Increased bone marrow uptake on Tc-99m DMSA scintigraphy in a patient with renal osteodystrophy

Anxiogenic action of m-chlorophenylpiperazine (mCPP), a 5-HT1C receptor agonist, was studied in naive rats and in ethanol-tolerant rats following withdrawal from chronic ethanol administration. The purpose of this investigation was to determine whether a sensitization to mCPP develops during withdrawal from chronic ethanol. Male Long-Evans hooded rats were fed a liquid diet containing 4.5% ethanol or dextrin (as control) for four days. Twelve hours (acute withdrawal) or 4 days (protracted withdrawal) after the last dose of ethanol, rats were injected with saline or mCPP (0.08-5.0 mg/kg) and were tested in the elevated plus-maze 15 min postinjection. A reduction in percent open-arm activity, indicative of anxiogenic behavior, was observed in ethanol-treated rats injected with saline. Administration of mCPP further reduced the percent open-arm entries and time in ethanol-withdrawn rats. An eightfold reduction in maximum effective dose of mCPP was observed during acute ethanol withdrawal as compared to that in naive rats. During protracted ethanol withdrawal the maximum effective dose of mCPP was reduced by 75%. A shift of the mCPP dose-response curve to the left following withdrawal from chronic ethanol may indicate that 5-HT1C receptor sites are more sensitive to the activation by an agonist. This effect may be exploited in developing specific 5-HT1C receptor antagonists for the treatment of ethanol withdrawal symptoms.     

Widespread unilateral increased rib uptake on bone scan

Some neuropathological changes characteristic of aging and Alzheimer's disease (AD) in humans are present also in senescent non-human primates. The human apoE4 allele is associated with an increased risk of developing late-onset familial and sporadic AD. We found that rhesus monkeys and three subspecies of squirrel monkeys are homozygous for apoE phenotype with arginine at positions 112 and 158 as in human apoE4. However, in both species threonine replaces arginine at position 61 of human apoE. It was previously shown that arginine 61 was critical in determining apoE4 lipoprotein distribution in humans.     

Discordant splenic uptake of Tc-99m colloid and Tc-99m denatured RBC in candidiasis-endocrinopathy syndrome

The aim of this study was to estimate the incidence of melanoma in the Paris region in 1994 and analyse the main clinical and histological characteristics of these lesions. It took the form of a prospective inquiry, mailed to public and private pathology laboratories, to count as accurately as possible the number of new cases diagnosed by pathologists in the region during the 1994 calendar year. In all, 1089 newly diagnosed Clark level I to V melanomas (excluding precancerous melanosis of Dubreuilh) were studied. Parameters recorded included age, sex, Clark level and Breslow's thickness. The incidence per 100,000 inhabitants was 9.93 for melanoma and 8.62 for invasive melanoma. The female to male ratio was 1.6. Clark level I or thin (< 0.75 mm) melanomas represented 64.8% of the lesions. At the time of diagnosis, the females were significantly younger than the males (P = 0.004). Breslow's thickness increased with age and was significantly lower in women (P = 0.00005), especially those between 40 and 49 years old. The incidence of melanoma in the Paris region in 1994 was close to that observed during the preceding 5 years in England, Scotland and the French department of Haut-Rhin. It was 2.32 times higher for males and 1.69 times higher for females than the rates estimated for France for the period 1978-1982.     

Clearance of technetium 99m N-NOET in normal, ischemic-reperfused, and membrane-disrupted myocardium

BACKGROUND: Technetium 99m-labeled bis(N-ethoxy, N-ethyl dithiocarbamato) nitrido technetium(v) (99mTcN-NOET) is a new neutral cardiac perfusion imaging agent that has been shown to have very high uptake and retention in vitro. The purpose of this study was to determine the clearance kinetics of 99mTcN-NOET in control, ischemic-reperfused, and membrane-disrupted myocardium. METHODS AND RESULTS: After a 100 microCi (3.7 x 10(6) Bq) bolus of 99mTcN-NOET was injected, myocardial clearance was monitored for 1 hour by the use of a sodium iodide detector in 30 isolated, Krebs-Henseleit (KH) perfused rat hearts. Seven hearts were used as controls (group 1). In seven ischemic-reperfused hearts, tracer administration and uptake was followed by 30 minutes of no flow and 1 hour of reflow (group 2). In six additional ischemic-reperfused hearts, tracer administration was followed by deprivation of flow for 1 hour followed by 1 hour of reflow (group 3). Six hearts were perfused with a 0.5% Triton X-100 KH perfusate for 1 hour (group 4). Four hearts were perfused with KH for 10 minutes, followed by cyanide for 10 minutes (group 5). This cycle was repeated three times. Activities remaining in each heart at the end of each experiment were quantitated, and activity at peak uptake was calculated. The 99mTcN-NOET myocardial clearance was near linear in the control (0.6 +/- 0.4) and both ischemic-reperfused groups with virtually no fractional clearance (1.2% +/- 0.6% and 2.1% +/- 0.6%, respectively; p = NS). In the Triton X-100 membrane-disrupted hearts, clearance was substantial (94.2% +/- 4.0%; p < 0.0001 compared with the control and ischemic-reperfused groups). Cyanide treatment produced rapid clearance, which was arrested by a return to the standard KH perfusate. Peak uptake as a percentage of injected dose was 74.9% +/- 1.4% for all groups combined. CONCLUSION: Thus 99mTcN-NOET has extremely high myocardial retention after 1 hour in normal myocardium and is not significantly affected by ongoing myocardial ischemia or reperfusion injury in this model. Clearance is increased markedly in extreme conditions of membrane disruption. These data are consistent with the concept that 99mTc-NOET is localized predominantly in or on cell membranes. 99mTcN-NOET is a promising, new myocardial perfusion imaging agent that exhibits a stable myocardial distribution in the setting of acute developing injury.     

Diagnosis of Meckel diverticulum by sodium pertechnetate Tc 99m scan

Meckel diverticulum was diagnosed preoperatively as the cause of recurrent rectal bleeding in a 2-year-old child by means of a sodium pertechnetate Tc 99m scan. Although false-negative scans have been reported to occur in approximately 50% of all cases of Meckel diverticulum, the procedure should be considered in any case of unexplained, painless rectal bleeding, especially in pediatric patients.     

Scintigraphic discordances between technetium 99m and iodine 131 in the study of thyroid nodules

Eighty thyroid nodules found to be hyperfixating, isofixating or heterogeneous after an initial scintigraphy with Technetium 99m were studied comparatively using iodine 131. Differences in the apparent activity of the nodule and the extra-nodular parenchyma were found in one third of cases. A "cold nodule" appearance, not seen with techneitum was found in 8 cases at the time of the examination using iodine. Five of these patients underwent operation, the diagnosis being a carcinoma in one.     

Clinicopathological correlation of technetium bone scan in vascularization of hydroxyapatite implants. A primate model

OBJECTIVES: To report the histopathological and bone scan characteristics of the stages of hydroxyapatite fibrovascular integration and to consider the implications for the timing of peg drilling in a primate model. DESIGN: Three monkeys received hydroxyapatite implants covered only anteriorly with a fascia lata button to which the rectus muscles were sutured. Weekly bone scans were evaluated quantitatively and qualitatively. The orbits were harvested at 2, 4, and 8 weeks and examined histopathologically. RESULTS: Quantitatively, the implant's technetium uptake increased, then reached a plateau by 4 weeks. Peripheral uptake was present on the images and histologically at 2 weeks. When bone scan images suggested complete vascularization by the fourth week, the implant was 99% vascularized histologically. Completion of vascularization was ascertained at 8 weeks, without further discernible changes in the bone scans. CONCLUSIONS: The technetium bone scan is sensitive to the vascularization of the hydroxyapatite implant and discerns when complete vascularization is approached. This primate study models closely the clinical findings we have recently reported. We advocate at least a 4-week interval between the time the bone scan suggests full vascularization and peg drilling.     

Comparative myocardial uptake of technetium-99 m sestamibi and technetium-99m tetrofosmin one hour after stress injection

Technetium-99m sestamibi and 99mTc-tetrofosmin are at present the preferred tracers for simultaneous assessment of myocardial perfusion and function by gated single-photon emission tomography (SPET). The aim of this work was to compare sestamibi and tetrofosmin myocardial uptake 1 h after stress injection. Consecutive unselected patients were studied either with sestamibi or with tetrofosmin on a random basis, until at least 100 patients had been enrolled for each gender and tracer. Stress was obtained by dipyridamole or exercise or combined dipyridamole + exercise; in the latter cases, exercise was sustained for at least 1.5 min after tracer injection. Injected activity was similarly adjusted to body weight. For each patient, imaging began 60-75 min after injection. All SPET projections were summed; due to the acquisition technology ("roving zoom", i.e. a mobile zoom), the heart always appeared at the centre of the frame in all projections and in the sum image. Thus minimal lung background contamination could be assumed in an elliptic region of interest placed over the heart on the sum image. Three indexes were analysed: total myocardial counts (Sum), mean myocardial pixel (Mean) and maximum myocardial pixel (Max). Four patient groups were analysed: males with sestamibi or tetrofosmin (MS: n = 189 and MT: n = 157), females with sestamibi or tetrofosmin (FS: n = 101 and FT: n = 104). MS and MT groups were comparable for physical variables, maximum heart rate and stress type, as were the FS and FT groups. Sum, Mean and Max were significantly higher with sestamibi (P = 0.0001 by ANOVA). Comparing MS vs MT and FS vs FT, mean values +/- SD were as follows: for Sum (kcounts) 750+/-184 vs 652+/-166, and 707+/-202 vs 594+/-189; for Mean (counts) 4517+/-1171 vs 4107+/-898, and 4908+/-1119 vs 4144+/-1025; and for Max (counts) 6471+/-1654 vs 5794+/-1312, and 7318+/-1886 vs 6152+/-1684. The mean gain with sestamibi was +15%, +10% and +12% in males, and +19%, +18% and +19% in females. Similar differences were found within each stress type subgroup. No gender-specific effect was found for Mean, so the overall mean gain was calculated for Mean: +13% for sestamibi vs tetrofosmin. These findings are consistent with other published smaller sample series. Possible differences between tracers with regard to residual activity in syringes were ruled out by an additional experiment. In summary, we found significantly higher myocardial counts with sestamibi than with tetrofosmin, in males as well as in females.     

Comparison of technetium 99m nanocolloid and indium 111 leucocytes in the diagnosis of orthopaedic infections

It has been suggested that technetium 99m nanocolloid is as effective an inflammatory radiopharmaceutical as indium 111 leucocytes. This study compares the efficacy of 99Tcm nanocolloid and 111In leucocytes in the detection of orthopaedic infection in 19 patients with a high clinical suspicion of infection. The two scintigrams were performed within 24 h of each other. A scintigram was considered positive where there was an increase in tracer uptake at the site of interest. Concordance rate of 73% was achieved. The numbers of false positives with 111In leucocytes and 99Tcm nanocolloid were three and six respectively. The single false negative in both was of a patient with tuberculous spondylodiscitis. Sensitivity was 75% in both. Specificities were 79% and 60% for 111In leucocytes and 99Tcm nanocolloid respectively. Positive Predictive Value was only 33% with 99Tcm nanocolloid and 50% with 111In leucocytes. 99Tcm nanocolloid also proved less reliable in accurately detecting infected prostheses. We conclude that 99Tcm nanocolloid cannot replace 111In leucocytes in the diagnosis of orthopaedic infections.     

Tc-99m MIBI uptake in simultaneous thyroid and lung cancers

The authors present a patient with simultaneous follicular thyroid and small-cell lung cancers, both of which showed Tc-99m MIBI uptake. CT scans showed two masses: one involving the right lower neck including the right supraclavicular area and the right superior mediastinum, and the other involving the peripheral portion of the right upper lobe of the lung. I-131 imaging showed increased uptake in the right neck mass only. Tc-99m MIBI imaging, which was performed for evaluation of chest pain, showed intense uptake in the neck mass (tumor to heart ratios in planar and tomographic images were 0.92 and 0.96, respectively), and less uptake in the lung mass (tumor to heart ratios in planar and tomographic images were 0.53 and 0.40, respectively). Biopsy of the right supraclavicular mass revealed a follicular carcinoma, and a bronchoscopic biopsy of the right upper lobe mass revealed a small cell carcinoma.     

Anatomic correlates of memory from intracarotid amobarbital injections with technetium Tc 99m hexamethylpropyleneamine oxime SPECT

OBJECTIVE: To better identify regions of the brain affected by intracarotid amobarbital injections and to more precisely predict whether resections of specific brain regions will cause postoperative memory deficits. DESIGN: We modified the standard intracarotid amobarbital procedure by adding a radioactive tracer to the amobarbital injection, thereby providing better correlation between behavior and deactivated brain region. SETTING: Tertiary-care hospital center with a dedicated program for medical and surgical treatment of epilepsy. PATIENTS: We studied 39 patients with medically intractable epilepsy drawn from a regional referral base. INTERVENTION: Intracarotid injection of 125 mg of sodium amobarbital with 37 MBq of technetium Tc 99m hexamethylpropyleneamine oxime (HMPAO), followed by language and memory testing. MAIN OUTCOME MEASURES: The distribution of amobarbital as measured by single photon emission computed tomographic imaging of HMPAO and patient performance on memory tasks. RESULTS: Medial temporal regions were irrigated by the amobarbital in only 28% of the injections. Overall, findings suggest that medial temporal and lateral neotemporal cortex play a role in memory. CONCLUSIONS: The regions involved in memory function vary by individual, as does the distribution of amobarbital. Thus, the most accurate method of determining correlation of brain region with memory function during intracarotid amobarbital injection involves the use of a tracer such as HMPAO.     

Detection of skeletal metastases in Nigerian breast cancer patients: evaluation of radioisotope bone scan and radiography

Cerebellar granule cells isolated from postnatal day 7 mice, and cultured in minimal medium containing only insulin-like growth factor-I (IGF-I), both survive and differentiate. This differentiation is marked by neurite growth and expression of genes associated with terminal differentiation, the myocyte-specific enhancer factor 2A (MEF2A) and the alpha 6 subunit of the gamma-aminobutyric acidA receptor (GABAA alpha 6). Percoll gradient purified granule cells maintained without IGF-I, in minimal medium alone or in medium containing the antioxidant N-acetylcysteine (NAC), also express MEF2A and GABAA alpha 6. Thus, cultured granule neurons can differentiate to some extent cell-autonomously and IGF-I may not be a critical factor for this process.