Bone scan has long been considered to be an important diagnostic test in searching for bone metastases. However, considerable difficulty is encountered in the vertebral region due to the complexity of structures and the fact that other benign lesions, especially degenerative changes, are very common there. Single-photon emission tomography (SPET) has been reported to be useful in the differentiation of benign from malignant conditions. Here we report our experience with bone SPET in the diagnosis of vertebral metastases. This is a retrospective study of technetium-99m methylene diphosphonate (MDP) bone scans in 174 consecutive patients who were referred for the investigation of back pain in our department. MDP planar and SPET images were obtained. Of teh 174 patients, 98 had a known history of malignant tumours. The diagnosis of vertebral metastasis was made on the basis of the patients' clinical histories and the findings with other imaging techniques such as magnetic resonance imaging, computed tomography or follow-up bone scan. We found that the presence of pedicle involvement as seen on SPET was an accurate diagnostic criterion of vertebral metastasis. SPET had a sensitivity of 87%, a specificity of 91%, a positive predictive value of 82%, a negative predictive value of 94% and an accuracy of 90%. On the other hand, planar study had a sensitivity of 74%, a specificity of 81%, a positive predictive value of 64%, a negative predictive value of 88% and an accuracy of 79% in diagnosing vertebral metastasis. Except with regard to the negative predictive value, SPET performed statistically better than planar imaging. Only 9/147 (6.4%) lesions involving the vertebral body alone and 3/49 (6.1%) lesions involving facet joints alone were subsequently found to be metastases. We conclude that bone SPET is an accurate diagnostic test for the detection of vertebral metastases and is superior to planar imaging in this respect.
Objective: Ultrasound-guided percutaneous insertion of a long-term tunneled central venous catheter (TCVC) is now a very common procedure, but catheter-related sepsis remains a significant problem. This study aims to review our results concerning this complication. Methodology: Fifty-seven central venous catheters were inserted into 50 patients percutaneously under ultrasound guidance in Queen Elizabeth hospital for between 1 March 2003 and 30 April 2004. Data was retrospectively collected and analysed from hospital records. Results: This study had a successful placement rate of 100%. The overall complication rate was 31% (18 out of 57), comprised of four mechanical complications (all occurring within 30 days of insertion). There was no complication documented within the first 24 h. Fourteen patients developed infective complications, and of these eight patients were classified as catheter-related sepsis, all requiring premature removal of their catheters. There were in total 6161 catheter days, with the incidence rate of catheter-related sepsis of 1.2 per 1000 catheter days. The infecting organisms were heterogeneous, with the majority being Gram-positive cocci (47%). Our study found that patients who developed neutropaenia within 30 days after insertion were significantly associated with catheter-related sepsis ( P < 0.05). Conclusion: Insertion of TCVC under ultrasound guidance is a safe method with a high success rate. Incidence of catheter-related sepsis of TCVC under percutaneous guidance was comparable to the open method. Neutropaenia developing within 30 days after ultrasound-guided percutaneous insertion of central venous catheter may be associated with increased risk of catheter-related sepsis.
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