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Objective: Transmyocardial laser revascularization is a new technique that improves symptoms in patients with refractory angina not amenable to conventional revascularization. The aim of this study was to assess whether transmyocardial laser revascularization produces changes in innervation, perfusion scintigraphy, or both that could explain the benefit to patients.Methods: Sixteen patients (12 men and 4 women; mean age, 60 ± 8 years) with coronary artery disease were studied. Transmyocardial laser revascularization was performed in 39 myocardial areas supplied by a stenotic vessel. A technetium 99m-labeled tetrofosmin stress-rest tomographic scan and iodine 123-labeled metaiodobenzylguanidine planar scans were performed before and after transmyocardial laser revascularization (3 and 12 months later) to evaluate myocardial perfusion and innervation. Stress and rest perfusion images were quantified on a polar map. Ischemia uptake was also defined as the difference between rest and stress uptake for each area. Innervation planar images were visually analyzed and semiquantified.Results: A significant decrease in angina class from baseline was observed at 3, 6, and 12 months after transmyocardial laser revascularization (P < .005). A significant decrease in ischemia uptake was also found between the pre-transmyocardial laser revascularization and the post-transmyocardial laser revascularization studies in treated areas (P < .001). A significant improvement in stress myocardial perfusion at 3 and 12 months after transmyocardial laser revascularization was only found in treated areas that were considered ischemic in the pre-transmyocardial laser revascularization study (P < .05). At 3 months, a significant myocardial innervation worsening was observed in treated areas (P < .001), with partial recovery at 12 months (P < .05).Conclusion: The transmyocardial laser revascularization mechanism involves both perfusion improvement and denervation, mainly at 3 months, that partially recovered at 12 months.

Gallium-67 single photon emission computerized tomography (Ga-67 SPECT) was performed in 13 chronic lymphocytic leukaemia (CLL) patients suspected of evolution into diffuse large B-cell lymphoma (DLCL) or Richter's syndrome (RS). Six positive and nine negative Ga-67 SPECTs were observed. Ten patients were biopsied (five in each group). DLCL was not detected in any Ga-67-positive patient, including those in whom Ga-67-positive areas were biopsied. The only case of DLCL was demonstrated in a Ga-67-negative patient. The tumoral proliferative index (Ki67 antigen expression) was moderate and similar in both groups of patients. These results illustrate the limitations of Ga-67 SPECT in identifying RS.

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.

Objectives To evaluate the usefulness of 123 I-labelled anti-vascular cell adhesion molecule-1 (VCAM-1) monoclonal antibody (MAb) scintigraphy in the assessment of colonic inflammatory damage. Design Colitis was induced by intracolonic administration of 30 mg trinitrobenzenesulphonic acid in 0.5 ml of 50% (v/v) ethanol. Rats injected with vehicle served as controls. Animals were studied at day 7 after induction of colitis. Methods Scintigraphy was performed in control and trinitrobenzenesulphonic acid-induced colitic rats 2, 4 and 24 h after intravenous administration of 123 I-anti-VCAM-1 MAb. Scintigraphic uptake was quantified in selected areas on scintigraphs. Animals were killed, tissue 1231 radioactivity accumulation was measured, and accumulation of anti-VCAM-1 MAb in each organ was calculated. 99m Tc-hexamethyl propylene amine oxime-labelled leucocyte scintigraphy was performed in additional groups of animals for comparison. Results Colonic tracer uptake was visible in scans of colitic, but not control animals. Quantification of scintigraphic uptake in the colon was significantly higher in colitic rats than in control animals (P < 0.0001). The specificity of the increase was demonstrated by lack of 123 I-labelled non-binding MAb uptake in the colon, and by displacement of 123 I-anti-VCAM-1 MAb colonic uptake by pre-treatment with unlabelled MAb. Accumulation of anti-VCAM-1 MAb in the colon of colitic rats was eightfold higher than in control animals. Strong correlations were found between quantification of scintigraphic uptake, anti-VCAM-1 MAb accumulation, histological damage and myeloperoxidase activity in the colon. Conclusion 123 I-labelled anti-VCAM-1 MAb scintigraphy allows an accurate evaluation of colonic inflammatory damage in trinitrobenzenesulphonic acid-induced colitis, suggesting a potential role for this imaging technique in the assessment of human IBD.

The purpose of this study was to evaluate the usefulness of labelled platelet scintigraphy in the differential diagnosis of a prolonged febrile syndrome (PFS) in patients on dialysis carrying a non-functioning renal allograft. We prospectively performed an indium-111 mercaptopyridine-labelled platelet scan on 91 patients (54 men, 37 women; mean age 39.6+/-12 years). The mean duration of PFS was 35 days (range 7-122). Forty-six of the 91 patients underwent steroid therapy (2-10 mg/day). Platelet labelling was carried out following Thakur's method. Platelet scans were performed 48 h after reinjection of labelled platelets. The platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft ROI by cpm/pixel in a mirror background ROI. The final diagnosis of PFS was established depending on the outcome after treatment. In 61/91 patients the fever had an immunological origin because it disappeared after graft embolisation or transplantectomy. In 30/91 patients the PFS disappeared after antibiotic therapy (non-immunological origin). The PUI in patients with immunological PFS was 1.80+/-0.7, while in patients with non-immunological PFS it was 1.12+/-0.1 (P0.05). When a PUI ofor =1.5 was considered as the threshold to establish PFS of immunological origin, the sensitivity of platelet scan was 76%, the specificity 100%, and the negative and positive predictive values 69% and 100%, respectively. In patients classified with immunological PFS who underwent steroid therapy, the PUI was significantly lower than in patients without steroids (P0.05). These results suggest that 111In-labelled platelet scintigraphy can accurately predict an immunological PFS in patients on dialysis carrying a non-functioning renal allograft. Therapy with steroids could reduce the sensitivity of 111In-labelled platelet scintigraphy in detecting immunological PFS.

Introduccion y objetivos La historia natural dela miocardiopatia diabetica no esta bien definida,debido principalmente a la comun asociacion conenfermedad coronaria e hipertension arterial. Dadoque estas dos entidades son infrecuentes en los pacientesjovenes, estos constituyen un modelo adecuadopara el estudio de la miocardiopatia diabeticaen sus fases incipientes. Pacientes y metodos Se estudiaron 33 pacientesafectados de diabetes mellitus tipo I sin antecedentesde hipertension arterial ni enfermedad coronaria.Su edad media era de 28 ± 8 anos (rango, 18-46anos) y 14 eran varones. Resultados En el ecocardiograma se observo unventriculo izquierdo de tamano normal y sin anomaliasde la motilidad segmentaria, excepto en uncaso. En la ventriculografia isotopica se detectouna fraccion de eyeccion basal del 56,5 ± 6,6% queaumento al 63 ± 7,4% (p Conclusiones La disfuncion ventricular latentees un hallazgo frecuente en los pacientes diabeticosjovenes asintomaticos, y esta no es secundaria aaterosclerosis coronaria ni a enfermedad de pequenovaso. En este grupo de pacientes las anomaliashistologicas son constantes y se manifiestan por fibrosisintersticial, hipertrofia celular, miocitolisis ydepositos lipidicos.

Monoclonal 111In antimyosin (AMS) uptake indicates the presence of ongoing myocyte damage. In idiopathic dilated cardiomyopathy (IDC), there is diffuse myocyte damage. We have attempted to find a correlation between AMS uptake and functional myocardial parameters. With this purpose in mind, we studied two groups of subjects: group 1 comprised 19 subjects with IDC and group 2 comprised 6 control subjects. In all subjects, an antimyosin scan was performed. Among the subjects with IDC, two-dimensional echocardiography was carried out to determine the left ventricular ejection fraction (LVEF) and left ventricular dimensions, and a gated blood pool study was undertaken to assess the LVEF at rest and end-diastolic and end-systolic volumes. Three months later, repeat antimyosin scintigraphy and equilibrium gated blood pool were performed on 13 of the patients. The mean heart to lung (H/L) ratio in the IDC subjects was 1.82 +/- 0.25 (range 1.42-2.25), a value significantly higher than that obtained in the controls: 1.41 +/- 0.12 (range 1.26-1.58) (P < 0.001). Linear regression analysis did not find a statistically significant correlation between H/L and gated blood pool or echocardiography measures. No marked changes in ejection fraction and antimyosin uptake were found between baseline and follow-up studies. Subjects with IDC have a high incidence of positive antimyosin scans, but antimyosin uptake is not related to any functional or morphological parameters.

Cardiac resynchronisation therapy (CRT) is a technique indicated in patients with moderate to severe heart failure and ventricular dyssynchrony. To evaluate left ventricular ejection fraction (LVEF) and synchronisation changes after CRT with a biventricular pacing implant, we used an equilibrium radionuclide angiography (ERNA).Fifty patients were studied. An ERNA was made 72 h and 6 months after the implant. Two acquisitions were performed: with the CRT device connected and after disconnecting it. In the follow-up, responders were defined as those who had improved in accordance with various clinical variables. Quantitative changes in LVEF and visual changes in synchronisation (phase analysis) were studied comparing the two studies and also comparing the connected and disconnected modes.At 6 months, 30 patients were defined as responders. LVEF increased significantly at 6 months compared with the 72-h study only in responders. At 72 h, the number of patients showing a decrease in LVEF (p0.05) or a synchronisation worsening after disconnecting the device was higher in responders than in nonresponders. At 6 months, 57% of responders had no synchronisation changes between the connected and disconnected modes, suggesting a resynchronisation process.ERNA permits the study of resynchronisation patients, showing a statistical LVEF improvement at 6 months. Moreover, visual phase analysis permits the study of the mechanism involved in the response, with an important number of responders with no changes between the two modes at 6 months. In the 72-h study, after disconnection of the device, LVEF and resynchronisation worsening can predict patient improvement at 6 months.

Although prostatitis is a common problem the diagnosis is still controversial despite the availability of a wide variety of diagnostic tools. In fact, there is still no accurate method of localizing the infected tissue. The aims of the present study were to assess whether 111In labelled leukocytes (ILLs) accumulated in the infected tissue of acute prostatitis and if such uptake responded to treatment. We prospectively studied 10 adult male patients who had community acquired prostatitis and compared them with six male patients who had urinary tract infections but without prostatitis. An initial urinary culture and two blood cultures were carried out for each patient. All patients were followed up for 8 weeks after therapy was completed. Pre- and post-treatment scintigraphies were performed. Before treatment, all patients with prostatitis showed uptake of ILLs in the prostate area. After the patients had completed treatment with antibiotics, the scintigraphy results showed no uptake in the prostate area in 9/10 patients. The remaining patient showed a marked decrease in the uptake of ILLs. None of the six patients with urinary tract infection showed ILL uptake in the prostate region. It is suggested that ILLs could be useful for detecting acute prostatitis, especially in clinically ambiguous patients with urological infections. Furthermore, scintigraphy with 111In labelled leukocytes could help to determine the most appropriate course of therapy.

Radioimmunoscintigraphy (RIS) and radioimmunoguided surgery (RIGS) were assessed for their usefulness in patients with colorectal carcinoma. Twenty-nine patients (18 primary tumours, 10 with a suspicion of recurrence and one colonic diverticulitis) were studied. Radioimmunoscintigraphy was performed 48 and 72 h after the injection of an anti-TAG72 monoclonal antibody (CYT-103) labelled with 111 In. Radioimmunoguided surgery was performed between 72 and 96 h post-injection. During surgery, a systematic screening was performed with a hand-held gamma detecting probe and a surgical index (tumour-to-normal tissue) was obtained. There were statistically significant differences between counts in normal tissue versus tumour (P < 0.001) and RIGS was considered positive for the detection of tumour if the ratio between the counts in the area suspicious of tumour and the counts in the normal tissue was greater than 1.5. The overall sensitivity for RIS and RIGS was 71.4% (55.6% in primary tumours and 100% in recurrences) and 82.1% (83.3% in primary tumours and 80% in recurrences), respectively. Radioimmunoguided surgery changed the surgical procedure in two cases with small tumour deposits. Occult regional lymph node involvement in primary tumours was not found; therefore, RIGS, as a complementary technique to RIS, is particularly useful in recurrences and can help the surgeon in the resection of small tumour deposits which are difficult to localize.

67 Ga scintigraphy has proven to be of value in the evaluation of patients with lymphoma, especially in their management after treatment. In this study, computed tomography (CT) and 67 Ga scans were compared in 53 patients with lymphoma who had previously been treated. Twenty-eight were patients in continuous clinical remission in whom recurrence was suspected. The remaining 25 patients were studied between 1 and 3 months post-treatment to assess a residual mass. The sensitivity for the detection of lymphoma recurrence was 88% for 67 Ga, with two false-negative results, and 59% for CT, with seven false-negative results. In the diagnosis of recurrence, the specificity of 67 Ga was 100% and that of CT 72%, with three false-positive results. Therapeutic response was assessed in 25 patients and the ability to predict response to treatment resulted in a specificity of 86% for 67 Ga and 81% for CT. Treatment failed in four patients, as detected by 67 Ga scan, whereas CT did not detect any of these. In the remaining 21 patients who showed good response to treatment, there were three false-positive results for 67 Ga and four for CT. 67 Ga scintigraphy can detect relapse more accurately and much earlier than CT, as well as diagnose complete remission after treatment. Therefore, 67 Ga scintigraphy should be used routinely in monitoring response to treatment in lymphoma.

A 71-year-old woman had a Tc-99m labeled nonspecific polyclonal human immunoglobin G (HIG) scintigraphy to test for synovitis. The scans showed an intense uptake in a pelvic mass, which was confirmed to be a calcified uterine myoma. Labeled HIG scintigraphy was introduced for the detection of inflammation. Although uptake of Tc-99m HIG has been shown in malignant lesions in patients without inflammation, this case indicates that uptake in benign tumors must also be taken into account.

Tc-99m MDP bone imaging was performed on a 66-year-old man with known prostatic adenocarcinoma. A large area increased activity in the right inguinal area was observed. Dynamic imaging with Tc-99m pertechnetate showed a photopenic area at the same site, which filled in with the patient standing erect. This demonstrated that the lesion corresponded to a bladder hernia, which the patient had previously refused to have repaired.

Recently, it has been suggested that lateral (LAT) spine bone mass measurements by absorptiometry may be more sensitive for detecting bone loss than the standard anteroposterior (AP) projection. The aim of this study was to evaluate the precision of LAT spine dual-energy X-ray absorptiometry (DEXA) and its diagnostic sensitivity. A group of 1554 subjects with no risk factors that might affect bone metabolism and 185 osteoporotic patients with vertebral fractures were studied. Bone mineral density (BMD) was measured in the lumbar spine (standard AP and LAT projections) and proximal femur with a DEXA absorptiometer. The precision of the measurements was assessed in 15 volunteers. Diagnostic sensitivity was evaluated by the Z-score method. Comparing young people and the elderly, spine bone loss in the latter was similar for AP and LAT projections, when it was evaluated in absolute values (glcm2). However, when it was evaluated in percentage terms, bone loss was about twice as high in the LAT projection. LAT spine BMD correlated significantly with all the other areas assessed. The best correlation was found with the standard AP projection (r=0.67,P

An elderly man undergoing evaluation for a frontal expansive procedure demonstrated focal TI-201 accumulation during the performance of a TI-201 brain scan. This TI-201 accumulation corresponded to a heterogeneous frontal lesion found on CT and MRI studies. The lesion was removed completely and the pathologic diagnosis was consistent with a mucocele. This case report highlights the need for cautious evaluation of focal TI-201 uptake, despite the presence of typical scintigraphic features of brain tumor.

The gallbladder was observed 24 hours after labeled RBC reinjection on a Tc-99m RBC gastrointestinal bleeding site imaging study. in come cases, the presence of the tracer in the gallbladder could represent hematobilia. in other cases, it may also be due to Tc-99m labeled to the porphyrin portion of hemoglobin.

This study was performed to determine the value of dipyridamole-99 mTc-methoxy-isobutyl isonitrile perfusion (99mTC-MIBI) tomographic scintigraphy in the assessment of cardiac risk in patients being evaluated prior to combined pancreas-kidney transplantation (PKT). We performed perfusion tomographic scintigraphy using single photon emission computed tomography (SPECT) on 77 patients. The tomographic images did not show clinically relevant findings in 65 patients. In the remaining 12 patients, coronary arteriography was performed: 2 showed normal results, 4 showed no stenosis, and 6 showed significant stenosis (≥ 70%). Seventy-two patients underwent PKT. During the follow-up (6–48 months), there were seven cardiac events, 4 patients with significant stenosis, and 3 with nonsignificant stenosis upon coronary arteriography, and all had pathological tomographic images. 99mTc-MIBI tomographic scintigraphy may be useful in identifying patients at low risk of incurring cardiac events after PKT and may, in a large group of patients, obviate the need for routine coronary angiography.