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Biomedical subjects

Mordechai Lorberboym

Publications and source records attributed to Mordechai Lorberboym.

At least 19 recordsLinked to original sources
PubMed2006

Prospective evaluation of malignant middle cerebral artery infarction with blood-brain barrier imaging using Tc-99m DTPA SPECT.

BACKGROUND: Malignant middle cerebral artery (MMCA) infarction is associated with severe brain edema which may lead to a rapid deterioration of consciousness, increase of intracranial pressure, brain midline shift and finally, herniation. We examined the correlation between the degree of the blood-brain barrier (BBB) permeability and MMCA. METHODS: Twenty-five consecutive patients (17 men and 8 women, mean age 62.1+/-10.1) were included in the study. Each patient had a daily clinical examination, and the neurological deficits were scored using NIHSS score. A CT without contrast material was performed in all patients. (99m)Tc-DTPA SPECT was performed at 36 h after the stroke. A quantitative index of BBB breakdown (disruption index) was calculated. RESULTS: The mean volume of stroke was 138+/-87 cm(3). The mean DTPA disruption index was 6.6+/-4.6 (range 1.0-21.0). The mean NIHSS score was 14+/-4 (p=0.2). Five of 25 patients had brain herniation as evidenced on brain CT. The volume of stroke was only marginally elevated in patients with herniation (p=0.062). All patients showed significant, inverse correlation between NIHSS score and DTPA uptake (r=-0.43, p=0.033). There was a significant correlation between the extent of DTPA distribution (more than one vascular territory) and the occurrence of herniation (p<0.001). CONCLUSIONS: DTPA-SPECT imaging is a reliable complementary predictive tool in patients with an MCA stroke. The specific pattern found on DTPA SPECT, compatible with diffuse BBB disruption, may be of value in predicting "malignant MCA."

Aged↗
PubMed2006

In vivo imaging of apoptosis in patients with acute stroke: correlation with blood-brain barrier permeability.

BACKGROUND: We wished to determine the ability of radiolabeled annexin V to concentrate at sites of ischemic injury in patients with acute cerebral stroke. Secondly, we sought to correlate annexin V imaging in these patients with the degree of blood-brain barrier (BBB) breakdown. METHODS: Twelve patients with acute stroke had a complete neurological examination, including the National Institutes of Health (NIH) stroke scale and the Glasgow Coma Score (GCS). A non-contrast CT scan was performed on all patients. A SPECT of the brain was obtained 2 h after injection of annexin V. The integrity of the BBB was evaluated in seven patients using Tc-99m-DTPA brain SPECT. RESULTS: All patients had an infarct in the MCA territory. Eight patients had abnormal increased annexin V activity, which was more common in patients with cortical strokes (P = 0.01). The concentration of annexin had no correlation to the volume of stroke, but it was significantly and inversely related to the GCS on admission (r = -0.7, P = 0.02). Foci of apoptosis were noted contralateral to the affected hemisphere as well. All seven patients who underwent DTPA SPECT showed breakdown of the BBB. DTPA uptake was significantly and positively associated with NIH score (r = 0.80, P = 0.01) and inversely associated with GCS (r = -0.89, P = -0.03). CONCLUSION: This study shows that it is possible to identify in vivo regions of ischemic neuronal injury using radiolabeled annexin V in patients with acute stroke. Annexin imaging can play a major role in the selection of therapy in the initial period following stroke in adults.

Acute Disease↗
PubMed2006

[123I]-FP/CIT SPECT imaging for distinguishing drug-induced parkinsonism from Parkinson's disease.

Parkinsonism in patients taking neuroleptic medications might be induced by dopamine receptor blockade alone or by dopamine blockade with nigrostriatal dysfunction. The differentiation between Parkinson's disease (PD) and drug-induced parkinsonism (DIP) is difficult to assess on clinical grounds alone. In this study, we have evaluated the clinical characteristics and striatal binding of (123)I-FP-CIT (N-omega-fluoropropyl-2beta-carboxymethoxy-3beta-{4-iodophenyl}tropane) in patients who developed DIP. A total of 20 patients (mean age, 62 +/- 13 years) who developed parkinsonism while on neuroleptic agents and 10 age-matched controls were enrolled. [123]-FP-CIT single-photon emission computed tomography (SPECT) was performed in all subjects. Neurological assessment was performed with the Motor part of the Unified Parkinson's Disease Rating Scale. [123]-FP-CIT binding of the entire striatum, caudate, and putamen was calculated. Patients were divided into two subgroups according to SPECT results for comparison of clinical characteristics. There were 9 patients who had normal scans and 11 who showed significantly diminished striatal binding, suggesting degeneration of the nigrostriatal system. Subanalyses of abnormal scans revealed significantly diminished binding in the caudate (P < 0.001 for right and left caudate) and putamen (P = 0.002 and P < 0.05 for right and left putamen, respectively). There were no differences in clinical features between patients with normal and abnormal scans. Symptoms included asymmetric tremor, bradykinesia, and rigidity in both groups. Freezing gait was present in two patients with normal scans. These results indicate that DIP is clinically indistinguishable from PD. Brain imaging with FP-CIT helps to determine whether DIP is entirely drug-induced or an exacerbation of subclinical PD.

Aged↗
PubMed2006

Fat intolerance in developmentally impaired children with severe feeding intolerance.

Children with a variety of genetic, metabolic, and neurologic disorders can suffer from severe feeding intolerance that is unresponsive to medical, surgical, and nutritional therapy. Developmentally disabled tube-fed children with severe upper gastrointestinal symptoms that persisted after fundoplication who were unresponsive to all medical, surgical, and nutritional interventions underwent a thorough gastrointestinal evaluation, including gastroscopy, pH-metry, upper gastrointestinal barium series, and gastric emptying studies. They were placed on a low-fat diet, and the symptoms before and after the diet were compared. The patients were then rechallenged with incremental increases in fat until the symptoms recurred or the patients reached their former fat concentration. Six children meeting the study criteria were evaluated. Four of these patients had a significant improvement in symptoms, oral intake and feeding tolerance with a decrease in fat intake, and relapse of symptoms when fat calories were increased. Improvement occurred in children who had been intolerant to duodenal feeding. We were subsequently able to wean two children from tube feeding. Dietary fat can provoke upper gastrointestinal symptoms in children with gastric and intestinal dysmotility. Short-term manipulation of dietary fat intake can improve tolerance to feeding.

Child, Preschool↗
PubMed2005

Prognostic significance of blood brain barrier permeability in acute hemorrhagic stroke.

BACKGROUND: Blood brain barrier (BBB) disruption is accompanied by edema in the surrounding areas of the intracerebral hemorrhage (ICH). The aim of the study was to clarify the correlation between BBB breakdown and outcome in ICH. PATIENTS: Twenty-seven patients with primary ICH were included in the study. Each patient underwent CT and DTPA-SPECT, and the National Institutes of Health (NIH) and modified Rankin score were performed as well. RESULTS: DTPA-SPECT had a significant correlation with the modified Rankin score after 3 months (p = 0.008) and 6 months (p = 0.01). The CT scan was directly correlated with the NIH score on days 1, 7 and 30 (p = 0.01, p = 0.01 and p = 0.04, respectively). No correlation was found between DTPA-SPECT and CT scan data. CONCLUSIONS: The degree of BBB breakdown, as imaged by the DTPA-SPECT technique, was directly correlated with the late functional outcome. The CT scan has an inverse correlation with the NIH score. These findings may have broad clinical implications.

Acute Disease↗
PubMed2005

Neonates with extra-renal pelvis: the first 2 years.

Extra-renal pelvis (ERpel) is a common ultrasonographic finding among neonates who have undergone recurrent ultrasound examinations for a better definition of prenatal renal pelvic dilatation. This study tries to determine whether or not ERpel has important prognostic implications. Seventy-nine neonates (17 female) were examined. All had a diagnosis of prenatal renal pelvis dilatation, which was shown by postnatal ultrasound to be ERpel. Sixty ERpel neonates were examined 1.5 months to 2.5 months after the ultrasound (US) diagnosis by both Tc-99m diethylene triamine penta-acetic acid (DPTA) dynamic renal scanning and (99m)Tc-pertechnetate direct cystography. Clinical assessment, urine cultures and renal ultrasound follow-up were maintained for 2 years. The proportion of urinary tract infections (UTIs) in patients with ERpel was compared with that of the total neonatal and infantile population with normal US scans in the region of our hospital. Associated minor congenital malformations were found in 12 of 79 neonates (15.2%). Four had a family history of ERpel. Among 60 neonates who underwent renal scanning, 36 (60%) were found to have urinary retention in the collecting system. Another nine (15%) had vesico-ureteral (VU) reflux, of which seven had urinary retention. Fifteen (25%) showed normal isotope imaging. Urinary tract infection was diagnosed in 16 ERpel neonates in whom only one exhibited VU reflux (grade 2). The incidence of neonatal UTI in the ERpel group was more than that of either neonatal or infantile UTI in those with normal US scans in the local population (20.2% vs 1.2% and 4.3%, respectively). Fifty-three infants completed a 2-year follow-up. Repeat renal ultrasonography indicated that one infant (1.8%) had developed bilateral hydronephrosis, 12 (22.6%) had unchanged findings, 18 (40%) showed an improvement (decrease of ERpel width or resolution in one side) and, in 22 (41.5%) infants, the condition had resolved. No clinical or kidney function deterioration was observed. Seven patients (13.2%) each had one episode of UTI during the 2-year follow-up period; none of them had VU reflux. Neonatal ERpel is more frequent in male infants. It is associated with greater rates of minor congenital malformations, VU reflux and UTI than in the general population of the same ages. The increased UTI incidence is not attributed to VU reflux.

Abnormalities, Multiple↗
PubMed2005

Preoperative technetium Tc 99m sestamibi SPECT imaging in the management of primary hyperparathyroidism in patients with concomitant multinodular goiter.

HYPOTHESIS: Preoperative parathyroid and thyroid imaging using technetium Tc 99m sestamibi scintigraphy-single-photon emission computed tomography (Tc 99m MIBI SPECT) and technetium Tc 99m sodium pertechnetate, respectively, in patients with parathyroid adenomas and concomitant multinodular goiters enables the selection of those suitable for minimally invasive radio-guided surgery. DESIGN: One hundred thirty patients with primary hyperparathyroidism were treated surgically during a 30-month period. Forty-one of these 130 patients had an associated multinodular goiter. All patients underwent planar and SPECT parathyroid scintigraphy using Tc 99m MIBI, and thyroid scintigraphy with technetium Tc 99m pertechnetate 2 to 5 days before surgery. On the morning of surgery each patient was reinjected with Tc 99m MIBI for intraoperative localization and validation. Minimally invasive radio-guided parathyroidectomy was performed using a handheld gamma-detection device with a thyroid probe. Removed glands were submitted for histopathologic examination for comparison with the scintigraphic results. Quantitative analysis of parathyroid activity was performed. RESULTS: Minimally invasive, radioguided parathyroidectomy was successfully performed in 21 (51%) of 41 patients who had a concomitant multinodular goiter. The remaining 20 patients underwent standard neck exploratory surgery because of associated thyroid disease; 5 of them had malignant thyroid disease. Among the 41 patients planar scintigraphy correctly identified 28 adenomas (68%). Single-photon emission computed tomographic imaging identified an additional 11 adenomas for a sensitivity of 95% and a specificity of 100%. Moreover, SPECT imaging correctly identified malignant thyroid nodules in 4 of 5 patients. Technetium Tc 99m MIBI retention was noted in only 25 adenomas (61%) while the remaining adenomas demonstrated a rapid washout. The average uptake ratio of parathyroid counts to maximum thyroid activity was significantly correlated with parathyroid hormone levels before surgery (P = .04). CONCLUSIONS: Our data encourage the use of preoperative SPECT imaging of parathyroid adenomas in patients who have multinodular goiters to select those suitable for minimally invasive radioguided surgery. This technique also offers important information regarding thyroid nodules that are suspicious for malignancy. The intraoperative gamma-probe technique enables the surgeon to focus his or her search, provides instant feedback regarding the progress of the operation, reduces surgical trauma and complications, and yields better cosmetic results. Patients with higher presurgical parathyroid hormone levels may especially benefit from radioguided surgery.

Adult↗
PubMed2005

The hot skull sign on bone scans of obese patients resulting from disparate soft tissue attenuation.

We have frequently observed diffusely increased skull activity on bone scans of obese patients, who do not have evidence of metabolic or metastatic bone disease. Skull activity of 25 obese patients were compared to that of age and sex-matched nonobese 25 patients visually and quantitatively. The results clearly indicated that diffusely increased skull activity is significantly more common on bone scans of obese patients because of disparate attenuation of overlying soft tissues. This knowledge will help obviate the need for additional radiologic and/or laboratory tests in search of other conditions associated with hot skull, ie, Paget's disease and metabolic bone disorders such as renal osteodystrophy and primary hyperparathyroidism.

Artifacts↗
PubMed2005

Auditory hallucinations in acute stroke.

Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996-2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months.

Acute Disease↗
PubMed2005

Analysis of red cell mass and plasma volume in patients with polycythemia.

CONTEXT: Polycythemia describes an increased proportion of red blood cells in the peripheral blood. In absolute polycythemia, there is increased red cell mass (RCM) with normal plasma volume, in contrast with apparent polycythemia, in which there is increased or normal RCM and decreased plasma volume. In order to deliver the appropriate treatment it is necessary to differentiate between the two. OBJECTIVE: A retrospective analysis of RCM and plasma volume data are presented, with special attention to different methods of RCM interpretation. DESIGN: The measurements of RCM and plasma volume in 64 patients were compared with the venous and whole-body packed cell volume, and the incidence of absolute and apparent polycythemia was determined for increasing hematocrit levels. Measurements of RCM and plasma volume were performed using chromium 51-labeled red cells and iodine 125-labeled albumin, respectively. The measured RCM of each patient was expressed as a percentage of the mean expected RCM and was also defined as being within or outside the range of 2 SD of the mean. The results were also expressed in the traditional manner of mL/kg body weight. RESULTS: Twenty-one patients (13 women and 8 men) had absolute polycythemia. None of them had an increased plasma volume beyond 2 SD of the mean. When expressed according to the criteria of mL/kg body weight, 17 of the 21 patients had abnormally increased RCM, but 4 patients (19%) had a normal RCM value. Twenty-eight patients had apparent polycythemia. The remaining 15 patients had normal RCM and plasma volume. CONCLUSIONS: The measurement of RCM and plasma volume is a simple and necessary procedure in the evaluation of polycythemia. In obese patients, the expression of RCM in mL/kg body weight lacks precision, considering that adipose tissue is hypovascular. The results of RCM are best described as being within or beyond 2 SD of the mean value.

Adult↗
PubMed2004

Early, postinjection MIBI-SPECT as the only preoperative localizing study for minimally invasive parathyroidectomy.

HYPOTHESIS: Early, postinjection technetium Tc 99m sestamibi scintigraphy-single-photon emission computed tomography (MIBI-SPECT) can be used as the only localizing study for focused parathyroidectomy in patients with primary hyperparathyroidism. DESIGN: During a 26-month period, 82 consecutive patients with primary hyperparathyroidism underwent a standard planar scan using a double-tracer subtraction technique for localization. On the morning of surgery, each patient received radiolabeled technetium Tc 99m sestamibi for intraoperative detection and validation. We performed an early, postinjection SPECT study for comparison with the planar study. RESULTS: The SPECT study revealed a sensitivity of 96% vs 78% for the planar study. The SPECT study was helpful in locating adenomas in 10 patients with multinodular goiter disease, of whom 3 patients had ectopic adenomas and 2 patients had 2 adenomas each. A significant correlation was noted between uptake ratio and preoperative parathyroid hormone levels (r = 0.41; P =.04). No recurrent or persistent hyperparathyroidism was reported during a follow-up period of at least 6 months. CONCLUSIONS: Our results encourage the use of preoperative SPECT as the only localizing study on the morning of the operation, both to select patients for minimally invasive radioguided surgery and to provide accurate 3-dimensional information on deeply seated or ectopic adenomas. This approach lowers the costs of preoperative localization and intraoperative validation to a single study. The intraoperative gamma probe technique enables the surgeon to focus the search, provides instant feedback regarding the progress of the operation, reduces surgical trauma and complications, and yields better cosmetic results.

Adenoma↗
PubMed2004

Technetium 99m ethylcysteinate dimer single-photon emission computed tomography (SPECT) during intellectual stress test in children and adolescents with pure versus comorbid attention-deficit hyperactivity disorder (ADHD).

Children and adolescents with the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of attention-deficit hyperactivity disorder (ADHD) can have comorbid conditions such as conduct disorder, oppositional defiant disorder, and obsessive-compulsive disorder (comorbid type). The purpose of our study was to compare the pattern of regional cerebral perfusion in these two groups of children with ADHD during a computerized performance test. Nineteen children and adolescents were enrolled in the study. Seven boys and one girl with pure ADHD (group 1: mean age 12 years, range 9-16 years) and nine boys and two girls with comorbid ADHD (group 2: mean age 11 years, range 8-16 years) were studied by single-photon emission computed tomography (SPECT). The patients were not receiving any medication for at least 48 hours prior to the study. All patients were injected with 99mTc-ethylcysteinate dimer while doing a computerized performance test. Nine age-matched control children (five boys and four girls, mean age 12 years, range 9-17 years) with a normal brain SPECT served as controls. All patients in group 2 showed significantly decreased perfusion in the temporal lobes (P < .005). Five patients had decreased frontal lobe perfusion. Additionally, two patients in group 2 had decreased perfusion in the basal ganglia (not significant). Four of eight patients in group 1 had decreased frontal lobe perfusion (not significant). In addition, two patients had bilateral temporal lobe abnormalities, whereas two patients had a normal SPECT. Three patients in group 1 also had decreased basal ganglia perfusion. In contrast to previous studies of brain perfusion in ADHD that focused mainly on frontal and prefrontal cortical abnormalities, our study demonstrates that temporal lobe perfusion abnormalities are more common in patients with the comorbid type of ADHD. We postulate that these findings can have therapeutic implications and explain the decreased response to stimulants in this group of patients.

Adolescent↗
PubMed2004

Dynamic radioisotope scintigraphy for gastric banding adjustment.

BACKGROUND: Gastric banding is today a common restrictive procedure to treat morbid obesity. After operation, adjustment of the band is required to adequately restrict food intake, allowing better results. The aim of this study was to evaluate the results of a unique method of adjustment using dynamic radioisotope scintigraphy. METHODS: 40 patients after Laparoscopic Adjustable Gastric Banding (LAGB) were prospectively divided into 2 equal groups, and the results of adjustment analyzed using the conventional method of fluoroscopic image and barium swallow (FA Group), and our proposed new method of dynamic radioisotope scintigraphy (DRS Group) using Tc99-phytate labeled plain yogurt. RESULTS: After 6 months follow-up, the FA group lost 12.34%, while the DRS group lost 20.34% of their initial weight. In the FA group, we found that 95% of the patients needed re-adjustments versus only 25% in the DRS group (P <0.0001). Vomiting was more frequent in the FA group than in the DRS group, mean 0.65 and 0.2, respectively (P < 0.009). The radiation exposure was 4 times higher in the FA group, but the cost of the 2 adjustment procedures was similar. CONCLUSION: DRS is a more physiologically friendly and accurate method of gastric banding adjustment than the conventional barium swallow adjustment; it also results in a better weight loss during the first 6 months after operation.

Adult↗
PubMed2004

123I-FP-CIT SPECT imaging of dopamine transporters in patients with cerebrovascular disease and clinical diagnosis of vascular parkinsonism.

UNLABELLED: The purpose of our study was to prospectively evaluate the striatal uptake of 123I-labeled N-(3-fluoropropyl)-2beta-carbomethoxy-3beta-(4-iodophenyl)nortropane (FP-CIT) and the response to l-dopa therapy in patients with cerebrovascular disease (CVD) who develop clinical symptoms of vascular parkinsonism (VP). METHODS: Twenty consecutive patients who developed VP in the course of CVD were prospectively enrolled in the study. All patients had CT evidence of CVD (17 patients had lacunar infarcts, 3 patients had territorial strokes). The clinical stage of the patients was assessed using the Hoehn and Yahr scale, and the severity of the symptoms was measured using the Unified Parkinson's Disease Rating Scale score. Ten age-matched subjects were used as controls. SPECT was performed 180 min after injection of 185 MBq 123I-FP-CIT using a dual-head gamma-camera. The ratio of the mean specific-to-nonspecific striatal binding for the entire striatum, caudate, and putamen was calculated in all patients and compared with that of controls. Putamen-to-caudate binding ratios were compared as well. The response to therapy was compared between patients with normal and abnormal 123I-FP-CIT binding. RESULTS: No correlation was found between any of the clinical variables and response to therapy in patients with VP. Nine patients had normal striatal 123I-FP-CIT binding with no significant differences in striatal or subregional binding ratios compared with those of the controls. In contrast, 11 patients had significantly diminished striatal binding compared with that of controls (P < 0.001). Subanalyses showed significantly decreased binding in the caudate (P < 0.04 and P < 0.01 for the right and left caudate, respectively), diminished binding in the putamen (P < 0.04 and P < 0.01 for the right and left putamen, respectively), and a decreased putamen-to-caudate ratio on the right side (P < 0.001). The latter ratio was not significant on the left. Two of the 3 patients with territorial strokes had significantly diminished striatal 123I-FP-CIT binding in the hemisphere contralateral to the CT lesion. All 9 patients with normal scan findings had a poor response to L-dopa. Six of 11 patients with abnormal studies had no response to L-dopa, whereas 5 patients had a good response (P < 0.03). CONCLUSION: The diagnosis of VP cannot be accurately confirmed on the basis of clinical features alone because CVD may alter the typical presentation of PD. Functional imaging with 123I-FP-CIT is highly recommended in patients with CVD who develop symptoms of VP to confirm or exclude the existence of nigrostriatal dopaminergic degeneration. Identifying a subset of patients with reduced 123I-FP-CIT binding in the striatum is important for better treatment selection.

Aged↗
PubMed2003

Correlation of neuropsychological evaluation and SPECT imaging in patients with Alzheimer's disease.

BACKGROUND: Mini-Mental State Examination (MMSE) is a very useful tool for diagnosing changes in cognitive functions by the general practitioner or other medical staff who is not familiar with neuropsychological tests. On the other hand, HMPAO brain SPECT has been shown to have a high sensitivity to detect neurodegenerative processes, which lead to dementia. The correlation between both methods is unknown. We compared both methods in order to find a rational evaluation tool for the practitioner to obtain a higher efficacy and cost effective way of using both methods. PATIENTS AND METHODS: Fifty-one patients diagnosed as having Alzheimer's disease (AD) were examined. Each patient underwent MMSE analysis, as well as HMPAO brain SPECT. The severity of SPECT abnormalities was categorized into mild, moderate and severe. Statistical analysis was performed in order to evaluate the correlation between imaging findings and neuropsychological testing. RESULTS: Marginal inverse correlation was found between global MMSE SPECT imaging on right and left side (p = 0.05) and the left temporal region (p = 0.05). MMSE subgroup component of orientation was highly significantly inversely associated with SPECT imaging of right and left frontal region (p > 0.0001). The MMSE subgroup of immediate memory was significantly correlated to left and right temporal regions (p = 0.001 and p = 0.002 respectively). Age was not significantly correlated to global MMSE or any of its subtest components. CONCLUSION: MMSE score has no linear correlation to SPECT perfusion findings. In cases of abnormal orientation score subgroup SPECT imaging is not recommended. In most instances, a combination of both methods should be employed by the general practitioner for further evaluation of dementia.

Aged↗
PubMed2003

Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma.

UNLABELLED: The purpose of this prospective study was to evaluate the diagnostic value of early parathyroid SPECT combined with quantitative analysis as compared with planar imaging in patients undergoing minimally invasive radioguided surgery. METHODS: A total of 52 consecutive patients with primary hyperparathyroidism underwent planar and SPECT parathyroid scintigraphy 2-5 d before surgery. Each patient had a single-tracer dual-phase technique using (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) and a double-tracer subtraction technique using a delayed (99m)Tc-pertechnetate scan. Immediately after the first (99m)Tc-MIBI planar image, a SPECT study was acquired. Before radioguided parathyroidectomy, each patient was reinjected with (99m)Tc-MIBI. Serum calcium levels were available for all patents before surgery and at 8 and 24 h after surgery. Serum parathyroid hormone (PTH) levels were also available for all patients. Quantitative analysis was performed using the average count ratio of parathyroid to left thyroid lobe, right thyroid lobe, and maximum thyroid activity. All patients had histopathologic examination of the removed glands. RESULTS: The average time for radioguided surgery was 30 min (range, 20-40 min). Postsurgical calcium levels correlated significantly with the adenoma weight (r = 0.5; P = 0.016). Combined planar scintigraphy correctly identified 41 adenomas (79%). SPECT increased the sensitivity to 96%. SPECT was superior to planar imaging in 9 patients, mainly in patients with ectopic adenomas or with multinodular goiters. Gland size did not affect significantly the detectability of SPECT. (99m)Tc-MIBI retention was noted in only 31 adenomas (60%). The average uptake ratios of parathyroid counts to the left lobe, right lobe, and maximum thyroid activity were 1.20 +/- 0.42, 1.29 +/- 0.45, and 0.84 +/- 0.35, respectively. The latter ratio was significantly correlated with PTH levels before surgery (r = 0.408; P = 0.04). CONCLUSION: Our data indicate that early preoperative SPECT in patients with primary hyperparathyroidism is essential for accurate localization of parathyroid adenomas and for the selection of patients who are candidates for minimally invasive radioguided surgery. Planar parathyroid imaging is less sensitive compared with SPECT, and washout kinetics of (99m)Tc-MIBI are unreliable in the dual-phase technique. Patients with higher presurgical PTH levels may especially benefit from radioguided surgery.

Adenoma↗
PubMed2003

Correlation of 99mTc-DTPA SPECT of the blood-brain barrier with neurologic outcome after acute stroke.

UNLABELLED: We conducted a study on humans to determine whether quantitative evaluation of blood-brain barrier (BBB) breakdown using the (99m)Tc-diethylenetriaminepentaacetic acid ((99m)Tc-DTPA) SPECT technique at the peak time of stroke evolution can predict neurologic outcome. METHODS: Thirty consecutive patients with acute stroke of the middle cerebral artery occurring >24 h and <48 h before admission were included in the study. Each patient underwent a complete neurologic examination according to the Scandinavian stroke score at 72 h after the stroke (S1) and again at 30 d (S2). The difference between initial and late scores was calculated (Delta S) and used to evaluate the change in neurologic status. A CT scan was obtained on all patients to determine the volume of stroke. The integrity of the BBB was evaluated using (99m)Tc-DTPA brain SPECT. A quantitative index of BBB disruption was defined as the ratio of the mean counts/pixel in the infarcted region compared with the mean counts/pixel in the contralateral nonaffected hemisphere. SPECT perfusion imaging was also performed with (99m)Tc-hexamethylpropyleneamine oxime ((99m)Tc-HMPAO) at 24 h after the (99m)Tc-DTPA study. The relative perfusion in the infarct region was expressed as the percentage of contralateral perfusion. RESULTS: The mean (99m)Tc-DTPA disruption index was 6.8 +/- 6.9 (range, 1-26.2). Seven patients (23%) had no BBB disruption. Statistical analysis showed that the disruption index was negatively correlated with Delta S (r = -0.423, P < 0.02). A disruption index of <2.5 was associated with a significantly better neurologic outcome (mean Delta S, 17.5 +/- 9.5) compared with patients with an index of >2.5 (mean Delta S, -0.85 +/- 4.97, P < 0.0001) with a sensitivity of 95% and a specificity of 89%. S2 was significantly correlated with S1 (r = 0.738, P < 0.001) and with Delta S (r = 0.656, P < 0.001). Perfusion abnormalities on the (99m)Tc-HMPAO SPECT studies ranged between 12% and 90% (mean, 37.6% +/- 17.8%) compared with those on the contralateral nonaffected side. No correlation was found between (99m)Tc-HMPAO uptake and Delta S, infarct volume by CT, or disruption index. The CT volume measurements were negatively correlated with S2 (r = -0.560, P < 0.004) but not with Delta S. CONCLUSION: (99m)Tc-DTPA SPECT of the BBB combined with quantitative analysis in patients with acute stroke is significantly related to clinical outcome, with a distinct prognostic cutoff threshold of 2.5. The use of this radionuclide brain SPECT technique represents a unique application of conventional nondiffusible brain agents.

Adult↗