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KMID : 0378019710140050041
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New Medical Journal
1971 Volume.14 No. 5 p.41 ~ p.53
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Scintillation Camera in Diagnosis of Intracranial Lesions
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Abstract
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The importance and difficulty of detecting and localizing intracranial lesions by neurological examination alone have led to the application of various supplemental procedures. The introduction of pneumoencephalo￢graphy, ventriculography and arteriography has been of great assistance. However, these procedures are often unpleasant for the patient and are associated with some complications. Electroencephalography and
echoencephalographv, which are safe and not unpleasant, have proved somewhat disappointing except as a coarse screening technique.
In 1947 Moore reported that brain tumors appeared to exhibit a consistent special affinity for the absorption of previously injected fluorescein. On the next year Moore and his colleagues succeeded in the diagnosis and localization of brain tumors using radioactive diiodofluorescein by means of Geiger-Muller counter.
Radioiodinated human serum albumin was first used for brain scanning in 1953 by Moore, et al. Thereafter,
other substances, such as 1311, 1151, 74 As, 72 As, "Cu, 203Hg 19,Hg 99mTC 113-In, etc., have been used.
Improvements have also been made in the detection instruments. Geiger-Muller detectors were gradually replaced by crystal scintillation counters, well type scintillation counter, positron-emitting radionuclides, collimators, and recently scintillation camera.
The purpose of this report is to present the diagnostic value of scintillation camera (Anger type) in
detecting and localizing various intracranial lesions with the use of `Tc-pertechnetate and 113- In-DTPA.
A number of different views were taken in 10 normal persons as preliminary study. The increased
uptake of RI was observed in the regions of the large venous sinuses, paranasal sinuses, temporal
muscles, face and scalp. K ,.}T
The results in fifty two patients with_ various intracranial lesions, including eighteen with intracranial, tumors, were analyzed. In eleven tumor cases accurate localization was obtained. In seven cases, who t had infratentorial tumors or pituitary tumors, the results were poor. This technique is more valuable with supratentorial tumors in about 80 per cent. Supratentorial gliomas and meningiomas give the, highest incidence of satisfactory results.
Lesions other than tumors, such as brain abscess, subdural hematoma, intracerebral hematoma, cerebral contusion, and some cerebral infarction also gave positive results.
Serial scannings were made following either direct injection of 113-in-DTPA into the lateral ventricle, or intravenous or intracarotid arterial injection of "I-In-DTPA.
In hydrocephalic patient the size of ventricles and patency of cerebrospinal fluid flow were well visualized following intraventricular injection of RI. In one cerebral hemispherectomized patient, in whom the right anterior, posterior, and middle cerebral arteries were ligated at the bifurcations, ipsilateral side showed early increased uptake of RI then both sides became similar in late stage.
In conclusion it might be mentioned that scintillation camera is very simple, painless and reliable in detection and localization of various intracranial lesions. The possibility of taking different views and serial scanning following a single dose of tracer, and dynamic analysis of the uptake pattern is the definite advantage as an supplementary diagnostic procedure.
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