Use of radioactive technetium Tc-99m in peripheral arteriography

A simple method of determining peripheral circulation time and timing of exposures of peripheral arteriography is described. The technic and its advantages are briefly discussed.     

International prospective evaluation of scintimammography with (99m)technetium sestamibi

BACKGROUND: The purpose of this study is to evaluate the efficacy of scintimammography with (99m)Technetium-Sestamibi for the diagnosis of breast cancer. METHODS: This was a multicenter prospective cohort clinical trial. A total of 1,734 women were enrolled of whom 1,243 had complete data upon study completion. RESULTS: The mean +/- standard error age of the patients is 56 +/-12 years (with a range of 19 to 94). Mammographic results were classified by the Breast Imaging Reporting and Data System (BIRADS) as 199 (16%) BIRADS 5, 149 (12%) BIRADS 4, 199 (16%) BIRADS 3, and 696 (56%) BIRADS 2 or 1. Scintimammography was positive for 322 (26%) of the patients and negative for 921 (76%). Histopathology showed malignancy for 201 (16%) of the patients. Sensitivity and specificity of scintimammography was estimated 93% and 87% respectively. A positive predictive value (PPV) of 58% with a negative predictive value of 98% were calculated. CONCLUSIONS: The present study suggests that scintimammography with (99m)Technetium-Sestamibi is highly accurate for the detection of breast cancer.     

Diagnosis of atretic prolonged obstructive jaundice; technetium 99m hepatolite excretion study

Since 1982 we have developed a diagnostic method for differentiation between atretic prolonged obstructive jaundice (biliary atresia) and nonatretic prolonged obstructive jaundice in a neonate. The first report was presented at the Fukuoka Meeting in 1983. Analysis of duodenal juice (excretion test of intravenous injected hepatolite into the duodenum) has proved to be extremely reliable to differentiate biliary atresia from nonatretic prolonged obstructive jaundice. The major diagnostic features of the study are (1) biliary tract to bowel transit of radiotracer, and (2) observation on color of duodenal juice. Diagnostic accuracy was 98.4%. It is time-saving, requiring only 6 hours, noninvasive, and simple.     

Intraoperative 99m technetium bone imaging in the treatment of benign osteoblastic tumors

Benign bone tumors can be successfully treated by local resection with the use of intraoperative bone imaging. Intraoperative bone imaging provided accurate localization of an osteoid osteoma in a patella of a 16-year-old girl when standard radiographs failed to demonstrate the lesion. In a case of osteoblastoma of the sacrum in a 12-year old girl, intraoperative scanning was used repeatedly to guide completeness of resection. In these cases in which routine intraoperative radiographs would have failed, intraoperative scanning proved to be essential for success.     

Preliminary results of thallium 201 and technetium 99m subtraction scanning of parathyroid glands

An evaluation of double isotope subtraction scanning with 201Tl and 99mTc was performed in 14 patients with primary hyperparathyroidism. Twelve of 13 adenomas and seven of seven hyperplastic glands were localized correctly by preoperative scanning. The technique appears useful for the identification of abnormal parathyroid glands before operation.     

High surface tension pulmonary edema

Dogs were anesthetized with pentobarbital and placed on a piston ventilator with room air. Ten animals received an endobronchial lavage of normal saline (3 mg/kg). Ten other animals received an endobronchial lavage of the same volume of a nonionic detergent, Tween 20, 5% in saline. Detergent lavage was shown by Wilhelmy balance to increase surface tension of lung extracts. Saline lavage did not alter the surface tension of lung extracts. No significant differences between the groups were noted in cardiac output, left ventricular and diastolic pressure, mean pulmonary artery pressure, or colloid oncotic pressure. Static compliance and arterial PO2 were decreased following detergent lavage. Animals were sacrificed 2 hr after lavage and pulmonary extravascular water volume (PEWV) was measured gravimetrically. Saline-lavaged lungs with normal surface tension had a PEWV of 4.3 ml/g dry lung. Tween-lavaged lungs with increased surface tension had a PEWV of 5.3 ml/g dry lung (P less than 0.005). When the estimated volume of residual lavage solution remaining in the lung parenchyma was subtracted from the total wet lung wt, the corrected PEWV was 3.62 +/- 0.12 ml/g dry lung for saline-lavaged lung and 4.76 +/- 0.19 ml/g dry lung for Tween-lavaged lung. PEWV for 11 control animals ventilated 2 hr without lavage was 3.61 +/- 0.13 ml/g dry lung. It is concluded that, experimentally, high alveolar surface tension can induce pulmonary edema even when pulmonary microvascular hydrostatic and colloid oncotic pressures are normal.     

The value of technetium99m pyrophosphate scanning in the diagnosis of myocardial contusion

Twelve patients who sustained significant blunt chest trauma and had abnormal electrocardiographic changes unrelated to hypotension, hypoxia, or pre-existing myocardial disease were studied prospectively during a one-year period. The patients were divided into two groups on the basis of serum creatine phosphokinase (CPK)/MB isoenzyme concentrations: Group A (six patients) had normal CPK/MB isoenzymes (less than 8 IU), and Group B (six patients) had elevated CPK/MB isoenzymes (greater than 8 IU). All patients underwent cardiac scanning with technetium99m pyrophosphate. All studies were interpreted as normal. These data suggest that technetium99m pyrophosphate scanning is not a reliable adjunctive test to confirm myocardial contusion in patients with significant blunt trauma of the chest. However, the diagnosis of myocardial contusion in such patients can be established by the presence of abnormal electrocardiographic changes associated with an elevation of the serum CPK/MB isoenzyme concentration.     

The use of scintiangiography with technetium 99m in the diagnosis of traumatic pseudoaneurysm

Pseudoaneurysm formation is a known complication of peripheral arterial access procedures. Although standard contrast angiography has been considered the diagnostic study of choice to identify pseudoaneurysms, isotope angiography has been described as an alternative method. In this study, we examined the role of 99mTc-tagged red blood cell scans in the diagnosis of traumatic pseudoaneurysm. Forty patients underwent scans; 25 scans were reported as abnormal and 15 as normal. There were no false-negative results; one scan had false-positive results (2.5%). The presence of pseudoaneurysm among the patients with abnormal scans was verified at operation in 23 of 25 patients. The one false-positive test was verified by ultrasound. All patients with normal scans were followed up for verification. Follow-up time ranged from 2 to 28 months. Radionuclide vascular flow study appears to give information similar to that of conventional angiography. With a series false-positive rate of 2.5%, the examination has a high specificity. The 99mTc-tagged red blood cell scan is a viable alternative to conventional angiography for the diagnosis of traumatic pseudoaneurysms and is associated with less radiation and morbidity.     

Hepato-cholescintigraphy using technetium Tc 99m diethyl IDA in the follow-up of biliodigestive anastomoses

The results of a study conducted on 24 patients given biliodigestive shunts are reported. Follow-up involved cholescintigraphy using 99m-IDA technetium. This examination provided valuable information about the morphodynamics of biliary flow and when the biliary peak and intestinal appearance times were lengthened, it was also able to identify significant obstructions. The technique is considered highly significant.     

吸入性全身麻醉药对肺泡表面张力的影响

目的 观察临床使用的四类吸入性麻醉药对肺泡表面张力的影响。方法 ５０只家兔随机分成五组（每组１０只）,一组作为正常对照组（Ｃ组）,另四组分别吸入５５％～６０％氧化亚氮（Ｎ组）、４．５％～５％乙醚（Ｆ组）、０．８％～１．０％氟烷（Ｆ组）和０．８％～１．０％异氟醚（１组）,４ｈ后,用Ｗｉｌｈｅｍｌｙ平衡仪测定其肺泡灌洗液的表面张力。结果 与对照组相比,Ｅ、Ｆ、Ｉ三组肺泡灌洗液表面张力明显升高,稳定指数     

Lymphoscintigraphic anatomy of sentinel lymphatic channels after subareolar injection of technetium 99m sulfur colloid

BACKGROUND:

Injection of Technetium 99m sulfur colloid (Tc-99m-SC) into the subareolar lymphatic plexus provides a rapid and reliable method of identifying breast sentinel lymph nodes and their lymphatic connections to the areola, termed sentinel lymphatic channels (SLCs). The objective of this study was to define the anatomic origin, number, and direction of the SLC in relation to the areola after subareolar injection of Tc-99m-SC.

STUDY DESIGN:

Using a hand-held goniometer, the exit angle (θ_e) and direction from the vertical (to the patient’s right or left) of SLCs were determined in 87 successful preoperative lymphoscintigrams (46 left breast and 41 right breast).

RESULTS:

One major lymphatic trunk was identified in 91% of cases (n = 79), and two lymphatic trunks were identified in 9% of cases (n = 8). Overall, 24% (n = 21) of major lymphatic trunks exited the areola vertically (θ_e = 0 degrees), 33% (n = 29) exited the areola with θ_e = right or left 1 to 30 degrees, and 32% (n = 28) exited with a θ_e = right or left 31 to 60 degrees. In total, 90% (n = 78) of SLCs exited the areola with a θ_e = right or left 0 to 60 degrees, equivalent to 10 to 12 o’clock in the right breast, and 12 to 2 o’clock in the left breast.

CONCLUSIONS:

Radial angular measurements of SLCs from preoperative lymphoscintigrams performed by SA injection confirm that the origin of the majority of SLCs is within the upper, outer edge of the areola, and that all SLCs ultimately traverse the upper, outer quadrant of the breast and terminate on axillary sentinel nodes.     

^99mTc标记单克隆抗体膀胱内灌注诊断膀胱癌

目的 使放射免疫显像诊断膀胱癌更加简便，安全，可靠。方法 采用抗人膀胱癌单克隆抗体ＢＤＩ－１通过２－巯基乙醇直接还原法标记＾９９ｍＴｃ（＾９９ｍＴｃ）制备了＾９９ｍＴｃ－ＢＤＩ－１。结果 标记率为６９．９％，放化纯度大于９５％，３３例患者接受了通过膀胱内灌注的放射免疫显像诊断，其中４例非膀胱癌患者均未见显像，２９例膀胱癌患者肿瘤显像阳性率为８８．５％，原发和复发肿瘤可获得清晰的显像，显像肿瘤最小为     

The use of 99m technetium pertechnetate to detect transplanted gastric mucosa in the dog

A surgical model of a Meckel's diverticulum with ectopic gastric mucosa was constructed in seven dogs by implanting a full-thickness patch of gastric wall into the open end of a Roux-en-Y ileoileostomy. ^99mTc Pertechnetate scintiphotography with a gamma camera consistently identified this ectopic gastric mucosa when it was 1.8 sq cm or larger. Excision of the surgical models after ^99mTc injection showed that gastric mucosal radioactive counts were 6–20 times those in the adjacent ileum. Contact radioautographs of the specimens compared to the histologic sections from which they were made demonstrated that the ^99mTc was concentrated in the mucous cells of the gastric mucosal surgace and gastric pits. ^99mTc Scintiphotography should be utilized to identify ectopic gastric mucosa in symptomatic patients, recognizing that the amount of ectopic gastric mucosa present will be one determining factor in visualization.     

Limitations of technetium 99m sestamibi scintigraphic localization for primary hyperparathyroidism associated with multiglandular disease

Successful surgical treatment of primary hyperparathyroidism requires the localization and excision of the parathyroid tissue responsible for excessive parathyroid hormone secretion while ensuring that the patient will have sufficient endogenous parathyroid hormone production to maintain eucalcemia. In selecting patients with primary hyperparathyroidism for unilateral parathyroidectomy the surgeon should be able to diagnose multiglandular disease either preoperatively or intraoperatively. We performed a retrospective review of 123 patients who underwent surgical treatment for primary hyperparathyroidism to determine the potential feasibility of selecting patients for minimally invasive surgery based on preoperative imaging studies. All patients were studied preoperatively with 99m technetium-sestamibi scintigraphy. High-resolution ultrasonography was performed in 119 of these patients. All patients except one underwent bilateral cervical exploration. A patient with an intrathoracic adenoma was successfully diagnosed by scintigraphy thereby allowing treatment by a limited thoracotomy. One hundred eight patients had solitary adenomas and 15 had multiglandular disease. In none of the patients with bilateral multiglandular disease were all abnormal glands localized preoperatively. Patients in our study with primary hyperparathyroidism and multiglandular disease were underdiagnosed by preoperative imaging. A minimally invasive approach based solely on preoperative imaging studies may result in treatment failure in patients with multiglandular involvement.     

Sentinel node biopsy and lymphoscintigraphy with a technetium 99m labeled blue dye in a rabbit model.

BACKGROUND: Lymphatic mapping for sentinel node biopsy in breast cancer and melanoma usually involves initial peritumoral injection of a radioisotope, gamma camera detection of the sentinel lymph node several hours prior to the operation, and separate perioperative injection of a blue dye. We have developed a combined approach using technetium 99m labeled blue dye (Evans Blue) for use in lymphoscintigraphy that may be injected as a single dose just prior to the operation. METHODS: In an anesthetized rabbit model we dissected a hind limb to display the popliteal node and afferent lymphatic. Technetium 99m Evans Blue ((99m)Tc-EB) (22 MBq; 0.5 mL) was injected subdermally in the dorsum of the paw. Simultaneous digital and gamma camera images were obtained at 14 time intervals to 30 minutes post injection. For each of these time intervals the percentage of radioactivity and percentage blueness of the popliteal node were determined. Urine and afferent lymphatic fluid were analyzed by chromatography. The popliteal node was excised post mortem, placed into solvent solutions and analyzed for blueness and radioactivity. RESULTS: Time-activity curves for radioactivity and time-blueness curves for Evans Blue uptake showed strong correlation (r = 0.958). Lymph analysis suggested (99m)Tc-EB is mainly bound to endogenous proteins. Urine was radioactive but not colored, (99m)Tc-EB being metabolized and excreted in the urine as 1,7-diamino-8-naphthol-2,4-disulfonic acid. Prolonged exposure of node to solvents did not dissociate any blue coloration or radioactivity. CONCLUSIONS: (99m)Tc-EB and Evans Blue are simultaneously retained and concentrated in the sentinel lymph node. This process is rapid and reproducible. (99m)Tc-EB migrates at the same rate as Evans Blue in lymph, where it is transported as bound to endogenous proteins. These dye molecules are metabolized by reductive cleavage in the liver and then excreted renally as colorless, radioactive metabolites. This novel agent has the potential to facilitate lymphatic mapping and subsequent sentinel node biopsy for a range of solid malignancies including breast cancer and melanoma.     

Prospective evaluation of the efficacy of technetium 99m sestamibi and iodine 123 radionuclide imaging of abnormal parathyroid glands.

BACKGROUND. Technetium 99m sestamibi is an isonitrile radionuclide imaging agent that, when used with subtraction iodine 123 thyroid scans, has the potential for imaging abnormal parathyroid glands. METHODS. We prospectively evaluated 20 patients with hyperparathyroidism to study the efficacy of Tc 99m sestamibi and 123I subtraction radionuclide scanning for the imaging of abnormal parathyroid glands. All patients underwent neck exploration and histologic confirmation of all parathyroid glands identified. RESULTS. The solitary adenomas in 11 of 16 patients with primary hyperparathyroidism were localized with sestamibi scans. The scans in four of five patients with diffuse parathyroid hyperplasia showed bilateral localization consistent with enlarged glands. The fifth patient previously underwent a subtotal parathyroidectomy, and a fifth supernumerary gland was localized with the sestamibi scan. Four patients had hyperparathyroidism related to kidney disease. Three of these had bilateral localization of enlarged glands. The fourth patient had undergone two previous operations, and a fifth supernumerary gland was localized with the sestamibi scan. CONCLUSIONS. The preliminary data indicate that Tc 99m sestamibi in combination with 123I radionuclide scanning may be useful in the preoperative localization of abnormal parathyroid glands. This technique localized all of the solitary adenomas that were subsequently resected, and in two reoperative cases it identified the remaining solitary gland causing persistent hypercalcemia.