Progressive diaphyseal dysplasia masquerading as shoulder capsulitis in an adult.
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Adrenal Cortex Hormones↗
Biomedical subjects
O Israel
Publications and source records attributed to O Israel.
The role of Ga-67 scintigraphy in evaluating the results of therapy of lymphoma patients.
Gallium-67 scintigraphy using high-dose, modern equipment, and SPECT plays an important role in the evaluation of patients with lymphoma after treatment. Being a viability agent, taken up by lymphomatous, but not by necrotic or fibrotic tissue, it is used to assess the nature of a residual mass after treatment. Gallium also predicts disease-free survival and overall survival after treatment. It is used with high sensitivity and specificity for diagnosis of recurrence after a continuous clinical remission, which is achieved after successful treatment. A potential use for Gallium is in early evaluation, during treatment, of the rapidity of response. This evaluation determines early the effectiveness of therapy in the individual patient. After treatment Ga-67 scintigraphy appears to be superior to computed tomography and probably magnetic resonance imaging. It is used routinely in the management of patients with lymphoma.
Disease-Free Survival↗
Ga-67 scintigraphy with a dual-head camera.
High quality images are necessary for correct interpretation of Ga-67 studies in lymphoma. The authors were interested if there is a significant change in the quality of the Ga-67 images using a newly introduced dual-head camera compared with a conventional single-head camera. The tomographic spatial resolution, full width at half maximum, was found to be 9.63 mm compared with 13.7 for a single-head camera. The volume sensitivity was 380 cps/microCi/ml per axial cm as compared with 333 cps/microCi/ml, and point source sensitivity was 5.6 cps/microCi compared with 3.8. There was a significant difference (P < 0.001), when using the threshold technique, in the number of counts per pixel over a wide range of volumes and concentrations in phantoms when the two cameras were compared. There was also a significant difference (P < 0.001) in Ga-67 uptake in lymphoma lesions in patients when the same parameters were used for both cameras when using SPECT. The average uptake in lymphoma lesions, using a dual-head camera, was 529 counts/pixel with a range of 112 to 1275 counts/pixel in different tumors. With a single-head camera, the average for the same tumor was 216 counts/pixel with a range of 59 to 469 counts/pixel. The high sensitivity of the dual-head camera enabled high-quality, whole body scintigraphy, including the limbs, in 20 minutes compared with the 35 minutes necessary for the single-head camera for images which did not include the legs. Whole body Ga-67 scintigraphy is shown to be important in patients with lymphoma of the upper and lower limbs.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Bone loss in patients with chronic renal disease: prediction with quantitative bone scintigraphy with SPECT.
PURPOSE: To determine whether quantitative bone scintigraphy (QBS) with single-energy photon emission computed tomography (SPECT) can help predict which patients with chronic renal disease will show bone mineral density (BMD) loss. MATERIALS AND METHODS: In 18 patients, the percentage of injected dose of technetium-99m methylene diphosphonate per cubic centimeter of bone was measured with QBS SPECT in the lumbar vertebrae and femoral neck. The differences in BMD over an average of 20 months were measured and compared with SPECT measurements. QBS values were also compared with serum bone turnover markers. RESULTS: There was a negative correlation (r = -.54, P < .05 for the lumbar spine and r = -.60, P < .01 for the femoral neck) between QBS values and bone loss. Positive and negative predictive values, sensitivity, and specificity of QBS for bone loss in the lumbar spine were 78%, 71%, 78%, and 71%, respectively, and in the femoral neck, 82%, 100%, 100%, and 78%, respectively. Differences between predictive values of serum bone turnover markers were not statistically significant. CONCLUSION: QBS with SPECT enabled prediction of rapid bone loss in patients with renal disease.
Absorptiometry, Photon↗
Single-photon emission computed tomography quantitation of gallium citrate uptake for the differentiation of lymphoma from benign hilar uptake.
PURPOSE: To assess the role of quantitative gallium citrate (Ga 67) single-photon emission computed tomography (SPECT) in differentiating lymphoma from benign hilar uptake, concentrations of Ga 67 in 29 sites of documented lymphoma and in 75 benign lesions were compared. PATIENTS AND METHODS: One hundred seven thoracic Ga 67 SPECT studies obtained in 101 consecutive lymphoma patients were reviewed. Fifty-nine studies detected Ga 67 uptake in the hilar and or mediastinal regions. Forty-eight studies showed no such abnormality. The concentration of Ga 67 in the thoracic lesions was measured using a quantitative SPECT technique and its nature was determined by correlation with computed tomographic (CT) scans and follow-up evaluation of the sites. RESULTS: In 20 of 59 abnormal studies (34%), there was lymphoma in the hilar and or mediastinal regions. In the remaining 39 abnormal studies (66%), Ga 67 uptake was benign. There were 29 sites of lymphoma and 75 benign lesions. The concentration of Ga 67 in lymphoma was significantly higher than in benign hilar uptake (13.2 +/- 5.4 %ID/mL x 10(-3) v 5.6 +/- 1.5 % injected dose (ID)/mL x 10(-3); P < .001). A concentration value of 8.3 %ID/mL x 10(-3) was found to best separate lymphoma and benign uptake, with a sensitivity of 90%, a specificity of 93%, a positive predictive value of 84%, and a negative predictive value of 96%. CONCLUSION: Lymphoma and benign hilar uptake differ significantly in their concentration of Ga 67. The present study shows that quantitative Ga-67 SPECT reliably differentiates lymphoma and benign uptake.
Adolescent↗
SPECT diagnosis of Creutzfeld-Jacob disease.
SPECT with 99mTc-HMPAO was performed on a 65-yr-old patient with Creutzfeld-Jacob disease. Cerebral blood flow was heterogeneously decreased throughout the brain, differing from the pattern observed in other common types of dementia. These results suggest that HMPAO-SPECT may provide useful information in the differential diagnosis of dementia, specifically when Creutzfeld-Jacob disease is suspected.
Aged↗
Liver involvement in lymphoma: role of gallium-67 scintigraphy.
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Adult↗
Gallium-67 scintigraphy in lymphoma with bone involvement.
UNLABELLED: Both Hodgkin's and non-Hodgkin's lymphoma (NHL) may involve bone. Traditionally, 99mTc-MDP bone scintigraphy has been used to detect such involvement. In recent years, 67Ga scintigraphy has shown to be useful in monitoring treatment response in lymphoma. Although 99mTc-MDP has not been found particularly useful for monitoring bone response to cancer treatment, we were interested in whether 67Ga scintigraphy and SPECT could be used to monitor bone involvement with lymphoma. METHODS: Gallium-67 and 99mTc-MDP uptake were investigated in 20 patients with lymphoma involving the bone before treatment. Gallium-67 scans were done in 16 patients for monitoring response to treatment in the bone lesions. RESULTS: Gallium-67 studies diagnosed bone lesions in 19 of the 20 patients. Technetium-99m-MDP detected bone lesions in all patients investigated. In four patients, uptake by Ga-67 was more intense than 99mTc-MDP and in another four patients 99mTc-MDP uptake was more evident. Gallium-67, however, was useful in detecting other regions of involvement in 18 of the 19 patients with soft-tissue lymphoma lesions. Gallium-67 scintigraphy also correctly monitored bone response to treatment in all but one of the 16 patients who had 67Ga scintigraphy after completing therapy. CONCLUSION: Gallium-67 uptake by lymphoma involving the bone can be used to monitor osseous response to treatment.
Adolescent↗
SPECT quantitation of cobalt-57-bleomycin to predict treatment response and outcome of patients with lung cancer.
UNLABELLED: Our hypothesis is that the concentration of 57Co-bleomycin (Co-bleo) in lung tumors reflects tumor cell kinetics and thus, prognosis. The relationship between the tumor concentration of Co-bleo measured in vivo by quantitative SPECT, response to chemotherapy and survival was investigated. METHODS: Twenty patients with small-cell lung carcinoma (SCLC) and 49 patients with non-small-cell lung carcinoma (NSCLC) were studied. The concentration of Co-bleo was measured by SPECT in vivo in the tumor. The correlation between Co-bleo concentration in the tumor and the fraction of Co-bleo bound to DNA was investigated in an EMT6 murine tumor model and in samples of eight human tumors. RESULTS: Tumors that did not respond to treatment showed a significantly higher Co-bleo concentration 8 hr after injection than tumors that responded (5.83% +/- 1.97% ID/cc * 10(-3) versus 2.55% +/- 1.23% ID/cc * 10(-3), p < 0.001). Values of Co-bleo concentration of 2.97% ID/cc * 10(-3) for SCLC and 2.72% ID/cc * 10(-3) for NSCLC were found to best separate patients into short- and long-term survival groups. In the EMT6 murine tumor model, a good correlation was found between the concentration of Co-bleo in the tumor and the fraction of Co-bleo bound to DNA (r = 0.75). In human tumor samples, a good correlation was found between DNA-bound Co-bleo measured in vitro and the concentration measured in vivo by SPECT (r = 0.85). CONCLUSIONS: SPECT-measured Co-bleo concentration predicts the response to treatment and the outcome in patients with lung tumor by showing Co-bleo binding to DNA and tumor cell kinetics.
Aged↗
Bone turnover in cortical and trabecular bone in normal women and in women with osteoporosis.
UNLABELLED: This study is based on the assumption that is bone turnover, shown by the uptake of 99mTc-MDP, indicates a high rate of bone loss in patients with osteoporosis, it could potentially predict bone loss in patients at risk before significant bone loss has occurred. METHODS: Quantitative bone SPECT (QBS) using 99mTc-MDP, expressed as the %ID/cc x 10(-3), was performed in 71 women who had osteoporosis in the lumbar vertebrae, the femoral neck or both, and in 54 age-matched normal female controls. Of the women with osteoporosis, 42 had postmenopausal osteoporosis and 29 had primary hyperparathyroidism (HPT) and osteoporosis. RESULTS: QBS increased with age in the cortical bone and decreased in the trabecular bone of the normal women. Quantitative bone SPECT in the femoral neck was 3.18 +/- 1.20 and was 2.73 +/- 1.06 in the femoral shaft in 20 women with postmenopausal osteoporosis of the femoral neck. In 19 women with HPT and osteoporosis of the femoral neck, the QBS value in the femoral neck was 3.57 +/- 0.92 and in the femoral shaft 3.38 +/- 1.12. These values were also significantly higher for the femoral neck and for the femoral shaft than those of normals. Although QBS values were higher in the lumbar region in 39 women with postmenopausal osteoporosis (4.59 +/- 1.45) and in 27 women with HPT (4.30 +/- 1.52), as compared with the normal group (4.28 +/- 1.61), the difference was not statistically significant. CONCLUSION: This study shows that bone turnover is significantly higher in the cortical bone of women with osteoporosis than in normal women.
Bone Density↗
Gallium-67 uptake in a mass of benign transformation mimicking recurrence of nodular lymphocytic predominance Hodgkin's disease.
Gallium-67 is now widely used in the management of lymphoma patients. It is not, however, tumor-specific and reasons for uptake in nonmalignant and premalignant lesions associated with lymphoma should be recognized. Gallium-67 uptake in a mass of progressively transformed germinal centers and sarcoid-like reaction, mimicking recurrence in a 31-yr-old man with nodular lymphocytic predominance Hodgkin's disease, is described. Gallium-67 was taken up on two occasions and a recurrence was suspected. On the first occasion, abnormal uptake was present in axillary lymph nodes and on the second in mediastinal and parahilar lymph nodes. Histology of the lesions on both occasions showed progressively transformed germinal centers and sarcoid-like reaction but no evidence of Hodgkin's disease (HD). Bilateral parahilar abnormal uptake of 67Ga disappeared spontaneously without treatment after several months. The mass on CT regressed but did not disappear. This case demonstrates that the appearance of a new mass which takes up 67Ga in lymphocytic-predominance HD during a continuous clinical remission does not necessarily indicate recurrence and the need for treatment. It suggests that a biopsy should be performed to determine the nature of the lesion.
Adult↗
Evaluation of maxillofacial vascular abnormalities with Tc-99m RBC.
Three-phase scintigraphy using Tc-99m RBC was performed in seven patients with vascular abnormalities of the maxillofacial region. Scintigraphy was able to distinguish whether the lesions had increased perfusion (three patients) or only a large venous component (four patients), and thus helped in assessing the best route for contrast angiography. In four patients a recurrence was suspected. In one, a follow-up Tc-99m RBC study showed successful embolization therapy and no recurrence, and in three patients it showed early recurrence of the lesion. The results of this report indicate the value of Tc-99m RBC scintigraphy in the management of patients with vascular abnormalities of the maxillofacial region.
Adult↗
Benign mediastinal and parahilar uptake of gallium-67 in treated lymphoma: do we have all the answers?
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Adolescent↗
Nuclear medicine in Israel: independent, alive and well.
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Israel↗
Ga-67 uptake unsuppressed by leukopenia and intense antibiotic therapy.
The authors describe a patient with myelofibrosis who showed intense Ga-67 uptake in spite of being severely leukopenic and receiving large amounts of antibiotics. They conclude that false-negative results associated with leukopenia or intensive antibiotic treatment may not always be correct.
Abscess↗
Spectrum of scintigraphic appearance of liver hemangiomas.
Two hundred and twenty five liver hemangiomas in 166 patients were studied with Tc-99m labeled RBC and are the basis for this atlas. All hemangiomas showed various presentations of the perfusion blood pool mismatch, which is the basis for diagnosis. The size of the hemangiomas was the factor that determined the mixing of the Tc-99m RBC with the blood and, hence, the sequence of visualization of the lesion. Hemangiomas may appear as multiple lesions on liver scan and imitate metastases. Ninety-five hemangiomas appeared in 36 patients as multiple focal abnormalities. Hemangiomas are extremely variable in size. They may be huge (31 hemangiomas) and sometimes occupy most of the abdomen. Or they can be very small and are then detected only by SPECT (two cases). Thrombosed large hemangiomas appear as focal defects on Tc-99m RBC.
Erythrocytes↗
Lymphoma: predictive value of Ga-67 scintigraphy after treatment.
The negative predictive value (PV-) and positive predictive value (PV+) of gallium-67 scintigraphy and computed tomography (CT) were compared after treatment in 43 patients with Hodgkin disease and in 56 patients with non-Hodgkin lymphoma. The usefulness of these studies in predicting survival was also evaluated. In patients with Hodgkin disease, the PV- of Ga-67 scintigraphy was 0.84 and of CT was 0.88. The PV+ was 0.80 for Ga-67 studies and only 0.29 for CT. In patients with non-Hodgkin lymphoma, the PV- of Ga-67 scintigraphy was 0.84 and of CT was 0.80. The PV+ was 0.73 and 0.35, respectively. For both groups, the differences in disease-free survival between patients with negative and positive Ga-67 studies were significant (P less than .05 in Hodgkin disease and P less than .001 in non-Hodgkin lymphoma), but the differences were not significant for CT. These data show that, after treatment of patients with lymphoma, Ga-67 scintigraphy is a good predictor of clinical outcome and can be used beneficially in patient treatment.
Adolescent↗
Local and systemic effects of radiation on bone metabolism measured by quantitative SPECT.
Quantitative bone scintigraphy (QBS), which measures 99mTc-MDP uptake expressed as percent of injected dose per cc, indicates bone metabolism. It is measured in the bones of patients before and after radiation treatment and then compared to normal controls. QBS was performed in a group of 22 normal individuals and was measured twice, 2-10 mo (mean 4.9) apart. There was no significant difference between the two measurements. QBS was performed also in 28 patients before, immediately after and at certain time intervals after radiation therapy for cancer. Both the irradiated and the nonirradiated bones showed significant decreases in bone metabolism at 2-18 mo (mean 8.8) after irradiation. In addition, increases and decreases of 99mTc-MDP uptake were similar in the irradiated and in the nonirradiated bones, and there were significant correlations of the QBS values in the different bones of each individual patient. The etiology of the changes in bone metabolism in the nonirradiated bones is not yet fully understood, but it appears to be the result of a systemic effect of radiation.
Bone and Bones↗