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PubMed2006

Sentinel node biopsy using dye and isotope double tracers in early gastric cancer.

BACKGROUND: The results of sentinel node (SN) biopsy have been improved by the use of dye and isotope double tracers in melanoma and breast cancer. However, the usefulness of this double tracer technique has not been determined in gastric cancer. The aim of this study was to investigate the possibility of improving SN biopsy results by using double tracers in gastric cancer. METHODS: Sixty-four gastric adenocarcinoma patients preoperatively diagnosed as cT1N0, were enrolled in the study. (99m)Tc tin colloid was injected by preoperative endoscopy, and lymphoscintigraphy was performed prior to operation. After laparotomy, isosulfan blue was intraoperatively injected using an endoscope. Blue-stained or radioactive nodes were identified and defined as SNs. Gastrectomy with D2 lymphadenectomy was performed in all patients. All dissected lymph nodes were evaluated for metastasis by hematoxylin and eosin staining and immunohistochemistry. RESULTS: SN detection rates using dye, isotope, or both tracers were 95.3%, 84.4%, and 96.9%, respectively, and their corresponding sensitivities were 52.9%, 52.9%, and 70.6%. In the pT1 subset, the sensitivity of the double tracer was 87.5%; and in a subset of tumors with diameter <4.5 cm, this was also 87.5%. CONCLUSIONS: These findings confirm that SN biopsy results are improved by using double tracers in gastric cancer and suggest that SN biopsy is suitable in cases of small-sized early gastric cancer.

Adult↗
PubMed1978

An evaluation of the use of 99Tcm-dimercaptosuccinic acid (DMSA) as a static renal imaging agent.

The clinical value of 99Tcm-dimercaptosuccinic acid, utilized as a static renal imaging agent, has been analysed in 366 patients. It proved to be diagnostically most useful in space occupying lesions of the kidney when equivocal on IVU and provided useful additional information when used in the determination of divided renal function or the distribution of intrarenal function. Its use is contraindicated in the determination of divided renal function in obstructed kidneys because of accumulation of significant amounts of DMSA that are excreted by glomerular filtration. When DMSA uptake at three hours after injection is compared with 99Tcm-DPTA uptake from 90 to 150 seconds after bolus injection, there is a good correlation between the two methods of determination of divided renal function.

Humans↗
PubMed1984

A comparison of computed tomography, ultrasound and scintigraphy in the diagnosis of alcoholic liver disease.

In 35 alcoholics with histologically proven liver disease, computed tomography (CT), grey scale ultrasonography and liver scintigraphy were evaluated for their abilities to detect an abnormal liver and to identify the patients with cirrhosis. Abnormal studies were present on CT in 83% of patients, in 64% on ultrasound and in 94% on scintigraphy. In 10 control patients specificity was 90% by CT, 100% by ultrasound and 70% by scintigraphy. CT and ultrasound were poor in identifying the alcoholics with cirrhosis. Scintigraphy suggested cirrhosis in all but one of the patients with this diagnosis. Similar images were obtained in half of the patients with fatty change without cirrhosis but, with the exception of one patient, this appeared to be due to co-existent hepatitis. The results suggest that scintigraphy is the best of the imaging tests for screening alcoholics for cirrhosis.

Fatty Liver, Alcoholic↗
PubMed1987

Measurement of relative renal function. A comparison of methods and assessment of reproducibility.

A good correlation was found between relative uptake of 99Tcm dimercaptosuccinic acid (DMSA) and relative 131I orthoiodohippuric acid clearance in a group of 100 consecutive patients without evidence of renal failure. In the majority, attenuation correction was found to make no significant difference to relative function measurement. Those in whom it did could be readily identified by inspection of the posterior DMSA images at the time of examination. Two hundred patients were reviewed in whom serial studies had been performed over the previous 5 years. Differences in relative function greater than 5% indicated a high probability that a real change in renal function had occurred. We conclude that whilst renography and DMSA scintigraphy yield complementary information, relative function (L/L + R) can be measured equally well by either method, and the results are sufficiently reproducible to be clinically useful.

Humans↗
PubMed1987

The importance of using anterior and posterior views in the calculation of differential renal function using 99Tcm-DMSA.

Radionuclide techniques for determining relative renal function are well established. One simple method uses the count rate from static images obtained using 99Tcm-dimercaptosuccinic acid (DMSA). We have reviewed 277 DMSA scans and shown that it is important to obtain the geometric mean of counts from the anterior and posterior views in order to correct for the different amounts of attenuation for each kidney. If counts were obtained from the posterior view only, erroneous results would be obtained in 8% of children under 13 years, in 28% of patients aged between 13 and 20 years and in 32% of patients over 20 years of age.

Adolescent↗
PubMed1987

Effect of cirrhosis on accuracy of 99Tcm-tin colloid scintigraphy and ultrasound scanning in diagnosis of hepatocellular carcinoma.

The effect of cirrhosis on the accuracy of ultrasonography and scintigraphy in the diagnosis of hepatocellular carcinoma (HCC) has not been established. We have therefore studied the findings on ultrasound and scintigraphy in four groups of patients. Fourteen had HCC and cirrhosis, 13 had HCC but no cirrhosis, 53 had cirrhosis but no HCC and 31 had evidence neither of cirrhotic nor malignant liver disease. The accuracies of a positive interpretation of HCC on ultrasound and scintigraphy in the absence of cirrhosis were 85% and 66% respectively (NS), but fell (significantly in the case of scintigraphy: p less than 0.05) to 80% and 31% respectively in the presence of cirrhosis (p less than 0.01). The poorer performance of scintigraphy in the presence of cirrhosis was a result both of its lower sensitivity (50% compared with 85%) and the greater frequency of false positives (28% vs 5%: p less than 0.001). The accuracy of a negative interpretation of HCC on scintigraphy in the absence of cirrhosis was 96% but fell to 84% in the presence of cirrhosis, whereas on ultrasound it remained the same (96%). In conclusion, we recommend ultrasound in preference to scintigraphy as a more accurate technique for the diagnosis of HCC in the presence of cirrhosis.

Carcinoma, Hepatocellular↗
PubMed1990

Comparison of 99Tcm dimercaptosuccinic acid scans and intravenous urography in children.

A retrospective comparison of 99Tcm dimercaptosuccinic acid (DMSA) scans and intravenous urograms (IVUs) was performed on a large, unselected paediatric population to assess critically the relative merits of these two techniques. A total of 205 children were studied, providing 388 kidneys for comparison. The studies agreed in 81%, both being normal in 39%, and both abnormal in 42%. In 28 kidneys (7%), the IVU was abnormal when the 99Tcm DMSA was normal. There was a collecting system abnormality in 27 kidneys, but 10 kidneys also showed a parenchymal abnormality. In all these the parenchymal abnormality was global thinning on the IVU, and the contralateral kidney was small. In 40 kidneys (10%) the 99Tcm DMSA was abnormal when the IVU was normal: the abnormalities demonstrated were predominantly focal defects. After excluding IVUs of poor diagnostic quality, only 14 kidneys (3.6%) showed this disparity. The important clinical subgroups are infection, with or without reflux (27 kidneys), hypertension (4) and neonates with poor renal function (2). The one false positive 99Tcm DMSA was a result of an anatomical variant. Global thinning in a "normal" kidney on a 99Tcm DMSA scan may be overlooked when the contralateral kidney is poorly functioning and small.

Adolescent↗
PubMed1992

Scintigraphic abnormalities in patients with painful hip replacements treated conservatively.

A retrospective review of the scintigraphic appearances of 98 painful hip replacements was made. 16 patients (16%) underwent revision surgery whereas in the remaining 82 hips (84%), symptoms settled with conservative management. 73 of these (89%) had at least one area of increased activity on delayed diphosphonate scintigraphy with 27% having increased activity in three or more areas around the femoral component. Hips with increased activity at the lesser trochanter and tip were less likely to undergo spontaneous resolution of symptoms. Uncemented prostheses were more likely to have multiple areas of increased activity. Abnormalities in dynamic bone scintigraphy and gallium studies were also seen in patients whose symptoms resolved without surgery. Whereas a normal bone scintigram indicates that loosening or infection is most unlikely, the presence of increased activity does not necessarily indicate a need for revision surgery, even when multiple areas are present. A period of conservative management should be considered before operative intervention is undertaken.

Diphosphonates↗
PubMed1997

The value of ventilation-perfusion imaging in pregnancy.

Pulmonary embolism (PE) is a major cause of maternal death during pregnancy. The aims of this retrospective study were to review 5 years experience of ventilation-perfusion (V/Q) imaging in pregnancy, to evaluate the effect of the V/Q scan report on the referring clinician's use of anticoagulants and to monitor the course and outcome of pregnancy. 82 patients (aged 17-44 years, gestation 6-40 weeks) underwent V/Q imaging for suspected PE, over a 5 year period. Modified PIOPED criteria were used to assess the probability of PE. 31 patients were shown to have normal scans (38%); 19 (23%) had low probability (LP) scans; 14 (17%) had intermediate probability (IP) scans and 18 (22%) had high probability (HP) scans for PE. Referring clinicians saw the reports and took action within 12 h. Anticoagulation was continued or started in 31 patients (all HP, 12 IP and 1 LP). Anticoagulation was considered unnecessary in 52 patients (all normal, 19 LP and 2 IP). None of the patients with normal or LP scans had documented PE during the follow-up period (median 25 months, range 3-60 months). No complications of anticoagulation were observed and no adverse outcome of pregnancy were reported. V/Q imaging is a valuable technique in the management of pregnant women suspected of having PE.

Adolescent↗
PubMed2004

[First experiences with a new radiopharmaceutical for sentinel lymph node detection in malignant melanoma: (99m)Tc colloidal rhenium sulphide].

UNLABELLED: AIM of this study was to localize the sentinel lymph node by lymphoscintigraphy using technetium-99m colloidal rhenium sulphide (Nanocis), a new commercially available radiopharmaceutical. Due to the manufacturers' instructions it is licensed for lymphoscintigraphy. PATIENTS AND METHODS: 35 consecutive patients with histologically proved malignant melanoma, but without clinical evidence of metastases, were preoperatively examined by injecting 20-40 MBq Nanocis with (mean particle size: 100 nm; range: 50-200 nm) intradermally around the lesion. Additionally blue dye was injected intraoperatively. A hand-held gamma probe guided sentinel node biopsy. RESULTS: During surgery, the preoperatively scintigraphically detected sentinel lymph nodes were identified in 34/35 (97%) patients. The number of sentinel nodes per patient ranged from one to four (mean: n = 1.8). Histologically, metastatic involvement of the sentinel lymph node was found in 12/35 (34%) patients; the sentinel lymph node positive-rate (14/63 SLN) was 22%. Thus, it is comparable to the findings of SLN-mapping using other technetium-99m-labeled nanocolloides. CONCLUSION: (99m)Tc-bound colloidal rhenium sulphide is also suitable for sentinel node mapping.

Adult↗
PubMed1985

Osteomyelitis of the head and neck: sequential radionuclide scanning in diagnosis and therapy.

Sequential technetium and gallium scans of the head and neck were used to confirm the diagnosis of osteomyelitis and as an important therapeutic aid to delineate the transformation of active osteomyelitis to inactive osteomyelitis in 11 cases involving sites in the head and neck. Illustrative cases are presented of frontal sinus and cervical spine osteomyelitis and laryngeal osteochondritis.

Adult↗
PubMed1986

Osteomyelitis of the base of the skull.

Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism.

Aminoglycosides↗
PubMed1992

Results of the Harris-Galante cementless hip prosthesis.

We reviewed 82 primary arthroplasties (in 71 patients) in which cementless porous-coated hip prostheses were used. The mean age of the patients at operation was 52 years (24 to 86); they were followed up for an average of 62.1 months (60 to 66). The diagnosis was avascular necrosis of the femoral head in 35%, fracture of the femoral neck in 24%, primary osteoarthritis in 16% and miscellaneous in 25%. The average preoperative Harris hip score was 56.7 points and the average postoperative score was 83.3 points. Eight hips (10%) had component loosening; four had been revised and four were awaiting revision. In 27 hips (33%) there was a radiolucent line wider than 2 mm in zones 1 and 7. In 55 hips (67%) there was calcar resorption of more than 10 mm. Twenty patients (28%) complained of thigh pain although they had no radiographic evidence of loosening of a component. Factors that may have contributed to the poor clinical and radiographic results were: 1) inadequate surface area for bone ingrowth, particularly on the lateral aspect of the upper part of the prosthesis, 2) poor initial fit of the stem in the metaphysis, which resulted in cantilever motion of the proximal part of the stem about the well-fixed distal stem, and 3) the collar of the prosthesis, which prevented it from subsiding to a naturally stable position and caused damage to the calcar.

Bone Cements↗
PubMed2000

Hepatopulmonary syndrome: a prospective study of relationships between severity of liver disease, PaO(2) response to 100% oxygen, and brain uptake after (99m)Tc MAA lung scanning.

BACKGROUND: Because of the spectrum of intrapulmonary vascular dilation that characterizes hepatopulmonary syndrome (HPS), PaO(2) while breathing 100% oxygen varies. Abnormal extrapulmonary uptake of (99m)Tc macroaggregated albumin (MAA) after lung perfusion is common. GOAL: To describe relationships between (1) severity of liver disease measured by the Child-Pugh (CP) classification; (2) PaO(2) while breathing room air (RA) and 100% oxygen on 100% oxygen; and (3) extrapulmonary (brain) uptake of (99m)Tc MAA after lung scanning. METHODS AND PATIENTS: We prospectively measured PaO(2) on RA, PaO(2) on 100% oxygen, and brain uptake after lung perfusion of (99m)Tc MAA in 25 consecutive HPS patients. RESULTS: Mean PaO(2) on RA, PaO(2) on 100% oxygen, PaCO(2) on RA, and (99m)Tc MAA brain uptake were similar when categorized by CP classification. Brain uptake was abnormal (> or = 6%) in 24 patients (96%). Brain uptake was 29 +/- 20% (mean +/- SD) and correlated inversely with PaO(2) on RA (r = -0.57; p<0.05) and PaO(2) on 100% oxygen (r = -0.41; p<0.05). Seven patients (28%) had additional nonvascular pulmonary abnormalities and lower PaO(2) on 100% oxygen (215+/-133 mm Hg vs 391+/-137 mm Hg; p<0.007). Eight patients (32%) died. Mortality in patients without coexistent pulmonary abnormalities was associated with greater brain uptake of (99m)Tc MAA (48+/-18% vs 25+/-20%; p<0.04) and lower PaO(2) on RA (40+/-7 mm Hg vs 57+/-11 mm Hg; p<0.001). CONCLUSION: The degree of hypoxemia associated with HPS was not related to the CP severity of liver disease. HPS patients with additional nonvascular pulmonary abnormalities exhibited lower PaO(2) on 100% oxygen. Mortality was associated with lower PaO(2) on RA, and with greater brain uptake of (99m)Tc MAA.

Adolescent↗
PubMed2000

Quantitation of regional ventilation during the washout phase of lung scintigraphy: measurement in patients with severe COPD before and after bilateral lung volume reduction surgery.

STUDY OBJECTIVES: We sought to investigate the effect of lung volume reduction surgery (LVRS) on regional lung ventilation. DESIGN: Retrospective analysis of routinely acquired data before and after LVRS. SETTING: Large, urban, university medical center. PATIENTS: Twenty-nine patients with severe emphysema. INTERVENTION: Bilateral LVRS. MEASUREMENTS AND RESULTS: (133)Xe washout curves during lung scintigraphy exhibit a biphasic pattern (the first component of the washout curve [m(r)] corresponds to an initial rapid phase in washout that reflects larger airways emptying, and the second component [m(s)] reflects a slower phase of washout that is attributed to gas elimination via smaller airways). We analyzed six standardized regions of the lung (upper, mid, and lower zones of the right and left lung), and calculated m(r) and m(s) for each lung region. The mean (+/- SE) baseline FEV(1) was 0.69+/-0.04 L, total lung capacity (TLC) was 139 +/-4% predicted, and the residual volume (RV)/TLC ratio was 65+/-2%. The mean improvement in FEV(1) 3 months post-LVRS was 38%. Post-LVRS, m(r) and m(s) increased in 79 and 74 lung regions, respectively, and there was no relationship with respect to lung regions that had or had not been operated on. The increase in m(s), however, significantly correlated with the increase in FEV(1) (r = 0.66; p<0.0001) and the decrease in RV/TLC (r = -0.67; p<0.0001). An increase in m(s) also correlated with a decrease in PaCO(2) (r = -0.39; p = 0.03), but m(r) showed no relationship with any parameter. CONCLUSIONS: Small airways ventilation in lung regions that had and had not been operated on is associated with a greater improvement in lung mechanics following LVRS.

Administration, Inhalation↗