Tc-99m polyclonal human immunoglobulin scintigraphy in brucellosis.

The aim of this study was to evaluate the accuracy of Tc-99m polyclonal human immunoglobulin (HIG) scintigraphy for the diagnosis of brucellosis, and to compare its effectiveness in the diagnosis of osteoarticular involvement in comparison with bone scanning. Of 30 patients with brucellosis, Tc-99m HIG detected osteoarticular involvement in 18 (60%) patients, in whom the sacroiliac joints were affected most commonly (n = 13; 72.2%), with statistically predominant bilateral involvement (p < 0.05). By bone scanning, the rate of osteoarticular involvement was 70% (21 of 30 patients), and the joints affected most commonly were sacroiliac (15 of 21 patients; 71.4%). Although bilateral involvement was observed mostly by bone scanning, there was no significant difference between the rate of bilateral and unilateral involvement. The anatomical distribution of osteoarticular complications, as detected by Tc-99m HIG and bone scintigraphy, did not differ significantly. With Tc-99m HIG, orchitis was detected in two patients and paravertebral abscess in one patient. Since bone scanning did not detect these soft tissue complications, Tc-99m HIG scintigraphy might be useful for the detection of both osteoarticular and soft tissue complications resulting from brucellosis.

Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis.

OBJECTIVE: To compare the effects of erythromycin and metoclopramide on gastric emptying and symptoms of gastroparesis in diabetic patients with delayed gastric emptying. RESEARCH DESIGN AND METHODS: The study group consisted of 13 patients with symptoms of severe gastroparesis and delayed gastric emptying. Gastric emptying was evaluated using a radionuclide method, and gastrointestinal symptoms were scored. The patients were given either erythromycin (250 mg 3 times/day) or metoclopramide (10 mg 3 times/day) in random order for 3 wk, and after a washout period of 3 wk they were crossed-over to the other medication for another 3 wk. Parameters of gastric emptying were assessed before treatment and after both erythromycin and metoclopramide administration. RESULTS: The half-time of gastric emptying in diabetic subjects was 110 (77-120) min before treatment. At 60 and 90 min, the median value of residual isotope activity was 66.5 (55-83.5) and 55% (43-74.3), respectively. The half-time decreased to 55 min (28.6-115) after 3 wk of treatment with erythromycin and percentages of meal retention in the stomach at 60 and 90 min were 49.9 (38.4-70) and 40.5% (29.7-60), respectively. After taking metoclopramide, the median value of half-time was 67 min (15-115) and percentages of meal retention at 60 and 90 min were 51 (34.5-93.9) and 42% (24-71.2), respectively. When compared with baseline values a significant difference in gastric emptying parameters was found after both erythromycin and metoclopramide. A significant improvement of the total score for gastrointestinal symptoms was observed with both drugs, but this improvement was more pronounced with erythromycin. CONCLUSIONS: Erythromycin, a macrolide antibiotic and a motilin receptor agonist, appears to stimulate intestinal motility and seems to be an alternative agent for the treatment of gastroparesis caused by diabetic autonomic neuropathy.

Evaluation of active and passive transport mechanisms in genital tracts of IUD-bearing women with radionuclide hysterosalpingoscintigraphy.

The objective of this study was to evaluate the active and passive transport mechanisms in the genital tracts of copper T-200 intrauterine device (IUD)-bearing women. (Tc-99m)HMPAO-labeled spermatozoa and (Tc-99m)-labeled albumin macrospheres were placed into the vagina at midcycle. Serial scintigraphic images were obtained over a period of 2 h. Migration of spermatozoa and particles in the genital tract and the direction of transport related to dominant follicle were evaluated. While active sperm migration was greatly inhibited, the passive transport of the particles was not affected in IUD-bearing women. The direction of radiolabeled particles and spermatozoa was toward the dominant follicle side. Passive transport was not affected, whereas active transport of spermatozoa was strongly inhibited in the genital tract by the presence of the IUD. However, the direction of active and passive transport related to dominant follicle side was unchanged in IUD-bearing women and was preferentially toward the tube ipsilateral to the dominant follicle.

Visualization of bone pathologies and lung cancer with 99mTc-glucose phosphate: a comparative study.

Glucose phosphate (GP) labelled with 99mTc was used to obtain scintigraphic images of bone lesions in one group of patients (n = 28) and of lung tumors in another (n = 35). All bone lesions detected by 99mTc-MDP were also demonstrated by 99mTc-GP; all lung tumors except 4 were detected by 99mTc-GP, the failure rate being about the same as that for 67Ga. The use of 99mTc-GP is preferable to that of 99mTc-MDP because the former does not accumulate in normal bone; the advantage of 99mTc-GP over 67Ga lies in its better physical characteristics and in the fact that the result of the study is available within a few hours rather than three days.

Serum thyroid hormone and thyroid gland weight measurements in protein-energy malnutrition.

Protein-energy malnutrition (PEM) is a problem which concerns about half the world's children. We investigated the effects of malnutrition on thyroid gland weight and thyroid hormone levels. 22 children suffering from malnutrition (14 children suffering from marasmus and 8 children suffering from kwashiorkor) and 7 healthy controls were studied. Malnutrition was confirmed clinically and according to the Wellcome classification definition of malnutrition. Serum thyroid hormone concentrations were measured by radioimmunoassay and the weights of the thyroid gland were evaluated scintigraphically. In the groups with marasmus and kwashiorkor the mean TT4, TT3 and FT3 levels were significantly lower, and TSH levels were significantly higher, compared to controls. FT4 was not influenced by PEM. The mean thyroid gland weights of the groups with marasmus and kwashiorkor were higher than that of the control group. We found no significant differences in all these parameters between groups with marasmus and kwashiorkor. In each of the three groups, the most marked positive correlation was between thyroid gland weight and ratio of thyroid gland weight to body surface area.

Effects of eradication therapy on gastric emptying in patients with Helicobacter pylori-positive duodenal ulcers.

In this study 28 patients with Helicobacter pylori-positive duodenal ulcers were treated with a 7-day triple-therapy regimen (omeprazole, clarithromycin, amoxycillin). Gastric emptying time was measured scintigraphically before and after therapy. Only 13 patients attended regularly for their endoscopic and scintigraphic follow-ups. Gastric emptying time was 57.6+/-16.5 min in 28 patients before therapy, and 44.4+/-13.9 min after therapy (44.7+/-7.9 min in the control group). The present study demonstrated gastric emptying time to be longer in the ulcer patients compared with healthy controls and that, after eradication therapy, gastric emptying time became almost normal in the ulcer patients.

Evaluation of microcirculation in Buerger's disease using 201thallium/99mtechnetium macroaggregated albumin scintigraphy.

In the current study, 10 patients with Buerger's disease (thromboangiitis obliterans) and seven control patients with atherosclerosis obliterans (ASO) were evaluated for microvascular disturbance. After exercising for 1 min, patients were injected with 37 MBq 201thallium (201Tl) intra-arterially, and anterior planar images of the feet and whole body images of the lower extremities were taken. The same procedure was repeated after 1 week using 185 MBq 99mtechnetium macroaggregated albumin (99mTc-MAA). Rectangular regions of interest were drawn on the 201Tl and 99mTc-MAA images, and 201Tl/99mTc-MAA uptake ratios were calculated. 201Tl/99mTc-MAA ratios of the toes of those with Buerger's disease were significantly lower than those of ASO cases, whereas no significant difference was found for the lower limbs and feet. These findings may be explained by disturbances of microvascular regulation observed in Buerger's disease.

Effect of cisapride on gastric emptying in patients with gastro-oesophageal reflux disease.

To investigate the effect of cisapride in gastro-oesophageal reflux disease (GERD), gastric emptying time, measured using scintigraphy, and reflux symptoms were compared before and after cisapride therapy in 30 patients with endoscopically proven GERD. Gastric emptying time was also measured in 20 age-matched controls. Patients with GERD were treated with 30 mg cisapride orally three times daily for 7 days. Gastric emptying time was significantly reduced following cisapride therapy in 28 of these patients (71.6 +/- 18.1 min versus 57.9 +/- 13.9 min), although it was still longer than the gastric emptying time of the control group (i.e. 46.2 +/- 8.1 min). In addition, cisapride relieved heartburn, which is a representative symptom of GERD. These findings suggest that cisapride may be useful in treating reflux symptoms and oesophagitis in patients with GERD.

Evaluation of eustachian tube function with ventilation scintigraphy by using 133Xe gas.

The aim of this study was to evaluate Eustachian tube function by ventilation scintigraphy. In 13 patients with normal tube function and 16 with one-sided tube dysfunction, 50 MBq 133Xe was applied into the nasopharyngeal space through a tube inserted into the nasal cavity. Immediately after the insufflation, the patients were asked to perform three Valsalva manoeuvres. The visualization of the middle ear was possible in 10 of the 13 patients (77 per cent) with normal tube function. Decreased uptake of the middle-ear region in the side of dysfunction was demonstrated in 11 of the 16 patients (68.7 per cent) with one-sided tube dysfunction. Quantitative evaluation by region of interest technique revealed that by using percentage retention of activity and uptake rates, there were significant differences between the sides of dysfunction and sides of normal tube function (p < 0.05) and also between sides of dysfunction and both sides of controls (p < 0.05). There was no significant differences between normal sides of patients and both sides of controls (p > 0.05). As a conclusion, this method is non-invasive, easy- to perform and has a low radiation burden in the evaluation of Eustachian tube function. Although the number of patients is limited, the test seems to be applicable with a success rate of about 74 per cent.

Lymphoscintigraphic evaluation of primary congenital lymphedema.

A-four-year-old girl with primary nonfamilial congenital lymphedema was evaluated by lymphoscintigraphy using 99mTc-Dextran. It was demonstrated that there was no accumulation of radioactivity in the left inguinal and femoral lymph nodes and faint accumulation in the contralateral lymph node. It was concluded that lymphoscintigraphy is a safe, reliable, noninvasive technique which is helpful in the evaluation of a patient with lymphedema, especially small children in whom conventional contrast lymphangiography offers some challenges.

Chronic myeloid leukemia detected on FDG PET/CT imaging in a patient with renal cell carcinoma.

It is well known that hematopoietic cytokine stimulation can cause increased fluorodeoxyglucose (FDG) accumulation in bone marrow on PET/CT imaging, which simulates that seen in patients with bone marrow metastases. However, increased bone marrow FDG uptake can be caused by other etiologies. We report a patient with operated renal cell carcinoma had no history of hematopoietic cytokine stimulation. The FDG PET/CT images showed increased bone marrow FDG uptake, and the patient was diagnosed as chronic myeloid leukemia. This case revealed that increased FDG uptake on bone marrow may be related to neoplastic disease of the hematopoietic tissues.

Evaluation of hepatic metabolic activity in non-alcoholic fatty livers on 18FDG PET/CT.

OBJECTIVE: The liver has been used as a reference organ for the assessment of abnormal (18)F-fluoro-2-deoxy-d-glucose ((18)FDG) in the body. Some researchers found that hepatosteatosis significantly changed the hepatic (18)FDG uptake, while others did not. This study investigated whether the liver's (18)FDG uptake was affected by the diffuse fatty infiltration of the liver. MATERIAL AND METHODS: A total of 156 cases were included in this study. Different patient groups were defined according to the liver Hounsfield unit (HU). The HU was calculated from an unenhanced CT, for all patients, and we calculated the mean standardized uptake value (SUVmean) and maximum standardized uptake value (SUVmax) on an (18)FDG PET scan. For this purpose, we placed regions of interest (ROIs) on the liver image. We statistically compared the SUVmean and SUVmax measured in the fatty liver patients and the control group. RESULTS: The average SUVmean and SUVmax values were calculated as 2.58±0.66 and 3.94±1, respectively, in the patient group and 2.54±0.57 and 3.7±0.88, respectively, in the control group. We found the average SUVmean and SUVmax values in the fatty liver group and its subsets were not significantly different from the values in the control group (p>0.05). We also did not find any statistically significant correlation between average liver density (HU) and the average SUV values (p>0.05). CONCLUSION: Fatty infiltration may not have a significant effect on the liver's (18)FDG uptake. Thus, the liver may be used as a reference or comparator on (18)FDG PET scans in patients with fatty liver disease.

Differences between right- and left-femoral bone mineral densities in right- and left-handed men and women.

To test whether handedness has an asymmetric effect on femur bone mineral density (BMD), the right- and left-proximal femur BMDs were compared in 124 right- and 23 left-handed university students. In the right-handed men, the mean left-femur BMD was significantly greater than the right-femur. In the left-handed men, the mean right-femur BMD was significantly greater than the left-femur. There were no significant differences between BMDs from the right- and left-femurs in women. These results suggest that hand preference may be related to asymmetry in BMD, but only for men.

Scintigraphic evaluation of the short- and long-term renal effects of oral felodipine using technetium-99m-mercaptoacetyl triglycine.

The short- and long-term effect of felodipine on renal perfusion and tubular function was investigated using a new renal tubular imaging agent, 99mTc-mercaptoacetyl triglycine (99mTc-MAG3). Twelve patients with essential hypertension (mean age = 49 +/- 8 years) were studied. Renal scintigraphies with 180 MBq 99mTc-MAG3 were performed at baseline, at the 2nd hour following oral administration of 5 mg felodipine and 4 weeks later on 5-10 mg daily felodipine therapy. The time-activity curves of each kidney were obtained following background subtraction. The 99mTc-MAG3 clearance value was measured for each kidney. In addition, perfusion index (PI), reno index, time to maximum, half-maximum and two thirds of maximum activity values of each kidney were calculated. Systolic and diastolic blood pressures were significantly lowered with long-term administration of felodipine (from 159 +/- 12/105 +/- 5 to 141 +/- 11/87 +/- 7 mm Hg, p = 0.01 and p = 0.002, respectively). Heart rate did not change significantly. Initially, a decrease in PI indicating an increase in renal blood flow (from 246 +/- 96 to 194 +/- 54, p = 0.01) was observed, whereas no change was noted during the chronic administration (to 230 +/- 69, p = NS). Total clearance of 99mTc-MAG3 was decreased nonsignificantly following the initial dose of felodipine (from 361 +/- 93 to 351 +/- 91 ml/min, p = NS). During long-term therapy, felodipine did not alter the perfusion and tubular function of the kidneys. Our results indicated that felodipine causes a significant increase in renal blood flow initially, even with a nonsignificant change in systemic blood pressure.

Short-term effects of somatostatin analogue (SMS 201-995) on left ventricular function in healthy persons: a scintigraphic study.

Since somatostatin has been reported to have a negative inotropic and chronotropic effect on atria and positive inotropic effect on ventricle, present study was designed to investigate the acute effects of somatostatin analogue SMS 201-995 infusion on the left ventricular function in healthy volunteers. After labeling the autologous red blood cells with 750-1000 MBq 99mTc-pertechnetate, ECG-gated radionuclide ventriculography was performed. Using Fourier analysis of the left ventricular time-activity curve, ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR), time to end-systole (TES) and normalized TES/T values were calculated. Study group consisted of 12 healthy volunteers. Somatostatin analogue SMS 201-995 infusion was given at a rate of 100 micrograms/h during 2h. Baseline, 1st, 2nd h and 4th h imagings were done using the same protocol. Simultaneously heart rate and blood pressure were recorded. The difference between parameters was tested using Kruskall-Wallis test. The mean heart rate, systolic and diastolic blood pressures and did not show any statistically significant change during the somatostatin analogue infusion and 2h later in comparison to baseline values. The mean PER and PFR had a slight decrease at the first hour of infusion, but the change was not significant. However, the significant correlation of PER values with heart rate, EF and TES observed at baseline study were disappeared during the infusion. These results indicate that somatostatin analogue infusion does not appear to change the left ventricular systolic and diastolic function in healthy persons significantly.

Scintigraphic evaluation of functional renal reserve using angiotensin-converting enzyme inhibition in patients with type II diabetes mellitus.

Acute effects of 20 mg oral enalapril (E), and angiotensin-converting enzyme inhibitor, on renal function and the renin-angiotensin-aldosterone system were investigated in 13 patients with type II diabetes mellitus (8 female, 5 male) and 10 hypertensive controls using a radionuclide method. Plasma glucose control was evaluated with fructosamine (F) determinations. After intravenous administration of 370 MBq 99mTc-DTPA, sequential images were recorded. Glomerular filtration rate (GFR), perfusion index (PI), time to maximum activity and reno index values of the kidneys were calculated. Two days later, renal scintigraphy was repeated after oral administration of E. Plasma levels of renin, angiotensin II and aldosterone were analyzed using RIA. Basal GFR values (mean: 92.6 ml/min) correlated with F (r = 0.364; p < 0.05). In the diabetic group, 5 patients had a decrease in GFR and an increase in PI after oral E. The mean percent change of GFR was 12 +/- 32 for patients and 20 +/- 12 for controls, respectively. Percent change of GFR had a slightly negative correlation with F values (r = -0.51; p < 0.05) and with PI (r = -0.65; p < 0.001). The patients with good metabolic control had an increase in GFR and a decrease in PI indicating an increase in renal blood flow and glomerular filtration. In patients with proteinuria and poorly controlled diabetes, in response to E-induced efferent arteriolar dilation, there is a decrease in GFR and an increase in PI which indicates a fall in filtration and renal blood flow. This glomerular hemodynamic pathology precedes morphological changes due to diabetes.