A pattern of post-traumatic demineralization of bone simulating permeative neoplastic replacement: A potential source of misinterpretation

Long bones with a prominent endosteal trabecular pattern, particularly the herringbone configuration, when immobilized, will demineralize in a striking spotty pattern which may simulate neoplastic permeative replacement of bone. The recognition of this phenomenon will obviate needless concern and investigation.     

The value of bone imaging in multiple myeloma

In a series of 20 patients with a proven diagnosis of myeloma, both full radiographic skeletal surveys and full ratio-nuclide bone images were performed. When these were compared, they showed that (i) imaging underestimated the number of areas involved by 50%, but there were no false negative whole images when compared with the radiology, (ii) large lytic areas on X-ray show as cold areas on the bone image but small ones show as normal, (iii) images that show areas of increased uptake (hot) are almost always associated with fracture, and (iv) patients with bone pain very commonly had hot images corresponding to the region of pain.4th year medical student     

Agreement between emergency physician diagnosis and radiologist reports in patients discharged from an emergency department with community-acquired pneumonia

To evaluate the level of concurrence between radiologist reports and the diagnosis of community-acquired pneumonia (CAP) in patients discharged from an emergency department (ED), a retrospective chart audit of patients discharged with a diagnosis of pneumonia or possible pneumonia from the ED during a 2-year period was conducted. Emergency physician (EP) and radiology report (RR) diagnoses were categorized as pneumonia, possible pneumonia, non-pneumonia and normal, and categories from each were compared. 815 charts were analyzed. Of 671 EP diagnoses of pneumonia, 304 (45.3%) RRs reported pneumonia and 82 (12.2%), possible pneumonia. Of 815 EP diagnoses of pneumonia or possible pneumonia, 426 (52.3%) RRs were in agreement, while 216(26.5%) were of diagnoses other than pneumonia and 173 (21.1%) were read as normal. EPs and radiologists frequently disagree on whether a patient has pneumonia or not. Perhaps it is time to revisit the gold standard status of plain chest X-ray.Presented at the 9th International Conference of Emergency Medicine, Edinburgh, Scotland, 17–21 June, 2002.     

Disco-vertebral destructive lesions (So-called Andersson Lesions) associated with ankylosing spondylitis

Radiological examination of 31 patients with established ankylosing spondylitis revealed 58 disco-vertebral destructive lesions. Careful assessment of their radiological features permitted differentiation into two main types, (1) inflammatory and (2) non-inflammatory. The inflammatory type may represent either an active inflammatory process or a late sequel to such a lesion. In this series 44 lesions were included in this category, with a marked predilection for the lumbar spine. Moreover, all were observed within the first decade following the onset of the disease.The non-inflammatory type reflects an attempt of a stress fracture in the diseased spinal column to repair by connective tissue, causing a pseudoarthrosis. Eleven such lesions were obseved in this series all occurring more than 12 years after the onset of the disease. In a much smaller group of three cases-here termed the ambivalent type — differentiation between the inflammatory and non-inflammatory types could not be established on radiological grounds alone. It is of interest that all three cases occurred within the first year after the onset of the disease.It is suggested that the term Andersson lesion should be used to include all disco-vertebral destructive lesions related to ankylosing spondylitis—be they of inflammatory or non-inflammatory pathogenesis —as the better known term Romanus lesion includes all types of circumscribed marginal destructive lesions of vertebral bodies without involvement of the disc in ankylosing spondylitis.     

‘Hot’ and ‘cold’ lesions detected by gallium-67 scintigraphy in a pyogenic liver abscess

Most pyogenic liver abscesses appear to be not in a ⁶⁷Ga-citrate study; rarely, a warm or cold area may also be seen. We present a patient with a pyogenic liver abscess that had both cold and hot areas in the ⁶⁷Ga-citrate study. This striking finding is probably related to the different stages of evolution of the abscess.     

Scintigraphic visualisation of Walker carcinoma-256 in Sprague-Dawley rats by means of 99mTc-labelled monocytes

Labelled macrophages accumulate in Walker carcinosarcoma-256 after in vivo and in vitro stimulation with a lectin and are theretically suitable for scintigraphic tumour detection. At present, routine application of the technique in man is precluded by: (1) the use of PHA, and (2) a labelling method for macrophages with considerable limitations to its application and which results in significant uptake of activity in liver and spleen. However, the purpose of the study was primarily to demonstrate the principle of a possible alternative to the use of labelled monoclonal antibodies for the scintigraphic detection of tumours.     

Positive 131Cesium scanning in parathyroid adenoma

In a case of primary hyperparathyroidism, a palpable nodule, at the base of the right lobe of the thyroid, proved cool during ^99mTc scanning, but hot when scanned with radiocesium. The uptake of this tracer was higher than the uptake of ⁷⁵Se-selenomethionine after suppression with T₃.The authors discuss the possibility of cases of false-positive radiocesium uptake in extrathyroid nodules, and in particular, the use of this tracer for the detection of parathyroid adenoma by scanning.     

Cerebrovascular doppler examination and cerebral angiography-alternative or complementary?

Summary Obstructions in the extracranial cerebral arteries can be detected noninvasively by directional Doppler ultrasound technique using indirect and direct criteria. The indirect criteria are based on measurement of flow in the common carotid and in the terminal branches of the ophthalmic artery before and after the common carotid artery and branches of the external carotid artery are compressed. With the direct criteria, internal and external carotid artery are differentiated by diastolic flow, and local inhomogeneities of flow (turbulence) are detected. Flow in the vertebral artery is picked up transorally in the oropharynx. The Doppler examination was used in 2230 patients of whom 436 underwent angiography. The results of Doppler and angiography correlated in more than 90% of the cases.     

Design and application of finite impulse response digital filters

The finite impulse response (FIR) digital filter is a spatial domain filter with a frequency domain representation. The theory of the FIR filter is presented and techniques are described for designing FIR filters with known frequency response characteristics. Rational design principles are emphasized based on characterization of the imaging system using the modulation transfer function and physical properties of the imaged objects. Bandpass, Wiener, and low-pass filters were designed and applied to ²⁰¹T1 myocardial images. The bandpass filter eliminates low-frequency image components that represent background activity and high-frequency components due to noise. The Wiener, or minimum mean square error filter sharpens the image while also reducing noise. The Wiener filter illustrates the power of the FIR technique to design filters with any desired frequency reponse. The lowpass filter, while of relative limited use, is presented to compare it with a popular elementary smoothing filter.This study was supported in part by National Institutes of Health Grants No. HL17646 and HL13851.     

Improved lesion detection with dimethyl-amino-diphosphonate: A report of two cases

In two patients with metastatic disease more lesions were detected on scintigraphs obtained with the low uptake bone-scanning agent dimethyl-amino-diphosphonate than on images produced using methylene diphosphonate. The results in these two patients provide practical support for the suggestion that bone-scanning agents with low uptake in normal bone, but high tumour-to-normal bone ratios, will allow better delineation of local bone abnormalities.     

81mKr gas and 99mTc-MAA V/Q ratio images for detection of V/Q mismatches

Methods for creating ventilation/perfusion ratio images have been reported previously using radioxenon. With the availability of ^81mKr gas, corresponding ventilation and perfusion views in multiple projections to evaluate for V/Q mismatch may be performed more readily. A technique for the creation of a functional V/Q ratio image to highlight V/Q mismatches to aid in the evaluation of pulmonary embolism is described. By removing nonpertinent and distracting information and by converting a cold spot imaging modality to a hot spot modality, these functional images aid in the synthesis of the information provided by the ventilation and perfusion images. The limitations due to technical artifacts and the advantages of using these functional images are described.Presented as a Scientific Exhibit at the Annual Society of Nuclear Medicine Meetings, St. Louis, Missouri, June 1983     

γ-Glutamyltransferase test as a new tool for identification of seminal stains

Summary A simple qualitative method for identification of seminal stains based on a high activity of -glutamyltransferase (-GTP) in human semen is described. It employs the release of -naphthylamine from N--glutamyl--naphthylamide by the -GTP action; -naphthylamine couples with Fast Garnet GBC salt to produce a strong brownish-red color. The data on its simplicity, specificity, and stability show that the present method is suitable for medicolegal examination of seminal stains as a preliminary test.     

Synovial fluid cytokine concentrations as possible prognostic indicators in the ACL-deficient knee

Approximately 44% of patients develop osteoarthritis (OA) following rupture of the anterior cruciate ligament (ACL) if the injury is left unrepaired. Restoring knee stability through reconstruction, while providing symptomatic relief, has not been shown to reduce the incidence of degenerative changes. In fact, recent studies have shown that 50%–60% of ACL-reconstructed patients go on to develop degenerative changes or frank osteo-arthritis. In light of these data, our group suggests that the cause of post-traumatic osteoarthritis is not biomechanical but biochemical. To test this hypothesis, we measured levels of nine cytokines which are important in modulating physiological and pathophysiological metabolism of cartilage in knee joint synovial fluid following ACL rupture. Our patient population contained both acute und chronic ACL ruptures. A total of 84 samples were collected and analyzed by enzyme-linked immunosorbent assay. On the basis of the data collected, we were able to identify subgroups of patients who, on the basis of their synovial fluid cytokine profile, may be at greater or leasser risk of developing post-traumatic OA. In general, patients displayed concentrations of interleukin-1 (IL-1), basic fibroblastic growth factor (bFGF), transforming growth factor- (TGF-), granulocyte/macrophage-colony stimulating factor (GM-CSF), IL-6, and IL-8 that we interpreted as being consistent with an inflammatory reaction. Of great interest is the fact that the levels of these cytokines were very similar in patients 4 weeks after injury and in chronic patients, leading us to hypothesize that a chronic smoldering inflammatory reaction persists after resolution of the acute effusion. This chronic inflammatory reaction could be the cause of cartilage degeneration seen in patients after ACL reconstruction. Furthermore, this study identified two distinct subpopulations of patients with dramatically differing levels of IL-1 and TNF- in their synovial fluids. IL-1 and TNF- were either high acutely and decreased to moderate levels over time, or they were zero acutely and remained zero or low. This is likely to be a very important observation as these two cytokines are key components of the inflammatory response and are the main intra-articular cytokines that provoke cartilage loss. It is our hypothesis that the group with high levels of IL-1 and TNF- contains the 50%–60% of the patient population which goes on to develop OA, despite knee stabilization with ACL reconstruction. Conversely, we suggest that the group whose synovial fluid contains no IL-1 or TNF- is protected from developing OA post-traumatically. IL-1-receptor antagonist protein (IRAP), the cytokine that antagonizes the biological effects of IL-1, was present acutely in our patient population; however, it was undetectable in chronic ACL-deficient knees. These data suggest the loss with time of an important cartilage-protective cytokine. The lack of IRAP chronically may allow IL-1 to act in an unrestrained manner resulting in cartilage loss. In addition, IL-1 promotes the secretion of many other inflammatory cytokines which may result in the chronic smoldering inflammatory reaction referred to above. These data encourage further study of the evaluation of cytokine concentrations in the ACL-deficient joint as a means of obtaining both prognostic and mechanistic information of clinical value to the physician.     

The reduction of inter- and intra-observer variability for defining regions of interest in nuclear medicine

The use of region-of-interest (ROI) techniques to quantify data obtained in radionuclide images is common-place. However, the reproducibility of quantitation due to inter- and intra-observer variations using particular methods of deriving ROIs is often not appreciated. We examined such variations in the results obtained by four independent observers of varying experience using four methods of depicting a ROI about an organ. The set of image data consisted of renal scans with varying target-to-background ratios, and the ROI facilities included two edge-detection methods. The results indicated that, once observers were experienced with edge-detection methods, a lower inter- and intra-observer variation could be achieved, although the technique of shrinking a ROI about a subjectively chosen display level was reasonably satisfactory. In terms or reproducibility, the least satisfactory method of depicting a ROI was the commonly used manually guided bug around arbitarily chosen display levels representing the boundary of an organ.     

Impact of CT in the neurosurgical management of intracranial tumors

Summary A total of 103 brain tumor patients examined with CT, radionuclide brain scan, and angiography or pneumoencephalography, and all surgically verified, were studied to evaluate the impact of CT on the neurosurgical handling of brain tumors. CT alone was usually sufficient for optimal handling of astrocytoma patients, angiography in most meningioma cases, and pneumoencephalography in cases with sellar, suprasellar, and some other midline tumors. Information obtained only through CT sometimes altered the therapy. Sometimes it led to biopsy instead of a meaningless attempt at a radical excision; in other cases it permitted a radical excision otherwise not possible.     

Vergleich der nach Essen-Möller berechneten Vaterschaftswahrscheinlichkeit einschließlich „Zuordnung“ mit anthropologischen Resultaten bei Einmannfällen

Zusammenfassung Nach der Formel von Essen-Möller berechnete Vaterschaftswahrscheinlichkeiten von 909 Vätern und 909 Nichtvätern, ausgedrückt als lg Y/X, verteilen sich in einer aus 2 Normalverteilungen zusammengesetzten Kurve. Der überlagernde Anteil von 5% der Fälle wird auf eine Beimengung echter bzw. falscher Terzetten mit einem populationsfremden Mann zurückgeführt. Der Mittelwert von Nichtvätern liegt bei einem höheren lg Y/X-Wert als der von Vätern. Die Zuordnungswahrscheinlichkeiten von Vätern, ausgedrückt als lg(1–Z)/Z, sind ebenfalls normal verteilt, während Nichtväter und — in geringerem Maß — serologisch nichtausgeschlossene Männer aus Ein- und Mehrmannsachen (n=910) eine nach niederen Z-Werten hin schiefe Verteilung zeigten. Serostatistische und anthropologische Urteile gehen, wie an 331 Einmannfällen gezeigt werden konnte, weitgehend parallel. In 7 Fällen kam es zum Widerspruch zwischen der serostatistischen Vaterschaftswahrscheinlichkeit (W90%) und dem anthropologischen Ergebnis (Vaterschaft sehr unwahrscheinlich bis praktisch ausgeschlossen). Bei 5 von diesen handelte es sich jedoch im eigentlichen Sinn um Mehrmannfälle.Unter Anwendung der Grundsätze des Feststellungsparagraphen des neuen Unehelichengesetzes der BRD wären 254 von 331 bei Einmannfällen beteiligte Männer aufgrund des serostatistischen Resultats (W80%) und weitere 61 aufgrund des anthropologischen als Erzeuger zu verurteilen. In 16 Fällen müßte die Klage abgewiesen werden, weil aufgrund des anthropologischen Befundes an der Vaterschaft des beteiligten Mannes ernsthaft zu zweifeln ist.

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Evaluation of probability of paternity as determined by the essen-möller formula in a given mother-child constellation

Summary Using the formula of Essen-Möller, the probability of paternity was evaluated in 909 fathers and in 909 non-fathers. The lg Y/X of these groups yield two identical curves of gaussian distribution. 5% of the total number of cases is believed to result from an admixure of true or false trios with a man outside of the normal population. Non-fathers show a higher mean value of lg Y/X than fathers. The classification possibility of fathers, expressed as lg(1–Z)/Z shows a normal distribution curve; non-fathers, however, and to a smaller extent also serologically non-excluded individuals involved in single or multiple-men cases (n=910), show an oblique curve. Evaluation of the serological and anthropological data in 331 single-man cases indicates a significant correlation. In 7 cases there was a discrepancy between the serological evaluation of paternity (W90%) and the anthropological results (paternity very unlikely or practically excluded). Five of these were multiple-men cases, however. According to the new illegitimacy law of the German Federal Republic, 254 men out of 331 single-man paternity cases should be found guilty on the grounds of serostatistical data (W80%) and an additional 61 should be found guilty of paternity on the basis of anthropological findings. 16 cases should be dismissed on the basis of serious doubt cast by the anthropological data.

     

Dystrophic intracranial calcification: CT evidence of ‘cerebral steal’ from arteriovenous malformation

Summary Two cases of dystrophic intracranial calcification due to arteriovenous malformations (AVM) are reported. The characteristic distribution is in the watershed areas and away from the AVM. Deposition of calcium on ischaemic brain tissues as a result of cerebral steal by the AVM is the probable pathogenetic mechanism.     

The lead arthrogram—Plumbography

When lead bullets, which have been discharged with high energy, impact on bone they will shatter. Should the contact with bone take place within the capsule of a joint the synovium will be outlined subsequently by trans-synovial spread of the small fragments. The curious radiologic appearance developing in consequence bears some resemblance to an orthodox arthrogram and is here termed a plumbogram.     

The binding parameters of radiolabelled monoclonal F (ab′)2 and Fab′ fragments relative to immunoglobulin G in reactions with surface-bound antigens

The binding parameters of iodine-125-labelled intact monoclonal immunoglobulin G (IgG), F(ab)₂ and Fab fragments were compared. The study was carried out with the two monoclonal antibodies (MoAbs) K13 and K16 specific for human Ig light chains K and , respectively. When testing the ¹²⁵I-MoAbs against monodisperse polymer particles coated with the specific antigens, the K_a for the F(ab)₂ fragments were similar to that for IgG, while the K_a for the Fab fragments were reduced to 10%–20% of that for IgG. The number N of effective target sites revealed with Fab was higher than with F(ab)₂ and IgG, presumably because less surface area is occupied by the small Fab molecules. The immunoreactive fraction F ranged according to IgG > F(ab)₂ > Fab. The explanation of the moderate difference between the K_a of the monoclonal Fab and the divalent IgG and F(ab)₂ was that the divalent molecules were not divalently attached to the particles. When testing the same antibody preparations against human lymphoma cells producing Ig with light chains K or , the binding results were less reliable than when particles were utilised, presumably due to antigen shedding. Different MoAbs vary in their loss of immunoreactivity due to enzymatic degradation and the radiolabelling procedure. The preparation of the radiolabelled fragments should therefore be optimized for each MoAb, and evaluation is necessary before injection. Artificial targets with a low leakage of antigen, like the monodisperse polymer particles here applied, are recommended for the in vitro evaluation of the immunoreactivity of labelled MoAb preparations.     

Sterotaxic exploration in 200 supratentorial brain tumors

Summary The authors emphasize the advantages of stereotaxic methodology in the management of 200 brain tumors. Nowadays computerized tomography is the first stage of radiologic diagnosis. Both CT scan and stereotaxic examination have been carried out in more than 35% of these tumors. Rather than a comparison of the two examinations, the authors' purpose is to attempt to demonstrate their complementarity in the assessment of location, volume, and nature of the lesion and eventually in the choice of a therapeutic attitude. Analysis of topographic data and staged biopsies, gathered from the stereotaxic space, provides the neurosurgeon with accurate information for planned surgical excision or interstitial irradiation.