Helena R. Balon

The Role of Scintigraphy in Confirmation of Suspected Brain Death

We present a case illustrating how cerebral perfusion scintigraphy can be used to assist in crucial medical decision making in the intensive care setting for patients who are maintained on life support but are clinically suspected to have brain death. Cerebral perfusion scintigraphy can confirm brain death but cannot be used to diagnose it. 99mTc-HMPAO and 99mTc-ethylcysteinate dimer are the preferred imaging agents since they cross the blood–brain barrier.

Lumbosacral Transitional Vertebra Diagnosed on 99mTc-Methylene Diphosphonate SPECT/CT

Lumbosacral transitional vertebra (LSTV) is a congenital anomaly of the lumbosacral junction. The association between back pain and LSTV is controversial; however, in our patient the symptoms localized to a hemisacralized left transverse process of L5. LSTV should be included in the differential diagnosis in young patients with lower back pain, and scintigraphic imaging should be considered for diagnostic purposes.

Hypertrophic Osteoarthropathy on Bone Scintigraphy

We present the case report of a patient with a history of lung cancer in whom the typical pattern of hypertrophic osteoarthropathy was seen on bone scintigraphy. We discuss the etiologies, pathophysiology, and management of this entity.

Spleen Uptake on a Bone Scan

We present a patient with spleen uptake on bone scanning that was due to sickle cell disease. We also discuss other etiologies for this finding.

Appearance of Meningioma on 99mTc-HMPAO SPECT: Correlation with MRI

On brain perfusion SPECT, a primary brain lesion presents as a localized defect that corresponds to the mass lesion. 99mTc-HMPAO images generally show a focal defect in the region of abnormality, whether containing necrotic tissue, recurrent tumor, or both. Further characterization with MR imaging is needed to confirm the diagnosis, as demonstrated in this case report.

Complementary Role of 18F-FDG PET and 123I-Ioflupane SPECT in the Diagnosis of Lewy Body Disease

We present a case demonstrating how correlative imaging with 123I-ioflupane SPECT and 18F-FDG PET can be used to help make the diagnosis of Lewy body disease more specific.

17-Year-Old Runner with Shin Pain

Stress injury is a common cause of exercise-induced anterior shin pain. It is important to distinguish between the various causes of stress injury in a timely manner in order to optimize favorable treatment outcomes. Here, we will discuss a case of medial tibial stress syndrome, or shin splints, as one of the causes of shin pain, as well as how to approach shin pain for a successful diagnosis.

Scintigraphy of Patient with Hematochezia

Gastrointestinal bleeding can result in significant morbidity. Scintigraphy plays an important role in detecting, localizing, and grading the bleed. Effective scintigraphic evaluation of gastrointestinal bleeding can be complicated by its intermittent nature and the patient’s hemodynamic instability. Dynamic evaluation, delayed imaging, and an understanding of the labeling process are necessary tools to help improve detection rate and localization.

Application of heat-damaged Tc-99m RBCs in a patient with suspected hepatic metastasis

We present a patient with a remote history of splenectomy and recent hemicolectomy for colon adenocarcinoma. On routine surveillance chest/abdomen/pelvis CT, a lesion suspicious for hepatic metastasis was identified. Followup MRI was inconclusive. For more specific tissue characterization, imaging with Tc-99m heat-damaged RBCs was obtained to guide further patient management. Tc-99m–labeled, heat-damaged RBC scintigraphy is an underused modality that is highly specific for detecting ectopic or accessory splenic tissue. There have been many reported cases of patients undergoing unnecessary biopsies or laparotomies to remove suspicious masses that were subsequently found to be ectopic splenic tissue.