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J J Coupal

Publications and source records attributed to J J Coupal.

At least 19 recordsLinked to original sources
PubMed1993

Communication between peritoneal cavity and mediastinal lymph nodes demonstrated by Tc-99m albumin nanocolloid intraperitoneal injection.

Lymphatic drainage from the peritoneal cavity to mediastinal lymph nodes has been reported, indicating that abdominal fluid is not immobile. We studied this movement in rats receiving Tc-99m albumin nanocolloid which has smaller particle sizes than does Tc-99m microaggregated albumin colloid used for liver/spleen imaging. The Tc-99m albumin nanocolloid had a radiochemical purity of 99.33%-99.77% with free pertechnetate of 0.23%-0.67%. During pentobarbital anesthesia, thoracoabdominal images were obtained 4-6 hr after intraperitoneal injection of 350 mCi Tc-99m albumin nanocolloid with 5 ml of normal saline. The images showed symmetrical radiotracer localization in the mediastinal lymph nodes. Scintigraphic demonstration of drainage to the mediastinal region from the peritoneal cavity may be explained by flow directly into mediastinum through the lymphatic system, indicating lymphatic patency between the peritoneal cavity and mediastinum. Absence of visualization may indicate lymphatic block. This type of information concerning lymphatic drainage may have clinical impact for a patient with malignant or intractable ascites. The radionuclide technique is easily performed for this assessment.

Animals↗
PubMed1990

I-123 HIPDM planar brain images demonstrating crossed cerebellar diaschisis.

I-123 HIPDM or IMP brain planar images, as well as SPECT images, have been useful in the detection of large lesion(s) of the cerebral cortex. Planar imaging may be useful not only for cerebral lesions, but also for a cerebellar abnormality and in certain clinical situations, such as phobia to a gantry or being too heavy for the imaging table, when SPECT imaging cannot be performed. The authors concur that a large cerebral lesion can be detected by planar images; in addition, cerebellar lesions, such as the presence of crossed cerebellar diaschisis (CCD), may be detectable by planar imaging using I-123 HIPDM. This article presents a patient with a large cerebral infarct detected by planar imaging whose CCD has been demonstrated by planar images.

Aged↗
PubMed1990

I-123 hydroxyiodobenzyl propanediamine (HIPDM) cerebral blood flow imaging demonstrating transtentorial diaschisis.

To assess the clinical significance of transtentorial diaschisis (TTD) as demonstrated by I-123 HIPDM brain imaging, SPECT and/or planar images of 35 patients with stroke, 26 patients with Alzheimer's disease (AD), 2 patients with Creutzfeldt-Jakob disease (CJD), and 1 patient with a schizoaffective disorder were analyzed. TTD was observed in 21 of the 35 patients with strokes. In 13 stroke patients, TTD was associated with large infarcts in the middle cerebral artery (MCA) territory; in the remaining 8 stroke patients, TTD was associated with internal capsule and/or basal ganglia infarcts. TTD was not associated with small occipital or parietal infarcts. Despite cortical perfusion decrements, TTD was not seen in the AD patients, the CJD patients, or the patient with schizoaffective disorder. It is concluded that 1) TTD frequently occurs following cerebral infarct of the MCA territory (60% of the patients in this sample); 2) absence of TTD in the presence of a large cerebral perfusion abnormality may represent neuronal dysfunction of the cerebral cortex; and 3) the presence of TTD without a significant cortical perfusion abnormality may indicate basal ganglia and/or internal capsule infarct.

Alzheimer Disease↗
PubMed1990

Iodine-123-HIPDM lung imaging in pulmonary vein-banded pulmonary hypertension.

To evaluate the use of N,N,N'-trimethyl-N,-[2-hydroxy-3-methyl-5 iodobenzyl-1, 3 propanediamine iodine-123 (HIPDM) in lung imagings for the diagnosis of individual pulmonary vein stenosis, 14 single-pulmonary vein-banded rats underwent lung imaging. After i.v. injection of 250-300 microCi [123I]HIPDM lung images were recorded at 2 min by a gamma camera interfaced with a PDP computer. Banded lung demonstrated higher [123I]HIPDM radioactivity than that of nonbanded lungs. The activity ratio of banded-to-nonbanded lungs ranged from 4.0 to 1.22 (average 1.62). Technetium-99m-macroaggregated albumin (MAA) lung images showed decreased perfusion in banded lung, and normal perfusion in the nonbanded lung. Postmortem microscopic changes in pulmonary arteries and veins were compatible with the elevated pulmonary artery and venous pressure in vein-banded lung. Whether the high uptake of [123I]HIPDM in banded lungs relates to endothelial receptors for HIPDM is unknown. Nevertheless, the finding of high lung uptake in banded lung in [123I]HIPDM lung imaging may be potentially used to diagnose individual pulmonary vein stenosis.

Animals↗
PubMed1989

Technetium-99m radiochemical assay by rapid filtration: a superior alternative to chromatography.

A new method for simultaneously measuring radiochemical purity and estimated lung trapping of colloidal technetium-99m (99mTc) radiopharmaceuticals is described. The method employs a small filtration device comprised of two stacked membrane filters, differing in membrane composition and in pore size, situated over a filtrate collection vial. Specifically, an 8-microns pore polycarbonate membrane filter is situated above a 0.22-microns pore mixed-cellulose-esters membrane filter. For assay, a diluted aliquot of radiopharmaceutical is passed through the filtration device. Technetium-99m radioactivity on the membranes and in the vial is then measured. The polycarbonate filter traps and quantitates lung-capillary-occluding particles. The mixed-cellulose-esters filter traps and quantitates radiocolloid particles irrespective of relative size. The filtrate contains free pertechnetate. Within 4 min, this method yields results that compare well with those achieved by conventional techniques. The method works equally well for large colloidal particles [( 99mTc]stannous colloid), intermediate-size particles [( 99mTc]sulfur colloid), and small-size particles [( 99mTc] antimony trisulfide colloid).

Antimony↗
PubMed1988

Application of I-123 HIPDM as a lung imaging agent.

N,N,N'-Trimethyl-N'-(2-Hydroxyl-3-Methyl-5-123I Iodobenzyl)-1,3-Propanediamine.Hcl (123I-HIPDM) has been used for diagnosis of patients with strokes and dementias. Since this radiopharmaceutical is also accumulated in the lung, we routinely performed a lung image or images immediately prior to cerebral planar and SPECT images after a 3-5 mCi 123I-HIPDM injection. During the past 14 months, we obtained 78 (age from 41 to 92 years, average 66.7 +/- 8.9 years; 64 males, 14 females) suspected stroke or dementia patients' lung images. All lung images were correlated to chest X-ray (CXR) or CT and other clinical data. Sixty five of 78 patients had normal lungs showing homogeneous distribution of activity throughout the lungs which correlated well to normal CXR and/or CT studies. Abnormal scintigraphic patterns of the 13 patients included lung defect (5 bronchogenic carcinoma with or without atelectasis) and decreased uptake in apices (8 chronic obstructive pulmonary disease). The findings of pulmonary intrathoracic pathologies on lung images with 123I-HIPDM suggests further evaluation of the agent for detection of localized pulmonary diseases and pulmonary physiological studies relating to amine metabolism.

Adult↗
PubMed1987

Disorders of gallbladder function related to duodenogastric reflux in technetium-99m DISIDA hepatobiliary scintigraphy.

Controversy exists over the relation between gallbladder dysfunction and the propensity for duodenogastric reflux. To evaluate this, Tc-99m DISIDA hepatobiliary imaging studies in 120 patients were reviewed, excluding patients who had had cholecystectomy or subtotal gastrectomy before scintigraphy. Serial images were obtained at 5, 10, 15, 30, 45, and 60 minutes and up to 24 hours, if indicated, after intravenous injection of 5-10 mCi of Tc-99m DISIDA. Normally, the liver, bile ducts, gallbladder, common bile duct, and bowel are visualized sequentially. Reversal of the normal sequence of gallbladder (GB) and bowel visualization indicates GB dysfunction; nonvisualization of the GB reflects cystic duct obstruction or absent GB function. Duodenogastric reflux is identified by radiotracer localized in the area just below or immediately adjacent to the tip of the left hepatic lobe. The intragastric location of the tracer may be verified by oral administration of 300 uCi of Tc-99m sulfur colloid. Twenty-nine patients had duodenogastric reflux between 10 and 60 minutes after injection. Of the 29 patients, 22 had a nonvisualized gallbladder, four had reversal of appearance of GB and bowel activity, and three had a normal study. GB dysfunction or nonfunction is more frequently demonstrated when duodenogastric reflux is present than with normal gallbladder function (P less than 0.001). In conclusion, gallbladder malfunction is closely associated with duodenogastric reflux, an abnormality that may be diagnosed noninvasively by Tc-99m DISIDA hepatobiliary scintigraphy.

Adult↗
PubMed1987

Iodine-123 HIPDM brain imaging findings in subacute spongiform encephalopathy (Creutzfeldt-Jakob disease).

Decreased perfusion of the left frontal and left temporoparietal cortex has been shown in [123I] HIPDM planar and single photon emission computed tomographic images of a patient with Creutzfeldt-Jakob disease (CJD) that was proven by brain biopsy and subsequent autopsy. An EEG showed diffuse, periodic discharges most prominent to the left hemisphere. Concurrent head computed tomography (CT), nuclear magnetic resonance (NMR), and cerebral angiographic studies were negative. Abnormalities demonstrated by [123I]HPDM imaging and by EEG may represent changes in neurophysiological and neurochemical status while cerebral angiography, CT, and possibly NMR register only anatomic or structural lesions. Premortem diagnosis of CJD depends on brain biopsy; the availability of the [123I] HIPDM study may provide regional cerebral neurochemical and neurophysiological information, guiding or avoiding brain biopsy in the appropriate clinical setting.

Aged↗
PubMed1986

Diffuse thoracoabdominal radioactivity seen in bone imaging.

Diffusely increased radioactivity in the thoracoabdominal region (lower thorax and/or upper abdomen) occasionally has been observed when performing Tc-99m phosphonate bone studies. To assess the significance of activity in this finding, 1100 bone scintigrams were reviewed and the clinical data and other diagnostic imaging procedures were evaluated in these cases. With the exclusion of Tc-99m sulfur colloid liver-spleen scans 18 patients were found to have mild but diffuse increased radioactivity in the thoracoabdominal region either on the right or left. Clinical findings in these cases with abnormal uptakes were pleural effusions (six cases), hepatic colonic metastases (six cases), splenic metastases from bronchogenic carcinoma (one case), abdominal and peritoneal colonic metastases (one case), a massive metastatic squamous cell carcinoma (from lung) in the right lower chest (one case), and defective radiopharmaceuticals (three cases). Since the defective radiopharmaceuticals contained 5% of hydrolyzed reduced Tc-99m colloid by thin-layer chromatography, each of three patients received approximately 740 mu Ci of Tc-99m sulfur colloid. Factors to be considered in the interpretation of diffuse thoraco-abdominal activity from a bone agent should include splenic or hepatic metastases, a Tc-99m sulfur colloid splenic or hepatic metastases, a Tc-99m sulfur colloid study within the previous 24 hours, pleural effusion, faulty radiopharmaceuticals, and abdominal and peritoneal colonic metastases.

Abdomen↗
PubMed1986

Demonstration of pulmonary mass defect by iodine-123 N,N,N'trimethyl-N'[2-hydroxy-3-methyl-5-iodobenzyl]-1,3-propanediamine lung imaging.

A patient whose huge lung mass was demonstrated as a large defect on I-123 N,N,N'trimethyl-N'[2-hydroxy-3-methyl-5-iodobenzyl]-1,3-propanediamine (HIPDM) lung imaging is presented. I-123 HIPDM, a lipophilic agent, is designed for early detection of abnormal cerebral perfusion. Since up to 50% of the administered agent is accumulated and perhaps metabolized in the lung, the radiopharmaceutical may be potentially useful for detection of pathology of the lung in addition to evaluation of pulmonary amine metabolism.

Aged↗
PubMed1986

Incidentally evaluating the status of renal function in technetium-99m DISIDA hepatobiliary imaging.

During hepatobiliary imaging studies, approximately 9% of Tc-99m DISIDA normally is excreted via the kidney. In routine 2, 5, 10, 15, 30, 45, and 60-minute images, the kidneys and urinary bladder are best visualized at 5-10 minutes and after 10-15 minutes, respectively. Nonvisualization of the kidney and/or urinary bladder may indicate renal dysfunction. To evaluate this hypothesis, Tc-99m DISIDA hepatobiliary images of 63 patients were correlated with concurrent serum BUN and creatinine levels (measured within 24 hours of the hepatobiliary study). Serum creatinine and BUN values were normal in patients with renal visualization. In patients without renal visualization, 17 of 19 had abnormal BUN and creatinine levels. The values of BUN and creatinine were significantly elevated (P less than 0.001) in patients without renal visualization when compared with those showing renal visualization. One patient had visualization of a single kidney due to a nephrectomy; in another, persistent visualization was due to hydronephrosis. Nonvisualization of the kidneys and/or urinary bladder suggests abnormal renal function, and asymmetric renal activity raises the possibility of renal disease.

Adult↗
PubMed1986

Localization of 99mTc-HMDP in hepatic metastases from colonic carcinoma.

To evaluate the significance and frequency of skeletal imaging agent localization in hepatic metastases from colonic carcinoma, scintigrams from 54 patients were retrospectively studied. Of 54 patients, 22 had hepatic metastases, and skeletal metastases were present in seven of 54. Six of the seven patients with skeletal metastases had concurrent hepatic deposits. Two patterns of bone agent localization in liver metastases occurred: diffuse and mild (10 patients) and ringlike in appearance (two patients). Twelve of the 22 patients had localization of skeletal imaging agent in hepatic metastases and extensive or large liver lesions. Concurrent serum calcium values for nine of 12 patients were reviewed; none had a high level of serum calcium. Among available plain films and /or CT scans of the abdomen for 21 of the 22 patients, only one patient with extensive colonic metastases had multiple calcifications shown on CT but not seen in plain films. The data indicate a high frequency of hepatic metastases in colon carcinoma (22/54, 40%) and a high frequency of skeletal imaging agent localization in the hepatic colonic metastases (12/22, 54.5%). Once skeletal metastases are observed, there are almost always hepatic metastases present (6/7). There was no relation between elevated serum calcium values and bone agent localization in hepatic deposits. The relation between skeletal imaging agent localization or radiographic calcifications and histopathology of colonic carcinoma was inconclusive. The presence of bone agent localization in a 99mTc hydroxymethylene diphosphonate (HMDP) bone study indicates colonic hepatic metastases that are substantially widespread and/or bulky.

Aged↗
PubMed1982

Complementary role of reticuloendothelial and hepatobiliary imaging agents in the assessment of liver disease.

The merit of concomitant hepatic imaging with Tc-99m-sulfur colloid (SC) and Tc-99m-HIDA was examined in 40 patients with abnormal liver function tests. The studies were performed sequentially within a 2 to 5 day interval with 5 mCi each of SC or HIDA. Routine static images in all cases, and dynamic studies with HIDA in 15 patients, were graded and compared with the liver function tests and clinical diagnoses. Of the 40 patients, the images with SC showed an abnormality in 22 while HIDA images were abnormal in 38. Thirteen of 21 patients with hepatocellular diseases showed an abnormality of the SC images, and 20 of the same 21 patients had abnormal HIDA images. Abnormal HIDA images were more closely related to abnormal liver function tests. These results suggest that alterations of hepatic function reflected by abnormal liver function tests are better demonstrated with hepatobiliary imaging agents than with reticuloendothelial imaging agents, while either type of imaging agents will detect focal anatomic lesions.

Humans↗
PubMed1981

Effects of dissolved oxygen on Tc-99m methylene diphosphonate: concise communication.

Tc-99m methylene diphosphonate (MDP) was prepared using stannous methylene diphosphonate (ligand) kits of similar formula from either of two manufacturers (A or B), and physiologic saline of either regular dissolved oxygen content (RDO, 6.7 mg O2/l) or low (LDO, 3.8 mg O2/l). A resulting Tc-99m MDP dose was administered to each of 70 patients for bone imaging. The A + RDO combination led to greater film density in the bone image than did the B + RDO (p less than 0.05). However, use of LDO saline to reconstitute B improved bone-image density to equal that from A + RDO. Overall image quality with A + RDO was judged to be superior to that with either B + RDO (p less than 0.05) or B + LDO (p less than 0.01) by an investigator unaware of the particular DO and ligand combination injected. However, neither bone delineation nor soft-tissue radioactivity on images was judged to be different among the four combinations (p greater than or equal to 0.05). There was also no difference in soft-tissue radioactivity among the four combinations as revealed by image densitometry. Under the conditions of this study, the major differences in clinical performance between products A and B were only minimally affected by the O2 content of the saline used for reconstitution.

Bone and Bones↗