POOR-QUALITY RED-BLOOD-CELL LABELING WITH TC-99M - CASE-REPORT AND REVIEW OF THE LITERATURE

Technetium-99m red blood cell (RBC) venography is a simple and sensitive technique for the diagnosis of deep vein thrombosis of the lower limb, but optimal labelling of the blood pool is essential for a diagnostic study. Here we report the case of a 44-year-old male with deep vein thrombosis of the right leg. RBC venography of the lower extremities showed poor labelling. In addition we review the literature on the subject

Comparison of Tc-99m MIBI and TI-201 uptake in musculoskeletal lesions

The aim of this study was to make a comparison between the uptake of Tc-99m MIBI and Tl-201 in evaluation of musculoskeletal lesions, Fourteen cases were studied, Each study consisted of a Tl-201 study followed by a Tc-99m MIBI scan, In addition, a whole-body bone scan was performed in each patient to visualize bone metastases, Tl-201 and Tc-99m MIBI uptakes were evaluated by visual assessment and by using lesion-to-background (L/B) ratio, The authors found increased Tl-201 uptake with a mean L/B ratio of 2.81 and less Tc-99m MIBI uptake with a mean L/B ratio of 2.18 in malignant lesions, Both agents showed lower uptake with mean L/B ratios of 1,6 and 1.2 in benign lesions, but there was no statistical difference between the uptakes of either Tl-201 or Tc-99m MIBI in those with malignant and those with benign lesions, In addition, false-positive imaging was observed with both Tl-201 and Tc-99m MIBI. The results demonstrated that Tl-201 and Tc-99m MIBI accumulations in musculoskeletal lesions are not specific for malignancy

Acute myocardial infarction due to chemotherapy in a patient with testis tumor

A 26-year-old male patient was admitted to our clinic due to precordial pain, sweating, nausea and vomiting. Electrocardiogram and cardiac enzymes were consistent with an acute myocardial infarction (AMI). The patient had a history of 2 courses of chemotherapy (cisplatin + etoposide + bleomycin) upon detection of testis tumor (seminoma) on the last day of which he had symptoms of AMI. Acute myocardial infarction was accepted to be caused by cisplatin and etoposide. Since AMI due to chemotherapy is a very rare complication, it is decided to report this case

VISUALIZATION OF A PERFORATED SMALL-BOWEL DUPLICATION DURING MECKEL SCINTIGRAPHY

A case of a small bowel tubular duplication is described. It was lined with ectopic gastric mucosa which showed a perforation. The diagnosis was made preoperatively by Tc-99m pertechnetate scintigraphy

Tc-99(m)-polyclonal IgG scintigraphy in the detection of infected hip and knee prostheses

We investigated the usefulness of Tc-99(m)-polyclonal human IgG (Tc-99(m)-HIG) scintigraphy in the diagnosis of infected hip and knee prostheses. Twenty-nine scintigraphic studies were performed in 27 patients (17 females, 10 males) with a suspected prosthetic infection. As some patients had bilateral prostheses, a total of 35 prostheses were evaluated. There were 25 hip replacements and 10 knee prostheses. The images were analysed both visually and quantitatively. The scintigraphic results were compared with the culture results of surgical specimens and also with clinical follow-up after 3 months. Increased uptake was observed in 22 prostheses, of which 12 were true-positive and 10 were false-positive results. Staphylococci were the agents most commonly isolated. In all false-positive patients, aseptic inflammation was diagnosed. Based on quantitative analysis, no statistically significant difference was found between the true-positive and false-positive cases. For the prostheses as a whole, the sensitivity, specificity, positive predictive value and negative predictive value were 100%, 41%, 54% and 100% respectively. For the hip prostheses alone, these values were 100%, 53%, 57% and 100% respectively. Taking its high sensitivity and predictive value into consideration, Tc-99(m)-HIG scintigraphy can be used as a screening test to help eliminate prosthetic infection

Tc-99(m)-tetrofosmin scintigraphy in the evaluation of palpable breast masses

Tl-201 and Tc-99(m)-MIBI have been used io evaluate palpable breast masses. The aim of this study was to evaluate the potential of Tc-99(m)-tetrofosmin as a new tumour localizing agent in patients with palpable breast masses. Nineteen palpable breast masses were evaluated in 18 patients. Each patient received 740 MBq Tc-99(m)-tetrofosmin intravenously. Ten minutes after the injection, planar breast images in the anterior, right lateral and left lateral views were obtained with the patient in the supine position. Mammography and ultrasonography were performed in all patients. Biopsy or mastectomy with axillary dissection was performed in all patients. Thirteen of 14 primary breast tumours were detected (9 invasive ductal carcinomas, 3 invasive lobular carcinomas, 1 papillary carcinoma). One patient with mucinous carcinoma did not demonstrate Tc-99(m)-tetrofosmin accumulation. Four of five patients with histopathologically proven benign lesions did not demonstrate Tc-99(m)-tetrofosmin accumulation (2 fibrocystic diseases, 2 fibroadenomas). Tc-99(m)-tetrofosmin accumulation was seen in a patient with chronic mastitis. The sensitivity and specificity of Tc-99(m)-tetrofosmin for malignant breast lesions was 92 and 80% respectively. Four of seven (57%) axillary lymph node metastases showed Tc-99(m)-tetrofosmin uptake. In conclusion, Tc-99(m)-tetrofosmin shows real promise for use in evaluating patients with palpable breast masses

Determination of medullary thyroid carcinoma metastases by Tl-201, Tc-99(m)(V)DMSA, Tc-99(m)-MIBI and Tc-99(m)-tetrofosmin

Medullary carcinoma of the thyroid (MCT) is malignancy derived from the parafollicular cells (or C-cells) of the thyroid. It is usually sporadic, although it is familial in some cases. Several scintigraphic procedures can provide information regarding the primary and metastatic foci of the tumour. We performed whole-body scanning to establish the pathology of MCT using Tl-201, Tc-99(m)(V)DMSA and Tc-99(m)-MIBI in 14 patients, and found average sensitivities of 73%, 82% and 81%, respectively. Moreover, we also scanned three patients with Tc-99(m)-tetrofosmin and identified two of four pathological foci as well as residual thyroid tissue. The sensitivities of Tl-201, Tc-99(m)(V)DMSA and Tc-99(m)-MIBI were 100%, 100% and 85% in identifying lymphadenopathies; 40%, 50% and 71% for soft tissue foci; 100%, 100% and 100% for foci in pulmonary parenchyma; and 100%, 66% and 100% for recurrences in thyroid gland. Although Tc-99(m)(V)DMSA identified all bony metastases in three patients (100%), Tc-99(m)-MIBI detected only two of three foci (66%) and Tl-201 none. Tl-201, Tc-99(m)-MIB and Tc-99(m)-tetrofosmin accumulated in residual thyroid tissue, but Tc-99(m)(V)DMSA did not, as expected. We conclude that these agents were complementary, since they had different sensitivities in different tissues. The tumour-seeking properties of tetrofosmin are to be evaluated in a larger series. ((C) 1999 Lippincott Williams & Wilkins)