[PET-CT in evaluation of pulmonary nodule--case report]. / Zastosowanie PET-TK w diagnostyce guza pluca--opis przypadku.

A 52-year-old woman underwent a left nephrectomy for clear cell type renal carcinoma. One year after, chest computed tomography revealed the presence of small nodule (7 mm) in 9th segment of right lung. Radiological examination not make possible to determine a character of the nodule. Positron emission tomography with computed tomography in patient no demonstrated increased fluorodeoxyglucose uptake typical for malignant tumors. Diagnosis of the small peripheral nodules in the lung is very difficult. The most important specificity and sensitivity to distinguish benign from malignant was described for PET-CT. It is first paper in Poland about use of the PET-CT in differential diagnosis small nodules in lung.

[Beating myocardial cross sections and polar maps techniques in assessment of myocardial perfusion disturbances with gated single photon emission tomography]. / Analiza ruchomych przekrojów i map biegunowych w ocenie zaburzen perfuzji serca za pomoca bramkowanej tomografii emisyjnej pojedynczego fotonu.

UNLABELLED: In modern world the risk of circulatory system diseases is increasing. Effective techniques are sought of prevention and detection of coronary artery disease. The development of diagnostic modalites is directed to reduction of invasiveness and risk for patients with providing as much information from a single examination, as possible. Gated scintigraphy examinations by single photon emission method (GSPET) seem to meet these requirements. They combine information that could be obtained as yet only with two separated examinations. They provide data on left ventricular perfusion and function. AIM OF THE STUDY: The aim of the study was application of gated single photon emission tomography (GSPET) technique by means of polar maps and beating cross-sections in the assessment of parameters describing left ventricular function in various degrees of myocardial perfusion disturbances. A comparison was also done of GSPET processing by polar map and beating cross-section methods in the diagnosis of perfusion disturbances. MATERIAL AND METHODS: The study group included 142 patients (mean age 55.8 +/- 10.9 years), in whom myocardial scintigraphic examination was carried out by GSPET method using Tc99m-MIBI complex according to two-day protocol. The examinations were performed using a two-head Varicam gamma camera. For study data processing Xpert Pro software for workstation was used. The examinations were analysed using both polar maps and beating cross-sections. Additional values were considered offered by gated GSPET examinations. In all, 284 examinations were analysed. The patients were divided into groups according to gender and changes in perfusion both in the maps and cross-sections. RESULTS: The total number of 112 consistent results of perfusion changes were obtained both in the polar maps and cross-sections (71%). Most differences were observed in the group with effort perfusion disturbances. During processing of GSPET examination by the method of polar maps were obtained more reversible perfusion disturbances then in the beating cross-sections, differences were found which required further studies and comparison with clinical data. CONCLUSIONS: On the basis of the obtained results the conclusions were drawn that processing of gated single photon emission tomography (GSPET) by methods of both polar maps and mobile cross-sections makes possible to assess the parameters describing left ventricular function at rest and during exercise in various degrees of myocardial perfusion disturbances.

[Fusion of pulmonary scintigraphy with Tc99m-depreotide imaging with CT scan in recognizing solitary pulmonary nodule]. / Scyntygrafia pluc z 99mTc-depreotydem i nakladanie obrazów tomografii komputerowej w rozpoznawaniu pojedynczego guza pluca.

UNLABELLED: At present also radionuclide methods are used to diagnose pulmonary malignancies. One of them is solitary pulmonary nodule (SPN) scintigraphy using 99mTc-depreotide. 99mTc-depreotide is a somatostatin analogue with affinity to 3 out of 5 subtypes of somatostatin receptors. AIM OF THE STUDY: was to confirmed the usefulness of 99mTc-depreotide in detecting malignancy in SPN; finding lymph nodes metastases; and overlapping scintigraphic scans and CT in precise localizsation of malignancy and its lymph nodes metastases. MATERIAL AND METHODS: The group studied comprised 50 patients with radiologically diagnosed SPN. Forty patients had a high resolution CT scan done with a GE Light Speed equipment-device. The acquired CT scans were sent via LAN (Local Area Network) to an ARPACS server in the Department of Nuclear Medicine, and thence to a Hermes Nuclear Diagnostics workstation. CT examinations were followed by scintigraphy with 99mTc-depreotide. RESULTS: In 32 patients 99mTc-depreotide was found to have accumulated excessively in SPN: in 23 cases malignancy was found, in the 9 remaining cases they were other abnormalities. In the 23 lung cancer patients, 99mTc-depreotide was found in 24 foci, including 18 in the mediastinum and axillary region. CT revealed affected lymph nodes only in 7 cases. The calculated sensitivity, specificity and accuracy in SPN were 89%, 60%, 82%, respectively. The tumour/background index in malignancies confirmed histologically was 2.58 +/- 0.89. Where lymph nodes metastases were suspected in the diagnosed malignancies, the lymph node/background index was 2.60 +/- 0.85. In 25 cases lesion localization was more accurate when scans were overlapped. CONCLUSIONS: 99mTc-depreotide based examination is a sensitive method in the evaluation of SPN malignancy. Overlapping SPECT and CT scans in diagnosing SPN enables both pathological and physiological changes to be localized precisely. This method seems particularly valuable in imaging lymph nodes where metastases are suspected, especially when CT scans revealed no abnormalities.

Co-registration of cardiac MRI and rest gated SPECT in the assessment of myocardial perfusion, function and viability.

PURPOSE: Myocardial perfusion is routinely measured by SPECT--this technique has a rather low spatial resolution but covers the whole myocardium and is equipped with efficient image analysis software. Cardiac MRI has higher spatial resolution than SPECT and excellent sequences for myocardial function and viability detection but the lack of easy-to-use methods of acquisition and post-processing of perfusion images prevents this method from being used for perfusion evaluation in clinical practice. The aim of the study was to explore whether the 3-D co-registration of "cine" MRI (cine MRI), delayed enhancement MRI (DE MRI) and gated SPECT (GSPECT) images might be used for differentiating all reversible and irreversible effects of ischemia in anatomically matched myocardial regions. METHODS: We analyzed 685 segments of the heart (6 segments in each short axis slice)-obtained as a result of MRI and GSPECT studies performed in 18 patients. In each segment, myocardial function, perfusion and viability were analyzed. Myocardial wall function was evaluated using the matched images of diastolic and systolic phases of cine MRI. Perfusion as MIBI uptake per volume (MIV) (counts/mm3) in each myocardial segment was evaluated by co-registration of diastolic phases of cine MRI and GSPECT. Transmural extent of infarction was determined by co-registration of DE MRI and diastolic phase of cine MRI. RESULTS: We have found a close correlation between regional perfusion and function at rest in matched MRI and SPECT images: dysfunctional segments had significantly less MIV (MIV = 4.63 SD 1.58) than normal segments (MIV = 8.86 SD 2.77) (p < .05). There was no significant difference in MIV between viable and non-viable dysfunctional segments defined by DE MR due to a small number of nonviable segments in our study (18/685). CONCLUSION: Matching rest perfusion and function in anatomically co-registered myocardial segments in our study confirms that 3-D image co-registration of cine MRI, DE MRI and gated SPECT could be a precise method of integrated visualization of perfusion, function and viability helping in differentiating all forms of reversible and irreversible effects of myocardial ischemia.

[Left ventricular function in gated single photon emission computed tomography (GSPET) in patients with myocardial infarction subjected to thrombolysis or primary PTCA]. / Ocena czynnosci lewej komory serca za pomoca bramkowanej tomografii emisyjnej pojedynczego fotonu (GSPET) u chorych z zawalem leczonych fibrynolitycznie lub pierwotna angioplastyka naczyn wienicowych.

Primary Percutaneous Transluminal Coronary Angioplasty (PTCA) is increasingly common method of treatment patients with acute myocardial infarction. The aim of the study was to assess the left ventricular function in patients with myocardial infarction subjected to thrombolysis or primary PTCA. Gated Single Photon Emission Computed Tomography was performed in 40 patients 6 months after myocardial infarction treated either with thrombolysis or primary PTCA. Left ventricular ejection fraction (LVEF), left ventricular enddiastolic (LVED) and systolic (LVES) volumes were analysed both at rest and after stress. Six months after myocardial infarction LVEF was significantly greater and LVED, LVES volumes smaller in patients treated with primary PTCA in comparison to patients treated with thrombolysis. The above observation suggests that patients subjected to primary PTCA might have better functional outcome in comparison to matched patients treated with thrombolysis after 6 months post myocardial infarction.

[Mycotic lacrimal canaliculitis--cases report]. / Grzybicze zapalenie kanalików--opisy przypadków.

Mycotic lacrimal canaliculitis is a rare eye disease. Overuse of antibiotics and steroids in the treatment of eye infections is a very serious risk factor. Initial diagnosis of the mycotic infection may be difficult, thus infection may lasts for months. Chronic conjunctivitis, itching, burning sensations, poor response to the treatment may suggest a suspicion of the mycosis. In our paper we report two cases of the mycotic lacrimal canaliculitis, diagnosis and treatment. We could not culture fungal colonies, but we have found fungal structures in direct microscopic detection during the examination of deposits found in the canaliculi. In our opinion it is important to consider fungal infections during the treatment of chronic eye disorders.

[Radionuclide cisternography in the diagnosis of normal pressure hydrocephalus]. / Cysternografia radioizotopowa w rozpoznawaniu wodoglowia z prawidlowym cisnieniem plynu mózgowo-rdzeniowego.

An overview of significant research results of the last four decades as well as the author's own experience have served as a basis for the presentation of the radioisotope method and the radiopharmaceuticals in the diagnostics of normal pressure hydrocephalus (NPH). Also the physiology of the formation of PM-R its flow and absorption have shortly been discussed. Hydrocephalus is a major clinical, diagnostic and therapeutical problem. In the initial diagnosis of that pathology, methods like CT and MRI play an important role, which has also been the subject of this article. A clear and useful classification of hydrocephalus has been presented as well as NPH in adults as a clinical pathological syndrome together with its etiology, diagnostics and the differentiation in relation to other forms of hydrocephalus. Hydrocephalus and the atrophy of the brain have been illustrated by images taken by the author. In the assessment of the NPH in terms of a patient's qualification for a shunting operation a number of diagnostic factors are of particular importance. These are: the infusion test using PM-R pressure measurement of the ventricle system or the subarachnoid space on the spinal cord level, the neuropsychological evaluation as well as the brain imaging using emission tomography SPECT or the measuring of the brain metabolism by PET technique. None of these methods has been universal in diagnostic terms. Radionuclide cisternography seems to be the most physiological method that allows to gain more direct insight into the dynamics and the PM-R flow and its absorption. The results of the radioisotope examination turn out to be the most reliable criterion in the diagnostics of NPH.

[Technetium99 labelled synthetic somatostatin analogue (depreotide) in the diagnosis of peripheral solitary pulmonary nodules]. / Syntetyczny analog somatostatyny (depreotide) znakowany technetem99 w diagnostyce obwodowych zmian plucnych.

UNLABELLED: Lung carcinoma is one of the most common neoplasms, both in men and women. Many methods are employed within diagnostics approaches in oncology, among them are radiological, endoscopic, cytological and isotopic ones. Synthetic proteins labelled with gallium (Ga67), indium (In111) or technetium (Tc99) binding with receptors localised on cells surface enable scintigraphic determination of intensive uptake sites. The aim of the study was to asses clinical usefulness of technetium99 labelled synthetic somatostatin analogue (depreotide) in the diagnosis of solitary pulmonary nodules. Thirty one patients (19 men and 12 women) with isolated peripheral pulmonary lesions in chest X-ray examination were included into the study. All patients received intravenous infusion of synthetic protein compound, trifluorodepreotide acetate labelled with technetium99, with radio activity of 555-740 MBq (mega Becquerel) [Neospect--Nycomed Amersham, UK]. Radiopharmaceutical uptake was determined by two-head gamma camera according SPECT method (single photon emission computed tomography) after 3-4 hours after an injection. Intensive radiopharmaceutical uptake by abnormal lesions was found in 22 patients (71%), however in 9 (29%) it was not found in the sites of radiological changes. Among 22 patients with intensive uptake, in 17 (77%) patients a diagnosis of carcinoma was confirmed and in 5 patients benign lesions were diagnosed. In the group of 5 patients without marker uptake single case of carcinoma was found and in 4 benign lesions. Four patients refused further invasive diagnostic procedures. The sensitivity of this method was 94% with a specificity of 44%. No serious adverse clinical reactions associated with 99Tc depreotide were observed. CONCLUSIONS: 1. Technetium99 labelled synthetic somatostatin analogue [(depreotide) (NeoSpect)] is safe in pulmonological and oncological clinical diagnostics. 2. The use of this compound is a valuable scintigraphic, supplementary method to qualify patients for further invasive diagnosis of peripheral pulmonary solitary nodules.

(99m)Tc human IgG radiolabelled by HYNIC. Biodistribution and scintigraphy of experimentally induced inflammatory lesions in animal model.

BACKGROUND: Our goal was the efficient labelling of highly purified human gammaglobulin. This radioactive protein fraction can be used as a basic compound of radiopharmaceutical formulation for inflammation lesion diagnosis. This application was experimentally illustrated in animal models with artificially induced inflammatory lesions after turpentine oil injection into mouse leg muscle. MATERIALS AND METHODS: Hydrazine nicotinamine derivative of human gammaglobulin (IgG-HYNIC) was synthesized according to Abrams method. The radionuclide: technetium (99m)Tc has been introduced into protein molecules by indirect method incorporation in phosphate buffer, pH 7.4, in the presence of stannous chloride as a reducing agent for sodium pertechnetate, and EDTA as a coligand. Radiochemical purity was estimated by thin layer chromatography. The stability of labelled IgG-HYNIC derivative in human serum in presence of copper, cobalt, iron and manganum salts was analyzed by HPLC method (BioSEP SEC 4000, eluent: 0.1 mol/L phosphate). Inflammation lesions were induced in Balb/3 mice muscles by injection of 0.2 ml turpentine oil into the leg muscle. Five days later, inflammation lesions were visualized by hIgG-HYNIC- (99m)Tc injections. The tracer accumulation in tissue was evaluated by gamma camera at 1 to 24 hour intervals. RESULTS: Efficiency of technetium99m Tc human gammaglobulin labelling (pH 7.4, temp. 37 degrees C) was strictly dependant on ligand and coligand presence in the reaction mixture. Labelling of IgG molecules without any supplements resulted in very low efficiency, never exceeding the range of 5%. Presence of EDTA or hydrazine nicotinamide (HYNIC) conjugated with IgG increased radiolabelling efficiency to 50%. IgG-HYNIC derivative in EDTA presence enables us to reach value above 95% radiochemical purity. Stability of IgG-HYNIC derivative labelled with technetium (99m) Tc decreased rapidly in serum in time--up to 70% of initial value in 30 minutes and only 20% during further 4 hr incubation. This means that as much as 80% of radiotracer present in IgG molecules has been dissociated during incubation with serum. This forced us to find proper conditions for improving the stability of radioactive IgG-HYNIC conjugate in circulating serum for at least six hours. It was achieved by using a reaction medium supplement with divalent metal cations in the following compounds: MgCl2, CoSO4, Cu (NO3)2 and FeCl2 in equimolar ratio to EDTA. Scintigraphy of (99m)Tc gammaglobulin in artificially induced inflammatory lesions of mouse thigh muscle showed a 4 times higher accumulation of the tracer after 6 hours post injection, and 6 times higher after 24 hours. CONCLUSIONS: A human gammaglobulin derivative (hIgG-HYNIC) labelled with technetium (99m)Tc by indirect method with high radiochemical purity can be a basic compound of formulation for infection/inflammation scintigraphy.

The comparison of two gated SPET protocols: adenosine Tc-99m tetrofosmin and treadmill exercise Tc-99m MIBI.

BACKGROUND: The effect of adenosine and exercise on gated SPET left ventricular ejection fraction (LVEF), end diastolic volume (EDV) and end systolic volume (ESV) has not been fully investigated. The aim of the study was to compare functional measurements obtained in one-day adenosine rest and two-day stress-rest protocols in relation to ischaemia. MATERIAL AND METHODS: Out of 226 consecutive patients examined with submaximal treadmill stress-rest 700 MBq Tc-99m MIBI, 26 were chosen to match those subjected to adenosine (140 micro g/kg/min) enhanced by a low level exercise protocol (300 MBq and 700 MBq Tc-99m tetrofosmin for stress and rest respectively). All images were acquired on a double head system and were gated using 8 frames, 25 s per frame. RESULTS: ED and ES volumes increased after adenosine but decreased after treadmill resulting in the post-stress LVEF being significantly greater than after adenosine, 60 +/- 11 v. 51 +/- 13% (p < 0.01). This was caused by the smaller post-stress ESV in the treadmill group 40 +/- 20 v. 51 +/- 34, p < 0.05. In non-ischaemic scans the LVEF was greater (61 +/- 8 v. 51 +/- 14, p < 0.01) and EDV and ESV smaller after both stress and rest. CONCLUSIONS: The adenosine test may have an opposite influence on the EDV and ESV in comparison to the submaximal treadmill test and therefore the left ventricular function measurements after adenosine infusion should be interpreted carefully and may not represent those acquired after physical exercise. In the gated SPET scans showing ischaemia the post-stress EDV and ESV may be greater and the LVEF lower than at rest.