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Background. Radioimmunodetection of cancer usingmonoclonal antibody fragments offers certain potentialadvantages over that with whole monoclonal antibodies,including the ability to image early (i.e., to provideimages at an early time after injection of the radio- antibody) while minimizing the incidence of human antimouseantibody response. This paper reports a prospectivetrial comparing radioimmunodetection withIMMU-4 (a murine anti-CEA monoclonal antibody)[Tc.sup.99m]-labeled Fab' fragments to conventional imaging in 35 colorectal cancer patients.Methods. All patients were investigated by conventionaldiagnostic methods (CDM) within 4 weeks ofradioimmunodetection. Surgical corroboration of findingswas obtained in 26 patients (15 with evidence of diseaseon CDM [CDM+] and 11 with abnormal serum CEA[CDM-] as the only evidence for recurrence). After 1 mgIMMU-4 [Tc-.sup.99m]-Fab' was injected (19.3 mCi on average), patients underwent planar/SPECT radioimmunodetection2-5 hours later and planar radioimmunodetection18-24 hours later. Three patients underwent a secondradioimmunodetection study 16, 20 and 23 months afterthe first.Results. Radioimmunodetection was superior toCDM, accurately predicting disease distribution in sixnonsurgical and ten CDM+ surgical patients, and wascomplementary to computed tomography in two nonsurgicaland two CDM+ surgical patients. Radioimmunodetectionwould have directed or changed management decisionsin 6 of the 15 (40%) CDM+ surgical patients.Radioimmunodetection correctly identified all recurrenttumor in 8 of 11 CDM- surgical patients and was negativein one patient with cirrhosis and no recurrence, representing a potential clinical benefit of 82%. Analyzed ona regional basis, radioimmunodetection was found to besuperior to CDM in extrahepatic abdomen and pelvisimaging and was complementary to (although not as accurateas) CDM in the liver. Human anti-mouse antibodydid not develop in any of the patients, including threewho were injected twice.

Spermatic cord torsion (twisting) occurs sometimes in the newborn male. It appears as a mass in the scrotum. It has never been characterized using sonography, an imaging process using ultrasound. This study examined sonographic findings in five cases of spermatic cord torsion that had been diagnosed surgically. These findings were then compared with pathologic findings. The results of sonography showed enlarged and globular testes corresponding to abnormalities found by touch (palpation). Four of the five infants showed heterogeneous structure of the functional part of the testis (testicular parenchyma). Hypoechoic regions (empty regions on the sonogram) were seen in four of the five patients. Skin thickening and hydrocele (serous tumors of the testis) were seen in all five patients. Scintigraphs (photographs of outlines of organs using radioactive substances) revealed the torsion in two patients and showed ambiguous results in the other three. Surgery was performed after the sonography and confirmed the diagnosis of spermatic cord torsion. Pathologic findings showed complete hemorrhage in the testis. Other pathologic findings of hemorrhage, calcification, and tissue death (necrosis) corresponded well with sonographic findings. Although spermatic cord torsion is relatively rare, these results indicate that it should be considered a possibility when a neonatal sonogram exhibits a scrotal mass. This indication in addition to skin thickening and hydrocele are predictors of this problem. Early detection can lead to early surgical treatment and possibly lessen the damage caused by the torsion. (Consumer Summary produced by Reliance Medical Information, Inc.)