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Sample records for 99m mibi para

  1. Combined Tc-99m sesta MIBI scin

    Enas Abdel Ghany Ibrahim

    2015-12-01

    Conclusions: Accurate localization of adenomas should be obtained prior to surgery for minimal invasive surgical procedure. In this study, combined ultrasonography and Tc-99m MIBI improved localization of parathyroid adenomas.

  2. MIBI-99mTc mammary scintigraphy

    121 patients suspected of breast cancer were studied with MIBI-99mTc to evaluate the suitability of the mammary scintigraphy in patients with doubtful cancer diagnosis.The results show 93 % sensitivity and 95 % specificity and indicate the usefulness of this procedure to increase the accuracy of the diagnosis

  3. Combined Tc-99m sesta MIBI scin

    Enas Abdel Ghany Ibrahim; Momena Essam Elsadawy

    2015-01-01

    Purpose: To evaluate the role of combined high resolution ultrasonography and technetium Tc-99m methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy in preoperative detection and localization of parathyroid adenoma, for better operative outcome. Patients and methods: 40 patients were included in this study, 25 of them were females and 15 were males, with age ranging between 31 and 75 (mean 46 ± 15). All patients presented with some of symptoms of hyperparathyroidism with venous blood ...

  4. Evaluation of myocardial perfusion using Tc-99m MIBI

    Tc-99m MIBI (methoxy isobutyl isonitrile) is newly introduced cationic myocardial perfusion agent. For its favorable dosimetry, upto 30 mCi of Tc-99m MIBI can be used in a patient. Therefore, unlike T1-201, first-pass ejection fraction, ventricular wall motion, and SPECT studies are readily evaluated using Tc-99m MIBI on patients who are undergoing myocardial perfusion study. Nineteen individuals entered into this study and 9 of 19 had T1-201 myocardial scintiscan. For the detection of myocardial ischemia, an IV dipyridamole with hand-grip or bicycle exercise was used. Tc-99m MIBI scintigraphic findings are compared to patients 'EKG' T1-201 scans and coronary angiograms. The result were summerized as follows; 1. In 9 cases, Tc-99m MIBI studies were comparable to T1-201 scintiscans. 2. In the remaining 10 cases, Tc-99m MIBI images were correlated well with clinical pictures, EKG, and angiographic findings. 3. Using Tc-99m MIBI, one can easily obtain fist-pass ejection fraction, ventricular wall motion and SPECT studies. It was concluded that Tc-99m MIBI seems to be an excellent agent for myocardial perfusion study. Tc-99m MIBI images are superior in quality than T1-201 images mainly due to high photon yield and ideal energy of Tc-99m MIBI

  5. Myocardial imaging with Tc-99m MIBI in human subjects

    The kinetics of myocardial imaging with Tc-99m methoxy methylpropyl isonitrile (MIBI) were studied in four healthy adult volunteers and ten patients with coronary artery disease and ischemia on exercise Tl-201 imaging. After administration of 4-10 mCi of Tc-99m MIBI, patients were reexcerised to the same level and imaged in the same manner at peak exercise levels and after rest. Low initial lung uptake, rapid biliary excretion, and good myocardial contrast without a change in heart rate or redistribution over 2 hours were seen on both exercise and rest injected studies. The data suggest the usefulness of Tc-99 MIBI in tomography, in the gated study of wall motion studies, in the assessment of acute infarction, and in the detection of coronary artery disease

  6. Phase I clinical study on 99mTc-MIBI

    A phase I clinical study on 99mTc-hexakis 2-methoxy isobutylisonitrile (99mTc-MIBI) was carried out in 6 normal volunteers. There was no significant change in vital signs and laboratory parameters attributing to the reagent other than complaint of slight and transient metallic taste immediately after the injection in 4 volunteers. The highest dosimetry was calculated as 1.1 mGy/37 MBq at lower large intestine, which was within the acceptable range. 99mTc-MIBI was rapidly cleared from the blood and accumulated in the heart immediately after the injection with 1.4% dose and 1.8% dose at 5 min at rest and at stress, respectively. The retention of radioactivity in the heart well continued for at least several hours. The heart-to-lung ratio was over 2.00 at 5 min and heart-to-liver ratio was over 1.00 at 60 min. Myocardial planar and SPECT images were obtained with high quality. In conclusion, 99mTc-MIBI is a useful myocardial perfusion imaging agent. (author)

  7. Comparative {sup 99m}Tc-MIBI, {sup 99m}Tc-tetrofosmin and {sup 99m}Tc-furifosmin uptake in human soft tissue sarcoma cell lines

    Rodrigues, M.; Chehne, F.; Sinzinger, H. [Dept. of Nuclear Medicine, University Hospital, Vienna (Austria); Kalinowska, W.; Zielinski, C. [Clinical Div. of Oncology, Department of Internal Medicine I, University Hospital, Vienna (Austria)

    2000-12-01

    The uptake characteristics of technetium-99m hexakis-2-methoxyisobutylisonitrile (MIBI), {sup 99m}Tc-tetrofosmin and {sup 99m}Tc-furifosmin in human soft tissue sarcoma cell lines were investigated and compared. After 10-120 min of incubation at 37 C, 32 C and 22 C with {sup 99m}Tc-MIBI, {sup 99m}Tc-tetrofosmin and {sup 99m}Tc-furifosmin, the kinetics of cellular uptake of these tracers in human soft tissue sarcoma cells SW 684 (fibrosarcoma), SW 872 (liposarcoma), SW 982 (synovial sarcoma) and SW 1353 (chondrosarcoma) was assessed. The uptake of {sup 99m}Tc-MIBI, {sup 99m}Tc-tetrofosmin and {sup 99m}Tc-furifosmin was temperature dependent. The kinetics of uptake of {sup 99m}Tc-MIBI and of {sup 99m}Tc-tetrofosmin was similar between fibrosarcoma and liposarcoma cells, as well as between synovial sarcoma and chondrosarcoma cells. {sup 99m}Tc-furifosmin showed similar uptake kinetics in all cell lines. The uptake of {sup 99m}Tc-furifosmin was, however, significantly higher in liposarcoma than in the other cells. The data indicate that the cellular uptake of {sup 99m}Tc-MIBI, {sup 99m}Tc-tetrofosmin and {sup 99m}Tc-furifosmin is dependent on cellular metabolic activity. (orig.)

  8. Comparative 99mTc-MIBI, 99mTc-tetrofosmin and 99mTc-furifosmin uptake in human soft tissue sarcoma cell lines

    The uptake characteristics of technetium-99m hexakis-2-methoxyisobutylisonitrile (MIBI), 99mTc-tetrofosmin and 99mTc-furifosmin in human soft tissue sarcoma cell lines were investigated and compared. After 10-120 min of incubation at 37 C, 32 C and 22 C with 99mTc-MIBI, 99mTc-tetrofosmin and 99mTc-furifosmin, the kinetics of cellular uptake of these tracers in human soft tissue sarcoma cells SW 684 (fibrosarcoma), SW 872 (liposarcoma), SW 982 (synovial sarcoma) and SW 1353 (chondrosarcoma) was assessed. The uptake of 99mTc-MIBI, 99mTc-tetrofosmin and 99mTc-furifosmin was temperature dependent. The kinetics of uptake of 99mTc-MIBI and of 99mTc-tetrofosmin was similar between fibrosarcoma and liposarcoma cells, as well as between synovial sarcoma and chondrosarcoma cells. 99mTc-furifosmin showed similar uptake kinetics in all cell lines. The uptake of 99mTc-furifosmin was, however, significantly higher in liposarcoma than in the other cells. The data indicate that the cellular uptake of 99mTc-MIBI, 99mTc-tetrofosmin and 99mTc-furifosmin is dependent on cellular metabolic activity. (orig.)

  9. Accumulation of Tc-99m-MIBI and Tc-99m-tetrofosmin in tumor cells. Uptake and washout studies

    Aim: To investigate in-vitro the uptake and washout of Tc-99m-MIBI and Tc-99m-tetrofosmin in human breast adenocarcinoma and soft tissue sarcoma cell lines. Methods: The uptake of Tc-99m-MIBI and Tc-99m-tetrofosmin (at 370C, 10, 30 and 60 minutes after incubation with 7.4x10E5 Bq each tracer) was investigated in breast adenocarcinoma MCF-7 and SK-BR-3 cells, synovial sarcoma SW 982 cells and chondrosarcoma SW 1353 cells (concentration of 1x10E6 cells/ml incubation medium). Tracer uptake in cells incubated with ouabain (Na/K-ATPase pump inhibitor; 100 μM and 1mM; 15 and 30 minutes), nigericin (increases mitochondrial potential and disrupts cell membrane potential; 5 and 50 μg/ml; 15 minutes) and carbonyl cyanide m-chlorophenylhydrazone (CCCP) (depolarizes mitochondrial membrane; 10 and 100 μM; 30 minutes) was compared to that in cells without incubation with chemical agents (control cells). The washout (at 370C, 10-60 minutes, 30 and 60 minutes after tracer incubation) of Tc-99m-MIBI and Tc-99m-tetrofosmin was studied in MCF-7 cells, SK-BR-3 cells , SW 1353 cells and fibrosarcoma SW 684 cells. Results: Cellular tracer uptake decreased with ouabain (decrease of Tc-99m-tetrofosmin > Tc-99m-MIBI in SK-BR-3 cells and SW 982 cells) and increased with nigericin (increase of Tc-99m-MIBI > Tc-99m-tetrofosmin in all cells) as compared to the uptake in control cells. With CCCP, decrease of Tc-99m-MIBI uptake in cells preincubated with nigericin was higher than that in cells under basal conditions, whereas a similar decrease of Tc-99m-tetrofosmin uptake in these two group of cells was found. Washout of Tc-99m-MIBI from all cells was lower than that of Tc-99m-tetrofosmin. No significant difference in cell-associated activity of both tracers was found between washout after 30 minutes and that after 60 minutes of incubation, in all cells. Washout of Tc-99m-MIBI from SK-BR-3 cells Tc-99m-tetrofosmin) and Na/K-ATPase pump (Tc-99m-tetrofosmin > Tc-99m-MIBI). Tc-99m-MIBI and Tc-99

  10. Quantification analysis in Tc-99m MIBI myocardial perfusion scintigraphy

    Aims: Technetium-99-MIBI myocardial perfusion scintigraphy is a routinely employed nuclear medicine procedure. This study was carried out to get additional information in terms of Lung-heart ratio (LHR), Right ventricular index (RVI) by computer assisted quantification analysis of this procedure. Material and Methods: Fifty diagnosed cases of coronary artery disease (CAD) underwent 99mTc-MIBI planar studies at stress and rest. A group of 15 subjects with low pre-test likelihood of CAD and normal exercise and rest 99mTc-MIBI images was used as control. LHR was calculated from the static images in the anterior view. A circular region of interest (ROI) of about 8 pixel in diameter was selected in left lung area at maximal count density as assessed visually. Similar ROI was drawn on left ventricular wall at maximal count density area, as assessed visually. Ratio of the counts in the lung ROI to the counts in the myocardial ROI was expressed as Lung Heart ratio or 'lung index. LHR = Average counts in Lung ROI/Average counts in Left Myocardial ROI. Right ventricular index (RVI) was determined from the static images in LAO 450 views. ROIs were drawn on the right ventricle (RV) with maximal counts and on the left ventricle (LV) with maximal counts as assessed visually. The ratio of the counts in the two ROIs gave the right ventricular index. RVI = Average counts in RV ROI/ Average counts in LV ROI. Results: A close correlation was noted in the findings of three independent observers. In patients or coronary artery disease group (CAD Group), stress was induced by treadmill exercise or dipyridamole infusion. The CAD Group showed higher LHR at stress and at rest than controls. Student's t-test comparison of patients versus controls. p99mTc-MIBI myocardial perfusion images provides reproducible and clinically useful information regarding left ventricular function in CAD patients

  11. The Reevaluation of MIBI as the Ligand of 99mTc-MIBI Radiopharmaceutical for Myocardial Imaging

    Z. Nurlaila; I. Daruwati

    2008-01-01

    Methoxy isobutyl isonitrile labelled with technetium-99m (99mTc) radionuclide can be used for the evaluation of acute myocardial infarction. The 99mTc-MIBI radiopharmaceutical is available in the lyophilized-kit, which is separately packed with its radionuclide. Recently, in CNTMR-BATAN Bandung, 99mTc-MIBI radiopharmaceutical was prepared using MIBI ligand synthesized in 1996 as lyophilized-kits having the radiochemical purity less than 90 % and not accumulated in the myocardium. It could be ...

  12. Different dynamic of Tc-99m-tetrofosmin and Tc-99m-MIBI in a parathyroid adenoma; Unterschiedliche Dynamik von Tc-99m-Tetrofosmin und Tc-99m-MIBI in einem Nebenschilddruesen-Adenom

    Nowak, B.; Sabri, O.; Reinartz, P.; Kleinhans, E.; Zimny, M. [Universitaetsklinikum Aachen (Germany). Klinik fuer Nuklearmedizin; Hoff, C. [Universitaetsklinikum Aachen (Germany). Medizinische Klinik III

    1999-07-01

    Case report of a patient with hypercalcemia and suspected parathyroid adenoma. Because of a previous strumectomy a precise preoperative localization of the suspected parathyroid adenoma was demanded. Tc-99m-tetrofosmin scintigraphy in double phase technique failed to detect a parathyroid adenoma by failing to show a region of increased focal uptake with delayed washout in relation to the thyroid gland. Only comparison of the Tc-99m-tetrofosmin images with a Tc-99m-pertechnetate scan revealed a right caudal parathyroid adenoma. A double phase Tc-99m-MIBI study of the same patient was able to localize this parathyroid adenoma without the need of a corresponding Tc-99m-pertechnetate scintigraphy due to a differential washout with persistent focal uptake in the parathyroid adenoma and a progressively decreasing uptake in the thyroid tissue. This case indicates that Tc-99m-tetrofosmin is a suitable agent for parathyroid imaging only if used together with Tc-99m-pertechnetate but is seems to lack the differential washout characteristics of Tc-99m-MIBI according parathyroid gland and thyroid gland. (orig.) [German] Bei einer Patientin mit Hyperkalzaemie und Verdacht auf primaeren Hyperparathyreoidismus wurde wegen einer vorherigen Strumektomie eine genaue praeopertive Lokalisationsdiagnostik gefordert. Eine in Zwei-Phasen-Technik durchgefuehrte Szintigraphie mit Tc-99m-Tetrofosmin allein erbrachte keinen sicheren Nachweis eines Nebenschilddruesen-Adenoms, da an keiner Lokalisation eine fokale Mehranreicherung mit relativ zur Schilddruese verzoegertem Washout festzustellen war. Erst der Vergleich mit dem Tc-99m-Pertechnetat-Szintigramm ergab den Hinweis auf ein Nebenschilddruesen-Adenom rechts kaudal. Eine zusaetzlich durchgefuehrte Tc-99m-MIBI-Szintigraphie konnte dieses Adenom alleine aufgrund einer hier vorhandenen Persistenz der Nuklidspeicherung im Nebenschilddruesen-Adenom bei gleichzeitig deutlichem Washout aus der uebrigen Schilddruese nachweisen. Dies weist darauf

  13. Pituitary Incidentalomas Detected with Technetium-99m MIBI in Patients with Suspected Parathyroid Adenoma: Preliminary Results

    Tiktinsky, Ekaterina; Horne, Tifha; Friger, Michael; Agranovich, Svetlana; Lantsberg, Sophie

    2012-01-01

    Tc-99m MIBI (MIBI) is a cationic lipophilic agent, which has traditionally been used for myocardial perfusion scintigraphy, detection and monitoring of different benign and malignant tumors. The objective of this study was to evaluate the frequency of pituitary incidentalomas detected on MIBI scans performed on patients with suspected parathyroid adenomas and to provide semiquantitative analysis of tracer uptake in the pituitary region. Tomographic images of MIBI scans on 56 patients with sus...

  14. Localization of primary hyperparathyroidism using {sup 99m}Tc-MIBI scintigraphy

    Yane, Katsunari; Emoto, Mie; Okamoto, Hideyuki; Yuki, Kazue; Hosoi, Hiroshi [Nara Medical Univ., Kashihara (Japan); Miyahara, Hiroshi [Osaka Prefectural Hospital (Japan)

    2003-03-01

    To determine the clinical utility of 99mTc-MIBI scintigraphy (MIBI) in the localization of hyperfunctioning parathyroid lesions, detection of lesions in 14 patients with primary hyperparathyroidism was compared between MIBI, ultrasonography and computed tomography (CT). MIBI (85.7%) and ultrasonography (78.5%) demonstrated higher detection rates than CT (50%). Furthermore, combination of MIBI and ultrasonography (92.8%) increased the detection rate. One case of ectopic parathyroid adenoma was detected only on MIBI. The smallest parathyroid lesion detected using MIBI was a parathyroid adenoma weighing 300 mg. A combination of MIBI and ultrasonography is therefore useful for the localization of primary hyperparathyroidism, and MIBI is particularly useful for detecting ectopic lesions. (author)

  15. The usefulness of 99mTc-MIBI in the detection of active pulmonary tuberculosis

    The use of radiopharmaceuticals in evaluation of pulmonary tuberculosis may help to resolve difficult diagnostic problems such as discordance between sputum examinations and chest roentgenographic findings. We investigated the usefulness of 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy in the detection of active pulmonary tuberculosis. Forty-six patients with suspected active pulmonary tuberculosis were studied with sputum smear of AFB, sputum AFB culture, chest X-ray and MIBI scan. MIBI image was obtained 15 and 60 min after intravenous injection of 370MBq(10mCi) 99mTc-MIBI. In 16 patients of them Ga scans were performed in addition to MIBI scan. Repeated MIBI scans were done in 7 patients with active pulmonary tuberculosis after 4∼6 months of antituberculous chemotherapy. Thirty-two patients were confirmed as active tuberculosis by sputum culture. Sensitivity of MIBI scan to active tuberculosis was 87.5%(28/32) and MIBI findings were negative in all of 14 patients with inactive disease. Focal uptake of MIBI was dense in the area that was strongly suggested active tuberculous lesions by chest roentgenogram. There was no discordance between MIBI and Ga image in 16 patients. But the uptake areas of Ga images were broader than that of MIBI images. After 4∼6 months of antituberculous treatment all repeated MIBI scans revealed negative findings except 1 patient with persistent active pulmonary tuberculosis due to drug resistance. MIBI scan could be used in the detection of active pulmonary tuberculosis as a useful noninvasive diagnostic tool

  16. Different dynamic of Tc-99m-tetrofosmin and Tc-99m-MIBI in a parathyroid adenoma

    Case report of a patient with hypercalcemia and suspected parathyroid adenoma. Because of a previous strumectomy a precise preoperative localization of the suspected parathyroid adenoma was demanded. Tc-99m-tetrofosmin scintigraphy in double phase technique failed to detect a parathyroid adenoma by failing to show a region of increased focal uptake with delayed washout in relation to the thyroid gland. Only comparison of the Tc-99m-tetrofosmin images with a Tc-99m-pertechnetate scan revealed a right caudal parathyroid adenoma. A double phase Tc-99m-MIBI study of the same patient was able to localize this parathyroid adenoma without the need of a corresponding Tc-99m-pertechnetate scintigraphy due to a differential washout with persistent focal uptake in the parathyroid adenoma and a progressively decreasing uptake in the thyroid tissue. This case indicates that Tc-99m-tetrofosmin is a suitable agent for parathyroid imaging only if used together with Tc-99m-pertechnetate but is seems to lack the differential washout characteristics of Tc-99m-MIBI according parathyroid gland and thyroid gland. (orig.)

  17. The Reevaluation of MIBI as the Ligand of 99mTc-MIBI Radiopharmaceutical for Myocardial Imaging

    Z. Nurlaila

    2008-01-01

    Full Text Available Methoxy isobutyl isonitrile labelled with technetium-99m (99mTc radionuclide can be used for the evaluation of acute myocardial infarction. The 99mTc-MIBI radiopharmaceutical is available in the lyophilized-kit, which is separately packed with its radionuclide. Recently, in CNTMR-BATAN Bandung, 99mTc-MIBI radiopharmaceutical was prepared using MIBI ligand synthesized in 1996 as lyophilized-kits having the radiochemical purity less than 90 % and not accumulated in the myocardium. It could be caused by several factors, among others were technical preparation of lyophilized dry-kit and the quality of MIBI; therefore the reevaluation of the ligand for the quality improvement was needed. Firstly, MIBI ligand was recristallized. It was found that MIBI as [Cu(MIBI4]BF4 salt was a glassy solid with the melting point of 98 -99 oC. The infra red analysis showed the presence of spectra vibration at 1085, 1180 cm-1 and 2180, 2220 cm-1 for –OCH3 and N≡C groups, respectively. The preparation of 99mTc-MIBI was performed by adding 99mTc radionuclide into new MIBI liquid-kit, then boiled in water bath for minimum period of 10 minutes. The radiochemical purity of 99mTc-MIBI was analysed by thin layer chromatographic method using absolute ethanol as a mobile phase. The pre-clinical evaluation was observed in Wistar rat and clinical studies were performed in volunter using gamma camera. It is revealed that the radiochemical purity of more than 90 % i.e. 96.83 ± 1.43 % was still stable until 24 hours storage at room temperature. The stability studies of 99mTc-MIBI in human blood plasma showed that in 6 hours, the radiochemical purity was decreased to 90.89 ± 2.90 %. Clinical application of 99mTc-MIBI with tomography techniques using gamma camera showed the distinct accumulation of radioactivity in the heart.

  18. A correlative study between {sup 99m}Tc-ESTCPTA and {sup 99m}Tc-MIBI in rats

    Unak, Perihan E-mail: unak@bornova.ege.edu.tr; Enginar, Huseyin; Zuemruet Biber, F.; Yurt Lambrecht, Fatma; Aslani, M.A.A.; Ozkilic, Hayal

    2002-11-01

    Tissue distribution of the {sup 99m}Tc labeled derivative of the estrogen compound 3,17-{alpha}-estradiolyl propyl 1,4,8,11-tetraazacyclotetradecanyl-1-(4-methylbenzoic acid) ester (ESTCPTA), which has an 3,17-{alpha}-estradiolyl propinol coupled to 1-(4-methylbenzoic acid)1,4,8,11-tetraazacyclotetradecane (CPTA), was compared to {sup 99m}Tc-MIBI (methoxyisobutyl isonitrile) in female Albino Wistar rats. Tissues of interest included lung, liver, heart, kidneys, spleen, stomach, intestines, pancreas, muscle, blood, breast, ovary, fat, and uterus. {sup 99m}Tc-ESTCPTA uptake by the uterus and ovary, as ER-rich tissues, was highly selective. Maximum uptakes for {sup 99m}Tc-MIBI and {sup 99m}Tc-ESTCPTA are 90 min in breast, ovary and uterus. The pancreas also showed significant receptor saturated and unsaturated ratios for {sup 99m}Tc-ESTCPTA. Results are sufficiently encouraging to generate further evaluation of these and related compounds as possible estrogen receptor based tumor imaging and therapeutic agents in estrogen-rich tissues.

  19. Myocardial reversibility detection. Rest NTG 99mTc-MIBI versus 201Tl reinjection. Preliminary results

    This study test whether sublingual administration of nitroglycerin (NTG) could improve the capability of 99mTc-MIBI to detect reversibility in exercise-induced perfusion defects and to compare it with the 201Tl stress-redistribution-reinjection protocol. Twenty-one patients with previous myocardial infarction were submitted to exercise, rest and NTG rest 99mTc-MIBI imaging (3-day protocol). The patients also underwent exercise, redistribution and reinjection 201Tl myocardial scintigraphy. A total of 273 myocardial segments were analyzed: 76 (28%) had irreversible defects on stress-rest 99mTc-MIBI, 60 (79%) appeared as fixed defects and 16 (21%) were reversible on NTG rest 99mTc-MIBI. Of the 78 myocardial segments with irreversible defects on standard stress-redistribution thallium cardiac imaging, 63 (81%) did not change and 15 (19%) demonstrated enhanced uptake of thallium after reinjection. Data show that rest NTG 99mTc-MIBI study improves the detection of reversible myocardium versus standard exercise/rest 99mTc-MIBI and achieve similar results than 201TI reinjection protocol. (author)

  20. [Complementary scintigraphic examinations (99mTc-MDP, 99mTc-MIBI and Octreoscan) in breast neoplasm assessment].

    Stefănescu, C; Chossiere, L; Rusu, V; Meignan, M

    1996-01-01

    Scintigraphic imagery was used in breast carcinoma mostly for the bone metastases screening, using 99mTc-MDP. Others radiopharmaceuticals can be used to visualize either the primary tumour or the soft tissues metastases. It's mainly the case of 99mTc-MIBI, and also of some somatostatin analogues, like Octreoscan. This case report of a patient with a T3N1M+ breast adenocarcinoma having different secondary sites represent also a prove of the complementarity of these explorations, which give the possibility of diagnostic and therapeutic evaluation and, in the same time, the possibility of a better understood of the metastasizing mechanism. PMID:9455458

  1. Bone marrow uptake of 99mTc-MIBI in patients with multiple myeloma

    In a previous study, we showed the ability of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) scan to identify active disease in patients with multiple myeloma (Eur J Nucl Med 1998; 25: 714-720). In particular, a semiquantitative score of the extension and intensity of bone marrow uptake was derived and correlated with both the clinical status of the disease and plasma cell bone marrow infiltration. In order to estimate quantitatively 99mTc-MIBI bone marrow uptake and to verify the intracellular localization of the tracer, bone marrow samples obtained from 24 multiple myeloma patients, three patients with monoclonal gammopathy of undetermined significance (MGUS) and two healthy donors were studied for in vitro uptake. After centrifugation over Ficoll-Hypaque gradient, cell suspensions were incubated with 99mTc-MIBI and the uptake was expressed as the percentage of radioactivity specifically retained within the cells. The cellular localization of the tracer was assessed by micro-autoradiography. Twenty-two out of 27 patients underwent 99mTc-MIBI scan within a week of bone marrow sampling. Whole-body images were obtained 10 min after intravenous injection of 555 MBq of the tracer; the extension and intensity of 99mTc-MIBI uptake were graded using the semiquantitative score. A statistically significant correlation was found between in vitro uptake of 99mTc-MIBI and both plasma cell infiltration (Pearson's coefficient of correlation r=0.69, P99mTc-MIBI inside the plasma cells infiltrating the bone marrow. Therefore, our findings show that the degree of tracer uptake both in vitro and in vivo is related to the percentage of infiltrating plasma cells which accumulate the tracer in their inner compartments. (orig.)

  2. Diagnostic value of Tc-99m MIBI SPECT in the differential diagnosis of lung lesions

    Aim: This study was conducted to assess the feasibility of using Tc-99m labelled 2-methoxy isobutyl isonitrile (MIBI), which shows uptake in malignant lung lesions, to evaluate benign and malignant lung lesions and to assess the value in the differential diagnosis. Methods: The patients randomly selected among the patients examined at the Kocaeli University Pulmonary Clinic. (19 men, 18 women) who had a pathological PA chest x-ray and did not received any treatment. After intravenous injection of 15-25 mCi Tc-99m MIBI, early (10 minutes) and delayed (2,5 hours) static spot images of posterior and anterior thorax and SPECT images were obtained. The assessment of MIBI uptake was done visually and quantitatively. Results: Of the 18 patients with primary bronchial carcinoma, increased abnormal uptake of MIBI corresponding to the lesion location was found in 14 patients with planar imaging and in 15 patients with SPECT imaging. Three patients did not have any unusual activity accumulation. Of the 19 patients with benign lesions, 4 had abnormally increased uptake of MIBI. In the detection of malignant lesions Tc-99m MIBI was found to have 83.3% specificity, 78.9% sensitivity, 78.9% positive predictive value, and 81.1% negative predictive value. Conclusion: Tc-99m MIBI tumor scintigraphy might be a valuable non-invasive method for the differential diagnosis of malignant and benign lung lesions, however further studies are required as it has relatively low sensitivity and specificity

  3. Preliminary clinical observation of 99mTc-MIBI breast tumor imaging

    An effective, noninvasive diagnostic method of breast cancer is investigated. 99mTc-MIBI breast tumor imaging was performed in 78 patients with palpable breast mass. All was pathologically proved after operation. Of 78 patients, 42 were breast carcinoma, among them 35 were detected using 99MTc-MIBI scintigraphy. The smallest detectable mass was a infiltrating ductal carcinoma measuring 1.5 cm x 1.5 cm x 1.2 cm. Of 36 patients with benign lesions, 30 with negative result, among the 6 positive one, 5 were big adenoma, 1 was plasma cell mastitis. The sensitivity and specificity of 99mTc-MIBI imaging in detecting breast cancer wa 83.3% either. 99mTc-MIBI scintigraphy can be used as an accessory method in detecting breast cancer. But it was useless for differentiation between breast cancer and big adenoma

  4. Incidentally detected diaphragmatic hernia mimicking angina pectoris with Tc-99m MIBI myocardial perfusion imaging

    Cınar, Alev; Sadıc, Murat; Demırel, Koray; Korkmaz, Meliha

    2013-01-01

    In recent years 99mTechnetium methoxy-isobutyl-isonitrile (99mTc MIBI) is widely used in the evaluation of myocardial perfusion imaging (MPI). In this imaging protocol besides the cardiac evaluation, numerous other organs are included in the field of view. 99mTechnetium MIBI is taken up in all metabolically active tissue in the body except for the brain. Extracardiac uptake patterns as benign or serious conditions can be revealed during the MPI. In the imaging protocol, we should be aware of ...

  5. Incidentally detected diaphragmatic hernia mimicking angina pectoris with Tc-99m MIBI myocardial perfusion imaging

    In recent years 99mTechnetium methoxy-isobutyl-isonitrile (99mTc MIBI) is widely used in the evaluation of myocardial perfusion imaging (MPI). In this imaging protocol besides the cardiac evaluation, numerous other organs are included in the field of view. 99mTechnetium MIBI is taken up in all metabolically active tissue in the body except for the brain. Extracardiac uptake patterns as benign or serious conditions can be revealed during the MPI. In the imaging protocol, we should be aware of distribution of this radiotracer in order to recognize the abnormal uptake. Here in, we present a large diaphragmatic hernia, seemed as a mirror vision of myocardium that was determined incidentally during the MPI with 99mTc MIBI

  6. Incidentally detected diaphragmatic hernia mimicking angina pectoris with Tc-99m MIBI myocardial perfusion imaging

    Cınar, Alev; Sadıc, Murat; Demırel, Koray; Korkmaz, Meliha

    2013-01-01

    In recent years 99mTechnetium methoxy-isobutyl-isonitrile (99mTc MIBI) is widely used in the evaluation of myocardial perfusion imaging (MPI). In this imaging protocol besides the cardiac evaluation, numerous other organs are included in the field of view. 99mTechnetium MIBI is taken up in all metabolically active tissue in the body except for the brain. Extracardiac uptake patterns as benign or serious conditions can be revealed during the MPI. In the imaging protocol, we should be aware of distribution of this radiotracer in order to recognize the abnormal uptake. Here in, we present a large diaphragmatic hernia, seemed as a mirror vision of myocardium that was determined incidentally during the MPI with 99mTc MIBI. PMID:24379540

  7. The value of {sup 99m}technetium-MIBI scintiscanning for diagnostic evaluation of breast cancer; Stellenwert der {sup 99m}Technetium-MIBI-Szintigraphie in der Mammadiagnostik

    Hagedorn, K.; Kraemer, S.; Lang, N. [Universitaets-Frauenklinik, Erlangen (Germany); Schulz-Wendtland, R.; Bautz, W. [Universitaet Erlangen-Nuernberg (Germany) Institut fuer Diagnostische Radiologie; Kat, S.; Wolf, F. [Universitaet Erlangen-Nuernberg (Germany). Nuklearmedizinische Klinik

    1998-03-01

    We performed {sup 99m}Tc-MIBI scintiscanning in 42 patients with indications for surgery of mammary lesions, ascertained by palpation, mammography, ultrasonography, or MRI. We had a total of 62 histologically examined tumors for our analysis, comprising 24 benign tumors (10 fibroadenomas, 1 papilloma, 1 cyst, 1 lymph node, 10 mastopathies), 4 in-situ carcinomas, and 34 malignant tumors (32 duct carcinomas, 1 intramammary lymph node matastasis, 1 low-grade malignant sarcoma). The benign mammary gland tumors were not shown by contrast agent accumulation in the {sup 99m}Tc-MIBI scintiscans. Out of 14 carcinomas of a size less than 15 mm across, only 5 were detected by scintiscanning, and none of the in-situ carcinomas was revealed in the scintiscans. However, all malignomas of a size of 15 mm or more were detected by scintiscanning. The results of the comparative analysis of the diagnostic methods relating to sensitivity and specificity are (n=58, without CIS):{sup 9}9mTc-MIBI scintiscans: 73.5%/100%; mammography: 94,1%/62.5%; palpation:82.4%/91.7%; ultrasonography:94.1%/58.3%. As compared to the other four methods, {sup 9}9mTc-MIBI scintiscanning ranks last in terms of sensitivity, and is the best method interms of specificity. The high specificity shown by our study could not be confirmed by other studies, and the sensitivity is particularly restricted when tumors are small in size, or at unfavourable locations. The conclusion therefore is that this scintiscanning method is not to be recommended as a screening method, nor is it a method of choice for complementary diagnostic evaluation of breast lesions, except perhaps for a few specific cases. (orig./CB) [Deutsch] Wir fuehrten die {sup 99m}Tc-MIBI-Szintigraphie bei 42 Patientinnen mit operationsbeduerftigem Mammabefund durch, die zuvor palpatorisch, mammographisch, sonographisch und zum Teil mittels Magnetresonanztomographie der Mamma untersucht worden waren. Insgesamt konnten wir 62 histologisch untersuchte

  8. Comparison of uptake of 99mTc-MIBI, 99mTc-tetrofosmin and 99mT-Q12 into human breast cancer cell lines

    Technetium-99m hexakis-2-methoxyisobutyl-isonitrile (MIBI), 99mTc-tetrofosmin and 99mTc-Q12 were all introduced for myocardial imaging but found additional applications as they are taken up by different tumours, enabling imaging of these lesions in patients. The aim of this study was to compare the uptake characteristics of these compounds in vitro in the human adenocarcinoma breast cell lines MCF-7 and ZR-75. It was shown that 99mTc-MIBI had the highest cellular uptake (15.9%±0.5% dose/mg protein after 60 min in MCF-7, and 14.2%±0.4% dose/mg protein in ZR-75), followed by 99mTc-tetrofosmin (6.8%±0.6% dose/mg protein in MCF-7, and 8.2%±0.2% dose/mg protein in ZR-75) and 99mTC-Q12 (3.2%±0.1% dose/mg protein in MCF-7, and 3.5%±0.3% dose/mg protein in ZR-75 cells). For all three compounds tenfold differences in specific activity did not influence total cell-associated radioactivity. Uptake of 99mTc-MIBI and 99mTc-tetrofosmin was obviously lower at 4 C than at 37 C, whereas 99mTc-Q12 uptake showed only slight temperature dependence. When uptake was compared in cells grown to different cell densities (1 mg/ml cellular protein versus 0.3 mg/ml), no differences in uptake were detected when uptake was corrected for the amount of cellular protein present in the dishes. Furthermore, for all compounds it was shown that cellular radioactivity decreased rapidly after washing. Apart from the differences in cellular uptake of the three compounds after 60 min, no differences in residual cellular radioactivity after washing were found between the different compounds when expressed as a percentage of their 60-min uptake, suggesting that the efflux process of the radiolabelled compounds was similar. The differences in cell-associated activity after 60 min were thus presumably caused by differences in uptake. (orig./MG)

  9. Preparation of kit MIBI for 99mTc Labeling Using in Nuclear Medical Diagnostic Imaging

    99mTc-MIBI is the cation complex of 99mTc of oxidation states +1 with ligand methoxy-isobutyl-isonitrile using diagnostic imaging of many illnesses especially use in myocardial perfusion studies. Coronary artery disease present is quite common in our country so that need to use kit MIBI for labelling with Tc-99m is great. Therefore we implement studies of preparation of kit MIBI and find the labelling procedure with Tc-99m of labelling yield or the highest radiochemical purity. In this annual report presents the results of researches made be like finding the optimal conditions for the labelling procedure, preparation procedure of kit MIBI and SnCl2.H2O content. This report also describes studies of the optimization of the preparation of 99mTc-MIBI. Stability studies of these complexes are also described. The comparative results between our kit and Cardiolite® kit are reported. Also the results of sterility test and bacterial endotoxin test are presented. (author)

  10. Diagnosis and monitoring of skin cancer no-melanoma using 99mTc-MIBI. Studies in an animal model

    The aim of the work was to evaluate the usefulness of 99mTc-MIBI as a tracer for the tumor diagnosis and progression of NMSC in a chemically induced model in mice. After administration of 99mTc-MIBI animals were sacrificed at different times. Samples of tumor and healthy skin were dissected in order to perform histological analysis and to evaluate 99mTc-MIBI uptake. Animals under 22 weeks of tumor evolution showed a statistically difference in 99mTc-MIBI uptake between healthy skin and NMSC. Our results showed that the better protocol for the study of the tumor diagnosis and progression of NMSC in mice is the administration of 1 mCi of 99mTc-MIBI and acquisition of images 30 minutes post injection. Results showed that, as tumor progresses, the uptake of 99mTc-MIBI is significantly lower than healthy skin

  11. Evaluation of multiple myeloma with technetium-99m-MIBI scintigraphy

    Aim: To evaluate the clinical utility of whole-body scintigraphy with 99mTc-MIBI in the detection of bone marrow involvement in patients (pts) with multiple myeloma (MM) and related monoclonal disease, in assessing a disease extent and activity, and to define the relationship of different patterns of 99mTc-MIBI uptake with clinical status and stage of disease. Material and Methods: Eighty-three consecutive pts (40 men and 43 women) with MM or monoclonal gammopathy of undetermined significance (MGUS) enrolled in this study were divided into three subgroups: 1. Forty-three MM pts with active disease (AD) in stage II or III according to standard criteria, 2. Thirteen pts in complete remission (CR), and 3. Twenty-seven MGUS pts or MM pts in stage IA. Whole-body scans were obtained 10 min after the i.v. injection of 740 MBq 99mTc-MIBI in anterior and posterior view. The scans were scored semi-quantitatively according to extension and intensity of tracer uptake. Results: Thirty-nine MM pts in the first subgroup with AD showed different patterns of 99mTc-MIBI uptake of high intensity while 4 exhibited physiological distribution of tracer. All thirteen pts in CR in the second subgroup showed a negative 99mTc-MIBI scan. In the third subgroup, twenty-three MGUS pts had no pathological uptake of the radiotracer while 3 MM pts in stage IA presented the diffuse and one both focal and diffuse pattern of 99mTc-MIBI uptake. The uptake score correlated significantly with clinical status and stage of disease and its activity as determined by infiltration of bone marrow by plasma cells (p<0.05), paraprotein (p<0.05), beta2-microglobulin (p<0.05), serum thymidinekinase (p<0.05) and telopeptide-ICTP (p<0.05). Overall sensitivity of the scintigraphic procedure was 91% and specificity 90%. Conclusion: Our results show that whole-body 99mTc-MIBI scintigraphy provides important information which is clinically useful in the detection of bone marrow involvement and in assessing the extent

  12. [Imaging of hyperparathyroidism-Ultrasonography and 99mTc-MIBI scintigraphy-].

    Kawabe, Joji; Higashiyama, Shigeaki; Yoshida, Atsushi; Kotani, Kohei; Shiomi, Susumu

    2016-06-01

    Treatments for primary hyperparathyroidism due to adenoma, hyperplasia and carcinoma and secondary hyperparathyroidism are mainly surgical resections of them. Accurate imaging diagnoses of the existences and the regions are very important for reductions of invasiveness. We describe ultrasonography and 99mTc-MIBI scintigraphy of hyperparathyroidism. We explain an advantage, a disadvantage and diagnosability of these modalities. We mention utilities of SPECT/CT, too. We show echogram and 99mTc-MIBI scintigraphy images about 3 cases of hyperparathyroidism. PMID:27230842

  13. Iterative reconstruction: an improvement of technetium-99m MIBI SPET for the detection of parathyroid adenomas?

    Moka, D.; Eschner, W.; Voth, E.; Dietlein, M.; Schicha, H. [Dept. of Nuclear Medicine, University of Cologne (Germany); Larena-Avellaneda, A. [Dept. of Surgery, St. Katharinen-Hospital, Frechen (Germany)

    2000-05-01

    The purpose of this study was to assess the value of technetium-99m methoxyisobutylisonitrile (MIBI) single-photon emission tomography (SPET) and an iterative reconstruction algorithm for the preoperative localisation of parathyroid adenomas (PTAs). Seventy-two patients (26 male, 46 female, mean age 58{+-}16 years) with known primary hyperparathyroidism were examined preoperatively. First, a thyroid examination was performed to detect possible MIBI-accumulating thyroid lesions. Planar scans were then acquired 15 and 120 min and tomographic images 120 min after intravenous injection of 740 MBq {sup 99m}Tc-MIBI, using a triple-head gamma camera (Picker Prism 3000). Additionally, {sup 99m}Tc-MIBI/ {sup 99m}Tc-pertechnetate subtraction scintigraphy of the early planar images was performed. The SPET data were evaluated using an iterative reconstruction (multiplicative iterative SPET reconstruction: MISR) as well as a standard algorithm (FBP: filtered back-projection with application of a 3-D low-pass postfilter). The weight of the resected PTAs ranged from 110 mg to 5 g. Using planar MIBI scans, correct localisation of the side of the PTA was possible in 81% of cases (58% for PTAs weighing less than 500 mg). Sensitivity increased to 94% using SPET and FBP, while with MISR it rose further, to 97%. Patients with PTAs weighing less than 500 mg showed a sensitivity of 88% with MISR and 81% with FBP. Furthermore, there was a clear improvement in image quality using MISR. None of the normal parathyroid glands were visualised. This study indicates that, in comparison with planar scintigraphy, {sup 99m}Tc-MIBI SPET is a more sensitive and specific tool for topographical localisation of PTAs, especially those that are small. There is a further improvement in sensitivity and image quality when iterative reconstruction is used instead of FBP. (orig.)

  14. Bone marrow uptake of {sup 99m}Tc-MIBI in patients with multiple myeloma

    Fonti, R. [Medicina Nucleare, Facolta di Medicina, Univ. Federico II, Naples (Italy); Centro per la Medicina Nucleare C.N.R., Cattedra di Medicina Nucleare, Napoli (Italy); Del Vecchio, S.; Zannetti, A.; Di Gennaro, F.; Pace, L.; Salvatore, M. [Centro per la Medicina Nucleare C.N.R., Cattedra di Medicina Nucleare, Napoli (Italy); De Renzo, A.; Catalano, L.; Califano, C.; Rotoli, B. [Cattedra di Ematologia, Dipt. di Medicina Clinica e Sperimentale, Napoli (Italy)

    2001-02-01

    In a previous study, we showed the ability of technetium-99m methoxyisobutylisonitrile ({sup 99m}Tc-MIBI) scan to identify active disease in patients with multiple myeloma (Eur J Nucl Med 1998; 25: 714-720). In particular, a semiquantitative score of the extension and intensity of bone marrow uptake was derived and correlated with both the clinical status of the disease and plasma cell bone marrow infiltration. In order to estimate quantitatively {sup 99m}Tc-MIBI bone marrow uptake and to verify the intracellular localization of the tracer, bone marrow samples obtained from 24 multiple myeloma patients, three patients with monoclonal gammopathy of undetermined significance (MGUS) and two healthy donors were studied for in vitro uptake. After centrifugation over Ficoll-Hypaque gradient, cell suspensions were incubated with {sup 99m}Tc-MIBI and the uptake was expressed as the percentage of radioactivity specifically retained within the cells. The cellular localization of the tracer was assessed by micro-autoradiography. Twenty-two out of 27 patients underwent {sup 99m}Tc-MIBI scan within a week of bone marrow sampling. Whole-body images were obtained 10 min after intravenous injection of 555 MBq of the tracer; the extension and intensity of {sup 99m}Tc-MIBI uptake were graded using the semiquantitative score. A statistically significant correlation was found between in vitro uptake of {sup 99m}Tc-MIBI and both plasma cell infiltration (Pearson's coefficient of correlation r=0.69, P<0.0001) and in vivo score (Spearman rank correlation coefficient r=0.60, P<0.01). No specific tracer uptake was found in bone marrow samples obtained from the two healthy donors. Micro-autoradiography showed localization of {sup 99m}Tc-MIBI inside the plasma cells infiltrating the bone marrow. Therefore, our findings show that the degree of tracer uptake both in vitro and in vivo is related to the percentage of infiltrating plasma cells which accumulate the tracer in their inner

  15. Myeloma, source of false positive of parathyroid scintigraphy with {sup 99m}Tc-MIBI; Le myelome, source de faux-positif de la scintigraphie parathyroidienne au 99mTc-MIBI

    Zaabar, L.; Ben Sellem, D.; El Ajmi, W.; Slim, I.; Letaief, B.; Mhiri, A.; Ben Slimene, M.F. [Institut Salah Azaiez, Service de medecine nucleaire, Tunis (Tunisia)

    2010-07-01

    Purpose: Considering a specificity of the MIBI dual-phase parathyroid scintigraphy with {sup 99m}Tc-MIBI presents false positives which number has declined since the systematic implementation of the SPECT. We report a case of a superior mediastinal false-positive. Conclusions: the myeloma represents a potential cause of false-positive of parathyroid scintigraphy with {sup 99m}Tc-MIBI. (N.C.)

  16. 99mTc-MIBI SPECT in estimation of adalat influence on myocardial perfusion in CAD patients

    Calcium antagonists (CA) adalat effect on myocardial perfusion in CAD patients are studied using 99mTc-MIBI SPECT. 99mTc-MIBI SPECT provides useful information for evaluation of CA effect on myocardial perfusion and revealing of steel syndrome as a result of CA treatment. The IPD is one of the most sensitive signs of improvement in myocardial perfusion after treatment

  17. Non-visualized Thyroid Gland by Tc-99m MIBI Scan with Normal Thyroid Scan

    We present the case of a 21-year-old man who was referred to us for parathyroid scintigraphy with high blood levels of intact parathormone and osteoporosis. Several methods and radiopharmaceuticals, e.g., Tc-99m MIBI and Tl-201 chloride/Tc-99m pertechnetate (Tl-201/TcPO-4) subtraction, are commonly used for this purpose. We present the case of a thyroid gland that demonstrates quite normal Tc-99m pertechnetate uptake, no accumulation of Tc-99m MIBI, and very low grade Tl-201 uptake. To the best of our knowledge, no similar case has been reported previously. A 21-year-old male with osteoporosis and growth-development retardation was referred for MIBI parathyroid scan because of high blood levels of intact parathormone and bone-specific alkaline-phosphatase, which were 219.4 (15-88 pg/ml) and 355 (21-58 U/L), respectively. In his Tc-99m pertechnetate (TcPO-4) pinhole scintigraphy, bilateral clearly visualized radioactivity accumulation in the thyroid gland was seen. In both early or late images of the Tc-99m MIBI parathyroid scan, the thyroid gland was not visualized. Therefore, a Tl-201/TcPO-4 subtraction scan method was used. However, the Tl-201 accumulation level in the thyroid gland was not sufficient for the subtraction method. In his thyroid ultrasonography, the thyroid gland echo was homogenous, and there was neither any solid nor cystic lesion. The physical examination of his neck was normal. Other laboratory findings were all normal as follows. TSH: 3.03 (0.35-5.6 IU/mL), free T3: 3.66 (2.5-3.9 pg/mL), free T4: 0.90 (0.59-1.3 ng/dL), Anti-TPO:0.3 (0.40 IU/mL), Anti-TG-Ab: -4 subtraction methods are commonly applied. The thyroid gland was not visualized on Tc-99m MIBI scintigraphy of suppressed thyroid tissue in a study by Turkolmez et al.. It should be taken into account that sometimes we may not be able to visualize a normal thyroid gland, and in these cases we might encounter suboptimal visualization in T1-201 subtraction method as well. Erdil et al. foun

  18. Mammography and 99mTc-MIBI scintimammography in breast cancer diagnosis

    The aim of this work has been to evaluate whether a diagnostic protocol based on the joint use of mammography and 99mTc-MIBI scintimammography can help to distinguish the lesions and to reduce the number of biopsies required in patients with suspected breast cancer. A total of 58 women were evaluated by palpation, mammography, scintimammography. Twenty-four patients were scintimammographed with 99mTc-MIBI at 10 min after injection. Thirty-four patients were taken double phase scintimammography with 99mTc-MIBI 10 min and 60-90 min after injection. Based on mammography, the suspicion degrees of malignancy were rated, and 30 results of malignancy were confirmed by histopathology. Based on mammography, 18 lesions were considered to be most probably benign (of which 3 were histopathologically breast cancer), 19 as indeterminate (of which 9 were histopathologically breast cancer), and 21 as malignant (of which 18 were histopathologically breast cancer). The results of early and delayed phases 99mTc-MIBI scintimammography were the same. The sensitivity, specificity and accuracy of scintimammography were 74.29%, 86.96% and 79.31%, respectively. Scintimammography gave 16 correct diagnosis in 19 mammogram indeterminate (84.2%) and demonstrated 5 out of 8 cases axillary lymph nodes metastasis (62.5%). These studies show that 99mTc-MIBI scintimammography used as a complementary testing technique to mammography is useful in the examination of patients with suspected breast cancer. The adoption of a joint mammography-scintimammography diagnostic protocol could considerably reduce the number of biopsies performed in patients with lesions of indeterminate mammographic suspicion of malignancy

  19. Lesion localization in patients with hyperparathyroidism using double-phase Tc-99m MIBI parathyroid scintigraphy

    Shin, Jung Woo; Ryu, Jin Sook; Kim, Jae Seung; Moon, Dae Hyuk; Hong, Seung Mo; Gong, Gyung Yub; Hong, Suk Joon; Lee, Hee Kyung [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    1999-02-01

    This study was performed to evaluate the diagnostic usefulness of double-phase Tc-99m MIBI parathyroid scintigraphy with single photon emission computed tomography (SPECT) in patients with hyperparathyroidism. We also evaluated the relationship between Tc-99m MIBI uptake and oxyphil cell contents in parathyroid glands. The subjects were 28 parathyroid glands of 10 patients who underwent Tc-99m MIBI parathyroid scintigraphy and parathyroidectomy for clinically suspected hyperparathyroidism. Early and delayed pinhole images were obtained at 15 minutes and 2 hours after injection of Tc-99m MIBI, and SPECT images were followed. The weight and oxyphil cell contents of parathyroid tissue were obtained from pathologic specimen, and the scintigraphic findings were compared with histopathology. In surgical histopathology, 6 parathyroid adenomas and 9 parathyroid hyperplasias were confirmed. The sensitivity, specificity, and positive predictive value of early and delayed images were 46.7% (7/15), 76.9% (10/13), 70% (7/10) and 66.7% (10/15), 92.3% (12/13), 90.9% (10/11), respectively. SPECT image detected an additional small hyperplasia. The sensitivity, specificity, and positive predictive value of combined interpretation of early and delayed images with SPECT were 73.3% (11/15), 100% (13/13), 100% (11/11). The sensitivity was 100% (6/6) for adenoma, whereas that was 55.5% (5/9) for hyperplasia. Both adenomas and hyperplasias showed significantly increased oxyphil cell contents compared with normal parathyroid glands (p<0.0001), but the oxyphil cell content and weight were not significantly different between adenomas and hyperplasias. Double-phase Tc-99m MIBI parathyroid scintigraphy with SPECT is useful for lesion localization in patients with hyperparathyroidism. Although both adenoma and hyperplasia have increased oxyphil cell content, the sensitivity is high in adenoma, but low in hyperplasia.

  20. Technetium-99m tetrofosmin for parathyroid scintigraphy: a direct comparison with {sup 99m}Tc-MIBI, {sup 201}Tl, MRI and US

    Wakamatsu, Hideyuki [Dept. of Radiology, Noguchi Thyroid Clinic and Hospital Foundation, Oita (Japan); Noguchi, Shiro; Yamashita, Hiroyuki [Dept. of Surgery, Noguchi Thyroid Clinic and Hospital Foundation, Oita (Japan); Yamashita, Hiroto [Dept. of Pathology, Noguchi Thyroid Clinic and Hospital Foundation, Oita (Japan); Tamura, Shozo; Jinnouchi, Seishi; Nagamachi, Shigeki; Futami, Shigemi [Dept. of Radiology, Miyazaki Medical College, Miyazaki (Japan)

    2001-12-01

    The aim of this study was to evaluate the efficacy and role of technetium-99m tetrofosmin for the detection of abnormal parathyroid glands to be referred for surgical treatment. Twenty-eight consecutive patients, including 25 primary and 3 secondary cases of hyperparathyroidism, were evaluated. {sup 99m}Tc-tetrofosmin/{sup 99m}Tc-pertechnetate subtraction scintigraphy (TF/Tc) was performed on all patients, and the results were directly compared with those of {sup 99m}Tc-methoxyisobutylisonitrile (MIBI)/{sup 99m}Tc-pertechnetate subtraction scintigraphy (MIBI/Tc), {sup 201}Tl/{sup 99m}Tc-pertechnetate subtraction scintigraphy (Tl/Tc), magnetic resonance imaging (MRI) and ultrasonography (US). In cases of single-gland disease, the sensitivities of TF/Tc, MIBI/Tc, Tl/Tc, MRI and US were 63.2%, 68.4%, 57.9%, 55.6% and 63.2%, respectively. In cases of multi-gland disease, the sensitivities of TF/Tc, MIBI/Tc, Tl/Tc, MRI and US were 41.7%, 41.7%, 37.5%, 58.3% and 54.2%, respectively. In cases of parathyroid adenoma, the sensitivities of TF/Tc, MIBI/Tc, Tl/Tc, MRI and US were 68.8%, 75.0%, 68.8%, 62.5% and 75.0%, respectively. In cases of parathyroid hyperplasia, the sensitivities of TF/Tc, MIBI/Tc, Tl/Tc, MRI and US were 40.7%, 40.7%, 33.3%, 53.8% and 48.1%, respectively. It is concluded that, for the detection of abnormal parathyroid glands, {sup 99m}Tc-tetrofosmin is as useful as {sup 99m}Tc-MIBI and is more useful than {sup 201}Tl. (orig.)

  1. Tc-99m-MIBI brain SPECT in differentiating tumor recurrences from necrosis

    Brain SPECT using 99m-TC MIBI can distinguish between local tumor recurrence and radio necrosis of the primary brain tumor, whereas CT scan and MRI do not have this ability. 1. Is it possible to search for tumoral cells in the brain by using TC-99m MIBI? 2. How sensitive and specific is the SPECT in distinguishing the presence of active tumor in the brain and differentiating it from post-therapy necrosis? 3. Is it feasible to substitute this diagnostic modality for stereotactic biopsy surgery? Patients who presented to the neurosurgery clinic with the clinical manifestations of brain tumor relapse between 22nd August 1999 and 1.; February 2000 and were candidates for stereotactic biopsy were chosen. A 99m-TC MIBI SPECT was performed before biopsy. The total number of patients was 13. Five patients had the diagnosis of brain tumor by surgery and biopsy and had undergone a course of radiotherapy and chemotherapy. These patients were normal clinically and MIBI SPECT was done for the purpose of follow-up. Clinical manifestations consisted of, Weakness, Vertigo visual disorders, loss of consciousness, headache, aphasia and hemiparesis. The primary tumors were composed of a variety of lei sons including: grade I, II astrocytoma (62.5%), glioblastoma (25%) and medulloblastoma (12.5%). eight patients who had MIBI SPECT firstly and then had biopsy, brain tumor relapse was reported by both biopsy and SPECT in seven patients. This proved a 100% sensitivity and a 100% specificity for MIBI SPECT in differentiating, between tumor relapse and necrosis, a result comparable to stereotactic biopsy. Also in 5 patients with clinical evidence of remission, MIBI SPECT was negative for tumor recurrence in all. Patients who present with the clinical manifestations of brain tumor relapse, usually have a history of surgery, radiotherapy or chemotherapy and any invasive procedures like stereotactic biopsy on these patients carries a high risk for anesthesia and surgery, besides being costly

  2. Comparison of Tc-99m pertechnetate images with dual-phase Tc 99m MIBI and SPECT images in primary hyperparathyroidism

    Sait Sager

    2014-01-01

    Full Text Available Background: The purpose of this study was to evaluate the value of Tc-99m pertechnetate planar, dual-phase MIBI and MIBI-SPECT images in the determination and localization of parathyroid lesions. Materials and Methods: In this study, 38 patients who underwent operation for primary hyperparathyroidism were included. Tc-99m pertechnetate planar-pinhole imaging of the neck and then MIBI planar and SPECT images in supine position was performed. Late SPECT images were acquired 120 minutes after the injection. Early and late MIBI images were quantitatively evaluated. Results: Of the 38 patients, 30 of them had adenoma, 2 patients had hyperplasia and 6 of them were normal on planar images. Thirty-four of 38 patients were positive on SPECT images. SPECT images of the patients with positive results were matched with pathology results. Conclusion: As a result, Tc-99m pertechnetate planar-pinhole, Tc-99m MIBI planar and SPECT images are useful for localization of parathyroid lesions especially in multinodular thyroid gland. However, US or CT images are necessary for more accurate localization and Tc-99m pertechnetate images are useful for interpreting and comparing with the early and late MIBI images.

  3. Synthesis of Cu[MIBI]4Cl to prepare 99m Tc [MIBI]6+ as a myocardial perfusion agent

    2-Methoxyisobutylisonitrile (MIBI) is a key starting material in the preparation of technetium-99m hexakis (2-methoxyisobutylisonitrile). This cationic complex has been reported to be clinically useful as myocardial perfusion agent. In this work, we designed an improved synthetic method to prepare 2-methoxyisobutylisonitrile in a two step synthesis with an overall yield of 52.9 % , on the basis of 2-methoxyisobutylamine is a primary amine which, when is heated with a mixture of chloroform and alcoholic potash, produces an isonitrile. Its spectroscopic properties as well as the preparation of its copper and technetium-99m complexes are also presented. (Author)

  4. Three-dimensional display of 99mTc-MIBI myocardial scintigraphy

    One of 99mTc-hexakis, 99mTc-methoxyisobutyl isonitrile (MIBI), has been demonstrated to have a myocardial uptake proportional to regional coronary blood flow. In this study, 99mTc-MIBI myocardial scintigraphy was performed for 16 patients with ischemic heart disease. After injection of 740 MBq of 99mTc-MIBI, 64 projection images were collected during a 360-degree rotation. Three-dimensional (3D) display of the left ventricle was reconstructed with depth-shading method from 99mTc-MIBI SPECT images, which were reconstructed by filtered back projection method. In 9 of the patients, left ventricular cineangiography were performed as diagnostic gold standard. Four physicians blinded to patients' clinical information interpreted 3D images and SPECT images on separate occasions. Diagnosis of hypoperfusion by 3D displays agreed with those of SPECT in 92.9% (104/112 segments), and disagreed in 7.1% (8 segments). Sensitivity and specificity of 3D images were 87.0% and 93.9%, which were not statistically different (p<0.05) from that of SPECT images (91.3%, 97.0%). Receiver operating characteristic (ROC) analysis revealed nearly identical curves for the two. Although 3D display had nearly identical diagnostic ability with SPECT, observers reported that 3D images were easier to diagnose than SPECT images. An advantage of the 3D display is that the display gives a more realistic impression of the left ventricle to an observer than tomography or planar imaging. Another advantage is that 3D display can reduce the amount of data storage compared with that of SPECT. In conclusion, 3D images may be useful for diagnosis of hypoperfusion of left ventricle. (author)

  5. 99mTc-MIBI scintigraphy and beta-2-microglobulin in patients with multiple myeloma

    Multiple myeloma is malignancy characterizing with autoimmune proliferation of malignant plasma cells. The aim of the study was to investigate the clinical usefulness of 99mTc-MIBI scintigraphy and serum beta-2-microglobulin for diagnosis, staging and therapy control in patients with multiple myeloma. 67 patients with multiple myeloma were investigated. 42 patients ware in active state and 25 patients were in remission. Planar images and/ or SPECT were performed on the rotating gamma camera (Siemens) 30 minutes and 3 hours after i.v. injection of 555-740 MBq 99mTc-MIBI. The uptake patterns were grouped as normal, diffusely increased and focal increased. Beta-2-microglobulin levels were measured by radioimmunoassay. The scintigraphy with 99mTc-MIBI was true positive in 40 patients with MM. From them, 21 patients were with diffuse uptake and 19 were with focal uptake with 29 lesions. 99mTc-MIBl marrow uptake correlated with the percentage of bone marrow plasma cells. All samples from patients in active state had a serum beta-2-microglobulin above the normal range. In two patients with false negative scan, the results were compared with the data of CT images. Positive clinical findings and increased value of tumour marker were found in these patients. One patient was with false positive scintigraphy. After therapy, the scintigraphy was true negative in 25 patients. In these patients in remission, the levels of the serum beta-2-microglobulin were near to the normal levels. In conclusion, our results demonstrated the effectiveness of both methods - 99mTc-MIBI scintigraphy and serum beta-2-microglobulin in different stage of the disease for the diagnosis, staging and therapy control by patients with multiple myeloma. (authors)

  6. TB or cancer: Tc-99m MIBI or Tl-201 SPECT for focal pulmonary abnormalities

    Aim: Radiographically detected focal pulmonary abnormalities often suggest the presence of malignancy. Primary bronchogenic carcinoma and benign granulomas account for over 80% of these cases. Because of the high incidence of tuberculosis (TB) in South Africa, it is important to exclude TB as a cause of lung nodules. Both Tl-201 and Tc-99m MIBI, primarily used as myocardial perfusion imaging agents, are known to concentrate in tumors, which includes lung tumors. The main aim of the study was to determine whether it is possible to differentiate between a malignant lung nodule and a nodule due to tuberculosis by using Tl-201 and/or Tc-99m MIBI. Materials and methods: Patients presenting at the respiratory clinic with focal pulmonary abnormalities on chest X-ray (CXR) were included in the study. Tl-201 and Tc-99m MIBI studies were performed on the same day in all patients. Planar views and SPECT of the chest area were obtained. The follow-up of the patients generally included chest CT scan, bronchoscopy and one of the following: Thoracotomy, fine-needle aspiration cytology or repeated CXR documentation over two years. Histological, cytological or microbiological proof of the etiology of the solitary lung nodule was used as the 'gold standard' for determining the final diagnosis. In some cases a two-year follow-up period documenting no progression of lesion size was used to confirm the benign lesion. Results: Of the first 16 patients 13 were included in this report. These included 8 men and 5 women with a mean age of 53.4 years (range 29-72 years). In three patients the final diagnosis has not yet been established. Benign lesions were found in eight patients, five of these were proven TB. In seven of eight patients there was no or very vague uptake of activity in the lesions. One case of active TB showed high uptake with both tracers. Malignant lesions were present in five patients. Avid uptake of both Tl-201 and Tc-99m MIBI was found in these lesions. Uptake was also

  7. First experience of brain tumour scintigraphy with 99mTc-MIBI before and after surgery

    Full text: Morphological imaging techniques like computed tomography and magnetic resonance imaging are routinely used to localize tumours. However, their use for prediction of histopathological diagnosis and tumour changes after treatment is difficult. Functional imaging using positron emission tomography and single photon emission computed tomography (SPECT) were introduced as non-invasive methods for the differentiation and evaluation of brain tumours, especially for their follow-up. The purpose of present study was to investigate the uptake of 99mTc-MIBI in case of malignant brain tumours before and after surgery. 25 patients (13 males and 12 females; age range 21-75 years; average age 48.76±17.25 years) with brain tumours were investigated. The histological diagnoses of the tumours were confirmed from surgical specimens. None of the patients had received any treatment before enrolment for the study. 99mTc-MIBI brain SPECT was performed 3.88±2.85 days before surgery and 9.88±2.24 days after surgery in all cases. SPECT scans were acquired in 64 projections over 360 deg. using a dual-head gamma camera (Siemens E.Cam) coupled with low energy collimator, 15 minutes after intravenous injection of 550 MBq 99mTc-MIBI. Data were recorded in a 64x64 matrix at a zoom factor of 1.78. SPECT images were reconstructed and analysed in the transversal, axial and coronal planes. The study results are presented in the table. Of the 25 tumors, only 19, majority glioblastoma (11) showed avid uptake in the pre- surgery scan. Tumors, II0 astrocytoma (1), oligoasrtrocytoma (1), III0 astrocytoma (3) were missed in the pre surgery scan. Comparison of pre- and postoperative images showed the reduction of 99mTc-MIBI uptake post-operatively except in one case of gliosarcoma where the uptake increased after surgery. In one case of III deg. astrocytoma the 99mTc-MIBI uptakes was observed only after the surgery. All post-operative images showed more intensive uptake in the scalp (zone of

  8. The Role of Scintimammography with 99mTc-MIBI in Evaluation of the Breast Lesions

    A. Khancherly

    2003-07-01

    Full Text Available The breast cancer is common in females.Early detection with safe , convenient , noninvasive and accessible diagnostic tools are important. X- ray mammography is still the first choice imaging for breast cancer, but has low specificity and limited value in dense breast and surgically scarred breasts. In recent years , MIBI scintimammography has been used for this purpose. The aim of this study was to determine diagnostic value of prone lateral 99mTc-MIBI scintigraphy in detection of primary breast cancer in patients with breast lesions. We evaluated 55 patients with breast lesions and/or suspicious mammographic findings with MIBI scintimammography. In all patients , the diagnosis was established by pathology. Pattern of MIBI uptake and ratio of lesion to normal tissue uptake was recorded. All lesions with focal uptake and T/N ratio of more than 1.31 were considered as positive. Absence of focal activity or diffuse uptake either unilaterally or bilaterally were considered negative for malignancy. Focal uptake with T/N ratio of 1.01- 1.30 was equivocal in MIBI scan. Mammographic and sonographic findings were classified as negative ( normal or benign , equivocal and Positive (suspecious for malignancy or strongly malignant. Of 55 patients , 10 had cancer in pathologic examination. The MIBI scan detected all of the 10 cancerous lesions. X-mammography was positive in 6 of 10 patients and was negative or equivocal in 3 of them. In this study the MIBI breast scintimammography showed sensitivity and specificity of 100% and 95.4%. With respect to the limitations of X-ray mammography particularly in the young females , dense breasts and surgically scarred breasts , and low specificity of it , MIBI scan can be used as complementary imaging to the mammography and sonography in the evaluation of the breast lesions.

  9. Miocárdio viável pela tomografia computadorizada com Tc-99m (MIBI) sensibilizada por nitroglicerina endovenosa Viable myocardium scintigraphy with intravenous nitroglycerine by computed tomography with Tc-99m (MIBI)

    José Ramos Filho; Marcos Welber Nascimento; Rafael Mariano Gislon da Silva; Thiago Negrini de Camargo; Roberto Simões de Almeida; Eloá Jacinto Lima

    2008-01-01

    FUNDAMENTO: A seleção de pacientes com doença coronariana crônica para recanalização baseia-se na detecção do miocárdio comprometido, potencialmente viável. OBJETIVO: Avaliar o miocárdio isquêmico, potencialmente viável pelo SPECT com MIBI sensibilizado por nitroglicerina em dose máxima tolerada. MÉTODOS: Investigamos de forma prospectiva, de abril de 2004 a novembro de 2005, pela tomografia computadorizada por emissão de fóton único SPECT com Tc-99m (MIBI), 40 pacientes (média etária 62 ± 8,...

  10. Regional lymph node staging in melanoma patients by means of 99mTc-MIBI scintigraphy

    Aim: Nearly 20% of melanoma patients with AJCC stages I-II who do not undergo sentinel/elective lymphadenectomy will develop regional lymph node metastases (RLM). Diagnosis of such lesions is frequently performed clinically during first two-year follow-up. Since 1996, our team has been studying the usefulness of 99mTc-MIBI scintigraphy in the evaluation of recurrent melanoma lesions. The aim of the present study was to prospectively evaluate the clinical value of 99mTc-MIBI scintigraphy in the diagnosis of sub-clinical RLM. Material and Methods: We included 66 patients within 6 months of melanoma diagnosis, with Breslow's thickness > 1.0 mm. When MIBI scans were performed, 49 of them did not have evidence of disease, and 17 presented clinically questionable regional lymph node lesions. Planar images of lymph node regions were acquired 10 min post-injection, using a dose of 740 MBq in a LFOV gamma camera equipped with a LEHR collimator. Scan findings were confirmed by pathology (n=41) or by clinical follow-up with an average time of 31 months (n=25). Results: Thirty out of 33 patients with RLM were correctly diagnosed: palpable lesions (n=14), non-palpable (n=16). In 3 cases that were initially MIBI negative, nodal metastases were found during follow-up. Diagnostic values were as followed: sensitivity 91% (76-98), specificity 85% (68-95), PPV 86% (70-95) and NPV 90% (74-98); (95% CI). Conclusion: 99mTc-MIBI scanning is a sensitive and specific technique for the diagnosis of sub-clinical nodal metastases. Therefore, it could be helpful in the follow-up of melanoma patients

  11. Diagnosis brain tumors with Tc-99m-MIBI and follow-up surrounding oedema after and post oedema therapy with Tc-99m-ECD

    Aim: To precisely diagnose the brain tumors and surrounding oedema is very difficult. The purpose of this study was to analyse the occurrence of visualisation the surrounding brain oedema after and post oedema therapy. Material and Methods: The study included 86 patients with brain tumor and surrounding oedema. All patients were simultaneously subjected SPECT scintigraphy with 550-740 MBq Tc-99m-MIBI as specific tumor marker and 550-740 MBq Tc-99m-ECD as brain oedema marker. Post oedema therapy were all patients SPECT scintigraphy with 550-740 MBq Tc-99m-ECD subjected as follow-up oedema regression. Results: In 86 patients with brain tumor and surrounding oedema the SPECT scintigraphy with Tc-99m-MIBI detected the tumor region while the SPECT with Tc-99m-ECD detected greater area on decreased accumulation implying the surrounding oedema. On the post oedema therapy SPECT scintigraphy with Tc-99m-ECD detected small or non area on decreased accumulation. Conclusion: SPECT scintigraphy of brain with Tc-99m-MIBI and Tc-99m-ECD is a methods for detection of brain tumors and surrounding oedema and enables follow-up effects of oedematous therapy

  12. Assessment of resistance to paclitaxel of murine tumors by 99mTc-MIBI/201Tl dual-radionuclide imaging

    This study investigated P-glycoprotein (Pgp) expression by murine tumors with and without resistance to paclitaxel and the role of 99mTc-2-methoxyisobutylisonitrile (MIBI)/201Tl imaging in predicting the effect of paclitaxel. Antitumor effect of paclitaxel and biodistribution of the radiopharmaceuticals were evaluated in mice bearing four tumor types. Pgp expression did not correlate with the antitumor efficacy of paclitaxel. Although the absolute uptake of 99mTc-MIBI did not correlate with Pgp expression, 99mTc-MIBI could predict paclitaxel sensitivity by its higher uptake

  13. Preoperative localization of parathyroid lesions in patients with primary hyperparathyroidism by {sup 99m}Tc-MIBI scintigraphy

    Suzuki, Noriyuki; Miura, Daisyu; Nakazawa, Hideki [Toranomon Hospital, Tokyo (Japan)

    2000-09-01

    The purpose of this study was to evaluate parathyroid scans obtained by early and late imaging following {sup 99m}Tc-MIBI injection. {sup 99m}Tc-MIBI scintigraphy was performed 15 min and 2 hr after intravenous injection of 300 MBq (or 370 MBq) of {sup 99m}Tc-MIBI. The subjects were 37 patients with primary hyperparathyroidism (adenoma, 34 cases; hyperplasia, 3 cases; and carcinoma 1 case) operated on between January 1994 and March 1996. Sensitivities for localization of adenoma, hyperplasia, and for the both lesions were 84%, 54%, and 76%, respectively. These results were poorer than the results of ultrasonography (US) (adenoma 91%, hyperplasia 54%, and both lesions 81%), and better than by {sup 201}TlCl/{sup 99m}Tc-O{sub 4}{sup -} subtraction scintigraphy (adenoma 69%, hyperplasia 23%, and both lesions 55%). Parathyroid gland weight and associated thyroid lesions decreased the sensitivity of localization detection using {sup 99m}Tc-MIBI. Combined use of {sup 99m}Tc-MIBI scintigraphy and US yielded higher sensitivity (89%), than obtained by either method alone. In the 53 cases operated on between April 1996 and March 2000 (adenoma, 47 cases; hyperplasia, 4 cases; carcinoma, 1 case; and diagnosis uncertain, 1 case), the sensitivities of {sup 99m}Tc-MIBI scintigraphy for the localization adenoma, hyperplasia, and for the both lesions were 83%, 20%, and 71%, respectively, versus 98%, 30%, and 85%, respectively, for US. It is possible that the light weight of parathyroid glands in the patients with hyperplasia decreased the sensitivity of late imaging. {sup 99m}Tc-MIBI scintigraphy is of high diagnostic value in terms of parathyroid function, and US in terms of morphology. The combination of {sup 99m}Tc-MIBI scintigraphy and US appeared to be the optimal diagnostic tool for localization of the lesion in hyperparathyroidism. (K.H.)

  14. The comparison of two gated SPET protocols: adenosine Tc-99m tetrafosmin and treadmill exercise Tc-99m MIBI

    The effect of adenosine and exercise on gated SPET left ventricular ejection fraction (LVEF), end diastolic volume (EDV) and end systolic volume (ESV) has not been fully investigated. The aim of the study was to compare functional measurements obtained in one-day adenosine rest and two-day stress-rest protocols in relation to ischaemia. Out of 226 consecutive patients examined with submaximal treadmill stress-rest 700 MBq Tc-99m MIBI, 26 were chosen to match those subjected to adenosine (140 μg/kg/min) enhanced by a low level exercise protocol (300 MBq and 700 MBq Tc-99m tetrofosmin for stress and rest respectively). All images were acquired on a double head system and were gated using 8 frames, 25 s per frame. ED and ES volumes increased after adenosine but decreased after treadmill resulting in the post-stress LVEF being significantly greater than after adenosine, 60 ± 11 v. 51 ± 13% (p < 0.01). This was caused by the smaller post-stress ESV in the treadmill group 40 ± 20 v. 51 ± 34, p < 0.05. In non-ischaemic scans the LVEF was greater (61± 8 v. 51 ± 14, p < 0.01) and EDV and ESV smaller after both stress and rest. The adenosine test may have an opposite influence on the EDV and ESV in comparison to the submaximal treadmill test and therefore the left ventricular function measurements after adenosine infusion should be interpreted carefully and may not represent those acquired after physical exercise. In the gated SPET scans showing ischaemia the post-stress EDV and ESV may be greater and the LVEF lower than at rest. (author)

  15. {sup 99m}Tc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance

    Melloul, M.; Paz, A.; Cytron, S. [Dept. of Nuclear Medicine, Hasharon Hospital, Rabin Medical Center, Petah Tikva (Israel); Koren, R.; Gal, R. [Dept. of Pathology, Hasharon Hospital, Rabin Medical Center, Petah Tikva (Israel); Feinmesser, R. [Dept. of Oto-Rhino-Laryngology, Hasharon Hospital, Rabin Medical Center, Petah Tikva (Israel)

    2001-02-01

    The aim of this study was to assess the correlation between technetium-99m methoxyisobutylisonitrile (MIBI) uptake by parathyroid adenomas, oxyphil cell content and volume of the lesions. Thirty-one patients with parathyroid adenomas were evaluated prospectively. Preoperative double-phase {sup 99m}Tc-MIBI scintigraphy was performed in all patients and tracer uptake by parathyroid lesions was assessed semi-quantitatively employing region of interest ratios to normal adjacent neck areas. Surgical specimens underwent histological evaluation and oxyphil cell content was determined. The intensity of tracer uptake was compared with oxyphil cell content, volume of the lesions and serum levels of calcium and parathormone. {sup 99m}Tc-MIBI tracer uptake was correlated with oxyphil cell content, volume of parathyroid lesions and the functional status of the parathyroid adenomas. Tracer accumulation in oxyphil cells might partially explain the preferential {sup 99m}Tc-MIBI retention in parathyroid lesions. (orig.)

  16. 99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance

    The aim of this study was to assess the correlation between technetium-99m methoxyisobutylisonitrile (MIBI) uptake by parathyroid adenomas, oxyphil cell content and volume of the lesions. Thirty-one patients with parathyroid adenomas were evaluated prospectively. Preoperative double-phase 99mTc-MIBI scintigraphy was performed in all patients and tracer uptake by parathyroid lesions was assessed semi-quantitatively employing region of interest ratios to normal adjacent neck areas. Surgical specimens underwent histological evaluation and oxyphil cell content was determined. The intensity of tracer uptake was compared with oxyphil cell content, volume of the lesions and serum levels of calcium and parathormone. 99mTc-MIBI tracer uptake was correlated with oxyphil cell content, volume of parathyroid lesions and the functional status of the parathyroid adenomas. Tracer accumulation in oxyphil cells might partially explain the preferential 99mTc-MIBI retention in parathyroid lesions. (orig.)

  17. Comparison of the uptakes of Tc-99m MIBI and Tc-99m tetrofosmin in A549, an MRP-expressing cancer cell, in vitro and in vivo

    Uptakes of Tc-99m MIBI (MIBI) and Tc-99m tetrofosmin (tetrofosmin) in human non-small cell lung cancer A549, multidrug-resistance associated protein (MRP) expressing cell, were investigated in vitro and in vivo. Western blot analysis and immunohistochemistry were used for detetion of MRP in A549 cells with anti-MRPr1 antibody. Cellular uptakes of two tracers were evaluated at 100 μM of verapamil (Vrp), 50 μM of cyclosporin A (CsA) and 25 μM of butoxysulfoximide (BSO) after incubation with MIBI and tetrofosmin for 30 and 60 min at 37.deg.C, using single cell suspensions at 1x106 cells/ml. Radioactivities in supernatants and pellets were measured with gamma well counter. A549 cells were inoculated in each flanks of 24 nude mice. Group 1 (Gr1) and Gr3 mice were treated with only MIBI or tetrofosmin, and Gr2 and Gr4 mice were treated with 70mg/kg of CsA i.p. for 1 hour before injection of 370KBq of MIBI or tetrofosmin. Mice were sacrificed at 10, 60 and 240 min. Radioactivities of organs and tumors were expressed as percentage injected dose per gram of tissue (%ID/gm). Western blot analysis of the A549 cells detected expression of MRPr1 (190 kDa) and immunohistochemical staining of tumor tissue for MRPr1 revealed brownish staining in cell membrane but not P-gp. Upon incubating A549 cells for 60 min with MIBI and tetrofosmin, cellular uptake of MIBI was higher than that of tetrofosmin. Coincubation with modulators resulted in an increase in cellular uptakes of MIBI and tetrofosmin. Coincubation with modulators resulted in an increase in cellular uptakes of MIBI and tetorfosmin. Percentage increase of MIBI was higher than that of tetrofosmin with Vrp by 623% and 427%, CsA by 753% and 629% and BSO by 219% and 140%, respectively. There was no significant difference in tumoral uptakes of MIBI and tetrofosmin between Gr1 and Gr3. Percentage increases in MIBI (114% at 10 min, 257% at 60 min, 396% at 240 min) and tetrofosmin uptake (110% at 10 min, 205% at 60 min, 410% at

  18. Comparison of the uptakes of Tc-99m MIBI and Tc-99m tetrofosmin in A549, an MRP-expressing cancer cell, in vitro and in vivo

    Yoo, Jeong Ah; Jeong, Shin Young; Seo, Myung Rang; Bae, Jin Ho; Ahn, Byeong Cheol; Lee, Kyu Bo; Lee, Jae Tae [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of); Choi, Sang Woon; Lee, Byung Ho [Korea Institute of Chemical Technology, Daejon (Korea, Republic of)

    2003-12-01

    Uptakes of Tc-99m MIBI (MIBI) and Tc-99m tetrofosmin (tetrofosmin) in human non-small cell lung cancer A549, multidrug-resistance associated protein (MRP) expressing cell, were investigated in vitro and in vivo. Western blot analysis and immunohistochemistry were used for detetion of MRP in A549 cells with anti-MRPr1 antibody. Cellular uptakes of two tracers were evaluated at 100 {mu}M of verapamil (Vrp), 50 {mu}M of cyclosporin A (CsA) and 25 {mu}M of butoxysulfoximide (BSO) after incubation with MIBI and tetrofosmin for 30 and 60 min at 37.deg.C, using single cell suspensions at 1x10{sup 6} cells/ml. Radioactivities in supernatants and pellets were measured with gamma well counter. A549 cells were inoculated in each flanks of 24 nude mice. Group 1 (Gr1) and Gr3 mice were treated with only MIBI or tetrofosmin, and Gr2 and Gr4 mice were treated with 70mg/kg of CsA i.p. for 1 hour before injection of 370KBq of MIBI or tetrofosmin. Mice were sacrificed at 10, 60 and 240 min. Radioactivities of organs and tumors were expressed as percentage injected dose per gram of tissue (%ID/gm). Western blot analysis of the A549 cells detected expression of MRPr1 (190 kDa) and immunohistochemical staining of tumor tissue for MRPr1 revealed brownish staining in cell membrane but not P-gp. Upon incubating A549 cells for 60 min with MIBI and tetrofosmin, cellular uptake of MIBI was higher than that of tetrofosmin. Coincubation with modulators resulted in an increase in cellular uptakes of MIBI and tetrofosmin. Coincubation with modulators resulted in an increase in cellular uptakes of MIBI and tetorfosmin. Percentage increase of MIBI was higher than that of tetrofosmin with Vrp by 623% and 427%, CsA by 753% and 629% and BSO by 219% and 140%, respectively. There was no significant difference in tumoral uptakes of MIBI and tetrofosmin between Gr1 and Gr3. Percentage increases in MIBI (114% at 10 min, 257% at 60 min, 396% at 240 min) and tetrofosmin uptake (110% at 10 min, 205% at 60

  19. 99mTc-MIBI SPET in non-small cell lung cancer in relationship with Pgp and prognosis

    Higher technetium-99m methoxyisobutylisonitrile (MIBI) uptake in non-small cell lung cancer (NSCLC) has been reported to be associated with a positive response to chemotherapy. It has previously been found that in tumour cells, P-glycoprotein (Pgp) expression is of importance for tracer uptake. However, some studies have indicated that Pgp expression does not play an important role in 99mTc-MIBI uptake in NSCLC; indeed, a negative correlation between 99mTc-MIBI uptake and Pgp expression has been reported. Against the background of conflicting results, our aim was to evaluate the relationship between 99mTc-MIBI uptake, prognosis and Pgp expression in NSCLC. A total of 37 patients with NSCLC underwent 99mTc-MIBI single-photon emission tomography (SPET) before chemotherapy. In 19 patients both Pgp and p53 expression, and in two patients only p53 expression (due to the limited biopsy material), were measured with immunohistochemical staining. 99mTc-MIBI uptake was significantly higher in responders than in non-responders: 3.09±1.14 vs 2.24±0.88 (P99mTc-MIBI uptake tend to show a positive response to chemotherapy, and patients with ER and DR values above 3 have a significantly better prognosis. We also found that Pgp expression seems to play only a minor role in 99mTc-MIBI uptake. Our finding that patients with ER and DR values above 3 have a better prognosis needs to be confirmed in larger series of patients. (orig.)

  20. Dynamic coupling of 99mTc-MIBI efflux and apoptotic pathway activation in untreated breast cancer patients

    Our previous studies showed that the efflux rate of technetium-99m methoxyisobutylisonitrile (MIBI) is directly correlated to P-glycoprotein (Pgp) levels in breast carcinoma. The aim of this study was to test whether the Pgp-dependent efflux of 99mTc-MIBI is related to the apoptotic pathway activation in breast carcinoma. Thirty-three untreated non-consecutive patients were intravenously injected with 740 MBq 99mTc-MIBI and serial images were obtained up to 4 h. The rate of efflux was determined by mono-exponential fitting of decay-corrected time-activity curves. Tumour specimens were then obtained at surgery and processed for the determination of the apoptotic index by in situ end-labelling of DNA fragments (Tunel). The rate of tumour cell proliferation was also determined using Ki67 monoclonal antibody. All breast carcinomas showed focal uptake of 99mTc-MIBI and the time to half clearance varied between 85 and 574 min. The apoptotic index ranged between 0.3% and 4.2%, whereas the rate of proliferation varied between 13% and 40%. We found a positive and significant correlation between the apoptotic index and the rate of proliferation (r=0.79, P99mTc-MIBI was directly and significantly correlated with the apoptotic index (r=0.74, P99mTc-MIBI (r=0.57, P99mTc-MIBI sequestration, a model for the dynamic coupling of Pgp-dependent 99mTc-MIBI efflux and apoptotic pathway activation may be derived. (orig.)

  1. The Relation between Collateral Circulation and 99mTc-MIBI Heart SPECT

    The coronary collateral vessels have revealed their significance in terms of reduction of infarct size, preservation left ventricular function, and prevention of left ventricular aneurysm in patients with myocardial infarction. The purpose of this study were to evaluated the relation between collateral circulation and 99mTc-MIBI Heart SPECT in patient with acute myocardial infarction and their clinical significance. The fifty six MI patients with antegrade TIMI perfusion grade 0 and 1 were studied. The patients were classified into two groups; Group I included 30 patients with grade 2, 3 Collateral flow. Group II included 26 patients with grade 0, 1 Collateral flow. Collateral filling were graded from 0 to 3; 0- none, 1- Filling of side branch only, 2- Partial filling of the epicardial segment, 3- Complete filling of epicardial segment. Clinical variables, left ventricular function, 99mTc-MIBI Heart SPECT were analyzed with angiographic finding. Results were following: 1) Collateral visualization was found to be greater in patient with involvement of right coronary artery (RCA). The collateral development site of infarct related artery was RCA 15 cases, left anterior descending artery (LAD) 10 cases, left circumflex artery (LCX) 5 cases, and the collateral circulation from LAD to RCA was 13 cases (40.6%). 2) There was a tendency to be decreased in peak CK activity with group I . 3) The presence of good collateral channels was more frequently 99mTc-MIBI reversible perfusion defect (83.4% vs 15.3%, p99mTc-MlBI reversible perfusion defect.

  2. 99mTc-MIBI scintigraphy in metastatic renal cell carcinoma: clinical validation of the relationship between 99mTc-MIBI uptake and P-glycoprotein expression in tumour tissue

    Technetium-99m hexakis-2-methoxyisobutylisonitrile (MIBI) and thallium-201 imaging was performed in a patient with metastatic renal cell carcinoma (RCC), which is a well-known tumour type demonstrating P1-glycoprotein (PGP) overexpression. Two scintigraphic patterns - Tl(+)/MIBI(-) in primary tumour and Tl(+)/MIB(+) in metastatic tumour - were observed, suggesting high- and low-level PGP expression, respectively. Immunochemical study for PGP revealed strong staining of the primary tumour cells. This case clinically validates the previously suggested relationship between 99mTc-MIBI uptake and PGP expression. (orig.)

  3. Regional detection of cervical LN metastasis in head and neck cancer with Tc-99m MIBI SPECT

    In head and neck cancer, it is very important to detecting cervical LN metastasis for decision of staging. The aim of this study was to evaluate diagnositc value of Tc-99m MIBI SPECT for the detection of cervical LN metastasis in head and neck cancer. Tc-99m MIBI SPECT was preformed at 10 minutes after injection of 740 MBq of Tc-99m MIBI on 24 patients (21 males, 3 females, mean age=60.8yr) who were performed surgery of head and neck tumors with cervical LN dissection. All LN lesions were subdivided according to anatomical position (level I, IIa, IIb, III, IVa, IVb, V). We interpreted LN metastasis by the anatomical level. Among 238 cervical LN levels, metastatic lesions were 17 and negative lesions were 221. Tc-99m MIBI SPECT revealed 16 TP, 1 FN, 24 FP, and 197 TN. The sensitivity and specificity for head and neck cancer were 94.1% and 89.1%, respectively. In the accuracy of Tc-99m MIBI for the detection of each level LN metastasis, level IIb was 4 FP, level III was 5 FP, level IVa was 1 FP, level IVb was 2 FP, and level V was 12 FP and 1 FN. If level V was excluded, sensitivity and specificity were 100% and 93.7%, respectively. Our study revealed that Tc-99m MIBI SPECT was a very useful for the screening method of detection of cervical LN metastasis in head and neck cancer

  4. The role of 99mTc-MIBI SPECT-CT in reoperation therapy of persistent hyperparathyroidism patients

    Yin Lijie

    2015-01-01

    Full Text Available To compare the role of 99mTc-MIBI SPECT-CT image and US in reoperation of persistent secondary hyperparathyroidism patients. A total of 8 persistent secondary hyperparathyroidism patients underwent parathyroidectomy. The sensitivity and accuracy of US and 99mTc-MIBI images before operation were determined. 9 of 14 surgical resection tissues from 8 persistent secondary hyperparathyroidism patients were confirmed to parathyroid hyperplasia. The results showed that the sensitivities were 77.8% and 100%, respectively, for US and 99mTc-MIBI SPECT-CT images. And the accuracies of US and 99mTc-MIBI dual time planar image and SPECT-CT were 50%, 78.6%, respectively. There was significantly difference between two procedures (P=0.021. The superior and inferior localization of glands were both detected by the ultrasound and scintigraphy. Two ectopic parathyroidism nodules were found by 99mTc- MIBI SPECT-CT imaging, while US provided no consistent findings. There was no significantly difference between two procedures (P=0.3. Although two cases of them were not confirmed by pathology, the iPTH of them (800 and 1429 respectively were much higher than other four cases (<400 pg/ml. PTX is a safe and effective treatment for the patients with persistent SHPT. 99mTc-MIBI planar and SPECT-CT imaging may provide more helps for clinician’s localization the hyperparathyroidism glands accurately.

  5. Miocárdio viável pela tomografia computadorizada com Tc-99m (MIBI sensibilizada por nitroglicerina endovenosa Viable myocardium scintigraphy with intravenous nitroglycerine by computed tomography with Tc-99m (MIBI

    José Ramos Filho

    2008-09-01

    Full Text Available FUNDAMENTO: A seleção de pacientes com doença coronariana crônica para recanalização baseia-se na detecção do miocárdio comprometido, potencialmente viável. OBJETIVO: Avaliar o miocárdio isquêmico, potencialmente viável pelo SPECT com MIBI sensibilizado por nitroglicerina em dose máxima tolerada. MÉTODOS: Investigamos de forma prospectiva, de abril de 2004 a novembro de 2005, pela tomografia computadorizada por emissão de fóton único SPECT com Tc-99m (MIBI, 40 pacientes (média etária 62 ± 8,9 anos, 30 homens com obstrtução coronariana demonstrada angiograficamente, e a cintilografia miocárdica foi realizada em repouso e com nitroglicerina endovenosa (EV, iniciando com a dose (1 µg/kg/min e incremento a cada minuto, até a queda da pressão arterial sistólica em 20 mmHg. A redução da perfusão dos segmentos foi classificada em moderada e severa, e comparada depois da nitroglicerina. Analisamos as variáveis angiográficas, hemodinâmicas e de perfusão miocárdica. RESULTADOS: Analisamos 680 segmentos miocárdicos em repouso: 538 com distribuição homogênea e 142 com hipoperfusão (54 com redução moderada e 88 severa. Depois da nitroglicerina, ocorreu aumento da perfusão em 19 (47,5% de 40 pacientes. Tornaram-se viáveis 55 de 142 segmentos: 33 (61,1% com redução moderada e 22 (25% com redução severa, ambos apresentaram aumento significativo da distribuição do radiofármaco (p BACKGROUND: The selection of patients with chronic coronary disease for recanalization is based on the detection of the affected myocardium that is potentially viable. OBJECTIVE: To evaluate the potentially viable ischemic myocardium through single photon emission computed tomography (SPECT with MIBI after a maximum tolerated dose of I.V. nitroglycerin. METHODS: We prospectively investigated by SPECT with Tc-99m (MIBI, from April 2004 to November 2005, 40 patients (mean age: 62 ± 8.9 yrs, 30 men with coronary obstruction demonstrated

  6. A comparative study of 99mTc-HL91 and 99mTc-MIBI imaging in experimental tumor and inflammatory models

    Aim: 99mTc-HL91 is a newly developed hypoxic imaging agent for ischemic myocardium and tumor imaging. 99mTc-MIBI is one of imaging agent for mammary tumor imaging. The aim of this experiment is to evaluate the diagnostic value of 99mTc-HL91 in detection of solid tumor in experimental tumor and inflammatory models, via comparative study with 99mTc-MIBI. Material and Methods: HL91 kits was provided by China Nine Star Co. Three kinds of bearing solid neoplasm mice groups (bearing Ehrlich carcinoma mice, bearing H22 carcinoma mice and bearing human ovarian COC1 neoplasm nude mice) and two inflammatory model groups (chemical and bacterial inflammation) underwent static whole body planar images at 1 and 4 hours post injection of 99mTc-HL91. Two kinds of bearing neoplasm mice groups (bearing Ehrlich carcinoma mice, bearing H22 carcinoma mice) and two inflammatory model groups (chemical and bacterial inflammation) underwent static planar images post injection of 99mTc-MIBI, at early phase (10∼20 minutes) and delayed phase (2 hrs). All of mice were sacrificed at 4 hrs. The tumors, or inflammatory lesions, blood and contralateral muscles were removed, weighed and the radioactivity was measured. Regions of interesting (ROIs) were drawn around tumor, inflammatory lesions and contralateral muscles in planar images, and the radioactivity ratios of target (tumor or inflammatory lesions)-to-blood (T/B), target-to-non target (contralateral muscles) i. e. T/NT was calculated. Results: Neoplasm can be clearly visible in planar images at 1hr and 4 hrs post injection of 99mTc-HL91 in all tumor models. At same time inflammatory lesions cannot be seen clearly. Neoplasm can be seen in delayed phase in 99mTc-MIBI groups, but not easy to distinguish them from inflammation. Conclusion: Compared with 99mTc-MIBI imaging, 99mTc-HL91 has much more diagnostic value in detection of solid neoplasm, and can distinguish neoplasm from inflammation

  7. Diagnostic accuracy of Tc-99m MIBI scintimammography in breast cancer

    For the characterization of breast mass, the results of Tc-99m MIBI scintimmamography were much varied between studies. This may result from various factors including tumor size, experience of observer and expression of MDR gene, So, we evaluated the influence of tumor size, knowledge of clinical information, experience of observer and expression of Pgp53 gene on the accuracy of MIBI scintimmamography for the characterization of breast mass. MIBI scintimmamography was prospectively performed in 44 patients with breast masses before surgical resection. The anterior and both lateral prone chest images were acquired at 5 min and 3 hour after injection of 740 MBq of Tc-99m MIBI. Two independent observers reviewed the images for characterization of breast mass without any clinical information. Then the images were reviewed with knowledge of clinical information including tumor size and location. If lesions proved to be malignant, presence of Pgp53 was evaluated by immunohistochemical staining. The comparisons of intraobserver/interobserver diagnostic accuracy and variance were performed by chi-square test and kappa test, respectively. The 54.4% of all lesions (24/44) were malignant. The sensitive, specificity and accuracy of scintimmamography were 73.3%, 82.8%, 79.5% and 73.3%, 84.5%, 80.7% with/without clinical information in observer A, and 76.7%, 86.2%, 83% and 70%, 89.7%, 83% with/without clinical information in observer B, respectively. There were no significant differences in sensitivity, specificity and accuracy between two observers or in same observer with/without clinical information. The agreement for the characterization of breast mass between the two observers was significantly excellent (κ=0.876/ κ=0.897 with/without clinical information, respectively). Intraobserver variance according to the knowledge of clinical information was also small ( κ=0.795 in observer A; κ=0.900 in observer B). Pgp53 was positive in 8 lesions. The sensitivities of

  8. Role of scintigammagraphy with 99mTc-Gluthatione and 99mTc-MIBI in the evaluation and staging of lymphoma

    Full text: The aim of this study was to assess the utility of scintigammagraphy using 99mTc-MIBI and 99mTc-Gluthatione for the evaluation and staging of patients with lymphomas. We studied thirty patients (age range 16-66 years) of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). A control group (CG) of 8 patients with negative histological results was also studied. The patients were divided in three groups; HD group: thirteen patients (7 males and 6 females); NHL: seventeen patients (10 males and 7 females); CG: eight patients (2 males and 6 females). Scintigammagraphy studies were performed 20 min and 2 h after intravenous administration of 925-1110 MBq of 99mTc-MIBI or 99mTc-Gluthatione (GSH) using a gamma camera (Sophy DS-7, Sopha Medical System, France) equipped with low energy all purpose parallel hole collimator. Anterior and posterior images of thorax, abdomen and pelvis in 128x128 pixels matrix each for 1 million counts per view were acquired. A 20% window centered on the 140 keV was used for all acquisitions. All images were processed and analysed on a workstation (Power Vision, SMV, Canada) and interpreted by three qualified and experienced nuclear medicine specialist. The final diagnosis was reached by consensus. The images with a focal abnormal intense uptake were considered positive. Images showing diffuse bilateral and symmetrical uptake, bilateral lung uptake and intestinal uptake were considered negative. The overall sensitivity, specificity and accuracy of results for both radiopharmaceuticals were calculated using the histological findings, x-ray, ultrasound and CT scanning as confirmation criterion as gold standard. The nodular sclerosis was the most frequent type in HD group. In this group twelve patients were positive with 99mTc-MIBI scintigammagraphy while one was negative (nodular sclerosis, grade II). Scintigammagraphy with 99mTc-GSH was positive in all patients in HD group. However, scintigammagraphy with both radiopharmaceuticals

  9. Evaluation of some ratio effects in 99mTc-MIBI imaging of breast tumors

    2001-01-01

    The effectiveness of using some ratios in 99mTc-MIBI imaging fbr the diagnosis of breast tumors was evaluated. After 100 patients with the breast tumor underwent 99mTc-MIBI imaging, the ratios of tunor to contralateral uptake (T/N). tumor to heart uptake (T/H), and tumor to sternum uptake (T/S) were obtained and then analysed about their reproducibility and values in differentiating benign breast lesion the from malignant tumor. To detect breast cancers, the sensitivity, specificit y and accuracy of T/N were 92%, 90% and 91%, respectively. However, those of T/S were 70% (p <0.01), 74% (p <0.05), 72% (p <0.01), and those of T/H were 74%(p <0.05). 76% (p >0.05). 75% (p <0.01). The average coefticients of variation(CV) of T/N, T/S and T/H were 9.439±9.712. 4.856+4.420 (p >0.05), and 3.736±3.489 (p <0.05). It was found that T/N had the best sensitivity, specificity and accuracy todetect the breast cancer, but its reproducibility is poor. On the other hand, T/H has better reproducibility.

  10. THE CLINICAL SIGNIFICANCE OF 99mTc-MIBI BREAST IMAGING IN THE DIAGNOSIS OF EARLY BREAST CANCER

    任长才; 金少津; 邹强; 朱汇庆; 王红鹰; 梁春立

    2001-01-01

    Objective: To find an effective, sensitive, specific and noninvasive diagnostic method of breast cancer. Methods: 109 masses of 102 patients with breast lesions smaller than 2 cm in diameter were divided into three groups to undergo 99mTc-MIBI imaging and compared with the results of pathology examination. 20 cases without breast lesions were selected as control. Abnormal condensation of 99mTc-MIBI in the breast reaching 10% higher than that in the counterpart of the healthy breast was regarded as positive. Results: Of 32 breast cancers, positive imaging appeared in 25. Negative imaging were found in 31 of 38 benign breast lesions. Of 39 occult breast lesions, positive imaging appeared in 6 and 3 of them were breast cancer, 2 of 3 patients with slightly increased 99mTc-MIBI imaging threshold were breast cancer also. No positive imaging was found in the control group. The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value of 99mTc-MIBI was 88.4%, 89.2%, 88.0%, 75.0% and 95.3%, respectively. Conclusion: 99mTc-MIBI imaging had higher sensitivity and accuracy in the diagnosis of breast cancer and differentiation between benign and malignant breast lesions. It could provide useful information for the diagnosis of clinically suspected breast cancer.

  11. Is Tc99m-MIBI scintigraphy a predictor of response to pre-operative neoadjuvant chemotherapy in Osteosarcoma?

    Vahidreza Dabbagh Kakhki

    2013-10-01

    Full Text Available Objectives: Multidrug resistance (MDR, which may be due to the over expression of P-glycoprotein (Pgp and/or MRP, is a major problem in neoadjuvant chemotherapy of osteosarcoma. The aim of this study was to investigate the role of Tc-99m MIBI scan for predicting the response to pre-operative chemotherapy. Materials and Methods: Twenty-five patients (12 males and 13 females, aged between 8 and 52y with osteosarcoma were studied. Before the chemotherapy, planar 99mTc-MIBI anterior and posterior images were obtained 10-min [tumor-to-background ratio: (T1/B110min] and 3-hr after tracer injection. After completion of chemotherapy, again 99mTc-MIBI scan was performed at 10-min after tracer injection. In addition to calculation of decay corrected tumor to background (T/B ratios ,  using the 10-min and 3-hr images of the pre-chemotherapy scintigraphy , percent wash-out rate (WR% of 99mTc-MIBI was calculated. Using the 10-min images of the pre- and post-chemotherapy scans, the percent reduction in uptake at the tumor site after treatment (Red% was also calculated. Then after surgical resection, tumor response was assessed by percentage of necrosis. Results: All patients showed significant 99mTc-MIBI uptake in early images. Only 9 patients showed good response to chemotherapy (necrosis≥90% while 16 patients were considered as non-responder (necrosis

  12. Preparation of 186 Re-MIBI Complex for Myocardial Perfusion Imaging as Potential Replacement of Analogues 99mTc-MIBI

    The aim of the present study is to label 2-methoxy isobutyl-isonitrile (MIBI) compound with pure 186 Re and study the optimum conditions to prepare the 186 Re-MIBI complex as a stable contrast agent for myocardial perfusion imaging. From the obtained data the complexation of MIBI with 186 Re was carried out of using 1 mg MIBI, 1 mg SnCl2, 3 mg gentesic acid and 1 ml 186 Re(37 MBq) at ph 2 in a boiling water bath for 30 min. The biodistribution studies in mice indicate that, the complex was cleared from the body by kidneys to urinary bladder and finally was eliminated from the body by urine. 186 Re-MIBI demonstrated satisfactory heart uptake and retention like 99mTc-MIBI (8.94% dose/organ at 5 minutes), blood clearance was fast, while liver activity decreased by time and negligible activity in the lunges. The obtained data showed that 186 Re-MIBI as a potential replacement of 99mTc-MIBI for myocardial perfusion imaging

  13. Relationship between the 99mTc-MIBI and expression of P-glycoprotein in lung cancer

    Objective: To correlate the imaging of 99mTc-MIBI with the expression of P-glycoprotein (PGP) in lung cancer. Methods: All patients, undergoing early (30 min) and delayed (3h) 99mTc-MIBI imaging before initiation of chemo-or radiotherapy, were diagnosed pathologically. Immunohistochemical studies were performed using a monoclonal antibody, P-170, developed against the internal epitope of PGP. Normal tissue and tumor washout rate and tumor-to-background ratio were correlated with the level of PGP expression. Results: There was an inverse correlation between tumor-to-background ratio and the density of PGP (P 0.1). Conclusion: The reduced ability for the tumors to accumulate MIBI correlates well with the increased levels of PGP expression, tumor washout rate of MIBI does not correlate with the density of PGP in tumor tissues

  14. Alternative chromatographic system for the quality control of lipophilic technetium-99m radiopharmaceuticals such as [99mTc(MIBI)6]+

    Knowledge of the radiochemical purity of radiopharmaceuticals is mandatory and can be evaluated by several methods and techniques. Planar chromatography is the technique normally employed in nuclear medicine since it is simple, rapid and usually of low cost. There is no standard system for the chromatographic technique, but price, separation efficiency and short time for execution must be considered. We have studied an alternative system using common chromatographic stationary phase and alcohol or alcohol:chloroform mixtures as the mobile phase, using the lipophilic radiopharmaceutical [99mTc(MIBI)6]+ as a model. Whatman 1 modified phase paper and absolute ethanol, Whatman 1 paper and methanol: chloroform (25:75), Whatman 3MM paper and ethanol:chloroform (25:75), and the more expensive ITLC-SG and 1-propanol: chloroform (10:90) were suitable systems for the direct determination of radiochemical purity of [99mTc(MIBI)6]+ since impurities such as 99mTc-reduced-hydrolyzed (RH), 99mTcO4- and [99mTc(cysteine)2]- complex were completely separated from the radiopharmaceutical, which moved toward the front of chromatographic systems while impurities were retained at the origin. The time required for analysis was 4 to 15 min, which is appropriate for nuclear medicine routines. (author)

  15. Alternative chromatographic system for the quality control of lipophilic technetium-99m radiopharmaceuticals such as [{sup 99m}Tc(MIBI){sub 6}]{sup +}

    Faria, D.P.; Buchpiguel, C.A.; Marques, F.L.N., E-mail: danielefaria1@gmail.com [Universidade de Sao Paulo (USP), Sao Paulo, SP (Brazil). Faculdade de Medicina. Departamento de Radiologia. Servico de Medicina Nuclear

    2015-10-15

    Knowledge of the radiochemical purity of radiopharmaceuticals is mandatory and can be evaluated by several methods and techniques. Planar chromatography is the technique normally employed in nuclear medicine since it is simple, rapid and usually of low cost. There is no standard system for the chromatographic technique, but price, separation efficiency and short time for execution must be considered. We have studied an alternative system using common chromatographic stationary phase and alcohol or alcohol:chloroform mixtures as the mobile phase, using the lipophilic radiopharmaceutical [{sup 99m}Tc(MIBI){sub 6}]{sup +} as a model. Whatman 1 modified phase paper and absolute ethanol, Whatman 1 paper and methanol: chloroform (25:75), Whatman 3MM paper and ethanol:chloroform (25:75), and the more expensive ITLC-SG and 1-propanol: chloroform (10:90) were suitable systems for the direct determination of radiochemical purity of [{sup 99m}Tc(MIBI){sub 6}]{sup +} since impurities such as {sup 99m}Tc-reduced-hydrolyzed (RH), {sup 99m}TcO4{sup -} and [{sup 99m}Tc(cysteine){sub 2}]{sup -} complex were completely separated from the radiopharmaceutical, which moved toward the front of chromatographic systems while impurities were retained at the origin. The time required for analysis was 4 to 15 min, which is appropriate for nuclear medicine routines. (author)

  16. Alternative chromatographic system for the quality control of lipophilic technetium-99m radiopharmaceuticals such as [99mTc(MIBI6]+

    D.P. Faria

    2015-01-01

    Full Text Available Knowledge of the radiochemical purity of radiopharmaceuticals is mandatory and can be evaluated by several methods and techniques. Planar chromatography is the technique normally employed in nuclear medicine since it is simple, rapid and usually of low cost. There is no standard system for the chromatographic technique, but price, separation efficiency and short time for execution must be considered. We have studied an alternative system using common chromatographic stationary phase and alcohol or alcohol:chloroform mixtures as the mobile phase, using the lipophilic radiopharmaceutical [99mTc(MIBI6]+ as a model. Whatman 1 modified phase paper and absolute ethanol, Whatman 1 paper and methanol:chloroform (25:75, Whatman 3MM paper and ethanol:chloroform (25:75, and the more expensive ITLC-SG and 1-propanol:chloroform (10:90 were suitable systems for the direct determination of radiochemical purity of [99mTc(MIBI6]+ since impurities such as 99mTc-reduced-hydrolyzed (RH, 99mTcO4 - and [99mTc(cysteine2]- complex were completely separated from the radiopharmaceutical, which moved toward the front of chromatographic systems while impurities were retained at the origin. The time required for analysis was 4 to 15 min, which is appropriate for nuclear medicine routines.

  17. Preoperative localization of parathyroid lesions. Value of {sup 99m}Tc-MIBI tomography and factors influencing detection

    Ansquer, C.; Carlier, T.; Kraeber-Bodere, F. [Hotel Dieu Univ. Hospital, Nantes (France). Nuclear Medicine Dept.; Mirallie, E. [Hotel Dieu Univ. Hospital, Nantes (France). Surgery Dept.; Abbey-Huguenin, H. [Rene Gauducheau Centre, Saint Herblain (France). Biostatistics Dept.; St Jacques Univ. Hospital, Nantes (France). PIMESP; Aubron, F. [Ultrasonography Centre, Nantes (France)

    2008-07-01

    The aim of our study was to assess retrospectively the value of {sup 99m}Tc-MIBI SPECT in the localization of parathyroid lesions in primary hyperparathyroidism and to determine the impact of PTH level, age, sex, characteristics of the lesions and thyroid nodules on the sensitivity of imaging. Patients, methods: Fifty nine patients who were cured after the resection of 60 lesions (50 adenomas, 9 hyperplasias and 1 carcinoma, 9 of them in ectopy) were selected. {sup 99m}TcO{sub 4}{sup -}, early and late {sup 99m}Tc-MIBI planar images (n=59), {sup 99m}Tc-MIBI SPECT (n=58) and ultrasound (n=50) performed preoperatively were analyzed. The imaging results were compared to surgical and histological findings and correlated to different factors suspected of influencing the imaging's sensitivity. Results: Sensitivity of double phase {sup 99m}Tc-MIBI/{sup 99m}TcO{sub 4}{sup -} scintigraphy was higher than that of early or late scintigraphy alone. SPECT increased the sensitivity of scintigraphy from 85% to 92% and was useful to confirm doubtful foci and to localize ectopic lesions. Ultrasound (US) had the lowest sensitivity (56%) and the highest rate of false-positive results (n=10), but identified 2 adenomas which were not detected by scintigraphy. Combining all imaging modalities, sensitivity reached 96%. Better sensitivities were observed when age <69 years, preoperative PTH level {>=}155 pg/ml, weight of the gland {>=}0.80 g and in the absence of thyroid nodules. US was more influenced by these factors than scintigraphy. Conclusion: Combination of US, double-phase {sup 99m}Tc-MIBI/{sup 99m}TcO{sub 4}{sup -} planar scintigraphy and SPECT is the most accurate method for the detection of parathyroid lesions and should be performed before minimally invasive surgery, especially when PTH level is low, in older patients and in cases of multinodular goiter. (orig.)

  18. Role of 99mTc-MIBI in evaluation of palpable breast lesions

    Full text: Breast carcinoma is the most frequently diagnosed malignancy in women with 41% of all new cases diagnosed in developing countries. Over 323,000 women in the developing countries were detected in 1990, leading to 140,000 deaths. The annual incidence of breast carcinoma among women in Pakistan accounts for 32% of all detected carcinomas and 18% of all cancer related deaths. Three years data (2000-2002) collected from Bahawalpur Institute of Nuclear Medicine and Oncology (BINO) indicated that 16.5% of the total patients were registered with carcinoma breast. To reduce the mortality associated with this disease, screening of asymptomatic women has been advocated to diagnose problems at an early stage, particularly by X-ray mammography on annual basis after the age of 50. The available imaging modalities like mammography and ultrasound lack the desired specificity to differentiate the malignant masses from benign ones; hence there is a need to search for more specific imaging tool and to save the patients from unnecessary biopsies. Technetium-99m labeled methoxy-isobutyl-isonitrile (99mTc-MIBI) is a well-known cardiac perfusion-imaging agent. After convincing reports from various parts of the world that it specifically accumulates in malignant breast masses, we carried out a study to evaluate the diagnostic performance of 99mTc-MIBI scintimammography in palpable breast lesions. Patients with palpable breast lesions were studied after obtaining informed written consent. The study was carried out as a prospective trial. A total of 42 patients with 45 palpable breast masses were included in this study. The median age was 44 years (range 19-84 years). Tc-99m-MIBI was injected in a dose of 740 MBq in dorsal pedal vein and if unsuccessful then in medial cubital vein on the opposite side of the breast, to be imaged for the lump. Planar 10 minutes images in prone lateral and in supine position with arms raised behind the head were acquired 10 minutes and 60-90 minute

  19. Non-visualized Thyroid Gland by Tc-{sup 99m} MIBI Scan with Normal Thyroid Scan

    Koca, Gokhan; Atilgan, Hasan Ikbal; Baskin, Aylin; Demirel, Koray; Korkmaz, Meliha [Ankara Training and Research Hospital, Ankara (Turkmenistan)

    2013-09-15

    We present the case of a 21-year-old man who was referred to us for parathyroid scintigraphy with high blood levels of intact parathormone and osteoporosis. Several methods and radiopharmaceuticals, e.g., Tc-99m MIBI and Tl-201 chloride/Tc-99m pertechnetate (Tl-201/TcPO{sup -4}) subtraction, are commonly used for this purpose. We present the case of a thyroid gland that demonstrates quite normal Tc-99m pertechnetate uptake, no accumulation of Tc-99m MIBI, and very low grade Tl-201 uptake. To the best of our knowledge, no similar case has been reported previously. A 21-year-old male with osteoporosis and growth-development retardation was referred for MIBI parathyroid scan because of high blood levels of intact parathormone and bone-specific alkaline-phosphatase, which were 219.4 (15-88 pg/ml) and 355 (21-58 U/L), respectively. In his Tc-99m pertechnetate (TcPO{sup -4}) pinhole scintigraphy, bilateral clearly visualized radioactivity accumulation in the thyroid gland was seen. In both early or late images of the Tc-99m MIBI parathyroid scan, the thyroid gland was not visualized. Therefore, a Tl-201/TcPO{sub -4} subtraction scan method was used. However, the Tl-201 accumulation level in the thyroid gland was not sufficient for the subtraction method. In his thyroid ultrasonography, the thyroid gland echo was homogenous, and there was neither any solid nor cystic lesion. The physical examination of his neck was normal. Other laboratory findings were all normal as follows. TSH: 3.03 (0.35-5.6 IU/mL), free T3: 3.66 (2.5-3.9 pg/mL), free T4: 0.90 (0.59-1.3 ng/dL), Anti-TPO:0.3 (0.40 IU/mL), Anti-TG-Ab: <2.2 (0-+u/L), TSH receptor Ab: 1.0 (0.14 U/L), osteocalcine: 9.13 (1.5-15 ng/dL), growth hormone: 1.3 (0.014-5.21), calcitonin:17 (0.150 ng/mL), sedimentation:6 (0.15 mm/h). There were no significant symptoms of acute or chronic thyroiditis. The cause for discordant uptake in the thyroid gland with T1-201 and Tc-99m MIBI scan could not be provided through clinical or

  20. Effect of multidrug resistance gene-1(mdr1) overexpression on in-vitro uptake of 99mTc-sestaMIBI in murine L1210 leukemia cells

    To determine whether 99mTc-MIBI is recognized by the multidrug resistant P-glycoprotein (Pgp), we have measured quantitatively 99mTc-MIBI uptake in cancer cells. The effects of various Pgp reversing agents on cellular 99mTc-MIBI uptake were also investigated in the presence of multidrug resistance gene-1 (mdr 1 gene) overexpression. We measured percentage uptake of 99mTc-MIBI at different incubation temperatures both in mdr1 positive and negative cells. The effects of verapamil, cyclosporin, and dipyridamole on cellular uptake of 99mTc-MIBI were also evaluated with or without overexpression of mdr1 gene in cultured murine leukemia L1210 cells. The mdr1 gene expressing cell lines were effectively induced in in vitro with continuous application of low-dose adriamycin or vincristine. Cellular uptake of 99mTc-MIBI was higher in mdr1 negative L1210 cells than those of mdr1 positive cells, and higher when incubated in 37 .deg. C than 4 .deg. C. In the presence of verapamil, cyclosporin or dipyridamole, 99mTc-MIBI uptake was increased upto 604% in mdr1 positive cells. Cellular uptake of 99mTc-MIBI is lower in leukemia cells over-expressing mdr1 gene, and MDR-reversing agents increase cellular uptake. These results suggest the 99mTc-MIBI can be used for characterizing Pgp expression and developing MDR-reversing agents in vitro

  1. Correlation between P-glycoprotein (P-gp) expression in parathyroid and Tc-99m MIBI parathyroid image findings

    Sun, S.-S.; Shiau, Y.-C.; Lin, C.-C.; Kao, Albert E-mail: albertkaotw@yahoo.com.tw; Lee, C.-C

    2001-11-01

    The major factor to influence localization of parathyroid adenomas is tumor size. P-glycoprotein (P-gp) expression in parathyroid adenomas has been considered to be an another possible factor to influence localization of parathyroid adenomas because false-negative studies have been reported with large tumors and true-positives reported with very small tumors in previous studies. The aim of this study was to characterize Tc-99m MIBI uptake and retention by parathyroid adenomas and to correlate this with cell surface expression of P-gp. Sixteen patients with parathyroid adenoma (larger than 1.5 gm) underwent dual-phase (10min and 2hr) Tc-99m MIBI parathyroid image immediately before parathyroid exploration. Tissues were obtained from normal and abnormal parathyroid glands and from the thyroid gland. Immunohistochemistry (IHC) was obtained with monoclonal antibodies to identify P-gp expression in all tissues. All of the 16 parathyroid adenomas and 32 normal control specimens (16 normal parathyroid and 16 normal thyroid specimens) were submitted for P-gp detection by IHC. The dual-phase Tc-99m MIBI parathyroid image accurately localized 14 parathyroid adenomas, but not the remaining 2 adenomas. The 14 parathyroid adenomas with significant Tc-99m MIBI uptake in delayed 2hr images revealed negative P-gp expression, but the 2 adenomas without significant Tc-99m MIBI uptake, as well as normal parathyroid and normal thyroid specimens, revealed positive P-gp expression when evaluated by IHC. Not only the size of parathyroid adenomas, but also significant P-gp expression limited the sensitivity of dual-phase Tc-99m MIBI parathyroid image to localize parathyroid adenomas before operation.

  2. 99mTc-MIBI SPECT in primary hyperparathyroidism. Influence of concomitant vitamin D deficiency for visualization of parathyroid adenomas

    Aim of the study was to analyse the influence of a concomitant vitamin D deficiency on the results of 99mTc-MIBI studies in patients (pts) with primary hyperparathyroidism (pHPT). Patients, methods: between January 1998 and May 2004, 71 pts with pHPT had undergone operation after a 99mTc-MIBI study of whom 54 pts (76%) had normal values of 25-OH-vitamin D3 and 17 pts (24%) had vitamin D deficiency. Results of a dual-phase 99mTc-MIBI protocol with SPECT were compared with histopathology. Results: in 54 pts with normal vitamin D values late SPECT images identified more lesions (n 51, sensitivity 91%) than early planar (n = 45, sensitivity 82%) or late planar images (n = 50, sensitivity 88%). In 17 pts with vitamin D deficiency late SPECT images identified more lesions (n = 13, sensitivity 72%) than early planar (n = 10, sensitivity 56%) or late planar images (n = 10, sensitivity 56%) too. In pts with vitamin D deficiency the sensitivity of a 99mTc-MIBI SPECT study was lower than in those with normal vitamin D status (72% vs. 91%) and dependent on the value for PTH. However, the results did not reach statistical significance: early planar: p = 0.1625; late planar: p = 0.0039; 99mTc-MIBI SPECT: p 0.1180. Conclusion: the likelihood of a pathological 99mTc-MIBI study being obtained in pts with pHPT is dependent on the parathyroid hormone level. However, a negative influence of a low vitamin D level on the scintigraphic detection rate of a parathyroid adenoma could not be proven which may be due to the low number of pts with vitamin D deficiency. (orig.)

  3. Labelling, biodistribution and compartmental analysis of N-acetylcysteine labelled with Tc-99m. Comparative investigation with with {sup 99m} Tc-MIBI in an in vivo tumoral model; Estudo de marcacao, biodistribuicao e analise compartimental da N-acetil cisteina marcada com Tc-99m. Investigacao comparativa com MIBI-{sup 99m}Tc em modelo tumoral in vivo

    Faintuch, Bluma Linkowski

    1997-07-01

    Labelling and biodistribution studies were done with two different ligands, respectively Methoxy isobutyl isonitrile (MIBI) and N-acetylcysteine (NAC), employing Tc-99m as a tracer. The main objective was to assess the pharmacokinetic properties of the second substance, aiming at its possible application in cancer diagnosis. To this purpose an in vivo investigation was done using healthy and tumor-bearing rats with experimental cancer. Images of tumor-bearing rats registered in a scintillation camera indicated that with {sup 99m} Tc-MIBI none of the two selected times was adequate for visualization of the cancer mass. In contrast, {sup 99m} Tc-NAC permitted clear identification of the humor, four hours after injection. The results have demonstrated that {sup 99m} Tc-NAC is a radiopharmaceutical with affinity for cancer tissue and promising for further investigation concerning imaging diagnosis of tumors. (author)

  4. Localization of parathyroid adenoma by echography and scintigraphy with 99mTc-MIBI: the influence of lesion's weight

    In the examination for pre-surgery localization of a primary hyperparathyroidism (HPT I), the size of parathyroid lesion constitutes the main factor limiting the diagnostic efficiency of different imaging techniques. We have tried to test this hypothesis by echography and scintigraphy with MIBI for the detection of unique adenomas. The study covered 16 patients explored pre-surgically by echography and scintigraphy with 99mTc-MIBI for a HPT I as referred to a unique cervical adenoma (reference = surgery + anatomical-pathological examination). The scintigraphy with MIBI is achieved and interpreted by the 'double phase' technique proposed by Taillefer with pin-hole acquisition of 15 and 120 minutes after injection of around 370 MBq of 99mTc-MIBI. The average weight of adenoma is 3180 mg (218 to 22000). The echography localizes correctly the adenoma in 8 cases, in a wrong position, in 2 cases and does not find images evoking abnormal parathyroid in 6 patients. The MIBI visualizes properly the adenoma in 15 cases and in an incorrect position, in 1 patient. A table is given presenting the echography and MIBI-scintigraphy sensitivities as a function of adenoma weights. In conclusion, in our study the MIBI appear to be more sensitive than the echography in localizing the parathyroid adenoma. The diagnostic value of the two examinations appears to be independent of its weight; however, the results should be confirmed on larger batches

  5. Contribution of MIBI 99mTc mammary scintigraphy in mammary cancer detection

    Recent publications indicate the interest in 99mTc - SESTA-MIBI in diagnosing mammary cancers. The goal of this paper was to study the feasibility of this method and define its place relative to the classical tripod: mammography, echography, cyto-puncture. The mammary scintigraphy is achieved, in condition ventral-decubitus at 10 minutes after the injection of 20 mCi of SESTA-MIBI, in 100 patients for which a surgery decision was made. Ten minute incidences from the left, right and front sides were achieved. A visual score ranging from G1 to G4 was established: G1 - no anomalous fixation; G2 - slight fixation of irregular shape; G3 - moderate well-defined fixation; G4 - intense circular fixation. The final diagnosis is given by histology. Results with the score ranging from G1 to G4 for five diagnosis types are given. By considering G3 and G4 as positive to biopsy the sensitivity found was 91.2%; the specificity, 62.8%; the positive predicting value, 76.4% and the VPN, 84.4%. Five falsely negative cancers correspond to micro-calcification sub-centimeter lesions. In conclusion, the contribution of the mammary scintigraphy consists in identification of positive MIBI lesions having a uncertain and/or ensuring ensuring and multi-focal lesions for the cases in which the tripod indicate a single lesion. Making evident these multi-focal lesions allows establishing a surgical operation scheme which will guide an enlarged extirpation

  6. Effect of P-glycoprotein and multidrug resistance associated protein gene expression on Tc-99m MIBI imaging in hepatocellular carcinoma

    P-glycoprotein (Pgp) and multidrug resistance-associated protein (MRP) expressions as well as Tc-99m methoxisobutylisonitrile (MIBI) images were assessed in 25 patients hepatocellular carcinoma (HCC). Tc-99m MIBI imaging was performed 10 minutes after intravenous injection of 20 mCi Tc-99m MIBI. Using immunohistochemical staining, 60% of the HCC lesions showed positive for Pgp and 64% showed positive for MRP. In 3 patients with MIBI uptake, immunohistochemical study of tumor tissue showed no Pgp stained cells. Nevertheless, they were all positive for MRP. The result of Tc-99m MIBI imaging is more related to the expression of Pgp than MRP gene. It is possible that other membrane transporters as well as Pgp and MRP are involved in the efflux of Tc-99m MIBI

  7. Interobserver Reproducibility of Segmental Scoring of 99mTc-MIBI Myocardial SPECT

    The accuracy of dipyridamole stress/rest 99mTc-MIBI myocardial imaging for detection of ischemia depends on reproducible image interpretation. To evaluate the reproducibility of visual assessment, agreement in interpretation among two independent observers, blinded to clinical data, was evaluated in SPECT images of 131 patients (94 males, 38 females, mean age 58 ±7 yr) with suspected coronary artery disease who underwent both dipyridamole stress/rest 99mTc-MIBI myocardial SPECT and coronary angiography, The left ventricle was divided into twenty-nine segments in stress and rest SPECT images and each segment was visually graded according to a five point scale (segmental score: O=normal, 1 =equivocal, 2=mild decrease, 3=severe decrease and 4=absent uptake). Overall concordance of segmental scoring between the two observers was 80%. The Pear- sons correlation coefficient (r) of the segmental scores for stress and rest images were 0.67 and 0.65, respectively, while the difference in score between the two images showed a correlation of 0.45 (all p<0.001). Agreement between two observers in final SPECT diagnosis as absence or presence of disease was 93%. The degree of agreement in segmental scoring showed no difference between patients with or without agreement as to the presence of disease. Therefore it appeared that cases with inconcordant diagnosis between the 2 observers were mainly due to a difference in individual threshold for interpretating the significance of a particular decreased uptake area rather than to a difference in perceiving the degree of the hypoactivity. Thus, establishment of individual optimum thresholds in visual interpretation of myocardial SPECT may be helpful to improve reproducibility and accuracy of scan diagnosis.

  8. Non-Q-wave myocardial infarction: impaired myocardial energy metabolism in regions with reduced 99mTc-MIBI accumulation

    Reduced regional technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) accumulation in patients with chronic non-Q-wave infarction (NQWI) but without significant coronary artery stenosis indicates non-transmural damage of the myocardial wall. The aim of this study was to characterise cardiac energy metabolism after NQWI using phosphorus-31 magnetic resonance spectroscopy (31P-MRS) and to compare the biochemical remodelling with changes in regional 99mTc-MIBI uptake and with morphological and functional parameters assessed by magnetic resonance imaging (MRI). Fifteen patients with a history of NQWI, exclusion of significant coronary artery stenosis (31P-MRS to study the effects of NQWI on myocardial energy metabolism. Spectroscopic measurements were performed in the infarct-related myocardial region. Corresponding gradient-echo MR images and myocardial 99mTc-MIBI single-photon emission tomography images were acquired for exact localisation of the infarct region. All examinations were performed at rest under anti-ischaemic medication. Data were compared with those of patients in whom coronary artery disease had been excluded by angiography (group B, n=10). All patients of group A displayed anterior wall hypokinesia in the infarcted area on both ventriculography and MRI, with a reduced myocardial accumulation of 99mTc-MIBI (66.3%±11.8% vs 95.6%±2.2% in group B). The mean wall thickness during the complete cardiac cycle (9.5±1.8 mm vs 13.1±1.1 mm in group B, P99mTc-MIBI displays a reduced PCr/ATP ratio. Our results indicate that morphological remodelling after NQWI is accompanied by fundamental changes in cardiac energy metabolism. (orig.)

  9. Absorbed radiation to the nuclear medicine nurses from patients administered 201Tl and 99mTc- MIBI

    People who have administrated radiopharmaceuticals could be a source of radiation to their relatives, medical nurses, and people who have contact them. In this study, the dose rates at various distances of 5, 10,50 and 100 cm from 70 patients, who were administered diagnostic amounts of 201Tl -Chloride and 99mTc -MIBI, was measured using an ionization chamber. For determination of external radiation dose to the nurses the radiations in three deferent interval times have measured. The maximum values of external dose rates of 201Tl and 99mTc-MIBI were 11.2μSv/h ±2.3 and 43.1μSv/h ±11.9 respectively at 5 cm from the patients. Significant exposure from patients after injection of 99mTc -MIBI was limited on the day of administration. Departure doses rate of 201Tl fell gradually so by 3 days after administration was significant. Maximum and average absorbed dose of nuclear medicine staff for one 201Tl scan was 4.6 and 2.7μSv/h, and for 99mTc-MIBI was 18.1 and 9.8μSv/h in a working day. (author)

  10. Absorbed radiation to the nuclear medicine nurses from patients administered 201Tl and 99mTc- MIBI

    People who have administrated radiopharmaceuticals could be a source of radiation to their relatives, medical nurses, and people who have contact them. In this study, the dose rates at various distances of 5, 10,50 and 100cm from 70 patients, who were administered diagnostic amounts of 201Tl-Chloride and 99mTc-MIBI, was measured using an ionization chamber. For determination of external radiation dose to the nurses the radiations in three deferent interval times have measured. The maximum values of external dose rates of 201Tl and 99mTc- MIBI were 11.2μSv/h ±2.3 and 43.1μSv/h ±11.9 respectively at 5cm from the patients. Significant exposure from patients after injection of 99mTc-MIBI was limited on the day of administration. Departure doses rate of 201Tl fell gradually so by 3 days after administration was significant. Maximum and average absorbed dose of nuclear medicine staff for one 201Tl scan was 4.6 and 2.7μSv/h, and for 99mTc-MIBI was 18.1 and 9.8μSv/h in a working day. (author)

  11. Parathyroid glands: combination of (99m) Tc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules

    Colagrande, S; C. Biagini; BISI, G; L.Vaggelli; D. Borrelli; P. Cicchi; TONELLI, F; Amorosi, A; M.Serio; De Feo, M.L; Brandi, M.L.

    2000-01-01

    PURPOSE: To determine the appropriate choice of imaging techniques for localization of nodular lesions of parathyroid glands. MATERIALS AND METHODS: First, computed tomographic (CT), magnetic resonance (MR), ultrasonographic (US), and technetium 99m methoxyisobutyl-isonitrile (MIBI) scintigraphic images in 49 patients with primary hyperparathyroidism were retrospectively evaluated. A single-blind, prospective study that included 16 patients with primary hyperparathyroidism was then condu...

  12. {sup 99m}Tc-MIBI pinhole SPECT in primary hyperparathyroidism: comparison with conventional SPECT, planar scintigraphy and ultrasonography

    Carlier, Thomas; Bodet-Milin, Caroline; Kraeber-Bodere, Francoise; Ansquer, Catherine [Hotel Dieu University Hospital, Nuclear Medicine Department, Nantes (France); INSERM CRCNA, Nantes (France); Oudoux, Aurore [Hotel Dieu University Hospital, Nuclear Medicine Department, Nantes (France); Mirallie, Eric [Hotel Dieu University Hospital, Surgery Department, Nantes (France); Seret, Alain [University of Liege, Institute of Physics, Experimental Medical Imaging, Liege (Belgium); Daumy, Isabelle [Ultrasonography Center, Nantes (France); Leux, Christophe [Saint Jacques University Hospital, PIMESP, Nantes (France)

    2008-03-15

    A pinhole collimator is routinely used to increase the resolution of scintigraphy. This prospective study was conducted to determine the interest of {sup 99m}Tc-MIBI pinhole single-photon emission computed tomography (SPECT) for the preoperative localisation of parathyroid lesions in primary hyperparathyroidism. All patients underwent a neck ultrasonography (US), {sup 99m}TcO{sub 4}{sup -} and {sup 99m}Tc-MIBI planar images and two consecutive SPECT with a parallel (C-SPECT) and a pinhole collimator (P-SPECT). P-SPECT was performed with a tilted detector equipped with a pinhole collimator and reconstructed with a dedicated OSEM algorithm. A diagnostic confidence score (CS) was assigned to each procedure considering intensity and extra-thyroidal location of suspected lesions: 0 = negative, 1 = doubtful, 2 = moderately positive, 3 = positive. The results of these preoperative localisation studies were compared with surgical, pathological and 6-month biological findings. Fifty-one patients cured after surgery were included. Surgery revealed 55 lesions (median weight 0.5 g, 11 in ectopy). Sensitivities of US, planar imaging, C-SPECT and P-SPECT were, respectively, 51, 76, 82 and 87%. Nine glands were only detected by tomography and five glands only by P-SPECT. {sup 99m}Tc-MIBI/{sup 99m}TcO{sub 4}{sup -} planar scans and P-SPECT were complementary and, when combined together, showed the highest sensitivity (93%). Compared with planar imaging and C-SPECT, P-SPECT increased CS for 42 and 53% of lesions, respectively, and contributed to markedly reduce the number of uncertain results. A combination of planar {sup 99m}Tc-MIBI/{sup 99m}TcO{sub 4}{sup -} scintigraphy and P-SPECT appears to be a highly accurate preoperative imaging procedure in primary hyperparathyroidism. (orig.)

  13. Combined Use of Tc-99m MIBI Scan and MRI for Evaluation of Active Lesions in Multiple Myeloma

    Full text: Multiple Myeloma is a malignancy of plasma cells, in which neoplastic bone involvement is one of the leading symptoms. Many researchers have been trying to develop new imaging modalities and new methods for detecting the bone involvement, mainly because apart from the fact that bone marrow infiltration is one of the diagnostic criteria, typical radiographic findings can be found only in 60 70% of pts with first diagnosis of MM, and 10% of pts can present only osteoporosis-like changes. Purpose To evaluate the efficacy of 99mTc-MIBI whole-body scan in diagnosis of Multiple Myeloma, in correlation with other imaging modalities, and mainly with MRI. Material and Method: We performed a retrospective review of 29 cases of Multiple Myeloma Patients, all of them in active stage of the disease. All of them underwent 99mTc-MIBI whole body scan, MRI examination of the spine and a bone scan. Diagnosis and staging of the disease was made by using standard criteria. MRI was performed mainly for imaging spinal cord compression and for morphological characterization of lesions. We obtained saggital and transverse images which included T1-weighted spin-echo, T2-weighted turbo spin-echo and STIR sequences. We performed whole body MIBI scan in anterior and posterior views, 10 - 20 min after IV injection of 500-550 MBq of 99mTc-MIBI, using a dual head gamma-camera Philips- Axis. Results: We obtained pathologic changes in 25/29 pts that underwent whole-body MIBI scan(86.75%), and in 27/29(89.65%) for the MRI. Bone scan shown pathologic uptake of radiotracer in 18/29 pts(62.06%). In 4 pts that demonstrated pathologic increased uptake of MIBI we found photopenic lesions on the bone scan which were missed at the first interpretation of the bone scan; these lesions were reported only after comparative evaluation of bone scan and MIBI scan.We found three different patterns of pathologic MIBI uptake: focal increased uptake of MIBI in different sites (9 pts), diffuse increased

  14. Multiple myeloma: predictive value of Tc-99m MIBI scintigraphy and MRI in its diagnosis and therapy

    We assessed the validity of 99mTc-MIBI scintigraphy and MRI in the diagnosis and prediction of the effect of therapy in patients with multiple myeloma (MM) and monoclonal gammopathy of unknown significance (MGUS), in whom both examinations were performed within 14 days. Forty-seven consecutive patients with MM and 5 with MGUS were enrolled in the study. Out of 47 MM patients, 6 were in Durie-Salmon stage I and 41 had active disease in stage II or III. Fifteen patients were examined before and within 2 months of intensive chemotherapy. Anterior and posterior whole-body scans were obtained 10 min after IV administration of 740 MBq (20 mCi) 99mTc-MIBI. MRI of Th and LS spine, T1 w.i. and STIR in the sagittal plane were performed. Bone marrow pathological changes in 41 MM patients with active disease were detected in 39 (95%) scintigraphic examinations and in 38 (94%) of MRI. Among 41 MM patients with active disease, 21 showed diffuse patterns of 99mTc-MIBI uptake, 8 showed focal patterns and 10 showed both focal and diffuse patterns, while 34 patients exhibited focal lesions in MRI and 4 both focal and diffuse findings. Moreover, 5 of 38 patients had epidural mass and 18 had vertebrae compression. Out of 15 patients after therapy, 13 reached complete remission and 2 had stable disease. Normal 99mTc-MIBI scintigraphy was found in 11 (85%) patients with complete remission, 2 presented both focal and diffuse patterns of 99mTc-MIBI uptake. Two patients with stable disease also had focal and diffuse radiotracer uptake. MRI findings were normal only in 3 (23%) patients in complete remission. Eight patients exhibited focal lesions and 2 showed partial conversion in MRI. 99mTc-MIBI scintigraphy and MRI are methods of equal sensitivity in detecting active MM and complement each other. The advantage of 99mTc-MIBI scintigraphy is the possibility of whole body examination, which allows superiority in detection of MM in appendicular skeleton and extramedular lesions, and faster

  15. Contribution of the Technetium-99m-sestamibi (MIBI) scintigraphy in primary hyperparathyroidism to determination of parathyroidectomy

    Nishida, Takuro; Hayakawa, Katsumi; Nishimura, Kazumasa; Kawakami, Satoshi; Sakamoto, Makoto; Koh, Toshikiyo; Hida, Shuichi [Kyoto City Hospital (Japan)

    1999-02-01

    We reviewed retrospectively the 12 patients who underwent parathyroidectomy because of hyperparathyroidism and judged to what degree the Technetium-99m-sestamibi (MIBI) scintigraphy contributed to determination of parathyroidectomy. From the view point that weather parathyroidectomy could be decided without the MIBI scintigraphy, we classified the cases into three groups; great, fair, and poor contribution. We judged 4 cases as great contribution, 5 cases as fair contribution and 3 cases as poor contribution. We concluded that if the MIBI scintigraphy is positive in patients with primary hyperparathyroidism, parathyroidectomy is strongly recommended, because of its high sensitivity and accuracy for detection of parathyroid adenomas and because there were no false-positive cases with the MIBI scintigraphy. (author)

  16. 99mTc-(V)DMSA scintimammography in the assessment of breast lesions: comparative study with 99mTc-MIBI

    The purpose of this study was to evaluate and compare the diagnostic accuracy of pentavalent technetium-99m dimercaptosuccinic acid [99mTc-(V)DMSA] and 99mTc-methoxyisobutylisonitrile (MIBI) in the detection of primary breast cancer and metastatic lymph node involvement, and in the clarification of cases with indeterminate mammograms. Forty-one women (mean age±SD 55±7 years) referred for a suspicious breast lesion on physical examination and/or an abnormal mammogram underwent MIBI and (V)DMSA scintimammography (SMM) at separate sessions (48-h interval). Lateral prone and anterior supine images were obtained at 10 and 60 min after administration of 740-925 MBq of each tracer, in the arm contralateral to the breast lesion. The ipsilateral axillary region was also included in the field of view. The results of SMM and mammography were compared with histological findings. Breast cancer was histologically confirmed in 26 patients (mean diameter±SD 2.87±1.5 cm). Benign lesions were found in 15 patients (mean diameter±SD 2.04±2.7 cm). Mammography was definitely positive in 23/26 patients with breast cancer and indeterminate in 3/26 (sensitivity 88.4%). In benign lesions, mammography was true negative in 5/15 cases and indeterminate in 10/15 (specificity 33.3%). Both MIBI and (V)DMSA SMM detected 23/26 breast cancers (sensitivity 88.4%) and were true negative in 14/15 (specificity 93.3%). T/B ratios for breast cancer in MIBI and (V)DMSA scans were similar, and significantly higher than for benign lesions. MIBI correctly diagnosed 12/13 and (V)DMSA 11/13 cases in which the findings of mammography were indeterminate. In addition, (V)DMSA detected seven of eight cases of in situ ductal carcinoma (DCIS) associated with infiltrating carcinomas, while MIBI detected only two of these eight cases. (V)DSMA was also diffusely concentrated in benign lesions complicated by epithelial hyperplasia. Metastatic lymph node involvement was successfully imaged in 15/19 patients with

  17. 99mTc-MIBI Washout Rate to Evaluate the Effects of Steroid Therapy in Cardiac Sarcoidosis

    Shin-ichiro Morimoto

    2013-10-01

    Full Text Available Introduction: We sought to determine the usefulness of the 99mTc-MIBI (MIBI washout rate for the evaluation of steroid therapy in cardiac sarcoidosis (CS. Methods: Eleven CS patients underwent MIBI myocardial SPECT both before and 6 months after initiating steroid therapy. The washout rate (WOR of MIBI was calculated using early and delayed polar map images. The washout score (WOS of MIBI was derived from the difference between the early and delayed total defect scores (TDS. Results: Serum ACE and BNP exhibited significant improvement after the therapy (p = 0.004, p = 0.045. In the LV function, EDV and E/A ratio exhibited significant improvement after the therapy (p = 0.041, p = 0.007, while there were no significant differences between before and after therapy in EF or ESV. Early and delayed TDS showed no significant differences between before and after the therapy. In contrast, WOR differed significantly (p < .0001, while WOS did not differ significantly between before and after the therapy.Conclusion: The washout rate of MIBI is suitable for assessment of cardiac function in CS with steroid therapy, being especially better than the washout score of MIBI for assessment of disease activity of mild myocardial damage in CS with steroid therapy.

  18. 99mTc-MIBI Washout Rate to Evaluate the Effects of Steroid Therapy in Cardiac Sarcoidosis

    Masayoshi Sarai

    2013-10-01

    Full Text Available Objective: We sought to determine the usefulness of the 99mTc-MIBI (MIBI washout rate for the evaluation of steroid therapy in cardiac sarcoidosis (CS. Methods: Eleven CS patients underwent MIBI myocardial SPECT both before and 6 months after initiating steroid therapy. The washout rate (WOR of MIBI was calculated using early and delayed polar map images. The washout score (WOS of MIBI was derived from the difference between the early and delayed total defect scores (TDS. Results: Serum ACE and BNP exhibited significant improvement after the therapy (p = 0.004, p = 0.045. In the LV function, EDV and E/A ratio exhibited significant improvement after the therapy (p = 0.041, p = 0.007, while there were no significant differences between before and after therapy in EF or ESV. Early and delayed TDS showed no significant differences between before and after the therapy. In contrast, WOR differed significantly (p < .0001, while WOS did not differ significantly between before and after the therapy.Conclusion: The washout rate of MIBI is suitable for assessment of cardiac function in CS with steroid therapy, being especially better than the washout score of MIBI for assessment of disease activity of mild myocardial damage in CS with steroid therapy.

  19. A comparative study on thallium-201 and technetium-99m-MIBI, urinary excretion and external radiation dose

    Thallium Chloride and technetium-metoxy isobutyl isonitril (MIBI) are the most frequently used in Iran. The aim of this work was to study the kinetic and dosimetric characteristics of the above-mentioned radiopharmaceuticals produced at the cyclotron department of Nuclear Research Center for Agriculture and Medicine (NRCAM), In order to compare our results with others. The dose rates at various distances of 5, 10, 50 and 100cm from 70 patients, who were administered diagnostic amounts of 201Tl-Chloride and 99mTc-MIBI, was measured using an ionization chamber. The measurements were taken at three different time intervals, 0.5 hour, 3 hours and 5 hours after injection. In order to assess the excretion of activity, the urine from 16 patients was collected for the period of 24 hours after administration. Eight patients had received 201Tl-chloride and the rest 99mTc-MIBI. The period of urine collection was therefore limited 2 to 4 hours. The maximum values of external dose rates of 201Tl and 99mTc-MIBI were 11.2 μSv/h ±2.3 and 43.1μSv/h ±11.9 respectively at 5cm from the patients. Significant exposure from patients after injection of 99mTc-MIBI was limited on the day of administration. Departure dose rate of 201 Tl fell gradually so by 3 days after administration was significant. All excreted urine was also collected from 16 patients for the 24 days after administration. The urinary excretion rate of 201Tl was slow; about 2% of the activity within 24h after injection. The urinary excretion of 99mTc-MIBI was rapid, and large amount of activity was excreted in a few hours after injection; 22% within 20h after injection. According to this study for 99mTc-MIBI Cardiac investigations significant exposure from the patients are limited to the few hours after administration. In case of administration 201Tl the dose rates from the patients continues to decrease until three days after injection. Consideration of protection for carers is need during these days. These data

  20. Effect of verapamil on cellular uptake of Tc-99m MIBI and tetrofosmin on several cancer cells

    Kim, Dae Hyun; Yoo, Jung Ah; Bae, Jin Ho; Jeong, Shin Young; Suh, Myung Rang; Ahn, Byeong Cheol; Lee, Kyu Bo; Lee, Jae Tae [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    2004-02-01

    Cellular uptake of {sup 99}mTc-sestamibi (MIBI) and {sup 99}mTc-tetrofosmin (TF) is low in cancer cells expressing multidrug resistance(MDR) by p-glycoprotein(Pgp) or multidrug related protein(MRP). Verapamil is known to increase cellular uptake of MIBI in MDR cancer cells, but is recently reported to have different effects on tracer uptake in certain cancer cells. This study was prepared to evaluate effects of verapamil on cellular uptake of MIBI and TF in several cancer cells. Cellular uptakes of Tc-99m MIBI and TF were measured in erythroleukemia K562 cell, breast cancer MCF7 cell, and human ovarian cancer SK-OV-3 cells, and data were compared with those of doxorubicin-resistant K562(Ad) cells. RT-PCR and Western blot analysis were used for the detection of mdr1 mRNA and Pgp expression, and to observe changes in isotypes of PKC enzyme. Effects of verapamil on MIBI and TF uptake were evaluated at different concentrations upto 200 {mu}M at 1*10{sup 6} cells/{sup m}l at 37.deg.C. Radioactivity in supernatant and pellet was measured with gamma counter to calculate cellular uptake ratio. Toxicity of verapamil was measured with MTT assay. Cellular uptakes of MIBI and TF were increased by time in four cancer cells studied. Co-incubation with verapamil resulted in an increase in uptake of MIBI and TF in K562(Adr) cell at a concentration of 100 {mu}M and the maximal increase at 50 {mu}M was 10-times to baseline. In contrast, uptakes of MIBI and TF in K562, MCF7m SK-OV3 cells were decreased with verapamil treatment at a concentration over 1 {mu}M. With a concentration of 200 {mu}M verapamil, respectively. Cellular uptakes of MIBI and TF in MCF7 and SK-OV-3 cells were not changed with 10{mu}M, but were also decreased with verapamil higher than 10{mu}M, resulting 40% and 5% of baseline at 50 {mu}M. MTT assay of four cells revealed that K562, MCF7, SK-OV3 were not damaged with verapamil at 200 {mu}M. Although verapamil increases uptake of MIBI and TF in MDR cancer cells

  1. The role of 99m-Tc-MIBI in diagnosis of breast cancer

    Mammography is the diagnosing method with the greatest usefulness in screening and diagnosis of breast cancer, but it has a low positive predictive value (p pv: 10-40%) . for enhancing the p pv of mammography a complementary diagnostic procedure id needed. Scintimammography (SMM) is a new, non- invasive method of imaging breast tumors which in various studies the overall sensitivity of 83-95. 5% and specificity of 52%-95%, in diagnosis of breast cancer is reported. The purpose of our study was to evaluate the usefulness of 99m Tc-MIBI SMM in our environment in detecting breast cancer and in reducing the rate of biopsy. 65 patients aged 23-70 years from Sep 2000 through Jan 2002 included in our study. Each patient had a physical examination by a breast surgeon in Motahari Clinic and each had mammography using a standard two view technique. Study entry criteria consisted of either a lesion found in mammography and or a mass palpated on physical examination that required biopsy or FNA cytology. All these patients had standard 99m Tc-MIBI SMM in Nuclear Medicine Department of Nemazee Hospital and reported by a nuclear medicine physician who were blinded to the clinical status, physical examination, x-ray mammogram and histopathologic results. Then the sensitivity and specificity of SMM were evaluated by SPSS and FPI INFO program considering the results of biopsy or those who refused biopsy or within deep seated lesion, the results of follow-up mammograms after 6 month, as gold standard. The sensitivity and specificity of SMM were 84/6% and 71/8% respectively the PPV was 66/6% and NPV was 87/5%. Which were the same as previously reported. SMM did not increase the specificity and PPV of mammography which were 71% and 64% respectively. The most important role for SMM is in category 3 (probably begin) and category 4(suggestive for malignancy) groups of mammograms. The NPV is 58% and 90/9% in these groups respectively so it could reduce the rate of biopsy. In lesions less

  2. Myocardial scintigraphy using 99m-Tc-methoxyisobutylisonitrile (Tc-MIBI): A full substitution of 201-Tl?

    The results of selective coronary angiography, myocardial 201-Tl scintigraphy (stress and redistribution) and after 99m-Tc-methoxyisobutylisonitrile stress and rest injections (Tc-MIBI, Cardiolite, DuPont de Nemours, USA) were compared in 19 patients with manifest ischemic heart disease in identical three projections and after same ergometric load. 16 patients had significant stenoses of 1-3 main coronary arteries inclusive of left coronary artery main stem, insignificant stenoses (<50%) were present in the remaining 3 patients. Scintigraphic localizations of accumulation defects in both Tc-MIBI and 201-Tl stress scintigraphy were in agreement in 70.6% of evaluated left ventricular wall segments. A positive 201-Tl redistribution and rest-stress Tc-MIBI scintigraphic difference agreed in 52.6% of images of all three projections with verified accumulation defects. The sensitivity of ischemic area detection in reference to coronary angiography was nearly identical in 201-Tl (75%) and Tc-MIBI scintigraphy (81.2%). Better physical properties of 99m-Tc from the point of view of a gamma camera detection, a possibility to get markedly higher counting rate and sufficient accumulation of the radiopharmaceutical in the perfused myocardium enable to reach scintigraphic pictures with a high contrast after labelled Tc-MIBI injection, even in case of sequential impulse summation during heart cycle (gating). (author) 1 tab., 1 fig., 14 refs

  3. Significance of 99mTc-MIBI myocardial SPECT imaging in diagnosis of syndrome X

    To assess the value of myocardial imaging in the diagnosis of syndrome X, the study was performed with 99mTc-MIBI myocardial SPECT imaging in 64 patients. The patients were divided into three groups: group 1 had 21 patients diagnosed as syndrome X, group 2 had 17 patients with chest pain and normal coronary arteries without ST segment depression during exercise, group 3 had 26 patients with the angina pectoris and coronary stenoses≥50%. The myocardial SPECT imaging of the three groups was compared qualitatively and semi-quantitatively. Myocardial imaging identified 11 cases of myocardial ischemia from 21 patients with syndrome X. The ischemic score of myocardial imaging was 1.1 +- 0.3 for syndrome X and 1.8 +- 0.7 for patients with coronary heart disease (CHD) angina pectoris (t = 3.1746, P<0.01). Myocardial imaging may partly show myocardial ischemia in patients with syndrome X. The extent of ischemia in patients with syndrome X was significantly less than that in patients with CHD angina pectoris

  4. Tc-99m MIBI scintimammographic study with a new, simple imaging device

    Objective: The present study was performed in order to test the clinical value of a special breast imaging device made by ourselves in scintimammography. Method: The device is special wooden board with two cutouts at two borders. By two pairs of vertical troughs and two horizontal belts, it can be firmly fixed on the examine table. 60 patients with unilateral palpable breast masses were performed Tc-99m MIBI breast imaging with the help of the special device. The early and delay images were acquired at 10 min and 1 hr after intravenous injection, in positions of an anterior supine, a left lateral prone and a right lateral prone. A ratio of radioactivity value of mass to appositive corresponding tissue T/NT was half-quantitatively (T/NT≥1.21 is positive). Result: The diagnostic sensitivity and specificity was 92.9% and 90.6% respectively, and the accuracy was 91.7%; positive predictive value 89.7%; negative predictive value 93.5% and Youden index 83.5%. The lateral views (which were obtained with help of the device) were superior to routine anterior view in detecting lesions. Conclusion: The special device is simple and practical. It may be clinically applied to improve the SMM technique and diagnosis for breast mass

  5. Comparison of wall thickening and perfusion analysis in cardiomyopathy by gated Tc-99m MIBI

    The objective of this study was to clarify the relationship between left ventriculr (LV) function, wall thickening (WT) and perfusion in cardiomyopathy. Twenty-six cases (15 males, 11 females: mean age, 58 y), consisting of 10 healthy control subjects, 10 patients with hypertrophic cardiomyopathy (HCM) and 6 patients with idiopathic dilated cardiomyopathy (DCM) was studied with gated Tc-99m MIBI SPECT. LV WT, LV perfusion and function (LV wall motion, LVEDV, LVESV and LVEF) by using gated SPECT quantification and CEqual software were analysed. In HCM and DCM group, mean WT was significantly decreased. (HCM: 15.2±6.7%, DCM: 4.9%, control: 34.1±4.9% (p<0.01). Adenosine stress test didn't show any reversible or fixed perfusion defects in all HCM patients, controls and five DCM patients except one patient (but, no coronary artery stenosis in coronary angiography). LVEF for HCM, DCM and control was 48.4±13.2%, 28.7±8.8%, 62.7±9.5%, respectively (p<0.05)). LVEDV and LVESV didn't show a significant differences between HCM and control group, not DCM group. In HCM, WT was decreased as like DCM even though LV myocardial perfusion and function was reserved

  6. Myocardial perfusion scintigraphy with technetium99m-MIBI in the diagnosis of coronary artery disease in women

    Aim: To assess the value of myocardial perfusion scintigraphy for coronary artery disease (CAD) in women, we compared the results of a technetium99m-methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy with those of a coronary angiography in a group of women referred for evaluation of chest pain. Material and Methods: Twenty women, 15 of them postmenopausal, were included. A 99mTc-MIBI myocardial scintigraphy with one-day protocol (rest-stress) was performed. When needed, a combined stress (ergometric plus dipyridamole) was used. Both qualitative and quantitative regional uptake analysis was done. In patients with normal coronary arteries and positive myocardial scintigraphies, measurements were made of serum cholesterol and triglycerides (CHOD-PAD enzymatic colorimetric test), and lipoprotein(a) -Lp(a)- (BioSCREEN Lp(a) method). Results: Change in regional uptake (stress/rest) was as follows: during stress 99mTc-MIBI, 116 segments had normal uptake (from 93±9% to 94±7%), 52 had moderately reduced uptake (from 67±9% to 75±17%), and 12 had severely reduced uptake (from 33±9% to 64±28%). Qualitative and quantitative analysis coincided in 18 cases. The two non-coincident cases were patients in whom qualitative analysis and coronary angiography were normal, but on quantitative analysis it appeared a reversible defect in one case and a 'reverse redistribution' pattern in the other. Breast attenuation defects were detected in four cases. Myocardial scintigraphy and coronary angiography coincided in 70% cases (figure). The remainder 30% was constituted by patients with positive scintigraphy and normal coronary arteries; among these cases, the 71% were postmenopausal and had systolic hypertension, chest pain at rest, positive ergometric test and hypercholesterolemia (table). Conclusion: We concluded that 99mTc-MIBI myocardial scintigraphy can help in the CAD diagnosis in postmenopausal women

  7. The value of Tc-99m MIBI scintigraphy in active disease and remission phase of multiple myeloma

    Background: 99m Tc methoxy isobutyl isonitrile (99m Tc -MIBI)has been proposed as a tumor seeking agent in malignant disease. The goal of this study is to evaluate the frequency distribution of the different patterns, intensity and extension of abnormal uptake identified in MIBI scan in relation with various clinical status of the patients diagnosed as a multiple myeloma. Methods: forty-three patients entered the study, including six patients with no prior treatment , 22 patients who received autologous bone morrow graft, and 15 patients with history of chemotherapy and radiotherapy. Plasma protein electrophoresis for monoclonal antibody, bone morrow biopsy and urine analysis for Bence-Jones protein has been carried out and standard criteria were used for diagnosis of active disease and remission phase for each patients. The extension of each lesion(E-score) on scintigraphy were categorized into E0-E3 by three nuclear physicians who were blinded to the patient's clinical condition. I-score was also obtained with comparing the intensity of the lesions with intensity of myocardial uptake and classified as I0-I3. Results: the sensitivity, specificity, positive predictive value and negative predictive value of 99m Tc -MIBI scan for determining active lesions and released cases were 69%, 100%, 100% and 60%, respectively. Nineteen patients were initially thought to be in remission phase, but scintigraphy was abnormal in 5 cases who were diagnosed as active myeloma later in the course of the study. There was a significant correlation between clinical status and pattern, intensity and extension of the abnormal uptake of 99m Tc -MIBI. Also a significant correlation between intensity and extension of the abnormal tracer uptake with serum monoclonal component and urine Bence-Jones protein was noted, however no correlation between blood hemo globulin and degree of extension in scintigraphy was seen. Conclusion: Our study suggests the pattern, extension and intensity of 99m Tc

  8. Clinical Investigation of 99mTc-MIBI Imaging in Head and Neck Tumors%头颈部肿瘤99mTc-MIBI阳性显像的临床研究

    刘志军; 张永学; 张萍; 张继青

    2006-01-01

    Objective: To investigate the diagnostic potential value of 99mTc-MIBI imaging in head and neck tumors. Methods: Ninety-one patients with malignant and benign head and neck lesions were subjected to99mTc-MIBI tomography, and 20 healthy volunteers served as control group. Results: The overall sensitivity, specificity, accuracy and positive predictive accuracy of early/delay 99mTc-MIBI imaging in diagnosis of head and neck malignant tumors were 78.7%/72.3%, 72.1%/88.4%, 75.6%/80.0% and 75.5%/87.2%respectively. The results of 99mTc-MIBI Imaging in diagnosis of nasopharyngeal cancer and sinonasal non-Hodgkin's lymphoma were more satisfactory than those in maxillary sinus cancer. In distinguishing recurrent/residual nasopharyngeal carcinoma and sinonasal non-Hodgkin's lymphoma, 99mTc-MIBI scintigraphy was superior to CT/MRI. Conclusion: 99mTc-MIBI imaging is a promising useful tool in identifying head and neck tumor, and it has a special value to evaluate the local invasion and metastasis involved.

  9. The significance of a dipyridamole induced 99mTc-MIBI perfusion abnormality on single photon emission tomography: A quantiative validation with labelled water and positron emission tomography

    To relate 99mTc-MIBI uptake to regional myocardial blood flow (rMBF), 99mTc-MIBI SPET and H215O PET scans were obtained at rest and after dipyridamole infusion in six patients with single vessel coronary artery disease. 99mTc-MIBI-H215O data sets were created for each segment perfused by the stenotic vessel and for a normal reference area, assigning regions on the SPET tomograms to comparable regions on the PET by similar transaxial image reconstructions. All patients demonstrated post-dipyridamole 99mTc-MIBI perfusion defects in the territories supplied by the stenotic arteries; Resting rMBF in these regions was slightly lower than that in the normal areas. A 43% ± 14% reduction in 99mTc-MIBI activity in the area at risk was coupled with on average a 60% ± 9% reduction in post-dipyridamole rMBF compared with control regions. Thus, SPET assessment of 99mTc-MIBI uptake tends to underestimate the perfusion contrast between areas with normal and areas with low coronary vasodilatory reserve when compared to PET. However, these findings may still not affect the clinical usefulness of 99mTc-MIBI and more extensive studies are required to confirm these results in the clinical environment (orig./MG)

  10. Reproducibility of gated myocardial perfusion SPECT for the assessment of myocardial function: comparison with thallium-201 and technetium-99m-MIBI

    We compared the reproducibility of 291Tl and 99mTc-sestamibi (MIBI) gated SPECT (g-SPECT) for the assessement of myocardial function. G-SPECT acquisition for the assessment of myocardial function was repeated in the same position in 34 patients who received 201Tl and in 31 who received 99mTc-MIBI . The quantification of enddiastolic volume (EDV), endsystolic volume (ESV) and ejection fraction (EF) on 201Tl and 99mTc-MIBI g-SPECT were processed independently using Cedars quantitative g-SPECT software. The reporducibility of the assessment of myocardial function on 201Tl g-SPECT was compared to that of 99mTc-MIBI g-SPECT. Correlation between the two measurements for volumes and EF was excellent by the repeated g-SPECT studies of 291Tl(r=0.928 to 0.986; p99mTc-MIBI (r=0.979 to 0.997; p99mTc-MIBI g-SPECT(EDV: 14.1 ml, ESV; 9.4 ml and EF: 5.5%) than by repeated 201Tl g-SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI g-SPECT (EDV: 2.1 ml. ESV 2.7 ml and EF:2.3%) than by repeated 2'01TI g-SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). 99mTc-MIBI provides more reproducible volumes and EF and 201Tl on repeated acquisition s-SPECT. 99mTc-MIBI g-SPECT is the preferable method for the clinical monitoring of myocardial function

  11. Effect of multidrug resistance gene-1(mdr1) overexpression on in-vitro uptake of {sup 99m}Tc-sestaMIBI in murine L1210 leukemia cells

    Chun, Kyung Ah; Lee, Jae Tae; Lee, Sang Woo; Kang, Do Young; Sohn, Snag Kyun; Lee, Jong Kee; Jun, Soo Han; Lee, Kyu Bo [College of Medicine, Kyungpook National Univ., Taegu (Korea, Republic of); Chung, June Key [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1999-02-01

    To determine whether {sup 99m}Tc-MIBI is recognized by the multidrug resistant P-glycoprotein (Pgp), we have measured quantitatively {sup 99m}Tc-MIBI uptake in cancer cells. The effects of various Pgp reversing agents on cellular {sup 99m}Tc-MIBI uptake were also investigated in the presence of multidrug resistance gene-1 (mdr 1 gene) overexpression. We measured percentage uptake of {sup 99m}Tc-MIBI at different incubation temperatures both in mdr1 positive and negative cells. The effects of verapamil, cyclosporin, and dipyridamole on cellular uptake of {sup 99m}Tc-MIBI were also evaluated with or without overexpression of mdr1 gene in cultured murine leukemia L1210 cells. The mdr1 gene expressing cell lines were effectively induced in in vitro with continuous application of low-dose adriamycin or vincristine. Cellular uptake of {sup 99m}Tc-MIBI was higher in mdr1 negative L1210 cells than those of mdr1 positive cells, and higher when incubated in 37 .deg. C than 4 .deg. C. In the presence of verapamil, cyclosporin or dipyridamole, {sup 99m}Tc-MIBI uptake was increased upto 604% in mdr1 positive cells. Cellular uptake of {sup 99m}Tc-MIBI is lower in leukemia cells over-expressing mdr1 gene, and MDR-reversing agents increase cellular uptake. These results suggest the {sup 99m}Tc-MIBI can be used for characterizing Pgp expression and developing MDR-reversing agents in vitro.

  12. Diagnostic ability of Tc-99m MIBI SPECT in coronary artery diseases in not affected by the degree of exercise

    The sensitivity of ST-depression in the electrocardiogram during exercise is influenced by the level of efforts. However, unlike the prevalence of ST-depression of exercise ECG, the degree of exercise is reported to do not influence the diagnostic ability of myocardial perfusion scan. Furthermore, the relation between the prevalence of myocardial ischemia and effort is still controversial. We evaluated the effect of the degree of exercise on the ability of SPECT imaging to detect coronary artery stenosis. The patient population was comprised of 111 patients (73 men and 38 women, mean age 56 years) who underwent an exercise test in conjunction with Tc-99m MIBI and cardiac catheterization within 3 months apart each other. The degree of exercise was classified into four groups according to the percentage of maximal predicted heart rate. The sensitivity and specificity was compared between each group. The overall diagnostic sensitivity was significantly higher with Tc-99m MIBI SPECT than exercise ECG. The specificity was not significantly different between two tests. Sensitivity and specificity of Tc-99m MIBI was not different between four groups. Sensitivity for individual coronary stenosis seemed to be lower in subjects who had premature termination of exercise due to early appearance of ST depression. These results suggest that the overall diagnostic sensitivity of Tc-99m MIBI myocardial perfusion SPECT is not significantly affected by the degree of exercise in stable patients undergoing symptom-limited treadmil exercise testing. Myocardial perfusion SPECT imaging should be added to routine exercise stress testing for the detection of coronary artery disease

  13. Prognostic value of normal exercise 99mTc-MIBI myocardial perfusion SPECT: comparison with exercise electrocardiography and coronary angiography

    Myocardial perfusion scintigraphy is a useful technique to diagnose and to predict prognosis in patients with suspected or known coronary artery disease. The purpose of the present study is to evaluate the prognostic value of normal exercise 99mTc-MIBI myocardial perfusion single photon emission computed tomography (SPECT) and to analyze results with regard to those of exercise electrocardiography or coronary angiography. We evaluated 301 patients (mean age 52±10 years, 166 males and 135 females) with normal exercise 99mTc-MIBI myocardial perfusion SPECT performed for suspected coronary artery disease. Subjects were evaluated for cardiac events and followed for 8-55 months (mean 19±10 months) after imaging. During the follow-up period, there was no cardiac death but only one non-fatal myocardial infarction (event rate 0.21% per year). In addition, only one patient underwent coronary revascularization. There was no significant difference in cardiac event rate between patinets with positive (n=3D27) and negative (n=3D235) exercise electrocardiography (p:NS). There was no cardiac event in 17 patients who underwent coronary angiography (4 patients with >50% luminal narrowing, 2 patients with vasospasm and 11 patients with no significant lesion). Patients with normal exercise 99mTc-MIBI myocardial perfusion SPECT has a very low risk for cardiac events regardless of exercise electrocardiographic and coronary angiographic findings.=20

  14. Reproducibility of gated myocardial perfusion SPECT for the assessment of myocardial function: comparison with thallium-201 and technetium-99m-MIBI

    We compared the reproducibility of 201TI and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. Gated SPECT acquisition was repeated in the same prosition in 30 patients who received 201TI and in 26 who received 99m Tc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201TI and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201TI gated SPECT was compared with that of 99mTc-MIBI gated SPECT. Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201TI (r=0.928 to 0.986; p99mTc-MIBI (r=0.979 to 0.997; p99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5 %) than by repeated 201TI gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: , 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by more reproducible volumes and EF than 201TI on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function

  15. Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: changes in left ventricular uptake, dyssynchrony, and function

    99mTc-MIBI gated myocardial scintigraphy (GMS) evaluates myocyte integrity and perfusion, left ventricular (LV) dyssynchrony and function. Cardiac resynchronization therapy (CRT) may improve the clinical symptoms of heart failure (HF), but its benefits for LV function are less pronounced. We assessed whether changes in myocardial 99mTc-MIBI uptake after CRT are related to improvement in clinical symptoms, LV synchrony and performance, and whether GMS adds information for patient selection for CRT. A group of 30 patients with severe HF were prospectively studied before and 3 months after CRT. Variables analysed were HF functional class, QRS duration, LV ejection fraction (LVEF) by echocardiography, myocardial 99mTc-MIBI uptake, LV end-diastolic volume (EDV) and end-systolic volume (ESV), phase analysis LV dyssynchrony indices, and regional motion by GMS. After CRT, patients were divided into two groups according to improvement in LVEF: group 1 (12 patients) with increase in LVEF of 5 or more points, and group 2 (18 patients) without a significant increase. After CRT, both groups showed a significant improvement in HF functional class, reduced QRS width and increased septal wall 99mTc-MIBI uptake. Only group 1 showed favourable changes in EDV, ESV, LV dyssynchrony indices, and regional motion. Before CRT, EDV, and ESV were lower in group 1 than in group 2. Anterior and inferior wall 99mTc-MIBI uptakes were higher in group 1 than in group 2 (p99mTc-MIBI uptake. (orig.)

  16. Differences between accumulation of 99mTc-MIBI and 201Tl-Thallous Chloride in tumour cells: Role of P-glycoprotein

    Both 99mTc-MIBI and 201Tl have been used for tumour imaging. It has recently been reported that 99mTc-MIBI is a substrate for P-glycoprotein (Pgp), a membrane pump which mediates multidrug resistance. It has been evaluated the role of Pgp in the cellular accumulation of 201TI by using sensitive and resistant strains of Chinese hamster ovary (CHO) fibroblasts (AuxB1 and CHRC5, respectively) grown in suspension culture. 201Tl accumulation was the same in sensitive and resistant cells, whereas 99mTc-MIBI accumulation was much lower in resistant cells than in sensitive ones. Down-modulation of Pgp with 100 μM verapamil did not alter cellular accumulation of 201Tl while it significantly increased 99mTc-MIBI accumulation in both types of cell. Similarly, 10 μM verapamil did not affect the rate of washout of 201Tl from preloaded cells, while 99mTc-MIBI washout was greatly reduced in the presence of verapamil. These results suggest that 201Tl will accumulate in both sensitive and resistant tumour cells, whereas 99mTc-MIBI will be extruded from resistant cells and therefore may be less useful for tumour detection when the tumour cells express high Pgp levels

  17. Value of 99mTc-MIBI brain SPECT in differentiating recurrence and radiotherapy effects in tumors brain patients

    Full text: Accurate neuroimaging can assist in the diagnosis, management, prognosis, and follow-up of central nervous system (CNS) malignancies. Differentiation between tumor progression and radiation necrosis is one of the most difficult tasks in oncologic neuroradiology. The main role of functional imaging in oncological practice is to determine whether a lesion observed in an anatomical study such as CT scan or MRI consists of tumor cells or is formed by fibrotic tissue only. 99mTc-MIBI brain SPECT is considered a useful tool in the management of brain tumors. The demonstration of increased tracer extraction and subsequent accumulation in the lesion indicates viability of the suspected tumor mass. Aim: Gliomas, arising from glial cells, account for approximately the 45-55% of all brain tumors. 99mTc-MIBI tumor uptake is related to histological grading, cellular proliferation index and prognosis. Our aim was to evaluate 99mTc-MIBI brain SPECT and MRI studies efficacy in the differential diagnosis between recurrence of malignant gliomas and glioblastomas and the local modification after radiotherapy. Material and methods: Eight patients with suspected recurrence after surgical removal of a supratentorial glioma (2 low grade and 6 high grade), 6-12 months before study and treated with radiotherapy were investigated. For brain SPECT - 740MBq of 99mTc-MIBI were i.v. injected to each patient 15 minutes before image acquisition by a dual-head gamma camera, using a fan-beam collimator. Transverse, coronal and sagittal views were reconstructed. Gd-DTPA enhanced TI and T2 weighted MRI studies were carried out in every patient within 3 days before 99mTc-MIBI SPECT. The brain SPECT images were analyzed by calculating lesion-to-normal ratios (I/n). Areas of abnormal tracer uptake were defined as focally increased uptake or as asymmetric uptake, compared with the contralateral side. Uptake ratios were calculated using reference regions in the contralateral hemisphere, because

  18. Tc-99m MIBI imaging for secondary skeletal involvement in breast and prostate cancers and multiple myeloma

    Objective:The Objective of the study was to evaluate the role of Tc-99m MIBI whole body imaging in assessing secondary osseous involvement in patients with malignancy of breast, prostate or multiple myeloma. In this study a total of 41 patients were included. Out of these 18 had breast carcinoma, 12 had prostate carcinoma and 11 were diagnosed cases of multiple myeloma. All patients had their whole body MIBI imaging done which was compared with MDP bone scan by employing some other diagnostic modality (plain radiographs, CT scan, MRI scan or histopathological evidence) to confirm the lesions detected by either of the scans. The results of all the studies were evaluated qualitatively by assessing the number of lesions visually by three experienced nuclear physicians. Quantitative analysis of the lesions was also done, by calculating the lesion to normal uptake ratio, to augment the findings of visual assessment and for statistical analysis. Results: Results obtained in this study by MIBI and MDP imaging varied significantly among different groups and subgroups of patients depending on the primary malignancy and stage of therapy. However results obtained by imaging of patients within a group and subgroup were consistent with each other. MIBI scan showed a sensitivity of 99% in cases of multiple myeloma, where MDP scan was only 16% sensitive. In case of pre-therapy patients of breast and prostate carcinoma, the sensitivity of MIBI scan came out to be 80% and 74% respectively. In patients who were on chemo/radiotherapy MIBI scan was 54% sensitive in patients with breast carcinoma and 38% sensitive in patients with prostate carcinoma. MDP scan showed a sensitivity of 100% in all the groups. The positive predictive value of MIBI scan came out to be 100% but that of MDP was 42-76% in different groups. It is therefore concluded that the most significant role of MIBI imaging is in detection of bone metastases secondary to breast and prostate carcinoma in pre

  19. Scintigraphy with Tc99m-MIBI to annual prediction the evolution of women referred for evaluation of precordial pain

    In order to evaluate the capacity of myocardial perfusion scintigraphy with Tc99m-MIBI to predict the evolution of women referred for evaluation of precordial pain, the rates of cardiovascular events at one year were studied in a group of patients with normal scintigraphy (group 1: 17 patients) and in another with reversible perfusion defects (group 2: 17 patients). The one-day protocol was applied for scintigraphy with Tc99m-MIBI (rest/stress) with combined stress (ergometrin bicycle plus 0.28 mg/Ig of dipyridamole) in those cases where it was necessary. A quantitative and qualitative analysis of the regional uptake was made. Patients from group 1 were younger than those from group 2 (average age: 49 vs 55, respectively, p = 0.04) and they had less hypercholesterolemia (112 % vs 59 %, respectively, p = 0.01). The rates of appearance of cardiovascular events at one year were calculated for patients from group 2 by using the Kaplan-Meier's method. The rates of appearance of clinical events (myocardial infarction and unstable angina) and of revascularization procedures (percutaneous transluminal coronary angioplasty and aortocoronary bypass surgery) were 0.24 in both cases. Only a patient from group 1 presented varying angina at 5 months. No deaths were reported in any of the groups. 94 % of the patients with normal perfusion scintigraphy were free of events after a one-year follow-up, whereas only 53 % of those with reversible perfusion defects showed a similar behavior. It was concluded that myocardial perfusion scintigraphy with Tc99m-MIBI is a useful tool to predict the evolution of women referred for evaluation of precordial pain at one year

  20. 99mTc-MIBI scintigraphy as a functional method for multi drug resistance (MDR) evaluation in breast cancer patients

    Full text: The purpose of this study was to evaluate the role of 99mTc-MIBI scintigraphy for assessing MDR in breast cancer (BC) patients and correlate the results with P-gp overexpression. 22 women of 35-68 years age having breast cancer were studied. Two or 3 cycles of chemotherapy (NCT) were given to all patients using standard regimen (FEC in 15 and CMF in 7). Planar and SPECT scintigraphy using 740-925 MBq Tc-99m MIBI was performed before and after NCT. Focal uptake of Tc-99m MIBI in BC lesions was used as scintigraphic criteria of abnormality. Tumor/Background uptake index (T/B) was also calculated. Immunohistochemistry was carried out after surgery for P-gp detection in all cases. The degree of expression was evaluated according to the semiquantitative score analysis from 0 to 4. Planar imaging was true positive in 21 patients, false positive in 1 patient and false negative in 1 patient. SPECT imaging was true positive in 22 patients, false positive in 1 patient. SPECT showed additional tumor masses in 3 patients with multi focal BC. Sensitivity was 95% (21/22) and 100% (22/22) respectively for planar and SPECT detection of BC. P-gp expression was positive in 40.8% of patients and negative in 59.2%. Intensive 99mTc-MIBI uptake was seen on the planar images in 21 patients independent of P-gp expression. No significant relationship was seen between T/B Index and P-gp detection. Objectively 2 patients showed complete remissions, 50% tumoral reduction in 1 patient and minimal response (20-35% reduction) in 12 pts. No change in the lesion was noticed in 7 patients. T/B Index was reduced after NCT > 20% in 9 patients. In conclusion, use of SPECT is an important diagnostic approach for identification of deeply located breast cancer lesions and satellite tumor spots in multifocal BC. T/B Index does not correlate with P-gp overexpression. (author)

  1. Breast Scintigraphy using Tc-99m MIBI in Patients with Malignant Breast Mass: The correlation between scintigraphy and histopathology

    Purpose: In this study, we evaluated the relationship between measurements (10 minutes, 2 hours uptake ratio and washout ratio) acquired in Tc-99m MIBI breast scintigraphy and postoperative histopathologic finding. Materials and Methods: We studied 23 patients of breast malignant tumor (mean age = 50 ∫5.8 years old); 16 cases of invasive ductal carcinoma, 3 cases of metaplastic carcinoma, 2 cases of infiltrative ductal carcinoma and 2 cases of atypical ductal carcinoma. In all patients, Tc-99m MIBI breast Scintigraphy was obtained with measuring uptake and washout ratio. The regions of interests (ROI) were drawn within the central portion of the lesion and the diameters of ROI were about 70% of the diameter of the lesion. The uptake ratio was calculated by counts within the lesion in affecting side dividing by the counts of comparable region of opposite side in 10 minutes and 2 hours after injection. Washout ratio was calculated by subtracting counts at 2 hours from these at 10 minutes and dividing by the number of counts at 10 minutes. Histopathologic findings were graded by size of the mass, Ki-67 index, number of mitosis in 10 high power fields, number of metastatic lymphadenopathy and grade of structural atypism. To compare the measurement of Tc-99m MIBI breast scintigraphy and histopathologic finding, we used Pearson's correlation analysis and P<0.05 was regarded as significant. Results: There was statistically significant positive correlation between 10 minutes uptake ratio and 2 hours uptake ratio (r=0.91, P<0.01). There is positive relationship between 10 minutes, 2 hours uptake ratio and size of the lesion (r=0.48, r=0.31), between washout ratio and Ki-67 index (r=0.28), between washout ratio and size(r=0.29), but without statistical significance. There is negative relationship between 10 minutes, 2 hours uptake ratio and KI-67 index (r=-0.36, r=-0.29), between 10 minutes, 2 hours uptake ratio and number of mitosis (r=-0.30, r=-0.22), 10 minutes, 2 hours

  2. Rapid preparation and quality control of 99mTc-ECD, MAG3 and MIBI using microwave heating and sep-pak cartridges

    We evaluated a rapid preparation procedures for the labeling and quality control of 99mTc-ECD, MAG3 and MIBI using microwave heating and Sep-Pak cartridges. 99mTc labeling of ECD, MAG3, and MIBI kit preparation was performed according to the package inserts with microwave heating modification. Heating time was 10-15 sec, and heating was performed with 3 mm plastic bottle with screw cap to prevent radiation contamination. Labeling efficiency was obtained with C18 or Alumina N Sep-Pak cartridges. The radiochemical purity of 93 ∼ 96% for 99mTc-ECD and 95 ∼ 99% for 99mTc-MIBI was obtained using Alumina N Sep-Pak cartridge. The optimum irradiation time of microwave method for 3 ml 99mTc-labeled radiopharmaceutical solution was 10 sec for 99mTc-ECD and 99mTc-MIBI, and 15 sec for 99mTc-MAG3. The results of quality control data with Sep-Pak cartridges were well correlated wth TLC method. The total preparation time of these radiopharmaceuticals was 5 ∼ 6 min including quality control procedure. This study demonstrates that radiopharmaceuticals preparation by microwave heating and quality control by Sep-Pak cartridges can be efficiently utilized as an alternative to the recommended method by manufacture's manual

  3. Normal limits of left ventricular volumes and ejection fraction measured by gated myocardial perfusion SPECT: comparison of Tc-99m MIBI and Tl-201

    We evaluated radioisotope and sex-specific differences of normal limits for left ventricle volumes (LWs) and ejection fraction (EF) using myocardial perfusion gated SPECT (g-SPECT). Rest Tl-201/post-stress Tc-99m MIBI g-SPECT measurements with acquisitions of 8-frame were evaluated for 70 patients (mean age 55 ± 14, 56% female) who either had 50%) (n=58). LVEF, LWs were automatically determined by quantitative gated SPECT using QGS program. Similar results were obtained for mean LVEF between Tc-99m MIBI (62% ± 7%) and Tl-201 (63% ± 8%) g-SPECT measurements. In contrast, Tl-201 g-SPECT had significantly lower LWs values (EDV; 74 ± 23 mL, ESV; 28 ± 14 mL) than Tc-99m MIBI g-SPECT (EDV; 82 ± 25 mL, ESV; 32 ± 15 mL) (p<0.05). Women had significantly lower EDV (Tc-99m MIBI; 71 ± 18 mL, Tl-201; 65 ± 17 mL), and ESV values (Tc-99m MIBI; 27 ± 10 mL, Tl-201; 23 ± 8 mL) compared with EDV (Tc-99m MIBI; 96 ± 27 mL, Tl-201; 85 ± 24 mL), and ESV values (Tc-99m MIBI; 40 ± 17 mL, Tl-201; 36 ± 16 mL) of men (p<0.05). Women had significantly higher LV EF values (65% ± 7%) than men (60% ± 8%) by Tl-201 gated SPECT (p<0.05). These data suggest significant differeuces in normal limits for LWs and EF, according to genders and radiopharmaceutical. Therefore, the evaluation of cardiac function in patients should consider radioisotope and sex-matched normal values

  4. Labelling, biodistribution and compartmental analysis of N-acetylcysteine labelled with Tc-99m. Comparative investigation with with 99m Tc-MIBI in an in vivo tumoral model

    Labelling and biodistribution studies were done with two different ligands, respectively Methoxy isobutyl isonitrile (MIBI) and N-acetylcysteine (NAC), employing Tc-99m as a tracer. The main objective was to assess the pharmacokinetic properties of the second substance, aiming at its possible application in cancer diagnosis. To this purpose an in vivo investigation was done using healthy and tumor-bearing rats with experimental cancer. Images of tumor-bearing rats registered in a scintillation camera indicated that with 99m Tc-MIBI none of the two selected times was adequate for visualization of the cancer mass. In contrast, 99m Tc-NAC permitted clear identification of the humor, four hours after injection. The results have demonstrated that 99m Tc-NAC is a radiopharmaceutical with affinity for cancer tissue and promising for further investigation concerning imaging diagnosis of tumors. (author)

  5. Myocardial perfusion: Comparison between 99mTc-MIBI scintigraphy and microbubbles- Pesda and Levovist-echocardiography

    Myocardial perfusion scintigraphy has been used for the last 25 years. Recently echocardiography is trying to realize the same kind of test with microbubbles injected intravenously. Aim: Comparison of the results of myocardial perfusion scintigraphy with 99mTc-MIBI and microbubbles - Pesda and Levovist-echocardiography. The nuclear medicine is considered the gold standard. Material and method: We studied 27 patients, 15 male, aging 58+/- 12.5 years with angina unstable or myocardial infarction (19 pts ) and normal (8 pts ). All patients received 740 MBq of 99mTc-MIBI during the echo examination. The SPECT scintigraphies were performed in an ADAC Vertex Plus scintillation camera. The echo were performed in a HDI 3000/5000 ATL, P3-2 transducer, intermittent harmonic image, VHS and 2 independent observers. During the echo examination the patients received Pesda- 2-7 ml/min- and Levovist- 400mg/ml 2-4 min. Results: NM versus Pesda and NM versus Levovist are presented. Concordance 87% (K=0.42). Concordance 89% (K0.57). Conclusion: Despite of the feasibility, echocardiography can detect myocardial perfusion defects with a good concordance of 87-89 % of these cases. The learning curve, the qualitative analysis is jeopardized by fibrotic areas, and the attenuation are problems that they need to solve

  6. Molecular imaging with {sup 99m}Tc-MIBI and molecular testing for mutations in differentiating benign from malignant follicular neoplasm: a prospective comparison

    Giovanella, L.; Treglia, G.; Ceriani, L. [Oncology Institute of Southern Switzerland, Department of Nuclear Medicine and Thyroid Centre, Bellinzona (Switzerland); Campenni, A. [Policlinico Universitario, Istituto di Medicina Nucleare, Messina (Italy); Verburg, F.A. [RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen (Germany); Trimboli, P. [Oncology Institute of Southern Switzerland, Department of Nuclear Medicine and Thyroid Centre, Bellinzona (Switzerland); Ospedale Israelitico, Sezione di Endocrinologia e Diabetologia, Roma (Italy); Bongiovanni, M. [Centre Hopitalier Universitaire Vaudouise, Institut de Pathologie, Lausanne (Switzerland)

    2016-06-15

    To compare mutation analysis of cytology specimens and {sup 99m}Tc-MIBI thyroid scintigraphy for differentiating benign from malignant thyroid nodules in patients with a cytological reading of follicular neoplasm. Patients ≥18 years of age with a solitary hypofunctioning thyroid nodule (≥10 mm), normal thyrotropin and calcitonin levels, and a cytological diagnosis of follicular neoplasm were prospectively enrolled. Mutation analysis and {sup 99m}Tc-MIBI scintigraphy were performed and patients were subsequently operated on to confirm or exclude a malignant lesion. Mutations for KRAS, HRAS and NRAS and for BRAF and translocations of PAX8/PPARγ, RET/PTC1 and RET/PTC3 were investigated. Static thyroid scintigraphic images were acquired 10 and 60 min after intravenous injection of 200 MBq of {sup 99m}Tc-MIBI and visually assessed. Additionally, the MIBI washout index was calculated using a semiquantitative method. In our series, 26 % of nodules with a follicular pattern on cytology were malignant with a prevalence of follicular carcinomas. {sup 99m}Tc-MIBI scintigraphy was found to be significantly more accurate (positive likelihood ratio 4.56 for visual assessment and 12.35 for semiquantitative assessment) than mutation analysis (positive likelihood ratio 1.74). A negative {sup 99m}Tc-MIBI scan reliably excluded malignancy. In patients with a thyroid nodule cytologically diagnosed as a follicular proliferation, semiquantitative analysis of {sup 99m}Tc-MIBI scintigraphy should be the preferred method for differentiating benign from malignant nodules. It is superior to molecular testing for the presence of differentiated thyroid cancer-associated mutations in fine-needle aspiration cytology sample material. (orig.)

  7. Using 99mTc-MIBI to Evaluate the Effects of Chemosensitizer on P-glycoprotein in Multidrug-resistant Carcinoma Cells

    ZHANGZhenwei; ZHANGXuemei; WUHua; ZHAOMing; XIANYUZhiqun; ZHOUJian; LAIShiying

    2005-01-01

    Objective: To establish a method to evaluate the effects of chemosensitizer on P-glycoprotein using 99mTc-MIBI, and observe the changes of 99mTc-MIBI uptake kinetics and P-glycoprotein levels after using verapamil in MDR human breast cells MCF-7/Adr. Methods: MDR breast carcinoma cells, MCF-7/Adr, were incubated and different protocols were performed. Protocol I: a chemosensitizer, verapamil (10μmol/L), was added into cell culture medium, while in control group, the same volume of DMEM was given. Cells were harvested after 2 h incubation with 99mTc-MIBI. Protocol Ⅱ: Verapamil (10μmol/L) was added into cell culture medium and incubated for 20 min, 40 min, 60 rain, 80 min, 8 h, 24 h, 48 h and 72 h respectively. Cells were harvested after 2 h incubation with 99mTc-MIBI. The radioactivity of the cells was measured and P-glycoprotein expression levels were determined with immunohistochemical stain. Results: Protocol I: After 2h incubation with verapamil the cellular uptake of 99mTc-MIBI was remarkably higher than control group (t=2.33, P0.05). Protocol

  8. Impact of the parathyroid scintigraphy with MIBI -{sup 99m}Tc in the detection of an infra-centimetric parathyroid adenoma; Impact de la scintigraphie parathyroidienne au MIBI-99mTc dans la detection d'un adenome parathyroidien infracentimetrique

    Ben Ali, K.; Mortazavi-Jhanno, N.; Burg; Rouzet, F.; Lebtahi, R.; Le Guludec, D. [Service de medecine nucleaire, hopital Bichat, AP-HP, Paris, (France); Leghzali, H.; Besse, H.; Stievenart, J.L. [service de medecine nucleaire, hopital Beaujon, AP-HP, Paris, (France)

    2009-05-15

    The objective is to enlighten the contribution of the parathyroid scintigraphy with MIBI-{sup 99m}Tc in the detection of infra-centimetric parathyroid adenomas. Conclusions: the small low intense visible centres with a single time of scintigraphy can correspond to adenomas. The association parathyroid scintigraphy with MIBI-{sup 99m}Tc to a cervical echography contributes to raise the sensitivity in the detection of parathyroid infra-centimetric adenomas. (N.C.)

  9. The role of 99mTc-MIBI scintigraphy in the assessment of MDR1 overexpression in patients with musculoskeletal sarcomas: comparison with therapy response

    The occurrence of multidrug resistance (MDR), which is in part due to the overexpression of P-glycoprotein (Pgp), is a major problem in neoadjuvant therapy of malignant musculoskeletal tumours. The aim of this study was to investigate the role of technetium-99m hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy for functional imaging of the MDR1 phenotype in patients with musculoskeletal sarcomas. We aimed to compare 99mTc-MIBI uptake and washout kinetics with the expression of Pgp and with chemotherapy response. Twenty-five patients (16 males and 9 females, aged between 8 and 65 years) with malignant musculoskeletal tumours were studied. After injection of 555-740 MBq 99mTc-MIBI, dynamic flow images of the involved area were obtained for 3 min, and planar images were acquired at 10 min and 1 h. From the dynamic images, a tumour perfusion index (TPI) was obtained using Patlak-Rutland analysis. Tumour to background (T/B) ratios of both early and delayed images and percent wash-out rate (WR%) of 99mTc-MIBI were calculated. Immunohistochemical analysis of Pgp was performed on biopsy specimens and the degree of expression was graded according to a semiquantitative scoring system, from 0 to 6. After neoadjuvant therapy, tumour response was assessed by examining the ratio of viable cells and by detecting percent necrosis. Scintigraphic results were compared with Pgp status and therapy response. Irrespective of the Pgp status, all patients showed significant perfusion and 99mTc-MIBI uptake in early images. There was not a significant correlation between T/B ratios of early and delayed images and Pgp expression. We observed a positive correlation between WR% and Pgp status (r=0.61, P99mTc-MIBI was significantly higher in patients with high Pgp expression than in those with a low Pgp score (33%±9% vs 17%±9%). Therapy response was determined in 21 of 25 patients, and in only 5 of 21 cases was the percent necrosis more than 90%. Neither Pgp expression rate nor WR

  10. The role of {sup 99m}Tc-MIBI scintigraphy in the assessment of MDR1 overexpression in patients with musculoskeletal sarcomas: comparison with therapy response

    Burak, Z.; Erinc, R.; Oezcan, Z.; Dirlik, A. [Dept. of Nuclear Medicine, Ege University Medical Faculty, Bornova (Turkey); Ersoy, Oe.; Basdemir, G. [Dept. of Pathology, Ege University Medical Faculty, Izmit (Turkey); Moretti, J.-L. [Service de Medecine Nucleaire et Biophysique, Univ. Paris 8 (France); Sabah, D. [Dept. of Orthopaedics, Ege University Medical Faculty, Izmir (Turkey)

    2001-09-01

    The occurrence of multidrug resistance (MDR), which is in part due to the overexpression of P-glycoprotein (Pgp), is a major problem in neoadjuvant therapy of malignant musculoskeletal tumours. The aim of this study was to investigate the role of technetium-99m hexakis-2-methoxyisobutylisonitrile ({sup 99m}Tc-MIBI) scintigraphy for functional imaging of the MDR1 phenotype in patients with musculoskeletal sarcomas. We aimed to compare {sup 99m}Tc-MIBI uptake and washout kinetics with the expression of Pgp and with chemotherapy response. Twenty-five patients (16 males and 9 females, aged between 8 and 65 years) with malignant musculoskeletal tumours were studied. After injection of 555-740 MBq {sup 99m}Tc-MIBI, dynamic flow images of the involved area were obtained for 3 min, and planar images were acquired at 10 min and 1 h. From the dynamic images, a tumour perfusion index (TPI) was obtained using Patlak-Rutland analysis. Tumour to background (T/B) ratios of both early and delayed images and percent wash-out rate (WR%) of {sup 99m}Tc-MIBI were calculated. Immunohistochemical analysis of Pgp was performed on biopsy specimens and the degree of expression was graded according to a semiquantitative scoring system, from 0 to 6. After neoadjuvant therapy, tumour response was assessed by examining the ratio of viable cells and by detecting percent necrosis. Scintigraphic results were compared with Pgp status and therapy response. Irrespective of the Pgp status, all patients showed significant perfusion and {sup 99m}Tc-MIBI uptake in early images. There was not a significant correlation between T/B ratios of early and delayed images and Pgp expression. We observed a positive correlation between WR% and Pgp status (r=0.61, P<0.01), and the wash-out rate of {sup 99m}Tc-MIBI was significantly higher in patients with high Pgp expression than in those with a low Pgp score (33%{+-}9% vs 17%{+-}9%). Therapy response was determined in 21 of 25 patients, and in only 5 of 21 cases

  11. Using Tc-99m MIBI scintimammography to differentiate nodular lesions in breast and detect axillary lymph node metastases from breast cancer

    王景; 吴华; 周健; 胡健

    2003-01-01

    Objective To test the clinical value of using Tc-99m MIBI scintimammography (Tc-99m MIBI SMM) to differentiate nodular lesions in breasts and detect axillary lymph node metastases of breast cancer. Methods The subjects consisted of sixty female patients exhibiting unilateral palpable breast mass. The early and delay static acquisitions were undertaken in all subjects at 10 and 90 min after injection with Tc-99m MIBI. The acquisition included three positions: anterior supine, left lateral prone and right lateral prone. A special device for SMM which was developed by our laboratory was used. The ratio of [(T-B)/(NT-B)] was calculated as radioactivity of mass to that of opposite corresponding tissue, and [(T-B)/(NT-B)]≥1.21 was used as the cut-off for semi-quantitative discrimination of malignancy from benignity in semi-quantitative analysis. The final diagnosis was obtained from histology examination in all subjects. Results Using Tc-99m MIBI SMM to differentiate between nodular lesions in breasts, the diagnostic sensitivity and specificity were 92.9% and 90.6% respectively, the positive predictive value 89.7%, the negative predictive value 93.5%, and the accuracy 91.7%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained with Tc-99m MIBI SMM for detecting axillary lymph node metastases were 83.3%, 86.1%, 80%, 88.6% and 85% respectively. Conclusions It is suggested that Tc-99m MIBI SMM may be not only valuable in differentiating malignant lesions from benign nodular masses of breast, but also helpful in detecting axillary lymph node metastases of breast cancer.

  12. Comparison of 99mTc-MIBI scanning and sentinel node biopsy in the detection of occult melanoma lymph node metastases

    Aim: Sentinel node biopsy (SNB) is a highly accurate technique for detecting occult metastatic disease in the regional lymph nodes. Our group has reported that 99mTc-MIBI scintigraphy is an imaging technique that can detect clinically undetectable metastases. This prospective study shows preliminary results on the comparison of both techniques for the detection of lymph node invasion. Material and Methods: Twenty-two consecutive patients (15 women, 7 men; mean age, 55 years) with primary melanoma > 1.0 mm thick were enrolled (mean 2.6 mm). Patients underwent 99mTc-MIBI scintigraphy of regional lymph nodes 1-2 weeks before surgery, acquiring 10-minute planar images with a LFOV gamma camera. A preoperative lymphoscintigraphy using 99mTc-colloidal (Re) sulphide was performed the day before surgery, using a dose of 74-93 MBq. Radio guided SNB was performed with a hand-held gamma probe. Lymph nodes were examined histologically and immunostained for S-100 and HMB-45. Results: The sentinel node (SN) was identified in 21/22 patients. An average of 1.6 SN/lesion were harvested from melanomas located in the following regions: head and neck (n=3), trunk (n=6), extremities (n=12). All patients with negative SN (n=11) were also negative with MIBI. In 10 cases the SN demonstrated metastatic involvement, whereas 99mTc-MIBI was positive in 8 of them (80%). In cases with positive SN/negative 99mTc-MIBI, the pathology report revealed micro metastatic disease. Conclusion: These preliminary results suggest that 99mTc-MIBI scanning has the potential of selecting a group of patients who might benefit from a selective complete lymphadenectomy

  13. {sup 99m}Tc-MIBI SPECT in primary hyperparathyroidism. Influence of concomitant vitamin D deficiency for visualization of parathyroid adenomas

    Schmidt, M.; Thoma, N.; Dietlein, M.; Moka, D.; Eschner, W.; Schicha, H. [Dept. of Nuclear Medicine, Univ. of Cologne (Germany); Faust, M. [Dept. of II of Internal Medicine (Endocrinology), Univ. of Cologne (Germany); Schroeder, W. [Dept. of Surgery, Univ. of Cologne (Germany); Huelst-Schlabrendorff, M. von; Ehses, W. [Dept. of Endocrinology Clinic, Univ. of Cologne (Germany)

    2008-07-01

    Aim of the study was to analyse the influence of a concomitant vitamin D deficiency on the results of {sup 99m}Tc-MIBI studies in patients (pts) with primary hyperparathyroidism (pHPT). Patients, methods: between January 1998 and May 2004, 71 pts with pHPT had undergone operation after a {sup 99m}Tc-MIBI study of whom 54 pts (76%) had normal values of 25-OH-vitamin D3 and 17 pts (24%) had vitamin D deficiency. Results of a dual-phase {sup 99m}Tc-MIBI protocol with SPECT were compared with histopathology. Results: in 54 pts with normal vitamin D values late SPECT images identified more lesions (n = 51, sensitivity 91%) than early planar (n = 45, sensitivity 82%) or late planar images (n = 50, sensitivity 88%). In 17 pts with vitamin D deficiency late SPECT images identified more lesions (n = 13, sensitivity 72%) than early planar (n = 10, sensitivity 56%) or late planar images (n = 10, sensitivity 56%) too. In pts with vitamin D deficiency the sensitivity of a {sup 99m}Tc-MIBI SPECT study was lower than in those with normal vitamin D status (72% vs. 91%) and dependent on the value for PTH. However, the results did not reach statistical significance: early planar: p = 0.1625; late planar: p = 0.0039; {sup 99m}Tc-MIBI SPECT: p = 0.1180. Conclusion: the likelihood of a pathological {sup 99m}Tc-MIBI study being obtained in pts with pHPT is dependent on the parathyroid hormone level. However, a negative influence of a low vitamin D level on the scintigraphic detection rate of a parathyroid adenoma could not be proven which may be due to the low number of pts with vitamin D deficiency. (orig.)

  14. Evaluation of MS-209, a novel multidrug-resistance-reversing agent, in tumour-bearing mice by technetium-99m-MIBI imaging

    MS-209 is a newly synthesised multidrug-resistance (MDR)-reversing agent with few side-effects. In this study, we evaluated the effect of MS-209 on P-glycoprotein (Pgp)-positive tumours in mice by means of technetium-99m methoxyisobutylisonitrile (MIBI) imaging. Mice received Pgp-negative KB-3-1 or Pgp-positive KB-C1 cell xenografts. KB-3-1-bearing mice were administered 0 or 100 mg/kg of MS-209 (groups S0 and S100, respectively), and KB-C1-bearing mice 0, 50, 100 or 200 mg/kg (groups R0, R50, R100 and R200, respectively), 30 min before imaging studies. Dynamic 99mTc-MIBI images were acquired for 30 min, followed by biodistribution studies. Washout of 99mTc-MIBI from the tumours was faster in group R0 than in group S0 on visual analysis, and the washout half-time estimated by region of interest analysis was shorter in group R0 than in group S0. Biodistribution studies revealed that 99mTc-MIBI accumulation in tumours (expressed as %ID/g) was also lower in group R0 than in group S0. MS-209 delayed the 99mTc-MIBI washout from KB-C1 tumours. Washout half-time was longer in groups R50, R100 and R200 than in group R0. A higher %ID/g was observed in groups R100 and R200 than in group R0. In KB-3-1 tumours, MS-209 had no effect on the washout half-time or the %ID/g. This study demonstrated that MS-209 increases the 99mTc-MIBI accumulation in Pgp-positive tumours. The MDR-reversing effect of MS-209 could be effectively evaluated with 99mTc-MIBI visually and non-invasively in vivo. 99mTc-MIBI imaging with MS-209 prior to chemotherapy should contribute significantly to the treatment strategy in patients with multidrug-resistant tumours. (orig.)

  15. Comparison of thallium-201, Tc-99m MIBI and I-131 scan in the follow-up assessment after I-131 ablative therapy in differentiated thyroid cancer

    Kwon, Jae Sung; Lee, Sung Keun; Kim, Doe Min; Park, Sae Jong; Jang, Kyong Sun; Kim, Eun Sil; Kim, Chong Soon [Hanil General Hospital, Seoul (Korea, Republic of)

    1999-08-01

    We conducted a comparative study to evaluate the diagnostic values of Tl-201, Tc-99m MIBI and I-131 scans in the follow-up assessment after ablative I-131 therapy in differentiated thyroid cancer. The study population consisted of 20 patients who underwent surgical removal of thyroid cancer and ablative radioactive iodine therapy, and followed by one or more times of I-131 retreatment (33 cases). In all patients, Tl-201, Tc-99m MIBI, diagnostic and therapeutic I-131 scans were performed and the results were analyzed retrospectively. Also serum thyroglobulin levels were measured in all patients. The final diagnosis of recurrent or metastatic thyroid cancer was determined by clinical, biochemical, radiologic and/or biopsy findings. Positive rates (PR) of Tc-99m MIBI, Tl-201, diagnostic and therapeutic I-131 scans in detecting malignant thyroid tissue lesions were 70% (19/27), 54% (15/28), 35% (17/48) and 63% (30/48), respectively. The PR in the group of 20 cases (28 lesions) who underwent concomitant Tl-201 and I-131 scans were in the order of therapeutic 131 scan 71%, Tl-201 scan 54% and diagnostic I-131 scan 36%. There was no statistically significant difference between Tl-201 and diagnostic I-131 scans (p>0.05). In the group of 20 cases (27 lesions) who underwent concomitant Tc-99m MIBI and I-131 scans, the PR were in the order of Tc-99m MIBI scan 70%, I-131 therapeutic scan 52% and I-131 diagnostic scan 33%. The PR of Tc-99m MIBI was significantly higher than that of diagnostic I-131 scan (p<0.05). Tc-99m MIBI scan is superior to diagnostic I-131 scan in detecting recurrent or metastatic thyroid cancer following ablation therapy in patients with differentiated thyroid cancer. Tl-201 scan did not showed significantly higher positive rate than diagnostic I-131 scan. Instead of diagnostic I-131 scan before the I-131 retreatment, Tc-99m MIBI scan without discontinuing thyroid hormone replacement would be a prudent and effective approach in the management of these

  16. Role of pre-operative imaging using {sup 99m}Tc-MIBI and neck ultrasound in patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy

    Fuster, David; Ortin, Jaime; Setoain, Xavier; Paredes, Pilar; Duch, Joan; Pons, Francesca [Hospital Clinic, Nuclear Medicine Department, Barcelona (Spain); Ybarra, Juan; Torregrosa, Jose-Vicente [Hospital Clinic, Renal Transplant Unit, Barcelona (Spain); Gilabert, Rosa [Hospital Clinic, Radiology Department, Barcelona (Spain)

    2006-04-15

    The purpose of this study was to assess whether pre-operative {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) scintigraphy and neck ultrasound (US) are of value in improving the outcome of subtotal parathyroidectomy in patients with secondary hyperparathyroidism. Forty-eight consecutive haemodialysis patients with severe secondary hyperparathyroidism prospectively underwent ''blinded'' subtotal parathyroid surgery, with 1-year follow-up to establish cure or relapse of their secondary hyperparathyroidism. Double-phase {sup 99m}Tc-MIBI scintigraphy and neck US were performed pre-operatively in all patients. When the preserved gland showed {sup 99m}Tc-MIBI uptake or an abnormal size on US, it was considered that ''{sup 99m}Tc-MIBI advice'' and ''US advice'', respectively, had not been followed. Pre-operative and follow-up parathyroid hormone (PTH) levels were obtained in all patients. All data were evaluated on a patient by patient basis. Four parathyroid glands were identified in each patient at primary surgery, resulting in an operative success rate of 100%. Their weight ranged from 15 to 7,300 mg (mean 1,120{+-}900 mg). Nine of the 48 patients (19%) showed a recurrence of their secondary hyperparathyroidism. The recurrence rate was 2% (1/48) and 10% (5/48), respectively, when {sup 99m}Tc-MIBI and US advice was followed. The sensitivity, specificity, NPV and PPV for pre-operative imaging were 72%, 95%, 97% and 80% respectively for {sup 99m}Tc-MIBI, and 55%, 67%, 87% and 28% for US. {sup 99m}Tc-MIBI scintigraphy is a reliable non-invasive exploratory tool and its preoperative use results in a significant reduction in the number of recurrences in haemodialysis patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. The use of neck US did not significantly improve the results obtained with {sup 99m}Tc-MIBI alone. (orig.)

  17. Evaluation of MS-209, a novel multidrug-resistance-reversing agent, in tumour-bearing mice by technetium-99m-MIBI imaging

    Tatsumi, Mitsuaki; Nishimura, Tsunehiko [Division of Tracer Kinetics, Osaka University Graduate School of Medicine (Japan); Tsuruo, Takashi [Department of Chemical Biology, Institute of Molecular and Cellular Biosciences, University of Tokyo (Japan)

    2002-03-01

    MS-209 is a newly synthesised multidrug-resistance (MDR)-reversing agent with few side-effects. In this study, we evaluated the effect of MS-209 on P-glycoprotein (Pgp)-positive tumours in mice by means of technetium-99m methoxyisobutylisonitrile (MIBI) imaging. Mice received Pgp-negative KB-3-1 or Pgp-positive KB-C1 cell xenografts. KB-3-1-bearing mice were administered 0 or 100 mg/kg of MS-209 (groups S0 and S100, respectively), and KB-C1-bearing mice 0, 50, 100 or 200 mg/kg (groups R0, R50, R100 and R200, respectively), 30 min before imaging studies. Dynamic {sup 99m}Tc-MIBI images were acquired for 30 min, followed by biodistribution studies. Washout of {sup 99m}Tc-MIBI from the tumours was faster in group R0 than in group S0 on visual analysis, and the washout half-time estimated by region of interest analysis was shorter in group R0 than in group S0. Biodistribution studies revealed that {sup 99m}Tc-MIBI accumulation in tumours (expressed as %ID/g) was also lower in group R0 than in group S0. MS-209 delayed the {sup 99m}Tc-MIBI washout from KB-C1 tumours. Washout half-time was longer in groups R50, R100 and R200 than in group R0. A higher %ID/g was observed in groups R100 and R200 than in group R0. In KB-3-1 tumours, MS-209 had no effect on the washout half-time or the %ID/g. This study demonstrated that MS-209 increases the {sup 99m}Tc-MIBI accumulation in Pgp-positive tumours. The MDR-reversing effect of MS-209 could be effectively evaluated with {sup 99m}Tc-MIBI visually and non-invasively in vivo. {sup 99m}Tc-MIBI imaging with MS-209 prior to chemotherapy should contribute significantly to the treatment strategy in patients with multidrug-resistant tumours. (orig.)

  18. Magnetic resonance Imaging (MRI) and technetium-99m-methoxyisonitrile (MIBI) scintigraphy to evaluate the abnormal parathyroid gland and PEIT efficacy for secondary hyperparathyroidism

    Wada, Akihiko; Sugihara, Masaki; Sugimura, Kazuro [Shimane Medical Univ., Izumo (Japan); Kuroda, Hiroyuki

    1999-08-01

    Percutaneous ethanol injection therapy (PEIT) of the abnormal parathyroid gland is an effective treatment in patients with chronic renal failure with dialysis that tends to be unresponsive to medication. To evaluate the efficacy of PEIT, we investigated the correlation between serum intact PTH (iPTH), and the findings of MR imaging and {sup 99m}Tc-MIBI scintigraphy. PEIT was performed 32 times in 24 patients with secondary hyperparathyroidism. Both MR imaging and MIBI scintigraphy were performed before and after PEIT. The detectability of parathyroid lesions was evaluated by MRI and MIBI scintigraphy with reference to ultrasound (B-mode) findings (as a standard) and the comparison of each treatment was done between imaging changes and serum iPTH levels. In the small parathyroid glands (<0.5 ml with US), MR images detected abnormal glands in 74.0% (20/27), and MIBI accumulation was observed in 40.7% of the cases. Whereas, MR images and MIBI showed similar detectability (95.0% vs. 90.0%) to large parathyroid glands ({>=}0.5 ml with US). After PEIT, glands in which ethanol was successfully injected showed decreased signal intensity on T2-weighted images and decreased accumulation of MIBI. MR imaging and MIBI scintigraphy showed almost equivalent high sensitivity in evaluating therapeutic changes (73.3% vs. 76.4%) according to our evaluation category of more than 30% reduction of iPTH as effective. However, the specificity of MR imaging was much higher (100%) than that of MIBI scintigraphy in evaluating therapeutic effects. In conclusion, MRI provided better detectability of abnormal parathyroid glands than {sup 99m}Tc-MIBI scintigraphy. The reduction of high signal intensity area after PEIT on T2-weighted MR images is considered an useful therapeutic evaluation guideline than the reduction of MIBI accumulation on scintigraphy. (author)

  19. Sympathetic reinnervation in cardiac transplants: 123I-MIBG and 201Tl/99mTc-MIBI scintigraphy

    Iodine-123 metaiodobenzylguanidine (123I-MIBG) is a norepinephrine (NE) analogue and taken up by myocardial sympathetic nerves. To determine whether cardiac sympathetic reinnervation occurs after orthotopic heart transplantation (TPL). We performed 24 serial or followup cardiac 123I-MIBG imaging and 201T1/99mTc-MIBI dipyridamole stress gated myocardial perfusion SPECT (g-MPS) in 15 pts(M : F =10 : 5; mean ages = 34.67±12.92 yr; idiopathic: rheumatic=14:1) (10.80±11.88 (1-48) mo) after TPL. 123I-MIBG imagins were performed in anterior position 15 minutes, 4 and 24 hours after i.v. injection of 148 MBq 123I MIBG. Image quantitation was based on the ratio of heart to mediastinal MIBG uptake (HMR). 12 subjects with 1 year after TPL whereas reinnervation is less likely to occur in pts with a pretransplantation diagnosis idiopathic cardiomyopathy

  20. The key role of 99mTc-MIBI SPECT/CT in the diagnosis of parathyroid adenoma: a case report.

    Li, Qing; Pan, Jiemin; Luo, Quanyong; Wang, Yan; Bao, Yuqian; Jia, Weiping

    2015-06-01

    The concomitant occurrence of primary hyperparathyroidism (PHPT) due to parathyroid adenoma and papillary thyroid carcinoma (PTC) is not common. The co-occurrence of parathyroid tumors and thyroid diseases can lead to misdiagnosis owing to mutual interference of imaging in the early period of disease. The most commonly used imaging techniques for the preoperative localization of parathyroid and thyroid adenomas are technetium-99m sestamibi (99mTc-MIBI) scintigraphy and ultrasonography of the neck. Recently, 99mTc-MIBI single-photon emission computed tomography associated with computed tomography scintigraphy (SPECT/CT) has been used to detect PHPT, and its diagnostic value is being evaluated. Herein, we report a patient with an unusual co-occurrence of parathyroid adenoma and multiple thyroid diseases, including papillary thyroid carcinoma, thyroid adenoma and lymphocytic thyroiditis, which were localized with 99mTc-MIBI SPECT/CT and confirmed surgically. We suggest that 99mTc-MIBI SPECT/CT can play an important role in the diagnosis of parathyroid and thyroid lesions. PMID:26154096

  1. The key role of 99mTc-MIBI SPECT/CT in the diagnosis of parathyroid adenoma: a case report

    The concomitant occurrence of primary hyperparathyroidism (PHPT) due to parathyroid adenoma and papillary thyroid carcinoma (PTC) is not common. The co-occurrence of parathyroid tumors and thyroid diseases can lead to misdiagnosis owing to mutual interference of imaging in the early period of disease. The most commonly used imaging techniques for the preoperative localization of parathyroid and thyroid adenomas are technetium-99m sestamibi (99mTc-MIBI) scintigraphy and ultrasonography of the neck. Recently, 99mTc-MIBI single-photon emission computed tomography associated with computed tomography scintigraphy (SPECT/CT) has been used to detect PHPT, and its diagnostic value is being evaluated. Herein, we report a patient with an unusual co-occurrence of parathyroid adenoma and multiple thyroid diseases, including papillary thyroid carcinoma, thyroid adenoma and lymphocytic thyroiditis, which were localized with 99mTc-MIBI SPECT/CT and confirmed surgically. We suggest that 99mTc-MIBI SPECT/CT can play an important role in the diagnosis of parathyroid and thyroid lesions. (author)

  2. The key role of {sup 99m}Tc-MIBI SPECT/CT in the diagnosis of parathyroid adenoma: a case report

    Li, Qing; Pan, Jiemin; Luo, Quanyong; Wang, Yan; Bao, Yuqian; Jia, Weiping, E-mail: wpjia@sjtu.edu.cn, E-mail: wpjia@yahoo.com [Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China)

    2015-06-15

    The concomitant occurrence of primary hyperparathyroidism (PHPT) due to parathyroid adenoma and papillary thyroid carcinoma (PTC) is not common. The co-occurrence of parathyroid tumors and thyroid diseases can lead to misdiagnosis owing to mutual interference of imaging in the early period of disease. The most commonly used imaging techniques for the preoperative localization of parathyroid and thyroid adenomas are technetium-99m sestamibi ({sup 99m}Tc-MIBI) scintigraphy and ultrasonography of the neck. Recently, {sup 99m}Tc-MIBI single-photon emission computed tomography associated with computed tomography scintigraphy (SPECT/CT) has been used to detect PHPT, and its diagnostic value is being evaluated. Herein, we report a patient with an unusual co-occurrence of parathyroid adenoma and multiple thyroid diseases, including papillary thyroid carcinoma, thyroid adenoma and lymphocytic thyroiditis, which were localized with {sup 99}mTc-MIBI SPECT/CT and confirmed surgically. We suggest that {sup 99m}Tc-MIBI SPECT/CT can play an important role in the diagnosis of parathyroid and thyroid lesions. (author)

  3. Frequency and severity of myocardial perfusion abnormalities using Tc-99m MIBI SPECT in cardiac syndrome X

    Cardiac syndrome X is defined by a typical angina pectoris with normal or near normal (stenosis <40%) coronary angiogram with or without electrocardiogram (ECG) change or atypical angina pectoris with normal or near normal coronary angiogram plus a positive none-invasive test (exercise tolerance test or myocardial perfusion scan) with or without ECG change. Studies with myocardial perfusion imaging on this syndrome have indicated some abnormal perfusion scan. We evaluated the role of myocardial perfusion imaging (MPI) and also the severity and extent of perfusion abnormality using Tc-99m MIBI Single Photon Emission Computed Tomography (SPECT) in these patients. The study group consisted of 36 patients with cardiac syndrome X. The semiquantitative perfusion analysis was performed using exercise Tc-99m MIBI SPECT. The MPI results were analyzed by the number, location and severity of perfusion defects. Abnormal perfusion defects were detected in 13 (36.10%) cases, while the remaining 23 (63.90%) had normal cardiac imaging. Five of 13 (38.4%) abnormal studies showed multiple perfusion defects. The defects were localized in the apex in 3, apical segments in 4, midventricular segments in 12 and basal segments in 6 cases. Fourteen (56%) of all abnormal segments revealed mild, 7(28%) moderate and 4 (16%) severe reduction of tracer uptake. No fixed defects were identified. The vessel territories were approximately the same in all subjects. The Exercise treadmill test (ETT) was positive in 25(69%) and negative in 11(30%) patients. There was no consistent pattern as related to the extent of MPI defects or exercise test results. Our study suggests that multiple perfusion abnormalities with different levels of severity are common in cardiac syndrome X, with more than 30 % of these patients having at least one abnormal perfusion segment. Our findings suggest that in these patients microvascular angina is probably more common than is generally believed

  4. Are there any differences in uptake of Tc-99m MIBI and tetrofosmin between cancer cells expressing P-glycoprotein and MDR-related protein?

    Uptake of Tc-99m MIBI and Tc-99m tetrofosmin(TF) in two multidrug resistance cells, human colon cancer HCT/CLO2 cells expressing P-glycoprotein(Pgp) and non-small cell lung cancer A549 cells showing multidrug-resistance related protein(MRP) in vivo. RT-PCR Western blot analysis and immunohistochemistry(IHC) were used to detect Pgp and MRP. Cellular uptake of MIBI and TF was measured with single cell suspension of HCR/CLO2 and 549 cells. Cells were inoculated in flanks of 24 nude mice. Group 1 (Gr1) and Gr3 mice were injected with only MIBI or TF, and Gr2 and Gr4 mice were treated with cyclosporin A(CsA) before injection of MIBI or TF. Mice were sacrificed at 10, 60 and 240-min after tracer injection. Radioactivities of organs and tumors were measured. 549 cells expressed MRPr1 protein detected by Western blot and IHC staining of tumor tissue at cell membrane but not Pgp, A549/CLO2 was vice versa. Cellular uptake and % increases with CsA were higher for MIBI than TF for both cells in vitro. Animal studies showed that MIBI and TF uptake were progressively increased by time in both Pgp(+) HCT/CLO2 tumor and MRP(+) A549 cells in both Gr1 and Gr3. There were no significant differences in tumoral uptake of MIBI and TF between Grl and Gr3 for both cells except higher MIBI uptake in Pgp cells at 60-min. % increases of MIBI (111% at 10 min, 220% at 60 min, 426% at 240 min) and TF uptake (186% at 10 min 579% at 60 min, 390% at 240 min) were progressively increased with time up to 240-min with CsA % increases of MIBI (114% at 10 min, 257% at 60 min 396% at 240 min) and TF uptake (110% at 10 min, 205% at 60 min, 410% at 240 min) were similar with those in HCT/CLO2 tumor. There were no differences in MIBI and TF uptake between Pgp and MRP tumors. Although MIBI showed better MDR reversal effect of modulator CsA than TF in vitro, there were no differences for both tumors in vivo. MIBI and TF are suitable tracers for imaging Pgp and MRP-mediated drug resistance in cancers

  5. Are there any differences in uptake of Tc-99m MIBI and tetrofosmin between cancer cells expressing P-glycoprotein and MDR-related protein?

    Seo, J. H.; Yoo, J. A.; Seo, M. R.; Bae, J. H.; Jeong, S. Y.; Ahn, B. C.; Lee, K. B.; Lee, J [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2004-07-01

    Uptake of Tc-99m MIBI and Tc-99m tetrofosmin(TF) in two multidrug resistance cells, human colon cancer HCT/CLO2 cells expressing P-glycoprotein(Pgp) and non-small cell lung cancer A549 cells showing multidrug-resistance related protein(MRP) in vivo. RT-PCR Western blot analysis and immunohistochemistry(IHC) were used to detect Pgp and MRP. Cellular uptake of MIBI and TF was measured with single cell suspension of HCR/CLO2 and 549 cells. Cells were inoculated in flanks of 24 nude mice. Group 1 (Gr1) and Gr3 mice were injected with only MIBI or TF, and Gr2 and Gr4 mice were treated with cyclosporin A(CsA) before injection of MIBI or TF. Mice were sacrificed at 10, 60 and 240-min after tracer injection. Radioactivities of organs and tumors were measured. 549 cells expressed MRPr1 protein detected by Western blot and IHC staining of tumor tissue at cell membrane but not Pgp, A549/CLO2 was vice versa. Cellular uptake and % increases with CsA were higher for MIBI than TF for both cells in vitro. Animal studies showed that MIBI and TF uptake were progressively increased by time in both Pgp(+) HCT/CLO2 tumor and MRP(+) A549 cells in both Gr1 and Gr3. There were no significant differences in tumoral uptake of MIBI and TF between Grl and Gr3 for both cells except higher MIBI uptake in Pgp cells at 60-min. % increases of MIBI (111% at 10 min, 220% at 60 min, 426% at 240 min) and TF uptake (186% at 10 min 579% at 60 min, 390% at 240 min) were progressively increased with time up to 240-min with CsA % increases of MIBI (114% at 10 min, 257% at 60 min 396% at 240 min) and TF uptake (110% at 10 min, 205% at 60 min, 410% at 240 min) were similar with those in HCT/CLO2 tumor. There were no differences in MIBI and TF uptake between Pgp and MRP tumors. Although MIBI showed better MDR reversal effect of modulator CsA than TF in vitro, there were no differences for both tumors in vivo. MIBI and TF are suitable tracers for imaging Pgp and MRP-mediated drug resistance in cancers.

  6. Internal Dosimetry and the pharmacokinetic of the Cuban Kit of Methoxy-Isobutyl-Isonitrile (MIBI) marked with 99mTc

    The objective of the present work consisted on evaluating the Internal Dosimetry and the pharmacokinetic of the Cuban Kit of Methoxy-Isobutyl-Isonitrile (MIBI) marked with 99mTc. In the dosimetry studies and biodistribution five healthy volunteers were included and in the pharmacokinetic studies five patients were included with less than 5% of probability of suffering illness of artery coronary

  7. A comparative study of primary coronary stenting with intravenous thrombolysis for acute myocardial infarction using 99mTc-MIBI SPECT imaging

    To evaluate and compare the therapeutic effectiveness of primary coronary stenting with that of intravenous thrombolysis for acute myocardial infarction (AMI) using 99mTc-MIBI myocardial SPECT imaging. A total of 42 patients with AMI was undergoing primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis groups 19 patients). 99mTc-MIBI myocardium SPECT imaging was performed before and 1 week after stenting or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99mTc-MIBI uptake was expressed with a five-point scoring system. The scores of scanning before stenting or intravenous thrombolysis was SBS. The scores of scarring after stenting or intravenous thrombolysis was SAS. Deducting SAS from SBS was SDS. Make a comparison between the SAS. stenting group and fhrombolysis group: SBS was 41.3±9.8 and 39.4±7.9 (t=1.2, P>0.05); SAS was 17.8±6.4 and 27.3±6.7 (t=5.8, P99mTc-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and intravenous thrombolysis in treatment of AMI. At the same time;, the results indicate that primary coronary stenting seems to be more effective than intravenous thrombolysis

  8. Clinical assessment of myocardial viability by stress-reinjection 201Tl/rest 99mTc-MIBI dual-isotope imaging strategy

    Objectives: To assess area and severity of myocardial ischemia and myocardial viability by dobutamine stress-reinjection 201Tl/ rest 99mTc-MIBI dual-isotope myocardial perfusion tomography. Methods: The study included 35 patients who underwent tress-reinjection 201Tl/ rest 99mTc-MIBI dual-isotope SPECT and coronary angiography (CAG). Dobutamine stress was carried out 20 min after 99mTc-MIBI was injected intravenously at rest, then 201Tl was administrated intravenously, and dual-isotope SPECT was performed instantly. Because both of stress 201Tl and rest 99mTc-MIBI imaging showed area of defect radioactivity, 1mCi 201Tl was reinjected at rest, dual-isotope SPECT was performed again 4 hours later. Results: (1) of 86 segments showing defected activity, 54 segments were fill with radioactivity and the other 32 segments were not improved after 201Tl was reinjected. (2) All of 35 patients, 9 patients were normal and 26 patients were abnormal by coronary angiography (one cronory artery stenosis in 2 patients, 2 coronary arteries stenosis in 7 patients, 3 coronary arteries stenosis in 17 patients.). There were 17 patients with 50-75% coronary stenosis, 3 patients with 75-85% coronary stenosis and 15 patients with more than 85% coronary stenosis. The stenosis coronary arteries detected by coronary angiography were consistent with those detected by tress-reinjection 201Tl/ rest 99mTc-MIBI dual-isotope SPECT. (3) Assessed by stress-reinjection 201Tl/ rest 99mTc-MIBI dual-isotope SPECT, all ischemic cardiac muscles in 26 patients with CAD were viable. Of 26 CAD patients, 2 patients underwent PTCA, 2 patients underwent PCI, 6 patients underwent CABG in two or more vessels, 1 patient was treated with thrombolysis, the other 15 patients received medical treatment. (4) 14 segments with defect activity were detected by myocardial imaging in 9 normal patients by CAG. Of them, 5 segments were in lateral wall, 3 segments in anterior wall, 7 segments in septal wall near basement. 11

  9. Diagnostic accuracy of quantitative 99mTc-MIBI scintimammography according to ROC curve analysis

    Kim, J. H.; Lee, H. K.; Seo, J. W.; Cho, N. S.; Cha, K. H.; Lee, T. H. [Gachon Medical College, Gil Medical Center, Inchon (Korea, Republic of)

    1998-07-01

    99mTc-sestamibi scintimammography (SMM) has been shown to be a useful diagnostic test in the detection of breast cancer and the receiver operating characteristic (ROC) curve analysis provides detailed information of a diagnostic test. The purpose of this study was to evaluate the feasibility and efficacy of quantitative indices of SMM in the detection of malignant breast lesions according to ROC analysis. Prone anterior, lateral planar and supine SPECT imagings were performed on 75 female patients (mean age=43.4 yr) with breast mass (size{>=}0.8cm) after intravenous injection of 20-30 mCi 99mTc-sestamibi. 45 Malignant (Invasive ductal ca(36), Inv lobular ca(5), Inv duc + lob (1), Inv tubular ca (3)) and 30 benign (fibroadenoma (13), fib cyst(12), Fat necrosis(3), papilloma(1), paraffinoma (1)) lesions were histologically proven. Data were analyzed by creating three regions of interest (ROIs) over designated areas: lesion, normal breast and right chest wall. Lesion to normal (L/NL) and lesion to chest wall (L/CW) ratios were calculated for each patient both on the planar and SPECT. The area under the ROC curve (AUC) was calculated and compared among four semiquantitative indices and an average scintimammographic index (SMM(mean)) from arithmatic mean. ROC curve analysis revealed planar L/N, SPECT L/N and L/CW ratios provide comparable better diagnostic accuracies for detection of breast cancer than planar L/CW ratio (p<0.05), respectively. For quantitative SMM of 75 lesions, malignancy rate was 60%, and Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy were 0.78, 0.77, 0.84, 0.72 and 0.77, respectively. Quantitative SMM is an useful objective method for differentiating malignant from benign breast lesions.

  10. Assessment of the efficiency of ECG-Gated99mTc-MIBI SPECT for the evaluation of myocardial viability

    In the field of nuclear cardiology, various methods have been employed to evaluate myocardial viability. It is more challenging when one wants to evaluate viability in the hibernating myocardium. Electrocardiographic (ECG)-gated Tc-MIBI SPECT has the unique capability of evaluating both perfusion and ventricular function (wall motion and thickness), simultaneously. We studied forty patients with coronary artery disease who had positive previous history of myocardial infraction. They all underwent ECG-gated99mTc-MIBI SPECT before and 2-3 months after coronary artery bypass rafting (CAB G). Global ejection fraction, segmental myocardial perfusion and ventricular wall motion were compared before and after operation. Assessment of perfusion, alone, in some myocardial segments such as apical, mid and basal segments of septum-demonstrated no statistical meaningful difference. There was no significant changes in septal wall motion. The pre and post operative mean ventricular ejection (E F) were 51.35% and 51%, respectively. (p=0/85). Regarding the severity of perfusion defeat as the only criterion for viability, a number of the myocardial segments were preoperatively evaluated as non-viable, that was not in agreement with the post-operative results, (in other words the myocardial viability was underestimated). Based on dual criteria (perfusion and wall motion) all the myocardial walls were viable on both pre and post operative scintigrams. We concluded that severity of myocardial perfusion defect was not a perfectly accurate rit erion for myocardial viability. Also ejection fraction was not appropriate for the evaluation of ventricular functional improvement after CAB G

  11. Evaluation of parathyroid imaging methods with {sup 99m}Tc-MIBI. The comparison of planar images obtained using a pinhole collimator and a parallel-hole collimator

    Fujii, Hirofumi; Iwasaki, Ryuichiro; Hashimoto, Jun; Nakamura, Kayoko; Kunieda, Etsuo; Sanmiya, Toshikazu; Kubo, Atsushi [Keio Univ., Tokyo (Japan). School of Medicine; Ogawa, Koichi; Inagaki, Kazutoshi

    1999-07-01

    Parathyroid scintigraphy with {sup 99m}Tc-MIBI was performed using two kinds of collimators, namely, a pinhole one and a parallel-hole one, to evaluate which one was more suitable for the detection of hyperfunctioning parathyroid lesions. In the studies using {sup 99m}Tc source, the pinhole collimator showed better efficiency and spatial resolution in the distance where the parathyroid scan are actually performed. In the phantom study, the nodular activities modeling parathyroid lesions were visualized better on the images obtained using the pinhole collimator. In clinical studies for 30 patients suspicious of hyperparathyroidism, hyperfunctioning parathyroid nodules were better detected when the pinhole collimator was used. In conclusion, the pinhole collimator was thought to be more suitable for parathyroid scintigraphy with {sup 99m}Tc-MIBI than the parallel-hole collimator. (author)

  12. Radionuclide assessment of lower limb perfusion using 99mTc-MIBI in early stages of atherosclerosis

    The aim of the work was a scintigraphic evaluation of regional blood supply of thigh and calf muscles using 99mTc-MIBI as a radiopharmaceutical, in early stages of atherosclerosis revealed during ultrasonographic examination of lower limbs, in patients without typical clinical symptoms of chronic ischaemia of lower limbs and with preserved normal Doppler spectrum of blood flow. Moreover, basic relations between early signs of lower limb atherosclerosis and abnormal myocardial perfusion, as well as asymptomatic hypoperfusion of lower limbs, were analysed. Stress and rest radionuclide study of lower limb muscles and myocardium using 99mTc-MIBI was performed in 47 men, who were divided into two groups based on ultrasonography results. The first group (group I) comprised 22 patients with early atherosclerotic changes in peripheral vessels and the second (group II) comprised 25 people with normal arteries. For the purposes of quantification of study results normal values of regional blood supply and indices of asymmetry at levels of thighs and calves, as proposed by Segall et al., were applied. Myocardial scintigrams were evaluated according to widely accepted rules (visual and semi quantitative ? normative analysis). Mean values of stress and rest perfusion indices of thighs as well as calves in gr. I were statistically significantly lower (p < 0.001) than in gr. II. Incidence of asymmetry in the stress perfusion of calves and thighs was statistically significantly higher (p = 0.04) in patients with atherosclerotic changes as compared with the control group. Abnormal myocardial perfusion was found in 77% of patients from group I and in 28% from group II (p = 0.001). Reversible, stress induced ischaemia was found in 59% and 16%, resp. (p = 0.01). 1. Radionuclide study revealed a reduced stress as well as rest perfusion of lower limb muscles in clinically asymptomatic patients with atherosclerotic changes of lower limb vessels of low degree and a preserved normal Doppler

  13. Quantitative comparison of dobutamine and exercise stress 99mTc-MIBI myocardial SPECT in diagnosis of coronary artery disease

    Aim: To compare the value of dobutamine and exercise stress 99mTc-MIBI myocardial imaging in diagnosis of coronary heart disease (CHD). Material and Methods: The subjects included twenty-one patients, in whom 18 were suspected with CHD and 3 were clinically diagnosed with myocardial infarction. The final diagnosis in all patients was confirmed by coronary angiography. Both dobutamine stress (DOB-ST) and bicycle exercise stress (EX-ST) 99mTc-MIBI myocardial perfusion SPECT were undertaken in every patient. The two stress imaging in one patient were performed within three days. Results: Twenty-four vessels in fourteen patients were diagnosed with coronary artery disease. There were no significant difference between DOB-ST and EX-ST in overall sensitivity (92.8% vs 92.8%), specificity (71.4 vs 85.7%), positive predictive value (86.7% vs 92.9%) and negative predictive value (83.3 vs 85.7%). There were also no significant difference in the sensitivity and specificity for detecting single or multiple vessel disease and for detecting specified vessel lesions (LDA, RCA, LCX). However, in 69 segments which related to the diseased vessels DOB-ST revealed 47 ischemic segments and EX-ST found 30 ischemic segments (P<0.05). The ischemic size which was expressed by the percentage of black-out area in polar map were bigger in DOB-ST image than that in EX-ST image (22.8±11.4% vs 17.5±12.3%, P<0.01) and, average radioactivity uptake ratio of ischemic region in DOB-ST image was lower than that in EX-ST image (43.2±13.8% vs 57.4±14.6%, P<0.01). Conclusion: DOB-ST demonstrated similar diagnostic efficacy to EX-ST in detecting coronary artery disease, thus it may be a feasible intervention for myocardial perfusion imaging. Whether DOB-ST is more sensitive to detect mild ischemia than EX-ST remains to be further investigated

  14. Scintimammography with 99mTc-MIBI and magnetic resonance imaging in the evaluation of breast cancer

    This study was performed to evaluate the sensitivity and specificity of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) scintimammography (SMM) and contrast-enhanced magnetic resonance imaging (MRI) in patients with breast masses, using the histological findings as the gold standard. Forty-five consecutive patients with a breast lesion, detected by self-examination, physical examination or screening mammography, underwent SMM and MRI. In 38 cases (84.5%), the histopathology was malignant; the breast cancers ranged from 3 to 100 mm in diameter (mean 22 mm). In the overall patient group, MRI showed a slightly higher sensitivity than SMM (92% vs 84%), but SMM showed a better specificity: 71% vs 42%. The accuracy was 82% and 84% for SMM and MRI respectively. To evaluate the influence of lesion size on the results, patients with lesions ≤20 mm and ≤15 mm were examined. In patients with lesions ≤20 mm, the sensitivity of SMM and MRI decreased to 64% and 82% respectively, while SMM again displayed considerably better specificity: 83% vs 50% for MRI. The accuracy of SMM and MRI was 64% and 82% respectively. In patients with lesions ≤15 mm, SMM again showed better specificity (75% vs 50%), while MRI displayed better sensitivity and accuracy (sensitivity, 81% vs 62%; accuracy, 75% vs 65%). In this study the specificity of SMM in patients with breast lesions was thus superior to that of MRI. The combination of SMM and MRI may be used in those patients with equivocal findings at mammography and ultrasound to reduce the number of unnecessary surgical biopsies. (orig.)

  15. Prediction of response to chemotherapy in locally advanced breast cancer patients using Tc-99m MIBI scintimammography

    Locally advanced breast cancer is a common presentation in our part of the world. Down staging of the disease followed by surgery and further therapy has shown to prolong survival in such patients. Early prediction of response to therapy and chemo-resistance is of vital importance to ensure better outcome. The study was done to evaluate the possible role of Tc-99m MIBI scintimammography (MSM) in reliable and early prediction of response to therapy through tracer dynamics of the tumor. Response assessment through clinical criteria and other available modalities was also compared. 16 female patients were evaluated through dynamic and static prone MSM performed before and after two cycles of chemotherapy. Decay corrected washout curves were generated by drawing regions of interest (ROIs) all around the tumor. The tracer washout kinetics of the tumor were studied through half life estimation and tracer retention at 60 minute with reference to peak activity on pre and post therapy studies. Results were subjected to statistical analysis. There was a good correlation between the clinical assessment and dynamic MSM findings in good responders while the dynamic MSM was able to provide better information in poor responders. The results conclude that using tracer kinetics of MSM, early and reliable prediction of response to therapy and chemo-resistance may be possible

  16. Evaluation of portal circulation in animal model experiments using {sup 99m}Tc-MIBI per rectum

    Xu Lanwen; Chen Shaoliang; Chen Xuefen; Jin Gang; Zhao Huiyang; Qing Xingyu [Shanghai Medical Univ., SH (China); Tonami, Norihisa

    1995-03-01

    A series of animal models for portal hypertension was prepared using the method of portal vein constriction. Four New Zealand domestic rabbits and six dogs were given portal imaging by per-rectal administration of {sup 99m}Tc-MIBI and characteristics of quantitative portal hypertension were investigated. When the portal of domestic rabbits were constricted to 1/2, the heart/liver value (H/L) rose from 0.10{+-}0.04 to 0.57{+-}0.11, and the heart shunt index (S.I.h) rose from 0.08{+-}0.03 to 0.36{+-}0.09. These differences have significant meanings (p<0.05). The shunt index for whole organs (S.I.w), however, only changed slightly. When the portal veins of the dogs were constricted to 1/3, 1/2 and 2/3 of their original widths, their H/L, S.I.h and S.I.w values rose in proportion respectively, and their correlation with the portal pressure measured during operation was very good. Immediately after the operation, the main feature observed was the compensational swelling of the spleen. One month later, image of the heart became even more conspicuous, demonstrating formation and establishment of the collateral circulation. (author).

  17. Scintimammography with {sup 99m}Tc-MIBI versus dynamic MRI for non-invasive characterization of breast masses

    Imbriaco, M.; Del Vecchio, S.; Pace, L. [Nuclear Medicine Center of the National Research Council (CNR), University Napoli (Italy); Riccardi, A.; Di Salle, F.; Di Gennaro, F.; Salvatore, M.; Sodano, A. [Department of Biomorphological and Functional Sciences, University ' ' Federico II' ' , Napoli (Italy)

    2001-01-01

    Although mammography remains the technique of choice for the early detection of breast cancer, several imaging techniques, including scintimammography and magnetic resonance imaging (MRI), have recently been proposed as adjuncts for this purpose and included in many diagnostic protocols. This study was undertaken to assess the clinical accuracy of scintimammography with technetium-99m methoxyisobutylisonitrile (MIBI) and contrast-enhanced MRI in the detection of primary breast carcinoma in patients with equivocal mammographic findings. Forty-nine patients with a suspicious breast mass detected either by physical examination or by mammography and ultrasound (US) were studied. All patients underwent scintimammography and dynamic contrast-enhanced MRI 1 week apart. The results of the two techniques were compared and correlated to the final diagnoses. Two independent readers reported the scans using a four-point confidence scale. The areas under the receiver operator characteristic (ROC) curves were obtained. Scintimammography showed an accuracy for tumour detection of 84%, with a sensitivity of 80% and a specificity of 88%. MRI showed an accuracy of 86%, with a sensitivity and specificity of 96% and 75%, respectively. Comparison of the two areas under the ROC curves showed no significant differences between MRI, 0.91{+-}0.05 (mean{+-}SD), and scintimammography, 0.88{+-}0.05 (P=0.9). It is concluded that dynamic MRI and scintimammography possess comparable accuracy in the diagnosis of primary breast carcinoma in patients with equivocal mammographic or US findings. (orig.)

  18. Myocardial perfusion scintigraphy with technetium 99m-MIBI in the diagnosis of coronary artery disease in women

    The results of technetium 99m - methoxy-isobutyl-isonitrile scintigraphy in a one-day protocol: rest - physical or combined stress bicycle plus endovenoous dipyridamole were compared with those of coronary angiography in 20 women referred for the evaluation of pre cordial pain and of the usefulness of myocardial perfusion scintigraphy. The uptake of the radio drug under stress and at rest varied from 93 +-9 to 94 +- 7 % in the 204 segments with normal uptake under stress, from 67 He articulates it analyzes the reasons or utility of the employment of the radioactive iodine in the diagnosis and treatment of the thyroid affections +- 9 to 75 +- 17 % in the 89 with moderate reduction, and from 33 +- 9 to 64 +-28 % in the 27 with severe reduction. The qualitative and quantitative uptake analyses coincided in 18 patients. The perfusion scintigraphy and the angiography agreed in 70 % of the patients. It was concluded that the myocardial perfusion scintigraphy with technetium 99-MIBI contributes to the diagnosis of the coronary artery disease in women

  19. A trial for the quantification of regional myocardial blood flow with continuous infusion of Tc-99m MIBI and dynamic SPECT

    We propose a new method to quantify regional myocardial blood flow (rMBF) by continuous infusion of Tc-99m MIBI and dynamic SPECT. Five patients with old myocardial infarction were studied. During continuous infusion of MIBI (approximately 740 MBq) with a syringe pump in 10 min, dynamic SPECT scan was performed every minute and lasted 20 min after the start of infusion to identify myocardial uptake of MIBI. Input function was obtained from the radioactivity in the left ventricle (LV) in dynamic SPECT images. Spillover fraction between LV and myocardium (M) was corrected with phantom data. The influx constant (Ku) was calculated by Patlak plot graphical analysis, and compared with rMBF measured by PET (F) with N-13 ammonia based on Patlak plot analysis with correction for the extraction fraction. To correct the limited first-pass extraction of MIBI, linearization correction by means of the permeability-surface area (PS) product value was also applied. Spillover fractions of MIBI were 0.169±0.056 from LV to M, and 0.042±0.021 from M to LV. Ku was well correlated with F (Ku=0.057+0.220F, r=0.83, pMIBI=-0.131+0.858F, r=0.94, p<0.01). The proposed method has the potential to be a clinically feasible tool for quantitative measurement of rMBF. (author)

  20. Localization of parathyroid adenoma by echography and scintigraphy with {sup 99m}Tc-MIBI: the influence of lesion`s weight; Localisation de l`adenome parathyroidien par echographie et scintigraphie au {sup 99m}Tc-MIBI: influence du poids de la lesion

    Venault, S.; Denizot, B.; Morel, O.; Le Jeune, J.J.; Jallet, P. [Service de Medecine Nucleaire du CHU d`Angers (France)

    1997-12-31

    In the examination for pre-surgery localization of a primary hyperparathyroidism (HPT I), the size of parathyroid lesion constitutes the main factor limiting the diagnostic efficiency of different imaging techniques. We have tried to test this hypothesis by echography and scintigraphy with MIBI for the detection of unique adenomas. The study covered 16 patients explored pre-surgically by echography and scintigraphy with {sup 99m}Tc-MIBI for a HPT I as referred to a unique cervical adenoma (reference = surgery + anatomical-pathological examination). The scintigraphy with MIBI is achieved and interpreted by the `double phase` technique proposed by Taillefer with pin-hole acquisition of 15 and 120 minutes after injection of around 370 MBq of {sup 99m}Tc-MIBI. The average weight of adenoma is 3180 mg (218 to 22000). The echography localizes correctly the adenoma in 8 cases, in a wrong position, in 2 cases and does not find images evoking abnormal parathyroid in 6 patients. The MIBI visualizes properly the adenoma in 15 cases and in an incorrect position, in 1 patient. A table is given presenting the echography and MIBI-scintigraphy sensitivities as a function of adenoma weights. In conclusion, in our study the MIBI appear to be more sensitive than the echography in localizing the parathyroid adenoma. The diagnostic value of the two examinations appears to be independent of its weight; however, the results should be confirmed on larger batches

  1. Dual-phase 99mTc-MIBI scintigraphy with delayed neck and thorax SPECT/CT and bone scintigraphy in patients with primary hyperparathyroidism. Correlation with clinical or pathological variables

    The purpose of this study was to assess the relationship between 99mTc-MIBI and 99mTc-MDP bone scintigraphy and clinical or pathological variables, including preoperative serum PTH levels and tumor diameter, in patients with newly diagnosed PHPT. Dual phase 99mTc-MIBI planar scintigraphy was performed in 244 patients with PHPT. Of these patients, 155 underwent 99mTc-MDP bone scintigraphy to detect bone changes before parathyroidectomy. Factors influencing 99mTc-MIBI scintigraphy and 99mTc-MDP bone scintigraphy detection rate were assessed using univariate and multivariate logistic regression analysis; optimal cutoff values for predicting positive 99mTc-MIBI and 99mTc-MDP bone scintigraphy were evaluated using ROC analysis. Among 244 patients, 174 (71.31%) patients with 181 foci had a positive 99mTc-MIBI planar scintigraphy; delayed neck and thorax SPECT/CT could identify and locate the 99mTc-MIBI lesions but could not find more lesions than planar scintigraphy. 70 (28.69%) patients had a negative 99mTc-MIBI planar scintigraphy. Tumor diameter, serum PTH level and symptoms were statistically significant predictive factors in predicting positive 9mTc-MIBI scintigraphy both univariate and multivariate logistic regression analyses. The optimal thresholds for tumor diameter and serum PTH by ROC analysis were 1.03 cm and 127.60 ng/L, respectively. Among 155 patients with bone scintigraphy, 99mTc-MDP bone scintigraphy showed positive finding in 80 (51.61%) patients and negative finding in 75 patients. Univariate logistic regression analysis showed that patient age, sex, tumor diameter and PTH level (≥150 ng/L) were statistically significant in predicting positive 99mTc-MDP bone scintigraphy. Multivariate logistic regression analysis showed both tumor diameter and PTH ≥150 ng/L were statistically significant in predicting positive 99mTc-MDP bone scintigraphy. The optimal thresholds for tumor diameter and serum PTH by ROC analysis were 1.96 cm and 163.85 ng

  2. Thyroid nodules with indeterminate cytology: molecular imaging with {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) is more cost-effective than the Afirma registered gene expression classifier

    Heinzel, Alexander [RWTH Aachen University Hospital, Department of Nuclear Medicine, Aachen, Pauwelsstrasse 30 (Germany); Institute for Neuroscience and Medicine (INM-4), Research Centre, Juelich (Germany); Mueller, Dirk [University of Cologne, Institute for Health Economics and Clinical Epidemiology, Cologne (Germany); Behrendt, Florian F. [RWTH Aachen University Hospital, Department of Nuclear Medicine, Aachen, Pauwelsstrasse 30 (Germany); Giovanella, Luca [Institute of Southern Switzerland, Department of Nuclear Medicine Oncology, Belinzona (Switzerland); Mottaghy, Felix M.; Verburg, Frederik A. [RWTH Aachen University Hospital, Department of Nuclear Medicine, Aachen, Pauwelsstrasse 30 (Germany); Maastricht University Medical Center, Department of Nuclear Medicine, Maastricht (Netherlands)

    2014-08-15

    To compare the cost-effectiveness of {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) thyroid scintigraphy and the Afirma registered gene expression classifier for the assessment of cytologically indeterminate thyroid nodules. A decision tree model was used. Costs were calculated from the perspective of the German health insurance system. The robustness of the results was assessed with probabilistic sensitivity analyses using a Monte Carlo simulation. Life expectancy was 34.3 years (estimated costs per patient EUR1,459 - EUR2,224) for the MIBI scan and 34.1 years (estimated costs EUR3,560 - EUR4,071) for the molecular test. These results were confirmed by the Monte Carlo simulation. MIBI thyroid scintigraphy is more cost-effective than the gene expression classifier. (orig.)

  3. Thyroid nodules with indeterminate cytology: molecular imaging with 99mTc-methoxyisobutylisonitrile (MIBI) is more cost-effective than the Afirma registered gene expression classifier

    To compare the cost-effectiveness of 99mTc-methoxyisobutylisonitrile (MIBI) thyroid scintigraphy and the Afirma registered gene expression classifier for the assessment of cytologically indeterminate thyroid nodules. A decision tree model was used. Costs were calculated from the perspective of the German health insurance system. The robustness of the results was assessed with probabilistic sensitivity analyses using a Monte Carlo simulation. Life expectancy was 34.3 years (estimated costs per patient EUR1,459 - EUR2,224) for the MIBI scan and 34.1 years (estimated costs EUR3,560 - EUR4,071) for the molecular test. These results were confirmed by the Monte Carlo simulation. MIBI thyroid scintigraphy is more cost-effective than the gene expression classifier. (orig.)

  4. Relationship Between Adenosine - Induced ST Segment Depression During 99mTc-MIBI Scintigraphy and The Severity of Coronary Artery Disease

    Pharmacologic coronary vasodilation in conjunction with myocardial perfusion scintigraphy has become an alternative to dynamic exercise test for the diagnosis and risk stratification of coronary artery disease, especially in patients who are unable to perform adequate exercise. Dipyridamole and adenosine have been used for pharmacologic stress testing with myocardial perfusion imaging. Adenosine is a potent, coronary vasodilator with rapid onset of action, short half life, near maximal coronary vasodilation and less serious side effects. ST segment depression has been reported in about 7-15% of patients with coronary artery disease receiving dipyridamole in conjunction with myocardial perfusion imaging. The exact cause and clinical significance are not known. In order to evaluate the relationship between adenosine-induced ST segment depression during 99mTc-MIBI myocardial perfusion scintigraphy and the severity of coronary artery disease, we performed 99m-MIBI imaging after intravenous infusion of adenosine in 120 patients with suspected coronary artery disease. Of the 120 patients, 28 also performed coronary angiography. There were 24 patients with ST segment depression during 99mTc-MIIBI scintigraphy and 96 patients without ST segment depression. Adenosine was infused intravenously at a dose of 0.14 mg/kg per minute for 6 minutes and 99MmTc-MIB1 was injected at 3 minute. We then compared the hemodynamic changes, side effects, scintigraphic and angiographic findings. Heart rate increased 90 ± 19 beats/minute in the group with ST depression compared with 80 ±16 beats/minute in the group without ST depression(p9mTc-MIBI images were abnormal in 23(96%) patients with ST segment depression and 66(69%) patients without ST segment depression(p99mTc-MIBI myocardial perfusion scintigraphy with intravenous adenosine is related to the severity of coronary artery disease.

  5. assessment of the clinical role of simultaneous 99mTc-MIBI and 201Tl dual-isotopic myocardial perfusion SPECT imaging in the patients wit hypertension

    Objective: To study the clinical role of Simultaneous rest technetium-99m sestamibi (99mTc-MIBI) and stress thallium-201 (201Tl) Dual-isotopic myocardial perfusion SPECT imaging in the patients with hypertension. Methods: 116 patients with high blood pressure underwent simultaneous dual-isotopic myocardial perfusion SPECT imaging with 99mTc-MIBI and 201Tl. 99mTc-MIBI was injected at rest, 15 min later dobutamine was instilled into vein begin with 5 mg/kg/min, before and after instilling the base ECG, blood pressure, heart rate was recorded. when the maximal dose of Dobutamine was achieved, thallium-201 was injected, the dual-isotopic simultaneously SPECT imagine was performed. The stress and rest imagine was obtained. After tomographic reconstruction, the images were interpreted by two experienced observers without previous knowledge of results of other studies. Coronary angiography was performed in two weeks. All of 116 patients were found normal. Results: (1) All of 116 patients with high blood pressure were divided as three group by the course of disease: A group (20 year), 15. The heart/lung ratios of A, B, C group were 2.651±0.246, 2.546±0.231, 2.490±0.36 (mean±SD)respectively, no significant difference was noted among three group. Normal heart/lung ratios is 2.50±0.28 among of control group of 20. (2) The overall sensitivity for the dual-isotopic simultaneously myocardial SPECT imagine of high blood pressure was 46.55%(54/116). (3) Anterior, lateral, inferior, apex, interventricular septal segment were regarded as a whole segment, 111 segments display abnormal 201Tl uptake. 63, 30, 18 segments were in A, B, C group respectively, and no significant difference was noted among three group. 4 85 segments reveal reduced stressing 201Tl uptake and no typical redistribution was observed in the delay 201Tl imagines. 20, 24, 14, 12, 15 segments were in anterior, lateral, inferior, apex, interventricular septal segment respectively. 26 segments display inverse 201

  6. A comparison of radionuclide thyroid angiography, {sup 99m}Tc-MIBI scintigraphy and power Doppler ultrasonography in the differential diagnosis of solitary cold thyroid nodules

    Demirel, Koray; Kapucu, Oezlem [Department of Nuclear Medicine, Gazi University School of Medicine, Ankara (Turkey); Yuecel, Cem; Oezdemir, Hakan [Department of Radiology, Gazi University School of Medicine, Ankara (Turkey); Ayvaz, Goeksun [Department of Endocrinology and Metabolic Diseases, Gazi University School of Medicine, Ankara (Turkey); Taneri, Ferit [Department of Surgery, Gazi University School of Medicine, Ankara (Turkey)

    2003-05-01

    We prospectively studied 43 patients with solitary cold thyroid nodules greater than 1.5 cm in diameter to determine the comparative diagnostic value of radionuclide thyroid angiography (RTA), technetium-99m methoxyisobutylisonitrile ({sup 99m}Tc-MIBI) scintigraphy and power Doppler ultrasonography (PDUS) in the differentiation of benign and malignant thyroid nodules. Perfusion of the nodules in RTA was compared with the perfusion in the surrounding normal thyroid tissue and classified as follows: 0, avascular; 1, hypovascular; 2, isovascular; 3, hypervascular. {sup 99m}Tc-MIBI uptake in the nodules compared with that in surrounding thyroid tissue was scored for both early and delayed images as follows: 0, cold; 1, decreased; 2, equal; 3, increased. PDUS patterns were classified as nodule vascularisation patterns. The malignancy criteria were set as follows: hypervascular nodule with rapid washout in RTA; complex ring sign with anarchic structure or delta sign in PDUS, and positive retention and increased uptake in the nodule in the early and delayed {sup 99m}Tc-MIBI images. These data were compared with the histopathological results. Histology revealed thyroid carcinoma in nine patients (five cases of papillary carcinoma, three of follicular carcinoma and one of medullary carcinoma) and benign conditions in 34 patients (30 cases of nodular goitre, three of lymphocytic thyroiditis and one of follicular adenoma). Sensitivity, specificity and accuracy were, respectively, 0.89, 1.00 and 0.97 for RTA, 1.00, 0.76 and 0.81 for PDUS, and 0.67, 0.91 and 0.86 for {sup 99m}Tc-MIBI scintigraphy (when nodules with increased uptake in both the early and the delayed images and a positive retention index were considered as malignant). RTA, {sup 99m}Tc-MIBI scintigraphy and PDUS could be helpful in the preoperative assessment of solitary cold thyroid nodules. In this study, RTA was found to be the most accurate and specific method for differentiation of malignant from benign

  7. Usefulness of 99mTc-MIBI stress myocardial SPECT Bull's-eye quantification incoronary artery disease

    99mTc-methoxy-isobutyl isonitrile (MIBI) myocardial SPECT quantification performed using a Bull's-eye polar map, was evaluated and compared with visual analysis in 120 patients with proven or suspected CAD. The study series comprised 106 men and 14 women, age 37-75 years, 68 of whom had had a prior myocardial infarction. Coronary angiography was taken as the gold standard. Forty age-matched subjecs, with less than a 5% chance of having CAD, were enrolled to establish the normal database for males and females. ROC analysis was used to calculate the optimal thresholds for the definition of the disease extension in each vascular territory of the Bull's-eye polar map. Bull's-eye analysis agreed with visual analysis in 296/360 vessels. Two and three-vessel disease were most frequently observed using the Bull's-eye approach. However, a greater number of false positive (FP) cases were found with Bull's-eye than with visual analysis (28 versus 3 cases): FP cases were detected principally (21/28) in patients with previous myocardial infarction. It is interesting to note that this phenomenon, commonly observed in the LCX or RCA territory, was almost always correctly interpreted as a FP case by visual analysis. In conclusion, it is found the sensitivity and specificity for CAD diagnosis with the Bull's-eye approach to be similar to that of visual analysis, but the former method seems to be somewhat more sensitive for the localization of LAD and LCX disease. However, particular attention should be paid to patients with previous myocardial infarction, as FP cases are not infrequently observed with quantitative analysis, especially in the LCX and RCA territories

  8. Comparison of myocardial blood flows using 99mTc-MIBI myocardial SPECT and 15O-water PET

    Myocardial SPECT is widely used in the diagnosis and evaluation of coronary artery disease (CAD). However. due to the results expressed as relative values, myocardial SPECT has limitation in multi-vessel disease and diffuse CAD. Water PET is used in estimating the coronary blood flow non-invasively. In this study, we investigated the coronary blood flow relationship between myocardial SPECT and water PET. 99mTc-MIBI myocardial SPECT and 15O-water PET were done in 15 patients with suspected CAD (M:F=10:5, Mean age 61±8yrs) under conditions of rest and adenosine stress, respectively. SPECT scan was performed using low energy high resolution collimator dual head SPECT camera (Vertex EPIC, Philips-ADAC Labs, Milpitas, USA) and images were analyzed using automated software (AutoQUANT, ADAC Labs., CA, U.S.A.). PET scan was performed using ECAT EXACT camera (CTI, Knoxville, TN/ Siemens Medical System, Inc., Hoffman Estates, IL, USA). Left myocardium was extracted using ensemble independent component analysis, and the 9 ROIs were drawn (apex, 4 mid walls and 4 basal walls). Fourteen segments of myocardial SPECT excluding basal segments were matched with 9 PET segments. No correlation was found between myocardial SPECT and water PET in both rest and stress, in the analysis of a total of 135 segments. However, in the analysis of segments with myocardial blood flow under or equal to 1 ml/g/min in the stress water PET (n=22), there were statistically significant correlation between myocardial SPECT and water PET in both rest (Pearson correlation=0.58. p<0.01) and stress (Pearson correlation=0.58. p<0.01), respectively. In segments with decreased myocardial blood flow in the stress water PET, there were statistically significant correlation between myocardial SPECT and water PET, in both rest and stress

  9. Assessment of cardiac outcome in pancreas kidney transplant recipients using 99mTc-MIBI myocardial perfusion scintigraphy

    Full text: Simultaneous pancreas-kidney transplantation (SPK) in diabetic patients (patients) 99mTc-MIBI myocardial perfusion scintigraphy (MPI) in predicting cardiac outcome post SPK. One hundred and forty patients underwent SPK at our institution over a 15-year period. Sixty-six subjects were excluded because of incomplete follow-up (n=54) or death from non-cardiac causes (n=12). Seventy-four patients (44 men, 30 women) with age 44.3+/-7.4 yrs (range: 31-62yrs) were followed for up to 14 yrs post SPK. The mean interval between SPK and MPI was 48.1+/-37.1 months (median: 37.5, range: 6-132 months). MPI was performed using a standard two-day protocol with Adenosine or Dipyridamole and a dual-head gamma camera using 900 configuration, attenuation and scatter correction and resolution recovery. Images were reported by at least one experienced observer using standard software. MPI were classified as normal (n=33), infarct (n=4), small (n=32) or large (n=2) areas of impaired coronary flow reserve (CFR) or a combination of infarct and impaired CFR (n=3). Cardiac events were considered if infarct, angina, death or coronary revascularisation occurred. Two patients underwent coronary artery bypass surgery five yrs post SPK (both two yrs post MPI) and one patient developed angina six yrs post SPK (three yrs post MPI). In these patients, MPI showed only small areas of impaired CFR. The negative and positive predictive values for MPI were 100 and 9%, respectively. In summary, MPI has excellent NPV post SPK. The PPV is poor, suggesting that myocardial perfusion defects correlate only weakly with overall atherosclerotic risk profile post SPK. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  10. Planar scintimammography 99mTc-MIBI in breast cancer. Part 1. Review of literature and studies in healthy women

    After reviewing of the literature concerning 99mTc-MIBI and scintimammography (SCM) using this tracer, the results of planar technique obtained in 40 ''healthy'' women chosen from the candidates for myocardial perfusion study are presented. The aim of the study was to assess the normalcy rate, e.g. the percentage of normal images in women with minimal risk of breast cancer and the analysis the sources of potential overdiagnosis changes caused by this disease. Two observers an oncologists and a nuclear medicine physician) reviewed scintigrams of both sides of the chest (80 images) focusing on the regions where changes caused by breast cancer may happen to occur. Positive approval as normal met 95% images of the breast and subclavicular region, 82.5% of the axilla, 97% of the supraclavicular region and 96% of the parasternal region. In 2 women prominent ductal pattern was noted. In 7 cases focal uptake in the axilla was observed (on 4 in the same side as injection) and in further 7 patients increased accumulation in the infero-external part of the axilla was shown (the muscles?). In 3 patients foci of increased uptake were noted in the parasternal region. Two cases of symmetrically increased activity in suclavicular region and 1 in supraclavicular region were recognized as due to overexpression. Planar SCM is specific enough to be used in the breast cancer patients, although avoiding of overexpression of the images and caution in interpretation of the results (especially for the axilla) is recommended. Nonspecific accumulation of the tracer in various conditions may lead to false positive diagnosis, therefore an interview about trauma and possible inflammatory or vasculary changes is mandatory with the analysis of other additional results. (author)

  11. Lack of correlation between Tc-99m-sestaMIBI uptake and cadherin expression in infiltrating ductal breast carcinoma as prognostic indicators

    Despite using various kinds of prognostic indicators, it is still not possible to predict the biological behavior of breast cancer in all patients. Tc-99m-sestaMIBI (MIBI) uptake determined by breast scintigraphy and cadherin expression of tumor tissue revealed by immunohistochemistry are suggested as potential agents for this purpose. We hypothesize that there can be a correlation between MIBI whose cellular mitochondrial content is claimed to play a significant role in its tumor uptake and cadherin whose downregulation causes an increase in mitochondrial activity in human mammary carcinoma cell lines. The aim of this study was to assess the relationship between the degree of MIBI tumor uptake and cadherin expression in infiltrating ductal breast carcinoma. Correlation with response to chemotherapy and some known prognostic factors of breast cancer such as tumor size, number of metastatic axillary lymph nodes and microscopic grading was also done. Fourteen patients who underwent scintimammography and subsequent surgical excisional biopsy that revealed infiltrating ductal carcinoma were enrolled in this study. Statistical analysis did not show any correlation between MIBI uptake and cadherin expression (p>0.05). Also, no statistically significant correlation was noted between MIBI uptake and tumor size, number of metastatic lymph nodes, microscopic grade, stage of the disease or response to chemotherapy. Similarly, there was no statistically significant correlation between cadherin expression and tumor size, number of metastatic lymph nodes, microscopic grade, stage of the disease or chemotherapy response. The results of this study imply that there is no correlation between MIBI tumor uptake and cadherin expression with neither of them good enough to be used as prognostic indicators for breast cancer. (author)

  12. Relation between expression p-glycoprotein and the findings of the centellography with Tc-99m MIBI in patients with advanced mammary cancer

    We have previously shown that pre-treatment tumor uptake of 99mTc-MIBI, a transport substrate of P-glycoprotein (Pgp), is correlated to clinical response to doxorubicin-based chemotherapy in advanced breast cancer (ABC) patients. The aim of this study was to investigate the possible association between Pgp expression, MIBI uptake and clinical response to chemotherapy in breast cancer lesions. Twenty-seven lesions from 26 patients with ABC were included in the study. Pre-chemotherapy Pgp expression was investigated by immunocytochemistry. MIBI scintigraphy was performed 2-8 days prior chemotherapy. Images were acquired 10 minutes (early phase) and 60 minutes (delayed phase) post injection of 740-1110 MBq of 99mTc-MIBI. Tumor-to-normal background tissue uptake ratios were calculated in the early (T/Be) and delayed (T/Bd) phase of the study. Both ratios were significantly higher (p< 0.05) in Pgp negative (n=21) than in Pgp positive lesions (n=6). Furthermore, both ratios were higher in responder compared to non-responder lesions (T/Be 2.2 vs 1.4; T/Bd 1.8 vs 1.4; p< 0.05). All lesions with a T/Be ratio higher than 1.5 were classified as responders. No significant association was found between Pgp expression and response to chemotherapy. We concluded that MIBI scintigraphy may predict MDR1 phenotype and response to doxorubicin-based chemotherapy in ABC. Pgp expression would not be useful for predicting chemotherapy response (Au)

  13. Sympathetic reinnervation in cardiac transplants: 123I-MIBG and 201Tl/99mTc-MIBI scintigraphy

    The purpose was to evaluate cardiac sympathetic reinnervation and hemodynamic changes after orthotopic heart transplantation (TPL). We performed 24 serial or followup cardiac 123I-MIBG imaging and rest 201Tl/99mTc-MIBI dipyridamole stress gated myocardial perfusion SPECT (g-MPS) in 15 patients (M:F=10:5;mean ages=34.5±13.0 yr; idiopathic:rheumatic=14:1; one heart lung TPL)(10.80 ±11.88 (1-48) mo) after TPL 123I-MIBG imagings were performed in anterior position 15 minutes, 4 and 24 hours after i.v. injection of 148 MBq 123I MIBG. Image quantitation was based on the ratio of heart to mediastinal MIBG uptake (HMR) Compared to HMR on 15 min images (1.48 ± 0.28), neither four nor 24 hour delayed images (1.26 ± 0.23 vs. 1.06 ± 0.26: p<0.05, respectively, ANOVA) showed definite delayed localization of MIBG. 12 subjects with <13 (4.9 ±3.7) months after TPL had no visible 123I-MIBG uptake on early 15 min imaging however, 12 subjects with 13 to 48(28.6±12.8) months had visible cardiac 123I-MIBG uptake (HMR: 1.65±0.21 vs. 1.32±0.26; p=0.002). One-year followup 123I-MIBG scintigraphy in nine pts showed significantly increased HMR(1.40±0.31 to 1.61±0.16, p<0.05) but a plateau was reached at HMR value of 2.0, which was still lower than 3.0 in normal controls. Plasma NE was increased according to I-123 MIBG myocardial uptake. Annual G-MPS detected an allograft atherosclerosis in one pt and showed progressive normalization of tachycardia and significant deterioration of LVEF and cardiac indices according to severity of rejection. To dipyridamole stress, transplant heats showed significant subnormal hemodynamic responses. Partial sympathetic late reinnervation can occur <1 year after TPL, and reached a plateau of two-third of normal value. G-MPS seems to be a useful screening test for the detection of allograft atherosclerosis and rejection

  14. Sympathetic reinnervation in cardiac transplants: 123I-MIBG and 201Tl/99mTc-MIBI scintigraphy

    Kim, J. H.; Oh, S. J.; Son, M. S.; Son, J. W.; Koh, K. K.; Choi, I. S.; Shin, E. K.; Park, K. Y. [Gachon Medical College, Gil Heart Center, Inchon (Korea, Republic of)

    1998-07-01

    Iodine-123 metaiodobenzylguanidine (123I-MIBG) is a norepinephrine (NE) analogue and taken up by myocardial sympathetic nerves. To determine whether cardiac sympathetic reinnervation occurs after orthotopic heart transplantation (TPL). We performed 24 serial or followup cardiac 123I-MIBG imaging and 201T1/99mTc-MIBI dipyridamole stress gated myocardial perfusion SPECT (g-MPS) in 15 pts(M : F =10 : 5; mean ages = 34.67{+-}12.92 yr; idiopathic: rheumatic=14:1) (10.80{+-}11.88 (1-48) mo) after TPL. 123I-MIBG imagins were performed in anterior position 15 minutes, 4 and 24 hours after i.v. injection of 148 MBq 123I MIBG. Image quantitation was based on the ratio of heart to mediastinal MIBG uptake (HMR). 12 subjects with < 13 (4.91{+-}3.67) months after TPL had no visible 123I-MIBG uptake on early 15 min imaging however, 12 subjects with 13 to 48(28.58{+-}12.77) months had visible cardiac 123I-MIBG uptake (HMR: 1.65 {+-}0.21 vs. 1.32{+-}0.26 p=0.002). Correlation was found between plasma NE concentration and HMR ( r=0.80: p<0.05). Compared to HMR on 15 min images (1.48{+-}0.28), neither four nor 24 hour delayed images (1.26{+-}0.23 vs. 1.06{+-}0.10 : p<0.05, respectively, ANOVA) showed definite delayed localization of MIBG. To dipyridamole stress, transplant hearts showed significant subnormal hemodynamic responses of HR, s-BP, d-BP, and rate pressure product (90.9{+-}14.9 to 102.2{+-}15.3, 136.5{+-}17.3 to 124.9{+-}13.3, 83.3{+-}12.5 to 74.7{+-}15.6, 123.2{+-}19.4 to 127.4{+-}21.8 p<0.05, respectively). One-year followup 123I-MIBG scintigraphy in nine pts showed increased HMR (1.50{+-}0,37 to 1.61{+-}0.15, p=ns) but couldnt reach the statistical significance. Out of nine followup patients, five showed increased HMR but four didnt. gMPS performed at post-TPL 48 months in one patient complaining vague chest pain whose HMR value 1.73 to 1.62 showed an apicoanterior wall reversible perfusion defect which confirmed as 90% distal left anterior descending artery stenosis by

  15. Sensitivity of parathyroid scintigraphy with Tc99m-MIBI (two phase) for localization of parathyroid adenoma

    Hyperparathyroidism is caused by increment of serum parathyroid Hormone and parathyroid adenoma is the underling pathology in 85 to 90% of cases. In 9 to 15% of cases etiology is parathyroid Hyperplasia. Treatment is surgical resection of abnormal gland. Nuclear medicine method is one of the best methods for localization of abnormal parathyroid gland. All patients who referred for parathyroid scan to nuclear medicine department were studied. After complete history and thyroid examination, the patients were injected with 20 mCi-Tc-99m-MIBI intravenously and imaging were performed in 2 seconds intervals for 2 minutes than one minute images for 10 minutes and another 10 minutes image was recorded. Also delayed image was down at 2 hours. Forty eight patients were studied. Parathyroid scan was negative in 26 patients and positive in 22 patients. Chief complaint was general malaise in 37.8% of patients. From 14 patients who have adenoma in pathology, in 11 patients adenoma were accurately localized and 3 patients had negative scan. From 4 cases with parathyroid hyperplasia only one case had positive scan and 3 foci was detected in scintigraphy. Sensitivity of scan for diagnosis and localization of parathyroid adenoma was 78.5% and sensitivity for diagnosis of hyperplasia was only 33.3%. Serum Ca level was significantly higher inpatients with parathyroid adenoma (10.4 mg/d L) in scintigraphy compared with scan negative patients (9.5 mg/d L). (P=0.02) Respectively serum phosphorus level was 2.5 mg/d L in patients with adenoma and 3.4 mg/dl in other patients. (P=0.003). Serum T H level was 316.2 I U in patients with adenoma and 191.4 I U in other patients which was statistically significant (P=0.03). Conclusion: Parathyroid scan is recommended for all patients undergoing parathyroid surgery with respect high sensitivity for localization of parathyroid adenoma and fairly low cost. The mean serum Ca in patients with parathyroid adenoma was 10.4 mg/d L which is far less than

  16. Assessing Response Using Tc99m-MIBI Early after Interstitial Chemotherapy with Carmustine-Loaded Polymers in Glioblastoma Multiforme: Preliminary Results

    D. Cecchin

    2014-01-01

    Full Text Available Introduction. Early signs of response after applying wafers of carmustine-loaded polymers (gliadel are difficult to assess with imaging because of time-related imaging changes. Tc99m-sestamibi (MIBI brain single-photon emission tomography (SPET has reportedly been used to reveal areas of cellularity distinguishing recurrent neoplasm from radionecrosis. Our aim was to explore the role of MIBI SPET in assessing response soon after gliadel application in glioblastoma multiforme (GBM. Methods. We retrospectively reviewed the charts on 28 consecutive patients with a radiological diagnosis of GBM who underwent MIBI SPET/CT before surgery (with intracavitary gliadel placement in 17 patients, soon after surgery, and at 4 months. The area of uptake was selected using a volume of interest that was then mirrored contralaterally to obtain a semiquantitative ratio. Results. After adjusting for ratio at the baseline, the effect of treatment (gliadel versus non-gliadel was not statistically significant. Soon after surgery, however, 100% of patients treated with gliadel had a decreased ratio, as opposed to 62.5% of patients in the non-gliadel group P=0.0316. The difference between ratios of patients with radical versus partial resection reached statistical significance by a small margin P=0.0528. Conclusions. These data seem to suggest that the MIBI ratio could be a valuable tool for monitoring the effect of gliadel early after surgery.

  17. Reversal of multidrug resistance with KR-30035: evaluated with biodistribution of Tc-99m MIBI in nude mice bearing human tumor xenografts

    Kim, Jung Kyun; Lee, Jae Tae; Lee, Byung Ho [Kyungpook National Univ. Hospital, Taegu (Korea, Republic of)] [and others

    2001-06-01

    KR-30035 (KR), a new MDR reversing agent, has been found to produce a similar degree of increased Tc-99m MIBI uptake in cultured tumor cells over-expressing mdr1 mRNA compared to verapamil (VP), with less cardiovascular effects. We assessed the MDR-reversing ability of KR in vivo, and effects of various doses of KR on MIBI uptake in nude mice bearing P-glycoprotein (P-gp) positive (+) and P-gp negative (-) human tumor xenografts. P-gp (+) HCT15/CLO2 colorectal and P-gp (-) A549 non-small cell cancer cells were inoculated in each flank of 120 nude mice (20 mice x 6 groups). Group 1 (Gr1) mice received 10mg/kg Kr i.p. 3 times (x3); Gr2, 10mg/kg VP i.p. x3; Gr3, 10mg/kg KR i.p. x2 + 25mg/kg KR i.p. x1; Gr4, 10mg/kg KR i.p. x 2 + 50mg/kg i.p. x1; Gr5, 10mg/kg Kr i.p. x2 + 25mg/kg KR i.v. x1, GrC, controls. The mice were then injected with Tc-99m MIBI and sacrificed after 10 min, 30 min, 90 min and 240 min. Tumor uptake of MIBI (TU) in each group was compared. Tu in P-gp (+) and (-)tumors were both higher in Gr1 than Gr2. Washout rate between the 10 min and 4 hours was lower in Gr5 of P-gp (+) cell (0.93) than the control. Percentage increases in Tu were higher in P-gp (+) than P-gp (-) tumors with all KR doses. Pgp (+) TU were highest at 10 min (173% of GrC) and persisted up to 240 min (144%) in Gr3. Larger doses of KR resulted in a lesser degree of increase in P-gp (+) TU at 10 min (130% in Gr4 and 117% in Gr5) and 30 min (178%, 129%), but TU increased by time up to 240 min (177%, 196%). Heart and lung uptakes were markedly increased in Gr4 and Gr5 at 10 and 3C min, likely due to cardiovascular effects. No mice died. These data further suggest that KR that has significantly lower cardiovascular toxicity than verapamil can be used as an active inhibitor of MDR. Even a relatively low dose of KR significantly increased Tc-99m MIBI uptake in P-gp (+) tumors in vivo.

  18. Early detection of radiation-induced heart disease using 99mTc-MIBI SPECT gated myocardial perfusion imaging in patients with oesophageal cancer during radiotherapy

    Background and purpose: The primary aim of this prospective study was to investigate the value of 99mTc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) in the detection of radiation-induced heart disease (RIHD) as early as during radiotherapy (RT) for oesophageal cancer (EC). The second aim was to analyse the correlation between cardiac toxicity and the dose–volume factors. Materials and methods: The 99mTc-MIBI SPECT GMPI was performed both pre-RT and during RT (40 Gray). The results of the SPECT were quantitatively analysed with QGS/QPS software and read by two experienced nuclear medicine physicians. The correlation between the changes in the SPECT parameters and the RT dosimetric data was analysed. Results: Eighteen patients with locally advanced EC were enrolled in the study. Compared with the baseline, the imaging during RT showed not only significant decreases in the wall motion (WM) (1/20 segments), wall thickening (WT) (2/20 segments), end-diastolic perfusion (EDP) (5/20 segments) and end-systolic perfusion (ESP) (8/20 segments) (p < 0.05) but also a significant increase in the heart rate (74.63 ± 7.79 vs 81.49 ± 9.90, p = 0.036). New myocardial perfusion defects were observed in 8 of the 18 patients. The V37–V40 was significantly higher (p < 0.05) in the patients with the new perfusion defects during RT than in the patients who did not exhibit these defects. Conclusions: Radiotherapy for EC induces cardiac damage from an early stage. 99mTc-MIBI SPECT GMPI can detect the occurrence of cardiac impairment during RT. The WM, WT, EDP and ESP may be valuable as early indicators of RIHD. The percentage of the heart volume that receives a high dose is an important factor that is correlated with RIHD

  19. Is technetium-99m-MIBI taken up by the normal pituitary gland? A comparison of normal pituitary glands and pituitary adenomas

    The aim of this study was to compare the behavioral uptake of a normal gland and a pituitary adenoma and to assess the ability to diagnose pituitary adenoma by means of technetium-99m-hexakis-2-methoxy-isobutyl-isonitrile (MIBI) single photon emission computed tomography (SPECT). The study included 15 patients with pituitary adenomas (mean age=44.0 years, range 19-63) and 15 control subjects (mean age=50.7 years, range 20-67). SPECT was performed 15 minutes after an intravenous injection of MIBI 600 MBq. The shape and location of MIBI uptake were evaluated on a magnetic resonance (MR) imaging/SPECT registration image. The shape patterns and location were classified as follows: Shape C (circular); LO (longitudinal oval); T/R (triangular or rectangular) and location P (pituitary gland or adenoma); D/C (dorsum sellae and/or clivus). Analysis of the uptake showed that 10 (67%) adenomas were C, and 5 (33%) were LO. Of the controls, 5 (33%) were C, and 10 (69%) were T/R. With regard to location, all patients with pituitary adenomas were classified as P, and all control subjects (93%) but one showed uptake in the dorsum sellae and clivus (D/C). MIBI was taken up in the dorsum sellae or clivus but not the normal pituitary gland and had a strong affinity for the pituitary adenoma. This result implies that MIBI SPECT may be a useful new auxiliary examination technique for the location diagnosis of pituitary adenoma. (author)

  20. Solitary pulmonary nodules: Tc99m-MIBI to discriminate between malignant and benign lesions in a region with a high prevalence of tuberculosis

    Full text: A solitary pulmonary nodule (SPN) is defined as a single circumscribed lung lesion surrounded by aerated lung without atelectasis, satellite lesions or cavity. The generally accepted definition of such nodules includes lesions up to 3 cm in diameter. Some studies include larger lesions of up to 6 cm. Most SPN are due to primary bronchogenic carcinoma or benign granulomas. South Africa has a high incidence of tuberculosis, which often presents as SPN. Assessment of pulmonary nodules is important to differentiate benign and malignant lesions. Radiological imaging is often inconclusive in determining the presence of malignancy. F-18 FDG PET is useful in the evaluation but is expensive and not available in South Africa. Tc-99m MIBI has been used in the evaluation of various malignancies, including lung cancers for diagnosis and staging. The aim of our study was to evaluate Tc-99m MIBI scintigraphy as a non-invasive diagnostic tool to differentiate whether the SPN is malignant or benign. The study group included thirty patients, 19 men and 11 women, with a mean age of 53 years (range 19-90 years). The nodule size ranged between 1 and 5 cm in diameter, with a mean size of 2 cm. All the patients were referred from the Lung Unit of Tygerberg Hospital. The inclusion criteria were a recent chest X-ray and a planned or available CT scan of the chest. Pregnant patients were not included in the study. Imaging was performed after the administration of Tc-99m MIBI intravenously in the arm opposite to the SPN. Planar views and SPECT of the chest area were obtained. Final diagnosis was obtained by means of: bronchoscopy with histology, cytology, microbiology or thoracotomy, fine needle aspiration cytology (image guided) or serial CXR follow-up (documenting 2 year lesion stability). Two experienced nuclear physicians who were blinded to the aetiology of the SPN evaluated MIBI scans. All-malignant lesions showed uptake of MIBI. There were three false positive scans in the

  1. Evaluation of the influence of percent labeling of 99mTc-MIBI on nuclear medicine procedures in Recife, Pernambuco State, Brazil

    The aim of this work was to evaluate the influence of percent labeling of the radiopharmaceutical 99mTc-MIBI on the procedures adopted by the nuclear medicine clinics in Recife, Pernambuco State, Brazil, and their possible interference with image quality in myocardial perfusion examinations. This work was performed at two nuclear medicine services in Recife that use pharmaceuticals provided by two different manufacturers: Cardiolite, provided by Dupont and Cardiosyd, provided by SYDMA. The pH, percent labeling and stability of samples of 99mTc-MIBI and the percent uptake in heart and liver of a number of patients were evaluated. The results showed that the pH values measured in all samples of both radiopharmaceuticals were within the limits recommended. In 48% of the Cardiolite samples, the percent labeling was less than 90%, which is the minimum recommended limit. On the other hand, 87,5% of the Cardiosyd samples measured values above 98%. Both radiopharmaceuticals had good labeling stability, even in samples with low percent labeling efficiencies. In spite of the higher percent labeling of Cardiosyd its heart uptake is similar to that observed with the Cardiolite, even when the percent labeling is lower than 90%. On the other hand, the image quality, according to physicians, evaluation was poorer for Cardiosyd images, due to high noise and poor sharpness. (author)

  2. The value of serial 99mTc-MIBI myocardial SPECT imaging in animal models of acute myocardial ischemia and reperfusion

    The purpose is to evaluate acute ischemia and reperfusion in canine models by serial 99mTc-MIBI myocardial SPECT studies. In 24 dogs, myocardial ischemia was induced by dilated balloon inserted in LAD or LCX, followed by reperfusion at 1h (Group I), 4h (Group II) later, and permanent ischemia by copper coil (Group III). The first and second imaging was taken after ischemia and after reperfusion. The 3rd, 4th and 5th SPECT were at 7, 14 and 28 days later. Defect fraction (DF), and ischemic fraction (IF) was obtained from the Bull's-eye images. The first DFs in all 3 groups correlated well with the myocardium at risk (IF) measured by pathological study. DF in group I decreased consistently since the second SPECT, in Group II DF had some decrease, while in Group III no decrease of DF was measured. The SF in all animals showed the same trend. The last DF was correlated with the real size of infarct foci (NF) determined by TTC staining by pathological study. 99mTc-MIBI SPECT was sensitive and accurate in revealing myocardial damage after acute ischemia and its response to reperfusion. The first (before), second (right after), and the last SPECT (4 weeks after reperfusion) were the most informative and clinically useful

  3. The value of Dedicated Tc-99m MIBI Scintimammography in the Evaluation of Patients with Palpable Breast Lesions in Comparison with Mammography: Preliminary Result

    There are few studies evaluating the usefulness of dedicated high-resolution scintimammography and no studies using delayed washout with this dedicated high resolution scintimammography for the evaluation of breast lesions. We underwent this study to evaluate the clinical usefulness of Tc-99m MIBI in evaluating patients with palpable breast lesions using dedicated high-resolution scintimammography. This study included 19 patients with 23 palpable breast lesions who underwent mammography. Tc-99m MIBI was taken to further characterize these lesions. Scintimammography images were acquired with standard craniocaudal and mediolateral oblique views and delayed images were additionally taken. Final conclusions were based on histopathology, either by biopsy or mastectomy results. Eighteen lesions were malignant and five were benign. Mammography was indeterminate for thirteen lesions, nine of those were malignant. Mammography also categorized one lesion as benign in a dense breast, but scintimammography and pathology results showed malignancy. Of the five benign lesions, two were visible on scintimammography, but delayed images showed washout. Based on our preliminary results, dedicated high resolution scintimammography seems to be very useful in characterizing palpable lesions that were indeterminate or negative on mammography

  4. Potential roles of 99m-Tc-MIBI and [18F]-FDG in the management of breast cancer

    MIBI scinti-mammography and FDG-PET are non invasive and accurate techniques for the characterization of breast lesions larger than 1 cm. They are not indicated as first line tools but can be useful when diagnosis is difficult. Their sensitivity is too low for lymphatic staging but they can reveal supraclavicular of internal mammary chains secondary locations not detectable by any other technique. FDG-PET also allows the visualization of regional and distant metastases, as well as the early assessment of treatment efficacy. MIBI mammo-scintigraphy can be useful for the prediction of MDR mediated resistance to chemotherapy. The clinical impact of these techniques in the management of breast cancer remains to be evaluated. (authors)

  5. Long-term prognostic value of exercise {sup 99m}Tc-MIBI SPET myocardial perfusion imaging in patients after percutaneous coronary intervention

    Zhang, Xiaoli; Liu, Xiujie; He, Zuo-Xiang; Shi, Rongfang; Yang, Minfu; Gao, Runlin; Chen, Jilin; Yang, Yuejin; Fang, Wei [Cardiovascular Institute and Fu Wai Hospital, PUMC and CAMS, A 167 Beilishilu, 100037, Beijing (China)

    2004-05-01

    The purpose of this study was to evaluate the long-term prognostic value of exercise technetium-99m methoxyisobutylisonitrile ({sup 99m}Tc-MIBI) single-photon emission tomography (SPET) imaging in patients after percutaneous coronary intervention (PCI). Three hundred and eighteen consecutive post-PCI patients who underwent exercise and rest {sup 99m}Tc-MIBI SPET myocardial perfusion imaging (MPI) were followed up for 38{+-}27 months. Patients with early revascularisation (<3 months after MPI) were excluded. A semiquantitative visual analysis employing a 20-segment and four-point scoring system was used to define the summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS). Death and non-fatal myocardial infarction (MI) were considered as hard events, and late revascularisation procedures ({>=}3 months after MPI) as soft events. Fifty-one patients (16.0%) suffered from cardiac events during follow-up, including 1 (0.3%) death, 13 (4.1%) non-fatal MIs, 9 (2.8%) coronary artery bypass grafting procedures and 28 (8.8%) PCIs. According to the SPET results, patients were classified into three groups: patients with normal MPI (SSS=0, n=153), patients with irreversible defects (SDS<3 and SRS>1, n=100) and patients with reversible defects (SDS{>=}3, n=65). The annual hard cardiac event rate in patients with reversible defects was 3.9%, which was significantly higher than that in patients with normal MPI (0.2%, {chi}{sup 2}=7.71; P<0.01). The annual soft cardiac event rate in patients with reversible defects was 10.7%, which was significantly higher than that in patients with irreversible defects (2.5% {chi}{sup 2}=17.69; P<0.001), and also significantly higher than that in patients with normal MPI (1.5%, {chi}{sup 2}=33.89; P<0.001). In patients with normal and reversible defects, there was no significant difference in soft and hard cardiac event rates according to whether patients were symptomatic or asymptomatic (P>0.05). However, the annual

  6. Invasive ductal carcinoma arising from dense accessory breast visualized with 99mTc-MIBI breast-specific γ imaging.

    Yoon, Hai-Jeon; Sung, Sun Hee; Moon, Byung In; Kim, Bom Sahn

    2014-08-01

    Primary accessory breast cancer is extremely rare, and the diagnostic efficacy of Tc-MIBI breast-specific γ imaging (BSGI) has not been reported elsewhere. We present a case of primary carcinoma arising from dense accessory breast that was visualized with BSGI. A 43-year-old female patient with a palpable axillary mass underwent mammography, which showed dense parenchyma on both of the anatomic and accessory breasts with no abnormality. Subsequent BSGI showed no abnormal uptake in bilateral anatomic breasts, but focal abnormal uptake was noted in the accessory breast. Permanent pathologic evaluation confirmed invasive ductal carcinoma (not otherwise specified type) of the accessory breast. PMID:24445272

  7. Low-dose dobutamine stress test for the evaluation of cardiac function using ECG-gated SPECT scintigraphy with 99mTc-MIBI

    Although 201TlCl myocardial scintigraphy has so far been widely used for the evaluation of the viability of the myocardial infarcted area, functional evaluation using low dose dobutamine (DOB) loaded echography also became recently available. We performed 99mTc-MIBI gated SPECT on eight cases of myocardial infarction at rest and low dose (4-6μg/kg/min) DOB-loading and related data were collected. Next, we calculated myocardial count increase rate (%WT=ES-ED/ED x 100) with left ventricular contraction from end-diastolic (ED) and end-systolic (ES) pictures in short-axial image, and made a comparative examination of regional contractilities at rest and DOB-loading. DOB-loaded echography performed on the same cases at the same dose revealed 15 segments as infarcted area (WM(+)) presenting improvement in wall movement at loading and 5 segments as infarcted area (WM(-)) presenting no such improvement, and %WT at rest and loading were 29.1±6.2 and 33.2±2.4 for (WM(-)) and 26.8±9.8 and 40.0±12.3 for (WM(+)), indicating a significant increase (p<0.05) at loading. Contractility analysis using MIBI gated SPECT in combined use of DOB-loading was considered as a useful method of examination in view of its reflectionality in the evaluation of the wall movement in DOB-loaded echography and of its high quantitativity. (author)

  8. Comparison of relative 18FDG uptake to metabolic rate (MRGlucose) in the myocardium in CAD, classified by 99mTc MIBI

    In 55 non-diabetic patients with CAD, relative myocardial perfusion (99mTc MIBI SPECT at rest) and relative 18FDG uptake (PET after glucose load) were used to separate for various flow/metabolism constellations. In addition, regional glucose metabolic rate (rMRGlu in μmol/100 g/min; dynamic-graphic analysis from Gambhir/Patlak) was determined in 13 segments of the left ventricle each (i.e., in a total of 715 segments). rMRGlu revealed wide standard deviations (up to 51%). It decreased from normal (52.7±27.3 μmol/100 g/min), mismatch (45.3±17.3) and intermediate (35.2±12.4) to match ('non viable'; 26.7±13.3) significantly (p18FDG uptake. Thus, the higher efforts employed to compute rMRGlu do not yield diagnostic advantage. The segmental perfusion maximum, used for normalization of relative 18FDG uptake (100% MIBI uptake=100% FDG uptake) was reliable in euglycemic patients even with 3-vessel disease. (orig.)

  9. The role of 99mTc-SestaMIBI in predicting post-revascularization recovery in patients with chronic coronary artery disease and LV dysfunction: a meta-analysis

    The utility of 99mTc-Sesta (MIBI) as a marker of myocardial viability is still a controversial topic. A perusal of the different published studies was therefore done to address this issue by looking at the ability of this tracer to predict recovery or non-recovery of a dysfunctional myocardium after revascularization based on MIBI uptake. Literature search was done using the Index Medicus, MEDLINE and cross-reference on the use of 99mTc-SestaMIBI in thrombolytic therapy, revascularization and viability assessment. Only studies in human were included. A qualitative and quantitative (visual) uptake was studied. These segments are supposedly expected to have no recovery even after revascularization. Eventual revascularization was done however on their corresponding coronary vessels. 57% (78/136) showed recovery in function while only 43% (58/136) were identified correctly (p>0.05=ns). Quantitative analysis of uptake were done on these segments with poor visual uptake. One study (Marzullo et.al.) divided these segments into those with MIBI uptake above and below 55%. His findings revealed that 35/45 segments with uptake >55% had improved function after revascularization (PPV=78%) while 14/21 segments with uptake 50% showed functional improvement while 61% (NPV) of segments with uptake 99mTc-SestaMIBI is primarily a perfusion agent. Attempts therefore to use this tracer to asses myocardial viability should be made with caution and if ever, must be done quantitatively. (author)

  10. Evaluation of the quality of the radiopharmaceutical 99mTc-MIBI and its influence on image quality in myocardial perfusion scintigraphy

    This study evaluated the quality of the 99mTc-MIBI radiopharmaceutical from different manufacturers, used in three nuclear medicine services (NMS) in Recife-PE, through labeling procedure of each service. It was observed their biodistribution by quantifying the activity present in the organs of interest (heart / liver), the influence and interference in image quality and in myocardial scintigraphy diagnosis exam. In these NMS (A, B and C) were done quality controls in the eluates of 99Mo/99mTc generators (radionuclidic, chemical and radiochemical purity and pH) and of the 99mTc-MIBI radiopharmaceutical (radiochemical purity and pH) used in myocardial scintigraphy exam. In the case of radiochemical purity (RCP), was used the thin layer chromatography technique; after the chromatographic ran on, the plates were analyzed both in the dose calibrator, and in scintillation camera of each NMS. The radiopharmaceutical biodistribution was evaluated through the activities present in the heart and liver images in 60 patients, using the technique of combined images counting. Five nuclear physicians analyzed 24 images through myocardial perfusion visual interpretation during stress, it was verified the agreement degree among them. The results of the quality control showed that all eluate samples were in agreement with the manufacturers in relation to radionuclidic purity and pH. In relation to chemical purity, 10% of the services samples B and C showed Al+3 values above 10 ppm. In the RCP, it was observed that using the scintillation camera, only 22% of the samples would be discarded, while with dose calibrator would be 78%, indicating that the scintillation camera is more sensitive in chromatographic pale analysis. For the labeled radiopharmaceutical, the services B and C presented respectively one and three samples with RCP percentage below 90%. However, C service presented the lowest medium to liver/heart proportions, showing that this factor does not depends on the labeling

  11. Comparison of the kinetics of active efflux of Tc-99m-MIBI in cells with P-glycoprotein-mediated and multidrug-resistance protein-associated multidrug-resistance phenotypes

    Vergote, J; Moretti, JL; De Vries, EGE; Garnier-Suillerot, A

    1998-01-01

    The overexpression of two membrane glycoproteins, P-glycoprotein and multidrug-resistance protein (MRP1) is a major cause of resistance to chemotherapeutic agents in the treatment of human cancers. Both proteins confer a similar multidrug-resistant (MDR) phenotype. Tc-99m-MIBI, a myocardial imaging

  12. Evaluation of the influence of percent labeling of {sup 99m}Tc-MIBI on nuclear medicine procedures in Recife, Pernambuco State, Brazil; Avaliacao da influencia do percentual de marcacao do {sup 99m}Tc-MIBI em procedimentos de medicina nuclear em Recife, PE

    Pereira, Jucilene Maria

    2003-08-15

    The aim of this work was to evaluate the influence of percent labeling of the radiopharmaceutical {sup 99m}Tc-MIBI on the procedures adopted by the nuclear medicine clinics in Recife, Pernambuco State, Brazil, and their possible interference with image quality in myocardial perfusion examinations. This work was performed at two nuclear medicine services in Recife that use pharmaceuticals provided by two different manufacturers: Cardiolite, provided by Dupont and Cardiosyd, provided by SYDMA. The pH, percent labeling and stability of samples of {sup 99m}Tc-MIBI and the percent uptake in heart and liver of a number of patients were evaluated. The results showed that the pH values measured in all samples of both radiopharmaceuticals were within the limits recommended. In 48% of the Cardiolite samples, the percent labeling was less than 90%, which is the minimum recommended limit. On the other hand, 87,5% of the Cardiosyd samples measured values above 98%. Both radiopharmaceuticals had good labeling stability, even in samples with low percent labeling efficiencies. In spite of the higher percent labeling of Cardiosyd its heart uptake is similar to that observed with the Cardiolite, even when the percent labeling is lower than 90%. On the other hand, the image quality, according to physicians, evaluation was poorer for Cardiosyd images, due to high noise and poor sharpness. (author)

  13. Parathyroid ectopia evidenced by {sup 99m}Tc-sestamibi scintigraphy: Case report; Ectopie parathyroidienne objectivee par la scintigraphie au {sup 99m}Tc-MIBI: a propos d'un cas

    Ghfir, I.; Ben Rais, N. [Hopital Ibn-Sina, Service de Medecine Nucleaire (Morocco)

    2007-08-15

    Introduction The presence of an ectopic parathyroid gland is the most frequent cause of persistent hyperparathyroidism. Its detection constitutes a source of topographic diagnostic difficulties particularly for purely morphological explorations. The goal of this work is to elucidate the interest of scintigraphy using {sup 99m}Tc-sestamibi in the diagnosis and the therapeutic orientation of ectopic parathyroid. Case report A 50-year-old patient was followed for persistent hyperparathyroidism after subtotal para thyroidectomy. The clinical examination was without particularity contrasting with an always high parathormone rate. Echography, computed tomography and magnetic resonance imaging were not conclusive. Scintigraphy carried out after intravenous injection of 740 MBq of sestamibi-Tc{sup 99m} with acquisition of static images at 20 min and 2 h showed an area of high uptake in projection of the right upper mediastinum. The diagnosis of an ectopic parathyroid localization was retained. Resection and pathologic examination of the surgical specimen revealed parathyroid adenoma tissue. The evolution was marked by a normalisation of the rate of parathormone. Discussion {sup 99m}Tc-sestamibi scintigraphy is a functional exploration with a higher sensitivity than the other morphological imaging techniques for preoperative topographic determination of ectopic parathyroid. It significantly contributes to an elective and more rapid surgical resection of these lesions. (authors)

  14. Left ventricular function behavior in patients with inducible ischaemia evaluated with gated SPECT with mibi-Tc 99M

    Introduction: Gated SPECT allows the evaluation of left ventricular function (LVF), both at rest and in the immediate post exercise. However, recent studies in patients with inducible ischemia suggest that LVF in the immediate post exercise does not reflect LVF at rest. Objectives: To assess LVF (ejection fraction EF), end systolic volume (ESV), end diastolic volume (EDV), and motility score (SSPM), both at rest and in the immediate post exercise, in patients with inducible ischemia. Methods: One hundred and four patients were evaluated with the Bruce protocol in which a gated SPECT with Tc99m sestamibi was done. Patients were divided in two groups: G1 (inducible ischemia present) and G2 (control patients) according to the results of the perfusion scans. Results: EF post exercise in G1 was significantly lower than EF at rest (48 ± 1.43 vs 52 ± 1.29; p < 0.01). There were no changes of EF in G2 (62 ± 0.93 vs 61 ± 1.03; p = NS). In G1, ESV post exercise increased significantly compared to ESV at rest (57 ± 3.57 vs 51 ± 2.86; p < 0.01). Again, there were no changes of these parameters in G2 (32 ± 1.44 vs 33 ± 2.05; p = NS). In G1, SSMP increased during the post exercise vs SSMP at rest (4.9 ± 0.6 vs 1.8 ± 0.4; p < 0.01). In G2, SSMP was 0 both post exercise and at rest. Conclusion: Patients with inducible ischemia had a depressed EF, higher end systolic volumes and alterations in motility score immediately post exercise compared to rest images. In contrast, there were no changes of these parameters in control patients. These different results could be explained to the presence of stunned myocardium in ischemic patients. (author)

  15. Synthesis of the compound tetrakis (2- methoxy isobutyl isonitrile) copper (I) tetrafluoroborate -(Cu[MIBI]4BF4): substance used in the production of the radiopharmaceutical sestamibi 99m Tc

    The radiopharmaceutical SESTAMIBI-99mTc presents interest and application in the clinical routine in Nuclear Medicine, especially for evaluation of the myocardium function and in the diagnosis of some tumors types, and the Center of Radiopharmacy of the IPEN has interest in the development of this radiopharmaceutical for attendance of the nuclear medicine class necessities. In this work it was demonstrated the synthesis and characterization of the active compound tetrakis (2- methoxy isobutyl isonitrile) copper (I) tetrafluoroborate - Cu[MIBI]4BF4- to be used in the preparation of lyophilized reagents for labeling with technetium-99m as well as labeling studies and biological distribution. The synthesis of the reagent Cu[MIBI]4BF4 was carried out in accordance with previously described procedures, in 5 steps and the compounds were characterized for infra-red, magnetic nuclear resonance, melting point and thin layer chromatography. The characterization of the chelate of MIBI -Cu[MIBI]4BF4 - was carried out using high performance liquid chromatography, compared with a standard sample of the product and presented similar results, as described in literature. The lyophilized reagent was prepared and labeled with technetium-99m, showing high radiochemical purity, higher than 97%, with high stability. Biological distribution in different animals showed good uptake in the heart, in time compatible with the acquisition of scintigraphy images, demonstrating the applicability of the reagent synthesized in the attainment of cardiac scintigraphy images. (author)

  16. Detection of DCIS using 99mTc-MIBI scintimammography in patients with suspected primary breast cancer, comparison with conventional mammography

    Background: Scintimammography using Tc-99m MIBI (SMM) is often used clinically as a second line diagnostic test for the detection of breast cancer in cases where there is concern about the results of x-ray mammography (XMM) and ultrasound. Both of these methods, but particularly XMM, may miss a significant proportion of ductal carcinoma in situ (DCIS). MATERIAL AND METHODS: This study was performed to determine the possible accuracy of SMM in finding DCIS and comparing this with the accuracy of XMM in the same patient. Over a 3 year period 353 patients with no previous history of breast cancer were imaged with both XMM and SMM. The histology of any suspect area was verified by pathological examination of biopsy material. There were 203 malignant breast tumours. RESULTS: In those 203 cancers there were 15 pure DCIS cancers. SMM correctly diagnosed 12 of these (sensitivity was 80%). XMM diagnosed correctly 8 DCIS (sensitivity 53%) and was equivocal in 2. Combining of both SMM and XMM provided the best result with all but one DCIS identified (sensitivity 93%). CONCLUSIONS: This study shows that the SMM is helpful in detecting DCIS in those cases where XMM failed to detect DCIS or was equivocal. The combination of the two techniques produces a higher sensitivity result than either modality alone. (author)

  17. A comparison of 99mTc-MIBI myocardial perfusion imaging and electron beam CT in detection of CAD in patients without myocardial infarction

    Our previous researches have demonstrated that 99mTc-MIBI myocardial tomography (SPECT) has higher specificity in detection of coronary artery disease (CAD) than that of coronary artery calcification (CAC) assessed by cardial electron beam CT(EBCT). However, these researches involved patients with myocardial infarction, which may be in favor of obtaining high accuracy for detection of CAD by SPECT.The purpose of this study was to compare SPECT with EBCT in detection of CAD in patents without myocardial infarction history. Seventy-three patients (55 male, 18 female, 52.6 ± 10.6 yrs old) without myocardial infarction underwent stress-rest SPECT, cardiac EBCT and coronary angiography (CAG) within one month. CAC as CT value ≥ 130 HU within the boundary of coronary artery on EBCT, and ≥50% coronary narrowing was considered as diagnostic standard of CAD. There were 35 patients and 38 patients with and without ≥ 50% coronary stenosis, respectively. Ninety-six percent (23/24) patients with abnormal SPECT and CAC detected by EBCT had coronary arteries with ≥ 50% stenosis, and 90.5% (19/21) patients with normal SPECT and EBCT had normal CAG or 45 yrs old the specificity f SPECt (94.3%) was significantly

  18. Noninvasive stress testing of myocardial ischemia: comparison of GRE-MRI perfusion and wall motion analysis to 99mTc-MIBI-SPECT, relation to coronary angiography

    In the evaluation of ischemic heart disease only MR imaging seems to have the potential to assess myocardial perfusion, function, and coronary morphology on a single instrument. The aim of this study was to assess the feasibility of a stress test with dipyridamole (0.56 mg/kg) to analyze myocardial perfusion by Gd first-pass enhancement in ultrafast gradient-recalled-echo MRI (perf-MRI), and wall motion by cine gradient-recalled-echo MRI (Cine-MRI) in one imaging session. Twelve patients underwent complete rest and stress studies; satisfactory MR images were acquired in 10 patients. By 99mTc-MIBI-SPECT sensitivities to detect ischemic segments were 66.7 % with Perf-MRI, 80.0 % with WM-MRI and 86.7 % for Perf-WM-MRI (Perf-MRI vs Perf-WM-MRI; p = 0.03). Scar was equally detected with a sensitivity of 91.6 % with either MRI technique. Thus, Perf-Cine-MRI provides complementary information for the management of ischemic heart disease and has a higher sensitivity than Perf-MRI alone. (orig.). With 3 figs., 2 tabs

  19. Initial and delayed stress phase imaging in a single-injection double-acquisition SPECT. The potential value of early 99mTc-MIBI redistribution in assessment of myocardial perfusion reversibility in patients with coronary artery disease

    Some studies reported that 99mTc-MIBI may redistribute in ischaemic myocardium and this phenomenon may have potential role for better assessment of viability by delayed 99mTc-MIBI imaging. Some studies also suggested that infusion of low dose dobutamine during delayed imaging may enhance the value of 99mTc-MIBI imaging for evaluation of viability. The aim of this study is to determine whether the observed changes of perfusion defects on delayed images are caused by early radiotracer redistribution or as a result of reversal partial volume effect secondary to inotropic stimulation. Patients, methods: 89 patients with angiographically proven coronary artery disease (CAD) were enrolled in this randomized clinical trial study. In all cases, gated-SPECT images were obtained 60 minutes after stress with dipyridamole injection. Subsequently the patients were randomly allocated in two groups and the second imaging was performed at 120th minute during low dose dobutamine (dobutamine group; 45 cases) or placebo infusion (placebo group; 44 cases). Difference between summed stress score of the first (SSS1) and second (SSS2) stress images (ΔSSS) was considered as a marker of reversibility in single-injection double-acquisition (SIDA) protocol. Also summed difference score (SDS) was recorded as a marker of reversibility in standard stress/rest, double-injection double-acquisition (DIDA) protocol. ΔSSS of the two studied groups were compared. Also the correlation and agreement between ΔSSS and SDS were analyzed. Results: A significant difference was found between SSS1 (median 15, range 0-48) and SSS2 (median 11, range 0-42) in total patients (p 99mTc-MIBI injection in the stress phase imaging. These changes correlate well and are in agreement with perfusion improvement on the rest images. This phenomenon may be independent of improvement in myocardial function, in more delayed imaging or following inotropic augmentation, and thus is likely due to 99mTc-MIBI redistribution

  20. Comparison of whole-body {sup 18}F-FDG PET, {sup 99m}Tc-MIBI SPET, and post-therapeutic {sup 131}I-Na scintigraphy in the detection of metastatic thyroid cancer

    Iwata, Masahiro [Department of Radiology, Hikone Municipal Hospital, 1882 Hassakacho, 522-8539, Hikone, Shiga (Japan); Kasagi, Kanji [Department of Nuclear Medicine, Takamatsu Red Cross Hospital, Takamatsu (Japan); Misaki, Takashi [Radioisotope Center, Tenri Hospital, Tenri (Japan); Matsumoto, Keiichi; Nakamoto, Yuji [Institute of Biomedical Research and Innovation, Kobe (Japan); Iida, Yasuhiro; Ishimori, Takayoshi; Higashi, Tatsuya; Saga, Tsuneo; Konishi, Junji [Department of Nuclear Medicine and Diagnostic Imaging, Kyoto Graduate School of Medicine, Kyoto (Japan)

    2004-04-01

    The usefulness of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in differentiated thyroid cancer (DTC) has been demonstrated by many investigators, but in only a small number of studies have FDG-PET images been compared with those obtained using other non-iodine tumour-seeking radiopharmaceuticals. In most of the studies, planar imaging was performed for comparison using thallium-201 chloride or technetium-99m 2-methoxyisobutylisonitrile ({sup 99m}Tc-MIBI). Furthermore, FDG-PET studies were not always performed in the hypothyroid state with increased levels of thyroid stimulating hormone (TSH), which are known to increase FDG uptake by DTC. The aim of this study was to compare the ability of FDG-PET to detect metastatic DTC with that of {sup 99m}Tc-MIBI whole-body single-photon emission tomography (SPET) and post-therapeutic iodine-131 scintigraphy, evaluated under TSH stimulation. Nineteen patients (8 men, 11 women; age range, 38-72 years, mean 60 years; 17 thyroidectomised and 2 inoperable patients following {sup 131}I ablation of the remaining thyroid tissue; 16 papillary and 3 follicular carcinomas) with metastatic DTC underwent FDG-PET whole-body scan (WBS) and {sup 99m}Tc-MIBI SPET WBS at an interval of less than 1 week, followed by {sup 131}I therapy. The SPET images were reconstructed using the maximum likelihood expectation maximisation (ML-EM) method. All patients were hypothyroid at the time of each scan. {sup 131}I WBS was performed 3-5 days after oral administration of the therapeutic dose. A total of 32 lesions [10 lymph node (LN), 15 lung, 6 bone, 1 muscle] were diagnosed as metastases, as confirmed by histopathology and/or other imaging modalities (X-ray, US, CT, MRI, bone, {sup 201}Tl and {sup 131}I scans). FDG-PET, {sup 99m}Tc-MIBI SPET and post-therapeutic {sup 131}I scintigraphy respectively revealed a total of 26 (81.3%), 20 (62.5%) and 22 (68.8%) lesions. These techniques respectively demonstrated nine (90.0%), eight

  1. Comparison of relative {sup 18}FDG uptake to metabolic rate (MRGlucose) in the myocardium in CAD, classified by {sup 99m}Tc MIBI; Vergleich von relativer {sup 18}FDG-Aufnahme mit metabolischer Rate (MRGlukose) im Myokard bei KHK, klassifiziert mit {sup 99m}Tc-MIBI

    Buell, U. [RWTH, Klinikum Aachen (Germany). Klinik fuer Nuklearmedizin; Foroutan, Y. [RWTH, Klinikum Aachen (Germany). Klinik fuer Nuklearmedizin; Hellwig, D. [RWTH, Klinikum Aachen (Germany). Klinik fuer Nuklearmedizin; Kaiser, H.J. [RWTH, Klinikum Aachen (Germany). Klinik fuer Nuklearmedizin; Schulz, G. [RWTH, Klinikum Aachen (Germany). Klinik fuer Nuklearmedizin; Sabri, O. [RWTH, Klinikum Aachen (Germany). Klinik fuer Nuklearmedizin; Schreckenberger, M. [RWTH, Klinikum Aachen (Germany). Klinik fuer Nuklearmedizin; Vom Dahl, J. [RWTH, Klinikum Aachen (Germany). Medizinische Klinik 1

    1995-12-01

    In 55 non-diabetic patients with CAD, relative myocardial perfusion ({sup 99m}Tc MIBI SPECT at rest) and relative {sup 18}FDG uptake (PET after glucose load) were used to separate for various flow/metabolism constellations. In addition, regional glucose metabolic rate (rMRGlu in {mu}mol/100 g/min; dynamic-graphic analysis from Gambhir/Patlak) was determined in 13 segments of the left ventricle each (i.e., in a total of 715 segments). rMRGlu revealed wide standard deviations (up to 51%). It decreased from normal (52.7{+-}27.3 {mu}mol/100 g/min), mismatch (45.3{+-}17.3) and intermediate (35.2{+-}12.4) to match (`non viable`; 26.7{+-}13.3) significantly (p<0.01). In 26% of the perfusion maxima, MRGlu was <40 {mu}mol/100 g/min. Out of these, only in five patients (of 28) with 3-vesell disease, it was even smaller (<30 {mu}mol). In three out of the latter, glucose blood levels were below euglycemia. rMRGlu in CAD revealed an identical perfusion/metabolism pattern as relative {sup 18}FDG uptake. Thus, the higher efforts employed to compute rMRGlu do not yield diagnostic advantage. The segmental perfusion maximum, used for normalization of relative {sup 18}FDG uptake (100% MIBI uptake=100% FDG uptake) was reliable in euglycemic patients even with 3-vessel disease. (orig.) [Deutsch] Bei 55 Patienten mit KHK wurden die relative myokardiale Speicherung von {sup 99m}Tc-MB (in Ruhe; SPECT) und von {sup 18}FDG (nach Glukoseladung, PET) vergleichend zu rMRGlu (in {mu}mol/100 g/min) in je 13 Segmenten des linken Ventrikels (insgesamt 715 Segmente) bestimmt. Die rMRGlu zeigte Streubreiten von bis zu 51%. Sie nahm in der Reihenfolge normal (52,7{+-}27,3 {mu}mol/100 g/min), mismatch (p<0,01) ab. In 26% der Perfusionsmaxima war MRGlu <40 {mu}mol/100 g/min, darunter nur bei fuenf Dreigefaesserkrankungen (von 28) <30 {mu}mol. Die Serumglukosewerte zeigten bei drei dieser fuenf Patienten eine ungenuegende Antwort auf die orale Glukosebelastung. rMRGlu erbrachte bei KHK die gleichen

  2. Validation of 4D-MSPECT and QGS for quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPET: comparison with cardiac magnetic resonance imaging

    The main aim of this study was to validate the accuracy of 4D-MSPECT in the assessment of left ventricular (LV) end-diastolic/end-systolic volumes (EDV, ESV) and ejection fraction (LVEF) from gated technetium-99m methoxyisobutylisonitrile single-photon emission tomography (99mTc-MIBI SPET), using cardiac magnetic resonance imaging (cMRI) as the reference method. By further comparing 4D-MSPECT and QGS with cMRI, the software-specific characteristics were analysed to elucidate clinical applicability. Fifty-four patients with suspected or proven coronary artery disease (CAD) were examined with gated 99mTc-MIBI SPET (8 gates/cardiac cycle) about 60 min after tracer injection at rest. LV EDV, ESV and LVEF were calculated from gated 99mTc-MIBI SPET using 4D-MSPECT and QGS. On the same day, cMRI (20 gates/cardiac cycle) was performed, with LV EDV, ESV and LVEF calculated using Simpson's rule. Both algorithms worked with all data sets. Correlation between the results of gated 99mTc-MIBI SPET and cMRI was high for EDV [R=0.89 (4D-MSPECT), R=0.92 (QGS)], ESV [R=0.96 (4D-MSPECT), R=0.96 (QGS)] and LVEF [R=0.89 (4D-MSPECT), R=0.90 (QGS)]. In contrast to ESV, EDV was significantly underestimated by 4D-MSPECT and QGS compared to cMRI [130±45 ml (4D-MSPECT), 122±41 ml (QGS), 139±36 ml (cMRI)]. For LVEF, 4D-MSPECT and cMRI revealed no significant differences, whereas QGS yielded significantly lower values than cMRI [57.5%±13.7% (4D-MSPECT), 52.2%±12.4% (QGS), 60.0%±15.8% (cMRI)]. In conclusion, agreement between gated 99mTc-MIBI SPET and cMRI is good across a wide range of clinically relevant LV volume and LVEF values assessed by 4D-MSPECT and QGS. However, algorithm-varying underestimation of LVEF should be accounted for in the clinical context and limits interchangeable use of software. (orig.)

  3. Evaluation of the quality of the radiopharmaceutical 99mTc-MIBI and its influence on image quality in myocardial perfusion scintigraphy; Avaliacao da qualidade do radiofarmaco {sup 99m}Tc-MIBI e sua influencia na qualidade da imagem em cintilografia de perfusao do miocardio

    Santos, Poliane Angelo de Lucena

    2013-07-01

    This study evaluated the quality of the {sup 99m}Tc-MIBI radiopharmaceutical from different manufacturers, used in three nuclear medicine services (NMS) in Recife-PE, through labeling procedure of each service. It was observed their biodistribution by quantifying the activity present in the organs of interest (heart / liver), the influence and interference in image quality and in myocardial scintigraphy diagnosis exam. In these NMS (A, B and C) were done quality controls in the eluates of {sup 99}Mo/{sup 99m}Tc generators (radionuclidic, chemical and radiochemical purity and pH) and of the {sup 99m}Tc-MIBI radiopharmaceutical (radiochemical purity and pH) used in myocardial scintigraphy exam. In the case of radiochemical purity (RCP), was used the thin layer chromatography technique; after the chromatographic ran on, the plates were analyzed both in the dose calibrator, and in scintillation camera of each NMS. The radiopharmaceutical biodistribution was evaluated through the activities present in the heart and liver images in 60 patients, using the technique of combined images counting. Five nuclear physicians analyzed 24 images through myocardial perfusion visual interpretation during stress, it was verified the agreement degree among them. The results of the quality control showed that all eluate samples were in agreement with the manufacturers in relation to radionuclidic purity and pH. In relation to chemical purity, 10% of the services samples B and C showed Al{sup +3} values above 10 ppm. In the RCP, it was observed that using the scintillation camera, only 22% of the samples would be discarded, while with dose calibrator would be 78%, indicating that the scintillation camera is more sensitive in chromatographic pale analysis. For the labeled radiopharmaceutical, the services B and C presented respectively one and three samples with RCP percentage below 90%. However, C service presented the lowest medium to liver/heart proportions, showing that this factor

  4. Sympathetic reinnervation in cardiac transplants: {sup 123}I-MIBG and {sup 201}Tl/{sup 99m}Tc-MIBI scintigraphy

    Kim, J. H.; Oh, S. J.; Son, M. S.; Son, J. W.; Choi, I. S.; Shin, E. K.; Park, C. H. [Gachon Medical School, Gil Heart Cener, Inchon (Korea, Republic of)

    2000-07-01

    The purpose was to evaluate cardiac sympathetic reinnervation and hemodynamic changes after orthotopic heart transplantation (TPL). We performed 24 serial or followup cardiac 123I-MIBG imaging and rest 201Tl/99mTc-MIBI dipyridamole stress gated myocardial perfusion SPECT (g-MPS) in 15 patients (M:F=10:5;mean ages=34.5{+-}13.0 yr; idiopathic:rheumatic=14:1; one heart lung TPL)(10.80 {+-}11.88 (1-48) mo) after TPL 123I-MIBG imagings were performed in anterior position 15 minutes, 4 and 24 hours after i.v. injection of 148 MBq 123I MIBG. Image quantitation was based on the ratio of heart to mediastinal MIBG uptake (HMR) Compared to HMR on 15 min images (1.48 {+-} 0.28), neither four nor 24 hour delayed images (1.26 {+-} 0.23 vs. 1.06 {+-} 0.26: p<0.05, respectively, ANOVA) showed definite delayed localization of MIBG. 12 subjects with <13 (4.9 {+-}3.7) months after TPL had no visible 123I-MIBG uptake on early 15 min imaging however, 12 subjects with 13 to 48(28.6{+-}12.8) months had visible cardiac 123I-MIBG uptake (HMR: 1.65{+-}0.21 vs. 1.32{+-}0.26; p=0.002). One-year followup 123I-MIBG scintigraphy in nine pts showed significantly increased HMR(1.40{+-}0.31 to 1.61{+-}0.16, p<0.05) but a plateau was reached at HMR value of 2.0, which was still lower than 3.0 in normal controls. Plasma NE was increased according to I-123 MIBG myocardial uptake. Annual G-MPS detected an allograft atherosclerosis in one pt and showed progressive normalization of tachycardia and significant deterioration of LVEF and cardiac indices according to severity of rejection. To dipyridamole stress, transplant heats showed significant subnormal hemodynamic responses. Partial sympathetic late reinnervation can occur <1 year after TPL, and reached a plateau of two-third of normal value. G-MPS seems to be a useful screening test for the detection of allograft atherosclerosis and rejection.

  5. Labelling, biodistribution and compartmental analysis of N-acetylcysteine labelled with Tc-99m. Comparative investigation with with sup 9 sup 9 sup m Tc-MIBI in an in vivo tumoral model

    Faintuch, B L

    1997-01-01

    Labelling and biodistribution studies were done with two different ligands, respectively Methoxy isobutyl isonitrile (MIBI) and N-acetylcysteine (NAC), employing Tc-99m as a tracer. The main objective was to assess the pharmacokinetic properties of the second substance, aiming at its possible application in cancer diagnosis. To this purpose an in vivo investigation was done using healthy and tumor-bearing rats with experimental cancer. Images of tumor-bearing rats registered in a scintillation camera indicated that with sup 9 sup 9 sup m Tc-MIBI none of the two selected times was adequate for visualization of the cancer mass. In contrast, sup 9 sup 9 sup m Tc-NAC permitted clear identification of the humor, four hours after injection. The results have demonstrated that sup 9 sup 9 sup m Tc-NAC is a radiopharmaceutical with affinity for cancer tissue and promising for further investigation concerning imaging diagnosis of tumors.

  6. Initial and delayed stress phase imaging in a single-injection double-acquisition SPECT. The potential value of early {sup 99m}Tc-MIBI redistribution in assessment of myocardial perfusion reversibility in patients with coronary artery disease

    Beiki, D. [Research Inst. for Nuclear Medicine, Tehran Univ. of Medical Sciences, Tehran (Iran); Dept. of Nuclear Pharmacy, Tehran Univ. of Medical Sciences, Tehran (Iran); Fallahi, B.; Fard-Esfahani, A.; Eftekhari, M. [Research Inst. for Nuclear Medicine, Tehran Univ. of Medical Sciences, Tehran (Iran); Mohseni, Z.; Khalaj, A. [Dept. of Nuclear Pharmacy, Tehran Univ. of Medical Sciences, Tehran (Iran)

    2010-07-01

    Some studies reported that {sup 99m}Tc-MIBI may redistribute in ischaemic myocardium and this phenomenon may have potential role for better assessment of viability by delayed {sup 99m}Tc-MIBI imaging. Some studies also suggested that infusion of low dose dobutamine during delayed imaging may enhance the value of {sup 99m}Tc-MIBI imaging for evaluation of viability. The aim of this study is to determine whether the observed changes of perfusion defects on delayed images are caused by early radiotracer redistribution or as a result of reversal partial volume effect secondary to inotropic stimulation. Patients, methods: 89 patients with angiographically proven coronary artery disease (CAD) were enrolled in this randomized clinical trial study. In all cases, gated-SPECT images were obtained 60 minutes after stress with dipyridamole injection. Subsequently the patients were randomly allocated in two groups and the second imaging was performed at 120{sup th} minute during low dose dobutamine (dobutamine group; 45 cases) or placebo infusion (placebo group; 44 cases). Difference between summed stress score of the first (SSS{sub 1}) and second (SSS{sub 2}) stress images ({delta}SSS) was considered as a marker of reversibility in single-injection double-acquisition (SIDA) protocol. Also summed difference score (SDS) was recorded as a marker of reversibility in standard stress/rest, double-injection double-acquisition (DIDA) protocol. {delta}SSS of the two studied groups were compared. Also the correlation and agreement between {delta}SSS and SDS were analyzed. Results: A significant difference was found between SSS{sub 1} (median 15, range 0-48) and SSS{sub 2} (median 11, range 0-42) in total patients (p < 0.0001). A significant correlation was noted between {delta}SSS and SDS in dobutamine group (r = 0.58, p = 0.002) as well as in placebo group (r = 0.57, p < 0.0001). Considering DIDA protocol as a standard reference method, the influence of dobutamine infusion was not

  7. Clinical role of {sup 99m}TcO{sub 4}/MIBI scan, ultrasound and intra-operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism

    Casara, D.; Rubello, D. [Dept. of Radiotherapy, Regional Hospital of Padova (Italy); Pelizzo, M.R. [Dept. of Surgery, University of Padova, Padova (Italy); Shapiro, B. [Dept. of Radiology, University of Michigan Medical Center, Ann Arbor (United States)

    2001-09-01

    One hundred and forty-three consecutive patients with primary HPT were enrolled in the study. We used a modified {sup 99m}TcO{sub 4}/MIBI scintigraphic procedure which included the oral administration of potassium perchlorate to cause rapid {sup 99m}TcO{sub 4} washout from the thyroid tissue, thereby permitting the acquisition of high-quality early MIBI images. A single-photon emission tomography (SPET) acquisition was also obtained in 21 patients, of whom seven had an enlarged parathyroid gland (EPG) in the mediastinum at planar scintigraphy and 14 had discordant scan/US findings for the presence of a cervical EPG. Neck US was performed in the same session as scintigraphy using a small-parts, high-resolution 10-MHz transducer. All patients were then operated on by the same surgical team. Quick PTH assay (QPTH) was used to measure PTH intraoperatively to confirm successful parathyroidectomy. In patients with scan/US evidence of a solitary EPG and with a normal thyroid gland, limited, unilateral neck surgery or, more recently, MIRS was planned (n=91). In patients with scan/US evidence of multiglandular disease (MGD) (n=21) or concomitant nodular goitre (n=24) or in patients with a negative scan/US evaluation (n=7), extensive bilateral neck exploration was planned (n=52). In 87 of the 91 patients (95.6%) in whom preoperative imaging indicated the presence of a solitary EPG and a normal thyroid gland, a single parathyroid adenoma was found at surgery, and these patients were treated by unilateral neck exploration or MIRS. In the remaining four patients of this group, conversion to bilateral neck exploration was required because parathyroid carcinoma (n=3) or MGD (n=1) was diagnosed at operation. In some cases SPET was helpful in better localising the EPG. In particular, in 5 of the 21 patients evaluated, SPET localised an EPG deep in the neck or mediastinum and at surgery a parathyroid adenoma was found in the paratracheal or para-oesophageal space. In 43 of the 46

  8. Value of I-123-subtraction and single-photon emission computed tomography in addition to planar Tc-99m-MIBI scintigraphy before parathyroid surgery

    Jorna, Francisca H.; Jager, Pieter L.; Que, Tjin H.; Lemstra, Clara; Plukker, John T. M.

    2007-01-01

    Purpose. To find out if single-photon emission computed tomography (SPECT) and I-123-subtraction can enhance the findings of Tc-99-methoxyisobutylisonitrile (MIBI) scintigraphy for the preoperative localization of parathyroid (PT) tumors. Methods. Among the 111 consecutive patients who underwent pre

  9. Normative values of 99mTc-MIBI distribution in myocardium in males and females, as a basis for quantitative planar scintigraphic method for detection of coronary artery disease in patients of both sexes

    Radionuclide perfusion studies of myocardium are being performed using planar and tomographic (SPECT) procedures. The latter method enables better detection as well as assessment of localisation and severity of scintigraphically visualised perfusion defects. On the other hand, lower cost of planar procedures using 99mTc-MIBI as the tracer and their much wider availability in countries of Central and Eastern Europe could significantly increase the diagnostic potential of nuclear cardiology in this region.The aim of the study was an assessment of normal distribution of 99mTc-MIBI in the myocardium and generation of normative basis for quantitative planar scintigraphic procedure, aiming at detection of CAD in patients of both sexes.The study was based on 250 patients. The reference (control) group consisted of 53 individuals (29 men, 24 women) with the low (0 and LAO 700). These mean curves differed significantly between both sexes. In LAO 450 projection the differences affected mostly the region of the septum and postero-lateral wall of the left ventricle (LV). In LAO 700 projection differences were most pronounced in the antero-septal wall of the LV. Sensitivity, specificity and accuracy of CAD detection using the elaborated method, taking into account inter-sex differences, amounted to 86, 87 and 86% respectively in males, and correspondingly 81, 84 and 83% in females. The differences between corresponding indices for two sexes were statistically insignificant. For the whole group of patients the sensitivity, specificity and accuracy was 85, 86 and 85%, respectively. (author)

  10. Evaluation of occult lymph node metastases by means of 99mTc-MIBI scintigraphy and sentinel node biopsy with RT-PCR multi-marker assay in early-stage melanoma patients

    Early diagnosis of regional lymph node metastasis is a key step in the management of melanoma patients. This enables the identification of those patients who are candidates for adjuvant therapy and early therapeutic lymph node dissection. PET using FDG, has been shown to be effective in detecting recurrent melanoma lesions. However, this technique has no proved to offer any significant advantage in diagnostic sensitivity for pre-treatment nodal staging. Lymphoscintigraphy along with intraoperative probe detection of the sentinel node (SN) has become widely accepted for regional lymph node staging. Serial sectioning and immuno-histochemistry (IHC) have been shown to improve the detection of occult melanoma cells, compared with conventional hematoxylin and eosin (H and E) staining alone. More recently, mRNA multi-marker RT-PCR assays have been used to detect micro metastases in lymph nodes where disease was not found by either H and E or IHC techniques. During the last few years, our group has been studying the clinical value of 99mTc-MIBI scintigraphy for the evaluation of melanoma lesions. The technique was found to have the potential of detecting sub clinical recurrent disease including lymph node metastases. Therefore, the aim of the study was to compare the sensitivity of 99mTc-MIBI with that of sentinel node biopsy (SNB) with histopathological and molecular analysis, for the detection of sub clinical nodal disease

  11. Technetium-99m Sestamibi in Multiple Myeloma

    Technetium-99m 2-methoxy - isobutyl - isonitrile (99mTc-MIBI) has been reported to be useful in evaluating patients with multiple myeloma. The aim of this study is to evaluate the role of technetium-99m sestamibi (99mTc-MIBI) scintigraphy in the diagnosis. staging and follow-up of patients with multiple myeloma. Methods and Materials: twenty-five consecutive patients with multiple myeloma were studied using 99mTc- MIBI. Of the 25 patients included in this study, 6 were in stage I, II in stage II and 8 in stage III. Anterior and posterior whole-body imaging were obtained 20 min after I.V. injection of 740 MBq of 99mTc-MIBI. Four different MIBI patterns could be described in our patients: physiological (P), diffuse (D), focal (F) and combined diffuse and focal (D+F). All patients in stages II and III as well as 3 patients in stage I were treated with chemotherapy (cyclophosphamide and prednisone) then 99mTc-MlBI scans were repeated after 6 courses. Results: in comparison to conventional X-ray skeletal survey, 99mTc-MIBI scans showed a higher number of myeloma bone disease at diagnosis. All patients with stage II and III multiple myeloma were positive with 99mTc-MlBl scans at diagnosis. The pattern of positive MIBI accumulation was diffuse in 13 (52%) patients, focal in 4 (16%) and combined focal and diffuse in 6 (24%) patients. The intensity of 99mTc-MIBI correlated with disease activity as determined by lactate dehydrogenase (LDH), number of plasma cells in bone marrow and serum electrophoresis. There was a direct correlation between 99mTc-MIBI scan result and clinical outcome of patients following 6 courses of chemotherapy. Sensitivity and specificity of 99mTc-MIBI scintigraphy in detecting myeloma bone lesions were 92% and 90% respectively. Conclusion: 99mTc-MIBI scintigraphy is a reliable method to evaluate bone marrow activity in patients with multiple myeloma and follow-up of myeloma bone lesions

  12. Surgical management of primary hyperparathyroidism guided by double-phase Tc-99m-MIBI scintigraphy%Tc-99m-MIBI双时相显像在原发性甲状旁腺功能亢进症手术治疗中的价值

    Abdel Hamid Hussein Ezzat; Tarek El. Baradie; Amr Attia; Magdy Kotb; Ahmad Zaher; Iman Gouda

    2012-01-01

    Objective: The aim of this work was to study the clinicopathological features of cases with primary hyperparathyroidism (PHPT) referred to National Cancer Institute (NCI), Cairo University in the last six years and to study the role of nuclear medicine techniques in the initial diagnosis and preoperative localization directing surgical management of these cases. Methods: This study included 27 patients with PHPT properly diagnosed and treated in the NCI, Cairo University from January 2005 to December 2010. Preoperative neck U/S and Tc-99m-MIBI scintigraphy were done in all cases. If preoperative localization detected a single lesion, unilateral exploration was done. Bilateral exploration was done if multiple foci of active parathyroid glands or no lesions were detected. Results: This study included 27 patients (8 males and 19 females). The median age was 43 years (range from 19 to 68 years). All cases presented with bone disease in the form of bony pain in 23 patients, bony swellings in 15 patients and pathological fractures in 6 cases. Twenty one patients (77.8%) had single adenoma, 5 cases (18.5%) had parathyroid hyperplasia, and only one case had double adenomas. The sensitivity of neck U/S in detecting single adenoma was 61.9% (13/21), with 81% positive predictive value (PPV) while the sensitivity of Tc-99m- MIBI scintigraphy was 90.5% (19/21) with 100% PPV. Based on preoperative localization tests, unilateral exploration was done in 19 patients with solitary adenomas. All cases in this group were cured with no reported case of persistent or recurrent hypercalcemia. Conclusion: Presentation of PHPT may mimic malignant bone tumors but fortunately these patients were correctly diagnosed with bone scan which confirm the presence of metabolic bone disease rather than bone metastases. This was followed by estimation of serum calcium and parathormone levels for confirmation. Unilateral exploration based on the combination of ultrasound and preoperative localization

  13. {sup 99m}Tc-M.I.B.I. pinhole SPECT in primary hyperparathyroidism; Tomographie stenopeique au {sup 99m}Tc-MIBI dans l'hyperparathyroidie primaire

    Oudoux, A.; Carlier, T.; Bodet-Milin, C.; Kraeber-Bodere, F.; Ansquer, C. [Centre Hospitalier Universitaire, Service de Medecine Nucleaire, Hotel-Dieu, 44 - Nantes (France); Mirallie, E. [Centre Hospitalier Universitaire, Service de Chirurgie, Hotel-Dieu, 44 - Nantes (France); Seret, A. [Liege Univ. (Belgium). Inst. de Physique; Aubron, F.; Daumy, I. [Centre d' Echographie de l' ile Gloriette, 44 - Nantes (France); Leux, C. [Centre Hospitalier Universitaire, PIMESP, Hopital Saint-Jacques, 44 - Nantes (France)

    2007-10-15

    Purpose: this prospective study was conducted to determine the interest of 99 mTc-M.I.B.I. pinhole SPECT compared with conventional SPECT, planar scintigraphy and ultrasonography, for the preoperative localization of parathyroid lesions in primary hyperparathyroidism. Methods: fifty-one patients cured after surgery were studied. Pinhole SPECT was reconstructed with a dedicated O.S.E.M. algorithm. Scintigraphies were analyzed visually. A diagnostic confidence score (C.S.) was assigned to each procedure considering intensity and extra thyroidal location of suspected lesions and was defined as follows: 0 = negative, 1 = doubtful, 2 = moderately positive, 3 positive. Results: surgery revealed 55 lesions. Sensitivity of ultrasonography, planar imaging, conventional SPECT and pinhole SPECT were respectively, 51, 76, 82 and 87%. Five glands were only detected by pinhole SPECT. Combination of ultrasonography, planar and pinhole SPECT showed the highest sensitivity (94.5%). The mean C.S. of the 55 pathologic glands was significantly higher with pinhole SPECT compared with planar imaging and conventional SPECT (p < 0.0001). Compared with planar imaging and conventional SPECT, pinhole SPECT increased C.S. for 42 and 53% of parathyroid lesions, respectively, and contributed to markedly reduce the number of uncertain results. Nevertheless, planar imaging and ultrasonography were useful to analyze thyroid morphology and to detect some ectopic glands. Conclusion: the use of pinhole SPECT increases sensitivity and C.S. of scintigraphy. Combination of ultrasonography, planar and pinhole SPECT appears the optimal preoperative imaging procedure in primary hyperparathyroidism. (authors)

  14. Transient prolonged stunning by dipyridamole stress proved by post-stress (1 hour) and 24 hour Tc-99m-MIBI gated SPECT

    We performed 1st day Tc-99m-sestamibi gated SPECT with dipyridamole/rest Tl-201 SPECT and 2nd day 24 hour delay Tl-201 SPECT/rest Tc-99m-sestamibi gated SPECT in 27 patients with coronary artery disease (24) or having chest pain(3). Stress and rest Tc-99m-sestamibi gated SPECT was acquired at 60min post-injection. A 4-point scoring system (0 to 3 for normal to absent tracer uptake) for 17 segments was used. Wall motion was scored on another 4 point scale (0 to 3 for normal to dyskinesia) in the 1st day post-stress gated and the 2nd day rest gated SPECT. Post-stress gated SPECT showed wall motion abnormality in 94 segments (20%). Fifty-five segments among these 94 showed the same wall motion between post-stress and rest gated SPECT : i.e. 1-1 : 23 segment, 2-2 : 29 segments, 3-3 : 3 segments. Remaining 39 segments (41.5%) showed different wall motion between post-stress and rest Tc-99m-sestamibi gated SPECT. Twenty one segments with wall motion abnormality had normal perfusion (rest : 15 segments, 24 hour delay : 6 segments) at either rest or 24 hour delay. Fifteen among these 21 segments showed persistent post-stress and the 2nd day rest wall motion abnormality (persistent stunning). However, in 6 segments with prolonged (1 hour after stress) stunning, abnormal wall motion did improve in the 2nd day rest Tc-99m-sestamibi gated SPECT (transient prolonged stunning). These 6 segments had normal perfusion at rest (n=4) or at 24 hour delay (n=2). Post stress wall motions showed significantly higher scores in persistent stunning than in prolonged transient stunning (P value<0.05). It was concluded that we could find stunned myocardium with gated Tc-99m-sestamibi SPECT at either post-stress or rest and that some myocardial walls of post-stress 1 hour gated SPECT did not show truly rest wall motion. So, we should be cautious if we use post-stress Tc-99m-sestamibi wall motion to asses rest wall motion

  15. Comparison study among methodologies of planar chromatography for radiochemical control of technetium-99m; Estudo comparativo entre metodologias de cromatografia planar para controle radioquimico de radiofarmacos de tecnecio-99m

    Monteiro, Elisiane de Godoy

    2012-07-01

    Radiopharmaceuticals are substances that have radioisotopes in their composition. About 95% of the procedures performed in nuclear medicine use radiopharmaceuticals with diagnostic purposes, and the Lyophilized Reagents (LR) labeled with Technetium-99m ({sup 99}mTc), obtained from {sup 99}Mo/{sup 99}mTc generator, are the most one used. Quality Control represents the set of assays to be performed to assure that the product is adequate to its purpose. An important feature to be evaluated in {sup 99m}Tc radiopharmaceuticals is the radiochemical purity (% RqP) to quantify free pertechnetate ({sup 99}mTcO{sub 4}{sup -}) and technetium colloidal (99mTcO{sub 2}) mainly by paper chromatography (PC), thin layer (TLC) and High Performance Liquid Chromatography (HPLC). The objective of this work was to perform the comparison among the radiochemical control methodologies of LR labeled with {sup 99m}Tc, described in the United States Pharmacopoeia (USP) and European Pharmacopoeia (EP) and those used by IPEN. {sup 99m}TcO{sub 4}{sup -} eluate and DISIDA, DMSA, DTPA, EC, ECD, GHA, MIBI, MDP, PIRO, SAH and Sn Coloidal LR were provided by IPEN-CNEN/SP. TLC-cellulose, TLC-SG.TLC-SG reverse phase, HPTLC-cellulose, HPTLC-SG (Merck) and ITLC-SG (Pall Corporation), W1MM, W3MM, W17M e W31ET (Whatman) chromatographic plates were used. The measurement of the radioactivity was done in a Perkin Elmer Cobra D-5002 gamma counter. LR were labeled to obtain 55,0 MBq mL{sup 1} (1,5 mCi mL{sup 1}) of final radioactive concentration. The %{sup 99m}TcO{sub 4}{sup -}, %{sup 99m}TcO{sub 2} and % RqP were determined up to 4 hour labeling. From 11 LR, only EC and GHA have no radiochemical control methods in USP and EP. In USP and/or EP, DTPA, MDP, PIRO, SAH and Sn Coloidal methods use ITLC-SG; IPEN uses this chromatography plate in DISIDA, EC, ECD, GHA, PIRO, MIBI and SAH. As ITLC-SG had been out of production (recommended in 40, 70 and 41% of the USP, EP and IPEN methodologies, respectively), it was

  16. Nude mice multi-drug resistance model of orthotopic transplantation of liver neoplasm and Tc-99m MIBI SPECT on p-glycoprotein

    Yu Han; Xiao-Ping Chen; Zhi-Yong Huang; Hong Zhu

    2005-01-01

    AIM: To establish a model of drug-resistant neoplasms using a nude mice model, orthotopic transplantation of liver neoplasm and sporadic abdominal chemotherapy.METHODS: Hepatocellular carcinoma cells HepG2 were cultured and injected subdermally to form the tumorsupplying mice. The orthotopic drug-resistant tumors were formed by implanting the tumor bits under the envelope of the mice liver and induced by abdominal chemotherapy with Pharmorubicin. Physical examination, ultrasonography, spiral CT and visual inspection were used to examine tumor progression. RT-PCR and immunohistochemistry wereused to detect expression of mdr1 mRNA and its encodedprotein p-glycoprotein (p-gp). Tc-99m sestamibi scintigraphy was performed by obtaining planar abdominal images at 20 min after injection, and the liver/heart ratios werecalculated.RESULTS: Post-implantation mortality was 0% (0/25),tumor implantation success was 90% (22/25), and the rate of implanting successfully for the second time was 100% (3/3). Tumor induction using Pharmorubicin was 80% (16/20). The mdr1 mRNA expression of the induced group was 23 times higher than that of the control group, and p-gp protein expression was 13-fold higher compared to the control group. The liver/heart ratio (as assessed in vivo, using Tc-99m radiography) was decreased significantly in the induced group as compared to the control group. CONCLUSION: We have established an in vivo model of mdr1 in nude mice by orthotopic transplantation of liver neoplasm coupled to chemotherapy. We propose that identification of drug resistance as characterized by decreased 99mTc-ppm radiography due to enhanced clearance by p-gp may be useful in detecting in vivo drug resistance, as well as a useful tool in designing more effective therapies.

  17. Significance of reverse redistribution perfusion abnormality using a standard Tl-201 rest/Tc-99m MIBI stress myocardial perfusion study protocol - correlation with angiographic findings and review of the literature

    Full text: 'Reverse redistribution' (RR) refers to worsening of a perfusion abnormality or the appearance of a new perfusion defect on rest imaging when compared to stress. Opinion remains conjectural regarding the patho-physiological mechanism of this phenomenon and its clinical and prognostic implications. Of the current data, most studies employ a standard one-day thallium stress/ redistribution protocol with no literature available regarding the significance of RR in dual isotope imaging, using the commonly employed one-day Tl-201 rest/ Tc-99m MIBI stress protocol. We reviewed retrospectively all cases of RR reported at Sir Charles Gairdner Hospital from January 1997 to January 2002, using such a protocol in patients who underwent both myocardial perfusion imaging and coronary angiography within a six-month time frame. Semi-quantitative evaluation was performed on the myocardial perfusion studies using a twenty segment, five-grade model, with RR defined as a reduction in perfusion on the rest images by at least one grade relative to the stress image. In total, twelve patients were found, with RR observed in 88 segments. We correlated the scintigraphic findings of these twelve patients to their angiographic results to determine the relationship of RR to angiographically proven coronary stenoses. Comparison of our findings to historical series using single isotope (thallium or MIBI) studies has been made and the findings are similar. This suggests a common underlying patho-physiological mechanism for this phenomenon in both single and dual isotope studies. RR in dual isotope studies has not been previously reported to our knowledge and the available literature is reviewed. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  18. Clinical Value of Double-phase 99mTc-MIBI Scintigraphy in the Diagnosis of Hyperparathyroidism%99mTc-MIBI双时相法诊断甲状旁腺功能亢进症的临床价值

    唐玲; 马云川; 王荣福; 付占立; 范岩

    2008-01-01

    目的 探讨核素99mTc-甲氧基异丁基异腈(99mTc-MIBI)双时相法显像在诊断甲状旁腺功能亢进症(hyper-parathyroidism,HPT)中的作用,并与其他影像检查方法进行比较.方法 65例临床考虑为HPT的患者均分别进行了核素显像及超声检查, 20例做了CT检查,11例做了MRI检查. 核素显像采用99mTc-MIBI双时相法.比较几种影像检查的灵敏度、特异性,分析其对HPT的诊断价值.结果 65例患者中,甲状旁腺激素(PTH)增高36例,以PTH结果为诊断标准.核素检查阳性34例,阴性2例,灵敏度94.4%,特异性100%,准确性96.9%;超声检出32例,阴性4例,假阳性2例,其灵敏度88.9%,特异性93.1%,准确性90.8%;CT阳性17例,MRI阳性8例.结论 核素99mTc-MIBI双时相法甲状旁腺显像是一种简便有效的检查方法,可提高甲状旁腺瘤术前定位诊断的准确率.临床高度怀疑原发性甲状旁腺功能亢进症的病人,若超声检查阴性应进一步行核素检查除外甲状旁腺瘤.

  19. Effect of the reverse redistribution pattern on the left ventricular ejection fraction in the Tc- 99m MIBI SPECT myocardial perfusion scintigraphy

    Bekir Taşdemir

    2015-09-01

    Full Text Available Objective: The causes and prognostic significance of the reverse redistribution pattern (RRP is not clear yet. In this study, we aimed to evaluate the RRP effect on the left ventricular ejection fraction (EF. Methods: Imaging of the patients whose technetium-99m sestamibi myocardial perfusion scintigraphy was carried out and reported as normal were retrospectively examined. One-day protocol and/or pharmacologic stress testing applied patients were excluded. 21 patients with RRP met the inclusion criteria. All of these patients were included in the study as RRP group. Randomly selected 21 patients with non-RRP were included in the study as control group. Transient ischemic dilation (TID scores and EF values were automatically calculated with the Quantitative Gated SPECT (QGS program. Results: While a statistically significant difference was not found between the RRP and control groups in terms of age, sex, hypertension, family history, hyperlipidemia, and diabetes (p>0.05, there was a statistically significant difference in terms of smoking (p=0.019. TID scores in the RRP group were significantly lower compared to the control group (p<0.001. In addition, a statistically significant decrease was determined in the EF values in the rest images compared to the stress images in the RRP group (p=0.002. Furthermore, this decrease was significantly higher than in the control group (p= 0.034. Conclusion: The results related to the TID scores and EF values are suggesting the existence of an ischemic cause in the background of the RRP. Additionally, the relationship found between smoking and RRP may be associated with the tachycardia and / or coronary spasm-inducing effect of smoking. J Clin Exp Invest 2015; 6 (3: 286-290

  20. Marcaje de ciprofloxacina con 99mTc para el diagnóstico de infección activa.

    Abel Hernández Cairo

    2005-01-01

    Full Text Available Introducción: La 99mTc-Ciprofloxacina, es un radiofármaco eficaz para el diagnóstico gammagráfico de infecciones que sólo detecta la presencia de bacterias vivas, ventaja que la distingue de los productos ya conocidos. Radiomarcarla con 99mTc, estudiar su actividad biológica in vivo y su biodistribución en ratas, fueron los objetivos propuestos en esta investigación. Materiales y Métodos: Para marcar con 99mTc se estudiaron varias relaciones molares Ciprofloxacina: Fluoruro de Estaño (SnF2, manteniendo fija la cantidad de fármaco y la actividad. Se controló la pureza por cromatografía en TLC silica gel. Se realizó modelo de absceso con Staphilococcus Aureus (SA y Escherichia coli (EC y los estudios biocinéticos se realizaron en ratas Wistar. Se administró 666-740 MBq/kg de 99mTc-Ciprofloxacina y se midió el porciento de dosis inyectada en diferentes órganos. Se colectó toda la orina durante 24 horas en 4 ratas. Resultados: La mayor pureza radioquímica se obtuvo cuando se utilizó 19.1¿g del reductor (92.5 ± 2.5%. El marcaje fue >90% por más de 10 horas. La relación lesión/ fondo en el modelo animal se mantuvo en aumento durante 20 horas. El momento óptimo para la adquisición resulto ser a las 4 horas de la inyección del radiofármaco. La biodistribución mostró marcada acumulación en hígado, riñones y en intestinos todo el tiempo. Por vía renal se eliminó el 41±1% de la dosis. Conclusiones: Con esta técnica se logró un alto rendimiento de 99mTc-Ciprofloxacina con adecuada estabilidad. El radiofármaco fue capaz de reconocer abscesos activos en zonas músculo-esqueléticas de ratas Wistar y presentó una biocinética favorable para los propósitos perseguidos en la clínica. La técnica es simple y perfectamente reproducible.

  1. 99mTc-MIBISPECT-CT显像在纵隔内异位甲状旁腺诊治中的应用价值%Application value of 99m Tc-MIBI SPECT-CT scintigraphy in diagnosis and treatment of mediastinal ectopic parathyroid

    李征

    2015-01-01

    Objective To analyze the application value of single photon emission computed tomography (SPECT)‐CT 99m Tc‐methoxyisobutylisonitrile(MIBI) scintigraphy in the diagnosis and treatment of mediastinal ec‐topic parathyroid .Methods 100 cases of secondary hyperparathyroidism in the Beijing Shijitan Hospital from Aug . 2013 to Feb .2013 were selected as the research subjects and performed the 99m Tc‐MIBI dual‐phase scintigraphy , plane and SPECT and CT imaging with the same machine .The fused images of mediastinal abnormal radioactive high uptake lesions were analyzed .And the relationship between T/NT radioactivity ratio and intact parathyroid hormone (iPTH) level and pathological results were also analyzed .Results Among 100 cases ,mediastinal ectopic parathyroid appeared in 2 cases (2 .0% ) ,in which 1 case was given the parathyroidectomy before imaging and the postoperative iPTH was increased again;another case was treated by medication .These two cases showed the ectopic parathyroid imaging by postoperative SPECT‐CT imaging ,which located in the sternoclavicular joint .The plane ,SPECT and CT imaging with the same machine showed that the highest T/NT radioactivity ratio of parathyroid was positively corre‐lated with the iPT H level before imagine(r=0 .419 ,P0 .05) .Conclusion 99m Tc‐MIBI SPECT‐CT scintigraphy could effectively fuse the anatomical im‐ages and functional images ,may have the extremely high specificity ,sensitivity and accuracy for the diagnosis of hy‐perparathyroidism ,at the same time could accurately localize the lesions ,increase the operation efficiency and make the operation to reach the satisfactory effect .%目的:分析99mTc‐甲氧基异丁基异腈(MIBI)单光子发射计算机断层显像(SPECT)‐CT显像在纵隔内异位甲状旁腺诊治中的应用价值。方法以2013年8月至2014年2月北京世纪坛医院收治的100例继发性甲状旁腺功能亢进症(SHPT)患者为研究

  2. Study on Effect of Shenmai Injection Protecting Myocardium against Ischemia-Reperfusion Injury in Thrombolytic Therapy with Urokinase for Acute Myocardial Infarction Patient Evaluated by 99mTc-MIBI Myocardial Imaging

    2001-01-01

    Objective: To evaluate the myocardial protecting effect of Shenmai injection (SMI) against ischemia/reperfusion injury in thrombolytic therapy with urokinase (UK) for acute myocardial infarction patients by 99mTc-MIBI myocardial imaging (SPECT). Methods: Five hundred and thirty-seven patients were divided into two groups randomly. The SMI group (n=292) was treated with thrombolytictreatment plus SMI and the control group (n=245) with thrombolytic treatment solely. Single photon emission computed tomography (SPECT) was carried out on the 7th day after thrombolysis to determine the ischemic myocardial area (IMA) and ejection fraction (EF) in both groups and compared. Results: The infarction related area (IRA) of reperfusion rate in the two groups was not different significantly (72.26% vs 72.65%, P >0.05). The IMA in patients of the SMI group, no matter with or without reperfused IRA (211 cases and 81 cases) respectively, was significantly lower than that in the control group (178 cases and 67 cases) respectively, P<0.01 and P<0.05 respectively. The EF value in the SMI group was significantly higher than that in the control group (P<0.01). Conclusion:Using SMI in early stage of thrombolytic treatment in acute myocardial infarction could significantly reduce IMA and increase EF. SMI showed good protective effect against myocardial ischemia/reperfusion injury in thrombolytic treatment.

  3. Study on Effect of Shenmai Injection Protecting Myocardium against Ischemia-Reperfusion Injury in Thrombolytic Therapy with Urokinase for Acute Myocardial Infarction Patient Evaluated by 99mTc-MIBI Myocardial Imaging

    郭松鹏; 张言镇

    2001-01-01

    Objective: To evaluate the myocardial protecting effect of Shenmai injection (SMI) against ischemia/reperfusion injury in thrombolytic therapy with urokinase (UK) for acute myocardial infarction patients by 99mTc-MIBI myocardial imaging (SPECT). Methods: Five hundred and thirty-seven patients were divided into two groups randomly. The SMI group (n=292) was treated with thrombolytictreatment plus SMI and the control group (n=245) with thrombolytic treatment solely. Single photon emission computed tomography (SPECT) was carried out on the 7th day after thrombolysis to determine the ischemic myocardial area (IMA) and ejection fraction (EF) in both groups and compared. Results: The infarction related area (IRA) of reperfusion rate in the two groups was not different significantly (72.26% vs 72.65%, P >0.05). The IMA in patients of the SMI group, no matter with or without reperfused IRA (211 cases and 81 cases) respectively, was significantly lower than that in the control group (178 cases and 67 cases) respectively, P<0.01 and P<0.05 respectively. The EF value in the SMI group was significantly higher than that in the control group (P<0.01). Conclusion:Using SMI in early stage of thrombolytic treatment in acute myocardial infarction could significantly reduce IMA and increase EF. SMI showed good protective effect against myocardial ischemia/reperfusion injury in thrombolytic treatment.

  4. Cintilografia do miocárdio com tecnécio 99m-MIBI e administração de adenosina em portadores de doença arterial coronária: correlação dos resultados com a angiografia coronária e o ultra-som intracoronário Adenosine myocardial perfusion SPECT with Tc-99m-MIBI in patients with obstructive coronary artery disease: correlation between quantitative coronary angiography and intravascular ultrasound measurements

    Luiz Eduardo Mastrocolla

    2006-01-01

    Full Text Available OBJETIVO: Estabelecer a correlação da cintilografia de perfusão do miocárdio (CPM com Tecnécio 99m-MIBI (MIBI e injeção de adenosina, empregando a angiografia coronária quantitativa (ACQ e o ultra-som intracoronário (UIC como comparação. MÉTODOS: Estudo de 70 pacientes com doença arterial coronária (DAC, encaminhados à CPM com MIBI e adenosina. As manifestações clínicas, do eletrocardiograma (ECG e os resultados das imagens foram correlacionadas às variáveis da análise visual e quantitativa da angiografia, bem como ao UIC. RESULTADOS: A média de idades foi de 60,6 anos, com 39 pacientes do sexo masculino. A angiografia coronária evidenciou estenose do diâmetro da luz (E% de 49,94% em 105 artérias, com reavaliação à ACQ em 83 artérias (79% e média de 44,20%, pOBJECTIVE: To correlate myocardial perfusion scintigraphy (MPS with Tc-99m-MIBI and adenosine infusion using quantitative coronary angiography (QCA and intravascular ultrasound (IVUS. METHODS: Seventy patients with coronary artery disease (CAD referred for myocardial perfusion scintigraphy (MPS with MIBI and adenosine were studied. Clinical, electrocardiographic (ECG, and scintigraphic findings were correlated with variables of visual and quantitative angiographic analysis, as well as to those of IVUS. RESULTS: The mean age of patients was 60.6 years, and 39 were male. Coronary angiography showed percentage of diameter stenosis (% DS of 49.94% in 105 arteries, 83 of which were re-evaluated by QCA (79%, mean of 44.20%, p<0.05. ST-segment depression during adenosine infusion was associated with higher degrees of % DS (55.0% vs. 47.8%, p<0.05. Scintigraphic ischemia was correlated with greater cross-sectional area of lumen obstruction by IVUS (% CSA. Clinical, ECG, and IVUS findings were considered together and expressed as global ischemic versus non-ischemic responses. Ischemia was associated with lower values of minimal lumen diameter (MLD and minimal lumen area

  5. 99mTc-MIBI运动后早期门控心肌显像诊断冠心病的价值%Diagnostic value of ECG-gated early post-exercise 99mTc-MIBI myocardial perfusion imaging in coronary artery disease

    李殿富; 黄峻; 冯建林; 李建华; 程旭; 杨志建; 朱铁兵; 曹克将

    2006-01-01

    目的:比较99mTc-MIBI门控心肌显像(G-MPI)与传统的非门控心肌显像(NG-MPI)对冠心病(CHD)的诊断价值.方法:215例同期1个月内做负荷(运动后15~20 min)/静息2日法99mTc-MIBI G-MPI和冠状动脉造影的CHD患者,以冠状动脉直径狭窄≥50%为诊断标准,比较NG-MPI和G-MPI的诊断价值. 结果:心电图运动试验(ETT)、NG-MPI和G-MPI诊断CHD的敏感性分别为:58.0%,88.3%,90.7%;特异性分别为:67.9%,79.2%,88.7%.NG-MPI和G-MPI的敏感性与ETT相比均差异有统计学意义(P<0.01).G-MPI的诊断敏感性比NG-MPI有增高趋势 ,但两者比较差异无统计学意义(P>0.05).在诊断特异性方面,G-MPI与ETT相比差异有统计学意义 (P<0.01);对男、女2个性别的特异性分析发现,G-MPI对女性诊断特异性的增加尤其显著.对于严重CHD(狭窄≥70%), G-MPI对严重3支病变的诊断敏感性显著高于NG-MPI(100%:92.2%,P<0.05).结论:G-MPI对诊断CHD的价值显著优越于ETT,也优于NG-MPI.

  6. 99mTc-sestamibi and 99mTc-tetrofosmin scintigraphy in myeloma bone disease

    Full text: Evaluation of the role of scintigraphy with 99mTc-Sestamibi (99mTc-MIBI) and 99mTc-Tetrofosmin (99mTc-TF) in the detection of bone marrow involvement in patients (pts) with multiple myeloma (MM) and in follow-up. 62 pts with MM and 38 pts with monoclonal gammopathy of undetermined significance (MGUS) were enrolled in this study. Forty-seven out sixty-two MM pts had active disease (AD), 10/62 were in complete remission (CR) and 5/62 in partial remission (PR) after chemotherapy. Whole-body scans were obtained 10 min after the i.v. injection of 740 MBq of 99mTc-MIBI in anterior and posterior view. The scans were scored semiquantitatively according to extension and intensity of tracer uptake. All 38 MGUS pts had a negative 99mTc-MIBI scan. As to the MM pts, 49/62 pts (44 with AD, 4 with PR and 1 with CR) had a positive 99mTc-MIBI scan, while the 99mTc-MIBI scan was negative in 13/62 pts (9 with CR, 1 with PR and 3 with AD). The overall sensitivity of the scintigraphic procedure was 92 % while specificity was 97 %. A total of 42 follow-up scans with 99mTc-MIBI were performed in 30 MM pts after high-dose chemotherapy, with an average follow-up duration of 14.6 ± 8.9. The follow-up 99mTc-MIBI scintigraphy was positive in 14/15 of the AD pts, while 6/8 negative scans were observed in the CR pts; the seven PR pts exhibited in five cases a negative scan and in two a mild scintigrafic positivity. The overall sensitivity and specificity of the follow-up scan were, respectively, 86 % and 75 %. In six patients, one at the diagnosis and five showing a positive 99mTc-MIBI scan during the follow-up, 740 MBq of 99mTc-TF was administered within two days with the same acquisition protocol. The scans provided substantially identical information. 99mTc-TF provided a mildly higher contrast between lesion and background activities. The results obtained in this study provide additional evidence indicating that 99mTc-MIBI scintigraphy closely reflects myeloma disease activity in

  7. Is Brown Adipose Tissue Visualization Reliable on 99mTc-Methoxyisobutylisonitrile Diagnostic SPECT Scintigraphy?

    Haghighatafshar, Mahdi; Farhoudi, Farinaz

    2016-01-01

    Abstract The 99mTc-MIBI has been used with great value as a diagnostic technique in patients with primary hyperparathyroidism. False-positive scans may occur due to misinterpretation of the physiologic distribution of the 99mTc-MIBI. Reviewing consecutive SPECT scans, we evaluated this possibility and assessed how frequently brown adipose tissue (BAT) is seen on 99mTc-MIBI scintigraphy. Here, we retrospectively reviewed scans of consecutive patients who were evaluated for parathyroid adenomas...

  8. Synthesis, formulation and quality control of methoxy isobutyl isonitrile as a 99m Tc radiopharmaceutical kit for myocardial perfusion scintigraphy

    99m Tc - MIBI is a lipophile cationic 99m Tc complex which has been found to accumulate in viable myocardial tissue. The chemical structure of Isonitriles in particular Methoxy Isobutyl Isonitrile (MIBI) as well as the procedures of synthesis, formulation of kit and labelling with 99m Tc is discussed. Investigation of effective factors and finding the optimum parameters to obtain the highest labelling efficiency and radiochemical purity of 99m Tc - MIBI complex is also included in this research work

  9. Technetium-99m Radiopharmaceuticals for Monitoring Drug Resistance. Chapter 12

    Resistance to chemotherapy constitutes a major obstacle to cancer cures. Cellular mechanisms of resistance involve efflux pumps, P-glycoprotein (Pgp), the product of the MDR1 gene and the related membrane glycoprotein, multidrug resistance associated protein 1 (MRP1). Multidrug resistant cell lines overexpressing Pgp are resistant to a structurally and functionally diverse group of chemotherapeutic agents. Many of these drugs tend to be lipophilic and positively charged at neutral pH. This suggested the application of the two lipophilic cationic 99mTc radiopharmaceuticals currently used for myocardial perfusion, 99mTc-MIBI and 99mTc-Tetrofosmin. Efforts were also made to develop specific 99mTc labelled substrates for Pgp based on lipophilic cationic 99mTc complexes. A large number of studies indicated that 99mTc-MIBI, 99mTc-Tetrofosmin and some related 99mTc compounds are substrates for Pgp. However, it remains uncertain whether these 99mTc labelled compounds are substrates for MRP1. Thus, both 99mTc-MIBI and 99mTc-Tetrofosmin would be general probes of transporter mediated multidrug resistance in tumour cells. (author)

  10. Technetium-99m Sestamibi and [F18]Fluorodeoxyglucose (FDG) PET in assessing patients with multiple myeloma

    Full text: The aim of the study is to evaluate the diagnostic and prognostic value of 99mTc-Sestamibi (MIBI) in the detection on bone marrow involvement in patients suffering from Multiple Myeloma (MM), its possible role in the follow-up and comparison of 99mTc-MIBI and [F18]FDG PET imaging. We present the results, for patients at our institution, that have undergone 99mTc-MIBI scans to assess MM. We considered patients (pts) with MM (in active disease, partial and chronic remission) and with monoclonal gammopathy of undetermined significance (MGUS). A subgroup of patients with MM repeated a 99mTc-MIBI scintigraphic study at least 2 months after high-dose chemotherapy. All the scans were scored semi-quantitatively according to extension and intensity of tracer uptake. Twelve patients had concurrent 99mTc-MIBI and [F18]FDG PET. The overall sensitivity of the 99mTc-MIBI scintigraphy was 92%, specificity was 96%. In the follow up of the pts treated with chemotherapy 99mTc-sestamibi closely paralleled the activity of myeloma bone disease. A multivariate analysis showed that 99mTc-MIBI uptake pattern has an added value in relation to known prognostic variables. In another study, patients showing disease progression at restaging had higher washout of 99mTc-MIBI (10 and 60 minutes) than patients in remission; disease free survival was significantly better in patients with lower washout in absence of differences in therapeutic regimen and stage of disease at admission. [F18]FDG-PET and MIBI were concordant in seven of 12 cases (58%); only in one case FDG detected bone marrow sites in addition to those detected by 99mTc-MIBI. Our experience indicates that 99mTc-MIBI scintigraphy closely reflects myeloma disease activity in the bone marrow, and that a negative 99mTc-MIBI scan in pts with suspected MM indicates absence of disease or clinical remission. The results of these studies suggest a potential role of 99mTc-MIBI washout in predicting response to chemotherapy in

  11. A Pilot Comparison of 18F-fluorocholine PET/CT, Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism

    Michaud, Laure; Balogova, Sona; Burgess, Alice; Ohnona, Jessica; Huchet, Virginie; Kerrou, Khaldoun; Lefèvre, Marine; Tassart, Marc; Montravers, Françoise; Périé, Sophie; Talbot, Jean-Noël

    2015-01-01

    Abstract We compared 18F-fluorocholine hybrid positron emission tomography/X-ray computed tomography (FCH-PET/CT) with ultrasonography (US) and scintigraphy in patients with hyperparathyroidism and discordant, or equivocal results of US and 123I/99mTc-sesta-methoxyisobutylisonitrile (sestaMIBI) dual-phase parathyroid scintigraphy. FCH-PET/CT was performed in 17 patients with primary (n = 11) lithium induced (n = 1) or secondary hyperparathyroidism (1 dialyzed, 4 renal-transplanted). The refer...

  12. Preparation and assessment of [{sup 99m}Tc]technetium aquacarbonyl complexes with 1,2-diaminoethane-N-substituted ligands for tumor detection; Preparo e avaliacao de complexos de [{sup 99m}Tc]tecnecio aquacarbonil com ligantes 1,2-diaminoetano-N-substituidos para deteccao de tumores

    Radin, Adriano

    2010-07-01

    Over least 15 years the complex [[{sup 99m}Tc](H{sub 2}0){sub 3}(CO){sub 3}]{sup +} has been used as an intermediary to obtain technetium radiopharmaceuticals for applications in cardiology, neurology and oncology. Two important characteristics of this molecule are: the facility for obtaining that compound from aqueous solutions and the easiness of substituting H{sub 2}O molecules by atoms of other ligand molecules. In this project we prepared new complexes [[{sup 99m}Tc](CMN{sup S001-3})(H{sub 2}O)(CO){sub 3}]{sup +}, where (CMNS001) = N-[(4-methoxy) benzyl]-1,2-diaminoethane, (CMNS003) = N,N'-bis-[(4-methoxy)benzyl]-1,2-diaminoethane, and assessed the uptake of these complexes in murine melanoma cancer cell B16F10 and breast cells MCF-7 and MDA-MD-231, and compared with [[{sup 99m}](MIBI){sub 6}]{sup +} uptake. In vitro uptake for both new technetium complex reached values close to 5%, for all cell lines, whereas the [[{sup 99m}Tc](MIBI){sub 6}]{sup +} uptake was close to 1 %. The assessment of subcellular distribution showed high accumulation of the new complex in the membrane fraction, for MDAMB-231, while for B16F10 accumulation occurred both in membrane and cytoplasm; the concentration of [[{sup 99m}Tc](MIBI){sub 6}]{sup +} was mainly in the cytoplasm portion. Biodistribution study in mice allowed to observe the capture of up to 1.6% of the administered dose per gram of tumor tissue for the complex [[{sup 99m}Tc](CMNS001)(H{sub 2}O)(CO){sub 3}]{sup +}, whereas other organs such as heart, lung and muscle, showed uptake of about 5.6%, 6.4% and 2%, respectively. The complexes in this work showed a high rate of uptake in vitro, but was not reproduced in vivo model, which can be related to low concentration of the complexes inside the cells and reduced vascularity of tumor tissue, with lower intake of complex through the blood system. (author)

  13. Are P.T.H. plasma levels useful for the selection of patients with secondary hyperparathyroidism for preoperative MIBI ({sup 99m}Tc)/{sup 123}I dual-isotope scintigraphy?;La concentration plasmatique de PTH permet-elle de selectionner les patients atteints d'hyperparathyroidie secondaire pour beneficier de la scintigraphie double isotope MIBI ({sup 99m}Tc)/{sup 123}I preoperatoire?

    Balogova, S.; Sauer, A.M.; Dudczak, J.; Pascal, O.; Kerrou, K.; Huchet, V.; Montravers, F.; Talbot, J.N. [Universite Pierre-et-Marie-Curie, Service de medecine nucleaire, hopital Tenon, 75 - Paris (France); Perie, S.; Lacau St-Guily, J. [Universite Pierre-et-Marie-Curie, ORL, hopital Tenon, 75 - Paris (France); Nataf, V. [Universite Pierre-et-Marie-Curie, hopital Tenon, Service de radiopharmacie, 75 - Paris (France); Balogova, S. [Faculte de medecine, universite Comenius, Bratislava (Slovakia)

    2010-07-15

    The utility of preoperative scintigraphy in case of secondary hyperparathyroidism is questioned by some authors. Obviously, an imaging modality that will detect all hyperplastic glands, including the ectopic ones, would be of interest in those patients at high risk for surgery. However, scintigraphy has a limited detection rate in some patients. We investigated whether one of the following parameters would identify a subgroup of patients in whom the detection rate would be optimal: age, gender, hemodialysis and duration since its onset, and plasma levels of parathyrin (P.T.H.). Methods: Retrospective series of 38 patients referred for preoperative parathyroid scintigraphy due to secondary hyperparathyroidism who then underwent para thyroidectomy. Scintigraphy was performed 20 min and then 3 h after injection of 8 MBq/kg of sestamibi ({sup 99m}Tc) with a previous ingestion of 0.1 MBq/kg iodine-123, 3 h before. Result: No significant correlation was observed between the number of glands detected on scintigraphy (and confirmed by postoperative histology) and plasma P.T.H. levels (r = -0.17). A weak positive correlation (r = +0.34) was noted in the group of six non-hemo dialysed patients. No significant relationship between this number of detected glands and a clinical parameter was observed. Conclusion: In our experience, these parameters do not permit to select, among patients with secondary hyperparathyroidism and scheduled for para thyroidectomy, those who will better benefit from parathyroid scintigraphy. (authors)

  14. A Pilot Comparison of 18F-fluorocholine PET/CT, Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism: Influence of Thyroid Anomalies.

    Michaud, Laure; Balogova, Sona; Burgess, Alice; Ohnona, Jessica; Huchet, Virginie; Kerrou, Khaldoun; Lefèvre, Marine; Tassart, Marc; Montravers, Françoise; Périé, Sophie; Talbot, Jean-Noël

    2015-10-01

    We compared (18)F-fluorocholine hybrid positron emission tomography/X-ray computed tomography (FCH-PET/CT) with ultrasonography (US) and scintigraphy in patients with hyperparathyroidism and discordant, or equivocal results of US and (123)I/(99m)Tc-sesta-methoxyisobutylisonitrile (sestaMIBI) dual-phase parathyroid scintigraphy. FCH-PET/CT was performed in 17 patients with primary (n = 11) lithium induced (n = 1) or secondary hyperparathyroidism (1 dialyzed, 4 renal-transplanted).The reference standard was based on results of surgical exploration and histopathological examination. The results of imaging modalities were evaluated, on site and by masked reading, on per-patient and per-lesion bases.In a first approach, equivocal images/foci were considered as negative. On a per-patient level, the sensitivity was for US 38%, for scintigraphy 69% by open and 94% by masked reading, and for FCH-PET/CT 88% by open and 94% by masked reading. On a per-lesion level, sensitivity was for US 42%, for scintigraphy 58% by open and 83% by masked reading, and for FCH-PET/CT 88% by open and 96% by masked reading. One ectopic adenoma was missed by the 3 imaging modalities. Considering equivocal images/foci as positive increased the accuracy of the open reading of scintigraphy or of FCH-PET/CT, but not of US. FCH-PET/CT was significantly superior to US in all approaches, whereas it was more sensitive than scintigraphy only for open reading considering equivocal images/foci as negative (P = 0.04). FCH uptake was more intense in adenomas than in hyperplastic parathyroid glands. Thyroid lesions were suspected in 9 patients. They may induce false-positive results as in one case of oncocytic thyroid adenoma, or false-negative results as in one case of intrathyroidal parathyroid adenoma. Thyroid cancer (4 cases) can be visualized with FCH as with (99m)Tc-sestaMIBI, but the intensity of uptake was moderate, similar to that of parathyroid hyperplasia.This pilot study confirmed that

  15. The Relationship Between Technetium-99m-Methoxyisobutyl Isonitrile Parathyroid Scintigraphy and Hormonal and Biochemical Markers in Suspicion of Primary Hyperparathyroidism

    Güler Silov; Ayşegül Özdal; Zeynep Erdoğan; Özgül Turhal; Hatice Karaman

    2013-01-01

    Objective: Technetium-99m-methoxyisobutyl isonitrile (Tc-99m MIBI) has been widely used to evaluate hyperfunctioning autonomous parathyroid glands in patients with elevated intact parathyroid hormone (iPTH) and/or calcium (Ca) level. The aim of this study was to evaluate the relationship between Tc-99m MIBI parathyroid scintigraphy and hormonal and biochemical markers in suspicion of primary hyperparathyroidism (PHPT). Material and Methods: Dual-phase Tc-99m MIBI parathyroid scintigraphy and ...

  16. Contribution of {sup 99m}Tc-sestamibi scintigraphy by double phase in the exploration of hyperparathyroidism. Report of 20 cases; Apport de la scintigraphie parathyroidienne au {sup 99m}Tc-MIBI en double phase dans l'exploration des hyperparathyroidies. A propos de 20 cas

    Ghfir, I.; Ben Rais, N. [Hopital Ibn Sina, CHU de Rabat, Service de Medecine Nucleaire de Rabat (Morocco)

    2008-11-15

    Introduction {sup 99m}Tc-sestamibi parathyroid scintigraphy is a means of functional imaging allowing the exploration of hyperparathyroidism. The aim of our study is to demonstrate the utility of double-phase {sup 99m}Tc-sestamibi scintigraphy in the exploration of the secreting abnormal parathyroid gland. Materials and methods We report, through this work, the observation of 20 patients followed for a biologically ascertained hyperparathyroidism and explored, for the majority of them, by ultrasonography and/or computed tomography. All our patients benefited from a double-phase {sup 99m}Tc-sestamibi scintigraphy. Results On the 20 studied cases, the sex-ratio was equal to 1, two patients exhibited three high uptake foci at the {sup 99m}Tc-sestamibi scintigraphy, six exhibited two foci, twelve exhibited one parathyroid focus. In our series, 80% of patients exhibited secondary hyperparathyroidism and 20% exhibited a primary hyperparathyroidism. The pathologic exam revealed four cases of parathyroid adenoma and 16 parathyroid cases of hyperplasia. Discussion The double-phase {sup 99m}Tc-sestamibi scintigraphy contributes to the orientation and the improvement of the surgical attitude of the hyperparathyroidism, insofar as it could affirm the multiplicity of some adenomas, the diffuse form of some hyperplasia, and especially ectopic localization of the abnormal parathyroid gland.

  17. Development of methods of labeling pentavalent DMSA with {sup 99m}Tc and {sup 188}Re; Desenvolvimento de metodos para marcacao de DMSA pentavalente com {sup 99m}Tc e {sup 188}Re

    Brambilla, Tania de Paula, email: jtoniolo@ipen.br

    2009-07-01

    Technetium-99 m is the most useful radionuclide in diagnostic imaging procedures in Nuclear Medicine, more than 80 percent of radiopharmaceuticals are {sup 99m}Tc-labeled compounds. {sup 99m}Tc-DMSA(V) has been used for imaging of soft tissue, head and neck tumors. It shows a particularly high specificity for medullary thyroid carcinoma and bone metastases in a variety of cancers. Biodistribution studies of {sup 188}Re-DMSA(V) have shown that its general pharmacokinetic properties are similar to that of {sup 99m}Tc-DMSA(V), so this agent could be used for targeted radiotherapy of these tumors. The aim of this work is the development of methods of labeling DMSA(V) with {sup 99m}Tc and {sup 188}Re. {sup 99m}Tc-DMSA(V) can be prepared by two methods. One of them is the indirect one, through the use of a commercial kit of DMSA (III), by adjusting the pH from 2.5 to {approx} 8.5 with NaHCO{sub 3}. This method was evaluated and optimized presenting high labeling yields. The other method is the direct one, through the preparation of a lyophilised kit ready for labeling with {sup 99m}Tc, being the method of interest of this work, due to the easy of its clinical use. The most adequate formulation of the kit was: 1.71 mg of DMSA, 0.53 mg of SnCl{sub 2}.2H{sub 2}O and 0.83 mg of ascorbic acid (pH 9). Labeling yields higher than 95% were achieved labeling this kit with 1 to 2 m L of {sup 99m}Tc with activities up to 4736 MBq (128 mCi). The kit was stable up to 6 months and biodistribution studies confirmed the quality of the DMSA (V) labeled with {sup 99m}Tc using this kit. The reduction potential of Re is lower than the one for Tc, so the labeling conditions of {sup 188}Re-DMSA(V) are different from the ones used for {sup 99m}Tc- DMSA(V). {sup 188}Re-DMSA(V) is prepared in acid solution, that makes it possible to use the DMSA (III) commercial kit developed for labeling with {sup 99m}Tc, prepared in pH 2.5, for labeling with {sup 188}Re. Labeling yields higher than 95% were

  18. Is Brown Adipose Tissue Visualization Reliable on 99mTc-Methoxyisobutylisonitrile Diagnostic SPECT Scintigraphy?

    Haghighatafshar, Mahdi; Farhoudi, Farinaz

    2016-01-01

    The 99mTc-MIBI has been used with great value as a diagnostic technique in patients with primary hyperparathyroidism. False-positive scans may occur due to misinterpretation of the physiologic distribution of the 99mTc-MIBI. Reviewing consecutive SPECT scans, we evaluated this possibility and assessed how frequently brown adipose tissue (BAT) is seen on 99mTc-MIBI scintigraphy. Here, we retrospectively reviewed scans of consecutive patients who were evaluated for parathyroid adenomas from March 2015 to June 2015, using dual-phase (early and delayed) planar imaging and SPECT. We identified 60 patients (48 female and 12 male; mean age, 52.25 ± 15.20 years; range, 22-86 years).We detected the presence of 99mTc-MIBI uptake in BAT in 20 of 60 patients (33.33%) in the neck. Although the patients with T99mc-MIBI uptake in BAT were younger (mean age, 48.85 ± 15.27 years, range, 26-73 years) than the patients with no 99mTc-MIBI uptake (mean age, 53.95 ± 15.07 years, range, 22-86 years), this difference was not statistically significant (P = 0.224). The percentage of female patients with BAT detection was higher (17/48 patients; 37.5%) than that of the male population (3/12 patients; 25%), this difference was not also statistically significant (P = 0.85).In patient population referred to 99mTc MIBI scintigraphy of the parathyroid glands, uptake of 99mTc-MIBI in BAT should not be misinterpreted with 99mTc-MIBI-avid-tumors. Fused SPECT/CT images (not SPECT-only) are necessary to distinguish BAT from bone, muscle, thyroid, myocardium, parathyroids, and other structures in the neck and chest. PMID:26765463

  19. Standardization of a method to calculate absolute renal uptake of {sup 99m} Tc-DMSA in children; Padronizacao do metodo para calculo da captacao renal absoluta do {sup 99m}Tc-DMSA em criancas

    Ono, Carla Rachel; Sapienza, Marcelo Tatit; Watanabe, Tomoco; Costa, Paulo Luiz Aguirre; Okamoto, Miriam Roseli Yoshie; Garcez, Alexandre Teles; Buchpiguel, Carlos Alberto [Sao Paulo Univ., SP (Brazil). Hospital das Clinicas. Servico de Medicina Nuclear]. E-mail: crachelo@usp.br; Machado, Beatriz Marcondes; Machado, Marcia Melo Campos [Paulo Univ., SP (Brazil). Faculdade de Medicina. Hospital Universitario; Liberato Junior, Waldyr de Paula

    2006-01-15

    Objective:To standardize a method and determine normal values for absolute renal uptake of 99m Tc-DMSA in children with normal creatinine clearance. Materials and methods: Twenty-two children (between 7 months and 10 years of age; mean 4.5 years) without clinical evidence of renal disease were studied using 99m Tc-DMSA scintigraphy. Eighteen had normal renal ultrasonography, micturating urethrocystography, creatinine clearance and visual interpretation of the scintigraphy with 99m Tc-DMSA. Four children were excluded, one with incomplete creatinine clearance and three due to reduction in the creatinine clearance. Absolute renal uptake of 99m Tc-DMSA (DMSA-Abs) was expressed as the fraction of the administered dose retained by each kidney six hours after administration of the radiopharmaceutical. Results: DMSA-Abs was 21.8 +- 3.2% for the right kidney and 23.1 +-3.3% for the left kidney. There was no correlation between renal uptake and the age groups studied, although there was a tendency to an increase in the creatinine clearance with age. Conclusion: Normal values of DMSA-Abs can be used as an additional parameter for the initial diagnostic evaluation and during follow-up of renal diseases, mainly when bilateral impairment of renal function is suspected or in a patient with a single functioning kidney (in which renal differential function is of limited value). (author)

  20. {sup 99m} Tc-UBI 29-41: radiolabelled antimicrobial peptide for the diagnostic by image of infectious processes; {sup 99m} Tc-UBI 29-41: peptido antimicrobiano radiomarcado para el diagnostico por imagen de procesos infecciosos

    Ferro F, G.; Ramirez C, F.M. [ININ, 52045 Ocoyoacac, Estado de Mexico (Mexico); Murphy, C.A. de; Pedraza L, M.; Rodriguez C, J. [INCMNSZ, 14000 Mexico D.F. (Mexico); Melendez A, L. [Facultad de Medicina, UAEM, 50000 Toluca, Estado de Mexico (Mexico)

    2005-07-01

    Recently the radiolabelled anti microbic peptides has intended as new radiopharmaceuticals for distinguish a bacterial infection of a sterile inflammatory process through a diagnostic image. The ubiquicidine 29-41 (UBI), it is a fragment of an anti microbic cationic peptide located in the human skin whose sequence of amino acids is Thr-Gly-Arg-Ala-Lys-Arg-Arg-Met-Gln-Tyr-Asn-Arg-Arg. The objective of this study was to develop a derived of the UBI 29-41 radiolabelled with Tc-99m in high radiochemical purity and to evaluate the feasibility of using it in the specific detection of infectious focuses. The molecular structures of the UBI as well as of other 2 cationic peptides used as control (Tat-1-Scr and Tat-2-Scr), they were calculated and optimized in their more stable configuration by molecular mechanics procedures and quantum mechanics. Once established the site for the labelled with {sup 99m} Tc, the three complexes were represented by the general formula [Tc(V)(O)(H{sub 2}O){sub 2} (Lys{sub n=1,2}-Arg{sub n=0.1}-peptide)]{sup 10+,11+}, with potential energy of 104.5 Kcal/mol, 95.6 Kcal/mol and 90.8 Kcal/mol for the {sup 99m}Tc-Tat-1-Scr, {sup 99m} Tc-Tat-2-Scr and {sup 99m}Tc-UBI 29-41 respectively. The three radio complexes got ready experimentally and their stability in vitro saline solution is evaluated, human serum and cysteine solutions. The experimental results correlated appropriately with the calculated data. The specificity in vitro was carried out evaluating the percentage of union of the {sup 99m}Tc-UBI 29-41 as well as of the control peptides at bacteria of S. aureus and two tumoral cellular lines (LS174T and ACHN). The In vivo specificity was determined using Balb-C mice with induction in a paw of an infectious process and in another paw of a sterile inflammatory process. Simultaneously it was administered to the mice with infection and inflammation induced {sup 99m}Tc-UBI 29-41 and {sup 67}Ga-citrate this last an unspecific radiopharmaceutical

  1. Development of lyophilized kit of Tin-Glucoheptonate for in vitro labeling of leucocytes with {sup 99m}Tc; Desenvolvimento de reagente liofilizado de glucoheptonato-estanho para marcacao de leucocitos com Tecnecio-99m in vitro

    Nascimento, Rosemeire Fagundes

    2007-07-01

    The study and localization of inflammatory and infection process in Nuclear Medicine represents a relevant tool in diagnostic procedures. In same cases, the diagnostic is easy and based on anamnesis and clinical observation; in other cases, the patients are asymptomatic or present non specific symptoms that difficult the diagnostic. The early diagnostic of inflammatory or infectious process allow the early introduction of therapy and prevents complications. Farther, the differentiation between inflammation and infection is of extreme importance as well as the localization of the focus. The use of labeled leucocytes, studied and applied in much pathologies, is the method of choice for the visualization of inflammation and infection. The scintigraphy using labeled leucocytes was introduced at 1976 by McAffe and Thakur and since of this is used in the diagnostic of different pathologies related to leucocyte infiltration like intestinal inflammatory disease, bone or prosthetic-vascular infections. The in vitro labeling of leucocytes with {sup 111}In was performed using oxime or tropolone as ligand and with {sup 99m}Tc using hexamethylpropylene amine oxime (HMPAO) as ligand, resulting in a lipophilic complex. The {sup 99m}Tc-HMPAG complex was preferably employed in many indications and countries do to the ideal physical properties of {sup 99m}Tc that results in low dose to the patient. However, the labeling employing the HMPAO complex results in some disadvantages like the low stability of the complex, and some requirements related to the {sup 99m}Tc elution (like the time pos elution), beyond the high cost of the compound that is imported. The aim of this work was the development of a tin-glucoheptonate lyophilized kit for in vitro leucocytes labeling with {sup 99m}Tc using the pre-stannization method. The optimization of the labeling technique was developed using leucocytes isolated from total blood and employing different volumes of the tinglucoheptonate reagent and

  2. Staging and therapy monitoring of multiple Myeloma by 99mTc-Sestamibi Scintigraphy: a five year single center experience

    The aim of the present study was the evaluation of the diagnostic value of 99mTc-sestamibi (MIBI) in the detection of bone marrow involvement in patients suffering from multiple myeloma (MM) and its possible role in the follow-up. Between 1998 and 2003, 68 patients with MM and 42 pts with monoclonal gammopathy of undetermined significance (MGUS) were consecutively enrolled in this study. 51/68 MM patients had active disease (AD), 11/62 were in complete remission (CR) and 6/68 in partial remission (PR) after chemotherapy. 18 patients with MM repeated a 99mTc-MIBI scintigraphic study at least 2 months after high-dose chemotherapy. All the scans were score semi quantitatively according to extension and intensity of tracer uptake. All MGUS pts had a negative 99mTc-MIBI. As far as the MM pts are concerned, 54/68 (49%) pts (48 with AD, 5 with PR and 1 with CR) had a positive 99mTc-MIBI scan, while the 99mTc-MIBI scan was negative in 14/68 pts (10 with CR, 1 with PR and 3 with AD). The overall sensitivity of the 99mTc-MIBI scintigraphy was 92%; specificity was 96%. In the follow up of the pts treated with chemotherapy 99mTc-MIBI closely paralleled the activity of myeloma bone disease. In conclusion, these results indicate that 99mTc-MIBI scintigraphy closely reflects myeloma disease activity in the bone marrow, and that a negative 99mTc-MIBI scan in patients with suspected MM clearly, though not absolutely, indicates absence of disease or clinical remission. The results of this study suggest a clear diagnostic value of 99mTc-MIBI scintigraphy in patients with MM and its potential role during the follow-up for the monitoring of MM bone disease

  3. Development of a formulation lyophilized for the obtention of a antimicrobial peptide Ubiquicidine labelled with {sup 99m} Tc; Desarrollo de una formulacion liofilizada para la obtencion del peptido antimicrobiano Ubiquicidina marcado con Tc-99m

    Palomares R, P.; Hernandez B, C.A.; Contreras N, G.; Garcia P, M.L.; Pantoja H, I.E. [UAEM, Toluca (Mexico); Ferro F, G. [ININ, A.P. 18-1027, 11801 Mexico D.F. (Mexico)]. E-mail: patodish@hotmail.com

    2004-07-01

    The {sup 99m} Tc-UBI 29-41 are a labelled fragment of the antimicrobial human peptide Ubiquicidine proposed as a new radiopharmaceutical able to differentiate an infectious process of an inflammatory one through the gamma graphic image. It has been demonstrated that the {sup 99m} Tc-UBI 29-41 unite to bacteria in vitro and that accumulates in infection sites in human with minimum captivation in inflammation sites. In this work the development of a pharmaceutical lyophilized formulation is presented for the instantaneous marked one of the UBI 29-41 with {sup 99m} Tc. The selection of the components of the formulation settled down by means of the employment of an experimental design of 3 factors with mixed levels, evaluating the effect of the diluent type, concentration of tinny chloride and the reaction volume. The obtained formulations showed to be stable until for 6 months, being obtained complexes of the radiolabelled peptide with radiochemical purity > 95 % in sterile form and apirogen. The developed pharmaceutical form, will facilitate the routinary use of this new radiopharmaceutical in the diverse hospital departments of nuclear medicine. (Author)

  4. Development of methodology for evaluation of {sup 99m}Tc and {sup 131}I incorporated activities during lactation; Desenvolvimento de metodologia para avaliacao da atividade de {sup 99m}Tc e {sup 131}I em lactantes

    Santos, L. [Universidade Federal do Rio de Janeiro (IF/UFRJ), RJ (Brazil). Inst. de Fisica; Dantas, A.L.A.; Mesquita, S.A. [Universidade Federal do Rio de Janeiro (IF/UFRJ), RJ (Brazil). Inst. de Fisica; Oliveira, S.M.V., E-mail: adantas@ird.gov.br, E-mail: silvia@ird.gov.br [Universidade Federal do Rio de Janeiro (IF/UFRJ), RJ (Brazil). Inst. de Fisica; Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil). Div. de Dosimetria

    2012-07-01

    Internal contamination of babies may occur for milk ingestion or inhalation of mothers occupationally exposed to ionizing radiation with possible incorporation or mothers submitted to medical exposures during lactation. Radionuclide concentrations in the mother's milk may cause organ absorbed doses in the babies proportionally to the breast volumes. Milk analysis allow to determine activities ingested by the babies by determining the peak of mother's milk considering the decrease of the activity rate and the milk activities drunk at different time intervals. The work had the aim to develop simulators and methodology to evaluate {sup 99m}Tc and {sup 131}I in lactation, in the following steps: to prepare standard solution of contaminated milk separately with {sup 99m}Tc and {sup 131}I; to build four breast simulators (600 g and 800 g) and respective calibration for two geometries (breast and whole-body) in the Whole-Body Counter Unit in Instituto de Radioprotecao e Dosimetria. The results demonstrated the system efficiency to determine {sup 99m}Tc and {sup 131}I activities in breasts during the lactation period. The methodology for positioning in the 'breast geometry' seemed to be more efficient than the 'whole-body geometry' for different breast volumes. The experiment allows achieving better evaluation of internal dosimetry of mothers and their young children. (author)

  5. Clinical significance of exercise-induced ST segment depression in patients with lateral myocardial infarction involving the left circumflex artery. Evaluation by exercise 99mTc-MIBI myocardial scintigraphy

    The aim of this study is to clarify the causes of exercise-induced ST-segment depression in patients with broad lateral old myocardial infraction involving left circumflex branch (LCX) (LCX-OMI) without ischemia on exercise scintigraphy. Twenty one patients (M/F=11/10, age=62±19 years) with myocardial infraction involving LCX (LCX-MI), but without fill-in on exercise and rest MIBI quantitative gated SPECT (QGS), were selected. They were divided into two groups of Group ST(+) (n=11, with significant ST depression (max-2.8±0.4 mm), Group ST (-) (n=10) without ST depression. On 20 SPECT segments of both exercise and rest SPECT, we scored uptake score as defect score (DS) (0=normal to 3=defect) and wall motion as wall motion score (WMS) (0=normal to -5=dyskinesis) and summed DS (TDS) and WMS (TWMS) in LCX region, furthermore, calculated the difference of TWMS (ΔTWMS {exercise-rest}), end diastolic volume (EDV) and ejection fraction (EF) during exercise were compared between the two groups. Group ST(+) showed significantly (p2-4 without ischemia in LCX-MI was observed in patients with broad LCX-MI, low EF, and was related to impaired wall motion in LCX region. ST depression in V2-4 was considered to appear as miller image of ST elevation at postero-inferior wall due to disturbed wall motion on exercise. (author)

  6. Prediction of sensitivity to anticancer agents for patients with advanced or recurrent breast cancer by Tc-99m sestamibi

    Tc-99m Sestamibi (99mTc-MIBI) is known to be a substrate of P-glycoprotein (P-gp) that effluxes the drugs out of cancer cells. The overexpression of P-gp involved in multidrug resistance phenomenon in patients with advanced or recurrent breast cancers was shown in the plasma membrane of breast cancer cells. In this study, we examined the usefulness of 99mTc-MIBI scintigraphy for the prediction of sensitivity to anticancer agents in 8 cases with advanced or recurrent breast cancer. The retrospective analysis showed that the sensitivity to the chemotherapy could be evaluated in 3 cases by 99mTc-MIBI scintigraphy, but in the other 5 cases 99mTc-MIBI scintigraphy was not eligible for the prediction of sensitivity. Two out of 3 cases showed over 50% in reduction rate of target tumors (PR) with higher accumulation of 99mTc-MIBI, while another case with PD showed lower. These results suggest that the accumulation of 99mTc-MIBI could be associated with the sensitivity to P-gp-related anticancer agents, and that the functional analysis of P-gp by 99mTc-MIBI might be useful for the prediction of responsiveness of chemotherapy in patients with breast cancer. (author)

  7. Scintigraphic findings on 99mTc-MDP, 99mTc-sestamibi and 99mTc-HMPAO images in Gaucher's disease

    We report here on the use of the lipophilic cationic complex technetium-99m sestamibi (99mTc-MIBI), employed as an indicator of increased cellular density and metabolic activity, to evaluate Gaucher cell infiltrates in the bone marrow; 99mTc-hexametazime (99mTc-HMPAO) was also employed, as a pure indicator of lipidic infiltration in the bone marrow. A 67-year-old patient with known type 1 Gaucher's disease presented with a painful left hip and knee and difficulty in gait subsequent to traumatic fracture of the left femoral neck that had required implant of a fixation screw-plaque. Bone scan with 99mTc-methylene diphosphonate revealed reduced uptake at the distal metaphyseal-epiphyseal femoral region. In addition, whole-body maps and spot-view acquisitions of the thighs and legs were recorded at both 30 min and 2.5 h after the injection of 99mTc-MIBI: the scintigraphic pattern clearly showed increased uptake at several sites involved by Gaucher deposits in the bone marrow (both knees, with variable intensity in different areas), matching the bone changes detected by conventional x-ray. The target to non-target ratios slowly decreased with time, from an average value of 2.25 in the early scan to an average value of 2 in the delayed scan. The lipid-soluble agent 99mTc-HMPAO exhibited a superimposable scintigraphic pattern of accumulation at the involved sites, though with lower target to non-target ratios (1.27-1.48). The results obtained in this patient suggest a potential role of 99mTc-MIBI in the scintigraphic evaluation of Gaucher's lipid deposits in the bone marrow. If the results are confirmed in other patients, this radiopharmaceutical would offer clear advantages over 133Xe because of its wider availability and greater practicality (i.v. administration of 99mTc-MIBI versus inhalation of 133Xe, and use of a single gamma camera instead of two as with 133Xe). (orig.). With 3 figs

  8. Radiation exposure of the patient in diagnostic nuclear medicine. Experimental studies of the biokinetics of {sup 111}In-DTPA-D-Phe{sup 1}-octreotide, {sup 99m}Tc-MIBI, {sup 14}C-triolein and {sup 14}C-urea, and development of dosimetric models

    Leide Svegborn, S

    1999-03-01

    Biokinetic and dosimetric models for a number of clinically used radiopharmaceuticals, for which information on the radiation dosimetry is scarce, have been produced. On patients undergoing investigations with {sup 111}In-DTPA-D-Phe{sup 1}-octreotide (for diagnosis of neuroendocrine tumours) and {sup 99m}Tc-MIBI (for myocardial perfusion imaging), whole body gamma camera scanning was performed several times after administration of the radiopharmaceutical. Total body and organ activity content was determined using the geometric mean of the number of counts in two 180 deg opposed planar images. A thorough investigation of sources influencing the accuracy of the quantification of activity was carried out, showing an overall uncertainty varying from 10% to 30% for organs with a significant uptake and 5% for the whole body. The activity in blood and urine was also measured. {sup 111}In-DTPA-D-Phe{sup 1}-octreotide was predominantly excreted via the kidney-bladder system and a typical investigation with 1200 MBq resulted in an effective dose of 8.4 mSv (0.076 mSv/MBq). {sup 99m}Tc-MIBI was to a great extent excreted via the gastrointestinal tract and an investigation with 1200 MBq resulted in an effective dose of 13 mSv (0.011 mSv/MBq). Accelerator mass spectrometry (AMS) was used to investigate the possibility to measure ultra-low activity concentrations of {sup 14}CO{sub 2}, in exhaled air from patients undergoing {sup 14}C-breath tests, with special application to {sup 14}C-triolein (for study of fat malabsorption). AMS was proven to be a useful technique for long-term retention studies of {sup 14}C, and was used together with liquid scintillation counting in an investigation of the biokinetics of {sup 14}C-urea in adult and paediatric patients (for diagnosis of Helicobacter pylori infection in the upper gastrointestinal tract). The effective dose for {sup 14}C-urea was 0.019 mSv/MBq for adults and from 0.041 to 0.019 mSv/MBq for seven- to fourteen -year-old children

  9. Radiation exposure of the patient in diagnostic nuclear medicine. Experimental studies of the biokinetics of 111In-DTPA-D-Phe1-octreotide, 99mTc-MIBI, 14C-triolein and 14C-urea, and development of dosimetric models

    Biokinetic and dosimetric models for a number of clinically used radiopharmaceuticals, for which information on the radiation dosimetry is scarce, have been produced. On patients undergoing investigations with 111In-DTPA-D-Phe1-octreotide (for diagnosis of neuroendocrine tumours) and 99mTc-MIBI (for myocardial perfusion imaging), whole body gamma camera scanning was performed several times after administration of the radiopharmaceutical. Total body and organ activity content was determined using the geometric mean of the number of counts in two 180 deg opposed planar images. A thorough investigation of sources influencing the accuracy of the quantification of activity was carried out, showing an overall uncertainty varying from 10% to 30% for organs with a significant uptake and 5% for the whole body. The activity in blood and urine was also measured. 111In-DTPA-D-Phe1-octreotide was predominantly excreted via the kidney-bladder system and a typical investigation with 1200 MBq resulted in an effective dose of 8.4 mSv (0.076 mSv/MBq). 99mTc-MIBI was to a great extent excreted via the gastrointestinal tract and an investigation with 1200 MBq resulted in an effective dose of 13 mSv (0.011 mSv/MBq). Accelerator mass spectrometry (AMS) was used to investigate the possibility to measure ultra-low activity concentrations of 14CO2, in exhaled air from patients undergoing 14C-breath tests, with special application to 14C-triolein (for study of fat malabsorption). AMS was proven to be a useful technique for long-term retention studies of 14C, and was used together with liquid scintillation counting in an investigation of the biokinetics of 14C-urea in adult and paediatric patients (for diagnosis of Helicobacter pylori infection in the upper gastrointestinal tract). The effective dose for 14C-urea was 0.019 mSv/MBq for adults and from 0.041 to 0.019 mSv/MBq for seven- to fourteen -year-old children, resulting in an effective dose of approximately 0.002 mSv per investigation

  10. Evaluation of aptamers labelled with {sup 99m}Tc for identification of Staphylococcus aureus bacteria; Avaliacao de aptameros marcados com {sup 99m}Tc para identificacao de focos infecciosos de Staphylococcus aureus

    dos Santos, Sara Roberta

    2014-06-01

    Staphylococcus aureus is specie of great medical importance because it is often associated with many infections in humans. This bacterium can cause diseases ranging from simple infections to life-threatening infections such as endocarditis, pneumonia, meningitis, toxic shock syndrome, septicemia, osteomyelitis, among others. S. aureus is the most commonly agent found in infections of the skin and soft tissues, bone infections and bone prostheses. The difficulty in early detection of specific foci caused by bacteria has raised the need to search for new techniques for this purpose. Diagnosis by scintigraphy has advantages over other methods because it is able to identify damage tissues without the need of invasive procedures and is able to perform an early diagnosis even before anatomic changes. Thus, nuclear medicine could contribute to an accurate diagnosis of bacterial infections, since specific radiopharmaceuticals were developed. Aptamers are oligonucleotides that have high affinity and specificity for their molecular targets and are emerging as a new class of molecules for radiopharmaceuticals development. Radiolabeled aptamers specific to the infectious agents, could give a significant contribution to the infection diagnosis by scintigraphy. In this study, aptamers selected to S. aureus were labeled with {sup 99m}Tc and used for the bacteria identification in vitro and in vivo. The aptamers labeled with {sup 32}P and incubated in vitro with S. aureus cells showed high affinity for the bacterial cells when compared with the library of oligonucleotides with random sequences used as control. The aptamers labeled with {sup 99m}Tc also showed affinity for S. aureus cells when compared with the library, but unspecific binding was also verified. The {sup 99m}Tc labelled aptamers were stable in 0.9% saline, plasma of Swiss mice and in excess of cysteine. The in vivo biodistribution studies using Swiss mice with intramuscular infection in the right thigh showed that