Martin A. Winston

The Scintillation Camera in the Dynamic Evaluation of Renal Disorders

Abstract Scintillation camera techniques with multiple radioisotopic compounds have greatly increased diagnostic accuracy in the dynamic evaluation of renal disorders. 99mTc pertechnetate and Hippuran have proved to be excellent agents for the evaluation of renal vascular perfusion and the study of renal function and morphology. The combined use of these two agents is practical and reliable and represents no hazard to the patient. 203Hg or 197Hg chlormerodrin and 99mTc-iron-complex also play a part in the radioisotopic evaluation of renal disease.

Variation in the appearance of the lateral liver scan with patient position.

Using a scintillation camera, lateral views of the liver may be obtained with the patient in positions other than the left lateral decubitus required for rectilinear imaging. The use of the supine position induces an artifactual change in the lateral image which could easily be mistaken for a space-occupying mass. Probable mechanisms are discussed.

Rapid diagnosis of pericardial effusion utilizing the scintillation camera

Abstract A new method for the rapid diagnosis of pericardial effusion employing the gamma ray scintillation camera and an intravenous bolus injection of technetium sulfide 88 Tc is presented. Since a chest roentgenogram is not required and scanning times are significantly reduced, this method appears to be superior to previously reported radioisotopic techniques.

PREOPERATIVE LOCALIZATION OF PARATHYROID ADENOMAS BY TECHNETIUM-THALLIUM AND ULTRASOUND IMAGING

38 patients with biochemical evidence of primary hyperparathyroidism were studied. A 50K count image of the neck was computer acquired with a gamma camera and pinhole collimator 30 minutes after IV injection of 1 mCi of Tc-99m pertechnetate. Without patient movement, 1–2 mCi of T1–201 chloride was injected IV, and sequential 30 second images were acquired for 25 minutes. The thallium images were summed and computer subtraction of the normalized pertechnetate image was performed to identify areas of discordant radionuclide uptake. Ultrasound examination was performed using a B-mode static scanner with a 5 MHz transducer. 12 patients have had surgery to date, each of whom had a single parathyroid adenoma. Nuclear imaging successfully localized 5/12 adenomas, including 4/5 inferior or upper mediastinal adenomas and 1/7 superior adenomas. There was 1 false positive. Ultrasound identified 4/12 adenomas, each of which was located posterior to the thyroid gland, including 2/5 inferior or mediastinal adenomas and 2/7 superior adenomas. There were 3 false positives by ultrasound. The combination of techniques successfully localized 7/12 adenomas, including 5/5 inferior or upper mediastinal adenomas and 2/7 superior adenomas. Nuclear imaging appears most sensitive for parathyroid adenomas located inferiorly or in the upper mediastinum, while ultrasound is useful for identifying adenomas located posterior to the thyroid gland.