Lymphocytic interstitial pneumonitis: a cause of pulmonary gallium-67 uptake in a child with acquired immunodeficiency syndrome.

Lymphocytic interstitial pneumonitis (LIP) is currently recognized as a frequent pediatric manifestation of the acquired immunodeficiency syndrome (AIDS). We report the gallium scan findings in a 3-yr-old girl with this disorder and review its clinical, radiologic, and pathologic features. LIP must be a prime consideration in the differential diagnosis of diffuse pulmonary gallium uptake in pediatric AIDS patients. Further experience will afford greater perspective on the diagnostic role that nuclear medicine will ultimately play in this disease.

Axillary lymph node uptake of technetium-99m-MDP.

UNLABELLED: We sought to determine the frequency and significance of axillary lymph node visualization on bone scans performed with diphosphonates. METHODS: Consecutive 99mTc-methylene diphosphonate (99mTc-MDP) bone scans (2435) were inspected for axillary soft-tissue uptake. In positive cases, the results of physical examination, correlative imaging studies and serial bone scans were recorded, as was the site of venipuncture. RESULTS: Forty-eight studies (2%) showed axillary uptake ipsilateral to the injection site. Extravasation of tracer, documented by focal activity near the injection site, was present in every case. There was no association with axillary adenopathy, mass, induration or radiographically visible calcification. On some images, foci adjacent to the axilla were superimposed on the rib, scapula, or humerus. The bone-to-background ratio was frequently reduced; repeat imaging after 1-2 hr usually improved osseous detail. CONCLUSION: Ipsilateral axillary lymph node visualization due to extravasation of 99mTc-MDP is frequently associated with additional foci superimposed on osseous structures simulating pathology. Delayed skeletal uptake is common in such cases and necessitates a greater time interval between injection and imaging.

Effect of patient positioning on liver size estimation.

Technetium sulfur colloid imaging is widely regarded as a simple, accurate technique for the evaluation of liver size. Although numerous strategies have been proposed for standardizing measurements, none has considered the possibility of a variation depending on whether the patient is imaged erect or recumbent. We imaged several patients in both positions and observed an apparent increase in the vertical length of the liver from supine to upright. We confirmed this by demonstrating a significant increase in the vertical length of both the right and left lobes in a majority of 55 patients imaged in both positions.

ECT treatment and cerebral perfusion in Catatonia.

A 40-yr-old woman with a diagnosis of schizoaffective disorder developed catatonia in the context of a depressive episode. A dramatic decrease in perfusion of the inferior frontal, posterior temporal and parietal lobes bilaterally and in posterior frontal lobes corresponding to the motor cortices was noted on the 99mTc-HMPAO SPECT scan obtained in the acute phase. The most dramatic decreases compared to normal control subjects were observed in the left parietal and left motor cortices. The patient was treated with a five-treatment course of electroconvulsive therapy (ECT), which resulted in a complete resolution of catatonia and some resolution of her symptoms of depression. The repeat HMPAO-SPECT scan showed improved perfusion in all areas. The most dramatic increases occurred in the left parietal and left motor cortices. Decreased perfusion in motor and parietal cortices could be state-specific to catatonia. Thus, SPECT imaging may be a useful method for monitoring catatonia treatment response.

Hypofrontality and negative symptoms in major depressive disorder.

UNLABELLED: The purpose of the current study was to compare regional cerebral blood flow (rCBF) in patients with major depressive disorder (MDD) to that of healthy subjects and to examine the relationship between rCBF, depressive symptoms (DS) and negative symptoms (NS) in these patients. METHODS: Eleven psychiatric inpatients with diagnosed (MDD) and 15 normal control subjects were administered the scale for the assessment of negative symptoms (SANS) and the modified Hamilton rating scale for depression with items descriptive of NS excluded (HRSD-DS). Each patient underwent a SPECT scan using 99mTc-HMPAO at rest. Cortical and subcortical regions of interest (ROIs) were symmetrically defined in each hemisphere. Cortical-to-cerebellar perfusion ratios were established quantitatively using ADAC software. RESULTS: Subjects in the MDD group had significantly lower rCBF in the frontal cortex and cinglulate gyrus (MANOVA, p = 0.038) due to differences in dorsolateral prefrontal cortex bilaterally (right F = 7.69, p = 0.01; left F = 8.41, p = 0.01) in the right orbitofrontal cortex (F = 6.79, p = 0.02) and in the cingulate gyrus (F = 5.34, p = 0.03). The MDD group also had lower rCBF in the posterior cortical structures (MANOVA, p = 0.072), which was due to decreased perfusion in the right parietal cortex (F = 7.54, p = 0.01). There were negative correlations between the SANS total score and rCBF in both the left dorsolateral prefrontal cortex (Pearson's correlation coefficient r = .-67, p < 0.05) and the left anterior temporal cortex (r = -0.71, p < 0.01) in MDD patients. Additionally, there were positive correlations between HRSD scores and rCBF in the left anterior temporal (r = 0.71, p < 0.01), left dorsolateral prefrontal (r = 0.70, p < 0.01), right frontal (r = 0.82, p < 0.01) and right posterior temporal (r = 0.74, p < 0.01) cortices. Cerebral blood flow was not correlated with either mini-mental state examination scores or age. CONCLUSION: This preliminary study replicates the finding of hypofrontality in MDD and indicates that decreased perfusion is associated specifically with negative symptom severity. These results support the hypothesis that, in MDD, negative symptoms and symptoms of depression are distinct phenomena and underscore the importance of negative symptom evaluation in neuroimaging studies of MDD and other disorders.

Detection of coronary collaterals using dipyridamole PET myocardial perfusion imaging with rubidium-82.

UNLABELLED: This study evaluated the ability of dipyridamole PET myocardial perfusion imaging to detect coronary collaterals. A previous study showed an association between dipyridamole-induced coronary steal on PET imaging and the presence of coronary collaterals on angiography. METHODS: Dipyridamole PET myocardial perfusion imaging using 82Rb was performed in 45 patients who had recent coronary angiography. The stress/rest count ratio (rubidium activity with stress divided by activity at rest)-was used to express the change in regional tracer uptake with dipyridamole and was calculated manually and automatically. The accuracy of the stress/rest count ratio for detecting coronary collaterals was determined. RESULTS: A manual stress/rest count ratio < or = 0.80 identified coronary collaterals with 81% sensitivity, 92% specificity and 90% accuracy (p < 0.0001). An automated ratio < or = 0.80 had 90% sensitivity, 88% specificity and 90% accuracy (p < 0.0001). Vascular beds incorrectly identified by PET as having collaterals had an increased frequency of severe stenoses and abnormal wall motion. CONCLUSION: PET perfusion imaging using the stress/rest count ratio can serve as a unique imaging method to identify coronary collaterals noninvasively.

Value of gallium imaging in the evaluation of tattoo granulomas due to sarcoidosis.

We report the case of a patient who developed granulomas in a ten-year-old tattoo. Total body gallium scanning detected the presence of bilateral hilar adenopathy not apparent on routine chest roentgenograms and thus established a diagnosis of systemic sarcoidosis.

Detection of gastroesophageal reflux in the head and neck: the role of scintigraphy.

Patients with gastroesophageal reflux (GER) present to the head and neck specialist with a myriad of nonspecific complaints that may be manifestations of pharyngoesophageal or upper airway involvement. Numerous diagnostic tests for GER have been used in the past with varying success. In the present study, gastroesophageal scintigraphy using 99mtechnetium-sulfur colloid was used to evaluate 28 patients with head and neck manifestations of GER. The role of gastroesophageal scintigraphy as an accurate and noninvasive method of detecting GER is discussed in the context of other current diagnostic modalities.

The offensive wrist.

Fencing between injection of Tc-99m MDP and imaging resulted in a diffuse increase in radioactivity in the asymptomatic wrist of a right-handed fencer. Repeat study two weeks later showed normal distribution of radiopharmaceutical. At that time, the athlete was fenced into the patient waiting area between injection and scan.

Gallium-67 imaging in candidal esophagitis.

Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis.

Scintigraphic pattern of pneumothorax complicating Pneumocystis carinii pneumonia in patients with AIDS.

Spontaneous pneumothorax is a serious though infrequently reported pulmonary complication of AIDS. An unsuspected lung collapse was discovered via gallium scintigraphy for the study of Pneumocystis carinii pneumonia. Neither the pneumonia nor the pneumothorax were apparent on the most recent chest roentgenogram. In evaluating gallium images during the work-up of AIDS patients with associated pulmonary pathology, the possible complication of lung collapse should be considered. If pneumothorax is suspected on gallium imaging, a chest roentgenogram in expiration must be obtained for prompt delineation of this serious, yet correctable, condition.

Gallium scanning in the 'new' tuberculosis.

PURPOSE: To evaluate the findings and usefulness of Ga-67 scanning in recent cases of tuberculosis (TB). MATERIALS AND METHODS: The authors reviewed chest x-ray films and Ga-67 citrate scans of 52 patients with culture-confirmed infection caused by Mycobacterium tuberculosis treated after 1988. RESULTS: Ga-67 scans were positive in every case, delineating upper lobe lung lesions in 6 patients, diffuse involvement or lower lobe disease in 34 patients, and intrathoracic adenopathy in 15 patients. Pulmonary parenchymal lesions were not detected on x-ray films in 3 patients, and nodal lesions were not apparent in 3 patients. In addition, in 6 patients cervical adenopathy was detected by Ga-67 scintigraphy; 4 underwent biopsy with culture confirmation. CONCLUSIONS: Ga-67 scanning is more sensitive than routine chest radiography for detection of both TB parenchymal lung involvement and adenopathy. Ga-67 imaging facilitates the choice of biopsy sites by identifying accessible peripheral nodes. Typical patterns in recent cases of TB differ significantly from the upper lobe predilection of classical TB.