Norimasa Yamada

The role of Gallium-67 imaging in the detection of foci in recent cases of fever of unknown origin

We have assembled data from patients with fever of unknown origin who underwent gallium scintigraphy during the past 5 years in order to obtain a more current sampling of patients, and evaluated the role of gallium scintigraphy retrospectively. Of the 36 patients studied, gallium scintigraphy was positive and contributed to the detection of the foci or fever origins in 17 (47.2%). The ratio of neoplastic diseases with myeloproliferative and with lymphoproliferative disorders was relatively high compared with previous reports. However, gallium scintigraphy did not contribute to the diagnosis of collagen disease. With the ability to detect both inflammatory and neoplastic lesions, gallium scintigraphy was useful in detecting the foci of fevers of unknown origin.

Scintigraphic analysis of hemodynamics in a patient with a single large pulmonary arteriovenous fistula.

A pulmonary perfusion study was performed on a 54- year-old man with a single large pulmonary arteriovenous fistula (aneurysmal type) using Tc-99m MAA. On the static imaging, a defect corresponding to the location of the mass and right-to-left shunt was clearly documented. Decreased uptake of Tc-99m MAA in the lung field surrounding the lesion was observed and was thought to reflect a “steal” of blood flow by the fistula. One advantage of using radionuclide angiography with Tc-99m MAA rather than with Tc-99m pertechnetate was that it more easily provided a time-activity curve that added useful quantitative information about the altered pulmonary hemodynamics.

Demonstration of inguinal hernia by means of peritoneal99mTc-MAA scintigraphy with a load produced by standing in a patient treated by continuous ambulatory peritoneal dialysis

A 45-year-old man receiving continuous ambulatory peritoneal dialysis developed scrotal swelling and edema which was aggravated in the standing position. Physical examination failed to find inguinal hernia and although ultrasonography revealed the patent had processus vaginalias, it failed to prove its continuity to the peritesticular space of the tunica vaginalis. Peritoneal scintigraphy with intraperitoneal instillation of99mTc-Macroaggregated albumin followed by standing clearly demonstrated the connection. The use of the standing load makes possible faster visualization of a positive finding and more accurate diagnosis than examination in the supine position.

Bone and gallium scintigraphy in sacral chordoma. Report of four cases.

Bone scintigraphy with Tc-99m HMDP and gallium scintigraphy were evaluated in four patients with a primary sacrococcygeal chordoma. All lesions showed a photon-deficient or cold lesion corresponding to the tumor on bone scintigraphy, with no abnormal accumulation clearly observed on gallium scintigraphy. These findings led the authors to conclude that a midline sacrococcygeal tumor showing reduced uptake or a cold lesion on bone scintigraphy and no increased accumulation on gallium scintigraphy could be a chordoma rather than the malignant neoplasm suspected in this region.