Sara Gips

Spectrum of scintigraphic appearance of liver hemangiomas.

Two hundred and twenty five liver hemangiomas in 166 patients were studied with Tc-99m labeled RBC and are the basis for this atlas. All hemangiomas showed various presentations of the perfusion blood pool mismatch, which is the basis for diagnosis. The size of the hemangiomas was the factor that determined the mixing of the Tc-99m RBC with the blood and, hence, the sequence of visualization of the lesion. Hemangiomas may appear as multiple lesions on liver scan and imitate metastases. Ninety-five hemangiomas appeared in 36 patients as multiple local abnormalities. Hemangiomas are extremely variable in size. They may be huge (31 hemangiomas) and sometimes occupy most of the abdomen. Or they can be very small and are then detected only by SPECT (two cases). Thrombosed large hemangiomas appear as focal defects on Tc-99m RBC.

Observer variation in the interpretation of bone scintigraphy

To assess the reliability of bone scintigraphy, a random sample of 100 bone scans was reviewed twice by each of two physicians. Observer variation in the description and interpretation of bone scintigrams varied by diagnosis. Good to excellent k values were obtained for inter- and intraobserver variation in relation to metastasis or normal scans. For degenerative bone disease, as well as the specific agreement on major pathologies other than metastases, k values were found to be moderate. The agreement on the need for further radiographic studies was poor to moderate. The interpretation of bone metastases or normal scintigrams was found to be more reliable in a research setting than in the usual clinical framework, and the latter requires improvement. The interpretation of bone scintigraphy as consistent with degenerative changes is not reliable. The diagnosis should be evaluated by radiography.

Myocardial perfusion abnormalities early (12-24 h) after coronary stenting or balloon angioplasty: implications regarding pathophysiology and late clinical outcome.

Objective: We prospectively examined the prevalence of reversible perfusion defects on very early (12–24 h) thallium-201 single photon emission computed tomography (SPECT) scintigraphy after angiographically successful percutaneous coronary intervention (PCI) by stenting and/or stand-alone balloon angioplasty and the predictive value of these defects for late target lesion revascularization (TLR). Patients and Methods: 83 consecutive patients undergoing PCI for 88 lesions (38 balloon angioplasties, 50 stents) underwent very early (12–24 h) SPECT thallium-201 scintigraphy at rest and following administration of 0.7 mg/kg intravenous dipyridamole after PCI. Univariate and multivariate clinical, procedural and scintigraphic correlates of target lesion revascularization during long-term follow-up were examined. Results: Coronary stenting achieved a larger immediate post-PCI minimal luminal dimension (2.7 ± 0.4 vs. 2.1 ± 0.4 mm, p < 0.001) and less residual stenosis (4 ± 12 vs. 19 ± 11%, p < 0.001) than stand-alone balloon angioplasty. Nonetheless, early reversible perfusion defects were similarly present in the territory supplied by 36% of stented lesions and 32% of lesions treated by balloon angioplasty (NS). Of 81 lesions (76 patients) available for long-term clinical follow-up, TLR was performed in 11% of the stent group and 14% of the balloon angioplasty group (NS). By multivariate logistic regression analysis, diabetes mellitus was the only predictor of late TLR (p < 0.05). The type of intervention (balloon or stent) predicted neither early perfusion defects nor late TLR. Conclusions: Early 201-thallium SPECT scintigraphy was abnormal in a third of patients treated by stand-alone balloon angioplasty or by stent placement. The very early SPECT scintigraphic findings did not differentiate between balloon and stent and did not predict late TLR.

Imaging Patterns of Vascular Lesions of the Head and Neck Demonstrated by Tc-99m Labeled Red Blood Cells

The authors report on three patients with head and neck masses who demonstrated different imaging patterns on Tc-99m RBC scintigraphy, suggesting different vascular pathology of the lesions. Defining these patterns can be helpful in the diagnosis and decision making concerning the appropriate treatment of these patients.

Bone imaging in Kohler's disease.

Kohlers disease is a rare self-limited osteochondrosis of the tarsal navicular bone affecting children between the ages of 3 and 7 years. The condition is more frequent in boys than in girls, with a ratio of 4-6:1. The diagnosis may be missed because of the usual mild clinical manifestations and the difficulty in distinguishing the radiographic abnormalities from the normal radiographic changes of bone growth. In this report, bone scintigraphy was useful in detecting an avascular disorder of the tarsal navicular bone characteristic of Kohlers disease.

Multifocal osteoarticular tuberculosis resembling skeletal metastatic disease. Evaluation with Tc-99m MDP and Ga-67 citrate.

Extrapulmonary tuberculosis is uncommon in the western world. In the United States, skeletal involvement accounts for 1-2% of all cases of tuberculosis and about 10% of extrapulmonary disease. As a result of lymphohematogenous dissemination, infection of bone and joints with Mycobacterium tuberculosis occurs concomitantly with the pulmonary infection. Because malignant bone disease is more common even in children, the diagnosis of tuberculosis may be delayed. Ga-67 scintigraphy is generally used for follow-up in soft tissue and bone infection. However, its pattern in multifocal osteoarticular tuberculosis has not been reported. The authors describe the scintigraphic patterns of bone and Ga-67 imaging in a 12-year-old girl with multifocal bone and joint tuberculosis

Cervico-facial actinomycosis evaluated by multiple imaging studies.

The differential diagnosis of pre-auricular masses include malignant and non-malignant neoplasms as well as non-neoplastic and Infectious processes. The latter may comprise up to 27% of the cases. The authors describe a woman with a pre-auricular mass that was suspected to be a hemangloma. The mass was subsequently resected, and histologic examination detected actinomy-cosis with bone involvement. The radionuclide studies were helpful In assessing the lack of vascularity in the mass, thus suggesting its Inflammatory or tumoral nature.

Atypical scintigraphic pattern of liver hemangioma

Cavernous hemangiomas of the liver are known to have slow perfusion with large blood volume, and therefore, they demonstrate slow accumulation of Tc-99m labeled red blood cells on scintigraphy. Several atypical radiologic patterns, such as prompt filling or late washout of contrast material on angio

Osteomyelitis and cellulitis. The value of the lateral view in Ga-67 scintigraphy.

Ga-67 scintigraphy is performed routinely in the anterior and posterior views. A lateral view in the cases presented here enabled differentiation between osteomyelitis and cellulitis.