David C. Farlow

Impact of F18-fluorodeoxyglycose positron emission tomography/computed tomography on the management of resectable pancreatic tumours.

Background:  Positron emission tomography/computed tomography (PET/CT) using F18‐fluorodeoxyglucose has been shown to be valuable in the management of malignant disease. The aim of this study is to investigate the impact of this technique on the management of patients with resectable pancreatic tumours.

Mercaptoacetyltriglycine diuretic renography and output efficiency measurement in renal transplant patients.

Abstract Suspected urinary tract obstruction following renal transplantation presents a diagnostic dilemma. The purposes of this study were: (1) to establish a normal range of measurement of output efficiency (OE) in the renal transplant population, and (2) to assess prospectively the usefulness of OE in the setting of allograft obstruction. Twenty-two renal transplant patients with stable renal function and no evidence of hydronephrosis on serial ultrasound examination had a diuretic mercaptoacetyltriglycine scan with calculation of OE. Three renal transplant patients with confirmed graft obstruction were also studied. Standard qualitative and quantitative parameters as well as OE were calculated. The mean OE for the 22 normal renal transplant patients was 86.3%±3.7% (range: 77%–91%). OE values in the three obstructed patients were 59%, 68% and 75% respectively. It is concluded that OE should normally exceed 77% in renal graft recipients. OE is a promising means of diagnosing functional obstruction in these patients.

Diagnosis and treatment of antenatal uropathies.

Abstract Thirty‐five patients with significant fetal hydronephrosis detected on antenatal ultrasound had postnatal investigations which included ultrasound, 99mtechnetium diethylenetriamine pentacetic acid (99mTcDTPA) renal scans and micturating cysto‐urethrograms. Antenatal and postnatal ultrasound were unable to determine reliably the level of obstruction causing the hydronephrosis. The 99mTcDTPA renal scan was useful in determining the necessity and timing of surgery, but could not exclude vesico‐ureteric reflux. Seven patients required surgery in the neonatal period and a further seven children had surgery because of deterioration of the scan appearance on follow‐up studies performed at 3, 6 and 12 months of age and then at longer time intervals. Twenty patients (almost 60%) have been managed conservatively for a mean of 28 months (range: 12 months‐7 years) with no deterioration in renal function.

The significance of isolated gallium-67 uptake in the hilar lymph nodes of an untreated lymphoma patient.

A 69-year-old woman presented with non-Hodgkins lymphoma of the right ilioinguinal region in whom bilateral uptake of Ga-67 in hilar lymph nodes was noted on thoracic SPECT. There were no Ga-67 abnormalities elsewhere within the thorax, and a chest CT scan was also normal. The patient received radiotherapy to the inguinal region and remained in clinical remission for 28 months following treatment. She subsequently relapsed at a number of peripheral lymph node sites, but not in the chest. The authors postulate that isolated hilar uptake of Ga-67 SPECT may not be clinically significant in some untreated patients with lymphoma. This scintigraphic finding should be interpreted cautiously, particularly when other chest imaging studies remain negative.

Sentinel lymph node biopsy for early oral cancers: Westmead Hospital experience: SLNB for OCSCC: the Westmead experience

Sentinel lymph node biopsy (SLNB) has become an alternative option to elective neck dissection (END) for early oral cavity squamous cell carcinoma (OCSCC) outside of Australia. We sought to assess the technical feasibility of SLNB and validate its accuracy against that of END in an Australian setting.

Tc-99m DTPA uptake in Paget's disease of the left ilium

Skeletal visualization during dynamic renal imaging is an uncommon finding that has previously been related to underlying neoplastic disease. The authors report a case of active Pagets disease of the left ilium resulting in uptake of Tc-99m DTPA in the arterial flow and early blood pool images. This report emphasizes that it is the increased blood flow, rather than the bone pathology per se, that determines uptake of Tc-99m DTPA in Pagets disease.

Multicentre, randomised, blinded, control trial of drug-eluting balloon vs Sham in recurrent native dialysis fistula stenoses

Background: Endovascular treatment of autogenous arteriovenous haemodialysis fistula stenosis has high reintervention rates. We investigate the effect of drug-eluting balloons in the treatment of recurrent haemodialysis fistula stenosis. Methods: This is a randomised, controlled, investigator-initiated and run, prospective, blinded, multicentre trial. Patients with recurrent autogenous arteriovenous haemodialysis fistula stenosis received standard endovascular treatment plus drug-eluting balloon or standard endovascular treatment plus uncoated balloon (Sham). Primary endpoint was late lumen loss in trial area on ultrasound at 6 weeks, 3, 6 and 12 months. Secondary endpoints were freedom from reintervention to the Index Trial Area and decline in fistula flow (Qa). Interim analysis was performed at 6 months (unblinded due to timeliness). Results: Patients with 132 recurrent stenoses (48% in bare Nitinol stents) were randomised with 70 receiving drug-eluting balloon and 62 Sham. At 6 months, decline in late lumen loss was 0.23 ± 0.03 mm/month for Sham and 0.045 ± 0.03 mm/month for drug-eluting balloon arm, a significant difference (0.18 mm, p = 0.0002). At 12 months, this difference persisted at 0.12 mm (p = 0.0003). At 6 months, significant difference in late lumen loss for instent restenoses (p = 0.0004) was observed, with non-significant difference for unstented restenoses (p = 0.065). Mean time for freedom from reintervention was 10.14 months for Sham versus 42.39 months for drug-eluting balloon (p = 0.001). The same was shown for instent (p = 0.014) and unstented (p = 0.029) restenoses. Qa decline rate at 6 months was 36.89 mL/min/month (Sham) and 0.41 mL/min (drug-eluting balloon). The difference was significant (36.48 mL/min; p = 0.02) and persisted to 12 months (p = 0.44). Conclusion: Paclitaxel drug-eluting balloon significantly delays restenosis after angioplasty for recurrent autogenous arteriovenous haemodialysis fistula stenosis, persisting to 12 months. Drug-eluting balloon significantly increases freedom from reintervention at 12 months with these effects true in stented and unstented fistulas.

Utility of hybrid SPECT/CT in primary melanoma lymphoscintigraphy: A retrospective case series

Sentinel lymph node (SLN) biopsy is widely accepted as an important part of staging cutaneous malignant melanoma. Hybrid single photon emission computed tomography and computed tomography (SPECT/CT) may identify additional SLN and provide important information to the surgeon performing SLN biopsy. We report our experience at a major referral centre for melanoma surgery.

SPECT/CT in Melanoma Lymphoscintigraphy.

Sentinel lymph node biopsy is a crucial part of staging intermediate and thick melanoma. Lymphatic drainage from a tumor site can be highly variable, especially on the head, neck, and trunk. SPECT/CT fuses nuclear medicine and x-ray CT images to produce images with high anatomic detail. At our institution, SPECT/CT is performed routinely in addition to planar imaging. This article presents examples where SPECT/CT has proven helpful in image interpretation.

Assessment of Pediatric Hydronephrosis Using Output Efficiency

UNLABELLED Diagnosing obstruction in pediatric patients with hydronephrosis, and renal impairment is often difficult. Renal output efficiency (OE) is a parameter that may improve diagnostic accuracy by allowing normalization of washout according to renal function. The aims of this study were to define a normal range for OE in infants and children and to evaluate its diagnostic accuracy in cases with hydronephrosis. METHODS Seventy-four children (91 hydronephrotic kidneys; median age, 4 mo; 22 girls and 52 boys) underwent 99mTc-labeled mercaptoacetyl-triglycine scintigraphy using intravenous volume expansion (15 ml/kg normal saline), furosemide diuresis and urethral catheterization, if vesicoureteric reflux was present. Images were interpreted by consensus of two or more experienced observers using visual assessment of the images, differential function and clearance half-time after furosemide (T(1/2)), as well as OE. The final diagnosis was based on surgical findings (n = 23 kidneys) or follow-up for >12 mo (n = 68). RESULTS Final diagnosis in 22 of the 91 hydronephrotic kidneys was obstruction at the pelviureteric (n = 21) or vesicoureteric (n = 1) junction and no obstruction in the remaining 69. The overall diagnostic accuracy of OE was 89%. Using exhaustive search multivariate logistic regression analysis, only reduced OE (p < 0.001) and decreased renal uptake by visual assessment (p = 0.058) were independently predictive of obstruction (R2 = 0.726). In dilated but unobstructed kidneys, mean OE was 93% +/- 7.1%. In the normal kidneys, mean OE was 96% +/- 3.1%. CONCLUSION OE improves the diagnostic accuracy of diuretic renography in children and neonates with hydronephrosis and suspected obstruction. Output efficiency should exceed 89% in normal kidneys and 79% in unobstructed, hydronephrotic kidneys.