Regional migratory osteoporosis: a review illustrated by five cases

Regional migratory osteoporosis is an uncommon self-limiting disease characterized by an arthralgia which migrates between the weight-bearing joints of the lower limb. The radiological features of the disease obtained by conventional radiography, CT, MRI and radionuclide scintigraphy are illustrated by means of five case reports. These range from the most common presentation of sequential, proximal to distal spread in the lower limb to the rare intra-articular form, and disease involving the axial skeleton is also recognized. Clinical and radiographical features often overlap with those of diseases such as transient osteoporosis of the hip and transient bone marrow oedema syndrome, which is reflected in confusing terminology. Histological sampling is usually unnecessary; the radiological features are characteristic and the histological findings are not specific. Regional migratory osteoporosis is associated with systemic osteoporosis. This association is probably under-recognized, and has implications for the pathophysiology of the disease and for treatment.     

16-Detector multislice CT in the detection of stress fractures: a comparison with skeletal scintigraphy

AIMS: To test the hypothesis that the improved resolution afforded by 16-detector computed tomography (CT) would translate to better stress fracture detection when compared with skeletal scintigraphy. MATERIALS AND METHODS: Thirty-three cases of suspected stress fractures in 26 patients were investigated using skeletal scintigraphy and 16-detector CT performed on the same day. Planar images of the lower limbs were taken 3h post-injection of 400MBq (99m)Tc-methylene diphosphonate ((99m)Tc-MDP). (99m)Tc-MDP uptake was quantified at suspected fracture sites. CT was performed using a 16-detector multisection machine employing 0.75mm detectors and images reconstructed in 0.5mm increments. Examinations were reported independently and discordant results were compared at follow-up. RESULTS: At initial reporting scintigraphy identified fractures in 13 of the 33 cases and CT identified four of the 33. In one case, on review of the CT images, a fracture was present in the distal fibula that was not initially identified. This resulted in eight scintigraphic-positive CT-negative discordant cases. The (99m)Tc-MDP uptake was significantly lower in the discordant fracture group compared with the concordant group (p<0.01). CONCLUSIONS: Despite technological advances in CT, scintigraphy appeared to detect more stress fractures. As such, multidetector CT should not be used as a routine initial investigation in stress fracture detection. The potential use of (99m)Tc-MDP quantification at fracture sites is of interest and may be worth further investigation.     

Preliminary results of transarterial rhenium-188 HDD lipiodol in the treatment of inoperable primary hepatocellular carcinoma

A multicentre study was sponsored by the International Atomic Energy Agency (Vienna) to assess the safety and efficacy of trans-arterial rhenium-188 HDD conjugated lipiodol (radioconjugate) in the treatment of patients with inoperable hepatocellular carcinoma (HCC). The radioconjugate was prepared by using an HDD (4-hexadecyl 1-2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol) kit developed in Korea, and lipiodol. Over a period of 18 months, 70 patients received at least one treatment of radioconjugate. Some patients were re-treated if there was no evidence of disease progression. The level of radioconjugate administered was based on radiation-absorbed dose to critical normal organs, calculated following a scout dose of radioconjugate. The organs at greatest risk for radiation toxicity are the normal liver, the lung and the bone marrow. An Excel spreadsheet was used to determine maximum tolerated activity (MTA), defined as the amount of radioactivity calculated to deliver no more than 12 Gy to lungs, or 30 Gy to liver, or 1.5 Gy to bone marrow. These doses have been found to be safe in multiple trials using external beam therapy, but this has not been confirmed for systemically administered radiopharmaceuticals. Patients were followed for at least 12 weeks after therapy, until recovery from all toxicity. The clinical parameters evaluated included toxicity, response as determined by contrast-enhanced computed tomography, palliation of symptoms, overall survival, performance status (Karnofsky) and hepatic function (Childs classification). Liver function tests, serum -fetoprotein (AFP) levels and complete blood counts were done at each follow-up visit. In the majority of patients, the scout dose studies indicated the radiation absorbed dose to normal liver to be the limiting factor to the treatment dose, while in a few patients dose to lung was the limiting factor. Radiation dose to bone marrow was negligible and was thus not a factor for the MTA calculations. Side-effects were minimal and usually presented as loss of appetite, right hypochondrial discomfort and low-grade fever, even at high levels of administered radioactivity. The symptoms resolved with simple supportive therapy within 3 days of onset. Liver function tests at 24 and 72 h showed no significant changes and complete blood counts at 1 week, 4 weeks and 12 weeks showed no changes (no bone marrow suppression). Sixteen patients were treated in the dose escalation phase of the study, when the activities administered started at 1.8 GBq (50 mCi) and rose to 7.7 GBq (206 mCi). In the efficacy phase of the study a further 54 patients were treated. Both groups of patients are included in this paper. The treatment activity of ¹⁸⁸Re-lipiodol administered transarterially ranged from 1.8 to 9.8 GBq (50–265 mCi), with a mean activity of 4.6 GBq (124 mCi). Survival at 3 months was 90%, and at 6 months, 60%; 19% survived for 1 year. Mean survival after treatment in the total treated group of 70 patients was 9.5 months, with a range of 1–18 months. The results of this multicentre study show that ¹⁸⁸Re-lipiodol is a safe and cost-effective method to treat primary HCC via the transarterial route. In terms of efficacy, it is potentially a new therapeutic approach for further evaluation by treatment of larger numbers of patients.     

Current management of infants with fetal renal pelvis dilation: a survey by French-speaking pediatric nephrologists and urologists

To analyze the current management recommendations among French-speaking physicians treating infants with antenatal renal pelvis dilatation, we surveyed 83 pediatric nephrologists and 68 pediatric urologists by questionnaire. A total of 45 (54%) pediatric nephrologists and 38 (56%) pediatric urologists responded. The threshold for the diagnosis of abnormal fetal renal pelvis dilatation was significantly higher among pediatric urologists than nephrologists. All responders perform renal ultrasound examinations after birth. Postnatal renal pelvis dilatation was considered abnormal if the anteroposterior diameter was 11±1.9 mm by the pediatric urologists and 9±2.9 mm by the pediatric nephrologists (P=0.003). Pediatric urologists were more likely than nephrologists to recommend routine voiding cystourethrography [41% versus 20% (P=0.04)]. Mercaptoacetyl-triglycine renography was the most routinely used tool to achieve functional evaluation during follow-up among the responders. Pediatric urologists were more likely to recommend surgical treatment in dilated kidneys with initial function <40%. In conclusion, pediatric urologists had significantly higher thresholds for the detection of prenatal and neonatal renal pelvis dilatation. They also more frequently recommended routine voiding cystourethrography and surgical therapy of dilated kidneys with low function than pediatric nephrologists. The variability in attitudes is most probably due to the absence of clear guidelines based on prospective and controlled trials.The following workers contributed to this study. For the French-speaking Society of Pediatric Nephrology (SNP): J. Al Hosri (Hôpital Nord, Amiens, France), J.L. André (Hôpital dEnfants, Nancy, France), A. Bensman (Hôpital Trousseau, Paris, France), E. Berard (LArchet II, Nice, France), J.P. Bertheleme (Centre Hélio Marin, Roscoff, France), F. Bouissou (Hôpital des Enfants, Toulouse, France), G. Bourdat-Michel (CHU, Grenoble, France), G. Champion (CHU, Angers, France), S. Cloarec (Hôpital Clocheville, Tours, France), L. Collard (Hôpital E. Herriot, Lyon, France), J.C. Davin (Emma Childrens Hospital, Amsterdam, Holland), L. de Parscau (Hôpital Augustin Morvan, Brest, France), S. Decramer (Hôpital des Enfants, Toulouse, France), V. Desvignes (CH, Clermont Ferrand, France), R. Donckerwolcke (AZ, Maastricht, Holland), J. Ehrich (MHH, Hannover, Germany), M. Fischbach (Hôpital de Hautepierre, Strasbourg, France), M. Foulard (Hôpital Jeanne de Flandre, Lille, France), M.S. Ghuysen (CHU Sart Tilman, Liège, Belgium), J.B. Gouyon (Hôpital dEnfants, Dijon, France), J.P. Guignard (CHUV, Lausanne, Switzerland), C. Guyot (CHU, Nantes, France), P. Hansen (Hôpital Tivoli, La Louvière, Belgium), J.P. Hehunstre (Hôpital Pellegrin, Bordeaux, France), F. Janssen (Hôpital Universitaire des Enfants, Brussels, Belgium), M.J. Krier (Hôpital dEnfants, Nancy, France), A. Lahoche-Manucci (Hôpital Jeanne de Flandre, Lille, France), H. La Selve (Centre Hélio Marin, Roscoff, France), M.P. Lavocat (Hôpital Nord, Saint Etienne, France), C. Loirat (Hôpital Robert Debré, Paris, France), J. Lombet (CHR La Citadelle, Liège, Belgium), A. May (CH Sud Francilien, Evry, France), D. Morin (Hôpital Arnaud de Villeneuve, Montpellier, France), J.B. Palcoux (Hôtel Dieu, Clermont Ferrand, France), S. Palomera (CTMR, Bordeaux, France), C. Pietrement (American Memorial Hospital, Reims, France), S. Ploos van Amstel (Emma Childrens Hospital, Amsterdam, Holland), W. Proesmans (UZ Gasthuisberg, Leuven, Belgium), N. Ranguelov (CHU, Charleroi, Belgium), B. Roussel (American Memorial Hospital, Reims, France), M.H. Said (Hôpital E. Herriot, Lyon, France), A. Taque (Hôpital de Pontchaillou, Rennes, France), M. Tsimaratos (Hôpital La Timone, Marseille, France). R. Van Damme-Lombaerts (UZ Gasthuisberg, Leuven, Belgium)For the French-speaking Pediatric Urology Study Group (GEUP): T. Aivazoglou (Aglaia Kyriakou Hospital, Athens, Greece), J.L. Alain (CHU Dupuytren, Limoges, France), P. Alessandrini (Hôpital Nord, Marseille, France), G. Audry (Hôpital Trousseau, Paris, France), M. Avérous (Hôpital Lapeyronie, Montpellier, France), R. Besson (Hôpital Jeanne de Flandre, Lille, France), J. Biserte (Hôpital Huriez, Lille, France), B. Boillot (CHU Albert Michallon, Grenoble, France), J.M. Bondonny (Hôpital des Enfants, Bordeaux, France), J.P. Bonnet (Hôpital Simone Veil, Montmorency, France), P. Bugmann (Hôpital des Enfants, Geneva, Switzerland), F. Collier (Hôpital Universitaire des Enfants, Brussels, Belgium), J.F. Colombani (CHU, Fort-de-France, France), H. Dodat (Hôpital E. Herriot, Lyon, France), B. Dore (CHU, Poitiers, France), A. El Ghoneimi (Hôpital R. Debré, Paris, France), C. Esposito (Universitary Hospital, Naples, Italy), B. Fremond (Clinique Chirurgicale infantile, Rennes, France), P. Frey (CHUV, Lausanne, Switzerland), S. Geiss (Centre de la Mère et lEnfant, Colmar, France), I. Germouty (CHU, Brest, France), Y. Heloury (CHU, Nantes, France), A. Lacombe (Hôpital Clocheville, Tours, France), S. Lortat-Jacob (Hôpital Necker-Enfants Malades, Paris, France), T. Merrot (Hôpital Nord, Marseille, France), R. Moog (Hôpital de Hautepierre, Strasbourg, France), G. Morisson-Lacombe (Hôpital Saint Joseph, Marseille, France), J. Moscovici (Hôpital des Enfants, Toulouse, France), P. Mouriquand (Hôpital Debrousse, Lyon, France), E. Sapin (CHU, Dijon, France), A. Savanelli (Universitary Hospital, Catanzaro, Italy), M. Schmitt (Hôpital dEnfants, Nancy, France), H. Steyaert (Fondation Lenval, Nice, France), C. Tölg (CHU, Fort-de-France, France), J.S. Valla (Fondation Lenval, Nice, France), F. Varlet (Hôpital Nord, Saint Etienne, France), P. Wallon (Centre de Chirurgie de lEnfant, Bordeaux, France), D. Weil (Centre Hospitalier, Le Mans, France)     

Imaging for primary hyperparathyroidism--what beginners should know

For patients with primary hyperparathyroidism surgical removal of the hyperfunctioning parathyroid gland is curative. With advances in minimally invasive surgery, accurate pre-operative localization of the hyperfunctioning parathyroid tissue is essential to aid successful surgical treatment. The onus of identifying this hyperfunctioning parathyroid tissue therefore falls on imaging techniques such as high-resolution ultrasound, radionuclide imaging, computed tomography and magnetic resonance imaging. This article is not an exhaustive review, and its main aim is to familiarize the general radiologist, trainee radiologists and clinicians with the basics of various imaging techniques and their roles in practical management of patients with primary hyperparathyroidism.     

对^14C呼气试验患者进行心理干预的效果分析

^14C-呼气试验是近年来发展起来的非侵入性的Hp重要检查方法，虽然该检查无创伤、无痛苦、无交叉感染，但由于禁食，口服药物等，患者存在许多心理问题，我们对不同年龄、不同文化程度、不同经济状况和不同病情的患者采取不同的交流和沟通技巧，根据患者不同心理问题实施相应心理干预，取得良好效果。     

新生儿左室心肌应变和应变率的定量分析

目的探讨足月和早产新生儿的左室心肌组织应变及应变率差异。方法应用组织多普勒技术对足月新生儿和早产儿各21例左心室室间隔、前壁、侧壁、下壁进行不同节段间的收缩期应变、应变率比较。结果足月和早产儿室间隔心尖段收缩期应变值分别为(-11.36±15.24)%、(-0.95±15.65)%,前壁中段的收缩期应变值分别为(-9.87±7.55)%、(-0.09±8.17)%,有显著性差异(Pa<0.05)。足月和早产儿左室心肌室间隔心尖段收缩期应变率分别为(-3.15±2.04)/s、(-1.75±2.01)/s,有显著性差异(P<0.05)。足月和早产儿左室收缩期心肌不同节段心肌应变及应变率有差异。结论心肌应变率成像可作为评价新生儿局部心肌运动的新方法。     

核医学检查对早期亚甲炎的诊断价值

目的评价核素显像对于早期亚甲炎的诊断价值.方法对239例早期亚甲炎病人进行甲状腺吸131I率、血清甲状腺激素测定及甲状腺显像.结果以吸131I率和激素测定结果的"分离现象"为指标,诊断符合率为91.6%;甲状腺显像异常影像检出率高达96.2%.结论"分离现象"对早期亚甲炎的诊断灵敏度高、特异性强.核素显像在灵敏反映甲状腺功能的基础上,能直观显示病变范围及其受损程度,从而为早期亚甲炎的诊断及病情评价提供客观依据.     

67Ga-枸橼酸盐用于肺癌显像的诊断分析

目的　探讨６７Ｇａ－枸橼酸盐在肺癌诊断中的应用价值。方法　对１８４ 例住院病人进行了６７Ｇａ的胸部显像。病人均经穿刺活组织检查,手术切除或其他方法获得病理结果,其中肺癌１２７例,良性病变５７ 例。结果　在１２７ 例肺癌中,６７Ｇａ显像阳性１０１ 例,显像阴性２６ 例;５７ 例良性病人中,阳性１２ 例,阴性４５ 例。６７ Ｇａ在肺癌诊断中的显像灵敏度、特异性和准确率分别为７９．５％ 、７８．９％ 和７９．３％ 。阳性预测率８９．４％ ,阴性预测率６３．３％ 。其灵敏度与肿瘤类型及肿块大小有关。结论　６７Ｇａ——枸橼酸盐在用于肺部疾病,尤其在肺癌诊断中具有较好的应用价值。     

Evaluation of left ventricular performance in infants and children using radionuclide angiography

Summary Eight quantitative first-pass (FP) radionuclide angiograms were performed in six children with left ventricular (LV) dysfunction without associated LV outflow obstruction and one infant with obstructive cardiomyopathy (CM) to define regional and global LV function. All patients (3 months to 15 years) had clinical findings of congestive heart failure. Echocardiographic evaluation was performed within 24 hours of the FP study. LV ejection fraction (LVEF), regional ejection fraction index (REFI), LV wall motion perimeters, transit time, and curve analysis were evaluated. Ejection fraction by FP-RNA was compared to echo in all patients. FP-RNA derived end-diastolic and end-systolic LV perimeters were compared to corresponding contrast angiographic definition of LV wall boundaries. FP-LVEF ranged from 23–44% in 6 patients with non-obstructive CM and was 79% in 1 patient with obstructive CM. REFI revealed diffuse hypokinesis in 6 patients with non-obstructive CM, with additional apical akinesis in 1 patient. The infant with obstructive CM had hyperdynamic wall motion. These data compared favorably with echo EF and angiographic assessment of LVEF and wall motion.