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PubMed1985

Measurement of glomerular filtration rate in children using technetium-99m diethylenetriamine penta-acetic acid.

During the past 5 years, we have measured the glomerular filtration rate (GFR) by the slope-clearance method using technetium-99m diethylenetriamine penta-acetic acid (99mTc-DTPA) in 130 infants and children. The results in 22 children have been compared with inulin clearance, and a very good correlation between the two methods of measurement of GFR was demonstrated (r = 0,9616; P less than 0,0001). This study provides further evidence that 99mTc-DTPA is a satisfactory agent for the clinical measurement of GFR in children.

Child↗
PubMed1985

Technetium-99m DTPA renal flow studies in Goldblatt hypertension.

Computer-assisted dynamic renal studies were performed on a group of 14 mongrel dogs before and after the induction of unilateral renal artery stenosis. Ninety-second technetium-99m diethylenetriaminepentaacetic acid ( [99mTc]DTPA), 15-min [99mTc]DTPA, and 30-min iodine-131 orthoiodohippurate ( [131I]hippuran) time-activity curves were analyzed and correlated with reduction of renal blood flow as measured by electromagnetic flow probe and PAH clearance techniques. Parameters of the 90-sec [99mTc]DTPA curves found to be significantly different for the same kidney before and after stenosis were: upslope, curve width at 75% maximum, maximum activity value, and differential (stenotic/contralateral) maximum activity ratio. For blood flow reductions greater than 33%, the [99mTc]DTPA studies were judged diagnostic of unilateral renal artery stenosis in all cases, whereas the [131I]hippuran time-activity curves were indicative of stenosis in only six of ten studies. Thus, in this model we find the computer-assisted 90-sec [99mTc]DTPA renal flow study to be superior to conventional [131I]hippuran renography in the diagnosis of moderate-to-severe unilateral renal artery stenosis.

Animals↗
PubMed1985

Radiation doses from technetium-99m DTPA administered as an aerosol.

A model is presented which enables radiation doses following the administration of technetium-99m diethylenetriaminepentaacetic acid ([99mTc]DTPA) aerosol to be calculated. The organ with potentially the highest radiation dose is shown to be the bladder wall. Radiation doses to the lungs, kidneys, and bladder wall and the effective whole-body dose are discussed in terms of the lung clearance rate of [99mTc]DTPA aerosol and the pattern of bladder voiding. The model indicated the influence of urine flow rate on bladder dose assuming a critical volume at which bladder voiding occurs. It is concluded that significant reductions in radiation doses may be achieved by encouraging patients or subjects undergoing investigations using [99mTc]DTPA aerosols to drink freely following the study.

Aerosols↗
PubMed1985

Comparison of indium-labeled-leukocyte imaging with sequential technetium-gallium scanning in the diagnosis of low-grade musculoskeletal sepsis. A prospective study.

We prospectively compared sequential technetium-gallium imaging with indium-labeled-leukocyte imaging in fifty patients with suspected low-grade musculoskeletal sepsis. Adequate images and follow-up examinations were obtained for forty-two patients. The presence or absence of low-grade sepsis was confirmed by histological and bacteriological examinations of tissue specimens taken at surgery in thirty of the forty-two patients. In these thirty patients, the sensitivity of sequential Tc-Ga imaging was 48 per cent, the specificity was 86 per cent, and the accuracy was 57 per cent, whereas the sensitivity of the indium-labeled-leukocyte technique was 83 per cent, the specificity was 86 per cent, and the accuracy was 83 per cent. When the additional twelve patients for whom surgery was deemed unnecessary were considered, the sensitivity of sequential Tc-Ga imaging was 50 per cent, the specificity was 78 per cent, and the accuracy was 62 per cent, as compared with a sensitivity of 83 per cent, a specificity of 94 per cent, and an accuracy of 88 per cent with the indium-labeled-leukocyte method. In patients with a prosthesis the indium-labeled-leukocyte image was 94 per cent accurate, compared with 75 per cent accuracy for sequential Tc-Ga imaging. Statistical analysis of these data demonstrated that the indium-labeled-leukocyte technique was superior to sequential Tc-Ga imaging in detecting areas of low-grade musculoskeletal sepsis.

Adolescent↗
PubMed1985

Technetium-99m HIDA hepatic lobar distribution and retention ratios in detection of intrahepatic lithiasis.

Technetium-99m HIDA hepatic lobar distribution and retention ratios were developed to evaluate patients with intrahepatic lithiasis. The data of 57 cases were analyzed. Results reveal a highly significant difference in these ratios between the patients and normal individuals. They are simple, objective, and easily obtainable. Thus, the determination of these ratios may replace [99mTc]HIDA sequential scintiphotography, which is qualitative and time consuming, for screening intrahepatic lithiasis.

Calculi↗
PubMedDate not supplied

Technetium-99m-methylenediphosphonate scintimetry after femoral neck fracture. A three-year follow-up study.

Thirty-nine patients with femoral neck fractures were followed up clinically and radiographically by technetium-99m-methylenediphosphonate (99mTc-MDP) scintimetry two to 20 days and four, eight, 12, 24, and 36 months after surgery or until redisplacement, pseudarthrosis, or segmental collapse occurred. The scintimetric data were calculated by selecting regions of interest on the fractured and intact sides over the femoral head, neck, greater trochanter, and shaft; ratios of fractured/intact side were obtained for each region. Bone metabolism after femoral neck fracture was expressed and analyzed numerically. Prognosis regarding the course of healing could be made with precision by studying femoral head isotope activity shortly after surgery, preferably one to three weeks after operation. Intact femoral head uptake (ratio greater than 1.0) was connected with uneventful healing, while defective uptake (ratio less than 1.0) was observed with healing complications. The vast majority of femoral heads with primary uptake defects showed increased uptake (greater than 1.0) after four months, often as early as six to eight weeks, indicating revascularization. Segmental collapse, as well as redisplacement and pseudarthrosis, appear to be related to femoral head vascular injury. Femoral head uptake in patients in whom healing complications developed secondary to avascularity differed significantly from that in patients with normal healing, except at investigations performed four to eight months after operation. 99mTc-MDP uptake in the femoral neck, trochanter, and shaft areas was increased for all femoral neck fractures. Subsequent normalization was considerably slower in patients with healing complications. A significant difference from normal healing did not occur until 12-24 months after operation. For patients with contralateral hip disease affecting the femoral head ratio, the prognosis regarding complications was made with the aid of the femoral head/shaft ratio on the fracture side.

Adolescent↗
PubMed1981

The diagnosis of renal osteodystrophy: a comparison of Technetium-99m-pyrophosphate bone scintigraphy with other techniques.

In order to determine the place of Technetium-99m-pyrophosphate bone scintigraphy in the assessment of renal osteodystrophy, 17 patients with chronic renal failure requiring hemodialysis underwent bone scans and these were compared to results of biochemical, radiological and histologic studies. Bone histology was abnormal in all patients with most having evidence of osteomalacia and hyperparathyroid bone disease. Using semi-quantitative scan scores and regional bone-standard ratios, isotope uptake was increased in 16 patients, while 15 had elevated alkaline phosphatase levels and 7 had X-ray changes. An osteoid-osteoclast index combining histological osteomalacia and hyperparathyroid disease was derived and was found to correlate more closely with alkaline phosphatase and parathyroid hormone levels than with scan parameters. It was concluded that bone scans did not provide therapeutically useful information that could not be obtained from biochemical and radiological studies. It appeared that only bone histology could differentiate osteomalacia and hyperparathyroid bone disease.

Adult↗
PubMedDate not supplied

[Sympathetic reflex dystrophy with hypofixation of technetium 99 m pyrophosphates on bone scintigraphy (author's transl)].

A patient with sympathetic reflex dystrophy following injury to the right foot presented fairly typical clinical and radiological signs, though the hot phase was particularly short. Bone scan with technetium 99 m pyrophosphates demonstrated hypofixation, which, though extremely rare, has been previously reported in the published literature. The fact that isotopic bone hypofixation can occur during sympathetic reflex dystrophy should be recognised, as far from constituting an argument against the early diagnosis of this affection, it should enable the organic nature of the disorder to be confirmed, and assist the physician in making an early diagnosis.

Adult↗
PubMed1981

[Assessment of the results of aorto-coronary bypass surgery with the technetium 99m pyrophosphate scintigram (author's transl)].

In 40 patients with angiographically-documented coronary artery disease, technetium 99m pyrophosphate (99mTc-PYP) myocardial scintigrams were obtained prior to and four to six weeks after aorto-coronary bypass surgery. In the majority of patients, preoperative and postoperative exercise testing with simultaneous pulmonary artery pressure recordings was performed. In 22 of 30 patients with preoperatively increased 99mTc-PYP myocardial activity, no tracer accumulation could be found postoperatively. In the latter patients, there was also a significant increase in exercise capacity and lessening of ischemic ST-segment depression in the exercise ECG. In the remaining eight patients in whom increased tracer accumulation was found to persist postoperatively, there was no improvement in exercise capacity. In ten patients with no myocardial tracer accumulation preoperatively, unchanged myocardial scintigrams and a significant decrease of the ischemic ST-segment depression in the exercise ECG were seen postoperatively except in one patient with perioperative myocardial infarction. These results were also partially confirmed by repeated coronary angiography and ventriculography. Patent bypass grafts were associated with regional improvement in left ventricular function. The results indicate that postoperative absence of myocardial tracer accumulation appears due to amelioration of preexisting myocardial ischemia at rest. Thus, in the assessment of the results of aorto-coronary bypass surgery, the 99mTc-PYP scintigram offers an important diagnostic potential.

Coronary Artery Bypass↗
PubMed1982

The distal femoral defect: technetium-99m pyrophosphate bone scan results.

To determine the scintigraphic findings in children with distal femoral defects (or subperiosteal desmoids) the authors retrospectively examined 94 sets of radiographs and technetium-99m pyrophosphate bone scans of 54 children. Twenty-four examples of distal femoral defects were identified in 19 children. Only two children demonstrate focally increased uptake of radionuclide in the distal femur. The positive bone scan was caused by osteomyelitis in one of these patients and by metastatic lymphoma in the other. None of the 17 other children with distal femoral defects on radiography had a corresponding focal increase in uptake of radionuclide. The bone scan appears to be a useful method for confirming that a distal femoral defect is benign and, when positive, indicates the presence of other disease.

Adolescent↗
PubMed1982

[Metastatic calcifications as demonstrated by technetium-99m-pyrophosphate bone scanning. Case reports].

Two cases of chronic renal failure showing very interesting technetium-99m-pyrophosphate bone scans are presented. In both cases striking uptake of activity was shown in the left ventricle of the heart, the mucosa of the stomach and in both lungs. This picture was attributed to metastatic calcification in these organs. Cases of metastatic calcification demonstrated with bone-seeking agents have been presented previously, but have mainly shown intense uptake of activity in the lungs and in a few cases, and to a lesser degree, in the stomach. However, we believe that our cases are unique in showing especially the left ventricle of the heart as well as the mucosa of th stomach with exceptional clarity.

Adult↗
PubMed1983

A comparison of infarct identification with technetium-99m pyrophosphate and staining with triphenyl tetrazolium chloride.

The topographic relationship between the uptake of technetium-99m pyrophosphate (PPi) and myocardial infarction delineated by 2,3,5-triphenyl tetrazolium chloride (TTC) was studied in a canine model of permanent coronary occlusion (24-48 hr). Photographs of TTC staining and scintigraphic images of PPi uptake were planimetered for infarct area. In addition, narrow tissue samples (3 X 10 mm) were taken on both sides of the TTC border and counted for PPi uptake. A significant correlation (p less than 0.001) was found between area of PPi uptake and area of myocardium unstained by TTC (r = 0.84 in epicardium and r = 0.91 in endocardium). The slope relating PPi to TTC for all infarcts was 1.01 +/- 0.11, indicating that variations in infarct size were followed equally by the two techniques. Tissue counting showed the ratio of PPi activity just inside the infarct to activity just outside the infarct to be 9.2 +/- 0.6 (mean +/- s.e.m.). Thus, PPi is distributed topographically in a manner identical to the distribution of irreversibly injured myocardium as delineated by TTC.

Animals↗
PubMed1984

[Myocardial tomoscintigraphy with technetium pyrophosphate in the diagnosis of recent infarction].

Technetium pyrophosphate myocardial scintigraphy has become, together with Thallium scintigraphy, a common diagnostic aid in recent myocardial infarction. However, some cases with moderate diffuse fixation (2+ diffuse in Parkey's classification) are considered equivocal results by many workers. We tried to assess the value of emission tomoscintigraphy in classifying these border-line cases. This non-invasive investigation requires sophisticated equipment, including a rotating gamma camera coupled to a computer. The computer reconstructs tomographic images in the three planes (frontal, sagittal, transverse) at 6 mm intervals. After analysis of 34 coronary patients using classical clinical criteria, standard and tomographic scintigraphy were performed and the results interpreted by a double blind procedure. The following conclusions were drawn: Interpretation of the results of tomography was more reproducible than that of standard scintigraphy (91 p. 100 compared with 79 p. 100). The sensitivity of detection of myocardial infarction was higher (96 p. 100 compared to 80 p. 100) without any loss of specificity (preliminary study in 15 non-coronary patients); this improvement is due to the elimination of the "equivocal" cases observed on standard scintigraphy. The infarcted area was easier to determine as the interpretation was more reproducible. The estimation of the size of the infarcted area and the detection of rudimentary infarcts did not seem to be improved by emission tomography. Our criteria of positivity for the tomographic images were : at least 2+ fixation (significant but less intense than that of the sternum); fixation visible in at least 2 different tomographic planes (e.g. sagittal and frontal); fixation visible on at least 2 consecutive images in each plane.

Adult↗
PubMed1980

Dynamics of Technetium-99m methylenediphosphonate imaging of the femoral head after hip fracture.

A prospective study of the development of necrosis of the femoral head was performed in 34 patients with fractures of the femoral neck. Technetium-99m MDP images of the hip regions were obtained immediately after nailing of the hip and at four, eight and 12 months. There was a good correlation between qualitative and numeric evaluation of isotope uptake in the femoral heads. Comparison of the activity level in the femoral head on the fracture side with that in the contralateral control site showed activity ratios to vary between < 1.0 for those heads showing a general reduction in activity on conventional images to > 1.4 with a mean of 2.0 for those showing increased activity. The initial postoperative images in 2/7 undislocated fractures showed a marked depression in femoral head activity on the fracture side; 13/21 dislocated fractures showed a similar defect suggesting a significant loss of bone remodeling. Normal Tc-99m activity in the femoral head (category 2) was observed in two fracture cases imaged within 24 hours of fracture, just prior to nailing. Repeat studies within one week of fracture and nailing demonstrated a marked depression in activity (category 0). Radiographic evidence of collapse later developed in both patients. The perfusion and blood pool images were useful for identifying femoral heads with deficient circulation. This investigation has demonstrated that the nailing procedure may threaten the vascular condition of the femoral head in hip fracture, that a dead head may be radiographically normal and clinically asymptomatic, and that the metabolic condition of the femoral head may be expressed in numeric terms suitable for statistical analysis.

Adult↗
PubMed1981

[Myocardial scintigraphy using technetium-99m labelled methylene diphosphonate in coronary care units. 82 cases].

Many isotopic methods have been proposed recently for the investigation of normal and diseased myocardium in ischaemic heart disease. The results of myocardial scintigraphy with Technetium 99 m marked methylene diphosphonate in the supine, left lateral and 30 degrees or 45 degrees right anterior oblique incidences are reported. A preliminary study of the tracer's fixation on diseased myocardium was performed in 18 patients. Scintigraphy every 30 minutes over a five hour period showed the optimal time for investigation to be situated between the third and fourth hour after the injection of the tracer. Seventy eight patients were then investigated; 82 scintigraphies were performed, 58 in patients with acute myocardial infarctions confirmed by the usual biological and electrocardiographic changes. A 74% sensitivity and 67% specificity were obtained with the methylene diphosphonate method. These figures varied according to the type of necrosis, subendocardial or transmural and with its extent, chronicity and degree of CPK elevation. Methylene diphosphonate scintigraphy would appear to be less sensitive and more specific for diseased myocardium than other isotopic methods. It may be carried out at the bedside and could improve the diagnosis of acute myocardial infarction when the clinical history and electrocardiographic changes are difficult to interpret.

Adult↗
PubMed1983

Diagnosing papillary stenosis by technetium-99m HIDA scanning.

The diagnosis of papillary stenosis, occasionally seen after cholecystectomy, is confirmed by endoscopic retrograde cholangiopancreatography (ERCP), which demonstrates delayed emptying of contrast material into the duodenum for more than 45 minutes. The authors assessed 2,6-dimethyl phenyl carbamoyl methyl iminodiacetic acid labelled with technetium-99m (99mTc HIDA) as a less invasive procedure in these circumstances by comparing it with the findings from ERCP. Twenty-six patients who had pain after cholecystectomy were studied by continuous 1-hour scintigraphy after injection of 99mTc HIDA. Biliary flow was estimated by measuring uptake and clearance of the entire liver and common bile duct. Volunteers who had no pain after cholecystectomy served as controls. Of the 26 study patients, all 99mTc HIDA scan findings were within the control range in 11. Of these, 10 had normal biliary drainage confirmed by ERCP. The one patient with delayed drainage did not improve after endoscopic sphincterotomy. Two patients demonstrated pooling of 99mTc HIDA in cystic dilatations of the biliary tree, while the other 13 patients had obstruction of the distal common bile duct and impaired flow demonstrated on the 99mTc HIDA scan. All 13 of these patients had papillary stenosis proven by ERCP. The authors conclude that 99mTc HIDA scanning is a valuable, minimally invasive method of diagnosing papillary stenosis.

Ampulla of Vater↗
PubMed1981

Renal transplant uptake of technetium-99m sulfur colloid in various time periods after transplantation.

The uptake of technetium-99m sulfur colloid (TSC) by transplanted kidneys undergoing rejection has been described. In this retrospective study, the value of TSC uptake in diagnosing renal rejection was studied in different time intervals after renal transplantation. Within 14 days after transplantation, increasing uptake was seen in 88% of 26 rejection episodes. In patients with acute tubular necrosis, 42% of their studies showed TSC uptake. TSC did not predict rejection within the three days prior to rejection. Sensitivity, specificity and accuracy of 128 TSC studies were compared at different thresholds of TSC uptake; at best, accuracy was only 76%. In later time intervals, a much smaller percentage of patients had increasing uptake with rejection; this tendency was to remain unchanged. Many non-rejection studies showed some TSC uptake. In chronic rejection, persistently marked uptake dominated prior to one year after transplantation, but not beyond this. Thus, within 14 days after transplantation, TSC uptake may support the diagnosis of rejection. Thereafter its value becomes greatly limited.

Evaluation Studies as Topic↗