Makoto Morijiri

A case of retroperitoneal extramedullary plasmacytoma with multiple metastases

We investigated a patient with extramedullary plasmacytoma in the retroperitoneal space with multiple metastases using abdominal CT scan and 67Ga scintigraphy. Abdominal enhanced CT revealed the retroperitoneal tumor mimicking lymphoma. 67Ga scintigraphy showed multiple tumor localization. We could detect retroperitoneal extramedullary plasmacytoma with multiple metastases using 67Ga scintigraphy. This retroperitoneal tumor may appear similar to lymphoma on CT.

Brain SPECT of Creutzfeldt-Jakob disease

SPECT imaging with I-123 IMP or Tc-99m HMPAO was performed in two patients with Creutzfeldt-Jakob disease to evaluate abnormalities in brain perfusion. In the first patient, there was decreased perfusion of the left frontal, parietal, and temporal lobes. CT and MRI were negative. In the second patient, there was patchy perfusion and slightly decreased perfusion of the right hemisphere. MRI revealed slight brain atrophy and bilateral high intensity areas in the basal ganglia on T2 weighted images. Subsequent SPECT imaging revealed severely decreased perfusion of the entire brain. Subsequent MRI demonstrated severe brain atrophy.

Contralateral cerebellar activation in frontal lobe epilepsy detected by ictal Tc-99m HMPAO brain SPECT.

A 65-year-old woman with Alzheimer dementia type with status epilepticus had an electroencephalogram, which showed an epileptic focus in the right frontal area. MRI showed no pathologic findings except for mild brain atrophy. Tc-99m HMPAO brain SPECT imaging during the ictal phase showed a marked increase of regional cerebral blood flow in the right dorsolateral frontal lobe, and ipsilateral basal ganglia and thalamus, in which regional cerebral blood flow was increased by 23-83% as compared with the left side. Interestingly, contralateral cerebellar activation was observed, where regional cerebral blood flow was increased by 23% as compared with the right side.

Qualitative evaluation of chronic diffuse liver disease by STIR MRI.

Objective The purpose of our study was to characterize the relationship between signal intensity on STIR MRI, histology, and liver function. Materials and Methods MRI was performed in 39 patients with chronic liver diseases [chronic persistent hepatitis (CPH), chronic active hepatitis (CAH), liver cirrhosis (LC)] and 11 patients without liver dysfunction (normal). Results On STIR images, very low signal intensities compared with those of the spleen were seen in all 11 normal livers (100%), and brighter intensities were seen in chronic diffuse liver diseases (10 patients with CPH, 11 patients with CAH, and 18 patients with LC) (100%). The higher the signal grade on STIR images (moderate, marked), the more advanced was the chronic diffuse liver disease (p < 0.02). The levels of serum glutamic–oxaloacetic and glutamic-pyruvic transaminase increased in parallel with increasing signal intensity on STIR images (both p < 0.01). Conclusion We found that the signal intensity of liver on STIR images appeared to be associated with the degree of histologic and/or clinical severity in patients with chronic liver disease.

Brain SPECT in Wilson's disease

Brain SPECT in a patient with Wilsons disease revealed deceased perfusion in the areas of the basal ganglia and cerebellum. CT showed no abnormalities. Brain SPECT with Tc-99m HMPAO showed perfusion abnormalities.

The value of combined99mTc-Sn-colloid and99mTc-RBC scintigraphy in the evaluation of a wandering spleen

Wandering spleen is the term commonly applied to splenic hypermobility that results from laxity or maldevelopment of its suspensory ligaments. It comes to medical attention usually as an abdominal mass, or when the spleen undergoes torsion. Diagnosis on clinical grounds alone is rarely made, and ultrasonography, CT and MRI findings have no specific characteristics for this condition.99mTc-labeled colloid taken up by the spleen may provide a specific diagnosis. We report a case of wandering spleen, in which the preoperative diagnosis was made on the basis of sequential liverspleen scintigraphy with99mTc-Sn-colloid and blood-pool scintigraphy with99mTc-RBC. This is a rare case, in which hypermobility was assessed by sequential99mTc-Sn-colloid scintigraphy, and to our knowledge, is the first case in which99mTc-RBC scintigraphy provided useful information on splenic blood volume and its location.