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The bisphosphonate space (BPS) is a quantitative measurement of skeletal uptake of 99mTc-HMDP. We measured BPS in 36 patients with Paget's disease of bone, both before and 6 months after treatment with intravenous APD (disodium pamidronate) infusions. BPS fell after treatment, but proportionally less than serum alkaline phosphatase (ALP) and fasting urinary hydroxyproline/creatinine (HYPRO). There was no dose-response relationship between the dose of APD given and the percentage reduction in ALP and HYPRO at 6 months. Log dose of APD/pretreatment BPS, however, predicted the percentage reduction in ALP and HYPRO very well, and from the respective regression equations it was possible to predict the dose of APD needed to achieve normal values of ALP and HYPRO. In the 10 patients who achieved a normal ALP and 9 patients a normal HYPRO after more than 6 months treatment with APD (range 7-18 months), the predicted dose of APD agreed closely with the actual dose. In conclusion, our data support the idea that log dose APD/pretreatment BPS is a valid predictor of biochemical response in Paget's disease.

A retrospective study was undertaken in six patients (three male and three female) with neural crest tumours who received therapeutic doses of 131 I-meta-iodobenzylguanidine ( 131 I-MIBG) (6.7-10.5 GBq). The age range of the patients was 13-65 years (mean 36 years). Quantification of tumour uptake was obtained from images acquired with a large-field-of-view gamma camera on a single occasion between 2 and 10 days post-treatment. Tumour uptake was calculated to be 0.1% and 3.2% of the administered dose, corresponding to uptakes of 6.7-142.8 MBq. Tumour volume was assessed from computed tomography (CT) or magnetic resonance (MR) images and estimates of tumour dose made from the Medical Internal Radiation Dosimetry scheme (MIRD) tables. Estimated doses were between 7 and 113 Gy. Most significantly, our findings indicate that high tumour uptake did not always correlate with good clinical response.

Objective To investigate the clinical application of an 111In-labelled anti-MUC1 mucin monoclonal antibody (mAb) imaging for staging invasive bladder cancer. Patients and methods Indirect immunohistochemistry was used to confirm the expression of the MUC1 target antigen by metastatic tumours. Twelve patients with bladder cancer (two with superficial and 10 with locally invasive/metastatic disease) underwent planar γ-scintigraphy 48 h after an intravenous injection with 111In-labelled anti-MUC1 mucin mAb C595. Results No bladder uptake was detected in the two patients with superficial disease, but scintigraphy showed primary and recurrent bladder tumours and metastases in nine of the remaining 10 patients with invasive disease. In three patients additional staging information was obtained from the mAb imaging which would have altered patient management. There were no reported side-effects. Conclusion This study confirmed the ability of the mAb technique to detect both primary and recurrent invasive bladder tumours and distant metastases. Some lesions shown by mAb imaging were not detected by other methods. The use of mAb imaging has the potential to improve clinical staging and assist in selecting those patients most likely to benefit from radical therapy.

The functional nature of nuclear medicine procedures makes them especially valuable in the management of patients undergoing intensive care. However, the severe nature of the patient's condition invariably prevents him or her from attending the nuclear medicine department for diagnostic investigations. We have piloted a bedside nuclear medicine service using a four-probe detector system linked to an IBM computer with curve processing software. Protocols for a range of radionuclide probe investigations, including renal, hepatobiliary, gastric outflow and lung vascular permeability, using 99 Tc m and 111 In radiopharmaceuticals have been established. The measurement of lung vascular permeability in patients with clinical symptoms of adult respiratory distress syndrome was considered to be a valuable procedure on the intensive care unit. Due to the poor availability of 113 In m , which had previously been used for the measurement of lung permeability, we used a technique based on in vivo labelling of serum transferrin with ll1 In-chloride together with 99 Tc m -red blood cells for the calculation of the plasma protein accumulation index. Other procedures include the measurement of gastric outflow in patients previously on parenteral feeding, and the assessment of hepatobiliary and renal function. The equipment proved to be reliable and convenient for use at the bedside, although ultrasound imaging was essential for the correct positioning of the probe detectors over smaller organs such as the kidneys and the gallbladder. The high sensitivity of the probe detectors required only low administered amounts of activity, minimizing radiation protection measures for patients and staff. The administration of radiopharmaceuticals via indwelling lines and tubes presented particular problems and we recommend that parenteral injections should not be given through manifold giving sets, or via Teflon cannulae.

The reproducibility of Technetium-99m macroaggregated albumin (99mTc-MAA) foot perfusion imaging was assessed in 14 diabetic patients with foot ulcers. Bilateral femoral intra-arterial injections of 99mTc-MAA were administered and the feet imaged with a gamma camera. Patients returned 1 week later for a repeat study. The scans of 10 patients including one unilateral amputee were evaluated. Of these 19 limbs there were 4 failed injections (21%). The remaining 15 completed repeat studies were analysed both subjectively and semiquantitatively by 2 different observers who were blind to the patient's name and scan date. Subjectively the images of each individual were similar with reports highlighting the same abnormalities. Semiquantitatively areas of increased uptake on both images were significantly correlated for each individual (Pearson's Rho correlation coefficient = 0.96, r2 = 0.92, p < 0.0001) as were areas of poor uptake reported, reflecting decreased tissue perfusion (Pearson's Rho = 0.93, r2 = 0.86, p < 0.0001). There were no side-effects. 99mTc-MAA has proven to be a safe, generally acceptable, and reproducible technique for assessing tissue perfusion in the extremities which provides an accurate means of differentiating viable from non-viable tissue in patients with foot ulcers.

In a prospective study we performed bone scans on 84 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected but could not be confirmed on the original set of five routine “scaphoid view” radiographs. In 40 patients the bone scan was normal and in 25 there was increased uptake in areas other than the scaphoid. In 19 there was localized increased uptake in the scaphoid bone. In seven of these a scaphoid fracture was subsequently demonstrated on repeat radiographs (five cases) or a CT scan (two cases). In the remaining 12 no fracture could be demonstrated.

Macroaggregated albumin has been used to assess capillary circulation for over 20 years. The aim of the present study was to use 99mTc-macroaggregated albumin (99mTc-MAA) perfusion scanning to assess capillary circulation in feet with ischaemic ulcers in patients with diabetes, and relate the appearances to outcome. Twenty-three patients with diabetes presented with a total of 41 neuroischaemic foot ulcers. Perfusion scanning was performed by direct femoral artery injection of approximately 400,000 particles of 99mTc-MAA and imaging with a gamma camera. Patients were followed prospectively for 3 months. Scans were graded independently by a radiologist who was unaware of the site of the ulcers. Significant associations were detected between a radiologist's assessment of increased tissue perfusion and complete healing after 3 months (p = 0.047) and poor tissue perfusion on the image and failure to heal (p = 0.0005). This technique may be useful in deciding whether to persist with conservative treatment in patients with diabetes and foot ulceration.

The pulmonary deposition of 99mTc-labelled hexamethyl propylene amine oxime, used as a model for propellant soluble drugs, was studied in healthy volunteers using gamma scintigraphy. The radiolabel was delivered using a metered dose inhaler using a low vapour pressure chlorofluorocarbon fill (LVPA, 255 kPa) or a high vapour pressure chlorofluorocarbon fill (HVPA, 448 kPa) in a cross-over design trial. The data showed that a lower proportion of the dose (35%) was swallowed for HVPA compared with LVPA (49%). Within the lung, the proportion of the dose reaching the peripheral airways as determined by the penetration index was the same for both aerosols, although a greater pulmonary deposition of the dose was observed with HVPA. The results obtained confirm previous observations that greater than 40% of the marker achieves pulmonary deposition when dissolved in the propellant phase.

The 99Tcm-labelled antigranulocyte antibody BW250/183 has been used in the detection of intestinal inflammation in patients with active ulcerative colitis and Crohn's disease. Planar images were obtained up to 24 h after intravenous injection of the antibody. Eight out of nine patients with ulcerative colitis and six out of seven patients with Crohn's disease gave positive images. In 11 patients distribution of the inflammation was confirmed by barium studies, colonoscopy or surgery, whilst in two the antibody scan suggested more extensive disease than barium enema. None of the patients had any adverse reactions. Imaging with BW250/183 appears to give an accurate indication of the extent of inflammation in inflammatory bowel disease.

Patients with germ cell testicular tumours customarily have repeated follow-up chest radiographs after treatment. This study assesses the contribution of chest radiography to the detection of recurrent disease in 162 patients. Six patients developed an intrathoracic recurrence, but in only one case was the chest radiography the only indication of recurrence. Five had other evidence to suggest recurrence, such as raised serum markers or palpable masses. The yield from follow-up chest radiographs in patients with germ cell testicular tumours is very low and their use must be balanced against both the harmful effects of radiation and the financial cost.

We report a 43-year-old woman who presented with post-coital bleeding. Pelvic examination revealed a uterine cervical mass, which confirmed to be large B cell lymphoma on histopathological examination. Computed tomography showed a primary lesion in the uterine cervix with no lymph node or other extranodal involvement. The patient responded to CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) chemotherapy regime with no major side effects.

Non-tuberculous mycobacterial infection (NMI) occurs in elderly women with no pre-existing lung disease, and this has been termed the Lady Windermere syndrome. NMIs are increasing in prevalence and an increasing number of pulmonary mycobacterial infections is due to non-tuberculous mycobacteria. The diagnosis is often difficult because the organism is not readily isolated or cultured, and the condition may not be considered by the radiologist. We report NMI in a 64-year-old woman, based on clinical and radiological findings. Although termed the Lady Windermere syndrome, the name does not correspond to the character in Oscar Wilde's play; hence the eponym is not widely used.

Radiation-induced sarcomas are well-known though uncommon potential late sequelae of radiation therapy. We report irradiation-induced osteosarcoma involving the maxilla following treatment of nasopharyngeal carcinoma in a 44-year-old man who presented with painful cheek swelling. Radiographs and computed tomography showed a large destructive lesion of the left maxilla. Diagnosis of osteosarcoma was confirmed by excision biopsy.

There is an awareness of the increased incidence of splenic abscess in Southeast Asia giving rise to unexplained fever. This study looks at the role of computed tomography (CT) in evaluating focal splenic lesions in patients presenting with fever.37 patients presenting with fever of unknown origin underwent CT and this study retrospectively analyses the findings in these patients. 13 patients also had associated abdominal pain. Patients with conditions at high risk for splenic infection include: diabetes mellitus in ten patients, leukaemia in seven patients, human immunodeficiency virus infection in five patients, intravenous drug abuse in six patients, and steroid therapy in two patients. No risk factors could be identified in seven patients.Splenic abscess was diagnosed in 28 patients. A range of infecting organisms was isolated but the most frequent were Staphylococcus aureus (eight), tuberculosis (four), Streptococcus (four), fungal (four) and melioidosis (four). No infecting organism could be identified in ten cases though in patients with leukaemia with multiple low attenuation areas, the cause was presumed to be fungal. Six patients were diagnosed to have splenic infarcts though differentiation from splenic abscess could be difficult; these patients were treated for an abscess and all had endocarditis. Three patients were subsequently diagnosed with lymphoma. Percutaneous abscess drainage was performed in five patients and splenectomy was carried out in six patients.CT proved to be very useful as it not only revealed the size and extent of any splenic abnormality but it assisted with guidance for percutaneous drainage, determined the site for biopsy, and provided follow-up after treatment.

To investigate the clinical application of an 111In-labelled anti-MUC1 mucin monoclonal antibody (mAb) imaging for staging invasive bladder cancer.Indirect immunohistochemistry was used to confirm the expression of the MUC1 target antigen by metastatic tumours. Twelve patients with bladder cancer (two with superficial and 10 with locally invasive/metastatic disease) underwent planar gamma-scintigraphy 48 h after an intravenous injection with 111In-labelled anti-MUC1 mucin mAb C595.No bladder uptake was detected in the two patients with superficial disease, but scintigraphy showed primary and recurrent bladder tumours and metastases in nine of the remaining 10 patients with invasive disease. In three patients additional staging information was obtained from the mAb imaging which would have altered patient management. There were no reported side-effects.This study confirmed the ability of the mAb technique to detect both primary and recurrent invasive bladder tumours and distant metastases. Some lesions shown by mAb imaging were not detected by other methods. The use of mAb imaging has the potential to improve clinical staging and assist in selecting those patients most likely to benefit from radical therapy.

Fistula-in-ano is a common condition in which accurate diagnosis of the fistula track is essential as inadequate assessment and surgical treatment may lead to multiple unnecessary operations and may also render the patient incontinent. Several studies have suggested that Magnetic Resonance Imaging (MRI) can accurately identify the fistula track in relation to the sphincter complex. The aim of this study was to investigate the value of the routine use of completely non-invasive pre-operative MRI in patients with suspected fistula-in-ano. Each scan was reported by a consultant radiologist on two occasions to determine whether the radiologist's opinion had changed and/or become more accurate with further experience. Surgical assessment of the fistula was performed under general anaesthesia by one surgeon without knowledge of the result of the MRI scan. The results of the surgical assessment and the MRI scan were compared and the surgical procedure completed. Thirty three patients with a clinical diagnosis of fistula-in-ano were treated and 27 subsequently confirmed to have a fistula. MRI detected 42% of tracks, identified correctly on initial assessment which increased to 50% at the end of the study, 63% and 74% of internal openings, 33% and 46% of external openings and 50% and 33% of abscesses. These data suggest that there is a learning curve for radiologists undertaking MRI scanning for fistula in ano, this is probably because the pathology of fistula in ano and anatomy of the anal sphincter complex are relatively new to radiologists. Routine MRI scanning of patients with fistula-in-ano is not necessary but there may be a role for MRI in assessing complex or difficult fistulae.

Oedema of the lower limbs may be associated with a number of factors, most commonly a lymphatic or venous abnormality. Generally effective treatment options are only available with venous disorders. The aim of this study is to show that a combination of duplex Doppler sonography and lymphoscintigraphy in patients with limb oedema will help to determine the aetiology and thus identify patients for whom treatment is appropriate. 32 patients presenting with unexplained oedema involving the lower limb have been studied. Each patient underwent Doppler sonography followed by lymphoscintigraphy. In 16 patients the lymphoscintigraphy was abnormal, showing absent or poorly visualized lymphatics. The Doppler study was abnormal in 17 patients, nine of whom went on to receive definitive surgical treatment. In five patients both studies were abnormal and there were six cases where both investigations were normal. It is concluded that in the great majority of referrals (82%), the combination of lymphoscintigraphy and Doppler ultrasound is a satisfactory means of assessment of patients with unexplained limb oedema.

Thyroid cancer is treated by thyroidectomy followed by radioiodine ablation of the residual active tissue in the thyroid bed. Completeness of ablation can be assessed from neck images of whole-body 131I scans by visual estimation or quantitative analysis By visual assessment, ablation can be considered complete if there is no uptake in the neck or the uptake is empirically considered too small. By quantification, ablation is considered complete if neck uptake is < 1%. Further radioiodine therapy is considered necessary only if neck uptake exceeds 1% of the administered dose. Both visual assessment and quantification of thyroid bed uptake were applied to 46 scans after diagnostic or therapeutic doses of 131I had been administered to 25 patients who were being followed up for follicular or papillary carcinoma of the thyroid. The results were compared to assess the effect of either method on determining the need for a further ablative dose of 131I. Visual assessment overestimated thyroid bed uptake in 10 of 46 (22%) of the scans. Bearing in mind the unpleasantness of radioiodine ablation and the potential for bone marrow toxicity, it is recommended that quantification of neck uptake should be routinely performed as a guide to completeness of ablation and to determine the need for a therapeutic dose of the isotope. This should help to avoid unnecessary radioiodine treatment in patients with thyroid cancer.

In a prospective study we investigated 12 clinical features for scaphoid fractures in 52 patients: 23 in whom a fracture of the scaphoid was diagnosed radiologically and 29 patients in whom a fracture was clinically suspected but could not be confirmed by radiography or scintigraphy. The signs were tested within a few days of injury and again 2 weeks later. None was reliable in diagnosing a scaphoid fracture.

The monoclonal antibody conjugate 111In-B72.3 was the first such antibody-based radiopharmaceutical for tumour detection to be granted a propriety product licence in Europe. However, the optimum activity of 111In for planar and SPET imaging is yet to be established. A baseline study of 20 patients with suspected recurrent colorectal cancer has been carried out to assess any effect of administered activity of radionuclide on image quality and tumour detection. Ten patients were administered 80 MBq 111In-Oncoscint and 10 patients a larger amount of activity, 150 MBq (resulting in effective dose equivalents of 25 and 47 mSv, respectively). Planar, orthogonal SPET and 3D volume-rendered SPET images were obtained and the image quality was assessed. The clinical results were compared with computed tomography (CT) and in selected patients magnetic resonance imaging (MRI). No difference in the overall tumour detection was apparent between the two groups and the use of 150 MBq 111In for planar imaging alone cannot be justified. Orthogonal and 3D SPET imaging was helpful in confirming sites of uptake and may justify the use of the higher administered amount of activity; however, false-positive results raise the need for caution in the interpretation of these images. Volume-rendered 3D images offer an attractive method of displaying antibody data and require further evaluation.

The scintigrams of 76 patients with gastrointestinal bleeding referred over an 8 year period have been reviewed together with their subsequent clinical course. Twenty-five patients had either 99Tcm-sulphur colloid or 99Tcm-labelled red cell scintigraphy to localize a source of active bleeding. Fourteen patients had 99Tcm-sulphur colloid scintigraphy, of which seven were false negatives, two were false positives and two were true positives. Eleven patients had 12 99Tcm-labelled red cell scintigrams, of which three were false negatives, one was a false positive and four were true positives. Fifty patients had 99Tcm-pertechnetate scintigraphy to look for ectopic gastric mucosa in Meckel's diverticula. There were 43 true negatives, two false negatives, two true positives and three false positives in this group. Our results emphasize the need for caution in interpreting nuclear medicine studies in patients with blood loss from the gastrointestinal tract.

Arteriography does not reliably distinguish between acute and chronic arterial occlusions. Seventeen patients with acute lower limb ischaemia were investigated by arteriography and by imaging with a platelet-specific monoclonal antibody (P256 Fab'); 20 MBq 111In-labelled P256 Fab' was administered intravenously and patients were imaged at intervals of between 20 min and 24 h. Thirteen patients were subsequently treated with intra-arterial thrombolysis. In six the images showed foci of increased uptake of 111In-labelled P256 Fab' and the corresponding arterial segment was recanalized. Patency to 30 days was maintained in four cases. Seven patients had negative scans, only four of whom achieved lysis, and two of these suffered early rethrombosis. The remaining four patients were excluded from thrombolysis by the arteriographic appearances. 111In-labelled P256 Fab' imaging can identify sites of acute arterial thrombosis and may have clinical applications in the management of peripheral vascular disease. Further studies are required to test whether the technique has a role to play in patient selection for thrombolysis.

Three dose administration protocols for 99Tcm-MIBI were applied to groups of 15 patients with known or suspected ischaemic heart disease. Firstly, injections were given on consecutive days, with 300 MBq at rest and 500 MBq 24 h later at exercise. Secondly, both injections on the same day with 200 MBq at rest followed 1.5 h later by 1000 MBq during exercise. Finally, both injections on the same day with 200 MBq at rest followed 1.5 h later by 600 MBq during exercise. The diagnostic accuracy was significantly better when the administrations were on separate days than when given on the same day. There was no difference in diagnostic accuracy between the two same day protocols. The same day protocols gave a significantly higher false negative reporting rate than the separate day protocol.

Comparison between the plasma levels of intravenously injected technetium 99m hydroxy methylene [corrected] diphosphonate (99mTc-HMDP) and chromium 51 ethylene diamine tetra-acetic acid (51Cr-EDTA) reflects the uptake of diphosphonate into bone (the diphosphonate space). This can be used as an index of skeletal function in metabolic bone disease. In a series of 49 patients with Paget's disease the diphosphonate space (DPS) correlated well with other indicators of disease activity such as alkaline phosphatase and urinary hydroxyproline levels. The DPS is a good predictor of the volume of skeletal involvement as estimated from bone images. The DPS also provides a sensitive indicator of response to treatment with intravenously administered bisphosphonate. The DPS is simple to perform and is a useful adjunct to routine bone imaging.

Streptokinase (Sk) and recombinant tissue plasminogen activator (rt-PA) have widely different effects on platelet aggregation. We have therefore undertaken a prospective evaluation of the deposition of indium-111 platelets following peripheral arterial thrombolysis. Seventeen patients were studied using autologous indium-111 labelled platelets. Patients were randomly allocated to receive 0.5 mg h-1 intra-arterial rt-PA (ten patients), or 5000 units h-1 Sk and 250 units h-1 heparin intra-arterially (seven patients). Initial uptake ratios (comparing affected limb to contra-lateral limb) at 24 h were usually low for both agents (medians: Sk 1.17; rt-PA 1.20) despite previous angioplasty or extensive thrombosis. There were minimally higher uptake ratios at 48 h and 72 h following Sk (1.64-1.45), than with intra-arterial rt-PA (0.93-1.43). Overall, two patients (one from each group) failed to achieve complete lysis or incurred early rethrombosis. Both were associated with a progressive increase in uptake ratio which was not present in those patients with successful initial lysis and continued patency at 30 days (1.18-0.94-1.19). We have been unable to demonstrate any significant difference in post-lysis platelet deposition between intra-arterial streptokinase and recombinant tissue plasminogen activator in this preliminary study. However, higher platelet deposition was associated with failure to achieve complete lysis and early rethrombosis. Concurrent therapy with antiplatelet agents may therefore be indicated in these patients.

The hepatic perfusion index (HPI) was measured in 180 patients with colorectal cancer: 109 with primary colorectal cancer, 38 with suspected recurrent colorectal cancer and 33 following curative resection of colorectal cancer. In 21 patients with proven metastatic disease serial imaging studies were performed. HPI was determined using the peak of the left kidney time-activity curve to define the division of arterial and portal blood flow. HPI was elevated (greater than 0.37) in 54 of 115 patients (47%) with no evidence of hepatic metastases, 17 of 27 patients (63%) with hepatic metastases at initial presentation and 21 of 25 (84%) with metastatic disease detected during follow-up. Only 4 of 13 patients (31%) with local recurrence but no evidence of liver metastases had an elevated HPI. Serial imaging of patients with metastatic liver disease demonstrated a rising HPI with clinical disease progression in 18 of 21 patients (86%). This study confirms the association of an elevated HPI with hepatic metastases and suggests that a rising HPI in serial studies is associated with progression of disease but highlights the deficiency of one single HPI estimation in the identification of patients with overt hepatic metastases.

Eighteen patients with suspected primary or recurrent ovarian carcinoma have been investigated in each case by the assay of serum levels of the antigen CA125, immunoscintigraphy using 131I-OC125 antibody and magnetic resonance imaging using a 0.15 Tesla system. The final diagnosis was confirmed by laparotomy or laparoscopy. Serum levels of CA125 ranged between 5 and 780 units/ml (normal range less than 35). Antibody images and MRI were truly positive in 11 patients, 2 of whom were subsequently found to have bowel tumours. MRI showed greater detail of smaller lesions whilst immunoscintigraphy was more suited to the detection of distant metastases. In 7 patients the antibody images were positive whilst the serum marker levels were normal. This pilot study provides a preliminary comparison of the more recent techniques currently being evaluated for the detection of ovarian carcinoma.

Background Endovascular repair (EVR) of abdominal aortic aneurysm (AAA) is feasible for selected patients. Placing an uncovered stent across the origins of the renal arteries may improve fixation and seal of the proximal end of the stent-graft. However, this has potential for problems (e.g. renal artery stenosis or microembolization). This study aimed to evaluate the short-term effect of a suprarenal stent on the function of the individual kidney. Methods In 30 patients undergoing EVR for AAA, renal function was assessed before and after operation by 99mTc-radiolabelled diethylenetriamine penta-acetate radionuclide renography and daily measurement of serum creatinine levels. Eleven patients had infrarenal stent-grafts using an aorta uni-iliac system (group 1); 19 patients had the device with an uncovered suprarenal stent (modified Gianturco Z stent), ten of which were aorta uni-iliac and nine bifurcated systems (group 2). Individual kidney function was expressed as the whole kidney transit time (WKTT). In addition, glomerular filtration rate (GFR) was measured from serial blood samples following renography. Conclusion No result reached statistical significance. Placing an uncovered stent over the origins of the renal arteries does not appear to impair kidney function in the short term.

Twelve patients with a clinical diagnosis of possible vascular graft infection have been studied over the last 3 years. All patients had their leucocytes labelled with indium-111 and γ-camera imaging after 24 and 48h. Subsequent management was according to established surgical techniques. Eight patients proved to have vascular graft infection and indium uptake was seen along the length of the graft in six. Two patients with open wound infections and synthetic grafts had localized uptake only on leucocyte scanning. Four patients, all of whom had negative scans were not thought to have infected grafts after further investigation using digital subtraction angiography and computed tomography scanning. These patients have been followed up for a median period of 19 months (range 5–25 months) and have remained symptom free. Initial experience with 111In-labelled leucocyte scanning has been encouraging, both in diagnosis and in planning the management of patients with graft infections.

One hundred and twenty-seven patients with locally advanced prostatic cancer were evaluated for the presence and progress of bone metastases before and during hormonal therapy, by serial radionuclide imaging and frequent measurement of plasma acid (tartrate-labile) and alkaline phosphatase. For comparison, serial changes in imaging and phosphatases were classified in each patient into one of six groups. Of 71 patients with negative imaging before treatment, 82% had normal alkaline phosphatase levels and 83% had normal acid phosphatase levels. Of 56 patients with bone metastases at presentation, false negative alkaline and acid phosphatase levels were noted in 18% and 36% respectively, though a few patients eventually developed abnormal levels. Serial plasma biochemistry and particularly alkaline phosphatase showed a response to treatment which was not always obvious on imaging. An assessment of the hepatic component of alkaline phosphatase by reference to plasma gamma glutamyl transpeptidase and isoenzyme electrophoresis was helpful in the evaluation of a false positive result but unnecessary where imaging was positive and phosphatase elevated. It is concluded that serial alkaline phosphatase estimation is essential in the follow-up of patients with prostatic cancer and bone metastases, and probably renders serial imaging studies superfluous once the presence of skeletal metastases has been proven. By comparison, acid phosphatase is a much less effective marker.

The radiolabeled monoclonal antibody 791T/36 raised against a human osteosarcoma was injected into 20 patients with known or suspected bone tumors. Gamma camera images were acquired at 48 or 72 hours after injection, and assessed for antibody localization. Positive images were obtained in all five osteosarcomas and four other primary malignant sarcomas. Two of the four other primary bone tumors gave positive images. Three patients with trauma had negative images as did one patient with Paget's disease. Two patients with suppurative disease gave positive images. The antibody localized in the majority of malignant sarcomas tested. In one tumor where tissue was available, a tumor:non-tumor ratio of 2.8:1 was measured. Repeat imaging was performed in five patients. Immunoscintigraphy using the monoclonal antibody 791T/36 has shown tumor localization in patients with bone and soft tissue sarcomas.

Summary. Twenty-five women with primary carcinoma of the cervix were examined with magnetic resonance imaging (MRI). A number of different pulse sequences with T1 and T2 weighting were employed to determine optimum tissue contrast, and the potential for staging cervical cancer was assessed and compared with the clinical findings. MRI is seen to give a unique view of cervical cancer in particular in stage I and II disease where other imaging techniques have known limitations. In addition, stages III and IV were well seen with demonstration of tumour comparable with that of computerized axial tomography (CT).

With the development of new surgical techniques the outlook for infants with biliary atresia has improved significantly. It has therefore become increasingly important to identify these patients quickly in order to allow prompt surgical intervention. Differentiation of biliary atresia from other causes of jaundice, in particular idiopathic neonatal hepatitis, is often difficult as there is considerable clinical and histological overlap of the two conditions. Demonstration of biliary patency using radiopharmaceuticals is a well established technique. 131I rose bengal and the 99Tcm-labelled iminodiacetic acid derivatives have both been used, but are not completely satisfactory, and controversy still exists as to which is the most suitable agent. Nine infants with prolonged jaundice have been studied using 123I-labelled rose bengal. All infants with biliary atresia and neonatal hepatitis were correctly identified. The results indicate that 123I rose bengal provides a reliable tracer for assessing biliary patency and is the agent of choice in the investigation of neonatal obstructive jaundice.

The roentgenologic features in 87 cases of recurrent pyogenic cholangitis are described.The characteristic findings on cholangiography are strictures, stones and dilatation of the hepatic and common bile ducts.The importance of establishing the diagnosis is stressed and the special techniques in operative and T-tube cholangiography to give the maximum information are outlined.