Occult intestinal bleeding imaged by technetium-99m-HSA-D radionuclide angiography: a case report.
Mizuno S. Ikehira H. Aoki T. Ito H. Takano H. Yamamoto Y.
Department of Radiology, Kawatetu Chiba Hospital, Japan.
Radionuclide angiography (RNA) with 99mTc-diethylenetriamine pentaacetic acid human serum albumin (99mTc-HSA-D) is a sensitive screening method for diagnosing systemic perfusion abnormalities. Sometimes the results produce unexpected information. This information is helpful when considering the clinical perfusion pathophysiology. Recently, we were able to detect an intestinal bleeding lesion clearly for a patient by using RNA.
Effects of in vitro versus in vivo red cell labeling on image quality in gastrointestinal bleeding studies.
Maurer AH. Urbain JL. Krevsky B. Knight LC. Revesz G. Brown K.
Department of Diagnostic Imaging, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
OBJECTIVE: Both in vivo and in vitro red cell labeling methods are available for performing gastrointestinal bleeding studies. While in vitro labeling has been shown to result in higher binding efficiency, no comparison of clinical image quality has been reported between those techniques. This study compares in vivo and in vitro methods using both subjective and objective measurements of image quality. METHODS: A consecutive series of gastrointestinal bleeding studies performed on 23 patients using in vivo labeling was compared to a series of 23 studies using in vitro labeling. Images at 30 min postinjection were randomized and analyzed by two observers. Subjective evaluation of image quality, as well as renal activity, was based on a comparison of femoral vein and inferior vena cava activity to adjacent background using numerical scores with a scale of 0-3. Image quality using the subjective scores was further classified as acceptable and poor. Target-to-background measurements of femoral vein to adjacent soft tissue in the thigh and inferior vena cava to adjacent abdominal background also were made. RESULTS: In vitro label subjective image quality was acceptable in 87% and 91% of cases for vascular and renal activity, respectively, but only 35% and 52% for in vivo labeling. In vitro label target-to-background ratios were significantly better than in vivo label for the femoral vein and inferior vena cava, as well as for the subjective assessment of vascular image quality, but not for renal activity. CONCLUSION: In vitro red cell labeling improves clinical image quality as compared with in vivo labeling. Both subjective and objective measurements of image quality are useful for comparing the results of labeling methods.
An unusual case of a tibial metastasis as the clinical presentation of bronchogenic adenocarcinoma.
Shih WJ. Magoun S. Lahar B. Stipp V. Gross K.
Nuclear Medicine Service, Veterans Administration Medical Center, Lexington, Kentucky 40511-1093, USA.
A patient with initial complaints of leg pain and difficulty walking was found to have a large right tibial metastatic tumor and poorly differentiated adenocarcinoma of the lung. Findings from total-body bone scintigraphy include a large area of increased uptake in the proximal half of the right tibia with a photon-deficient area medially, and focal areas of uptake in a right rib, in the femoral neck and the left ileum. An irregular area of increased uptake in the left lung mass was shown by thoracic bone SPECT. This is an unusual case of a tibial metastasis as the first clinical presentation of bronchogenic adenocarcinoma.