Is it Necessary to Perform Sentinel Lymph Node Biopsy in Thin Melanoma? A Retrospective Single Center Analysis.

Sentinel lymph node biopsy (SLNB) is a standard procedure for regional lymph node staging and still has the most important prognostic value for the outcome of patients with thin melanoma. In addition to ulceration, SLNB had to be considered even for a single mitotic figure in thin (<1 mm) melanoma according to AJCC7th guideline, therefore, a retrospective review was conducted involving 403 pT1 melanoma patients. Among them, 152 patients suffered from pT1b ulcerated or mitotic rate ≥ 1/ mm2 melanomas according to the AJCC7th staging system. SLNB was performed in 78 cases, of which nine (11.5%) showed SLN positivity. From them, interestingly, we found a relatively high positive sentinel rate (6/78-8%) in the case of thin primary melanomas ˂0.8 mm. Moreover, the presence of regression increased the probability of sentinel positivity by 5.796 fold. After reassessing pT stage based on the new AJCC8th, 37 pT1b cases were reordered into pT1a category. There was no significant relation between other characteristics examined (age, gender, Breslow, Clark level, and mitosis index) and sentinel node positivity. Based on our data, we suggest that mitotic rate alone is not a sufficiently powerful predictor of SLN status in thin melanomas. If strict histopathological definition criteria are applied, regression might be an additional adverse feature that aids in identifying T1 patients most likely to be SLN-positive. After reassessing of pT1b cases according to AJCC8th regression proved to be independent prognostic factor on sentinel lymph node positivity. Our results propose that sentinel lymph node biopsy might also be considered at patients with regressive thin (˂0.8 mm) melanomas.

Autonomic nervous system dysfunction involving the gastrointestinal and the urinary tracts in primary Sjögren's syndrome.

OBJECTIVE: Antibodies reacting with the m3 subtype muscarinic acetylcholine receptor appear to be an important pathogenic factor in primary Sjögren's syndrome (pSS). As this receptor subtype is functionally important in the gastrointestinal and urinary tracts, and very little is known about the autonomic nervous system function in these organs in pSS patients, the occurrence and clinical significance of an autonomic nervous system dysfunction involving the gastrointestinal and urinary tracts were investigated. METHODS: Data on clinical symptoms attributable to an autonomic dysfunction were collected from 51 pSS patients. Gastric emptying scintigraphy and urodynamic studies were performed on 30 and 16 patients, respectively, and the results were correlated with patient characteristics and with the presence of autonomic nervous system symptoms. RESULTS: Gastric emptying was abnormally slow in 21 of the 30 examined patients (70%). Urodynamic findings, compatible with a decreased detrusor muscle tone or contractility were found in 9 of the 16 patients tested (56%). Various symptoms of an autonomic nervous system dysfunction were reported by 2-16% of the patients. CONCLUSION: Signs of an autonomic nervous system dysfunction involving the gastrointestinal and the urinary systems can be observed in the majority of pSS patients. This high occurrence is rarely associated with clinically significant symptoms. The authors presume a role of autoantibodies reacting with the m3 muscarinic acetylcholine receptor in the elicitation of the autonomic dysfunction.

Clinical value of technetium-99m-HMPAO-labeled leukocyte scintigraphy and spiral computed tomography in active Crohn's disease.

OBJECTIVES: The diagnostic accuracy of technetium-99m-HMPAO-labeled leukocyte scintigraphy (LS) and spiral CT for the detection of inflammatory activity was assessed; the extent of the inflammation and the complications were compared with the clinical and laboratory parameters and with the endoscopic and radiological findings in patients with clinically active Crohn's disease (CD). METHODS: Twenty-eight patients (13 men, 15 women, average age 32.5 yr, range: 18-59 yr) with an acute exacerbation of CD were enrolled in the study. The disease behavior type and the maximum extent of inflammation were established by means of endoscopy (jejunoscopy and colonoscopy) and enteroclysis. Nine patients with severe complications (abscess and stenosis) underwent operation. The GI tract was divided into five segments (small bowel, ascending colon, transverse colon, descending colon, and rectosigmoid), the LS, CT, endoscopic, and radiological pictures of all segments were graded (range: 0-3) and the scores were summed and compared. RESULTS: The investigations indicated that LS and CT had sensitivities of 76.1% and 71.8%, specificities of 91.0% and 83.5%, and accuracies of 82.6% and 77.5%, respectively, for detection of segmental inflammatory activity. With regard to the disease behavior type, the sensitivities of LS and CT were, respectively, 77% and 100% in the penetrating-fistulizing, 80% and 73% in the stricturing, and 68% and 64% in the inflammatory form of CD. CT detected all abdominal abscesses, whereas the diagnostic value of LS for the detection of the complications of CD was lower. The inflammatory activity scores measured by LS displayed a closer correlation than that of CT with the Best index (r = 0.71, p < 0.0005 vs r = 0.63, p < 0.001), the van Hees index (r = 0.61, p < 0.005 vs r = 0.59, p < 0.005), the serum fibrinogen level (r = 0.67, p < 0.005 vs r = 0.59, p < 0.005), or the C-reactive protein level (r = 0.64, p < 0.005 vs r = 0.51, p < 0.01). CONCLUSIONS: Both LS and CT are valuable noninvasive diagnostic methods in cases involving severe, active CD. LS seemed better for the detection of segmental inflammatory activity, whereas CT displayed excellent suitability for the recognition of complications: abdominal abscesses were diagnosed with 100% efficiency.

Gallbladder hypomotility in diabetic polyneuropathy.

This study was performed to evaluate the gallbladder motility in long-standing diabetes mellitus. The gallbladder function of diabetic patients was measured by means of quantitative hepatobiliary scintigraphy, and the severity of the associated autonomic and sensory polyneuropathy was determined. The presence of a marked gallbladder hypomotility was established, and a positive correlation was observed between the severity of the autonomic disturbance and the contractile disorder. This study underlines the important role of the neuropathy in the development of gallbladder hypomotility accompanying long-term diabetes mellitus.

[Clinical experience with rhenium-188 HEDP therapy for metastatic bone pain]. / 188Re HEDP-terápiával szerzett tapasztalatok a metasztatikus csontfájdalom kezelésében.

Rhenium-188 hydroxyethylidene diphosphonate (Re-188 HEDP) is a new radiopharmaceutical for treatment of metastatic bone pain. Re-188 is a generator-produced radionuclide emitting high energy beta and gamma rays and having a relative short physical half-life makes it of especially interesting for therapeutic purpose. Seven patients (pts) with multiple painful bone metastases were treated with Re-188 HEDP. Five pts with prostate cancer and 2 pts with breast cancer received a fixed activity of 3000 MBq of Re-188 HEDP intravenously in two steps. Complete blood counts were determined, blood chemistry examinations and urine-analysis were performed before and 1, 2, 3, 4, 6, 8, 12 weeks following the treatment. A visual analogue score, a verbal rating scale, the Spitzer index and the Karnofsky score were used to assess pain and performance status. Three hours after Re-188 HEDP administration at 1 m from the anterior mid-trunk of the pts gamma and at the patient body surface beta-radiation dose measurements were made, together with urine radioactivity measurements. Three pts become pain-free, 2 pts exhibited partial pain improvement and 1 patient gave no response to the Re-188 HEDP therapy. In 1 patient due to central nervous system metastasis the modification of the pain intensity could not be evaluated. Three pts displayed a flare reaction within 1 week after the treatment. Transient decreases in platelet and white blood cell counts were observed. There were no significant changes in the liver and renal functions. Radiation dose rate values of 6.3 +/- 1.0 microSv/h for gamma, and of 183 +/- 40 s-1 for beta-radiation were found. 25-32% of the administered dose was eliminated via the urinary tract in the first three hours. The preliminary data suggests that Re-188 HEDP is an effective radiopharmaceutical in treatment for metastatic bone pain. An administered activity of 3000 MBq can bring about a pain reduction without causing any clinically significant bone marrow toxicity.

[Initial experiences with 123-Iodine-IBZM neuroreceptor scintigraphy in extrapyramidal disorders]. / 123I-IBZM (3-jód-6-metoxi-benzamid) neuroreceptor-szcintigráfiával szerzett kezdeti tapasztalatok extrapyramidalis kórképekben.

The receptor scintigraphy of the dopaminergic system of the brain is of interest in the evaluation of movement disorders. The 123I-IBZM is a radiopharmaceutical with affinity predominantly to postsynaptic D2 receptors. The aim of this study was to evaluate the role of IBZM SPECT investigations in the differentiation of disorders with Parkinson's syndrome. Eight patients with idiopathic Parkinson's syndrome and 8 patients Parkinson's syndrome with other etiology were investigated with 123I-IBZM SPECT (6 females, 10 males, mean age +/- SD: 59 +/- 9). The patients according to the clinical signs and symptoms, results of CT/MRI and rCBF SPECT investigation were categorized. The reconstructed SPECT slices were evaluated visually and quantitatively. The visual interpretation of the images were performed by two observer and scored the radiopharmaceutical uptake (from 1-3) of the cortex and the striatum separately. For quantification striatum/frontal cortex activity ratio were calculated with ROI technique. The differences between the patient groups were statistically analyzed by two tailed t-test. The IBZM uptake were different in the two group of patients. The striatal IBZM accumulation was higher in the idiopathic Parkinson's syndrome patients compared to the other parkinsonians. The striatum/frontal lobe activity ratio was 1.69 +/- 0.9 (mean +/- SD) in the right, 1.67 +/- 0.04 (mean +/- SD) in the left hemisphere of the patients with idiopathic Parkinson's syndrome. The corresponding data in the nonidiopathic parkinsonian group were 1.53 +/- 0.06 (mean +/- SD), 1.52 +/- 0.04 (mean +/- SD) respectively (p < 0.01). The quantitative data correlated with the results of the visual evaluation. According to the data presented IBZM-SPECT is an effective tool in the differentiation of disorders with Parkinson syndrome.

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.

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 the nature of brain tumors using methods of nuclear medicine]. / Agydaganatok természetének vizsgálata nukleáris medicinai módszerekkel.

FDG-PET studies permit an assessment of the degree of brain tumour malignancy and detection of tumour recurrence. MIBI-SPECT also affords promising results in this respect. In this work, the diagnostic value of MIBI-SPECT was compared with that of FDG-PET for the determination of primary brain tumours malignancy and the detection of recurrent brain tumours. SPECT and PET examination were carried out within a week in 14 patients (12 males, 2 females, mean age: 40 years, range 16-61 years) with brain tumours. Seven patients had a primary tumour, and in a further 7 MRI or the clinical signs and symptoms let to a suspicion of tumour recurrence. All tumours were verified histologically to be gliomas of grades I-IV. The SPECT and PET images were analysed visually and semiquantitatively. In 3 of the investigated 7 primary glioma patients, there was a visibly enhanced MIBI-positive cases, only one had an increased FDG uptake. In 4 of the 7 tumour recurrence cases, either the MIBI or the FDG uptake was visibly increased. All of these were histologically high-grade gliomas. In the remaining low grade tumours (primary of recurrent), neither MIBI nor FDG revealed a pathologically increased uptake. The intensity of radiopharmaceutical uptake at the site of the tumours was visually and semiquantitatively higher for MIBI that for FDG. It is concluded that MIBI-SPECT is a valuable and simple tool for evaluation of the biological characteristics of brain tumours, showing increased uptake of MIBI according to the malignancy and tumour recurrence of brain tumours.

[Regional cerebral blood flow changes in schizophrenic patients detected by SPECT studies under resting and active conditions]. / Nyugalmi és aktivációs agyi vérátfolyás SPECT-vizsgálatok krónikus schizophreniában szenvedö betegekben.

Brain SPECT studies in schizophrenia revealed changes in regional cerebral blood flow (rCBF). The rCBF changes can be detected more accurate by activating tests. The aim of this study was to assess rCBF changes under resting and activation condition by the Raven test. Four control patients (2 male, 2 female, average age 45 years, 26-57 years) and 11 chronic, treated schizophrenic patients (4 male, 7 female, average age: 46 years, 33-56 years) were studied in two HMPAO brain SPECT sessions, 48 hours apart, both resting and during activation task. The images were evaluated visually and semiquantitatively. Under resting condition in the control group, there were no significant rCBF changes. In the Raven activation test, a significantly higher blood flow in the prefrontal region was seen (p < 0.05). The schizophrenic group had a significantly lower rCBF in the temporal region under resting condition (p < 0.05): four patients displayed left, 4 right temporal hypoperfusion and 3 exhibited no rCBF abnormality. In the Raven activation tests 5 patients had prefrontal hyperperfusion, and the remaining 6 patients had no such activation answer. Five patients had hypoperfusion in the temporal region. In our sample, patients with chronic schizophrenia displayed significant temporal hypoperfusion. Moreover the chronic schizophrenic group exhibited a poor response to prefrontal activation compared to the control group.

[Experience with ambulatory radioiodine therapy of hyperthyroidism]. / Ambuláns radiojód kezeléssel szerzett tapasztalatok a hyperthyreosis gyógyításában.

Since 1993, outpatient radioiodine therapy has been available in Hungary. The reported study evaluated the efficacy of outpatient radioiodine treatment in subjects with hyperthyroidism. The data on 118 patients with Graves' disease and 36 patients with thyroid autonomy were analysed retrospectively. All patients were treated within the period 1994-1997. The activities of radioiodine were individually calculated. The applied dose in Graves' disease was 150 Gy, and in thyroid autonomy 150 Gy or 300 Gy. The efficacy of the treatment were evaluated 3, 6, and 12 months after radioiodine therapy. In patients with persistent hyperthyroidism repeated therapies were performed. Overall the radioiodine therapy was successful in 85% of the Graves' disease patients. The first 150 Gy treatment was effective in 70% of the patients with Graves' disease and in 43% of the patients with increased radioiodine turnover. In thyroid autonomy, the treatment with 150 Gy was successful in 71%, with 300 Gy in 89% of the patients. The efficacy of radioiodine treatment was similar to the results of one dose application. It was concluded, that radioiodine therapy with 150 Gy absorbed dose in Graves' disease and with 300 Gy absorbed dose in thyroid autonomy proved successful by the method of the authors.

[Leukocyte scintigraphy in the diagnosis of acute pancreatitis]. / Leukocyta szcintigráfia az akut pancreatitis diagnosztikájában.

The authors investigate the place and clinical usability of the 99mTc-HM-PAO leukocyte scintigraphy (LS) in patients with acute pancreatitis. Another purpose was to establish the diagnostic value of LS to differenciate between infected and noninfected pseudocysts following acute pancreatitis. Seventy-five patients with acute pancreatitis were examined and divided into two groups. In group 1, LS was performed in 46 consecutive patients in the early phase (mean 3 days following the beginning of the symptoms, range 1-6 days) of acute pancreatitis. In group 2, LS was performed in 29 patients with pancreatic pseudocysts following acute pancreatitis. The diagnosis of acute pancreatitis was based on the typical clinical symptoms, laboratory parameters, Ranson criteria, US and CT findings. In group 1, most of the cases with a severe clinical outcome (Ranson classification) gave positive LS results (13/15). Leukocyte accumulation was also detected in patients with mild acute pancreatitis (5/26), but at a lower frequency. The scintigraphic activity correlated with the leukocyte count, fever, and duration of hospitalization. In group 2, there were seven LS positive cases. A pancreatic abscess or infected pseudocyst was found in all of them during surgery. In 9 LS negative cases surgery and bacterial culturing revealed sterile pseudocyst. In conclusion, a positive LS indicated a severe course of acute pancreatitis. The method also seems useful for differentiation between infected and noninfected pancreatic pseudocysts.

Regional cerebral blood flow single-photon emission tomography with 99mTc-HMPAO and the acetazolamide test in the evaluation of vascular and Alzheimer's dementia.

The diagnostic potential of technetium-99m hexamethylpropylene amine oxime (HMPAO) following systemic administration of the cerebral vasodilator acetazolamide (acetazolamide test) was evaluated by regional cerebral blood flow (rCBF) single-photon emission tomography (SPET) in patients with Alzheimer's disease (AD) or vascular dementia (VD). An initial, high-resolution SPET study was performed with 99mTc-HMPAO, and after 2 days the patients were re-evaluated with 99mTc-HMPAO following systemic administration of acetazolamide. Reconstructed SPET slices were evaluated visually and semiquantitatively by a semi-automatic rCBF map method. When 99mTc-HMPAO alone was used, bilateral hypoperfusion was found in the temporal and/or parietal regions in 33% (6/18) of the VD patients and in 70% (23/33) of the AD patients. The corresponding data obtained by quantitative evaluation were 41% (7/17) and 71% (15/21), respectively. The vascular reserve capacity, as determined with the acetazolamide test, was preserved visually in 22% (4/18) and quantitatively in 29% (5/17) of the VD patients, but in 73% (24/33) and 76% (16/21) of the AD patients. The differences in the perfusion patterns between the VD and AD patients were statistically significant (P<0.01, Fischer's exact test). Of the VD patients with hypoperfusion (bilateral temporal and/or parietal), 4/6 (67%, visual evaluation) and 4/7 (57%, quantitative evaluation) had a decreased vascular reserve capacity as determined with the acetazolamide test. In the AD group of patients the corresponding results were 3/23 (13%) and 4/15 (27%). It is concluded that the acetazolamide test is promising in rCBF SPET to differentiate VD from AD.

[The role of 99mTc-MIBI mammoscintigraphy in the diagnosis of breast cancer]. / 99mTc-MIBI mammoszcintigráfia szerepe az emlödaganatok diagnosztikájában.

Among several investigative methods currently undergoing evaluation for the differentiation of biological features of breast mass lesions, mammoscintigraphy with different radiopharmaceuticals appears promising. The reported study evaluated the efficacy of 99mTc-MIBI mammoscintigraphy in detection of the malignancy of focal breast lesions. Mammography, 99mTc-MIBI 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 the mammoscintigraphy, early (5 min p. i. of MIBI) and late (2 h p. i. of MIBI) planar images of the breast and the axillary regions were evaluated visually and semiquantitatively. The sensitivity and specificity values of MIBI mammoscintigraphy were in the detection malignant breast lesions evaluated visually according to the early images 95% and 73%, according to the late images 98% and 82%, respectively. Revealed to the quantitative results the corresponding results were according to the early images 90% and 64% according to the late images 95% an 64%. 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. In the detection of metastatic lymph node involvement, the sensitivity and specificity with MIBI were 53% and 81%. It was concluded that MIBI (2 h 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.

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.

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.

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.

[First Hungarian experiences with positron emission tomography (PET) studies. Members of the PET working group]. / Elsö hazai tapasztalatok pozitron emissziós tomográfiás (PET) vizsgálatokkal. PET munkacsoport tagjai.

Diagnostic investigations commenced on the 28th of June 1994 in Hungary's and Central Europe's first PET Centre at the University Medical School of Debrecen. The Centre is equipped with a GE 4096 Plus whole body PET scanner. A metabolic tracer, 18F-deoxy-D-glucose (FDG), was used in the investigations. During the first 15 months 249 PET investigations were made in the Centre of which 242 were diagnostic and 7 normal subjects served as control for the patient studies with brain scans. The number of oncological indications (intra- and extracranial tumours, Hodgkin's lymphomas) was n = 105 (43.4% of the 242 diagnostic examinations), neurological investigations (without intracranial tumours) formed the dominant group (n = 117; 48.3%), whereas the number of cardiological indications was 20 (8.3%). The oncological studies included those of intracranial tumours (n = 76; 31.4%); thyroid tumours (n = 9; 3.7%); Hodgkin's lymphomas (n = 7; 2.9%) and other extracranial tumours (n = 13; 5.4%). The distribution of different neurological and psychiatric investigations was as follows: localization of focal epileptogen zone (n = 60; 24.8%); differential diagnosis of dementias (n = 30; 12.4%); exploration of cerebrovascular diseases (n = 10; 4.1%); and other neurological diseases (n = 17; 7.0%). The main objective of the cardiological PET investigations was the exploration of viable myocardium. The present paper overviews both the procedures (including administrative issues, as well) and the results of the first 249 FDG-PET investigations.

[Cerebral blood flow studied by SPECT and transcranial Doppler sonography in subarachnoid hemorrhage]. / Agyi vérátfolyás SPECT és transcranialis Doppler-szonográfiás vizsgálatok subarachnoidealis vérzésben.

The detection of vasospasm plays an important role for the definition of the strategy of treatment in patients with subarachnoid hemorrhage (SAH). Besides the invasive contrast angiography, the non-invasive 99m-Tc-HMPAO brain perfusion SPECT and transcranial Doppler sonography (TCD) are recently used for this purpose. For the investigation of the possibilities of the last two methods, comparative studies were performed in 29 SAH patients in the subacute phase of the disease. In the detection of regional brain ischaemia the sensitivity of the SPECT study was 90%, the specificity was 28% and the accuracy was 50%, the corresponding values of TCD were 82%, 71% and 75%. In patients, in whom chronic neurological symptoms, or morphological abnormalities could be excluded, the specificity of the SPECT study was 67% at unchanged sensitivity. Based on the results it is concluded, that the brain perfusion SPECT and the TCD investigation are useful methods for the detection of vasospasm after SAH. The combination of the two methods is recommended for the correct diagnosis of vasospasm in SAH. Further investigations are necessary to clarify the prognostic impact of the result of these investigations.

Evaluation of technetium-99m-ECD in childhood epilepsy.

UNLABELLED: In childhood epilepsy, it is difficult, but of critical importance, to determine whether surgical intervention might be beneficial for an individual patient. Because both established procedures-MRI and electroencephalography (EEG)-have limitations, interictal and ictal regional cerebral blood flow (rCBF) SPECT has proven to be a valuable adjunctive method in the presurgical evaluation of children. METHODS: We evaluated the usefulness of the new rCBF tracer 99mTc-ECD in 14 children with focal epilepsy (mean age 9.7 yr). Eleven interictal and 8 ictal studies were performed. Results were correlated with ictal and interictal surface EEG, MRI and histological findings and the postsurgical outcome. RESULTS: On the basis of the presurgical evaluation, nine patients underwent surgery. MRI studies demonstrated pathological features with possible relation to epilepsy in 50%. Overall, interictal 99mTc-ECD SPECT showed areas of hypoperfusion in 80% of patients. Ictal rCBF SPECT was informative in all patients, including one who showed bifrontal hyperperfusion in accordance with EEG results. CONCLUSION: Technetium-99m-ECD has proven to be of value for interictal and ictal rCBF SPECT in childhood epilepsy. No side effects during or after tracer administration were noticed. Ictal and interictal rCBF SPECT showed good correlation with MRI and EEG results in patients in whom correlation with the postoperative situation was possible and presented additional significant information in those patients with normal MRI and uninterpretable EEG results. No false lateralizations occurred. In children with focal epilepsy, interictal rCBF SPECT may accelerate the application of long-term electrocorticography (ECoG) in patients with normal MRI results. Ictal rCBF SPECT may also help to avoid ECoG, if a focal hyperperfusion correlates with a focal MRI abnormality, and the surface EEG gives no contradictory information.