Abnormal 67Ga-citrate scan of the abdomen in tuberculous peritonitis: case report.

Tuberculous peritonitis in a 34-year-old alcoholic man was associated with an abnormal 67Ga-citrate scan of the abdomen. Repeated studies after thorough bowel cleansing revealed no change in the site and shape of the abnormality for 2--5 days after injection of the tracer. The inflammatory process may have been responsible for the abnormal scan.

Simultaneous treatment of toxic diffuse goiter with I-131 and antithyroid drugs: a prospective study.

We report a prospective study to avaluate the effect of antithyroid drugs containing the sulfhydryl radical on the outcome of I-131 (RAI) therapy. Twenty-four male patients withe toxic diffuse goiter were assigned randomly into tow treatment groups: Group A received RAI treatment while on antighyroid drugs after attainment of euthyroidism; Group B received no antithyroid drugs before, or when, RAI was given. Patients in each group received a dose of RAI calculated to deliver approximately 5000 rads per treatment. The incidence of hypothyroidism at 12 mo was 8% for Group A and 36% for Group B (p less than 0.01). During 12-102 mo of follow-up, no additional hypothyroidism was encountered in Group A. Two patients with significantly elevated TSH levels were found in Group B, one at 20 mo and one at 75 mo after RAI. The mean time to cure was 15.2 +/- 9.1 mo for Group A and 19.7 +/- 8.2 mo. for Group B (NS: p more than 0.45). The improved therapeutic outcome of patients in Group A suggests that further validation of the method in a larger patient population, including females, is warranted.

Alteration of the cerebral bloodflow study due to reflux in internal jugular veins.

This paper considers abnormalities of flow patterns in the flow patterns in the cervical vasculature due to varying degrees of jugular venous reflux, and their influence on cerebral bloodflow studies. Two commonly encountered patterns are described. In the first group, the abnormal flow study resulted from reflux of the activity in the left internal jugular vein. In the second group, the observed abnormality resulted from reflux of the activity in the left internal jugular vein, followed by flow into the contralateral jugular vein, most probably through the transverse and sigmoid sinuses.

Effect of vitamin D3 on imaging of experimental myocardial infarcts with technetium-99m pyrophosphate: further studies of the role of calcium.

We previously found that a pulse dose of vitamin D3 increased [99mTc]PPi uptake by rat myocardial necrosis. Vitamin D3 raised serum and lesion [Ca] but not, we now report, lesion [Fe]. We now also report that D3 increased [99Tc]PPi uptake by myocardial infarcts (L) in dogs from 0.345 +/- 0.007% administered (kg) dose/g in controls to 0.703 +/- 0.089 in treated (p less than 0.025). Vitamin D3 decreased uptake by dog bone (B) as measured in rib and sternum, increasing L/B from 1.10 +/- 0.23 to 2.30 +/- 0.52 (p = 0.06) X (L) was positively, (p less than 0.005) and uptake by sternum was negatively (p less than 0.05) correlated with serum [Ca] and [P], respectively. Scintigrams graded by a "blinded" observer, showed 4+, 4+, and 3+ infarcts, respectively, in three D3-treated dogs, and 2+, 2+, and 1+, respectively, in three untreated. One untreated and one treated dog were negative; the latter showed the least response to D3 in serum [Ca] and [99mTc] in tissue samples. Vitamin D3 can increase L/B in dogs, enhancing scintigraphic images.

Perioperative myocardial infarction: a diagnostic dilemma.

Patients undergoing coronary bypass grafting were studied for incidence of perioperative myocardial infarction (MI) using three modalities: serial electrocardiograms (ECG), serial creatine phosphokinase isoenzymes (MB-CPK), and serial technetium 99m-labeled pyrophosphate scans. A definite perioperative MI was diagnosed if the results were positive in two of the three variables studied. The perioperative infarction rate for the entire group was 8%. The operative mortality was 2.9%. Seven of 8 perioperative MIs were diagnosed by the use of scanning alone. The combination of isoenzyme and ECG analysis diagnosed 5 of 8 perioperative MIs. The MB-CPK and ECG studies were associated with a higher incidence of false-positive diagnoses than myocardial scanning. Patients with perioperative MI had a benign clinical course. Justification for performing three routine 99mTc-pyrophosphate scans on all patients undergoing aortocoronary bypass operation is still to be determined.

Comparative performance of three radioimmunoassays for prostatic acid phosphatase.

Three commercial radioimmunoassays and one enzymatic assay for prostatic acid phosphatase (PAP) have been tested on 122 patients to determine their relative specificity, sensitivity, and diagnostic value. Each of the three radioimmunoassays was found to have special merits. For distinguishing Stage IV prostatic cancer from normal patients without prostatic disease, the Smith Kline (SKF) and New England Nuclear (NEN) assays provide more significant differences. The SKF test also best distinguishes all stages of prostatic cancer from benign prostatic hyperplasia (BPH), but is inferior to the Malinckrodt (MAL) assay for contrasting Stage IV prostatic cancer from BPH. Values obtained with the NEN assay best distinguish the stages of prostatic cancer. Only with the MAL assay are significantly higher PAP values obtained in patients with metastases to bone than those without positive bone scans. Viewed from the point of sensitivity, the SKF assay proves best at all levels of specificity examined in detecting all stages (I-IV), and Stage IV prostatic cancer. By none of the assays can estrogenized Stage III and IV cancer patients be distinguished from those not on estrogen.

Fat tissue and fat suppression.

Fat tissues consist of fat cells, capillaries, and collagen fibers. In order to completely suppress the signals from fat tissues in clinical magnetic resonance imaging, the signal from capillaries and collagen fibers as well as from fat cells should all be suppressed. We have previously reported that fat signal can be uniformly suppressed by applying an optimized presaturation pulse. The inhomogeneously broadened fat peak of tissue spectrum is excited by the optimized pulse and dephased by a subsequent field gradient. The broadened water peak is not affected. In this paper we discuss a technique that suppresses signals from fat tissues completely as well as uniformly. This technique is based on the cancellation of fat and water signals in the same image voxel by combining the optimized selective excitation with the opposite phase imaging technique. Experimental and clinical images demonstrate that the new technique improves the delineation and depiction of anatomy in clinical fat suppression imaging.

False-positive studies in early 67Ga-citrate scintigraphy.

Two cases of false-positive early 67Ga-citrate scintigraphs are presented. In both cases, the initial accumulation of the radiotracer in the region of the right iliac fossa could not be substantiated on the delayed study. It is suggested that the results of an early gallium scan be interpretated cautiously, especially when any apparent abnormality is within the region of the normal colonic anatomy. A delayed study should be performed whenever possible.

Unusual Tc-99m and I-123 images in metastatic thyroid adenocarcinoma.

A patient with metastatic thyroid carcinoma showed discordance of I-123 and Tc-99m imaging results. In addition, despite close histologic similarities, the metastatic lesions differed considerably in their ability to trap Tc-99m.

Usefulness of the posterior cerebral flow study in subdural hematoma.

Anterior and posterior radionuclide cerebral flow studies and brain images were performed on two patients with surgically proven subdural hematoma. In both patients, the posterior flow study showed perfusion defects corresponding in location to the static image abnormalities. The anterior radionuclide flow study was negative in both patients, even though the abnormality in one of the patients was more anterior than posterior in location. On the basis of these cases, it is suggested that the performance of a posterior radionuclide flow study in suspected subdural hematoma might provide useful information not obtained on the routine anterior study.

Bilateral breast masses in a man.

Other than gynecomastia, bilateral breast masses in a male patient is an unusual occurrence. We present a case of fat necrosis presenting in a male veteran as bilateral palpable breast masses.