Can (18)F-FDG PET/CT scan change treatment planning and be prognostic in recurrent colorectal carcinoma? A prospective and follow-up study.

OBJECTIVE: To prospectively study whether in patients with resected primary colorectal cancer fluorine- 18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) examination could diagnose the stage, specify treatment procedure and be prognostic. SUBJECTS AND METHODS: This prospective study included 75 patients with resected primary colorectal adenocarcinoma referred for (18)F-FDG PET/CT to the National PET Center, at the Clinical Center of Serbia, Belgrade, from January 2010 to May 2013. Findings of (18)F-FDG PET/CT were compared to findings of subsequent histopathological examinations or with results of clinical and imaging follow-up. Patients were followed after PET/CT examination for a mean follow-up time of 16.7±5.9 months. RESULTS: In the detection of recurrent disease (18)F-FDG PET/CT showed overall sensitivity, specificity, PPV, NPV and accuracy of 96.6%, 82.4%, 94.9%, 87.5% and 93.3%, respectively. In the detection of stages I and II sensitivity, specificity and accuracy of (18)F-FDG PET/CT were: 88%, 96.6% and 94.7%, respectively, and in the detection of stages III and IV sensitivity, specificity and accuracy were 94.9%, 87.5% and 93.3%, respectively. These findings prevented or changed intended surgical treatment in 12/32 cases. Univariate and multivariate Cox proportional regression analyses revealed that metastatic recurrence (stages III and IV) was the only and independent prognostic factor of disease progression during follow-up (P=0.012 and P=0.023, respectively). Although, survival seemed better in patients with local recurrence compared to metastatic recurrent disease, this difference did not reach significance (Log-rank test; P=0.324). In addition, progression-free survival time was significantly longer in patients in whom (18)F-FDG PET/CT scan led to treatment changes (Log-rank test; P=0.037). CONCLUSION: (18)F-FDG PET/CT was sensitive and accurate for the detection and staging of local and metastatic recurrent colorectal carcinoma, with higher specificity in the detection of local recurrences. The (18)F-FDG PET/CT scan induced treatment changes in 30/75 patients, including 12/32 patients in which surgical treatment was previously planned, and progression free survival time was significantly longer in these patients.

The diagnostic performance and added value of (18)F-FDG PET/CT in the detection of liver metastases in recurrent colorectal carcinoma patients.

OBJECTIVE: The aim of this study was to assess the value of (18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT in detection of liver metastases in patients with suspected recurrent colorectal carcinoma, as well as to compare diagnostic performance of (18)F-FDG PET/CT with conventional imaging methods (MDCT). SUBJECTS AND METHODS: This study included 73 patients with resected primary colorectal adenocarcinoma referred for (18)F-FDG PET/CT to the National PET Center, at the Clinical Center of Serbia, Belgrade, from January 2010 to May 2013, with suspicion of recurrence. The patients underwent (18)F-FDG PET/CT examination on a 64-slice hybrid PET/CT scanner (Biograph, TruePoint64, Siemens Medical Solutions, Inc. USA). Prior to (18)F-FDG PET/CT all patients underwent contrast-enhanced MDCT. Findings of (18)F-FDG PET/CT and MDCT were compared to findings of subsequent histopathological examinations or with results of clinical and imaging follow-up over at least six months. Final diagnosis of liver metastases of colorectal cancer was made either by histopathological examination of specimen after biopsy or surgery, or based on clinical, laboratory and imaging evaluation during first six months after PET/CT scan. RESULTS: In detection of liver metastases (18)F-FDG PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 83.3%, 95.3%, 92.6%, 89.1% and 90.4%, respectively. In addition, MDCT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy in detection of liver metastases of 60%, 88.4%, 78.3%, 76% and 76.7%, respectively. There was significant difference in sensitivity (83.3% vs 60%; P=0.045) between these two methods. In addition, significant difference was observed in accuracy between PET/CT and MDCT (90.4% vs 76.7%; P=0.016). The higher specificity in visualization of liver metastases was also achieved by (18)F-FDG PET/CT compared to MDCT (95.3% vs 88.4%), but this difference was not significant (P=0.37). CONCLUSION: (18)F-FDG PET/CT was highly sensitive, specific and accurate method in detection of liver metastases in patients with suspected recurrent colorectal carcinoma in our study. This hybrid imaging showed superior diagnostic performance in evaluation of suspected colorectal cancer liver metastases compared to conventional imaging.

Clinical value of immunoscintigraphy in the rectal carcinomas: immunoscintigraphy of rectal carcinomas.

BACKGROUND/AIM: The aim of this study was to evaluate the clinical reliability of the immunoscintigraphy with radiolabeled monoclonal antibodies for the detection of metastases and recurrences of rectal carcinomas. METHODOLOGY: A total of 65 patients underwent immunoscintigraphy with radiolabeled monoclonal antibodies. Indication for that examination was suspicious rectal cancer or suspicious rectal cancer recurrence and/or metastases. RESULTS: The method proved to have 92.7% sensitivity, specificity 83.3%, positive predictive value 90.5%, negative predictive value 87.0% and accuracy 89.2%. There was a statistically significant relationship between immunoscintigraphy findings and rectoscopy findings (rs=0.415, p=0.013), as well as significant relationship between immunoscintigraphy findings and US findings (rs=0.332, p=0.001). Tumor marker levels were in positive correlation with findings of immunoscintigraphy (rs=0.845, p=0.001), especially raised CEA level (rs=0.816, p=0.004). Patients with higher CA19-9 level had higher Duke's stage (p=0.025). CONCLUSIONS: We can conclude that immunoscintigraphy can be helpful in the detection of metastases and recurrences of colon carcinomas.

Gallbladder motility disorders estimated by non-invasive methods.

BACKGROUND/AIMS: The aim is to compare the radionuclide (DC) and ultrasonographic (US) method in the assessment of gallbladder (GB) motility. METHODOLOGY: The study was performed in 15 controls (C), 10 patients with acute cholecystitis (AC), 20 patients with chronic acalculous cholecystitis (CAC), 26 patients with chronic cholecystitis with calculosis (CCC) as well as in 15 patients with GB dyskinesia (D). GB emptying period (EP), ejection fraction (EF) and ejection rate (ER) were estimated with dynamic cholescintigraphy (DC) and US. RESULTS: The DC and US finding in the patients with AC was typical in all the patients, i.e. GB was not visualized at all on DC, while on US, stone was visible in the cystic duct. There were significant differences (p<0.05) between the EF and ER values obtained between C and the three groups of patients CAC, CCC and D, using both methods. However, there were no significant differences in EF, EP and ER values among CAC, CCC and D (p>0.05). There was also high correlation between the results obtained with both methods in all the groups of patients studied. CONCLUSIONS: The results obtained by both methods are valuable for the assessment of GB motility. Although there are no significant differences and there is a high correlation between the values, radionuclide method is more precise, because it can register motility continuously.

Diagnosis of mesh infection after abdominal wall hernia surgery - role of radionuclide methods.

BACKGROUND/AIMS: The aim of this investigation was to evaluate the role of detection of late mesh infection following incisional hernia repair with radiolabeled antigranulocyte antibodies. METHODOLOGY: Mesh infection diagnoses were set up with clinical examination and laboratory analysis and confirmed by ultrasonography (US), computerized tomography (CT), scintigraphy with 99mTc-antigranulocyte antibodies and microbiological examination. RESULTS: Of the 17 patients investigated, 6 had a late mesh infection, and 11 had both mesh infection and recurrent incisional hernia. Clear clinical signs of late mesh infection were present in 13 patients. Four remaining patients had non-specific discomfort and recurrent incisional hernia without clinical manifestation of mesh infection ('silent infection'). US was positive in 12/17 patients, CT in 13/17 patients, while scintigraphy with antigranulocyte antibodies in 17/17 patients. Therefore, sensitivity of US was 71%, of CT 76% and of scintigraphy 100%. In four patients late mesh infection was confirmed exclusively by 99mTc-antigranulocyte antibody scintigraphy, while US and CT did not indicate the infection. CONCLUSIONS: According to the present results, scintigraphy with 99mTc antigranulocyte antibodies is a useful method for the detection of 'silent' abdominal wall infections after surgery, which is very important for prompt and appropriate therapy.

Radioimmunoscintigraphy of colorectal carcinomas with 99mTc-labelled antibodies.

BACKGROUND/AIMS: The aim of the study was the evaluation of the clinical validity of immunoscintigraphy with 99mTc labeled antibodies for the detection of metastases and recurrences of colorectal carcinomas. METHODOLOGY: We examined 17 patients with colorectal carcinomas. Scintigraphy was performed with anti-CEA MoAb 99mTc-BW 431/26. RESULTS: Recurrences of carcinomas were detected and confirmed by surgery in 6 patients, recurrences with liver metastasis in 5 patients, and only liver metastases in 3 patients. Planar immunoscintigraphy was positive in 5/8 patients with liver metastases and 8/11 patients with recurrences, whereas in 1/8 liver metastases and 3/11 recurrences were detected only by tomography. In two patients with metastases in the abdominal lymph nodes immunoscintigraphic findings both on planar scintigraphy and tomoscintigraphy were false negative. CONCLUSIONS: Immunoscintigraphy with 99mTc labeled antibodies can be useful in the diagnosis of recurrences and metastases of colorectal carcinoma, viability assessment after radiotherapy and in the choice of the adequate surgical treatment.

Is identification of malignant lesions of the liver and of hemangiomas possible by Doppler ultrasonography and radionuclide angiography?

The aim of this study was to try to diagnose malignant liver lesions and hemangiomas by means of vascularisation and perfusion studies. The study was performed in 32 patients with hepatocellular carcinoma (HCC), in 74 with metastatic liver carcinoma (MLC) and in 40 with hemangiomas (H). Color Doppler ultrasonography (DUS) was done with an ATL Ultramark 9 apparatus with convex probe 2.5 MHz using pulse and DUS. Hepatic radionuclide angiography (HRA) was performed with bolus injection of 740 MBq (99m)Tc-pertechnetate, (1 min, 1 f/s), using ROTA scintillation camera and MicroDelta computer. Hepatic perfusion index (HPI) indicated the percentage of the portal blood inflow to the liver. Our results showed that in HCC and MLC there was a decrease of portal inflow while arterial inflow was increased resulting in pulse arterial wave velocity increase and in continuous venous waves velocity in the tumors. There was significant linear correlation between the increase of the arterial inflow and the arterial pulse wave found in the center and in the margin of the tumors. In hemangiomas, hepatic perfusion index related to arterial inflow was within normal range. In conclusion, our results suggest that HCC and MLC have specific characteristics in vascular and/or perfusion studies while hemangiomas show normal liver parenchyma findings.

Relationship between Helicobacter pylori infection estimated by 14C-urea breath test and gender, blood groups and Rhesus factor.

The aim of this study was the detection of helicobacter pylori (HP) infection and estimation of this infection relationship with age, gender, blood groups and Rhesus factor, as well as the assessment of the accuracy of the method. A total of 227 patients with gastritis were examined. Blood ABO groups and Rh positivity were determined using standard tests. Infection by HP was proved by (14)C-urea breath test and gastric biopsy. Patients were aged 20-81 years (X=51.7 years) and the presence of HP was not related to the age (P>0.05). From the total number of patients, 25/69 males and 68/158 females were HP positive. There was no significant difference between genders and HP infection (P>0.05). From the 227 investigated patients, 69 (30%) belonged to blood group O, 96 (42%) to A, 40 (18%) to B and 22 (10%) to AB. HP was detected in 27/69 patients with blood group O, 45/96 patients with blood group A, 16/40 patients with blood group B and 5/22 patients with blood group AB. There was no statistically significant difference (P>0.05) in the incidence of HP infection between these groups (proving that HP infection did not depend upon the blood groups). Also, there was no significant correlation between the presence of particular blood group in HP+ patients related to the reported frequency of the blood groups in Serbian population (0--38%, A--42%, B--15%, AB--5%). HP was found in 16/36 Rh- and in 77/191 Rh+ patients without statistical difference (P>0.05). Also, there was no significant correlation of the presence of the Rh factor in the HP positive patients to the frequency of the Rh factor in the Serbian population (84% Rh+ and 16% Rh-). The basic value of the HP+ test was slightly, but not significantly lower in comparison to the HP- patients (P>0.05). On the contrary, test values showed a highly significant difference (P<0.01) in HP+ and HP- patients. In conclusion, in adults HP infection does not depend upon the patient's age, gender, blood group type or Rh factor. In clinical terms, there were 93 true positive (TP), 129 true negative (TN), 5 false negative (FN) and 0 false positive (FP) patients. Sensitivity of the method was 94.9%, specificity 100%, positive predictive value 100%, negative predictive value 96.3% and accuracy 97.8%.

Detection of gastrointestinal and abdominal infections by 99mTc-antigranulocyte antibodies.

BACKGROUND/AIMS: The aim of the study was detection of abdominal infections by 99mTc- antigranulocyte antibodies. METHODOLOGY: Total of 36 patients with clinical suspicion on abdominal or gastrointestinal infections was investigated. RESULTS: There were 23 true positive (TP) findings (one pulmonary abscess, 2 subhepatic abscesses after surgery, 2 perianal fistula, 2 chronic and 4 acute appendicitis, 5 abdominal and 3 pelvic abscesses, 3 M. Crohn, one ulcerative colitis), 9 true negative (TN) (3 tumors of the coecum, 2 tumors of papilla Wateri, 2 gastric carcinoma, 2 colon carcinoma), and 4 false negative (FN) (2 abscesses subphrenic and 2 enterocolic fistula). False positive (FP) findings were not observed. The smallest lesion found was 19x18 mm. SPECT increased the number of TP findings from 17 to 23. Fifteen of 23 infectious of inflammatory lesions could be detected in the early scan. Sensitivity was 85%, specificity 100%, positive predictive value 100%, negative predictive value 69% and accuracy 89%. CONCLUSION: According to the present results, scintigraphy with 99mTc antigranulocyte antibodies is a useful method for detection and assessment of exact localization abdominal infections, which is very important for the prompt and appropriate therapy.

The association of early postoperative lactate levels with morbidity after elective major abdominal surgery.

Lactate levels are widely used as an indicator of outcome in critically ill patients. We investigated the prognostic value of postoperative lactate levels for postoperative complications (POCs), mortality and length of hospital stay after elective major abdominal surgery. A total of 195 patients were prospectively evaluated. Lactate levels were assessed on admission to the intensive care unit (ICU) [L0], at 4 hours (L4), 12 hours (L12), and 24 hours (L24) after the operation. Demographic and perioperative clinical data were collected. Patients were monitored for complications until discharge or death. Receiver operating characteristic (ROC) curves were used to determine the predictive value of lactate levels for postoperative outcomes. The best cut-off lactate values were calculated to differentiate between patients with and without complications, and outcomes in patients with lactate levels above and below the cut-off thresholds were compared. Univariate and multivariate analyses were used to identify variables associated with POCs and mortality. Seventy-six patients developed 184 complications (18 deaths), while 119 had no complications. Serum lactate levels were higher in patients with complications at all time points compared to those without complications (p < 0.001). L12 had the highest predictive value for complications (AUROC12 = 0.787; 95% CI: 0.719-0.854; p < 0.001) and mortality (AUROC12 = 0.872; 95% CI: 0.794-0.950; p < 0.001). The best L12 cut-off value for complications and mortality was 1.35 mmol/l and 1.85 mmol/l, respectively. Multivariate analysis revealed that L12 ≥ 1.35 mmol/l was an independent predictor of postoperative morbidity (OR 2.58; 95% CI 1.27-5.24, p = 0.001). L24 was predictive of POCs after major abdominal surgery. L12 had the best power to discriminate between patients with and without POCs and was associated with a longer hospital stay.

Hepatic radionuclide angiography and Doppler ultrasonography in the detection and assessment of vascular disturbances in the portal system.

BACKGROUND/AIMS: The aim of the study was evaluation of the morphology of the blood vessels, blood flow velocity and direction with Doppler ultrasound (D-US) and correlation with the relative liver parenchymal perfusion assessed by hepatic radionuclide angiography (HRA). METHODOLOGY: Real-time, D-US and HRA were performed in 108 patients. RESULTS: In patients with portal venous aneurysm, hepatopetal blood flow was increased, while portal perfusion did not differ from controls. In portal hypertensive patients, D-US detected dilatation of the portal system veins, with decreased blood flow. In comparison to the portal perfusion in controls and portal venous aneurysm, values were significantly (p < 0.01) lower in chronic active hepatitis and liver cirrhosis and differed between themselves (p < 0.01). In the groups of cirrhotic patients with esophageal varices, sclerosed esophageal varices, recanalized umbilical vein, partial portal thrombosis and cavernous portal vein with hepatofugal, hyperkinetic or slow blood flow, and very low velocities beside the thrombi, portal perfusion was lower (p < 0.01) than in controls, portal venous aneurysm, chronic active hepatitis and liver cirrhosis without collaterals. In complete thrombosis, minimal collateral flow was found with D-US, while HRA proved no portal supply. CONCLUSIONS: D-US and HRA are complementary for the estimation of various liver vascular disorders.

Immunoscintigraphy of colorectal carcinomas with radiolabeled monoclonal antibody fragments.

BACKGROUND/AIMS: The aim was evaluation of the accuracy and clinical impact of the immunoscintigraphy for the detection of metastases and recurrences of colorectal carcinomas using two different radiolabeled antibody fragments. METHODOLOGY: The study was performed in 5 patients with IMACIS 1 containing the cocktail of 111MBq 131I MoAb 19-9 F(ab')2 and MoAb anti-CEA F(ab')2 and 8 patients with INDIMACIS 19-9 containing 150MBq of 111In-labeled MoAb 19-9 F(ab')2. RESULTS: With IMACIS 1, in all the patients, both tumor marker values were elevated. The number of TN was 3/5 and TP 2/5. From 2 TP, one had recurrence of the diseases with peritoneal carcinosis and one with liver metastases. In one patient, the results influenced the therapeutical management. With INDIMACIS 19-9, there were 2/8 TN, with borderline value of CEA and CA 19-9. TP were 6/8 (all with elevated tumor marker values, five of them many times; 3 with recurrences, 1 with recurrence and liver metastases and two with only liver metastases. In three patients, immunoscintigraphy influenced patient management. CONCLUSIONS: With both radiopharmaceuticals, immunoscintigraphy significantly influenced the patient management or it was complementary. It would be performed in the detection of recurrence, assessment of viability and follow-up of the therapy.

Simultaneous dynamic study of gastric emptying and changes of serum levels of gut hormones in patients after peptic ulcer surgery.

BACKGROUND: The aim was to examine the influence of different modalities of peptic ulcer surgery on the gastric emptying (GE) pattern and related serum level changes of selected gut hormones. MATERIAL AND METHODS: Fifty eight subjects were examined. In 48 of them peptic ulcer surgery was performed at least six months before the examination: Billroth I (B1) in 11, Billroth II (B2) in 16, B1 with the selective vagotomy--Harkins 1 (H1) in 9 and B2 with the selective vagotomy--Harkins 2 (H2) in 12. Ten healthy volunteers (C) were also examined. RESULTS: The results of gastric emptying showed that the lag phase duration was inversely related to the GE rates, and the GE pattern was linear in both controls (C) and in operated patients, except in B2 group, in which the GE pattern was exponential. In comparison with C group, GE was slower in B1, H1 and H2 groups, and faster in B2 group. The plasma gastrin values in C group, showing two peaks, were higher in relation to other groups. In relation to C group, higher values of motilin were obtained in patients after the selective vagotomy. The plasma somatostatin values recorded in B1 and H1 groups, showing the marked peaks, were higher in relation to C group. In relation to C group the highest plasma neurotensin values were obtained in B2 group. CONCLUSIONS: In order to understand entirely the influence of peptic ulcer surgery on the GI function, further research of the role of specific hormones and neuropeptides is needed, which would enable more precise selection of the therapy in order to prevent postvagotomy and postgastrectomy syndromes.

The relationship between gallbladder motility and the presence of enterogastric reflux.

BACKGROUND: The aim of the study was an estimation of the relation between the gallbladder (GB) motility function and the presence and quantity of enterogastric reflux (EGR). MATERIAL AND METHODS: We investigated 172 patients: 90 with physiological GB function (filling and emptying) (FGB), 21 with impaired GB function (prolonged filling and ejection fraction < 45%) and 61 with afunctional gallbladder (AGB) (without visualisation). The study was performed during 90 min (1 f/min) after i.v. application of 185 MBq 99m Tc-dietil IDA. After 30 min, a test meal was given while at the end the stomach was marked. According to the parameters from time activity curves over the stomach and hepatobiliary system, the index of EGR was calculated, while GB filling and ejection fraction were estimated from the GB time/activity curve. RESULTS: Most frequently, EGR occurs in AGB (47.5%), followed by IGB (43%) and FGB (41%), without significant differences (p > 0.05). The significantly (p < 0.05) highest value of EGR was obtained in the patients with AGB in comparison to IGB and FGB. EGR values were in correlation (r = 0.168, p < 0.05) with the functional status of the GB. In the patients with pathological values of EGR (> 10%), significantly higher values (p < 0.05) are obtained in AGB than in IGB and FGB. Also, these values were in correlation with the functional status of the GB (r = 0.284, p < 0.05). CONCLUSIONS: We can conclude that EGR occurs more frequently in the patients with afunctional GB in comparison with those with functional and decreased motor function. Also, EGR quantity is in correlation with the impairment of the GB function.

Clinical outcome of early glottic carcinoma in Serbia.

OBJECTIVE: Proposed methods for treating early glottic carcinoma are cordectomy through laryngofissure, laser cordectomy, and radiotherapy. The aim of the study was to conduct comprehensive study to evaluate oncological and functional results of different treatment modalities for Tis and T1 glottic carcinoma, identify prognostic factors for the outcome of treatment and decide where we stand in applying worldwide standards of early glottic carcinoma treatment. METHODS: Prospective study was conducted on 221 patients treated with Tis and T1 glottic carcinoma from 1998 to 2003 (72 patients were treated endoscopically with CO2 laser, 75 patients with cordectomy through laryngofissure and 74 with radiotherapy), with follow-up period from 38 to 107 months. Important demographic and clinical variables were analyzed. Voice quality after the treatment was assessed using multidimensional voice analysis. RESULTS: Comparing oncological results of three modalities of treatment, there were no significant differences. Functional results of treatment were better after laser cordectomy and primary radiotherapy than following the open cordectomy. Five-year survival rate was almost identical in all three groups of patients, and important prognostic factors for survival were age and histological grade of the tumor. CONCLUSION: Considering that the choice of treatment in our country is also greatly influenced by other paramedical factors, such as distance from treatment facility, reliability of follow-up, significant time delay of radiotherapy because of small number of radiology centers and strong patients' surgeon and treatment preference, we consider endoscopic laser surgery highly efficient and preferred choice of treatment for early glottic carcinoma.

Helicobacter pylori infection in various groups of patients studied, estimated by 14C-urea breath test.

The aim of this study was the detection of helicobacter pylori (HP) infection and estimation of the clinical validity and the accuracy of the 14C-urea breath test in the groups of patients studied. A total of 248 patients with gastric diseases were examined. There were 38 patients with gastric ulcer, 41 with duodenal ulcer, 43 with gastroduodenitis erosiva, 26 with hiatus hernia, 36 with gastric carcinoma and 64 patients with gastritis. There were 103 true positive (TP), 139 true negative (TN), 4 false negative (FN) and 2 false positive (FP) patients. There was no significant difference in the incidence of the HP infection between the groups of patients studied (p > 0.05). Sensitivity of the method was 96.3%, specificity 98.6%, positive predictive value 98.1%, negative predictive value 97.2% and accuracy 97.6%. Our results point out that the method is very accurate for the detection of HP infection.

Preliminary experience with 18f-fluoro-deoxy-glucose positron emission tomography/computed tomography in pediatric oncology patients.

The aim of this study was to present preliminary experience with FDG PET/CT in pediatric oncology patients in National PET Center, Clinical Center of Serbia and to asses its impact on management of malignancies in children. 33 FDG PET/CT scans were performed on 30 pediatric patients. PET/CT imaging was performed for staging the disease, assessing therapy efficacy and diagnosing recurrent or metastatic disease. FDG PET/CT changed the stage of the disease in 60.6% (20/33) of the cases. 14 patients were down-staged after PET/CT, mostly patients with Hodgkin's disease, were in 7/10 cases PET/CT showed no activity in residual masses. Six scans led to upstage of the disease. In three cases PET/CT did not change the stage of disease, but has showed new distant metastases. In conclusion, FDG PET/CT showed important role in managing pediatric patients with different malignancies and was useful complementary diagnostic tool to conventional imaging methods.

Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis.

OBJECTIVE: Assessment of the first febrile urinary tract infection (UTI) in children has been the subject of debate for many years. Diagnosis of acute pyelonephritis (APN) is usually based on clinical and biological data. The clinical usefulness of early Tc-99m DMSA scintigraphy remains controversial, although it may influence the type and duration of treatment. The aim of this study was to assess the role of initial cortical scintigraphy in the detection of early renal parenchymal damage in children highly suspected of having APN and to compare the scintigraphic findings with selected clinical/laboratory parameters and ultrasonography. METHODS: A prospective study was conducted in 34 infants and young children (18 boys, 16 girls), aged 1.5-36 months (mean 9.8 ± 8.7 months), hospitalized with a first episode of clinically suspected APN. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography (US), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC) and urine analyses were performed. RESULTS: DMSA scintigraphy showed changes consistent with APN in 27/34 (79%) patients, with a mean age of 10.9 months, including 12 males (44%) and 15 (56%) females. Out of 9 febrile children with negative urine culture and supportive evidence of UTI, scintigraphy showed parenchymal involvement in 8 children (24% in the whole group, 30% in scintigraphically documented APN). There were no statistically significant correlations between the frequency or size of the initial scintigraphic abnormalities and age, sex, body temperature, CRP levels or ESR. A CRP level of >54 mg/L and a WBC of >13,300/mm³ had sensitivities of 56 and 59% and specificities of 86 and 71%, respectively. US showed changes consistent with APN in 7/34 (21%) in the whole group and in 7/27 (26%) patients with positive cortical scan (p < 0.05). CONCLUSION: Initial DMSA renal scintigraphy is a sensitive method for the early diagnosis of APN in young children and is useful in the assessment of the severity of kidney injury even in patients with negative urine culture. Clinical, biological and ultrasound parameters do not identify children with renal damage. Normal DMSA study, excluding parenchymal involvement and late sequelae, could minimize the use of scintigraphy in the follow-up and reduce the redundancy of cystography.

Possible role of the scintigraphic estimation of the relative liver perfusion in the diagnosis and therapy of liver carcinomas.

BACKGROUND: The aim of the study is evaluation of the possible role of the scintigraphic estimation of the relative liver perfusion in diagnosis and the choice of treatment of liver carcinomas. MATERIAL AND METHODS: Hepatic perfusion index was obtained by dynamic scintigraphy in 126 patients. RESULTS: In the control group values did not differ from the value in the patients with benign tumors (p > 0.05). However, in hepatocellular carcinoma and liver metastases of different tumors, HPI values were significantly decreased in comparison to controls and benign tumors (p < 0.01), but they didn't differ between themselves (p > 0.05). The values were especially low in the patients with malignant diseases in the liver accosciated with vascular disturbances in the portal system. CONCLUSION: HRA could be easily done during the different conventional nuclear medicine methods. It can be an useful method for the assessment of different degrees of hemodynamic alterations in portal system, for differential diagnosis of benign and malignant liver tumors, as well as for assessment of the liver tissue and tumor perfusion, which might be helpful in the decision making for the undertaking of intraarterial (radionuclide, chemotherapy etc.) therapy.