ABSTRACT
We intended to assess the accuracy of re-expressed Modification of Diet for Renal Disease [MDRD] and Cockcroft-Gault [CG] equations to estimate glomerular filtration rate [GFR] in chronic kidney disease in two different etiologies of acute renal failure [ARF]: acute tubular necrosis [ATN] and acute glomerulonephritis [AGN]. Patients admitted for ARF or the patients complicated with ARF during the course of their hospitalization were enrolled to the study [n=21; 14 females and 7 males; 11 ATN and 12 AGN]. When the plasma creatinine reached a steady state [DPSM] using [99m]Tc-DTPA. GFR was also estimated by MDRD [GFRMDRD] and CG [GFRCG] equations. The patients aged 44.8 +/- 19.5 years and weighted 67.8 +/- 10.7kg. GFRDPSM [32.9 +/- 14.7 ml/min] was statistically different from the GFRMDRD [11.6 +/- 8.2 ml/min; pCG was lower than GFRDPSM in patients with either ATN [16.5 +/- 12.5ml/min and pDPSM and GFRMDRD [r=0.34; p=0.13] but GFRDPSM and GFRCG values were correlated [r=0.48; p=0.03]. Out of subjects with GFRDPSM >30, 92.3% had GFRMDRDCG Our results indicate that MDRD and CG equations were substantially inaccurate in patients with ARF. More precise methods of GFR evaluation is recommended in these patients
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The aim of the present study was to evaluate the efficacy and safety profile of bone palliative therapy following administration of [153]Sm-EDTMP in patients with intractable metastatic bone pain. Sixteen patients [9 male, 7 female] aged 29-80 years [57.3 +/- 16.7 years] with severe metastasis-related bone pain resistant to analgesic medications were enrolled in the study. All patients having multiple bone metastases, positive bone scans, and estimated life expectancy of more than 2-3 months were entered the study. All patients received intravenous injection of 1.5 mCi [56 MBq]/kg of [153]Sm-EDTMP. Four subscales for the intensity of pain were recorded: one as the present pain score [PPS] and the other three as maximum pain score [Max PS], minimum pain score [Min PS] and average pain score [APS] over the last 24 hours. Also the mean value of these 4 subscales was calculated as the mean total pain score [MTPS]. The pain mental interference [PMI] was also assessed in 9 separate. Seven patients with breast cancer [43.75%], seven with prostate cancer [43.75%], one with papillary thyroid carcinoma [6.25%] and one with malignant paraganglioma [6.25%] were included in the study. A significant response to therapy, i.e. 2-point reduction in pain score and/or remarkable reduction [>/=25%] in the equivalent narcotic dose, was observed in 11 out of 16 patients [68.7%] by the 2nd week and in 12 patients [75%] by the 8[th] week. Regarding the palliative response to treatment and equivalent narcotic dose reduction, no significant difference between two major types of underlying malignancies [breast and prostate cancer] was found. There was no significant difference regarding response to therapy between two genders and among different age groups. The severity of bone marrow suppression was graded
Subject(s)
Humans , Male , Female , Organophosphorus Compounds , Palliative Care , Neoplasm Metastasis , Bone Neoplasms , Pain, Intractable/therapy , Prostatic Neoplasms , Breast NeoplasmsABSTRACT
Monte Carlo [MC] is the most common method for simulating virtual SPECT projections. It is useful for optimizing procedures, evaluating correction algorithms and more recently image reconstruction as a forward projector in iterative algorithms; however, the main drawback of MC is its long run time. We introduced a model based method considering the effect of body attenuation and imaging system response for fast creation of noise free SPECT projections. Collimator detector response [CDR] was modeled by layer by layer blurring of activity phantom using suitable Gaussian functions. Using the attenuation phantom, in each angle, attenuation factor [AF] was calculated for each voxel. This calculated AF is the weight for the emission voxel and states the detection probability of photons that are emitted from that voxel. Finally weighted ray sum of the blurred phantom was driven to create a projection. For the next projection, our phantom was rotated and the procedure was repeated until all projections were acquired. Root Mean Square error [RMS] between all 60 modelled projection and real MC simulated projections was decreased from 0.58 +/- 0.15 using simple Radon to 0.19 +/- 0.03 using our suggested model. This value was 0.56 +/- 0.16 using blurred Radon without attenuation modelling, and 0.21 +/- 0.03 using attenuated Radon without CDR modelling. Our suggested model that considers the effect of both attenuation and CDR simultaneously results in more accurate analytical projections compared with conventional Radon model. Creation of 60 primary SPECT projections in less than one minute may make this method as a proper alternative for MC simulation. This model can be used as a forward projector during iterative image reconstruction for correction of CDR and attenuation that is necessary for quantitative SPECT
ABSTRACT
Percutaneous transluminal coronary angioplasty [PTCA] is an effective method for revascularizing of stenotic coronary vessels. Lack of response to this treatment, either in symptomatic or asymptomatic patients, is usually due to incomplete revascularization, restenosis, and/or irreversibility of myocardial perfusion. Introduction of a noninvasive method with high predictive value for diagnosis of reversibility in ischemic myocardium is of high importance to determine the patients who will benefit from PTCA. Sixty patients with one or two vessel disease, who were candidates for PTCA and had a successful PTCA [proved by post-revascularization angiography], enrolled the study. For all patients myocardial perfusion within 6 months after PTCA. The predictive values of pre-PTCA scan for the diagnosis of reversibility and prediction of perfusion improvement after PTCA were evaluated. Perfusion improvement after PTCA was noted in 52 of 60 patients [86.7%]. The positive predictive value of pre-intervention MPI for diagnosis of reversibility was 94.3% and the corresponding negative predictive value was 71.4%. Myocardial perfusion imaging may play an important role for accurate prediction of perfusion improvement after percutaneous transluminal coronary angioplasty
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A 29-year old female with bone pain and history of precocious puberty was referred for bone scintigraphy. On physical examination caf au lait macular spots were noted on her neck, buttocks and left leg. Bone scan showed multiple areas of intense increased activity which was in favour of polyostotic fibrous dysplasia. Considering the presence of polyostotic fibrous dysplasia, precocious puberty and caf au lait macular spots, MacCune-Albright syndrome was confirmed in this patient
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Ubiquicidin [UBI] 29-41 is a synthetic antimicrobial peptide that binds with the microbial cell membrane at the location of infection. This study was conducted to evaluate its probable efficacy as an infection-imaging agent with potential to differentiate bacterial infection from sterile inflammation in humans. Fifteen diabetic foot patients [10 males and 5 females] with suspected bacterial infection, prior to starting antibiotic treatment, were selected for this study. First a routine three phase bone scan and later a [99m]Tc-UBI scan was performed for all the patients. 555-740 MBq of [99m]Tc-UBI was injected intravenously. A 10 minute dynamic study was followed by spot views of the suspected region of infection and corresponding normal areas [liver and kidneys] at 60 and 120 min. Whole-body anterior and posterior images were also acquired. To interpret the studies as positive or negative, visual score [0 -3] was used, with scores of 0 [minimal or no uptake; equivalent to soft tissue] and 1 [mild; less uptake than in liver] being considered negative and scores of 2 [moderate; uptake equal to or greater than that in liver] and 3 [intense uptake equal to or greater than that in kidneys] being considered positive. Of 15 studies performed with [99m]Tc-UBI, all had positive bacterial cultures. The result of bone scan was positive for osteomyelitis in 12 patients [80%]. [99m]Tc-UBI Scintigraphy was positive in 6 patients, but negative in nine. The sensitivity of [99m]Tc-UBI for detection of infection was therefore 40%. From 12 patients who had positive bone scans, only 6 had a positive [99m]Tc-UBI [50%] indicating the sensitivity of 50% for [99m]Tc-UBI in osteomyelitis cases. 99mTc-UBI was not positive in any patient who had evidence of soft tissue infection in the bone scan. Although [99m]Tc-UBI 29-41 was well tolerated by all the patients without any side effects, considering low sensitivity of this agent, this radiopharmaceutical is not of great value for diabetic foot infection diagnosis
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A 57-year-old male with history of prostatectomy, cyctectomy, cecal urinary diversion for invasive prostate cancer and with a recent rise in PSA level, was referred for bone scintigraphy to rule out osseous metastatic disease. An interesting finding was abnormal tracer accumulation throughout the large bowel, which was proved to be due to urinary diversion
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A 36-year-old woman with right upper quadrant abdominal pain since three months previously and no other significant medical history was referred for evaluation of an abdominal mass. Upon clinical examination, a large palpable mass in the mid -upper abdominal area was noted. Abdominal ultrasound and spiral CT-scan showed a large hepatic mass in the left liver lobe. The patient was referred for Tc-99m labeled RBC scintigraphy to assess the possibility of presence of liver hemangioma. The radionuclide imaging confirmed the diagnosis of hemangioma which in this case, the huge size of the lesion was of interest
Subject(s)
Humans , Female , Radionuclide Imaging , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Tomography, Spiral Computed , Liver Neoplasms/etiology , Liver Neoplasms/diagnosis , TechnetiumABSTRACT
The field of stem cell biology and regenerative medicine is rapidly moving toward translation to clinical practice. Stem cell therapy seems to be a new treatment option for some diseases. So, tracking the distribution of stem cells is crucial to their therapeutic use. Based on this fact we labeled human mesenchymal stem cells [MSCs] with 111In-oxine for the first time in our country. The aim of this study was to investigate the possibility of stem cell labeling in Iran. In addition the researchers assessed the cell viability, specific activity and labeling efficiency after labeling. After culturing mesenchymal stem cells [MSCs], for radio-labeling, the sample [which contained 1x106MSCs] were mixed, and suspended with 50 micro Ci 111In-oxine, and then incubated for 20 min at the room temperature. The cells were then washed with normal saline twice to remove the free 111In. The labeling efficiency, specific activity and cell viability was 70.6%, 31.70 micro Ci/106 and 100%, respectively. It seems that, this method is practical and easily applicable with acceptable efficiency and specific activity in our laboratory settings using pharmaceutical produced in Iran
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In patients with coronary artery disease [CAD] noninvasive evaluation for detection of ischemia is important to avoid invasive interventions like angiography. Exercise stress test is conventionally the first study used in evaluation of CAD. Considering the noninvasive nature of the myocardial perfusion scan, we decided to compare its accuracy with stress test. Patients with chest pain, and intermediate risk for CAD underwent stress test with Bruce standard method by treadmill, and myocardial perfusion SPECT scan with Tc-99m MIBI and the results were compared to the angiography as the gold standard. Analysis of the data was performed by SPSS 11.5 soft ware. The study was performed on 89 patients [mean age: 55.5, min: 29 max: 80] including 53 man and 36 women. Exercise stress test had 54% sensitivity, 65% specificity, 68% PPV, 50% NPV, while for myocardial perfusion scan sensitivity was 94%, specificity 94%, PPV 96%, and NPV 92%. Correlation between involved walls in myocardial perfusion scan with stenotic artery in angiography was 77.6%, while this value was 32.7% for exercise stress test. There was also relationship between degree of stenosis determined by angiography and severity of ischemia detected by myocardial perfusion scan. Myocardial perfusion scan is of great value in detection of CAD with sensitivity and specificity far better than exercise stress test. It is suggested that this noninvasive study being considered the first diagnostic method for patient at risk for coronary artery disease
Subject(s)
Humans , Male , Female , Coronary Artery Disease/diagnostic imaging , Myocardial Perfusion Imaging , Exercise Test , Myocardial Ischemia , Chest PainABSTRACT
Background: [99m]Tc methoxy isobutyl isonitrile [[99m]Tc MIBI] has been proposed as a tumor-seeking agent in malignant disease. The goal of this study is to evaluate the frequency distribution of the different patterns, intensity and extension of abnormal uptake identified in MIBI scan in relation with various clinical status of the patients diagnosed as multiple myeloma
Methods: forty-three patients entered the study, including six patients with no prior treatment, 22 patients who received autologous bone marrow graft, and 15 patients with history of chemotherapy and radiotherapy. Plasma protein electrophoresis for monoclonal antibody, bone marrow biopsy, and urine analysis for Bence-Jones protein has been carried out and standard criteria were used for diagnosis of active disease and remission phase for each patients. The extension of the lesions [E-score] on scintigraphy were categorized into E0-E3 by three nuclear physicians who were blinded to the patient's clinical condition. I-score was also obtained with comparing the intensity of the lesions with intensity of myocardial uptake and classified as I0-I3
Results: the sensitivity, specificity, positive predictive value and negative predictive value of [99m]Tc MIBI scan for determining active lesions and relapsed cases were 69%, 100%, 100%, and 60%, respectively. Nineteen patients were initially thought to be in remission phase, but scintigraphy was abnormal in 5 cases who were diagnosed as active myeloma later in the course of the study. There was a significant correlation between clinical status, and pattern, intensity, and extension of the abnormal uptake of [[99m]Tc-MIBI. Also a significant correlation between intensity and extension of the abnormal tracer uptake with serum monoclonal component and urine Bence-jones protein was noted, however no correlation between blood hemoglobulin and degree of extension in scintigraphy was seen
Conclusion: our study suggests the patterns, extension and intensity of [99m]Tc MIBI uptake, in addition to the hematological findings are associated with disease activity and clinical status of the patients. Hence, in addition to the standard protocol, [99m]Tc-MIBI has a very high accuracy for detection of active myeloma disease and also can detect the group of patients who might benefit from treatment
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Reverse redistribution pattern is defined as decreased activity in the myocardium in the rest phase of the myocardial perfusion scan in comparison with the stress images. There are many studies concerning the etiology and clinical significant of this phenomenon in nuclear medicine literature. The dominant idea about etiology of reverse redistribution is early wash out of the radiotracer from the myocardium. There is rather unaminous agreement among researchers about viability of the areas of reverse redistribution and the majority of the studies point to existence of viable tissue in these regions. However from prognostic point of view, this issue is much more controversial. In this review, we tried to summarize the current literature and reach a guideline for practical significance of reverse redistribution in every day work of nuclear medicine specialists
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Radioisotope scanning is the best method for objective assessment of salivary gland function. Thus, it was used in a randomized trial of concomitant pilocarpine for assessment of radiation-induced xerostomia, in addition to subjective evaluation by an approved questionnaire and objective standard xerostomia grading. Patients randomized in placebo-controlled trial of pilocarpine concurrent with irradiation for prevention of radiation-induced xerostomia were evaluated by salivary gland scintigraphy immediately before and 6 months after the end of head and neck radiotherapy. Salivary gland function was measured by ejection fraction [EF] of Technetium-99m pertechnetate. The mean values for pre and post-radiotherapy scans were calculated and compared. Also post-radiotherapy scan findings in the two groups of pilocarpine and placebo were compared using the student's t-test. In addition, comparison was made between the scan results and the subjective findings and objective gradings. Twenty patients underwent the pre-radiotherapy salivary scintigraphy, and also 20 post-radiotherapy scans were performed. Mean parotid EF was 60.85% in the pre-radiotherapy and 9.08% in the post-radiotherapy scans [P<0.01]. The means for submandibular glands in the pre and post-radiotherapy scans were 41% and 11.2%, respectively [P<0.01]. Also the mean EF was 14.5% in the pilocarpine group and 3.65 in the placebo group for parotid glands [P=0.07] and 18.3% and 4.1% respectively for submandibular glands [P<0.05]. The salivary scans confirmed the subjective and objective xerostomia findings. Salivary gland scintigraphy is a valuable method for evaluation of xerostomia after head and neck radiotherapy, quantitatively demonstrating the protective effect of pilocarpine compared to placebo on salivary glands