A 69-year-old woman with multiple myeloma came to our department for F-FDG PET/CT scan for routine surveillance. The patient denied any history of fever, cough, shortness of breath, or body aches. F-FDG PET/CT scan from vertex to knees was performed. PET/CT images revealed extensive peripheral ground-glass opacities showing intense FDG uptake (SUVmax 12) involving bilateral lower lobes. Possibility of an infective etiology including novel coronavirus (COVID-19) infection was raised. The patient's oropharyngeal swab for COVID-19 by polymerase chain reaction amplification test came back positive for COVID-19 infection. The patient and her husband were advised home quarantine for 14 days.
When gallium citrate is injected intravenously the gallium is rapidly transchelated to transferrin. If the stability of the gallium-transferrin association is sufficiently strong it should be a good macromolecular tracer suitable for quantitative measurements of vascular permeability. Studies of the stability of the gallium transferrin complex in human plasma and serum were done using ultrafiltration and dialysis. It was found that the stability was sensitive to bicarbonate level. Above 13 mM of bicarbonate, 97%-99% of the gallium is bound to molecules greater than 10,000 MW by ultrafiltration. However, at 10 mM binding is 95% and at 7 mM 83%. Similar results were obtained with dialysis. This suggests the gallium-transferrin complex may not be sufficiently stable for quantitative measures of vascular permeability, particularly if the bicarbonate concentration is low.
From the Departments of Radiology (Division of Nuclear Medicine), University of Iowa Hospitals and Clinics,† Iowa City, Iowa, and Rush Presbyterian St. Luke’s Medical Center,* Chicago, Illinois Received for publication September 27, 2001. Revision accepted October 7, 2002. Reprint requests: Michael M. Graham, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1077. E-mail: [email protected]
Localization of inflammation with two recently described radiotracers, 111In-labelled polyclonal IgG and 99Tcm albumin colloid labelled leukocytes (Tc-WBC), was studied. Accumulation of activity was compared with lllIn-labelled leukocytes (In-WBC) using 131I human serum albumin as a control. Ratios of activity in a chemically induced abscess in the thigh of rabbits compared with normal muscle tissue were measured. The results showed that all agents localize in inflammation but Tc-WBC consistently localizes to a greater degree than the other agents. At 2 h the inflammed-to-normal ratios for Tc-WBC were 4, IgG 2.1, albumin 1.9 and In-WBC 1.7. The pattern of the ratios remained similar over the 18 h period of the study. The short time in which leukocytes can be labelled and the quality of the images obtained suggest that Tc-WBC imaging is the method of choice for this model.
—To assess the safety and efficacy of optic nerve decompression surgery compared with careful follow-up alone in patients with nonarteritic anterior ischemic optic neuropathy (NAION).
Design.
—The Ischemic Optic Neuropathy Decompression Trial (IONDT) is a randomized, single-masked, multicenter trial.
Setting.
—Twenty-five US clinical centers.
Participants.
—The IONDT ceased recruitment on October 20, 1994, on the recommendation of its Data and Safety Monitoring Committee. The preliminary results presented herein are based on data as of September 8,1994, from 244 patients with NAION and visual acuity of 20/64 or worse. One hundred twenty-five patients had been randomized to careful follow-up, and 119 had been randomized to surgery, with 91 and 95, respectively, having completed 6 months of follow-up.
Intervention.
—Patients in the surgery group received optic nerve decompression surgery and follow-up ophthalmologic examinations; those in the careful follow-up group received ophthalmologic examinations at the same times as the surgery group.
Main Outcome Measures.
—Gain or loss of three or more lines of visual acuity on the New York Lighthouse chart at 6 months after randomization, as measured by a technician masked to treatment assignment.
Results.
—Patients assigned to surgery did no better when compared with patients assigned to careful follow-up regarding improved visual acuity of three or more lines at 6 months: 32.6% of the surgery group improved compared with 42.7% of the careful follow-up group. The odds ratio (OR) for three or more lines better, adjusted for baseline visual acuity and diabetes, was 0.74 (95% confidence interval [CI], 0.39 to 1.38). Patients receiving surgery had a significantly greater risk of losing three or more lines of vision at 6 months: 23.9% in the surgery group worsened compared with 12.4% in the careful follow-up group. The 6-month adjusted OR for three or more lines worse was 1.96 (95% CI, 0.87 to 4.41). No difference in treatment effect was observed between patients with progressive NAION and all others.
Conclusion.
—Results from the IONDT indicate that optic nerve decompression surgery for NAION is not effective, may be harmful, and should be abandoned. The spontaneous improvement rate is better than previously reported. (JAMA. 1995;273:625-632)
To assess vascular permeability in intracerebral grafts of the 36B-10, F-344 rat glioma following 20 Gy137 Cs whole brain irradiation, the blood-to-tissue transport constant, K, of $[{}^{14}{\rm C}...
Neurolymphomatosis (NL) is a rare condition associated with lymphomas in which various structures of the nervous system are infiltrated by malignant lymphocytes. Rarely, it may be the presenting feature of recurrence of lymphoma otherwise deemed to be in remission. It is crucial, as is the case with all types of nodal or visceral involvement of lymphoma, to identify the disease early and initiate treatment with chemotherapy and/or radiation therapy. Positron emission tomography-computed tomography (PET-CT) has been shown to be a sensitive modality for staging, restaging, biopsy guidance, therapy response assessment, and surveillance for recurrence of lymphoma. Magnetic resonance imaging (MRI) is another useful imaging modality, which, along with PET/CT, compliment cerebrospinal spinal fluid (CSF) cytology and electromyography (EMG) in the diagnosis of NL. Performing nerve biopsies to confirm neurolymphomatosis can be challenging and with associated morbidity. The case presented herein illustrates the practical usefulness of these tests in detecting NL as a heralding feature of lymphoma recurrence, especially in the absence of histopathologic correlation.
