Rikushi Morita

Clinical Evaluation of Serum Ferritin to Iron Ratio in Malignant Diseases

Serum ferritin levels were measured in 72 normal subjects and in 214 cases with various diseases by an immunoradiometric assay. In normal subjects, the serum ferritin levels were 27–230 ng/ml. Elevated serum ferritins were observed in most cases with iron excess and acute hepatitis. Markedly elevated levels were found in the majority of cases with acute leukemia, malignant lymphoma, hepatoma, and pancreatic cancer. High ferritin levels were also found in other malignant diseases. However, the range cverlapped broadly with that of nonmalignant diseases. The serum ferritin correlated significantly with serum iron in normals and in those with iron deficiency anemia. In most nonmalignant cases, the serum ferritin and iron levels distributed on a regression line obtained from levels in normals and those with iron deficiency anemia. However, 92% of the malignant cases showed a serum ferritin to iron ratio higher than that of normal subjects. The estimation of the serum ferritin to iron ratio is a useful means for screening patients or in the differential diagnosis of a suspected malignant lesion.

Visualization of skeletal muscle involvement of mycosis fungoides on 67Ga scintigraphy

Intense accumulation of radioactivity during 67Ga-citrate scanning was observed in the leg of a patient with advanced mycosis fungoides after repeated radiotherapy and chemotherapy. Infiltration of the calf muscle by neoplastic lymphoid cells was confirmed at autopsy. Radionuclide visualization of an uncommon involvement of the skeletal muscle by the disease has not been previously reported.

Technetium coordination state as a factor of stability in 99mTc-complexes used in hepatobiliary system: Comparative studies on 99mTc-complexes of pyridoxal with glutamate (Tc-PG) and isoleucine (Tc-PI)

Studies on 99mTc-Penicillamine (Tc-Pen) have given us some insight into the significance of the technetium coordination state in hepatobiliary clearance behavior.A 99mTc-complex of pyridoxal and glutamate (Tc-PG) prepared by Baker et al. (1975) using an autoclaving process or by a Sn-Resin kit method (Horiuchi 1981) was compared with a 99mTc-complex of pyridoxal and isoleucine (Tc-PI) prepared by the method of Kato and Hazue (1978) through an intermediate compound of stannous ion, at room temperature.Tc-PG and TcPI complexes analyzed by thin layer chromatography, sephadex column chromatography (G-15), octanol extraction, and ligand exchange reaction showed different chemical properties. Their biological evaluation also demonstrated great differences in biodistribution in mice, metabolic studies, protein binding, and rat bile excretion.Tc-PG was estimated as an hepatobiliary agent with strong metal-ligand binding, inert to ligand exchange reaction with Pen at physiological pH; the likely occurrence of technetium in a mononuclear or dinuclear state providing the great stability observed in its biological and in vivo behavior was compared with the relatively weaker binding observed in Tc-PI, a highly lipophilic complex of high liver partition but of low stability, denoting its different chemical characteristics.The technetium coordination state in radiopharmaceuticals is responsible for the integrity of the molecule while in the blood pool and its relevance in impaired liver uptake is discussed.

Tin-adsorbed resin for the preparation of 99mTc-radiopharmaceuticals: Stable complex of 99mTc-bleomycin

Stannous chloride has been the reducing agent of choice for the preparation of 99mTc-containing radiopharmaceuticals, whose effective chemical form is considered to be a complex, or complexes, of the reduced form of technetium. Labeling of 99mTc-BLM, a technetium complex of bleomycin, has been reported previously, but a stable complex for adequate clinical evaluation has been difficult to obtain. The main role of stannous chloride is as reducing agent but, depending upon the amount and the chemical state of the stannous ion, other phenomena have been detected and further implications for the incorporation of 99mTc into a ligand are discussed. However, the stannous ion adsorbed onto a cationic exchange resin showed specific characteristics allowing the preparation of a stable complex of BLM, considered to be a mononuclear complex. The usefulness of this tin-adsorbed resin (Sn-resin) as an efficient device (kit) for the controlled delivery of Sn2+ ion, permitting the simple preparation of a stable complex with good reproducibility in Nuclear Medicine facilities is presented.

Evidence that factors other than 1,25 dihydroxyvitamin D may play a role in augmenting intestinal calcium absorption in patients with primary hyperparathyroidism

SummaryWe examined 17 patients with primary hyperparathyroidism for their serum 1,25 dihydroxyvitamin D levels and for their fractional intestinal calcium absorption rates using a whole body counter and calcium-47. As controls, 10 normal volunteers were examined both before and after administration of 1α-hydroxyvitamin D to increase serum 1,25 dihydroxyvitamin D. Values of serum 1,25 dihydroxyvitamin D were 71.6±37.6 pg/ml (mean ±SD) in patients with primary hyperparathyroidism and 75.3±27.7 pg/ml (mean ±SD) in normal volunteers after administration of 1α-hydroxyvitamin D, while values of intestinal calcium absorption rate were 61.5±16.5% (mean ±SD) in patients with primary hyperparathyroidism and 34.1±5.1% (mean ±SD) in normal controls, respectively. There was a positive correlation between values of serum 1,25 dihydroxyvitamin D and intestinal calcium absorption in both groups. However, in patients with primary hyperparathyroidism, intestinal calcium absorption was more increased than that in normal volunteers when compared to their serum values of 1,25 dihydroxyvitamin D. This suggests that another factor than 1,25 dihydroxyvitamin D plays an important role in the intestinal calcium absorption in patients with primary hyperparathyroidism.

Accumulation of 99mTc-methylene diphosphonate within benign cystic teratoma of the ovary

Intense accumulation of radioactivity was observed in a case of histologically proven benign cystic teratoma of the ovary during routine bone scans with 99mTc-methylene diphosphonate. To our knowledge, imaging of a benign ovarian tumor with a 99mTc-phosphorus complex has not been previously reported.

Accumulation of 99mTc-pyrophosphate in a muscle hernia of the thigh

A patient with a muscle hernia in the thigh showed increased muscle uptake of radioactivity during bone imaging using 99mTc-pyrophosphate. The area of excessive accumulation corresponded well to the location and extent of the herniated muscle tissue observed at surgery. Microscopic examination revealed chronic muscle damage, which was assumed to be responsible for the abnormal muscle labelling found in this patient.

The importance of the chemical state of 99mTc radiopharmaceuticals: an effective tumor imaging form of 99mTc bleomycin

Abstract 99 m Tc-labeled bleomycin ( 99 m Tc-BLM) has been introduced as a tumor-imaging agent. Nevertheless, this complex has been misjudged and its value for clinical use has received no proper evaluation. Various 99 m Tc-BLM species labeled with 99 m Tc in different chemical states are produced depending upon the labeling conditions such as the concentrations of BLM and SnCl 2 , pH and reaction time. As a consequence, their biological behavior is found to be markedly affected by the state of 99 m Tc in the labeled compound administered. Detailed studies of the labeling reactions lead us to conclude that of the complexes tested, a 99 m Tc-BLM complex in which tetravalent 99 m Tc is coordinated through three nitrogen atoms of BLM, is considered to be a valuable one for clinical use. This 99 m Tc species is chemically the most stable and a rapid clearance from blood is obtained; yielding a high tumor-blood ratio of 99 m Tc activity after injection into tumor-bearing mice. A selective labeling method for this 99 m Tc complex is described.

Analysis of 99mTc-pyridoxylidene-glutamate complex formation and its preparation with tin-adsorbed-resin: Sn-Resin kit method.

Abstract99mTc-Pyridoxylidene-glutamate (Pc-PG) was introduced in 1975 by Baker et al. as a cholescintigraphic agent. Nevertheless its routine use has been limited due to the autoclaving process involved. To shorten the labeling procedure, an analysis of Tc-PG complex formation using the stannous chloride method was carried out. Sn-Resin (stannous ion adsorbed onto cation exchange resin) was used for labeling a stable Tc-PG with high efficiency. A preautoclaved complex of pyridoxal and glutamate was required but the labeling procedure took only 10–15 min after the elution of 99m-TcO4-from the generator.Formation of a complex other than a 99mTc-complex of the Schiff-base ligand pyridoxylidene-glutamate is discussed.The new formulation of a Tc-PG kit (Sn-Resin) simplified the labeling method and reproducible data to that already reported by Baker was obtained in chromatographic studies. Its suitability in hospital departments has already been shown in clinical studies.

Scintigraphic visualization of extraosseous xanthomatosis

A histologically proven case of extraosseous xanthomatosis is presented. Both Ga-67 citrate and Tc-99m-MDP imagings demonstrated tumor uptake of radiotracers. A second Ga-67 imaging taken after excisional biopsy of the left knee lesion revealed disappearance of the lesional uptake of the tracer seen on the preoperative Ga-67 scan. Radiotracer accumulation in extraosseous xanthomatosis has not been reported previously.