Gerard W. Moskowitz

Feasibility of total thyroidectomy in the treatment of thyroid carcinoma: Postoperative radioactive iodine evaluation of 140 cases☆

The objective of this study was to evaluate our experience with so-called total thyroidectomy. Fifty cases (the retrospective group) had been operated on before the start of the study and had been on thyroid replacement therapy; this was discontinued, thyroid-stimulating hormone was administered, and iodine-131 studies were performed. Ninety cases (the prospective group) were evaluated 3 or more weeks postoperatively with no thyroid hormone having been administered. All patients were given 50 microcuries of iodine-131 and uptake studies were performed 24 hours later. All the patients were evaluated at a time when it was believed that practically all circulating hormone secreted by the thyroid gland before its removal had been metabolized or excreted from the body. If the patients with iodine-131 uptakes only in the region of the pyramidal lobe are considered to have had total thyroidectomy, we find that 85.7% of the patients studied had an uptake of less than 1.5%, and 96.4% had an uptake of less than 2.5%. There is increasing evidence to indicate that total thyroidectomy is the procedure of choice in the treatment of differentiated thyroid carcinoma. The present study indicates that with proper technique, total resection of the thyroid gland is feasible in nearly all cases of thyroid carcinoma.

Preoperative localization of parathyroid adenomas

During a 12-month period, 64 patients were operated on for primary hyperparathyroidism. Sixty-one had single adenomas and 3 had double adenomas. Preoperative imaging was used to localize the adenomas. Half of the patients (32 of 64) had magnetic resonance, thallium-201/technetium-99m subtraction scintigraphy, and high-resolution ultrasonography; the other 32 patients had 1 or 2 of the imaging modalities. Sensitivity and specificity of magnetic resonance imaging was 82 percent and 97 percent, respectively; the sensitivity and specificity of the other two modalities was 59 and 98 percent for subtraction scintigraphy and 73 and 98 percent for ultrasonography. The use of preoperative imaging facilitated surgical exploration, reduced operating time, and resulted in an increased number of successful operations. There were no negative explorations in this series as compared with 19 negative explorations (2.6 percent) in our prior experience with 720 operations.

Pulmonary scintigraphy in elastase-induced emphysema in pigs. Correlation with high-resolution computed tomography and histology

OBJECTIVES The objective of this study is to evaluate the mild physiologic changes of elastase-induced pulmonary emphysema in the pig by radionuclide scintigraphy and to correlate these findings with high-resolution computed tomography (HRCT) and histologic examination. METHODS Eight 7- to 12-week-old Yorkshire pigs were studied. Perfusion and ventilation studies were performed in six pigs at 1- or 2-week intervals after elastase instillation. HRCT was simultaneously performed for correlation with radionuclide scintigraphy. For the perfusion scans, technetium 99m (99mTc) macroaggregated albumin (MAA) was used, and both planar and single-photon emission CT (SPECT) images were obtained. Ventilation studies were performed with xenon-133 gas with dynamic sequential imaging. RESULTS Histopathologic findings demonstrated dilatation and destruction of the alveoli and were similar to those previously reported by the authors. The SPECT perfusion images showed significantly impaired perfusion of the involved segment of the lung, corresponding to the region where elastase was instilled. The planar xenon-133 ventilation scintigraphy did not show abnormal air trapping. The mild emphysema induced with elastase manifested as decreased and impaired perfusion with no detectable ventilation abnormalities. The sensitivity of SPECT perfusion studies for the detection of the mild changes of elastase-induced pulmonary emphysema were higher than that of HRCT. CONCLUSIONS The perfusion studies reflect functional or physiologic changes in contrast to structural changes seen on HRCT. This pig model was valuable to study the scintigraphic manifestation of elastase-induced pulmonary emphysema.

Long-term fate of the vascularized iliac crest bone graft for mandibular reconstruction

Vascularized bone grafts, such as the iliac crest, have become a major tool for mandibular reconstruction. Due to the growing trend toward immediate bone replacement followed by implant osseointegration and dental rehabilitation, further understanding of the long-term characteristics of these grafts is essential. Early postoperative bone scans demonstrate increased activity within the vascularized graft relative to surrounding bone. This study addressed the use of bone SPECT (single photon emission computed tomography) scintigraphy as a long-term method of evaluating the integrity of vascularized bone grafts.

111Indium-tropolone labeled human PMNs: a rapid method of preparation and evaluation of labeling parameters.

Pure polymorphonuclear leukocytes (PMNs) have been isolated from a small amout of human blood by a single-step density gradiant centrifugation method using a commercially available Ficoll-Hypaque mixture of density 1.114. The cells were labelled with [111]Intropolone in both buffer and plasma. Cell viability, ability to generate superoxide anion, and chemotaxis were found to be unaltered both before and after labeling. The optimum tropolone concentration for labeling was found to be 1 × 10−4 M. Labeling efficiency was higher at 37°C than at room temperature. Compared to [111In]oxine, tropolone preparation both in buffer and plasma resulted in consistently higher yields. Preliminary experiments of in vivo cell viability of the labeled PMNs were carried out in rabbits. The ability of the cells to localize in experimentally produced inflammatory lesions was found to be intact. The method of cell separation and labeling described has been found to be simple and rapid and could easily be incorporated in routine nuclear medicine laboratory practice.

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The Radiologic Clinics of North America

CONTENTS pages v-viii PDF (28 KB) Forthcoming Issues page ix PDF (18 KB) Preface Imaging of the acute abdomen by Balthazar EJ pages xi-xii Full Text | PDF (51 KB) Impact of multislice CT on imaging of acute abdominal disease by Kundra V, Silverman PM pages 1083-1093 Full Text | PDF (413 KB) Radiologic diagnosis of gastrointestinal perforation by Rubesin SE, Levine MS pages 1095-1115 Full Text | PDF (1077 KB) The acute right lower quadrant: CT evaluation by Macari M, Balthazar EJ pages 1117-1136 Full Text | PDF (1541 KB) Adult intussusception: Diagnosis and clinical relevance by Huang BY, Warshauer DM pages 1137-1151 Full Text | PDF (710 KB) CT of acute abdominal aortic disorders by Bhalla S, Menias CO, Heiken JP pages 1153-1169 Full Text | PDF (763 KB) Blunt injury to mesentery and small bowel:: CT evaluation by Hanks PW, Brody JM pages 1171-1182 Full Text | PDF (603 KB) Spontaneous intraperitoneal hemorrhage: Imaging features by Mortele KJ, Cantisani V, Brown DL, Ros PR pages 1183-1201 Full Text | PDF (1230 KB)

Visualization of a pseudomeningocele on isotope cisternography.

Pseudomeningocele, a hernial protrusion of the meninges, most commonly forms in wounds that have been incompletely closed at surgery. They are frequently seen with hydrocephalus, with or without increased intracranial pressure. The authors present a case of an incidental finding of a posterior fossa pseudomeningocele seen on cisternography that was performed because of postoperative hydrocephalus after removal of a cerebellar astrocytoma.