Charles D. Teates

Tumor detection with 67Ga-citrate: a literature survey (1970--1978).

Gallium scan detection of various neoplasms is tabulated by anatomic and histologic categories. The experience with many neoplasms is sufficient to accurately predict the likelihood of detection with gallium. This tabulation helps to point out other areas where the cumulative experience is insufficient to accurately predict sensitivity rates.

Case Report: Diabetes Mellitus as a Predisposing Factor in the Development of Pyomyositis

Pyomyositis is an uncommon infection in temperate climates, usually resulting from Staphylococcus aureus infection of skeletal muscle. In this report, the authors describe a patient with untreated Type 2 diabetes mellitus who suffered nonpenetrating blunt trauma to his left anterior thigh, and S. aureus pyomyositis and secondary osteomyelitis of his proximal tibia and patella subsequently developed as a result of delayed diagnosis and treatment. Patients with diabetes mellitus are at increased risk for the development of pyomyositis because of more frequent S. aureus colonization of skin, nasal mucosa, and oropharynx; a delay in definitive treatment can lead to significant morbidity in these patients. Computed tomography or magnetic resonance imaging may be helpful in the diagnosis of pyomyositis. An anemia of chronic disease may result from this disorder, which resolves with treatment.

Estimation of 24-hour thyroid uptake of I-131 sodium iodide using a 5-minute uptake of technetium-99m pertechnetate.

The authors have developed a method to estimate the 24-hour sodium iodide thyroid uptake based on a 5-minute Tc-99m pertechnetate thyroid uptake using the equation: Estimated Iodide Uptake = 17.72*In(Pertechnetate Uptake) + 30.40. This estimation has a correlation coefficient of 0.90. It is based on a data pool of 44 patients who underwent I-131 and Tc-99m studies within 2 weeks of each other from 1978-1988, with established diagnoses as follows: 12 euthyroid, 6 hyperthyroid with multinodular goiters, 15 hyperthyroid with diffuse goiters, 4 with subacute thyroiditis, and 7 unknown. The population consisted of 30 women and 14 men with a mean age of 52.0 ± 17.5 years; this sample was screened for use of thyroid hormone, propylthiouracil, and radiographic contrast. The authors believe this estimation method is of value whenever a 24-hour iodide uptake is desired, and where speed and minimizing radiation dose are factors. This method is strongly recommended for thyroid uptake evaluation before I-131 therapy.

Nuclear Scintigraphic Assessment of Radiation-Induced Intestinal Dysfunction

Abstract Kirichenko, A.V., Mason, K.A., Straume, M., Teates, C.D. and Rich, T.A. Nuclear Scintigraphic Assessment of Radiation-Induced Intestinal Dysfunction. Radiation-induced damage to the intestine can be measured by abnormalities in the absorption of various nutrients. Changes in intestinal absorption occur after irradiation because of loss of the intestinal absorptive surface and a consequent decrease in active transport. In our study, the jejunal absorption of 99mTc-pertechnetate, an actively transported γ-ray emitter, was assessed in C3H/Kam mice given total-body irradiation with doses of 4, 6, 8 and 12.5 Gy and correlated with morphological changes in the intestinal epithelium. The absorption of 99mTc-pertechnetate from the intestinal lumen into the circulation was studied with a dynamic γ-ray-scintigraphy assay combined with a multichannel analyzer to record the radiometry data automatically in a time-dependent regimen. The resulting radioactivity–time curves obtained for irradiated animals were compared to those for control animals. A dose-dependent decrease in absorptive function was observed 3.5 days after irradiation. The mean absorption rate was reduced to 78.8 ± 9.3% of control levels in response to 4 Gy total-body irradiation (mean ± SEM tracer absorption lifetime was 237 ± 23 s compared to 187 ± 12 s in nonirradiated controls) and to 28.3 ± 3.7% in response to 12.5 Gy (660 ± 76 s). The decrease in absorption of 99mTc-pertechnetate at 3.5 days after irradiation correlated strongly (P < 0.001) with TBI dose, with the number of cells per villus, and with the percentage of cells in the crypt compartment that were apoptotic or mitotic. A jejunal microcolony assay showed no loss of crypts and hence no measured dose–response effects after 4, 6 or 8 Gy TBI. These results show that dynamic enteroscintigraphy with sodium 99mTc-pertechnetate is a sensitive functional assay for rapid evaluation of radiation-induced intestinal damage in the clinically relevant dose range and has a cellular basis.

The mucous Plug syndrome, a pulmonary embolism mimic

Reported are ten instances of major bronchial obstruction by mucous plugs in eight patients during which the clinical features resembled pulmonary embolism. Perfusion lung studies showed significantly diminished perfusion of the involved portions of the lungs. The chest radiographs generally did not, however, reflect the severity of the airway obstruction and in some instances were completely normal. The ventilation studies indicated the extent and severity of the obstruction and matched with the perfusion scans. Pulmonary arteriograms were performed in three patients and gave direct evidence of focally diminished lung perfusion without embolism. The physiologic mechanisms underlying the condition are discussed.

Osteosarcoma Extraosseous Metastases Demonstrated on Bone Scans and Radiographs

Four patients with non-pulmonary soft tissue metastases of osteosarcoma are presented. These lesions were readily demonstrated on 99mTc bone scans. Calcification was evident radiographically in all of the non-pulmonary lesions. In one instance, the recurrence would have been missed without the bone scan, and in another the bone scan first suggested the diagnosis. Bone scans have proven useful in the initial evaluation of osteosarcoma and in monitoring the results of therapy.

Detection of Enteric-Urinary Fistulas with a Noninvasive Quantitative Method

The 51chromium test is an inexpensive, noninvasive test to evaluate patients for enteric-urinary fistulas. Of 11 patients studied the 51chromium test demonstrated correctly a fistula in 5 of 6 patients with fistulas and showed no lesion in all 5 without fistulas. Excretory urography, barium enemas, visible contrast medium, cystograms and upper gastrointestinal series failed to demonstrate the fistulas with similar accuracy. Cystoscopy suggested a possible lesion in 4 patients but was definite for a fistula in only 2 of those patients.

THE VALUE OF GALLIUM07 SCANNING IN THE EVALUATION OF HEAD AND NECK MALIGNANCY

Gallium (07Ga) citrate is a scanning agent that has been shown to have a differential uptake in a variety of malignancies. Investigation of the usefulness of 07Ga scanning in patients with proven squamous cell carcinoma of the head and neck region is now in progress. These patients have a 07Ga total body scan as part of the pre‐treatment evaluation. The accuracy of the procedure is then judged by correlation with clinical and surgical findings. The results in 25 patients show that a clearly positive uptake occurs in 60 percent in the region of the primary. Uptake in metastatic disease in lymph nodes is much less, occurring in 6 of 18 sides of the neck. In one case, where clinical examination was considered to be negative, the gallium scan was positive and subsequently proven to be correct by histological examination of the surgical specimen. The various difficulties encountered in interpreting gallium scans in the head and neck region are described. It is felt that by improved patient selection and special techniques the yield of positive cases can be improved and unsuspected extension of malignancy demonstrated.

New radiopharmaceuticals and new applications in medicine

All areas of radiology are constantly evolving. At times rapid advances are made because new equipment or pharmaceuticals are introduced. At others the evolution is gradual as established procedures and techniques are refined. The following review of selected areas in nuclear medicine includes both dramatic changes due to new developments and evolutionary changes in established techniques. The first section reviews the development of monoclonal antibodies for use in radioscintigraphy of neoplastic disease. Although many articles have been written about this topic over the years, the clinical applications have suddenly expanded because the Food and Drug Administration (FDA) recently approved one monoclonal antibody for use in the imaging of colorectal and ovarian cancer. It is anticipated that a number of other antibodies will be approved for clinical scintigraphy of both malignant and benign disease and immunotherapy. It is advised that the radiologist performing nuclear medicine procedures become knowledgeable about this expanding area of clinical application. The second section reviews several new radiopharmaceuticals that are being used with increasing frequency for myocardial imaging. The behavior of these tracers is different from that of thallium, and specialized imaging techniques are required. Although the clinical value of these agents is still questioned by some, they are widely used. Familiarity with this topic is recommended. The last section reviews some of the radiopharmaceuticals available for renal imaging and functional evaluation. The relatively new technetium-labeled pharmaceutical that approximates the behavior of hippuran is emphasized. New applications with the renal cortical imaging agent technetium DMSA are also reviewed. A thorough knowledge of the biologic behavior of these tracers and appropriate imaging and measurement techniques is extremely important for their appropriate clinical use.

Epicardial lipoma: a CT diagnosis

Primary cardiac tumors are rare and epicardial lipomas are rare within this group. We are reporting a case diagnosed by CT in an 89-yr-old female.