The influence of radiation therapy on T-lymphocyte subpopulations defined by monoclonal antibodies.

We studied the influence of radiation therapy on lymphocyte subpopulations in 17 patients undergoing adjuvant radiation therapy for primary breast cancer, and eight patients receiving brachytherapy and external beam irradiation for primary cancer of the uterus. Radiation therapy reduced B- and T-lymphocytes in proportion to the total lymphocyte population so that their percentages remained unchanged. Determination of helper and suppressor T-lymphocytes before, during and 6 months after completion of radiotherapy revealed that in both groups of patients suppressor T-lymphocytes were more resistant to and recovered faster after radiotherapy. This resulted in a decline of the "immunoregulatory balance" (helper/suppressor ratio). Although this ratio had been higher in both groups of patients than in healthy age- and sex-matched controls before therapy, it became normal and subnormal during and after radiotherapy. The clinical significance of the differential influence of radiotherapy on T-lymphocyte subpopulations remains to be determined.

Stereotactic percutaneous single dose irradiation of brain metastases with a linear accelerator.

The effectivity of stereotactic percutaneous single dose irradiations in the treatment of solitary brain metastases has been assessed in a series of 12 consecutive patients. Only radioresistant deeply localized metastases have been treated. Photon-irradiation was carried out with the convergent beam technique using stereotactic localization methods, in a linear accelerator facility. In 11 of the 12 patients no side effects occurred. The first 7 patients, who could be observed 3 months or longer, have been studied in detail. In each of these cases single dose irradiation with 20-30 Gy yielded arrest of tumor growth. In one case a marked decrease in contrast enhancement and in four cases shrinkage of the metastasis as well as a marked decrease of the edema occurred. In every patient a marked, sometimes dramatic improvement of the clinical condition was achieved, beginning a few days after irradiation. Stereotactic radiosurgery is a valuable tool in the treatment of inoperable, radioresistant brain metastases, the major advantage being high efficacy and smoothness of the procedure, as well as extremely short hospitalization times (2-3 days).

Scintigraphy of a neuroblastoma with I-131 meta-iodobenzylguanidine.

Radioiodinated m-iodobenzylguanidine has been applied mainly for the diagnosis of pheochromocytoma and blastoma. In this paper we show that an ontogenetically related tumor, the neuroblastoma, is also scintigraphically visualized by its high uptake of I-131 MIBG. Because of the kinetic findings and the high uptake of more than 30% of the injected activity, it is likely that the neuroblastoma, by analogy with pheochromocytoma, is susceptible to specific radionuclide therapy.

Radiological evaluation of temporal bone disease: high-resolution computed tomography versus conventional X-ray diagnosis.

Sixty-two patients with different temporal bone lesions were prospectively examined by high-resolution computed tomography (CT) and conventional plain radiography, including pluridirectional tomography. High-resolution CT enabled a clear diagnosis in 80% of cases, conventional radiology in 63%; 1.6-times more bone information was recorded by high-resolution CT which is clearly superior for imaging cholesteatomas, metastases and inflammatory processes and for evaluating osseous destruction. With regard to pathological soft tissue or effusions filling the tympanic cavities, conventional radiology shows poor sensitivity (0.61). High-resolution CT is the most sensitive method for the imaging and classification of temporal bone fractures, including labyrinthine damage and ossicular chain injuries. Only in cases of atypical fractures with an unfavourable relationship to the CT planes, can carefully directed tomography be more effective. In most cases high-resolution CT replaces conventional radiology and should be the method of choice for comprehensive radiological examination of the temporal bone.

[Whole body computer tomography in the planning and follow-up of radiation therapy (author's transl)]. / Ganzkörper-Computertomographie in der Planung und Kontrolle der Strahlentherapie.

Whole body computer tomography provides accurate transverse sections of the areas to be irradiated in the position used for irradiation. The method has been used in 167 patients with malignant tumours in various parts of the body on a routine basis. Actual-size cuts allowed accurate delineation of the tumour or of the area to be irradiated with its neighbouring organs in 135 patients; in 66 patients CT scanning probided additional information regarding the extent of the tumour. Follow-up examinations carried out in 29 patients proved effective in showing the results of treatment. The introduction of the whole body scanner into radiation therapy has improbed radiation planning when compared with conventional methods because of the more accurate delineation of the area to be irradiated and of the surrounding organs.

[Computed tomography and scintigraphy in malignant pheochromocytoma]. / Computertomographie und Szintigraphie beim malignen Phächromozytom.

Two patients with malignant metastasising phaeochromocytomas are described. Special attention is paid to the findings on computed tomography and scintigraphy with meta-I-benzylguanidine. The scintigraphic findings are not uniform. A review of the literature has shown that the sensitivity of scintigraphy is less for malignant phaeochromocytomas than it is for benign tumours.

[Value of 3-phase skeletal scintigraphy in the diagnosis of bone metastases]. / Wert der Drei-Phasen-Skelettszintigraphie in der Diagnostik von Knochenmetastasen.

51 patients suffering from 125 bone metastases of various primary tumors were investigated with three-phase skeletal scintigraphy in an attempt to define criteria characteristic for bone metastases with regard to differential diagnosis. During the 3 phases of imaging, the metastases exhibited 5 different patterns of activity concentration. None of these patterns was correlated either to the size and morphological X-ray appearance of the metastases or to the histology of the primary tumors. The intensity of radionuclide concentration was also varying. The most frequent patterns of activity concentration were increased uptake during the blood-pool phase and skeletal phase combined with absence of concentration during the angiographical phase (43%), and increased uptake during all of the 3 phases (34%). In this series, a pattern of scintigraphical findings characteristic for bone metastases or helpful in the differential diagnosis could not be determined. In our experience, three-phase skeletal scintigraphy is not useful in the diagnosis and differential diagnosis of bone metastases.

[Bone marrow scintigraphy using radiocolloids in bone metastases. Sensitivity, specificity, reliability and indications]. / Knochenmarkszintigraphie mit Radiokolloiden bei Skelettmetastasen. Sensitivität, Spezifität, Treffsicherheit und Indikationen.

The sensitivity and specificity of bone marrow scintigraphy in demonstrating skeletal metastases was examined in 40 patients with focal metastases. Radiology and MDP scintigraphy were used as reference methods. Sensitivity depends on the region of the skeleton. False negatives are the rule in parts of the skeleton containing little bone marrow. In relation to the entire bone marrow content, sensitivity is 0.64. The high proportion of false negatives (36%) in the presence of confirmed metastases and the incomplete demonstration of the bone marrow makes marrow scintigraphy unsuitable as a screening method. Occasionally lesions confined to the marrow can be demonstrated when radiographs and bone scintigrams are still negative. In advanced cases, marrow scintigraphy can demonstrate the extent of destruction of the bone marrow. Demonstration of displacement or of an 'empty bone' is evidence of invasion of the bone marrow in patients with tumours. In patients with reduced haematopoiesis of unknown origin or unidentified diffuse skeletal uptake, bone marrow scintigraphy may provide valuable information.

[Real-time sonography. An important imaging procedure in the diagnosis and treatment planning of bone metastases]. / Die real-time-Sonographie. Ein wichtiges bildgebendes Verfahren bei Diagnostik und Therapieplanung von Skelettmetastasen.

The value of sonography for diagnosis and therapy planning of bone metastases is shown in 110 affected skeletal regions (60 patients with malignant diseases). Whereas sonography is inferior to conventional x-ray in respect of defects of the spongiosa, it is equal with regard to defects of the cortical layer but superior in respect of changes of the periosteum and the surrounding soft tissue. Moreover, there is an excellent correlation (97%) between pain and the reaction of periosteum and soft-tissue layer. Because of the three dimensional representation of the tumourous processes sonography has proved valuable in radiotherapy planning (field size, radiation method, risk organs etc.).

[Epi- and sub-dural haematomas on computer tomograms (author's transl)]. / Das epi- und subdurale Hämatom im Computertomogramm

The computer tomographic investigation of two epidural and 26 subdural haematomas is described. Various computer tomographic signs are discussed and illustrated by some examples. Measurements of absorption values of subdural haematomas were related to in-vitro experiments.

[Indications for and value of computed tomography and conventional skeletal diagnosis in suspected bone metastases]. / Indikation und Wertigkeit von Computertomographie und konventioneller Skelettdiagnostik bei Verdacht auf Knochenmetastasen.

In 1003 patients with a total of 2467 clinically or scintigraphically suspect skeletal parts, conventional x-ray examination at the time of first study resulted in 95% of cases (2331 skeletal parts) in a correct diagnosis. Computed tomography permitted an exact diagnosis in 52% of roentgenologically equivocal findings (136 skeletal parts). In 40% of these patients even by computed tomography metastasis was only suspected, in 8% there were unspecific findings, while by follow-up bone metastasis was proven. In 64.8% of the whole patient collective there were metastatic destructions and in 32.6% of patients benign lesions were found. Superiority of CT compared to conventional x-ray diagnosis resulted from exact demonstration of the intra- and extraosseous extent of lesions and the possibility of density measurements. It depended mainly upon the localisation of the pathologic process.

[Angio-CT: an improvement in the diagnosis of malignant liver diseases]. / Angio-CT: Eine Erweiterung der Diagnostik maligner Leberprozesse.

Dynamic contrast studies of the liver make it possible to evaluate the vascularity of liver metastases. Up to the present, the examination has only been carried out in single planes, whereas studies of the whole of the liver during one examination have not yet been published. This can be obtained by performing sequential CT (angio-CT), using special software. A clinical study of the value of the procedure has been undertaken on 64 patients with suspected liver metastases. In addition to the plain scans, the examination was repeated during the early phase of a bolus injection and subsequently ten minutes after injection (enhancement). The various structures which can be seen are described and the changes in density patterns have been interpreted according to contrast kinetics derived from nephrographic examinations. The advantages of angio-CT as compared with plain films and with scans after normal contrast infusions are described. The improved sensitivity and specificity obtained by using the three modes of examination, as compared with a single examination, is stressed.

[Panel discussion: problems of the specialist's duty to inform the patient (author's transl)]. / Medico-legale Fragen in der Radiologie--Fragen der fachärztlichen Aufklärungspflicht. Rundtischgespräch beim 59. Deutschen Röntgenkongress am 6.5. 1978 in Bonn.

The obligation of the physician to inform the patient--which he has to prove in case of a suit--is based on the patient's right of selfdetermination. This self-decision information was subject of the panel discussion. Not discussed in detail were the information concerning diagnosis and prognosis, and the instruction of the patient regarding his conduct postoperatively and during medical treatment. Not considered was the so-called malpractice and negligence respectively. Medical liability suits are increasing for various reasons and are frequently directed at a failure to inform the patient because the patient is often unable to prove a negligence of the physician ("surrogate liability"). The dimension of the duty of disclosure (complete information--no information at all) is discussed in general and with special regard to the radiological field.

[Functional heterogeneity of liver metastases in 3-phase computerized tomograms]. / Funktionelle Heterogenität von Lebermetastasen im Dreiphasen-Computertomogramm.

Ninety patients with liver metastases (68 colorectal carcinomas, 22 breast carcinomas) were examined by triphasic angio-CT. This included demonstration of the entire liver after a bolus-like injection of contrast. Originally, the metastases were hypodense, but showed four patterns of contrast enhancement. Quantitative evaluation of the mammary carcinomas showed a marked increase in density during the bolus phase, with similar contrast values in the liver and at the centre and edge of the metastasis at ten minutes after the injection. Colorectal carcinomas showed only slight increase in density after contrast injection. The difference in density between the centre and the periphery of the metastasis was still present on later images. This finding indicates that there are differences in the vascularisation of these metastases.

[Lithium as an adjuvant in the radioiodine therapy of thyroid cancer]. / Lithium als Adjuvans in der Radiojodtherapie des Schilddrüsenkarzinoms.

14 patients were, after surgery for thyroid cancer, given radioiodine to ablate residual thyroid tissue, and, in addition, lithium carbonate. In 8 patients increasing serum lithium levels between 0.3 and 0.9 mmol/l and in 6 patients a constant level higher than 0.9 mmol/l were achieved. The radioiodine kinetics were compared with a control group of 16 patients without lithium therapy. Neither in a low nor in a high dosage the lithium medication could increase 131I uptake or prolong its effective half-life in the residual thyroid. Thus with lithium an increase of tumor dose could not be achieved. We suggest that in our patients the effect of lithium on thyroid metabolism was compensated by the enormous TSH-stimulation after thyroidectomy.

[ACTH-altered adrenal cortical uptake of the radioiodinated 11 beta-hydroxylase inhibitor (L)-SKF 12185]. / ACTH-alterierte Nebennierenrindenanreicherung des radiojodierten 11 beta-Hydroxylaseinhibitors (L)-SKF 12185.

(L)-SKF 12185, a reversible inhibitor of the enzyme 11 beta-hydroxylase, can, if radioiodinated, be used for the scintigraphic imaging of the adrenal cortex. An increased uptake of 131I-(L)-SKF 12185 was observed therein 2-3 hrs after ACTH stimulation. This effect can be explained by the steroid neogenesis induced by ACTH stimulation and the activation of the required enzymes connected therewith. The inhibitor attaches competitively with the relevant substrates to the free enzyme binding sites and produces an enhanced adrenal uptake. Thus ACTH stimulation increased the 3 hr uptake by 69% whereas the 24 hr uptake which, because of its relatively high adrenal/liver ratio, is more useful in the scintigraphic imaging of the adrenals, could not be improved significantly.

The influence of substituents in 99mTc-benzylidenediphosphonate complexes on their organ distribution in rats.

The biodistribution of a series of new 99mTc-benzylidenediphosphonate complexes (99mTc-BDP) in rats was found to vary considerably with substituents in the alpha (X) and para (R) position of the BDP ligands. From the in vivo behaviour of the 99mTc-BDP complexes the following conclusions could be drawn: 1. the blood clearance was accelerated by X = NH2; 2. the kidney uptake was decreased by X = OH; 3. the bone uptake was enhanced by X = OH and R = OH; and 4. R = Cl retarded the blood clearance, increased the kidney and lowered the bone uptake. A subcutaneously transplantable osteosarcoma was tested with 99mTc-BDP complexes as a bone lesion model. Although rapidly growing the osteosarcoma accumulated less activity than the femur diaphysis. The small amount of binding sites in the tumor tissue for osteotropic radiopharmaceuticals was attributed to the formation of necroses.

Scintigraphy of the spleen.

The various radiopharmaceuticals and techniques of spleen scintigraphy are described. The indications for spleen scanning and typical examples of various diseases are given.

Scintigraphy of lymph nodes.

The basic considerations, pharmacology, techniques, and clinical results of lymphoscintigraphy performed after the interstitial application of radiocolloids or after i.v. injection of radiogallium or radiobleomycin are described. The advantages and disadvantages are summarized, and the indications are given.

Xeroradiography of the lymphatics.

Lymphograms of 40 patients were made on xeroradiographic plates and conventional X-ray films. Both imaging procedures are compared in regard to their spatial and contrast resolution. Although xeroradiography offers little advantage in retroperitoneal lymphography, it essentially improves imaging of brachial lymphatic vessels and lymph nodes.