Left ventricular enlargement associated with diagnostic outcome of schizophreniform disorder.
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Cerebral Ventricles↗
Biomedical subjects
P Stritzke
Publications and source records attributed to P Stritzke.
The timing of brain morphological changes in schizophrenia and their relationship to clinical outcome.
The present study is an examination of ventricular and temporal lobe size in 50 DSM-III-R first-episode schizophreniform or schizoaffective patients who were ill for less than 6 months. Two-year clinical follow-up and magnetic resonance imaging (MRI) scan analyses are also reported from data collected on an initial group of 30 first-episode schizophrenic patients and controls. Left ventricular enlargement, which was present in our previously published report of first-episode cases of schizophrenia, is not present to the same extent in this larger group of schizophreniform patients closer to the onset of their illness, and no temporal lobe volume reduction was detected. However, lateral ventricular size at the time of the first-episode was generally correlated with outcome--the larger the ventricles, the poorer the outcome. No mean change in ventricular or temporal lobe size was found at rescanning 2 years later, but the degree of ventricular change was inversely correlated with the number of hospitalizations and the amount of time spent in hospital; it did not correlate with temporal lobe size. When rescanned, some patients showed change greater than 20% in ventricular size and 10% in temporal lobe size. Thus, these findings need further evaluation by serial scans over a longer time period before it can be determined that no progression of brain structural abnormalities is occurring as part of the pathology of schizophrenia, even in a subgroup of patients.
Adult↗
Anomalous lateral sulcus asymmetry and cognitive function in first-episode schizophrenia.
This study examines the cognitive functioning of first-episode schizophreniform patients within several weeks of hospitalization and at 2 years into the illness. Differences between patients and controls are also reported for measurements of the length of the lateral sulcus, which borders the planum temporal, an area of the brain integral to language function. Neuropsychological test results are also correlated to magnetic resonance imaging structural variables at the time of first hospitalization. Findings on neuropsychological summary scales reveal a diffuse pattern of cognitive impairment in schizophreniform patients compared to controls, which appears to improve over time. An atypical pattern of anatomic lateral symmetry is found in female schizophreniform patients, with female appearing to have a reduction in the normally occurring left greater than right length of the lateral sulcus. Such atypical asymmetry of the lateral sulcus is also associated with better cognitive function, particularly in schizophreniform patients. These findings suggest that atypical lateralization in an area critical to language function may be related to cognitive function in schizophreniform illness.
Adult↗
Organ perfusion by dynamic scintigraphy convection-diffusion tracer kinetics in a phantom.
Dynamic scintigraphy is used widely to evaluate qualitatively the perfusion of an organ. Attempts to quantify blood flow to an organ by means of scintigraphic imaging modalities have often employed assumptions that lead to oversimplifying the physiology of the tracer kinetics. We used a mathematical formalism described by W. Perl and F. P. Chinard (Circ. Res. 22: 273-298, 1968), the convection-diffusion tracer kinetics, model, for parameter evaluation of flow (F) and volume of distribution (V). This modeling methodology was evaluated using a circulatory phantom with absolute flow measured independently by flowmeter. In a series of 22 phantom experiments with F/V < 0.32 s-1, there was a strong correlation between F and flow probe measurement [r = 0.97; slope = 1.08 +/- 0.06 (SE)]. The theoretical analysis comparing this approach with classical tracer kinetics methods explains both the satisfactory results for F/V using mean transit time and the systematic overestimation of F/V using decay constant methods.
Animals↗
The simultaneous measurement of glomerular filtration rate (GFR) and renal plasma flow (RPF) following renal transplantation by use of functional imaging.
A new method for evaluating renal function using dynamic scintigraphy and deconvolution is described; functional images can be created from the data to quantitate kidney function. Our data are indicating that GFR measurements obtained by this method do not differ from those obtained by classical renal clearance methods. As was expected measurements of renal plasma flow exceed the values of PAH clearance. Additional studies to determine extraction ratios must be done along with direct flow meter measurements.
Animals↗
Technetium-99m ECD: a new brain imaging agent: in vivo kinetics and biodistribution studies in normal human subjects.
Lipophilic neutral 99mTc complexes of diaminedithiol (DADT) ligands cross the brain-blood barrier. A new derivative of DADT family, 99mTc ethyl cysteinate dimer (ECD) showed high brain uptake in nonhuman primates. We report here the in vivo kinetics and biodistribution results in 16 normal human subjects. Dynamic images of brain obtained for 10 min following an i.v. administration of [99mTc]ECD showed that the maximum 99mTc brain activity reached within 1 min and remained near that level for the next 10 min. The blood clearance of the tracer was very rapid and the activity remaining in blood after 5 min was less than 10%. Within 2 hr 50% of 99mTc activity was excreted in urine. Anterior and posterior total-body images were obtained at 5, 30, 60 min, 2, 4, 24, and 48 hr using a moving table at 20 cm/min. Percent injected dose was calculated for different organs and tissues. The brain uptake was 6.5 +/- 1.9% at 5 min postinjection and remained relatively constant over several hours. Two-compartment analysis of brain time-activity curve showed that 40% of brain activity washed out faster (T 1/2 = 1.3 hr) while the remaining 60% had a slower clearance rate (T 1/2 = 42.3 hr). Some of the tracer was excreted through the hepatobiliary system. Lung uptake and retention of [99mTc]ECD was negligible. Radiation dosimetry is favorable for the administration of up to 20-40 mCi of [99mTc]ECD. These results show that [99mTc]ECD is rapidly extracted and retained by the brain providing favorable conditions for single photon emission computed tomography imaging.
Adult↗
Comparison of the clearance of technetium-99m MAG3 and iodine-131 OIH.
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Humans↗
[Bone scintigraphy in assessing the success of chemotherapy in osteosarcoma].
During preoperative chemotherapy regional 99mTc-MDP clearance by tumor and healthy bone as well as tumor blood flow were determined in 13 patients with osteosarcoma. The results were compared to histologic regression grades. After good response (tumor vitality less than 10%) tumor blood flow normalized and regional 99mTc-MDP clearance decreased by 66% (range 56-82%). After poor response to chemotherapy (tumor vitality greater than 10%) tumor blood flow remained increased, whereas regional 99mTc-MDP clearance was unchanged or increased except in one patient. After 4-7 weeks of chemotherapy tumor viability was accurately assessed in 8 of 9 patients (89%) by means of regional 99mTc-MDP clearance. Tumor viability could be evaluated also by simple tumor/non-tumor ratios. A decrease of 99mTc-MDP clearance by more than 20% indicated an effective chemotherapy with a specificity of 80%. After 10-13 weeks of chemotherapy the specificity was improved including the results of tumor blood flow determination.
Adolescent↗
[The 4 hr-washout-functional picture: a quantitative visualization of 201Tl myocardial stress kinetics and the significance of paradoxical redistribution].
Between March and August 1983, 62 patients with suspected coronary artery disease were investigated by both 201Tl myocardial scintigraphy and coronary angiography. Functional images of the 4 h-201Tl-washout were compared with conventional scintigrams of the stress and rest phases and with results of coronary angiography. Myocardial scintigraphy with 4 views was performed immediately after exercise and 3-4 h later. After interpolative background subtraction, 4 h-washout functional images were computed from each of the initial scintigrams and the corresponding delayed scintigrams. Using a special-coded colour table, the 4 h-washout could be read quantitatively from the functional image. The additional analysis of washout images increased the accuracy of myocardial 201Tl scintigraphy for the detection and localization of coronary stenoses from 42% to 69%. Sensitivity increased from 42% to 73%, definitivity from 50% to 79%. Ischemic regions appeared more obvious in the washout images, even to less experienced observers. In comparison with circumferential washout profiles the interpretation of washout images was easier because of more obvious anatomical localization. The phenomenon of "reverse redistribution" was found to be associated with a decreased 201Tl-washout in apparently "normal" regions, whereas in those regions with "reverse redistribution" the washout was normal or at least relatively high. In addition diffuse myocardial ischemia occurring in 3-vessel disease could be recognized in the 4 h-washout functional images.
Coronary Disease↗
[Function scintigraphy: a uniform method for quantifying organ metabolism and function].
Functional scintigraphy is a quantitative method with which metabolic parameters of an organ can be determined by measuring the time activity course of a radioactive tracer in tissue. Their quantitative value is, however, limited by inherent sources of error, e.g. the absorption of radiation in the organ or overlapping of fore- and background activities. Hitherto, existing procedures for calculation of metabolic parameters are based more on given technical possibilities than on common theoretical foundations. They are notable for their variety in methodical approach, frequently being of empirical character. Quantitative results from different institutes and hospitals can therefore rarely be compared. The present work describes a methodical approach to obtain comparable methods in nuclear medicine, by including the pharmacokinetics of a tracer in blood. This leads to the compartment analysis (deterministic) or to a stochastic (non-deterministic) description of the kinetics in an organ. The stochastic description requires the calculation of the linear response function from a convolution integral. By means of functional analytical methods a mathematical procedure has been developed which for the first time permits the calculation of the linear response function in each pixel and at any time of the study. Easily readable functional images show how relevant parameters can be calculated from the linear response function. Due to its independence on any model, the linear response function enables furthermore a regional investigation of existing or new compartment models of tracer kinetics in the organ concerned.
Bone and Bones↗
[New criteria for scintigraphic follow-up of bone metastases following radiotherapy. Results of functional scintigraphy using 99mTc-MDP].
After radiation therapy regional 99mTc-MDP clearance by 17 metastatic lesions was determined repeatedly in 13 patients. 99mTc-MDP clearance rates decreased within 14 weeks after irradiation of osteoblastic metastases, but were normalized in only one lesion. In osteolytic lesions 99mTc-MDP clearance increased 4 weeks after completion of radiation therapy indicating reossifications evident from X-ray examinations subsequently. 99mTc-MDP clearance decreased subsequently and returned to normal after 28-50 weeks in 6 out of 11 metastases demonstrating reossification on X-ray. Monitoring of radiation therapy of bone metastases should be adapted to these complex variations of tracer kinetics. The initial increase of tracer accumulation in osteolytic metastases due to bone repair should not be misinterpreted as a local progression of metastatic bone disease.
Adult↗
Assessment of myocardial necrosis immediately after intracoronary thrombolysis by intracoronary injection of technetium-99m pyrophosphate.
To assess myocardial necrosis immediately after intracoronary thrombolysis, thallium-201 (TL-201) and technetium-99m pyrophosphate (Tc-99m PYP) were injected simultaneously into the coronary artery in 25 patients with acute transmural myocardial infarction. In 17 of the 25 patients, the occluded coronary artery was reopened. Minutes after the intracoronary injection of Tc-99m PYP into the reopened coronary artery a localized accumulation was seen within the area of the Tl-201 defect in all patients. Control intravenous scintigraphy, which was performed in 8 of these 17 patients 1-6 days later, and in 2 patients 18 and 42 days after infarction, revealed a Tc-99m PYP spot similar to that of the acute intracoronary Tc-99m PYP scintigram in all 10 patients. In the 8 of the 25 patients, in whom intracoronary thrombolysis failed, no localized Tc-99m PYP accumulation was seen after injection into the infarct vessel. In 5 of these patients, a control intravenous scintigram, performed 1-8 days later, resulted in a Tc-99m PYP spot in the area of the Tl-201 defect. We conclude that, in the presence of therapeutic or spontaneous reperfusion, Tc-99m PYP scintigraphy may provide a useful method of assessing myocardial necrosis during the early stage of an acute myocardial infarction.
Adult↗
Use of dual intracoronary scintigraphy with thallium-201 and technetium-99m pyrophosphate to predict improvement in left ventricular wall motion immediately after intracoronary thrombolysis in acute myocardial infarction.
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Adult↗
Quantification of tracer kinetics in intra- and extrahepatic bile ducts and of gallbladder filling rates in hepatobiliary dynamic scintigraphy using 99mTc-IDA derivates.
A method is presented of calculating the flow of 99mTc-labelled IDA derivates in intra- and extrahepatic bile ducts. By computer means the superimposed liver parenchymal activity is subtracted from the original sequence data in each pixel and at each time. In addition to known evaluation methods, the described procedure seems to be helpful for clinical application in order to better display anatomical details of intrahepatic structures like bile ducts and to calculate quantitative parameters like appearance times in intra- and extrahepatic regions. Examples are given and the possibility of calculating a gallbladder filling rate for separating normal gallbladders from stone-filled ones is statistically proven.
Adult↗
Biokinetics of bone tracers by means of deconvolution analysis--comparison of 99mTc MDP, 99mTc DPD and 99mTc EHDP.
Transfer functions of 99mTc methylene diphosphonate (MDP), 99mTc 2,3-dicarboxypropane-1,1-diphosphonate (DPD) and 99mTc ethane-1-hydroxy-1,1-diphosphonate (EHDP) into bone and extravascular fluid of soft tissues were determined in 5 dogs by deconvolution analysis of the time-course of plasma, soft tissue and bone radioactivity. The transfer rates 5 min after injection--indicating the rapid exchange of the tracer between plasma and the extravascular fluid--decrease in the order MDP greater than EHDP greater than DPD (P less than 0.05). The transfer rates into bone--determined from transfer rates between 30 and 60 min--decreased in a different order, i.e. MDP greater than DPD greater than EHDP (P less than 0.05). The fractional bone uptake of diphosphonates estimated from the ratio of early to late transfer rates was slightly greater for DPD than for MDP and EHDP respectively. The difference between DPD and MDP was not significant (P greater than 0.05). The average bone and soft tissue concentrations of DPD 60 min after injection were greater than that of MDP and EHDP due to different plasma concentrations (DPD greater than EHDP greater than MDP), whereas the bone-to-soft tissue ratios decreased in the sequence MDP greater than DPD greater than EHDP (P less than 0.05).--Our results reveal different biokinetics of MDP, DPD and EHDP explaining variations in osseous and soft tissue uptake suggesting that deconvolution analysis could play an important role in bone scan interpretation.
Animals↗
[Scintigraphy of liver after combined chemo-/immunotherapy with malignant melanoma (author's transl)].
Thirty patients with malignant melanoma received combined chemo-/immunotherapy with Dacarbazine and BCG after operation. Before therapy and 6-10 weeks after the liver was examined by clinical, laboratory and scintigraphic means. We wanted to find out the side effects of the therapy on liver and the use of the gated scintigraphy to diagnose liver parenchymal changes. Each of the patients had normal laboratory results as well as a normal scintigraphy before therapy. After chemotherapy 19 patients had a pathological liver scintigram. Also specific liver enzymes were elevated. While 12 patients showed a diffuse, inhomogeneous liver pattern with scintigraphy, 5 patients had an additional diffuse liver increase on top. Four patients also showed signs of intrahepatic cholestasis. In 11 patients the result was unsignificant. Related to the liver toxicity of Dacarbazine, liver scintigraphy is able to detect a liver reaction at a point where laboratory and clinical signs don't give a significant information.
Adult↗
Deconvolution analysis of 99mTc-methylene diphosphonate kinetics in metabolic bone disease.
The kinetics of 99mTc-methylene diphosphonate (MDP) and 47Ca were studied in three patients with osteoporosis, three patients with hyperparathyroidism, and two patients with osteomalacia. The activities of 99mTc-MDP were recorded in the lumbar spine, paravertebral soft tissues, and in venous blood samples for 1 h after injection. The results were submitted to deconvolution analysis to determine regional bone accumulation rates. 47Ca kinetics were analysed by a linear two-compartment model quantitating short-term mineral exchange, exchangeable bone calcium, and calcium accretion. The 99mTc-MDP accumulation rates were small in osteoporosis, greater in hyperparathyroidism, and greatest in osteomalacia. No correlations were obtained between 99mTc-MDP bone accumulation rates and the results of 47Ca kinetics. However, there was a significant relationship between the level of serum alkaline phosphatase and bone accumulation rates (R = 0.71, P less than 0.025). As a result deconvolution analysis of regional 99mTc-MDP kinetics in dynamic bone scans might be useful to quantitate osseous tracer accumulation in metabolic bone disease. The lack of correlation between the results of 99mTc-MDP kinetics and 47Ca kinetics might suggest a preferential binding of 99mTc-MDP to the organic matrix of the bone, as has been suggested by other authors on the basis of experimental and clinical investigations.
Adult↗
[Functional imaging of characteristic kinetic parameters of kidney and thyroid (author's transl)].
A procedure has been developed by which the reaction of an organ to a very short delta-function activity pulse of an organ-specific tracer introduced into the blood can be determined for the kidney and the thyroid. The data for the procedure are available from sequence scintigrams and the change with time of the activity of the tracer in the blood. The nature and duration of this reponse function makes it possible to calculate organ-specific parameters such as uptake rates, clearance rates or transit times. They may be calculated for the total field of the gamma camera and delineated as grey or colour gradations to yield the respective parametric functional images. The apparatus necessary for the procedure is described and its possible clinical application in comparison to conventional scintigraphic procedure is discussed.
Humans↗