Lingual thyroid: diagnosis using a hybrid of single photon emission computed tomography and standard computed tomography.

AIM: To present a rare case of lingual thyroid detected using a hybrid of single photon emission computed tomography and standard computed tomography in a young woman with hypothyroidism. MATERIALS AND METHODS: A 29-year-old woman was screened for autoimmune thyroid disorders in early pregnancy, and found to have subclinical hypothyroidism. No thyroid tissue was found in the anterior neck upon ultrasonography, raising suspicions of an ectopic thyroid. The patient was treated with levothyroxine throughout the remainder of her pregnancy, and developed postpartum thyroiditis requiring an increase in levothyroxine dosage. Whole-body scintigraphy and zoomed static head and neck scintigraphy were performed. Abnormal 99mTc-pertechnetate uptake was observed in the oral region, whereas no uptake was found in the usual thyroid location. Hybrid imaging using single photon emission computed tomography and standard computed tomography was performed to improve three-dimensional representation of the area of increased activity. RESULTS: The latter imaging modality detected ectopic thyroid tissue in the tongue. CONCLUSION: Whole body 99mTc-pertechnetate scintigraphy and a hybrid of single photon emission computed tomography and standard computed tomography are effective imaging modalities for the investigation of ectopic thyroid tissue. The latter modality is particularly recommended, as it allows more precise spatial visualisation of increased isotope uptake activity in the head and neck.

Experiences with detection of the ectopic gastric mucosa by means of Tc-99m pertechnetate disodium scintigraphy in children with lower gastrointestinal bleeding.

AIM AND BACKGROUND: We report our experience of the detection of ectopic gastric mucosa by means of perfusion Tc-99m pertechnetate disodium scintigraphy in patients with lower gastrointestinal bleeding. Gastric mucosa may be present in Meckel's diverticulum and is associated with peptic ulcer disease and lower gastrointestinal (GI) bleeding; Tc-99m pertechnetate scintigraphy can help to make the diagnosis of ectopic gastric mucosa. PATIENTS AND METHOD: Seventy-nine children (40 boys, 39 girls, aged 1 - 17, mean age 8 years) underwent Tc-99m pertechnetate scintigraphy in the last thirteen years. All patients had melena or hematochezia. Morphology imaging and endoscopy were negative in all patients. Dynamic scintigraphy of the abdomen was started immediately after i. v. administration of Tc-99m pertechnetate. The static image of the abdomen was performed subsequently. Where necessary, SPECT was additionally performed to improve the sensitivity, specificity and spatial specification. RESULTS: Three patients (two boys: two and ten years old; one girl: four years old) had positive scintigraphy results. All 3 patients underwent surgery and Meckel's diverticulum with ectopic gastric mucosa found (histology). GI bleeding stopped spontaneously in patients with a negative scintigraphy. These patients did not undergo intraoperative enteroscopy or surgery. CONCLUSION: Tc-99m pertechnetate scintigraphy can help to detect ectopic gastric mucosa in the abdomen and improve the management of patients with lower gastrointestinal bleeding.

Prospective evaluation of samarium-153-EDTMP radionuclide treatment for bone metastases in patients with hormone-refractory prostate cancer.

PURPOSE: Bone is a common site of metastatic disease and the most frequent site of metastatic spread in patients with prostate cancer. Most patients with bone metastases complain of bone pains. This pain may be alleviated or eliminated by administration of radiotherapy at the site of metastases. Currently, two forms of radiotherapy administration exist: external-beam irradiation or intravenous administration of bone-seeking therapeutic radiopharmacon such as samarium-153-ethylene-diamino-tetramethylene-phosphonate (EDTMP). This radiopharmacon produces beta-particles and concentrates in the areas of enhanced osteoblastic activity. The aim of this study was to assess the efficacy of (153)Sm-EDTMP therapy. MATERIALS AND METHODS: 32 men (aged 50-83, mean 70 years) with bone disseminated hormone-refractory prostate cancer and bone pain received (153)Sm-EDTMP. Mean applied dosage was 40 MBq/kg of the patient's body weight. Karnofsky performance status, pain score (numerical rating scale), analgesic score (WHO) and blood count were evaluated before, and 1 and 3 months after the treatment. RESULTS: Significant pain relief was observed in 44 and 38% of patients, mild relief in 31 and 34% and no effect in 25 and 28% of patients, 1 and 3 months after administration, respectively. Pain palliation was accompanied by an improvement in mobility and a decrease in necessary dosage of analgesics. Mild and transient bone marrow suppression was observed as a side effect of (153)Sm-EDTMP treatment. None of the patients showed hematological toxicity grade 4, and only 2 showed grade 3 (NCI CTC). The majority of the patients had hematological toxicity grade 1 or 2. CONCLUSION: After (153)Sm-EDTMP administration, bone pain palliation was observed in 72% of patients for 3 months. Hematological toxicity after (153)Sm-EDTMP treatment was mild and transient.

Immunoscintigraphy and intra-operative radioimmunodetection in the treatment of colorectal carcinoma.

PURPOSE: Intra-operative radioimmunodetection of malignant involved lymph nodes follows the pre-operative immunoscintigraphy in the treatment of patients with colorectal carcinoma. The aims of this clinical study were to determine the sensitivity of the method, to compare the results in study when using Oncoscint and CEA-Scan and to evaluate the importance of the method of surgery and postoperative adjuvant therapy. PATIENTS AND METHODS: 121 patients with colorectal tumours (106 primary and 15 recurrent) were operated on using radioimmunoguided surgery (RIGS). The study compared results of pre-operative immunoscintigraphy, intra-operative radioimmunodetection and postoperative histological examination. Histological investigation used classical H&E staining. In histologically negative and RIGS positive cases the immunohistochemical investigation was supplemented. Two radiopharmaceuticals were used Oncoscint CR 103 (MAb B72.3, Satumomab Pendetide), labelled with 111In in 56 patients and CEA-Scan (IMMU 4-Fab' fragments MAb against CEA, Arcitumomab), labelled with 99mTc in 65 patients. RESULTS: The relationship between RIGS positive results and histological examination was statistically assessed after 38 operations and the most acceptable RIGS evaluating index was determined. All subsequent results were evaluated by this index. Immunoscintigraphy of tumour was positive in 112 cases (92.6%). Fifty-five RIGS positive cases of malignant infiltrated lymph nodes were confirmed by 43 histologically positive examinations (78%). In this group 9 cases were discovered only by immunohistochemistry. Sixty-six remaining RIGS negative results were confirmed in 62 (94%) cases by negative histology. CONCLUSIONS: Both immunoscintigraphy and RIGS enable one to make a more accurate diagnosis. While treating the primary disease the use of RIGS may help in assessment of necessary extent of operation performance and in staging of the disease by revealing occult lymph nodes involved. Pre-operative immunoscintigraphy seems to be a useful diagnostic method for detection of tumour recurrence. When comparing two radiopharmaceuticals used, CEA-Scan seems to be more suitable for diagnostic studies, but using the Oncoscint for tumour recurrence detection had some specific benefit, too.

[Hexakis, (t-butylisonitryl/technetium, 99mTc-TBI), a cold-focal cardiac radiopharmaceutic agent and its distribution in the body]. / Studenoloziskové srdecní radiofarmakon Hexakis (t-Butylisonitryl/Technetium (99mTc-TBI) a jeho distribuce v organismu.

The distribution of coldfocal cardiopharmacological substance 99mTc-TBI has been studied on a total of 14 dogs in relation to the healthy heart tissue. The quality heart scan resulted from the use of 99mTc-TBI. It may be performed 30 min after the administration of mentioned substance, when its blood activity is smaller than 10% activity of myocardium From the other organs, the myocardium scan may be influenced negatively with only liver which achieves 200% activity of left heart ventricle what is evidently consequential in worse imaging of "lower" ischemic lesions. These results justify us to conclude that the 99mTc-TBI is a substance suitable for scintigraphical imaging of myocardium.

99mTc-aminohexylidendiphosphonate and 99mTc-pyrophosphate in the scintigraphic diagnosis of experimental myocardial infarction in dogs.

99mTc-aminohexylidendiphosphonate (99mTc-AHDP) is a new Czechoslovak pharmaceutical of the phosphonate line which contains the amino group NH2 in its molecule. This substance was tested in 5 dogs with experimentally provoked 48-h old myocardial infarction. The in-vivo scan and the radioactivity of tissue samples demonstrated that 99mTc-AHDP is as suitable for imaging acute myocardial infarction as is the commonly used 99mTc-pyrophosphate.

99mTc-aminohexylidendiphosphonate and 99mTc-pyrophosphate in the scintigraphic diagnosis of experimental cardiomyopathy in dogs.

Experimental cardiomyopathy was provoked in 24 dogs with high intravenous doses of adrenaline and theophylline. These lesions were studied by means of the new agent 99mTc-AHDP and 99mTc-PYP in comparison. Cardiomyopathy could be imaged as early as 4 h after the onset of involvement but not later than 7 days. A maximum accumulation occurred in lesions 24 h old. 99mTc uptake in the myocardium was graded scintigraphically. 99mTc-AHDP was accumulated in the altered myocardium to a greater extent than 99mTc-PYP. Scintigraphic findings were in good agreement with plasma levels of creatine-kinase. A comparison with histology demonstrated that the maximum accumulation of radiopharmaceuticals occurred at the time when the development of myocardium involvement reached the stage of myocytolysis.

Pyrophosphate scintigraphy and other non-invasive methods in the detection of cardiac involvement in some systemic connective tissue diseases.

Thirteen patients with systemic lupus erythematosus, 8 patients with polymyositis, and 6 patients with spondylitis ankylopoetica (Bechterew's disease) underwent clinical cardiologic examination and scintigraphy of the myocardium (99mTc-pyrophosphate), ECG, echocardiography, polygraphy, and their blood pressure was taken. The aim of the study was to ascertain how such a combination of non-invasive examinations can help in recognizing a cardiac involvement. In systemic lupus erythematosus cases one or more positive findings were revealed in 9 patients (69%), in 4 patients all examinations were negative (31%). Four patients (50%) with polymyositis had positive findings. In patients with spondylitis ankylopoetica positive findings occurred in 2 cases (33%). The study has shown that a combination of non-invasive cardiologic methods increases the probability of detecting cardiac involvement in systemic connective tissue diseases.

Scintigraphic detection of experimental myocardial infarction with 99mTc-heparin in the dog.

Experimental infarctions were produced in 12 dogs by ligation of the Ramus interventricularis anterior of the left coronary artery, and their uptake of 99mTc-heparin was measured 7, 24 and 48 h as well as 7 days thereafter by recording an in vivo chest scintigram 4 h after intravenous injection of the compound. The dogs were subsequently killed, the heart removed and an in vitro scintigram obtained. Finally, the uptake of the compound was measured in tissue samples. The results indicate that 99mTc-heparin is accumulated in lesions which are not older than 24 h. At the other points in time uptake is low but even 24-h old lesions cannot be demonstrated reliably. The results are impaired by the high blood activity on the cardiac chambers and by the background activity of the lungs. In general, 99mTc-heparin has less useful properties than the more frequently employed 99mTc-pyrophosphate so that a change of procedure is not to be recommended.

The pyrophosphate heart scintigram in children with progressive muscular dystrophy.

A pyrophosphate heart scintigram was obtained in 16 boys with progressive muscular dystrophy Duchenne. All of them showed pathological ECG findings and high plasma levels of CK, AST, ALT and LD. In 4 patients the scintigram was distinctly positive and in further 3 it reached borderline values. The remaining 9 boys had normal scintigraphic findings. Those with a positive heart scintigram had very high plasma levels of the enzymes under study which was suggestive of current progression of the disease. There was, however, no relation between heart scintigraphy and the affliction of the skeletal muscles expressed by means of an index.

Scintigraphic myocardial imaging with 99mTc-labelled gluconate of experimentally produced cardiomyopathy in dogs.

In 10 dogs experimental cardiomyopathy was produced using high intravenous doses of adrenaline and theophylline. The possibility of scintigraphic detection of this non-ischaemic damage was tested by means of 99mTc-gluconate. In 5 dogs the scintigraphic examination was carried out 4 hrs following the production of the damage. In all 5 cases a marked positivity of the heart scan was observed. The finding was confirmed by the radioactivity of tissue samples from all sections of the heart. In 3 out of 5 dogs the histological examination of the myocardium (PAS and HBFP staining) was positive. In the remaining 5 dogs the scan was performed 24 hrs following the development of the damage. A positive scintigraphic finding was observed in 4 cases, the degree of accumulation being lower than at 4 hrs. The radioactivities of tissue samples were also significantly lower as compared with the 4-hr values. In contrast, the histological findings were markedly positive in all 5 dogs. It follows that 99mTc-gluconate is capable of detecting in addition to infarctions non-ischaemic damages to the myocardium, too. The normalization of the finding is very quick. This experimental finding appears to be of importance in clinical practice.