Rachel A. Powsner

Role of single photon emission computed tomography and transcranial doppler ultrasonography in clinical vasospasm

This report presents our experience with Transcranial Doppler (TCD) ultrasonography and Single Photon Emission Computed Tomography (SPECT) in the assessment of patients with aneurysmal subarachnoid haemorrhage (SAH). It was designed to evaluate clinical vasospasm with both TCD and SPECT and determine their diagnostic value. Twenty-eight consecutive patients were examined with both TCD and SPECT, performed within 24 hours of each other. They had a total of 45 TCDs and 46 SPECT scans. Eight patients (29%) developed clinical vasospasm, noted from day 2 to day 11 post subarachnoid haemorrhage; these patients underwent TCDs and SPECT scans when the diagnosis of vasospasm was made. Twenty patients (71%) did not demonstrate clinical vasospasm throughout their hospital stay and underwent TCDs and SPECT scans within the first 2 weeks of their SAH, mostly between day 2 and day 10, the period of greatest risk for vasospasm. TCD and SPECT sensitivity for clinical vasospasm was 100% and 50% respectively, their specificity was only 20% and 60%. TCD sensitivity for symptomatic vasospasm was found to be excellent, whereas SPECT was not found to be as useful. We conclude that TCD is the preferred method in the evaluation of patients with subarachnoid haemorrhage.

Diagnosis of postoperative urinary ascites using renal scintigraphy.

Nuclear medicine biliary studies have been routinely used to identify bile leaks that occur after laparoscopic cholecystecomy. The use of a Tc-99m mercaptoacetyltriglycine (MAG3) renal scan to diagnose a case of urinary leakage that occurred after a laparoscopic-assisted colectomy is shown in this report. Laparoscopic surgery is widely used in place of conventional laparotomy to minimize recovery time and discomfort after surgery. The complication rate for laparoscopic colectomy has been reported as approximately 6% to 10%. In particular, ureteral leak has been reported in 2% of procedures. Ascites of unknown origin can become a diagnostic dilemma. We present a case of postoperative ascites of unknown origin that was successfully diagnosed as urinary leakage using renal scintigraphy.

Bone marrow suppression after Strontium-89 therapy and local radiation therapy in patients with diffuse marrow involvement

Strontium-89 is routinely used for pain control in advanced skeletal metastatic disease. A common side effect of Sr-89 therapy is a mild to moderate bone marrow suppression. To avoid complications from marrow suppression, a pretreatment platelet count of > 60,000/mm3 and a WBC count of > 2,400/mm3 are suggested. The authors present two patients who, despite satisfying these criteria, developed profound and prolonged bone marrow suppression after therapy. The severity of this response was most likely caused by pre-existing extensive bone marrow replacement with tumor. The contribution of local radiation therapy to bone marrow suppression is presumed to be minimal. The authors recommend that pretreatment criteria for determination of eligibility for Sr-89 therapy in selected patients be expanded to include steadily decreasing blood counts, and evaluation of extent of marrow involvement by biopsy or MR imaging.

Symmetrical cervical muscle uptake of Ga-67 in lyme disease

An unfortunate dermal exposure to an ixodes tick infected with the spirochete Borrelia burgdorferi causes the multifaceted Lyme disease. Patients with Lyme disease have dermatologic, arthritic, neurologic, and cardiac abnormalities. Also, symptoms secondary to musculoskeletal inflammation may be present. A case of a 28-year-old man who presented with flu-like symptoms and neck pain is presented. A Ga-67 scan revealed marked symmetric Increased posterior cervical muscular uptake in the distribution of the splenius capitis and semispinalis muscles, which is most likely due to inflammation secondary to spirochete organisms within these tissues.

Skeletal imaging in corrected pectus excavatum.

A 20-year-old male college fooball player with traumatically induced neck pain was referred for a bone scan following an abnormal plain radiogragh of third cervical vertebral spinous process. Tc-99m MDP images revealed an incidental finding of extensively increased sternal and costochondral uptake. The patient had a surgical repair of pectus excavatum 10 years earlier but no recent anterior chest pain. The increased uptake in the sternum and the distal anterior ribs is presumed to be secondary to posttraumatic ossification. Although the exact surgical procedure in this patien is unknow, a common surgical correction in this deformity includes excision of the deformed costal cartilages, disarticulation of thexiphisternal joint, and a posterior transverse osteotomy of the sternum with insertion of a wedge of bone for support