Diagnostic nuclear medicine in the ED.

Although the decision to use nuclear medicine (NM) modalities in the acute care setting is limited by several factors, there are instances in which the use of NM techniques can provide elegant and efficient solutions to otherwise expensive and resource consuming situations. Herein, we describe the indications and NM techniques used for the evaluation of low-risk patients with chest pain, suspected pulmonary embolus, acute cholecystitis, gastrointestinal bleeding, acute scrotum, and the radiographically occult fracture.

[1]  S. Chatziioannou,et al.  Hepatobiliary scintigraphy is superior to abdominal ultrasonography in suspected acute cholecystitis. , 2000, Surgery.

[2]  J. Owen,et al.  Intravenous urography during lactation. , 1982, The British journal of radiology.

[3]  J. Udelson,et al.  Radionuclide imaging in risk assessment after acute coronary syndromes , 2004, Heart.

[4]  William F Lavelle,et al.  The role of bone scintigraphy in treatment planning, and predicting pain relief after kyphoplasty , 2008, Nuclear medicine communications.

[5]  B. Hutton,et al.  An international survey of hospital practice in the imaging of acute scaphoid trauma. , 2006, AJR. American journal of roentgenology.

[6]  K. Mackway-Jones,et al.  Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study , 2006, Emergency Medicine Journal.

[7]  Holder Le Bone scintigraphy in skeletal trauma. , 1993 .

[8]  Samuel Z Goldhaber,et al.  Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER) , 1999, The Lancet.

[9]  Mireya Diaz,et al.  CT pulmonary angiography: a comparative analysis of the utilization patterns in emergency department and hospitalized patients between 1998 and 2003. , 2004, AJR. American journal of roentgenology.

[10]  R B D'Agostino,et al.  Missed diagnoses of acute myocardial infarction in the emergency department: results from a multicenter study. , 1993, Annals of emergency medicine.

[11]  U. Schoepf,et al.  The Age of CT Pulmonary Angiography , 2005, Journal of thoracic imaging.

[12]  G. Kovacs,et al.  Excluding Pulmonary Embolism at the Bedside without Diagnostic Imaging: Management of Patients with Suspected Pulmonary Embolism Presenting to the Emergency Department by Using a Simple Clinical Model and d-dimer , 2001, Annals of Internal Medicine.

[13]  P. Lichtenstein,et al.  Pulmonary embolism and stroke in relation to pregnancy: how can high-risk women be identified? , 2002, American journal of obstetrics and gynecology.

[14]  J. Hoffman,et al.  Influence of electrocardiographic findings on admission decisions in patients with acute chest pain. , 1985, The American journal of medicine.

[15]  J. Alpert,et al.  Mortality in patients treated for pulmonary embolism. , 1976, JAMA.

[16]  S. Wilson,et al.  Pancreatic neoplasms: how useful is evaluation with US? , 1988, Radiology.

[17]  Randall C. Thompson,et al.  Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain. , 1994, Journal of the American College of Cardiology.

[18]  J. Ornato,et al.  Comparison of myocardial perfusion imaging and cardiac troponin I in patients admitted to the emergency department with chest pain. , 1999, Circulation.

[19]  M. Boulvain,et al.  D‐dimer levels during delivery and the postpartum , 2005, Journal of thrombosis and haemostasis : JTH.

[20]  S. Rhemrev,et al.  A prospective comparison for suspected scaphoid fractures: bone scintigraphy versus clinical outcome. , 2007, Injury.

[21]  C. Gaebler,et al.  Trauma of the wrist. , 1997, European journal of radiology.

[22]  J. Udelson,et al.  Emergency department perfusion imaging for suspected coronary artery disease: the ERASE Chest Pain Trial. , 2001, Maryland medicine : MM : a publication of MEDCHI, the Maryland State Medical Society.

[23]  J. McGahan,et al.  Comparison of ultrasonography, computerized tomography, and radionuclide imaging in the diagnosis of acute and chronic cholecystitis. , 1982, American journal of surgery.

[24]  F. Zboralske,et al.  Cholecysto-cholestasis: A cause of cholecystographic error , 1962, The American Journal of Digestive Diseases.

[25]  G V Heller,et al.  Gated SPECT imaging. , 1999, Seminars in nuclear medicine.

[26]  P. Grenier,et al.  Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study , 2002, The Lancet.

[27]  G. Coates,et al.  Suspected pulmonary embolism in pregnancy: clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. , 2002, Archives of internal medicine.

[28]  S. Underwood,et al.  Economics of myocardial perfusion imaging in Europe--the EMPIRE Study. , 1997, European heart journal.

[29]  F. Gleeson,et al.  Perfusion scintigraphy: diagnostic utility in pregnant women with suspected pulmonary embolic disease , 2007, European Radiology.

[30]  H. Galloway,et al.  Use of early magnetic resonance imaging in the diagnosis of occult scaphoid fractures: the CAST Study (Canberra Area Scaphoid Trial). , 2005, The New Zealand medical journal.

[31]  R. Wigton,et al.  Diagnosing pulmonary embolism using clinical findings. , 1986, Archives of internal medicine.

[32]  S. Bird Failure to diagnose acute myocardial infarction. , 2002, Australian family physician.

[33]  B. Lewis,et al.  Usefulness of 64-Slice Cardiac Computed Tomographic Angiography for Diagnosing Acute Coronary Syndromes and Predicting Clinical Outcome in Emergency Department Patients With Chest Pain of Uncertain Origin , 2007, Circulation.

[34]  I. Matheson,et al.  Excretion of Iohexol and Metrizoate in Human Breast Milk , 1987, Acta radiologica.

[35]  J P Ornato,et al.  Comprehensive strategy for the evaluation and triage of the chest pain patient. , 1997, Annals of emergency medicine.

[36]  J. Johansen Assessment of a non-ionic contrast medium (Amipaque) in the gastrointestinal tract. , 1978, Investigative radiology.

[37]  D. Lask,et al.  The value of radionuclide scrotal imaging in the diagnosis of acute testicular torsion. , 1995, British journal of urology.

[38]  W. Webb,et al.  Imaging evaluation of suspected pulmonary embolism. , 1999, Current problems in diagnostic radiology.

[39]  P. Hohlfeld,et al.  TAFI antigen and D‐dimer levels during normal pregnancy and at delivery , 2001, British journal of haematology.

[40]  E. Hall,et al.  Radiobiology for the radiologist , 1973 .

[41]  Fernando Holguin,et al.  Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001. , 2005, Chest.

[42]  B. Yawn,et al.  Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case-control study. , 2001, American journal of obstetrics and gynecology.

[43]  A. Ellrodt,et al.  Selecting the best triage rule for patients hospitalized with chest pain. , 1989, The American journal of medicine.

[44]  N. Kleiman,et al.  Earlier diagnosis and treatment of acute myocardial infarction necessitates the need for a 'new diagnostic mind-set'. , 1994, Circulation.

[45]  Pamela K Woodard,et al.  Multidetector computed tomography for acute pulmonary embolism. , 2006, The New England journal of medicine.

[46]  B. Psaty,et al.  Predictors of myocardial infarction in emergency room patients , 1985, Critical care medicine.

[47]  R. Sparks,et al.  Radiation absorbed dose to the embryo/fetus from radiopharmaceuticals. , 1997, Health physics.

[48]  P. Christian,et al.  Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium-99m-labeled red blood cells in an experimental model. , 1987, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[49]  I. Lieberman,et al.  Vertebroplasty and kyphoplasty for the management of osteoporotic vertebral compression fractures. , 2007, The Orthopedic clinics of North America.

[50]  H. Jorulf Iohexol compared with diatrizoate in pediatric urography. , 1983, Acta radiologica. Supplementum.

[51]  Konstantin Nikolaou,et al.  Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. , 2005, Journal of the American College of Cardiology.

[52]  Hampson Nb Pulmonary embolism: difficulties in the clinical diagnosis. , 1995 .

[53]  C A Williams,et al.  The value of hepatic ultrasound and biochemical liver tests in screening for liver metastases. , 1986, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[54]  E. Paulson,et al.  Radiation dose to the female breast from 16-MDCT body protocols. , 2006, AJR. American journal of roentgenology.

[55]  R. Hendel,et al.  Clinical value of acute rest technetium-99m tetrofosmin tomographic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms. , 1998, Journal of the American College of Cardiology.

[56]  A. Strashun,et al.  Diagnosis of acute testicular torsion using radionuclide scanning. , 1983, The Journal of urology.

[57]  K. Moser,et al.  Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. , 1994, JAMA.

[58]  G. Raff,et al.  Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. , 2005, Journal of the American College of Cardiology.

[59]  C. Orlandi,et al.  Emergency room technetium-99m sestamibi imaging to rule out acute myocardial ischemic events in patients with nondiagnostic electrocardiograms. , 1993, Journal of the American College of Cardiology.

[60]  D. Ackery,et al.  Isotope bone imaging in suspected scaphoid trauma. , 1981, The British journal of radiology.

[61]  K. Mckusick,et al.  Evaluation of gastrointestinal bleeding by red blood cells labeled in vivo with technetium-99m. , 1979, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[62]  E F Cook,et al.  Ruling out acute myocardial infarction. A prospective multicenter validation of a 12-hour strategy for patients at low risk. , 1991, The New England journal of medicine.

[63]  W. Kuhle,et al.  Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. , 2003, Radiology.

[64]  Ferdinand K. Hui,et al.  Female breast radiation exposure during CT pulmonary angiography. , 2005, AJR. American journal of roentgenology.

[65]  Frans J. Th. Wackers,et al.  Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction. , 1985, The New England journal of medicine.

[66]  L. Goldman,et al.  A chest pain clinic to improve the follow-up of patients released from an urban university teaching hospital emergency department. , 1987, Annals of emergency medicine.

[67]  Richard L. Abbott,et al.  A Follow-up Study , 1990 .

[68]  G W Rouan,et al.  Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. , 1987, The American journal of cardiology.

[69]  J. Engel,et al.  Bone scanning in the assessment of fractures of the scaphoid. , 1979, The Journal of hand surgery.

[70]  Brian O'Neil,et al.  The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. , 2007, Annals of emergency medicine.

[71]  D. Panicek,et al.  Iodine allergy: an oyster without a pearl? , 1997, AJR. American journal of roentgenology.

[72]  J. Gatti,et al.  Current management of the acute scrotum. , 2007, Seminars in pediatric surgery.

[73]  H P Selker,et al.  Coronary care unit triage decision aids: how do we know when they work? , 1989, The American journal of medicine.

[74]  E. Palmer,et al.  Practical Nuclear Medicine , 1992 .

[75]  M. Bell,et al.  Does the emergency room electrocardiogram identify patients with suspected myocardial infarction who are at low risk of acute complications? , 1990, Australian and New Zealand journal of medicine.

[76]  J. Boone,et al.  Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. , 2002, Radiology.

[77]  S. Goldhaber,et al.  Normal D-dimer levels in emergency department patients suspected of acute pulmonary embolism. , 2002, Journal of the American College of Cardiology.

[78]  R. Mathews,et al.  An Analysis of Clinical Outcomes Using Color Doppler Testicular Ultrasound for Testicular Torsion , 2000, Pediatrics.

[79]  Jeani Chang,et al.  Pregnancy-Related Mortality Surveillance — United States , 1991 – 1999 , 2003 .

[80]  M. Sayre,et al.  A rapid diagnostic and treatment center for patients with chest pain in the emergency department. , 1995, Annals of emergency medicine.

[81]  S. Baum,et al.  RADIOGRAPHIC DEMONSTRATION OF UNKNOWN SITES OF GASTROINTESTINAL BLEEDING. , 1963, Surgical forum.

[82]  Gabriel P. Krestin,et al.  High-Resolution Spiral Computed Tomography Coronary Angiography in Patients Referred for Diagnostic Conventional Coronary Angiography , 2005, Circulation.

[83]  Suman Jana,et al.  Nuclear medicine studies of the prostate, testes, and bladder. , 2006, Seminars in nuclear medicine.

[84]  H. Sexton,et al.  Failure to diagnose acute myocardial infarction. The clinicopathologic experience at a large community hospital. , 1983, JAMA.

[85]  J. Cook,et al.  Radiation from CT and perfusion scanning in pregnancy , 2005, BMJ : British Medical Journal.

[86]  W. G. Ketel,et al.  Sensitization to povidone-iodine. , 1990 .

[87]  Henrik S. Thomsen,et al.  The use of iodinated and gadolinium contrast media during pregnancy and lactation , 2005, European Radiology.

[88]  Pierre Durieux,et al.  Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism , 2005, BMJ : British Medical Journal.

[89]  J. Remy,et al.  Spiral CT angiography of the pulmonary circulation. , 1999, Radiology.

[90]  D. Berman,et al.  An economic analysis of an aggressive diagnostic strategy with single photon emission computed tomography myocardial perfusion imaging and early exercise stress testing in emergency department patients who present with chest pain but nondiagnostic electrocardiograms: Results from a randomized trial. , 2000, Annals of emergency medicine.

[91]  E. Lee,et al.  Role of radionuclide imaging in the orthopedic patient. , 2006, The Orthopedic clinics of North America.

[92]  B. Lewis,et al.  Usefulness of 64-Slice Cardiac Computed Tomographic Angiography for Diagnosing Acute Coronary Syndromes and Predicting Clinical Outcome in Emergency Department Patients With Chest Pain of Uncertain Origin , 2007 .

[93]  Simon Wildermuth,et al.  Accuracy of MSCT coronary angiography with 64-slice technology: first experience. , 2005 .

[94]  B. Modan,et al.  Disposition of presumed coronary patients from an emergency room. A follow-up study. , 1976, JAMA.

[95]  W. Shehadi Adverse reactions to intravascularly administered contrast media. A comprehensive study based on a prospective survey. , 1975, The American journal of roentgenology, radium therapy, and nuclear medicine.