Intra-arterial Tc-99m MDP injection mimicking reflex sympathetic dystrophy.
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Adolescent↗
Biomedical subjects
O Uğur
Publications and source records attributed to O Uğur.
Assessment of penile bone graft viability by bone scintigraphy: a case report.
A 20-year-old man, who had penile reconstruction surgery with an iliac bone graft a year ago due to malcircumcision at 6 years old underwent bone scintigraphy in order to detect bone graft viability. The accumulation of 99mTc-MDP in the penile region revealed the viability of the bone graft. This case report shows that bone scintigraphy can be used to assess the viability of a bone graft located inside the penis as well as bone grafts placed elsewhere in the extremities.
Adult↗
The role of Tc-99m (V) DMSA scintigraphy in the evaluation of superscan on bone scintigraphy.
PURPOSE: This study evaluated the biodistribution of Tc-99m (V) DMSA in patients with superscans on bone imaging and defined its role in differentiating the underlying cause. METHODS: Nine patients (five with metastatic and four with metabolic bone disease) with classical superscans were entered into the study. All patients had the necessary radiologic and biochemical studies and a final diagnosis was reached accordingly. Tc-99m (V) DMSA scintigraphy was performed 1 week after Tc-99m MDP whole-body bone imaging. RESULTS: In four of five patients with widespread skeletal metastases, Tc-99m (V) DMSA scan showed diffusely increased bone uptake. In the remaining patient, the Tc-99m (V) DMSA scan showed a normal distribution pattern. All patients with metabolic bone disease had increased bone uptake on Tc-99m (V) DMSA scans. CONCLUSION: Tc-99m (V) DMSA shows increased bone uptake in patients having a superscan appearance in metastatic or metabolic bone disease. Tc-99m (V) DMSA imaging may play a role in the evaluation of patients with equivocal bone scan findings for a superscan.
Adult↗
Tc-99m DTPA acetylsalicylic acid (aspirin) renography in the detection of renovascular hypertension.
PURPOSE: Prostaglandins play important roles in renal physiology and in the development of renovascular hypertension. In a recent study, inhibition of renal prostaglandin synthesis was found to be useful for detecting renovascular hypertension using renal scintigraphy. In the current study, the authors evaluated the role of aspirin (an inhibitor of prostaglandin synthesis) and compared it with Tc-99m DTPA captopril renal scintigraphy (CS). MATERIALS AND METHODS: Twenty-five patients were examined with Tc-99m DTPA in a three-step manner: a baseline study, CS, and aspirin scintigraphy (AS). Each scintigraphic study was interpreted visually and according to the renogram curve patterns. Semiquantitative parameters (Tmax, renal indices [%], 20-minute/max count ratio, glomerular filtration rate) were also calculated. Plasma renin activity was determined for each study. The blood pressures of all patients were measured during AS. All patients had a contrast-enhanced angiogram that was used as the reference test. RESULTS: Three groups of patients were observed based on the scintigraphic and angiographic results. In each group, no difference was observed in blood pressure after aspirin administration. In group 1, seven patients had normal angiographic and scintigraphic results. In group 2, eight patients had angiographically confirmed renal artery stenosis (RAS). In 6 patients (mean, 47% RAS), both AS and CS were negative for RVH. In the remaining two patients with RAS (mean, 83% stenosis), the kidneys were atrophic on the stenotic side, and thus the kidneys did not respond to the interventions. No difference was observed in plasma renin activity in groups 1 and 2. Group 3 included 10 patients who had angiographically confirmed RAS (mean, 86%). In 9 patients, both CS and AS were positive for RVH. In the remaining one patient, scintigraphic results were falsely negative. Statistical analyses performed for semiquantitative parameters did not reveal any significant difference in this group, although there was a tendency toward prolonged Tmax values after captopril and aspirin administration. In four cases, unexpected elevation of plasma renin activity was observed in group 3. CONCLUSIONS: These data indicate that AS with Tc-99m DTPA is an alternative for CS. It has the advantage of having no effect on blood pressure and does not require that angiotensin-converting enzyme inhibitors be discontinued. Although in this study 9 of 10 patients had correct diagnoses of RAS, further studies, especially using tubular agents with the calculation of parenchymal transit time, might provide valuable information in this patient group. An ongoing study is being performed in the authors' institute.
Adolescent↗
Prediction of response to revascularization in patients with renal artery stenosis by Tc-99m-ethylenedicysteine captopril scintigraphy.
The aim of the present study was to assess the predictive value of captopril scintigraphy with the new renal agent 99mTc-ethylenedicysteine (99mTc-EC) for post-interventional improvement in blood pressure. Twelve patients who had persistently high blood pressure with previous demonstration of various degrees of renal artery lesion on angiography were included into the study. Baseline and captopril scintigraphies were performed on the same day at 4 hour intervals after the injection of 74 and 296 MBq of 99mTc-EC, respectively. All patients had percutaneous transluminal angioplasty (PTA), and improvement in blood pressure was evaluated 3-6 months after the intervention. 99mTc-EC captopril scintigraphy successfully predicted a positive or negative outcome in 11 of 12 patients. In one patient with captopril induced renal function deterioration, scintigraphy failed to predict post-interventional response. Our preliminary findings showed that 99mTc-EC captopril scintigraphy can be used to determine patients who will benefit from revascularization.
Adult↗
Comparison of Tc-99m EC and Tc-99m DTPA captopril scintigraphy to diagnose renal artery stenosis.
PURPOSE: Although, captopril scintigraphy is a well established method to detect renovascular hypertension, the optimal radiopharmaceutical for this test remains to be determined. Recently, Tc-99m ethylenedicysteine (Tc-99m EC) appeared as an alternative agent for captopril scintigraphy. The aim of this study was to compare the diagnostic accuracy of Tc-99m EC with Tc-99m DTPA, which is a well-established renal radiopharmaceutical for the captopril test. METHODS: Nineteen hypertensive patients who had various degrees of renal artery stenosis on angiography were included in the study. All patients had baseline and captopril Tc-99m EC and Tc-99m DTPA scintigraphy within a 1-week period. The results were compared with angiography and in eight patients with changes in blood pressure after revascularization. The images were interpreted without knowledge of the angiography and revascularization data as low, intermediate, or high probability for hemodynamically significant renal artery stenosis, which was defined as an area of stenosis exceeding 50%. RESULTS: Tc-99m EC and Tc-99m DTPA study results were in agreement in 16 of the 19 patients. In two patients with branch artery stenosis, Tc-99m EC was definitely superior to Tc-99m DTPA and correctly identified the probability of stenosis on scintigraphy. On kidney analysis, Tc-99m EC had a slightly greater diagnostic sensitivity compared with Tc-99m DTPA (79% vs. 68%; P > 0.05 by the chi-squared test) but equal specificity (93% for both agents). Both Tc-99m EC and Tc-99m DTPA showed the same accuracy in predicting the outcome after revascularization in all but one patient with branch artery stenosis, in whom Tc-99m EC accurately predicted a successful outcome of the intervention but Tc-99m DTPA did not. Tc-99m EC had better renal uptake in patients with decreased renal function and provided more dramatic evidence of renogram changes after captopril intervention, which resulted in more confident interpretation. CONCLUSIONS: There is no significant difference between Tc-99m EC and Tc-99m DTPA captopril scintigraphy for detecting renal artery stenosis. However, because of the better imaging characteristics and more confident interpretation provided by the dramatic changes in the degree of renogram abnormality after captopril intervention, Tc-99m EC captopril scintigraphy should be used, particularly in patients with decreased renal function or branch artery stenosis.
Adult↗
Hypophosphatemic rickets with sacroiliitis-like presentation in an adolescent.
Rickets can manifest with a wide variety of rheumatic symptoms. In this paper, a fifteen year old female patient with hypophosphatemic rickets presenting with symptoms suggesting sacroiliitis at disease onset is reported. The sacroiliac joint involvement in this case was attributed to the subchondral bone fractures due to the secondary hyperparathyroidism. Her symptoms resolved completely after treatment with calcitriol and phosphate solution for hypophosphatemic rickets.
Adolescent↗
Renovascular hypertension due to Takayasu's arteritis demonstrated by Tc-99m ethylenedicysteine captopril scintigraphy.
A 34-year-old woman with severe hypertension underwent Tc-99m ethylenedicycteine (Tc-99m EC) captopril renal scintigraphy. There was bilateral parenchymal retention of the tracer suggesting renal artery stenosis. Angiography confirmed bilateral renal artery stenosis and also demonstrated contour irregularities of the abdominal aorta, and stenosis in mesenteric and subclavian arteries with increased collateral circulation consistent with Takayasu's arteritis. In light of this case of renal artery stenosis, it was concluded that Tc-99m EC can be used successfully as a potential renal agent in the diagnosis of renal involvement in patients with Takayasu's arteritis.
Adult↗
Technetium-99m-ethylenedicysteine in the diagnosis and follow-up of renovascular hypertension.
Technetium-99m-ethylenedicysteine (99mTc-EC) captopril scintigraphy performed in a patient with severe hypertension revealed increased parenchymal retention in the left kidney, suggesting renal artery stenosis. After angiographic confirmation of renal artery stenosis, percutaneous transluminal angioplasty (PTA) was performed on the left renal artery. Captopril scintigraphy after PTA showed normal findings with no evidence of parenchymal retention, consistent with reversal to normal kidney functions. In light of this case of renal artery stenosis, it was concluded that 99mTc-EC can be used successfully as a potential renal agent in the diagnosis and follow-up of renovascular hypertension.
Adult↗
Comparison of 201Tl, 99Tcm-MIBI and 131I imaging in the follow-up of patients with well-differentiated thyroid carcinoma.
Problems stemming from the withdrawal of TSH suppressing doses of T4 or T3 and false-negative studies associated with 131I scintigraphy have justified the search for other radionuclides in the follow-up of patients with well-differentiated thyroid carcinoma. Although 201Tl and 99Tcm-MIBI (MIBI) have been suggested as alternatives, their role in the detection of residual and recurrent disease has yet to be established. We therefore studied 36 patients who had undergone total or near total thyroidectomy for well-differentiated thyroid carcinoma to determine the imaging potential of 201Tl, MIBI and 131I in the detection of residual or recurrent disease. Eighteen of the 36 patients had undergone 131I ablation. Imaging was performed 20 min following the intravenous injection of 111 MBq 201Tl or 555 MBq MIBI, or 48 h after the oral ingestion of 185 MBq 131I. The overall concordance between the 201Tl, MIBI and 131I scans was 70%. The concordance between thyroglobulin (TG) levels and the 131I scans was 78%; that between the 201Tl and MIBI scans and TG levels was 83%. Among the group of pre-ablative patients, there were six false-negative results with 201Tl and three false-negative results with MIBI. Among the post-ablation group, the 201Tl and MIBI scans were falsely negative in five patients. The 131I scans revealed all known residual or recurrent diseases. In conclusion, 201Tl, MIBI or TG levels should not be used in the place of 131I for the detection of residual or recurrent thyroid cancer. However, in patients who have not had their TSH suppressing doses of T4 or T3 withdrawn, the role of 201Tl and MIBI is debatable.
Adenocarcinoma, Follicular↗
Segmental ATN in a kidney with a single artery transplanted from living related donor.
A sequential 99mTc-MAG3 renogram of a 20-year-old male who received a kidney from a living related donor is presented. Pre-transplant angiography of the donor showed the kidney had a single renal artery with upper and lower branches. The transplantation procedure was uneventful, allowing rapid simultaneous perfusion to the entire kidney. The first scan performed 2 days after the transplantation was normal except for retention of the radiotracer at the upper pole of the kidney. The renal collecting system was normal and no signs of dilatation or obstruction were noticed on ultrasonographic examination. A follow-up scan done on the 5th day of transplantation showed almost complete evacuation of the parenchymal retention previously seen on the upper pole of the kidney. This unusual finding was consistent with segmental acute tubular necrosis (ATN) of the upper pole of the kidney and showed that ATN might involve only a portion of a kidney in spite of the existence of a single artery of the transplant.
Adult↗
Pre- and post-therapy thallium-201 and technetium-99m-sestamibi SPECT in nasopharyngeal carcinoma.
UNLABELLED: We prospectively studied the diagnostic potential of 201Tl and 99mTc-sestamibi (MIBI) SPECT for evaluating the extent of primary disease and differentiating residual/recurrent disease from post-therapy changes in patients with nasopharyngeal carcinoma (NPC). METHODS: Fifty patients (20 initial presentation, 30 post-therapy evaluation) underwent 201Tl and MIBI imaging. The findings were correlated with CT/MRI results. Tumor-to-background ratios were obtained. Biopsy confirmation (14 patients) and/or 6-12 mo clinical follow-up data (16 patients) were available in the post-therapy group. RESULTS: All primary disease sites were accurately detected by both imaging studies in the pretherapy group. However, MIBI-SPECT was superior to 201Tl SPECT (p = 0.0057) in detecting regional metastases (sensitivities of 95% versus 68%). In the post-therapy group, MIBI and 201Tl imaging were true-positive in 14 of 16 patients with proven residual/recurrent. In 17 patients who had no evidence of residual/recurrent tumor. CT/MRI was false-positive in 13 when MIBI and 201Tl imaging were true-negative in 10 and false positive in 3. MIBI, 201Tl and CT/MRI had sensitivities of 87.5%, 87.5%, 100%, specificities of 82.4%, 76.5%, 23.5% and accuracies of 85%, 82%, 61%, respectively. Tumor-to-background ratios were < or = 1.5 in all false-positive cases except one. CONCLUSION: MIBI-SPECT proves more accurate than 201Tl SPECT in detecting regional metastases at initial presentation. MIBI and 201Tl imaging have higher specificity and accuracy than CT/MRI and MIBI-SPECT is slightly more specific than 201Tl SPECT in differentiating residual/ recurrent disease from post-therapy changes in patients with NPC.
Adolescent↗
Increased accumulation of hexakis (2-methoxyisobutylisonitrile)technetium(I) in osteosarcoma and its metastatic lymph nodes.
Scintigraphy using hexakis (2-methoxyisobutylisonitrile) technetium (I) [Tc-MIBI] was performed in a patient with osteosarcoma of the right tibia. Increased accumulation of Tc-MIBI was observed in the primary site of the tumor as well as in metastatic lesion of the right inguinal lymph nodes, which were later confirmed by biopsy.
Adolescent↗
Combined use of chemotherapy and 131I-metaiodobenzylguanidine in the treatment of advanced-stage neuroblastoma.
Despite intensive chemotherapy, surgery and/or radiation, prognosis continues to be very poor in disseminated neroblastoma. Owing to neuroblastoma sensitivity progress might be achieved with high-dose radiation. Metaiodobenzyl guanidine (MIBG) coupled with 131I provides the opportunity for highly selective radiation treatment of neuroblastoma, which could potentially deliver five to 10 times the dose of conventional external-beam treatment without specific tissue toxicity. To improve the long-term results in advanced-stage neuroblastoma, we integrated this new treatment modality with conventional chemotherapy. Eight neuroblastoma patients refractory to conventional treatment were treated with 131I-MIBG-chemotherapy (vincristine, VP16, iphosphamide, carboplatin, epirubicin, cyclophosphamide) combination. Five of the eight patients responded to 131I-MIBG treatment (2 complete and 3 partial responses). There were also three patients with stable disease. Median survival was 48 months (range 1 to 84 months), and five patients relapsed in their follow-up and died of progressive disease. We concluded that a combined 131I-MIBG and chemotherapy approach is useful in advanced-stage neuroblastoma patients, with considerably less side effects. Although survival is improved when compared to conventional treatment, the overall prognosis is still poor. More lethal radionuclide conjugation to MIBG which will deliver higher tumor and lower critical organ doses may offer the best solution for targeted radionuclide therapy of neuroblastoma.
3-Iodobenzylguanidine↗