Thomas P. Haynie

Changes of arterial blood flow patterns during infusion chemotherapy, as monitored by intra-arterially injected technetium 99m macroaggregated albumin

Arterial catheter tip position and arterial flow was monitored by intra-arterial infusion of 99Tcm macroaggregated albumin in patients treated by intra-arterial chemotherapy. Variations in arterial flow pattern as monitored by macroaggregated albumin perfusion studies were encountered in 16 patients without apparent change in the catheter position as monitored by arteriographic and/or radiographic examinations. Possible mechanisms causing changes in arterial flow pattern include: (a) development of collateral circulation, (b) arterial spasm, (c) progressive arteritis causing thrombi with or without associated spasm, and (d) laminar flow. It is important to recognise that changes in perfusion patterns are not always accompanied by change in the position of the arterial catheter.

Value of routine radionuclide bone scans in renal cell carcinoma

Radionuclide bone scans were obtained as part of the routine evaluation of 85 patients with renal cell carcinoma. Twenty-nine patients (34%) were found to have metastatic disease at presentation. Bone scans were abnormal in 27 of these 29 patients for a sensitivity of 93 per cent; of the remaining 56 without metastatic disease, 48 had normal bone scans for a specificity of 86 per cent. In all patients whose abnormal bone scans indicated metastatic disease, there were either clinical signs (bone pain), laboratory findings (elevated alkaline phosphatase), or routine radiographic procedures (chest roentgenogram, intravenous pyelogram, or angiogram) suggesting disease metastatic to bone. Although bone scanning was useful for confirming clinically or radiographically suspected metastatic disease, it did not influence the staging of the renal cell carcinoma in any patient. We therefore conclude that bone scans should be used to confirm the presence and to determine the extent of osseous metastases in patients with renal cell carcinoma but are unnecessary as a routine staging procedure.

Distribution and pharmacology of intravenous 99mTc-labeled multilamellar liposomes in rats and mice

Abstract The use of liposomes for the delivery of macrophage activators offers a new approach for the selective targeting of antitumor therapy. We have investigated the distribution, retention, and pharmacology of multilamellar liposomes (phosphatidylserine (PS): phosphatidylcholine (PC) 3:7) on i.v. injection in normal rats. Sprague-Dawley rats were injected with doses varying from 300 to 1000 mg/kg of 99m Tc-liposomes. The organ distribution of doses ranging from 300 to 500 mg/kg showed 45% mean uptake by liver, 25% by spleen, and 4% by lung. At higher doses of 800–1000 mg/kg, uptake in the lung increased significantly to 9 ± 3%. Whole body retention at 24 h after i.v. injection in Hale Stoner mice was 70%. The blood disappearance curve was biphasic and compared with the free isotope, a decrease was observed in the initial a phase t12 while the terminal phase t12 increased by 100%. These data suggest that encapsulation prolongs the initial distribution to the peripheral compartments and that higher doses may increase uptake by organs other than the liver.

Detection of a brain metastasis from osteosarcoma with 99mTc-methylene diphosphonate bone scanning

Abstract99mTc-methylene diposphonate (MDP) bone scintigraphy demonstrated localization in an intracranial metastasis of osteogenic sarcoma. This unusual case suggests that bone scintigraphy may have diagnostic value in the early diagnosis of metastatic ossifying lesions.

Technetium‐99m‐labeled macroaggregated albumin arteriography for detection of abnormally positioned arterial catheters during infusion chemotherapy

The arterial catheter position of 500 courses of intra‐arterial chemotherapy were monitored by intraarterially introduced Technetium‐99m macroaggregated albumin (MAA) particles. Seventeen instances of abnormally positioned catheters (3.4%) were detected by MAA arterial perfusion (MAAAP). All these abnormally positioned catheters were subsequently repositioned resulting in improved tumor perfusion. Plain radiographs obtained in eight instances failed to reveal the abnormally positioned catheter in four, while all eight of these abnormally positioned catheters were detected by MAAAP. Abnormally positioned catheters detected by MAAAP were either immediately after arterial catheter placement (nine instances) or during the course of chemotherapy (eight instances). Of the right instances of displaced catheters during intra‐arterial chemotherapy, six instances were accompanied by clinical signs and symptoms suggestive of displaced catheter. Arteriovenous shunting was documented in 5 of 12 hepatic MAAAP studies as evidenced by increased lung activity. When the catheters were displaced in these cases, the lung activity changed: completely disappearing in two instances; decreasing in two instances and remaining unchanged in one.

Role of nuclear medicine in chemotherapy of malignant lesions

The major role of nuclear medicine in clinical oncology is in tumor imaging, which includes evaluating specific organs or the entire body for the presence of tumor. Nuclear medicine studies have been used clinically in the initial evaluation of the tumor extent and in the subsequent management of the cancer patient to assess response to treatment, to detect early relapse, and to assist in making decisions concerning follow-up treatment. Technetium-99m macroaggregated albumin perfusion study for intraarterial chemotherapy has been helpful in monitoring the catheter tip, providing a map of regional perfusion at the capillary level (tumor vascularity), evaluating the degree of arteriovenous shunt in tumor bed, and optimizing division of the dose of chemotherapeutic agent when bilateral arterial catheters are used. Quantitative and serial radionuclide angiocardiography has been useful in assessing doxorubicin (Adriamycin, Adria Laboratories, Columbus, Ohio) toxicity, and 67Ga-citrate imaging has been used to monitor chemotherapy effect on lungs and kidneys. Radionuclide venography can demonstrate suspected thrombus, and the delineation of the vascular anatomy also allows proper placement of another catheter for continuous effective chemotherapy. Serial bone scans have been the primary modality to assess the response of bone metastasis to systemic therapy in breast cancer patients, and nuclear hepatic imaging may show tumor response, hepatocellular dysfunction, and cholecystitis related to chemotherapeutic agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent renal cell carcinoma following nephrectomy mimicking a normal kidney on bone scan

A case is described in which recurrent renal cell carcinoma simulated a nearly normal kidney image on the bone scan at the site of previous total nephrectomy.

Bone scintigraphic findings related to unilateral mastectomy

The total body bone scans of 51 breast cancer patients who had received unilateral mastectomies were reviewed to establish the incidence of bone scintigraphic changes related to the surgery. Several features were noted: (a) increased radioactivity in the ribs on the side of the mastectomy in 76% of patients, (b) increased radioisotope uptake in the remaining breast in 36% of patients, (c) increased radioisotope uptake in the soft tissue of the arm on the mastectomy side in 18% of patients. Familiarity with the incidence of these findings may be of use in bone scan interpretation of breast cancer patients.

Transcatheter infusion of 99mTc MAA for predicting response of intra-arterial chemotherapy in osteogenic sarcoma

Ten patients with histologically proven osteogenic sarcoma received multiple courses of intra-arterial chemotherapy. Patients received 2-3 mCi 99mTc macroaggregated albumin (MAA) infused through indwelling arterial catheters prior to, during and after the chemotherapy, and static images of tumor beds and lungs were taken and compared with contrast angiographic findings. Of the 31 studies to evaluate tumor vascularity, 26 agreed and five showed discrepancies. In general, decreased tumor vascularity, as represented by reduced MAA uptake by the tumor, corresponded to decreased tumor size and to increased tumor calcification seen on radiographs. Twenty-six of the 31 lung-imaging studies also revealed agreement between decreasing tumor vascularity, based on decreasing MAA tumor uptake, and decreasing lung uptake of the radioactivity. Decreased lung uptake of the activity on the last follow-up study in eight patients corresponded to reduced tumor involvement and improved patient performance status.

Radiation dose and biological effects to mouse testis from sodium 32P-phosphate.

Radiation dose to mouse testis was estimated to be about 1.65 rad per microCi of intravenously injected 32P. This high dose to the organ was due to the incorporation of this isotope into the macromolecules of the testis. Up to 30% of the total testis activity was in DNA molecules. Biologic effects on mouse testis from 32P were determined by testis weight loss and the decrease in the number of sperm heads in the testis. Number of sperm heads reached a minimum of 1.3% of control 36 days after injection of 3.5 microCi/g body weight of 32P. Significant decreases in sperm head counts were observed after as little as 0.2 microCi/g body weight of 32P.