Victor Mansberg

Yttrium 90 Bremsstrahlung SPECT/CT scan demonstrating areas of tracer/tumour uptake

A 64-year-old woman with known metastatic colon carcinoma of the right lobe of the liver was referred for therapy with yttrium labeled SIR spheres. The hepatic artery was cannulated via a right femoral percutaneous approach. The hepatic angiogram demonstrated good clearance of the right hepatic artery from the gastro duodenal vessels allowing a good margin of safety for injection of the SIR spheres. Three GBq yttrium labeled SIR spheres were injected, and repeated angiography showed little evidence of reflux of contrast into the gastroduodenal circulation. The patient experienced some discomfort and pain that required analgesia. Subsequently, whole body planar images and SPECT/CT were acquired on a Philips Precedence camera. The camera peaked Y-90 at 90 keV with a 30% window. Medium energy collimators were used with a 256×256 matrix at 35 s a step with 64 projections. CT parameters were low dose attenuation correction and localization at 50mAs. Images were then attenuated corrected and filtered with Philip’s new Astonish filter with 3 iterations and a subset of 8. Images were then coregistered with CT using Syntegra software. The tomographic images (see figure top row CT, middle row SPECT, bottom row fusion) demonstrated areas of maximum tracer uptake which correlate anatomically with sites of maximum tumour density [1], unlike in traditional bremsstrahling images [2] which offer little anatomical detail.

Tl-201 and Ga-67 scintigraphy in non-Hodgkin's lymphoma.

Ga-67 scintigraphy is routinely used to stage and monitor non-Hodgkins lymphoma (NHL). It is highly sensitive in high-grade NHL but less so in intermediate- and low-grade NHL. Several studies have reported the use of Tl-201 in the low and intermediate grades of NHL and found it superior in low-grade NHL. In this study, the authors evaluated the utility of combined Ga-67 and Tl-201 scintigraphy in low, intermediate, and unusual types of NHL. Combined Tl-201 and Ga-67 scintigraphy were done in 33 patients (18 women, 15 men; age range, 21-91 years; mean age, 56 years). Tl-201 and Ga-67 had similar overall patient sensitivity in the 33 patients studied. However, the use of both agents increased the overall patient sensitivity from 67% (for Ga-67 only) to 82% and improved the overall site detection from 59 positive sites with Ga-67 to 81 abnormal sites with both Tl-201 and Ga-67. The combined use of Tl-201 and Ga-67 scintigraphy in low- and intermediate-grade NHL resulted in increased disease and site detection and is beneficial for clinical follow-up.

Development of osteoradionecrosis demonstrated on bone scintigraphy.

&NA; A 62‐year‐old woman was examined because of chronic groin pain indicative of possible symphysitis pubis. She had a total hysterectomy 2.5 years earlier for squamous cell carcinoma of the cervix and underwent postoperative radiotherapy. A whole‐body bone scan performed 1 year later revealed a sacral insufficiency fracture with instability reaction in the left sacroiliac joint but no evidence of bony metastatic disease or abnormal uptake in the symphysis pubis. The current whole‐body bone scan did not show evidence of bony metastatic disease but did reveal marked focal osteoblastic activity and hypervascularity within the symphysis pubis in keeping with active osteitis pubis. A pelvic radiograph confirmed the typical radiographic features of radiation‐induced osteitis pubis.

An unusual pattern of prostatic metastases.

A 78-year-old man had limited skeletal scintigraphy of his left leg for assessment of recent pain. Because early images reflected abnormal vascularity in the region of the left distal femur and proximal tibia, additional whole-body scans were included when delayed images were acquired. These showed intense uptake throughout the distal femur, tibia, fibula, tarsals, and metatarsals of the left lower extremity. Although this was an unusual pattern of uptake (because of the relative lack of axial skeleton involvement), metastatic disease seemed the likely diagnosis. In further discussions with the patient, he reported a problem with his prostate.

Healed rib fractures presenting as linear foci of increased tracer uptake on bone scintigraphy.

A case of healed rib fractures presenting as linear foci of increased tracer uptake on bone scintigraphy is presented. A 58-year-old woman was referred for bone scintigraphy because of increasing left chest pain. Her history included osteoporosis but no cancer. The Tc-99m MDP bone scan showed abnormal linear foci of intense increased tracer uptake along the left eighth and ninth ribs posteriorly and the right eighth rib posteriorly. Excision biopsy of the posterior left eighth and ninth ribs was macroscopically normal externally, and sectioned bony surfaces and histologic analysis confirmed healed rib fractures.