Rapid washout of technetium-99m-MIBI from a large parathyroid adenoma.
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Adenoma↗
Biomedical subjects
K Kletter
Publications and source records attributed to K Kletter.
Scintigraphic pitfalls in giant parathyroid glands.
We report a case of hyperparathyroidism with surgically confirmed bilaterally enlarged parathyroid glands mimicking a normal thyroid gland. Technetium-99m-pertechnetate-201Tl chloride subtraction scintigraphy was inconclusive because of suppressed thyroidal [99mTc]pertechnetate uptake after coronary angiography. Technetium-99m-sestamibi double-phase scintigraphy showed homogeneous 99mTc-sestamibi uptake that mimicked a normal thyroid gland and no differential washout, thus leading to an erroneous visual interpretation of a normal scan. Semiquantitative assessment of tracer washout, however, can differentiate between normal thyroid tissue and symmetrical parathyroid uptake mimicking normal thyroid tissue. We conclude that semiquantitative assessment of tracer washout increases the diagnostic sensitivity of 99mTc-sestamibi double-phase scintigraphy if: (a) the interpreter is unaware of the anatomical situation, (b) the scintigraphic delineation of the thyroid is hampered by a blocked tracer uptake or (c) the visual interpretation reveals no differential washout in the neck region.
Aged↗
The role of iodine-123-Tyr-3-octreotide scintigraphy in the staging of small-cell lung cancer.
The purpose of this study is to investigate the role of 123I-Tyr-3-octreotide scintigraphy in staging small-cell lung cancer (SCLC), its efficacy for the discrimination of limited and extensive disease stages and its regional sensitivity for different metastatic locations. Twenty patients with histologically confirmed SCLC and 50 radiologically staged tumors sites were investigated by an imaging protocol including dynamic (0-30 min p.i.), static (30 min, 90 min, 4 hr, 24 hr p.i.) and SPECT (90 min p.i.) studies. The primary tumor site was visualized in 84%, whereas the best delineation was noted in early planar (15-30 min p.i.) and SPECT studies, due to a rapidly decreasing tumor-to-background ratio. Lymph node metastases were seen in 73%, but SPECT was needed for anatomical localization. All three adrenal metastases could be identified in sequential planar images. One clinically unsuspected brain metastasis was seen, whereas a second clinically overt metastasis was not visualized. The global and regional sensitivity for liver and bone metastases was unsatisfactory. In summary, 78% (7/9) of the patients with extensive disease were correctly identified by scintigraphy alone. We conclude that 123I-Tyr-3-octreotide scintigraphy is a substantial tool in the staging work-up of SCLC if it is performed initially to allow fast identification of patients with extensive disease stages and save additional radiological or invasive examinations. Yet, 123I-Tyr-3-octreotide scintigraphy cannot substitute liver sonography or conventional bone scanning in patients who have no scintigraphic evidence of distant tumor spread.
Carcinoma, Small Cell↗
[Recommendations for carrying out nuclear medicine kidney function tests with a gamma camera and computer].
Standardization of nuclear medicine renal studies is required in order to permit the comparison of study results of a patient obtained at different laboratories. Furthermore, standardization is a prerequisite for quality control of the analysis part of the procedure. The guidelines presented here are based on a survey carried out amongst nuclear medicine laboratories in Austria and have been edited and harmonized in a workshop organized by the Austrian Nuclear Medicine Society. The guidelines include detailed descriptions of the requirements of instrumentation, of the methods of acquisition, dosage and radiation dose of the commonly used radiopharmaceuticals and all aspects of the analysis of digital renograms. A comprehensive section deals with the determination of renal clearance from the renogram, further sections cover the usage and recommended methods of captopril renography for the diagnosis of unilateral renal artery stenosis and of the frusemide renogram for the diagnosis of nephropathy and uropathy.
Austria↗
Predictive value of thallium-201-dipyridamole myocardial stress scintigraphy in chronic hemodialysis patients and transplant recipients.
The prognostic impact of thallium(Tl)-201-dipyridamole (DPM) stress and redistribution scintigraphy done in 36 patients on chronic hemodialysis (HD) and in 23 renal transplant recipients (TRs) was evaluated according to cardiovascular complications and survival in a follow-up period of six years. Though symptomatic ischemic heart disease (IHD) was present in 33% of HD patients and in 17% of TRs, 50% and 39%, respectively, had Tl-201 findings indicative of IHD. The duration of HD treatment was similar for patients with an abnormal or normal scintigraphic finding. Abnormal Tl-201 results were seen more frequently in older patients. During follow-up, 27 of 36 HD-patients died, 16 had an abnormal and 11 a normal Tl-201-DPM finding; cardiovascular complications were the cause of death in 88% and 18% of these patients, respectively. Thus the incidence of death from fatal cardiac events was 12% per year at risk for the former and 1.9% per year at risk for the latter. In TRs survival was not different for patients with an abnormal or normal Tl-201 finding (56% vs. 64%). However, fatal or nonfatal cardiovascular events were seen more frequently in patients with an abnormal Tl-201 results (78% versus 7%; p less than 0.0001). Stepwise logistic analysis and survival analysis demonstrated Tl-201-DPM stress/redistribution scintigraphy to be the only predictor for identifying patients at increased risk for cardiovascular events. In patients with abnormal Tl-201-DPM scintigraphy subsequent survival was extended for symptomatic patients as compared to asymptomatic ones )30.3 +/- 21.6 versus 22.0 +/- 17.3 months; p less than 0.008).
Adult↗
Captopril renography and duplex sonography: comparison of two noninvasive methods for the diagnosis and follow-up in renovascular hypertension.
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Captopril↗
Deep vein thrombosis: scintigraphic diagnosis with In-111-labeled monoclonal antifibrin antibodies.
Fifty-two patients suspected of having deep vein thrombosis under-went scintigraphy with an indium-111-labeled monoclonal antifibrin antibody. Venography disclosed deep vein thrombosis in 31 patients. With the whole limb considered an anatomic entity, antifibrin antibody scintigrams obtained 2 hours after injection had a specificity and sensitivity of 81% and 84%, respectively. A higher sensitivity (92%) was found for a subgroup of patients (n = 44) with symptoms for less than 10 days. Regional sensitivities for all patients and for the subgroup, respectively, were 92% and 100% in the calf, 82% and 94% in the popliteal region, 63% and 71% in the thigh, and only 18% and 13% in the pelvis. Additional imaging performed 6 hours and 21 hours after injection in 12 patients and quantitative analysis done from scintigrams with and without blood-pool (technetium-99m human serum albumin) correction did not improve sensitivity. In-111-antifibrin antibody scintigraphy is an accurate method for diagnosis of acute established deep vein thrombosis of the calf and popliteal region; its sensitivity in the thigh is lower, and it is not feasible for diagnosis in the pelvic area.
Adolescent↗
Small bowel function after surgery for chronic radiation enteritis.
The retention of the gamma-emitting 75Se-homotaurocholic acid (SeHCAT) after 72 and 168 h was assessed in 10 patients after ileal resection for radiation injury (group I). 6 patients suffering from chronic postirradiation diarrhea (group II) and 6 patients in whom the ileum had been resected for other indications (group III) were also examined. The retention of SeHCAT was abnormally low (less than 50%) in all cases after 72 h and below 20% in 19 out of 21 cases after 168 h. The length of resected small bowel (groups I and III) was inversely related with SeHCAT retention after 72 h (r = 0.63; p = 0.015), but not after 168 h. There was no correlation between the diarrhea score and the extent of bowel resection, SeHCAT retention or xylose absorption. Hydrogen breath test with lactulose revealed a significantly shortened orocecal transit time in group I, compared to groups II and III. Xylose absorption was significantly reduced in patients with positive 5 g xylose-H2 breath test. In groups I and III, however, xylose absorption tended to improve with increasing time interval following resection (r = 0.79; p = 0.003). It is concluded that radiation injury in addition to small-bowel resection contributes significantly to malabsorption and diarrhea in patients after ileal resection for radiation sequelae. The chronic radiation damage seems to act mainly through impaired motility.
Body Weight↗
Diagnostic potential of diuresis renography: limitations by the severity of hydronephrosis and by impairment of renal function.
Eighty ureterorenal units (65 patients) with upper urinary tract dilatation underwent pressure perfusion studies and diuresis renographies separated by short intervals. Pressure perfusion studies were evaluated as suggested by Whitaker, while wash-out curves of diuretic renographies were analysed quantitatively by calculating peak elimination rates. Upper urinary tract volume was estimated from i.v. urographies and measured directly in 21 cases. Renal function was assessed from base-line renograms and plasma creatinine levels. In patients with minor upper urinary tract dilatation (less than 30 ml) the two procedures agreed in 88% of cases, in those with massive dilatation (greater than 70 ml) agreement was limited to 58%. Diuretic renal scans were more often obstructed than pressure perfusion studies in the latter situation. The effect of severely reduced renal function was less prominent than that of massive dilatation. This was confirmed by the exaggerated response to frusemide reflected by urinary flow measurements in patients with a creatinine clearance of 10 ml min-1 or less. Of the eight patients with severely reduced renal function, who did not show full agreement between the procedures, six had massive dilatation of the upper urinary tract.
Dilatation, Pathologic↗
Functional asplenia after bone marrow transplantation. A late complication related to extensive chronic graft-versus-host disease.
STUDY OBJECTIVE: To evaluate splenic function in bone marrow transplant recipients, with relation to chronic graft-versus-host disease and infections. DESIGN: Survey, outpatients geographically accessible for voluntary participation. SETTING: Bone marrow transplantation referral center. PATIENTS: Fifteen bone marrow graft recipients (13 allogeneic, 2 autologous), out of a total of 33 patients who received transplants at the center and survived more than 6 months after grafting. MEASUREMENTS AND MAIN RESULTS: In 6 of 15 patients impaired splenic function (functional asplenia) was indicated by the presence of Howell-Jolly bodies in peripheral blood smears, reduced spleen size (P less than 0.001), higher platelet counts (P less than 0.01), higher indium-111 labeled autologous platelet recovery (P less than 0.005), reduced splenic blood flow (P less than 0.001), and reduced accumulation of radioactivity at the splenic site (P less than 0.001). All patients with functional asplenia but only 2 patients without functional asplenia had extensive chronic graft-versus-host disease. The incidence of bacterial infections was four times higher in patients with impaired splenic function. CONCLUSIONS: Functional asplenia is a late complication after allogeneic bone marrow transplantation and contributes to the high susceptibility to bacterial infections in patients with extensive chronic graft-versus-host disease.
Adolescent↗
[New aspects of nuclear medicine diagnosis of kidney function: improved potential by pharmacologic intervention and quantitative analytic procedures].
In nuclear medicine new trends in the diagnosis of renal function are based on the introduction of new radiopharmaceuticals, improvements in the methodological part of the procedure and precise pharmacological intervention in response to given indications. Tc99m mercaptoacetyltriglycine (Tc99m MAG3) was tested as replacement for I123 orthoiodohippuric acid (I123 oIH) both in the form of a HPLC purified substance and as an impure kit preparation. HPLC purified Tc99m MAG3 clearance determinations in anuric patients showed a low extrarenal excretion amounting to only about 5% of the total clearance in normal patients. Kit preparations yielded about 90% of the labelled product; impurities were pertechnetate, reduced hydrolyzed Tc99m and chemically unidentified labelled products which showed a significantly lower renal, but increased hepatobiliary excretion in comparison with Tc99m MAG3. The renal clearance with kit preparations of Tc99m MAG3 was 55% of the clearance with oIH at a comparable urinary excretion. Significantly higher protein binding and therefore, a decrease in the distribution volume of Tc99m was found in comparison with I123 oIH. No difference was recorded between the two substances with respect to the renogram curves in normal subjects, apart from a modest delay in the elimination of Tc99m MAG3. For clinical purposes kit preparations of Tc99m MAG3 proved equal to I123 oIH. The influence of angiotensin converting enzyme (ACE) inhibitors (captopril) leads to characteristic changes in the renograms of patients with Goldblatt hypertension. Quantitative criteria for the evidence of haemodynamically significant renal artery stenosis were derived from investigations without and with captopril (25 mg) (I123 oIH and Tc99m DTPA) in 21 patients with essential hypertension. The criteria were defined as follows: a delay in peak activity (Tmax) in the I123 oIH captopril renogram exceeding 2 minutes as compared with the baseline value and/or a lower uptake of Tc99m DTPA in comparison with the uptake of I123 oIH (uptake quotient I123 oIH/Tc99m DTPA greater than 1.2). The diagnostic and prognostic potential of the captopril renogram was compared with that of the captopril test by investigating 34 patients with renal artery stenosis (23 uni-, 11 bilateral) (atherosclerosis: 23, fibromuscular hyperplasia: 11). The captopril renogram was positive more often (n = 12) than the captopril test (n = 4) in patients without renal functional impairment of the stenosed kidney. Similar results were obtained with both methods in patients with atrophic kidneys: captopril renography was positive in all cases with a positive captopril test.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Captopril renography in Goldblatt hypertension.
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Animals↗
Successful outcome of a complicated pregnancy in a renal transplant recipient taking cyclosporine A.
The successful outcome of a pregnancy complicated by reversible renal failure secondary to total ureteral obstruction caused by a pregnant uterus and treated temporarily with nephrostomy is reported. The cyclosporine A (CsA) and prednisone treated female recipient of a cadaveric renal allograft gave birth to a male child, which at 2080 grams was small for gestational age (35 weeks of pregnancy). The child presented neither signs of congenital anomalies or chromosome aberrations nor nephrotoxicity, hepatotoxicity or anemia. Simultaneous measurement of trough CsA blood levels (CsA RIA, Sandoz) displayed reduced values in the child's blood (mother 864 ng/ml-4 hours after oral CsA intake; son 312 ng/ml). Beside postrenal failure the patient's pregnancy was complicated by 7 rejection episodes treated with high doses of methylprednisone (total dose 5 g) with reversible damage of the transplant function, two episodes of a urinary tract infection and increasing anemia necessitating blood transfusions. The HIV negative patient had developed a Kaposi's sarcoma 6 weeks after grafting. The progression of infiltrating skin lesions during pregnancy was not seen.
Adult↗
[Immunoscintigraphy with a technetium 99m-labeled monoclonal antibody in patients with melanoma].
In 24 patients with malignant melanoma the clinical feasibility of immunoscintigraphy (ISC) with a Tc99m-labeled F(ab)2 fragment of an anti-melanoma monoclonal antibody was evaluated. This antibody (225.28S) recognizes a human high molecular weight melanoma associated antigen with restricted tissue distribution, which is expressed on melanoma cells in about 90%. The results of ISC were related with the clinical stage of the patients and the level of invasion of the primary tumor (Clark level). Results of ISC indicate the possibility that patients with the highest Clark level have a higher incidence of false negative scintigrams than those with lower levels of invasion of the primary tumor. In 3 out of 5 patients with Clark level 5 false negative scintigrams were found, whereas in 14 patients with lower Clark levels ISC was true positive, however, the number of metastases was underestimated. 14 of 18 patients with clinical stage II-IIIb had positive scans visualizing 27 of 59 metastases. Thus overall sensitivity was 77% and regional sensitivity 46%. Scintigraphically lesions in lymph-nodes, liver and skin were frequently detected, whereas ISC was less sensitive for lung, bone and brain metastases. No false positive findings were observed by ISC (specificity 100%). Relating the sensitivity and specificity of ISC to the prevalance of disease post-test likelihoods for a normal and an abnormal test result were calculated. Post-test likelihood for the disease with an abnormal scintigraphic finding is 100%. However, with a disease prevalance of 75%, according to our patients, the predicitive value of a normal test result is 60%, thus the post-test likelihood for the disease remains rather high (40%).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Quantitative assessment of the diuresis renogram.
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Diuresis↗
[Method of determining glomerular filtration rate and extracellular fluid volume in the perioperative phase].
In the course of an investigation concerning the renal response in abdominal surgery, we paid special attention to the precision of determination of the glomerular filtration rate (GFR) and extracellular fluid volume (ECF). The influence of the applied mathematical model on calculation using slope techniques was examined. ECF and GFR were measured by single injection of the radioactive tracer 51Cr-EDTA; plasma samples were taken during the first 4 h postinjection. The results were computed according to the compartmental and noncompartmental model. The correlation between two-compartmental and noncompartmental GFR and ECF values was highly significant. However, values calculated from two-compartmental model were significant lower (p less than 0.01) and differences up to 20% were observed. Calculating ECF by the most widely used approximative method (assuming an early equilibrium between the extra- and intravascular part of ECF) yields incredible high values and correlation to other methods was poor. Based on our data, we conclude that GFR and ECF values obtained by compartmental analysis depend on flow rates between the theoretical compartments. Also the use of two or three exponential components for the plasma curve in the course of noncompartmental analysis (as done by most authors) is not any better than compared conventional compartmental analysis. Noncompartmental analysis should be preferred especially when small changes in ECF and GFR are observed, as it is the more accurate.
Body Fluid Compartments↗
Myocardial studies in haemodialysis patients.
Myocardial perfusion was studied using Thallium-201 (Tl-201) after dipyridamol in 33 patients on maintenance haemodialysis. It could be shown that coronary artery disease was underestimated by clinical symptoms, 55 per cent of patients had abnormal Tl-201 scintigrams, whereas typical or atypical chest pain was present in only 33 per cent of the patients. Eleven patients died within a year of the scintigraphic study, which resulted in an average mortality rate of 7.7 per cent/year. The risk of developing fatal cardiovascular complications was higher in patients with an abnormal Tl-201 perfusion (7 of 18) than in those with a normal scintigram (1 of 15). Thus nuclear medicine procedures appear to be of diagnostic value in haemodialysis patients, which in addition may have prognostic implications.
Adult↗