99mTechnetium skeletal scintigraphy performed at the time of diagnosis was compared with pain and radiographs in 24 children with acute lymphocytic leukemia. Localized intense uptake of the labeled compound in one or several metaphyses and increased uptake in diaphyses were typical findings by scintigraphy. The skeleton of each child was subdivided into 18 regions, and investigated for the presence of pain and for possible radiographic and scintigraphic abnormalities. In a total of 432 regions (18 regions in each of 24 children), pain was present in 23 regions, radiographic anomalies in 54 regions, and abnormal technetium uptake in 98 regions. Signs and symptoms were most often found in the lower extremities. Pain and radiographic or scintigraphic abnormalities were not regularly found in the same skeletal regions. The individual number of radiographic abnormalities was negatively correlated with age, whereas the number of regions with abnormal technetium uptake was positively correlated with age. No significant correlation was found between the number of abnormal scintigraphic or radiographic regions and the clinical outcome of the disease.

Over a period of 2 years, 77 patients, strongly suspected of having pancreatic cancer, had abdominal CT as part of the diagnostic work-up. The CT images were reviewed by 2 radiologists who did not know the clinical course, the surgical procedure, or the final diagnosis. The positive predictive value of CT for the diagnosis of pancreatic cancer was 92% (82-97%) and the negative predictive value 69% (41-89%). The 95% confidence limits of the positive predictive value of CT in staging the extent of periampullary cancer in 52 patients varied between 21 to 79% and 59 to 100%, with the lowest values in diagnosis of liver metastases. The confidence limits for the negative predictive values in staging varied between 17 to 56% and 67 to 94%, with the highest values concerning liver metastases. We conclude that CT cannot be used as the only diagnostic procedure for confirming or excluding the diagnosis of pancreatic or periampullary cancer, and that the staging of periampullary cancer by CT alone is too inaccurate for the evaluation of resectability.

We report a case of splenic peliosis imitating metastases on CT. The patient was a 44·year·old man who previously had a retroperitoneal paraganglioma surgically removed. Peliosis must be considered a potential differential diagnosis of hypo dense foci of the spleen seen on CT.

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