The complementary role of indium-111 labeled leukocyte imaging, ultrasonography and computed tomography in the evaluation of postoperative infection or abscess

We report our experiences with the combined use of indium-111 labeled leukocyte imaging (In-III WBC scan.), computed tomography (CT) and ultrasonography (US) for evaluation of suspected postoperative infection or abscess, and discuss the complementary roles of these modalities. Postoperative abscesses or infections were diagnosed in 9 of 20 patients. All patients were correctly diagnosed by In-111 WBC imaging and 4 patients could not be diagnosed by US because of bowel gas. One false-positive CT examination and another artifact on CT images due to respiratory movements were obtained. The three modalities were found to be complementary: CT and US were efficient imaging methods for diagnosis and treatment of abscess. In-111 WBC imaging could estimate the activity of inflammation.

[Necessary radiological items for radiation therapy of esophageal cancer]

Necessary items for radiation therapy of an esophageal cancer are discussed in detail. These radiological items can be dissolved through the radiological findings by use of the fine double contrast method of treating the esophagus. One method is to dissolve the infiltrative depth of the esophageal cancer; the other is the radiological diagnostic method to dissolve the effect of the radiation therapy on the esophageal cancer. In fact, regarding the former, the classification of the X-ray type is essential and depends upon the infiltrative depth of the cancer and, for the latter, the radiological findings before and after irradiation must be compared.

[The criteria of radiotherapy for treating carcinoma of the esophagus]

The criteria of radiation therapy is given for the treatment of a carcinoma of the esophagus, said criteria decided by a committee of the Japanese Association for Radiotherapy Systems at the request of the Japan Radiological Society. The indication for radiation therapy is described and adapted to the new TNM Classification, based on the depth of the invasion of the tumor. The depth of the tumor invasion is divided into 4 stages and the radiological images for each are shown. To evaluate the effect of radiotherapy, cases are divided into curable and non-curable groups, according to the degree of changes of the radiological findings after irradiation, and each group is further subdivided into absolute and relative categories.

Rett syndrome: new observations

Two elderly females with Rett syndrome are reported with evidence of a slowly progressive central and distal peripheral nervous system involvement. Thermography in 4 girls confirmed distal hypothermia of the extremities in a glove and stocking distribution. Unilateral sympathectomy during surgery for scoliosis in one of them resulted in increased warmth and physical growth of the foot and nails, compared to the uninjured side. This suggests increased sympathetic tone as the probable cause of distal hypothermia, vasomotor instability and dystrophy of the feet in this disorder. In an attempt to identify a marker, girls with clinically classical Rett syndrome had plasma and urinary cell evaluation for an unusual glycolipid. A blind study using a small number of patients failed to prove absolute specificity and additional studies are required to evaluate its validity as a marker for Rett syndrome.

Helmet for infant skull fixation during stereotactic neurosurgery

A thermoplastic helmet was designed to allow the use of the Leksell stereotactic frame in infants.

Magnetic resonance planned thalamotomy followed by X-ray/CT-guided thalamotomy

Magnetic resonance imaging (MRI) is currently the optimal neuroradiologic technique for visualizing the anterior and posterior commissure for defining the AC-PC line. CT is the optimal technique for electrode and probe guidance during stereotactic thalamotomy. Various possibilities of transferring or overlying MRI and CT are outlined which in some future might result in more refined methods of CT-MRI guidance for stereotactic surgery.

Intraoperative CT monitoring during stereotactic brain surgery

This paper reports our experience in performing the entire stereotactic surgical procedure with a CT scanner, which shows that target shifting can occur as the probe approaches the target. Therefore, when sampling of small targets or specific sites within larger targets is desired. CT confirmation of the probe's position ensures that the specific area seen on CT is biopsied.

[Performance of gamma camera collimators used for single photon emission computed tomography imaging with 123I-isopropyl iodoamphetamine]

123I Produced by 124Te(p, 2n)123I reaction is contaminated with 124I (less than 5%) and 126I (less than 0.3%). High energy photons from these mixed radioiodine compromise seriously image quality due to scattered photons and to septal penetration in the collimator. Four collimators of LEAP (for low energy all purpose), LEHR (for low energy high resolution), MESI (for medium energy made by Siemens) and MENU (for medium energy made by nuclear technology) mounted on a rotating gamma camera (Siemens, ZLC-7500), were examined in order to select a suitable collimator for 123I SPECT (single photon emission computed tomography) imaging. Sensitivities were measured with a plane source (5 X 5 X 0.5 cm) at the collimator face and distances from 2 to 30 cm in air. And, spatial resolutions in FWHM (full width at half maximum) and FWTM (full width at tenth maximum) were determined from line spread functions with planar and SPECT imaging. From the comparison of collimator performances with 99mTc and 123I, both collimators for low energy were not useful for 123I imaging. In other two collimators for medium energy, however, apparently the effect of septal penetration by the higher energy photons were also recognized, MENU with high geometrical resolution was more suitable for 123I SPECT imaging compared with MESI. And, it is important to perform the SPECT imaging with radius as short as possible.

[Application of NMR-CT in the staging of cancer of the digestive organs]

To assess the potential of NMR-CT for demonstrating cancer of the digestive organs, we examined a total of 232 patients (89 with esophageal cancer, 52 with liver cancer, 40 with colorectal cancer, 9 with pancreatic cancer, 9 with gastric cancer, and 33 with other diseases). NMR-CT has many features, but we use especially those features which it is possible to select not only in the transverse plane but also in the coronal and sagittal planes, and it has excellent soft tissue contrast resolution. Our machine is a Picker International NMR-CT using a superconducting magnet of 0.256 tesla. Diagnosis of lymph node involvement of esophageal cancer. Using only the coronal plane, each patient was scanned by the spin echo technique (TE = 40, TR = 400) from the plane of the descending aorta to the plane of the trachea 1 cm in thickness, at 1 cm intervals, continuously. All the vessels were clearly differentiated as no-signal regions, especially in coronal images, from areas of carcinomatous involvement. Lymph nodes were identified as intense grey masses in fat tissue of high intensity. Twenty cases were proved by surgery or autopsy, and it was possible to assess 160 lymph-node groups. A total of 25 patients were imaged as having positive lymph nodes, but 17 of them had metastasis-positive nodes. In other 135 nodes imaged as negative lymph nodes, only two had metastasis and 133 were negative for metastasis. Overall accuracy was 93.8%. Diagnosis of liver cancer. Intrahepatic vessels were clearly imaged without using contrast enhancement in NMR-CT, so it was easy to diagnose the segment containing the tumor and to detect tumor emboli in the portal vein. The capsule was imaged in 84% (16/19) using IR techniques, although only 37% (7/19) could be imaged by X-CT. Diagnosis of colorectal cancer. Using the sagittal plane, the sacrum, urinary bladder and other organs were imaged better parallel to their axis, so that the relationship between rectal cancer and surrounding organs could be clearly visualised with NMR-CT. With regard to lymphatic metastasis, coronal imaging was useful for picturing mesenteric and pelvic vessels, so that lymph nodes were imaged as low-intensity masses along the vessels. Lymph metastasis almost 1 cm size can be detected using coronal NMR-CT.

Indium-111 leukocyte imaging in patients with rheumatoid arthritis

This study evaluates the usefulness of labeled leukocyte imaging in patients with rheumatoid arthritis. In 33 patients, the incidence of pain and swelling in 66 wrist joints and 66 knee joints was compared with the accumulation of [111In]leukocytes. No accumulation of [111In]leukocytes was seen in any of the patients' wrists (0/12) or knee joints (0/14) when both pain and swelling were absent. In contrast, 93% (25/27) of wrist joints and 80% (24/30) of knee joints with both pain and swelling were positive by [111In]leukocyte scintigraphy. There was little correlation between the stage of the disease, as determined by radiography, and [111In]leukocyte accumulation. This study suggests that [111In]leukocyte imaging may be a reliable procedure for monitoring the activity of rheumatoid arthritis, especially for confirming the lack of an ongoing inflammatory response.

Carotid blood flow measured by an ultrasonic volume flowmeter in carotid stenosis and patients with dementia

The volume flowmeter is a simple, noninvasive Doppler ultrasound technique that provides accurate measurement of carotid artery diameter and flow. The device provides a useful laboratory test that can aid significantly in diagnosis of carotid stenosis and dementia.

Thermographic imaging of cutaneous sensory segment in patients with peripheral nerve injury. Skin-temperature stability between sides of the body

Sensory examination based on the patient's subjective assessment of symptoms may raise difficult questions about whether the individual's expressed complaint is based on organic nerve damage, psychogenic factors, or even malingering. A prototype computerized telethermograph has allowed clinical quantification of peripheral nerve injury. The system makes possible mapping and imaging of the damaged area, as well as skin temperature measurements. In normal persons, the skin temperature difference between sides of the body was only 0.24 degree +/- 0.073 degree C. In contrast, in patients with peripheral nerve injury, the temperature of the skin innervated by the damaged nerve deviated an average of 1.55 degrees C (p less than 0.001). The new technique requires further refinement, but it appears that use of this method may be cost-effective in helping to resolve medicolegal conflicts concerning peripheral nerve injury.

Thermographic presentation of cutaneous sensory and vasomotor activity in the injured peripheral nerve

Impaired function of cutaneous segments of monkey peripheral nerves experimentally blocked by lidocaine anesthesia was clearly visualized by means of elevated temperature measurements obtained on computerized color telethermography. Mean temperature elevations in the segments of anesthetized primate nerves were 2.40 degrees C at the ulnar segment 17 minutes after nerve block, and 1.20 degrees C at the peroneal nerve at 20 minutes. The vasomotor activity of specific nerves, recorded after local anesthesia and displayed by color telethermographic imaging, corresponded to the distribution of sensory segments identified by more cumbersome means. Telethermography is therefore shown to be a useful tool, both qualitatively and quantitatively, in mapping cutaneous distribution of peripheral nerves and for evaluation of peripheral nerve injuries.