Howard J. Dworkin

Indium-111 OncoScint CR/OV and F-18 FDG in colorectal and ovarian carcinoma recurrences. Early observations.

lndlum-111 satumomab pendetide (ln-111 OncoScint) planar and SPECT imaging and F-18 FDG positron emission tomography (PET) have been found individually to be helpful in the detection of recurrent colorectal and ovarian cancer, but have not been compared. Twelve patients who were examined for recurrent colorectal or ovarian carcinoma underwent both ln-111 OncoScint imaging and F-18 FDG PET imaging. All had normal or equivocal results of CT or MR studies. Tumor detection abilities were similar in most cases. However, Oncoscint demonstrated an advantage in the detection of carcinomatosls. PET demonstrated an advantage in detecting focal tumor recurrence in one case and, not unexpectedly, In detecting liver metastases. All positive nuclear studies for tumor were found to be true-positives at pathology (7 patients), or by diagnostic new CT changes (1 patient). Finally, unreported, bone marrow, bowel, and colostomy sites appear to be normal sites of localization of F-18 FDG 1 hour after injection.

F-18 FDG positron emission tomographic image of an aortic aneurysmal thrombus.

A 70-year-old woman with a history of breast cancer was referred for an F-18 fluorodeoxyglucose (FDG)-positron emission tomographic (PET) scan to evaluate a 1.1-cm single pulmonary nodule detected on a computed tomographic (CT) scan to determine whether it was benign or malignant. An incidental finding on the PET scan was an aneurysm of the descending thoracic aorta. In addition, a well-defined crescent-shaped area of absent F-18 FDG uptake was apparent in the posterior mediastinum within the expected location of the lumen of the descending thoracic aorta and along its wall. A CT scan of the chest revealed an intraluminal thrombus in the aneurysm of the descending thoracic aorta corresponding in location to the photopenic area on the F-18 FDG-PET scan. The metabolically inert area on the F-18 FDG-PET scan was thought to represent a thrombus within the aortic aneurysm.

High predictive value of F-18 FDG PET patterns of the spine for metastases or benign lesions with good agreement between readers.

Two nuclear medicine physicians retrospectively evaluated fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) spine abnormalities in patients with cancer with the purpose of identifying straightforward criteria for benign versus malignant spine abnormalities. Four hundred seventy-five consecutive patients with colon, breast, and lung cancer were evaluated with FDG. Thirty-two patients (32) had spine abnormalities, 30 of 32 patients had adequate follow up for a final diagnosis, and 29 of 30 patients’ studies were available to both PET readers for this retrospective review. The readers categorized the FDG PET abnormalities as benign, metastatic, or equivocal using a straightforward set of criteria. A final diagnosis was made using magnetic resonance imaging (MRI), computed tomography (CT), plain films, bone scans, previous studies, and clinical follow up. A single spinal focus of increased FDG activity had a relatively high probability of being a spinal metastasis (71%); and the more foci, the higher the probability. Segmental decreased activity of the spine after radiation therapy indicated benignity. The only discrepancies were with 3 abnormalities, each called metastasis by 1 reader and equivocal by the other, with a final diagnosis of metastasis in each case. Equivocal patterns required CT or MR correlation, because these could be either malignant or benign. However, abnormal patterns fulfilling either the benign or metastatic criteria described here resulted in the correct diagnoses of benign spinal changes or spinal metastases, respectively, in 100% of cases with low interobserver variation. No study was interpreted as benign by 1 reader and metastasis by the other. The 2 nuclear medicine readers agreed in their interpretations in 90% of cases.

Abnormal left ventricular myocardial dynamics in eleven patients with chronic fatigue syndrome.

Eleven patients diagnosed with chronic fatigue syndrome were found to have abnormal left ventricular myocardial dynamics as indicated on MUGA studies. Among the abnormalities noted were abnormal wall motion at rest and stress, dilatation of the left ventricle, and segmental wall motion abnormalities.

Reaction after Administration of Macroaggregated Albumin for a Lung Scan

THE simplicity, speed and apparent lack of toxicity have caused the rapid acceptance of the radionuclide perfusion lung scan as an indicator of relative pulmonary blood flow. Although the possibili...

Is the upright position more sensitive than the supine position in Breast cancer sentinel node Lymphoscintigraphy

Purpose The authors compared the supine and standing positions for lymphoscintigraphy in breast cancer patients to identify any changes in the number of affected lymph nodes detected and the quality of images. Methods Twenty-three patients were examined using lymphoscintigraphy in both positions. Sequential supine, standing, and supine oblique images were acquired in each patient. Results The number of lymph nodes detected or the quality of the images acquired was improved in 20 of the 23 patients in the standing position compared with the supine position. The remaining three patients’ images were judged to be equal in lymph node number and image quality in both positions. Conclusions Lymphoscintigraphy in patients with breast cancer appears to be more sensitive in the standing than in the supine position.

F-18 FDG uptake by recurrent Hürthle cell carcinoma of the thyroid using high-energy planar scintigraphy.

F-18-2-deoxy-2-fluoro-D-glucose (FDG) has been reported to localize in various tumors. Localization or recurrent Hürthle cell cancer with FDG is described. An unsuccessful attempt was made to image this patients tumor with I-131 and Tc-99m MIBI. Because of the patients size, he could not be accommodated in the PET camera apperature. Use of a planar high energy gamma camera facilitated detection and ultimate treatment.

The effect of drug therapy on the uptake of radioactive fluorine by osseous metastases.

RadioisotopiC techniques are potentially of considerable value to clinical pharmacology. Scintigrams and uptake studies are of particular interest, as they permit one to visualize lesions in many organs and to obtain simultaneously quantitative information on the degree of abnormality in the area of the lesion. Bone metastases take up increased amounts of fluorine‐18; the present study was an investigation of the effect of therapy on this abnormal uptake. In eight patients with metastatic lesions to bone, chemotherapy or hormonal therapy produced temporary improvement in five, as ;udged by roentgenographic or clinical criteria, during the first four months after initiation of therapy. Serial scintigrams and quantitative uptake studies throughout this period showed that the abnormal ratio in fluorine uptake remained unchanged, despite the other evidence of emporary regression of metastases. Although the duration of time chosen for this study was consistent with that commonly used by physicians for evaluation of the effect of a given type of chemotherapy, our results suggest that such short‐term studies must be interpreted cautiously.

Adductor Insertion Avulsion Syndrome

A 51-year-old woman with a history of chronic thigh muscular exertion was examined for pain on the medial aspect of the thighs. A bone scan showed symmetric focal radiotracer uptake at the medial cortex of both proximal femoral shafts. SPECT localized the focal activity to the cortical surface of the femoral shafts. Findings of magnetic resonance imaging (MRI) were unremarkable and hot spots on the bone scan were localized to the anterior end of both adductor brevis muscle insertions. Plain radiographs of the femurs, which showed bilateral periosteal reactions along the medial proximal femoral shafts, further confirmed the diagnosis of thigh splints at the insertion of the adductor brevis.

Krukenberg tumor and lung metastases from colon carcinoma diagnosed with F-18 FDG PET

The authors report a case of a patient with postsurgical colorectal carcinoma and metastatic disease to the ovaries (Krukenberg tumor), the lung, and the liver first revealed by F-18 FDG PET imaging. The value of PET in a patient with an unexplained rising CEA is cited.