Influence of human anti-mouse antibodies on thyrotropin in-vitro analysis: a comparison of 6 thyrotropin IRMA kits

OBJECTIVE

The aim of the study was to evaluate the influence of human anti-mouse antibodies on the measurement of thyrotropin.

INVESTIGATIONS

Samples from 11 patients with measureable human anti-mouse antibody titres (19 micrograms/l-3880 micrograms/l) after radioimmuno-scintigraphy were analysed with 6 different thyrotropin immuno-radiometric assay kits (IRMA). Each sample was analysed in the routine way (sample influenced by human anti-mouse antibodies), as well as after incubation with murine immunoglobulin to precipitate human anti-mouse antibodies (samples not influenced by human anti-mouse antibodies).

RESULTS

Two kits showed clear deviations of measured thyrotropin levels when the human anti-mouse antibody titres were higher than 1350 micrograms/l. A third kit was influenced to a lesser extent by human anti-mouse antibodies. Three of the 6 investigated thyrotropin IRMA kits produced thyrotropin values that were unaffected by the presence of elevated human anti-mouse antibodies. In comparison with former studies after immunotherapy, the thyrotropin deviations were marginal. However, differences were found between the commercially available thyrotropin assays. According to the results of this study only three out of the six investigated kits were unaffected by human anti-mouse antibodies.

CONCLUSION

Since thyrotropin is one of the key quantities for the endocrinologist dealing with the thyroid gland, every laboratory should ensure high quality thyrotropin assays by critically analysing their method for human anti-mouse antibody.

Technetium-99m-tetrofosmin uptake in sarcoidosis stage I

The uptake of 99mTc-tetrofosmin in enlarged lymph nodes, of the lung hilus, in the case of sarcoidosis Stage I (histopathologically confirmed by mediastinoscopic biopsy) is demonstrated. On a routine chest radiograph of a 78-yr-old woman, hilar lymphadenopathy was first detected. In the following mammography, disseminated micro calcifications were found in the left breast and a 99mTc-tetrofosmin study was performed for detection of breast cancer. Scintigraphy using 99mTc-tetrofosmin showed clear uptake in the hilar lymph nodes, but not in the left breast. The 99mTc-tetrofosmin uptake in the hilar lymph nodes was due to sarcoidosis confirmed by histology. Therefore, 99mTc-tetrofosmin scintigraphy may be useful in patients with suspected sarcoidosis, especially in Stage I.

Toxoplasma gondii infection in the mountain hare (Lepus timidus) and domestic rabbit (Oryctolagus cuniculus). II. Early immune reactions

As already reported, the mountain hare is much more susceptible than the domestic rabbit to oral inoculation with Toxoplasma gondii, as judged by pathological changes and dissemination of parasites within the body. In the present paper, further interspecies variations are reported. Concentrations of the acute phase reactant haptoglobin were raised in hares but not in rabbits one week post-infection (pi), probably reflecting the severe tissue damage present. No difference in the early humoral immune response of hares and rabbits was found, both species producing IgM and IgG antibodies to T. gondii one week pi. Lymphocyte stimulation tests performed before and one week after inoculation showed a high proliferative response to the parasite in blood cell cultures from rabbits but not hares. The fatal outcome of T. gondii infection in the hares is probably due, at least in part, to the lack of cellular response.

Clinical observations, pathology, bioassay in mice and serological response at slaughter in pigs experimentally infected with Toxoplasma gondii

Experimental infections of a total of 47 pigs with tachyzoites of the Toxoplasma gondii RH-strain, tissue cysts of the SSI-119 and R92 strains as well as oocysts of the SSI-119 strain were performed to determine the sensitivity of an indirect IgG-ELISA, using tachyzoite lysate of the RH-strain as antigen. The infections led to a dose dependent moderate clinical affection (inappetence, fever and poor general condition). Pigs infected with 10000 oocysts or with 1/2 mouse brain containing tissue cysts of the SSI-119 strain showed a significant decrease in weight gain compared to uninoculated pigs during the first 2 weeks p.i., followed, however, by compensatory growth during the next 6 weeks. At slaughter 3 to 4 months after inoculation 39/41 (95.1%) of pigs positive by bioassay in mice were seropositive in ELISA. Tissue cysts were not demonstrable by immunohistochemistry. ELISA OD-values obtained by analysis of meat juice from heart muscle and tongue (diluted 1:40) correlated strongly with OD-values by analysis of serum (diluted 1:400) (r heart juice = 0.942; r tongue juice = 0.915). Thus, meat juice samples were shown to provide a suitable alternative to serum for serological detection of Toxoplasma infection in pigs.

Gamma probe-guided resection of a lymph node metastasis with I-123 in papillary thyroid carcinoma

The authors report the case of a 27-year-old woman with gamma probe-guided resection of a recurrent regional lymph node metastasis in papillary thyroid cancer. Reoperation is often impaired in cases with extensive scarring because of previous surgery, high-dose radioiodine therapy, and external irradiation. In this case with nodal metastasis, the high I-123 uptake allowed more rapid intraoperative detection and influenced the surgical approach. Evidence of complete removal of tumor tissue could be given intraoperatively by measuring the tumor bed, and this was confirmed by postoperative normalization of Tg levels and a negative I-131 scan. In other locations, and especially for small solitary lesions, gamma probe-guided surgery may be a promising alternative to high dose I-131 therapy.

Technetium 99m tetrofosmin parathyroid imaging. Results with double-phase study and SPECT in primary and secondary hyperparathyroidism

RATIONALE AND OBJECTIVES

The aim of our study was to evaluate the sensitivity, specificity, and positive predictive value (PPV) of technetium 99m (99mTc) tetrofosmin double-phase scintigraphy and single-photon emission computer tomography (SPECT) in preoperative localization of parathyroid adenoma in case of primary and secondary hyperparathyroidism (HPT).

METHODS

Sixty-eight consecutive patients biochemically or sonographically suspected of parathyroid adenoma were included in our study. Apart from biochemical analysis of serum calcium, phosphate, and intact parathyroid hormone, double-phase scintigraphy was performed in each patient 5 and 45 minutes after injection of 370 MBq 99mTc tetrofosmin, followed by SPECT imaging. In consciousness of the scintigraphic results, ultrasound of the neck was performed as well to exclude false-positive results due to thyroid adenomas.

RESULTS

Depending on the results of the biochemical analysis in combination with the results of the scintigraphic and ultrasound examination, the patients were classified retrospectively into three groups: group A with primary HPT (n = 35), group B with secondary HPT (n = 13), and group C without any biochemical suspicion of primary or secondary HPT (n = 20). In group A, double-phase study localized 25 of 36 (69.2%) parathyroid adenomas (one double adenoma) as against 34 of 36 (94.4%) with SPECT. Nine adenomas could be visualized only by SPECT. The reason for nonvisualization on planar scans was suspected to be an ectopic location in 2 cases (retrotracheal dislocation, retrovascular dislocation), a maximal diameter less than 15 mm (9-13 mm) in 6 cases, and oxyphilic-cell-poor cellularity in 1 case. Four false-positive retention (3 thyroid adenomas and 1 papillary thyroid carcinoma) were observed. SPECT showed a sensitivity of 94.4%, a specificity of 85%, and a PPV of 91.9% in biochemically suspected primary HPT. In group B, planar scintigraphy demonstrated 12 hyperplastic glands in 5 of 13 patients, and SPECT demonstrated 20 hyperplastic parathyroid glands in 8 out of 13 patients, which corresponds to a sensitivity of 38% and 61.5%, respectively.

CONCLUSIONS

Technetium 99m tetrofosmin seems to be a promising alternative tracer with similar capabilities to 99mTc sestamibi in localization of parathyroid adenoma. SPECT showed clear advantages in terms of sensitivity over planar scintigraphy and should be used at least in cases with poor or no uptake in double-phase study. In endemic goiter areas, ultrasound of the neck should be performed to exclude false positive retention in thyroid adenomas. Technetium 99m tetrofosmin, like 99mTc sestamibi, is not ideal for localization of hyperplastic glands in secondary hyperparathyroidism because of low sensitivity.

Workers exposed to thermal degradation products of TDI- and MDI-based polyurethane: biomonitoring of 2,4-TDA, 2,6-TDA, and 4,4'-MDA in hydrolyzed urine and plasma

The aim of the study was to investigate biomarkers of exposure to thermal degradation products of 2,4- and 2,6-toluene diisocyanate (TDI)- and 4,4'-methylenediphenyl diisocyanate (MDI)-based polyurethane and the toxicokinetics of these products. Blood and urine were collected from 15 factory workers exposed to thermal degradation products of MDI-based polyurethane glue and TDI-based flexible foam. Four of these workers were also studied during an exposure-free period. Urine and plasma were analyzed after acidic hydrolysis and the concentrations of the isocyanates' corresponding amines, 2,4-, 2,6-toluenediamine (TDA), and 4,4'-methylenedianiline (MDA), were determined as derivatives of pentafluoropropionic anhydride by gas chromatography using chemical ionization mass spectrometry monitoring negative ions. Urinary elimination rates were in the range of < 0.01-5.7 micrograms of 2,4-TDA per hour, < 0.01-3.5 micrograms of 2,6-TDA per hour, and < 0.01-1.6 micrograms of 4,4'-MDA per hour. Plasma levels were in the range of < 0.1-5.5 ng of 2,4-TDA per mL, < 0.1-2.3 ng of 2,6-TDA per mL, and < 0.1-45 ng of 4,4'-MDA per mL. The urinary half-lives of 4,4'-MDA for four of the workers were found to be 59, 61, 73, and 82 hours. The half-lives of 4,4'-MDA in plasma were 10, 14, 16, and 22 days. Elimination rate peaks of 2,4-TDA, 2,6-TDA, and 4,4'-MDA in urine varied during and between workdays. The individual variation in plasma concentrations of 2,4-TDA, 2,6-TDA, and 4,4'-MDA with time was small, but between individuals the variation was great.

The time course of the specific antibody response by various ELISAs in pigs experimentally infected with Toxoplasma gondii

With the aim of developing routine serological tests for monitoring the Toxoplasma infection status of Danish swine herds, four ELISAs based on tachyzoite antigen were set up: (1) an indirect ELISA for IgG-antibody; (2) a blocking ELISA for antibody to the membrane antigen, P30; (3) an indirect ELISA for IgM; (4) a reverse, antibody-catching IgM-ELISA. Groups of pigs (number between 6 and 10) were inoculated with tachyzoites of the RH-strain, tissue cysts of two complete strains, or oocysts in two doses (10(3) and 10(4). All inoculations were tolerated well. Irrespective of strain and stage used for inoculation, specific IgG and anti-P30 blocking activity appeared after 1-2 weeks, with OD-values stabilizing after 3-6 weeks and persisting throughout the study period (3-4 months). Specific IgM appeared quickly, but was short-lived (approximately 2 weeks). A cut-off OD-value of 0.36 for positive seroreaction in the indirect IgG-ELISA was determined on the basis of 69 sera from four herds, investigated in the dye-test (serum dilution 1:10) and ELISA. The chosen cut-off gave optimal combined sensitivity and specificity of 0.94 and 0.92, respectively, using the dye-test as a standard. Corresponding figures for the blocking ELISA were 37% inhibition as cut-off, with sensitivity and specificity of 0.94 and 0.94, respectively. Sera from a total of 87 pigs, experimentally infected with bacteria of the genera Salmonella, Yersinia or Actinobacillus and with the parasites Isospora suis, Trichinella spiralis or Ascaris suum, in no case produced cross-reactions in the IgG-ELISA. However, 3/9 pigs inoculated with 50 000 sporocysts of Sarcocystis miescheriana gave maximal OD-readings of 0.40-0.45 during the 13-15 weeks observation period. None of the sera from heterologously infected animals produced inhibitions in the anti-P30 blocking ELISA exceeding 36%.

Serological assays for the identification of Oesophagostomum dentatum infections in pigs

Oesophagostomum dentatum antigen preparations of third (L3) or fourth (L4) stage larvae were characterised by Western blotting. Panels of sera obtained from pigs infected with O dentatum and Ascaris suum, respectively, reacted with the same bands of L3 antigen. In contrast high specificity against a characteristic band, was observed when L4 extract was employed as antigen. To establish an enzyme-linked immunosorbent assay (ELISA), a panel of homologous and heterologous sera was tested against O dentatum L4 extract. The best combined specificity and sensitivity was obtained when horseradish peroxidase (HRP) goat anti swine IgG conjugate was used rather than HRP rabbit anti swine Ig conjugate. Testing series of sera from pigs infected with single doses of either 2000, 20,000 or 200,000 infective larvae by the ELISA, a significant dose dependency in the antibody response was observed between the low and high dosage groups. This assay may be useful in future studies of the immune-mechanisms against nodular worm infections in pigs.

Evaluation of thyroid nodules with technetium-99m tetrofosmin dual-phase scintigraphy

Technetium-99m tetrofosmin, a lipophilic cationic complex molecule, was introduced for myocardial imaging. In some biodistribution studies it has also been reported to accumulate in the thyroid gland. Our objectives were to determine which thyroid nodules retain tetrofosmin and whether preoperative evaluation of malignancy is possible. Tetrofosmin scintigraphy was performed in 57 patients with a cold thyroid nodule on previously performed pertechnetate scintigraphy. All patients had undergone ultrasonography and sonographically guided fine-needle aspiration biopsy. The tetrofosmin scintigrams were obtained 5 min (early image) and 1 h (late image) after intravenous injection of 370 MBq. Only nodules that showed clear tracer retention after 1 h in comparison with retention at 5 min were classified as TETRO positive. Nodules without late retention were classified as TETRO negative. All patients underwent surgery and the histological results were compared with the results of tetrofosmin scintigraphy. Ten out of 11 patients with thyroid carcinoma (two pT1, three pT2, five pT4) were TETRO negative. One patient with papillary carcinoma (pT2) was TETRO positive. The mean nodular to thyroid tissue (N/T) ratio for the late scan was 1.0+/-0.20. There were 21 patients with thyroid adenomas (seven follicular, seven microfollicular and seven oxyphilic); 15 of these patients were TETRO positive and six TETRO negative. The mean N/T ratio for the late images was 1.34+/-0.41. All patients with degenerative goitre (24 cases) and the one patient with Hashimoto's disease were TETRO negative after 1 h and the N/T ratio was 0.92+/-0.12 on the late scan. Our results indicate that 99mTc-tetrofosmin scanning is of little value preoperatively in distinguishing thyroid carcinoma from other thyroid nodules. Tetrofosmin tends to demonstrate thyroid adenomas but does not have a routine role in the assessment of thyroid nodules.

Schwannoma of the neck simulating a thyroid nodule

A 31-year-old man is reported with the rare occurrence of a neurogenic tumor simulating a thyroid nodule. A growing nodule of the right neck was the only clinical symptom. Ultrasonography revealed a hypoechogenic nodule on the right side of the thyroid gland. Technetium (Tc)-99m pertechnetate showed a normal thyroid scintiscan. Due to ultrasonography-guided fine-needle aspiration biopsy, a schwannoma (neurilemmoma) was suspected. Surgical intervention removed the nodule and histology confirmed a schwannoma with Antoni A structures. To avoid unnecessary or inappropriate surgical intervention in cases of hypoechogenic nodules in connection with the thyroid gland, other nonthyroidal structures that may cause hypoechogenic patterns with ultrasonography should also be considered. The key preoperative investigations in such cases are ultrasonography and sonographically guided fine-needle aspiration biopsy.

[Diagnosis of achalasia using 99m-Tc pertechnetate scintigraphy]

A 73-year-old patient presented a 99mTc scintiscan with a focal tracer accumulation left and caudal of the thyroid gland. Further investigations with sonography, CT, esophagoscopy and barium swallow provided the diagnosis of achalasia as the reason for focal 99mTc retention caudal of the thyroid gland. Explanation for 99mTc accumulation within the esophagus may be the nonspecific accumulation of 99mTc not only in the thyroid gland but also in the salivary glands. Excretion of the tracer follows with the saliva. Structural and motor disorders of the esophagus can thus lead to focal tracer retention within the esophagus simulating thyroid tissue.

Detection of antibodies to Salmonella lipopolysaccharide in muscle fluid from cattle

OBJECTIVE

To compare muscle fluid with serum samples for detection of antibodies to Salmonella lipopolysaccharide.

SAMPLE POPULATION

Muscle fluid and serum samples from 2 cattle populations: 1 from the island of Bornholm with no history of salmonellosis (n = 39), and the other from the S dublin-enzootic areas of Jutland (n = 144).

PROCEDURE

Salmonella dublin (O:1,9,12), S typhimurium (O:1,4,5,12), and Salmonella O:9-blocking ELISA were used for testing the samples.

RESULTS

In the S dublin ELISA, all serum and muscle fluid samples from cattle on the island of Bornholm had OD450 values well below the cutoff value (0.5). For samples obtained from cattle in the enzootic areas of Jutland, high correlation was found between serum and muscle fluid samples (rs = 0.89, P < 0.001). In addition, 19% (28/144) of the cattle had ELISA-positive muscle fluid and serum samples; 2% (3/144) had positive results for muscle fluid only, whereas 1 animal had positive results for serum only (kappa = 0.91, P < 0.0001; sensitivity and specificity of 97%). The same samples had similar significant correlation in the S typhimurium ELISA (rs = 0.88, P < 0.001, kappa = 0.7, P < 0.001; sensitivity of 73% and specificity of 98%) and the O:9-blocking ELISA (rs = 0.49, P < 0.001).

CONCLUSION AND CLINICAL RELEVANCE

Muscle fluid samples taken at slaughter can be used as a practical alternative to serum samples for surveillance of Salmonella infections in cattle.

Technetium-99m-tetrofosmin whole-body scintigraphy in the follow-up of differentiated thyroid carcinoma

The purpose of this study was to evaluate prospectively the reliability of the new nonspecific tumor-searching tracer tetrofosmin in the postoperative follow-up of differentiated thyroid carcinoma (DTC) during TSH suppressive thyroid hormone treatment.

METHODS

Whole-body scintigraphy was performed in 114 patients under TSH suppressive L-T4 treatment 20 min after intravenous injection of 370 MBq 99mTc-tetrofosmin by means of a dual-head gamma camera followed by three-dimensional SPECT in case of suspicious tracer uptake. The results of serum thyroglobulin, ultrasonography of the neck, 131I whole-body scintigraphy, chest radiograph, transmission CT or MRI, and bone scintigraphy were also available.

RESULTS

A group of 68 patients without thyroid remnants who were tumor free and had no history of metastases or tumor recurrence showed a negative 99mTc-tetrofosmin whole-body scan. Another 24 patients (papillary carcinoma pT1NOMO) were also in complete remission, but had sonographically proven remnants (echonormal). Sixteen of them (67%) exhibited 99mTc-tetrofosmin accumulation in the thyroid bed, which corresponded excellently to the localization of the remnant. The third group comprises seven cases of local recurrence confirmed by histopathology after reoperation or by cytology after fine-needle aspiration where tetrofosmin scintigraphy clearly revealed relapse of malignancy in all cases. A total of 17 patients had distant metastases (11 pulmonary, 3 bone, 2 bone and pulmonary, 1 bone and soft tissue) discovered by different modalities, resulting in 44 lesions to be evaluated. Of the 23 radioiodine negative metastases, 17 were detected by tetrofosmin (74%), whereas all 21 radioiodine accumulating lesions also showed tetrofosmin positive scans. The overall sensitivity of 99mTc-tetrofosmin in detecting distant metastatic lesions was 86%. Four additional cases with radioiodine-negative disseminated lung metastases showed diffuse pulmonary tetrofosmin uptake.

CONCLUSION

Technetium-99m-tetrofosmin is a promising tracer to detect malignant recurrence and distant metastases in the follow-up of DTC without the necessity of thyroid hormone withdrawal.

Albumin adducts in plasma from workers exposed to toluene diisocyanate

Desalted plasma from a 2,4- and 2,6-toluene diisocyanate (2,4- and 2,6-TDI) exposed worker at a factory producing flexible polyurethane foam was separated and fractionated into 200 fractions using ion-exchange chromatography followed by a gel-filtration separation and fractionation into 59 fractions. The corresponding amines (to the isocyanates), 2,4- and 2,6-toluenediamine (2,4- and 2,6-TDA), were determined in each fraction after sulfuric acid hydrolysis as pentafluoropropionic anhydride derivatives by capillary gas chromatography and chemical ionisation mass spectrometry monitoring negative ions. The ion exchange fractions containing TDA (81-115) were added together and the solution was separated and fractionated on the gel-filtration column. The fractions 81-115 contained 84 and 72% of 2,4- and 2,6-TDA, respectively, as compared to the unfractionated plasma. The gel filtration fractions 22-27 contained 107 and 119% of 2,4- and 2,6-TDA, respectively, as compared to the amounts in the ion exchange fractions (81-115). Agarose gel-electrophoresis and electroimmunoassay demonstrated that albumin, 2,4- and 2,6-TDA co-eluted in both ion-exchange and gel-filtration chromatography. Quantitative determination of albumin, 2,4- and 2,6-TDA also demonstrated that these components co-eluted using albumin-immunosorption chromatography. In addition, studies of affinity isolated IgG revealed that this fraction was devoid of 2,4- and 2,6-TDA. These results indicate that albumin is the major receptor molecule for 2,4- and 2,6-TDI in blood plasma and that these isocyanates form covalent bondings with albumin.

Long-term humoral antibody responses by various serologic tests in pigs orally inoculated with oocysts of four strains of Toxoplasma gondii

Antibody titers to Toxoplasma gondii were determined in 16 pigs orally inoculated with 1000 or 10,000 oocysts of one of the four strains (GT-1, ME-49, TS-2, TC-2) of T. gondii. Pigs were euthanized on postinoculation days 103-875 and their tissues were bioassayed for T. gondii. Antibody titers were measured in the modified agglutination test (MAT) using formalin-preserved (test A) or acetone-preserved (test B) tachyzoites, latex agglutination test (LAT), indirect hemagglutination test (IHA), enzyme-linked immunobsorbant assay (ELISA), and the Sabin-Feldman dye test (DT). Toxoplasma gondii was isolated from all but two (one with GT-1 strain and one with TC-2 strain) of the inoculated pigs. Results of the serologic tests varied by test used, by strain of T. gondii and from pig to pig within groups. One pig inoculated with the TC-2 strain was considered not to be infected because it remained seronegative in all tests and T. gondii was not isolated from its tissues by bioassay. The IHA and LAT did not produce consistently positive results with infected pigs and two pigs remained seronegative (< 1:64) in both tests. At the time of necropsy, IHA titers had declined to < 1:64 in five pigs and LAT titers had declined to < 1:64 in four pigs. The MAT (test A) and ELISA detected antibodies in all infected pigs but ELISA did not detect antibody at the time of necropsy in one pig. Antibody titers peaked earliest in the DT. Antibody titers in the MAT (test B) peaked at 2560 in all seropositive pigs by 6 weeks postinoculation (PI) but declined to < 1:160 by 15 weeks PI; this test may be useful in determining recency of T. gondii infection in pigs. Overall, the MAT (test A) gave most consistent results.

Scintimammography using Tc-99m tetrofosmin

Breast cancer, the most common malignancy in women, still poses a challenge to diagnostic procedures and therapy. Despite low specificity routine mammography is the method of choice to screen women for breast cancer. In the last years other additional diagnostic procedures such as high frequency ultrasonography (US) and especially magnetic resonance imaging (MRI) have improved breast cancer diagnosis. However, all these imaging methods are lacking in specificity which makes biopsy or surgery necessary. The purpose of our study was to evaluate prospectively the sensitivity, specificity, PPV and NPV of scintimammography with a new cationic complex Tc-99m tetrofosmin in patients with suspicious mammographic lesions. One hundred and thirty seven patients in whom mammography and/or high resolution ultrasonography (10 MHz) revealed suspicious breast lesions were studied with Tc-99m tetrofosmin scintimammography. In 84 of them biopsy and/or surgery was performed for histological evaluation. After intravenous injection of 555 MBq Tc-99m tetrofosmin planar images in anterior and lateral projections (5 min.p.i.) and SPECT imaging including 3-D-reconstruction (20 min.p.i.) were performed. Scintimammography was evaluated as negative, equivocal (+), probably (+2) or definitely (+3) positive. Planar scintimammography with Tc-99m tetrofosmin was negative in 46 patients (43 true negative-f.n; 3 false negative-f.n.) and positive in 38 patients (27 true positive-t.p.; 11 false positive-t.p.). Using SPECT imaging Tc-99m scintimammography was negative in 43 cases (41 t.n.; 2f.n.) and positive in 41 cases (28 t.p.; 13 t.p). Sensitivity of Tc-99m tetrofosmin scintimammography in this prospective study was 90%, specificity 80%, PPV 71% and NPV 93% for planar imaging and 93%, 76%, 68% and 95% for SPECT, respectively. Scintimammographic results in patients with suspicious breast lesion show, that Tc-99m tetrofosmin accumulates in breast cancer as well as in some fibroadenoma with high cellularity. However, the high NPV of 93 and 95% respectively excludes breast cancer in suspicious mammographic lesions to a very high degree and therefore reduces the need of biopsy and/or surgery in most of these patients.

Preoperative scintigraphic and intraoperative scintimetric localization of parathyroid adenoma with cationic Tc-99m complexes and a hand-held gamma-probe

AIM

The aim of our study was to evaluate the possibility of intraoperative scintimetric detection of parathyroid adenomas with Tc-99m labelled tracers for its usefulness in dystropic or ectopic adenomas.

METHODS

12 women with biochemically confirmed hyperparathyroidism were included in our study. After injection of 370 MBq Tc-99m tetrofosmin e.g. sestamibi, preoperative scintigraphy (double phase study and SPECT) was performed and T/NT ratios were evaluated for early, delayed and SPECT images. Surgery was performed using a hand-held gamma-probe after preoperative injection of 555-925 MBq Tc-99m tetrofosmin e.g. sestamibi. Count rates (cts/10 sec) were measured and used for calculating in situ- and ex situ-T/NT ratios.

RESULTS

In 9 out of 12 patients, adenoma could be detected on static images. Mean T/NT ratios for Tc-99m tetrofosmin were 1.29 for early and 1.23 for delayed images, respectively 1.39 and 1.23 for early and delayed Tc-99m sestamibi scan. Three cases could only be detected with SPECT reconstruction, 11 of 12 parathyroid adenomas could be confirmed intra-operatively.

CONCLUSION

SPECT with Tc-99m labelled cationic complexes showed advantages in detection, precise localization and contrast over static scintigraphy and should therefore be performed at least in cases with poor or no uptake on static images to avoid failures in detection of deeply sited, dislocated glands or adenomas with low uptake. Intraoperative localization and confirmation of parathyroid adenoma with Tc-99m labelled cationic complexes and a gamma probe is possible an 1 may be useful in case of dys- or ectopic adenoma by influencing surgical approach and operating time.

Biomarkers in hydrolysed urine, plasma and erythrocytes among workers exposed to thermal degradation products from toluene diisocyanate foam

Blood and urine samples were collected from six workers and two volunteers exposed to thermal degradation products from toluene diisocyanate (TDI)-based polyurethane (PUR) before and during the summer vacation. Air samples were collected on filters impregnated with 9-(N-methylaminomethyl)anthracene. The concentrations of the amines corresponding to 2,4- and 2,6-TDI, i.e., 2,4- and 2,6-toluenediamine (TDA), were determined in urine (U-TDA), plasma (P-TDA) and erythrocytes (E-TDA) after acid hydrolysis as pentafluoropropionic anhydride derivatives by GC-MS. Among the workers urinary elimination phases were seen. The estimated medians of the urinary half-lives were for the slow phase 18 d for 2,4-TDA and 19 d for 2,6-TDA. P-2,4-TDA ranged between 2.5 and 19 ng ml-1 and P-2,6-TDA between 4.4 and 30 ng ml-1. The estimated median of the half-lives in plasma were 7.8 d for 2,4-TDA and 9.6 d for 2,6-TDA. E-2,4-TDA ranged between 0.5 and 6.6 ng g-1 and E-2,6-TDA between 1.2 and 14 ng g-1. A significant linear relationship was found between the mean P-TDA and the mean E-TDA. Linear relationships were observed between the mean daily U-TDA and P-TDA and E-TDA. Virtually linear relationships were obtained for P-TDA and E-TDA and the TDI air levels. Proteins from lysed erythrocytes were separated and fractionated by gel filtration. 'TDI'-modified proteins were found in six out of a total of 80 fractions (fractions 51-56). These co-eluted completely with the haemoglobin (UV, 415 nm). Fractions 51-56 contained 89% of the applied amounts of 2,4-TDA and 81% of 2,6-TDA.

Technetium-99m-MIBI scintigraphy of thyroid nodules in an endemic goiter area

Technetium-99m-methoxyisobutylisonitrile (MIBI) was introduced for myocardial imaging as an alternative to 201TI. According to biodistribution studies, MIBI also accumulates in the thyroid gland. The aim of this study was to find out which thyroid nodules retain MIBI and whether preoperative evaluation of malignancy is possible.

METHODS

Single injection, dual-phase (30 min and 2 hr) thyroid scintigraphy with 99mTc-MIBI was performed on 62 patients who showed a cold nodule on previously performed 99mTc scintigraphy. MIBI scans were considered positive if there was a clear tracer retention in the late 120-min image compared to the early 30-min image. Sonographic examination and fine-needle aspiration biopsy, guided by ultrasonography, was also done on each patient. In the following days and weeks, all patients underwent surgery.

RESULTS

Histopathological diagnoses revealed a total of 12 thyroid carcinomas, five were MIBI positive and seven MIBI negative. Out of 27 patients with thyroid adenomas (nine microfollicular, ten follicular, eight oxyphilic), 18 were MIBI positive and nine MIBI negative. There was no MIBI retention on the scans of 22 patients with degenerative changes in the goiter and the one with Hashimoto's disease.

CONCLUSION

These results indicate that MIBI accumulation and retention is not specific for thyroid malignancy. Indeed, all evidence points to the fact that a positive MIBI scan is more likely to indicate thyroid adenoma than a malignant tumor.

[Use of a gamma probe for intraoperative localization of parathyroid adenomas with Tc-99m-tetrofosmin and Tc-99m-sestamibi]

Especially ectopic adenomas may be problematic in intraoperative localization despite preoperative imaging resulting in a longer operating time and more extensive surgical preparation. The aim of our study was to evaluate the possibility of intraoperative scintimetric detection of parathyroid adenomas with cationic, Tc-99m labelled tracers for its usefulness in ectopic adenomas. 12 women with biochemically confirmed hyperparathyroidism were included in our study. After injection of 370 MBq Tc-99m Tetrofosmin respectively Sestamibi, preoperative scintigraphy (double phase study and SPECT) was performed and T/NT ratios were evaluated for early, delayed and SPECT images. Surgery was performed using a hand-held gamma probe after preoperative injection of 555-925 MBq Tc-99m Tetrofosmin or Sestamibi. Count rates (cts/10 sec) were measured and used for calculating in situ- and ex situ-T/NT ratios. In 9 out of 12 patients, adenoma could be detected on static images. Three cases could only be detected with SPECT. 11 of 12 parathyroid adenomas could be confirmed intraoperatively. Intraoperative localization of parathyroid adenoma with Tc-99m-labelled cationic complexes and a gamma probe is possible and may be useful in case of ectopic adenoma by influencing surgical approach and operating time.