Renal scintigraphy in the acute care setting.

Renal scintigraphy is a powerful imaging method that provides both functional and anatomic information, which is particularly useful in the acute care setting. In our institution, for the past 2 decades, we have used a 25-minute renal diuretic protocol, technetium-99m ((99m)Tc) mercaptoacetyltriglycine with simultaneous intravenous injection of furosemide, for all ages and indications, including both native and transplant kidneys. As such, this protocol has been widely used in the workup of acutely ill patients.

F-18 FDG PET positive hilar and mediastinal lymphadenopathy mimicking metastatic disease in a melanoma patient treated with interferon-alpha-2b.

A 49-year-old man with a history of recurrent melanoma in the parotid was treated with parotidectomy, external beam radiation, and high-dose interferon-alpha-2b. Combined F-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) performed for restaging demonstrated multiple bilateral hilar and mediastinal hypermetabolic foci corresponding to hilar and mediastinal lymphadenopathy. Cytologic specimens obtained by bronchoscopy were negative for malignancy, revealing reactive lymph nodes.

Intra-operative use of PET probe for localization of FDG avid lesions.

Localizing positron emission tomography (PET)/computed tomography (CT) findings in heavily scarred surgical fields can be challenging. A high energy gamma probe (PET probe) can be used to guide surgery in those difficult areas. We describe our experience localizing and removing fluorodeoxyglucose (FDG) avid lesions in different body areas.

Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function.

The study examined whether deficits in cardiac output and blood volume in a CFS (chronic fatigue syndrome) cohort were present and linked to illness severity and sedentary lifestyle. Follow-up analyses assessed whether differences in cardiac output levels between CFS and control groups were corrected by controlling for cardiac contractility and TBV (total blood volume). The 146 participants were subdivided into two CFS groups based on symptom severity data, severe (n=30) and non-severe (n=26), and two healthy non-CFS control groups based on physical activity, sedentary (n=58) and non-sedentary (n=32).

Contemporary Encephalitis Lethargica: phenotype, laboratory findings and treatment outcomes.

Background: Encephalitis lethargica (EL) is a CNS disorder that manifests with lethargy sleep cycle disturbances, extrapyramidal symptomatology, neuropsychiatric manifestations, ocular features and cardio-respiratory abnormalities. Although there have been no reported outbreaks of EL recently, a number of reports show that cases of EL are still encountered regularly. Against this background we conducted a study aiming to elucidate the clinical characteristics, describe laboratory/ neuroimaging findings (MRI, PET) and present treatment options and outcomes in sporadic EL.

A renal protocol for all ages and all indications: mercapto-acetyl-triglycine (MAG3) with simultaneous injection of furosemide (MAG3-F0): a 17-year experience.

Current clinical requirements mandate the existence of a renal diuretic protocol, which is fast and easy, applicable in all ages and for all indications, convenient for both the patient and the technologist, and provides diagnostic as well as prognostic information. Seventeen years ago a 25-minute protocol, after oral hydration, with no bladder catheterization, and simultaneous injection of mercapto-acetyl-triglycine (MAG(3)) and furosemide (MAG(3)-F(0)), was initiated. It initially was used for the evaluation of drainage and emerged as a protocol to also evaluate the renal parenchyma.

Analysis of the effects of injecting drug use and HIV-1 infection on 18F-FDG PET brain metabolism.

Unlabelled: Injecting drug use (IDU) is a major risk factor for contracting HIV-1 infection. Both HIV and IDU are neurotoxic, and their coexistence may lead to increased dysfunction of brain metabolic processes. The objective of this research was to investigate the effects of HIV-1 infection and IDU on (18)F-FDG PET brain metabolism.

The sodium-iodine symporter and the proton-pump inhibitors in - related to the side effects of- the treatment of thyroid cancer with iodine-131.

Iodine-131 ((131)I) administered to patients for imaging or treatment, concentrates in the gastrointestinal tract, including the salivary glands, stomach and bowel. In Nuclear Medicine practice this biological property of iodine causes side effects when the therapeutic dose of (131)I is large. This occurs during the treatment of patients with differentiated thyroid carcinoma (DTC).

Routine use of auxiliary partial orthotopic liver transplantation for children with fulminant hepatic failure: Preliminary report.

Auxiliary partial orthotopic liver transplantation (APOLT) has been performed for both metabolic disorders and fulminant liver failure (FHF). When the native liver regenerates, the patients with FHF who undergo APOLT have a chance to withdraw immunosuppression. It may be most beneficial for children.

Chorea and contraceptives: case report with pet study and review of the literature.

Chorea is a well-recognized but rare complication of oral contraceptive use. A 27-year-old woman developed right hemichorea while taking an oral contraceptive (OC). No other causes of chorea were found.

Hepatobiliary scintigraphy in liver transplant patients: the "blind end sign" and its differentiation from bile leak.

Purpose: Hepatobiliary scintigraphy is commonly performed on liver transplant patients to exclude biliary complications such as obstruction or leak. Biliary reconstruction in these patients is performed using either a direct duct-to-duct anastomosis (choledochocholedochostomy) or a biliary-enteric anastomosis (Roux-en-Y hepaticojejunostomy). The authors have observed a finding in scans performed on the latter group of patients that often simulates a bile leak.

A comparison of unenhanced helical computerized tomography findings and renal obstruction determined by furosemide 99m technetium mercaptoacetyltriglycine diuretic scintirenography for patients with acute renal colic.

Purpose: We assessed unenhanced helical computerized tomography (CT) secondary findings as predictors of renal obstruction as determined by diuretic scintirenography, and determined their reproducibility.

Materials And Methods: We performed a retrospective review of the records of 77 consecutive patients with unenhanced helical CT findings (stones and secondary findings, including renal parenchymal edema, hydronephrosis, hydroureter, perinephric fat stranding, periureteral fat stranding and extravasation) of urinary lithiasis who had also undergone concomitant diuretic scintirenography during the initial emergency room evaluation during a 1-year period. Unenhanced helical CT films were independently reviewed by 2 attending radiologists (blinded to clinical outcome) to determine interobserver variability.

Diuretic MAG3 scintigraphy (F0) in acute pyelonephritis: regional parenchymal dysfunction and comparison with DMSA.

Unlabelled: 99mTc-DMSA late static planar imaging or SPECT is being used for the investigation of focal acute pyelonephritis (APN), especially in children with urinary tract infection (UTI). Diuretic 99mTc-mercaptoacetyltriglycine (MAG3) dynamic scintirenography has been applied in the evaluation of kidney function and structure, frequently to exclude obstruction. However, in children and adults with a clinical picture of APN, diuretic MAG3 scintigraphy with zero time injection of furosemide (MAG3-F0) was observed to display focal parenchymal abnormalities; regional dysfunction (focal parenchymal decrease in early uptake; slow filling in and prolonged late retention of activity); or, less frequently, fixed defects.

MAG3-F0 scintigraphy in decision making for emergency intervention in renal colic after helical CT positive for a urolith.

Unlabelled: Patients with renal colic are evaluated with clinical, laboratory, and imaging methods for stratification for emergency decompression, medical treatment, or discharge and follow up. The current standard practice is heavily based on unenhanced helical CT for detecting uroliths. However, the presence of a urolith does not necessarily mean that the kidney is obstructed and requires emergency decompression.

Diuretic MAG3 scintirenography in children with HIV nephropathy: diffuse parenchymal dysfunction.

Unlabelled: HIV nephropathy (HIVN) is prevalent in 15%-56% of HIV-infected children and induces mild to severe progressive nephropathy.

Methods: A total of 33 renal diuretic scintirenographic studies with 99mTc-mercaptoacetyltriglycine (MAG3) were reviewed and analyzed from 23 HIV pediatric patients, 21 of whom had HIVN with varying degrees of renal impairment. Results were compared with 10 studies of control patients of matching ages.

Unfiltered sulfur colloid and sentinel node biopsy for breast cancer: technical and kinetic considerations.

Background: There are few clinical data on technical limitations and radiocolloid kinetics related to sentinel lymph node (SLN) biopsy for breast cancer.

Methods: In 70 clinical node-negative patients, unfiltered 99mTc sulfur-colloid was injected peritumorally and cutaneous hot spots were mapped with a gamma probe. SLN biopsy was performed followed by axillary lymph node dissection.

ACE inhibition scintigraphy in the management of hypertension in children.

Angiotensin converting enzyme (ACE) inhibition scintirenography was performed to help establish the diagnosis and plan treatment of renovascular hypertension (RVH) in 57 hypertensive pediatric patients, 33 infants and 24 children older than 1 year. In 16 of 33 hypertensive infants, ACE inhibition scintirenography established the diagnosis of RVH from renal ischemia (due to aortic or renal arterial thrombi). Two scintigraphic criteria were used for the diagnosis of RVH: criterion I, ischemic and damaged kidney (a non-functioning kidney on or off ACE inhibition) and criterion II, ischemic but not damaged kidney (ACE inhibition induced deterioration of function of the kidney).

Pseudoaneurysm of the superior mesenteric artery with an arteriovenous fistula after simultaneous kidney-pancreas transplantation.

Vascular complications remain a significant source of morbidity after pancreatic transplantation. We describe a pseudoaneurysm of the superior mesenteric artery (SMA) with an arteriovenous fistula (AVF) involving the SMA and the superior mesenteric vein (SMV) discovered and treated surgically in the second week after kidney pancreas transplantation. The patient experienced pain over the graft, and subsequent radionuclide and Doppler ultrasound scan were suggestive of a pseudoaneurysm in the head of the pancreas.

A thousand points of light or just dim bulbs? Radiolabeled antibodies and colorectal cancer imaging.

Radioimmunoscintigraphy (RIS) is coming into its own as an imaging modality in clinical oncology. Early experience with indium-111-labeled intact murine monoclonal antibodies (MoAbs) in colorectal cancer suggested that RIS images hepatic metastases poorly. Moreover, an antimurine immune response was frequently provoked, precluding multiple follow-up RIS studies in individual patients due to reticuloendothelial sequestration of the radioimmunoconjugate before tumor targeting could occur.

Treatment of AIDS-related primary central nervous system lymphoma with zidovudine, ganciclovir, and interleukin 2.

AIDS-related primary central nervous system lymphoma (AIDS PCNSL) is a rapidly fatal disease. Conventional therapeutic modalities offer little and new approaches are needed. Previous work has shown that zidovudine (AZT) in combination with other agents is active in retroviral lymphomas.