Search

We report our 1-year postapproval clinical experience with Radium-223 dichloride for treatment of castrate-resistant prostate cancer with bone metastases.The clinical courses of the first 25 patients treated were reviewed retrospectively. Incidence of hematologic, gastrointestinal, and other adverse events were identified, including those events that led to cessation or delay in treatment. Alterations in bone pain and serum alkaline phosphatase and prostate-specific antigen (PSA) levels were evaluated.Six patients received all 6 scheduled doses of Radium-223 dichloride, 2 completed 5 doses, 6 received 4 doses, 2 completed 3 doses, 6 patients had 2 doses, and 3 patients received one dose, for a total of 91 doses administered. Nine patients discontinued treatment after receiving at least one dose due to progressive disease, 5 required blood transfusions, 5 developed gastrointestinal symptoms, 4 reported worsening bone pain, and 1 developed dermatitis. Downward trends in serum alkaline phosphatase and PSA were seen in 11 and 5 patients, respectively.About one-quarter of cohort completed the entire six-dose treatment. Advancing soft tissue disease was the primary reason for cessation of therapy. The adverse events were mild and manageable. A decline in serum alkaline phosphatase was more common than a decline in PSA.

Numerous studies have shown that chemotaxis is affected by certain antibiotics and steroids. A patient had Crohn's disease in relapse with multiple small bowel fistulae and mesenteric abscesses. Although the Tc-99m WBC scan did not show the intra-abdominal inflammatory foci, an In-111 WBC scan performed within a week delineated the abscesses and these were later confirmed at surgery. This case is being presented not only to show the relative sensitivities of a Tc-99m WBC vs. an In-111 WBC scan, but also to discuss the impediment to polymorphonuclear leukocyte chemotaxis by steroids, which may be a contributory factor to the sensitivities of the different radiopharmaceuticals selected for detection of intra-abdominal septic foci.

A 46-year-old woman with advanced ovarian carcinoma had progressive dyspnea and was evaluated with ventilation and perfusion lung imaging. A characteristic pattern of multiple branching perfusion defects of a segmental nature on the perfusion scan suggested tumor microembolism and lymphangitic carcinomatosis. However, in this case, this pattern was associated with pulmonary thromboembolism and was documented by the post mortem examination. Pulmonary thromboembolism should be included among the differential diagnoses in a patient with clinical symptoms and a perfusion scan that reveals multiple branching perfusion defects.

A 40-year-old woman was examined for a sudden onset of malignant hypertension. When she was normotensive after symptomatic treatment, a captopril renogram was performed and showed decreased left renal perfusion. Although a conventional angiogram did not reveal significant renal artery stenosis, a subsequent contrast-enhanced abdominal CT scan showed a large soft-tissue mass encasing the left renal artery. Biopsy showed this to be a non-Hodgkin's lymphoma. A whole-body Ga-67 scan revealed tracer uptake in the left perirenal area with no evidence of other sites of lymphoma. A postchemotherapy CT scan of the abdomen at 6 months showed nearly complete resolution of the perirenal mass.

A 49-year-old man with alcoholic liver disease and insulin dependent diabetes was admitted for left-sided abdominal pain, fever, chills, and leukocytosis. An ultrasound showed hepatosplenomegaly and bilateral pleural effusions. A Tc-99m sulfur colloid scan revealed marked reticulo-endothelial shift

A 55-year-old woman had recurrent bouts of low substernal and epigastric pain radiating into the interscapular region. A hepatobiliary scan initially showed what was believed to be a dilated common bile duct and nonvisualization of the gallbladder. A delayed image obtained after having the patient move about revealed the presence of a filled gallbladder and normal common bile duct. The combination of recurrent pain with this scintigraphic picture may be representative of a floating gallbladder or an incomplete torsion with spontaneous detorsion. This case is presented to describe the scintigraphic appearance of a mobile gallbladder that may be prone to volvulus and to emphasize the importance of obtaining decubitus or oblique views at the end of a hepatobiliary study in selected cases of unusual findings.

A 10-year-old girl had pain in the left tibia with associated soft tissue swelling. One week earlier, she had participated in extensive jump roping at school of approximately 1 hours' duration. A bone scan revealed local hyperemia, soft tissue inflammation, and intense circumferential tracer uptake in the midshafts of both tibiae. Conventional radiographs of both legs revealed increased radiographic density in the midshafts of the tibiae with a loss of the endosteal margins. The authors believe that these changes represent stress fractures of both tibiae secondary to excessive recreational activity.

Objectives: The purpose of this study was to evaluate the utility of positron emission tomography with F18-fluorodeoxyglucose in the preoperative evaluation and staging of malignant mesothelioma in patients who were candidates for aggressive combined modality therapy. Methods: Eighteen consecutive patients with biopsy-proven malignant mesothelioma underwent positron emission tomographic scanning. The results of positron emission tomographic imaging were compared with results obtained by computed tomography, mediastinoscopy, thoracoscopy, and pathologic examination of surgical specimens. All patients fasted and received an average of 14.5 ± 2.7 mCi of F18-fluorodeoxyglucose for positron emission tomographic scanning. Attenuation-corrected whole-body and regional emission images of the chest and upper abdomen were acquired and formatted into transaxial, coronal, and sagittal images. Results: All primary malignant mesotheliomas accumulated F18-fluorodeoxyglucose, and the mean standardized uptake value was 7.6 (range, 3.33-14.85; n=9). There were no false-negative results of positron emission tomography. Identification of occult extrathoracic metastases by positron emission tomography was the basis for excluding two patients from surgical therapy. There were two false-positive results of positron emission tomography: increased F18-fluorodeoxyglucose uptake in the contralateral chest that was negative by thoracoscopic biopsy (n = 1) and increased abdominal F18-fluorodeoxyglucose uptake after partial colectomy for diverticular disease (n = 1). Conclusions: Positron emission tomography can identify malignant pleural mesothelioma and appears to be a useful noninvasive staging modality for patients being considered for aggressive combined modality therapy. (J Thorac Cardiovasc Surg 2000;120:128-33)

An adult female patient presenting with a cystic abdominal mass and intermittent fever, was found at surgery to have a large cyst of the left adrenal gland. The imaging findings and pathology of this uncommon entity are discussed.