13 results on '"Phillip H. Kuo"'
Search Results
2. Exploratory Assessment of K-means Clustering to Classify 18F-Flutemetamol Brain PET as Positive or Negative
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Sandra E. Black, Vincent Gaudet, Maria Carmela Tartaglia, Corinne E. Fischer, Neil Vasdev, Mario Masellis, Sanjeev Kumar, Sabrina Adamo, Katherine Zukotynski, Morris Freedman, Aparna Bhan, Benjamin Lam, Christopher J.M. Scott, Anthony E. Lang, Phillip H. Kuo, and David F. Tang-Wai
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Male ,Amyloid ,medicine.medical_specialty ,Neurocognitive Disorders ,Audiology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Image Processing, Computer-Assisted ,Cluster Analysis ,Humans ,Medicine ,Dementia ,Radiology, Nuclear Medicine and imaging ,Spectrum disorder ,Benzothiazoles ,Aged ,Retrospective Studies ,Aged, 80 and over ,Aniline Compounds ,business.industry ,k-means clustering ,Brain ,General Medicine ,Middle Aged ,medicine.disease ,Positron-Emission Tomography ,030220 oncology & carcinogenesis ,Female ,Observational study ,Alzheimer's disease ,CRITERION STANDARD ,business ,Neurocognitive - Abstract
Rationale We evaluated K-means clustering to classify amyloid brain PETs as positive or negative. Patients and methods Sixty-six participants (31 men, 35 women; age range, 52-81 years) were recruited through a multicenter observational study: 19 cognitively normal, 25 mild cognitive impairment, and 22 dementia (11 Alzheimer disease, 3 subcortical vascular cognitive impairment, and 8 Parkinson-Lewy Body spectrum disorder). As part of the neurocognitive and imaging evaluation, each participant had an 18F-flutemetamol (Vizamyl, GE Healthcare) brain PET. All studies were processed using Cortex ID software (General Electric Company, Boston, MA) to calculate SUV ratios in 19 regions of interest and clinically interpreted by 2 dual-certified radiologists/nuclear medicine physicians, using MIM software (MIM Software Inc, Cleveland, OH), blinded to the quantitative analysis, with final interpretation based on consensus. K-means clustering was retrospectively used to classify the studies from the quantitative data. Results Based on clinical interpretation, 46 brain PETs were negative and 20 were positive for amyloid deposition. Of 19 cognitively normal participants, 1 (5%) had a positive 18F-flutemetamol brain PET. Of 25 participants with mild cognitive impairment, 9 (36%) had a positive 18F-flutemetamol brain PET. Of 22 participants with dementia, 10 (45%) had a positive 18F-flutemetamol brain PET; 7 of 11 participants with Alzheimer disease (64%), 1 of 3 participants with vascular cognitive impairment (33%), and 2 of 8 participants with Parkinson-Lewy Body spectrum disorder (25%) had a positive 18F-flutemetamol brain PET. Using clinical interpretation as the criterion standard, K-means clustering (K = 2) gave sensitivity of 95%, specificity of 98%, and accuracy of 97%. Conclusions K-means clustering may be a powerful algorithm for classifying amyloid brain PET.
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- 2021
3. Pearls and Pitfalls of Quantitative Software Analysis of Dopamine Transporter SPECT
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Raza Mushtaq, Phillip H. Kuo, Matthew D. Kay, Devdutta Warhadpande, and Laura Steinmeyer
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Male ,Striatal dopamine ,Nortropanes ,Head tilt ,Visual interpretation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Parkinsonian Disorders ,Image Processing, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Software analysis pattern ,Aged ,Dopamine transporter ,Tomography, Emission-Computed, Single-Photon ,Dopamine Plasma Membrane Transport Proteins ,biology ,business.industry ,Parkinsonism ,Dopaminergic ,General Medicine ,Middle Aged ,medicine.disease ,030220 oncology & carcinogenesis ,biology.protein ,Female ,Artifacts ,business ,Neuroscience ,Software - Abstract
Dopamine transporter SPECT with I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane (I-ioflupane) aids in the diagnosis of parkinsonian syndrome by demonstrating loss of striatal dopamine transporters, proportional to nigrostriatal dopaminergic neuronal loss. Quantitative software analysis (QSA) is a helpful adjunct to visual interpretation. An atlas of pearls and pitfalls of QSA is presented. Examples include correction for head tilt/orientation, scaling artifacts, and detection of balanced loss of activity. Additional examples are provided where QSA can potentially fail such as patient variation and vascular disease.
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- 2020
4. 99mTc-Sestamibi Scintigraphy Reveals Parathyroid Adenoma Masquerading as Esophageal Diverticulum
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Lilah F. Morris-Wiseman, Matthew D. Kay, Phillip H. Kuo, Blair A. Winegar, and Justin S. Caskey
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Technetium Tc 99m Sestamibi ,medicine.medical_specialty ,Single Photon Emission Computed Tomography Computed Tomography ,Paraesophageal ,Context (language use) ,Scintigraphy ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Aged ,Parathyroid adenoma ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Esophageal diverticulum ,Killian–Jamieson diverticulum ,Parathyroid Neoplasms ,030220 oncology & carcinogenesis ,Diverticulum, Esophageal ,Female ,Radiology ,business ,Primary hyperparathyroidism ,Diverticulum - Abstract
A 74-year-old woman with primary hyperparathyroidism diagnosed from routine laboratory tests described symptoms of fatigue and difficulty with concentration. During surgical consultation, the cervical and thoracic spine MRI scans from the preceding 10-year period, performed for relapsing-remitting multiple sclerosis, were reviewed. In this clinical context, the slowly enlarging left upper paraesophageal lesion, reported as a lateral proximal esophageal (Killian-Jamieson) diverticulum, was reevaluated for a potential parathyroid adenoma. 99mTc-sestamibi SPECT/CT demonstrated focal uptake in the paraesophageal lesion with surgical resection, confirming it to be a large parathyroid adenoma.
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- 2020
5. The Use of Random Forests to Classify Amyloid Brain PET
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Jean-Paul Soucy, Alexander Thiel, Howard Chertkow, Robert Laforce, Katherine Zukotynski, Vincent Gaudet, Robin Hsiung, Vesna Sossi, Maged Goubran, Eric E. Smith, Sandra E. Black, Demetrios J. Sahlas, Christian Bocti, Michael Borrie, Frank S. Prato, Sabrina Adamo, Jean-Claude Tardif, Richard Frayne, Michael D. Noseworthy, Christopher J.M. Scott, and Phillip H. Kuo
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Male ,Amyloid ,Neuroimaging ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Alzheimer Disease ,mental disorders ,Image Processing, Computer-Assisted ,Humans ,Medicine ,Cognitive Dysfunction ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Aged ,Aged, 80 and over ,Aniline Compounds ,business.industry ,Brain ,Pattern recognition ,General Medicine ,Middle Aged ,Random forest ,Data set ,Amyloid deposition ,Positron-Emission Tomography ,030220 oncology & carcinogenesis ,Ethylene Glycols ,Female ,Supervised Machine Learning ,Artificial intelligence ,business - Abstract
To evaluate random forests (RFs) as a supervised machine learning algorithm to classify amyloid brain PET as positive or negative for amyloid deposition and identify key regions of interest for stratification.The data set included 57 baseline F-florbetapir (Amyvid; Lilly, Indianapolis, IN) brain PET scans in participants with severe white matter disease, presenting with either transient ischemic attack/lacunar stroke or mild cognitive impairment from early Alzheimer disease, enrolled in a multicenter prospective observational trial. Scans were processed using the MINC toolkit to generate SUV ratios, normalized to cerebellar gray matter, and clinically read by 2 nuclear medicine physicians with interpretation based on consensus (35 negative, 22 positive). SUV ratio data and clinical reads were used for supervised training of an RF classifier programmed in MATLAB.A 10,000-tree RF, each tree using 15 randomly selected cases and 20 randomly selected features (SUV ratio per region of interest), with 37 cases for training and 20 cases for testing, had sensitivity = 86% (95% confidence interval [CI], 42%-100%), specificity = 92% (CI, 64%-100%), and classification accuracy = 90% (CI, 68%-99%). The most common features at the root node (key regions for stratification) were (1) left posterior cingulate (1039 trees), (2) left middle frontal gyrus (1038 trees), (3) left precuneus (857 trees), (4) right anterior cingulate gyrus (655 trees), and (5) right posterior cingulate (588 trees).Random forests can classify brain PET as positive or negative for amyloid deposition and suggest key clinically relevant, regional features for classification.
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- 2019
6. Recurrent Osteosarcoma Presenting as an Isolated Bone Marrow Relapse
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Lisa M. Kopp, Brandon T. Larsen, Phillip H. Kuo, Lee D. Cranmer, and Julia Liu
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0301 basic medicine ,Malignant bone tumor ,medicine.medical_specialty ,Recurrent osteosarcoma ,Adolescent ,Pancytopenia ,Diagnosis, Differential ,Proto-Oncogene Proteins p21(ras) ,03 medical and health sciences ,Distal femur ,Fatal Outcome ,0302 clinical medicine ,Neoplasm Recurrence ,stomatognathic system ,Bone Marrow ,Recurrence ,Humans ,Initial treatment ,Medicine ,Osteosarcoma ,business.industry ,Hematology ,medicine.disease ,Jaw Neoplasms ,Surgery ,stomatognathic diseases ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Female ,Bone marrow ,Neoplasm Recurrence, Local ,Bone Marrow Neoplasms ,business - Abstract
Osteosarcoma (OS) is a malignant bone tumor which is found primarily in adolescents, with the distal femur as the most common location. OS with a jaw primary is present in only about 10% of cases and the risk of recurrence is considered to be decreased in the jaw versus other primary locations. We present a unique case of a patient with localized OS of the jaw with an isolated recurrence in her bone marrow almost 5 years after completion of initial treatment.
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- 2017
7. 18F-FDG PET/CT for Monitoring Response of Merkel Cell Carcinoma to the Novel Programmed Cell Death Ligand 1 Inhibitor Avelumab
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Phillip H. Kuo, Tamara F. Lundeen, Naghmehossadat Eshghi, Ryan Avery, and Lea MacKinnon
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Male ,medicine.medical_specialty ,Skin Neoplasms ,medicine.medical_treatment ,Antineoplastic Agents ,Active immunotherapy ,Antibodies, Monoclonal, Humanized ,030218 nuclear medicine & medical imaging ,Programmed cell death ligand 1 ,Avelumab ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged, 80 and over ,Chemotherapy ,business.industry ,Merkel cell carcinoma ,Antibodies, Monoclonal ,General Medicine ,Immunotherapy ,medicine.disease ,Carcinoma, Merkel Cell ,Radiation therapy ,030220 oncology & carcinogenesis ,Fdg pet ct ,Radiology ,Radiopharmaceuticals ,business ,medicine.drug - Abstract
An 85-year-old man with stage IIIA Merkel cell carcinoma of the left arm was initially treated with local excision and axillary node dissection followed by radiation therapy. Eight months after surgery, whole-body FDG PET/CT demonstrated intensely hypermetabolic hepatic metastases and abdominal lymphadenopathy. Given his age and comorbidities, he was considered a poor candidate for chemotherapy, and therefore the novel programmed cell death ligand 1 inhibitor avelumab was initiated. FDG PET/CT after 4 cycles showed complete resolution of hepatic and nodal metastases. Whole-body FDG PET/CT can be used for monitoring response of multisystem metastases from Merkel cell carcinoma to active immunotherapy.
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- 2018
8. Dynamic Adaptation of Tumor Immune Response With Nivolumab Demonstrated by 18F-FDG PET/CT
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Phillip H. Kuo, Tamara F. Lundeen, and Naghmehossadat Eshghi
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medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,Adenocarcinoma of Lung ,Adenocarcinoma ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,medicine ,Axillary Lymphadenopathy ,Humans ,Radiology, Nuclear Medicine and imaging ,Neoplasm Metastasis ,Lung cancer ,PET-CT ,Lung ,business.industry ,Antibodies, Monoclonal ,General Medicine ,Immunotherapy ,Middle Aged ,medicine.disease ,Adaptation, Physiological ,Nivolumab ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Radiology ,business - Abstract
A 61-year-old woman with lung adenocarcinoma failed first-line treatment and was placed on immunotherapy with nivolumab. FDG-PET/CT before immunotherapy showed metastases to thoracic nodes, liver, adrenal gland, and skeleton. Seven weeks after starting nivolumab, FDG-PET/CT showed mild residual activity in thoracic nodes and otherwise complete response. After 15 weeks, enlarged and FDG-avid axillary lymphadenopathy and worsening supraclavicular lymphadenopathy developed. After 20 weeks, FDG-PET/CT demonstrated marked improvement of axillary and supraclavicular lymphadenopathy. This case demonstrates that later progression of disease can still respond to continuing immunotherapy, hypothetically because of dynamic adaptations in the tug-of-war between the immunotherapy-augmented immune system and tumor.
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- 2018
9. 'Occipital Tunnel' Sign on FDG PET for Differentiating Dementias
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David M. Sawyer and Phillip H. Kuo
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Pathology ,medicine.medical_specialty ,Occipital region ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,mental disorders ,medicine ,Humans ,Dementia ,Radiology, Nuclear Medicine and imaging ,Dementia with Lewy bodies ,business.industry ,Posterior cortical atrophy ,Biological Transport ,General Medicine ,medicine.disease ,Positron-Emission Tomography ,Occipital Lobe ,Alzheimer's disease ,business ,030217 neurology & neurosurgery ,Sign (mathematics) - Abstract
PET using FDG is a critical tool for evaluation of dementias, with characteristic patterns of hypometabolism suggesting specific diagnoses. Hypometabolism in the occipital region is recognized as an important finding associated with dementia with Lewy bodies and posterior cortical atrophy. We describe here the novel "occipital tunnel" sign, which results from relative sparing of FDG uptake in the medial occipital (primary visual) cortex compared with more severe loss in the surrounding lateral occipital (visual association) cortex. This sign is useful for recognizing the occipital findings of dementia with Lewy bodies and posterior cortical atrophy, especially when viewing sagittal projections.
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- 2018
10. Optimal Time Points for Scintigraphic Imaging of Pleuroperitoneal Shunts
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Phillip H. Kuo, Gagandeep Choudhary, Elizabeth A. Krupinski, Matthew F. Covington, and Ryan Avery
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Pleural effusion ,Pleuroperitoneal ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Child ,Radionuclide Imaging ,Aged ,Retrospective Studies ,Pleural Cavity ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,Thorax ,Pleural cavity ,Time optimal ,medicine.disease ,Pleuroperitoneal shunt ,Pleural Effusion ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Scintigraphic imaging ,Female ,Radiology ,business ,Shunt (electrical) - Abstract
OBJECTIVE Nuclear imaging can confirm pleuroperitoneal shunt as the cause of pleural effusion. No society guidelines exist for scintigraphic pleuroperitoneal shunt detection. Our institutional protocol was evaluated to determine optimal imaging time points for shunt detection. METHODS Pleuroperitoneal shunt studies over 4 years were blindly reviewed by 2 nuclear radiologists. Data from blinded review included presence or absence of pleuroperitoneal shunt, laterality of shunt and time points for shunt detection. RESULTS Chart review yielded 30 studies. Three cases were excluded because of improper injection. Imaging was positive for pleuroperitoneal shunt in 81% (22/27) of cases. In positive cases, activity was identified in the right hemithorax in 82% (18/22), left hemithorax in 9% (2/22), and bilaterally in 9% (2/22). One-hour imaging demonstrated 91% (20/22) of positive cases. The remaining 2 positive cases were negative at 1 hour but positive after 4 hours. No study was negative at 1 and 4 hours and positive at 24 hours. All negative cases (5/27) were confirmed on 24-hour imaging. CONCLUSIONS The majority of positive pleuroperitoneal shunt examinations will demonstrate activity in the right hemithorax on 1-hour imaging. Although no case was negative at 1 and 4 hours and positive at 24 hours, imaging at 24 hours may still be necessary to confirm absence of shunt. Therefore, optimal imaging time points consist of early 1-hour and delayed 24-hour images if the 1-hour time point was negative. The 4-hour time point may be considered optional, thereby potentially optimizing patient safety and resource utilization.
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- 2016
11. Imaging of Systemic Mastocytosis by FDG-PET/CT Demonstrates Increased Activity in Cortical Bone
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Phillip H. Kuo, James C. McEachen, and Roger T. Tomihama
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Male ,Pathology ,medicine.medical_specialty ,Axial skeleton ,Appendicular skeleton ,Bone and Bones ,Osteosclerosis ,Mastocytosis, Systemic ,Fluorodeoxyglucose F18 ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Systemic mastocytosis ,Fluorodeoxyglucose ,PET-CT ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Positron emission tomography ,Positron-Emission Tomography ,Cortical bone ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,business ,medicine.drug - Abstract
A patient with systemic mastocytosis underwent a FDG-PET/CT scan. CT demonstrated loss of corticomedullary differentiation in the axial skeleton and thickening of cortical bone in the appendicular skeleton consistent with myelofibrosis and osteosclerosis. Remarkably, the bones of the lower
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- 2008
12. 18F Sodium Fluoride PET/CT Detects Osseous Metastases From Breast Cancer Missed on FDG PET/CT With Marrow Rebound
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Phillip H. Kuo and Ryan Avery
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musculoskeletal diseases ,Fluorine Radioisotopes ,medicine.medical_specialty ,medicine.medical_treatment ,Bone Neoplasms ,Breast Neoplasms ,chemistry.chemical_compound ,Breast cancer ,Fluorodeoxyglucose F18 ,Sodium fluoride ,medicine ,Humans ,Whole Body Imaging ,Radiology, Nuclear Medicine and imaging ,Pelvis ,Aged ,Chemotherapy ,PET-CT ,Rib cage ,Osteoblasts ,business.industry ,General Medicine ,musculoskeletal system ,medicine.disease ,medicine.anatomical_structure ,chemistry ,Positron-Emission Tomography ,Sodium Fluoride ,Female ,Fdg pet ct ,Bone marrow ,Radiology ,Tomography, X-Ray Computed ,Nuclear medicine ,business - Abstract
Intense FDG uptake by bone marrow following recent chemotherapy limits evaluation for osseous metastases. The impact of marrow rebound on accuracy of (18)F-fluoride PET/CT is unclear. A 73-year-old woman with breast cancer presented for restaging FDG PET/CT, which showed intense activity throughout almost the entire axial skeleton and no osseous metastases. An (18)F-fluoride PET/CT performed 7 days later identified multiple osseous metastases in the spine, ribs, and pelvis. This case demonstrates that (18)F-fluoride PET/CT should be considered for the evaluation of osseous metastases in patients with rebound marrow uptake on FDG PET/CT.
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- 2013
13. Diagnosis of Septic Joint in an Immunosuppressed Patient by Twenty-Four Hour Delayed Imaging with Tc-99m HMPAO Labeled White Blood Cell Scan
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David Cheng, Phillip H. Kuo, and Rahat Sadar
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Male ,Leukocyte migration ,Pathology ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Burkholderia cepacia ,White blood cell scan ,Technetium Tc 99m Exametazime ,Shoulder Pain ,White blood cell ,Leukocytes ,medicine ,Humans ,Delayed imaging ,Radiology, Nuclear Medicine and imaging ,Radionuclide Imaging ,Arthritis, Infectious ,Shoulder Joint ,business.industry ,Arthrocentesis ,Burkholderia Infections ,General Medicine ,Middle Aged ,medicine.disease ,Lymphoma ,medicine.anatomical_structure ,Bacteremia ,Radiopharmaceuticals ,business - Abstract
A 64-year-old male with a history of allogeneic bone marrow transplantation for lymphoma 10 months earlier presented for evaluation of bacteremia. The white blood cell count was 4,400 cells/microliter with 76% neutrophils. A tagged white blood cell scan was performed to localize the infection. Images obtained 4 hours postinjection of radiolabeled leukocytes displayed no focus of infection, but delayed 24-hour images demonstrated the interval development of markedly increased activity in the left shoulder. Arthrocentesis yielded purulent fluid. We hypothesize that delayed leukocyte migration in this immunosuppressed patient might have accounted for the significant disparity between the standard and delayed scans.
- Published
- 2005
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