Charles M. Boyd

Early and delayed indium 111 leukocyte imaging in Crohn's disease

Twenty-seven patients with Crohns disease were studied for the presence and location of activity by both early (4 h) and delayed (18-24 h) indium 111 leukocyte imaging. The results were compared with other parameters of disease activity including Crohns disease activity index, barium studies, and endoscopy. There was a correlation between early images and Crohns disease activity index (r = 0.78) and between delayed images and index (r = 0.82). Based upon the corresponding Crohns disease activity index, the sensitivity of early and delayed imaging was 81.0% and 95.2%, respectively. Specificity of early and delayed imaging was 75.0% and 87.0%, respectively. Presence of activity on the early and delayed imaging agreed with activity on barium studies and colonoscopy in approximately 80% of cases. Correlation of location of disease by leukocyte imaging and x-ray was observed in 58.9% of early scans and 55.0% of delayed scans. Correlation of the location of disease by imaging and endoscopy was observed in 71.4% of early and 75.0% of delayed studies. Because of the possibility of occurrence of false-negative results in early images, delayed imaging should always be included in evaluation of disease activity in patients with Crohns disease who are suspected of having mild activity. Delayed imaging is not required if the early imaging study clearly shows activity.

Diffuse Pulmonary Uptake of Indium-111 Chloride in Idiopathic Myelofibrosis

Unusual indium-111 accumulation and extramedullary hematopoiesis in the lungs of a patient with idiopathic myelofibrosis are described. The bone marrow scan taken 24 hours after intravenous injection of 111InCl3 faithfully depicted the abnormal distribution of marrow elements as assessed histologically at autopsy, thereby supporting the usefulness of 111InCl3 for marrow imaging.

Clinical Utility of In-111 Leukocyte Imaging in Crohn's Disease

Thirty six patients with Crohns disease were studied with in-111 leukocyte imaging. There was a correlation of the presence of activity on early (4 hour) imaging (r=0.516, P < 0.001) and on delayed 18-24 hour) imaging (r=0.457, P < 0.003). In the total group of 36 patients, the results of imaging were useful in the immediate management of 13 patients (36.1%). These included four patients (11.1%) who refused to undergo colonoscopic examination and nine patients (25%), six of whom had previous intestinal resection.

Clinically Silent Brain Metastases: Can Radionuclide Scintigraphy Detect Them?

The role of static and dynamic radionuclide brain imaging in the detection of occult brain metastases was evaluated by reviewing the brain images and case histories of 136 patients with neoplastic disease (mostly lung cancer) who, at the time of the scintigraphic study, lacked clinical evidence of brain metastases. Static studies were normal in 121, equivocal in 13, and abnormal in 2. One of the patients with an abnormal study had dural metastases; the other had skull metastases. None of the 13 equivocal scans was found to be indicative of metastasic disease. Cerebral flood flow studies were performed in 99 of the 136 patients and all were negative for evidence of metastatic disease. The results of this study do not support the use of brain scintigraphy for routine screening of asymptomatic cancer patients.

Use of intraoperative radionuclide study and colonoscopy in gastrointestinal hemorrhage.

Tc-99m labeled red cell imaging is used in the diagnosis and localization of gastrointestinal hemorrhage. A patient in whom a preoperative scan was positive in the right paraumbilical region is discussed. Intraoperative Tc-99m labeled red cell imaging was used in conjunction with colonoscopy, and the site of active bleeding was found in the proximal transverse colon, which had been displaced downward because of adhesions.

Clinical Experience With the 20-Minute 99mTc-Neck/Thigh Ratio: A Quick, Simple, Reproducible Test of Thyroid Function

Technetium-99m neck/thigh ratios were obtained in 110 patients referred for evaluation of thyroid function by injecting 2 mCl of 99mTc-pertechnetate intravenously and 20 minutes after injection, taking 1-minute counts over the neck and thigh with a standard radionuclide uptake probe. The Tc-99m neck/thigh ratio was: 1) normal in all 46 patients judged to be free of thyroid disease; 2) normal in 28 and elevated in 6 of 34 patients with nontoxic goiters; 3) elevated in all 12 untreated hyperthyroid patients; 4) normal in all 5 patients with hypothyroidism; and 5) reliable in monitoring response to therapy for hyperthyroidism. Correlation was higher with the 2-hour 131I thyroid uptakes (r = 0.987) than with the 24-hour uptakes (r = 0.826). The 20-minute 99mTc-neck/ thigh ratio is a quick, safe, simple reproducible and reliable thyroid function test for the diagnosis of hyperthyroidism, followup of treated hyperthyroid patients, and for the evaluation of nontoxic goiters. The test is not useful in hypothyroidism. It is a measure of the trapping function of the thyroid gland; elevated values are indicative of a hyperactive thyroid trapping mechanism.