Clinical evaluation of the Cleon imager.

We have compared bone images from a number of patients using three instruments. In 38 patients, Cleon body images were compared with whole-body rectilinear scans. Cleon images were also compared with scintillation camera images of the trunk or extremities of 31 patients and of the skull of 70 patients. The Cleon was superior to the rectilinear scanner in resolution, lesion detectability, and speed of scanning. The Cleon and gamma camera were comparable in lesion detection, but the Cleon was consdierably faster. Clinical studies and comparative evaluation are presented.

The value of the bone scan in idiopathic regional migratory osteoporosis.

Idiopathic regional migratory osteoporosis is a self-limited entity of unknown origin, which has received little attention in the nuclear medicine literature. It is characterized by severe joint pain, typically in a hip, with normal laboratory and normal early radiographic findings. Spontaneous recovery occurs, but recurrence is frequent in another joint, often the opposite hip. Recurrence in the same joint has never been reported. The bone scan is shown to be positive with first symptoms and is important in the diagnosis and management of this entity. Three cases are presented.

Preservation of the eye in paranasal sinus cancer surgery.

Forty-one patients undergoing surgery between 1977 and 1985 for malignant tumors of the paranasal sinuses abutting or eroding the orbital walls were studied for the need to remove the orbital contents. All patients had preliminary computed tomographic scans to delineate the extent of orbital invasion. All were treated with preoperative radiotherapy. If the tumor mass could be peeled from the periorbita, the eye was saved. Preservation of eyes in the patients without periosteal invasion did not alter survival. Frozen-section control may be used to determine periorbital involvement. If the periorbita was minimally involved, it was locally resected. If invasion of the periorbita was extensive, an orbital exenteration was done. Only five of 41 patients required exenteration. Local recurrence of disease in the orbit has not occurred in these patients.

Computed tomography as a diagnostic aid in diabetic and other problem feet.

Determining whether osteomyelitis is present in patients with foot infections represents a significant diagnostic challenge. As bone uptake with nuclide scans can be affected by soft tissue infection, we performed computed tomography (CT) on seven patients to see if marrow or bone abnormalities could be seen and used to predict the presence or absence of osteomyelitis. The CT scans correctly predicted the presence or absence of osteomyelitis in all seven patients. Four patients had osteomyelitis and three patients did not. Nuclide bone scans had one false-positive and one false-negative result. In this small series, CT proved helpful in evaluating foot problems.

Tumor detection with 67Ga-citrate: a literature survey (1970--1978).

Gallium scan detection of various neoplasms is tabulated by anatomic and histologic categories. The experience with many neoplasms is sufficient to accurately predict the likelihood of detection with gallium. This tabulation helps to point out other areas where the cumulative experience is insufficient to accurately predict sensitivity rates.

Patency evaluation of a LeVeen shunt using 99mTc-sulfur colloid.

The LeVeen shunt has proved valuable in relieving intractable ascites. It is however subject to failure in about 5--8% of cases. To our knowledge there are only three reports in the literature describing the use of nuclides to assess patency; two using 99mTc-sulfur colloid and one using 99mTc-albumin. The purpose of this paper is to add our experience to the data currently published and stress that late liver visualization may occur with an obstructed shunt.

Patent umbilical vein. Diagnosis by technetium-99m tagged red blood cell scintigraphy.

Abdominal scanning with Tc-99m labeled red blood cells serendipitously demonstrated collateral flow in a patent umbilical vein in a patient with unsuspected advanced cirrhotic liver disease and portal hypertension. Knowledge of this was crucial in planning the optimal surgical approach in this patient, referred for resection of a bladder carcinoma. Furthermore, the nuclide study was helpful in clarifying several questions posed by a prior abdominal pelvic CT scan.

Radionuclide brain scan findings in superior sagittal sinus thrombosis.

Superior sagittal sinus thrombosis is a serious condition requiring early diagnosis. This paper presents our experience with two cases and describes the findings. In one case radionuclide brain imaging was the first study performed. In the other, the diagnosis was made at arteriography with scanning used for follow-up.

Poorly differentiated lymphocytic lymphoma with ectopic parathormone production: visulization of metastatic calcification by bone scan.

Metastatic soft tissue calcification is known to occur in hypercalcemia and is usually present in the kidneys, stomach and lungs. 1--3 This case presents two unusual features: 1) ectopic parathormone production in association with poorly differentiated lymphocytic lymphoma; and and 2) uptake of 99mTc-pyrophosphate in the liver in the absence of demonstrable abnormality at autopsy. The more usual sites of metastatic calcification also showed uptake of the radionuclide. We will discuss metastatic soft tissue calcification, ectopic parathyroid hormone production, hypercalcemia in malignancy and bone scan agent localization in soft tissues.

Value of routine flow studies in nuclide brain scanning.

Nuclide brain scanning offers a noninvasive means of obtaining dynamic information about intracranial disease. Lesions which could be missed without the flow study are described, and other instances in which the differential diagnosis is greatly improved by the use of the vascular sequence are demonstrated. We recommend the routine use of the flow study when performing brain scans.

The chest X-ray in quadriplegia: a review of 119 patients.

Chest X-rays of 119 quadriplegic patients were reviewed. The unusual findings were rib erosions and ossification of the coracoclavicular ligaments. It is suggested that pressure from the scapula is likely to be responsible for the erosions but the cause of ossification in the ligaments remains conjectural.

Adrenal involvement in non-Hodgkin lymphoma.

Adrenal masses are described in seven cases of non-Hodgkin lymphoma in a series of 173 patients. In all seven patients the lymphoma was diffuse rather than nodular. Three patients had adrenal masses at the time of presentation, whereas in four cases the adrenal gland was a site of tumor recurrence after therapy. Three patients had simultaneous bilateral adrenal involvement by tumor. No characteristic features were recognized that might have distinguished these tumors from other adrenal masses. Appropriate therapy successfully resolved the adrenal masses in all but one case. The latter patient was the only one with evidence of adrenal insufficiency.

Epipericardial fat pad: CT findings.

Epicardial and mediastinal fat around the apex of the heart may produce the classic appearance of a cardiac fat pad filling in the anterior cardiophrenic angle on a lateral chest radiograph. A review of 50 computed tomographic (CT) scans of the chest that were normal save for possible cardiomegaly, together with chest radiographs obtained within a 14-day interval, revealed a wide variation in the configuration of this fat pad in 16 patients (32%). Depending on geometric circumstances, the fat pad may produce a well-marginated region of increased density, a region of increased density with poor margination, or an area of reduced density lying anterior to the heart. In an additional four patients (8%), however, a simulation of a cardiac fat pad was produced by cardiomegaly alone or by relative levoposition of the heart. In these four patients, the left side of the heart contacted the chest wall on the left over a larger than normal area and thereby excluded lung from the vicinity, simulating the appearance of a fat pad where none existed.

Computed tomography of low periesophageal focal fat collections.

Focal fat collections in the middle compartment of the lower mediastinum are reported in the literature. However, this explanation for a mass in that location is not widely recognized. We found four cases of focal fat collections on routine computed tomography. We then reviewed 100 consecutive computed tomography scans and found another four examples.

The renal parenchymal stone: a benign calcified renal mass.

Five patients are described, each with a densely calcified solitary mass in a peripheral location in the kidney. There was exophytic projection of the calcification in 4 cases. Three lesions were so completely calcified as to be regarded as stones. The bulk of the lesion was calcified in the 2 other cases, in which the noncalcified portion was either avascular or hypovascular. In no case was there evidence of a soft-tissue mass extending beyond the confines of the calcification. Pathologic correlation in 1 case showed only calcification in association with some renal scarring, and in a second case demonstrated an old organized and calcified abscess. Long-term follow-up in the other 3 cases has demonstrated complete stability without evidence of tumor. All cases are believed to represent examples of calcified renal parenchymal scars, resulting from old granulomatous disease, renal abscess, or hematoma. We propose that these lesions be regarded as solitary renal parenchymal stones without malignant potential, rather than calcified masses. The significance of the findings for patient management are discussed.

Fertility of spermatozoa from the excurrent ducts of the guinea-pig.

Guinea-pigs were inseminated with spermatozoa from the vas deferens, where they are characteristically arranged in rouleaux, or from that part of the epididymis where rouleaux are infrequent. Fertility was much reduced in the 16 females inseminated with a suspension of single spermatozoa: only 4 became pregnant (compared with 10/11 controls) and all these had had some (0.5-0.75%) rouleaux in the insemination suspension. It is concluded that rouleau formation is indicative of physiological as well as morphological maturity.