Planar and high-resolution SPECT bone imaging in the diagnosis of facet syndrome.

UNLABELLED: This study's goals were to determine the appearance of potentially symptomatic facet joints on planar and high-resolution SPECT radionuclide bone imaging, relate the relative sensitivity of the two techniques and assess the predictive value in a clinical setting. METHODS: Fifty-eight consecutive patients referred with a diagnosis of possible facet syndrome were imaged during the same visit using both a well-established planar and a SPECT technique developed to emphasize high spatial resolution. The standard of reference included facet injections with a marcaine and steroid mixture, with review of a pain journal completed by the patient included in the followup criteria. RESULTS: In the 43 patients comprising the final study group, 7 were diagnosed with facet syndrome, 5 with abnormal planar images and 7 with abnormal SPECT images. A total of 10 facet joints with abnormal increased uptake were seen on SPECT which were not demonstrated on planar imaging. There was high sensitivity (100% SPECT, 71% planar), but somewhat lower specificity (71% SPECT, 76% planar). The negative predictive value was high (100% SPECT, 93% planar). Radionuclide bone imaging additionally discovered a nonfacet joint etiology for patient symptoms in 16 of the 43 patients. CONCLUSION: Higher spatial resolution SPECT images are better accepted by referring physicians who correlate them with CT or MR images. The high negative predictive value allows radionuclide bone imaging to be used to select appropriate patients to undergo the invasive facet injection procedure.

The pattern of vertebral involvement in metastatic vertebral breast cancer.

The spine is a common site of bony metastasis. To date, studies have not identified the initial site and pattern of vertebral metastasis in a homogeneous group of patients. Twenty-seven magnetic resonance imaging studies performed on 25 patients with metastatic vertebral breast cancer were reviewed retrospectively. The location and extent of metastatic vertebral involvement were determined. The vertebral body is the most frequent initial site of metastatic seeding. Although radiographically an absent pedicle is often the first sign of metastatic disease, involvement of the pedicle is by direct extension from either the vertebral body or the posterior elements and is therefore a late occurrence in the disease process.

Gene dosage effects of the structural gene for a lipoprotein of the Escherichia coli outer membrane.

The gene dosage effects of the structural gene (lpp) for the lipoprotein of the Escherichia coli outer membrane were examined. A novel F-prime factor containing the lpp gene was constructed. The amount of the free-form lipoprotein in the merodiploid strain carrying the F-prime factor was found to be about two times as great as that in the corresponding haploid strain. On the other hand, the amount of the bound-form lipoprotein, which is vovalently linked to the peptidoglycan, was not significantly different in the merodiploid strain as compared with the corresponding haploid strain. The present results suggest that the lpp gene is expressed constitutively in contrast to another major protein of the E. coli outer membrane, tolG protein (protein II, D. B. Datta et al., J. Bacteriol. 128:834-841, 1976). The F-prime factor isolated may include a portion of the E. coli chromosome (located between 33 and 36 min on the genetic map) that is not covered by any other F-prime factor.

An evaluation of spinal deformity in metastatic breast cancer.

Between October 1984 and January 1988 31 magnetic resonance (MR) imaging studies were performed on 27 patients with metastatic vertebral breast cancer (MVBC). The MR images were reviewed to determine the extent and type of sagittal spinal deformity, and whether spinal canal compromise was present. Adjunct studies were compared to determine the pathogenesis of spinal deformity and the etiology of spinal canal compromise. An analysis of the data revealed that a consistent pattern of sagittal spinal deformity exists with MVBC, and a classification system was developed to describe the stages of vertebral deformity. Criteria are suggested for identifying metastatic spinal instability. A protocol is presented for treating patients with metastatic spinal involvement. By understanding the natural history of metastatic spinal deformity, instability and spinal canal compromise can be recognized and treated early, before the onset of progressive deformity and neurologic sequelae.