Yukiharu Sumi

Usefulness of201Tl and99mTc MIBI scintigraphy in a case of oncogenic osteomalacia

A 45-year-old male was admitted with difficulty in walking due to leg pain. At the time of the first visit, a reduced serum phosphorus concentration and an increased serum alkaline phosphatase concentration of unknown etiology were observed. Either a whole body bone scintigraphy or CT of the neck, chest and abdominal region did not reveal any underlying disease. However both the whole body201T1 scintigraphy and99mTc MIBI SPECT showed accumulation in the right knee region, and a small tumor was detected by MRI examination. After a diagnosis of oncogenic osteomalacia due to this tumor was determined the tumor was surgically removed, and turned out to be a hemangiopericytoma. By removal of the tumor, either the symptoms or the laboratory data were improved significantly. In this case, both201T1 scintigraphy and99mTc scintigraphy MIBI were useful in identifying the location of the tumor which caused oncogenic osteomalacia.

Stabilization of a Percutaneously Implanted Port Catheter System for Hepatic Artery Chemotherapy Infusion

A port catheter system for hepatic artery infusion chemotherapy was implanted percutaneously via the left subclavian artery in 41 patients for treatment of unresectable liver metastases. The catheter tip was inserted into the gastroduodenal artery (GDA), the end hole was occluded with a guidewire fragment, and a side-hole for infusion was positioned at the bifurcation of the proper hepatic artery and the GDA. The GDA was embolized with steel coils around the infusion catheter tip via a transfemoral catheter. This procedure is designed to reduce the incidence of hepatic artery occlusion and infusion catheter dislocation.

Spontaneous intracranial hypotension: characteristic findings of radionuclide cisternography using In-111 DTPA

The authors describe two patients with spontaneous intracranial hypotension. The patients had the cardinal features of a postural headache. In both patients, radionuclide cisternography revealed cerebrospinal fluid (CSF) leakage at the cervicothoracic junction and early accumulation of isotope in the urinary tract. Postmyelography CT scans showed no underlying structural abnormalities. Both patients were treated successfully by intravenous infusion of low-osmolarity fluid. Radionuclide cisternography obtained after treatment in one of the patients showed that the CSF leak had disappeared. Radionuclide cisternography enabled the causes of spontaneous intracranial hypotension to be differentiated and visualized the sites of CSF leakage. It was also useful for evaluating changes in a CSF leak after treatment. FIGURE 1 FIGURE 2

Small bowel intussusception caused by intestinal angiosarcomatosis: usefulness of MR enteroclysis with infusion of water through a nasojejunal catheter

Abstract. We report a case of intestinal angiosarcomatosis manifesting as jejuno-jejunal intussusception.

Usefulness of cerebral blood flow (CBF) measurements to predict the functional outcome for rehabilitation in patients with cerebrovascular disease (CVD).

PurposeThe objectives of this study were to (1) elucidate the relationship between the mean CBF in the whole brain (Av.mCBF) before rehabilitation of CVD patients and the BI score before and after rehabilitation, (2) determine whether the efficacy of rehabilitation can be predicted by measurement of the Av.mCBF, and (3) investigate what part of the brain was most important to improving the BI score.Materials and MethodsThe Av.mCBFs in 160 patients with CVD were calculated by Patlak plots with99mTc-HMPAO before rehabilitation, and we determined the BI score before and after rehabilitation. Based on the BI scores before and after rehabilitation, patients were divided into four groups: Group A, BI=100; Group B, 80≤BI≤99; Group C, 60≤BI≤79; Group D, 0≤BI≤59. We evaluated the relationship between the Av.mCBF and BI score before and after rehabilitation.ResultsThe Av.mCBF before rehabilitation showed a tendency to be more correlated with the BI score after rehabilitation (r=0.414, p<0.0001) than before rehabilitation (r=0.272, p=0.0006). After rehabilitation, there was a tendency for the Av.mCBF value to increase in direct proportion to the BI score of the group: it was highest in Group A and lowest in Group D. The strongest correlation was found between the frontal lobe regional CBF before rehabilitation and the BI score after rehabilitation (r=0.343, p<0.0001).ConclusionsMeasurement of the Av.mCBF before rehabilitation of CVD patients will permit prediction of the efficacy of rehabilitation. Also the regional CBF of the frontal lobe is most important for improving the BI score.

Emphysematous pyelonephritis— conversion of type i to type II appearance on serial CT studies

Recently, emphysematous pyelonephritis (EPN) has been classified into two subtypes based on CT findings. We recently experienced a patient whose CT image changed from type I (extensive destruction of the renal parenchyma with a large amount of air density without any fluid collection) to type II (containing a large amount of fluid) during the course of conservative treatment. We believe that some patients with type I EPN can change to type II EPN.

Tuberculosis peritonitis: Gallium-67 scintigraphic appearance

Tuberculosis peritonitis is a rare manifestation of extrapulmonary tuberculosis. The results of gallium-67 scintigraphy of three patients with tuberculosis peritonitis were reviewed to assess its usefulness in the diagnosis of this condition. Tuberculosis peritonitis was associated with diffuse or focal abdominal localization and decreased hepatic accumulation of gallium-67. These gallium-67 scan features of tuberculosis peritonitis may help to optimize the diagnosis and management of this disease.

Paratesticular aggressive fibromatosis: CT findings

Aggressive fibromatoses commonly originate from the musculoskeletal system, mesentery, and retroperitoneum. We report a case of aggressive fibromatosis arising from the spermatic cord. On helical computed tomography, the lesion appeared as a solid mass with well-defined borders in the scrotum and with infiltrative features in the retroperitoneum.

Cerebral blood flow-SPECT in a patient with Sneddon's syndrome

We report a 50-year-old woman diagnosed with Sneddon’s syndrome and examined by CBF scintigraphy several times for follow-up of the disease. There were no significant changes in her CBF scintigraphic findings or neurological status during the 6-year follow-up period. Sneddon’s syndrome is a slowly progressive disorder in which livedo reticularis precedes cerebrovascular accidents. Because small cortical arteries are predominantly affected in Sneddon’s syndrome, MR and conventional angiography often fail to show any abnormal findings, and MR imaging may not visualize decreased CBF in the early stage. Therefore, CBF scintigraphy should be performed in patients who have or are suspected of having Sneddon’s syndrome.

Gallium-67 uptake in Bellini duct carcinoma of the kidney

Bellini duct carcinoma is a rare variant of renal cell carcinoma and usually has a poor prognosis. In this article, we report the Gallium-67 citrate (Ga-67) uptake in Bellini duct carcinoma. To our knowledge, this is the second reported case of Bellini duct carcinoma in which Ga-67 uptake was positive. We suggest that Ga-67 scintigraphy has potential utility in detecting Bellini duct carcinoma of the kidney. And if a hypovascular tumor of the kidney shows Ga-67 uptake, Bellini duct carcinoma should be included in the differential diagnosis.