99mTc-HMPAO labelled white blood cell scintigraphy in patients with osteoarticular infection: the value of late images for diagnostic accuracy and interobserver reproducibility

The objectives of this study were to evaluate the diagnostic value of 99mTc-HMPAO labelled white blood cell scintigraphy (WBCS) in patients with suspected osteomyelitis using late images and to study interobserver reproducibility. This study prospectively included 120 patients, and after a follow-up of one year, only 70 patients (n = 49 with implants, n = 21 without implants) were selected. The final diagnosis of infection was based either on microbiological data (n = 54) or follow-up (n = 16). We performed WBCS with 4 h and 24 h scans. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 77%, 72%, 83%, 64%, and 75% at 4 h, and 74%, 87%, 91%, 59%, and 79% at 24 h, respectively. The interobserver reproducibility shows a 63% prevalence of agreement between results (kappa = 0.5) at 4 h and 80% (kappa = 0.74) at 24 h, respectively. WBCS with 24-h images improves specificity and interobserver reproducibility in patients with suspected osteoarticular sepsis.

[Diagnostic procedures and more particularly, place of scintigraphy in neuroendocrine tumors, example of vipoma in MEN 1]

Functioning endocrine pancreatic tumors in multiple endocrine neoplasia type 1 (MEN1) are rare. We present a case of a symptomatic neuroendocrine tumor in a 27-year old woman. The identification of the nature of the neuroendocrine tumors was difficult despite the use of a wide range of diagnostic procedures. This case is interesting in many ways: this is an exceptional illustration of MEN 1 with vipoma associated with calcitonin secretion and it is also a good example of the benefits and limitations of each diagnostic procedure in the heterogeneous group of neuroendocrine tumors.

Interest of laparoscopy in polysplenia syndrome

Polysplenia syndrome (PS) is usually discovered in symptomatic patients in association with congenital heart disease or biliary atresia. Asymptomatic patients can present associated anomalies of the digestive tract such as intestinal malrotation and gastric or splenic malfixation. We report a case of PS presenting as a left flank mass shown to be an accessory spleen by denatured red blood cell scintigraphy. Upper gastrointestinal tract studies showed intestinal malrotation. Laparoscopic exploration confirmed intestinal malrotation and showed the absence of fixation of the accessory spleen. We performed a laparoscopic Ladd's procedure followed by fixation of the accessory spleen and resection of Meckel's diverticulum through a short left-flank incision.

[Prevalence of thyroid cancer in Réunion from scintigraphic data]

This work is a retrospective two years study of thyroid cancer, diagnosed in Reunion Island, using scintigraphic cold regions. Between April 1993 and April 1995, 1,364 thyroid scintigraphic studies were performed in the CHD F. Guyon at Saint Denis, Réunion). These studies resulted from all types of indication and of them 691 had cold regions, with 22 thyroid cancers among them, (i.e. a prevalence of 3.20% of cold areas). Analysis of these cancers allowed recognition of various characteristics. A large majority (82%) were in females, whose median age at the time of diagnosis was 49 years (as opposed to 48 years for the male patients). The associated cold zones were usually isolated cold nodules. Anatomical pathology investigation indicated six were papillary, five mixed, three vesicular nodule, four microcarcinoma, one each of anaplastic, one follicullar thyroid carcinoma, and two were metastases. Their geographical distribution was superposed on their medical demography. Treatment was surgical, but a variety of procedures was used. Generally the diagnostical, therapeutical and follow up procedures were not standardised. Needle cell biopsy was virtually excluded from the decision-making trees and a variety of protocols was used. In addition there are no local epidemiological data available concerning thyroid cancers. An improved method for dealing with these cancers appears to be essential for Reunion. It must be associated with a greater awareness from medical practitioners, agreement on procedures for diagnosis, treatment and follow up and the setting up of a register for thyroid cancer in the "Department". Some thought before detailed involvement should be given to the setting up of a team, trained in needle cell biopsy, and an associated metabolic radiotherapy facility, so allowing appropriate procedures and follow up for thyroid cancers in this "Department".