Preliminary assessment of interand intraobserver reproducibility, and normative values of renal mean transit time (MTT) and parenchymal transit time (PTT) for 99mTc-etylenodicysteine

BACKGROUND: The clinical significance of MTT and PTT, determined by deconvolution of renographic curves, is arguable. Their usefulness in diagnosis of obstructive uro- and nephropathy, renovascular hypertension and monitoring of transplanted kidneys is pointed out, but susceptibility of deconvolution methods to errors resulting from “statistical noise” is also stressed. So far there are no reports on normative MTT values for 99mTc-EC, although such values were already determined for 131I-OIH, 99mTc-DTPA and 99mTc-MAG3. The aim of this study is an assessment of inter- and intraobserver reproducibility of MTT and PTT for 99mTc-EC, and determination of normative values for these parameters. MATERIALS AND METHODS: 31 patients (17 women and 14 men aged 19–75, average 44 years) referred for dynamic renal scintigraphy with: unilateral flow impairment (11), unilateral nephrolithiasis (2), control after unilateral lithotripsy (4), moderate hypertension (demographically with > 99% probability of primary hypertension) (4), suspected cirrhosis of one kidney (3), future kidney donors (3), control after abdominal injuries (3), incontinence (1). 42 functionally efficient kidneys were included in the study. Criteria for recognition of a kidney as functionally efficient were: — no earlier history of renal disease, signs of renal damage in basic blood and urine tests, or abnormalities in ultrasonography; — normal result of dynamic renal scintigraphy (in terms of sequential images and renographic curve). MTT and PTT values were determined independently by two operators, using a matrix method for deconvolution of renographic curves. RESULTS: Differences between mean MTT and PTT from two studies by one operator were insignificant and those values were closely correlated (r = 0.99 and r = 0.97, respectively). Differences of values obtained by both operators were practically insignificant for MTT (r = 0.93), and significant for PTT (r = 0.81 and p < 0.001). These differences do not disqualify that processing method. The upper limits of normative values of MTT and PTT were based on the results from first study performed by more experienced operator — 200 s and 170 s, respectively. CONCLUSIONS: The procedure of processing dynamic renal scintigraphy used in this study is reproducible. Normative values of MTT and PTT for 99mTc-EC were established as 200 s and 170 s, respectively. An attempt to optimize and standardize the technique of determining parenchymal ROI in a matrix deconvolution method, followed by an evaluation of clinical usefulness of these parameters in the diagnosis of chosen renal function impairments would be a logical continuation of this initial research

Application of stress-only myocardial perfusion imaging

BACKGROUND: Single-photon emission computed tomography myocardial perfusion study is usually a sequence of stress and rest part. In case of a normal stress study rest part can be given up. The objective of this study was to examine factors affecting concordance of results of stress-only (SO) and stress-rest (SR) studies. MATERIAL AND METHODS: SO and SR studies without and with attenuation correction (AC) of 212 selected patients (without cardiomyopathy, history of myocardial infarction or coronary artery bypass grafting) were analyzed visually. Influence of percutaneous coronary intervention (PCI) in the past, type of stress (physical/pharmacological) and application of AC (in form of combined method of non-corrected and corrected images — CM), patient body mass index (BMI) and gender on concordance rates of SO and SR studies were examined. RESULTS: Neither a history of PCI, nor a type of stress affected concordance rate. AC (in form of CM) improved concordance rate significantly, from 60% to 68% (p = 0.018). Patient BMI affected concordance rates — 72% in non-obese and 59% in obese patients (p = 0.05). In the whole group, risk of overlooking patients with abnormal perfusion in SO study was small (< 2%), but it grew significantly with patient BMI. Rest study was necessary in about 20% of non-obese and in about 50% of obese patients. CONCLUSION: MPS can be limited to stress part in appropriately selected, especially non-obese, patients provided that AC is applied, due to a low risk of overlooking patients with abnormal perfusion. In case of obese patients, careful analysis of exercise images for their normality is particularly important

Adenosine receptors expression is elevated in leukocytes of gestational diabetes mellitus (GDM) subjects — a preliminary study

Introduction: Adenosine receptors (ARs), belonging to the G-protein-coupled receptors (GPCRs), are present in the majority of human cells and tissues. Depending on their biochemical and pharmacologic properties, four subtypes of ARs (i.e. A1, A2A, A2B, and A3) have been distinguished. Currently, these receptors are attractive molecular targets for pharmacological interventions in various diseases, including diabetes. The literature published to date has shown an altered expression of ARs in several types of cells under diabetic conditions. However, there has been no publication devoted to the investigation of ARs expression in leukocytes of subjects with gestational diabetes mellitus (GDM). Therefore, this study was aimed to determine the expression level of AR subtypes in leukocytes of GDM patients and its relationship to anthropometric and biochemical parameters. Material and methods: Gene expression of four AR subtypes in leukocytes of both healthy (n = 34) and GDM (n = 67) subjects in the third trimester of pregnancy (from 24 to 33 weeks) was investigated. Multiple regression analyses were used to assess the association between the expression level of ARs and both anthropometric and biochemical parameters. Results: Statistically significant (p < 0.05) higher levels of A2A and A2B mRNAs were observed in leukocytes of the GDM subjects compared to the control group. There was a positive correlation of A2B mRNA level with glucose concentration at 120 min of oral glucose tolerance test (OGTT) (r = 0.24, p = 0.041). Conclusions: Overexpression of A2BAR in leukocytes of the GDM subjects and, additionally, the existence of a relationship between its elevated expression level in these cells and abnormal values of glucose concentration at 120 min of OGTT for GDM, suggest that this subtype might be involved in the pathogenesis of GDM. (Pol J Endocrinol 2012; 63 (2): 110&#8211;114)Wstęp: Receptory adenozynowe (ARs) należą do błonowych receptorów sprzężonych z białkami G, które są obecne w większości ludzkich komórek i tkanek. Na podstawie ich biochemicznych i farmakologicznych właściwości wyróżniono cztery podtypy ARs (tj. A1, A2A, A2B, A3). Obecnie receptory te stanowią atrakcyjne molekularne cele dla farmakologicznych interwencji w różnych chorobach, w tym cukrzycy. W dostępnym piśmiennictwie istnieją dane wskazujące, że poziom ekspresji receptorów może ulegać zmianom w niektórych typach komórek podczas cukrzycy, natomiast nie ma publikacji dotyczących badania ekspresji ARs w leukocytach pacjentek z cukrzycą ciążową (GDM). Dlatego celem pracy było określenie poziomu ekspresji czterech podtypów ARs w leukocytach kobiet z GDN i ich korelacja z wybranymi parametrami antropometrycznymi i metabolicznymi. Materiał i metody: Poziom ekspresji czterech podtypów ARs badano w leukocytach kobiet w ciąży, zarówno zdrowych (n = 34; grupa kontrolna), jak i ze zdiagnozowaną GDM (n = 67). Poziomy ekspresji korelowano z oznaczonymi parametrami antropometrycznymi i biochemicznymi. Wyniki: W grupie GDM zaobserwowano istotny statystycznie (p < 0,05) wzrost poziomu mRNA receptorów A2A and A2B w porównaniu z grupą kontrolną. Zaznaczyła się również dodatnia korelacja między poziomem ekspresji receptora A2B a stężeniem glukozy w 2. godzinie testu doustnego obciążenia 75 g glukozy (r = 0,24; p = 0,041). Wnioski: Zarówno istotnie podwyższony poziom ekspresji receptora A2B w leukocytach kobiet z GDM, jak i istnienie dodatniej korelacji między poziomem ekspresji receptora A2B w tych komórkach a stężeniem glukozy wskazują na jego potencjalny udział w patogenezie GDM. (Endokrynol Pol 2012; 63 (2): 110&#8211;114

Usefulness of clearance parametric images in detection of regional renal parenchyma dysfunction

BACKGROUND: The aim of the study was to examine whether parametric clearance images (PAR) enhance diagnostic potential of a dynamic renal scintigraphy with detection of local dysfunction of kidneys, on a model of kidneys after treatment with extracorporeal shock wave lithotripsy (ESWL), MATERIAL AND METHODS: Kidneys after ESWL were accepted as a proper model for the implementation of this objective because of the previously proven damaging effect of a shock wave on renal parenchyma and known region of ESWL application. Forty patients (23 males and 17 females) at the age of 37 to 70 years (mean value 54) with untreated earlier single, one-sided nephrolithiasis, currently treated with ESWL, underwent a study. A dynamic renal 99mTc-EC scintigraphy was performed three times: before ESWL, a week and a month after this therapeutic intervention. PAR images generated with use of an in-house developed software were compared with summation (SUM) of images obtained from radiopharmaceutical uptake phase and quantitative global function parameters (GFP) of each kidney, like split function, MTT — mean transit time and PTT — parenchymal transit time. RESULTS: PAR and SUM images of all 40 kidneys before ESWL were normal. PAR images revealed local or diffused defects a week and a month after therapeutic intervention in statistically significantly larger numbers of kidneys than SUM images (19 vs. 6, p = 0.002 and 16 vs. 5, p = 0.003, respectively). A week after ESWL, when defects in PAR images were observed in about a half of all renal segments (29/57 — 51%) all GFP values were significantly worse than in kidneys without defects. A month after ESWL defects in PAR images could be observed in ab. 1/3 (17/48 — 35%) of segments and were less extensive, whereas GFP values did not differ significantly from values in kidneys without clearance function impairment in the PAR images. CONCLUSIONS: PAR images enhance diagnostic potential of a dynamic renal scintigraphy with detection of local function defects. These images allow to detect more local renal function defects than SUM images

The utility of the gonadotrophin releasing hormone (GnRH) test in the diagnosis of polycystic ovary syndrome (PCOS)

Wstep: Test z gonadoliberyną (GnRH) może ujawnić względną przewagę syntezy LH nad FSH, w wyniku zwiększonej częstości podwzgórzowych pulsów GnRH w zespole policystycznych jajników (PCOS, polycystic ovary syndrome). W pracy podjęto zatem próbę oceny, czy stymulacja przysadki przez GnRH może być przydatna w diagnostyce PCOS. Materiał i metody: Badaniem objęto 185 osób: kobiety z PCOS, n = 151, z zaburzeniami miesiączkowania o typie oligo- lub amenorrhoea, w wieku (średnia &#177; SD) 24,8 &#177; 5,4 lat, wskaźnikiem masy ciała (BMI, body mass index) 24,5 &#177; 6,0 kg/m2 oraz kobiety z grupy kontrolnej, n = 34, wiek 26,6 &#177; 5,0 lat, BMI 24,6 &#177; 5,5 kg/m2. U 121 kobiet z PCOS oraz u 32 kobiet z grupy kontrolnej oznaczono LH i FSH przed (0 minut) oraz w 30 i 60 minut po podaniu GnRH (100 &#956;g i.v.). Insulinooporność oceniono za pomocą modelu HOMA oraz za pomocą indeksu insulinooporności (IRI), obliczanego na podstawie stężeń glukozy i insuliny w doustnym teście tolerancji glukozy (75 g). Wyniki: Kobiety z PCOS miały wyższe stężenia testosteronu całkowitego (p = 0,0002), androstendionu (p = 0,0021), 17OH-progesteronu (p < 0,0001) oraz charakteryzowały się większą insulinoopornością. Podwyższone stężenia któregoś z androgenów obserwowano u 58,1% kobiet z PCOS. Wyjściowe oraz stymulowane stężenia LH były wyższe u kobiet z PCOS (9,09 &#177; 5,56 v. 4,83 &#177; 1,71 IU/L, 35,48 &#177; 31,4 v. 16,30 &#177; 6,68 IU/L, 33,86 &#177; 31,8 v. 13,45 &#177; 5,2 IU/L, odpowiednio w 0, 30 i 60 minucie testu, p < 0,0001). Nie było różnic pomiędzy wyjściowymi oraz stymulowanymi stężeniami FSH między grupami. Stosunki stężeń LH oraz FSH po stymulacji przez GnRH w porównaniu z wartościami wyjściowymi były zbliżone w obu badanych grupach. Zaobserwowano znaczący wzrost stosunku LH/FSH u kobiet z PCOS, w porównaniu z grupami kontrolną (LH0min/FSH0min 1,59 &#177; 0,95 v. 0,76 &#177; 0,2, LH30min/FSH30min 4,07 &#177; 3,0 v. 1,89 &#177; 0,79, LH60min/FSH60min 3,56 &#177; 2,58 v. 1,55 &#177; 0,63, p 2,11 lub LH60min/FSH60min > 1,72 charakteryzował się odpowiednio czułością 78,3% i swoistością 87,5% oraz czułością 81,7% i swoistością 81,3% dla kobiet z PCOS. Wnioski: U kobiet z PCOS stwierdza się wyższe stężenia LH, zarówno przed, jak i po stymulacji przez GnRH. Stosunek stężeń LH do FSH ulega istotnemu zwiększeniu po stymulacji przez GnRH u kobiet z PCOS. Autorzy wnioskują, że ocena stosunku LH/FSH po stymulacji przez GnRH może być przydatna, jako badanie dodatkowe w diagnostyce PCOS. (Endokrynol Pol 2011; 62 (2): 120&#8211;128)Introduction: Polycystic ovary syndrome (PCOS) is characterised by increased frequency of hypothalamic GnRH pulses leading to a relative increase in LH synthesis by the pituitary. As GnRH stimulation can reveal a relative LH excess, we have endeavoured to assess whether GnRH test might be useful in the diagnosis of PCOS. Material and methods: The study involved 185 subjects: a PCOS group, n = 151, all with oligo- or amenorrhoea, aged (mean &#177; SD) 24.8 &#177; &#177; 5.4 years, BMI 24.5 &#177; 6.0 kg/m2; and regularly menstruating controls, n = 34, aged 26.6 &#177; 5.0 years, BMI 24.6 &#177; 5.5 kg/m2. In 121 subjects with PCOS and in 32 controls, serum LH and FSH were measured before (0 minutes) and 30 and 60 minutes after GnRH stimulation (100 &#956;g i.v.). Insulin resistance was assessed by HOMA and Insulin Resistance Index derived from glucose and insulin concentrations during 75 gram oral glucose tolerance test. Results: Women with PCOS had higher testosterone (p = 0.0002), androstendione (p = 0.0021), 17OH-progesterone (p < 0.0001) and were more insulin resistant. Raised concentrations of at least one androgen were, however, found only in 58.1% of women with PCOS. Baseline and stimulated LH concentrations were higher in PCOS (9.09 &#177; 5.56 vs 4.83 &#177; 1.71 IU/L, 35.48 &#177; 31.4 vs 16.30 &#177; 6.68 IU/L, 33.86 &#177; 31.8 vs 13.45 &#177; 5.2 IU/L, at 0, 30 and 60 mins post GnRH, respectively, p < 0.0001). There was no difference in baseline or stimulated FSH concentrations between groups. Relative increases of LH or FSH in comparison to respective baseline values were similar in both groups. There was, however, a marked increase in LH/FSH ratio in PCOS in comparison to controls (LH0 min/FSH0 min 1.59 &#177; 0.95 vs 0.76 &#177; 0.2, LH30 min /FSH30 min 4.07 &#177; 3.0 vs 1.89 &#177; 0.79, LH60 min/FSH60 min 3.56 &#177; 2.58 vs 1.55 &#177; 0.63, p < 0.0001 at all time points). Further analysis revealed that LH30 min/FSH30 min > 2.11 or LH60 min/FSH60 min > 1.72 had 78.3% and 87.5% sensitivity and 81.7% and 81.3% specificity for the diagnosis of PCOS, respectively. Conclusions: Women with PCOS have higher baseline and GnRH-stimulated LH concentrations. GnRH stimulation results in an increase in LH/FSH ratio in women with PCOS. Therefore we postulate that this phenomenon might be potentially useful as an additional tool in the diagnosis of PCOS. (Pol J Endocrinol 2011; 62 (2): 120&#8211;128

Retinol-binding protein 4 (RBP-4) levels do not change after oral glucose tolerance test and after dexamethasone, but correlate with some indices of insulin resistance in humans

Introduction: Secretory products from adipocytes may contribute to deterioration in glycaemic control and increased insulin resistance (IR). Retinol-binding protein 4 (RBP-4) may increase IR in mice, with elevated levels in insulin-resistant mice and humans with obesity and type 2 diabetes. However, the mechanisms regulating RBP-4 synthesis remain not fully understood. It is not clear whether short-term glucose-induced hyperglycaemia and hyperinsulinaemia as well as glucocorticosteroid-induced increase in IR might be reflected in alterations in serum RBP-4 levels in humans. In order to investigate this, we measured serum RBP-4, glucose and insulin concentrations during 75.0 gram oral glucose tolerance test (OGTT) - Study 1, as well as before and after oral administration of dexamethasone - Study 2. Material and methods: Both studies included 35 subjects (8 males), age (mean &#177; SD) 39.1 &#177; 15.6 years, BMI 35.8 &#177; 8.7 kg/m2. Twenty-four of those subjects (5 males), age 38.7 &#177; 15.1 years, BMI 34.4 &#177; 8.3 kg/m2, had 75 gram oral glucose tolerance test (OGTT) - Study 1. Blood samples were taken before (0 minutes), and at 60 and 120 minutes of OGTT. 17 subjects (3 males, 4 subjects with type 2 diabetes), age 43.1 &#177; 18.1 years, BMI 36.7 &#177; 9.0 kg/m2 underwent screening for Cushing&#8217;s disease/syndrome (Study 2). Dexamethasone was administered in a dose of 0.5 mg every 6 hours for 48 hours. Fasting serum concentrations of RBP-4, glucose and insulin were assessed before (D0) and after 48 hours of dexamethasone administration (D2). IR was assessed by HOMA in all non-diabetic subjects and in subjects participating in study 1 also by Insulin Resistance Index (IRI), which takes into account glucose and insulin levels during OGTT. Results: Glucose administration resulted in significant increases in insulin and glucose (p < 0.0001). There was, however, no change in RBP-4 concentrations (124.1 &#177; 32 mg/ml at 0 minutes, 123 &#177; 35 mg/ml at 60 minutes and 126.5 &#177; 37.5 mg/ml at 120 minutes of OGTT, p = ns). All subjects in Study 2 achieved suppression of cortisol below 50 nmo/l. Dexamethasone administration resulted in an increase in fasting insulin (from 11.6 &#177; 6.8 to 17.1 &#177; 7.2 &#956;U/ml; p = 0.003), and an increase in HOMA (from 2.73 &#177; 1.74 to 4.02 &#177; 2.27; p = 0.015), although without a significant change in RBP-4 levels (119 &#177; 26.8 vs. 117.5 &#177; 24.8 mg/ml, p = ns). RBP-4 correlated with fasting insulin (r = 0.40, p = 0.025), fasting glucose (r = 0.41, p = 0.02) and HOMA (r = 0.43, p = 0.015), but not with IRI (r = 0.19, p = 0.31). There was, however, only a moderate correlation between HOMA and IRI (r = 0.49 [r2 = 0.24]; p = 0.006, Spearman rank correlation), while the best correlation was obtained between the product of glucose and insulin levels at 60 min of OGTT and IRI in a non-linear model (r = 0.94 [r2 = 0.88]; pWstęp: Niektóre substancje syntetyzowane przez adipocyty mogą zwiększać insulinooporność oraz nasilać zaburzenia tolerancji glukozy. Białko wiążące retinol 4 (RBP-4) nasila insulinooporność u myszy, zaś podwyższone stężenia RBP-4 obserwuje się u myszy z insulinoopornością oraz u osób z otyłością i cukrzycą typu 2. Mechanizmy regulujące syntezę RBP-4 nie są do końca poznane. Między innymi nie howiadomo czy krótkotrwała hiperglikemia i hiperinsulinemia po podaniu glukozy, jak również zwiększona insulinooporność wyidukowana glukokortykosteroidami mogą w istotny sposób zmienić stężenie RBP-4 w surowicy u ludzi. W związku z tym autorzy artykułu ocenili stężenie RBP-4, glukozy i insuliny w teście doustnego obciążenia glukozą (75 g) (OGTT) - badanie 1, oraz przed i po doustnym podaniu deksametazonu - badanie 2. Materiał i metody: W obu badaniach uczestniczyło 35 osób (8 mężczyzn) w wieku 39,1 &#177; 15,6 lat, BMI 35,8 &#177; 8,7 kg/m2 (średnia &#177; SD). Spośród nich u 24 osób (5 mężczyzn) w wieku 38,7 &#177; 15,1 lat, BMI 34,4 &#177; 8,3 kg/m2 wykonano OGTT (badanie 1). Krew pobierano przed (0 minuta) oraz w 60. i 120. minucie OGTT. Badanie 2 objęło 17 osób (3 mężczyzn, 4 osoby z cukrzycą typu 2) poddanych badaniu przesiewowemu pod kątem choroby/zespołu Cushinga w wieku 43,1 &#177; 18,1 lat, BMI 36,7 &#177; 9,0 kg/m2. Deksametazon podawano co 6 godzin w dawce 0,5 mg przez 48 godzin. Stężenia RBP-4, glukozy i insuliny w surowicy oznaczono na czczo przed (D0) i po 48 godzinach podawania deksametazonu (D2). U osób niechorujących na cukrzycę IR oceniano metodą HOMA, zaś w badaniu 1 również według Insulin Resistance Index (IRI) obliczanego na podstawie zmian stężeń insuliny i glukozy podczas OGTT. Wyniki: Podczas OGTT w badaniu 1 wzrosły stężenia insuliny i glukozy (p < 0,001), przy braku istotnych zmian stężeń RBP-4 (124,1 &#177; 32 mg/ml w 0 min, 123 &#177; 35 mg/ml w 60. min i 126,5 &#177; 37,5 mg/ml w 120. min OGTT, p = ns). W badaniu 2 u wszystkich osób uzyskano supresję stężenia kortyzolu do wartości poniżej 50 nmo/l. Skutkiem podania deksametazonu był wzrost stężeń insuliny na czczo (z 11,6 &#177; 6,8 do 17,1 &#177; 7,2 &#956;U/ml; p = 0,003) oraz wzrost współczynnika HOMA (z 2,73 &#177; 1,74 do 4,02 &#177; 2,27; p = 0,015). Nie zaobserwowano jednak istotnych zmian stężeń RBP-4 (119 &#177; 26,8 mg/ml vs. 117,5 &#177; 24,8 mg/ml, p = ns). Stężenia RBP-4 korelowały z insulinemią na czczo (r = 0,40, p = 0,025), glukozą na czczo (r = 0,41, p = 0,02) oraz z HOMA (r = 0,43, p = 0,015), lecz już nie z IRI (r = 0,19, p = 0,31). Stwierdzono obecność korelacji pomiedzy indeksami insulinooporności HOMA i IRI (r = 0.49 [r2 = 0,24], p = 0,006, współczynnik korelacji rang Spearmana), lecz znacznie silniejszą korelację obserwowano dopiero miedzy IRI a iloczynem stężeń insuliny i glukozy w 60. minucie OGTT (r = 0,94 [r2 = 0,88];

Should non-movement specialists refer patients for SPECT-DaTSCAN?

Background. SPECT with radioligand DaTSCAN (SPECT-DaTSCAN) is a sensitive tool used for assessing the functional integrity of the presynaptic part of the nigrostriatal dopaminergic system. The procedure is useful whenever there is a need to distinguish between neurodegenerative parkinsonism and other parkinsonian syndromes in subjects with equivocal signs and symptoms. It can be assumed that the neurologist’s decision to perform SPECT-DaTSCAN depends on his or her experience and skill in the diagnosis of parkinsonian and tremor syndromes. Aims. To assess the accuracy of referrals to SPECT-DATSCAN made by non-movement disorders specialists. Material and methods. Sixty seven patients referred for SPECT-DaTSCAN by a general neurologist were studied. In all subjects, a movement disorder specialist performed the neurological examination, collected medical history, and analysed previous treatments and the results of diagnostic tests. Results. Evaluation carried out by a movement disorder specialist did not confirm an indication for SPECT-DaTSCAN in 31 patients (46.3%). General neurologists needed support for clinical diagnosis with SPECT-DaTSCAN most frequently in subjects with parkinsonism even though they were presenting a full-blown disease manifestation and even though the patients met the diagnostic criteria for Parkinson’s disease or one of the atypical parkinsonian syndromes. Conclusions. Our presented results probably reflect the limited experience of general neurologists in the evaluation of parkinsonian syndromes and tremor. The use of SPECT-DaTSCAN by non-movement disorders specialists is associated with a significant risk of overuse of this tool. To minimise this risk, the skills of general neurologists in diagnosing parkinsonian and tremor syndromes should be improved. Moreover, patients should be provided with access to movement disorders specialists

The effect of image translation table on diagnostic efficacy of myocardial perfusion SPECT studies

BACKGROUND: The aim of this study was to determine which of the most popular colour scales used in the Xeleris processing system (GE) should preferably be used during a clinical interpretation of myocardial perfusion images, and to find out whether a colour scale saturation level affects the diagnostic efficacy of the study. MATERIAL AND METHODS: From among 100 patients in whom a myocardial perfusion scintigraphy had been performed, a subgroup of people referred for coronary angiography, with neither prior history nor ECG signs of a myocardial infarction has been selected retrospectively. This group consisted of 41 patients (14 females) in the age group 46 to 76 years. All patients underwent two-day myocardial perfusion SPECT imaging using 99mTc-MIBI as a radiopharmaceutical. Reconstructed slices were interpreted in 3 colour scales: white-red-yellow-green-blue-black with computer-assigned thresholds (French 100%), the same French scale but without a white colour (image maximum set manually to a border value between red and white &#8212; French w.w.), and a white-yellow-violet- pink-blue-black scale (GEcolor), by consensus of two experienced nuclear medicine specialists. A semiquantitative method for evaluation of perfusion images was applied, based on myocardium segmentation. Perfusion in each segment was scored using a five-point system. Study interpretation (normal/ abnormal perfusion) was based on summed stress scores (SSS), being equal/above or below a given threshold value. The choice of optimal SSS threshold value was based on sensitivity and specificity of the study in detection of perfusion defects resulting from critical stenoses of main coronary arteries RESULTS: SSS values differed among colour scales (p < 0.00001). The lowest values were obtained for a French 100% scale (mean value = 5.0, SD = 8.0), the highest for French w.w. (mean values = 8.1, SD = 8.7), and for GE colour scale &#8212; mean value &#8212; 5.6, SD &#8212; 7.9. A French 100% scale gave high sensitivity (88%), as well as specificity (83%), but only when a low SSS threshold value of 2, hardly acceptable for study interpreters, was used. When higher threshold values were applied, they compromised the sensitivity of the study. A French w.w. scale with SSS threshold values lower than 3 provided a slightly higher sensitivity (94%), but with a significant reduction in specificity (to values below 50%). Only a threshold value of 4 provided acceptable, but still low specificity (63%) with preserved high sensitivity (88%). At the same time, the scale GE colour provided indices of diagnostic efficacy with the SSS threshold value of 3 as high as a scale French 100% with threshold value of 2. CONCLUSIONS: A French scale (Xeleris, GE) is not the scale of choice for the interpretation of myocardial perfusion SPECT images. It seems that a GE colour scale is better suited for this purpose. SSS threshold values accepted as diagnostic criteria for the detection of myocardial perfusion abnormalities should be suited separately for every translation table. The choice of optimal value should be verified by results of coronary angiography. Nuclear Med Rev 2010; 13, 2: 64&#8211;6

Single nucleotide polymorphisms of NR3C1 gene and recurrent depressive disorder in population of Poland

Depressive disorder is a disease characterized by disturbances in the hypothalamo–pituitary–adrenal axis. Abnormalities include the increased level of glucocorticoids (GC) and changes in sensitivity to these hormones. The changes are related to glucocorticoid receptors gene (NR3C1) variants. The NR3C1 gene is suggested to be a candidate gene affecting depressive disorder risk and management. The aim of this study was to investigate polymorphisms within the NR3C1 gene and their role in the susceptibility to recurrent depressive disorder (rDD). 181 depressive patients and 149 healthy ethnically matched controls were included in the study. Single nucleotide polymorphisms were assessed using polymerase chain reaction/restriction fragment length polymorphism method. Statistical significance between rDD patients and controls was observed for the allele and genotype frequencies at three loci: BclI, N363S, and ER22/23EK. The presence of C allele, CC, and GC genotype of BclI polymorphism, G allele and GA genotype for N363S and ER22/23EK variants respectively were associated with increased rDD risk. Two haplotypes indicated higher susceptibility for rDD, while haplotype GAG played a protective role with OR(dis) 0.29 [95 % confidence interval (CI) = 0.13–0.64]. Data generated from this study support the earlier results that genetic variants of the NR3C1 gene are associated with rDD and suggest further consideration on the possible involvement of these variants in etiology of the disease