James H. Christie

Radionuclide bone scan, radiographic bone survey, and alkaline phosphatase: studies of limited value in asymptomatic patients with ovarian carcinoma.

Bone scans or skeletal surveys were obtained in 104 patients with ovarian carcinoma. No metastases were identified at staging in the 43 patients with Stage I or II disease. Four patients in the entire series had osseous metastases. Three of the 40 patients with Stage III epithelial ovarian carcinoma had osseous metastases at the time of staging. All of these were Grade III lesions. One Stage I, Grade III patient demonstrated osseous metastases two years after initial diagnosis. None of the four patients with osseous metastases had an elevated alkaline phosphatase; three of the four had bone pain. Based on these results, it is suggested that radiographic bone survey and radionuclide bone scans are not indicated as screening procedures in asymptomatic patients with ovarian carcinoma.

Tc-99m PYP scanning following low voltage electrical injury.

An adolescent boy sustained low voltage electrical injury to his extremities when he inadvertently touched a low tension (440 volts) wire with a metal tube. Early in his hospital course, he was evaluated with Tc–99m pyrophosphate whole body scanning for the extent of his injuries. The scintigraphic findings correlated well with his subsequent clinical course.

Intrathoracic kidney on radionuclide renography. A case report.

A child with an asymptomatic mass in the lower right thorax was evaluated with sonography, intravenous urography, and radionuclide renography. High renal ectopia was only diagnosed with radionuclide renography.

Sulfur colloid distribution in normal hips.

The normal distribution of Tc-99m sulfur colloid is described in 100 patients with no clinical or radiographic evidence of hip disorders. Two-thirds of the patients had uptake in the femoral neck and some uptake in the femoral head. In the other one-third, no uptake was detected in either femoral head. A high degree of symmetry was noted. Judging both the symmetry and pattern of uptake in both hips is important in evaluating femoral head vasculature after a fracture.

Diagnostic imaging of choledochal cysts.

A review of the literature concerning the diagnostic accuracy of various imaging modalities for choledochal cysts indicates that both ultrasound and scintigraphic methods have approximately 80% accuracy. Oral cholecystography and intravenous cholangiography methods have between 60 and 80% accuracy. Ultrasound is recommended as the initial preoperative test of choice, with hepatobiliary scintigraphy or CT scanning being most useful for postoperative evaluation.

Sensitivity of radionuclide brain imaging and computerized transaxial tomography in detecting subdural hematoma

In a series of 23 patients with surgically proven subdural hematoma of durations ranging between two days to seven months, the detection rate of Tc-99m-pertechnetate brain imaging was higher than computerized transaxial tomography (CT). With dynamic perfusion scanning, the detection rate was 71.5%. However, when combined with sequential static images obtained at 10 minutes, 2 hours and 3-4 hours, the detection rate rose to 92% regardless of the duration of the disease. In contrast, CT demonstrated the hematoma in 52% of the cases. In another 28% the diagnosis was suggested through nonconclusive evidence or presence of contralateral shift of midline structures. Lastly, the result of CT scanning was dependent on the size of the subdural hematoma as evaluated at the time of operation.

The Scintigraphic Pattern of Acute Renal Vein Thrombosis

The radiographic pattern of acute renal vein thrombosis is well known; however, the scintigraphic appearance has not been described. A scintigraphic pattern of delayed blood flow to a relatively large kidney and delayed blood flow to a relatively large kidney and delayed accumulation of l-131-Hippuran should be considered suggestive of acute renal vein thrombosis in the appropriate clinical setting.

Focal lung uptake of Tc-99m-sulfur colloid.

Minimal pulmonary uptake of sulfur colloid can be accentuated by atelectasis or compression of pulmonary parenchyma, causing a focal “hot spot.” This disappears with resolution of the atelectasis.

Ascites causing a false-positive radionuclide liver image

False-positive radionuclide liver images can occur due to impingement on the liver by adjacent normal anatomic structures or adjacent pathologic masses or fluid collections. A patient with ascites in the anterior subphrenic space had an apparent “cold” lesion in the left lobe of the liver. Ultrasonography demonstrated a normal left lobe and localized the fluid collection.