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Biomedical subjects

S J Goldsmith

Publications and source records attributed to S J Goldsmith.

At least 91 records · Page 5Linked to original sources
PubMed1990

Appearance of acute gouty arthritis on indium-111-labeled leukocyte scintigraphy.

Indium-111-labeled leukocyte scintigraphy was performed on a 66-yr-old male with polyarticular acute gouty arthritis. Images revealed intense labeled leukocyte accumulation in a pattern indistinguishable from septic arthritis, in both knees and ankles, and the metatarsophalangeal joint of both great toes, all of which were involved in the acute gouty attack. Joint aspirate as well as blood cultures were reported as no growth; the patient was treated with intravenous colchicine and ACTH for 10 days with dramatic improvement noted. Labeled leukocyte imaging, repeated 12 days after the initial study, revealed near total resolution of joint abnormalities, concordant with the patient's clinical improvement. This case demonstrates that while acute gouty arthritis is a potential pitfall in labeled leukocyte imaging, in the presence of known gout, it may provide a simple, objective, noninvasive method of evaluating patient response to therapy.

Acute Disease↗
PubMed1989

Low-density lipoprotein (LDL) distribution shown by 99mtechnetium-LDL imaging in patients with myeloproliferative diseases.

STUDY OBJECTIVE: To image and identify by noninvasive methods the sites of low-density lipoprotein (LDL) catabolism in patients with myeloproliferative disease in whom chronic hypocholesterolemia was previously reported. STUDY DESIGN: The 99mTechnetium-LDL (Tc-LDL) distribution in patients with myeloproliferative diseases was compared with that in normal subjects. The Tc-LDL distribution was also compared with the distribution and organ uptake of a macrophage-seeking radiotracer. 99mTc-sulfur colloid (Tc-SC). SETTING: Major metropolitan referral center and institutional practice. PATIENTS: Three normal subjects, two patients with polycythemia vera, two with post polycythemia myeloid metaplasia, and one with agnogenic myeloid metaplasia. The patients were being managed with hydroxyurea or phlebotomy. INTERVENTION: Ten mCi of Tc-LDL (homologous) was injected intravenously. MEASUREMENTS AND MAIN RESULTS: Gamma camera images of Tc-LDL biodistribution and organ uptake were obtained 4 hours after injection of the tracer. In normal subjects, the Tc-LDL was predominantly taken up by the liver, with relative nonvisualization of spleen and central or peripheral marrow. Patients with myeloproliferative disease showed marked splenic uptake of Tc-LDL. Peripheral bone marrow uptake extended to the lower tibia in two patients with post-polycythemia myeloid metaplasia. Splenic and bone marrow uptake paralleled that of Tc-SC. Hypercellularity of central and peripheral marrow at the sites of Tc-LDL uptake was confirmed by biopsy specimens. The Tc-LDL uptake, however, was not correlated with collagen fibrosis. CONCLUSIONS: These results indicate that spleen and bone marrow are sites of LDL catabolism in patients with myeloproliferative disease and suggest the role of macrophages in the hypocholesterolemia and accelerated LDL catabolism of myeloproliferative disease.

Adult↗
PubMed1989

Effect of patient position on interpretation of lung images complicated by chest radiograph opacities.

Lung images in which perfusion defects correspond to chest radiograph (CXR) opacities in size and location are generally classified as having an intermediate probability for pulmonary embolism, while those studies in which the perfusion defects are considerably smaller than the CXR opacities are classified as having a low probability for pulmonary embolism. A case is presented in which, by imaging a patient in both the erect and supine positions, the authors were able to change the interpretation of the study from intermediate probability (perfusion defect = CXR opacity) to low probability (perfusion defect less than CXR opacity).

Humans↗
PubMed1989

Detection of abnormalities in febrile AIDS patients with In-111-labeled leukocyte and Ga-67 scintigraphy.

Thirty-six patients with acquired immunodeficiency syndrome (AIDS), who were febrile but without localizing signs, underwent indium-111 leukocyte scintigraphy 24 hours after injection of labeled white blood cells (WBCs) and were restudied 48 hours after injection of gallium-67 citrate. Fifty-six abnormalities were identified as possible sources of the fever; 27 were confirmed with biopsy. Of these 27, 15 were identified only on In-111 WBC scans (including colitis, sinusitis, and focal bacterial pneumonia); six, only on Ga-67 scans (predominantly Pneumocystis carinii pneumonia and lymphadenopathy); and six, on both studies (predominantly pulmonary lesions). In-111 WBC scanning revealed 21 of 27 abnormalities (78%) and gallium scanning, 12 of 27 (44%). If only one scintigraphic study has been performed, particularly with Ga-67, a significant number of lesions would not have been detected. The authors believe radionuclide evaluation of the febrile AIDS patient without localizing signs should begin with In-111 WBC scintigraphy. Gallium scanning may be used depending on results of In-111 WBC scans or if there is a high index of suspicion for P carinii pneumonia.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Radial and vertebral bone density in white and black women: evidence for racial differences in premenopausal bone homeostasis.

The reasons for a different incidence of osteoporotic fractures in white and black women are unknown. Previous racial comparisons of bone mass have been limited by racial differences in body weight and socioeconomic, health, and nutritional status. This cross-sectional study examined bone density in 105 black and 114 white healthy nonobese women, 24-65 yr old, using dual photon absorptiometry of the lumbar spine and single photon absorptiometry of the distal radius. Bone density at both sites was higher in blacks at all ages than in whites. When adjusted for age and body mass index, mean bone density was 6.5% higher in blacks at both spine and radius (P less than 0.0001). The cross-sectional rate of decline of vertebral bone density was similar between races; however, radial density increased 3.8%/decade (P = 0.03) in premenopausal blacks under age 46 yr, while it declined 3.2%/decade (P = 0.09) in premenopausal whites. The racial difference in slopes in these premenopausal women is significant (P = 0.002). These findings suggest that attainment of higher peak bone mass and delayed onset of bone loss contribute to the lower incidence of osteoporotic fractures in black women.

Adult↗
PubMed1989

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↗
PubMed1989

Acute effects of radiation therapy on indium-111-labeled leukocyte uptake in bone marrow.

We recently performed [99mTc]MDP bone and 111In-labeled leukocyte scintigraphy on a patient receiving radiation therapy to the lower cervical and upper thoracic spine. While the bone images revealed only minimally increased activity in the radiation port, leukocyte images revealed diffuse, intensely increased uptake in this same region. Radiation therapy should be included in the differential diagnosis of increased bone marrow activity on 111In leukocyte images.

Aged↗
PubMed1989

Bone SPECT in patients with persistent back pain after lumbar spine surgery.

Twenty-five patients with persistent pain after lumbar spine surgery for pain were evaluated by single photon emission computed tomography (SPECT) bone scanning. The patients were divided into three groups, depending on the type of surgery performed. The data obtained indicates that lumbar spine SPECT is most useful in conditions where there is the greatest likelihood of instability. The study shows that the improved contrast and better three-dimensional patient information gained through lumbar spine SPECT permits more accurate delineation of the level of maximum instability and stress on the vertebra.

Adult↗
PubMed1989

Biodistribution, dosimetry, and clinical evaluation of technetium-99m ethyl cysteinate dimer in normal subjects and in patients with chronic cerebral infarction.

Technetium-99m ethyl cysteinate dimer (ECD) has high initial cerebral uptake with slow clearance in nonhuman primates suggesting ideal characteristics for single photon emission computer tomography (SPECT) imaging. We evaluated the biodistribution, dosimetry and scintigraphic pattern of [99mTc]ECD in normal subjects and the accuracy of SPECT imaging in patients with chronic cerebral infarction. Sixteen normal subjects were injected with approximately 10 mCi of [99mTc]ECD. Anterior and posterior single-pass whole-body images were obtained at multiple times after injection. Blood clearance of the radiotracer was rapid, falling to 10.0 +/- 6.6% and 4.9 +/- 1.1% of the injected dose at 2 and 60 min, respectively. Brain uptake was 6.4 +/- 2.1% of the injected dose 5 min after injection. The critical organ was the urinary bladder. Technetium-99m ECD SPECT was performed with a rotating gamma camera in ten of the 16 normal subjects and 34 patients with clinical and CT evidence of chronic stroke. Thirty-three of the thirty-four patients had focal [99mTc]ECD abnormalities on SPECT (97.1%) based on visual inspection of the SPECT images. In summary, we obtained high quality SPECT images as a result of the optimal physical and biologic characteristics of the tracer. Technetium-99m ECD SPECT shows promise for the evaluation of patients with stroke.

Cerebral Infarction↗
PubMed1989

Value of blood-pool subtraction in cardiac indium-111-labeled platelet imaging.

Blood-pool subtraction has been proposed to enhance 111In-labeled platelet imaging of intracardiac thrombi. We tested the accuracy of labeled platelet imaging, with and without blood-pool subtraction, in ten subjects with cardiac thrombi of varying age, eight with endocarditis being treated with antimicrobial therapy and ten normal controls. Imaging was performed early after labeled platelet injection (24 hr or less) and late (48 hr or more). Blood-pool subtraction was carried out. All images were graded subjectively by four experienced, "blinded" readers. Detection accuracy was measured by the sensitivity at three fixed levels of specificity estimated from receiver operator characteristic curve analysis and tested by three-way analysis of variance. Detection accuracy was generally improved on delayed images. Blood-pool subtraction did not improve accuracy. Although blood-pool subtraction increased detection sensitivity, this was offset by decreased specificity. For this population studied, blood-pool subtraction did not improve subjective detection of abnormal platelet deposition by 111In platelet imaging.

Adult↗
PubMed1989

Systemic biodistribution of radioiodinated interleukin-2 in the rat.

Interleukin-2 (IL-2) is a lymphokine capable of modulating a variety of immune functions. In vitro and in vivo studies have shown promising cytotoxic potential. Despite numerous ongoing clinical trials, however, little is known about the biodistribution of this lymphokine after in vivo administration. In this study using a rat model, the fate of radioiodinated human recombinant IL-2 (RIL-2) was analyzed by camera imaging, autoradiography, and well counting experiments. Camera imaging demonstrated the liver and kidney to be the organs of greatest radioactivity accumulation with peak liver uptake noted at approximately 10 min from onset of infusion, and peak kidney uptake at approximately 20 min. Autoradiographic assessment of selected organs (kidney, adrenal, liver, lung, and brain) revealed marked heterogeneity of uptake in the kidney and adrenal gland with preponderance of RIL-2 in the cortex of these organs. A more homogeneous distribution of RIL-2 uptake was noted in liver, lung, and brain parenchyma. Well counting confirmed the liver and kidney as the organs of greatest RIL-2 accumulation. Knowledge of the biodistribution of IL-2 may be of benefit both in studying mechanisms of toxicity and in designing novel therapeutic approaches.

Animals↗
PubMed1989

Effect of source strength and attenuation on dual photon absorptiometry.

A systematic error in dual photon absorptiometry (DPA) measurements of bone mineral density (BMD) related to source strength has been previously described and attributed to an erroneous algorithm for deadtime correction. Since detected counts (or photon flux) is a product of source strength and attenuation, the effect of various source activities and attenuation depths on BMD calculations were evaluated using a phantom. Ten DPA scans were acquired at two source strengths, 0.3 and 1.0 Ci, and at each of two water depths, 16.4 and 24.5 cm. These activities and depths are within the range encountered clinically. Scans were acquired and processed using a commercially available lumbar spine scanner and software, and were reanalyzed with two upgraded versions of software. Mean BMD obtained with the initial software varied by 2 to 14% with changes in both sources strength and attenuating depth. Software revisions reduced but did not entirely eliminate these differences. The remaining 6% discrepancy is of sufficient magnitude to influence both patient management and research investigations.

Absorptiometry, Photon↗
PubMed1988

Low density lipoprotein receptor-independent hepatic uptake of a synthetic, cholesterol-scavenging lipoprotein: implications for the treatment of receptor-deficient atherosclerosis.

The metabolism of infused 111In-labeled phospholipid liposomes was examined in Watanabe heritable hyperlipidemic (WHHL) rabbits, which lack low density lipoprotein (LDL) receptors, and in normal control rabbits. The half-times (t1/2) for clearance of 111In and excess phospholipid from plasma were 20.8 +/- 0.9 hr and 20.3 +/- 4.6 hr in WHHL and 20.0 +/- 0.8 hr and 19.6 +/- 2.2 hr in the normal rabbits (means +/- SEM; n = 4). By 6 hr postinfusion, the plasma concentration of unesterified cholesterol increased by 2.2 +/- 0.23 mmol/liter in WHHL and 2.1 +/- 0.04 mmol/liter in normal rabbits, presumably reflecting mobilization of tissue stores. Disappearance of excess plasma cholesterol was greater than 90% complete in both groups of rabbits by 70 hr postinfusion. By quantitative gamma camera imaging, hepatic trapping of 111In-labeled liposomes over time was indistinguishable between the two groups. At autopsy, the liver was the major organ of clearance, acquiring 22.0% +/- 1.7% (WHHL) and 16.8% +/- 1.0% (normal of total 111In. Aortic uptake of 111In was less than 0.02%. Thus, mobilization of cholesterol and hepatic uptake of phospholipid liposomes do not require LDL receptors. Because phospholipid infusions produce rapid substantial regression of atherosclerosis in genetically normal animals, our results suggest that phospholipid liposomes or triglyceride phospholipid emulsions (e.g., Intralipid) might reduce atherosclerosis in WHHL rabbits and in humans with familial hypercholesterolemia.

Animals↗