Bio

Clinical Focus


  • Nuclear Medicine, Pediatric
  • Thyroid Cancers
  • Nuclear Medicine

Academic Appointments


Professional Education


  • Medical Education:University of Glasgow (1967) Scotland
  • Fellowship:Stanford University School of Medicine (1974) CA
  • Board Certification: Nuclear Medicine, American Board of Nuclear Medicine (1976)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (1978)
  • Residency:Glasgow Royal Infirmary (1968) Scotland
  • Internship:Stobhill General Hospital (1968) Scotland

Publications

Journal Articles


  • F-18-FDG PET/CT Demonstration of a Liver Metastasis in a Patient With Papillary Thyroid Cancer CLINICAL NUCLEAR MEDICINE Mosci, C., McDougall, I. R., Jeffrey, R. B., Iagaru, A. 2012; 37 (9): E234-E236

    Abstract

    A 51-year-old woman with papillary thyroid cancer had recurrent disease. An unexpected FDG-avid hepatic metastasis was identified. Follow-up contrast-enhanced CT scan showed a hepatic lesion, compatible with malignancy. Histopathologic examination demonstrated metastatic carcinoma, consistent with thyroid primary. Few studies reported liver metastases originating from thyroid cancer on FDG PET. These were medullary thyroid carcinomas (MTC) or poorly differentiated cancers. There are no reports describing liver metastasis from PTC diagnosed by FDG PET/CT.

    View details for DOI 10.1097/RLU.0b013e318262ae07

    View details for Web of Science ID 000307808000007

    View details for PubMedID 22889801

  • Thyroid Stunning: Fact or Fiction? SEMINARS IN NUCLEAR MEDICINE McDougall, I. R., Iagaru, A. 2011; 41 (2): 105-112

    Abstract

    Stunning of thyroid tissue by diagnostic activities of (131)I has been described by some investigators and refuted by others. The support both for and against stunning has at times been enthusiastic and vigorous. We present the data from both sides of the debate in an attempt to highlight the strengths and deficiencies in the investigations cited. Clinical, animal, and in vitro studies are included. There are considerable differences in clinical practice, such as the administered activity for diagnostic whole-body scan, delay between diagnostic scan and treatment, time between treatment and posttherapy scanning, and timing of follow-up studies, that have to be analyzed with care. Other factors that often cannot be judged, such as levels of thyroid-stimulating hormone and serum iodine at time of diagnostic testing versus treatment could have an influence on stunning. Larger diagnostic doses and longer delays to therapy appear to increase the likelihood of stunning. The stunning effect of early-absorbed radiation from the therapy should also be considered.

    View details for DOI 10.1053/j.semnuclmed.2010.10.004

    View details for Web of Science ID 000287263600006

    View details for PubMedID 21272684

  • Cutaneous Graft-Versus-Host Disease on Tc-99m Leukocyte Scintigraphy CLINICAL NUCLEAR MEDICINE Mittra, E., McDougall, I. R. 2009; 34 (12): 894-895

    View details for Web of Science ID 000272363600012

    View details for PubMedID 20139825

  • Efficacy of F-18-FDG PET/CT in the evaluation of patients with recurrent cervical carcinoma EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Mittra, E., El-Maghraby, T., Rodriguez, C. A., Quon, A., McDougall, I. R., Gambhir, S. S., Iagaru, A. 2009; 36 (12): 1952-1959

    Abstract

    Only a limited number of studies have evaluated the efficacy of 18F-FDG PET/CT for recurrent cervical carcinoma, which this study seeks to expand upon.This is a retrospective study of 30 women with cervical carcinoma who had a surveillance PET/CT after initial therapy. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated using a 2 × 2 contingency table with pathology results (76%) or clinical follow-up (24%) as the gold standard. The Wilson score method was used to perform 95% confidence interval estimations.The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for the detection of local recurrence at the primary site were 93, 93, 93, 86, and 96%, respectively. The same values for the detection of distant metastases were 96, 95, 95, 96, and 95%, respectively. Seventy-one percent of the scans performed in symptomatic patients showed true-positive findings. In comparison, 44% of scans performed in asymptomatic patients showed true-positive findings. But, all patients subsequently had a change in their management based on the PET/CT findings such that the effect was notable. The maximum standardized uptake value ranged from 5 to 28 (average: 13 ± 7) in the primary site and 3 to 23 (average: 8 ± 4) in metastases which were significantly different (p = 0.04).This study demonstrates favorable efficacy of 18F-FDG PET/CT for identification of residual/recurrent cervical cancer, as well as for localization of distant metastases.

    View details for DOI 10.1007/s00259-009-1206-x

    View details for Web of Science ID 000271979300004

    View details for PubMedID 19585114

  • F-18-FDG PET/CT evaluation of patients with ovarian carcinoma NUCLEAR MEDICINE COMMUNICATIONS Iagaru, A. H., Mittra, E. S., McDougall, I. R., Quon, A., Gambhir, S. S. 2008; 29 (12): 1046-1051

    Abstract

    The role of F-FDG PET has been studied in ovarian carcinoma, but its sensitivity and specificity calculations are based on dedicated PET acquisition, not PET/CT in the majority of the published studies. Therefore, we were prompted to review our experience with PET/CT in the management of patients with ovarian carcinoma.This is a retrospective study of 43 women with ovarian carcinoma, 27-80 years old (average: 53.9+/-7.8), who had whole-body PET/CT at our institution from 1 January 2003 to 31 August 2006. We reviewed the patients' outcomes from medical records and compared them to the interpretation of the PET/CT scans. Sensitivity and specificity were calculated using a 2 x 2 table with pathology results (79.1% of the patients) or clinical follow-up (20.9% of the cases) as the 'gold standard'. Confidence interval (CI) estimations were performed using the Wilson score method.All patients had advanced stage ovarian cancer and the study was requested for re-staging. A total of 60 scans were performed: 30 patients had one scan, nine patients had two scans and four patients had three scans. The administered doses of F-FDG ranged from 381.1 to 769.6 MBq (average: 569.8+/-73.3). PET/CT had a sensitivity of 88.4% (95% CI: 75.1-95.4) and a specificity of 88.2% (95% CI: 64.4-97.9) for detection of ovarian cancer. The SUV max of the detected lesions ranged from 3 to 27 (average: 9.4+/-5.9). The CA-125 tumor marker ranged from 3 to 935 kU/ml (average: 265.2) in patients with positive scans and 4-139 kU/ml (average: 17.1) in patients with negative scans. This difference was statistically significant (P value: 0.0242).This study confirms the good results of F-FDG PET/CT for identification of residual/recurrent ovarian cancer, as well as for distant metastases localization. PET/CT should be an integral part in evaluation of patients with high-risk ovarian cancer or rising values of tumor markers (CA-125), prior to selection of the most appropriate therapy.

    View details for DOI 10.1097/MNM.0b013e32831089cb

    View details for Web of Science ID 000261164200004

    View details for PubMedID 18987524

  • Uncommon causes of thyrotoxicosis JOURNAL OF NUCLEAR MEDICINE Mittra, E. S., Niederkohr, R. D., Rodriguez, C., El-Maghraby, T., McDougall, I. R. 2008; 49 (2): 265-278

    Abstract

    Apart from the common causes of thyrotoxicosis, such as Graves' disease and functioning nodular goiters, there are more than 20 less common causes of elevated free thyroid hormones that produce the symptoms and signs of thyrotoxicosis. This review describes these rarer conditions and includes 14 illustrative patients. Thyrotropin and free thyroxine should be measured and, when the latter is normal, the free triiodothyronine level should be obtained. Measurement of the uptake of (123)I is recommended for most patients.

    View details for DOI 10.2967/jnumed.107.041202

    View details for Web of Science ID 000252866300035

    View details for PubMedID 18199610

  • Incidental gallbladder visualization on nonhepatobiliary nuclear medicine studies - Case series and review of the literature CLINICAL NUCLEAR MEDICINE Niederkohr, R. D., McDougall, I. R. 2007; 32 (12): 915-919

    Abstract

    Gallbladder uptake is occasionally encountered with commonly used nonhepatobiliary radiopharmaceuticals. Identification of the biliary tract by a nonhepatobiliary agent can identify disease, such as uptake of labeled white blood cells. However, in most cases, gallbladder uptake of nonhepatobiliary tracers is not due to pathology in these cases. It is important to avoid attributing gallbladder uptake to disease in the gallbladder or adjacent anatomic structures. We present 3 cases of unexpected gallbladder tracer uptake and provide a review of the literature describing incidental gallbladder uptake on nonhepatobiliary nuclear medicine studies. The potential for misdiagnosis and the steps taken to avoid this are discussed.

    View details for Web of Science ID 000251208500002

    View details for PubMedID 18030040

  • Treatment of micropapillary carcinoma of the thyroid: Where do we draw the line? THYROID McDougall, I. R., Camargo, C. A. 2007; 17 (11): 1093-1096

    Abstract

    Two patients with papillary thyroid cancer were seen in consultation after they had been treated in other medical centers. Their cancers measured 1 and 1.2 mm, respectively. Both patients were treated by two thyroid operations and (131)I ablation. We believe that, apart from lobectomy, these therapies were not justified. We draw attention to this to provide a topic for debate and to attempt to prevent this happening to other patients.

    View details for DOI 10.1089/thy.2007.0203

    View details for Web of Science ID 000251445700010

    View details for PubMedID 18047431

  • F-18 FDG PET/CT in the management of thyroid cancer CLINICAL NUCLEAR MEDICINE Iagaru, A., Kalinyak, J. E., McDougall, I. R. 2007; 32 (9): 690-695

    Abstract

    There are approximately 32,000 new cases of thyroid carcinoma annually in the United States. F-18 FDG PET/CT has an established role in cancer management, including thyroid cancer, usually in patients who are thyroglobulin (Tg) positive/iodine negative. We reviewed our experience with F-18 FDG PET/CT in thyroid cancer, with an emphasis on correlation with Tg, and maximum standardized uptake values (SUV). We also analyzed the role of thyroid stimulating hormone (TSH) on PET/CT results.This is a retrospective study (January 2003 to December 2006) of 76 patients with differentiated thyroid cancer, who had F-18 FDG PET/CT scans. There were 44 women and 32 men, with age range of 20 to 81 years (average, 51.1 +/- 18.1). The administered doses of F-18 FDG ranged from 396 to 717 MBq (15.8-19.4 mCi) (average, 566 +/- 74.8) (15.3 +/- 2). Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.A total of 98 PET/CT scans were analyzed (59 patients had 1 scan, 12 patients had 2, and 5 patients had 3). PET/CT was 88.6% sensitive (95% CI: 78.-94.3) and 89.3% specific (95% CI: 71.9-97.1). Mean Tg level was 1203 ng/mL (range, 0.5-28,357) in patients with positive PET/CT and 9.72 ng/mL (range, 0.5-123.0) in patients with negative PET/CT scans (P = 0.0389). Mean SUV max was 10.8 (range, 2.5-32) in the thyroid bed recurrence/residual disease and 7.53 (range, 2.5-26.2) in metastatic lesions (P = 0.0114). Mean SUV max in recurrent/residual disease in patients with TSH 30 mIU/L was 8.1 (range, 2.6-32) (P = 0.2994).F-18 FDG PET/CT had excellent sensitivity (88.6%) and specificity (89.3%) in this patient population. Metastatic lesions were reliably identified, but were less F-18 FDG avid than recurrence/residual disease in the thyroid bed. TSH levels at the time of PET/CT did not appear to impact the FDG uptake in the lesions or the ability to detect disease. In the setting of high or rising levels of Tg, our study confirms that it is indicated to include PET/CT in the management of patients with differentiated thyroid cancer.

    View details for Web of Science ID 000248959000004

    View details for PubMedID 17710020

  • Recurrent silent thyroiditis: A report of four patients and review of the literature THYROID Mittra, E. S., McDougall, I. R. 2007; 17 (7): 671-675

    Abstract

    Silent thyroiditis, excluding postpartum thyroiditis and destructive amiodarone thyroiditis, is a relatively uncommon cause of thyrotoxicosis and recurrent cases are even rarer. We present four patients with recurrent silent thyroiditis. The number of episodes ranged from two to nine. All four patients had episodes that were similar in duration (4-6 weeks) as well as in their clinical (no viral prodrome or neck pain), biochemical (high total triiodothyronine [T(3)], free thyroxine [T(4)], and low thyrotropin [TSH] presence of antibodies to thyroid antigens), and scintigraphic (low radioiodine uptake) findings. Individual symptoms and symptom-free duration (from 1 to 4 years) were more variable. No associations were found with regard to medications, pregnancies, or other disease states previously implicated in thyroiditis. One patient was unsuccessfully prescribed thyroid hormone to prevent recurrence. Three were treated with radioablative iodine therapy during the recovery phase of an episode; they became hypothyroid and take replacement l-thyroxine. They have remained symptom free.

    View details for DOI 10.1089/thy.2006.0335

    View details for Web of Science ID 000248742000011

    View details for PubMedID 17696838

  • Reproducibility of whole-body I-131 scan and serum thyrotropin and stimulated thyroglobulin values in patients studied twice after injection of recombinant human thyrotropin EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Niederkohr, R. D., McDougall, I. R. 2007; 34 (3): 363-367

    Abstract

    Recombinant human TSH (rhTSH) is used to increase radioiodine uptake during imaging of thyroid cancer, obviating the need to render the patient hypothyroid. We assessed the reproducibility of radioiodine uptake, serum thyrotropin (TSH), and stimulated serum thyroglobulin (Tg) levels after rhTSH administration.A retrospective review was performed of patients at Stanford who underwent whole-body (131)I scanning for surveillance of thyroid cancer twice after thyroidectomy and (131)I ablation, with rhTSH prior to each scan. Forty-eight hour radioiodine uptake, peak serum TSH, and stimulated serum Tg levels for each study were recorded. Paired t tests and correlation analysis were used to assess interexamination repeatability.Twenty-three patients underwent two scintiscans with rhTSH, for a total of 46 exams. There was no significant difference between percent uptake at 48 h in the paired exams (p=0.40). Serum TSH level was measured in 45 of 46 exams; TSH exceeded 50 mIU/l in all cases, and there was no significant difference between paired TSH levels (p=0.93). All patients had stimulated serum Tg levels measured, with no significant difference between paired Tg levels (p=0.40); after excluding one patient whose Tg changed from 15.8 ng/ml to undetectable between scans without interval treatment, the p value rose to 0.95. There was a strong correlation among paired uptake values (r=0.85, p<0.0001), peak serum TSH (r=0.69, p=0.0003), and stimulated Tg levels (r=0.81, p<0.0001). No discordant scan interpretations were reported.Forty-eight hour radioiodine uptake, peak serum TSH, and stimulated serum Tg levels after administration of rhTSH are repeatable between studies, demonstrating reproducibility of diagnostic results without rendering patients hypothyroid.

    View details for DOI 10.1007/s00259-006-0227-y

    View details for Web of Science ID 000244294600009

    View details for PubMedID 17021814

  • Treatment of thyrotoxicosis JOURNAL OF NUCLEAR MEDICINE Iagaru, A., McDougall, I. R. 2007; 48 (3): 379-389

    Abstract

    In this review, the causes of thyrotoxicosis and the treatment of syndromes with increased trapping of iodine are discussed. The benefits and the potential side effects of 3 frequently used therapies--antithyroid medications, thyroidectomy, and (131)I treatment--are presented. The different approaches to application of (131)I treatment are described. Treatment with (131)I has been found to be cost-effective, safe, and reliable.

    View details for Web of Science ID 000244937400016

    View details for PubMedID 17332615

  • F-18 FDG PET/CT imaging of a subcutaneous scalp metastasis from primary carcinoma of the thyroid CLINICAL NUCLEAR MEDICINE Niederkohr, R. D., Dadras, S. S., Leavitt, M., McDougall, I. R. 2007; 32 (2): 162-164

    View details for Web of Science ID 000243782800023

    View details for PubMedID 17242580

  • F-18FDG PET/CT demonstration of an adrenal metastasis in a patient with anaplastic thyroid cancer CLINICAL NUCLEAR MEDICINE Iagaru, A., McDougall, I. R. 2007; 32 (1): 13-15

    Abstract

    An adrenal metastasis was identified on an F-18 FDG PET/CT scan in a patient with anaplastic thyroid cancer. There are very few reports of thyroid cancer, even anaplastic thyroid cancer, metastasizing to the adrenal.

    View details for Web of Science ID 000243200800004

    View details for PubMedID 17179796

  • Clinical role of F-18-FDG PET/CT in the management of squamous cell carcinoma of the head and neck and thyroid carcinoma JOURNAL OF NUCLEAR MEDICINE Quon, A., Fischbein, N. J., McDougall, I. R., Le, Q., Loo, B. W., Pinto, H., Kaplan, M. J. 2007; 48: 58S-67S

    Abstract

    18F-FDG PET/CT has rapidly become a widely used imaging modality for evaluating a variety of malignancies, including squamous cell carcinoma of the head and neck and thyroid cancer. Using both published data and the multidisciplinary experience at our institution, we provide a practical set of guidelines and algorithms for the use of 18F-FDG PET/CT in the evaluation and management of head and neck cancer and thyroid cancer.

    View details for Web of Science ID 000243420900008

    View details for PubMedID 17204721

  • 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography/computed tomography in the management of melanoma MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Quon, A., Johnson, D., Gambhir, S. S., McDougall, I. R. 2007; 9 (1): 50-57

    Abstract

    2-Deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is widely available as a powerful imaging modality, combining the ability to detect active metabolic processes and their morphologic features in a single exam. The role of FDG-PET is proven in a variety of cancers, including melanoma, but the estimates of sensitivity and specificity are based in the majority of the published studies on dedicated PET, not PET/CT. Therefore, we were prompted to review our experience with FDG-PET/CT in the management of melanoma.This is a retrospective study on 106 patients with melanoma (20-87 years old; average: 56.8 +/- 15.9), who had whole-body FDG-PET/CT at our institution from January 2003 to June 2005. Thirty-eight patients (35.9%) were women and 68 patients (64.1%) were men. Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.All patients had the study for disease restaging. The primary tumor depth (Breslow's thickness) at initial diagnosis was available for 76 patients (71.7%) and ranged from 0.4 to 25 mm (average: 3.56 mm). The anatomic level of invasion in the skin (Clark's level) was determined for 70 patients (66%): 3, level II; 13, level III; 43, level IV; 11, level V. The administered dose of (18)F FDG ranged from 9.8 to 21.6 mCi (average: 15.4 +/- 1.8 mCi). FDG-PET/CT had a sensitivity of 89.3% [95% confidence interval (CI): 78.5-95] and a specificity of 88% (95% CI: 76.2-94.4) for melanoma detection.This study confirms the good results of FDG-PET/CT for residual/recurrent melanoma detection, as well as for distant metastases localization. PET/CT should be an integral part in evaluation of patients with high-risk melanoma, prior to selection of the most appropriate therapy.

    View details for DOI 10.1007/s11307-006-0065-0

    View details for Web of Science ID 000243545600007

    View details for PubMedID 17051322

  • F-18FDG PET/CT evaluation of osseous and soft tissue sarcomas CLINICAL NUCLEAR MEDICINE Iagaru, A., Quon, A., McDougall, T. R., Gambhir, S. S. 2006; 31 (12): 754-760

    Abstract

    Osseous and soft tissue sarcomas (OSTS) represent a histologic heterogeneous group of malignant tumors. Most of the current clinical data on the role of F-18 FDG PET in sarcomas come from patients studied with dedicated PET and less frequently with hardware fusion PET/CT. Therefore, we were prompted to review our experience with F-18 FDG PET/CT in OSTS.This is a retrospective study (January 2003-December 2005) of 44 patients with histologic diagnoses of OSTS who had F-18 FDG PET/CT at our institution. The group included 22 men and 22 women with an age range of 2 of 84 years (average, 37 +/- 20.2 years). The administered doses of F-18 FDG range 4.1 to 19.5 mCi (average, 14.3 +/- 3 mCi). Reinterpretation of the imaging studies for accuracy and data analysis from medical records was performed.The sensitivity and specificity of combined F-18 FDG PET/CT were 100% (95% confidence interval [CI] = 75.7-100) and 93.3% (95% CI = 78.7-98.1) for the primary OSTS, and 80% (95% CI = 58.4-91.9) and 86.4% (95% CI = 66.7-95.2) for metastases. When interpreted separately, CT outperformed PET for pulmonary metastases detection: CT was 76.5% sensitive and 88% specific, whereas PET was only 57.1% sensitive but 96.4% specific. For detection of other metastases, CT was 82.3% sensitive and 76% specific, with PET demonstrating 78.6% sensitivity and 92.8% specificity.Relatively similar results (except better specificity for PET and PET/CT) were noted when examining the rate of metastases detection, excluding pulmonary lesions. However, CT had a better detection rate for pulmonary metastases when compared with PET alone. A negative PET scan in the presence of suspicious CT findings in the chest cannot reliably exclude pulmonary metastases from OSTS.

    View details for Web of Science ID 000242481400004

    View details for PubMedID 17117068

  • Burkitt's lymphoma presenting as a rapidly growing thyroid mass THYROID Kalinyak, J. E., Kong, C. S., McDougall, I. R. 2006; 16 (10): 1053-1057

    Abstract

    A 53-year-old man was admitted to the hospital because of tracheal compressive symptoms from a rapidly expanding thyroid mass. The patient first noticed the nodule less than a week prior to admission. Thyroid tests were normal. A fine-needle aspiration (FNA) biopsy showed a monotonous population of intermediate-sized lymphoid cells with scant cytoplasm suspicious for lymphoma. Twelve hours later an emergent computed tomography (CT) scan confirmed left tracheal deviation with compression, however, there were no signs of tumor invasion. The patient received emergent CHOP (clophosphamide, adriamycin, vincristine, prednisone) and rituxan therapy. His mass completely resolved within 36 hours. Bone marrow biopsy provided the final diagnosis of stage IV Burkitt's lymphoma and his therapy was changed to hyper CVAD-R chemotherapy (cytoxan, vincristine, adriamycin, dexamethasone, rituxan). The patient's hospital course was complicated by tumor lysis syndrome that was managed by hydration and allopurinol. To our knowledge, this is only the second reported case of Burkitt's lymphoma presenting as a thyroid mass. His presentation highlights the urgency in diagnosis and provides an opportunity to review a rare type of primary thyroid lymphoma.

    View details for Web of Science ID 000241981900018

    View details for PubMedID 17042693

  • Merkel cell carcinoma: Is there a role for 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography/computed tomography? MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Quon, A., McDougall, I. R., Gambhir, S. S. 2006; 8 (4): 212-217

    Abstract

    2-Deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is becoming widely available as a powerful imaging modality, combining the ability to detect active metabolic processes and their morphologic features in a single study. The role of FDG-PET/CT is proven in lymphoma, melanoma, colorectal carcinoma, and other cancers. However, there are rare malignancies such as Merkel cell carcinoma that can potentially be evaluated with PET/CT. We were therefore prompted to review our experience with FDG-PET/CT in the management of patients with Merkel cell carcinoma.This is a retrospective case series of six patients with Merkel cell carcinoma, 58-81 years old (average 69 +/- 8.3), who had whole-body PET/CT at our institution from January 1st, 2003 to August 31st, 2005. Two patients were women and four were men. Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.Twelve examinations were acquired for the six patients (one patient had six PET/CT, one patient had two PET/CT, and four patients had one PET/CT). The injected FDG doses ranged 381.1-669.7 MBq (average 573.5 +/- 70.3). Four patients had the PET/CT as part of initial staging, and two patients had the exam for restaging (after surgery and XRT). A total of six Merkel lesions (pancreas, adrenal, lip, submandibular lymph nodes, cervical lymph nodes, and parapharyngeal soft tissue) were identified in three patients and confirmed on histopathological examination. The FDG uptake in these areas was intense, with maximum standardized uptake value (SUVmax) values of 5-14 (average 10.4 +/- 3.8). In one patient, the PET/CT scan identified abnormal focal distal sigmoid uptake that was biopsied and diagnosed as adenocarcinoma. Two patients had negative scans and had no clinical evidence of disease on follow-up office visits (up to one year after PET/CT).This case series suggests that FDG-PET/CT may have a promising role in the management of patients with Merkel cell carcinoma.

    View details for DOI 10.1007/s11307-006-0047-2

    View details for Web of Science ID 000239124800003

    View details for PubMedID 16724293

  • Metastatic struma ovarii: The burden of truth CLINICAL NUCLEAR MEDICINE McDougall, I. R. 2006; 31 (6): 321-324

    Abstract

    A 58-year-old woman was found to have metastatic thyroid cancer in her liver. This was identified when she was investigated for upper abdominal pain and underwent biopsy of hepatic lesions. She had no palpable thyroid nodule and had a normal ultrasound of the thyroid. Previously, both ovaries had been removed because of tumors. The pathologic findings in one of the ovaries could not be recovered because the procedure was more than 40 years ago, when the patient was a teenager. By a process of elimination, a diagnosis of metastatic struma ovarii was established. Treatment of metastatic thyroid cancer from struma ovarii, including removal of the normal thyroid and administration of I-131, is presented.

    View details for Web of Science ID 000237907700002

    View details for PubMedID 16714888

  • Whole-body scanning with radionuclides of iodine, and the controversy of 'thyroid stunning' NUCLEAR MEDICINE COMMUNICATIONS Kalinyak, J. E., McDougall, I. R. 2004; 25 (9): 883-889

    View details for Web of Science ID 000223729200004

    View details for PubMedID 15319592

  • Elephantiasic prefibial myxedema THYROID Cohen, J. B., Balzer, B., Wapnir, I., McDougall, I. R. 2004; 14 (3): 237-238

    View details for Web of Science ID 000220580300011

    View details for PubMedID 15072707

  • Clinical implications of the differences between diagnostic I-123 and post-therapy I-131 scans NUCLEAR MEDICINE COMMUNICATIONS Cohen, J. B., Kalinyak, J. E., McDougall, I. R. 2004; 25 (2): 129-134

    Abstract

    123I has been promoted for diagnostic imaging as a means of avoiding 'stunning'. It has also been suggested that the more favourable physical characteristics and consequent enhanced imaging resolution provided by 123I offers a more accurate diagnostic assessment of the extent of disease prior to therapy. This study evaluated pairs of diagnostic 123I and post-therapy 131I scans for differences in patterns of radioiodine uptake.Thirty-eight patients (31 women and seven men) with a history of differentiated thyroid cancer underwent 41 diagnostic 123I studies. 131I therapy was administered to 29 patients as soon as possible after positive diagnostic findings were confirmed (with one patient being treated twice during the study period, making 30 treatments). Post-treatment scans were obtained an average of 5.8 days after therapy.Qualitative comparison of diagnostic 123I and post-therapy 131I scans revealed a decrease in the extent of post-treatment uptake in four of the 30 treatments (13%). Seven patients (23%) demonstrated increased uptake on their post-therapy 131I scan.Because the physical characteristics of 123I make it inconceivable that it could cause stunning, the decrease in post-treatment uptake seen in 13% of patients from this series increases the likelihood that this pattern is due to factors other than stunning, such as differential rates of radioiodine turnover. In addition, the increase in extent of post-therapy uptake seen in 23% of patients suggests that diagnostic imaging with 123I is vulnerable to the same pre-therapy staging inaccuracies as is low-dose diagnostic imaging with 131I. Further work is needed to determine whether larger diagnostic doses of 123I might mitigate this problem.

    View details for DOI 10.1097/01.mnm.0000116974.02363.cb

    View details for Web of Science ID 000220962600006

    View details for PubMedID 15154700

  • Common and uncommon sonographic features of papillary thyroid carcinoma JOURNAL OF ULTRASOUND IN MEDICINE Chan, B. K., Desser, T. S., McDougall, I. R., Weigel, R. J., Jeffrey, R. B. 2003; 22 (10): 1083-1090

    Abstract

    To determine the relative frequency of various sonographic findings in papillary carcinoma of the thyroid.We retrospectively analyzed the sonographic features in 55 patients with proven papillary carcinoma of the thyroid. Sonographic features analyzed were echo texture, cystic change, margin, contour, presence of a peripheral halo, vascularity, and calcification pattern. Features were classified as common (> or = 35% of cases) or uncommon (< 10% of cases). Combinations of features were also analyzed.Common sonographic features of papillary carcinoma included hypoechoic texture (86%), microcalcifications (42%) or no calcifications (47%), well-defined margins (47%), and intrinsic hypervascularity (69%). Uncommon features included hyperechoic or mixed echo texture, cystic elements, irregular margins, hypovascularity, and coarse or peripheral calcifications. Of the 29 lesions that had calcifications, 20 (69%) had microcalcifications; 5 (17%) had coarse calcifications; and 1 had peripheral calcifications. In total, 54% of cases had at least 1 uncommon feature, and 11% had 2 or more uncommon features. Cystic carcinomas were rare and accounted for only 6% of lesions; all had hypervascular solid components. No carcinomas in our series were completely avascular.There is a broad spectrum of sonographic findings in papillary carcinoma of the thyroid. Half of the lesions in this series had at least 1 uncommon sonographic feature.

    View details for Web of Science ID 000185658300011

    View details for PubMedID 14606565

  • Modern management of differentiated thyroid cancer CANCER BIOTHERAPY AND RADIOPHARMACEUTICALS Cohen, J. B., Kalinyak, J. E., McDougall, I. R. 2003; 18 (5): 689-705

    Abstract

    The outcome in differentiated thyroid cancer is excellent. Simple prognostic factors, including the age of the patient at diagnosis, the size of the primary cancer, completeness of surgical excision, and the presence of distant metastases, allow the clinician to judge how a patient will do. The preferred treatment is total thyroidectomy and in selected patients radioactive iodine can be used to ablate residual thyroid or functioning metastases in lymph nodes and distant sites. The physician has two excellent methods for following the patient: the whole-body scan with radionuclides of iodine, and measurement of serum thyroglobulin. In patients with elevated thyroglobulin and negative scans with radioactive iodine, there is increasing evidence that positron emission tomography (PET) is helpful in locating the site of thyroglobulin production.

    View details for Web of Science ID 000186592600003

    View details for PubMedID 14629818

  • The interpretation of I-131 scans in the evaluation of thyroid cancer, with an emphasis on false positive findings NUCLEAR MEDICINE COMMUNICATIONS Carlisle, M. R., Lu, C., McDougall, I. R. 2003; 24 (6): 715-735

    Abstract

    Radioiodine has aided the management of differentiated thyroid cancer for several decades. Most thyroid cancers retain the ability to trap iodine, and radionuclides of iodine can be used both diagnostically and therapeutically. The availability of sensitive diagnostic tests, coupled with the ability to deliver targeted therapy, gives physicians the ability to manage thyroid cancer better than with any other type of cancer. The correct interpretation of radioiodine scans is critical in the appropriate management of patients with thyroid cancer. False positive findings do occur. A radioiodine scan showing abnormal uptake outside the thyroid bed must be studied carefully and alternative reasons for the finding must be considered. The scan should be analysed systematically. Is there residual thyroid? If so, what is the 48 or 72 h neck uptake? Radioiodine uptake in the salivary glands, stomach, gastrointestinal and urinary tracts should be acknowledged as physiological. Diffuse uptake is seen in the liver in most patients with functioning thyroid at the time of their post-therapy scan. When there is uptake of the radioiodine outside these regions, contamination must be considered. A variety of cases illustrating true positive, true negative, and false positive findings is presented in this review, and the causes and consequences of misinterpretation of radioiodine scans are discussed.

    View details for DOI 10.1097/01.mnm.0000075202.18521.ab

    View details for Web of Science ID 000183373800015

    View details for PubMedID 12766609

  • Ectopic intrathyroidal thymoma: A case report and review THYROID Cohen, J. B., Troxell, M., Kong, C. S., McDougall, I. R. 2003; 13 (3): 305-308

    Abstract

    Ectopic intrathyroidal thymomas are an exceedingly rare clinical entity that can be challenging to diagnose. This report describes a 39-year-old Japanese woman who presented with prominent left-sided thyroid enlargement that was thought to be a dominant thyroid nodule by ultrasound. Two fine-needle aspiration biopsies showed an atypical lymphoid proliferation that was suspicious for although not diagnostic of a low-grade lymphoma. A diagnosis of ectopic intrathyroidal thymoma was made only after appropriate histopathologic assessment of the surgical specimen.

    View details for Web of Science ID 000182200000012

    View details for PubMedID 12729482

  • Intraoperative ultrasonography improves identification of recurrent thyroid cancer SURGERY Karwowski, J. K., Jeffrey, R. B., McDougall, I. R., Weigel, R. J. 2002; 132 (6): 924-928

    Abstract

    Surgical resection is the only curative treatment option for locoregional recurrence of well-differentiated thyroid cancer that does not trap radioiodine. We hypothesized that intraoperative ultrasonography would aid in the localization of recurrent thyroid cancer and would enhance the ability to perform a complete resection.Between June 2000 and October 2001, 13 patients with recurrent, scan-negative, papillary thyroid cancer were explored by using intraoperative ultrasonography.All patients had identification and resection of recurrent papillary thyroid cancer. Eleven patients had a complete resection, and 2 patients had incomplete resection as a result of local invasion. Ultrasound was required for identification of tumor in 7 patients and included all patients with a history of external beam radiotherapy. In 6 of these 7 patients, the tumor was paratracheal or invasive into the trachea or thyroid cartilage. In 11 patients with detectable serum thyroglobulin preoperatively, the level demonstrated a decline in 10 patients and became undetectable in 7 patients.Intraoperative ultrasonography is a useful method to identify nonpalpable, locoregional recurrences of thyroid cancer. Ultrasound was particularly helpful in patients who had previous external beam radiotherapy and in the identification of tumor nodules of 20 mm or less that were invasive or adherent to the airway.

    View details for DOI 10.1067/msy.2002.128478

    View details for Web of Science ID 000180123000004

    View details for PubMedID 12490837

  • Needle track seeding of papillary thyroid carcinoma from fine needle aspiration biopsy - A case report ACTA CYTOLOGICA Karwowski, J. K., Nowels, K. W., McDougall, I. R., Weigel, R. J. 2002; 46 (3): 591-595

    Abstract

    Dissemination of tumor cells from needle biopsy has been observed in a wide range of tumor types. Fine needle aspiration (FNA) biopsy has become accepted as the first-line test in the evaluation of thyroid nodules. Local recurrence of thyroid cancer from needle track seeding is an extremely rare complication of thyroid FNA.A 59-year-old woman developed local recurrence of papillary thyroid carcinoma three years after FNA of the primary cancer. Local metastases developed in the skin and sternocleidomastoid muscle. The location of the recurrent cancer and the linear relationship of the metastases indicated that local recurrence was due to needle track seeding at the time of FNA.Needle track seeding has been recognized as a possible, albeit rare, complication of FNA of thyroid cancer. Although proper FNA technique can reduce the potential for needle track seeding, its occurrence is an unavoidable complication of FNA evaluation of thyroid malignancies.

    View details for Web of Science ID 000175644700026

    View details for PubMedID 12040660

  • Thyroid carcinoma after successful treatment of osteosarcoma: A report of three patients JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Verneris, M., McDougall, I. R., Becton, D., Link, M. P. 2001; 23 (5): 312-315

    Abstract

    We report three cases of papillary thyroid carcinoma occurring after successful treatment of osteosarcoma. Only one of the three patients received radiation therapy (to the chest) as part of the primary treatment of osteosarcoma. The onset of thyroid carcinoma occurred between 8 and 16 years from the cessation of osteosarcoma therapy. All patients are alive and disease-free from both malignancies. Whereas the association between osteosarcoma and thyroid carcinoma has not previously been recognized, there have been five case reports of these two entities occurring in the same patient. Three of these cases occurred in patients with Werner syndrome. None of the patients reported here had physical stigmata of Werner syndrome or a family history consistent with a hereditary cancer syndrome. Thyroid carcinoma occurs infrequently in patients with osteosarcoma, but in view of the rarity of these two disorders, this association may represent an inherited predisposition to these malignancies.

    View details for Web of Science ID 000169804200014

    View details for PubMedID 11464990

  • Positron emission tomography of the thyroid, with an emphasis on thyroid cancer NUCLEAR MEDICINE COMMUNICATIONS McDougall, I. R., Davidson, J., Segall, G. M. 2001; 22 (5): 485-492

    Abstract

    The role of Positron Emission Tomography (PET) using 18F-fluorodeoxyglucose (FDG) in the management of thyroid cancer is discussed. It is important to ensure that patients are relaxed because uptake of FDG in tense or active muscles in the neck and larynx can be misinterpreted as metastases. The major role for PET is in patients where the stage of disease is uncertain, usually the result of discordant negative 131I scan and a positive serum thyroglobulin (Tg) values. PET identifies the source of Tg production in 50-80% of patients. PET scan can be negative in well differentiated cancers which retain the ability to trap iodine. This can result in a 'flip/flop', with negative PET, positive radio-iodine scan, or positive PET, negative radioiodine scan. PET is also valuable in identifying the source of calcitonin production in patients with medullary thyroid cancer. When focal uptake is seen in the thyroid of patients who are scanned for non thyroidal reasons, the likelihood of primary thyroid cancer is high. In contrast diffuse uptake of FDG in the thyroid is usually the result of auto-immune thyroid disorders.

    View details for Web of Science ID 000168832200004

    View details for PubMedID 11388568

  • Intraoperative ultrasonography for localization of recurrent thyroid cancer SURGERY Desai, D., Jeffrey, R. B., McDougall, I. R., Weigel, R. J. 2001; 129 (4): 498-500

    Abstract

    Advances in measurement of thyroglobulin (Tg) and in imaging techniques including high resolution ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scan have increased our ability to detect thyroid cancer recurrences at an earlier stage. (1,2) After thyroidectomy, patients are often treated with radioiodine, but the recurrent cancers may not image with radioiodine. In these instances, the only definitive treatment is surgical resection. Reoperative neck surgery can be challenging, especially when trying to find a small cancer nodule within the central neck that contains dense fibrotic scar tissue. Herein we describe the use of intraoperative ultrasonography to identify the location of recurrent thyroid cancer. This technique can aid in tumor localization and may help to avoid complications such as recurrent nerve injury.

    View details for Web of Science ID 000167986600016

    View details for PubMedID 11283542

  • Management of thyroglobulin positive/whole-body scan negative: Is Tg positive/I-131 therapy useful? JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION McDougall, I. R. 2001; 24 (3): 194-198

    View details for Web of Science ID 000167875700013

    View details for PubMedID 11314751

  • Recombinant human thyrotropin in the management of thyroid cancer CURRENT OPINION IN ONCOLOGY McDougall, I. R., Weigel, R. J. 2001; 13 (1): 39-43

    Abstract

    Radioiodine has been shown to reduce recurrences and improve survival in well-differentiated thyroid cancer. To maximize the effectiveness of radioiodine therapy, patients are first treated by total thyroidectomy and then allowed to become hypothyroid. The elevation of thyroid-stimulating hormone, or thyrotropin (TSH), that occurs with hypothyroidism stimulates uptake of radioiodine in normal and cancerous thyroid tissues. A recent advance has been the introduction of recombinant human TSH (rhTSH), which is administered intramuscularly prior to testing with radioiodine. Phase III trials have demonstrated that rhTSH stimulates both uptake in and production of thyroglobulin by thyroid cells and the results are comparable to those of hypothyroid protocols in the majority of patients. Patients prefer the rhTSH protocol because they continue to ingest exogenous thyroid hormone and the symptoms of hypothyroidism are avoided. The rhTSH protocol is preferable in patients with pituitary dysfunction and in those who cannot tolerate hypothyroidism. RhTSH can also allow treatment of patients who have not had an adequate thyroidectomy and who are poor candidates for reoperation.

    View details for Web of Science ID 000166162300008

    View details for PubMedID 11148684

  • Dramatic parotid uptake of I-131 on a diagnostic whole-body scan CLINICAL NUCLEAR MEDICINE Carlisle, M. R., McDougall, I. R. 2000; 25 (11): 895-897

    Abstract

    Radiation sialadenitis is a complication of I-131 therapy for thyroid cancer. They authors report a case of intense uptake by parotid glands in a diagnostic I-131 scan (2 mCi) in whom sialadenitis had developed previously after a 100-mCi dose of I-131. Similar examples of images could not be found in the literature.

    View details for Web of Science ID 000165048600007

    View details for PubMedID 11079586

  • Recombinant human thyrotropin (rhTSH) in the management of differentiated thyroid cancer NUCLEAR MEDICINE COMMUNICATIONS Durski, J. M., Weigel, R. J., McDougall, I. R. 2000; 21 (6): 521-528

    Abstract

    Recombinant human thyrotropin (rhTSH) has been evaluated in 38 patients with differentiated thyroid cancer. The patients had all been treated previously by operation and 31 had received radioiodine 131I. The patients continued to take thyroid hormone and changed to a low iodine diet for 14 days before and throughout the week of testing. The rhTSH was injected intramuscularly on two consecutive days, 74 MBq 131I was administered on the next day and scintigraphy completed 48 h after that. TSH was measured before administration of 131I, and thyroglobulin after the scan. All patients preferred this method to withdrawal of thyroid hormone, but 45% had mild symptoms including headache and nausea. The average TSH was 127 mU x l(-1), and was inversely related to the weight of the patients. Thirty-four had negative scans with a mean uptake of 0.06%. Thyroglobulin values above 10 ng x ml(-1) were found in seven patients, of whom four had similar findings when scanned after withdrawal of thyroid hormone. Of four with positive scans, two had undetectable thyroglobulin. The rate of clearance of 131I was compared in patients studied at 72 h who were hypothyroid and at 48 h in euthyroid patients given rhTSH and was found to be longer in the latter. We conclude that rhTSH can be used to stimulate thyroid tissue to trap 131I and secrete thyroglobulin. Both scan and thyroglobulin should be obtained. The method is well tolerated.

    View details for Web of Science ID 000087457700004

    View details for PubMedID 10894560

  • Systemic radiation therapy with unsealed radionuclides SEMINARS IN RADIATION ONCOLOGY McDougall, I. R. 2000; 10 (2): 94-102

    Abstract

    Systemic unsealed radiation therapy is achieved when a radioactive substance is administered orally or parenterally and that material is concentrated in an organ or site for sufficient time to deliver a therapeutic dose of radiation. The radioactive material usually emits beta particles. In general, there is intense local radiation of the abnormal tissues, and normal organs, which do not trap the radioactive material, are exposed to a small radiation dose. The most frequent treatments involve radioiodine (131)I for hyperthyroidism and differentiated thyroid cancer. Other applications include treatment of painful skeletal metastases, polycythemia vera, malignant cysts, and neuroendocrine tumors. The treatments are usually well tolerated and not associated with long-term effects, such as cancer or infertility.

    View details for Web of Science ID 000086455600003

    View details for PubMedID 10727598

  • Uptake of I-131 in the biliary tract: A potential cause of a false-positive result of scintiscan CLINICAL NUCLEAR MEDICINE Carlisle, M., Cortes, A., McDougall, I. R. 1998; 23 (8): 524-527

    Abstract

    Focal uptake of I-131 in the region of the liver was seen on whole-body scans in a 22-year-old asymptomatic woman who had invasive papillary cancer. Hepatic metastases were unlikely because of the clinical risk factors, and a CT scan of the liver was normal. By superimposing the I-131 scintiscan and a hepatobiliary scan, the site of the uptake was shown to be in the biliary tract, and it had migrated to the gallbladder on more delayed images. No pathologic cause was found.

    View details for Web of Science ID 000075105000007

    View details for PubMedID 9712386

  • Ultrasound-guided fine-needle aspiration biopsy of thyroid masses THYROID Carmeci, C., Jeffrey, R. B., McDougall, I. R., Nowels, K. W., Weigel, R. J. 1998; 8 (4): 283-289

    Abstract

    The purpose of this study was to determine the impact of ultrasound-guided fine-needle aspiration biopsy (USFNA) in the cytological diagnosis of nodular thyroid disease. It remains unclear exactly what role USFNA should play in the cytological diagnosis of nodular thyroid disease. All patients who underwent fine-needle aspiration (FNA) for nodular thyroid disease at Stanford University Medical Center from 1991 to 1996 were included in the study. Histopathologic diagnoses were compared to cytological diagnoses for those patients who underwent surgery. FNA was performed on a total of 497 thyroid nodules. Palpation-guided FNA (pFNA) was performed on 370 nodules, and USFNA was done on 127. The USFNAs were performed for the following reasons: 95 (75%) for nonpalpable or difficult-to-palpate nodules; 14 (11%) for previously failed FNA; and 18 (14%) for incidentally detected nodules. FNA had an unsuccessful biopsy rate of 16% and a sensitivity and specificity of 89% and 69%, respectively. USFNA had an unsuccessful biopsy rate of 7% and a sensitivity and specificity of 100% and 100%, respectively. The cancer yield at surgery for pFNA was 40%, and the cancer yield at surgery for USFNA was 59%. The complementary use of USFNA with pFNA improves the diagnostic approach to nodular thyroid disease. The use of USFNA has increased the cancer yield at surgery and the sensitivity of thyroid biopsy at our institution.

    View details for Web of Science ID 000073292800002

    View details for PubMedID 9588492

  • I-131 treatment of I-131 negative whole body scan, and positive thyroglobulin in differentiated thyroid carcinoma: What is being treated? THYROID McDougall, I. R. 1997; 7 (4): 669-672

    Abstract

    Several aspects of the management of differentiated thyroid cancer cause considerable controversy. Among these is the role of 131I therapy in patients after thyroidectomy. There is no controlled study to demonstrate whether this treatment reduces the recurrence rate or improves mortality. Because of the overall excellent prognosis, it is unlikely that a controlled study will ever be conducted. Most frequently, patients have a diagnostic scan with 131I to determine whether radioiodine would be an appropriate therapy and to judge much to be prescribed, based on the extent of abnormalities seen on the scintiscan. Serum thyroglobulin (Tg) has been found to be a valuable tumor marker, with very good sensitivity and specificity. In most patients, the result of whole-body 131I scintiscan and Tg measurement give concordant results. However, in some patients, Tg is measurable, but the diagnostic scan with 131 is normal. There has been data published about treatment of these patients with therapeutic doses of 131I. The author questions whether this treatment is appropriate, prompted by seeing and hearing of patients who were treated with therapeutic doses of 131I, but had no abnormal uptake of the therapeutic doses and who had no improvement in serum Tg level. These patients have no clinical evidence of disease, and the only abnormality is measurable Tg. Since large doses of radioiodine are not without problems, a controlled clinical trial should be developed to evaluate efficacy in this situation.

    View details for Web of Science ID A1997XU74700022

    View details for PubMedID 9292959

  • 74 MBq radioiodine I-131 does not prevent uptake of therapeutic doses of I-131 (ie it does not cause stunning) in differentiated thyroid cancer NUCLEAR MEDICINE COMMUNICATIONS McDougall, I. R. 1997; 18 (6): 505-512

    Abstract

    Altogether, 147 scintiscans, completed 48-72 h after 74 MBq 131I, were compared with scintiscans obtained on average 7.8 days after therapeutic doses of 131I. The therapeutic doses ranged from 1100 to just over 7400 MBq. The reasons for the investigation were to determine (1) if the diagnostic dose interfered with uptake of the therapeutic dose and (2) how often more lesions, or greater extent of disease, was seen on the images using the larger therapy dose. The post-treatment scan showed less uptake in one region in 2 of the 147 patients (1.4%). The post-treatment scan showed more lesions in 12 patients (8%). In eight patients, the extent of disease, but not the stage of disease, was greater. In four patients, the stage of disease was increased, three due to lung uptake on the post-treatment scan which was not seen on the diagnostic scan and one due to uptake in lymph nodes on the post-treatment scan which was not present on the diagnostic scan. 74 MBq 131I seldom interferes with subsequent therapy and seldom underestimates the extent of thyroid cancer. It would appear to be an appropriate dose for diagnostic scintigraphy.

    View details for Web of Science ID A1997XM10500002

    View details for PubMedID 9259520

  • Diagnosis and localization of bronchopulmonary air leaks using ventilation scintigraphy CHEST Mark, J. B., McDougall, I. R. 1997; 111 (2): 286-289

    Abstract

    To determine the usefulness of radioaerosol ventilation scans for the detection and localization of air leaks from the lungs or bronchial tree.Selected patients with suspected air leaks underwent ventilation scans. Retrospective analysis of data was carried out.Twenty-eight hospitalized patients were included in the study.Ventilation scintigraphy using 99mTc-DTPA (technetium aerosol) was carried out in patients with air leaks.Of the total group, there were 50% true-positive scans, 36% true-negative scans, and 14% false-negative scans giving a sensitivity of 78%, specificity of 100%, and accuracy of 86%.99mTc-DTPA ventilation scintigraphy is useful in some patients with air leaks from the lung or tracheobronchial tree and may help to guide surgical intervention should this become necessary.

    View details for Web of Science ID A1997WH30400011

    View details for PubMedID 9041970

  • Persistent fever in a patient with polycystic kidney and liver diseases and bilateral hip prostheses JOURNAL OF NUCLEAR MEDICINE Kwok, C. G., McDougall, I. R. 1996; 37 (12): 2062-2065

    Abstract

    Persistent fever in a 60-yr-old man with polycystic kidney and liver diseases and bilateral hip prostheses was presented in this study. Multiple diagnostic tests failed to localize a source of infection. Subsequently, a combination of a 111In-oxine labeled WBC and 99mTc-sulfur colloid scans (and computer subtraction) demonstrated abnormally increased WBC activity in the left lobe of the liver, thus, diagnosis of an infected cyst (or cysts) was made. The patient responded to the treatment with antibiotics. This article discusses the clinical features of polycystic disease of the liver and kidneys. Infection in cysts are discussed as well as radiographic and scintigraphic investigations that can be used to diagnose and localize infection in a cyst.

    View details for Web of Science ID A1996VY98800040

    View details for PubMedID 8970535

  • What is the role of 1100 MBq (<30 mCi) radioiodine I-131 in the treatment of patients with differentiated thyroid cancer? NUCLEAR MEDICINE COMMUNICATIONS VanWyngaarden, M., McDougall, I. R. 1996; 17 (3): 199-207

    Abstract

    Based on pre-therapy whole-body 131I scintiscans showing only residual thyroid, 64 patients with differentiated thyroid cancer were treated with 1100 MBq ( < 30 mCi) 131I as out-patients. A follow-up whole-body scan with uptake measurements was made 6-12 months later. An uptake of 10%, this fell to 59%. A serum TSH > 10 microU ml-1 at the time of the first scan was associated with ablation (i.e. an uptake of < or = 0.3% on the follow-up scan) in 93% of patients. We recommend measurement of TSH and a whole-body scan to exclude regional or distant metastases, plus calculation of uptake in the neck to determine whether out-patient therapy with 1100 MBq is appropriate.

    View details for Web of Science ID A1996TZ72500005

    View details for PubMedID 8692486

  • WHOLE-BODY SCINTIGRAPHY WITH RADIOIODINE-131 - A COMPREHENSIVE LIST OF FALSE-POSITIVES WITH SOME EXAMPLES CLINICAL NUCLEAR MEDICINE McDougall, I. R. 1995; 20 (10): 869-875

    Abstract

    Whole-body scintigraphy with radioiodine-131 is an important diagnostic test in the management of patients with differentiated thyroid cancer who have undergone surgical treatment. The scan can demonstrate the presence of residual thyroid or functioning metastases in lymph nodes or distant sites. However, there are a number of potential pitfalls in the interpretation of this scan that could lead to a false-positive diagnosis of cancer. The scintiscans are presented for five patients in whom uptake outside of the thyroid was not due to functioning metastases. Some of these abnormalities are physiologic, such as uptake of iodine in the gastrointestinal tract. A comprehensive list of false-positive results are tabulated.

    View details for Web of Science ID A1995RY50900002

    View details for PubMedID 8616989

  • FAMILIAL DIFFERENTIATED CARCINOMA OF THE THYROID - REPORT OF 5 PAIRS OF SIBLINGS THYROID Kwok, C. G., McDougall, I. R. 1995; 5 (5): 395-397

    View details for Web of Science ID A1995TF02000010

    View details for PubMedID 8563479

  • HYPOTHYROID WOMEN NEED MORE THYROXINE WHEN PREGNANT JOURNAL OF FAMILY PRACTICE McDougall, I. R., MACLIN, N. 1995; 41 (3): 238-240

    Abstract

    There have been several published reports that hypothyroid women do not need to increase the dose of levothyroxine when they become pregnant.For this study, 20 pregnant women who were hypothyroid as a result of surgical thyroidectomy, radio-iodine therapy, or combination therapy were followed for the duration of their pregnancies. These patients were seen regularly, and evaluated clinically and by measurement of free thyroxine (FT4) and thyrotropin (thyroid-stimulating hormone [TSH]).The amount of levothyroxine that was adequate in the nonpregnant state was found to be inadequate during pregnancy. The dosage of levothyroxine given to these patients was increased by an average of 36 micrograms and returned to earlier levels after delivery. There was considerable individual variation in the requirement for additional levothyroxine during pregnancy.For hypothyroid pregnant patients, thyroid function tests, especially TSH, are recommended during each trimester to determine the need for additional levothyroxine.

    View details for Web of Science ID A1995RU78600011

    View details for PubMedID 7650501

  • TREATMENT GUIDELINES FOR PATIENTS WITH HYPERTHYROIDISM AND HYPOTHYROIDISM JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., NIKOLAI, T. F. 1995; 273 (10): 808-812

    Abstract

    To develop a set of minimum clinical guidelines for use by primary care physicians in the evaluation and management of patients with hyperthyroidism and hypothyroidism.Guidelines were developed by a nine-member ad hoc Standards of Care Committee of the American Thyroid Association (the authors of this article). The participants were selected by the committee chair and the president of the American Thyroid Association on the basis of their clinical experience. The committee members represented different geographic areas within the United States, in order to take into account different practice styles.Guidelines were developed on the basis of expert opinion of the participants, as well as on available published information.Input was obtained from all of the participants, each of whom wrote an initial section of the document. A complete draft document was then written by three participants (P.A.S., D.S.C., and E.G.L.) and resubmitted to the entire committee for revision. The revised document was then submitted to the entire membership of the American Thyroid Association for written comments, which were then reviewed (mainly by P.A.S., D.S.C., and E.G.L.). Many of the suggestions of the American Thyroid Association members were incorporated into the final draft, which was then approved by the Executive Council of the American Thyroid Association. The entire process, from initial drafts to final approval, took approximately 18 months.A set of minimum clinical guidelines for the diagnosis and treatment of hyperthyroidism and hypothyroidism were developed by consensus of a group of experienced thyroidologists. The guidelines are intended to be used by physicians in their care of patients with thyroid disorders, with the expectation that more effective care can be provided, and at a cost savings.

    View details for Web of Science ID A1995QJ75000034

    View details for PubMedID 7532241

  • MANAGEMENT OF THYROID PAPILLARY CARCINOMA WITH RADIOIODINE IN A PATIENT WITH END-STAGE RENAL-DISEASE ON HEMODIALYSIS CLINICAL NUCLEAR MEDICINE MELLO, A. M., Isaacs, R., Petersen, J., Kronenberger, S., McDougall, I. R. 1994; 19 (9): 776-781

    Abstract

    Metastatic papillary carcinoma was diagnosed in a 42-year-old woman. The cancer had invaded out of the gland and was present in many lymph nodes. After her surgical procedure, she was advised to have radioiodine. However, the patient had total renal failure and was on dialysis. Studies were carried out using a tracer dose of 2 mCi of radioiodine, demonstrating that approximately 60% of the radioactivity in the body was removed with each dialysis. Calculations indicated that a meaningful dose of radiation could be delivered to residual thyroid and metastases with 100 mCi of radioiodine and the total body radiation would be < 100 rad delivered over several days. Based on these analyses, she received 100 mCi of I-131 on two separate occasions and on follow-up scan, clinical evaluation and thyroglobulin measurement is free of disease.

    View details for Web of Science ID A1994PF16200006

    View details for PubMedID 7982310

  • LOCALIZATION OF BRONCHOPLEURAL FISTULA USING VENTILATION SCINTIGRAPHY JOURNAL OF NUCLEAR MEDICINE NIELSEN, K. R., Blake, L. M., Mark, J. B., DECAMPLI, W., McDougall, I. R. 1994; 35 (5): 867-869

    Abstract

    It can be difficult to localize or even lateralize the site of persistent bronchopleural fistula in patients who have undergone thoracotomy. If the site of persistent air leak can be identified noninvasively, it may be possible to repair the leak with thoracoscopic techniques and thereby avoid repeat thoracotomy. This article reports experience using 99mTc-DTPA ventilation scintigraphy to localize persistent bronchopleural fistulas in six patients. The site of bronchopleural fistula was identified in four patients. In the other two patients, no leak was identified, and the clinical course confirmed that a significant bronchopleural fistula did not exist.

    View details for Web of Science ID A1994NK51400027

    View details for PubMedID 8176473

  • THYROID-CANCER IN PREGNANT-WOMEN - DIAGNOSTIC AND THERAPEUTIC MANAGEMENT THYROID Choe, W., McDougall, I. R. 1994; 4 (4): 433-435

    Abstract

    There is considerable literature on the effect of pregnancy on established thyroid cancer. In contrast, there are only isolated case reports of management of thyroid cancer diagnosed de novo during pregnancy. We describe four such patients. We recommend fine-needle aspiration biopsy (FNA) of solitary thyroid nodules found early in pregnancy. When the cytopathology is diagnostic of thyroid cancer, thyroidectomy under local or general anesthesia is advised. The patient should be given levothyroxine in a dose sufficient to keep serum thyroid-stimulating hormone (TSH) low. Serum thyroglobulin is a valuable noninvasive method of evaluating completeness of this therapy. The work-up of a nodule found late in pregnancy is best deferred until after delivery.

    View details for Web of Science ID A1994QB89700007

    View details for PubMedID 7711507

  • ABLATION OF THYROID-FUNCTION WITH RADIOACTIVE IODINE AFTER RECURRENT EPISODES OF SILENT THYROIDITIS THYROID Choe, W., McDougall, I. R. 1993; 3 (4): 311-313

    Abstract

    We report the history of a 44-year-old woman, who had four episodes of thyrotoxicosis in 4 years. The clinical findings and laboratory results were all indicative of recurrent silent thyroiditis. Because silent thyroiditis is self-limiting, treatment is usually symptomatic. In this patient radioiodine therapy was eventually prescribed to obviate further recurrences. We were unable to find reports of this number of recurrences.

    View details for Web of Science ID A1993MQ06100010

    View details for PubMedID 8118225

  • COLD LESIONS ON IN-111 WHITE BLOOD-CELL SCINTIGRAPHY SEMINARS IN NUCLEAR MEDICINE MELLO, A. M., Blake, L., McDougall, I. R. 1992; 22 (4): 292-294

    View details for Web of Science ID A1992JV83700009

    View details for PubMedID 1439875

  • THE ROLE OF FUNCTIONAL IMAGING IN NEOPLASMS OF THE THYROID CRITICAL REVIEWS IN CLINICAL LABORATORY SCIENCES MELLO, A. M., McDougall, I. R. 1992; 29 (2): 117-139

    Abstract

    Iodine-123 and Iodine-131 have suitable physical properties that enable them to be used for functional imaging of the thyroid. Iodine-123 is used for routine testing for hyperthyroidism and thyroid nodules, whereas I-131, which has a longer half-life, is used for whole body imaging for detecting metastatic thyroid cancer in patients who have undergone thyroidectomy. The radionuclides of iodine are trapped and organified like nonradioactive iodine. In contrast, technetium as pertechnetate is trapped by the thyroid and can be used for imaging immediately after intravenous injection. There can be differences in scintiscans made in the same patient using radioiodine vs. technetium. Thallium is a useful adjuvant imaging agent for thyroid cancer. It should be stressed that correlation with the clinical findings and biochemical thyroid function tests are very important when evaluating thyroid scintiscans.

    View details for Web of Science ID A1992JQ11300002

    View details for PubMedID 1418597

  • PAPILLARY CANCER IN A PATIENT TREATED WITH RADIOIODINE FOR GRAVES HYPERTHYROIDISM - CASE-REPORT AND A REVIEW OF THE RISK CLINICAL NUCLEAR MEDICINE Tomlinson, C., NOWLES, K. W., McDougall, I. R. 1991; 16 (10): 729-731

    Abstract

    A small encapsulated papillary thyroid cancer was found in a patient who had received I-131 therapy for Graves' disease 31 months previously. The relationship of Graves' hyperthyroidism and thyroid cancer is discussed, as well as the possible role of I-131 as a cause of the cancer. The published data do not support I-131 as an etiology. The patient is clinically well and cured of both hyperthyroidism and the cancer.

    View details for Web of Science ID A1991GK00400001

    View details for PubMedID 1742925

  • UTILIZATION OF BONE SCANS IN CONJUNCTION WITH PROSTATE-SPECIFIC ANTIGEN LEVELS IN THE SURVEILLANCE FOR RECURRENCE OF ADENOCARCINOMA AFTER RADICAL PROSTATECTOMY JOURNAL OF NUCLEAR MEDICINE Terris, M. K., KLONECKE, A. S., McDougall, I. R., Stamey, T. A. 1991; 32 (9): 1713-1717

    Abstract

    Follow-up evaluation of patients who have undergone radical prostatectomy routinely consists of serial bone scintigraphy and, more recently, prostate-specific antigen (PSA) levels. The utility of serial bone scans in combination with PSA levels is retrospectively reviewed in 118 men treated by radical prostatectomy for clinical Stage A or B disease who, at the time of surgery, had no evidence of metastatic disease. Of the 118 patients, 75.4% had no abnormality on either test (mean follow-up 32.4 mo), 9.3% demonstrated a detectable or rising PSA level with negative bone scan (mean follow-up 35 mo), and 8.5% exhibited a detectable and or rising PSA level and positive bone scan (mean follow-up 30.7 mo). Follow-up bone scans were read as either positive or indeterminate with undetectable PSA levels in 6.8% of patients (mean follow-up 27.3 mo). Critical review of the equivocal studies suggests that postoperative PSA levels more truly represent the clinical situation than bone scans. Following radical prostatectomy, routine bone scintigraphy provides little additional information when PSA levels are negative. If PSA becomes detectable or the patient develops symptoms, bone scintigraphy should then be performed.

    View details for Web of Science ID A1991GD04300015

    View details for PubMedID 1715394

  • ROLES OF THROMBIN AND PLATELET MEMBRANE GLYCOPROTEIN-IIB/IIIA IN PLATELET-SUBENDOTHELIAL DEPOSITION AFTER ANGIOPLASTY IN AN EXVIVO WHOLE ARTERY MODEL CIRCULATION Kaplan, A. V., Leung, L. L., Leung, W. H., GRANT, G. W., McDougall, I. R., Fischell, T. A. 1991; 84 (3): 1279-1288

    Abstract

    Platelet deposition at the site of injury caused by balloon angioplasty is associated with acute closure and restenosis.In a new ex vivo whole artery angioplasty model, we examined the roles of thrombin inhibition with D-Phe-Pro-ArgCH2Cl (PPACK) and inhibition of the platelet membrane fibrinogen receptor glycoprotein IIb/IIIa (GPIIb/IIIa) with monoclonal antibody 7E3 on platelet deposition at the site of balloon injury. Fresh rabbit aortas were mounted in a perfusion chamber. One half of the mounted arterial segment was dilated with a standard angioplasty balloon catheter and the uninjured half served as the control segment. The vessels were perfused with human blood at physiological pressure and shear rates of 180-250 second-1 for 30 minutes. Platelet deposition was measured using 111In-labeled platelets and scanning electron microscopy. With heparin (2 units/ml) anticoagulation, 8.2 +/- 2.2 x 10(6) platelets/cm2 were deposited at the site of balloon injury compared with 0.7 +/- 0.2 x 10(6) platelets/cm2 on uninjured segments (p less than 0.02, n = 7). PPACK was tested at a concentration (10 microM) that totally inhibited platelet aggregation in response to thrombin. 7E3 was tested at a concentration (10 micrograms/ml) that totally inhibited platelet aggregation. Platelet deposition at the site of balloon injury was reduced 47% by PPACK and 70% by 7E3 compared with heparin.At shear rates seen in nonstenotic coronary arteries, PPACK and 7E3 are more effective than heparin in reducing platelet deposition at the site of balloon injury. The significant inhibition of platelet deposition by PPACK demonstrates the importance of heparin-resistant thrombin in platelet thrombus formation. The 7E3 results suggest that approximately 70% of platelet deposition at the site of balloon injury is GPIIb/IIIa dependent and that the remaining 30% results from non-GPIIb/IIIa-mediated platelet-subendothelial adhesion. Finally, the ex vivo whole artery system is a useful model for studying platelet-vessel wall interactions under physiologically defined parameters.

    View details for Web of Science ID A1991GF18400031

    View details for PubMedID 1832095

  • THYROID-DISEASES AFTER TREATMENT OF HODGKINS-DISEASE NEW ENGLAND JOURNAL OF MEDICINE Hancock, S. L., Cox, R. S., McDougall, I. R. 1991; 325 (9): 599-605

    Abstract

    Thyroid disease, especially hypothyroidism, is common in patients with Hodgkin's disease who have been treated with irradiation. We reviewed the records of 1787 patients (740 women and 1047 men) with Hodgkin's disease who were treated with radiation therapy alone (810 patients), radiation and chemotherapy (920 patients), or chemotherapy alone (57 patients) at Stanford University between 1961 and 1989. Among these patients, 1533 were alive at the last follow-up, and 254 had died of causes other than Hodgkin's disease. (Four other patients were excluded from the analysis because they had undergone thyroidectomy before treatment for Hodgkin's disease. The thyroid was irradiated in 1677 patients. Follow-up averaged 9.9 years.A total of 573 patients had clinical or biochemical evidence of thyroid disease. Among the 1677 patients whose thyroid was irradiated, the actuarial risk of thyroid disease 20 years after treatment was 52 percent, and it was 67 percent at 26 years. Hypothyroidism was found in 513 patients. A total of 486 patients received thyroxine therapy for elevated serum thyrotropin concentrations and either low free thyroxine (208 patients) or normal free thyroxine values (278 patients); 27 had transient elevations of the serum thyrotropin level that were not treated. Graves' hyperthyroidism developed in 30 patients (2 of whom had not undergone thyroid irradiation), and ophthalmopathy developed in 17 of these patients. Ophthalmopathy developed in four other patients with Graves' disease during a period of hypothyroidism (n = 3) or euthyroidism (n = 1). The risk of Graves' disease was 7.2 to 20.4 times that for normal subjects. Silent thyroiditis with thyrotoxicosis developed in six patients. Forty-four patients were found to have single or multiple thyroid nodules, 26 of whom underwent thyroidectomy. Six of the 44 had papillary or follicular cancers. Among the patients who did not undergo operation, 12 had small functioning nodules, 4 had cysts, and 2 had multinodular goiters. The actuarial risk of thyroid cancer was 1.7 percent. The risk of thyroid cancer was 15.6 times the expected risk.High risks of thyroid disease persist more than 25 years after patients have received radiation therapy for Hodgkin's disease, reinforcing the need for continued clinical and biochemical evaluation. Prolonged follow-up confirms an elevated risk of thyroid cancer and Graves' disease as well as hypothyroidism in these patients.

    View details for Web of Science ID A1991GC32800002

    View details for PubMedID 1861693

  • A TECHNIQUE FOR INTRAOPERATIVE BONE-SCINTIGRAPHY - A REPORT OF 17 CASES CLINICAL NUCLEAR MEDICINE KLONECKE, A. S., Licho, R., McDougall, I. R. 1991; 16 (7): 482-486

    Abstract

    Since 1981, intraoperative bone scanning has been used at Stanford University Hospital to assist in the localization and excision of skeletal lesions in the surgical suite. The utility of bone scans to detect lesions not otherwise "visible" is valuable in guiding the surgeon to the pathological site. In addition, intraoperative scanning can define the exact amount of tissue to be excised, averting excessive surgery near joints or along weight-bearing bones. Seventeen cases are presented.

    View details for Web of Science ID A1991FY06600003

    View details for PubMedID 1934791

  • THE DISTRIBUTION OF VENTILATION AND PERFUSION AFTER SINGLE-LUNG TRANSPLANTATION IN PATIENTS WITH PULMONARY FIBROSIS AND PULMONARY-HYPERTENSION TRANSPLANTATION PROCEEDINGS Kramer, M. R., Marshall, S. E., McDougall, I. R., KLONECK, A., Starnes, V. A., LEWISTON, N. J., Theodore, J. 1991; 23 (1): 1215-1216

    View details for Web of Science ID A1991EV39100121

    View details for PubMedID 1989191

  • THYROTOXICOSIS WITH LOW THYROIDAL UPTAKE OF RADIOIODINE SEMINARS IN NUCLEAR MEDICINE Klonecke, A., Petersen, M. M., McDougall, I. R. 1990; 20 (4): 364-366

    View details for Web of Science ID A1990ED02500008

    View details for PubMedID 2237454

  • Nuclear medicine: single-photon-emission computed tomographic imaging of the bone. Western journal of medicine KLONECKE, A. S., McDougall, I. R. 1990; 152 (6): 704-?

    Abstract

    The Scientific Board of the California Medical Association presents the following inventory of items of progress in nuclear medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, research workers, or scholars to stay abreast of these items of progress in nuclear medicine that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Nuclear Medicine of the California Medical Association, and the summaries were prepared under its direction.

    View details for PubMedID 18750738

  • KINETICS OF LEUKOCYTE SEQUESTRATION IN THE LUNGS OF ACUTELY SEPTIC PRIMATES - A STUDY USING IN-111 LABELED AUTOLOGOUS LEUKOCYTES JOURNAL OF SURGICAL RESEARCH HANGEN, D. H., Segall, G. M., HARNEY, E. W., Stevens, J. H., McDougall, I. R., Raffin, T. A. 1990; 48 (3): 196-203

    Abstract

    To further clarify the role of leukocytes in the pathogenesis of ARDS, we studied the localization and kinetics of leukocyte migration using 111In-labeled autologous white cell scans (111In wbc scans) in four primates made acutely septic with infusions of Escherichia coli. Whole body images were obtained with a gamma camera and were acquired on computer every 15 min beginning immediately after the E. coli infusion. Simultaneous measurements of C5a and peripheral blood leukocyte count were also obtained. Within 5 min of initiating sepsis, three major events occurred: complement activation as measured by the production of C5a, a profound fall in peripheral leukocyte count, and a significant increase in the sequestration of leukocytes in the lungs. The pulmonary sequestration reached a peak at 15 min with a mean of 152% of baseline activity. This sequestration consisted of a population that was predominantly neutrophils. Damage to the pulmonary capillary endothelium was demonstrated by an increase in extravascular lung water. The results support a role for neutrophils and complement as mediators in the pathogenesis of ARDS.

    View details for Web of Science ID A1990CV60600003

    View details for PubMedID 2314092

  • SEQUENTIAL ASSESSMENT OF PULMONARY EPITHELIAL DIETHYLENE TRIAMINE PENTA-ACETATE CLEARANCE AND INTRAPULMONARY TRANSFERRIN ACCUMULATION DURING ESCHERICHIA-COLI PERITONITIS AMERICAN REVIEW OF RESPIRATORY DISEASE Ishizaka, A., Stephens, K. E., Segall, G. M., HATHERILL, J. R., McDougall, I. R., Wu, Z. H., Raffin, T. A. 1990; 141 (3): 631-639

    Abstract

    The individual roles of pulmonary capillary endothelial and alveolar epithelial permeability in the pathogenesis of the adult respiratory distress syndrome (ARDS) are unclear. We developed a method for the sequential assessment of pulmonary macromolecule accumulation and small solute clearance in vivo using a gamma camera. We measured the exponential clearance coefficient of 111In-labeled diethylene triamine penta-acetate (111In-DTPA) to assess airway clearance of small solutes. We also calculated the exponential equilibration coefficient of 111In-labeled transferrin (111In-TF) to assess intrapulmonary accumulation of transferrin. We determined these parameters in guinea pigs with Escherichia coli peritonitis and compared them with a saline-treated control group, oleic-acid-treated groups, and a group treated with low molecular weight dextran Ringer solution. The pulmonary DTPA clearance and the intrapulmonary transferrin accumulation were significantly increased in the peritonitis group (29.4 +/- 8.2 x 10(-3) min-1, p less than 0.02, and 15.1 +/- 3.1 x 10(-3) min-1, p less than 0.02) when compared with the control group (3.1 +/- 0.8 x 10(-3) min-1 and 4.5 +/- 0.5 x 10(-3) min-1). These changes developed within 5.5 h of the initial insult. Neither increased extravascular lung water nor elevated pulmonary artery and left atrial pressures were detected in the peritonitis group. The low molecular weight dextran Ringer group did not show a significant increase in the pulmonary DTPA clearance and the intrapulmonary transferrin accumulation.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1990CT66700020

    View details for PubMedID 2178527

  • SCINTIGRAPHIC TECHNIQUES IN MUSCULOSKELETAL TRAUMA RADIOLOGIC CLINICS OF NORTH AMERICA McDougall, I. R., RIESER, R. P. 1989; 27 (5): 1003-1011

    Abstract

    Scintigraphic techniques play an important role in the diagnosis and evaluation of a wide variety of musculoskeletal injuries. They provide physiologic and pathophysiologic information but do not provide the exquisite resolution of computed tomography or magnetic resonance imaging. Thus, scintigraphy studies should be ordered only when they would be expected to provide data that will establish a diagnosis or help in planning therapy.

    View details for Web of Science ID A1989AN66300013

    View details for PubMedID 2672079

  • METASTATIC MALIGNANT STRUMA OVARII PRESENTING AS PARAPARESIS FROM A SPINAL METASTASIS JOURNAL OF NUCLEAR MEDICINE McDougall, I. R., Krasne, D., HANBERY, J. W., Collins, J. A. 1989; 30 (3): 407-411

    Abstract

    A 42-yr-old woman had a solitary metastases to her spine (T2) from a malignant struma ovarii. The thyroid was excluded as the site of the primary cancer. The lesion caused paraparesis. The spinal metastasis was treated by surgery and two doses of 131I (200 mCi each time). The patient responded very well and is entirely free of symptoms and signs. Repeat whole-body 131I scan shows no abnormality.

    View details for Web of Science ID A1989T600900022

    View details for PubMedID 2738669

  • HYPERTHYROIDISM WITH LOW RADIOIODINE UPTAKE AFTER HEAD AND NECK IRRADIATION FOR HODGKINS-DISEASE JOURNAL OF NUCLEAR MEDICINE Petersen, M., KEELING, C. A., McDougall, I. R. 1989; 30 (2): 255-257

    View details for Web of Science ID A1989T060300020

    View details for PubMedID 2738654

  • ROLE OF RADIONUCLIDE IMAGING IN THE DIAGNOSIS OF ACUTE OSTEOMYELITIS JOURNAL OF PEDIATRIC ORTHOPAEDICS DEMOPULOS, G. A., BLECK, E. E., McDougall, I. R. 1988; 8 (5): 558-565

    Abstract

    Over the last decade, the role of nuclear medicine studies in the diagnosis of acute osteomyelitis has been discussed in depth in the literature. Yet, the respective roles played in this setting by each of the commonly used radionuclide studies often are confusing. In an attempt to develop a cogent diagnostic strategy, we reviewed the literature published within the last 12 years pertaining to the use of radiophosphate bone scintigraphy as well as gallium and indium WBC imaging in the diagnosis of this condition. Based on our findings, we propose an alternative approach to the evaluation of a patient with suspected acute osteomyelitis.

    View details for Web of Science ID A1988P861800013

    View details for PubMedID 3049669

  • COMPLICATIONS OF FRACTURES AND THEIR HEALING SEMINARS IN NUCLEAR MEDICINE McDougall, I. R., KEELING, C. A. 1988; 18 (2): 113-125

    Abstract

    The role of nuclear medicine studies in diagnosing late complications of fractures is described. Static bone scintigraphy is not helpful in predicting delayed or non-union of fractures. Several investigators have developed simple formulae comparing uptake in fracture site with adjacent or contralateral normal bone and described criteria that will predict problems with healing. These types of tests should only be used in patients who are at risk for delayed union. The scintigraphic diagnosis of infection complicating a fracture is difficult. Bone scintigraphy alone is not useful and combined 67Ga/99mTc MDP scanning has been disappointing. Most published series support the role in 111In WBC in this situation, but not all cases are correctly diagnosed. 111In (Chloride) cannot differentiate an infected from a delayed-healing fracture. Bone scintigraphy has a significant role in determining whether a bone graft is viable or not. Reflex sympathetic dystrophy is a rare complication of a fracture; it can be diagnosed by increased periarticular uptake on bone scan in all the joints of the affected part. Bone scintigraphy, especially when done with SPECT, is a very sensitive test for the diagnosis of avascular necrosis (AVN).

    View details for Web of Science ID A1988N448200003

    View details for PubMedID 3291125

  • DIAGNOSTIC PERFORMANCE OF SENSITIVE MEASUREMENTS OF SERUM THYROTROPIN DURING SEVERE NONTHYROIDAL ILLNESS - THEIR ROLE IN THE DIAGNOSIS OF HYPERTHYROIDISM CLINICAL CHEMISTRY BAYER, M. F., Macoviak, J. A., McDougall, I. R. 1987; 33 (12): 2178-2184

    Abstract

    Serum thyrotropin (TSH) concentrations were measured serially in 14 heart-transplant recipients (group 1) and 21 patients undergoing coronary artery bypass surgery (group 2), all without thyroid disease, and randomly in 158 patients hospitalized for various other nonthyroidal illnesses, including 144 judged euthyroid (group 3), six with increased FT4 and (or) T3 (group 4), and eight classified hypothyroid by conventional tests. The serial measurements indicated profound fluctuations. In group 1, TSH was subnormal in 21% of studies and increased in 10%. In group 2, corresponding abnormalities were found in 7% and 13%, respectively. Transiently low or high TSH tended to be associated with normal free thyroxin (FT4), prolonged subnormal TSH (greater than 1 week) with subnormal FT4. By contrast, subnormal TSH plus elevated FT4, or high TSH plus low FT4, were not encountered, making it unlikely that they occur by chance in severely ill patients who are not also hyper- or hypothyroid. In group 3, a suppressed TSH (plus borderline high FT4, T3/FT3) identified four cases of subclinical hyperthyroidism; however, another 11% of patients had subnormal and 10% had above-normal TSH, paired with normal FT4 and no evidence of thyroid disease. In group 4, suppressed TSH confirmed hyperthyroidism in five of six patients, and all in group 5 had increased TSH. We conclude that, in the hospital setting, sensitive TSH measurement can help to detect or confirm mild hyperthyroidism, but the positive predictive value of TSH alone may be as low as 35%.

    View details for Web of Science ID A1987L621100006

    View details for PubMedID 3319288

  • RADIATION-THERAPY FOR HODGKINS-DISEASE FOLLOWED BY HYPOTHYROIDISM AND THEN GRAVES HYPERTHYROIDISM CLINICAL NUCLEAR MEDICINE Constine, L. S., McDougall, I. R. 1982; 7 (2): 69-70

    View details for Web of Science ID A1982NC46100006

    View details for PubMedID 7060300

Conference Proceedings


  • Long-term results of irradiation for patients with progressive Graves' ophthalmopathy Marquez, S. D., Lum, B. L., McDougall, I. R., Katkuri, S., Levin, P. S., MacManus, M., Donaldson, S. S. ELSEVIER SCIENCE INC. 2001: 766-774

    Abstract

    To determine the long-term outcome of radiotherapy (RT) in patients with progressively symptomatic thyroid eye disease and to evaluate the potential long-term sequelae.Four hundred fifty-three patients provided written informed consent and received retrobulbar RT for Graves' ophthalmopathy at Stanford University Medical Center; 197 with 1 year of follow-up were retrospectively analyzed. Of the 197 patients, 189 received RT to the bilateral retrobulbar regions, and 4 received unilateral RT. The technical information was unavailable for 4 patients. Patients were assessed by chart review, telephone interview, questionnaire, and multidisciplinary physician examination. Eye impairment was scored using the SPECS system. The end point review included the before and after treatment SPECS score, surgical intervention, and patient satisfaction. Potential complications, including cataract development, retinopathy, and tumor formation, were investigated. Multivariate analyses were performed to assess the prognostic variables.Improvement or resolution was 89% for soft-tissue findings; 70% for proptosis; 85% for extraocular muscle dysfunction; 96% for corneal abnormalities; and 67% for sight loss. The response to RT may take >6 months to stabilize. Factors predictive of response varied in the individual SPECS categories but included the initial SPECS score, pretreatment thyroid status, female gender, a 20-Gy RT dose, and a history of hypertension. Nonpredictive factors included a history of tobacco use, diabetes mellitus, steroids, and prior cataracts. Only 16% required surgical intervention to preserve their vision or restore binocular vision. Twenty-two patients (12%) developed cataracts after irradiation (median 11 years). No patient developed a tumor within the RT field during the follow-up period (range 1-29 years). Ninety-eight percent of patients were pleased with their results, and 2% believed their symptoms progressed despite RT.Retrobulbar irradiation (20 Gy) is safe and effective treatment for progressive Graves' ophthalmopathy, with a 96% overall response rate, 98% patient satisfaction rate, and no irreparable long-term sequelae, with follow-up extending 29 years. The most common late effect observed was cataract development, which occurred more frequently in older patients and was reversible with extraction. Elective surgical intervention after RT should be withheld until patients have demonstrated a plateau in response.

    View details for Web of Science ID 000171892800026

    View details for PubMedID 11697323

  • Radiotherapy for Graves' ophthalmopathy: Current treatment recommendations McDougall, I. R., Donaldson, S. S. KARGER. 2001: 57-64

    View details for Web of Science ID 000171311600006

    View details for PubMedID 11351953

  • Parathyroid localization with high-resolution ultrasound and technetium Tc 99m sestamibi Purcell, G. P., Dirbas, F. M., Jeffrey, R. B., Lane, M. J., Desser, T., McDougall, R., Weigel, R. J. AMER MEDICAL ASSOC. 1999: 824-828

    Abstract

    High-resolution ultrasound and technetium Tc 99m sestamibi scanning can be used for preoperative localization of abnormal parathyroid glands in patients with hyperparathyroidism.Ultrasound and sestamibi scanning were performed in patients undergoing neck exploration for hyperparathyroidism. If the 2 scans agreed in identifying a single adenoma, and surgery confirmed the location of a single adenoma and an ipsilateral normal gland, a unilateral exploration was performed.University tertiary care center.Sixty-one consecutive patients undergoing surgery for hyperparathyroidism from September 1, 1994, through September 30, 1997.High-resolution ultrasound was performed in 59 patients and sestamibi scanning in 58 patients; all patients underwent neck exploration by a single surgeon.The results of preoperative ultrasound and sestamibi scanning were compared with operative and histological findings.All patients were cured of hypercalcemia. Specificity of ultrasound and sestamibi scanning was 98% and 99%, respectively; however, their sensitivity was only 57% and 54%, respectively. Both imaging modalities had lower sensitivities in the setting of multigland disease. If both imaging studies were considered as a single test, sensitivity for imaging in patients with primary hyperparathyroidism reached 78%. Our localization protocol allowed a unilateral approach in 43% of patients (23 of 53).These results confirm the value of preoperative localization in patients with hyperparathyroidism. A unilateral approach can be used with a high degree of success in cases when ultrasound and sestamibi scanning agree in the identification of a single adenoma confirmed by surgical exploration with the identification of a normal ipsilateral gland.

    View details for Web of Science ID 000081876300006

    View details for PubMedID 10443804

  • THYROID ABNORMALITIES AFTER THERAPEUTIC EXTERNAL RADIATION Hancock, S. L., McDougall, I. R., Constine, L. S. ELSEVIER SCIENCE INC. 1995: 1165-1170

    Abstract

    The thyroid gland is the largest pure endocrine gland in the body and one of the organs most likely to produce clinically significant abnormalities after therapeutic external radiation. Radiation doses to the thyroid that exceed approximately 26 Gy frequently produce hypothyroidism, which may be clinically overt or subclinical, as manifested by increased serum thyrotropin and normal serum-free thyroxine concentrations. Pituitary or hypothalamic hypothyroidism may arise when the pituitary region receives doses exceeding 50 Gy with conventional, 1.8-2 Gy fractionation. Direct irradiation of the thyroid may increase the risk of Graves' disease or euthyroid Graves' ophthalmopathy. Silent thyroiditis, cystic degeneration, benign adenoma, and thyroid cancer have been observed after therapeutically relevant doses of external radiation. Direct or incidental thyroid irradiation increases the risk for well-differentiated, papillary, and follicular thyroid cancer from 15- to 53-fold. Thyroid cancer risk is highest following radiation at a young age, decreases with increasing age at treatment, and increases with follow-up duration. The potentially prolonged latent period between radiation exposure and the development of thyroid dysfunction, thyroid nodularity, and thyroid cancer means that individuals who have received neck or pituitary irradiation require careful, periodic clinical and laboratory evaluation to avoid excess morbidity.

    View details for Web of Science ID A1995QU29500009

    View details for PubMedID 7713780

  • GRAVES-DISEASE - CURRENT CONCEPTS McDougall, I. R. W B SAUNDERS CO. 1991: 79-95

    Abstract

    Graves' disease is an organ-specific autoimmune disorder. There is no universal agreement on the mechanism of Graves' disease, but the over-activity of the thyroid is due to an antibody capable of attaching to and activating the TSH receptor of follicular cells. There are other extrathyroidal features that are not caused either by this antibody or by hyperthyroidism. The clinical diagnosis is generally straightforward and can be confirmed by in vitro measurement of thyroid hormones and TSH. A measurement of radioiodine uptake is also valuable. Treatment is not specific for the immunologic defect, but its purpose is to lower the thyroid hormone levels to normal. This can be achieved with antithyroid medication, radioiodine iodine-131, or thyroidectomy. In most clinical situations, a strong argument can be made for iodine-131 therapy, which is safe and definitive, although posttreatment hypothyroidism and the need for lifelong thyroxine are to be expected.

    View details for Web of Science ID A1991EU65200006

    View details for PubMedID 1987448

  • PROGNOSTIC FACTORS IN THE RADIOTHERAPY OF GRAVES OPHTHALMOPATHY Petersen, I. A., KRISS, J. P., McDougall, I. R., Donaldson, S. S. PERGAMON-ELSEVIER SCIENCE LTD. 1990: 259-264

    Abstract

    Between April 1968 and February 1988, 311 patients with symptomatic and progressive Graves' ophthalmopathy were treated with megavoltage orbital radiotherapy. The patients were divided into three groups: I (156 patients) treated with 20 Gy/2 weeks; II (69 patients) treated with 30 Gy/3 weeks, and III (a most recent set of 86 patients) received 20 Gy/2 weeks. The degree of eye involvement was evaluated numerically before and after therapy for each of five parameters: soft tissue signs, proptosis, eye muscle impairment, corneal involvement, and sight loss. Pre-treatment and current thyroid diagnosis and status were also noted. To evaluate the effects of radiotherapy alone, follow-up was terminated at the time any eye surgery was done; for those not treated surgically the minimum follow-up was 12 months. Because there were significant demographic differences between the patient groups, the results of each group were analyzed separately. A stepwise linear regression analysis was performed to determine if there were any significant variables affecting outcome. Based on these data formulae were derived which enable outcome to be predicted in any patient. Before therapy more than 90% of patients in all groups had soft tissue and eye muscle involvement, whereas 65-75% had proptosis and about half 50% had some degree of sight loss. Radiotherapy arrested progression of ophthalmic parameters in all but 1-6% of the patients. Objective and symptomatic improvement was noted for all parameters assessed, but there was marked individual variability. The best responses were noted for soft tissue, corneal involvement, and sight loss; however over half the patients had some improvement in eye muscle function and proptosis. Factors which resulted in less favorable outcome included male gender, advanced age, need for concurrent therapy for hyperthyroidism, and no history of hyperthyroidism. No complications have been observed. No significant differences in outcome were observed between the two dosage schedules. Following radiotherapy 29% of patients subsequently underwent some form of eye surgery, mostly eye muscle surgery to correct diplopia. After radiotherapy corticosteroid therapy was stopped without relapse in 76%. Orbital radiotherapy can result in improvement in signs and symptoms of Graves' ophthalmopathy in the majority of patients. For the remainder of patients the disease manifestations can be stabilized to allow functional surgical correction.

    View details for Web of Science ID A1990DZ02500004

    View details for PubMedID 2118493

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