Accumulation of<Superscript>99m</Superscript>Tc-PMT in renal metastasis of hepatocellular carcinoma

We describe here a case in which 99mTc-Sn-N-pyridoxy-5-methyltryptophan (99mTc-PMT) scintigraphy was useful in diagnosing renal metastasis of hepatocellular carcinoma (HCC). A 62-year-old man who had undergone hepatectomy for HCC presented 6 years after initial diagnosis with left flank pain and was found on CT and MRI to have a tumor in the left kidney. Hepatobiliary scintigraphy using 99Tc-PMT was performed, and 99mTc-PMT accumulation was found in the tumor. Nephrectomy was performed and metastasis of HCC was confirmed.     

The effects of <Superscript>99m</Superscript>Tc-HMPAO-labelled leucocyte scan on human karyotype

Technetium-99m hexamethylpropylene amine oxime (HMPAO) white blood cell scan (WBCS) requires separation and labelling of mixed leucocytes, which include particularly radiosensitive cells, lymphocytes. Lymphocytes labelled during the mixed leucocyte labelling procedure could represent a problem for patients owing to the possible induction of chromosomal aberrations. Lymphocytes labelled in mixed leucocyte preparations are probably killed by the high-dose radiation. Nevertheless, it has been reported that some of these lymphocytes can proliferate after in vitro stimulation. If these cells were to reproduce themselves in vivo, onset of, or increase over time in, chromosomal aberrations could occur on peripheral blood lymphocytes. The present study was performed on 21 patients who underwent WBCS for suspected infection/inflammation. Blood samples of these patients were submitted to cytogenetic study, comprising karyotype determination, evaluation of sister chromatid exchanges (SCE) and evaluation of induced chromosomal breakages or rearrangement rate (B/R). This study was performed 2 h before and 7 days and 6 months after the WBCS. The results demonstrated no statistically significant differences between SCE and B/R values before and after WBCS. No cause-effect relationship appeared to exist between WBCS and the onset of chromosomal aberrations in peripheral blood lymphocytes, at least during the first 6 months post WBCS and within the limits of this study's approach. The high-dose radiation administered to lymphocytes was almost certainly sufficient to kill these cells.     

Single-photon agents for tumor imaging:<Superscript>201</Superscript>TI,<Superscript>99m</Superscript>Tc-MIBI,and<Superscript>99m</Superscript>Tc-tetrofosmin

This review aims at fostering comprehension and knowledge not only for expert physicians who can skillfully handle various techniques for tumor imaging but also for young practitioners in the field of nuclear medicine. As image processing software and hardware become smaller, faster and better, SPECT will adapt and incorporate these advances. A principal advantage of SPECT over PET is the more widespread availability of the equipment and lower cost for the introduction of the system in community-based facilities. Moreover, SPECT has become less dependent on a limited number of acknowledged experts for its interpretation owing to a variety of handy computer tools for imaging analyses. The increasing use of PET in tumor imaging is not necessarily proportional to the decline of SPECT. General physicians' attention to SPECT technology would also increase more by evoking their interest in "tracer imaging."     

Regional differences between <Superscript>99m</Superscript>Tc-ECD and <Superscript>99m</Superscript>Tc-HMPAO SPET in perfusion changes with age and gender in healthy adults

A number of studies using single-photon emission tomography (SPET) have shown perfusion changes with age in several cortical and subcortical areas, which might distort the results of perfusion imaging studies of neuropsychiatric disorders. Technetium-99m labelled ethyl cysteinate dimer (ECD) and hexamethylpropylene amine oxime (HMPAO) are both used as markers of cerebral perfusion, but have different pharmacokinetics and retention patterns. The aim of this study was to determine whether age and gender effects on perfusion SPET differ depending on whether ^99mTc-HMPAO or ^99mTc-ECD is used. Forty-five subjects (20 male and 25 female, mean age 52.8±6.6 years) were assigned to ^99mTc-HMPAO SPET (HMPAO group), and 39 subjects (24 male and 15 female, mean age 52.6±6.7 years) to ^99mTc-ECD SPET (ECD group). SPET images were obtained about 10 min after intravenous injection of approximately 800 MBq ^99mTc-HMPAO or ^99mTc-ECD using the same SPET scanner. Three-dimensional volumetric magnetic resonance imaging was performed to as7sess morphological changes in the grey matter. All image processing and statistical analyses were performed using SPM99 software. An area in the right anterior frontal lobe showed an increase in perfusion with age only in the HMPAO group, whereas areas in the bilateral retrosplenial cortex showed decreases in perfusion with age only in the ECD group; neither group showed corresponding changes in the grey matter. The present study shows that different effects of age on perfusion are observed depending on whether ^99mTc-HMPAO and ^99mTc-ECD is used. This suggests that the results of perfusion SPET are differently confounded depending on the tracer used, and that perfusion SPET with these tracers has limitations when used in research on subtle perfusion changes.     

<Superscript>99m</Superscript>Tc-GSA liver dynamic SPECT for the preoperative assessment of hepatectomy

OBJECTIVE: The purpose of the present study was to devise a predictive index to predict residual liver function before hepatic resection, using technetium-99m diethylenetriamine-penta-acetic acid-galactosyl human serum albumin (99mTc-GSA) liver dynamic single photon emission computed tomography (SPECT). METHODS: Fifty-seven patients with liver disease underwent liver dynamic SPECT with 99mTc-GSA. Dynamic SPECT was performed to obtain the k-value according to the accumulation curve after injection of 99mTc-GSA. The k-value is a mathematical reflection of the rate of disappearance of the circulating radiotracer as it is accumulated into the hepatocytes. We devised an original predictive residual index (PRI) by combining k-value with liver volume (V) and functional liver volume (FV). Correlation between these parameters and results of liver function tests and the grade of liver disease severity was analyzed. We investigated retrospectively the correlation between PRI and post-operative patient prognosis. RESULTS: The k-value slightly correlated with indocyanine green clearance test at 15 mins, bilirubin level and hepaplastin test. FV and V did not correlate with liver function tests. Post-operative complications were observed in 5 patients. The PRI of these patients was below 0.37. When PRI was above 0.38, no patient had hepatic failure. CONCLUSIONS: When PRI is above 0.38, there is a low probability of hepatic failure after hepatectomy. The PRI is useful in preoperative prediction of post-hepatectomy residual liver function in patients with liver disease.     

<Superscript>99m</Superscript>Tc-HYNIC octreotide in neuroblastoma

Disease status assessment of neuroblastoma patients requires computed tomography (or magnetic resonance imaging), bone scan, metaiodobenzylguanidine (MIBG) scan, bone marrow tests, and urine catecholamine measurements. There is no clinical experience concerning the evaluation of these patients by means of technetium-99m (^99mTc)-somatostatin analog scintigraphy. Furthermore, these radiopharmaceuticals are promising imaging agents owing to their lower cost, availability, dosimetry, and ease of preparation. An 8-year-old boy already diagnosed with stage-IV neuroblastoma received chemotherapy. In the follow-up, after obtaining the parents’ informed consent, iodin 131 (¹³¹I)-MIBG and ^99mTc-6-hydrazinopyridine-3-carboxylic acid (HYNIC)-octreotide scans were done on separate days to evaluate tumor extension. Even as the ¹³¹I-IBG scan showed mild diffuse uptake in the projection of both lung hili, the ^99mTc-HYNIC-octreotide scan showed multiple axial and appendicular bone uptakes and paravertebral, abdominal, mediastinal, and supraclavicular ganglionar uptakes. The ^99mTc-HYNIC-octreotide showed much more lesion extension than the ¹³¹I-MIBG. Therefore, ^99mTc-HYNIC-octreotide may be a promising radiopharmaceutical for the evaluation of neuroblastoma patients. This finding justifies the pre liminary evaluation of this tracer in the context of a clinical trial.     

Reduction of <Superscript>99m</Superscript>Tc-sestamibi and <Superscript>99m</Superscript>Tc-tetrofosmin uptake in MRP-expressing breast cancer cells under hypoxic conditions is independent of MRP function

Hypoxia reduces the uptake of technetium-99m sestamibi (MIBI) in human cancer cell lines. In the current investigation, we attempted to identify the relationship between hypoxia-induced alteration of ^99mTc-MIBI accumulation and expression of multi-drug resistance-associated protein (MRP) in the MCF7/WT breast cancer cell line and its subclonal cell line, MCF7/VP, which expresses high levels of MRP1. A second cationic compound, ^99mTc-tetrofosmin (TF), was also examined. Cellular uptake of ^99mTc-MIBI and ^99mTc-TF was significantly higher in parental MCF7/WT cells than in MCF7/VP cells. Hypoxic conditions generated with a mixture of 95% N₂ and 5% CO₂ reduced cellular uptake of the two tracers in both parental MCF7/WT cells and MRP1-expressing MCF7/VP cells. Cell binding assay with iodine-125-labelled anti-MRP1 antibody demonstrated its specific binding to MCF7/VP cells. Hypoxia did not affect the amount of antibody bound to MCF7/VP cells. These results indicate that hypoxia-induced reduction of tracer uptake in tumour cells is a phenomenon independent of MRP function.     

Prospective dosimetry with <Superscript>99m</Superscript>Tc-MDP in metabolic radiotherapy of bone metastases with <Superscript>153</Superscript>Sm-EDTMP

Purpose

On the basis of the encouraging results achieved in several clinical trials and its proven therapeutic efficacy, ¹⁵³Sm-ethylene diamine tetramethylene phosphonic acid (EDTMP) has become widely used to palliate pain from bone metastases. The results reported in the literature have led the product suppliers (QUADRAMET®, Schering) to suggest administering a fixed activity per kilogram (37 MBq/kg). However, considering the observed extreme inter-patient variability of skeletal uptake of ¹⁵³Sm-EDTMP, a real therapy optimization would require the individualization of the activity to be administered on a dosimetric basis. This should be planned taking into account the generally accepted 2-Gy dose constraint to the haematopoietic red marrow, the critical organ in palliative treatments with beta-emitting, bone-seeking radiopharmaceuticals.

Methods

Seven to 14 days before treatment with ¹⁵³Sm-EDTMP, 44 patients underwent ^99mTc-methylene diphosphonate (MDP) total-body bone scan with two scans (the first within 10 min of injection, the second after 6 h). The percentage bone uptake (Tc_%) was evaluated as the ratio between total counts at 6 h, adjusted for decay, and total counts at the first scan. Tc_% was then compared to Sm_% similarly derived from 10-min and 24-h whole-body scans. Tc_% and Sm_% were compared both with and without Brenner’s method for soft tissue uptake.

Results

The correlation between Tc_% and Sm_% was R ²?=?0.81 and R ²?=?0.88 with and without soft tissue correction, respectively. The difference between their average values was statistically significant (Sm_%?=?64.3?±?15.2, Tc_%?=?56.2?±?16.0; p?=?0.017) with soft tissue correction, while was not statistically significant (Sm_%?=?68.2?±?15.5, Tc_%?=?66.9?±?14.0; p?=?0.670) without soft tissue correction.

Conclusions

The rate of retention of ^99mTc-MDP in bone provides a reliable estimate of the ¹⁵³Sm-EDTMP rate of retention. The proposed method can be usefully adopted for prospective dosimetry seeing its extreme simplicity, and it requires no special investment in terms of human or instrumental resources. This allows an optimization of administered ¹⁵³Sm-EDTMP activity.

     

<Superscript>11</Superscript>C-acetate PET imaging of lung cancer: comparison with <Superscript>18</Superscript>F-FDG PET and <Superscript>99m</Superscript>Tc-MIBI SPET

Recently carbon-11 acetate (AC) positron emission tomography (PET) has been reported to be of clinical value for the diagnosis of cancer that is negative on fluorine-18 fluorodeoxyglucoce (FDG) PET. We investigated the uptake of AC in lung cancer to determine whether this tracer is of potential value for tumour detection and characterisation, and to compare AC PET imaging with FDG PET and technetium-99m sestamibi (MIBI) single-photon emission tomography (SPET). Twenty-three patients with 25 lung cancers underwent AC and FDG PET. Twenty of 23 patients were also investigated with MIBI SPET. Dynamic images were acquired for 26 min after the injection of 555 MBq of AC. Standardised uptake values (SUVs) and/or tumour to non-tumour activity ratios (T/N) for each tumour were investigated at 10–20 min after AC administration, 40–60 min after administration of 185 MBq FDG and 15–45 min after administration of 555 MBq MIBI. Twenty lung cancers were resected surgically, and the degree of tracer uptake in the primary lesion was correlated with histopathological features (cell dedifferentiation and aggressiveness) and prognosis. Rapid uptake of AC followed by extremely slow clearance was observed. For the purpose of tumour identification, AC PET was inferior to FDG PET in 8 of 25 (32%) lung cancers, and the T/N of AC was lower than that of FDG. However, AC PET was superior to FDG PET in the identification of a slow-growing tumour (bronchiolo-alveolar carcinoma). There was a positive correlation between AC uptake (T/N) and MIBI uptake (T/N) (r=0.799, P<0.0001). A positive correlation was not observed between either AC or MIBI uptake and the degree of cell dedifferentiation in lung adenocarcinomas, whereas FDG uptake did correlate with the degree of cell dedifferentiation. In lung adenocarcinoma, there was a weak correlation between aggressiveness and FDG uptake, but no correlation was evident for AC and MIBI. In addition, a positive correlation was not observed between AC or MIBI uptake and postoperative recurrence in lung adenocarcinoma, whereas FDG uptake did correlate with postoperative recurrence. Thus, the greater the FDG uptake, the higher the malignant grade. In conclusion, for the purpose of tumour identification, AC PET was inferior to FDG PET but superior to MIBI SPET. Neither AC nor MIBI uptake reflects the malignant grade in lung adenocarcinoma, whereas FDG uptake does. AC PET is less diagnostically informative than FDG PET in patients with lung cancer. However, AC PET may play a complementary role in the identification of low-grade malignancies that are not FDG avid.     

彩色多普勒超声在活体肝移植供体术中术后的应用价值

 目的 探讨彩色多普勒超声在活体肝移植供体术中术后的应用价值.方法 应用Mylab30、Sequoia512超声诊断仪对60例活体供肝肝移植供体进行术中、术后超声检查.术中应用超声标记肝中静脉及其粗大属支走行,协助外科医师进行供肝切取;术中切除供肝后,检查残肝血流情况;术后对供体残肝进行超声监测.结果 60例供者在术中超声定位引导下均成功切取肝脏;术中超声发现残肝门静脉狭窄1例(1/60,1.67%);术后超声检查发现胆漏4例(4/60,6.67%)、脾脏增大16例(16/60,26.67%),其中8例(8/16,50%)伴腹水.结论 在活体肝移植供体术中及术后彩色多普勒超声检查具有重要价值.     

Relationship between <Superscript>99m</Superscript>Tc-GSA scintigraphic indices of liver function reserve and portal circulation in patients with chronic liver disease

Objectives In order to predict the prognosis or complications of portal hypertension in patients with chronic liver disease, it is important to evaluate both hepatic functional reserve and portal circulation. On ^99mTc-galactosyl human serum albumin (^99mTc-GSA) scintigraphy, the index of blood clearance (HH15) and receptor index (LHL15) have been widely used to evaluate the hepatic functional reserve. However, the relationship between these indices and portal circulation is unknown. The purpose of this study was to examine the relationship between HH15 and LHL15 and portosystemic shunts evaluated with arteriographic portography or esophagogastroduodenoscopy. Methods A total of 82 patients with chronic liver disease (mean age, 66.7 years) who underwent ^99mTc-GSA scintigraphy, arteriographic portography, and esophagogastroduodenoscopy were enrolled. HH15 and LHL15 were obtained from dynamic ^99mTc-GSA scintigraphy. The patients were divided into three groups according to the arteriographic portography findings: group 1, no portal collateral circulation; group 2, mild collateral development; and group 3, moderate to severe collateral development. They were also divided into three groups based on the esophagogastroduodenoscopic findings: group A, no varices; group B, small-caliber varices; and group C, enlarged varices. The Kruskal–Wallis test was used to compare each index among these groups. Receiver operating characteristic (ROC) analysis was used to determine whether each index was an indicator for the presence of portosystemic shunts. Results Both HH15 and LHL15 differed significantly between groups 1 and 2 and between groups 1 and 3. However, only HH15 differed significantly between groups A and B and between groups A and C. On the basis of the ROC analysis, the HH15 threshold value of 0.62 yielded both excellent sensitivity (83.9%) and specificity (84.6%) for the presence of portosystemic shunts, as evaluated with arteriographic portography. The HH15 threshold value of 0.64 yielded both good sensitivity (66.1%) and specificity (69.2%) for the presence of portosystemic shunts, as evaluated with esophagogastroduodenoscopy, whereas no adequate threshold value of LHL15 was found for the presence of portosystemic shunts. Conclusions HH15 is a potent indicator of the presence of portosystemic shunts in chronic liver disease.     

<Superscript>11</Superscript>C-methionine uptake in cerebrovascular disease: A comparison with<Superscript>18</Superscript>F-FDG PET and<Superscript>99m</Superscript>Tc-HMPAO SPECT

OBJECTIVES: Carbon-11-L-methyl-methionine (11C-methionine) has been reported to be useful for evaluating brain tumors, but several other brain disorders have also shown signs of high methionine uptake. We retrospectively evaluated the significance of 11C-methionine uptake in cerebrovascular diseases, and also compared our results with those for 18F-FDG PET and 99mTc-HMPAO SPECT. METHODS: Seven patients, including 3 patients with a cerebral hematoma and 4 patients with a cerebral infarction, were examined. All 7 patients underwent both 11C-methionine PET and 99mTc-HMPAO SPECT, and 6 of them underwent 18F-FDG PET. RESULTS: A high 11C-methionine uptake was observed in all 3 patients with cerebral hematoma. Increased 99mTc-HMPAO uptake was observed in 2 out of 3 patients, and all 3 patients had decreased 18F-FDG uptake. Of 4 patients with a cerebral infarction, high 11C-methionine uptake was observed in 3. Increased 99mTc-HMPAO uptake was also observed in one patient, whereas 3 patients had decreased 18F-FDG uptake. CONCLUSIONS: We should keep in mind that high 11C-methionine uptake is frequently observed in cerebrovascular diseases. CVD should therefore be included in the differential diagnosis when encounting patients with a high 11C-methionine uptake.     

Abnormal retention of<Superscript>99m</Superscript>Tc-TF in a hamster model of cardiomyopathy analyzed by<Superscript>99m</Superscript>Tc-TF and<Superscript>125</Superscript>I-BMIPP autoradiography

OBJECTIVE: Enhanced washout of 99mTc-tetrofosmin (TF) has been reported in patients with hypertrophic cardiomyopathy (HCM). Here, using quantitative dual-autoradiography, the relationship between TF retention abnormality and metabolism depicted by 125I-BMIPP uptake was investigated quantitatively in a hamster model of cardiomyopathy. METHODS AND RESULTS: Early and delayed TF images were obtained at 5 min (7 cardiomyopathic and 5 normal hamsters) and 60 min (8 cardiomyopathic and 5 normal hamsters) after injection, respectively. BMIPP image was obtained 5 min after injection. Five cardiomyopathic and 5 normal hamsters were evaluated histologically. Percent uptake of TF and BMIPP in the heart was measured by an auto-well counter. The left ventricular wall was divided into 12 segments, and the relative regional uptake of TF and BMIPP was measured for each segment. Heterogeneity of radioactive distribution was determined by the standard deviation (SD) of radioactive counts in the left ventricular wall on autoradiogram. The uptake of early TF, delayed TF, and BMIPP in cardiomyopathic hamsters was 8.8%, 20.3%, and 25.3% lower than that in normal hamsters, p < 0.05, p < 0.01, and p < 0.001, respectively. In normal hamsters, distribution of radioactivity in all images was homogeneous, and the SD values were about 13. In cardiomyopathic hamsters, heterogeneous distribution was observed on all images, and the degree of heterogeneity was marked on delayed TF and BMIPP images. The SD was 19.7 +/- 1.2 for early TF image, 25.5 +/- 1.4 for delayed TF image, and 31.7 +/- 2.4 for BMIPP image, respectively. A weak linear correlation was observed between the relative regional uptake of the delayed TF and BMIPP in cardiomyopathic hamsters (r = 0.57). Electron microscopy demonstrated ultra-structural changes in mitochondria of cardiomyopathic hamsters. CONCLUSION: Degree of retention abnormality on delayed TF image corresponded to the metabolic abnormality, probably due to mitochondrial dysfunction, depicted on BMIPP imaging.     

Comparison of whole-body <Superscript>18</Superscript>F-FDG PET, <Superscript>99m</Superscript>Tc-MIBI SPET,and post-therapeutic <Superscript>131</Superscript>I-Na scintigraphy in the detection of metastatic thyroid cancer

The usefulness of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in differentiated thyroid cancer (DTC) has been demonstrated by many investigators, but in only a small number of studies have FDG-PET images been compared with those obtained using other non-iodine tumour-seeking radiopharmaceuticals. In most of the studies, planar imaging was performed for comparison using thallium-201 chloride or technetium-99m 2-methoxyisobutylisonitrile (^99mTc-MIBI). Furthermore, FDG-PET studies were not always performed in the hypothyroid state with increased levels of thyroid stimulating hormone (TSH), which are known to increase FDG uptake by DTC. The aim of this study was to compare the ability of FDG-PET to detect metastatic DTC with that of ^99mTc-MIBI whole-body single-photon emission tomography (SPET) and post-therapeutic iodine-131 scintigraphy, evaluated under TSH stimulation. Nineteen patients (8 men, 11 women; age range, 38–72 years, mean 60 years; 17 thyroidectomised and 2 inoperable patients following ¹³¹I ablation of the remaining thyroid tissue; 16 papillary and 3 follicular carcinomas) with metastatic DTC underwent FDG-PET whole-body scan (WBS) and ^99mTc-MIBI SPET WBS at an interval of less than 1 week, followed by ¹³¹I therapy. The SPET images were reconstructed using the maximum likelihood expectation maximisation (ML-EM) method. All patients were hypothyroid at the time of each scan. ¹³¹I WBS was performed 3–5 days after oral administration of the therapeutic dose. A total of 32 lesions [10 lymph node (LN), 15 lung, 6 bone, 1 muscle] were diagnosed as metastases, as confirmed by histopathology and/or other imaging modalities (X-ray, US, CT, MRI, bone, ²⁰¹Tl and ¹³¹I scans). FDG-PET, ^99mTc-MIBI SPET and post-therapeutic ¹³¹I scintigraphy respectively revealed a total of 26 (81.3%), 20 (62.5%) and 22 (68.8%) lesions. These techniques respectively demonstrated nine (90.0%), eight (80.0%) and six (60.0%) LN metastases, and eleven (73.3%), seven (46.7%) and ten (66.7%) lung metastases. They each demonstrated five of the six bone metastases (83.3%). FDG-PET and ^99mTc-MIBI SPET were positive in 17 (78.3%) and 14 (63.6%) of the 22 ¹³¹I-positive lesions, respectively, and also in nine (90.0%) and six (60.0%) of the ten ¹³¹I-negative lesions, respectively. Three of the five ¹³¹I-positive and FDG-PET-negative lesions were miliary type lung metastases with a maximal nodular diameter of less than 10 mm. Comparison of FDG-PET with ^99mTc-MIBI SPET revealed concordant results in 24 lesions, and discordant results in eight lesions (seven with positive FDG-PET alone and one with positive ^99mTc-MIBI SPET alone). In conclusion: (a) even using whole-body SPET, FDG PET is superior to ^99mTc-MIBI in terms of ability to detect metastases of DTC; (b) the higher sensitivity of FDG-PET compared with the previous studies could partly be due to increased serum TSH.     

Two phase imaging of<Superscript>99m</Superscript>Tc-SESTAMIBI and<Superscript>123</Superscript>I-BMIPP for patients with angina pectoris

We saw three cases of angina pectoris in which 99mTc-SESTAMIBI delayed images at rest were useful in diagnosing ischemia risk areas. These findings indicated that delayed 99mTc-SESTAMIBI images may be more sensitive to slight ischemia than 123I-BMIPP images, and suggested that imaging with 99mTc-SESTAMIBI twice at rest may be more effective. The addition of 123I-BMIPP SPECT was considered to be useful in making an evaluation of the severity of ischemia.     

<Superscript>99m</Superscript>Tc-ECD brain perfusion SPECT in hyperalgesic fibromyalgia

Purpose Neuro-imaging studies with ^99mTc-HMPAO SPECT in fibromyalgia (FM) patients have reported only limited subcortical hypoperfusion. ^99mTc-ECD SPECT is known to provide better evaluation of areas of high cerebral blood flow and regional metabolic rate. We evaluated a homogeneous group of hyperalgesic patients with FM using ^99mTc-ECD SPECT. The aim of this study was to investigate brain processing associated with spontaneous pain in FM patients. Methods Eighteen hyperalgesic FM women (mean age 49 years, range 25–63 years; American College of Rheumatology criteria) and ten healthy women matched for age were enrolled in the study. A voxel-by-voxel group analysis was performed using SPM2 (p<0.05, corrected for multiple comparisons). Visual Analogue Scale score for pain was 82±4 at the time of the SPECT study. Results Compared with control subjects, we observed individual brain SPECT abnormalities in FM patients, confirmed by SPM2 analysis, with hyperperfusion of the somatosensory cortex and hypoperfusion of the frontal, cingulate, medial temporal and cerebellar cortices. Conclusion In the present study, performed without noxious stimuli in hyperalgesic FM patients, we found significant hyperperfusion in regions of the brain known to be involved in the sensory dimension of pain processing and significant hypoperfusion in areas assumed to be associated with the affective-attentional dimension. As current pharmacological and non-pharmacological therapies act differently on the two components of pain, we hypothesise that SPECT could be a valuable and readily available tool to guide individual therapeutic strategy and provide objective follow-up of pain processing recovery under treatment.     

Usefulness of<Superscript>201</Superscript>Tl and<Superscript>99m</Superscript>Tc MIBI scintigraphy in a case of oncogenic osteomalacia

A 45-year-old male was admitted with difficulty in walking due to leg pain. At the time of the first visit, a reduced serum phosphorus concentration and an increased serum alkaline phosphatase concentration of unknown etiology were observed. Either a whole body bone scintigraphy or CT of the neck, chest and abdominal region did not reveal any underlying disease. However both the whole body 201Tl scintigraphy and 99mTc MIBI SPECT showed accumulation in the right knee region, and a small tumor was detected by MRI examination. After a diagnosis of oncogenic osteomalacia due to this tumor was determined the tumor was surgically removed, and turned out to be a hemangiopericytoma. By removal of the tumor, either the symptoms or the laboratory data were improved significantly. In this case, both 201Tl scintigraphy and 99mTc scintigraphy MIBI were useful in identifying the location of the tumor which caused oncogenic osteomalacia.     

Brown adipose tissue: Evaluation with<Superscript>201</Superscript>Tl and<Superscript>99m</Superscript>Tc-sestamibi dual-tracer SPECT

Brown adipose tissue is one kind of adipose tissue and regulates body temperature and balance of energy via non-shivering thermogenesis. The authors present a case that strongly suggested the presence of activated brown adipose tissue in the neck, shoulders and axillary space by increased 18F-FDG uptake. 99mTc-sestamibi and 201Tl dual-tracer SPECT study showed increased 99mTc-sestamibi uptake and non-increased 201Tl uptake in the corresponding 18F-FDG uptake sites. Brown adipose tissue has dense mitochondria in the cells, which play an important role in thermogenesis. 99mTc-sestamibi uptake and retention depend on the mitochondrial activity but 201Tl uptake does not. Therefore, the activity of mitochondria in activated brown adipose tissue may explain the discrepant uptake between 99mTc-sestamibi and 201Tl.     

MRI一站式综合扫描对活体肝移植的应用价值

 目的 研究MRI一站式综合扫描对活体肝移植的应用价值.方法 选择活体肝移植的患者及供体各20名.进行MRI扫描,包括3.0T磁共振采用常规血管四期增强扫描.磁共振平扫采用flash序列及TSE序列扫描.血管增强后选择与平扫相同的T,vibe压脂序列进行扫描.依据个体需要,在注射后40-120 min之间进行延迟扫描.以手术所见为参考标准,比较MRI平扫与一站式MRI综合扫描(MRI平扫+MRCP+血管增强+肝实质增强+延迟)对病灶检出的敏感度,评估其诊断价值.结果 MRI平扫对供体/受体血管变异、胆道变异和癌变的检出敏感性分别为40.0%、72.22%、75.0%.而一站式MRI扫描对病灶检出的敏感性都为100.0%,两种方法对后两种病变的敏感性比较差异有统计学意义(P<0.05).结论 在活体肝移植中一站式MRI综合扫描检查具有重要价值.     

Targeted functional imaging of estrogen receptors with <Superscript>99m</Superscript>Tc-GAP-EDL

Purpose To evaluate the feasibility of using ^99mTc-glutamate peptide-estradiol in functional imaging of estrogen receptor-positive [ER(+)] diseases. Methods 3-Aminoethyl estradiol (EDL) was conjugated to glutamate peptide (GAP) to yield GAP-EDL. Cellular uptake studies of ^99mTc-GAP-EDL were conducted in ER(+) cell lines (MCF-7, 13762 and T47D). To demonstrate whether GAP-EDL increases MAP kinase activation, Western blot analysis of GAP-EDL was performed in 13762 cells. Biodistribution was conducted in nine rats with 13762 breast tumors at 0.5–4 h. Each rat was administered ^99mTc-GAP-EDL. Two animal models (rats and rabbits) were created to ascertain whether tumor uptake of ^99mTc-GAP-EDL was via an ER-mediated process. In the tumor model, breast tumor-bearing rats were pretreated with diethylstilbestrol (DES) 1 h prior to receiving ^99mTc-GAP-EDL. In the endometriosis model, part of the rabbit uterine tissue was dissected and grafted to the peritoneal wall. The rabbit was administered with ^99mTc-GAP-EDL. Results There was a 10–40% reduction in uptake of ^99mTc-GAP-EDL in cells treated with DES or tamoxifen compared with untreated cells. Western blot analysis showed an ERK1/2 phosphorylation process with GAP-EDL. Biodistribution studies showed that tumor uptake and tumor-to-muscle count density ratio in ^99mTc-GAP-EDL groups were significantly higher than those in ^99mTc-GAP groups at 4 h. Among ^99mTc-GAP-EDL groups, region of interest analysis of images showed that tumor-to muscle ratios were decreased in blocking groups. In the endometriosis model, the grafted uterine tissue could be visualized by ^99mTc-GAP-EDL. Conclusion Cellular or tumor uptake of ^99mTc-GAP-EDL occurs via an ER-mediated process. ^99mTc-GAP-EDL is a useful agent for imaging functional ER(+) disease.