Yi-Chun Chen

Chronic edema from protein-losing enteropathy: scintigraphic diagnosis

Yi-Chun Chen, Shang-Jyh Hwang, Jainn-Shiun Chiu, Mei-Hua Chuang, Mei-Ing Chung and Yuh-Feng Wang Division of Nephrology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China; Department of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China; Department of Pharmacy, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China and Graduate Institute of Pharmaceutical Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China Correspondence: Yuh-Feng Wang, Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, No. 2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan-Republic of China. E-mail: chenyichun0320@yahoo.com.tw

Protein-losing gastropathy in peritoneal dialysis as a wolf in sheep's clothing: Tc-99m human serum albumin SPECT/CT diagnosis.

Protein-losing gastropathy (PLG) is a rare cause of hypoalbuminemia and may be missed in patients with peritoneal dialysis (PD), because PD therapy can lead to hypoalbuminemia and conceal the occurrence of edema. We report a 58-year-old man who underwent PD and presented with unexplained hypoalbuminemia, but lacked gastrointestinal symptoms and edema. PLG was diagnosed by Tc-99m human serum albumin SPECT/CT. The patient’s serum albumin level normalized after treatment with a protonpump inhibitor for 4 months, and his biochemical improvement was also supported by follow-up imaging. Hypoalbuminemia clearly relates to high mortality in PD patients, and Tc-99m human serum albumin SPECT/CT can promote early detection of occult PLG that is masked by PD.

Diagnostic Value of I-131 NP-59 SPECT/CT Scintigraphy in Patients with Subclinical or Atypical Features of Primary Aldosteronism

Accumulating evidence has shown the adverse effect of long-term hyperaldosteronism on cardiovascular morbidity that is independent of blood pressure. However, the diagnosis of primary aldosteronism (PA) remains a challenge for patients who present with subtle or atypical features or have chronic kidney disease (CKD). SPECT/CT has proven valuable in the diagnosis of a number of conditions. The aim of this study was to determine the usefulness of I-131 NP-59 SPECT/CT in patients with atypical presentations of PA and in those with CKD. The records of 15 patients with PA were retrospectively analyzed. NP-59 SPECT/CT was able to identify adrenal lesion(s) in CKD patients with suspected PA. Patients using NP-59 SPECT/CT imaging, compared with those not performing this procedure, significantly featured nearly normal serum potassium levels, normal aldosterone-renin ratio, and smaller adrenal size on CT and pathological examination and tended to feature stage 1 hypertension and non-suppressed plasma renin activity. These findings show that noninvasive NP-59 SPECT/CT is a useful tool for diagnosis in patients with subclinical or atypical features of PA and those with CKD.

Peritoneo-scrotal shunting diagnosed by Tc-99m DTPA SPECT/CT imaging

Yi-Chun Chen, Yu-Chieh Su, Jainn-Shiun Chiu, Chang-Kuo Wei and Yuh-Feng Wang Division of Nephrology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Department of Nuclear Medicine, Shuang-Ho Hospital, Taipei County, Taiwan; Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan and Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

NP-59 SPECT/CT Imaging in Stage 1 Hypertensive and Atypical Primary Aldosteronism: A 5-Year Retrospective Analysis of Clinicolaboratory and Imaging Features

Objective. We retrospectively analyzed all primary aldosteronism (PA) patients undergoing NP-59 SPECT/CT imaging with regard to their clinicolaboratory and imaging features, investigation, and outcomes. Material and Methods. 11 PA patients who presented to our hospital for NP-59 SPECT/CT imaging between April 2007 and March 2012 and managed here were analyzed. Results. Among 11 PA patients, eight (73%) had stage 1 hypertension, three (27%) stage 2 hypertension, four (36%) normal plasma aldosterone concentration, nine (82%) nonsuppressed plasma renin activity (PRA), six (55%) normal aldosterone-renin-ratio (ARR), eight (73%) serum potassium ≧3u2009mEq/L, seven (64%) subclinical presentation, seven (64%) negative confirmatory testing, and four (36%) inconclusive results on CT scan and seven (64%) on planar NP-59 scan. All 11 (100%) patients had positive results on NP-59 SPECT/CT scan. Two (18%) met typical triad and nine (82%) atypical triad. Among nine atypical PA patients, three (33%) had clinical presentation, six (67%) subclinical presentation, six (67%) negative confirmatory testing, and four (44%) inconclusive results on CT scan and six (67%) on planar NP-59 scan. All patients had improved outcomes. Significant differences between typical and atypical PA existed in PRA and ARR. Conclusions. NP-59 SPECT/CT may provide diagnostic potential in stage 1 hypertensive and atypical PA.

Diagnosis of primary aldosteronism in chronic kidney disease by I-131 NP-59 SPECT/CT imaging.

Primary aldosteronism (PA) may be missed in patients with chronic kidney disease (CKD), because CKD may disturb the renin-angiotensin-aldosterone system. Adrenal vein sampling has increased risks in patients with CKD. We report the case of a 58-year-old man with CKD and suspected PA. Left adrenal aldosteronism was diagnosed by NP-59 SPECT/CT. Left adrenalectomy demonstrated adrenocortical nodular hyperplasia. Plasma aldosterone normalized and blood pressure stabilized after surgery. NP-59 SPECT/CT may be a helpful diagnostic tool for detecting and lateralizing PA in CKD patients.

Technetium-99m-Labeled Autologous Serum Albumin: A Personal-Exclusive Source of Serum Component

Technetium-99m human serum albumin (99mTc-HSA) is an important radiopharmaceutical required in nuclear medicine studies. However, the risk of transfusion-transmitted infection remains a major safety concern. Autopreparation of serum component acquired from patient provides a “personal-exclusive” source for radiolabeling. This paper is to evaluate the practicality of on-site elusion and subsequent radiolabeling efficacy for serum albumin. Results showed that the autologous elute contained more albumin fraction than serum without extraction procedure. Good radiochemical purity and stability were demonstrated after radiolabeling. Biodistribution study showed that labeled albumin accumulated immediately in the lung, liver, and kidney. It was cleared steadily and excreted in the urine. The biologic half-life was defined, and all samples passed the pyrogenicity and sterility tests. In conclusion, autoalbumin could be extracted and radiolabeled properly in a nuclear medicine setting. Moreover, the risk of transfusion-transmitted infection associated with nonautologous, multisource 99mTc-HSA agents can be reduced.

Clinical Application of On-site Prepared Technetinum-99m Human Serum Albumin for Scintigraphic Detecting of Protein-losing Enteropathy

Background: Abdominal scintigraphy performed with technetium-99m ((superscript 99 m) Tc)-labeled human serum albumin (HSA) provides direct evidence of protein-losing enteropathy (PLE). However, because of transfusioninduced infections, the safety of serum products is a major concern. We previously developed an on-site preparation of (superscript 99 m) Tc-HSA using domestic serum products, which showed good labeling efficiency, stability, and bioavailability. The purpose of this pilot study was to initially evaluate those preparations of (superscript 99 m) Tc-labeled HSA for clinical application. Methods: HSA was locally acquired and appropriately screened for infectious diseases. (superscript 99 m) Tc-HSA was prepared according to our previous protocol. It was intravenous administration to patients with clinically suspected PLE. Sequential abdominal images were acquired by a gamma camera. Sites of obvious PLE were localized after the radiolabeled HSA was administered. Patients were monitored for adverse events. Results: Five patients with clinical suspicious of PLE were enrolled in this pilot study. Areas of protein loss were demonstrated in two patients. Another three cases, the origin of diminished serum albumin levels remained undetermined. All patients tolerated with procedure well with no specific adverse effects or major complaints. Conclusion: Scintigraphy with (superscript 99 m) Tc-HSA is noninvasive and can be used to detect, localize, and follow up cases of occult or intermittent PLE. Our pilot study demonstrated that this on-site prepared (superscript 99 m) Tc-HSA was appropriate for clinical application. Procedure of on-site radiolabeling from the native serum product was easy to be performed and achieved good labeling efficiency and bioavailability. It might also reduce the incidence of transfusion-induced infections. This technique resulted in good image quality and improved patient safety.