Lajos Szabados

Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

Although macrovascular complications are typical for type 2 diabetes mellitus (T2DM), cerebral microvascular damage develops both in type 1 diabetes mellitus (T1DM) and T2DM. Color Doppler ultrasound is widely used for the examination of large- and medium-sized arteries, whereas SPECT and MRI are capable of identifying disturbances in the circulation of microvessels. Former studies using semiquantitative methods showed reduced reactivity and reserve capacity of cerebral vessels in both T1DM and T2DM patients. Our aim was to investigate whether there was any difference in the effects of the 2 types of diabetes mellitus on the global or regional cerebral blood flow, influenced by microvascular damage. Methods: In our study, the circulation and reserve capacity of cerebral arteries was examined using 99mTc-hexamethylpropylene amine oxime SPECT. A total of 17 individuals with T1DM and 43 individuals with T2DM were involved in the study. Results: Both basal and acetazolamide-challenged brain circulation were significantly lower in T2DM patients than in T1DM patients. We did not find a significant difference in the reserve capacity. However, the circulation of the frontal and occipital lobes changed differently in the 2 groups. The ratio of the circulation of the frontal and occipital lobes was significantly reduced both in basal and in acetazolamide-stimulated states in T2DM patients, independently of age (P < 0.0005 and P < 0.017), showing a greater relative decrease in the circulation of the frontal lobe in T2DM patients. Conclusion: There was a significant association between basal brain circulation and age, body mass index, and high-density lipoprotein (HDL), whereas acetazolamide-stimulated circulation showed a significant association with serum triglyceride and HDL.

Rapid response to and long-term effectiveness of anti-CD20 antibody in conventional therapy resistant Graves’ orbitopathy: A five-year follow-up study

Abstract The aim of this investigations was to study the effectiveness of anti-CD20 antibody therapy in Graves’ orbitopathy (GO) resistant to glucocorticoids. Five patients were entered in the study. The protocol required no improvement of orbital status after a recent course of glucocorticoids. Activity of GO was confirmed by three independent techniques: clinical activity score (CAS), 99mTc-labeled diethylene triamine pentaacetic acid (99mTc DTPA) single photon emission computed tomography and magnetic resonance imaging. Rituximab (RTX) was given as weekly infusions of 375 mg/m2 body surface area for four weeks. The mean follow-up period was 67 (range 58–81) months. Improvement of GO has been observed in all patients: CAS before therapy was 6.5 ± 1.7 and decreased to 3.4 ± 1.6 by one month (p < 0.05) and remained unchanged (3.2 ± 1.7) at 12 months. No further CAS change, in either direction, was detected during the yearly follow-up visits. The mean DTPA uptake before therapy was 16.52 ± 4.51 MBq/cm3 and decreased to 11.97 ± 2.36 MBq/cm3 at one year (p < 0.002). The mean of T2 relaxation times before and one year after therapy were 96.91 ± 17.61 ms and 84.29 ± 9.41 ms, respectively (p < 0.001). The mean serum TSH receptor antibody (TRAb) levels before therapy, at the one month and one year control visits were 7.4 ± 3.4 U/L, 5.6 ± 4.5 U/L and 1.7 ± 1.5 U/L, respectively (p < 0.004). No correlation between changes of TRAb and activity parameters has been found. Anti-CD20 treatment seems to influence positively the clinical course of GO, and this effect seems to be stable for five years. To our knowledge, this is the longest published follow-up of RTX treatment in GO.

High prevalence of oesophageal involvement in patients with undifferentiated connective tissue disease using radionuclide oesophageal transit scintigraphy.

AimTo look for the frequency of oesophageal dysfunction using radionuclide oesophageal transit scintigraphy in 145 patients with undifferentiated connective tissue disease (UCTD); to seek the correlation between the clinical/laboratory data and scintigraphic alterations; and to determine predictive value of radionuclide oesophageal transit scintigraphy for evolution to established connective tissue disease (CTD). MethodOne hundred and forty-five patients with UCTD were examined by99mTc-DTPA oesophageal transit scintigraphy. The intraoesophageal transport of the radiopharmaceutical was followed and imaged by a gamma camera, a series of 128×128 images were stored and evaluated. The correlation between the scintigraphic data and clinical and laboratory parameters was analysed statistically. ResultsUnequivocally positive scintigraphy, indicative of motor abnormality was found in 46% of patients (66), 71% (47) of whom were totally asymptomatic. Significant correlation was found between the presence and severity of scintigraphic alterations and antinuclear antibodies, the anti-&bgr;2GPI, IgM, IgG, the aCL antibody positivity, and the skin symptoms. Scintigraphic positivity was significantly more frequent in patients evolving to definitive CTD (P=0.0178), and abnormal scan predisposed to transition into the definitive CTD (odds ratio, 2.292; CI, 1.610–4.525). Its cumulative positive predictive value was found to be 43% and cumulative negative predictive value 73% with regard to the development of a definitive CTD. ConclusionOur results show that scintigraphic alterations together with clinical and laboratory alterations can help the clinician in the prediction of final outcome.

Hand perfusion with 99mTc-HSA in patients expecting to undergo coronary bypass surgery: Elaboration of a new complex diagnostic protocol for the safe removal of a radial artery graft

BackgroundThe Allen test is used worldwide for radial artery graft removal. The postoperative examination of our patients’ hand function and circulation proved that beside the transient neurological complications chronic hand circulatory disorders may arise. AimTo develop a non-invasive method suitable for an objective evaluation of the hands circulation to make it possible to use radial arteries safely for the revascularization of coronary arteries. MethodsWe examined 35 patients. After selective compression of the radial and ulnar arteries of both hands, we injected 400 MBq 99mTc-HSA intravenously and acquired 240 images, each of 1 s. After 30 s we released the ulnar artery first, and after 120 s the radial artery, too. Then computer analysis was performed. ResultsThe patients could be divided into two groups. In the majority of them, releasing only the ulnar artery resulted in a good circulation of the fingers. It meant that the time–activity curve rapidly reached its maximum, and the activity did not change even after releasing the radial artery. In a smaller proportion of the patients the activity of the fingers increased only slowly, and did not reach a plateau even after 30 s. Following the release of the radial artery a further increase in the activity could be observed. We assume that the latter patient group is at risk of consequent circulatory disorder of the fingers after the removal of the radial artery, whereas in the former group the artery could be removed safely. ConclusionsHand perfusion with 99mTc-HSA is useful in patients selected for coronary bypass operations, so we recommend the introduction of this method as a routine examination before the removal of the radial artery in patients with an abnormal Allen test.

The impact of 99mTc-DTPA orbital SPECT in patient selection for external radiation therapy in Graves' ophthalmopathy

ObjectiveIn Graves’ ophthalmopathy (GO), there is a demand to differentiate the immunologically active disease state, when immunosuppressive therapy is necessary, from the inactive state, when the patient would not benefit from it. We measured the inflammatory activity in the retrobulbar region using 99mTc-diethylene triamine pentaacetic acid (DTPA) SPECT before and after external radiation to determine whether this method is suitable for predicting the effectiveness of this therapy. Materials and methodsThirty-two patients with suspected active GO were involved in this retrospective study. The initial image, DTPA uptake value (UV) and its change after therapy were assessed to monitor the effect of the therapy and investigate whether a pretreatment scan is capable of predicting the outcome. ResultsDepending on the change in DTPA UV after radiotherapy, three patient groups were formed: decreased, increased or minimally changed (less than 1×10−6 injected dose (ID)/ml). The initial DTPA UVs of these groups were significantly different (P<0.001). Improvement was observed mainly in patients with higher initial values. When comparing the groups with low (<12×10−6 ID/ml) versus high (≥12×10−6 ID/ml) initial uptake, an unexpected increase was observed in the first group after therapy (mean: +2.89±2.66×10−6 ID/ml), whereas the average change in the DTPA UV was negative in the latter group as anticipated (−2.24±4.47×10−6 ID/ml, P<0.00001). ConclusionWe found that in GO patients a high DTPA UV may predict the response to orbital radiation therapy. DTPA orbital SPECT may be a suitable technique for the selection of GO patients for radiation therapy.

Anti-granulocyte scintigraphy in early rheumatoid arthritis — does it work?

ObjectiveTo compare the performance of anti-granulocyte scintigraphy with those of widely used prognostic indices (such as DAS28, anti-CCP, early MRI imaging).MethodsTwenty-five patients with early arthritis were enrolled into the study. Following the review of clinical data and the evaluation of disease activity, we performed MRI imaging of the hands, anti-granulocyte scintigraphy, and determined anti-CCP positivity. The relationship between the changes of MRI scores and the above prognostic factors were analyzed statistically.ResultsAt baseline, values were as follows: DAS28 3.86±1.19, CRI 0.15±0.12, MRI erosions and synovitis scores 25.11±12.82 and 4.32±4.02 (respectively), the ratio of anti-CCP positivity was 7/12 (58%). After the follow-up period of 13.6±2.52 months, erosion and synovitis scores were 43.11±22.23, and 5.32±6.16, respectively (p=0,001 and p=0,015). The occurrence of new erosions was correlated with baseline erosion score (k=0.523, p=0.022) and anti-CCP positivity (p=0.021). The relationship between CRI and baseline synovitis score was strong (=0.518, p=0.023), whereas it was weak only between the former and baseline erosion score (=0.402, p=0.08).ConclusionAs shown by this study, potential markers for predicting subsequent destructiveness in early RA include MRI and anti-CCP testing, primarily. 99mTc labeled anti-granulocyte joint scintigraphy is appropriate for the objective and quantitative appraisal of disease activity.

Uncommon Late Relapse of Angioimmunoblastic T-Cell Lymphoma after 16-Year Remission Period

Abbreviations AITL Angioimmunoblastic T-cell lymphoma EBV Epstein-Barr virus FDG-PET/ CT Fluoro-deoxy-glucose Positron Emission Tomography/Computed Tomography LDH Lactate dehydrogenase CHOP Cyclophosphamide, doxorubicine, vincristine, prednisone COPBLAM Cyclophosphamide, vincristine, prednisone, bleomycin, adriamycin and procarbazin CEVP Cyclophosphamide, vinblastine, epirubicin and prednisone DHAP Dexamethasone, cytarabin, and cisplatin TNF Tumor necrosis factor EBER Epstein-Barr early RNA