FIGURE 1 - uploaded by Christopher J. Palestro
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Radionuclide angiogram (4 sec per image) of posterior pelvis. Note intense uterine blush cephalad to urinary bladder
Source publication
Bone and gallium scintigraphy were performed as part of the diagnostic workup of a 21-yr-old woman who presented at our institution with a history of progressively worsening low back pain over a 1-wk period of time. The angiographic phase of the bone scan demonstrated a well-defined radionuclide blush within the pelvis just cephalad to the urinary...
Context in source publication
Context 1
... of technetium-99m methylene diphos phonate ([99mTcIMDP) A large field-of-view gamma cam era equipped with a 3/8 in. Nal (TI) crystal, and a high resolution parallel hole, low-energy collimator were em ployed. The angiographic phase of the study demonstrated a well-defined radionuclide blush within the pelvis just cepha lad to the urinary bladder (Fig. 1). Persistent hyperemia in this region was noted on the blood-pool image (Fig. 2). De layed osseous images were interpreted as normal, with the exception of some extrinsic compression upon the dome of the Received May 14, 1985;revision accepted Nov. 7, 1985. In our own case, we attribute the angiographic blush to the pronounced uterine ...
Citations
... Palestro et al. published the incidental diagnosis of pregnancy on Tc-99m MDP and Ga-67 citrate scans of a pregnant patient who was under evaluation for low back pain and discussed the estimated fetal radiation doses from these scans (15). ...
Although it is extremely rare, nuclear imaging of a pregnant woman presents a unique challenge to the nuclear medicine physician because of the high concern for radiation risk to the embryo or the fetus. This challenge has been exacerbated due to recent heightened public concern of medical procedures involving radiation. This awareness also has been emphasized to the referring physicians to the extent that the risks of most nuclear medicine scans are overstressed relative to the benefit. Radionuclide procedures are reluctantly ordered by clinicians in pregnant patients, because of the malpractice fear or because of uncertainty regarding fetal radiation dose. However, when used appropriately, the benefits of nuclear imaging procedures usually outweigh the minimal risks associated with small amount of radiation even in pregnant patients.
Conflict of interest:None declared.
... 24 In addition, another report presenting a 21-year-old woman, who also underwent bone scan following the same radionuclide injection at 16 weeks of gestation, suggests that there is no fetal uptake. 25 However, a report on the cases of 2 pregnant women with malignant tumors showed direct skeletal fetal and placental uptake of radionuclide at 30 and 32 weeks of gestation. None of the children presented adverse effects. ...
Objective:
The unique pharmacokinetics of bisphosphonates (BPs) in conjunction with their use by an increasing number of women at reproductive age has raised serious concerns about their safety during pregnancy and lactation. Bisphosphonates cross the placenta. Animal studies have shown adverse effects on both the fetus and the mother, mostly at doses much higher than those commonly used in humans. Protracted parturition, maternal mortality, embryolethality, severe general underdevelopment and marked skeletal retardation of the fetuses (increased amount of diaphyseal bone trabeculae, decreased diaphyseal length), small fetal weight and abnormal tooth growth have been observed.
Design:
We conducted a thorough research of the literature in order to identify human studies concerning this issue.
Results:
We identified a total of 78 cases involving fetuses whose mothers had been exposed to BPs before conception or during pregnancy, along with 7 cases of BPs exposure prior to or during lactation. The vast majority of mothers and infants did not demonstrate serious adverse effects. However, there were cases of shortened gestational age, low neonatal birth weight and transient hypocalcaemia of the newborns, while the very few reported cases of spontaneous abortions and congenital anomalies probably resulted from maternal underlying diseases and concomitant medication.
Conclusion:
The administration of bisphosphonates in pregnancy should be assessed in view of their potential hazardous effects on both mother and fetus. In cases of absolute or relative indications of BPs prior to pregnancy, close observation of the mother and the infant, especially during the first two weeks of life, is imperative for the successful outcome of pregnancy.
... 24 In addition, another report presenting a 21-year-old woman, who also underwent bone scan following the same radionuclide injection at 16 weeks of gestation, suggests that there is no fetal uptake. 25 However, a report on the cases of 2 pregnant women with malignant tumors showed direct skeletal fetal and placental uptake of radionuclide at 30 and 32 weeks of gestation. None of the children presented adverse effects. ...
• ABSTRACT The unique pharmacokinetics of bisphosphonates (BPs) in conjunction with their use by an increasing number of women at reproductive age has raised serious concerns about their safety during pregnancy and lactation. Bisphosphonates cross the placenta. Animal studies have shown adverse effects on both the fetus and the mother, mostly at doses much higher than those commonly used in humans. Protracted parturition, maternal mortality, embryolethality, severe general underdevelopment and marked skeletal retardation of the fetuses (increased amount of diaphyseal bone trabeculae, decreased diaphyseal length), small fetal weight and abnormal tooth growth have been observed.
We conducted a thorough research of the literature in order to identify human studies concerning this issue.
We identified a total of 78 cases involving fetuses whose mothers had been exposed to BPs before conception or during pregnancy, along with 7 cases of BPs exposure prior to or during lactation. The vast majority of mothers and infants did not demonstrate serious adverse effects. However, there were cases of shortened gestational age, low neonatal birth weight and transient hypocalcaemia of the newborns, while the very few reported cases of spontaneous abortions and congenital anomalies probably resulted from maternal underlying diseases and concomitant medication.
The administration of bisphosphonates in pregnancy should be assessed in view of their potential hazardous effects on both mother and fetus. In cases of absolute or relative indications of BPs prior to pregnancy, close observation of the mother and the infant, especially during the first two weeks of life, is imperative for the successful outcome of pregnancy.
Despite dramatic advances in its prevention and treatment, infection remains a major cause of morbidity in children, accounting for approximately 30 % of childhood deaths worldwide (Children's Infection Defense Center, St. Jude Children's Research Hospital, 2004). The development of powerful antimicrobial agents has improved patient survival, but timely diagnosis is equally, if not more, important. In adults, most infections can be diagnosed with a thorough history, a complete physical examination, and appropriate laboratory tests. In the pediatric population, unfortunately, this is a difficult task. Children do not, or will not, verbalize their feelings, and often the history is little more than secondhand information obtained from a parent. The physical examination of an ailing child can be difficult, if not impossible. Further complicating matters is the fact that conditions such as vasculitis and other inflammatory diseases can mimic infection. Consequently, empiric treatment with antibiotics, which may be neither appropriate nor effective, often is instituted. Imaging procedures usually are reserved for those patients in whom symptoms or physical findings point to a specific region of the body. Because of concerns about radiation exposure, pediatricians tend to utilize radionuclide imaging only as a last recourse after all other resources have been exhausted. The nuclear physician often is faced with the formidable task of diagnosing and localizing infection and inflammation late in the course of an illness when an expeditious and correct diagnosis is even more critical. © 2014 Springer Science+Business Media New York. All rights reserved.
Despite dramatic advances in its prevention and treatment, infection remains a major cause of morbidity in children, accounting for approximately 30% of childhood deaths worldwide.1 The development of powerful antimicrobial agents has improved patient survival, but timely diagnosis is equally, if not more, important. In adults, most infections can be diagnosed with a thorough history, a complete physical examination, and appropriate laboratory tests. In the pediatric population, unfortunately, this is a difficult task. Children do not, or will not, verbalize their feelings, and the history is often little more than secondhand information obtained from a parent. The physical examination of an ailing child can be difficult, if not impossible. Further complicating matters is the fact that inflammatory conditions such as vasculitis and inflammatory disease may mimic infection. Consequently, empiric treatment with antibiotics, which may be neither appropriate nor effective, is often instituted. Imaging procedures are usually reserved for those patients in whom symptomatology or physical findings point to a specific region of the body.
A 48-year-old illiterate woman who is congenitally deaf and mute underwent F-NaF PET/CT study to evaluate bone metastases from newly diagnosed breast cancer. Unexpectedly, a fetus in early second trimester was noted on CT images. In addition, subtle F-NaF uptake by the fetus could also be observed.
A 6-month pregnant 35-year-old woman with hematemesis and dark blood in her stool was evaluated for location of an active gastrointestinal bleeding site. The findings from 2 esophagogastroduodenoscopies and a colonoscopy were negative. The patient was referred for a Tc-99m red blood cell scintigraphy, for location of an active bleeding site. As the patient was 6 months pregnant, the necessity of the case was discussed with the patient's referring physician and after determining that this study was necessary, the risk of radiation exposure to the fetus was discussed with the radiation safety officer and the patient. The procedure was performed after the patient signed informed consent regarding the considerations of radiation safety to the fetus. The Tc-99m red blood cell bleeding scan clearly shows activity in the fetus in addition to a large arteriovenous malformation in the patient. The visualized fetus prompted this report to discuss radiation risks concerns and a brief review of indications and guidelines for performing nuclear medicine procedures in pregnant patients.
Gallium-67 citrate and labeled leukocyte imaging are established procedures for diagnosing inflammation and infection. Knowledge of the normal biodistribution of these tracers, variations, and unusual disease presentations improves the accuracy of their interpretation. During the first 24 hours after injection, the principal excretory pathway of gallium is renal; subsequently, excretion is primarily colonic. By 72 hours, approximately 75% remains in the body, equally distributed among soft tissues, liver, and bone/bone marrow. This normal distribution is subject to considerable variation. Nasopharyngeal and lacrimal gland uptake can be prominent. Breast uptake, generally faint and symmetric, is intense in hyperprolactinemic states such as pregnancy. Colonic uptake is very variable. Normally healing surgical incisions concentrate gallium for variable amounts of time. In patients receiving multiple transfusions renal, bladder, and bone activity are increased; liver and colon uptake are decreased. The contrast agent gadolinium exerts similar effects. At 24 hours after injection, the normal biodistribution of indium labeled leukocytes is limited to liver, spleen, and bone marrow. The normal biodistribution of technetium-labeled leukocytes includes, in addition to the reticuloendothelial system, colon, urinary tract, and occasionally gall bladder. Images obtained shortly after injection of labeled leukocytes show intense pulmonary activity, which decreases over time. Except in cystic fibrosis, segmental or lobar pulmonary activity indicates bacterial pneumonia. Diffuse pulmonary uptake is associated with various conditions but rarely with bacterial pneumonia. Labeled leukocytes do not accumulate in surgical wounds that heal by primary intention. They do accumulate in wounds healing by secondary intention, such as ostomies and skin grafts. Because labeled leukocytes accumulate in the bone marrow, complementary bone marrow imaging helps differentiate marrow activity from infection. Labeled leukocyte imaging is not useful for diagnosing spinal osteomyelitis because 50% or more of cases present as nonspecific decreased activity. This test is not useful for diagnosing septic arthritis because labeled leukocytes accumulate in inflammatory, noninfectious arthritis. Nodal uptake in patients with lower extremity joint prostheses produces incongruent white blood cell/marrow images in the absence of infection. Careful attention to uptake patterns minimizes this problem. Radiation effects on bone marrow activity are dramatic. Acutely, there is intense, diffusely increased activity. As inflammation subsides, and marrow becomes fibrotic, the irradiated area appears as decreased activity.
Retention of 99mTc-MDP in the fetal skeleton and placenta at 30 and 32 wk gestation was observed during bone scan examination of the maternal skeleton for staging of malignant tumors. The implications and significance of these observations are discussed.
