Parameters of dynamic and static iodine-123-MIBG cardiac imaging.

UNLABELLED: Dynamic and static 123I-MIBG studies were used to investigate various parameters with regard to their usefulness in evaluating cardiac disorders. METHODS: Four patient groups and one control group were included in this study. Dynamic study was acquired immediately after injection at 1 frame/sec for 2 min and at 1 frame/6 sec for the next 30 min using a 64 x 64 matrix format. Static study consisted of planar images at the anterior and left anterior oblique 45 degrees views in a 512 x 512 matrix format for 1 min. The early and delayed planar images were acquired soon after dynamic acquisition and approximately 4 hr after injection, respectively. Net injection dose was calculated as the difference in syringe counts before and after injection. From the dynamic and static studies, the heart uptake ratios at 3 min and 30 min, early uptake ratio and delayed uptake ratio were calculated at various intervals. Early and delayed clearance rates, Ke and Kd, respectively were also determined. These parameters were compared and correlated with each other. RESULTS: Three-minute heart uptake ratios were significantly higher than early or delayed uptake ratios or uptake ratios at 30 min in all groups. All uptake ratios in hemodialysis patients were significantly higher than those in other groups. The Kd values in dilated cardiomyopathy, doxorubicin therapy and vasospastic angina patients were significantly higher than those in hemodialysis patients and normal controls. At least bi-exponential clearance patterns of MIBG from the heart were observed in all groups. CONCLUSION: Three-minute and delayed heart uptake ratios calculated from dynamic and static studies are helpful in elucidating the uptake at nonvesicular sites, which reflect the severity of sympathetic nervous system abnormalities in the heart.

Indium-111 leukocyte imaging in patients with rheumatoid arthritis.

This study evaluates the usefulness of labeled leukocyte imaging in patients with rheumatoid arthritis. In 33 patients, the incidence of pain and swelling in 66 wrist joints and 66 knee joints was compared with the accumulation of [111In]leukocytes. No accumulation of [111In]leukocytes was seen in any of the patients' wrists (0/12) or knee joints (0/14) when both pain and swelling were absent. In contrast, 93% (25/27) of wrist joints and 80% (24/30) of knee joints with both pain and swelling were positive by [111In]leukocyte scintigraphy. There was little correlation between the stage of the disease, as determined by radiography, and [111In]leukocyte accumulation. This study suggests that [111In]leukocyte imaging may be a reliable procedure for monitoring the activity of rheumatoid arthritis, especially for confirming the lack of an ongoing inflammatory response.

Abdominal wall desmoid mimicking intra-abdominal mass: MR features.

A case of abdominal wall desmoid which enlarged toward the liver and mimicked an intra-abdominal tumor is presented. T*2-weighted MR images clearly demonstrated the tumor's continuity with the rectus abdominis muscle. The case presented suggests MRI may provide more valuable information concerning the origin of a right-upper-quadrant mass than CT does. However, the nature of the signals and attachment which this case showed were so unusual for desmoids that this case has not been diagnosed accurately.

Analysis of a uranium solution for evaluating the total number of fissions in the JCO criticality accident in Tokai-mura.

The uranium solution in the precipitation tank in the JCO's uranium conversion facility was analyzed in order to evaluate the total number of fissions in the criticality accident. Two analytical groups at JAERI performed chemical analyses independently in order to check the validity of the results: the concentration of the fission products (95Zr, 99Mo, 103Ru, 131I, 140Ba, etc), uranium, boron and impurity elements in the solution. The analytical results obtained by the two groups were almost in agreement within the analytical error. The number of fissions per one gram of uranium in the accident was determined to be (1.5 +/- 0.1 ) x 10(14). Also, the total number of events was evaluated to be (2.5 +/- 0.1) x 10(18) fissions using the total amount of uranium (16.6 kg) fed into the precipitation tank at the accident.

Scintigraphic changes in bone metastasis from prostate cancer after hormonal therapy--comparison with tumor markers and bone X-ray.

Bone scintigraphy is often performed to assess the response to systemic therapy of bone metastasis from prostate cancer. We examined the changes in bone scintigraphic findings and the agreement with AIP, AcP, or other tumor markers measured in the follow-up of patients with known bone metastasis after hormonal therapy. Out of 32 patients, 22 (69%) showed improved scintigraphic findings on the first follow-up bone scintigraphy after hormonal therapy. However, 7 out of 22 patients who showed improvement on the first follow-up scintigraphy, deteriorated thereafter. Changes in the scintigraphic findings were closely correlated with those in the measured tumor markers except for patients with small bone metastasis. Though there were no significant differences in the agreement ratios of the 6 tumor markers evaluated, AIP might be a practical and acceptable indicator. Bone X-ray findings did not change at all in almost half of the cases though the scintigraphic findings showed improvement or deterioration.

A new liver functional study using Tc-99m DTPA-galactosyl human serum albumin: evaluation of the validity of several functional parameters.

Several parameters calculated with a new functional imaging agent for the liver, Tc-99m DTPA-galactosyl human serum albumin, were evaluated in 9 patients with liver cirrhosis, one with hepatocellular carcinoma, and five with both liver cirrhosis and hepatocellular carcinoma. LU3, which represents the cumulative uptake of the tracer from 3 to 4 minutes after injection, showed a strong correlation (r = 0.858, p = 0.0001) with LHL15, which represents the count ratio for the liver to sum for the liver and heart 15 minutes after injection of the tracer. It also showed a strong correlation (r = -0.896, p = 0.0001) with the indocyanine green retention rate (ICGR15). Regional ICGR15 is therefore calculable from the regional LU3. GSAR15, which represents the radioactivity of the tracer retained in the blood 15 minutes after injection, showed a strong correlation (r = 0.878, p = 0.0001) with HH15, which represents the count ratio for the heart 15 minutes after injection of the tracer divided by the count for the heart 3 minutes after injection. In conclusion, LU3 and GSAR15 are interesting and promising parameters for assessing liver function.

Radioimmunoscintigraphy of CEA/CA 19-9 producing tumors with I-131 labeled monoclonal antibodies.

A total of 7 (4 males and 3 females) patients were included in this retrospective study to determine the sensitivity of radioimmunoscintigraphy with I-131 labeled anti CEA/CA 19-9 monoclonal antibodies. Out of 7 patients 2 had ascending colon cancer, one had sigmoid colon cancer, one had rectal cancer and one had adenocarcinoma in the CBD and the remaining two had metastatic tumor (one in the lungs and the other in the liver). Whole body as well as spot images showed a 72% (5/7) positive scan. But post operative specimen counts and imaging showed a high tumor to non-tumor ratio and a good tumor to non-tumor contrast of activity of I-131 labeled monoclonal antibody. We did not find any relation between CEA/CA 19-9 levels and scan findings. A case of liver metastasis was also detected by this radioimmunoscintigraphy.

Visualization of the bone/bone marrow of lower extremities in Ga-67 whole-body images.

Patients whose Ga-67 whole-body images showed increased uptake by the bone/bone marrow of the lower extremities were selected and classified into three types according to the extent and the grade of the visualization. These types were then compared with their serum iron levels, iron-binding capacities, and the results of several other serum biochemical tests. Of 374 consecutive whole body 72-hr images reviewed, 59 (15.8%) showed increased uptake of the tracer by the bone/bone marrow of the lower extremities. The three classified types were as follows: type T--visualization of both tibiae and femurs; type S--strong visualization of the femurs; and type W--weak visualization of the femurs. The serum iron concentration was significantly high in type T and low in type S. In conclusion, the pattern of Ga-67 uptake by the bone/bone marrow of the lower extremities fairly closely reflects the status of iron metabolism.

Diffuse arteriovenous malformation involving jejunum and total colon with mesenteric varices. Case report.

Diffuse intestinal arteriovenous malformation (AVM) is very rare. We describe a case of diffuse AVM involving the jejunum and the total colon in an adult. In addition, mesenteric varices without portal hypertension is demonstrated on angiography of the superior mesenteric artery. The high flow through the AVMs may be a major component in the etiology of the mesenteric varices in our case.

Hypertrophic pulmonary osteoarthropathy inactivated by antitumor chemotherapy.

A case of hypertrophic pulmonary osteoarthropathy (HPO) associated with carcinoma of the lung is reported. HPO in this patient was documented by Tc-99m methylene diphosphonate scans over a period of seven months. He was treated solely by antitumor chemotherapy, and his HPO was inactivated in three months. Whereas most reports refer to surgery, vagotomy, or radiotherapy for the treatment of lung carcinoma, this case demonstrates the effect of palliative chemotherapy in inactivating HPO in a rather short period of time.

A case of intracranial involvement of Hodgkin's disease.

We report a rare case of Hodgkin's disease in which intracranial involvement developed during the course of the patients illness. A 20-year-old man who had complained of lymph node swelling on the right neck was admitted to a hospital in December 1978. Lymph node biopsy revealed Hodgkin's disease, and he was treated by various series of chemotherapy and radiotherapy with unsatisfactory results. He was transferred to Yamanashi Medical College Hospital in June 1985. He was in a far-advanced state at the time, and palliative treatment was applied. In the middle of May 1986, he complained of headache, tinnitus, and sleeplessness. Vomiting and tremor were observed by the end of May 1986. Brain CT scan revealed a space occupying lesion in the right temporal region. Whole brain irradiation of 45 Gy was effective, and the lesion disappeared. However, his general condition deteriorated and he died in November 1986. Brain autopsy could not be performed.

A study of chondroitin sulfate iron colloid as a liver specific MR contrast agent.

Chondroitin sulfate iron colloid (CSIC) is a therapeutic agent for iron deficiency anemia. The potential of CSIC to decrease liver signal intensity at magnetic resonance (MR) imaging has already been tested. Enhanced detection of liver carcinoma by CSIC at MR imaging was studied in vivo. Our purpose was to determine the time period required to obtain the maximum contrast enhancement from CSIC at different dose levels. We performed MR imaging of eight rats with hepatic carcinoma before and after CSIC administration. For all dose groups it was found that on T2-weighted images the maximum contrast to noise ratio (C/N) was at 4-8 hours after the drug administration, while on proton density-weighted images the maximum C/N was at 2-8 hours.

Dense parenchymal accumulation of Lipiodol after transarterial chemoembolization.

Dense accumulation of Lipiodol in hepatic segmental parenchyma was studied by computed tomography (CT) after transarterial chemoembolization (TACE) for hepatic tumor. Six patients showed dense accumulation of Lipiodol in hepatic segmental parenchyma on CT two weeks after TACE. Four of the six showed parenchymal accumulation of Lipiodol as dense as that in a tumor at three weeks after TACE. Therefore, it was considered that evaluation with CT should be performed after one month or more in order to differentiate between Lipiodol accumulation in tumors and that in non-neoplastic liver parenchyma.

MR imaging of seminal vesicle cysts associated with adult polycystic kidney disease.

An unusual case of seminal vesicle cysts associated with adult polycystic kidney disease (APKD) is presented. The magnetic resonance (MR) appearance of this rare entity has not been described before. A brief review of the literature is included and the role of MR imaging is discussed.

Multilocular cystic hemangioma: CT and MR appearance.

An atypical case of multilocular cystic hemangioma is presented. A 4.5 cm multilocular cystic mass was incidentally found in a 66-year-old healthy woman on ultrasound screening. CT, MR imaging, and angiography were performed: however, the features that are characteristic of cavernous hemangioma were not obtained. The final diagnosis could not be made until surgery.

Decreased signal intensity of cerebral cortex on T2-weighted MR images.

To define the frequency of decreased signal intensity (DSI) in cerebral cortex on T2-weighted images relative to aging and to the incidence of identifying white matter pathology, T2-weighted MR brain images of 906 patients consecutively examined between July 1989 and June 1991 were reviewed. MR images of cerebral cortex were divided into five areas: frontal lobe (F), pre- and postcentral gyri (C), parietal lobe (P), occipital lobe (O) and temporal lobe (T). Each area was separately and independently evaluated for the presence or absence of DSI. The frequency of DSI in each area was plotted against patients' ages. The severity of leukoaraiosis was evaluated in relation with DSI in each cortical area. Patients with DSI in area F numbered 61 (5.7%), in area C 236 (26.0%), in area P 174 (15.9%), in area O 428 (47.2%), and in area T 10 (1.1%). The number of patients with DSI in each area increased with age. The greater the severity of leukoaraiosis, the greater the chance of finding DSI of the cerebral cortex. The incidence of DSI in the cerebral cortex increased with the patient's age as well as with the severity of co-existent white matter pathology.

The usefulness and limitations of combined Tc-99m pertechnetate and Ga-67 citrate imaging of salivary gland disorders.

The usefulness of combined Tc-99m and Ga-67 scans in diagnosing salivary gland disorders was evaluated in a total of 31 patients. Out of 6 patients with Warthin's tumor, 4 showed a typical pattern of high-activity in the gland with retention of Tc-99m, but without an affinity for Ga-67. Out of 9 patients with pleomorphic adenoma, 8 showed a "cold" area in the tumor by Tc-99m and 5 of the 9 patients had accumulated Ga-67. Five of 6 patients with malignant tumor showed an affinity for Ga-67. Nine of 10 patients with sialadenitis showed diffuse uptake of both Tc-99m and Ga-67 in the involved gland. Combined Tc-99m and Ga-67 imaging was useful in detecting the cases of Warthin's tumor and sialadenitis (90% sensitivity and 89% specificity for sialadenitis), but the study had limitations in differentiating malignant tumors from benign tumors (66% sensitivity and 84% specificity). However, Ga-67 imaging showed a 91% negative predictive value. A negative scan could almost rule out the possibility of malignant disease of the salivary gland.

[Functional parameters calculated by 99mTc-MAG3 in transplanted kidney].

A newly developed 99mTc-labeled renal tubular agent, 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) was evaluated and compared with 99mTc-DTPA and 123I-OIH in 10 patients with a transplanted kidney. Renal uptake of MAG3 correlated well with both DTPA and OIH; however, these uptake values of MAG3 were lower than those of OIH and higher than those of DTPA. Renogram parameters also correlated well with each other, but excretion of MAG3 was slower than that of OIH and faster than that of DTPA. The bladder to kidney ratio of MAG3 also correlated well, but these ratios of MAG3 were lower than those of OIH and higher than those of DTPA. In conclusion, MAG3 is a promising agent for evaluating the function of transplanted kidney.

[123I-iodoamphetamine single photon emission computed tomography in three patients with amyotrophic lateral sclerosis].

We examined the 123I-iodoamphetamine SPECT for 3 patients with ALS, who were clinically diagnosed. Patient 1 was a 31-years-old man, who had bilateral muscle weakness of his upper extremities, and spasticity in lower extremities. Patient 2 was a 51-years-old woman, who had marked weakness of her upper extremities and bulbar sign. Patient 3 was a 68-years-old man, who had severe degree of marked weakness of his upper extremities and mild bulbar signs. Cerebral cognitive function were all normal in three patients. Computed tomographic and magnetic resonance imagings showed moderate degree of cortical atrophy in patient 1, but no abnormalities in patients 2 and 3. In 123I-IMP SPECT, however, hypoperfusion were recognized on the bilateral fronto-parietal border zone areas in these three patients with ALS. It was suggested that patients with ALS showed varying degrees of impaired perfusion in the fronto-parietal border zone areas in spite of normal cognitive functions.

[Detectability of metastatic bone tumor by Ga-67 scintigraphy].

Ga-67 scintigrams in patients with malignant diseases sometimes reveal uptake of the tracer in the bone metastases. Detectability of Ga-67 scintigraphy for metastatic bone tumors and benign bone lesions was compared with that of Tc-99m bone scintigraphy. Countable bone metastases detected by bone scintigraphy were evaluated whether the lesion showed apparent, faint, or negative Ga-67 uptake. Of 47 lesions 23 (49%) showed apparent uptake and 17 (36%) showed negative uptake. On the other hand, of 71 benign bone lesions, only 7 (10%), mostly fracture/osteotomy, showed apparent uptake of the tracer. Uptake in the other benign lesions such as trauma of the ribs, spondylosis deformans, and arthrosis deformans was rather faint. In patients with multiple bone metastases, 9 patients (82%) out of 11 showed more prominent abnormal findings in Tc-99m MDP bone scintigraphy than in Ga-67 scintigraphy; that is, Ga-67 scintigraphy was not able to reveal all metastatic bone lesions. In patients with untreated or recurrent tumors, relation between Ga-67 uptake in the tumors and that in the bone metastases was evaluated. Of 7 patients with negative Ga-67 uptake in the primary tumors, 5 showed positive Ga-67 uptake in the bone metastases; that is, there seemed to be little relation between Ga-67 affinity to the primary tumors and that to the bone metastases. Mechanisms of the Ga-67 uptake in the bone metastases were discussed. Not only the tumor cells or tissues in the bone metastases but also bone mineral or osteoclasts might be the deposition sites of Ga-67.