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[Study of space-occupying lesions in the liver using technetium-99m tin colloid and indium-113m chloride].

Liver scanning with radiocolloids is an important method to determine the presence, the position and the size of space-occupying lesions in the liver. Unfortunately, this information is nonspecific and it is not possible to distinguish between tumours, abscesses or cysts. Thirty-six patients in whom a definite diagnosis of hepatoma, amoebic liver abscess or echinococcus cyst had been made were examined with technetium-99m tin colloid and indium-113m chloride. The amoebic liver abscesses were avascular, showed a hyperaemic area surrounding the abscess and appeared smaller on the indium than on the technetium scan. The hepatomas showed greater vascularity and absence of the hyperaemic area. Cysts were avascular, did not show a hyperaemic rim and the size was equal on both scans. The experience of the observers had an influence on the accuracy of interpretation of the scans; experienced observers made a correct diagnosis in 73% of cases. It is suggested that simultaneous 99mTc tin colloid and 113mIn-chloride scans provide additional specificity in the differential diagnosis between hepatoma, amoebic liver abscess and echinococcus cysts.

Adult↗

Radionuclide imaging of the spleen with heat denatured technetium-99m RBC when the splenic reticuloendothelial system seems impaired.

Imaging of the spleen of 10 patients who had been hematologically diagnosed with sickle-cell anemia (SCA) was studied with [99mTc]tin colloid and heat denatured [99mTc]RBCs. In all ten patients, there was faint or nonvisualization of the spleen with [99mTc]tin colloid. However, with heat denatured [99mTc]RBCs, nine spleens were well visualized, and the uptake was homogenous. One spleen had two patchy areas of uptake. The results indicate that when splenic phagocytic function is impaired as reflected by nonvisualization of the spleen with [99mTc]tin colloid, it is still possible to image such a spleen with heat denatured [99mTc]RBCs.

Adolescent↗

A scintigraphic method for the assessment of intraluminal volume and motility of isolated intestinal segments.

The isolated in vivo intestinal segment is a popular experimental preparation for the investigation of intestinal function, but its value has been limited because no method has been available for measuring changes in intraluminal volume under experimental conditions. We report a scintigraphic technique for measuring intraluminal volume and assessing intestinal motility. Between 30 and 180 ml, the volume of a 75-cm segment of canine jejunum, perfused with Tc-99m-labeled tin colloid, was found to be proportional to the recorded count rate. This method has been used to monitor the effects of the hormone vasopressin on intestinal function.

Animals↗

An evaluation of technetium-99m tin colloid--its value in the diagnosis of renal transplant rejection.

The value of the Technetium-99m tin colloid (TTC) scan in the diagnosis of renal transplant rejection occurring more than 1 month following transplantation was assessed. To our knowledge, use of this agent has not previously been reported. Gamma camera imaging was performed on 15 occasions in 14 patients in whom plasma creatinine was rising and in three patients in whom renal function was stable. Both a qualitative and a quantitative assessment of images was made. The radioactivity recorded over the graft at 12-16 min post injection was expressed as a percentage of that recorded at 0-4 min. In the nine patients in whom graft perfusion was adequate to allow interpretation of the TTC scan and in whom rejection was diagnosed by biopsy (six cases) or on clinical grounds (three cases), the index ranged from 45 to 153%. In two patients the graft was poorly perfused and the accumulation of TTC was predictably low despite the presence of rejection. In the seven patients with either a stable creatinine or with rising creatinine not due to rejection, the index ranged from 5 to 43%. Previously reported studies have shown that sulphur colloids may be of value in diagnosing graft rejection. This study suggests that Tc99m tin colloid may be regarded as a suitable alternative scanning agent and that some simplification of data collection and analysis can be achieved.

Colloids↗

Perfusion scintigraphy in the diagnosis of pulmonary embolism: a self-assessment quiz.

The authors present ten case reports with lung scintigrams in a format suitable for a self-assessment quiz. The first seven cases include perfusion scintigrams and the final diagnosis was established by postmortem examination. The last three studies include ventilation images (using nebulized Tc-99m tin colloid) and the final diagnosis established by nonradionuclide studies. The authors believe this quiz demonstrates the necessity for ventilation studies when using lung scintigraphy for a positive diagnosis.

Adult↗

Sentinel lymph node identification for patients with breast cancer using large-size radiotracer particles: technetium-99m-labeled tin colloids produced excellent results.

Sentinel lymph node (SLN) biopsies using radioactive tracers have been reported to detect the metastatic status of the axillary lymph nodes in breast cancer patients. However, the optimal radioactive tracer particle sizes remain to be determined. In this study, identification of SLNs with large radiolabeled tin colloid particles was evaluated. Seventy-five patients with T1-2, N0 breast cancer were enrolled. Two hours prior to surgery, 1 to 2.5 mL technetium-99m-labeled tin colloid particles were injected around the tumor under ultrasonographic guidance. Immediately before the operation, dye fluids were also injected around the tumor to increase the interstitial pressure. After axillary dissection, lymph nodes with x100 or more uptake of radioactivity than the mean of the other lymph nodes are considered to be SLN. All lymph nodes from the axillary dissections were pathologically investigated, and the characteristics of SLNs were evaluated. SLNs were clearly identified in 74 of 75 patients (98.7%). Of 37 patients without SLN metastasis, pathological investigation revealed no further involvement of the remaining non-SLNs. The SLNs tended to be larger in size, and more than 50% were located in the lower medial site of the axilla. This is the first study to show that SLNs could successfully be identified with radiolabeled tin colloid particles. When SLNs were negative for metastases, non-SLNs were always negative.

Breast Neoplasms↗

Increasing age does not affect efficacy of sentinel lymph node biopsy using smaller-sized technetium-99m tin colloids for breast cancer patients.

BACKGROUND: Increasing age of breast cancer patients was reported to cause not only failure of sentinel lymph node (SLN) identification but also false negative results. METHODS: A retrospective review was conducted of breast cancer patients who underwent sentinel lymph node biopsy (SLNB) using small-sized technetium-99m-labeled tin colloid (particle size: 200-400 nm in diameter). A comparison between 82 patients who were less than 60 years and 40 patients who were > or =60 years of age was performed to evaluate the efficacy of SLNB using the small-sized tin colloid in older patients. RESULTS: One hundred twenty-two clinically node-negative breast cancer patients underwent SLNB. Apart from age, there were no statistically significant differences between the younger patients and the older patients in terms of the clinicopathologic characteristics. Successful mapping rates, false negative rates, and accuracy were comparable between the 2 groups. CONCLUSIONS: SLNB using the small-sized tin colloid was not affected by increasing age.

Adult↗

[Hepatic hydrothorax without ascites].

A case of hepatic hydrothorax without clinical ascites is reported. The diagnosis was confirmed by intraperitoneal injection of 99mTc-tin colloid: scintigraphic images taken between 5 min and 18 h p.i. demonstrated a one-way transdiaphragmatic flow into the pleural cavity. The therapy consisted of diuretic treatment, pleural drainage and chemical pleurodesis, and resulted in prompt clinical improvement.

Adult↗

Comparison of three tracers for detecting sentinel lymph nodes in patients with clinical N0 lung cancer.

The goal of this pilot study was to compare three tracers for the detection of sentinel nodes in patients with lung cancer. Forty-eight patients with clinical N0 non-small cell lung cancer were enrolled. Indocyanine green (n=16) or isosulfan blue (n=18) was injected around the tumor intraoperatively, or technetium tin colloid was injected preoperatively under CT guidance (n=14). Sentinel nodes were detected in 6.3% of patients injected with indocyanine green, 50.0% of patients injected with isosulfan blue, and 64.3% of patients injected with technetium tin colloid. The detection rate achieved with indocyanine green was significantly lower than with the other two tracers. A false-negative sentinel node was seen in 1 patient using isosulfan blue. Both isosulfan blue and technetium tin colloid seem to be suitable for intraoperative sentinel node mapping in patients with lung cancer.

Adult↗

Intradermal radioisotope injection is superior to subdermal injection for the identification of the sentinel node in breast cancer patients.

BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate whether the intradermal injection of radiocolloids would improve the identification rate of sentinel nodes over the subdermal injection in breast cancer patients. METHODS: Sentinel node biopsy was performed in T2 breast cancer patients with clinically negative nodes, using subdermal or intradermal injection of radioisotopes with the peritumoral dye injection. We used Tc-99m tin colloid, with a larger particle size (0.4-5 microm), rather than sulfur colloid and colloidal albumin. RESULTS: The initial 55 patients underwent subdermal injection of radiocolloids; the next 61 patients underwent intradermal injection of radiocolloids for sentinel node biopsy. The detection rate of sentinel nodes was significantly (P = 0.048) higher in the intradermal injection group (61/61, 100%) than in the subdermal injection group (51/55, 92.7%). False-negative rates were comparable between the two groups. Lymphoscintigraphy visualized the sentinel nodes significantly (P < 0.0001) more often in the intradermal injection group (59/61, 96.7%) than in the subdermal injection group (20/54, 37.0%). CONCLUSIONS: A significantly higher identification rate of sentinel node biopsy and lymphoscintigraphy can be achieved by intradermal injection of Tc-99m tin colloid with a large particle size than by subdermal injection.

Axilla↗

[An evaluation of radioactive colloid for measuring the volume of effective liver].

A methods for liver scintigraphy for finding the effective liver volume were developed. Matrix ROI (region of interest) was set on the anterior liver scintigram with 99mTc tin colloid and 198Au colloid, respectively. The various depths of liver under matrix ROI were calculated from the count rate noting the absorption coefficient. The effective liver volume was the sum total of the areas of matrix ROI to the various depths. In order to check the accuracy of this method, the effective liver volume was calculated using the liver phantom and the patient's liver scintigraphy. The volume obtained for the liver phantom was nearly equal to the real volume. The liver volume in 19 patients using 99mTc tin colloid and 198Au colloid showed good correlation with the volume as measured by computed tomography (CT) scan (r = 0.841, r = 0.749).

Aged↗

Mesojejunal lymph node metastasis in esophageal cancer following total gastrectomy.

We report on a case of thoracic esophageal cancer following total gastrectomy (rho-Roux-en-Y reconstruction) with metastasis to the mesojejunal lymph nodes. Subtotal esophagectomy with reconstruction using pedicled colon and dissection of two lymph node fields was performed. During the operation, we found three lymph nodes showing metastasis at the rho-Roux loop of the mesentery, and resected the rho-Roux loop. The route of the lymphatic drainage to the abdomen from the thoracic tumor seemed to have been changed by the prior gastrectomy. Based on the pathological findings, the case was diagnosed with T2N4M0, Stage IVa. We did not confirm that the distant metastases skipped the mesojejunal lymph nodes preoperatively; the distant metastases were detected accidentally by lymphoscintigraphy using technetium-99m tin colloid. We believe this case highlights the need for detailed examinations in esophageal cancer patients who have had prior gastrectomy.

Aged↗

111In-leukocyte imaging: intrasplenic abscesses.

A 52-year-old female patient was routinely referred for an indium-111 white-cell scan due to elevated white blood cell count after mitral-valve replacement. A scan with technetium-99m tin colloid was also performed, and the resulting subtraction image showed two areas of white-cell accumulation within the spleen which were presumed to be abscesses. This was confirmed at postmortem examination.

Abscess↗

Biodistribution in rats of 99Tcm-labelled human serum albumin.

Three different 99Tcm-human serum albumin (HSA) preparations were simultaneously studied by high pressure liquid chromatography (HPLC) and gamma camera techniques in rats. The products contained variable amounts of 99Tcm-human albumin, 99Tcm-tin colloid and a 99Tcm-low molecular weight complex. The biological half life varied from 55 to 132 min and the bladder excretion for the first 60 min from 2 to 31%. Separated HPLC fractions of 99Tcm-albumin and 99Tcm-tin colloid both showed considerably longer biological half life when injected separately than when injected in the unfractionated preparation. A final evaluation of the quality of such products seem to require evaluation in humans.

Animals↗

Metabolism of a tetraphenyltin compound in rats after a single oral dose.

The metabolism of tetraphenyltin in rat liver and kidney has been examined. Tetraphenyltin and its metabolites in the tissue were determined periodically for 96 h after a single oral dose of 55.4 mg kg(-1) of tetraphenyltin by gas chromatography. The gas chromatographic method was able to determine simultaneously both inorganic tin and phenyltin compounds. Although initial (at 24 h) levels of tetraphenyltin in the liver approximated four times those in the kidneys, the levels of tetraphenyltin decreased more rapidly with time than those in the kidneys. These findings show that the tetraphenyltin accumulated more rapidly and highly in the liver, but was metabolized faster than that in the kidney. The levels of total tin in the liver 24 h after treatment were distinctly lower than those of di- or triphenyltin treatments in our previous studies and none of the animals showed characteristic symptoms. The toxic potencies of organotins generally correlate with accumulation of the chemicals. These results imply that the slight toxicities of tetraphenyltin might be due to the relatively low uptake of tin compounds after ingestion. The highest tin concentration among the metabolites of tetraphenyltin in the tissue, especially in liver, was observed as diphenyltin throughout the time period studied. These results suggest that part of the administered tetraphenyltin may cause some harmful effects as diphenyltin in rats, and this must be taken into consideration in toxicological research on tetraphenyltin.

Administration, Oral↗

Optimal sentinel node examination and a new strategy for axillary control in breast cancer.

The sentinel lymph nodes (SLNs) have been reported to reflect the other nodal status in breast cancer, and it is thought that axillary dissection can be avoided in SLN-negative patients, whereas an additional axillary dissection must be performed for SLN-positive patients. To avoid any unnecessary dissection, non-SLN-negative patients should be distinguished among SLN-positive patients. In this study, an optimal histological examination of SLNs was investigated for a precise indication of additional axillary clearance. A modified radical mastectomy with an axillary dissection was performed for 61 patients. Technetium-labeled tin colloids were used to identify the SLNs. In all lymph nodes that were diagnosed as negative at one section by hematoxylin and eosin (H&E) examination, another additional slice was produced for each lymph node. We evaluated how minute areas of cancer in the SLNs can indicate the non-SLNs to be negative. Among 1,092 lymph nodes previously diagnosed by H&E examination as negative at one section, 3 nodes were revealed to be positive in 46 SLNs (6.52%), whereas in additional slices, only 3 nodes out of 1,046 non-SLNs were positive (0.29%). The mean ratio of the cancer cell area to the whole area of SLN on the slice was 15.6% (10-18%) in 12 non-SLN-negative patients and 45.6% (30-83%) in 16 non-SLN-positive patients. It is possible that additional axillary clearance is not needed for patients with a cancer area of less than approximately 20% in the SLN slice, based on an H&E staining evaluation of two slices. SLNs identified with radiolabeled tin colloids could reflect the other nodal status in breast cancer. There is a possibility that additional axillary clearance is not needed for patients with a cancer area of less than approximately 20% in the SLN slice.

Axilla↗

A method for demonstrating subclinical inguinal herniae in patients undergoing peritoneal dialysis: the isotope 'peritoneoscrotogram'.

We report six patients who presented with genital oedema associated with continuous ambulatory peritoneal dialysis (CAPD) who had no clinically detectable inguinal hernia at the time of initial presentation. In the absence of conventional clinical signs of an inguinal hernia, isotope imaging of the pelviscrotal region after introducing technetium-labelled tin colloid through the dialysis tube has proved to be an accurate guide to localisation of the hernia, has avoided unnecessary bilateral explorations, and has facilitated early repair of the hernia, thus allowing reinstitution of CAPD.

Edema↗