Twenty-four-hour quantitative thallium imaging for predicting beneficial revascularization

To determine the utility of 24-h thallium single-photon emission tomographic imaging for the assessment of myocardial viability, 40 patients with persistently decreased uptake on 3-h delayed imaging after exercise were studied before and after bypass surgery (n = 34) or coronary angioplasty (n = 6). Wall motion improvement after revascularization was also analysed in 23 patients with respect to the segments with and without 24-h redistribution. Of a total of 113 segments without redistribution at 3-h imaging after exercise, 62 (55%) demonstrated redistribution at 24 h. After revascularization 57 (92%) of these 62 segments revealed improvement of thallium uptake. On the other hand 40 (78%) of the 51 segments with persistently decreased thallium uptake until 24 h did not show improvement of uptake after revascularization. Of the 15 segments with > 50% relative thallium uptake and without redistribution on 24-h images, ten showed improvement of thallium uptake after revascularization. Hence higher uptake even without 24-h redistribution may indicate viability. Regional wall motion improved in 22 of 23 segments with redistribution on 24-h images, and did not improve after revascularization in 19 of 22 segments without redistribution at 24 h. These data suggest that 24-h late imaging with quantitative analysis may provide reliable information about reversible myocardial ischaemia in segments that demonstrate a fixed perfusion abnormality on conventional 3-h delayed imaging.

Kinetics of iodine-123-BMIPP in patients with prior myocardial infarction: assessment with dynamic rest and stress images compared with stress thallium-201 SPECT

Myocardial kinetics of 123I-labeled 15-(p-iodophenyl)3R, S-methylpentadecanoic acid (BMIPP) were evaluated with dynamic SPECT, and stress and rest BMIPP images were directly compared in conjunction with stress 201Tl.

METHODS

We studied 26 patients with prior myocardial infarction. Two minutes after injection of BMIPP, dynamic data acquisition with a three-headed SPECT was started and continued for 12 min. Conventional SPECT images were obtained at 20 min and 3 hr after injection. On a separate day, exercise, stress 201Tl SPECT was performed at 10 min and 3 hr after injection. Exercise stress-BMIPP imaging was performed in 15 of the patients, and static SPECT images were obtained.

RESULTS

With dynamic SPECT, early clearance of BMIPP from the myocardium was observed in the segments with reversible 201Tl defects, suggesting enhanced contribution of backdiffusion from BMIPP. In myocardial segments with reversible 201Tl defects, 20-min BMIPP images showed a higher frequency of reduced uptake when compared to 3-hr 201Tl (90/163) imaging.

CONCLUSION

With BMIPP dynamic SPECT, an enhanced contribution of backdiffusion in the early phase from ischemic myocardium was suggested. When exercise stress BMIPP images were obtained, a more severe defect was observed than on rest BMIPP and stress 201Tl imaging, possibly due to decreased coronary blood flow and impaired fatty acid uptake induced by ischemia during exercise.

[Quantitative analysis of 123I-BMIPP imaging in relation to exercise-redistribution 201Tl in patients with old myocardial infarction]

Myocardial kinetics of 123I-labeled 15-(p-iodophenyl)3R,S-methylpentadecanoic acid (BMIPP) was evaluated with BMIPP imaging in conjunction with stress-201Tl. We studied 20 patients with old myocardial infarction. BMIPP SPECT was obtained at 20 min and 3 h after injection. On a separate day, exercise stress-201Tl SPECT was performed at 10 min and 3 h after injection. Then, left ventricular myocardium was divided into 20 segments. For quantitative analysis, in each SPECT data, the maximum value (average counts per pixel) of all 20 myocardial segments was taken as 100%; the other values were calculated as a percentage of this maximum (Relative regional uptake, RRU). On the basis of stress-201Tl pattern, the myocardial segments were classified into 4 groups; normal 201Tl uptake, reversible 201Tl defect, fixed 201Tl defect and 201Tl defect with reverse redistribution. The 20 min BMIPP showed reduced activity compared with 3 h-201Tl (p < 0.001), especially in the area of 201Tl redistribution (50/111 segments, 45%), implicating impaired fatty acid utilization at resting condition. The washout rate of the segments with reversible 201Tl defect (-1.6 +/- 13.9%) was significantly lower than that of the segments with normal 201Tl uptake (9.0 +/- 9.8%) and fixed 201Tl defect (3.8 +/- 12.9%). Thus, BMIPP in combination with stress 201Tl imaging provides precise informations of impaired myocardial fatty acid utilization in patients with old myocardial infarction.

Comparison of benzodiazepine receptor and regional cerebral blood flow imaging of epileptiform foci in hippocampal kindled rabbits: a preliminary report

To clarify experimentally which of benzodiazepine (BZ) receptor or regional cerebral blood flow (rCBF) imaging is more sensitive in the detection of epileptic foci, we simultaneously examined the BZ receptor and rCBF distribution changes in hippocampal kindled rabbits with in vivo double tracer autoradiography using 125I-labeled Ro 16-0154 (125I-Iomazenil) and 99mTc-labeled hexamethyl-propyleneamine oxime (99mTc-HMPAO). In visual analysis of brain slices extracted after the intravenous injection of the double tracer following the kindling completion, 125I-Iomazenil accumulation was more markedly and extensively decreased in the kindled right CA1 region mimicking a primary epileptic focus than 99mTc-HMPAO accumulation. Further, this decrease in 125I-Iomazenil accumulation was not due to neuropathological abnormalities which consisted only of tissue damage corresponding to electrode track in the right CA1. These results suggest that BZ receptor imaging is more sensitive in the detection of epileptic foci than rCBF imaging and, therefore, that BZ receptor imaging is useful in clinical epilepsy.

Decreased 123I-MIBG uptake and increased clearance in various cardiac diseases

123I-metaiodobenzylguanidine (MIBG), a tracer for sympathetic neuron integrity and function, was applied to 155 patients with various types of cardiac disease. The methods for quantification of MIBG and washout were studied as well as normal ranges. Heart-to-mediastinum average count ratio (H/M) correlated well with total heart count divided by injected activity (r = 0.60, P < 0.0001 and r = 0.72, P < 0.0001 for early and delayed images, respectively). Although as a whole left ventricular ejection fraction (LVEF) positively correlated with H/M ratio, decreased H/M ratio could be associated with normal LVEF, which may indicate that the MIBG activity was an independent variable compared with cardiac contractility. High washout rate was seen in various cardiac diseases, such as dilated cardiomyopathy, hypertrophic cardiomyopathy, ischaemic heart disease, hypertension, hypothyroidism and arrhythmia. The increased washout seems to be nonspecific to disease type, but is a common feature of damaged or failing myocardium.

Intense accumulation of Tl-201 in carcinoid tumor of the thymus

A case of carcinoid tumor of the thymus is presented in which Tl-201 SPECT demonstrated intense accumulation in the lesion. Conventional chest radiograph and CT scan in a 66-year-old man who had been experiencing cough and pain at the anterior part of the chest revealed a tumor in the anterior mediastinum, suggesting a thymoma. The tumor was clearly delineated in both early and delayed SPECT studies. On the delayed scan, the tumor was more prominently visualized with an extremely high uptake ratio of the lesion compared to the contralateral background; therefore, the tumor was believed to possess very prolonged Tl-201 retention. The pathological and immunohistochemical examinations confirmed that the area of intense Tl-201 uptake was rich in viable cells.

[123I-BMIPP whole-body scintigraphy in relation to left ventricular ejection fraction]

Heart uptake and clearance of 123I-15-(p-iodophenyl)-3(R,S)-methylpentadecanoic acid (BMIPP) by whole-body scintigraphy in relation to left ventricular injection fraction (LVEF) was evaluated in 19 patients with myocardial infarction. At 45 and 210 min after injection, anterior whole-body images were obtained with a single-headed gamma camera system. In each patient, gated blood pool scintigraphy was also performed, and LVEF was calculated. Percent washout from the heart from the 45 to the 210 min imaging positively correlated with LVEF (r = 0.61, p < 0.01), although percent uptake and count density of the heart at 45 min imaging did show any positive correlation with LVEF (r = -0.10 and r = 0.35, respectively). The count density did not correlated with the percent washout (r = 0.32, p = 0.18). Thus, some relationship between LVEF and washout rate of BMIPP from the heart was suggested by analysis of BMIPP whole-body scintigraphy in patients with myocardial infarction.

Comparison of benzodiazepine receptor and regional cerebral blood flow imaging of epileptiform foci in hippocampal kindled rabbits: a study with in vivo double tracer autoradiography using 125I-iomazenil and 99mTc-HMPAO

To clarify experimentally whether benzodiazepine (Bz) receptor or regional cerebral blood flow (rCBF) imaging is more sensitive in the detection of epileptic foci, we simultaneously examined the Bz receptor and rCBF distribution changes in hippocampal kindled rabbits with in vivo double tracer autoradiography using 125I-labeled Ro 16-0154 (125I-Iomazenil) and 99mTc-labeled hexamethylpropylene amine oxime (99mTc-HMPAO). In visual and quantitative analyses, 125I-Iomazenil accumulation in brain slices extracted after the completion of the kindling was markedly and extensively decreased in the kindled right CA1 region, and further in the right temporal lobe, dentate gyrus, CA2, CA4, and bilateral CA3 regions, regarded as the propagated sites of seizure discharges. 99mTc-HMPAO accumulation was much more slightly and less extensively decreased in the right CA1, frontal, temporal and dentate gyri. Further, this decrease in 125I-Iomazenil accumulation was not due to neuropathological abnormalities, which consisted only of tissue damage corresponding to electrode track in the CA1. Both the kindled and propagated sites are known to have a possibility of acquiring epileptogenesis as experimental epileptic foci. These results suggest that Bz receptor imaging is much more sensitive in the detection of epileptic foci than rCBF imaging, and therefore that Bz receptor imaging is useful in clinical epilepsy.

Left ventricular dysfunction during exercise in patients with angina pectoris and angiographically normal coronary arteries (syndrome X)

Left ventricular function during exercise and recovery was investigated in patients with angina pectoris, ST segment depression during exercise and angiographically normal coronary arteries (syndrome X) using a continuous left ventricular function monitor with cadmium telluride detector (CdTe-VEST). Fourteen patients with syndrome X and 14 patients with atypical chest pain without ST segment depression during exercise and normal coronary arteries (control group) performed supine ergometric exercise after administration of 740-925 MBq of technetium-99m labelled red blood cells, and left ventricular function was monitored every 20 s using CdTe-VEST. Left ventricular ejection fraction (EF) response was impaired (< or = 5% increase from rest to peak exercise) in 11 or 14 patients with syndrome X but in none of the control patients. Resting EF was similar in the two groups (62.1% +/- 6.7% in patients with syndrome X, 61.9% +/- 6.2% in controls); however, EF increase from rest to peak exercise was lower in syndrome X (-3.1 +/- 9.5% vs 14.7% +/- 7.4%, P < 0.001). After cessation of exercise, all patients showed rapid EF increase over baseline and this EF overshoot was lower (19.3% +/- 8.3% vs 26.4% +/- 7.3%, P < 0.001) with the time to EF overshoot longer (114 +/- 43 s vs 74 +/- 43 s, P < 0.05) in patients with syndrome X. Thus, in patients with syndrome X, left ventricular dysfunction was frequently observed during exercise in spite of normal epicardial coronary arteries.

Correlations between quantitative EEG and regional cerebral blood flow (SPECT) in patients with partial epilepsy

During interictal periods in 9 patients with partial epilepsy we examined whether there were correlations between the relative power of background EEG (power spectral analysis) and the absolute values of regional cerebral blood flow (rCBF) measured by 99mTc hexamethylpropylene amine oxime (HMPAO) SPECT in each cerebral region. None of the patients had any organic cerebral lesions on X-ray CT examinations, neurological abnormalities or mental retardation. There was an inverse correlation between rCBF and the relative power of the theta band, and a direct correlation between rCBF and that of the alpha band of 10-12.8 Hz, in the right and/or left frontal, parietal and temporal regions. In the occipital regions, there was a direct correlation only between rCBF and the relative power of the beta band. These correlations were noted whether the analyzed regions were epileptic foci or not. These results suggest that background EEG and rCBF changes in epileptic patients are closely coupled.

Renal artery pseudoaneurysm demonstrated on radionuclide scintiscan

The authors present a case of renal artery pseudoaneurysm demonstrated on the Tc-99m DTPA dynamic study. On the blood flow image, localized increased activity was noted in the are of the renal hilus. This activity disappeared on the subsequent sequential renal images.

Utility of 123I-IMP SPECT brain scans for the early detection of site-specific abnormalities in Creutzfeldt-Jakob disease (Heidenhain type): a case study

Serial changes in brain imaging of regional cerebral blood flow with single photon emission computed tomography (SPECT) using N-isopropyl-(iodine-123) p-iodoamphetamine (123I-IMP) were observed in a patient with probable Heidenhain type of Creutzfeldt-Jakob disease, which was characterized by the initial onset of visual symptoms. Corresponding to the visual signs and periodic synchronous discharges localized in the bilateral parietal and occipital regions on EEG, focal hypoperfusion images in the occipital lobes were detected on the SPECT scan before brain X-ray computed tomography and magnetic resonance imaging showed any abnormalities. These results suggest that SPECT brain imaging is useful in the early detection of site-specific abnormalities in Creutzfeldt-Jakob disease.

Tumour affinity of 203Pb-chloride: comparison with 67Ga-citrate and 201Tl-chloride

The radionuclide 203Pb decays completely by electron capture to stable 203Tl with a half-life of 52 h. The primary radiation from the decay is gamma-ray radiation 280 keV (80%). 203Pb is produced easily from the natural metal thallium by the method described below. 203Pb-chloride is a promising imaging agent for tumour scanning because of the large retention value for tumour tissue and the small value for normal organs, but the large value for the kidney and bone is a shortcoming when considering it as an imaging agent. The retention value of 203Pb in tumour tissue is larger than that of 201Tl and smaller than that of 67Ga. The tumour/inflammatory lesion retention ratio for 203Pb is very large in comparison with those for 67Ga and 201Tl. 203Pb accumulates to a large extent in viable tumour tissue, and less in necrotic tumour tissue and in inflammatory lesion. Therefore, 203Pb-chloride is far better for visualization of viable tumour tissue than 67Ga and 201Tl if the large retention values for the kidney and bone were reduced.

Intense gallium-67 uptake in ovarian dysgerminoma

In a patient with an ovarian dysgerminoma, intense uptake of gallium-67 citrate was demonstrated. This report indicates that dysgerminoma should be added to the list showing abnormal accumulation of gallium-67 citrate in the abdomen.

99mTc colloid and 99mTc IDA imagings in diffuse hepatic disease

Ninety-six patients with various diffuse hepatic diseases were observed using both 99mTc colloid and 99mTc iminodiacetic acid (IDA), focusing on the potential etiologies of the disease process as well as its chronicity and severity. The presence of acute hepatic disease was more sensitively depicted with 99mTc IDA than with 99mTc colloid. In chronic hepatic disease, on the other hand, 99mTc colloid and 99mTc IDA demonstrated a similar sensitivity. The potential etiology of the disease process (differential diagnosis) and the chronicity of the disease could be evaluated better with 99mTc colloid. Among the patients with different stages of liver cirrhosis, however, 99mTc IDA significantly discriminated the severity of the hepatic disease. These results suggest that 99mTc IDA may be used to determine the degree of functional disorder in acute hepatic disease and evaluate the severity of diffuse hepatic disease, whereas 99mTc colloid can effectively evaluate the potential etiology and chronicity of the disease.

[Evaluation of early kinetics of 123I-BMIPP in patients with ischemic heart disease]

Early kinetics of 123I-BMIPP was evaluated in 200 left ventricular myocardial segments from 10 patients with old myocardial infarction, employing dynamic SPECT. Dynamic SPECT acquisition was performed from 2 minutes to 14 minutes after injection of 123I-BMIPP. Conventional static SPECT with 123I-BMIPP (BM-S) at 20 min after injection and delayed image from stress 201Tl SPECT (Tl-RD) were visually evaluated by dividing each myocardial segment into the following four groups, NL (the segments with normal radioactivity in BM-S and Tl-RD), Tl < BM (the segments with reduced radioactivity in Tl-RD compared with BM-S), Tl > BM (the segments with reduced radioactivity in BM-S compared with Tl-RD) and Tl = BM < NL (the segments with equally reduced radioactivity in BM-S and Tl-RD). In the dynamic SPECT, washout rate (WR) from 2-4 to 12-14 minutes images was calculated. The WR of Tl > BM group (12.9 +/- 15.5% (mean +/- SD), 55 of 200 segments) was significantly higher than those of NL (-8.6 +/- 11.9%, 95 of 200 segments), Tl = BM < NL (-0.6 +/- 16.0%, 45 of 200 segments) and Tl > BM (-4.4 +/- 9.2%, 5 of 200 segments) groups. This high WR of Tl > BM group may reflect "back diffusion" from myocardium in early phase after injection of 123I-BMIPP.

Regional uptake of iodine-125-metaiodobenzylguanidine in the rat heart

Regional uptake of iodine-125-metaiodobenzylguanidine ([125I]MIBG) was evaluated in normal (n = 12) and reserpinized (n = 12) rat hearts. At 15 min and 1, 3 and 6 h after injection of [125I]MIBG, tissue activities were calculated for the right ventricular myocardium (RV), the whole left ventricular myocardium (whole LV), the epicardial layer of the left ventricular myocardium (Ep LV), the endocardial layer of the left ventricular myocardium (En LV), the basal segment of the left ventricular myocardium and the apical segment of the left ventricular myocardium. The uptake of [125I]MIBG at 6 h after injection in the normal rat heart was higher in RV than in whole LV (0.45 +/- 0.09% vs 0.30 +/- 0.06% kg dose/g), and in Ep LV than in En LV (0.32 +/- 0.07% vs 0.25 +/- 0.05%). In the reserpinized rat heart, the difference in the uptake between Ep LV and En LV was smaller. This suggests that the difference in the regional [125I]MIBG uptake might reflect different intravesicular uptake in the layers of the heart. To our knowledge, the low uptake in the endocardial layer was a new finding which seems to indicate a difference in innervation between the epicardial and endocardial layers of the left ventricle in the rat heart. Autoradiographic study also showed the low uptake of [125I]MIBG in the endocardial layer, while homogeneous perfusion was observed with thallium-201, supporting the tissue uptake study. Thus, the endocardial and epicardial layers of the left ventricle in the rat heart were considered to be differently innervated.

Comparative SPECT study of stroke using Tc-99m ECD, I-123 IMP, and Tc-99m HMPAO

Brain perfusion SPECT imaging using Tc-99m ethyl cysteinate dimer (ECD) was carried out in 12 patients with chronic cerebrovascular disease. The sensitivity of lesion detection and lesion-to-normal tissue contrast was compared with those of I-123 IMP and Tc-99m HMPAO. Eight patients underwent all three studies and the remaining four patients had Tc-99m ECD and I-123 IMP scans. The sensitivity of lesion detection and lesion contrast was analyzed quantitatively using an asymmetric index determined by the equation: 100 x [right - left[/(right + left). In the cerebral cortex, cerebellum, and white matter, I-123 IMP showed higher lesion sensitivity than Tc-99m ECD and Tc-99m HMPAO. In the striatum and thalamus, Tc-99m ECD and I-123 IMP showed higher lesion sensitivity than Tc-99m HMPAO. I-123 IMP showed the highest lesion contrast in cerebral cortex and cerebellum, whereas Tc-99m ECD showed the highest contrast in thalamus and striatum. In all regions, Tc-99m ECD showed higher lesion contrast than Tc-99m HMPAO. These results suggest regional variation in the sensitivity of lesion detection and lesion contrast of Tc-99m ECD compared to I-123 IMP, and the superiority of Tc-99m ECD to Tc-99m HMPAO.

Myocardial perfusion imaging and dynamic analysis with technetium-99m tetrofosmin

Technetium-99m tetrofosmin is a new myocardial perfusion imaging agent that accumulates rapidly and shows slow clearance from the myocardium. Dynamic acquisition and SPECT imaging were performed in a total of 26 patients. Using exercise-rest protocol, the single-photon emission computed tomography (SPECT) findings of 130 myocardial segments were classified as infarction, ischemia and partial filling and compared to those with 201Tl. Complete concordance of findings was obtained in 108 segments (83%) between images with 99mTc tetrofosmin and 201Tl. Partial filling was observed in 24 segments with 201Tl and 14 segments with tetrofosmin, showing a greater number of ischemic regions in 201Tl. However, in comparison with coronary arteriography (n = 19), overall sensitivity and specificity for detecting coronary artery stenosis (> or = 75%) was 15 of 25 (0.60) and 27 of 32 (0.84), respectively, which did not differ significantly from those of 201Tl, which was 18 of 25 (0.72) and 27 of 32 (0.84), respectively. Graphic analysis that assumes unidirectional transfer of the tracer was applied to initial dynamic changes and uptake constant k and distribution volume V were computed. Multiple vessel disease and congestive heart failure showed a low perfusion index (k/V), and may be used in this type of tracer with unidirectional uptake. This preliminary study in the clinical trial showed the usefulness of 99mTc tetrofosmin as a myocardial perfusion imaging agent.

SPECT analysis of regional cerebral blood flow changes in patients with schizophrenia during the Wisconsin Card Sorting Test

Single photon emission computed tomography (SPECT) images were obtained in 10 right-handed neuroleptic-treated schizophrenic patients and 10 healthy volunteers using Tc-99m-hexamethyl-propylenamine oxime (Tc99m-HMPAO) during performance of the Wisconsin Card Sorting Test (WCST) and at rest. None of the patients showed severe impairment on the WCST. The patient group showed a statistically insignificant trend to incur more unique errors. In both the patient and control groups, the left lateral prefrontal blood flow significantly increased during the WCST, as compared to during resting conditions. Only during the WCST, the patient group showed a significant regional cerebral blood flow (rCBF) decline in the left medial prefrontal cortex, as well as in the right side under both the test and resting conditions. This left medial prefrontal rCBF during the WCST correlated positively with the number of unique errors, although this correlation was statistically insignificant. The right fronto-parietal rCBF was significantly increased in the patient group under both the test and resting conditions. Moreover, in the left hippocampal region, the patient group showed a significant rCBF increase under resting conditions.

Renal perfusion with Tc-99m DTPA--simple noninvasive determination of extraction fraction and plasma flow

A simple, noninvasive method for the determination of extraction fraction and renal plasma flow in Tc-99m DTPA studies is presented. This method could be performed in conjunction with the measurement of glomerular filtration rate, providing additional information about renal plasma flow. Graphic analysis of the Patlak plot was employed for the determination of the unidirectional influx rate constant (ku) of Tc-99m DTPA from the blood to the kidney and the initial nonspecific distribution volume (Vn) in the kidney. The first pass extraction fraction was estimated from Ku and Vn, assuming a bolus input to the kidney. The glomerular filtration rate was measured by renal counting corrected for depth and dose. Using the estimated extraction fraction (EF) and glomerular filtration rate (GFR), the renal plasma flow (RPF) was calculated using the formula of RPF = GFR/EF. In a total of 76 kidneys in 38 patients (including 9 patients with normal renal function and without evidence of nephrourologic disease), the value of renal plasma flow showed good correlation with that of effective renal plasma flow measured by renal counting with I-131 orthoiodohippuran. There was a characteristic tendency for the extraction fraction to show a larger value as the renal plasma flow decreased. These results indicate that this method is valid for renal plasma flow estimation and the determinations of extraction fraction and renal plasma flow in Tc-99m DTPA studies is helpful as an adjunct to the measurement of glomerular filtration rate in order to adequately assess the pathophysiologic changes of renal disorders.

Evaluation of suspected malignant pulmonary lesions with 201Tl single photon emission computed tomography

201Tl single photon emission computed tomography (SPECT) was evaluated in 170 patients suspected of having a malignant pulmonary lesion greater than 20 mm in diameter on the surgical specimen. Delayed SPECT (at 3 h after injection) visualized all of the 147 malignant pulmonary lesions and 16 of the 23 (69.6%) benign pulmonary lesions, and generally exhibited the lesion more clearly than the early SPECT images (at 15 min after injection). There was no significant difference in delayed ratio (uptake ratio of the lesion to the normal lung on delayed scan) among the various histological groups except between the adenocarcinoma and large cell carcinoma groups (P < 0.05), and no difference was noted between the malignant and benign lesions. However, in retention index (degree of retention in the lesion) a significant difference was noted between the malignant and benign lesions (P < 0.01), although there was no significant difference in this index among malignant different histology groups. These results indicate that this method is useful for visualizing malignant pulmonary lesions greater than 20 mm in diameter to exclude the possibility of malignancy in the lesions when no abnormal 201Tl accumulation is observed. When the lesion shows abnormal 201Tl accumulation, the retention index seems to help differentiate malignant from benign lesions.

[Evaluation of renal function using 99mTc-MAG3: comparison with 123I-OIH and 99mTc-DTPA]

The utility of 99mTc-mercaptoacetyltriglycine (MAG3) with studied clinically. In the renography obtained with 99mTc-MAG3, the abdominal aorta and the common iliac arteries were clearly visualized in the vascular phase. Due to less background activity and high target to background ratio, the quality of 99mTc-MAG3 image was superior to that of 123I-OIH or 99mTc-DTPA image. The parameters on the renogram including Tmax, T2/3, and T1/2 were compared. The correlation of Tmax and T2/3 or T1/2 were not significant between 99mTc-MAG3 and 123I-OIH. Another parameter of C20/Cmax, where C20 and Cmax are renal activities at 20 min after injection and at Tmax respectively, showed an excellent correlation between 99mTc-MAG3 and 123I-OIH. Using C20/Cmax, pattern of renogram can be characterized numerically. Concerning about the relation between C20/Cmax and renogram pattern, standard renogram pattern showed the C20/Cmax value of less than 0.4, while hypofunctioning pattern showed more than 0.5. The correlation coefficient between the renal uptake of 99mTc-MAG3 and 123I-OIH was 0.880 with a correlation plot: "Y = 1.16X-0.043", where X and Y represent renal uptake of 99mTc-MAG3 and 123I-OIH, respectively. It can be concluded that 99mTc-MAG3 is useful renal imaging agent as an alternative to 123I-OIH, in order to evaluate the proximal tubular function and calculate ERPF.

[67Ga SPECT in the evaluation of orbital and ocular mass-like lesions]

We evaluated 67Ga SPECT in the differentiation of mass-like lesions in the orbital and ocular areas. A two-headed SPECT system equipped with parallel-hole collimator was used. 67Ga SPECT demonstrated three dimensionally the extent of tumors found by CT and MRI. 67Ga SPECT was especially useful in the assessment of localized lesions in and around the lacrimal gland. In a total of 43 patients studied, the overall accuracy of 67Ga SPECT in diagnosing orbital and ocular lesions was 72%. Sixteen of 21 malignant lesions (76%) showed true positive findings and 15 of 22 benign lesions (68%) showed true negative findings. All seven malignant lymphoma lesions showed true positive findings. One of four cases of malignant melanoma was not visualized. This lesion was less than 15 mm in diameter. None of the three cases of retinoblastoma was visualized, regardless of tumor size. Four of seven cases of pseudotumor or pseudolymphoma showed false positive findings. The differentiation of pseudotumor and pseudolymphoma from malignant lymphoma seemed to be difficult. We conclude that 67Ga SPECT is useful in the differentiation of lesions in the orbital and ocular areas and that evaluation of the extent of malignant lesions can be improved by comparing the findings obtained by morphological diagnostic modalities.