Static Scintigraphy Research Articles

99mTc-pertechnetate thyroid static scintigraphy unexpectedly revealed ectopic gastric mucosa of upper esophagus.

Technetium-99m (99mTc)-pertechnetate can be taken up by both gastric mucosa and thyroid tissue. Ectopic gastric mucosa of upper esophagus found in thyroid scintigraphy is rare. We reported a 31-year-old woman who underwent 99mTc-pertechnetate thyroid static scintigraphy for abnormal ultrasound findings. A focal uptake lesion was found in her upper chest. Single photon emission computed tomography/computed tomography (SPECT/CT) imaging showed increased uptake in multiple sites of the upper esophagus without significant thickening. Eventually, gastroscopic findings revealed multiple ectopic gastric mucosa of upper esophagus.

CT Lymphography Using Lipiodol® for Sentinel Lymph Node Biopsy in Early-Stage Oral Cancer.

This study evaluated sentinel lymph node (SLN) identification with CT lymphography (CTL) following peritumoral administration of Lipiodol® relative to conventional 99mTc-nanocolloid lymphoscintigraphy (including SPECT/CT) in 10 early-stage oral cancer patients undergoing SLN biopsy. Patients first underwent early dynamic and static scintigraphy after peritumoral administration of 99mTc-nanocolloid. Subsequently, Lipiodol® was administered at the same injection sites, followed by fluoroscopy and CT acquisition. Finally, late scintigraphy and SPECT/CT were conducted, enabling the fusion of late CTL and SPECT imaging. The next day, designated SLNs were harvested, radiographically examined for Lipiodol® uptake and histopathologically assessed. Corresponding images of CT, 99mTc-nanocolloid lymphoscintigraphy and SPECT/late CTL fusion were evaluated. 99mTc-nanocolloid lymphoscintigraphy identified 21 SLNs, of which 7 were identified with CTL (33%). CTL identified no additional SLNs and failed to identify any SLNs in four patients (40%). Out of six histopathologically positive SLNs, two were identified by CTL (33%). Radiographic examination confirmed Lipiodol® uptake in seven harvested SLNs (24%), of which five were depicted by CTL. CTL using Lipiodol® reached a sensitivity of 50% and a negative predictive value (NPV) of 75% (median follow-up: 12.3 months). These results suggest that CTL using Lipiodol® is not a reliable technique for SLN mapping in early-stage oral cancer.

Predictive Factors for Metastasis of Skin Melanoma of Varying Thickness According to Breslow to Sentinel Lymph Nodes

Purpose: To evaluate the prognostic factors in patients with Breslow skin melanoma of various thicknesses that affect the incidence of metastases in the signal lymph nodes (SLN).Material and methods: From November 2018 to November 2020, 324 patients with diagnosed melanoma of the skin of various localization and stages were examined and operated on. We used lymphotropic colloidal radiopharmaceutical (RPh) labeled with 99mTc. RPh with an activity of 150 MBq was administered one day before the operation intradermally around the scar of resected melanoma or peritumorally at 4 points in the case of a primary tumor. Lymphoscintigraphy was performed 1–3 hours after the RP injection on a Symbia E or Symbia E gamma camera (Siemens, Germany). Anteroposterior and lateral static polypositional scintigraphy was performed to determine the topography and mark the SLN. 324 planar studies were performed. In 259 cases, an additional study was performed SPECT (including SPECT / CT) on a Symbia T2 device (Siemens, Germany). Surgical intervention was performed the next day, taking into account the data of intraoperative radiometry using a domestic specialized hand-held gamma detector Radical (Amplituda, Russia).Results: The mean primary melanoma Breslow thickness was 2.77 ± 2.2 mm (range 0.2–13.0 mm). Localization of SLN: axillary (n = 161. 51 %), inguinal (n = 100. 31 %), cervical (n = 16. 5 %), submandibular (n = 9. 3 %), supraclavicular (n = 4. 1 %), more than one basin (n = 34. 9 %). In the group of melanomas <0.75 mm thick, no SLN metastases were found, among 0.75–1 mm melanomas, one positive lymph node with metastasis (SLN+) was found, in the largest group of melanomas of medium thickness (1–3.5 mm) — 25 (17 %). The largest percentage of metastases in SLN is determined in thick melanomas (>3.5 mm) — 17 (28 %), which is consistent with the data of foreign literature, while SLN is most often affected with a Breslow tumor thickness of more than 7 mm.In the group with negative sentinel lymph nodes (SLN–), the average tumor thickness according to Breslow was 2.6 ± 2.0 mm, in the SLN+ group — 4.0 ± 2.9 mm, the differences between the groups are statistically significant, which is confirmed by the result of one-way analysis of variance.The optimal threshold value of tumor thickness according to Breslow for the isolation of patients with a positive prognosis of metastasis in the SLN is 2.0 mm. It is characterized by the maximum levels of sensitivity (79 %) and specificity (59.1 %). An older age of patients (over 35 years old) is also associated with an increased incidence of metastases in the SLN, but this indicator is not statistically significant. Most often, SLN metastases were detected when the primary tumor was localized in the back (more often in men) and lower extremities (more often in women), while they are thicker (> 3.5 mm).Conclusion: 1. According to the ROC-analysis, the optimal threshold value of the tumor thickness according to Breslow for the isolation of patients with a positive prognosis of metastasis in the SLN is 2.0 mm. It is characterized by the maximum levels of sensitivity (79 %) and specificity (59.1 %). 2. Statistically significant prognostic factors of metastasis in SLN: localization of the primary tumor in the back (more often in men) and lower extremities (more often in women); Breslow thickness over 3.5 mm. 3. The absence of the influence of gender and age was noted, with a slight predominance of women in both groups.

Comparing the Relative Glomerular Filtration Rate with the Relative Renal Function Calculated by 99mTc-DMSA Static Scintigraphy

Objective: To compare whether there is a statistical difference between the relative glomerular filtration rate (RGFR) obtained from renal dynamic imaging using 99mTc-DTPA and the relative renal function (RRF) obtained from renal static imaging using 99mTc-DMSA for children with urinary tract infection. Methods: We retrospectively analyzed 52 children with urinary tract infections, [31 females and 21 males, age: 3~168 months]. All patients underwent renal dynamic imaging with 99mTc-DTPA and renal static imaging with 99mTc-DMSA within one week period. RGFRs and RRFs were calculated for left and right kidneys. Wilcoxon Rank Sum Test is used for comparing the RGFR and RRF. Results: For 99mTc-DTPA renal dynamic imaging, the median and interquartile ranges of RGFRs are 52.55 (49.50, 57.98) for left kidneys and 47.45 (42.02, 50.50) for right kidneys. For 99mTc-DMSA renal static imaging, the values of RRFs are 52.20 (47.92, 57.31) for left kidneys and 47.80 (42.69, 52.08) for right kidneys. The RGFRs were statistically different from the RRFs in the groups of patients (Z =—2.377, P = 0.017). Conclusion: There exists statically difference between the relative glomerular filtration rate (RGFR) measured by renal dynamic imaging using 99mTc-DTPA and the relative renal function (RRF) measured by the renal static imaging using 99mTc-DMSA for the children with urinary tract infections.

P0305DIAGNOSTIC VALUE OF TGF-B-1 AND ANG II EXCRERION IN URINE IN CHILDREN WITH VESICOURETERAL REFLUX DEPENDING ON THE THERAPEUTIC APPROACH

Abstract Background and Aims to determine the diagnostic value of profibrogenic cytokines of transforming growth factor (TGF-β1) and angiotensin II (AngII) in urine to detect the severity of tubulointerstitial fibrosis in children with vesicoureteral reflux (VUR) depending on the therapeutic approach. Method 117 patients aged 3 to 16 years (mean age 10.2 ± 4.5, 70.1% of girls) with VUR were examined. The control group consisted of 20 healthy children. All children underwent a complete nephrological examination. The levels of TGF-β1 and AngII were determined in morning urine using the ELISA method and counted for urine creatinine. To identify the severity of the lesion of the renal parenchyma, a static DMSA scintigraphy was performed. Results depending on the therapeutic approach, the children were divided into 2 groups: 1 gr. - children on conservative treatment (63.2%), 2 gr. - children, after surgical correction of VUR (36.8%). In each group, 3 subgroups were identified depending on the development of tubulo-interstitial fibrosis according to DMSA: A subgr. - without signs of sclerosis (15.4%), B subgr. - 1-2 foci (44.74%) and C subgr - > 3-4 foci of sclerosis (40.1%). All patients with VUR had a high urinary excretion of TGF-β1/Cr and AngII/Cr when compared with the control group (p<0.05). Regardless of the therapeutic approach, in subgroups A (without foci of sclerosis) and B (1-2 foci of sclerosis), patients had a statistically significantly lower level of excretion of these cytokines when compared with patients from subgroup C (p <0.05). No significant difference was found in the urinary excretion of TGF-β1/Cr and AngII/Cr depending on the therapeutic approach. Conclusion we established a reliable dependence of the excretion of TGF-β1/Cr and AngII /Cr in the urine on the severity of tubulo-interstitial fibrosis according to DMSA scintigraphy in children with VUR. At the same time, we did not note the dependence of the excretion of TGF-β1/Cr and AngII/Cr in the urine on the method of the therapeutic approach. Therefore, the study of the excretion of TGF-β1/Cr and AngII/Cr in the urine as non-invasive markers can be used as a criterion for the progression of nephropathy in VUR, regardless of treatment methods.

RADIOISOTOPE DIAGNOSTIC ALGORITHM FOR THE RELAPSE AND METASTASES DETECTION IN THE IODINE-NEGATIVE DIFFERENTIATED THYROID CANCER.

Developing of algorithm for the post-surgical management of patients with iodine-negative metastasesof differentiated thyroid cancer (DTC). The DTC patients with iodine-negative metastases (n = 115) were enrolled in the study.Of them the whole body scintigraphy (WBS) was performed with technetium-99m-hexakis-2-methoxyisobutylisonitrile(99mTc-MIBI) (n = 30), WBS with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) (n = 30), 18FDG PET (n = 30), andcomputer tomography (CT-scan) (n = 25). Complex 99mTc-pertechnetate scans including the dynamic and static scintigraphy was performed supplementary to 99mTc-MIBI WBS in 10 patients to obtain the angiographic curves from DTCmetastatic foci. The non-radioiodine radiopharmaceutical technologies, namely the labeled 99mTc-MIBI, 99mTc-DMSA, 99mTc-pertechnetate, and 18FDG were applied to detect the iodine-negative DTC metastases. Radioisotopic examinationswere performed at the dual-head gamma camera (Mediso Medical Imaging Systems Ltd., Hungary) and single photonemission computed tomography (SPECT) scanner «E.CAM» (Siemens, Germany). PET/CT scans were performed on the«Biograph 64 TruePoint» imaging platform (Siemens, Germany) in accordance with the European Association of NuclearMedicine (EANM) recommendations for the Siemens imaging devices with 3D-mode data acquisition. The conducted research suggested that it is feasible to use the non-radioiodine (99mTc-MIBI and 99mTc-DMSA)radiopharmaceutical technologies to detect the iodine-negative DTC metastases. 18FDG PET is a highly informativetechnology for the detection of iodine-negative DTC metastases in case of lung involvement in the process. Compareof the non-radioiodine radiopharmaceuticals, CT scan and 18FDG-PET/CT indicated the highest sensitivity of 18FDGPET/CT (p < 0.05). WBS with 99mTc-MIBI and 99mTc-DMSA featured the highest specificity (100 %, p < 0.05). X-ray CTis marked by the significantly lower either sensitivity, specificity, and accuracy rate (p > 0.05). Developing andapplication of algorithm for the post-surgical management of patients with iodine-negative forms of DTC will allowfor the betimes detection of relapses and metastases with administration of adequate surgical, radiation, and targeted treatment. Obtained results offer the opportunity to optimize the post-surgical management of patients withiodine-negative DTC forms using the options of radionuclide diagnostics with non-radioiodine radiopharmaceuticals. The latter are readily available providing the cost-cutting of diagnostic support in these patients. Place ofmorphological methods of diagnosis is determined and stage of monitoring of patients with the iodine-negativemetastases is established. Possibility of the 18FDG-PET tests for the early diagnosis of iodine-negative metastases inDTC for the first time have been studied and substantiated in Ukraine. A comprehensive radiation algorithm for thelong-term monitoring of this category of patients will allow the timely detection of recurrences and metastases ofDTC and appropriate surgery, radiation and targeted therapy administration. Data obtained as a result of the studyallowed to improve the overall and recurrence-free survival rates in the able-bodied DTC patients and reduce thecosts of follow-up of patients with iodine-negative forms of DTC.

COMPLEX RADIONUCLIDE EVALUATION OF STRUCTURAL AND FUNCTIONAL STATE OF THE SINGLE KIDNEY IN CHILDREN

Summary. Introduction. The aim of the work is the determination of functioning of the single kidney (SK) by&#x0D; complex scintigraphic research with using nephrotrophic radiopharmaceuticals (NRP) of different mechanisms of elimination and the detection of its diagnostic significance.&#x0D; Materials and methods. 90 children (range 5-16 years) with SK were examined: dynamic (DRSG) and static (SRSG) scintigraphy with angiography was made them. 150 scintigraphic examinations with different NRP were made: 99mTc-DTPA (diethyleneaminopentacetate) – 51, 99mTc – PP (pyrophosphate) – 40,99mTc – DMSA (dymethylenesuccinateacetate) – 34, 99mTc MAG3 (mer- captoacetyle-3-glycine) – 15, 99mTc-EC (ethylenedicysteine) – 10. Time options of renal blood flow and transport of NRP, SGF, ERP were determined. Control group consists of15 children.&#x0D; Results.The main scintigraphic features ofSK are: presence of single kidney on scintigraphic image; slowdown of time options of renal haemodynamic, increasing of SGF and ERP of SK on 50-60 %; decreasing of standard parameters SGF and ERP on 40-50%. The slowdown of SK excretion ability is associated with retention NRP in parenchyma. Proportions of SK increase on 2-3 sm average, and size of scintigraphic picture – on 40%. The main type of renographic curve in children with SK is parenchymatose, and it is found in 50% ofpatients. The accumulation and distribution of NRP in SK in 73,3 % is quite uniform.&#x0D; Conclisions. Thus, SK in children functions in strain way of all compensation mechanisms that provide blood purification from products of vital functions, which shows the slowdown of main options of the SKfunctioning.

Diagnosis of Raynaud's phenomenon by 99mTc-pertechnetate hand perfusion scintigraphy: a pilot study.

We assess the usefulness of 99mTc-pertechnetate hand perfusion scintigraphy in patients with Raynaud's phenomenon (RP). The study population consisted of 18 patients with primary RP, 25 patients with secondary RP within systemic sclerosis (SSc), and ten healthy individuals. Gamma camera dynamic first-pass study during the first 60s and a static scintigraphy after 5min were recorded following a bolus injection of 99mTc-pertechnetate via a cubital vein. Regions of interest were drawn on the summed images around the fingers and the palmar region. The fingers-to-palm ratios were then calculated. The mean fingers-to-palm ratio for dynamic study (blood flow) was 0.58±0.19 for the healthy group, 0.45±0.18 for the primary RP, and 0.43±0.21 for the SSc patients. The mean fingers-to-palm ratio for static study (blood pool) was 0.44±0.06 for the healthy group, 0.42±0.06 for the primary RP, and 0.36±0.07 for the SSc patients. Analysis of variance showed these differences to be significant (p=0.039 from blood flow and p=0.004 from blood pool). The receiver operating characteristic curve showed sensitivity of 80% and a specificity of 60% when using cutoff values of 0.40 for blood flow and sensitivity of 79% and a specificity of 70% when using cutoff values of 0.37 for blood pool. Our method is able to differentiate between patients with normal and those with abnormal microcirculation of the hands. Dynamic study separates the healthy subjects from patients with RP, while static study separates primary from secondary RP.

Kidney Function Evaluation According to Percentage of Technetium-99m Capture With Addition of Correcting Factor for Technetium-99mm Decay.

Assess the safety and accuracy of renal static scintigraphy with introduction of the amendment coefficient for decay of 99m metastable (Tc-99m) at the calculation formula of capture percent Technemec 99m. This study analyzes retrospectively the results of renal static scanning of 44 patients. Of this group of patients, 21 are Chornobyl Nuclear Power Station accident liquid ators who have arterial hypertension and chronic pyelonephritis. Renal scanning was carried out with Genesys EPIC single-photon emission computed tomography system. Calculation of the capture percent of the radiopharmaceutical Technemec 99m was executed in the standard way with introduction of the amendment coefficient Tc-99m to decay at the calculation formula of capture percentage Technemec. Significant differences by standard calculation method took place in the both the Chornobyl Nuclear Power Station accident liquidators and persons who were not subjected to the influence of a small radiation dosage (P < .05). A small radiation dose did not affect kidney function (P > .05) with introduction of the amendment coefficient for decay of technetium 99m; therefore, static scintigraphy is a safe method for assessing kidney structure and morphology. Introduction of amendment for decay of Tc-99m allowed false positive results in 11.9% of renal function assessments for patients with arterial hypertension and kidney dysfunction (P < .05). Calculation of the specific capture percent of radiopharmaceutical on 1 cm2 of visualization of renal parenchyma enabled a 29% increase in renal function identification accuracy.

99mTc-octreotide receptor scintigraphy in NCI-H446 small cell lung cancer nude mice model

背景与目的小细胞肺癌恶性程度高，早期诊断对其预后有重要价值，目前的检查方法比较局限，传统影像学方法特异性差，而PET/CT价格昂贵，难于推广应用。小细胞肺癌属神经内分泌肿瘤，高表达生长抑素受体，是其早期进行分子影像诊断的理论基石。本实验旨在观察99mTc-octreotide在正常裸鼠体内的分布、代谢及荷人NCI-H446小细胞肺癌裸鼠模型体内显像变化，为临床小细胞肺癌早期诊断奠定基础。方法建立人小细胞肺癌的裸鼠肿瘤模型，正常裸鼠及荷瘤鼠静脉注射99mTc-octreotide显像剂后行动态及延迟显像。运用感兴趣区（region of interest, ROI）技术勾画各时相裸鼠各脏器、肿瘤（T）及肿瘤对侧对应部位（N）放射性计数，计算相应T/N比值，并建立30 min内各ROI的时间-放射性（A-T）曲线。结果① 正常裸鼠的肾脏、肝脏内99mTc-octreotide分布最多，肺部、心脏部位分布较低，头部放射性分布最少，99mTc-octreotide主要通过泌尿系统排泄；各脏器30 min内A-T曲线显示放射性分布随时间延迟呈逐渐下降趋势。②5例荷瘤裸鼠的肿瘤显像均呈阳性；静脉注射99mTc-octreotide后肿瘤部位在3 h显像最清楚，整个检查时间内肝脏放射性强度明显高于肿瘤组织，肺部放射性与肿瘤部位较相近。半定量分析结果显示，静脉注射99mTc-octreotide后肿瘤组织与对侧肢体肌肉的T/N比值在0.5 h、2 h、3 h、4 h分别为1.163±0.03、2.08±0.12、3.03±0.23、2.689±0.31；各时相T/N比值差异有统计学意义（F=51.69, P < 0.000, 1）；通过两两比较发现，静脉注射显像剂后3 h的T/N比值与其他各时相差异均有统计学意义（P < 0.05）；不同检查时间肝脏部位的放射性平均计数高于肿瘤部位，肺部的平均计数与肿瘤相近。肿瘤部位A-T曲线显示，注射99mTc-octreotide后2 min-3 min出现一过性放射性分布高峰。结论运用99mTc-octreotide作显像剂，人小细胞肺癌NCI-H446裸鼠模型具有极高的显像阳性率，且3 h肿瘤显像最清楚。

OP133: Tongue carcinoma: Were lympha goes? A one center study on lymphatic mapping

Purpose Neck treatment in cN0 tongue squamous cells carcinoma is still debated. Sentinel node (SN) technique could help the decision making, but is still unclear which kind of neck dissection must be performed in SN+ cases. Moreover, the pattern of cervical metastases has wide intra-individual variation and up to 5% of nodal metastases are found to be contralateral. In 2006 we published the lymphatic mapping study on 14 N0 patients affected by advanced tongue cancer. Contralateral drainage occurred in 11 patients and in two of them metastatic nodes were found on the contralateral side only. Metastases were found only in radioactive lymph nodes. The limits of this technique were the need of lymphoscintigraphy of specimens as to compare preoperative and postoperative imaging and the impossibility to visualize the lymphatic ways during surgery. Our purpose is to overcome these limits comparing lymphoscintigraphy with Tc-99 and near-infrared fluorescence imaging using indocyanine green die. Material and methods The study population will include 14 patients with cT4 cN0 M0 SCCs. The lymphatic drain of each patient is studied 12 h before surgery with a static scintigraphy and then with intraoperative injection of indocyanine green. Neck dissection is performed in two steps: first is performed a green indocyanine guided lymphatic dissection checked by a radioactive probe that are send separately for histopathological examination and then completion of bilateral neck dissection and en-block tumor resection. Results We expect to find that the scintigraphic positive lymph nodes are the same identified by the green indocyanine, and that the metastases are found only in the guided dissection specimens. Conclusion This study could provide a reliable tool to intraoperatively visualize the lymphatic draining of tongue tumor in order to achieve tailored patient treatment, identifying and removing the only and real lymphatic ways at risk to be involved by metastases.

The use of static scintigraphy for the diagnostics of urolithiasis in patients with a single kidney

The paper deals with a study of the content of calcium in the tissues by means of static scintigraphy in order to diagnose intranephron calculosis in patients with a single “intact” kidney.

Lingual thyroid: diagnosis using a hybrid of single photon emission computed tomography and standard computed tomography

To present a rare case of lingual thyroid detected using a hybrid of single photon emission computed tomography and standard computed tomography in a young woman with hypothyroidism. A 29-year-old woman was screened for autoimmune thyroid disorders in early pregnancy, and found to have subclinical hypothyroidism. No thyroid tissue was found in the anterior neck upon ultrasonography, raising suspicions of an ectopic thyroid. The patient was treated with levothyroxine throughout the remainder of her pregnancy, and developed postpartum thyroiditis requiring an increase in levothyroxine dosage. Whole-body scintigraphy and zoomed static head and neck scintigraphy were performed. Abnormal 99mTc-pertechnetate uptake was observed in the oral region, whereas no uptake was found in the usual thyroid location. Hybrid imaging using single photon emission computed tomography and standard computed tomography was performed to improve three-dimensional representation of the area of increased activity. The latter imaging modality detected ectopic thyroid tissue in the tongue. Whole body 99mTc-pertechnetate scintigraphy and a hybrid of single photon emission computed tomography and standard computed tomography are effective imaging modalities for the investigation of ectopic thyroid tissue. The latter modality is particularly recommended, as it allows more precise spatial visualisation of increased isotope uptake activity in the head and neck.

The non-conventional use of 99mTc-Tetrofosmine for dynamic hepatobiliary scintigraphy

Classic dynamic hepatobiliary scintigraphy (DHBS) is commonly performed with 99mTc-Iminodiacetic Acid (IDA) derivatives and represents a non-invasive diagnosis method for biliary dyskinesia, fistulas, surgical anastomosis, etc (1). This study assesses the possibility of performing DHBS with 99mTc-Tetrofosmine (TF), a radiopharmaceutical (RF) dedicated to myocardial perfusion scintigraphy (MPS), but being excreted through the liver. The possibility to use 99mTc-TF for DHBS may be important in situations when the standardized RF for this procedure (IDA derivatives) is not available. We performed DHBS for 30 patients referred for investigation by internal medicine and surgery departments. The patients had been fasting for 12 hours. The dynamic investigation started simultaneously with the intravenous (IV) administration of 37-110 MBq (1-3 mCi) 99mTc-TF. Dynamic images were recorded for 30-45 minutes, one image per minute, followed by static scintigraphy at 1 h, 1.5 h, 2 h, and 3 h after IV injection. The quality of scintigraphic images of the liver and biliary tree obtained at DHBS with 99mTc-TF ensured the correct diagnosis of biliary dyskinesia, stasis, stenosis, and fistulas. DHBS using 99mTc-TF is justified by the image quality and by the good cost/benefits ratio. Because the IDA derivatives are not always available, this finding may be important for medical practice. 99mTc-TF evacuated through the bile duct allows DHBS interpretation, while the necessary dose is approximately 8 to 20 times smaller than that used for myocardial perfusion scintigraphy.

Can Tc 99m DTPA be Used in Adult Patients in Evaluation of Relative Renal Function Measurement as the Reference Tc 99m DMSA Method?

Objective: In the literature, there are many reports comparing relative renal function calculated with Tc 99m DTPA and Tc 99m DMSA in adults and children. However, there is no consensus about the results. As there is indeterminacy in the reliability of Tc 99m DTPA for the calculation of the relative renal functions, we retrospectively designed a study to compare the relative renal functions measured with Tc 99m DMSA and Tc 99m DTPA in adult patients with renal diseasesMaterial and Methods: We retrospectively analyzed the data of 144 patients who applied to Nuclear Medicine Department of three hospitals between 2009 and 2010 and who had both dynamic and static renal imaging. Renal dynamic scintigraphies were compared to the relative function measured using Tc 99m DMSA static scintigraphy. Comparison of relative renal function measurements using dynamic and static renal scintigraphies was performed using Pearson correlation test. The comparison results were expressed with Bland-Altman analysis. Results: The study was conducted with 144 patients and 288 kidneys. Fifty six of patients were male. Mean age was 39.9±15.2 years. Thirty four patients had hydronephrosis, 28 pyelonephritis, 53 renal calculi, 3 chronic renal failure, 2 acute renal failure, 1 benign renal neoplasia, 15 renal atrophy, 8 ureteropelvic junction stenosis. Relative renal function was calculated in Tc 99m DMSA and 99m Tc-DTPA studies. The mean relative renal functions measured with Tc 99m DTPA was 52.54±23.09% and 47.25±23.09, with Tc 99m DMSA 52.85±21.80% and 47.07±21.77% for right and left kidneys, respectively. In bivariate correlation analysis (Pearson) a significant positive correlation was found between the relative renal functions calculated with Tc 99m DTPA and Tc 99m DMSA (r =0.937, p< 0.001). In Bland-Altman plots, the mean difference between two methods was 0.3 and the correlation limits were between 16.2 to -15.5.Conclusion: As a result, we concluded that Tc 99m DTPA is also a good method for the relative renal function evaluation when compared to Tc 99m DMSA scan. Although Tc 99m DMSA is the most reliable method for the calculation of relative renal function, Tc 99m DTPA can be another choice for the calculation of relative renal function without a complementary DMSA scan particularly in patients who require renogram curve and GFR calculations. Conflict of interest:None declared.

Assessment of lower extremities ischemic disease by thallium 201 perfusion scintigraphy in patients with diabetic angiopathy

Tibial perfusion in diabetic microangiopathy is considered to be a diagnostic problem. A special place in quantifying muscle microcirculatory perfusion belongs to thallium 201 muscle perfusion scintigraphy (201T1 PS). Thallium, showing the characteristics of potassium (K+), enters a cell by means of active cell transportation and follows erythrocyte up to the tissue. The aim of this study was to determine if T1 PS of lower extremities (LE) is a good method for estimating muscle microcirculatory perfusion in diabetic microangiopathy. The study included 32 patients of an average age 66.1 +/- 14.9 years with signs of LE ischemia befalling into III and IV stage of ischemic disease according to the Lariche-Fontain classification. Out of that number there were 27 of the patients with non-insulin-dependent diabetes mellitus (NIDDM), while 5 of the patients were with Burger's disease and Raynand's disorder. Lower extremities PS was performed after 3 min of tibial loading by the use of dorsoplantar foot flexion and intravenous 74 MBq 201T1 as a 10-minute dynamic study. A 10 minute static scintigraphy was carried out of the gluteal region, femurs, tibias and feet per a position and repeated after 3 h at rest in the same projections. The results were interpreted visually and by the semiquantitive method using a program for calculating the number of pulses per pixel in the corresponding region over 1-, 2- and 10-minute dynamic study, thus obtaining numerical data for estimating perfusion. Binding ratio in both legs was estimated visually as low (1), medium (2) and significant (3) difference in both legs. The results were compared with doppler hemodynamic indices (PI and RI). Regardless the group, 201T1 binding intensity rising was significantly 2 min after application, as compared to 1 min, and the obtained level of binding was maintained even after 10 min. In the group Fontain III the majority of the patients showed a medium difference in binding 201T1 (2) in regard to the group Fontain IV with the patients having a low difference (1) between both legs and a significant difference between both legs (3). A statistically significant positive corellation was obtained between the values of RI index regarding distal region of a. tibialis posterior (p < 0.05, r = 0.43), as well as a. tibialis anterior (p = 0.05, r = 0.38). There was no corellation for the PI index. Low collateral net development based on the values for the indices PI and RI showed a less muscle perfusion on 201T1 in regard to medium and well developed collateral net with identical perfusion. The results of lower extremities perfusion scintigraphy are reliable indice of muscle microcilculatory perfusion. There is a statistically significant correlation between the doppler hemodynamic indices and 201TI perfusion scintigraphy.

One-day or two-day procedure for sentinel node biopsy in melanoma?

We compared the outcome of a 1-day and a 2-day sentinel node (SN) biopsy procedure, evaluated in terms of lymphoscintigraphic, surgical and pathological findings. We studied 476 patients with melanoma from two melanoma centres using static scintigraphy and blue dye. A proportional odds model was used for statistical analysis. The number of SNs visualized at scintigraphy increased significantly with time from injection to scintigraphy and activity left in the patient at scintigraphy, and depended on the melanoma location. The number of SNs removed at surgery increased with the number of SNs visualized at scintigraphy and time from injection to surgery. The frequency of nodal metastasis increased with increasing thickness and Clark level of the melanoma, and was highest for two SNs visualized at scintigraphy. This study showed that early vs. late imaging and surgery do make a difference on the outcome of the SN procedure and confirmed the importance of the scintigraphic visualization of all true SNs.

Validity of dual tracer 99mTc-tetrofosmin and 99mTc-pertechnetate subtraction parathyroid scintigraphy in patients with primary and secondary hyperparathyroidism

Primary hyperparathyroidism (pHPT) is an endocrine disease with the third highest incidence of all endocrine disorders after diabetes mellitus and hyperthyroidism. pHPT is typically caused by a solitary parathyroid adenoma, less frequently by multiple parathyroid gland disease (MGD) and rarely by parathyroid carcinoma. Secondary hyperparatyroidism (sHPT) is a common complication in patients with chronic renal failure. The aim of this study was to estimate sensitivity of dual tracer 99mTc-tetrofosmin and 99mTc-pertechnetate subtraction scintigraphy in detection of abnormal parathyroid glands in patients with pHPT and sHPT confirmed by histopathology. In 46 patients, (77 abnormal parathyroid glands), 30 with pHPT and 16 with sHPT parathyroid scintigraphy was done preoperatively. All the patients had histopathological confirmation of diagnosis. Abnormal parathyroid glands weighted from 0.1 to 7 g. After iv injection dynamic scintigraphy during 25 minutes (one frame-one minute) using 555 MBq of 99mTc-tetrofosmin, and three hours latter using 111 MBq of 99mTc/pertechnetate was performed. 99mTc-tetrofosmin dynamic study was followed by static scintigraphy of the neck and chest 30 minutes, 1, 2 and 3 hours after iv injection. An abnormal scintigraphic finding was found in 44 of 46 patients with sensitivity of 96%. In pHPT sensitivity was 93% (28 of 30 patients, and 28 of 30 glands). In sHPT scintigraphy was abnormal in all the patients (sensitivity 100%). In the patients with sHPT scintigraphy detected 30 of 47 abnormal parathyroid glands (sensitivity 64%). An overall sensitivity of scintigraphy per gland, for pHPT and sHPT in detecting 58 of 77 abnormal parathyroid glands was 75%. An abnormal scintigraphic result per patient was found in 44 patients (sensitivity 96%) and 58 of 77 abnormal parathyroid glands were detected (sensitivity 750/0). A high sensitivity of dual tracer subtraction 99mTc-tetrofosmin/99mTc-pertechnetate parathyroid scintigraphy in detecting abnormal parathyroid glands in primary and secondary hyperparathyroidism was achieved.

Ventilation/perfusion lung scintigraphy: what is still needed? A review considering technetium-99m-labeled macro-aggregates of albumin

Lung perfusion scintigraphy (LPS) with technetium-99m-labeled macro-aggregates of albumin (Tc-99m-MAA) is well established in the diagnostic of pulmonary embolism (PE). In the last decade, it was shown that single-photon emission computer tomography (SPECT) acquisition of LPS overcame static scintigraphy. Furthermore, there are rare indications for LPS, such as preoperative quantification of regional lung function prior to lung resection or transplantation, optimization of lung cancer radiation therapy, quantification of right-left shunt, planning of intra-arterial chemotherapy, and several rare indications in pediatrics. Moreover, LPS with Tc-99m-MAA is a safe method with low radiation exposure. PE can also be diagnosed by spiral computer tomography (CT), ultrasound, magnetic resonance angiography, or pulmonary angiography (PA, former gold standard). The present review considers all these methods, especially spiral CT, and compares them with LPS with respect to sensitivity and specificity and gives an overview of established and newer publications. It shows that LPS with Tc-99m-MAA represents a diagnostic method of continuing value for PE. In comparison with spiral CT and/or PA, LPS is not to be defeated as mentioned also by the most actual Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II reports. This applies in particular to chronic or recurring embolisms, whereas currently spiral CT may be of greater value for major or life-threatening embolisms. At present, LPS cannot be replaced by other methods in some applications, such as pediatrics or in the quantification of regional pulmonary function in a preoperative context or prior to radiation therapy. LPS still has a place in the diagnostics of PE and is irreplaceable in several rare indications as described earlier.

Effects of background substraction on differential kidney function measured by static scintigraphy with DMSA and dynamic scintigraphy with MAG 3

The aim of this study was to assess the influence of background subtraction (BS) on estimation of differential kidney function (DF) on the static scintigraphy with (99m)Tc dimercaptosuccinic acid (DMSA) and dynamic scintigraphy with (99m)Tc mercaptoacetyltriglicine (MAG3) and to establish possible differences between DF values estimated with these methods. Patients (n=106) were selected among those scheduled to static and dynamic scintigraphies within 3 months, with no interim clinical and laboratory changes, regardless the kidney pathology. DF was estimated according to the uptake ratio method. Four background regions of interest (ROIs) were applied, identical for both studies, and DF values were recalculated after BS. The corrected values were compared to the values before correction, separately for DMSA and MAG3, and between the studies. The results showed that ROIs used introduce variable results for the same patients, predominantly when noncorrected DF values were <45%. There were no significant differences between DF values (corrected and noncorrected) obtained from static and dynamic scintigraphy in all groups of patients. Since numerous reasons can bring to the errors in DF estimation when BS is used, the conclusions are that it would probably be more accurate to avoid BS, particularly when DF values are compared in a patient follow-up, and when kidney function is normal. BS should be used, but always in the same way, only when there is a significant difference in kidney size, or when DF is <25%, since background activity is then considerable. MAG3 and DMSA can be equally used for DF estimation and their results compared in patient follow-up.