Three-dimensional presentation of the Fourier amplitude and phase: a fast display method for gated cardiac blood-pool SPECT.

The routine clinical use of gated SPECT is inhibited by sophisticated, time-consuming processing techniques. The present paper describes a new technique for the simultaneous three-dimensional presentation of the amplitude and phase of the first Fourier harmonics, with the aim of obtaining detailed information about the ventricular motion in a relatively short time, from each angle of view of three-dimensional space. The method is simple and robust, and processing is automatic. It does not need carefully elaborated techniques for surface determination, because the cardiac surface is merely used as a reference skeleton onto which the functional information of amplitude and phase is mapped. The Fourier analysis before reconstruction results in running times shorter than 15 min and may further open the way for the routine use of gated SPECT.

Prognostic role of 99mTc-HM-PAO-leukocyte scintigraphy in acute pancreatitis and in patients with pancreatic pseudocysts.

Fifty-five leukocyte scintigraphies were performed. Thirty-five patients (group 1) with acute pancreatitis in the early phase and 20 patients (group 2) with pancreatic chronic pseudocysts following acute pancreatitis were tested. The clinical features, laboratory parameters, and Ranson classifications were registered during hospitalization. In group 1, most of the cases with a severe clinical outcome gave positive leukocyte scintigraphic results (10/12). Leukocyte accumulation was also detected in patients with mild acute pancreatitis (4/23), but at a lower frequency. In the acute phase, significant differences in laboratory parameters (sedimentation rate and leukocyte count) were found in the leukocyte scintigraphy-positive versus-negative cases. The scintigraphic activity correlated with the sedimentation rate, leukocyte count, fever, and duration of hospitalization. In group 2 there were five cases with a positive leukocyte scan. A pancreatic abscess was found in four of them during surgery. In seven patients with a normal scintigram, surgery revealed a noninfected pancreatic pseudocyst. Leukocyte infiltration of the pancreas can be demonstrated by leukocyte scintigraphy. A positive leukocyte scan indicated a severe course of acute pancreatitis. The method also seems useful for differentiation between infected and noninfected chronic pancreatic pseudocysts.

The Effect of Intra-arterial Insulin and Glucagon on the Glucose Metabolism of the Small intestine in the Dog.

The authors have examined the effect of locally (intra-artcrially) given insulin and glucagon on the absorption and portal transport of glucose from the isolated jejunal loop of the dog. The insulin rcduccd significantly the rate of portal glucose transport, while the quantity of glucosc absorbed remained unchanged. Under the influence of glucagon the blood flow through the isolated intestinal loop and the rate of the portal glucose transport both increased. In the majority of the cases an amount of sugar exceeding the quantity of the glucose that disappeared from the lumen of the intestine appeared in the venous blood of the jejunal loop during the experimental period. On the basis of their experiments the authors suggest the ability of glucagon to mobilize glucose from the intestinal wall.

Value of 99m-Tc MIBI and 99m-Tc(V) DMSA scintigraphy in evaluation of breast mass lesions.

Among several investigative methods currently undergoing evaluation for the differentiation of biological features of breast mass lesions, mammoscintigraphy with different radiopharmaceuticals appears promising. This study evaluated the efficacy of 99m-Tc MIBI and 99m-Tc(V) DMSA mammoscintigraphy in the detection of malignant focal breast lesions. Mammography, ultrasonography, 99m-Tc MIBI and 99m-Tc(V) DMSA mammoscintigraphy were performed in 51 women with palpable breast mass lesions. Following surgical removal of the abnormalities, histological examination revealed 40 malignant and 11 benign breast mass lesions. In mammoscintigraphy, early (5 minute p.i. of MIBI, 2 hours p.i. of DMSA) and late (2 hours p.i. of MIBI and 5 hours p.i. of DMSA) planar images of the breast and the axillary regions were evaluated visually and quantitatively. The efficacy of the methods was assessed via ROC curves and variance analysis. The visual scores and the quantitative T/NT values with MIBI demonstrated a significant difference between malignant and benign breast mass lesions. A significant difference was also found as concerns the grade of malignancy from the MIBI accumulation. The late MIBI images seemed optimal. The DMSA values indicated no relationship with the breast lesion malignancy. In the detection of metastatic lymph node involvement the sensitivity and specificity with mammography and ultrasonography were 57% and 85%, with MIBI 53% and 81%, and with DMSA 53% and 95%, respectively. It is concluded that MIBI (2 hours p.i.) mammoscintigraphy is a useful and simple method for differentiation of malignant breast abnormalities from benign lesions and for determination of the grade of malignancy. DMSA mammoscintigraphy appears superior to MIBI only in the detection of axillary lymph node metastases.

Effect of glyceryl trinitrate on the sphincter of Oddi spasm evoked by prostigmine-morphine administration.

OBJECTIVE: In this study the effect of glyceryl trinitrate on the prostigmine-morphine-induced sphincter of Oddi spasm was evaluated in nine female patients with sphincter of Oddi dyskinesia. METHOD: Sphincter of Oddi spasm was induced by prostigmine-morphine administration (0.5 mg prostigmine intramuscularly and 10 mg morphine subcutaneously) and visualized by quantitative hepatobiliary scintigraphy. The entire procedure was repeated during glyceryl trinitrate infusion (Nitrolingual 1 microg/kg/min for 120 min). RESULTS: Prostigmine-morphine provocation caused significant increases in the time to peak activity (Tmax) over the hepatic hilum (HH: 34.33 +/- 5.05 vs. 22.77 +/- 3.26) and the common bile duct (CBD: 60.44 +/- 5.99 vs. 40.0 +/- 2.88) and in the half-time of excretion (T1/2) over the liver parenchyma (LP: 120.04 +/- 16.01 vs. 27.37 +/- 2.19), HH (117.61 +/- 14.71 vs. 31.85 +/- 3.99) and CBD (158.11 +/- 9.18 vs. 40.1 +/- 6.24), indicating a complete spasm at the level of the sphincter of Oddi. Glyceryl trinitrate infusion completely normalized the prostigmine-morphine-induced alterations in these quantitative parameters (TmaX over the LP: 11.33 +/- 1.13; over the HH: 18.88 +/- 1.48; and over the CBD: 36.22 +/- 1.92; and T1/2 over the LP: 28.21 +/- 1.83; over the HH: 33.42 +/- 3.10; and over the CBD: 41.66 +/- 6.33), suggesting an effective sphincter-relaxing effect of glyceryl trinitrate. CONCLUSION: These results provide the first evidence of the effectiveness of glyceryl trinitrate on the morphine-induced sphincter of Oddi spasm in humans. Since glyceryl trinitrate is able to overcome even the drastic effect of morphine, it might be of relevance in the treatment of sphincter of Oddi dyskinesia.

The effects of somatostatin and octreotide on the human sphincter of Oddi.

OBJECTIVE: Somatostatin acts at different sites in the human gastrointestinal tract and generally inhibits the release and effects of many gastrointestinal hormones and neuropeptides. Together with its long-acting analogue octreotide, somatostatin is widely used in the treatment of hormone-producing tumours, variceal bleeding, etc., but multi-centre trials have failed to prove a beneficial effect in the treatment of acute pancreatitis or in the prevention of post-ERCP pancreatitis (pancreatitis following endoscopic retrograde cholangiopancreatography). The aim of the present work was to study the effects of somatostatin and octreotide on the human sphincter of Oddi by means of quantitative hepatobiliary scintigraphy (QHBS). METHOD: Fifteen cholecystectomized patients were enrolled in the study, six in the somatostatin group and nine in the octreotide group. QHBS was performed initially with a standard protocol (baseline data), then repeated after 0.1 mg octreotide or a 250 microg bolus + 250 microg/h somatostatin administration. In the 60th min of QHBS, 0.5 mg glyceryl trinitrate (GTN) was administered sublingually. RESULTS: QHBS demonstrated that both somatostatin and octreotide caused a marked impairment in the bile flow: the half-time of excretion (T1/2) over the common bile duct was significantly prolonged compared with baseline data (somatostatin group: common bile duct T1/2 180 min versus 59.7+/-31 min; octreotide group: common bile duct T1/2 140.9+/-60.5 min versus 30.7+/-11.7 min). Glyceryl trinitrate administration accelerated the transpapillary bile flow, with significant decreases in the elevated T1/2 in both groups. CONCLUSION: Increased transpapillary flow induced by glyceryl trinitrate may be beneficial in the treatment of acute or post-ERCP pancreatitis.

Evaluation of cerebral vasoreactivity by SPECT and transcranial Doppler sonography using the acetazolamide test.

rCBF SPECT with 99mTc-HMPAO was performed prospectively in 29 patients (3 controls and 26 stroke patients) as well as TCD studies in 20 patients (3 controls and 17 stroke patients) before and after 1 g i.v. acetazolamide. The sensitivity of rCBF SPECT increased from 62% to 77% after acetazolamide provocation in stroke patients. In patients with a reversible neurological deficit, the sensitivity under resting conditions was 50% which increased to 71%, while in cases with a permanent deficit it increased from 75% to 83%. In the evaluation of the cerebrovascular reserve capacity the results of rCBF SPECT and TCD coincided in 91% of the hemispheres. The correlation was statistically significant.

Detection and localization of ventricular preexcitation in Wolff-Parkinson-White syndrome (comparative study with body surface mapping).

21 patients with Wolff-Parkinson-White (WPW) syndrome were investigated through radionuclide imaging and body surface mapping. Ventricular preexcitation was localized by display of identical phase ventricular regions (phase display). In 79% of the cases radioisotope and body surface mapping methods have identical results for the site of preexcitation. In two patients of the control group (10 patients with Lown-Ganong-Levine (LGL) syndrome), false positive outside-of septum ventricular preexcitation was detected, i.e. an 80% specificity. It is concluded that phase display might be a suitable method in the diagnosis of WPW syndrome. The sensitivity of this method can be improved using several views.

Tc-99m HMPAO leukocyte and Tc-99m nanocolloid scintigraphy in posttraumatic bone infection.

Posttraumatic osteomyelitis was investigated in 23 patients using nuclear medicine techniques. Tc-99m hexamethylpropilene amine oxime (HMPAO)-labeled leukocyte scintigraphy was performed in 11 patients, and Tc-99m nanocolloid scanning was performed in the other 12 patients. The scintigraphic findings were compared with clinical, laboratory, radiologic, and bacteriologic results. The findings on leukocyte imaging were consistent with the clinical symptoms in 7 of 11 patients, with the laboratory pattern in 7 of 10 patients, with the radiologic findings in 7 of 11 patients, and with the results of bacteriology in 6 of 7 patients. The findings on nanocolloid scintigraphy corresponded with the clinical symptoms in 9 of 12 patients, with the laboratory pattern in 8 of 10 patients, with the radiologic findings in 8 of 12 patients, and with the bacteriology in 4 of 5 patients. The results suggest that both methods were of similar value for the detection of chronic posttraumatic osteomyelitis regardless of whether the process was active. Conversely, on the basis of semiquantitative analysis of the images, leukocyte scintigraphy seemed to characterize the grade of inflammation better than did nanocolloid scintigraphy.

Investigation of gamma camera detector uniformity using a dynamic line phantom.

BACKGROUND: Investigation of the applicability of the dynamic line phantom for determination o the uniformity of circular and rectangular field-of-view gamma cameras. METHODS: Count rate - activity and uniformity - count rate functions were determined by the dynamic line phantom on three circular field-of-view gamma cameras with 37 PMTs, on one circular field of view camera with 19 PMTs, and on one rectangular field-of view gamma camera with 59 PMTs, with and without a collimator. For an evaluation of the efficacy of the dynamic line phantom, the results were compared with the uniformity values obtained with a 99mTc point source and a 57-Co sheet source. RESULTS: In the optimum count rate range (20,000-30,000 cps for a circular field-of-view, 15,000-65,000 cps for a rectangular field-of-view) determined individually for each gamma camera, the uniformity values obtained with the dynamic line phantom did not differ statistically from the refined with the 99mTc point source or the 57-Co sheet source. CONCLUSIONS: The dynamic line phantom is suitable for the determination of detector uniformity, but the measurements should be performed within a well-defined activity (count rate) interval.

Diagnostic value of 99mTc-HM-PAO leukocyte scintigraphy and computer tomography in patients with sternal wound infections.

METHODS: 99mTc-HM-PAO leukocyte scintigraphy (LS) and computer tomography (CT) were carried out on 19 patients after cardiac surgery; 10 patients with a high clinical probability of an infected sternal wound (group II) and additionally 9 postoperative patients without clinical symptoms of infection, as a control group (group I). LS was carried out with mixed, autologous leukocytes, labelled with 99mTc-HM-PAO in vitro. CT scans were obtained with the use of intravenous contrast material. Findings from the LS of control patients (group I) were as follows: a cold area in the view of the sternum, a 'biffed sternum' and a diffuse, increased lung uptake of leukocytes. The CT scans of the control group showed focal oedema, focal haematoma and moderate sternal abnormalities. The CT findings of a well-defined fluid collection in the retrosternal space led to one control patient being classified as having a retrosternal abscess. In the group II, the LS finding of an increased leukocyte uptake and the CT finding of a structural irregularity of the sternum, or of air or fluid collection in the retrosternal space, were taken as signs of infection. In 11 of the 13 cases, the infection was verified clinically: 9 of these proved positive on LS and 8 on CT. LS was positive in cases with either superficial or deep processes. In all cases, CT revealed whether the infection was limited to the presternal space or whether the sternum and mediastinum were also involved. CONCLUSIONS: LS and CT are sensitive methods for the early detection of postoperative sternal wound infections. CT is superior for the exact localisation of the process, while specific signs of infection can be differentiated from those of uninfected sternotomy by the use of LS. A combination of LS and CT is suggested in the diagnosis of poststernotomy infection.

rCBF SPECT and the acetazolamide test in the evaluation of dementia.

BACKGROUND: The diagnostic potential of 99mTc-HMPAO following systemic administration of the cerebral vasodilator acetazolamide (acetazolamide test) was evaluated using regional-cerebral-blood-flow (rCBF) SPECT in patients with Alzheimer's disease (AD) or with vascular-type of dementia (VD). METHODS: An initial, high-resolution SPELT study was performed with 99mTc-HMPAO, and after 2 days patients were re-evaluated with 99mTc-HMPAO following systemic administration of acetazolamide. Reconstructed SPELT slices were evaluated visually and semiquantitatively by a semiautomatic rCBF map method. RESULTS: Using 99mTc-HMPAO alone, a bilateral hypoperfusion was found in the temporal and/or parietal regions in 33% (6/18) of VD patients and in 70% (23/33) of AD patients. The vascular reserve capacity, as determined with the acetazolamide test, was not impaired in 22% of the VD patients but in 76% of the AD patients. The differences in the perfusion patterns between VD and AD patients were statistically different (p < 0.01, Fischer's exact test). Of the 6 VD patients with hypoperfusion (bilateral temporal and/or parietal), 4 had a decreased vascular reserve capacity as determined in the acetazolamide test. Decreased reserve capacity was found in only 4 out of 25 patients with AD. CONCLUSIONS: The acetazolamide test is helpful in rCBF SPECT to differentiate VD from AD.

[SPECT--single photon emission computer tomography. A new imaging method in isotope diagnosis]. / SPECT--Single Photon Emissziós Computer Tomográfia. Uj képalkotó eljárás az izotópdiagnosztikában.

The paper gives an introduction to the basis and quality control of a relatively new imaging method. First the different kinds of SPECT instruments, and then the aspects of diagnostic application are described. Details are given on examinations of the central nervous system, the abdomen, the hearth and the skeletal system, on the possibilities of immunoscintigraphy, and also on the indications of SPECT studies and the clinical performance. Finally, the state and future of this technique in Hungary are considered.

[Internal mammary lymphoscintigraphy in breast cancer]. / Mammaria interna nyiroklánc-szcintigráfia emlörákban.

Clinical importance of the internal mammary radionuclid lymphoscintigraphy (IM RNLS) have been studied in 203 breast cancer patients at the primer staging in 94 unilateral, 7 bilateral independent breast tumor, 13 inflammatory breast cancer, and in the frame of the clinical follow-up in 41 local/regional recurrence, 9 soliter sternal lesion and 2 metastatic bilateral breast tumor. Based on the results the routine use of the IM RNLS is suggested beyond the primer staging in the course of the clinical follow-up at the appearance of the above mentioned entities related to the lymphogen tumor spread.

[Value of the ejection fraction in patients with right ventricular necrosis during the rehabilitation period]. / Az ejekciós frakció értéke jobb kamrai necrosisban a rehabilitáció idöszakában.

The right ventricular ejection fraction was determined in 58 patients with simultaneous right and left ventricular myocardial infarction and in 77 patients with only left ventricular myocardial infarction. The results were analysed in four groups of patients (patients with anterior, anterior and right ventricular, posterior, posterior and right ventricular myocardial infarction). Furthermore, the relation between left and right ventricular ejection fraction, stress capacity and heart volume was investigated. There was no influence of the age and gender of patients on the observed values of right and left ventricular ejection fraction. In younger patients, after myocardial infarction, the heart volume was found to be less and the stress capacity to be higher then in elderly patients. The right ventricular ejection fraction was normal in patients with "poor" left ventricular infarction, and it was decreased in patients with right ventricular myocardial infarction. The right ventricular ejection fraction did not influence the stress capacity and the heart volume of the patients. The left ventricular ejection fraction found to be less in anterior, compared to posterior myocardial infarction. This difference was independent on the presence of right ventricular infarction. The authors consider the decreased right ventricular ejection fraction as a valuable indicator of the abnormal contractility of the right ventricle even at the time of the rehabilitation after myocardial infarction.

[Measurement of bone mineral content by single-photon absorptiometry in children]. / Csont ásványianyag mérés gyermekkorban egyfotonos abszorpciometriás eljárással.

Bone mineral content (BMC) was measured in 64 children (33 boys [aged 4-17] and 31 girls [aged 2-12]) having no signs of metabolic bone disease, at the distal third of their radius using single photon absorptiometry (SPA), to establish normative data. Relationships were studied between the obtained bone mineral content and the age, weight, as well as height of children. The obtained BMC values were compared with that of healthy Swedish and American children. Authors suggest the routine use of SPA in home children suffering from metabolic bone diseases.

[Radionuclide imaging of parathyroid adenoma using the 201TI-99mTc substraction scintigraphy method]. / Mellékpajzsmirigy adenoma kimutatása 201TI-99mTc subtractiós szcintigráfiás eljárással.

Primary hyperparathyroidism is the most frequent parathyroid disease. Parathyroid adenomas account for the majority of primary hyperparathyroidism (81%) while carcinoma and diffuse hyperplasia occur less frequently (4% and 15%). Ten per cent of adenomas are located substernally. The difficulties of preoperative localization of parathyroid adenomas may lead to incomplete surgical removal. Therefore an accurate technique for preoperative localization of the parathyroid gland is of utmost importance. Various imaging methods are available (ultrasonography, computer tomography, angiography, etc.), each with their own limitations. Thus, a nuclear technique performed via 201Tl-99mTc dual isotope subtraction scintigraphy may well contribute to the safety of diagnostics. The authors present a case of parathyroid adenoma diagnosed by this method and confirmed histologically. The role of non-invasive techniques in preoperative localization of parathyroid adenomas protecting the patient from invasive procedures and repeated surgical explorations is highly emphasized.

[Bone scintigraphy in breast cancer: a ten-year follow up study]. / Csontszcintigráfia emlörákban: 10 éves követés.

The value of bone scanning in the primary staging and clinical course of breast cancer was studied in a 10-years follow-up. Bone metastases (BM) were detected at the time of primary diagnosis in 6.8% of the patients. After primary therapy, the skeleton was the first site of the relapse in 42% of the cases. During the follow-up, BM were revealed in 25% of 623 patients a mean of 22.3 months after the operation. BM were manifested in 17% of the cases with small primary (pT1) tumors and negative axillae. Forty-three percent of the patients had no symptoms at the time of BM diagnosis. The mean survival after the appearance of BM in 163 patients was 18.2 months. Thirteen patients survived more than 5 years after the diagnosis of BM. The routine use of bone scanning is suggested at the time of primary diagnosis, and then yearly in a minimum 5-years period, independently of the symptoms.

[Uterine artery embolization for the conservative management of leiomyoma]. / Myoma konzervatív kezelése az arteria uterina embolisatiójával.

Uterine leiomyoma, a benign, monoclonal tumor derived from a single myometrial cell, is one of the most frequent diseases in the female reproductive system. However, the factors involved in its initiation and growth remain poorly understood. Most commonly, it results in dysmenorrhea, menorrhagia, urinary tract and neurological symptoms, and abdominal distension. Additionally, it may cause infertility, late miscarriage or other severe complications in pregnancy. The conventional treatment for fibroids has been hysterectomy. However, many women do not like to lose their uterus and potential fertility. Myomectomy and medical treatment with GnRH analogue are accepted as alternative organ-conserving methods with limited efficacy. Selective embolization of uterine arteries might therefore have a significant role in the management of the disease. The purpose of this study was to determine the effectiveness of uterine embolization as primary therapy in the management of myomas. Uterine arterial embolization was performed in 3 patients with symptomatic leiomyomas. The uterus and fibroids were objectively evaluated with ultrasound and MRI. The efficacy and safety convinced the authors that this promising technique is at present the only reasonable alternative method in organ-conserving therapy. It is less invasive than surgery, it can restore fertility, it is well tolerated and the recovery time is shorter than that following surgical procedures. This preliminary experience is sufficient to encourage gynecologists to introduce the method in Hungary.

[Isolated right ventricular infarction]. / Izolált jobb kamrai infarctus.

Generally, right ventricle infarction is accompanied by left ventricle infarction. Isolated right ventricle necrosis is rare. Among 1707 patients with 6-week-old myocardial infarction there were 2 cases with isolated right ventricle infarction. Diagnosis based on pathologic Q waves in right precordial chest wall leads, radionuclide and echocardiographic observations. In one case, diagnosis was supported by coronary angiography, too.