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Evolution™ for Bone & Infinia™ Hawkeye® 4 Procedure time = 10 min
Bone scintigraphy - case RC 465.
A 58-YOF patient with known breast malignancy referred for metastatic survey. Comparison was made with a previous study. The patient is under therapy.
There are sites of variable intensity of uptake along the vertebral column and rib cage. Some osteoblastic lesions seen on the CT part are without uptake in keeping with sites of burnt out disease and some lesions correspond in location with the scintigraphic abnormalities.
The combination between the CT and the SPECT allow to separate active from non-active metastases.
Courtesy: Sourasky Medical Center, Tel-Aviv, Israel.
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Infinia™ Hawkeye® 4 in In111-Somatostatin imaging
A 42 year-old patient with Carcinoid diagnosed by biopsy of a liver lesion.
Increased In111-Somatostatin uptake was detected in multiple bone lesions localized in the axial and peripheral sites with corresponding osteoblastic lesions on the CT part of the study.
Multiple liver lesions were detected on both SPECT and CT in the two liver lobes and increased uptake was found to be located in the left lung with a corresponding CT abnormality in keeping with lung involvement. The findings on the In111-Somatostatin SPECT/CT study suggest metastatic carcinoid which is over expressing somatostatin receptors.
The patient was therefore referred for labeled Somatostsin therapy. The current study serves as a baseline study and will be used for comparison when monitoring response to therapy.
Courtesy: Sourasky Medical Center, Tel-Aviv, Israel.
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Evolution Bone & Hawkeye® 4
Stress fracture
Clinical History:
Woman aged 60, pain at stress in the left feet.
Findings:
SPECT shows multiple areas of increased activity in the left feet. Hawkeye CT locates those areas not at the joints but exactly distal in metatarsal 2, in the upper part of the cuboideum bone and in the cuneiformis medialis bone.
Conclusion:
Multiple stress fractures in the left feet. Joint injuries were excluded.
Courtesy of Clinic St Jean, Brussels, Belgium
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Hip : Degenerative Change
Clinical History:
B.Cell C.L.L. In the past, multiple episodes of Left septic hip+osteomyellitis. Presents now with pain in the Right hip? Focus of Infection?
Findings:
1st and 2nd Phase Bone Scan normal. SPECTCT shows increased activity in the head of the femur on the Left. On the Right hip, activity is mostly confined to the acetabulum.
Conclusion:
There is insufficient evidence to suggest the presence of acute osteomyelitis on the Right hip. In the Left hip the changes are due to previous osteonecrosis with an element of degenerative change.
Courtesy of INM: University College London Hospitals
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Knees : Osteonecrosis
Clinical History:
Fungating lesion left leg. Squamous cell carcinoma confirmed. Is there involvement of underlying bone ?
Findings:
Focal increased tracer uptake is seen in the lateral condyle of the Left femur, within the posterior compartment. In the remaining regions adjacent to this, fairly low grade uptake is seen, similar in intensity to that in the adjacent tibial articular surfaces.
Conclusion:
The focal uptake in the lateral condyle of the left femur is suspicious in view of the fact that the primary site is antero-medial to this finding. Osteonecrosis needs to be considered prior to concluding that the abnormality is due to a bony metastasis.
Courtesy of INM: University College London Hospitals
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Hand injury
Clinical History:
A woman, aged 42, complaining of persistent pain in the right wrist after an accident some weeks ago. Planar RX was negative and the clinical examination was unclear about the correct diagnosis and rather suggested tendinitis or athritis.
Findings:
A three phase bone scan showed a very active and hyperemic focal lesion somewhere in the wrist. A SPECT-CT was realized and indicated the trapezium bone as very active on bone scan. Given the correct location and the clinical information this case was diagnosed as fracture or necrosis. Any other pathology could be excluded.
Conclusion:
Bringing together the anatomical and physiological information and also knowing the clinical history are very often the key elements for the diagnosis. Even in the complex area of the wrist a SPECT-CT individualizes all the different small bones and joints and proves its contribution to the diagnostic accuracy.
Courtesy of Clinic St jean, Brussels, Belgium
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In111-Neuro endocrine tumor
Clinical History:
59 years old man. Preoperative staging of tumor of small intestine with mesenteric adenopathy.
Findings:
Top and medium: mild focal uptake of the distal ileum with CT abnormalities corresponding to the primary tumour (close to the ileocecal junction).
Bottom and medium: high uptake of mesenteric bulky nodes: corresponding CT and SPECT slices at a level located between the third and the fourth lumbar vertebrae, above the primary tumor.
Conclusion:
Metastatic carcinoid tumour.
Courtesy of HEGP hospital, Paris, France
Drs C.Hignette and M.Faraggi
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Clinical History:
Woman, aged 76. Pain at stress in the right knee after an accident.
Findings:
Intense uptake exactly on the medial border of the right tibial plate (with increased blood-flow and blood-pool) and moderate uptake in the tuberositas tibiae. Fused datasets allow correct localisation of the areas with increased bone activity.
Diagnosis:
Stress fracture in the medial part of the right tibial plate and mechanical stress or an enthesopathy at the tuberositas tibiae.
Courtesy of Clinic St jean, Brussels, Belgium
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Clinical History:
Woman, aged 52. Pain at the right shoulder.
Findings:
SPECT images demonstrate an increased uptake in or around some articulations. Fused dataset clearly confirms uptake within the joints like in the right acromio-clavicular joint, the area where the patient is suffering.
Diagnosis:
Degenerative disease in the acromio-clavicular joint and no traumatic injuries.
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Clinical History:
Woman, aged 68. Rest and stress pain in the right hip since an accident.
Findings:
SPECT images show an small area of intense uptake in medulla of the right femoral head. On Hawkeye CT a small area showing lack of contrast is visible. Fused dataset confirms co-registration of these areas.
Diagnosis:
This study is very suggestive for avascular necrosis in the right femoral head. A dedicated diagnostic CT was done afterwards
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