Gamze Çapa Kaya

Water-pipe smoking effects on pulmonary permeability using technetium-99m DTPA inhalation scintigraphy

ObjectiveAlthough extensive work has been done on cigarette smoking and its effects on pulmonary function, there are limited number of studies on water-pipe smoking. The effects of water-pipe smoking on health are not widely investigated. The aim of this study was to determine the effects of water-pipe smoking on pulmonary permeability.MethodsTechnetium-99m DTPA inhalation scintigraphy was performed on 14 water-pipe smoker volunteers (all men, mean age 53.7 ± 9.8) and 11 passive smoker volunteers (1 woman, 10 men, mean age 43.8 ± 12). Clearance half-time (T 1/2) was calculated by placing a monoexponential fit on the time activity curves. Penetration index (PI) of the radioaerosol was also calculated.ResultsPI was 0.58 ±0.14 and 0.50 ± 0.12 for water-pipe smokers (WPS) and passive smokers (PS) respectively. T1/2 of peripheral lung was 57.3 ± 12.7 and 64.6 ± 13.2 min, central airways was 55.8 ± 23.5 and 80.1 ± 35.2 min for WPS and PS, respectively (p ≤ 0.05). FEV1/FVC% was 82.1 ± 8.5 (%) and 87.7 ± 6.5 (%) for WPS and PS, respectively (0.025 < p ≤ 0.05).ConclusionsWe suggest that water-pipe smoking effects pulmonary epithelial permeability more than passive smoking. Increased central mucociliary clearance in water-pipe smoking may be due to preserved humidity of the airway tracts.

Technetium-99m HMPAO brain SPECT in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a developmental, neurobehavioral syndrome with an onset in childhood. The aim of this study was to investigate the existence of regional perfusion changes in ADHD by means of Tc-99m HMPAO brain SPECT. Thirteen children with a diagnosis of ADHD and 7 healthy, age-matched controls were included in this study. Hypoperfusion was observed on the right temporal cortex in 9, and on the left temporal cortex in 3 children. The distribution of the lesions showed right lateral temporal cortex involvement in 3, right medial temporal cortex in 9 and left medial temporal cortex in 8 children. The distribution of the lesions showed right lateral temporal cortex involvement in 3, right medial temporal cortex in 9 and left medial temporal cortex in 8 children. Asymmetric perfusion was seen on the caudate nucleus in 4, on the thalamus in 3 and on the frontal cortex in 6 children. There was a significant difference between children with ADHD and controls in right medial temporal cortex: cerebellum and righ lateral temporal cortex: cerebellum ratios. Hypoperfusion in the right medial temporal cortex was significantly and inversely correlated with Du Paul teachers’ questionnaire rating scale (r=−0.71, p=0.0006). It has been postulated that difficulty in self regulating response to stimuli in ADHD is mediated by underfunctioning of the orbital frontal cortex and subsequent connection to the limbic system. Decreased temporal cortex perfusion may dysfunction of the limbic system or the orbito-frontal-limbic axis.

Technetium-99m HMPAO brain SPECT in autistic children and their families

The purpose of the study was to investigate perfusion patterns in autistic children (AC) and their families. Ten AC (9 boys, 1 girl; mean age: 6.9+/-1.7 years) with autistic disorder defined by DSM-III-R criteria, five age-matched children (3 boys, 2 girls) as a control group, and the immediate family members of eight AC (8 mothers, 8 fathers, 7 siblings; mean ages: 39+/-4 years, 36+/-5 years and 13+/-5 years, respectively) were included in the study. Age- and sex-matched control groups for both the parents and the siblings were also included in the study. Brain perfusion images were obtained 1 h after the intravenous injection of an adjusted dose of Tc-99m HMPAO to children and the adults. Visual and semiquantitative evaluations were performed. Hypoperfusion was seen in the right posterior parietal cortex in three AC, in bilateral parietal cortex in one AC, bilateral frontal cortex in two AC, left parietal and temporal cortex in one AC, and right parietal and temporal cortex in one AC. Asymmetric perfusion was observed in the caudate nucleus in four AC. In semiquantitative analyses, statistically significant hypoperfusion was found in the right inferior and superior frontal, left superior frontal, right parietal, right mesial temporal and right caudate nucleus. In parents of AC, significant hypoperfusion was noted in the right parietal and bilateral inferior frontal cortex. In siblings of AC, perfusion in the right frontal cortex, right nucleus caudate and left parietal cortex was significantly decreased. This preliminary study suggests the existence of regional brain perfusion alterations in frontal, temporal, and parietal cortex and in caudate nucleus in AC and in their first-degree family members.

Tc-99m-HMPAO uptake by bronchoalveolar cells.

Lung uptake of intravenously injected Tc-99m-HMPAO is observed in smokers and in lung toxicity due to various agents. We investigated the Tc-99m-HMPAO uptake of bronchoalveolar lavage (BAL) cells in the lungs after incubation inin vitro conditions (6 patients), intravenous injection (IV) (7 patients) and inhalation (INH) (6 patients) of Tc-99m-HMPAO in order to show whether BAL cells are also responsible for Tc-99m-HMPAO uptake in the lungs. Cell/supernatant (C/S) count ratio was 7.0±3.5, 29.3±40.8 and 8.4±4.5 forin vitro, IV and INH groups, respectively. C/Sin vitro showed a positive correlation with % alveolar macrophages (r=0.943, p=0.0048) and a negative correlation with % neutrophils (r=−0.945, p=0.0045). Cells/whole BAL fluid ratio correlated with the amount of daily cigarette consumption in INH group (r=0.95, p=0.0037). Tc-99m-HMPAO showed adherence to mucus after inhalation. Tc-99m-HMPAO diffuses into alveolar spaces after, injection and is present in BAL fluid and BAL cells both after injection and inhalation. Glutathione concentration and oxido-reductive state of the epithelial lining fluid and BAL cells may influence the lung uptake of Tc-99m-HMPAO.

Improvement in Tc-99m HMPAO brain SPECT findings during donepezil therapy in a patient with pure akinesia

A 58-year-old man presented with a history of disturbance in initiating gait. His history revealed meningoencephalitis five years prior to admission. Neurological examination included gait disturbance as difficulty in initiation and a hesitating speech with many freezing episodes and micrographia Magnetic resonance imaging (MRI) showed diffuse hyperintensity of frontal subcortical white matter on T2 weighted images. He was diagnosed with PA. l-Dopa up to the dosages of 1000 mg/ day and Selegiline 10 mg/day were given. First brain SPECT using technetium-99m labeled d,l-hexamethylpropylene amine oxime (Tc-99m HMPAO) was performed when he was taking l-dopa and Selegiline. In visual evaluation, hypoperfusion in bilateral frontoparietal cortex was seen (Fig. 2). Treatment with l-dopa and Selegiline produced no benefit. Donepezil 10 mg/day was begun. This therapy regimen resulted in dramatic clinical improvement within several days that was confirmed by blinded raters who watched the patient’s video recordings. During this response second brain perfusion SPECT study was repeated during donepezil therapy. Markedly increased perfusion in bilateral frontoparietal cortex was observed. This is the first case of PA to develop possibly after an episode of bacterial pneumococcal meningoencephalitis and who responded to donepezil as documented by changes in clinical findings and Tc-99m HMPAO brain SPECT studies.

Tl-201 uptake in bone and soft tissue involvement of sarcoidosis.

The authors describe a 38-year-old man who was referred to the nuclear medicine department because of pain and swelling of his fingers in both hands. Tc-99m MDP and Tl-201 scans were performed to evaluate the lesions. A Tc-99m MDP bone scan showed hyperemia and increased uptake in the lesions. A Tl-201 scan showed marked uptake in both early and delayed images in the lesions of his fingers. Bone biopsy and histologic examination confirmed sarcoidosis. This case indicates that Tl-201 uptake can be seen in bone lesions resulting from sarcoidosis.

Technetium-99m labeled Mebendazole and biodistribution in experimentally Trichinella spiralis-infected rats

The aim of this study was to localize the biodistribution of Technetium-99m (99mTc) Mebendazole in experimentally Trichinella spiralis (T. spiralis)-infected rats. Localizing and distinguishing the “T. spiralis” in body sites are very important and life saving processes. Scintigraphic detections may help to determine the sites of trichinellosis infection. Twelve healthy female Wistar rats were infected via oral administration of infected muscle containing 750 to 1000 larvae. In this study, the antibiotic was labeled with Tc-99m, and 99mTc-Mebendazole was assessed as an infection imaging agent in a rat model. 99mTc-mebendazole was examined for localizing the normal, and inflamed with trichinellosis in rat muscle tissues after administrated 99mTc-mebendazole via intravenous (IV) or oral gastric catheter, and also for differentiating them from each other. 99mTc labeled mebendazole was retained in infectious areas. It was established that 99mTc-mebendazole which was administrated via IV route has high organ restrain level. It was observed that 99mTc-mebendazole uptake was high in tongue and diaphragm muscles of T. spiralis-infected rats after administration of radiolabeled mebendazole via either oral or IV routes. This study may be viewed as a basement of future studies on diagnosis of T. spiralis infection.

Comparison of brain perfusion SPECT and MRI findings in children with neuronal ceroid-lipofuscinosis and in their families

Purpose: Neuronal ceroid lipofuscinoses (NCL) are among the progressive encephalopathies of childhood that are inherited in an autosomal recessive manner. In this study we specifically aimed to investigate any white-matter changes in the carriers (parents) and the healthy siblings of individuals with neuronal ceroid lipofuscinosis disease and whether we may be able to predict the occurrence of any neurological symptoms in healthy children in the future thus enabling early management.Materials and Methods: Since the NCLs are genetically determined diseases, we investigated fifteen individuals in three families that had diseased children of the juvenile type, with brain perfusion SPECT and MRI. Brain perfusion SPECT was performed after administering 222–555 MBq (6–15 mCi) Tc-99m HMPAO intravenously in a dimmed and quiet room. Imaging was performed at least one hour after injection, with a three headed gamma camera equipped with high resolution collimators. A Metz filter (FWHM: 11 mm) was used for processing. Cranial MRI was performed with an imager operating at 1.5 Tesla. Spin-echo TI- and T2-weighted and FLAIR slices were obtained for each individual.Results: In all of the five diseased children we observed pathologic findings both on MRI and Tc-99m HMPAO SPECT. The findings on MRI were mainly features of cerebral and cerebellar atrophy and the observations on Tc-99m HMPAO SPECT were regional perfusion abnormalities. We observed some structural abnormalities on MRI in four of the parents and two of the four healthy siblings. We also noted perfusion abnormalities on Tc-99m HMPAO SPECT in two of the parents and two of the healthy siblings.Conclusion: Because the disease is inherited in an autosomal recessive manner, the parents and the healthy siblings were not supposed to exhibit any demonstrable brain lesions, but the brain perfusion SPECT and MRI examinations clearly revealed multiple lesions in some of the parents and healthy siblings. Detailed neurological examinations of these individuals were normal except for one apparently healthy sibling (EY). Follow-up imaging of these families is being undertaken and further studies are essential in understanding the pathogenesis and genetics of neuronal ceroid-lipofuscinoses.

F-18 fluorodeoxyglucose PET in Fournier gangrene.

Abstract: A 64-year-old man with a locally advanced rectum adenocarcinoma was referred for 18-fluoro-2-deoxyglucose (F-18 FDG) imaging for the purpose of restaging and tumor response. Circumferentially increased perirectal F-18 FDG uptake was seen. Three days after the first F-18 FDG positron emission tomography clinically Fournier gangrene was diagnosed and surgical debridement was performed. Increased perirectal uptake was attributed to Fournier gangrene.

Does cisplatin chemotherapy decrease the MDP uptake of normal bone? An experimental study

ObjectiveBone scan is the accepted initial imaging modality for skeletal metastases. Cisplatin is a cell-cycle nonspecific antineoplastic agent used in some chemotherapy regimens. Knowing that platinum reacts with phosphate compounds such as methylenediphosphonic acid (MDP), decreases bone resorption and new bone formation, it can be proposed that cisplatin chemotherapy may decrease Tc-99m MDP bone uptake. We aimed to demonstrate, if present, the decrease in bone uptake and to determine the duration of this effect.MethodsThirty male Wistar rats were randomized into five groups, namely, placebo group (G1) and cisplatin groups (G2, G3, G4, G5). Pre-therapy bone scintigraphies were obtained in all the groups. Cisplatin chemotherapy was given as infusion. Post-therapy bone scintigraphies were obtained 10 min, 1 h, 24 h, and 72 h after chemotherapy in groups G2–G5, respectively. A placebo bone scintigraphy was obtained 10 min after infusion of serum physiologic in G1. Plasma samples for cisplatin plasma values were obtained. The graphite furnace atomic absorption spectrophotometry technique was used for cisplatin analysis. Quantitative analysis (bone uptake ratios) was performed by drawing regions of interest on the right femur, vertebral column, and adjacent soft tissues. The injection/examination time delay and the net injected MDP doses were also noted.ResultsThere was no statistically significant difference in bone uptake values, injected MDP doses or injection/examination time delay in any group. Cisplatin plasma values were significantly different in G2, G3, G4, and G5 (P < 0.05) but not in G1.ConclusionsCisplatin chemotherapy seems to have no effect on the Tc-99m MDP uptake of normal bone.