Gastric emptying is accelerated in obese type 2 diabetic patients without autonomic neuropathy.

OBJECTIVE: To clarify the impact of type 2 diabetes mellitus on the gastric emptying rate. MATERIAL AND METHODS: Using a double-isotope scintigraphic technique, we assessed the gastric emptying of a standard liquid-solid meal in 13 obese type 2 diabetic patients without autonomic neuropathy (age: 47.4 +/- 8.6 yr, body mass index: 33.9 +/- 4.8 kg/m(2), glycaemia: 9.1 +/- 2.6 mmol/l) and in 7 controls with similar sex ratio, age, BMI and body fat distribution. RESULTS: The half gastric emptying time for the liquid phase was not significantly different between diabetic patients and controls (respectively: 52.7 +/- 14.5 min and 63.1 +/- 15.2 min). However, the half gastric emptying time for the solid phase was significantly shortened in diabetic patients versus controls (respectively 88.8 +/- 23.2 min in diabetic patients and 113.6 +/- 26.9 min in controls; p<0.04). Furthermore, a negative relationship was highlighted between the half gastric emptying time for the solid phase and basal glycaemia (r=-0.65, p<0.02) in diabetic patients. No significant relationship was found between gastric emptying parameters and cardiac autonomic nerve function, insulin or gastrin levels. CONCLUSION: Solid gastric emptying is accelerated in obese type 2 diabetic patients without patent autonomic neuropathy when compared to obese non diabetic patients.

Quantitative comparison of prone and supine myocardial SPECT MIBI images.

The myocardial count distribution and the stress/rest ratio distribution were compared between prone and supine Tc-99m MIBI myocardial SPECT acquisitions. Ninety-nine male patients with a low stress supine inferior wall count underwent stress and rest acquisitions in the supine and prone positions successively. For each study, values depicting the inferior, anterior, septal, and lateral wall counts were extracted from a medioventricular normalized circumferential profile and underwent a statistical analysis (Student's paired t-test). On prone imaging, when compared to supine imaging, counts showed a highly significant mean relative increase of 11% +/- 1% in the inferior wall and of 7% +/- 1% in the septum. Conversely, these counts showed a significant mean relative decrease of 4% +/- 1% in the anterior wall and of 3% +/- 1% in the lateral wall. Moreover, the inferior wall stress/rest ratio showed a highly significant mean relative increase (6% +/- 2%). The prone position is probably preferable for interpreting the inferior wall and septum, where relative counts are enhanced, as with TI-201, and because the inferior stress-rest discrepancies are reduced in that position. But the anterior and lateral wall information is impaired in the prone position. The authors suggest, in case of a low stress supine inferior count, the combination of both positions, which is feasible with Tc-99m MIBI, in order to prevent a misleading interpretation.

Visualization of myocardial infarction six hours after injection of 111 In-antimyosin antibodies using an image subtraction technique.

111 In-antimyosin antibodies are capable of visualizing acute myocardial infarction (MI). Because of slow blood clearance, images are usually recorded 24 or 48 h postinjection. This pilot study was aimed at validating a blood pool subtraction technique, which makes it possible to visualize MI 6 h postinjection. Twenty-five patients with proven MI (16 anterior, 9 inferior) were imaged 10 minutes, 6 and 24 h after an injection of 110 MBq 111 In-labelled antimyosin antibodies, with a mean delay of two weeks after infarction. Three planar views were obtained each time. Using software which performs geometric registration, grey level normalization and subtraction of images, the blood pool image (obtained 10 minutes postinjection) was subtracted from the 6 hour image. The resulting image was the blood pool corrected 6 h image. The 24 h images and the blood pool corrected 6 h images were interpreted blindly and the number of correct, incorrect and indeterminate MI localizations were tabulated. The number of correct localizations was 19/25 for the standard 24 h images and 22/25 for the blood pool corrected 6 h images. With this blood pool subtraction method it was possible to visualize MI 6 h postinjection. Theoretically, this method could be applied six hours after myocardial infarction.

Shape preserving three-dimensional display of myocardial scintigraphic data.

A three-dimensional display has been developed which is specifically suited to the visualization of myocardial single photon emission tomographic (SPET) data. A set of radial maxima voxels, representative of the whole left ventricle uptake and shape is first extracted by cylindrical and spherical sampling of the short axis slices. A three-dimensional representation of these voxels is then obtained, with hues depicting the uptake amount and shades (i.e. intensity and saturation) depicting the shape. This technique is suitable for 201Tl and 99TCm-hexakis-2-methoxyisobutyl isonitrile (99TCm-sestamibi) myocardial images. It is proposed as an aid to interpreting myocardial SPET as it enables the physician to distinguish simultaneously the actual shape, the extent and the severity of perfusion defects on a single frame.

Usefulness of imaging ovarian cancer recurrence with In-111-labeled monoclonal antibody (OC 125) specific for CA 125 antigen. The INSERM Research Network (Nantes, Rennes, Reims, Vuillejuif, Saclay.

BACKGROUND: A progressive rise in serum CA 125 concentration during follow-up monitoring of ovarian cancer after treatment of primary tumor is suggestive of a recurrence. PATIENTS AND METHODS: A study was carried out in 19 patients with suspected recurrence of a previously treated ovarian carcinoma. All patients underwent ultrasonography (US), computed tomography (CT) and immunoscintigraphy (IS) using F(ab')2 fragments of indium-111-labeled OC 125 monoclonal antibody (specific for CA 125 antigen). The definitive diagnosis of recurrence was made on the basis of histological data obtained at surgery. RESULTS: In all 15 of the patients with recurrence, all three of the imaging methods had false negative results once. In 7 patients, only the IS method had positive results; six of these 7 benefited from a macroscopically total resection of the recurrence. IS was positive and concordant with US and/or CT in 7 further patients. Two of them benefited from a total resection of their recurrence. The usefulness of IS was more evident when serum CA 125 concentration was below 500 U/ml. The absence of recurrence was correctly indicated by IS and CT in 1 case and by IS associated with negative US and CT in 2 other cases. IS and CT were falsely positive in 1 case. CONCLUSION: Thus, immunoscintigraphy would appear to be an efficient method for detecting a recurrence early when limited involvement can make it possible for the surgeon to achieve total resection.

Visualization of myocardial infarction 6 h after injection of 111In-antimyosin antibodies using a blood pool subtraction technique.

111In-antimyosin antibodies are capable of visualizing myocardial infarction (MI). Because of slow blood clearance, images are usually recorded 24 or 48 h postinjection. In this pilot study, a blood pool subtraction technique, which makes it possible to visualize MI 6 h postinjection, is validated. Twenty-five patients with proven MI (16 anterior, 9 inferior) were imaged a few minutes, 6 and 24 h after an injection of 111 MBq 111In-labelled antimyosin antibodies. Three planar views are obtained each time. Using software which performs the geometric registration, the grey level normalization and the subtraction of images, the blood pool image (obtained a few minutes postinjection) is subtracted from the 6 h image. The resulting image is the blood pool corrected 6 h image. The 24 h images and the blood pool corrected 6 h images were interpreted blindly and the number of correct, incorrect and impossible MI localizations was counted. The number of correct localizations is 19/25 for the standard 24 h images and 22/25 for the blood pool corrected 6 h images. Then, with this blood pool subtraction method, it is possible to visualize MI 6 h postinjection. This has to be taken into account when discussing the role of antimyosin scintigraphy in the management of patients with MI.

Superimposition of computed tomography and single photon emission tomography immunoscintigraphic images in the pelvis: validation in patients with colorectal or ovarian carcinoma recurrence.

A method of superimposing computed tomography (CT) and immunoscintigraphic (IS) single photon emission tomography (SPET) slices is presented and has been applied to 10 patients with suspected cancer recurrence. IS was performed with carcinoembryonic antigen (CEA)-specific indium-111 monoclonal antibodies (MoAbs) in 5 patients with colorectal cancer, and with OC125 111In-MoAbs in 5 patients with ovarian cancer. All patients had an abnormal CT image result in the pelvis, which was interpreted 5 times as recurrence, once as doubtful and four times as scar fibrosis. Recurrence was subsequently proven in all patients. Bone scintigraphy (BS) SPET was recorded at the same time as IS. No special technique was used during BS, IS or CT acquisition. CT images were fed into a computer using a CCD camera. Using the internal anatomical landmarks provided by the pelvic bone structures seen on CT and BS, an operator had to select corresponding fiducial points, which were used by the software to register the images. The final results were CT-BS and CT-IS superimposed images. CT-BS images were used for quality control. In all patients, the inspection of CT-BS and CT-IS showed that the registration process is accurate and assists in the co-interpretation of CT and IS images.

Volume rendering and bicolour scale in double isotope studies: application to immunoscintigraphy and bone landmarking.

Combining the volume rendering and bicolour visualization techniques is proposed as an aid in interpreting single photon emission tomography (SPET) immunoscintigraphy (IS) recorded simultaneously with SPET bone landmarking (BL). The combination helps in localizing abnormal monoclonal uptake and in differentiating it from a physiological radioactivity distribution. The so-called rendered images (RIs) are obtained in both IS and BL studies according to a depth- weighted maximum activity projection algorithm. Fused BL and IS RIs are constructed by a simple, pixel by pixel addition. They are displayed using a bicolour grey-red scale, which makes it possible to visualize both studies by a transparency effect. This method was applied to patients suspected of suffering colorectal or ovarian cancer recurrences, in whom monoclonal antibodies against carcinoembryonic antigen, B72-3 or OC125 labelled with indium-111 were used.

Correlative imaging study in the diagnosis of ovarian cancer recurrences. The INSERM Research Network (Nantes, Rennes, Reims, Villejuif, Saclay), France.

A correlative imaging study was carried out in 61 female patients previously treated for ovarian carcinoma. Upon suspicion of recurrence, abdominopelvic immunoscintigraphy (IS) using F(ab')2 fragments of indium-111-labelled OC 125 monoclonal antibody was performed in all patients, Ultrasonography (US) and computed tomography (CT) were performed 53 and 37 times, respectively. The diagnostic accuracy of the different imaging techniques was studied per site (abdomen and pelvis) and per patient. The diagnostic accuracy of planar scintigraphy (PS) was slightly lower than that of emission computed tomography (ECT): 66% vs 73% for abdomen, 65% vs 72% for pelvis, and 78% vs 84% in analysis per patient. The accuracy of IS (PS and ECT combined) was markedly better than that of US and CT for abdomen (IS = 73%; US = 30%; CT = 47%), pelvis (IS = 73%; US = 37%; CT = 52%) and analysis per patient (IS = 85%; US = 43%; CT = 59%). The results of IS and morphological imaging techniques (MIT: US and/or CT) were correlatively analysed with the frequency of recurrence. When IS and MIT were both negative, the frequency of non-recurrence was 14/23 for abdomen, 7/12 for pelvis and 8/13 in analysis per patient. On the other hand, when both IS and MIT were positive, the frequency of recurrence was high (9/9 for abdomen, 17/21 for pelvis and 24/26 for analysis per patient). It was also found that a positive IS associated with a negative MIT was still highly suggestive of recurrence (17/21 for abdomen, 16/22 for pelvis and 17/19 for analysis per patient).(ABSTRACT TRUNCATED AT 250 WORDS)