Rolf L. Schapiro

The Normal Range and Position of the Pineal Gland on Computed Tomography

Precise measurements with the Vanguard Motion Analyzer were made to determine the position of the pineal gland as shown on the Polaroid displays of 145 normal scans. The relatively midline positions of the gland are expressed in terms of percentage shift of the gland in these 145 normal cases is defined by a mean value of 0.8% with a standard deviation of 0.6%. More than 99% of normal CT scans can be expected to show a percentage shift of 2.6% or less.

Nuclide imaging and computed tomography in cerebral vascular disease

This report presents our experience with computed tomographic and radionuclide scans in 224 patients with ischemic or hemorrhagic infarcts or intracerebral hematomas secondary to cerebral occlusive vascular diseases. The results vary according to the site of vascular occlusion. The radionuclide angiograms and static scintigrams show four distinct patterns in cases of occlusion of the middle cerebral artery. Computed tomographic scans exhibit less variation in appearance and have a higher sensitivity in cases of recent ischemic infarction. The tentorial confluence sign is an important finding on static scintigrams in patients with occipital infarction; if this sign is not present, this diagnosis should be suspect. Earlier reports have established the value of computed tomography and radionuclide scans in the evaluation of cerebral infarction. In individual cases, however, each of these modalities may render nondiagnostic or false negative findings; combining both both types of examinations and comparing results yield a greater likelihood of an accurate diagnosis of cerebrovascular disease. Computed tomography is clearly more valuable than radionuclide scans in the diagnosis and follow-up of hemorrhagic infarcts or parenchymal hematomas.

Scintigraphic Findings in Hyperostosis Frontalis Interna

Transient diminution of activity was seen on early radionuclide images of the brain in 5 patients with hyperostosis frontalis interna and filled in on subsequent studies. Radiographs confirmed the diagnosis. In 3 patients the changes corresponded extremely well with both modalities. This entity should be considered when diminished activity is seen in the frontal area.

Sequential Brain Scanning as an Adjunctive Scanning Procedure

Sequential brain scans were performed at various time intervals of up to four hours after injection of 99mTc pertechnetate in 108 patients who had previously undergone routine one-hour brain scans which were considered normal or equivocal. Forty-six patients were proved to have a discrete morphologic brain lesion. Pathologic processes were demonstrated by the sequential scanning technique in all but 6 cases. In nearly a third of these 46 patients (28%), careful observation of the progressive and subtle changes in radioactivity in the whole sequential scan series was necessary for detection of the lesions: they could not be appreciated on any single static scan when viewed independently.

Brain image manifestation in the patient with cavernous sinus occlusion

Radionuclide findings in a case of cavernous sinus occlusion by an intracavernous aneurysm are described. A brain image obtained 10 minutes after injection of 99Tc pertechnetate shows diminished activity in the area of the right cavernous sinus and increased activity in the area of the right sylvian veins; these are attributed to abnormal venous blood flow and may serve as a sign of cavernous sinus occlusion.

The Manifestations of Diaphragmatic and Juxtadiaphragmatic Diseases in the Liver-Spleen Scintigraph

Diaphragmatic and juxtadiaphragmatic abnormalities can be recognized on liver-spleen scintigraphs by alteration of the normal disparity in height between the liver and the spleen and by flattening of the superior margins of the liver and spleen. A unilateral abnormality is manifested by exaggeration or reversal of the normal disparity in height between the superior margins of the liver and spleen by cephalad or caudad displacement of one of these organs. Bilateral peridiaphragmatic abnormalities are manifested by flattening of the superior margins of the liver and spleen by caudad displacement of both organs.

The Scintigraphic Features of the Occipital Sinus

The occipital sinus could be identified in 190 (76%) of 250 brain scans. A midline single sinus was observed in 163 cases (86%), a double sinus in 17 (9%), and a laterally deviated sinus in 10 (6%). The relative width of the sinus as well as its course and intensity of activity are discussed. Correct diagnosis of posterior fossa lesions requires appreciation of the variability of appearance of the. occipital sinus on brain scans. The value of posterior stereoscanning is emphasized.