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1.
Clin Nucl Med ; 39(7): 598-604, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24873786

ABSTRACT

PURPOSE: The objectives of the study were to use the International Atomic Energy Agency (IAEA) software package for the analysis of scintigraphic renal dynamic studies to obtain values of curve parameters and excretory parameters in children with hydronephrosis and to validate the reliability of these numerical outputs by comparing with values established by consensus reports. PATIENTS AND METHODS: Fifty children with hydronephrosis (median age, 16 months; 30 boys, 20 girls; 99 kidneys) underwent Tc-MAG3 diuresis renography. Studies were analyzed by 2 observers, and according to the assessment of images, renograms, and differential function, kidneys were classified as normal (42, kidneys contralateral to hydronephrotic kidney), hypotonic unobstructed (49), and obstructed (8). The IAEA software was applied to each renogram. The parameters analyzed were as follows: normalized residual activity at 20 minutes (NORA 20) and on postmicturition (PM) acquisition, output efficiency at 20 minute (OE 20), PM to maximum renal count ratio (PM/max), and mean transit time (MTT). RESULTS: Mean values for normal, hypotonic unobstructed, and obstructed kidneys were as follows: NORA 20: 0.25, 0.57, and 2.16; OE 20 (%): 94.5, 87, and 57; normalized residual activity on PM acquisition: 0.02, 0.03, and 0.27; PM/max: 0.01, 0.02, and 0.13; and MTT (minutes): 1.9, 3.5, and 8.9, respectively. Difference between obstruction/dilatation and normal/dilatation was significant (P < 0.0001), as well as the correlation between NORA 20/OE 20 (R = -0.982). Cutoff values to predict obstruction were as follows: NORA 20, 1.6; OE 20, 73%; NORA PM, 0.11; PM/max, 0.06; and MTT, 8.23 minutes. CONCLUSIONS: The IAEA software package gives reliable values of numerical parameters of renal excretion. The use of the software improves diagnostic accuracy of diuresis renography in children.


Subject(s)
Kidney Pelvis/diagnostic imaging , Kidney Pelvis/pathology , Software , Case-Control Studies , Child , Child, Preschool , Dilatation, Pathologic , Female , Humans , Hydronephrosis/diagnostic imaging , Infant , Male , Numerical Analysis, Computer-Assisted , ROC Curve , Radionuclide Imaging , Reproducibility of Results
2.
Cancer Biother Radiopharm ; 29(3): 108-15, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24450327

ABSTRACT

AIM: The aim was to investigate somatostatin receptor (sstr) expression in normal prostate by determining the maximum standardized uptake value (SUVmax) of (68)Ga-DOTATOC PET/CT in neuroendocrine tumor (NET) patients, without NET involvement of the prostate gland, for establishing the reference standard. METHODS: Sixty-four NET patients underwent (68)Ga-DOTATOC PET/CT. SUVmax of the prostate gland, normal liver, testes, and gluteus muscles were evaluated. The prostate gland size was measured. Statistical analysis was performed using dedicated software (SPSS13). RESULTS: Mean/median (68)Ga-DOTATOC SUVmax values were as follows: normal prostate 2.6 ± 0.0, slightly enlarged prostate 4.2 ± 1.6, prostatic hypertrophy 4.9 ± 1.6, prostatic hyperplasia 5.0 ± 1.5, prostate cancer 9.5 ± 2.1, normal liver 7.3 ± 1.8, testes 1.8 ± 0.5, and gluteus 1.0 ± 0.2. The normal prostate gland had three times less sstr expression than normal liver tissue. Strong correlation was found between patient age and sstr expression in prostate/prostate size. No significant difference existed in sstr expression between prostatic hypertrophy and hyperplasia. Much higher sstr expression was found in prostatic cancer compared with normal prostate. CONCLUSION: (68)Ga-DOTATOC PET/CT defines the baseline sstr uptake in prostate not affected by NET (significantly lower than in the liver). Higher values were established in prostatic hyperplasia and hypertrophy. Only concomitant prostate cancer was associated with higher SUVmax in comparison with non-neoplastic liver.


Subject(s)
Neuroendocrine Tumors/diagnostic imaging , Octreotide/analogs & derivatives , Organometallic Compounds , Prostate/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging , Receptors, Somatostatin/analysis , Adult , Aged , Aged, 80 and over , Gallium Radioisotopes , Humans , Male , Middle Aged , Positron-Emission Tomography , Prostate/chemistry , Prostatic Hyperplasia/diagnostic imaging , Tomography, X-Ray Computed
3.
Clin Nucl Med ; 38(7): 516-21, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23486337

ABSTRACT

PURPOSE: This study aimed to compare baseline to follow-up 18F-FDG PET/CT findings after treatment for active chronic sarcoidosis and to correlate changes on 18F-FDG PET/CT with changes in clinical status. PATIENTS AND METHODS: The sample included 66 patients with chronic sarcoidosis and evidence of active inflammation on baseline F-FDG PET/CT for which they received therapy. Of these 66 patients, 30 returned for the follow-up 18F-FDG PET/CT after 12 (5) months to evaluate response to treatment. They were also asked to indicate changes in clinical status. Baseline characteristics of patients who did and did not return for the follow-up were compared to assess selection bias. RESULTS: SUVmax was significantly decreased at the follow-up compared with baseline 18F-FDG PET/CT (8.46 [3.52] vs 4.90 [0.96]; P = 0.006), primarily in the mediastinum. Inflammatory activity appeared absent in 9 patients, decreased in 12 patients, and increased in 9 patients, with the corresponding changes in SUVmax of -80%, -41%, and +54%, respectively. The changes on 18F-FDG PET/CT were in agreement with self-perceived changes in clinical symptoms (P = 0.019). The angiotensin-converting enzyme at the follow-up was not significantly different from baseline (49.80 [19.25] vs 46.35 [25.58], P = 0.522). There was no difference in baseline characteristics of patients who did and did not return for the follow-up. CONCLUSIONS: 18F-FDG PET/CT is able to detect clinically meaningful changes in magnitude and extent of inflammatory activity in patients receiving treatment for active chronic sarcoidosis. Thus, 18F-FDG PET/CT is a valuable adjunct to clinical evaluation for monitoring the response to treatment in these patients.


Subject(s)
Fluorodeoxyglucose F18 , Multimodal Imaging , Positron-Emission Tomography , Sarcoidosis/diagnostic imaging , Tomography, X-Ray Computed , Chronic Disease , Female , Fluorodeoxyglucose F18/pharmacokinetics , Follow-Up Studies , Humans , Inflammation/diagnostic imaging , Male , Middle Aged
4.
Hell J Nucl Med ; 15(2): 134-8, 2012.
Article in English | MEDLINE | ID: mdl-22833860

ABSTRACT

Dopa-responsive dystonia (DRD) is a genetic disorder characterized by childhood onset dystonia, dominant inheritance, diurnal symptoms fluctuation and positive levodopa response. Adult-onset DRD is frequently combined with parkinsonism and can be mistaken with young onset Parkinson's disease (YOPD). Both conditions are caused by dopamine deficiency, due to nigral cells' loss in YOPD, and due to enzymatic defects in dopamine synthesis in DRD. Single photon emission tomography (SPET) with (123)I-N--fluoropropyl-2b-carbomethoxy-3b-(4-iodophenyl) nortropane ((123)I-FP-CIT)-DaTSCAN is a sensitive neuroimaging method for the assessment of nigrostriatal dopaminergic system integrity and degeneration. Our aim was to evaluate the usefulness of (123)I-FP-CIT( DaTSCAN) SPET in the differential diagnosis of DRD and YOPD in clinical practice. Brain SPET with (123)I-FP-CIT was performed in 13 patients (7 males, 6 females), age 20-58 years, with mean age of onset of their disease, 29 years, eleven patients with early onset parkinsonian symptoms and 2 with genetically proved DRD. The images were evaluated by visual and semiquantitative analyses (ROI). The ratio of specific-striatal to non specific-occipital binding was calculated. Ten out of 11 patients with YOPD had decreased accumulation of DaTSCAN in striatum, especially in putamen, that is typical findings for Parkinson's disease. In three patients DaTSCAN was normal with symmetric tracer uptake in both striata, caudate nucleus and putamen and the diagnosis of DRD was suspected. Two patients with initial dystonic symptoms and genetically proved DRD had normal DaTSCAN. In one patient after normal DaTSCAN findings the initial diagnosis of YOPD was changed to the diagnosis of DRD. Region of interest (ROI) analyses have shown significantly lower(123)I-FP-CIT binding ratios in YOPD than in DRD in all 3 regions of interest: striatum (1.95±0.32) vs (2.76±0.10) P<0.001, putamen (1.76±0.25) vs (2.84±0.14) P<0.0001 and caudate nucleus (2.37±0.51) vs (3.27±0.14) P<0.01. In conclusion, our results indicate that DaTSCAN is an objective neuroimaging method able to distinguisch neurodegenerative disease YOPD from DRD and clarify a clinical dilemma, which is important for the treatment, prognosis and genetic counseling of patients and their families.


Subject(s)
Dihydroxyphenylalanine/therapeutic use , Dopamine Plasma Membrane Transport Proteins/metabolism , Dystonia/diagnostic imaging , Parkinson Disease/diagnostic imaging , Tomography, Emission-Computed, Single-Photon , Tropanes , Adult , Age of Onset , Diagnosis, Differential , Dystonia/drug therapy , Dystonia/metabolism , Female , Humans , Male , Middle Aged , Parkinson Disease/epidemiology , Parkinson Disease/metabolism , Young Adult
5.
Clin Nucl Med ; 37(1): 14-20, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22157022

ABSTRACT

PURPOSE: The aim of our study was to assess diagnostic accuracy of Tc-99m depreotide and Tc-99m-EDDA/HYNIC-TOC scintigraphy for evaluation of pulmonary lesions that appeared ambiguous on computed tomography (CT). MATERIAL AND METHODS: Forty-nine consecutive patients (37 men and 12 women; mean age, 60 ± 11 years) with 60 pulmonary lesions on chest radiography and CT were referred for nuclear imaging. They were prospectively allocated to undergo whole-body scintigraphy (WBS) and single photon emission computed tomography (SPECT) using either Tc-99m depreotide (26 patients, group 1) or Tc-99m-EDDA/HYNIC-TOC imaging (23 patients, group 2). Histologic findings after tissue biopsy served as a gold standard for determining diagnostic accuracy of the 2 somatostatin analogs. Visual assessment was complemented by semiquantitative analysis based on target to background ratio. RESULTS: Among the 32 pulmonary lesions scanned with Tc-99m depreotide, focal uptake was increased in 22 of 25 malignancies, whereas no uptake was found in 6 of 7 benign lesions (88% sensitivity, 85% specificity, and 88% accuracy) on both WBS and SPECT. Imaging of 28 pulmonary lesions with Tc-99m-EDDA/HYNIC-TOC had a similar diagnostic yield (sensitivity 87%, specificity 84%, and accuracy 86%). Overall, target to background ratios were higher on SPECT than WBS but not significantly different between groups 1 and 2 (SPECT 2.72 ± 0.70 vs. 2.71 ± 0.50, WBS 1.61 ± 0.32 vs. 1.62 ± 0.28, respectively). CONCLUSION: This study demonstrates that Tc-99m depreotide and Tc-99m-EDDA/HYNIC-TOC have similar diagnostic value for characterizing pulmonary lesions that appear ambiguous on CT.


Subject(s)
Lung Neoplasms/diagnostic imaging , Organotechnetium Compounds , Somatostatin/analogs & derivatives , Female , Humans , Male , Middle Aged , Radionuclide Imaging , Radiopharmaceuticals , Reproducibility of Results , Sensitivity and Specificity
6.
Hell J Nucl Med ; 14(3): 284-90, 2011.
Article in English | MEDLINE | ID: mdl-22087451

ABSTRACT

Several techniques have been applied for the assessment of severe congenital heart diseases (SCHD) including echocardiography, cardiac catheterization with angiocardiography, and more recently, cardiovascular multi detector tomography and magnetic resonance imaging (MRI). The value of gated single photon emission tomography (GSPET) myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV) for evaluating myocardial ischemia, tissue viability, and left ventricular function in SCHD is less apparent. The risk of radiation exposure is greatest in the youngest patients. Both, GSPET MPI and RNV seem to be underutilized in pediatric clinical practice due to increased radiation exposure. We have reviewed basic and specific technical and diagnostic aspects, as well as specific clinical indications of GSPET MPI and RNV in children with SCHD in comparison with other cardiology methods. Some of our own tests are also presented where they apply. In conclusion, GSPET MPI and RNV can provide clinical relevant information of functional significance of SCHD in pediatric patients especially when the other cardiology methods are indeterminate. With regard to radiation exposure appropriate patient selection and recommendations for reduction of radiation exposure are of great importance.


Subject(s)
Myocardial Perfusion Imaging , Radionuclide Ventriculography , Echocardiography , Humans , Myocardial Ischemia/diagnostic imaging , Tomography, Emission-Computed, Single-Photon
7.
Acta Chir Iugosl ; 58(1): 33-8, 2011.
Article in English | MEDLINE | ID: mdl-21630550

ABSTRACT

BACKGROUND: The aim of the study is evaluation of the possible role of the scintigraphic estimation of the relative liver perfusion in diagnosis and the choice of treatment of liver carcinomas. MATERIAL AND METHODS: Hepatic perfusion index was obtained by dynamic scintigraphy in 126 patients. RESULTS: In the control group values did not differ from the value in the patients with benign tumors (p > 0.05). However, in hepatocellular carcinoma and liver metastases of different tumors, HPI values were significantly decreased in comparison to controls and benign tumors (p < 0.01), but they didn't differ between themselves (p > 0.05). The values were especially low in the patients with malignant diseases in the liver accosciated with vascular disturbances in the portal system. CONCLUSION: HRA could be easily done during the different conventional nuclear medicine methods. It can be an useful method for the assessment of different degrees of hemodynamic alterations in portal system, for differential diagnosis of benign and malignant liver tumors, as well as for assessment of the liver tissue and tumor perfusion, which might be helpful in the decision making for the undertaking of intraarterial (radionuclide, chemotherapy etc.) therapy.


Subject(s)
Carcinoma, Hepatocellular/diagnostic imaging , Liver Circulation , Liver Neoplasms/diagnostic imaging , Radionuclide Angiography , Carcinoma, Hepatocellular/blood supply , Humans , Liver Neoplasms/blood supply , Portal Vein/diagnostic imaging , Radiopharmaceuticals , Sodium Pertechnetate Tc 99m
8.
Acta Chir Iugosl ; 58(1): 95-8, 2011.
Article in English | MEDLINE | ID: mdl-21630553

ABSTRACT

The aim of this study was the detection of helicobacter pylori (HP) infection and estimation of the clinical validity and the accuracy of the 14C-urea breath test in the groups of patients studied. A total of 248 patients with gastric diseases were examined. There were 38 patients with gastric ulcer, 41 with duodenal ulcer, 43 with gastroduodenitis erosiva, 26 with hiatus hernia, 36 with gastric carcinoma and 64 patients with gastritis. There were 103 true positive (TP), 139 true negative (TN), 4 false negative (FN) and 2 false positive (FP) patients. There was no significant difference in the incidence of the HP infection between the groups of patients studied (p > 0.05). Sensitivity of the method was 96.3%, specificity 98.6%, positive predictive value 98.1%, negative predictive value 97.2% and accuracy 97.6%. Our results point out that the method is very accurate for the detection of HP infection.


Subject(s)
Breath Tests , Carbon Radioisotopes , Helicobacter Infections/diagnosis , Helicobacter pylori , Stomach Diseases/microbiology , Urea , Humans , Predictive Value of Tests , Sensitivity and Specificity , Stomach Diseases/diagnosis
9.
Nucl Med Commun ; 31(11): 962-73, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20802363

ABSTRACT

OBJECTIVES: (i) To examine blood perfusion and metabolic activity of various brain tumours using radionuclide cerebral angiography (RCA) and single-photon emission tomography (SPET) after a single dose of Tc-methoxyisobutylisonitrile (MIBI). (ii) To examine if the inclusion of RCA can improve insight into the relative contribution of tumour perfusion to the uptake of MIBI shown by SPET, and to improve evaluation of tumour biology. (iii) To determine the value and the roles of MIBI in the management of brain tumour patients. METHODS: Fifty adult patients (38 male, 12 female) with a total of 56 intracranial space-occupying lesions have been included prospectively, 37 of which were newly diagnosed and the remaining with signs of recurrence/rest of earlier resected and irradiated brain tumours. The control group consisted of nine volunteers with no evidence of organic cerebral disease. Scintigraphic examination consisted of a dynamic first-pass study lasting 60 s (3 s/frame) and two SPET studies (60 projections each, 25 s/projection), starting 15 min and 2 h after intravenous injection of MIBI. Regions of interest of the tumour and normal brain tissue were drawn on RCA and both early and delayed SPET slices. The following tumour/brain activity ratios have been calculated: (i) tumour perfusion index (P); (ii) early uptake index (E); (iii) delayed uptake index (D); and(iv) retention index (R). Analogous indices have been calculated from the same examinations performed in controls, reflecting maximal physiologic regional variations of perfusion and uptake in brain tissue. RESULTS: Mean P of various brain tumours (low-grade gliomas 0.98, anaplastic gliomas 1.14, glioblastoma multiforme 1.20, metastases 1.09, lymphomas 1.08) differ little from each other and do not exceed maximal physiologic regional variations of cerebral perfusion (1.33), with the exception of meningioma (1.87, F=2.83, P=0.015). The receiver operating characteristics curve analysis of P showed that for the cut-off value of 1.45 the sensitivity for distinguishing meningioma from other tumours is 75%, specificity 87%, positive predictive value 33% and negative predictive value 97%. Mean E of malignant brain tumours (8.3, n=31, 23 primary, eight secondary), except anaplastic gliomas (3.5, n=5), differed significantly (P=0.02) from those of benign gliomas (3, n=9) but not from that of meningioma (11.9, n=4). The cut-off value for distinguishing malignant from benign lesions on the basis of E set at 4.8 resulted in sensitivity 67%, specificity 75%, accuracy 70%, positive predictive value 80% and negative predictive value 60%. D and R showed tendency of wash-out of MIBI from meningiomas, but otherwise did not improve the results substantially. CONCLUSION: Integrated results of RCA and SPET with Tc-MIBI indicate that blood perfusion, blood-tumour barrier permeability and metabolic activity of the tumour are all very important for the resultant uptake shown by SPET. If the perfusion index is less than 1.45, then meningioma can be ruled out. Early SPET is recommendable for distinguishing glioblastoma from low-grade gliomas, as a complement to standard magnetic resonance imaging and/or computed tomography.


Subject(s)
Brain Neoplasms/blood supply , Brain Neoplasms/metabolism , Cerebral Angiography , Cerebrovascular Circulation , Technetium Tc 99m Sestamibi/metabolism , Tomography, Emission-Computed, Single-Photon , Adolescent , Adult , Aged , Biological Transport , Brain Neoplasms/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Young Adult
10.
Nucl Med Commun ; 31(1): 12-21, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19952920

ABSTRACT

OBJECTIVES: The value of gated single-photon emission computed tomography technetium-99m methoxyisobutylisonitrile (gated SPECT (99m)Tc-MIBI) in children is not yet established probably because gated SPECT (99m)Tc-MIBI has rarely been used in pediatric clinical and research studies. The purpose of this study was to evaluate perfusion abnormalities and left ventricular (LV) function by gated SPECT (99m)Tc-MIBI in children and adolescents with severe congenital heart disease (CHD). METHODS: Seventeen children and adolescents with severe CHD (11 boys and six girls, mean age 11+/-4 years) underwent 2-day rest-stress (11 boys) or 1-day rest (six girls) gated SPECT (99m)Tc-MIBI. Myocardial perfusion was evaluated by a 17-segment model with a 5-point score to derive the summed stress score, the summed rest score (SRS), and the summed difference score based on the 4D-MSPECT software results. The extent of myocardial perfusion abnormalities was also expressed as a percentage of the LV size. The 4D-MSPECT software was used to calculate LV end-diastolic volume, end-systolic volume (ESV), and ejection fraction (EF). RESULTS: Reversible myocardial perfusion defect was found in 7 of 11 children (64%) who underwent rest-stress gated SPECT (99m)Tc-MIBI. The LV segments involved were anterior, anteroseptal, anterolateral, apical and inferior. These seven children showed significantly larger perfusion abnormalities on stress compared with rest study (18+/-5 vs. 7+/-4%, P<0.01) and higher summed stress score compared to SRS (11+/-4 vs. 4+/-2, P<0.01). Children and adolescents with myocardial ischemia had significantly lower poststress EF than rest EF (53+/-12 vs. 59+/-11%, P<0.05) and significantly higher poststress ESV than rest ESV (81+/-24 vs. 61+/-25 ml, P<0.05). In six children evaluated only at rest, perfusion defects involved anterior, anteroseptal and apical, or inferolateral segments, accounting for 31+/-12% of LV and with SRS of 12+/-5. Their global LV parameters were: end-diastolic volume 118+/-23 ml, ESV 56+/-16 ml, EF 51+/-10%. CONCLUSION: Poststress and rest-gated SPECT (99m)Tc-MIBI results indicate that children and adolescents with severe CHD show a range of abnormalities in myocardial perfusion and LV function, which is useful for determining functional importance of morphological malformations. Thus, gated SPECT (99m)Tc-MIBI provides complementary information that may guide clinical decision making in children and adolescents with severe CHD.


Subject(s)
Coronary Circulation , Heart Diseases/diagnostic imaging , Heart Diseases/physiopathology , Heart/physiopathology , Nitriles/chemistry , Organotechnetium Compounds , Adolescent , Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography , Child , Child, Preschool , Female , Follow-Up Studies , Heart Diseases/congenital , Heart Diseases/therapy , Humans , Male , Organotechnetium Compounds/chemistry , Rest , Stress, Physiological , Ventricular Dysfunction, Left/diagnostic imaging
11.
World J Gastroenterol ; 15(26): 3269-75, 2009 Jul 14.
Article in English | MEDLINE | ID: mdl-19598303

ABSTRACT

AIM: To estimate the characteristics of Color Doppler findings and the results of hepatic radionuclide angiography (HRA) in secondary Hodgkin's hepatic lymphoma. METHODS: The research included patients with a diagnosis of Hodgkin's lymphoma with metastatic focal lesions in the liver and controls. Morphologic characteristics of focal liver lesions and hemodynamic parameters were examined by pulsed and Color Doppler in the portal, hepatic and splenic veins were examined. Hepatic perfusion index (HPI) estimated by HRA was calculated. RESULTS: In the majority of patients, hepatomegaly was observed. Lesions were mostly hypoechoic and mixed, solitary or multiple. Some of the patients presented with dilated splenic veins and hepatofugal blood flow. A pulse wave was registered in the centre and at the margins of lymphoma. The average velocity of the pulse wave was higher at the margins (P > 0.05). A continuous venous wave was found only at the margins of lymphoma. There was no linear correlation between lymphoma size and velocity of pulse and continuous wave (r = 390, P < 0.01). HPI was significantly lower in patients with lymphomas than in controls (P < 0.05), pointing out increased arterial perfusion in comparison to portal perfusion. CONCLUSION: Color Doppler ultrasonography is a sensitive method for the detection of neovascularization in Hodgkin's hepatic lymphoma and estimation of its intensity. Hepatic radionuclide angiography can additionally help in the assessment of vascularisation of liver lesions.


Subject(s)
Hodgkin Disease/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Radionuclide Angiography , Ultrasonography, Doppler, Color , Hodgkin Disease/pathology , Humans , Liver/blood supply , Liver/diagnostic imaging , Liver/pathology , Liver Neoplasms/blood supply , Liver Neoplasms/pathology , Neovascularization, Pathologic/diagnostic imaging
13.
Nucl Med Commun ; 30(1): 68-75, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19306516

ABSTRACT

OBJECTIVE: Optimal treatment for chronic total occlusion (CTO) in the infarct-related coronary artery is not clear. Our aim was to assess myocardial perfusion, left ventricular ejection fraction (EF), and left ventricular size using gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging with 99mTc-methoxy-isobutyl-isonitrile in patients with CTO before and 1 year after recanalization. METHODS: Thirty patients with earlier myocardial infarction and at least one CTO underwent percutaneous coronary intervention (PCI) as well as nitrate-enhanced gated SPECT myocardial perfusion and dobutamine stress echocardiography before and 11 +/- 1 months after recanalization. They were divided into three groups based on the outcome of the follow-up angiography: (i) successful recanalization with no evidence of in-stent restenosis (n=13); (ii) successful recanalization with in-stent restenosis (n=7) and (iii) unsuccessful recanalization (n=10). RESULTS: Overall success of recanalization for CTO was 74%. In group 1, myocardial viability was preserved in 11 of 13 (85%) patients at baseline. Gated SPECT at 1 year showed a significant decrease in perfusion abnormalities (29 +/- 12 to 23 +/- 14%, P < 0.05) and left ventricular end-diastolic volume (EDV) (168 +/- 47 to 151 +/- 47 ml, P < 0.05). Improvement in EF (51 +/- 11 to 54 +/- 13%, P > 0.05) and reduction in left ventricular end-systolic volume (ESV) (84 +/- 37 to 77 +/- 40 ml, P > 0.05) did not reach the level of significance. Myocardial viability was preserved in only two of seven patients (28%) in group 2. Neither mean perfusion abnormalities (37 +/- 24 to 35 +/- 22%, P > 0.05) nor global left ventricular parameters (EF 41 +/- 15 vs. 42 +/- 19%, EDV 298 +/- 33 vs. 299 +/- 57 mL, ESV 197 +/- 12 vs. 195 +/- 32 ml; P > 0.05) changed at the follow-up. In group 3, myocardial viability was preserved in seven of 10 patients (70%) at baseline, but no significant changes in perfusion (40 +/- 18 vs. 41 +/- 19%, P > 0.05) and left ventricular function (EF 42 +/- 17 vs. 44 +/- 14%, EDV 228 +/- 101 vs. 227 +/- 81 ml, ESV 143 +/- 87 vs. 146 +/- 8 ml; P > 0.05) were seen at the follow-up. CONCLUSION: Myocardial perfusion and EDV may significantly improve 1 year after PCI provided recanalization of CTO was successful. Our preliminary findings suggest that successful recanalization of CTO may have favorable outcome on left ventricular perfusion and function, particularly in patients with viable myocardium before PCI. The gated SPECT myocardial perfusion imaging with 99mTc-methoxy-isobutyl-isonitrile may be useful for monitoring long-term functional outcome of PCI in patients with CTO.


Subject(s)
Coronary Occlusion/diagnostic imaging , Coronary Occlusion/physiopathology , Myocardial Infarction/complications , Myocardial Infarction/diagnostic imaging , Technetium Tc 99m Sestamibi , Administration, Cutaneous , Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography , Coronary Occlusion/complications , Coronary Occlusion/therapy , Female , Follow-Up Studies , Heart Ventricles/diagnostic imaging , Heart Ventricles/pathology , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Myocardial Ischemia/complications , Myocardial Ischemia/diagnostic imaging , Myocardial Perfusion Imaging , Tissue Survival , Treatment Outcome
14.
Nucl Med Commun ; 30(2): 148-54, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19077915

ABSTRACT

OBJECTIVES: We used gated single-photon emission computed tomography methoxyisobutylisonitrile (SPECT MIBI) to (i) determine whether location of myocardial infarction (MI) and severity of perfusion abnormalities affect post-stress left ventricular function in patients with single-vessel coronary artery disease, and (ii) correlate changes between post-stress and rest ejection fraction (EF) with the severity of perfusion and regional wall motion abnormalities (RWMAs). METHODS: Eighty-eight patients with a history (> or =3 months) of anterior MI (n=45) or inferior MI (n=43) underwent a 2-day stress-rest gated SPECT MIBI. 4D-MSPECT software was used to calculate left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), EF, and the difference from post-stress to rest EF (EFs-EFr). Summed stress scores, summed rest scores, and summed difference scores (SDS) were calculated based on the 17-segment model. RWMAs were visually assessed using a 5-point score. RESULTS: Patients with anterior MI, compared with those with inferior MI, showed significantly greater perfusion abnormalities (summed stress score 11.0+/-5.5 vs. 7.5+/-2.4, P<0.01, summed rest score 7.4+/-4.7 vs. 5.2+/-1.9, P<0.01, SDS 3.3+/-1.0 vs. 1.9+/-1.0, P<0.05) and higher post-stress and rest RWMA (RWMSS 12.2+/-6.0 vs. 8.7+/-4.1, P<0.01, RWMRS 8.7+/-5.4 vs. 5.6+/-3.0, P<0.01). In 22 patients with anterior reversible ischemia in addition to fixed defect, post-stress and rest EDV and ESV were significantly larger and post-stress EF decreased more than in 21 patients with inferior MI (EDV 144.0+/-28.9 ml vs. 108.6+/-36.9 ml, ESV 70.6+/-22.2 ml vs. 53.4+/-20.5 ml, EFs-EFr -4.2+/-3.5% vs. -1.5+/-2.2%, P<0.01). SDS and RWMA were highly correlated with EFs-EFr. CONCLUSION: In patients with single-vessel coronary artery disease, the extent and severity of perfusion and RWMAs assessed by gated SPECT MIBI are greater after anterior MI than inferior MI. Global left ventricular function is significantly more affected after anterior MI only in patients with reversible ischemia in addition to fixed wall defect. Decrease in EF from post-stress to rest is closely associated with the severity of perfusion and RWMAs. Overall results suggest that the extent and severity of perfusion and RWMAs are more prominent in the myocardial region supplied by left anterior descending coronary artery than by right coronary artery, which may explain significantly worse post-stress left ventricular function after anterior MI.


Subject(s)
Coronary Artery Disease/diagnostic imaging , Gated Blood-Pool Imaging/methods , Myocardial Infarction/diagnostic imaging , Technetium Tc 99m Sestamibi , Tomography, Emission-Computed, Single-Photon/methods , Ventricular Dysfunction, Left/diagnostic imaging , Coronary Artery Disease/complications , Exercise Test , Female , Humans , Male , Middle Aged , Myocardial Infarction/complications , Radiopharmaceuticals , Reproducibility of Results , Sensitivity and Specificity , Severity of Illness Index , Ventricular Dysfunction, Left/complications
15.
Otolaryngol Head Neck Surg ; 137(3): 405-11, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17765766

ABSTRACT

OBJECTIVE: To determine the value of 201-thallium (201-Tl) and technetium-99m sestamibi (Tc-99m MIBI) single photon emission computed tomography (SPECT) for detecting primary undifferentiated carcinoma of nasopharyngeal type (UCNT), residual/recurrent tissue, and lymph node involvement. STUDY DESIGN AND SETTING: SPECT of head and neck was prospectively performed in 46 patients with a history of UCNT (201-Tl in 24 patients, Tc-99m MIBI in 22). CT/MRI findings, clinical follow-up, and pathohistological verification served as a gold standard for calculating sensitivity, specificity, and accuracy of each scintigraphic technique. Tumor-to-background index (T/Bg) was derived when SPECT findings were positive. RESULTS: Sensitivity of 201-Tl SPECT was 87 percent, with 78 percent specificity, 83 percent accuracy, and T/Bg of 4.05 +/- 1.50. Tc-99m MIBI SPECT had 85 percent sensitivity, 78 percent specificity, 82 percent accuracy, and T/Bg of 4.45 +/- 1.27. CONCLUSION AND SIGNIFICANCE: 201-Tl SPECT and Tc-99m MIBI SPECT are useful for detecting primary UCNT, residual/recurrent disease, and lymph node involvement. This use is particularly valuable after chemoradiotherapy when CT/MRI may be ambiguous.


Subject(s)
Carcinoma/diagnostic imaging , Nasopharyngeal Neoplasms/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Thallium Radioisotopes , Tomography, Emission-Computed, Single-Photon , Adult , Carcinoma/pathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Nasopharyngeal Neoplasms/pathology , Neoplasm Recurrence, Local/diagnosis , Neoplasm, Residual , Predictive Value of Tests , Prospective Studies
16.
Nucl Med Rev Cent East Eur ; 9(1): 51-5, 2006.
Article in English | MEDLINE | ID: mdl-16791805

ABSTRACT

BACKGROUND: The aim was to examine the influence of different modalities of peptic ulcer surgery on the gastric emptying (GE) pattern and related serum level changes of selected gut hormones. MATERIAL AND METHODS: Fifty eight subjects were examined. In 48 of them peptic ulcer surgery was performed at least six months before the examination: Billroth I (B1) in 11, Billroth II (B2) in 16, B1 with the selective vagotomy--Harkins 1 (H1) in 9 and B2 with the selective vagotomy--Harkins 2 (H2) in 12. Ten healthy volunteers (C) were also examined. RESULTS: The results of gastric emptying showed that the lag phase duration was inversely related to the GE rates, and the GE pattern was linear in both controls (C) and in operated patients, except in B2 group, in which the GE pattern was exponential. In comparison with C group, GE was slower in B1, H1 and H2 groups, and faster in B2 group. The plasma gastrin values in C group, showing two peaks, were higher in relation to other groups. In relation to C group, higher values of motilin were obtained in patients after the selective vagotomy. The plasma somatostatin values recorded in B1 and H1 groups, showing the marked peaks, were higher in relation to C group. In relation to C group the highest plasma neurotensin values were obtained in B2 group. CONCLUSIONS: In order to understand entirely the influence of peptic ulcer surgery on the GI function, further research of the role of specific hormones and neuropeptides is needed, which would enable more precise selection of the therapy in order to prevent postvagotomy and postgastrectomy syndromes.


Subject(s)
Gastric Emptying , Gastrointestinal Hormones/blood , Peptic Ulcer/surgery , Gastrins/chemistry , Humans , Neurotensin/blood , Neurotensin/chemistry , Radioimmunoassay , Time Factors , Vagotomy/methods
17.
Nucl Med Rev Cent East Eur ; 7(1): 31-8, 2004.
Article in English | MEDLINE | ID: mdl-15318308

ABSTRACT

BACKGROUND: The aim of this study was to present and compare the results of proposed methods for optimal red cell mass and plasma volume (RCM&PV) estimation, and their influence on the interpretation of obtained results. MATERIAL AND METHODS: In 120/280 patients with polycythaemia rubra vera, subjected to RCM&PV determination with autologous erythrocytes in vitro labelled with 51Cr-sodium chromate, optimal volumes were determined using: 1. traditional ml/kg of: --the real body weight method (ml/kg RBW); --the optimal body weight method (ml/kg OBW). 2. the body weight, height, and sex based method (Retzlaff's tables), 3. the method recommended by the International Council for Standardization in Haematology (ICSH), based on body surface area. RESULTS: Different interpretation of the same results of 120 RCM&PV measurements was registered in 48/120 patients (40%). The greatest disagreement existed between ml/kg RBW and ml/kg OBW methods (in 39/120 subjects, 32.5%). In underweight patients the ml/kg RBW method, and in overweight patients the ml/kg OBW method, offered better agreement with ICSH&Retzlaff's methods. The ml/kg RBW method disagreed with ICSH&Retzlaff's methods and ml/kg OBW in 25% and 19.2% of patients respectively. ICSH and Retzlaff's methods disagreed in 10/120 patients (8.3%). The ICSH method yielded significantly lower optimal volumes than Retzlaff's. CONCLUSION: Three methods for optimal RCM&PV estimation lead to different interpretations of the same results of RCM&PV measurements with 51Cr-erythrocytes in 40% of patients. Two ml/kg body weight methods show greater disagreement in comparison with ICSH and Retzlaff's methods, which differ significantly. The ICSH method yields lower optimal values compared to Retzlaff's.


Subject(s)
Blood Volume Determination/methods , Erythrocytes/diagnostic imaging , Image Interpretation, Computer-Assisted/methods , Plasma Volume , Plasma/diagnostic imaging , Polycythemia Vera/blood , Polycythemia Vera/diagnostic imaging , Adult , Aged , Aged, 80 and over , Algorithms , Blood Volume Determination/standards , Body Composition , Chromates/blood , Guidelines as Topic , Humans , Image Interpretation, Computer-Assisted/standards , Isotope Labeling/methods , Middle Aged , Polycythemia Vera/physiopathology , Radionuclide Imaging , Radiopharmaceuticals/blood , Reproducibility of Results , Sensitivity and Specificity , Sodium Compounds/blood
18.
Nucl Med Rev Cent East Eur ; 5(2): 121-5, 2002.
Article in English | MEDLINE | ID: mdl-14600870

ABSTRACT

BACKGROUND: The aim of this work was to estimate the significance of a dynamic study performed during the first 20 minutes after autologous (111)In-oxinate-platelets injection in patients with chronic immune thrombocytopenic purpura (ITP). Two hypotheses were tested: a) dynamic study indicates the place of platelet sequestration; b) dynamic study reflects the quality of platelet separation and labelling procedure. MATERIAL AND METHODS: Thirty-nine persons were investigated: 25 with shortened platelet life span (ITP), and 14 with normal platelet life span (6 healthy subjects and eight patients with myelodysplastic syndrome--MDS). Platelet blood count on the day of platelet labelling, general yield of platelet labelling (GYL), differential yield of platelet labelling (DYL), platelet life span, dynamic study with initial platelet accumulation in the liver (IPAL), sequential static study for determining the platelet sequestration index (SI) and platelet sequestration site (SS) were investigated. RESULTS: Two types of labelled platelet kinetics were determined in both groups of patients: IPAL < 20% and IPAL > 20%. A statistically significant difference in GYL and DYL was noted between the patients with IPAL < 20% and IPAL > 20%. No significant difference was registered in platelet blood count, life span, SS and SI between the two groups of patients. Both yields of platelet labelling were higher in the group with IPAL < 20%. There was no correlation between IPAL and platelet SI, or between IPAL and platelet SS. CONCLUSIONS: Dynamic study with (111)In-platelets cannot predict platelet sequestration site in ITP patients, but it is a useful and sensitive method of platelet labelling procedure quality control.

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