Small pulmonary arteriovenous fistulae revealed by scintigraphy during selective injection of 99Tc(m)-macroaggregated albumin.

We report a case of small pulmonary arteriovenous fistulae precisely diagnosed by a combination of selective pulmonary arteriography and scintigraphy during (99)Tc(m)-macroaggregated albumin injection via the peripheral pulmonary artery.

Evaluation of axillary status in breast cancer. CT-based determination of sentinel lymph node size.

PURPOSE: To determine whether the location and size of sentinel lymph nodes (SLN) on CT are predictive of the axillary lymph node status in patients with breast cancer. MATERIAL AND METHODS: Forty patients with confirmed breast cancer underwent 5-mm CT of both breasts and axillae and the most inferior lymph node in the affected axilla was designated the SLN. Based on CT assessment of the axillary lymph node status, 22 (55%) patients then underwent dye- and gamma probe (DGP)-guided SLN biopsy followed by axillary dissection; 18 (45%) underwent dissection without prior SLN biopsy. The localization and status of the SLN determined on CT and by DGP-guided biopsy were compared. Biopsied and excised nodes were subjected to histopathologic examinations. RESULTS: All SLN identified on CT were close to the lateral thoracic artery and their localization corresponded well with SLN identified by the DGP-guided method. The positive predictive value of CT diagnosis was 100%. Histopathologic examination of excised nodes confirmed that none of the SLN biopsies was false-negative. CONCLUSION: Our CT criteria were highly accurate for identification and diagnostic assessment of SLN and useful for evaluating the axillary status in patients with breast cancer.

Relationship between cognitive function and regional cerebral blood flow in Alzheimer's disease.

The Mini-Mental State examination (MMSE) is frequently used to assess the cognitive function of neurological patients. The purpose of this study was to investigate associations between regional cerebral blood flow (rCBF) and MMSE scores in Alzheimer's disease (AD) and localization of cognitive functions. Fifty-nine patients with probable AD (21 males and 38 females; mean age 74 years) and 12 normal volunteers (five males and seven females; mean age 73 years) were studied. CBF was measured by SPECT using the N-isopropyl-p-[(123)I]iodoamphetamine autoradiography method. The CBF images were reconstructed in parallel with the orbitomeatal line and parallel to the long axis of the temporal cortex. Regions of interest were set in the cerebral and cerebellar cortex. Multivariate analysis was performed by the step-wise method, using each section of the MMSE as the dependent variable and the rCBF ratio as the independent variable. The decline in rCBF in the parietal cortex and hippocampus reflected disorientation, and the most significant cortex affecting scores on each section of the MMSE were found to be the anterior temporal cortex for registration, the frontal cortex for attention and calculation, the medial temporal cortex for recall, and the posterior temporal cortex for language.

Utility of follow-up studies using meta-[123 I]iodobenzylguanidine scintigraphy for detecting recurrent neuroblastoma.

Neuroblastomas sometimes recur after the initial disappearance of the tumour. We evaluated the utility of meta-[123I]iodobenzylguanidine (123I-MIBG) scintigraphy for the detection of recurrent neuroblastomas by comparing with the measurement of biochemical markers and clinical findings. Forty patients who had received treatment for neuroblastomas were included in the study. After the disappearance of the initial tumours, periodic measurements of urinary vanillyl mandelic acid, homovanillic acid and serum neuron specific enolase values, and an 123I-MIBG scintigraphy were performed. Whenever an abnormal finding was observed, other appropriate examinations and/or follow-up examinations were performed to elucidate the true state of the patient. Eleven recurrent episodes in eight patients were observed. Most of them occurred in the bone marrow or bone. Corresponding symptoms were observed in only two episodes; the other episodes were asymptomatic, and discovered by the periodic examinations. 123I-MIBG scintigrams visualized the recurrent tumours in 10 (91%) episodes. Elevated tumour markers were observed in only three episodes. 123I-MIBG scintigrams visualized most of the recurrent tumours, unless they were accompanied by any symptoms or elevations in biochemical tumour markers. Periodic examinations with 123I-MIBG scintigraphy appears to be a useful technique for the detection of the recurrences.

Tracer accumulation in femoral head during early phase of bone scintigraphy after renal transplantation.

UNLABELLED: Nontraumatic osteonecrosis of the femoral head (ONF) is a complication of renal transplantation. The pathogenic mechanism of ONF is thought to be an ischemic event. The purpose of this study was to investigate whether 3-phase bone scintigraphy can reveal early hemodynamic changes associated with ONF after renal transplantation. METHODS: We performed 3-phase bone scintigraphy on 19 renal allograft recipients between 3 and 9 wk after they underwent renal transplantation. Regions of interest (ROI) were assigned bilaterally in the femoral heads, diaphyses, and soft tissue. The head-to-diaphysis ratio (HD) in each phase was then calculated. RESULTS: ONF occurred in 8 femoral heads of 4 patients. Three of the 4 ONF patients had no abnormal MRI findings at the time of bone scintigraphy. In phase 1, no significant difference in HDs was observed between the ONF patients (mean HD +/- SD, 0.62 +/- 0.44) and the non-ONF patients (0.31 +/- 1.40). The difference between the mean counts for bone and soft tissue was small in both instances, and the HD had a large dispersion. In phase 2, the HDs for the ONF patients (0.70 +/- 0.27) and the non-ONF patients (1.31 +/- 0.43) were significantly different (P = 0.0005). The HD was <1.00 in all femoral heads of the ONF patients, whereas 9 non-ONF heads had an HD that was <1.00. In phase 3, the HD of the ONF patients was significantly lower than that of the non-ONF patients (ONF patients, 0.92 +/- 0.17; non-ONF patients, 1.62 +/- 0.46; P = 0.0002). CONCLUSION: All ONF patients were in the group with a low HD in phase 2, suggesting a reduction in blood flow or blood pool. Phase 2 accumulation in 3-phase bone scintigraphy can be used to estimate early hemodynamic changes in patients with ONF after renal transplantation.

Thallium-201 scintigraphy of neuroblastoma: different results for primary tumors and skeletal lesions.

Thallium-201 scintigraphy was performed in 8 children with neuroblastoma, and uptake by the tumors was evaluated in comparison with the results of 123I-MIBG scintigraphy. No primary tumors or metastatic lymph nodes showed 201Tl accumulation, but in 4 cases of bone marrow metastases accompanied by focal cortical invasion, the metastatic lesion was demonstrated more clearly on the early image than on the delayed image. In another case of bone metastases infiltrating cortical bone revealed by 123I-MIBG scintigraphy and biopsy before treatment, 201Tl scintigraphy performed after chemotherapy showed abnormal accumulation in the tibia, but the second 123I-MIBG scintigraphy performed 1 week after the 201Tl scintigraphy showed no abnormal uptake. 201Tl does not appear to have good affinity for neuroblastoma, but it accumulates in metastatic skeletal lesions. A reactive hypermetabolic bone marrow, and/or inflammatory process and periosteal reaction due to the presence of metastatic foci may have induced the 201Tl accumulation. It seems that 201Tl is not useful for the diagnosis. Nevertheless, the discordance between 201Tl uptake in primary tumors and skeletal lesions allows speculation on the mechanism of 201Tl accumulation in skeletons.

Assessment of left ventricular diastolic function from quantitative electrocardiographic-gated 99mTc-tetrofosmin myocardial SPET.

We have developed new software which can evaluate left ventricular (LV) diastolic functional parameters from a quantitative gated SPET (QGS) program. To examine its accuracy, we compared these findings with the LV diastolic functional indices obtained from gated radionuclide ventriculography (RNV). Twenty-four patients were selected for this study. Gated SPET with technetium-99m tetrofosmin was performed and the QGS program was used with a temporal resolution of 32 frames per R-R interval. The LV volume of each frame was calculated and four harmonics of Fourier series were retained for the analysis of the LV volume curve. From this fitted curve and its first derivative curve, we derived LV systolic functional indices, e.g. ejection fraction (EF), peak ejection rate (PER) and time to PER (TPER), as well as LV diastolic functional variables, e.g. 1/3 filling fraction (1/3 FF), peak filling rate (PFR) and time to PFR (TPFR). Within 5+/-2 days, gated RNV was performed and diastolic functional parameters were determined by the same method. No significant difference was observed between the variables calculated by gated SPET and by gated RNV. There was a good correlation between EF, PER, TPER, 1/3 FF, PFR and TPFR determined by these two methods (EF: r=0.95, P<0.0001; PER: r=0.87, P<0.0001; TPER: r=0.84, P<0.0001; 1/3 FF: r=0.87, P<0.0001; PFR: r=0.92, P<0.0001; TPFR: r=0.89, P<0.0001). Bland-Altman plots did not reveal any significant degree of directional measurement bias in any of the comparisons of gated SPET data and RNV data. It is concluded that, in addition to the conventional LV systolic functional indices, our program accurately provides LV diastolic functional parameters from gated SPET. Also, this program will be useful for detecting LV diastolic dysfunction in various cardiac diseases before LV systolic dysfunction becomes evident.

Cutting edge: the common gamma-chain is an indispensable subunit of the IL-21 receptor complex.

The common gamma-chain (gamma(c)) is an indispensable subunit of the functional receptor complexes for IL-4, IL-7, IL-9, and IL-15 as well as IL-2. Here we show that the gamma(c) is also shared with the IL-21R complex. Although IL-21 binds to the IL-21R expressed on gamma(c)-deficient ED40515(-) cells, IL-21 is unable to transduce any intracytoplasmic signals. However, in EDgamma-16 cells, a gamma(c)-transfected ED40515(-) cell line, IL-21 binds to the IL-21R and can activate Janus kinase (JAK)1, JAK3, STAT1, and STAT3. The chemical cross-linking study reveals the direct binding of IL-21 to the gamma(c). These data clearly demonstrate that the gamma(c) is an indispensable subunit of the functional IL-21R complex.

False-positive I-131 accumulation in a liver cyst in a patient with thyroid carcinoma.

Iodine-131 uptake was seen in the right upper abdominal quadrant of a patient with postoperative differentiated thyroid cancer that corresponded with a large liver cyst.

[Iodine-123-MIBG scintigraphy in neuroblastoma; relationship between the intensity of uptake and tumor characteristics].

Iodine-123-MIBG (123I-MIBG) scintigraphy were performed for 23 patients with neuroblastoma at diagnosis. The intensity of MIBG activity in the primary tumor was evaluated visually (grade 3; intense uptake-grade 0; no definite uptake), and its relationship to the size, degree of tumor spread, urinary catecholamine metabolites (VMA, HVA), and histological types were investigated. The results of 123I-MIBG uptake grade were as follows: grade 3; 44% (10/23), grade 2; 30% (7/23), grade 1; 17% (4/23), grade 0; 9% (2/23). The grade was not associated with the tumor size, or the degree of tumor extension to the distant lesion, either. The more catecholamine metabolites were excreted in the urine, the tumor tended to have more intense uptake. The tumors of neuroblastoma rosette fibrillary type, and ganglioneuroblastoma poorly differentiated type had more intense uptake than neuroblastoma round cell type and ganglioneuroblastoma well differentiated type. The case of ganglioneuroma did not have definite MIBG uptake. The intensity of MIBG uptake is not relevant to the pathological grade of neuroblastoma, but considering the electromicroscopical features of neuroblastoma reported previously, it is thought to reflect the histological type.

Reverse redistribution of Tc-99m-tetrofosmin in patients with acute myocardial infarction.

We examined reverse redistribution (RR) of Tc-99m-tetrofosmin after a single injection in patients with acute myocardial infarction (AMI). Tc-99m-tetrofosmin myocardial SPECT was performed in 28 patients with AMI 10-14 days after the onset. Myocardial images were obtained 30 min and 180 min after the injection of 740 MBq of Tc-99m-tetrofosmin. The left ventricular wall was divided into 9 segments. Regional myocardial uptakes of Tc-99m-tetrofosmin were scored by 4-point scoring (0 = normal, 1 = mildly reduced, 2 = moderately reduced, and 3 = defect). RR was defined as an increase of more than 1 in the regional score in images at 180 min. RR of Tc-99m-tetrofosmin was observed in 17 of 20 patients with direct PTCA and 3 of 8 patients without reperfused therapy. RR was observed in 61 of all 252 segments. Coronary angiography performed 1 month later revealed that the infarct-related artery was patent in 19 of 20 patients (95%) with RR and in 3 of 8 patients (37.5%) with persistent defects (PD) (p < 0.05). In segment-by-segment analysis, the incidence of regional wall motion abnormality I month later was reduced in regions with RR compared to those with PD (p < 0.0001). In conclusion, RR of Tc-99m-tetrofosmin was frequently observed in patients with successful direct PTCA. As the segments with RR showed signs of preserved function 1 month later, this phenomenon may reflect a salvaged myocardium in AMI.

Reverse redistribution of Tc-99m-tetrofosmin in exercise myocardial SPECT in patients with hypertrophic cardiomyopathy.

We examined the usefulness of Tc-99m-tetrofosmin in detecting exercise induced perfusion abnormalities in patients with hypertrophic cardiomyopathy (HCM) and to clarify time-related changes in myocardial distribution of Tc-99m-tetrofosmin after a single injection. We studied 44 consecutive patients with HCM by means of exercise/rest Tc-99m-tetrofosmin single photon emission computed tomography (SPECT). After injecting 370 MBq of Tc-99m-tetrofosmin at the peak exercise, the early SPECT imaging was performed at 30 min (EX-30) and the delayed imaging at 180 min (EX- 180). Immediately after the delayed imaging, 740 MBq of Tc-99m-tetrofosmin was injected in the resting state, and the rest SPECT imaging was performed 30 min later. Exercise-induced regional perfusion defects and/or apparent reversible left ventricular cavity dilation were identified in 26 (68.2%) of the 44 patients. When EX-30 images and EX-180 images were compared, reverse redistribution was confirmed in 36 patients (81.8%). Reverse redistribution was detected most frequently in the septal portion of the anterior wall, followed by the septal portion of the posterior wall and the septum. Exercise/rest Tc-99m-tetrofosmin myocardial imaging was a useful method for assessing myocardial perfusion abnormalities in patients with HCM. Reverse redistribution was detected very frequently on early and delayed images of exercise. We assumed that reverse redistribution may reflect a retention disorder of Tc-99m-tetrofosmin caused by some metabolic dysfunction of myocytes.

Increased subglottic gallium uptake in relapsing polychondritis.

Gallium scintigraphy was performed on a 14-yr-old girl with subglottic airway narrowing that caused wheezing and dyspnea. The study showed increased gallium uptake in the neck. A biopsy was performed on the subglottic region, and the histology was compatible with relapsing polychondritis. After treatment with steroids, laboratory data that had indicated active inflammation soon normalized. Repeat gallium scintigraphy showed diminished uptake, although the subglottic stenosis did not improve. These results suggest that gallium scintigraphy is valuable for evaluating inflammatory activity in relapsing polychondritis.

A case of cap polyposis investigated by scintigraphy with human serum albumin labeled with Tc-99m DTPA.

Cap polyposis is a rare intestinal disease that can be difficult to differentiate from inflammatory bowel disease. When cap polyposis is suspected, it is important to confirm protein loss. A 54-year-old woman who had been treated for ulcerative colitis for 7 years had severe hypoproteinemia. Scintigraphy with Tc-99m-labeled DTPA complexed with human serum albumin showed protein loss from the descending colon. Left hemicolectomy and sigmoid colectomy were performed. Cap polyposis was diagnosed on the basis of histologic findings from an operative specimen. The patient's diarrhea resolved after surgery and her hypoproteinemia improved. Scintigraphy with this label gave information helpful in the diagnosis of cap polyposis.

[123I-metaiodobenzylguanidine (MIBG) scintigraphy for the staging of neuroblastoma].

Nineteen children with neuroblastoma (aged 2 w.-7 y.o.) were studied to evaluate the optimal scan conditions for Iodine-123-Metaiodobenzylguanidine (MIBG) scintigraphy for accurate staging at the time of diagnosis. Six and 24 hours after an injection of 123I-MIBG, whole body image and truncal spot and SPECT images were obtained. Compared with other studies (CT or MRI and bone scintigraphy), each 123I-MIBG image was evaluated visually to investigate which image can demonstrate the extent of neuroblastoma most exactly. MIBG images demonstrated primary tumors in all patients, and metastatic lymphadenopathy in 8 of 9 patients. Twenty-four hour SPECT images gave us the most detailed information about the extent of abnormal accumulation. As to bone and bone marrow lesions, 6 hour images were superior to 24 hour images in detectability. Moreover, MIBG showed many more lesions and more extended accumulation than the bone scan. 123I-MIBG scintigraphy was very useful in detecting neuroblastomas. In order to get the most valuable information, both delayed SPECT and early whole body planar images should be obtained.

[Trial of radiation and cisplatin, carboplatin combination chemotherapy for advanced cancer (W-platinum chemoradiotherapy].

Cisplatin was reported to be an effective radiation sensitizing agent. The effect was also reported to depend on dose intensity. But the incidence of complication was demonstrated in the relationship with the dose escalation curve of anti-cancer agent. The major side effect of CDDP was occasionally serious, as in renal toxicity or bone marrow suppression. W-Platinum is the trial of concurrent chemoradiotherapy. Cisplatin and its derivative, Carboplatin, were selected as effective radiation sensitizing agents and to obtain high-dose intensity and additive cytotoxicities by interaction between the two drugs. Concomitant administration of two platinum anti-cancer agents has the advantage of reduction of side effects compared with administration of single anti-cancer agents to the same degree. The first case was a recurrence of epipharyngeal cancer after 3 courses of chemotherapy, including CDDP or CBDCA. This case was suspected to be cancer-resistant to CDDP. The second case was post-operative residual lung cancer. The pre-operative diagnosis was stage III A. A poor prognosis was expected. This case was disease-free and alive for 1 year after W-Platinum administration. The most frequent complication was bone marrow suppression. Patients were rescued from bone marrow suppression with administration of G-CSF. Renal toxicity could be suppressed with sufficient hydration.

[The serial change of the 123I-BMIPP SPECT in patients with hypertrophic cardiomyopathy].

We studied the serial change of 123I-BMIPP SPECT in the process of hypertrophic cardiomyopathy (HCM). In 16 patients with HCM, the imaging data were acquired 15 minutes after injection of 111 MBq 123I-BMIPP. The SPECT image was divided into 17 segments and the severity of the defect in each segment was scored visually using defect score, a 4-point grading system (score 0 = normal, score 1 = mildly decreased uptake, score 2 = moderately decreased uptake, score 3 = severely decreased uptake or defect). Each patient underwent this examination twice with interval of 25 +/- 14 months. In the first examination, we observed reduced uptake in 14 cases (88%), and often found it in septal portion of anterior or posterior wall. In the second examination, compared with the first study, total defect score (TDS: the summation of defect score of 17 segments) had increased in 7 cases (44%) of 16 cases, decreased in only 1 case (6%), and unchanged in 8 cases (50%). The regional defect score often increased in septal portion of anterior and posterior walls, and the high score area widespread toward the septum. There was no difference between TDS unchanged group and TDS worsened group in the point of background (age, family history of HCM), the interval of the two studies, and the findings of echocardiography (Dd, Ds, %F). In TDS worsened group (n = 7), clinically only 1 case became progressed stage. In others there were no progression in each clinical, echocardiographic, or 201Tl scintigraphic findings. This study revealed that myocardial fatty acid metabolic disorder often progresses during short interval in patients with HCM. In conclusion, the serial examination of 123I-BMIPP SPECT may contribute to an estimation of the stage or the prognosis in HCM.