Demonstration of gastroesophageal reflux in children by radionuclide gastroesophagography.

Twenty-five infants and children with proved gastroesophageal reflux were studied by radionuclide gastroesophagography to determine its sensitivity in detecting reflux. Patients swallowed an inert radiotracer (Tc-99m sulfur colloid) and gamma camera images of the stomach and esophagus were made with and without abdominal pressure. The test was easy to perform and was well tolerated. Reflux was demonstrated in 20 patients (80%); this compared favorably with barium gastroesophagography.     

Demonstration by radionuclide imaging of possible vascular steal from a renal transplant.

Radionuclide studies in a renal-transplant patient with congestive heart failure suggested vascular steal from the renal allograft by a contralateral femoral arteriovenous fistula. These reliable, noninvasive diagnostic procedures have potential use in similar settings to evaluate allograft perfusion and function. Correction by removal of the fistula was demonstrated.     

Frequency and pattern of radionuclide administration to medical patients in a general hospital

As part of a drug surveillance programme details of nuclide administration were recorded for 5288 consecutive patients admitted to the medical wards of a large general hospital.Overall use of nuclides amongst this group was found to be low, and multiple exposure during one hospital admission was rare. Exposure to radiation as a result of nuclide administration is not a major hazard when compared to the diagnostic information provided.     

Gastroesophageal reflux in children: radionuclide gastroesophagography

Sixty-five symptomatic infants and children underwent radionuclide gastroesophagography, acid reflux testing, and barium esophagography with water-siphon testing to evaluate the clinical efficacy of the scintigraphic technique in detecting gastroesophageal reflux. After ingesting 99mTc sulfur colloid in fruit juice, patients rested beneath the gamma camera for 30-60 min while esophageal activity was monitored continuously. By using the acid reflux test as a standard of comparison, the sensitivity of radionuclide gastroesophagography was 75%. Because of its physiologic nature, low radiation exposure, and convenience, radionuclide gastroesophagography warrants further evaluation as a screening test for gastroesophageal reflux.     

Guidelines for direct radionuclide cystography in children

These guidelines, which summarise the views of the Paediatric Committee of the European Association of Nuclear Medicine, provide a framework which may prove helpful to nuclear medicine teams in daily practice. They contain information on the indications, acquisition, processing and interpretation of direct radioisotope cystography in children. The guidelines should be taken in the context of "good practice" and any local/national rules which apply to nuclear medicine examinations.     

Subintimal dissection of peritoneovenous shunt tubing. Demonstration with radionuclide study

A case report is presented in which malfunction of a peritoneovenous shunt was caused by subintimal dissection of the venous end of the shunt tubing. The radionuclide shunt patency study demonstrated a collection of radioactivity at the venous end of the tubing, representing the abnormal intramural collection of peritoneal fluid. Scintigraphic demonstration of this complication of a peritoneovenous shunt has not been reported previously.     

The pattern of radionuclide scrotal scan in torsion of testicular appendages

The aim of this study was to define the radionuclide scrotal imaging (RSI) pattern in cases of torsion of testicular appendages and to correlate it with the duration of symptoms. Two hundred and seventeen patients with acute scrotal pain were evaluated prospectively during the past 13 years. Two groups of patients were defined according to the interval between the onset of symptoms and the performance of RSI: group A comprised patients in whom RSI was performed within 5 h after the onset of symptoms, while group B comprised patients in whom RSI was performed between 5 and 24 h after the onset of symptoms. An SPX-4 Elscint or an Apex 405 gamma camera with a parallel hole or converging collimator was used. Between 5 and 15 mCi of technetium-99m pertechnetate was injected as a bolus intravenously. The radionuclide angiogram consisted of six to eight consecutive 5-s frames. The scrotal static scan was obtained immediately following the radionuclide angiogram. The hot dot sign, which is a small spot of increased tracer perfusion and uptake on RSI, was not present during the first hours after the onset of symptoms. Therefore, RSI is inaccurate and is not indicated for the diagnosis of torsion of testicular appendages of less than 4–5 h duration. The hot dot sign was, however, demonstrated on the RSI in 45% of the patients with scrotal pain lasting between 5 and 24 h. The overall sensitivity and accuracy of RSI in diagnosing torsion of testicular appendages in this group of patients were 68% and 79%, respectively. In all the patients with a positive hot dot sign, torsion of testicular appendages was found at exploration (specificity 100%). Therefore, the hot dot sign was found to be pathognomonic of torsion of testicular appendages.     

Demonstration of collateral pathways in superior vena cava syndrome by means of radionuclide venography

Radionuclide venography was used to study lesions producing obstruction in the superior vena caval system. This procedure is a simple and safe diagnostic method; it offers precise information regarding the site and degree of venous obstruction and the extent of the collaterals. It is useful not only in diagnosis, but also in radiotherapy planning and follow-up evaluation.     

Evaluation of viral myocarditis in children by radionuclide method

Evaluation of viral myocarditis is essential for the clinician to assess the prognosis. In this study, Tl-201 myocardial scintigraphy and Tc-99m gated cardiac blood pool scan were performed in 16 patients with myocarditis diagnosed by clinical symptoms and laboratory findings and these nuclear medicine techniques were followed up for 5 years. Exercise Tl-201 scintigraphy using a bicycle ergometer was performed in 8 patients by SPECT imaging. There were mild to severe persistent defects found in all cases (100%), but pressure rate products showed normal response. The Tl-201 defect ratio improved gradually, but did not change significantly. In the resting Tl-201 image one of 16 patients showed severe multifocal defects. LVEF increased significantly from 1 year to 5 years after onset, while RVEF measured by gated blood pool scans showed slight increases 3 years to 5 years after diagnosis. It was concluded that myocardial perfusion improved only incompletely. Cardiac function (LVEF and RVEF) improved gradually, and pressure rate products were normal. Myocarditis should therefore be followed up in order to assess the prognosis; moreover, the relationship of myocarditis to dilated cardiomyopathy needs to be further studied.     

Demonstration of intracardiac tumor and its associated hemodynamic derangement by radionuclide angiography

A case of malignant lymphoma primarily involving the heart is reported for the first time in which the tumor per se and its accompanying hemodynamic abnormalities were demonstrated by radionuclide angiography (RNA). The patient had severe and progressive failure of the right side of the heart of obscure origin. The tumor was pathologically proven to have involvement of the pericardium, right atrium, and right ventricle, causing significant tricuspid and pulmonic obstruction.     

Demonstration of persistent left superior vena cava by first pass radionuclide angiography

A case of the left superior vena cava draining to the coronary sinus without associated intracardiac shunt was initially demonstrated by first pass radionuclide angiography. The patient had atypical chest pain for 8 years, and had sick sinus syndrome with a long cardiac pause. Cardiac catheterization confirmed this diagnosis, and a transvenous pacemaker was successfully implanted through the left superior vena cava.     

Cutaneous fistula communicating with the hip in a patient with a painful total hip prosthesis. Demonstration by radionuclide arthrography

Radionuclide arthrography is becoming increasingly useful in the evaluation of femoral component loosening in patients with a painful total hip prosthesis. Additional potential advantages of radionuclide arthrography include detection of abnormal communications with the hip, such as bursae, abscess cavities, and fistulas. A case of cutaneous fistula communicating with the hip in a patient with loosening and infection of the femoral component of the total hip prosthesis that is clearly demonstrated by radionuclide arthrography is presented.     

放射性核素骨显像在神经母细胞瘤中的研究价值

目的:探讨放射性核素骨显像在神经母细胞瘤的分期、治疗方案的选择和预后中的研究价值.方法:回顾性的分析了52例神经母细胞瘤患儿的临床资料及放射性核素骨显像的表现.结果:52例NB患儿Ⅰ期2例,Ⅱ期7例,Ⅲ期8例,Ⅳ期35例,其中Ⅳ期患儿在发病早期占绝大多数(67.3%).核素骨显像阳性33例(63.5%),阴性19例(36.5%);33例核素骨显像阳性的患儿,多个浓聚病灶的患儿28例(84.8%),单个浓聚病灶的患儿5例(15.2%),以多灶性转移为主;四肢长骨、脊柱、颅骨、肋骨、骨盆及肩胛骨受累分别为26例(78.8%)、17例(51.5%)、15例(45.5%)、12例(36.4%)、9例(27.3%)及2例(6.1%).有36例患儿出现原发灶显影.结论:放射性核素骨显像可做为神经母细胞瘤骨转移的首选诊断方法,对NB的分期、选择治疗方案和判断预后意义重大.     

Indirect radionuclide renocystography for determination of vesico-ureteral reflux in children

Indirect radionuclide renocystography (IRRCG) is a method for the detection of vesico-ureteral reflux by analysis of the activity-time curves over the kidneys and bladder during voiding of urine about 30 min after intravenous administration of a radioactive indicator. This paper presents a new method for detection of reflux by a statistical test, the magnitude of the reflux is evaluated by the reflux volume per 1.73 m² body surface area. Residual urine volume and urine voiding efficiency are also calculated. In a retrospective study of 154 children examined for renal and urological diseases consisting mainly of urinary tract infections, vesico-ureteral reflux was found by IRRCG in 16% of the kidneys (23% of the children). Reflux volumes were below 10 ml/1.73 m² in 90% of the children with reflux. The mode value of the reflux volume was 2 ml/1.73 m². For a subgroup of 97 children, the results were compared with micturating cysto-urethrography (MCU). This showed that a negative IRRCG in conjunction with the renal mean transit time of the radioactive indicator determined by gamma camera renography could be used as a screening test for vesico-ureteral reflux when MCU was considered a true reference method. Hence, about 75% of the invasive and high radiation dose MCU can be replaced by the non-invasive and low radiation dose IRRCG. The discrepancies between the two methods and the reasons for them are discussed.