Scrotal scintigraphy in varicocele compared with physical examination and venography

Scrotal scintigraphy using a gamma-camera and 740 MBq of 99mTc-labeled human serum albumin was performed on 43 patients with suspected varicocele. In 39 patients (37 left-sided, 2 bilateral) with proven varicoceles, sensitivities by the static and dynamic images were 92.3% and 51.3%, respectively. There were no false positive cases in either image (4 cases with no varicocele). It has been suggested that static images are useful for the detection of varicocele in infertile men. A comparison between the static and clinical grades showed that the static grades appeared to become higher in proportion to the clinical grades. A comparison between the static grades and the diameter of the internal spermatic vein (ISV) showed that the mean value of the diameter of the ISV in SG 1, SG 2 and SG 3 was 4.1 +/- 0.66 mm, 5.1 +/- 0.68 mm, and 6.2 +/- 0.79 mm, respectively. Patients with higher static grades had ISVs of significantly larger diameter (SG 1 vs SG 2; p less than 0.05, SG2 vs SG3; p less than 0.01, SG 1 vs SG 3; p less than 0.01, t-test). A comparison between the dynamic images and the degree of reflux in the ISV showed that patients with positive dynamic images had a significantly greater degree of reflux (p less than 0.01, Chi-square test). From these observations, scintigraphic findings would reflect the degree of reflux in the ISV, the diameter of ISV, and the size of the varicocele. Furthermore, from the remarkable changes between pre- and post-therapeutic findings on the scintigrams, therapeutic effects could be easily and objectively assessed by scintigraphy.     

Complication rate with supine phlebography.

The incidence of complications following supine phlebography was studied in 109 patients (142 legs) retrospectively and 89 patients (106 legs) prospectively. Virtually all patients had some discomfort during the procedure, while three patients had delayed pain for up to 4 days following examination. Three patients developed hives, one of whom also had bronchospasm. There were two cases with subcutaneous extravasation. The shorter endothelial contact time of supine phlebography compared to the semiupright technique might explain the reduced incidence of pain.     

Radionuclide venography in the management of proximal venous occlusion. A comparison with X-ray contrast venography.

Ascending contrast venography often fails to show the proximal venous system when there is co-existing occlusion of femoral or iliac veins. Retrograde and pertrochanteric venography both have severe limitations in terms of invasiveness and reliability. Radionuclide venography (RNV) is suggested as a less invasive alternative. 100 patients were investigated by both RNV and X-ray contrast venography (XRV). There was a 72% overall correlation between two methods of investigation. The proximal definition of XRV was limited in those cases with femoral obstruction. RNV, however gave progressively better views as imaging became more proximal and this was accentuated in the presence of femoral or iliac occlusion. RNV is simple and easy to perform and less invasive than XRV. The definition at calf level is such that it cannot at this stage replace XRV as the standard diagnostic procedure. However, in patients with proximal occlusions it gives more reliable information than that obtainable by ascending contrast venography.     

Cardiac output by impedance cardiography: two alternative methodologies compared with thermodilution

One critical component of the Kubicek (8) stroke volume equation, used to measure cardiac output by impedance cardiography, is dZ/dt(max). The present study, conducted on six anesthetized dogs, compared impedance cardiac output derived using two alternative methods of quantifying dZ/dt(max), with simultaneous thermodilution measures. Values for dZ/dt(max) quantified relative to dZ/dt = 0 baseline and relative to the dZ/dt B-point were entered into the Kubicek equation to generate cardiac output measures designated as impedance-A and impedance-B, respectively. Emphasis was placed upon evaluating impedance cardiac output within its accepted limits as a relative change measure. Systematic alterations in cardiac output were produced by intravenously administered isoproterenol, phenylephrine and nitroprusside. Drug-induced changes in cardiac output measured by the impedance-A method were statistically identical to thermodilution. For the impedance-B method, similarity to thermodilution was limited to two of the three drug conditions. Correlations of impedance cardiac output with thermodilution tended to be higher for the impedance-A method. Together with theoretical and practical considerations, these results support quantification of dZ/dt(max) relative to dZ/dt = 0 when used in the Kubicek stroke volume equation.     

Lower-extremity venous thrombosis: comparison of venography, impedance plethysmography, and intravenous manometry

This study was undertaken to compare impedance plethysmography with lower-extremity venography and venous manometry in the diagnosis of acute deep venous thrombosis (DVT) of the lower extremity. Ninety-six extremities were studied. In this population, in which the prevalence of acute DVT was 43.8%, plethysmography had a sensitivity of 86.8% and a specificity of 72.0%. The predictive value of abnormal findings at plethysmography was 70.2%, and the predictive value of normal findings at plethysmography was 87.8%. Venous manometry was performed successfully in 89 extremities. A statistically significant difference was shown in the mean intravenous pressure between patients with and without acute DVT. However, there was considerable overlap between the two populations, limiting the predictive value of impedance plethysmography in any given patient.     

Cervicovertebral phlebography: pathological results.

Cervical phlebography via the femoral vein approach was done in patients with spinal tumors, cervical radiculopathies, and myelopathies. Tumors originating from or extending into the spinal canal readily compress and obstruct the epidural venous plexus. Because of the lateral position of the epidural veins, the foraminal veins are deformed when cervical roots are compressed in the intervertebral foramina by spondylosis of the uncinate processes or lateral disk herniation. In congenitally narrow canals without significant spondylotic bars, the epidural veins were not opacified. Nonfilling of veins was also seen when the canal was narrowed by multiple spondylotic bars. With a few or even a single spondylotic bar, the epidural veins opacified but this was interrupted at the affected levels. When a significant spondylotic bar was associated with a narrow canal higher up, filling of the epidural veins at the level of the bar was completely arrested.     

Thrombosis following phlebography with ionic and non-ionic contrast media.

The side-effects at phlebography of the lower limb were evaluated using an ionic contrast medium, meglumine-metrizoate, and a non-ionic contrast medium, metrizamide. A post-phlebographic accumulation of 125I-fibrinogen was found in 6 patients examined with meglumine-metrizoate indicating a post-phlebographic thrombosis. Ten patients were examined with metrizamide with no post-phlebographic increase in 125I-fibrinogen uptake. Though the groups are small the difference is statistically significant at the 0.2 per cent level.     

Interobserver variability in the interpretation of contrast venography, technetium-99m red blood cell venography and impedance plethysmography for deep vein thrombosis

Contrast venography (CV) is the standard technique for diagnosing deep vein thrombosis (DVT). Newer noninvasive tests have also proven efficacious. However, there is a lack of data on the level of agreement among observers in their interpretation of the results of the various tests. After agreeing on well-defined criteria, three experienced observers assessed, blindly, the results of tests performed over a 4-month period on 117 patients who were suspected clinically of having had a first episode of DVT. The kappa statistic was used to measure the level of agreement beyond chance for CV (69 patients), red blood cell venography (RBCV) (82 patients) and impedance plethysmography (76 patients). The results of CV were assigned to normal, abnormal or inadequate categories, and those of RBCV and IPG to normal, equivocal or abnormal categories. The kappa values for CV, RBCV and IPG ranged from 0.53 to 0.56, 0.42 to 0.56 and 0.90 to 0.91 respectively. Values greater than 0.75 represented excellent agreement beyond chance and those between 0.40 and 0.75 represented fair to good agreement. Excellent kappa values were obtained for IPG because interpretation of the results of this method is entirely objective. Although the values for CV and RBCV showed good to fair agreement, there was a greater degree of observer variation, despite the well-defined criteria, indicating the subjectivity of interpretation of these test results. It is concluded that the kappa statistic can be used to measure observer variation of the results of tests for diagnosing DVT and may serve as a quality control tool for studies in which more than one person interprets the results.     

Cerebral venography with MR

The authors describe a two-dimensional time-of-flight magnetic resonance (MR) angiography technique to create projection venograms of the head. The technique was applied to 27 healthy volunteers and 39 patients. The superior sagittal and straight sinuses, the internal cerebral veins, and the Galen vein were visualized in all the volunteers. Other veins were seen in a high percentage of subjects. Systematic comparison of digital subtraction angiography (DSA) after intraarterial contrast medium injection and MR venography in patients showed good correlation between the two techniques. MR venography proved helpful in identifying thrombosis or patency of cerebral veins and sinuses and showed collateral venous drainage and venous drainage from arteriovenous malformations. There was good correlation between conventional contrast angiography and MR venography. In conclusion, MR venography is considered reliable for showing the cerebral venous system and provides information additional to that of conventional spin-echo imaging.     

Transfemoral lumbar epidural venography.

Lumbar epidural venography performed in 107 patients with normal or nondiagnostic myelograms resulted in correct preoperative diagnosis in 25 of 27 patients (92%) with herniated disc disease and three of six patients (50%) with nerve root compression without associated disc herniation. Compression or occlusion of an epidural and/or radicular vein at the disc level is the most significant venographic abnormality. Potentially confusing venographic findings such as flow defects, extravertebral veins mimicking epidural veins, and occlusion of radicular veins by the catheter must be recognized to prevent false diagnoses. Lumbar epidural venography is valuable for the diagnoses of herniated lumbar discs not demonstrated by myelography.     

A comparison between phlebography,radioisotope venography,and 99mTc Urokinase scintigraphy for the detection of deep vein thrombosis

In a series of patients suspected for deep vein thrombosis a comparison was made between phlebography, radioisotope venography with the aid of ^99mTc labeled macroaggregates, and ^99mTc Urokinase scintigraphy. A good degree of correlation was found between all three techniques, although ^99mTc Urokinase tended to localize somewhat aspecifically in the vessels around the thrombosis. It was concluded that the technique of choice was radioisotope venography using ^99mTc macroaggregates (RIV). With this technique both the circulating disturbances and the precise localisation of thrombi (as hot spots) could be demonstrated, thus providing the information to be obtained from phlebography and Urokinase scintigraphy in one simple study. An additional advantage of radioisotope venography (RIV) is that a lung scintigram can also be made. A significant number of patients with signs of deep vein thrombosis also showed positive lung scintigrams.Based on a paper presented to the First Congress of Nuclear Medicine of the European Nuclear Medicine Society, Lausanne, 12–15 May 1976