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A 71 y-old female with 40 degrees C fever and a change in consciousness during haemodialysis was referred for a gallium-67 scan, which revealed a horseshoe-like radioactive accumulation in the mediastinal region. Salmonella enteritidis was isolated from blood culture. Magnetic resonance imaging confirmed an aortic arch aneurysm. The patient died without surgery.

This study was performed to compare Tl-201 myocardial perfusion single photon emission computed tomography (SPECT) with planar scintigraphy in the diagnosis of coronary artery disease (CAD).Retrospectively, 240 of 3262 patients, with exercise-redistribution Tl-201 myocardial perfusion scintigraphy performed between January 1990 and October 1997, were analyzed to compare Tl-201 scintigraphy and coronary arteriography. Within 30 days, all 240 patients underwent both coronary arteriography and exercise-redistribution Tl-201 myocardial perfusion scintigraphy with 86 SPECT and 154 planar images acquired.The sensitivities of Tl-201 myocardial perfusion scintigraphy in individual coronary arteries including left anterior descending (LAD) artery, left circumflex (LCX) artery, and right coronary artery (RCA), were 77%/72%, 31%/30%, and 77%/50% in the SPECT/planar study groups, respectively. The sensitivities of CAD detection in patients with single-vessel, double-vessel, and triple-vessel diseases were 96%/82%, 91%/85%, and 96%/90% in the SPECT/planar study groups, respectively.SPECT images provide greater advantages over planar images for better detection of the number, location, and extent of CAD. Cardiac SPECT does improve the accurate interpretation in abnormal Tl-201 distributions due to the higher contrast resolution and better separation of overlapping myocardial regions.

Objectives. To examine retrospectively the clinical presentations, microbiologic characteristics, and treatment outcomes of psoas abscess in patients with diabetes mellitus (DM) and to assess the usefulness of computed tomography and gallium-67 scanning in its early diagnosis. Methods. During a 9-year period, psoas abscesses in patients with DM were collected at a medical center. The clinical history and associated etiologic factors, microbiologic results, clinical outcomes, and hospitalization days were recorded. The use of imaging in the diagnosis of psoas abscess and other concomitant infectious lesions was also studied. Results. Fifteen patients with DM and psoas abscess (13 women and 2 men; mean age 58.7 ± 9.0 years) were found. The most frequent symptom was fever (12 of 15). Of the six different microorganisms that grew in the blood and/or abscess cultures, Staphylococcus aureus was the most frequent (7 of 15). The most commonly associated pathologic finding was vertebral osteomyelitis (5 of 15). Computed tomography and/or magnetic resonance imaging confirmed the diagnosis of psoas abscesses in all 15 patients. The gallium-67 scan especially aided in the diagnosis of the patients who had initially been diagnosed as having fever of unknown origin (4 of 5) and in the diagnosis of concomitant lesions (9 of 12). Debridement or surgical drainage of the abscess was done in 12 patients. All the patients received adequate antibiotic treatment. However, the mortality rate was 20%. The average hospitalization stay was 42.7 ± 20.7 days. Conclusions. Psoas abscess in patients with DM is a disease with both diagnostic and therapeutic challenges. We found the infecting microorganisms to be variable and the mortality rate high.

A whole-body gallium-67 (Ga-67) scan of a 61-y-old male with diabetes mellitus who suffered from endogenous Klebsiella endophthalmitis is reported. The scan revealed right orbital and lower abdominal lesions. Urinary analysis revealed pyuria. The causes of endogenous Klebsiella endophthalmitis and the usefulness of Ga-67 are discussed.

A 77-year-old woman was referred for Ga-67 scan to evaluate intermittent fever and chills that had lasted more than 20 days. The Ga-67 whole-body scan revealed a doughnut-shaped Ga-67 accumulation in the lower abdominal region. Combined Ga-67 and Tc-99m MDP bone scan confirmed that this activity was in the uterus, because the shape of the urinary bladder on bone scan was different from that of the Ga-67-avid lesion. Pyometra was proved during operation, and pus culture was performed.

Purpose: The purpose of our study is to evaluate the efficacy of cerebral perfusion single photon emission computerized tomography (SPECT) in patients with transient ischemic attack (TIA). Methods: Thirty-seven patients with TIA were collected for study. All patients had transient focal neurological symptoms or signs with complete recovery within 24 h after onset. The patients underwent cerebral perfusion SPECT between 6 h and 11 days after onset, with 10 cases performed within 24 h (group A), nine cases performed between 1 and 3 days (group B), 11 cases performed between 3 and 5 days (group C), and seven cases performed after more than 5 days (group D). A semi-quantitative method was used for analyzing the SPECT data, and the difference ratios between lesion side and contralateral normal side were calculated on each pair of regions of interest. Results: In total, 78.4% (29/37) of patients had reduced perfusion in the cerebral cortical regions or deep nuclei, and the regions with reduced perfusion corresponded with clinical presentations of the patients. The abnormal rate with reduced perfusion was 90.0% in group A, 77.8% in group B, 72.7% in group C and 71.4% in group D. Cross cerebellar diaschisis (CCD) was present in seven patients, and all of the primary cerebral perfusion defects of these patients were located at the territory of left or right middle cerebral artery. Conclusion: Cerebral perfusion SPECT is a potential tool to detect cerebral perfusion defects and CCD in patients with TIA. Although the perfusion defect may persist more than 5 days after onset, we suggest cerebral perfusion SPECT should be performed as soon as possible.

A psoas abscess is a rare clinical entity that presents diagnostic and therapeutic challenges. In this retrospective study, we reviewed gallium-67 scan findings in cases of psoas abscess to determine the specific uptake pattern and the usefulness of 67Ga scans in diagnosis and management. Fifteen psoas abscess lesions in 13 patients who had undergone a 67Ga scan during an 8-year period were found in the hospital computer. All but two of the patients had been diagnosed as having fever of unknown origin, urinary tract infection or another irrelevant disease prior to the 67Ga scan. Of the 15 psoas abscess lesions, 12 (80%) could be clearly diagnosed on the basis of the specific 67 Ga uptake pattern, in which: (1) the oblique direction of the 67Ga-avid lesion correlates with the orientation of the psoas muscle from the lumbar region to the hip joint region; (2) the lesion does not cross the abdominal midline; (3) the lesion goes through the inguinal region; and (4) the lesion involves at least two-thirds of the whole length of the psoas muscle. The specific features may help in the differentiation of psoas abscess from other intra-abdominal lesions or normal bowel distribution, especially with single-photon emission tomographic images. In 7 of 13 patients (53.8%) the 67Ga scan findings contributed to the clinical management of the patients by first detecting the focus of the infection. Multiple concomitant 67Ga-avid lesions were found in ten patients. In conclusion, the specific features as well as the whole-body survey with 67Ga scan are useful and important in the diagnosis of psoas abscesses and the detection of unexpected concomitant multiple infectious foci in clinically suspicious infectious disease patients.

Severe cerebral involvement may occur in patients with systemic lupus erythematosus. Methylprednisolone pulse therapy is a management choice for those with severe cerebral involvement. However, its effectiveness is uncertain. This article describes Tc-99m HMPAO cerebral perfusion single-photon emission computerized tomography to document the restoration of cerebral perfusion after methylprednisolone pulse therapy in a case of systemic lupus erythromatosus with severe cerebral manifestations.

The authors discuss a series of radionuclide inferior venocavography (RIVC) studies that were performed on a 57-year-old man who had Budd-Chiari syndrome before and after balloon angioplasty. The RIVC showed IVC obstruction with collateral circulations. The day after successful angioplasty, RIVC showed the temporary coexistence of IVC and the collateral circulation. The latter was unexpected. Two weeks later, a repeat RIVC showed a normal IVC without collateral circulation, including azygos and hemiazygos veins. The temporary coexistence of the patent IVC and collateral circulation after angioplasty should be interpreted carefully as only a transient phenomenon.

We studied 21 hips in 20 patients who had acetabular reconstruction with a femoral head allograft in primary (n 2) and secondary (n 19) total hip arthroplasty. The fate of the graft was evaluated by serial bone SPECTs (single photon emission computed tomography). With a mean follow-up period of 37 (30-60) months, 14 of the 21 hips showed evidence of incorporation at earliest 13 (6-18) months after operation. There was no correlation between the fate of allograft and the compatibility of A, B, 0 blood typing between host and donor, the use of bone cement in the fixation of acetabular component, or loosening of the acetabular component.

A 76-year-old woman with fever of unknown origin had a cholecystectomy 2 months earlier. Blood and pus cultures from percutaneous transhepatic drainage showed Staphylococcus aureus. Immediately after drainage, both Tc-99m DISIDA and Ga-67 imaging were performed. Tc-99m DISIDA cholescintigraphy showed stasis of radiotracer at the dome of the right hepatic lobe and in the biliary tree. The Ga-67 scan revealed multiple focal areas of increased radiotracer accumulation in both hepatic lobes. Under both drainage and antibiotic treatment, the patient was discharged in stable condition.