Biomedical subjects
Publications and source records attributed to M Salvatore.
Thallium-201 was given to 71 patients with various pulmonary diseases. Positive uptake was noted in primary malignant neoplasms and also in 6 cases of Hodgkin's lymphoma. No uptake was seen in pulmonary diseases other than active tuberculosis. A disadvantage is the high myocardial accumulation of this radionuclide which impairs proper visualization of paracardiac neoplasms.
A case of accessory thyroid in the anterior mediastinum, physically separated from the thyroid gland, is reported. The mediastinal thyroid was incidentally discovered during the preoperative evaluation of a patient with breast carcinoma. The extreme rarity of the case is outlined.
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The responses of seven hpv-77 rubella vaccinees to initial challenge with "wild" rubella virus have been compared with their responses to rechallenge with Brown strain rubella virus and to the responses of five "natural" immunes to initial Brown strain challenge. Previous exposure to "wild" rubella virus 220 days post vaccine-induced immunity had resulted in six of the seven vaccinees experiencing asymptomatic reinfection. On "rechallenge" none of the previously "reinfected vaccine immunes" demonstrated clinical, virologic or serologic evidence of reinfection. These data are consistent with the conclusion that persons with vaccine-induced immunity may be assured of more prolonged and solid immunity to rubella without having to suffer the clinical disease if they are reinfected with nonattenuated rubella virus. Rigidly controlled experiments, designed to study the practicality and safety of immunization with live rubella vaccine(s), followed by deliberate challenge of vaccinees with "wild" or low tissue culture passage rubella virus, seem warranted. In addition, these data indicate that it is imperative that a distinction should be made between "vaccine immunes" and previously "reinfected vaccine immunes" in any evaluation of long term rubella vaccine(s) efficacy and vaccine-induced antibody decay.
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A magnetic resonance (MR) image processing technique that uses a single color image for simultaneous presentation of spin-echo information and its application to MR studies of the brain is described. Relaxation rate and proton-density maps were calculated from 160 brain MR studies performed at 1.5 and 1.0 T with standard spin-echo sequences. Maps were fused into single color images, with R1, R2, and proton density coded, respectively, by red, green, and blue. The possibility of standardizing the technique was evaluated. Comparative analysis of color and conventional MR images of white matter disease and brain tumors was performed to assess intra- and interobserver variability. Unequivocal and reproducible chromatic characterization of normal brain structures and a variety of lesions was obtained. Intra- and interobserver analysis showed that color images can be used as a diagnostic tool. The technique may provide a simplified and timesaving approach for interpretation and presentation of brain MR studies.
BACKGROUND: We evaluated the prognostic value of exercise 201Tl indexes of myocardial hypoperfusion in patients with suspected or known coronary artery disease. METHODS AND RESULTS: Patients were divided into two groups: group I consisted of 332 patients with diagnostic electrocardiographic stress test results and group II consisted of 144 patients with nondiagnostic (inadequate or uninterpretable) stress electrocardiograms. At the 2-year follow-up, 20 hard events (16 cardiac deaths and 4 nonfatal myocardial infarctions) and 80 soft events (coronary revascularization procedures) occurred in group I. Considering total events, thallium imaging provided significant prognostic information in addition to clinical and exercise stress test data in the total study population (p < 0.001) and in patients with previous myocardial infarction (p < 0.001); in patients without previous infarction, thallium imaging added incremental prognostic value only in those with positive electrocardiographic stress test results (p < 0.01). When only hard events were considered, thallium variables added further information only in patients with previous myocardial infarction (p < 0.05). In group II at the end of follow-up, 15 hard and 39 soft events had occurred. In these patients occurrence of total (p < 0.001), hard (p < 0.05), and soft (p < 0.001) events was higher in those with abnormal thallium scintigraphic results than in those without. Moreover, no clinical and exercise variable, except history of myocardial infarction, was significantly related to outcome, whereas both indexes of extent and severity of hypoperfusion were significant. CONCLUSIONS: The results of this study demonstrate that scintigraphic indexes of myocardial hypoperfusion obtained by qualitative planar thallium imaging give unique prognostic information in patients with nondiagnostic electrocardiographic stress test results. Thallium imaging provides incremental prognostic information even in patients with diagnostic electrocardiographic stress test results but not in the low-risk subset of patients without previous infarction who have negative electrocardiographic stress test results.
BACKGROUND: We compared rest-redistribution thallium 201 and resting technetium 99m methoxyisobutyl isonitrile (MIBI) cardiac imaging in 29 men with angiographically proven coronary artery disease and regional ventricular dysfunction. Left ventricular ejection fraction at radionuclide angiography was 35% +/- 9%. METHODS AND RESULTS: Regional left ventricular wall motion was assessed on gated 99mTc MIBI images according to a 3-point scale (0 = normal, 1 = hypokinetic, 2 = akinetic or dyskinetic). 201Tl and 99mTc MIBI uptake values were analyzed quantitatively. A total of 435 myocardial segments were classified on the basis of wall motion analysis into three groups: group 1 (normal wall motion; n = 201), group 2 (hypokinetic; n = 132), and group 3 (akinetic or dyskinetic; n = 102). 201Tl and 99mTc MIBI uptake values were significantly higher in groups 1 and 2 compared with group 3 (p < 0.05) and in group 1 compared with group 2 (p < 0.05). When 201Tl and 99mTc MIBI uptake values were directly compared, no significant differences in group 1 and 2 were observed. In group 3, 99mTc MIBI uptake (67% +/- 14%) was significantly lower (p < 0.001) than initial (72% +/- 11%) and delayed 201Tl uptake (73% +/- 12%). CONCLUSION: Thus rest-redistribution 201Tl and resting 99mTc MIBI cardiac imaging reflect the severity of left ventricular dysfunction in coronary artery disease. However, in segments with severely impaired regional ventricular function, 201Tl uptake is significantly higher than 99mTc MIBI uptake.
Although the liver and spleen are frequently involved in primary systemic amyloidosis, the clinical manifestations of hepatic and splenic involvement are usually mild and a dominant symptomatic hepatic presentation is uncommon. We report a case of a 51-year-old woman with giant hepatomegaly, hypertransaminasemia, increase in alkaline phosphatase, and ascites, in whom the findings of dual-phase spiral computed tomography suggested liver and splenic amyloidosis.
In the peritoneal cavity, diffuse serosal replacement by tumor is demonstrated usually by extensive carcinomatous involvement from gastric, colonic, or pancreatic tumors or less frequently by mesothelioma. Primary tumors other than mesothelioma are extremely rare in the peritoneum. The computed tomographic appearances of two cases of rare peritoneal tumors, epithelioid hemangioendothelioma and desmoplastic small round cell tumor, are described.
BACKGROUND: This study was designed to compare the results of rest-redistribution thallium-201 imaging with those of rest technetium 99m furifosmin single photon emission computed tomography in the same patients with chronic ischemic left ventricular (LV) dysfunction. METHODS: Twenty-one patients (mean age 62 +/- 9 years) with chronic myocardial infarction and LV dysfunction (mean LV ejection fraction 34% +/- 8%) underwent rest-redistribution thallium imaging and resting furifosmin single photon emission computed tomography on the same day. In each patient, regional thallium and furifosmin activity was quantitatively measured in 13 myocardial segments. Regional LV function was assessed in corresponding segments by echocardiography. RESULTS: At thallium imaging, 91 (33%) segments had normal uptake, 16 (6%) showed reversible defects, and the remaining 166 (61%) irreversible defects. Of these 166 irreversible defects, 74 (45%) had moderate (> or =58% of peak activity) and 92 (55%) severe (<58% of peak activity) reduction of thallium uptake. Regional furifosmin uptake was significantly related to both rest (r = 0.87, P < .0001) and redistribution (r = 0.90, P < .0001) thallium activity. Agreement in the evaluation of regional perfusion status between thallium and furifosmin imaging was observed in 70% of the 84 hypokinetic segments (kappa = 0.54) and in 76% of the 78 akinetic or dyskinetic segments (kappa = 0.60). Concordance in the detection of myocardial viability between thallium and furifosmin imaging was observed in 69 (82%) of hypokinetic regions (kappa = 0.60) and in 65 (83%) of akinetic or dyskinetic regions (kappa = 0.67). CONCLUSIONS: These results suggest that in patients with chronic coronary artery disease and LV dysfunction, quantitative rest-redistribution thallium scintigraphy and furifosmin tomography at rest provide similar results in the evaluation of perfusion status and in the detection of myocardial viability.
BACKGROUND: Exercise and dipyridamole 99mTc-labeled methoxy isobutyl isonitrile (MIBI) myocardial scintigraphy have been widely used for the diagnosis of coronary artery disease (CAD). However, only limited data on adenosine 99mTc-labeled MIBI cardiac imaging are currently available. This study was designed to assess the accuracy of quantitative adenosine-rest 99mTc-labeled MIBI tomography in the diagnosis and localization of CAD. METHODS AND RESULTS: Fifty-seven consecutive patients with suspected CAD who underwent coronary angiography and 22 normal volunteers were studied. All patients underwent 99mTc-labeled MIBI tomography after administration of adenosine (140 micrograms/kg intravenously for 6 minutes) and at rest. A total of 171 vascular coronary territories were analyzed quantitatively. All patients with CAD (> or = 50% luminal stenosis) (n = 55) had abnormal 99mTc-labeled MIBI tomograms. The normalcy rate was 86% by quantitative analysis. Overall sensitivity, specificity, and diagnostic accuracy for detection of individual stenosed vessels were 84%, 87%, and 85%, respectively. In patients with one-vessel CAD (n = 24), sensitivity and diagnostic accuracy in the detection of individual stenosed vessels were significantly (p < 0.05) higher compared with patients with multivessel CAD (n = 31). Moreover, 75% of patients with one-vessel disease showed a scintigraphic pattern characterized by the presence of perfusion defects in only one coronary artery territory, and 74% of patients with multivessel disease showed a scintigraphic pattern characterized by the presence of perfusion defects in two or more coronary artery territories. Sensitivity, specificity, and diagnostic accuracy for detecting individual diseased vessels were similar in patients without previous myocardial infarction (n = 18) compared with those with previous myocardial infarction (n = 39). In myocardial territories related to noninfarcted areas (n = 124), sensitivity and specificity in the detection of stenosed vessels were 75% and 88%. In infarcted areas (n = 47), sensitivity and specificity in the detection of stenosed vessels were 98% and 80% (differences not significant vs noninfarcted areas). CONCLUSIONS: Adenosine-controlled coronary vasodilation combined with quantitative 99mTc-labeled MIBI tomography is accurate for identifying patients with CAD and localizing individual stenosed coronary arteries.