Sequential dermal-peritumoral radiocolloid injection for sentinel node biopsy for breast cancer: the University of Florida experience.

Although sentinel lymph node (SLN) biopsy is rapidly becoming the standard of care for small breast cancers the optimal radiocolloid injection technique remains controversial. We report our experience with sequential dermal-peritumoral radiocolloid injection that takes advantage of both techniques. One hundred eighteen patients with clinical stage T(is), T1, T2 and N0 breast cancer underwent SLN biopsy at the University of Florida. Twelve to 18 hours before surgery patients received either an injection of 0.5 to 1.0 mCi 50:50 filtered:unfiltered technetium sulfur colloid into the dermis overlying the tumor and/or a peritumoral injection of a 3 to 4-mCi of radiocolloid 30 minutes later. Dynamic lymphoscintigraphy was performed and the topographical location of all imaged lymph nodes was marked on the skin. The next morning the surgeon utilized a hand-held gamma probe to remove all SLN(s) defined as any lymph node with radioactive counts 10 per cent or more of the ex vivo counts of the most radioactive SLN [internal mammary (IM) nodes were not removed]. The SLN identification rate was 98.5 per cent (3 IM nodes) for dermal injection (d.), 83.3 per cent (1 IM node) for peritumoral injection (p.), and 100 per cent (14 IM nodes) for sequential dermal-peritumoral injection (d.p.) (p < 0.05 DP versus D). Sequential d.p. 50:50 filtered:unfiltered technetium sulfur colloid injection results in a rapid, high SLN identification rate that persists until surgery the next morning. Delineation of nonaxillary SLNs may lead to more accurate breast cancer staging and may also influence the delivery of IM node radiation.

Case of double-outlet right ventricle after repair with pulmonary arteriovenous malformations using cardiac CT.

We present a case where cardiac CT clearly defines the complex anatomy of a 22 year old man with double outlet right ventricle who is status bilateral bidirectional Glenn and Fontan conduit. This case also shows the association of pulmonary arteriovenous malformations with Fontan and Glenn procedures.

Age-related radiological imaging in children with acute pyelonephritis.

Accurate diagnosis of acute pyelonephritis (APN) using clinical and laboratory parameters is often difficult in children. The aims of this retrospective study were twofold. Firstly, to correlate the clinical and laboratory manifestations of APN with the results of the dimercaptosuccinic acid (DMSA) renal scan in different age groups. Secondly, to compare the DMSA renal scan, renal ultrasonography (RUS), and voiding cystourethrography (VCUG) in patients with clinical APN. The DMSA renal scan was utilized as the gold standard for renal involvement. We determined the sensitivity of these tests in febrile urinary tract infections (UTI) in three age groups: group I less than 2 years; group II 2-8 years; group III older than 8 years. During the period January 1992 through December 1998, 222 children presented with a febrile UTI. All patients had a DMSA renal scan, 208 had contrast VCUG, and 163 had RUS. The clinical and laboratory manifestation of pyelonephritis correlated better with a positive DMSA renal scan in the older children than in the younger children; 85% of the DMSA renal scans were positive in group III; 69% in group II; 48% in group I (P<0.001). Vesicoureteral reflux detected by contrast VCUG was more prevalent in the younger age groups. Although high grades of reflux (grade IV-V) correlated better with a positive DMSA renal scan, it did not reach a level of statistical significance (P>0.05). RUS did not correlate with a positive DMSA renal scan in any age group.

Detection and reproducibility of mental stress-induced myocardial ischemia with Tc-99m sestamibi SPECT in normal and coronary artery disease populations.

BACKGROUND: Mental stress-induced ischemia, as detected by radionuclide studies, has yielded reversible ischemia in only 30% to 60% of patients with exercise-induced ischemia. Little is known about the reproducibility of myocardial perfusion imaging in detecting mental stress-induced ischemia. The purpose of this study was to further evaluate the occurrence and reproducibility of mental stress-induced ischemia in patients with coronary artery disease (CAD) and in normal control subjects with a low likelihood of CAD by using sestamibi single photon emission computed tomography (SPECT) imaging. METHODS AND RESULTS: A total of 40 patients were enrolled in this study: 19 patients with CAD and typical angina or reversible ischemia (positive exercise treadmill study or positive adenosine thallium study) and 21 normal control subjects underwent mental stress testing as well as myocardial perfusion imaging. The subjects were given a speaking task, and SPECT imaging was subsequently performed. Two experienced readers compared mental stress imaging with a resting image using a 20-segment cardiac model. Hemodynamic changes in blood pressure and heart rate with mental stress were also measured in all subjects. Each patient with CAD also underwent repeat mental stress testing and myocardial imaging approximately 2 weeks later. Of the 19 patients with CAD and typical angina or with evidence of reversible ischemia, 16 (84%) demonstrated ischemia with mental stress, as detected by sestamibi SPECT imaging. The mean number of new or worsened perfusion defects attributable to mental stress was 3.5, with a mean severity of 1.7. These results were also reproducible. With repeated mental stress testing and myocardial imaging, 12 of the 16 CAD patients (75%) demonstrated evidence of myocardial ischemia. None of the 21 normal control subjects had evidence of mental stress-induced myocardial ischemia. Mental stress also induced reproducible and significant hemodynamic changes in CAD patients. CONCLUSIONS: In patients with known CAD with typical angina or with evidence of reversible ischemia despite taking medications, mental stress was very effective in inducing myocardial ischemia, as detected by sestamibi SPECT imaging. Mental stress was also found to elicit significant hemodynamic responses. Furthermore, these findings demonstrated good reproducibility.