Physical and subjective evaluation of a three-detector (TRIAD 88) SPECT system.

The three-detector TRIAD 88 is a variable cylindrical FOV whole-body SPECT system designed for both brain as well as body organ imaging. The system performance was assessed in terms of physical indices and clinical quality. Measures of low contrast resolution using contrast-detail curves, high contrast resolution using LSFs and associated frequency descriptors, display characteristics, system sensitivity, energy resolution and uniformity analysis were utilized. In addition, images of Carlson phantom, Hoffman brain phantom and clinical brain images were used to compare two collimators subjectively. Measurements and calculations were obtained for two sets of parallel hole collimators, i.e., LEUR_PAR and LEHR_PAR. Of special interest is the consistency among the three detectors. The planar and volume sensitivities for the LEUR_PAR collimator were about 58% of those of the LEHR_PAR collimator. The planar spatial resolution of the two collimators differed by about 14%. The display was characterized by a logistic model H & D curve. The planar contrast-detail curves demonstrated no statistical difference in lesion detectability between the two collimator types, however SPECT phantom and clinical images demonstrated improved performance with the LEUR_PAR collimator. Images of Hoffman single slice brain and Carlson phantoms and Tc-99m (HMPAO) brain images demonstrated excellent image quality. There was similarity in performance parameters of the three detector heads.

Preserved cognitive skills in dementia of the Alzheimer type.

OBJECTIVE: To describe preserved cognitive skills in patients with dementia. DESIGN: Case series. SETTING: Community clinic. PATIENTS: Five patients who met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease and were claimed to retain a cognitive skill. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Standard neuropsychological tests and individualized measures of patient's skilled behaviors. For patients who remained skilled at games, performance was compared with that of normal controls in direct competition. For the patient-trombonist, raters compared premorbid and postmorbid recordings of his play. RESULTS: One patient continued to play the trombone in a Dixieland band, although he could not name well-known numbers that he played. Another continued to solve adult jigsaw puzzles. A third patient retained skill at canasta, the fourth at dominoes. The fifth patient remained a skillful contract bridge player, although he could not name the suits or articulate simple bidding rules. Four patients had impaired performance on standard anterograde and remote memory and naming tests but performed normally on pursuit rotor and letter fluency tests. Mini-Mental State Examination scores for these patients ranged from 10 to 22. One patient refused neuropsychological testing but displayed his skill. CONCLUSIONS: Together with previous studies of preserved piano playing or painting skills, our findings indicate that a broad range of complex cognitive abilities may be preserved in patients with dementia of the Alzheimer type who cannot perform simpler actions.

First-pass studies of acute lung injury.

Mild hydrochloric acid was introduced to a caudal lung section in each of eight dogs to induce injury. Transits of 99mTc-labeled red blood cells (RBC) and [123I]iodoantipyrine (IAP) injected intravenously were recorded by a scintillation camera. Lungs and blood samples were analyzed post-mortem. Peak-to-equilibrium ratios (P/E) of RBC time-activity curves were computed to be 3.83 +/- 0.54 for the control lung, 2.58 +/- 0.55 for the injured lung and 2.23 +/- 0.58 for the injured caudal section. For IAP, the respective results were 3.78 +/- 0.29, 2.02 +/- 0.18 and 1.77 +/- 0.17. The decrease of P/E in injured areas was attributed to reduced blood flow. Using mean transit times of the tracers, we computed extravascular lung water per unit blood volume to be 0.35 +/- 0.18 for the control lungs and an increased value of 0.68 +/- 0.24 for the injured lungs. These results displayed sensitivity to injury, but were gross underestimates relative to the corresponding values of 2.04 +/- 0.54 and 4.56 +/- 1.85 in post-mortem analyses.

Distributions of perfusion and lung water.

We investigated the feasibility of using 123I-iodoantipyrine (123I-IAP) and 99mTc-labeled macroaggregated albumin (99mTc-MAA) to describe and compare the distributions of perfusion and water content in lung injuries. These radiopharmaceuticals were administered to 9 rabbits, 5 control and 4 with lung injuries. Isolated lungs were imaged by a scintillation gamma camera. The distribution of 123I-IAP outlined the entire lung mass whereas perfusion defect in the distribution of 99mTc-MAA was seen clearly in the case of severe lung injury.

Lung water measurements with iodo-antipyrine.

131I labeled iodo-antipyrine and 99mTc labeled erythrocytes were used to measure water content in lungs. These radioactive tracers were injected into 10 rabbits with normal lungs and 11 rabbits with injured lungs. Blood samples were drawn and the subjects were killed. The lungs were removed, weighed and homogenized. Samples of blood and lung homogenate were assayed for 131I and 99mTc. Samples were also weighed before and after drying to a constant weight at 70-75 degrees C. Extravascular lung water was determined by the dual isotope technique and again by gravimetric analysis. The average ratio of the results from the 2 different methods is 1.03 +/- 0.15. The 2 methods were compared by regression analysis and the correlation coefficient was 0.92 +/- 0.09. Our investigation suggests the possibility of measurement of lung water with equilibrium distribution of iodo-antipyrine.

Disposal of low-level radioactive waste. Impact on the medical profession.

During 1985, low-level radioactive waste disposal has become a critical concern. The issue has been forced by the threatened closure of the three commercial disposal sites. The medical community has used radioactive isotopes for decades in nuclear medicine, radiation therapy, radioimmunoassay, and biomedical research. Loss of disposal capacity for radioactive wastes generated by these activities, by the suppliers of radioisotopes, and by pharmaceutical companies will have a profound impact on the medical profession.

Effect of cardiac drugs on imaging studies with thallous chloride Tl 201.

The effects of commonly used cardiac drugs on cardiac imaging with thallium-201-labeled thallous chloride were studied. This retrospective study included 62 men ranging in age from 37 to 70 years who had cardiac imaging attempted with thallium during an eight-month period. Seven drugs were being used by at least eight patients each--propranolol, nitroglycerin ointment, isosorbide dinitrate, digoxin, hydrochlorothiazide, potassium chloride, and quinidine. Myocardial-to-background (M/Bk) ratios were calculated for each patient. No drug consistently affected the M/Bk ratios. The lowest M/Bk ratio was found in patients receiving digoxin, but there was no significant difference between the M/Bk ratios for patients taking digoxin (1.38 +/- 0.16) and those not taking digoxin (1.45 +/- 0.10) (0.05 less than p less than 0.10, Student's t test). It is concluded that the drugs studied do not affect cardiac imaging with thallous chloride Tl 201.

Gluceptate renal imaging: experience in a pediatric population.

Gluceptate renal imaging was performed to evaluate renal function and morphology in 50 pediatric patients (27 males, 23 females). Retrospective categorization revealed that 49% (27) of the studies were for functional evaluation, 27% (15) were for anatomic considerations and 23% (13) were of a miscellaneous nature. Thirty-one patients also underwent intravenous pyelograms (IVP) and in seven discordant cases gluceptate imaging provided correct information in five, compared with only one correct IVP. While both the IVP and gluceptate imaging provide clinical information concerning renal function and morphology, the ability to obtain blood flow data and to quantitate differential renal functional mass allows gluceptate imaging to define renal function more specifically than the IVP making a more meaningful diagnostic procedure for the evaluation of patients with known or suspected renal abnormalities.

Renal cortical imaging and the detection of renal mass lesions.

Tc-99m gluceptate renal imaging was compared with the intravenous urogram in 41 patients. While the specificity of the examination was essentially the same for both techniques, the sensitivity for the detection of renal mass lesions was better with gluceptate imaging. The study suggests the desirability of a shift in emphasis from the IVU to the Tc-99m gluceptate scintigram in the early evaluation of suspected renal mass lesions, and merits further clinical evaluation.

Insulin secretion in response to glycemic stimulus: relation of delayed initial release to carbohydrate intolerance in mild diabetes mellitus.

Insulin secretory responses to paired intravenous and oral glucose loads were determined in 38 nonobese individuals classified as normal (nondiabetic) subjects, "mild" diabetics (fasting blood glucose below 105 mg per 100 ml), or "moderate" diabetics (fasting glucose below 192 mg per 100 ml). Studies were also performed in 29 obese persons who were similarly grouped. The intravenous load was given to assess the alacrity of hormonal release after glycemic stimulus, and the oral glucose to determine how the speed of initial insulinogenesis modifies the disposition of ingested carbohydrate. In the nonobese group, normal subjects responded to massive hyperglycemia after rapid injection of glucose with immediate and maximal outpouring of insulin, in contrast to a desultory insulinogenic response in patients with mild diabetes, and no initial response at all in moderate diabetics. During oral glucose tolerance tests, the much faster clearance of blood sugar in nondiabetic subjects was actually associated with lower absolute insulin output than was found in mildly diabetic patients, since the latter exhibited delayed hyperinsulinemia in concert with prolonged hyperglycemia. Moderate diabetics never showed excessive insulin release despite even greater hyperglycemia. An empirical "insulinogenic index," the ratio relating enhancement of circulating insulin to magnitude of corresponding glycemic stimulus, was used to compare the secretory capacities of respective groups. Despite the higher absolute hormonal output after oral glucose in mild diabetics, the index revealed that insulin release in normal subjects was proportionally more than twice as great. This relatively greater normal secretory response declared itself shortly after the administration of glucose by either route, and was maintained throughout both tests. In the 29 obese individuals, differences among groups were essentially the same as in persons of normal weight. Obese nondiabetics did show much larger absolute insulinogenic responses during both tests than did nonobese controls. Since corresponding glucose tolerance curves were also higher, the mean insulinogenic indexes for obese subjects were not statistically greater. Moreover, when comparable glucose curves of obese and nonobese controls