Ritsuo Matsui

Tc-99m sestamibi uptake by malignant lymphoma and slow washout

Tc-99m sestamibi has been used to detect primary brain tumors, lung tumors, and breast cancers. The authors report a patient who had superior vena cava (SVC) syndrome and underwent Tc-99m sestamibi and TI-201 SPECT to differentiate the tumor from thrombus in the mediastinum because of an abnormal mass lesion on a contrast enhanced CT scan. An abnormal area of increased Tc-99m sestamibi uptake in the supra azygos area was demonstrated on early and delayed SPECT imaging. The washout of tumor uptake was slow. The removed tumor was confirmed to be malignant lymphoma.

Esophageal varices before and after endoscopic variceal ligation: evaluation using helical CT.

Abstract. The purpose of this study was to demonstrate the utility of helical CT in assessing the therapeutic effects of endoscopic variceal ligation (EVL). Twenty-four patients with esophageal varices were examined. Helical scanning was initiated 60 s after intravenous injection (Iopamidol 300 mgI/ml, total 120 ml, 3 ml/s) was started. Esophageal varices were clearly depicted as high-density areas. Multiplanar reformation and 3D images demonstrated collateral circulation three-dimensionally. After EVL, mucosal high-density areas had diminished markedly, but collateral veins around the esophagus, and gastro- and/or spleno-renal shunts, were unchanged in all patients. Of 21 patients with collateral circulation, esophageal varices recurred endoscopically in 6 patients within 12 months. In 3 patients without collateral circulation, esophageal varices did not recur within 12 months. From these findings, we conclude that helical CT is a useful method for assessing the therapeutic effects of EVL.

Technetium-99m MIBI single photon emission computed tomography as an indicator of prognosis for patients with lung cancer —Preliminaly report—

Purpose: We performed technetium-99m hexakis-2-methoxyisobutylisonitrile (Tc-99m MIBI) single photon emission computed tomography (SPECT) in 23 patients with primary lung cancer between July 1993 and March 1996. We evaluated the relationships among the uptake ratio, retention index and the prognosis after radiation therapy and/or chemotherapy.Materials and Methods: Tc-99m MIBI SPECT was performed at 30 minutes and at 3 hours after intravenous injection of 600 MBq of Tc-99m MIBI with three gamma camera detectors (GCA-9300A/HG) on transverse SPECT images. Regions of interest were set in the area of abnormal uptake of Tc-99m MIBI and in the contralateral normal lung. The ratio of uptake in the lesion to that in the contralateral normal lung was obtained on early images (early ratio; ER) as well as delayed images (delayed ratio; DR). The retention index (RI) was calculated as follows: RI=(DR-ER)/ER×100. The ratio was compared with survival time and prognostic factors.Results: There was no correlation between ER and DR. The patients with high RI survived longer than those with low RI (median survival, 19.4 months vs. 9.4 months; p=0.0104 by the Mantel-Cox test).Conclusion: These results suggest that RI is the most useful among Tc-99m MIBI indices of primary lung cancer in predicting prognosis.

Evaluation of uptake and release of technetium-99m MIBI SPECT of pulmonary and mediastinal lesions

We evaluated the uptake and release of Tc-99m MIBI in 7 benign and 30 malignant pulmonary and mediastinal lesions. Of the 37 patients, 13 underwent surgery; malignant involvement was examined in 21 mediastinal lymph nodes. Tl-201 SPECT was also performed in 10 patients. Tc-99m MIBI SPECT studies were performed on transverse SPECT images acquired 30 minutes and 3 hours after intravenous injection of 600 MBq of Tc-99m MIBI with three gamma camera detectors (GCA-9300A). Regions of interest were set in the area of abnormal uptake of Tc-99m MIBI and in an area of normal tissue in the contralateral lung. The uptake ratio of the lesion in the contralateral normal lung was obtained on the early image (early ratio; ER) as well as the delayed image (delayed ratio; DR). The benign lesions showed significantly lower ER (1.6 ± 0.3) and DR (1.4 ± 0.4) than the malignant lesions (1.9 ± 0.5 and 1.8 ± 0.5, respectively; both p < 0.05). There was no significant difference in the retention index (RI), calculated as RI = (DR − ER)/ER × 100. The DR obtained with Tl-201 SPECT images was significantly higher than that obtained with Tc-99m MIBI SPECT (p < 0.05). For the detection of mediastinal lymph node metastases, the early images showed sensitivity, specificity, and accuracy of 85.7%, 100%, and 95.2%, respectively, for the delayed images these values were 85.7%, 92.9%, and 90.5%, respectively. These results suggest that the uptake ratio of Tc-99m MIBI is a useful index in assessing benign or malignant pulmonary and mediastinal lesions.

Evaluation of Tl-201 SPECT for monitoring the treatment of pulmonary and mediastinal tumors

Tl-201 single photon emission computed tomography (SPECT) was performed in 88 patients with pulmonary or mediastinal tumors in order to evaluate its usefulness for the detection of disease and for the assessment of the effect of treatment. We also examined mediastinal and hilar lymph node metastasis from lung cancer. Tl-201 SPECT showed abnormal accumulation on delayed images in all lung cancer patients with tumor diameters more than 12 mm. In the 14 operated lung cancer patients, mediastinal and hilar lymph node metastases with diameters of more than 15 mm were imaged, but one with a diameter of 9 mm was missed. The retention index (RI) was 27.52±31.58 in malignant tumors and −13.67 ± 8.15 in benign tumors (p < 0.05). The RI was significantly lower after treatment than before treatment. The interval until tumor recurrence or reactivation tended to be longer in patients who showed a significant decrease in the RI after therapy. These findings suggest the usefulness of the RI as an index of therapeutic efficacy.

Evaluation of the ventilation-perfusion ratio in lung diseases by simultaneous anterior and posterior image acquisition

Ventilation and perfusion images were acquired during tidal breathing using81mKr gas and99mTc-MAA. Anterior and posterior functional images of V/Q and Q/V were simultaneously acquired in 34 subjects with various lung diseases and 6 healthy controls. Superimposed anterior and posterior images were constructed and histograms of the frequency distribution for ventilation, perfusion, and the V/Q ratio were displayed for both lungs as well as for the left and right lungs individually. Blood gas analysis and general lung function tests were also performed on the day before scintigraphy. A correlation between marked uneven distribution of V/Q and A-aDO2 was found. When the proportion of counts at V/Q < 0.67 and/or V/Q > 1.50 in the V/Q counts histogram was compared with A-aDO2, there was a significant positive correlation for anterior images (r = 0.684, p < 0.05), posterior images (r = 0.654, p < 0.05) and superimposed images (r = 0.696, p < 0.05). Superimposed images therefore showed the highest correlation. There was no correlation between the results of lung function testing and A-aDO2. Coronal SPECT images were also obtained in 15 patients and compared with the superimposed anterior and posterior planar images. There was a good correlation (r = 0.888, p < 0.001) between both the imaging methods regarding the marked uneven distribution of V/Q. Simultaneous anterior and posterior planar image acquisition reduces the examining time, is simple, and is noninvasive. The present results also suggest that it is useful for quantitative evaluation of the ventilation-perfusion ratio.

Three-dimensional CT angiography of the splenic-portal venous system by using multiple threshold display

We assessed the three-dimensional (3D) CT angiographic reconstruction of the splenic-portal venous system obtained by using multiple threshold display (MTD) in 40 patients with liver disease. In each patient, both shaded surface display(SSD) and MTD images were generated by using an Xtension with a Sun SPARCstation 20, and they were compared by two radiologists. MTD image quality was superior to that of SSD images, because MTD diminished longitudinal direction artifacts and the image depicted the small vessels clearly. Based on the above results, we consider MTD to be a useful method for 3D-CT angiography of the splenic-portal venous system.

3D Imaging of the Trachea and Bronchi from Helical Scan CT.

ヘリカルCTのデータから気管・気管支系の三次元立体表示を行い, 最適な表示条件とその描出能について検討した. 対象は気管支鏡およびヘリカルCTが施行された肺病変16例である.使用装置は東芝社製Xforceで, 撮像条件はX線ビーム幅5mm, テーブル移動速度5mm/1.5秒, 1回転1.5秒で連続20回転スキャンし, 2mmピッチで横断像を画像再構成した. 得られたデータから三次元表示ソフトウエアCEMAX-VIPstationを用いて気管・気管支を立体表示し, 気管支鏡所見と対比検討した. 気管・気管支の三次元表示には, CT値の抽出閾値-650HU～-100HUが最も描出良好であった. また区域気管支まで気管支内腔の観察が可能であり, 気管支内の腫瘤は内腔狭窄, 壁肥厚として描出された. 気管・気管支の三次元表示を観察することにより病変部の全体的な把握が容易となり, また気管支壁の外方からの観察も可能であることから気管支病変の解析により有用であると考えられた.