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S J Goldsmith

Publications and source records attributed to S J Goldsmith.

At least 37 records · Page 2Linked to original sources
PubMed1995

Somatostatin-receptor imaging in lymphoma.

Patients with Hodgkin's or non-Hodgkin's lymphoma are staged for treatment based on the extent of known disease involvement and the histopathologic grading of the disease. Radiological techniques, including computed tomography, usually depend on estimates of lymph node enlargement and mass effects as the criterion for disease involvement. Lymphomatous tissue obtained at surgery has shown high-density somatostatin receptors. Several groups have evaluated the utility of 111In-DTPA-pentetreotide (Octreoscan, Mallinckrodt, St. Louis, MO) to detect lymphomatous tissue for more accurate staging of patients with lymphoma. The procedure is safe; both Hodgkin's and non-Hodgkins disease involvement is identified. The results, however, have not been uniformly predictive of disease involvement. Consequently, the routine use of this technique in place of currently used anatomic imaging methods is not recommended at this time. The significance of detecting somatostatin receptors in vivo in patients with malignant lymphoma requires further study.

Adult↗
PubMed1995

The role of gallium and labeled leukocyte scintigraphy in the AIDS patient.

Because AIDS patients frequently present with minimal symptomatology, radionuclide imaging with its ability to survey the entire body, is especially valuable. Gallium-67 citrate, the most commonly performed radionuclide study for localizing infection in these patients, is most useful for detecting opportunistic infections, especially in the thorax. A negative gallium scan, particularly when the chest X-ray is unremarkable, rules strongly against pulmonary disease. A negative gallium scan in a patient with an abnormal chest X-ray and Kaposi's sarcoma, suggests that the patient's respiratory distress is related to the neoplasm. Diffuse pulmonary parenchymal uptake of gallium in the HIV (+) patient is most often associated with PCP. While there are other causes of diffuse pulmonary uptake, the more intense or heterogeneous the uptake, the more likely the patient is to have PCP. Focal pulmonary uptake is usually associated with bacterial pneumonia although PCP may occasionally present in this fashion. Lymph node uptake of gallium is usually associated with Mycobacterium avium complex, tuberculosis, or lymphoma. When corresponding abnormalities are present on thallium scintigraphy lymphoma is likely. Gallium positive, thallium negative, studies suggest mycobacterial disease. Labeled leukocyte imaging is not useful for detecting opportunistic infections probably because of the inflammatory response incited by these organisms. Leukocyte imaging is, however, more sensitive for detecting bacterial pneumonia. In the abdomen, gallium imaging is most useful for identifying lymphadenopathy, while labeled leukocyte imaging is superior for detecting AIDS-associated colitides. In summary, radionuclide studies are valuable diagnostic modalities in AIDS. Their success can be maximized by tailoring the study to the individual's needs.

AIDS-Related Opportunistic Infections↗
PubMed1994

SPECT evaluation of lumbar spondylolysis and spondylolisthesis.

Fifty patients with back pain and radiologically diagnosed spondylolysis were evaluated by a single-photon emission computed tomography (SPECT bone scanning). These patients were separated into three groups according to the degree of spondylolisthesis accompanying the spondylolysis. The data obtained from the study indicate that in acute spondylolysis, the SPECT scan is positive at the pars interarticularis. As the spondylolysis becomes chronic, the SPECT scan tends to revert toward normal even though healing of the spondylolysis has not occurred. As spondylolisthesis develops and progresses, the SPECT scan again becomes positive. The positivity, however, is more anterior and more diffuse. The authors propose that SPECT scanning in spondylolysis is not a positive or negative process, but rather varies with the time and stability of the spondylolytic spine.

Adolescent↗
PubMed1994

Gallium-67-citrate imaging in nuclear oncology.

Gallium-67-citrate is one of the most useful radiopharmaceuticals to detect tumors, stage extent of the disease, monitor response to treatment and distinguish recurrent disease from post-treatment changes. Gallium is likewise very sensitive to detect and locate infections and inflammatory foci. This application is extremely important in the management of immunocompromised cancer patients. Image interpretation should be tempered with full knowledge of the patients clinical condition, anatomic alterations due to prior surgery and correct timing of image acquisition. Early imaging at 4-6 h is useful to detect gastrointestinal infections, whereas 24 h imaging is used to evaluate chest infections. Although gallium-67 is a non-specific agent, the identification of the etiology of the inflammation may be improved by adequate clinical and laboratory information as well as correlation with other imaging modalities such as sonography and computerized x-ray tomography (CT). High dose (10 mCi) gallium-67 single photon emission computed tomography (SPECT) imaging with image co-registration is important for accurate uptake localization.

Citrates↗
PubMed1994

Clinical applications of fusion imaging in oncology.

Recent developments in tumor imaging, made possible by advances in instrumentation and radiopharmaceuticals, has led to an increasing need for accurate anatomic correlation of single photon emission computed tomography (SPECT) and positron emission tomography (PET) images. Fusion imaging permits the functional strengths of SPECT and PET to be combined with the anatomic resolution of computed tomography (CT) and magnetic resonance imaging (MRI). Clinical applications of fusion imaging include the evaluation of brain tumors, lymphoma, hepatic lesions and monoclonal antibody studies. The continued development of these techniques will eventually allow fusion imaging to become a routine part of nuclear medicine practice.

Antibodies, Monoclonal↗
PubMed1994

SPECT evaluation of unilateral spondylolysis.

Three patients with unilateral spondylolysis were evaluated with SPECT and Lumbar CT. All three cases had positive scans. However, the SPECT images were unique to each case. Therefore, the interpretation of the SPECT activity was undertaken in terms of the known natural history of both unilateral and bilateral spondylolysis.

Adolescent↗
PubMed1994

Postoperative changes on brain SPECT imaging after aneurysmal subarachnoid hemorrhage. A potential pitfall in the evaluation of vasospasm.

Serial brain SPECT imaging was performed on patients after subarachnoid hemorrhage and surgical clipping of intracranial aneurysms. A total of 20 HMPAO scans were performed on 9 patients in whom clinical vasospasm did not develop. Areas of diminished regional cerebral blood flow (rCBF) were found near the operative site in 17 of 20 studies, which did not correlate with the patients' neurologic condition and were suggestive of postoperative edema. Brain SPECT imaging has a potentially valuable role to play in the evaluation of postoperative patients susceptible to vasospasm; however, it is important to be aware of postoperative changes in rCBF that are not related to vasospasm.

Brain↗
PubMed1994

Flare on bone scintigraphy following Taxol chemotherapy for metastatic breast cancer.

UNLABELLED: Our goal was to determine if a healing flare response seen on bone scintigraphy occurs following chemotherapy with Taxol (paclitaxel; Bristol-Myers Squibb Co., Princeton, NJ), a novel antimicrotubule agent for metastatic breast cancer. METHODS: We performed 74 bone scans on 21 females with breast cancer and bone metastases entering a Phase II trial of Taxol chemotherapy with granulocyte colony stimulating factor (G-CSF). All patients had baseline scans within 6 wk prior to therapy, after the second cycle (4-6 wk) of Taxol, and then after 6-12 mo. All bone scans were reviewed by two nuclear medicine physicians, without knowledge of the patients' clinical history. Skeletal radiographs, CT and MRI scans, as well as clinical history were compared with scan findings. RESULTS: Seven of the 21 patients showed improvement in bone scan findings. Of these seven, three had a flare response following two cycles (4-6 wk) of Taxol, characterized by increased activity in baseline lesions and the appearance of new lesions, followed by improvement on follow-up scans. Evidence of clinical response (> or = 50% reduction in tumor mass) was seen in all of these patients. Seven patients showed no change in baseline findings on follow-up bone scans. Seven patients had post-Taxol scans showing new lesions, with no overall improvement on later follow-up. CONCLUSION: Flare on bone scintigraphy may be seen shortly after commencing Taxol chemotherapy. Bone scans done within the first 3 mo must be interpreted with caution and should be correlated with clinical and radiological findings to avoid inappropriate discontinuation of Taxol chemotherapy.

Adenocarcinoma↗
PubMed1994

Radon update: facts concerning environmental radon: levels, mitigation strategies, dosimetry, effects and guidelines. SNM Committee on Radiobiological Effects of Ionizing Radiation.

The risk from environmental radon levels is not higher now than in the past, when residential exposures were not considered to be a significant health hazard. The majority of the radon dose is not from radon itself, but from short-lived alpha-emitting radon daughters, most notably 218Po(T1/2 3 min) and 214Po (T1/2 0.164 msec) along with beta particles from 214Bi (T1/2 19.7 min). Radon gas can penetrate homes from many sources and in various fashions. Measuring radon in homes is simple and relatively inexpensive and may be accomplished in a variety of ways. Although it is not possible to radon-proof a house, it is possible to reduce the level. In high radon areas, if the average level is higher than 4-8 pCi/liter (NCRP recommended level is 8 pCi/liter; EPA recommended level is 4 pCi/liter), appropriate action is advised. The shape of the dose response curves for miners exposed to alpha-emitting particles in the workplace is consistent with current biologic knowledge. It is linear in the low dose range and saturates in the high dose range. No detectable increase in lung cancer frequency is seen in the lowest exposed miners (those with exposures < 120 WLM, the relevant dose interval for most homes). Evidence for a health effect from radon exposure is based on data from animal studies and epidemiologic studies of mines. Extensive radiobiologic data predict a linear dose-response curve in the low dose region due to poor biological repair mechanisms for the high density of ionizing events that alpha particles create. However, no compelling evidence for increased cancer risks has yet been demonstrated from "acceptable" levels (< 4-8 pCi/liter).

Air Pollutants↗
PubMed1993

Hiatal hernia on whole-body radioiodine survey mimicking metastatic thyroid cancer.

Total body I-131 scanning done on a 67-year-old woman with thyroid cancer revealed abnormal tracer uptake within the mid-thorax, thought to represent metastasis in the mediastinum or thoracic spine. Single-photon emission computed tomography images of the thorax showed contiguity between the thoracic uptake and the normal, physiologic uptake of radioiodine in the stomach, suggesting physiologic accumulation within a hiatal hernia. To confirm the alimentary tract location of the radioiodine, a study using orally administered Tc-99m SC in water was performed. The images were similar to the iodine images and revealed a pattern consistent with hiatal hernia. A hiatal hernia was also observed as an incidental finding on chest radiographs and an MRI. This case illustrates the potential for an abnormal anatomic configuration to mimic metastatic thyroid cancer and shows how SPECT and oral Tc-99m SC images may be useful in making this distinction.

Aged↗
PubMed1993

Specificity and sensitivity of distinctive chest radiographic and/or 67Ga images in the noninvasive diagnosis of sarcoidosis.

An analysis of gallium-67 (67Ga) uptake in the lacrimal and salivary glands and intrathoracic lymph nodes was made in 162 patients with sarcoidosis, consisting of a large number with chronic "fibrotic" disease, and 167 HIV-positive patients (most of whom have/had AIDS). This study was designed to further assess the diagnostic sensitivity and to fully evaluate the diagnostic specificity of chest radiographic and/or 67Ga uptake findings found to be characteristic of sarcoidosis. A lambda 67Ga uptake image or a panda 67Ga uptake image with associated bilateral, symmetrical hilar lymphadenopathy (BSHL) or bilateral, symmetrical parenchymal infiltration indicative of pulmonary fibrosis on chest radiograph (BSIF) was commonly present in sarcoidosis. These distinctive 67Ga uptake images were frequently observed in patients with normal chest radiographs (stage 0 [33 percent]), as well as in patients with BSHL on chest radiograph whether the disease was in an "early" stage, ie, stages I (74 percent) and II (90 percent) or a chronic "fibrotic" stage, ie, IVa (71 percent). A panda 67Ga uptake image was observed in 8 percent of HIV-positive patients; however, a lambda 67Ga uptake image alone or any of the other chest radiographic and/or 67Ga uptake patterns distinctive for sarcoidosis were not observed in any of 167 HIV-positive patients. We conclude that (1) a lambda 67Ga thoracic image (usually associated with a panda 67Ga uptake image) or a panda 67Ga uptake image together with BSHL or BSIF on chest radiograph represent distinctive patterns that are highly specific and sensitive for the noninvasive diagnosis of the majority of sarcoidosis patients, and (2) the finding of a panda 67Ga uptake image, not associated with BSHL or BSIF on chest radiograph, should suggest, in addition to a limited number of readily diagnosable disorders, the presence of a positive HIV status.

Gallium Radioisotopes↗
PubMed1993

Effect of blood-brain barrier and blood-tumor barrier modification on central nervous system liposomal uptake.

In this study of 25 central nervous system (CNS) tumor-bearing rats, the CNS biodistribution of intravenously administered, indium-labeled liposomes was investigated. In 16 animals, the blood-brain barrier and blood-tumor barrier were modified using intracarotid administration of etoposide. In control animals, analysis by autoradiography and well-counting experiments demonstrated uptake of liposomes in the tumor-bearing hemisphere (% injected dose/g tissue = 0.135) with minimal uptake in the non-tumor-bearing hemisphere (% injected dose/g tissue = 0.007), p < 0.01. Unilateral intracarotid etoposide administration enhanced liposome uptake in both hemispheres-0.215 and 0.023 (tumor-bearing and nontumor-bearing), respectively. The presence of meningeal tumor involvement in nontumor-implanted hemispheres increased liposomal uptake 10-fold. These findings may have clinical applicability in designing therapeutic protocols for the treatment of CNS tumors.

Animals↗
PubMed1993

Detection of silent left ventricular dysfunction during daily activities in coronary artery disease patients by the nuclear VEST.

Myocardial ischemia during routine daily activities was studied in patients with known coronary artery disease with an ambulatory radionuclide probe and recording device (VEST) and routine rest and exercise gated blood pool imaging. Seventeen patients were monitored for 60 minutes while sitting (baseline), standing in place, walking, eating (6 patients), and urinating (4 patients). Eleven of them (64%) failed to show an augmentation of at least 5% in the LVEF on an exercise gated blood pool imaging study (Group I) and 6 (36%) showed a normal response (Group II). Three patients (18%) in Group I experienced angina. Transient left ventricular dysfunction was detected by the VEST during walking, urinating or eating in 80% of the patients in Group I and 33% in Group II (p < 0.05). During walking, mean ejection fraction slightly decreased from 45 +/- 12% to 43 +/- 13% in Group I while the ejection fraction increased from 46 +/- 8% to 51 +/- 12% in Group II (p = 0.04 for the difference in responses). Standing in place and eating did not affect the mean ejection fraction. Urination in 4 patients in Group I caused a significant drop in ejection fraction in 3 patients for a mean change from 51 +/- 9% at rest to 42 +/- 15%. By contrast, none of the patients had angina or diagnostic ECG changes during the monitoring period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Assessing collateral cerebral perfusion with technetium-99m-HMPAO SPECT during temporary internal carotid artery occlusion.

Cerebral infarction following internal carotid artery occlusion results from either embolism or inadequate collateral blood flow. Although risk of embolism can be minimized, detecting compromised collateral circulation is more difficult. Cerebral angiography, carotid stump pressures and clinical evaluation during internal carotid artery occlusion are of limited utility. Xenon-133 radionuclide studies and stable xenon computed tomography are not readily available. We evaluated 99mTc-HMPAO SPECT, during temporary carotid artery occlusion, in 20 patients considered for internal carotid artery occlusion. Fourteen demonstrated symmetric cerebral perfusion during occlusion; eleven underwent transient and three had permanent carotid artery occlusion without complications. Five patients had ipsilateral globally decreased perfusion during temporary occlusion. One patient underwent transient occlusion of this vessel and one underwent carotid sacrifice without bypass grafting; both recovered without sequelae. The three remaining patients underwent carotid artery bypass grafting prior to sacrifice of this vessel. One patient with a small focal perfusion defect underwent carotid artery sacrifice without bypass grafting and developed acute neurologic deficits postoperatively. These initial results suggest that symmetric cerebral perfusion during temporary occlusion indicates that internal carotid artery occlusion will be tolerated. Although its implications are not yet well defined, the abnormal study identifies patients potentially at risk for postocclusion complications, thus providing a basis for neurosurgical management.

Adolescent↗
PubMed1993

Chemistry and biological behavior of samarium-153 and rhenium-186-labeled hydroxyapatite particles: potential radiopharmaceuticals for radiation synovectomy.

Hydroxyapatite (HA), a natural constituent of bone, was studied as a particulate carrier for beta-emitting radionuclides in radiation synovectomy. Particles were radiolabeled with 153Sm or 186Re and their in vivo safety was investigated following intra-articular injection into knees of normal rabbits and rabbits with antigen-induced arthritis (AIA). Radiolabeling efficiency was greater than 95%; in vitro studies showed minimal (< or = 1%) loss of activity from particles over a 6-day period with 153Sm-labeled HA and about 5% loss of activity over a 5-day period with 186Re-labeled HA. The total cumulative extra-articular leakage of 153Sm over 6 days was 0.28% in normal rabbits and 0.09% in AIA rabbits. Leakage of 186Re from the joint was 3.05% over a 4-day period with 80% of extra-articular activity found in the urine. Histopathological evaluation of treated knees showed that HA particles are distributed throughout the synovium, embedded in the synovial fat pad. The ease and efficiency with which this HA carrier is labeled, coupled with observed extremely low leakage rates from the joint, make radiolabeled HA particles an attractive candidate as a radiation synovectomy agent for evaluation in rheumatoid arthritis patients.

Animals↗