Biomedical subjects
Publications and source records attributed to S Jinnouchi.
Tl-201 SPECT was used to evaluate myocardial involvement in 13 patients with Duchenne's muscular dystrophy. Serial studies of 9 patients were done at two-year intervals. The hypoperfused areas of the left ventricle became more prominent with age and severity.
201Tl myocardial SPECT was performed to evaluate cardiomyopathy in Duchenne type of progressive muscular dystrophy (DMD). Follow up SPECT images of the same patients were also obtained about 1 year after the first scan. Cases subjected to study were 10 DMD. At the first study the hypoperfusion area of the left ventricular muscle was observed in 6 cases (60%) out of 10. At the second study the hypoperfusion areas became wider and lower in 4 out of 6 cases (66.7%). The new hypoperfusion area which was not demonstrated at the first study was observed at the second study in one case of these cases. These results suggested that the positive rate of cardiomyopathy in DMD by 201Tl myocardial SPECT was high, and 201Tl myocardial SPECT is a useful examination to detect the change of myocardial damage in DMD.
The usefulness of IMP-SPECT and rCBF image by 133Xe inhalation method on rCBF in patients with moyamoya disease was studied. Six patients with moyamoya disease were diagnosed by cerebral angiogram, and STA-MCA anastomosis technique and EMS were done to reconstruct the rCBF. Low perfusion areas were detected around the cerebral infarction and hemorrhage and that of anterior and middle cerebral arteries by IMP-SPECT and 133Xe-rCBF image met by X-ray CT. After surgery, 4 out of 6 cases showed the improvement of rCBF by IMP-SPECT and 133Xe-rCBF image, as for clinical symptoms, there were reduction of TIA in 3 cases, and no rehemorrhage in 3 cases. In summary IMP-SPECT and 133Xe-rCBF image may be useful method to evaluate the rCBF in moyamoya disease and the change of rCBF post STA-MCA anastomosis technique and EMS.
The bone marrow distribution of Ga-67 citrate may be influenced by various elements in serum. In order to make these points clear, 1,955 whole body images were reviewed on the relationship between the accumulation of bone marrow and laboratory examination data of each patients. Increasing accumulation in the bone marrow was determined as positive when the bones of lower extremities were deposited on the images, because these bones was not visualized in normal gallium image. Laboratory data of 20 patients without having bone marrow accumulation was used as control. The positive findings of bone marrow accumulation was observed in 38 patients (2%) including 23 malignancies and 15 benign disease. The malignant tumor infiltration to the bone marrow was demonstrated by bone marrow aspiration biopsy in 2 out of 7 patients with bone marrow accumulation of Ga-67. Seven out of 15 patients with benign disease were collagen disease such as aortitis syndrome or SLE. The values of hemoglobin, hematocrit, serum iron and creatinine clearance were significantly lower in the patients with positive findings in comparison with control. These results suggest that the lower level of serum iron and anemia may cause increasing bone marrow accumulation of Ga-67 citrate.
At the first place, some experimental knowledges on the biodistribution of IMP were described for the understand of this agent. And on the basis of our clinical experience, the usefulness of cerebral perfusion imaging using SPECT and IMP was reviewed. The patients with possible ischemic cerebral diseases such as infarction, TIA and RIND are main candidates for this examination. Clinical significance of the so-called "redistribution" of IMP was discussed in detail. Dementia and epilepsy are considered to be the other indication. With improvement of the method, cerebral perfusion imaging may be accepted as essential test in the hospital dealing with the patient with neuropsychiatric deficits.
Regional cerebral blood flow (rCBF) was measured by single photon emission computed tomography (SPECT) using 133Xe, N-isopropyl-p-[123I]iodoamphetamine ([123I]IMP) and [99mTc] hexamethylpropyleneamine oxime ([99mTc]HM-PAO) in 24 patients with cerebrovascular diseases. The greatest advantage of 133Xe SPECT was to be able to provide absolute rCBF values without arterial sampling. However, its image quality was very poor. Iodine-123 IMP SPECT provided rCBF images of higher quality and it had good correlation to 133Xe SPECT. Iodine-123 IMP SPECT provided the best images to detect mild ischemic lesions. It could detect obstructive or stenotic changes of large cerebral arteries very well except for a moderate stenosis of internal carotid artery. Technetium-99m HM-PAO SPECT also provided very good rCBF images and it had good correlation to 133Xe SPECT. However, the count-density ratios for the ischemic lesions to the contralateral presumed normal areas of [99mTc] HM-PAO SPECT were significantly higher than those of [123I]IMP SPECT.
Regional cerebral blood flow (rCBF) was assessed in patients with cerebrovascular diseases (CVD) by single photon emission computed tomography (SPECT) using 133Xe and N-isopropyl-p-[123I]iodoamphetamine ([123I]IMP). The purpose of this study was to determine the infarcted and symptomatic blood flow thresholds of cerebral cortex by SPECT. In the 133Xe inhalation method rCBF was calculated by employing the Celsis modification of the Kanno and Lassen algorithm. In the [123I]IMP SPECT quantitation was obtained by counting-rate ratio for the low flow lesion to the contralateral homologous region which was presumed to be normal (Lesion/Normal ratio, L/N ratio). The infarcted and symptomatic blood flow thresholds by 133Xe SPECT was 19-23 and 33-36 ml/100 g/min, respectively. While, those of L/N ratio in the [123I]IMP SPECT were 39-48 and 65-72%, respectively. There was a significant correlation between the ischemic degrees evaluated by 133Xe and [123I]IMP SPECT studies.
Technetium-99m hexamethylpropyleneamine oxime ([99mTc]HM-PAO) has recently been introduced as an alternative to N-isopropyl-p-[123I]iodoamphetamine ([123I]IMP) for measurement of regional cerebral blood flow. This study compares dynamic SPECT studies using the two tracers in seven patients with meningiomas. Regions of interest were placed over the lesion and contralateral homologous presumed normal area. The counting-rate ratio for the lesion to the contralateral homologous area (L/N ratio) was then calculated in the first image. L/N ratios of [99mTc]HM-PAO single photon emission computed tomography (SPECT) were lower than those of [123I])IMP SPECT, particularly in hypervascular meningiomas. Furthermore, time-activity curves showed that the washout of [99mTc]HM-PAO in the tumors was very slow or incomplete, preventing an accurate assessment of vascularity of meningiomas with [99mTc]HM-PAO, as is generally possible with [123I]IMP.
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Gallium scintigraphy was evaluated in 25 patients with adult T-cell leukemia lymphoma (ATLL). Anterior and posterior images were obtained at 72 h after administration of 3 mCi 67Ga-citrate using a gamma camera (Maxi-Camera 400 T, General Electric Co.) with a medium energy standard parallel hole collimator. Abnormally high accumulations were observed in 17 out of 25 cases (superficial lymph node, 8; hilar and mediastinal lymph node, 7; paraaortic lymph node, 2; lung, 9; liver, 1; bone, 1). There were 10 malignant lesions detected by 67Ga scintigraphy in 9 out of 17 cases (superficial lymph node, 1; hilar and mediastinal lymph node, 6; paraaortic lymph node, 1; liver, 1; bone, 1). White blood cell count and serum LDH levels were raised in patients with abnormally high accumulations of 67Ga. In conclusion, 67Ga scintigraphy seemed to be a useful examination to detect malignant lesions in patients with ATLL.
Early and delayed single photon emission computed tomography (SPECT) using N-isopropyl-p-(123I)iodoamphetamine (IMP) was performed on 28 subjects (2 normal, 12 with cerebrovascular diseases and 14 with brain tumors) to evaluate the reversibility of the cerebral abnormality and cerebral viability. The results were compared with X-ray CT, 99mTc brain scintigraphy and rCBF by 133Xe inhalation method. Three types of IMP kinetics were observed. Initial hypoactivity that changed over 4 to 6 hours approaching a normal pattern suggests a hypofunctional parenchyma without significant tissue damage: long-lasting abnormalities on IMP SPECT indicates cellular damage.
Gallium scintigraphy was performed as an aid for determining the presence or absence of malignant neoplasm in two patients with hemochromatosis treated by deferoxamine. However, gallium scan images could not be obtained. So gallium scintigraphy was performed once more to investigate the cause of low activity. Both patients had heavy urinary excretion of gallium in the first 24 hrs after the injection, and activity was very low on the day of examination. This phenomenon may be attributed to the effect of deferoxamine which is highly bound to the gallium.
Biodistribution of N-isopropyl-p-iodoamphetamine (IMP) was evaluated in mice. After synthesis of IMP and exchange labeling with radioactive iodine, IMP was injected intravenously in male ddY mice. Activity in the brain reached 8.0 (%dose/g), at 10 min after injection and it was almost constant till 120 min. Activities in the lung and heart were high just after injection, decreased rapidly and was almost constant from 30 to 120 min. Activity in the liver increased slowly compared with other organs, and reached peak level at 60 min. In autoradiography, almost the same activity in the spinal cord as the brain was observed. Uptake and excretion of IMP were shown in kidneys and stomach, which may be the main route of the excretion of IMP and their metabolites. We concluded IMP showed good uptake in the central nervous system.
Uptake of Tc-99m Hexamethylpropylene-amine Oxine (HM-PAO) was seen in bone metastases from carcinoma of the lung. The uptake was prominent when compared to Tc-99m MDP, I-123 IMP, and Ga-67 citrate. Brain imaging with Tc-99m HM-PAO and N-isopropyl-p-[I-123] iodoamphetamine (IMP) is now frequently performed. Uptake of these agents has been reported in brain tumors and melanomas. In this report, uptake of Tc-99m HM-PAO in a metastatic lesion in bone is discussed.
Ten patients with unusual uptake and retention of I-123 IMP in their brain tumors were studied. Of these ten patients, five had meningiomas and the remaining five had glioblastoma, malignant astrocytoma, malignant lymphoma, metastatic brain tumor, and cellular blue nevus. Six tumors (five meningiomas and the glioblastoma) showed short term retention of I-123 IMP. Three tumors (the malignant astrocytoma, the malignant lymphoma, and the metastatic brain tumor) showed a delayed increase of radioactivity and the cellular blue nevus showed a gradual increase and long term retention of the tracer.
The usefulness of radionuclide angiography in patients with vascular occlusion or aneurysm is well documented. In this paper, a rare case of pseudoaneurysm of the celiac artery demonstrated by radionuclide angiography is reported.
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Regional cerebral blood flow (rCBF) was measured in 20 patients with ruptured aneurysm. rCBF images are obtained by 133Xe inhalation method using a ring type gamma camera (SET-020, Shimazu Co.) with high sensitivity collimator. Examinations are performed at acute stage (1-7 days after onset) and at subacute stage (8-14 days after onset). In acute stage, rCBF in the affected cerebral hemisphere has tendency to be low in 12 patients with angiospasm after the aneurysmal rupture comparing to those in patients without angiospasm. Low rCBF areas in cerebral hemisphere at acute stage were apt to become normal in subacute stage. rCBF measurement by 133Xe inhalation method seemed to be an useful method to evaluate rCBF in patients with ruptured aneurysm.