Daniel T. Myers

Visualization of renal angiomyolipoma on F-18 FDG PET/CT.

Abstract:Focally increased FDG activity in the kidney can present a significant diagnostic dilemma. In the presented case, a 75-year-old woman underwent whole body F-18 FDG PET/CT after diagnosis of recurrent left breast cancer. A solid hypermetabolic mass was found in the left kidney and reported a

Intraosseous Injection of Iodinated Computed Tomography Contrast Agent in an Adult Blunt Trauma Patient

Intraosseous venous access can be life-saving in trauma patients when traditional methods for obtaining venous access are difficult or impossible. Because many blunt trauma patients require expeditious evaluation by computed tomography (CT) scans with intravenous contrast, it is important to evaluate whether intraosseous catheters can be used for administering CT contrast agents in lieu of waiting until secure peripheral intravenous or central venous catheter access can be established. Previous case reports have demonstrated that tibial intraosseous catheters can be used to safely administer CT contrast in the pediatric patient population. Here we report a case in which intraosseous access was the only means of administering intravenous contrast agent in an adult blunt trauma patient. An intraosseous catheter was placed in the standard manner in the right proximal humerus. Intravenous contrast agent was administered through the intraosseous catheter, using the standard blunt trauma protocol at our institution. CT scans were evaluated by a staff radiologist and assessed for the adequacy of diagnosis for blunt traumatic injuries. CT scans of the thorax, abdomen, and pelvis were considered to be adequate for diagnostic purposes and subjectively equivalent to those of studies using traditional central venous access. The intraosseous catheter was discontinued the following day. No complications of intraosseous placement or of contrast administration were identified. Intraosseous catheterization appears to be a feasible and effective alternative to traditional methods of venous access in the administration of iodinated contrast agents for CT evaluation in adult blunt trauma patients. Further study is warranted.

Multidetector CT imaging of bariatric surgical complications: a pictorial review

The prevalence of obesity is increasing, along with the number of bariatric surgical procedures performed to treat obesity. Laparoscopic sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and laparoscopic gastric banding (GB) comprise the vast majority of procedures with SG now the dominant procedure in the USA. Although multidetector computed tomography (MDCT) is not always the examination of choice for a particular suspected complication, many of these patients present with non-specific abdominal symptoms and undergo MDCT evaluation as an initial diagnostic test. This pictorial essay will review and discuss the normal post-surgical bariatric appearance on MDCT, and the appearance of common and uncommon complications associated with the common bariatric procedures on MDCT with correlative imaging. SG complications include leak/abscess, hemorrhage, splenic injury, and portomesenteric thrombosis. RYGB complications include leak/abscess, gastrogastric fistula, small bowel obstruction, internal hernia, and intussusception. Although GB is waning in popularity, radiologists continue to see the legacy of these patients and complications include gastric prolapse, band erosion, and port/tubing mechanical failures. Awareness of the characteristic findings of bariatric complications on MDCT is critical, allowing for earlier recognition and prompt intervention.

Tc-99m nofetumomab merpentan complements an equivocal bone scan for detecting skeletal metastatic disease from lung cancer

A 56-year-old man with recently diagnosed mixed small-cell and non-small-cell lung carcinoma of the left lung apex was referred for bone scintigraphy to identify possible skeletal metastatic disease. Whole-body planar images showed subtle focal uptake along the lateral portion of the right fifth rib and in the superior L1 vertebra. These findings were suggestive of metastatic disease, but benign post-traumatic or degenerative change could not be excluded. A nofetumomab merpentan scan was performed to help determine whether these bone scan findings represented skeletal metastatic disease. After the injection of 12.9 mCi Tc-99m nofetumomab merpentan, delayed 15-hour whole-body planar images and SPECT images of the chest and abdomen were obtained. These images showed increased uptake in the apical portion of the left upper lobe and left hilum, which corresponded to the known tumor in the left apex with metastatic hilar adenopathy. In addition, increased activity was noted in the lateral right fifth rib and L1 vertebra body, corresponding to the subtle bone scan abnormalities. A lumbar spine CT performed approximately 1 month later revealed a lytic lesion at L1 that confirmed the detection of metastatic disease on the nofetumomab merpentan study.

Possible false-positive metastatic prostate cancer on an In-111 capromab pendetide scan as a result of a pelvic kidney.

A 61-year-old man who had a radical prostatectomy for adenocarcinoma of the prostate 8 months before now had a Gleason score of 9 and a prostate-specific antigen level that had increased to 0.6 since the surgery. An In-111 capromab pendetide scan was ordered to determine the presence and extent of disease. SPECT images of the pelvis showed asymmetric uptake in the left posterior pelvis suggestive of metastatic disease in the left internal iliac nodes. Correlation with the preoperative CT images revealed a low-lying pelvic kidney in this location, which explained this worrisome appearance.

Unsuspected lymphoma detected on Tc-99m sestamibi parathyroid scan.

Technetium-99m complexes, specifically Tc-99m sestamibi, initially showed great promise as cardiac and parathyroid imaging agents at the time of their introduction in the 1980s. Since then, noncardiac and parathyroid applications have been expanding rapidly. The utility of Tc-99m sestamibi as a tumor imaging agent has been well demonstrated. Uptake by thyroid and bronchial carcinomas and by non-Hodgkins lymphoma has been documented. A 76-year-old woman was examined for evaluation of a presumed thyroid nodule. Ultrasound examination revealed a 1.1-cm nodule in the anterior left neck, which was thought to be a parathyroid adenoma. A Tc-99m sestamibi parathyroid scan showed abnormal uptake in the lateral left neck and left suprahilar region. Subsequent computed tomographic imaging and biopsy of a mesenteric soft tissue mass led to a diagnosis of malignant B-cell lymphoma.

Incidental detection of calcified dialysis graft on Tc-99m MDP bone scan.

A 48-year-old woman with a renal transplant and a history of immunosuppressive steroid use presented with a history of persistent hip pain. She was referred for radionuclide bone scan to evaluate the presence of avascular necrosis. No evidence of avascular necrosis was seen; however, incidental uptake of Tc-99m MDP was seen in a heavily calcified, nonfunctioning, synthetic dialysis access graft in the left groin.

Incidental finding of periodontal disease on bone scan

A 45-year-old woman underwent a Tc-99m MDP bone scan to rule out the presence of active Pagets disease. The bone scan shows strikingly abnormal focal areas of uptake in both the maxilla and the mandible. A correlative panoramic radiograph of the mandible and maxilla shows findings of significant periodontal disease that correspond to the abnormal uptake seen on bone scan. The striking degree of uptake is atypical for periodontal disease, although it is seen in other disorders of the mandible and maxilla.

Hysterosalpingography: an imaging Atlas with cross-sectional correlation

Hysterosalpingography (HSG) provides a unique combination of both fallopian tube and uterine cavity evaluation. A comprehensive understanding of both HSG and correlative cross-sectional imaging findings are essential radiologic skills. This article will review the spectrum of technical artifacts, anatomic variants, congenital uterine anomalies, uterine and tubal pathology, and postsurgical findings as they appear on HSG. Additionally, correlation with MR and ultrasound images is provided. This review article serves as a reference for residents new to HSG as well as staff who perform and interpret HSG infrequently.

Intestinal transplants: review of normal imaging appearance and complications

Intestinal transplant (IT) is one of the least common forms of organ transplant but is increasing both in volume of cases and number of centers performing intestinal transplants, with the busiest centers in North America and Europe. IT can be performed in isolation or as part of a multivisceral transplant (MVT). Intestinal failure either in the form of short gut syndrome or functional bowel problems is the primary indication for IT. The normal post-surgical anatomy can be variable due to both recipient anatomy in regard to amount of residual bowel and status of native vasculature as well as whether the transplant is isolated or part of a multivisceral transplant. Complications of isolated IT and IT as part of an MVT include complications shared with other types of organ transplants such as infection, rejection, post-transplant lymphoproliferative disorder and graft versus host disease. Mechanical bowel complications of the graft include bowel obstruction, stricture, leak, perforation and enterocutaneous fistula. Lastly, vascular complications of both the venous and arterial anastomoses including stricture and pseudoaneurysm occur.