Perfusion lung scintigraphy for the prediction of postoperative residual pulmonary function in patients with lung cancer

BACKGROUND: Accurate prediction of postoperative pulmonary function in patients with non-small cell lung cancer is crucial for proper qualification for surgery, the only effective therapeutic method. The aim of the study was to select the most accurate method for acquisition and processing of lung perfusion scintigraphy (LPS) combined with spirometry for prediction of postoperative pulmonary function in patients qualified for surgery. MATERIAL AND METHODS: LPS was performed in 70 patients (40 males, 30 females), with preoperative spirometry (mean FEV1preop = 2.26 ± 0.72 L), after administration of 185 MBq of 99mTc-microalbumin/macroaggregate, using planar (appa) and SPECT/CT methods. Predicted postoperative lung function (FEV1pred) was calculated as a part of active lung parenchyma to remain after surgery. A non-imaging segment counting method was also applied. FEV1pred(appa, SPECT, SPECT/CT, segm.) were further compared with actual FEV1postop values obtained from postoperative spirometry. RESULTS: In the whole studied group (47 lobectomies, 23 pneumonectomies) mean value of FEV1postop was equal to 1.76 (± 0.56) L. FEV1pred(appa, SPECT, SPECT/CT, segm.) were equal to 1.75 (± 0.58) L, 1.71 (± 0.57) L, 1.72 (± 0.57) L and 1.57 (± 0.58) L, respectively. A segment counting method systematically lowered predicted FEV1 values (p < 10–5). Moreover, in 31 patients with FEV1preop < 2 L error of predicted values was assessed with Bland-Altman method. Mean absolute differences FEV1postop – FEV1pred amounted to: appa — (0.04 ± 0.13) L, SPECT — (0.07 ± 0.14) L, SPECT/CT — (0.06 ± 0.14) L and segm. — (0.21 ± 0.19) L, respectively. Lower limit of 95% confidence interval calculated for planar — optimal method, was equal to –220 mL (also determined separately in subgroups after lobectomy and pneumonectomy). CONCLUSIONS: This study shows that planar LPS may be applied for prediction of postoperative pulmonary function in patients qualified for pneumonectomy and lobectomy. If actual FEV1postop value is to be ≥ 800 mL, predicted value should exceed 1000 mL

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 normalized values of kidney clearance function in the diagnosis of bilateral obstructive nephropathy — a preliminary report

BACKGROUND: Dynamic renal scintigraphy provides effective diagnosis of obstructive uropathy and nephropathy. However, in case of a bilateral outflow impairment, relative differential renal function (DRF), which is a primary quantitative criterion for diagnosis of unilateral obstructive nephropathy (when its value is below 45%, according to EANM guidelines from 2011), becomes unreliable. In case of bilateral nephropathy with similar severity, this parameter may even be within the normal range (45–55%) for both kidneys. The aim of this study was therefore to assess diagnostic usefulness of the original, normalized, absolute parameter proportional to the value of renal clearance function (K) in the evaluation of obstructive nephropathy in a group of patients with bilateral uropathy. MATERIAL AND METHODS: 16 healthy volunteers (32 kidneys) without history of kidney diseases were examined to determine normative value of K index. Then, 8 patients (16 kidneys) with bilateral obstructive uropathy found in standard dynamic renal scintigraphy performed using 111 MBq of 99mTc-EC (cumulative renographic curve that continued rising or dropped by less than 50% after i.v. administration of Furosemide) were examined. For each of the subjects 60 sequential 20s images were obtained, which were then assessed using an original method of post-processing scintigraphic data. It included normalization of renographic curves to the area under the heart curve. Subsequently, these normalized values from the uptake phase (between 2nd and 3rd minute) were inserted into the linear regression equation, from which K index was obtained. RESULTS: In healthy volunteers the average value of K index was 0.23 ± 0.05. The value of 0.13 (mean –2 SD) was taken as the lower limit of the norm. Values below that limit suggest obstructive nephropathy. In patients with bilateral obstructive uropathy, 5 kidneys met the conventional criteria of nephropathy (DRF < 45%), while 11 kidneys had DRF within normal range. K index was below the norm in 9 kidneys (including 4 kidneys with low and 5 with normal DRF), while its value was normal in 7, including one kidney with reduced DRF (37%). K index changed the diagnosis in 6 kidneys out of 16 (38%). CONCLUSIONS: Preliminary results indicate usefulness of K index in diagnosis of obstructive nephropathy in patients with bilateral obstructive uropathy. For further evaluation of clinical value of this method, it is planned to examine a larger group of patients with varying degrees of renal parenchymal function impairments

Body composition analysis in women aged 50-80 in Kujawsko-Pomorskie Voivodeship

Obesity is a problem which is more and more common in Polish population. The reason for that is excessive energy delivery from food against the quantity used by organism, as well as too small physical activity. These factors lead to excessive increase of body fat quantity which has a detrimental impact on the health condition. The purpose of the study is a body composition assessment in women aged 50-80 living in Kujawsko-Pomorskie Voivodeship. 1902 female inhabitants of Kujawsko-Pomorskie Voivodeship participated in the study which was divided into six age groups. The fat mass level and the fat free mass level of the body was evaluated with the assistance of electrical bioimpedance method. The content of water in the organism and, indirectly, the basic metabolism level were also determined. With age women exhibit the decrease of fat free body mass and water level in the organism; whereas the body mass and, at the same time, the body fat content are observed to increase for women between 50 and 70 years of age. Above the age of 70 this tendency is reversed and the body mass and the body fat level decline. It was also observed that with age the basic metabolism level systematically diminishes within the population.Otyłość to problem coraz częściej występujący w polskiej populacji. Przyczyną jest nadmierne dostarczanie energii z pokarmów w stosunku do ilości zużywanych przez organizm, a także zbyt mała aktywność fizyczna. Czynniki te prowadzą do nadmiernego zwiększenia ilości tkanki tłuszczowej, niekorzystnie wpływającej na stan zdrowia. Celem badania jest ocena składu ciała kobiet między 50 a 80 rokiem życia zamieszkujących województwo kujawsko-pomorskie. W badaniu uczestniczyły 1902 mieszkanki województwa kujawsko-pomorskiego, które podzielono na sześć grup wie-kowych. Oceniono u nich za pomocą metody bioimpedancji elektrycznej poziom masy tłuszczowej i beztłuszczowej ciała. Określono również zawartość wody w organizmie i pośrednio poziom podstawowej przemiany materii. Wraz z wiekiem u kobiet następuje obniżenie beztłuszczowej masy ciała i poziomu wody w organizmie. Obserwuje się natomiast wzrost masy ciała i jednocześnie zawartości tkanki tłuszczowej u kobiet między 50 a 70 rokiem życia. Powyżej 70 roku życia tendencja ta ulega odwróceniu i dochodzi do spadku masy ciała i poziomu tkanki tłuszczowej. Jednocześnie zaobserwowano, że wraz z wiekiem poziom podstawowej przemiany materii systematycznie ulega zmniejszeniu w populacji

Fat tissue content assessment in women population between 50 and 70 years of age

Nowadays obesity is one of the most important problems in the developed countries. It is characterized by the excess increase of fat tissue. The main causes of obesity are insufficient amount of physical activity and overdosing of energy delivered with food. The purpose of this paper is the assessment of skinfold thickness and the percentage of fat tissue content in women between 50 and 80 years of age. 1215 female inhabitants of Kujawsko-Pomorskie Voivodeship participated in the study and were divided into 6 age groups in 5-year divisions. The skinfold thickness was assessed and the percentage of fat tissue content was calculated. The measurements were made with the skinfold caliper. All tested women in the respective age groups, according to BMI index, were overweight, whereas the percentage of fat tissue content was over 40% in all groups. In 65-69 age bracket there is an increase of all tested parameters, whereas in women above 70 years of age a visible decrease of measured skinfold thickness values is observed as well as reduction of proportional fat tissue content.Otyłość obecnie jest jednym z ważniejszych problemów w krajach wysokorozwiniętych. Charakteryzuje się nadmier-nym zwiększeniem ilości tkanki tłuszczowej. Głównymi przyczynami występowania otyłości są: niedostateczna ilość aktywności fizycznej i nadmiar dostarczanej energii z poży-więniem. Celem pracy jest ocena grubości fałdów skórno-tłusz-czowych i procentowej zawartości tkanki tłuszczowej u kobiet między 50 a 80 rokiem życia. W badaniu uczestniczyło 1215 mieszkanek województwa kujawsko-pomorskiego, które podzielono na sześć grup wiekowych w przedziałach 5-letnich. Oceniono grubość fał-dów skórno-tłuszczowych i obliczono procentową zawartość tkanki tłuszczowej. Pomiary wykonano u nich za pomocą fałdomierza. Wszystkie badane kobiety w poszczególnych grupach wiekowych według wskaźnika BMI miały nadwagę, natomiast procentowa zawartość tkanki tłuszczowej wyniosła we wszystkich grupach ponad 40% wskazując na otyłość według norm WHO. W przedziale wiekowym 65-69 lat dochodzi do wzrostu wszystkich badanych parametrów, natomiast u kobiet powyżej 70 roku życia obserwuje się wyraźny spadek wartości mierzonych fałdów skórno-tłusz-czowych i zmniejszenie procentowej zawartości tkanki tłuszczowej

Assessment of the relation between pelvicalyceal dilatation in ultrasound and features of obstructive uropathy in dynamic renal scintigraphy

BACKGROUND: Ultrasound is the first-line imaging in the diagnostics of the urinary system. It provides valuable morphological information, but its usefulness in assessment of the function of renal parenchyma is limited. Dynamic renal scintigraphy provides much more accurate information about parenchymal function of kidneys and urinary outflow. The aim of the study was to establish morphological ultrasound criteria for high likelihood of obstructive uropathy. MATERIAL AND METHODS: 59 patients (38 women, 21 men, between 18 and 82 years old, average age 50) with the pelvis dilatation > 10 mm in one or both kidneys newly diagnosed in ultrasound, without earlier history of kidney and urinary tract diseases or renal surgery. A total of 79 kidneys were included in the study. Ultrasound and dynamic renal scintigraphy were performed on the same day. In ultrasound, maximum anteroposterior diameter of the renal pelvis (mAPD) and anteroposterior pelvic diameter at hilum (hAPD) were obtained. The ratio of total pelvicalyceal area to the whole kidney area (%PCS) was also calculated. Uropathy was determined by the positive diuretic test in renal scintigraphy performed using 111 MBq of 99mTc-EC. RESULTS: In dynamic renal scintigraphy, features of uropathy were found in 18 out of 79 kidneys (23%). Optimal thresholds for detection of obstructive uropathy for measured ultrasound parameters were determined based on the ROC curves: mAPD ≥ 23 mm (sensitivity 94%, specificity 76%, accuracy 80%, AUROC 0.91) hAPD ≥ 20 mm (sensitivity 78%, specificity 87%, accuracy 85%, AUROC 0.82) PCA/WKA ≥ 22% (sensitivity 83%, specificity 74%, accuracy 76%, AUROC 0.85). CONCLUSIONS: Determined thresholds of parameters measuring pelvicalyceal dilatation in ultrasound, including the easiest one to obtain in routine diagnostics — mADP, provide satisfactory effectiveness in isolating kidneys with high likelihood of obstructive uropathy. Their application can optimize the selection of patients for further kidney diagnostic imaging (dynamic renal scintigrapy or urography)

Mask-Related Motion Artifact on 99mTc-MIBI SPECT: Unexpected Pitfalls of SARS-CoV-2 Countermeasures

A 61-year-old man was referred for myocardial perfusion scintigraphy (MPS) by an occupational physician to exclude coronary artery disease (CAD). The patient had a complete left bundle branch block (LBBB) that rendered the routine exercise stress test non-diagnostic, but otherwise had no history of heart diseases, good stress tolerance with no symptoms of angina, and no abnormalities in transthoracic echocardiogram, apart from contraction patterns typical for LBBB. Initial MPS, performed using technetium-labeled Sestamibi on a Discovery NM 530c camera equipped with solid-state semiconductor detectors, revealed a significant stress-induced ischemia that did not match the good overall condition of the patient. A motion detection procedure revealed significant heart motion in Z-axis during the stress study. Upon inquiry, the patient reported breathing difficulties caused by the mandatory mask, which slipped into an uncomfortable position during the study. Repeated acquisition, without motion artifacts, revealed no features of ischemia

Assessment of Renal Function Based on Dynamic Scintigraphy Parameters in the Diagnosis of Obstructive Uro/Nephropathy

This study evaluates the usefulness of parameters allowing assessment of renal function in absolute values in dynamic renal scintigraphy (DRS) with 99mTc-ethylenedicysteine (99mTc-EC) uptake constant (K), mean transit time (MTT), and parenchymal transit time (PTT) in the diagnosis of obstructive uro/nephropathy. The study included 226 people: 20 healthy volunteers, for whom normative values of assessed parameters were determined, and 206 patients. Reproducibility of results obtained by two independent operators, specificity, correlation with estimated GFR (eGFR), and Cohen’s kappa were used to evaluate reliability of assessed parameters. Normative values were as follows: K ≥ 1.6, MTT ≤ 250 s, and PTT ≤ 225 s. Reproducibility of determination of K (rs = 0.99) and MTT (rs = 0.98) was significantly higher than that of PTT (rs = 0.95) (p = 0.001). Specificity was 100% for K, 81% for MTT, and 91% for PTT. Correlation of eGFR with K (rs = 0.89) was significantly higher than with PTT (rs = 0.53) and with split function (SF) (rs = 0.66) (p < 0.0001). Cohen’s kappa was κ = 0.89 for K, κ = 0.88 for MTT, and κ = 0.77 for PTT. In a group of patients where standard DRS parameters are unreliable (bilateral obstructive uro/nephropathy or single functioning kidney), the use of K (the most effective among assessed parameters) changed the classification of 23/79 kidneys (29%). K enables reproducible assessment of absolute, individual kidney function without modifying routine DRS protocol. Diagnostic value of MTT and PTT is limited