[Digital subtraction angiography in oncologic diagnosis]. / Die digitale Subtraktionsangiographie in der onkologischen Diagnostik.

Digital subtraction angiography has become a safe, accurate and reproducible means of evaluating the vascular system. It offers the possibility of obtaining high quality vascular images at very low intravascular iodine concentrations. In oncology, digital subtraction angiography is performed in preoperative visualization of the vascular supply of tumours, in planning and control of liver-port-systems and evaluation of complications following radiation therapy or chemotherapeutic measures. DSA has widely replaced film angiography in vascular imaging.

[Computed tomography in follow-up of differentiated thyroid carcinoma]. / Computertomographie in der Nachsorge des differenzierten Schilddrüsenkarzinoms.

The importance of computed tomography in follow-up aftercare and therapy planning in differentiated carcinoma of the thyroid is examined on the basis of the authors' experiences in a group of about 600 patients. The individual indication ranges are discussed and demonstrated by means of examples.

[Radioiodine therapy of differentiated thyroid cancer. 10-year results of a standardized therapy in 269 patients]. / Die Radiojodtherapie des differenzierten Schilddrüsenkarzinoms. 10-Jahres-Ergebnisse einer standardisierten Therapie bei 269 Patienten.

Between 1969 and 1977, 269 patients submitted to thyroidectomy were treated exclusively with radioiodine according to a standardized irradiation scheme. The patients were observed during thirteen years. 195 patients were free of metastases at the time of the first therapy, whereas 74 patients had lymph node metastases or remote metastases. The survival rates of the total group were 89% (five years) and 76% (10 years), respectively. Patients with regional lymph node metastases had a ten-year survival rate of 74%. The fourty patients suffering from remote metastases had a five-year survival rate of 75% and a ten-year survival rate of 40%. Patients who were in stage T3 at the moment of diagnosis had a survival probability of 74% for five years and of 59% for eight years. None of these patients presented with remote metastases during the follow-up period. Taking into consideration these results and the small rate of complications, we are of the opinion that a routine combination therapy with external post-irradiation is not necessary.

Scintigraphy of a neuroblastoma with I-131 meta-iodobenzylguanidine.

Radioiodinated m-iodobenzylguanidine has been applied mainly for the diagnosis of pheochromocytoma and blastoma. In this paper we show that an ontogenetically related tumor, the neuroblastoma, is also scintigraphically visualized by its high uptake of I-131 MIBG. Because of the kinetic findings and the high uptake of more than 30% of the injected activity, it is likely that the neuroblastoma, by analogy with pheochromocytoma, is susceptible to specific radionuclide therapy.

[Long-term observation of 15 patients with differentiated thyroid cancer and elevated plasma thyroglobulin levels of unclear origin]. / Langzeitbeobachtung bei 15 Patienten mit differenziertem Schilddrüsenkarzinom und unklar erhöhten Plasmathyreoglobulinspiegeln (Tg).

The follow-up of 15 patients with differentiated cancer of the thyroid was analysed retrospectively. All patients had persistent or developed elevated thyroglobulin (Tg) plasma levels (greater than 10 ng/ml) after total thyroidectomy and 131 I therapy. There was no evidence of thyroid remnants or metastases in the 131 I whole body scan, bone scan, chest X-ray or clinical investigation. Nine of 15 patients developed local or distant metastases during a follow-up period of 3-39 months (mean = 18 months). Only one of seven recurrences tested were 131 I positive, Tg values of 9 from 12 patients showed no correlation to the Thyroid-stimulating hormone (TSH) level. It is concluded that: (1) this group of patients is at high risk of developing a recurrence (2) new methods have to be developed for the localization of 131 I negative but Tg positive metastases.

[Nuclear medicine diagnosis of malignant lymphomas]. / Nuklearmedizinische Diagnostik bei malignen Lymphomen.

Non-invasive and hazard-free methods for diagnosing malignant lymphomas are represented by scintigraphy with gallium 67 and by lymphoscintigraphy, especially of the retroperitoneum. These methods are particularly suitable for closely following up the course of the disease. In this article, radiopharmacology, pharmacokinetics and techniques of examination associated with these methods, are described, and typical findings are demonstrated by means of clinical case examples. Attention is also paid to radiation exposure load. The ranking of these methods within the framework of x-ray diagnostics, is also discussed.

A comparison of the effectiveness of 131I whole body scans and plasma Tg determinations in the diagnosis of metastatic differentiated carcinoma of the thyroid: a retrospective study.

In 68 patients with proved metastases of differentiated thyroid carcinoma the comparative value of the 131I whole body scan and plasma Tg measurements in establishing the diagnosis of metastasis or recurrence was analyzed retrospectively. At the time of primary therapy most metastases were diagnosed by the post-therapy scan (78%). Eight of 9 scintigraphic negative metastases in the post-therapy scan were indicated by elevated Tg levels (greater than 10 ng/ml). Twenty-four of 28 recurrences after a disease free interval were negative in the 2 mCi 131I scan, 18 of these patients were Tg positive. Of the 4 recurrences with positive 131I uptake all were Tg positive; two of them only during endogenous TSH stimulation. It is concluded that the routine 2 mCi whole body scan is less efficient in follow-up than is generally assumed. The most important follow-up parameter for these patients is the plasma Tg which can be obtained under suppressive therapy if a sensitive assay is used. In patients with a negative post-therapy scan and a negative Tg (less than 5 ng/ml) it seems justified to omit further 131I whole body control scans as long as Tg remains negative.

Disposition of human fibrinopeptide A in normal and nephrectomized rabbits.

The distribution, elimination, and metabolism of human fibrinopeptide A (FPA) were studied in normal and nephrectomized rabbits. The activity of 125-I-labeled desamino-tyrosyl human FPA (DAT-FPA) was followed over 4 hours after i.v. administration. Results show that in normal rabbits (n = 10) DAT-FPA is eliminated from plasma in four phases with half-lives of 30 sec, 3.5 min, 15 min, and 90 min. The distribution of 123-I-labeled DAT-FPA in plasma was determined in 15 control rabbits with scintigraphy over 2 hours. DAT-FPA was distributed primarily in the cardiovascular system, liver, and kidneys. In some animals minimal radioactivity was detected over the gall bladder. Radioactivity accumulated rapidly in the urinary bladder, approximately 50% being recorded after 15 min and 90% after 120 min. In the heart area radioactivity decreased with half-lives of 25 sec, 7.5 min, 25 min, and 180 min. Nephrectomized rabbits had similar initial fast distribution of DAT-FPA after administration of 125-I-labeled (n = 10) and 123-I-labeled peptide (n = 10). The estimated half-life of the slow component was in the order of several hours. The results of the scintigraphic and gel chromatographic studies show that FPA is primarily excreted in the urine. Previously reported half-lives of FPA reflect distribution rather than steady state conditions.

[Angio-CT: an improvement in the diagnosis of malignant liver diseases]. / Angio-CT: Eine Erweiterung der Diagnostik maligner Leberprozesse.

Dynamic contrast studies of the liver make it possible to evaluate the vascularity of liver metastases. Up to the present, the examination has only been carried out in single planes, whereas studies of the whole of the liver during one examination have not yet been published. This can be obtained by performing sequential CT (angio-CT), using special software. A clinical study of the value of the procedure has been undertaken on 64 patients with suspected liver metastases. In addition to the plain scans, the examination was repeated during the early phase of a bolus injection and subsequently ten minutes after injection (enhancement). The various structures which can be seen are described and the changes in density patterns have been interpreted according to contrast kinetics derived from nephrographic examinations. The advantages of angio-CT as compared with plain films and with scans after normal contrast infusions are described. The improved sensitivity and specificity obtained by using the three modes of examination, as compared with a single examination, is stressed.

[Diagnostic value of 131I-whole body scintigraphy in the after care of differentiated thyroid cancer]. / Diagnostischer Wert des 131J-Ganzkörperszintigramms in der Nachsorge des differenzierten Schilddrüsenkarzinoms.

The value of scintiscanning after treatment and of routine control scanning in differentiated thyroid carcinoma was evaluated in a retrospective study for the diagnosis of metastases and recurrencies. Scintigrams after treatment detected 76% of all metastases at the time of primary treatment. In contrast, only 4 (18%) out of 22 late relapses were positive in the radioiodo-scintigram. Three of these had been diagnosed earlier already on clinical grounds. Thus, routine whole-body scintigrams using 2 mCi 131I for the after-care of differentiated thyroid carcinoma is without relevant benefit for patients, and certainly not if an aggressive treatment concept has been followed from the beginning. Whole-body scintigraphy should be used only in exceptional cases. Follow-up care should be based on regular thyreoglobulin assessment using a sensitive and controlled method.

[Nuclear medicine therapy of bone metastases]. / Nuklearmedizinische Therapie von Knochenmetastasen.

The osteotropic radionuclides 89Sr and 32P are now mainly used in the treatment of bone metastases. This therapy is palliative and is mainly directed at alleviating pain. The indications, procedure, treatment result and side effects are described as discussed. Bone metastases of iodinophilous thyroid carcinomas represent a special case. These can be treated selectively with 131I. However, complete regression of the tumour by means of radioactive iodine is only rarely achieved in bone metastases. Nevertheless, the complaints and symptoms are definitely alleviated even with relatively small radiation doses, similar to the therapy employing strontium.

[Radiologic diagnosis of bone metastases]. / Radiologische Diagnostik von Knochenmetastasen.

Radiological diagnosis of bone metastases comprises multifarious examinations of varying diagnostic value. The incidence and topography of osseous metastases, as well as the x-ray morphological pattern, are described and the ranking of the various radiological methods discussed in detail. The diagnostic procedure to be followed in osseous metastases is explained on the basis of clinical examples, and the value of the individual methods in assessing the therapeutic effect is subjected to critical evaluation.

[ACTH-altered adrenal cortical uptake of the radioiodinated 11 beta-hydroxylase inhibitor (L)-SKF 12185]. / ACTH-alterierte Nebennierenrindenanreicherung des radiojodierten 11 beta-Hydroxylaseinhibitors (L)-SKF 12185.

(L)-SKF 12185, a reversible inhibitor of the enzyme 11 beta-hydroxylase, can, if radioiodinated, be used for the scintigraphic imaging of the adrenal cortex. An increased uptake of 131I-(L)-SKF 12185 was observed therein 2-3 hrs after ACTH stimulation. This effect can be explained by the steroid neogenesis induced by ACTH stimulation and the activation of the required enzymes connected therewith. The inhibitor attaches competitively with the relevant substrates to the free enzyme binding sites and produces an enhanced adrenal uptake. Thus ACTH stimulation increased the 3 hr uptake by 69% whereas the 24 hr uptake which, because of its relatively high adrenal/liver ratio, is more useful in the scintigraphic imaging of the adrenals, could not be improved significantly.

[Gc subtypes: demonstration using isoelectric focusing. Study of population and formal genetics]. / Die Gc-Subtypen: Darstellung mittels isoelektrischer Fokussierung. Studie zur Populations- und Formalgenetik.

Gc-subtypes were determined by isoelectric focusing and immunfixation on samples from 492 unrelated blood donors from Berlin. The frequency of the three genes was found to be GcIF = 0.1270, GcIS = 0.6006, Gc2 = 0.2724. Analysis of 78 parents with 190 children did not show deviations from the expected mode of inheritance. Investigation of the adults from paternity cases and of their children on the other hand obtained similar results. No rare alleles were observed.

Noninvasive assessment of myocardial contractility in asymptomatic patients with sever aortic regurgitation and normal left ventricular ejection fraction at rest.

In 14 asymptomatic patients with isolated aortic insufficiency the slope k of the end-systolic pressure-volume relation was determined noninvasively with equilibrium radionuclide angiography. The results were compared with changes in left ventricular ejection fraction during maximal physical stress. Nine normal volunteers served as a control group. Patients with aortic insufficiency did not differ significantly from the control group with respect to left ventricular ejection fraction at rest (aortic insufficiency 62 + 8 percent, control 65 +/- 6; probability [p] = not significant [NS]), physical work capacity (aortic insufficiency 113 +/- 32 watts, control 117 +/- 25; p = NS) or age (aortic insufficiency 40 +/- 10 years, control 47 +/- 7; p = NS). The slope (k) of the end-systolic pressure-volume relation was found to be significantly lower in the group with aortic insufficiency (3.1 +/- 1.1) than in the control group (4.1 +/- 0.5; p less than 0.05). Patients with aortic insufficiency could be classified into two subgroups with respect to the slope k. In subgroup A (n = 7) the slope fell within the normal range (4.0 +/- 0.6) as defined by the control group, and the left ventricular exercise reserve was normal (6 percent +/- 1). In subgroup B (n = 7) the slope was significantly lower (2.2 +/- 0.6, p less than 0.01), indicating depressed myocardial contractility, and all patients experienced left ventricular dysfunction during exercise (left ventricular exercise reserve -5 +/- 5 percent). Thus, noninvasive determination of the end-systolic pressure-volume relation identified two subsets of asymptomatic patients with aortic insufficiency, one with impaired myocardial contractility and normal left ventricular exercise reserve and a second group with depressed myocardial contractility and left ventricular dysfunction during exercise. Therefore, an abnormal baseline contractile state in asymptomatic patients with aortic insufficiency may be uncovered by noninvasive determination of the end-systolic pressure-volume relation or by assessing the left ventricular exercise reserve. Serial studies in a larger group of patients undergoing surgical correction of the valve lesion are indicated to determine whether this information will be helpful in evaluating when to operate on asymptomatic patients with aortic insufficiency.