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Impact of functional genomics and proteomics on radionuclide imaging.

The assessment of gene function following the completion of human genome sequencing may be performed using radionuclide imaging procedures. These procedures are needed for the evaluation of genetically manipulated animals or newly designed biomolecules, which requires a thorough understanding of physiology, biochemistry, and pharmacology. The experimental approaches will involve many new technologies, including in vivo imaging with single photon emission computed tomography and positron emission tomography. Nuclear medicine procedures may be applied for the determination of gene function and regulation using established and new tracers, or using in vivo reporter genes, such as genes encoding enzymes, receptors, antigens, or transporters. Visualization of in vivo reporter gene expression can be performed using radiolabeled substrates, antibodies, or ligands. Combinations of specific promoters and in vivo reporter genes may deliver information about the regulation of the corresponding genes. Furthermore, protein-protein interactions and activation of signal transduction pathways may be visualized noninvasively. The role of radiolabeled antisense molecules for the analysis of messenger ribonucleic acid (RNA) content has to be investigated. However, possible applications are therapeutic intervention using triplex oligonucleotides with therapeutic isotopes, which can be brought near to specific deoxyribonucleic acid sequences to induce deoxyribonucleic acid strand breaks at selected loci. Imaging of labeled siRNA makes sense if these are used for therapeutic purposes to assess the delivery of these new drugs to their target tissue. Pharmacogenomics will identify new surrogate markers for therapy monitoring, which may represent potential new tracers for imaging. Drug distribution studies for new therapeutic biomolecules are needed at least during preclinical stages of drug development. New treatment modalities, such as gene therapy with suicide genes, will need procedures for therapy planning and monitoring. Finally, new biomolecules will be developed by bioengineering methods, which may be used for the isotope-based diagnosis and treatment of disease.

Animals↗

The diagnostic role of radionuclide imaging in evaluation of patients with nonhypersecreting adrenal masses.

UNLABELLED: The aim of this study was to evaluate the role of radionuclide imaging in the characterization of nonhypersecreting adrenal masses. METHODS: A total of 54 patients (19 men, 35 women; mean age, 50 +/- 16 y) with nonhypersecreting unilateral adrenal tumors that had been originally detected on CT or MRI underwent adrenal scintigraphy using different radiotracers. None of the patients showed specific symptoms of adrenal hypersecretion. Screening tests for excess cortical and medullary products showed normal adrenal hormone levels. Radionuclide studies (n = 73) included (131)I-norcholesterol (n = 24), (131)I-metaiodobenzylguanidine (MIBG) (n = 23), and (18)F-FDG PET (n = 26) scans. RESULTS: Histology after surgery (n = 31) or adrenal biopsy (n = 23) was obtained. Adrenal lesions were represented by 19 adenomas, 4 cysts, 1 myelolipoma, 1 neurinoma, 2 ganglioneuromas, 5 pheochromocytomas, 4 pseudotumors, 6 carcinomas, 2 sarcomas, and 10 metastases (size range, 1.5- to 5-cm diameter; mean, 4.9 +/- 3.1 cm). For norcholesterol imaging, diagnostic sensitivity, specificity, and accuracy were 100%, 71%, and 92%, respectively; the positive predictive value (PPV) of the norcholesterol scan to characterize an adrenal mass as an adenoma was 89%, whereas the corresponding negative predictive value (NPV) to rule out this type of tumor was 100%. For MIBG imaging, diagnostic sensitivity, specificity, and accuracy were 100%, 94%, and 96%, respectively; the PPV of the MIBG scan to characterize an adrenal mass as a medullary chromaffin tissue tumor was 83%, whereas the corresponding NPV to rule out this type of tumor was 100%. For FDG PET, diagnostic sensitivity, specificity, and accuracy were 100%, 100%, and 100%, respectively; the PPV of FDG PET to characterize an adrenal mass as a malignant tumor was 100%, whereas the corresponding NPV to rule it out was 100%. Furthermore, in 7 patients with malignant adrenal tumors, FDG whole-body scanning revealed extra-adrenal tumor sites (n = 29), allowing an accurate diagnosis of the disease's stage using a single-imaging technique. CONCLUSION: In patients with nonhypersecreting adrenal masses, radionuclide adrenal imaging, using specific radiopharmaceuticals such as norcholesterol, MIBG, and FDG, may provide significant functional information for tissue characterization. Norcholesterol and MIBG scans are able to detect benign tumors such as adenoma and pheochromocytoma, respectively. Conversely, FDG PET allows for recognition of malignant adrenal lesions. Therefore, adrenal scintigraphy is recommended for tumor diagnosis and, hence, for appropriate treatment planning, particularly when CT or MRI findings are inconclusive for lesion characterization.

19-Iodocholesterol↗

Gamma camera radionuclide images: improved contrast with energy-weighted acquisition.

An energy-weighted acquisition (EWA) technique has been developed that utilizes all scintillation events, weighting their contributions depending on their energy, to formulate a radionuclide image. Photopeak events from primary radiation contribute positively; scatter events contribute negatively, providing for scatter subtraction and improved image contrast. EWA is employed with an on-line weighted-acquisition module (WAM) as the data are acquired, rather than as a postprocessing technique. EWA was compared with normal window imaging in patients and in phantoms. For gallium-67 and thallium-201, contrast improved by as much as 40%. A much smaller improvement in contrast was observed with technetium-99m due to its ideal monoenergetic emissions. Single photon emission computed tomographic studies also showed improved contrast and were without artifact. EWA has great promise, and with further development quantitative scatter correction may be possible.

Gallium Radioisotopes↗

Radionuclide imaging for hyperparathyroidism (HPT): which is the best technetium-99m sestamibi modality?

BACKGROUND: To determine the utility of available radionuclide imaging modalities for preoperative parathyroid localization, we compared the accuracy of 4 types of technetium-99m ((99)Tc) sestamibi-based scans. METHODS: Over 5 years, 833 patients with sporadic primary hyperparathyroidism underwent either (99)Tc-sestamibi with planar views (Planar; n = 138); sestamibi single photon emission computed tomography (SPECT; n = 165); SPECT with thyroid (123)I-subtraction phase (SPECT/(123)I; n = 350); or SPECT combined with conventional CT (SPECT/CT; n = 180). The accuracy of each modality was determined on the basis of intraoperative parathyroid pathology, defined as single adenoma or multigland disease. RESULTS: Planar scans had significantly more false negatives (no tumor visualized) than SPECT-based scans (P < 0.01), but positive predictive values were similar. A false-negative scan was present in 38% of Planar scans, 27% SPECT, 4% SPECT/(123)I, and 17% SPECT/CT, with single adenoma found at operation in 77%, 64%, 53%, and 74%, respectively. When a scan had a single focus of uptake, SA was found at that location in 77%, 85%, 68%, and 87%, respectively. SPECT, SPECT/(123)I, and SPECT/CT did not significantly reduce the false-positive rate. CONCLUSIONS: We recommend obtaining multiplanar SPECT-based imaging, which offers 3-dimensional localization and improved detection of parathyroid tumors when compared with Planar scans. A negative scan did not predict multigland disease.

Humans↗

Radionuclide imaging in intrascrotal lesions.

Twenty-three patients with a variety of intrascrotal lesions were studied by means of imaging after the intravenous injection of sodium pertechnetate Tc 99m. The features of the radionuclide image correlated well with the clinical course or findings at surgical exploration or both. The conditions in which this technique was helpful in diagnosis included testicular torsion, acute inflammatory lesions, abscess, and hematoma.

Abscess↗

Emission tomography with a large-hole collimator (CACAO): a possible new way to improve radionuclide imaging.

This work aims to improve the quality of scintigraphy. It evaluates the use of a large-hole collimator, the Computer Aided Collimation Gamma Camera Project (CACAO), in SPECT. Acquisition data from the same object were simulated for CACAO and for a conventional collimator. Better signal-to-noise ratios were found for CACAO images, whatever the number of emitted photons. This work demonstrates that high-resolution images may be obtained with large-hole collimators. The combination of CACAO and pixilated detectors may further improve radionuclide imaging.

Algorithms↗

Radionuclide imaging of mesenchymal stem cells transplanted into spinal cord.

In vivo tracking of stem cells implanted to spinal cord by radionuclide imaging was investigated. The high expression of transferrin receptor on human mesenchymal stem cells (hMSCs) was verified by flow cytometry, radioligand binding and immunofluorescence. Radiolabelled transferrin was chosen as a tracer for scintigraphic imaging of the hMSCs transplanted into spinal cord of rabbits. Comparative experiments with radiolabelled human serum albumin as tracer and PBS as graft as well as ex vivo autoradiography demonstrated the specific uptake of radiolabelled transferrin of hMSCs. hMSCs could be detected in vivo with radiolabelled transferrin targeting at cellular transferrin receptors at an early stage after transplantation into spinal cord.

Animals↗

Radionuclide imaging in extraskeletal myxoid chondrosarcoma.

The authors present a case of extraskeletal myxoid chondrosarcoma. The MR study clearly showed the extent of the tumor and a "rings and arcs" pattern appeared after Gadolinium-DTPA administration in the T1 weighted images. Dynamic Tc-99m MDP and Tc-99m DTPA scintigraphy showed increased blood flow in the mass. The delayed 3-hour images demonstrated moderate Tc-99m MDP uptake, but intense Tc-99m DTPA accumulation in the tumor. Surprisingly, the Ga-67 scan failed to demonstrate the tumor.

Adult↗

Ectopic supernumerary kidney. Functional assessment using radionuclide imaging.

A three-year old male presented with severe hydronephrosis secondary to posterior urethral valves; a pelvic supernumerary kidney was discovered postoperatively. Radionuclide imaging assisted in the management of this patient by providing estimates of relative renal function. A report of the case and a complete summary of the literature concerning this unusual duplication anomaly follows.

Child, Preschool↗

Observations of radionuclide imaging in hypertrophic pulmonary osteoarthropathy.

99mTc pyrophosphate was employed in the study of patients with hypertrophic pulmonary osteoarthropathy. Several facts emerge when comparing the radionuclide, radiographic and clinical findings. Radionuclide imaging reveals the presence and extent of subperiosteal activity with greater clarity than does radiography. Synovitis associated with the syndrome is readily disclosed, and the regression of the skeletal manifestions following excision of the pulmonary lesion can be documented.

Female↗

Radionuclide imaging in scrotal swellings.

The patient with an acute scrotal swelling may be misdiagnosed and either have unnecessary surgery or not have necessary surgery. Radionuclide imaging has been used on 33 patients with scrotal swellings and has been found to be an easy, cheap and painless investigation with a high degree of accuracy of diagnosis. It is recommended as a useful diagnostic tool in cases of scrotal swelling of doubtful aetiology, particularly when emergency surgery is being considered.

Adult↗

Physiological considerations in radionuclide imaging of the penis during impotence therapy.

The increased use of intracorporeal drugs in the treatment of impotence has advanced our understanding of erectile physiology. Radionuclide imaging of the penis (nuclear penogram) has provided clinicians with a noninvasive, objective measure of blood flow and blood pool changes during erection and with assistance in the quantitative documentation of therapeutic effect.

Drug Combinations↗

Comparison of radionuclide imaging and ultrasonography of the liver.

Radionuclide liver scans and gray scale ultrasonography of the liver were compared in 456 patients with various abnormalities including normal variants, jaundice, abscesses, and metastatic diseases. In general the better resolution of sonography detected smaller and deeper focal lesions than nuclide scans, but nuclide studies were more informative in hepatocellular disorders. Nuclide studies frequently demonstrated lesions that could be further delineated by sonography as either cystic or solid. This ability was of particular significance in isolated liver lesions found during metastatic surveys.

Breast Neoplasms↗

Radionuclide bone imaging.

Radionuclide bone imaging of the skeleton, now well established as the most important diagnostic procedure in detecting bone metastases, is also a reliable method for the evaluation of the progression or regression of metastatic bone disease. The article concentrates on the technetium-99m agents and the value of these agents in the widespread application of low-dose radioisotope scanning in such bone diseases as metastasis, osteomyelitis, trauma, osteonecrosis, and other abnormal skeletal conditions.

Arthritis↗

201Thallium scintigraphy--a new method for radionuclide imaging of the uterus.

A new radionuclide method for uterus imaging is described. After intravenous application of 201Tl chloride the myometrium can be displayed by means of a gamma camera and a small digital computer. Early results suggest that Tl accumulation by the uterus depends on its histopathologic structure. After intra-uterine injection of 133Xe in saline demarcation between myometrium and uterine cavity is possible.

Adult↗