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PubMed2000

[Evaluation of technetium-99m-MIBI scintigraphy in metastatic differentiated thyroid cancer--comparison study with 131I and 201Tl].

Detectability of metastasis in differentiated thyroid cancer using technetium-99m-methoxyisobutyl isonitrile (99mTc-MIBI) was compared with that of 131I and 201Tl. Forty patients after total thyroidectomy were evaluated. The scan results were compared with those of 131I and 201Tl whole body scintigraphy per patient. The positive rate was 68% in 99mTc-MIBI, 84% in 131I, 60% in 201Tl respectively. As to the lymph node metastasis, the positive rates were 56% in 99mTc-MIBI, 78% in 131I, 39% in 201Tl. In lung metastasis, the positive rate was 46% in 99mTc-MIBI, 82% in 131I and 55% in 201Tl. Serum thyroglobulin (Tg) was significantly higher in 201Tl and/or 99mTc-MIBI positive group compared to that of negative group independent of 131I scan results. Although the detectability of both 99mTc-MIBI and 201Tl were inferior to that of 131I, 9 to 22% of metastasis were detected only by these radiopharmaceuticals. Both 99mTc-MIBI and 201Tl, therefore, should be used in cases with high serum Tg even with negative 131I uptake. Basing on the fact there was no prominent difference between 99mTc-MIBI and 201Tl in the detectability of metastasis, 99mTc-MIBI might be more suitable tracer because of better quality image.

Adult↗
PubMed1979

[Value and limitations of sequential technetium 99m angiocardiography in the detection, localization and quantification of left-right intracardiac shunts apropos of 110 cases].

A comparative study of the diagnosis of intracardiac left-to-right shunts by isotope radiography on the one hand and oxymetry, abnormal catheter trajectory and angiocardiography on the other, was performed on a series of 110 patients, comprising 12 normals, 46 valvulopathies or cardiomyopathies without shunts, 23 ASDs, 22 VSDs, and 7 other shunts. Intravenous injection of Technetium 99 m with scintigraphic imagery and interpretation of time-activity curves detected even small left-to-right shunts and appeared to be more sensitive than oxumetry. The estimation of the size of the shunt correlated well with oxymetry for VSDs but not for ASDs. The localisation of the shunt was more difficult. The atrial level of the defect was detected in some but not the majority of cases. The isotopic technique appeared unreliable in the presence of severe haemodynamic disturbances. The isotopic method is a quick means of detecting left-to-right shunts without measurable risk, particularly useful in the investigation of children and young adults thought to have left-to-right shunts.

Adolescent↗
PubMed2000

Evaluation of ocular tumors with technetium-99m-MIBI: planar pinhole technique or SPECT?

OBJECTIVE: This study compares 2 imaging protocols, planar pinhole technique (PPHT) and SPECT, for evaluating ocular masses with 99mTc-MIBI. METHODS: Sixteen patients with ocular lesions were studied. Planar images were acquired 10 min after the injection of 740 MBq 99mTc-MIBI with an LFOV camera fitted with a pinhole collimator (5.0 mm). A SPECT study was performed immediately after the planar study, using a 360 degrees orbit, 64 steps, 20 s/stop, a 128 x 128 matrix, and a low-energy high-resolution (LEHR) collimator. Twelve lesions (9.5-18.0 mm) proved to be malignant: 8 primary tumors (ocular melanoma); 3 local relapses of different tumors of the conjunctiva; and 1 ocular metastasis from breast cancer. The remaining 4 lesions (10.0-16.0 mm) were benign: 1 inflammatory lesion; 1 benign intraocular calcification; and 2 naevi. RESULTS: SPECT images showed 11 of 12 malignant lesions (91.6%), whereas the planar technique demonstrated only 4 of the 12 lesions (33.3%). One false-positive result, the inflammatory lesion, was visualized by both techniques. The remaining benign lesions were not detected with either method. CONCLUSION: Technetium-99m-MIBI SPECT is a sensitive technique for detecting malignant ocular tumors. SPECT imaging is a better alternative to planar imaging for ocular tumors.

Adolescent↗
PubMed1975

Receptor sites for antigen-antibody complexes on cells derived from solid tumors: detection by means of antibody sensitized sheep erythrocytes labeled with technetium-99m.

Surface receptor sites for the Fc portion of antigen-antibody complexes were demonstrated on cells derived from three methylcholanthrene-induced fibrosarcomas, one of strain C3H and two of strain BALB/c origin, two spontaneously occurring malignant melanomas (B16 in strain C57BL/6 and Harding-Passey in strain BALB/c mice), a Moloney sarcoma virus-induced tumor of strain BALB/c origin and the Walker 256 carcinosarcoma of Holtzman rats. Primary cell cultures derived from these tumors adsorbed technetium-99m labeled, antibody-sensitized sheep erythrocytes (99mTc EA) as determined either by visual scoring of adherence or radioisotopic quantitation. Depending upon the tumor tested, from 20% to greater than 95% of the target cells absorbed 99mTc EA. All cells lost their reactivity after 1 or 2 passages in vitro, but this was regained after a single passage in vivo. Indicator erythrocytes coated with F(ab')2 fragments of the sensitizing sheep erythrocytes (SRBC) antiserum did not adhere thereby demonstrating that the hemadsorption required an intact Fc portion of the antibody molecule. Adherence of 99mTc EA was blocked by soluble immune complexes prepared with ovalbumin and rabbit antibody directed against it and Escherichia coli 055:B5 lipopolysaccharide and mouse antibody directed against it. Normal rabbit or mouse serum, immune serum, or antigen alone did not block adherence of 99mTc EA thereby demonstrating that the receptors had greater affinity for immune complexes than for either antigen or antibody alone. The existence of membrane receptors on tumor-derived cells which react with the Fc portion of antigen-antibody complexes may provide an explanation for the mechanism by which immune complexes are capable of blocking cell-mediated tumor cell destruction irrespective of whether the receptors are on the tumor cells themselves or on admixed lymphocytes and macrophages.

Animals↗
PubMed1975

Technetium-99m-diphosphonate accumulation in amyloid.

A well-documented case of multiple myeloma complicated by histologically demonstrable amyloidosis is presented. Technetium-99m-diphosphonate in the areas of amyloid deposition about the shoulders and hips is shown. This adds another dimension to the extraosseous sites without demonstrable calcification where accumulation of bone-seeking radiopharmaceutical can be observed. In patients where symmetrical uptake of such agents is noted in the periarticular soft tissue, particularly of the hips and shoulders, amyloidosis must become a diagnostic consideration. This is particularly true in patients presenting with undiagnosed arthralgia.

Amyloidosis↗
PubMed2001

Technetium-99m-sestamibi scintigraphy in multiple myeloma and related gammopathies: a useful tool for the identification and follow-up of myeloma bone disease.

BACKGROUND AND OBJECTIVES: Technetium-99m 2-methoxy-isobutyl-isonitrile ((99m)Tc-sestamibi) has recently been proposed as a potential tracer in patients with multiple myeloma (MM), as its increased uptake in the bone marrow has been reported as indicator of myeloma activity. We evaluated the role of (99m)Tc-sestamibi scintigraphy in the detection of myeloma bone disease in MM and related gammopathies, and also assessed its relationship with clinical status and stage of the disease, focusing in particular on the early follow-up of a small series of MM patients treated with high-dose therapy. DESIGN AND METHODS: Forty-six consecutive patients affected by MM or monoclonal gammopathy of undefined significance (MGUS) were studied by whole body scans obtained 20 minutes after administration of 740 MBq of (99m)Tc-sestamibi. A semiquantitative uptake score was used and scintigraphic findings were correlated with clinical and laboratory data. RESULTS: All the MGUS patients showed a negative (99m)Tc-sestamibi scan. Among the 32 MM patients (25 with active disease and 7 in clinical remission) 24 showed a positive scan, while 8 presented only a physiologic uptake of the tracer. The uptake score correlated significantly with all the most relevant clinical variables. In the follow-up of 8 MM patients treated with high-dose chemotherapy (99m)Tc-sestamibi closely paralleled the activity of myeloma bone disease. Comparison with X-ray skeletal survey showed discordant results in 14 out of the overall 56 scans obtained (27%), with 10 cases of negative (99m)Tc-sestamibi scans but lytic bone lesions revealed by X-ray (7 of them were in clinical remission), and 4 negative X-ray surveys in patients with positive (99m)Tc-sestamibi scans. Overall sensitivity and specificity of (99m)Tc-sestamibi scintigraphy in detecting myeloma bone disease were 90% and 88%, respectively. INTERPRETATION AND CONCLUSIONS: This study provides additional evidence indicating that (99m)Tc-sestamibi scintigraphy closely reflects myeloma disease activity in bone marrow, with very high sensitivity and specificity. (99m)Tc-sestamibi scintigraphy is therefore suggested as a reliable new tool for the staging and follow-up of myeloma bone disease.

Adult↗
PubMed2000

[Effective intraoperative identification of parathyroid adenomas by means of a gamma probe after injection of technetium 99m-sestamibi in 5 patients].

Primary hyperparathyroidism is caused by a single adenoma in the majority of patients. In five patients (2 men aged 74 and 78 and 3 women aged 78, 58 an 73 years) a recently introduced approach for intraoperative identification of pathological parathyroid glands was applied using intravenously injected technetium-99m(99mTc)-sestamibi and a gamma probe. For two patients this was a reoperation in this region. All patients had one adenoma removed and became normocalcaemic postoperatively. The time between the start of the operation until the extirpation of the adenoma was 13-25 min, a lot shorter than bilateral cervical exploration takes, even in the two reoperations. These results confirm the literature that this approach minimizes operative intervention, thereby shortening operative time and reducing potential surgical complications.

Adenoma↗
PubMed2000

Krypton-81m ventilation and technetium-99m macroaggregated albumin perfusion scintigraphy for detection of pulmonary embolism: the first experience in Taiwan.

BACKGROUND: This study was designed to assess whether the self-made (Institute of Nuclear Energy Research, Taiwan) krypton (Kr)-81m could be used as a ventilation agent to detect patients with suspected pulmonary embolism (PE). In addition, xenon (Xe)-133 ventilation scintigraphy was also performed for comparison. METHODS: Forty patients with suspected PE were studied. Each patient received Kr-81m ventilation, Xe-133 ventilation and technetium (Tc)-99m macroaggregated albumin (MAA) perfusion studies on the same day. Images were judged using the criteria of the modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). For those with a high or intermediate probability of PE on lung scans and normal pulmonary function tests, anticoagulants were given and patients were monitored with Tc-99m MAA perfusion studies after treatment. The final diagnosis was based on chest radiography, pulmonary function tests and lung scans. RESULTS: All 40 patients successfully underwent lung scans. Of these, 11 had PE. Ten of the 11 cases were detected using Kr-81m ventilation and Tc-99m MAA perfusion studies, resulting in a sensitivity of 91%. Seven of 11 cases were detected using Xe-133 ventilation and Tc-99m MAA perfusion studies, resulting in a sensitivity of 64%. Of the 11 patients with PE, four had PE alone; Kr-81m and Xe-133 results agreed in three patients, but Kr-81m detected PE in the remaining patient. Of the remaining seven patients who suffered from PE with obstructive airway disease, Kr-81m and Xe-133 agreed in four, but Kr-81m detected PE in another two patients and one case was missed by both studies. CONCLUSIONS: Self-made Kr-81m was safe and effective for ventilation scintigraphy in humans. When Kr-81m was used for the detection of PE, it was particularly advantageous when PE occurred in small areas of the lungs or when the patient with PE had concurrent obstructive airway disease.

Adolescent↗
PubMed2001

P-Glycoprotein and multidrug resistance-related protein expressions in relation to technetium-99m methoxyisobutylisonitrile scintimammography findings.

The purpose of this study was to retrospectively study 48 patients with infiltrating ductal breast cancer to evaluate the relationship between the degree of accumulation of technetium-99m methoxyisobutylisonitrile (Tc-MIBI) and P-glycoprotein (Pgp) or multidrug resistance-related protein (MRP) expression in breast cancer tissues. Before surgery or biopsy, all 48 patients underwent scintimammography started 10 min after the injection of Tc-MIBI. Tumor:background (T:B) ratios were calculated from the Tc-MIBI scintimammography. Immunohistochemical analysis was performed on the pathological specimens of the 48 breast tumors to determine Pgp and MRP expression. According to the results of immunohistochemical analysis, the 48 breast cancers were separated into four groups: (a) group 1, 12 cancers with both positive Pgp expression and positive MRP expression; (b) group 2, 12 cancers with positive Pgp expression and negative MRP expression; (c) group 3, 12 cancers with negative Pgp expression and positive MRP expression; and (d) group 4, 12 cancers with both negative Pgp expression and negative MRP expression. Among the four groups, the T:B ratio was lowest in group 1 (1.13+/-0.10) and highest in group 4 (2.17+/-0.14), respectively (P < 0.05). The T:B ratios of groups 2 (1.30+/-0.25) and 3 (1.32+/-0.26) were between those of groups 1 and 4. Our data confirmed that Tc-MIBI scintimammography is useful for determining Pgp and MRP expression in patients with breast cancers.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2000

Evaluation of technetium-99m ciprofloxacin (Infecton) in the imaging of infection.

INTRODUCTION: The aim of this study was to evaluate the usefulness of technetium-99m (Tc-99m) ciprofloxacin in imaging inflammation/infection. The ciprofloxacin for labelling, as a kit, was obtained from St Bartholomew's Hospital in London. MATERIALS AND METHODS: Patients were injected intravenously with Tc-99m ciprofloxacin and imaging was done at 10 minutes, 4 hours and 24 hours if necessary. Tomographic images (SPECT) were obtained in a few patients. Ninety-six patients were studied using Tc-99m ciprofloxacin. Forty-eight patients had bone scans and 22 had Tc-99m IgG scans. Eight patients were imaged using Tc-99m HMPAO labelled white blood cell, and bacteriological culture results were available in 24 patients. Organisms cultured included Acinetobacter baumanii, Streptococcus, Staphylococcus aureus, Pseudomonas, Klebsiella, Blastococidia, Methicillin-resistant S. aureus, Salmonella and Candida. RESULTS: Findings were evaluated against microbiology, alternative imaging modalities and clinical outcome. There were 47 true positives, 33 true negatives, 5 false positives and 11 false negatives, giving a sensitivity of 81% and specificity of 87%. The positive and negative predictive values were 90% and 75%, respectively. There were no side effects and the scan was particularly useful in the evaluation of painful joint prosthesis to exclude infection. Repeat studies on 8 patients given antibiotics over a long period were very useful in deciding on termination of the antibiotic treatment.

Abscess↗
PubMed1975

[Quantitative functional exploration of the salivary glands. Measurement of salivary elimination of technetium 99].

The authors propose a method for the quantitative functional exploration of the salivary glands using two objective criteria, on the one hand the level of fixation in the parotid of technetium 99m injected in the form of its pertechnate and on the other hand by the fraction of radioactivity found in different specimens of saliva collected in the course of a test carried out using a pharmacological agent free of toxic effects--lemon juice. The quantitative results obtained and its simplicity render the method particularly useful in evaluating the course of salivary function in all forms of disorder, pathological or iatrogenic.

Arthritis, Rheumatoid↗
PubMed1975

Technetium bone scanning as an aid in the diagnosis of atypical acute osteomyelitis in children.

Technetium bone scanning is a simple, safe and accurate method for the diagnosis of acute osteomyelitis in children whose presenting clinical findings are atypical of bone infection. Bone scanning was effective in the localization of the exact site of osteomyelitis, thus facilitating needle aspiration as well as subsequent surgical decompression. Tehcnetium bone scanning is a diagnostic technique for determining bone infection in children who are unable to communicate adequately or in those whose signs have been modified by previous inadequate antibacterial therapy.

Acute Disease↗
PubMedDate not supplied

[Technetium-99m production for use in nuclear medicine].

INTRODUCTION: Technetium-99m is the most important radioisotope used in nuclear medicine. Its routine application is ensured by introduction of 99Mo/99mTc generators. This paper reviews the present status and perspectives of different types of generators. Novelties in the production of either 99Mo for generators or directly 99mTc by using accelerators are also included. PRODUCTION OF 99MO IN NUCLEAR REACTORS AND 99MO/99MTC TYPES OF GENERATORS: The main source of 99Mo is a nuclear reactor. Nuclear reaction 99Mo(n, gamma)99Mo is rather simple, but the main disadvantage is a low specific activity of 99Mo. For routine production the nuclear reaction 235U(n,f)99Mo is used. It gives high yields of 99Mo of very high specific activity. However, its main disadvantages are high costs and generation of large quantities of highly radioactive waste. Depending on the separation method several types of generators were developed. The predominant is the chromatographic generator based on fission-produced 99Mo. Due to the disadvantages of (n,f)99Mo production, the alternatives based on (n, gamma)99Mo were developed. However, sublimation (except low temperature sublimation) and extraction generators at the present stage have no perspective. Only gel generators are promising. PRODUCTION OF 99MO AND 99MTC IN ACCELERATORS: Several nuclear reactions are considered. 100Mo(gamma, n)99Mo gives 99Mo of low specific activity. So it could be used in production by sublimation generators. The reaction 100Mo(p,pn)99Mo was also investigated but it seems not to be suitable for routine production of 99Mo. 99mTc can be directly produced by 98Mo(p, gamma)99mTc and 100Mo(p,2n)99mTc nuclear reactions. It seems that the latter could serve as an auxilliary source of 99mTc. CONCLUSION: At present chromatographic generators based on fission-produced 99Mo seem to have no real alternative. Gel and in lesser extent sublimation generators are prosperous, but still not suitable for large scale production of 99mTc. The accelerators offer good possibilities but a real alternative to fission 99Mo has not been found yet.

Molybdenum↗
PubMedDate not supplied

Detection of cervical lymph node metastases in nasopharyngeal carcinomas: comparison between technetium-99m methoxyisobutylisonitrile single photon emission computed tomography and computed tomography.

The aim of this study was to compare the effectiveness of technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) single photon emission computed tomography (SPECT) and computed tomography (CT) of head and neck in evaluating cervical lymph node (LN) metastasis in nasopharyngeal carcinomas (NPC). Fifty NPC patients with suspected cervical LN metastases underwent Tc-99m MIBI SPECT and CT of the head and neck to evaluate cervical LN metastases. Among the 50 patient.s cervical LN lesion were confirmed by biopsy histopathological results in 40 patients. For 22 LN lesions with discordant results between Tc-99m MIBI SPECT and CT Tc-99m MIBI SPECT could correctly detect 5 metastatic and 7 benign LN lesions, while could correctly detect 5 metastatic and 6 benign LN lesions. Tc-99m MIBI SPECT and CT could correctly detect all of the 18 metastatic LN lesions. Tc-99m MIBI SPECT showed a better specificity but a lower sensitivity for detecting cervical LN metastases in NPC when compared with CT. The combined use of Tc-99m MIBI SPECT and CT could increase the accuracy, compared with the single use of either Tc-99m MIBI SPECT or CT, to detect cervical LN metastases in NPC.

Adult↗
PubMed2001

Appropriate procedures for the safe handling and pathologic examination of technetium-99m-labelled specimens.

Technetium 99m may now be used to identify sentinel nodes for surgical excision in a growing number of cancer sites. The pathology specimens of these sentinel nodes and of any injected tumoural sites are radioactive. Consequently, specific clinical and laboratory procedures must be developed to handle these specimens safely. It is recommended that specimens containing the injection site should be quarantined for a period to permit decay of radioactivity. This quarantine does delay the reporting of pathology results to surgeons, oncologists and other clinicians, but it does not adversely affect final patient management.

Canada↗
PubMed2001

Detection of restenosis after percutaneous transluminal coronary angioplasty using the exercise treadmill test and technetium 99m-sestamibi scintigraphy.

BACKGROUND: The detection of myocardial ischemia after percutaneous transluminal coronary angioplasty (PTCA) is important because 30-50 per cent of the patients will develop restenosis within 6 months. Symptoms of chest pain and exercise stress test (EST) have shown to be less sensitive for detection of ischemia than exercise Technetium-99m Sestamibi (Tc-99m MIBI). The purpose of this study was to compare the sensitivity and specificity of chest pain, EST and Tc-99m MIBI with coronary angiography (CAG). METHOD: Tc-99m MIBI with SPECT imaging was performed at months 1, 3 and 6 and CAG was repeated 6 months after successful PTCA. Earlier Tc-99m MIBI and CAG were performed in patients with recurrent angina pectoris or suspected restenosis. RESULTS: Forty six patients (M 29, F 17) who had undergone successful angioplasty were prospectively enrolled. Their mean age was 61 +/- 19 yrs. Eighty eight lesions (LAD63%, LCX34%, RCA19%) were performed. Lesion characteristics were type A in 9 per cent, type in B 30 per cent and type C in 61 per cent. Fifty four per cent of PTCA were performed for single vessel disease and 46 per cent for multivessel disease. The mean duration of time between PTCA and follow-up CAG was 6.1 +/- 2.7 months. We detected restenosis from CAG in 58 per cent of the cases. The Tc-99m MIBI had higher sensitivity to detect restenosis than anginal pain (85.0% vs 39.4% p < 0.005) or EST (85.0% vs 63.6% p < 0.05) when compared with CAG. The overall accuracy of Tc-99m MIBI for the detection of restenosis was 80 per cent. CONCLUSION: Tc-99m MIBI with SPECT imaging constitutes a better means than symptoms or exercise test to detect restenosis after successful coronary angioplasty.

Adult↗
PubMedDate not supplied

Comparison of technetium-99m methoxyisobutylisonitrile single photon emission computed tomography and computed tomography to detect recurrent or residual nasopharyngeal carcinomas after radiotherapy.

The diagnostic accuracy of technetium-99m methoxyisobutylisonitrile (Tc-MIBI) single photon emission computed tomography (SPECT) of head and neck to differentiate between recurrent or residual nasopharyngeal carcinomas (NPC) and benign lesions after radiotherapy was evaluated, and compared with computed tomography (CT). Thirty-six NPC patients 4 months after radiotherapy underwent Tc-MIBI SPECT and CT of head and neck, as well as histopathological examination of nasopharyngeal biopsies. Based on the biopsy results, the sensitivity, specificity, and accuracy of CT were 73%, 88%, and 83%, respectively. The sensitivity, specificity, and accuracy of Tc-MIBI SPECT were 64%, 96%, and 86%, respectively. The sensitivity, specificity, and accuracy of combined Tc-MIBI SPECT and CT were 100%, 88%, and 92%, respectively. Tc-MIBI SPECT had a better specificity and a lower sensitivity to differentiate benign lesions from recurrent/residual NPC when compared with CT The combined use of CT and Tc-MIBI SPECT significantly increased accuracy compared with the single use of either Tc-MIBI SPECT or CT to differentiate benign lesions recurrent/residual NPC.

Adolescent↗
PubMed2001

Lack of correlation of functional scintigraphy with (99m)technetium-methoxyisobutylisonitrile with histological necrosis following induction chemotherapy or measures of P-glycoprotein expression in high-grade osteosarcoma.

In osteosarcoma, some studies have suggested P-glycoprotein expression is a prognostic factor. The clearance of (99m)technetium hexakis-2-methoxyisobutylisonitrile ((99m)Tc-MIBI) has been used in some tumor systems as an in vivo measure of P-glycoprotein-mediated efflux. In this study we explored the correlation between (99m)Tc-MIBI clearance and histological necrosis following induction chemotherapy and P-glycoprotein expression in osteosarcoma. The primary tumors of 20 patients with high-grade osteosarcoma were imaged at diagnosis with (99m)Tc-MIBI, and the uptake ratios and biological half-lives were calculated. P-Glycoprotein expression in the tumor tissue was determined immunohistochemically and by measuring mRNA expression of the multidrug resistance-1 gene. The histological necrosis following induction chemotherapy was assessed by the Huvos grading system. The biological half-life of (99m)Tc-MIBI ranged from 1.4 to 52.5 h. Seven of the 20 tumor samples had a favorable extent of necrosis following induction chemotherapy. The (99m)Tc-MIBI half-life and uptake ratio showed no correlation with histological necrosis following induction chemotherapy. The (99m)Tc-MIBI half-life and uptake ratio did not correlate with either measure of P-glycoprotein expression. The results of this pilot study indicate that (99m)Tc-MIBI imaging is not an effective predictor of histological necrosis following induction chemotherapy in high-grade osteosarcoma. (99m)Tc-MIBI imaging did not correlate with measures of P-glycoprotein expression in the tumor tissue.

ATP Binding Cassette Transporter, Subfamily B, Mem↗