Bone marrow scintigraphy using technetium-99m antigranulocyte antibody in malignant lymphomas.

BACKGROUND: The purpose of this study was to elucidate the clinical reliability of immunoscintigraphy (IS) to detect infiltration of the bone marrow in patients with malignant lymphoma. PATIENTS AND METHODS: Whole body IS was performed in 103 patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) using Tc-99m labelled anti-NCA-95 which allows visualization of the granulopoietic bone marrow. Of these, 52% were studied prior to any therapy. Findings were compared to posterior iliac crest biopsy as well as MRI and/or follow-up examination. Criteria of marrow infiltration were a positive biopsy, positive follow-up, or positive results of MRI. RESULTS: Comparison of IS and biospy revealed concordant findings in 69 and discordant findings in 34 of 103 patients. Of the 34 patients with discordant results, IS showed lesions suspicious of bone marrow infiltration in 29 patients despite normal biopsy findings. When follow-up and additional examinations were taken into consideration, 10 patients remained with probably false positive and five with false negative IS findings. IS proved to be highly sensitive and specific in patients with HD (100% and 84%, respectively) and high-grade NHL (93% and 84%, respectively). Moderate sensitivity (60%) was found in low-grade NHL. This was possibly due to false negative IS in three to five patients with chemotherapy in contrast to one of five false negative results in patients without chemotherapy. CONCLUSION: Bone marrow scintigraphy using antigranulocyte antibodies is highly sensitive in HD and high-grade NHL. Positive findings in IS subsequent to a negative biopsy should be followed by guided re-biopsy or MRI.

Impaired cardiac uptake of meta-[123I]iodobenzylguanidine in Parkinson's disease with autonomic failure.

OBJECTIVE: To selectively investigate postganglionic sympathetic cardiac neurons in patients with Parkinson's disease and autonomic failure. MATERIAL AND METHODS: Metaiodobenzylguanidine (MIBG) is a pharmacologically inactive analogue of noradrenaline, which is similarly metabolized in noradrenergic neurons. Therefore the uptake of radiolabelled MIBG represents not only the localization of postganglionic sympathetic neurons but also their functional integrity. Ten patients with Parkinson's disease and autonomic failure underwent standardized autonomic testing, assessment of catecholamine plasma levels and scintigraphy with [123I]MIBG. RESULTS: The cardiac uptake of MIBG, as demonstrated by the heart/mediastinum ratio, was significantly lower in patients in comparison with controls. Scintigraphy with MIBG allowed the selective in-vivo investigation of postganglionic sympathetic cardiac efferents in patients with autonomic failure, a procedure which was previously confined to post-mortem examination. CONCLUSION: These findings point to a relevant postganglionic pattern of involvement of the autonomic nervous system (ANS) in Parkinson's disease and autonomic failure.

Comparative diagnostic accuracy of magnetic resonance imaging and immunoscintigraphy for detection of bone marrow involvement in patients with malignant lymphoma.

PURPOSE: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) and immunoscintigraphy (IS) for detection of bone marrow infiltration in malignant lymphoma. PATIENTS AND METHODS: In 32 patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL), MRI of the axial skeleton and whole-body IS using technetium-99m (99mTc)-labeled monoclonal antibodies were reviewed and compared with iliac crest biopsies. Criterion for marrow infiltration was a positive biopsy or concordant positive results of MRI and IS. RESULTS: In 16 patients (50%), MRI, IS, and iliac crest biopsies were negative for marrow infiltration. Iliac crest biopsy showed infiltration in only four patients (13%). Infiltration was missed in two of 32 patients with IS and in one patient with MRI. In one additional patient, MRI was false-positive because of pelvic hematopoietic hyperplasia. A subset of nine patients (28%) with negative biopsies had bone marrow involvement according to MRI and IS with identical location and pattern of infiltration. In eight of these nine patients, diagnostic imaging indicated marrow involvement only in noncrest marrow. Subsequent biopsy confirmed infiltration in five patients. The clinical course suggested true-positive imaging results in the remaining four patients. Two patients (6%) remained equivocal. Overall concordance of MRI and IS for marrow infiltration was 88% (28 of 32 patients). CONCLUSION: Diagnostic imaging is essential for optimal staging in malignant lymphoma, as blind biopsies appear to have low sensitivity for bone marrow infiltration because of frequent involvement in noncrest marrow. both imaging modalities show a high rate of detection of bone marrow infiltration.

[Immunoscintigraphy of bone marrow in plasmacytoma]. / Immunszintigraphie des Knochenmarks beim Plasmozytom.

In 26 patients with plasmocytoma and 4 patients with benign monoclonal gammopathy bone marrow scintigraphy using 99mTc-labelled monoclonal antigranulocyte-antibodies was performed. Focal marrow defects were found in 18/26 patients with plasmocytoma but in none with benign monoclonal gammopathy. The results in plasmocytoma patients correlated well with the clinical staging system of Durie and Salmon. Quantification showed a suppressed bone marrow uptake ratio in 8/26 patients. A marked bone marrow expansion was present in only 2/26 patients. Bone marrow scintigraphy seems to be a valuable diagnostic tool in patients with plasmocytoma, especially as it is able to visualize the degree of bone marrow infiltration in a single protocol and so allows to follow up patients in a simple noninvasive manner.

[Comparison of skeletal scintigraphy and bone marrow scintigraphy in detection of osseous metastases]. / Vergleich von Skelettszintigraphie und Knochenmarkszintigraphie beim Nachweis ossärer Metastasen.

The purpose of this review is to define the role of bone scanning and bone-marrow scintigraphy in the detection and monitoring of skeletal metastasis. The bone scan has remained the screening method of choice for many years, because of its exquisite sensitivity for lesion detection and its ability to evaluate the whole skeleton in one setting. Bone-marrow scintigraphy with 99mTc-labelled antigranulocyte monoclonal antibodies allows high-quality, whole-body visualization of hematopoetically active bone marrow. The importance of imaging the bone marrow is founded in the fact that, in general, bone-marrow invasion precedes skeletal involvement in the development of skeletal metastasis. The advantages and disadvantages of the two methods are compared, and the possible indications for using bone-marrow scintigraphy complementary to or instead of the bone scan are discussed.

[The value of bone marrow scintigraphy and magnetic resonance tomography in diagnostic imaging of bone marrow]. / Stellenwert von Knochenmarkszintigraphie und Magnetresonanztomographie in der bildgebenden Diagnostik des Knochenmarks.

This article provides an overview of the possibilities and indications for magnetic resonance imaging (MRI) and bone marrow scintigraphy in imaging the bone marrow. After a brief review of the anatomical and physiologic structures of bone marrow, the principles of both methods are described. The radiopharmaceuticals of choice for bone marrow scintigraphy are the newly developed 99mTc-labelled anti-granulocyte monoclonal antibodies. They allow a high-quality, whole-body visualization of haematopetically active bone marrow by specifically targeting granulopoetic bone marrow cells and mature granulocytes. MRI enables us to visualize the bone marrow with high contrast and spatial resolution by assessing different properties of the biological tissue--mainly fat, water, and mineral content. Both methods provide a non-invasive and sensitive approach for imaging the bone marrow in different benign and malignant disorders.

False-positive diagnosis of a pheochromocytoma with I-123 metaiodobenzylguanidine.

The rare case of a false-positive scintiscan with I-123 labelled metaiodobenzylguanidine (MIBG) in a patient with suspected pheochromocytoma is reported. Focal accumulation of the tracer in the upper right abdomen, primarily thought to represent a right-sided pheochromocytoma, was subsequently proven to be caused by an ampullary renal pelvis. In cases of unexplained MIBG accumulation the possibility of prolonged retention of the tracer, because of an abnormality of the renal pelvis, should be considered and excluded by ultrasound.

[Reinjection of 201TL in postinfarct patients so as to improve the demarcation between cicatrix and ischemia]. / Re-Injektion von 201Tl bei Postinfarktpatienten zur besseren Abgrenzung von Narbe und Ischämie.

In patients with earlier myocardial infarction the value of additional imaging after reinjection of 201Tl for better detection of ischemic myocardium was assessed. In 40 patients 40 MBq 201Tl were reinjected 24 h after stress and additional SPECT was performed 1 h later. Quantification of defect sizes showed a further reduction of 4 h redistribution defects by more than 30% in 18 patients. Comparison with clinical, electrocardiographic and scintigraphic parameters showed that none of these was sufficiently accurate for predicting additional thallium uptake after reinjection. In 22 patients with coronary angiography all 11 patients with collateralized occlusions of a coronary artery showed a reduction of the 4 h redistribution defect by > 20%, whereas all patients (5/5) with occlusions without distal collateralization had changes < 20%. This demonstrates that an improved thallium uptake after reinjection is typical of ischemic but vital myocardium.