Scintigraphic detection of colon carcinomas with iodinated monoclonal antibodies.

PURPOSE: The aim of this study was to evaluate the clinical reliability of the immunoscintigraphy with iodinated monoclonal antibodies for the detection of metastases and recurrences of colon carcinomas. METHODS: A total of 45 patients with colon carcinoma was investigated with gamma camera, after intravenous application of iodinated monoclonal antibodies. RESULTS: The sensitivity of the method was 90%, specificity 86%, positive predictive value 93%, negative predictive value 80% and accuracy 87%. There was statistically significant relationship between immunoscintigraphic and ultrasonographic (US) findings (p=0.005). Also, there was significant relationship between immunoscintigraphy and Dukes stage (p=0.019). Tumor marker levels were not significantly correlated with immunoscintigraphic findings (p<0.05). Significant difference was noted in patients with positive findings for malignancy on US and immunoscintigraphic findings (p=0.006), i.e. patients with positive findings for malignancy had more frequently immunoscintigraphic findings of malignancy. Correlation with other diagnostic procedures (rectoscopy, colonoscopy, CT) did not show significant correlations. CONCLUSION: We conclude that immunoscintigraphy can be helpful in the detection of metastases and recurrences of colon carcinomas.

Diagnostic value of ocular melanoma immunoscintigraphy.

PURPOSE: To estimate the diagnostic value of ocular immunoscintigraphy (ISG) in the differentiation of melanoma from other ocular tumors or lesions. PATIENTS AND METHODS: ISG was performed in 27 patients. Twenty-four patients were suspected of having ocular melanoma and 3 patients had previous eye enucleation for melanoma and were without recurrent disease. Monoclonal antibody (MoAb) 225.28S was administered intravenously and the patient's head was imaged with gamma camera after 5 minutes and after 5 hours collecting 500.00 counts per image. RESULTS: The diagnosis of malignant melanoma was established by clinical examination in 12 patients (10 of them were subjected to enucleation and histopathological confirmation). ISG was positive in 10 out of 12 patients (sensitivity 83%). Two patients with operated melanoma had negative scintigraphic result. Fifteen patients with non melanoma lesions had negative findings except one patient with haemangioma who had positive ISG. The specificity of ISG was 93%. CONCLUSION: ISG is a sensitive and specific diagnostic method for ocular melanoma. The reliability of the results depends on proper acquisition of data and interpretation of images, including comparison of both eyes and early and late images with contrast enhancement.

[Papillary microcarcinoma of the thyroid and secondary hyperparathyroidism in a patient on hemodialysis]. / Papilarni mikrokarcinom stitaste zlezde i sekundarni hiperparatireoidizam kod bolesnika na hemodijalizi.

Association between non-medullary thyroid carcinoma and secondary hyperparathyroidism have been rarely reported in patients with renal failure. A few cases of micropapillary thyroid carcinoma have been reported in patients before and after renal transplantation. We present a case of incidental detection of thyroid carcinoma at the time of parathyroidectomy in patient on dialysis after cadaver renal transplantation.

[Stress-rest myocardial tomoscintigraphy with 99mTc-tetrofosmin in the diagnosis of ischemic disease]. / Stress-rest tomoscintigrafija miokarda 99mTc-tetrofosminom u dijagnostici ishemijske bolesti.

The aim of this study was to evaluate the accuracy of 1-day stress-rest technetium-99m tetrofosmin myocardial tomography in the identification of patients with coronary artery disease (CAD), and in the detection of the individual occluded coronary vessels. A total of 42 patients with suspected CAD were studied. Significant coronary narrowing (> or = 50% luminal stenosis) was detected by angiography in 22 patients. All patients received two i.v. injections of 99mTc tetrofosmin, one at peak exercises (370 MBq) and the other (740 MBq) at rest 3 h after exercise (images 15-30 min after injections for both studies). At visual analysis, all patients with CAD (> or = 50% luminal stenosis) (n-22) had an abnormal 99mTc tetrofosmin tomogram. Nine out of 20 patients without significant coronary narrowing (but with tortuosis, atheromathosis, with microvascular diseases) showed abnormal findings. Overall sensitivity, specificity and diagnostic accuracy in the identification of CAD was 100%, 55%, and 79%, respectively. Sensitivity, specificity and diagnostic accuracy in the identification of individuals with occluded coronary vessels were 100%, 76% and 85%, respectively. The results of this study demonstrate that 1-day exercise-rest 99mTc tetrofosmin single-photon emission tomographic imaging (SPET) is a suitable and accurate technique to identify patients with CAD and for detection of individual occluded coronary vessels.

[Dynamic scintigraphy of the kidney using 99m-Tc-DTPA before and after extracorporeal shock wave lithotripsy]. / Dinamska scintigrafija bubrega pomocu 99m-Tc-DTPA pre i posle ESWL.

The results of dynamic scintigraphy of the kidneys using 99mTc-DTPA that is glomerular radiopharmaceutic in patients before and after ESWL (extracorporeal shock wave lithotripsy) are presented. Investigation was performed in 22 patients--in 8 patients immediately before ESWL, 7 days and 3 months later, and in 14 patients before and 7 days after ESWL. The time alteration of the achievement of the maximal values of radiorenographic curve obtained by dynamic scintigraphy (Tmax), as the alteration of separate clearance (SCI) counted as an integral below the other phase of renographic curve. No significant differences were observed in the values of separate clearance before and after ESWL, while Tmax was significantly reduced 3 months after ESWL (p < 0.05). Our results indicated the improvement of glomerular filtration of the kidneys 3 months after ESWL (faster passing of DTPA through the treated kidney).

[Assessment of embolism risk in deep vein thrombosis in various locations using radionuclide phlebography and perfusion scintigraphy of the lungs]. / Procena embologenog rizika pojedinih lokacija tromboze dubinskih vena radionuklidnom flebografijom i perfusionom scintigrafijom pluca.

With the aim of the estimation of embolism at certain locations of deep vein thrombosis (DVT) 3 groups comprising 22 patients were investigated in whom isolated thrombosis in one of the deep veins segments: lower leg, upper leg, and pelvis was determined by radionuclide phlebography (RNF) and contrast phlebography. Afterwards, all necessary investigations relevant for pulmonary thromboembolism (PTE), including perfusion scintigraphy of the lungs (PSL) were performed. Out of all patients with DTV, 17% were with pulmonary changes confirming PTE. Out of patients with DVT, 59% were with the changes in the upper leg segment, and 66% of patients were with changes in pelvic segment, respectively.

[Diagnostic validity of radionuclide phlebography in the detection of clinically occult deep venous thrombosis in patients with thromboembolism]. / Dijagnosticka pouzdanost radionuklidne flebografije u otkrivanju klinicki neispoljenih tromboza dubinskih vena kod bolesnika sa tromboembolijom

Diagnostic reliability of radionuclide phlebography (RNP) compared to contrast phlebography in the detection of deep veins' thrombosis (DVT) in patients with confirmed thromboembolism of the lungs (TEL) was evaluated. RNP. These findings were compared to contrast phlebography (CP), performed in the group of 25 patients in whom TEL was confirmed clinically, radiologically, scintigraphically and biochemically, but without clinical signs and symptoms of DVT. In 15 patients where RNP revealed unilateral DVT, CP finding was confirmed in all: in 6 (40%) on the left, and in 9 (60%) on the right side. In 10 patients with bilateral signs of DVT observed by scintigraphy, DVT finding was confirmed in 7 (70%), while in 3 (30%) patients, scintigraphic signs of DVT were falsely positive. In the segments of deep venous system, specificity of RNP in the detection of DVT in the lower leg was 60%, sensitivity was 100%, accuracy was 64% with 62% falsely positive findings. In the upper legs specificity was 79%, sensitivity was 100%, and accuracy was 86% with 24% falsely positive findings, while in the pelvis specificity was 87%, sensitivity was 100%, accuracy was 83% with 14% falsely positive findings.

Interobserver variability in 99mTc-DMSA renal scintigraphy reports: multicentric study.

BACKGROUND: The aim of the study was to evaluate the interobserver variability and reproducibility of the renal scintigraphy reports. METHODS: The study was prospective performed in 60 99mTc DMSA scintigraphies (116 kidneys), done in one centre, displayed on X ray films as analogue 300 kcounts images in 4 standard projections. Six observers from 4 different centres (group A), including three observers from one institution (group B), were asked to interpret original scans. Seven parameters of scintigraphy protocol were analysed with at least two responses: kidney size (1), uptake (2), outlines (3), scars (4), SOL (5), differential function (6) and conclusion (7). RESULTS: Among 116 kidneys, concordant results in interpretation of seven points of report from 1 to 7, in the group A were found in 62%, 42.5%, 45%, 9%, 47%, 52% and 34%, and In the group B in 72%, 55%, 59%, 22%, 62%, 60% and 41% respectively. Some improvement in concordant reporting was noted in the group of 3 observers, in comparison of group of all, statistically significant in category of scar reports (p < 0.01). CONCLUSIONS: Results suggest to use of standardised criteria and terminology in interpretations, to improve low interobserver reproducibility and objectivity of renal scintigraphy reports, particularly in evaluation of renal scars.

[Multicystic dysplastic kidney. Therapeutic dilemmas and personal experience]. / Multicisticni displazicni bubreg. Terapijske dileme i nase iskustvo.

A multicystic dysplastic kidney (MCDK) is one of the most frequent causes of abdominal mass in the neonate. Prenatal echography permits early and frequent diagnostics. It is a nonfamilial disease without associated cystic disease of the pancreas, liver or lungs. Indications for elective surgery are clear when there is a symptomatic disease. However, treatment of asymptomatic patients is controversial. A rising number of authors prefer nonsurgical approach, leaving MCDK intact with a close follow-up of patients for possible severe complications (malignancy, hypertension, infection, pain, rupture). We treated 15 patients with MCDK from 1984 to 1994. Diagnosis was passed antenatally in 7 (47%) patients, accidentally in 2, and based on the presence of abdominal mass in 6 patients. Two patients had renal failure due to the abnormal contralateral kidney. Nine patients were operated on and 6 were treated nonsurgically. The risk of complications associated with nonsurgical treatment, easiness of efficient surgery at the age of 3-6 months, avoiding stress in the child and family due to long-term follow-up, all suggest operative treatment. We suggest to parents both operative and nonoperative options, explaining the risk and danger of both. We believe that nephrectomy is the best solution in a child with MCDK who is growing, develops hypertension, with uncertain diagnosis or when adequate follow-up is impossible.

Significance of sacroiliac index in diagnostics of seronegative spondyloarthropathies.

Sacroiliac index (SI index) was determined by the quantitative scintigraphy in 106 patients:28 with ankylosing spondilitis, 51 with Reiter's disease, 9 with psoriatic, 18 with unclassified seronegative spondylarthropathy and in 20 controls. For the right joint, statistically significant difference was found between the control group SI-index value and the one in patients' group (p < 0.001 to p < 0.005) except in patients with psoriatic spondylarthropathy. Analysing each group of patients separately, statistically significant difference between the SI index of both left and right joint was present only in the group with Reiter's disease (t = 2.08: p < 0.05). Increased SI-index was found in 45.28% of all patients and this also confirmed sensitivity of the applied method, while the value of test specificity was 86.96%. Correlation between sedimentation rate and SI index as well as between radiographic finding and SI index was not present. There was a positive correlation between clinical findings and Reiter's disease but only in 56% of cases. It was concluded that scintigraphy is a useful but insufficient method in the diagnosis of seronegative spondylarthropathies.

Salivary gland scintigraphy in patients with primary Sjögren's syndrome.

Methodology, interpretation and results of salivary gland scintigraphy in 33 patients with primary Sjögren's syndrome (pSs) are presented. Patients were divided in two groups: 14 patients with isolated pSs and 19 patients with pSs and extraglandulary manifestations. There was no correlation between scintigraphic findings and duration of disease, and between scintigraphic findings and presence of recurrent swelling of parotid glands. The damage of salivary glands, detected by scintigraphy, was more marked in patients with pSs and extraglandulary manifestations than in patients with isolated pSs.

Evaluation of diagnostic reliability of radionuclide phlebography using 99mTc-MAA to detect deep venous thrombosis; its role in establishing indications for inferior vena cava filter implantation.

Radionuclide phlebography (RNP) of the lower extremities and pelvis was performed using 99mTc-MAA in 40 patients with pulmonary thromboembolism. Deep venous thrombosis (DVT) was found in all patients, more frequently in the right calf and in the left iliac veins in 20 patients (55%). RNP and contrast phlebography (CP) were performed in 18 patients and confirmed the presence of DVT in all cases. The greatest specificity of RNP was obtained in the left (92.4%) and in the right pelvis (80%). In 12 of 18 patients in whom a cava filter was implanted, specificity of RNP was 100% for the left thigh and 91.7% for other localizations. In establishing indications for cava filter implantation, RNP should be performed prior to CP and bilaterally, but in case of non-indicated CP, RNP findings should be sufficient.

[The role of radionuclide phlebography in the detection of deep venous thrombosis in the lower extremities and pelvis and in establishing indications for implantation of a caval filter]. / Uloga radionuklidne flebografije u otkrivanju tromboze dubokih vena donjih ekstremiteta i karlice u postavljanju indikacija za ugradnju kava-filtera.

In all 40 patients with pulmonary thromboembolism (PTE) radionuclide phlebography (RNP) detected deep venous thrombosis (DVT), most commonly in the left iliac veins, in 20 (50%). RNP and contrast phlebography (CP) were performed in 18 patients and RNP sensitivity was found in 100% in all localizations of DVT and the largest specificity was obtained in the left side of the pelvis, in 92%. In 12 out of 18 patients cava filter was implanted and BNP specificity in the left upper leg reached 100% and in the right one 89.3%. In establishing indications for cava filter implantation RNP should be performed first so that by detecting embologenous TDV localizations the risk of jatrogenous PTE at cava filter implantation would be avoided or CF, if necessary.

Synthesis of p-aminohippuric acid analog and its labeling by technetium-99m.

A procedure is described for the synthesis of p-[(bisacarboxymethyl)aminomethyl carbamino] hippuric acid (PAHIDA). The compound was identified by i.r. and NMR spectroscopy. A lyophilized complex was prepared and labeled with 99mTc. The purity of the preparation is better than 98%. The stability of the 99mTc-PAHIDA complex is achieved 8 h after labeling. Biodistribution tested on white rats shows a maximum accumulation in kidneys of 6-10% within 2 min after injection, while the accumulation in the liver is 2-4% of the administrated dose. Preliminary clinical studies of 99mTc-PAHIDA on patients and its comparison with 131I-hippuran showed that the 99Tc-PAHIDA preparation has excellent characteristics for visualization of kidneys. However, it has slightly slower urinary elimination compared to hippuran, which it makes possible to use PAHIDA as a replacement of hippuran to a certain extent.