Lobar decrease in 99mTc-GSA accumulation in hilar cholangiocarcinoma.
Hilar cholangiocarcinoma can obstruct hepatic ducts and involve the portal veins. Both biliary stasis and decrease in portal venous flow are known to reduce 99mTc-diethylenetriamine pentaacetic acid-galactosyl human serum albumin (GSA) accumulation. The specific relationship between these pathological conditions due to hilar cholangiocarcinomas and 99mTc-GSA accumulation has never been clarified. METHODS: Sixteen patients with hilar cholangiocarcinomas who underwent 99mTc-GSA liver scintigraphy were reviewed. The relationship between significant decrease in 99mTc-GSA accumulation and lobar biliary stasis, or decrease in the portal venous flow, was evaluated. Average counts of region of interest placed in both right and left lobes were compared in the same transaxial SPECT section. Count ratios of right and left lobes were calculated. RESULTS: Significant lobar decrease in 99mTc-GSA accumulation was observed in 6 of the 16 patients. Ipsilateral portal venous stenosis or obstruction was seen in all these 6 patients, whereas ipsilateral portal venous stenosis or obstruction was seen in only 1 of the other 10 patients. Symmetric bile duct dilatation was seen in 13 patients, and asymmetric bile duct dilatation was seen in 3. Lobar decrease in 99mTc-GSA accumulation correlated well with decrease in ipsilateral portal venous flow (P < 0.0005). The count ratio was significantly reduced when unilateral portal venous flow decreased (P < 0.05). CONCLUSION: Using 99mTc-GSA liver scintigraphy, we can predict lobar decrease in ipsilateral portal venous flow and monitor hepatic functional lateralities in patients with hilar cholangiocarcinomas. (+info)
Hypotensive response to captopril: a potential pitfall of scintigraphic assessment for renal artery stenosis.
A characteristic pattern seen on captopril renography is described that is due to systemic hypotensive response. Most patients with these findings on captopril renography do not receive renal artery angiograms in our clinic because it is usually recognized. However, this pattern has received little attention in the medical literature and may be misinterpreted as being due to physiologically significant renal artery hypertension. METHODS: Over the last 3 y, renal artery angiograms were performed on three patients with systemic hypotensive response pattern on captopril renography. This allowed a unique opportunity to correlate the results of the captopril renogram with the renal artery angiograms in this patient population. Captopril renography was performed with a glomerular filtration agent, diethylenetriamine pentaacetic acid (DTPA), and a tubular agent, o-iodohipurate (OIH). RESULTS: Renal artery angiograms showed no evidence of renal artery stenosis in three patients with systemic hypotensive response pattern on captopril renography. Systemic hypotension on captopril renograms results in preserved uptake of both DTPA and OIH and hyperconcentration in the cortex and collecting system. CONCLUSION: The systemic hypotensive response pattern seen on captopril renography is a distinctive pattern that does not represent physiologically significant renal artery stenosis. (+info)
Improvement of nebulised antibiotic delivery in cystic fibrosis.
AIM: To investigate deposition patterns and to assess the delivery rate of two nebuliser systems in children with cystic fibrosis (CF). METHODS: Thirty three children with CF on regular treatment with nebulised antibiotics had radioisotope scans performed using technetium-99m labelled aerosol antibiotic generated by a Ventstream nebuliser (median mass diameter (MMD), 3.3 microm; delivery rate, 0. 075 ml/min) under conditions similar to their routine home practice. The inhomogeneity of the images was scored on a 1-10 rating scale (a low score indicating even distribution of the antibiotic), and stomach deposition was measured as a percentage of overall deposition. Twenty patients had a repeat scan using an Optimist nebuliser (MMD, 1.8 microm; delivery rate, 0.02 ml/min). RESULTS: The mean inhomogeneity scores were 5.4 in the Ventstream group and 3. 5 in the Optimist group. Mean stomach deposition was 17.3% in the 33 patients using the Ventstream nebuliser. There was an inverse relation between height and stomach deposition (r = 0.69). In the 20 patients who had both nebulisers, the mean percentages of stomach deposition for the Ventstream and Optimist nebulisers were 11.8% and 1.6%, respectively. The Ventstream nebuliser delivered antibiotic at an average 2.8 times faster rate than the Optimist nebuliser. IMPLICATIONS: A smaller particle size results in a more homogenous distribution of the antibiotic in the lungs with decreased stomach deposition. This should not be seen as a recommendation to use the Optimist nebuliser because more antibiotic was delivered to most parts of the lung with the Ventstream because of its increased delivery rate. (+info)
Pulmonary granulocyte kinetics in relation to endothelial and granulocyte activation.
The aim of the study was to measure the peripheral blood levels of soluble E-selectin in patients with systemic inflammation and compare them with in vivo granulocyte activation, pulmonary intravascular granulocyte pooling, pulmonary extravascular granulocyte migration and 99mTc-diethylenetriaminepenta-acetic acid (DTPA) aerosol clearance, an index of lung injury. The level of soluble E-selectin was measured by capture ELISA. Granulocytes were labelled with 111In and 99mTc for quantification of pulmonary granulocyte kinetics. The pulmonary vascular granulocyte pool (PGP) was expressed as a fraction of the total blood granulocyte pool. Pulmonary granulocyte migration was quantified on 24-h images using the 111In signal. Granulocyte activation was quantified as the percentage of circulating cells showing shape change ('primed'). Lung injury was assessed from the clearance rate of inhaled 99mTc-DTPA aerosol. Eighteen patients with systemic inflammation were studied: five with inflammatory bowel disease, eight with systemic vasculitis, four with graft versus host disease and one with a recent renal transplant. The peripheral blood levels of soluble E-selectin were significantly elevated in patients with systemic inflammation. The level of soluble E-selectin showed a significant association with granulocyte migration (Spearman rank correlation coefficient, Rs=0.53; P<0.05) but not with PGP or with the percentage of cells showing shape change (P>0.05 for both). Granulocyte migration was bimodal: patients were therefore subdivided into 'migrators' and 'non-migrators'. Soluble E-selectin level, 99mTc-DTPA clearance and PGP, but not the percentage of cells showing shape change, were significantly higher in migrators than in non-migrators. We conclude that pulmonary intravascular granulocyte pooling is increased in the presence of increased numbers of circulating primed granulocytes but increased pooling does not by itself promote granulocyte migration into the lung interstitium. Insofar as an elevated level of E-selectin in peripheral blood reflects vascular endothelial activation, the data are consistent with the notion that pulmonary endothelial activation is required, in addition to granulocyte activation and an expanded PGP, for granulocyte migration into lung parenchyma and, therefore, for lung injury to occur. (+info)
Dynamic SPECT evaluation of renal plasma flow using technetium-99m MAG3 in kidney transplant patients.
OBJECTIVE: The purpose of this study was to evaluate Patlak's graphic analysis method to determine renal plasma flow (RPF) in kidney transplants. METHODS: Dynamic SPECT was performed with 99mTc MAG3 in 12 patients. RPF was determined by both Patlak's graphic analysis method and Russell's method. Ventral, central and dorsal tomographic images of the transplanted kidney were reconstructed to estimate intrarenal distribution of renal plasma flow. RESULTS: The renal influx constant (Ku) calculated by Patlak's graphic analysis method was reproducible and correlated with both serum creatinine (r = -0.88, P < 0.001) and blood urea nitorogen levels (r = -0.82, P < 0.002). However, a significant difference was noted between the RPF values derived from Patlak's graphic analysis method and Russell's method. Ku was corrected by a factor calculated from raw and reconstructed data, and the resulting values were in fair agreement with those determined by Russell's method. CONCLUSION: These methods are useful in evaluating the function of transplanted kidneys. (+info)
The effect of dialysate dwell on gastric emptying time in patients on continuous ambulatory peritoneal dialysis.
METHODS AND PATIENTS: We evaluated gastric emptying time (GET) with a technetium (Tc) 99m-sulfur colloid gastric emptying scan in 11 patients on continuous ambulatory peritoneal dialysis (CAPD) (6 males, 5 females) and in 14 controls. We investigated the effect of dialysate dwell on GET by studying the subjects twice: once without dialysate in the abdomen (drained) and once with 2 L of dialysate in the abdomen (full). We also investigated the relationship between body surface area (BSA) and delayed gastric emptying. RESULTS: (1) The mean gastric emptying rate in 120 minutes in patients on CAPD when drained (67.8%+/-13.4%) was not different from that in controls (65.4%+/-8.6%). (2) The mean gastric emptying rate in 120 minutes in patients on CAPD when full was significantly slower than that when drained (55.6%+/-14.6% versus 67.8%+/-13.4%, p < 0.05). In four of the 11 patients (36.4%), gastric emptying was extremely delayed from normal to abnormal range when full. (3) The BSA of patients who had extremely delayed GET from normal to abnormal range was smaller than that of patients who had minimal delayed or unchanged GET when full (1.5+/-0.11 m2 versus 1.74+/-0.22 m2). CONCLUSION: This study showed that patients on CAPD had normal gastric emptying when drained, and that gastric emptying was delayed by dialysate dwell, especially in patients who has less than 1.5 m2 of body surface area. Therefore, we suggest that, based on adequacy, intermittent nocturnal peritoneal dialysis or a small volume of dialysate be considered for patients with small body surface area. (+info)
Glomerular filtration rate estimated from the uptake phase of 99mTc-DTPA renography in chronic renal failure.
BACKGROUND: The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea. METHODS: Fifty patients with reduced renal function (serum creatinine between 150 and 600 micromol/l) were enrolled in the study. GFR was estimated from the uptake phase of 99mTc-DTPA renography (GFR(DTPA)). The renal clearance of 51Cr-EDTA (GFR(EDTA)) was used as the reference method. Creatinine clearance (C(Cr)), urea clearance (C(Ur)) and the mean of urea and creatinine clearance (C(Cr+Ur)/2) were also calculated from urine collected during a period of 24 h. Limits of agreement were used for method comparison. RESULTS: The limit of agreement between GFR(DTPA) and GFR(EDTA) was 2 +/- 17 ml/min. The mean difference did not deviate significantly from zero. The other clearance techniques had larger limits of agreement and a mean difference significantly different from zero. Furthermore, C(Ur) and C(Cr+Ur)/2 had systematic deviations of the differences, indicating that C(Ur) and C(Cr+Ur)/2 are poor estimates of GFR. CONCLUSION: The limit of agreement between GFR(DTPA) and GFR(EDTA) are acceptable and, therefore, GFR estimated from 99mTc-DTPA renography is acceptable for clinical use in patients with reduced renal function. Furthermore, the method is simple and less time consuming compared with renal clearance techniques. (+info)
Asialoglycoprotein receptor scintigraphy in evaluation of auxiliary partial orthotopic liver transplantation.
The purpose of this study was to evaluate asialoglycoprotein receptor scintigraphy in the post-transplant monitoring of liver graft and native liver functions in recipients of auxiliary partial orthotopic liver transplantation (APOLT) from living donors. METHODS: We performed 36 asialoglycoprotein receptor scintigraphies on 13 patients who had undergone APOLT for noncirrhotic metabolic liver diseases or for small-for-size grafts. The portal vein of the native liver was separated in 12 patients. Anterior dynamic images including the heart and both livers were obtained for 16 min after intravenous injection of 99mTc-diethylenetriamine pentaacetic acid-galactosyl human serum albumin (GSA), and thereafter static SPECT images of both livers were obtained. Uptake rates from the blood to the graft and to the native liver were determined separately by Patlak plot graphical analysis. Relative uptake of GSA by the graft was calculated from transverse SPECT images. The relative volume of the graft liver was determined by CT. RESULTS: The relative uptake of GSA by the graft was higher or increased more rapidly than the relative volume of the graft in 8 of 11 patients with no severe complications concerning the graft. The relative uptake by severely damaged graft liver in 2 patients was much lower than the relative volume. The uptake rate of GSA by the graft was low in these 2 patients. The uptake rate by the native liver decreased when the portal vein was separated. CONCLUSION: The relative uptake of GSA was a better indicator of graft liver function than was anatomic volume. The uptake rate provided additional independent information of each liver. Asialoglycoprotein receptor scintigraphy is useful for distinguishing and monitoring the graft and native liver functions in patients who had undergone APOLT. (+info)