A novel cause of Ga-67 localization. Subclinical myopathy after conventional exercise.
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Adult↗
Biomedical subjects
R S Hattner
Publications and source records attributed to R S Hattner.
Bilateral testicular neuroblastoma. Scintigraphic depiction and therapy with I-131 MIBG.
The authors describe a 29-year-old man who had a 16-year history of neuroblastoma and uncommon manifestations. At age 13, he was diagnosed with stage III retroperitoneal ganglioneuroblastoma that was resected. Ten years later, bilateral testicular enlargement and a pelvic mass from infiltration of the neuroblastoma became palpable. Metastatic involvement was depicted with MIBG, a radiotracer that concentrates in tissues of the sympathetic nervous system. Using I-131 MIBG, the tumors were treated with therapeutic doses of radiation and a partial response was obtained. This case is unique because of the massive degree of bilateral testicular infiltration and its occurrence as a late manifestation of neuroblastoma in early adulthood.
3-Iodobenzylguanidine↗
Efficacy of metaiodobenzylguanidine as a scintigraphic agent for the detection of neuroblastoma.
RATIONALE AND OBJECTIVES: Metaiodobenzylguanidine (MIBG) has been shown to be both sensitive and highly specific for the detection of neuroblastoma. However, controversy surrounds its sensitivity in detecting neuroblastoma when compared with radionuclide (technetium 99m-methylene diphosphonate [99mTc]-MDP) bone scans. Because a diagnostic test ideally should be easy to interpret in addition to being sensitive and specific, this study aims to determine the most efficacious scintigraphic agent for diagnostic use in neuroblastoma. METHODS: Twenty patients with neuroblastoma had a total of 26 paired MIBG and 99mTc-MDP bone scans obtained less than 4 weeks apart. Each study was evaluated independently of its counterpart by six separate observers (3 experienced and 3 inexperienced in MIBG scintigraphy) to determine the presence or absence of disease and the tumor burden. RESULTS: Inexperienced observers reported more confidence in their interpretations of 99mTc-MDP bone scans; however, seven false-positive bone scans were reported. Using MIBG, all true-positive and true-negative scans, as well as significantly more sites of both primary and metastatic disease, were identified by all observers. CONCLUSION: This study suggests that MIBG is the more efficacious agent for the scintigraphic evaluation of neuroblastoma.
3-Iodobenzylguanidine↗
Neuroblastoma: dose-related sensitivity of MIBG scanning in detection.
Iodine-131 metaiodobenzylguanidine (MIBG) has shown effectiveness as a systemic radiotherapeutic agent in neuroblastoma. The authors postulated a likely dose-related relationship of MIBG sensitivity when it was administered for neuroblastoma detection. They studied this relationship in neuroblastoma patients who underwent scanning after receiving diagnostic and therapeutic doses of MIBG in temporal proximity. Seven patients with stage IV disease received a total of 14 therapeutic administrations of I-131 MIBG (150-350 mCi [5,550-12,950 MBq]/m2 per treatment). Posttherapy scans were obtained at 3 and at 5-7 days. Diagnostic MIBG scans had been obtained no more than 4 weeks before the start of therapy. Use of diagnostic MIBG scanning led to underestimation of the tumor burden by 50% compared with use of posttherapy scanning. This difference may be an important consideration in selecting therapeutic strategies for individual patients. It further suggests that use of much larger diagnostic doses of MIBG is a rational strategy in histologically confirmed cases of advanced disease.
3-Iodobenzylguanidine↗
Diagnostic and therapeutic uses of metaiodobenzylguanidine.
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3-Iodobenzylguanidine↗
Scintigraphic assessment of MIBG uptake in globally denervated human and canine hearts--implications for clinical studies.
To further characterize the behavior of metaiodobenzylguanidine (MIBG) in the myocardium and to test the hypothesis that the denervated heart would show normal early uptake on MIBG due to non-neuronal localization, we examined the early and late distribution of 123I-labeled MIBG in normal and globally denervated canine and human hearts. Canine hearts were denervated by intravenous injections of 6-hydroxydopamine, while patients were studied a mean of 4.3 mo following cardiac transplantation. Results in denervated hearts were compared to normal controls. Normal hearts showed prominent MIBG uptake on initial 5-min and 3-hr delayed images. Globally denervated canine hearts showed prominent uptake on initial images and absence of localization on delayed images, indicating complete washout of non-neuronally bound radionuclide. The transplanted human hearts showed no localization of MIBG on either early or delayed images. These results suggest that the non-neuronal uptake mechanism (uptake 2) is not significant in human myocardium. This finding has significant implications for interpreting the myocardial behavior of MIBG in various pathologic situations such as dilated cardiomyopathy.
3-Iodobenzylguanidine↗
Unique scintigraphic findings of bile extravasation in the presence of ascites: a complication of hepatic transplantation.
A 99mTc-HIDA scan was performed on a 4-mo-old female, six days after hepatic transplantation. Gradually, a diffuse increase in activity was seen over the peritoneal region, consistent with a slow bile leak into ascitic fluid. Although the scintigraphic appearance of a bile leak has been previously described, it is usually seen as a focal area of extrabiliary activity. In this case, we report a pattern identified when the leak occurs in conjunction with ascites.
Anastomosis, Surgical↗
ART: Ambiguous Radioimaging Terminology.
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Abbreviations as Topic↗
Duration of etidronate effect demonstrated by serial bone scintigraphy.
There have been several reports of etidronate disodium (EHDP) interference upon the biodistribution of 99mTc-methylene diphosphonate (MDP). With the increasing use of etidronate for the treatment of Paget's disease, hypercalcemia, and osteoporosis, nuclear physicians can expect to encounter increasing numbers of cases in which EHDP-induced artifacts impair the diagnostic utility of bone scans. The temporal duration of this effect is unknown yet obviously important. We report serial bone scintigraphy in a patient who received a single dose of EHDP for hypercalcemia. Normal biodistribution of 99mTc-MDP was noted at 15 days, suggesting that 2 wk are sufficient before performing a bone scan after a single intravenous dose of etidronate.
Aged↗
Determining gastric emptying rate.
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Energy Intake↗
Gallium-67/stable gadolinium antagonism: MRI contrast agent markedly alters the normal biodistribution of gallium-67.
An 11-yr-old patient was scanned 96 hr after the administration of gallium-67 (67Ga). The scan emulated the biodistribution of a typical bone-seeking radipharmaceutical-rather than that of 67Ga. None of the factors previously identified with alteration of the biodistribution of 67Ga were found. However, the patient had been injected with gadopentetate in conjunction with magnetic resonance imaging 4 hr before receiving the 67Ga. Gadolinium appears to cause a strong carrier-like effect in 67Ga scans.
Burkitt Lymphoma↗
Scintigraphic assessment of regional cardiac adrenergic innervation.
To assess the feasibility of noninvasively imaging the regional distribution of myocardial sympathetic innervation, we evaluated the distribution of sympathetic nerve endings, using 123I metaiodobenzylguanidine (MIBG), and compared this with the distribution of myocardial perfusion, using 201Tl. Twenty dogs were studied: 11 after regional denervation, and nine as controls. Regional denervation was done by left stellate ganglion removal, right stellate ganglion removal, and application of phenol to the epicardial surface. Computer-processed functional maps displayed the relative distribution of MIBG and thallium in multiple projections in vivo and excised heart slices in all animals. In six animals, dual isotope emission computed tomograms were acquired in vivo. Tissue samples taken from innervated and denervated regions of the MIBG images were analyzed for norepinephrine content to validate image findings. Normal controls showed homogeneous and parallel distributions of MIBG and thallium in the major left ventricular mass. In the left stellectomized hearts, MIBG was reduced relative to thallium in the posterior left ventricle; whereas in right stellectomized hearts, reduced MIBG was in the anterior left ventricle. Phenol-painted hearts showed a broad area of decreased MIBG extending beyond the area of phenol application. In both stellectomized and phenol-painted hearts, thallium distribution remained homogeneous and normal. Norepinephrine content was greater in regions showing normal MIBG (550 +/- 223 ng/g) compared with regions showing reduced MIBG (39 +/- 44 ng/g) (p less than 0.001), confirming regional denervation. Combined MIBG-thallium functional maps display the regional distribution of sympathetic innervation. This new ability to noninvasively map the distribution of sympathetic nerves with simultaneous comparison to regional perfusion may provide important new insights into mechanisms, whereby an imbalance in sympathetic activity may relate to clinical disorders.
3-Iodobenzylguanidine↗
Bayesean-deblurred Planar and SPECT nuclear bone imaging for the demonstration of facial anatomy and craniomandibular disorders.
Ambiguities in diagnoses can often be resolved when images from different imaging modalities are compared, and when images are processed with algorithms that improve resolution and contrast. Bayesean deblurring algorithms were developed and applied to Planar and SPECT images of the maxillofacial and temporomandibular joint regions. The combined use of Planar and SPECT imaging with Bayesean deblurring were complementary and provided more diagnostic information than either modality individually. A facial imaging protocol using Planar and SPECT imaging and Bayesean deblurring is described. SPECT maxillofacial anatomy is presented, as well as the application of the imaging protocol of craniomandibular dysfunction. Although not recommended for all patients with craniomandibular disorders, combined use of Planar and SPECT images and Bayesean deblurring techniques appears to be useful in diagnostically difficult or refractory cases.
Adult↗
Emission imaging of patients with craniomandibular dysfunction.
Signs and symptoms of craniomandibular dysfunction in 37 patients were compared with the results of corrected cephalometric tomography and an emission imaging protocol consisting of both planar and single photon emission computed tomography (SPECT) (7500 ZLC Orbiter) images. The planar images and the single photon emission computed tomography projection views were processed with a bayesian deblurring algorithm to improve image quality. The correlation of emission imaging with craniomandibular dysfunction, as indicated by temporomandibular joint pain and joint noise, showed a high sensitivity (93%) and a high specificity (86%), whereas the correlation of corrected cephalometric tomography with temporomandibular joint pain and joint noise showed a relatively high sensitivity (89%) but a low specificity (27%). These results indicate that emission imaging is a sensitive and accurate indicator of craniomandibular dysfunction.
Adult↗
Analysis of thallium-201 "washout" from parametric color coded images.
We developed a parametric washout image which color codes regional washout, and blindly compared enhanced perfusion images in multiple projections with regional washout graphs and images in 25 patients. Washout images permitted true spatial and anatomic assessment of regions viewed en face as well as those seen in tangent, making possible the exclusion of non-coronary irregularities and permitting evaluation of washout over the apparent cavity. "Cavitary" washout was abnormal in 10 of 12 patients with apparent cavitary dilation on the post stress image, but in none without this finding. The distribution and rotation of washout abnormalities seen over the cavity when viewed en face, and the long delay between the termination of stress and post-exercise image acquisition, suggest that apparent cavitary dilation is often related to improved visibility of the 201T1 deficient blood pool due to relative ischemia of the overlying myocardial wall.
Color↗
No gravity-independent gradient of blood flow distribution in dog lung.
The existence of a major gravity-independent gradient of blood flow in lungs has recently been described based on single photon emission computed tomography after intravenous injection of radioactively labeled macroaggregates. We wanted to test this hypothesis of a major gravity-independent gradient in lung blood flow in experiments with direct measurement of macroaggregate distribution in the dog lung. In six anesthetized (4 prone spontaneously breathing, 2 mechanically ventilated) dogs we injected 111In-labeled albumin macroaggregates intravenously. We killed the dogs, removed, inflated, and froze the lower lobes. We sliced the lobes 1 cm thick and made gamma camera images of the slices. We then cut three or four slices in each lobe into two or three concentric layers and measured the radioactivity per gram of tissue in a well-type gamma counter. In three of the dogs we also labeled the red cells (99mTc) so that blood volume in each sample could be determined. The gamma camera images were acquired on a 64 X 64 matrix with 4 X 4 mm pixels. On the numeric printouts from the individual slices we made two or three concentric layers and calculated activity per pixel in each layer. Neither by the well counting nor by the pixel analysis of the gamma scans did we detect any gravity-independent distribution of blood flow. With the well counting the distribution was the same whether macroaggregate activity was expressed per gram of tissue or per gram of blood-free tissue. We conclude that by direct measurements no major gravity-independent gradient of pulmonary blood flow can be detected in dog lungs.
Animals↗
Improved immune-specificity in monoclonal radioimmunoimaging using dual radionuclide color functional maps.
Diagnostic radioimmunoimaging is potentially limited by tissue localization of radiolabeled antibody products through mechanisms other than antigen binding. Comparing the distributions of reactive and nonreactive products can distinguish tracer in targeted and nontargeted tissues. To achieve this in a single imaging procedure, dual photopeak scintigraphy was performed using 111In and 67Ga products. Melanoma-bearing athymic mice were coadministered intravenously subtype-matched 111In melanoma-reactive and 67Ga melanoma-nonreactive murine monoclonal antibodies. Paired images from 245 and 93 keV windows were processed with a unique dual parameter color display program. The display algorithm expresses pixel counts from paired photo-peak images in polar coordinates and color-encodes angle as hue and magnitude as intensity. The color functional maps permitted ready distinction of immune from nonimmune uptake. Compared with single tracer imaging methods, this technique better depicts antigen distribution.
Animals↗
The effects of coronary angioplasty and reperfusion on distribution of myocardial flow.
To assess the effects of angioplasty (PTCA) and intracoronary streptokinase (ICSK) on relative myocardial perfusion, we administered 99mTc-macroaggregated albumin (MAA) to the uninvolved coronary artery before successful PTCA in 33 patients and before successful infusion of ICSK in eight patients and of 111In-MAA into the same vessel after the intervention. In 10 patients who underwent PTCA, MAA was injected into the involved, instrumented coronary artery. Computer-processed images were acquired in registry and compared. Similar scintigraphic studies were performed in six control patients and in 11 in whom planned interventions were not performed or were unsuccessful. Distribution of MAA was also compared with angiographic results and with the distribution of 201Tl on images obtained in patients at rest or on redistribution images obtained before and soon after intervention in 22 patients. In control patients and those studied after aborted or unsuccessful intervention, scintigraphic results showed excellent correlation with the angiographic anatomy and were without serial change. When MAA was injected into the uninvolved vessel, the scintigram revealed evidence of collateral perfusion with retraction of the perfusion zone from that of the involved coronary in 19 of 33 patients undergoing PTCA and in three of eight of those receiving ICSK. When MAA was injected into the involved artery, a relative increase in perfusion was seen in eight of 10 patients after PTCA. Although 30 patients demonstrated scintigraphic evidence of collateral vessels, only 10 patients had angiographic evidence of collateral circulation before intervention. The distribution of 201Tl demonstrated little change in its global pattern and regions previously supplied by collaterals were generally well perfused after intervention. Coronary collateral perfusion may be inapparent angiographically and regress rapidly after angioplasty or reperfusion. Native perfusion is generally and quickly restored after successful PTCA or ICSK infusion, which obviates the need for collaterals. After intervention, the distribution of total perfusion may not change, but its regional source may demonstrate beneficial alterations, shifting from collateral to native circulation.
Angioplasty, Balloon↗