The purpose of this atlas is to present a review of the literature showing the advantages of SPECT brain perfusion imaging (BPI) in mild or moderate traumatic brain injury (TBI) over other morphologic imaging modalities such as x-ray CT or MRI. The authors also present the technical recommendations for SPECT brain perfusion currently practiced at their center. For the radiopharmaceutical of choice, a comparison between early and delayed images using Tc-99m HMPAO and Tc-99m ECD showed that Tc-99m HMPAO is more stable in the brain with no washout over time. Therefore, the authors feel that Tc-99m HMPAO is preferable to Tc-99m ECD. Recommendations regarding standardizing intravenous injection, the acquisition, processing parameters, and interpretation of scans using a ten grade color scale, and use of the cerebellum as the reference organ are presented. SPECT images of 228 patients (age range, 11 to 88; mean, 40.8 years) with mild or moderate TBI and no significant medical history that interfered with the results of the SPECT BP were reviewed. The etiology of the trauma was in the following order of frequency: motor vehicle accidents (45%) followed by blow to the head (36%) and a fall (19%). Frequency of the symptoms was headache (60.9%), memory problems (27.6%), dizziness (26.7%), and sleep disorders (8.7%). Comparison between patients imaged early (<3 months) versus those imaged delayed (>3 months) from the time of the accident, showed that early imaging detected more lesions (4.2 abnormal lesions per study compared to 2.7 in those imaged more than 3 months after the accident). Of 41 patients who had mild traumatic injury without loss of consciousness and had normal CT, 28 studies were abnormal. Focal areas of hypoperfusion were seen in 77% (176 patients, 612 lesions) of the group of 228 patients. The sites of abnormalities were in the following order: basal ganglia and thalami, 55.2%, frontal lobes, 23.8%, temporal lobes, 13%, parietal, 3.7%, insular and occipital lobes together, 4.6%.

This iterative algorithm enabled accurately segment PET lesions, independently of their contrast value.

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Two patients with sarcoma, one with recurrent osteosarcoma of the spine and the other with metastatic synovial cell sarcoma, were treated with high-dose chemotherapy that produced severe leukopenia. The patients received granulocyte colony-stimulating factor (G-CSF) to stimulate the bone marrow (480 mg given subcutaneously twice daily for 5 to 7 days); their responses were seen as a marked increase in peripheral leukocyte count with no change in the erythrocyte or platelet counts. The patients had fluorine-18 fluorodeoxyglucose (F-18 FDG) imaging 24 hours after the end of G-CSF treatment. Diffusely increased uptake of F-18 FDG was seen in the bone marrow in both patients. In addition, markedly increased uptake in the spleen was noted in both, indicating that the spleen was the site of extramedullary hematopoiesis. The patients had no evidence of splenic metastases. The first patient had a history of irradiation to the dorsal spine, which was less responsive to G-CSF administration than was the nonirradiated lumbar spine.

Repeated F-18 FDG DHCI examinations proved to have an impact on the clinical management of patients with malignant bone and soft tissue sarcoma. It helps to differentiate postoperative changes from local recurrence.

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e17591 Background: Sodium iodide (I-131) is eliminated predominantly through renal clearance. There is no consensus on the ideal dose of I-131 to be administered for patients with impaired kidney function. We aim to compare the rate of I-131 clearance in patients with impaired to those with normal renal functions. Methods: 27 cases (34 treatments) of differentiated thyroid cancer and eGFR 15-59 ml/min/1.73 m2 received I-131 (mean dose of 150 mCi) for remnant ablation between 2010 and 2016. Another 34 patients matched for age, gender, weight and I-131 dose with eGFR ≥ 60 ml/min/1.73 m2 were selected as controls. Endpoints of interest were (a) Length of hospital stay (LOHS) until the patient’s I-131 activity declines to < 30 mCi (b) Exposure rate measured by Geiger counter 0 to 48 hours after treatments (ER 48). Paired t-test was used to compare both groups. Results: Mean LOHS for cases vs. controls was 2.47 vs. 2 days respectively (P = 0.007). Results of ER 48 were available and matched in 18 cases and controls. Mean ER 48 for cases vs. controls was 3.74 vs. 1.8 mR/h respectively (P = 0.002). The mean proportional reduction of exposure rate after 48 hours compared to hour 0 for cases and controls was (-88% vs. -92.6%, P = 0.008), (-93.5% vs. -94.5%, P = 0.5) and (-67.2% vs. 94.3%, P = 0.04) for eGFR 46-59 (n = 13), 30-45 (n = 3) and 15-29 ml/min/1.73m2 (n = 2) respectively. Conclusions: Patients with impaired renal function are subject to longer hospital stay and delayed renal clearance of the tracer with consequent increased radiation exposure. Guidelines should consider adjusting the dose of I-131 in these patients to avoid possible harmful effects of excess I-131 on vital organs.