Comparative evaluation of the cytotoxic effects of different oral antiseptics: A primary culture study.

BACKGROUND: Dental plaque is a major oral health problem with severe consequences. Oral antiseptics provide important means for controlling dental plaque formation and are widely used by the public. However, some of these antiseptics have been shown to have side effects on oral tissues. AIM: In this study, we aimed to investigate the time and dose-dependent cytotoxic effects of various antiseptics on primary human gingival fibroblasts (HGF). METHODS: HGF cells were obtained using primary culture techniques. The effects of various doses of 5 antiseptics containing Chlorhexidine-Gluconate (CHX), CHX with Benzydamine-Hydrochloride (Benzydamine-HCl), Povidone-Iodine (PVP-I), Benzydamine-HCl and Essential-Oil on HGFs were analyzed by using 2,3-bis (2-metoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide cell viability assay after 30, 60, and 180 s of exposure. Results: Cell viability analyses showed that cell death increased in an application time and dose-dependent manner. There was a statistically significant difference in the effects of each antiseptic on live-cell densities compared to the control group and each other (P < 0.001). Antiseptic containing 0.2% CHX showed the highest cytotoxicity on cells. The remaining viable cell density after administration of 0.2% CHX at a dose of 12.5% for 30 s is 35.19%. The high cytotoxic effect of 0.2% CHX was followed by 0.12% CHX with 0.15% Benzydamine-HCl, PVP-I and 0.15% Benzydamine-HCl groups. The lowest cytotoxic effect was observed for the Essential-Oil containing antiseptic solution. CONCLUSIONS: The results of this study show that these five antiseptic agents have variable effects on in vitro HGF proliferation. The doses and administration times of antiseptics should be controlled carefully during dental applications.

Examining the aetiopathogenesis of varicoceles: the relationship between retroperitoneal adipose tissue and testicular venous drainage.

This study evaluated the effect of retroperitoneal adipose tissue on testicular venous drainage and tested the nutcracker phenomenon by clinical and imaging findings. A total of 95 patients were included. The patients were evaluated with a detailed medical history and physical examination for varicocele. Their weight, height and waist circumference were also recorded. Body mass index was calculated as weight (kg)/height squared (m(2) ). Pampiniform plexus diameters were measured by scrotal colour Doppler ultrasonography, and retroperitoneal adipose tissue was evaluated by noncontrast abdominal computed tomography. We determined an almost significant correlation between BMI and varicocele presence by physical examination (P = 0.06). However, there was a significant relationship between WC and varicocele identified by physical examination (P = 0.021). There was a positive and significant relationship between BMI and pampiniform plexus diameters. Furthermore, we detected a negative correlation between retroperitoneal adipose tissue measurements and CDU findings. Additionally, there was a significant correlation between WC, pampiniform plexus diameters and CT findings. It is concluded that increasing BMI and increasing WC may play a protective role in the development of varicocele. There is a need for further studies to verify the effect of obesity on varicocele formation.

Unenhanced respiratory-navigated NATIVE® TrueFISP magnetic resonance angiography in the evaluation of renal arteries: Comparison with contrast-enhanced magnetic resonance angiography.

PURPOSE: To compare unenhanced three-dimensional (3D) NATIVE® true fast imaging with steady-state precession (TrueFISP) magnetic resonance (MR) angiography with the more conventional MR angiography technique obtained after intravenous administration of a gadolinium chelate in the evaluation of renal arteries and their branches in patients with suspected renal artery stenosis. MATERIALS AND METHODS: A total of 39 patients (25 men, 14 women) with a mean age of 51.4±17.5years (SD) (range: 10-82years) were included in the study. All patients with suspected renal artery stenosis underwent unenhanced 3D NATIVE® TrueFISP MR angiography and contrast-enhanced MR angiography. The two MR angiography methods were compared by two independent readers for image quality using a four-point scale, diagnostic performance and grading of renal artery stenosis on a total of 78 renal arteries. RESULTS: For both readers image quality of unenhanced 3D NATIVE® TrueFISP MR angiography (3.12 to 3.63) was greater than that of contrast-enhanced MR angiography (1.94 to 2.71) for renal artery ostium-trunk and the left renal artery segmental branches. The sensitivity of 3D NATIVE® TrueFISP MR angiography for the diagnosis of renal artery stenosis was 100% for both readers for the right renal artery and 66% and 80% for the left renal artery for reader 1 and reader 2, respectively. Agreement between 3D NATIVE® TrueFISP MR angiography and CE-MR angiography was 95% (74/78) for reader 1 and 92% (72/78) for reader 2. CONCLUSION: Unenhanced NATIVE® TrueFISP magnetic resonance angiography can play an additional role in the evaluation of renal arteries in patients with hypertension, especially in subjects at risk of nephrogenic systemic fibrosis.

Anatomic variations of popliteal artery: Evaluation with 128-section CT-angiography in 1261 lower limbs.

PURPOSE: The purpose of this study was to evaluate the variations in popliteal artery branching in a large population on computed tomography angiography (CTA) using a 128-section configuration. MATERIALS AND METHODS: A total of 652 patients (532 men, 120 women) with a mean age of 61.7±18.1 (SD) years (range: 11-93 years) who had CTA of the lower limbs with a total of 1261 lower limbs (bilateral limbs in 609 patients, unilateral limb in 43 patients) were retrospectively included. CTA images were reviewed for popliteal artery branching and possible variations. RESULTS: The usual pattern of popliteal artery branching was observed in 1118 limbs (88.7%) (type IA) whereas branching variations without the usual pattern were found in 143 limbs (11.3%). Forty limbs (3.2%) were categorized as type I with non-classical patterns. Forty limbs (3.2%) showed type II high-level bifurcation and 63 limbs (4.9%) showed type III aplasia or hypoplasia. The type IIC pattern was not observed. Importantly, one single case considered as hypoplasia of the peroneal artery and another case identified with a long tibioperoneal artery were categorized into new subgroups. CONCLUSIONS: Recognizing and evaluating variations in popliteal artery branches is important in terms of vascular surgery approaches and interventional vascular procedures. CTA is an effective screening method to show the vascular frame of lower extremities and variations of popliteal artery. Our study allowed identifying two new branching patterns of the popliteal artery not previously described in the literature.

Combined sphenoid and frontal sinus aplasia accompanied by bilateral maxillary and ethmoid sinus hypoplasia.

We describe CT scans of a case with bilateral aplasia of frontal and sphenoid sinuses with symmetrical hypoplasia of the ethmoid cellules and maxillary sinuses. This case appears to be first in the English-language literature with these combined findings.

The use of a vessel sealing system in thyroid surgery.

Thyroidectomy is one of the most common operations performed for thyroid diseases throughout the world and has an extremely low morbidity rate. Although the technique of thyroidectomy has changed little for several years, different techniques have been developed for haemostasis in addition to the conventional methods. The vessel sealing system (Ligasure) is a new technology that can be applied in several surgical situations. However, there is no data in the literature regarding its use in thyroid surgery. Fifteen consecutive euthyroid patients (ten women, five men) with a range of 37-71 years of age who met the inclusion criteria were studied. The surgical procedures were performed by a single surgeon using standard techniques, but all vascular structures encountered were sealed by Ligasure and no suture material was used. The pre-operative, intraoperative and postoperative parameters were recorded and analyzed. Fluid collection was evaluated by ultrasonography and clinical examination on the 3rd postoperative day, The results were compared with the conventional knot tying method in a group of 25 patients. A Ligasure device was successfully used in 15 consecutive procedures, including ten total thyroidectomies, three hemithyroidectomies, one subtotal thyroidectomy and one near-total thyroidectomy. There was no operative mortality or technique-related morbidity in patients. The operating time was 75 +/- 11 minutes. The mean volume of the resected thyroid specimens was 68.3 +/- 18.9 cm3. The mean fluid collection at postoperative day three was 7.5 +/- 1.6 cm3. In conclusion, we have found that a Ligasure device can be safely used for haemostasis in thyroid surgery. It has the potential to decrease the operating time, fluid collection and blood loss.

The effect of coronary artery bypass surgery on brain perfusion.

UNLABELLED: Coronary artery bypass grafting (CABG) is one of the major treatment methods of coronary artery disease. CABG is an open-heart surgery that uses cardiopulmonary bypass (CPB). After CPB, it is well known that neurological and neuropsychological complications may occur. The purpose of this study was to evaluate brain perfusion patterns before and after CPB and to locate brain perfusion changes in patients with neurological and neuropsycological complications after CPB. METHODS: Twenty-five patients who underwent open-heart surgery (22 CABG, 3 valve replacement) and 5 patients (4 cholecystectomy, 1 periferic vascular surgery) as a control group were included in the study. The 99mTc-HMPAO injected dose was 925 MBq. Brain perfusion SPECT images were obtained 30-60 min postinjection using a dedicated triple-head brain SPECT camera. Imaging was performed 1 wk before and 4-6 wk after surgery. Technetium-99m-HMPAO brain SPECT slices were evaluated visually and semiquantitatively. RESULTS: None of the patients had severe neurologic complications. Neuropsychological deficits occurred in eight patients after CABG. Cognitive deterioration and depressive mood occurred in five patients. Disorientation, agitation and confusion periods were present in another two patients. Frontal hypoperfusion was found in these patients by visual and semiquantitative evaluations (p = 0.0277) and left parietal hypoperfusion was also present semiquantitatively (p = 0.0277). Visual hallucinations occurred in one patient. Computed tomography of these patients was normal. No perfusion abnormalities were observed in the patient with visual hallucinations and in patients without symptoms after open-heart surgery nor in the control group. Brain SPECT was repeated in two symptomatic patients 5 mo after CABG. Frontal hypoperfusion became normal, and these patients' symptoms disappeared. CONCLUSION: The results of this study indicate that regional cortical hypoperfusion may occur in patients with neuropsychological complications after CABG. Technetium-99m-HMPAO brain SPECT is a useful method to locate and determine brain perfusion changes after CABG.

Technetium-99m-tetrofosmin scintigraphy in pulmonary tuberculosis.

UNLABELLED: Technetium-99m-tetrofosmin, an agent that is widely used in myocardial imaging, has been reported to accumulate in several types of malignancies, including lung tumors. Yet, there is limited knowledge about its role in imaging infection or inflammatory lesions. The aim of this study was to investigate the role of 99mTc-tetrofosmin scintigraphy in pulmonary tuberculosis in cases with active and inactive tuberculosis in comparison with radiological and microbiological findings. METHODS: Twenty-seven patients with active pulmonary tuberculosis (APTB) and 6 patients with inactive pulmonary tuberculosis (IPTB), proven by sputum smears and cultures, were included in this study. Mean age of the group was 42.6+/-13 yr. Nine months after therapy, 99mTc-tetrofosmin scintigraphy was repeated in 6 patients with APTB to evaluate response to therapy. Ten-minute anterior and posterior chest images were acquired 20 and 60 min after the injection of 370 MBq (10 mCi) 99mTc-tetrofosmin. The images were evaluated both visually and semiquantitatively by two blinded nuclear medicine physicians. For semiquantitative evaluation, regions of interest (ROIs) were drawn over the lesion (L) and nonlesion areas (NL). The mean count values of ROIs were obtained and L/NL ratios were calculated. RESULTS: According to the visual evaluations, 99mTc-tetrofosmin uptake was Grade (+) in 4 (15%) and Grade (++) in 23 (85%) patients with APTB. Technetium-99m-tetrofosmin uptake was negative in 5 patients with IPTB. Grade (+) 99mTc-tetrofosmin uptake was observed in only one inactive case. After therapy, there was no 99mTc-tetrofosmin uptake in 3 patients, which correlated well with chest radiography and clinical findings. In the other 2 patients, 99mTc-tetrofosmin uptake was slightly decreased when compared with a previous scan that correlated with radiological and clinical findings. In 1 patient with bilateral lung disease, 99mTc-tetrofosmin uptake decreased on the right lung lesions, whereas the left lung lesions persisted with no change. The mean early and delayed L/NL ratios of APTB were 1.53+/-0.22 and 1.45+/-0.21, respectively. Although 99mTc-tetrofosmin uptake in APTB lesions was more visually marked in early images than that in delayed images, there was no statistically significant difference between these two sets of images. CONCLUSION: Technetium-99m-tetrofosmin scintigraphy showed increased uptake in APTB lesions related to disease activity. After treatment, 99mTc-tetrofosmin uptake disappeared or decreased, correlating well with radiological and clinical findings. Technetium-99m-tetrofosmin scintigraphy may have a complementary role in the assessment of APTB as well as in follow-up treatment.

Tc-99m erythromycin lactobionate inhalation scintigraphy in parenchymal lung diseases.

We have investigated Technetium 99m erythromycin lactobionate (Tc 99m EL) clearance from the lungs after inhalation, in the presence of an alveolitis. Eighteen patients (6 sarcoidosis, 7 idiopathic fibrosis, and 5 miliary tuberculosis) were imaged after the patients inhaled 1,110 MBq of Tc 99m EL. Clearance half time for the first 45 min, for 24 h, and retention at 24 h correlated with percentage of lymphocytes in bronchoalveolar lavage fluid (BAL) (r = .729, r = .883, and r = .826, respectively). There was a positive correlation between peripheral penetration (PP) and forced expiratory volume in 1 s (FEV1) (r = .806) and forced vital capacity (FVC) (r = .781). Retention was more marked in sarcoidosis compared with tuberculosis (0.025 < p < or = 0.05). Radioaerosol lung imaging may reflect the pulmonary function impairment in parenchymal lung diseases. Retention of Tc 99m EL may be related to number of BAL cells or presence of a lymphocytic alveolitis. Long residency time of Tc 99m EL in the lungs implies that erythromycin can also be administered by inhalation for therapeutic purposes.

Tc-99m HMPAO brain perfusion SPECT in drug-free obsessive-compulsive patients without depression.

The aim of this study was to confirm prior results of brain-imaging studies on obsessive-compulsive disorder (OCD) in a sample of Turkish patients, as a cross-cultural study. Tc-99m HMPAO brain perfusion SPECT imaging was performed in nine drug-free OCD patients without depression and six controls. The patients' Hamilton Depression Rating Scale scores were <16. The severity of obsessive-compulsive symptoms was rated with the Yale-Brown Obsessive-Compulsive Rating Scale (YBOCS). Quantitative evaluation of regional cerebral blood flow revealed that right thalamus, left frontotemporal cortex and bilateral orbitofrontal cortex showed significant hyperperfusion in patients with OCD compared with controls. YBOCS scores did not show any correlation with hyperperfusion in regional cerebral blood flow in these areas. Results of this cross-cultural study may support orbitofrontal and thalamic dysfunction in OCD in a sample of Turkish patients.

Indium-111 octreotide uptake in the surgical scar.

Indium-111 octreotide uptake has been reported in various somatostatin receptor positive tumors, granulomas and autoimmune diseases in which activated leucocytes may play a role, subcutaneous cavernous hemangioma and angiofibroma. We present Indium-111 octreotide uptake in a surgical abdominal scar tissue 1.5 and 6 months after surgery in a patient who had been treated for recurrent carcinoid tumor in the rectosigmoid junction. Indium-111 octreotide uptake in a surgical scar may be related to the binding to somatostatin receptors in the activated lymphocytes and fibroblasts that is previously reported.

99mTc sestamibi scintimammography. Screening mammographic non-palpable suspicious breast lesions: preliminary results.

AIM: Investigation of the diagnostic role of technetium-99m methoxyisobutylisonitrile ((99m)Tc sestamibi) scintimammography in non-palpable, suspicious breast lesions described as microcalcification, mass and increased density using mammography. PATIENTS AND METHOD: 35 women with non-palpable breast lesions were enrolled in the study. Anterior, left and right lateral, ipsilateral posterior oblique images were obtained 15 min after the injection of 740 MBq of (99m)Tc sestamibi. All scintigraphic images were evaluated visually and focal increased (99m)Tc sestamibi uptake was accepted as malignant lesion. Breast lesions were classified as microcalcification (13 women), mammographic mass (16 women) and increased density (6 women). Excisional biopsy was performed in all of them irrespective of the scintigraphic results. RESULTS: The focally increased (99m)Tc sestamibi uptake was seen in 11 breast lesions with malignant lesions and in 4 breast lesions with benign lesions. The diffuse uptake of (99m)Tc sestamibi was seen in 18 breast lesions with benign lesions and 2 breast lesions with malignant lesions. There was no false positive result of (99m)Tc sestamibi in microcalcification group and there was no false negative result of the mammographic mass and increased density groups. CONCLUSION: Scintimammography might be a complementary method in decision making for the non-palpable, suspicious breast lesions that were evaluated as microcalcification, mass and increased density mammograpically.

Lung clearance of inhaled 99Tcm-erythromycin lactobionate in non-smokers and smokers.

99Tcm-labelled erythromycin lactobionate (99Tcm-EL) was used as a radioaerosol for lung ventilation imaging in humans after animal studies had shown slow clearance of 99Tcm-EL from the alveolar spaces. We performed inhalation studies in 26 volunteers: 11 non-smokers, 13 smokers (3 of whom smoked one cigarette just before inhalation of 99Tcm-EL) and 2 patients with pulmonary emboli (PE). The PE patients were imaged by both 99Tcm-EL and xenon-133 (133Xe) for comparison. The image quality with 99Tcm-EL was comparable to that with 133Xe, showing good peripheral penetration. The biological clearance half-lifes for 99Tcm-EL were 3.9 +/- 1.1 h in the non-smokers, 5.9 +/- 2.2 h in the smokers and 9.8 +/- 6.6 h in the three subjects who smoked a cigarette just before inhalation of the aerosol. 99Tcm-EL was cleared more slowly in the smokers and after smoke exposure, which could have indicated alveolar macrophage uptake. 99Tcm-EL can be used as an alternative to 99Tcm-diethylenetriamine pentaacetate (99Tcm-DTPA) in ventilation imaging, thus overcoming the problem of the fast clearance of 99Tcm-DTPA in smokers.

Sublingual nitrate plus 99Tcm-tetrofosmin infusion in the detection of severely ischaemic but viable myocardium: a comparative study with stress, redistribution, reinjection and late redistribution 201Tl imaging.

To investigate the role of sublingual nitrate plus 99Tcm-tetrofosmin infusion in the detection of severely ischaemic but viable myocardium, we selected 25 patients with coronary artery disease who had at least one fixed segmental defect during conventional stress-redistribution (ST-RD) 201Tl single photon emission tomographic (SPET) imaging. Reinjection (RI) and 24 h late redistribution (LRD) imaging were also performed. Within a week of 201Tl imaging, one-day rest-stress (R-ST) 99Tcm-tetrofosmin SPET was performed with the same stress levels. The following day, 99Tcm-tetrofosmin was infused over 1 h immediately after sublingual nitrate administration and SPET images (N + Inf) were acquired. Of 100 fixed defects on R-ST 99Tcm-tetrofosmin imaging, 15 were reversible on N + Inf 99Tcm-tetrofosmin imaging. There was 91% concordance between ST-RD/RI/LRD 201Tl and R-ST/N + Inf 99Tcm-tetrofosmin imaging regarding reversibility. We conclude that N + Inf 99Tcm-tetrofosmin imaging may be clinically useful in the detection of severely ischaemic but viable myocardium.

Tc-99m MDP, thallium-201 chloride and Tc-99m MAG3 renal uptake in subacute and chronic radiation nephritis compared.

The authors present a comparison of the findings for thallium-201 (Tl-201), Tc-99m MAG3 and Tc-99m MDP in subacute and chronic radiation nephritis in a 9-yr-old boy who was treated by radiation therapy for alveolar rhabdomyosarcoma of the left chest wall by a radiation port that partially included the left kidney. Tl-201 imaging three and six months later showed a cortical defect in the left kidney due to radiation nephritis. Tc-99m MDP scan showed increased uptake on both occasions, but more marked in the subacute period than in the chronic period. Tc-99m MAG3 showed decreased concentration and increased cortical retention three months later. Six months after the radiation therapy, a cortical defect corresponding to the cortical area that showed increased parenchymal retention was more prominent in the Tc-99m MAG3 scan. In the present case, Tc-99m MDP, Tl-201 and Tc-99m MAG3 findings may provide useful information for understanding pathophysiological damage in the kidney after radiation.

Tc-99m polyclonal human immunoglobulin G imaging in Graves' ophthalmopathy.

PURPOSE: The authors evaluated the utility of Tc-99m-labeled human immunglobulin G (HIG) in determining the severity of orbital inflammation and the relation of orbital Tc-99m HIG uptake and clinical parameters in patients with Graves' ophthalmopathy. MATERIALS AND METHODS: Images were obtained in 23 patients (13 women, 10 men; mean age, 51+/-10 years) with Graves' ophthalmopathy. Planar orbital images were obtained and SPECT was performed using a triple-detector gamma camera 4 hours after 370 MBq (10 mCi) Tc-99m HIG injection. Tc-99m HIG uptake was classified using transaxial and coronal slices as 1, mild; 2, moderate; and 3, severe. The clinical severity of orbital disease was categorized, according to the criteria described by Feldon and Unsold, as class I, mild involvement; class II, moderate; and class III, severe. Disease was considered to be clinically inactive if symptoms and signs were stable or improved in the last two examinations performed at least 6 months apart. RESULTS: Sixteen patients were clinically inactive, and seven patients were active. The mean Tc-99m HIG classes were 1.5+/-0.5 and 2.6+/-0.5, respectively (P = 0.02). There was not a good correlation between the clinical classification and Tc-99m HIG classification, whereas the presence of active disease showed a good correlation with Tc-99m HIG classification (r = 0.703; P = 0.0002). CONCLUSIONS: Tc-99m HIG imaging showed possible ongoing subclinical inflammation in the orbits of the patients with Graves' ophthalmopathy regardless of the clinical classification. Tc-99m HIG SPECT seems a promising procedure for evaluating the presence of active orbital inflammation.

Infusion versus bolus injection of Tc-99m tetrofosmin in the identification of viable myocardium.

In this report, a patient with 100% RCA stenosis and prominent collaterals, in which TI-201 rest/redistribution and Tc-99m tetrofosmin infusion imaging findings were compatible with viable myocardium in contrast to Tc-99m tetrofosmin bolus imaging is presented. Viability was confirmed with improvement of wall motion and perfusion 3 months after revascularization. Infusion of Tc-99m tetrofosmin rather than a bolus injection may be a more reliable technique in the identification of severely ischemic but viable myocardium.

Clearance of Tc-99m DTPA aerosol in mismatched and matched pulmonary perfusion defects.

PURPOSE: To evaluate clearance changes of Tc-99m DTPA aerosol in mismatched and matched pulmonary perfusion defects. MATERIALS AND METHODS: Twenty-one patients (14 women, 7 men; mean age, 51 +/- 14 years) with possible pulmonary embolism were included in the study. On the day after perfusion (Q) scintigraphy with 5 mCi Tc-99m MAA, radioaerosol inhalation scintigraphy was performed using 45 mCi Tc-99m DTPA. Immediately and 45 minutes after the inhalation, early and delayed inhalation images (EI and DI, respectively) were obtained. Group 1 included 11 patients with mismatched defects who had a high probability of pulmonary embolism according to the Q/EI scan results. Group 2 included 10 patients with matched defects who had a low probability of PE. Contralateral normal lungs of 7 patients in group 2 served as controls (group 3). In groups 1 and 2, regions of interest were drawn over the mismatched and matched perfusion defects where they were best visualized, and this region of interest was mirrored to the same region on EI and DI images. For the control group, this was done in the contralateral normal lung. Mean counts in each region of interest were used for quantitative analysis, and the percentage clearance ratio was calculated using the following formula: early counts - late counts/early counts x 100. RESULTS: The average percentage clearances for the three groups were as follows: group 1, 37% +/- 10%; group 2, 21% +/- 4%; group 3, 24% +/- 7%. Differences between groups 1 and 3 were significant, as were those between groups 1 and 2 (P < 0.05). Patients with mismatched perfusion defects had increased DTPA clearance compared with the control group and those with matched defects. CONCLUSIONS: Vascular occlusion may lead to impairment of the alveolar-capillary barrier and consequently an increase in the clearance of Tc-99m DTPA aerosol in embolized regions. Immediately after inhalation, Tc-99m DTPA imaging should be started in the projection where perfusion defects are best seen to avoid potential misinterpretation of pulmonary embolism.

Detection of bilateral multifocal breast cancer using Tc-99m sestamibi imaging. The role of delayed imaging.

PURPOSE: Early determination that breast cancer is bilateral and multifocal can change therapy strategy and, subsequently, mortality and morbidity rates. The authors present a case with bilateral, multifocal breast cancer detected only by Tc-99m sestamibi imaging. METHODS: Early and delayed Tc-99m sestamibi imaging and dynamic MRI were performed in a patient with a right-sided lesion shown on mammography. RESULTS: Although early Tc-99m sestamibi imaging detected bilateral breast cancer foci, both dynamic MRI and mammography missed the lesion in the left breast. Additional lesions seen on delayed Tc-99m sestamibi images of the left breast, which were initially thought to be benign, completely disappeared after concomitant chemotherapy and radiotherapy, suggesting multifocal malignant lesions in the left breast. CONCLUSION: This case suggests that Tc-99m sestamibi may be useful for detecting bilateral cancer, and delayed imaging may give additional information regarding the possible multifocal nature of the disease.

Tl-201 uptake in bone and soft tissue involvement of sarcoidosis.

The authors describe a 38-year-old man who was referred to the nuclear medicine department because of pain and swelling of his fingers in both hands. Tc-99m MDP and Tl-201 scans were performed to evaluate the lesions. A Tc-99m MDP bone scan showed hyperemia and increased uptake in the lesions. A Tl-201 scan showed marked uptake in both early and delayed images in the lesions of his fingers. Bone biopsy and histologic examination confirmed sarcoidosis. This case indicates that Tl-201 uptake can be seen in bone lesions resulting from sarcoidosis.