Stefan D. Miron

Preliminary imaging results using In-111 labeled CYT-356 (Prostascint) in the detection of recurrent prostate cancer.

To evaluate whether In-111 capromab pendetide (an antibody conjugate directed to a glycoprotein found primarily on the cell membrane of prostate tissue) radioimmunoscintigraphy can localize residual or metastatic prostatic carcinoma in 15 patients after prostatectomy and lymphadenectomy for prostatic carcinoma with rising serum prostate-specific antigen. One patient with 0.6 ng/ml serum prostate-specific antigen had normal imaging results and 14 patients had scintigraphic evidence of residual prostatic bed or metastatic prostatic carcinoma. Two patients with borderline abnormal bone scans had abnormal activity in the same regions on In-111 capromab pendetide images. All patients had negative radiographic abdominal and pelvic cross-sectional prestudy images, and there were no adverse effects related to In-111 capromab pendetide infusion and little human antimouse antibody response.

The ST segment/heart rate slope as a predictor of coronary artery disease: Comparison with quantitative thallium imaging and conventional ST segment criteria☆

The ST segment shift relative to exercise-induced increments in heart rate, the ST/heart rate slope (ST/HR slope), has been proposed as a more accurate ECG criterion for diagnosing significant coronary artery disease (CAD). Its clinical utility, with the use of a standard treadmill protocol, was compared with quantitative stress thallium (TI) and standard treadmill criteria in 64 unselected patients who underwent coronary angiography. The overall diagnostic accuracy of the ST/HR slope was an improvement over TI and conventional ST criteria (81%, 67%, and 69%). For patients failing to reach 85% of their age-predicted maximal heart rate, its diagnostic accuracy was comparable with TI (77% and 74%). Its sensitivity in patients without prior myocardial infarctions was equivalent to that of thallium (91% and 95%). The ST/HR slope was directly related to the angiographic severity (Gensini score) of CAD in patients without a prior infarction (r = 0.61, p less than 0.001). The ST/HR slope was an improved ECG criterion for diagnosing CAD and compared favorably with TI imaging.

The value of quantitative sacroiliac scintigraphy in detection of sacroiliitis

SummaryTo evaluate clinical usefulness of quantitative sacroiliac scintigraphy (QSS) in detecting sacroiliitis, we used a modified, pixel by pixel technique for calculating sacroiliac joint/sacrum uptake ratios (sacroiliac joint index - SII). We studied 90 controls, 18 selected patients with active sacroiliitis, 2 ankylosing spondylitis patients with completely ankylosed sacroiliac joints, 14 patients with nonspecific low back pain and 5 patients with rheumatoid arthritis. In the controls, we found that the SII decreases with increasing age (P<0.001) and is higher in males than in females (P<0.005). In the patients with active sacroiliitis, 9 out of 14 older than 30 had an abnormal SII; 3 of these patients showed no radiographic or CT abnormalities of the sacroiliac joints. None of the 4 patients with sacroiliitis under 30 years of age had values which fell out of the normal range for their age and sex. Only 1 of the 14 patients with non-inflammatory low back pain had an abnormally high SII. A borderline SII was found in 1 of the 5 patients with rheumatoid arthritis. QSS may be useful in detecting active sacroiliitis, sometimes even before the occurrence of radiologic abnormalities. However, because of its low sensitivity, its clinical usefulness is limited, especially in patients under 30 years of age.

Scintigraphic measurement of oropharyngeal transit in man

Scintigraphic studies of the oropharyngeal transit of a liquid bolus were performed in 15 healthy controls, 12 patients with symptoms of oral-pharyngeal dysphagia, and 13 patients with neuromuscular disease, who did not have dysphagia. Gamma camera imaging of the head, neck, and upper thorax was undertaken, in the lateral projection, during the swallowing of the radiolabeled bolus of water. Inspection of summed images permitted the selection of regions of interest (ROI) to represent the mouth, pharynx, and upper esophagus. Transit times between each ROI were calculated and compared. Significant prolongation of bolus transit time between the mouth and esophagus was present in both patients with and without dysphagia (0.59 ± 0.38 sec and 0.33 ± 0.7 sec; mean ± SD, respectively) compared with controls (0.26 ± 0.04 sec P < 0.001, P < 0.01, respectively, Mann-Whitney U test). Repeat studies in 25 individuals indicated that the transit measurements were more reproducible between swallows in normal subjects than in patients with symptoms. Deglutitive scintigraphy provides a noninvasive technique for the quantitative study of swallowing and its disorders.

Review of some common artifacts in nuclear medicine

In nuclear medicine, artifacts may simulate a pathologic process; their recognition is therefore necessary to avoid misdiagnosis. Artifacts may be divided into three groups: 1) camera dependent artifacts; 2) radiopharmaceutical dependent artifacts; and 3) patient-related artifacts. The authors present a variety of artifacts and discusses their possible prevention.

Relation of exercise Doppler left ventricular filling to thallium lung uptake

The exercise-induced changes in left ventricular filling in patients with coronary artery disease are poorly understood. Therefore these changes were studied in relation to a noninvasive indicator of exercise pulmonary venous congestion, the lung-to-heart (L:H) ratio on symptom-limited thallium stress testing. Fifty-six patients undergoing diagnostic treadmill testing were studied; 50 of them had technically adequate Doppler recordings and became the subjects of this study. Doppler left ventricular filling was assessed with patients in the supine position both before and after exercise. Measurements included early (E) and late (A) filling velocities, their ratio, the diastolic time-velocity integral, and the diastolic filling time. The L:H ratio was considered abnormal if it was greater than the upper 95% confidence limit for a separate group of normal subjects. Twelve subjects had a documented prior myocardial infarction, 16 had stress-induced ischemia, and 20 had abnormal L:H ratios. A greater E and a longer diastolic filling time in the group with an abnormal L:H ratio were the only postexercise measurements that differed; however, E was the only filling parameter that both differed between groups after exercise (abnormal L:H group 87 +/- 25 cm/sec; normal 68 +/- 20 cm/sec; p < 0.01) and whose change from rest to after exercise was significantly different (p < 0.05). Since Doppler velocities are directly related to instantaneous gradients, the higher E in patients with evidence of exercise pulmonary congestion suggests a higher exercise early diastolic left atrial pressure.

Generation of parametric images during routine Tc-99m PYP inhalation/Tc-99m MAA perfusion lung scintigraphy. Technical note.

A simple technique is described for generating ventilation/ perfusion ratio and perfusion/ventilation ratio images from the posterior Tc-99m PYP aerosol inhalation and Tc-99m MAA perfusion images obtained during routine lung scintigraphy. These images highlight areas of ventilation/perfusion incongruence—mismatch or reverse mismatch—that may sometimes be difficult to detect on conventional images.

Accumulation of In-111 Octreotide in brain infarcts: a case report.

Presented is a case in which there was significant accumulation of In-111 Octreotide in brain infarcts. It is likely that the accumulation was nonspecific and due to breakdown of the blood-brain barrier.

Accumulation of In-111 tagged white blood cells in heterotopic new bone

In-111 tagged white blood cells are known to accumulate in various noinfectious conditions of the skeleton, such as healing fractures, at sites of bone marrow aspiration, or at bone graft donor sites. A case is presented with leukocyte accumulation at the sites of heterotopic new bone formation

Focal Fatty Infiltration of the Liver Appearing as a Defect on a Liver-Spleen Scintigram: Case Report

The authors present a biopsy-proven case of focal fatty infiltration of the liver that appeared as a focal defect on a liver/spleen scintigram, matching a defect seen on a CT scan.