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Cranial computerized axial transmission tomography with and without contrast enhancement compared with radionuclide brain imaging.

To the Editor.— The article by Heath et al (Archives138:628-629, 1978) that prompted two editorials in theArchives(138:530-532, 1978) makes the statement: "Comparative studies of radionuclide imaging and CT [computerized tomographic] scans, with and without iodine enhancement, in diagnosing brain abscesses have not appeared in the literature." Two recent publications address themselves at least partially to this issue 1.2 We disagree with the statement that credits radionuclide imaging (RI) with an almost 100% sensitivity rate in detecting intracranial abscesses. Radionuclide imaging has inherent limitations; the resolution limit of presently available large field-of-view gamma cameras for brain lesions is about 1.5 cm. In clinical practice, a lesion below that limit is unlikely to be detected. Unless a scrupulous technique is used in positioning the head, structures in the posterior fossa may be poorly visualized. Pathologic findings near the base of the skull are also known to present greater diagnostic difficulty.