John A. Vento

Aortic Calcification Contributing to Bone Densitometry Measurement

A 75-yr-old glucocorticoid-dependent asthmatic male had a bone mineral density study to assess possible osteoporosis prior to initiating therapy. A radiograph of the lumbar spine revealed an asymmetrical compression of the second lumbar vertebra, marked scoliosis, vertebral osteopenia, and a highly calcified abdominal aorta. Bone mineral density (dual X-ray absolptiometry [DXA]) revealed low bone mass in L2-L4 and a markedly abnonrnal pattern, with a linear central density representing a calcified aorta. Posterior-anterior measurements of the midlumbar region with and without the overlying aorta indicated that the calcified vessel contributed up to 33% of the measured density. This was a far higher contribution than reported in other studies. Lateral DXA measurements of the L2 vertebra and the overlying aorta were performed to validate this finding. The density of the L2 vertebra was 0.215 g/cm(2), and that of the overlying calcified aorta was 0. 210 g/cm(2). This case suggests that aortic calcifications may contribute sign)ficantly to overall lumbar bone density and, unless recognized, can inadvertently lead to misclassification of osteoporosis.

Neuroimaging findings and brain-behavioral correlates in a former boxer with chronic traumatic brain injury

Chronic traumatic brain injury (CTBI) is associated with contact sports such as boxing. CTBI results from repetitive blows to the head rather than from a single impact. CTBI individuals present with motor symptoms (incoordination, spasticity, parkinsonism), cognitive impairment (executive dysfunction, memory deficits) and neuropsychiatric symptoms (irritability, affective disturbances). The structural and functional neuroimaging findings and clinical presentation of a CTBI case are described. We propose hypotheses about the pathophysiology of the observed neuroimaging findings and their relationship to the neuropsychiatric symptoms of the patients.

A study comparing SPECT and MRI in patients with anosmia after traumatic brain injury

Purpose: The initial or first clinical presentation of altered sensation of smell is directly linked to the degree of impaired sensitivity. We took the opportunity to examine normal and nonspecific MRI findings in 6 patients with known anosmia after traumatic brain injury with perfusion SPECT brain imaging. Material and Methods: Patients included those with primary loss of smell after head injury. All patients underwent standard testing by the Taste & Smell Center. Normal or nonspecific near normal brain MRI studies were subsequently referred for SPECT perfusion neuroimaging. Results: MRI studies were negative in 3 cases. In the remaining studies, one case showed nonspecific white matter change, another low signal in the left frontal gyrus, and the sixth case merely some cortical atrophy. All 6 cases demonstrated lesions on SPECT involving the frontal, temporal, and temporoparietal cortex. Conclusion: This study identified altered blood perfusion pattern in otherwise normal anatomic structures on MRI.

SPECT brain imaging in chronic Lyme disease.

Objectives Lyme disease is an infectious disease that frequently involves the central nervous system, leading to cognitive and/or mood dysfunction. The basis for these symptoms remains to be defined but may be the result of a vasculitis or metabolic abnormality secondary to the infection. SPECT scans of the brain might provide an objective measure of abnormalities present in patients with otherwise difficult to objectify clinical findings. The objective of this study was to determine the frequency, location, and severity of abnormalities in SPECT scans of the brain of patients with chronic Lyme disease. Methods A total of 183 individuals who met the clinical definition of chronic Lyme disease underwent SPECT scanning of the brain using 99mTc and standard nuclear imagine techniques. Abnormalities of perfusion to affected areas of the brain were defined as mild, moderate, or severe. Results Of all patients, 75% demonstrated abnormalities in perfusion to various areas of the brain, most notably the frontal, temporal, and parietal lobes. Patients considered to be seropositive and those considered seronegative had similar rates, types, and severity of perfusion defects. Abnormalities of MRI of the brain were seen in 14% of patients. Treatment with antibiotics, especially those with intracellular-penetrating activity, resulted in resolution or improvement of abnormalities in 70% of patients over a 1- to 2-year period. Conclusions Brain SPECT scans are abnormal in most patients with chronic Lyme disease, and these scans can be used to provide objective evidence in support of the clinical diagnosis. The use of certain antibiotic regimens seems to provide improvement in both clinical status and SPECT scans.

Potential role of a hybrid intraoperative probe based on OCT and positron detection for ovarian cancer detection and characterization

Ovarian cancer has the lowest survival rate of the gynecologic cancers because it is predominantly diagnosed in the late stages due to the lack of reliable symptoms and efficacious screening techniques. A novel hybrid intraoperative probe has been developed and evaluated for its potential role in detecting and characterizing ovarian tissue. The hybrid intraoperative dual-modality device consists of multiple scintillating fibers and an optical coherence tomography imaging probe for simultaneously mapping the local activities of 18F-FDG uptake and imaging of local morphological changes of the ovary. Ten patients were recruited to the study and a total of 18 normal, abnormal and malignant ovaries were evaluated ex vivo using this device. Positron count rates of 7.5/8.8-fold higher were found between malignant and abnormal/normal ovaries. OCT imaging of malignant and abnormal ovaries revealed many detailed morphologic features that could be potentially valuable for evaluating local regions with high metabolic activities and detecting early malignant changes in the ovary. These initial results have demonstrated that our novel hybrid imager has great potential for ovarian cancer detection and characterization during minimally invasive endoscopic procedures.

Presacral hematopoietic tissue : Correlation of radionuclide and MRI findings

A 68-year-old woman with evidence of vertebral compression underwent MRI that revealed a presacral mass; the area enhanced on gadolinium administration. Biopsy of the mass and the vertebra revealed blood and hematopoietic cells. Tc-99m-sulfur colloid image confirmed extramedullary hematopoiesis. The patient did not have a hemoglobinopathy, and could have an occult malignancy.

Bilateral simultaneous femoral neck fractures following minimal stress

Following jogging, a 53-year-old man experienced bilateral hip discomfort. Two weeks later, after stepping backward suddenly, he had severe pain in the right hip. Radiographs showed a displaced fracture of the right femoral head; this was pinned. Bone imaging revealed intense uptake in the other femoral head as well. This also was believed to be fractured, and therefore was repaired. During the two operations, no pathological cause of the bilateral femoral neck fractures was noted. The literature on simultaneous bilateral femoral neck fractures, without underlying bone disease, was reviewed.

Positive Tc-99m MIBI breast study related to a psoriatic lesion.

A woman was examined because of a painful left breast accompanied by excoriation and ulceration of the areola and nipple and some deformity. Because of the pagetoid changes in the nipple, a Tc-99m Miraluma (Tc-99m sestamibi) imaging study was performed. This revealed uptake in the areola and a small area near the chest wall. Biopsy of the areola revealed psoriasis. She was treated with an antipsoriatic cream, which healed the skin lesion. Two months after the initial Tc-99m Miraluma image, the results of another study were negative in both the areola and deep regions.

Persistent binding of Tc-99m pertechnetate to erythrocytes in a patient receiving multiple pharmaceuticals.

In a 50-year-old man, an attempt to visualize the thyroid using intravenous Tc-99m pertechnetate produced a blood-pool scan. The same finding was noted when the study was tried again 7 days later. The thyroid was functional, as shown by accumulation of 1-123 sodium iodide. The patient was taking a polypharmacy of medications, which may have facilitated binding of Tc-99m pertechnetate to erythrocytes.

Graves' disease initial presentation with exophthalmos and solitary hot nodule

A 52-year-old man presented with left exophthalmos. A thyroid scan showed a right lobe hot nodule with suppression of the remainder of the gland. Thyroid function tests were normal. In less than two years, the patient had worsening of the exophthalmos. Thyroid indices then revealed hyperthyroidism and the thyroid image had markedly altered (with evidence of diffuse function). This change, initially showing a hot nodule and then diffuse thyroid overactivity, has been reported previously in three cases (all women). Characteristics of the disorder in these four individuals were reviewed. It is possible that the patients had two distinct diseases, separated temporally.