Usefulness of techntium-99m hexamethylpropylene amine oxime lung scan to detect subclinical lung injury in patients with noninsulin-dependent diabetes mellitus

In this study, we employed techntium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan to detect subclinical lung injury of patients with noninsulin-dependent diabetes mellitus (NIDDM) who had normal chest X-ray findings (CXR) and pulmonary function test (PFT). The degree of pulmonary vascular endothelium damage was represented as lung/liver uptake ratios (L/L ratios) calculated by Tc-99m HMPAO lung scan. The L/L ratios of the 20 male NIDDM patients with normal CXR and PFT were compared with those of the 20 male normal controls. The results show that the L/L ratios on Tc-99m HMPAO lung scan were significantly higher in NIDDM patients than those in normal controls. Using a cutoff value of 0.50, 17 of the 20 (85%) NIDDM patients had abnormally increased L/L ratios. Our findings concluded that the pulmonary vascular endothelium damage represented as significantly increased L/L ratios on Tc-99m HMPAO lung scan in NIDDM patients with normal CXR and PFT. In addition, Tc-99m HMPAO lung scan has the potential to be a sensitive, objective, and noninvasive method to detect subclinical lung injury of patients with NIDDN, which are different from the traditional studies such as CXR or CFT.

Usefulness of technetium-99m hexamethylpropylene amine oxime lung scan to detect inhalation lung injury of patients with pulmonary symptoms/signs but negative chest radiograph and pulmonary function test findings after a fire accident--a preliminary report

OBJECTIVE

In this study, we employed technetium-99m hexamethylpropylene amine oxime (99mTc HMPAO) lung scan to detect inhalation lung injury of patients after a fire accident.

METHODS

Ten healthy men for controls and 10 male patients with pulmonary symptoms/signs from a fire accident were enrolled in this study for comparison. 99mTc HMPAO lung scan was performed in each control and patient, as well as the degree of pulmonary vascular endothelium damage was represented as lung/liver uptake ratios (L/L ratio). All of the controls and patients had no smoking histories. None of the controls and patients had positive findings of plain chest radiograph (CXR) and pulmonary function test (PFT).

RESULTS

The results showed that significantly higher L/L ratio in the 10 patients (0.53 +/- 0.07) than in the 10 controls (0.30 +/- 0.07) (the p value < 0.05). Using a cut-off value of 0.40, all of the 10 patients had abnormally increased L/L ratios.

CONCLUSIONS

We conclude that 99mTc HMPAO lung scan has the potential to be a sensitive, objective and noninvasive method to detect inhalation lung injury of patients with pulmonary symptoms/signs but negative CXR and PFT findings after a fire accident.

A pilot trial of quantitative Tc-99m HMPAO and Ga-67 citrate lung scans to detect pulmonary vascular endothelial damage and lung inflammation in patients of collagen vascular diseases with active diffuse infiltrative lung disease

Diffuse infiltrative lung disease (ILD) includes a heterogeneous group of disorders predominantly affecting lung parenchyma and sparing the airway. To assess the degree of pulmonary vascular endothelial damage in active ILD, lung/liver uptake ratios (L/L ratio) on technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan were determined in 30 patients with active ILD. Meanwhile, the gallium-67 citrate (Ga-67) uptake index (GUI) on Ga-67 lung scan was used to evaluate the severity of lung inflammation in active ILD. In this study, high-resolution CT (HRCT) was used to evaluate disease activity in ILD. The results show statistically significant differences between normal controls and patients with active ILD as shown in L/L ratios and GUI. However, when the patients were divided into two groups of 15 patients with normal chest X-ray findings and 15 with abnormal X-ray findings, there was no significant difference in those parameters. In addition, there was no statistically significant difference between the groups in HRCT scoring. No good correlation between the degree of pulmonary vascular endothelial damage and the severity of lung inflammation was found. In addition, there were no good correlations between HRCT scoring vs GUI and HRCT vs L/L ratio in different study subgroups. In conclusion, L/L ratios on Tc-99m HMPAO and GUI on Ga-67 lung scans differ from chest X-ray findings and have the potential to detect the degree of pulmonary vascular endothelial damage and severity of lung inflammation in active IDL. However, the relationships between HRCT scoring, GUI, and L/L ratio in patients with collagen vascular diseases and active ILD are not significant.

Increased lung uptake of technetium-99m hexamethylpropylene amine oxime in diffuse infiltrative lung disease

BACKGROUND

Diffuse infiltrative lung disease (ILD) is a heterogeneous group of disorders which predominantly affect the lung parenchyma and spare the airway.

OBJECTIVE

To assess pulmonary vascular endothelium damage in ILD, the lung uptake of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) was determined.

METHODS

In 20 ILD patients and 25 controls without ILD, the lung uptake of 99mTc-HMPAO was measured. Anterior lung imaging, including a large part of the liver, was made 10 min after intravenous injection of 20-25 mCi of 99mTc-HMPAO. Regions of interest covered the liver and lung to calculate the lung/liver uptake ratios. The 20 ILD patients included 10 patients with clinically manifest pulmonary disease (group 1) and 10 asymptomatic patients (group 2). All of the study subjects had normal pulmonary function test results.

RESULTS

The mean lung/liver uptake ratio in the 25 controls without ILD (0.36 +/- 0.10) was significantly lower than that in the 20 ILD patients (0.97 +/- 0.61). In addition, the mean lung/liver uptake ratio in the 10 ILD patients with clinically manifest pulmonary disease (1.45 +/- 0.51) was higher than that of the other 10 asymptomatic ILD patients (0.49 +/- 0.09).

CONCLUSIONS

Our results indicated that determining the lung/liver uptake ratio on 99mTc-HMPAO lung imaging should be an objective method to assess subclinical pulmonary damage in ILD patients.

Comparing the relationship of Taxol-based chemotherapy response with P-glycoprotein and lung resistance-related protein expression in non-small cell lung cancer

Our aim was to compare Taxol-based chemotherapy response of non-small cell lung cancer (NSCLC) with P-glycoprotein (Pgp) or lung resistance protein expression (LRP). Immunohistochemical analyses were performed on multiple nonconsecutive sections of the biopsy specimens to detect Pgp and LPR expressions in 40 patients with advanced NSCLC before Taxol-based chemotherapy. The chemotherapy response was evaluated by clinical and radiological methods in the third month after completion of treatment. No significant differences of prognostic factors (age, sex, body weight loss, performance status, tumor size, tumor stage, and tumor cell type) were found between the 20 patients with good and the 20 patients with poor responses. The incidence difference of positive Pgp expressions between good and poor responses was significant, however, the difference of LRP expression was not. We concluded that Taxol-based chemotherapy response of patients with NSCLC was related to Pgp but not LPR expression.

Technetium-99m tetrofosmin SPECT predicts chemotherapy response in small cell lung cancer

The multidrug resistance gene 1 encoding human P-glycoprotein (Pgp) is thought to play an important role in the multidrug resistance of lung cancer. The purpose of this study was to predict chemotherapy response by technetium-99m tetrofosmin (Tc-99m TF) lung single photon emission computed tomography (SPECT) and compare Pgp expression in patients with untreated small cell lung cancer (SCLC). Forty patients with untreated SCLC received Tc-99m TF lung SPECT prior to chemotherapy. The chemotherapy response was evaluated in the 3rd month after completion of treatment. Immunohistochemical staining of Pgp expression was performed on multiple nonconsecutive sections of biopsy specimens. By quantitative analyses, tumor to background ratios were 1.86 +/- 0.27 and 1.17 +/- 0.26 for patients with a good and poor response, respectively (p < 0.05). All of the 20 patients with a good chemotherapy response also had a positive Tc-99m TF lung SPECT and negative Pgp expression. In contrast, only 4 of the 20 patients with a poor chemotherapy response had a positive Tc-99m TF lung SPECT. Moreover, 10 of the 20 patients with a poor chemotherapy response also had negative Pgp expression (p < 0.05). Therefore, we concluded that Tc-99m TF lung SPECT can accurately predict the chemotherapy response, and Tc-99m TF lung SPECT findings can be partially compatible with Pgp expression in patients with untreated SCLC.

Usefulness of technetium-99 m sestamibi myocardial perfusion SPECT in detection of cardiovascular involvement in patients with systemic lupus erythematosus or systemic sclerosis

The main purpose of the study was to evaluate the utility of technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (Tc-99m sestamibi SPECT) in detection of cardiac involvement in systemic lupus erythematosus (SLE) or systemic sclerosis (SS) patients. Fifty SLE or SS female patients with cardiac symptom/sign such as chest discomfort and/or dyspnea and/or occasionally palpitation and 50 SLE or SS female patients without any cardiac symptom/sign were investigated using Tc-99m sestamibi SPECT during rest and stress after dipyridamole infusion. Twenty-five age- and sex-matched healthy females were also included as controls in this study. The results of Tc-99m sestamibi SPECT were classified into four types including normal, persistent perfusion defect (PD), reversible perfusion defect (RD), and reverse perfusion defect (RR). The results of Tc-99m sestamibi SPECT in the 25 healthy females were normal. Perfusion abnormalities were detected in 44/50 (88%) symptomatic SLE or SS patients. However, myocardial perfusion abnormalities were only detected in 19/50 (38%) asymptomatic SLE or SS patients (P value<0.05 by a chi2 test). However, for risk factor of coronary artery disease and abnormal resting EKG, the incidences were not significant between symptomatic and asymptomatic patients (P values >0.05 by a chi2 test). Tc-99m sestamibi SPECT is a useful noninvasive imaging modality to detect cardiac involvement in symptomatic or asymptomatic SLE or SS patients.

The effects of one-week fluticasone propionate inhalation therapy for Tc-99m DTPA radioaerosol distribution in asthma of children: a preliminary report

This study evaluated the effects of fluticasone propionate inhalation therapy for the distribution pattern of Tc-99m DTPA radioaerosols in 10 children with asthma. The homogeneous degree of depositing Tc-99m DTPA radioaerosol was evaluated using a modified standard score system over the bilateral lungs. The baseline scores were calculated from Tc-99m DTPA radioaerosol inhalation lung scintigraphy before inhalation therapy (100 microg fluticasone propionate two times daily for one week), and the scores were recalculated after inhalation therapy to evaluate the effects of one-week of fluticasone propionate inhalation therapy for Tc-99m DTPA radioaerosol distribution patterns. After one week of fluticasone propionate inhalation therapy, the scores were decreased in all of the 10 children, which may mean that the bronchial constriction degree due to asthma is decreased. In addition, there was a significantly statistical difference in the scores before and after one-week fluticasone propionate inhalation therapy (p < 0.05). In conclusion, one-week fluticasone propionate inhalation therapy could significantly improve the bronchial constriction due to asthma in children based on the evidence of Tc-99m DTPA radioaerosol inhalation lung scintigraphic findings.

A comparative study on body figure and serum lipid profile between aboriginal and Chinese elementary schoolchildren in mid-Taiwan

The aim of this study was to compare the body figure and serum lipid profiles of aboriginal students living in rural side in Nantou and Chinese students living in Taichung City.

METHODS

Body figure and blood lipid profile was examined in elementary school fifth grade aboriginal students in Nantou and Chinese students in Taichung City, aged 10-year-10-month old to 11-year-6-month old.

RESULTS

In girls, aboriginal students in Nantou have higher body mass index (BMI) (20.7 vs. 17.83 kg/m2, p < 0.01) and percentage of overweight (46.43% vs. 21.28%, p < 0.05) than Chinese students in Taichung City. However, Chinese girls have higher levels of total cholesterol (175.17 vs. 150.36 mg/dL, p < 0.01), low-density lipoprotein cholesterol (104.31 vs. 92.78 mg/dL, p < 0.05), and high-density lipoprotein cholesterol (54.96 vs. 43.49 mg/dL, p < 0.01) than aboriginal girls. In boys, body height of Chinese students in Taichung city is significantly higher (144.37 vs. 139.71 cm, p < 0.01) than aboriginal students but other body figure and blood lipid profile have no significant difference.

CONCLUSIONS

Our results suggest that in Taiwan BMI and blood lipid profile differ in female children by race and geographical location but this is not so for male children.

High prevalence of asymptomatically poor muscle perfusion of lower extremities measured in type II diabetes patients with abnormal myocardial perfusion

Foot problems are the most common cause of hospital admission in patients with type II diabetes mellitus (DM). Poor muscle perfusion of lower extremities is thought to be the major component in the pathogenesis of foot problems. Therefore, it is important and interesting to investigate if high prevalence of poor muscle perfusion of lower extremities in type II DM patients with abnormal myocardial perfusion and more cardiovascular risk factors. We used a well-established and noninvasive radionuclide method (Xe-133 muscle washout) to objectively evaluate the anterior tibial muscle perfusion of 60 type II DM male patients without symptoms/signs of peripheral vascular disease (PVD) in the lower extremities. The patients were separated into groups according to the myocardial perfusion imaging results and cardiovascular risk factor survey. Meanwhile, 30 normal male controls with a matched age distribution were also included for comparison. The muscle perfusions were of significant difference (P-values <.05) between (1) 60 type II DM patients (1.84+/-0.43 ml/100 g/min) and 30 normal controls (2.95+/-0.52 ml/100 g/min), (2) 24 patients with abnormal myocardial perfusion (1.31+/-0.45 ml/100 g/min) and 36 patients with normal myocardial perfusion (2.24+/-0.48 ml/100 g/min), as well as (3) 28 patients with more cardiovascular risk factors (1.33+/-0.46 ml/100 g/min) and 22 patient with less cardiovascular risk factors (2.22+/-0.49 ml/100 g/min). Based on Xe-133 muscle washout method, we concluded that the muscle perfusion in the lower extremities of type II DM patients without symptoms/signs of PVD is significantly decreased and related to abnormal myocardial perfusion and more cardiovascular risk factors.

Using technetium-99m tetrofosmin chest imaging to predict taxol-based chemotherapy response in non-small cell lung cancer but not related to lung resistance protein expression

In vitro studies have shown that technetium-99m tetrofosmin (Tc-99m TF) is a transport substrate for the P-glycoprotein (Pgp) pump. Therefore, Tc-99m TF uptake of tumors can be used to predict chemotherapy response in lung cancers. However, whether lung resistance-related protein (LRP) expression affects tumor accumulation and efflux of Tc-99m TF in lung cancers is not known. Our aim was to use Tc-99m TF uptake of tumors to predict paclitaxel-based chemotherapy response of non-small cell lung cancer (NSCLC) and to compare Pgp or LRP expression. Twenty patients with advanced NSCLC received Tc-99m TF chest images before Taxol-based chemotherapy was used in this study. The chemotherapy response was evaluated by clinical and radiological methods in the third month after completion of treatment. No significant differences of prognostic factors (age, sex, body weight loss, performance status, tumor size, tumor stage, and tumor cell type) were found between the patients with good and those with poor responses. Early and delayed tumor/normal lung (T/L) uptake ratios were calculated on Tc-99m TF chest images. Immunohistochemical analyses were performed on multiple nonconsecutive sections of the biopsy specimens to detect Pgp and LPR expressions. The early and delayed T/L uptake ratios of 10 patients with good response were significantly higher than those of the other 10 patients with poor response. Significantly higher early and delayed T/L uptake ratios were found in patients with negative than those with positive Pgp expression ( p < 0.05). However, no significant differences of early and delayed T/L uptake ratios were found between patients with negative and positive LRP expressions ( p > 0.05). We found that Tc-99m TF imaging could accurately predict Taxol-base chemotherapy response. In addition, the Tc-99m TF tumor uptake was related to Pgp but not LPR expression in NSCLC.

Usefulness of technetium-99m hexamethylpropylene amine oxime lung scan to detect subclinical lung injury in patients with chronic renal failure

We used technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan to detect subclinical lung injury in patients with chronic renal failure (CRF), on regular hemodialysis (HD), who had normal chest X-ray findings (CXR) and pulmonary function test (PFT). The degree of pulmonary vascular endothelium damage was represented as lung/liver uptake ratios (L/L ratios) calculated by Tc-99m HMPAO lung scan. The L/L ratios of the 20 male CRF patients on HD with normal CXR and PFT were compared with those of the 20 male normal controls. The results show that the L/L ratios on Tc-99m HMPAO lung scans were significantly higher in CRF patients on HD (1.06 +/- 0.55) than those in normal controls (0.34 +/- 0.09). Using a cut-off value of 0.50, 18/20 [90%] CRF patients had abnormally increased L/L ratios. Our findings concluded that the pulmonary vascular endothelium damage represented as significantly increased L/L ratios on Tc-99m HMPAO lung scan in CRF patients on HD with normal CXR and PFT. In addition, Tc-99m HMPAO lung scan has the potential to be a sensitive, objective and noninvasive method to detect subclinical lung injury of CRF patients on HD, which is different from the traditional studies such as CXR or PFT.

Differentiating Solitary Pulmonary Metastases in Patients with Renal Cell Carcinomas by 18F-Fluoro-2-Deoxyglucose Positron Emission Tomography – A Preliminary Report

OBJECTIVE

This preliminary study was to evaluate the characteristics of indeterminate solitary pulmonary lesions in patients with renal cell carcinomas (RCC) using (18)F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET).

MATERIAL AND METHODS

Fifteen patients with RCC were found to have solitary pulmonary lesions with indeterminate chest X-ray and CT findings. Pulmonary metastases were suspected in all cases so whole body surveys with FDG-PET were performed.

RESULTS

FDG-PET correctly identified 9 true-positive and 4 true-negative cases. However, FDG-PET failed to interpret 1 false-positive and 1 false-negative case. Standard uptake values (SUV) were used as parameters to differentiate the solitary pulmonary lesions. Using SUV >2.5 as the cutoff to diagnose malignancy, the sensitivity, specificity, and accuracy of FDG-PET were 90, 80, and 87%, respectively.

CONCLUSION

We conclude that FDG-PET is an accurate modality to differentiate solitary pulmonary lesions in patients with RCC.

Comparing thallium-201 spect mammoscintigraphy and ultrasonography to detect breast cancer in mammographical dense breasts

The aim of our study was to compare the usefulness of thallium-201 (Tl-201) single photon emission computed tomography (SPECT) mammoscintigraphy and ultrasonography to detect breast cancer in mammographical dense breasts. This study included 32 Taiwanese female patients with indeterminate mammographic probability of malignancy due to mammographical dense breasts. Both Tl-201 SPECT mammoscintigraphy and ultrasonography were performed for each patient. Then, all of the 32 breast masses undervent biopsies or operations to obtain finally pathological diagnoses. Based on the finally pathological diagnoses, 24 masses were breast cancer and 8 masses were benign breast tumors among the 32 patients. Twenty-two cancers and one benign tumor had positive Tl-201 SPECT mammoscintigraphic findings. The sensitivity, specificity, and accuracy were 92%, 88%, and 91%. Twenty-two cancers and 5 benign tumors had positive ultrasonographic findings. The sensitivity, specificity, and accuracy were 92%, 38%, and 78%, respectively. To detect breast cancer in patients with non-diagnostic mammogram because of mammographically dense breasts, Tl-201 SPECT mammoscintigraphy and ultrasonography have the same sensitivity to screen breast masses. However, due to its higher specificity, Tl-201 SPECT mammoscintigraphy should be useful to confirm the ultrasonographic findings.

Usefulness of chest single photon emission computed tomography with technetium-99m methoxyisobutylisonitrile to predict taxol based chemotherapy response in advanced non-small cell lung cancer

In vitro studies have shown that technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) is a transport substrate for the P-glycoprotein (Pgp) pump. Therefore, Tc-99m MIBI uptake of tumors can be used to predict chemotherapy response in lung cancers. However, whether lung resistance-related protein (LRP) expression affects tumor accumulation and efflux of Tc-99m MIBI in lung cancers is not known. Our aim was to use Tc-99m MIBI uptake of tumors to predict Taxol based chemotherapy response of advanced non-small cell lung cancer (NSCLC) and to compare Pgp or LRP expression. Before chemotherapy with Taxol, 30 patients with stage IIIb or IV NSCLC were enrolled in this study. Chemotherapy response was evaluated in the third month after completion of treatment by clinical and radiological methods. No significant differences were found for other prognostic factors (age, sex, body weight loss, performance status, tumor cell type, and tumor stage) between the 15 patients with good response and the other 15 patients with poor response. Early chest single photon emission computed tomography (SPECT) was performed 10 min after intravenous injection of Tc-99m MIBI. Early tumor-to-normal lung (T/L) uptake ratios were calculated quantitatively on Tc-99m MIBI chest SPECT images. Immunohistochemical analyses were performed on multiple nonconsecutive sections of the biopsy specimens to determine Pgp and LRP expressions. The T/L uptake ratios on early Tc-99m MIBI chest SPECT images of 15 patients with good response were significantly higher than those of the other 15 patients with poor response. Significantly higher T/L uptake ratios were found in patients with negative than positive Pgp expression (p<0.05). However, no significant differences of T/L uptake ratios were found between patients with negative and positive LRP expressions (p>0.05). We concluded that Tc-99m MIBI chest SPECT could accurately predict Taxol base chemotherapy response of patients with advanced NSCLC. In addition, The Tc-99m MIBI tumor uptake was related to Pgp but not LPR expression in NSCLC.

Using Tc-99m DMSA renal cortex scan to detect renal damage in women with type 2 diabetes

Women with diabetes mellitus (DM) have urinary tract infection (UTI) more often than women without DM. It is unknown, however, what the prevalence and type of renal damage due to UTI is in these women. Therefore, in this study, we compared type 2 DM women with or without UTI history for the prevalence and type of renal damage by technetium-99m dimercapto-succinic acid (Tc-99m DMSA) renal scan. A total of 128 type 2 DM women with or without UTI history received Tc-99m DMSA renal scan were included in this study. The patients were separated into three groups: (1) 43 patients without UTI history, (2) 42 patients with only lower UTI (cystitis) history and (3) 43 patients with upper UTI (pyelonephritis) history. The renal scan findings were separated into three types: (A) normal, (B) inflammation and (C) scar. The 31.9% (50/128) of type 2 DM patients had renal damages. Group 1 patients had a significantly lower prevalence of renal damages including inflammation and scar as compared to Groups 2 and 3 patients. In addition, the prevalence of renal damage was significantly higher in Group 3 than in Group 2 patients. Renal scars only were visualized in Group 3 patients. However, other clinical data were not statistically different among the three group patients. Type 2 DM women with UTI history, especially if they had upper UTI have a significantly higher prevalence of renal damage than in those without UTI.

Detecting metastatic pelvic lymph nodes by 18F-2-deoxyglucose positron emission tomography in patients with prostate-specific antigen relapse after treatment for localized prostate cancer

AIM

To evaluate whether positron emission tomography (PET) with (18)F-2-deoxyglucose (FDG) can detect pelvic lymph node metastases in prostate cancer patients who had elevated serum prostate-specific antigen (PSA) levels after treatment.

METHODS

Twenty-four patients with a rising serum PSA level after treatment for localized prostate cancer were examined with FDG-PET before pelvic lymph node dissection. All patients had negative findings on whole body bone scan and equivocal pelvic computed tomography (CT) results. The results of FDG-PET were then compared to the histology of the pelvic lymph nodes obtained at surgery.

RESULTS

Lymph node metastases were detected by histopathological examination in 16/24 (66.7%) patients. At the sites with histopathologically proven metastases, increased FDG uptake was found in 12/16 (75.0%) patients. In addition, there were 4 patients with false-negative results, but no patient with a false-positive result on FDG-PET images. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET in detecting metastatic pelvic lymph nodes were 75.0, 100.0, 83.3, 100.0, and 67.7%, respectively.

CONCLUSIONS

These results suggest that FDG-PET may be a valuable diagnostic tool in the staging of pelvic lymph nodes in patients with PSA relapse after treatment of localized prostate cancer when the whole body bone scan is negative and pelvic CT findings are equivocal.

Assessing transient pulmonary injury induced by volatile anesthetics by increased lung uptake of technetium-99m hexamethylpropylene amine oxime

Volatile anesthetics such as halothane and isoflurane have long been thought to affect pulmonary function. The purpose of this study was to examine whether volatile anesthetics (halothane and isoflurane) can induce pulmonary vascular endothelium damage. Before surgery, 1 h after surgery, and 1 week after surgery, the degree of pulmonary vascular endothelium damage was represented as increased lung/liver uptake ratios (L/L ratio) and measured on technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan in 3 groups of the patients. Group 1 included 20 patients undergoing surgery and receiving volatile anesthesia with 1% halothane. Group 2 included 20 patients undergoing surgery and receiving volatile anesthesia with 1.5% isoflurane. Group 3 included 20 patients undergoing surgery with intravenous anesthesia drugs. No significant change of L/L ratio was found from before surgery, 1 h after surgery, to 1 week after surgery in group 3 patients. In groups 1 and 2 patients, significantly transient increased L/L ratio was found 1 h after surgery. We conclude that volatile anesthesia (halothane and isoflurane) can induce transient pulmonary vascular endothelium damage, represented as transiently increased L/L ratios on Tc-99m HMPAO lung scan.

To predict response chemotherapy using technetium-99m tetrofosmin chest images in patients with untreated small cell lung cancer and compare with p-glycoprotein, multidrug resistance related protein-1, and lung resistance-related protein expression

Our preliminary studies found technetium-99m tetrofosmin (Tc- TF) chest imaging was related to Pgp or MRP1 expression and successfully predict chemotherapy response and in SCLC in human. However, there was no published literature to study relationship of Tc-TF chest images and LRP expression in SCLC patients. Therefore, the aim of this study was to investigate the relationships among Tc- TF accumulation in untreated small cell lung cancer (SCLC), the expression of P-glycoprotein (Pgp), multidrug resistance related protein-1 (MRP1), and lung resistance-related protein (LRP), as well as the response to chemotherapy in patients with untreated SCLC. Thirty patients with SCLC were studied with chest images 15 to 30 minutes after intravenous injection of Tc-TF before chemotherapeutic induction. Tumor-to-background (T/B) ratios were obtained on the static and plantar Tc-TF chest images. The response to chemotherapy was evaluated upon completion of chemotherapy by clinical and radiological methods. These patients were separated into 15 patients with good response and 15 patients with poor response. No significant differences of prognostic factors (Karnofsky performance status, tumor size, or tumor stage) were found between the patients with good and poor responses. Immunohistochemical analyses were performed on multiple nonconsecutive sections of biopsy specimens to detect Pgp, MRP1, and LRP expression. The difference in T/B ratios on the Tc-TF chest images of the patients with good versus poor response was significant. The differences in T/B ratios of the patients with positive versus negative Pgp expression and with positive versus negative MRP1 expression were significant. The difference in T/B ratios of the patients with positive versus negative LRP expression was not significant. We concluded that Tc-TF chest images could accurately predict chemotherapy response of patients with SCLC. In addition, The Tc-TF tumor uptake was related to Pgp or MRP1 but not LPR expression in SCLC.

Detecting abnormal regional cerebral blood flow in patients with primary Sjögren's syndrome by technetium-99m ethyl cysteinate dimer single photon emission computed tomography of the brain--a preliminary report

Technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in 32 female patients with primary Sjögren's syndrome (PSS) showing definite neuropsychiatric symptoms/signs and normal brain magnetic resonance imaging (MRI) findings. It demonstrated hypoperfusion brain lesions in 18 (56.3%) of the patients, most frequently in the parietal lobes, and appears to be a sensitive tool for this clinical application.

Usefulness of quantitative Tc-99m HMPAO and Ga-67 citrate lung scans in detecting pulmonary vascular endothelium damage and lung inflammation in patients with systemic lupus erythematosus: a preliminary report

Pulmonary vascular endothelium damage in 34 patients with systemic lupus erythematosus (SLE) was measured by technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan. The degree of damage was represented as lung/liver uptake (L/L) ratio. The patients were divided into two subgroups according to the following criteria: (a) clinical features, separated as stable or flare stage and (b) chest X-ray findings separated as positive or negative results. Meanwhile, quantitative gallium-67 citrate (Ga-67) lung scan was performed as Ga-67 uptake index (GUI) to evaluate the severity of inflammation in the SLE lungs. The results show (a) no significant statistical differences in the degree of pulmonary vascular endothelium damage (the L/L ratio on Tc-99m HMPAO lung scan) between the two subgroups according to clinical features or chest X-ray findings and (b) no good correlation between the degree of pulmonary vascular endothelium damage and lung inflammation (GUI on Ga-67 lung scan). In conclusion, the change in pulmonary vascular endothelium damage in SLE may be unrelated to the clinical presentation or chest X-ray findings, and its degree is not related to the severity of pulmonary inflammation.

Usefulness of technetium-99m tetrofosmin liver imaging to detect hepatocellular carcinoma and related to expression of P-glycoprotein or multidrug resistance associated protein-a preliminary report

Technetium-99m Tetrofsomin (Tc-TF) has been shown to be useful in identifying several types of tumors, such as breast, lung, and thyroid cancers. There was no report in the literature for Tc-TF uptake in hepatocellular carcinoma (HCC). The aim of this study was to evaluate the usefulness of Tc-TF liver imaging to detect HCC and investigate the relationship between Tc-TF liver imaging findings and P-glycoprotein (Pgp) and multidrug resistance associated protein (MRP) expression. Before any therapy, 22 patients with HCC were enrolled in this study. Tc-TF liver images were performed l0 minutes after intravenous injection of 20mCi Tc-TF. All patients had liver biopsy or surgery within l week after Tc-TF liver imaging. Immunohistochemical study of the biopsy or resected HCC specimens was performed using anti-human Pgp and MRP antibodies. Twenty of the 22 (90.9%) patients showed negative Tc-TF liver imaging results without significant Tc-TF uptake in HCC, whereas only the remaining 2 (9.1%) patients showed positive Tc-TF liver imaging results with significant Tc-TF uptake in HCC. Positive Pgp expression was observed in 13 of 20 patients with negative Tc-TF liver imaging results, whereas positive MRP expression was observed in 6 of the remaining 7 patients with negative both Tc-TF liver imaging results and Pgp expression. However, negative Pgp expression but positive MRP expression was observed in all of the remaining 2 patients with positive Tc-TF liver imaging results. The correlation between Tc-TF liver imaging findings and Pgp expression was significant and better than between Tc-TF liver imaging findings and MRP expression. Pgp or MRP expression in HCC may induce no significant Tc-TF uptake in HCC resulting in negative Tc-TF liver imaging findings. Therefore, Tc-TF liver imaging is potential to be a non-invasive method to predict Pgp or MRP expression in HCC. However, further studies with a larger series of patients and longer follow-up time are necessary to confirm our findings.

Evaluating the changes in alveolar permeability and lung ventilation in patients with chronic renal failure after haemodialysis using 99mTc-DTPA radioaerosol inhalation lung scan

Hypoxaemia occurring in patients with chronic renal failure (CRF) during haemodialysis (HD) has long been known. Several mechanisms of pathogenesis have been proposed. Before and after regular HD, lung ventilation (LV) and alveolar permeability (AP) were measured in 24 male patients with CRF (age, 61-75 years). LV and AP were determined by 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) radioaerosol inhalation lung scan (99mTc-DTPA lung scan). The LV images were visually interpreted according to established criteria, including the presence or absence of an inhomogeneous distribution, inverted base to apex gradient and segmental hypoventilation. The degree of AP in the total right lung was presented as the clearance rate (K; %.min-1) of the time-activity curve from dynamic total right lung images. Ten male normal controls (age, 62-76 years) were enrolled in the study for comparison. Ten of 24 (42%) cases showed an inhomogeneous distribution and eight of 24 (33%) cases showed hypoventilation on equilibrium LV images. After regular HD for 5 h, no significant changes in the LV images were found. Before HD, the CRF patient group (K=1.14+/-0.36%.min-1) had a significantly faster clearance rate than that of normal controls (0.75+/-0.14%.min-1, P<0.05). Moreover, the clearance rate after HD was significantly slower (0.87+/-0.15%.min-1, P<0.05) than that before HD. CRF can predispose patients to LV change and AP damage. After HD, the damage to AP is significantly improved. However, after HD, the change in LV is not significant.

Lumbar bone mineral density in prostate cancer patients with bone metastases

Because of the discrepant findings on regional bone mineral density (BMD) in stage IV patients with bone metastases due to prostate cancer, we decided to evaluate BMD of lumbar spines in 30 prostate cancer patients with lumbar spine metastases. These measurements of BMD in lumbar spines were compared with 30 stage IV prostate cancer patients without lumbar spine metastases.

METHODS

Before BMD measurements, the bone scan with technetium-99m labeled diphosphonate was carried out in all of the men to evaluate lumbar spine metastases. Dual energy x-ray absorptiometry was used to measure BMD in the lumbar spines.

RESULTS

There was no difference of age, height, weight, and body mass index between the two group patients. However, significantly higher BMD of the lumbar spines in the 30 patients of prostate cancers with lumbar spine metastases was found (p value <0.05).

CONCLUSIONS

Our results show that patients of prostate cancers with lumbar spine metastases demonstrated by Tc-99m MDP bone scan have increased BMD in the lumbar spines, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by Tc-99m MDP bone scan.

The influence of volatile anesthetics on alveolar epithelial permeability measured by noninvasive radionuclide lung scan

Many volatile anesthetics have long been thought to affect pulmonary functions including lung ventilation (LV) and alveolar epithelial permeability (AEP). The purpose of this study is to examine the influence of volatile anesthetics on LV and AEP by noninvasive radionuclide lung imaging of technetium-99m labeled diethylene triamine pentaacetic acid radioaerosol inhalation lung scan (DTPA lung scan). Twenty patients undergoing surgery and receiving volatile anesthesia with 1% halothane were enrolled as the study group 1. The other 20 patients undergoing surgery and receiving volatile anesthesia with 1.5% isoflurane were enrolled as the study group 2. At the same time, 20 patients undergoing surgery with intravenous anesthesia drugs were included as a control group. Before surgery, 1 hour after surgery, and 1 week after surgery, we investigated the 3 groups of patients with DTPA lung scan to evaluate LV and AEP by 99mTc DTPA clearance halftime (T1/2). No significant change or abnormality of LV before surgery, 1 hour after surgery, or 1 week after surgery was found among the 3 groups of patients. In the control group, the 99mTc DTPA clearance T1/2 was 63.5 +/- 16.4, 63.1 +/- 18.4, and 62.8 +/- 17.0 minutes, before surgery, 1 hour after surgery, and 1 week after surgery, respectively. In group 1, it was 65.9 +/- 9.3, 62.5 +/- 9.1, and 65.8 +/- 10.3 minutes, respectively. No significant change in AEP before surgery, 1 hour after surgery, or 1 week after surgery was found. However, in group 2, the 99mTc DTPA clearance T1/2 was 65.5 +/- 13.2, 44.9 +/- 10.5, and 66.1 +/- 14.0 minutes, respectively. A significant transient change in AEP was found 1 hour after surgery, but it recovered 1 week after surgery. We conclude that volatile anesthesia is safe for LV and AEP, and only isoflurane can induce transient change of AEP.