Subperiosteal hematoma. Another scintigraphic "doughnut"

The "doughnut" sign has been described frequently in brain and skeletal scintigraphy, but not previously in a subperiosteal hematoma associated with neurofibromatosis and focal gigantism. The primary cause and evolution of this skeletal "doughnut" sign is discussed; a brief review of other causes of this scintigraphic finding also is given.     

"Doughnut" sign in brain scanning.

The significance of the "doughnut" sign at present is relegated to characterizing the morphology of a lesion. The use of the "doughnut" sign in differential diagnosis should not be attempted except in specific clinical contexts, and never excluding other evidence. The "doughnut" sign in scanning together with other studies such as angiography and computerized axial tomography gives additional characterizing data in the neuroradiologic evaluation of a patient.     

Pelvic "doughnut". Sign of incidental pregnancy on bone scintigraphy

The "doughnut" sign as a scintigraphic pattern compatible with a gravid uterus was observed on the multiphase bone scan. Awareness of this scintigraphic finding should alert the nuclear physician to the possibility of incidental pregnancy.     

核素骨显像在骶骨肿瘤术前诊断中的应用

目的 评价术前骨显像在骶骨肿瘤诊断中的临床价值。方法103例骶骨肿瘤患者术前进行了99Tcm-亚甲基二膦酸盐（MOP）全身骨显像,其中39例加做了局部断层显像。全身显像用于观察有无多骨病变及骶骨肿瘤对显像剂的摄取;断层显像用于进一步观察骶骨肿瘤的核素摄取特征。结果该组恶性肿瘤为65例,良性病变38例。骨显像在17．5％（18／103）的患者中检出了多发病灶,51．7％（12／21）的转移性骶骨瘤患者在骨显像上仅表现骶骨单发病变。骶骨肿瘤表现为放射性减低型者在平面显像中占46．6％（48／103）,在断层显像中占84．6％（33／39）。放射性浓聚型或伴局部浓聚的放射性减低型骶骨肿瘤多为恶性病变;而单纯的放射性减低型骶骨肿瘤在无多骨病变发生的情况下多为良性病变;呈现“炸面圈”征的骶骨肿瘤则多为骨巨细胞瘤。结论骶骨肿瘤术前骨显像有助于全身多发病变的筛查,但对于单发的转移性肿瘤其诊断价值有限;观察肿瘤对显像剂的摄取特征,可为其鉴别诊断提供帮助。     

"Doughnut" technetium pyrophosphate myocardial scintigrams. A marker of severe left ventricular dysfunction

The "doughnut" pattern on Tc-99m pyrophosphate (PPi) myocardial scintigraphy is characterized by a border of tracer uptake surrounding a central zone of relatively decreased activity. This pattern is generally associated with large transmural anterior myocardial infarcts (MI) caused by occlusion or critical stenosis of the left anterior descending coronary artery. Such infarcts typically involve a significant portion of the anterior wall and are associated with a complicated clinical course and poor prognosis. In order to evaluate the relationship between the presence of the doughnut pattern and left ventricular (LV) function, radionuclide ventriculography was performed within 15 days after infarction in 58 patients with transmural anterior MI. In patients without previous MI, 15/38 (39.5%) had doughnut scintigrams. These patients demonstrated significant reductions in LV ejection fraction (EF) (28 +/- 10% versus 45 +/- 12%, P less than 0.001) and normalized LV wall motion scores (29 +/- 11% versus 61 +/- 10%, P less than 0.001) when compared with patients with "nondoughnut" scintigrams. Patients with doughnut scintigrams had a significantly greater incidence of severe septal hypokinesis (P less than 0.001) and apical dyskinesis (P less than 0.03). LV end-systolic volumes were also larger in the patients with doughnut scintigrams (73 +/- 32 ml versus 40 +/- 17 mI/M2, P less than 0.005). In contrast, there was no significant difference in LVEF, normalized LV wall motion score, or LV volumes between doughnut and nondoughnut groups in patients with previous MI.     

An unusual cause of "doughnut" sign in brain scanning.

The "doughnut" sign in brain scanning was originally described in association with certain mass lesions having central necrotic, cystic, or avascular areas. A case in which this pattern occurred as a result of a superficial lesion, a large cephalhematoma, is presented.     

Giant cell tumor of the fourth metacarpal bone

Giant cell tumor is among the rare tumors of the bone. We present a case of metacarpal giant cell tumor with radiographic, computed tomographic (CT) and histologic findings, as well as grey scale and Doppler sonographic features. We also present the "doughnut"-shaped appearance on scintigraphy of the lesion, which has not been shown on a metacarpal giant cell tumor.     

A case of idiopathic aseptic osteonecrosis of the patellae: repeat study of Tc-99m HMDP bone scintigraphy in a reparative phase]

A 37-year-old woman entered our hospital because of bilateral knee pain. Tc-99m HMDP bone scintigram demonstrated increased activity in the bilateral patellae and cold lesion in the center and left lateral segments of the left patellae, so-called doughnut pattern. Trephine biopsy was performed to prove bilateral idiopathic asepct osteonecrosis of the patellae. The knee pain subsided and a bone scan 5 months later demonstrated increased activity in the bilateral patellae more widely than initial scan. We report the usefulness of Tc-99m HMDP bone scintigraphy to observe a reparative phase of idiopathic asepct osteonecrosis of the patellae.     

Doughnut phenomenon in bone scintigraphy

A doughnut phenomenon was observed in bone scintigraphy in three cases of metastatic thyroid carcinoma to the skull. Additional dynamic and static studies were performed to evaluate the relative roles of vascularity, vessel permeability and new bone formation in producing this phenomenon. This was accomplished through the use of 99mTc-diphosphonate, 99mTc-labeled red blood cells and 99mTc-pertechnetate. The important factor was found to be a new bone formation. Late uptake of diphosphonate was shown only in the periphery of the lesion, where formation of new bone takes place. This occurred even in the presence of increased vascularity and vessel permeability in the lesion as a whole.     

The uterine doughnut: potential pitfall for technetium-99m gastrointestinal bleeding study

A case of intense uterine hyperemia secondary to recent pregnancy, the so-called uterine "doughnut" sign, is presented as a potential pitfall in the evaluation of gastrointestinal bleeding. Delayed imaging helped in evaluating the lack of serial change in appearance and the failure of progression of the scintigraphic abnormality.     

Doughnut lesions of the cranial vault: an hereditary bone dysplasia

We describe a large family of whom twelve members were shown to have a benign bone dysplasia known as "doughnut lesions of the skull". Its clinical features are pathological fractures and cranial lumps; its radiological features comprise doughnut cranial lesions, double cortical lines of the vertebral bodies ("bone in bone"), squaring of the metatarsal and metacarpal bones, osteopenia, and tubulation defects of the diaphyses of the long bones. We believe the disease to be transmitted as an autosomal dominant trait.     

Comparison of fluorodeoxyglucose positron emission tomography and "conventional diagnostic procedures" for the detection of distant metastases in breast cancer patients

The presence of distant metastases is the main prognostic factor in patients with breast cancer and has a significant influence in the choice of therapy. Therefore, chest X-ray, bone scintigraphy and ultrasound of the abdomen are performed to detect distant metastases at diagnosis and follow-up. Fluorodeoxyglucose positron emission tomography (FDG PET) has been shown to provide sensitive detection of primary tumour and metastases for many tumour entities, but little information is available about the diagnostic value for breast cancer patients. This study retrospectively compared FDG PET for detection of metastatic disease with chest X-ray, bone scintigraphy and ultrasound of the abdomen, referred to as "conventional diagnostic procedures" (CDPs), in 50 breast cancer patients. Imaging procedures were analysed in a blinded fashion with the results classified as "no evidence of metastases", "equivocal" and "evidence of metastases". Clinical follow-up and the results of other imaging modalities including computed tomography and magnetic resonance imaging were used to determine if metastases were present. FDG PET identified metastatic disease with a sensitivity and specificity of 86% and 90% as compared to 36% and 95% for CDPs, respectively. Regarding "equivocal" and "evidence of metastases" as positive, the sensitivity of CDPs increased to 57% with a corresponding specificity of 81%, whereas sensitivity and specificity of FDG PET remained unchanged. Regarding different localities of metastases the sensitivity of FDG PET was superior in the detection of pulmonary metastases and especially of lymph node metastases of the mediastinum in comparison to chest X-ray, whereas the sensitivity of FDG PET in the detection of bone and liver metastases was of the same magnitude as compared with bone scintigraphy and ultrasound of the abdomen.     

Incidental diagnosis of pregnancy on bone and gallium scintigraphy

Bone and gallium scintigraphy were performed as part of the diagnostic workup of a 21-yr-old woman who presented at our institution with a history of progressively worsening low back pain over a 1-wk period of time. The angiographic phase of the bone scan demonstrated a well-defined radionuclide blush within the pelvis just cephalad to the urinary bladder with persistent hyperemia noted in the blood-pool image. We attribute these findings to a uterine blush secondary to the pronounced uterine muscular hyperplasia, hyperemia, and edema that accompany pregnancy. Gallium scintigraphy demonstrated intense bilateral breast accumulation of the imaging agent in a typical doughnut pattern which is commonly found in the prelactating and lactating breast. Also demonstrated was apparent gallium accumulation in the placenta. This case is presented to emphasize the radionuclide findings that occur during pregnancy, particularly the incidental finding of radionuclide blush during the angiographic phase of a radionuclide scintigraphy which should alert the nuclear physician to the possibility of pregnancy in a woman of childbearing age.     

皂泡征-罕见的何杰金淋巴瘤骨病变的X线表现

分析９例何杰金淋巴瘤软罕见的皂泡状骨病变之Ｘ线表现及其形成机制,提高对有类似表现的骨肿瘤鉴别诊断的认识。材料与方法,１９５９－１９９５年间有３２例ＨＤ骨受侵病例。９例表现为包状骨病变,男８例,女１例。年龄１４－６５岁。     

Obstructive jaundice and advanced gastric carcinoma--correlation with its histopathology

One hundred twenty-nine patients with far advanced or recurrent gastric carcinoma underwent computed tomography (CT) of the abdomen. There were three histologic types: differentiated (n = 41), undifferentiated (n = 68), and unclassified (n = 20). Eighteen patients who had developed obstructive jaundice were retrospectively studied to elucidate the nature of obstruction with histologic correlation. In differentiated carcinomas tumor tended to grow in an expansive fashion. A fairly large, well-defined lymph adenopathy was observed on CT. The extrahepatic bile duct surrounded by lymph nodes appeared as "doughnut sign" in six of eight patients. Undifferentiated gastric carcinoma had tendency to extend infiltratively. Bile duct obstruction was only a part of diffuse spreading. In spite of the presence of obstructive jaundice, no discrete mass was demonstrated around the extrahepatic bile duct on CT. In none of nine patients was present "doughnut sign". The significance of lymph node dissection along the extrahepatic bile duct in patients with differentiated gastric carcinoma was emphasized. The region of hepatoduodenal and pancreatico-duodenal lymph nodes should be carefully evaluated in interpretation of abdominal CT.     

The scintigraphic "duodenal cut off sign" in acute pancreatitis

Acute pancreatitis is a dreaded complication of biliary calculus disease, and several radiographic signs have been reported in association with this condition. We report a new sign demonstrated on hepatobiliary scintigraphy, the duodenal cut off sign, seen in a patient being evaluated for stone disease and later found to have acute pancreatitis. Hepatobiliary scans are commonly performed during the initial evaluation of patients with suspected calculus disease, and visualization of this sign may indicate to the clinician that he is dealing with a more serious condition.     

Squamous cell carcinoma in a thyroglossal duct cyst and 99mTc-MIBI findings

The incidence of carcinomas in thyroglossal duct cysts is extremely low. The vast majority are papillary carcinomas, with only 14 cases of squamous cell carcinomas reported in the literature. A 78 years old male patient presented with an asymptomatic large mass in his anterior neck, considerably immobile, with inflamed overlying skin. Imaging studies confirmed the cystic nature-doughnut shape of the lesion, giving evidence of malignant infiltration of the surrounding tissues, without lymph node enlargement. Fine needle aspiration was positive for a possible squamous cell malignancy. A wide Sistrunk procedure was performed and the mass was excised along with the strap muscles and the infiltrated overlying skin. Histopathology confirmed the diagnosis of a moderately differentiated squamous cell carcinoma. In conclusion, scintigraphy with (99m)Tc-MIBI showed the characteristic doughnut sign. The rarity of this diagnosis along with differential diagnosis dilemmas are the key points of this presentation.     

A "reverse" Maffucci's syndrome: case report and short review of the literature

Maffucci's syndrome is a congenital, non-hereditary mesodermal dysplasia associated with multiple enchondromas and after some years accompanied by hemangiomas. We describe a rare case of "reverse" Maffucci's syndrome in a 42-year-old woman who has suffered from multiple hemangiomas for the last 24 years. The last two years she complained for heel pain. Bone scintigraphic examination showed abnormal findings in the left calcaneal bone. The scintigraphy, radiology and histology findings revealed multiple enchondromas, so the diagnosis was changed into Maffucci's syndrome. After one year, the left calcaneal bone showed sarcomatous transformation.