Tc-99m polyclonal human immunoglobulin scintigraphy in brucellosis

The aim of this study was to evaluate the accuracy of Tc-99m polyclonal human immunoglobulin (HIG) scintigraphy for the diagnosis of brucellosis, and to compare its effectiveness in the diagnosis of osteoarticular involvement in comparison with bone scanning. Of 30 patients with brucellosis, Tc-99m HIG detected osteoarticular involvement in 18 (60%) patients, in whom the sacroiliac joints were affected most commonly (n = 13; 72.2%), with statistically predominant bilateral involvement (p < 0.05). By bone scanning, the rate of osteoarticular involvement was 70% (21 of 30 patients), and the joints affected most commonly were sacroiliac (15 of 21 patients; 71.4%). Although bilateral involvement was observed mostly by bone scanning, there was no significant difference between the rate of bilateral and unilateral involvement. The anatomical distribution of osteoarticular complications, as detected by Tc-99m HIG and bone scintigraphy, did not differ significantly. With Tc-99m HIG, orchitis was detected in two patients and paravertebral abscess in one patient. Since bone scanning did not detect these soft tissue complications, Tc-99m HIG scintigraphy might be useful for the detection of both osteoarticular and soft tissue complications resulting from brucellosis.     

Cumulated activities determined from biodistribution data in pregnant rats ranging from 13 to 21 days gestation. I. Tc-99m pertechnetate

Cumulated activity estimates for Tc-99m pertechnetate were determined using biodistribution data from pregnant and nonpregnant rats. The pregnant rats were studied at 13, 15, 17, 19, and 21 days gestation. The results indicate that maternal organ cumulated activities are not a simple function of gestational age. The organs into which Tc-99m pertechnetate enters through passive diffusion follow the pattern established by the blood, generally resulting in an increase from the 13th through the 17th day with a decrease on the 19th and 21st day. The organs dominated by active transport follow unique and different patterns. The fetal cumulated activity estimates increased exponentially with gestational age and the placental estimates increased linearly.     

Study of the auditory tube by ventilation scintigraphy with technetium-99m

The two essential regulating mechanisms of the middle ear pressure are the trans-mucosal gas exchange in the middle ear and the ventilation function of the eustachian tube (ET). The physiological mechanism of these both functions is not yet clear. The purpose of this study was to evaluate the role of the ET pressure equilibrium function by ventilation scintigraphy with technetium-99m. The rabbit animal model in vivo was used to study the presence and role of the ventilation of the tympanic cavity via auditory tube. The obtained results did not show any ventilation function of the ET despite active opening by muscle movement. In our experience, ventilation scintigraphy with technetium-99m is not a reliable method to study the auditory tube pressure equilibrium function in physiological conditions.     

Clinical significance of Tl-201/Tc-99m subtraction scintigraphy as a parameter for surgical indication of cold struma nodules

In a retrospective study Tl-201/Tc-99m subtraction scintigraphy (method acco. to Ferlin et al.) was performed in addition to Tc-99m scintigraphy, sonography and fine needle puncture in 400 patients. Postoperative histological evidence was available of all patients (carcinomas [n = 31], follicular and oncocytic adenomas [n = 235], nodular hyperplasia, Hashimoto's thyroiditis, Riedel's struma and de Quervain's thyroiditis [n = 134]). With regard to possible malignancy the sensitivity, in case of positive Tl-201 uptake was 85%. As however, adenomas also have a high tendency towards isolated Tl-201 uptake, the specificity for malignant growth was 62%. Thus Tl-201/Tc-99m subtraction scintigraphy is well suited as a criterion to exclude thyroid carcinomas; on the other hand, a positive Tl-201 uptake is not a fail-safe indication of malignant processes. At best it suggests the occurrence of autonomous growth and can thus, in addition to sonography and fine needle biopsy, serve as an aid in the decision as to whether surgical intervention is indicated.     

^99mTc—MIBI鼻咽癌阳性显像的探讨

目的用(~99m)Tc-MIBI来探索鼻咽癌的原发灶和转移灶的诊断.资料与方法 用(~99m)Tc-MIBI断层显像检测21例对照组和41例治疗前鼻咽癌病例,病灶的放射性摄取与头皮比较,由3名以上的医师在不知道任何临床情况下分别阅片.结果41例治疗前鼻咽癌病例中共有36例阳性.特异性为91%,灵敏度为88%.结论用(~99m)Tc-MIBI来探索鼻咽癌的原发灶和转移灶的诊断,是一种灵敏的,值得进一步探讨的影像学方法.     

Splenic atrophy as complication of ulcerative colitis diagnosed by antigranulocyte antibodies labeled with Tc-99m-pertechnetate

The scintigraphic examination with Tc-99m pertechnetate-labeled anti-NCA 95 antigranulocyte antibodies (AGAb) was performed in a 14-year-old boy with a 7-year history of poorly controlled ulcerative colitis to estimate the spread and activity of the disease. The disturbance of the splenic function was also suspected because Howell-Jolly bodies were present in the peripheral blood smears. High AGAb uptake in the rectum, sigma, and descending colon was observed on scintigraphy scans, indicating an active inflammatory process. Slight depression of hemopoiesis was also noticed. The spleen was not visible on the scans, although it was visible on ultrasound examination performed a few years earlier. Because of the refractory disease, total colectomy was performed. The spleen was not found on surgery. This case shows all benefits of using AGAb as a diagnostic tool. With a single injection we were able to show the spread and activity of the intestinal disease, distribution and function of the granulopoietic bone marrow, and absence of the spleen.     

Tc-99m attenuation coefficients in water-filled phantoms determined with gamma cameras

Quantitative imaging with gamma cameras requires compensation for attenuation of source photons. Some methods of compensation make use of a constant or average estimated attenuation coefficient mu. A value for mu of 0.15 cm-1 for 140.5-keV photons in water or tissue is commonly used. This value, however, neglects scattered photons which are detected within the energy window in gamma camera imaging. Values for mu of 0.12 cm-1 used in attenuation compensation of Tc-99m single-photon emission computed tomography scans of uniform cylindrical sources have been shown to give improved results compared with use of mu = 0.15 cm-1. In this study, gamma cameras and a multichannel pulse-height analyzer were used to determine effective values of mu for photons in water as a function of energy window. Two cylindrical water-filled phantoms, circular and elliptical, were used with a point source of Tc-99m at depths up to 18 cm. Energy data were integrated over the top half of the photopeak, and over 10%, 20%, and 30% windows centered on the photopeak. Attenuation curves were exponential for all photopeak windows with values of mu of 0.12 +/- 0.014 cm-1 for all windows up to 20% and 0.1 cm-1 for a 30% window. This study suggests that a value of mu of 0.11-0.12 cm-1 is, in fact, appropriate for use in attenuation compensations where an average is required.     

Quantitative simultaneous In-111/Tc-99m planar imaging in a long-bone infection phantom

In-111-white-blood-cell and Tc-99m-sulfur-colloid dual-radionuclide imaging are frequently utilized in the evaluation of patients with suspected osteomyelitis. We have developed a quantitative planar imaging method in which Tc-99m and In-111 scans are acquired simultaneously in accurate spatial registration. Long, thin tubes containing only In-111 or Tc-99m were first imaged in a list mode within a water bath inclined with respect to the water surface; from these, 12 energy spectra corresponding to different Tc/In ratios were synthesized. Triple-energy-window (TEW) parameters for scatter and radionuclide crosstalk correction, including scatter windows and weights, were optimized using 100 noise realizations of each of the spectra (1200 total). A long-bone phantom containing a simulated infection site was then imaged in water with five In/Tc ratios; 100 noise realizations of two conjugate-view images were generated from each acquisition (500 total). Two regions of interest (ROIs) were defined, and the ratio of In/Tc count ratios in these two ROIs was evaluated with and without the TEW scatter correction and geometric mean attenuation compensation. The average bias improved from 17.2% to 5.3%, with comparable precision. TEW corrections with non-optimized but practical energy windows also improved the bias to 6.4%. Compared with subjective visual assessment, quantitation of In-111/Tc-99m ratios may improve diagnostic accuracy and could eventually permit grading of osteomyelitis.     

Effects of radiofrequency ablation on individual renal function: assessment by technetium-99m mercaptoacetyltriglycine renal scintigraphy

We quantitatively evaluated total and individual renal function by technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) renal scintigraphy before and after radiofrequency ablation (RFA) of renal tumors. Eleven patients who underwent Tc-99m MAG3 renal scintigraphy 1 week before and after RFA were evaluated (7 men and 4 women; age range: 23-83 years; mean age: 60.6 years). Five patients had solitary kidneys, and five had normally or minimally functioning contralateral kidneys. One patient had a renal cell carcinoma in the contralateral kidney. One patient with a solitary kidney underwent RFA a second time for a residual tumor. In patients with a solitary kidney, MAG3 clearance decreased after 5 of 6 RFAs, and in patients with a normally functioning contralateral kidney, MAG3 clearance decreased after 4 of 5 RFAs, but no significant differences were observed between before and after treatments. In addition to the total MAG3 clearance, the split MAG3 clearance was evaluated in patients with a normally functioning contralateral kidney. MAG3 clearance decreased in 4 of 5 treated kidneys, while it adversely increased in the contralateral kidneys after 4 of 5 RFAs. No significant differences, however, were observed between before and after treatments. The results of our study revealed no significant differences in sCr, BUN, CCr, or MAG3 clearance between pre- and post-RFA values. These results support data regarding the functional impact and safety of renal RFA in published reports. We evaluated total and individual renal function quantitatively using Tc-99m MAG3 renal scintigraphy before and after treatment. This scintigraphy was very useful in assessing the effects of RFA on renal function.     

99m Tc-Sandostatin显像早期诊断高表达生长抑素受体胰腺癌的实验研究

目的 :99mTc -Sandostatin显像对胰腺癌的早期诊断价值及其瘤体组织生长抑素受体 (SSR)的表达情况。方法 :用99mTc标记Sandostatin进行裸鼠胰腺癌模型显像 ,计算瘤体与对侧正常组织的放射性比值 (T/N) ;用RT -PCR方法检测瘤体组织的SSR1、SSR2、SSR2、SSR5mRNA的表达。结果 :1 6只胰腺癌裸鼠模型中有 1 1只显像阳性 ,5只显像阴性。显像阳性鼠的T/N为 2 5 3± 0 84 ,显像阴性鼠的T/N为 1 0 4± 0 0 6 ,两者之间有显著性差异 (P <0 0 1 )。显像阳性的瘤体组织其SSR1、SSR2、SSR5mRNA的表达分别显著高于显像阴性的瘤体组织的SSR1、SSR2、SSR5mRNA表达 ,P均 <0 .0 1。结论 :99mTc -Sandostatin生长抑素受体显像是一种无创、安全、有效、简便的检查方法 ,对胰腺肿瘤有一定的诊断价值 ,但只有生长抑素受体表达水平高的肿瘤能够显像     

Myopericarditis in acquired immunodeficiency syndrome diagnosed by gallium scintigraphy

Myocarditis is among the cardiac complications of acquired immunodeficiency syndrome and, yet, is often not discovered until autopsy. Gallium scintigraphy has been employed in diagnosing this entity, but few data are available about its diagnostic accuracy and value. Here, the authors report two cases of myopericarditis as diagnosed by gallium scan.     

Transport dynamics of the hepato-biliary system: a mathematical model allied to Tc 99m IDA scintigraphy

A generalised mathematical model of hepatic biliary tracer flows is formulated in terms of physiologically identifiable transport parameters. From a particular solution derived from this, the system response to intravenous administration of Tc99m IDA biliary tracer is predicted. Minimisation procedures applied to this solution combined with experimental scintigraphic observations yield estimates for the physiological parameters pertaining to a number of patient studies. Some hepatic conditions where quantitative indicators may contribute to clinical diagnosis are discussed.     

~(99m)Tc-DTPA肾动态显像测定肾小球滤过率常见影响因素辨析

目的 探讨在~(99m)Tc-DTPA肾动态显像测定肾小球滤过率(GFR)过程中是否有影响GFR准确性的因素存在,以确保诊断的准确性.方法 对326例患者及1例健康志愿者应用~(99m)Tc-DTPA肾动态显像测定GFR.健康志愿者首次检查在饮水500 ml后5 min进行;第2次检查按常规在饮水500ml后30 min进行.结合肾功能曲线和GFR对检测结果进行分析.结果 注射放射性的有效剂量与实测剂量不符导致GFR误差共61例,发生率为18.7%(61/326).在该类患者中有88.5%(54/61)的病例是由于注射点有放射性药物外渗所致.有8.2%(5/61)的病例因袖口过紧导致放射性药物存留在袖口压迫点的远端并缓慢释放.有3.3%(2/61)病例在测量空针筒时没有采集注射器针帽内漏出的放射性,GFR减低.饮水后短时间内注射放射性药物,导致肾功能曲线峰值减低,排泄段抬高,GFR减低.65例糖尿病患者GFR异常增高,而肾功能曲线形态表现为正常.结论 GFR的影响因素较多.综合分析肾功能曲线与GFR值,对于发现误差,确保结果的准确性具有重要意义.再密切结合病史和肾脏影像,可以进一步确保诊断的准确性.     

Diagnostic capabilities of I-131, TI-201, and Tc-99m-MIBI scintigraphy for metastatic differentiated thyroid carcinoma after total thyroidectomy

We investigated the diagnostic capabilities of I-131, Tl-201, and Tc-99m-MIBI (hexakis-2-methoxyisobutyl- isonitrile) scintigraphy for thyroid cancer metastases after total thyroidectomy over the entire body and for every locus before and after thyroid bed ablation. After total thyroidectomy of thyroid cancer, 36 cases were subjected to I-131 treatment 64 times. They consisted of 17 men and 19 women with 31 papillary carcinomas and 5 follicular carcinomas. Their ages were 22--75(an average of 60.5+/-12.3) years. I-131 scintigraphy(I-131), Tl-201 scintigraphy(Tl-201), and Tc-99m- MIBI scintigraphy (Tc-99m-MIBI) were performed. We defined the metastases as those cases in which serum thyroglobulin (Tg)increased significantly or in which we were able to prove the lesions on CT (computed tomography), MRI (magnetic resonance imaging) or bone scintigram. Three radiology medical specialists visually evaluated each scintigram and calculated the sensitivity, specificity, and likelihood ratio. For whole-body sensitivity, both Tl-201 and Tc-99m-MIBI were high before ablation and I-131 was high after ablation. Before ablation, the negative likelihood ratio was less than 0.1 for Tl-201 and Tc-99m-MIBI, while the positive likelihood ratio was more than 10 for Tl-201. After ablation, the positive likelihood ratio for I-131, Tl-201, and Tc-99m-MIBI was more than 10. The sensitivity of the mediastinum was appropriate, except for I-131 before ablation, and the sensitivity of the lung before and after ablation was inferior for either tracer. The specificity of the cervix for I-131 before ablation was markedly deteriorated, but it increased after ablation.     

Improvement of the fluorine-18 fluorodeoxyglucose images in simultaneous F-18 FDG/Tc-99m collimated spect imaging.

Collimated F-18 FDG SPECT imaging has been shown to be an acceptable alternative to F-18 FDG PET imaging for evaluating injured but viable myocardium. Ultra-energy (UHE) imaging is usually performed in simultaneous F-18 FDG/Tc-99m MIBI studies. The main limitations of this technique are degradation of the Tc-99m MIBI images due to F-18 downscatter to the Tc-99m window, and loss of resolution in Tc-99m images caused by using a UHE rather than a low-energy collimator. The quality of F-18 images has not been addressed. In our clinical and phantom studies we have found that F-18 images are inferior to simultaneously acquired Tc-99m MIBI images. This paper compares two correction methods for F-18 FDG images in a realistic cardiac phantom study. One approach is subtractive scatter correction, which employs a third 410 keV energy window image to estimate scatter. The other approach is based on restoration. The phantom acquisition was performed with 7.2 MBq of F-18 and 22.2 MBq of Tc-99m injected into the left ventricular (LV) wall. Three inserts, 3 cm, 2 cm, and 1 cm in diameter, were placed in the LV wall to simulate infarcts. Circumferential profiles were drawn from three successive short-axis slices and compared with true phantom data. The differences were calculated as root-mean-square error (rmse). Scatter correction improved rmse only 4.5 +/- 0.3%, while restoration improved rmse 16.1 +/- 0.4%, when compared with raw data. The same differences, measured as rmse, were 9.5 +/- 0.5, 6.8 +/- 0.4, and 5.1 +/- 0.5 for raw, scatter corrected, and restored F-18 data, respectively, when compared with Tc-99m window 140 keV data. The amount of noise, measured as root-mean-square % (rms%) was 5.3 +/- 0.5% for the Tc-99m image, 4.9 +/- 0.7% for the F-18 restored image, 6.2 +/- 0.6% for the raw F-18 image, and 6.5 +/- 0.9% for the scatter corrected F-18 image. The contrast measured for 2 cm and 3 cm inserts was 0.17 +/- 0.07 and 0.26 +/- 0.06 for F-18 raw data, 0.19 +/- 0.08 and 0.29 +/- 0.06 for the scatter corrected F-18 image, and 0.28 +/- 0.06 and 0.43 +/- 0.07 for the restored F-18 image. The contrast was 0.20 +/- 0.07 and 0.46 +/- 0.05 for the Tc-99m 140 keV window image. The restoration approach provided F-18 images of better contrast and detectibility than uncorrected or scatter corrected F-18 images. Restored F-18 images match better with the simultaneously acquired Tc-99m images.     

腹腔穿刺诊断非外伤性急性腹膜炎69例的体会

急性腹膜炎即由腹内脏器穿孔、破裂、缺血、炎症扩散或腹部手术污染腹腔、胃肠道吻合口瘘等诸多原因引起腹腔壁腹膜与脏腹膜炎性改变的一种严重的急腹症。我院自1995年6月至2005年12月收治非外伤性急腹症并急性弥漫性腹膜炎病人256例，采用腹腔穿刺检查，再经剖腹探查证实，阳性符合率为82．6％。现报告如下。     

Detection of melanoma,breast cancer and head and neck squamous cell cancer sentinel lymph nodes by Tc-99m Tilmanocept (Lymphoseek®)

Clinical & Experimental Metastasis - Technetium-99m-labeled Tilmanocept or Lymphoseek® (Cardinal Health, Dublin, Ohio) is a soluble, synthetic molecule with a small diameter...     

True uterine diverticulum. A partial müllerian duct duplication?

True uterine diverticulum is an exceedingly rare entity. We report only the second case, to our knowledge, of a nulliparous uterus containing a diverticulum communicating with the endometrial cavity. True uterine diverticula probably arise from a localized duplication of the distal Müllerian duct on one side. They may be confused pathologically with uterine sacculations of pregnancy, but tend to have thicker walls. Associated conditions include "ectopic" pregnancy in the diverticulum, dysmenorrhea, and abnormal uterine bleeding.