Effects of gender and age differences on the distribution of bone content in the third lumbar vertebra.

STUDY DESIGN: A cross-sectional study on the distribution of bone mineral content in the third lumbar vertebrae. OBJECTIVES: To evaluate the effects of age and gender on the distribution of bone mineral content in the third lumbar vertebrae. SUMMARY OF BACKGROUND DATA: Compression fractures occur mainly at the vertebral body. Variations in the distribution of bone mass in a vertebra, if undefined, may bias the ability of the acquired bone mineral density values, which was usually measured posteroanteriorly, to predict the risk of fractures. METHODS: The bone mineral content of the whole L3, including the L3 vertebral body and the posterior segment, was measured using a lateral approach with a dual energy radiograph absorptiometer on 177 healthy Taiwanese adults including 65 men and 55 premenopausal and 57 postmenopausal women. RESULTS: The proportion of bone mineral content in the vertebral body was significantly lower in premenopausal women than in age-matched men (39.1 +/- 0.9% vs. 50.0 +/- 1.7%, P < 0.0001). Furthermore, whereas postmenopausal women showed a decreased proportion of bone mineral content in the vertebral body with increased age (about -0.0022 per year, P = 0.0001), premenopausal women and men showed a sustained proportion. CONCLUSIONS: The proportion of bone mineral content distributed in the body of L3 vertebrae was lower in women than in men. The discrepancy of this parameter between the genders was even larger with increased ages.

Comparison of 18-fluoro-2-deoxyglucose positron emission tomography and computed tomography in detection of cervical lymph node metastases of nasopharyngeal carcinoma.

Neck lymph nodes (LNs) from 18 patients with nasopharyngeal carcinoma (NPC) were evaluated with 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET). Eighteen NPC patients underwent head and neck FDG-PET and computed tomography (CT) for detection of suspected neck LN metastases. For final diagnosis, biopsies were taken from neck LNs with discordant findings between FDG-PET and CT. Meanwhile, standard uptake values (SUVs) of the FDG-PET images were calculated to differentiate metastatic LNs from benign LNs. A total of 90 neck LNs found on either FDG-PET or CT were evaluated. In addition to 27 concordant positive results and 42 concordant negative LN results, biopsy findings revealed 11 metastatic LNs that were detected by FDG-PET but not by CT. However, the SUVs of the 11 metastatic LNs and 7 benign LNs were not significantly different. The CT scanning showed positive findings for I metastatic LN with negative FDG-PET findings. In addition, the tumor stage was upgraded in 5 patients on the basis of FDG-PET findings. In comparison with CT, FDG-PET has a higher potential for detecting neck LN metastases of NPC and assessing NPC tumor stage.

Factor of risk for hip fracture in normal Chinese men and women in Taiwan.

We have investigated the age-related change in factor of risk (Phi) for the proximal femoral load during free fall in 548 females and 240 males aged 21-79 years. These individuals were divided into either young (age <50 years) or old group (age >/=50 years). Another 26 females with hip fractures were included for comparison. The bone mineral density (BMD) of proximal femoral neck was measured by a Norland XR-26 dual-energy X-ray absorptiometer (DXA). The estimated fracture load (L) of femoral neck was calculated from the BMD with the regression equation derived by Courtney et al. [2,3] and estimated fall force (F) by body weight and height according to the regression equation derived by Nakamura et al. [6] respectively. Phi was defined as the quotient of F/L. The results showed an age-related decrease of BMD (P < 0.001) in both genders corrected for weight and height. By multiple linear regression analysis, the F decreased significantly with aging corrected for BMD in old males (partial r = -0.255, P < 0.01) and increased with aging in all females (young, partial r=0.287, p < 0.001; old, partial r = 0.252, P < 0.001). L decreased significantly with aging corrected for height and weight in males (young, partial r = -0.401, P < 0.01; old, partial r = -0.178, P < 0.05) and females (young, partial r = -0. 168, P < 0.05; old, partial r = -0.459, P < 0.001). However Phi decreased with aging in young males (P < 0.01) and females (young: P < 0.001, old: P < 0.001). Phi increased in old women but not in old men, and was higher in old women compared with old men. The 26 patients with hip fractures had a significantly higher Phi value than 85 age-matched women. In conclusion, Phi may provide a comprehensive comparison of the risk of hip fracture in the elderly population.

The effectiveness of cyclic and continuous oral clodronate therapy on bone density and markers in osteopenic postmenopausal women.

Bisphosphonates have been used effectively to treat established osteoporosis and prevent postmenopausal bone loss. However, the optimal manner of its administration-whether cyclic or continuous-has not been well established. This study investigated the efficacy of cyclic and continuous oral administration of clodronate in 54 newly identified osteopenic postmenopausal women in a randomized, double-blind, crossover fashion. The participants were randomly separated into two groups. The cyclic group (n = 29) received 800 mg twice daily of oral clodronate for 2 weeks every 3 months for the first 12 months followed by placebo for the second 12 months. The continuous group (n = 25) received placebo in the first 12 months and ingested 400 mg of clodronate once daily for the second 12 months. The urinary amino-terminal (NTXtrade mark) and carboxy-terminal (CrossLapstrade mark) cross-linked fragments of type I collagen, both markers of bone resorption, showed a marked decrease (25-50%) with both regimens during the period of active treatment. In the cyclic group, the levels of these two markers increased in the second 12 months with placebo, but did not return to the baseline completely. However, bone mineral density (BMD), determined by dual-energy X-ray absorptiometry (DXA), showed no significant change of BMD at various sites after 1 year of active treatment in both groups. Thoracic and lumbar spine X-ray showed no new vertebral fracture in either group after 2 years of treatment. With the two treatment protocols in this study, oral clodronate was effective in decreasing postmenopausal bone resorption, causing no significant changes in BMD at various sites.

The role of FDG-PET, HMPAO-SPET and MRI in the detection of brain involvement in patients with systemic lupus erythematosus.

Involvement of the brain is one of the most important complications of systemic lupus erythematosus (SLE); however, its diagnosis is difficult due to the lack of effective imaging methods. We combined three brain imaging modalities - positron emission tomography with fluorine-18 2-fluoro-2-deoxy-d-glucose (FDG-PET), single-photon emission computed tomography with technetium-99m hexamethylpropylene amine oxime (HMPAO-SPET) and magnetic resonance imaging (MRI) - in order to detect brain involvement in SLE. Thirty-seven SLE patients, aged 22-45 years, were divided into three groups. Group 1 (G1) consisted of ten patients with major neuropsychiatric manifestations; group 2 (G2) consisted of 15 patients with minor manifestations; and group 3 (G3) consisted of 12 patients without manifestations. FDG-PET findings were abnormal in 51% of patients: 90% of G1, 67% of G2 and 0% of G3 patients respectively. HMPAO-SPET findings were abnormal in 62% of patients: 100% of G1, 73% of G2 and 17% of G3 patients respectively. MRI findings were abnormal in 35% of patients: 70% of G1, 40% of G2 and 0% of G3 patients respectively. Grey matter was more commonly involved than white matter; 62% of patients presented with lesions in the cerebral cortex, 27% with lesions in the basal ganglion, 5% with lesions in the cerebellum, and 19% with lesions in white matter. No white matter lesions were found on FDG-PET or HMPAO-SPET. However, in 19% of patients, MRI demonstrated abnormally high signal lesions in white matter. Forty-three percent of cases had positive serum anticardiolipin antibodies (ACA). However, ACA was not related to FDG-PET, HMPAO-SPET or MRI findings. It may be concluding that HMPAO-SPET is a more sensitive tool for detecting brain involvement in SLE patients when compared with FDG-PET or MRI. However, MRI is necessary for detecting lesions in white matter.

Discrepancy between regional cerebral blood flow and glucose metabolism of the brain in systemic lupus erythematosus patients with normal brain magnetic resonance imaging findings.

OBJECTIVE: In this study, 2 updated brain-imaging modalities, technetium-99m hexamethylpropylene amine oxime-single-photon-emission computed tomography (HMPAO-SPECT) and fluorine-18 2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET), were used to simultaneously detect regional cerebral blood flow (rCBF) and glucose metabolism of the brain in patients with systemic lupus erythematosus (SLE). METHODS: Twenty-five female SLE patients, ages 25-40 years, were enrolled in this study and assigned to 1 of 2 groups. Group 1 consisted of 13 patients with neuropsychiatric manifestations (7 had major and 6 had minor manifestations). Group 2 consisted of 12 patients without neuropsychiatric manifestations. Serum levels of anticardiolipin antibodies (aCL) and anti-ribosomal P antibodies (anti-P) were measured. All patients had normal brain magnetic resonance imaging (MRI) findings. Ten healthy female volunteers also underwent brain MRI, HMPAO-SPECT, and FDG-PET for comparison. RESULTS: 99mTc-HMPAO-SPECT revealed hypoperfusion lesions in 11 (44%) of 25 SLE patients, including 9 (69%) of the 13 patients in group 1, 7 (100%) of the 7 patients with major manifestations, 2 (33%) of the 6 patients with minor manifestations, and 2 (17%) of the 12 patients in group 2. Parietal lobes were the areas most commonly involved. FDG-PET revealed hypometabolism in 7 (54%) of the group 1 patients, 6 (86%) of the 7 patients with major manifestations, and 1 (17%) of the 6 patients with minor manifestations. Temporal lobes were the most commonly involved areas. However, no significant hypometabolism brain lesions were found in group 2 patients. All of the 4 patients with headaches and dizziness or headaches alone had normal findings on HMPAO-SPECT and FDG-PET. Nine (36%) of the 25 patients were positive for aCL. However, the presence of aCL was not related to neuropsychiatric manifestations or to HMPAO-SPECT or FDG-PET findings. Five (20%) of the 25 patients had anti-P antibodies and psychosis/depression. CONCLUSION: In patients with normal brain MRI findings, decreases in glucose metabolism coupled with decreases in rCBF are associated with serious neuropsychiatric SLE (NPSLE) presentations, while normal glucose metabolism with decreases in rCBF may be found in SLE patients with or without NPSLE.

Detection of recurrent or persistent nasopharyngeal carcinomas after radiotherapy with 18-fluoro-2-deoxyglucose positron emission tomography and comparison with computed tomography.

PURPOSE: The effectiveness of positron emission tomography (PET) with 1 8-fluoro-2-deoxyglucose (FDG) for detecting suspected recurrence of nasopharyngeal carcinomas (NPC) was evaluated and compared with computed tomography (CT). PATIENTS AND METHODS: FDG-PET studies were performed on 36 NPC patients 4 months after radiotherapy. The images were interpreted visually and quantitatively by calculating standardized uptake values (SUVs). RESULTS: The sensitivity, specificity, and accuracy of visually interpreted FDG-PET images, for differentiation of recurrent or persistent NPC from benign lesions, were 100%, 96%, and 97%, respectively. Cases with recurrent or persistent NPC (1.6 to 5.8) had significantly higher SUVs than cases with benign lesions (0.8 to 1.5). The sensitivity, specificity, and accuracy of CT for detecting recurrent or persistent NPC were 72%, 88%, and 83%, respectively. CONCLUSION: FDG-PET is a better tool than CT for the detection of recurrent or persistent NPC. Either visual interpretation or SUV can be used to differentiate benign lesions from recurrent or persistent NPC.

False-positive 2-[F-18]-fluoro-2-deoxy-D-glucose positron emission tomography studies for evaluation of focal pulmonary abnormalities.

Positron emission tomography (PET) with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) can demonstrate the glucose metabolism characteristics of a lesion, which may be helpful in differentiating between benign and malignant focal pulmonary lesions. Malignant cells demonstrate higher glucose metabolic activity than benign lesions. However, some inflammatory processes also show significant FDG uptake. We present two cases where high FDG uptake was found in inflammatory lesions in the lungs. The first case was that of a 38-year-old woman with chronic cough for more than 20 years. FDG PET revealed a hypermetabolic lesion with a lesion-to-background ratio of 8.0 at the posterior aspect of the right middle lung. She underwent thoracotomy and tumor resection, and was diagnosed with cryptococcosis. The second case was that of a 72-year-old woman who had pulmonary tuberculosis previously with cavitation in the left lower lobe. She suffered from fever, chills and severe hemoptysis for several days before this admission. FDG PET revealed a hypermetabolic ring at the periphery of the cavity. The lesion-to-background ratio was 7.8. Echo-guided biopsy showed no evidence of malignancy. She was treated with antibiotics and the symptoms subsided gradually. Lung abscess complicating a pre-existing cavity was diagnosed. These two cases substantiate that positive FDG PET results should be interpreted with caution in differentiating benign from malignant pulmonary abnormalities, especially in regions with a high prevalence of granulomatous lesions.

Technetium-99m-HMPAO SPECT and MRI of brain in patients with neuro-Behçet's syndrome.

UNLABELLED: Involvement of the brain is one of the most important complications of Behçet's disease (BS). It is difficult to diagnose, however, because of the lack of effective imaging methods. METHODS: Thirteen BS patients with neuropsychiatric symptoms or signs [Neuro-Behçet's syndrome (NBS)] were included in this study. We combined two routine brain imaging modalities-brain SPECT with 99mTc-hexamethyl propyleneamine oxime (HMPAO) and brain MRI-with clinical manifestations to diagnose brain involvement. RESULTS: Technetium-99m-HMPAO brain SPECT findings were abnormal in 100% (13/13) of patients. Brain MRI findings were abnormal in 31% (4/13) of patients. Gray matter was involved more commonly than white matter. In the gray matter, the cerebral cortex was the most commonly involved area and the cerebellum was the least commonly involved area in NBS. CONCLUSION: SPECT is a more sensitive and useful tool in detecting brain involvement in NBS patients compared with brain MRI. The combination of HMPAO and MRI is necessary to detect brain lesions in both gray and white matter in NBS.

Gastric emptying in male neurologic trauma.

UNLABELLED: Prolonged gastric emptying half-time (GET1/2) has been observed in several neurological disorders. Most patients with moderate to severe neurologic trauma (NT) initially do not tolerate enteral or nasogastric feedings. However, previous findings of altered gastric emptying (GE) in patients with NT have been questionable. Quantitative measurements of GE, to determine a possible mechanism for intolerance to enteral feeding, are lacking. In this study, we measured GET1/2 sec of solid and liquid meals by radionuclide imaging in men who were neurologic trauma patients. METHODS: A prospective study was conducted to assess GET1/2 in 30 men who were patients with spinal cord injuries (SCIs) and 20 men who were patients with head injuries (HIs) using radionuclide-labeled solid and liquid meals, respectively. Meanwhile, 18 and 14 male control subjects underwent the same imaging techniques for solid and liquid meals, respectively, to evaluate the normal ranges of solid and liquid GET1/2 sec (84.5 +/- 16.7 and 29.2 +/- 3.7 min). RESULTS: In the 30 SCI patients, GET1/2 of solid meals was significantly prolonged (138.3 +/- 49.2 min, p < 0.05), and 53% (16/30) of patients had abnormal GET1/2. A more prolonged GET1/2 and a higher incidence of abnormal GET1/2 were observed in patients with high-level injury, when compared with patients with low-level injury (p < 0.05). In the 20 HI patients, GET1/2 of liquid meals was prolonged significantly (51.7 +/- 24.8 min, p < 0.05), and 65% (13/20) of patients had abnormal GET1/2. Coma, as indicated by the Glasgow Coma Scale score, was not a statistically significant factor influencing GET1/2 (p >0.05). CONCLUSION: NT can cause significantly prolonged GE, especially in patients with high-level SCI.

Positron emission tomography for detecting iodine-131 nonvisualized metastasis of well-differentiated thyroid carcinoma: two case reports.

To investigate the usefulness of positron emission tomography (PET) in detecting I-131 nonvisualized metastatic foci of well-differentiated thyroid carcinoma (WDTC), 2 patients with papillary and follicular thyroid carcinoma respectively, were studied with I-131 total body scan, thallium-201 scan, Tc99m bone scan and [18F]-2-deoxy-2-fluoro-D-glucose (FDG) PET. Case 1 showed no metastatic lesion in I-131 (up to 150 mCi) total body scan, 1 anterior mass in thallium-201 scan, none in Tc99m bone scan and 7 including the main anterior mediastinal mass in FDG-PET. Case 2 showed 2 metastatic lesions in I-131 (150 mCi) total body scan, 11 bony metastatic lesions in Tc99m bone scan and 13 in FDG-PET. However, lower extremities were not scanned in FDG-PET. Tumor/background ratio of 1.5 or above is needed to be visualized grossly. The FDG-PET tumor/background ratios are higher than those of thallium-201 except in one site. In conclusion, I-131 scintigraphy is still the first line method to use in detecting WDTC recurrence and metastasis, as I-131 has the advantage of being both a therapeutic and imaging agent. For I-131 nonvisualized metastasis of WDTC, thallium scintigraphy and FDG-PET may be considered. Even though FDG-PET has better sensitivity, resolution imaging and spatial localization, this has to be balanced with its higher cost when compared with thallium scintigraphy.

Regional cerebral blood flow and glucose metabolism in Sjögren's syndrome.

UNLABELLED: Involvement of the brain is one of the most important complications of Sjögren's syndrome (SS). However, diagnosis of brain involvement in SS patients is difficult due to the lack of effective imaging methods. In this study, we compared two updated brain imaging modalities, 18F-2-fluoro-2-deoxy-D-glucose (FDG) PET and 99mTc-hexamethyl propyleneamine oxime (HMPAO) SPECT, in SS patients with neuropsychiatric manifestations, to detect glucose metabolism of the brain and regional cerebral blood flow. METHODS: Sixteen primary female SS patients with normal brain MRI findings were enrolled in this study. RESULTS: Technetium-99m-HMPAO SPECT findings were abnormal in 13 (81%) patients. Parietal and temporal lobes were the most common areas of brain involvement. Fluorine-18-FDG PET findings were abnormal in 3 (19%) patients. Temporal lobes were the most common areas of brain involvement. CONCLUSION: We conclude that brain HMPAO SPECT has better correlation with clinical manifestations than brain FDG PET or CT/MRI.

Technetium-99m methoxyisobutylisonitrile chest imaging of small cell lung carcinoma: relation to patient prognosis and chemotherapy response--a preliminary report.

BACKGROUND: The purpose of this preliminary study was to evaluate retrospectively the relation between chemotherapy response and survival time, using technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) uptake in small cell lung carcinoma (SCLC) to detect the expression of multidrug resistance (mdr)-mediated 170-kDa P-glycoprotein (PgP). METHODS: Before the administration of chemotherapy (which consisted of cisplatin 25 mg and etoposide 125 mg every day per 3-day course), 15 male patients (ages 54-64 years) with SCLC were enrolled in this study to undergo Tc-99m MIBI chest imaging, including single photon emission computed tomography (SPECT) and planar imaging, for qualitative and quantitative assessments of PgP in their SCLC. RESULTS: In 12 of 15 cases (80%), SCLC could be detected by visual interpretation of the Tc-99m MIBI chest SPECT images. In 13 of 15 cases (87%), Tc-99m MIBI chest SPECT images (either positive SPECT with good response or negative SPECT with poor response) correctly predicted chemotherapy response. The correlation between tumor uptake ratios obtained by planar images (total counts in the region of interest [ROI] of the tumor divided by total counts in the same size ROI of the contralateral normal lung) and survival days (from the time of SCLC diagnosis to the time of the patient's death) was both positive and good (correlation coefficient=0.83). CONCLUSIONS: Tc-99m MIBI chest images have the potential to demonstrate mdr-PgP expression in SCLC and to predict patient prognosis and chemotherapy response.

Gastric emptying in head-injured patients.

OBJECTIVE: Most patients with moderate to severe head injury (HI) initially do not tolerate enteral feedings. Intolerance to nasogastric feeding is also commonly observed after HI. Quantitative measurements of gastric emptying (GE), to determine a possible mechanism for intolerance to enteral feeding, are lacking. METHODS: We prospectively evaluated gastric emptying half-time (GET1/2) of liquid meals in 35 patients with moderate to severe HI. RESULTS: In comparison with 16 age-matched healthy control subjects (29.4 +/- 3.7 min), GET1/2 was significantly prolonged (57.2 +/- 20.8 min, p < 0.05) and abnormal in 80% of the HI patients. A prolonged GET1/2 and higher incidence of abnormal GET1/2 were observed in female patients, older patients, and patients with low Glasgow coma scale (GCS) scores, when compared with male patients, younger patients, and patients with high GCS scores. However, the differences for the means of GET1/2 and the incidences of abnormal GET1/2 between the subgroup patients were not significant (p > 0.05). In addition, significantly prolonged GET1/2 and higher incidence of abnormal GET1/2 (p < 0.05) were observed in patients with short injury duration, in comparison with patients with long injury duration. CONCLUSION: Head injury can cause significant prolonged GE of liquid meals, especially in patients with short injury duration.

Detection of nasopharyngeal carcinoma with head and neck Tc-99m tetrofosmin SPECT imaging.

Tc-99m tetrofosmin SPECT imaging of the head and neck was performed on 10 patients with nasopharyngeal carcinoma (NPC) and 10 controls. There was no abnormal nasopharyngeal uptake of tetrofosmin in the 10 controls. In the patients with NPC, 3/10 (30%) of the cases had no abnormal uptake and 7/10 (70%) had increased nasopharyngeal uptake. Considering our preliminary study, we find that Tc-99m tetrofosmin SPECT of the head and neck may be helpful in the detection of NPC. However, further study with a larger number of patients is needed to ascertain the value of Tc-99m tetrofosmin SPECT in such cases.

Comparison of S-T segment/heart rate slope with exercise thallium imaging and conventional S-T segment criteria in detecting coronary artery disease: effect of exercise level on accuracy.

The S-T segment/heart rate (ST/HR) slope has been proposed as a more accurate electrocardiographic criterion for the diagnosis of coronary artery disease, but studies comparing the diagnostic value of the ST/HR slope with exercise thallium imaging are scant. The aims of this study were to assess the diagnostic accuracy of the ST/HR slope, conventional S-T segment criteria and exercise thallium imaging in detecting coronary artery disease and to evaluate the effect of exercise level on the sensitivity and specificity of these three techniques. Ninety consecutive patients underwent treadmill testing and exercise thallium single-photon emission computed tomography (SPECT) simultaneously. All 90 patients also underwent coronary angiography within 1 month of the exercise test. We found that exercise thallium SPECT had a significantly higher diagnostic accuracy than either the ST/HT slope or conventional S-T segment criteria (thallium imaging 82%, ST/HR slope 67%, conventional S-T segment criteria 63%). The overall accuracy of the ST/HR slope was slightly but insignificantly greater than conventional S-T segment criteria (ST/HR slope 67%, conventional S-T segment criteria 63%; p = 0.639). In 50 patients with a lower exercise level, defined as not achieving 85% of their maximal predicted heart rate, the accuracy of the ST/HR slope was insignificantly greater (ST/HR slope 72%, conventional S-T segment criteria 66%; p = 0.517). In 40 patients with adequate exercise, the accuracy rate was the same (60%) for both the ST/HR slope and conventional S-T segment criteria. We conclude that exercise thallium imaging is more accurate than the ST/HR slope in diagnosing coronary artery disease and that the accuracy of the ST/HR slope is marginally better than conventional S-T segment criteria only in patients with a lower exercise level, and not in those with adequate exercise.

HMPAO brain SPECT in acute carbon monoxide poisoning.

UNLABELLED: Technetium-99m-hexamethylpropylene amine oxime (HMPAO) brain images with fanbeam SPECT, in combination with surface three-dimensional display, were used to detect basal ganglion and cerebral cortex anomalies in the acute phase of carbon monoxide (CO) poisoning. METHODS: Ten patients, aged 16-29 yr, with acute CO poisoning and no past history of neurologic disorders were enrolled in this study. After oxygen treatment, all 10 patients were investigated using 99mTc-HMPAO brain images with fanbeam SPECT and surface three-dimensional display. Meanwhile, 6 of 10 patients also received a brain CT scan. RESULTS: CT scan findings were negative in all 6 patients. Fanbeam SPECT demonstrated unilateral or bilateral hypoactivity of basal ganglia in 6 patients. Local hypoactivity anomalies were found in the brain cortex of 7 patients, using surface three-dimensional display of the brain. Only 2 of 10 patients had normal 99mTc-HMPAO brain images. CONCLUSION: This study suggests that, in comparison with traditional brain imaging techniques, 99mTc-HMPAO brain imaging with fanbeam SPECT in combination with surface three-dimensional display is a better tool for early detection of regional cerebral anomalies in acute CO poisoning.

Technetium-99m-HMPAO brain SPECT in Sjögren's syndrome.

UNLABELLED: Technetium-99m-hexamethylpropylene amine oxime (HMPAO) brain images with fanbeam SPECT, in combination with surface three-dimensional display, were used to detect basal ganglion and cerebral cortex anomalies in Sjögren's syndrome patients. METHODS: Forty-eight female Sjögren's syndrome patients with normal brain CT or magnetic resonance imaging findings were enrolled in this study and were investigated using 99mTc-HMPAO brain images with fanbeam SPECT and surface three-dimensional display. These patients were separated into two subgroups. Group 1 consisted of 38 patients with definite neuropsychiatric symptoms/signs and Group 2 consisted of 10 patients without any neuropsychiatric symptoms/signs. RESULTS: Fanbeam SPECT demonstrated unilateral or bilateral hypoactivity of basal ganglia and thalamus in 14% and 0% of patients in Groups 1 and 2, respectively. Using surface three-dimensional display of the brain, local hypoactivity anomalies were found in the brain cortex of 53% and 20% of patients in Groups 1 and 2, respectively. In Group 1 patients, parietal lobes were the most common areas of brain involvement. The cerebellum and thalamus were the least common areas of brain involvement. In Group 2 patients, parietal and temporal lobes were the most common areas of brain involvement. CONCLUSION: This study suggests that 99mTc-HMPAO brain imaging with fanbeam SPECT, in combination with surface three-dimensional display, is a sensitive tool for detecting regional cerebral anomalies in Sjögren's syndrome patients with and without neuropsychiatric symptoms/signs.

Assessment of coronary artery disease in women by dobutamine stress echocardiography: comparison with stress thallium-201 single-photon emission computed tomography and exercise electrocardiography.

BACKGROUND: Dobutamine stress echocardiography (DSE) is sensitive and specific in detecting myocardial ischemia of male patients. However, there have been few reports about the use of DSE for the detection of coronary artery disease (CAD) in women. METHODS: DSE was evaluated in 51 consecutive women who underwent concomitant quantitative coronary angiography. Forty-four of the 51 patients received stress thallium-201 single-photon emission computed tomography (SPECT), and 30 of the 51 patients had interpretable results (exercise level > or = 85% of age-predicted maximal heart rate) of treadmill exercise. Twenty-nine patients had angiographically documented CAD defined as > or = 50% diameter stenosis. RESULTS: The overall sensitivity of DSE and stress 201Tl SPECT in detecting CAD was 93% and 79% (p = nonsignificant), and the specificity was 82% and 75% (p = nonsignificant), respectively. A combination of both tests increased the sensitivity (96%) at the expense of some decrease in specificity (60%). The agreement of DSE and 201Tl SPECT was 68% (30 of 44; kappa statistic = 0.35; p < 0.0001). The overall sensitivity, specificity, and accuracy in detecting CAD by treadmill exercise test and DSE were 71% vs 93% (p = nonsignificant), 44% vs 82% (p = 0.036), and 57% vs 88% (p = 0.003). In patients with abnormal results of treadmill exercise testing, the false-positive rate in detecting CAD was 2 (18%) of 11 in patients with abnormal results of DSE and 7 (88%) of 8 in those with normal results of DSE (p = 0.005). In patients with normal results of treadmill exercise testing, the false-negative rate in detecting CAD was 4 (100%) of 4 in patients with abnormal results of DSE and 0 (0%) of 7 in those with normal results of DSE (p = 0.003). CONCLUSION: The diagnostic accuracy of DSE was similar to that of stress 201Tl SPECT in women. DSE was able to stratify female patients with either abnormal or normal results of treadmill exercise testing and to avoid unnecessary cardiac catheterization.