RESUMEN
A 64-year-old man complained of pain in the left side of his neck and chest. Subsequently, the symptoms were aggravated and paralyzes of the left upper and lower extremities appeared. With the diagnosis of polyneuritis, steroid pulse therapy was started, but he showed no improvement in symptoms. An FDG-PET/CT scan was performed. FDG accumulated in the lumbar spinal canal and along the left brachial and bilateral lumbosacral plexuses, suggesting involvement by malignant tumors. These findings appeared to be consistent with the clinical and cytologic diagnosis of malignant lymphoma. After systemic chemotherapy, all the above-mentioned accumulations disappeared and he achieved a complete remission.
Asunto(s)
Fluorodesoxiglucosa F18 , Linfoma no Hodgkin/diagnóstico por imagen , Canal Medular/diagnóstico por imagen , Humanos , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Canal Medular/patología , Tomografía Computarizada por Rayos XRESUMEN
To elucidate the role of lactate in the brain, we used a novel method, 'Bioradiography', in which the dynamic process could be followed in living slices by use of positron-emitter-labeled compounds and imaging plates. We studied the incorporation of 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) into rat brain slices incubated in oxygenated Krebs-Ringer solution. Under the glucose-free condition, [18F]FDG uptake rate in the cerebral cortex decreased with time and plateaued within 350 min but the addition of 5 mM lactate made the [18F]FDG uptake linear. When an inhibitor of the lactate transporter, 0.5 mM alpha-cyano-4-hydroxycinnamate (4-CIN) was applied to the glucose-free solution, the uptake rate decreased. Under the normal glucose condition, [18F]FDG uptake linearly increased for 6 h, but when 10 mM lactate was applied, the uptake rate decreased. In contrast, when 0.5 mM 4-CIN was applied to the normal glucose solution, [18F]FDG uptake rate increased. These results suggest that exogenous and endogenous lactate can substitute for glucose in the brain.
Asunto(s)
Encéfalo/metabolismo , Metabolismo Energético/fisiología , Ácido Láctico/metabolismo , Radiografía/métodos , Animales , Encéfalo/anatomía & histología , Ácidos Cumáricos/farmacología , Relación Dosis-Respuesta a Droga , Fluorodesoxiglucosa F18/metabolismo , Glucosa/metabolismo , Técnicas In Vitro , Masculino , Ratas , Ratas Sprague-Dawley , Factores de TiempoRESUMEN
BACKGROUND/AIMS: Conventional methods predicting survival in patients with primary biliary cirrhosis are based on the results of blood tests and on clinical condition, both of which may be affected by treatment. Portal circulation can be evaluated in a relatively noninvasive manner by per-rectal portal scintigraphy. We used this method to evaluate portal hemodynamics and assess prognosis in patients with primary biliary cirrhosis. METHODOLOGY: Per-rectal portal scintigraphy with Tc-99m pertechnetate was done in 51 patients with primary biliary cirrhosis. A solution containing Tc-99m pertechnetate was instilled into the rectum, and serial scintigrams were taken while radioactivity curves for the liver and heart were recorded sequentially. The per-rectal portal shunt index was calculated from the curves. RESULTS: The shunt index was higher in patients with stage IV primary biliary cirrhosis than in those with stage I, II, or III primary biliary cirrhosis. On the basis of portal shunt index, the patients were divided into those with a shunt index of less than 18%, and those with a shunt index of 18% or more. The cumulative survival rate was lower among patients with the higher shunt index. On regression analysis, the portal shunt index was found to be significantly related to survival. CONCLUSIONS: Our results indicate that per-rectal portal scintigraphy with Tc-99m pertechnetate can be used to non-invasively evaluate the portal circulation of patients with primary biliary cirrhosis and is useful in establishing prognosis in such patients.
Asunto(s)
Cirrosis Hepática Biliar/diagnóstico por imagen , Sistema Porta/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Pertecnetato de Sodio Tc 99m , Administración Rectal , Biopsia , Hemodinámica/fisiología , Humanos , Hígado/patología , Hígado/fisiopatología , Cirrosis Hepática Biliar/mortalidad , Cirrosis Hepática Biliar/patología , Cirrosis Hepática Biliar/fisiopatología , Pruebas de Función Hepática , Sistema Porta/fisiopatología , Vena Porta/patología , Vena Porta/fisiopatología , Pronóstico , Cintigrafía , Pertecnetato de Sodio Tc 99m/administración & dosificación , Análisis de SupervivenciaRESUMEN
MicroPET (positron emission tomography) has been implemented for use in experiments with small animals. However, the quantification and optimal conditions for scanning are not established yet. The aim of this study was to compare the results obtained by microPET with those by ex vivo autoradiography of rat brain slices, based on the 2-[18F]fluoro-2-deoxy-D-glucose (FDG) method, and to establish the optimal conditions for scanning. As an example, we examined glucose metabolism in the rat brain under 6 types of anesthesia and in the conscious state. The scanning conditions for the rat brain were (1) use of a 4-mm-thick leaden jacket, (2) an energy window of 350-650 keV, and (3) a coincidence time window of 6 ns. Under these conditions, the quantitative ROI data from microPET showed a good correlation with the corresponding ROI data from FDG autoradiography in the animal study (r2=0.81). With our protocol, when anesthesia was started 40 min after the FDG injection, the glucose metabolism was almost the same as that in the conscious rat brain.
Asunto(s)
Anestesia , Autorradiografía , Encéfalo/diagnóstico por imagen , Tomografía Computarizada de Emisión/métodos , Algoritmos , Animales , Interpretación Estadística de Datos , Fluorodesoxiglucosa F18/farmacocinética , Glucosa/metabolismo , Procesamiento de Imagen Asistido por Computador , Masculino , Modelos Anatómicos , Radiofármacos/farmacocinética , Ratas , Ratas Sprague-DawleyRESUMEN
BACKGROUND/AIMS: Portal circulation can be evaluated in a relatively noninvasive manner by per-rectal portal scintigraphy. We used this method to evaluate portal hemodynamics in patients with primary biliary cirrhosis and idiopathic portal hypertension. We did the procedures simultaneously in some patients to examine the relation between portal circulation and hepatic functional reserve in these diseases. METHODOLOGY: Per-rectal portal scintigraphy with Tc-99m pertechnetate was done in 17 healthy subjects, 154 patients with chronic hepatitis, 447 patients with cirrhosis, 40 patients with primary biliary cirrhosis, and 20 patients with idiopathic portal hypertension. Eighty-three patients (14 with hepatitis, 48 with cirrhosis, 16 with primary biliary cirrhosis, and 5 with idiopathic portal hypertension) also underwent scintigraphy with Tc-99m galactosyl human serum albumin with 2 weeks. A solution containing Tc-99m pertechnetate was instilled into the rectum, and serial scintigrams were taken while radioactivity curves for the liver and heart were recorded sequentially. The per-rectal portal shunt index was calculated from the curves. A receptor index was calculated by dividing the radioactivity of the liver region of interest by that of the liver-plus-heart region of interest 15 min after the injection of Tc-99m galactosyl human serum albumin. The index of blood clearance was calculated by dividing the radioactivity of the heart region of interest at 15 min by that of the heart region of interest at 3 min. RESULTS: The shunt index was higher for more severe disorders, increasing in the order of chronic hepatitis, cirrhosis without varices, and cirrhosis with varices. The shunt indices in patients with primary biliary cirrhosis and idiopathic portal hypertension were higher than that in patients with chronic hepatitis. In terms of receptor index, the standard residuals were more than 0 in 10 of 16 patients with primary biliary cirrhosis and 4 of 5 patients with idiopathic portal hypertension. In terms of index of blood clearance, the standard residuals were more than 0 in 10 of 16 patients with primary biliary cirrhosis and 4 of 5 patients with idiopathic portal hypertension CONCLUSIONS: Abnormalities of portal hemodynamics in patients with primary biliary cirrhosis or idiopathic portal hypertension occur while hepatic functional reserve is still satisfactory as compared with patients who have chronic hepatitis or cirrhosis.
Asunto(s)
Cirrosis Hepática Biliar/fisiopatología , Sistema Porta/diagnóstico por imagen , Sistema Porta/fisiopatología , Enfermedad Crónica , Hemodinámica , Hepatitis/fisiopatología , Humanos , Hipertensión Portal/fisiopatología , Cintigrafía , Radiofármacos , Pertecnetato de Sodio Tc 99m , Agregado de Albúmina Marcado con Tecnecio Tc 99m , Pentetato de Tecnecio Tc 99mRESUMEN
Positron emission tomography (PET) imaging is in common use preoperatively to clinically evaluate patients who present with central nervous system mass lesions. The usefulness of PET is also recognized as a method to detect intracranial tumorous lesions. A number of papers reportthat some inflammatory processes also showed the uptake of Fluorine-18-Fluorodeoxyglucose (FDG) and Carbon-11-Methionine (Met) tracers. We performed two PET studies before and after treatment in 4 patients with brain abscess. PET showed the uptake of both tracers to thebrain abscess before treatment. The area showing an increased uptake of Met corresponded closely to the enhanced area on both CT and MR images. FDG-PET visually showed an uptake of FDG in a small area corresponding to an enhanced lesion within the CT and MR images. After treatment the area of lesions became small on enhancement CT or MRI and both PET studies showed reduced lesion and decreased uptake. The mechanism of Met uptake in the inflammatory area may be related to the higher metabolic rate and the active transport of amino acids as well as disruption of the blood brain barrier. Furthermore, it appears that the mechanism of FDG uptake is also related to a higher metabolic rate and, in addition, is related to the increased density of inflammatory cells. PET studies, more directly, reflect the degree of inflammatory response in brain abscess than enhancement CT or MRI. Therefore, PET is useful in detecting the inflammatory lesion and assessing the clinical effects of antibiotics treatment on brain abscesses.
Asunto(s)
Antibacterianos/uso terapéutico , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/tratamiento farmacológico , Fluorodesoxiglucosa F18 , Metionina , Adulto , Anciano , Absceso Encefálico/etiología , Absceso Encefálico/patología , Humanos , Masculino , Persona de Mediana Edad , Radiofármacos , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico por imagen , Tomografía Computarizada de Emisión/métodos , Resultado del TratamientoRESUMEN
UNLABELLED: The purpose of this study was to evaluate PET using (18)F-FDG for gynecologic lesions with continuous bladder irrigation to eliminate artifacts from the (18)F-FDG activity in the bladder. METHODS: Forty-one patients were studied. They had 23 cervical uterine lesions (15 cases of cancer, 5 recurrences, 3 nonrecurrences); 8 cases of uterine corpus cancer, including 2 recurrences; and 10 ovarian masses (6 malignant, 4 nonmalignant). All cases of cancer were histologically proven; however, 2 cases of nonrecurrent uterine cervical carcinomas were diagnosed by clinical course. Continuous bladder irrigation was performed 35-55 min after intravenous administration of 185-370 MBq (18)F-FDG, and an emission scan was obtained 40-55 min after intravenous administration. Standardized uptake value (SUV) was used to estimate the degree of (18)F-FDG uptake quantitatively. RESULTS: After bladder irrigation, the (18)F-FDG activity in the urinary tract was eliminated in 33 patients, so that detection of tumor (18)F-FDG accumulation was easy. Two patients showed residual activity in the urinary bladder, and 6 patients showed activity in the ureter. An artifact was seen in 1 patient with residual activity in the urinary bladder caused by insufficient irrigation. However, these residual activities had no influence on detecting (18)F-FDG accumulation in tumor. The mean (+/-SD) of SUVs of malignant lesions was 6.04 +/- 3.22, that of nonmalignant lesions was 1.71 +/- 1.12, and the difference was significant (P = 0.0002). SUVs of all malignant lesions were greater than 2.0, and SUVs of all nonmalignant lesions, except the 1 case of ovarian fibroma, were less than 2.0. CONCLUSION: (18)F-FDG PET with continuous bladder irrigation is useful for eliminating (18)F-FDG activity in the bladder and for differentiating between malignant and nonmalignant uterine or ovarian masses.
Asunto(s)
Carcinoma/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neoplasias Ováricas/diagnóstico por imagen , Radiofármacos , Tomografía Computarizada de Emisión , Vejiga Urinaria/diagnóstico por imagen , Neoplasias Uterinas/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Artefactos , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Irrigación Terapéutica , Neoplasias del Cuello Uterino/diagnóstico por imagenRESUMEN
UNLABELLED: Liver tumors, especially hepatocellular carcinomas (HCCs), often exhibit no contrast with surrounding non-tumorous liver tissue in F-18-fluoro-2-deoxy-2-fluoro-D-glucose (FDG) positron emission tomography (PET) images obtained at the usual interval of one hour after intravenous FDG injection. We evaluated the usefulness of FDG PET studies of liver tumors performed 2 hours after intravenous injection. METHODS AND MATERIALS: Fifteen pretherapeutic patients with 33 liver tumors were studied, including 11 patients with 18 HCCs, and 4 patients with 15 metastatic liver tumors (METAs) from 3 colorectal carcinomas and 1 esophageal carcinoma. After transmission scans, emission scans were obtained 45-55 minutes and 115-125 minutes after intravenous injection of 185-370 MBq FDG as early images and delayed FDG PET images, respectively. Visual analysis of early and delayed images was performed, and the FDG uptake in the tumor to that in nontumorous liver ratio (T/N ratio), the FDG uptake in tumor to that in soft-tissue ratio (T/S ratio) and the FDG uptake in non-tumorous liver to that in soft-tissue ratio (N/S ratio) were calculated for each image. RESULTS: In visual analysis, visual improvement seen in images was observed in 6 of 18 HCC lesions and all 15 META lesions. In quantitative analysis, the mean T/S ratio and T/N ratio of HCCs in early images were 4.97 and 1.90, respectively, and those in delayed images were 6.24 and 2.20, respectively. The mean T/S ratio and T/N ratio of METAs in early images were 5.97 and 2.21, respectively, and those in delayed images were 6.99 and 3.80, respectively. The T/S ratio of HCCs and T/S ratio and T/N ratio of METAs were significantly higher in delayed images than in early images. The mean N/S ratios of HCC cases were 2.58 in the early images and 2.57 in the delayed images, but the ratio showed no constant tendency in the images. All N/S ratios of META cases were decreased in delayed images, although the significance of the difference between early and delayed images in N/S ratios was not analyzed because of the small number of cases. CONCLUSION: FDG PET studies performed 2 hours after intravenous injection were useful for clear visualization of liver tumors, especially metastatic liver tumors.
Asunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/secundario , Fluorodesoxiglucosa F18 , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/patología , Neoplasias Esofágicas/patología , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Cintigrafía , Radiofármacos , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
UNLABELLED: There have been a number of reports of gastric emptying in cirrhosis, all with unconfirmed results. Moreover, the mechanism for delayed emptying in cirrhotic patients is unclear. We evaluated gastric emptying in patients with chronic hepatitis and cirrhosis by means of gastric emptying scintigraphy. METHODS: The subjects were 18 normal controls and 75 patients with chronic viral hepatitis (50 patients had chronic hepatitis and 25 patients had cirrhosis). Tc-99m diethyltriamine pentaacetic acid labeled solid meals were used to evaluate gastric emptying; the half-time (T 1/2) of which was calculated. Digestive symptom scores were determined at the time of gastric emptying tests. RESULTS: Fourteen (28%) of 50 patients with chronic hepatitis and 16 (64%) of 25 patients with cirrhosis had delayed gastric emptying. T 1/2 in patients with cirrhosis was significantly higher than that in normal controls and patients with chronic hepatitis (p = 0.0001 and 0.0003, respectively). The difference between T 1/2 in patients with chronic hepatitis and that in normal controls was not significant. On regression analysis, two indices-the serum albumin level and platelet count-were found to be significantly related to delayed gastric emptying. CONCLUSIONS: Gastric emptying was more delayed in cirrhotic patients than in those with chronic hepatitis and normal controls. Delayed gastric emptying may be related to liver function and portal hypertension.
Asunto(s)
Vaciamiento Gástrico , Hepatitis Crónica/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Estómago/diagnóstico por imagen , Enfermedad Crónica , Femenino , Hepatitis Crónica/fisiopatología , Humanos , Cirrosis Hepática/fisiopatología , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Cintigrafía , Radiofármacos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estadística como Asunto , Pentetato de Tecnecio Tc 99mRESUMEN
Gastric duplications are relatively rare, and communication with the gastric lumen is extremely rare. A 67-year-old man was referred to our hospital because of recurrence of epigastric pain and fullness. An upper gastrointestinal contrast study revealed a double compartment stomach, with gastric duplication starting at the esophagogastric junction outside the greater curvature. Computed tomography of the stomach with gastrografin as contrast demonstrated complete communication of the gastric duplication and primary stomach. The patient was diagnosed with complete gastric duplication. Gastric emptying scintigraphy with Tc-99m diethyltriamine pentaacetic acid was performed. Test meal entered the primary stomach and duplication cyst simultaneously, and radioactivity in the primary stomach decreased linearly and gastric emptying was not delayed. In the duplication cyst, about 70% of the food that entered the cyst once was immediately evacuated from it, but the remaining 30% remained in the cyst for a long time. Gastric emptying of the primary stomach was not affected by formation of the duplication cyst.
Asunto(s)
Vaciamiento Gástrico , Gastropatías/diagnóstico por imagen , Estómago/anomalías , Pentetato de Tecnecio Tc 99m , Anciano , Quistes/congénito , Quistes/diagnóstico por imagen , Humanos , Radiografía , Cintigrafía , Radiofármacos , Estómago/diagnóstico por imagen , Gastropatías/fisiopatologíaRESUMEN
PURPOSE: In scintigraphy of the sentinel lymph node, it is common to use a lead plate as a shield to reduce star artifact and scattered radiation in the portion surrounding the injected site of radioactive colloid. We have developed an imaging method without using a lead plate, and examined its usefulness in phantom and clinical imagings. METHODS, RESULTS: Star artifact was eliminated using a medium energy collimator. Effects of scattered radiation from the injection site were reduced by setting energy window at higher level. CONCLUSIONS: Our method without using a lead plate can be applied to dynamic data acquisition and imaging of a portion where it is difficult to place a lead plate. It also seems to be a useful imaging method in that it takes patients' feelings into consideration.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Cintigrafía/métodos , Artefactos , Humanos , Dispersión de Radiación , Sensibilidad y EspecificidadRESUMEN
Choroid plexus papilloma (CCP) is an uncommon benign neoplasm of the neuroectoderm. We present the 18F-fluoro-2-deoxy-D-glucose (FDG) and 11C-methyl-L-methionine (methionine) positron emission tomography of CPP in comparison with that of low-grade glioma. Patients were two women and one man (20, 23, and 72 years old). The Ki-67 labeling index ranged from 0.98 to 2.22%, and histologically the cases belonged to grade 2. On quantitative analysis, the tumor/normal ratio (T/N) was calculated using the standardized uptake value. Methionine T/N was significantly higher in CPP (3.24+/-0.69) than in low-grade glioma (1.23+/-0.81; p<0.01), although no clear difference could be determined for FDG T/N between the two (0.87+/-0.39, 0.75+/-0.53). These results may suggest that the metabolism of amino acid in CPP is quite different from that in low-grade glioma.
Asunto(s)
Fluorodesoxiglucosa F18 , Metionina , Papiloma del Plexo Coroideo/diagnóstico por imagen , Radiofármacos , Tomografía Computarizada de Emisión , Adulto , Anciano , Neoplasias Encefálicas/diagnóstico por imagen , Radioisótopos de Carbono , Femenino , Humanos , Masculino , Valor Predictivo de las PruebasRESUMEN
OBJECTIVE: Bone loss frequently appears in the natural history of liver disease. The effects of therapy for osteoporosis associated with cirrhosis of the liver are still controversial. We evaluated the effects of vitamin K2 on osteopenia in women with cirrhosis. METHODS: The subjects were 50 women with cirrhosis who had underlying hepatitis viral infections. Half of the patients were randomly assigned to receive vitamin K2 (menatetrenone). The bone mineral density (BMD) of the lumbar vertebrae was measured by dual-energy X-ray absorptiometry at entry and at 1-yr intervals for 2 yr. RESULTS: The percentages of change from the initial BMD at 1 and 2 yr after initiation of the study were, respectively, +0.1 +/- 2.6% and -0.5 +/- 3.5% for the vitamin K2-treated group and -2.2 +/- 2.4% and -4.6 +/- 3.9% for the control group. The changes in BMD at each timepoint differed significantly between the control and treated groups (p = 0.008 for 1 yr and p = 0.002 for 2 yr). In the vitamin K2-treated group, the ratio of osteocalcin to undercarboxylated osteocalcin in those patients with increases in BMD after 1 yr of treatment was significantly lower than that in patients showing decreases in BMD (p = 0.017). No adverse effects of vitamin K2 were noted. CONCLUSIONS: Vitamin K2 can prevent bone loss and may therefore be useful in the management of bone disease in women with cirrhosis of the liver.
Asunto(s)
Hemostáticos/uso terapéutico , Hepatitis B/complicaciones , Hepatitis C/complicaciones , Cirrosis Hepática/complicaciones , Osteoporosis/tratamiento farmacológico , Osteoporosis/etiología , Vitamina K 2/análogos & derivados , Vitamina K 2/uso terapéutico , Absorciometría de Fotón , Adulto , Anciano , Densidad Ósea/efectos de los fármacos , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/efectos de los fármacos , Persona de Mediana Edad , Osteoporosis/diagnóstico por imagen , Factores de TiempoRESUMEN
UNLABELLED: Assessment of reversible perfusion defects in exercise (201)Tl perfusion SPECT has low sensitivity and high specificity for detection of multivessel coronary artery disease (CAD). The goal of this study was to evaluate whether worsening of left ventricular regional wall motion assessed by an automated algorithm in exercise (201)Tl electrocardiography-gated SPECT had incremental diagnostic value over perfusion data for detection of multivessel CAD. METHODS: Two hundred one patients underwent exercise (201)Tl gated SPECT. Software that automatically analyzes left ventricular function was used to assess exercise and rest regional wall motion. Regional wall motion on initial images was compared with that on rest images, that is, delayed images for patients without reinjection images and reinjection images for patients with reinjection images. The left ventricle was divided into 9 segments, with individual segments assigned to 3 coronary territories. Worsening of wall motion was defined as worsening in any segment on initial images compared with rest images. RESULTS: Of 73 patients with multivessel CAD, 20 (27.4%) had reversible perfusion defects in multiple coronary territories, 26 (35.6%) exhibited worsening of regional wall motion in multiple territories, and 37 (50.7%) had reversible perfusion defects or worsening of regional wall motion in multiple territories. The sensitivity of the combination of reversible perfusion defect and worsening of regional wall motion was significantly higher than that of reversible perfusion defect alone for detection of multivessel CAD (50.7% vs. 27.4%, P < 0.05). The specificity of the combination of reversible perfusion defect and worsening of regional wall motion for detecting multivessel CAD did not differ from that of reversible perfusion defect alone and that of worsening of regional wall motion alone (94.5% vs. 99.2% and 97.7%, respectively, P = not statistically significant). CONCLUSION: Combined assessment of worsening of left ventricular regional wall motion by exercise and perfusion data in exercise (201)Tl gated myocardial SPECT was more sensitive, with acceptable specificity, than was assessment with perfusion data alone for detection of multivessel CAD.
Asunto(s)
Enfermedad Coronaria/diagnóstico por imagen , Prueba de Esfuerzo , Radiofármacos , Radioisótopos de Talio , Tomografía Computarizada de Emisión de Fotón Único , Función Ventricular Izquierda , Angiografía Coronaria , Circulación Coronaria , Enfermedad Coronaria/fisiopatología , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Variaciones Dependientes del Observador , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Disodium cycloheptylaminomethylenediphosphonate monohydrate (incadronate disodium) is a third-generation bisphosphonate compound which potently inhibits bone resorption, and a highly effective drug in the treatment of metastatic bone disease. We first labeled incadronate disodium with 99mTc, and examined its biodistribution and bone uptake after intravenous injection in rats to assess its potential for clinical use as a bone-seeking agent for judgment of the therapeutic effect of incadronate on bone metastases. Bone scan with 99mTc-labeled incadronate (99mTc-incadronate) may yield important information prior to the use of incadronate for treatment of bone metastases. METHODS: Synthesis of 99mTc-incadronate was carried out by reduction of 99mTc-pertechnetate in the presence of SnCl2 and N2 gas. Normal rats were injected with 18.5 MBq (0.5 mCi) 99mTc-incadronate in a volume of 0.1 ml intravenously and then sacrificed at 15 min, 30 min, 1 h or 2 h (six rats at each time point) after injection. Samples of muscle, stomach, small intestine, kidney, liver and bone (femur) were taken and weighed. In addition, a 1-ml sample of blood was drawn from the heart, and urine was taken from the urinary bladder immediately after sacrifice. Samples were measured for radioactivity and expressed as percent uptake of injected dose per gram or per milliliter (% ID/g or ml). Bone-to-blood and bone-to-muscle uptake ratios were determined from the % ID/g or ml values for these organs. RESULTS: The greatest accumulation of 99mTc-incadronate was found in bone. Radioactivity in bone was as high as 3.22 +/- 0.68% ID/g at 2 hours after injection. Scintigraphic images of 99mTc-incadronate in normal rats revealed highly selective skeletal uptake. CONCLUSION: 99mTc-incadronate exhibited high uptake in bone, and relatively low uptake in soft tissue, suggesting that it may be useful as a bone-seeking agent for judgment of the therapeutic effect of incadronate on bone metastases, by determining the degree of its accumulation in metastatic bone lesions.
Asunto(s)
Huesos/diagnóstico por imagen , Huesos/metabolismo , Difosfonatos/metabolismo , Difosfonatos/farmacocinética , Compuestos de Organotecnecio/farmacocinética , Radiofármacos/farmacocinética , Animales , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/metabolismo , Difosfonatos/sangre , Difosfonatos/síntesis química , Difosfonatos/química , Difosfonatos/orina , Estudios de Factibilidad , Femenino , Concentración de Iones de Hidrógeno , Riñón/diagnóstico por imagen , Riñón/metabolismo , Modelos Moleculares , Músculos/diagnóstico por imagen , Músculos/metabolismo , Compuestos de Organotecnecio/sangre , Compuestos de Organotecnecio/síntesis química , Compuestos de Organotecnecio/orina , Cintigrafía , Radiofármacos/química , Ratas , Ratas Wistar , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Pertecnetato de Sodio Tc 99m/química , Distribución Tisular , Orina/química , Recuento Corporal Total/métodosRESUMEN
Prediction of survival of patients with primary biliary cirrhosis (PBC) has been based on results of blood tests and other indices of clinical condition, which may be affected by treatment. We earlier evaluated hepatic receptor imaging with 99mTc galactosyl human serum albumin as an alternative method for prediction of survival. To evaluate whether this method is useful for this purpose, we examined the cumulative survival rate of patients with PBC since their first examination by this method. The subjects were 60 patients with PBC, 10 healthy subjects, 65 patients with chronic hepatitis, and 196 patients with cirrhosis. Computer acquisition of gamma-camera data was started just before the injection of 99mTc galactosyl human serum albumin and was stopped 20 min later. As indices of hepatic functional reserve, the receptor index and the index of blood clearance were calculated. Among the patients with PBC, the receptor index was lower in those with stage IV than in those with stages I, II, or III, and the index of blood clearance was higher in patients with stage IV than in those with stages I, II, or III. On the basis of the receptor index, the patients with PBC were divided arbitrarily into two groups of roughly equal size: group A with a receptor index of greater-than-or-equal0.94, and group B with index <0.94. On the basis of the index of blood clearance, the patients were also divided into two groups of roughly equal size: group C with an index of blood clearance of <0.52, and group D with index greater-than-or-equal0.52. Cumulative survival rates were significantly lower in group B than in group A (P=0.026), and lower in group D than in group C (P=0.005). Regression analysis showed the index of blood clearance to be significantly related to survival. In conclusion, hepatic receptor imaging with 99mTc galactosyl human serum albumin can be used to noninvasively evaluate the hepatic functional reserve of patients with PBC and is useful clinically in establishing their prognosis.
RESUMEN
We examined the effects of interferon-alpha or -beta therapy on gastric emptying and digestive symptoms. The effects of cisapride on gastric emptying and digestive symptoms were also evaluated. The subjects were 48 patients with chronic hepatitis C. All patients were randomly assigned to one of four groups (A, interferon-alpha group; B, interferon-alpha and cisapride group; C, interferon-beta group; D, interferon-beta and cisapride group). Gastric emptying was measured before initiation of interferon therapy and two weeks after initiation of therapy. The half-time of gastric emptying (T1/2) was calculated. The T1/2 ratio was calculated by dividing the T1/2 after interferon therapy by the T1/2 before interferon therapy. Digestive symptom scores were determined at the time of the gastric emptying tests. The T1/2 after interferon therapy was higher than that before therapy in groups A and C (P = 0.002 and 0.059, respectively). The digestive symptom score after interferon therapy was higher than that before therapy in groups A and C (P = 0.012 and 0.093, respectively). The T1/2 ratio in group B was significantly lower than that in group A (P = 0.021), and the T1/2 ratio in group D was lower than that in group C, but the difference did not reach statistical significance (P = 0.057). Interferon-alpha is associated with a greater delay in gastric emptying and a higher symptom score than is interferon-beta. Administration of cisapride corrects the delayed gastric emptying and relieves associated digestive symptoms.
Asunto(s)
Cisaprida/uso terapéutico , Vaciamiento Gástrico/fisiología , Fármacos Gastrointestinales/uso terapéutico , Hepatitis C Crónica/fisiopatología , Hepatitis C Crónica/terapia , Interferón-alfa/uso terapéutico , Interferón beta/uso terapéutico , Adulto , Cisaprida/administración & dosificación , Sistema Digestivo/efectos de los fármacos , Sistema Digestivo/fisiopatología , Femenino , Vaciamiento Gástrico/efectos de los fármacos , Fármacos Gastrointestinales/administración & dosificación , Humanos , Interferón-alfa/administración & dosificación , Interferón beta/administración & dosificación , Masculino , Persona de Mediana EdadRESUMEN
UNLABELLED: Assessment of reversible defects in exercise (201)Tl perfusion SPECT has low sensitivity and high specificity for detection of multivessel coronary artery disease (CAD). The goal of this study was to evaluate whether the left ventricular ejection fraction (LVEF) in exercise (201)Tl gated SPECT had incremental diagnostic value over perfusion data for detection of multivessel CAD. METHODS: One hundred eighty-two patients underwent exercise (201)Tl gated SPECT. Automated LV function analysis software was used for calculation of the postexercise and the rest LVEF. The best threshold between 0- to 1-vessel CAD and 2- to 3-vessel CAD was determined as the cutoff that on receiver-operating-characteristic analysis resulted in the best sensitivity for detection of multivessel CAD with an associated specificity of >90%. RESULTS: Only 18 (26.9%) of 67 patients with multivessel CAD had reversible defects in multiple territories. Sensitivities of the postexercise and the rest LVEF and the worsening of the LVEF by exercise did not differ from those of perfusion data alone. Sensitivities of the combination of perfusion data and the postexercise and rest LVEF did not differ from those of perfusion data alone, whereas the sensitivity of the combination of perfusion data and worsening of the LVEF (i.e., reversible defects in multiple territories or worsening of the LVEF >5.6% [or both]) was significantly greater than that of perfusion data alone (43.3% vs. 26.9%; P < 0.05), with an acceptable level of specificity (90.4%). CONCLUSION: The worsening of the LVEF by exercise has the potential to detect patients with multivessel CAD among those without multivessel patterns of reversible defects.
Asunto(s)
Enfermedad Coronaria/diagnóstico por imagen , Prueba de Esfuerzo , Volumen Sistólico , Radioisótopos de Talio , Tomografía Computarizada de Emisión de Fotón Único , Función Ventricular Izquierda , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico , Electrocardiografía , Femenino , Corazón/diagnóstico por imagen , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Análisis Multivariante , Sensibilidad y EspecificidadRESUMEN
Osteoporosis is associated with cirrhosis of the liver. We evaluated the effects of cyclical etidronate on osteopenia in women with cirrhosis of the liver. The subjects were 50 women with cirrhosis who had underlying hepatitis viral infection. Half of the patients were randomly assigned to receive cyclical etidronate (200 mg). The bone mineral density (BMD) of the lumbar vertebrae was measured by dual-energy X-ray absorptiometry at entry and at 1 year intervals for at least 2 years. After 1 year of treatment, the median BMD was +0.7% in the treated group and minus sign2.0% in the control group. After 2 years of treatment, the median BMD was +0.1% in the treated group and minus sign3.4% in the control group. After 3 years of treatment, the median BMD was minus sign0.6% in the treated group and minus sign5.2% in the control group. These differences between the groups were significant. No adverse effects of cyclical etidronate were noted. These results suggest that cyclical etidronate can prevent bone loss and may therefore be useful in the management of bone disease in women with cirrhosis of the liver.