Shimato Ono

Increased accumulation of N-isopropyl-p-(123I)-iodoamphetamine in two cases with mitochondrial encephalomyopathy with lactic acidosis and strokelike episodes (MELAS)

SummaryWe present two cases with mitochondrial encephalopathy with lactic acidosis and strokelike episodes (MELAS), which showed both increased and decreased accumulation of N-isopropyl-p-(123I)-iodoamphetamine (123I-IMP) in single photon emission computed tomography (SPECT). The increased accumulation of the tracer occurred, before low density appeared on conventional computed tomography, suggesting that 123I-IMP SPECT may be useful in pathophysiological study of MELAS.

Usefulness of bone imaging in diagnosis of sternocostoclavicular hyperostosis.

Four Patients with sternocostoclavicular hyperostosis showing characteristic abnormal uptake on bone imageing are described Bone imaging was useful in the diagnosis of sternocostoclavicular hyperostosis.

Chronological SPECT studies of a patient with subacute sclerosing panencephalitis

We describe here chronological single photon emission computed tomography (SPECT) with N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) of a patient with subacute sclerosing panencephalitis (SSPE) from the early clinical stages. The case, an 8-year-old Japanese girl, was in clinical stage I of the disease on admission. A SPECT study with 99mTc-hexamethylprophyleamine oxime (99mTc-HM PAO) and 123I-IMP revealed hypoperfusion of cerebral blood flow in the bilateral occipital areas and a part of the cerebellum. Initially, no abnormal findings were observed on CT and MRI. Subsequently, however, MRI indicated abnormal signal intensity dominantly in the area of the occipital white matter where hypoperfusion of cerebral blood flow was found by the initial SPECT studies. This abnormal cerebral hypoperfusion appeared to improve after treatment with oral inosiplex and intrathecal interferon-alpha over 6 months of the clinical course. The abnormal signal intensity on the MRI also decreased, but simultaneous cranial CT demonstrated diffuse cortical atrophy and slight ventricular dilatation.

Iodine-131 uptake in a patient with thyroid cancer and rheumatoid arthritis during acupuncture treatment

A patient with thyroid carcinoma had abnormal accumulation of I-131 in the areas of both feet and hands on whole body scan. The sites of abnormal accumulation of I-131 were similar to those on bone scintigraphy. The radiographic examination of the lesions showed characteristic findings of rheumatoid arthritis, and the presence of small gold needles for acupuncture treatment was demonstrated. There were no findings of bone metastases. Although the mechanism of accumulation of I-131 in this patient is unknown, interpreters of I-131 whole body scintigraphs should keep this case in mind when acupuncture treatment has been done. The authors can only speculate on a common blood flow mechanism for enhanced HMDP and I-131 uptake in this arthritic patient who had been treated by acupuncture.

Visualization of soft tissue by technetium-99m MDP in polymyositis : case reports

Two patients with polymyositis showed abnormal muscular uptake of Tc-99m-methylene diphosphonate (MOP) during routine bone imaging. Imaging with Tc-99m MDP is a uselul tool in monitoring the activity of the diseased muscle.

The cerebral circulation in cases of carotid cavernous fistula

SummaryTen patients with carotid cavernous fistula (CCF) were reviewed. Single photon emission computed tomography (SPECT) for regional cerebral blood flow (rCBF) study was performed in six patients with fast flow shunt. Five of these six patients with fast flow shunt angiographically demonstrated cortical venous drainage, and two of these patients suffered intracerebral hemorrhage. The rCBF decreased in the region demonstrating the cortical venous drainage in five patients, and in one patient the angiography demonstrated arterial steal and the rCBF decreased in a part of the ipsilateral cerebral hemisphere. SPECT proved to be useful in assessing the cerebral circulation in cases of CCF.

Accumulation of99mTc-HM-PAO in photon deficient areas in bone scan of bone metastasis from hepatocellular carcinoma

To evaluate bone metastasis from hepatocellular carcinoma (HCC), both bone and99mTc-HM-PAO scintigraphies were performed in six patients with clinically and pathologically confirmed HCC. Two patients had a bone scintigram which revealed abnormal accumulation in the skull base, pelvic bone and thoracic spine. The99mTc-HM-PAO scans of both these patients also showed abnormal accumulation in the same sites. The bone scintigrams in one patient revealed not only abnormal accumulation in the ribs but also photon deficient areas in the sternum, thoracic spine and femur, while99mTc-HM-PAO scans showed abnormal accumulation in all these sites. In three patients, bone scintigraphy revealed photon deficient areas in the ribs, pelvic bone and femur, and their99mTc-HM-PAO scintigrams showed abnormal accumulation in the same sites. Thus, it was shown that, in the detection of bone metastasis from HCC by means of bone scintigraphy, it was necessary to pay attention to hot and cold lesions, and that a combination study with99mTc-phosphorous compounds and99mTc-HM-PAO was useful in evaluating these lesions.

Lateral scanning of the lumbar spine: Bone mineral density determination with dual energy X-ray absorptiometry

In order to exclude the metabolically less-active cortical bone in the posterior portion of the lumbar spine, and to exclude the calcification of abdominal aorta which frepuently occurs in elderly persons, both of which are included in the conventional anteroposterior (AP) bone mineral determinations, clinical interest has been directed toward lateral scanning. In this paper, the performance and clinical application of lateral scanning with dual energy X-ray absorptiometry (DEXA) have been reviewed.The precision, estimated as the reproducibility of measurements, of lateral bone mineral density (BMD), is inferior to that of AP-BMD (N=5, C.V. 5.57% vs 1.80%). With lateral scanning, the distributions of bone mineral within the vertebral body was different. The highest BMD was observed in the posterior inferior portion (100%), followed by the posterior superior (89%), anterior inferior (77%), and anterior superior portions (65%). In lateral scans, BMD within the region of interest (ROI) containing the shell, composed of cortical bone, is higher than BMD within the ROI without the shell (N=28, 87.8±5.9% for shell (+) vs 81.5±10.3% for shell (−), p<0.01, when AP-BMD in L3 is defined as 100%). Age-related bone loss in males was recognized from lateral BMD measurements (r=−0.342, p<0.01), while no significant correlation was recognized between age and AP-BMD.In conclusion, although lateral scanning needs further improvement in precision, lateral scanning of the lumbar spine with DEXA will provide more informations in evaluating age-related bone loss.