Response of small cell carcinoma of pancreas to a small cell lung cancer regimen: a case report.

Small cell carcinoma of the pancreas is a very rare malignancy with 18 cases reported in the literature, of which only 3 were treated with chemotherapy. A 52-year-old man was diagnosed with small cell carcinoma originating in the head of the pancreas and invading the duodenum. He was treated with a similar approach as for localized small cell lung cancer, with six cycles of combination chemotherapy and local radiotherapy, and went into complete remission. After 3 months, he developed liver metastases along with an enlarged left supraclavicular lymph node. He was treated with two cycles of CVA, but developed lung metastases and was treated with ifosfamide/mesna. However, his overall condition deteriorated and hospice care was instituted until the patient's demise. The patient survived 14 months following diagnosis, significantly longer than the 15 reported patients with small cell pancreatic carcinomas not treated with chemotherapy. Combination chemotherapy and radiation therapy as it is utilized for small cell lung cancer appear to be beneficial for small cell carcinoma of the pancreas.

Tc-99m DISIDA hepatobiliary scintigraphy in AIDS cholangitis.

Sixteen patients with documented AIDS cholangitis who underwent Tc-99m DISIDA hepatobiliary scintigraphy were retrospectively reviewed to assess the spectrum of changes observed in this disease. AIDS cholangitis was documented by either ERCP with aspiration/biopsy or the presence of typical sonographic/CT abnormalities with positive stool culture and a minimum of 6 months follow-up. Images were graded as regards parenchymal function (blood pool clearance, peak parenchymal activity, and degree of parenchymal retention), gallbladder visualization, presence of ductal dilatation, and time of intestinal activity. Three patterns were identified: 1) focal ductal dilatation with focal narrowing and focal or diffuse parenchymal retention; 2) ductal dilatation, without narrowing, and diffuse parenchymal retention; and 3) severe diffuse parenchymal retention with or without ductal abnormality. All 16 studies revealed abnormal parenchymal retention. Gallbladder nonvisualization was demonstrated in nine studies and delayed in two. The hepatobiliary scan is a very sensitive technique for evaluating AIDS cholangitis. Although a spectrum of findings may be observed, parenchymal retention with some degree of ductal abnormality is the most commonly observed pattern.

Hepatic SPECT imaging in the detection and clinical assessment of hepatocellular disease.

A total of 95 patients, including 45 people with no evidence of liver disease and 50 documented hepatocellular disease patients, were studied to assess the value of planar and SPECT scintigraphy in the evaluation of hepatocellular disease. The accuracy and concordance between techniques was assessed using two criteria. Criterion 1, heterogeneity of the tracer in liver, yielded a concordance of 64%, whereas with criterion 2, liver and spleen tracer pattern, concordance was 78%. SPECT was significantly more accurate than planar imaging (P < 0.01), using both criteria. The clinical severity of the hepatocellular disease was further assessed in 72 of the patients and correlated with a liver scan severity rating scale. The SPECT technique showed a good correlation (r = 0.89) with the composite clinical severity score; however, no significant relationship with planar imaging was noted. The results of this study suggest that liver SPECT is a reliable technique for the assessment of hepatocellular disease.

The value of SPECT imaging in the diagnosis of hepatic hemangioma.

Radionuclide flow studies, planar, and SPECT hepatic blood pool imaging were performed in 23 patients with 39 hepatic hemangiomas, 23 patients with primary and secondary liver tumors, 12 patients with hepatocellular disease, two patients with hepatic cysts, and 10 patients with no evidence of liver disease. The hepatic SPECT imaging identified all 39 hemangiomas as having a sequestration pattern compared with a yield of 69% (27 of 39 cases) for the planar imaging. None of the 47 other patients demonstrated this pattern. The SPECT approach is considered superior to planar blood pool imaging because of improved diagnostic yield, reduced patient imaging time, and greater ease of correlation with other cross-sectional imaging modalities.

Single photon emission computed tomography and transmission computed tomography in the evaluation of liver disease.

To assess the relative strengths of hepatic SPECT and transmission computed tomography (TCT), a comparison of these methods was made in 88 patients during a 20-month period. The scans were classified into four categories: normal, solitary focal, multifocal, or diffuse hepatocellular patterns. The final disease category was determined by histologic evaluation-biopsy/autopsy, surgery, or a combination of ultrasound, laboratory, and clinical follow-up for a minimum of 6 months. Both SPECT and TCT were normal in the 47 patients classified as normal. Of the 16 patients with diffuse hepatocellular disease, SPECT correctly identified 16 and TCT identified two patients. Eleven patients had solitary focal disease; 11 were detected by SPECT and 10 by TCT. Fourteen patients were in the multifocal disease group; 13 were detected by SPECT and 10 by TCT. Overall, SPECT and TCT findings were in agreement in 68 (77%) of the cases. This study demonstrates that SPECT is equal to TCT in the assessment of the liver parenchyma in normal and focal disease states and that SPECT is superior in the assessment of diffuse disease.

Abdominal SPECT imaging.

Over the past several years, abdominal single photon emission computed tomography (SPECT) imaging has evolved from a research tool to an important clinical imaging modality that is helpful in the diagnostic assessment of a wide variety of disorders involving the abdominal viscera. Although liver-spleen imaging is the most popular of the abdominal SPECT procedures, blood pool imaging is becoming much more widely utilized for the evaluation of cavernous hemangiomas of the liver as well as other vascular abnormalities in the abdomen. Adjunctive indium leukocyte and gallium SPECT studies are also proving to be of value in the assessment of a variety of infectious and neoplastic diseases. As more experience is acquired in this area, SPECT should become the primary imaging modality for both gallium and indium white blood cells in many institutions. Renal SPECT, on the other hand, has only recently been used as a clinical imaging modality for the assessment of such parameters as renal depth and volume. The exact role of renal SPECT as a clinical tool is, therefore, yet to be determined.

Preoperative detection of gallbladder perforation.

Tc-99m-hepatobiliary imaging is an excellent tool for noninvasive investigation of biliary tract perforation. This article documents a case in which this imaging method was employed to establish a preoperative diagnosis of gallbladder perforation.