Localisation of malignant germ-cell tumours by external scanning after injection of radiolabelled anti-alpha-fetoprotein

Sheep IgG antibody to alpha-fetoprotein was labelled with 131I and used to identify human germ-cell tumours by emission scanning. Eleven patients were studied after resection of their primary tumours. Ten had malignant teratoma and one an endodermal sinus tumour. All eight patients with raised serum alpha-fetoprotein concentrations had metastases apparent in the antibody scans. Of the remaining three patients with normal serum alpha-fetoprotein concentrations, two had positive scans. Three of the patients with positive results were scanned twice; the second scans were negative after treatment, when the alpha-fetoprotein concentrations had returned to normal. These result suggest that antibody scans are useful in the clinical management of patients with germ-cell tumours.     

Lack of uniformity in the clinical approach to the interpretation of urinary catecholamines and their metabolites

A study of the case notes from 101 of the 113 instances where at least one of the results was abnormal from the analysis of 24 hr urinary collections for noradrenaline, adrenaline, and dopamine and their metabolites 4-hydroxy-3-methoxy-mandelic acid (HMMA) and homovanillic acid (HVA) in screening for phaeochromocytomas in hospitals affiliated to the Royal College of Surgeons in Ireland Medical School from a total of 199 false positives from all sources shows that 51% had a second sample, 33% had ultra sound, 12% had a CT scan, 6% had an¹³¹I metaiodobenzylguanadine (MIBG) scan, 40% had no imaging performed and in 5% the reports were not received by the referring medical team. The 12 sets of data where case notes could not be retrieved were disregarded. Of the 22 patients with one or more biochemical value greater than twice the upper reference range, 8 had not, by our criteria had a phaeochromocytoma positively excluded. The sensitivity and specificity for phaeochromocytoma diagnosis for the free catecholamines together was 82% and 88.4%; for HMMA 60% and 95.8%; and for catecholamines and HMMA together 82% and 93.2% respectively. A protocol which includes repeat samples where results are abnormal and the appropriate use of diagnostic imaging should be systematically pursued to minimise false negative diagnoses.     

~(18)F-FDG与~(131)I显像在甲状腺癌诊断中的应用

目的评价~(18)F-FDG与~(131)I显像在诊断甲状腺癌复发和转移中的价值。方法53例手术病理确诊的甲状腺癌患者,进行甲状腺全切和大剂量~(131)I去除甲状腺治疗,并进行~(18)F-FDG SPECT/CT全身显像和~(131)I全身扫描。结果在39例血清hTg高于正常的患者中,11例患者~(18)F-FDG SPECT/CT全身显像与~(131)I全身扫描均为阳性;2例均为阴性;12例~(18)F-FDG SPECT/CT全身显像阳性,而~(131)I全身扫描阴性;14例~(18)F-FDG SPECT/CT全身显像阴性,而~(131)I全身扫描阳性。在14例血清hTg正常的患者中,~(18)F-FDG SPECT/CT全身显像与~(131)I全身扫描均为阴性。结论~(18)F-FDG SPECT/CT全身显像和~(131)I全身扫描联合显像,在探测甲状腺癌复发和转移病灶中具有重要价值;甲状腺癌细胞对~(18)F-FDG和~(131)I的摄取与肿瘤细胞的分化程度密切相关。     

Role of venous sampling in locating a phaeochromocytoma

Selective venous sampling was performed in 31 patients in whom the diagnosis of phaeochromocytoma was suspected on clinical and biochemical grounds. Data from samples assayed for their adrenaline and noradrenaline content using a radioenzymatic technique were used to confirm or refute the suspected diagnosis. In 19 of the 31 patients a phaeochromocytoma was subsequently removed surgically, and the remaining 12 patients are now thought not to have tumours (mean follow up period: four years). Analysis of the assay data shows that selective venous sampling correctly identified the presence of a tumour in all 19 patients, and correctly excluded the diagnosis in 11 of the 12 remaining patients--an overall success rate of 97%. Success rates of 88% for arteriography and 84% for computed tomography were recorded, though these investigations were not performed in all patients. Ultrasound and intravenous urography were much less accurate. On the basis of this study a sequence of investigation is proposed for patients with a suspected phaeochromocytoma. Computed tomography occupies a central role in this sequence with venous sampling (and occasionally other techniques) being used only as complementary investigations when specific indications for their use exist.     

The impact of recent advances in diagnostic technology on the clinical presentation of phaeochromocytoma.

OBJECTIVE: To examine the impact of recent advances in diagnostic technology on the spectrum of clinical and biochemical features of patients presenting with a new diagnosis of phaeochromocytoma. DESIGN: A retrospective review of the clinical and biochemical features of patients diagnosed by our laboratory as having phaeochromocytoma within a 27-month period up to December, 1990. Noradrenaline, adrenaline and dihydroxyphenylglycol were assayed in 24-hour urine specimens (19 patients) or plasma (1 anuric patient) by gas chromatography/mass spectrometry. SETTING: A tertiary level chemical pathology department. PATIENTS: Twenty patients with a new diagnosis of phaeochromocytoma. RESULTS: The classic, episodic adrenergic symptoms traditionally associated with phaeochromocytoma were absent in 9 of the 20 patients (45%). "Atypical" phaeochromocytoma presented as a mass on computed tomography imaging (6 patients, 30%), "phaeochromocytoma crisis" (4 patients, 20%) or family screening (1 patient, 5%). Excessive adrenaline production was found in 11 patients (55%) and six (30%) had predominantly adrenaline-secreting tumours. The urinary noradrenaline:dihydroxyphenylglycol ratio was raised in all nine patients with predominantly noradrenaline-secreting tumours but was not raised in nine out of ten patients with adrenaline-secreting phaeochromocytoma. Adrenaline excretion was significantly correlated with tumour size (r = 0.8; P less than 0.05). CONCLUSIONS: Advances in diagnostic technology, particularly specific adrenaline assays and computed tomography, have made possible the early diagnosis of patients with phaeochromocytoma presenting in ways previously thought to be uncommon. All patients with adrenal masses noted incidentally on CT scan should be investigated for phaeochromocytoma. Adrenaline-secreting tumours are common and both noradrenaline and adrenaline should be assayed in all patients investigated for phaeochromocytoma.     

18F-FDG PET/CT显像在131I全身扫描及血清Tg均阴性的已清除残留甲状腺组织的分化型甲状腺癌患者中的应用价值

目的探讨18F-FDG PET/CT显像在血清Tg和131I-全身扫描均为阴性的行甲状腺癌切除和清除残留甲状腺组织治疗后的患者中检测肿瘤复发和转移的应用价值。方法 41例接受了甲状腺全切和大剂量131I清除残留甲状腺组织治疗的DTC患者,在随访中进行了血清Tg测定、131I-WBS、颈部B超、胸部CT及18F-FDG PET/CT全身显像。结果 41例患者血清Tg和131I-WBS均为阴性,颈部B超或胸部CT均显示存在异常病灶;其中23例患者18F-FDG PET/CT显像阳性,18例患者18F-FDG PET/CT显像阴性。18F-FDG PET/CT显像阳性患者中,有3例经病理检查证实为甲状腺癌转移;18F-FDG PET/CT显像阳性病灶与阴性病灶的长短径差异无统计学意义。结论接受甲状腺全切和大剂量131I清除残留甲状腺组织治疗后的DTC患者术后随访血清Tg及131I-WBS均为阴性时,18F-FDG PET/CT显像可显示可疑的阳性病灶,有助于发现复发和转移病灶。     

Differential diagnosis and laparoscopic treatment of adrenal pheochromocytoma and ganglioneuroma

Background Adrenal ganglioneuroma is a rare adrenal pathogenic disease with difficult differential diagnosis from adrenal pheochromocytoma. Currently, very limited literature is available to allow a differential diagnosis of these two conditions from each other. This study aimed to evaluate the clinical profile, differential diagnosis and surgical treatments of both conditions. Methods Clinical characteristics of 36 patients with adrenal pheocheomocytoma and 18 patients with adrenal ganglioneuroma were analyzed. Data from CT scans and surgical treatments from 1999 to 2007 were collected. Endocrine hormone tests and ^131I-metaiodobenzylguanidine （MIBG） were performed. Neither ^131I-MIBG nor endocrine hormone tests were available in 9 cases of asymptomatic adrenal ganglioneuroma with tumor size less than 4 cm and there were negative findings from contrast enhanced CT scans. The level of urine catecholamine of patients was compared by one-way analysis of variance. Results The mean age of patients in the adrenal ganglioneuroma group was 41.2 years （16-67 year） and in the adrenal pheochromocytoma patients 38 years （17-74 year）. Contrast enhanced CT showed that the foci were intensified in 5 cases （27.8%） of adrenal ganglioneuroma and there were obvious contrast indications in 30 （83.3%） of the pheochromocytoma. Catecholamine levels in a 24-hour urine sample were normal in 4 patients with adrenal ganglioneuroma and increased in 36 （100%） cases with adrenal pheochromocytoma. ^131I-MIBG nuclear scan showed negative results in 4 patients （100%） with adrenal ganglioneuroma and positive results in 25 （96.2%） with adrenal pheochromocytom. Laparoscopy for adrenal tumors was performed through a transperitoneal or retroperitoneal approach during a follow-up period of （43±6） months, and all cases survived well. Conclusions CT, urinary catecholamine and ^131I-MIBG are standard and efficient tools for differential diagnosis of adrenal ganglioneuroma from pheochromocytoma. Laparoscopic surgery can be performed through a transperitoneal or retroperitoneal approach depending on the finding of CT scans. Open surgery is necessary for patients with blood loss of more than 800 ml and violent fluctuation of intraoperative blood pressure.     

Clinical presentation and investigation of patients proceeding to isotope lung scanning for suspected pulmonary embolism

The presenting features of 250 consecutive patients who underwent a ventilation/perfusion lung scan for suspected pulmonary embolus (PE) were analysed. Ninety-six patients had lung scans highly suggestive of PE, with one or more unmatched segmental perfusion defects (scan positive), 86 had low probability scans (scan negative) and 68 an indeterminate scan. Scan positive patients were more likely to have a PaO2 of less than 10.7 kPa, an elevated P(A-a)O2 and an abnormal chest X-ray compared with scan negative patients but these measurements were of poor specificity. Furthermore, scan-positive patients had a higher incidence of lung disease. Localized chest wall tenderness was more common in scan-positive patients, occurring in 9% of patients, but there were no other significant differences in individual symptoms, signs or electrocardiographic findings between scan-positive and scan-negative patients. The diagnosis of PE should not be made on clinical grounds alone and all patients suspected of having a PE should at least undergo isotope lung scanning.     

Single-photon emission computed tomography. A method of measuring cerebral blood flow in three dimensions (preliminary results of studies in patients with epilepsy and stroke)

The recent development of single-photon emitting radiopharmaceuticals that reflect cerebral blood flow has introduced a new era for the useful application of nuclear medicine to the investigation of neurological disease. Using 123I labelled N-isopropyl-p-iodoamphetamine, we have performed emission-computed tomographic scans of the brain in several clinical settings. These studies display cross-sectional maps of cerebral blood flow and promise significant clinical utility in a variety of brain diseases. In the eight patients with epilepsy, the scans showed good localization of the abnormal foci, and correlated well with the findings at operation in the five patients who were submitted to surgery. All 10 patients with stroke had abnormal scans, and the abnormalities in cerebral blood flow were frequently more extensive than the lesions seen on the transmission-computed tomographic scan. This initial experience leads us to anticipate an increasing role in clinical neurology for single-photon emission computed tomographic scans of cerebral blood flow.     

The role of brain scanning in the differential diagnosis of seizures

Of 200 patients with seizures who had brain scans, the studies were abnormal in 86% of patients with tumours and in 67% of those with strokes. The scan detected 84% of the 19 potentially curable lesions. There were no false positive studies. Seventy-nine per cent of patients with seizures of less than one year's duration had an abnormal scan; however, the scan was also abnormal in 22% of patients with non-focal seizures of less than one year's duration.     

The role of radioimmunodetection in the management of testicular cancer

Five patients with testicular cancer received an intravenous injection of between 1 and 2.5 mCi of iodine 131-labeled antibody to human chorionic gonadotropin (HCG) or alpha-fetoprotein (AFP), followed by total-body photoscanning to visualize areas of abnormal radioactivity. Blood-pool and nontarget sites of radioactivity were reduced by subtracting the images derived by injection of technetium Tc 99m-labeled components from the iodine 131 scans. The HCG-immune scintiscans proved helpful in tumor localization and in the selection of appropriate therapy, while the AFP scan presented corroborative evidence of widespread tumor. Elevated serum levels of these two markers did not hinder successful tumor detection and localization by this method of radioimmunodetection. Cancer radioimmunodetection with antibodies to HCG and to AFP appears to be a useful procedure for the pretreatment and posttreatment evaluation of patients with testicular cancer and can reveal sites of tumor not detected by other methods.     

Accidental provocation of phaeochromocytoma: the forgotten hazard of metoclopramide?

The perilous potential of metoclopramide when used inadvertently in patients harbouring phaeochromocytomas goes largely under-recognised. Despite the rarity of phaeochromocytoma, clinicians should exercise caution in the use of metoclopramide among hypertensives and those with labile blood pressures, given the potentially life-threatening crisis it can readily evoke in those with this tumour. We report a series of three patients with phaeochromocytoma who developed acute crises from metoclopramide.     

CLINICAL DIAGNOSIS AND TREATMENT OF NONFUNCTIONING PHEOCHROMOCYTOMAS IN 14 PATIENTS

Objective To analyze the clinical characteristics of nonfunctioning pheochromocytoma, and to evaluate the efficacy of ^131I-metaiodobenzylguanidine (MIBG) scan in the diagnosis and perioperative treatment of nonfunctioning pheochromocytoma. Methods The clinical data of 14 patients with nonfunctioning pheochromocytoma were analyzed retrospectively. Plasma free corticoid, renin, aldosterone, and urine catecholamines levels were estimated. B-mode ultrasonography, computed tomography scan, thoracic X-ray and ^131I-MIBG were used. Results All patients with nonfunctioning pheochromocytoma had no hypertension and the tumors were found incidentally. The 24 hours urine catecholamines levels in 80% (8/10) patients were normal. The positive rate of ^131I-MIBG was 80% (8/10) and the specificity was 100%. All patients underwent surgical operation of tumor resection. No preoperative volume expansion was given to all patients. All tumors were resected completely, and no death accident happened. There was no recurrence and metastasis after operation by long-term follow-up. Conclusin ^131I-MIBG scan is the first choice technique for the diagnosis ofnonfunctioning pheochromocytoma. Blood volume expansion is unnecessary before resection ofpheochromocytoma.     

Ablation of recurrent primary liver cancer using 131I-lipiodol.

A case of recurrent hepatocellular carcinoma following resection is reported. The patient received 2 treatments of 131I-lipiodol administered via the hepatic artery at angiography. Good localization in tumour tissue was observed on subsequent computed tomographic scans and no adverse effects were seen after either treatment. After the first treatment 2 nodules of recurrent tumour were resected and proved to be totally necrotic. The patient remains well 9 months later with a persistently elevated serum alphafetoprotein but no evidence of residual tumour. It is suggested that 131I-lipiodol may be the treatment of choice for small tumours in elderly high-risk patients.     

Improved tumour localisation using indium-111 labelled antibodies

Immunoglobulin G (IgG) antibodies to carcinoembryonic antigen (CEA) were labelled with radioactive indium (111In) or iodine (131I) and a comparison made of their value in locating CEA producing tumours. Eleven patients given 111In-anti-CEA had 31 tumours as judged by a combination of all techniques. Of these, 28 were detected by 111In-anti-CEA and 26 by conventional clinical techniques. Five of the patients also received 131I-anti-CEA. These patients had 15 tumour areas. Thirteen were detected by 111In and eight by 131I. 111In also produced a better signal to noise ratio in the scans and thereby showed lesions with greater certainty. In addition, the 111In isotope continued to accumulate in the tumour areas for considerably longer than 131I. Absorbed doses (whole body) were similar for both isotopes. The results show that antibody scanning is greatly improved by using 111In as the radiolabel in place of 131I and should allow the detection of smaller or deeper lesions.     

A patient with co-existing bronchial carcinoid tumour and bilateral phaeochromocytoma.

We report a 31-year-old Chinese man with bronchial carcinoid tumour and bilateral phaeochromocytoma. His sister also gave a history of bilateral carotid body paraganglioma. This case demonstrates the importance of screening for other endocrine disorders in patients with foregut carcinoid tumours.     

99Tcm-MDP骨显像常见伪影的识别与分析（附278例报告）

[目的]总结99Tcm-MDP骨显像中常见伪影的影像特点和成因。[方法]回顾性分析了6602例(次)99Tcm-MDP骨显像并识别其中伪影。[结果]278例次核素骨显像出现伪影。伪影可分为“热区”(局部异常放射性分布增强/浓聚,占88.5%)或“冷区”(局部异常放射性分布稀疏/缺损,占11.5%)伪影。“热区”伪影为尿液(77.7%)或显像剂(10.8%)污染所致。“冷区”伪影由各种高密度异物衰减所致。[结论]充分认识伪影的影像特征及其成因有助于对伪影的识别。     

^18F-FDG PET-CT对分化型甲状腺癌肺转移患者的诊断和疗效评价的价值

目的 探讨18F-氟脱氧葡萄糖（18F-FDG）PET-CT对分化型甲状腺癌（DTC）肺转移病灶的诊断和疗效评价的价值.方法 收集2006年7月至2010年12月上海交通大学附属第六人民医院对38例DTC肺转移患者行18F-FDG PET-CT、131I全身扫描（131I-WBS）检查,并随访,了解患者肺内病灶变化及预后情况.结果 18F-FDG PE-CT、131I-WBS共发现肺内病灶68个,45个病灶131I-WBS阳性、18F-FDG PET-CT呈阴性,19个病灶18F-FDG PET-CT阳性、131I-WBS阴性;4个病灶两种检查均为阴性,两者联合检测的灵敏度为94.11%,而在131I-WBS阴性的患者中18F-FDG PET-CT阳性率为82.61%.18F-FDG PET-CT对DTC肺内转移灶的检出率与患者血清促甲状腺激素水平密切相关.结论 131I-WBS联合18F-FDG PET-CT在探测DTC转移病灶时具有重要的临床价值,明显优于各自独立应用的结果.DTC细胞对18F-FDG的摄取与肿瘤细胞的分化程度相关,对指导治疗和预后的判断有重要作用.     

Phaeochromocytoma presenting with pseudo-intestinal obstruction and lactic acidosis

Phaeochromocytomas are rare neuroendocrine tumours with variable clinical signs and symptoms. Hypertension, tachycardia, sweating and headaches are cardinal manifestations. Although nausea and abdominal pain are the more common gastrointestinal features, rare gastrointestinal spectrums have been reported that can mimic abdominal emergencies. Metabolic effects of hypercatecholaminaemia are vast and one such rare presentation is lactic acidosis. We describe a case of phaeochromocytoma presenting with both intestinal pseudo-obstruction as well as lactic acidosis. This case report highlights the importance of having a high index of suspicion for and early recognition of the gastrointestinal and metabolic manifestations of phaeochromocytomas.     

How ominous is an abnormal scan in bronchogenic carcinoma?

Bone, brain, and liver radioisotope scans as prognostic indicators were studied in a series of 162 patients with primary bronchogenic carcinoma. One or more scans positive for metastasis reliably predicted death in less than six months. An abnormal bone scan was most significant (P less than .001). Reliability in predicting less than one year's survival in abnormal liver and brain scans was P less than .05 for both. Patients with two normal scans were found to have a 50% six-month survival expectation. Brain scans added little information, as they would have predicted a different prognosis for only three of 114 patients who received them.