Biomedical subjects
Publications and source records attributed to N Tonami.
Thallium-201 SPECT is reported in a rare case with simultaneously developing double cancers of the lung and the breast. The TI-201 SPECT was initiated to evaluate mediastinal involvement from the lung cancer, and an abnormal tracer accumulation was unexpectedly found in the breast in addition to the pulmonary lesion.
For assessment of gastrointestinal protein loss, seven patients suspected of having protein-losing enteropathy were studied by gamma camera imaging using in-111 transferrin. Four patients with a value equal to or more than 20 ml/day on the alpha-antitrypsin clearance test or a high protein content on the gastric juice showed definite intestinal activity on an early image, demonstrating protein loss. The loss site could be determined by observing the movement of radiotracer within the bowel lumen on the subsequent images. The three patients with a value of less than 20 ml/day in the test showed no obvious intestinal activity throughout the study. Therefore, in-111 transferrin abdominal imaging appears to be useful for determining the loss site as well as for establishing the rapid diagnosis of protein-losing enteropathy.
An unusual pattern of Tc-99m IDA scintigraphy was observed in a 20-year-old woman with arteriohepatic dysplasia (Alagille syndrome). Although neither hepatic imaging with Tc-99m tin colloid nor radiographic CT revealed any morphologic abnormality in the liver, sequential hepatobiliary imaging demonstrated abnormal radiotracer behavior--specifically, differences in tracer clearance between the peripheral and central portions of the liver. Radioactivity was persistently retained in the periphery of the liver, but the central portion showed normal tracer clearance, resulting in a photopenic center surrounded by a hot peripheral rim on the later images. The gallbladder and small intestine appeared promptly. This image pattern may be characteristic for intrahepatic bile duct hypoplasia.
Two different methods to assess the change of split renal function following angioplasty or bypass grafting were studied in a total of 12 patients with renovascular hypertension. The studies were performed before and within seven days after the therapeutic intervention. Split effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) after injections of I-131 hippuran and Tc-99m DTPA were measured using kidney counting corrected for depth and dose, described by Schlegel and Gates. In six of 10 patients with unilateral renal artery stenosis and in two patients with bilateral renal artery stenoses (two of 4 affected kidneys), the split renal function was improved after the therapeutic intervention, in accordance with the drop in blood pressure and the reduction of plasma renin activity. The improvement in ERPF and GFR was more likely in the patients without severely reduced renal function. In such patients, the improvement in ERPF was more pronounced than that in GFR. And in two patients with functional improvement, the Captopril-induced reduction of split GFR in the affected kidney was disappeared after the intervention. Moreover, in the long-term follow-up of three patients with functional improvement, one patient showed the deterioration of split renal function suggesting the relapse of renal artery stenosis. These results suggest that the combined studies of split ERPF and GFR determinations can be useful to evaluate the therapeutic effect as well as the presence or absence of functional improvement after the intervention.
Thallium-201 SPECT was performed in 30 patients with suspected lung cancer. Both early and delayed scans demonstrated abnormal accumulation in all of 23 malignant pulmonary lesions including 21 lung cancer and in two of seven benign conditions. There were significant differences in delayed ratio (uptake ratio of the lesion to the normal lung on delayed scan) and retention index (degree of retention in the lesion) between lung cancer and benign conditions, respectively (p less than 0.01, p less than 0.05). The delayed ratio and retention index revealed that adenocarcinoma showed higher 201Tl accumulation than squamous cell carcinoma and small cell carcinoma (p less than 0.05) and 201Tl clearance in squamous cell carcinoma was faster than in the other two (p less than 0.05). Mediastinal involvement was detected in five of seven patients on delayed scans. The smallest lesion depicted was 1.5 cm in diameter. Two false negatives had small metastases less than 1.0 cm in diameter. This method seems to be useful to detect lung cancer, to differentiate malignant from benign lesions, and to evaluate mediastinal involvement from lung cancer.
Forty patients with ischemic heart disease confirmed by coronary arteriography were performed Tl-201 stress myocardial scintigraphy using SPECT. Fifteen patients had anginal attack during exercise Tl-201 myocardial perfusion study (symptomatic group), and 25 patients had horizontal or downsloping ST segment depression more than 0.1 mV without angina (asymptomatic group). The washout maps were derived from circumferential profile analyses of tomographic short-axis slices, and the data were plotted as a bull's eye map. The patient's washout map was compared with the lower limit of normal (mean--2 SD), and the extent and severity scores were calculated. On visual analysis 87% (13/15) of symptomatic patients showed redistribution, while only 56% (14/25) of asymptomatic patients showed redistribution (p less than 0.05). The extent score was significantly higher in the symptomatic group than in asymptomatic group (37.2 + 23.6 vs. 19.6 + 20.8, p less than 0.05), but severity score was slightly higher in symptomatic group (56.1 + 59.4 vs. 30.0 + 54.8, NS). In conclusion, symptomatic ischemia may be more severe than asymptomatic one and the degree of ischemia may be one of the factors that determine the presence of angina during ischemia.
The kinetics and distribution of I-125 beta-methyl iodophenyl pentadecanoic acid (BMIPP) in rat's heart were studied for separate evaluation of perfusion and metabolism. Tl-201 and BMIPP were simultaneously injected. The experimental groups consisted of control (C), glucose (G) and sodium lactate loaded group (L). In C, myocardial uptake at 5 minutes after BMIPP injection was 3.60% ID/g and remained constant up to 60 minutes. The myocardium/lung ratio (2.44) and the myocardium/muscle ratio (4.55) of BMIPP were almost equal to those of Tl-201. But myocardium/liver ratio was low (1.31). In G, myocardial uptake of BMIPP (1.94 +/- 0.36% ID/g) and g-BMIPP/Tl (0.31 +/- 0.03) at 15 minutes after injection were significantly decreased (p less than 0.001) than those of C (3.16 +/- 0.18% ID/g and 0.48 +/- 0.05). In L. myocardial perfusion was decreased and g-BMIPP/Tl (0.73 +/- 0.14) was significantly higher (p less than 0.01) than those of C. Coefficient of variance of the density within a myocardium, and the ratio of inner to outer layer of myocardium (I/O ratio) were calculated from autoradiogram by videodensitometry. The myocardial distribution of BMIPP was more inhomogeneous, and the I/O ratio was lower than that of Tl-201, although these were not specific for metabolic interventions. In conclusion BMIPP is suitable for SPECT imaging and dual nuclide imaging by BMIPP and Tl-201 will provide informations about myocardial fatty acid metabolism and perfusion.
The split renal function was measured in order to evaluate the alteration of renal function secondary from transient renal vein obstruction. Three microcuries of I-131 Hippuran and 7 microCi of Tc-99m DTPA were injected into the femoral vein of adult male rats 30 min, 3 hr, 6 hr, 2 days and 1 week after the renal vein obstruction for 30 min. Blood samples were taken from the tail vein 5, 10, 15, 20 and 30 min after injection. Immediately after taking blood sample at 30 min, both kidneys and urinary bladder with ureters were taken. The radioactivities of Tc-99m and I-131 of these samples were measured respectively using a well type scintillation counter at the energy ranges of 140 KeV +/- 25% and 360 KeV +/- 25%. In the obstructed side, the blood clearances of I-131 Hippuran (ERPF) and Tc-99m DTPA (GFR) were decreased at 30 min and 6 hr after the release of left renal vein obstruction. Therefore the filtration fraction was not significantly changed. In conclusion, the single study using either Tc-99m DTPA or I-131 Hippuran may be enough to evaluate the alteration of split renal function in a model of renal vein obstruction, although the combined study using both agents is more preferable.
To evaluate the mechanism for prolonged retention of In-111 monoclonal antibody (MoAb) by the liver, we investigated the subcellular kinetics of the In-111 225.28S, an antimelanoma IgG2a. Forty microCi/10 micrograms of the In-111 MoAb was injected IV into groups of SD rats. The liver was excised at 3, 8, 17, 24, 48 and 72 hr and homogenized with 0.25 M sucrose containing 0.01 M Tris-HCl buffer (pH 7.6). Subcellular fractionation was carried out by 3-step (ultra-)centrifugation. The radioactivity of each fraction including nuclear, mitochondrial (lysosomal), microsomal and supernatant fraction was measured and expressed as a percentage of the total radioactivity of all the fractions. Moreover, the supernatant fraction was assessed by size exclusion HPLC. The supernatant was a predominant fraction of the In-111 radioactivity, 61% at 3 hr, and was decreased with time, 21% at 72 hr (p less than 0.01), while the activity in the mitochondrial fraction continued to increase from 11% to 44%. As compared to these two fractions, the nuclear and microsomal radioactivities were relatively constant, 10-25%, throughout the study. The HPLC analysis revealed that the supernatant In-111 activity at early time points was mainly eluted with an intact IgG and thereafter this major peak activity was reduced with associated activity peaks found in smaller moiety fractions. To compare the In-111 MoAb with the iodine labeled MoAb, we also investigated the subcellular kinetics of the I-125 MoAb in the same manner.(ABSTRACT TRUNCATED AT 250 WORDS)
The retention values for 42K, 86Rb and 134Cs in the tissues and blood were quite similar to those for 201Tl, but were very different from those for 22Na. In an experiment for subcellular fractionation of tumors, most of these nuclides were localized in the supernatant fraction, with small amounts in other fractions. The concentration ratios for these nuclides in each fraction were approximately constant regardless of the time after administration. Radioactive alkaline metals in the supernatant fraction of the tumor homogenate existed mostly as free ions and were bound to protein in other fractions of tumor tissue. These results were essentially the same as those for 201Tl. Ouabain suppression studies indicated that 201Tl is taken up into the tumor cells partly through Na+, K+-ATPase of their membranes. Ionic radii of alkaline metals and thallium were related to their blood and tumor retention values. This relationship suggested that monovalent cations whose ionic radii exceed 0.133 nm, and which exist as free ions in the tissue fluids, behave like the potassium ion. Potassium and K analogs (Tl, Rb, Cs) are avidly taken up into viable tumor cells whose Na+, K+-ATPase activity is elevated. Therefore, suitable radionuclides of K and K analogs can be excellent agents for visualization of viable tumor tissues.
A new method of oral administration of an enteric coated capsule of 201Tl (201Tl-capsule) was developed to evaluate the portal circulation through the superior mesenteric vein (SMV). The 201Tl-capsule was not collapsed in the artificial gastric juice, whereas it melted soon after soaking in the artificial intestinal juice. In a clinical trial of 42 cases, 201Tl was satisfactory released in the duodenum in 36 cases where clear liver images were observed except in 1 patient. Heart to liver ratio (H/L) at 60 or 90 min after duodenal release of 201Tl was 0.32 +/- 0.07 (mean +/- 1 s.d.) in normal controls, 0.34 +/- 0.12 in chronic hepatitis, 0.31 +/- 0.12 in acute hepatitis, 0.45 +/- 0.13 in liver cirrhosis and 0.48 +/- 0.32 in cirrhosis with hepatocellular carcinoma. In 11 patients who had both oral and rectal studies with 201Tl, 7 showed a high H/L ratio of more than 0.8 in the rectal study but only 1 showed a similarly high ratio of 1.07 in the oral study. In the group of varied liver disorders we have studied so far, it was found that most of the SMV blood flowed into the liver and the degree of portal systemic shunting (PSS) from the SMV was much smaller compared to that from the inferior mesenteric vein. The present study with oral administration of the 201Tl-capsule was of value in understanding portal circulation through the SMV, however, this technique seemed of limited usefulness for evaluating overall pathologic PSS.
We developed monoclonal antibodies against human thyroid cancer-associated antigen by fusing mouse myeloma cells with mouse spleen cells immunized by insoluble fraction of homogenized thyroid papillary carcinoma cells. One monoclonal antibody (KTC-3, IgM) was selected to evaluate basic usefulness for radioimmunoscintigraphy in xenografted human thyroid carcinoma. KTC-3 was labeled with 131I by Iodogen method of 20 to 1 Iodogen to IgM molar ratio. It was also labeled with 111In by cyclic DTPA anhydride method of 20 to 1 DTPA to IgM molar ratio. The labeling efficiency and specific activity for 131I labeling were 16.5% and 0.66 mCi/mg IgM respectively, and those for 111In labeling were 12.7% and 1.6 mCi/mg IgM. Imaging and biodistribution of labeled KTC-3 were evaluated in nude mice bearing thyroid anaplastic carcinoma (THC-5-JCK). The tumors were well visualized 3 and 5 days after injection of 131I KTC-3. Tumor uptake of 131I KTC-3 on day 7 was 0.52 +/- 0.27% ID/g and tumor to blood ratio was 1.98 +/- 0.76 (n = 6). Those of 111In KTC-3 were 0.88 +/- 0.09% ID/g and 5.51 +/- 3.36 (n = 6). In conclusion, KTC-3 is promising for radioimmunoscintigraphy of thyroid cancer.
Twenty-six specimens obtained from 23 patients with clinically and laboratory-proven silent thyroiditis were examined histologically; 11 specimens were obtained during the thyrotoxic phase, and 15 specimens during the early or late recovery phase. All specimens showed chronic thyroiditis, focal or diffuse type; and lymphoid follicles were present in about half of the specimens. Most specimens showed neither stromal fibrosis nor oxyphilic cell changes. The follicular disruptions, which varied from moderate to severe and involved nearly all the visible follicles, were characteristic and common histologic features of this disorder. Giant cells were present in about two thirds of specimens. Six of the 7 specimens taken during the late recovery phase showed no follicular disruption. In 3 patients who had follow-up biopsies, the histologic involvement in the initial biopsy specimens clearly had disappeared in the second biopsy specimens. These histologic features indicate that silent thyroiditis may be a form of chronic thyroiditis, i.e., "chronic thyroiditis with marked follicular destruction." Thyroid biopsy is recommended as a useful tool in differentiating this disease from other thyroid diseases causing hyperthyroidism. In addition to the histologic analysis, intrathyroidal lymphocyte subsets were examined immunohistochemically and compared to those in chronic thyroiditis (Hashimoto's thyroiditis). In both silent and chronic thyroiditis, a great majority of lymphocytes infiltrating between thyroid follicles showed a T-cell phenotype, and no significant differences in T-cell and B-cell distribution between the diseases were observed.
A case is presented in which uptake of Tc-99m DTPA has been demonstrated in an extramedullary plasmacytoma of the retroperitoneum. Because Ga-67 citrate does not concentrate in the same areas as Tc-99m DTPA, a radionuclide-specific uptake mechanism may be present. Extramedullary plasmacytoma should be included in the list of possible causes if extrarenal or extracentral nervous system uptake of Tc-99m DTPA occurs.
Delineation of malignant tumor by scintigraphy is divided into two categories; visualizing tumor as positive foci or negative foci. Our clinical experiences with 67Ga, 201Tl, 131I-MIBG and 131Imonoclonal antibodies including 111In-ZMEO18 were described and literatures relevant to positive delineation of malignant tumor were reviewed.
Tl-201 per-rectal scintigraphy was performed before and after injection sclerotherapy of esophageal varices and/or partial splenic embolization in patients with esophageal varices to observe the changes of portal systemic shunting by these treatments. The changes in the heart-to-liver uptake ratio of Tl-201 after injection sclerotherapy ranged widely from a decrease to an increase with a mean change rate (mean of the absolute value of change rate) and one standard deviation of 19.0 +/- 19.9%. By partial splenic embolization the heart-to-liver uptake ratio was decreased significantly with the mean change rate and one standard deviation of 26.2 +/- 17.4% (P less than .05). This noninvasive and simple method seems to be useful in evaluating pathophysiological changes of portal systemic shunting observed from inferior mesenteric vein blood flow after treatments of portal circulation system.
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Tl-201 per-rectal scintigraphy was performed before and after injection sclerotherapy of esophageal varices and/or partial splenic embolization in patients with esophageal varices to observe the changes of portal systemic shunting by these treatments. The changes in the heart-to-liver uptake ratio of Tl-201 after injection sclerotherapy ranged widely from a decrease to an increase with the mean change rate (mean of the absolute value of change rate) +/- 1 SD of 19.0% +/- 19.9%. By partial splenic embolization the heart-to-live uptake ratio was decreased significantly with the mean change rate +/- 1 SD of 26.2% +/- 17.4% (P less than 0.05). This noninvasive and simple method seems to be useful in evaluating pathophysiological changes of portal systemic shunting observed from inferior mesenteric vein blood flow after treatments of portal circulation system.