Errol M. Bellon

Preliminary imaging results using In-111 labeled CYT-356 (Prostascint) in the detection of recurrent prostate cancer.

To evaluate whether In-111 capromab pendetide (an antibody conjugate directed to a glycoprotein found primarily on the cell membrane of prostate tissue) radioimmunoscintigraphy can localize residual or metastatic prostatic carcinoma in 15 patients after prostatectomy and lymphadenectomy for prostatic carcinoma with rising serum prostate-specific antigen. One patient with 0.6 ng/ml serum prostate-specific antigen had normal imaging results and 14 patients had scintigraphic evidence of residual prostatic bed or metastatic prostatic carcinoma. Two patients with borderline abnormal bone scans had abnormal activity in the same regions on In-111 capromab pendetide images. All patients had negative radiographic abdominal and pelvic cross-sectional prestudy images, and there were no adverse effects related to In-111 capromab pendetide infusion and little human antimouse antibody response.

A comparison of clinical examination, history, and magnetic resonance imaging for identifying orthodontic patients with temporomandibular joint disorders

The temporomandibular joint (TMJ) status of 51 juvenile orthodontic patients was assessed with magnetic resonance imaging (MRI), clinical examination, and questionnaire data. The results of this study demonstrated that the prevalence of anterior displacement of the meniscus was 11.8% (6 of 51) as assessed by MRI. Clicking or pain in the TMJ area was found in 9.8% (5 of 51) of the subjects by clinical exam, and 19.8% (10 of 51) of the subjects had a history of pain or clicking of the TMJ. Three subjects had a positive MRI and a negative history and clinical examination. However, all subjects with positive MRI findings had a history of other risk factors known to be associated with TMJ internal derangement (TMJ-ID). Therefore practitioners should use a history form and a clinical examination technique that includes a broad range of signs and symptoms of temporomandibular disorders (TMD) to identify patients who may have abnormal condyle disk relationships and be at risk for TMD. Clicking and pain in the TMJ helped identify only one half of the patients with abnormal condyle-disk relationships in this study population. Future cephalometric studies will monitor the effects of abnormal condyle disk relationships on facial growth during orthodontic treatment.

Prostate cancer and prostate bed SPECT imaging with Prostascint® : Semiquantitative correlation with prostatic biopsy results

ProstaScint® (Cytogen Corporation, Princeton, NJ) murine monoclonal antibody imaging is FDA‐approved for imaging of prostate cancer patients at high risk for metastatic disease and patients postprostatectomy with a rising serum prostate‐specific antigen (PSA) level. ProstaScint® is a murine monoclonal antibody which targets prostate‐specific membrane antigen (PSMA). PSMA expression is upregulated in primary and metastatic prostate cancer. FDA Cytogen (Princeton, NJ) protocol studies using 111indium‐labeled ProstaScint® revealed correlation between areas of increased concentration in the prostate and biopsy‐proven tumors in patients imaged pretherapy.

The value of quantitative sacroiliac scintigraphy in detection of sacroiliitis

SummaryTo evaluate clinical usefulness of quantitative sacroiliac scintigraphy (QSS) in detecting sacroiliitis, we used a modified, pixel by pixel technique for calculating sacroiliac joint/sacrum uptake ratios (sacroiliac joint index - SII). We studied 90 controls, 18 selected patients with active sacroiliitis, 2 ankylosing spondylitis patients with completely ankylosed sacroiliac joints, 14 patients with nonspecific low back pain and 5 patients with rheumatoid arthritis. In the controls, we found that the SII decreases with increasing age (P<0.001) and is higher in males than in females (P<0.005). In the patients with active sacroiliitis, 9 out of 14 older than 30 had an abnormal SII; 3 of these patients showed no radiographic or CT abnormalities of the sacroiliac joints. None of the 4 patients with sacroiliitis under 30 years of age had values which fell out of the normal range for their age and sex. Only 1 of the 14 patients with non-inflammatory low back pain had an abnormally high SII. A borderline SII was found in 1 of the 5 patients with rheumatoid arthritis. QSS may be useful in detecting active sacroiliitis, sometimes even before the occurrence of radiologic abnormalities. However, because of its low sensitivity, its clinical usefulness is limited, especially in patients under 30 years of age.

Scintigraphic measurement of oropharyngeal transit in man

Scintigraphic studies of the oropharyngeal transit of a liquid bolus were performed in 15 healthy controls, 12 patients with symptoms of oral-pharyngeal dysphagia, and 13 patients with neuromuscular disease, who did not have dysphagia. Gamma camera imaging of the head, neck, and upper thorax was undertaken, in the lateral projection, during the swallowing of the radiolabeled bolus of water. Inspection of summed images permitted the selection of regions of interest (ROI) to represent the mouth, pharynx, and upper esophagus. Transit times between each ROI were calculated and compared. Significant prolongation of bolus transit time between the mouth and esophagus was present in both patients with and without dysphagia (0.59 ± 0.38 sec and 0.33 ± 0.7 sec; mean ± SD, respectively) compared with controls (0.26 ± 0.04 sec P < 0.001, P < 0.01, respectively, Mann-Whitney U test). Repeat studies in 25 individuals indicated that the transit measurements were more reproducible between swallows in normal subjects than in patients with symptoms. Deglutitive scintigraphy provides a noninvasive technique for the quantitative study of swallowing and its disorders.

A prospective study of femoral versus subclavian vein catheterization during cardiac arrest

Femoral vein catheterization has advantages over subclavian vein catheterization during cardiac arrest in that there is minimal interference to ongoing CPR. In addition, risks of subclavian catheterization are not a factor in femoral vein catheterization. Few studies have compared the success rate for catheterization of one site with that of the other during cardiac arrest. We conducted a prospective study to compare the success and complication rates for femoral with those of subclavian vein catheterization. Ninety-four patients undergoing CPR had either femoral or subclavian vein catheters placed during the course of the arrest. Catheter placement was verified by injection of radiopaque contrast material. We found that the success rate for femoral catheterization was 77% compared with a success rate of 94% for subclavian vein catheterization (P less than .05). There were no instances of pneumothorax with subclavian vein catheterization. There was no apparent learning curve leading to an increased success rate during the course of the study. We conclude that femoral vein catheterization should not be used except in those instances where attempts at peripheral and central venous cannulation are unsuccessful.

Middle meningeal artery trauma

We present the case of a patient who had the symptoms of a subarachnoid hemorrhage but was subsequently found to have an unusual combination of a separate traumatic pseudoaneurysm and a traumatic arteriovenous fistula of the middle meningeal artery. A review of the literature revealed a difference in the clinical course of patients with traumatic pseudoaneurysms compared to that of patients with arteriovenous fistulas. Patients who were found to have traumatic pseudoaneurysms of the middle meningeal artery frequently manifested signs of delayed hemorrhage. This mechanism may account for the prolonged lucid intervals exhibited in some patients subsequently found to have epidural hematomas.

MRI method for high liver iron measurement using magnetic susceptibility induced field distortions

A subject (22), such as a human patient, is positioned with a region of interest (24), such as the liver, close proximity to a phantom (12). A Volume image through the liver, the phantom, and adjacent portions of the subject are collected (40) with a magnetic resonance scanner. The phase component of the magnetic resonance data is reconstructed (50) into a three-dimensional phase map. An actually measured field map Hm (r) is determined (42) from the phase map. A geometric model of the volumes occupied by the liver, the phantom, and adjacent portions of the subject are defined mathematically (44). A calculation routine (46) calculates a calculated or estimated field map Hc (r) of the distortions to the magnetic field in the phantom which would be caused by the model. A least squares fit routine (48) (i) compares the calculated field map and the measured field map, (ii) based on the difference adjusts a susceptibility of material in the region of interest as defined in the model, and (iii) recalculates the field map. This fitting procedure is iteratively repeated until a susceptibility is determined for the region of interest which predicts the actually measured field map. This susceptibility is proportional to iron concentration.

Magnetic resonance imaging of a third trimester abdominal pregnancy

Abdominal pregnancies are rare, representing 1% of all ectopic pregnancies. Early and accurate diagnosis is essential in order to avoid the serious complications associated with the condition, including catastrophic hemorrhage secondary to placental separation. The clinical presentation of abdominal pregnancy is extremely variable and physical examination by itself may be insufficient for diagnosis. Ultrasound (US) is currently the imaging method of choice for establishing gestational location, but sonographic interpretation may be difficult due to gas within the gastrointestinal tract and distorted pelvic anatomy. The use of magnetic resonance imaging (MRI) in obstetric diagnosis, including abdominal pregnancy, has been described. We report a case of an abdominal pregnancy of 32 wk gestation diagnosed by MRI.

Involvement of the mandibular canal: early sign of osteogenic sarcoma of the mandible.

A case of osteogenic sarcoma of the mandible is presented. The most striking radiologic finding in this case was irregular widening of the mandibular canal, with areas of narrowing and loss of fine parallel cortical margins of the walls of the canal. These changes were accompanied by widening of the periodontal membrane of the adjoining teeth, an early sign of osteogenic sarcoma described by Garrington and colleagues, and loss of lamina dura of the same teeth and one additional adjacent tooth.