At our tertiary care institution, a targeted minimally invasive parathyroidectomy (MIP) is the preferred surgical procedure for primary hyperparathyroidism. Similar to unilateral neck exploration (UNE), preoperative scintigraphic localization of the adenoma in relation to the midline is required. However, in contrast to the abbreviated standard incision for UNE, 2 distinct incision sites, 1 medial and 1 lateral, are available on each side with MIP. The incision site is ultimately chosen based on scintigraphic determination of the adenoma's vascular origin to facilitate ligation and removal. Unfortunately, the scintigraphic location of a parathyroid adenoma does not necessarily reflect the site of its vascular origin. We reviewed our database to identify factors that accurately predict the site of vascular origin of parathyroid adenomas. A retrospective chart review was performed on 125 patients who underwent Tc-99m sestamibi scintigraphy and parathyroidectomy. Scintigraphic localization, surgical findings, and histopathology were recorded. Preoperative image interpretations that were discordant with operative findings were independently reviewed. Scintigraphy identified the presence of an adenoma in 105 of 118 patients (89%) with primary hyperparathyroidism. In 17 of the 105 cases (16%), the scintigraphic interpretation did not accurately reflect the site of superior or inferior vascular origin seen at surgery. In many discordant cases, anterior images were insufficient for determining the vascular origin. The posterior displacement of an adenoma in relation to the thyroid on early lateral images was often critical in determining the superior or inferior vascular origin. Scintigraphic determination of the superior or inferior vascular origin of a parathyroid adenoma directs incision placement for MIP. Imaging protocols should include early lateral images when localizing parathyroid adenomas before minimally invasive parathyroidectomy.

Background. The objective of this study was to review and describe the usage of fluorine-labeled deoxyglucose (FDG) and positron emission tomography (PET) in the diagnosis and management of head and neck cancer.Methods. Several prospective series,-including 159 newly diagnosed and previously untreated and 23 previously irradiated head and neck squamous cell carcinoma patients initially seen at the Wake Forest University Medical Center and evaluated by clinical examination, conventional computed tomography/ magnetic resonance imaging (CT/MRI) scans, PET scans, and histopathologic studies,-were reviewed and the findings summarized for comparison of the correct differentiation of primary and metastatic cancers and for postirradiation tumor clearance in a subsegment of those cases.Results. Position emission tomography scanning using a fluorine-labeled deoxyglucose (FDG) radiotracer proved as reliable as conventional scanning for primary and metastatic tumor identification. Compared with clinical examination, PET was better for identification of nodal metastatic tumors but poorer for small primary tumors. For previously irradiated patients treated at least 4 months before the test, PET scanning was clearly superior to clinical examination and conventional imaging in differentiating tumor recurrence from soft-tissue irradiation effects.Conclusions. Fluorine-labeled deoxyglucose-PET scanning is comparable to conventional imaging of head and neck cancers in detecting primary and metastatic carcinoma. Lack of anatomic detail remains its major drawback. Currently. its greatest role is in the evaluation of the postradiotherapy patient. (C) 1998 John Wiley & Sons. Inc.

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HomeRadiologyVol. 168, No. 2 PreviousNext ReviewsRadionuclide Bone Imaging and DensitometryStanley P. Bohrer, Nat E. WatsonStanley P. Bohrer, Nat E. WatsonStanley P. BohrerNat E. WatsonPublished Online:Aug 1 1988https://doi.org/10.1148/radiology.168.2.546MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished in print: Aug 1988 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 168, No. 2 Metrics Altmetric Score PDF download

The logistic approach in diagnosis of focal nodular hyperplasia (FNH) of the liver is discussed, based on the experience with three children. In only one child could the diagnosis be made without angiography. In that child the combination of hypervascularity on the radionuclide angiogram and uptake of the radiocolloid by Kupffer cells was sufficient for the diagnosis of FNH. If the radionuclide scintigraphy is inconclusive, angiography has to be done to show the typical features of FNH, seen in all three patients. Only if scintigraphy and angiography are not able to differentiate FNH from hepatic adenoma, biopsy or exploratory laparotomy is indicated as a final diagnostic procedure. Ultrasonography or computerized tomography is of value only in screening for hepatic mass lesions.

Cowan, R. J.; Chilton, H. M.; Ball, J. D.; Watson, N. E. Jr.; Muss, H. B.; Van Duzee, B. F.; Schaefer, J. A. Author Information

The effect of methotrexate (MTX) treatment upon Ga-67 distribution was investigated. Tumor bearing mice were injected with Ga-67 citrate at varying time intervals following MTX treatment administered either as a single dose or in multiple doses. Altered Ga-67 distribution was observed following MTX therapy, the general pattern showing decreased levels in blood and increased uptake in bone. MTX therapy decreased Ga-67 uptake in liver, tumor, and muscle. The effects of MTX are related to the dose and time interval between the administrations of MTX and Ga-67. The serum of MTX-treated mice had lower unsaturated iron-binding capacities and higher levels of unbound Ga-67. Serum iron and iron binding in rats determined 20 hr after MTX therapy showed significantly higher levels of serum iron and lower levels of Ga-67 in blood, and the percent transferrin saturation was approximately 95%. These observations suggest that MTX inhibition of erythropoiesis elevates serum iron levels and decreases the availability of gallium-binding sites in serum, resulting in altered Ga-67 tissue distribution.

Single photon emission tomographic techniques for evaluation of the brain have as their major advantage the ability to employ readily available radionuclides, such as technetium-99m. With present radiopharmaceuticals, single photon emmision tomography of the brain primarily provides morphological information that may be complimentary to standard gamma camera images. Particular areas of assistance have included detection of basal lesions, delineation of multiplicity of lesions, definition of medial extent of abnormalities, clear separation of skull and intracranial abnormalities, and perhaps improved lesion characterization. Overall, however, the reported improvement in sensitivity has been relatively small. To optimally utilize the tomographic and quantiative capabilities of single emission tomography, new classes of radiopharmaceuticals must be developed that can penetrate the blood-brain barrier and provide information on CNS function and pathophysiology. If such radiopharmaceuticals can be labeled with single emission radionuclides, this technique has the potential to provide critically important information. The ultimate outcome of single emission tomographic techniques for the study of the brain may depend on radiopharmaceutical advances.

A clinical comparison between a new bone seeking radiopharmaceutical, Tc-99m hydroxymethylene diphosphonate (TcHMDP) and the standard agent, Tc-99m pyrophosphate (TcPPi), was performed in 18 patients with acute myocardial infarction. Each patient was imaged initially with either TcHMDP or TcPPi, and imaged 24 hr later with the other tracer. All 18 patients had images positive for acute myocardial infarction with TcPPi, whereas 16 of 18 patients (89%) had positive studies with TcHMDP. The TcPPi images were graded significantly superior to those obtained with TcHMDP in 61% of the patients, and they were equal in 33%. In only one patient (6%) was TcHMDP better. The results indicate that compared with TcHMDP, TcPPi not only has a superior sensitivity for acute myocardial infarction but also has a significantly increased intensity of uptake in positive areas. TcPPi remains the agent of choice for myocardial infarct imaging.