Several illustrative cases involving hyper- and hypovascular lesions are presented. The authors recommended increased use of immediate postinjection blood pool studies in all routine brain and bone scans as a means of renal screening at negligible cost.

Technetium-99m MDP accumulation in hepatic metastasis from osteogenic sarcoma.

Primary bone sarcomas, of which osteogenic sarcoma is the most common, occur in only one of every one hundred thousand inhabitants of the United States. (1) Dissemination of osteogenic sarcoma is predominantly hematogenous, and while the lung is the most frequent site of metastasis, liver metastases are detected in 8 to 16% of autopsied cases (2,3). Bone formation in hepatic osteogenic sarcoma metastasis has been described (4). Uptake of the technetium bone imaging agents in hepatic metastasis from a variety of tumors, notably colon and breast carcinoma, has been described (5,6); however a previous report of this occurrence in hepatic metastasis from osteogenic sarcoma could not be found. Such a case, a 16-year-old female with osteogenic sarcoma of the left femur, is presented.

Gated blood pool scintigraphic monitoring of doxorubicin cardiomyopathy: Comparison of camera and computerized probe results in 101 patients

Serial gated blood pool scintigraphic monitoring of cardiac function with both a nonimaging scintillation probe and a conventional gamma camera-computer imaging system was performed in 101 patients receiving doxorubicin hydrochloride (Adriamycin) chemotherapy. Comparison of probe- and camera-derived ejection fractions (n = 287) correlated significantly (r = 0.70, p less than 0.005) as did the interstudy (n = 183) change in ejection fraction (r = 0.76, p greater than 0.005). Significant discordance in probe- and camera-derived ejection fraction change occurred in 3 (1.6%) of 183 interstudy intervals. Average intrastudy variability of absolute probe-derived ejection fraction was 2.9%. This variability was unrelated to the level of cardiac function. Thirteen patients (13%) developed clinical cardiotoxicity, including four at cumulative Adriamycin levels less than 450 mg/m2. Mean absolute camera ejection fraction decline for these patients was 21% from baseline evaluation, and mean absolute probe ejection fraction decline was 22%. The minimal absolute ejection fraction decline was 11% for patients with clinical congestive heart failure. Eight asymptomatic patients had therapy terminated before the development of clinical cardiotoxicity after a mean decline in absolute camera ejection fraction of 19 +/- 4% (SD) and in probe ejection fraction of 19 +/- 9% into abnormal ranges (a decline in magnitude equivalent to that in patients developing congestive failure). None of these five asymptomatic patients available for clinical follow-up at 6 months after termination of Adriamycin therapy subsequently developed signs of ventricular dysfunction. The majority of patients (83%) studied at 450 mg/m2 cumulative dose levels did not have a 15% or greater decline from baseline into the abnormal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Testicular scintigraphic findings two to three months after torsion. Correlation with sonography and histopathology.

A patient with a nontender testicular mass had sonographic abnormalities compatible with but not entirely typical of a chronic torsion. His scintigraphic studies, done on the same day as ultrasonography and 1 month later, revealed only findings consistent with a very mild subsiding scrotal inflammatory process. On surgical exploration and pathologic examination, it was found that he had an organizing infarct of the testicle secondary to torsion. The clinical history, diagnostic studies, and microscopic slides of the surgical specimen were reviewed. It appeared that tissue granulation and lipogranulomatous changes in the epididymis, known histologic sequelae to the unusually prolonged testicular torsion of 2-3 months, produced scintigraphic findings different from those which have been described for a late or an atrophic torsion.

Attempts at clarification of splenic visualization on reticuloendothelial images: Tc-99m DISIDA compared with heat- denatured Tc-99m RBC imaging.

Four patients with enlarged left hepatic lobes and questionable or difficult splenic visualization on Tc-99m sulphur colloid (SC) images were further examined with additional radionuclide procedures. All four patients had Tc-99m DISIDA imaging, and three of them also had heat-denatured Tc-99m RBC imaging. The hepatobiliary images appear very effective in confirming postsplenectomy expanded enlargement of the left lobe of the liver and in refuting the presence of spleen in such cases. However, distinct visualization of the spleen in these patients can be achieved only through selective spleen imaging with heat-damaged red cells.

Increased focal uptake of Tc-99m-IDA hepatobiliary agent by a liver metastasis.

A patient with fever and right upper quadrant abdominal pain was referred for a hepatobiliary scan. Tc-99m-PIPIDA scanning revealed a hypervascular hepatic focus that persisted as a “hot spot” in delayed views. Ga-67-citrate scanning revealed increased uptake in the same hepatic focus. The patient suddenly died. Postmortem examination revealed that this abnormal site represented a necrotic tumor histologically compatible with metastatic breast carcinoma.

Scintigraphic demonstration of postural induced drainage stasis in an en bloc renal allograft.

Within 6 months after an en bloc transplantation of two kidneys from a cadaveric pediatric donor, the recipient was referred for further scintigraphic evaluation because of clinical suspicion of having a postural related function impairment of the grafted kidneys. Tc-99m MAG3 imaging, modified by varying the position of the patient during the procedure, resulted in detection of drainage stasis only with the patient standing. This drainage stasis had not been appreciated in the preceding routine examinations performed with the patient supine. Although the positional outflow stasis by itself may not be severe enough to cause alarming dysfunction of the grafted kidneys, it could conceivably be a significant contributing factor.