[Follow-up care for differentiated thyroid cancer].
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Adenocarcinoma↗
Biomedical subjects
C Reiners
Publications and source records attributed to C Reiners.
[Factors interfering with and influencing the measurement of direct and indirect parameters of free thyroxine].
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Autoantibodies↗
111In-oxine-labelled white blood cells in the diagnosis and follow-up of Crohn's disease.
Prospectively, 43 patients with Crohn's disease (41 clinically active, 2 clinically inactive) and 7 patients with irritable bowel syndrome were examined by 111In-oxine-labelled leukocytes ('mixed' leukocyte preparations, n = 8; 'pure' granulocyte preparations, n = 42). The number of scintigraphically diagnosed inflamed bowel segments correlated significantly (r = 0.95, p less than 0.001) with the number of radiologically and endoscopically diagnosed segments. The exact localization of the diseased ileum may be difficult by scintigraphy. One complicating abscess and two fistulas were correctly diagnosed. The percentage of fecal excretion of radiolabelled leukocytes is highly specific for intestinal inflammations. It correlates significantly with the erythrocyte sedimentation rate (r = +0.69, p less than 0.001), serum albumin (r = -0.54, p less than 0.001), orosomucoid (r = +0.65, p less than 0.001), and with the A.I. (van Hees) (r = +0.67, p less than 0.001). In the follow-up of 9 patients, the percentage of fecal excretion decreased or increased more rapidly, but in correlation with the CDAI, A.I., or ESR. The authors conclude that this method is an alternative to common methods and that it is superior in primary diagnosis in patients with severe disease, bowel stenosis, abscesses, and after surgery. After clinical and biopsy-proven diagnosis of Crohn's disease, the special value of the leukocyte scan lies in the noninvasive follow-up of patients and its potential of localizing inflamed bowel segments and assessing disease activity.
Colon↗
[Surgical indications for scintigraphically cold thyroid nodules in relation to clinical, scintigraphic, sonographic and cytologic findings].
The frequency of indication for surgical resection of goitre was retrospectively analysed for 2100 thyroid examinations. During 1974/75 (group I) only scintigraphy was available in addition to clinical examination; in 1979/80 (group II) cytological criteria were added, and in 1983/84 (group III) ultrasound findings were available as well. There were 700 patients in each group. The proportion of scintigraphically negative nodules was largely the same in the three groups (I and II: 21%; III: 22%). Indication for operation was less common after the introduction of ultrasound (I: 56%; II: 55%; III: 44% of patients with scintigraphically cold nodules). In particular, there was a decrease in the proportion of those nodules not definitely considered benign which would have required histological diagnosis (I: 32%; II: 18%; III: 8%). The results underline the special place of small-needle biopsy and, especially, ultrasound examination of the thyroid, in addition to clinical and scintigraphic findings, in providing the indication for and planning of operative nodular goitre resection.
Biopsy, Needle↗
[Indications status and surgical strategy in cold struma nodule].
Scintigraphy, sonography and fine needle cytology have the best accuracy in the evaluation of a cold nodular goitre. In 2,100 investigations on nodular goitre, it could be found that the incidence of the prophylactic operation for histological diagnosis decreased more than half. On the other hand, with the precise diagnosis the surgeon was able to perform thyroidectomy for thyroid cancer in the first operation. Thus complications of thyroidectomy (paralysis of the recurrent laryngeal nerve, tetany, residual thyroid tissue) could be reduced.
Diagnosis, Differential↗
Three-phase white blood cell scan: diagnostic validity in abdominal inflammatory diseases.
Indium-111-oxine saline-labeled "mixed" leukocyte (n = 16) and "pure" granulocyte (n = 66) scans were prospectively performed as "three-phase" white blood cell (WBC) scans (imaging: 30 min, 4 hr, and 24 hr after reinjection of the cells) in 82 patients suspected of having abdominal or retroperitoneal abscesses or inflammatory lesions. Inflammation was verified histologically, endoscopically, radiologically or by autopsy in 51 and excluded in 31 patients. Sensitivity, specificity, and diagnostic accuracy of the 30-min scan (90%, 56%, 72%) were statistically significantly lower than the 4-hr scan (96%, 97%, 98%). Of the 24-hr scan sensitivity, specificity, and diagnostic accuracy were only 84%, 98%, and 89% because many patients with chronic inflammatory bowel diseases had excreted a portion of intestinal 111In activity by 24 hr. The overall sensitivity, specificity, and accuracy of the "three-phase" WBC scan were 98%, 97%, and 98%, respectively. Only one female patient showed a false-positive scan with granulocyte uptake in an ulcerating adenocarcinoma of the colon. The 4-hr scan or the three-phase study are recommended because of their high sensitivity, specificity, and excellent diagnostic accuracy (98%). The 30-min scan is less specific (56%); the 24-hr scan less sensitive (84%). The three-phase study additionally allows the differentiation between inflammatory bowel diseases and abscesses because it allows observation of granulocyte kinetics for 24 hr.
Abdomen↗
[Quality assurance in in vitro diagnosis in nuclear medicine].
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Humans↗
Immunoscintigraphy in medullary thyroid cancer using an 123I- or 111In-labelled monoclonal anti-CEA antibody fragment.
The monoclonal anti-CEA F(ab')2 fragment MAb BW 431/31, labelled with 123I or 111In, was used for immunoscintigraphy (IS) in 9 patients with medullary cancer of the thyroid (CCC). The results of 11 studies lead to the following conclusions: When using radioiodine as a label for MAb in IS, potassium iodide is absolutely necessary to block the thyroid which is of special importance in patients with thyroid cancer; Preinjection of "cold" MAb reduces the relatively high unspecific uptake (especially in bone marrow) of MAb BW 431/31, which is of special importance for the antibody labelled with 111In; IS with MAb BW 413/31 in patients with CCC and elevated serum CEA is positive only in cases with large secondaries; and In patients with CCC and several manifestations of secondaries, only a single (large) metastasis may be apparent.
Antibodies, Monoclonal↗
[111In-oxine-labeled granulocytes in Crohn disease and ulcerative colitis. Labeling and study technics].
111In-oxine "pure" granulocyte scanning allows an exact localisation of infiltrated bowel in Crohn's disease and ulcerative colitis. Fecal excretion of labeled granulocytes yields a good parameter of disease activity. In comparison to 111In-oxine "mixed" leukocyte scanning, this method is more specific in assessing disease activity and more sensitive in localising diseased bowel. Radiation exposure to blood cells is not as high as in "mixed" leukocyte scanning. Pure granulocytes were isolated by discontinuous density gradient centrifugation of an isolated "mixed" leukocyte fraction.
Adult↗
[Separate measurements of compact and spongy bone density using a transverse rotation scanner. Determination of mineral content of the radius using a least squares algorithm].
The absorption profile of the distal forearm, which depends on bone mineralisation, was measured using a high resolution microcomputer-controlled transverse rotational scanner with a tightly collimated I-125 photon source and a scintillation counter. Reconstruction of the anatomical structures within the measured area occurred in two stages. Subsequently the linear attenuation coefficient for soft tissues, compacta and spongiosa was obtained by a "least-square" algorithm. The absorption coefficient of the compacta and spongiosa provided a measure of bone mineralisation. Correlation between the reconstructed images and the calculated results and measurements was tested by calculation. Ten measurements of a model and of in vivo bones resulted in a coefficient of variation of 1.8% and 3.3% for the compacta and 2.5% and 3.8% for the spongiosa. Relative deviation from the standard varied from +1.3% to -1.0%, depending on mineral content. This new, technically simple procedure for the separate determination of the compacta and spongiosa in the distal radius is useful for the early recognition of changes in bone mineralisation which are usually apparent first in the spongiosa.
Bone and Bones↗
[The suppression test in the control of the course of antithyroid drug therapy: renaissance of an in vivo nuclear medicine procedure?].
Measurements of thyroidal suppressibility by thyroid hormones belong to the diagnostic program in nuclear medicine for more than 30 years. Suppression tests are used in follow-up of antithyroidal treatment to predict remission or relapse of hyperthyroidism. Recently, the number of publications dealing with suppression tests has been increasing. Apparently, non-suppressibility of the thyroid after antithyroidal treatment for about 1 year corresponds to a rate of relapse of about 70% whereas in the case of a positive suppression test, the relapse rate amounts to about 20% only. The diagnostic procedures described in the literature are different with respect to radiopharmaceuticals, activity doses, thyroid hormone suppression and, above all, to the time of uptake measurements. After a critical discussion of the literature, a modern diagnostic procedure for the suppression test is proposed using 123I or 99mTc and a computer-assisted gamma camera.
Antithyroid Agents↗
The influence of dietary fiber on gastric transit time.
Little is known about the effect of dietary fiber on gastric emptying. At present, we do not know whether any therapeutic effects result from delayed gastric transit time. Functional scintigraphy was used to determine the effect of wheat bran, guar and pectin on the transit time of 200 ml fruit juice and 200 or 400 ml of a liquid test meal in normal healthy subjects. The transit time of fruit juice was significantly delayed by the addition of 4 g guar (viscosity 7079 mPA X s). Neither wheat bran, pectin nor guar resulted in a delay of the test meal transit time despite maximal increases in viscosity of up to 21,500 mPa X s. We therefore conclude that dietary fiber does not significantly delay the gastric transit time of test meals regardless of the increase in viscosity. The reduction in postprandial glucose levels after ingestion of guar or pectin is, therefore, probably not due to delayed gastric emptying.
Beverages↗
[111In-oxine marked leukocytes: a method for diagnosing the location and evaluating the activity of Crohn disease and ulcerative colitis].
Patients with Crohn's disease (n = 22), ulcerative colitis (n = 5), inactive Whipple's disease (n = 1), irritable bowel syndrome (n = 2), arthritis (n = 1) and Yersinia infections (n = 2) were examined with 111In-oxine labelled "mixed" leukocyte preparations (n = 12) or with 111In-oxine labelled "pure" granulocyte preparations (n = 21). Compared with barium enemas of the gut and colonoscopy, performed within of one week in 31 patients there was a correct location of infiltrated bowel segments in 24 patients (78%). The scan diagnosed more infiltrated segments in 4 patients (13%). In 3 patients it failed to diagnose one inflamed segment. In 24 patients the faecal 111In-excretion was expressed as percentage of the reinjected 111In-activity. All patients with non inflammatory bowel diseases and patients with inactive inflammatory bowel diseases excreted less than 2% of the reinjected 111In-activity. All but one female patient with active bowel disease excreted more than 2%. In 24 patients the correlation of ESR, CDAI and A.I. was available. There was a good correlation between ESR (r = 0.77, P less than 0.001), A.I. (r = 0.61, p less than 0.001) and the %-faecal faecal excretion. The 111In-labelling of white blood cells, especially of granulocytes, seems to be a reliable alternative method to localize infiltrated bowel segments and to assess disease activity in patients with inflammatory bowel diseases, compared to usually performed radiological, endoscopical and clinical methods.
Adult↗
[The place of nuclear medicine methods in thyroid gland diagnosis].
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Goiter↗
[Metastatic differentiated thyroid cancer. Diagnostic accuracy of thyroglobulin-RIA in comparison with 131I-whole body scintigraphy].
In a retrospective analysis in patients with differentiated thyroid carcinoma, the diagnostic validities of 131I whole-body scans and radioimmunologic determinations of thyroglobulin (hTg) are compared with special regard to late metastases. Metastases were found in 83 out of 311 patients with differentiated thyroid carcinoma. In two thirds of the cases, these were primary metastases while in the remaining third of the cases, metastases developed in later follow-up with a mean time of latency of 3.3 years. While about 70% of the early metastases could bei detected by 131I scintigraphy, this percentage amounted to only 40% in late metastases. With a diagnostic sensitivity of 90%, hTg-RIA was clearly superior in the detection of early as well as of late metastases. hTg was measurable, however, only in iatrogenous hypothyroidism in 4 out of 49 cases. Based on these results and an analysis of the literature, a program for follow-up of differentiated thyroid carcinoma is proposed. The hTg-RIA is thereby used as an alternative to 131I scintigraphy in the late phase of follow-up after complete ablation of any thyroid tissue.
Adenocarcinoma↗
[Differential diagnosis of thyroid nodules. Sonography as a complement to scintigraphy and puncture cytology].
The place of ultrasound in the diagnosis of thyroid nodules was assessed in 384 patients by comparing its findings with those obtained on palpation, scintigraphy, fine-needle cytology and (in 45 cases) histology. Further diagnosis of scintigraphically "cold" nodules is the main indication for ultrasound examination in goitre-endemic areas. In 13 of 69 cases of a cold nodule with complex or echo-poor echo image proved it to be malignant, while in 74 with cold nodules but with a normal or increased echo pattern there was no malignant tumour. Thus, if the echo pattern is "complex" or "echo-poor" urgency of surgical intervention is strengthened, while with echo-normal or echo-rich nodules or cysts indications for operation are relative. In future, a combination of scintigraphy, ultrasound and cytology (ultrasound-guided small-needle biopsy) will give the highest rate of diagnostic accuracy in the differentiation of malignant from benign thyroid lesions.
Biopsy, Needle↗
[Direct and indirect parameters for free thyroxine. II. Diagnostic accuracy in disorders of thyroid function and binding protein anomalies].
Part II of the study concerning the clinical applicability of direct and indirect parameters for free thyroxine evaluates the diagnostic accuracy of the FT4-RIAs ImmoPhase, GammaCoat, Liquisol, Amerlex and LisoPhase in relation to FT4 index and T4/TBG ratio. This comparison of methods is done on a thoroughly classified collection (n = 640) of patients with normal and impaired thyroid function including patients with binding protein anomalies (pregnancy, estrogen-medication, phenytoin therapy, renal protein loss). FT4 normal ranges of a given kit harmonize well with data of the manufacturers and of the literature. On the other hand, the normal ranges of the various kits are not comparable. The differentiation of euthyroidism from hyper- or hypothyroidism can be made without problems using any of these methods, with the exception of the FT4-RIA GammaCoat. As expected, patients with euthyroid goiter show, on the average, slightly lower parameters for FT4. In pregnancy all direct and indirect parameters for FT4 have a tendency to lower values after the first trimester. This trend is most distinct for the T4/TBG ratio. A weak negative correlation of FT4 parameters with basal TSH, which does not exceed the upper normal range, however, can be interpreted in the sense of a relative hypothyroxinemia. Under contraceptive estrogen medication FT4 parameters do not fall outside the normal range, with the exception of the FT4-RIA ImmoPhase assay which yields a significantly increased frequency of high FT4 levels. On therapy with phenytoin FT4 values are generally lower than in controls. FT4 parameters in patients with renal protein loss of more than 2 g daily do not behave uniformly. While three of the FT4-RIAs tested (ImmoPhase, GammaCoat, Amerlex) show a tendency to lower values, the results of the remaining FT4 parameters do not differ significantly from the distribution of normals. The study leads to the conclusion that indirect FT4 parameters are still useful in the diagnosis of thyroid function; currently available FT4 radioimmunoassays may yield comparable results. With regard to the varying quality of the various commercial test kits, the choice between FT4-RIAs and indirect FT4 parameters does not depend primarily on clinical but on technical viewpoints.
Adult↗
[Direct and indirect parameters of free thyroxine. I. Method, quality control and in vitro experiments on storage of samples and effect of drugs].
The clinical applicability of direct FT4 determinations by the radioimmunoassays ImmoPhase, GammaCoat, Liquisol, Amerlex and LisoPhase is tested in comparison to the FT4 index and the T4/TBG ratio. Part I of this study deals with technical aspects concerning quality control as well as with in-vitro experiments concerning storage of samples and interference of drugs. The precision of FT4-RIAs is satisfactory; inter-assay coefficients of variation are generally lower than 10% for medium hormone concentrations. Because of a change of the standard curve calibration by the manufacturer of the Liquisol kit, the inter-assay variability (17%) of this assay is unacceptably high. The comparison of working ranges shows that the sensitivity of all FT4 assays is sufficient. However, the upper limits of working ranges of the Liquisol and LisoPhase kits are too low. Storing the samples in form of serum yields lower values for any FT4 parameter than storing as whole blood. This unexpected observation is true for room temperature as well as for refrigeration at 4 degrees C. To be sure, the values of indirect FT4 parameters from serum and whole blood coincide somewhat better especially when the samples are stored in the refrigerator. Repeated thawing and refreezing does not influence the results of FT4-RIAs significantly. In vitro testing of drug interferences by addition of therapeutic doses of primidone, phenobarbital, phenytoin and acetylsalicylic acid yields significant effects only for the last quoted pharmaceutical. While the FT4 levels of the Liquisol and LisoPhase assays rise with the acetylsalicylic acid dose according to expectations, the values of the Amerlex and GammaCoat assays decrease. With regard to handling of the tests, there are no special technical problems for all FT4-RIAs tested.
Aspirin↗