The importance of 99Tcm-DMSA renal scintigraphy in the follow-up of acute pyelonephritis in children: comparison with urographic data

OBJECTIVE: To investigate worry in a nonclinical sample of children aged 8 to 13 years (N = 193). METHOD: Children were interviewed about the content, characteristics, origins, and severity of their main intense worry. Furthermore, children completed questionnaires to study the relationship between worry, trait anxiety, and depression. RESULTS: Almost 70% of the children reported that they worried every now and then. The content of these worries predominantly pertained to school performance, dying and health, and social contacts. An examination of the characteristics of children's main intense worries revealed that these worries occurred on average 2 to 3 days per week, were accompanied by modest levels of interference and anxiety, elicited relatively high levels of resistance, and were rather difficult to control. A minority of the children were found to exhibit symptoms of worry in the pathological range: the percentages of children who met the DSM-III-R criteria of overanxious disorder and generalized anxiety disorder were 4.7% and 6.2%, respectively. Finally, worry, anxiety, and depression seemed to be strongly related. CONCLUSION: Worry seems to be a common phenomenon in normal children aged between 8 and 13 years.     

99Tcm-DMSA as a dynamic imaging agent for estimating renal blood flow. A comparison with 99Tcm-DTPA

A technique for estimating fractional renal blood flow (RBF) from the early part of the 99Tcm-diethylenetriaminepentaacetate (DTPA) renogram has been described previously and its reproducibility validated in the pig model. The technique is assumed to be applicable to any recirculating gamma-emitting tracer compound. The aim of this study was to determine whether the same method could be applied to 99Tcm-dimercaptosuccinic acid (DMSA) which has been largely neglected as a dynamic imaging agent. Paired estimates of fractional RBF were obtained in Large White (n = 16) and G?ttingen miniature pigs (n = 6) in three groups: group 1, paired 99Tcm-DTPA studies; group 2, paired 99Tcm-DMSA studies; group 3, alternate 99Tcm-DTPA and 99Tcm-DMSA studies. The results showed good agreement between paired results independent of whether 99Tcm-DTPA or 99Tcm-DMSA was used, supporting the assumption that the technique is applicable to any recirculating gamma-emitting tracer compound. The demonstration that fractional RBF can be reliably estimated from the DMSA renogram means that, if required, it may be combined in a single nuclear medicine procedure with conventional static DMSA renal imaging.     

Technetium-99m-MIBI scintigraphy in pulmonary tuberculosis

The acute phase plasma protein ceruloplasmin (Cp) appears to play some role in host defense. The possibility that production of Cp in extrahepatic sites may also be essential for the activation, effector functions and cytoprotection of immune cells in localized environments has received minimal attention. Here, we have surveyed various types of human and rat immune cells for the presence of Cp mRNA using RT-PCR with primers that span exons 17-19 as an initial step in addressing this possibility. Validated Cp RT-PCR bands were obtained from RNA samples isolated from resting and activated human lymphocytes, CD4 and CD8 T-cells and B-cells. Semiquantitative RT-PCR indicated that Cp mRNA in immune cells is present at about 0.2% the level of Cp mRNA in HepG-2 human liver cell line. Various human cell lines derived from the immune system, rat splenic MNC and purified rat T-lymphocytes also constitutively express Cp gene.     

99Tcm-MDP scintigraphy in high-voltage electrical burn patients

In high-voltage electrical burn injuries (> 1000 V), it is difficult to identify the site and extent of non-viable deep tissue damage for debridement to avoid further tissue injury from wound infection and the risk of sepsis. This prospective study was designed to evaluate the usefulness of 99Tcm-methylene di-phosphonate (99Tcm-MDP) scintigraphy in detecting the extent of tissue injury and determining the level of amputation required for electrical burn patients. Over a 5 year period, 33 high-voltage electrical burn patients were studied. Blood flow and blood pool studies revealed absent perfusion in 37 limbs, all of which eventually were amputated. In addition to a routine three-phase bone scan, images were obtained at 30-60 min (early images) to evaluate whether soft tissue injury could be detected better at that time. For comparison of the detection rate from the early images and bone (delayed) images, 164 corresponding spot views of both images were reviewed. Eighty-three and 125 tissue necrotic lesions were demonstrated by the early images and bone images respectively. All of the 83 lesions found by the early images were more clearly identified by the bone images. All but one of the 125 lesions underwent surgical debridement or amputation. We concluded that the blood flow and blood pool images correlated well with the level of amputation required. The site and extent of tissue necrotic lesions can be clearly identified on 99Tcm-MDP bone scans. Because the early images were less sensitive in detecting tissue necrosis, we suggest that early imaging is not necessary.     

Tc-99m sestamibi scintigraphy in multiple myeloma

Tc-99m sestamibi imaging was performed in two patients with multiple myeloma. Focal areas of increased uptake in one patient and diffuse skeletal uptake in the second patient were found. Tc-99m sestamibi appears to identify bone marrow and osteolytic involvement in multiple myeloma.     

Long-term evaluation with DMSA-Tc 99m scintigraphy of renal parenchymal involvement in children after shockwave extracorporeal lithotripsy

BACKGROUND: Endothelin 1 (ET-1), a vasoconstrictor peptide, has been implicated as a tumour growth stimulator and an angiogenesis factor. METHODS: To assess the involvement of ET-1 in colorectal cancer, immunoelectron microscopy for ET-1 was performed in colorectal liver metastases and normal liver (n = 6). ET-1 plasma levels were measured by radioimmunoassay in patients with colorectal cancer, with (n = 18) and without (n = 12) liver metastases, and in controls (n = 22). RESULTS: In normal liver, ET-1 was present in endothelial cells; in tumour, it was observed in endothelial cells, tumour cells and myofibroblasts. Mean(s.d.) plasma ET-1 levels were 2.75 (1.37) pg/ml in controls, 4.53(1.61) pg/ml in patients with colorectal liver metastases (P = 0.001) and 3.92(1.32) pg/ml in patients without metastases (P = 0.02). CONCLUSION: ET-1 was present in various cell types within colorectal liver metastases and raised levels were found in the plasma of patients with colorectal cancer. ET-1 may not only modulate tumour vascular tone but also act on tumour growth and angiogenesis, both locally and systemically.     

Pentavalent technetium-99m-dimercaptosuccinic acid scintigraphy in renal osteodystrophy

OBJECTIVE: To establish whether oxytocin modifies the stimulatory effect of vasoactive intestinal polypeptide (VIP) on prolactin secretion in healthy women. DESIGN: Controlled clinical study. SETTING: Healthy women in an academic research environment. PATIENT(S): Seven healthy women (aged 24-32 years) were tested on the 22nd day of two consecutive normal menstrual cycles. INTERVENTION(S): Vasoactive intestinal polypeptide (4 pmol x kg(-1) x min(-1) in 50 mL of normal saline infused i.v. for 60 minutes) was administered in either the presence or absence of concurrent treatment with oxytocin (2 IU injected plus 0.07 IU/min infused for 60 minutes). MAIN OUTCOME MEASURE(S): Serum prolactin levels. RESULT(S): The administration of VIP induced a significant increase in serum prolactin levels, with a mean peak response 1.6 times higher than baseline at 45 minutes after injection. In the presence of oxytocin, the prolactin response to VIP was significantly higher, with a mean peak response 2 times higher than baseline. CONCLUSION(S): These data suggest that in healthy women, oxytocin facilitates the regulation of the stimulating effect of VIP on prolactin secretion.     

Usefulness and limitations of 99mTc-MIBI scintigraphy for detection of parathyroid lesions

To evaluate the usefulness of MIBI scintigraphy (MIBI) for parathyroid lesions, the detectability of lesions by MIBI was compared with that by Tl-Tc subtraction imaging, ultrasonography, CT and MRI in 56 histologically proved lesions. In neck lesions, ultrasonography (92%) and MIBI (85%) showed better detectability than those by the other three modalities. With MIBI, detectability was decreased for smaller parathyroid lesions that coexisted with thyroid disease. Among the five modalities, MIBI showed the highest detectability (88%) for ectopic or metastatic lesions. The smallest parathyroid lesions detected by MIBI were a parathyroid adenoma weighing 220mg and a parathyroid hyperplasia weighing 200mg. MIBI was thought to be more valuable for ectopic or metastatic parathyroid lesions.     

Technetium-99m-tetrofosmin for parathyroid scintigraphy: comparison to thallium-technetium scanning

The efficacy of 99mTc-tetrofosmin for the detection of parathyroid lesions was investigated prospectively in patients with hyperparathyroidism referred for surgical treatment. METHODS: Twenty-seven patients with primary and 18 with tertiary hyperparathyroidism were studied. Twelve patients had undergone one or more previous neck explorations. Static imaging with 201Tl was performed first, immediately followed by a 30-min 99mTc-tetrofosmin dynamic study. Delayed views of up to 3 hr postinjection were also obtained. Technetium-99m-pertechnetate was used for thyroid delineation. The tetrofosmin/99mTc-pertechnetate subtraction scan (TF/TC), the single-tracer washout technique and the thallium/technetium subtraction (TL/TC) were compared. Quantification of relative uptakes of tracers in the thyroid and abnormal parathyroids was accomplished by measuring activity within regions of interest. Kinetics of tetrofosmin in the thyroid and abnormal parathyroids were studied by evaluating the plots of the parathyroid to thyroid ratios against time as well as by calculation of the half-clearance times from the slow component of the time-activity curves. RESULTS: The overall sensitivity, specificity and accuracy of TF/TC and TL/TC were 76%, 92% and 83% and 52%, 85% and 65%, respectively. The respective sensitivities were 87% and 70% for adenomas and 72% and 46% for hyperplasia. The parathyroid-to-thyroid activity ratios of tetrofosmin were significantly higher than those of thallium (p < 0.001). The tetrofosmin single-tracer washout study was less accurate than the subtraction technique (overall sensitivity and specificity, 70% and 69%, respectively). The washout properties of tetrofosmin in abnormal parathyroids were not substantially different from those in the thyroid, with a few exceptions (p = 0.4). No correlation of half-clearance times with parathyroid size, degree of early uptake, parathyroid hormone levels or histology could be established. Comparing adenomas to hyperplasia in respect to tetrofosmin retention, a statistically significant difference was observed (p = 0.005). CONCLUSION: Technetium-99m-tetrofosmin is suitable for parathyroid imaging. The kinetic properties of this agent in parathyroid and thyroid tissues do not warrant differential washout protocols. The diagnostic impact of the observed difference in tetrofosmin kinetics between parathyroid adenomas and hyperplasia requires further investigation.     

Diagnosis of diabetic gastroparesis on Tc-99m hepatobiliary scintigraphy

Diabetic gastroparesis is a common problem in diabetics, especially insulin-dependent diabetics. The diagnosis usually is suggested on plain radiographs and confirmed on either upper gastrointestinal barium series or radionuclide gastric emptying studies. The clinical diagnosis is not always easy and some patients may present atypically with right upper quadrant pain simulating acute cholecystitis. In these patients, hepatobiliary scintigraphy may be the initial investigation performed and may first demonstrate unsuspected gastroparesis. Therefore, it is useful for the nuclear medicine physician to be aware of this entity to ensure early diagnosis and prompt treatment. The authors report one such case of diabetic gastroparesis that was diagnosed initially on a Tc-99m hepatobiliary scan.     

99mTc pertechnetate scintigraphy and premedication for the search for ectopic gastric mucosa in Meckel's diverticulum

BACKGROUND: Meckel's diverticulum (MD) is the most common anomaly of the large intestinal tract (1-3%) and is more frequent in children (62% < 2 years) and in males (66%). It often involves ectopic gastric mucosa which manifests through gastrointestinal bleeding in 50% of cases. 99m-Technetium scintigraphy (99mTcO4) is one of the procedures available for the non-invasive diagnosis of ectopic gastric mucosa. METHODS: Twenty-eight patients (11 females, 17 males), including 16 children and 12 adults, aged 8 months-80 years old, were included in the study. The patients were admitted to hospital for hematochezia and melena (22) associated with abdominal pain (5): 3 patients repeatedly presented occult blood in their stools. Two patients only suffered from abdominal cramps and one only anemia. Patients were studied using plain abdominal radiographs and ultrasound; 10 underwent gastroscopy and colonoscopy; radiological contrast studies were performed in 5 patients. All tests were inconclusive. All the patients were premedicated with oral cimetidine (20 mg/kg in pediatric patients and 300 mg q.i.d. for adults, 48 hours before the test) or with ranitidine i.v. (1 mg/kg, max 50 mg, in 20 minutes, one hour before the test); barium meals and colonoscopy were deferred for 2-3 days after examination. An intravenous injection of 37-180 Mbq of 99mTcO4 was given followed by a dynamic study of the abdomen in anterior projection. Images were acquired for one hour or until the visualisation of abnormal foci of intake: in this case, lateral and oblique images were acquired for a better localisation of the suspicious area. Some patients were administered furosemide i.v. (0.75 mg/kg). All underwent a follow-up period of 12 months. RESULTS: Pertechnetate scintigraphy was positive in 10 cases and the presence of ectopic gastric mucosa was confirmed by surgery. The study was negative in 18 cases: 3 of them were discharged with a diagnosis of Salmonella infection, polyp of the small bowel or ulcer of the large bowel respectively; the other 15 patients did not show symptoms of onset during follow-up. CONCLUSIONS: These results confirm the high diagnostic accuracy of pertechnetate scintigraphy to detect ectopic gastric mucosa if associated with H2-receptor-blocking agent premedication.     

Technetium-99m-MIBI and thallium-201 scintigraphy of primary lung cancer

We evaluated the usefulness of 99mTc-MIBI scintigraphy in primary lung cancer in comparison with 201Tl-chloride scintigraphy. METHODS: There were 45 patients with primary lung cancer. All patients underwent dual-isotope imaging with 201Tl-chloride and 99mTc-MIBI. Regions of interest were placed over the tumors (T) and contralateral normal lung tissue (N) on one coronal view in the SPECT, and T/N ratio and retention index were calculated. RESULTS: The positive rate was 98% in both the early and delayed images for 201Tl-chloride and 96% in the early and 89% in the delayed image for 99mTc-MIBI. Both early and delayed T/N ratios for 201Tl-chloride were higher than those for 99mTc-MIBI. There was no significant correlation between T/N ratio and histological type of tumor in both images. However, in both images, there was a tendency for the early and delayed ratios to increase as the tumor diameter became larger. The retention index of 201Tl-chloride was higher than that of 99mTc-MIBI. There were no significant differences in the retention index with respect to the histological type and tumor size. CONCLUSION: The results of this preliminary clinical study suggest that 99mTl-MIBI can depict primary lung cancer similar to 201Tl-chloride. However, T/N ratio and retention index of 99mTc-MIBI in the tumor areas are significantly lower compared with those of 201Tl-chloride.     

A composite score of enterogastric reflux quantitation on 99mTc-HIDA scintigraphy

BACKGROUND/AIM: Enterogastric reflux of bile, and duodenal and pancreatic secretions may occur either spontaneously or, more commonly, after gastric surgery. The most reliable method in discriminating symptomatic from asymptomatic postgastric surgery refluxers, and in predicting a good clinical result after surgical diversion in the former group, is the quantitation of reflux by 99mTc-HIDA scintigraphy. MATERIALS AND METHODS: In 28 normal subjects and 143 postgastric surgery patients, the enterogastric reflux (EGR) was demonstrated by 99mTc-HIDA scintigraphy on 230 occasions. The EGR index was quantitated according to two different formulae: the former one based on the amount of refluxate (percentage of maximal radioactivity of the gastric area over the total abdominal activity--EGR-Im) and the latter one based on the amount and the duration of the time of reflux (CompEGR-Im) and representing the area of the surface below the curve, which was yield by plotting EGR-Im values (obtained every 5 min for one hour) against time. RESULTS: Although there was a highly significant correlation of values between the two methods (p<0.0000001), the latter one was more reliable in classifying postgastric surgery patients according to the presence of reflux symptoms and the reflux index. CONCLUSIONS: In patients with a CompEGRpIm>770 and postgastric surgery symptoms, at least some of the symptoms can be safely be attributed to enterogastric reflux.     

Pitfall in 201Tl-99mTc subtraction scintigraphy: a case of 99mTc-pertechnetate uptake in a parathyroid hyperplasia]

201Tl-99mTc subtraction scintigraphy has been recognized as a useful procedure in the preoperative localization of hyperfunctioning parathyroid glands. We experienced a case which showed 99mTc-pertechnetate uptake in a parathyroid hyperplasia. This case warned us to focus a lot of attention on the detection for preoperative localization. There has been no such case reported in the previous Japanese literatures. Hypervascularity and thick fibrous capsule presumed explanation for a rare case of marked pertechnetate uptake into a parathyroid hyperplasia.     

99m-Tc-MIBI SPECT parathyroid gland scintigraphy for the preoperative localization of small parathyroid gland adenomas

AIM: It was the of this study to assess the value of the 99mTc-MIBI scintigraphy in SPECT technique in the preoperative lateral location of small parathyroid adenoma (PTA). METHODS: 25 consecutive patients (8 male, 17 female, mean age 63 +/- 13 years) with the established diagnosis of primary hyperparathyroidism and non-diagnostic ultrasonography were scanned preoperatively. After a thyroid examination to exclude radionuclide accumulating thyroid adenoma, planar and tomographic images were acquired 20 min. and 120 min. after i.v. injection of 740 MBq 99mTc-MIBI using a 3 head gamma camera (Picker Prism 3000). The first 10 patients underwent an additional 201Tl/99mTc subtraction scintigraphy in a 2 days protocol. RESULTS: All patients had small, solitary PTA (< 1 g). 201Tl/99mTc subtraction scintigraphy (n = 10) showed only a sensitivity of 50%. Using planar MIBI-scintigraphy lateral location of PTA was possible in 18 cases (sensitivity: 72%). There was an increase in sensitivity up to 96% using the SPECT technique and the 3D display (volume-rendered reprojection). CONCLUSION: In contrast to 201Tl/99mTc subtraction scintigraphy, which showed only a low sensitivity, a reliable lateral location of small PTA was obtained using the tomographic 99mTc-MIBI scintigraphy. This method offers e.g. the possibility for the surgeon to perform an unilateral parathyroidectomy.     

The mechanism of positive scintigraphy with 99mTc-pertechnetate in adenolymphomas of the parotid grand

Inhibin is a peptide hormone produced by ovarian granulosa cells and testicular Sertoli cells. Ovarian granulosa cell and other sex cord-stromal tumors usually exhibit positive immunohistochemical staining with antiinhibin antibodies, and this may be valuable in differentiating these neoplasms from histologic mimics. In the present study, we investigated the immunohistochemical staining of testicular sex cord-stromal tumors using antiinhibin. Immunostaining with CAM5.2, vimentin, S-100 protein, desmin, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), and placental alkaline phosphatase (PLAP) also was performed because few studies have investigated in detail the immunophenotype of testicular sex cord-stromal tumors. Fifteen of 16 Leydig cell tumors exhibited strong positive staining with antiinhibin. A proportion of Leydig cell tumors also stained positively with CAM5.2 (7 of 16), vimentin (14 of 16), S-100 protein (10 of 16), desmin (2 of 16) and epithelial membrane antigen (4 of 16). Four of six testicular sex cord-stromal tumors with varying degrees of Sertoli or granulosa cell differentiation were positive with antiinhibin, as were two of three sex cord-stromal tumors that were unclassified. Some of these tumors were positive with CAM 5.2, vimentin, S-100 protein, desmin, and epithelial membrane antigen. All tumors were negative with carcinoembryonic antigen and placental alkaline phosphatase. The immunohistochemical findings show that, analogous to their ovarian counterparts, most testicular sex cord-stromal tumors are immunoreactive with antiinhibin. Immunohistochemistry using this antibody as part of a panel may be valuable in confirming a diagnosis of testicular sex cord-stromal tumor and in differentiating these neoplasms from others that may mimic them.