A novel view for the scintigraphic assessment of the elbow.

Using any imaging modality, the elbow is a complex joint to evaluate. The use of scintigraphy in the evaluation of the effects of acute or chronic trauma has largely been confined to epicondylitis. We developed a skyline view of the elbow that minimized the effect of overlap and assessed its incremental value in the scintigraphic assessment of several pathological conditions. Thirty-four abnormalities were evaluated in 20 patients with a range of pathologies, including epicondylitis, ligamentous avulsion injury, articular injury, fractures and synovitis. The incremental value of addition of the skyline view to the standard views was assessed in addition to the overall accuracy of scintigraphy. Overall, scintigraphy detected 27 of 34 abnormalities, with the standard views of the elbow accurately identifying 15 and the skyline view 23 abnormalities. This gave the skyline view an incremental value of 24% over the standard views. In conclusion, scintigraphy has the potential to identify a greater range of pathologies in the elbow than previously reported, due to the addition of the skyline view to the standard views.

Tc-99m stannous colloid-labeled leukocyte scintigraphy in the evaluation of the painful arthroplasty.

The aim of this study was to evaluate the utility of scintigraphy using leukocytes labeled with Tc-99m stannous colloid in the assessment of painful arthroplasties. The results of three-phase bone scintigraphy and imaging with Tc-99m-labeled leukocytes in 40 patients with painful joint prostheses, requiring the exclusion of infection are reported. Results were compared with microbiologic culture and/or long-term clinical review. Bone scintigraphy had a sensitivity of 100%, a specificity of 64%, and a diagnostic accuracy of 73% in detecting prosthetic infection. Tc-99m-labeled leukocytes yielded a sensitivity of 70%, a specificity of 100%, and a diagnostic accuracy of 93%. Leukocyte scintigraphy improves the specificity of bone scintigraphy in the assessment of the painful prosthetic joint. A positive study is highly suggestive of infection and warrants appropriate treatment.

Asystole and bradycardia during dipyridamole stress testing in patients receiving beta blockers.

Only rarely have serious side effects been reported with the use of intravenous dipyridamole. We describe two cases of severe bradycardia, of which one led to asystole, in patients undergoing dipyridamole-thallium studies. The association between beta blocker therapy and the seven reported cases of asystole with dipyridamole is discussed and mechanisms postulated. Some caution is advised when patients on beta blockers or similar medications have dipyridamole-thallium studies.

Current role of gallium scanning in the management of lymphoma.

Gallium 67 scanning in the malignant lymphomas has been done, with variable success, for over 20 years. After initial enthusiasm, the technique fell into disrepute and it was not until the early 1980s that it enjoyed a revival. There have been many major contributions to the literature, both favourable and unfavourable. The reasons for the latter include: poor instrumentation (only single-pulse height analysis), low gallium 67 doses, impatient and careless scanning techniques, timing of the study after treatment (chemotherapy, radiation) and insensitive methods of confirmation of the presence or absence of disease ("truth"). Anatomical diagnostic techniques (computed tomography, plain X-radiography, magnetic resonance imaging and others) are incapable of distinguishing viable tumour in normal-size lymph nodes or necrotic/fibrotic residual masses. With improvements in instrumentation (triple-pulse height analysis, gamma camera resolution and tomographic techniques) gallium 67 can detect active tumour in residual masses and in normal-size nodes. This is due to gallium 67's unique ability to localize in viable tumour cells. It has greater than 90% sensitivity, specificity, accuracy and positive predictive value in patients with lymphoma. Its major contributions are in: staging (changing management of mediastinal disease, obviating the need for a laparotomy and clearly identifying stage IV disease); detecting relapse or residual, progressive disease (it establishes true complete remission and is often the first and only evidence of relapse before clinical evidence); predicting response to therapy (failure to convert to a negative scan post-treatment signals a poor prognosis and alternative therapy is required); and predicting outcome--prognosis (it is the only diagnostic modality to predict outcome accurately).