Effect of angiotensin-converting enzyme inhibitors on systemic inflammation and myocardial sympathetic innervation in normotensive patients with type 2 diabetes mellitus.

Diabetes mellitus (DM) may cause an increase in the inflammatory status and oxidative stress as well as sympathetic nervous system overactivity, even in the absence of any other organic heart disease. We investigated the effect of perindopril, an angiotensin-converting enzyme inhibitor (ACE-i), on indexes of systemic inflammation and oxidative stress in normotensive patients with type 2 DM. We also examined the effect of the drug on the disturbances of left ventricular myocardial adrenergic innervation that may be seen in these patients. We studied 62 normotensive patients with type 2 DM, who were randomized to receive perindopril (n=32) or placebo (n=30). At the start of the study and after 6 months' therapy blood samples were taken to evaluate total peroxides (TP), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha), and the patients underwent a (123)I-metaiodobenzylguanidine myocardial scintigraphy study. ACE-i caused a significant reduction in levels of cytokines and TP (P<0.001 for IL-6 and TNF-alpha, P=0.001 for TP). There was also a reduction in total defect score (P<0.001) and the heart to mediastinum ratio at 10 min and 4 h was improved (P<0.001 for both). No significant alterations were observed in the placebo group. Our data indicate that the addition of ACE-i to the medication of normotensive diabetic type 2 patients may improve the disturbed myocardial adrenergic innervation, the systemic inflammatory status and oxidative stress. Our findings indicate the cardioprotective action of ACE-i and suggest that earlier treatment might be appropriate in those patients.

Increased human placental growth hormone at midtrimester pregnancies may be an index of intrauterine growth retardation related to preeclampsia.

OBJECTIVE: To evaluate the relationship between maternal serum and amniotic fluid levels of human Placental Growth Hormone (hPGH) with the fetal intrauterine growth retardation (IUGR) related to preeclampsia. DESIGN: We analyzed samples in pairs of serum and amniotic fluid retrospectively from 25 women, who manifested preeclampsia and IUGR in the late second or the third trimester of gestation. The samples were obtained at 16-22 weeks' gestation during amniocentesis for fetal karyotyping. At this time, there was no clinical or sonographic evidence of preeclampsia or IUGR, respectively. Sixty-two serum samples were used as controls which were obtained at 16-22 weeks' gestation from women with singleton, uncomplicated pregnancies, with normal outcome, and appropriate for gestational age neonatal birth weight. Forty-seven amniotic fluid samples were also used as controls which were obtained at 16-22 weeks' gestation from the women that were included in the control group who underwent an amniocentesis. hPGH levels were measured by a solid phase immunoradiometric assay. RESULTS: The mean hPGH values in the serum and the amniotic fluid of the IUGR related to preeclampsia affected pregnancies were significantly higher (P<0.05) than those of the normal pregnancies at 16-22 weeks' gestation: mean+/-SD in the serum was 13.16+/-10.52 ng/ml vs. 4.39+/-2.23 ng/ml; mean+/-SD in the amniotic fluid 2.49+/-1.6 ng/ml vs. 0.82+/-0.67 ng/ml. CONCLUSION: hPGH levels in maternal serum and amniotic fluid were found to be higher at 16-22 weeks' gestation in pregnancies that will be complicated subsequently by IUGR related to preeclampsia. Our findings suggest that the evaluation of the changes of hPGH levels at midtrimester should be further investigated for the possibility to provide a potential predictive index of IUGR and preeclampsia.

Clearance of technetium-99m-DTPA in pulmonary sarcoidosis.

BACKGROUND: The aim of this study was to explore the possible association of the lung clearance of 99mTc-DTPA scan with HRCT lung abnormalities and with the pulmonary function tests [PFTs] in patients with sarcoidosis. METHODS: We studied prospectively 15 patients [5 males, 10 females] of median age 46yr [range 27-67] with histologically proved sarcoidosis. HRCT scoring included the sum of the severity and extent of lymph node enlargement and parenchymal involvement. RESULTS: The mean DTPA clearance half-time [tau 1/ <40 min] was found [mean [SD]] 38.3+/-4.5min. The lymph node enlargement was found 34% and the parenchymal involvement 12%. DTPA clearance was negatively correlated with the parenchymal involvement [r= -0.651, p=0.0091]. The HRCT parenchymal abnormalities were found significantly correlated with PFTs [FVC [r= -0.65, p=0.008] and TLCO [r= -0.76, p=0.02]. CONCLUSIONS: Our data suggest a moderate association between 99mTc-DTPA scan and HRCT in pulmonary sarcoidosis. However, further studies in large scale of sarcoid patients are needed to clarify the role of this novel methodology in the evaluation and follow-up of this disorder.

Liposomal doxorubicin and conventionally fractionated radiotherapy in the treatment of locally advanced non-small-cell lung cancer and head and neck cancer.

PURPOSE: Stealth (ALZA Corporation, Palo Alto, CA) liposomal drug formulation allows a higher intratumoral accumulation and a prolonged plasma half-life of the encapsulated drugs. In the study presented here, we evaluated the feasibility of Stealth liposomal doxorubicin (Caelyx; ALZA Corporation) administered concurrently with conventionally fractionated radiotherapy in the treatment of non-small-cell lung cancer (NSCLC) and head and neck cancer (HNC). PATIENTS AND METHODS: Fifteen patients with NSCLC and 15 with squamous-cell HNC were recruited in two phase I dose-escalation trials. The starting dose of Caelyx was 10 mg/m(2) every 2 weeks (for three cycles during radiotherapy) and was increased by 5 mg/m(2) dose increments for every three patients. RESULTS: The maximum tolerated dose of Caelyx was 20 mg/m(2) for HNC and 25 mg/m(2) in NSCLC patients. Oral/pharyngeal mucositis was the dose-limiting toxicity for HNC patients. "In field" radiation skin toxicity was slightly increased. Hematologic toxicity was minimal. Single photon emission computed tomographic evaluation of Caelyx distribution, using technetium-99m-diethylenetriamine pentaacetic acid labeling, revealed a high intratumoral accumulation of the drug. The tumor to thoracic vessel area count ratio in the NSCLC cases ranged from 0.6 to 1.6 (mean +/- SD, 1.01 +/- 0.29), whereas this ratio was higher (0.8 to 1.85; mean +/- SD, 1.35 +/- 0.39) in HNC cases (P =.049). The complete response rate was 21% in the NSCLC cases and 75% in the HNC cases. NSCLC cases with higher Caelyx tumor accumulation responded better to the regimen. The tumor microvessel density assessed with the anti-CD31 monoclonal antibody directly correlated with the degree of the Caelyx accumulation (P =.007; r =. 92). CONCLUSION: We conclude that combination of radiotherapy with Stealth liposomal doxorubicin is feasible. The potential role of such a regimen in the treatment of highly angiogenic tumors requires further investigation.

Phasic coronary flow pattern and flow reserve in patients with left bundle branch block and normal coronary arteries.

OBJECTIVES: The purpose of this study was to determine whether scintigraphic myocardial perfusion defects in patients with left bundle branch block (LBBB) and normal coronary arteries are related to abnormalities in coronary flow velocity pattern and/or coronary flow reserve. BACKGROUND: Septal or anteroseptal defects on exercise myocardial perfusion scintigraphy are common in patients with LBBB and normal coronary arteries. METHODS: Thirteen patients (7 men, age 61+/-8 years) with LBBB and normal coronary arteries underwent stress thallium-201 scintigraphy and cardiac catheterization. In all patients and in 11 control subjects coronary blood flow parameters were calculated from Doppler measurements of flow velocity in the left anterior descending coronary artery (LAD) before and after adenosine administration. RESULTS: The time to maximum peak diastolic flow velocity was significantly longer both for the seven patients with (134+/-19 ms) and for the six without (136+/-7 ms) exercise perfusion defects than for controls (105+/-12 ms, p < 0.05), whereas the acceleration was slower (170+/-54, 186+/-42 and 279+/-96 cm/s2, respectively, p < 0.05). Coronary flow reserve in the patients with exercise perfusion defects (2.7+/-0.3) was significantly lower than in those without (3.7+/-0.5, p < 0.05) or in the control group (3.4+/-0.5, p < 0.05). CONCLUSIONS: Patients with LBBB have an impairment of early diastolic blood flow in the LAD due to an increase in early diastolic compressive resistance resulting from delayed ventricular relaxation. Furthermore, exercise scintigraphic perfusion defects in these patients are associated with a reduced coronary flow reserve, indicating abnormalities of microvascular function in the same vascular territory.

Myocardial perfusion in patients with permanent ventricular pacing and normal coronary arteries.

OBJECTIVES: The purposes of this study were to test the specificity of dipyridamole myocardial perfusion scintigraphy in patients with permanent ventricular pacing (PVP) and to evaluate coronary blood flow and reserve in these patients. BACKGROUND: Permanent ventricular pacing is associated with exercise perfusion defects on myocardial scintigraphy in the absence of coronary artery disease (CAD). On the basis of studies in patients with left bundle brunch block, coronary vasodilation with dipyridamole has been proposed as an alternative to exercise testing for detecting CAD in paced patients, but this approach has never been tested. METHODS: Fourteen patients with a PVP and normal coronary arteries underwent stress thallium-201 scintigraphy and cardiac catheterization. In these patients and in eight control subjects, coronary flow velocities were measured in the left anterior descending coronary artery (LAD) and in the dominant coronary artery before and after adenosine administration. RESULTS: In the paced patients, coronary flow velocities in the LAD and in the dominant coronary artery were significantly lower than those in the control subjects. In addition, seven patients showed perfusion defects on dipyridamole thallium-201 single-photon emission computed tomography, with a specificity of 50% for this test. The defect-related artery in these patients had lower coronary flow reserve (2.6 +/- 0.5) as compared with those without perfusion defects (3.9 +/- 1.0, p < 0.05) or the control group (3.5 +/- 0.5, p < 0.05). CONCLUSIONS: Permanent ventricular pacing is associated with alterations in regional myocardial perfusion. Furthermore, abnormalities of microvascular flow, as indicated by reduced coronary flow reserve in the defect-related artery, are at least partially responsible for the uncertain specificity of dipyridamole myocardial perfusion scintigraphy.

Non-small cell lung cancer functional imaging: increased hexakis-2-methoxy-isobutyl-isonitrile tumor clearance correlates with resistance to cytotoxic treatment.

Detection of P-glycoprotein and other multidrug resistance protein activity is currently under investigation to identify subgroups of cancer patients with tumors resistant to chemotherapy. Application of a test that reliably evaluates the phenomenon in vivo would not only serve as a predictor for responses to chemotherapy but would also be of use in testing the efficacy of multidrug resistance reversers in humans. Tc-99m radiolabeled hexakis-2-methoxy-isobutyl-isonitrile (Tc-sestamibi) has been recently shown to be extruded from cells through P-glycoprotein activity. In the present study, we examined the uptake and extrusion rate of the radiotracer in 25 patients with advanced non-small cell lung cancer undergoing chest radiotherapy, using a novel scintigraphic technique based on simulation-guided pinhole imaging. Five-min tumor images were taken 10, 60, and 120 min postinjection of 20 mCi of Tc-sestamibi. Six of 25 (24%) of tumors showed a 1.3-1.7 times higher extrusion rate as compared to that of normal lung tissue. Increased tumor clearance of Tc-sestamibi significantly correlated with resistance to radiotherapy (P = 0.05) as well as the existence of distant metastasis (P = 0.008). Patients with known resistance to chemotherapy had a higher extrusion rate as compared to chemotherapy-naive patients (P = 0.01). Moreover, increased Tc-sestamibi tumor capture was seen in patients with distant metastasis (P = 0.09). We concluded that functional imaging of lung cancer with Tc-sestamibi may have a role in predicting responses to cytotoxic treatment and in identifying tumors with aggressive behavior. Additional clinicopathological trials are required to investigate whether Tc-sestamibi kinetics correlates with P-glycoprotein expression, intratumoral angiogenesis, or other mechanisms.

Octreotide enhances the accelerating effect of erythromycin on gastric emptying in healthy subjects.

BACKGROUND: Erythromycin exhibits gastrokinetic properties through cholinergic pathways. Reports regarding the action of octreotide on gastric emptying are conflicting. AIM: : To assess: (i) the hypothesis that serotonin receptors are involved in the accelerating effect of erythromycin on gastric emptying; and (ii) any modification of the gastrokinetic action of erythromycin induced by octreotide. SUBJECTS AND METHODS: Gastric emptying of a standard meal was estimated in 20 healthy subjects by scintigraphy on three different occasions in a double-blind, placebo-controlled manner and in random order: (i) after placebo; (ii) after 200 mg of intravenous erythromycin; and (iii) after 200 mg of intravenous erythromycin following pre-treatment with either 4 mg of intravenous ondansetron (10 subjects) or 50 micro g octreotide. RESULTS: Erythromycin significantly accelerated gastric emptying in all subjects by abolishing the lag phase. Pre-treatment with ondansetron abolished the accelerating effect of erythromycin by restoring the emptying times to placebo levels. Octreotide significantly enhanced the accelerating effect of erythromycin by reducing both the lag and post-lag phases of gastric emptying. CONCLUSIONS: Serotonin receptors are involved in the accelerating effect of erythromycin on gastric emptying. This effect seems to be enhanced by pre-treatment with octreotide, possibly as a result of the modification of the gastrointestinal hormonal environment.

Enhancement of gastric emptying of solids by erythromycin in patients with Roux-en-Y gastrojejunostomy.

BACKGROUND: Roux-en-Y reconstruction is sometimes associated with symptoms that suggest food stasis, as a result of dysmotility of either the gastric remnant and/or the efferent jejunal limb. OBJECTIVE: To study the possible effect of intravenous erythromycin lactobionate on gastric emptying of solids in patients who have undergone a Roux-en-Y procedure. PATIENTS: Twenty-four patients with a Roux-en-Y procedure participated in the study. Ten of them had undergone truncal vagotomy with pyloroplasty; the remaining 14 had undergone a Billroth II subtotal gastrectomy as the initial antiulcer procedure. Sixteen healthy subjects served as controls. METHODS: All healthy subjects and patients underwent assessment of gastric emptying of a standard radiolabeled solid meal after administration of placebo or 200 mg of erythromycin lactobionate intravenously. Scanning was done with a gamma camera, and emptying curves were constructed. From these curves the half-time of gastric emptying was calculated. RESULTS: Patients with severe symptoms of gastric stasis had a significantly longer half-time than did patients with mild or no symptoms (P=.002). Patients with a Billroth II subtotal gastrectomy as the initial antiulcer procedure had a significantly worse grade of symptoms (P=.01) and a significantly prolonged half-time (P=.02) compared with patients with a truncal vagotomy with pyloroplasty as the initial antiulcer procedure. Erythromycin significantly reduced the half-time in the controls (P<.001) and all patients after Roux-en-Y procedure (P<.001). CONCLUSION: Erythromycin could be a useful prokinetic drug in patients with Roux stasis syndrome.

Evaluation of inflammatory cytokines in malignant and benign pleural effusions.

We measured the levels of inflammatory cytokines interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha) in pleural effusions and serum in 65 consecutive patients: 32 with malignant pleural effusion (MPE) (group A), and 33 with inflammatory benign pleural effusion (BPE) (group B). Serum levels of 15 healthy individuals served as control. Concentrations of IL-1alpha were higher in serum compared to pleural fluid in both groups (47.1+/-33.9 vs. 25.9+/-1.7 fmol/ml, p<0.001, in group A; and 39.9+/-30.9 vs. 25.4+/-16.3 fmol/ml, p<0.02, in group B). Similarly, concentrations of IL-1beta and IL-2 were significantly higher in serum compared to pleural fluid in both groups. In contrast, IL-6, IL-8 and TNF-alpha were found at high concentration in MPE in comparison to serum IL-6: 171.8+/-60.4 vs. 7. 2+/-7 fmol/ml (p<0.001), IL-8: 1175.15+/-2385.6 vs. 285.2+/-187.2 pg/ml (p<0.05), TNF-alpha: 204.9+/-82.9 vs. 79.4+/-31.9 fmol/ml (p<0. 001). Similarly, pleural concentrations of IL-6, IL-8 and TNF-alpha were higher in BPE patients in comparison to serum IL-6: 124.3+/-56. 2 vs. 8.6+/-6.4 fmol/ml (p<0.001) IL-8: 2109.2+/-4121.5 vs. 291. 6+/-197.9 pg/ml (p<0.02), TNF-alpha: 183.8+/-28.2 vs. 86.2+/-23.9 fmol/ml (p<0.001). These data suggest that IL-6, IL-8 and TNF-alpha might be secreted locally at the site of active disease both in benign and malignant pleural effusions.

Immunohistochemical analysis of the ras p21 oncoprotein in Hashimoto's thyroiditis.

We studied the ras oncogene expression using immunohistochemical detection of p21 oncoprotein in paraffin-embedded tissue sections or fine needle aspiration (FNA) material from 25 patients with Hashimoto's thyroiditis and 12 healthy individuals. We also investigated the presence of this protein in the lymphocytes of thyroid gland, as well as in peripheral blood lymphocytes. We found increased expression of p21 oncoprotein by thyroid epithelial cells in 22 patients (intensity of staining ++), whereas we observed negative or slightly positive in 9 and 3 out of 12 normal controls, respectively (intensity of staining, - or +/-). We also detected p21 oncoprotein in moderate amounts in patients' intrathyroid lymphocytes (intensity of staining +), but peripheral blood lymphocytes did not present any staining result. Our findings provided evidence that epithelial cells, as well as lymphocytes infiltrating the thyroid gland, are probably "activated" in Hashimoto's thyroiditis. The significance of this "activation" in thyroid tumorigenesis remains unknown.

Effect of dual and triple energy window scatter correction methods on image quality in liver scintigraphy.

AIM: To investigate the effect of two scatter correction methods on lesion detectability for both planar and tomographic hepatic imaging. METHODS: All planar and tomographic acquisitions involved simultaneous collection of photons in the main photopeak window (126-154 keV) and three additional windows (92-116, 116-126 and 154-164 keV). Uncorrected and corrected for scatter images were obtained from the same acquisition data. The dual energy window (DEW) and the triple energy window (TEW) scatter compensation methods were used to obtain two sets of corrected images. The DEW method was implemented with main photopeak window 126-154 keV, Compton scatter window 92-126 keV and scatter multiplier k = 0.5. A modified TEW method was also applied with main photopeak window 126-154 keV and scatter subwindows 116-126 keV and 154-164 keV. Phantoms were used to study the effect of scatter correction on contrast and signal-to-noise ratio. The observer's ability to identify lesions was studied on uncorrected and corrected for scatter patient images. RESULTS: In planar imaging, both scatter compensation methods yielded contrast enhancement. However signal to noise ratio (SNR) was degraded to 0.63 and 0.67 when DEW and TEW were applied respectively. In SPECT images, contrast was increased by a factor of 2.4 and 1.7, while SNR was degraded to 0.60 and 0.64 when DEW and TEW methods were used respectively. CONCLUSIONS: Scatter correction using DEW and TEW methods may improve observer's ability to distinguish lesions in planar (p < 0.05 for both methods) and SPECT (p < 0.05 for both methods) liver studies.

[Myocardial perfusion scintigraphy using 99mTC-tetrofosmin: a comparison with coronary angiography]. / Myokard-Perfusionsszintigraphie mit 99mTc-Tetrofosmin: Ein Vergleich mit der koronaren Angiographie.

AIM: Coronary angiography is still the most reliable method for the detection of coronary artery disease. In this study we compared to this method the accuracy of 99mTc-Tetrofosmin myocardial SPECT. METHOD: Fifty two patients (38 male and 14 female) were studied with stress-rest 99mTc-Tetrofosmin myocardial SPECT. Two independent observers evaluated the uptake of the radiotracer using a score from 0 to 4. All patients underwent coronary angiography and the results were compared to SPECT findings. We considered as hemodynamic significant any obstruction greater than 50% and as ischemic any myocardial region with radiotracer uptake less than 4 at stress. RESULTS: There was good segmental correspondence between tetrofosmin scintigram and angiography. Sensitivity 72.2-91.1%, specificity 80.0-88.2%, ppv 76.4-88.5% and npv 83.3-85.7%, depending on the obstructed vessel. CONCLUSION: 99mTc-Tetrofosmin myocardial SPECT is a reliable alternative for the detection of CAD.

Functional imaging of tumours with 99Tcm-sestamibi pinhole scintigraphy.

This study presents the advantages of pinhole over parallel-hole scintigraphy in the assessment of 99Tcm-sestamibi-related tumour biology. Twenty-five patients with malignancies underwent 99Tcm-sestamibi scintigraphy (Cardiolite, Dupont) before radiotherapy, 10 of whom had repeat scintigrams after the delivery of 25 Gy and at the end of radiotherapy. A total of 45 scintigrams with parallel-hole and pinhole collimation were evaluated for tumour avidity and ability to provide images for differential biological analysis within the tumour (areas of different uptake) or beyond the main mass (multifocality, satellite tumoral foci). The pinhole collimator was located with precision over the tumour area using a radiotherapy simulator. In 19 of 45 (42%) parallel-hole scintigrams the tumours were non-avid, whereas in 13 of 45 (29%) the tumours could be identified but the image quality was very poor. In contrast, tumour avidity was assessed in all 25 cases (100%) using pinhole scintigraphy and all pinhole images were evaluable for assessment of 99Tcm-sestamibi biology. The tumour-to-normal tissue (T/N) count ratio for the tumoral centre ranged from 1.71 to 4.36 (median 3.07) vs 1.54 to 3.20 (median 2.18) at the periphery, as assessed by pinhole imaging. Of 10 cases followed up with repeated scintigrams during radiotherapy, 2 showed an increasing T/N ratio during radiotherapy, both of whom did not respond to treatment. In the other eight cases, the T/N ratio decreased progressively during radiation treatment and all eight cases showed a varying degree of response on computed tomography or magnetic resonance imaging carried out 2 months after radiotherapy. It is concluded that 99Tcm-sestamibi tumour avidity can be successfully assessed with pinhole scintigraphy. Pinhole scintigraphy provides tumour images suitable for the evaluation of biological features related to radiolabelled pharmaceuticals. The premature observation that tumours showing increased 99Tcm-sestamibi uptake during radiotherapy correlated with poor therapeutic outcome requires further investigation.

The role of 99m Tc-sestamibi scintimammography and colour Doppler ultrasonography in the evaluation of breast lesions.

In the present study we evaluated comparatively the diagnostic value of mammography, of 99mTc-sestamibi scintimammography (sestamibi-SC) and of colour Doppler ultrasonography (CD-US) in 116 breast lesions. Diagnosis was based on histopathological examination. Overall, out of 86 malignant tumours, 80 (93%) and 75 (87%) had a positive sestamibi-SC and positive CD-US, respectively. Out of 30 benign lesions, 25 (83%) and 26 (87%) had a negative sestamibi-SC and negative CD-US respectively. The true positive results were similar in palpable and in non-palpable lesions for both methods. Out of 19 non-palpable malignant tumours, mammography confirmed malignancy in only one case (5%), which was significantly lower than the results obtained by sestamibi-SC (89%; Px0.0001) and by CD-US (74%; P=0.0001). In palpable malignant tumours, by using mamography, true positive results were obtained in 54/67 (80.5%) patients, which was significantly lower than the results obtained by sestamibi-SC (94%; P=0.03) and marginally different to the results obtained by CD-US (91%; P=0.13). It is concluded that sestamibi-SC and CD-US are useful tools in clarifying the nature of breast lesions in cases with doubtful mammography. The clinical value of these diagnostic procedures in guiding subsequent therapeutic interventions requires further investigation.

Contribution of 99mTc-anti-carcinoembryonic antigen antibody and 99mTc-sestamibi scintimammography in the evaluation of high risk palpable breast lesions.

Mammography is the screening test of choice for breast cancer. Its low specificity leads to a large number of unnecessary biopsies. Scintimammography, with either Tc-sestamibi (MIBI) or Tc-anti-carcinoembryonic antigen (CEA) Fab', has been proposed as a non-invasive test to lower the high false positive rate of mammography in certain patients. The two agents have not been compared, nor has their combined application been evaluated. We performed a prospective, non-randomized, open-label, single-centre study of 32 women with clinically and mammographically suspected breast cancer [Breast Imaging Reporting and Data System (BI-RADS, American College of Radiology) 4 or 5]. All patients underwent Tc-MIBI and Tc-anti-CEA Fab' scintimammography, and the results were correlated with histopathology. Overall, the accuracies for MIBI and CEA scans were 90.3% (28/31) and 77.4% (24/31), respectively. The probability of disease after mammography was 0.939+/-0.081 (95% confidence interval, CI). The post-mammography probabilities after positive MIBI or CEA scan were 0.965 and 0.960, respectively, and after negative MIBI or CEA scan 0.750 and 0.875, respectively. None of the above differences is significant. The post-test probability when both scans were positive (irrespective of which was performed first) was 0.977. It can be concluded that there are indications that scintimammography with Tc-MIBI is superior to that with Tc-anti-CEA Fab' when these tests are used as screening tests for breast cancer. However, mammography remains the screening test of choice for highly suspicious clinically palpable breast lesions. In this group of patients, the application of scintimammography with either Tc-MIBI or Tc-anti-CEA Fab' (alone or in combination) offers no additional advantage.

Effectiveness of Tc-99m sestamibi compared to Ga-67 in patients with pulmonary sarcoidosis.

The authors evaluated the suitability of Tc-99m MIBI to be used as an alternative to Ga-67 in pulmonary sarcoidosis imaging. Studies were performed on 21 patients. Eleven patients (group I) had been on corticosteroid treatment before the study, while 10 patients (group II) had received no treatment. Activity of sarcoidosis was assessed from clinical manifestations of the disease, pulmonary function tests, bronchoalveolar lavage, high-resolution computed tomography, and serum biochemistry. Ga-67 imaging results were abnormal in 73% of patients of group I (n = 8) and 90% of patients of group II (n = 9). Tc-99m MIBI imaging results were abnormal in 0% of patients of group I (n = 0) and 40% of patients of group II (n = 4). The lymph nodes were better demonstrated with Ga-67. Abnormal results of Ga-67 imaging were 100% sensitive to clinically active sarcoidosis, but had a relatively low specificity (33%). In contrast, abnormal MIBI imaging had very low sensitivity (11%). The authors conclude that planar Tc-99m MIBI scintigraphic images are not sensitive for the diagnosis of pulmonary sarcoidosis.

Tc-99m tetrofosmin myocardial perfusion imaging before and six months after percutaneous transluminal coronary angioplasty.

The role of Tc-99m tetrofosmin single-photon emission tomography (SPECT) in the evaluation of myocardial perfusion before and 6 months after successful percutaneous transluminal coronary angioplasty (PTCA) was assessed in 41 consecutive patients (32 men and 9 women). Twenty-five patients had one-vessel disease, 14 had two-vessel disease, and 2 had three-vessel disease. Thirty-six patients had dilation of one vessel and five patients dilation of two stenosed vessels, with a total of 46 dilated vessels. All patients underwent coronary angiography both before PTCA and 6 months after revascularization. Restenosis was angiographically demonstrated in 16 (39%) patients and 16 (34.8%) vessels. Tc-99m tetrofosmin myocardial SPECT was 81.3% sensitive and 88% specific for the detection of restenosis in the group of patients with a positive predictive value of 81.3% and a negative predictive value of 88%. Sensitivity, specificity, positive predictive value, and negative predictive value were 81.3%, 90%, 76.5%, and 89.7%, respectively, for restenosis detection in specific vessels. It was concluded that most patients who underwent successful PTCA (34 of 41, or 82.9%) had significant (P < 0.001) improvement in their scan image 6 months after the angioplasty, and that Tc-99m tetrofosmin myocardial SPECT is an excellent tool to follow these patients because it can detect restenosis accurately and noninvasively.

Hybrid cardiac imaging: insights in the dilemma of the appropriate clinical management of patients with suspected coronary artery disease.

AIM: To evaluate the potential of SPECT myocardial perfusion imaging (MPI)-computed tomography coronary angiography (CTCA) hybrid fusion imaging to improve the diagnostic performance of cardiac SPECT/MPI and CTCA alone in order to act as more accurate gate keeper to further investigation invasive or not. METHODS AND RESULTS: Twenty-five patients were subjected to SPECT/MPI and CTCA within a period of 1 month without any medical treatment modification. A fusion software package was used for cardiac SPECT-CTCA image fusion. Semiquantitative analysis was performed for cardiac SPECT, CTCA and SPECT/MPI-CTCA fusion images. Patients were classified in 2 groups according to the clinical decision for further investigation (group A), or not (group B). Statistically significant differences were observed when SPECT/MPI-CTCA fusion images were used instead of cardiac SPECT alone (p<0.05). No statistically significant differences were observed comparing CTCA alone to SPECT/MPI-CTCA fusion images (p=0.25). A mid-term follow-up (mean 3.58 ± 0.24 years) showed that all patients classified in group A based on the interpretation of SPECT MPI-CTCA fused images underwent conventional coronary angiography with further necessity for PTCA or CABG whereas absence of major or minor cardiac events was revealed for all patients of group B. CONCLUSION: In patients suspected for coronary artery disease, cardiac SPECT/MPI-CTCA fusion imaging was found to considerably alter the clinical decision for referral to further investigation derived from SPECT/MPI.