Frank Keeling

Case report 759

Fig. 1. Radiograph of lcft tibia and fibula demonstrating multiple, small, well-defined, lytic lesions involving the tibia, fibula, and talus Fig. 2. Radiograph of the left tibia and fibula obtained 8 weeks later demonstrated an increase in size and number of lytic lesions affecting the tibia, fibula, and talus Fig. 3. Radiograph of left femur demonstrates multiple, well-defined lytic lesions involving the neck and shaft of the femur

The utility of 99mTc-sestamibi scintigraphy in the localisation of parathyroid adenomas in primary hyperparathyroidism.

BackgroundThere are conflicting data in the literature about the sensitivity of sestamibi scintigraphy in parathyroid tumour localisation in primary hyperparathyroidism (PHPT).AimWe aimed to evaluate the overall sensitivity of this modality in parathyroid tumour localisation and to determine clinical and biochemical factors which influence sensitivity of this method.MethodsWe performed a retrospective review of 57 patients with a biochemical diagnosis of PHPT who had sestamibi scintigraphy performed.ResultsThe sensitivity of sestamibi scanning was 56% in whole group and 63% in those without nodular thyroid disease. Among the patients with confirmed single gland disease (biochemical cure after surgical removal of a single adenoma), sensitivity was 71%. A positive scan was associated with younger age, greater adenoma weight and higher pre-operative serum calcium. Concordance between the sestamibi and neck ultrasonography was 92% accurate in pre-operative tumour localisation.ConclusionSestamibi scintigraphy was more likely to be positive in younger patients without nodular thyroid disease who have larger parathyroid adenomas with more severe hyperparathyroidism.

Radiologic evaluation of simultaneous pancreas-kidney transplantation

We describe the radiographic imaging modalities that were used in the first twelve consecutive patients who have undergone simultaneous pancreas and kidney transplantation (SPK) at our institution. The total number of examinations undertaken in this study included ultrasound (n=22), radionucleide scanning (n=19), cystography (n=14), computed tomography (n=2) and magnetic resonance imaging (n=l). Eighteen percent (5/22) ultrasound examinations were abnormal (perirenal collection [n=4], peri-pancreatic collection [n=l]). Two collections required aspiration and were confirmed as lymphocoeles. Cystography showed ureteric reflux in two patients and radionucleide DTPA scanning revealed a delay in the excretory phase in 20% of patients. CT was used in two patients with SPK and demonstrated large peri-pancreatic collections. No episodes of rejection or late graft pancreatitis were noted in this series.We discuss the role of radiographic imaging in detecting early graft failure and also in defining the surgical complications that may arise following transplantation. We also outline the merits and disadvantages of each imaging modality. We conclude that the most useful initial imaging techniques in the evaluation of patients following SPK are ultrasound including Doppler and nuclear medicine.