Fernando Di Gregorio

Scintimammography with technetium-99m tetrofosmin in the diagnosis of breast cancer and lymph node metastases

The aim of the study was to evaluate the possible role of scintimammography (SMM) with technetium-99m tetrofosmin in breast cancer. Thirty-three patients with breast disease and ten normal controls were included in the study. Planar scintigraphic images in supine anterior, prone lateral and lateral views, with the patient lying in lateral recumbency, were acquired. A qualitative analysis evaluating both breasts and lymph nodes was performed. All breast lesions were verified after surgery and/or by fine-needle aspiration. In 8 of the 33 patients, mammography was inconclusive because of mastectomy or dense breasts. For mammography, a sensitivity of 95.6%, a specificity of 66.7% and an accuracy of 89.6% were obtained. At SMM, 26 out of 28 malignant lesions (average size 2.8 cm, range 0.4–12 cm), including two recurrences, were detected with a 92.8% sensitivity, a 100% specificity and a 95.1% accuracy. The smallest detectable carcinoma measured 0.6 cm. Two false-negative results on SMM were found in a 0.4-cm intraductal carcinoma and in the only mucinous papillary carcinoma in our series. With regard to lymph node analysis, 11 out of 12 axillary metastases (sensitivity=91.6%) were detected. A false-positive result, yielding a specificity of 92.3% was also obtained. A metastatic involvement of the internal mammary chain was observed. No uptake was seen in 11 benign mammary lesions or at the level of the breast and axilla when neoplastic involvement was absent. In conclusion, SMM with99mTc-tetrofosmin is an effective technique for the evaluation of primary breast carcinomas, recurrences and lymph node metastases.

Breast Cancer Detection With Tc-99m Tetrofosmin

Myocardial SPECT imaging was performed with Tc-99m tetrofosmin. Intense focal uptake at the level of the left breast was observed. At mammography a breast carcinoma was suspected, which was confirmed after surgery. This may be the first report of neoplastic mammary uptake of Tc-99m tetrofosmin.

Infection Imaging Using SPECT-CT

The clinical use of radiolabelled white blood cells (WBC) is of invaluable importance for the diagnosis and follow-up of many diseases and for research purposes. In the field of inflammation and infection imaging, radiolabelled white blood cell scintigraphy (WBC-S) is the gold standard technique for infection detection [1–4]. The body of evidence accumulated so far about the use of WBC-S all over the world makes this technique the method of choice, and it will be the standard technique for many years to come. Over the past 30 years, there has been phenomenal growth in the use of this technique to satisfy clinical demands.

Long-term effects on left ventricular function after late thrombolysis in patients with myocardial infarction

This open-label, uncontrolled, retrospective study assessed the long-term effects of late thrombolysis on left ventricular (LV) function. We studied 79 patients (52 men and 27 women; mean age, 51 ± 5 years) treated with alteplase (group 1) and 46 patients (33 men and 13 women; mean age, 52 ± 8 years) treated with heparin alone (group 2) at their first myocardial infarction (MI). Patients were eligible for the study if they were younger than 62 years, their duration of pain was longer than 6 hours, and they had no episodes of angina in the 48 hours preceding their MI. The peak of creatine kinase-muscle and brain subunits was significantly less in group 1 than group 2 (106 ± 67 vs 205 ± 102 IU/L). Both LV ejection fraction and wall-motion score were better in thrombolysed patients, and the cumulative frequency of radionuclide defects was higher in these patients during the 4-year follow-up. Our study supports the concept that thrombolysis reduces the incidence of long-term post-MI residual ischemia, improving global LV function even when given late after the onset of MI symptoms.