Steven J. Brown

The role of iodine-131 and thallium-201 imaging and serum thyroglobulin in the management of differentiated thyroid carcinoma.

Background. A prospective study was conducted to evaluate the use of iodine‐131 sodium scintigraphy, thallium‐201 chloride scintigraphy, and quantitative serum thyroglobulin estimation in the detection of differentiated thyroid carcinoma after thyroidectomy and iodine‐131 sodium ablative therapy.

Triple-phase bone image abnormalities in Lyme arthritis.

Arthritis is a frequent manifestation of Lyme disease. Limited triple-phase Tc-99m MDP bone imaging of the wrists and hands with delayed whole-body images was performed in a patient with Lyme arthritis. This demonstrated abnormal joint uptake in the wrists and hands in all three phases, with increased activity seen in other affected joints on delayed whole-body images. These findings are nonspecific and have been previously described in a variety of rheumatologic conditions, but not in Lyme disease. Lyme disease should be considered in the differential diagnosis of articular and periarticular bone scan abnormalities.

Mismatch between99mTc-DTPA aerosol and81mKr lung ventilation scintigraphy: a pitfall of radionuclide imaging

Pulmonary ventilation and perfusion scintigraphies were performed using99mTc-MAA,81mKr, and99mTc-DTPA aerosol in a patient with asthma. Lung perfusion scintigraphy and99mTc-DTPA aerosol scintigraphy showed multiple matching defects, however,81mKr ventilation scintigraphy showed mismatch with lung perfusion scintigraphy. A pitfall of this examination was discussed.

Diagnostic significance of apparent abnormal bowel activity on Ga-67 scans in AIDS patients.

Twenty-one Ga-67 studies on 19 AIDS patients were analyzed to investigate the relationship between clinically acute gastrointestinal disease and abnormal scintigraphic bowel activity. Whole body images were obtained at times ranging from 4 to 192 hours, with most exams imaged at 48 and 72 hours. Abnormal bowel activity was observed in eight of 21 exams. Patients experienced acute Gl disease during seven studies. Gallium scan results and clinical presentation agreed in 14 cases; both were abnormal in four and normal in 10. However, four exams showed abnormal activity in asymptomatic patients, while three normal studies were obtained in patients with clinically evident Gl disease. Sensitivity was 57% and specificity 71 %. Positive predictive value was .50 and negative predictive value .77. All true-positive cases were associated with Mycobacterium avium intracellulare (MAI) infection. This study implies that gallium imaging is unreliable for diagnosing acute bowel disease in AIDS patients, but may suggest a particular pathogen (MAI) in the symptomatic individual.

Evaluation of Maffucci Syndrome With Tc-99m Oxidronate Bone Scintigraphy

Tc-99m Oxidronate bone scintigraphy was performed on a 39-year-old woman who had Maffucci syndrome. Planar blood pool images demonstrated multiple nodular regions of increased activity in the left hand and wrist, corresponding to hemangiomas. Delayed bone images revealed multiple areas of diffusely increased uptake in the appendicular skeleton consistent with enchondromas. Maffucci syndrome is a rare congenital, nonhereditary mesodermal dysplasia associated with multiple enchondromas and soft tissue hemangiomas. The enchondromas exhibit a definite tendency to undergo malignant transformation to chondrosarcomas. Maffucci syndrome is closely related to Ollier disease (multiple enchondromatosis) in which multiple enchondromas are found in the epiphyses, adjacent metaphysis, and shafts of the large and small tubular bones

Marked bladder displacement by dilated rectosigmoid colon

A 22-year-old man admitted to the hospital after blunt trauma to the head, neck, flank, and abdomen developed sickle cell crisis, Escherichia coli sepis, tooth abscesses, and pain in his back and shoulders. Initial examination disclosed a massively dilated colon. A whole-body bone scan and a CT scan of the abdomen and pelvis were performed. Tc-99m HDP delayed bone images demonstrated abnormal uptake in multiple sites and a markedly displaced bladder, which emptied after voiding. The CT scan of the pelvis revealed a dilated stool-filled rectosigmoid displacing the bladder and loops of bowel

INDIUM-lll LABELLED ANTI EGFr-425 SCINTIGHAPHY IN THE DETECTION OF MALIGNANT GLIOMAS

BACKGROUND The monoclonal antibody anti-epidermal growth factor receptor (EGFr) antibody-425, against the epidermal growth factor receptor, has the potential to bind specifically to gliomas and not normal brain tissue. A prospective study was conducted (1986-1988) to evaluate the use of Indium-111 (111In)-labeled anti-EGFr-425 in the localization of gliomas before radioimmunotherapy with Iodine-125 (125I)-labeled anti-EGFr-425. METHODS Twenty-eight patients with intracranial neoplasms were injected intravenously with an average dose of 2.2 mCi 111In-labeled anti-EGFr-425. Planar and single-photon emission computed tomography scans were performed after 48 and 72 hours. Control studies also were performed in two cases with 111In-labeled Co 17-1A (an antibody to colorectal cancer) and in one case with unlabeled 111In chloride. RESULTS The immunoscintigraphic findings were generally in good agreement with computerized tomographic findings. The definitive diagnosis was established by biopsy findings: 23 gliomas (1 Grade I, 5 Grade II, 6 Grade III, and 11 Grade IV), 1 meningioma, and 4 metastatic lesions. The localization of gliomas with 111In-labeled anti-EGF-425 had a sensitivity of 0.96, a specificity of 0.60 and an accuracy of 0.90. CONCLUSION Immunoscintigraphy with 111-In labeled anti-EGFr-425 can be useful in the management of malignant gliomas, especially before radioimmunotherapy with 125I-labeled anti-EGFr-425.