Renography before heart transplantation in patients with cardiomyopathy.

UNLABELLED: In patients with ischemic cardiomyopathy (CM), abnormal renograms may result not only from circulatory failure (which should reverse after transplantation) but also from intrinsic renal disease (which contraindicates heart transplantation). Here, the outcome of heart transplantation was related to preoperative renograms, and the differentiating and prognostic value of renography was analyzed. METHODS: The study population consisted of 50 patients with ischemic CM expecting heart transplantation. Anatomical renal pathology was excluded in all patients. Dynamic renal scintigraphy was performed with 99mTc-mercaptoacetyltriglycine. Background-subtracted renograms were inspected visually and characterized numerically. Mean parenchymal transit time (mPTT), renal tracer content at 15 min (RTC15) and retention index (RI) were determined. The parametric renogram values were related to a normal reference group of 64 patients. The preoperative renograms were matched with the postoperative outcome. RESULTS: Three characteristic types of symmetrical findings in the kidneys were found: no pathological findings, mildly delayed peak and excretion phase and severely delayed peak and excretion phase. Pathological renograms were observed in 36 of 50 (72%) patients. The mean parametric renogram values in ischemic CM were as follows: Group A (normal kidney function), mPTT = 142+/-26.6 sec, RTC15 = 22.3%+/-4.6% and RI = 24.7+/-11.9; Group B (mild dysfunction), mPTT = 210+/-44.0 sec, RTC15 = 42.6%+/-10.3% and RI = 101.4+/-50.5; Group C (severe dysfunction), mPTT = 320+/-94.2 sec, RTC15 = 79.6%+/-15.9% and RI = 347.7+/-194.7; and reference patients (normal kidney function), mPTT = 137+/-31.1 sec, RTC15 = 22.8%+/-3.8% and RI = 24.6+/-7.9. Postoperative serum creatinine levels were <1.5 mg/dl in all Group A patients, between 1.5 and 2.5 mg/dl in 78% of Group B patients and >2.5 mg/dl in 75% of Group C patients. CONCLUSION: Renography revealed abnormal kidney function when structural pathology was excluded. The renographic abnormalities in ischemic CM did not reflect simply the circulatory failure. The numerical grading of renograms allowed patient stratification, suggestive of possible renal insufficiency after cardiac transplantation and immunosuppressive therapy. With further experience, renography may become a useful tool for predicting postoperative outcome in ischemic CM.

[Results of bone marrow scintigraphy in hematological diseases]. / Ergebnisse der Knochenmarkszintigraphie bei hämatologischen Erkrankungen.

Bone marrow scintigraphy was performed in 40 patients with haematological disorders (lymphomas, multiple myeloma, myeloid leukaemia, panmyelopathy and others). Routine skeletal scintigraphy was available for comparison in 18 patients. In agreement with the literature it became evident that marrow scintigraphy can show infiltrations of the bone marrow in haematological disorders earlier than skeletal scintigraphy. Hot lesions were caused by reactive proliferation of the bone marrow such as may occur with acute inflammatory joint diseases, osteomyelitis, fracture healing or other entities. Marrow imaging demonstrated reliably the actual distribution of the functioning bone marrow, a characteristic that is important for diagnosis and staging, especially in myeloproliferative diseases.

[A computer macro-programme for osteoscintimetry and activity profile in Perthe's disease (author's transl)]. / Computermakroprogramm zur Osteoszintimetrie mit Aktivitätsprofilen bei Morbus Perthes.

A computer macro-programme has been developed which permits quantitative scintigraphy by means of an activity profile. The slope and width of the profile are variable; a view at right angles to the epiphyseal plate of the femoral head is able to determine activity in the plate and in the epiphysis. Measurements of the abnormal and normal hip produce uptake rates. These indicate to what extent the abnormal femoral head and epiphyseal plate differ from the normal side, with respect to their uptake. The method and results are discussed.

A case of parathyroid carcinoma visualized on Tc-99m-sestamibi scintigraphy.

Recent studies indicate that Tc-99m-Sestamibi (MIBI, DuPont Pharma) is a useful tracer for detecting parathyroid adenomas. We present a patient with focal Tc-99m-MIBI uptake in parathyroid carcinoma which has only been described once before (1). Tc-99m-MIBI scintigraphy may be considered for diagnosing pathological parathyroid tissue. But presently the histopathological examination only allows the differentiation between adenoma and carcinoma.

[Relative uptake of 99mTc-diphosphate and its temporal change in bone diseases]. / Relative Speicherwerte von 99mTc-Diphosphat und deren zeitliche Anderung bei Skeletterkrankungen

Quantitative regional measurements of the distribution of a bone seeking radiopharmaceutical is performed easily together with a bone scan using a scintillation camera. Comparative measurements of regional radioactivities yield a ratio of relative uptake. The time change of such a relative uptake ratio is obtained by repeating the regional comparison measurements after a 4--8 weeks interval. The time change of the relative uptake ratio was found to be a clinically useful parameter in the follow-up of skeletal diseases. A decrease in the relative uptake ratio was found with healing fractures, with receding osteomyelitis and during radiation therapy of bone metastases; an increase was observed with spreading metastases, developing osteomyelitis, developing pseudathrosis, and in the beginning of normal fracture healing.

Follow-up of osteomyelitis of infants with systemic serum parameters and bone scintigraphy.

AIM: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). METHODS: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. RESULTS: CRP was the most effective serum parameter for follow-up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. CONCLUSION: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

[Comparison of brain scintigraphy with 99mTc-pertechnate and 99mTc-citrate]. / Vergleichende Hirnszintigraphie mit 99mTc-Pertechnetat und 99mTc-Zitrat.

20 patients with ultimately proven cerebral lesion were studied consecutively with 99mTc-pertechnetate and 99mTc-citrate. A comparison of the brain scans showed neoplastic lesions to be visualized more clearly with 99mTc-citrate, and vascular lesions to be demonstrated better with 99mTc-pertechnetate. Comparative brain scanning utilizing 99mTc-citrate and 99mTc-pertechnetate facilitates the differentiation between acute brain infarcts and neoplastic lesions which is difficult or may be impossible by cerebral computer tomography. The reduced radiation exposure from 99mTc-citrate and its superior usefulness in the visualization of neoplastic lesions suggest its use as the primary brain scanning agent.

[Modified biological behaviour of 99mTc-pertechnetate in man as a result of a preceeding administration of tin (tin effect) (author's transl)]. / Verändertes biologisches Verhalten zon 99mTc-Pertechnetat nach vorangegangener Zinngabe ("Zinn-Effekt") am Menschen.

An increased image of blood-filled spaces (Plexus choriodeus, Sinus transversus) was observed in 99mTc-pertechnetate scintigraphy when it had been preceded by the administration of tin (e.g. of 99mTc-Sn-diphosphonate). We have called this behaviour the "tin effect". In vitro studies demonstrated binding of about 80% of the administered activity in the blood with a biological half-life of about 44 hr and an effective half-life of about 5.3 hr. 95% of the blood activity was bound to red cells and 5% to plasma. This resulted in an increased radiation dose to the bone marrow of about 530 mrad/mCi 99mTc-pertechnetate (following tin). The extent of the tin effect decreased with the length of the interval between tin and 99mTc-pertechnetate administration. Because of the tin effect 99mTc-DTPA or 99mTc-citrate should be used for brain scintigraphy if this has to be performed within the first 5 or 7 days following a bone scintigraphy with a tin-containing radiopharmaceutical. The "tin effect" might be taken advantages of when labelling red cells and imaging vascular spaces.

[Indications for MIBG scintigraphy in the diagnosis of neuroblastoma]. / Indikationen zur MIBG-Szintigraphie in der Neuroblastomdiagnostik.

The significance and indications of MIBG scintigraphy are critically assessed. The results are compared with the results of whole-body bone scintigraphy, computed tomography (CT) and magnetic resonance tomography (MRT), and are related to values of catecholamine metabolites in 24-h urines. In our patients (10 histologically proven cases) MIBG scintigraphy turned out to be most useful in tumor follow-up. In contrast, the significance was much lower in primary tumor diagnosis and tumor staging as the exact primary diagnosis was established by other means such as CT, MRT, MDP whole-body scan, urine chemistry and bone marrow biopsy in all cases. MIBG scintigraphy in diagnostic imaging of neuroblastoma is an additive diagnostic tool and is called for in (1) tumour follow-up (progress, recurrencies, metastases); (2) primary diagnosis if the primary tumour has not been localized by means of CT or MRT; and (3) tumour staging to differentiate stage IV disease from lower stages as long as stage IV disease has not been established by bone-marrow biopsy or MDP whole-body scan.

Results of three-phase bone scintigraphy and radiography in 20 cases of neonatal osteomyelitis.

Neonatal osteomyelitis, a rare, potentially crippling disease, requires early diagnosis and effective therapy. This study of 20 neonates analysed the diagnostic value of three-phase bone scintigraphy (motivated by its controversial role), plain radiography and local clinical signs in neonatal osteomyelitis and complicating septic arthritis. The sensitivities for detecting focal skeletal involvement were as follows: bone scintigraphy 90%, radiography 65%, clinical local signs 20%. Reliable scintigraphic signs were localized hyperperfusion (phase I), vasodilation (phase II) and hot or cold lesions on 3-h images. Radionuclide angiography definitely increased the validity of bone scintigraphy. During follow-up, the reduction or normalization in focal hyperperfusion was the first and most sensitive sign of an adequate response to antibiotic treatment; persistence (or recurrence) of focal hyperperfusion, increasing relative uptake ratios and the appearance of new foci of bone involvement indicated escape from antibiotic therapy. Radiography revealed no pathological signs in 35% of cases, soft tissue changes in 20% and effusion of the hip joint in 45%. Local clinical signs were not a reliable predictor of scintigraphic or radiographic findings. We consider bone scintigraphy in neonatal osteomyelitis to be a successful, efficient and cost-effective diagnostic modality, not only for early diagnosis, but also during follow-up.

99Tcm-tetrofosmin scintigraphy in Hodgkin's disease.

The aim of this study was to assess the suitability of 99Tcm-tetrofosmin (tetrofosmin) scintigraphy as a diagnostic modality in patients with Hodgkin's disease. Fourteen untreated patients with biopsy proven Hodgkin's disease (clinical stage Ia-IVb) were investigated. Post-treatment investigations were also done in 7 of the 14 patients. Focal pathological tetrofosmin uptake was seen in 42 site in the pre-treatment studies. Computed tomography identified 36 pathological regions. The tumour-to-background ratio ranged from 1.44 to 2.17 (mean 1.63). Follow-up studies demonstrated a response to treatment, in that there was a reduction in, or complete disappearance of, localized tetrofosmin uptake in regions previously pathological, and a decrease in tumour-to-background ratios. Tetrofosmin appears suitable for the localization of lymphomatous lesions, especially supradiaphragmatic ones, and for the follow-up of therapeutic response.

A computer controlled automated dispensor for the eluting, calibrating and dispensing of 99Tcm-pertechnetate.

This paper describes an automated 99Tcm-Dispensor, a computer controlled device for the programmed, automated elution of 99Tcm-sodium pertechnetate, its calibration, metered delivery and dilution. The elution can be programmed up to 7 days in advance. The total radioactivity of the eluate is assayed by a semiconductor counter integrated in the shielding of the pertechnetate reservoir. The volume of eluate actually available for dispensing is measured by capacitance and is monitored continuously. The specific concentration is calculated from total activity and volume, and is corrected for decay prior to each delivery. All activity bearing sections are shielded by lead-antimony covers specified to attenuate the radiation from generators up to 2 Ci 99Mo/99Tcm. The labelling vials are inserted into the dispensing chamber within a shielding vessel manually. The sodium pertechnetate solution is dispensed prior to the optional additional delivery of normal saline. The Tc-Dispensor maintains sterility, guards against accidental radioactive contamination, and is suited to reduce the radiation burden of personnel. All operations are recorded by the computer enabling the print-out of protocols. We found the Tc-Dispensor safe, precise and accurate.

Quantitative static and dynamic renal scintigraphy with diuresis stimulation in renovascular hypertension.

The results of computer-assisted static and dynamic renal scintigraphy in 57 patients with renovascular hypertension (RVH) and 23 patients with essential hypertension (EH) are presented. The following parameters were quantified: renal size (RS), count density (CD), relative unilateral renal clearance (RRC), mean parenchymal transit time (PTT), difference of time-to-peak of activity (tmaxd) to stenosed minus non-stenosed side, effect of frusemide (FE) and renal parenchymal radionuclide retention (RI). Among 57 stenosed renal arteries we detected 54 (true-positive cases) and missed three (false-negative cases); among 23 patients with EH and no significant haemodynamic renal artery stenosis, we found 21 cases correctly negative and two patients falsely positive. These data yielded a sensitivity of 95% and a specificity of 92%. The quantification of renal radionuclide studies in renal artery stenoses minimizes false-positive results and increases their specificity. This study shows that, because of its sensitivity, quantitative renal scintigraphy reliably allows the assessment of the functional haemodynamic effects of a renovascular lesion (significant stenosis) in the diagnostic work-up and during follow-up after surgical reconstruction or percutaneous transluminal angioplasty (PTA). The evaluation of renal function is in general greatly supported by the quantitative parameters, yet particularly after medication with converting enzyme inhibitors and after intervention.

Semi-quantitative scintigraphic follow-up studies of cerebral arteriovenous malformations after radiosurgical treatment.

An evaluation of semi-quantitative 99Tcm-red blood cell scintigraphy (RBCS) was undertaken in patients with cerebral arteriovenous malformations (AVM) during follow-up after radiosurgical treatment. Twenty-seven patients were studied with an initial dynamic imaging sequence of 32 frames each lasting 2 s, planar images in four projections beginning 15 min post-injection and single photon emission tomography immediately following the planar imaging. A 2 ml cubital vein blood sample was imaged to obtain an extracorporeal equivalent of the intravascular activity. The counts within the AVM on a planar image were divided by the counts obtained from the image of the blood sample (corrected for the same acquisition time and radioactive decay). This value yielded the 'volume index' (VI), which was proportional to the volume of the AVM. The VI obtained from the first RBCS served as the initial reference value and was set at 100%. The VIs obtained from the follow-up investigations of the same patient in the same projection were expressed as the percentage of the initial VI. We found RBCS identified the AVM in all patients. The VIs obtained from the follow-up studies demonstrated a decrease in blood volume at different time intervals after radiosurgical treatment. RBCS provides a sensitive, relatively non-invasive, semi-quantitative method for measuring the relative volume and follow-up of the degree of obliteration of AVMs after radiosurgical treatment.

SPET quality control: a comprehensive test procedure for evaluating the rotation system parameters COR-offset, y-shift and detector tilt.

This paper describes a method for SPET quality control that facilitates the determination of COR-offset, parallel y-shift and detector tilt by means of a single, comprehensive test using a special phantom consisting of three point sources. The evaluation of the method was performed by a series of measurements utilizing manually adjusted detector tilts and a simulation of y-shift by moving the phantom. The results show that y-shift and detector tilt are measured with reasonable accuracy, and that y-shift caused by variations in detector tilt can be differentiated from y-shift caused by other factors.

Diminished response to furosemide in I-123 Hippuran renal studies of renovascular hypertension caused by unilateral renal artery stenosis.

Dynamic I-123 Hippuran renal studies to measure furosemide response (FR) were performed in three groups of patients: 1) 57 patients with renovascular hypertension due to a poststenotic, ischemic kidney; 2) 23 patients with essential hypertension; and 3) 50 nonhypertensive patients with healthy kidneys (control group). FR was observed as renal parenchymal tracer washout within 10 minutes after the injection of 40 mg of furosemide. The retention index (RI) took into consideration the renal parenchymal tracer content before and 10 minutes after furosemide injection. In the control group, the FR was greater than 50% and the RI was less than 20. Patients with essential hypertension revealed no differences in the amounts of FR and RI compared with the control group. In renovascular hypertension, the FR was diminished and the RI was raised significantly. The values of FR and RI showed a good correlation to the degree of the renal artery stenosis before and after percutaneous transluminal angioplasty. It is concluded that the stimulation of diuresis with furosemide and its quantification represent an important additional step in the evaluation of dynamic I-123 Hippuran studies to detect renal ischemia.

Abdominal metastases of an ovarian cancer demonstrated on bone imaging.

Tc-99m HMDP uptake by abdominal metastases of an ovarian cancer was seen on a bone image. The findings were confirmed by computed tomography and by biopsy at surgery. The psammoma bodies throughout the tumor tissue appeared to be the substrate of this unusual extraosseous tracer uptake.

[Changes in thyroxine conversion (low T3 syndrome) in children at the time of their first manifestation of type I diabetes]. / Veränderungen der Thyroxinkonversion ("low T3-syndrome") bei Kindern mit Typ-I-Diabetes zum Zeitpunkt der Erstmanifestation.

Measurements of T4, T3, rT3, and TSH were done in 27 children with newly diagnosed type I diabetes mellitus prior to institution of treatment. Serum T4 concentrations were low in 18%, serum T3 concentrations were low in 37%. Serum rT3 concentrations were elevated in 59%; the ratio rT3/T3 was elevated in 78%. The ratio rT3/T3 was significantly higher in the group of patients with the low pH, the low bicarbonate levels, the high blood glucose, and the high serum osmolality values than in the group of patients with the high pH, the high bicarbonate levels, the low blood glucose, and the low serum osmolality values.

[Value of cholescintigraphy in the differential diagnosis of direct hyperbilirubinemia in infancy]. / Wertigkeit der Choleszintigraphie in der Differentialdiagnose der direkten Hyperbilirubinämie des Säuglingsalters.

Cholescintigraphy using 99mTc-diethyl-, 99mTc-diisopropyl-, 99mTc-iodo-diethyl- and 99mTc-bro-motrimethyl-IDA was performed in 22 newborns and infants with direct hyperbilirubinaemia. Retrospective evaluation of 99mTc-diethyl- and 99mTc-diisopropyl-IDA (n = 18) showed an efficiency of 66% in the differentiation between extrahepatic biliary atresia and neonatal intrahepatic diseases if the hepatocyte-clearance index and transit time were taken into consideration; the sensitivity of detecting extrahepatic biliary atresia was 100%. Cholestyramine treatment (n = 9) did not increase the efficiency of the test. Efficiency was markedly reduced when the serum direct bilirubin level was above 5.5 mg/dl (94 mumol/l). The gall bladder was not visualized in 13 out of 18 examinations. The prospective and retrospective analysis of 99mTc-iodo-diethyl- and 99mTc-bromo-trimethyl-IDA revealed intrahepatic disease in all 6 infants with serum values up to 12.6 mg/dl (216 mumol/l) direct bilirubin; the gall bladder was not visualized in 4 out of 7 examinations.

[A prospective study on the occurrence of postoperative thrombosis of leg-veins and the possible influence of aescin in its prevention (author's transl)]. / Prospektive Untersuchung der Häufigkeit postoperativer Beinvenenthrombosen und ihre medikamentöse Beeinflussung durch Aescin

Based on the frequency of subclinical, postoperative thrombosis which we detected using radio-iodine-tagged fibrinogen (125I-fibrinogen) in 2 comparable test groups of 100 female patients each, we were able to compare the effectiveness of Aescin (Reparil) to the untreated group. Whereas only 16 patients in the Reparil group were thrombose-positive we found 27 such cases in the control group. The analysis of these data shows Reparil to be of distinct advantage when compared to the untreated group.