Correlation of (Na+--K+)-ATPase activity with growth of normal and transformed cells

Relationship between cancer cell proliferation, tumour angiogenesis and 201Tl uptake in non-small cell lung cancer

PURPOSE

To investigate whether 201Tl uptake is associated with cell proliferation and angiogenesis in non-small-cell lung carcinoma (NSCLC).

METHODS

Eighty-four patients with scheduled NSCLC underwent 201Tl single photon emission computed tomography (SPECT) imaging: 15 min (early scan) and 240 min (delayed scan) after intravenous injection of 111 MBq of 201Tl chloride. 201Tl indices were calculated on early images (early ratio: ER) and delayed images (delayed ratio: DR). The retention index (RI) was also calculated from these two parameters. Using surgically resected cancer specimens (54 adenocarcinoma, 24 squamous cell carcinoma (SCC), six large-cell carcinoma), immunohistochemical stains for both Ki-67 (MIB-1 index) and CD34 were performed to examine the proliferative activity and the micro-vessel density (MVD), respectively.

RESULTS

The mean value of 201Tl index was 1.69+/-0.77 (ER) and 2.31+/-1.08 (DR). The average RI was 42.6+/-42.9%, respectively. Both DR and RI positively correlated with MIB-1 index (r = 0.68, P < 0.05 and r = 0.52, P < 0.05). When we analyse adenocarcinoma and SCC separately, there was a significant positive correlation (r = 0.62, P < 0.05) between RI and MIB-1 index in adenocarcinoma but not in SCC (r = 0.20, P = NS). The value of ER positively correlated with MVD (r = 0.75, P < 0.05). It demonstrated strong positive correlation with both histological types (adenocarcinoma: r = 0.80, P < 0.05, SCC: r = 0.66, P < 0.05).

CONCLUSION

201Tl SPECT imaging is effective non-invasive method for assessing both the proliferation and the angiogenesis in NSCLC. Both DR and RI are useful indicators for assessing cancer cell proliferation in lung adenocarcinoma. ER is a useful marker for assessing the tumour angiogenesis in NSCLC.

Comparison Between Contrast-enhanced Magnetic Resonance Imaging and Technetium 99m Glucohepatonic Acid Single Photon Emission Computed Tomography With Histopathologic Correlation in Gliomas

OBJECTIVE

: To determine and compare the accuracy of contrast-enhanced magnetic resonance imaging (MRI) and Technetium 99m glucohepatonic acid single photon emission computed tomography (Tc-GHA SPECT) in grading of gliomas, compared with neuropathologic findings.

MATERIALS AND METHODS

: The study included 20 adult patients (13 men and 7 women) with clinical/radiological suspicion of brain tumor (glial tumor) who were subjected to magnetic resonance examination and Tc-GHA brain SPECT.The lesions were evaluated by using MRI imaging score, based on 9 MRI criteria. Based on the discrimination threshold of 0.9 for mean MRI score, the gliomas were graded as low- or high-grade glioma. The Tc-GHA SPECT retention index was calculated as the ratio between delayed and early uptake ratios. Based on the discrimination threshold of 1 for Tc-GHA SPECT retention index, the gliomas were graded as low- or high-grade glioma.The diagnosis was verified by means of histopathologic examination in all patients (open surgery in 19 patients and stereotactic biopsy in 1 patient). Correlation between MRI findings/scores, SPECT scores, and histopathologic grades was done in all the patients, and comparison between MRI and Tc-GHA SPECT was made using paired Student t test and correlation coefficient.

RESULTS

: The study revealed significant difference between the mean MRI scores and early uptake ratio, delayed uptake ratio, and retention index of low-grade (grades I-II) and high-grade (grades III-IV) gliomas. No statistically significant difference could be demonstrated between the abilities of contrast-enhanced MRI and Tc-GHA SPECT to allow differentiation between high- and low-grade gliomas. The accuracy of MRI (78.4%), however, was slightly higher than that of Tc-GHA SPECT (73.68%). However, Tc-GHA SPECT allowed differentiation between high-grade gliomas (between grades III and IV gliomas).

CONCLUSIONS

: The accuracy of contrast-enhanced MRI in the distinction of high- and low-grade malignancy was higher than that of Tc-GHA SPECT. The performance of Tc-GHA SPECT adds little in determining tumor grade when MRI is performed. However, it may act as a useful adjunct to differentiate between grades III and IV gliomas.

Early dynamic 201Tl SPECT in the evaluation of brain tumours

OBJECTIVE

To estimate the usefulness of early dynamic 201Tl single photon emission computed tomography (SPECT) studies in distinguishing the histological malignancy of brain tumours.

METHODS

Dynamic 201Tl SPECT was performed for 3 min per scan for 15 min immediately after the administration of 201TlCl in 110 patients with brain tumours (111 lesions). The data obtained each 3 min were used for dynamic SPECT, and the five sets of data obtained were added to acquire static SPECT data. For static SPECT, the static thallium index (STI) was calculated as the ratio of 201Tl uptake in the tumour to that of the contralateral normal brain. The ratio of the 201Tl uptake for each 3 min was defined as the dynamic thallium index (DTI). The dynamic thallium rate (DTR), as a per cent, was calculated as DTR=(DTI for every 3 min)/STI H 100. The five values were approximated as a linear function and the slope (%/min) was calculated.

RESULTS

In static SPECT, there was no significant difference between the STI of malignant tumours (glioblastoma and anaplastic astrocytoma) and that of benign tumours (low-grade glioma, meningioma, pituitary adenoma, neurinoma and haemangioblastoma) (3.7+/-1.5, 5.0+/-3.5, respectively). On dynamic SPECT, DTI increased markedly over 15 min for malignant tumours. In contrast, the DTI of benign tumours increased slightly, steadily or decreased. The slope of the linear functions calculated from the DTRs was much higher in the malignant tumour group than in the benign tumour group (P<0.001).

CONCLUSIONS

We suggest that the performance of 201Tl dynamic SPECT for 15 min is useful for distinguishing malignant brain tumours from benign brain tumours and reduces the examination stress of patients.

Technetium-99m sestamibi single photon emission computed tomography findings correlated with P-glycoprotein expression in pituitary adenoma

The aim of this study is to evaluate whether the technetium-99m sestamibi ((99m)Tc-MIBI) single photon emission computed tomography (SPECT) characteristics of pituitary adenomas might be correlated with cavernous sinus invasion, proliferative potential or the multidrug-resistance (MDR-1) gene product P-glycoprotein (Pgp) expression in pituitary adenomas. Fifteen patients with pituitary adenomas, including 10 nonfunctioning adenomas, two prolactinomas, two GH producing adenomas, and one ACTH producing adenomas was investigated for this study. SPECT images with (99m)Tc-MIBI were acquired 15 minutes (early) and 3 hours (delayed) after injection. The tumor-to-normal brain ratio was calculated both early (ER) and delayed (DR) images. Retention index (RI) was calculated using the following formula: (DR-ER)/ERx100%. The pituitary adenomas specimens were examined by immunohistochemistry using anti-Pgp and MIB-1 monoclonal antibodies.(99m)Tc-MIBI SPECT findings were not related to MIB-1 labeling index or cavernous sinus invasion. (99m)Tc-MIBI SPECT RI (-38.55+/-20.77) of the Pgp-positive group was significantly lower than that (-15.78+/-19.40) of Pgp-negative group (p=0.0494). No significant difference was observed in the ER and DR of (99m)Tc-MIBI SPECT between Pgp-positive and negative groups. Our study suggests that although (99m)Tc-MIBI SPECT is not useful to evaluate the proliferative potential or cavernous sinus invasion of pituitary adenomas. (99m)Tc-MIBI SPECT could predict anti-cancer drug resistance related to the expression of Pgp in pituitary adenomas.

Scintigraphy for interpretation of malignant tumours of the head and neck: comparison of technetium-99m-hexakis-2-methoxyisobutylisonitrile (Tc-MIBI) and thallium-201-chloride (Tl-201)

OBJECTIVES

The purpose of this study was to compare the usefulness of technetium-99m-hexakis-2-methoxyisobutylisonitrile (99Tc(m)-MIBI) and thallium-201-chloride (Tl-201) as scintigraphic agents.

METHODS

Dynamic and static scintigraphic imaging with 99Tc(m)-MIBI and Tl-201 were performed on patients with a variety of malignant and benign tumours. Factors of the grade of the static scan, the blood flow index, the early and delayed retention indexes, and the tumour retention index were obtained from the scintigraphy. In addition to these factors, the grade of tissue differentiation and tumour size were evaluated to clarify the difference between 99Tc(m)-MIBI and Tl-201 for the diagnosis of malignant tumours of the head and neck.

RESULTS

99Tc(m)-MIBI accumulation depended upon the blood flow index in the early static scan, but this accumulation did not correlate with tumour size. The accumulation in most subjects decreased in the delayed static scan, and the tumour retention index had a tendency to decrease with the grade of tissue differentiation. Tl-201 accumulation depended upon the blood flow index in the early static scan similar to 99Tc(m)-MIBI, and the accumulation correlated with tumour size, unlike 99Tc(m)-MIBI. The tumour retention index had a tendency to increase with the grade of tissue differentiation. Thus, the tumour retention indexes showed opposite behaviours between 99Tc(m)-MIBI and Tl-201, but they both accurately determined tumour malignancy.

CONCLUSIONS

There was no major difference between 99Tc(m)-MIBI and Tl-201scintigraphy with respect to accuracy of diagnosis of malignant tumours of the head and neck. However, 99Tc(m)-MIBI was superior to Tl-201 for small-size tumours and Tl-201 was useful for large-size tumours.

Thallium-201 brain SPECT to diagnose aggressiveness of meningiomas

This investigation was conducted to determine the ability of 201Tl brain SPECT with respect to preoperative prediction of lesional aggressiveness of meningioma. Fifty-nine lesions in 42 patients were examined. Early (15 min) and late (3 h) SPECT were obtained. Early uptake ratio (ER; lesion to normal brain average count ratio), late uptake ratio (LR) and the ratio of LR to ER (L/E ratio) were calculated. Twenty-three lesions exhibited malignant features based on histologic or clinical course such as recurrence or skull invasion. Both ER and LR of malignant meningiomas were significantly higher than those in thirty-six benign lesions. Benign lesions were classified into two groups for further analysis: meningotheliomatous type, which is the most common histology, and benign lesions other than the meningotheliomatous (other benign) type. ER in other benign type was lower than the meningotheliomatous and the malignant type. LR afforded differentiation of the malignant type from the two benign types. These two benign types could be distinguished on the basis of the L/E ratio. These results indicate that high pre-operative ER and LR values in patients with meningioma are indicators of the aggressiveness of lesions, i.e., malignant meningioma, recurrence or skull invasion.

Technetium-99m sestamibi single photon emission computed tomography findings correlated with P-glycoprotein expression, encoded by the multidrug resistance gene-1 messenger ribonucleic acid, in intracranial meningiomas

The present study evaluated whether technetium-99m sestamibi (99mTc-MIBI) single photon emission computed tomography (SPECT) characteristics of intracranial meningioma are correlated with the histological malignancy, proliferative potential, and P-glycoprotein (Pgp) expression, encoded by the multidrug resistance gene-1 (MDR-1) messenger ribonucleic acid (mRNA). Twenty-one patients with intracranial meningiomas, including 17 benign and four nonbenign meningiomas, underwent 99mTc-MIBI SPECT imaging at 15 minutes (early) and 3 hours (delayed) after injection. The tumor-to-normal pituitary gland ratio was calculated on both early (ER) and delayed (DR) images. Retention index (RI) was calculated using the following formula: (DR - ER)/ER x 100%. Meningioma specimens were examined by immunohistochemistry using anti-Pgp and MIB-1 monoclonal antibody. MDR-1 mRNA expression was also investigated using reverse transcription-polymerase chain reaction assay. 99mTc-MIBI was highly accumulated and retained in the tumors. 99mTc-MIBI SPECT findings were not related to MIB-1 labeling index. 99mTc-MIBI SPECT RI of the Pgp-positive group (-9.12 +/- 22.27%) was significantly lower than that of the Pgp-negative group (28.79 +/- 22.80%) (p = 0.0016). No significant difference was seen in ER and DR between the positive and negative groups. These results show that 99mTc-MIBI may not be useful for determining proliferative potential and histological malignancy, but could predict anticancer drug resistance related to the expression of MDR-1 mRNA and its gene product Pgp in patients with intracranial meningiomas.

Image fusion of thallium-201 SPECT and MR imaging for the assessment of recurrent head and neck tumors following flap reconstructive surgery

The aim of this study was to assess the value of fused MR and Tl-201 single photon emission computed tomography (SPECT) images in the diagnosis of recurrent head and neck tumors in patients after flap reconstruction surgery. Twenty-four patients after resection of primary head and neck tumors with flap reconstruction were suspected of having recurrent tumor by follow-up MR examination. Both MR examination and Tl-201 SPECT were prospectively performed to produce fused images. For qualitative analysis, two independent readers separately evaluated the existence of tumor recurrence in the fused images. The Tl-201 uptake of the lesion (Tl index) was also quantitatively compared with that of the normal nuchal muscles. Eighteen patients were histologically proved as having recurrence. The remaining 6 patients, false positive on MRI alone, had non-recurrence. Using the fused images, false positive was found in 1 case for one reader and 2 cases for the other reader. The Tl index of recurrent tumors was significantly higher (p < 0.001) than that of non-recurrent mass lesions. In the assessment of recurrent tumors following flap reconstruction surgery in the head and neck, the use of fused MRI and Tl-201 SPECT images can reduce the number of false positives.

Dynamic scintigraphy with thallium-201 chloride (Tl-201) for the diagnosis of tumors of the head and neck

OBJECTIVE

The purpose of this study was to differentiate between malignant tumors and benign tumors of the head and neck by means of thallium-201 chloride scintigraphy.

STUDY DESIGN

Thallium-201 chloride (Tl-201) scintigraphy and Ga-67 citrate (Ga-67) scintigraphy were performed in 10 patients with a benign tumor and in 90 patients with a malignant tumor. The blood flow index and the tumor retention index were obtained by means of Tl-201 scintigraphy. The blood flow index = the count of tumor/the count of control in the early dynamic scan from 30 to 120 seconds after injection, and the tumor retention index = (the count of tumor/the count of control in the delayed dynamic scan 2.5 hours after injection)/(the count of tumor/the count of control in the early dynamic scan from 4 to 5 minutes after injection).

RESULTS

The early and delayed scans with Tl-201 demonstrated a very high correlation with the blood flow index. The tumor retention index had a tendency to increase in malignant tumors, especially in the poorly differentiated tumors and the severely invasive tumors. Likewise, the tumor retention index decreased in benign tumors. These results proved to be statistically significant, and in turn Tl-201 scintigraphy was deemed superior to Ga-67 scintigraphy. Tl-201 scintigraphy was also useful in detecting small-size tumors.

CONCLUSION

The tumor retention index of Tl-201 was useful for the differentiation of malignant tumors of the head and neck from benign tumors of the same areas.

Comparison of 99Tcm-MIBI with 201Tl chloride SPET in patients with malignant brain tumours

The purpose of this study was to evaluate the usefulness of 99Tcm-MIBI accumulation for the differentiation of histological diagnosis of malignant brain tumours in comparison with the findings obtained using 201Tl chloride. A total of 25 patients with malignant brain tumours were investigated. The histological categories of tumours included glioblastoma multiforme (n = 5), anaplastic astrocytoma (n = 4), malignant lymphoma (n = 5), and metastatic tumour (n = 11). Simultaneous dual single photon emission tomography (SPET) images with 99Tcm-MIBI and 201Tl were acquired 15 min (early) and 2 h (delayed) after injection, and the early ratio, delayed ratio and retention index were measured. The new indices 201Tl/99Tcm-MIBI ratios and 201Tl/99Tcm-MIBI retention index were also calculated. With respect to the histological type, a higher retention index using 99Tcm-MIBI was noted in glioblastoma multiforme compared with metastatic tumour. Higher values of both ratios using 201Tl were noted in glioblastoma multiforme compared to metastatic tumour. The value of the delayed ratio obtained using 201Tl was higher in glioblastoma multiforme than in anaplastic astrocytoma, and the value was also higher in malignant lymphoma than in metastatic tumour. The 201Tl/99Tcm-MIBI early ratio of glioblastoma multiforme was significantly higher than that of metastatic brain tumour. The 201Tl/99Tcm-MIBI retention index of malignant lymphoma was significantly higher than that of glioblastoma multiforme. In the histological type of tumour, 99Tcm-MIBI is not superior to 201Tl, but the combined indices using 201Tl/99Tcm-MIBI may add new information about differential diagnosis.

TI-201 SPECT compared with histopathologic grade in the prognostic assessment of cerebral gliomas

PURPOSE

Although TI-201 SPECT has been used to evaluate the malignant grade of cerebral gliomas, the gold standard continues to be histopathologic examination. The authors assessed and compared the prognostic abilities of the two studies using survival analysis.

MATERIALS AND METHODS

Twenty-nine patients underwent 34 sessions of TI-201 SPECT plus surgery for primary or recurrent cerebral gliomas 12 to 78 months before this analysis. Using conventional survival analyses, such as the log-rank test, Cox regression, and the Akaike cross-tab method, the authors evaluated the prognostic significance of 10 variables: histopathologic grade, TI-201 SPECT, Tc-99m HMPAO SPECT, tumor cell viability, radionecrosis, neurologic defects, clinical improvement, surgery, chemotherapy, and external beam radiotherapy.

RESULTS

TI-201 SPECT was most strongly related to prognosis, followed by histopathologic grade. The other variables had little prognostic value. The Cox stepwise selection procedure indicated that TI-201 SPECT was the only independent predictor of outcome, whereas histopathologic analysis was eliminated from the prognostic model. However, the Kaplan-Meier survival curve and the Akaike method indicated that histopathologically low-grade tumors were more closely associated with longer-term survival than were TI-201 low uptake tumors.

CONCLUSIONS

TI-201 SPECT is not only closely correlated with the histopathologic grade of tumor but is a significantly better predictor of outcome than histopathologic grade. However, histopathologic examination may provide additional information on longer-term survival. TI-201 SPECT is a valuable procedure, especially in patients in whom a histologic diagnosis of possible glioma cannot be made.

Role of scintigraphy with tumor-seeking agents in the diagnosis and preoperative staging of malignant thyroid nodules

The commonly used procedure for the diagnosis of thyroid nodule malignancy is based on high resolution thyroid ultrasonography (US) combined with US-guided fine needle aspiration cytology (FNAC). The other imaging procedures have a limited role in malignancy diagnosis. However, nuclear medicine procedures, particularly scintigraphy with tumor-seeking agents such as 201-thallium (201-TI), 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) and 99mTc-tetrofosmin may play an important role in the differential diagnosis between benign and malignant thyroid nodules in cases of non-diagnostic or inadequate FNAC. This type of scintigraphy can also be used in the follow-up of patients with cytologically 'high'-risk thyroid nodules such as Hurtle cell adenomas and follicular adenomas. Furthermore, scans with tumor-seeking agents can be helpful in determining the preoperative staging of thyroid carcinoma patients with locally advanced disease, and in accurately evaluating the extent, and consequently, the surgical management of the disease.

Intense and prolonged Tl-201 accumulation in a slow growing bronchioloalveolar carcinoma

Thallium-201 SPECT was performed to evaluate a pulmonary lesion in a 73-year-old male which had been considered to be an inflammatory lesion for two years. The lesion has slowly increased in size on x-CT. Tl-201 was intensely taken up and retained in the lesion, suggesting a malignant lesion. Histological examination revealed that the lesion was bronchioloalveolar carcinoma. This case suggested that Tl-201 uptake of pulmonary carcinoma would not be necessarily related to cell growth rate.

Relationship between thallium-201 uptake by supratentorial glioblastomas and their morphological characteristics on magnetic resonance imaging

Single-photon emission tomography (SPET) with thallium-201 is used in the assessment of patients with gliomas because the amount of 201Tl accumulated by the tumoral cells increases in proportion to the degree of tumour malignancy, thus making it possible to differentiate high-grade from low-grade gliomas or recurrences from radiation necrosis. However, in large areas of tissue such as those examined in 201Tl SPET studies, the uptake of 201Tl may vary considerably even in tumours with the same histological diagnosis, as occurs in glioblastomas (GBMs). In order to evaluate the possible influence of the macroscopic characteristics of tumours on 201Tl uptake, we studied a series of 13 patients with histologically proven GBMs, comparing magnetic resonance imaging (MRI) parameters such as tumour dimensions, perilesional oedema, intratumoral necrosis and contrast enhancement with the degree of 201Tl uptake. The patients underwent both 201Tl SPET and MRI before surgery. The 201Tl index (tumour/contralateral unaffected brain) was calculated using two different region of interest (ROI) methods: the first employed irregular large ROIs (3.2+/-13.9 cm2) including pixels with more than 50% maximum activity; the second employed regular square small ROIs (2.7 cm2) centered on the maximum activity of the lesion. Of the MRI morphological parameters studied, only necrosis significantly reduced the degree of 201Tl uptake in GBMs when larger ROIs were used. However, by using small regular ROIs the influence of necrosis on 201Tl uptake was found to be less relevant. Since necrosis is related to tumour proliferative activity and represents a negative prognostic factor in astrocytoma, a possible underestimation of 201Tl uptake due to intratumoral necrosis must be carefully evaluated.

Relationship between thallium-201 uptake and tumour proliferative ability in thyroid nodules

To evaluate whether thallium-201 scan can reflect tumour proliferative activity in thyroid nodules. We compared the degree of 201Tl uptake with the tumour proliferative ability as assessed immunohistochmically by the labelling index of proliferating cell nuclear antigen (PCNA) in malignant and benign thyroid nodules. The case material comprised ten benign and 31 malignant surgically resected nodules from a total of 41 patients. 201Tl scan was performed 5 min (early scan) and 2h (delayed scan) after intravenous injection of 74 MBq of 201Tl. The degree of 201Tl uptake was visually divided into three grades [from (-) to (++)], as compared with its uptake in normal adjacent thyroid tissue. Immunohistochemical staining of PCNA was performed using a monoclonal antibody for PC10 on paraffin-embedded specimens. On both the early and the delayed scans, the mean PCNA index in the nodules with an intense 201Tl, i.e. (++), was significantly higher than that in nodules with a lower or with negative 201Tl uptake. The correlation was higher on the delayed 201Tl scan (P=0.009) than on the early scan (P=0.019). Our results indicate that 201Tl uptake may reflect the tumour proliferative activity of thyroid nodules, and this is especially true with regard to the uptake on delayed scans.

201TL SPECT for evaluating head and neck cancer

BACKGROUND

Thallium-201 (201Tl) has come to be widely used in diagnosis of several kinds of malignant tumor, but its usefulness in diagnosing head and neck cancer has not been established.

PURPOSE

This study investigated the usefulness of 201Tl SPECT imaging in patients with head and neck cancer histologically confirmed.

METHODS

Eighteen patients with histologically proven head and neck cancer were studied. 201Tl SPECT images were obtained both 15 min and 4 hours after intravenous injection of 148 MBq of 201Tl-chloride. 201Tl-indices were calculated semiquantitatively to assess the tracer uptake in relation to tumor size and histological type.

RESULTS

High 201Tl uptake was noted in all primary tumors and metastatic lymph nodes on the both early and delayed images, but 201Tl-indices did not show any correlation with tumor size or histological type.

CONCLUSION

Primary had and neck cancer and lymph node metastasis can be effectively visualized with 201Tl SPECT. It may provide information in addition to morphological changes and may be supplemental method to use in the evaluation of head and neck cancer.

Cerebral demyelination syndrome in a patient treated with 5-fluorouracil and levamisole. The use of thallium SPECT imaging to assist in noninvasive diagnosis--a case report

BACKGROUND

The use of 5-fluorouracil (5-FU) and levamisole in patients with Stage III adenocarcinoma of the colon has now become standard. There have been several reports of a multifocal cerebral demyelination syndrome following 5-FU and levamisole administration.

METHODS

We describe a patient who developed focal neurologic symptoms while being treated with levamisole and 5-FU in whom the diagnosis of central nervous system (CNS) metastases was considered.

RESULTS

A magnetic resonance imaging (MRI) scan showed a diffuse, multifocal white matter process. Diagnostic evaluation did not support a diagnosis of CNS metastasis. 201Thallium chloride single photon emission computed tomography (SPECT) study was cold. A stereotactic brain biopsy disclosed demyelination but not tumor. The patient had complete functional resolution of symptoms with 1 month of dexamethasone therapy, although follow-up MRI scans have shown persistent abnormality on T2-weighted images.

CONCLUSIONS

In patients receiving 5-FU and levamisole who develop focal neurologic symptoms with an abnormal MRI scan, the diagnosis of CNS metastasis should not be made without a thorough diagnostic evaluation. We suggest the use of 201thallium chloride SPECT imaging to support the diagnosis of multifocal leukoencephalopathy related to 5-FU and levamisole. In atypical cases, a stereotactic brain biopsy may be required for confirmation.

The role of thallium-201 single photon emission tomography in the investigation and characterisation of brain tumours in man and their response to treatment

The aim of this study was to characterise brain tumour type and treatment response in relation to the uptake of thallium-201. 201T1 single photon emission tomography (SPET) was performed in 58 patients with brain tumours. Fifty-six patients were utilised for the statistical comparison of the early and delayed 201T1 indices expressed as the ratio of tumour to contralateral cerebral hemisphere uptake. The retention index of 201T1 in the tumour tissue calculated from the early and delayed scans was also analysed. Furthermore, in 56 patients with 58 brain tumours, a comparison was made of the diagnostic value of high 201T1 uptake and gadolinium diethylene triamine penta-acetic acid (Gd-DTPA) enhancement on MRI scans. Although high 201T1 uptake was observed in viable malignant gliomas, brain metastases, meningiomas and malignant teratoma, the viable malignant gliomas could not be differentiated from brain metastases and extracerebral tumours by means of 201T1 indices. 201T1 SPET failed to diagnose a viable ring-enhanced tumour with a thin rim and small tumours of less than 1.5 cm in diameter visualised by Gd-DTPA-enhanced MRI. In spite of this, 201T1 SPET appears to be effective for determination of the malignant viability of tumours.

The Na+K+ATPase activity in cultured human fibroblasts with an elevated phospholipid triene:tetraene ratio

Human skin fibroblasts were cultured at low density for 11 days in MCDB 110, 0.4% fetal bovine serum, a mitogen mixture, and were supplemented with 18:2n-6 or 18:1n-9 as a fatty acid-albumin complex. The cells cultured with the 18:2n-6 supplement had a 20:3n-9/20:4n-6 ratio of 0.29 +/- 0.07; the 18:1n-9 supplemented cells had a ratio of 1.51 +/- 0.27. There was less than 4% difference in total growth of the cell population under the two culture conditions. The cells supplemented with 18:2n-9 had similar levels of protein/cell, K+/mg cell protein and functional Na+K+ATPase activity.

Antiproliferative activity of mammalian lignan derivatives against the human breast carcinoma cell line, ZR-75-1

The effect of each of twelve mammalian lignan derivatives on the growth of human mammary tumor ZR-75-1 cells was examined. At a concentration less than 10 micrograms/ml, tumor cell growth was inhibited from 18-68%. The effect of 2,3-dibenzylbutane-1,4-diol(hattalin) was found to be strongest, inhibiting growth by 50% at a concentration (EC50) of 2.1 micrograms/ml. Hattalin inhibited membrane Na+, K(+)-ATPase of canine kidney cortex. It also inhibited the ATPase of the plasma membrane fraction from both cultured cells and a section of human breast cancer tissue at a concentration ranging from 0.5 to 2.0 mM. However, only a few percent of membrane ATPase from either ZR-75-1 cells or breast carcinoma tissue was inhibited by 2.0 mM of ouabain, suggesting that the target ATPase of hattalin was other than ouabain-sensitive ATPase. The relative incorporation of [3H]thymidine per 1 x 10(5) cells into the acid-precipitable fraction of ZR-75-1 cells was not affected by 1-50 micrograms/ml of hattalin, while a marked decrease resulted from 1-10 micrograms/ml of 5-fluorouracil (5-FU). These results suggest that the suppressive effect of hattalin on tumor cell growth may not occur through inhibition of DNA synthesis but rather partly by inhibition of the plasma membrane ATPase other than Na+ and K(+)-dependent ones.

Use of thallium-201 SPECT to quantitate malignancy grade of gliomas

A quantitative preoperative technique using thallium-201 single-photon emission computerized tomography is described which predicts whether specific gliomas are of high- or low-grade malignancy. An index, based on the ratio of thallium uptake in the tumor versus the homologous contralateral brain, was calculated and compared with tumor histology. The index in 14 patients with low-grade malignant gliomas was 1.27 +/- 0.40 in contrast to an index of 2.40 +/- 0.61 in 11 patients with high-grade malignant gliomas (p less than 0.0005). Whether gliomas were of low- or high-grade malignancy could be predicted with 89% accuracy using a threshold of 1.5. Low-grade gliomas with an index higher than 1.5 acted biologically more like high-grade tumors, and no tumor histologically classified as being of high-grade malignancy had an index lower than 1.7. This technique could help to reduce unrecognized sampling errors during needle biopsies of brain tumors, particularly of high-grade lesions classified in error as low-grade tumors due to inadequate biopsy material.

Density-related changes of potassium (86Rb) uptake by amphibian endothelial cells

Potassium influx has been investigated in XTH-2 cells, a line derived from tadpole heart endothelia. In this line, the density at which the cultures become confluent is clearly separated from the density at which growth arrest takes place. Density-related changes in K+ influx were monitored by determining the uptake of 86Rb into well adhering cells kept in culture medium. The main observations were 1) 86Rb uptake is highest in single cells, and on confluency it reaches a low level, which is kept constant at higher cell density regardless of whether the cultures are stationary or still in logarithmic growth phase; 2) the relative amount of 86Rb taken up via the Na+ -K+ -2Cl- cotransport pathway and via the Na+/K+ pump changes from low cell density to confluent cultures; 86Rb uptake of single cells is nearly insensitive to ouabain, a maximum of ouabain sensitivity is reached around confluency, whereas piretanide-sensitive 86Rb uptake is highest in single cells and seems to reach a minimum at the onset of confluency; 3) the variations in Na+/K+ pumping rate reflect neither differences in the amount of enzyme present nor changes in enzyme repartition between apical and basolateral plasma membranes; they seem to result from either "masking" or "unmasking" of the enzyme; 4) no alterations in K+ uptake occur that would be characteristic of the "stationary growth phase." The only changes that seem to be related to arrest of proliferation are concerned with the Na+/K+-ATPase, which achieves an extraordinary susceptibility to stimulation by monensin and exhibits an increase in PNPPase activity.

Thallium-201 tumor/cardiac ratio estimation of residual astrocytoma

Treatment of high-grade astrocytoma includes surgery, chemotherapy, and various methods of irradiation. Radiation therapy usually results in necrosis and edema around the primary tumor site. Contrast-enhanced computerized tomography (CT) and standard radionuclide imaging techniques are unable to reliably distinguish recurrent tumor from necrosis or edema since these images depict localization of contrast material or tracer, which primarily depends on blood-brain barrier breakdown. Thallium-201 (201Tl) appears to incorporate into viable tumor cells more rapidly than into normal brain cells. This report describes a new method to quantify the uptake of 201T1 in the tumor: the tumor-to-cardiac uptake ratio (T/C). Twenty-three 201T1 brain scans were performed on eight patients to differentiate recurrent viable high-grade astrocytoma from posttherapy changes. Planar images of the head and heart were obtained in order to calculate the ratio of tumor counts to cardiac counts. This ratio represents a numerical estimation of 201T1 uptake in the brain tumor relative to cardiac counts and is expressed as the T/C index. The T/C index correlated well with the clinical course in all eight patients. In general, however, CT suggested more extensive regrowth of tumor than the actual clinical status suggested. In one patient's course of radiological monitoring, tumor recurrence was detected by means of 201T1 imaging four months prior to its appearance on CT. In conclusion, when performed serially, the T/C index can provide an accurate estimate of residual tumor burden or recurrence, and detect and quantify viable tumor during therapy.

Tissue distribution of an endogenous ligand to the Na, K ATPase molecule

A variety of evidence indicates the presence of a circulating ligand to the Na, K ATPase molecule that is involved in the regulation of extracellular sodium metabolism. To examine the potential role of endogenous ligands to the Na, K ATPase molecule in the regulation of intracellular sodium metabolism, the tissue distribution of digitalis-like activity was quantitated in several brain regions and peripheral organs. The digitalis-like activity of desalted and delipidated extracts of tissue was widely distributed and produced a displacement of tritiated ouabain that was parallel to the displacement produced by cold ouabain. These results suggest that tissue contains an endogenous ligand to the Na, K ATPase molecule and that this ligand may regulate intracellular sodium metabolism in an autocoid-like manner.

The influence of virus transformation and cell population density on some membrane properties of mouse fibroblasts in culture

The influence of cell population density and simian virus 40 transformation on the activity of the Na-K pump was studied in mouse fibroblasts cultured in medium supplemented with fetal bovine serum. The activity of the Na-K pump was determined from K+ influx, ethacrynate-sensitive K+ influx, (Na+ + K+)-ATPase assay, and the determinations of intracellular potassium and sodium ion concentrations in these cells. The activity of the Na-K pump was found to decrease in density-inhibited cultures of normal fibroblasts (designated as 3T3 cells), while in the virus-transformed cells (SV3T3) the activity remained fairly constant at all cell population densities.

The influence of cell population density and serum on the (Na+K)-ATPase of 3T3 cells

The (Na+K)-ATPase of 3T3 cells has been measured as a function of culture density and the type of serum in which the cells were grown. When 3T3 cells were grown in medium containing 10% newborn calf serum their (Na+K)-ATPase activity increased as the culture density increased and the cells became quiescent at densities of about 17.5 X 10(4) cells/cm2. When these cells are subcultured into medium containing 10% foetal bovine serum the activity of the enzyme decreases as the culture density increases and the cells attain final densities of about 5 X 10(4) cells/cm2.

Sodium and ouabain induce proliferation of rat thymic lymphocytes via calcium- and magnesium- dependent reactions

When the concentrations of either calcium or of magnesium in the culture medium were increased from the normal 0.6 and 1.0 mM to 1.8 and 2.5 mM respectively mitotic activity of rat thymic lymphocytes increased. Very high (10(-4)M) ouabain concentrations abolished these mitogenic actions whilst lower (10(-7) and 10(-11)M) concentrations had no effect. However in the normal medium these lower concentrations of ouabain were themselves mitogenic. The stimulatory effect of 10(-7)M ouabain was calcium-dependent and oestradiol-blockable and that of 10(-11)M magnesium-dependent and testosterone-blockable. A 10 mM increment in extracellular sodium concentration also stimulated mitosis in these cells in a calcium-dependent manner whilst a 20 mM increment required the presence of magnesium to exert its mitogenic effect. However, when similar osmotic increments were provided by potassium and lithium salts, or sucrose no mitotic stimulation was provoked. Subtle interactions between sodium and the divalent cations are clearly involved in events which lead to mitosis and the steroids oestradiol and testosterone can somehow block these effects.

Increase in K+ and alpha-AIB active transport in CHO cells after low [K+] treatment

We have studied the effects of prolonged incubation in low [K+] medium (approximately 0.3 mM) on both K+ and amino acid transport in Chinese hamster ovary (CHO) cells. When incubated in low [K+] medium, CHO cells redressed partially the loss of intracellular K+ after 12 h. After 24 h of incubation, both the activity of Na+-K+-ATPase in crude homogenates, and the transport capacity (Vmax) for ouabain-sensitive (i.e., active) K+ influx approximately doubled. The magnitude of the ouabain-insensitive (i.e., passive) K+ influx decreased by 50%. Thus the regulatory response involves an apparent increase in Na+-K+ pump and a decrease in K+ leak. The transport capacity for the nonmetabolized amino acid, alpha-aminoisobutyric acid (alpha-AIB), also increased after 24 h in low [K+] medium. The Vmax for the Na+-dependent (i.e., active) alpha-AIB influx increased by about 150%, and the magnitude of the Na+-independent influx increased by 20-40%. These changes in alpha-AIB transport result in a twofold greater capacity to accumulate this amino acid. Thus the regulation of K+ and alpha-AIB transport systems appears to be linked and possible mechanisms of this linkage are discussed.

Regulation of passive potassium transport of normal and transformed 3T3 mouse cell cultures by external calcium concentration and temperature

Regulation of passive potassium ion transport by the external calcium concentration and temperature was studied on cell cultures of 3T3 mouse cells and their DNA-virus transformed derivatives. Upon lowering of external calcium concentration, passive potassium efflux generally exhibits a sharp increase at about 0.1 mM. The fraction of calcium-regulated potassium efflux is largely independent of temperature in the cases of the transformed cells, but shows a sharp increase for 3T3 cells upon increasing temperature above 32 degrees C. In the same range of temperature, the 3T3 cells exhibit the phenomenon of high-temperature inactivation of the residual potassium efflux at 1 mM external calcium. At comparable cellular growth densities, the transformed cell lines do not show high-temperature inactivation of "residual" potassium efflux. These results are consistent with the notion of a decisive role of the internal K+ concentration in the cell-density dependent regulation of cell proliferation. In particular, the growth-inhibiting effect of lowering the external Ca2+ concentrations is considered as largely due to a rise of passive K+ efflux and a subsequent decrease of internal K+ concentration. The experimental data on the Ca2+ dependence of passive K+ flux are quantitatively described by a theoretical model based on the constant field relations including negative surface charges on the external face of the membrane, which cooperatively bind Ca2+ ions and may concomitantly undergo a lateral redistribution. The present evidence is consistent with acidic phospholipids as representing these negative surface charges.

Sodium and rubidium uptake in cells transformed by Rous sarcoma virus

Rates of uptake and intracellular concentrations of monovalent cations were measured in virus-transformed and nontransformed chick embryo (CE) cells. Uptake of 22Na+ into cells transformed by the BH strain of Rous sarcoma virus (RSV-BH) (CE-BH) was about double the rate of uptake into CE cells, or cells transformed by the Schmidt-Ruppin strain (RSV-SR): CE-SR. Likewise, the rate of efflux of 22Na+ was greater in CE-BH cells than in CE or CE-SR cells. The greater permeability of CE-BH cells to Na+ was apparent in higher intracellular Na+ concentrations. Experiments with cells exhibiting temperature-dependent transformation showed that new RNA and protein synthesis was a requirement for the acquisition of increased Na+ permeability, suggesting that the change is an indirect effect of the virus-coded transformation-inducing protein. Rates of 86Rb+ uptake, used as a measure of K+ influx, were indistinguishable in CE, CE-BH, and CE-SR cells. Also, equilibrium intracellular levels of 86Rb+ were similar in transformed and nontransformed cells, as were observed concentrations of K+. Also, no differences in ATPase activity, as indicated by ouabain binding or temperature sensitivity, were observed. We conclude that monovalent cations play no direct role in RSV-induced transformation, although the higher levels of Na+ in CE-BH cells may be responsible for other distinguishing biochemical features of these cells.

Potassium fluxes and ouabain binding in growing, density-inhibited and Rous sarcoma virus-transformed chicken embryo cells

Potassium fluxes, ouabain binding, and Na+ and K+ intracellular concentrations were determined for cultures of growing normal, density-inhibited and Rous sarcoma virus-transformed chicken embryo fibroblasts. No significant differences in K+ influx or ouabain binding were detected between growing normal cells and Rous sarcoma virus-transformed cells; however, ouabain binding and ouabain-sensitive K+ influx were 1.5- to 1.8-fold lower in density-inhibited cells. Thus, potassium influx in this system can be classified as a growth-related, but not transformation-specific change. As determined by both flame photometry and radioisotopic (42K) equilibration, growing normal and density-inhibited cells had similar potassium contents, whereas transformed cells exhibited 1.4-fold higher potassium levels. Sodium ion levels, as measured by flame photometry, were also 2- to 4.5-fold higher in transformed than normal or density-inhibited cells. Complementary studies of potassium efflux showed a 1.3- to 1.5-fold higher rate (based on the percentage of pool exiting the cell) in growing normal versus density-inhibited or transformed fibroblasts. Because of the larger potassium pool in transformed cells, efflux based on absolute number of potassium ions is similar in normal and transformed chicken embryo fibroblasts.

Properties of Na-K pump in primary cultures of kidney cells

Activities related to Na-K transport were measured in cell cultures of ground squirrel kidney cortex in order to compare these cells with those of intact kidney and of continuous cell lines. A microsomal preparation containing plasma membrane Na,K-ATPase from fresh kidney showed twice the activity of a similar preparation from 72-hour cultured cells. Na,K-ATPase of homogenates of 72-hour cells showed one-third to one-fourth the specific activity of that from 6-hour cultured cells. The associated K-dependent phosphatase activity also declined as a function of time in culture. The ouabain-sensitive influx of K into 6-hour cultured cells was twice as great as the K influx into 72-hour cells. The number of sites binding 3H-ouabain in intact cultured cells declined 81% on a cell protein basis between 6 and 72 hours in culture. This decline in ouabain binding sites was relatively greater than that of K influx, so that the K turnover number increased over this same time period. The decline in ouabain-sensitive K influx during culture was complementary to an increase in furosemide-sensitive K influx. Measurements of unidirectional and net K fluxes showed that there were three components of K influx into 3-day cultured cells: ouabain-sensitive Na:K exchange, furosemide-sensitive K:K exchange, and K diffusion. In the 6-hour cultures, however, there was no furosemide-sensitive K:K exchange. Thus, after three days in culture ground squirrel kidney cells lose a feature characteristic of the original parent cells (high Na,K-ATPase activity), and gain a feature common to many undifferentiated cultured cells (furosemide-sensitive K:K exchange).

Effect of imposed serum deprivation on growth of the mouse 3T3 cell. Dissociation from changes in potassium ion transport as measured from [86Rb)rubidium ion uptake

Decreased serum concentrations that substantially alter the growth of normal 3T3 cells alter neither the active and non-active components of unidirectional (86)Rb(+) influx nor the intracellular K(+) content when compared with cells in exponential growth. Thus the changes in K(+) transport (measured with (86)Rb(+) as an analogue for K(+) movements) that occur on density-dependent growth inhibition of the mouse 3T3 cell are not mimicked by serum deprivation of the cells before density inhibition.

An altered response of virally transformed 3T3 cells to ouabain

The effect of ouabain on K+ transport was examined in 3T3 and virally transformed 3T3 cells. A 10 min exposure to ouabain (10(-3) M) produced approximately 40% inhibition of the unidirectional K+ influx in all cell lines. In 3T3 cells the response was not significantly altered by up to 70 min exposure to the drug. In contrast, the continued exposure of transformed cells to ouabain produced a time-dependent increase in the K+ influx. This increased influx was shown to be accompanied by an increase in the K+ efflux. The results suggest that, in transformed cells, ouabain produces both an inhibition of Na+-K+ exchange and a stimulation of K+-K+ exchange. The latter was shown to be more readily reversible than the former.

Variation in potassium transport properties of mouse 3T3 cells as a result of subcultivation

Unindirectional potassium influx and the fraction of this influx sensitive to ouabain, an inhibitor of the (Na + K) activated ATPase, have been evaluated as a function of subcultivation of the 3T3 and SV40 transformed 3T3 cell. Total and ouabain-sensitive K influx change little over approximately 50 passages of the transformed 3T3 cell. In contrast, these components of K influx increase nearly 5-fold over a similar number of passages of the 3T3 cell. During early passages total and ouabain-sensitive K influx of the 3T3 cell are below that of the SV40 3T3 cell on a per cell volume basis. At later passages the magnitude of these components of K transport exceed those found in the SV40 3T3 cell. Previous studies have reported the ouabain-sensitive uptake of K and the levels of (Na + K) activated ATPase as being higher, lower or equivalent in the 3T3 versus transformed 3T3 cell. The present data suggest these differences may results from the degree to which the cells were passaged at the time of the experiments. Evaluation of previous studies substantiates this conclusion.

Cell growth and quabain-sensitive 86Rg+ uptake and (Na++K+)-ATPase activity in 3T3 and SV40 transformed 3T3 fibroblasts

The uptake of ouabain-sensitive 86Rb+ uptake measured at 5 min and the uptake measured at 60 min was 4.5- and 2.7-fold greater respectively for SV40 transformed 3T3 cells compared to 3T3 cells during the late log phase of growth. This uptake, however, varied markedly with cell growth. Ouabain-sensitive 86Rb+ uptake was found to be a sensitive indicator of protein synthesis as measured by total protein content. Cessation of cell growth as measured by total protein content was associated with a decline in ouabain-sensitive 86Rb+ uptake in both cell types. This increase ouabain-sensitive cation transport was reflected in increased levels of (Na++K)-ATPase activity for SV40 3T3 cells, which showed a 2.5-fold increase V but the same Km as 3T3 cells. These results are compared with the results of related work. Possible mechanisms for these effects are discussed and how changes in cation transport might be related to alterations in cell growth.

Potassium transport in normal and transformed mouse 3T3 cells

The components of unidirectional K influx and efflux have been investigated in the 3T3 cell and the SV40 transformed 3T3 cell in expontntial and stationary growth phase. Over the cell densities used for transport experiments the 3T3 cell goes from exponential growth to density dependent inhibition of growth (4 X 10(4) to 4 X 10(5) cell cm-2) whereas the SV40 3T3 maintains exponential or near exponential growth (4 X 10(4) to 1 X 10(6) cell cm-2). In agreement with previous observations, volume per cell and mg protein per cell decrease with increasing cell density. Thus, transport measurements have been expressed on a per volume basis. Total unidirectional K influx and efflux in the 3T3 cell is approximately double that of the SV40 3T3 cell at all cell densities investigated. Both cell types have similar volumes initially and show similar decreases with increasing cell density. Thus, in this clone of the 3T3 cell SV40 transformation specifically decreases unidirectional K flux. The magnitude of the total K flux does not change substantially for either cell line during transition from sparse to dense cultures. However, the components of the K transport undergo distinct changes. Both cell lines possess a ouabain sensitive component of K influx, presumably representing the active inward K pump. Both also possess components of K influx and efflux sensitive to furosemide. The data suggest this component represents a one-for-one K exchange mechanism. The fraction of K influx mediated by the ouabain sensitive component is reduced to one half its value when exponential versus density inhibited 3T3 cells are compared (63% versus 31% of total influx). No comparable drop occurs in the SV40 3T3 cell at equivalent cell densities (64% versus 56% of total influx). Thus, the pump mediated component of K influx would appear to be correlated with growth. In contrast, the furosemide sensitive component represents approximately 20% of the total unidirectional K influx and efflux in both cell lines in sparse culture. At high cell densities, where growth inhibition occurs in the 3T3 cell but not the SV40 3T3, the furosemide sensitive component doubles in both cell lines. Thus, the apparent K-K exchange mechanism is density dependent rather than growth dependent.

Contact-mediated changes in ATPase activity at the surface of primary cultured hepatoma cells

Hepatoma cells grown in monolayer culture display certain alterations in their Mg-ATPase activity present on the cell surface as a function of time during a exponential growth. Levels of enzyme estimated biochemically and expressed as activity per cell increase as the cell population density increases. Histochemical investigation shows that Mg-ATPase activity is located intensively on the surface of cell contact and the activity is not encountered on the cell surface facing the free space. No enzyme activity is detected histochemically on the cell surface of sparse culture. Deposits of acidic polysaccharide are also seen on the surface of cell contact.

Survival of unprotected, mammalian plateau-phase cells following freezing in liquid nitrogen

Unprotected, mammalian cells in plateau phase are at least a factor of four times more sensitive to freeze-thaw damage than exponential-phase cells. The former suffer about 15-20% more sublethal damage after one freeze-thaw cycle than the latter and repair this damage more slowly. Exposure of plateau-phase cells to freeze-thaw damage lengthens the time required to traverse the cell cycle in the exposed generation. These cells may more closely represent the state in tissues than exponential-phase populations.

The chronic and acute effects of ethanol on adenosine triphosphatase activity in cultured astroblast and neuroblastoma cells

Mg2+ATPase and (Na+ + K+)ATPase activities were measured in clonal line NN hamster astroblasts and in clonal lines M1 and N1E-115 mouse neuroblastoma cells after the cells had been subjected to the acute and chronic actions of 100 mM ethanol. Exposure of the astroblasts to ethanol for periods as long as 68 days produced an increase in total cellular Mg2+ ATPase activity, as measured in cell homogenates; however, activity reverted to control levels upon withdrawal of ethanol. Chronic exposure of clonal line N1E-115 neuroblastoma cells to ethanol produced an increase in Mg2+ATPase and (Na+ +K+)ATPase activities. In contrast, the activities of both ATPases of clonal line M1 neuroblasts were unaffected by chronic exposure to ethanol. Acute exposure of cell homogenates to 100 mM ethanol inhibited Mg2+ ATPase and (Na+ + K+)ATPase of astroblasts but not that of neublastoma cells. These findings suggest that neural cells in culture may serve as useful models for studying the effects of ethanol on specific cell types.