David B. Hayt

Radionuclide venography: Its place as a modality for the investigation of thromboembolic phenomena

The radionuclide venogram graphically depicts thrombotic disease and appears particularly helpful in the visualization of the external pelvic venous system, inferior vena cava, and veins of the thigh. Since the pulmonary scintigram also may be performed in conjunction with the radionuclide venogram, the patient also is screened for possible pulmonary emboli. The extent of thrombotic disease in the area imaged by radionuclide venography appears to be related to the incidence of pulmonary emboli. It is likely to image nonocclusive thrombi, those which are more likely to embolize. It provides information regarding the status of venus channels, varicose veins and venous insufficiency, in addition to the presence of thrombi. Several authors have shown a better than 90% correlation between the findings on radionuclide venography and those of the most widely accepted means of assessing thrombosis in leg veins, radiographic phlebography. The technique and clinical results of radionuclide venography as well as its advantages and disadvantages in comparison to radiographic phlebography are discussed here. A simplified, standardized method of performing radionuclide venography with a moving-table accessory is described and illustrated.

Diagnosis of Hepatic Hemangioma with Combined Scanning Technique

A combined liver-scanning technique with 198Au and 13lI-HSA permits the evaluation of both parenchymal and blood pool elements. It is suggested that this method may be helpful in differentiating hemangiomata from other benign and malignant hepatic masses, particularly hepatoma.

Radionuclide Venography of the Lower Extremities and Inferior Vena Cava by Continuous Injection and Moving Bed Gamma Camera Technique

Radionuclide venography has proved to be a tedious procedure because of the need for multiple imaging set-ups with coordinated, repeated injections of radionuclide. The use of a moving bed gamma camera has shortened the procedure. This method enables the entire sapheno-femoral-iliac-caval system to be visualized in continuity on a single film. The moving table top system also adequately imaged the suspected areas of thrombi or endothelial damage on the post-exercise study on a single film.

Radionuclide Venography By Antegrade and Retrograde Whole Body Gamma Camera Imaging Methods

The use of a whole body gamma camera system and continuous injection represents a simplified and shortened procedure for radionuclide venography. Standardization of the procedure by moving the detector system in a direction retrograde to the flow of radionuclide, delineates the inferior vena cava and iliac system best by avoiding interference from radionuclide which has already accumulated in the lungs. This produces the best possible image in the most efficient manner to evaluate those areas of the venous system most likely to contribute clinically significant emboli to the lungs. The use of a second imaging pass prior to exercise gathers confirmatory evidence regarding blockage of specific veins, thereby substantiating the presence of venous occlusion as well as evaluating the presence of venous stasis. The use of a third, post exercise static study of the entire lower half of the body, enables documentation of “hot spots” which appear to represent labled thrombi, such as is seen in non occlusive venous vascular disease or thrombophlebitis.

Extensive Calcification of the Tricuspid Valve in Rheumatic Heart Disease

From the Medical and Radiological Services of: Misericordia-Fordham Hospital 600 East 233rd Street Bronx, New York 10466. The aortic and mitral valves are frequently involved in rheumatic heart disease. Subsequent calcification of these valves is a common occurrence. However, rheumatic involvement of the tricuspid valve is less frequently seen, and extensive calcification of this valve is a rarity. Reported herein is a 16 year old girl with rheumatic involvement of the mitral and tricuspid valves and, in addition, diffuse calcification of the tricuspid valve.

Renal cyst puncture: utilization of pediatric guide wire technique and upright radiographic changers.

After puncture of a renal cyst with a polytetrafluoroethylene needle a pediatric 0.021-inch guide wire is inserted through a polytetrafluoroethylene sheath needle. The sheath is then advanced over the wire. The technique is controlled by fluoroscopy or performed under ultrasonography. Aspiration of the contrast material is performed, and then air and diatrizoate meglumine and diatrizoate sodium are injected to outline the borders of the cyst. The patient is then taken to an upright and lateral radiographic changer for routine radiography in the upright and decubitus positions.

Direct serial magnification radiography using a film changer of standard height and a tilting radiographic table.

An existing multipurpose fluoroscopic and special-procedure room with a film changer of standard height can be used for direct serial magnification radiography by adding a simple stand and a sliding plastic table top. The motor drive of the radiographic table top is used to elevate the patient, eliminating the need for special tables or cassette changers.

Rapid Radiograph Copying from Closed-Circuit Television

A method for rapid radiograph copying of ordinary negative films using closed-circuit television image reversal and contrast control is described. It is rapid and convenient and provides high-quality slides when used with ninety-second X-omat processible films. The technique allows individual manipulation of contrast, detail and edge enhancement, and other characteristics on each film and employs materials available in a medium- to large-size radiology department.