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JOURNAL OF NUCLEAR MEDICINE 7:128-139, 1966
The Anatomical Correlation
of the
Abnormal RIHSA Brain Sca&
Murray Budabin, M.D.,2'4 George J. Siegel, M.D.
Chicago, Illinois
Although the exact reason for the accumulation of radio-iodinated human
serum albumin ( RIHSA ) in pathological tissues is as yet unknown, this phe nomenon is usually associated with the presence of focal intracranial disease. If brain scanning is performed in crossed axes, these abnormal concentrations of RIHSA can be localized within the cranium and measured in terms of their length, width and breadth. Mass lesions such as neoplasms, hematomas, and abscesses, as well as acute vascular infarcts and arrterio-venous malformations are the types of pathology most frequently detected (1-4). In 1961, Di Chiro indicated that certain lesions visualized by RIHSA brain scanning ultimately proved to have approximately the same dimensions as the actual lesions themselves (5). He restricted his analysis to meningiomas and a few other discrete, long standing tumors, mentioning the difficulties that might be encountered in evaluating the more protean but quite common forms of intracranial disease. Although a correlation of scan abnormalities with the anatomy and dimensions of other types of intracranial disease would also have been of interest, no further systematic effort has been made in this direction to date. This report compares the localization and size of lesions diagnosed by means of RIHSA brain scanning with the autopsy findings in a series of un selected cases.
iSupported by grant number NB 05221 from the United States Public Health Service. 2Research Fellow in Neurology (Assigned to Physics). @USPHSTraineeinNeurology(USPHS grantnumberNB 5072). 4From the Department of Neurology, the Department of Neuropathology and the Andre 1'%Ieyer Department of Physics of the Mount Sinai Hospital, Chicago, Ill. 128
PathologyNo. casesNo.
abnormal scansI
Aneurysm
II Encephalomalacia
III Hematoma, intracerebral IV Neoplasm
16TABLE
II
RESULTS OF RIHSA BRAIN SCANS IN AUTOPSIED CASES WITH NEOPLASMSNumber INTRACRANIAL
of casesPathologic
ClassificationScan Negative6 Positive
20Glioblastoma
Meningioma Metastatic Carcinoma Metastatic Melanoma Chondrosarconia
TOTAL
ANATOMICAL CORRELATION 129
METHODS AND MATERIALS The anatomical position and size of intracranial lesions were determined in 28 consecutive autopsy cases where RIHSA brain scanning was performed. Two cases proved unsuitable for inclusion. In one case, scanning was technically unsatisfactory. In the other case, scanning was performed five weeks prior to an acute cerebro-vascular occlusion. Measurements of the lesions visualized by brain scanning were taken in the anterior-posterior, transverse, and rostral-caudal planes in order to coincide with the manner of post mortem examination. Scans were performed in both anterior and appropriate lateral views. Further technical details are as described
TABLE I INCIDENCE OF ABNORMAL RIHSA BRAIN SCANS IN CONSECUTIVE AUTOPSIED CASES
ANATOMICAL CORRELATION 131
Fig. la. (T.R.) Coronal section showing old intracerebral hematoma of the right parietal lobe and an adjacent recent hemorrhage with rupture into the right lateral ventricle.'
@@ .@ (^) ..@.... — @ .. .. @.. .-^ •S.'S. @ • • **@** (^) **• ,..—•** .. S. **•_^ S. ..• .• _ @^ -^.**^ S.^ S.@ S^ ••..SS S. @ •. —
@@ •
@ • .@ (^) •@—@. -•s5 @•.-..‘ -
@—@. ———
R * ••.•. S.
• • _. S.@• Fig. lb. Anterior lateral brain scan, (Fig. la).
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• S.@ *. * S.S.. @. @. -S*^ @.‘ @@ •^ S @•^ @-.^ S.^ • ••.*^ S S S. @@^ .@-•^ 5 @.^ •^ **•** •5S^ - •@• .• ,•
_____^ ——— - - S • _S.S..@_** _@••••.
Fig lc. Right lateral brain scan, (Fig. la). 11n all illustrations of the pathological anatomy, the ruler is on the right.
c@
CaseScan•PM
interval (days) @— RTScan
size (cm)PM
size localizationR.R.64 (cm)Scan localizationPM
temporaltemporalH* x 3 x 57 x 6 x 5posterior
.S.135 x 3 x 36 x 4 x 4mesial^ posterior frontalcorpus
callosum thalamusE.J.24—**—@trigone, and
corpus callosum, temporal parietalJ.F.315 bilateral
x 5 x 4***inferior mid frontalinferior
mid frontalG.L.
x 4 x 38 x 7 x 5mesial mid
frontalinsula,
mid frontal corpus callosum caudateHe.S.128x3 opposite
x 3 x 35 x 3 x 3posterior frontalposterior frontal central grey
132 BUDABIN, AND SIEGEL
IV Neoplasm. Twenty patients proved to have intracranial neoplasms. Table
II indicates the types of neoplasms and the results of brain scanning in
each category.
A. Chondrosarcoma. Scanning was negative in a case of chondrosarcoma
which invaded the sphenoid sinus and sella turcica.
B. Metastatic Melanoma. Scanning was negative in a case of metastatic
melanoma with many small lesions disseminated throughout the brain and meninges. None of these lesions was more than 2 cm in diameter.
C. Meningioma. Brain scanning correctly localized the three meningiomas
in this autopsy series. The sizes of the lesions seen on the scans were comparable to the actual sizes of the meningiomas, Table III. Experience with an additional 21 surgically verified cases of menin
gioma detected by RIHSA brain scanning indicated that these lesions
TABLE IV GLIOBLASTOMA Anatomic Correlation of RIHSA Brain Scans With the Post Mortem Findings
*Fresn hemorrhage **Djffuse and invasive @ Resected
CaseScan-PM
interval (days) —@ RTScan
size (cm)PM
size localizationS.S. (cm)Scan localizationPM
(1)87x4 x 3 x 42^ x 2 x 2parieto-occipitaloccipital,^ para sagittal(2)
x 2—-frontal, (^) para sagittal(3)—<
cerebralE.B. cm.——multiple
(1)108x2 x 2 x 23^ x 2 x 2mid^ posterior frontalmid
posterior frontal(2)—
x 3 x 1—superior parietal ipsilateralG.K. lobule,
(1)168x2 x 3 x 33^ x 3niesial^ mid frontalcentral
mid frontal(2)—<
cm.multiple cerebral
134 BUDABIN, AND SIEGEL
scan abnormality are shown in Figures 2, 3. Measurements in one case (R.R.) reflectthe inclusionof a preterminalhemorrhage.The single tumor in this group not detected by scanning was an infiltrating type
of growth which invaded the deep structures of the right side of the
brain with extension to the left side as well ( Figure 4).
E. Metastatic Carcinoma. Scanning correctly localized lesions in eight of the nine autopsied cases with metastatic carcinoma. In cases with mu! tiple metastases, intracerebral lesions under 2.5 cm in diameter were usually not detected. A large lesion in the posterior fossa measuring
TABLE VB METASTATIC CARCINOMA Anatomic Correlation of RIHSA Brain Scans With the Post Mortem Findings (87-168 Day Scan-PM Interval)
*Skull nietastases
ANATOMICAL CORRELATION 135
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• S (^) S. •S.• • S.5. S S • S. •@ (^) S -.•S-• SS. • S
- 5.5.5 .55^.^ S.... • S S.—- S 5. - S. S S -^ _5.5.5 55 ••@ •_* - (^).. *S. S. *5* •@ •^ S.^ • ••^5 55 4@ 55. @ •^ • •.^ 5.^ - • 5..^5 S ‘-5 5 ••@••
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Fig. 2a. (H.S.) Coronal section showing a glioblastoma of the corpus callosum and left thalamus.
Fig. 2b. Anterior brain scan, Fig. 2a.
S.^ _5_*^ 5... •
S - S S.. ..
Fig. 2c. Left lateral brain scan, Fig. 2a.
ANATOMICAL CORRELATION 137
Fig. 4a. (E.J.) Coronal section showing enlargement of the right thalamus, fornices, corpus callosum, and the right parietal and temporal lobes, all of which regions on histologic examination contained infiltrating glioblastoma. Brain scan was negative in this case.
-S.^ S.^ _- S 5 S.--5.S.5. .5 -5• 5 -_* • • 5.
S_ *
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Fig.4b.Anteriorbrainscan,Fig.4a.The scaniswithinnormallimits.
5. .• - 5.. .5. • 5. @55@-
5 - S.. • (^) •. 555. • •. 5.5 5. 55. 5- (^) .5. .5 (^) 5.5 5 •5.-• - @ 5 5 5• @ -. (^) S 5. (^) 55 555.55. * 55. (^) •5 5. (^) 5.5.5. 5. 5. - 5 (^). 5. .5 ••• @ @ .• .55@5 -S. (^) 555-S 5.@ -. 5.5-. 5 —. S S @ - (^) •- 5.. 5.5.5.@5. 5.@——5.5@. 55- - • 5 5.-5 55 S @ — (^) S • • 5.S@5• @@5.S5. (^) I 5. - (^) • S .5 (^5) - S. (^) — S —- S S @ @s—@. •u@ S •.
Fig.4c.Rightlateralbrainscan,Fig.4a.The scaniswithinnormallimits.
Fig. 5b. Anterior brain scan, Fig. 5a.
BUDABIN, AND SIEGEL
S 5- 5-- 5- 55
•^ __^ S. S. 5 •S^ __^5 _ •55_* (^) S 5 -. S.^ .5 5. 55 5-. • 5. (^) S (^) 5 5. S 55 .5, 5.^55555 5.5.^. S.^5 5. 55^ 5•^ -.^ - 5 5
5 •5@ @ (^) 5 o 5.
. - _ 555_*
Fig. 5a. (G.K.) Coronal section showing a metastatic carcinoma in the supero-lateral portion of the head of the caudate and adjacent white matter of the left frontal lobe.
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.5. S S S
5 * (^) 5 55
S
•i5j
5.
5— S. —
5. (^) •• 55 _5.* 5 _S @_*
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Fig.5c.Leftlateralbrainscan,Fig.5a.
