Abstract: A 61-year-old man with end-stage renal failure resulting from polycystic disease (hepatic and renal) who was on hemodialysis was investigated because of the development of ascites. During the previous 2 months, he had extremely high levels of carbohydrate antigen (CA) 19-9 (4951.1 U/mL [normal range, 0–37 U/mL]) and CA 50 (4365.6 U/mL [normal range, 0–25 U/mL]). Ultrasound, CT, and MRI, as well as endoscopy, were negative for tumor. He was referred to our Nuclear Medicine Department to be investigated for a possible neuroendocrine pancreatic tumor by In-111 pentetreotide scintigraphy. An upward displacement of the diaphragm into the thorax was noted such that the spleen appeared in the left lower lung field and the liver at the site of the right lower lung field. These topographic changes were explained by the ascites.
Abstract: Purpose In patients with connective tissue diseases (CTD), the early detection and evaluation of the severity of the pulmonary involvement is mandatory. High-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) are considered to be valuable noninvasive diagnostic modalities. Radiopharmaceuticals have also been used for this purpose. Our aim was the evaluation of technetium-labeled human polyclonal immunoglobulin G (HIG) lung scintigraphy in the early detection and assessment of the severity of the pulmonary
involvement in CTD patients.
Methods Fifty-two nonsmoking CTD patients were studied by PFTs, HRCT, and HIG. According to PFTs, patients were divided in group A (impaired PFTs—abnormal pulmonary function) and group B (normal pulmonary function). Semiquantitative analysis was done on HIG and HRCT and corresponding scores were obtained.
Results Significant difference was found between HIG scores in the two groups (0.6±0.07 vs 0.51±0.08, P<0.001). There was a statistically significant negative correlation between HIG scores and PFTs results and a positive correlation between HIG and HRCT scores. HIG demonstrated similar clinical performance to HRCT. At the best cut-off levels of their score (0.56 and 7, respectively), HIG had a superior sensitivity (77.5 vs 57.5%) with lower specificity (75 vs 91.7%). The combination of the two methods increased the sensitivity of abnormal findings at the expense of specificity.
Conclusions HIG scintigraphy can be used in the early detection and evaluation of the severity of the pulmonary
involvement in CTD, whereas, when used in combination with HRCT, the detection of affected patients can be further improved.
Abstract: Aim: 99mTc-2-methoxyisobutylisonitrile (MIBI) scintigraphy has been suggested in MM patients. According to ISS, serum b2-microglobulin (Sβ2M) and serum albumin (SA) are dominant predictive factors and different cut-off values for those can separate patients into stages with significantly different outcome. The purpose of this study was to assess the relationship between these factors, ISS staging and the MIBI scan.
Materials and Methods: Twenty-five MM patients were studied. 99mTc-MIBI scans were obtained and scored according to intensity (I) and extent (E) of the radiotracer uptake; a summed score (S) was calculated for each patient. Scintigraphic findings were correlated by simple linear regression analysis with ISS, Sβ2M, and SA.
Results: Eighteen pts were stage I, 3 stage II and 4 stage III. The S was 2.28 ± 2.2 for stage I and 5 ± 0.58 for stage II and III (p<0.0001). There was a positive correlation between scores and Sβ2M and an inverse correlation between scores and SA; statistically significant differences were found between E and S scores and Sβ2M, and SA levels. Statistically significant differences were also found in scores for those patients who died as against for those alive at the end of the follow –up period.
Conclusions: 99mTc-MIBI scan provides useful information in the detection of disease activity, well correlated with Sβ2M, SA and ISS staging system.
Abstract: In a 62-year-old man with medullary carcinoma of the thyroid, a postoperative Tc-99m dimercaptosuccinic acid [(V) DMSA] study was requested. In the Tc-99m (V) DMSA scan. no abnormalities, indicating local recurrence or metastatic disease, were observed. However, there was increased uptake in the spleen and liver and significantly diffusely increased uptake in the bone marrow. The patient also had a history of myelofibrosis and these findings appear to have been the result of this pathology.
Abstract: This study determined the role of the combined use of 99mTcsestamibi and 99mTc-pentavalent dimercaptosuccinic acid (VDMSA) scintigraphy in evaluating the effectiveness of chemotherapy in patients with multiple myeloma.
Methods: In 20 patients with multiple myeloma who had received or were receiving chemotherapy, 99mTc-sestamibi and 99mTc-V-DMSA scanning was performed to evaluate the effectiveness of chemotherapy.
Results: In group A (11 patients with active disease), 42 99mTc-sestamibi–positive lesions were found. Thirtyseven of those lesions were also positive for 99mTc-V-DMSA uptake, as were 16 additional lesions (nonactive) (NAL). Thus, in group A, the total number of positive lesions (TPL) detected was 58 and the NAL/TPL ratio was 16:58. In group B (9 patients in remission), 5 99mTc-sestamibi–positive lesions were found. A further 22 lesions were also positive for 99mTc-V-DMSA uptake. Thus, in group B, the NAL/TPL ratio was 22:27. Therefore, the NAL/TPL ratios considered to represent effectively treated lesions were 27.6% and 81.5% for groups A and B, respectively.
Conclusion: Combined use of the 2 agents allows the effectiveness of chemotherapy to be evaluated through a comparison of NAL and TPL multiple myeloma lesions even in the
absence of a baseline study.
Abstract: Purpose: The objective of this study was to compare the uptake
changes of Tc-99m 2-methoxy isobutyl isonitrile (MIBI) and Tc-99m
pentavalent dimercaptosuccinic acid (V-DMSA) in multiple myeloma
(MM) lesions in response to high-dose chemotherapy (HDC).
Materials and Methods: The authors compared Tc-99m MIBI and
Tc-99m V-DMSA scans before and after HDC in a patient with
focal MM lesions without amyloidosis who had received previous
standard chemotherapy as well.
Results: HDC had the effect of eliminating all Tc-99m MIBI uptake
in the lesions. Tc-99m V-DMSA uptake was increased in lesions
presenting significant initial Tc-99m MIBI uptake. In 1 particular
lesion that demonstrated this phenomenon, magnetic resonance
showed necrosis of the area of MM.
Conclusion: The authors consider that the effect of increasing Tc-99m
V-DMSA uptake in the absence of an increase in viable plasma cells
possibly reflects the treatment-generated inflammatory and fibrotic
changes and not necessarily viable tumor tissue. Exclusive focal Tc-
99m V-DMSA uptake in this clinical setting could be considered as a
sign of effectively treated lesions and not a sign of deterioration.
