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A highly sensitive cytotoxicity assay based on the release of reporter enzymes, from stably transfected cell lines.

The well-established methods of generating stably transfected cell lines, and the detection of nanomolar amounts of an enzyme in a fast and reproducible assay, were utilised to establish non-radiometric cytotoxicity assays. In these assay systems, the detection of released enzymes was used to quantitate the leakage of intracellular proteins after membrane disintegration. Target cell lines were transfected with a luciferase reporter gene under the control of a strong eucaryotic promoter. Release of the intracellular expressed enzyme into the culture supernatant occurred after membrane perforation and was measured as an indicator of cellular death. The quantitation of released enzyme was a reliable indicator of cell death initiated either by complement-mediated killing, or by cell-mediated cytotoxicity. This system was initially established with P815 mastocytoma cells as an example of a target cell line. Transfection with the firefly luciferase gene provided an intracellular enzyme absent in mammalian cells. In a parallel approach, P815 and BW5147 target cells were transfected with bacterial beta-galactosidase to provide a similar cytotoxicity system. This enzyme, however, has a considerably longer half life in tissue culture medium than luciferase. In a direct comparison between the standard 51Cr release and beta-galactosidase release, the enzyme release showed a much higher signal-to-noise ratio, i.e., low background and high induced release if spontaneous release and detergent induced maximal lysis were measured. Since a wide range of human and murine cell lines can be stably transfected and several reporter genes are available, the system should provide an alternative for conventional cytotoxicity assays. The detection of released enzymes by colorimetric or luminometric methods makes this cytotoxicity assay independent of radionuclides. The sensitivity of luminometric enzyme detection systems should also permit the measurement of apoptotic processes and might make in vivo studies of cellular death using transgenic animals feasible.

Animals↗

The influence of renal function on normalized residual activity.

OBJECTIVE: To quantify the influence of overall renal function on normalized residual activity (NORA) and to evaluate the modifying factors. METHODS: A computer simulation model generated renograms by convolution of plasma disappearance curves with artificially created retention functions. From a database, 1099mTc-MAG3 plasma curves were selected, corresponding to renal clearances ranging from 33 to 405 ml x min(-1). The retention functions had three properties: (1) until the minimal transit time (MinTT), no output and a linear increase in transit time after MinTT; (2) a ratio of MinTT to mean transit time (MTT) equal to 0.3 or 0.8; and (3) a MTT between 3 and 60 min, increasing in steps of 1 min. The model generated 1160 renograms and for each of them the NORA was calculated at 20, 40 and 60 min. For each value of MTT, the coefficient of variation (CV) of the NORA was calculated at 20, 40 and 60 min. RESULTS: For the same retention function, different clearances resulted in different values of NORA. The degree of variability of NORA depended on several factors, including the time of measurement, the MTT and the MinTT to MTT ratio. For clearances between 100 and 400 ml x min(-1), the CV of the NORA ranged from 15% to 30%, whilst for clearances below 100 ml x min(-1), the CV of the NORA ranged from 22% to 67%. Little influence of the MinTT to MTT ratio was observed. CONCLUSION: NORA is influenced by overall renal function. The influence is limited for 99mTc mercaptoacetyltriglycine (99mTc-MAG3) renal clearances over 100 ml x min(-1), whilst for clearances less than 100 ml x min(-1), the NORA is influenced much more.

Algorithms↗

Negative bone scans of joints after aspiration or arthrography: experimental studies.

It has long been suspected anecdotally that needle aspiration or contrast arthrogram before bone scan may cause a false-positive bone scan. This dictum often directs the sequence of events in the clinical workup of joint disease, yet data to support or refute this are lacking. This study was undertaken to generate such data. Fifty-six joints in mature dogs were examined, including hips, knees, elbows, and shoulders. The joints were examined in pairs; one joint was injected with Conray 60 for an arthrogram, and the contralateral joint was injected with an equal volume of normal saline to simulate a joint aspiration. Confirmation of needle placement and injection into the joints was made with fluoroscopic and digital subtraction imaging. Numbers of attempts required for aspiration and quantity of contrast material extravasated were noted for each joint. Baseline 99mTc-HDP or 99mTc-MDP bone scans were done before the experimental joint aspirations, with follow-up scans at 24 and 96 hr. The scans showed no significant change from baseline after either needle aspiration or arthrogram. When the diagnostic workup suggests the need for such a procedure, it should be performed. In contradiction to popular belief, joint aspiration and/or arthrogram did not affect a subsequent bone scan.

Animals↗

In vitro and in vivo characterization of Indium-111 and Technetium-99m labeled CCK-8 derivatives for CCK-B receptor imaging.

Cholecystokinin (CCK) receptors of the subtype B (CCK-BR) have been shown to be overexpressed in certain neuroendocrine tumors including medullary thyroid cancer. Our recent work has focused on new methods to radiolabel the CCK8 peptide with 111In or 99mTc for CCK-B receptor imaging. Derivatives of CCK8 were obtained by addition at the N-terminus in solid phase of a DTPA derivative (DTPAGlu) linked through a glycine spacer (DTPAGlu-G-CCK8) or cysteine, glycine and a diphenylphosphinopropionyl moiety (PhosGC-CCK8) for labeling with 111In and 99mTc, respectively. CCK-BR overexpressing A431 cancer cell lines were utilized to characterize in vitro properties of the two compounds as well as for generating xenografts in nude mice for in vivo characterization. Both 111In-DTPAGlu-G-CCK8 and 99mTcPhosGC-CCK8 showed similar binding affinities for CCK-BR with dissociation constants of 20-40 nM, were internalized after interaction with the receptor and displayed prolonged cellular retention times. Specific in vivo interaction with the receptor of both CCK8 analogs was observed in our animal model. 111In-DTPAGlu-G-CCK8 showed better target to non-target ratios, although it appeared to be rapidly metabolized after injection and activity cleared through the kidneys. 99mTc-PhosGC-CCK8 was more stable in vivo but showed marked hepatobiliary clearance with resulting high background activity in the bowel. The rapid clearance and lower background obtained with 111In-DTPAGlu-G-CCK8 make this a better candidate for further development.

Animals↗

Inhalation scintigraphy with an ultrafine aerosol in infants with functional bronchial stenoses.

Evaporation of Tc-99m pertechnetate at about 2500 degrees C on a carbon surface generates an ultrafine aerosol of Tc-99m-labeled carbon clusters (Technegas). The small particle size of about 100 nm enables the aerosol to behave similarly to a gas in its ability to penetrate. After inhalation, the radioactive particles adhere to the walls of the respiratory bronchioles and alveoli, or to the greater bronchial tubes if the airflow is not laminar. The high concentration of radioactivity in the argon carrier gas makes it possible to perform inhalation scintigraphy after only a few breaths. The authors investigated 24 infants with multiple events of bronchitis, most of whom had pneumonia. Seventeen patients had inhalation scintigraphy and bronchoscopy. Of these, 11 had scans diagnostic of bronchial stenosis and 6 had normal scans. Except for two pathologic scans, all scintigraphic findings matched well with the results of bronchoscopy. Seven patients had scintigraphy only, of which four were normal. Inhalation scintigraphy with Technegas is a reliable, nonhazardous procedure to preselect young patients for directed bronchoscopy.

Aerosols↗

111Indium pentetreotide imaging in the evaluation of head and neck tumors.

OBJECTIVES/HYPOTHESIS: Peptide receptor imaging with Indium pentetreotide is useful in the diagnosis of diffuse neuroendocrine system tumors (DNEST) of the head and neck. Uses of Indium pentetreotide scintigraphy include tumor and metastases detection, familial tumor screening, and surveillance for recurrence. Using target to background ratios (TBR) could generate a comparative scale for these tumors. STUDY DESIGN: A retrospective study evaluated the size, TBR, conventional imaging, and outcomes of patients imaged with Indium pentetreotide scintigraphy for suspected head and neck DNEST. METHODS: Patients with head and neck tumors imaged by Indium pentetreotide scintigraphy during a nine-year period were reviewed. Data analyzed were age, sex, scintigraphy, pathology, and conventional radiology. Tumor data included dimension, multiplicity, metastases, and tumor and brain counts. RESULTS: Fifty-three patients underwent 58 scans. The sensitivity and specificity were 93% and 92%. Several different DNEST were successfully evaluated, including familial paragangliomas and multiple paragangliomas. TBRs were variable depending on type of DNEST. CONCLUSIONS: Indium pentetreotide scintigraphy is accurate in determining the presence of paragangliomas, carcinoid tumors, esthesioneuroblastomas, small cell neuroendocrine tumors, andmetastases. It is an excellent surveillance tool. Screening patients for familial paragangliomas can be accomplished. No reliable comparative scale to distinguish amongst the various DNEST could be developed using TBR.

Adolescent↗

Behavioral and neurofunctional changes over time in healthy and aphasic subjects: a PET Language Activation Study.

BACKGROUND AND PURPOSE: Follow-up neuroimaging studies of aphasia never addressed a comparison between aphasic and healthy subjects. Investigation of changes over time in healthy subjects during language tasks seems a prerequisite before interpretation of longitudinal changes in aphasic patients. METHODS: Six healthy subjects and 8 aphasic patients were PET scanned twice (PET1 and PET2) at a 1-year interval during a word generation task. Using SPM99, language-rest main effect was compared at PET1 and PET2 in each group, whereas group effect was assessed at each session. Correlations were analyzed in each group between performance indexes and changes in regional cerebral flood flow (rCBF) between the 2 sessions. RESULTS: Language performances were improved in both groups. rCBF decreased from PET1 to PET2 in the healthy group and increased in the aphasic group in perisylvian regions bilaterally. Correlations between performance and rCBF changes across sessions were similar in the 2 groups; positive correlations involved superior temporal cortexes bilaterally, and negative correlations concerned superior frontal and medial temporal regions. CONCLUSIONS: Increased perisylvian activation over time probably reflects improved performance at the expenses of cognitive effort in aphasic patients. Decreased activation in different neural systems suggests a familiarization effect with reduced emotional load.

Adult↗

The buildup factor: effect of scatter on absolute volume determination.

We have developed a new method for generating attenuation-corrected images for use in absolute volume and activity measurements. The technique relies on the use of a set of measured buildup factors to correct for the effects of scatter inherent in the broad-beam conditions of clinical nuclear medicine and requires anterior and posterior count-rate measurements. The scatter correction requires that the well-known attenuation factor e-mud be replaced by 1-(1-e-mud)B(infinity), where B(infinity) is the buildup factor at infinite depth. The buildup factors for four different scintillation camera window settings and three different source sizes are reported. The method was validated by calculating phantom volumes and comparing the results to a previously reported technique which does not account for the scatter contribution by assuming mu = 0.15 cm-1. The results showed that the buildup factor method provides less than 7.3% error for volume determinations at all investigated depths, window settings, and source sizes, whereas errors of 3.3-26.7% were found with the other technique.

Mathematics↗

Human recombinant TSH preceding a therapeutic dose of radioiodine for multinodular goiters has no significant effect in the surge of TSH-receptor and TPO antibodies.

Radioiodine (RAI) treatment has increasingly been used mostly in elderly patients with multinodular goiter (MNG) as an alternative for surgery. Recombinant human thyrotropin (rhTSH) has been demonstrated to increase the uptake of RAI and also to promote a more even distribution of radionuclide among the various nodules. We have compared the surge of autoantibodies to thyroid peroxidase (anti-TPO) and to the TSH receptor (TRAb) in two groups of patients with MNG. Group RAI (n = 15) received only RAI, and Group RAI+rhTSH (n = 15) received RAI 24 h after 0.45 mg of rhTSH intramuscularly. At baseline, all 30 patients had negative anti-TPO antibodies. After RAI, 16 patients (eight in each group) exhibited a positive anti-TPO test (range, 70-2359 U/mL). In the rhTSH-treated group, anti-TPO values were significantly higher (as compared to basal levels; p < 0.02) after 3 months of RAI treatment. After 12 months, the anti-TPO values decreased to lower but still positive concentrations in nine patients (Group RAI: three patients; Group RAI+rhTSH: five patients). Only one patient had a positive TRAb test at baseline (67.5% inhibition of the TSH binding). After RAI, positive TRAb values were present in 21/30 patients. After 6 months of RAI treatment, there was a significant increase of the TRAb values in Group RAI+rhTSH patients. After 12 months, only four patients had positive TRAb (Group RAI: three patients; Group RAI+rhTSH: one patient). Two patients, one of each group, had an elevation of free T4 levels and suppressed serum TSH values, indicating hyperthyroidism (Graves' disease). Bioassay of TSH receptor (TSHR) indicated absence of a significant elevation of cAMP in the medium before and after RAI treatment in all patients. Moreover, predominantly blocking TSHR autoantibodies were detected in six of the 30 patients (three of each group). Sera from these patients were able to reduce the TSH-stimulated cAMP generation by CHO cells. We conclude that the autoantibodies to the TSHR and to TPO may occur after RAI treatment of patients, either with or without previous stimulation by rhTSH. The antibodies to the TSH comprised a combination of agonist (stimulating) and antagonist (blocking) antibodies, which in most patients did not induce clinical and laboratory evidence of active Graves' disease.

Animals↗

Efficacy of 15-(123I)-p-iodophenyl pentadecanoic acid (IPPA) in assessing myocardial metabolism in a model of reversible global ischemia.

In a canine model of reversible global ischemia, the residual quantity of 123I was assessed following a bolus injection of 15-p-(123I)-iodophenyl pentadecanoic acid (123I-IPPA). This technique was used to assess changes in free fatty acid metabolism following the utilization of three cardioplegic formulations. Cardioplegic arrest was initiated with Tyers' iso-osmolar (IO) solution (Group A); IO + superoxide dismutase (SOD) (Group B) and IO + allopurinol (Group C). Pre and post operative scanning were completed with 2-5 mCi 123I-IPPA. Clearance was assessed by IPPA time activity curve analysis generating t1/2 (half lives in min) for the early and late phases of the curve. The assessment between groups demonstrated that the elimination of 123I-IPPA products (early phase) was faster from the lateral wall in groups B and C versus group A (14 +/- 12 min, 13 +/- 9 min and 24 +/- 10 min, respectively). The elimination of IPPA (late phase) was also faster from the lateral wall in groups B and C when compared to group A (240 +/- 270 min, 132 +/- 85 min and 416 +/- 238 min). Examining the changes between control and postoperative values for each area of the left ventricle within each group demonstrated no significant changes for groups B and C. Group A, however, demonstrated significantly increased t1/2 values for the lateral wall (early and late phases) and the apical wall (late phase).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Hereditary nephropathic systemic amyloidosis caused by a novel variant apolipoprotein A-I.

We report a family with autosomal-dominant hereditary systemic amyloidosis in three generations, presenting with renal involvement. Two members of the current generation received renal transplants for end-stage renal failure 16 and 18 years ago, and remain very well clinically despite massive visceral amyloidosis. Two other members of this generation, aged 32 and 47 years, have massive systemic amyloid but no clinical disability. Individuals known to be affected in previous generations died of renal failure in early adult life. Amyloid deposits in the proband, one of the transplanted individuals, were composed of apolipoprotein A-I (apoA-I), and among living family members there was complete concordance between amyloidosis and the presence of a novel 9 base pair in-frame deletion mutation in exon 4 of the apoA-I gene, causing a loss of residues Glu70Phe71Trp72. This predicts the acquisition of a single extra positive charge by mature apoA-I, and this variant was detected in the plasma of all carriers. All the previously reported amyloidogenic variants of apoA-I also carry an extra positive charge, indicating that this electrostatic change is likely to be relevant to the amyloidogenicity of apoA-I.

Amyloid↗

An antifibrin monoclonal antibody useful in immunoscintigraphic detection of thrombi.

Balb/c mice were immunized with human plasmin-generated fibrinogen degradation product Y. Spleen cells were fused with P3X63-Ag8.653 myeloma cells. A clone (Y22) was found that produces monoclonal antibodies (MoAbs) with a strong reactivity with human fibrin and only a weak reactivity with fibrinogen in an enzyme immunoassay (EIA). Y22 also reacts with fibrin of rabbits, rats, sheep, and dogs. The antibodies are of the IgG1 kappa-type and appear to be directed against a conformation-dependent epitope in the D-domain of fibrin. Experiments with 99mTc-labeled Y22 in vitro show that Y22 binds rapidly to forming clots. 99mTc-Y22 also binds to preformed plasma clots in a plasma milieu, even in the presence of high concentrations of heparin. Clot localization experiments in rabbits and rats confirm the high fibrin specificity and the potential of 99mTc-Y22 for thrombus imaging in vivo.

Abdomen↗

Detection of inflammatory lymph nodes in rabbits by 99mTc-HIG lymphoscintigraphy.

Tc-Human immunoglobulin G ( Tc-HIG) is a well-known radiopharmaceutical for the evaluation of inflammatory lesions. Recently, it has been demonstrated as a new agent for the visualization of the lymphatic system by our group. Our aim was to investigate the feasibility of detection of inflammatory lymph nodes by Tc-HIG lymphoscintigraphy. Ten adult New Zealand rabbits were used as group A. In a baseline study, 37 MBq Tc-HIG (0.1 ml) was injected into both hind legs of the rabbits, and sequential posterior gamma imaging with the rabbits lying prone was performed at 5, 15, 30, 60, 90 and 120 min using a single-headed gamma camera (Toshiba GCA G01 E). One week later, microorganisms ( ) were injected in a volume of 0.1 ml intradermally into the web space between the second and third toes in the bilateral hind legs of each rabbit in order to obtain inflammation in the popliteal lymph nodes. After 4 days, 37 MBq Tc-HIG (0.1 ml) was injected into the hind legs of the rabbits bilaterally, and sequential posterior gamma imaging was performed as described above (second study). Another group of 10 adult New Zealand rabbits (group B) was injected with the same microorganisms in the right hind legs only. After 4 days, scintigraphic imaging was carried out in the same way as described above (third study). Regions of interest were drawn over the injection sites and popliteal lymph nodes on each image for semiquantitative analysis. Count rates for each were calculated and a decay correction was applied. Time-activity curves were generated to show the percentage retention of radioactivity in each region. After the scintigraphic study, some of the group B rabbits were killed by intravenous injection of pentobarbitone (100-150 mg.kg, and both left and right lymph nodes were removed for microscopic examination. On the scintigrams, lymphatic channels and popliteal lymph nodes were visualized within 15 min. In the second study, bilateral popliteal lymph nodes were visualized more clearly than in the baseline study. The right popliteal lymph nodes of the rabbits were more clearly visualized in the third study. Semiquantitative analysis showed a higher percentage uptake of radioactivity in the right compared to the left popliteal lymph nodes in group B rabbits. Microscopic examination of the tissue sections demonstrated inflammation in the right lymph nodes of group B rabbits. In this preliminary study, it was found that Tc-HIG is a new promising agent for the demonstration and evaluation of inflammatory lymph nodes.

Animals↗

The pharmacokinetic characteristics of a hepatobiliary 99mTc-radiopharmaceutical: comparison of the imported and national kits.

In nuclear medicine, the search for the perfect hepatobiliary agent started in 1955 with the rose bengal dye labeled with 131I. With the advent of technetium-99m, many ligands were labeled and Tc-99m-PG and 99mTc-HIDA were among the best suited for this purpose. Both were synthesized at the radiopharmacy laboratory during 1977-1980 and have been used at INNSZ for clinical studies. For the last three years, a new ligand with a bromine atom and an extra methyl radical has been reported as being one of the best third generation HIDAs. We received the gift of several kits of trimethyl-Br-IDA from Sorin Biomedica, Italy, (A) and of Mebrofenin from ININ, Mexico, (B) to be labeled and tested in order to select one of them for clinical work. For a comparative study on the radiopharmacodynamic characteristics of the two labeled ligands, six healthy women volunteered to undergo two tests with a 72 hour hour rest period to assure complete washout. After the I.V. dose of 111 MBq (3 mCi) the dynamic study was started and a total of 127 16-second images were acquired with a Siemens Digitrac 750 scintillation camera coupled to a Scintiview computer. Static images were taken at the end of the dynamic study and after breakfast. Blood and urine samples were collected for 24 hours and the amount of radioactivity was measured with a well type scintillation detector. The radiopharmacokinetic results are listed in tables 1-4.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Enhanced drug retention in VX2 tumors by use of degradable starch microspheres.

Twenty-nine rabbits with 12- to 14-day-old VX2 tumors in the hind leg were injected intraarterially with technetium-99m (99mTc) DTPA and various combinations of biodegradable starch microspheres, Spherex (Pharmacia, Sweden), to evaluate the efficacy of the microspheres in enhancing tumor retention of 99mTc DTPA. A gamma camera and nuclear medicine computer were used to generate time activity curves of 99mTc DTPA concentration in the tumors. Blood flow to the tumor and various muscles was also measured at intervals by left ventricular injection of 15 micron radiolabeled plastic microspheres. Ninety minutes following the administration of 99mTc DTPA, specimens from the tumor, plasma and different muscles were counted in a NaI well counter connected to a multichannel analyzer. When biodegradable microspheres mixed with 99mTc DTPA were injected and followed by a slow infusion of plain starch microspheres, the 99mTc DTPA was retained in the tumor at concentrations up to 11 times that seen when 99mTc DTPA alone was injected; the corresponding biological half-time was 13 times longer than control values. Additionally, the degree of drug retention was inversely related to blood flow, with retention increasing as blood flow decreased. The results have possible applications to the use of biodegradable microspheres in the intraarterial delivery of chemotherapeutic agents to solid tumors.

Animals↗

Improved computer analysis of solid phase gastric emptying scans.

OBJECTIVES: The solid phase gastric emptying scan (GES) is used to confirm the clinical impression of abnormal gastric emptying. There is variability in the interpretation of GES. Determination of initial lag phase of the GES and the emptying half-time (t1/2) is generally performed by curve inspection and thus may suffer from lack of objectivity. The purpose of this study was to develop a physiological model for interpretation of the GES using nonlinear curve fitting. This model resulted in computer-generated best fits for lag time and t1/2, which were analyzed in a group of patients with suspected gastroparesis. METHODS: All gastric emptying scans performed at our institution over a 3.5-yr period were studied. Raw data from these studies were analyzed by nonlinear curve fitting. Using the equation: If (x < xo, plateau, plateau * exp( - K * (x - xo))) data were best fit to a function describing a lag followed by a log linear decay. This model generated four parameters; lag, K, t1/2, and T50%. Forty patients with less than 50% emptying at 1 h (group II) were compared with 31 patients with normal emptying (group I). RESULTS: The nonlinear model resulted in better curve fitting (higher r2) in 59 of 71 studies (81%) when compared with a monoexponential decay after a lag of 0 min. Mean lag for patients in group I was 8.5 +/- 1.2 min and was 25.9 +/- 3.1 min in group II (p < 0.0005). Mean t1/2 was 31.7 +/- 1.8 min in group I and 69.7 +/- 5.0 min in group II (p < 0.007). By adding 2 SD to lag and t1/2 in group I, normal values for these parameters were 21.9 and 52.2 min, respectively. Eleven patients in group II had a prolonged lag alone, 13 had a prolonged t1/2, and 13 had prolongation of both parameters. CONCLUSIONS: A new physiological model for the interpretation of GES is presented. Individual patients with delayed gastric emptying may have increased lag times, a decreased rate of antral emptying, or both abnormalities.

Gastric Emptying↗

The role of the bronchial vasculature in soluble particle clearance.

Although a role for the airway circulation in the clearance of inhaled particles is generally assumed, there is little information to confirm its importance. We studied the effects of decreased bronchial blood flow on the uptake of the soluble tracer technetium=99m-labeled diethylenetriamine pentaacetic acid (99mTc-DTPA) from subcarinal airways in sheep (n = 7). The bronchial artery was cannulated and perfused with autologous blood at a control flow (0.6 mL/min/kg) or when the perfusion pump was stopped (no flow). (99m)Tc-DTPA (6-10 microL) was delivered by a microspray nozzle inserted through a bronchoscope to a fourth-generation bronchus both during control blood flow conditions and no-flow conditions. Airway retention (by scintigraphy) and blood uptake were monitored for 30 min after the local deposition of (99m(Tc-DTPA. During control flow conditions, 30 min after the delivery of the radiolabel, 21% of the tracer remained at the deposition site. Of the total delivered tracer, maximum blood uptake was 18% (n) = 3). When bronchial perfusion was stopped, airway retention 30 min after deposition increased to 43%, and maximum blood uptake decreased to 7% of the total delivered tracer. Although mucociliary clearance was not directly measured, radiolabel tracer was observed to move progressively from the deposition site up to larger airways and contributed to the overall removal of tracer from the site of deposition during both flow conditions. However, these results demonstrate that decreased bronchial perfusion increases airway retention by limiting vascular uptake of the soluble tracer. These results emphasize the importance of normal perfusion of the airway vasculature for uptake of therapeutic agents delivered specifically to the conducting airways.

Animals↗

Evaluation of interoperator variance in shunt fraction calculation after transcolonic scintigraphy for diagnosis of portosystemic shunts in dogs and cats.

OBJECTIVE: To determine interoperator variance in shunt fraction calculation. DESIGN: Case series. SAMPLE POPULATION: 101 transrectal portoscintigraphic studies. PROCEDURE: Results of dynamic portoscintigraphic studies were reviewed by 4 radiologists without knowledge of signalment, history, or medical profile. Results were judged to be negative or positive on the basis of the dynamic scan. Composite images were formulated, and hand-drawn regions of interest were determined for the heart and liver. Time-activity curves were generated, time-zero points were selected, curves were integrated during a 10-second interval, and shunt fractions were calculated. RESULTS: Radiologists were in agreement regarding positive versus negative results for 99 of 101 studies. Interoperator variance in shunt fraction calculation ranged from 0.4 to 59.6%. For 51 studies with positive results, variance ranged from 2.5 to 59.6% (mean +/- SD, 22.8 +/- 14.5%); differences among reviewers were significant. For 48 studies with negative results, variance in shunt fraction ranged from 0.4 to 25.9% (mean, 5.3 +/- 5.8%); significant differences among reviewers were not detected. Shunt fraction calculations were not exactly reproducible among radiologists in 94 and 100% of studies with negative or positive results, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that shunt fraction values are not reproducible among operators. Range in variability was greater in studies with positive results. This factor may be of particular clinical importance in reassessment of patients after incomplete shunt ligation.

Animals↗