Joel M. Rosen

A brain imaging (single photon emission computerized tomography) study of semantic and affective processing in psychopaths

Psychopaths have been described as human predators who use charm, intimidation, and violence to control others and to satisfy their own needs. Underlying their propensity to violate social norms and expectations is a profound lack of empathy, guilt, or remorse, affective processes that have long resisted scientific investigation. Using brain imaging technology we found that psychopaths differed from nonpsychopaths in the pattern of relative cerebral blood flow during processing of emotional words. The results were consistent with the hypothesis that there are anomalies in the way psychopaths process semantic and affective information.

Gallbladder Uptake Simulating Hydronephrosis on Tc-99m MAG3 Scintigraphy

Tc-99m mercaptoacetyltriglycine (MAG3) is a valuable agent for renal scintigraphy in patients with diminished renal function. However, hepatobiliary excretion of this agent can cause misleading images and represents a potential pitfall in the interpretation of renal scans. Delayed posterior images from a Tc-99m MAG3 scan of a 79-year-old man with poor renal function demonstrated an apparent prominent accumulation of activity in the renal pelvis simulating a hydronephrotic obstructed kidney. Anterior, oblique, and lateral images clearly demonstrated that this activity was in the gallbladder. The possibility of significant hepatobiliary excretion should be considered when interpreting scans performed with Tc-99m MAG3.

Hepatobiliary scintigraphy in spontaneous perforation of the common bile duct.

A 7-week-old infant had jaundice and ascites. Sonographic evaluation confirmed the presence of ascites, but was otherwise unremarkable. Hepatobiliary scintigraphy revealed a collection of radiotracer at the inferior margin of the liver on initial images, followed by diffuse Intraperitoneal activity on subsequent images, indicating biliary perforation. Surgical exploration confirmed a diagnosis of spontaneous perforation of the common bile duct

Hepatobiliary scintigraphy in the evaluation of preeclampsia and HELLP syndrome.

Hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) may develop in patients with preeclampsia. These patients often have right upper quadrant pain, and they may suffer from hepatic, intraparenchymal, or subcapsular hematomas, or hepatic necrosis. During her 37th week of pregnancy, one woman in whom this syndrome developed had right upper quadrant pain and was evaluated after delivery with hepatobiliary scintigraphy. This may be the first report of hepatobiliary scintigraphy in the evaluation of patients with this syndrome. The scan excluded acute cholecystitis as the cause of the patients symptoms and demonstrated focal defects consistent with hepatic hematomas, necrosis, or both

A comparison of indium-111 leukocyte and gallium-67 scintigraphy in a patient with a myocardial abscess.

A myocardial abscess, which developed in a 59-year-old man 3 years following aortic valve replacement, was detected by In-111 leukocyte scintigraphy but not by Ga-67 scintigraphy. Although both In-111 leukocyte scintigraphy and Ga-67 scintigraphy have been reported to detect myocardial abscesses, a comparison of the two studies in the same patient has not been reported previously. In this patient, only the scan performed with In-111 leukocytes demonstrated significant localization of radiotracer in the abscess

Bone scintigraphy in oxalosis

Several physiologic and pathologic conditions demonstrating extraosseous localization of bone scanning agents have been described, including metastatic calcification of the soft tissues secondary to metabolic disorders, malignancies, and chronic renal failure. However, extraosseous uptake in primary oxalosis has not been documented, although scintigraphic uptake pattern in a patient with primary oxalosis has been described. Oxalosis (Hyperoxaluria) is an autosomal recessive genetic disorder of glyoxylate metabolism. Type 1 (glycolic aciduria) is caused by the deficiency of 2-oxoglutarate; glyoxylate carboligase results in excessive urinary excretion of oxalic, glycolic, and glyoxylic acids

Scintigraphic detection of the loss of one kidney following en bloc transplantation of paired pediatric kidneys

Vascular occlusion of one of the transplanted kidneys represents a potential complication following en bloc transplantation of two pediatric kidneys into adults. Serial renal scans with Tc-99m DTPA, performed on a 26-year-old woman who underwent en bloc transplantation, revealed good perfusion and function of both kidneys in the early postoperative period but acute loss of perfusion and function in one kidney on the ninth postoperative day. Surgical exploration and open biopsy excluded rejection and twisting of the vascular pedicle as possible causes for the acute loss of perfusion and function in this kidney

Resolution of a photopenic lesion on bone imaging following chemotherapy for metastatic disease.

Resolution of abnormal foci of increased radiotracer deposition on bone imaging occurs commonly. Photopenic areas due to avascular necrosis and infarcts have been reported to resolve. This report describes serial changes in a photopenic lesion due to metastatic disease and demonstrates that such lesions can resolve following chemotherapy.