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Measurement of myocardial blood flow.

This paper represents a review of the recent literature on techniques to measure myocardial blood flow in man. A short discussion on flow meters in followed by a more detailed discussion of the radionuclide techniques used to measure myocardial blood flow. The radionuclide techniques are discussed in two groups: (1) qualitative measurement of blood flow using static images; and (2) quantitative measurements of blood flow using diffusible substances that actively enter the cell, radioactive labeled particles, and radioactive diffusible gases.

Absorptiometry, Photon↗

Comparison of observer variability and accuracy of different criteria for lung scan interpretation.

UNLABELLED: Different criteria have been advocated for the interpretation of ventilation/perfusion (V/Q) lung scans in patients with suspected pulmonary embolism (PE). Besides these predefined criteria, many physicians use an integration of the different sets of criteria and their own experience-the so-called Gestalt interpretation. The purpose of this study was to evaluate interobserver variability and accuracy of 3 sets of criteria: the Hull and PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria and the Gestalt interpretation. METHODS: Two experienced observers interpreted V/Q scans of all 328 patients according to the 3 different schemes. The diagnostic classification obtained for the different sets of criteria was analyzed against the presence or absence of PE. RESULTS: The interobserver variabilities as assessed by the kappa statistics of the PIOPED and Hull criteria and for the Gestalt interpretation were 0.70 (95% confidence interval [CI], 0.64-0.76), 0.79 (95% CI, 0.73-0.85), and 0.65 (95% CI, 0.58-0.72), respectively. The differences in kappa values between the Hull and PIOPED criteria and between the Hull criteria and Gestalt interpretation were statistically significant (P < 0.05 and P < 0.001, respectively). For 16 patients (14 without PE) with a normal lung scan result according to the Hull criteria, the result according to the PIOPED criteria was low probability. For 21 patients (12 with PE), the scans were intermediate probability according to the PIOPED criteria, whereas the result with the Hull criteria was high probability. Analysis of receiver-operating-characteristic curves yielded a comparable area under the curve for all sets of criteria (0.87-0.90). CONCLUSION: The Hull, PIOPED, and Gestalt interpretation of V/Q lung scans all have a good accuracy and interobserver variability. However, the reproducibility of the Hull criteria is superior in comparison with that of the other sets of criteria.

Female↗

[Diagnosis of respiratory system diseases using radio isotopes].

Common respiratory diagnostic imaging techniques using radioisotopes are ventilation-perfusion, perfusion, aerosol inhalation and tumor scintigraphy. The special features of respiratory imaging diagnostic techniques using radioisotopes are the possibility of early detection of disease and the non-invasiveness of the procedure. Also, no patient effort is required. The kinds of isotopes used are as follows: ventilation-perfusion (133Xe, 13N, 99mTc-pseudogas), perfusion (131I, 99mTc), aerosol inhalation (99mTc), tumor (67Ga, 201Tl). The advantages of these procedures are expected to lead to further developments in respiratory examinations using radio isotopes.

Female↗

[Pulmonary distribution of 99mTc-technegas--a comparative study of radioactive inert gases].

99mTc-technegas (99mTc-gas), which consists of fine particles, is produced in carbon crucibles burned at 2500 degrees C. On this study, the particle size of 99mTc-gas was measured and the pulmonary distribution of 99mTc-gas was assessed in 28 patients with various pulmonary diseases. Most particles were 5-30 nm in diameter as determined by electron microscopy. In a clinical study, about 37 MBq of 99mTc-gas was inhaled three times during deep breathing in a sitting position. In a comparative study with radioactive inert gases (133Xe, 81mKr), 99mTc-gas showed a similar distribution to the inert gas in most patients, although some with obstructive disease showed hot spots in the lung fields. In patients with severe obstructive change, marked deposits of 99mTc-gas was noted in the central airways, but 99mTc-gas penetrated to the peripheral lung field. This result suggests that 99mTc-gas can be used to evaluate ventilatory function even in patients with chronic obstructive pulmonary diseases.

Gases↗

[The effect of the pressure of metabolically inert gases and temperature on the membrane fluidity of liposomes].

The comparative analysis of pressure effects of helium, nitrogen (to 100 kg/cm2), cryptone (to 50 kg/cm2) and temperature (32-45 degrees C) on the lateral diffusion of pyrene in liposomal membranes of egg phospholipids was performed. The linear additivity of studied effects was demonstrated. The results are discussed from the point of view of the disturbances of cell processes in the hyperbaric conditions.

Animals↗

[81mKr scintigraphic evaluation of hemodynamics in gynecologic malignancies under condition of angiotensin II-induced hypertension].

Transcatheter arterial infusion chemotherapy is one of the most useful therapeutic procedures for gynecologic malignancies. Recently, several reports have been published about Angiotensin II-induced hypertension chemotherapy and the efficacy of the method, but there have been no reports to evaluate an application for gynecologic malignancies. We evaluate the usefulness of the method for gynecologic malignancies demonstrating the changes of hemodynamics of the tumor using 81mKr scintigraphy. Thirteen patients with pathologically confirmed gynecologic malignancies were evaluated by angiography and continuous infusion of 81mKr via the catheter with and without Angiotensin II. At first, continuous infusion of 81mKr was performed under the superselective catheterization of the uterine artery. The radioactivities in the ROI were counted. Then, withdrew the catheter from the uterine artery to the internal iliac artery, and again continuously infused 81mKr and counted the radioactivities in the same ROI. Finally, keeping the catheter in the internal iliac artery, Angiotensin II and 81mKr were infused simultaneously. And counted the radioactivities. The radioactivities were highest when the catheter tip was placed in uterine arteries and lowest when the catheter tip was placed in internal iliac arteries. But radioactivities in the ROIs were definitely increased when Angiotensin II was used, even if the catheter tip was keeping in the internal iliac arteries. The optimal catheter position of transcatheter arterial chemotherapy for gynecologic malignancies is at proximal uterine artery. Since Angiotensin II-induced hypertension may increase blood flow of tumors, it seems to have indication for post-operative cases, highly advanced cases and cases with difficulties to perform superselective catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Diagnosis of venous thrombosis in the legs using 81Krm venography.

Contrast venography, the accepted gold standard for the diagnosis of venous thrombosis of the leg, is a painful and invasive procedure with late side effects. There is controversy in literature reports about the sensitivity of 99Tcm-macroaggregated albumin (MAA) phlebography: indeed, using 99Tcm-MAA, poor results are obtained when one has to detect calf vein thrombosis. As with other isotopic procedures requiring a pedal injection of the tracer, the use of an injectable solution of 81Krm is a nonspecific method, based upon the abnormality in flow in the deep venous system which results from a deep venous thrombosis. However, when compared with 99Tcm-MAA, 81Krm offers theoretical advantages for phlebographic studies of the lower limbs. In this work 24 patients were studied both with contrast phlebography and with 81Krm. Although 81Krm provided images of high quality, there was a lack of sensitivity below the knee, where false negative results were observed. This could be explained by the fact that the radionuclide venographic procedures usually visualize only one or, in some cases, two of the three deep veins of the calf. Moreover, accurate differentiation between superficial and deep veins in the calf often appears difficult, even using a tourniquet.

Humans↗

[Dual nuclides SPECT for ventilation and perfusion study].

Dual nuclides SPECT using 81mKr and 99mTc-MAA for ventilation and perfusion study was performed in 24 subjects. Crosstalk of 81mKr to 99mTc-energy window was about 7.5% when ventilation and perfusion study were performed by 370 MBq of 81mKr gas and 185 MBq of 99mTc-MAA. Areas of low V/Q was significantly larger in SPECT study than in planar study, in 11 cases with various pulmonary diseases. High V/Q mismatches were also more clearly delineated in SPECT than in planar study. Dual nuclides SPECT study has advantages of obtaining V/Q distribution without movement artifacts and of simultaneous acquisition of ventilation and perfusion image. Area of high V/Q became larger in SPECT with crosstalk than in SPECT without crosstalk, but in the low V/Q area no significant difference was noted between SPECT with crosstalk and without crosstalk.

Female↗

[Right ventricular volume determination by continuous 81mKr infusion and 99mTc blood pool imaging].

Our newly developed radionuclide method for the calculation of right ventricular (RV) volume was examined in this study. Using a semi-geometric count-based method, volume can be measured by the following equation: Cv = Cm/(L/d). V = (Ct/Cv) x d3 = (Ct/Cm) x L x d2. (V = volume, Cv = voxel count, Cm = the maximum count of a container, Ct = the total count of the container, L = maximum length of the image of the container obtained from a direction perpendicular to the direction where the count data were collected, and d = pixel size.) A phantom study was performed by setting a cylindrical container in a system which circulated 5 liters of water per minute. 81mKr solution was infused continuously into the container, and images of the container were collected for one minute. Cm and Ct were obtained and, because the container was cylindrical, the maximum width of the image of the container was measured as L. The volume of the container was calculated using the above equation. The container's true volume and the volume measured by this method showed a good correlation with r = 0.997 (n = 13, p < 0.001). This theorem was applied to RV images obtained in the 30 degree right anterior oblique position by continuous infusion of the 81mKr solution. Multiple gated acquisition was performed and RV end-diastolic maximum counts and total counts were obtained. The RV maximum width was measured as L on the end-diastolic cardiac pool image with 99mTc-D-HSA collected in the 40 degree left anterior oblique position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The anatomy of radioisotope lung scanning.

An appreciation of the appearances of segmental and lobar defects on a lung scan is important for the diagnosis of pulmonary embolism. The appearances of segmental and lobar ventilation defects of known anatomical location have been examined on 81mKr ventilation scans in normal human subjects, utilizing fibreoptic bronchoscopy to place temporary occlusions under direct vision at the orifices of lobar and segmental bronchi. Scans were obtained in the posterior, posterior-oblique and lateral projections. Anterior views were included if the defects could not be adequately visualized on the other views. The completeness of the occlusion and the site and size of each defect could be confirmed by ventilating the segment itself with 81mKr via the balloon catheter while the occlusion was maintained. Segmental defects located anterior to the hilum of the lung tended to be optimally visualized on the lateral view and defects located posterior to the hilum tended to be optimally visualized on the posterior-oblique view. The size of segmental defects could be underestimated on the lung scan, especially those involving the anterior and lateral basal segments of both lower lobes. Defects involving the medial basal segment of the right lower lobe were undetectable on any view. By implication, the same conclusions apply to 99mTc perfusion scans.

Adult↗

[Who is obese?].

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Adipose Tissue↗

[Results of laser photocoagulation in diabetic retinopathy with maculopathy].

Examined were 91 eyes with non-proliferative and proliferative retinopathy with coexisting maculopathy in 51 patients in whom segmental or retinal pan-photocoagulation were performed. The period of observation--3 to 4.5 years. Stabilization of the pathological process was observed in 37.3 p.c. of cases, 54.9 p.c. of patients showed further deterioration and 7.6 p.c. loss of vision. The most frequent cause of deterioration was the progression of the macular lesions (72 p.c.), a smaller number of cases (28 p.c.) was due to other changes.

Adult↗

Colonic blood flow in cat and man as analyzed by an inert gas washout technique.

An inert gas elimination technique for studying blood flow and flow distribution in the colon was developed on the cat and applied to patients during abdominal surgery. The method involves recording of the elimination of intra-arterially injected 85Kr from a colonic segment whereby the gamma- and beta-radiation of the tracer is registered simultaneously by a scintillation detector and Geiger-Muller tube, respectively. Total blood flow was determined from the recording of gamma-radioactivity using a modification of Zierler's formula, and muscularis blood flow as calculated according to Kety from the mono-exponential elimination recorded by the Geiger-Muller tube. The relative weights of the muscularis and mucosa-submucosa were determined from dissections or histological sections. With these weights and total and muscularis blood flows, flow in the mucosa-submucosa was calculated. Total colonic blood flow was 18 +/- 2 ml per min and 100 g of colonic tissue (mean +/- SE; n = 21). In the muscularis layer blood flow amounted to 11 +/- 1 ml per min and 100 g of muscularis tissue (n = 12), and flow in the mucosa-submucosa was calculated to be 28 +/- 5 ml per min and 100 g of mucosal-submucosal tissue. A major fraction (66 +/- 6%) of total blood flow was distributed to the mucosa-submucosa. As total colonic blood flow was enhanced the increase in flow was diverted only to the mucosa-submucosa. The feline and human large bowel exhibited great qualitative and quantitative circulatory similarities.

Animals↗