The role of a 'rim sign' in increasing specificity for acute cholecystitis and sensitivity for complicated acute cholecystitis has been substantiated in many small retrospective studies. We sought to corroborate this correlation in a large population, as we have encountered doubt among surgeons about the emergent implications of this sign.We performed a small pilot interobserver reliability test with five nuclear medicine physicians from outside institutions. A total of 2881 consecutive hepatobiliary scans performed over 12 years for evaluation of acute cholecystitis were retrospectively reviewed. Available pathological (reference standard) and surgical reports were reviewed for all cases of acute cholecystitis (on scintigraphy) with a rim sign and for an equivalent set without a rim sign.There was no statistically significant interobserver agreement on the presence of a rim sign. There was a 32.4% incidence of acute cholecystitis, based on scintigraphy, and a 10.1% incidence of rim signs. Of 63 pathologic specimens from rim-sign-positive cases, 19 (30.2%) showed acute cholecystitis and 44 (69.8%) showed chronic cholecystitis. Six (9.5%) cases were complicated. Among 55 pathologic specimens from the acute scintigraphy cases without a rim sign, 21 (38.2%) showed acute cholecystitis and 34 (61.8%) showed chronic cholecystitis. There were eight (14.5%) complicated cases.There was no interobserver reliability in the identification of a rim sign. There was almost no difference in the incidence of pathologically acute, chronic, or complicated acute cholecystitis among scintigraphically acute cases with or without a rim sign, approximately two-thirds to three-quarters of which were chronic on pathological evaluation.

Purpose: To evaluate the benefit of adding a pertechnetate parathyroid scan (dual-isotope imaging) in the interpretation of sestamibi dual-phase parathyroid scintigraphy. Material and methods: One hundred and sixteen dual Tc-99m sestamibi (MIBI) and Tc-99m pertechnetate subtraction parathyroid studies, performed between January 2000 and February 2006, were retrospectively reviewed. Dual-phase technetium sestamibi examinations were initially interpreted, with blinding to the technetium pertechnetate findings. Subsequently, technetium pertechnetate scan findings were added, and changes in interpretation were recorded. Results: By adding Tc-99m pertechnetate imaging, the interpretation of 17 scans (17/116=14.6%) was substantially altered. This included 5 scans (4%) that changed from negative to positive and 9 scans (8%) that changed from equivocal to positive, excluding ectopic tissue and directing minimally invasive surgery, without the need for further imaging, such as ultrasound, in 12% of cases. One examination changed from positive to negative. In addition, 2 scans changed from equivocal to negative, necessitating further preoperative imaging for the evaluation of additional pathology such as thyroid nodules and lymph nodes and the consideration of hyperplasia. Among the remaining 99 patients, Tc-99m pertechnetate scans may also have contributed to the diagnosis in the 66 positive Tc-99m MIBI scans by increasing confidence in the interpretation and obviating additional imaging. Ten cases remained equivocal. Conclusion: By adding Tc-99m pertechnetate imaging, scan interpretation was changed in 14.6% of cases, and interpretation confidence was enhanced in all but 10 remaining equivocal cases. The addition of a dual-isotope subtraction also eliminated the need for additional testing, such as ultrasound, in 12% of our cases. Increased confidence in interpretation that comes with dual-isotope subtraction may come at the cost of slight lengthening of imaging time but likely simplifies preoperative localization and decreases intraoperative time for many patients with primary hyperparathyroidism. (C) 2013 Elsevier Inc. All rights reserved.

PURPOSE:The role of a 'rim sign' in increasing specificity for acute cholecystitis and sensitivity for complicated acute cholecystitis has been substantiated in many small retrospective studies. We sought to corroborate this correlation in a large population, as we have encountered doubt among surgeons about the emergent implications of this sign.METHODS:We performed a small pilot interobserver reliability test with five nuclear medicine physicians from outside institutions. A total of 2881 consecutive hepatobiliary scans performed over 12 years for evaluation of acute cholecystitis were retrospectively reviewed. Available pathological (reference standard) and surgical reports were reviewed for all cases of acute cholecystitis (on scintigraphy) with a rim sign and for an equivalent set without a rim sign.RESULTS:There was no statistically significant interobserver agreement on the presence of a rim sign. There was a 32.4% incidence of acute cholecystitis, based on scintigraphy, and a 10.1% incidence of rim signs. Of 63 pathologic specimens from rim-sign-positive cases, 19 (30.2%) showed acute cholecystitis and 44 (69.8%) showed chronic cholecystitis. Six (9.5%) cases were complicated. Among 55 pathologic specimens from the acute scintigraphy cases without a rim sign, 21 (38.2%) showed acute cholecystitis and 34 (61.8%) showed chronic cholecystitis. There were eight (14.5%) complicated cases.CONCLUSION:There was no interobserver reliability in the identification of a rim sign. There was almost no difference in the incidence of pathologically acute, chronic, or complicated acute cholecystitis among scintigraphically acute cases with or without a rim sign, approximately two-thirds to three-quarters of which were chronic on pathological evaluation.

Background. In approximately 80-85% of patients with chronic nonspecific low back pain (NSLBP), a precise pathoanatomical diagnosis cannot be identified. Mechanisms of bone nociception may contribute to NSLBP.Objective. To determine whether findings on bone scans, which provide a pathophysiological picture of functional activity, are associated with self-reports of NSLBP intensity.Design. A cross-sectional study of the relationship of self-reported chronic NSLBP intensity to the uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area.Study Participants. Patients referred for bone scans who were at least 18 years old.Outcome Measures. Subject reports of pain intensity and intensity of uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area.Results. Among subjects who were 65 years or younger, the age-adjusted worst pain intensity accounted for 45% of the variability in the amount of tracer uptake (r = 0.67, P = 0.0006). The association was not significant for those older than 65 years.Conclusion. Further studies should be conducted on possible mechanisms relating bone nociception to chronic NSLBP in individuals who are 65 years or younger.

Objective Complex regional pain syndrome (CRPS) type I, also known as reflex sympathetic dystrophy, usually develops after trauma or immobilization, is characterized by focal pain and autonomic dysregulation, and sometimes focal trophic changes such as osteoporosis. The pathophysiology is unknown and there have been few controlled treatment trials. The purpose of this study was to obtain pilot data on the safety and efficacy of a highly potent bisphosphonate, ibandronate, for the treatment of CRPS, which might be responsive to bisphosphonates' inhibition of osteoclast and anti-inflammatory activity. Methods An open-label trial (n=10) of 6 mg ibandronate infusions was administered on each of 3 days. The infusions were preceded by a 2-week baseline period, and followed by a 4-week follow-up period. Results One participant dropped out after the first infusion because of a decreased glomerular filtration rate. Otherwise, aside from transitory flu-like symptoms characteristic of bisphosphonate treatments, the drug was well tolerated. Significant postintervention improvements were observed in average and worst pain ratings; the neuropathic pain qualities of “unpleasant,” “sensitive,” “deep,” “intense,” “surface,” “hot,” “cold,” “sharp,” and “dull”; and hyperalgesia and allodynia. Participants with hand CRPS improved significantly more than those with foot CRPS in average and worst pain, as well as in the following neuropathic pain qualities: “dull,” “intense,” “deep,” and “time.” Discussion These data justify a randomized, double-blind, placebo-controlled trial of ibandronate that should perhaps be limited to patients with hand CRPS.

Radiopharmaceutic tracers are used commonly to diagnose and monitor benign and malignant conditions of the genitourinary system. Most often, these tracers assess renal function and obstruction in "normal" and transplanted renal units. More recently, especially with the advent of positron emission tomography (PET)/CT, the role of nuclear pharmaceutics in the staging and monitoring of malignancies has expanded.

LettersJanuary 1990Imaging investigation of urinary tract infection.Authors: M J Schoeneman, C R Goldfarb, F Ongseng, and H FinestoneAuthor Info & AffiliationsVolume 154, Issue 1https://doi.org/10.2214/ajr.154.1.2104714 METRICS

Goldfarb, Richard M.D.; Ongseng, Fukiat M.D.; Finestone, Howard M.D.; Garcia, Herbert M.D. Author Information

No AccessJournal of UrologyLetters to the Editor1 Jan 1987Re: Incidental Hydronephrosis On Bone Scintigraphy: Sonographic Verification, by S. Balachandran, T. L. Angtuaco, H. R. Shah, N. N. Sheth and C. M. Boyd, J. Urol., 134: 649-650, 1985 C. Richard Goldfarb C. Richard GoldfarbC. Richard Goldfarb More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)43900-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Incidental Hydronephrosis On Bone Scintigraphy: Sonographic Verification, by S. Balachandran, T. L. Angtuaco, H. R. Shah, N. N. Sheth and C. M. Boyd, J. Urol., 134: 649-650, 1985." The Journal of Urology, 137(1), p. 126 © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 1January 1987Page: 126 Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information C. Richard Goldfarb More articles by this author Expand All Advertisement Loading ...

Nuclear medicine board review , Nuclear medicine board review , کتابخانه دیجیتال جندی شاپور اهواز