Clinical value of technetium-99m-HMPAO-labeled leukocyte scintigraphy and spiral computed tomography in active Crohn's disease.

OBJECTIVES: The diagnostic accuracy of technetium-99m-HMPAO-labeled leukocyte scintigraphy (LS) and spiral CT for the detection of inflammatory activity was assessed; the extent of the inflammation and the complications were compared with the clinical and laboratory parameters and with the endoscopic and radiological findings in patients with clinically active Crohn's disease (CD). METHODS: Twenty-eight patients (13 men, 15 women, average age 32.5 yr, range: 18-59 yr) with an acute exacerbation of CD were enrolled in the study. The disease behavior type and the maximum extent of inflammation were established by means of endoscopy (jejunoscopy and colonoscopy) and enteroclysis. Nine patients with severe complications (abscess and stenosis) underwent operation. The GI tract was divided into five segments (small bowel, ascending colon, transverse colon, descending colon, and rectosigmoid), the LS, CT, endoscopic, and radiological pictures of all segments were graded (range: 0-3) and the scores were summed and compared. RESULTS: The investigations indicated that LS and CT had sensitivities of 76.1% and 71.8%, specificities of 91.0% and 83.5%, and accuracies of 82.6% and 77.5%, respectively, for detection of segmental inflammatory activity. With regard to the disease behavior type, the sensitivities of LS and CT were, respectively, 77% and 100% in the penetrating-fistulizing, 80% and 73% in the stricturing, and 68% and 64% in the inflammatory form of CD. CT detected all abdominal abscesses, whereas the diagnostic value of LS for the detection of the complications of CD was lower. The inflammatory activity scores measured by LS displayed a closer correlation than that of CT with the Best index (r = 0.71, p < 0.0005 vs r = 0.63, p < 0.001), the van Hees index (r = 0.61, p < 0.005 vs r = 0.59, p < 0.005), the serum fibrinogen level (r = 0.67, p < 0.005 vs r = 0.59, p < 0.005), or the C-reactive protein level (r = 0.64, p < 0.005 vs r = 0.51, p < 0.01). CONCLUSIONS: Both LS and CT are valuable noninvasive diagnostic methods in cases involving severe, active CD. LS seemed better for the detection of segmental inflammatory activity, whereas CT displayed excellent suitability for the recognition of complications: abdominal abscesses were diagnosed with 100% efficiency.

[Initial experiences with 123-Iodine-IBZM neuroreceptor scintigraphy in extrapyramidal disorders]. / 123I-IBZM (3-jód-6-metoxi-benzamid) neuroreceptor-szcintigráfiával szerzett kezdeti tapasztalatok extrapyramidalis kórképekben.

The receptor scintigraphy of the dopaminergic system of the brain is of interest in the evaluation of movement disorders. The 123I-IBZM is a radiopharmaceutical with affinity predominantly to postsynaptic D2 receptors. The aim of this study was to evaluate the role of IBZM SPECT investigations in the differentiation of disorders with Parkinson's syndrome. Eight patients with idiopathic Parkinson's syndrome and 8 patients Parkinson's syndrome with other etiology were investigated with 123I-IBZM SPECT (6 females, 10 males, mean age +/- SD: 59 +/- 9). The patients according to the clinical signs and symptoms, results of CT/MRI and rCBF SPECT investigation were categorized. The reconstructed SPECT slices were evaluated visually and quantitatively. The visual interpretation of the images were performed by two observer and scored the radiopharmaceutical uptake (from 1-3) of the cortex and the striatum separately. For quantification striatum/frontal cortex activity ratio were calculated with ROI technique. The differences between the patient groups were statistically analyzed by two tailed t-test. The IBZM uptake were different in the two group of patients. The striatal IBZM accumulation was higher in the idiopathic Parkinson's syndrome patients compared to the other parkinsonians. The striatum/frontal lobe activity ratio was 1.69 +/- 0.9 (mean +/- SD) in the right, 1.67 +/- 0.04 (mean +/- SD) in the left hemisphere of the patients with idiopathic Parkinson's syndrome. The corresponding data in the nonidiopathic parkinsonian group were 1.53 +/- 0.06 (mean +/- SD), 1.52 +/- 0.04 (mean +/- SD) respectively (p < 0.01). The quantitative data correlated with the results of the visual evaluation. According to the data presented IBZM-SPECT is an effective tool in the differentiation of disorders with Parkinson syndrome.

[Evaluation of the nature of brain tumors using methods of nuclear medicine]. / Agydaganatok természetének vizsgálata nukleáris medicinai módszerekkel.

FDG-PET studies permit an assessment of the degree of brain tumour malignancy and detection of tumour recurrence. MIBI-SPECT also affords promising results in this respect. In this work, the diagnostic value of MIBI-SPECT was compared with that of FDG-PET for the determination of primary brain tumours malignancy and the detection of recurrent brain tumours. SPECT and PET examination were carried out within a week in 14 patients (12 males, 2 females, mean age: 40 years, range 16-61 years) with brain tumours. Seven patients had a primary tumour, and in a further 7 MRI or the clinical signs and symptoms let to a suspicion of tumour recurrence. All tumours were verified histologically to be gliomas of grades I-IV. The SPECT and PET images were analysed visually and semiquantitatively. In 3 of the investigated 7 primary glioma patients, there was a visibly enhanced MIBI-positive cases, only one had an increased FDG uptake. In 4 of the 7 tumour recurrence cases, either the MIBI or the FDG uptake was visibly increased. All of these were histologically high-grade gliomas. In the remaining low grade tumours (primary of recurrent), neither MIBI nor FDG revealed a pathologically increased uptake. The intensity of radiopharmaceutical uptake at the site of the tumours was visually and semiquantitatively higher for MIBI that for FDG. It is concluded that MIBI-SPECT is a valuable and simple tool for evaluation of the biological characteristics of brain tumours, showing increased uptake of MIBI according to the malignancy and tumour recurrence of brain tumours.

[Regional cerebral blood flow changes in schizophrenic patients detected by SPECT studies under resting and active conditions]. / Nyugalmi és aktivációs agyi vérátfolyás SPECT-vizsgálatok krónikus schizophreniában szenvedö betegekben.

Brain SPECT studies in schizophrenia revealed changes in regional cerebral blood flow (rCBF). The rCBF changes can be detected more accurate by activating tests. The aim of this study was to assess rCBF changes under resting and activation condition by the Raven test. Four control patients (2 male, 2 female, average age 45 years, 26-57 years) and 11 chronic, treated schizophrenic patients (4 male, 7 female, average age: 46 years, 33-56 years) were studied in two HMPAO brain SPECT sessions, 48 hours apart, both resting and during activation task. The images were evaluated visually and semiquantitatively. Under resting condition in the control group, there were no significant rCBF changes. In the Raven activation test, a significantly higher blood flow in the prefrontal region was seen (p < 0.05). The schizophrenic group had a significantly lower rCBF in the temporal region under resting condition (p < 0.05): four patients displayed left, 4 right temporal hypoperfusion and 3 exhibited no rCBF abnormality. In the Raven activation tests 5 patients had prefrontal hyperperfusion, and the remaining 6 patients had no such activation answer. Five patients had hypoperfusion in the temporal region. In our sample, patients with chronic schizophrenia displayed significant temporal hypoperfusion. Moreover the chronic schizophrenic group exhibited a poor response to prefrontal activation compared to the control group.

[The role of 99mTc-MIBI mammoscintigraphy in the diagnosis of breast cancer]. / 99mTc-MIBI mammoszcintigráfia szerepe az emlödaganatok diagnosztikájában.

Among several investigative methods currently undergoing evaluation for the differentiation of biological features of breast mass lesions, mammoscintigraphy with different radiopharmaceuticals appears promising. The reported study evaluated the efficacy of 99mTc-MIBI mammoscintigraphy in detection of the malignancy of focal breast lesions. Mammography, 99mTc-MIBI mammoscintigraphy were performed in 51 women with palpable breast mass lesions. Following surgical removal of the abnormalities, histological examination revealed 40 malignant and 11 benign breast mass lesions. In the mammoscintigraphy, early (5 min p. i. of MIBI) and late (2 h p. i. of MIBI) planar images of the breast and the axillary regions were evaluated visually and semiquantitatively. The sensitivity and specificity values of MIBI mammoscintigraphy were in the detection malignant breast lesions evaluated visually according to the early images 95% and 73%, according to the late images 98% and 82%, respectively. Revealed to the quantitative results the corresponding results were according to the early images 90% and 64% according to the late images 95% an 64%. The visual scores and the quantitative T/NT values with MIBI demonstrated a significant difference between malignant and benign breast mass lesions. A significant difference was also found as concerns the grade of malignancy from the MIBI accumulation. The late MIBI images seemed optimal. In the detection of metastatic lymph node involvement, the sensitivity and specificity with MIBI were 53% and 81%. It was concluded that MIBI (2 h p. i.) mammoscintigraphy is a useful and simple method for differentiation of malignant breast abnormalities from benign lesions and for determination of the grade of malignancy.

rCBF SPECT and the acetazolamide test in the evaluation of dementia.

BACKGROUND: The diagnostic potential of 99mTc-HMPAO following systemic administration of the cerebral vasodilator acetazolamide (acetazolamide test) was evaluated using regional-cerebral-blood-flow (rCBF) SPECT in patients with Alzheimer's disease (AD) or with vascular-type of dementia (VD). METHODS: An initial, high-resolution SPELT study was performed with 99mTc-HMPAO, and after 2 days patients were re-evaluated with 99mTc-HMPAO following systemic administration of acetazolamide. Reconstructed SPELT slices were evaluated visually and semiquantitatively by a semiautomatic rCBF map method. RESULTS: Using 99mTc-HMPAO alone, a bilateral hypoperfusion was found in the temporal and/or parietal regions in 33% (6/18) of VD patients and in 70% (23/33) of AD patients. The vascular reserve capacity, as determined with the acetazolamide test, was not impaired in 22% of the VD patients but in 76% of the AD patients. The differences in the perfusion patterns between VD and AD patients were statistically different (p < 0.01, Fischer's exact test). Of the 6 VD patients with hypoperfusion (bilateral temporal and/or parietal), 4 had a decreased vascular reserve capacity as determined in the acetazolamide test. Decreased reserve capacity was found in only 4 out of 25 patients with AD. CONCLUSIONS: The acetazolamide test is helpful in rCBF SPECT to differentiate VD from AD.

Value of 99m-Tc MIBI and 99m-Tc(V) DMSA scintigraphy in evaluation of breast mass lesions.

Among several investigative methods currently undergoing evaluation for the differentiation of biological features of breast mass lesions, mammoscintigraphy with different radiopharmaceuticals appears promising. This study evaluated the efficacy of 99m-Tc MIBI and 99m-Tc(V) DMSA mammoscintigraphy in the detection of malignant focal breast lesions. Mammography, ultrasonography, 99m-Tc MIBI and 99m-Tc(V) DMSA mammoscintigraphy were performed in 51 women with palpable breast mass lesions. Following surgical removal of the abnormalities, histological examination revealed 40 malignant and 11 benign breast mass lesions. In mammoscintigraphy, early (5 minute p.i. of MIBI, 2 hours p.i. of DMSA) and late (2 hours p.i. of MIBI and 5 hours p.i. of DMSA) planar images of the breast and the axillary regions were evaluated visually and quantitatively. The efficacy of the methods was assessed via ROC curves and variance analysis. The visual scores and the quantitative T/NT values with MIBI demonstrated a significant difference between malignant and benign breast mass lesions. A significant difference was also found as concerns the grade of malignancy from the MIBI accumulation. The late MIBI images seemed optimal. The DMSA values indicated no relationship with the breast lesion malignancy. In the detection of metastatic lymph node involvement the sensitivity and specificity with mammography and ultrasonography were 57% and 85%, with MIBI 53% and 81%, and with DMSA 53% and 95%, respectively. It is concluded that MIBI (2 hours p.i.) mammoscintigraphy is a useful and simple method for differentiation of malignant breast abnormalities from benign lesions and for determination of the grade of malignancy. DMSA mammoscintigraphy appears superior to MIBI only in the detection of axillary lymph node metastases.

[Cerebral blood flow studied by SPECT and transcranial Doppler sonography in subarachnoid hemorrhage]. / Agyi vérátfolyás SPECT és transcranialis Doppler-szonográfiás vizsgálatok subarachnoidealis vérzésben.

The detection of vasospasm plays an important role for the definition of the strategy of treatment in patients with subarachnoid hemorrhage (SAH). Besides the invasive contrast angiography, the non-invasive 99m-Tc-HMPAO brain perfusion SPECT and transcranial Doppler sonography (TCD) are recently used for this purpose. For the investigation of the possibilities of the last two methods, comparative studies were performed in 29 SAH patients in the subacute phase of the disease. In the detection of regional brain ischaemia the sensitivity of the SPECT study was 90%, the specificity was 28% and the accuracy was 50%, the corresponding values of TCD were 82%, 71% and 75%. In patients, in whom chronic neurological symptoms, or morphological abnormalities could be excluded, the specificity of the SPECT study was 67% at unchanged sensitivity. Based on the results it is concluded, that the brain perfusion SPECT and the TCD investigation are useful methods for the detection of vasospasm after SAH. The combination of the two methods is recommended for the correct diagnosis of vasospasm in SAH. Further investigations are necessary to clarify the prognostic impact of the result of these investigations.

Evaluation of cerebral vasoreactivity by SPECT and transcranial Doppler sonography using the acetazolamide test.

rCBF SPECT with 99mTc-HMPAO was performed prospectively in 29 patients (3 controls and 26 stroke patients) as well as TCD studies in 20 patients (3 controls and 17 stroke patients) before and after 1 g i.v. acetazolamide. The sensitivity of rCBF SPECT increased from 62% to 77% after acetazolamide provocation in stroke patients. In patients with a reversible neurological deficit, the sensitivity under resting conditions was 50% which increased to 71%, while in cases with a permanent deficit it increased from 75% to 83%. In the evaluation of the cerebrovascular reserve capacity the results of rCBF SPECT and TCD coincided in 91% of the hemispheres. The correlation was statistically significant.

Epilepsia partialis continua: follow-up with 99mTc-HMPAO-SPECT.

A three-year-old girl with epilepsia partialis continua involving the left side of the face and the left arm and leg was followed-up by 99mTc-HMPAO-SPECT in addition to EEG and CT. Increased regional cerebral blood flow was found in the right Rolandic area in the early stage of the disease, when the CT was normal and the EEG showed marked right hemispheric slowing. Seven months later severe hypoperfusion, extending to the right fronto-temporal region, and localised hyperperfusion in the right parietal area were observed by the 99mTc-HMPAO-SPECT when CT detected right hemispheric atrophy and EEG recorded severe epileptic activity, involving even the contralateral areas. The 99mTc-HMPAO-SPECT proved to be useful for the follow-up of the dynamics of the disease process.

[The value of acetazolamide provocation combined with blood flow tests in the diagnosis of ischemic cerebrovascular diseases]. / Acetazolamid provokációval kombinált vérátfolyás-vizsgálatok lehetöségei az ischaemiás cerebrovascularis betegségek diagnosztikájában.

In 28 (3 normal, 11 TIA, 14 completed stroke) patients 99mTc-HMPAO rCBF SPECT studies were performed at rest and after acetazolamide administration. For the investigations, a one-day protocol (the stress study directly followed the rest investigation) was used. The reconstructed and normalized slices were evaluated visually and semiquantitatively with a side difference analysis method. In the group of TIA patients, the abnormal results of the rCBF investigations increased from 55% to 82% after acetazolamide provocation. The corresponding results in the completed stroke group were 80% and 87%. After acetazolamide stimulation, hypoperfusion appeared or become more pronounced in the majority of the TIA group patients in contrast with the completed stroke patients with an unchanged or decreased perfusion abnormality. The semiquantitative evaluation method was mostly effective in the TIA group, where predominantly a one-sided cerebrovascular disorder was suspected. It was concluded that the 99mTc-HMPAO studies allow demonstration of the acetazolamide-induced cerebral perfusion alterations, and this method can be useful in the diagnosis and management of cerebrovascular disorders.

[SPECT follow-up of cerebral blood circulation after stroke]. / Cerebrovascularis inzultust követöen végzett agyi vérátfolyás SPECT vizsgálatok.

rCBF SPECT investigations with 99mTc-HMPAO were performed in 22 completed ischemic stroke patients on average 2.5, 16.8 and 38.0 days after stroke onset. As control group, 12 neurologically healthy volunteers were examined with the same method. The overall sensitivity of the rCBF SPECT method in the detection of cerebral blood flow abnormalities was 91%, with a specificity of 83% and an accuracy of 88%. The rCBF study was highly effective, particularly in the acute phase of the disease. Regional increased tracer uptake or a false normal 99mTc-HMPAO distribution due to the developing hyperemia mostly complicated the rCBF image interpretations in the subacute period. In the chronic phase, the spatial resolution of the SPECT system limited the detection of the continuously retracted stroke lesions.

[Effect of intra-arterial chemotherapy of head and neck tumors on cerebral blood circulation]. / Fej és nyaki tumorok intraarteriális chemotherapiájának hatása az agyi keringésre.

A combination of Cisplatin and Epirubicin was administered through the external carotid artery system according to a standard protocol as preoperative or palliative therapy in 14 oral cancer patients. With the aim of clarifying the subacute side-effects of this chemotherapy on the intracerebral circulation, rCBF SPECT investigations with 99mTc-HMPAO were performed before and after the cytostatic treatment. The interval between SPECT studies was 24 (SD +/- 12) days. In concordance with the neurological condition, visual assessment of the rCBF SPECT reconstructed transversal slices revealed no perfusion abnormalities and no changes on the follow-up. No significant changes were found in the side activity ratios in 22 regions of each hemisphere (unpaired t-test) in the whole group of patients. It was concluded that within the investigated time interval this highly effective combination of cytostatics administered perfectly through the external carotid artery system causes no serious disturbances in the cerebral circulation in oral cancer cases.

[The role of combined SPECT studies of regional cerebral blood flow and volume in the detection of intracranial vascular malformations]. / A regionális agyi vérátfolyás és vértérfogat kombinált SPECT-vizsgálatának jelentösége agyi értorzképzödmények vizsgálatában.

Brain perfusion (rCBF) (99mTc--HMPAO) and blood volume (rCBV) (99mTc--RBC) investigations were performed by SPECT on 13 patients with intracranial AVM. In each cases the rCBF revealed a decreased tracer uptake at the site of the AVM. In the rCBV SPECT, abnormal AVM structures with increased radioactivity were detected in 92% of cases. In all of the patients surgical resection of the AVM was also carried out. In the cases where the rCBF disturbance was equal or larger than the rCBV abnormality the surgical complications were more frequent it was concluded that combined rCBF--rCBV method is suitable to detect the AVM-s, and to clarify their haemodynamic effects. It is helpful in planning the surgical intervention, and in the follow-up.