Increased Radioisotope Uptake Research Articles

Successful Treatment of Congenital Hyperinsulinism Due to KJNJ11 Gene Mutation with Long-Acting Release Octreotide: A Case Report from the Arab Region

AbstractCongenital hyperinsulinism is a rare hereditary condition that is caused by various gene mutations related to the function of the pancreatic β-cells. It is characterized by dysregulation of insulin secretion leading to profound and recurrent hypoglycemia. Its clinical presentation, histology, response to treatment, and underlying genetic defects are variable making it a heterogeneous condition. Pancreatectomy is indicated in diazoxide un-responsive cases. However, surgical treatment is associated with the possibility of persistent hypoglycemia and iatrogenic diabetes. We report a 3 months old girl who presented with hyperinsulinemic hypoglycemia. She was born to consanguineous parents and had a history of four neonatal deaths in siblings. Whole exome sequencing detected a KCNJ11 variant c.350_352del p.(Phe117del) in a homozygous state. Pancreatic scan (positron emission tomography/computed tomography) showed a diffusely increased radioisotope uptake in the head and tail of the pancreas. She was resistant to diazoxide and nifedipine and was shifted to octreotide treatment through multiple daily subcutaneous injections initially. Treatment was changed to monthly depot injection of octreotide that resulted in euglycemia. She kept a normal rate of growth, insulin-like growth factor-1, and liver function. This case is an example of an alternative effective medical therapy that avoids major surgical intervention and prevents long-term complication of recurrent hypoglycemia and iatrogenic diabetes resulting after surgery.

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Symptomatic Rotator Cuff Tears Show Higher Radioisotope Uptake on Bone Scintigraphy Compared With Asymptomatic Tears

Background: Some patients with rotator cuff tears complain of pain, whereas others are asymptomatic. Previous studies have pointed out the presence of active bone metabolism in the painful shoulder, identified with increased radioisotope uptake during bone scintigraphy. Hypothesis: Shoulders with symptomatic rotator cuff tears will demonstrate higher radioisotope uptake than shoulders with asymptomatic tears with bone scintigraphy, reflecting active bone metabolism in symptomatic tears. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study consisted of 3 groups: patients with symptomatic tears (symptomatic group), patients with asymptomatic tears (asymptomatic group), and controls (no tear group). The symptomatic group consisted of 28 shoulders from 28 patients with symptomatic rotator cuff tears (pain score ≤4 on the University of California, Los Angeles [UCLA] shoulder evaluation form) who underwent bone scintigraphy followed by rotator cuff repair. Of 70 volunteers who had previously undergone bone scintigraphy for diseases unrelated to their shoulder, 34 were selected for the asymptomatic group (pain score ≥8 on the UCLA shoulder form), and 32 were selected for the no tear group. Results: The mean radioisotope uptake in the symptomatic group was significantly higher than that in the asymptomatic group (P = .02) and the no tear group (P = .02). Ten of 28 shoulders (36%) in the symptomatic group showed increased radioisotope uptake exceeding 2 standard deviations from the mean of the no tear group. This percentage was significantly higher when compared with the asymptomatic group (0%) (P < .01). Conclusion: Shoulders with a symptomatic rotator cuff tear showed higher radioisotope uptake on bone scintigraphy than those with an asymptomatic tear. The radioisotope uptake in shoulders with an asymptomatic tear was comparable with that in shoulders without a tear. Clinical Relevance: Positive radioisotope uptake may be associated with pain in a subgroup of patients with rotator cuff tears.

Technetium-99mTc MDP imaging of 293 quadrants of idiopathic facial pain: 79% show increased radioisotope uptake

To evaluate the association between facial pain and maxillofacial scintigraphy. A total of 117 patients with idiopathic facial pain (IFP) (88% females; average age = 46.7 years) underwent 99mTc-MDP scans, as did 32 age-matched controls. Pearson χ(2) analysis was used to determine associations. Of subject quadrants, 63% were painful (average duration: 5.4 years); 79% of painful quadrants had positive 99mTc-MDP scans, i.e., "hot spots," significantly different from 13% in nonpainful quadrants (P < .0001). Five percent of controls had quadrants with hot spots; the proportion of hot spots in subjects versus controls was significantly different (P < .0001). No difference was found between pain-free quadrants in subjects and controls (P = .0688). A positive 99mTc-MDP scan is strongly correlated with the location of pain in IFP, and patients with IFP have significantly more hot spots than controls, suggesting that pain in some IFP is associated with or caused by cancellous bone disease.

Quantitative evaluation of subchondral bone injury of the plantaro‐lateral condyles of the third metatarsal bone in Thoroughbred horses identified using nuclear scintigraphy: 48 cases

Increased radio-isotope uptake (IRU) in the subchondral bone of the plantaro-lateral condyle of the third metatarsus (MTIII) is a commonly reported scintigraphic finding and potential cause of lameness in UK Thoroughbred racehorses in training and has not been fully documented. To characterise lameness attributable to IRU of the subchondral bone of MTIII, compare the scintigraphic findings of these horses with a normal population and evaluate the use of scintigraphy as an indicator of prognosis. IRU will be in significantly higher in horses with subchondral bone injury and will be related to prognosis and future racing performance. Data were analysed from 48 horses in which subchondral bone injury of the plantaro-lateral condyle of MTIII had been diagnosed using nuclear scintigraphy and that met the inclusion criteria. Data recorded included age, sex, trainer, racing discipline, lameness assessment, treatment regimes, radiographic and scintigraphic findings, response to diagnostic analgesia where performed and racing performance pre- and post diagnosis. Region of interest (ROI) counts were obtained for the plantar condyle and the mid diaphysis from the latero-medial view, the ratio calculated and then compared with a control group of clinically unaffected horses. The mean condyle mid-diaphysis ROI ratio was significantly (P<0.001) higher in the affected population and with positively correlation (P = 0.024) with the level of lameness. The presence of radiographic findings had no significant effect on the ROI ratio. Subchondral bone injury of the plantar lateral condyles of MTIII is a significant cause of lameness in UK Thoroughbred racehorses. Nuclear scintigraphy is a useful diagnostic imaging modality in the detection of affected horses but is a poor indicator of prognosis for the condition. Better understanding of the clinical manifestations, diagnosis of and prognosis for subchondral bone injury will benefit the Thoroughbred industry in the UK.

A Case of Graves' Disease with Pancytopenia

Hematological disorders, and especially single lineage abnormalities, have been described in patients suffering with thyrotoxicosis, but pancytopenia is a rare complication of thyrotoxicosis. Pancytopenia with thyrotoxicosis has been reported to be totally reversible with antithyroid drug treatment. We experienced a case with pancytopenia associated with Graves’ disease in a 57-year-old woman who had no specific cause of pancytopenia. She presented with dyspnea and palpitation. The laboratory findings revealed thyrotoxicosis and pancytopenia. Increased radioisotope uptake was seen on the thyroid scan and normal cellularity and maturation were found in the bone marrow aspiration biopsy. Based on these findings, she was diagnosed as ,

Gamma Probe Assisted Biopsy of Suspected Metastatic Rib Lesions

Retrieving diagnostic tissue from a rib lesion can be challenging. Using a hand-held intraoperative gamma probe to target and biopsy the areas of increased radioisotope uptake has been limited largely to use by thoracic surgeons and interventional radiologists. Such techniques also have been used by orthopaedic oncologists in localizing osteoid osteomas. We pursued a similar technique in localizing the rib lesion. During the 10 months, two patients with a history of cancer and recent bone scans indicative of possible rib metastasis required biopsies for definitive tissue diagnosis. Both patients had gamma-probe localization of their rib lesions intraoperatively using minimally invasive techniques. The operation of the probe was simple with a short learning curve. Both patients had biopsies that yielded diagnoses verifying the abnormality on the staging bone scan. Localization was sensitive and accurate with histologic confirmation in both patients. The length and extent of surgery were markedly reduced with no complications. These results match those reported in the literature by thoracic surgeons and radiologists. The hand-held gamma probe assisted biopsy of suspicious rib abnormalities can be an effective surgical technique that the orthopaedic surgeon should consider. Additional experience with the technique will allow an assessment of the sensitivity and specificity.

Intraoperative Detection of a Bronchial Carcinoid With a Radiolabeled Somatostatin Analog

Carcinoid tumors of the lung are rare neuroendocrine tumors that make up approximately 1 to 2% of all lung neoplasms. These tumors overexpress somatostatin receptors, and somatostatin analog therapy has become standard in the treatment of carcinoid tumors. In addition, radiolabeled somatostatin analogs have been used to diagnose and treat these lesions. We describe the case of a patient with a right lung mass diagnosed as a carcinoid tumor. The patient underwent complete resection of this tumor with the assistance of intraoperative detection with a handheld gamma probe after the administration of the radiolabeled somatostatin analog (111)In-pentetreotide. This approach allowed us not only to detect the tumor easily, but to scan the bed of the tumor after resection and to re-excise an area of increased radioisotope uptake that corresponded to the presence of residual tumor. We believe this to be the first reported case of bronchial carcinoid resected with the assistance of intraoperative gamma detection after the administration of a radiolabeled somatostatin analog. This technology allowed us to achieve a complete surgical resection with no residual tumor detected either pathologically or by somatostatin scanning.

Earache and back pain

A 53-year-old woman, a native of Surinam, was admitted in April, 1999, complaining of severe low back pain with radiation to her right lower leg. The pain started in January, 1999, while she was returning from a visit to Surinam. She had previously been well, apart from two episodes of ear pain in December, 1998, diagnosed as otitis media by her general practitioner. She received amoxicillin for 7 days and then co-amoxyclav for 7 days. Neurological examination elsewhere in January, 1999, showed an L5 root radiculopathy; a computed tomogram (CT) of the lumbar spine (figure, A) showed a soft-tissue mass at the L4–5 level on the right side. A diagnosis of lumbar disc herniation was made and she was given nonsteroidal anti-inflammatory drugs and physiotherapy. However, her pain worsened and she became bedridden. When examined in April, 1999, she was in pain but otherwise appeared well. Her temperature was 37oC, but rose to 38·6oC 3 days later. Muscle strength was diminished in her right anterior tibial and extensor hallucis muscles. Sensation to pinprick was impaired on the dorsum of her right foot. Deep-tendon reflexes were decreased but equal in both legs. Straight-leg raising provoked severe back pain with radiation down her right leg. Investigations showed haemoglobin 55 g/L, leucocyte count 8·4 10/L, and erythrocyte sedimentation rate (ESR) 136 mm/h. C-reactive protein (CRP) was 40 mg/L rising to 151 mg/L over the next 2 weeks. A contrast magnetic resonance image (MRI) (figure, B), showed an L4–5 hypointense ring-enhancing lesion extending within the spinal canal on T1-weighted images, suggesting an abscess. A bone scan (technetium-99m phosphate) showed increased radioisotope uptake at the L4–5 level. Cerebrospinal fluid (CSF) obtained by suboccipital puncture was normal and CSF cultures were sterile. Microscopic examination of a CT-guided needle biopsy specimen of the L4–5 mass showed no organisms and no malignant cells; stains for acid-fast bacteria and bacterial cultures were also negative. A second biopsy specimen yielded the same results on microscopy but after 3 days of incubation the culture grew Fusobacterium varium. Treatment with co-amoxyclav 1200 mg six times daily, was started. The strain subsequently produced A: Disc herniation at L4–5 level on the right side (black arrow) on CT of lumbar spine. B: L4–5 hypointense ring-enhancing lesion on T1-weighted MRI images

Maxillofacial osteonecrosis in a patient with multiple “idiopathic” facial pains

Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53-year-old man with multiple debilitating, "idiopathic" chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia-inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.

Maxillofacial osteonecrosis in a patient with multiple “idiopathic” facial pains

Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53‐year‐old man with multiple debilitating, “idiopathic” chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia‐inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.

Ischemic osteonecrosis under fixed partial denture pontics: Radiographic and microscopic features in 38 patients with chronic pain

Statement of problem. Previous studies have identified focal areas of alveolar tenderness, elevated mucosal temperature, radiographic abnormality, and increased radioisotope uptake or “hot spots” within the quadrant of pain in most patients with chronic, idiopathic facial pain (phantom pain, atypical facial neuralgia, and atypical facial pain). Purpose. This retrospective investigation radiographically and microscopically evaluated intramedullary bone in a certain subset of patients with histories of endodontics, extraction, and fixed partial denture placement in an area of “idiopathic” pain. Material and methods. Patients from 12 of the United States were identified through tissue samples, histories, and radiographs submitted to a national biopsy service. Imaging tests, coagulation tests, and microscopic features were reviewed. Of 38 consecutive idiopathic facial pain patients, 32 were women. Results. Approximately 90% of subpontic bone demonstrated either ischemic osteonecrosis (68%), chronic osteomyelitis (21%), or a combination (11%). More than 84% of the patients had abnormal radiographic changes in subpontic bone, and 5 of 9 (56%) patients who underwent radioisotope bone scan revealed hot spots in the region. Of the 14 patients who had laboratory testing for coagulation disorders, 71% were positive for thrombophilia, hypofibrinolysis, or both (normal: 2% to 7%). Ten pain-free patients with abnormal subpontic bone on radiographs were also reviewed. Conclusions. Intraosseous ischemia and chronic inflammation were suggested as a pathoetiologic mechanism for at least some patients with atypical facial pain. These conditions were also offered as an explanation for poor healing of extraction sockets and positive radioisotope scans. (J Prosthet Dent 1999;81:148-58.)

Scintigraphic and clinical findings in the Standardbred metatarsophalangeal joint: 114 cases (1993-1995).

To correlate scintigraphic and clinical findings of the metatarsophalangeal joint (MTPJ) in Standardbreds, radiographic findings in horses with confirmed MTPJ lameness, and determine if stress reaction and more advanced bone remodelling occurred in the MTPJ, medical records of 114 Standardbreds admitted between September 1993 and April 1995 in which bone scintigraphy included standing lateral and plantar views of the metatarsophalangeal joint (MTPJ) were reviewed. Images obtained using a large field of view gamma camera were evaluated visually for location, definition and intensity of increased radioisotope uptake (IRU), which was graded as mild, moderate, or intense. Clinical history and lameness examination findings were recorded and, in horses with documented MTPJ lameness, radiographic examination included the 30 degree (down-angled) dorsolateral 45 degree plantaromedial view thought to be useful in evaluation of the plantarolateral condyle of the third metatarsal bone (MtIII). The most common abnormality, IRU of the plantarolateral aspect of MtIII, was seen in 67 horses, and horses were further classified according to scintigraphic and clinical findings. In 43 horses in which lameness was not localised to the MTPJ, mild (32 horses), moderate (10 horses), and intense (one horse) IRU of MtHII was found. In 24 horses with lameness localised to the MTPJ, moderate (18 horses) and intense (6 horses) IRU was found. Of 18 horses with moderate IRU of MtIII, 9 had radiographic evidence of abnormal bony remodelling of MtIII, whereas 5 of 6 horses with intense IRU had radiographic changes. In 12 horses with MTPJ lameness and radiographic evidence of bony remodelling without fracture, radiographic changes consisted of plantarolateral subchondral radiolucency and sclerosis (7 horses), radiolucency and osteochondrosis (one horse), and plantar MtIII sclerosis without radiolucency (4 horses). In 2 horses with moderate IRU and MTPJ lameness, radiographic evidence of radiolucency and MtIII fracture was found. Of 19 starters with MTPJ lameness and IRU of MtIII, 18 horses raced after diagnosis, but only 13 remained at the same racing class or improved. The results of this study suggest the most common scintigraphic abnormality of the MTPJ, IRU of the plantarolateral aspect of MtIII, may precede other stress-related changes, and in some horses is associated with a continuum of stress-related subchondral bone remodelling which results in lameness and later radiographic changes. Since 24 of 35 horses with moderate or intense IRU of MtIII had MTPJ lameness, and 5 of 7 horses with intense IRU of MtIII had lameness and radiographic evidence of abnormal remodelling, it was concluded that horses with advanced, scintigraphic findings are more likely to have lameness and radiographic evidence of subchondral bone damage.

Enostosis-like lesions in the long bones of 10 horses: scintigraphic and radiographic features.

Ten horses admitted for lameness evaluation including bone scintigraphy had enostosis-like lesions, described scintigraphically as focal or multifocal areas of intense increased radioisotope uptake within the medullary cavity of one or more long bones, and radiographically as one or multiple round to irregularly shaped radiopacities within the medullary cavity, often in close proximity to the nutrient foramen. There were 6 Thoroughbreds, one male, one female and 4 geldings, 3 Standardbreds, all geldings and one Appaloosa gelding; age 3-10 years. Enostosis-like lesions were seen in the tibia (5 horses), radius (3 horses), humerus (one horse) and third metatarsal bone (MT-III) (4 horses). The number of affected bones in each horse was 1-3. Of 16 affected limbs, there were 9 hindlimbs and 7 forelimbs. Enostosis-like lesions were considered a possible cause of lameness in 5 horses, but were considered incidental findings in the other horses. Lesions thought to cause lameness were seen in the tibia (2 horses), MT-III (one horse) and in the radius (4 horses). Lameness resolved after horses were rested (2-6 months) and given nonsteroidal anti-inflammatory drugs (4 horses). Follow-up scintigraphic examination in 3 horses (2, 6 and 9 months later, respectively) revealed normal radioisotope uptake in the affected areas.

Technetium-99-Labelled Methylene Diphosphonate Uptake Scans in Patients with Dialysis Arthropathy

Patients on long-term haemodialysis suffer from dialysis arthropathy due to the deposition of dialysis amyloid. We investigated the use of 99Tc-labelled methylene diphosphonate bone scans in 17 patients as a possible in vivo diagnostic technique. In most clinically affected joints, with the exception of shoulders and hands, there was increased radioisotope uptake consistent with uptake by periarticular bone. In addition, we describe intense soft-tissue uptake around some clinically affected large joints. In contrast, control groups of patients on haemodialysis without arthropathy and patients without renal failure did not have increased uptake. A semi-quantitative scale of uptake was devised, and the following correlations were significant: pain perception and isotope uptake score in the ankles and feet, and the number of radiological lesions and isotope uptake scores in the wrists and knees. The following sites where the radioisotope might bind in the affected joints are proposed: amyloid deposits, areas of soft-tissue calcification, or areas of increased bone turnover. It is concluded that whereas the scanning technique cannot make a definite diagnosis of amyloid and, therefore, cannot be expected to supersede histological diagnosis, it is a useful adjuvant investigation, of particular importance in those patients unable or unwilling to undergo biopsy.

Bone scintigraphic findings related to unilateral mastectomy.

The total body bone scans of 51 breast cancer patients who had received unilateral mastectomies were reviewed to establish the incidence of bone scintigraphic changes related to the surgery. Several features were noted: (a) increased radioactivity in the ribs on the side of the mastectomy in 76% of patients, (b) increased radioisotope uptake in the remaining breast in 36% of patients, (c) increased radioisotope uptake in the soft tissue of the arm on the mastectomy side in 18% of patients. Familiarity with the incidence of these findings may be of use in bone scan interpretation of breast cancer patients.

BONE SCINTIGRAPHIC FINDINGS RELATED TO UNILATERAL MASTECTOMY

The total body bone scans of 51 breast cancer patients who had received unilateral mastectomies were reviewed to establish the incidence of bone scintigraphic changes related to the surgery. Several features were noted: (a) increased radioactivity in the ribs on the side of the mastectomy in 76% of patients, (b) increased radioisotope uptake in the remaining breast in 36% of patients, (c) increased radioisotope uptake in the soft tissue of the arm on the mastectomy side in 18% of patients. Familiarity with the incidence of these findings may be of use in bone scan interpretation of breast cancer patients.

Early increase in the phosphorylation of liver chromatin non-histone proteins from thyroidectomized rats treated with triiodothyronine.

The effect of triiodothyronine (T3) on the endogenous phosphorylation of chromatin nonhistone proteins (NHP) was investigated. Chromatin NHP were extracted from livers of thyroidectomized rats treated with T3 (30 μg/100 g BW) for varying times, and the preparations were then incubated in vitro in a medium containing [γ-32P]ATP. Moreover, because of the complex heterogeneity of these proteins, we analyzed by disc gel electrophoresis the 32P uptake of the individual major classes of phosphorylated NHP. A marked increase in 32P uptake was found not only in chromatin NHP prepared from rats treated with T3 for 2 or 4 consecutive days, but also in NHP preparations obtained from rats sacrificed 3 h after a single injection of T3, accounting for an early effect of the thyroid hormone. Electrophoretic fractionation of the phosphorylated NHP obtained from T3 treated rats provided evidence that for the most effective hormonal treatments, the increased radioisotope uptake into NHP was more evident in some protein fra...

Radionuclide scanning and microangiography of evolving and completed brain infarction. A correlative study in monkeys.

A correlative study between sequential radionuclide brain scanning and time-lapse microangiograms has been carried out in an experimental model of ischemic cerebral infarct in monkeys. In the majority of animals, brain scintigraphy became positive by two weeks, then regressed toward negative by four to six weeks after ligation of the middle cerebral artery. Increased radioisotope uptake is clearly related to neovascularization around the area of infarct as shown by the microangiograms. At later stages, decreased vascularity, peripheral gliosis, and central cavity formation are the main factors determining diminution of radionuclide penetration in the involved area.