A percutaneous needle biopsy technique for sampling the supraclavicular brown adipose tissue depot of humans.

Brown adipose tissue (BAT) has been proposed as a potential target tissue against obesity and its related metabolic complications. Although the molecular and functional characteristics of BAT have been intensively studied in rodents, only a few studies have used human BAT specimens due to the difficulty of sampling human BAT deposits. We established a novel positron emission tomography and computed tomography-guided Bergström needle biopsy technique to acquire human BAT specimens from the supraclavicular area in human subjects. Forty-three biopsies were performed on 23 participants. The procedure was tolerated well by the majority of participants. No major complications were noted. Numbness (9.6%) and hematoma (2.3%) were the two minor complications noted, which fully resolved. Thus, the proposed biopsy technique can be considered safe with only minimal risk of adverse events. Adoption of the proposed method is expected to increase the sampling of the supraclavicular BAT depot for research purposes so as to augment the scientific knowledge of the biology of human BAT.

Pediatric gastric emptying: value of right lateral and upright positioning.

UNLABELLED: Gastroesophageal reflux and gastric emptying are usually assessed simultaneously with a 1-hr procedure. After ingestion of radiolabeled formula sequential images are gathered when the infant is in the supine position. This position is adequate for gastroesophageal reflux assessment, but delays gastric emptying. METHODS: We studied 48 children, 1 wk to 2 yr of age, who presented with vomiting or failure to thrive. They received 99mTc-sulphur colloid in formula. After completing 1 hr supine imaging we obtained additional abdominal views after changing the position of the infant to right lateral for 30 min, and upright for another 30 min. RESULTS: The percent of gastric emptying at 60 min in the supine position was 35% +/- 19%. After 90 min, in the right lateral decubitus, the percent gastric emptying was 60% +/- 25%. At 120 min, after an upright period, the gastric emptying was 73% +/- 20%. In the supine position 19 of 48 patients showed significant emptying (defined as > 40% emptying). This increased to 41 of 48 normal studies considering the right lateral position and to 45 of 48 normal studies considering the infant upright position. CONCLUSION: Many patients with delayed gastric emptying show significant emptying just by changing position. We routinely complement gastric emptying studies with delayed views in the right lateral and upright position.

Mammoscintigraphy with technetium-99m-sestamibi in suspected breast cancer.

UNLABELLED: Our goal was to determine the clinical usefulness of 99mTc-sestamibi to identify breast cancer in patients prior to biopsy. METHODS: We studied 66 patients who received 20 mCi 99mTc-sestamibi intravenously. Lateral and anterior planar images were gathered within 30 min of the injection. Only focal increased uptake was interpreted as positive. Confirmatory pathologic diagnoses were obtained within 2 mo. The prevalence of breast cancer in our sample was 54%. RESULTS: We report an overall sensitivity of 83% and specificity of 93% for the diagnosis of breast cancer. In palpable lesions, the sensitivity was of 94% with a specificity of 91%, while in nonpalpable abnormalities the sensitivity was of 64% with a 100% specificity. Six patients with a malignancy had negative scans, four of these lesions were nonpalpable. Only two of 31 patients with benign lesions had an abnormal scan. CONCLUSION: Mammoscintigraphy with 99mTc-sestamibi has high specificity and adequate sensitivity for the noninvasive diagnosis of breast carcinomas.

Skeletal scintigraphy with technetium-99m-tetraphenyl porphyrin sulfonate for the detection and determination of osteomyelitis in an animal model.

UNLABELLED: This article explores the accumulation of 99mTc-tetraphenyl porphyrin sulfonate (TPPS4) at inflammatory sites, especially osteomyelitis, and compares the results with 111In Cl3 and 111In-WBC in an animal model. METHODS: Osteomyelitis was induced in 12 New Zealand white rabbits by injecting staphylococcus aureus in the left tibia. Three weeks later, radiographs confirmed the disease. Two hours later, after injection of 74 MBq 99mTc-TPPS4, scintiphotos of the lower extremities were acquired and repeat scintiphotos were obtained 24 hr after injection of 5.55 MBq 111In Cl3. After these studies, 24- and 48-hr scintiphotos of the lower extremities were acquired after injecting 5.55 MBq 111In-labeled WBC. RESULTS: The left tibia averaged three times the uptake with 99mTc-TPPS4 compared with right tibia; with 111In Cl3 and 111In WBC the ratios are two times. These three radiopharmaceuticals reveal positive images, but the image quality using 99mTc-TPPS4 is better, as would be expected from the more favorable physical characteristics of 99mTc and the higher uptake. CONCLUSION: The traditional combination of three-phase bone and 67Ga-citrate scintigraphy can be replaced by a single injection of 99mTc-TPPS4 with imaging as early as 2 hr. Finally, the use 99mTc-TPPS4 should result in a substantial reduction in radiopharmaceutical cost.

Mediastinal scintigraphy for parathyroid localization in hyperparathyroidism.

Two cases are reported demonstrating that mediastinal scintigraphy for hyperparathyroidism should be routinely performed along with scintigraphy of the neck region. Because of the relative cost-benefit ratio, consideration should also be given to performing the procedure before the initial surgery. For the most accurate diagnosis and favorable outcome, our cases suggest that scintigraphic physiologic results should be correlated with anatomic results of conventional radiography.

Blastomycotic osteomyelitis of the pelvis: a case report.

Blastomycosis dermatitis is an unusual fungal infection that can become a diagnostic dilemma if a high index of suspicion is not maintained in patients who present with a chronic granulomatous infection of bone and soft tissue. We present a patient with a long history of pain, systemic manifestations of chronic infection, a draining sinus, and lytic changes on plain films to illustrate the difficulty in establishing the diagnosis. Appropriate staging studies and a bone biopsy led to the correct diagnosis in the patient.

Sarcoid: an unusual mimicker of classic pulmonary embolus.

A patient had both the clinical presentations and the ventilation-perfusion scan that simulated pulmonary embolism so closely that anticoagulant therapy was administered. Computed tomography of the chest and Ga-67 citrate scintigraphy identified hilar adenopathy due to sarcoidosis as the cause of a ventilation-perfusion mismatch.

Three-phase bone and Ga-67 scintigraphy in disseminated sporotrichosis.

A 27-year-old man, who had been shoveling gravel in southern Texas for 3 years, had a history of papules and nodules in the left lateral wall of the abdomen. The lesions increased in number and severity with spread to other regions of the body. A punch biopsy of the right arm lesion revealed intracellular, round and cigar shaped budding yeast. The cultures grew Sporotrichum schenkii. Three-phase bone imaging and a Ga-67 scan defined the extent of the disease including involvement of the right tibia, left second metacarpal, and the left wrist joints, the latter two of which were not apparent on clinical examination.

Three-phase Tc-99m labeled RBC scintigraphy of a splenic hemangioma.

A 46-year-old man presented with right upper quadrant pain with a clinical suspicion of cholelithiasis and was referred for an abdominal ultrasound (US). On US evaluation, the liver and gallbladder were normal. Incidentally noted a homogeneous, well demarcated, hyperechoic, 5-cm mass in the inferior portion of the spleen. A subsequent Tc-99m labeled RBC scan showed a 5-cm photopenic area in the inferior portion of the spleen on perfusion and early blood pool images. Subsequent filling in on delayed images with slightly increased uptake relative to surrounding splenic tissue was seen on the final images (85 min). Splenic hemangiomas are rare neoplasms, although they still represent the most common primary neoplasm of the spleen. The incidence of splenic hemangiomas ranges from 0.03-14% in autopsy studies.

Tc-99m sestamibi imaging of a pancreatic VIPoma and parathyroid adenoma in a patient with multiple type I endocrine neoplasia.

Technetium-99m sestamibi is known to localize in primary malignant and metastatic tumors. Specifically, brain, breast, thyroid, parathyroid, lung, and kidney tumors have been imaged. The Verner Morrison syndrome, which is caused by excessive vasoactive intestinal peptide (VIP), consists of watery diarrhea, hypokalemia, and achlorhydria. This condition is rarely associated with multiple endocrine neoplasia. The authors present a case of multiple endocrine neoplasia type I with visualization of a pancreatic VIPoma and parathyroid adenoma with Tc-99m MIBI.

Peritoneoscintigraphy using Tc-99m MAA for diagnosis of diaphragmatic disruptions in trauma patients.

The diagnosis of diaphragmatic disruptions secondary to blunt trauma is difficult because the patients are usually asymptomatic. Delay in recognition of this injury can be life threatening. The presence of previous pulmonary pathology makes the diagnosis even more difficult to establish. In this report, a diaphragmatic tear was diagnosed using intraperitoneal instillation of Tc-99m MAA.

Spinal-cerebrospinal fluid leak demonstrated by radiopharmaceutical cisternography.

Cerebrospinal fluid (CSF) leaks are known to occur under several conditions: lumbar puncture performed for contrast myelography, spinal surgery, spinal stab wounds, fracture of the thoracic spine, inadvertent spinal puncture during epidural anesthesia, traumatic lumbar meningocele, and bronchopleural subarachnoid fistula due to bronchogenic carcinoma. Spontaneous spinal leaks are uncommonly encountered in neurosurgical practice, but they are increasingly recognized as a cause of spontaneous intracranial hypotension. Most CSF leaks are located at the cervicothoracic junction or in the thoracic spine. The disease is often self-limiting. A CSF leak can be detected directly by accumulation of radioactivity outside the subarachnoid space or suggested indirectly by the rapid disappearance of tracer from the subarachnoid space and early appearance in the urinary bladder. In this paper we present two unusual cases of CSF leak identified by radiopharmaceutical cisternogram.

Intense myocardial and lung uptake of 99m-Tc-pyrophosphate using single photon emission computed tomography in a patient with end-stage renal disease and secondary hyperparathyroidism.

Metastatic calcification, a frequent and potential lethal complication of chronic renal failure, is rarely detected before death because of the absence of specific radiographic abnormalities. We report the case of a patient on haemodialysis, with secondary hyperparathyroidism and a second degree A-V block who had a 99m-Tc-pyrophosphate scan to rule out myocardial infarction. The scintigram showed marked myocardial and lung uptake that is indicative of severe metastatic hydroxyapatite calcifications.