Three-phase bone scintigraphy in Pellegrini-Stieda disease

In a patient with Pellegrini-Stieda disease, radiographs of the knees were unremarkable at the time the three-phase bone scintigraphy was abnormal. The results of follow-up radiographs three months later remained normal in the left knee, where local steroid injection was given, but revealed typical positive results in the right knee with no treatment. The three-phase bone scintigraphic pattern is rather typical and antedates the radiographic changes. Thus, the radionuclide technique would provide a useful procedure for the early diagnosis and treatment of Pellegrini-Stieda disease.     

Three-phase radionuclide bone imaging in sports medicine

Three-phase radionuclide bone (TPB) imaging was performed on 238 patients with sports-related injuries. A wide variety of lesions was encountered, but the most frequent lesions seen were stress fractures of the lower part of the leg at the junction of the middle and distal thirds of the posterior tibial cortex (42 of 79 lesions). There were no differences in the type, location, or distribution of lesions between males and females or between competitive and noncompetitive athletes. In 110 cases, bone stress lesions were often diagnosed when radiographs were normal, whereas subacute or chronic soft-tissue abnormalities had few specific scintigraphic features. TPB imaging provides significant early diagnostic information about bone stress lesions. Normal examination results (53 cases) exclude underlying osseous pathologic conditions.     

Three-phase bone scintigraphy of hydroxyapatite ocular implants

Hydroxyapatite ocular implants are replicas of lamellar bone tissue derived from the exoskeleton of a reef-building coral by a hydrothermal chemical exchange reaction. Attached to the eye muscles, they act as a passive framework for fibrovascular ingrowth and can be drilled to hold the visible part of the artificial eye and allow synchronous eye movement. Fibrovascular ingrowth has to be confirmed by bone scintigraphy before the drilling procedure. This study monitored the vascular ingrowth into the implant in ten patients over 12 months to establish a clinically feasible imaging protocol. Tracer accumulation was monitored visually and quantitatively in dynamic and single-photon emission tomography (SPET) scans after the intravenous administration of 600 MBq of^99mTc-DPD. The implants showed no tracer accumulation in the arterial or blood pool phase. Accordingly, dynamic scintigraphy can be omitted from the imaging protocol. Delayed tracer accumulation appeared no earlier than 2 and no later than 6 months after surgery. Planar scintigraphy is not recommended as high-resolution SPET is necessary to separate the implant from the surrounding bone. We conclude that imaging can be confined to high-resolution SPET 3 h after tracer injection, no earlier than 3 months after surgery. The vascularized hydroxyapatite orbital implant is an important in vivo model for bone-seeking agents to study their uptake kinetics independently of any soft tissue and bone disease. Our results provide evidence that in normal bones the chemical adsorption of^99mTc-DPD into the crystalline structure of hydroxyapatite is the only quantitatively relevant uptake mechanism.     

Three-phase bone scintigraphy of Kienb?ck disease]

Thirty-three joints in 31 patients of Kienb?ck disease were evaluated with three-phase bone scintigraphy. Follow-up studies were performed in 19 cases of them. The patients with increased ulnar blood flow on arterial phase and ample perfusion on venous phase in angiograms showed good clinical prognosis. This ample ulnar blood flow and perfusion might be essential for the recovery of this disease. Although staging was possible using static images alone, blood pool images provided more information about the present condition of lesions, such as hyperemic state and remodeling reactions. Blood pool image was indispensable for staging and analyzing lesions and evaluating post-operative course. Increased lunate perfusion in venous phase of angiograms and localized lunate uptake in blood pool images were the favorable signs, which were shown in most cases with good prognosis. It is concluded that three-phase bone scintigraphy gives useful informations for evaluating Kienb?ck disease which can not be obtained by conventional bone scintigraphy.     

Three-phase radionuclide bone imaging in stress injury of the anterior iliac crest

Two adolescents with stress-related avulsion injury of the anterior iliac crest apophysis are presented. Increased tracer concentration in the anterior iliac crest area is present on the blood-pool and delayed images. Increased iliac crest activity was demonstrated on the radionuclide angiogram in one patient. Scintigraphic detection of this injury is useful when clinical findings are atypical, if objective evidence of a fracture is required, or when the fracture is not readily apparent radiographically.     

Three-phase bone scanning in reflex sympathetic dystrophy of the hand

Three-phase bone scanning was performed in 181 patients suffering from reflex sympathetic dystrophy (RSD) of the hand. Four quantitative parameters were defined as follows: (a) hemovelocity and (b) blood pool (determined from the Fourier processing of angiographic data); (c) early (3-5 min) and (d) delayed (2-3 hr) bone fixation. Three significant stages of RSD were demonstrated scintigraphically. Stage I (0-20 wk from onset) demonstrated increases in velocity, blood pool, and early and delayed fixations. At stage II (20-60 wk) blood velocity and blood pool were normalized, but early and delayed hyperfixation persisted. During stage III (60-100 wk) blood velocity and blood pool were reduced on the affected hand, and early and delayed fixations were normalized. Such abnormality of decreased hemodynamic parameters may become associated with bone hypofixation in stage III. Early treatment of RSD (as compared with delayed treatment) has been demonstrated to induce normalization of hemovelocity (p less than 0.05), blood pool (p less than 0.02), and joint stiffness (p less than 0.001) without any change in the bone fixation; therefore, three-phase bone scanning may provide useful information regarding the pathophysiologic and clinical evolution of RSD.     

Three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses

The three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses (UHPs) has not previously been elucidated. We evaluated 28 patients with complicated UHPs who had undergone total hip arthroplasty a very long time previously (range 3–20 years, mean 8.4). All the patients were surgically reviewed: 26 UHPs were found to be loosened and two infected. Nine asymptomatic UHPs were taken as controls. The dynamic phase was invariably negative in both loosened and asymptomatic UHPs while markedly positive in the infected ones. The blood pool phase was positive to various degrees in 16 of the 26 loosened UHPs as well as in the infected UHPs, but was invariably negative in painless replacements. In the bone phase, areas of significantly (discrete to marked) increased uptake were observed in all the loosened prostheses as well as in two-thirds of the asymptomatic ones. However, the regions of the lesser trochanter and/or tip and/or shaft were involved exclusively in the case of the loosened UHPs, and diffuse periprosthetic uptake was found only with loosened or infected implants. Areas of slight methylene diphosphonate (MDP) uptake were found at every periprosthetic site and areas of discrete to marked MDP uptake were commonly found in the acetabulum and/or the greater trochanter with both loosened and painless prostheses and are thus considered to be nonspecific findings.     

Diabetic oesophagoparesis: assessment by solid phase radionuclide scintigraphy

Oesophageal function was assessed by solid phase radionuclide scintigraphy in 13 normal volunteers and 23 patients with diabetes mellitus. The diabetics had significantly delayed oesophageal emptying times 23 min versus 7.6 min in normals (p less than 0.02). In addition, the diabetics had significantly more oesophageal activity at 5 and 10 min than normals (p less than 0.03). These differences were unrelated to the age of the patients. Despite these population differences, no clear relationship was seen within the diabetic population between oesophageal emptying time and duration of disease, insulin dose, or presence of neuropathy. Oesophageal emptying time was only weakly correlated with gastric emptying times (r = 0.37, p less than 0.03). These data indicate that by using sensitive radionuclide techniques, abnormalities of oesophageal emptying are common in diabetics, even in those without evidence of other end-organ complications of diabetes.     

Progressive systemic sclerosis: radionuclide esophageal scintigraphy and manometry

Radionuclide esophageal scintigraphy (RES) and manometry were used for prospective evaluation of esophageal involvement and disease severity in 11 patients (nine women and two men; median time since diagnosis, 1 year) with progressive systemic sclerosis (PSS). Quantitation of RES included calculation of the percentage of emptying at 30 seconds, while manometry provided measurements of proximal, distal, and lower esophageal sphincter (LES) pressures. The findings of both RES and manometry were abnormal in all 11 patients. There was a high correlation between the percentage of emptying and either distal esophageal pressure (r = .86, P less than .01) or LES pressure (r = .79, P less than .01). No significant correlation was found between the percentage of emptying and proximal esophageal pressure (r = .28, P = .39). RES is a safe, simple procedure that is readily accepted by patients and can be used in place of manometry for the detection and staging of esophageal involvement in PSS.     

New radiopharmaceuticals for receptor scintigraphy and radionuclide therapy.

In vitro data have demonstrated a high amount of receptors for various hormones and peptides on malignant cells of neuroendocrine origin. Among these, binding sites for members of the SST-family (hSSTR1-5) are frequently found, and their expression has led to therapeutic and diagnostic attempts to specifically target these receptors. Receptor scintigraphy using radiolabeled peptide ligands has proven its effectiveness in clinical practice. In addition, initial results have indicated a clinical potential for receptor-targeted radiotherapy. Based on somatostatin (SST) receptor (R) recognition, the novel radiopharmaceuticals 111In/90Y-DOTA-lanreotide developed at the University of Vienna as well as 111In/90Y-DOTA-DPhe1-Tyr3-octreotide (NOVARTIS) both have provided promising data for diagnosis and treatment of hSSTR-positive tumors. SSTR scintigraphy using 111In-DTPA-DPhe1-octreotide has a high positive predictive value for the vast majority of neuroendocrine tumors and has gained its place in the diagnostic work-up as well as follow-up of patients. We have used 111In-DOTA-lanreotide scintigraphy in 166 patients since 1997 and have seen positive results in 93% of patients. In 42 patients with neuroendocrine tumors comparative data were obtained. As opposed to 111In-DTPA-DPhe1-octreotide and 111In-DOTA-DPhe1-Tyr3-octreotide, discrepancies in the scintigraphic results were seen in about one third of patients concerning both the tumor uptake as well as tumor lesion detection. Initial results both with 90Y-DOTA-lanreotide as well as 90Y-DOTA-DPhe1-Tyr3-octreotide has pointed out the clinical potential of radionuclide receptor-targeted radiotherapy. This new therapy could offer palliation and disease control at a reduced cost. The final peptide therapy strategy is most probably cheaper than conventional radiotherapies or prolonged chemotherapies. Overall, receptor-mediated radiotherapy with 90Y-DOTA-lanreotide/90Y-DOTA-DPhe1-Tyr3-octre otide might also be effective in patients refractory to conventional strategies.     

Visualization of bullet track and bullet by radionuclide brain scintigraphy

Radionuclide brain scintigraphy is a commonly performed examination for the confirmation of brain death. Although the absence of scintigraphically detectable flow of lipophilic tracers to the brain combined with the lack of uptake in the brain is considered consistent with brain death in the appropriate clinical scenario, the cause of death itself is usually not apparent on the scan. A case of bullet track and bullet visualization during a radionuclide brain death study with Tc-99m hexamethylpropyleneamine oxime (HMPAO) is described.     

核素肝脾显像评估部分性脾栓塞术疗效

目的探讨核素肝脾显像在评估部分性脾栓塞术（ＰＳＥ）疗效中的价值。方法对２０例肝硬化脾功能亢进病人ＰＳＥ治疗前后进行放射性核素肝脾显像。应用感兴趣区技术测定肝、脾区活性，计算脾栓塞分数（ＦＳＥ），并对ＦＳＥ与疗效及并发症间的关系进行相关分析。结果随着ＦＳＥ的增高，术后发热时间延长；术后白细胞和血小板等明显恢复，且与ＦＳＥ有明显的相关关系，ｒ分别为０６３８（Ｐ＜００５）和０８５６（Ｐ＜００１）。５例术后出现并发症的病人ＦＳＥ均在７０％以上。结论核素肝脾显像定量测定ＦＳＥ简便易行，可为临床医师准确掌握部分性脾栓塞体积和评估疗效等提供较可靠的客观依据；ＦＳＥ控制在４０％～７０％时ＰＳＥ治疗可取得较满意的疗效。     

Staging of prostatic carcinoma with radionuclide bone scintigraphy and lymphography

One hundred patients with histologically proven carcinoma of the prostate were examined by radionuclide bone scintigraphy and bipedal lymphography. In 27 cases the bone scintigram and lymphogram were positive, in 16 the bone scintigram only was positive and in 10 the lymphogram only was positive. Although radionuclide bone scintigraphy is the most useful single investigation for detecting metastatic spread from prostatic carcinoma, lymphography should be performed if the bone scintigram is negative, as it is likely to demonstrate nodal metastases in 18% of patients.     

双核素结肠显像检测结肠运动功能

目的 建立一种新的、无创性的放射性核素定量检测结肠运动功能的方法。方法 正常对照者３２例,便秘患者２４例。将Ｎａ＾１３１Ｉ密封于在胃肠道内不被消化吸收的聚氯乙烯胶囊内,受检者同时口服Ｎａ＾１３１Ｉ胶囊及＾９９Ｔｃ－硫胶体,然后定时静态双核素采集,并计算图形中心（ＧＣ）值。结果 （１）＾９９Ｔｃ－硫胶体能清晰显示结肠轮廓,对Ｎａ＾１３１Ｉ胶囊进行准确体内定位;（２）正常对照组其口盲,结肠及全胃肠道通     

核素肾皮质显像在急性肾盂肾炎中的作用

急性肾盂肾炎是一种常见的泌尿系疾病,可引起不可逆性肾实质损害——肾疤痕形成,并导致一系列并发症,如高血压、慢性肾功能衰竭等。若对其进行早期诊断和积极治疗,可避免上述异常的出现。核素肾皮质显像是一种良好的显像方法,它可用于急性肾盂肾炎的早期诊断和疗效评价。