Ga-67 citrate imaging in tumors of the genito-urinary tract: report of cooperative study.

Whole-body imaging with Ga-67 citrate in 127 tumors of the genito-urinary tract has been evaluated by a cooperative group using a uniform protocol. Primary sites of tumor were not detectable by imaging, except for one bladder and one kidney tumor. Proven and apparent metastases yielded positive scans, however, in 51% of prostatic, 50% of bladder, 72% of kidney, and 53% of testicular neoplasms. In bladder and kidneys metastases, if bone sites are excluded, detection of soft tissue metastases was 61% and 75%, respectively. In embryonal-cell carcinoma of the testicle, 74% of metastatic foci were detected.

Radionuclide angiographic assessment of left ventricular function during exercise in patients with a severely reduced ejection fraction.

To study the effect of exercise on left ventricular ejection fraction in patients with congestive cardiomyopathy and the relation of the response to the origin of the myocardial dysfunction, 30 patients with a severely reduced ejection fraction (30 percent or less) were evaluated with radionuclide angiography. Group I consisted of 16 patients with ischemic cardiomyopathy and a mean (+/- standard deviation) resting ejection fraction of 22.3 +/- 6.1 percent. Group II was composed of 14 patients with primary cardiomyopathy and a mean resting ejection fraction of 19.3 +/- 4.7 percent. The mean age, left ventricular end-diastolic pressure, cardiac index and resting left ventricular ejection fraction of Groups I and II were similar; however, the change in the ejection fraction during similar levels of exercise differed significantly. The mean exercise ejection fraction decreased to 16.7 +/- 6.8 percent in Group I, but increased to 24.6 +/- 6.4 percent in Group II (p less than 0.001). Thus, exercise usually results in a directionally opposite change in left ventricular ejection fraction depending on the origin of the congestive cardiomyopathy.

Noninvasive diagnosis of left ventricular pseudoaneurysm: role of two dimensional echocardiography and radionuclide gated pool imaging.

This report describes a case of left ventricular pseudoaneurysm diagnosed with two dimensional real time echocardiography. The two dimensional echocardiogram identified not only the pseudoaneurysmal sac but also the site of left ventricular rupture. When supplemented with radioisotope gated cardiac blood pool scanning, the noninvasive studies demonstrated combined true and false left ventricular aneurysms. Left ventricular pseudoaneurysm can be diagnosed using two dimensional echocardiography and nuclear imaging, permitting early operative intervention before fatal rupture.

Effects of disopyramide on left ventricular function: assessment by radionuclide cineangiography.

To determine the effects of disopyramide on resting systolic left ventricular (LV) function and LV functional reserve, gated equilibrium radionuclide cineangiography was performed at rest and during maximal symptom-limited supine bicycle exercise in 12 patients after a single 300 mg oral loading dose of disopyramide, and in 22 patients (including the 12 patients just mentioned) after they received disopyramide 150 mg 4 times daily for 5 to 10 days (average 7). The oral loading dose (average serum level 3.6 +/- 1.3 micrograms/ml [standard deviation] produced decreases in ejection fraction in 9 of 12 patients with a decrease in average resting ejection fraction from 40 +/- 15% to 33 +/- 11% (p less than 0.005). However, the lower, sustained dosage of disopyramide was associated with a lower average serum level of 2.5 +/- 0.8 micrograms/ml and with smaller but significant decreases in ejection fraction in 3 of 22 patients during exercise only. At this dosage there was no significant decrease in average ejection fraction for the group at rest or during exercise. Adverse effects of disopyramide on ejection fraction occurred even in patients with previously normal LV function at rest. Hence, disopyramide may be associated with significant decreases in LV systolic function, particularly when given in high, oral "loading" doses. However, sustained therapy with lower dosages as well as lower drug levels is also associated with less depression of LV function.

The evolution of a brain abscess the complementary roles of radionuclide (RN) and computed tomography (CT) scans.

Serial Tc-99m glucoheptonate brain scans demonstrated a brain abscess in a patient from the earliest phase of acute focal encephalitis (cerebritis) through the capsule formation and the recovery phase. The role of the RN and CT scans in the diagnosis of the early stage of cerebritis and the complementary nature of RN and CT scans in intracranial infections, particularly abscesses, are discussed. Guidelines for the use of RN and CT scans are suggested.

Small cell lung cancer: radionuclide bone scans for assessment of tumor extent and response.

Radionuclide bone scans were performed before and during combination chemotherapy in 119 systematically staged patients with small cell carcinoma of the lung. Before therapy, 49 patients (41%) had positive scans. Scan positivity was significantly associated with the presence of metastatic tumor in the bone marrow, positive skeletal radiographs, and elevated serum alkaline phosphatase levels. Nonosseous distant metastases were significantly more likely to be detected as the number of areas of focal abnormalities on bone scan increased. The survival of patients with documented distant metastases in bone and nonosseous sites was significantly inferior to the survival of patients with limited disease, isolated osseous extensive disease, and extensive disease occurring only in nonbony sites. Of 36 patients with initially abnormal scans and tumor regression documented by other methods, scan findings improved in 24 (67%). In 26 (36%) of 72 scans in patients demonstrating disease progression in extraosseous sites, new areas of increased radionuclide uptake appeared. Improvement or worsening in follow-up scans was associated with nonbony tumor response or progression, respectively, 70% of the time. Serial bone scans provide reasonably accurate staging and prognostic information in patients with small cell lung cancer, although they are probably not sufficiently reliable to be used as the sole parameter in therapeutic decision-making.

Comparative value of bone scintigraphy and radiography in monitoring tumor response in systemically treated prostatic carcinoma.

Radionuclide bone scans and skeletal radiographs were obtained before and during combination chemotherapy or initial hormonal treatment in 46 patients with disseminated adenocarcinoma of the prostate. The purpose of the study was to determine the usefulness of these two modalities in evaluating tumor response to therapy. Prior to treatment, bone scans were positive in 44 patients (96%). In all but one patient either bone radiographs or bone marrow biopsy revealed evidence of osseous metastases. In 22 patients partial response to therapy was documented by a variety of other staging tests. Eleven of these patients showed concurrent or later improvement on bone scans; one showed improvement on a radiograph. "Flare phenomena" were observed relatively frequently since 23% of the scans and 50% of the radiographs showed worsening at the time of response. Bone scans revealed worsening in 79% of 33 patients with disease progression of extraosseous tumor; radiographs were equally sensitive (82% worsening). It is concluded that bone scans in particular are useful for monitoring tumor status in systemically treated patients with prostate cancer. However, because of the lack of sensitivity for response and paradoxical worsening with tumor regression in some patients, scans are not accurate enough to be employed as the sole test in following these patients.