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Biomedical subjects

Jacek Kuśmierek

Publications and source records attributed to Jacek Kuśmierek.

At least 19 recordsLinked to original sources
PubMed2006

Differential diagnosis of solitary pulmonary nodules based on 99mTc-EDDA/HYNIC-TOC scintigraphy: the effect of tumour size on the optimal method of image assessment.

PURPOSE: The aim of the study was to determine an optimal method for the evaluation of scintigrams obtained with (99m)Tc-EDDA/HYNIC-TOC for the purpose of differential diagnosis of solitary pulmonary nodules (SPNs) and to assess the diagnostic value of the method. METHODS: Eighty-five patients (48 males and 37 females, mean age 57 years, range 34-78 years) were enrolled in the study. Patients underwent (99m)Tc-EDDA/HYNIC-TOC scintigraphy for the purpose of differential diagnosis of SPNs (size between 1 and 4 cm). Images of all patients were evaluated visually in a prospective manner. RESULTS: Positive scintigraphic results were found in 37 out of 40 (93%) patients with malignant SPNs including 34 out of 35 (97%) patients with primary lung carcinoma. Two remaining false negative cases turned out to be metastatic lesions of malignant melanoma and leiomyosarcoma. Among 45 benign tumours, negative results were obtained in 31 cases (69%) and positive results in 14. The accuracy of the method was 80%. Analysis of the results of the visual assessment of scintigrams revealed a significantly higher frequency of false positive results among larger nodules (diameter at least 1.4 cm). Uptake of the tracer in those nodules was therefore assessed semi-quantitatively (using the tumour-to-background ratio), in expectation of an improvement in the low specificity of the visual method. The semi-quantitative assessment reduced the total number of false positive results in a subgroup of larger nodules from 13 to six, while preserving the high sensitivity of the method. CONCLUSION: The combination of visual analysis (for lesions smaller than 1.4 cm in diameter) and semi-quantitative assessment (for larger lesions) provided a high sensitivity of the method and significantly improved its specificity (84%) and accuracy (88%) in comparison with visual analysis (p<0.05).

Adult↗
PubMed2006

Sentinel node biopsy in skin melanoma patients--measurements of absorbed doses of radiation to the hands of medical staff.

BACKGROUND AND OBJECTIVES: The goal of this study was to measure absorbed doses of radiation to the hands of medical staff performing sentinel node biopsy (SNB) in skin melanoma patients. METHODS: The study was conducted from January 2004 to May 2004, during SNBs (lymphoscintigraphy-(99m)Tc on albumin carrier, surgery after 24 hr; blue dye; intraoperative detection of gamma radiation) in 22 skin melanoma patients. During lymphoscintigraphy and surgical procedures, 57 highly sensitive thermoluminescent dosimeters (TLDs) were placed on different parts of the hands of the medical staff. RESULTS: Mean doses of radiation recorded on different parts of the hands of the physician injecting the radiotracer ranged from 2.43 to 84.11 microSv for single procedures, ranged from 3.20 to 5.84 microSv for the hands of surgeon, and ranged from 2.65 to 5.47 microSv for the hands of the remaining members of the medical staff. Absorbed doses of radiation to the hands of helping medical staff present in operating room was only slightly lower than absorbed doses to the hands of operating surgeon and assistant surgeon. CONCLUSION: The maximum recorded dose during this study was 1,900 times smaller than the current 1-year dose limit recommended by the International Commission on Radiological Protection (ICRP).

Hand↗
PubMed2006

Short communication: Semiquantitative assessment of 99mTc-EDDA/HYNIC-TOC scintigraphy in differentiation of solitary pulmonary nodules--a complementary role to visual analysis.

UNLABELLED: The aim of this study was the assessment of a value of a semiquantitative analysis of scintigrams obtained with (99m)Tc-EDDA/HYNIC-TOC as a radiopharmaceutical (RPH) in differential diagnosis of solitary pulmonary nodules (SPNs), as a method complementary to visual evaluation of scintigrams. MATERIAL AND METHODS: Scintigraphic images of 59 patients (33 males and 26 females between 34 and 78 years of age, mean value, 57) with SPN on chest radiographs (39 malignant and 20 benign) were retrospectively assessed semiquantitatively. Visual scintigram analysis was made earlier, prospectively. Nodule diameters ranged from 1 to 4 (mean 2.2) cm. A single photon emission computed tomography (SPECT) acquisition was performed at 2-4 hours after administration of 740 to 925 MBq of a RPH. Verification of scintigraphic results was based on a pathological examination of tumor samples (histopathology or cytology) and, in some cases, on bacteriological studies. As an additional criterion for tumor benignity, its stable size in a time interval not shorter than 3 years was accepted. A simple, semiquantitative method for assessment of radiopharmaceutical uptake in SPNs was used, based on "count sample" taken from tumor center (T) in relation to radiopharmaceutical concentration in the background (B) measured in the contralateral lung. A criterion for optimal differentiation between malignant and benign nodules (T/B ratio threshold value) was introduced, based on a receiver operating characteristic (ROC) curve. Additionally, a value of T/B ratio was searched for, excluding tumor benignity with high probability. RESULTS: Visual analysis of scintigrams revealed enhanced uptake of RPH at 36 of 39 (92%) sites, corresponding to locations of malignant nodules (including 34 of 35-97% cases of lung cancer). In 13 of 20 (65%) benign nodules, true negative results were obtained. Accuracy of the method equalled 83%. Optimal differentiation between malignant and benign nodules was found for a value of a T/B ratio amounting to 2. The semiquantitative method gave true positive results in 35 of 39 (90%) malignant nodules (as in visual method in 34 of 35-97% cases of lung cancer). True negative results were obtained in 17 of 20 (85%) benign cases. Accuracy of the method reached 88%. A T/B ratio exceeding 4 excluded tumor benignity with high probability. CONCLUSIONS: A simple method, of quantitatively assessing 99mTc-EDDA/HYNICTOC uptake in solitary pulmonary nodules by means of a T/B ratio can play a role that is complementary to the visual evaluation of scintigrams. It improves low specificity of the method in the detection of malignant nodules, without significant reduction of its sensitivity and provides a T/B ratio excluding tumor benignity with high probability.

Adult↗
PubMed2006

Radionuclide assessment of lower limb perfusion using 99mTc-MIBI in early stages of atherosclerosis.

BACKGROUND: The aim of the work was a scintigraphic evaluation of regional blood supply of thigh and calf muscles using 99mTc-MIBI as a radiopharmaceutical, in early stages of atherosclerosis revealed during ultrasonographic examination of lower limbs, in patients without typical clinical symptoms of chronic ischaemia of lower limbs and with preserved normal Doppler spectrum of blood flow. Moreover, basic relations between early signs of lower limb atherosclerosis and abnormal myocardial perfusion, as well as asymptomatic hypoperfusion of lower limbs, were analysed. MATERIAL AND METHODS: Stress and rest radionuclide study of lower limb muscles and myocardium using 99mTc-MIBI was performed in 47 men, who were divided into two groups based on ultrasonography results. The first group (group I) comprised 22 patients with early atherosclerotic changes in peripheral vessels and the second (group II) comprised 25 people with normal arteries. For the purposes of quantification of study results normal values of regional blood supply and indices of asymmetry at levels of thighs and calves, as proposed by Segall et al., were applied. Myocardial scintigrams were evaluated according to widely accepted rules (visual and semi quantitative--normative analysis). RESULTS: Mean values of stress and rest perfusion indices of thighs as well as calves in gr. I were statistically significantly lower (p < 0.001) than in gr. II. Incidence of asymmetry in the stress perfusion of calves and thighs was statistically significantly higher (p = 0.04) in patients with atherosclerotic changes as compared with the control group. Abnormal myocardial perfusion was found in 77% of patients from group I and in 28% from group II (p = 0.001). Reversible, stress induced ischaemia was found in 59% and 16%, resp. (p = 0.01). CONCLUSIONS: 1. Radionuclide study revealed a reduced stress as well as rest perfusion of lower limb muscles in clinically asymptomatic patients with atherosclerotic changes of lower limb vessels of low degree and a preserved normal Doppler blood flow spectrum. 2. Presence of early atherosclerotic changes in lower limb vessels implies a higher probability of asymptomatic hypoperfusion of lower limbs as well as coronary artery disease.

Atherosclerosis↗
PubMed2006

Comparative analysis of 99mTc-depreotide and 99mTc-EDDA/HYNIC-TOC thorax scintigrams acquired for the purpose of differential diagnosis of solitary pulmonary nodules.

BACKGROUND: Aiming at comparison of diagnostic efficacy of 2 radiopharmaceuticals: 99mTc-depreotide (Neospect, Amersham) and 99mTc-EDDA/HYNIC-Tyr3-octreotide (Tektrotyd, Polatom), in differentiation between malignant and benign etiology of solitary pulmonary nodules (SPNs), radionuclide studies with 2 radiotracers were performed in 18 patients. MATERIAL AND METHODS: For both radiopharmaceuticals the same acquisition and processing protocols were applied. Studies were acquired with SPECT technique, after administration of 740 MBq of activity. Scintigrams were assessed visually, as: positive (+), equivocal (+/-) and negative (-). Additionally, uptake intensity of both radiotracers in nodules was assessed semiquantitatively, using a tumour-to-background ratio. Verification of scintigraphic results was based in 14 cases upon a pathological examination of tumour samples (histopathology) and in the remaining 4 - on clinical observation and bacteriological studies. RESULTS: Normal scintigrams obtained with both radiopharmaceuticals differed significantly. 99mTc-depreotide was markedly accumulated in spine, sternum, ribs and lungs (mean lung/heart ratio = 2.2). This accumulation was not observed on 99mTc- -EDDA/HYNIC-TOC scintigrams (mean lung/heart ratio = 0.7). In 6 patients a malignant etiology--lung cancer--was revealed (5--adenocarcinoma, 1--squamous cell) and the other 12 cases turned out to be benign (4 hamartomas, 3 tuberculomas, a tuberculous infiltrate, an alien body with inflammatory reaction, a hyperplasia of lymphatic tissue and 2 cases of unknown etiology, from which one had a stable size and the other resolved during a 6 month observation period). In all 6 cases of lung cancer positive results were obtained with both tracers. Moreover, in 2 patients metastases in mediastinum could be observed on scintigrams obtained with both radiopharmaceuticals. From among 12 cases of benign etiology 6 99mTc-depreotide scintigrams were true negative, 1--equivocal and 5--false positive, whereas 6 99mTc-EDDA/HYNIC-TOC scintigrams were true negative, 4--equivocal and 2 false positive. Moreover, 99mTc-depreotide additionally revealed mediastinal and hilar lesions in 9 patients with benign lesions and 99mTc-EDDA/HYNIC-TOC - in 8. A visual comparison of scintigrams revealed a higher quality of 99mTc-Depreotide images in comparison with 99mTc-EDDA/HYNIC-TOC ones. 99mTc-Depreotide showed a higher than 99mTc-EDDA/HYNIC-TOC accumulation in lung tumours compared with blood pool (heart) - 4.5 (s.d. 1.05) and 1.8 (s.d. 0.29), respectively (p < 0.05). However, mean values of tumour-to-lung-background ratio were equal for both radiotracers (2.2 in malignant and 1.4 in benign lesions, respectively). A statistically significantly higher non-uniformity of counts inside lung background regions was found on 99mTc-EDDA/HYNIC-TOC scintigrams than on 99mTc-depreotide ones (16.4% vs. 11.4%; p < 0.01). CONCLUSIONS: Although both radiopharmaceuticals show similar diagnostic efficacy in differentiation of SPNs, a tendency toward a higher number of false positive results on 99mTc-depreotide scintigrams probably leads to a lower specificity. Better statistical quality of 99mTc-depreotide scintigrams facilitates their interpretation and a distinct outline of lungs simplify localization of lesions. A substantial number of false positive lesions in mediastinal and hilar regions in patients without a neoplastic process hamper the usefulness of both radiotracers for effective detection of lung cancer metastases to lymph nodes.

Adult↗
PubMed2006

Specific 99mTC-HEPIDA hepatic clearance--essential value ranges from a clinical stand-point.

BACKGROUND: Determinations of plasma 99mTc-HEPIDA clearance (ClPl) have been performed in some centres for 30 years to assess liver parenchyma damage, mostly for monitoring of organ performance in the course of various diseases. The main disadvantage of such a procedure rests with the fact that elimination of the compound from the system occurs not only via the liver and gall ducts, but also via the urinary route; the contribution of the latter compound being quite variable. This circumstance may lead to false assessment of liver parenchyma performance. A method has been developed therefore for assessment of specific hepatic clearance of 99mTc-HEPIDA (Cl(Hp)). Using this method it was demonstrated that results of Cl(Hp) correlated better with independently assessed degrees of liver impairment than did the values of ClPl. MATERIAL AND METHODS: To delineate ranges of Cl(Hp) that would provide valuable clinical information 134 individuals were studied, of whom 48 served as healthy controls and 86 had varying degrees of livers function impairment, resulting from various chronic diseases affecting the organs functional capacity. The latter was assessed on the basis of a series of commonly used biochemical indicators. RESULTS AND CONCLUSIONS: For delineation of meaningful ranges of 99mTc-HEPIDA specific hepatic clearance ROC curve method was used. The following results were obtained: Cl(Hp) >or= 150 ml min(-1) 1.72 m(-2)--excludes with high probability presence of substantial liver parenchyma damage; Cl(Hp) <or= 120 ml min(-1) 1.72m(-2)--indicates a substantial impairment of liver function (damage). Values of Cl(Hp) <or= 90 ml min(-1) 1.72 m(-2) are highly specific for serious liver damage, of intensity typical for cirrhosis of the organ.

Adolescent↗
PubMed2005

Recurrent cerebral gliomas in MRI and Iodine-123[corrected]-alpha-methyl-tyrosine SPECT: the use of digitally fused images.

BACKGROUND: Early detection and site location of recurrent cerebral glioma helps design optimum therapeutic regimen, which contributes to prolonged survival time of the patients. However, diagnosing the neoplastic growth at the post-resection site is a difficult process. The diagnostic modality to provide the most extensive morphological data is dynamic MR tomography. On the other hand, the tumour-related metabolic changes can be best diagnosed using the PET and SPECT techniques of nuclear medicine that employ radiolabelled amino acid 131 I-alpha-metyl-tyrosine (IMT) as the tracer. Thus, for comprehensive diagnostics of brain tumours, it is most effective to combine both the modalities and evaluate the fused images. The aim of the present study was to verify the usefulness of the calculated algorithm for a digital fusion of RM/SPECT images for the assessment of post-resection site of cerebral gliomas. MATERIAL AND METHODS: The findings of MR and SPECT imaging for 21 patients who had surgery for cerebral glioma were subject to assessment. Diagnosis was based on histopathology results (8 cases of anaplastic astrocytoma and 13 cases of multiform glioblastoma). The site and size of the contrast enhancement areas from MR was compared with the hot focus location from SPECT. RESULTS: The study confirmed the feasibility of digital fusion of images yielded by SPECT and MR. The fused images reflect the non-homogeneity of the post-resection site of cerebral gliomas. Contrast enhancement areas only partially overlapped with the hot foci which, furthermore, were found to be substantially smaller. CONCLUSIONS: The consistency of tumour locations detected with MR and SPECT was higher for tumours of the anaplastic astrocytoma type than for multiform glioblastomas (higher polymorphism of pathological changes).

Adult↗
PubMed2005

[Lymphoscintigraphy as a method of choice for the assessment of lymphatic oedema of the lower limbs].

Among various pathologic conditions characterized by swelling of the lower limbs, lymphatic oedema is that of more frequent occurrence. The oldest method used in the examination of the lymphatic system besides its clinical assessment is colour lymphography based on the application of methylene blue. A more accurate method was employment of iodic contrast media visualised on roentgenological plates. Nowadays disturbances of lymphatic drainage are almost exclusively examined by means of lymphoscintigraphy with the use of radioactive markers. The study discusses the technique of this examination as well as the criteria of the assessment of the results obtained.

Humans↗
PubMed2004

99mTc-EDDA/HYNIC-TOC scintigraphy in the differential diagnosis of solitary pulmonary nodules.

Forty-three consecutive patients with solitary pulmonary nodules (SPNs) on chest radiographs were studied scintigraphically after administration of the somatostatin analogue (99m)Tc-EDDA/HYNIC-TOC. The objective of the study was to assess the usefulness of the procedure for differentiation of SPNs as malignant or benign. The administered activity was 740-925 MBq, and a single-photon emission computed tomography imaging technique was employed. Verification of the nodule aetiology was based on histology or cytology and bacteriology. A stable tumour size on chest radiography for at least 3 years was accepted as an additional criterion of benignity. In 29 patients, nodules were found to be malignant. The diagnoses included ten adenocarcinomas, five squamous cell carcinomas, two large cell carcinomas, six non-small cell lung cancers without specification of the more detailed morphology, two small cell lung cancers, two typical carcinoids and two metastatic tumours (leiomyosarcoma and malignant melanoma). In 14 patients the following benign tumours were diagnosed: four tuberculomas, one other granuloma, three hamartomas, one non-specific inflammatory infiltrate, one abscess, one peripheral carcinoid with the morphological characteristics of a benign tumour, one ectopic lesion of thyroid tissue and two benign tumours of unspecified aetiology with a stable size over 3 and 5 years respectively. Positive scintigraphic results were obtained in 26 of the 29 patients (90%) with malignant SPNs; among these, 24 of the 25 (96%) cases of primary pulmonary carcinoma yielded positive results. The remaining two false negative cases were the metastatic tumours, liposarcoma and melanoma. Of the 14 benign lesions, ten (71%) did not accumulate the radiopharmaceutical. The remaining four benign tumours that were visible on scintigrams comprised one tuberculoma, one hamartoma, one abscess and one case in which the diagnosis could not be established (the tumour had a stable size over 3 years). In conclusion, scintigraphy with (99m)Tc-EDDA/HYNIC-TOC appears to be an effective procedure for differentiation between malignant and benign SPNs. A fully credible assessment of the clinical efficacy of this procedure requires further study in a larger number of patients.

Adult↗
PubMed2004

Efficacy of 99mTc-EDDA/HYNIC-TOC scintigraphy in differential diagnosis of solitary pulmonary nodules.

Fifty consecutive patients with solitary pulmonary nodules (SPN) on chest radiographs were studied scintigraphically after the administration of a somatostatin analog 99mTc-EDDA/HYNIC-TOC. The activity amounted to 740-925 MBq and a single photon emission computed tomography (SPECT) technique was applied. Verification of the nodule etiology was based on histology or cytology and bacteriology. As additional criterion for nodule benignity, its stable size in a chest radiograph for at least 3 years was accepted. In 31 patients, malignant etiologies of nodules were found. The diagnoses included: 11 adenocarcinomas, 6 squamous-cell carcinomas, 2 large-cell carcinomas, 6 nonsmall-cell lung cancers (NSCLC) of unspecified, more detailed morphology, 2 small-cell lung cancers (SCLC), 2 typical carcinoids, and 2 metastatic tumors: leiomyosarcoma and malignant melanoma. In 19 patients, the following benign tumors were diagnosed: 6 tuberculomas, 2 other granulomas, 4 hamartomas, 2 nonspecific inflammatory infiltrates, 1 abscess, 1 peripheral carcinoid of morphological characteristics of a benign tumor, 1 ectopic lesion of thyroid tissue, and 2 benign tumors of unspecified etiology, with stable size over 3 and 5 years. Positive scintigraphic results were obtained in 28 of 31 patients (90%) with malignant SPNs; among these there were 26 of 27 (96%) cases of primary pulmonary carcinoma. The remaining 2 false-negative cases included metastatic tumors: liposarcoma and melanoma. Among 19 benign lesions, 15 (79%) did not accumulate the radiopharmaceutical. The remaining 4 tumors visible on scintigrams included: 1 tuberculoma, 1 hamartoma, 1 abscess, and 1 case of nonestablished diagnosis (with stable size over 3 years). In conclusion, scintigraphy with 99mTc-EDDA/HYNIC-TOC appears to be an effective procedure for differentiation between malignant and benign SPNs.

Adenocarcinoma↗
PubMed2004

Assessment of clinical usefulness of 131I alpha-methyl-tyrosine and fused SPECT/MRI imaging for diagnostics of recurrent cerebral gliomas.

BACKGROUND: Early detection and diagnostic differentiation of neoplastic tissue from necrotic changes and scars following the treatment of cerebral gliomas is essential for determining further therapy and prognosis. The primary technique used for the diagnostics of recurrent neoplastic growth is the magnetic resonance imaging (MRI), which in some cases, however, does not allow one to identify the character of cerebral lesions. Recently, MRI has been supplemented with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) employing radiolabelled amino acids. e.g. tyrosine or methionine. The aim of the project was to assess the diagnostic potential of SPECT when iodine-131 alpha-methyl tyrosine (IMT), a Polish make of radiopharmaceutical (OBRI--POLATOM, Otwock-Rwierk, Poland), was applied. The use of 131I as a substitute for the more costly, imported iodine-123 has been justified in view of the nature and significance of the diagnostic problem on the one hand, and the possibility of 131-iodine application on a larger scale in CEE countries, on the other. MATERIAL AND METHODS: MRI and SPECT were performed in 24 patients with a history of surgical treatment and radiotherapy of cerebral glioma (WHO grade II/IV). A SPECT was carried out 15 min after an i.v. injection of 74-111 MBq IMT. The tomograms were evaluated visually and in quantitative terms. The fused SPET/MR images were also analyzed. The obtained results were verified against histopathological findings, control MRI examinations and the clinical course of disease within 7-28 months of monitoring. RESULTS: In 19 patients, an increased IMT uptake indicative of a recurrent tumour was found, and the presence of the tumour was confirmed. In five patients no hot spots were detected which would indicate the neoplastic growth and verification did not provide any evidence for relapse. CONCLUSIONS: The examination employing iodine-131 IMT made it possible to confirm or exclude tumour recurrence in all the subjects, also in the cases when the CT/MR images were inconclusive. The MRI/SPECT fusion made it possible to more accurately identify the location of tumour recurrence as well as determine the area for spectroscopic MR analysis, for stereotactic biopsy and radiotherapy.

Adult↗
PubMed2004

A visual and semi-quantitative assessment of (99m)Tc-EDDA/HYNIC-TOC scintigraphy in differentiation of solitary pulmonary nodules.

BACKGROUND: The aim of the study was the assessment of the clinical usefulness of scintigraphy with (99m)Tc-EDDA/HYNIC-TOC for purposes of a differential diagnosis of SPNs by means of a visual inspection and semi-quantitative assessment of uptake intensity of the radiopharmaceutical (RPh). MATERIAL AND METHODS: In 53 patients (32 males and 21 females at the ages between 38 and 78 years, mean value 57) with SPN on chest radiographs or CT scans, of diameters from 1 to 5.5 (mean 2.3) cm a SPECT acquisition was performed, 2-4 h after administration of 740 MBq of RPh. Additionally, aiming at the implementation of a correction of a partial volume effect resulting from finite resolution of this technique, the measurement of the resolution of this technique was performed on an thorax phantom. Scintigraphic studies were inspected visually visually and semi-quantitatively, restoring real concentration of the RPh in nodules in comparison with the peritumoral background (tumour-to-background ratio) by the application of resolution recovery coefficients for the respective nodule diameters. The threshold values of tumour-to-background ratio providing optimal differentiation between malignant and benign nodules of sizes smaller and larger than 2 cm in diameter were determined. Verification of scintigraphic results was based on pathological examinations of tumour samples (histopathology or cytology) and in some cases on bacteriological studies. The additional criterion of tumour benignity was accepted, based on its stable size in a time interval no shorter than 3 years. RESULTS: In 32 patients the following malignant tumours were diagnosed: 12 adenocarcinomas, 6 squamous cell carcinomas, 6 non-small cell lung cancers of unspecified more detailed morphology, 2 large cell carcinomas, 2 small cell lung cancers, 2 carcinoids and 2 metastatic lesions (malignant melanoma and leiomyosarcoma). In 21 patients benign etiologies were found: 6 tuberculomas, 2 other granuloma, 4 hamartomas, 2 non-specific inflammatory infiltrate, 1 alien body with inflammatory reaction and 1 suppurating inflammatory lesion, 1 abscesses, 1 peripheral carcinoid of morphological features of a benign tumour, 2 tumours of unspecified etiology with sizes stable over 3 and 5 years, and 1 ectopic lesion of thyroid tissue. A visual inspection of scintigrams revealed enhanced uptake of RPh at 29 of 32 sites corresponding to locations of malignant nodules, in 2 cases (1 adenocarcinoma and 1 metastatic lesion of malignant melanoma) results were negative and in 1 (metastatic leiomyosarcoma) equivocal; in 13 of 21 benign nodules true negative results were obtained, in 4--positive (foreign body with inflammatory reaction, abscess, suppurating inflammatory lesion and tuberculoma), in the next 4--equivocal (2 tuberculomas, 1 hamartoma, 1 tumour of unspecified aetiology, but with a stable size over 3 years). The mean values of tumour-to-back-ground ratio without resolution recovery in malignant and benign nodules equalled 4.6 (sd 5.9) and 1.8 (sd 1.2), resp. (p = 7 x 10(-4)), while after resolution recovery coefficients--7.8 (sd 7.2) and 2.7 (sd 2.8), resp. (p = 2 x 10(-4)). The semi-quantitative method resulted in true positive results in 29/32 malignant cases and true negative in 15/21 benign cases. CONCLUSIONS: (99m)Tc-EDDA/HYNIC-TOC scintigraphy is a very promising method for the differentiation of SPNs. The semi-quantitative method using resolution recovered tumour-to-background ratio enables the differentiation of malignant and benign SPNs based on the intensity of RPh uptake and facilitates the making of a decision as to the positive or negative scintigraphic character of the equivocal lesions.

Adult↗
PubMed2004

Cortical scintigraphy in the evaluation of renal defects in children with vesico-ureteral reflux--optimization of the procedure and study interpretation.

BACKGROUND: The objective of this study was to analyse the performance of several variants of kidney scintigraphy in children from the standpoint of: scar detection, an assessment of the rating of the pathology and an investigation of interobserver variability involved in the diagnostic procedure. MATERIAL AND METHODS: The analysis is based on results of a planar kidney scintigraphy and of a tomographic (SPECT) procedure. The latter was performed in two variants: 1) in which slices were obtained with axis of reconstruction identical with longitudinal axis of the body (SPECT I) and 2) in which axes were fitted to the long axis of each kidney separately (SPECT II). The rating of the diagnosed pathology was made using two scales, according to Goldraich and Howard. Evaluation of the images involved on the one hand, 150 individual kidneys and 75 patients on the other. The assessment was made by three independent observers, differing in experience in nuclear medicine and employed in three independent departments. In the statistical analysis, as a measure of observer agreement, a proportion of agreeing readings (%) was accepted; in addition, the kappa index of agreement was calculated. RESULTS: Better agreement among three observers was attained when planar images were read in contrast to SPECT (I and II) results. The reading of SPECT II images yielded a higher frequency of diagnosed pathology (scars) in kidneys and is characterized by better overall agreement in detection by individual observers than a similar evaluation of SPECT I images. The Goldraich scale secures better interobserver agreement of renal scar detection than is seen when the Howard scale was applied to acquire the rating. CONCLUSIONS: The conclusion may be drawn that kidney scintigraphy is a method still burdened with a substantial subjectivism. Planar scintigraphy should be treated as a basic option for imaging post-inflammatory changes in kidneys.

Child↗
PubMed2003

Clinical usefulness of 99mTc-EDDA/HYNIC-TOC scintigraphy in oncological diagnostics: a preliminary communication.

This study assessed the clinical usefulness of a new technetium-99m labelled somatostatin analogue from the standpoint of oncological diagnostics. The study group comprised 40 patients in whom malignant neoplasms (32 primary and 8 metastatic) had been diagnosed. Among the primary tumours there were 21 cases of lung cancer (2 small cell and 19 non-small cell), seven pituitary adenomas (five hormonally active and two inactive), one liposarcoma, two carcinoids and one breast carcinoma. The metastatic tumours consisted of three malignant melanomas, one phaeochromocytoma, one prostatic cancer, one leiomyosarcoma, one pancreatic carcinoma ectopically secreting ACTH and one carcinoid of the thymus. The radiopharmaceutical 99mTc-EDDA/HYNIC-Tyr3-octreotide was administered i.v. at an activity of 740-925 MBq. The imaging comprised a whole-body scan and a single-photon emission tomography acquisition. Positive scintigrams were obtained in all cases of small cell and non-small cell lung cancer, four out of five hormonally active pituitary adenomas, one out of two cases of carcinoid, the liposarcoma and the breast cancer. Neoplastic metastases were visualised in two out of three patients with melanoma and in patients with phaeochromocytoma, ACTH-secreting pancreatic carcinoma and thymic carcinoid. Scintigrams were negative in both hormonally inactive pituitary adenomas, in one case of metastatic malignant melanoma, in the leiomyosarcoma and in the case of metastasis from prostatic carcinoma. The results of this pilot study indicate that 99mTc-EDDA/HYNIC-TOC is a potentially useful radiopharmaceutical for imaging of a wide range of primary and metastatic tumours. Special attention should be paid to the successful imaging of all cases of non-small cell lung cancer.

Adult↗
PubMed2003

Scintigraphic and ultrasonographic assessment of the effect of lumbar sympathectomy upon chronic arteriosclerotic ischaemia of lower extremities.

The aim of the study was an evaluation of the effect of onesided lumbar sympathectomy in patients with peripheral vascular disease of lower extremity(ies), using perfusion scintigraphy with (99)mTc-MIBI and ultrasound Doppler blood flow-rate measurements. A secondary aim was a comparison of the diagnostic efficacy of the two techniques applied. The study was performed on 30 patients, studied prior to and early after one-sided lumbar sympathectomy. The scintigraphy yielded results indicating a statistically significant increase in perfusion of femoral and calf muscles (p < 0.001). Ultrasound investigation demonstrated significant (p < 0.001) increase of the maximal blood flow rate in the popliteal artery. Scintigraphic perfusion study yielded better agreement with the clinical evaluation than the ultrasound Doppler technique (83 v. 47 per cent, p < 0.01) and higher sensitivity in demonstration of improved blood supply (88 v. 36 per cent, p < 0.001).

Adult↗
PubMed2003

99mTc-HEPIDA hepatic clearance as a diagnostic tool: usefulness of plasma and hepatic clearance for assessment of hepatic parenchyma performance.

Plasma clearance of (99m)Tc-HEPIDA (Cl(Pl)) has been used for two decades for assessment of liver function in patients with diseases of this organ. A specific determination of (99m)Tc-HEPIDA liver clearance (Cl(Hp)) has been developed that provides more direct possibility to evaluate performance of liver parenchyma. Both tests have been studied in healthy volunteers of varying age (48 individuals) and in 83 patients with varying degree of liver damage. The liver damage has been evaluated on the basis of 5 biochemical tests (AspAT, ALAT, GGTP, bilirubine serum concentration, proteinogram) and a score system used for total impairment, which was calculated for each patient. Normal range of Cl(Pl) and Cl(Hp) was determined from a study on healthy individuals (volunteers). The results seem independent of age, but show sex differences. The following values (mean +/- SD) of Cl(Hp) were found in males and females of: (181 +/- 31) ml//min/1.73 m(2) and (158 +/- 22) ml/min/1.73m(2), and of Cl(Pl) were (224 +/- 33) ml/min/1.73 m(2) and (202 +/- 25) ml/min/1.73 m(2) respectively. Accepted lower boundaries of both quantities (mean -2SD) are 115 ml/min/1.73 m(2) and 150 ml/min/1.73 m(2) correspondingly. Negative correlation of individual values of both clearances in all patients with individual score of liver damage were highly significant and correlation coefficients obtained were higher for Cl(Hp) (r = -0.63) than those for Cl(Pl) (r= -0.56). Factorial analysis was performed with the intention of seeing which of the studied factors had the highest factor loading for parenchyma performance that was assumed as the common factor responsible for correlations. The highest value was obtained for hepatic clearance (Cl(Hp)) of (99m)Tc-HEPIDA. In conclusion this quantity seems highly promising as a clinically useful test for assessment of liver performance, both in screening for liver damage and for monitoring of organ conditions during therapy and follow-up of patients.

Adolescent↗
PubMed2003

[Assessment of left ventricular ejection fraction and wall motion in patients after myocardial infarction with and without persistent electrocardiographic ST-segment elevation--using gated radionuclide angiography].

UNLABELLED: In everyday practice two-dimensional echocardiography is a routine method used to diagnose left ventricular (LV) wall motion abnormalities and determine ejection fraction (EF). However, in some patients, for technical reasons, it is possible to apply only apical projections and EF and LV wall motion abnormalities cannot be therefore obtained. The aim of the study was to measure LV EF and wall motion abnormalities in the patients healed from MI, with and without persistent electrocardiographic ST segment elevation, in whom echocardiographic diagnosis was difficult. LV wall motion abnormalities and EF were determined using non-invasive method--gated radionuclide angiography. Gated radionuclide angiography was performed in 45 patients, 3 months after previous anterior MI. The study was acquired after technetium 99mTc red cell labeling in vivo. The data were collected using a Toshiba scintillation gamma camera with a MODUMED computer system coupled with a gating device. Patients were divided into two groups. Group I consisted of 24 patients with persistent electrocardiographic ST segment elevation and group II--of 21 patients without persistent elevation of this segment. RESULTS: In the group I, left ventricular ejection fraction ranged between 10 and 36% (mean: 24%). In 9/24 patients (38%) diffuse hypokinesis, in 7/24 patients (29%) regional akinesis and in the last 8/24 patients (33%) regional dyskinesis with impaired dilated left ventricular systolic and diastolic function were observed. In the group II, left ventricular ejection fraction ranged from 19 to 47%. Mean value of this parameter equaled 32% and was statistically significantly higher than in patients from group II. In 9/21 patients (42%) diffuse hypokinesis, in 2/21 patients (10%) regional anterior wall hypokinesis with the normal function of other walls, and in the last 10/21 patients (48%) regional anterior wall akinesis with the diffuse hypokinesis of other walls were localized. In the patients without persistent electrocardiographic ST segment elevation, diffuse hypokinesis was observed in majority of cases. In none of those patients ventricular aneurysm was diagnosed. In the patients with persistent electrocardiographic ST segment elevation, three types of decreased left ventricular function (diffuse hypokinesis, regional akinesis and ventricular aneurysm) were observed. It should be noted that in 1/3 of those patients ventricular aneurysm was diagnosed. Presence of diskinetic wall motion abnormalities in group I (in 8/24 patients) was statistically significantly more frequent (p < 0.01) than in group II (in 0/21 patients). CONCLUSIONS: 1. Presence of persistent electrocardiographic ST segment elevation in a patient with post infarction myocardial failure is a prerequisite for suspicion of post myocardial infarction left-ventricular aneurysm. 2. In patients without persistent electrocardiographic ST segment elevation and post infarction myocardial failure diffuse hipokinesis (sometimes with regional akinesis) is predominantly observed.

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