Primo P. Milan

F-18 FDG PET demonstrates crossed cerebellar diaschisis 20 years after stroke.

Stroke produces an area of focal damage and distant areas of reduced blood blow and metabolism termed diaschisis. Tc-99m ECD and HMPAO brain SPECT have demonstrated crossed cerebellar diaschisis (CCD) in patients with cerebral cortical infarct. SPECT findings reflect abnormal cerebral blood flow. CCD as shown on F-18 FDG PET reflects abnormal reflects glucose metabolism. We present the case of a patient with laryngeal cancer who also had a stroke in the left cerebral hemisphere involving the territory of the middle cerebral artery 20 years ago. This patient underwent PET, including the head and neck. A current brain F-18 FDG PET exhibited hypometabolism in the contralateral cerebellum (CCD) as well as hypometabolism of the primary insult in the left cerebral hemisphere. These findings reflect partial impairment or diminished glucose metabolism in the primary insult to the cerebrum and contralateral cerebellum. In addition, this patient illustrates that on PET imaging, CCD could be demonstrated 20 years after a stroke.

Duodenogastric reflux shown on raw data images on dual-isotope gated cardiac Tc-99m tetrofosmin SPECT in a patient with esophagectomy for Barrett esophagus

Extracardiac activity in the thorax can be malignant or benign on dual-isotope raw data images. The authors present a postesophagectomy patient for Barrett esophagus that resulted in duodenogastroesophageal reflux exhibited on raw data images of dual-isotope cardiac SPECT with Tl-201 and Tc-99m tetrofosmin. The incidental extracardiac activity in the thorax should be included in comprehensive cardiac SPECT interpretation.

Intrathoracic gastric activity on cholescintigraphy results in a large hiatus hernia with duodenogastric reflux.

Abstract: When a radiopharmaceutial is seen in the intrathoracic cavity on Tc-99m iminodiacetic acid (IDA) cholescintigraphy, basically 2 abnormalities are seen: first the stomach, such as a hiatus hernia, which is abnormally located in the thoracic cavity, and duodenogastric reflux (bile) which is simultaneously seen. However, intrathoracic gastric activity seen on Tc-99m IDA hepatobiliary scintigraphy is rarely documented in a patient with hiatus hernia. This report is of an 83-year-old man with a large hiatus hernia with duodenogastric reflux who underwent hepatobiliary scintigraphy; the scans show an area of increased activity on the top of the liver due to duodenogastric reflux in a large hiatus hernia. This was confirmed by surgery: the patient successfully underwent laparoscopic paraesophageal hernia repair with Nessen fundoplication and laparoscopic cholecystectomy.

Hashimoto thyroiditis and Takayasu aortitis: visualization of the thyroid gland and ring appearance of the mediastinum on F-18-FDG PET.

A woman with Hashimoto thyroiditis, treated with levothyroxine for 4 years, complained of chest pain that radiated to the neck and had progressively worsened for 2 months. CT of the chest showed circumferential thickening of the ascending aorta and aortic arch, compatible with Takayasu arteritis. She underwent F-18 FDG PET imaging, which revealed an abnormal thyroid gland and a ring-like appearance of the mediastinum.

Duodenogastric reflux in a hiatal hernia seen as retrocardiac activity on 99mTc-tetrofosmin cardiac SPECT raw-data images.

We present a patient with a large hiatal hernia resulting in duodenogastric reflux that was seen as abnormal activity below and behind the heart (retrocardiac) on SPECT images and on 99mTc-tetrofosmin cardiac SPECT raw-data projection images. Incidental findings such as extra- and retrocardiac activity in the thorax and abdomen should be included on all comprehensive cardiac SPECT reports.

Intense and Diffuse Liver Uptake and Mild (Subtle) Multiple Skeletal Metastases on Bone Scintigraphy in a Patient with End-stage of Multiple Myeloma: Correlation with CT and MRI Findings

Diffuse hepatic uptake of bone-imaging agent can be due to a variety of causes including radiopharmaceutical fault of elevation of serum albumin level and hypoxemia secondary to respiratory failure. We present the case of a patient with end-stage of multiple myeloma whose (superscript 99m)Tc-HMDP bone images at 2- and 21-h showed diffusely and intensely increased activity in the liver in addition to subtle skeletal metastases. Concurrent CT, MRI, and subsequent bone radiography survey demonstrated multiple osteolytic lesions in the vertebrae, ribs, scapulae, and pelvic bones without abnormality of the liver.

A Large and Distinct Gallbladder Fossa in a 60-miunte Image of Hepatobiliary Scintigraphy: Correlation with CT, ERCP, and Autopsy Findings

An image at 60 min of hepatobiliary scintigraphy in a patient with severe jaundice and post endoscopic retrograde cholangiopancreatogray (ERCP) illustrated prominent activity in the liver with a large and distinctive defect in the gallbladder fossa, no activity in the gallbladder, biliary duct and bowel. In addition, blood pool activity in the enlarged heart and renal activity of both kidneys and sign of ascites were also seen. These findings correlated with CT and ERCP radiographic findings showing common bile duct stones, gallbladder stones, and ascites. Dysfunction of the liver and heart failure also contributed to these findings. At autopsy, ascites, gallstones, evidence of cirrhosis of the liver secondary to hepatitis C infection, and cardiomegaly with severe coronary artery disease and myocardial infarction were confirmed.

Indium-111-White Blood Cells and Magnetic Resonance Imagings Congruent Positive for Pedal Osteomyelitis

A patient with pain and swelling of the right foot underwent plain radiography, magnetic resonance imaging (MRI), and (superscript 111)In-WBC imaging diagnostic imaging studies. Of these diagnostic modalities, (superscript 111)In-WBC provided definite positive lesion of osteomyelitis, but did not offer the exact location; MRI gave early and precise location of the lesion in the right 5(superscript th) metatarsal. The patient received surgical resection of the 5(superscript th) metatarsal with debridement of the metatarso-phalangeal joint that was confirmed to be osteomyelitis and soft tissue acute inflammation. Although plain radiography of the right foot did not inform early diagnosis, plain radiographies were valuable for pre- and post-surgical evaluations of osteomyelitis.