G. Gopinath

Simultaneous assessment of parathyroid and heart in renal and non-renal patients with raised PTH

Aim:To determine the rate of occult myocardial disease in end stage renal failure (ESRF) patients undergoing 99mTc-MIBI parathyroid SPECT imaging and determine the incidence of cardiac disease in patients with a proven parathyroid adenoma, ESRF needing dialysis or both. Method:A retrospective case finding review was performed by looking at the heart in the 99mTc-MIBI SPECT of 94 patients imaged for suspected adenoma. Forty-four patients were on dialysis for ESRF. The patients had no history of cardiac symptoms. Results:Forty-six patients had a scan positive for parathyroid adenoma (29 renal and 17 non-renal). The highest rate of abnormality was in the ESRF patients with parathyroid adenoma: 13 (45%) had defects on their cardiac scan compared to 5/15 (33%) patients with ESRF without an adenoma. There were cardiac defects in 6/17 (35.2%) patients without renal failure and with an adenoma. In 33 patients with no parathyroid adenoma, only 1 (3%) patient had a cardiac defect. This was significantly less than the other groups (P<0.01). Conclusion:The risk of having a myocardial defect is 15 times greater when both renal failure and a parathyroid adenoma are present. While imaging the parathyroid in ESRF patients, the heart should be reviewed.

Foregut neuroendocrine tumours and functional SPECT tumour volume

Aim:To assess the change in tumour volume and response using 111In pentretreotide SPECT in patients treated with chemotherapy and chemoembolization for foregut neuroendocrine tumours. Methods:Thirty-six patients with liver tumours were treated with systemic chemotherapy (20 patients) and chemoembolization (16 patients). Tumour uptake volume, a measure of metabolically active tumour tissue, was calculated from the SPECT images using 10 point colour display and drawing a region of interest around 50% of maximum tumour activity slice by slice and then multiplying by the slice thickness pre- and post-treatment. The change was compared using χ2. A P value of 0.05 was considered significant. Results:In patients who had chemotherapy tumour volume increased in 10 patients (mean increase 143%), decreased in 7 patients (mean decrease 76%) and remained unchanged in 3 patients. In patients who had chemoembolization tumour volume increased in 4 patients (mean 52%), decreased in 7 patients (mean 42%) and it remained unchanged in 5 patients. Chemoembolized patients had a better response rate than those treated with chemotherapy (P<0.05). Conclusion:The functional STV is useful in monitoring tumour response after treatment. The patients treated with chemoembolization had a better functional response than those treated with chemotherapy.