Technetium-99m pentavalent DMSA imaging detects metastases of poorly differentiated carcinoma of the thyroid.
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Sixty patients with a variety of malignant tumors were examined with Tc-99m(V) dimercaptosuccinic acid (DMSA) prepared by modification of a commercially available DMSA kit. Significant uptake of Tc-99m(V)-DMSA was observed in a number of tumors, offering additional clinically useful information. In the majority of cases in this study, however, the benefit of the Tc-99m(V)-DMSA image was limited because of low sensitivity. The most striking observation was the similarity between the tumor concentration of Tc-99m(V)-DMSA and the Tc-99m-MDP uptake in the tumor on the regular bone image. Therefore, patients with Tc-99m-MDP uptake in nonosseous tumor sites on the bone scan may be suitable candidates for tumor imaging with Tc-99m(V)-DMSA.
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Tc-99m(V) DMSA scintigraphy was performed on two patients with primary cardiac amyloidosis. Scintigraphy performed (after radionuclide administration) showed accumulation in the myocardium.
Voiding cystourethrography is widely used in children to detect vesicoureteral reflux disease. A case of radionuclide voiding cystourethrography is reported, where the initial location of the catheter tip in an open ureter ostium might have lead to erroneous interpretation. Recommendations for catheter technique and control of imaging in voiding cystourethrography are given.
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A neonate with infantile polycystic kidney disease underwent Tc-99m DMSA imaging. The pattern of uptake in infantile polycystic disease is different from the multiple cystic lesions reported in the literature for adult polycystic kidney disease. The infantile pattern of uptake shows large kidneys with diffuse, symmetric localization of the radiopharmaceutical, which seems to be characteristic and may be pathognomonic of the disease process.
Twenty-seven patients (24 men, 3 women; ages: 39-74 years) were diagnosed as having squamous cell carcinoma of the nasopharynx (NPC) as confirmed by pathologic findings of biopsies. In addition, three of the 27 patients had metastases to neck lymph nodes. The results of 2-4-hour SPECT images of the head and neck after intravenous injection of 15-20 mCi of Tc-99m (V) DMSA were compared with normal Tc-99m (V) DMSA images and CT of heads and necks. The results showed that of the 27 NPC cases, none of the patients had a significant uptake of Tc-99m (V) DMSA. However, in the three cases complicated with metastases of neck lymph nodes, the metastatic lesions could be detected by Tc-99m (V) DMSA. Our results challenge previous reports in which carcinomas of the head and neck were detected by Tc-99m (V) DMSA. The tumor-seeking agent Tc-99m (V) DMSA is not a good choice for the detection of NPC among malignancies of the head and neck.
The 10-year survival rate for medullary carcinoma of the thyroid (MCT) is 50%; thus, good tumor-seeking radiopharmaceuticals are needed to localize foci of recurrence and metastasis during follow-up. Two patients with metastatic MCT were studied with Tl-201, I-131 MIBG, Tc-99m (V)-DMSA, and Tc-99m MIBI. A SPECT study with the latter agent allowed the visualization and precise localization of a metastatic mediastinal lymph node. More studies need to be done to evaluate the role of Tc-99m MIBI in the detection of recurrence and metastases of MCT.
The aim of this study was to establish nomograms of renal length in children comparing age, body weight, and height. Renal lengths were obtained from data derived from Tc-99m DMSA scintigraphy in 266 patients with 532 kidneys that appeared normal on DMSA studies. The children's ages ranged from 6 days to 19 years. Renal length appeared to have nonlinear relationships with patient weight and age, but was found to correlate linearly with patient height. On average, scintigraphic renal length exceeded sonographic renal length by approximately 1 cm. The most likely explanation for this is the effect of respiration causing renal motion during the acquisition of the scintigraphic images. It is hoped that the nomograms derived from these data will be of use in routine clinical practice for nuclear medicine departments performing DMSA scintigraphy in children.
Captopril-enhanced renal scintigraphy with Tc-99m DMSA was performed in an 11-year-old boy with hypertension. This showed a significant reduction in function of the right kidney. Renal arteriography was performed and showed two renal arteries on the right, the major one with stenosis. This case illustrates the possible role that scintigraphy with Tc-99m DMSA can play in the diagnosis of renovascular hypertension.
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Tc-99m DMSA renal scintigraphy was performed in 40 renal grafts. Cyclosporin A and glucocorticoids were given to all patients as antirejection therapy, and 11 also were given azathioprine. The kidneys were transplanted 1 to 97 months before the investigation. Seventy percent of kidneys had diffusely altered distribution of Tc-99m DMSA, and 43% had focal clear-cut parenchymal defects. The frequency of parenchymal defects observed on the DMSA scans was higher in patients who suffered manifest acute rejection episodes (8/16 versus 9/24 patients, borderline significance, P < 0.06), but had no relation to the living or cadaveric donor transplant or its function. A combination of peritubular edema and interstitial fibrosis is considered the most probable explanation of diffuse changes. The high frequency of clear-cut parenchymal defects most likely results from symptomatic or asymptomatic rejection episodes complicated by renal transplant infarcts.
SPECT imaging has been shown to identify additional defects when applied to Tc-99m DMSA scintigraphy. However, the nature of these defects is uncertain. They may be because of small scars or anatomical variants. The interrenicular septum (IRS) is a normal finding that may mimic a scar on ultrasound examination or tomography. In this study, it was found that the IRS may be identified on Tc-99m DMSA SPECT and that it was present in 32% of patients. Its characteristic appearance is a linear area of absent tracer uptake extending from the renal hilum into the parenchyma, usually anterosuperiorly. The preservation of renal cortical uptake differentiates it from a scar, which results in a defect in the rim of cortical Tc-99m DMSA accumulation.
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