Correlations between SPECT regional cerebral blood flow and psychometric testing in patients with Alzheimer's disease.

Thirty-nine patients with probable Alzheimer's disease (AD) were studied with [99mTc]HMPAO SPECT and a standardized neuropsychological battery testing intellect, memory, attention, language, motor and praxis functions, and depression. Spearman rank correlations and multivariate regression analyses were performed to correlate quantitative regional perfusion deficits to these tests. Patients were found to have decreased perfusion of left frontal, parietal, and temporal regions relative to right. WAB repetition scores and bilateral temporal flow were significantly correlated (P < 0.01). Correlations between visual memory and bilateral temporal flow and those between Mini-Mental State/ Geriatric Depression Scale scores and bihemispheric flow approached significance. Although in this study regional cerebral blood flow was relatively insensitive to neuroanatomical abnormalities underlying specific cognitive deficits, it may have some specificity for identifying the language disorder in AD.

Inferior vena cava obstruction and diffuse hepatic uptake on lower extremity radionuclide venogram.

Two patients with dissimilar but advanced malignancies and lower extremity swelling underwent bilateral lower extremity radionuclide venograms, several months apart. Both patients' scintigrams showed multiple collaterals in the abdomen and pelvis, consistent with inferior vena cava obstruction, and hepatic uptake in a diffuse pattern. One patient also had multiple bilateral pulmonary emboli on a lung scan. Although diffuse hepatic uptake has been mentioned before with inferior vena cava obstruction, it has usually been incidental to focal hepatic uptake near the porta hepatis. The case results in this study demonstrated that inferior vena cava obstruction can manifest itself solely as diffuse hepatic uptake on nuclear venograms. The authors believe that either pattern can be corroborative of inferior vena cava obstruction on a nuclear venogram.

SPECT findings on psychosis in Alzheimer's disease.

OBJECTIVE: This study examined whether psychosis in Alzheimer's disease is associated with cerebral perfusion patterns appreciable by single photon emission computed tomography (SPECT) scans. METHOD: All cooperative outpatients enrolled in an Alzheimer's disease research center with the diagnosis of probable Alzheimer's disease and a Clinical Dementia Rating of mild or moderate were interviewed with their primary caregivers. Current and past psychiatric functioning was assessed by using the Hamilton Depression Rating Scale, the Structured Clinical Interview for DSM-III-R, and the Behavioral Pathology in Alzheimer's Disease Rating Scale. Patients without premorbid psychosis received SPECT scans, and the scans of the patients with delusions or hallucinations (N = 30) were compared to the scans of patients without these symptoms (N = 16). RESULTS: The patients with delusions (N = 29) had hypoperfusion of the left frontal lobe in relation to the right frontal lobe. The patients with hallucinations (N = 10) had hypoperfusion in the parietal lobe. CONCLUSIONS: Psychotic patients with Alzheimer's disease had a pattern of cerebral blood flow deficits significantly different from that of nonpsychotic patients. This suggests that patterns of cerebral dysfunction may be expressed symptomatically as psychosis.

Scintigraphic assessment of pericardio-peritoneal window patency. Relevance to peritoneal dialysis.

To alleviate recurrent pericardial effusion secondary to systemic lupus erythematosus, pericardio-peritoneal window was performed. Subsequently, end stage renal disease developed and the patient required peritoneal dialysis. Patency of the pericardio-peritoneal window was demonstrated by intraperitoneal injection of Tc-99m SC through a Tenckhoff catheter, which prompted special counsel to the patient in order to prevent infectious pericarditis potentially complicating peritoneal dialysis induced-peritonitis.

Graves' disease and concurrent thyroid carcinoma. The importance of thyroid scintigraphy in Graves' disease.

A woman with Graves' disease and unsuspected coexisting thyroid cancer is presented. Although rare, this association has to be considered. It has been noticed that thyroid cancer is more common in hyperthyroid than euthyroid persons. Thus, thyroid scintigraphy is very important in the initial workup of Graves' disease. It helps determine whether medical or surgical therapy is more appropriate in a particular patient.

Chloramine-T induced binding of monoclonal antibody B72.3 to concanavalin-A.

The effects of chloramine-T (CT) on monoclonal antibody B72.3 were studied with particular reference to Con-A lectin binding. After exposure to chloramine-T concentrations from 0.8 to 4.0 mg/mL (115-574 mol CT/mol B72.3), B.72.3 showed progressive binding to agarose-linked Con-A. This behavior was paralleled by decreasing immunoreactivity and increasing fragmentation and aggregation of B72.3 demonstrated by SDS-PAGE and size exclusion HPLC.

The origin of biexponential T2 relaxation in muscle water.

Two theories have been proposed to explain the multiexponential transverse relaxation of muscle water protons: "anatomical" and "chemical" compartmentation. In an attempt to obtain evidence to support one or the other of these two theories, interstitial and intracellular macromolecular preparations were studied and compared with rat muscle tissue by proton NMR transverse relaxation (T2) measurements. All macromolecule preparations displayed monoexponential T2 decay. Membrane alteration with DMSO/glycerin did not eliminate the biexponential T2 decay of muscle tissue. Maceration converted biexponential T2 decay of muscle tissue to single exponential decay. It is concluded that the observed two component exponential T2 decay of muscle represents anatomical compartmentation of tissue water, probably intracellular versus extracellular.

Clinical, biochemical, and neuropathologic findings following transplantation of adrenal medulla to the caudate nucleus for treatment of Parkinson's disease.

We transplanted autologous adrenal medullary tissue into the caudate nucleus of 3 patients with advanced Parkinson's disease. The 1st patient, a 59-year-old man with parkinsonian symptoms for 15 years, had mild improvement in his motor functioning after the operation. However, his postoperative course was characterized by prolonged drowsiness and complex visual hallucinations. The patient died suddenly 8 months after the transplant, and an autopsy revealed coronary atherosclerosis. Examination of the graft site showed necrotic adrenal medullary tissue surrounded by inflammatory cells. The 2nd patient, a 50-year-old man with a 21-year history of parkinsonian symptoms, improved the most after the procedure. The 3rd patient, a 43-year-old man with 12 years of parkinsonian symptoms, had mild improvement in his motor functioning. CSF homovanillic acid increased postoperatively in the 3 patients, but then returned to preoperative levels in all except the 2nd patient. The anatomic, neurochemical, and physiologic basis for the modest clinical improvement shown in these patients is not yet understood.

Cerebral infarction: diagnosis and assessment of prognosis by using 123IMP-SPECT and CT.

A multicenter prospective study was performed in 49 patients with 77 regions of cerebral infarction. Each patient was evaluated in the acute (0-5 days) and subacute (6-17 days) phases by (1) clinical neurologic examination, (2) CT scans, and (3) N-isopropyl-p-123I-iodoamphetamine (123IMP) single-photon emission CT (SPECT) scans. The abilities of the scans to (1) detect a lesion and (2) predict the clinical outcome were assessed. For lesion detection, 123IMP-SPECT was superior to CT in the first 2 days, but the scans were equally effective 3-5 days after onset. In the subacute phase, IV contrast-enhanced CT was superior to 123IMP-SPECT and unenhanced CT. The clinical outcome was only mildly correlated with the results of the acute and subacute 123IMP-SPECT and the acute CT scans. Reduction in lesion size on the subacute scans did not correlate with clinical improvement. We conclude that the parameters measured by CT and 123IMP-SPECT in patients with acute cerebral infarction cannot reliably be used to predict clinical outcome. 124I contamination of 123IMP and the use of low-energy collimators may have decreased lesion detectability.

Ectopic thyroid in the right carotid triangle.

A neck mass in the right carotid triangle of a 28-year-old woman was found to be the only thyroid tissue she possessed. Resection of the mass led to clinical and biochemical hypothyroidism. A possible explanation for the unlikely occurrence of lateral aberrant thyroid tissue and absence of a thyroid gland in the usual location is offered. It is suggested that patients with midline or low lateral neck masses undergo isotopic scanning of the thyroid gland before any iodinated contrast materials are administered or surgery performed.

Technetium-99m labeled RBC imaging in gastrointestinal bleeding from gastric leiomyoma.

Tc-99m labeled RBC imaging is becoming increasingly useful in detecting gastrointestinal (GI) bleeding sites. A patient is presented who had massive GI bleeding from an unsuspected gastric leiomyoma in whom a Tc-99m sulfur colloid GI bleed image was negative. The Tc-99m labeled RBC imaging done on the day after sulfur colloid imaging revealed increased gastric activity due to active bleeding from an intragastric leiomyoma. Tc-99m labeled RBC imaging helped in early detection of the bleeding site resulting in its successful treatment. This experience also reinforces the assertion that Tc-99m labeled RBC imaging may be more helpful than Tc-99m sulfur colloid imaging in patients with upper GI or intermittent bleeding.

New 111In labeling of IgG: 111In-oxine mediated chelation.

Current methods of 111In chelate conjugation labeling of antibodies expose the protein to pH 5-6 during 111In chelation. These conditions could be detrimental if the antibody is acid labile. We have successfully labeled human IgG via the cyclic anhydride of DPTA and 111In-oxyquinoline(oxine). Chelation was achieved at pH 6.9-8.4 and was complete within 1 min at room temperature. The chelation was sensitive to trace metal contamination on labware and in some reagents (including commercial 111In-oxine).

Technetium-99m labeled red blood cells in the evaluation of hemangiosarcoma.

Imaging with Tc-99m labeled red blood cells (RBC) is increasingly being used in the detection of acute gastro-intestinal bleeding, especially in patients with intermittent bleeding. A patient is presented in whom the labeled RBC scan was helpful in the incidental discovery of a previously unsuspected probable angiosarcoma of the right femur and adjacent soft tissues of the right hip due to the "blood pool" or "blush effect" of the labeled cells. The labeled RBC scan also identified extravasation due to active gastrointestinal bleeding from a previously unknown angiosarcoma of the ascending colon. Thus, the Tc-99m labeled RBC scan was useful in simultaneously detecting extravasation and blood pool effect at two remote tumor sites in the same patient.

Spinal bone mineral after 5 weeks of bed rest.

Patients put at bedrest for medical reasons lose 1-2% of spinal bone mineral per week. Losses of this magnitude during even short-term space flights of a few months would pose a serious limitation and require countermeasures. The spinal bone mineral (L2-L4) was determined in 6 healthy males (precision = 2%) before and after 5 weeks of complete bed rest. Only one individual had a significant loss (3%) and the -0.9% mean change for the 6, was not significant (P = 0.06). The average negative calcium balance during the 5 weeks was 4 g or 0.36% of total body calcium, similar to that reported in other bed-rest studies. Spinal bone loss, however, in healthy bed-rested males is significantly less than reported for bed-rested patients, suggesting that a large loss of spinal bone mineral does not occur during space flight missions lasting 5 weeks or less.

Changes in nuclear magnetic resonance (T2) relaxation of limb tissue with bed rest.

Bed rest is used to simulate the effects of weightlessness on human physiology. A spin-echo procedure was used to image the lower leg of 15 normal male volunteers before and after 5 weeks of horizontal bedrest. In addition to noninvasively measuring muscle size changes, accurate T2 images were produced to investigate possible relaxation time changes immediately (2-4 h) and 1-2 days after bed rest. Subcutaneous fat showed no change in T2, bone marrow showed a decrease, and muscle showed no change immediately after bed rest but increased 1-2 days following reambulation.

Precision of dual photon absorptiometry measurements.

One of the important uses of bone absorptiometry is to examine the rate of bone mineral change in order to evaluate therapy and to identify individuals who need therapy. Generally, this involves comparing the difference between two scans obtained months to years apart. This study investigates the precision of dual photon absorptiometry using a human torso phantom, normal subjects, and abnormal patients. These studies showed that bone mineral calculated as g/cm2 was more precise than g/cm. Reanalysis of the same scan by the same individual produced an average error equivalent to that produced by scanning and analyzing the same subject on multiple occasions. Interobserver analysis error was essentially equal to the intraobserver error. In order to obtain maximum precision, care must be taken that the integrated area of a repeat scan is identical to the previous scan. Our findings indicate that to be confident (95%) of a real change between two scans a difference of at least 5.6% must be measured.

Bone and muscle atrophy with suspension of the rat.

A modification of the Morey tail suspension model was used to determine atrophic responses of rat bone and muscle with 14-90 days unloading of the hindlimbs. Bone uptake of methylene diphosphonate followed a phasic pattern similar to changes in bone formation rate in immobilized dogs and rats. Increased uptake at 60 days (P = 0.01, femur) indicated an increased bone metabolism. Regional densitometry demonstrated a preferential loss of bone mineral in the trabecular mass (P = 0.02) at 30 days and in the cortical shaft by 90 days (P = 0.03). Maximal muscle atrophy occurred within 14-30 days. The gastrocnemius was less severely affected by suspension than by immobilization techniques, whereas the soleus atrophied (by weight) similarly, suggesting that muscle atrophy in the suspension model is distinctly different from immobilization atrophy. One significant response of skeletal muscle to suspension was an altered blood distribution. Muscle blood distribution changes reflect the hypodynamic state of muscle that continues to contract but probably at an altered rate in response to altered functional demands.

High resolution bone mineral densitometry with a gamma camera.

A technique is described by which the regional distribution of bone mineral can be determined in bone samples from small animals. The technique employs an Anger camera interfaced to a medical computer. High resolution (less than 1 mm) imaging is possible by producing magnified images of the bone samples. Regional densitometry of femurs from oophorectomised and bone grafted rats demonstrated significant heterogenity of bone mineral loss.