Yasuhiko Morita

Interpretation of scintigraphy of papillary cystadenoma lymphomatosum (Warthin's tumor) on the basis of histopathologic findings

OBJECTIVES The accumulation of 99mTc-pertechnetate in Warthins tumor was estimated scintigraphically and histopathologically to determine the role of the epithelial component in scintigraphy. STUDY DESIGN Six cases underwent histopathologic examination and scintigraphic evaluation with 99mTc-pertechnetate. Histopathologically the tumors were classified into types according to the epithelial component and cystic space and compared with scintigraphic results evaluated by dynamic radioactive index and wash-out image. RESULTS Histopathologic and scintigraphic observations showed an adequate correlation. Cases with a large epithelial component and poor cystic space showed a large radioactive index of dynamic scintigraphy and hot accumulation of wash-out image. CONCLUSION The scintigraphic results were chiefly due to the epithelial component, but the influence of the cystic space could not be disregarded.

Clinical evaluation of lymphoscintigraphy of the head and neck

Thirty-six patients underwent static and dynamic lymphoscintigraphies with 99m-Tc rhenium colloid in this series. Static lymphoscintigrams were obtained at 3 hours after injection and dynamic lymphoscintigraphy was carried out immediately after injection. 99m-Tc rhenium colloid in each volume of 0.25ml (3.7×107 Bq) was applied by subcutaneous injection into bilateral areas behind the ears for the cervical lymph nodes, and by submucosal injection into the bilateral mucobuccal folds of the upper molar region for the submandibular lymph nodes. Most of the cases demonstrated abnormalities of the lymph node images; (1) asymmetry of lymph node drainage, (2) absence of lymph nodes, (3) reduced uptake, (4) rope-like appearance, (5) enlargement of lymph nodes, and (6) delay of flow rate along the cervical chain. The results of these two imaging techniques correctly predicted the metastatic involvement of cervical lymph nodes from malignant tumors at the rate of about 70%. This imaging technique of lymphoscintigraphy is one of the useful method for evaluating lymph node metastasis, and dynamic scintigraphy especially contributes to more accurate diagnosis of lymph node metastasis.

Scintigraphic detection of metastatic bone lesions from breast carcinoma: Report of a case

A 46-year-old woman with extensive skeletal metastases from primary breast carcinoma was examined scintigraphically using99mTc HMDP. The skeletal metastatic lesions, except for the mandible and hip joint, were clinically asymptomatic and hardly detected radiographically. Marked accumulation of99mTc HMDP was shown in both the asymptomatic and symptomatic lesions, and scintigraphy is also a useful imaging modality for the identification of whole body metastatic bone lesions, especially in the early stage.

Digital images with fuji computed radiography (FCR) in dento-maxillo-facial radiology

SummaryA digital radiographic system utilizing scanning laser stimulated luminescence (FCR) is used in pantomograms, tomograms of TMJ, cephalograms, sialograms and soft tissue radiograms. FCR provided the high quality images which were easy to interpret. In particular, with tomograms of TMJ, images of soft tissue were obtained, holding out the possibility of successful diagnosis of TMJ dysfunction.

Three-dimensional imaging of subcondylar fractures of the mandible with spiral CT

Recently, the clinical applications of three-dimensional CT (3D-CT) images to disease are rapidly increasing in the maxillofacial region. In particular, spiral CT is extremely useful for 3D reconstruction because of its fast and volumetric data acquisition which minimizes motion and step artifacts. Two cases of subcondylar fractures of the mandible were routinely examined by spiral CT program (Siemens ; SOMATOM PLUS) with 3-mm slice thickness and table feed of 3 mm/sec. 3D-CT images were generated from overlapping axial CT images which were reconstructed at 1-mm increments with a standard or high-resolution algorithm. Threshold values were selected to satisfy the demands for both eliminating soft tissue noise and leaving tiny bone structure, as far as possible. The objects were observed from various viewing directions, including cutting views. Case 1 : A 63-year-old woman fell and landed on her chin. Thereafter , she complained of disturbance on mouth opening. A panoramic radiograph and a P-A view revealed a right subcondylar fracture with severe displacement of the condyle, which was a typical indirect fracture (Fig. 1). For 3D reconstruction, a standard algorithm was used and the threshold value was set at 170HU. Manifestation of the fracture on 3D-CT images of right lateral view and cutting view of the back were approximately equivalent to that on conventional radiographs; however, 3D-CT images were easier to interpret (Fig. 2 A,B). The bot tom view precisely showed anteriomedial displacement of the condyle, and also suggested that it had been displaced when pulled by the lateral pterygoid muscle (Fig. 2 C). Case 2 : A 22-year-old man fell and landed on his right cheek and has since complained of disturbance on mouth opening. Panoramic radiograph revealed fractures in the posterior ridge of the right mandibular ramus and also in the posterior wall of the right maxi l lary sinus (Fig. 3 A). P-A view

A new computed tomography using imaging-plate and incomplete projection data

A new computed tomography using Imaging-plate (IP) and incomplete projection data is hereby presented. In this system, Imaging-plates with wide dynamic range were used as 2-dimensional X-ray detectors. Projection data were acquired along the mandibular bone. The author called this data “ Projection data along the mandibular bone” for convenience in this study. An algebraic iteration method was used for the image reconstruction. The maximum Likelihood method (EM method), which had been developed by Shepp and Vardi, was modified to take into account the geometry of this experimental system.Using this system, sequential 5 transverse sectional images of a dry mandibular bone could be reconstructed in one scanning. Considering the inaccurate mechanics of the experimental system and small number of projections, the quality of the obtained image was considered fairly good. These results suggested the possibility of the new computed tomography using Imaging-plate and incomplete projection data.

Interpretation of distant focal accumulations revealed by bone scintigraphy using Tc-99m HMDP in patients with oral malignant tumors

ObjectiveFocal accumulations in the skeleton were analyzed in order evaluate the usefulness of bone scintigraphy in the detection of distant skeletal metatases originating from malignant oral tumors.Study designOf 350 patients who underwent bone scintigraphy, 62 patients who showed distant focal accumulations in the skeleton were selected. Observations were performed on 12 skeletal regions: the skull, facial bone, clavicle, rib, scapula, sternum, cervical spine, thoracic spine, lumbar spine, pelvis, upper, and lower extremities. Distant focal accumulations were classified into 3 degrees: very hot, moderately hot and warm. A diagnosis of metastatic focal accumulation was made with reference to the CT, MR, X-ray and Ga-67 images, clinical features, and laboratory data.ResultsFour of the 350 cases showed skeletal metastases (1.1%). Sixty-two of the 350 patients showed 106 distant focal accumulations, with 10 accumulations proving to be skeletal metastases. The common sites of the skeletal metastases were the lumbar spine, rib, cervical spine, and sternum. Patients with skeletal metastases had a tendency to show distant focal accumulations of very hot images in some skeletal sites, and these focal accumulations were usually accompanied by severe pain. The most common cause of distant focal accumulations except metastasis was traumatic injury.ConclusionThe results in the present study indicate that the distant focal accumulations accompanied by severe pain and simultaneously observed in more than one skeletal site can be interpreted as skeletal metastases.Focal accumulations in the skeleton were analyzed in order evaluate the usefulness of bone scintigraphy in the detection of distant skeletal metatases originating from malignant oral tumors. Of 350 patients who underwent bone scintigraphy, 62 patients who showed distant focal accumulations in the skeleton were selected. Observations were performed on 12 skeletal regions: the skull, facial bone, clavicle, rib, scapula, sternum, cervical spine, thoracic spine, lumbar spine, pelvis, upper, and lower extremities. Distant focal accumulations were classified into 3 degrees: very hot, moderately hot and warm. A diagnosis of metastatic focal accumulation was made with reference to the CT, MR, X-ray and Ga-67 images, clinical features, and laboratory data. Four of the 350 cases showed skeletal metastases (1.1%). Sixty-two of the 350 patients showed 106 distant focal accumulations, with 10 accumulations proving to be skeletal metastases. The common sites of the skeletal metastases were the lumbar spine, rib, cervical spine, and sternum. Patients with skeletal metastases had a tendency to show distant focal accumulations of very hot images in some skeletal sites, and these focal accumulations were usually accompanied by severe pain. The most common cause of distant focal accumulations except metastasis was traumatic injury. The results in the present study indicate that the distant focal accumulations accompanied by severe pain and simultaneously observed in more than one skeletal site can be interpreted as skeletal metastases.

Eosinophilic granuloma of the ramus similar to malignant neoplasm or osteomyelitis: Report of a case

An eosinophilic granuloma was discovered in the region of the ramus of the mandible. This case occured in a very rare location limited only to the ramus, and showed similar features resembling osteomyelitis or malignant neoplasm at different stages of the disease. The radiographic findings indicated a diagnosis of malignant neoplasm and the scintigraphic manifestations showed that of osteomyelitis. The histopathological examinations showed different manifestations in accordance with the respective stages of the disease. This case was finally diagnosed as eosinophilic granuloma showing rapid regression.