ABSTRACTS OF CURRENT LITERATURE

Comparison of Cytosol Estrogen Receptor Status In OvarianCarcinoma Using Different Radiolabeled Llgands and Methods.S. B. Lele, M. S. Piver, J. J. Barlow, S. Chatterjee, S. Schneider, M.Ip; New York State Dept. Health, Buffalo, NY. J Surg Oncol 21:155-158, 1982

Reports in the literature regarding the presence or absence ofestrogen receptors in normal ovaries, or in ovaries with benign andmalignant tumors are mixed and contradictory. There is more thanone class of steroid hormone receptor in a given tissue. A total of29 specimens consisting of normal ovaries, benign ovarian lesions,and ovarian adenocarcinomas removed by laparotomy were submitted for estrogen receptor assay using three different methodsin ligands and incubation conditions. Samples were also assayedusing the dextran-coated charcoal as well as sucrose gradient. Thestudy confirmed the lack of receptor binding in normal ovaries andovaries with benign lesions, and the presence of estrogen receptorwas confirmed in malignant ovarian lesions. Discrepancies in thevalues of receptors binding in the same specimen, but determinedby different methodology, indicate the need for a standardizationof technique.

Transferrln Receptors and Galllum-67 Uptake In Vitro. D. C. P.

Chen, B. Newman, R. M. Turkall, M. F. Tsan; John Hopkins MedicalInstitutions, Baltimore, MD. EurJ NucíMod 7:536-540, 1982

The Ga-67 accumulation was investigated in different humancell lines to assess the relationship between transferrin receptorsand nuclide uptake. Two normal cell lines (WI-38 fibroblasts andforeskin fibroblasts), two transformed cell lines (AV-3 amnioniccells and Chang liver cells), and two neoplastic cell lines (HEp-2,larynx cancer and HeLa, cervical cancer) were selected and thetransferrin receptors were determined by an indirect immu-nofluorescence method. Ga-67 uptake was analyzed after a 24-hrincubation with Ga-67 in the presence and absence of transferrin.Additional 1-125 labeled transferrin uptake was measured by amethod similar to measurement of the uptake of Ga-67. Thefraction of cells with transferrin receptors was low in normal celllines (3.5% and 9.1%), intermediate in transformed cell lines(33.4% and 49.2%), and high in the neoplastic cell lines (59.2% and60.8%). As in other studies, Ga-67 uptake was significantly enhanced by human transferrin. The correlation coefficient betweenthe fraction of transferrin receptor positive cells and Ga-67 uptakewas low in the absence and presence of human transferrin (r = 0.46and r = 0.21 ). In contrast to these results, a good correlation wasnoted between Ga-67 uptake and 1-125 transferrin uptake in theabsence and presence of human transferrin (r = 0.80 and r = 0.96).The authors conclude that human cell lines in culture have bothtransferrin-dependent and transferrin-independent uptake ofGa-67. These results would not support directly the affect oftransferrin receptors on the uptake, but they would not rule outthis possibility.

Site-Specific, Sustained Release of Drugs to the Brain. N. Bodor,

H. H. FarAg, M. E. Brewster, III; Univ. of Florida. Science 214:1370-1372, 1981

The blood-brain barrier hampers the delivery of concentrationsof drugs (and scintigraphic imaging agents) to the brain tissue. Theauthors have used the dihydropyridine pyridinium salt redox

system to facilitate delivery of drugs through the blood-brainbarrier. The idea is that the drug be coupled to the carrier that isreduced to its dihydro form. The dihydro form is administered andquickly circulated throughout the body, including the brain. It isoxidized ubiquitously to the salt form, which is rapidly eliminatedfrom the body but cannot return through the blood-brain barrier,so it is "locked" into the brain. If, then, the drug and the carrier

could be cleaved, the carrier could leave the brain too. The theoretical formulation was tested with phenylethylamine and theanticancer agent berberine and seemed to be well borne out in thesecases.

Cerebral Metabolism and Atrophy in Huntlngton's Disease De

termined by FDG-18 and Computed Tomographie Scan. D. E. Kühl,M. E. Phelps, C. H. Markham, E. J. Metter, W. H. Riege, J. Winter;Univ. California, Los Angeles, CA. Ann Neural 12:425-434,

1982Local cerebral metabolism of glucose (LCMRglc) was studied

in 13 patients with Huntington's disease (HD), 15 subjects at risk

for HD, and 40 normal subjects. Results were correlated with theresults of CT indices of atrophy and psychological testing in thepatients and the at-risk groups. Radionuclide scans were begun40 min. after i.v. injection of 10 mCi F-18 labeled fluorodioxy-glucose (FDG) using an ECAT II tomograph. Subjects wereawake and unsedated while six sequential images (1.5 millioncounts each) were obtained in at least six levels parallel to thecanthomeatal plane. Zonal, hemispheric, and whole-brain averagevalues for LCMRglc were obtained for the entire scan series andmetabolic indices derived for comparison of the various regions.Cerebral perfusion studies were obtained from two HD patientsusing N-13 ammonia. The three CT indices of atrophy were elevated in HD patients as compared with normal age-matchedcontrols (p < 0.0001 ); disease duration and degree of dementiacorrelated with ventricle CT index (p < 0.05) while chorea correlated with the caudate CT index. Mean global metabolic rate(MR) for glucose did not differ significantly from controls, butcaudate MR scores were significantly higher (p < 0.0001).Caudate CT and MR indices clearly differentiated HD patientsfrom controls. Local relative perfusion was subnormal in each oftwo HD patients with marked striatal hypometabolism. CT scanswere normal in all at-risk subjects, but six of the 15 had caudateMR indices greater than 2 s.d. above normal.

Noninvaslve Detection of Multlvessel Disease After MyocardlalInfarction by Exercise Radionuclide Ventriculography. A. G.Wasserman, R. J. Katz, P. Cleary, V. M. Varma, R. C. Reba, A. M.Ross; George Washington Univ. Med. Ctr., Washington, D.C. AmJ Cardio! 50:1242-1247, 1982

To evaluate the ability of exercise radionuclide venlriculographyto detect multivessel disease after myocardial infarction (Ml),seventy-four patients who had had MI underwent exercise radionuclide ventriculography and cardiac cathcterization 8 wk later.Thirty-eight patients had had an inferior (INF) Ml, 25 withmultivessel disease and 13 with single-vessel disease of the rightcoronary artery. Thirty-six patients had had an anterior (ANT)MI, 26 with multivessel disease, and 10 with single-vessel diseaseof the left anterior descending coronary artery. The mean resting

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left ventricular ejection fraction (LVEF) of multivessel and singlevessel was 40 ±2% and 45 ±3%, respectively. The mean peakexercise LVEF of multiple vessel and single-vessel disease was 34±2% and 43 ±3%, respectively. There was no significant difference between single and multiple vessel disease regarding LVEFon rest and exercise and mean change from rest to exercise. Inpatients with inferior infarction there was no difference in the meanresting LVEF in those with single-vessel disease (53 ±2%) compared with those with multivessel disease (50 ±2%); however, themean exercise LVEF in patients with single-vessel disease (57 ±3%) was significantly higher than that in patients with multivesseldisease (45 ±2%). Sixteen of the 25 patients had multivessel disease but only one patient with single vessel disease had a decreasein LVEF of at least 5%. A new wall-motion abnormality developedin eight patients with ANT MI and 11 with INF MI with multi-vessel disease but in none with single-vessel disease. The sensitivityand specificity in predicting multivessel disease using the criteriaof the development of a new wall-motion abnormality or a decreasein LVEF with exercise of at least 5% were 80% and 92% for INFMl, but only 69% and 40% for ANT MI. The authors concludedthat exercise radionuclide ventriculography can be used to discriminate between single and multivessel disease after INF MI.For patients with ANT MI, only a new abnormality in wall motionaccurately predicts multivessel disease, but this occurs in only onethird of such patients.

Righi and Left Ventricular Response to Subcutaneous TerbutalineIn Patients with Chronic Obstructive Pulmonary Dlsease-Radio-

nuclide Angiographie Assessment of Cardiac Size and Function.W. W. Hooper, R. A. Slutsky, D. E. Kovcienski, K. F. Witztum, R. G.Spragg, W. L. Ashburn, K. M. Moser; Vets. Adm. Med. Ctr., SanDiego, CA. Am Heart J 104:1027-1032, 1982

To evaluate the response of both ventricular functions to theadministration of terbutaline sulfate, a beta-2 selective agonist,14 male patients with chronic obstructive pulmonary disease(COPD) were observed with cardiac gated blood pool study(CGBP). In the baseline study, 8 of 14 patients had a low rightventricular ejection fraction (RVEF), 4 had a low left ventricularejection fraction (LVEF), and 3 had low RVEF and LVEF. Afterterbutaline subcutaneous injection, RVEF increased in 13 of 14patients by 17 ±8%, whereas LVEF increased in all patients by15 ±7%. Both ventricular end diastolic volumes decreased,whereas stroke volume was unchanged. The cardiac output roseby 0.8 ±1.3 1/min, mainly due to the increase in heart rate. Theauthors concluded that terbutaline has significant beta-1 cardiaceffects in patients with COPD. It increases the heart rate and decreases cardiac size as well as reduces cardiac preload and after-

load.

Cholecystokinin Cholecystography, Sonography, and Scintigra-phy-Detection of Chronic Acalculous Cholecystitis. G. B. Davis,

R. N. Berk, F. W. Scheible, K. F. Witzum, I. T. Gilmore, R. M. Strong,A. F. Hofmann; Univ. Calif., San Diego Vet. Adm. Med. Center, SanDiego, CA. Am J Poentgenol 139:1117-1122, 1982

Cholecystokinin Cholecystography (CG), sonography (US), andPIPID scintigraphy (RN) were performed in 10 volunteers and10 patients with biliary-type symptoms to evaluate whether gallbladder contraction in the patients differed from that in normalvolunteers. The mean maximum contraction of the gallbladder ofthe CG, US, and RN studies was 63%, 61% and 68%, respectively,for the volunteers, and 72%, 63%, and 73%, respectively, for thepatients. The maximum gallbladder contraction during all threeprocedures was 64% ±26% s.d. in volunteers, and 74% ±17%s.d.in the patients. The degree of gallbladder contraction, as measuredby Cholecystokinin US or RN, correlates well with emptying de

termined by Cholecystokinin CG, but the assessment of contractionby any method is not a valid criterion for the presence of gallbladder disease.

Comparison of Ultrasonography, Computerized Tomography andRadionuclide Imaging in the Diagnosis of Acute and ChronicCholecystitis. N. M. Motólo,R. C. Stadalnik, J. P. McGahan; Sacramento Medical Center, Univ. of CA, Sacramento, CA. Am J Surg144:676-662, 1982

Seventy-five patients with abdominal pain in the right upperquadrant underwent cholescintigraphy, ultrasonography (US)and/or computerized tomography (CT) before operation. Beforecholescintigraphy the patients were instructed to take nothing bymouth or have only clear liquids, for at least 2 hr before the study.After administration of Tc-99m pyridoxylidoneglutamate or di-sofenin, 2 to 5 mCi for nonjaundiced patients and 5 to 10 mCi forpatients with jaundice (bilirubin over 5 mg/100 ml), serial 500Kimages were obtained at 15, 30,45 and 60 mins. Additional imagesat 2 to 6 hr and 24 hr were obtained if biliary obstruction wassuspected or if the biliary system or intestine was not visualizedat 1 hr. The criteria for positive cholescintigraphy are nonvisual-ization of gallbladder but prompt visualization of the common bileduct and small bowel, which indicate cystic duct obstruction.Delayed visualization of gallbladder is suggestive but not diagnostic of chronic cholecystitis. The positive US for cholelithiasisis visualization of an echogenic focus with acoustic shadow. Majorcriteria of US for acute cholecystitis includes presence of gallstones, a positive ultrasonographic Murphy's sign, and thickened

gallbladder wall. The criteria for diagnosis of cholelithiasis by CTinclude the presence of an area of increased density greater thanthat of blood within the gallbladder fossa. Histologically and op-eratively fifty-eight of 75 patients proved to have acute cholecystitis, and 17 patients had chronic cholecystitis and cholelithiasis.On the basis of analysis of data, the authors concluded that: (1)US is quite accurate and better than cholescintigraphy in diagnosisof chronic cholecystitis and cholelithiasis (94%), but less accuratein the detection of acute cholecystitis; (2) Cholescintigraphy ishighly sensitive and specific in the early diagnosis of acute cholecystitis (overall accuracy rate of 93%) but very inaccurate in thediagnosis of chronic cholecystitis and cholelithiasis unless the cysticduct is obstructed; (3) CT may be very helpful in problematic casessuch as the diagnosis of the cause of biliary obstruction or inimaging of the pancreas.

The Abdominal Technetium Scan (A Decade of Experience). E.R. Cooney, D. 0. Duszynski, E. Camboa, M. P. Karp, T. C. Jewett,Jr; Children's Hosp., Buffalo, NY. J Fed Surg 17:611-619, 1982

Abdominal technetium scans were performed in 270 children(age 13 days to 17 yr, mean 7.09 yr) because of suspected Meckel's

diverticulum. Of these, 30 (11%) had abnormal scans while 240(89%) had normal scans. In the positive scan group, 26 underwentlaparotomy with findings of Meckel's diverticulum in 12, small

bowel duplication in three, intussusception in three, inflammatoryperforation of the terminal ileum in one, anterior meningomye-locele in one, and pelvic kidney in one. Proven false-positive scanswere present in five of the 26 children (19%). Continued symptomsled to laparotomy in 19 of the 240 patients with negative scans, andtwo were found to have Meckel's diverticulum for an overall

false-negative rate of less than 1%. The relatively low yield ofpositive scan results indicates a need for improved patient selectionand stricter clinical criteria for use of the scan. False-negative scanresults may be minimized by having patients NPO and by havingthem void before scanning. Lateral views may also be used to improve separation of the area of abnormal uptake from urinarybladder activity. False-positive results resulted from overinter-

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pretation and were most common in the first 4 yr of the study.Careful correlation with the clinical course and with results of otherdiagnostic studies will diminish unnecessary surgery.

Splenic Abscess Due to Blastomycosis-Scintigraphic, Sonographic

and CT Evaluation. R. L. Dubuisson, T. B. Jones, M. S. Levine, I.Laufer, J. J. Thompson; Univ. S. Alabama, Mobile, AL. Am JRoentgenol 140:66-68, 1983

The authors presented a 29-yr-old drug abuser with splenicabscess due to blastomycosis. Radionuclide studies, ultrasono-graphy (US), and computerized tomography (CT) had beenperformed. The enlarged spleen with a large photosplenic defectin the Tc-99m sulfur colloid scan also showed a photosplenic areasurrounded by a rim of increased radioactivity on the Ga-67 scan.US revealed several hypoechoic areas within the enlarged spleen,some of which contained foci of high echogenicity. ConventionalCT and dynamic CT confirmed multiple low density lesionsthroughout the spleen and confirmed them to be avascular in nature. It is concluded that dynamic CT will be significantly usefulin the differentiation of vascular from avascular lesions in the diagnosis of splenic abscess.

Radionuclide Bone Scanning of Medullary Chondrosarcoma. T.M. Hudson, F. S. Chew, B. J. Manaster; Univ. of Florida HealthCenter, Med. Center, Gainesville, FL. Am J Roentgenol 139:1071-1076, 1982

Eighteen patients with medullary chondrosarcoma underwentpreoperative radiographie and radionuclide bone studies, whichwere correlated with pathologic macrosection of the tumors. Thetumors were classed Grade I, 5; Grade II, 8; Grade III, 4. Onepatient had differentiated chondrosarcoma. The 18bone scans withTc-99m méthylènediphosphonate demonstrated high uptake inthe tumors, and the uptake in 15 scans corresponded accuratelyto the anatomic extent of the tumors. Histologically, there wasintense reactive new bone formation and hyperemia around theperiphery of all 18 tumors, and there were foci of enchondralossification, hyperemia, or calcification within the tumor itself innearly every tumor. Three scans demonstrated less uptake in thecenter of the tumors than around their peripheries. One of thesethree tumors was necrotic in the center, but the other two werepathologically no different from tumors that showed homogenousactivity on the scan. There was no relation between the histologiegrades or features of the tumors and intensity or pattern of uptakeon the scans. Only three scans exhibited increased uptake beyondthe true tumor margins, thus, the "extended pattern of uptake"

beyond the true tumor extent is much less common in medullarychondrosarcomas than in many primary tumors. Therefore, increased uptake beyond the apparent radiographie margin of thetumor suggests possible occult tumor spread.

Uptake and Localization of 99mTc- MéthylèneDiphosphonate in

Mouse Osteosarcoma. H. Nakashima, H. Ochi. N. Yasui, H. Hamada,K. Ono; Osaka University Medical School, Fukushima-ku, Osaka,Japan. EurJ NucíMed 7:531-535, 1982

One of the characteristics of osteosarcomas is the productionof tumor bone within the malignant mass. The authors assessedthe accumulation of Tc-99m méthylènediphosphonate (Tc-99mMDP) in mouse osteosarcoma. In addition to skeletal imaging,macro- and microautoradiography were used to investigate thetumor in 26 mice. BF osteosarcoma, which initially was obtainedfrom Thelma Dunn mouse osteosarcoma of spontaneous origin,was maintained in CBA and C3H mice. This tumor was transferred to a cell culture system, maintaining the characteristics ofosteosarcoma. Three weeks after the subcutaneous injection of

approximately 4 X IO6cells in 0.3 ml tris-dextrose solution, all 26

mice were radiographed. Ten mice were used for scintigraphicimaging, eight for the macroautoradiographic examination, andeight for the microautoradiographic study.

Two hours after the injection of 0.5 mCi Tc-99m MDP the ratioof tumor-to-soft tissue (muscle) was 20.41 ±3.32 compared with3.77 ±0.27 after the injection of 0.5 mCi Tc-99m in a controlgroup. Tumor-to-bone ratio was lower (0.465 ±0.101) for Tc-99mMDP, whereas local blood flow was increased, represented by atumor-to-bone ratio of 1.53 ±0.49 after Tc-99m application. Theseobservations correlated with the macroauloradiographic studies,showing intense Tc-99m MDP deposition in theossificated partsof the tumor and a uniform distribution of nuclide within the tumortissue. In the microautoradiographic studies about 91% of Tc-99mMDP activity was seen in the mineralized matrix, 7% in the non-mineralized matrix (osteoid), and only 2% of the bone-seekingradionuclide was observed in the tumor cells. These findings indicate that the mineralization of the tumor bone matrix is mostimportant for the total Tc-99m uptake in osteosarcomas.

Bone Uptake of "Tc-MDP In Man: Its Relationship with Local

Blood Flow. A. Vattimo, G. Martini, M. Pisani; Institute of ClinicalMedicine and Nuclear Medicine Service, University of Siena, Siena,Italy. J NucíMed All Sci 26:173-179, 1982

Decrease of radioactivity after injection of 10 mCi Tc-99mméthylènediphosphonate (MDP) was monitored for 60 minutes.Six patients with Sudeck's foot atrophy, five patients sufferingfrom Paget's disease (limb or pelvis), and three patients with os

teomalacia were studied. In order to assess the blood flow, onepatient of every group received 1 mCi Tc-99m HSA. Blood tracerconcentration and count rate of the involved and healthy area wererecorded for 60 minutes (MDP) or 20 minutes (HSA). A two-exponential function was fitted to the curves. The ratio tracer countrate to area under the fitted plasma curve represents the fractionof the tracer that was extracted from the blood pool. This indexwas lower in the first five minutes in Paget's disease and Sudeck's

atrophy and higher in osteomalacic areas. In the late phase (5-60minutes) the ratio was out of the normal range in osteomalacia andincreased progressively in Paget's disease. Compared with healthyregions no significant differences were observed in Sudeck's at

rophy. These results show that the bone metabolism is the majordeterminant of the total radionuclide uptake whereas the localblood flow has influence on the initial uptake only.

Radioisotope Penogram in Diagnosis of Vasculogenlc Impotence.H. N. Fanous, M. J. Jevtich, D. C. P. Chen, M. Edson; WashingtonHosp. Center, Washington, DC. Urology 20:499-502, 1982

These authors imaged the penis (radioisotope penogram) by firstadministering 0.4 gm potassium perchlorate to the patient beforei.v. injection of 20 mCi Tc-99m. A lead shield was placed underthe penis to attenuate scrotal and thigh radioactivity. Radioactivityin the anterior view of the penis by gamma camera with parallelhole collimator was measured initially in 12 frames of 3-sec duration to assess arterial flow. Then 60-sec frames were acquiredfor an hour for the dynamic study. At ten min after injection ofTc-99m, 10 mg isoxsuprine (a peripheral vasodilator) was injectedi.v. A penogram index (PI) was calculated from: (peak radioactivity in penis) minus (radioactivity in penis at 10 min postinjectionof Tc-99m) divided by (radioactivity at 10 min postinjection ofTc-99). Separately, nocturnal penile tumescence (NPT) was alsomeasured in each subject, and in addition a penile brachial index(PBI) was derived from penile systolic blood pressure/brachialsystolic blood pressure. In nine patients (age 18-64 yr) with noerectile dysfunction (controls), NPT was normal, PBI ranged from0.7-1.2, and PI (in eight of the patients) ranged from 1.42 to 3.5.

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In one control patient, PI was 0.2 reflecting rapid uptake of radioactivity before vasodilator and minimal subsequent enhancement by drug. In 19 men (age 19-76 yr) with organic erectiledysfunction (e.g., from diabetes or arteriosclerosis), NPT measurement indicated none to occasional weak erections. FBI in thosepatients ranged from 0.4-1.0, while PI ranged from 0.3-2.33 (in16 of the 19 patients, PI was 1.37 or less). In 26 of the subjects, PIwas directly related to PB1 (r = + 0.73). The authors conclude thatthe radioisotope penogram: (a) may be useful for predicting thoseimpotent patients who will respond to therapy with vasodilators;or (b) through its demonstration of arterial blood supply, venousdrainage, and blood flow in the corporeal bodies may facilitateselection of candidates for penile revascularization.

A Critical Evaluation of a Specific Radioimmunoassay for ProstaticAcid Phosphatase. S. L. Goldenberg, H. K. B. Silver, L. D. Sullivan,M. J. Morse, E. L. Archibald; Univ. British Col., Vancouver, BC,Canada. Cancer 50:1847-1851, 1982

These authors compared a modified commercial double-antibody radioimmunoassay (RIA) with a standard enzyme assay tomeasure serum prostatic acid phosphatase (PAP) clinically. InGroup 1, 155 normal males age 19-89 yr, PAP by RIA was minimally elevated above the upper limit of normal (3.2 ng/ml) innine subjects. In Group 2, 89 patients with histologically confirmedbenign prostatic hyperplasia (BPH), PAP by RIA was elevatedabove the upper limit of normal (7.0 ng/ml) in three men. Patientswith BPH tended to have higher PAP by RIA than did normalmales. In Group 3, of 42 men with palpable prostatic nodules thatlater proved histologically to be benign, four had minimally elevatedPAP by RIA (using Group 1 cutoff) and no elevated values usingGroup 2 cutoff. Group 4, seventy-three patients with intracapsularcarcinoma, showed elevated PAP by RIA in ten patients basedupon Group 1cutoff, but in only four based upon Group 2 cutoff.In 45 patients with extracapsular carcinoma, Group 5, all hadnegative Tc-99m bone scan, 16 had elevated PAP by RIA (Group1cutoff), and seven had elevated PAP by RIA (Group 2 cutoff).In 36 patients with confirmed distant métastases.Group 6, 27 hadelevated PAP by RIA using Group 1cutoff; and 25 had elevatedPAP by RIA, using Group 2 cutoff. Multiple comparisons of meanPAP values between groups indicated essentially comparable results by enzyme assay and RIA. For all stages of carcinoma, theRIA revealed more acid phosphatase elevations than did the enzyme method, a finding especially apparent in widespread disease,Group 6. When PAP was measured by the RIA in sera from 55normal adult women, all values were within the normal range usingGroup 1cutoff, suggesting that the RIA is not entirely specific foracid phosphatase of prostatic origin. These authors state that theycannot recommend this PAP RIA for diagnostic screening forprostatic cancer. However, the PAP RIA is of value in monitoringresponse to treatment in patients with more advanced or metastaticdisease.

Serum Acid Phosphatase in the Assessment of Response toSystemic Therapy in Metastatic Prostate Cancer-Comparison of

Radioimmune and Enzymatic Assays. D. C. Ihde, W. D. Belville,J. L. Eddy, D. E. Marian, M. J. Genski; National Naval Medical Center,Bethesda, MD. Military Medicine 147:949-952, 1982

Twelve patients with disseminated carcinoma of the prostatetreated by combination chemotherapy or bilateral orchiectomyhad serial measurements of their serum acid phosphatase (SAP)by radioimmunoassay (RIA) and enzymatic assay. The two assayswere almost equally sensitive in detecting disease regressions.Neither assay was particularly helpful in confirming documentedtumor progression. Although these results were obtained in alimited number of cases, the authors concluded that RIA yielded

no more information than enzymatically measured SAP in monitoring response to systemic therapy in extensively staged patientswith metastatic carcinoma of the prostate.

Absorbed Doses at CT of the Kidneys and at Urography. G.Bankvall, L. Ekelund, M. Gustafsson, G. Svahn; University Hospital,Lund, Sweden. Acta Radiologica-Diagnosis 23:245-249, 1982

Urography is one of the standard examinations in patients withrenal diseases, but transmission-computed tomography is currentlyused with increasing frequency, e.g., in the assessment of renalmasses and of the adrenal glands. The authors measured the radiation doses at CT examinations of the kidneys and comparedtheir results with those obtained from conventional urography. Twodifferent screen-film systems were used for urography, with theaverage number of films per examination varying from 12 to 15.Computed tomography of the kidneys was performed with a fast,whole-body scanner (1.2 sec per scan, slice thickness 12 mm). Themean number of cross sections was 13 for kidney examinations and10 for the assessment of the adrenal glands. Thermoluminescentlithium fluoride dosimeters (TLD) were used to measure the radiation dose in different parts of the body (skin, ovary, testis,breast, bone marrow). The authors found in almost every regiona relation of approximately 1:10 between the absorbed dose in CTand urography. With urography the absorbed dose of the skin was180 mGy and with CT, 20 mGy; of the breast 9.3 mGy, with CT0.7 mGy; and of the ovary 12.7 mGy, with CT 0.58 mGy. A detailed knowledge of the distribution of the radiation dose is necessary for the comparison of the two different imaging modalities.With computed tomography the absorbed dose to the kidneys isapproximately 80% of the maximum skin dose, compared with 12%of the maximum skin dose with urography. The authors concludethat CT of the kidneys involves a considerably lower dose for thepatient than urography.

Positron Tomography and Nuclear Magnetic Resonance Imaging.G. L. Brownell, T. F. Budinger, P. C. Lauterbur, P. L. McGeer; Massachusetts Gen. Hosp., University of California, State University ofNew York, and Univ. of British Columbia. Science 215:619-626,

1982These four scientists assess two techniques. Of special interest

to the nuclear medicine audience well versed in ß+techniques is

the discussion of NMR. The authors predict the development ofhigh resolution hydrogen NMR imaging systems and of high fieldinstruments for phosphorus imaging of certain regions of the body.Both techniques are reviewed as important basic science tools forthe investigation of normal and disease processes.

Tumor Imaging with Radioactive Metal Chelates Conjugated toMonoclonal Antibodies. D. A. Scheinberg, M. Strand, P. Gansow;The Johns Hopkins Univ. and Michigan State and NIHM. Science215:1511-1513, 1982.

The authors used Rauscher murine erythroleukemia in mice asa model system. The monoclonal antibody binds to leukemic spleencells sixty times more than to normal spleen cells within hours afterinjection. The antibodies were attached to chelates and their biological activity tested. Attachment of either 1-(p-carboxym-ethoxybenzyl) EDTA and the carboxy-carbonic anhydride ofDTPA produced active antibodies.

In-111 and Sc-46 were used to label the chelate. The In-111chelated Ga-67, antibody was used in normal and leukemic micefor Anger camera imaging. Fifteen percent of the injected antibodyconcentrated in the affected spleen making imaging possiblewithout computer treatment.

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Geometric Effective Solid Angles and Intrinsic Efficiencies of a3 X 3 hi. Nal(TI) for Isotropie and Non-lsotropic Photon Emmission.

S. N. «aplanis; Univ. of Patras, Patras, Greece. Int J Appi Rad Isot33:127-135, 1982

A Monte Carlo code has been developed to calculate the effective solid angle, the geometric solid angle, and the intrinsic efficiencies of a 3 X3 Nal(Tl) detector for various 7-photon energies for isotropie sources, nonisotropic point sources, and distributed sources. The effective solid angle of a detector is defined asthe solid angle of a perfectly efficient detector of the same typerecording the same number of photons or particles. The effectivesolid angle is proportional to the total system efficiency, the constant of proportionality being 47r. Furthermore, the ratio betweenthe effective and the geometric solid angles is the intrinsic efficiency of the detector. The author has calculated the geometricand effective solid angles for isotropie and nonisotropic emittingpoint sources as a function of distance from the detector centralaxis and at various distances from the detector. The results arepresented in the form of graphs. Intrinsic efficiency is presentedfor point sources of 0.2 to 0.9 Mev photons. Also presented aremean solid angles and mean effective solid angle for sphericalsources with radii from 0.5 to 3.5 cm. Where corresponding dataare available in the literature, the author has found good agreementwith his results.

The Sonographlc "Scar Sign" In Focal Nodular Hyperplasla of the

Liver. J. C. Scatarige, E. K. Fishman, R. C. Sanders; The JohnsHopkins Medical Institutions, Baltimore, MD. J Ultrasound Meo 1:275-278, 1982

Two cases of focal nodular hyperplasia of the liver are reportedin which the lesion appeared as a well-circumscribed, slightlyhypodense, solid mass in the left lobe of the liver. Within the masswas a linear collection of dense echoes, referred to by the authorsas a "scar sign", that correlated well with the pathologic exami

nation showing a fibrous scar with or without radiating septa.Previous reports of focal nodular hyperplasia have described themass as hyperechoic or hypoechoic and the sonographic appearance has been relatively nonspecific. Although the scar sign maybe produced by other processes, the presence of a hypoechoic orisodense mass within the liver containing the dense linear internalecho should raise the suspicion of focal nodular hyperplasia.Representative sonograms and correlative pathological sectionsare provided.

Subhepatic Sonography Following Cholecystectorny. K. K. Shirazi,K. I. Maull; Medical College of Virginia. Richmond, VA. J UltrasoundMed 1:271-273, 1982

Seventy-six patients undergoing cholecystectomy were randomized into two groups with or without operative placement ofdrains in the subhepatic space. The right hemiabdomen was examined preoperatively and on the second and fifth postoperativedays by ultrasound. A total of nine patients ( 12%) had detectableaccumulations of fluid in this region. Twenty percent of the non-drained patients and 5% of the drained patients exhibited thisfinding. The fluid collections ranged from 3 to 7 cc in greatest di

ameter, and none proved to be clinically significant. Despite thehigher frequency of subhepatic fluid collections in those who hadnot been drained, these patients had less postoperative fever anda shorter mean hospital stay.

Sonographlc Findings in Perforation of the Gallbladder. B. L. Ma-

drazo, I. Francis, H. Hricak, M. A. Sandier, S. Hudak, K. Gitschlag;Henry Ford Hospital, Detroit, Ml. Am J of Roentgenol 139:491-496,

1982Thirteen cases of surgically proven perforation of the gallbladder

are presented. In 10 cases the cause was gangrene secondary toobstruction of the cystic duct by calculus; in two cases perforationwas due to a malignancy; and in the remaining case the cause wasnot determined. Pericystic collections varied in echogenicity fromcompletely echo-free to complex in nature; echogenicity of thecollection appeared to increase with increasing duration of theprocess. A proposed path of physiologic mechanism is most commonly that of obstruction of the cystic duct by calculus with subsequent distention of the gallbladder, compromise in the bloodsupply, and consequent ischemie perforation. Since clinical discrimination between acute cholecystitis and perforated gallbladdermay be difficult, sonography is a valuable diagnostic aid. Gravity-dependent imaging may be useful in separating localized fluidcollections from free acidic fluid.

UHrasonographic Features of Prostatlc Carcinoma. M. Greenberg.H. L. Neimen, R. Vogelzang, W. Falkowski; Northwestern MedicalSchool, Chicago, IL. J Clin Ultrasound 10:307-312, 1982

In a retrospective study of 93 prostatic examinations, the authorswere able to identify 16 out of 19 carcinomas. With standard staticand real-time equipment, the authors used a suprapubic transab-dominal approach through the distended urinary bladder. Ten ofthe carcinomas discovered were characterized by focal areas ofincreased echogenicity whereas six demonstrated a diminution inechoes. Most were confined to the posterior or posteriolateralportion of the gland. Thirteen of the 16 were ill-defined masses andthree were discrete. The reasons for the variability in echogenicityand shape are as yet undetermined. Extension of the neoplasmoutside the gland was not well evaluated by ultrasound, and CTwas found to be much more useful in this regard. The authorsrecommend a combination of ultrasound and CT in the detectionand staging of prostatic carcinoma respectively. Representativeultrasound and CT scans are provided.

JOHN J. COUPALPEGGY A. DOMSTADANDREW FRIEDWEI-JEN SHIH

University of Kentucky Med. Ctr.

and VA Hospital

Lexington, Kentucky

ROBERT E. ZIMMERMAN

Harvard Medical School

Boston, Massachusetts

BARBARA Y. CROFT

University of Virginia

Charlottesville, Virginia

LUDWIG STRAUSS

Klinikum Mannheim

Mannheim, West Germany

Volume 24, Number 5 459

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1983;24:455-459.J Nucl Med.   StraussJohn J. Coupal, Peggy A. Domstad, Andrew Fried, Wei-Jen Shih, Robert E. Zimmerman, Barbara Y. Croft and Ludwig  Abstracts of Current Literature

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