Christopher Rush

Tc-99m red blood cell venography in deep venous thrombosis of the lower limb. An overview

Tc-99m red blood cell venography is a simple and sensitive technique for the diagnosis of deep vein thrombosis of the lower limb. The static high count blood pool images of the deep venous system of the leg are readily interpretable and show good correlation with contrast venography. The advantages and limitations of this technique in the clinical setting are discussed in detail in this review.

Spectrum of Malignant Pleural and Pericardial Disease on FDG PET/CT

OBJECTIVE The purpose of this article is to illustrate a wide spectrum of malignant primary and secondary pleural and pericardial diseases imaged with (18)F-FDG PET/CT. CONCLUSION A wide variety of malignant pleural and pericardial diseases can be detected, staged, and monitored by FDG PET/CT. Although the PET/CT findings are often nonspecific, the aim of this atlas is to show that the spectrum of pleural and pericardial disease that can be evaluated with PET/CT is much broader than current literature would suggest. PET/CT readers and oncologists should be aware of the wide variety of malignancies that can affect the pleura and pericardium and some of the patterns of FDG uptake that can be observed in these cases.

Hypertrophic pulmonary osteoarthropathy diagnosed by FDG PET-CT in a patient with lung adenocarcinoma.

A 52-year-old man had a positron emission tomography computed tomography (PET-CT) scan for staging of a biopsy proven lung adenocarcinoma. An additional acquisition of the lower extremities was performed as the patient complained of bilateral leg pain. The PET-CT scan showed a 6.5 x 5.0 cm left upper lobe lung mass invading the mediastinum with maximal standardized uptake value of 10.7, compatible with primary lung cancer. The CT portion of the PET-CT of the legs showed extensive irregular bilateral periosteal new bone formation in the long bones. The PET images showed diffuse moderately increased FDG uptake in the periostea of the long bones of the legs, with some focal sites of more intense FDG uptake in the thicker portions of the periosteum. A bone scan showed mild hyperemia surrounding the long bones of the legs and intense Tc-99m MDP uptake in the periostea. The patient was diagnosed with hypertrophic pulmonary osteoarthropathy.

Pulmonary hypertension findings detected by F-18 FDG PET scan.

A 72-year-old female patient had severe pulmonary hypertension on transthoracic echocardiography with a pulmonary arterial pressure of 125 mm Hg, moderate tricuspid regurgitation, and a moderately dilated, mildly hypokinetic right ventricle (RV). A CT scan, performed to assess the etiology of the pulmonary hypertension, revealed a right middle lobe lung nodule and enlarged mediastinal lymph nodes. A subsequent F-18 FDG PET scan demonstrated the right middle lobe lung nodule and the mediastinal adenopathy to be FDGavid, but a striking incidental finding on this study was intense RV FDG uptake, secondary to RV hypertrophy and strain.

Technetium-99m red blood cell venography of the lower limb in symptomatic pulmonary embolization

Tc-99m RBC venography of the legs was obtained in 42 patients with primary pulmonary symptomatology and a diagnosis of pulmonary embolization. In 31 of these 42 patients (74%), the nuclear venogram revealed the presence of deep vein thrombosis (DVT) and a source of embolization. Of the 31 patients with leg DVT documented by venography, 13 (42%) showed thrombosis confined to the calf. Clinical findings suggested that only 20 of the 31 patients (65%) with DVT could have harboured a source of embolization in the legs. Tc-99m RBC venography is a useful noninvasive test for the global and comprehensive assessment of patients with symptomatic pulmonary embolization.

Infectious and inflammatory complications of surgical management of cancer patients imaged with 18F-FDG PET/CT: a pictorial essay

The aim of this pictorial essay was to highlight the usefulness of fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in evaluating incidental infection or inflammation in cancer patients, related to surgical management. A retrospective review of 10,985 consecutive oncologic PET/CTs was done, and nine cases with suspected FDG positive infectious or inflammatory processes were selected for further review. PET/CT helped identify infections and inflammatory processes related to surgical management of cancer patients, define the extent of infection or inflammation, guide the management and, in some cases, evaluate response to therapy.

Spectrum of gastric malignancy on 18F-FDG PET/CT: a pictorial essay

A wide variety of malignant gastric diseases can be detected, staged, and followed on (18)F-FDG PET/CT. Although the PET/CT findings are often nonspecific and some can be seen in certain benign gastric diseases, the aim of this atlas was to demonstrate that the wide histological spectrum of gastric tumors that can be evaluated, staged, and followed with PET/CT is much broader than current medical literature would suggest. PET/CT readers and oncologists should be aware of the utility of PET/CT in these tumors and the imaging characteristics and patterns of (18)F-FDG uptake that can be demonstrated in these cases.

Submandibular salivary gland transfer: a pitfall in head and neck imaging with F-18 FDG PET/CT.

Xerostomia is a significant morbidity of radiation treatment in the management of head and neck cancers. To preserve salivary function, a surgical technique has been developed that involves the transfer of one submandibular gland to the ipsilateral submental space, where it can be shielded during radiation therapy. F-18 FDG PET/CT imaging characteristics of recently or remotely transferred submandibular glands have not been previously described in the literature. We report 2 cases of patients with surgically transferred submandibular glands, which highlight a potential pitfall in the interpretation of PET/CT of the head and neck region in oncologic patients.

Radiocolloid liver imaging in hepatic steatosis.

In a review of 60 patients with fatty infiltration of the liver documented by Xe-133 imaging, 43% had normal radiocolloid liver images, and 57% had abnormal images with various combinations of hepatomegaly, mottling, splenomegaly, and splenic shift of radioactivity. None, however, showed focal defects. Fatty infiltrates do not simulate mass lesions on the radiocolloid study of the liver, and an area of photon deficiency in the presence of hepatic steatosis points to an additional pathologic process. The interpretation of the radiocolloid liver image is unhindered by fatty infiltration when searching for discrete space-occupying lesions.

Necrotizing Cervical Lymphadenitis Caused by Mycobacterium simiae in an HIV-Positive Patient: Imaging with 18 F-FDG PET/CT

Mycobacterium simiae (M. simiae) is an opportunistic pathogen rarely associated with human disease, although in recent years M. simiae has been detected with increasing frequency in human immunodeficiency virus (HIV)-infected patients, usually causing disseminated infection with fever, diarrhea and weight loss. We report the case of an HIV-positive man, who was referred for an 18F-FDG PET/CT to evaluate a solitary pulmonary nodule. The PET/CT showed incidental large necrotic cervical lymph nodes, compatible with necrotizing cervical lymphadenitis. Biopsy and culture of one of the affected lymph nodes were positive for M. simiae. We present the first report of 18F-FDG PET/CT imaging of an infectious process caused by M. simiae in humans.