Lipid granulomatosis: Erdheim-Chester disease.

Twenty-six cases of lipid (cholesterol) granulomatosis, Erdheim-Chester Disease (ECD), have been described in the literature to date. A new case of ECD in a 33-year-old man with an unusual presentation of exudative ascites following a four year history of abdominal pain is reported. The radiographic and bone scan findings in this disease have been established and Ga-67 scan findings are reported. The Tc-99m sulphur colloid bone marrow and In-111 chloride scan findings are presented.

The complementary role of plain radiographs and radionuclide shuntography in evaluating CSF-VP shunts.

Cerebrospinal fluid-ventriculoperitoneal shunts are often used in the treatment of hydrocephalus in children. Many complications can arise that may lead to shunt malfunction, including detachment of the distal limb of the shunt. A case is presented where such a complication occurred with distal migration of the detached tubing into the abdomen, which resulted in a patent subcutaneous tract through which cerebrospinal fluid could drain. The need for radiographic correlation at the time of radionuclide shuntography is stressed.

Hydroxyapatite orbital implants. Scanning with technetium-99m MDP.

Porous hydroxyapatite spheres are an ideal prosthetic device for orbital implantation because they are incorporated into soft tissues. Once vascularized, an eye prosthesis can be coupled to the sphere by a peg placed within a central motility hole. This hole should not be drilled while the sphere is avascular because of the risk of infection. Radionuclide scanning with Tc-99m methylene diphosphonate has been used to assess implant vascular ingrowth because radiophosphonate deposition within the sphere parallels vascularization. Using this technique, the authors examined the hydroxyapatite implants of 15 patients 6 months following insertion. Results showed that complete vascularization is best defined by planar imaging rather than SPECT. While the relative intensity of implant activity may be an important feature, uniformity of activity is probably more significant.

Sr-89 therapy for metastatic bone disease: scintigraphic and radiographic follow-up.

Ten patients with disseminated bone metastases, nine from prostatic and one from renal cell carcinoma, were treated with intravenous strontium-89. Half the patients experienced significant improvement in pain control and increased general well-being for an average of 14 weeks. Sequential radiophosphate bone scanning showed decreased activity in lesions present at the time of therapy, with subsequent remineralization of the metastases on radiographs. Some patients showed simultaneous reduction in alkaline and acid phosphatase levels. These objective findings prove a physiologic basis for the clinical improvement. Treatments, however, did not prevent progression at initially uninvolved sites, particularly in the extremities.

Chronic biliary-type pain in the absence of gallstones: the value of cholecystokinin cholescintigraphy.

Radiologic criteria for the diagnosis of gallbladder disease largely rest on the detection of calculi. Surgeons are reluctant to do a cholecystectomy in patients with symptoms of gallbladder disease if the results of sonography or cholecystography are normal. Consequently these patients are often left with no satisfactory treatment. Such patients may have chronic acalculous cholecystitis, partial obstruction of the cystic duct, or gallbladder dyskinesia. Increasing evidence indicates that at least some of these patients have decreased gallbladder emptying in response to a stimulus such as a test meal or cholecystokinin. Impaired emptying shown by cholecystokinin cholescintigraphy may be useful for predicting which patients with typical biliary-type pain but no evidence of calculi will be cured by cholecystectomy.

Biliary obstruction after cholecystectomy: diagnosis with quantitative cholescintigraphy.

Fifty patients with recurrent post-cholecystectomy pain underwent hepatobiliary scintigraphy. Time-activity curves were generated from regions of interest over the liver, bile duct, duodenum, and bowel. Patients were divided into obstructed and unobstructed groups with endoscopic retrograde cholangiopancreatography criteria. Measurements from the liver, duodenum, and bowel curves contributed little to the analysis. The washout phase of the bile duct curve showed intermittent emptying in both obstructed and unobstructed groups. Less than one-third of peak activity remained in both groups at 90 minutes. Retention fell more rapidly in the later portion of the sequence in patients with obstruction. Quantification was essential, since differences were subtle and could not be appreciated visually. In the absence of hepatocellular disease, the most reliable criterion was the time at which maximal bile duct activity occurred. A cutoff level of 29 minutes or more was used in the diagnosis of obstruction. A sensitivity of 93% with an adequate specificity of 64% and an overall accuracy of 80% was achieved in the prediction of obstruction.