Facial bone scintigraphy. IV. Diagnosis of bone involvement by purulent sinusitis.

Facial bone scintigraphy demonstrated bone tissue involvement by purulent maxillary sinuitis in 11 patients examined. In no case was bone involvement demonstrated by radiography. Bone scintigraphy in this respect appears more sensitive than does conventional radiography.     

Facial bone scintigraphy. V. Differentiation of purulent from non-purulent inflammation of the maxillary sinus

In a series of 25 patients 20 had a maxillary sinus not containing air at radiography, in 11 due to purulent and in 9 to non-purulent inflammatory lesion. At scintigraphy a definitely abnormal, high uptake of 99TcmDP was found in 10 and a probably high accumulation in one of the 11 with purulent sinuitis. Of the 9 patients with non-purulent inflammation 5 had a definitely normal and 4 a probably normal uptake. Thus, a differentiation between purulent and non-purulent sinuitis would seem to be possible by means of facial bone scintigraphy.     

Radionuclide esophageal and intestinal transit scintigraphy in patients undergoing radiation therapy

Radiation esophagitis and enteritis are common and significant side effects of radiation therapy. Non-invasive assessment of functional and/or anatomic changes responsible for the symptoms produced by radiation esophagitis and enteritis has been unsatisfactory. This paper demonstrates the value of radionuclide esophageal and intestinal transit scintigraphy in patients undergoing mediastinal or abdominal radiation.     

Cocaine-induced rhabdomyolysis. Findings on bone scintigraphy.

During the examination of a young patient with acute renal failure, bone imaging was performed for evaluation of possible osteomyelitis. Marked soft tissue activity was seen on the bone scan. The patient admitted to recent intravenous cocaine use. Vasoconstriction from cocaine use was thought to induce rhabdomyolysis, which led to acute renal failure with myoglobulinuria.     

99mTc-MIBI scintigraphy in untreated stage III multiple myeloma: comparison with X-ray skeletal survey and bone scintigraphy

Technetium-99m 2-methoxyisobutylisonitrile (99mTc-MIBI) is a lipophilic agent that has been proposed as a useful tracer for the detection of disease sites in patients with multiple myeloma (MM). We performed a prospective study to determine the potential of 99mTc-MIBI imaging for the evaluation of the extent of primary disease in patients with advanced stage MM, compared with skeletal survey and bone scintigraphy. Twenty patients with advanced stage MM at initial diagnosis underwent whole-body 99mTc-MIBI imaging, together with contemporaneous skeletal survey and bone scintigraphy. The findings of 99mTc-MIBI imaging were correlated with the results of skeletal survey and bone scan. All 99mTc-MIBI scans were positive for the presence of active MM, whereas skeletal surveys were positive in 18 patients (90%) with osteolytic lesions. Bone scintigraphy demonstrated MM in only 15 patients (75%). In two patients with no detectable lesions on skeletal survey, 99mTc-MIBI imaging revealed uptake in the spine, corresponding to the abnormalities seen on magnetic resonance imaging (MRI). With respect to the localization of bone lesions, 99mTc-MIBI imaging was superior to bone scintigraphy in 15 patients (75%) and had concordant results with bone scintigraphy in four (20%). 99mTc-MIBI imaging is a very sensitive imaging modality for the identification of the extent of disease in patients with advanced MM. It is clearly superior to bone scintigraphy and complements the results of skeletal survey by finding additional disease sites. Hence, in active MM patients, 99mTc-MIBI imaging has the potential to detect bone marrow disease that cannot be detected by skeletal survey and bone scintigraphy.     

Progressive myositis ossificans. Utility of bone scintigraphy

47 year old woman affected by myositis ossificans, with muscular calcifications in her evolution. Bone scintigraphy showed increased polyfocal activity as well as uptake of different intensity in soft tissues. The bone scintigraphy allows for early identification of ossification areas in soft tissues, as it can even detect injuries earlier than that observed with other image techniques. It is considered to be very useful in the diagnosis and establishment of the extension of the process, as well as follow-up.     

High-resolution bone scintigraphy of the adult wrist.

Bony anatomic landmarks of the wrist (e.g., pisiform, hook of hamate, radioulnar joint, and styloid processes of the radius and ulna) were routinely identified in 28 adult patients examined for wrist pain. With the wrists prone and immobilized, bone scintigrams were obtained for 500,000 counts with an asymmetric (133 to 161 keV) Tc-99m energy window and either a converging (best choice) or straight-bore, high-resolution collimator. High-resolution scintigraphy precisely localized degenerative joint disease (nine patients), scaphoid fractures (five), pisiform fracture (one), lunate avascular necrosis (one), radioulnar arthritis (one), septic or inflammatory arthritis (six), ulnocarpal impingement (two), and reflex sympathetic dystrophy syndrome (two). Images obtained palm down with the wrist in ulnar deviation helped identify increased uptake within the scaphoid. Fracture and significant bone or joint disease were excluded in one patient.     

Multiple myeloma evaluated with 201Tl scintigraphy compared with bone scintigraphy.

The purpose of this study was to investigate the clinical usefulness of 201Tl chloride scintigraphy in the diagnostic evaluation of 20 patients with multiple myeloma (19/20 patients) or extramedullary plasmacytoma (1/20 patients) in comparison with bone scintigraphy. METHODS: Both 201Tl and bone scintigraphy were performed to obtain planar images on the same instrument. RESULTS: 201Tl scintigraphy showed increased uptake in 15 of 20 patients (75%) and was negative in 5 of 20 patients (25%). In addition, 201Tl scintigraphy of multiple myeloma was more useful in detecting the lesions in 11 of 17 patients and less useful in 6 of 17 patients than bone scintigraphy. CONCLUSION: The combination of 201Tl and bone scintigraphy, compared with bone scintigraphy alone, shows promise in more accurately diagnosing multiple myeloma.     

Stage III thymoma: results of postoperative radiation therapy

The results of postoperative radiation therapy in 12 patients with stage III thymoma treated during 1966-1986 were reviewed. Surgical therapy consisted of total resection in one, subtotal resection in seven, and biopsy only in four. Megavoltage irradiation in the dose range of 3,000-5,600 cGy was employed, with nine patients receiving a dose of at least 5,000 cGy. The local control rate was 67%. The actuarial observed and adjusted 5-year survival rates were 57% and 75%, respectively. These results indicate that postoperative radiation therapy is an effective therapeutic modality in the control of stage III thymoma.     

Melorheostosis on three-phase bone scintigraphy. Case report.

Melorheostosis is a benign sclerosing bone dysplasia with a very unusual and characteristic roentgenographic appearance. Its scintigraphic appearance also is characteristic, with asymmetric cortical activity that may cross joints to involve contiguous bones. The authors report the appearance of melorheostosis on angiogram and blood pool phases of three-phase bone scintigraphy.     

Detection of bone metastases in patients with endocrine gastroenteropancreatic tumors: bone scintigraphy compared with somatostatin receptor scintigraphy.

Scintigraphy with somatostatin analogs is a sensitive method for the staging and therapeutic management of patients with endocrine gastroenteropancreatic (GEP) tumors. The aim of this study was to compare prospectively somatostatin receptor scintigraphy (SRS) using 111n-pentetreotide with bone scintigraphy using 99mTc-hydroxymethylene diphosphonate for the detection of bone metastases. METHODS: One-hundred-forty-five patients with proven endocrine GEP tumors were investigated. Patients were classified according to the presence of bone metastases as indicated by CT, MRI or histologic data. Group I included 19 patients with confirmed bone metastases, and group II included 126 patients without bone metastases. RESULTS: In group I, SRS was positive in all 19 patients with bone metastases, and bone scintigraphy was positive in 17 patients. Bone metastases were found to occur predominantly in patients with liver metastases. In group 11, 5 patients had recent bone surgery for fracture or arthritis. SRS showed bone uptake in 4 of these patients, and bone scanning showed abnormal uptake in 5. In 7 of the remaining 121 group II patients, SRS was negative and bone scanning showed abnormal bone uptake suggesting bone metastases. The detection of bone metastases was of major prognostic value, because 42% of group 1 patients died during a 2-y follow-up. CONCLUSION: In patients with GEP tumors, the accuracy of SRS appears to be similar to that of bone scintigraphy for the detection of bone metastases.