Appendix Summary of Indications for Testing

Endocrine system

• Thyroid studies 1231 Uptake and scan Indications

1. Assess goiter 2. Palpable nodules in neck 3. Clinical hypo- or hyperthyroid state 4. Follow progress of thyroiditis 5. History of prior neck irradiation 6. Evaluate substernal mass 7. Pre- and postoperative assessment 8. Postoperative therapy for thyroid carcinoma 9. Evaluate effects of thyroid medications

• TSH stimulation test Permits differentiation of primary and secondary hyper­thyroidism

• T 3 suppression test Evaluation of hot nodules

• Perchlorate washout test Useful in some forms of thyroiditis

INDICATIONS FOR NUCLEAR MEDICINE STUDIES

209

210 I APPENDIX

• Technetium scan Indications

1. Useful in pregnant patients 2. Useful in patients with previous iodine ingestion or

injection 3. May be helpful to differentiate between trapping

and organification dysfunction

• 131 1 whole-body scan Indications

Detection of functioning thyroid carcinoma metastases or residual tumor following thyroidectomy

• 1311 therapy Indications

1. Graves' disease 2. Plummer's disease 3. Thyroid carcinoma

• Adrenal scans Indications

1. Screening procedure after initial history, physical, and preliminary hormonal studies indicate abnor­mality of adrenal gland or ovary prior to more in­vasive and costly procedures

2. Differentiate between micronodular hyperplasia, macronodular hyperplasia, adenoma, and carcino­ma in patients with low-renin hypertension

3. Aid in diagnosis of diminished function of one adre­nal gland

4. Detect postoperative remnants following adrenalec­tomy

5. Screening procedure to detect source of androgen in women who have masculine secondary sex charac­teristics

6. Lateralization of pheochromocytoma now done by computerized tomography (CT)

7. Patients in whom the adrenal vein is technically difficult to catheterize

8. Allergy to iodinated contrast precluding vascular studies

CT is the procedure of choice for detecting adrenal masses, but these are nonspecific in nature. Nuclear adrenal scanning will aid in determination of the actual pathology owing to the physiologic nature of the study.

Bone and joint scans

Indications 1. Radiographically occult fractures following trau­

ma (stress fractures, may be important medicole­gally)

2. Primary bone neoplasm 3. Localization of osteomyelitis 4. To confirm bone or joint pathology to explain eti­

ology of pain 5. Vascular insult-infarcts, aseptic necrosis, radia­

tion necrosis 6. Staging neoplasms by detection of metastases prior

to and following therapy (most useful in lung, breast, and prostate tumors in adults, neuroblas­toma, leukemia in children)

7. Detect and evaluate the extent of metabolic bone disease (hyperparathyroidism), osteoarthropathies, Paget's disease, etc.

8. Evaluate extent and activity of arthritis as well as results of therapy

9. Detection of extraosseous calcifications (pulmo­nary, splenic, soft tissue, hepatic, cardiac, etc.)

10. Complications of prostheses-loosening or infec­tion

11. Will occasionally demonstrate gross pathology of genitourinary tract coincidentally

Bone scans are more sensitive than radiographs in most cases, but are nonspecific necessitating the comparison of scans with radiographs of symptomatic areas or positive regions on the scan.

Gallium scans

Indications 1. Abscess detection and localization 2. Tumor localization and staging-specifically good

for lymphoma (Hodgkin's), hepatoma, melanoma, lung and primary bone tumors

3. Response of tumor to therapy and recurrence 4. Benign processes

a. Osteomyelitis b. Sarcoid c. Tuberculosis-active d. Gall bladder empyema e. Acute pyelonephritis

APPENDIX I 211

212 I APPENDIX

Genitourinary

Indications

1. Determine vascularity of known renal masses 2. Detection of renovascular hypertension

• Renal function (renogram) Indications

1. Quantitative analysis and comparison of bilateral renal function secondary to various disease pro­cesses (obstruction, trauma, infection, metabolic disorders, etc.)

2. Diuretic function study-to distinguish between ureteral stasis and actual obstruction

• Renal architecture Indications

1. Congenital malformations 2. Mass lesions detection (tumor, trauma, column of

Bertin) 3. Renal infarct detection 4. Patients allergic to iodinated contrast

• Renal transplant scans Indications

1. Renal flow 2. Assess transplant function 3. Complications (acute tubular necrosis, rejection

states, masses, lymphocele, urinoma, hematoma)

• Cystogram (direct and indirect) Indications

1. Computerized quantitation of bladder emptying 2. Vesicoureteral reflux detection (effective in pedi­

atric age group owing to decreased radiation and simplicity)

• Scrotal flow and static scan Indications Distinguish between testicular torsion and acute epididy­mitis

Hematologic procedures

1. Red cell survival 2. Splenic sequestration 3. Red cell mass 4. Blood volume determination 5. Bone marrow scans

Indications 1. Selection of sites for bone marrow aspiration and

biopsy 2. Assessment of myeloproliferative disorders 3. Acute versus chronic anemia 4. Detect focal disease in bone marrow (metastases) 5. Possible aid in staging lymphoma 6. Possible aid in monitoring response to therapy

Gastrointestinal studies: in vivo procedures

• Esophageal studies Indications

1. Detect obstruction 2. Detect small fistulae (more sensitive than barium

study) 3. Peristaltic disorders 4. Detect and quantitate gastrointestinal reflux (more

sensitive than barium swallow, less radiation) 5. Detect ectopic gastric mucosa of Barrett's esopha­

gus

• Gastric studies Indications Detect functioning gastric mucosa postoperative gastrec­tomy; gastric emptying-solids and/or liquid

• Gastrointestinal bleeding TcSc-rapid localization of gastrointestinal bleed­better for heavier bleeding (more sensitive than angiog­raphy) Tc-Iabeled red blood cells-localize sites of slower bleeding

• Meckel scan Detect presence of Meckel diverticulum with ectopic gastric mucosa

• Hepatobiliary Liver-spleen scan Hepatic indications

1. Evaluate liver-size, shape, and position 2. Evaluate diffuse hepatic disease 3. Focal space-occupying lesions 4. Evaluate metastases pre- and posttherapy 5. Hepatic flow study to detennine vascularity of

known hepatic masses

APPENDIX I 213

214 I APPENDIX

High-resolution ultrasound and CT are more sensitive than liver scan for detection and follow-up of focal lesions

Splenic indications 1. Evaluate splenic size 2. Suspected trauma 3. Stage neoplasms and evaluate response to therapy 4. Asplenia 5. Detect accessory spleen (heat-treated red blood

cells) 6. Detect situs inversus

• Biliary studies Indications

1. Detection of acute cystic duct obstruction 2. Jaundiced patients to evaluate ductal obstruction 3. Postcholecystectomy patients to detect cystic duct

remnant or biliary fistula 4. Evaluate biliary enteric bypass procedures 5. Detect traumatic biliary fistulae 6. Evaluate biliary reflux following Billroth II 7. Evaluate neonatal jaundice to distinguish between

neonatal hepatitis and biliary atresia

Gastrointestinal studies: in vitro studies • Gastrointestinal malabsorption

1. Schilling test, with or without intrinsic factor to determine etiology of BI2 deficiency

2. Protein loss detection 3. Lipid loss detection

• Pancreas scan 1. Evaluate function and size of organ 2. Detection of masses intrinsic or extrinsic to pan­

creas Largely replaced by ultrasound and CT

Central nervous system • Brain scan with or without flow study

Indications 1. Neoplasm detection-benign, malignant, metas­

tatic 2. Infectious processes-abscess, encephalitis, men­

ingitis with empyema 3. Vascular disorders-arterial-venous malformation,

aneurysm (huge), cerebrovascular accident (CVA), intracranial bleed

4. Trauma-subdural and intracerebral hematoma

5. Miscellaneous-demyelinating diseases, possibly useful to determine brain death

Most of the above-listed pathologic states may be more rapidly and easily diagnosed by CT. The most efficacious use of radionuclide brain scanning now is limited to situa­tions in which one would like to assess both intracranial and extracranial flow (symmetry, detection of gross stenosis) prior to contrast examination. It can also be used to differ­entiate CV A from tumor frequently.

• Cistemography Indications

1. Suspicion of block in subarachnoid cerebrospinal fluid (CSF) pathway (subarachnoid adhesion sec­ondary to surgery or inflammation)

2. Document and localize CSF leak-otorrhea, rhinor­rhea

3. Communicating hydrocephalus-normal pressure hydrocephalus, subarachnoid block, failure of CSF reabsorption

4. Determination of shunt patency and complications of shunting

5. Porencephalic cyst determination 6. Estimate ventricular size

CT will demonstrate morphologic abnormalities of the ventricular system; however, cistemography is better to evaluate physiology of the subarachnoid spaces and ven­tricular system.

It will also assist in the determination of when a shunt will be an effective means of treating patients with commu­nicating hydrocephalus in addition to evaluating shunt pa­tency.

Pulmonary studies

• Perfusion Indications

1. Detection of pulmonary emboli and evaluate status posttherapy

2. Assist in diagnosis of congenital pulmonary anoma­lies

3. Evaluate extent of lung tumor (resectability)

• Ventilation Indications

1. Evaluation of chronic obstructive pulmonary dis­ease

APPENDIX I 215

216 I APPENDIX

2. Evaluation of ventilatory function prior to thoracot­omy

All perfusion scans should be evaluated in conjunction with recent radiographs. Owing to nonspecificity of perfu­sion abnormalities, most, if not all, positive perfusion stud­ies should be evaluated with a ventilatory scan.

Cardiac studies

• Radionuclide angiocardiography Indications

1. Diagnose congenital heart lesions-shunt lesions, valvular

2. Evaluate acquired valvular lesions 3. Pericardial effusion detection (ultrasound more ef­

fective) 4. Detection of pseudoaneurysms

• Avid infarct scans (pyrophosphate) Indications

1. Detecting acute infarcts in patients with question­able clinical findings, enzyme levels, and equivocal electrocardiogram (left bundle branch block)

2. Localization and estimation of infarct size

• Thallium-rest and/or stress 1. Detection and estimation of size of ischemic or in­

farcted region 2. Determine effects of stress on ischemic regions 3. Evaluate myocardial perfusion prior to and postcor­

onary bypass

• Gated studies-rest and/or stress Indications

1. Evaluate left ventricular function with and without stress (by calculation of ejection fraction and dem­onstrating abnormal cardiac wall motion)

2. Evaluation of right ventricular function 3. Monitor cardiac status of patients on cardiotoxic

drugs (Adriamycin) 4. Assist in distinguishing between diffuse cardiomyo­

pathy and ischemic heart disease 5. Detection of areas of dyskinesis (localized aneu­

rysms)

• Miscellaneous procedures: Dacryocystography Indications

1. Evaluate patients with epiphora in whom routine

clinical tests cannot determine etiology and site of obstruction

2. Determine presence of nasolacrimal abnormalities 3. Evaluation of postoperative patients with persistent

tearing 4. Performance of physiologic and pharmacologic in­

vestigations 5. Determine relationship of ductal system to orbital

mass

Liver-lung scan Indications

1. Specifically demonstrates juxtadiaphragmatic pa­thology-e.g., subphrenic abscess

2. Most useful in patients who are difficult to scan with ultrasound. CT has largely replaced this study, although it may be useful in children and pregnant women where one wants to reduce irradiation.

• Radionuclide venogram Indications

1. Simple way to detect deep venous thrombosis 2. Detect superior vena caval obstruction 3. Useful in patients allergic to iodine 4. Can be performed at time of pulmonary perfusion

scan

• Salivary gland scan Indications-limited

1. May aid in detection of certain tumors as prelimi­nary screening procedure (functioning versus non­functioning)

2. Assess function of salivary glands-in patient with xerostomia-e.g., Sjogren syndrome

Liver

1. Hepatocellular disease versus metastases 2. Focal lesions-cystic versus solid 3. Guided biopsies 4. Metastases detection-pre- and posttherapy 5. Staging lymphoma 6. Inflammatory disease-intrahepatic versus subphre­

nic versus sUbhepatic 7. Postoperative trauma

INDICATIONS FOR ULTRASOUND

APPENDIX I 217

218 I APPENDIX

Gall Bladder and Biliary System

1. Rule out cholelithiasis versus polyps 2. To aid in detection of acute cholecystitis 3. Rule out ductal dilatation 4. Medical versus surgical jaundice

Pancreas

1. Inflammatory disease versus tumor 2. Complications of pancreatitis-pseudocyst versus

phlegmon versus abscess

Abdominal Aorta

1. Atherosclerotic disease 2. Aneurysm detection 3. Complications of aneurysm-dissection 4. Status of grafts and complications

Spleen

1. Evaluate size 2. Focal lesions-cystic versus solid 3. Neoplasm 4. Inflammation 5. Trauma

Renal

1. Congenital anomalies 2. Hydronephrosis 3. Infectious disease 4. Renal masses on intravenous pyelogram-cystic ver­

sus solid 5. Diffuse renal disease 6. Complication of transplant-hydronephrosis, hema­

toma, abscess, lymphocele, urinoma 7. Renal failure-medical versus obstructive

Adrenal

1. Mass lesions-cystic versus solid

Retroperitoneal

1. Detection of lymphadenopathy 2. Fluid collections 3. Retroperitoneal fibrosis 4. Retroperitoneal neoplasms

Testicle

1. Epididymitis versus torsion 2. Masses 3. Fluid collections

General Abdominal

1. Ascites detection 2. Abscess or hematoma localization 3. Peritoneal (mesenteric) disease 4. Bowel lesions

Neck

1. Thyroid masses-cold nodules on isotope scan 2. Parathyroid masses-adenoma 3. Evaluate goiter 4. Extrathyroidal masses-cysts versus solid 5. Adenopathy 6. Vascular-carotid disease screening

Lower Extremity

1. Popliteal cyst 2. Aneurysm 3. Abscess and hematoma 4. Soft tissue tumors

Pelvis (Female)

1. Locate intrauterine device 2. Rule out intrauterine pregnancy 3. Uterine neoplasm 4. Ovarian masses-cystic versus solid 5. Localize hematoma or abscess 6. Pelvic inflammatory disease 7. Lymphadenopathy

Nongynecologic lesion 1. Bladder and prostate lesions 2. Congenital anomalies-pelvic, kidney, uterine-bi­

cornuate 3. Anomalies

Obstetrical

1. Rule out IUP 2. Gestational age 3. Abnormal gestation sac-blighted ovum, missed

abortion, molar pregnancy

APPENDIX I 219

INDICATIONS FOR COMPUTERIZED

TOMOGRAPHY

220 I APPENDIX

4. Placenta localization-placenta previa 5. Placental abnormalities (tumors) 6. Ectopic pregnancy versus ovarian lesions 7. Incompetent cervix 8. Fetal death 9. Fetal anomalies

10. Amniocentesis

Head

1. Trauma-sites of bleeding, fracture location 2. Neoplasm-primary or metastatic 3. Congenital anomalies 4. Inflammatory disease-abscess localization 5. Vascular lesions-AVM, aneurysm 6. White-matter disease 7. CV A-hemorrhagic versus ischemic 8. Orbital pathology 9. Detect hydrocephalus

10. Postoperative follow-up 11. Internal auditory canals 12. Sellar pathology

Neck 1. Paranasal sinus pathology 2. Facial trauma 3. Parotid gland pathology 4. Cervical-spine trauma-rule out spinal cord involve-

ment, determine the extent of fracture 5. Staging of tumors of larynx, pharynx 6. Laryngeal trauma 7. Neck mass localization

Chest

1. Search for pulmonary metastases 2. Evaluate pulmonary nodule 3. Evaluate widened mediastinum 4. Stage esophageal and lung tumors 5. Evaluate aortic aneurysms 6. Detection of lymphadenopathy (hilar or mediastinal)

Abdomen

• General 1. Abscess localization 2. Bowel or mesenteric involvement by tumor

3. Staging lymphoma 4. Guided biopsy-skinny needle

• Retroperitoneum 1. Nodal evaluation 2. Aortic aneurysm and complications 3. Aortic graft and complications

Pancreas

1. Evaluate and stage pancreatic carcinoma 2. Complications of pancreatitis 3. Jaundice of unknown etiology

Liver-spleen

1. Localized masses 2. Evaluate metastases pre- and posttherapy 3. Suspected trauma of liver or spleen

Adrenal-renal

1. Evaluate renal masses-cystic versus solid 2. Stage renal tumors 3. Screening for adrenal masses 4. Evaluate renal trauma

Pelvis

1. Stage bladder tumors 2. Define gross extent of pelvic tumors 3. Search for undescended testes 4. Lymph node evaluation 5. Pelvic trauma-specifically acetabular fracture defi­

nition and pelvic hematoma detection.

APPENDIX I 221

Abruptio placentae, 81 Accessory spleen, 50 Acetabular fractures, 175, 177 Acute tubular necrosis (ATN),

70 Adrenals

computerized tomography of, 199-204

nuclear medicine for, 198-199

ultrasound of, 199-200 Adriamycin, 109 Amniocentesis, 81 Amniotic fluid meconium, 84 Amyloidosis, 114 Androgen, excessive, 198 Anencephaly, 82 Angiography

of aorta, 119 cerebral, 127-128, 130-132,

136-137, 142, 144 coronary, 105, 108, 111-112,

114 gastrointestinal, 5, 7 of liver, 25 of mediastinal widening, 100 of pancreas, 37 of parathyroid, 204

Angiography (cont. ) of peripheral vessels, 119,

122 of undescended testes, 76

Aortic aneurysm, 118-119 Aortoiliac fistulae, 119, 121-

122 Appendiceal abscess, 15, 91 Arthritis, 154 Arthrography, 167 Aseptic necrosis, 173-174 Asplenia, 48, 50 Atrial myxoma, 113-115 Avascular necrosis, 208

Baker's cyst, 181 Barium enema, 9, 85 Barium swallow, 1-3, 100 Barrett's esophagus, 5 Biliary system

gall bladder inflammation, 26-29

jaundice, 27, 29-31, 35 malignancy of, 33-35 trauma and postoperative con­

ditions of, 31-33 Bladder, 58-60, 90

Index

Bone disease, generalized meta-bolic, 183-184

Bone lesions, primary, 176-179 Bone metastases, 178-180 Bone scan, 171-174

with soft tissue masses, 180 Bowel, large and small, 8-10,

90 Brain

brain death, 138 cerebrovascular disease, 136-

138 hydrocephalus, 82, 85, 130,

133, 141-145 inflammatory disease of, 130 magnetic resonance imaging

of, 141, 147-149 neonatal echoencephalogra-

phy, 145, 147 neoplasm in, 130-133 sellar lesions, 144-146 trauma of, 127-130 vascular lesions in, 132, 134-

136 white-matter disease, 141

Breast computerized tomography of,

187, 189

223

Breast (cont. ) magnetic resonance imaging

of, 208 ultrasound of, 185-188

Cardiac disease cardiomyopathy, 113-114 congenital heart disease, 105-

III ischemic heart disease, Ill,

117 magnetic resonance imaging

in, 207-208 pericardial disease, 114-117 valvular disease, 111-115;

see also Vascular disease Cardiomyopathy, 113-114 Central nervous system: see

Brain; Spine Cerebrovascular disease, 136-

138 Cholecystectomy, 32-33 Cholecystogram, oral and intra­

venous, 26 Circulatory system: see Vascular

disease Communicating hydrocephalus,

130, 133, 142, 145 Computerized tomography (CT)

of adrenals, 199-204 of aortic aneurysm, 119,

121-122 of biliary system, 33, 35 of bone and soft tissue, 173-

175 of bone metastasis, 179 of bowels, 9-12 of brain trauma, 127-130 of breast, 187, 189 of cerebrovascular disease,

137-140 of esophagus, 2, 5 of gall bladder, 27 in jaundice, 20 of joints, 182 in hydrocephalus, 142-144 of intracranial abnormalities,

130-134, 137, 147, 149 in ischemic heart disease, 117 of lacrimal glands, 161-162 of larynx and pharynx, 164,

166 of liver enlargement, 20

224 INDEX

Computerized tomography (cont.) of liver neoplasm, 23-25 of liver trauma, 17-19 in low-back pain, 154-155 in lung neoplasm, 97-99 magnetic resonance imaging

vs., 147, 149,207 of mediastinal widening and

masses, 100-103 of orbits, 157-159 of pancreatic inflammation,

39-40 of pancreatic neoplasm, 40-42 of pancreatic trauma, 42 of paranasal sinuses, 162-163 of parathyroid, 101, 205-206 of pelvic masses, 88 for pelvic postoperative as­

sessment, 90-92 in pericardial disease, 115,

117 of peripheral vessels, 119 of peritoneal cavity and ab­

dominal wall, 12-13, 16 of primary bone lesions, 177-

179 of prostatic enlargement, 71-

73 of pulmonary embolus, 96 of pUlmonary metastases, 99,

102 in renal failure, 61 in renal infection and reflux,

68-69 of renal mass or enlarged

kidney, 65-66 of renal trauma, 57-58 of renal vascular hyperten­

sion, 55 of respiratory inflammation,

94-95 of salivary gland-parotid en-

largement, 164, 167 of scrotum, 75 of sellar lesions, 144 of soft tissue masses, 181-182 spinal bone mineral estima-

tion with, 184 in spinal inflammatory dis­

ease, 152 of spinal neoplasms, 150-

151, 153 of splenic enlargement, 48-49

Computerized tomography (cont.) of splenic trauma, 45-47 of temporomendibular joint, 169 of thyroid gland, 197 of undescended testes, 76 of venous system, 122-124 of white-matter disease, 141

Congenital fetal anomalies, 82, 84 Congenital heart disease, 105-

III Coronary artery disease, III Coronary bypass graft patency,

117 Corpus luteum cyst, 79 Cystectomy, 90 Cystic hygroma, 84

Dacryocystography, 161 Death (brain death), 138 Digital subtraction angiography,

119, 142 Discitis, 152 Duplex Doppler B mode carotid

scanning, 137-138

Echocardiography, 106-109, Ill, 113

M-mode, 114, 116-117 pericardial effusions detected

with, 115-117 Echoencephalogram, 145, 147 Ectopic pregnancy, 79, 82, 86 Encephalitis, 130 Endocrine system: see Adrenals;

Parathyroid; Thyroid gland Endometriomas, 86, 88 Endoscopic retrograde cholan­

giopancreatography (ERCP), 29-30, 35, 37, 43

Epidural venography, 149 Epiphora, 161 Esophagus, 1-4, 164 Eye, 169; see also Orbits

Fabry's disease, 114 Facial structures

lacrimal glands, 161-162 paranasal sinuses, 162-166 orbits, 157-161 trauma to, 175

Female pelvis: see Gynecology; Obstetrics

Fetal indications, 81-85

Fibrocystic disease, 186 Fibroid uterus, 85-86 Fluoroscopy, 4, 169 Focal cerebritis, 130-131 Functional asplenia, 48, 50

Gall bladder: see Biliary system Gallium scanning, 13-14,66

for pelvic postoperative as­sessment, 90, 92

Gastroesophageal reflux, 1-2 Gastrointestinal diseases

bleeding, 5-7 bowels, 8-10 esophagus, 1-4, 164 Meckel's scan, 4, 7-8 stomach, 4-5; see also Peri-

toneal cavity and abdomi­nal wall

Genitourinary tract bladder and urethral trauma,

58-60 infection and reflux in, 66-68 postoperative assessment of,

90-92 renal failure, 61-66 renal mass or enlarged

kidney, 61-66, 69 renal transplant, 68, 70 renal vascular hypertension,

53-55 Gestational age, defining, 79-

80, 83 Glycogen storage disease, 114 Goiter, 191-193, 197 Graves' disease, 159, 191-193,

195 Gynecology

intrauterine device, 79, 89-90 pelvic masses, 85-89 postoperative pelvic assess-

ment, 90-92 presacral mass, 89

Hashimoto's thyroiditis, 193 Hepatic diseases, 208

enlargement, 19-20 neoplasm, 20-25 trauma, 17-19; see also Bili-

ary system Hepatoma, 122-123 Herniated disc, 154-155 Hilar lymphadenopathy, 2-4

Hydrocephalus communicating, 130, 133,

142, 145 detection of, 141-142 fetal, 82, 85 obstructive, 142-144

Hydronephrosis, 59-63 fetal, 82, 84-85

Hyperparathyroidism, 204-206 Hyperthyroidism, 191-193 Hypothalamic failure, 193 Hypothyroidism, 192-193

Indium oxine tagged to leuko­cytes, 14, 92

Intrauterine device (IUD), 79 localization of, 89-90

Intravenous pyelogram (IVP), 58, 61

Intussusception, 8 Iodine allergy, 55, 134, 199 Iodine scan, 191-192

whole body, 194-195 Ischemic heart disease, III, 117

Jaundice neonatal, 35 obstructive vs. nonobstruc­

tive, 27, 29-31 Joint pain, 181-183

temporomandibular, 167, 169, 182

Joint prostheses, 175-176

Kidney: see Genitourinary tract

Lacrimal gland dysfunction, 161-162

Larynx and pharynx malignancy of, 166-169 trauma to, 164, 166

Le Fort fracture, 163 Liver: see Hepatic diseases Low-back pain, 152, 154-155 Lung neoplasm, 97-99

Magnetic resonance imaging (MRI)

advantages of, 207-208 of br\lin, 141, 147-149 of breast, 185 in cardiac disease, 207-208 computerized tomography vS.,

147, 149, 207

Magnetic resonance imaging (cont.) limitations of, 207-208 of pelvis, 72 of spine, 155-156 white-matter disease detected

with, 141 Male pelvis, 71-72 Mammography, 185-189 Maternal indications, 79-80 Meckel's scan, 4, 7-8 Mediastinal lymphadenopathy,

2-4 Mediastinal widening and mass,

95, 99-103 Meningioma, 131-132, 144 Meningitis, 130 Meningoceles, 82, 151-152 Metrizamide cisternography, 145 Microcephaly, 82 Molar pregnancy, 79-81 Multiple gestations, 81, 83 Multiple sclerosis, 141 Musculoskeletal system

generalized metabolic bone disease, 183-184

inflammatory disease of, 171-174

joint pain, 181-183 joint prostheses problems,

175-176 neoplasms of, 176-179,208 soft tissue masses, 179-182 trauma to, 173-175

Myelography, 149-150, 154 Myelomeningoceles, 151 Myocardial infarcts, 108-109,

117

Neck structures, 164-169, 204-205

Neonatal adrenal hemorrhage, 199-200

Neonatal echoencephalography, 145, 147

Neonatal jaundice, 35 Norland-Cameron bone mineral

analyzers, 183-184 Nuclear medicine

for adrenals, 198-199 in aortic aneurysm, 118 in bone and soft tissue trau­

ma, 173-174 in bone metastases, 178-180

INDEX 225

Nuclear medicine (cont. )

in gall bladder inflammation, 26-27

in generalized metabolic bone disease, 183-184

in hepatic enlargement, 19 in hyperparathyroidism, 204 in jaundice, 27 in joint pain, 182 in liver neoplasm, 20-21 in liver trauma, 17 in pancreatic inflammatory

disease, 57-58 in pancreatic neoplasm, 39 for peripheral vessel abnor­

malities, 120 in primary bone lesions, 177-

178 for pulmonary embolus, 96-

98 in renal failure, 58-59 in renal infection and reflux,

66-67 in renal mass or enlarged

kidney, 61 in renal transplant, 68, 70 in respiratory inflammation,

93-94 in splenic enlargement, 46-47 in splenic trauma, 44-45 in stomach ailments, 4-5 for venous abnormalities,

121; see also Radionuclide study

Obstetrics fetal indications, 81-85 maternal indications, 79-80 placenta, 81

Optic chiasm, 160-161 Orbits, see also Eye

proptosis, 159 trauma to, 157-159, 175 vision loss, 159-161, 175

Osteomyelitis computerized tomography of,

172, 175 magnetic resonance imaging

of, 208 radionuclide bone scan of,

152, 154, 171-174 Ovarian cyst, 85, 87-89

226 INDEX

Pacemakers, 207 Paget's disease, 183 Pancreas

inflammatory disease of, 37-39

magnetic resonance imaging of, 208

neoplasm of, 39-43 and splenic vein occlusion,

122, 124 trauma to, 42-43, 58

Paranasal sinuses neoplasia of, 164-166 sinusitis, 162-163 trauma to, 163

Parathyroid computerized tomography of,

101, 205-206 magnetic resonance imaging

of, 208 nuclear medicine for, 204 ultrasound of, 204-205

Parotid gland, 164, 167 Pelvis: see Gynecology; Male

pelvis; Obstetrics Perchlorate washout test, 193,

195 Pericardial disease, ll4-ll7 Peripheral vessels, ll9-120 Peritoneal cavity and abdominal

wall computerized tomography of,

12-13, 16 magnetic resonance imaging

of, 208 radionuclide scans of, 13-15 ultrasound of, 10, 12

Pharynx: see Larynx and pharynx

Pheochromocytoma, 201 Phthisis bulbi, 160 Pituitary adenomas, 144-146 Pituitary failure, 193 Placenta, 81 Plummer's disease, 195 Pneumocephalus, 130 Pneumoencephalogram, 127-

128, 141, 144 Pneumopericardium, ll4 Polycystic kidney disease, 65,

82 Polyhydramnios, 82

Polysplenia, 50 Pregnancy: see Obstetrics Presacral mass, 89 Proptosis, 159 Prostheses

breast, 186 joint, 175-176

Prostatic enlargement, 71-73 Pseudoaneurysms, 19 Pseudocyst of pancreas, 38 Pseudokidney sign, 9 Psoas hemorrhage, 58 Pulmonary functions: see Respi-

ratory system Pyelogram, 85 Pyelonephritis, 66-67 Pyloric stenosis, 8 Pyrophosphate scan, myocar-

dial, 106

Radiation portals, 2, 25 Radioiodine therapy, 195 Radionuclide study

of bones, 171-174 of brain, 130, 132-136, 138-

140 of brain death, 138 in cardiomyopathy, 113 in cerebrovascular disease,

136, 138-140 in congenital heart disease,

105-106, 108 of esophagus, 1-2 in hydrocephalus, 143-145 of lacrimal glands, 161 of lung neoplasm, 98-101 of painless scrotal enlarge-

ment,75 for pelvic postoperative as­

sessment, 90, 92 in pericardial disease, ll5 of peritoneal cavity and ab­

dominal wall, 13-15 of renal trauma, 55-56 of renal vascular hyperten­

sion, 53-55 of salivary gland-parotid en­

largement, 164 of spinal inflammatory dis­

ease, 152, 154 of thyroid gland, 197; see

also Nuclear medicine

Raynaud's phenomenon, 120 Rectal tumor, 90-91 Renal agenesis, 82 Renal cell carcinoma, 122-123 Renal failure, 58 Renal mass, 61-66, 69, 208 Renal scan, nuclear, 61 Renal transplant, 68, 70 Renal vascular hypertension,

53-55 Respiratory system

inflammatory disease of, 93-95

lung neoplasm, 97-99 mediastinal widening and

mass, 95, 99-103 pulmonary embolus, 94-101 pulmonary metastases, 99-

100, 102 Reticuloendothelial system: see

Spleen and reticuloen­dothelial system

Retinal detachment, 158 Retinoblastoma, 160 Retroperitoneal nodes, 9, 12 RH incompatibility, 84

Sacroiliitis, 154 Salivary gland-parotid enlarge­

ment, 164, 167 Sciatica, 154 Scrotum, 72

inflammatory disease vs. tor­sion of testicle, 73-75

painless enlargement of, 75-76

undescended testes, 76 Sellar lesions, 144-146 Seminal vesicles, 71-72 Sinusitis, 162-163 Skull fractures, 128 Soft tissue masses, 179-182 Sonography: see Ultrasound Spinal bone mineral estimation,

184 Spinal dysraphism, 151-152 Spine

inflammatory disease of, 152-154

low-back pain, 152, 154-155 magnetic resonance imaging

of, 155-156

Spine (cont. )

neoplasm of, 150-153 trauma to, 149-151, 175-176

Spleen and reticuloendothelial system

accessory spleen, 50 asplenia, 48, 50 polysplenia, 50 splenic enlargement, 46-48 trauma to, 44-46 vein occlusion, 122, 124

Spondylolysis, 154 Stomach, 4-5 Sulfur colloid examination, I,

26,50 in gastrointestinal bleeding,

5-7 Syringomyelia, 150

Tagged red blood cell study, 120

in gastrointestinal bleeding, 5-7

spleen scans with, 50 Technetium-IDA agents, 26-27 Technetium scan, 195, 204 Temporal lobe, 147-148 Temperomandibular joint, 167,

169, 182 Testes

inflammatory disease vs. tor­sion of, 73-75

undescended, 76 Thallium scans, 108-110,204 Thoracic imaging, 2, 207 Thoracotomies, 100 Thrombophlebitis, pelvic, 124 Thymic tumor, 101 Thyroid gland, 169

computerized tomography of, 197

enlarged, 193-194 hyperthyroidism, 191-193 hypothyroidism, 192-193 magnetic resonance imaging

of, 208 radiotherapy for, 195 technetium scan of, 195 ultrasound of, 194-197, 204-

205 Thyroid-stimulating hormone

(TSH), 192

Tomograms, 169 Transplants, renal, 68, 70 Turner's syndrome, 82

Ulcer disease, 4-5 Ultrasound

of adrenals, 199-200 of aortic aneurysm, 118-119 of biliary malignancy, 34-35 of biliary system trauma and

postoperative complica­tions, 32-33

of bowels, 8-9 of breast, 185-188 in cardiomyopathy, 114 in cerebrovascular disease,

137, 140 in congenital heart disease,

109, 111-112 of fetus, 81-84 of gall bladder, 27, 29 for intrauterine device lo-

calization, 89-90 in ischemic heart disease, III in jaundice, 29-30 in liver enlargement, 20 in liver neoplasm, 21-24 in liver trauma, 17-18 of orbits, 158 in pancreatic inflammatory

disease, 38-39 of pancreatic neoplasm, 39-

41 of pancreatic trauma, 42 of parathyroid, 204-205 of pelvic masses, 85-89 in pericardial disease, 115-

117 of peripheral vessels, 119 of peritoneal cavity and ab-

dominal wall, 10, 12 of placenta, 81 of presacral mass, 89 of prostatic enlargement, 71-

72 in renal failure, 59-61 in renal infection and reflux,

67 of renal mass or enlarged

kidney, 61-62, 64-65 of renal transplant, 70 of renal trauma, 56-57

INDEX 227

Ultrasound (cant. )

of respiratory inflammation, 94

of scrotal enlargement, 75-76 of soft tissue masses, 180-

181 of spinal neoplasms, 151 of splenic enlargement, 47-

49 of splenic trauma, 44-45 of thyroid gland, 194-197 of undescended testes, 76 in valvular disease, 112-115

228 I INDEX

Ultrasound (cant.)

of venous system, 121-122 Undescended testes, 76 Urethral trauma, 58

Valvular disease, 111-115 Vascular disease, see also Val­

vular disease aortic aneurysm, 118-119 cerebrovascular disease, 136-

138 peripheral vessels, 119-120 venous system, 121-124

Venography, 76, 127 epidural, 149 of parathyroid, 204

Venous system, 121-124 Ventriculography, cardiac, 111 Virilism, 198, 200 Vision, 161-162, 175 Voiding cystourethrogram, 61,

67

White-matter disease, 141 Whole-body iodine scan, 194-

195