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Patterns of pertechnetate uptake were correlated with ultrastructural properties of the endothelial wall in 14 human brain tumours. In tumours with reduced uptake of the radionuclide, intercellular tight junctions were observed whereas absence of intercellular tight junctions was characteristic of all tumours with an increased uptake of pertechnetate. In some tumours with increased uptake, fenestrated endothelial wall was seen while in others non-fenestrated wall was evident. We concluded that intercellular junctions and not fenestrations affect the permeability of brain tumours to pertechnetate. [ABSTRACT FROM AUTHOR]

Background: Perfusion scintigraphy has been used to evaluate and monitor graft function in single-lung transplant recipients. In this study, our objective was to determine whether quantitatively measured regional breath sounds, using a computerized breath sound analysis device, correlate with the standard methods of monitoring graft function used at our facility for single-lung transplant patients., Methods: Quantitative regional breath sound measurements (QLD VRI) were performed with a VRIxp device on 37 single-lung transplant patients, who underwent perfusion scans and lung function testing for routine follow-up. The measurements were conducted on the same day., Results: Using a quantitative output based on objectively measured breath sounds, we established that there is good correlation (0.73) between QLD VRI and perfusion measurements for the grafted lung. Moreover, no significant differences were found between the two measurements (p = 0.898, t-test for paired data). In addition, the fraction of forced expiratory volume in 1 second (FEV(1); liters) of the graft lung was measured twice: once as a function of FEV(1) and regional perfusion and then as a function of FEV(1) and QLD VRI. High correlation (r = 0.88) and no significant differences (p = 0.72) were found between FEV(1tx) (perfusion) and FEV(1tx) (QLD VRI). Absolute error was 0.13 liter and the root-mean-square error (RMSE) was 0.17 liter., Conclusions: Objectively measured breath sound distribution in single-lung transplant patients can be readily quantified and correlated with graft function measurements. The method is quick and non-invasive and may provide useful information to aid clinicians in managing single-lung transplant patients.

The NETT study assessed the benefits of lung volume reduction surgery (LVRS) versus medical treatment. However, data is available only on the early outcome of LVRS (24 months). We evaluate the factors affecting the outcome at one-year and up to 6 years after LVRS. Thirty-seven patients underwent LVRS. Thirty-five patients, who survived the operation for at least one-year, were followed up to 6 years. Patients' laboratory, clinical and scintigraphic data before surgery were reviewed retrospectively, and follow-up at one-year and at the end of data collection. Successful LVRS with improvement of FEV(1)30% at one-year was observed in 13 of 35 patients. Five of these patients had initial FEV(1) values of <20% of the predicted. The group of patients with improvement was younger as compared to the 22 patients without improvement (P<0.005). The younger age group used less supplemental oxygen and had a PDiff of >23%. Combinations of age under 60 years and PDiff >23% were a favorable factor (P<0.002) for successful LVRS. Thirty-four patients were followed up to 6 years. Fifteen of the 34 patients (44.1%) remained well. Use of supplemental oxygen before surgery, and FEV(1) improvement of 30% at one-year after surgery were good prognostic factors. We concluded that the long-term success of LVRS is affected by non-dependence on oxygen supplementation before surgery, and the one-year post-surgical improvement of FEV(1) (30%). Based on our findings, the subgroup of patients below 60 years old with severe disease (FEV(1)<20%) and heterogeneous upper lobe emphysema (Pdiff>23%) has improved outcome.

Interpretation of positron emission tomographic (PET) scans in the absence of correlative anatomic information can be challenging. PET-computed tomography (CT) fusion imaging is a novel multimodality technology that allows the correlation of findings from two concurrent imaging modalities in a comprehensive examination. CT demonstrates exquisite anatomic detail but does not provide functional information, whereas 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) PET reveals aspects of tumor function and allows metabolic measurements. Subtle findings at FDG PET that might otherwise be disregarded or interpreted as physiologic variants may lead to detection of a malignant process after being correlated with simultaneously acquired CT findings. Alternatively, equivocal CT findings, which could represent malignant tumor, reactive changes, or fibrosis, can be clarified with the help of the additional metabolic information provided by concurrent FDG PET. Accurate interpretation of FDG PET scans requires a thorough knowledge of the normal physiologic distribution of FDG and of normal variants that may reduce the accuracy of PET studies, thereby significantly affecting patient treatment. Although in rare instances PET-CT cannot help resolve the diagnostic dilemma, it is enjoying widespread acceptance in the medical imaging community, usually allowing differentiation of physiologic variants from juxtaposed or mimetic neoplastic lesions and more accurate tumor localization., (Copyright RSNA, 2004)

Unlabelled: Hypotheses Melanoma of the distal lower extremity may drain to the popliteal basin. Drainage pathways and retrieval of the popliteal sentinel nodes may affect patient outcome., Design: Retrospective analysis of popliteal involvement in patients with stage IB or higher melanoma, operated on from August 1, 1993, to July 31, 2003., Setting: Tertiary referral, university-affiliated medical center., Patients: One hundred six melanoma patients who underwent combined lymphoscintigraphy and blue dye-guided sentinel node biopsy, radical popliteal dissection, or both., Main Outcome Measures: Incidence and patterns of drainage to popliteal nodes; effect on staging and outcome., Results: Lymphoscintigraphy (n = 8) and physical examination (n = 2) identified 10 cases (9%) of draining to the popliteal basin, with concurrent drainage to the groin. Three distinct drainage patterns were identified, with different popliteal node locations. Seven of 8 popliteal sentinel nodes were retrieved, 1 of which was metastatic with no groin metastasis. Two patients had synchronous palpable popliteal and groin metastases and underwent radical groin and popliteal dissection. All 3 patients with popliteal metastases relapsed early with synchronous systemic and in-transit disease. One of 7 patients with negative sentinel nodes is alive with in-transit disease; all others are disease free., Conclusions: According to this series, the popliteal basin is the site of first drainage in about 9% of patients, with concurrent drainage to the groin. The 3 distinct patterns of drainage to the popliteal region and the presence of isolated popliteal metastases may affect the surgical treatment. Therefore, drainage to popliteal sentinel nodes and the pattern of this drainage should be noted in all distal lower extremity melanomas.

Sentinel lymph node biopsy may be more technically challenging for melanoma of the head and neck compared with other locations because of the complex lymphatic drainage patterns. This study demonstrates the value of sentinel node biopsy for head and neck melanoma, and highlights the associated difficulties. Thirty consecutive patients with primary cutaneous melanoma of the head and neck (n=26) or draining to the neck (n=4) underwent preoperative lymphoscintigraphy. This was followed by intraoperative lymphatic mapping using blue dye alone (n=8) or in combination with a hand-held gamma probe (n=22) and sentinel lymphadenectomy. Modified neck dissection was performed in all patients with positive sentinel nodes. The study population had a male predominance (73%). Most lesions were nodular and were not ulcerated. In two patients (6.2%) preoperative lymphoscintigraphy failed to demonstrate the draining nodes, which were retrieved by surgery, and in two patients (6.2%) the sentinel node was not found at surgery despite preoperative visualization. Overall, the sentinel node was identified 93% of the time: in seven out of eight cases (88%) using blue dye alone, and in 21 out of 22 cases (96%) using a combination of blue dye and gamma probe. Four out of 28 basins were deemed positive for metastases. Twenty-three of the 24 patients with negative sentinel nodes were free of disease at a median of 31 months (range 9-91 months). There was one false-negative case salvaged by surgery. The sentinel node technique is technically demanding but advantageous for most patients with head and neck melanoma. Identification rates seem to be better when preoperative lymphoscintigraphy is combined with intraoperative blue dye mapping and a hand-held gamma probe. The relative contribution of each component could not be determined., (Copyright 2004 Lippincott Williams & Wilkins)

Venous vascular complications in liver transplant recipients are rare. Diagnosis is usually based on clinical criteria and typical findings on liver biopsy. The scintigraphic patterns of posttransplant liver veno-occlusive disease are described, and the value of follow-up studies is suggested. The authors present 2 patients who developed posttransplantation hepatic veno-occlusive disease. The first patient had a severe form of the disease and a fatal outcome. The second patient had a mild to moderate form of this disorder with complete resolution following treatment.

Purpose: To test the benefit of hydroxyurea in the treatment of recurrent and non-resectable slow-growing meningiomas., Methods: Twelve patients with regrowing non-malignant meningiomas, were enrolled for a protocol of 2 years with continuous chemotherapy with hydroxyurea, 20 mg/kg/day. Response to treatment was evaluated both clinically and by diagnostic imaging using computed tomography (CT) and 201-Thallium single photon emission CT. One minimal response was documented by CT, accompanied by clinical stabilization. Nine patients showed progressive disease, at least by one imaging procedure, with a median time to progression of 13 months (range 4-24). Two other patients were not available for response due to early removal from the study, following abrupt manifestation of grades 3-4 hematological toxicity., Conclusion: In this series hydroxyurea has not shown effectiveness in the treatment of non-resectable slow-growing meningiomas: neither for achieving response, nor for arresting disease progression.

Purpose: Conventional nuclear medicine equipment lacks sufficient spatial resolution to reliably visualize the papillary muscles (PM). Positron emission tomography (PET), however, can adequately visualize these structures using various positron emitters., Methods and Patients: We present various patterns of PM observed on myocardial PET imaging in 4 patients. These patterns demonstrate different pathologic conditions such as PM ischemia of varying severity, as well as hibernation, using both N-13 NH3 and F-18 FDG as perfusion and metabolic agents, respectively. These patterns of infarction, stress-induced myocardial ischemia, or hibernation can be identified in one or both PM using PET scanning. Normal PM visualization on chest F-18 FDG PET images is also presented., Conclusion: This report illustrates the potential ability of myocardial PET as a noninvasive modality to study the perfusion and metabolic abnormalities of the PM.

A case of a 70-year-old patient with advanced local vulvar cancer is presented. Treatment with neo-adjuvant chemo-radiotherapy for two courses was administered and two weeks after completion of treatment the patient underwent wide local excision with bilateral inguino-femoral lymph node dissection through three separate incisions. Two methods for the evaluation of sentinel nodes--lymphoscintigraphy and intraoperative gamma hand-held probe and blue dye injection, did not detect any sentinel node on either side. Groin-node dissection revealed 23 negative nodes. It is our hypothesis that the non-visualization of sentinel nodes in this patient was due to post-irradiation damage to the lymph channels.

Gastrointestinal symptoms such as nausea, abdominal pain, and bloating are frequent complaints of patients with Parkinson's disease (PD). It has been postulated that impaired gastrointestinal function may contribute to the development of motor fluctuations such as delay on and no on in patients with PD. Gastrointestinal impaired function and symptoms may be associated with the disease itself or secondary to levodopa treatment. Thus, we assessed gastric emptying (GE) and gastric motility in PD patients to examine the association between clinical status and gastric function. GE and antral contraction (frequency and amplitude) were evaluated by scintigraphy in 29 patients with mild PD (Hoehn and Yahr [H&Y] stage 1.0-2.0); 22 patients with moderate PD (H&Y stage 2.5-3.0); and 22 healthy volunteers, following the ingestion of a labeled standard meal. Gastric emptying (mean +/- SD of T(1/2)) and antral contraction were not significantly different between patients with mild PD (63.4 +/- 28.8 minutes) and moderate PD (54.7 +/- 25.5 minutes). In the control group, GE was 43.4 +/- 10.8 minutes (range 29.0 - 61.0 minutes). The prevalence of delayed emptying (>61 minutes) was not significantly different in patients with mild disease (48.3%) as compared with patients with moderate disease (36.4%). Antral contraction, both frequency and amplitude, were not significantly different between patients with mild and moderate PD throughout the entire 100 minutes of the study. Untreated patients (n = 28) had mean GE T(1/2) of 59 +/- 30.6 minutes. Patients with smooth response to levodopa showed slower GE (n = 10; 73.6 +/- 25.3 minutes), while treated patients with motor response fluctuations when tested at the on state (n = 13), had much faster GE (49.3 +/- 16.2 minutes). This shortened GE in the on state was similar to the GE of normal volunteers. We conclude that gastric emptying time in patients with PD was delayed compared with control volunteers. It was even slower in patients treated with levodopa. This effect of levodopa treatment was reversed to pseudonormalization (normal GE) at the advanced stages of the disease, when patients developed motor response fluctuation. Other clinical features of PD were not associated with delayed gastric emptying., (Copyright 2001 Movement Disorder Society.)

Two children with juvenile dermatomyositis and extensive, debilitating soft tissue calcifications are described. Whole-body bone scans with Tc-99m MDP were performed in both cases before and during specific treatment for the calcinosis. Baseline studies showed marked tracer localization in the soft tissues and provided an objective baseline assessment of the extent of the soft tissue calcifications. Follow-up studies showed gradual clearance of the extraskeletal uptake and were useful in monitoring the therapeutic response. These cases show that skeletal scintigraphy can function as a useful auxiliary tool to evaluate calcinosis in children with juvenile dermatomyositis.

Unlabelled: The objective of this study was to evaluate the role of quantitative perfusion lung scintigraphy (QPLS) in predicting the development of chronic rejection in patients who underwent single-lung transplantation., Methods: Eighteen patients (15 men, 3 women; age range, 41-60 y; mean age, 54.6+/-6.0 y) who underwent single-lung transplantation for emphysema (n = 14) or pulmonary fibrosis (n = 4) were studied. Patients were evaluated using QPLS and pulmonary function tests before surgery and at 1-3 mo and 1-3 y after transplantation. Relative perfusion of the transplanted lung was calculated from standard perfusion lung scintigrams. Values for forced expiratory volume in the first second (FEV1) were obtained from lung function tests at the same time points. The maximal and minimal relative perfusion and FEV1 values in the early (1-3 mo) and late (1-3 y) follow-up periods were identified for each patient. Receiver operating curve (ROC) analysis was performed on all parameters., Results: In total, 82 lung scans were performed (mean, 4.8+/-1.55 per patient) and 484 FEV1 test determinations were obtained (mean, 30.0+/-15.6 per patient) during a follow-up period ranging from 8 to 84 mo (mean, 39.6+/-19.3 mo). In 7 of the 18 patients, chronic rejection developed, whereas 11 patients had a favorable outcome. No significant difference was found in the number of complications (acute rejection and infection episodes) between patients with a favorable outcome and patients with chronic rejection, up to 1 y after transplantation. At 1-3 mo, minimal relative perfusion values were 67.1%+/-12.2% in the favorable outcome group and 50.8%+/-9.6% in the chronic rejection group (P = 0.02). Before surgery and at 1-3 y, minimal relative perfusion was not significantly different between the 2 groups. The difference in maximal relative perfusion at 1-3 y was marginally significant, with 76.5%+/-8.9% in the favorable group and 64.3%+/-15.0% in the chronic rejection group (P = 0.051). FEV1 values were not significantly different preoperatively and 1-3 mo after surgery between the chronic rejection and the favorable outcome groups. Late in the follow-up period (1-3 y), FEV1 values in the chronic rejection and favorable outcome groups were 35.6%+/-7.9% and 56.9%+/-13.6%, respectively (P = 0.002). ROC analysis of minimal relative perfusion at 1-3 mo identified a threshold of 57% under which the sensitivity and specificity for chronic rejection were 83% and 88%, respectively. Minimal FEV1 for the same period identified a threshold of 48% under which the sensitivity and the specificity were 80% and 67%, respectively., Conclusion: QPLS early after transplantation in our patients predicted the development of chronic rejection in patients with single-lung transplantation for emphysema and pulmonary fibrosis, whereas surgical complications, acute rejection, infection episodes, and lung function tests did not predict the outcome. This early prediction could not be obtained from lung function tests performed at the same time.

Purpose: Tc-99m MIBI has been used increasingly to evaluate benign and malignant tumors because of its tumor-seeking properties and ability to provide an imaging assessment of multiple-drug resistance. This study investigated the clinical utility of Tc-99m MIBI in the management of Ewing's sarcoma in children., Methods: Thirteen Tc-99m MIBI studies in nine (six male, three female) patients ages 6.5 to 20 years (mean, 13.4 years) with Ewing's sarcoma were reviewed. All patients had imaging studies at diagnosis, and four had follow-up studies during or after therapy. Scintigraphy was evaluated for Tc-99m MIBI uptake within the tumor and in metastases, which other imaging modalities had shown to be present in four patients. Scintigraphic results were correlated with the clinical course in all patients and with tumor P-glycoprotein status in six patients., Results: Tc-99m MIBI accumulated in 6 of 9 primary tumors and did not accumulate in one recurrent tumor. No metastases showed Tc-99m MIBI uptake. The presence or absence of Tc-99m MIBI uptake at diagnosis or after therapy carried no prognostic significance. Tc-99m MIBI was present in the two tumors that were P-glycoprotein positive and in only one of four tumors that were P-glycoprotein negative., Conclusion: Tc-99m MIBI imaging does not appear to be useful in Ewing's sarcoma.

Unlabelled: Bone loss is a major complication of primary hyperparathyroidism (PHPT), and it has significant implications in the treatment of this disease. Bone turnover was measured in patients with PHPT, using quantitative bone SPECT (QBS), to determine if the rate of bone loss could be predicted before a significant decrease in bone mass occurs., Methods: Forty-six patients were included in the study. QBS and bone mineral density (BMD) of the lumbar spine (LS) and femoral neck (FN) were done at baseline. The percent deviation of QBS in patients with PHPT from the values in normal matched controls was calculated. BMD was measured again after a mean of 17.5 mo in 38 patients, and in 29 patients a repeat BMD study was done after a mean of 41.4 mo. The change in BMD in patients with high and normal QBS values was compared using the nonparametric Mann-Whitney test. Regression analysis tested the correlation between baseline QBS values and BMD changes over time., Results: For the FN, there was a statistically significant difference in the BMD change between patients with high and normal QBS values for short-term follow-up (-2.82%+/-4.80% versus 1.45%+/-4.67%, p < 0.05) and for long-term follow-up (-3.53%+/-5.34% versus 0.92%+/-2.40, p < 0.02). There was a negative correlation in the FN, r=-0.48 between QBS values and the percentage of change in BMD. There was no significant difference between the percentage of change in BMD in the LS in patients with high and normal QBS values for either short- or long-term follow-up., Conclusion: The results of this study show that QBS can predict bone loss in the FN in patients with PHPT. QBS can thus indicate the need for surgery at an early stage of the disease to prevent bone loss.

We describe a 13 year-old Ethiopian girl with vitamin D deficiency rickets. Hypercalcemia, increased serum alkaline phosphatase and PTH levels, together with low serum levels of 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D suggested the co-existence of primary hyperparathyroidism. The surgical removal of a parathyroid adenoma led to bone healing and normalization of blood chemistry. We conclude that vitamin D deficiency masked the hyperparathyroidism and hypercalcemia, while excess PTH secretion delayed the cure of rickets until successful parathyroidectomy had been carried out.

Background: Fiber dropout and myocyte necrosis precede heart failure in experimental aortic regurgitation (AR). The current study aimed to determine whether this process can be detected by noninvasive scintigraphic imaging., Methods and Results: 111In-labeled antimyosin antibody Fab fragment (1 to 1.5 mCi) (Myoscint) was administered to each of 34 New Zealand White rabbits: 11 early (3 to 5 weeks) after surgical AR induction; 9 late (98 to 128 weeks) after AR induction; 5 normal and 3 sham-operated age-matched with early AR; and 3 normal and 3 sham-operated age-matched with late AR. Echocardiographic fractional shortening was indistinguishable among control, early AR, and late AR groups. In vivo gamma camera imaging 24 and 48 hours after isotope administration, post-mortem heart activity determination (percentage injected dose per gram), and autoradiography were performed. At 24 and 48 hours, heart-to-lung counts-per-pixel ratios from in vivo images were greater (p < 0.05) in the late AR rabbits than in each of the three other groups. No significant differences were found when early AR and older or younger control rabbits were compared. Heart activity (percentage injected dose per gram) in late AR rabbits trended toward higher values than in age-matched control rabbits (p = 0.057), but in early AR it was indistinguishable from that in the corresponding control (p = 0.413, difference not significant). The autoradiographic endocardial/epicardial activity ratio in late AR rabbits was greater than in control and early AR rabbits (1.27 +/- 0.13 vs 1.06 +/- 0.09 and vs 1.13 +/- 0.10, respectively, p < 0.02)., Conclusions: Whereas isotope uptake in late AR rabbits differed from that in control and early AR rabbits, systolic function was indistinguishable. Thus 111In-labeled antimyosin antibody imaging may permit noninvasive detection of AR-induced myocardial damage before functional deterioration.

A 59-yr-old man with chronic renal failure was admitted for evaluation of generalized skeletal pain and frontal bone mass, which was lytic on radiography. Bone scintigraphy demonstrated several foci of moderately increased uptake, without involvement of the skull mass. Radiographs of these lesions were compatible with brown tumors. Serum parathormone level was elevated and CT demonstrated a lower right cervical mass, consistent with parathyroid tumor. Following the removal of the mass and decrease in parathormone levels, the patient suffered from a prolonged period of hypocalcemia and his bone pain worsened. Repeat bone scintigraphy showed an increase in the number and intensity of the areas of focal uptake, consistent with hungry bone syndrome. This flare-up phenomenon is due to an increase in bone metabolism and is an uncommon finding following parathyroidectomy for primary hyperparathyroidism.

Eleven patients, each with a painful solitary cold nodule of the thyroid were evaluated. All patients had subacute thyroiditis associated with neck pain and tenderness. Despite elevated sedimentation rate and increased thyroglobulin levels, nine of the patients were euthyroid, and I-131 uptake was normal in six. In all patients, thyroid scintigraphy demonstrated a solitary cold nodule that resolved regardless of anti-inflammatory therapy. Granulomatous subacute thyroiditis is characterized by decreased I-131 uptake accompanied by transient hyperthyroidism. The uncommon localized variant of this entity may present with a painful solitary nodule, normal or only moderately decreased I-131 uptake, and should be suspected even in euthyroid patients.

We examined prospectively the hypothesis that the adequacy of initial dilatation may be a major determinant of the late result of coronary angioplasty and that a better assessment of initial dilatation can be made from a combined angiographic and perfusion study than from angiography alone. Angiographic and perfusion (thallium-201 single-photon-emission computed tomography) measurements were made very early (18 to 24 hours) after coronary angioplasty in 59 patients (67 lesions) and also immediately (37 +/- 16 minutes) after the procedures in 19 of them (23 lesions). The early measurements, singly, in combination, and as a restenosis index (restenosis index = thallium-201 ischemic score (units) - minimal luminal area (squared millimeters) were examined as predictors of the late angiographic result. At late angiography (5.5 +/- 2.2 months after angioplasty), residual stenosis was related to the immediate and very early postangioplasty minimal luminal dimension, thallium-201 ischemic score, and restenosis index, and also to day-1 loss and lesion length. The combination of a normal result in the immediate or early thallium-201 perfusion study with a large ( > or = 2 mm) angiographic luminal dimension stratified a group of patients with better long-term results after angioplasty and a lower incidence of late restenosis (p = 0.03). The findings emphasize the importance of the initial procedure as a determinant of the late result of angioplasty.

We have previously shown that after administration of (123)I-SP-4 (a synthetic ApoB peptide fragment) to Watanabe heritable hyperlipidemic (WHHL) rabbits that foci of tracer uptake can be identified by external gamma camera imaging which correspond to regions of the aortas found to contain abundant atherosclerotic lesions at postmortem evaluation. Because (99m)Tc is preferred over (123)I for scintigraphic imaging, we prepared a (99m)Tc-labeled form of the SP-4 peptide, designated (99m)Tc-P199. To assess the feasibility of detecting atherosclerotic lesions using (99m)Tc-P199 and to compare the relative uptake of the (99m)Tc-labeled and radioiodinated peptides by such lesions, an admixture of (99m)Tc-199 and (125)I-SP-4 was administered to 11 WHHL and 2 normal rabbits. These animals were imaged for up to 3 h and were sacrificed 3--4 h after injection. The extent of aortic lesion involvement and radiotracer uptake were quantitatively compared by planimetric analysis of photographs of the endothelial surface, (99m)Tc-P199 ex vivo images and (125)I-SP-4 autoradiograms of the excised aortas. Pairwise correlation coefficients for planimetric analysis were as follows: photographs versus ex vivo images, r = 0.83, p = 0.003; photographs versus autoradiograms, r = 0.87, p = 0.001; ex vivo images versus autoradiograms, r = 0.83, p = 0.003. (99m)Tc-199 in vivo gamma camera images revealed relatively weak focal aortic uptake in 8 of 11 WHHL rabbits manifesting aortic lesions, and focal carotid artery uptake in 4 of 6 WHHL rabbits manifesting carotid lesions. Neither aortic nor carotid foci were visualized in the normal rabbits. We conclude that (99m)Tc-199 localizes specifically in atherosclerotic lesions and may be useful for external imaging of atherosclerosis.

Two patients with unusual Hodgkin's disease who initially had a painless, solitary, thyroid cold nodule are described. Fine-needle aspiration revealed lymphocytic thyroiditis in one patient and a diagnosis of Hodgkin's disease was made 1 year later. In the second patient, aspiration of the nodule demonstrated a syncytial variant of nodular sclerosis Hodgkin's disease. Both patients underwent radiologic work-up, and surgery of the thyroid was avoided. After chemotherapy, both thyroid nodules disappeared. Thyroid involvement by Hodgkin's disease may be more common than anticipated, and may present atypically as a solitary thyroid nodule. Lymphocytic thyroiditis may accompany the disease and may cause a delay in the diagnosis. Recognition of this entity and the use of fine-needle aspiration may prevent unnecessary thyroid surgery, thus maintaining intact thyroid function after therapy.