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Background/Aim. Peripheral artery disease (PAD) is a common macrovascular complication in patients with diabetes mellitus (DM) as a result of impairment of homeostatic mechanisms of the endothelium, thus initiating the process of atherosclerosis. The imbalance between endothelium- derived vasodilators and vasoconstrictors plays an important role in the pathogenesis of diabetic microangiopathy, as well as in other vascular complications in diabetes. Perfusion scintigraphy using technetium-99m-methoxyisobutyl isonitrile (99mTc-MIBI) can be very useful method for evaluation of the lower limbs muscle perfusion. The aim of this study was: to compare the results of dynamic and static studies of lower limbs tissue muscle perfusion scintigraphy with 99mTc-MIBI (one-day rest-stress protocol) in patients with and without DM and to determine the perfusion reserve for diagnostic evaluation of PAD in patients with DM type 2, as well as to assess the endothelin-1 (ET-1) levels as a vasoconstrictor agent in patients with and without diabetes. Methods. Prospective study was performed in 90 patients, divided into two groups according to the presence of DM ? patients with DM type 2 (DP), 60/90 (67%), and patients without DM (NDP), 30/90 (33%). Lower limbs tissue muscle perfusion scintigraphy was done with 99mTc-MIBI including two studies (?rest? and ?stress?). Results. In the DP group significantly lower pick of radioactivity was detected in comparison with the NDP group, in both phases (rest and stress), for both calves. Lower counts from the static phase were registered in the region of both calves. Lower inter-extremity indexes as well as perfusion reserve were found in the DP group. There was a significant difference in concentrations of ET-1 between groups (higher concentrations were found in tzhe DP group). Conclusion. This one-day protocol (rest-stress with 99mTc-MIBI) of perfusion scintigraphy of lower limbs is considered a useful procedure in PAD assessment in patients with DM type 2, especially the asymptomatic form.

Aim. The aim of our study was to explore the possibilities of scintigraphy with 99mTc-MIBI for diagnosis of parathyroid glands disorders and advantages of SPECT/CT technology with 99mTc-MIBI for ectopic glands. Material and Methods. The study involved 682 patients with parathyroid glands disorders. 619 (90.8%) of them were women, 63 (9.2%) - men. With primary hyperparathyroidism were examined 549 (80.5%) patients, with secondary/tertiary hyperparathyroidism - 133 (19.5%) patients. Results and Discussion. In 490 patients (71.9%) high-quality diagnostic images were obtained. In 50 of them (7.3% patients) the multiglandular disease was visualized. In 52 (7.6%) patients were detected the intrathyroid adenomas of the parathyroid glands or parathyroid adenomas, which bordered directly with the thyroid tissue along the posterior surface of the thyroid gland. In 26 (3.8%) patients parathyroid adenomas were localized in the upper, anterior and/or middle mediastinum. Negative results of scintigraphy occurred in 114 (16.7%) patients. Conclusions. Results of study demonstrate high diagnostic value of scintigraphy with 99mTc-MIBI in diagnosis parathyroid glands disorders; SPECT/CT with 99mTc-MIBI allows more precisely determine the localization of ectopic parathyroid glands.

Background We sought to determine the diagnostic efficacy of Breast-specific gamma imaging (BSGI) in Chinese women with BI-RADS 4 category lesions and to compare this efficacy to that of ultrasound/mammography. Methods We retrospectively analyzed data from 177 women that had undergone BSGI of BI-RADS 4 category lesions originally detected via ultrasound and/or mammography. Results Of these 177 cases, 117 (66.1%) were malignant lesions and 60 (33.9%) were benign. The sensitivity, specificity, positive predictive values, and negative predictive values of BSGI were 94.9% (111/117), 78.3% (47/60), 89.5% (111/124), and 88.7% (47/53), respectively. The specificity and positive predictive values for mammography were 48.3% (29/60) and 77.5% (107/138), while for ultrasound they were 53.3% (32/60) and 79.6% (109/137), respectively. The sensitivity and specificity of BSGI for the detection of lesions ≤1 cm in size were 90.9% (10/11) and 88.0% (22/25), respectively, while for breast lesions >1 cm in size these values were 94.3% (100/106) and 71.4% (25/35), respectively. In addition, BSGI sensitivity and specificity values for dense breast tissue were 94.0% (79/84) and 78.0% (39/50), respectively, whereas for non-dense breast tissue these vales were 97.0% (32/33) and 80.0% (8/10), respectively. The sensitivity of BSGI for invasive ductal carcinomas (IDC) and ductal carcinomas in situ (DCIS) was 98.9% (95/96) and 75.0% (9/12), respectively. The tumor to normal tissue ratio of BSGI for malignant lesions was significantly higher than for benign lesions (2.18 ± 1.17 vs 1.66 ± 0.40, t = 7.56, P Conclusions These results indicate that BSGI is highly sensitive for the detection of such lesions, achieving good positive/negative predictive values. This suggests that for IDC in particular, BSGI is superior to ultrasound and mammography for the diagnosis of BI-RADS 4 category lesions, although this was less apparent for the diagnosis of DCIS lesions. BSGI exhibited excellent performance in dense breast tissue and for the detection of lesions ≤1 cm in size.

[ 99m Tc]MIBI thyroid scintigraphy is a useful tool to differentiate benign from malignant thyroid nodules. This report aims to show the diagnostic performance of [ 99m Tc]MIBI scintigraphy used in an 83-year-old woman who had a thyroidectomy about 7 years ago. She had a mass of thyroid which was very large, non-homogenous and painless. [ 99m Tc]MIBI scintigraphy could be a pre-surgical method to investigate the follicular nodules and predicting the malignant form of thyroid nodules. Also, it will provide tissue information for [ 99m Tc]MIBI images in thyroid lesions.

ObjectiveSecondary hyperparathyroidism (SHPT) usually need parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early SPECT/CT and delayed SPECT/CT in patients with SHPT.MethodsSixty patients with SHPT who were undergoing dialysis were evaluated preoperatively with ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early SPECT/CT and delayed SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy rate were determined for each method. Spearman correlation analysis was used to analyze the correlation of the hyperplastic parathyroid calcification with serum alkaline phosphatase (AKP) and parathyroid hormone (PTH). Results229 lesions in 60 patients were pathological confirmed to be parathyroid hyperplasia with 209 lesions in typical sites, 15 lesions in upper mediastinum and 4 lesions in the thyroid. 88.33% (53/60) patients had four lesions. US, early and delayed SPECT/CT had significantly higher sensitivity and accuracy rate (P < 0.001) than did dual-phase 99mTc-MIBI scintigraphy. Furthermore, early SPECT/CT had significantly higher sensitivity (χ2 = 17.521, P < 0.001, χ2 = 35.027, P < 0.001) and accuracy rate (χ2 = 11.076, P = 0.001, χ2 = 16.289, P < 0.001) than did US and delayed SPECT/CT. In ectopic hyperplastic parathyroid, the sensitivity of early SPECT/CT (90%) was significantly higher than US (55%) and dual-phase planar (50%) (P = 0.039 and P = 0.039). Spearman correlation results showed a significant linear association between the calcification and serum PTH (r = 0.398, P = 0.002) and AKP (r = 0.415, P = 0.002).ConclusionThe ability of early SPECT/CT to detect hyperplastic parathyroid in patients with SHPT is superior to US, 99mTc-MIBI scintigraphy and delayed SPECT/CT, and dual-phase SPECT/CT is not essential. Calcification of parathyroid gland is a special sign of SHPT and correlated with serum PTH and AKP.

Purpose: To investigate the feasibility of applying the dual imaging mechanisms of 99mTc-MIBI scintigraphy in predicting and evaluating the response to neoadjuvant chemotherapy in patients with osteosarcoma. Materials and methods: Thirty patients with osteosarcoma who underwent both pre-and post-chemotherapy 99mTc-MIBI scintigraphy were enrolled in the study. In each patient, the tumor to background ratio (T/B), tumor washout rate (WR) of MIBI and the alteration rate (AR) of tumor uptake after chemotherapy was calculated, respectively, on MIBI scintigraphy before or after chemotherapy. Based on the tumor necrosis rate histologically confirmed by tumor resection after chemotherapy, the diagnostic performance of MIBI scintigraphy was assessed in predicting tumor response with the WR of pre-chemotherapy imaging, as well as evaluating tumor response with the AR of both pre-and post-chemotherapy imaging. Results: On pre-chemotherapy MIBI imaging, no statistical difference was found in T/B values between patients with good response and those with poor response, but the WR in patients with good response was significantly lower. Tumor WR was negatively correlated with the tumor necrosis rate (r = −0.510, P = 0.004). When WR ≤ 25% was taken as the threshold for predicting good response, a sensitivity of 100%, a specificity of 91.7% and an accuracy of 95.8% would be yielded. On post-chemotherapy imaging, T/B values both on early and delayed phases were significantly lower in responders and AR of tumor uptake was significantly higher in these responders. When AR ≥ 38% was used as the threshold for a good response, a sensitivity of 91.7%, a specificity of 94.4% and an accuracy of 93.3% would be yielded. The diagnostic coincidence rate between WR for predicting chemotherapy response and AR for evaluating chemotherapy response was 90.0% (kappa = 0.789, P < 0.001). Conclusion: 99mTc-MIBI imaging is a useful tool for the evaluation of neoadjuvant chemotherapy in patients with osteosarcoma, and its dual mechanisms could be simultaneously used in predicting and evaluating tumor response to chemotherapy. Keywords: Osteosarcoma, Chemotherapy, 99mTc-methoxyisobutylisonitrile, Response, Radionuclide imaging

Aims: The study aimed at comparing two methods for evaluating thymidinekinase TK in serum - an older RIA method and novel DiviTum™ - in patients with MM and MGUS, and also comparing them with biochemical markers and degree of activity evaluated by imaging methods 99mTc-MIBI scintigraphy and 18F-FDG PET/CT. Methods: Serum thymidinekinase TK levels were evaluated by DiviTum™ and an RIA method (TK REA kit by Immunotech);The study analyzed correlation of TK activity in serum with biochemical markers reflecting activity of MM: β2-m, LDH, the ratio of kappa to lambda (κ/λ) free light chains and percentage of bone marrow plasma cells (BMPC). 99mTc-MIBI scintigraphy and 18F-FDG PET/CT were performed at the time of diagnosis. The degree of activity was expressed semiquantitatively. Scans were classified as 0 (normal activity), 1 (diffuse positivity) or 2 (focal positivity). Results: We found a strong positive correlation between TK in serum evaluated by DiviTum™ and by TK REA.. The DiviTum™ analytic method extended the detection range and was able to detect higher levels of TK than the RIA method. DiviTum™ technique found positive correlation with β2-m (r = 0.497) and LDH (r = 0.502) and moderate positive correlation with BMPC (r = 0.368). Significantly higher TK values measured by TK REA and DiviTum™ in the group of patients with MM (stages I, II or III) than in those with MGUS. Increased TK levels were observed in MIBI- or PET/CT-positive patients. Analysis of repeated measurements of TK in serum during treatment of MM patients found a correlation between change in TK measured by DiviTum™ and LDH during treatment. Conclusions: Analysis revealed a significant correlation between TK in serum and LDH, β2-m and BMPC. Increased levels of TK in serum were observed in MIBI- or PET/CT-positive patients. Combination of positivity of imaging methods which can localize active tumor lesions and increased levels of TK in serum can have an impact on decision-making and optimization of the therapeutic approach.

The aim of the present study was to evaluate the possible diagnostic role of the combined performance of BRAF mutation analysis and MIBI scintigraphy in papillary thyroid cancer (PTC) patients with incomplete bio-chemical response to first radioiodine therapy (RAIT) performed for thyroid remnant ablation. The records of 15 PTC patients with bio-chemical incomplete response to first RAIT were retrospectively analyzed. BRAFV600E analysis on primary tumor samples was obtained in all cases along with neck ultrasonography and 99mTc-MIBI scintigraphy of the neck–thorax regions at first follow-up. All patients then underwent RAIT with high radioiodine activities. A post-therapy whole-body scan (pT-WBS) was acquired 5–7 days after RAIT. Abnormal radioiodine uptake was found in 10 out of the 15 patients (67%, 131I+ve), while in the remaining 33%, no abnormal radioiodine uptake was detected (5/15, 131I−ve). Abnormal tracer uptake was found in 6 out of 10 131I+ve patients at 99mTc-MIBI scintigraphy (MIBI+ve). BRAFV600E mutation was not found in the majority of 131I+ve patients (9 out of 10 BRAFV600E−ve). On the contrary, in the 5 131I−ve patients, 99mTc-MIBI scintigraphy did not show any abnormal tracer uptake (MIBI−ve), while BRAFV600E mutation was present (BRAFV600E+ve). Thus, in our series, the association between MIBI−ve scintigraphy and BRAF+ve mutation was a useful diagnostic tool in predicting negative pT-WBS outcome. Albeit obtained in a small retrospective series, our results suggest that the combination of BRAFV600E+ve mutation and MIBI−ve scintigraphy may be considered a negative prognostic clue, which predicts the absence of radioiodine uptake at pT-WBS in DTC patients with incomplete bio-chemical response to first RAIT.

We report a case of breast cancer detected as an incidental finding on 99mTc-MIBI scintigraphy. 99mTc-MIBI scintigraphy is usually used to evaluate cardiac perfusion or to detect ectopic parathyroid adenomas; however, it is also known to sensitively detect breast cancer. Accordingly, a few reports have described the incidental detection of breast cancer by 99mTc-MIBI scintigraphy performed to detect parathyroid adenoma. Our present case underscores the importance of attending to any incidental findings when searching for parathyroid adenomas using 99mTc-MIBI scintigraphy.

ZusammenfassungZur Dignitätsabklärung hypofunktioneller Schilddrüsenknoten kann eine Szintigraphie mit 99mTc-MIBI erfolgen. Bei Minderspeiche- rung im Pertechnetat- und MIBI-Szintigramm lässt sich ein Schilddrüsenkarzinom relativ sicher ausschließen. Bei vermehrter MIBI-An- reicherung wird eine Operation empfohlen. Die Einstufung isointenser Knoten wird kontrovers gesehen. Untersucht wurde, welche Karzinomprävalenz isointense Knoten zeigen und ob sich durch SPECT-Technik ein diagnostischer Zugewinn ergibt. Patienten, Methodik: Retrospektive Auswertung von MIBI-Szintigraphien in planarer und SPECT- Technik. Die Szintigraphie erfolgte nach Applikation von 510 MBq 99mTc-MIBI eine Stunde p. i. Die Auswertung erfolgte visuell mit Einteilung der Knoten in hypo-, iso- und hy- perintens im Vergleich zum paranodulären Gewebe. Ergebnisse: Bei 83 von 225 Patienten mit MIBI-Szintigraphien erfolgte eine histologische Sicherung (Alter 48,6 ± 12,6 Jahre, 72% weiblich). Es fanden sich 12 papilläre Karzinome (14,5%). Bei planarer Aufnahme wurden 12, 34 bzw. 37 Knoten, in den SPECT- Aufnahmen 16, 21 bzw. 46 Knoten als hypo-, iso- bzw. hyperintens eingestuft. Unter den in planarer Technik als hypo-, iso- bzw. hyperin- tens eingestuften Knoten fanden sich 1, 5 bzw. 6 Karzinome und bei tomographischer Technik kein, 4 bzw. 8 Karzinome. Wurden die iso- und hyperintensen Knoten als malignom- supekt zusammengefasst, ergaben sich für Sensitivität, Spezifität, NPV und PPV bei planarer Aufnahme Werte von 91,7, 15,5, 91,7 bzw. 15,6% und bei tomographischer Aufnahme 100, 22,5, 100 bzw. 17,9%. Schlussfolgerung: Hypofunktionelle SD-Knoten mit iso- und hyperintenser MIBI-Speicherung zeigen eine vergleichbare Malignomprävalenz. Durch die Untersuchung in SPECT-Technik ergibt sich eine Verbesserung insbesondere von Sensitivi- tät und negativem Vorhersagewert.

Persistent secondary or tertiary hyperparathyroidism (HPT) results from failure to remove enough hyperfunctioning parathyroid tissue. Ectopically situated parathyroid glands and supernumerary glands make failure more likely. Recurrent HPT after subtotal Ptx is usually due to regrowth of the remaining parathyroid tissue. Recurrence may also develop from a hyperplastic supernumerary gland or rarely from parathyromatosis. Recurrent HPT after total Ptx with autotransplantation is usually due to overgrowth of the autograft or for the previously mentioned reasons.Since 1995, 464 patients with SHPT or THPT were treated surgically; intraoperative parathormone (PTH) was measured in 277 patients. Sixty-eight patients also had a preoperative MIBI scan. We compared the preoperative MIBI scan results with intraoperative findings, parathyroid gland weight and histology. We questioned whether MIBI uptake corresponded to parathyroid gland size and weight. We also correlated the number of Ki67 nuclear positive cells with MIBI uptake. For SHPT in group I with 145 patients, neither intraoperative PTH (IO-PTH) assay nor MIBI scanning was done. In group II with 163 patients IO-PTH was used and in group III with 48 patients both IO-PTH and MIBI scanning was used. For THPT in group I with 42 patients, neither IO-PTH assay nor MIBI scanning was done. In group II with 46 patients IO-PTH was used and in group III with 20 patients both IO-PTH and MIBI scanning was used.Parathyroid weight correlated directly with MIBI uptake. No correlation, however, occurred between MIBI uptake and parathyroid histology or between Ki67 staining and MIBI scanning. For SHPT in group I the persistence rate was 6.2% and recurrence rate 11%; in group II the persistence rate was 4.9% and recurrence rate 4.9%; in group III the persistence rate was 2%, and recurrence 4.2% (P0.05 between group I and III for persistence and recurrence). We obtained similar results in THPT, but recurrence was 0 in groups II and III, also when only 3 glands were removed, probably due to asymmetric hyperplasia commonly seen in this particular population (P0.05 regarding recurrence between group I and II-III, no difference between group II and III).In conclusion our findings support that the surgeon experience is a very important factor for good results in patients with SHPT and THPT. Preoperative MIBI scanning and IO-PTH are helpful but not essential except in reoperations.

OBJECTIVE To evaluate the effect of calcimimetics with 99mTc-methoxy-isobutyl-isonitrile (MIBI) parathyroid scintigraphy in secondary hyperparathyroidism. METHODS This prospective study included 30 consecutive haemodialysis patients with inadequately controlled secondary hyperparathyroidism despite standard medical treatment. Patients were given a single daily oral dose of 30 mg of cinacalcet. A baseline and 1-year follow-up dual-phase 99mTc-MIBI scintigraphy were performed. 99mTc-MIBI uptake in each parathyroid gland was graded on a semiquantitative scale (scoring 0-3). RESULTS Twenty-one of the 30 patients responded to cinacalcet (70%). Abnormal positive glands were identified by 99mTc-MIBI scintigraphy in 27 out of 30 patients (53 glands). The sensitivity and specificity of 99mTc-MIBI in detecting cinacalcet response were 90 and 89%, respectively. The mean baseline and posttreatment grades of 99mTc-MIBI uptake were 2.9 ± 1.8 and 1.1 ± 1.2 (P < 0.0001) in the responder group and 3.1 ± 2.1 and 3.9 ± 2.2 (P = ns) in the nonresponder group. CONCLUSION 99mTc-MIBI scintigraphy is useful in monitoring the response to calcimimetics in secondary hyperparathyroidism.

Introduction: It is sometimes difficult to diagnose an active TB case. The early evolution under treatment is also important. Aim: 1. To analyze the characteristics of 99mTc MIBI pulmonary scintigraphies of TB patients. 2. To integrate the clinical, radiological and bacteriological data. 3. To estimate the evolution of the lesions. 4. To decide the management of the cases. Material and Method: 99mTc MIBI scintigraphy was performed in 49 new cases of active pulmonary TB at 2 stages: initial and after 7 days of treatment. The patients received an i.v. radiotracer dose of 7.4 MBq (0.2 mCi)/kg. The uptake was qualitatively and quantitatively assessed. Results: Initially, all scintigraphic images were positive with different uptake degrees: 47% of cases - low uptake (23 patients), 41% - moderate uptake (20 patients) and 12% - high uptake (6 patients). At 7 days, in 30 cases (61%) the radiotracer uptake decreased, 16 presented no change (33%); 3 patients were not examined (6%). The mean value of lesion/normal index was 1.521. The sensitivity of the method was 96% and the specificity 86%. Conclusions: 1. Initially, the radiotracer uptake was positive in all active TB patients. The uptake level varied independently of the positivity of the smears. 2. At 7 days in 3 MDR cases the uptake was stationary. New sites were visible on scintigraphies in some cases compared to X-rays. 3. Generally, at 7 days the radiotracer uptake decreased, being proof of early treatment efficiency. 4. The scintigraphy has its use as a complementary diagnostic method in active TB. We intend to study the use of this type of scintigraphy for the diagnosis of bone TB and other difficult to study active TB sites.

Technetium-99m 2-methoxyisobutylisonitrile (99mTc-MIBI) is a lipophilic agent that has been proposed as a useful tracer for the detection of disease sites in patients with multiple myeloma (MM). We performed a prospective study to determine the potential of 99mTc-MIBI imaging for the evaluation of the extent of primary disease in patients with advanced stage MM, compared with skeletal survey and bone scintigraphy. Twenty patients with advanced stage MM at initial diagnosis underwent whole-body 99mTc-MIBI imaging, together with contemporaneous skeletal survey and bone scintigraphy. The findings of 99mTc-MIBI imaging were correlated with the results of skeletal survey and bone scan. All 99mTc-MIBI scans were positive for the presence of active MM, whereas skeletal surveys were positive in 18 patients (90%) with osteolytic lesions. Bone scintigraphy demonstrated MM in only 15 patients (75%). In two patients with no detectable lesions on skeletal survey, 99mTc-MIBI imaging revealed uptake in the spine, corresponding to the abnormalities seen on magnetic resonance imaging (MRI). With respect to the localization of bone lesions, 99mTc-MIBI imaging was superior to bone scintigraphy in 15 patients (75%) and had concordant results with bone scintigraphy in four (20%). 99mTc-MIBI imaging is a very sensitive imaging modality for the identification of the extent of disease in patients with advanced MM. It is clearly superior to bone scintigraphy and complements the results of skeletal survey by finding additional disease sites. Hence, in active MM patients, 99mTc-MIBI imaging has the potential to detect bone marrow disease that cannot be detected by skeletal survey and bone scintigraphy.

原発性副甲状腺機能亢進症における99mTc-MIBIシンチの局在診断の有用性について, 超音波検査, CTと比較検討した。対象はMIBIシンチを行い手術治療を施行した原発性副甲状腺機能亢進症14名で, 男性4名 (38-70歳, 平均47歳), 女性10名 (29-80歳, 平均57歳) であった。MIBIの検出率は12/14 (85.7%), 超音波11/14 (78.5%), CT7/14 (50%) で, MIBIと超音波を組み合わせることによって検出率は13/14 (92.8%) に上昇した。MIBIで検出可能な最小重量は300mgで, 異所性の副甲状腺腺腫はMIBIでのみ検出が可能であった。超音波は甲状腺周囲の局所診断に優れ, MIBIは異所性診断に優れていた。原発性副甲状腺機能亢進症の局在診断にはMIBIと超音波検査の組み合わせが相補的で検出率も高く, 効率的で経済的な方法と考えられる。

The aim of this study was to establish whether tumour uptake of 99mTc-MIBI can predict response to chemotherapy in patients with breast carcinoma. Forty women suffering from breast carcinoma confirmed by tumour biopsy were studied prospectively. Fifteen patients subsequently underwent surgery and 25 were candidates for neoadjuvant chemotherapy. Breast scintigraphy was performed and planar and tomographic views (single photon emission computed tomography (SPECT)) were obtained after injection of 740 MBq of 99mTc-MIBI. The tumoural uptake was quantified by computer analysis. P-glycoprotein was evaluated by immunohistochemistry only in operable patients. The response to chemotherapy was evaluated at 3 months upon completion of treatment. The results of this study showed no relationship between 99mTc-MIBI uptake and the histological type or tumour size. There was an inverse correlation with the degree of tumour differentiation (P0.05). 99mTc-MIBI uptake in negative P-glycoprotein lesions (2.36+/-1.72) was higher than in positive P-glycoprotein lesions (1.53+/-1.29), although the difference was not statistically significant. Lesions which responded to chemotherapy (16) showed higher 99mTc-MIBI uptake (7.70+/-5.20) than non-responding lesions (nine) (2.21+/-1.0) (P0.001). In conclusion, there is a correlation between 99mTc-MIBI uptake in breast cancer and response to chemotherapy. Furthermore, 99mTc-MIBI uptake may be influenced by other factors such as the degree of tumour differentiation or tumour P-glycoprotein levels.

We use the Hill function to analyze the dynamics of Tc-99m 2 methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy data and to examine the earlier lower extremity microvascular perfusion of diabetic patients without typical clinical symptoms and with the preserved normal ankle-brachial index (ABI). Eighty-eight participants (30 healthy control, 34 diabetic patients, and 24 diabetic patients with peripheral arterial disease [PAD]) were recruited and applied 99mTc-MIBI scintigraphy. Fourteen diabetic patients with PAD also underwent computed tomography angiography (CTA) examination and were performed endovascular interventions. Diabetic patients with normal ABI already have significantly impaired maximum 99mTc-MIBI muscle perfusion counts (P

To compare the sensitivity and positive predictive value of magnetic resonance (MR) imaging and technetium 99m 2-methoxyisobutyl-isonitrile (MIBI) scintigraphy for the detection of hyperfunctioning parathyroid tissue when used alone and in combination in a large patient population with recurrent or persistent hyperparathyroidism (HPT).In 98 consecutive patients with biochemically proved recurrent or persistent HPT after surgery, MR imaging and 99mTc MIBI study findings were retrospectively reviewed and compared with surgical and histopathologic findings. The sensitivity and positive predictive value of MR imaging and 99mTc MIBI scintigraphy were compared with each other and in combination.In these patients, 130 abnormal parathyroid glands were identified at surgery. The sensitivity and positive predictive value of MR imaging were 82% (95% CI: 75%, 89%) and 89%, respectively; those for (99m)Tc MIBI scintigraphy were 85% (95% CI: 79%, 91%) and 89%. No significant difference was found between MR imaging and 99mTc MIBI scintigraphy for sensitivity (P =.7). The sensitivity and positive predictive value for the detection of abnormal parathyroid tissue on a per-gland basis increased to 94% (95% CI: 90%, 98%) and 98%, respectively, when only one of the two tests was required to be positive.MR imaging and 99mTc MIBI scintigraphy have similarly good sensitivity and positive predictive value for the detection of hyperfunctioning parathyroid tissue in patients after surgery. The combination of the two tests provided a substantial increase in sensitivity and positive predictive value.

Although thymoma is a rare tumor, it is the most common anterior mediastinal tumor, usually affecting the adults in their fifth and sixth decade. We present a case of 68-year-old man with history of myocardial infarction, who presented to the cardiology OPD with recent onset of exertional dyspnea. On 99mTc MIBI myocardial perfusion SPECT, there was an extra cardiac accumulation of radiotracer in the anterior mediastinum just above the heart, which later was diagnosed as thymoma on histopathology.

Objective 99mTc-methoxyisobutyl isonitrile (MIBI) has been reported to show considerable clinical utility in the study of many neoplastic diseases. The aim of our study was to investigate the possible role of 99mTc-MIBI in the initial follow-up of patients with differentiated thyroid cancer (DTC) for detecting residual thyroid uptake and/or loco-regional/distant metastases. Methods Eighty-two patients with DTC (61 women, 21 men; mean age: 49 years) were studied after total or near-total thyroidectomy (not earlier than 3 months after thyroidectomy but before they underwent radioiodine therapy). About 20 min after the intravenous administration of 370 MBq of 99mTc-MIBI, planar images (and, if necessary, tomographic images, single photon emission tomography) of the cervical and thoracic regions were recorded and compared with posttherapy radioiodine scanning and thyreoglobulin serum levels. Results MIBI scans detected thyroid remnants in 53 of 82 patients (65%) and metastatic foci in 10 of 11 (91%) patients, in whom a standard activity of 1110 MBq of 131I administered following MIBI scan had shown the presence of thyroid remnants or metastatic foci, respectively. One metastatic patient was false negative for both MIBI scan and post-131I dose whole body scan. Conclusion Our data indicate that an MIBI scan has a high sensitivity in detecting metastatic lesions from DTC. Therefore, an MIBI scan after thyroidectomy and immediately before radioiodine treatment may be clinically useful for choosing the best therapeutic approach in terms of either ablative or therapeutic 131I activity for both thyroid remnants and/or DTC metastases and for evaluating surgical reappraisal of metastatic lymph nodes.

Das Ziel der Studie bestand in der Analyse eines begleitenden Vitamin-D-Mangels auf die Ergebnisse einer 99mTc- MIBI-Untersuchung bei Patienten (Pt) mit primarem Hyperparathyreoidismus (pHPT). Patienten, Methoden: Zwischen Januar 1998 und Mai 2004 wurden 71 Pt mit pHPT nach einer 99mTc-MIBI-Untersuchung operiert, von denen 54 Pt (76%) normale Werte fur 25-OH-Vitamin D3 und 17 Pt (24%) einen Vitamin-D-Mangel hatten. Ergebnisse eines Zweiphasen 99mTc-MIBI-Protokols mit SPECT wurden mit den histopathologischen Resultaten verglichen. Ergebnisse: Bei 54 Pt mit normalen Vitamin D-Werten zeigte die spate SPECT mehr Herdbefunde (n = 51, Sensitivitat 91%) als fruhe planare (n = 45, Sensitivitat 82%) oder spate planare (n = 50, Sensitivitat 88%) Aufnahmen. Bei 17 Pt mit Vitamin-D-Mangel fand die spate SPECT ebenfalls mehr Herdbefunde (n = 13, Sensitivitat 72%) als fruhe planare (n = 10, Sensitivitat 56%) oder spate planae (n = 10, Sensitivitat 56%) Aufnahmen. Bei Pt mit Vitamin-D-Mangel war die Sensitivitat einer 99mTc- MIBI SPECT niedriger als bei Pt mit normalen Vitamin- D-Werten (72% vs. 91%) und zudem abhangig vom PTHWert. Die Ergenbisse waren aber statistisch nicht signifikant: planar fruh: p = 0.1625; planar spat: p = 0.0039; 99mTc-MIBI SPECT: p = 0.1180. Schlussfolgerung: Die Wahrscheinlichkeit einer pathologischen 99mTc-MIBI-Untersuchung bei Pt mit pHPT ist abhangig vom Parathormonwert. Der negative Einfluss eines niedrigen Vitamin- D-Wertes auf die szintigraphische Nachweiswahrscheinlichkeit eines Nebenschilddrusenadenoms konnte nicht bewiesen werden, moglicherweise bedingt durch zu wenige Pt mit Vitamin-D-Mangel.

Background Technetium (Tc) 99m methoxyisobutyl isonitrile (99mTc-MIBI) has recently been introduced for parathyroid imaging, as well as for myocardial imaging. We studied the usefulness of 99mTc-MIBI scintigraphy for preoperative localization of abnormal parathyroid glands. Methods The usefulness of 99mTc-MIBI scintigraphy for detection of hyperfunctional parathyroid lesions was evaluated in 5 patients with primary hyperparathyroidism. The results of localizing the abnormal glands by using 99mTc-MIBI were compared with those obtained by using thallium (Tl) 201-technetium (Tc) 99m (2ulTI-99mTc) subtraction scintigraphy, computed tomography, and ultrasonography. Results The delayed (2 hours) imaging of 99mTc-MIBI scintigraphy was highly useful for accurate localization of the abnormal parathyroid lesions. The diseased glands were detected in all cases where 99mTc-MIBI scintigraphy was used, and using 99mTc-MIBI scintigraphy provided more information than did computed tomography, ultrasonography, or 201Tl-99mTc subtraction scintigraphy. Conclusion: This method is simple and essential for detecting hyperfunctioning parathyroid glands, especially those with small or ectopic lesions. This technique should be widely applied as a localizing diagnostic method for hyperparathyroidism.

Technetium-99m hexakis-2-methoxyisobutylisonitrile (MIBI) and thallium-201 imaging was performed in a patient with metastatic renal cell carcinoma (RCC), which is a well-known tumour type demonstrating P1-glycoprotein (PGP) overexpression, Two scintigraphic patterns - TI(+)/MIBI(-) in primary tumour and TI(+)/MIBI(+) in metastatic tumour - were observed, suggesting high- and low-level PGP expression, respectively, Immunochemical study for PGP revealed strong staining of the primary tumour cells, This case clinically validates the previously suggested relationship between Tc-99m-MIBI uptake and PGP expression.

The aim of study was to evaluate the effectiveness of 99mTc-MIBI (hexakis 2-methoxyisobutyl isonitrile) scintigraphy to differentiate malignant from benign lesions, detected on 99mTc-MDP planar bone scans. 59 patients with bony lesions were studied prospectively and compared with histopathology. Each patient underwent a 99mTc-MDP scan, and if evidence of lesion found, patient underwent 99mTc-MIBI scintigraphy after three to four days. 99mTc-MIBI scans were evaluated visually and quantitatively. For quantitative analysis count ratio of lesion to contralateral normal side (L/C) was taken and Student T test was applied. 99mTc-MDP scans showed increase tracer uptake but no significant difference between benign and malignant uptake was seen. Significant difference (p value 0.015), was seen in malignant (L/C 3.51 ± 1.02) and benign lesions (L/C 2.50 ± 0.42) on 99mTc-MIBI scan. Three of thirty benign lesions did not show significant 99mTc-MIBI uptake. Six malignant lesions appeared as false negatives. Specificity of 99mTc-MIBI was 86.66%, Negative Predictive Value (NPV) 81.25% whereas the sensitivity was 79.31%. 99mTc-MIBI scintigraphy provides its usefulness by distinguishing malignant from benign lesions along with correct identification of metastatic lesions. NPV points toward its ability to correctly diagnose the normal (benign) cases. However biopsy still remains the gold standard and a definitive diagnostic modality.

Initial reports suggest that 99mTc-methoxyisobutylisonitrile (MIBI) scanning may be of clinical value in staging patients with malignant melanoma. We carried out a study to evaluate the potential of this technique in the detection of recurrent disease. Whole-body 99mTC-MIBI scans were performed in 81 patients with a history of a surgically excised MM: 28 with known recurrent lesions and 53 during follow-up without evidence of disease. Images started 10 min post-injection, using a dose of 740 MBq. Diagnoses were confirmed by cytological/histological examination or at least one conventional imaging modality. Blinded interpretations of the MIBI scans were performed. Whole-body MIBI scanning correctly detected 68 (92%) of 74 metastatic lesions in the following sites: regional lymph nodes (n=23), non-regional lymph nodes (n=10), skin (n=16), brain/cerebellum (n=6), lung (n=8), bone (n=4) and breast (n=1). The technique failed to detect three subcutaneous regressive lesions (< 1 cm), one liver metastasis, one spleen metastasis and a case of multiple small lesions of the duodenal mucous membrane. In 14 patients the procedure detected previously unknown metastatic lesions. These results suggest that 99mTc-MIBI scanning is an effective imaging modality for whole-body screening of metastatic disease in malignant melanoma patients with the potential to influence treatment planning.