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A 34-year old lady had a (67)Gallium citrate scan and demonstrated uptake by both of her breasts--diffuse in the right breast, but focal in the left breast at the "9 o'clock position". Core biopsy from both breasts showed fibroadenoma and no malignant cells were found. Though uptake of (67)Gallium citrate is normally associated with malignancy or infection there may be other causes of uptake and follow-up biopsy should be performed.

Background: With the increasing demand for breast conservation surgery, the probability of recurrent tumour within the breast increases. Traditionally x-ray mammography (XMM) was used to assess the post-surgical breast, but post-surgery and radiotherapy changes have reduced the accuracy of this method. Scintimammography (SMM) has also been proposed and appears to be more accurate than XMM., Material and Methods: A total of 101 women received (Tc99m) MIBI SMM and 88 had a subsequent XMM. There were 142 sites suspected of loco-regional recurrence breast cancer. During the study the patients did not receive any treatment other then hormonotherapy. SMM was performed by the standard Diggles-Khalkhali method and XMM was performed using standard 2 views. Analysis was performed and the results of each type of imaging compared with histology. In the ROC curve analysis 5 points of certainty were used: from 1 being definitely normal to 5 being definitely cancer; grades 4 and 5 were counted as positive., Results: The overall sensitivity value of SMM was 84% and specificity was 85%, compared with a sensitivity of 52% for XMM and a specificity of 84%. Analysis of areas under ROC curves provides statistically significant difference between SMM and XMM (p < 0.05). Combining the two tests did not significantly improve the diagnostic accuracy of sequence imaging over SMM., Conclusion: ROC curve analysis demonstrates that scintimammography should be the primary investigation in suspected local recurrence following breast conservation surgery.

Background: The diagnostic approach that should be used in disseminated neuroendocrine tumours (NET) remains a significant clinical problem. A novel approach has been the use of 111In Octreotide as functional imaging to find NETs. Therefore, the aim of this retrospective study is to report our comparison with direct CT as standard anatomical imaging., Material and Methods: A total of 48 patients (aged 16-79 years; mean age 55, SD 14 years) were imaged using both techniques with final histological confirmation of NET. Histology was as follows: 26 carcinoids; 2 pheochromocytomas; 4 gastrinomas, 1 islet tumour; 2 paragangliomas, 1 modullary carcinoma of the thyroid, 8 undetermined NET and 4 other tumours with signs of neuro-ectodermal cancers (2 hepatocellular carcinomas (HCC), fibrolamellar HCC and fibrous tumour). All patients had (111)In Octreotide and 30 had (123)I mIBG scans followed by spiral CT with contrast enhancement. 26 patients had single functional scans and 22 had multiple, up to 6 scans. Extent of disease as number of lesions was compared between CT and octreotide., Results: CT was the best modality in 11 patients, in 6 it was as good as (111)In Octreotide. mIBG was the best in 6 patients; in 3 patients mIBG was as good as octreotide study. In 22 patients (111)In Octreotide was the most effective modality. In one patient there was no advantage with any of the tests. Comparison of the number of organs involved indicated that an octreotide study was much more effective than CT scanning (Wilcoxon matched pairs test, p < 0.001) and also the overall number of lesions detected using (111)In Octreotide was greater than with CT (Wilcoxon Matched Pairs test p < 0.01)., Conclusion: Our results confirm the recommendation of the European NET group that functional imaging should be performed in patients with suspected NET.

Background: The detection of breast cancer relies on physical examination and mammography (XMM). The sensitivity of conventional imaging is lesions-size dependent. However, mammography has good sensitivity in small tumours when microcalcification is present, but the sensitivity is relatively low in other small tumours. The use of scintimammography with Tc-99m sestaMIBI (SMM) may be helpful in this situation. The aim of this study is to compare the diagnostic accuracy of mammography and scintimammography across all groups with different sizes of lesions., Methods: Data for 273 patients aged 26 to 84 years (mean 52; SD 12) with 298 lesions were analysed. All lesions were removed and final histology and pathological size of the tumours were retrospectively reviewed (mean size 2.9 cm, SD 2.4 cm). All patients had XMM and SMM. Each imaging study was graded using five grades of certainty. SMM images were reviewed by an independent specialist blinded to clinical presentation and XMM results. The diagnostic accuracy of each test, overall and by each lesions size subgroup, was compared using receiver operating characteristic curve (ROC) analysis., Results: The sensitivity of scintimammography was consistently high across all size groups; overall 89% (82?100%) compared with 68% (51?88%) for mammography. In those tumours below 2 cm, the area under the ROC was significantly larger with SMM than XMM (p < 0.05), with 80% certainty indicative of greater diagnostic accuracy. Also in all patients the area under the ROC was significantly larger with SMM than XMM (p < 0.05), with 90% certainty indicative of greater diagnostic accuracy. In other groups of lesions size the area under ROC for SMM was larger in lesions size between 2 and 4 cm and slightly smaller in lesions over 4 cm, but it was not significant., Conclusion: Scintimammography using Tc-99m sestaMIBI seems to be a sensitive and consistently reliable diagnostic test for breast cancer independent of the size of the tumour.

Patients with multi-organ disorders may present with a plethora of confusing symptoms and signs. Often early diagnosis of significant disease is essential and can be difficult with standard radiological techniques. This case report presents the use of two radioisotopic techniques to assess brain and lung perfusion in a patient with such an acute-multi-organ disorder-the HELLP syndrome.

Background: Scintimammography using Tc-99m MIBI (SMM) is often used clinically as a second line diagnostic test for the detection of breast cancer in cases where there is concern about the results of x-ray mammography (XMM) and ultrasound. Both of these methods, but particularly XMM, may miss a significant proportion of ductal carcinoma in situ (DCIS)., Material and Methods: This study was performed to determine the possible accuracy of SMM in finding DCIS and comparing this with the accuracy of XMM in the same patient. Over a 3 year period 353 patients with no previous history of breast cancer were imaged with both XMM and SMM. The histology of any suspect area was verified by pathological examination of biopsy material. There were 203 malignant breast tumours., Results: In those 203 cancers there were 15 pure DCIS cancers. SMM correctly diagnosed 12 of these (sensitivity was 80%). XMM diagnosed correctly 8 DCIS (sensitivity 53%) and was equivocal in 2. Combining of both SMM and XMM provided the best result with all but one DCIS identified (sensitivity 93%)., Conclusions: This study shows that the SMM is helpful in detecting DCIS in those cases where XMM failed to detect DCIS or was equivocal. The combination of the two techniques produces a higher sensitivity result than either modality alone.

Scintimammography with 99mTc-MIBI is a new technique which has expanded the use of nuclear medicine to a new group of patients in whom scintigraphy was not been widely used. When performed correctly, and in those patients, such as the young, where x-ray mammography is often non-diagnostic, the sensitivity of scintimammography can exceed that of x-ray mammography with a similar specificity. A combination of the two techniques in this patient group can provide sensitivities greater than 98%. The mechanism of uptake of 99mTc-MIBI in breast tissue is better understood as is the efflux of the pharmaceutical from the tumour cell. The relationship between the efflux rate of 99mTc-MIBI and the expression of the multi-drug resistance gene may help in determining important aspects of tumour function, such as the response to cytotoxic chemotherapy. More recently the role of scintimammography has been found in those patients with suspected breast cancer recurrence where methods depending on the anatomical structure of the breast, such as mammography and MRI, are of less use. Scintimammography, when correctly performed and correctly applied, is able to deliver unique information which is of use to the patient with suspected primary or recurrent breast cancer.

Background: This study was performed to assess the utility of bone SPECT in the feet using a new commercially available uniplanar fan-beam collimator originally designed for cardiac imaging., Methods: 18 patients with symptoms or signs of probable skeletal pathology in either the foot or ankle were imaged using a two headed gamma camera fitted with uniplanar fan-beam collimators. All patients were imaged 2.5-4 h after administration of 500-750 MBq 99mTc MDP. If indicated planar dynamic and blood pool images were also obtained. The SPECT acquisition was performed in a 128 x 128 matrix, giving a pixel size of 2.00-2.30 mm depending on the radius of orbit. Images were displayed as transaxial, coronal and sagittal slices and a three dimensional volume rendered image and displayed for reading by three readers blind to the clinical results. Sites of abnormal uptake on the foot SPECT scan were then compared with the site of known or suspected pathology and in 17 patients with planar radiology., Results: The SPECT images produced using the uniplanar fan-beam collimators were of good quality in all patients with all three readers finding localisation easiest on the sagittal and three-dimensional images. In 10 patients abnormalities were found which could explain the patient's symptoms or signs and at the site expected from the patient's clinical history. In 5 patients there were abnormalities on the bone scan in the ipsilateral foot but at a different site, all were interpreted as degenerative disease. 2 patients had contralateral degenerative disease to side suggested by the clinical history and no abnormality in the bones of the foot with symptoms. One patient had bilateral degenerative disease. Planar radiology was normal or unhelpful in 13 of the 17 patients in which it was performed., Conclusion: SPECT imaging of feet is possible and provides accurate localisation of abnormal uptake when performed using uniplanar fan-beam collimators with a standard acquisition time of 15 min for a double headed gamma camera.