The impact of 123I-meta-iodobenzylguanidine scintigraphy on diagnostics and follow-up of neuroblastoma.

The present retrospective study includes all children suspected for having neuroblastoma, admitted to Odense University Hospital in September 1984 through December 1993. Thirty-six children at the age range of 1 month to 14 years and 10 month were investigated with 123I-metaiodobenzylguanidine (MIBG). Nineteen children had histologically verified neuroblastoma. Several MIBG scintigraphic examinations were made in all but one of these 19 children. Positive MIBG scintigraphy strengthened the diagnosis and indicated the volume and location of the tumour at diagnosis and during the treatment period. In a few patients only there was some disagreement between results obtained with MIBG scintigraphy and standard investigations as CT-scanning or ultrasonography. MIBG scintigraphy in all cases turned out to be the most sensitive modality.

[99mTc anti-carcinoembryonic antigen in colorectal cancer]. / 99mTc-anti-karcinoembryonalt antigen ved kolorektal cancer.

This investigation is a part of a phase three multicentre immunoscintigraphy study of a technetium-99m labelled monoclonal antibody (Mab), BW 431/26, directed against carcino-embryonic antigen (CEA). Ten patients with recently colonoscopically verified primary colorectal cancer were evaluated. In nine of ten patients colorectal cancers were detected by wholebody immunoscintigraphy and by single photon emission computerized tomography (SPECT). The ten patients were operated upon, and in nine cases immunohistochemical investigations were performed. Immunohistochemical investigation of nine tumour specimens show that CEA was present in much higher concentrations in the tumour than in normal intestinal epithelium. Active accumulation of the labelled Mab in tumours was demonstrated by scintimetry. There is a demand for new diagnostic techniques for early diagnosis of colo-rectal cancer. Immunoscintigraphy must however compete with other diagnostic possibilities. The development of immunoscintigraphic technique is proceeding very rapidly, and there is probably a future for the use of immunological methods in diagnosis and therapy of cancer.

Gastrointestinal accumulation of indium-111 labelled granulocytes in reactive arthritis.

Six patients with reactive arthritis (ReA) were examined for gastrointestinal accumulation of Indium-111 labelled granulocytes. Abnormal scintigrams were found in three of six patients all of which showed early (less than 4 h) accumulation of indium-111 labelled granulocytes which may represent small intestinal inflammation. Our findings may indicate that the small intestine is involved in ReA, and that indium-111 granulocyte scintigraphy is a useful method for demonstrating inflammatory changes in the small intestine in reactive arthritis (ReA).

Indium-111-granulocyte scintigraphy in brain abscess diagnosis: limitations and pitfalls.

The scintigrams and records of 28 patients referred for indium-111-granulocyte scintigraphy (111In-GS) because of a suspected brain abscess were studied retrospectively. The final diagnosis was brain abscess in 8 patients, brain tumor in 18 patients, and infarct and hematoma in 1 patient each. Five patients not on corticosteroid treatment showed intense focal 111In accumulation in abscesses, whereas an abscess patient receiving a high steroid dose showed no uptake. Two patients studied twice showed intense uptake in abscesses when not on steroid therapy or on a low dose, whereas no uptake was seen when they received high or medium doses. Weak or moderate 111In uptake was observed in nine tumors. Microscopically assessed degree of tumor granulocyte infiltration, vessel proliferation, and hemorrhage did not correlate with the outcome of 111In GS. Our results suggest that intense focal cerebral 111In uptake favors the abscess diagnosis. Abscesses may go undetected, however, in patients on high- or medium-dose steroid therapy.

57Co-bleomycin scintigraphy for the preoperative detection and staging of lung tumors.

Twenty-five consecutive patients with lung tumors were classified according to the presence of metastases by the use of 57Co-Bleomycin scintigraphy. Twenty-two of the tumors were visualized but metastatic spread to hilar lymph nodes was not detected. Reliable separation of central tumors with and without growth into neighbouring organs was not possible. Mediastinal uptake was found in eight cases but only a part of these could be verified by operation. The method can contribute to the evaluation of lung tumors and can be helpful to avoid some unnecessary thoracotomies.

Accumulation of indium-111-labeled granulocytes in malignant tumors.

In a retrospective study of 220 [111In]granulocyte scintigrams from 208 patients, 25 patients had malignant neoplasms. Among these, tumor uptake of 111In activity was observed in ten patients (intense activity in two patients with non-Hodgkin's lymphoma and colonic carcinoma, respectively; moderate uptake in a patient with non-Hodgkin's lymphoma, and in a patient with an ovarian carcinoma; weak activity in three patients with cerebral neoplasms; and activity within otherwise "cold" metastatic lesions of the liver in three patients). Microscopic investigation following specific granulocyte staining revealed the greatest extent of granulocyte infiltration in the tumors which took up 111In activity, emphasizing the importance of tumor granulocyte infiltration as the single most important factor underlying tumor accumulation of 111In activity during [111In]granulocyte scintigraphy.

Analysis of factors that may affect the speed of accumulation of 111In-labelled granulocytes at sites of inflammation.

The mechanisms governing the accumulation of granulocytes in inflammatory lesions are poorly understood. Using a sensitive method of sequential 111In-granulocyte scintigraphy, we recorded the speed of focal 111In-granulocyte accumulation in 70 patients with non-osseous inflammatory and infectious foci, with special reference to the influence exerted by the duration of disease, patient age, body temperature, antibiotic therapy and initial trapping of granulocytes in the lungs. About 50% of the images had turned positive at 30 min after injection. Except for patients with urinary tract infections, the age of the patient did not influence the speed of 111In-granulocyte accumulation; nor did the duration of disease, antibiotic therapy or degree of initial granulocyte hold-up in the lungs. High fever, on the other hand, presumably reflecting an intense inflammatory reaction, was associated with an accelerated focal 111In-granulocyte accumulation, indicating that properties of the inflammatory process per se are major determinants of the speed of accumulation of 111In-labelled granulocytes in inflammatory processes.

Experience with microlymphaticovenous anastomoses for congenital and acquired lymphoedema.

Ten unselected, consecutive patients were operated upon for lymphoedema of a limb. In order to evaluate the effect of microlymphaticovenous anastomoses no conservative treatments were used concomitantly. Seven patients had some relief of symptoms postoperatively, while six patients had a decrease in limb circumference. Three patients with primary lymphoedema had no effect of this treatment. Lymphoscintigraphy is advocated as an aid to the selection of suitable cases for microsurgery. Our future indications for microlymphaticovenous surgery for lymphoedema will be limited to patients with secondary lymphoedema with a duration of less than five years. The disease will be diagnosed by clinical examination as well as by lymphoscintigraphy.

Diagnosis and treatment of neuroblastoma using metaiodobenzylguanidine.

Neuroblastoma is a lethal and not uncommon tumor in childhood. Early detection and display of the spread of the tumor is highly desirable for proper treatment. Nine children suspected of having neuroblastomas were examined by I-131 metaiodobenzylguanidine (I-131 MIBG) imaging. In two recent studies I-123 metaiodobenzylguanidine (I-123 MIBG) was used. A primary adrenal neuroblastoma was correctly identified in three cases. In two patients additional tumor sites were found. In one patient, who was in complete remission, no pathologic accumulation of I-131 MIBG was found. I-131 MIBG images were also normal in four patients with other types of neoplastic diseases. A boy with multiple metastases was treated with 100 mCi of I-131 MIBG. He developed transient gastrointestinal illness and there was no regression of the tumor deposits. In one girl with a large adrenal neuroblastoma high uptake of I-131 MIBG was observed. She received two therapy doses of I-131 MIBG (35 mCi and 75 mCi) with curative intention giving a total absorbed dose in the tumor of approximately 76 Gy. In spite of high retention of radioactivity in the tumor, regression did not occur, but her general condition was improved. In the present study, images of superior quality were obtained with I-123 MIBG imaging. It is concluded that imaging using I-131 MIBG or I-123 MIBG should be used in both the initial evaluation and the follow-up of children with neuroblastoma.

Speed of accumulation of 111In-labelled granulocytes in focal non-osseous inflammatory processes.

Using a method of 111In-oxine granulocyte labelling in diluted plasma, we performed 162 scintigraphic studies in 159 patients with suspected non-osseous infection. We obtained a positive predictive value of 82%, and a negative predictive value of 97%, i.e. the method is very sensitive, albeit less specific. Sequential imaging showed around 50% of the scintigrams to turn positive at 30 min after the injection, the most rapid accumulation being seen in cases of superficial soft tissue infections and in pulmonary and pleural infections, cerebral abscesses showing a rather sluggish accretion of activity, urinary tract infections, abdominal abscesses and bowel inflammation accumulating activity at an intermediate rate. Our results indicate that the described method is sensitive, and that the sequential scintigraphic approach allows an early diagnosis in most cases, and facilitates the interpretation of delayed scans.

The place of 57Co-bleomycin in the evaluation of tumours.

162 patients were investigated by 57Co-bleomycin scintigraphy. 62 of these patients were also studied with 67Ga. 142 were suspected for malignant neoplastic disease, 20 for a focal inflammatory process. Good visualization with 57Co-bleomycin was obtained in 75% of malignant tumours and in 66% with 67Ga. Most of the patients were studied for abdominal disease and in this region 57Co-bleomycin was found to be qualitatively superior to 67Ga. The principal advantage of 57Co-bleomycin is a very low tissue background specially concerning the bowel. Neither 57Co-bleomycin nor 67Ga are tumour-specific. Both radiopharmaceuticals are taken up by inflammatory processes. This is a disadvantage in tumour diagnostics but the radionuclides can be useful for localizing inflammatory foci. The possibilities of studying the localisation of radionuclides at the cellular level will be discussed.

Gamma camera scintigraphy in the diagnosis of lymphocele following renal transplantation.

The symptoms and diagnosis of perirenal lymphocele following kidney transplantation are discussed. A case demonstrated by means of i.v. urography and gamma camera scintigraphy is reported. The value of the last mentioned method is stressed.

Placenta scintigraphy using markers of the uterine cervix and pelvic skeleton.

A method of placenta scintigraphy is described which provides a differential diagnosis between total and marginal placenta praevia. The uterine cervix, symphysis and 5th lumbar vertebra are included on the scintigram by means of atraumatic markers. Of 101 examined patients 6 had total placenta praevia and 12 marginal placenta praevia. No incorrect evaluation of the scans or complications occurred. The examination supplements ultrasound scanning in late pregnancy.

The diagnosis of urinary extravasation using gammacamera scintigraphy.

Gammacamera scintigraphy studies in three patients with urinary extravasation following renal transplantation are presented. Images were obtained using 131I-orthoiodohippurate. Urinary leakage were detected in each case. The diagnosis were in all three cases confirmed at surgery.