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At least 433 records · Page 24Linked to original sources

Lymphoscintigraphy in patients with malignant melanoma: a quantitative and qualitative evaluation of its usefulness.

Lymphoscintigraphy using 99mTcSb2S3 colloid was performed in 32 patients with malignant melanoma. Subcutaneous injections were made peritumorally in 20 patients and dorsopedally in 12 patients. Regional lymph node dissections were carried out on the following day in 16 patients and the resected lymph nodes were weighted, measured for radioactivity, and examined by light microscopy. Lymph flow to regional lymph nodes was shown in all but 2 patients. Twenty-nine of 239 lymph nodes contained metastases. Radioactivity was demonstrated in 17 of these nodes. In 5 of 11 patients with metastatic disease, the highest uptake was found in cancerous lymph nodes. The specific activity-uptake distribution in isolated ilio-inguinal lymph nodes after a dorsopedal injection was log-normal with a mean of 0.05%/g indicating a good saturation of colloid particles. This investigation concludes that the observed lymph flow directions in patients injected peritumorally are of value for the follow-up. Quantitative lymphoscintigraphy in patients with melanoma of the lower extremities is, however, of no value for excluding ilio-inguinal lymph node metastases.

Animals↗

Effect of 99mTc-Sn-colloid incubation time on in vivo distribution.

The in vitro particle size of 99mTc-Sn-colloid preparation increases with the length of incubation time after reconstitution. It was found that the percentage of particles trapped (T) by a 1-micron filter as a function of time (t) could be represented by the logarithmic equation T = 5.3 + 15.7 ln t (r = 0.96). This material was applied to a crossover study involving 25 patients each of whom received preparations of the same reconstituted 99mTc-Sn-colloid that had been incubated for 15 min and (each patient received both) 5 h. It was found that there was a significant shift of radioactivity to the spleen and a significant decrease in background with the material that had been incubated longer. The 99mTc-Sn-colloid is adequate for the disclosure of space-occupying disease in the liver and spleen, but unreliable for drawing conclusions on the status of liver function based on the changes in splenic concentration.

Adult↗

A new radiopharmaceutical: 99mTc DMP for renal scanning.

99mTc-Dimercaptopropionic acid (DMP), a new renal scanning agent was synthesized, and the optimum preparative conditions and stability of this compound were determined. It was demonstrated that scans performed with this agent in rats showed highly selective renal images which may be of promise in future clinical use. The relationships between chemical structure and renal affinity are discussed based on the present results.

Animals↗

Clinical evaluation of 99mTc(V)-dimercapto succinic acid (DMSA) for imaging medullary carcinoma of thyroid and its metastasis.

99mTc(V)-DMSA kits developed by the Radiopharmaceutical Division, Bhabha Atomic Research Centre, have been evaluated for potential use in scanning medullary carcinoma of the thyroid and its metastases. There were 15 patients with proved medullary carcinoma and 6 patients with other differentiated thyroid carcinoma. Amongst the 15 patients with medullary carcinoma, 12 (80%) showed positive localisation either in the primary or one or more metastatic sites. None of the six patients with carcinoma other than medullary showed increased concentration of 99mTc(V)-DMSA. Of the 37 known metastatic sites in 15 patients with medullary carcinoma, 24 showed concentration of 99mTc(V)-DMSA (64.9%). In addition, 99mTc(V)-DMSA concentration was seen in 14 sites where no evidence of metastasis was revealed. The incidence of 99mTc(V)-DMSA concentration in soft tissue and bone metastasis was similar.

Adult↗

Soft-tissue uptake of 99mTc-diphosphonate in systemic AL amyloidosis.

A case of systemic AL (amyloid light-chain-derived) amyloidosis is presented, in which a 99mTc-diphosphonate bone scan demonstrated the intense uptake of tracer in the liver, spleen, heart, thyroid, oropharyngeal region, intestinal tract and uterus. The presence of amyloid deposits in these organs was confirmed at autopsy. A review of the literature is given. In amyloidosis, the binding of radionuclide-labeled calcium-seeking agents, such as diphosphonate and pyrophosphate, may be explained by the high calcium content of amyloid. The presence of calcium in amyloid is due to the presence of the non-fibrillar protein, amyloid P-component (AP). In our patient, the amyloid deposits reacted on immunofluorescence with antibodies directed against AP.

Amyloid↗

Identification of factors affecting technetium 99m leucocyte labelling by phagocytic engulfment and development of an optimal technique.

Human autologous leucocytes can be simply and reproducibly labelled by phagocytic engulfment of technetium 99m stannous colloid with high leucocyte-labelling efficiency (LLE), similar human biodistribution to indium-111-oxine labelled leucocytes and good cell viability. A mean particle size of 2.1 microns is optimal for phagocytosis and the most important parameter in maintaining reproducibly high neutrophil uptake. It is more critical than hitherto appreciated. When such variables as type of colloid, purity of starting materials, speed of mixer rotation when preparing colloid and labelling leucocytes, heparin concentration, freshness of colloid preparation, type of sterilising membrane filter used and incubation time of cells with colloid are rigidly controlled, consistent labelling efficiencies in excess of 90% can be obtained with neutrophil predominance. The lyophilised kit tested produced suboptimal results.

Colloids↗

Effective dose equivalent from radiopharmaceuticals.

The concept of "effective dose equivalent", which was introduced by the International Commission on Radiological Protection (ICRP) for occupationally exposed workers, has also created the possibility of expressing by means of a single figure, the radiation risk to patients undergoing different medical radiodiagnostic procedures. In this study, we present the effective dose equivalent for various nuclear-medicine investigations. The figures given are primarily based on a review of data contained in the literature on the mean absorbed dose to various organs. In many cases, however, our own calculations, using biokinetic data derived from the literature, have been used. It was found that for the different radiopharmaceuticals, the effective dose equivalent per activity unit administered extends over an interval of five orders of magnitude, from 0.00015 to 20 mSv/MBq. For the technetium-labelled compounds, the absorbed dose for 90% of the substances lies within the narrower interval between 0.0060 and 0.025 mSv/MBq. With the aid of the figures presented, each nuclear medicine department will be able to estimate the effective dose equivalent and, hence, the risk to patients undergoing different investigations.

Adult↗

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↗

Preparation and evaluation of 99mTc(V)-DMSA complex: studies in medullary carcinoma of thyroid.

Consequent to the promising results reported with 99mTc(V)-DMSA for imaging certain types of soft tissue tumors, we have developed methods to prepare this radiopharmaceutical in three ways: from freshly prepared reagents, through the use of a two component kit and use of the standard renal DMSA kit by a modified recipe. The 99mTc(V)-DMSA complex has been subjected to paper electrophoretic and chromatographic procedures and also biodistribution studies. The distinctly different behaviour of this new product compared to that of the well known renal DMSA complex has been clearly established. Scintiimaging in a preliminary clinical trial in patients with medullary carcinoma of the thyroid has been encouraging.

Carcinoma↗

Two routes for 99mTc-DMSA uptake into the renal cortical tubular cell.

Critical factors determining the renal handling of 99mTc-dimercaptosuccinic acid (DMSA) are protein binding in plasma and the renal 99mTc-DMSA extraction efficiency. Comparison of the count rate over soft tissue with that over the cardiac blood pool about 1 h after injection demonstrated that 99mTc-DMSA is not exclusively an intravascular label. 99mTc-DMSA was 76% protein bound in plasma as demonstrated by HPLC and gel filtration. Assuming that the 24% that is not protein bound is filtered at the glomerulus, the renal extraction efficiency of 99mTc-DMSA by glomerular filtration is about 5%. Since the total renal extraction efficiency was also found to be about 5%, the majority of the activity that becomes fixed in the renal cortex arrives there as a result of filtration followed by tubular reabsorption rather than by direct extraction from peritubular blood. However, discordant changes in DMSA and DTPA uptake induced by captopril in renovascular hypertension (RVH) suggested that a minority of uptake was by direct peritubular extraction. This kinetic model was supported by indirect measurement of protein binding and extraction efficiency based on the kinetics of 99mTc-DMSA disappearance from plasma and kinetics of uptake in the kidneys. Furthermore, differential functional studies based on 99mTc-DMSA and 99mTc-DTPA before and after captopril in patients with RVH due to unilateral renal artery stenosis confirmed filtration followed by tubular reabsorption as the predominant route for DMSA uptake by the kidney.

Adult↗

Proximal subtotal gastrectomy for the treatment of carcinoma of the upper third of the stomach: its indications based on lymph node metastasis and perigastric lymphatic flow.

To clarify the indications for a proximal subtotal gastrectomy in the treatment of carcinoma in the upper third of the stomach based on lymph node metastases, 1055 patients in whom either a D2 or greater lymph node removal was performed were reviewed. In the patients in which the lesion was confined to the upper stomach and did not invade beyond the muscularis propria of the stomach wall, no metastases to either the lymph nodes above and below the pylorus or the lymph nodes along the greater curvature were observed. A lymphatic flow study revealed a minimal flow to these nodes from the upper stomach in patients without lymph node metastasis, but in cases with lymph node metastases the lymphatic flow changed. The indications for a proximal subtotal gastrectomy for a carcinoma of upper third of the stomach therefore must fulfill the following two conditions: (1) The deepest layer of cancerous invasion does not extend beyond the muscularis propria of the stomach wall, and (2) No macroscopic evidence of lymph node metastasis can be detected during surgery.

Case-Control Studies↗

99mTc-DTPA and 99mTc-DMSA renal gamma imaging in the surveillance of patients with conduit urinary diversion.

We studied renal anatomy and function using 99mTc-2-3 dimercaptosuccinic acid (DMSA) and 99mTc-diethylenetriaminepentaacetic acid (DTPA) in 27 patients with conduit urinary diversion. In this condition, free ureteral reflux is often associated with bacteriuria, and these factors are thought to precipitate progressive renal deterioration. Gamma-camera images provided valuable information concerning the structure of the renal parenchyma, the function of individual kidneys and possible ureteral obstruction, thus helping us to decide whether or not to instigate further treatment. The information gained using renal gamma imaging with 99mTc-DTPA and 99mTc-DMSA was complementary and partly overlapping. We preferred the use of 99mTc-DTPA because of its ability to visualise the ureters and the region of ureteroconduit anastomosis. Using diuretic medication, we were able to differentiate true ureteral obstruction from atony in 9 patients using 99mTc-DTPA.

Adult↗

Clinical evaluation of the 99mTc-CPI myocardial perfusion imaging.

99mTc-CPI myocardial perfusion scintigraphy including planar images in 35 patients and SPECT images in 16 patients has been studied. Scintigraphic data revealed that high quality 99mTc-CPI myocardial perfusion images were obtained. The sensitivity and specificity of 99mTc-CPI planar images in detecting CAD was 92% and 80% respectively. There was no significant difference in sensitivity for detecting CAD between planar and SPECT. However, the specificity of SPECT was much better than that of planar imaging.

Adult↗

Radiochemistry and biostability of autologous leucocytes labelled with 99mTc-stannous colloid in whole blood.

Autologous leucocytes were labelled in whole blood by phagocytic uptake of 99mTc-stannous colloid. This colloid has a mean particle size of 1.5 micron and labels leucocytes with 81% efficiency. Individual cell uptakes were: granulocytes 42%, monocytes 39%. Isotonic sodium citrate added after the labelling procedure did solubilise excess colloid but was not necessary for adequate removal of excess colloid. Labelled leucocytes were shown in vitro to be viable and maintain normal bactericidal and chemotactic capacity. Biodistribution, clearance rates and dosimetry are presented. These results indicate that autologous leucocytes can be efficiently labelled with 99mTc-stannous colloid with good residual cell function.

Animals↗

Is the relative 99mTc-DMSA clearance a useful marker of proximal tubular dysfunction?

The clearance of 125I-sodium iothalamate, 131I-sodium hippurate, 99mTc-DMSA, and beta 2-microglobulin were determined in 20 patients with proven or suspected proximal tubular dysfunction and in 18 control patients with various renal diseases. A clear distinction in the relative 99mTc-DMSA clearance was observed between patients with proximal tubulopathy (14%-35%) and control patients (less than 14%). A similar difference between the two groups was found in the relative beta 2-microglobulin clearance. Nine patients with proximal tubulopathy showed an elevated filtration fraction versus only two control patients. The renal handling of 99mTc-DMSA seems to be an indicator of proximal tubular function.

Adolescent↗