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1.
J Laparoendosc Adv Surg Tech A ; 29(10): 1271-1275, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31483185

RESUMO

Background: Increased intra-abdominal pressure resulting from pneumoperitoneum can cause renal physiological changes, such as oliguria and anuria, in mammals. Although videolaparoscopic operations are common, the occurrence of renal lesions due to these procedures has not been precisely documented in the literature. The aim of this study was to evaluate the impact of pneumoperitoneum on renal blood flow using renal scintigraphy in a rabbit model. Methods: Six New Zealand male rabbits weighing 3 kg, previously anesthetized, were mechanically ventilated and underwent pneumoperitoneum. Each animal served as its own control and was analyzed in two different moments: [99mTc] diethylenetriaminepentaacetic acid (DTPA) renal blood flow evaluation in baseline conditions (T0) and 30 minutes after installation of 15 mmHg-pneumoperitoneum (T1). The animals were monitored throughout the study by capnography, oximetry, and arterial pressure median, and were euthanized at the end of the experiment. Results: The quantitative analysis of the scintigraphic images of renal uptake of the radiopharmaceutical evidence reduced renal arterial blood flow during pneumoperitoneum. Compared with baseline conditions, all animals presented a reduction of renal blood flow varying from 16% to 82%, with mean [±standard deviation] of 53% [±24%]. Conclusions: Pneumoperitoneum induces a significant reduction of the renal blood flow, as determined in this experimental method in rabbits and dynamic renal scintigraphy with [99mTc] DTPA is an adequate method to investigate this event in the experimental setting.


Assuntos
Rim/diagnóstico por imagem , Pneumoperitônio Artificial/efeitos adversos , Circulação Renal/fisiologia , Animais , Rim/irrigação sanguínea , Testes de Função Renal , Masculino , Coelhos , Cintilografia , Compostos Radiofarmacêuticos , Pentetato de Tecnécio Tc 99m
2.
Clin Nucl Med ; 44(12): 964-965, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31283611

RESUMO

A 53-year-old man with a history of primary hypertension for over 8 years underwent Tc-DTPA renal dynamic scintigraphy to evaluate the renal function. The images revealed an unexpected focus of abnormally increased DTPA activity in the region superior to the upper pole of the right kidney. Subsequent MRIs confirmed an adrenal mass. The results of pathological examination and immunohistochemistry after the resection of the lesion were consistent with adrenal pheochromocytoma.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Achados Incidentais , Feocromocitoma/diagnóstico por imagem , Pentetato de Tecnécio Tc 99m , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/fisiopatologia , Cistografia , Humanos , Neoplasias Renais/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Feocromocitoma/patologia , Feocromocitoma/fisiopatologia , Cintilografia
3.
Clin Nucl Med ; 44(8): 648-649, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274612

RESUMO

Findings of Tc-DTPA renal scintigraphy of a retroperitoneal malignant peripheral nerve sheath tumor are reported here. The patient was a 48-year-old woman who presented discomfort and intermittent dull pain in the left upper quadrant of the abdomen for approximately 3 weeks.


Assuntos
Rim/diagnóstico por imagem , Neurofibrossarcoma/diagnóstico por imagem , Neurofibrossarcoma/patologia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Pentetato de Tecnécio Tc 99m , Feminino , Humanos , Pessoa de Meia-Idade , Cintilografia
4.
Ren Fail ; 41(1): 467-472, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31162994

RESUMO

Introduction: To investigate the validity of the full age spectrum (FAS) equation in determining the glomerular filtration rate (GFR) in Chinese patients with chronic kidney disease (CKD) and to compare the performance of FAS equation and the technetium-99m-diethylene triamine pentaacetic acid (Tc-99m-DTPA) renal dynamic imaging method. Methods: The GFR was determined by three methods in the same day: (a) Tc-99m-DTPA dual plasma sample clearance method (mGFR); (b) FAS equation (eGFR1); (c) Tc-99m-DTPA renal dynamic imaging method (eGFR2). The mGFR was used as the reference standard. The Bland-Altman method, concordance correlation coefficient and regression equation were applied to evaluate the validity of the estimated glomerular filtration rate (eGFR). The bias, precision and accuracy were analyzed to compare the performances of eGFR1 and eGFR2. Results: A total of 162 subjects were enrolled in this study. The eGFR1 was correlated well with mGFR (concordance correlation coefficient was 0.896, p < 0.0001) and the regression equation was mGFR = -0.374 + 1.029eGFR1 (p < 0001). The Bland-Altman analysis proved good agreement between the eGFR1 and mGFR. In comparison with eGFR2, the eGFR1 showed better performance on bias (-1.22 vs. 8.92, p < 0001), precision (15.69 vs. 18.36, p = 0.047) and 30% accuracy (75.31% vs. 59.26%, p = 0.0009) in all participants. Conclusions: The FAS equation is valid in determining the glomerular filtration rate in Chinese patients with chronic kidney disease. The Tc-99m-DTPA renal dynamic imaging method is less accurate than the FAS equation and cannot be employed as the reference method in assessing the performance of FAS equation.


Assuntos
Taxa de Filtração Glomerular , Rim/fisiopatologia , Modelos Biológicos , Eliminação Renal/fisiologia , Insuficiência Renal Crônica/diagnóstico , Adulto , Fatores Etários , Idoso , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Pentetato de Tecnécio Tc 99m/administração & dosagem , Pentetato de Tecnécio Tc 99m/metabolismo , Tomografia Computadorizada de Emissão de Fóton Único
5.
AJR Am J Roentgenol ; 213(4): 859-866, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31237781

RESUMO

OBJECTIVE. The objective of our study was to assess the accuracy of glomerular filtration rate (GFR) evaluation in patients with obstructive hydronephrosis using dynamic contrast-enhanced MR renography (DCE-MRR). MATERIALS AND METHODS. A group of 28 adult volunteers were enrolled in this study: 13 without hydronephrosis, eight with low-grade hydronephrosis, and seven with high-grade hydronephrosis. The GFR obtained from DCE-MRR (GFRMRR) and the GFR obtained from renal scintigraphy (GFRRS) were compared with the reference GFR (GFRRef) acquired using the two plasma sample method. The correlation and agreement between GFRMRR and GFRRef, GFRRS and GFRRef, and single-kidney GFRMRR (skGFRMRR) and single-kidney GFRRS (skGFRRS) were assessed. The interrater reliability of DCE-MRR and the interrater reliability of renal scintigraphy (RS) were measured. RESULTS. Both GFRMRR and GFRRS correlated well with GFRRef. In patients with hydronephrosis, DCE-MRR and RS overestimated GFR by 12.8 ± 13.9 mL/min (mean ± SD) and 11.5 ± 12.3 mL/min, respectively. The skGFRRS was higher than skGFRMRR by 5.7 ± 3.8 mL/min in high-grade hydronephrotic kidneys (p = 0.004). Good interrater reliability was observed for skGFRMRR (intraclass correlation coefficient [ICC] = 0.82-0.92) and skGFRRS (ICC = 0.79-0.90) for both nonhydronephrotic kidneys and hydronephrotic kidneys. The overall mean SDs of repeated measurements from three investigators were 4.0 and 3.8 mL/min for skGFRMRR and skGFRRS, respectively. CONCLUSION. Both DCE-MRR and RS tend to overestimate GFR in patients with hydronephrosis. RS-derived skGFR is slightly higher than that of DCE-MRR in kidneys with high-grade hydronephrosis. DCE-MRR is comparable to RS and may serve as an alternative noninvasive method for GFR measurement.


Assuntos
Taxa de Filtração Glomerular , Hidronefrose/diagnóstico por imagem , Hidronefrose/fisiopatologia , Imagem por Ressonância Magnética/métodos , Meios de Contraste , Feminino , Gadolínio DTPA , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Renografia por Radioisótopo , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Pentetato de Tecnécio Tc 99m
6.
Int J Pharm ; 565: 269-282, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31047994

RESUMO

Despite being in routine for onco-diagnostics for years, the applicability of nucleosidic molecular imaging probes is severely restricted in neurological applications due to their low permeability across blood-brain-barrier (BBB). For extending nucleoside tracers utility for neuro-onco early diagnostics, suitable modification which enhances their BBB permeation needs investigation. Among various modifications, lipidization of nucleosides has been reported to enhance cellular permeability. Extending the concept, the aim was to exemplify the possibility of lipidized nucleosides as potential brain tracer with capability to cross intact BBB and evaluate as metal based neuro-imaging SPECT agent. Uridine based non-lipidic (NSDAU) and di-C15-ketal appended lipidic (NLDPU) ligands were conjugated to chelator, DTPA (DTPA-NSDAU and DTPA-NLDPU) using multi-step chemistry. The ligands were evaluated in parallel for comparative physical and biological parameters. Additionally, effects of enhanced lipophilicity on UV-absorption, acid strength, fluorescence and non-specific protein binding were evaluated. Fluorescence quenching of BSA indicated appreciable interaction of DTPA-NLDPU with protein only above 10 mM without inducing conformational changes. In addition, DTPA-NLDPU was found to be haematocompatible and cytocompatible with low dose-dependent toxicity in HEK-cells. The chelator DTPA was used for 99mTc-complexation for SPECT imaging. Optimized 99mTc-radiolabeling parameters resulted in quantitative (≥97%) labeling with good stability parameters in in-vitro serum and cysteine challenge studies. We demonstrate that the nucleolipid radiotracer (99mTc-DTPA-NLDPU) was successfully able to permeate the BBB with brain uptake of 0.2% ID/g in normal mice as compared to 0.06% ID/g uptake of 99mTc-DTPA-NSDAU at 5 min. Blood kinetics indicate biphasic profile and t1/2(distribution) 46 min for 99mTc-DTPA-NLDPU. The preferential accumulation of 99mTc-DTPA-NLDPU in brain tumor intracranial xenograft indicate the targeting capability of the nucleoside. We conclude that as first-of-its-kind, this work presents the potential of the biocompatible nucleolipidic system for brain targeting and early diagnostics.


Assuntos
Barreira Hematoencefálica/metabolismo , Hidrocarbonetos/administração & dosagem , Cetonas/administração & dosagem , Compostos Radiofarmacêuticos/administração & dosagem , Pentetato de Tecnécio Tc 99m/administração & dosagem , Uridina/administração & dosagem , Animais , Neoplasias Encefálicas/metabolismo , Linhagem Celular Tumoral , Feminino , Células HEK293 , Humanos , Hidrocarbonetos/farmacocinética , Cetonas/farmacocinética , Camundongos Endogâmicos BALB C , Permeabilidade , Coelhos , Compostos Radiofarmacêuticos/farmacocinética , Pentetato de Tecnécio Tc 99m/farmacocinética , Distribuição Tecidual , Tomografia Computadorizada de Emissão de Fóton Único , Uridina/farmacocinética
7.
Nuklearmedizin ; 58(3): 282-284, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31064028

RESUMO

Lymphatic mapping for identification and subsequent removal of the sentinel lymph node (SLN) is an established procedure in breast cancer and cutaneous melanoma to minimize the extent of surgery (and thus, associated morbidity), simplify histopathological processing and subsequently provide prognostic information and help choose the optimal patient management. Established methods for SLN mapping include visual identification of nodal staining after peritumoral injection of a (blue) dye or the use of lymphoscintigraphy with technetium-labelled nanocolloid. In experienced hands, success rates for both methods exceed 95 %, nonetheless in some patients they fail despite correct application and imaging techniques. Potential reasons for false-negative SLN detection rates -beyond poor tracer injection technique or imaging of the wrong nodal basin- include inadequate pathologic examination of the SLN or complete replacement of the SLN with neoplastic disease, causing the injected tracer to completely bypass the infiltrated node 1.Beyond colloid particles, the more specific receptor-targeting small molecule [99mTc]Tilmanocept has recently been approved for scintigraphic SLN detection. Tilmanocept, or mannosyl diethylene-triamine-pentaacetate (DTPA) dextran, has a small molecular size of approximately 7 nm and works via specific binding to the mannose receptor (CD206) 2. The mannose receptor is particularly overexpressed on macrophages and dendritic precursor cells within lymph nodes, thus uptake in lymph nodes is not dependent on particle size 2, 3. In pilot studies scintigraphic SLN detection with [99mTc]Tilmanocept was superior to dye staining 4. Given its beneficial properties, [99mTc]Tilmanocept might offer advantages over the alternatively used radiocolloids. We present four cases of [99mTc]Tilmanocept application after inconclusive or unsuccessful attempts of SLN detection using [99mTc]nanocolloid lymphoscintigraphy.


Assuntos
Neoplasias da Mama/diagnóstico , Dextranos/metabolismo , Linfocintigrafia/métodos , Mananas/metabolismo , Cintilografia/métodos , Compostos Radiofarmacêuticos/metabolismo , Agregado de Albumina Marcado com Tecnécio Tc 99m/metabolismo , Pentetato de Tecnécio Tc 99m/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Biópsia de Linfonodo Sentinela , Padrão de Cuidado , Pentetato de Tecnécio Tc 99m/metabolismo
8.
Am J Vet Res ; 80(4): 416-424, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30919678

RESUMO

OBJECTIVE: To evaluate agreement of 4 methods (Tikhonov gamma variate adaptive regularization of plasma concentration-time curve fitting applied to technetium Tc 99m diethylenetriamine pentaacetic acid [99mTc-DTPA] plasma clearance [Tk-GV], plasma clearance of exogenous creatinine [CrCL], Gates gamma camera-based measurement method with 99mTc-DTPA renal clearance and dynamic scintigraphy [GTS], and iohexol renal clearance assessed with dynamic CT with Patlak plotting [CT-Pp]) for measuring glomerular filtration rates (GFR) in healthy cats. ANIMALS: 7 healthy, laboratory-raised cats. PROCEDURES: Each method for measuring GFR was performed twice in 7 cats at 24-day intervals. The Wilcoxon signed-rank sum test was used to compare the results obtained from the 14 studies for each method. Results from the 4 methods were assessed for agreement and correlation. RESULTS: The median GFR values were 2.75, 2.83, 3.14, and 4.26 mL/min/kg, for Tk-GV, CT-Pp, plasma CrCL, and GTS, respectively. Analysis with Wilcoxon signed-rank sum tests identified significant pairwise differences between results obtained with the Tk-GV versus the plasma CrCL method, the Tk-GV versus the GTS method, and the plasma CrCL versus the GTS method. The least variable method was Tk-GV, with an SD of 1.27 (mL/min/kg). CONCLUSIONS AND CLINICAL RELEVANCE: Findings indicated that Tk-GV yielded GFR measurements comparable with those obtained with CT-Pp, plasma CrCL, and GTS; however, the Tk-GV method yielded the tightest range of results among the methods evaluated.


Assuntos
Gatos/fisiologia , Taxa de Filtração Glomerular/veterinária , Testes de Função Renal/veterinária , Pentetato de Tecnécio Tc 99m/sangue , Animais , Creatinina/sangue , Feminino , Câmaras gama/veterinária , Iohexol/metabolismo , Testes de Função Renal/métodos , Cintilografia/veterinária , Compostos Radiofarmacêuticos
9.
J Cancer Res Ther ; 15(Supplement): S56-S59, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30900622

RESUMO

Context: Renal function assessment is of paramount importance before using the platinum agents especially cisplatin. Glomerular filtration rate (GFR) estimation by diethyl-triamine-penta-acetic acid (DTPA) scan (measured GFR [mGFR]) is considered gold standard. Aims: The aim of this study is to know if we can replace the mGFR with the GFR estimation with Cockcroft-Gault formula (eGFR) in patients undergoing chemoradiation. Settings and Design: This is a prospective, descriptive study. Subjects and Methods: Patients who are planned for definitive chemoradiation will be eligible for the study. Renal function will be measured DTPA scan and Cockcroft-Gault (CG) formula. Subgroup analysis based on the weight, age, and sex will be done. Statistical Analysis Used: Demographic and renal function parameters were analyzed using summary measures. To test the significance of the difference between mGFR and cGFR, a paired t-test will be used; to look for an association between various estimates of renal function, the Pearson's correlation coefficient will be calculated using a two-tailed test. Results: Median mGFR of patients was 82.7 (range: 65-125 ml/min, standard deviation [SD] =14.0 ml/min) while the median eGFR as per the CG formula was 83.9 ml/min (range: 37-137 ml/min, SD = 24.4 ml/min). The median mGFR was only 1.2 ml/min lesser when measures by the CG formula with no significance difference between them (P = 0.66, 95% confidence interval: -4.5-6.3). Conclusions: We concluded that in resource-limited setting eGFR using CG formula can replace mGFR, especially in patients with age <60 years. Although weight did not showed a significant difference by two methods, a study with large sample is needed to confirm the result.


Assuntos
Quimiorradioterapia/efeitos adversos , Taxa de Filtração Glomerular/efeitos dos fármacos , Rim/efeitos dos fármacos , Neoplasias/terapia , Radiossensibilizantes/efeitos adversos , Adulto , Fatores Etários , Idoso , Quimiorradioterapia/métodos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Feminino , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Neoplasias/sangue , Estudos Prospectivos , Radiossensibilizantes/administração & dosagem , Cintilografia/métodos , Compostos Radiofarmacêuticos/administração & dosagem , Pentetato de Tecnécio Tc 99m/administração & dosagem , Resultado do Tratamento
10.
J Cancer Res Ther ; 15(Supplement): S159-S162, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30900639

RESUMO

Incidentally, detected upper urinary tract urothelial carcinoma is a rare entity. We report the case of a 70-year-old female patient who presented with flank pain, pyuria, fever, and a unilateral nonfunctioning kidney with nephrolithiasis and pyonephrosis on pyelography. Routine imaging failed to identify a mass lesion. In an Indian setting, the clinical differential of tuberculosis was considered likely. A nephrectomy was performed in view of the poor perfusion and functional status of the right kidney. Histopathological examination of the kidney showed a tumor of urothelial origin arising at the renal pelvis displaying extensive squamous metaplasia. Such a near total metaplastic change is rare and has hitherto been undescribed in the renal pelvis. Activation of pleuripotent urothelial stem cells in the setting of chronic irritation and inflammation may be the pathogenetic process behind such an occurrence.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células de Transição/diagnóstico , Achados Incidentais , Neoplasias Renais/diagnóstico , Pionefrose/cirurgia , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células de Transição/complicações , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Neoplasias Renais/complicações , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefrectomia , Pionefrose/diagnóstico , Pionefrose/etiologia , Cintilografia , Pentetato de Tecnécio Tc 99m/administração & dosagem , Ultrassonografia
11.
Int Urol Nephrol ; 51(4): 677-690, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30830657

RESUMO

BACKGROUND: Hepatitis B virus (HBV) infection is a public health challenge, especially in China. In clinical practice, HBV infection is associated with nephropathy. Impaired renal function is frequently observed in compensated Chronic Hepatitis B (CHB) and cirrhosis (LC). Thus, renal function must be monitored to avoid nephrotoxic effects before and during nucleoside analog treatment. Investigating the predictive markers of early renal dysfunction is essential. New GFR-predicting equations, based on Pcr and/or CystC, have been recently recommended in the general population, but their performance in liver disease patients has been rarely studied. In this study, we will discuss how to detect renal dysfunction in patients with HBV infection. METHODS: A total of 16 LC patients and 23 CHB patients were enrolled in this study, and we collected and compared the clinical data of the two groups. The estimated glomerular filtration rates (eGFRs) were also calculated by several equations. All patients received 99mTc-DTPA dynamic radionuclide imaging examinations to obtain mGFRs as the reference standard. To evaluate the performance of any equation in the CHB and LC groups, paired t test, Pearson's correlation, Kappa analysis and Bland-Altman plots were utilized. Moreover, all 39 subjects were divided into two groups (according to GFR > 90 mL/min/1.73 m2). We compared the serum and urinary markers of kidney injury between the two groups and selected the indicators of renal injury by univariate analysis. RESULTS: The mGFR was 72.26 ± 20.69 mL/min/1.73 m2 in the LC group, and 87.49 ± 25.91 mL/min/1.73 m2 in the CHB group. The paired t test results of eGFR and mGFR showed no difference between eGFR (estimated by the CHINAcr-cys equation) and mGFR (p > 0.05) in the compensated LC and CHB groups. The difference between mGFR and eGFR estimated by other methods was obvious (p < 0.05). Comparing the eGFRs (estimated by 5 different equations) with mGFR in the compensated LC and CHB groups, Pearson's correlation showed that only eGFR (estimated by the CHINAcr-cys equation) had a significant correlation coefficient in CHB (r = 0.678, p = 0.000) and had the highest R2 (R2 = 0.459) among all other measures. The kappa consistency test showed that eGFR from CHINAscr-cys had poor consistency with mGFR in the compensated LC group but moderate consistency in the CHB group. Bland-Altman consistency analysis showed that in the CHB group, the CHINAcr-cys and CKD-EPIcr equations presented narrower acceptable limits than did the aMDRD, c-aMDRD, and CKD-EPIcr-cys equations (62.8, 56.1 vs .85.7, 102.9, 93.6 mL/min per 1.73 m2). In the compensated LC group, the CHINAcr-cys and CKD-EPIcr equations presented narrower acceptable limits than did the aMDRD, c-aMDRD, and CKD-EPIcr-cys equations (83.6, 81.3 vs. 98, 113.5, 106.3 mL/min per 1.73 m2). Serum or urinary markers were compared with renal function (GFR > 90 mL/min/1.73 m2) and showed International normalized ratio (INR) (p = 0.009), creatinine (p = 0.006), urine N-acetyl-ß-glucosaminidase (NAG) (p = 0.001) and serum cystatin C (CysC) (p = 0.044). CONCLUSION: The CHINAcr-cys equation may be more suitable for the estimation of GFR in Chinese patients with CHB or compensated cirrhosis. INR, creatinine, NAG, and CysC are proper biomarkers for screening renal dysfunction in Chinese patients with CHB or compensated LC.


Assuntos
Taxa de Filtração Glomerular , Hepatite B Crônica/fisiopatologia , Rim/fisiopatologia , Cirrose Hepática/fisiopatologia , Conceitos Matemáticos , Acetilglucosaminidase/urina , Adulto , Creatinina/sangue , Creatinina/urina , Cistatina C/sangue , Feminino , Humanos , Coeficiente Internacional Normatizado , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Pentetato de Tecnécio Tc 99m
12.
Mol Biol Rep ; 46(2): 1675-1682, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30680596

RESUMO

To assess the preclinical potential of technetium-99m labelled conjugated para-isothiocyanato-benzyl diethylene triamine penta-acetic acid cetuximab (99mTc-p-SCN-Bzl-DTPA cetuximab) for imaging EGFR in HNSCC mice and rabbits xenografts. Cetuximab, a chimeric monoclonal antibody targeting EGFR, was conjugated with p-SCN-Bzl-DTPA followed by labelling with 99mTc. The labelled conjugate was evaluated for in vitro stability in L-cysteine at 37 °C. The 99mTc-p-SCN-Bzl-DTPA cetuximab was also investigated for immunoreactivity, internationalization kinetics, dose escalation (up to 300 µg) and biodistribution in HNSCC mice xenograft. The suitability of labelled moiety as a specific EGFR radio-tracer was assessed in HNSCC rabbit xenograft. 99mTc-p-SCN-Bzl-DTPA cetuximab exhibited more than 98% radiochemical purity at room temperature. In excess L-cysteine, it showed a stable behaviour at 37 °C up to 4 h p.l. The labelled conjugate was internalized in vitro in FaDu tumor cells up to 19.55%. Significantly higher uptake in tumor (at 10 µg; 34.75 ± 0.38% ID/g: pi) was seen in HNSCC mice xenograft with dose escalation assay from 1 to 300 µg/mouse. Blocking of EGFR with excess cetuximab consequently decreased the uptake of tumor up to 6.80 ± 1.25%. SPECT images of rabbit xenograft confirmed increase in tumor to background ratio after 4 h pi and validated its potential in preclinical trial as a specific FaDu tumor tracer. Our in vitro and in vivo preclinical findings indicate that the 99mTc-p-SCN-Bzl-DTPA cetuximab prepared at optimal dose of cetuximab could become a useful tool for EGFR imaging in HNSCC using SPECT.


Assuntos
Cetuximab/farmacologia , Genes erbB-1/efeitos dos fármacos , Carcinoma de Células Escamosas de Cabeça e Pescoço/imunologia , Animais , Anticorpos Monoclonais , Anticorpos Monoclonais Humanizados/farmacologia , Carcinoma de Células Escamosas/patologia , Linhagem Celular Tumoral , Cetuximab/metabolismo , Cetuximab/farmacocinética , Relação Dose-Resposta a Droga , Receptores ErbB/efeitos dos fármacos , Receptores ErbB/genética , Genes erbB-1/genética , Neoplasias de Cabeça e Pescoço/genética , Xenoenxertos , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Coelhos , Compostos Radiofarmacêuticos/farmacologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Pentetato de Tecnécio Tc 99m , Distribuição Tecidual/genética , Distribuição Tecidual/fisiologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos
13.
Congenit Heart Dis ; 14(3): 454-463, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30664330

RESUMO

BACKGROUND: Patients with a Fontan circulation are at risk of renal dysfunction. We analyzed cross-sectional data in pediatric and adult Fontan patients in order to assess the accuracy of commonly used serum creatinine-based methods in estimating glomerular filtration rate (GFR). METHODS: A total of 124 Fontan patients (58 children, 66 adults) were enrolled across three study centers. Measurement of GFR (mGFR) using in vivo 99m Tc-DTPA clearance was performed. Various serum creatinine-based equations were used to calculate estimated GFR (eGFR). RESULTS: Mean mGFR was 108 ± 28 mL/min/1.73 m2 in children and 92 ± 20 mL/min/1.73 m2 in adults. Fourteen children (25%) and 28 adults (45%) had an mGFR <90 mL/min/1.73 m2 . There was no significant correlation between mGFR and eGFR (Schwartz) in children (r = 0.22, P = .1), which substantially overestimated mGFR (bias 50.8, 95%CI: 41.1-60.5 mL/min/1.73 m2 , P < .0001). The Bedside Schwartz equation also performed poorly in the children (r = 0.08, P = .5; bias 5.9, 95%CI: -2.9-14.6 mL/min/1.73 m2 , P < .0001). There was a strong correlation between mGFR and both eGFR (CKD-EPI) and eGFR (MDRD) in adults (r = 0.67, P < .0001 in both cases), however, both methods overestimated mGFR (eGFR(CKD-EPI):bias 23.8, 95%CI: 20-27.6 mL/min/1.73 m2 , P < .0001; eGFR (MDRD):bias 16.1, 95%CI: 11.8-20.4 mL/min/1.73 m2 , P < .0001). None of the children with an mGFR <90 mL/min/1.73 m2 had an eGFR (Schwartz) <90 mL/min/1.73 m2 . Sensitivity and specificity of eGFR (CKD-EPI) and eGFR (MDRD) for mGFR <90 mL/min/1.73 m2 in adults were 25% and 92% and 39% and 100%, respectively. CONCLUSIONS: This study identifies the unreliability of using creatinine-based equations to estimate GFR in children with a Fontan circulation. The accuracy of formulas incorporating cystatin C should be further investigated and may aid noninvasive surveillance of renal function in this population.


Assuntos
Creatinina/sangue , Técnica de Fontan , Taxa de Filtração Glomerular , Cardiopatias Congênitas/cirurgia , Nefropatias/diagnóstico , Rim/fisiopatologia , Modelos Biológicos , Adolescente , Adulto , Fatores Etários , Austrália , Biomarcadores/sangue , Criança , Estudos Transversais , Feminino , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/fisiopatologia , Humanos , Rim/diagnóstico por imagem , Nefropatias/sangue , Nefropatias/etiologia , Nefropatias/fisiopatologia , Masculino , Nova Zelândia , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/administração & dosagem , Sistema de Registros , Reprodutibilidade dos Testes , Fatores de Risco , Pentetato de Tecnécio Tc 99m/administração & dosagem , Resultado do Tratamento , Adulto Jovem
14.
BMC Endocr Disord ; 19(1): 10, 2019 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-30658624

RESUMO

BACKGROUND: The most frequently used methods of assessing Graves' orbithopathy (GO) include: Clinical Activity Score (CAS), ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI). There exists another, slightly forgotten, imaging method: single-photon emission computed tomography (SPECT) with the use of diethylenetriaminepentaacetic acid tagged with 99mTc (99mTc-DTPA). These days it is possible to conduct a SPECT examination fused with a CT scan (SPECT/CT), which increases the diagnostic value of the investigation. The aim of this paper is to evaluate the usefulness of 99mTc-DTPA SPECT/CT in diagnosing Graves orbitopathy, as compared with other methods. METHODS: Twenty-three patients with suspected active (infiltrative-edematous) Graves' orbithopathy were included in the study. Each patient underwent a CAS, an MRI, and a SPECT/CT. The obtained results were analysed statistically, with the assumed statistical significance of p < 0.05. RESULTS: The SPECT/CT and MRI were found to have the highest sensitivity: 0.93 each. The SPECT/CT had the highest specificity: 0.89. MRI and CAS had lower values: 0.78 and 0.56, respectively. The occurrence of an active form of GO had no impact on the exacerbation of exophthalmos or the thickness of the oculomotor muscles. CONCLUSIONS: The 99mTc-DTPA SPECT/CT method provides a very good tool for assessing the active form of GO and can, alongside the MRI scan, be used as a referential diagnostic procedure in GO.


Assuntos
Oftalmopatia de Graves/diagnóstico por imagem , Compostos Radiofarmacêuticos/uso terapêutico , Pentetato de Tecnécio Tc 99m/uso terapêutico , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Feminino , Oftalmopatia de Graves/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
15.
Jpn J Radiol ; 37(4): 315-320, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30656542

RESUMO

PURPOSE: To determine the utility of mean standardized uptake value (SUVmean) of whole liver measured by 99mTc-GSA SPECT/CT fusion imaging, for evaluation of liver fibrosis. MATERIALS AND METHODS: Eighty-six patients who underwent hepatectomy were enrolled, and were classified into the non-fibrosis or fibrosis group based on the pathological findings in the resected liver specimen. Univariate and multivariate analyses were performed between the two groups on four blood biochemical indices (albumin, total bilirubin, platelet count, and prothrombin time activity) and two 99mTc-GSA scintigraphy-derived liver function indices (LHL15 and SUVmean) to evaluate the independent predictive value for severe fibrosis. The diagnostic value of the index for severe fibrosis was assessed by calculating the area under the receiver operating characteristic curve. RESULTS: Multivariate analysis showed that prothrombin time activity [odds ratio (OR) 0.519], LHL15 (OR 0.513), and SUVmean (OR 0.168) significantly correlated with liver fibrosis. SUVmean showed the largest area under the curve, with value of 0.804, 0.730 for platelet count, 0.717 for LHL15, and 0.668 for prothrombin time activity. The optimal cut-off value for SUVmean was 6.7, which yielded 62.9% sensitivity and 96.9% specificity. CONCLUSIONS: SUVmean measured by 99mTc-GSA SPECT/CT fusion imaging enables highly accurate prediction of severe liver fibrosis.


Assuntos
Cirrose Hepática/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Agregado de Albumina Marcado com Tecnécio Tc 99m , Pentetato de Tecnécio Tc 99m , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatectomia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Cirrose Hepática/patologia , Cirrose Hepática/cirurgia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
16.
Nucl Med Commun ; 40(2): 145-152, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30650068

RESUMO

BACKGROUND: The relationship between posthepatectomy complications and liver functional parameters was preliminary reported in a pilot study. The present study sequentially evaluated the clinical significance of maximal removal rate of technetium-99m-galactosyl human serum albumin (GSARmax) in the future remnant liver (rGSARmax) in patients to predict posthepatectomy complications. METHODS: Between 2010 and August 2017, GSARmax, rGSARmax, their difference (Dif), and the rGSARmax to GSARmax ratio were examined in 247 additional patients who underwent hepatectomy for liver and biliary diseases. Hepatectomy-related postoperative complications (i.e. long-term ascites, intra-abdominal infection, and hepatic failure) occurred in 73 (29.6%) patients. RESULTS: The median and mean preoperative GSARmax values were 0.477 and 0.498±0.166 mg/min, respectively; rGSARmax values were 0.341 and 0.366±0.145 mg/min, respectively; Dif values were 0.105 and 0.132±0.111 mg/min, respectively; and the rGSARmax to GSARmax ratio values were 0.774 and 0.746±0.177, respectively. Among these, the GSARmax and rGSARmax values were significantly correlated with the liver functional parameters ICGR15, LHL15, HH15, prothrombin activity, serum hyaluronic acid level, and platelet count (all P<0.01). The rGSARmax values were significantly lower in patients with long-term ascites (P<0.05), and the predictive cutoff values of rGSARmax were 0.290 mg/min; however, the multivariate logistic regression analysis showed that rGSARmax was not independently related to long-term ascites. CONCLUSION: When accompanied by other functional liver reserve parameters, rGSARmax seemed to be an alternative liver functional parameter related to ascites.


Assuntos
Hepatectomia , Fígado/metabolismo , Fígado/cirurgia , Período Pré-Operatório , Agregado de Albumina Marcado com Tecnécio Tc 99m/metabolismo , Pentetato de Tecnécio Tc 99m/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/diagnóstico , Ascite/etiologia , Feminino , Hepatectomia/efeitos adversos , Humanos , Fígado/diagnóstico por imagem , Fígado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Prognóstico , Adulto Jovem
17.
Nucl Med Commun ; 40(2): 131-135, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30461697

RESUMO

OBJECTIVE: We aimed to design and synthesize a new macromolecule for sentinel node detection to improve the imaging quality and avoid possible adverse effect. BACKGROUND: The imaging of sentinel lymph node has been an important field in the nuclear medicine. A lot of imaging agents have been developed, including Tc-sulfer colloid, Tc-labeled dextrans and the latest Tc-DTPA-mannosyl-dextran. With the technology advanced, the imaging ability of the agents has been better and better. However, there are still some drawbacks. MATERIALS AND METHODS: The new macromolecule agent was based on the dextran macromolecule backbone. Then the gly-gly-gly and mannose molecules were conjugated onto the backbone proportionally by targeting two different reaction sites. Once the new macromolecule was labelled with Tc, its imaging ability was tested by single-photon emission computed tomography scanning with Tc-sulfur colloid as the comparison. RESULTS: The average numbers of gly-gyl-gyl and mannosyl groups on the dextran backbone are determined to be ∼1: 2 per dextran. The average molecular diameter and molecular weight are measured to be 5.4±0.7 nm and 10 324 g/mol, respectively. The macromolecule is labelled by Tc with 93.2±2.4% radiochemical yield. The lymphatic imaging by single-photon emission computed tomography with the labeled compound showed no worse imaging ability but cost less time than the commercially available Tc-sulfur colloid. CONCLUSION: A new macromolecule imaging agent for sentinel node detection has been synthesized with better imaging ability and less imaging time cost.


Assuntos
Dextranos/síntese química , Mananas/síntese química , Linfonodo Sentinela/diagnóstico por imagem , Pentetato de Tecnécio Tc 99m/análogos & derivados , Técnicas de Química Sintética , Dextranos/química , Marcação por Isótopo , Mananas/química , Pentetato de Tecnécio Tc 99m/síntese química , Pentetato de Tecnécio Tc 99m/química
18.
J Surg Res ; 233: 149-153, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502241

RESUMO

BACKGROUND: Sentinel lymph node biopsy (SLNB) is an important adjunct in the staging of patients with melanoma. Preoperative lymphoscintigraphy with radiolabeled isotopes is essential to localize sentinel nodes for removal. Our study compared the effectiveness of Lymphoseek to standard sulfur colloids in patients with melanoma undergoing SLNB. METHODS: We queried our IRB-approved melanoma database to identify 370 consecutive patients who underwent SLNB from 2012 to 2016 with at least 1 y of follow-up. There were 185 patients in each group. Data points included characteristics of the primary melanoma lymphoscintigraphy and SLNB. Student's t-test and chi-square were used to analyze the data with a P value of <0.05 being considered significant. RESULTS: Patients were equally matched in regard to age, sex, and primary characteristics of their melanoma. In comparison to sulfur colloid, Lymphoseek required lower radiation dosages (P < 0.001), shorter mapping times (P = 0.008), and decreased number of sentinel nodes removed (P = 0.03). There was no difference in the number of patients with positive nodes (P = 0.5). In addition, there were no statistical differences between the two radioactive tracers in regard to the number of patients with false-negative SLNB. CONCLUSION: Lymphoseek has the potential to decrease radioactivity and mapping time in patients who need SLNB. With a decrease in the number of nodes removed without loss of sensitivity, there is a potential to avoid unnecessary node removal and thus complications such as lymphedema. Longer follow-up will help to determine if there is any increase in false-negative rates despite fewer nodes removed.


Assuntos
Metástase Linfática/diagnóstico por imagem , Melanoma/patologia , Compostos Radiofarmacêuticos/administração & dosagem , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dextranos/administração & dosagem , Feminino , Seguimentos , Humanos , Metástase Linfática/patologia , Linfedema/etiologia , Linfedema/prevenção & controle , Linfocintigrafia/métodos , Masculino , Mananas/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/efeitos adversos , Pentetato de Tecnécio Tc 99m/administração & dosagem , Pentetato de Tecnécio Tc 99m/análogos & derivados , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Adulto Jovem
19.
Nucl Med Commun ; 40(1): 30-40, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30362986

RESUMO

BACKGROUND: Critical clinical decisions are made on the basis of the glomerular filtration rate (GFR) measured using technetium-99m-diethylenetriaminepentaacetic acid (DTPA) administration, followed by multiple time-point plasma sampling. As GFR studies rely on few data points and produce a single result, they are prone to technical errors that may remain inconspicuous. OBJECTIVE: We describe a data analysis worksheet that provides real-time quality control (QC) indicators and evaluate our initial clinical experience. METHODS: Two hundred and forty-six consecutive GFR studies carried out at our clinics were included. Our protocol used plasma samples at 2, 3, and 4 h after injection of technetium-99m-DTPA. Duplicate plasma samples, background samples, and aliquots of an activity dilution standard were counted. Times were logged for injection and dilution standard preparation, blood sampling, and counting. Data were entered into a custom GFR analysis spreadsheet that flagged QC in real time at warning and error levels, including QC of the expected ratio between dilution standard counts-activity ratio (CARs) measurements, which was newly introduced to our clinic. The prevalence of QC events was analyzed in three phases: baseline, training, and evaluation (n=31, 69, and 146, respectively). RESULTS: From the baseline and training phases (n=100), CAR reference values were determined for each of two sites. In the absence of the CAR QC indicator, errors were present in 5/31 (16%) examinations, but with QC indication decreased to 7/146 (5%) (P<0.05), suggesting that the real-time QC information guided the technologists to ensure proper standard preparation and sample handling, as intended. Improvements in other QC measures were also noted, resulting in an overall error rate reduction from 23 to 8%. CONCLUSION: Real-time analysis of redundant information as a component of the GFR worksheet ensures quality results, but training of technologists and interpreting physicians is essential for optimal utilization of these QC indicators.


Assuntos
Análise de Dados , Taxa de Filtração Glomerular , Testes de Função Renal/métodos , Pentetato de Tecnécio Tc 99m , Humanos , Controle de Qualidade , Fluxo de Trabalho
20.
IEEE J Biomed Health Inform ; 23(2): 787-794, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29994233

RESUMO

The glomerular filtration rate (GFR) is a crucial index to measure renal function. In daily clinical practice, the GFR can be estimated using the Gates method, which requires the clinicians to define the region of interest (ROI) for the kidney and the corresponding background in dynamic renal scintigraphy. The manual placement of ROIs to estimate the GFR is subjective and labor-intensive, however, making it an undesirable and unreliable process. This work presents a fully automated ROI detection method to achieve accurate and robust GFR estimations. After image preprocessing, the ROI for each kidney was delineated using a shape prior constrained level set (spLS) algorithm and then the corresponding background ROIs were obtained according to the defined kidney ROIs. In computer simulations, the spLS method had the best performance in kidney ROI detection compared with the previous threshold method (threshold) and the Chan-Vese level set (cvLS) method. In further clinical applications, 223 sets of 99mTc-diethylenetriaminepentaacetic acid renal scintigraphic images from patients with abnormal renal function were reviewed. Compared with the former ROI detection methods (threshold and cvLS), the GFR estimations based on the ROIs derived by the spLS method had the highest consistency and correlations (r = 0.98, p < 0.001) with the reference estimated by experienced physicians. The results indicate that the proposed automated ROI detection method has great potential in automated ROI detection for accurate and robust GFR estimation in dynamic renal scintigraphy.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Interpretação de Imagem Assistida por Computador/métodos , Rim/diagnóstico por imagem , Cintilografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Pentetato de Tecnécio Tc 99m/análogos & derivados , Adulto Jovem
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