Eur J Nucl Med (1984) 8: A 1-A104

European M I i t ' , l ~ J r Journal of I ~ l U ~ J l ~ r . . . 4 /

Medicine © Springer-Verlag 1984

European Nuclear Medicine Congress August 14-17, 1984, Helsinki, Finland

Abstracts AI

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DIAGNOSIS OF CHRONIC CORONARY INSUFFICIENCY BY EXERCISE SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY M. Amor, G. Karcher, A. galaud, C. Hoequard, G. Ethevenot, F. Cherrier, A. Bertrand

THE CLINICAL ROLE OF THALLIUM-201 SCINTIGRAPHY IN THE MANAGEMENT OF CORONARY ARTERY DISEASE. M.D. Gammage~ D.P. Murray, E. R m f f l q i , R.G. Mumrsy.

THALLIUM-20q SCINTIGRAPHY AFTER MYOCARDIAL INFARCTION: NO RELIABLE PREDICTION OF MULTIVESSEL DISEASE. E.E. v a n d e r W a i l , M . J . v a n E e n i g e , F.C. V i s s e r , G . A . K . H e i d e n d a l , J.P. R o o s .

In order to assess the interest of exercise single photon emission computed tomography by thallium 201 (SPECT) in patients with suspected isehemic heart disease (IHD) ]59 patients (M : 148, F : ]I, mean ~ge : 52 ! 8) were submited to the following protocol : l) SPECT after an injection o~ 2.5 mCi of TI 201 at maximal exercise 2) Coronary angiography performed within I month before or after SPECT. Methods : SPECT allowed the reconstruction of three types of slice according to the long axis (LA) of the heart which are called as in 2 D-Echocardiography : short-axis (perpendicular to LA), long~xis (parallel to LA), 4-chambers (parallel to LA) slices. The myocardial fixation was analysed in 5 walls (septal, anterior, lateral, inferior, Apex) by two independent observers who did not know angiogram results. Material : ]26 pts with IHO (coronary stenosis ~ 50 %) divided as follows : 63 one vessel disease (L.A.D. : 32, R.C.A. : 2~, L C . X . : IO), 37 two vessel disease (2 VD), and 26 three vessel disease (3 VD). 33 pts without coronary steresis : 26 Normal (group A), 7 pts with normal coronary arteries and angina or prior myocardial infarction. Results : Normal Cor A r t A SPECT + '4 SPECT - 22

g 7 0

SENS

I. IVA 31 I

H.

CD ! CX 21 1 6 0 4

97 ,]00

60

D. 2T 37 O

3T 26 0

I00

I00

In conclusion : Exercise SPECT has an overall sensitivity of 96 % and an overall specificity of 85 %. This allows us to consider it at the moment as the best non invasive method for the diagnosis of I.H.D.

To determine the clinical impact of Thallium201 (Ii-201) scintigraphy in coronary artery disease (CAD)~ the indications, diagnostic yield and contribution to patient management ~ere reviewed retrospectively in 105 patients referred for routine investigation, f×ercise and redistribution image data ~ere collected in multiple projections and inferpreted by visual and semi-quantitative means. A segmental image defect ~ss accepted as indicating the presence of CAD. Ii-201 sc~ntigraphy ~ss performed as a diagnostic procedure in 71 patients (69,~) ~ho had equivocal evidence of CAD. In 57 (80,%) of these patients, ~i-201 scintigraphy was ~ormal and 53 (75,~) ~ere spared diagnostic coronary srteriography, Despite normal If-Z01 seintigraphy, arteriography ~as performed in 4 patients ~ith persisting symptoms and demonstrated normal vessels in 2 patients and single vessel disease in 2 patients. Conversely, arteriogrsphy ~ss normal in 3 of 19 patients (16,~) ~ith unequivocal image defects. Ti-201 scintigraphy ~as performed as a Functional complement to coronary srteriography in 32 patients, influencing the decision for coronary surgery in 10, for sngioplmsty in 9 and against surgery in 2. Myocardial ischaemia ~as confirmed in 8 and refuted in 8 patients ~ith questionable arteriographic coronary disease. Positive management decisions ~ere taken as a result of [i-201 scintigraphy in 80 of these 103 patients (78%). These data confirm the vital role of TI-201 sclnfigraphy in the evaluation and management of patients with suspected and proven CAD. University Department of Cardiovascular Medimine~ East Birmingham Hospital, Birmingham B9 5ST. England.

The value of thallium-201 exercise scint i g r a p h y f o r t h e d e t e c t i o n of m u l t i v e s sel d i s e a s e a f t e r m y o c a r d i a l i n f a r c t i o n (MI) w a s d e t e r m i n e d in 176 p a t i e n t s 6 w e e k s a f t e r a f i r s t MI. In a l l p a tients coronary arteriography was performed within 3 days after the noni n v a s i v e p r o c e d u r e . Of t h e 176 p a t i e n t s , 77 h a d m u l t i v e s s e l d i s e a s e (prevalence 44%). T h e t h a l l i u m - 2 O l s c a n s w e r e q u a l i tatively assessed, and a positive scan w a s d e f i n e d as a n e x e r c i s e - i n d u c e d rev e r s i b l e d e f e c t in the n o n i n f a r c t e d region. The exercise electrocardiogram was posit i v e in 49 p a t i e n t s (sensitivity 64%), while the thalli~m-201 scan was positive in o n l y 24 p a t i e n t s ( s e n s i t i v i t y 31%). When the results of both exercise electrocardiography and scintigraphy were a d d e d , a s e n s i t i v i t y of 66% a n d a s p e c i f i c i t y o f 62% w a s f o u n d ; t h e p o s i t i v e and negative predictive values were c o n s i d e r e d t o o l o w for a c c u r a t e d i a g n o sis o f r n u l t i v e s s e l d i s e a s e in p a t i e n t s a f t e r MI. We conclude that the qualitative assessm e n t of thallilun-201 e x e r c i s e s c i n t i g r a p h y s h o u l d n o t b e u s e d t o p r e d i c t the presence or absence of multivessel dise a s e in p a t i e n t s w i t h p r e v i o u s MI.

Free University Hospital, Dept. of C a r d i o l o g y , d e B o e l e l a a n 1117, 1007 M B A m s t e r d a m , T h e N e t h e r l a n d s

Orant from the Fr~neh Society of Cardiology Service de M~decine Nucl~aire CHU NANCY-BRABOIS 54500 VANDOEUVP~E FRANCE

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DOES TL-201 $CINTIGRAPHY ADD TO CORONARY ANGIOGRAPHy IN ASSESSING THE HEMODYNAMIC SIGNIFICANCE OF COF~)NARY ARTERY STENOSEH? M.J. Eelly, V. Kalff, A. Soward, R.W. Harper, P.J. Currie, Y.L. L~n, A. Pitt.

1251 META-IODUB~qZYL GUANIDINE: SII~gHESIS ]I~AGING THE ADRENAL MEDULLA AND PHIEOOHROH0CYTOMA EolzRegT. , Hawkins, L.A., O ~ r o l l , M~J. , B r i t t o n K.E.

EXPERIENCE WITH 131-I-META-IODOBENZYLGUANID[~E (131-1~IBG) SCINTIGRAPHY IN TRE LOCATION OF PHEOCHROMOCYTOMAS (PHEOS). B. Shapiro, J.C. Sisson, T. Mang~er, D. Nieland, M.D. Gross, J. Copp, P. Eyre and W.H. Beierwaltes

This study tests the hypothesis that the results of stress TL-201 scans (TL201) are related to the trans-stenotic pressure gradient (GRAD) of coronary stenoses independent of the % lt~ninal d i t c h e r narrowing (%NAR) seen at angiography. The 22 study patients (mean age 46 years, range 30-62, 2 female) had no prior myocardial infarction. Each underwent a symptom limited erect bicycle exercise T1201 test off antianginal therapy, shortly before percutaneous transl~minal coronary angioplasty (pTCA) for isolated left anterior descending coronary stenosis. The %NAn, GRAD (mmHG) at PTCA and presence of TL-201 defects were independently evaluated and results compared. The GRAD (mean+SD) is listed in relation to positive (+) or--negative (-) TL201, and %MAR.

The aim of the study is to use Ig3I meta-iodobenzyl ~is/lidine [LIBG instead of 1511 MI~G because of its potentially hitcher sensitivity to localize adrendLl medullaz~j and extra-medullary %n~nours 8/Id metastases of phaeocbccomooytoma.

<70 %NAn

71-89 %NAn

+TL201

67+10 (N=4) 62+16 (N=7)

-TL201

25+22 (N=4) 45+9

(N=3)

>90 %NAR 72+11 (N=4) (N=0)

In the 18 patients with <90 %MAR, the GRAD was higher (P<.001) in those with +TL201 (64+15) than those with -TL201 (33+20) but their %NAn did not differ significantly (72+14% vs 66+19%; P=NS). At multiple regression analysis (N=22) the presence of a TL201 defect (p<.001) was a strong and %NAn (P<.05) a weak independent predictor for GRAD. Exercise workload, heart rate, blood pressure, and stress ECG results did not significantly predict GRAD. It is concluded that TL201 adds valid information on the hemedynamic significance of a stenosis independent of %MAR. This may be of most value when %MAR is <90% and the clinical significance of the stenosis is uncertain. Nuclear Medicine Department and Cardiology Service, Alfred Hospital, Commercial Rd, Melbourne, victoria 3181, Australia

MIBG was s~mthesized and labelled with 183I in a closed sys%em. 1 m~m ~[[BG is added to lO mCd dry 1251 in the Ilarwell vial, to this is added 1O0 ~i glacial Acetic Acid, and 5-5 mg ~ o n iur~ 81/iphate powder. The vial is sealed end is heated for 45 minutes at 140-160 ° in sn oil bath. After cooling, 1.5 ml 0.005 M Acetate buffer (pH 5.8-4.2) is added. It is then passed throt~h a Cellex-D ion exchange resin oolll~in into ~n evacuated vial via a 0.22 ~/m millex filter. iBbI M]~G Gamma Cg/aera images ~ e obtained 4, 22 8/%d 45 hours post injection of 5-5 mot 1251 MIBG. In seven out of eight hypertensives, the normal adfcenal medu/lae were visuslised indicating the sensitivity of the technique; in one patient who had had adrenalectomy for phaeoo~aromocytoma, 125l MI~G showed mu3_tiple livem metastases~ which X-ray eompllt -ed tomography and ultrasou/ld did not detect. In a second patient who had had a chest psmagamglioma excised, 125I M]~G scan detected m ~ t i p l e metastases in Ehe skull~ mediastinum~ 3n.ngs and pelvis. All lesions were seen clearly within 24 holt,s. S o i n t i ~ a p h y with 1251 MIBG gives a lower radiation exposume than 151I MIBG and provides a sensitive and reliable means of locating a wide range of phaeochromocytoma. St Ha~tholomew~s Hospital, West Smithfield, London, ECI, UoK.

The adrenomedullary-avid radiopharmaceutical, 131-I-MIBG, is concentrated in the eatecholamine storage granules BE adrenergic tissues and thus permits the localization of pheos of widely vatled type and location. 131-I-MIBG sci~tigraphy provides a simple, noninvasive technique to screen the entire body for pheos. The results of 131-I-MIRG scintigraphy in 429 cases referred for possible pheo were reviewed and classified as true positive~ true negative, false positive, false negative, equivocal positive and equivocal negative on the basis of: plasma and urine cateeholamines and catecholamine metabolites, CT scan, angiography and other radiologieal procedures, surgical exploration and histology, and follow-up. ~ e r e were 32 sporadic adrenal; 18 sporadic extra-adrenal (9 intra-thoracie and 9 intra-abdominal), 48 malignant metastatic and 20 familial pheos (multiple endocrine neoplasla 2a and gb, neurofibromatosis and Von HlppleLindau disease). In glO cases pheo was definitely ruled out and in 82 cases probably ruled out. Patient True True False False Bquivt EquivTt Category +ev -ev +ev -ev coal+ coalSporadic 40 210 S* I0"* 4 82 Benign Malignant 40 4 4 -Familial 12 8 -g 6 4 fFaint feel of MIBG uptake at sites where tumor was subsequently demonstrated fTMinor non-dlagnostic elevation of oatecholamines but no other evidence for pheo, MIBG scan and all other radiologlcal studies negative *2 cases had neuroendocrine tumors other than pheo **2 intra-adrenal, g extra-adrenal, 6 unknown sites despite all techniques of localization These results demonstrate, that where available, 131-I-NIBG scintigraphy is the technique of choice for locating pheos of all types. The University of Michigan Medical Center, ~nn Arbor, Michigan 48109, USA.

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EXPERIENCE WITH 1311-6E-IODOMETMYLNORCHOLESTEROL (NP-59) IN THE FUNCTIONAL LOCALIZATION OF ADRENOCORTICAL DISEASE. M,D. Gross, E. Shapiro, J.E. Freitas, W.H. Beierwaltes.

PHAEOCHROMOCYTOMA INFLUENCE OF TUMOR CATECHOLAMINES ON SCINTIGRAPHY WITH 131-t-MfBG. M. Fischer, J. Hengstmann and H. Verier 131-I-metaiodobenzylguamidine (13II-MIBG) is used for scintigraphic imaging of catecholamine producing lissue. In 28 p a t i e n t s w i t h biochemically proven catecholamine excess 131-[-MIBG s c i n t i g r a p h y was p e r f o r med after intravenous a d m i n i s t r a t i o n of 0,3 0,7 mCi 131-I-MIBG w i t h a computer assisted g a n ~ a camera. In 27 patients the diagnosis was confirmed by surgery. In i~ of these patients catecholamines were determined in tumor t i s s u e . Scintigraphy l o c a l i z e d a n intraadrena I phaeochromocytoma in 19, an e x t r a adrenal in one, a malignant m e t a s t a t i c tumor in 4 and a medulla ry hyperpZasia in 2 p a t i e n t s . In o n e patient with an intraadrenal phaeochromocytoma and in another one w i t h a unilocuZar extraadrenal manifestation 131-1MIBG scintigraphy was negative. The t u m o r was 4,5 cm r e s p e c t i v e l y 6 cm in diameter. In both p a t i e n t s e x c e s s i v e e x c r e t i o n of noradrenaline and normetanephrine was observed, whereas adrenaline and metanephrlne were in the normal range. In these two p a t i e n t s w i t h negative s c i n t i g r a phy adrenaline in the tumor tissue was belowe the detection limit. There was n o close correlation between scintigraphic imaging of catecholamine producing t i s s u e and noradrenaline in tumor t i s s u e . Our r e s u l t s document that e c i n t i g r a phy with 131-I-MIBG might depend on biosynthesis of a d r e n a i i n e in phaeochromocytoma rather than o n adrenaline e x c r e t i o n of the t u m o r .

The adrenocortic~l imaging agent, 1311-6Biodomerhylnorcholes~erol (NP-g9), has been used ~o scintigraphically depict disease of the adrenal cortex in 490 patients studied over an eight year interval (1976-1984). One mCi/l.73 M 2 was administered to 160 patients with suspected Cushing's Syndrome leg) and to 31 patients with miscellaneous disorders of the inner adrenal cortex. Images were obtained a= 5 to 7 days post injection in this group. Dexamethasone suppresslo~ of pituitary adrenocorticotrophic hormone (ACTH) was given Co 157 patients with primary aldosteronism (FA) and I19 patients with adrenal hyperandrogenlsm (A~): 8 mg for 2 days or 4 mg for 7 days prior to NP-59 and ~hroughou~ a 5 day pose-injection imaging interval. In CS 5 patterns of adrenal imaging were noted tha~ were a direct consequence of the pathophysiologlc process: ACTH dependent CS - bilateral adrenal visualization, ACTH independent CS from adrenal adenoma showed unilateral uptake, while ACTN independent CS due to nodular hyperplasia showed marked asymmetric adrenal uptake. CS due to carcinoma w a s depicted as bilateral nonvisualization. PA was depicted as early unilateral uptake (< 5 days) in adenoma and bilateral early uptake (< 5 days) in bilateral hyperplasia; while in AH early unilateral viaualizatio~ (< 5 days) was seen in patients with an adrenal adenoma, bilateral early visualization (< 5 days) in patients with adrenal hyperplasia and bilateral nonvisualization in those patients without an adrenal eontrihutio~ ~o abnormal androgen levels. There were 3 false positive studies for adenoma in CS~ PA, and AH and 6 false negative studies for bilateral hyperplasia and adenoma. Thus, AS is an efficacious modality for the localization of adrenal function in patients with suspected diseases of the adrenal cortex.

A9 RADIOPHARMACEUTICAL DEVELOPMENT. M. N. Croll The f i e l d of Nuclear Medicine and i t s p r a c t i t i o n e r s , the physicians and the technician, u t i l i z e two primary t o o l s : radionuclides and detection instruments. The e a r l y h i s t o r y of Nuclear Medicine p r i m a r i l y relates the development of radionuclides a n d radiopharmaceuticals. George DeHevesey introduced the tracer concept i n t o biology in 1923. He proved t h a t the amount of r a d i a t i o n needed for tracer studies was so small t h a t the system under study would not be affected. Dynamic flow studies were c l a s s i c a l l y reported by Blumgart and Weiss on the v e l o c i t y of the c i r c u l a t i o n in patients w i t h heart disease in 1927, seven years before the discovery of a r t i f i c i a l r a d i o a c t i v i t y by Curie and J o l i o t . With the invention of the cyclotron by E. O. Lawrence in 1931 radioiodine, 1-131, became the pre-eminent radionuclide of Nuclear Medicine during i t s infancy. This review l e c t u r e w i l l consider the q u a l i t y assurance to be maintained in the preparation as well as the use of radiopharmaceutical compounds. We w i l l b r i e f l y review a l l compounds in routine c l i n i c a l practice and pay special t r i b u t e to Tc99m-pertechnetate. Although Tc99m is used in almost 85% of c l i n i c a l Nuclear Medicine procedures, the remaining 15% t h a t are u t i l i z e d for special purposes w i l l be considered. Those lesser used compounds such as p o s i t r o n - e m i t t i n g radionuclides and organ-specific compounds such as iodocholesterol for adrenal imaging w i l l also be considered. The various reporting systems for adverse reactions to radiopharmaceuticals c u r r e n t l y being u t i l i z e d throughout the world w i l l be discussed. Current developments in radiopharmaceuticals w i l l include a discussion of monoclonal a n t i bodies such as I n - l l l labeled antimyosin, tumor markers, and so f o r t h .

The University o~ Michigan and ~he VA Me~ical Center, Ann Arbor, Michigan 48109.

Medizinische Universitdteklinik -Nuklearmedizin-, Albert-SchweitzerStroBe, D-44oo MEnster, FRG.

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DOCUMENTATION TECHNOLOGIES, DR. TERRY MILLIGAN

ARTEFACTS AND RADIONUCLIDE IMAGING. THE ROLE OF THE RADIOGRAPHER. A.F. M a c S w e e n e y , T. G i b b s .

SGF:IWARE GON'PFg:q_ GP G R E Y ~JCAL.E IN PHO]OGRAPItIC RECORDIN61 OF THE CQMPLITKR DISPLAY OF D I G I I I Z E D SC[N"I1GRAMS

T h e u l t i m a t e q u a l i t y o f the d a t a processed by modern gamma camerac o m p u t e r s y s t e m s c a n o n l y be as g o o d as the s t a n d a r d a c h i e v e d in t h e p r o c e s s o f d a t a a c q u i s i t i o n . T h e r o l e of t h e radiographer/technician in the i n i t i a l d a t a a c q u i s i t i o n s e q u e n c e is v i t a l if e r r o r s , a r t e f a c t s o r p i t - f a l l s a r e to be avoided.

U.

The evolution of techniques for recording, storing and communicating image information in nuclear medicine will be reviewed. From the early techniques using photographic film as an integrating detector, the CRT display and camera, and color imaging systems were i~troduced. The technical basis of photographic media and techniques will be compared with other technologies, such as magnetic recording, optical disks, and various printing methods.

0]~4 Marketing Department Polaroid Corporation 575 Technology Square Cambridge, Ma. 02139 U.S.A.

In t h i s p r e s e n t a t i o n , the authors review the main sources of error and aspects of quality control which need to be taken into account if the best d a t a p r o c e s s i n g is to be a c h i e v e d . Within this objective, aspec~ of instrumentation, radiopharmaceutical preparation, hard copy out-put, patient preparation and patient superv i s i o n a p a r t f r o m c r i t e r i a f o r operator techniques, will be discussed. Phantom and clinical data high-lighting each aspect mentioned items.

will be shown of the above

Ultimately, Nuclear Medicine data acquisition methods will become progressively automated, liberating the interpreter/physician in t h e w a s t e f u l supervision of the data acquisition p r o c e s s . In t h i s c o n t e x t , t h e r o l e o f the radiographer/technician gains a new status, guaranteeing appropriate data interpretation.

Institute of Nuclear Medicine Middlesex Hospital Medical School London, U.K.

Division of Nuclear Medicine Hahnemann U n i v e r s i t y Philadelphia, PA 19102, USA

R~]rl'~ei-', 14. R ,

M~li",:use

Modern flueleaP m e d i c i n e c o m P u t e c s o f f e r 9 P e a t I,' imPr.oved di se Ia'~.' o f di~ifized .~cinti.~raPhic imases. Fas feP d a ~ .:.L har, dlir',-~ ~,£lables I~r'r~er imaee matr. ice~; to l)e used, matching e~Eective re~olutior, w i t h sarama .camer,a resolutiorl. ComPuteP v i d e o output cof~tr'ol 1ePs are ~lso mor-e ~ o P h i s t i o a t e d , rePrc, d!]cir~ a st'eater r,u m b e r o£ s h l d e s o£ ~Jr.eY than it i~ e o s s i b l e to r ecor.d on t r.a.rl~pal-e rlt fitlll, Dis,i t i z e d iltr,~ge9 s h o u l d tteef-et-op£. be at least a~ -~ood ,is ;~n~]oglJe im~l~s. An M.rLs. A 2 c o m p u t e r srstem, c o u p l e d to a Matrix I n s t r . u m e n t ~ mul Li.-.Fermat video ~ llt~.~er is used to l:~r.oduce digitized scinti9rams. A T o s h i b a G.C.A. 401 ~amma-'camel.~ and enal o,-,ue i m ~ B e r ape used to Prod~Jce ~l-ta ] ague sci nt igPim~. The s',.'~tem/~ilm exPosur.e Peseorlse o~ both systems ~s me~.~ur.ed. The r e s u l t s ~ePe set out " s r ' ~ e h i c a ] ] ' , " ~rld a t h i r d L=r.aeh cPoss.-elotted t o . d e t e r m i n e video controller output l e v e l .~ r e - m i r e d to Pr.oduce a d e s i r e d den.~it,, on t h ~ dJsela',* o~ the d i s i t a l sYsteIIi. In this ~a','~ ~nd P r o v i d i n ~ that a d e g u a t e g u m / t r Y control PPOCedur.es are a P P l i e d to e h o t o ~ J r a r , h i c er"oces~ing, i% is Possible f(, Imimi(:l at~~~ r'.e=~ui r.e d a n a l c,~ue 9 r . e y - s c ~ ] e bY s i m p l ~ a l terir,.~ t h e erogr.am c.or~r.o] I irl9 the cc,~pijteP v i d e o o u t p u t signal,

]DeP%, o f Nuclear' M e d i c i n e . N e t h e r l a n d s C;l[ICel" In~,titute, F']eSlll~lrlle~l~ i~:[~ 106.&.. CXAms tePdam.

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THE VALUE OF 180 ° SPECT RECONSTRUCTION IN THE ASSESSMENT OF SPACE OCCUPYING DISEASE IN TEE LIVER. R J Ott~ M A Flower, N F Slack, 0 Khan and V R McCready.

SEGMENTAL ASSESSMENT ON THE RADIONUC L I D E I M A G E S OF T H E L I V E R . H. O y a m a d a , S. T e r u i , H. H a s e g a w a , S. Y a m a z a k i , M. M a k u u c h i , a n d N. O k a z a k i

A preliminary comparison of 180 ° and 360 ° reconstructions of liver SPECT has shown that an increase of lesion contrast can be obtained for known lesions if an appropriate 180 ~ reconstruction is used. We present here the results of a study involving 52 patients with suspected space occupying disease. ~ e aim was to assess the clinical usefulness of the 180 ~ reconstruction and, in particular, to determine if the contrast of small lesions can be enhaBced over the effective threshold determined by image mottle (noise). 18 patients were found to give positive results from 360 ° SPECT reconstruction studies in disagreement with ultrasound performed on the same day.

LPVER SPLEEN TOMOSCINTIGRAPHY IN THE EVALUATION OF HEPATIC DISEASES. PROSPECTIVE STUDy OF ITS CLINICAL VALUE. J.P.Vanvooren, R.Cytryn, M.Vanhaeverbeek, J.Pruhling, D.bourgeois and p.B~urgeois.

O w i n g to the r e c e n t a d v a n c e m e n t of e c h o g r a p h y , a n g i o g r a p h y , X - r a y CT, e t c . , preoperative s t u d y of the l i v e r for v a r i o u s k i n d s o f t u m o r o u s c o n d i t i o n s is n o w c o n d u c t e d in c o n n e c t i o n w i t h t h e segments. Fortunately, radionuclide imaging apparatus has been improved r e m a r k a b l y i n its r e s o l u t i o n f o r t h e past several years. Consequently, we h a v e c o m e to g e t i n t e r e s t e d in l i v e r s e g m e n t s o n the o r d i n a r y s c i n t i g r a m s as w e l l as S P E C T i m a g e s . We c a r r i e d o u t t h i s s t u d y f r o m the s t a n d p o i n t o f s e e k ~ ing t h e l o c a t i o n o f the d e f e c t s i n c a s e s in w h i c h the s e g m e n t s h a v i n g S O L were previously known by other modalities. A s a r e s u l t , w e c a m e to a c o n c l u s i o n that, in f a i r l y m a n y c a s e s , p r e c i s e j u d g m e n t of the s e g m e n t s o n r a d i o n u clide images might be possible. In t h i s s t u d y , w e f o l l o w e d the C o u i n a u d ' s segmentation. Also found were some incorrect illustrations about the liver s e g m e n t s in the p r e v i o u s l y p u b l i s h e d articles concerning nuclear medicine. At present, we think that the ordinary s c i n t i g r a m s a n d the S P E C T i m a g e s a r e complementary to e a c h o t h e r f o r s e g m e n tal a s s e s s m e n t of the l i v e r . It can be t h o u g h t a l s o t h a t t h e e f f o r t to c l a r i f y the s e g m e n t s w i l l i m p r o v e d i a g n o s t i c c a p a b i l i t y o f t h e l i v e r i n t h e f i e l d of clinical nuclear medicine. Reference: H. O y a m a d a , e t al., E u r o p e a ~ J. N u c l . M e d . , i n p r e s s .

A set of criteria were used to re-evaluate the suspected lesions in these patients. These were: I.

If % lesion contrast (LC) is > twice the % standard deviation (SD) of the mean pixel count over normal liver, the l~sion was considered positive.

2.

For LC < 2SD, 180 ° reconstruction was performed.

3.

If LC > 2SD for the 180 ° reconstruction, the lesion was considered positive.

Using these criteria the number of discordant results was reduced to 8 patients. ~e conclude that the technique may help to reduce the number of false positives obtained from SPECT liver studies, The Royal Marsden Hospital, Sutton, Surrey, England.

Radioisotope Diagnosis, Department of Diagnostic Radiology, National Cancer C e n t e r H o s p i t a l , T s u k i j i 5 - 1 - i, C h u o Ku, T o k y o , J a p a n

In order to establish the clinical value of liver spleen tomoscintigrams in routine medical practice, 200 consecutive patients with clinical and biological suspicion of liver diseases ( known cancer in 82, e~hylism in 117 ) were prospectively screened by hepatic tomoscintigra~hy (TScl. Transverse, coronal and sagihtal slices were in each case performed from ( single head single photon ) -Camera recording realised 10 min. after injection of 5 milliCurie$ of 99mTc colloids. Pictures were systematically analysed without knowledge of clinical data according to precise predefined criteria ( liver sizes, estimated sple nic volume ~ osseous reticulo~ndothelial fixation ,relative splenic hyperfixation, homogenous or heterogenous distribution of the colloidal activity in the liver, presence or absence of non or hypoactive zones I their number, localisation~ size and shape, "dissected" aspect of the slicesly.) A suspected diagnosis was in all cases proposed ( normal~ abnormal - hepatocellular and/or metastatic or primitive tumoral disease I. In 75 % out of the cases, one or more additional investiga~ tions were performed ( Echography~ CT scan or laparoscopy-biopsy ). In first analysis-( normal or abnormal )~ almost no falee negative TSc results were encountered ( high sensitivity ) but results varied according to the kind of disease investigated ( good in hepatocellul~r disease, less in metastatic process )~ A ROC analysis and Bayesian analysis of the images has been performed in order to establish the criteria or ~ombination of criteria allowing the most specific and or sensitive scintigraphdc criteria; From the clinician point of view, it was concluded that liver TSc is a highly sensitive investigation that should be regarded as a non aggressive scree ning test in suspected liver diseases permitting in most cases ~n orientation for luther examinations and in some, a final diagnosis. C.H.J.Bracops~ 79~ rue Dr Huet, Io70~ B e l g i e .

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A COMPARATIVE STUDY OF THE DIAGNOSTIC VALUE OF DLTRASOROGRAPHY, LIVER SCAN AND PERITONEOSCOPY IN MALIGNANT FOCAL LIVER LESIONS. J.Ponce,V.Garrigues,M.Prieto,D.Carrasco,R.Sopena,J.Carrasquer,C.Cano,O.Caballero,J.Eerenguer.

COMPARATIVE BIOKINETIC STUDIES OF THE REPATOBILIARY Tc-gPm~HIDA AND Tc-S9m-P-BUTYL-IDA KITS. N. H. Agha, A.M. Al-Billi, N.D. bahir, M.S. AI-Hissoni, M.N. Jasim, K.M. Miran and A.H. ShuDDer.

RELATIVE IMPORTANCEOF LIVER AND KIDNEY EXCRETION OF 99mTc-DIETHYL IDA AFTER TREATMENTOF MICE BY THYROXINE. C. Sawas-gimepoulou, N, Papanicolaou

The value of ultrasonography(US),99mTc-sulfur co lloid liver scan(LS) and perztoneoscopy(P) in the diagnosis of malignant focal liver disease (MFLD) has been evaluated cuantitmtively according to a score from -2 to +3 referred not only to tbe intrinsic information(IS) provided but al_ so to its impact on the prevzous clinical impre ssion(CS), and cualitatively according to the sual indexes:sensitivity(Se),specificity(Sp),the predictive value of a positlve(PVP) or negetive (PVN) test and accuracy(Ae).Seventy-seven conse cutive patieats with confirmed MFLD,56 with liver metsstases(LM) ~nd 21 hepat0cellular csrcinoma(HCC) were the study group.One hundred and twenty consecutive patients with diffuse liver disease(DLD); ii acute hepatltis,14 fatty live~ 24 chronic hepatitis and 71 hepatic cirrhosis were the control group.The results are shown in the table below. Se

S~

PVP

PVN

Ac

IS

CS

LM

HCC

LM

MCC

US ~ 7 3

~72

~83

~58

~72

LdO

L62

d90

L54

LS ~ 6 3

~9g

~90

%72

~78

~94

~50

~56

~3g

P

~gg

~98

~94

~95

181

1.53 ZI0

L42

&90

CONCLUSIONS:I)In HCC,US and peritoneoscopy obtained the best scores,significantly better than the obtained by LS.2)In LM group~peritoneoscopy reached the best results,significantly better than US and liver scan. Nuclear Medicine Service.Gastroenterology Service.Ciudad Sanitaria de la Seguridsd Social "La Fe".Avda de Campanar,20, Valencia. SPAIN.

Two hep~tobiliary(HB)agents, dilnethyl-IDA(HIOA) and p-butyl-IDA in form of instant kits produced in our department were subjected for a comparative biokinetie study in animals and human beings. The organ distribution data of the HB agents in mice showed substantial differences in the extent and rate of HB clearance and kidney uptake. The animal studies indicate that they are not in the same group of HB ~xcretmres as man. The in vivc plasma binding with both HB agents were determind by recording the activity of the columns(GCS-profiles)with a gamma camera. The high affinity of p-butyl-IDA to plasma protein, is probably influenced the rate of HB excretion into the bile.To the normal subjects NIDA and p-butyl-IDA were given in a dose of 5-TmCi, and the dynamic study was performed under gamma camera. To 19 individuals,7 patients were given HIDA and the rest were given p-butyl-IDA. Sequential scintigrams in a supine position were recorded every 5s/frame for the first 2min and a 30s/frame for the rest SCmin. Rectangular regions of interest were flagged,and the histograms were computed. In normal subjects, the duration of kidney visualization,early and late hepatic pictures,time of begininq visualization of bile duct and gallbladder and the appear= ance of agent in the gut were investigated. The data obtained in ~ormal subjects showed that HIDA provided superior hepatic duct images and rapid gallbladder visualization. Both agents showed rapid blood clearance. However, other differences were demonstrated which will be discussed. Nuclear Research Centre, Radioisotope Production Department, P.O.Sox 765, Baghdad, IRAQ, and Nuclear Medicine Department, Ebin Ai-Nafees Hospital, Baghdad, IRAQ.

Thyroid hormones have a marked effect on cholesterol metabolism. They have been proved e f f i cient in lowering plasma l i p i d concentration. The LDL clearance is increased from the plasma whereas the LDE synthesis is unchanged. However, D-thyroxine treatment induces high levels of plasma b i l i r u b i n concentration and increased a c t i v i t i e s of serum glutamic oxaloacetic transaminase and alkaline phospbatase. To i n v e s t i gate s e n s i b i l i t y of the hepatobiliary radiopharmaceutical 99mTc-diethyl IDA to small changes in l i v e r physiology, we have studied the influence of a short-term pretreatment with thyroxine on hepatic uptake and excretion of the radioactive agent. These b i o d i s t r i b u t i o n studies were performed in mice a f t e r the following treatment: control animals in group ( I ) were injected s.c. with saline only, whereas the group ( I I ) received s.c. thyroxine at a dose of 3 ug/20 g b,wt. per day f o r 9 days, 99mTcldiethy] IDA was injected i . v , 2-3 hr a f t e r the l a s t dose of thyroxine and the animals were sacrificed at various time intervals until one hour a f t e r injection of the radiopharmaceutical. The results snowed that the one-hour excretion of 9gmTc-diethyl IDA into intestine was s i g n i f i c a n t l y decreased (68.9% to 27,2%), whereas the excretion into urine was s i g n i f i c a n t l y increased (10.2% to 42.2%) a f t e r treatment, Thus, alterations of kidney and intestinal excretion of ggmTc-diethyl IDA are an early effect of changes induced by thyroxine treatment in mice. Laboratory ef Radiopharmacology, Isotope Dept., N.R.C. Demekritos, 153 41 Aghia Paraskevi,Attiki, and Therapeutic C l i n i c , IKA, Athens, Greece.

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THE INFLUENCE OF CHOLESTYRAMINEON THE BIODISTRIBUTION OF 99m-Tc DIETHYL IDA. C. SawasOimopoulou, N. Papanicolaou

A METHOD FOR QUTCKE~ DETECTION OF CYSTIC DUCT PATE~CY BY IDA-SCINTIGRAPHY M.M.Nehani, B.K.Das and K.Thirumurthl

The anion exchange resin cholestyramine has the a b i l i t y to chelate with b i l e salts in the i n t e s t i n e , thus e l i m i n a t i n g them i n the feces. The entero-hepatic c i r c u l a t i o n i s broken, serum b i l e acid l e v e l s f a l l and serum cholesterol drops. The serum b i l i r u b i n level tends to f a l l . Cholestyramine increases fecal f a t even in normal subjects. To study the e f f e c t o f such kind o f changes, related to b i l e s a l t s , on the processus o f 99m-Tc diethyl IDA-hepatobiliary excretion, we have performed b i o d i s t r i b u t i o n studies o f the above radiopharmaceutical in mice a f t e r treatment by Cholestyramine~ The drug was administered by addition of 4 g of resin to 150 ml of drinking water. The ingestion of that mixture by the animals lasted 5 days before the injection of gge-Tc diethyl IDA. The biodiatribution study showed normal blood clearance and hepatic uptake of 99m-Tc diethyl IDA. A significantly higher than normal level of radioactivity was found in the gallbladder from the 5th min to the f i r s t hour after iRjection (14.3% to 4.2% at 1 hr), and the excretion of radioactivity into intestine was lower than normal (50.1% to 68.6% at I hr). I t is suggested that conditions similar to cholestasis are simulated in mice by cholestyramine treatment. That effect may be related to the resininduced disruption of the enterohepatic circulation of bile acids. Restrained elimination of radioactivity from the gallbladder into intestine would be the consequence of these induced changes.

The value of IDA-ecintigraphy in the diagnosis of cholecystitis and other bil].iary channel abnormalities has been well established. But currently available procedures require fol]ow-up of fasting patient for 4 hrs or even more in the event of non-~isualisation of gallbladder. This causes inconvenience not only to the patient but e.lso dlffleulty in the routine functioning of the nuclear medicine department. We have studied the pattern of billiary dynamics in the CBD and tried to distinguish chronic from acute choleoystic. This presentation is based on Te-g9m-~IIDA study of 40 patients in which diagnosis was established b y e l i n i c a l ~ biechemical~ ERCP or operative findings. After I.V. injection of 4 to ~ mCi of Te-99m-EEIDA data collection was done at 30 see per frame upto 45 min. Late pictures were taken when required. Reigion of interest was marked over CBD and time activity curves were drawn. ~ollowing observations were made: a) i£ T-max of CBD curve is IOz 2 min the gallbladder is vlsualised early in most cases b) If T-max of CBD curve is 12-I~ min and half time of fall is 13~ 3 mln then g~llbladder is not visualised in late pictures as in acute cholecystltis c) If T-max of CBD curve is 18-26 min and half time of fall Is greater t h a n ~ O mln then gA1]bladder is visu~lised in late pictures as generm:iSy h~ppens in chronic eholecystitis.

99mTc PER-RECTAL INFUSION : A NONINVAS~VEMETHOD IN THE FOLLOW-UP OF PORTACAVAL SHUNT. M, Plga, A. L o v i s e l l i , L. SatEs, G. Madeddu and A. BalestrJeri

Laboratory of Radiopharmacology, Isotope Dept., N.R.C. Demokrito5, Aghia Paraakevi, Attiki, Therapeutic Clinic IKA, Athens, Greece.

The present study shows that by analysing CBD c u ~ e s ~ it is possible to predict the gallbladder visualisation so that patients need not be kept fasting for long hrs. Address: DePt . of Medical Physics and Bio-ENGO. & Nuclear Medicine~ I.E. Institute of Medical Scianees~ Srinagar~ Kashmir, Indla-190011.

Portal-systemic shunting is an important consequence of all diseases t h a t lead portal hypePten s~on. A p r a c t i c a l and noninveslve technique t o evaluate hepato-fusa] f~ow by recta] infusion o£ a r a d i o t r a c e r is described. The basis o£ the t e s t is to profit by the presence of the inferlor po~ taceva] anastomosis, that, trough the inferior mesenterlc vein, connects the splenic vein to the recta[ and anal network, in order to ~emonstPate the shunt. Fast{rig subjects ~ r e placed in She supine posit~on and 3mCI of mgc0- were infused by a mlCrOclysteP (~ml). A computerlzed large f i e l d s c l n t ~ l [ a t i o n camera with a 140 keV p a r a l lel hole c o l l i m a t o r was positioned to view the e n t i r e l i v e r and heart from the a n t e r i o r aspect, Images with e 6 4 x 64 resolution were recorded at the r a t e o f one per 20 sec f o r 5 min. Were obtei ned the histograms ( a c t i v l t y / t ~ m e ) o f two regbns o f i n t e r e s t (heart-H, l i v e r - L ) a~ter the t e s t a,~ the r a t i o H/L was calculated. In the normal subi ects, morphological findings were the immediate v i s u a i l z a t i o n o~ the l i v e r end subsequently o£ the heart. H/L r a t i o at 2 min was • 0.5, ~n 32 clrPhotJc p a t i e n t s with portal hypertension (ego phages] varJces and hJ9h wedged hepatic vein p r ~ sure-WHVP) the t r a c e r reached immediat[y the hea r t and the H/L ratio was constantly > 1.5. A close correlation was found between the H/L ra t i c and WHVP, concentration o f serum albumin and pPotrombin time. This technique is shown t o be useful in assassin 9 and in monitoring the pat i e n t s wlth portal hypertension, I n s t i t u t e o f C l i n i c a l Medicine - U n i v e r s i t y o f Casl~arl School o f Medicine v i a S, Giorslo 12 09100 Cagliari , I t a l y

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MEASUREMENT OF LIVER BLOOD FLOW BY INHALATION OR INTRAVENOUS APPLICATION OF XENON-133. A. Kroiss, K. Herholtz, L. Peschl, A. Neumayr

MODEL OF RADIOCOLLOID KINETICS FOR GAMMA-CAMERA STUDY OF LIVER HEMODYNAMICS

ANALYSIS OF NORMAL AND PATHOLOGICAL LIVER CIRCULATION BY TRANSFER FUNCTION /TF/. L. Nyitrai

After inhalation (Veenstra XV~133) or intravenous application of 133-Xe the course of activity was registered with an Anger-camera (Picker Dyna 4) over the upper abdomen (liver and spleen) as well as the exspirated air and recorded and stored by a computer (DEC PDP 11/34) Measurement of hepatic blood flow was performed in 19 patients with cirrhosis of the liver and we found a flow of 55.8+11 ml/100 g~/min. In five patients we ~ d this investigation twice on the same day and with one hour interval and there was no statistical difference between this two measurements and we found a very good correlation (r=O.976). This noninvasive technique for measurement of liver blood flow is easily, rapidly and repeatedly performed The results suggest that liver blood flow is decreased in patients with liver cirrhosis as we could show in former m o r e invasive investigations with 133Xe. With the splenoportography(direct injection of 133-Xe into the spleen) we found in patients without liver disease a flow of 103.4+12 and with cirrhosis of the liver 0f--58.1+12 ml/lOO gm/min. Simultaneously this ~echnique provides a good information of the presence of extra- and intrahepatic shunts. With the arterial method (133-Xe into the A. hepatica propria) we found the liver blood flow with 89.9+3 in patients without liver disease and of 49.3+11 ml/ 1OO ~ / m i n in patients with cirrhosis of the liver. The retrograde-venous method (133-Xe into the hepatic vein) showed in patients with liver cirrhosis a flow of 50.3+11 ml/100 gm/min. 1.Med. Dep., Institute of Nuclear Med. KA Rudolfstiftung, Juchgasse 25 A-IO30 Vienna, Austria

A. magrini, G. Izzo, M. Guerrisi, and A. Favella Cattedra di Fisica Medica, II" Universit&, Rome; and 0spedale Regina Apostolorum, Albano, Italy Radiocolloid kinetics within the first two minutes after i.v. injection is described with a new model which takes into account vascular transport thrE ugh dual hepatic circulation and extraction by Kupffer cells. 99mTc-human serum albumin colloids (3-4 mCi, 2-20 nm particle size) were used~ Images (32x32) were collected at the rate of one per second using a large-field-of-viewcomputeri zed gamma-camera. Curves obtaimed in several ROIS were analyzed automatically and parameters of the model were evaluated by means of a non-linear least-square procedure: extraction efficiency(E); transit time (T), arterial flow (AF) and venous flow (VF) through "functional" hepaticparen~n~a; transit time through intra-hepatio artero-venous anastomoses (TS) and shunted arterial flow (SAF); and hepatic clearance (CI=E(AF+VF)).Freliminary results (Table) are in agreement with well known physiopathological data. The method proposed a£ pears to be simple, fast, safe and reproducible, and thus suitable for routine use in the assess ment of liver hemodynemics for clinical purposes. Possible applications include the follow-up of phs]~macologicaland surgical treatment and the differentiation between arterialized and non-artE #ialized liver lesions. TABLE. Results (mean ~ 1 SD) in normal liver (N), liver cirrhosis of moderate severity (C), and ad v a n c e d liveT cirrhosis (AC). au = arbitrary unit. no. E (~)

AF (au)

VF (au)

T (s)

SAF (au)

TS {s)

C1 (au)

N 16 50+15 24+20 351+13S 24~9 12+15 24+9 175~51 C 10 46+13 25423 237+104 33+12 25+17 20+6 114+47 AC 10 39+17 34~23 64+39 27~6 38+20 15+6 35~19

After an injection of 99mTc04- liver perfusion examinations were carried out, then the TFS were computed by a program package /UNIDEK/ of the gamma camera computer system. On the basis of liver TPs /L-TP/ a new method to analyse quantitative liver perfusiou examinations was found out° L-TF gives the arterial mean transit time /MTTa/, the portal MTT ~ T T n / , the ratio of arterial and portal blood flow / A/P / and the shape of the portal upstream. The computed L-TFs are independent from the quantity of the activity injected and from the efficiency of detection, thus data of different patients can be compared quantitatively. Normal values /14 control patients/: MTT~=5.is SD~l.3s; MTTp=20°4a SDi5.3s; A/~=19%/81% SD±8% . Pstzents with portal hypertension /ll cases/ : MTTa=6.3s SDil.4a; MTTo=IO.Ys SDi4.4s; A/P=53%/47% SD!15% • MTTp is significantly shorter /p
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HEPAT]E FUNCTION AND DYSLIPIDENIAS WITH (16-1251) IODO-9- NEXADECENOIC ACID. A. C h a m ~ a i l l e r ~ 3. l u g e ~ Ph. S o u l i s s ~ ~ N. D e c o u s u s , W - 5 Ooornaer~. .

QUANTITATIVE ANALYSIS BY DIGITAL COMPUTER OF To 99m M

RETENTION STL~IES OF 75-Be-HOMOTAUROCHOLIC ACID (TB-Se HCAT) IN PATIENTS SUFFERING FROM LIVER DISEASES AND ENTEROPATHIC ABNORMALITIES. A.Centi-Colella, F.Secpinaro, M.Ceceanti, G.Valentini, E.Di Recto and M.Liberatore.

PYRIDO~YL-5-METRYLTUYPTOPHAN(Tc-98m PMT) REPATOGRA~[M BIRP~SE P~RENCHYMAL LIVER DISEASES. K. Sugimura*, ].

Radionuclide fatty acids metabolism in relationsheep ~ith heart has been studied by many authors. Ho~ever, liver is the most important organ in the fatty acid metabolism. Liver study has been performed, in 1£ patients ~ith 16-iodo-91~xadecenoic acid (IHA). The IHA label led ~ith I was supplied as a labelling kit (SEA,France). The experiment ~as done in supine position ~ith a gamma camera connected ~ifih a computer, lee total time of measurement is ~0 mn after IHA intravenous injection (]7 MBq). lhe backgroundl~tivity correction (at ]0 mn, 11 MBq Na I) i s d e s c r i b e d by F r e u n d l i e b et al (i). 2 patients groups were separated by clinical and biological analysis : 7 ~ith normal Liver (A) and 12 with liver cirrhosis (H). Before the isotopic investigation, total cholesterol (If), total triglycerid (TT), Apo A and ADO B ~ere measured ; also 2 isotopic parameters ~ere computed on the liver c o r r e c t e d curves : I max = time of the maximum count and %lS:perce~ rage of [HA excretion 1Smn after [max. In o~oup A : % 15 is correlated ~ith TC (r=-0,82~ p(O,05) and mith Apo B (r= -0,88 ~ p ~0,05) i it is net correlated eith TT and ANn A. In group 8 : there is no correlation between isotopic parameters and lipidic dalas. Also~ the group A liver scans are clearly visible and homogoneous ; on the contrary, in group B, there is a reduced and inhomogeneous distribution. Our preliminary study shoms that IHA can be used as a good tracer for certain dyslipidemias ; a I s o it could be used as a Functional hepatocyte marker. Further examinations are needed. (i) Freundlieb C e t 1043 - i050

AI. J. Noel. Hod. 1980,21,

Service Medecine Nucleaire, CHU de St Etienne, Hopital de Bellevue, Bd Pasteur 4202~ 5T Etienne Codex ~O.R.I.S. CEA, BP 21 91190 GIF BUR YVETTE.

Narabayashi~, N. lshldo*, K. Rabeshima~. C. Sugimura~, M. Mats~o*, S. Ki~ura~, and A. Kaj[la ~ .

Tc 9Bm R-pyridoxy[ 5 metbytt~ptopban (Tc-39m P~T) hepatoagrams were anal~zed to provide information

l i v e r and b i l e duet.

about the

Calculations were based on a ¢ com-

partmental model and included corrections for blood. tissue,

liver and bile backgrounds. The timeactivity

curves for Tc-8Om PMT in the cardiac region were described as the sum of 2 exponential functions, while c~rves for the hepatic region were described as the sum of U exponential comoonents.

The measured hectograms were compared

with s£mulated hepatograms and goodagreement between the two curves showed that the compartmental model adequately described the blood and b i l e aotl~itles i~ rive. Hepatic e x c r e t i o n rates were 0.17£±0.026 i~ 3 normal

subjects, 0,102±0.012 in ~ patients of chronic hepatitis and 0.i18 ~ 0.06I in aperients of liver cirrhosis. In the cases of d i f f u s e perenehy~al liver diseases, there were lower rate constants for the excretion fro~ the liver

to [he b i t e ducts than in ~or=als and the relative d i s t r i bution volumes also larger than normal. Prior to the development of this cozpartme~tal model, no u s e f u l k i n e t i c model had been found which could satisfactorily ezplain the time-aeti~it~ cur~es.

Ezperience in

human ~ i u d i e s proves this method to be accurate i~ determining the rate constants for hepatohiliar~ transport of Tc-89m PMT.

Kobe U n i v e r s i t y School of Medicine, Kobe. ~ The Center

Whole-body retention studies Of 7S-Be HCAT (370 F39q.) using a low background counting system we re performed in order to assess the intestinal function, associated with the bile salt resorpti on (entero-hepatie circulation). The 4th and 7th day retention values were determined in 8 "controls" and in 19 patients, affected by non alcoholic cirrhosis (5), terminal ileum resection (S), Crohn's disease (2), ulcerative colitis (1),alcoholic liver clrrhosis (4) and liver ate athosis (4). Counting tecP~iques were described elsewhere (A. C e n t i ~ o l e l l a et al.,J.Nucl.Med. All.Sol. 27,4,1983). In seven subjects retention curves were performed and were 8nalyzed by a general-purpose best fit program. NozTnal subje~ ts showed a noticeable variability of the reten tion values at 7th day (30,5%, range 1 3 , 8 ~ 4 2 , 4 %), althoug lower than those reported by others. The 4th and 7th day values differentiate "norma is" from patients affected by severe Crohn's di sease (5,0% at the 7th day). No significant di~ ferenee was observed between "normals" and non alcoholic cirrhotic patients. These patients showed lower retention values (20,2%) than those from patients with alcoholic cirrhosis (33,5 %). In patients affected by liver steathosis the 7th day retention seems higher (47,4%) than the corresponding no~nal mean value. The use of 7 5 - S e H C A T seems ~afe simple and useful in order to assess the resorptio~ of the terminal il~ um. T~e results On liver disease suggest that it is possible to differentiate by this method non alcoholic from alcoholic liver diseases.

for Adult Diseases, Osaka.

P-U-2. Kusunokbcho, Cbuo-ku, Robe, Japan

Cba/r of Nuclear Medicine, Institute of R~diolo g~, University "La Sapienza", 00161 Rome, Italy

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~JUCL~4~ ~ I C I N E v~qC~mU~p£ IN THE AZRE~S~ENT AND f { ~ f A ~ { R N T OF R~RLY PORTOPERATIVV P~RIOD IN hlV#~ ~#AN£~LANT&T!~N. d.I.minedo, A.Go]itsin J.A.Cienfue~os, J.L.Castillo-Olivares, d.Ort~z ~erroeal.

J EEW INDEX ~OR LIFFERENTIAL DIAGNOSIS BETWEEN tYLTLDHEPATIC LESIONS WITH CHRONIC ALCOHOLISM (STEATOSIS, STEATOFIBROSIS) AND ALCOHOLIC CIRRHOSIS, BY COMBTHATIOH OF AN AMINOPYRINE BREATH TEST (ABT) AND A COLLOIDAL HEPATOSPLEBIC SCINGRAPHY. D. URBAIN (x), P. WANET (xx), O. JEURERS (x), J.ABRAMOVICI (xx), C. PREUX (xx), A.LEBAERTg (x)

PEPTIC AND DUODENAL ULCER IMAGING USING 99mTc-SUCRALFATEo Aapo Ahonen, Reijo Or~nfors, Eauli Leino, Jyrki Luukko, Markku ~[rimaa

£pJte of recent advances in surgery technique, ~mmunosuppress~ve therapy and graft preservation a number of postoperative complications are produced in liver transplantation, which can he reduced to: acute rejection, hepatocellular damage, graft vascular thrombosis and complications of the biliodigest~ve anastomosis. Their differential diagnosis is extremely hard and Jt is based on invasive methods (peroutaneous needle biopsy, selective arteriography, cholangiography through T tubel or On CT and ultrasound, which may only DrOvlde morphological information; but, in a high number o { cases the diagnostic doubt persits. The introduction of cyclosporin A and steroids has done that rejection Js today the cause of death in very few patients (at autopsy it is ~ound in only about 10-15% of ceres). We used Tc-qPm-phitate and TC-qQm-ZDA in the assessment a~d management of liver transplantation along the early postoperative period, where even exists a very high mortality, most of which is considered to be technical in origin. We have studied the evolution of ~e both ortbotohic and heteretopi¢ liver transplantdtions in rats, 15 orthotopic in dogs and IO orthotopie in pigs. Acute rejection was only seen ~n 3 animals; remaining complications included the use of inadequately preserved grafts (5 cases), abscess into the graft (2], hepatic artery or portal thrombosis (3) and complications of biliary tract reconstruction ill). In 811 cases, information obtained from Nuclear ~edicine methods had a great value to orientate to surgeons on the transplantation course and to differentiate each t y p e of complication. Well-defined distinct patterns were found corresponding to each distinct complication, which will be shown in detail. From the Departments of Nuclear ~edicine, Zurgery and Pathology. ClfnJoa muerta de Nierro. ~an ~artin de Porres, 4. Madrid-SO. ~pain.

FREE UNIVERSITY BRUSSELS, Belgium (x) Int. Med. and Radioisotopes, gt. Pierre Hospital (Rue Raute, 322 -B-IBBO Brussels (Eels.) (xx) Radioisotope~ and Int.Med, IMC Ixelles (Rue J ~ n Paquot, 65- B-lOS0 Brussels(Belg.) 24 alcoholic subjects were submitted to on ANT (120-minute sampling) o~d a Tc-99m Sulphur Colloid Hepatosplenic scin~tgraphy, with measurement of the Liver~Splenic Activity Ratio (L/S A.E.). Among these 24 subjects, there were (diagnosis proved by biopsy) : 8 patients with Mild Hepatic Lesions (ITHL) and 16 cirrhotics (prevalence of cirrhosis : 67 %). Th~ L/S A.B. was abnormal in 3/8 patients with MHL and in 14/16 cirrhotic subjects (sensitivity : 88 %7 specificity : 63 %7 predictive value for a pmsitire test [pv (+)] : 82 %;[pv (-)] : 71%). The ANT was abnormal in 2/8 patients M i t h M H L and in 26/16 patients with cirrhosis (sensitivity : 100 %; specificity : 75 Z; ~pV (+)] : 89 %j v (-)]: lO0 %). order to improve th~ specificity, we h~ve defined a Eew Index : I = (ABT).(L/S A.E.) combining the results of both tests. Among thm 8 patients with MHL, none had an abnormal indem, whil~ 15/16 ~Zrrhotics had an ~I~normal indsx (sensitivity : 94 %; specificity : I00 Z; [pv (+~:IOOZ; [pv~-)]: s9 % ). AlthouFh these preliminary results are excellent, further investigation will be needed to confirm the usefulness of this new original index in differentiating aZeohoZic k]gL from alcoholic severe h~patic dis~se (cirrhosis).

~

S~cralfate is a drug used in the treatment of peptic ulcers. It forms a local protective layer which covers the ulcerated mucous membranes of the stomach and duodenum. Yasquez et.al, have used 99mTc-HgA-sucralfate complex in a preliminary study of ulcer patients. The aim of our study was to 1)develop a direct labelling method for the 99mTc-sucralfate complex 2)find out possibilities for the diagnosis of ulcer and other mucosal abnormalities and 3)see if follow-up of ulcer healing would be possibie with this imaging agent. Sucra!fate powder was mixed with other components and packed in monodose vials. The 99mTo-sucralfate complex was formed by adding I-4 mCi pertechnetate into the vial. After incubation~ the suspension was given orally to the patient. Preliminary trials for labell i ~ efficiency and in vivo-stability were made in rats. Imaging in the am. projection of the ventricle was started 20 minutes after administration. Other projections were used when necessary. Endoscopic verification was used to confirm our findings I-2 days before or after the sucralfate study. Results:According to our animal studies, direct labelling'method without HSA offered a stable 99mTc-sucralfate product. After oral administration only little sucralfate is usually absorbed from the gastrointestinal tract. In normal patients 99mTc-sucralfate passed along the ventricle and duodenum to the small intestine in 90 minutes. Only minimal activity was seen in the ventricle one hour after ingestion. In the case of ulcer, localized activity was seen in the area of the ventricle and duodenum. The decrease of activity was markedly slower than in normal patients. Optimal images were obtained between I-2 hours after ingestion. Good agreement was achieved between imaging and endoscopic results.Conclusions 99mTc-sucralfate suspension seemed to have in vivo-stability.According to our preliminary results 99mTc-sucralfate offers a method to visualize peptic ulcers. Clinitec Oy; Research Centre, Farmos Group Ltd. Turku University Central Hospital TURKU FINLAND

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9 9 m T C - H I D A D Y N A M I C S C I N T I G R A P H Y FOR T H E D I A G N O S I S G~ G A Z T R O E S O P B A G E A L R E F L U X (GEE)OF BILE. ~ . B o r t o l o t t i , A . A b b a t i , E. Turba,R.Pozzato,G.Bereani,G.Lab5.

ill-In EGG-WHITE AS A SOLID PHASE-MAPdiER FOR GASTRIC EMPTYING STUDIES. F. Scopinaro, L. Knigth~ M. Liberatore,M. Clemente,M. Eizzuti, C. Si~qor~

EFFECTS OF DOMPERIDONE ON GASTRIC EMPTYING EVALUATED BY RADIONUCLIDES.A.Del Geniol,S.Piccolo, N.Di Martinol,F.Saccaro,V.Maffettonel,L.Bazzicalupo and M.Salvatore.

It is well known that with esophageal p H m e t r y it is difficult to identify bile GERs(pH > 7) and it is also impossible to d i s t i n g u i s h GERs of bile mixed with acid juice. To study these kinds of GERs we me d i f i e d the s e i n t i g r a p h i e t e c h n i q u e u s e d for d e t e c t i n g d u o d e n o g a s t r i c bile r e f l u x In a series of 5 patients who u n d e r w e n t partial gastric r e s e c t i o n (3 B i l l r o t h II and 2 B i l l r e t h I) w i t h m o d e r a t e - s e v e r e esophagitis and without significant pH metric test v a r i a t i o n s , w e a d m i n i s t e r e d i.v. 5 m C i ( 1 8 5 M B q ) o f 9 9 m T c - H I D A , t h e pa tient l y i n g under a c o m p u t e r - a s s i s t e d gamma c a m e r a . W h e n g a l l b l a d d e r image was e v i d e n t ( 1 5 - 4 5 min a f t e r injection),Caert ! lein was infused i.v. at a dose of 2 n g / k g / m i n for 15 min to induce g a l l b l a d d e r c o n t r a c t i o n . D u r i n g the subsequent 45 min the patient was asked to p e r f o r m a sta_n dard series of m a n o e u v r e s to facilitate G E R . T i m e / a c t i v i t y curves obtained from areas of interest c o r r e s p o n d i n g to stria remnant and distal esophagus she w e d that in each p a t i e n t at least one of these m a n o e u v r e s was followed by a p e a k in the e s o p h a g e a l c u r v e , i n d i c a t i n g a 99 m T e - H I D A - t a g g e d bile GER. In conclusion, as this test gave p o s i t i v e results in pa tients in w h o m esophageal p H m e t r y failed diagnostic aim,we b e l i e v e that H I D A - G E R dynamic s e i n t i g r a p h y may be u s e f u l in d l s e c r e t i n g the b i l i a r y origin of an es~ phagitis.

The egg meal for gastric emptying studies is generally labelled by 9g-m-To radiopharmaceutical$ Aim of this paper is to introduce a method f o r labelling the egg white by lll-In.400 uCi of i!I In-oxine in 50 ml saline has been mixed whit 3ml of fresh egg white.A second dose of 200 uCi of lll-ln-oxine was injected trougththe egg shell by a 23 gauge needle, without crashing the yolk. The sa~e tecnique was ergployed to mix 99-~n-Te sulfur colloid, 99-m-To mierospheres and 99-m-To ovalbumin to the egg.20 minutes later the mixture was tested by G 25 sephadex column chromategraphy and by 9% glycine gel eleetrophoresis,pr~ viously set by fibrinogen, human serum albumin (HSA) and ovoalbu~Jn (OA).Dhl~omatography and ale ctrophoresis indicated that more than 96% of the radioactivity is bound to high weight proteins having eleetrophoretie motility close to that of fibrinogen;S.7% is bound to lighter proteins wi~h an eleotrophoretic motility near to HSA and 0A; finally the 0.16% is due to free lll-ln.The ant! re eggs were cooked and sliced.Slices were imaged by a ganrna-camera.Images of the egg slices demostrated an homogeneous tag of the egg white and no actfvity in the yolk,whereas images of sl~ cos of eggs tagged by 99-~-Tc r~diopharmaeeu~cals showed a strongly unhomogeneous distribution of the 99-m-Tc inside the egg.The results suggest that the ill-In tags the egg white proteins,providing an easy to perform solid meal marker. It has been obtained an homogeneous and high yeld label. gha.i.r ef Nuclear Medicine, Institute of Radiology, University "Ls Sapienza", 00161 Rome, Italy

Cliniea M e d i c s l , U n i v e r s i t & di Bologna, S e r v i z i o di M e d i e i n a Nucleate, 0 s p . M a g giore, U S L 27, Bologna, Italia,

We have studied the gastric emptying in 12 patients(mean age 35 and range 26-60 years)after Nissen fundoplication repair of sliding hiatus hernia and 13 normal subjects(mean age 32 and range 27-40) after ingesting a solid meal(two scrambled eggs labelled with 1 mCi of 99mTc-SC). In the first group of 12 patients the study was performed in basal conditions and repeated one week later after intravenous injection o£ i0 mg of Domperidone immediately after meal @dmnistrarich. The data collections were carried out by large field gamma-camera (SELO GANMA-CAT) on line wdth Digital Computer PDP-II; 60 seconds frames everg 15 minutes for 3 hours, using a 64x64 maatrix in word mode. The T i/2 and the percentage values in the various times were estimated on the total gastric area after flecay correction. The T i/2 in the healthy patient~ was 90 minutes ± 8(SD) with range 45-125. The T 1/2 in 12 patients was 130 ~ IO(SD)(p O01) Only 8 patients who had a delayed T 1/2 showed a significant reduction of this parameter after Domperidone. On the other hand no significant variations ~ere seen in the 4 patients with normal T i/E. Istituto di Scienze Radiologiche II Facolt& di Medicina e Chirurgia-Napoli Servizio di Medicina Nucleate Istituto Nazionale dei Tumori Fondazione S.Pascale-gapoli llstituto di Clinics Chirurgica Generale e Terapia Chirurgica. I Facolt& di Medicina-Napoli.

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EFFECTS OF GASTRIC Jr ICE ON TWO DIFFERENT RADIONUCLIDE COW,PLEbES: Tc 99M IN FILTER PAPER COATED WITH PERSPEX"(TC-FI-PERSPEX) AND TC PERTECHNSTATE IN KOLEST~EANINE (TC-KOLESTYR). I. Krekel~, J. Heikkil~, A. Ruokonen and J. Lehtola.

CAN GASTRIC PERTEOtNETATECLEARANCEBE USED AS AN INDEX OF ACID OUTPUT? A CLINICAL EVALUATION. Ph.Decostre, Y.Salmon, R. Finag, J.Toussaint.

DETECTION OF SITE OF ACUTE GASTROINTESTINAL BLEEDING : Tc-99m DTPA. H.M. Abdel-Dayem, G. Ziada, A. Owunwanne, K.K. Mahajan, S. Brickson.

Several radiopharm~ceutical isotopes have been introduced for measuring gastric emptying rates. Tc 99 m sulfur colloid incorporated in small R pieces of filter paper and coated with Perspex has been acted as a marker of solid component in the meal. Kolestyramine is an anion exchanging polysterin resin, the ability of which to bind Tc pertechnetate has not been tested earlier. We studied the stability of Tc-Fiperspex and Tc-Kolestyr in gastric juice of two different ph (below two and above six) in vitro at 37C for three hours. Tc-Fi-Perspex was prepared by impregnating the filter paper (3 mm x 30 ms) with a total of 200 uc of Tc 99m sulfur colloid, a minimum of which was in noneolloid form. After drying the paper was dipped in a 3 ~ w/v solution of Perspex in chloroform, dried, redipped and dried again. The filter paper was then cut imto 30 pieces (I mm x 3 mm) Tc-Kolestyr. was prepared• by mixing I g kolestyramlne (Questran) in 15 ml aqua with 250 uc Tc pertechnetate for ten minutes. During the inkubations, Tc-Fi-Perspex released radioactivity 20 ~ when ph in gastric juice was below two and 5~when ph was above six. Tc-Kolestyr released radioactivity 0.7 ~ and 0.5 ~ respectively. Our results show that a great amount of radioactivity is eluated from Tc-Fi-Perspex in gastric juice. Te-Kolestyr, however, remained stable in gastric juice the stability being over 99 ~- The similar good ability of other polysterin resins to bind technetium has been also noted in earlier tests. Tc-Kolestyr, easily prepared radionuclide complex, appears to be suitable for a semisolid marker of a meal in gastric emptying studies.

An essential step for deciding supra selective vagotomy and controlling its efficacy, or for diagnosing unfrequent gollinger-Ellison syndrome is the estimation of basal and stimulated acid output. This is classically performed through gastric aspiration before and during continuous perfusion of Pentagastrin (6 ugr/Kg B.W./hr). 9~nTc Pertechnetate is taken up by the gastric mucosa either by parietal cells or mucus cells but controversial results have been published. It has been proposed as an alternative method for estimating acid secretion. The present paper describes an original method for calculating gastric Pertechaetate clearance by simultaneous measurements of gastric uptake and plasma concentration with a scintillation camera connected with an all purpose mini computer with visually controlled ROI selection. In all cases studied, the gastric equivalent plasma space shows the same typical time evolution and the clearance may be easily calculated from its initial rate of change. In preliminary studies, classification into normal and duodenal ulcer patients was based on endoscopic examination. Gastric Pertechnetate clearance was significantly higher in duodenal ulcer patients (62,4 ml/min + 27 vs. 27,9ml/min ! 9,6 in normals). Incrnased clearance is observed after Pentagastrin stimulation, while decreased clearance is observed with Cimetidine. Our results suggest a similar trend for gastric aspiration results and Pertechnetate clearance values. If further studies demonstrate an adequate correlation between these two parameters, our simple and non aggressive method would advantageously replace a time cons~uing and uncomfortable e.vploration.

Tc-99m DTPA has been evaluated for detection of sites of acute G.I. bleeding both in humans and rabbit, tt localises at bleeding sites in the stomach, duodenum, hepatic and splenic flexures. The results were confirmed by endoscopic and surgical findings.

The Department of Gastroenterology and Clinical Chemistry, University Central Hospital of Oulu, SF-90220 Oulu 22, Finland.

Service de M~decine Nuclgaire, Hepital Erasme, Universft~ Libra de Bruxelles, Brussels, Belgium.

The technique requires use of LVOF camera to cover the whole abdomen. The patient is prepared by hydration and insertion of I.V. drip and c a t h e t e r in the bladder. 10-15 millicuries were injected intravenously, anterior views were acquired a t 2% 3% 10' and ldh Then 10-20 mg of lasix were injected LV. to clear the renal pelvis. Acquisition was continued at 20% 25% 30', 35', 40', 50', 60' and every hour up to # hours. Anterior views f}~. thyroid . . . were taken to confirm the absence of To% m vlvo. Tc-99gR DTPA is a b e t t e r radioDharmaceutical then ~rnTcO~, Tc-99m sulfur colloid, Tc-99m RBC (in-vivo or in-vitro labelled) and Tc-99m HSA for detection of acute G.L bleeding because Tc-99m DTPA achieves a higher target to non target ratio. It is easily cleared from the vascular system; it is stable in-vivo and is not re-absorbed from the intestine. From the depts, of Radiology & Nuclear Medicine and Surgery, Mubarak AI-Ka.beer Hospital, Kuwait University.

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SALIVARY G L A N D FUNCTIONAL SCINTIGRAPHY WITH COMPUTER ANALYSIS. A COMPARATIVE STUDY IN HEALTHY SUBJECTS AND IN PATIENTS WITH SICCA SYNOR~E. P.Reinikainen, L. P~yh~nen, A. Virjo and A. Uusitalo.

L~-L~NG SCAN IN T ~ DETECTION OF SUBDIAP~LRAG~IATIC ABSCESS. R. AMId, J. T~BZLST, A. LENAE~S.

GASTROESOPHAGEAL REFLUX IN CHILDREN : A NEW ISOTOPIC METHOD FOR DIAGNOSIS. O. LE MOING, G. MAUREL and B. MENSCH

The purpose of the study was to estimate the normal values and to compare them with those of patients with sirra syndrome. Computer-based sciotigpaphy was pepfo~ed in frontal v i e w . 75 MBq of 9 9 m T c - p e ~ t e c h n e t a t e was injected i.v. and 10 min later 0.25 mg of carbacholchloride s.c. to stimulate salivary flow. The total examination t i m e was 30 min, Tlme activity cuPves were obtained over parotid and submandibular glands and over a skull region. Maximum/background and maximum~minimum Patios were calculated. The study was carried out in 64 healthy people with no evidence of salivary gland disorders. The results were analysed with respect to age, sex, smoking habits and history of virus parotitis. 37 patients with sirra syndrome served as a comparative population. In the normal population the findings were very s~rmetcical. There were no differences between males and females, smokens o~ non-smokers, people with o~ ~ithouf history of parotitis. A slight decreasing f u n c t i o n was found i n elderly people. All patients with sicea syndrome had an abnormal finding which correlated to the severity of the disease. No significant side effects were observed. The method is of value, wbeo disturbaoce in the function of salivary glands is suspected. This method shows a clear difference in findings between the healthy people and patients with sirra syndrome. It is possible to estimate the degree of the functional distucbance, observe the pnog#ess of the disease and estimate the efficiency of the therapy. Department o f C l i n i c a l P h y s i o l o g y , Tampere University Central Hospital, SF-33520 Tarnpere 52, Finland

A right subphrenic abscess may Pe detected on a radionuclide lung-liver study by a separation of pulmonary and hepatic activity, since the liver lies close to the diaphragm and thus to the l,~ug. We have studied 65 liver-lung radionaclide scm~s using respectively Tc-99m-colloid and Te99m-MAA. The study concerned 3 ~oups of patients. The seintigraphic results have been compared to the su~-gical abdemtual exploration in the first group, to the combined results of abdom/~al ultrasound and C'f scan in the second group, and to the considered final dia~osis assessed by clinical examlretion, radiologica! and biological investigations and the evoluzion in the third group. The images were interpreted as positive when there was separation between liver and lung activity in anteriorandri~ht lateral views and when the upper part of the right lobe was normal on Tc-99m-eolloid imaging. Chest x-ray was available in 61 patients; it has been useful to confi~ the presence of lesions in the right pulmonary base. Among the 28 patients of the first group, 22 ~md normal radionuclide scan and no subdiapl~rag~atic abscess, 4 had subdiaphragmatic abscess also evidenced by the scintigraphy. One patient had a positive scan and an hydatic cyst at the liver dome with a fistula through the diaphra~. In the last patient has been found a massive subcapsular hematoma of liver with rupture. The scintigraphy was negative. In the second group of 12 patients, li had negative scan and no subphrenlc collection showed by ultrasound and CT scan. In one patient who had pneumonia in the lower part of the right lung, the scan was falsely positive. In the ~hird group of 25 patients, 24 had negative scan and no subdiap~u~agm~tic abscess. In the last patient who bad surinfeeted right pleural fluid, the scan was falsely positive. Despite the relative weak prevalence, these results confirm the usefulness of the radionuelide scan for the detection of right subphrenic abscess. Rout~e chest and abdominal x-ray films should be available when evaluating liver-lung scan images.

G a s t r o e s o p h a g e a l reflux in children has been implicated in various respiratory recurring diseases. Several techniques including oesophageal pH testing and scin tigraphy have been devised to detect and quantitate g a s t r o e s o p h a g e a l reflux. Limitations have been shown for each test : short duration with gamma-camera or restricted acceptability of pH probe by children. A radionuclide screening test for gastro esophageal reflux suitabie to children has been developed. Single INs (T1) probe eollimabed with lateral window ~s in CONTACT with sternum. Thzs probe is connect to a single channel analyzer and microcomputer for data storage. A oral dose of TO MBq of 99mTc phytate (Sn) followed by apple juice are given. Measurement or oesophageal radioactivity is continued for i hour by lO seconds sequences with real time display of acti vity. First 50 results are analyzed. To vali date this mebhod, on 5 patients we simul taneous record g ~ s t r o e s o p h a g e a l radioactl vity with single probe and with gamma camera, For conclusion, easy to u s e , w e l l a c c e p t e d by children, without immobilizing large equipment, this new method seems to be usefull for screening reflux in pediatric estate. Department of 8iophysic and Nuelesr Mede ripe. H6pital Tenon 75020 PARIS FRANCE.

Department of Radioisotopes, St Pierre Hospital, Free University of Brussels, Brussels, Belgium.

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CLINICAL JSSFU~SS OF DYNastIC ~ C I N 2 1 GRAPIg/ OF KIDNEYS IN CHILDREN. K. Teth, Ms Wr~bl~w~ka, L. Skobejke, E. Cichocka ~ d No K o ~ i e c z n y

RENAL SIZE IN CHILDREN ASSESSED BY 99m Tc DMSA AND DTRA SCANS: COMPARISON WITH RADI(XIqAPHIC SIZE. C. Zerva, D. Kyriaki-Manolaraki, A. Leonti, C. BaCOpOulos and P. Kostamis.

CLINICAL IMPLICATIONS OF VESICOURETERAI REFLUX 1N CHILDREN AS DETERMINED BY A DIRECT RADIONUCLIDE METHOD. H.J. Nerdrum

3 8 0 ex~linatie~e sf kidney~ in patients frem 2 w. t~ 18 y. h~v~ been dens. DuriHg the~s exams 99m2c-DTPA was injected as bolus and the frmmes were being rag l o t e r e d d u r i n g 30 min. /~aring first minute 2 seconds'frames, t h ~ i0 seconds" omss/~ D u r i m g the 2~d and the 3rd m i n u t e the relative GFR far bsth kid/aeym was caleu/~ted. ~he t e n , g r a p h i c c u r v ~ ~ere ~ v & l u a t e d by classic semi-quantitative methods amd the m e d i u m transit time f e r

Renal size in children has been studied radiographically and by ultrasound. Radioisotopic methods of measurement are scanh in the literature. Diseased kidneys frequent/y fall outside the normal range of size and thus demonstration of abnormally large or small kidneys is of value. 282 scans frcm 259 children, mean age 5.65 years (range 20 days to 14 years) were studied who had had either a DMSA scan or a DTPA renogram or both in the previous 14 mths. 155 had a DM~A scan, 72 had a DTPA renogra~, 16 had a DMSA scan and a DTPA renograrn, 10 had 2 DTPA scans and I also a DY~A scan and 6 had 2 DMSA scans. ~OIs were r ~ e round the kidneys by hand in the 128x128 images and with the help of a gradient image in the 64x64 knages, and the area of each kidney and its maxim~n length was calculated. Studies in which the patient had moved were rejected. The 2 minute rencgr~ image was used as being representative of the renal parenchyma without pelvic contribution. TO calibrate the size of the TV image we used a phantc~n of nine accurately spaced point sources, 2 magnifications of the image and 2 ~atrix sizes for aquisition. The size of the kidneys for the Di~A and the DMSA images was compared both together and separately with the radiographic size and the DMSA images were compared with the DTPA images. The results are discussed. Radioisotopic studies can be used to provide valid measuren~nts of kidney size under suitable conditions and are especially useful for follow up studies in petie~hs with various renal disorders.

each whsle kidzey was calculated by decomvelutisn a ~ l y s i e . Im cases of serious disturhamees sf @utflew f u r e ~ e m i d e was Injected. The f @ l l e w i ~ r e e u l t s h ~ v e ~ e e ~ ameer~aimed as the meet u s e f u l ames f o r the clinleal purposes: r e l a t i v ~ GFR ia qUal i f i e a t i e ~ f a r evem%u~l me~hreete~k7 , furssemlde exam effect in ~aae~ @f @~etrusted er me~-ebstructed dilatatie=a, e~rly 9e~t--sperative exam~, ev~luatism ef i m v i s i h l a ~r p e e r l y v i e i b l e kidneye i m u r s . g r a p h y ~md f u m e t i o ~ l evaluatiem ef set,pie kidmeya, Departmem% of Nuclear Mmdiai~e The M e m @ r l a l H ~ i t a l , Ohild H e a l t h Centre, AI. D m i e e l P ~ l e k i e h 20, 04-736 W&rszawm, P s l ~ d

Division of Nuclear Medicine. Department of CliDical Therapeutics, Athens university, "Alexandra" Hospital. Vassilissis Sophias Ave. and K. Lourou sir. 115 28 Athens, GREECE.

In our institution a direct radionuclide method for the investigation of vesicoureteral reflux has been in use for the last 8 years. In the method cathetherization of the child is done immediately prior to instillation of 0.9 % saline with Na99mTc04 added. Instillation is continued until voiding urge is reached. D~ring instillation and voiding computerized images of 5 seconds duration are continually obtained. Total investigation time is usually 5-10 minutes. Reflux to the kidney pelvis is reliably demonstrated. Generating time/activity curves for the reflux and evaluating the degree of reflux, it is possible to divide the patients into three groups: 1. Patients reflux. 2. Patients starting ation. 3. Patients

with early-onset~ usually marked with varying degrees of reflux during the middle part of instillwith late-onset reflux.

Follow-up show that patients in the first group almost always require operative treatment. In the second group this is less frequent and depends primarily on the degree of reflux, while the third group almost without fail respond well to long-term antibiotic treatment only. Section for Nuclear Medicine, Sentralsykehuset i Akershus, 1474 Nordhyhagen, Norway

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G A L L I U M - 6 7 I M A G I N G IN P E D I A T R I C O N C O LOGY. C.J. E d e l i n g

DIAGNOSIS OF BILIARY ATRESIA.

One h u n d r e d and s i x t y - n i n e c h i l d r e n s u s p e c t e d of h a v i n g m a l i g n a n t d i s e a s e were examined by 67-Gallium scintigraphy. In 99 c h i l d r e n w i t h u n t r e a t e d d i s e a s e s at t h e t i m e of e x a m i n a t i o n , a b n o r m a l a c c u m u l a t i o n of 6 7 - G a w a s f o u n d in 51 p a t i e n t s , i n c l u d i n g 40 w i t h m a l i g n a n t tumor. F o r t y - t r e e n e g a t i v e r e s u l t s w e r e o b t a i n e d in c h i l d r e n with benign disorders. Five false neg a t i v e r e s u l t s w e r e o b t a i n e d in pat i e n t s w i t h n e u r o b l a s t o m a of the a d r e nal gland. In 70 c h i l d r e n w i t h m a l i g n a n t d i s e a s e s t r e a t e d b e f o r e the e x a m i n a t i o n , a b n o r m a l a c c u m u l a t i o n of 6 7 - G a w a s s e e n in 40 p a t i e n t s , i n c l u d i n g 11 s t i l l s u f f e r i n g f r o m m a l i g nant disease. The r e s u l t s of 67-Ga s c i n t i g r a p h y in all of t h e c h i l d r e n w e r e e v a l u a t e d q u a l i t a t i v e l y . F o r the f i n a l d i a g n o sis o f m a l i g n a n t d i s e a s e , d i a g n o s t i c s p e c i f i c i t y w a s 86% a n d d i a g n o s t i c s e n s i t i v i t y 79%. The p r e v a l e n c e of m a l i g n a n t d i s e a s e w a s 56%. It is c o n cluded, t h a t 6 7 - G a s c i n t i g r a p h y s h o u l d he u s e d for p r i m a r y v i s u a l i z a t i o n a n d c o n t r o l of m a l i g n a n t t u m o r s in c h i l dren. D e p a r t m e n t Q~ N u c l e a r M e d i c i ~ e ~ hospitalet,Copenhagen, Denmark.

Rigs~

A48 A NEW TECHNIQUE.

M. E1 Tumi, M.B. Clarke, A. Mowat, E.R. Howard, J.J. Barrett

HA'rERNAL A N D NEONATAL SERUM T R A C E ELEMENT LEVELS IN FINLAND BY P I X E M. H y v S n e n - D a b e k I , P. N i k k i n e n - V i l k k i I

and J.T. The accurate and early diagnosis of billary atresia is still a major challenge for the clinician. Many tests are available, hut none are totally reliable. In our search for a simple and more reliable technique we have adopted a new radiopharmaceutical approach. 25 patients were investigated using an i.v. dose of Technetium Dislda and continuously recording the varying distribution of the zadioactivlty over the first 30 minutes. From the computer records, cardiac, hepatic and soft tissue regions were identified and the variation over this period in the nett count denslty in the cardiac and hepatic regions were analysed. An index of hepatic clearance (IBC) was devised and this was found to give good results and showed a wide separation between the patients with hiliary atresia and those with other causes of neonatal jaundice. To date 15 patients have been diagnosed as having biliary atresia and 10 with neonatal hepatitis. These results were compared with other isotopic methods, biochemical tests, liver biopsy, and laparotomy findings. This technique has been shown to have a high degree of sensitivity and specificity in identifying this very important cause of neonatal jaundice, which requires early diagnosis. It is also a simple non-invamive technique to exclude biliary atresia and avoid unneccesary trauma in patients with neonatal hepatitis.

Department of Nuclear Medicine, King's College Hospital, Denmark Bill, London~ SEE.

Dabek 2

Using EIXE(proton-induced X-ray emission analysis) we have s i m u l t a n e o u s l y determ i n e d s e r u m Se, Cu, Zn, Fe, Ca, Br & Pb in 25 n o r m a l and 31 c o m p l i c a t e d p r e g n a n cies and in 21 b a b i e s (cord serum). Pellets were pressed from the serum s a m p l e s after a d d i t i o n of y t t r i u m as an internal standard, mixing and evapora t i n g at 30 ° w i t h r e d u c e d p r e s s u r e . The p r o t o n b e a m of the 2.5 M V Van de graaff accelerator ( University of Helsinki) w~s b r o u g h t into the air through a K a p t o n ~ foil s u p p o r t e d on a p e r f o r a t e d c a r b o n d i s c w i t h a b o u t 200 exit holes, 0.3 m m in diameter. The samples were p o s i t i o n e d at 45 ° to the i n c i d e n t h~am and the X-rays, due to r e f i l l i n g of the K- and L - s h e l l ~ , d e t e c t e d w i t h a Ge(Li) d e t e c t o r at 80 ~ to the beam. The c u r r e n t was t y p i c a l l y 0.3 ~ A and run tines S -10 min. The X - r a y spectra w e r e a n a l y z e d b y the V I P U N E N p r o g r a m a n d c h e c k e d m a n u a l l D E a r l y p r e g n a n c y Se (0.045ppm) was h i g h e r than late (0.028 ppm, p<0.001) but c o r d levels lower than b o t h these (0.016 ppm, p<0.001), f i n d i n g s in h a r m o n y w i t h the i n c i d e n c e p a t t e r n of Keshan cardiomyopathy. C o r d and m a t e r n a l Pb w e r e s i m i l a ~ Cu, Zn, Fe and Ca s h o w e d k n o w n p a t t e r n s . M a t e r n a l Fe was h i g h e r in i n t r a - u t e r i n e g r o w t h r e t a r d a t i o n (1.7 ppm), Br in 9 r e e c l a m p s i a (3.59 ppm) and twins (3.61ppm) than in n o r m a l s (p
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CHANGES OF-IN-VIVO INVESTIGATIONS AND C L I N I C A L I N D I C A T I O N S IN N U C L E A R M E D I C I N E

BINOCULAR IMAGING OF THE LACRIMAL DRAINAGE SYSTEM. R.0. Boer, J. v.d. Endt, O. Lopes Cardozo.

NEW TRENDS FOR NUCLEAR MEDICINE. APPLICATION IN PUBLIC HEALTH. AN EXAMPLE THE FOLLOW UP OF VACC~ NATION PROGRAM AGAINST HEPATITIS e VIRUS (HBV) M.D.Mar~n, P.LOrenz, M.C.Mar~n, R. Santiago, P. Franco, J.L.Chamorro and J.Ortiz Berrocal.

H. Schicha, R. Klar, R. R e i c h m a n n , J. Bertram, Th. Ehlers, D. E m r i c h S i n c e 1979 all i n - v i v o e x a m i n a t i o n s of OUr dept. are s y s t e m a t i c a l l y s t o r e d by a c e n t r a l c o m p u t e r w i t h r e s p e c t to the k i n d of i n v e s t i g a t i o n , the c l l n i c a l indication, a n d the results. Up to n o w the d a t a of 46,500 i n - v i v o e x a m i n a t i o n s have been registered. D u r i n g t h i s t i m e the total n u m b e r of inv e s t i g a t i o n s i n c r e a s e d b y 8 percent. Inc r e a s i n g f r e q u e n c i e s w e r e o b s e r v e d for b o n e (+ 80 %), lung (+ 165 %), k i d n e y (+ 68 %) a n d e s p e c i a l l y for h e a r t studies (+ 460 %). A d e c r e a s e o c c u r e d in b r a i n (- 53 %) a n d l i v e r studies (- 35 %). The n u m b e r of t h y r o i d scans w a s n e a r l y constant. The a p p l i c a t i o n of c o m p u t e r i z e d s t u d i e s i n c r e a s e d f r o m 10 % to 60 %. C h a n g e s of c l i n i c a l i n d i c a t i o n s o c c u r e d m a i n l y in b r a i n a n d k i d n e y studies f r o m i m a g i n g of t u m o r s t o w a r d s dyn a m i c p e r f u s i o n a n d f u n c t i o n studies. F r o m the d a t a the p r e v a l e n c e of p a t h o l o g i c a l r e s u l t s w a s c a l c u l a t e d p e r yr. for e a c h k i n d of i n v e s t i g a t i o n . I n d e p e n d e n t l y the d e s i r a b l e p r e v a l e n c e s of pathological r e s u l t s w e r e e s t i m a t e d u s i n g the B a y e s t h e o r e m w i t h r e s p e c t to the c o s t b e n e f i t r a t i o and c o n s i d e r i n g a l t e r n a t i v e m e t h o d s . C o m p a r i n g the r e a l a n d d e s i r a b l e p r e v a l e n c e s of p a t h o l o g i cal r e s u l t s c o n s e q u e n c e s c o u l d be c o n t i n u o u s l y d r a w n c o n c e r n i n g e x p a n s i o n or r e d u c t i o n of i n d i c a t i o n s a n d the c o r r e c t a c c e p t a n c e of n e w m e t h o d s . C o n c l u s i o n : C o n t i n u o u s e v a l u a t i o n of ind i c a t i o n s a n d of the p r e v a l e n c e s of p a t h o l o g i c a l r e s u l t s is a g o o d t o o l to o p t i m i z e the a p p l i c a t i o n of d i a g n o s t i c n m p r o c e d u r e s a n d to p r e d i c t the req u i r e m e n t s f o r n e w methods. D p t . N u c l e a r Medicine, Dpt. Medical Data Proc. Informatic, University of Goettingen, RobertKoch-Str. 40,D-3400Gcettingen, F.R.G.

Until now function of the lacrimal drainage apparatus was studied by imaging with the scintillation camera equipped with a socalled "micro"pinhole with an aperture of I mm. Only one lacrimal drainage system at the time could ~visualized. This study of 40 patients shows the result of binocualr imaging of the lacrimal drainage system with a latest generation ga~acamera equipped with a 4 mm. pinhole collimator, after instilling 0,025 ml. containing 3,7 MBq 99m Tcpertechnetaat in each eye. The "degree" of obstruction is further evaluated by using 3 kinds of manipulations namely: I. positive vasslva manoevre, 2. negative vasalva manoevre, 3- massage of the saccus lacrimalis. It appears that hhs~e is coaslderably vaPiatlon in the normal drainage speed. Binocular imaging offers the advantage of comparing, in unilateral disease, the patients impaired lacrimal drainage system with his other "normal" functioning drainage system. The procedure is usef~l (I) in the preoperative diagnosis of lacrimal impairment, (2) for localizing the Bite of blockage or obstruction, and (3) in evaluating the succes of corrective surgery, Department of Nuclear Medicine~ St. Franciscusziekenhuis, Boerhaavelaan 25, 4708 AE Roosendaal, The Netherlands.

The main fie&d of Nuclear Medicine activities are Public Health according with the Alma Ate ru los. ;~ epidemiologic study has been performed among the high risk employees of our Hospital. In the vaccination program HBV marker-negative pe~ sons were included to avoidNBV infection and its sequelae. The response to the vaccine was confined to the novo appearance of anti-HBs. MATERIAL AND METHODS: 86 subjets has been vaccinated. The elegilibity criteria were the follow ing: no pregnancy; no systemic disease; willing hess to receave the vaccine and negative HBV mar kers that is: HBsAg, HBeAg, anti-HBe, anti-HBc and anti-HBs detected by radloinmunoassay. To check the vaccine response these markers were tested again seventh month after the former inye~ tion of vaccine. The vaccine used in the trial was a 1-ml, 40 ug dose of purified HEsAg. The first inyection was given as soon as the results of the screening blood test were avaible, the s~ cond one month later and the third six month af ter the first. P~SULTS: There were dropout among the vaccinate d subjets, one of them because pregnancy and the other employer becouse of a job change, so they were not includen in the analysis. 75 of the 84 vaccine recipients (89.28%) responded to the vaccine with appearance of anti-HBs alone. 5 (5.95% of the vaccinated subjets failed to respond to the vaccine withought developing any HBV markers. One subjet (1.19%) developed anti-HBc alone and in the three others appea ~ d anti-HBc and antiHBs together (3.57%) CONCLUSSIONS: The vaccine showedgood efficace as expressed by porcentage of anti-HBS in the blood peciments (92.85%).Me 6on't have any explication ~or the 7.14% of subjets who did'nt developed anti-sBs. 4.76% of the vaccinated subjets had se rologic evidence of HBV infection developed while the periods of vaccination which may be due boca use of an incompleted inmunization. CLINICA PUERTA DE HIHRRO. Dept. Nuclear Medicine S. Mart~n de Porres,4. MADRID-35-. SPAIN.

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O U T L I N E OF T H E O V E R A L L C O S T S OF N U C L E A R M E D I C I N E IN V I V O I N V E S T I G A T I O N S . T . G i b b s , A.F. M a c S w e e n e y .

SATOF l: A NEW DESIGN CONCEPT FOR A WHOLE BODY POSITRON EMISSION TOMOGRAPH WITH SMALL NECTANGULAN CRYSTALS, HIGH PACKING FRACTION AND EXCELLENT TOF-NESOLUTION.

HI~4 RESOLUflON POSITRC~ TCMOGRAPHY USING P(~-I. G. Brownell, C. Burnham, and D. Chesler

In o r d e r t o a c h i e v e s e n s i b l e s a v i n g s in health care, both "customer and client" need to be made aware of the major factors which determine cost and effec~ i v e n e s s . It is, t h e r e f o r e , d e s i r a b l e that a radiographer/technician is m a d e a w a r e o f t h e o v e r a l l c o s t s o f in v i v o n u c l e a r m e d i c i n e p r o c e d u r e s and, in particular, understands the break-down of c o s t i n g w h i c h u l t i m a t e l y e x p l a i n s the value of one particular diagnostic test when compared with an alternative approach. Whilst diagnostic efficacy c a n n o t b e j u d g e d by t h e r a d i o g r a p h e r / t e c h n i c i a n in i s o l a t i o n , h i s a w a r e n e s s of t h e d i a g n o s t i c p r o c e s s in g e n e r a l , competing techniques and costs can only improve the overall understanding and utilization of the diagnostic methods concerned. In t h i s p a p e r , t h e a u t h o r s p r o v i d e a b r e a k - d o o m o f the m a j o r in v i v o nuclear medicine procedures, itemizing the c o n t r i b u t i o n to c o s t of s u c h i t e m s as e q u i p m e n t , m a i n t e n a n c e , consuanables, disposable products, general over-heads and salary contributions. These costs w i l l be d e r i v e d f r o m t h e a n a l y s i s o f w o r k - l o a d in t w o m a j o r t e a c h i n g institutions.

The Institute of Nuclear Medicine, Middlesex Hospital Medical School, L o n d o n U.K.

g. Jordan,

U. Cettner,

R. Judas

Quite recently two different concepts are pursued in designing positron ringtomographs. One is the use of rectangular BG0 crystals with a width as small as possible arranged with the highest possible packing fraction. This leads to small sampling distances, extends the frequency content of the detector signals to higher values and yields a significant image resolution improvement without increasing image noise. It is called signal amplification technique (SAT}. The other concept uses time-of-flight information (TOF) for improvement of signal-to-noise ratio in the image. In this case combinations of fast cylindrical BaF2 crystals with fast photomultiplier tubes are used. As it is not possible to mount a small rectangular crystal with the help of a light guide to a circular photocathode (the T0F resolution would decrease considerably) the packing fraction and the sampling properties of TOF systems are comparatively poor. g new design concept with small rectangular B~Fz crystals of i0 mm width and a high packing fraction of 0.93 in combination with fast 20gOQ PMTs enables the combination of SAT and TOF in one system for the first time. A set of three crystals each is mounted to one timing PMT. A small encoding PMT associated with each crystal identifies the crystal of interaction at the moment. We report about the technical problems of optimal crystal mounting, getting a suitable encoding signal and reaching a TOF resolution as high as possible.

Positron tcmography has suffered in comparison with CT and ~ in that the resolution of typical systems has been l-2cm. PCR~I the M ~ analog coded positron tomograph is currently operating at a resolution of 4.8mmwithout interpolative motion. P(~-I uses 360 4rsa wide BGO detectors coupled through a light guide to 90 photomultiplier tubes. The location of the scintillation event is determined b y a n a l o g logic. A straight forward extension of the principles involved in its design will lead to an instrument with under 3mm resolation. PCR-I is a single plane demonstration tc~ograph. A multi-plane system with resolution of 2 - 3 m m i s currently in design. Biological studies to date have been designed to explore the application of high resolution tomography. Studies in rats and rabbits clearly demonstrate the ability to image structures within small animals. An extensive series of studies of compounds in the squirrel and rhesus monkey brain has demonstrated the usefulness of positron tomoraphy in these animal models. Distribution of blood flow, glucose metabolism and other metabolic processes have been imaged. In addition, stimelation studies have been commenced. These studies will lead towards the application of IKIR-I to high resolution imaging in the human brain, concentrating on those applications where small structures are to be observed or where regions of stimulation have small dimensions. Physics Research Laboratory, Massacusetts General Hospital, Boston, HA, 02114

Nedizinische Hochschule Hannover, Abteilung Nuklearmessteehnik, O-3OO0 Hannover gl, FRG

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A ROTATING DOUBLE-BEADED POSITRON CAMERA. A.M.J. Paans, W,Vaalburg and M.G. Woldring.

HIDH RESOLUTION POSITRON CAMERAS. L. Eriksson, Chr. gohm a~d M. K e s s e l b e r g

HIGH SPATIAL RESOLUTION SPECT OF THE HEAD USING ROTATING GAMMA CAMERA. S.A. Larsson, G. Bergstrand, H. Bergstedt, g. Berg, O. Flygare, P.O. Schnel], N. Anderssen and C. Lagergren

With the marketing of double-headed rotating scintillation cameras the basic hardware for a A/iger camera based positron imaging system became available. Our camera system consists of a Siemens Rota system with two uncollimated ZLC heads. To convert the system into a positron imaging device coincidence and communication electronics were installed: only coincident 511 kev events are passed on to the ADC system. The ADC system is a ILR-It incorporated in the processor box of a PDP-II/34 (gamma-ll). This ADC system is used since 4 position signals two from each camera, have to be digitized. The rotation of the gantry is controlled by the data acquisition program via the AR-II. After data acquisition the information stored on disk is used to reconstruct 16 transverse section images by hack-projection. To correct the images for the system response a three-dimensional deconvolution is carried out in Fourier space. After this the 16 transverse section images are stored on disk as a standard patient study. The spatial and time resolution of the system is 8 ~ FW}~4 and 7 ns F W ~ respectively. Tests showed that the images obtained reflected the real distribution of the radioactivity. The advantage of the rotating system above the older stationary system developed by us is that, due to the rotation, quantitative information can be obtazned. The limitations of the system are the maximum singles count rate which a camera can handle and the time required for the data acquisition. The first limitation can not be changed since the Rota system will not be used exclusively for PET. The time required to a perform rotating data acquisition limits the studies to imaging of steady state processes. An advantage is that PET becomes possible in any hospital with a double-headed rotating system. Return to single photon seintigraphy is possible by switching off the coincidence electronics and by replacing the collimators. Department of Nuclear Medicine~ University Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands.

A new detector for positron emission tOmOgraphy (PET) is suggested. The detector eonslsts of two crystals with different rise times, bismuth germanate (BGO) and g a d o l i n i u m orthosillcate ( G S O ) . The t w o c r y s t a l s with the sizes 6*20*30 ms3 are mounted o n o n e 1 4 mm P~4-tnbe, and with rise time selecting logic the two crystals can be individually identified, A positron camera system based on a detecter ring with 128 such crystals pairs , suitable for b r a i n s t u d i e s , is estimated to have a reconstructed resolution of less than 6 mm FWR~I f o r a > 200 keV energy setting . The

estimated s e n s i t i v i t y for a 20 c m d l a m field p h a n t o m .

25000 c/s/uCi/ml cylindric

flood

Department of N e u r o p h y s i o l o g y and N e u r o r a d iol ogy, K a r o l inska H o s p i t a l . I ~ s t i t u t e of P h y s i c s , U ~ i v e r s i t y of Stockholm,

( Department of Neurophysiology, Karolinska Hospital, S-10401 Stockholm, Sweden)

is

The r o t a t i n g gamma cameras, available at present, a r e not well designed f o r SPECT examinations of the head. I f the brain or the skull base shall be covered completely, a radius of r o t a t i o n of about 20 cm has to be used in order to permit the camera to pass outside the shoulders of the patient. This l i m i t s the achievable spatial resolution to between 15 and 20 mm (FWHM) depending on the collimator used. By cutting the edge of a modern gamma camera head, i t was possible to rotate the camera close to the s k u l l ; i . e . with a radius of r o t a t i o n of about 12-~3 cm - - s t i l l covering the entire brain and the skull base. Only a s l i g h t cut of the ] i g h t guide was made in the internal structure of the camera. Combined with an adjustment of the 64x64 acquisition matrix from a 40x40 cm2 to a 26x26 cm2 f i e l d of view, the overall spat t a l resolution improved to 10.4 mm (FWHM) with a Low Energy High Resolution (LEHR) collimator and to 12.6 mm using the ordinary Low Energy All Purpose (LEAP) collimator. A f u r t h e r improvement may be achieved with a newly designed "rectangular-hole" c o l l i m a t o r . Preliminary calculations on this device show an overall in-plane spatial resolution below 10 mm and a f a c t o r of 2 higher s e n s i t i v i t y than that of the present LEHR collimator - - s t i l l with an axial resolution below 20 mm (FWHM). The improved imaging properties thus obtained imply certain c l i n i c a l advantages in studies of the brain, the cerebrospinal f l u i d (CSF)-spane and the skull base. Dept of Hospital Physics, Karolinska Hospital, P.O. Box 60500, S-I04 01 STOCKHOLM,Sweden

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APPLICATION OF THE BUDINGER EQUATION TO EVALUATE SIGNAL TO NOISE RATIOS OF SINGLE PHOTON EMISSION TOMOGRAPHICSYSTEMS. W,J, Maclnfyre, T.S, Hsuser, g. Sufka, R.T.Go, J.K. O'Donnel].

INTERHEMISP~ER~CAL R A T I O S OF ~ E R R U S I O N IN 1 - 1 2 3 A M P H E T A M I N E E R E C T AND X e - 1 3 3 D Y N A M I C gREeT. A C O M P A R A T I V E S T U D Y IN P A T I E N TS W I T H C E R E B N O V A S C D L A R D I S E A S E (CVD). U. Buell, P. Echmiedek, C.M. Kitsch, W. Rrmppel, V. Olteanu, E. Kleinhans, E.A. Moser.

CEREBRAL ~LOOD FLOW IN PATrmNT$ WITH C O N G E E T I ~ ~ A R T FAILURE TREATED WITH CAPTOPRIL K.E. Britton, M. Granowska, MoJ. Car~oll, CoO. Nin~on.

I t has been proposed by Budinger, et 41, that the f r a c t i o n a l standard deviation (FSD) o f a target resolution cell as reconstructed by emission tomography may be expressed by the equation: FSD = K

(Me)3/4 (N)-½

where K i s a constant depending on the recons t r u c t i o n method, Me i s the e f f e c t i v e number o f t a r g e t c e l l s and N is the t o t a l number o f counts, The e f f e c t i v e number o f resolution c e l l s equals the sum of the number o f c e l l s in the t a r g e t plus the number of c e l l s in the background divided by the target-to-background contrast r a t i o , This relationship has been tested experimentally by reconstruction of an ellipsoidal phantom f i l l e d with a radioactive solution and imaged by the GE 400 T rotating fransaxial camera and both the single and dual head Siemens Rota Camera. All systems used 64 projections for 360° notation and reconstruction. The total counts recorded through the midpoint of the ellipsoid ranged from 120K to 6 million counts per slice. Goodagreement was obtained between the theoretical equation and the experimental results. In the slice with 120K total counts, the FSD was predicted at 39% and recorded experimentally at 25%. In the 256K slice, the prediction was g,s% and the measured value 11%. Between one million and ten million counts, hswever, the measured FSD decreased only from 11% to 7% suggesting that the asymptotic noise value is that due to the temagraphic system and cannot be improved by additional count collection.

Cleveland Clinic Foundation Department of Nuclear Medicine 950D Euclid Aveoue Cleveland, Ohio 44106 U.S.A.

ERECT may be used to examine regional cerebral blood flow by employing 1-123 labeled amphetamine (IMP) or Xe-133 gas. Xe-~33 provides flow values (ml/~OOg/min), IMP uptake reflects distribution of flow. To make these examinations comparable, right-to-left halfslice (Ng) ~atios of flow (HSRXe) or of uptake (HERI) may be determined by NoT from identical transaxial slic~s and differences D-to-normal HER (HERD) may be oomputed. 25 patients with CVD were examined twice: A) Xe-~33 DSPECT was done with a Tomomatio 64 system during inhalation of l.S GBq Xe-133 gasTWo reconstructed slices (thickness 2 cm) represent flow maps. TWO HER and HSRDXe were computed (normal ESRXe=I.02). E) within 24 hrs, 1-123 IMP SPECT was performed with a Rota gamma camera,commencing IS min (I) and 6 hrs (2) after iv injection of ~85 F~q 1-123° From each 360 ° rotation, slices were reconstructed (lhickness 2 pixels) and evaluated by ROT as in A) (HSRDI~ 2); normal HERII=I.00I. Decay corrected absolute'counts (cts[ were determined in each HE. HSRXe from 50 slices was constantly different from HSRI,. HSRDXe (.171) was greater (p 4.01)than ] ESRDII(.~0). The latter was significantly greatez (p~.01) than MHRDI 2 (.07g). Prom ~ to 2, HS cts increased, in CVD Dy 1.3B~.17, in normal HS by 1.32÷.15 and distribution pattern of IMP changed with a tendency to fill up perfusion defects. IMP 1 images were very similar to Xe images.Thus, interhemispherical differences D of rCNF were 30% greater than D in IMP uptake. IMP ~ decreased with time elapsed from injection (by 40% in 6 hrs), but IMP uptake increased by 32-39% during this period. We conclude that regional IMP uptake between 15 and 60 min p.i. is very similar hut not identical to flow with an increasing difference within the next 5 hours.

Oaptopril, an angiobensin oo~verfin~ enzyme irlhibitor, red.sos pre-load and afterload in patients with congestive heart failume, CHF, and is of potential benefit as therapy. However blood pressume falls wifh treatment. This study was undertaken to demonstrate if cerebral blood flow, C~F was affected. Seven patients with serene 0}IF consequent on previous old ~yooardial inf~u~stion had measurements before and 60 minutes after receiving 12.5 m~ captopril orally. C~F ml/min was measured mfter an intravenous injection of 15 mCi 99Tcm labelled albumin with a computer linked camera over the vertex and a probe over the aorta. Globsl and regional CBF is given by regional cerebral blood volume, measured as a fraction of total blood volume, divided by regional mean transit time, measured using deoonvolution analysis and corrected for aorta %o base of brain appesmanoe times as previously described. Results showed that 6/7 patients had a O I ~ w e l l beiow normal. With 0aptopril in 4 patients there was a marked improvement, average 27%, in CBF in spite of a 16% fall in blood pressure, BP; in g no change in CBF or BP and in one with a non demand pacemaker a fall of 16% in O~F and 17% in BP. The 4 patients showing improvement in 6 ~ were maintained on Captopril with clinical benefit. This objective approach is one example of tailoring drug therapy to the individual patient's disorder based on physiological measumements with radionuslides, St Bsmtholomew's Hospital~ West Smithfield, London EOl, U,K,

Division of Nuclear Medicine, Departments of R~diology and Neurosurgery, Univ. of Munich, Klinikum Grosshadern, Munich, FRGermany

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IODOA~fPHBTAMINE (iMP) ERECT-BRAIN STUDIES IN NEUROLOGICAL DISEASE. P.Dal Bianco, l~Podreka, K.H~II, A.Roszuczky, F.Angelberger*

CLEON-7IO CEREBKAL BLOOD FLOW (CEF) TOMOGRAFKY AFTER ACUTE CEKEBRAL INFARCTION. T.J. Steiner, R. Jewkes, Barbara Jones, P,J. Ell and F. Clifford Rose.

Basics of W~clear Magnetic Resonance Imaging

After i.v.-administration of 5.5-6.5 mCi IMP one early (during the first 6 min) and one late (30 min later) SPECT-image was obtained with a dual head rotating scintillation camera. The investigated patients (n=]O0) suffered from CVD and epileptic seizures. In 15 patients quantification of CBF was attempted by use of the "fluid microsphere- model " proposed by KUHL et al.. For this purpose 8rterialized venous blood was withdrawn during the first 6 min of the study. The octanol extracted true tracer activity was measured in a well counter. Before quantifica~ tion of the studies attenuation- and scattercorrection were performed. Reliable flow values (afflicted hemisphere 39.4 Z 14.6 ml/lO0g.min, contralateral hemisphere 55.2 ! 9.2 ml/lO0g.min) were found. In i0 normal volunteers regional increase of IMP uptake was observed after auditory- and visual stimulation in the auditory or visual cortex. Ischemic lesions seen in the IMP-studies were more extended than in the CT-scan. Epileptic foci were visualized in patient~ with seizures on the IMP-images wherea~ CT-scan was norm~l, Neurologische Universit~tsklinik Wien, Lazarettgasse 14, A-10g0 Vienna, Austria *0sterreichisches Forschungszentrum geibersdorf A-2444 Seibersdorf, Austria

Tomographic demonstration of regionally altered CBF in clinical syndromes of stroke can add to knowledge of their pathophysiology. The Cleon710 single photon emission computed tomography (SPECT) scanner yields, at low cost, images of diagnostic quality following intravenous injection of 1231-1shelled radio-pharmaceuticals able to cross the blood-b~ain harrier. We have used it to detect, characterlse and follow changes in EBF after acute cerebral hemisphere infarction (ACHI). Two or 3 transaxial tomograms were recorded on each of up to 3 scanning occasions in 36 patients. Standard methods were used and no adverse effects occurred. Marked defects in cerebral perfusion were invariably demonstrated in clinically evidentACHI even at times when conventional CT scanning was negative. SPECT was normal within a few hours of TIA with moderate hemiparesis. Cerebral haemorrhage could not, acutely, be readily distinguished from cerebral infarction but, in the former, CT was always positive. When CT was positive after ACRI there was correlation with SPECT in site but not size, the defect on ERECT often appearing substantially more extensive. During the 2 ~#eeks after ACNI, phenomena such as generalised hemisphere oligaemla, areas of hyperperfusion and an appearance suggesting crossed cerebellar diasehisis were demonstrated. Gross perfuslon defects remained evident in areas of infarction after several weeks. These findings are indicative of widespread CBF disturbances after ACHI with slow resolution. This suggests that, as well as having a diagnostic role in elinlcal practice, SPECT eanmonitor the effects of therapeutic intervention.

Departments of Neurology and Nuclear Medicine, Charing Cross Hospital, and Institute of Nuclear Medicine, The Middlesex Hospital Medical School, London, England.

Dr. F. W. Smith Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB9 2ZB Nuclear Magnetic Resonance (N.M.R.) Imaginghaa been undergoing rapid development in the past 4 years. From having been developed in one or two academic centres, it is now being applied to cllnical diagnosis in many eentres worldwide. Whilst it may be true to say that its full clinical r@le is not yet understood, it is true that it is already challenging X-Sty C,T. as the method of choice for making C.T. images. N.M.R. imaging utilises signals re-emitted from the nuclei of hydrogen atoms, which have been "activated" by a radlo frequency transmission, beamed into them when they are in a strong magnetlc field. All hydrogen nuclei have a positive charge and spin on their axes and at the same time precess around this axis at a frequency which is directly related to the magnetic field strength they are in. By selecting radio frequencies of the same frequency as the precesslal frequency, these protons may be manipulated. By using radio frequency pulses of differing lengths and at differing intervals and recording the re-emitted signal a n~mher of different parameters may be recorded and reconstructed into images. X~nose c o . o n l y used are proton density saturation recovery, inver sion recovery and spin echo signals. The hydrogen in water will me-craft signals which are dependent upon the environment of that water. In urine and CSF where the molecules of water are far apart a weak proton density signal and a long inversion recovery signal will be received. When the water is ho~nd to protein the proton density signal will be stronger and the inversion recovery signal longer. The inversion recovery signal varies from organ tO organ because of the differing protons present. In malignancy and infla~lation the proton density signal may he the same as normal but the T1 is longer.

A13 A65 THE CHANGING PERSPECTIVE F r e d e r i c T. L o v e g r o v e .

OF B O N E

IMAGING

Early radioactive t r a c e r s for b o n e i m a g ing w e r e not u s e d w i d e l y . The developm e n t of T e c h n e t i u m 9 9 m l a b e l l e d a g e n t s has c a u s e d m a r k e d c h a n g e s in the a p p l i c a t i o n of N u c l e a r M e d i c i n e to b o n e disease. Malignant tumour metastases cause abnormalities on b o n e scan by altered blood flow, altered healing r e s p o n s e a n d by s t r u c t u r a l c h a n g e s . T h e h e a l i n g r e s p o n s e to c h e m o t h e r a p y m a y be seen as an i n c r e a s i n g " a b n o r m a l i t y " on b o n e scan. Bone infection either due haematogenous osteomyelitis or to i n f e c t i o n in r e l a t i o n to a p r o s t h e t i c d e v i c e c a u s e s a b n o r m a l b l o o d flow, b l o o d p o o l and late i m a g e s . An i n c o n g r u o u s p a t t e r n of G a l l i u m - 6 7 c i t r a t e m a y be n e c e s s a r y to m o r e a c c u r a t e l y d e t e r m i n e c o n t i n u i n g infection. Orthopaedic and r b e u m a t o l o g i c a l c o n d i t i o n s w h i c h are i d e n t i f i e d on b o n e s c a n i n c l u d e avascular n e c r o s i s , a r t h r i t i s and s p o n d y l o s i s . Sacro-iliac u p t a k e v a r i e s w i t h age and d i s e a s ~ activity. Individual cases with uptake of T c - 9 9 m MDP in soft t i s s u e are not an i n d i c a t i o n for b o n e s c a n s in such cond i t i o n s b e c a u s e of p o o r s e n s i t i v i t y a n d specificity. B e c a u s e of the r a p i d i n c r e a s e in d e m a n d for b o n e s c a n s , p r o t o c o l s m u s t be s u i t e d to e x p e c t e d as w e l l as u n e x p e c t e d r e s u l t s . A flow s t u d y is u s e d to d i s t i n g u i s h c e l l u l i t i s from b o n e or j o i n t i n f e c t i o n . Target to b a c k g r o u n d r a t i o s are h i g h e s t for ~Jphosphonat~s b~]t an a d e q u a t e d e l a y p e r i o d s h o u l d be a l l o w e d e s p e c i a l l y in the e l d e r l y . Low resolution {whole body) s c a n s s h o u l d be s u p p l e m e n t e d by high resolution (including pinhole) views. O b l i q u e or c o m p u t e r r e c o n s t r u c t ed v i e w s i m p r o v e a n a t o m i c a l s i t i n g of abnormalities.

A66

A67

T ~ C ~ I C A L P A R A ~ T E R S AFFECTING SEGmentAL ~fCCARDIUM THALLIUM k~SHOUY CURVES. M. Ei-Sayed, A.R. Mahmoud, G. Ziada I .M. Hassan and H. Abdel-Dayem.

Neasurement of i n d i v i d u a l r e n a l f u n c t i o n by Tc-99m DNSA emission tomography: Comparison with the slope and kidney count methods. L.Pgyhgnen and N.Koskinen

Segmental quantitative analysis of stress thalliu~n myocardial imaging increases the sensitivity and specificity of this test for detection of ischaemic heart disease. In order to have accurate results there axe many pararQeters in acquisition and processing that has to be kept the same in the early and delayed i~%ages. Any change in one or more of these par~Teters will either give erroneous results or will make the irmages unqualified for quantitative processing. Acquisition parameters are: i) Ntmfoer of energy peaks, 2) Window setting. 3) local factor. 4) Heart position. 5) Positioning angle. 6) Collinmtion. 7) Fixed hirer of acquisition. Processing parameters are: l) Whether background subtraction is done by constant, billinear or non. 2) Selection of center and apex of the left ventricle. 3) Automatic versus manual detection of edge. 4) P/nether n ~ or average counts are used for curve display. Example of proper studies is c c ~ a r e d with the some studies in which one or n~Dre parameters have been intentionally cha~ged. ~hese parameters have been tested in over i00 cases. Our results confirmed that the acquisition & processing parameters has to be kept the same both in early and delayed images in order to obtain meaningfully interpretable quantitative data. Dept. of Nuclear Medicine, Faculty of Medicine Klz~ait University and Kuwait Cancer Control Center, M.P.H.

The total Cr-51 EDTA clearance obtained by single injection with two plasma samples in ten patients suspected for renovascular hypertension was divided between the kidneys in three ways. At f i r s t , t h e d y n a m i c i m a g i n g w i t h T e - 9 9 m DTPA was performed.The split renal funct i o n w a s e s t i m a t e d as t h e r a t i o of t h e slopes of the linear uptake phase of nephrograms. S e c o n d l y , t h e d i v i s i o n of t h e t o t a l c l e a r a n c e w a s d o n e a s the r a t i o o f the c o u n t r a t e s of t h e k i d n e y a r e a s a f t e r background subtraction using D~SA. At third,the tomographic imaging was performed w i t h ~ a x i c a m e r a 4 0 0 T a n d SPETS t0moprogramwith the same do~ of DNSA as above. A special computer program was constructed to select the edges of t h e k l d n e y s . T h e delineation 0routed intergetively using absolute count l e v e l as e d g e from a s e c t i o n t o a n o t h e r . A n a t t e n u a t i o n correction w a s u s e d i n the reconstruction of transverse sections. T h e b a c k g r o u n d s u b t r a c t i o n is p r o b l e m a t i c i n t h e s l o p e a n d k i d n e y cotter m e t h o d s w h e n one k i d n e y h a s p o o r fLtneti o n a n d i t s c o u n t c o n t e n t is low. In those cases the F~T method was more suecesful.There w a s n o sigalificant d i vergence between the slope and kidney count methods.The F~T m e t h o d g a v e s o m e what different values.We concluded that it m a y be m o r e r e l i a b l e w h e n t h e p o s i t i o n s of k i d n e y s a r e d i f f e r i n g . University Physiology

Central Hospital,Clinical unit,33520Tsmpere52,Finland

Sir Charles Gairdner Hospital, N e d l a n d s , W e s t e r n A u s t r a l i a , 6009.

A68

A69

A70

NEW DIASTOLIC FILLING PARAMETERS FOR EVALUATION OF LEFT VENTRICULAR HYPERTROPHIES BY EQUILIBRIUM GATED STUDIES. D.G. Pavel, P. Briandet, J. Sychra, R. Fang, S. Boonyaprapa, G. Kondos, S. Rich, J. Shanes, S. Virupannavar, R. Pietras.

SEQUENTIAL CHANGES IN LEFT VENTRICULAR EJECTION FRACTION ON EXERCISE ASSESSED BY GOLD-195m CAN PREDICT THE SEVERITY OF CORONARY ARTERY DISEASE. J Caplin I d O'Eeefe, W Flatman~ P Dymond.

ECG-GATED BLOOD POOL TOMOGRAPHY IN TIIE DETERMINATION OF LEFT VUNTRICULAR VOLUME, EJECTION FRACTION, AND WALL MOTION. S.R. Under~ood, P.J.EII, P.II.Jarritt, R.W.Emanuel, and R.E.Swanton.

Detection of abnormal ventricular compliance is of clinical importance and is most commonly found in left ventricular hypertrophy (LVH). The use of peak filling rate alone provides a very poor separation of patients (Pts) with LVH. We have evaluated the possibility to obtain a better separation by concentrating on early filling rate period. Method: 13 normal (NI) and 50 Pts with LVH of various etiologies. All had ejection fraction > 55%, and 23 had cardiac catheterization. LV time activity curve was replaced by weighted sum of 7 Fourier garmoolcs, expanded to 512 points. The duration of diastole was normalized to heart rate. Filling rates normalized and expressed as % stroke volume/see. Parameters (PAR): (A) Peak Filling Rate; (g) Duration from nadir of curve to (A); (C) Average Early Filling rate within early diastolic interval corresponding to duration of i/4 of normalized diastole; (D) same as (C) but using duration of I/5; (E) linear diseriminant function (df) containing values of (C) and (D) (dr = (D + .59 x C)/IOO). Specificity kept by study design at 100%. Results: Averages (NI vs LVH ± SD): (A) 545 i 61 vs 527 ± 172 NS~ (B) 148 ± ii vs 264 f 120 p<.001; (C) 293 f 36 vs 153 ± 56 p<.001; (D) 235 ± 35 vs 121 ± 45 p<.001; (E) 4.08 ± 0.55 vs 2.12 ± .076 p<.001; Sensitivity: A=48%; B=88%; C=98%; D=96%, E=98%. Ranking based on Fisher's discriminant measure, indicates top ranking for E (1.77) then C (1.72), D (1.44), B (.88). Besides parameter (E) no other combination of two PAR was found to be superior to single PAR (C). Conclusion: Average early filling rates within normalized early diastolic intervals are simple (can be used even as single PAR) and very sensitive for the evaluation of compliance abnormality in LVH. University of Illinois Medical Center Section of Nuclear Medicine 1740 W. Taylor, Room 2500 Chicago, Illinois 60612, USA

24 patients with documented coronary anatomy were studied by first pass radionuolide angiography using gold-195m (ti/2 30.5 see). 7 patients had normal coronaries (Nls)~ 5 had I vessel disease (IVD), 5 hsd 2 vessel disease (2VD) and 7 had 3 vessel disease (3VD). Ejection fraction was measured at rest (R) and at 3 mins (3')) 6 mins (6'), peak (P), i~m~ediate post (Ip) and 2 mins post (2'p) exercise. 5/7 Nls~ 2/5 IVD~ 3/5 2VD and 2/7 399 completed 6 mins or more exercise. In Nls ejection fraction was signifieantly elevated post exercise vs rest. In I and 2VD ejeetlon fraction was not signifieantly depressed at 3 and 6 mins but fell at peak exercise and rose i~mediately post and mins post exercise. In 3VDejeetion Traction fell at 3 mi~s and at peak exereise~ and rezained depressed immediately post exercise. At 2 min post exercise, in contrast to I and 2FD 7 ejection fraction was not significantly above rest. EF Mean (S.D,) [*=p<0.05 vs rest]

Nl~s 60(3) 60(6) 1 ~ 6 1 ( 1 3 ) 53(14)

6~-9) 65(10) 64(6) 68(6)* 57(16) 51(13) 62(14) 6R(11)

2~

56(7) 52(4) 42(8) 44(7)* 54(8 ) 64(5)* 57(12) 42(9)* 39(I) 35(8)* 44(9)* 61(11) An abnormal response to exercise was taken as a >5% fall in ejection fraction compared to rest. NO. of abnormal EF responses vs rest 3~' 6' Z I__PP 2.p Nls I/7 0/5 0/7 0/6 0/7

1~_~ 2~_~ 3~

3/5 I/5 5/7

0/E 2/3

3/5 4/4

1/5 3/5

0/5 0/5

2/2 7/7 5/7 I/7 In conclusion I) ejection fraction changes early in exercise may identify patients with more severe disease. 2) In general the duration of ejection fraction depression in response to exercise is related to the severity of CAD. 3) Ejection fraction criteria alone may be insensitive to less extensive disease. St. Bartholomew's Hospital, West Smibhfield, London ECIA 7BE, England.

ECO-gated blood pool tomography promises to provide a "gold standard" for noninvasive measurement of left ventricular volume, ejection fraction, and wall motion. This study Compares these measurements with those from planar radionuclide imaging and contrast

ventriculography. End diastolic and end systolic blood pool images were acquired tomographically using an ICE h00A rotating gamma camera and Star computer, and slices were reconstructed orthogonal to the long axis of the heart. Left ventricular volume was determined by summing the areas of the slices, and wall motion by comparison of end diastolic and end systollc contours. In phantom experiments this provided an accurate measurement of volume over the range 40nfl to 5OOml (r = 0.99). In h0 subjects who were either n o r ~ l or who had coronary artery disease, left ventricular volume (r = 0.83) and left ventricular ejection fraction (r = 0.89) correlated well with those using a counts based planar technique. In g2 of 24 subjects who underwent right anterior oblique X-ray contrast ventrieulography, tomographic wall motion agreed for anterior~ apical, and inferior walls, but abnormal septal motion which was not apparent by contrast ventrioulography, was seen in 13 subjects tomographically. All 13 had disease of the left anterior descending coronary artery supplying the septum. ECG-gated blood pool tomography can thus determine left ventricular volume and ejection fraction accurately, and provides a global description of wall motion in a way that is not possible from any single planar i ~ g e . The Middlesex Hospital and Medical Mortimer St., London, WIN 8AA, UK.

School,

A14

A71

A72

A73

FACTOR ANALYSIS OF DYNAMIC STRUCTURES : AN AUTOMATIC METHOD FOR PROCESSING FIRSI-PASS RADIO-

VALUE OF RADIONUCLIDE VENTRICULOGRAPHY (R~V) AND 2-DIMENSIONAL ECHOCARDIOGR2iPHY (2DE) FOR EVALUATION AND FOLLOW-UP OF ACUTE MYOCARDIAL INFARCTION. C.Delagardelle, E.Eenze, J.Kobler, S.Wiesham~ner, W.E.Adam, M.Stauch

ESTIMATION OF L E F T V E N T R I C U L A R EJECTION FRACTION BY A N E W C O M P U T E R I Z E D CARDIACPROBE SYSTEM WITH ECHOCARDIOGRAM. Y. S u z u k i , M. Ida, N. K a n e m o t o , H. T o m o d a a n d M. N a k a m u r a

This prospective study was performed to compare the value of 2 noninvasive diagnostic modalities Pd~V and 2DE in patients with acute myocardial infarction (MI) for both the primary localization, extent and hemodynamic consequences as well as for prognostic follow up. In 17 patients (mean age 55.2 yrs, range 38-72 yrs} with EOGdocumented MI BNV and 2DE were performed in an average of 5, ~8 and I05 days after the acute event. Both RNV and 2DE were scored visually by 2 experienced observers, blinded to the clinical and ECG findings, for location and extent of regional wall motion abnormaIities (RWMA), global ventricular function and the time course of these parameters. Results: In 7 patients with large infarcts (5 ant., i lot., t post.) primary location and the individual time course were recoqnized by both RNV and 2DE identically. In 4 patients (2 small ant., i intramural, t inf. MI) RWMA were seen with 2DE only, whereas in another 2 patienms only BNV succeded in detecting RWMA. In Z patients with intramural Mr, both R~V and 2DE slightly dislocated RWMA. In 2 patients with small inferior infarctions both methods failed. In addition ~o the target findings RNV revealed in 6 of 15 patients exercise induced RWMA, whereas 2 DE stud±as demonstrated a small pertcordial effusion in 4 patients, endocardial thro~g3i in 5 patients, and in i patient a papillary dysfunction could be verified. In conclusion, in large MI both RNV and 2DE are of almost equal diagnostic value, and it is this patient group that needs follow up studies for prognostic and therapeutic considerations. In smaller infarcts, however, both diagnostic modalities should rather be used complementary.

We developed a computerized single cardiac-probe system combined with echocardiogram which permits the physician to p o s i t i o n the probe more easily and properly. In t h i s s y s t e m l e f t v e n t r i eular ejection fraction(LVEF) c a n be estimated by the following three modes; first-pass(FP), beat-by-beat(B-B) and ECG multigated(MG) modes. In FP m o d e a complex demodulation technique is applied for estimation of b a c k g r o u n d counts. The sensitivity of t h i s s y s t e m is h i g h e n o u g h for FP a n d e q u i l i b r i u m s t u d i e s w i t h 1 m C i a n d 5 m C i of T c - 9 9 m human serum albumin. In 40 p a t i e n t s with various heart diseases, the LVEFs estimated by the system using the abovementioned 3 modes were compared with those obtained by gamma camera. The correlation coefficients(r) between the LVEFs estimated by FP mode, B-B mode a n d MG m o d e , a n d t h o s e e s t i m a t e d b y gamma camera were 0.938, 0.932 and 0.930 respectively. In 15 p a t i e n t s two successive FP mode studies were performed and LVEFs obtained in t h e f i r s t a n d s e c o n d studies were compared. There was good agreement between these results(r=0.9531 In 12 p a t i e n t s the probe was positioned over the left ventricle and background area; this was repeated 5 times and LVEF was estimated by B-B mode. Coefficients of v a r i a t i o n were less than 8 per cent. In c o n c l u s i o n , our results suggest that L V E F c a n be e s t i m a t e d accurately by each of t h e 3 m o d e s of t h i s s y s t e m a n d r e p r o ducibility seems to be sufficient for clinical studies.

NUCLIDE ANGIOCARDIOGRAPHY. f . E a v a i l l o t e s , Capderou~

JP.Bazin~

A.

R.Oi Paola

Fisrt-pass radionuolide angioeardiography (RNA) are usually processed usiqg time activity curves obtained by the region of interest (ROt) method. Scintigraphy beind a bi-dimensional projection of a tri-dimensionsl activity distribution, the a c t i v i t y detected i n each p i x e l is the sum of activities from several overlapp±ng or adjacent cardiac s t r u c t u r e s . Factor An-

a l y s i s of Dynamic Structures (FADS) solves, aut o m a t i c a l l y , t h e problem of crosstalk. It provides Factors which are estimates of the underlying physiological components and factor images which are estimates of the factors spatial distribution, this method was introduced by Bazin, Di Paola (1975) and Barber (1980) and used successfully in the field of dynamic studies. 47 consecutive RNA were processed using FADS. 13 patients were normal,18 had a congestive cardiomyopathy,5 a myocardial infarction, 4 a

v a l v u l a r disease, 2 an o b s t r u c t i v e cardiomyopathy and 5 a shunt (3 left-t0-right, 2 right-toleft). RNA was performed at a 64x6A frame rate of 0.5 s. during I minute, after IV injection of 7 MBq/kg of 99mTcRBC. 5 factors ~ere obtained in anterior view, which corresponded to the superior vena cava (SVC), the right heart, the lungs, the l e f t heart and a vascular factor i n c l u d i n g the recirculation. In LAO view, the fifth factor corresponded to the pulmonary artery. To focus the study on the right heart, FADS on the First frames provided 4 factors : the SVC, the right atria, the right ventricle and the lungs. The factors were unaffected by crosstalk and led to a non-ambiguous c l i n i c a l interpretation. Results were computed to those obtained by the R0I method. The time to peak of

each chamber was accurately determined by FADS. Particularly, the diagnosis of tricuspid insufficiency and shunts were easy to perform. Factors can directly be used to quantify the cardiac function. The method is automatic, has an exeelJent reproduelbility and is not operator dependent. INSERM

U66,

Institut

Gustave-Roussy,

94805

ivision of Cardiology, Department of Internal edicine, and Department of Radiology, niversity of Ulm, SteinbGvelstraSe 9 7900 Ulm/Donau, West Germany

Tokai University, School Bohseidai, Isehara-city 259-11, Japan

of

Medicine

-

VILLEJUIF CEDEX FRANCE

A74

A75

A76

EVALUATION OF GASTEOESOPHAGEAL REFLUX (GEE) %~ND BEONCSOASPIRATION (BA) WITH A COMBINED RADIOL~.BELED LIQUID - SOLID MEAL. A.Bischof-Delaloye, F.Crausaz, E.Krompecher-Kiss, J.J.Sonvers, G.Favez and B.Delaloye.

ASSESSMENT OF ESOPHAGEAL TRANSIT : COMPARISON OF SEVERAL DATA PROCESSING METHODS. M.R. Ham, B. Georges, M. GuitLaume, F, Erbsmann.

M E A S U ~ M E N T METHOD FOE BOLUS TRANSIT TIMES IN BLOOD VESSELS AND OESOPEAGIAL TRACT USING DECAY PROPERTIES OF SHORT-LIVED RADIONUCLIDES.

The aim of this work was to compare the advanta

F. Erbsmann, M. Guillaume, T. Khuc, Cl. Bzlhaye.

GEE is reliably detected by radionuclide studies. The presence of radioactivity over the lungs 815h after tracer ingestion suggests aspiration of gastric content. Usually these studies are performed with liquid tracers. Only about 10% of a liquid meal, however, remain in the stomach after 2h. Thus, the time interval in which GAB has to occur, in order to he detectable, is very short. Because about 40% of the solid label may be expected to zemain in the stomach after 2h, we introduced a combined liquld-solid labeled meal. 20 patients(ilM,7F)aged 23-aly(~56)were studied, i patient being studied twice. All pa tients presented recurrent respiratory disorders. The studies were performed in the late afternoon after 4h fast, the patient being supine. The esophageal transit of a single swallow of TC-99 m DTPA diluted in 10ml orange juice was evaluated for each segment with respect of transit times, motion disorders and GER. After dilution of the gastric content with 200ml non labeled orange juice a new dynamic study was started in order to visualize GEH. The third part of the investigation consisted in the search of GEE after a labeled solid meal(L egg labeled with Tc-99mDTPA before boiling). The next day, the thorax of the patient was imaged in order to detect pulmonary activity. 18/20 patients showed GEE after the liquid, 14 also after the liquid/solid meal, 18 patients presented motion disorders of the esophagus(prolonged transit time n=13, antiperistaltic n:18), BA was detected in 17 cases. The patient studied twice showed complete agreement between both studies. In i0 patients investigated with a liquid label only 4 cases presented BA. These data suggest a higher sensitivity for detection of BA of gastric contents with a tracer attached to a solid rather than a liquid meal. Nuclear Medicine Division and Medical Policlinic, Lausanne University, CH-i01t Lausanne

gas and the Eimifafions of several data processing techniques for the assessment of esophageal transit. The following qualitative m e t h o d s w e r e evaluated : (a) scintigraphic image (b) sequential images or cine-dispiay (c) regional time activity curves (d) a condensed image which consisted in replacing each image in the dynamic aerie by a single vertical fine, corresponding fo the projection of the image on the Y-axis. A condensed image was then reconstructed by

p u f f i n g the Lines side-by-side according fo t h e i r frame number, The q u a n t i t a t i v e methods evaluated were the Fixer t o p i x e t presentation of (a) curves parameters such as time of maximum etc. (b) mean t r a n s i t time (c) r a t i o of f i r s t and zero moments (d) a time parameter calculated from the radioactive decay. Patients data consisted of Kr-81m esophageal t r a n s i t study performed in 50 pafieots. The p a t i e n t was placed w i t h his back against the c o l l i m a t o r and was asked fo swallow 10 ml of Kr81m in 5% glucose s o l u t i o n . 60 one-second images were acquired and a l l the data processing methods described above were successively applied. The r e s u l t s showed that a q u a l i t a t i v e method should always be used is conjunction w i t h a q u a n t i t a t i v e method fo exclude causes of errors such as GE r e f l u x occuring during swaLLowing or fo evaluate the spread of the input bolus. PixeL to pixeL prensenfafion of curves parameters f a i l e d fo separate normal and pathoLogical cases. The optimal method was the simultaneous use of condensed image and the pixeL to pixeL presentation of r a t i o of moments or mean time from decay. Dept. of Radioisotope. Sf Peter Hospital, Free U n i v e r s i t y of Brussels and CRC, U n i v e r s i t y of Li6ge, BeLgium.

H. Ham, M. Zicot,

Since the dec~y of short-lived radionuclides occurs during their displacement in the human body, it is possible to calculate a transit time (TT) by measuring the decrease of radioactivity with distance : TT = [/k in At/A2, where A, and A 2 are the radioactive concentration in two points and ~ the decay constant. Experimental results were obtained with single bolus injections of 81mKr in solution. Demonstration has been made that TT is independant on shape of the bolus (short or long). TT is computed pixel by pixel and the radioactivity track is displayed in colors depending on the bolus displacement with time. From data observed on a phantom model, compared physical significance was made possible between commonly used terms such as arrival time, time to maximum, mean transit time. These studies were applied to different clinical routine investigations such as : evaluation by means of intrahumeral injections, of a blood flow index in the finger tips after restauration of arterial trauma; - venography studies of revascularisation after venous occlusions. Variations of blood velocity can be estimated in the main or collateral pathways from saphenous vein to inferior vena eava; - oesophagial transit studies performed for the evaluation of oesophaqial disorders and postoperative follow-up.

-

Specific merits of the single bolus method are discussed in respect with the constant perfusion method and in relation with the half-life of the injected radlonucliaeLs) and possible applications to SPECT. .Centre de Recherches du Cyclotron, B30 Sort Tilman - Universit4 de Liege, 4000 LIEGE. .E~pital St Pierre, BRUSSELS - BELGIUM.

A15 A77 RADIONUCLID5 GASTRIC EMPTYING STUDY (RGES] IN THE EVALUATION OF VERTICAL BANDED GASTROPLASTY FOR WEIGHT REDUCTION. G.L. Schall, C. Doherty, and L.B. Cart. He evaluated the role of the RGES in the management DE patients under~oin~ vertical banded gastroplasty. Three groups were studied: 14 nOl~al volunteers, 24 preoperative patients, and 15 postoperative patients, of whom i0 were 24 mo ±6 post-gastroplasty, patients ate a meal of one Scx~mbled e ~ labeled with 0.5 mCi of Tc-99m SC and emptying of the stomach or pouch was quantitated usin~ a 8amma camera. The data were expressed as a fraction of maximum activity and a half-time (T½) of emptying calculated. Gastric emptying of the solid meal in normals was linear with a T½ of 13-59 minutes. Nineteen preoperative patients had normal gastric emptyin~, i was rapid, 1 very delayed, and 5 borderline delayed. Half the patients showed a latent period of emptyin~ or a delayed peak. In the 2-year postoperative group, 7 had good results ( > 6 0 % excess weight loss), and 5 had satisfactory results (40% - 60% loss). There was strong direct correlation between pouch size, T½ pouch emptying, and percent of excess weight loss. The S patients with enlarged pouches had the most dramatic weight loss. We conclude that the AGES appears eo be an extxemely valuahle test for menitorin8 gastroplasty patients and may provide clues to the physiology of weight reduction i~ these patients. Because of the high correlation between pouch T½ and weieht loss in successful postoperative patients, the most useful aspect of this test may be in differenti&ti~ the reasons for failure of weight loss, i.e., inadequate surgery [short T½) versus patient overeatin~ (normal or prolonged T½). There is no definite ~vidence that abnormalities of gastric emptying play a role in the etiology of excessive obesity. Department of Nuclear Medicine Saint Francis Memorial Hospztal 900 Hyde Street San Prancisco, California USA 94109

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INFLUENCE OF BOLUS COMPOSITION ON THE RESULTS OF ESOPHAGEAL FUNCTIONAL SCINTIGRAPHY

CEOLESCINTIGRAPHIC AND ENDOSCOPIC EVALOATION OY BELIe-GASTRIC REFLUX (BGR) IN PANCP~ATICODUODENECTOMY WITH PYLORUS PRESEEVATION N. Mazzucar P.C. Oiulianotti, M. Arganini, F. Mosca, g. Mariani and R. Bianchi

B.Letsner, G.Anhalt, Ch.Bartsch Esophageal functional scintigraphy (EFS) assessing both the esophageal t r a n s i t and the gastroesophageal r e f l u x proved to be a sensitive,quant i t a t i v e and noninvasive screening t e s t f o r esophagus dysfunction. However, since bolus comp o s i t i o n has some e f f e c t on the emptying of the esophagus, the only use of l i q u i d s may be quest i o n a b l e . Therefore we t r i e d to determine whether the t r a n s i t rate of so]Jd food furnishes additional information about the fuectLonal state of the esophagus. Patients and methods: 70 consecutive p a t e n t s referred f o r suspected esophageal d y s f u n c t i o n uederwent EFS a f t e r swaltowing f ~ r s t l y 15 ml o f water m~xed w i t h 5 MBq TC-99m-DTPA and then a two centimeter cube o f i d e n t i c a l l y l a b e l l e d b~scuit. The r e s u l t s were expressed as 10 sec clearance (%) and t r a n s i t time (sec) r e s p e c t i v e l y . The r e f l u x t e s t was performed according to the method described by FISHER e t at (Gastroenterology 70:301,1976). Results: 30 % o f the p a t i e n t s showed normal, 27 % patho-

logica~ t r a n s i t of both the l i q u i d and the sol i d . 20 % bad a regular clearance of ]iqu~d but ae impaired evacuation of the s o l i d bolus. The inverse was found in 23 % of the cases. The mean r e f l u x index of the groups of patients w~th discrepant results was 6,0 + 2,6 % and 9,2 + 5,0 % r e s p e c t i v e l y . When considering only patients without suspected or proven collagen disease, chronic duodenal u l c e r was more frequent in the former group (7/9) and r e f l u x disease w~th hiat a l hernia in the l a t t e r ( 6 / 8 ) . Conclusion: TTresutts suggest that the s e n s l t ( v l t y of EFS is s i g n i f i c a n t l y increased when physiological boluses of varying composition are used, but that (iquids cannot be replaced by sol~d food. Radiologische KI~nJR der U n i v e r s i t ~ t MUnchen Nuklearmedizin Ziemssenstr. I D 8000 MOnchen 2 FRG

5th Medical Pathology, and Institute of General Surgery of the University of Piss; CNR ~nstitute of Clinical Physiology, Via Savi 8, Pisa, Italy

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A80 Current ideas on Huelear Cardiology W.E. ADAM, Ulm, University, ULM, FHO Nuclear Cardiology (NC) presently is focused on assessment of myoeardial perfuslon, metabolism and function (motion)° Imaging of myocardial perfusion and motion is part of routine diagnostic work in cardiac patients. TI-201 or labeled free fatty acids improve the diagnostic reliability for coronary arterjL~ise~se (CAD) patients %;ithout infarction for about 15 to 20%, as compared with exercise-ECO. Assessment of the infarction and postinfaretion period is domain of ~kyoc~rdial motion imaging (Cineventrieulography, Hadionuclide ventriculography (F~V)). Bedside investigations can help to ~mprove the prognostic assessment of acute infarction by imaging the size of motion abnormalities and providing data about the residual function of the left ~entricle. Follow-~p investigations finally sho~ impairment or improvement of regional wall motion abnormalities and very early yield hints about the eventual development of ~neurysms. RNV is a preferred method for therapy control before/ after bypass eperation/angiopl&sty, before/ after medication, and even makes possible the p r o ~ o s t i c 6ssessmenc of a planned ane~rysmekto~. Valvular failures ~ith regurgitation &llo~ an assessment of the reg~/rgitant volzLme (asp. Aortic regurgitation). The role of RNV in patients ~ith irreguls~rlties of the excitation and conduction system up to now ~s not clear. Hemog~nsmie effectiveness of pacemakers, control of cooperation between atri~ and ventr~eles~ ftLnctional relevance Of bundle brsneh blocks presently are main indications in patients care. Current ideas include also the differentiation between idiopathic and lesion~l conduction abnormallt[es.

OE~ELOPINGAN iDEAL PAT]ENTCAREMODEL Katie Eriksson, PH.DR.N.

Advances in Nuclear Ned}c~ne Instrumentan[~on by K. J. V i k t e r l ~ f , Sweden.

Panoreaticoduodenectomy with pylorus preservation (Lon
Principal, Helsinki Swedfsh School of Nursfng.

Regionsjukhuset, ~REBRO,

ThTs review paper on advances in nuclear medicine

w i l l mainly deal with problems concerned with in in v i v o diagnostic proceduces. The aim of these techinques is to demonstrate

the

transport of difFerent rad~opharmaceuticals through c e r t a i n organ or organ systems. The improvments in general have been obtained by meams of using s h o r t - l i v e d radlonuc]ides, in p a r t i c u l a r 99Tam-compounds, rep/aceing r e c t i l i n e a r scanners with gammacameras of varying designs and ~ncluding mini-computers as more or less integrated parts of the measuring instrumenbs. A dominating trend in gammaeamera designs is to make them larger and larger, e.g, to avoid relative movements in whole body scanning. To guarentee good intrinsic resolution the number of PMtubes has thus been increased. Problems of quality control w~]] be discussed and special attention payed to these prob}ems in emission tomo-

graphy. An oLher trend for gammacameras is ~o make them digital with large fleld and Tn emission tomographiy to use them in a dual head version. Also smaller mobile cameras seems however necessary to mee~ clinical demands; so ~ew dedicated cameras are under construction. DiFFerent approaches wlth due consideration to clinical praxis w{]l be analysed, Other options to Facilitate and make daily work more safe and accurate w i l l

be mentioned, e,g. radionuclide c a ) i b r a t o r s , p a t i e n t bables etc.

The need for basic research in patient care is reTated to the position one gives to nursing science. I f we presume that nursing science should achive the highest possible autonomy, we should also focus on basic research. And we cannot accept thor our fund of knowledgebe built up from or that appliearesearch be based soleIy on other applied sciences. The need for basic research has been discussed sporadically in nursing science ]itterature for several decades, but we Pave not progressed further than to express the need for this type of research. A generally accepted way of conducting basic research is to develop a model for a specific reality and in that case i t becomes a guestion of developing an ideal model. The ideal model describes the optimal situation and concist of a simpliffed abstraction of reaTfty, as also the modeT, and of course, is never identifical to reality. The advantage of an ideal model is, above all that through abstrac~ t~on, irrelevaht factors can be excluded and thus the possibilities of explaining and understandningthe reality increase. The purpose of attempting to develop an ideal model is to formalize the Patfent Care Process, to attempt to produce a logical totality of concept clauses and the course of events attached to them. One advantage of such pn ideal model is above all the increased possibilities of generalizing.

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CO~ARISOH OF REST IHALLILrM ~ O C A R D I A £ SCINTIGRAPHY BY TWO METHODS : PLANAR SCANS (P.S.) AND SINGLE PHOTON EMISSION OO}~UTED TOMOGRAPHY

GATEDTL-2Ol SCANNING IN PATIENTSWITH CHEST PAIN AND NORMALCORONARYARTERIOGRAMS. K.S.V{rDarien, T.Korppi-Tommola and A.Kivisaar{

(Se~CT)

MYOCARDIAL 201-T1SPECT {EXERCISE/REDISTRIBUTION)IN THE DETECTION AND LOCALIZATION OF CORONARY HEART DISEASE (CHD) IN CORRELATIONTO CORONARY ANGIOGRAPHY

A. Bertrand, M. Amor, G. Karcher, C. Bocquard, F. Aug, F. Georges

C.-M. Kirsch, R. Doliwa, U.BUII and B.E. Strauer

In order to assess the contribution of SPECT compared with PB, I00 consecutive patients (pts) admitted to the coronary care unit with suspected acute myocardial infarction (MI) who were referred to rest myocardial scintigraphy by thallium 20] unde~ent the following protocol : I) Repeated ECG, 2) Repeated Cardiac seric enzymes, 3) P.S. (4 standard views), 4) SPBCT with reconstruction of three types of oblique slices oriented according to the long axis of the heart (16 long-axis, 16 short-axis, 16 four-chambers slices), the thickness of each slice is about 8 mm. We have studied 15 normal pts, 6 pts with unstable angina, 79 pts with M.I. The intra-observer reproducibility shows 7 discrepancies in PB and 2 in BPECT and the inter-observer 9 discrepancies in PS and 2 in SPECT. All these discrepancies concern the inferior wall. The overall sensitivity is 73 % for PB a~d 96 % for SPECT. In inferior MI (n = 43) the sensitivity is 69 % For PB and 95 % for BPECT, likewise in anterior MI (n = 28) it is 70 % and 96 % respectively and inferior MI (n = 8) it is ;DO % for both. SPECT is more reliable, sensitive and accurate than PS, moreover it is as simple to perform as PS and easier to interpret. The routine performance of more than I 500 BPECT confirms these results.

Grant from the FrenchSociety of Cardiology. Service de M~decine Nucl~aire CNU NANCY-BRABOIS 54500 VANDOEUVRE FRANCE

To evaluate the a b i l i t y of TI-201 exercise/redis t r i b u t i o n imaging with SPECT to detect and l o cate coronary heart disease we studied 63 patients who a l l had undergone coronary angiography (CAG). Three groups were separated, patients with a) p r i o r myocardial i n f a r c t i o n (MI) (n=30), b) CHD but no history of MI (n=20) and c) normal CAG. The patients were studied r i g h t a f t e r exercise and three hours l a t e r using a single head rotating gamma camera system with 360° data acquisition. The subsequent three dimensional construction provided a transverse, sagittal and f r o n t a l plane f o r better localization of the lesion. The findings of SPECT evaluated v i s u a l l y were compared to the findings in tAG. The sensit i v i t y of SPEET was found to be 85% in group b and 97% in group a. Comprising group a and b i t was 92%. The s p e c i f i c i t y was 85%. Dividing in an anterior and posterior segment in group b, a transient ischemia was found by a r e d i s t r i b u t i o n pattern in the anterior portion in 70% of the patients and 79% in the posterior segment. In the infarct group a) 100%of the infarct sites were identified by a persisting defect the anterior segment and 94% in the posterior one. 9 segments in the anterior and 4 in the posterior location showed both a persisting defect and a redistribution pattern allowing a distinction between viable and nonviable myocardium. Applying SPECTwith exercise/redistribution imaging in less pronounced CHD increases both, the functional evaluation of myocardial segments and the anatomical association of CND. Division of Nuclear Medicine, Dept. of Medicinel University of Munich, Munich, FR Germany

15 patients with ang[nai chest pain under~ent T1-201 scanning after exercise(E) and i.v. dipyr~damole(O) with corresponding redistribution aquisitions. 6 symptomfree volunteers underwent scanning after D, and served as controls of this part of the study. TI uptake was aquisited in 3 projections and computer processed. Gated iate diastolic images were after 90% substraction divided into 4 steps by colour scale, 12,5% each. Coronary haemodynamlc and metabolic data obtained in connection with coronary catheterization at rest, during atrial pacing and after D were compared to the scans. Regional intensity decrease was observed in all patients in E and/or D scans (13 at 12.5% and 6

at 25% level) as compared to the corresponding redistribution scans; in 5 cases during E and in 14 cases after D. O induced no regional changes in controls, and none of them experienced chest pain, whiie D induced an anginal attack in 13 patients. 5 patients deveioped angina during E. Metabolic and coronary haemodynamic comparisons: I) Myocardlal lactate uptake was significantly reduced after D in the 14 patients with regiona1~ly reduced TI uptake after D. The values were 18.1~2.5(SEM) umol/min before and 7.2±4.1 umol/

min a f t e r D (p<0.025). 2) Both in patients with 12.5% and 25% regional intensity reduction the ratio between MVO 2 (~2 supply) and double product (02 demand) was sLgnif[cantly reduced; by 27.8±3.7% and i9.7*4.7% correspondingly (p
in patients with angina and normal coronaries, First Department of Medicine, University Central Hospital, SF-ooggo Helsinki, Finland

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LONGITUDINAL TL-201 EHISSION COHPUTER TO!IOGRAPHY OF THE HEART WITH THE ROTATING,BILATERAL SLANT HOLE COLLI~IATOR (RBS)FDR THE DETECTION OF CORONARY ARTERY DISEASE(CAD}:CO~PARISDN MITIi CORDNARY ANGIOGAPHY.R.Schneider,H.Paeprer, D.Calder,G.Oolde,H.Ootsch,R.Schmutzler, R.Felix.

COMPARISON IN THALLIUM REST STUDIES BETWEEN A PLANAR QUANTIFIED AUTOMATED M E T H O D AND SPECT. M. Michalski, M. Goris, J. Bretille, P. Brenot, S. Askienazy

QUALITY-CONTROLOF SPECTMYOCARDIALSTUDIES USING A 2OI-TI FILLED HEARTPHANTOM. H.Herzog, G.Notohamiprodjo, G.Spohr, L.E.Feinendegen

To i n v e s t i e a t e the c l l n i c ~ l a p p l i c a t i o n of TL-2OI-SPECT with a 30 RBS,we compared the r e s u l t s of CA with l o n g i t u d i nal tomography of the heart in 151 pat i e n t s ( p t s ) . I n 131 pts with CAD,75 pts had p r i o r myocardial i n f a r c t i o n ( ~ I I ) - g 4 had l - v e s s e l disease(VD),21 had 2-VD, 20 had 3-VO.56 pts had no ~41(29 I-VD, 13 2-V0,14 3-VD).20 pts had no CAD.Coronary stenosis was considered s i g n i f i cant narrowing~50% of lumen diamete~,adyskinesis in ventriculogram(RAO 30 ~) and s i g n i f i c a n t ECG-changes was taken as p r i o r ~iI.Longitudinal tomograms(lcm/ s l i c e ) f r o m apex to the base-perpendicul a r to the long axis-were obtained by ~econstruction of 8 plana~,3D slanted p r o j e c t i o n s of the heart +n a l l pts a f t e r symptom-limited exercise and in r e s t . l n the a n t e r i o r planar p r o j e c t i o n afte~ exercise a h e a r t / l u n g r a t i o was calculated by ? ROI's to q u a n t i t a t e i n creased lung-uptake. The slices were analyzed q u a n t i t a t i v e l y by c i r c u m f e r e n t i al p r o f i l e s exer vers. rest,whereby act i v i t y dimiuution to ~70% was cons!de ~ red pathologic. The o v e r a l l s e t ~ s i t i v i t y ( s e n s ) f o r detect i o n of CAD was 9 3 ~ , s p e c i f i c i t y was 85%. 1~ithout p r i o r HI sees was qO%,with !iI I00%.1-VD was c o r r e c t l y predicted in g2%,multivessel-disease(2-VD+3-VD)ie 81% by lar~e perfusion d e f e c t s - e x t e n ding in mo~e t h a n I w e l l d e f i n e d segment-and by i n c r e a s e d I L - 2 0 1 l u n g - u p take(~a~o~2). We conclude,that l o r g i t u d i n a l SPECT with ORS improves the detection and extant of CAD. Dep Radio+Cardio KI.CHa~I.,FU BerllnWG

50 cases of rest t h a l l i u m s t u d i e s are a n a l i z e d by two m e t h o d s . IPlanar studies as described by GORIS ( D A S I T . S G , J.N.M. 17, 1976), 3 acquisitions (ant, LOA45 and 65) are compared segment to segment with s e r i e s of n o r m a l t h a l l i u m studies. 2 types of images are p r o d u c e d r e p r e s e n ting : a- an i d e a l i z e d u p t a k e of t h a l l i u m (left v e n t r i c u l e figured as an e l l i p s e ) b- or a ratio : p a t i e n t v e r s u s the normal data (rest VS a b s o l u t e ) . 2- T o m o g r a p h i c s t u d i e s : 180 acquisition c o r o n a l and s a g i t t a l reconstruction r e s p e c t i v e l y octogonal and p a r a l lel to the main axis of the hart. Among these 50 patients, 10 are normal. A double blind interpretation was done in order to determine the amount of false positive by each m e t h o d and d i f f e r e n c e in localization of each m e t h o d . If G O R I S ' t e c h n i q u e is observer free rapid, entirely automatedt there is a lack of precision in l o c a l i z a t i o n and e x t e n t of defects. Tomograms s l i c e s are more a n a t o m i c but artefacts due to mistuning of the tomographic s y s t e m may lead to misinterpretation and false p o s i t i v e . S e r v i c e de M 6 d e c i n e N u c l G a i r e Hospitalier Sainte-Anne-1 rue 75D14 p a r i s - F r a n c e -

- Centre Cabanis

Single photon emission tomography of 201-TI uptake in the myocardium is increasing in use. Proper interpretation of data demands control of resolution, scatter, contrast and counting statistics. The present study aims at defining minimum detectable accumulation defect within an otherwise homogeneous distribution of tracer in a heart phantom. The heart phantom was filled with 5 MBq 201-TI and placed in a cylindrical tank that contained water and styropor simulating the human chest. A single head rotating gamma camera {Philips) was used f i r s t to establish attenuation. Rotating the camera a half circle from dorsal to ventral view, with the heart phantom in the axis of rotation, frames were collected in 32 projections, 50 sec for each, and thereafter in 16 projections, 100 sec each. Slices were oriented perpendicular to the heart axis and computed employing the Karolinska software. These studies were repeated after inserting two blocks of t i s sue equivalent material (5 cm long with cross sections I cm x I cm and 1 cm x 2 cm) into the phantom parallel to the phantom axis, in order to simulate infarcted regions. The uniformity test gave an integral difference of computed uptake of 23% for 32 projections and 25% for 16 projections. Maximu~ variation over circumferential sectors of 20 was 20% for 32 projections and 15% for 16 projections.The smaller of the two infarct simulations gave a nonsignificant depression of measured uptake, the larger one depressed uptake significantly by 50%. The study indicates reasonably acceptable image uniformity and acceptable resolution in detectin~ accumulation defects larger than about 2 cm . Institute of Medicine, Nuclear Research Center Juelich, O-5170 Juelich, West-Germany

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FALSE-POSITIVE PERFUSION DEFECTS AND IMAGE DISTORTION OF 180 DEGREE ACQUIRED THALLIUM-201 MYOCARDIAL SPECT IMAGES WITH AND WITHOUT ATTENUATION CORRECTION. W.J. Maclntyre, R.T.Go, T. Houser, C. Piez, J.K. O'Donnell, D.H. g e i g l i n and C. Napoli.

GATED CARDIAC IMAGING WITH NUCLEARMAGNETIC RESONANCE (NMR) TECHNIQUES. W.J. Maclntyre, R. T. Go, B.J. Sufka, J.K. O'Donnell, H.N. Young, D.H. Feiglin and W. Pavlicek.

A SINGLE CRYSTAL GAMMA CAMERA FOR THE EVALUATIOg OF SIMULTANEOUS MYOCARDIAL PER~USION (Thallium-201) AND LEFT VENTRICULAR (LV) FUNCTION (Gold-195m). A. Lahiri, G. ganelli, M. O'Hara, R. Jones, M. Bowles, A. Cave, H. Barker, J. Crawley and E.B. Raftery.

I n | t i a l preliminary phantom and i s o l a t e d c l i n i cal case studies have shown a r t i f a c t u a l f a l s e p o s i t i v e perfusion defects and image d i s t o r t i o n s with 180° acquired images. The present study was performed to v e r i f y i f previous findings were reproducible with other imaging systems and reconstruction as well as to determine the e f f e c t on s h o r t - a x i s o r i e n t a t i o n , in a d d i t i o n , the e f f e c t of attenuation c o r r e c t i o n s o f the two techniques on normg| and abnormally per~ fused myocardium was evaluated. Normal patients and patients with myocardial ischemia and i n f a r c t i o n diagnosed on 360° acquired images were confirmed by coronary angiography and reprocessed f o r the 180-360 ° comparison. Each p a t i e n t was processed twice, f i r s t with data from 0 e (ANT) to 180° (POS) then with data acquired from 315o (RAO) to 1350 (LPO). Recons t r u c t i o n s were displayed and r e i n t e r p r e t e d b l i n d l y without knowledge of the p a t i e n t ' s diagnosis. The present study confirmed that 180o acquired images produce s i g n i f i c a n t f a l s e p o s i t i v e defects and image d i s t o r t i o n in patients with normally perfused myocardium. The f a l s e defects were accentuated by the attenuat i o n c o r r e c t i o n program. The 180o acquired data also produced prominent streaking a r t i facts which were not seen on the 360° acquired images. Although the contrast r e s o l u t i o n o f the 180° acquired images was b e t t e r f o r inf a r c t s compared to the 360° , the display o f i s chemic r e d i s t r i b u t i o n pattern was more accurate on the 360°, This study r e i t e r a t e s our previous p r e l i m i n a r y conclusion that the recons t r u c t i o n o f 180° acquired data is not s u f f i c i e n t l y r e l i a b l e f o r Thallium-201 myocardial SPECT imaging. Cleveland C l i n i c Foundation Department o f Nuclear Medicine 9500 Euclid Avenue Cleveland, Ohio 44106 U.S.A.

Since the NMR signal from flowing blood i s usual|y much weaker than the surrounding cardiac s t r u c t u r e s , NMR cardiac imaging has the advantage o f an inherent contrast agent that serves to delineate the chamber wa]Is and v a l v u l a r structures. The advantages of t h i s cont r a s t cannot be achieved, however, i f measuremeets o f the heart are made at various positions or states o f motion. I f the pulse sequence i s synchronized to be i n i t i a t e d at a s p e c i f i c point in the R-R i n t e r v a l , the heart motion would not a f f e c t the image. This synchronization, or gating, has been accomplished both by using the e l e c t r i c a l spike o f the Rwave as a reference point or by detecting the shape o f the a r t e r i a ] pulse by means o f pressure detection devices. The l a t t e r technique is simpler and cheaper but i s more d i f f i c u l t to synchronize with the d i a s t o l i c phase. Gated cardiac NMR measurements provide the only technique a v a i | a b l e to image the heart in a l l planes and a t any or a l l phases o f the cardiac cycle. Cinematic display o f a cross-section has been accomplished so that a~sessment of valve movement, v e n t r i c u l a r function amd wall motioe can be achieved. A p p | i c a t i o e s have already been made f o r the i d e n t i f i c a t i o n of i n f a r c t s and congenital malformations. Assessment o f v e n t r i c u l a r wall thickness in l e f t v e n t r i c u l a r hypertrophy has been obtained. Since these cardiac images have only recently been a v a i l a b l e to the c a r d i o l o g i s t , i t is expected that many other cardiac applications w i l l be used in the future f o r both diagnosis and p a t i e n t handling. Cleveland C l i n i c Foundation Department o f Nuclear Medicine 9500 Euclid Avenue Cleveland, Ohio 44106 U.S.A.

Increasingly, studies of LV function and myocardial perfusion are requested in the same patient for the evaluation of coronary artery disease (CAD). We have asssessed the feasibility of performin~ simultaneous first pass radionuelide angiography (FPA) with Au-lg3m (Byk Mallinckrodt) and stress myocardial imaging with TI-201 using a digital gamma camera (Apex, Elscint). To validate the method of Au-195 FPA (740-1110 Mgq), 7 normal volunteers and 11 patients with cardiac disease underwent 3 FPA studies within i hr; 2 with Au-195m and i with Tc-99m (740 MBq). The correlation between the methods for the calculation of LV ejection fraction (EF) was: r=0.95 for the 2 Au-lg5m studies and r=0.93 between the Au-195m and Te-R9m studies. In ]8 patients with documented CAD Au-195m and TI-201 (74 MBq) were injected at peak seml-supine ergometric exercise (EX). Au~195m FPA in the 15 RAO view was stored and TI-201 imaging was performed in 3 views. Repeat Au-195m and TI-201 studies were performed 3-4 hours post-EX. EF fell by 5% in 12 out of 17 patients; a segmental TI-201 perfusion deficit was present in the EX images in 18/18; ST segment depression >i mm occurred in 13/I8 patients. Thus LV function and myocardial perfusion can he assessed simultaneously in patients with CAD using a single NX test and a single crystal gamma camera. •

o

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DeDartment of Cardiology Division, Northwick Park Research Centre, Harrow, Hospital, Halton, Bucks.

and Radioisotope Hospital & Clinical Middx. and R.A.F. ENGLAND.

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REST-TI-2OI-SINGLE PHOTON EMISSION COMPUTERIZED TOMOGRAPBY (SPECT) IN NON OBSTRUCTIVE CARDIOMYOPATHY : P. Peyeelon, P. Bailly, J.M. Vincent, D. Mestas, J, Cassagnes, A. Veyre.

S P E C T - T l ~ 2oi S T R E S S AND R E S T S T U D I E S OF THE M Y O C A R D C O M P A R E D W I T H C O R O N A R Y ANGIOGRAPWY. T. Chen and J. O i e s e

VALUE OF EXERCISE THALLIUM-Z01 SCINTIGRAPHY IN DETECTING MYOCARDIAL 15CHEMIA IN PATIENTS WITH PREVIOUS MYOCARDIAL INFARCTION. HV Huikuri,UR gorhonen,3 Heikkll~,JT Takkunen.

39 patients were studied for chest pain (56%), symptomatic heart fealure (54%), both symptoms (23%), syncope (7%). All had impaired left ventrieular function estimated with echocardlography or left angiography and all but one had no significant coronary stenosis. With a rotating y-camera (GE 4OCT) 32 views of 3Os each were c~lected, from LPO to RAG. Using a filtered backprojection algorithm, lO to 20 transverse 6.25rm~ thick slices were reconstructed, from which coronal and sagittal sections were obtained. SPECT was abnormal in all but 2 cases. Left ventricule appeared enlarged in 26 cases,as confirmed hy echo and angiography. Lung and right ventricuIar T] uptake was observed in 11 cases, all having a severe left ventricular dysfunction. Myocardial abnormalities were also considered : global non homogeneous uptake: 81%, partial defect defined as reduced uptake: 57% (anterior wall: 57%, inferior: 36%, other: 7%) and complete defect defined as no uptake: 41% (anterior: 70%, inferior: 18%, other: 12%). 6 patients had complete and partial defects. 2 patients had more than one complete defect. Defects are most frequent on the anterior wall and this abnormality is related to se~ental hypokinesis obser~ red in Io cases by angiography. Compared to planar imaging, SPECT allows a better appreciation of global heterogeneous distribution and a better defect localisation.Tha~ lium up~ake defects are non specific, occuring both in ischemic and congestive cardiomyopathy. Thi~ last diagnosis is not excluded by the presence of small complete defect while large com~ plete defect are only found in coronary disease. Excluding myocardial ischemia, defects seem to be related to interstieial fibrosis or to cell membrane abnormality, impairing thallium uptake. So if eehocardiography is useful in evaluating ventricular size and contraction, SPECT gives good information about myocardial dlsorders:these two non-invasive techniques should he associated to follow-up such patients. Services de M4decine Nuclgaire et Cardiologie Centre Jean Perrin - CHRU - Place Henri Dunant 63000 - CLERMONT-FERRAND - FRANCE.

In 1983 we examind 1.3oo Pat. with stress ant rest SPECT of the myokard using Tl-2o1. In this group 135 pat. had coronary angiography. The results of both investigations are compared. Method: All pat. were exercised upright on a bicycle ergometer starting at 25 Watt and increasing the work load by 25 Watt per minute. At peak exercise 2 mCi Ti-2oi was i.v. injected and the exercise continued for I minute. With a rotating gam~a camera (G.E. 4oo T) 32 frames over 18o 0 were counted for 30 seconds each. After 2.5 hours the measurement was repeated. About 2o transaxiale slices with a width of I pixel were reconstructed using a Ramp filter. The reconstructed data were agai~ filtered with a 3-dimensional nonliner filter. After defining the two angels of the long axis of the left ventricle, slices perpendicular to the long axis were reconstructed. These slices were evaluated by visual comparison and by calculating the washout times from the difference of the counts of the stress and delayed reconstructed images. The coronary angiograms were performed at 5 cardiological centers. The examinations were evaluated independentely, in this comparison narrowing of an arteny of 7o % or higher was cossidered as significant. Results: In 124 cases out of 135 the findings of both coronary angiography and SPECT are in agreement. There were 4 false positivs and 7 false negativs. The sensitivity of SPECT is thus 94 % and the specificity 80 %. Nuklearmedizin, St. Josef-Hospital~ Mglheimer Str. 83 D-42oo Oberhausen I, Germany

l'hallium-201 scintlgraphy at r e s t and during exercise~exercise electrocardiography,left ventricular cineangiography and coronary arterio graphy were performed on }0 patients with angina pectoris and previous myocardial infarction. 24 patients (80%) showed partial or complete redistribution of postexereise thallium defect

on delayed scan,while onty 12 p a t i e n t s (40~) had ischemic ST-segment depression on exercise electrocardiography, 11 patients (33%) showed p a r t i a l r e d i s t r i b u t i o n o f postexercise thallium defect in the zone of previous myocardial infarction,while in 19 patients (66%) no redistribution occurred in the zone of previous infarction.t0 of 11 patients with redistribution had normal or hypokinetic areas of wall motion on eineangiography,while 16 of Ig patients had akinetic or dyskinetic and 3 patients hypokinetic areas of wall motion. The degree of anatomical obstructions of coronary arteries subserving the area of previous myocardial infarction did not differ in patients with redistribution of thallium from those without redistribution. Thallium exercise scintigraphy appears to be superior to exercise electrocardiography in detecting myocardial ischemia in patients with prior myocardial infarction. Some patients appear to have partial redistribution of postexercise thallium defect on delayed scan in the zone of previous infarct/on. This cedistribution appears to reflect better the viability of the myocardium~as expressed by the degree of wall motion abnormality,than the coronary flow to infarct area,as expressed by the degree of coronary anatomies] obstructions.

Department of Medicine,Division of Cardiology and Department of Clinical Chemistry. Oulu University Central Hospital, 90220 Oulu.

Finland.

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P A R A M E T R I C IMAGING OF M Y O C A R D I A L TL-20~ CLEARANCE FOR THERAPY CONTROL IN A O R T O CORONARY BYPASS SURGERY. R.Zimmermann, W.H.Knapp, H.Tillmanns, P.MSller, F.J.Neumm]n, W.K~bler.

THALLIUM 201 EXERCISE SCINTIGRAPHY IN PATIENTS WITH a LEFT BUNDLE BRANCH BLOCK. S.H. Braat, A.P.M. Gorgels, K. den Dulk, H.J.J. Wellens.

T I - 2 0 1 S c i n t i g r a p h y in P a t i e n t s w~th Neuromuscular Disease S.N.Reske~.M. Probst~J.Gerloff~ C . W i n k l e r . Inst. N u c . M e d . N e u r o l , and Cardiol. Univ. Clin.~ Bonn~ FRG Cardiac i n v o l v e m e n t is a m a j o r progno stic f a c t o r in c e r t a i n n e u r o m u s c u l a r d i s e a s e s (ND). T h e r e f o r e m y o c a r d i a l p e r f u s i o n and tissue intergrity~ as well as v e n t r i c u l a r f u n c t i o n (VF) was e x a m i n e d w i t h T I - 2 0 1 s c i n t i g r a p h y (TS) and M - m o d e or 2D u l t r a s o n o g r a p h y (US). 16 p a t i e n t s (pts) w i t h ND, p r o v e n by s c e l e t a l m u s c l e biopsy~ were examined: 6 pts w i t h p r o g r e s s i v e m u s c u l a r d y s t r o phy (PMD), 6 pts w i t h spinal m u s c u lar a t r o p h y (SMA), i pt w i t h F r i e d reich's (F), P o m p e ' s and centr~l core disease. C l i n i c a l status and h i s t o r y were u n r e m a r e a b l e in i~ pts, u n s p e c i fic S T - s e g m e n t s b n o m a l i t i e s were found in 10/16 pts (12 lead s t a n d a r d ECG). Advanced dilatative cardiomyopathy was f o u n d in 1 pt w i t h PMD; 1 SM~-pt s u f f e r e d from CAD. TS was p e r f o r m e d after s y m p t o m - l i m i t e d bicycle e x e r c i s e (2 mCi i.v., Ii pts) or a f t e r d i p y r i d a m o l e - i n d u c e d v a s o d i l a t a t i o n (6mg/kg). In ~/6 pts w i t h PMD and 2/6 pts w i t h SMA, 1 pt w i t h F, m y o c a r d i a l d e f e c t s were found in TS. VF was n o r m a l in all pts except the pt w i t h DC~ who had typical TS and US findings. The CAD-pt had an i n f e r i o r d e f e c t in TS. 2 pts w i t h P~D and n o r m a l TS were s i g n i f i c a n t l y y o u n g e r c o m p a r e d to P ~ D - p t s w i t h ~ p a t h o l o g i c TS (mean age 22 vs. ~ y)~ i n d i c a t i n g p r o g r e s s i v e h e a r t i n v o l v e m e n t in a d v a n c e d PMD. No signif i c a n t age d i f f e r e n c e was o b s e r v e d in 2/6 p a t h o l o g i c vs. 4/6 n o r m a l SMA pts. In eonclusion~ TS r e v e a l e d p a t h o l o gical f i n d i n g s in a b o u t 2 / 3 of PMD and 1/3 of S~& pts s u g g e s t i v e for h e a r t i n v o l v e m e n t of the p ~ i m a r y disease. Age d i s t r i b u t i o n of p M D - p t s w i t h p ~ t h o l o g i c TS i n d i c a t e d p r o g r e s s i v e h e a r t i n v o l v e m e n t in a d v a n c e d stage. F o l l o w - u p studies are n e e d e d to s u b s t a n tiate these findings.

Since it is k n o w n that p a t i e n t s (pts) with coronary artery disease (CAD) reveal d i m i n i s h e d m y o c a r d i a l T1-2Oi elim i n a t i o n rates, q u a n t i f i c a t i o n of these kinetics should be p a r t i c u l a r y desirable in pts u n d e r g o i n $ a o r t o - c o r o n a r y bypass surgery (ACBS). In these pts comparative i n t e r p r e t a t i o n of conventional T1-20N scintigrams is often complicated: a c t i v i t y p a t t e r n s m a y change without showing a normal d i s t r i b u t i o n after ACBS. In o r d e r to p r o v i d e a quantitative p a r a m e t e r for t h e r a p y control, regional e l i m i n a t i o n rates were d e t e r m i n e d u s i n g a digital s u p e r p o s i t i o n a l g o r i t h m for p a i r e d myocardial images. I n v e s t i g a t i o n s have b e e n carried out in 37 pts before and a f t e r ACBS, in a control group (C) of 27 individuals, in 23 pts with triple vessel disease (SVD) and in iO pts with single vessel disease (~VD). The m y o c a r d i a l elimination rate between ~0 m A n and 4 h p.i. was: C: %5.0+2.3%, 3VD: 3 0 . 6 + 2 . 5 % (overall rate), ~ V D (poststen.):--~O.O+2.2%, 3 2 . 2 ~ 3 - 5 % in CAD before and ~2.1+_4.5% a f t e r ACBS. 29/5~ pts showing graft p a t e n e y had normal elimination rates a f t e r ACBS, whereas Tl=20d d i s t r i b u t i o n a p p e a r e d normal in only fl6/~i pts. Thus, c o n s i d e r a t i o n of regional activ i t y clearance exhibits improved rel i a b i l i t y in T1-20q sequential scintigraphy for graft p a t e n c y control. Med. U n i v e r s i t ~ t s k l i n i k Abt. Inn. Med. III (Kardielogie) Bergheimerstr. 58 D - 6900 Heidelberg, FR Germany

Exercise electrocardiography combined with thallium 201 scintigraphy has proven to have a high sensitivity and specificity to detect coronary artery disease in patients with no conduction abnormalities on the ECG. No data are available of patients with a left bundle branch block. Therefore, this study was undertaken. Fourteen patients with a left bundle branch block without docum e n t a t i o n of a new or old m y o c a r d i a l i n f a r c t i o n a d m i t t e d b e c a u s e of c h e s t pain were studied to assess the value of thallium 201 exercise scintigraphy to detect presence and extent of coronary disease. Coronary a n g i o g r a p h y was done in all patients within two weeks after sclntigraphy. N i n e p a t i e n t s s h o w e d d e f e c t s on the thallium 201 e x e r c i s e sclntigraphy, which disappeared after redistribution. Eight of these 9 patients had at least a n a r r o w i n g of the lumen of one coronary artery of 70%. Three patients had single vessel, 2 patiens had two and four patients had three vessel disease. Of the 5 p a t i e n t s w i t h n o r m a l t h a l l i u m 201 exercise s c i n t i g r a p h y ~ had normal coronary arteries. So thallium 201 exercise scintigraphy in patients with a left bundle branch block has a sensitivity of 89% and specificity of 80% to detect coronary artery disease. These results show that thallium 201 exercise scintlgraphy is a reliable m e t h o d to detect coronary artery disease in patients with a left bundle branch block. Dept. of Cardiology, University of Limburg, Annadal Hospital, 6201 BX MAASTRICRT, The Netherlands.

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Stress and r e d i s t r i b u t i o n TI-201 emission tomography(SP[CTl before and a f t e r coronary bypass operation, L.Karhum~ki,L.P~yh~nen, V.Turjasmaa, & . V i r j o , M.Koskinen, S.Sepp~nen, J . I s o l a u r i and P.Kuusinen

COMPARISON OF SENSITIVITY. SPECIFITY AND PROGNOSTIC VALUE OF 2 O l T L - M Y O C A R D I A L SCINTIGRAPHY AND R A D I O N U C L I D E - V E N T R I C U LOGRAPBY BEFORE AND AFTER TRANSLUMINAL CORONARY ANGIOPLASTY.

1,. ,~z:~.k[k, ~;. , r 6 ~] c w s k ~ i~.O s t r o ~ s L i

23 p a t i e n t s ( p t s ) who underwent a coronary bypass operation were studied pre- and posto p e r a t i v e l y with stress and r e d i s t r i b u t i o n T I - 201 SPECT. Stress imaging was started w i t h i n ten minutes a f t e r a maximal stress test, T l - c h l o r i d e was i n j e c t e d 1 min before the end o f the stress, R e d i s t r i b u t i o n images were t a ken 4 hours l a t e r . Imaging was performed with a MaxiCamera 400T equipped with Gamma-t1 computer system and SPETS tomographic software. There was a myocardial i n f a r c t i o n in the h i story of 13 pts. Coronary angiograpby showed in 4 pts l e f t main vessel disease, in II three-vessel, in 5 two-vessel end in 3 onevessel disease. Dyskiuesia was detected in 13 pts by contrast cineventriculography. A f t e r the operation the stress tolerance was increased 16 pts and decreased in one.The stress induced angina became less severe in 13 pts and in none i t was augmented compared to that before the operation. ST-depression in EKG was improved in 4 pts, unchanged in 5 pts and equivocal in 14 pts because of d i g i t a l i s therapy.The preoperative Tl-imaging showed myocardial ischemia in all 23 pts. Ischemia was decreased in 14 pts, unchanged in 5 and became worser in one. In 3 pts ischemia disappeared in one region but augmented in another. TI-SPECT showed postoperatively 5 new infarcts two of them were diagnosed perioperatively. In conclusion, TI-SPECT-imaging was able to show ischemia in all pts before the bypass operation.The effect of the operation to the myocardial perf~sien was demonstrated noninvasively and r e l i a b l y . Often problematic perioperative infarcts were detected. University Central Hospital 33520 Tampers 52, Finland

of Tampere, SF-

F . D , M a u l , G . H ~ r , g . K o b e r , R . S t a n d k e , g . Grenz H.Klepzig j r . , D . S c h e r e r , J . H a p p , M . K a l t e n bach. Div.Nucl. Med. and Cardiol.Univ. Frankfurt, FRG. S e n s i t i v i t y , s p e c i f i t y and prognostic value of exercise 2 O l T l - m y s c a r d i a l sci~tigraphy (MS) and exercise radionuclide v e n t r i c u l o g r a p h y (RNVG) were investigated in 109 pts. with a single vessel disease before and after transluminal coronary a n g i o p l a s t y (TCA), Pts. after successful TCA with stenoses less than 50% and without myocardial infarction served as controls. Vitality index (VI) and r e d i s t r i b u t i o n (RE) were calculated in 3 segments per view. Global EF (G-EF) and the EF in 4 segments (S-EF) were determined at rest anlexercise (ex) with an own f u l l y - a u t o m a t e d computer program. For the same specifity of 90% sensitivity of MS vs. RHVQ was for stenoses of LAD (n-18) 78 vs.82%, LAD after myocardial infarction (n=32) 76 vs.83%, RCA (n=lS) 4~ vs.71%, and LCX (n=8) 88 vs.63%. A stenosed LAD was identified with a accuracy of 82 vs.66%. After successful TCA comparable significant improvements were found for both procedures with borderline effects in RCA stenoses. Changes after unsuccessful TCA (n=ll) were not significant. After successful TCA the increases of VI and S-EF in dependance of the behaviour before TCA was: no Vl-decrease 8,8 vs. 6,7%, S-VI decrease 12,5 vs.8,4%, S-VI decrease plus RE 23 vs.12%, S-EF increase 15 vs.3,1%, absent S-EF increase 15,6 vs.18,5%. In conclusion both procedures are complementary in sensitivity and prognostic aspects and comparable in the control of success rats, with a better accuracy of MS in localising the stenosed vessel.

/.l,[ouieegsl!y~

]~ll 5'5 p a t i e n t s a q u a n t i t a t i v e zletilod was u s e d fop e s t i l ~ t i o n of t i ~ i i ~ - g o ~ scans b a s e r on a n a l y s i s of eirotnJiferential p r o f i l e s an p e r f u s i o n h o m o g e n e i t y a n a l y s i s . "iNie i n v e s t i g a t i o n s were done in 11 p a t i e n t s w i t h o u t c a r d i o v a s c u l a r ol~nges a n d 64 w i t h i s c b a e m i e h e a r t d i s e a s e s /21ii]/. In 42 eases e x e r c i s e tests were done. P h a n t o m i n v e s t i g a t i o n s d e m o n s t r a t e d tibet a f t e r h o m o g e n e o u s f i l l i n g of p l m n t o m c h a m b e r s w i t h thalli~au-201 the m e a n values of the profiles w e r e w i t h i n the range of 8 5 - 1 O O % of the m a x i m a l value. I/% the a n a l y s i s of p e r f u s i o n h o m o g e n e i t y th~ n u m b e r of p r o f i l e s aeeuL~ul~ting t L a l l i u m - 2 0 ~ in amotunts a b o v e 95)~ of the m a x i m a l v a l u e was 90-95%. I/z p a t i e n t s w i t h o u t IHD p r o f i l e ctu~es s h o w e d v a l u e s ~ b o v e 85% of the n~xi*~ual value. In p e r f u s i o n honlogen~ity a n a l y s i s the p r e v a i l i n g h i s t o g r a m d e m o n s t r a t e d th~llium-~O~ a c c u m u l a t i o n in o v e r ~0% of the r~xin~l ~ a l u e in d i f f e r e n t p r o f i l e s . Lxanlples are showll of q u a n t i t a t i v e e s t i m a t i o n of ~ e r f u s i o n d i s t u r b a n c e s in a eompreher~sive way in I}ID of var y i n g intensity, q~le p r e s e n t e d m e t h o d of qt%~ntitative e s t i ~ a t i o n of theilium.-201 scans m a k e s p o s s i b l e ~n objective a n d c o m p r e h e n s i v e d i a g n o s i s of m y o c a r d i a l p e r f u s i o n d i s t u r b a n c e s and is v e r y u s e f ~ l in r o u t i n e work, and p ~ r t i o u l a r l y in the ~ n a l y s i s of scans o b t a i n e d ~t r e s t a n d d u r i n g exercise. P o s t g r a d u a t e M e d i c a l ~ d u e a t i o n 0enter, ul. S z a s e r o w 128~oo-909 ~{arsaw,Poland

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A103 CLINICAL EXPERIENCE WITH STRESS AND DELAYED THALLIUM-Z01 qUANTITATIVE SEGMENTAL WASHOUT CURVES. l.M.Hassan, M.M.J.Mohammed,A.R.Mahmaod, M.E.Sayed and Abdul Dayem, The Departments of Nuclear Medicine and Cardiology, Faculty of Medicine, University of Kuwait and K.C.C.C. 25 patients with ischaemic heart disease (IHD) had stress thallium-2Ol myocardium imaging with early and ~ hours delayed images in anterior, 4W and 70 LAO projections. The study was interpreted using d i g i t a l display (D.D) versus quantitative segmental washout curves (QSWC) available on the G.E., Star computer. Findings of coronary angiagraphy was available in lO patients. The aim of the study is I. Compare the QSWC display versus the d i g i t a l display. 2. Find the advantages and disadvantages of this new 201-TL washout program. In every view the myocardium was divided to 3 segments. 9 segments in every study was available f o r comparison (3views in 3 patients were not v a l i d , making total segments-81). In the DD, 36 segments were normal and 45 abnormal, 3 showed delayed f i l l i n g . In the QSWC segments,21 were normal and 50 were abnormal; 3 showed rising of the curve (these are d i f f e r e n t from the above in DD). Comparison between both studies show that from 36 segments with normal DD, 23 were having delayed washout. In 21 segments with normal washout 8 were having abnormal DD. 13 were norraa~ by both displays. We conclude that ( I ) QSWC increases the s e n s i t i v i t y and s p e c i f i c i t y of stress 201-TL test f o r detecting segmental ischaemia of the myocardium, (2) Both studies should be interpreted together to avoid normal washout in certain regions with marked perfusion defect (3) Segments with rising washout curve indicates that in certain IHD the time from injection to peak myocardial uptake might be prolonged to several hours.

MYOCARDIAL I S C H E M I A IN P A T I E N T S WITH NORMAL CORONARY ANGIOGRAPHY : S T R E S S THALLIUM IMAGING.M. Gallazzi, G. Zat ta, G.L. Tarolo, B. Palagi, R. Picozzi ,A. A t h e r t i n i and M. Radice Stress Thallium 201 m y o c a r d i a l imaging xvas applied in 19 patients ~vith angina p e c t o r i s , p o sitive exercise e l e c t r o c a r d i o g r a m s and n o r m a l c o r o n a r y a~giogr aphy. T h e aim of this st~dy-~vas to a s s e s whedier, the s e techniques can provide useful informations in identifying m y o c a r d i a l ischemia unassociated to fixed c o r o n a r y disease. In 7 patients there w h e r e no defects in thallium 201 images, .12 subjects s h o w e d regional perfusion defects in i m a g e s r e c o r d e d immediately after exercise and 2 of t h e m kept these, alterations in late images. D u r i n g exercise monitoring episodes of S T d@ p r e s s i o n w e r e r e c o r d e d in 13 patients, in 2 of them there ~'as angina too. T w o subjects had negative exercise electrocar diograms during stress Thallium-201 imaging. M a n y authors judge that Thallium-201 is m o r e specific than stress electrocardiogram alone i~ the evaluation of c o r o n a r y disease. W e think that with the association of exercise e l e c t r o c a r d i o g r a m ahd stress Thallium-201 imaging in symptomatic patients it is possible to single out true m y o c a r d i a l ischemia despite of n o r m a l c o r o n a r y angiography.

Cattedra di M e d i e i n a Nucleare, Unlversit& degli Studi di Milano, O s p e d a l e S . P a o l o 201~2 MILANO, Via A . d i Rudini 8, Italia

A 105 DEVELOPMENT AND APPLICATION OF A WASH-OUT PROGRAY IN THALLIUM-201 STUDIES ON THE APEX 215M SYSTEM. A. van galen, P. v.d. geijden, J.L. van .. x xx xx Wijk~ J. Oudhof , D. Prefers and S~ Saul . The aim of this study was to develope a routine computer program for use in cardiac stress studies with Thallium~201. By using the available software Of the integrated Elscint camera (Apex 215M) the final program consists of acquisition in a 25Bx256 matrix during g minutes after injection of 2 mCi (7a Mbeq) of Thallium-g01 in S standard projections. A circular BOI is created around the left ventricle and after background substraction an angular profile is produced. By using the same ROI in the rest study after redistribution (4 hours p.i.) a second angular profile is produced. The rest-histogram is substracted from the stress-histogram and the washout curve is calculated by dividing this histogram by the stress-histogram. The wash-out histogram is divided into 7 segments and the quantitative wash-out is calculated for each segment The wash-out histograms of 30 cardiac patients (15 women and 15 men) without proven angina pecfurls were used to calculate the average washout profile and the standard deviation for women and men separately. women men mean S.D. mean S.D. 45° LAD 61% +/- 16% 54% +/- 12%

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anterior 57 13 52 Ii An attempt has been made to correlate pathological wash-out results with coronair angiograpby findings. In relation to visual interpretation this program proved to be very useful in previous myocardial infarction patients. In a further development the computer automatically calculates the extent of the hygoperfused area in the stress study as well as the area of diminished wash-out from the wash-out profile. The severity of the lesion is also calculated and expressed in terms of standard deviations in both instances. Bleuland Hospital Depts. of Nuclear Medicine x ' xx and Cardiology (Gouda) and Elscint (Brussels)

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THE CLINICAL UTILITY OF GATED TI-201

THALLIUM CARDIAC-LUNG INDEX (TCLI) : A NEW METHOD FOR QUANTITATIVE ANALYSIS OF 201 -T1 SCANS. V. Bosnjakovic, S. Pavlovic, Lj. Bozinovic, M. Grujic and M. Ostojic

VALUE OF E X E ~ I S E THALLIL~4 SC~N~flGRAM FOR THE DETECTION OF ISCHI~4IC MYCCARDIU~ 6 WEEKS A ~ A C L ~ ~ffOCXKRDIAL INFARCTION. P. De Coster, J. Col, J. Melin, J.M. Detry and C. Beckers.

TCLI, as a new planar anatomically o,'ientea method, has been developed for quantitation of 2u1-Tl scans at functional stress (S)-redistributzon(B) analysis. The method assumes relation of regional and overall myocaLdiai uptakes to lung uptake, imc±uding new approach to backgrouad (gg) analysis based on exponential attenuation function. Seven myocardial ROls (5 segmental, maximal and overall average), each wlth gg subtracted and lung related ROT (in terms of average number of counts per voxel - c/v, per ROI ), are analyzed in three scintillation camera (SC) views: ~aNT, LA0 45 and LL 90, according to the formula: TCLI=M-(Bg x (1-~n))/L, where: M - c/v of myocardial BOI, Bg - c/v oF Bg BOI, L - c/v of lung ROI, Fm - attenuation factor for relative myoeardlai to thoracic distances. Computer program calculates TCLI values at S, R~ and as a ratio S/R~ also, the mean per 3 SC views TCLI values of overall average myocard±al uptakes per view (AM) for S, R and S/B are calculated.

34 patients with transrmlral acute myocard±al infarction (7£MI) were ra~dc~nly assigned to intracoronary streptokinase treated group (SK = 18 patients) or to a control group (C : 16 patients). Vessel patency defined as referfusion occlzring after streptokinase or spDntaneously in C was assessed with an angiogram obtained during early phase of I~4I. Thalliu~n scintigram ~ere perfoz~aed at rest (TLR) and after m 4 3 ~ i exercise test {~L max) 6 weeks after /~v~. A s e ~ - ~ t i t a t i v e score of ~docardial thallit~n uptake was expressed as a percent of a maximal defect score (DS -+ gEM). At rest, DS were similax in both groups (21% -+4 in C and 19%_+3 in SKi . During exercise, DS increased in both groups to a similax level (29%-+4 in C, 31%!3 in SK) . Patients with reperfusion were pooled (23 pts = 17 successfull SK and 6 C in which the infarct related vessel was patent) and c ~ e d with pts without reperfusion (Ii pts = io C with an occluded vessel and one SK failure). Patients with reperfusion had DS at rest significantly lower than those without reperfusion (14%_+3 and 32%_+5 ; p < O.001) , but during exercise, DS of non reperfused patients did not change significantly (TLR 32% _+5 to TL max 36%_+5) whereas DS of reperfused patients increased n~rkedly (TLR 14%_+3 to TL max 27%+_4 ; p < O.(~31). In conclusion, 6 weeks after AMI, patients with reperfusion have a saklller DS at rest but during exercise, the reperfused area beoccaes reversibly ischemic and requires further rm~nagea~nt.

SCINTIGRAPHY. COMPARISON WITH STATIC TI-201 AND MUGA STUDIBS.

I. garty and J. Earzilay.

Sequential gated three-view TI-201 studies followed by 45 ° LAG multi-gated blood pool [MUGA) study were performed in 40 patients suffering from ischemic heart disease. A "static" image was obtained by adding all the gated frames of TI-201 study. In this way we found the conventional static study quite unnecessary. Comparison of the gated TI-201 study to the "static" one revealed significantly improved resolution in the gated images with additional information concerning wall motion and myocardial thickness. By the addition of the diastolic frames, a considerably improved image quality was obtained in a short imaging time of 8-10 minutes per view. Substraction of added diastolic TI-Z01 gated frames from the added systolic frames, enables a direct evaluation of myocardial wall motion. Comparison of gated TI-201 study to MUGA scintigraphy revealed the complementary role of these two methods in the assessment of the myocardial shape and perfusion, global and regional ejection fractions of Tight and left ventricles,evaluation of dyskinetic and aneurismatic wall motion. In this way, the combination of these two methods seems to provide much more information concernin E the above mentioned pazameters than each single one, in quite reasonable imaging time. This sequential method is suggested as a routine in the radionuclide evaIuatlon of patients with cardiac disease. Isotope Department, Central Emek Hospital, Afula 18101, Israel.

Twenty four coronary patients documented by coronary angiography - CA (12 triple~ 7 single and 5 double vessel disease - VD) and 5 normals were studied. Lowered regional TCLI S/B functional parameters ( d o . g ) were located according to pathologic CA findings. The mean AM TCLI(S) values with SDs were: normals - P_46 -+ 0.11 single VD - 2.12 -+ 0.57, triple V D - 1.54 -$ 0.40, showzng singificant difference between normals and triple VD and between single and triple VD (p~O.01). Prelim±nary results in~ica~ te that the method might provide for the detection o£ both, regional coronary insufficiencies and overall severity of disease. University Medical School, Belgrade, Yugoslavia.

University of Louvain Medical School, Brussels, B e l g i e .

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APPLICATION OF NMR IN THE SKELETAL SYSTEM R. Bauer, 0. lauer, M. Kratzer, H. Langhammer, H.W. Pabst

O3MPARATIVE EVALUATION OF N~ AND NUCLEAR MEDICINE IN DISC SPACE INFECTION - PILOT STUDY. D. Feiglin, M. ~odic, D. Piraino, J K. 0'Donnell, R . T Go, ~. Weinstein, W.J. ~cIntyre.

18F-FLUONODEOXYGLUCOSE (FDO) IMAGING IN THE D I F F E R E N T I A L DIAGNOSIS OF OSSEOUS LESIONS. A. Ahonen, R. Paul, A. Aho, A. Kiuru, M. Haaparanta, D. Roeda, E. Nordman

Six patients with proven disc space infection underwent bose scanning with 9 T b ~ q Tc-9~n ~DP together with NMR in.zing on a 0.6T superconducting magnet to obtain weighted Tl(30mSec Te .3 Sec TR) and T2(120mSec TE 3 Sec TR) images within a 48 hr. period. All patients had plain radiographic evaluation of the areas involved. Three pts. had C~-67 Citrate scans using 222MBq activity following the bone scan and 1 patient had CT imm~es of the involved area. All 6 bone scans showed increased bony uptake in at least the adjacent vertebral end plates but did not show any abnormal uptake in the region of the disc. Bony activity distribution was non-specific snd could have been consistent with either degenerative or osteomyelitic change. Gallium imaging in one case supported the latter diagnosis but did not indicate presence of disc space involvement. Two other cases showed bony involvement to the extent of the bone scan; one showing minimal uptake due to antiobiotie therapy. Plain radiographs were suggestive of disc space infection in all cases. ~ in all cases revealed marked disc space and adjacent bone involvement to the extent shown on bone scans. T1 and T2 weighted images appeared highly specific for either infection or degenerative change and were unaffectedby antibiotic therapy. ~ appears to be more sensitive in evaluation fo disc space infection than radionuclide studies. NMR is also able to provide significant auatomic information involving thecal sac and neural structures. Nuclear medicine studies appear equally sensitive though less specific in the evaluation of bone involvement except perhaps where antibiotic therapy has been used.

Scintigraphy with 99mTc-DPD is a sensitive method for detecting osseous lesions but it is unspecific; malignant neoplasms cannot be differentated from benign conditions. We have compared Tc-DPD and FDO images in 4 adult patients and I dog with different skeletal tumors in order to study whether FDG adds specificity. Onehour dynamic FDG and Tc-DPD images were performed using a conventional ~amma camera suitable for detection of 8F. FDG was administered iv (0.5-2.5 mCi). Resuits: The Tc-DPD images were positive in all studies except in a patient with benign cortical sclerosis. The FDG images were positive in the patients with histiocytoma and osteomyelitis and the dog with osteosarcoma, and negative in the patients with chondrosarcoma gr I and benign cortical sclerosis. Conclusions: It has been stated (I) that FDG does not accumulate into inflamed tissue, and so it was surprising to find high FDG uptake in the patient with osteomyelitis. It does, however~ appear that in cases of true malignancy of the bone FDG measures the degree of malignancy: The chondrosarcoma gr I~ a s e m i m a l i g n a n t neQplas~ did not accumulate FDG while the aggressive h i s t i o c y t o m a and o s t e o s a r c o m a did. In this sense, FDG seems to add specificity to the diagnosis of osseous lesions found in conventional bone scintigraphies.

NMR investigations were performed in patients (P) with various diseases of the skeleton using 0.15 T resistive (Technisare~ Kliniku~ Bausstein) or superconductive (Picker, Dr. Wallngfer, M~nehen) systems with 18 and I0 slice thickness, respectively. We investigated 13 P with suspected or documented femoral head necrosis of idiopathic or traumatic origin. The lesions known from radiographs could be visualized by NMR at least as well, whereas their 3-dimensional extent was superiorly demonstrated on additional orthogonal NMR t~ogra~s. ~n 6 P with idiopathic necrosis, NMR revealed envolve~ent of the sontralateral side unknown before. Pathology was documented best using IE1200/400/30 mode and with reduced contrast on SE500/30 images, whereas many lesions were missed using SE1500/60 and SEI500Y120 sequences. 14 P with bone tumors or metastases were investigated. Due to prolonged TI times, malignancy presented with reduced signal intensity on IE1200/400/30 images or was highlighted on IE1200/I00/30 images. In 6 P with radiographisally silent lesions, hone scintigraphy revealed pathology without discriminating malignaney~ degeneration or trauma, whereas NMR contributed essentially to the final diagnosis. The intervertebral discs were studied in 15 P with known degeneration and in 25 controls. NMR revealed 38 degenerated discs in 27 P, characterized by a reduced proton density and shortened TI and T2 times. Normal and diseased discs were best distinguished by SEI000/60 and IE1200/30/30 modes. 0nly once a prolaps could be confirmed. According to these preliminary results, NMR seems to be the best imaging modality in early diagnosing femoral head necrosis and can be useful in differential diagnosis of various pathologies of the skeletal system. Nuklearmedizinische and Orthop~disehe TU M~nchen, D-8000 Mlnchen 80

Klinik,

Cleveland Clinic Foundation Department of Nuclear Medicine 9500 Euclid Avenue Cleveland, Ohio 44106

(I) Som et al. J Nucl Med

1980;21:670

Turku Medical Cyclotron Project ku University Central Hospital, Turku, Finland

and TurSF-20520

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A COMPARISON BETWEEN ~ D P AND DPa FOB SKELETAL SCINTIGRAPHY IN DIFFERENT PATHOLOGIES. G. Godart, M. Durez, d. Abramovici, M. Bevilacqua and Y.J. Robience.

HIGH QUALITY BONE I ~ G I N G WITH TC-99MDIPHOSPHONATES: EFFECT OF THE NATURE OF D I P B O S P H O N A T E AND OF THE R E D U C I N G AGENT ON L E S I O N - T O - B O N E AND B O N E - T O - S O F T TISSUE R A D I O A C T I V I T Y RATIO. S.K. Shukla, G.B. Manni, C. Cipriani and P. V i l l e g ~ i a

G A M M A G R A R H Y WITH 99mTo-MHP A S S E S S E D QUAN T I T I V E L Y BY C O M P U T E R IN THE STUDY OF PATIENTS WITH F E M O ~ & L HEAD NECROSIS TREATED BY U N C E M E N T E D PROSTHESIS. O. Caballe r e Oarpena, V. Fliq~ete Peris, d. Pardo Montaner, R. Sopena Monforte and C. Cane Terol.

Bone imaging is now b e c o m i n g the m o s t frequently p e r f o r m e d and important nuclear m e d i c i n e p r o c e d u r e because of its early d i a g n o s t i c value in the d e t e c t i o n of several a n a t o m i c a l and functional disorders, e.g., p r i m a r y or s e c o n d a r y bone tumour, i d e n t i f i c a t i o n of bone p a i n or fever of u n k n o w n origin, s c r e e n i n g of p a t i e n t s w i t h s u s p e c t e d malignancy, etc. T c - 9 9 m d i p h o s p h o n a t e s commonly used n o w are: T c - 9 9 m - m e t h y l e n e d i p h o s p h o n a t e (Tc-99m-MDP), T c - 9 9 m - h y d r o x y m e t h y l e n e d i p h o s p h o n a t e (Tc-99m-HMDP), and Te-99m1,2-dicarboxypropane-3,3-diphosphonahe (Tc-99m-DPD). We have shown that the q u a l i t y of bone image o b t a i n e d depends h i g h l y on the nature of the d i p h o s p h o nate and of the reducing agent. By studying the e f f e c t of d i f f e r e n t v a r i a b l e s on the q u a l i t y of image, we were able to e s t a b l i s h the conditions under w h i c h high l e s i o n - t o - b o n e and b o n e - t o - s o f t tissue r a d i o a c t i v i t y ratio can be obtained. The n a t u r e of T c - 9 9 m species in v a r i o u s p r e p a r a t i o n s was examined chrom a t o g r a p h i c a l l y and e l e c t r o p h o r e t i c a l l y . The optimal f o r m u l a t i o n for the three d i p h o s p h o n a t e s and the bone image obt a i n e d from t h e m will be presented. The m e c h a n i s m of T c - 9 9 m uptake in bone will be discussed.

The advantages of u n c e m e n t e d prosthesis in the treatment of femoral head necrosis have increased its a p p l i c a t i o n in re c e n t years, the evol~tive orthopedic co L trol h a v i n g become n e c e s s a r y f o r an early d e t e c t i o n of the most frequent eompl~ cations. Bone g a m m a g r a p h y with 99m phoaphated complexes is of great u s e f u l n e s s to follow the e v o l u t i o n of such patients. Twentyfive patients, w i t h a d i a g n o s i s of f e m o r a l head necrosis and treated surgically by u ~ c e m e n t e d p r o s t h e s i s (Mittelmeier), have been studied. The radionuelide used was 99mTc-MDP in dosis of 555 MBq and the d e t e c t i o n system a gammacam e r a connected in line to a PDP-I1 computer which allows the activity to be c~ fleeted. In all cases, the g a m m a g r a p h i c recording of pelvis a/id femurs was o b t a i n e d t~ee hours after the a d m i n i s t r a t i o n of the ra dionu¢lide and the q u a n t i t a t i v e study o~ the bone uptake in the compute~ by sele~ ring the area of interest and o b t a i n i n g the indices relating the areas close to the p r o s t h e s i s ~ i t h simila~ oontralateral areas. The abnormal d e v i a t i o n s of the ratios obtained from the control group, has enabled us to d e t e r m i n e abnormal postoperative activity which, in our series, persists even six m o n t h s after the prosthesis has b e e n implanted~ and have shown the r e l i a b i l i t y of g a m m a g r a p h y to follow the e v o l u t i o n of these patients.

The aim of this study was to evaluate the performance of MDP vs. DPD in 2 0 p a t l e n t s with various pathologies. Each patient was investigated twice with an interval of 3 days between studies and using the same protocol, hence each case served as its own control. The results were : 1) in a subjective interpretation by 5 independent and experienced investigators, the difference between agents was small, vet in favour of MDP in 49 ~ of all cases against 18 ~ for DPD and 33 % scoring equally. MDP scans were considered to show more lesions in two patients by 2, respectively 3 out of five investigators and DPD was considered b y one investigator to show an additional lesion in one patient. 2) ROI analysis of the pooled results shows in 74.2 ~ of all cases a higher Target~normal bone (T/NB) ratio , and in 79.3 ~ of all cases a better target~soft-tissue (T/ST) ratio with MDP. 3) when considering pathology types separatelN, the T/NE ratio of MDP was 17.7 % higher than DPD in metastases, 9.5 % higher in polyarthritis. 2.8 % in metabolic diseases and 24.0 % higher in bone fractures. 4) Student's paired t-test on the pooled T/NB ratios shows a difference of 15.60 ~ for MDP, with p ~ 0.00155 for t = 3.216 and Df = 30. The T/ST ratio of MDP was higher by 18.5 % with p ~ 0.00093 for t = 3.437 and Df = 28. In conclusion, tracer uptake was in most cases better with MDP than with DPD. The former had higher normal bone uptake and lower soft-tissue activity than DPD. In pathologies with active osseous reconstruction, MDP was the better agent. With less important osteoblastic activity, M D P seemed to remain better but in a more moderate way. The overall results of our study favour MDP, but the small numbers in each category of pathology escape statistical analysis and need strenghtening by more cases. INSTITUT MEDICAL SPECIALISE, 230 Route de Mons, B.-7320 HOBNU, BELGIUM

Istituto di Cromatografia, C.N.R. C.P. iO, I-OOO16 M o n t e r o t o n d o St.ne (Roma), Italy

N u c l e a r Medicine Service. Ciudad ria "La Fe". Valencia. Spain.

Sanita-

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BONE SCAN IN OSSEOUS NONOPLASTIC GRAFTS: PRELIMI NARY STUDY A.Furno, C.Tarozzi, G.Fag~oli, R.Pozzato, F.Ruggeri*, L.Speechia*, S.Boriani ~

VALUE OF BONE SCINTIGRAPHY IN MULTIPLE MYELOMA. F. Lomega, E. EbellB, R. Nerranz, M. gymerich ~ , J. Sierra~ J. Blad@~ C. Rozman~end J. Setoain.

EXPERIMENTAL HEMARTHROSIS STUDIED WITH Tc-99m PYROPHOSPHATE (BYP) BLOOD POOL IMAGING. L.g. Samuels, J.E, Tessier, Z.A. Salimi, G.L, Restrepo, R.E. Burdge and H.J. Joist.

The present study was performed to evaluate the viability of bone grafts. Eleven patients (range 21-77 gears; m=dgy) were studied. The patients underwent surgery for multifragmentary fractures of long-bones {i ulna, T humerus, S femurus). Surgical intervention consisted in osteosynthesis with plate and opposite freeze-dried homoplastic bone graft. TeHSm-MDP (15mCi) bone-scan were performed in the whole group in the first weeks following surgery (m=20d). Six patients had an additional follow-up scan at 60-90 days after the first one. All 17 scans revealed uptake of the tracer in the graft. Although several papers concerning bone grafts demonstrated poor or absent tracer uptake in nonvaseularized bone grafts, in our experience, the freeze-dried bone implants showed early significant bone tracer uptake. Further investigations are needed to clarify possible mechanisms of early tracer uptake in homoplastic bone grafts.

Dept. of Nuclear Medicine - Ospedale Ma~iore USL 27 - Bologna and (*) Third Orthopaedic Dept. Istituti 0rtopedici Rizzoli - Bologna - Italy

In 30 patients (pt.) (20 M/10 F, mean age 62.3 yr.) diagnosed of multiple myeloma (MM) according to the criteria of the Leukemia-Myeloma Task Force, a bone scintigraphy (BS) with 99m-To-MOP and a radiological study (XN) of the skeleton were performed at the time of diagnosis. Localized images of increased uptake on the BS were compared to XR lesions of osteolysis, pathologic fractures and vertebral compression fractures. 73.3% of pt. showed lesions adscribable to MM in the BS and XR, whereas in 16.6% no lesion was observed in either study. Two pt. had a normal XR and positive BS; one pt. had a negative BB and abnormal XR. The XR was more sensitive than BS in detecting MM lesions in either the upper extremities (15 pt.), lower extremities (15 pt,) and pelvis (4 pt.). Of the 19 pt. with XR skull lesions, 5 ~ had an abnormal BE at the same place. BS could not demonstrate any lesions in the remaining 43%. The spine was affected in 12 pt., S with both positive BS and XE, in 4 only the XE was abnormal and in 5 pt. only the BS showed lesions. Of the 18 pt. with rib lesions, 83.3% had an abnormal SH with normal XR. Only 1 pt. with a radiological rib involvement had a normal aS. The extension degree appeared greater in the XR than in the aS, except in the rib cage. Finally, two pt. had a mandibular osteolysis with a normal SS.

To determine the validity of a method for induction of experimental hemarthrosis in dogs and for the nuclear imaging of hemarthrosls, serial Tc-9£m PYP flow and blood pool scans have been performed monthly in a series of dogs who were receivrng semiweekly ~njections of autologous blood into their knee joints. Control dogs were either injected with intraarticular saline or had sham injections. In addition to nuclear imaging, dogs were periodically removed from the study and explored surgically. Pathological examination of synovia] tissue was performed semi-quantltatively. Serial radiographs were also obtained and corre]ated with scan and surgical findings. There [s a striking abnormal increase in blood pool activity of Tc-99m PYP Tn treated knees beginning at first examination after one month o f b)ood i n j e c t i o n s and continuing for the length of the study. Radiographs remained normal during the three months of the study but both grossly and microscopically there was profuse pannus formation w i t h intense ioflammatory infiltrate also replacing much of the subsynovial fat.

The authors point out the usefulness of the BS to assess the skeletal involvement in MM, especially in the ribs, where it is more sensitive than the XE examination.

This study not only validates tb;s method for simulating hemophiliac hemarthrosi s but also validates this technique for quantitative joint imaging in hemartbrosis. The results w i l l be used in f u r t h e r i n v e s t i g a t i o n s of therapy for hemarthrosis.

SERVICIO DE MEDICINA NUCLEAR. SEEVICIO DE HEMATOLOGIA*. HOSPITAL CLINIC0 Y PROVINCIAL. UNIVEESIDAD DE BARCELONA. -Casanovas, 143. BARCELONA - 36. SPAIN.

St. Louis University Medical Center 1325 S. Grand, St. Louis, MO 63104

USA

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EGG WHITE AS A PREDICTIVE APPLICATION IN NUCLEAR MEDICINEo COMPARATIVE EFFECT 0F EGG WHITE ON BONE UPTAKE OF 4S-CALCIUM IN RATS. L.G. Angeloff.

C H A N G E S OF 74AWDIBUIAR SCIITTiGTAPkY U N D E R R A D I A T I O N ~HEP~koY. Z. i i t a s a l o a n d o. R u o t s a l a i n e n

R E G E O N A L S C I N T I M E T R Y IN S C A P H O I D F R A C TURES. N. Olsen,P. S c h o u s e n , H . D i r k s e n and J.K. C h r i s t o f f e r s e n .

I r r a d i a t i o n of h e e d a n d n e c k r e g i o n b y high doses has a tendency to induce dental end periodontal damage and i n f e c t i o n s . [
A quantitative scintigraphic method was i n t r o d u c e d to e x a m i n e the c a r p a l seaphoid bone.99m-Tc-Sn-phyrophosphate scin c i g r a p h y w a s o b t a i n e d by the use of a gamma camera equipped with a pinhole c o l l i m a t o r . R e g i o n s of i n t e r e s t w e r e p l a c e d in the p r o x i m a l , m i d d l e a n d d i s t a l t h i r d of the i m a g e d s c a p h o i d , a n d a c t i v i t i e s w e r e e x p r e s s e d as f r a c t i o n s of the i n j e c t e d a c t i v i t y . Of s i x i n v e s t i g a t e d p a t i e n t s in w h o m a u n i l a t e r a l f r e s h f r a c t u r e of the s c a p h o i d w a s c l i n i c a l l y suspected,radiology showed a fracture of the s c a p h o i d in four a n d no f r a c t u r e s in t w o . B y s c i n t i m e t r y the r e g i o n c o r r e s p o n d i n g to the l o c a t i o n of the r a d i o l o gical fracture had a higher activity t h a n the o t h e r two r e g i o n s in the fractured scaphoid (p
The effect of various egg whites on bone uptake of 45Ca in rats was investigated. The radioactive calcium was administered by orogastric intubation (2 uCi/100 g.b.wt.) without or with 1.0 ml of egg white to female Hooded rats fasted for 24 h. Twenty-four h. following the intubation of 45Ca all rats were sacrificed with chloroform and the right femur of each rat was: removed for radioactive content measured hy standard techniques. The results were as follows: (a) the control group of rats showed 78 muCi per g. fresh hone; (h) the group with hen's egg white 47 muCi 45CA per g. fresh bone (p<0.01); (e) the group with black duck's egg white 51 muCl 45CA per g. hone (p~0.01); (d) the group with Toulouse goose's egg white 61 muC~ 45Ca per g. hone (p?0,I) non significant; (e) the group with Australian emu's egg white 31 mute 45Ca per g. bone (p(O.001); and the group with Egyptian ostrich egg white 51 muCl 45 Ca per g. bone (p(0.05). It is known that a high uptake of radioactive fallout so dangerous a phenomenon of nuclear warfare. These results suggest that various egg white might he applied as preventives in case of a nuclear war. Copyright by L.G. Angeloff 1984. All rights reserved. Angel's Biomedical Laboratories Ltd., P.O. Box 122, Station ~La Cit6~, Montreal, Quebec, Canada E2W 2M9

D e p a r t m e n t of O t o r h i n o l e r y n g o l o ~ y of the University Central Hospital in ~urku S P - 2 0 5 2 0 T u r k u 52

D e p a r t m e n t of C l i n i c a l P h y s i o l o g y , H v i d ovre Hospital,DK-265o Hvidovre,Denmark.

A22 A121 THE SOLE OF M~DICNE IN EVALUATING TEE PAGET'S DISEASE. M.D.Marin,R.Santiago,A.Diez,R.Galvan, J.L.Chamorro,J.Ortiz Berrocal. The aim of this paper has been to correlate the analitical, ga~unagraphic and radiographic findings in Paget's disease. MATERIAL AND METHODS: It has been studied 152 patients;98 males and 54 females(1,7/~l with ages ranging from 24 to 85 years (mean 63 years). Seric levels of Alkaline Phosphatase,radiological state of the lesion and bone scan have evaluated. RESULTS: The main finding see in the blood chemestry is markedly elevated Alkaline Phosphatase [mean 283 mu/ml). Metastasis disease (bladder and pros_ tate) was reported in 8 patients. It has been diagnosed of Paget's disease 144 patients of the total: Monostotic form 46 (32%) and polyostotic Paget's 98 (68%). Skull location was the most son,non appearence in the monostotic form (14 of 46). Skull (46 of 98) and pelvis (46 of 98) locations were highest incidence in the multifocal Paget's. It has been detected 332 bone lesions: 248 (74%) by radiographic method and 328 by bone scan. The t00% of the monostotic lesions and the 45% (44/98) of the polyostotic were detected both on the ra ~ograph and on the scan; on the radio graph alone 4.08% (4/98) and on the scan alone 51% (50/98). CONCLUSIONS The scan positive and radiograph negative areas in polyostotic form represent ea ~y Paget's le sions, therefore bone scan must be utilized to evaluate the extent of the disease in the skele ton. Althought neither method alone detect all lesion, the bone scan are more sensitive.

CLINICA PUERTA DE NIERRO. Dept. of Nuclear Medicine. San Mart~n de Porres,4. MADRID-g5SPAIN.

A123

A 124

8 9 S t I N THE P A L I & T I V E TBERAI~ OF BONE ~TASTASES OF ~ H E P R O S T A T I C CARCINOMA. J.Masopust, J.Silar, V . V o m ~ k a

COLLOIDAL YTIRIUM-90 IN THE TREATMENT OF MALIGNANT EFFUSIONS - THE INCIDENCE OF PANCYTOPENIA.A .Franke and K.Oeff

The p a l i a t i v e therapy of the pain resulting f r o m bone metastases in cases of t h e g e n e r a l i z e d p r o s t a t i c carcinoma, b a sed on the use of 89 S r ~ - r a d i a t i 0 n , w a s employed in 14 patients, Those were 19 individuals w i t h g e n e r a l i z e d m e t a s t a s e s add remarkable pains, w h i c h limited the m o b i l i t y and disturbed sleeping, and I patient, where the therapy w a s applied as a prevention, still at a time w i t h o u t m a n i f e s t pains. The m e t a s t a t i c involvement w a s demonstrated by s seintigraphis method, using 99m Tc-pyrophosphata. Prior to the therapeutic a p p l i c a t i o n of 89 S~, the a c c u m u l a t i o n of gr in metastatic lesions was tested by the prophilographY using 85 Sr. In nine patients, there was a positive effect of the therapy, characterized by a m o d e r a t i o n or even d i s a p p e a ring of the pains w i t h an improved mobility and sleeping in eight patients for 1-4 month, in one p a t i e n t for 16 month. No effect w a s encountered in 4 patients. In the patient, who received 89 gr preventively, no pains oecured w i t h the gen e r a l i z e d involvement up to the p r e s e n t time, i.e. for one year.

The }addence of hematological complications following intracavkary radioyttr}am therapy was evaluated in 23 patients with malignant

State Institute af National Health, Nuclear Medicine D e p a r t m e n t , X a v e r i o v a 151 19 t ~ a h a 5, C z e c h o s l o v a k i a

effusions. 11 patients died 5 days up to 420 days, 10 are alife 60 days up to 570 days after treatment. 3 patients died wit}an 1 month. In the remaining 20 patients good palliation was achieved in 10. Pancytopenia (PCP) was ob~rv~d in 3 patients 34 weeks afte; }atrapeiitoneul edministzatinn of 3.7 and 4.1 GBq culluldal Y-90, respectively. Blood counts norm~dizedwithin 6 weeks after the occurrence of PCP. The udnary excretion of Y-90 during 48 hours after edminlstration ranged from 0.007 to 0.02%D/1 in patients wHhout hematological complications, while it was 0.83%D/1 in a patient who developed PCP 3 weeks later. Post-mortem tissue assays were performed in a patient who died 4 weeks after intrapleuml (]eft side) administration of 3.7 GBq colloidal Y~90 without evidence of FCP. The calculation of the absorbed energy doses yielded the following results: left pleura 10380 tad, left lung 50 red, right lung 12 tad, liver 40 tad. spleen 50 red, red marrow 12 tad. The inddence of PCP due to increased resorption of Y-90 in the present patient series was 10-15% Patients at risk are those with hemorrhagic ascites. None of our patients with pleural effusions developed PCP. Recovely will begin within 3-4 weeks and will be complete 65 weeks after the occurrence of PCP. Intermittent replacement of eryd~ocytes and thromboeytes as wen as infection control are }adispensabte. Department of Nuclear Medicine, KI}aikumStegtitz, Free University of Beatin, Hindenbur~amm 30, nd ~ Berlin 45, F.R.G.

l0

Institute of Biophysics and Nuclear Medicime C h a r l e ~ University, Faculty of General M e d i c i n e , S a l m o v s k ~ 3,120 O0 P r a h a 2 U r o l o g i c a l Clinic, C h a r l e s University, F a c u l t y of General M e d i c i n e , K e K a r l o v u 120 O0 P r a h a 2 , C z e c h o s l o v a k i a

6,

A125

A126

A128

THE APPLICATION OF SPECT TO DETERMINE THE RADIATION DOSE FROM P32- CHROMIC PHOSPHATE THERAPy OF THE PERITONEAL CAVITY. R J Ott, M A Flower, A Jones and V R McCready.

DISSOLUTION TIME OF 131-I CAPSULES IN THE STOMACH H S f l i n F., Noelpp U., Ledermann H.

LEFT VENTEICUL~LR FUNCTION FROM RADIONUCLIDE IMAGING - MOW IS IT BEST ASSESSED? (I) VALIDATION OF A MULT!PA~AMETER METHOD USING A CALCULATED MODEL LV. D.N. Taylor, J. Flint, K, Barfield and ~. Mills

Single Photon Emission Computed Tomography (SPECT) images of the distribution of P32Chromic Phosphate in the peritoneal cavity have been obtained using a GE40OA rotating gamma camera/STAR computer system. The Chromic Phosphate is used to provide superficial peritoneal radiotherapy for Stage I Ovarian Carcinoma. The colloid is infused with 2-3 litres of saline via one or two catheters inserted into the abdominal cavity. SPECT is carried out at 24 hours using a medium energy collimator (H2503BA) with the photopeak energy window set to 200-300keV.

For r e a s o n s o f radiation protection 131-I for diagnostic and t h e r a p e u t i c a l use can now be a d m i n i s t e r e d in a gelatine capsule.

Images obtained from the P32 Bremsstrahlen contain relatively few counts (~300,000), but provide sufficient information to determine tbe distribution of the colloid in the cavity. The transaxial image data has been used to estimte variations in the radiation dose to different parts of the cavity. It has been found that there are activity variations of up to 10/I - 15/t in some parts of the cavity, which can give rise to doses in excess of 200 Gy, for instance, to the Pouch of Douglas. W e conclude that estimates of both the distribution of the colloid and the radiation dose achieved can now be made using this technique. The Royal Marsden Hospital, Sutton, Surrey, England.

Especially in hypothyroid patients with thyroid cancer dissolution time o f t h e c a p s u l e i n t h e stomach t e n d s t o be v e r y l o n g (up t o 30 min and m o r e ) . As h i g h therapeutical doses (up t o 200 met 131-I) are administered to fasting patients (with an empty stomacht) local i r r a d i a t i o n to the stomach w a l l can be c o n s l d e r a b l e . We compared the d i s s o l u t i o n time of capsules in the stomach after swallowing with an equa] amount of either hot citric acid solution (pHW3) or cold water. By using hot citric dissolution time reduced ( p ~ 0,01).

acid is

solution the signifcantly

The r e s u l t s suggest t h a t t h e r a p e u t i c a l doses of 131-I i n g e l a t i n e capsules should be administered w i t h I - 2 d l of h o t , a c i d i c s o l u t i o n to minimize l o c a l stomach w a l l i r r a d i a t i o n .

Dept. of Nuclear Berne, Switzerland

Medicine,

Univ.

of

A calculated spherical model of the left ventricle (LV) blood pool was defined. The two dimensional images of this three dimensional model were calculated according to chord length. The sphere was decreased in volume to simulate systole, giving an ejection Traction (IF) of 60%. This contraction resulted in 16 b4x6h images simulating the cardiac cycle. Defects were well defined and superimposed on a normal motion pattern. The size, position and severity of defect could each be independantly varied. Defects of precisely known size, severity and position were assessed by two experienced observers. Three LV functional parameters were investigated, LVEF, Begional Wall Motion (EWM) and Phase Jinalysis (%ACV). The results show that LVSF is not a sensitive index of LV dEsfunction hut is safe in that the measured value is not severely affected by ~mage orientation. The local d~sfLtnction parameters of RWM and %ACV are very sensitive to minor changes in ~all motion but their accurate identification depends on image orientation. Department of Medic~l Physics and Cardiolo~, Walsgrave Hospital, Coventry, Warks, England

A23 A129

A 130

DISPLAYING MULTIPLE PARAMETER MAPPINGS. M.L. Goris

3-DIMENSIONAL

In Nuclear Medicine and Nuclear Magnetic Resonance, the information may be contained in spacial mappings of more than one parameter of the measurement. Ways ave suggested to combine this multi-dimensional information in a single image. In V/Q scanning, the desired information is analytical: the end result should indicate ]n what area of the image an abnormal ratio is present~ using tolerance limits computed from the linear regression between the images. If no analytical approach does exist as in most dual tracer measurements (e.g., liver subtraction in white cel[ scanning), o n e can create a veelorial p~'oduet, whose results however are in turn contained in two data sets (the modulus and angle). An alternative is to combine the data in a superposition of elementary colors, whose individual intensity is proportional to each parameter's value. For multiple parameters, we have investigated the potential of texture mapping. At each point of the image the texture is a function of the interrelationship of the parameters. This approach works well for images where structure plays an important part in the interpretation, and where large areas are expected to show an homogeneous texture. The display of multiparametric images requires a variety of approaches, according to the nature of the data.

A. KUBA*t F. WOLF

A131 ROl TECHNIQUES

H. FEISTEL,

IN SPECT

J. MAHLSTEDT,

C r o s s - s e c t i o n a l pictures p r o d u c e d by single photon emission t o m o g r a p h y (SPECT) include not only structural but also q u a n t i t a t i v e i n f o r m a t i o n (e.g. volume, activity concentration) about the r e c o n s t r u c t e d objects. To get quantitative i n f o r m a t i o n d i f f e r e n t m e t h o d s are feasible to define the 3 - d i m e n s i o n al regions of interest (3-D ROI) from the sequence of pictures. Several 3-D ROt techniques are possible and to be compared. Beside t r a d i t i o n a l techniques as used in 2-D methods, special s e g m e n t a t i o n methods of picture proc e s s i n g (i.e. h i s t o g r a m and c o n t o u r finding procedures, p a t t e r n recognition) and certain c o m b i n a t i o n s of them were developed. P h a n t o m studies confirmed the e f f e c t i v e n e s s k n o w i n g the real s t r u c t u r e and activity d i s t r i b u tion of the r e c o n s t r u c t e d objects. On the basis of these results a first step towards g a i n i n g q u a n t i t a t i v e inf o r m a t i o n of volume and activity conc e n t r a t i o n in d i f f e r e n t organs and organ c o m p a r t m e n t s is done. A n e w software package for easy visualization of m u l t ~ l e slices w i t h anatomical i d e n t f f i c a t i o n facilitates the d e m o n s t r a t i o n of clinical data durinf staff meetings.

Stanford University School of Medicine, Division of Nuclear Medicine, Stanford, California, USA, 94305 *) H U M B O L D T S c h o l a r s h i p

COMPARISON OF 180° AND 360° DATA COLLECTION IN SPECT. K. Kne{aurek and ~. Spaventi 180° data c o l l e c t i o n has been mostly used in T1-2RI grEET studies of heart, since heart is located anteriorly in the left chest so that i t seems reasonable to believe that more events are acquired with 180° sampling (RAO to LPO} than in the opposite Ig0° (LPO to RAO). In addition, 180° sampling has been used in some other SPECT studies when, for example, the lesion has been located in a particular non-central region of the body. In such situations 180 ° scans have better les]on's image contrast than 360 ° scans, because of lower background activity. Thus if [he main clinical question is relatively simple such as: is there a lesion or not, then 180° sampling may be better than the 360 ° one, especially if the lesion is located far from the center o f the s l i c e p i c t u r e . Also, sampling time is twice shorter in 180° studies. The disadvantage o f 180° data c o l l e c t i o n is that attenuation correction For 180o sampling has not yet been developed and evaluated. Also in such studies i t is not possible to make opposite views averaging and in the reconstructed images there is a geometrical d i s t o r t i o n mainly due tO v a r i a b l e spat i a l resolution with distance from the camera. Tomographic scans have been performed using a l a r g e - f i e l d - o f - v i e w hamma camera (GE400T). 64 views over 360° , providing sampling For every 5.6° of revolution of the detector, have been stored as 64x64 matrix each in the POP 11/34 computer. Transverse sectional images have been reconstructed by means of o~n software based on filtered backprojection algorithm, which enables to change start angle in 180 ° studies (in heart studies s t a r t angle is usually 225o) and thus providing to use only 32 successive views with the desired f i r s t one. Our results indicate that in some SPECT studies, especially in the lungs SPECT studies geometrical distortion can be significant and if SPECT study is used for lesion sizing or determination of an actual volume 360° scans should be used.

I n s t i t u t e of N u c l e a r Medicine University Erlangen-N~rnberg K r a n k e n h a u s s t r a g e 12 D-8520 E r l a n g e n (FRG)

Nuclear Medicine & Ontology Clinic, "Dr. Mladem Stojanovi6" Clinical Hospital, Vinogradska 29, 41000 Zagreb, Yugoslavia

A132

A133

A134

COMPARISON BETWEEN TWO MAT~IEMATIC A t METHODS IN TIiE ANALYSIS OF EQUILIBRIUM RADIONUCLIDE VENTRICULOGRAP H ¥ T IME -A C T IVIT Y CURVE: EVALUATION OF CLINICAL R E S U L T S . G. Z a t t a , M. Gall a z z i , G . L . T avolo, B . P a l a g G R. P i c o z z i ,

SEMI-AUTOMATIC PROGRAMFOR THE ANALYSIS OF FIRSTPASS STUDIES WITH SHORT LIVED ISOTOPES, F. Erbsmann, P. Bourgeois and J. FrUhling,

P R A C T I C A L A T T E M P T S OF A U T O A N A L Y Z I N G R E N O S C I N T I G R A M USING A M I C R O C O M P U T E R SYSTEM. T. Fukushima, F. Tanaka, H. Fujii, H. Washida, M. Tsugaya, N. Hirao and Y. Hachisuka.

M . Arosio and A. Albertini. T w o methods for the analysis of left ventricle time-aclivity curve (TAC) of equilibrium gated ventrieulography ~zere compared in three groups of subjects ( 8 controls, 13 patterns with C A D and Ii patients with M I ). The first method w a s based on a third-degt-ee poly]lomial fitting; the second on the EourieP analysis. The following parameters ~vere calculated: peak ejection rate (PER), peak Billing rate (PFR), time of P E R and P E R , filling fraction at the first third of diastole. Preliminary study of changing valnes of P E R and P F R and of the m e a n error ~zith increasing number of harmonics s u m m e d In order to obtain the best fitting of T A C demonstrated that the beyond the sum of the first four harmonics the~e %vas no further significative improvement. Eourie~ analysis showes the following advantages: ]) is indipendent of the operator and fits only one function to the whole cardiac cycle ; 2) requires less computer time; ~) provides a better separation between controls and C A D patients. In the latter group all 13 patients had abnormal P P R with Eourier analysis, only 9 with polynomial analysis. Nine of them had rest regional %vall motion abnormalities ~ while only t~o had abnormal rest ejection fraction. Cattedra di Medicina Nucleate, Universit& degli Btudi~ Ospedale San Paolo 20142 M I L A N O , V i a Di Rudin[ 8, ltaha

Repeated f i r s t - p a s s studies f o r the determinat i o n of cardiac functionnal parameters are now possible with the increasing use of short l i v e d radio-nuclides (multiple incidences or, stress studies). They are a considerable burden in computation time and date storage, We have developped a set o f semi-automatic programs for the anal y s i s of t h i s type of studies, Only Regions Of I n t e r e s t (ROI's) have to be drawn by hand. The l i s t of patient-data ;o be processed is f i r s t stored in a special f i l e called "NAMES" and at every step the data are processed sequentially : a) a sum of part of the data is performed in order to draw rough ROl's f o r the r i g h t (RV) and l e f t v e n t r i c l e ( L V ) , b) the computer finds the t i m e - i n t e r v a l f o r summation f o r optimal v i s u a l i sation of RV and LV. Precise ROI's are drawn. A background area is created by s h i f t i n g the ROl's 3 pixels diagonally to the r i g h t and l e f t , and keeping the nonoverJapping crescent, c) the moments o f highest e j e c t i o n v e l o c i t y are used tei f i n d the cardiac cycles (GORIS). The e j e c t i o n f r a c t i o n i s computed on a beat by beat basis. Phase and amplitude analysis is then performed on RV and LV separately. A complete report i s printed so t h a t the c l i n i c i a n can have a clear rue of the operations performed. Our program a l lows f o r the determination of r i g h t and l e f t e j e c t i o n f r a c t i o n , flow index, maximum e j e c t i o n v e l o c i t y . This program was tested in 53 routine f i r s t pass or mult~gated studies using 99mTcpyrophosphate, or in 19 cases of m u l t i l e v e l cardiac stress f i r s t pass studies with 195mAu in normal and pathological cases. Departement Autonome des Radioisotopes, Centre H o s p i t a l i e r J. Bracops, Rue Dr. Huet 79, 1070 Bruxelles, Belgium.

It is well known that dynamic renoscintigraphy using 99m T c - D T P A has been a useful tool for d i a g n o s i s of renal diseases. It, however, takes a lot of time to a n a l y s e the data: about 80 minHtes and some p h o t o g r a p h e s ~sing X - r a y film for a n a l y z i n g a data of one patient. We have been d e v e l o p i n g the n i g h t - a u t o a n a l y z i n g m e t h o d s of the r e n o g r a m using m i c r o c o m p u t e r system. We have reached the stage of practical a p p l i c a t i o n in p r a c t i c a l urology. The m e t h o d s are as follows: I. 10 mci of 99m T c - D T P A is injected i n t r a v e n o u s l y as a rapid bolus and serial images are o b t a i n e d one second for 66 frames and 24 seconds for 62 frames. In other words the "variable frame rate method". 2. The time a c t i v i t y curves are made from the r e g i o n of interestIROP} on the images. The images and time activity curves a r e s t o r e d into data file MT on w h i c h data of 100 cases can be stored. 3. From the data recalled from the MT to the images memory, n u m e r i c a l data w h i c h mean p a r a m e t e r s of renal function are obtained, and are stored on a floppy disk. 4. The curves, images and ROIs are p r i n t e d out by the BIT image m e t h o d from the MT, and n u m e r i c a l data, from the floppy disk. We have been using VIP 460(cpu 6800), MT(45 ips), hard disk w i t h 10 megabite, floppy disk and line printer(MP-82}. In conclusion, it has b e c o m e that data a q u i s i t i o n of r e n o s c i n t i g r a p h y is p e r f o r m e d d u r i n g the day and the analysis is done a u t o m a t i c a l l y at night by the microcomputer. This is very economical and b e n e f i c i a l for clinicians. Anjo Kosei

Hospital,

Anjo,

446, Japan.

A24 A135

A136

A137

ATTENUATION COERECTION FOR QUANTITATIVE TOMOGRAPHY - DIFFERENT METHODS. G.T. Gullberg and J.A. Malko

A NEW S . P , E . C . T . Q U A L I T Y CONTROL PHANTOM. R . A . Carlson and J . T , C o l v i n

DEPTH RESOLUTION OF COLLIMATOR CAMERA - SYSTEMS - I N V E S T I G A T I O N S BY MEANS OF A WEDGE-LINE-PHANTOM. D. Lange and U. Noelpp

Quantitative accuracy in SPECT imaging is determined hy the accuracy in delineating the attenuator and by the choice of the reconstruction algorithm. The delineation of the body contour is obtained by using either the emission data or other data acquisition protocols which may include the use of transmission computed tomography (TCT). Depending upon the desired accuracy, the body outline is fitted to either an elliptical, convex, or arbitrary nonconvex function which more closely follows the body contour. All methods assume that the attenuator is uniform within an enclosed outer boundary, except when TCT is used to more accurately define the attenuator; however, the accuracy of the emission commuted tomogram is determined by the magnitude of the noise propagated from the statistical fluctuations in both the transmission and the emission data. The attenuation correction algorithms use the boundary information to model the attenuation effect for either parallel or fan beam geometry. These algorithms can he classified into three categories: I) Preprocessing correction where the projection data are first corrected for attenuation before a reconstruction algorithm is applied giving accurate results for unfformity distributed sources in a constant attenuator, 2) Intrinsic correction which incorporate the attenuation correction within the reconstruction algorithm and best quantify arbitrary activity distributions in both constant or variable attenuators~ 3) Postprocessing correction which reconstructs an uncorrected image and then each pixel value is increased relative to an average attenuation factor. The preDrocessing and postprocessing attenuation correction procedures tend not to amplify data fluctuations, however, three dimensional filtering techniques improve the image noise that is characteristic of intrinsic techniques such as the conjugate gradient iterative algorithm.

A new q u a l i t y c o n t r o l phantom has been d e v e l o p e d for e v a l u a t i o n of s i n g l e p h o t o n emission t o m o g r a p h y systems. The phantom consists of a c y l i n d r i c a l t a n k w h i c h is f i l l e d w i t h Tc 99m. i n s i d e t h e t a n k are several sections d e s i g n e d to test the d i f f e r e n t parameters w h i c h are i m p o r t a n t in S . P . E . C . T . imaging.

I. 2.

3.

4.

5.

T h e sections

are as follows:

A u n i f o r m area to t e s t for the u n i f o r m i t y of response and a r t i f a c t p r o b l e m s in t h e system. Plastic spheres v a r y i n g in diameter from 5.9mm to 22.3ram in seven steps to test system r e s o l u t i o n and p a r t i a l v o l u m e effects, Plastic rods v a r y i n g in diameter from 5.9mm to 22.3mm in seven steps to test system r e s o l u t i o n of cold areas. A solid p l a s t i c area w i t h holes d r i l l e d t h r o u g h v a r y i n g from 4.Tram to 22.3ram in e i g h t steps to test for r e s o l u t i o n of h o t areas. A crossed g r i d of c u t - o u t channels in a plastic b l o c k to test for l i n e a r i t y of t h e system.

T h i s p h a n t o m is d e s i g n e d to t e s t several i m p o r t a n t parameters w i t h a s i n g l e a c q u i s i tion of data. It is easy to use on a r o u t i n e q u a l i t y c o n t r o l basis. Hutze[ Hospital, D e p a r t m e n t of Nuclear Medicine, 4707 S t . A n t o i n e 8 ] v d . , D e t r o i t , Michigan g8201 U . S . A .

The spatial resolution of d i f f e r e n t c o l l i m a t o r camera-systems is compared using a p h a n t o m in v a r i o u s distances in air and in tissue e q u i v a l e n t material. A l u c i t e b l o c k (30x15x20 cm) is c u t i n t o two wedges. Between these wedges a p l a n a r a r r a n g e m e n t of e q u i d i s t a n t line sources is placed so t h a t the lines are parallel to the collimator surface. Since the lines are twice as tong as t h e w i d t h of t h e l u c i t e b l o c k , the images show t h e sources w i t h and w i t h o u t s c a t t e r i n g material. With increasing distance from t h e c o l l i m a t o r , t h e image q u a l i t y decreases and t h e l i n e s t r u c t u r e d i s a p p e a r s . T h u s , t h e n u m b e r of lines d i s t i n g u i s h e d b y visual inspection is a measure for the spatial resolution in d e p t h . Using a c o m p u t e r and t a k i n g a slice t h r o u g h t h e images, a q u a n t i f i cation is p o s s i b l e : t h e decreasing modulation w i t h increasing distance g i v e s t h e l i m i t of v i s i b i l i t y . The r e s u l t s are p r e s e n t e d f o r d i f f e r e n t cameras and compared to clinical examples.

Z e n t r u m Radiologie ( S t r a h l e n k l i n i k ) U n i v e r s i t ~ t H e i d e l b e r g , V o s s - S t r . 3 (FRG) A b t e i l u n g fQr N u k l e a r m e d i z i n d e r U n i v e r s i t ~ t B e r n , I n s e l s p i t a l , CH 3olo B e r n e ( S w i t z e r l a n d )

General Electric Medical Systems Group P.0. Box 414, NB924 Milwaukee, WE 53201

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IMAGING CAPABILITIES OF THE HYDRATFD REGIONS ON THE SURFACE OF NAT/T1/ CAMERA CRYSTALS S.Keszthelyi-L~ndori

soME NEW THOUGHTS CONCERNING QUALITY CONTROL

DIAGNOSIS OF UNILATERAL RENAL ARTERY STENOSIS BY CAPTOPREL RENOGRAPHY. H.Y. Oei, G.G. Geyskes, J.C. Roos, E.J. Dorhout Mees.

Aging NaE/T1/ camera crystals may become hydrated. Hydration r e s u l t s in small spots on the crystal surfaces, which in the beginning are white, but later turn yellowish. The appearance of these spots in a diagnostic i m a g e - as with other artifacts - is to b e a v o i d e d , which means, that the crystal should be replaced. Lukes etal. have shown that the image of the hydrated spots of an aged NaI/Tl/ camera crystal appeared in 2 o i T i a n d 1 3 a X e f l o o d f i e l d i m a g e s , but did not appear in conventional STco a n d 9sn~2c f l o o d f i e l d t e s t s g i v i n g a n apparent energy dependence in the imaging capabilities of the hydrated spots, W e p r e s e n t h e r e an e n e r g y i n d e p e n d e n t m e t h o d - w h i c h c a n b e u s e d as a q u a l i t y control test for any camera crystal and interpretation of the imaging process of the hydrated spots. Gamma MNvek Hungary

H-15og,

Budapest

P.F.

i.

FOR SPECT.

T.D.

Cradduck,

T.J. Farrell

From its earliest inception it has been well recognized that single photon emission computed tomography (SPECT) places severe constraints on the performance of the scintillation camera, both mechanically and electronically, if high quality images are to result. Two significant parameters that must he subjected to rigorous quality control are the center of rotation (CoR) and the flood field uniformity. We have investigated the effect of CoR error upon the final image and also the stability of this parameter with one particular scintillation camera/computer combination. It is evident that a cog error in excess of one-quarter pixel width will lead to some degradation of the image, but, in our system, the long term stability is such that this parameter needs to be checked only weekly unless the collimator is changed. Most investigators have advocated extremely high count flood field images (30-100M counts) for uniformity correction purposes. It would appear that, providing the original flood field has an integral uniformity of better than 8%, then a high count correction matrix is not justified. Long term stability of our system has demonstrated that collection of a 10M count flood field correction matrix at least weekly may be sufficient to yield good results. Extremely high count density flood field images ~ake a long time to collect (overnight in some cases) and these quality control procedures may either become neglected or will encroach significantly on the time available for clinical imaging. Since the correction matrix is collimator dependent it is critical that the time taken to collect such data must be minimized. Victoria Hospital Corporation and University of Western Ontario, 375 South St., London, Ontario N6A 4G5, Canada

In patients with unilateral renal artery sCenesis (URAS) eaptopril a~ninistration will deteriorate glomerular filtration in the affected kidney possibly by interruption of autoregulatory mechanisms. ~3is effect might be detectable on renography and could be useful for the diagnosis of renovascular hypertension. After discontinuation of all medication, Tc-99m dietbylene triamine pentaaeetic (DTPAi gam3nacamera renography, followed by 1-131 orthoiodohippurate {OIH) renography were performed in il hypertensive patients who were poorly controlled with medical therapy. This double examination was repeated some days later after administration of 25 mg captopril one hour prior to the examination. After this, angiography was done and patients with stenosis of the renal artery were treated by percutaneous transluminal dilatation. Five URAS-patients, in whom the bloodpressure improved after percutaneous transluminal dilatation, showed after administration of captopril a striking renographic alteration in the affected kidney. ~te DTPA-renogram which initially had an upslope phase, showed a blooddisappearance curve and the OIH-zenogram, which still had an upslope phase, showed a slower excretion. These renographic alteration did not occur in the other 2 UP~S-patients, who had no benefit of the percutaneous transluminal dilatation and in the 4 remaining patients without stenosis. These findings suggest that captopril induced renographic alterations may be important for the diagnosis of hemodynamic significant URAS. Dept. of Nuclear Medicine, University Hospital, Catharijnesingel 101, Utrecht, The Netherlands.

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RADIONEPHROGRAPHIC FOLLOW-UP WITH HYPERTENSIVE PATIENTS AFTER ANGIOPLASTY OF RENAL ARTERY STENOSIS. A. ThOnf, H. ROsler, O. Noe!pp and T. Mahler

MULTIPARAMETER ANALYSIS OF RENAL GLOMERULAR FUNCTION USING DEDONVOLUTiONAND THE FACTOR ANALYTIC APPROACHTO DATA AND PATIENT GROUPING. H. Vosberg, Z.Szab6, L. L~tticke and L.E. Feinendegen

E S T I M A T I O N OF T H E E X E R C I S E R E N O G R A M IN SYSTEMIC HYPERTENSION B Y D O U B L E D O S E OF Tc-g9mDTPA. Y.Kubota, K.Miyao, T.Mineo, S.Husuoka and C.Yamada

Radionephrographies (RNG's) were performed in 23 hypertensive patients before and after 28 translunlinal dilatations (TLD) of their stenosed renal arteries. We registered the changes of clearances (global = Clal, For the stenosed and the contralateral kidney = el and C1 ) co. Bt separately, as well as the parenehymal translt time (=re-entry time) for the diseased ,'Rt ) • t and contralateral kidneys (Rt ). The results co are glven for three groups, whlch were made retrospectively dependent on their clinical outcome. A) NoZTnalized hypertension (antihypertensive medication stopped, RRdi a st -4 90mm Hg): for 9 patients the preoperatlve C1 was never lower than 150 ml/', but increased significantly after TLD. Rt fell significantly, Rt st . . c remained constant. Mean increase in Clg I = ~i ml/'(=+25%). B) Improved hypertension (medication reduced, NR , decreased by > 15%): In these 12 dsast patlents C1 and CI had been lower than with st co . . those in group A; postoperatlvely Clst increased, Rtst fell significantly. The Rt Q was prolonged early after TLD but norma~lzed later C) Permanent hypertension: for 7 patients there are no preoperative criteria for a discrimination against the other groups. But in all cases Rt did not normalize, and Rt incxeast co sed early after TLD. Even in later examinations Rt rexnained higher than preoperatively. co These results imply that the success of TLD depends mainly on the behavior of the contralateral kidney. A RNG one day after the TLD gives an optimal prognosis concerning the end result.

D i f f e r e n t i a l diagnosis of hypertension requires analysis of glomerular f i l t r a t i o n and tubular transport. 70 hypertensive patients (16 with renal artery stenosis, 37 with renal parenchyma] disease and 17 with essential hypertension) received 99mTcDTPA f o r dynamic renal scintigraphy. 10 i n d i v i duals without renal disease or hypertension served as controls. Time-activity curves were treated by deconvolution analysis in order to determine global and local renal perfusion (P), extraction f r a c t i o n (E) and mean transport time (T). The correlation between local P and E permitred d i s t i n c t i o n from background by correlation c o e f f i c i e n t ( r ) and orthogonality (~) as a function of renal i n t e q r i t y . P was s i g n i f i c a n t l y reduced in renal artery stenosis. T tended to be prolonged irrespect i v e of the etiology of hypertension, r and indicated better renal function in essential hypertension than in renal artery stenosis. All values and t h e i r r i g h t to l e f t quotients (R/L), 20 parameters in a l l , were treated by factor analysis resulting in three groups of correlations, characterizing values of P-E, T and R/Lquotients. The three groups of patients with hypertension could be c l e a r l y separated. For example, discriminance analysis identified renal artery stenosis with a s e n s i t i v i t y of 80 Z. The presented method obviously appears to be highly r e l i a b l e c l i n i c a l l y . Nukiearmedizinische Klinik der DOsseldorf, Moorenstr. 5, D-4000

Unlverslt~t 90sseldorf I

University of Bern, Dept. of Nuclear ~ edicine Inselspital, CH - 3010 Bern (Switzerland)

R e n a l i n v o l v e m e n t in e s s e n t i a l h y p e r t e n s i o n h a s b e e n a r g u e d b y m a n y a u t h e r s . In o r d e r to r e f i n e the d i a g n o s t i c p o s s i b i l i t i e s u s i n g r e n o g r a p h y for r e n a l i n v o l v e m e n t in s y s t e m i c h y p e r t e n s i o n , we have d e v e l o p e d t h e e x e r c i s e r e n o g r a p h y b y double dose of Tc-99mDTPA. W e r e p o r t o n 38 p a t i e n t s r e f e r r e d f o r renograpgy, 25 of a l l p a t i e n t s w i t h e s s ential hypertension, 7 with hypertension and diabetes mellitus, and 6 without hypertension. T h e r e s t r e n o g r a m w a s o b t a i n e d in s i t t i ng p o s i t i o n on t h e b i c y c l e e r g o m e t e r a n d for e x e r c i s e r e n o g r a m 30 m i n u t e s a f t e r e n d i n g of t h e r e s t r e n o g r a m h y , s e c o n d bolus i n j e c t i o n of 15 m C i of T C ~ 9 9 m D T P A was done intravenously to t h e p a t i e n t during ergometric stressing. In c o m p a r i n g t h e r e s u l t s of r e s t r e n o g r ams w i t h e x e r c i s e o n e s , 16 o f 3 2 ( 5 0 % ) p a tients demonstrated abnormal exercise renogram (delayed peak time and TI/2). Exercise caused bilateral renal dysfunct i o n in 1O of 2 5 ( 4 0 % ) p a t i e n t s with essential hypertension and 6 of 7(86%]patients with hypertension and diabetes mellitus. E x e r c i s e r e n o g r a m s o f all n o r m o t e n s i v e s w e r e n o r m a l . B e f o r e a n d a f t e r exercising there was not any difference between patients of normal and abnormal r e n o g r a m in c h a n g e s of b l o o d p r e s s u r e a n d h e a r t rate. T h e s e r e s u l t s i n d i c a t e t h a t t h e r e is r e n o v a s c u l a r h y p e r - r e a c t i vity by stress in systemic hypertension. T h e e x e r c i s e r e n o g r a p h y is a v a l u a b l e m e t h o d to e s t i m a t e r e n a l i n v o l v e m e n t in systemic hypertension. The Kyoto Second Red Cross Hospital, Department of Internal Medicine, KamaDza-Marutamachi-Agaru, Kamikyo-Ku, K y o t o 602, J a p a n

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DRY AEROSOL OF MONODISPERSE 99m To LABELLED MILLIMICROSPHERES COYL~ARED TO 81m KRYPTON AND 127 XENON. H. KOhn, A. Mostbeck, H. Klech, B. Angelberger, A. Strigl

ASSESSMENT OF A COMMERCIALAEROSOL DELIVERY SYSTEM FOR PULMONARY VENTILATION SCINTIGRAPHY BY CDMPARISONWITH Kr-81m. P. Wollmer, L. Eriksson and A.C. Andersson.

ASSESS~r~NT OF THE EFFICIENCY OF MUC0-CILIARY CLEAmA_NCE AND COUGH IN BRONCHITIS USING A RADIOACTIVE AEROSOL TECHNIQUE. F. Aug, A. Bertrand, E. Puchelle, D. Lauque, ~. Karcher, C. Hocquard, P. Sadoul

99m TC labelled monodisperse millimicroepheres (particle diameter less than I [un) nebulized from an ethanol suspension in a self developed system to deliver a dry aerosol achieved a high lung delivery efficiency of 22%. In 48 patients with chronic obstructive airway diseases (COAD) and in 24 patients with suspected pulmonary e/re bolism, inhalation J/nages were c o r ~ r e d quantitatively and qualitatively with 81m Kr or 127 Xe ventilation studies. A "penetration index" deflaed as the ratio of pixel-normalized counts of an inDer zone to a peripheral zone was calculated for each aerosol- and 81m Kr scan.These penetration indices correlated significantly (r=0.86, p < 0. 001 ) indicating penetration of the millLmicrospheres to the lung periphery com parable to 81m Kr. Four different patterns of aerosol deposition could be observed. An "aerosol hot spot score" provides reliable inforn~tion about the degree of airflow obstruction, since a close relationship between the hot spot score and the forced expiratory voltc~e in I s (FEVI) was f o ~ d in patients with COAD (r=-0.77, p < 0.001). Quantitation of regional ventilation of the upper, middle and i c ~ r lung fields demonstrated nearly identical results for the aerosol- and 81m Kr images (r=0.88, p<0.001) . Qualitative assessment of aerosol sca~s compared to the radioactive gases showed cor~plete or large a g r e ~ t in all but one patient. Ventilation it&aging using a dry aerosol of mDnedisperse milllmicrospberes see~s to be a reliable alternative to radioactive gases for clinical routine examination of patients with suspected pulmonary em~3olism or (]DAD. For patients with O0AD, aerosol imaging is more sensitive than 81m Kr.

Radioactive aerosols o f f e r a means f o r steady state v e n t i l a t i o n scanning in multiple views. The c l i n i c a l use of radioaerosol techniques has been hampered by the lack of delivery systems producing s u f f i c i e n t l y small particles. I f the aerosol contains large p a r t i c l e s , heavy deposition occurs in major airways, especially in patients with airways disease. This may i n t e r fere with the i n t e r p r e t a t i o n of the scan and the comparison with the perfusion scintigram.

Institute of Nuclear Medicine and Ludwig Boltzmann- Institute of Nuclear Medicine, Wilhelminen spital, ~ntleartstr. 37, A-1171 Vienna, Austria

We have assessed a new, commercial aerosol del i v e r y system (Syntevent) by a comparison with Kr-81m v e n t i l a t i o n scanning in 23 patients with airways obstruction. An i n d i r e c t comparison was also made with a s e t t l i n g bag technique (Fazio et a l , J Nucl Med 23:306, 1982). Ventilation scans in four projections were obtained during continous inhalation of Kr-81m. Subsequently, the patient inhaled an aerosol labelled with In-ll3m from the Syntevent system, and aerosol v e n t i l a t i o n scans were obtained in the same projections. Spirometry was performed to establish the degree of airways obstruction, The aerosol delineated the ventilated regions of the lungs adequately in a l l the patients. Deposition of aerosol in larger airways was seen in a few patients only, and this did not impede the i n t e r p r e t a t i o n of the scintigram. A quantitative analysis of the penetration of the aerosol to the periphery of the lung f a i l e d to demonstrate any s i g n i f i c a n t correlation between p a r t i c l e penetration and airways obstruction, Aerosol penetration was s i g n i f i c a n t l y greater (p
The muco-ciliary system (MCS) is £he main mechanism for getting rid of inhaled particles or cellular remains out of the airways. Defection of this system leads to secretion stasis and bronchial obstruction. Alteration of the MCS in bronchitis is well documented but dysfunction of bronchial clearance during different phases of bronchitis has not yet been studied. Radioisotopic techniques provide a good tool for this kind of study. We measured bronchial mucociliary clearance (MC) and clearance by cough using a radioactive aerosol technique (resin particles 7 . 4 ~ m in diameter, tagged with technetium 99m) in patients with reccurent bronchitis (group I, n = 5) and in chronic bronchitic patients, either at an early (group II, n = 13) or advanced (group III, n = 17) stage of their disease. The results were compared with those obtained from ~ control group (group O, n = ]0) and the respective efficiencies of the mucociliary system and cough were analysed with reference to respiratory function. The initial deposition of the aerosol in central airways is similar in all the patients and healthy subjects. In comparison with group O, the mucociliary clearance is only significantly reduced in groups II and III (p < 0.02). In healthy subjects, the clearance by cough is very weak, whereas in bronchitic patients, it can be roughly equal to or greater than the MC. However, the cough is less efficient in group IlP than in group II (p < 0.05). A reduced efficiency of the clearance by cough occurs together with abnormalities in the gas exchange. This technique provides a non invasive means of quantitating the muco-ciliary clearance and of evaluating the evolution of the chronic bronchitic diseases. Service de M~deeine Nuelgaire CHU NANCY-BRABOIS 54500 VANDOEUVRE FRANCE

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HEMODYNAMIC DATA, REGIONAL SXTRAVASCULAR LUNG WATER AND BLOOD VOLUME IN HEART FAILURE. 0. Schober, O.-J. Meyer, C. Bossaller, and H. Hundeshagen

QUANTITATIVE INDIUM-Ill PLATELET SCINTIGRAPHy IN DETECTION OF LEFT VENTRICULAR THROMBOSIS AFTER ACUTE MYOCARDIAL INFARCTION. A l b e r t J. F u n k e K ~ p p e r , F . W . A . V e r h e u g t , W. d e n H o l l a n d e r , E.E. v a n d e r W a l l , J.P. E o o s .

COMPARISON OF MYOCARDIALMETABOLISM OF I1-C-PALMITIC ACID II-C-PA) AND 123-I-HEPTADECANOIC ACID (123-1HA IN MAN. G. Notohamiprodjo, A. Schmid, G. Spohr, H. Herzog, L.E. Feinendegen.

Left ventricular failure is a common cause for the development of interstitial of alveolar pulmonary edema. It was the purpose of the study to measure quantitatively regional extravascular lung water (rELW) and blood volume (rag) with Positron Emission Tomography (PET) and correlate the data to hemodynamic standard parameters. The water pool is measured by constant infusion Of 0-15 labeled water, C-II labeled inhaled CO is used as a blood labeling agent. All patients had undergone left-ventricular cardiac catherization, including cineventrieulography and coronary angiography within 24 hours. Six controls (severity of the heart failure according to the NYHA - I), and 13 patients with congestive heart failure were studied (CHF: NYHA iI-IV; 7 patients coronary artery disease, 6 patients mitral of aortic valve disease). The analysis in 18 regions per patient revealed relatively homogenous rELW in controls, x = O.la + 0.03 g/cm ~ , range 0.08 - 0.21, whereas it increased in CHF: 0.25 + 0.06, range O.10 - O.51. rBV was 0.21 + O.O4 g/c~ in controis and 0.26 + 0.06 in CHF. The mean rELW in apical regions was lower than in the basal regions (2p<0.05). g good correlation was found between the severity of chronic heart failure (NYHA) and mean ELW (r=0.69), as well as between CHF and the ratio of mean rELW/rBV (r~.gg), whereas the correlation to hemodynamic data was less good (cardiac index: r=0.45, pulmonary capillary wedge pressure: r=0.47, ejection fraction: r=0.60). The data suggest that amount and distribution of fluid in pulmonary congestion can be assessed noninvasively by PET.

Medical School Hannover, Department of Radiology D-3000 Mannover, West Germany

A dual isotope bloodpool subtraction method with Indium-111 platelet scintig r a p h y {IND) a n d T c - g g m b l o o d p o o l s c i n t i g r a p h y w a s u s e d to d e t e c t l e f t v e n t r i cular thrombosis (LVT) in 56 p t s e 2 w k s after acute myocardial infarction (MI). L V p l a t e l e t d e p o s i t i o n w a s e x p r e s s e d as LV counts per pixel (LVcpp). Results were correlated with two-dimensional echocardiography (2DE) a n d w i t h t h e s i t e a n d n u m b e r o f s u s t a i n e d MI. B o t h I N D a n d 2 D E w e r e p e r f o r m e d 45 ± 7 h r s a f t e r labeling of autologous platelets with I n d i u m - o x i n e , d o s ± s : 180 ± 88 m Z c r o C i p e r p t (mean ± SD). E l e v e n p t s {grA) h a d a p o s i t i v e I N D a n d 45 p t s (grB) h a d a n e g a t i v e I N D (LVcpp: 0.55 ± 0.19 r e s p . 0 . 3 3 ± 0 . 2 0 ; p < 0.003). 2 D E s h o w e d L V T in 5 p t s of g r A a n d in n o n e o f grB. LV function with 2DE w a s m o d e r a t e in 5 a n d p o o r in 6 p t s o f grA, a n d g o o d in 17, m o d e r a t e i n 15 a n d p o o r in 13 p t s o f grB. A p o s i t i v e IND a n d 2 D E r e s p . w a s n o t e d in 3/19 a n d 2/19 of p t s w i t h a n t e r i o r MI, 3 / 2 3 a n d 1/23 o f p t s w i t h i n f e r i o r M I a n d 5/14 a n d 2 / 1 4 of p t s w i t h m u l t i p l e MI. T h e r e w a s n o s i g n i f i c a n t d i f f e r e n c e in L V c p p r e l a t e d to t h e s i t e a n d n u m b e r o f s u s t a i n e d MI. W e c o n c l u d e t h a t , I) b o t h I N D a n d 2 D E c a n d e t e c t L V T a f t e r a c u t e MI. 2) p t s w i t h m u l t i p l e MI a n d d e c r e a s e d L V f u n c tion are at higher risk for LVT. 3)plat e l e t d e p o s i t i o n in L V T c a n b e q u a n t i fied and used for intervention studies.

Comparison of myocardial accumulation and release of iodinated long chain f a t t y acids promises diagnostic differentiation between coronary artery disease and cardiomyopathy. The present study was designed to compare metabolism of iodinated fatty acids with natural fatty acids in the humanmyocardium.

Six patients without signs of heart- and/or metabolic disease, aged 24 to 52 years, 3 males and 3 females, consented under fasting condition and rest to undergo a) serial positron emission tomography following i . v . injection of 3 mCi II-C-PA, b) serial myocardial scintigraphy by a conventional y-camera following i . v . injection of 3 mCi 123-1HA and correcting f o r labelled free iodide. Both measurements lasted over a period of 90 minutes and were 5 days apart. Data were analyzed f o r peak accumulation, f i r s t and second component of release. The results showed nearly identical kinetics regarding peak accumulation and f i r s t component of release with half-times ranging from 6.0 be 14.0 min. In a l l individuals the second component of release was p r a c t i c a l l y in parallel f o r both tracers but at d i f f e r e n t levels. The data confirm results previously obtained in various mammalian species.

I t is concluded that conventional serial scintigraph// with 123-1HAwith correction for labelled free iodide permits accurate analysis Of fatty acid accumulation and utilization in the human myocardium and is thus a diagnostic tool which is essentially equivalent to positron emissio~ tomography, Institute of Medicine, Nuclear Research Center Juelich GmbH, D-B17g Juelich, F.R, Germany.

D e p t s o f C a r d i o l o g y and N u c l e a r M e d i c i n e Free University Hospital, de Boelelaan 1117, 1007 M B ~ s t e r d a m , The Netherlands

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SCINTIGRAPHIC ASSESSMENT OF MYOCARDIAL INFARCTION IN ABSENCE OF ECG Q WAVES.P.Marzullo,C.Carpeggiani,O.Parodi,D.Neglia,C.Marcassa,A.L'Abbate

K~NETICS OF 1-123 H E P T A D ~ J q O I C ACID IN NORMAL ~OCARDIUM. H.R. Sch~n, R. Se/lekowitsch, D. Berg, M. Schneidereith, S. MiSllenet~dt, H. Kriegel, H.W. pabst and H. Bl~mer

MAGNETIC RESONANCE D.iEGING OF TH~ HEART. J. Ennis, B. Akins, B. Subbiondo, R. Mink, B. Sattin, J. Fitzsimmons, D. Hamlin and C. Williams

In order to evaluate the significance of persistent post-angina ST-7 changes we studied 15 Pts with documented m 2 days ST-T abnormalities in the anterior leads in absence of previous myocar dial i n f a r c t i o n and Q waves.Study was performedin the acute phase in 5 Pts (2 had positive enzimatic c r i t e r i a f o r necrosis,3 had positive 99 mTc-Pyp)and 8f5 months a f t e r the acute episode in I0(6 had normal ECG at the time of the study) During coronary angiography human labeled albu-' min microsphares were injected in the l e f t vent r i c l e end gated sointigraphy (G-HAM)[obtained in LAO and AP projections.G-HAM was used to dete ct possible small and/or non transmural perfusi Z on defects (PD) l i k e l y hardly detectable by ungated images such as those obtained by Thallium 2Of.Coronary angiegraphy showed ~ 75% stenosis of the l e f t anterior descending coronary artery in 12 and complete occlusion of the same vessel with evident collateral circulation in 3.Left contrast ventriculography showed anteroseptal hypokinesis in 7 and akinesis in 5.Three Pts she wed normal regional myocardial function.A non transmur~l septal or anteroseptal PD was present in all Pts;12 Pts showed an additional apical PD In conclusien:I)In our study,long-lasting ST-T changes was characterized by transmural and non tra~smural PD as detected by G-HAM.2)Normalizet~on of the ECG did not imply normalization of pegiongl myocardial perfusian.g)In absence of Q waves,occlusive coronary artery disease or evident myocardial dysfunction,G-HAMcan represent the unique method to detect myocardial necrosis.

In order to def£%e the potential of 1-123 heptadecanoic acid (HDA) for noninvasive assesssent of rayocardial fatty acid ~etabolism with gaaI7~ camera in~gimg, the influence of n~ocardial oxygen consumption (MVO2) ~nd blood flow (F~F) on extraction (E) and halftimes (T) of HDA were investigated in 11 experiments in 7 fasted dogs. MVO 2 WaS altered by pacing. Following HDA injection into the left circumflex coronary artery, n~ocardial HDA time activity curve was recorded with a scintillation probe for 60 rain. E and T were derived ±rein the peak and slope of the tiKe activity curve which consisted of a vascular, an early and a late phase. E averaged 0.53 ~ 0.11 SD at ccntrol and was not influenced by MVO 2 and ~ F . T of the early phase (T-9.56 sin + 2.30 SD in controls) as well as the size of the early phase increased with MVO 2 (r=O.72, r=0.67 resp.) . This r~eans increased intracellular turnover of HDA, yet a slower clearance of activity during the early phase with increased cardiac work. T of the late phase (T=259.5 m/n + 146.2 SD in controls) ~ s not related to M%I35 and ~BF. chronl~tographic and electrophoretlc analysis of n~ocaxdial arterial and venous blood s a b l e s over time revealed that the early phase is characterized by decreasing ~ s h o u t of HDA and to an increasing ~gnount by a second c e m e n t , n~Dst likely prop±chic acid. We conclude that myocardial fatty acid exidation cannot ha measured frc~ T of the early phase and only in a semi-accurate way frc~ the size of this phase. Thus precise assessment of nTyccardial fatty acid n ~ t a b o l i ~ is not possible with HDA.

Objectives :

CNR I~stitute of Clinical Physinlogy,via Savi 8, 1-56100 Pisa,ltaly,

I. Med. E l i ~ k , ~ c h a . Universit~t ~lhlchen, Is~uninger Str. 22 8000 bKhnchen 80, FaG and Abtlg. Nuklearbiolcgie, GS~ Ingolst~dter Landstr. I 8000 ~lhnchen/Neuherberg, FRG

To assess the anatominal detail that is possible using gated magnetic resonance imaging of the heart with a 0.15 Tesla restrictive magnet (Technicare). Methods and Patients: Twenty normal volunteers were imaged in axial, sagittal and coronal planes using TE 30 and TE 60 pulse sequences. Single slice images at end diastole and end systole were evaluated and images of conrplete cardiac cycles at 70 msec intervals were obtained in some patients, using a Hewlett-Pankard gating device. In addition, vol~ne images of cadaver hearts were obtained to optimize anatomical detail. Results : i) M~gnetim resonance imaging provides exquisite anatomical detail of the ventricular and vascular anatomy, 2) Gross wall motion can be ascertained by analysis of end diastole and end systole images, 3) Resolution improvements to provide anatomical detail similar to the cadaveric images will be coil dependent, and 4) Respiratory gating prolongs the scan time but improves the image quality.

University of Florida College of Medicine, Gainesville, Florida, 32610, U.S.A.

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~{%C~ETIC RESONANCE I~,[AGING IN CARDIAC AMYLOIDOSIS. J.K. O'Donnell, R.T. Go, C. BottSilvermzn, D.H. Feiglin, E. 8alcedo, 1~.J. MacIntyre.

PREPARATION

Primary amyloidosis (AL) involves the n~yocarditch in 90% of cases and may present as apparent ischemia, vascular disease~ or congesfive heart failure, q%vo-dimensional eehoeardiography (echo) has proven useful in the diagnosis, particularly in differentiating AL frown constrictive pericardifis. The findings of thickened EV and LV myoeardit,n, nornml LV cavity dimension, s/ld a diffuse h?qoerrefractile "granular sp~ckling" appearance are virtually diagnostic. Magnetic resonance (~£R) imaging may improve the resolution of sllatornic changes seen in cardiac AL and has the potential to provide more specific information based on biochemical tissue alterations. In this preliminary study, we obtained both MR and echo imagoes in six patients with AL and biopsy-proven myocardial involvement. 5/6 patients also had Tc99m PYP myocardial studies including emission tomography (SPEOT). ~ studies utilize a 0.6 Tesla s11perconductive magnet. End diastolic gated images were obtained with TE-3Omsec and TR=R-R interval on the ECG. 6/g pts. showed LV wall thickening J]ieb was concentric and included the septum. Papillary muscles were identified in 8/1 and were enlarged in 3/6. 4/6 pts. showed Y~g wail thickening but to a lesser de~ree than the LV. Pericardial effusions were present in 4 cases. These findings correlated well with the results of echo although MR gave better RV free wall resolution. PYP scans were positive in 3 pts. but there was no correlation with degree of LV thickening. We conclude fhat there are identifiable ~R findings in patients with cardiac AL which encourage f~rther atfen~ts to characterize myocardial involvement by rneasttrer~enf of !@{ relaxation times in rive. Cleveland Clinic ~oundation Deparhnent of Nuclear ~ledicine 9500 Euclid Avenue Clevelsmd, Ohio 44106

AMIDE~

A POTENTIAL

11C-RADIOPHARMACEUTICALS USING t I c - L A B E L L E D A L K Y L B. L~ngstr6m, G. Antoni, C. Halldin, P. gullberg, P. Malmborg, A. Rimland

SYNTHESIZED HALIDES G. Bergson, K. N~gren, and H. Sv~rd

The d e v e l o p m e n t of new 1 1 C - l a b e l l e d precursors useful in the synthesis of 11C- r a d i o p h a r m a c e u t i c a l s has in the last years shown that PET has a p o t e n t i a l of b e c o m i n g a v a l u a b l e in vivo tracer technique a p p l i e d in h u m a n s and amimals 1[C-Methyl iodide r o u t i n e l y p r e p a r e d in an 2 - s t e p r e a c t i o n from a c c e l e r a t o r produced 11C-carbon dioxide w i t h synthetic time of 3-5 min has shown to be such a labelled precursor. So far about 50 c o m p o u n d s have been labelled by a l k y l a t i o n reactions using 11C-methyl iodide on S-, O-, N- or C- n u c l e o p h i l e s in o u r laboratorY. 11 Examples of such c o m p o u n d s are Cmorphine, 11C-hydromorphone, 11C-heroin, 11CLpetidine 1]C-nicotine, 11C-methvlspiperone, 1 ~ C - m e t h y l d e x e t i m i d e , 11C~ -methylketanserine, 11C-clozaDine, 11C- b r o m o c r i p t i n e , 11C-choline, ] I c - z i m i l i dine and ]IC-MPTP. All these substances have been p r e p a r e d starting w i t h 150-200 mCi of 11Cicarbon dioxide and after the synthesis of 11Cmethyl iodide the labelled c o m p o u n d s were o b t a i n e d in a r a d i o - p h a r m a c e u t i c a l sterile, p y r o g e n e - f r e e solution w i t h i n 40 m i n in good yields. All c o m p o u n d s have been used in animal or human studies using PET. The d e v e l o p m e n t s of new p r e c u r s o r s like 11C-ethyl, propyl, butyl etc. iodide and 1 1 C - l a b e l l e d aldehydes have strongly ind i c a t e d that a great number of c o m p o u n d s now are p o s s i b l e to label with 11C. 11C- L i d o c a i n e has for e x a m p l e been p r e p a r e d using 11C-ethyl iodide. D e p a r t m e n t of Organic Chemistry, U n i v e r s i t y of Uppsala, Box 531, 5-751 21 Uppsala, Sweden

DOPAMINE

BENZ-

RECEPTOR

ANTAGONIST FOR PET-VISUALiZATION

OF

CEREBRAL DOPAMINE RECEPTORS, E. E h r i n , P. Johnstrdm, S. S t o n e - E l a n d e r , J . L . G . Nilsson, Greitz,

T. d e P a u l i s , J.-E.

b. Farde, T.

Litton,

G. Sedvall

and

L. Widen. A new dopamine

receptor antagonist

S(-)-[(5-chloro-3-ethyl-2-hydroxy-6methoxybenzamido)methy~ - l - e t h y l - p y r r o lidine,

FLB 131, has been l a b e l l e d

using C - 1 1 - e t h y l i e d i d e nitrogen

to a l k y l a t e

of the p y r r o l i d i n e

ring

the

in the

corresponding secondary amine precurso< The r e a c t i o n was c a r r i e d out in a pneumatically-operated

HPLC i n j e c t o r

loop

and the l a b e l l e d

compound was subse-

quently purified

by HPLC. FLB 131 has

been shown to be a s e l e c t i v e

dspamine-

2 r e c e p t o r a n t a g o n i s t w~th high b i n d i n g affinity

f o r dopamine

low d i s s o c i a t i o n labelled

receptors

constant.

receptor rich

monkey b r a i n .

Since t h i s

areas of the

type of substi-

t u t e d henzamide seems s u i t a b l e further function

and a

The C-11-

FL8 131 was used to v i s u a l i z e

the dopamine

stu di es it

will

for

of dopamine

receptor

be t e s t e d

in a small

group o f h e a l t h y v o l u n t e e r s as well schizophrenic Karolinska

A 156

OF A C - I I - L A B E L L E D

as

patients.

Pharmacy,

Stockholm,

1-123 insulin. Characterization of a new radiopharmaceutical suitable for studying disorders of insulin metabolism and hepatocellular diseases. J.C.SODOYEZ, F. SODOYEZ-GOFFAUX, C.J. DE VOS, F. ERBSMANN, C. FALLAIS and R. JACQUEMIN Carrier-free 1-123- Tyr-Al4 insulin (I-123-ins) was prepared by reverse phase HPLC chromatography and shown to bind with a high affinity to specific antiinsulin antibodies and to specific insulin receptors.on cultured human IM 9 lyl,phocytes. 1-123-ins was also injected into anesthetized rats and its distribution followed using a scintillation camera connected to a computer. In rive, the tracer was mainly t~ken up by the liver, by specific interaction with insulin receptors on the hepatocytes. Liver time-activity profiles after portal ( mesenteric vein ) or peripheral ( jugular vein ) injection were compared, allowing to calculate that after one single transhepatic passage, the liver extraction coefficient was 6 1 % and the minimt
Sweden.

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S Y N T H E S I S OF S H O R T - L I V E D R A D I O - I S O T O P E S (IIc, faN, ~50, 18F) USING COMPACT MEDICAL C Y C L O T R O N (CYPRIS). Y. NISHIHARA, A. TANAKA, T. HIROISHI, Y. ADACHI AND Y. T A J I M A

A REMOTE CONTROLLED SYSTEM FOR THE ROUTINE SYNTHESIS OF 18-F-2-FLUOR0-2-DEOXYD-GLUC0SE (18-FDG). M. Haaparanta, d. Bergman, 0. So!in and D. Roeda

A system for s y n t h e s i z i n g v a r i o u s effective labeled c o m p o u n d s by using shortlived r a d i o - i s o t o p e s (iZC, IBN, ISO, and ISF), g e n e r a t e d through the n u c l e a r r e a c t i o n using proton and d e u t e r o n a c c e l e r a t e d by the compact m e d i c a l c y c l o t r o n ("CYPRIS": C Y c l o t r o n for P r o d u c t i o n of Radio-ISotopes), will be d i s c u s s e d here. The major components of this system are: the Cyclotron, target system, a u t o m a t i c s y n t h e s i z e r for labeled compounds, purity m e a s u r e m e n t system for labeled compounds, hot cell for synthesizing, waste system, and control system. Especially, labeled compounds in the form of gas (liCe, 11Co2, ~3N2, ISO2, ClsO, ClsO2, and IBF2), p r e c u r s o r s for organic synthesis (HIICN, IICH3I, IBNHs, H18F, etc.), arCfatty-acid, llC-glucose, I~FDG and other labeled compounds useful for the clinical use, can be a u t o m a t i c a l l y synthesized. This r e p o r t d e s c r i b e s the CYRRIS system, w i t h p a r t i c u l a r emphasis on the s t r u c t u r e of the a u t o m a t i c s y n t h e s i z e r for labeled c o m p o u n d s as well as on its synthesis data. Sumitomo Heavy Industries, Ltd., N u c l e a r B u s i n e s s D e v e l o p m e n t Div., i, Kanda, M i t o s h i r o - c h o , Chiyoda-ku, Tokyo i01, Japan

An apparatus was designed for the synthesis of 18-FDG for routine medical use in Turku U n i v e r s i t y Central Hospital. The m e t h o d is an adaptation of the chemical procedure described by Dicsic (Montreal) which gives in a much s h o r t ~ time an appreciable higher yield than the method of Ido (Brookhaven) used up till no~ in our laboratory. It com8Fp-production~ c o n v e r s i o n to F-acetylNypofluorite, addition to triacetylglucal, l i q u i d - l i q u i d e x t r a c t i o n t hydrolysis~ p u r i f i c a t i o n by flash-chrom a t o g r a p h y (ion retardation resin, alumina), treatment with charcoal and sterile filtration. The system is housed in a lead shielded hood. All m a n i p u l a tions (except the final filtration) such as transport of liquids~ extraction and separations are carried by remote control with pneumatic systems and electrical valves. The radiochemical yield~ which was studied as a function of type and amount of catalyst and . + amount of t r l a c e t y l g l u c a l is 14-6Z. The radiochemical purity was estimated using thin layer c h r o m a t o g r a p h y to be +L 93-7~. With a synthesls tlme of less than one hour, batches of 10 mCi can be obtained in our laboratory. This remote controlled production system provides us with a fast~ simple and reliable m e t h o d for 18-FDG synthesis with a minimal r a d i a t i o n hazard to the chemist.

~ises

Turku Medical Porthaninkatu Finland

Cyclotron Project~ 3-5, SF-20500 Turku

50,

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SYNTHESIS AND PHARMACOKINETICS 0E SOME NEW 99m-Tc-DI - AND TETRAMINE-GOMPLEXES W. B r a n d a u p M. E i s e n h u t ~ D. M. T a y l o r ~ P~ G e o r g i ~ K. z u m Wirukel

WHO INTEHCOMPARISON OF IMAGE QUALITY IN NUCLEA~ MEDICINE. G.N. Souchkevitch

IMTERLABORATORY COMPARISON STUDY OF NUCLEAR MEDICINE IMAGING IN 12 EUROPEAN COUNTRIES USING TOTAL PERFORMANCE PHANTOMS. E.Busemann Sokole, N.E. Herrera, R.F.Mould, and V.Volodin~

Various 99m-To-complexes containing TcO:N~-cores have been proposed as basic structures for the design of new radiopharmaceuticals. The present study describes t h e s~rnthesis a n d t h e c o m p l e x formation of N-(carboxymethyl)1,g-diaminoebhane, N-(earboxyethyl)1,2-diaminoethane~ N-(ea~boxyethyl)1,~-diaminopropane and Bis-N~NU(aminoacebyl)3,2-diaminoethane. The 99m-To-complexes of t h e s e l i g a n d s h a v e b e e n p r e p a r e d in aqueous solution at pH ~I0 either with sodi~, dithionite or w i t h S n ( I I ) as reducing agents. The radiochemical yields were always greater than 95%. The stability of the complexes was de%ermined at ~arious pH-v~lues a~Id c o m pared with the dissociation patterns o f s o m e know1% T c 0 z N @ - e o m p l e x e s . Relationships between ligand structure and complex stability are discussed. Tissue distribution of t h e t i t l e c o m plexes were determined in rats. The d)tnamie b e h a v i o r was studied by sequential seintigraphy of the renal excretion in rabbits. The 99m-Te-diand tetramine complexes were rapidly eliminated by the kidneys in both animal models. No otheT organ was significantly involved in activity uptake. The renal excretion ~as somewhat lower than the excretion of 99m-To-DTPA, The different in rive behavior is d i s cussed in terms of the different structures of the di- and be%famine ligands. Klinikum der Universitit Heidelberg Zentrum Radiologie FoTsohttngsgruppe Strahlenklinik Ym Neuen/leimer Feld 52S 6900 Heidelberg F.R,G.

Twelve countries partcipated in the intercomparison for which total performance phaetons were used. The CAP (College of American Pathologists) brain phantom, with 13 targets from h to 20 mm diameter, and liver phantom~ with 8 targets of 16 mm diameter and target/backrgound ratio of 0.72/I to 0.91/I were circulated to 59 laboratories. The London liver phantoms redcoded (target sizes I cm, 1.5 cm and 1.5 cm) green-coded (target sizes ] cm, 2 cm, 2.5 am) were circulated to 40 laboratories. Ninety-five studies were performed with CAP-brain phantom, 94 with CAP-liver phantom and 62 with London liver phantoms. A total of 157 imaging devices were tested, of which only 15 were linear scanners, the rest being gamma-cameras, mostly purchased after 1975. The study showed that the small targets (4-6 mm) were rarely identified and no laboratol 7 detected all 13 targets present in the CAP-brain phantom. A number of laboratories detected all 8 targets in the CAP-liver phantom and only a small number detected as few as 4 targets. However, one laboratory did not detect any targets. On average I false positive and 6 false negative results were reported by participants using CAP-brain phantoms and one false positive and false negative result using CAP-liver phantoms. Testing of Loudon liver phantoms with tissue equivalent rubber models of an abdomen gave the following data: I cm target in the green-coded phantom was never visualised. Two targets in this phantom were identified correctly in 34% and one target in 52%. Equivocal and false positive results were reported in 42%. For the red-coded phantom with its small target sizes, the "liver" was reported as normal with no targets present, although in 11 of the 62 studies one target was correctly detected. The WHO intercompsrison demonstrated the need be establish or to improve the existing quality control programme in the laboratories which participated in this study.

WHO, Radiation Medicine Unit, CN-1211 Geneva 27.

Between 1981 and 1983, 68 centres in 12 European countries participated in a comparison study organized by the World Health Organization (WHO) to assess the quality of nuclear medicine imaging. Transmission CAP brain and liver phantoms and emission London liver phantoms were used. Participants imaged these phantoms using their routine clinical imaging procedures and reported the total number, size and location of targets detected, and details of the instrumentation and imaging parameters used. The results were analyzed with respect to the number of true positive, false positive, true negative and false negative targets detected. The CAP phantom results showed wide variations between centres. Target detectability dropped below 75% for target sizes less than 9 to 10n~n, and for target contrast less than 0.84:1. Results did not appear to be influenced by instrument, collimator, energy window width or total counts acquired. Hot-target size was always overestimated, whereas cold-target size was generally underestimated. The London liver phantom similarly showed a variation in results. Targets of i cm were never visualized, but 2 and 2.5 cm targets were more frequently identified in the Netherlands than in other countries. This could not be explained by technique or instrnment used, but suggests a more conservative reporting approach in other countries. This study was a stimulus to participants to improve imaging performance and to increase their awareness of quality control. The WHO has now initiated another s~ch intercomparison study on a wider scale using other transmission phantoms. University of Amsterdam, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.

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WORLD HEALTH ORGANIZATION (W~O) AND A REVISED CONCEPT OF QUALITY CONTROL IN NUCLEAR MEDICINE E. Eusemann Sokole, T.D. Cradduck, H.D. Roedler

A NORWEGIAN NATIONWIDE QUALITY ASSURANCE PROJECT IN NUCLEAR MEDICINE

CR-51 EDTA : A SIMPLE METHODTO ESTIMATE GUT PERMEABILITY IN CHILDREN. F. Sodoyez-Goffaux, P, Forget and A. Zappitelli, An increased gut permeability to macromolecules is thought to be an important factor in the development of food allergy. This latter disease may be either primary or secondary to intestinal mucosal damage due to acute gastreenteritis or other diseases. Bjarnason et al. recently demonstrated that Cr-5] EDTA could be used to estimate gut permeability in adults. In the present work, we report a preliminary evaluation of this test in normal adults, in children with failure to thrive but no gastrointestinal tract disease (age 0.8 to 12 years) and in children recovering from acute gastroenteritis (aBe 0.2 to 1.4 year) or suffering from eczema (age 0.2 to 4 years). After an 8 hours fast Cr-51EDTA (50 uCi below 6 years of age, 100 uCi above) was administered orally, urinary excretion of radioactivity was measured during the following 24 hours and expressed as percentage of oral dose. Results in adult volunteers and control children were 2.35 + 0.77 % (mean~ SD) and 2.50 + 0.78 % respectively. By contrast, urinary exCretion of radioactivity was significantly increased in gastroenteritis (range 3.4 - 29.6 %) and eczema (range 6.5. - 22.8 %). In adult volunteers, absorbed dose to stomach, small bowel, colon, gonads and total body were evaluated at 2.2, 2.7, 35, 3.5 and i mrad/ 100 uCi respectively. We conclude that I. gut permeability to Cr-51 EDTA is the same in control infants and in normal adults. 2. permeability is significantly increased in healing gastreenteritis (p <0.001) and eczema patients (p < 0.001), supporting the hypothesis that increased gut permeability is an important factor in the development of food allergy. 3. provided that renal function is not severely impaired, this simple and non invasive test may be used to assess small bowel integrity in children. Dpt of Pediatrics, University of Liege, 66 bld de la Constitution, B-4020 Liege, Belgium.

In 1980 a group of scientific institutions, funded by the German Federal Ministry of the Interior (BMI), together with the WHO, held a meeting of European experts in Heidelberg to establish a set of guidelines for quality assurance in nuclear medicine. ~ i s meeting was comprehensive in its scope and led to the publication in 1982 of a WHO document outlining recommended quality control (QC) protocols for nuclear medicine instrumentation and radiopharmaceuticals. A subsequent meeting of many of the same experts, again supported by BMI, was organized by the German Federal Health Office and WHO in Munich, Nove~ber i983. This meeting took the form of a workshop at which the protocols advocated in the 1982 publication were put into practice and compared with protocols suggested by other interested parties such as the IA~A, American Association of Physicists in Medicine and Hospital Physicists' Association. The result of this workshop was the formulation of a revised concept of QC. Instead of rigorous daily, weekly, monthly and quarterly protocols, the workshop participants suggest that a simple total system QC test be applied on a frequent (daily) basis. Any deviation of the results of such a test from the accepted norm will require further investigation and decision trees can then be applied to localize faults. Infrequent Qc procedures serve no useful purpose if the total system test continues to function according to established standards. Such tests should be done annually and as post-service cheks to verify that system performance has been restored. The section of the 1982 document relating to single photon tomography and data handling systems were also reviewed and revised in the light of more recent experience, University of Amsterdam, Academic Medical Centre, Meibergdreef 9, Amsterdam, Netherlands.

By A Skretting, K Rootwelt, T Berthelsen, L Hertzenberg, T EjOrnerud, E Boye, H J merdrum, D Falch and P 0 Bremer This paper presents the methods used and the results obtained in measurements and tests performed on a total of 24 activity meters and 30 scintillation cameras in 24 nuclear medicine laboratories in Norway. The physical measurements on the scintillation cameras included l) a flood field study, 2) a geometrical resolution study with a small version of the BRH-OHTP transmission pattern with hole spacings ranging from 4 to E mm, 3) a study of energy resolution with a specially designed phantom, 4) measurements of count rate characteristics with absorbing copper plates and 5) measurement of sensitivity with a 57-Co source. As a total performance test, a liver/abdomen phantom was filled with SO mBq 99m-To and imaging and reporting was done by the staff of the actual laboratory and according to their study protocol. The quality of the activity meters was found to be satisfactory. Scintillation camera quality was variable. For example only 40 percent of the cameras had uniformity in the cathegories "excellent" and "very good", and 37 percent of the cameras managed to resolve more than 5 groups of holes. In the opinion of the project group, only 30 percent of the laboratories had a satisfactory total performance, managing to detect and describe satisfactory 4 out of 5 simulated defects in the liver phantom. Lack of information density and insufficient ntu~ber of projections was the main reason for unsatisfactory results with good cameras.

From the Norwegian Society of Nuclear Medicine and The State Institute of Radiation Hygiene, Oslo.

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A 167

JADED% C~ . d.I.°~nedo,

CHILDHOOD ABDOMINAL TRAUMA - AN EASY AND EFFICIENT DIAGNOSTIC APPROACH. D.L. Gilday, J.M. Ash, B.J, R e i l l y , D.J. Alton.

NEW RADIONUCLIDE M~THOD OF EVALUATING SHUNT FUNCTION AND CSF CIRCULATION IN HYDROCEPHALUS. R. Hok%uan-Giles.,A.McLaugblin & I. Johnston.

The di??erentiation between intra and extrahep~ t~c cholestasis in a jaundiced newborn is a clinical proWlem. It ~s necessary the early identification of hiliarv atresia rnA 1 and the d~rfere~tiatJon from neonatal hepatitis iNN). ~he e?fectiveness of surgical treatment for ~A decreases along the time, specially after 3 months. Tn this werk, we stud~ed the sensitivity, specificity and accuracy of radionuclide bepatobiliary a~ents for the d i a ~ o s ~ s of BA. 2s jaundiced newborns : < 3 months old) were imaged after I.V. injection o ? 1-2 mCi of Teegm-parabutyl-IDA. Images were obtained at 5,10 20,30,45 and NO min. and at 2,4 and 24 h., for identificatio e radiooativity in the intestine. No premedication was used. The £inal diagnosis was RA in 16 patients (by surgery and intraoperetire cholao~io~ra~by) and HNN Jn I~ (b~opsy: 3 m, laoarotomy:l p, and cl~nical improvement:8 O)- The total and direct bilirubin levels in serum showed no sdKnificant differences. 15 patients were correctly diagnosed of eA and I0 of N~. We observed in the oatients with NN a more hepatocyte dysfunction, in ~eneral, than in the patients with RA. The sensitivity foot the diagnosis of biI~a~y at~esia was 9 3 ' ~ , the soecificity was H3'3% and the accuracy was °q'2%. The absence of ~ntestinal radioactivity throuRh Pd ho was the most useful criterion because showed significative differences between both diseases (D
Single Photon Emission Computed Tomography (SPECT) has v a s t l y improved our a b i l i t y to examine m u l t i p l e organs which normally overlap in planar images. I f the presentation i s k i d ney trauma an IVP w i l l be p e r f o ~ e d in the Emergency Room, I f the child i s suspected of having l i v e r and/or spleen trauma, a f i v e minute kidpey scan w i l l be performed f i r s t , i f normal, a SPECT l i v e r / s p l e e n study and a continuing kidney study w i l l then be performed. I f the c h i l d has a head or spinal i n j u r y , a CT examination is done of those areas with t h i c k s l i c e s of the l i v e r and spleen and kidneys at the time of head or spine CT . This permits the most e f f i c i e n t and cost e f f e c t i v e method f o r the i n i t i a l evaluation o f patients suspected o f abdominal trauma. Follow-up l i v e r and spleen studies are primari l y done using SPECT. The kidneys are f o l l o w ed up by e i t h e r intravenous pyelogram, DMSA or 91ucoheptonate kidney scans using SPECT, which allows functional q u a n t i t a t i o n in the recovery period. In 51 patients suspected of having l i v e r and spleen trauma, planar imaging detected 5 l i v e r and 14 splenic abnormalities whereas SPECT determined 7 l i v e r and 17 splenic abnormali t i e s . Currently we are using t h i s as part o f a prospective study to compare the IVP and kidney scan performed in this manner w i t h i n 24 hours of i n j u r y . In conclusion, any hospital with access to good Nuclear Medicine (high q u a l i t y imaging and 7 day a week on-call service) should have this easy, accurate and cost e f f e c t i v e approach to i n v e s t i g a t i o n of blunt abdominal trauma in children.

Clinics Puerta de Mierro. Dept. of Nuclear Medi cine. nan Mart~n de Porres, 4. Madrid-B5. ~pai~

D i v i s i o n of Nuclear Medicine, The Hospital f o r Sick ChildTen, 555 U n i v e r s i t y Avenue, Toronto, Ontario. M5G 1X8 Canada

Radionuclide evaluation of shunt function using current techniques involves the injection of tracer into the shunt apparatus with assessment of its clearance through shunt. A new method for the evaluation of shunt function over extended periods which provides added information on alternative pathways of CSF has been developed. At the tJ~ne of insertion of the V-P shunt for hydrocephalus a separate ventricular catheter with a Rickham reservoir was placed into the frontal horn of the right lateral ventricle. The reservoir was punctured under aseptic conditions, the pressure measured and a CSF sa/uple taken for culture. One mCi of Tc99m OTPA was then injected. An external standard of ImCi of tracer was drawn up at the same time. Data was collected onto computer for 2 minutes and a ratio of the ventricular counts to standard counts generated. Scans were performed at 2,4,6,20,22 and 24 hours. From these ratios a clearance curve was obtained and evidence of tracer in peritoneal cavity or CSF pathways assessed. Thirty infants were studied over a 5-year period. Serial studies were performed in 24. Twenty cleared tracer rapidly down the shunt and remained either totally or partially shunt dependent. Four (17%) demonstrated proqressively less radionuelide clearance down the shunt with circulation via the basilar cisterns and normal CSF pathways. Ten children had clearance studies to assess patency for diagnosis of shunt malfunction. In 4 obstruction was confirmed at surgical revision. Six patients with normal studies recovered uneventually. This method permits an accurate assessment of drainage of ventricular CSF via the shunt over an extended period and the patency of normal or alternate CSF pathways where the shunt is malfunctioning.

I.nsstej6n, ~.Jars, J,P6veda, J.namos and ,T,Ortiz 3errocal.

Department of Nuclear Medicine, Royal Alexandra Hospital for Children, P.O. Box 34, CAMPERDOWN. N.S.W. AUSTRALIA. 2050.

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SPATIAL PROBABILITY M-%PPING OF SEQUENTIiL CHANGE DURING RADIOIPE~JNOSCINTIGRAPHY. C.C. Nimmon, MoJ.Carroll, W. Flatman, P. Marsden, M. Granowska, J. Boman~i and K.E. Britton

OUR E X P E R I E N C E S

CYTOTOXIC ACTIVITY OF LYMPHCCYTES AGAINST RENAL TUMOR CELLS AND PROSTATIC CARCINOMA CELLS. G. Neidel, *A.iehmer, *P. Sc h w e ~ e r and I.i~btt~er

With current labelled tt~nour associated monoclonal antibodies, tO/hOUr uptake usually increases with time over a 24 h~ period reaching a maximu~ of I to 7°% of the injected dose. Visual assessment of regions of change is difficult due to a combination of statistical noise, a high backgrotmd activity, complexity of the image and non-congruent image registration. This study presents a statistically based method in which temporal differences between a pair of spatially aligned images are quantitated in terms of a global linesm scaling facto= and a regional map of areas of altered distribution expressed in terms of probability. Alignment of the images is achieved with the aid of 5 radioactive markers which a~e accurately superimposed on skin marks for each recorded image of the series. 0c-ordinates corresponding to the centre of each marker are computed using a cross-cor~elation technique and correction for both translation and rotation is then made using a least squares error minimizafion method. Comparison between the sets of pixel values defining a pair of aligned images is made using a weighted linear regression. Pairs of values with deviations greater than 1.2 times the standard error of the estimate SEE, a~e excluded and regression is continued iteratively until a plateau in the Chisquared statistic is reached. Assuming a normal distribution about this linear segment, a probability map is constructed with levels p ~ . 0 0 1 , .01,and .05 corresponding to deviations of 5.4, 2.58, and 1.65 SE~ respectively. Effects of statistical noise are minimised by incorporation of a hierarchical cluster criterion. Preliminary studies with this method have shown enhanced ability to delineate significant regions of chan~e in ovarian cancer images obtained with lZBl labelled monoclonal antibody in agreement with surgical findings at lapsmotomy. St Bartholomew's Hospital, London, EC1,U.K.

~TH RADIOI~ODETECT I O N O F H U ~ A N TU~.~OURS G R O W I V G O N A T H Y MIC NUDE ~ICE. Z.Dienstbler, H.KopPivov~, P.Pou~kov~, ~,Nov~k, A.Glagoli~ev~, P.DvoP~k, J.Pospf~il, J.Du~kov~,J. K0va~fk, L.Lauercv~, J.Bubenfk Three types of human tumours (rectum carcinoma, bladder carcinoma T - 2 4 and mammary carcinoma YDA-HB-231)growing an athymic nude mice RALB/C were used for radioimaglng studies, 131-I-labelled rabbit p01yclonal antibodies to hmman placental ferrltin, mouse monoolcnal antibodies 7 E 9 s p e c i f i c f o r c e l l line T-24 and monoclonal antibodies ( H B C a 12) specific for MDA-HB-234 cell line were administered into mice i.v. or i,p. By means of external imaging with a gamma camera sites of abnormal radioactivity w e r e a s s e s s e d in 2 - 7 - d a y i n t e r v a l s . R e c tal carcinomas were clearly vizualized with radiolabelled antibodies to human ferrltln. Similarly we succeeded to det e c t t h e b l a d d e r t u m o u r s w i t h t h e use of 7E9 antibodies as w e l l as t h e m a m m a ry carcinoma with HBCa 12 antibodies. At intervals of 72 hours and longer blood background gradually decreased bat in the sites of tumours the radioactivity remained. Accumulation of radiolabelled antibodies i n s i t e s o f necrosis and necrotic inflammation was found by preliminary distribution studies. Imaging of tumours with antiferrltin and control nonspeclfic F/ab'/2 fragments will be also reported. Institute of Biophys. and Nucl.~ed,,Fac. Gen.Med., Charles University, Prague Institute of P a t h o l o g y Pac.Gen.~ed., Charles University, Prague Research Institute of Clln. and Experlm. Oncology, Brno Institute of ~olecul.GeneticCzechoslov. Academy of Science, Prague, CSSR

A suhpopulation of lymphoeytes, called natural killer cells (NK-cells), shows a spontanous capacity to kill tumor cells without previous sensitisation. Therefore, it plays an important role in tumor defence. T~e ability to prevent formation of metastases is suggested. ~ t h o d : The activity of the NN-cells was determined by means of a Cr-51-releasinA-test in oatients with prostatic carcinoma or renal adenocarcinoma. As target cedis were used: K-562 lymphoma cells, cultured prostatic earcinoma cells (PC-3) and homologous (Caki-]) and autolo~ous renal t&~or cells. The in vitro-stimulation with Interferon and other i~unstimu]sting a~ents was performed. Patients were grouped according to therapy and stare of disease. The results we, e compared to a control group of healthy men of same age. Results: 1.Patients with locai carcinoma showed a nearly u n c b a ~ e d NR-oell activity. 2. Patients with renal carcinoma who survived surgical therapy for more than one year and remained free of metastases showed normal activity. All patients who died On account of their disease had low or missinE activity already preoperative. 3. Estrogen therapy of prostatic carcinoma suppressed the activity of the NK-cells gradually in course of treatment, while estramustine did not change it. 4. In vitro-stimuiation with Interferon was possible. The degree if it decrased on treatment with estrogen and with progressive disease. Other immunstimulants did not affect the activity in vitro. 5. BCO vaccination stimulated low NK-cell activity; high activity could not be increased further. Nuklearmedizinische ~/inik und Poliklinik r.d.lsar der Techn. Universit~t Mlnchen *Urologisehe Klinik und Poliklinik r.d. Isar der Techn. Universit~t Mfinchen Ismanin~er Str. 22, D-8000 M3nchen 80~ F.R.G~

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ILIO~%VIC ~Y~PHOSOI~TIGP~A2P~ - C L I N I CAL S I G N I F I C A T I O N . T.Pop, ~.G~le~en~, N.Vesilese~, Doini~a Dumitreehe, E. Toroiman mnd V.Neagm

S U ~ R Y OF 211LNMPHO-SCINTIGRAPMIES NITH Tc 99m RHENIUM SULFIDE - COMPARATIVE STUDY WITH CT ULTRASOUND AND RADIOLOGIC LYMPHOGRAPHY. M. Melioul and E. Lubin.

RADIONOCLIDE SCAN IN NEOPLASTIC INVOLVEMENT OF L~MPHATIC SYSTEM.NodG~ ~. ,~'64~co ~. , C e n ~ <. ,

Detection of l y m p h n o d e m e t a s t a s e s in patients with genltourimmry neoplaetie d i s e a s e ie i m p o r t a n t i n d i s g n O S i s , f o r staging disease, to establish the type and e x t e n d o f t h e r a p y ( s u r g i e a l , e h e mio and/or radiotherapy). Since t h e r a d i o l o g i e t e e h n i q ~ e s , c o n trast lymphangiography, ~Itrasound,and computerized tomagraplkv s r e s o m e t i m e s associated w i t h a h i g h falee-negative rate, we performed the iliopelvie lymph~ oscintigrsplkv as a complementary metho& By this technique we have investigated 33 patients with different types of genitourinamy cancer.To the patlemt in supine position on a pelvic examining table we have administrated tw@ injections, approximatel~ i mCi each, of Te-99m-Lymphoscint (sulfur micrecollo-id-tin complex) - Solco, Iste~el to the a n a l m a r g i n , l o c a t e d at 3 a n d 9 o'cloek, 30-40 mm into the isohioreetal fosse, Sointillatian images were obtained 3 hr following radiocolloid edministrstion u s i n g a scintillation cammera connected t O a h i g h c a p a c i t y c o m p u % e ~ S o i n iron 5 that has the possibility to ree a r d t h e i m a g e s o n P o l a r o i d ( b l a c k and w h i t e , c o l o r ) ~r x - r a y f i l m . The o b t a i n e d d a t a p r o v e d t h a t t h i s t e e hnique offers a clinically acceptable level of sensitivity and e~ecifioit~ tO eval~ate %he internal, external, common iliee lymph node groups and the p a r s aortic chain.

Recent advances in chemistry, engineering and electronics have made new radiopharmaceuticals and new diagnostic modalities available. Pelvic and axillary lympho-scintigraphy was done on 211 patients during the last 20 months. With Tc 99m rhenium sulfide (TcK-17-C.I.S.), the vel~ city of migration of the radiocolloid enables a good quality visualization of the lymph vessels and lymph nodes of the abdominopelvic and axillary regions with a remarkable specificity and sensitivity. In 45 patients, lympho-scintigraphy was done and compared to diagnostic images taken via other modes such as computerized tomography, radiologi¢ iy~phography and ultrasound. This study demonstrates advantages and disadvantages of each diagnostic modality in various pathologies of the abdominopelvic lymph nodes. A definitive diagnosis wms derived from surgical and histological findings. Department of Nuclear Medicine, Beilinson Medical Center, P e t ~ Tiqv& and the Tel Aviv University Sackler School of Medicine, Israel.

Yn c ~ c o k oncolo~, ~ F A ~ t c ~y~em ~ v e ~ u ~ n A ~ a .~i~;~i~ceni i . ~ e n c e on ~ta~i~, trea~men~ ~Ae l ~ o l l c % ~ e m i~ not e a ~ ~vo~fJ_#oZ~. For e ~ a ~ u ~ d&a~no~tc p ~ o ~ a n c ~ o[ rad~oneci&de scun, Zmo m~btod4 Aave beet employed ~o detect nee picnic ~voivemen~ o~ l ~ m ~ a ~ c ~toJ~.Adenoiym~ho scO~gra~A~ {~OLS )~ p~r~o~med bF. ~ubcu~en~u~ eclion o[- ggm~Fc{Re; ~, cu~d,~,9 ~m~J l o Z ~ , re.Lc~o~ ~£a~ic r m ~ ~ e o b to J ~ . Yr ~ t~ e l c ~ t ~ o ~ e ~ , eve~c~Le~ b~z6 7 - ~ a l ~ O l e

~mpAo4ciniigaap~( L5 Y[

~t p4e~ea£ ~ e 218 M i e n i ~ unde~e~t ~O~: 123 o~ i ~ i e n ~ mommc~ cA(zi~;2@ o£ i~io peivic ~ d (z~domi_ ~ cA. ;64 o[ aec~ c]z.;9 o£ oxillo~ cA.._.Kuz~Ae2m~ 21 o~ ~h~e p~Lenl~ undemoeni LSYP~o c o n ~ a po~L t i r e r ~ u J ~ o~ AD~I HJ~J;2OZO~_COJ_~oInJ~lG/J~otl O[

MDL~~how~ a Tree Po~t~&ve Fraction o: 9~/o;Tr~e ~ Ziv~ of. 73%; LLk~iAoodRo~&Lo o[-8(Y~.f~ore recoJ~5/~ t,~rod~c~/~WSP ce,~not be c o ~ r e o t ~ ~udp~. Yn Am_ ~Ao~ ' opinion LPYPi~ a ~i~pie a~d r ~%&ableme~Aod [or d ~ e c l ~ g m ~ Z ~ t L c ~ p ~ o d ~ . FAeA£~ co~_ r ~L~Lon ~ hZaZolo~Lcc~ ~L~IL~#~ ~Ac~ LA~ ca~_ ph~ctc ~ a ~ w i M ~ ame~Aod v ~ c d l J ~ non ~zv~tve, ~a~e ~nd e ~ ~o p ~ o ~ _ . Not o ~ ~ v e ~ 9 ~ c i o n ~ ere n ~ c ~ tn c ~ e o~ nor~el ,o~,~,~__. TA~ po~il!_ v e re~ul~m~ r ~ u e s ~ a LSF~t e ~ , in oad~ to con

Clinic Hospital Pandari 76231 See.Psndari 20, Baohares% ROMANT~a

NUC~eCO~[~c.J31~ Fz14.~LU~elUFULv~ J i ~

CcL~_.tol.Lca

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201TI CI UPTAKE IN MELANCMA:"]~VIVO" AN6LYSIS OF THE ~CHANISM.sL~Dn~e.,G.Arie~,F .Avinol A .Florio I ,M.Salvatore,G .De

QUANTITATIVE 18F-FLUORODEOXYQLUCOSE UPT A K E INTO R O U S S A R C O M A OF THE RAT. N. Paul, A. Kiuru, K.-O. S g d e r s t r ~ m , R. J o h a n s s o n

A C C U M U L A T I O N OF 1 8 F - F L U O R O D E O X Y O L U C O S E (FDG} INTO S O M E H U M A N C A N C E R S . £. Paul, A. A b o n e n , A. K i u r u , R. J o b a n s s o n , M. 8 a a p a r a n t a , O. S o l i n , E. N o r d m a n

18F-fluoro-2-deoxyglucose (FOG) is in use as a p o s i t r o n e m i t t i n g r a d i o p h a r m a ceutieal for estimating glucose consumption in v i v o by positron e m i s s i o n t o m o g r a p h y (PET). In o r d e r to e v a l u a t e FDG as a m e a s u r e of g l u c o s e m e t a b o l i s m in m a l i g n a n t t u m o r s , we have d e t e r m i n e d FDO a c t i v i t y in the R o u s s a r c o m a of the rat at 30, 60 and 120 m i n u t e s a f t e r an iv i n j e c t i o n . The u p t a k e s at t h e s e times w e r e 0 . 9 ± 0 . 3 , 1 . 5 + 0 . 6 and I ~ 4 + 0 . 7 (~+SU) % of g i v e n d o s e / g t u m o r t i s s u e , respectively (N=7 at e a c h p o i n t ) . The l a r g e v a r i a t i o n s c a l l e d for c o r r e c t i o n s and, hence, we c o m p l e m e n t e d the e x p e r i ments with histopathological morphometr i e a l a n a l y s i s of the t u m o r s a m p l e s . W h e n c o r r e c t i o n s w e r e m a d e for n o n - t u m o r t i s s u e and for t u m o r n e c r o s i s , it was f o u n d that u p t a k e as a f u n c t i o n of the p e r c e n t a g e of v i a b l e t u m o r in the s a m p l e c o n v e r g e d at 100% of t u m o r at 2.2, 2.3 and 2.4 % of g i v e n d o s e / g , for 30, 60 and 128 m i n u t e s , r e s p e c t i v e l y . The l i n e a r r e g r e s s i o n f u n c t i o n s w e r e y=-O.93+O.O3x (N=5), y = O . 2 6 + O . O 2 x (N~O) and y = - 1 . 6 2 + O . O 4 x (N=8), r e s p e c t i v e l y . The c o r r e s p o n d i n g c o e f f i c i e n t s of corr e l a t i o n w e r e 0.91, 0.68 and 0.52. It a p p e a r s that in this t u m o r and in this a n i m a l the a b s o l u t e FDG u p t a k e s e e m s to be c o n s t a n t at a b o u t 2 . 3 % of i n j e c ted d o s e / g of v i a b l e t u m o r t i s s u e , at l e a s t as of 30 m i n u t e s p o s t i n j e c t i o n . If the s a m e is true f o r h u m a n c a n c e r s , it o p e n s p o s s i b i l i t i e s of d e t e r m i n i n g r e s p o n s e of t u m o r s to t h e r a p y in v i v o by PET.

M a l i g n a n t c e l l s are g e n e r a l l y g l y c o l y t i c a l l y m o r e a c t i v e than n o r m a l cells. With the a d v e n t oF FDO, c a n c e r d i a g n o s i s in v i v o b a s e d on e n h a n c e d t u m o r g l y c o l y s i s has b e c o m e p o s s i b l e . We have s t u d i e d 7 unselected adult cancer patients with 0 . 7 - 4 . 0 mCi FOG iv d e t e c t e d w i t h a specially collimated gamma camera with a I in. c r y s t a l . R e s u l t s : T h e r e w e r e 4 pat i e n t s w i t h m ~ t a s t a s i s in the c e r v i c a l l y m p h n o d e s , of t h e s e 2 were s p r e a d of head-and-neck c a n c e r , I of u n k n o w n oridin, I of m a m m a r y ca; I p a t i e n t had rec u r r e n t c o l o n ca; I r e c u r r e n t ca of the l u n g w i t h m e t a s t a s i s to c e r v i c a l in and liver; I h e p a t o m a . All t u m o r s w e r e seen on the s c a n s w i t h u n s u b t r a c t e d tumor-tos u r r o u n d i n g r a t i o s of 1 . 3 - 2 . 3 . In the hep a t o m a a l a r g e c e n t r a l d e f e c t w a s seen. In all of the in m e t a s t a s e s FDO a c c u m u l a t e d e n o u g h for v i s u a l i z a t i o n , although the o r i g i n of the d i s e a s e was d i f f e r e n t . We h o p e d to be able to i d e n t i f y the prim a r y c a n c e r in the p a t i e n t w h o only had c e r v i c a l in m e t a s t a s i s , but a FDG w h o l e body scan was not i n d i c a t i v e . This cont r a s t s to the p a t i e n t w i t h r e c u r r e n t lung c a n c e r w h e r e all k n o w n m e t a s t a t i c s i t e s s h o w e d up on a w h o l e b o d y image. The patient with hepatoma s h o w e d that FDG can d i s c r i m i n a t e b e t w e e n n e c r o t i c and v i t a l t u m o r t i s s u e . C o n c l u s i o n : FOG a c c u m u l a tes i n t o d i f f e r e n t c a n c e r s in man a n d a p p e a r s to be s e l e c t i v e for v i t a l t i s s u e . F u t u r e e x p e r i e n c e will r e v e a l the true p o w e r of FDG to d i s c r i m i n a t e a m o n g the m u l t i t u d e of h u m a n m a l i g n a n t and b e n i g n l e s i o n s . PET is m a n d a t o r y for q u a n t i t a tive i n f o r m a t i o n .

In order to evaluate the "in vivo" u~teke mecheeis7 of 201TI CI we studied due whale-body distributionin 12 patients.starti~ at 30 sin. otter dne i.v. injectionof 201Tl C1 (37 ~q), Six patientshad ~ e l ~ ; O~e hod an intcsder~ r~evus; one had a medullary carcinc~ of due nipple;~o had s ~ carcinomaof the Shin and ~ o bad fibrotic t u ~ , a fibros~ and a fibr~c~tosis. At due time of due s ~ t4o cut of six melg~oma patients had ly~h node involvmentwithout a p r i ~ lesion. Three had both p r i m ~ lesion and nodal metastasis; one patient hod due primary lesion alone. All of th~ showed 201TI uptake at the level of the necplastic tissue. The iciest upt~xe was observed in the patient with no metastasis. No uptake was seen in reactive b;~h nodes (if p~ser,t). ~b~%~ ~ e ocher patien~ a significont uptake was seen in a/l but due one with an intrad e ~ naevus. Very l~v uptake was seen in fibr~cmatoals. Our data indicate that d%allit~nuptake is not dep~dent on the presence of p i t t e d cells ( r ~ or trorlsformed) at due level of the lesion, but it s e ~ related to differ~t biologic factors. Indeedi thalliumuptake is preser/t also ~ m a l i ~ t skin tomou~ wi~1 no p i t t e d cell. In a previous study we de~trated that TI C1 uptake in cell culture s y s ~ is affected by g~x~in K rate a~d transformstion "per so". The present clinical evaluation is in agreement with this possibility.relativelyto ~ l o r ~ . So T1 Cl could be proposed as a biologicmarker of ~sl i ~ c y . Finally, in c ~ e~iences ly~h node uptake s~n~ly su~este intronodalpre~ence of metastatic tissue. Servizio di M~dicina Nucie~ iDivisione di Chirur~ia III Istituto NazioDale dei T ~ r i Fondazione S. P~cale-N~ooli.

Turku Medical Cyclotron Project, Turku University Central Hospital, SF-20520 T u r k u 52, F i n l a n d

Turku Medical Cyclotron Project ~u U n i v e r s i t y C e n t r a l H o s p i t a l , Turku, Finland

and TurSF-20520

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COMPARISON OF RETENTION IN TUMOR TISSUE BETWEEN IODINE RESPECTIVELY BROMINE LABELLED DYES. R.Senekowitsoh, H-J.Sinn*, S.M~llenst~dt, H.Kriegel

TU~iOR B L O O D F L O W ~ E A S U R H ~ E N T S W I T H TWO D I F F U S I B L E R A D I O N U C L I D E S . J. H e i k k o n e n , ~. M g n t y l ~ and J. P e r k k i 5

~Y~ I N V E S T I G ~ T I C N S C O N C E R N I N G THE POSb l B I L I T Y OF U S I N G Th~ N O N C O ? ~ E N T I O N A L S C I N T I G R A P H Y OF T H Y R O I D GLA~D IN E A R L Y CANCER D I A G N O S I S OF THIS GLAND. B. E u e z n o and Z. g z y b i ~ s k i

A f t e r mice bearing transplantable mammary tumors had been injected i . v . with dyes as bromphenol blue er bromcresol green a delayed excretion of these substances from the tumor tissue became evident. The rapid blood clearance and the prolonged r e t e n t i o n of these dyes labelled with Br-77 led to r a t i o s of the a c t i v i t y concentrations between tumor tissue and blood as well as between tumor t i s s u e and normal mammary t i s s u e of 5.3 and 6,11 r e s p e c t i v e l y w i t h i n B hours after administration of t h e dyes. These r a t i o s turned out to be dependent on the concentration of the dyes in the i n j e c ted s o l u t i o n . Thin-layer chromatograms of plasma, b i l e and urine were i d e n t i c a l with that of the injected compound and therefore confirmed the in r i v e s t a b i l i t y of the Br-77 label. Administration of the same dyes labelled with J-131 resulted in r a t i o s of the a c t i v i t y concent r a t i o n s between blood and tumor tissue and between tumor tissue and normal mammary tissue much lower than that o b t a i ned f o r the Br-77 labelled substance. The high a c t i v i t y concentration in the blood and the accumulation of r a d i o a c t i v i t y in the thyroid of the animals a f t e r i n j e c t i o n of the J-131 labelled dyes i n dicate that J-131 is released from the compound. Chromotography of plasma and urine confirmed the low in vivo s t a b i l i ty of the J-131 label in comparison to the 8r-77 label. Gesellschaft f~r Strahlen- u.Umwsltforschung mbH, Dep.of Nuclear Biology, Ingolst~dter Landstr. I , 8042 Neuherberg FRG *Krebsforschungszentrum Heidelberg, I n s t . of Nuclear Medicine, Nerenheimer Feld 280 6900 Heidelberg

Determination of t u m o r b l o o d f l o w requires k n o w l e d g e of the p a r t i t i o n coe f f i c i e n t of t r a c e r s b e t w e e n b l o o d and tissue. This p a r t i t i o n c o e f f i c i e n t is g e n e r a l l y a s s u m e d to be r e l a t i v e l y const ant and it s value is o f t e n d e t e r m i n a i a d in animal e x p e r i m e n t s or in v i t r o studies. In this s t u d y the m e a n b l o o d p e r f u s i o n of different h u m a n tumors was m e a s u r e d by using two d i f f u s i b l e r a d i o n u c l i d e s , K r - 8 5 m and X e - 1 3 3 . In o r d e r to e l i m i n ate the v a r y i n g b i o l o g i c a l f a c t o r s affecting the m e a s u r e m e n t s , the r a d i o n u s l i d e s were i n j e c t e d s i m u l t a n e o u s l y in i s o t o n i c saline into tumors. The injected amounts w e r e b e t w e e n 0 , 5 - 2 , 0 ml and the t u m o r v o l u m e s were b e t w e e n 0 , 5 - 1 5 0 ml, The r a d i a t i o n e m i t t e d b y the n u c l i des was m e a s u r e d by two d e t e c t o r s and p u l s e height analysators. Two-exponential curves as a f u n c t i o n of t i m e w e r e f i t t e d to the m e a s u r i n g p o i n t s and the m e a n p e r f u s i o n was calculated. N a n y s u b s t a n c e s p e r m e a t e t i s sues to an extent w h i c h is p r o p o r t i o n a l to t h e i r olive o i l - w a t e r p a r t i t i o n coefficients. U s i n g this fact the r a t i o of the p a r t i t i o n c o e f f i c i e n t s of k r y p t o n and x e n o n can be estimated. The c a l c u l a t i o n y i e l d s the v a l u e A K r / A X e = 0,46. The m e a s u r e d r a t i o of the p a r t i t i o n coe f f i c i e n t A K r / ~ X e was 0 , 5 9 ± 0 , 0 3 (mean + s.d.) in the m e a s u r e d 14 h u m a n t u m o r s . D e p a r t m e n t of R a d i o t h e r a p y and O n c o l o g y University Central H o s p i t a l , Haartma-' n i n k a t u 4, 0 0 2 9 0 H e l s i n k i 29, Finland.

The r e s e a r c h i n c l u d e d 92U p a t i e n t s of the E n d o c r i n o l o g y D e p a r t m e n t of medical A c a d e m y in Czacow, d i a g n o s e d as cold n o d u l e s of the t h y r o i d gland. E'ollowing v e r i f i c a t i o n that n o d u l e s are not cysts,all patients underwent additional s c i n t i g r a p h y of thyroid by m e a n s of iodine after TSH s t i m u l a t i o n and by m ~ ans of n o n c o n v e n t i o n a l m a r k e r s : g a l i u m 6 7 , s e l e n i u m - 7 5 , c a e s i u m - f S l . ~he eu~aul o t i o n of a d d i t i o n a l r e d i o n u c l i d e in n o d u l e s was d i a g n o s e d as thyroid cancer and the p a t i e n t s was t r a n e f e r e d to the s u r g i c a l treatment, a l o n ~ with checking of the level of Tg, n e e d l e biopsy end c y t o l o g i c a l e x a m i n a t i o n was p ~ rformed.2'ollowin~ s t r u m e e t o m y the findings w e r e v e r i f i e d by h i s t o p a t h o l o g i cal e x a m i n a t i o n s . T h e n u m b e r of thyroid cancer based on s u r g i c a l d a t a a m o u n t e d above 5 ~ . A d d i t i o n a l 8 e i n t i g r a p h i c exam i n a t i o n e n a b l e d the p r e - s u r g i e a l diag n o s i s of t h y r o i d cancer in 85~ of cas e s . T h e e f f i c i e n c y of the i s o t o p i c e x m m i n a t i o n s depends both on the kind of cancer and the kind of the m a r k e r used By m e a n s of 6 7 G a e x e l u s i v e l ~ the anapl a s t i c c a r c i n o m a was m a r k e d / 1 5 ~ efficiency of this m e t b o d / . B y use of 75Se 3 ~ of true p o s i t i v e f i n d i n g s were found. 1 3 1 0 8 e n s b l e d to d i a g n o s e the t h ~ r e i d cancer in 76~ of cases, uomplemen~ tsry to the 131Ca was the r e p e a t e d e x ~ m i n a t i o n by use of iodine f o l l o w i n g the T S E s t i m u l a t i o n . T h i s p r o c e d u r e was msed b e c a u s e the f o l l i c u l a r y c a r c i n o m a of t h y r o i d less e f f e c t i v e l y d e t e c t i n g 1310s in al~ost e v e r y case has s h o w n the c u m m u l a t i o n of iodine f o l l o w i n g the T S H s t i m u l a t i o n . D e p a r t m e n t of E n d o c r i n o l o g y of m e d i c a l { ~ y i n K r a k 6 v , , i 7 ~ o p e r n i k . . . . . k6w,

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THALLIUM-201 S C A N IN D E T E C T I N G ~ E T A S T A SES OF D I F F ~ E N T I A T E D T H Y R O I D C A N c ~ , L.Mange*,M.Cosimelli,A.Benaglia,P.Perri and R o C a v a l i e r e .

MULTIVARIATE SURVIVAL ARALYSIS OF THYROID CARCINOMAS USING WEIBULL AND COX MODELS ON 476 PATIENTS FOLLOWED IN THE SAME NUCLEAR MEDICINE DEPARTMENT.

SERUM THYROGLOBULIN IN PATIENTS WITH EAR LY THYROID CANCER WHO HAVE RESIDUAL THY~ ROID TISSUE AFTER TOTAL THYROIDECTO~IY, g. Panza, M. De Rosa, G. Lombardi, L. La penta~ M. Salvatore?

Our experience from 1978 includes 29 patients (pts) a f f e c t e d w i t h d i f f e r e n t i a ted t h y r o i d cancer and submitted to total t h y r o i d e c t o m y . In the last 10 pta w h o l e b o d y s c a n w i t h 2 0 1 - t h a l l i u m chloride ° a n d t h y r o g l o b u l i n (Tg) dosage were a d d e d in our d i a g n o s t i c protocol for early d e t e c t i n g tumor r e c u r r e n c e s during the follow-up. In t h i s g r o u p 3 pts show e d l o c o - r e g i o n a l m e t a s t a s e s and w e r e d e t e c t e d by w h o l e b o d y w i t h 2 S t - t h a l l i u m chloride in a s y m p t o m a t i c period. One ca~ se risulted false 9 o s i t i v e for l o c o ~ gional i n f l a m m a t o r y disease. All four pts w e r e c o n t r o l l e d w i t h s u r g e r y w h i l e the other 6 cases w e r e c o n f i r m e d true n e g a t i v e by w h o l e b o d y scan w i t h 131-I and periodic clinical controls.However, in one out of 3 pts w i t h l a t e r o - c e r v i c a l m e t a s t a t i c l y m p h n o d e s the w h o l e b o d y scan w i t h 131-I r e s u l t e d false negative. The a c c u r a c y rate of Tg m o n i t o r i n g w a s 100%.Iu our experience the 2 0 1 - t h a l l i u m scan a l l o w e d to detect m e t a s t a s e s of t h y r o i d carcinoma w i t h o u t i n t e r r u p t i n g suppressive therapy with L-T4,avoiding so TSH increase and discomfort for the therapy discontinuity. R e g i n a E l e n a Institute for C a n c e r R e s e arch. V i a l e R e g i n a Elena 291 - 00161 R o m e and *I~ P a t o l o g i a C h i r u r g i c a U n i v e r s i t y of H o m e . ITALY. ° B y k ' M a l l i n c k r o d t Cil

(Petten-Holland)

P. HANNEQUIN, J.C. LIEHN, C. M.J. DELISLE and J. VALEYRE.

GIBOLD,

WEIBULL and COX Models have already been proposed to model Thyroid Carcinoma Survival Data. We apply those models on a set of data obtained from 476 h i s t o l o g i c a l l y proven Thyroid Carcinomas followed in the same Nuclear Medicine Department. Maximum Follow up is 15 years. FOr the WEIBULL model the parameters are coded as in the 1979 OERTC study (D.P. BYAR and all. Europ J. Cancer 15 pp 1033, 1979). For the COX Model the p a r a m e t e r s are coded as in the 1983 Institut Curie Study (A.Fourquet and all. Annales d'Endoerinologie 44 pp 121, 1983). The regression coefficients are estimated by means of a second order non linear p r o g r a m m i n g technique and errors are estimated by the EFRON Monte-Carlo technique. For the WEIBULL Model the estimated values (~ i standard deviation) of the regression coefficients are : age : 0.058 + O.O12 ; sex : - O.12 + 0.37 ; principal cell type : 0.51 +-- 0.27 ; anaplasic : 2.02 ~ 0.28; T-category : 1.26 + 0.32 ; metastatic sites 0.46 + 0.28 a n d WEIBULL shape parameter k : 0.897 + 0.08. For the COX model the estimated values (+ 1 standard deviation) of regression coefficients are : age : 1.72 + 0.24 ; sex : - 0.07 + 0.25 and principal cell type : 1.21 + 0.14. A l t h o u g h our maximum follow up is longer, our results agree with those of the OERTC study. However, they differ from those of the Institut Curie study. INSTITUT J. GODINOT, REIMS, FRANCE.

In patients submitted to surgical thyroldectomy for early differentiated thyrold carcinoma (Ta,No,Mo) , the subsequent total body scanning with 131-I (TB S) often shows the only partial ablation of the thyroid tissue. In these patients high serum thyroglobulin levels (hT~) d~ monsrrate that the residual tissue in the thyroid bed is affected by differen~ tinted thyroid carcinoma. In the past 3 years, iu 29 subjects surgically treated for ezrly papilla~y tumor of the thyroid who had residual thyroid tissue, we measured serum hTg levels both durin~ suppressive hormonal treatment (l~g/KE/day of L-T3) and after the replacement ther~ spy discontinu~tlon. The results were as follows: fourteen patients had undetecta ble or very ic~ hTg levels (<9 ng/ml) -both during L-T3 therapy and after L-T3 withdrawal; sine patients during the sup pressive treatment had very low hTg le-vels (<9 ng/ml) that increased but remaining in the normal range (<5~ ng/ml) after the therapy discontinuation; six patients had an exaggerated increase of hTg values after L-T3 w i t h d r a w a l {>54 ng/ml), although they had undetectable hTg values duping the hormonal replacement. This study shows that serum hTg, in patients with early thyroid cancer previously submitted to surgical thyroid ectomy, is often undetectable during th~ suppressive hormonal therapy, although the p~tients have ~esldual tissue in the thymold bed. Moreover, it s h o w s that a group of patients, to all appearance homogeneous, could be divided in 3 subsets according to the variations of serum hTg levels during the suppressive therapy withdrawal. ~nstitute of Endocrinological Sciences; ~nd Institute of Radiolo~ieal Sciences. 2° School of Medieine,8Ol3i - ~APLES.

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THYREOGLOBULIN MEASUREMENT IN MANAGEMENTOF PATIENTS WITH DIFFERENTIATEDTHYROIDCARCINOMA. Z.Kusid, M.Senjanovid, Lj.Lukinac, D.Franceschi and {.Spaventi

CARCINOEMBRYONIC ANTIGEN,ALPHAFETOPROTEI N j B E T A g M I C R O G L O B U L I N AND F E R R I T I N IN P A T I E N T S W I T H L O C A L I S E D AND E X T E N D E D BREAST C A R C I N O M A L j . S t e f a n o v i 6 , E . K a m e = njicki,Z.Selir,Lj.Miljkovi6,B.Sterio,R. Semnic and N . S l ~ a p i 6

BONE SCAENING(BS) SERUMCEAANDTPA IN THE FOL

The thyreoglobulin (TG) concentration was measured in the sera of patients with d i f f e r e n t i a t e d thyroid carcinoma who had undergone surgical treatment, In a]most a l l of them radioiodine abl a t i o n of the thyroid remnant was done. TG was measured by commercial k i t in the range of 20-1280 ng/ml, A t o t a l number of 133 patients were included in the study and some of them were monitored during a longer period of time. In the sera of 63 patients without signs of tumour tissue, undetectible or low levels were found. Somewhat higher level was found in 7 patients in this group (x=77.6±19.5), but these values were considerably lower than those measured in patients with metastases. Increased TG levels (~=723.5±491.3) were found in 20 patients with recurrence of metastases which do or do not accumulate 1311. Low level of TG was found only fn two patients with metastases without uptake of 1311. Determination of TG in the sera of patients with differentiated cancer is of importance in observing such patients, particularly if we could monitor TG level during a longer period of time. ThTs is especially useful if metastases do not accumulate 1311. Nuclear Medicine & Oncology Clinic, "Dr.M1aden Stojanovid" Clinical Hospital, Vinogradska 29, 41000 Zagreb, Yugoslavia

The serum eoneentrations

of 4 tumour markers(TM):carciuoembryonic antigen(tEA),

alphafetoprotein(AFp),beta~microglobulin (BgM) and ferritin(FF~) ha~ been determi~ed by the radioimmunoassays in 60 patients w i t h breast carcinoma~before the operation and other treatment.The p a t i ents were divided into: group A with localised c a r c i n o m a ( 2 8 ) and g r o u p B w i t h carcinoma affecting t h e r e g i o n a l lymph nodes and/or producing distant metastases(32).No significant d e p e n d e n c e was proved between these groups of patients and TM l e v e l s ( p > 0 . 0 5 ) . T h e e l e v a t e d CEA was f o u n d i n t h e s m e l l number o f t h e p a tiemts~more frequently in B t h a n i n A (18.8% v e r s u s 1 0 . 7 % ) ~ i t s c o n c e n t r a t i o n s i n A were elevated only very slightly ( f r o m 15 t o 261ug/1).B~M and FER w e r e e l e v a t e d i n u e a ~ l y t h e game p e r c e n t s i n A and B(BvM:39.5% a g a i n s t 37.5%~FER: 42°9% a g a T n s t 46.5%).AFP was w i t h i n t h e normel limits in all p a t i e n t s . l n the both groups the percent of the patients with elevated TM(67.9~ versus 59.4%) did not differentiate s i g n i f i c a n t l y ( p > 0 . 5 ) , but in A were significantly more frequent the patients with elevated one T M (p
LOW-UP OF BREAST CANCER PATIENTS. A. Nicolini, A. Carpi, R. Bianchi. Hundred-four patients (pts) operated for breast cancer were followed up to 6 years. Initially BS was performed early after operation and ant cessively every 1.5 year. When BS was pathologi cal x-ray was i,~ediately performed; successive ly BS and x-ray were alternately repeated every 6 months up to 2 years. Sert~ CEA and more recen tly also TPA concentrations were measured every 4-6 months or more frequently whan metastases were suspected. Up to today 12 pts showed clini cal and radiological signs of metastases. BS was pathological in all the pts with bone metastases nevertheless it produced false positive results in 38% of all the pts. Sert~n CEA and TPA determinations were constantly elevated in all the pts with distant metastases. Sert~ CPA was ele rated (> iO ng/m/) also in ZO pts without meta stases nevertheless in all but one the value was lower than in the pts with metastases (iO to 30 ng/ml) and did not show any increase. Se rt~TPA level ranged from ISO to 13OOU/L in the pts with metastases while it was lower than 120 in all the other pts but 3. In these 3 pts sert~TPA was 140, 146 and 320 U/L respectively; the last had chronic hepatitits and the other two showed signs of liver disease. No increase of these values was observed. These data show that false positive results produced by ser~a CFA and T?A determinations are lower ~Id more easily identified than those produced by BE. The refore these tomoral markers are suitable indi cators of distant metastases while BS can be successively used to localize metastases. Nuclear Medicine Service, University of Pisa CNR Institute of Clinical Physiology, Via Savi, 8; 56100 Pisa, Italy

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SERUM tEA DETERMINATIONIN BREAST CANCERI ITS ROLE IN THE FOLLOW-UP AND AS AN INDEPENDENTPRETREATIIENT PROGNOSTIC FACTOR ALONE, OR IN COMBINAISON WITH INTERNAL MAMMARYLYMPHOSCINTIGRAPHY. J. FrShling, E, Renard and B. Massant.

IMAGING OF THE BREAST IVITH MAGNETIC RESONANCE. J. Ennis, C. Cazanave, D. Hamlin, T. ~hreci, K. Scott, K, Bland, E. Fredericks, E. Copelmtd and C. Williams

ESTROGEN A N D PROGESTERONE RECEPTOR ASSAY USING 1-125 ESTRADIOL A N D H-3 PROMEGESTONE AS LIGANDS : RESULTS IN FEMALE MAMMARY CARC I N O M A . D. Glaubltt, H.A. Hlenz, G. Bettges, B. Carmanns, and T. Uchtenberg

167 female patients (average age 55 y) entered in t h i s study, among them 29 c l i n i c a l stage I , 81 stage I I , 55 stage I I I and 2 without p r e c i sion~ 64 premenopausic and g9 oostmenopeusic. The serum CEA level has been determined by radioimmuno-assay using a commercial k i t , during the f i r s t week of the postoperative X-ray t r e a t ment and at least 3 times during a 18 month follow-up period. 113 among these patients undervent a posteperative combined i n t e r n a l mammary (IM) and s x i l l a r y lym0hoscintigraphy. (LSC). As shown by these 167 patients,an i n i t i a l serum tEA value superior to 5 ng/ml c o n s t i t u t e s an independent p e j o r a t i v e prognostic f a c t o r in comparison to the following i n d i v i d u a l l y analyzed indices : tumor s i z e , c l i n i c a l and postoperative h i s t o l o g i c a l a x i l l a r y nodal status, estrogen receptors end menopausic s t a t u s . l f serum CEA-level and i n t e r n a l mammary LSC are combined,oatients with higher than 5 ng/ml as i n i t i a l value and p o s i t i v e IMLSC present the highest recurrency rate a f t e r 18 months, whereas in patients with low CEA-level (~5 ng/ml) and normal IMLSC there was only 4 recurrencies out of 42 cases.The combinaison of both ( i n i t i a l serum t e a - l e v e l and IMLSC) prognostic factors studied i s able to mod i f y even the c o n t r i b u t i o n of postoperative axill a r y nodal status as established by anat.-path. examination. As f a r as the follow-up period is concerned : in 82,3% o f the cases the evolution of the serum tEA-level corresponded to the c l i nical course. Among the true p o s i t i v e cases ( r i sing CEA-level corresponding to a proven c l i n i cal recurrency) in 21,8 % of these patients the modified CEA value was the f i r s t sign of t h i s evolution.

Cancer of the breast is the most common malignancy in fenmles affecting approximately 7% of all women. X Ray mammography will detect 90% of all breast cmlcers but has 3 distinct problems: i) Unacceptable levels of ionizing radiation, 2) Difficulty in defining breast parenchymal pattern, and 3] High false negative rate. Objectives : To evaluate the ability of magnetic resonance imaging to outline the anatomy of the breast using different pulse sequences. Methods and Patients: Twenty female volunteers who undem#ent mm1~nography with no evidence of breast cancer were studied. All patients were studied using a prototype breast solenoidal coil 6.5 cm deep and 16 cm in diameter. Patients were examined in the prone position and the total length of examination depended on the pulse sequence. Thirty-two thin sliced magnified images were obtained on each breast in approximately l0 minutes. Results : l) Magnetic resonance imaging is very acceptable to the patients with no known hazard, 2) The anatomical details are superior to xeromanmlography, and 5] The slice magnified tech nique affords excellent spatial resolution.

If after surgical removal of a female breast carcinoma its tissue shows an elevated concentration of estrogen and progesterone receptors, subsequent hormonal therapy of the patient is considered to have good prognosis. Following methodological improvement by labellirg of estsadiol wi th [-125 and of promegestone, a synthetic progesterone derivative, with H-3 instead of tagging both ligands with H-3, the practibillty of such receptor assayswas estimated. ~n 56 women aged 40 to 86 years, with 36 of the patlents belng in the pastrnenopaasal state, the level of estrogen and promegestone receptors was determined in the cytosol of samples of mammary carcinoma of different stages after the turnout had been removed. The methods applied 16o(-(I-125)-3,176-estradiol and H-3 promegestone as ligands. The results were related to cytosol protein. In comparison with former methods the new assays needed only half the quantity of tumour tissue and distinctly less time for the measurement of radioactivity. The concentration of both astradiol and progesterone receptors was raised in 24 turnout cytosols indicating that hormonal therapy may be recommended i n these women. An increased level of solely estradiol receptors was noted in 9 tumour cytosols and of only progesterone receptors in 2. The concentration of both estradlol and progesterone receptors wasbelow20frnole,/rrg cytosol protein in 21 tumour cytosols. In conclusion, for mammary tumour cytosol an improved estrogen and progesterone receptor assay wlth 1-125 estradlol and a H-3 labelled progesterone dedvatlveas

ligands is highly practicable, especially by saving time and by requiring only small tissue samples.

Laboratoire des Radio-lsotopes, I n s t i t u t Jules Bordet, U n i v e r s i t 6 l i b r e de Bruxelles, 1000 Bruxelles, Belgium. University of Florida College of Medicine, Ga~lesville, Florida, 32610, U.S.A.

DepartmentS of Nuclear Medicine and Pathology, Academic Teaching Hospital, D-4150 Krefeld, Federal Republic of Germany

A33 A189 SCINTIGRAPHIC PERiTONEOGRAPHY ABVANCED O V A R I A N M A L I G N A N C I E S :

IN ITS

VALUE FOR CHEMOTHERAPEUTIC DISTRIBUTION STUDIES. B . J . G . van Weelde, E . K . J . P a u w e l s , B. J a m e s and A . T , van O o s t e c o m . The i n t r a p e r i t o n e a l introduction oR technetium £9m labelled human serum album±n through a catheter provides a m e a n s af s t u d y i n g fluid distribution as w e l l as i d e n t i f y i n g the c a t h e t e r position. This w a g ten p a t i e n t s underwent 24 p e r i t o n e a l s c a n s p r i o r to the administration of a c h e m o t h e r a p e u t i c agent, mitomycin C, for i n t r a p e r i t o n e a l s p r e a d R r o m sn o v a r i a n m ~ l i g n a n c y . N o n e of the p a t i e n t s had k o o w n p u l m o n a r y oR b o n e m G t a s t a s e s . All patients had multiple laparotomies and l a p e r o s e o p i e s and one p a t i e n t had l o c a l a b d o m i n a l radiotherapy. The a d h e s i o n s that had d e v e l o p e d as a r e s u l t oE the a b o v e , w e r e t h e c a u s e of incorrect catheter placement in E o u r patients as w e l l as a s u b o p t i m a l distri b u t i o n in m o s t s c a n s . In t w o p a t i e n t s activity w a s seen w i t h i n t h e l a r g e b o w e l , in ane p a t i e n t in t h e s m a l l b o w e l . Tn o n e p a t i e n t the c a t h e t e r

a p p e a r e d t o l y i n t h e l e s s e r sac. We ~ e e l t h a t t h e To-gBm-HSA p e r i t o n e o g r a p h y is a s i m p l e but i n d i s p e n s a b l e m e t h a d in e s t a b l i s h i n g the c a t h e t e r position as w e l l as s t u d y i n g the e x pected distribution o f the e h e m o therapeutdo a g e n t in p a t i e n t s in w h i c h t h i s f o r m of t h e r a p y is i n d i c a t e d . Departments of D i a g n o s t i c Radiology [ D i v i s i o n of N u c l e a r M e d i c i n e ] and Clinical Oncology, University Hospital, Leiden, The Netherlands.

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A191

RIA DETERNINATION OF TPA AND CEA IN PATIENTS WITH LUNG CANCER. G. Esposito,S. Del Vecchio,F. De y~rtinis,R. Tncmas,F. Pe~m/lio,P. Niola,N. Salvatore.P.l~to.

TUMOUR MARKERS IN THE SERUM OF PATIENTS WITH CARCINOMA OF THE BRONCHUS. M. Cordoni-Voutsas and D. Glaubitt

Aims of our study were detsrmioation of TPA and CEA in pat i ~ wit% lung cancel,and evaluation of ~neir clinical usefulness in monitorin~ cancer treatrent. We have studied 65 patients with ic~ cancer (30 squs~ous cell c a r c ~ , 8 8denocemc~ncmes,5 oat cell care/nones, 4 la~e cell c~rcincmas,snd 18 IL~ cancers with indef~z/te histslo~.Ten patients withcut mah~nant disease cast{Luted the control ~roup. lh~ive patients out of B5 were mc~itored durin~ ~ncer treatment. I/l the ~rot~o of cancer patients the mean value of CEA was 11.63 +- 19.2 (~), while in the control ~roup it was 3.17~

Thelreatment o[ patients with carcinoma of the bronchus has been improved markedly during the last decade. This progress was partly due to the determination of turnout markers in the serum of these patients which provided informetlon about growth, metastasizatlon or, alter therapy, recurrence of the turnout. We investigated the frequency of elevated serum levels of several tumour markers including those which had been ~ntroduced recently. Thlrty-six patients (27 men and 9 women) aged 24 to 80 years were examined who suffered from carcinoma of the bronchus of different stages. In 5 patients metastases been found. A t the time of study, the carcinoma of the bronchus had been removed surgically in 12 patients whereas the other patients who could not undergo surgery received chemotherapy. The serum concentration of TPA (tissue polypeptide ontlgen), ferritln, g~-mlcrogIobuUn, CEA (carc~,oembryonlc antigen), "CA 12-5, CA 19-9, AFP (0~l-fetoprotein), 6-HCG, and ACTH was me~ured by radioimmunoassay. Showing different patterns in serum, TPA was raised in

5.2 (~) (p¢0.oi). ~ e r r s 3 r e the mea~ value of TPA was 128.54 +- 75.11 (SD) in the group of cancer patients,whiie it was 87.42 ± g5.32 (~D) in the control group (~O.Ol).TPA and CEA d/drRt show any si~nificative correlation, When we considered the histhlo~ we ~oted a mean value of ~ A .Dre increased in aderloc~'cinc~ (23,75 +- 19,9) than in the other t2pes.Purthermore the large cell carcincmas didn't ,shawan increase~ meanvalue of TPA [89.12 +- 19.26), while they shewed an increased mear~ value Of CEA (14.1± 15.75 ).We related the levels of two ~ k e r s also with the sts~ir~ of disease. Durir~ treatment IS patients showedan increase of TPA levels,5 a decrease,12 constant,and 5 fluctuati~ levels. In a lot Of cases we fo~qd a relation with clinical status and CEA Far%er~ Nevertheless TPA levels se~m more immediately related to the activity of disease.

rstituth (h Scie-~ze E~diolo~iche II FG~olt~ di Medicine e ~hir~ia Napoli Nedicina Nucleate e Ch~J~rZia Toracica Istitato Nazionale de{ Tunori Fc~dazione S. Pascale Napoli

A 192 COFd~LATION B - ~

TPA SERUM,BYSTOTYPEAhrD

CELLULAR DEVIATION GRADING IN LUNG TUg,OURS. °F~Icone F., ~Sabbatanl S., ~ T u r b a E., °~Fini A., "D'Ales A. (@Divlsione di Pneumologia, Osp. M. Malpighi, Bologna- Italy) (°~Servizio di Medlcina Nucleate, Osp. Maggiore, Bologna- Italy)

A group of 48 individuals with pulmonaz~ neoplasies was studied; CEA (N.V. < 5 ng/ml) and TPA (N.V. < 95 U/l) measurement was carried out on all ~%tients during the dia~nostlo p h y s . The mdenocarcinomas (17) had tEA values of 68.5 ~ 150 and T P A values of 280.1 + 577.5; the epidermoidals (16) had CEA values o~ 14.4 Z 19.~ and TPA of 135 ~ 72.6; the nondifferentiate@ hmd ~ A values of ~.51 ~ ).4 and TPA of 118.8 ~ 71.5; the mlorocvtomes had 0EA values of 9.2 ~ 11.4 and TPA of 147 ~ 48.9. The above mentioned groups were compared statistically using Student's T test. The only relation with p < O . 0 5 is th&t between epidermoid~l smd non-~ifferentiated carcinomas, in which the values are significantly different. The adenocarclnama s~nd the epideraoidal groups were further divided according to the index of cellular deviation end the respectively assigned 0EA and ~PA values in the various subgroup@ were compared. AS regards the mean values, pa~hieularly in relation to the TPA ther~ is a significant increase in the values passing from G I to G . The statistical significance in the ~arious comparisons deem high for the TPA particularly in the G and C comparison in the ~pidezmoidals ( p < 01005) , 5 aund the G and G 2 in the adenocarclnomas (p = 0.01~. The percentage of positivity of the CEA And of the TPA in the various ~ d i n g s of cellular deviation takm different courses; the ~ A increases passing from G 1 to G 5 while the tEA presents the highest perhenta~e of =positivity at G 9 both in the adenoearcinomatous and epidez~oid&l fo~ms.

23 patients, C£A in 21, [errlt{n in 20, 62-mlcroglobulln in 9, ACTH in 8, CA 12-5 in 7, 8-HUG in 2, CA 19-9 in one patient, and AFP in none. In view of these results, TPA, CEA, {err{tln, 62-relateglobulin, ACI"H, and CA 12-5 were the most rewarding turnout markers. In these patients a strong relatior~ship was not evldent between the patterns of increased levels of tumour markers in serum and the stage o[ the disease. In conclusion, radioimmunoassay of several relevant tumour markers in the serum of patients with carcinoma of" the bronchus appears to he valuable for early recognltlon of tumour growth, recurrence, or metastases. Deportment of Nuclear Medicine, Academic Teaching Hospita/, D-4150 Kref"eld, Federal Repabllc of Germany

A193

A194

THE APPLICATION OF BAYES' THEOREM TO THE DIAGNOSIS

CONTRIBUTION TO THE MANAGEMENT OF PATIENTS WITH PROSTATE CARCINOMA I. RAg-OPERATIVE STAGING USING PAP DETERMINATIONS AND LYMPHADENECTOMY. x H.W. Bauer, F. $chmidt and A. van Dslen .

OF LUNG CANCERUSING 0057-BLEOHYCIN SCANNING. 0. Slosman, B. Polla, C. Sigmorelli, A. Junod, R. Megevand ano A, Sonath The Co57-bleomycin scan m~y be used for the diagnosis oR pulmonary cancer. We determined prospec tively the sensitivity and specificity Of this method for the diagnosis of pulmonary cancer and we have applied Bayes' theorem to our results. We studied 120 patients : 85 with pulmonary cancer and 35 with benign pulmonary lesions, 80 out of 85 patients with cancer had a positive scan. Among the 5 false negatives, there were 2 "in situ" carcinomas and the 3 others tumors were less than 2 cm in diameter. 28 out of the 35 patients with benign pulmonary disease had a negative scan. Among the 7 false positives, there were 4 act{yes tuberculoses and 3 bronchopneumonJas [BPN). 2 oatJ~nts with BPN and a RalsR po~i tive scan had a conzro! scan eater 2-3 months, which was then negative. The sensitivity is £A % and the specificity is SO %. OeRining the "a priori" erababilitg oE having lung cancer as clinicalg Iow lid %], medium i50 %) or h i g h [GO %], the "a posterior{" probability oE having lung cancer [p-0/T] in the presence oR either an abnormal saint{gram or a normal saint{gram may be calculated from gages' theorem. We can conclude that : - If the clinical probability (p-C] is low : in presenbe oR a normal scan, p-O/T is close to 1 % , while in presence oE an abnormal scan it is close to go %. Thus if the scan is negative we can exclude lung cancer, but iE zhe scan is positive, no conclusion is possible but a second scan after 2 months is recommended. - If the p-C is medium : in presence oP a normal scan, p-O/T is less than iO %, while in presence of an abnormal scan it is greeter than 85 %. Thus if the scan is positive, we must investigate further and iR the scan is negative we san exclude lung cancer. IR the p C is high : with a positive scan, the diagnosis is certain, but a negative scan is probably a false negative. SlY. Nucl.

Mad.,

H,C.U.,

1211 Geneva 4, Switz.

In cases of prostate carcinoma the final decision to attempt a curative radical prostatectomy depends entirely on wether or not there is lymph node involvement. If the lymph nodes contain metastases only palliative systemic treatment should be attempted. The investigation of iocoregional lymph nodes can only be done by histological analysls of lymph node material after a staging lymphadenectomy. TO decide wether the determination of prostate acid phosphatase (PAP) could be of help, the RAP levels were determined in 34 patients on which a stagin E lymphadenectomy was to he performed. The results of the PAP determinations were compared with the histological findings in the removed lymph nodes. There was a high correlation of histologically Rroven involvement of lymph nodes and an elevated level of PAR as determined b y the immunochemical method (EIA) of Merck. In ig of 19 patients without lymph node metastases the PAP concentrations were lower than i.O ~g/l. All of the 15 patients with positive lymph nodes had PAP levels above 1.0 ~g/l. The fact that 3 patients with histologically proven negative lymph nodes showed elevated RAP levels could possibly be explained by involvement of pre-saoral lymph nodes. The pre-sacral lymph nodes are not removed during a staging lymphadeneetomy. These results indicate a new perspective in the use and reliability of PAP determinations in patients with prostate cancer.

Urologische Klinik der Ludwig-Maximilians Universit~t, Klinikum Grosshadern (M~nchen) and Bleuland Hospital, Dept. of Nuclear Medicine x (Gouda)

A34

A195

A196

CONTRIBUTIONS TO THE MANAGEMENT OF PATIENTS WITH PROSTATE CARCINOMA If. FOLLOW-UP DURING TREATMENT USING PAP DETERMINATIONS AND BONE SCINTIGRAPNY. A. van Dales, P.J.N.J. Kok~ J.N.M. H. Thomas? R.D. van CauberghXXand N.W. Bauer xxx"

CA 19-9 TM IN BENIGN AND MALIGNANT PANCREATIC, LIVER AND BILIARY TRACT DISEASES. R. Novakovi~, J. Lemberger, £j. Gli~i~, V. PeriWig, S. Bankovi6, M. Plazibat

TPA ~ O N I T O R ~ G DURING THE ?0LLOW-UP OF PATIENTS N I g H C O L O R E C T A L CANCER. M.Oosimelli,L.~ango%F.Isabell~,AoBen~g l i a , A . C a p p o n i and R . C a v a l i e r e .

In order to evaluate different methods for estimating prostate acid phosphatase (PAP) a followup study was performed within a group of 89 patients with histologically proven prostate cancer. The results were related to bone seintigraphy. At operation 56 patients were free of bone metastases (M-) or in remlssion at the time of investigation and 33 patients were regarded as having bone metastases (M+) based on hone scintigraphy. Patients had undergone either transurethral resection and/or hormonal therapy with DES. In a later or advanced stage orchiectomy was performed and/or Androeur therapy given. If possible blood samples were taken every 6 weeks; the maximum follow-up time was 15 months. The different PAP methods were: I. Enzymatic using ~ -n~phtylphosphate; 2. Enzymatic using thymolphtaleinemonophosphate on the ACA; 3. Elisa (Behringwerke); 4. EIA (Merck); 5. RIA (Clinical Assays); 6. IRMA (Hybritech). Altogether 400 samples of 89 patients were analyzed. During the course of the investigation 7 patients were moved from M+ into M- because following treatment no changes in the seintigram occurred and X-ray or clinical examination provided alternative explanations for the abnormalities on the scintigram. All PAP methods had a specificity above 95 percent with sensitivities ranging from 80 to 9E percent, the EIA and IRMA method being the highest. We concluded that the determination of PAP at regular intervals with one of these methods provided a more reliable parameter for posttreatment monitoring of patients with prostate carcinoma than bone seintigraphy.

The Centocor Ca 19-9 TM r a d i o i m m u n o a s a y is a new solid phase assay for the m e a s u r e m e n t of a c a r b o h y d r a t e antigenic determinant on a c i r c u l a t o t y antiigen ( Koprowski 1979).

TPA m o n i t o r i n g of 28 patients (pts) subm i t t e d to r a d i c a l Surgery for large b o wel cancer was carried OUt d u r i n g the f o l l 0 w - u p every two m o n t h s for d e t e c t i n g early local or distant r e c u r r e n c e s , I n all cases the d i a g n o s i s w a s controlled by C~ scans, c o l o n s c o p [ a n d hepatic 8/1giography. In 4 pts t u m o r r e c u r r e n c e w a s observed w h e r e a s no evidence of disease w a s a c h i e v e d in 24 oases (medi8/l f o l l o w - u p = 17.5 months). In these 28 pts the difference b e t w e e n TPA and C E A s e n s i t i v i t y rate w a s h i g h (100% and 25% respectively) and s t a t i s t i c a l l y significant (p < 0 . 0 5 ) . T P A s p e c i f i c i t y rate w a s 79.2% b e c a u s e of t h e h i g h incidence of false positive cases (5 pts) as compared to the C E A monitoring, that s h o w e d only one false positive case and h i g h e r spec i f i c i t y rate (95.8%). A c c o r d i n g to vhe i ~ n u n o b i o l o g i c a l different c h a r a c t e ristics and to present results, the combined use of TPA and CEA dosages seems to be c o n s i d e r e d v e r y useful, g i v i n g a n early correct diagnosis in 71.4% out of the patients examined. A t i m e l y clinical control of the p o s i t i v e cases a l l o w e d the t r e a t m e n t of the recurrences and a b e t t e r prognosis.

CA 19-9 TM RIA kits (CIS) were used to measure c o n c e n t r a t i o n s of CA 19-9 in sera of 50 controls and 150 patients. The values of CA 19-9 in control patients: 10 t 6 U/ml (Mo 50) < 37 U / m l p < 0,001; chronic pancreatis: 18 t 20 U/ml (No 33) < 37 U/ml p < 0,001; acute p a n c r e a t i t i s : 3 6 ~ 48 U/ml (No 15) > 3~ U/ml p < 0,001; p a n c r e a t i c cancer: 300 800 U/ml (No I~) > 120 U/ml p < 0,001; cirrhosis: 16 - 19 U/ml (No 14) < 37 U/ml p < 0,05. chronic active hepatitis: 30 Z 36 (No 2 0 ) ) 3 7 U/ml,(No 16) > 1 2 0 U/ml p 0,001; biliary diseases (Cholecystis, biliar calculi): 30 ~ 160 (No 22) > 120 U/ml ~ < 0,054 biliary tract c a r c i n o m a : 46 - 300 (No 18) > 120 U/ml p < 0,001; The results suggest that Ca 19-9 antigen is useful m a r k e r in the diagnosis of upper gastrointestinal cancers especially pancreatic carcinoma and biliary tract carcinoma. Laboratory of Nuclear medicine, Medical Faculty of Belgrade, Dr Suboti6a 9 11000 Beograd Jugoslavija.

A197

R e g i n a Elena I n s t i t u t e for C a n c e r R e s e arch, V i a l e R e g i n a Elena 291 - 00161 Rome and *IV P a t o l o g i a C h i r u r g i c a U n i v e r s i t y of R o m e . ITALY.

Bleuland Hospital Depts. ef Nuclear Medicine, • . 'x xx Clin~cal Chemlstry and Urology (Gouda) and . . . . xxx . Urologische Kllnik und Pollkllnlk ,Kllnlkum Groszhadern (M~nchen).

A198

A199

A200

FERRITI~i IN GASTRfC ,IU~CE AS A ~O~EHT!A! TU~OR r~A~KER FOR GASTRIC CAt!CER. ,] .Lemb e r g e r ~R. Novakovi & ~ Lj. O I i ~ i 6, ~$. Oe ~ trakul j i 6 , R . g r h S 6 and M . T e r ~ j A - S s v J 6

VALUE OF SERU~ FERRITIN ~EASURED BY R.I.A. ~S &N INDICATOR OF ACTIVITY IN HODGKIN'S DISEASE. J.'[. Carril, J.J.i.. Cordovilla, J.I. Banzo~ E. ~azo, V. Hermosa, and A. Pereda.

MIXED ORIGIN OF SERUM FERRITIN IN PATIEntS k ~ MALIGNANCY. L. Muylle, P. Blockx, D. Becquart, add F. Van de ~A2ver.

It is known, that the results of' ser,~m ferrJtJn assays can be used Bs an aid Jn d i a g n o s i s of the tumors 0£ di
Ninety nine serum ferritin determinations were done in 58 patients diagnosed of Hodnkin's Disease (S.O.), to evaluate its role as a marker of the activity of the disease. The mean v~ lues of serum ferritin corresponding to active disease and remission were 390 n~rs./ml, and i15 ners./ml, respectively. Classified the 99 determinations accordin~ to sex and histology of the patients the results were ~s eollows: Males. Active M.D.: 393 n~rs/ml. Remission: lEl n~rs./ml. Females. Active M.D.: 382 n~rs./ml. Remission 69 n~rs./ml. AccordlnE to histology they were classifi~ ed into two Aroups obt~inin~ these results: Nodular Esclerosis. Active M.D.: 298 n~rs./ml. Remission ]OO nArs./ml. Mixed eellularit~. Active M.D.: 457 n~rs./ml. Remission: 1S5 nars./ml. The m e ~ values in sta~es I and II were 157 ngrs./ml, and in stages III and IV were 173 ngrs./ml. These results were compared with those obtained in 38 ~ormal wolunteers, in whom the most relevant hematological parameter were normal. From the statistical analysis of the results, we conclude that serum ferritin determination is a ~ood marker Of the activity in Hod~ kin's Disease.

Servieio de Medicina Nuclear. Mosoital National "Valdecilla". Santander. Spain

High levels of sermon ferritin were reported in various malignancies. The origin of this hyperferritinae~ia, however, remains unknown: non specific changes in iron or ferritin metabolism as well as production of increased a~ounts of nomal or abnormal ferritin by malignant cells may be involved. Normally serl~n ferritin is secreted by the cells of the reticuloeedothelial system. Norwood et al. have shown that a large proportion (80%) of the circulating ferritin binds to Concanavalin A (Con A), whereas tissue ferritin binds poorly to Con A. In order to investigate the s(~lrce of serum ferritin in patients with malignancy, sere of 28 cancer patients and of 7 normal persons, as well as i0 t~tlour cytosols were absorbed with Con A-Sephaxose. As expected, 22 + 3% (range 17-27%) of the ferritin in no~al--sert~n, and 89 + 5% (range 85-100%) in tunour cytosols was net--absorbed. A significant part of non-glycosylated, tissue-type ferritin, however, was found in all but one of the cancer patients' sara (even in case of non, el sermon ferritin levels) : 51 + 12% (ranqe 23-71%) of the ferritin w ~ not absorbed. These findirgs suggest the ferritinaemia in cancer patients to be of a mixed origin. V~nether this is due to ferritin release by d ~ e d cells or active ferritin secretion remains to be elucidated. B1cx)dtransfusion Center Antwerp and University Hospital Antwerp, Wilrijkstraat 8-10, B2520 Edeqe~, Belgiu~.

A35 A201 RELATIONSHIP BETWEEN SERUM CONCENTRATIONS OF CALC~ON~ AND THE EXTENT OF MA~GNANT ~SEASES. A. ~ a ~ e and K. Oeff

Serum levels of ca]citonin (Ct) were measured by r a d i o i m m u n o a s s a y in 657 patients subjected to skeletal s e i n t i g r a p h y for diagnosis and follow-up of malignant diseases (breast n=304, lung n=42, prostate n=54, urinary tract n=50, gynecological tumors n=31, alimentary tract n=4g, miscellaneous tumors n=6g, undetected primary tumors u=68). Of these patients 15% had low (30 pmol/l) Ct values. The number of patients with high levels of Ct increased in tumors of the respiratory (59%), urinary (54%) and female genital (48%) system, while it decreased in prostatic cancer (5%) and in undetected primary tumors (19%). The number of patients with low levels of Ct decreased in cancer of the urinary tract (6%). These difFerences in the distribution of Ct leveIs were significant (n = 657, X2=34.5, df=14, p
A 2O2

A 203

CALC1TONIN~ TPA, CEA, AND CARBOHYDRATE ANTIGENS (CA 19-9 AND CA 12-5) IN MALIGNANTEFFUSIONS. A.Franke and K.Oeff

TC-~ m BLEOiXOlI~

S. Tustanowski, The concentrations of calc~tonin(Ct), TPA, CEA, CA 19-9 and CA 12-5 in serum, asciles, and pleural effusions were measured by rallioimmunoassays in 30 patients with malignant diseases. Ct levels were lower (p< 0.05; level of significance e~aluated by the Wilcoxon matched-pahs test) in malignant effusions (mean ± SD 21.1 -+ 23.9 pmol/l) than in serum specimens (25.9 ± 32.1 pmol[1). TPA levels were much higher (p < 0.01) in malignant effusions (2125.6 -+ ] 209.g U/l) than m serum samples (545.3 + 813.8 U/I). Levels of CEA, CA 19-9 and CA 12.5 in serum (19.5 -+ 45.5 ng/ml, 145.5 -+ 439 U/ml and 121.1 -+ 120.1 U/ml, respectively) and malignant effusions (30.6 + 54.8 ng/ml, 372,7 -+792.7 U/ml and 329 6 +-229.7 U/ml, respectively) did not differ significantly. Elevated levels of El, CA 19-9, CEA, CA 12-5 and TFA were observed in 10%, 16%, 32%, 50% and 100% of the patients, respectively. The alevaflons in the ascitic and pleural fluid levels of CA 19-9 (cdiorectal carcinoma associated antigen) and CA 12-5 (ovarian carcinoma associated antigen) were found to b~ ~onspecifi~ with regard to the ~ite of the primary tumor. The tumor marker content of pleural effusions was reevaluated in 3 patients following intracavltary radioyttrium therapy. Good palliation was achieved in two of these patients. Their levels of CI and CA ] 9-9 were found to b~ unchanged, CEA levels to be lowered, artd TPA levels to be elevated. In the third patient radinyttgum therapy was xepeatell without improving her condition. Her levels of Ct and CEA augmented, TPA decreased, while CA 1929 was found to be unaltered. We conclude, that 1. high levels of TPA are a corrtmon feature ofmalig neat effusions, 2. elevated levels of CA 19-9 and CA 12-5 in malignant effusions do not necessazlly indicate gastxointesalna2or ovarian malignancies, respectively, 3. the measurement of Ct and CEA in malignant effusions is of minor diagnostic value a~ compared to the evaluation of serum levels and 4. longitudinal studies are needed to claflfy the relatinnsitip between alterations in the concentraBons of human tumor markers and response to therapy in individual patients. Department of Nuclear Medicine, Klialkum gtaglitz, Free University of Berlin, Hindenburgdamm 30, D-1000 Berlin 45, F.R.G.

I~ ROUTIi~E D I A G N O S T I C S

OF ~,~LI~[A/~ T ~ 4 0 ~ .

S. Szostak,

W. ~¢orak,

B. B i r k e n f e l d

and R. A l m a k i s w i c z Bleomycine

was l a b e l l e d

to the o~vn method. /3 - 5 m g B ~ venously.

Tc-99 m a c c o r d i n g

37 - 64 I ~ q B ~ 4 - T e 9 9 m

was a d m i n i s t e r e d

intra-

The whole b o d y s c i n t i g r a m w a s

registered

10 - 60 min.

after the inje-

ction w i t h P i c k e r

D y n e C a m e r a 4/15 lin-

k e d to I n f o r m a t e k

Simis

3 computer

stem. B ~ 4 - T e 9 9 m was employed examinations plasms

in 293 patients w i t h neo-

of the h e a d

and r e t r o b u l b a r roid gland, metastases asts,

or n e c k / i n t r a o c u l a r

tumours

salivary

of orbits,

gland,

to lymph nodes/,

liver,

skeletal

system

thy-

larynx, lungs,

bre-

and testi-

cles.

The r e s u l t

means

of B ~ 4 - T c 9 9 m was verified,

of the e x a m i n a t i o n

possible,

by p a t h o l o g i c a l

Clinical

and r a d i o i s o t o p e

were

sy-

to p e r f o r m

by

where

examination. diagnoses

the same in 92%.

Department

of R a d i o i s o t o p e s

~omerania~

Medical

Academy

el. Umii Lubelskiej

I

P1 71-344

2oland

Szczecin,

Departmentof Nuclear Medicine, ~ i n i k u m S ~ t z , Free Universi~ ~Ber~,~ndenburgdaram30,~lOO0 ~ N n 4 5 . F . R . G .

A 204

A205

A206

S E Q U E N T I A L 195m-Au V E N T R I C U L O G R A P H Y AND 201 T L - M Y O C A R D I A L IMAGING IN PATIENTS WITH M Y O C A R D I A L INFARCTION. O.Ei~ner, M.Mirid, K.Nahn and W.Kasper

CLINICAL USEFULNESS OF SERIAL EXERCISE FIRST PASS RADIONUCLIDE ANGIOGRAPHY USING GOLD-195m IN DRUG INTERVENTION STUDIES IN ANGINA PECTORIS. J.C. o'geefe, D.S. Dymond, J.L. Caplin, W. Flatman, S. Banim.

RIGHT VENTRICULAR EJECTION FRACTION FROM FIRST PASS RADIONUCLIDE ANGIOGRAMS: COMPARISON WITH CONTRAST RIGHT VENTRICULOGRAPHY, REPRODUCIBILITY, AND EFFECT OF BOLUS INTEGRITY. D.S. Dymond, J.L. Caplin, W.D. Flatman, d.C. O'Keefe, R.P. Grenier.

Rapid decay makes the short lived 195mAe suitable not only for repeated studies of left v e n t r i c u l a r function at different conditions but permits also T1 myocardial imaging i m m e d i a t e l y after radionutlide v e n t r i c u l o g r a p h y . Thus for the first time it is possible to compare beth methods under n e a r l y identical conditions of work load, blood pressure and heart rate. The study reports the results of 195m-Au-ventriculography and T l - m y o c a r d i a l imaging in 30 male patients with previous myocardial infarction. All patients underwent left v e n t r i c u l o g r a p h y and c o r o n a r y art e r i o g r a p h y few days before the radionuclide investigations. First p a s s - R N V was p e r f o r m e d with a m u l t i c r y s t a l gamma camera with hiEh count rabe capability. 195m-Au from a 1 9 5 m - H g / 1 9 5 m - A u generator was used for bolus injection. Myocardial scintigrams were obtained using a mono-crystal-gamma-camera. After the initial rest study (30Q-RiO-projection, upright position) a second investigation was done during peak exercise. Immediately after f i n i s h i n g data acquisition (25 sec. duration) T l - c h l o r i d e was injected while c o n t i n u i n g b i c y c l e exercise at the same level for approxim a t e l y one more minute. Myocardial imaging (ANT., LAO 45 a , LAO 80 °) was started w i t h i n 5 to 10 min. after injection and repeated 3 hours later after an oral dose of nitroglycerin. The results of regional wall m o t i o n analysis during rest and exercise were compared to the computer p r o c e s s e d data of myocardial imaging and the angiographic findings. Abteilung fdr Nuklearmedizin Klinikum der Johannes-Gutenberg-Universit~t Langenbeckstr. I, D 6500 Mainz

Multiple first pass radionuolide angiograms (FFRA) can now be performed using gold-195m (half llfe:30.tsecs) with acceptable radiation burden to the patient. Using a protocol of serial exercise FPRA and gold-195m the effects of niaoldipine, a new calcium antagonist, on global and regional exercise left ventrieular (LV) function were studied in 10 patients with stable angina and proven coronary disease. FPRA studies with gold-195m were performed at rest and peak exercise pre-nisoldipine and repeated at rest~ identical exercise level and new peak exercise level~ I hour post-nisoldipine tOmEs orally. Mean left ventrieular ejection Fraction (LVEF) decreased from 58_+6% to 37_+10% (p
Radionuelide right ventricular ejection fraction (RVEF) has rarely been compared with independent REEF calculations. In addition, poor bolus mixing could cause errors in first pass radionuelide angiography (FPHA). In this stully, 18 patients (pts) underwent right anterior oblique (RAO) contrast RV studies, and RAO FPRA was carried out within 24 hours. A further 18 pts underwent biplane contrast RV studies i~ediately preceded by NAO FRRA~ imaging being performed in all pts using a multicrystal ca/nora. Contrast REEF was measured using a single or biplane area length formula. For FPEA, an RV region of interest (ROI) was obtained with an iterative technique which minimised count contributions from pulmonary artery and right atrium, and ~sed only beats preceded by a complete diastolic phase. Background was a ringshaped ROI 2 em wide, and background counts per pixel at end diastole were uniformly subtracted from the RV pixels. REEF from FPRA correlated moderately well with single plane contrast RVEF ( r=0.74, SEE 6.5%) for RVEF range of 21-61%~ and better with biplane contrast RVEF (r=0.87, SEE 4.1%) over a similar RVEF range. RVEF from FPRA showed high inter-observer and sequential reproducibility (r=0.93, SEE 2.9% and r=0.96, SEE 2.5% respectively). The effect of bolus integrity on calculated REEF was assessed in a further 4 pts by sequential FPRA at different bolus injection rates (I-10 mls/sec) using gold195m (51/2 30.5 seconds). Mean + S.D. RVEF variability was 4.1~1.8%, and did not correlate with bolus duration. In conclusion, I) RVEF from FPNA correlates well with biplane contrast RVEF when studies are done close together, 2) the results are highly reproducible, and 3) rate of bolus delivery does not affect RVEF calculations. Department of Cardiology, St. Bartholomewts Hospital, London ECIA 7BE, England.

A36

A207

A208

A210

EARLY EFFECTS OF CORONARY BY-PASS SURGERY: E V A L U A T I O N BY R A D I O N U C L I D E VENTRICULOGRAPHY AND I S O M E T R I C H A N D G R I P : E.L~nsimies,3.Kuikka,K.Tahvanainen~H.Hu~ tunen,k. Huttunen,M.Halinen,P.Palom~ki, 5.Rehnberg,S.Soimakallio,S.Tanska

IS ESTIMATION o£ SEVERITY OF AORTIC VALVE STENOSIS POSSZBLE BY RADIONUOLIDR VENTRICULOGRAPBY (RNV)? P.Kress, m.Renze, J.Roth, R.Lippert, R.Weller, H.Sigel. M.Stauch, W.E.Adam

EQUILIBRIUM RADIONUCLIDE VENTRICULOGRAPHY AND TWO-D)MENS)ONAL ECROEARDIOGRAPHY IN CORONARY ARTERY DISEASE: A COMPARISONTO CONTRASTVENTRICULOGRAPHYAND CORONARYANG~OGRAPHY. M, Zigman, M. Jeri~, M. Senjanovid, D. Franceschi, K. Kne~aurek, ~. Spaventi

C o r o n a r y b y - p a s s s u r g e r y ~as s t a r t e d in N o v e m b e r 1983 at lhe U n i v e r s i t y C e n t r a l H o s p i t a l of K u o p i o , F i n l a n d . In SO patients a radionuelide ventriculography (RNV) b o t h at rest and d u r i n g i s o m e t r i c h a n d g r i p (IHG) ~as p e r f o r m e d 2-3 days preoperatively and tmo m o n t h s a f t e r operation. G l o b a l e j e c t i o n f r a c t i o n (EF) ~as decreased preoperatively and r e g i o n a l dist r i b u t i o n of EF c o r r e l a t e d well ~ i t h angiographic f i n d i n g s . IHG (50 per cent of v o l u n t a r y m a x i m u m ~ i m a g i n g from 1 minute t o e x h a u s t i o n , or for two m i n u t e s ) d e c r e a s e d g l o b a l EF in 90 per cent of s u b j e c t s . In m o s t p a t i e n t s e n d - d i a s t o l i c v o l u m e ( L V E D V ) i n c r e a s e d in s p x t e of imc r e a s e in h e a r t rate. A f t e r a p e r a t i o n r e s t i n g EF changed o n l y slightly, b u t LVEDV d e c r e a s e d by 10-20 per c e n t . Decrease i n EF d u r i n g IHG was less pronounced, but the responses varied. In B few p a t i e n t s ~ i t h e a r l y c o m p l i c a t i o n s the b e n e f i t of p r e o p e r a t i v e RNV ~as e v i d e n t : a b s e n c e of a new m y o c a r d i a l d y s f u n c t i o n area ~as the sign of a successful o p e r a t z o n and c o n s e r v a t i v e foll o w - u p was e n o u g h . It is c o n c l u d e d that p r e o p e r a t i v e RNV is useful: i. to e x c l u d e d e t e r i 0 r a t i e n of m y o e a r d i ~ f u n c t i o n b e t w e e n a n g i o g r a p h y and o p e r ation. 2. in s o l v i n g p o s s i b l e p o s t o p e r a t i v e problems. 3. IHG m a y r e v e a l r e g i o n a l d y s f u n c t i o n in a r e a s of n o r m a l f u n c t i o n at rest. The p r o g n o s t i c v a l u e of t~o m o n t h s ' p o s ~ o p e r a t i v e RNV ~ i l l be seen later. University Central Hospital, GF-70211 Kuopio~ Finland.

Evaluation of aortic stenosis (AS) is difficult both noninvasively as well as witll invasive methods. In this study, an attempt was made to estimate the severity of AS using ENV. In 20 consecutive patients (13 men, 7 women) with isolated Or predominant AS gated equilibrium }LNV was performed at rest with a high time resolution of 32 frames per cardiac cycle. Subsequent catheterization revealed 1O patients with a moderate pressure gradient across the aortic valve (~ 35 ~ g ) constituting group l, whereas the remainder had a gradient exceeding 70 I~Hg (group 2). All patients had a norm&l ejection fraction exceeding 60%. Time activity curve underwent Fourier transformation for smoothing. Time between enddiastole and endsystole as well as enddiastolic-endsystolic count rate differences (stroke volume equivalent) were normalized and expressed in %. Sequential analysis of the time activity curve in 10% volume-output increments during systole revealed that up to 60% of ejected stroke volume there was a significant contraction delay as seen by the longer time needed, thus reflecting the underlying hemodynamic disturbancies. This delay in contraction was quantified hy the area underneath the time activity curve during systole averaging 47.6~2.2% in group 1 but 50.5~2.6% in group 2 (p < 0.05). Using this latter index 6 of 10 patients with severe aortic stenosis could be detected noninvasively. If using additional parameters, i. e. the time necessary to eject the first i0% of the stroke volume, an even higher discrimination between moderate and severe AS can be reached. In conclusion, these initial results indicate that specific analysis of the ejectiQn phase from RNV time activity curves might be helpful in noninvasively discriminating the severity of aortic valve stenosis.

The aim of t h i s study was to evaluate global and r e g i o n a l l e f t v e n t r i c u l a r f u n c t i o n in p a t i e n t s w i t h coronary artery disease using radionuciide ventriculooraphy and two-dimensional echocardiography. The results were compared to those of contrast ventricu]ography and coronary angiography. The study was carried out in 30 patients w i t h coronary artery disease, w i t h and w i t h o u t h i s t o r y of previous myocardial infarction. Radionuclide ventriculography was performed as a gated cardiac blood pool study, at rest and during exercise. The rate and time parameters were computed from the l e f t ventrlcular timea c t i v i t y curve. For each of these paramegers functional images were obtained using Fourier phase and amplitude analysis. By means of twodimensional echocardiography global and segmen" ta] left ventricular anatomy and function (thickness, echo-structure, kinetics) were studied. All patients underwent contrast ventriculography using the usual technique and coronary angiography by the Judkins technique. In addition to the contrast ventriculography and coronary angiography data, our results indicate precise assessment of morphological and functional consequences of coronary artery disease by combined use of radionuclide ventriculography and two-dimensional echocardiography. The above non-invasiva procedure allows selection of patients for subsequent more invasive procedures and followup in coronary artery disease. Nuclear Medicine & O n c o l o g y Clinic, "Dr. Nladen Stojanovi6" Clinical Hospital, Vinogradska 29, 41000 Zagreb, Yugoslavia.

Division of Cardiology, Department of Internal Medicine, and Department of Radiology, University of Ulm, Steinhdvelstraae 9, D-7900 Ulm/Donau, West Germany

A211

A212

A213

REST-EXERCISE fIRST PASS VENTRIEULOGRAPHY WITH A DIGITAL GAMMA CAMERA IN THE DIAGNOSIS OF CORONARY ARTERY DISEASE: CORRELATION WITH CORONARY ANGIOGRAPHY. R.Giubbini, P.Guerra; A. Terzi, G.Bissoli*, G.La Canna*, M.Metra °, L. Nicoli ° . 63 patients,53 with suspected coronary artery disease and unconclusive stress EKG and 10 with post myocardial infarction angina, underwent rest-exercise First Pass Ventriculography (FPV) to evaluate alterations of left ventricular

RADIONUCLIDE VENTRICULOGRAPHY IN PATIENTS WITH CORONARY ARTERY DISEASE DURING EXERCISE.J.Maksimovi~,V.Bogdanova,B.Karanfilski

STRESS FIRST PASS CARDIAC STUDIES IN NOBV~L ~JILHTY VOLUNTEERS USING C~LD Ig5m. P.Bourgeois, P. Merveille, J.P.Vanvooren~ D.Demey~ ~.Erbsmann and J.Fruhling.

Left ventricular f u n c t i o n was e v a l u a t e d w i t h r e s t and e x e r c i s e r a d i o n u c l i d e equilibrium ventriculography in patients with coronary artery disease(DAD)• I n g r o u p o f normal s u b j e c t s mean v a l u e of left ventricular ejection fraction (EF)increased during e x e r c i s e by 16%. During e x e r c i s e EF in p a t i e n t s w i t h CAD a l s o increased but only by 9%.In p a t i e n t s w i t h previous myocardial i n f a r t i o n ( M I ) , E F decreased by I% during exercise. Mean e n d - s y s t o l i c volume(ESV)decreased during e x e r c i s e by 25,4% in c o n t r o l g r oup,by 18,9% in group o f p a t i e n t s w i t h BAD and by only 3% i n p a t i e n t s w i t h myocardial i n f a r c t i o n . L e f t v e n t r i c u l a r e n d - d i a s t o l i c volume (EDV)decreased during e x e r c i s e s i m i l a r l y in the c o n t r o l group and p a t i e n t s w i t h CAD. Left ventricular ejection rate(ER)increased during e x e r c i s e in c o n t r o l group by 46%,in p a t i e n t s w i t h CAD by 43% and i n p a t i e n t s w i t h myocardial i n f a r c t i o n by 15%. Exercise decreased mean value o f time to e n d - c y s t o l e ( p ) i n c o n t r o l group by 16%,patients w i t h CAD by 12%,and p a t i e nts w i t h myocardial i n f a r c t i o n by 6%• Mean value o f f i l l i n g rate(FR)increased during e x e r c i s e i n c o n t r o l group by 30% in p a t i e n t s w i t h CAD by 22% and in p a t i e n t s w i t h MI by 17%.

The use of the ultra short lived-generator produced radionuclide, Gold 195m, and the development of a semi automatic treatment program for first pass cardiac studies have allowed the development of the stress cardiac studies in our department. Previously to the application of the technique to pathological cases, evolution at stress ( cycloergometer in half sitting position ) of the fo. llowing functional cardiac parameters, he~J~t rate {HR), cardlac output lndex (COI)~stroke volume index ISVI), mean systolic and diastolic times (MST,MDT) 7 ventricular transit times (TT) and telediastolic volume index ITDVI) obtained from first pass cardiac curve analysis has been studied in 12 young healthy volunteers (23 y old, 21-39) using Gold 195m ( up to max 6 successive bolus injections performed at rest and thereafter at each stress level - 3 min. per level, from 50 to 200 Watts max by 25 or 50 ~atts steps ). Dynamic data ( 400 frames of 0,08 sec or 800 frames of 0.04 sec followed by 35 frames of 0.8 sac) were stored on disks and thereafter treated using a semi automatic treatment program necessiting a minimal intervention of the physician and "working" during the night. In all cases, H R a n d COI increased and TT decreased as stress level increased. Left ventricular ejection fraction I*) as 8VI increased as well. TDVI increased in most and slightly decreased in some. MST and F~IT decreased but the latter more than the former. These studies and their conclusions 1 repeated in four patients, were demonstrated to be reproducible. Results obtained by the present technique based on repeated first pass and allowed by the use of an ultrashort lived radionuclidecorrelated well with the corresponding stress cardiac studies performed mainly at equilibrium with ggmTc radlolabelled compounds. The use of Gold Ig5m should have allowed however the subsequent realisation of stress thallium scan in case of pathological patients. C.H.J.Bracops, 79, rue Dr Huet, IO70, Belgique°

kinetic secondary to ischemia. The studies were performed with a d i g i t a l gamma camera equipped with a h i g h sensitivity collimator. Each patient received 25+25 mCi of 99m Tc DTPAfrom a catheter positioned in the superior cava vein at rest and after a symptom- Limited exercise test, performed on a bycicte ergometer in the supine position. Coronary angiograms performed at the same period were negative for CAD in 25 and positive in 38 patients. We analyzed sensitivity (S), specificity (SP), positive and negative predictive value (PPV and NPV) of the global ejection fraction (EF) and the three functional images (fI): Regional Ejection Fraction (REF), Amplitude (A) and Phase (Ph). Our results are summarized as follows:

S

SP

PPV

NPV

EF REF

76% 70% 85% 69% 84% 88% 88% 78% A 89% 84% 89% 84% Ph 74% 88% 90% 62% Using the combination of two concordant fI we registered the following values: S=95%; SP=88%; PPV=92%; NPV=92%. In conclusion: FPV with the digital gamma camera, allowing to

collect sufficient count density for functional imaging, is a quite sensitive and specific method for the diagnosis of CAD. Servizi di Ned. Nucleare e Policardiografia*,

Ospedale Regionate, Cattedra di Cardiologia ° , Universita, 25100 Brescia, I t a l y

C l i n i c of Cardiology,Medical Faculty, 91000 S k o p j e , Y u g o s l a v i a .

A37 A214

A215

A216

L E P T VI~NT',~ICULAI~ ]~UNCTTOX' ]~ao?[ RA r)T O NU{.'LII)I~] ] ) I A G L ~ G - HOW I S T'P [~I~S'P A S S E -

A2PLICATICN 0F T ~ QUANTITATI,TE PanICNUCLIDE CARDIOA2~GZO~Fu%PIFf IN E V A L U A T ! 0 ~ OF TI~E C O N G E ~ I T A L HZ~{T DISEASES WI~H LEFT-T0-RI~{T SHinTo M. Wr~bl~¢ska, K. Teth, Ao Kewalski, K. Koaiec, J. Ksi~~ek and W, K o n i e c z n y

E V A L U A T I O N OF B A C K G R O U N D S U B T R A C T I O N

.~ZE[) ? VAI,[DATTON OF A MULTIPA~AH]gT];I~ METIIOD U S I N G A CALCULATEI] M O D E L LV I).No Taylor~ J. F.lint, E. l~arfield and J. MiJ]s A c a l c u l a t e d soherica] model ~f the ].eft v e n t r i c l e (iV) b ] o o d pool was defined, T h e two d:lmel~sional imagoes of this three d i m e n s i o n a l m o d e ] were caloul~ted aecordin{~ to chord ] encth~ Th(! sphere was decreased J~ v o l u m e to simulate systole, (fivin~ an e j e c t i o n frac-

tion (F.F) of 60~o This c o n t r a c t i o n resuited in 16 ~dxgi~ ilnar~es s i m u l a t i n ~ the c a m d i a c cycle~ I)efects were we] 1 d e f i n e d all<] superimposed on a normal m o t i o n pattern~ The size, p o s i t i o n a n d s e v e r i t y o f defect could be i n d e p e n d e n t l y varied~ D e f e c t s of p r e c i s e l y k n o w n size, sev e r i t y and p o s i t i o n were a s s e s s e d by two e x p e r i e n c e d observers. T h r e e LV f u n c t i o n a l parameters were i n v e s t i g a t e d LVEF, reLrional wall m o t i o n (}{WM) and phase a n a l y s i s (~ACV). "fbe r e s u l t s show that LVI~F is not a s e n s i t i v e index of LV d y s f u n c t i o n but is safe in that the m e a s u r e d v a l u e is not s e v e r e l y a f f e c t e d by image o r i e n t a t i o n . The local d y s f u n c t i o n p a r a m e t e r s of RWM and ?oADV are v e r y s e n s i t i v e to m i n o r chan~es in wall m o t i o n but t h e i r a c c u r a t e i d e n t i f i c a t i o n d e p e n d s on image orientation. D e p a r t m e n t of M e d i c a l P h y s i c s and Cardiology, ]¢a]sg~rave Hospital, Coventry, Warks, Z n g l a n d

In cur study the quantitative r~dieuuclid~ cardioazgiography w~s used to evaluate left-to-right shunt 2roblems. The investigatiam were perf@rmed ~ lO0 children with ASD iI - 19, VSD - 53 and 2DA - 28. I~ part of the aa~e~ the tests were perfarmed b~fore and after surgery. Th~ age of the ehildre~ ranged from 2 w. to l0 yo The i ~ e s t i g a t i o n was carried cut with a g~/mma camera coupled te a computer. 99m-Te-DTPA af 250 ~ C i / k g w ~ a tr~m,r wi~h a m i n i m u m d@se ef 2 mCi. The size ef heart chambers, time sf lumg <~ireulat i ~ , and the Qp/Qe rati~ w ~ r e ev~luatedo Ths rmdi@muclide dmtm have correlatsd sati8faeterily with oi~ea~gi@eardlegraphy. Th~ Qp/Qa ratia ef beth method~ w e r e e e m p a r e d , ,~ud the a e r r e l a t i @ n w a e r = 0 . 9 0 . 9 < 0 , 0 0 1 . I m the m a j o r i t y e f children, lung eirculatie~ time w a a ~hort /2-3 m,m./. I~ c a s e s w i t h pulm@~ary hyperten~i@~, l u ~ circulatiez time w a s

prel@~ged /4-6 sem./ a~d did mat change i~ early paeteperetive period. This method ia especially u~eful far moai~vaalve evalu&ti~m cf the restult~ of surgery. Datartmeat @f Nuclear Medicine The N e m @ r i a l Hospital, Child H e a l t h Cemtre A1. Dzieei P e l ± k i c h 20, 04-756 Warezmwa, Poland

M E ~ I O D U S I N G CUBIC S P L I N E F U N C T I O N I N T E R P O L A T I O N IN E J E C T I O N FRACTION DETERMINATION

V.Fidler,

J.Fettich

A new n o n l i n e a r m e t h o d of b i d i r e c t i o nal b a c k g r o u n d

s u b t r a c t i o n was intro-

duced to gated e q u i l i b r i u m v e n t r i c u l o graphy. Global fraction

and s e g m e n t a l e j e c t i o n

(EF) was studied by Yonder-

bill cardiac p h a n t o m at d i f f e r e n t collected counts,

f r e q u e n c i e s and small

p o s i t i o n a l change.

The global EF was

found to be underestimated count studies

(< 5 m i l l i o n )

at low and over-

e s t i m a t e d at h i g h count studies million).

( ~ iO

The r e g i o n a l d i s t r i b u t i o n of

segmental EF has low c o r r e l a t i o n coefficient

( < 0.60) at low count study

(< 3 million)

and O.70 - 0.85 for 3 -

Io m i l l i o n count study w h e n c o m p a r e d w i t h h i g h count study. The f r e q u e n c y (60 - 180 c/min) and p o s i t i o n a l rotation)

(150

d e p e n d a n c e of global and

s e g m e n t a l EF was nonsignificant.

The

correlation coefficlent between radion u c l i d e and c o n t r a s t v e n t r i c u l o g r a p h y EF was 0.92. R e p r o d u c i b i l i t y of global EF was 5% and of s e g m e n t a l EF was 4 8~ d e p e n d i n g on a n a t o m i c a l position.

University Medical Centre

- U~NM

Zaloska 7, 61000 L j u b l j a n a ,

A218

A217 OPTIMIZED COMPUTER ANALYSIS OF RIgHT/LEFT VENTRICUL~R FUNCTION IN NUCLEAR CARDIOLOGY 3ohn J. Almasi

AN

A219

EVJ~LUATILII OF S Y S T L L I g AND DIa-

S T O L I C INDEXES C,F L E F T V E N T R I C U b : , R / L V / FUHCTIEN

A set of computer algorithms has been developed for the quantitative analysis of right and left ventricular (RV, LV) function an~ valvular function using multigatsd nuclear blood pool studies as input. In the totally automatic mode of analysis, the chamber center, perimeters, background, ejection

fraction

and

ventricular

volume

curve, and regional wall motion quantitation are found without any operator interaction. This mode aorks most of the time in the LV and occasionally in the RV and allows a multi- or two-frame analysis. A computer-assisted manual mode (single-, two-, or multi-frame options) is also provided to complement the automatic mode. Here the user defines the center, perimeters, and background locations. The actual edges are joystick-drawn with the aid of a special multi-quadrant display routine. This routine traces the edges on up to four images simultaneously: the original image of interest and up to three other "help" images, which aid the user in defining valve planes, etc. and greatly increase the reliability of the analysis. These "help" images are chosen by the user from among the following: Fourier phase and amplitude, stroke count (SC), or another of the multigated images. A complete set of parametric, curve, contour, and static and dynamic (cine) image displays is available for data review after completion of analysis in either mode. These displays provide a standard means of (1) presenting the clinically pertinent results and (2) assuring quality control in the computer processing. Computed SC ratios and regurgitant indices are easily obtained after both ventricles have been analyzed. General Electric Medical Systems P. O. Box 414, Milwaukee, WI 53201 USA

DISEASE

/Cf~O/.

Slominskl O.M.

In c o n c l u s i o n : / a / r e s t l n g d i a s t o l i c i n d e x e s are more s e n s i t i v e than systolic indexes in d e t e c t i o n of CAD, ~b/improvement of s e n s i t i v i t y was obtained by simultaneous e v a l u a t i o n of PFR and P/Yr. Nucl. Mad. Dept. of I n t e r n a l M e d i c i n e Medical Academy

ul.D~binki 7 POLAND

C0~PARISON OF EJBCTI0~ FRACTION DETER~INATION BY T~J0 TECHNIQUES. Amiel Z. Rudavsky and ZuKene J. Fine

IN CCRONARY ARTERY

This study have been u n d e r t a k e n in order to compare c l i n i c a l u t i l i t y of d i a s t o l i c indexes /peal< filling rate /FFQ/~fast filling fraction and s l o w f i l l i n g f r a c t i o n / , r a t i o of s y s t o l i c p r e s s u r e to end s y s t o l i c v o l u m e / P / V r / sad e j e c t i o n f r a c t i o n / E F / in normal s u b j e c t s and pstient w i t h C A D . P a r a m e ters of LV f u n c t i o n were e v a l u a t e d st rest using e q u i l i b r i u m gated r a d i o n u clide a n g i o g r a p h y in 35 s u b j e c t s divided into three groups - group i = SO normal subjects,group 2 = i3 p a t i e n t s w i t h C A D , g r o u p 3 = 12 p a t i e n t s w i t h CAD and p r e v i o u s m y o c a r d i a l i n f a r c t i o n . The P/Vr was of s i m i l a r s e n s i t i v i t y to EF in d e t e c t i o n LV d y s f u n c t i o n caused by C A D . P e o r i a s PFR w e r e s i g n i f i c a n t l y d e p r e s s e d in both group 2 / p ( O . O 5 / and group 3 / p < O . O i / p a t i e n t s w h e n compare w i t h group l . D i a s t o l i c d y s f u n c t i o n was present in 8 of 13 in group 2 and ~0 of 12 in group Z.

Institute,

Yugoslavia

80-952

of G d a g s k GDANSK

This study was undertaken to compare e j e c t i o n fractions calculated by two different h a r d w a r e - s o f t w a r e packages a n a l y z i n g the same data. One hundred and fifty consecutive m u l t i g a t e d cardiae studies were acquired by a digital gamma camera with an integral mierocomp u t e r * ( ~ e a n E j e c t i o n Fraction:50.93: SD=21.40) and s i m u l t a n e o u s l y by a dedicated m i n i c o m p u t e r * * ( M e a n E j e c t i o n Fraction=51.7h;sD=21.58). These values were not s i g n i f i c a n t l y different by statistical analysis (p greater than 0.5). Ejection fraction calculation by the m a n u f a c t u r e r ' s software in the g a m m a camera takes less than two minutes, 0perator-computer i n t e r a c t i o n is limited to selecting a circular r e g i o n encompassing the left ventricular boundary. Ejection fraction c a l c u l a t i o n by a m o d i f i c a t i o n of the minicomputer manufacturer's software r e q u i r e s continuous operator-computer interaction during the program. The operator must outline and designate end-diastolic, endsystolic and background regions-of-interest and initiate each step in the program. This allows for considerable operator error and u n c e r t a i n t y as well as v a r i a t i o n in r e g i o n - o f - i n t e r e s t assignment. E j e c t i o n f r a c t i o n determinations using the digital gamma camera with integral m i c r o c o m p u t e r are reliable, rapid and reproducible. The technique requires minimal operator interv e n t i o n and utilizes r e l a t i v e l y inexpensive hardware to a c c u r a t e l y calculate the ejection fraction. *Elseint A p e x 410 * * D i g i t a l Equipment Gamma II Z o n t e f i o r e - N 0 r t h Central Bronx Affiliate, 3424 Kossuth Avenue, Bronx, New York 10467, U.S.A.

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THE STUDY OF LEFT V E N T R I C U L A R F U N C T I O N W I T H THE NUCLEAR S T E T H O S C O P E IN CORONARY A R T E R Y DISEASES. T r a p p o l i n i M ? , N a t t e o l i S ? , G a l l i V ? , R o n g a G ? ° , E o n g a G.A? °, Cesse~]i M . G ? ° , G r e c o V? o C o r o n a r y Dep., so N u c l e a r Medicine, End M e d i c a l Clinic, U n i v e r s i t y of Rome,

RADIONUCLIDE CARDICGRAPHY:COMPARISON OF VARIABLE AND FIXED REGION OF INTEREST ~THODS IN CALCULATIONS OF LEFT VENTRICULAR EJECTION FRACTION . A.Hietanen,R.Hgrk~] and P.P~utio

V4R AND RIGHT AND LEFT VENTRICULAR E J E C T I O N FRACTION. E.H. Hraat, P. Brugada, K. den Dulk, H.J.J. Wellens.

In order to d e f i n e in p o s t - i n f a ~ c t u a t s d p a t i e n t s n e w p a r a m e t e r s of p r o g n o s t i c and f u n c t i o n a l interest, a v a i l a b l e %hru non invasive methods, the a u t h o r s compare the results of a study of the left v e n t r i c u l a r function, p e r f o r m e d with the aid of the n u c l e a r stethoscope (NS), clinical and e c h o e a r d i e g r a p h i c data, Two p a r a m e t e r s were considered: the e j e c t i o n f r a c t i o n (EF) and the peak filling rate (PER) of the left ventricle The study was carried out on 32 patients. The clinical and e c h o c a r d i o g r a p h i c presence or absence of the left ventrieular failure (group A and g r o u p B) were both c o n s i d e r e d d i s e n i m i n a n t in comparison to a group of controls, The EF compared to the controls>resulted reduced w i t h statistic s i ~ n i f i s a n c e (group A p<0.001, group B p<0.01) in the patients with p r e v i o u s m y o c a r d i a l infarction; A c c o r d i n g l y the r e d u c t i o n of the m e a n EF in i n f a r c t u a t e d patients w i t h left v e n t r i e u l a r d i s f u n c t i o n (group A) compared to those w i t h good r e s i d u a l cont r a c t i l i t y (group B) appeared also stati s t i c a l l y s i g n i f i c a n t (P
In calculation of left ventricular ejection fraction from multiple gated bloodpool studies different techniques are used.Our purpose was to compare the fixed region-of-interest (FROI) method to the variable region-of-interest (VROI) method. 105 consecutive patients with suspected cardiac disease were examined at rest and at maximal exercise. Coefficient of correlation of VROI ejection fraction ~ and FEel ejection fraction EFf was at restv r=O.92 and at n~xin~l exercise r=8.95 (p<0.881) . Arithn~thic mean of EF at rest was 0.547 and at maximal exercise 0v572 . Arithmethic mean of ~ at rest was 8.508 and at maximal exercise f0.497. The main difference between the i~Ol and FROI methods was in the means of quantitatinq endsystolic counts. The site of valvular plane of left ventricle can reeve du]finq the contraction and so with the fixed ROI method parts of left atrium and the aortic root can be falsely included. The fixed ROI method can underestimate the ejection fraction especially at maximal exercise. We consider that the variable Eel method is more reliable than the fixed ROI method.

Department of Clinical Physiology North Karelia Central Hospital 80210 Jcensuu Finland

This study was u n d e r t a k e n to compare the right (RVEF) and left v e n t r l c u l a r ejection fraction (LVEF) after an acute inferior wall m y o c a r d i a l infarction (MI) caused by an obstruction in the right coronary artery (RCA) or circumflex coronary artery (CX) and to evaluate the value of lead V ~ R to predict the site of stenosls which caused the MI. In 42 consecutive patients (pts) admitted with an acute inferior wall MI a standard ECG and V4H were recorded. A nuclear angiogram w a s m a d e one w e e k after the acute Nl and the EVEF and LVEF were calculated. Ten to 14 days (mean 12.7) after the acute Ml a coronary a n g l o g r a m was p e r f o r m e d to determine the site of occlusion, which had caused the acute ME. A c c o r d i n g to the site of occlusion the pts were divided in three groups: Group A: the stenosis which h a d caused the Nl was located in the RCA above the first branch to the right ventricle (RV); Group E: the stenosls was below the first branch to the RV in the RCA and Group C: the stenosis was located in the CX. The EVEF and LVEF in these groups were as follows; No. of pts Group LVEF RVEF 17 A 55+7% 29+9% i~ B 56¥7% 43T5% ii c 53~9% 44~B~ Nineteen pts had S T - s e g m e n t e l e v a t i o n 1 man in V h E and 17 of these pts had an o b s t r u c t i d n above the first branch to the RV in the RCA. There is s t a t i s t i c a l ly no significant difference between the LVEF in the three different groups while the RVEF is s i g n i f i c a n t l y lower in group A. These pts can be identified by recording V4R. Dept. of Cardiology, U n i v e r s i t y of Limburg, Annadal Hospital, 6201 BX MAASTEICRT, The Netherlands.

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LEFT VENTRICULAR VOLUME DETERMINATION: TO ATTENUATION-CORRECT OR NOT TO ATTENUATION CORRECT. J. Siegel, A. Maurer, K. Blasius and L. Malmud.

A TECHNIQUE FOR MEASURING RAPID CHANGES IN LOFT VENTRICULAN (LV) FUNCTION IN PATIENTS WITH NEART FAILURE DURING ACUTE pHA~MACOUTICAL INTERVENTION. C. Robinson, A. Lahiri, J. Tovey, P. Cashman and E.B. Raftery.

LEFT V E N T R I O U L A R EJECTION FRACTION DURING EXERCISE IN ISCHEMIC HEART DISEASE. R . H i r k ~ n e n , A . H i e t a n e n , P . R a u t i o

The ability to accurately measure absolute left ventricular (LV) volumes is of great clinical importance. There is at present a controversy regarding the proper technique for radioauclide count-based volume determinations. The equation for LV volume (net LV count rate/(blood sample count rate x e-ud)) contains only three variables. Numerous methods for obtaining these parameters have been reported and at present no standardized techniques have been established. We have compared five reported methods for determining LV volumes in terms of regression equations, correlation coefficients, standard errors of she estimate, transmission factors, 95% prediction inter~als and their respective percent errors for both enddiastolic and end-systolic volumes. Based ca these statistics the op=imal volume technique should include semiautomated regions of interest to determine act LV counts, counting the blood samples in a geometry similar So that of the LV using a container which minimizes selfattenuation, and most importantly, attenuation correction. The assumption of a narrow beam linear attenuation coefficient (0.15 cm-I for Te-99m) is i~correct. Attenuation correction should be performed by either direct measuremeat or build-up factor analysis to include the scatter contribution. Department of Diagnostic Imaging, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA. 19140, U.S.A.

We have used the ~uclear stethoscope (NS) (Hies Inc) to study patients during acute pharmaceutical intervention. Nine patients (mean age 62.2 pears) with congestive cardiac failure (N.Y.H.A. stage II-III) underwent serial measurements of LV ejection fraction (EF) using the NS during an acute infusion of I0 mgs of nicardipine (a Ca channel blocker) over i0 minutes. The blood pool was labelled with 740 mBq Tc-99m. The NS was connected to a strip-chart recorder allowing continuous beat-to-beat recording of ECG and LV counts. An AIM 65 microcomputer (Cashman P. et el, Nncl. Ned. Comm.. 1984) calculated 30-second averaged EF continuously. The NS was used to calculate LVEF at rest, and at 2.5 and I0 minutes during drug infusion. Nicardipine significantly improved EF: the mean ~ SD EF (%) with the NS being 30 ~ 6.9, 32 ~ 6.7, 36 7.1 and 38 + 6.5 respectively. Paired t tests between rest and infusion results gave p values of 0.04, 0.01 and 0.001 respectively. Simultaneous EF values obtained by the AIM and the NS agreed to within 2.1 + 3.9%. Although high count rates map be obtained with the NS, the computer manipulation is time-consuming, and precludes continuous d a t a recording, which may he useful in intervention studies. The additional data analysis provided by the AIM offers advantages where rapid haemodynamic changes may occur. Departments of Cardiology & Bioengineering, Northwick Park ~ospital & Clinical Research Centre, Harrow, ENGLAND.

The response of left ventrieular ejection fraction(LVEF) to exercise was evaluated by means of multistage supine exercise test and r a d i o n u c l i d e ventriculography. LVEF was measured at rest and during the last two minutes of every stage using a multiple gated equilibrium method with moving region of interest. Study p o p u l a t i o n (n=I08) consisted of three subgroups: previous myocardial infarction(n=36), angina pectoris(n=39), no heart disease(n=33). During exercise four patterns of LVEFresponse were seen: 1)Ascending: LVEF rise ~5%; 2 ) I n d i f f e r e n t or descending: LVEF rise<5% or fall; 3 ) A s c e n d i n g - d e s c e n d i n g ( i n i t i a l rise ~ I 0 % and a later fall ~5% but the final LVEF still ~ 5% major to the redting value; 4)Low r e s ~ n g LVEF (iO.48,the lower limit of our normal values) but rise ~ 5 % at exercise. Frequencies of LVEF-patterns: PREVIOUS INFARCTION ASCENDING INDIFF/DESGEND ASCEND-DESCEND LOW AT REST

5 28 0 3

ANGINA 5 31 3 0

NO HEART DISEASE 29 4 0 0

In ischemic heart disease the sensitivity of the m e t h o d was o.87 and specificity 0.88. If only the final response was taken into c o n s i d e r a t i o n so neglecting the a s c e n d i n g - d e s c e n d i n g pattern the sensitivity was 0.83. We conclude that the multi stage e x e r d s e r a d i o n u c l i d e v e n t r i c u l o g r a p h y is more sensitive in ischemic heart disease than a two level (rest-exercise) stress test. It is a valuable diagnostic tool and combined with e x e r c i s e - E O G it gives a d d i t i o n a l information. Department of Clinical Physiology North Karelia Central Hospital SF-80210 Joensuu, Finland

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VALUE OF PARAMETRIC IMAGING IN THE EVALUATION OF 8RAIN ANGIOSCINTIGRAMS. S. Askienazy ,M. MichaLski ,H. Khayat, D. Romary

CEREBRAL BLOOD FLOW F ~ L ~ USING GT~tiA CAMERA, VERTEX PROJECTION AND 99m-TEC}{VE~IUM PERTECk~TETATE : M A T H E M A T I C A L A N A L Y S I S AND CLINICAL FEEDBACK. H. Toivonen, T. KorppiTommola, J. Kreula, A. Kivisaari and O. Korhola

CEREBRAL BLOOD VOLUME IN GENERALIZED SEIZU= RES IN THE BABOON pAPIO-PA~IO. D. Ancri et R. Naquet.

Representation of brain angioscintigrams (BRNA) is a major problem. Sequential presentations, ROI time activity curves, are most commonly used and are operator-dependant. GORIS with parametric imaging showed that less s u b j e c t i v e t e c h n i q u e could be used. For every pixsl as for t h e whole m a t r i x , different parameters can be s t u d i e d : Maximum a c t i v i t y (VM), time of maximum ( T M ) , slope of apparition (SI), slope of disappearance (SO), transit time (TT), value of minimum (Vm), area under the curve (AC) are coded so that each pixe[ of the matrix represents the value of the studied parameter. Representation of AC/TT gives an index picture of CBF. AS cerebral perfusion represents onIy 15% of the systemic circulation, the activity in each pixel is very low and signal/noise ratio poor. This led us to: a) perform spatial filtering (convolution filter); b) perform temporal smoothing on a 3 matrix basis; c) find a way to represent coded parameters where widspread of grey or color scale is adapted the studied parameter. 100 patients with XRay angiograms where analysed to evaluate our technique. Results : t h i s t e c h n i q u e appears to be of a high interest in study of cerebral ischemia: patients who showed normal BRNA had pathologic params- tric studies. In tumors so called normal SRNA appeared either avascu- lar or hypervascular. This technique is of a daily use (8-10 cases p.day). Programmed in assembly Language and running on a IMAE and On a Gamma 11 system. The whole protocole (spatial temporal filtration, functionnal analysis) takes less than lOmn Service de Medecine N u c l e a i r e , E . Hospitalier Ste Anne, 1 rue Cabanis, 75014 P a r i s , France

The complexity of brain blood flow is studied by a m a t h e m a t i c a l model. The flow indices calculated from measured data are only of iLmited diagnostic value unless the variation of the indices is explained in proper clinical terms. The simulation program allows to vary the ~ p u t activity supply and the p r o b a b i l i t y distribution of the transit time. The model is used to interprete the asyn~try of the timeactivity curves caused by changes in cerebral circulation. The results are available at once, displayed by GAMMA 11 software package. The data analysis is made by comparing the timeactivity curves of both hemispheres, a. cer. media and a. cer. posterior regions in pairs. The first circulation is extracted from the raw data by pixel correction, least squares s~oothing and exponential curve fitting. Various curve characteristics are calculated, e.g. the ratio of the integral counts of the first circulation, the rising part ~nd the equilibrit~, peak times, peak widths, rising times and disappearance constants. In addition, the data are processed by a method based on relative flow (inverse transit time e s t i m a t e d from the truncated activity distribution). A brain flow image is calculated pixel by pixel to show the regional differences of blood flow.

Relative variations of the cerebral blood volume (CDV) were measured continuously by an a t r a u m a t ~ method (red blood cells label= led with Tc ~ m ) in baboon tO explore the relationship between changes in the ~yste= mic circulation and in the cerebral vascu= lar r e s p o n s e s , before during and after gen~ ~ali~ed seizures induced by photic stimula= %ion. During the seizure disch~Tge, a subs= tamtlal increase in ODV occurs, associated with a d~amatio increase in arterial pros= sure. However, the greatest increase in CBV occurs after the peak mean arterial pressure. The results show that the OD~ does not passively follow the blood pres= sure, Service de Biophysique et M~decine Nucl4= aire, Hapital de la Pill4, 83, bd de I'HG= pital, paris 13e.

The sensitivity and the specificity of tile bulk of n~theds are tested in a retrospective study of patients with cerebral disorders verified by CT (infarcts, turnouts, haematomas). A group of patients with TIA is also included. Helsinki University Central Hospital, Meilahti clinics, Haartmaninkatu 4, SF-00290 Helsinki 29, Finland

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M E A S U R E M E N T OF LOCAL CEREBRAL BLOOD FLOW USING 1 - 1 2 3 - 1 O D O - A M P H E T A M I N E . J.Kuikka, T.Vornanen, E.Lgnsimies and P . R i e k k i n e n

1-123 A M P H E T A M I N E SCINTIGi~API[Y C O M P A R E D WITH C O M P U T E D 'POMOG]{APHY IN A C U T E STROKE, BRAIN T U M O R S AND EPILEPSY. M. ]ivanainen, A.-L0 Kairento, K. Liewendahl, O. Naltimo, Jo N o m d g m e n and M. Vuorialho

N~R SCANS IN MULTIPLE SCLEROSIS (M~) R. Bauer, O. Lauer, H. Langha~er, H.W. Pabst

1-123-IMP has w i d e l y used for imaging relative regional cerebral perfusion. The first-pass e x t r a c t i o n e f f i c i e n c y in animals is n e a r l y 100 %, washout is low and b r a i n - b l o o d ratio is high. The aims of this study were to estimate the first pass e x t r a c t i o n in man and to measure mapping of local cerebral blood flow in patients with various cerebral disorders. Bolus injections of a reference tracer (Tc-99m-HSA) and a test substance (I]23-IMP) were made into the antecubital vein and the T/A-curves were r e c o r d e d over the hemispheres. Thirty minutes after the injection the m a p p i n g of local CBF was m e a s u r e d u s i n g a s i n g l e h e a d rotating gamma c a m e r a (GE 400 A / T ) . The scan duration was 24 minutes. A c a p i l l a r y - t i s s u e model was used to describe cerebral blood flow and permeab i l i t y - s u r f a c e area product, PS: C(t)

= A'{1

- e CBF/~'ln(1-E)'t

= A-(1

- e -k't)

}

where C(t) is the tissue c o n c e n t r a t l o n of 1-123-1MP and I the t i s s u e - b l o o d p a r t i t i o n coefficient. The results show that the peak extraction in man was on the average g3 %, the ratio of PS/CBF was 2.6 and k 0.47 min -I . The results obtained with S P E T - p r o c e d u r es were compared to CT-scans, anglographic findlngs and to clinical symptoms. 1-123-IMP seems to be the most p r o m i s i n g imaging agent in e v a l u a t i n g regional cerebral blood flow in man. U n i v e r s i t y Central KuopJo, Finland

Hospital,

BF-70210

R e G i o n a l c e r e b r a l p e r ~ t s i o n was s t u d i e d u s i n ~ N - i s o p r o p y l - ( I- 1 2 3 ) - p - i o d o a m p h e t amine (IMP) and a r o t a t i n g t o m o ~ r a p h i c gamma camera. Of the 16 p a t i e n t s w i t h acute c e r e b r a l i n f a r c t i o n i~ (g8 ~) had a p o s i t i v e IMP scan w h e n studied 1-10 days a f t e ~ the onset~ w h e r e a s t r a n s m i s sion c o m p u t e d t o m o g r a p h y (CT) was positive in only 5 (38 ~) of the 15 p a t i e n ts studied. The two p a t i e n t s w i t h a heN a t i v e I~IP scan also had a n e g a t i v e UT and n u c l e a r m a g n e t i c r e s o n a n c e (MMI{) scan, The lesion in the CT s c a n was often s m a l l e r than that in the IMP scan. IMP is t h e m e f o r e a m u c h more s e n s i t i v e method than CT for l o c a l i z i n g p e r f u s i o n d e f e c t s in acute stroke. In 6 p a t i e n t s with v a r i o u s CT p o s i t i v e b r a i n tlusors the IMP scan was p o s i t i v e in 4. T h e two n e g a t i v e studies were Jn p a t i e n t s w i t h small a s t r o c y t o m a s . Of 8 p a t i e n t s with focal e p i l e p s y and n o r m a l CT scans two had an eqttivocally d e c r e a s e d local uptake of IMP when s t u d i e d i n t e r i c t a l l y o In 6 p a t i e n t s w i t h e p i l e p s y the I M P scan was c l a s s i f i e d as normal. Q u a n t i fying the u p t a k e of t r a c e r and p e r f o r m in 6 s c i n t i ~ r a p h y i c t a l l y w h e n p o s s i b l e might p r o v i d e more exact i n f o r m a t i o n on p e r f u s i o n d e r a n g e m e n t s in p a t i e n t s with epilepsy° D e p a r t m e n t s Of Neurology, N u c l e a r Medicine and R a d i o l o g y , M e l s i n k i U n i v e r s i t y Hospital, 00290 }{elsinki 29, F i n l a n d

In patients with suspected MS, often the disease cannot be confirmed at the first episode by liquor tests (LT) or CT scans. NMR has been shown to be superior to CT in demonstrating sclerotie lesions. In this study, accuracy and usefulness of NMR scans in MS was assessed. Patients (P) were scanned in a 0.15 T resistive magnet (Teslacon TM, Teehnieare) at the Hausstein Clinic. Usually spin echo modes with 1000 ms repetition time and 120 ms echo delay, SEIOO0/120, were applied, depicting normal brain and ventricles without contrast but highlighting MS lesions. Anatomy was assessed by SE500/30 mode, inversion echo IE1200/400/30 and IE1200/I00/30 demonstrated both anatomy and pathology. Slice thickness was 15 mm. One 200 ~ thick sagittal SE1200/120 image was recorded giving a survey of pathology. 43 P with MS suspected from history were studied. 3 had no clear evidence of Y~ due to neurological findings, LT or CT. In 37 P NMR was positive. The 5 P with negative NNR included I P with cerebellar atrophy, also seen on CT, I case with negative LT and likely psychogenic paralysis and 7 case with questionable positive LT. LT were done in 29 P, 21 positive and 3 negative consistently with NMR. In 2 P only NMR and in 3 P only LT were positive. Thus, sensitivity of NNR in diagnosing MS was 37/41 = 90% in our study. In 135 other cases not suspective of MS topographic comparable images with the same scan modes were taken. Only in I P periventricular lesions with high signal in SEIgO0/120 mode were seen. ~]~om these results, NMR seems to be highly specific. But when correctly evaluating specificity of NMB in diagnosing MS, investigation and long term follow up of a large number of patients with suspected MS at their first episode is necessary. Even thoagh NMR is an expensive investigation, it might be helpBal in dubious cases. However, its usefulness in early diagnosis of MS has still to be established. Nuklearmedizinische KLinik, TU ~]nchen, Ismaningerstr. 22, D-8000 Mfinchen BO

A40 A235 NEARLY SIMOULTANEOUS M F A S ~ S

OF QUANTITA ~

TIVE CEREBRAL BLOOD FLOW, CARDIAC INDEX A~D EJECTION FRACTION WITH THE SNOF~ ~

ISOTOPE

195m AU. P. Lind~er, O. Nickel, N. Schad

The short lived isotope 195~ Au enables to make subsequent first pass perfusion studies of the brain and the heart from the same patient within some minutes. Quantitative cor~putation of cerebral blood flow values after intravenous injection of the short-lived nondiffusible cer 195m Au are possible

tra-

(Quantitative first

pass technique described by Libdner). A group of 35 patients with heart disease has been examined by subsequent cardiac and brain first pass studies. By the use of 195m Au (half-live time:3o,5 sac) both examinations are passible within 5 minutes. From two first pass studies ejection fraction

(~), cardiac index (CI) and quantita-

tive cerebral blood flow values (CBF) have been co~guted. The brain-heart relationship concerning CBF and I~ is deaKzlstrated: a sic~%ificant decrease of CBF. There are patients with neckvessel stenosis and normal cardiac function which had a decreased CBF, demonstrating quantitatively the haemodynamic relevance of the stehosts. These exanunations can help to find out the reasons for decreased CBF.

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E F F E C T OF D R U G S F O R B L O O D P E R F U S I O N OF B R A I N O N RI A N G I O G R A P H Y BY SEQUENTIAL A D M I N I S T R A I O N OF 99m-TC. O. Shimamura, T. Bahizu, Y. Inoue, H. Adachi, H. ljiehi

CALCULATION OF REGIONAL CEREBRALBLOOD FLOW USING NON-DIFFUSIBLE TRACERS. A MODEL-FREE APPROACH. L. Nyitrai*and Z. Szabd**

RI angiography of brain by 99m-Tc intravenous injection were employed to evaluate the change of the cerebral circulation of patients with occlusive cerebrovascular disease in chronic stage and control cases. 99m-Tc pertechnetate, iB-Z0mCi, were administrated two time sequentially with 320 seconds interval. Six parameters (appearance to peak time, mode of transit time, peak count, peak count ratio, ups]ope value, upslope ratio) which were caluculated from time activity curve of ROI(region of interest) in each hemisphere were compared between first study and second study. There was good coeficiency of correlation between these two studies in each parameter of 1O controls. Eleven stroked patients were adn~inistrated papaverine hydrochloride intravenously during the interval of two studies. Angiotensine and methoxamine hydrochloride were given each 5 patients and same drugs for each B controls. Blood pressure elevated significantly in groups of angiotensine and methoxamine but in papaverine group there was no change of blood pressure and pulse rate. Upslope ratio and peak count ratio expanded significantly in second study of patients dosed papaverine. Changes of these parameters were not significant in angiotensine group and methoxamine group, but, comparing with first study, upslope value and peak count of second study decreased significantly in healthy hemisphere of patients and both hemisphere of controls whose blood pressure were elevated by drugs. T h e result may suggest that the blood perfusion in normal hemisphere have been more influenced by drugs than that in the lesion site. We may concluded that this method is useful to evaluate the reactivity of cerebral vessels for drugs.

99mTc is often used f o r brain perfusion studies. The problem of calculating regional blood flow is not uniquely solved in this way and requires complicated technical and mathematical procedures. Because of the large variety of possib]e models which w i l l s a t i s f y a given d i s t r i b u t i o n curve, a model-free determination of the transf e r function (e.g. organ response to a unique impulse) has been developed to produce exact calculation of two system parameters: a) regional blood volume (rBV) in m1/I00 g and b) regions] mean circulation time (MCT). The model-free estimation of the regional transf e r function presented here uses a f i l t e r function in the frequency domain,and the aortic a c t i v i t y is u t i l i z e d as input function. From t h i s transfer function, regional blood f)ew is calculated as rBF = rBV/MCT. The above approach has been validated by more than 100 measurements with a flow-calibrated closed circulatory phantom. After injection of 99mTc into the system, timea c t i v i t y curves were obtained, from which flow was ca]culated. Calculated and measured flow values correlated well (r = 0.96). The method provides a c l i n i c a l l y acceptable twodimensional display of cerebral rBF using conventiona] gamma cameras. * O~sa AndrOs Hospital, Isotope Laboratory, H-4401Ny~regyh~za, Pf. 159 ** Nuklearmedizinlsche Klinik der UniversitBt DUsseldorf, Moorenstr. 5, D-4BO0 D~sse]dorf I

D-839o Passau, W-Gerr~nny.

Rakuto Hospital, Department of Neurology, 583-Umebayashicho, Higas hiohji-Gojyo, Higashiyamaku, Kyoto 605, ] A P A N

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FUTURE CLINICAL REQUIREMENTSFBR HARD COPY IN NUCLEAR MEDICINE V. Ralph McCready Department of Nuclear Medicine & Ultrasound, Royal Marsden Hospital, Sutton, Surrey, U.K.

TYPES, R E Q U I R E M E N T S AND A P P L I C A B I L I T Y OF D O C U M E N T A T I O N M E D I A IN N U C L E A R MEDICAL IMAGING. H.K. D e i n i n g e r

CLINICALLY MEANINGFUL APPLICATIONS OF NXR R.Bauer, O. Lauer, A.Trappe, H. Langhammer, W.SchUtz, L.Lutilsky, M.H61scher, H.W. Pabst

First the structural analysis in m e d i cine was done by X-ray and recorded on film until new t e c h n o l o g i e s were introduced. They changed the m e t h o d s of d o c u m e n t a t i o n drastically. The ideal r e q u i r e m e n t s for r e c o r d i n g media are met by systems and materials. These are c o n s i d e r a b l y influenced. The need for image storage arises for diagnosis, r e p o r t i n g and reference, teaching and research. Even if the reports are made, the images must be stored for later r e v i e w and f o l l o w - u p examinations. The whole data are transferred to m a g n e t i c media for p e r m a n e n t store. The storage for teaching and r e s e a r c h includes a wide range from an image for the r e f e r r i n g p h y s i c i a n or the docum e n t a t i o n for publication. D e p e n d i n g on the p u r p o s e it m u s t be prints (patient's file, case notes, publication) or transparent film (clinical conferences, seminars), and slides are needed for meetings or c o r r e c t color rendition. The use of p h o t o g r a p h s in training has to be c l a s s i f i e d in this c a t e g o r y also. The r e l a t i o n s h i p b e t w e e n the above mentioned m a i n r e q u i r e m e n t s of a correct, permanent, reliable and instant a v a i l a ~ le documentation, and the a n t i c i p a t i o n of the user (compactness, economy, convenience) and/or the c o n d i t i o n s of the object recorded (movement, a c c e s s i b i l i ty, sensibility) are discussed. In connection with local p o s s i b i l i t i e s (type of archives, dark-room, film processor, color images etc.) all these factors are c o n c e r n e d in the choice of the documentation medla.

NMR images obtained in the head and body show outstanding soft tissue contrast. However, NMR imaging is time consuming and most expensive. Based on one year experience in more than 4B0 patients, we try to point out clinically meaningful indications for h~R studies: Concerning the CNS, NM.R seems to be superior to other imaging modslities in most cases. Often tumors like astrocytomas or small gliomas of the brain stem or of the cerebell~ can be localized only by means of NMR. Sagittal views of the spinal cord reveal pathologies and their cranio-caudal extent. 7nfla~natory or demyelinating processes can be detected at an early stage, influencing further diagnostic and possibly therapeutic procedures. In EKQ triggered tomograms, mediastinal masses can be discriminated from neighboring structures without contrast material. ~he four cavities of the heart can be visualized simultaneously, rendering additional information in certain eases. Tumors and metastases of abdominal organs can be detected by means of fast and unexpensive sodalities. However, the TI and T2 times may give evidence of the most likely etiology of the primary tumor. Different pathologies of the pelvis are primarily diagnosed by other sodalities, whereas NMR might be useful in staging and foIlow up in known disease. Femoral head necrosis at an early stage is best assessed by NMR. In suspected mali~nancy of the bone, NMR will be helpful in differential diagnosis when p l ~ e radiographs or CT are uncertain. In the future, more profound knowledge of normal and pathological relaxation times will certainly extend the present indications of NMR. The use of paramagnetic contmast agents will improve the capability of NMR in morphological and functional investigations.

St~'dt. Krankenhaus, Bischof-Piligrim-StraBe

I

Current a v a i l a b i l i t y of cheaper high resolution computer hardware and peripherals coupled with recent progress in the introduction of d i g i t a l l y based imaging devices in nuclear medicine, US, CT, NMR and new X-ray means that the process of recording and archiving is bound to change in the next few years. This presentation w i l l discuss the impact of and the way in which a d i g i t a l l y based department w i l l influence and modify the technique of saving images, reporting, production of hard copy, archiving and subsequent follow up. The range of grey scale now available requires more physician i n t e r action to produce the f i n a l image f o r hard copy. On the other hand the wide d i s t r i b u t i o n of terminals produces a need f o r simple daylight processing at the point of reviewing. The c l i n i c a l requirements in t h i s evolving situation w i l l be discussed.

M u n i c i p a l and Teaching Hospital of the J.W. G o e t h e U n i v e r s i t y of Frankfurt, Grafenstr. 9, D - 6 1 O O Darmstadt, W-Germany.

Technische Universit~t Y~inchen, Ismaningerstr. 22, D-8000 MJnchen 80

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P U L S E S E Q U E N C E V A R I A T I O N S IN N M R I M A G I N G F O R O P T I M A L D I S C R I M I N A T I O N OF P A T H O L O G I C A L T I S S U E C H A N G E S . * G. Bielke, M. M e v e s , S. M e i n d l , P. P f a n n e n s t i e l

THE POTE}~IAL USE OF FERRIOX~AINE B (FO) AS A CONTRASTIXqG AGENT FOR IN-VIVO M ~ 3 ~ T I C P~SON~N~E. R.A. Ik~isse, F.L. Van de Vyver, F.C. Alderweireldt and P.P.G. Blockx.

THE SENSITIVITY OF NMR VERSUS PET IN METABOLIC IMAGING. A.M.J. Paans W. Vaalburg and M.G. Woldring.

NMR imaging combines different information which takes especially into account the c h e m i c a l e n v i r o n m e n t of the s i n g l e proton. The s i g n a l s the p i c t u r e s a r e c a l c u l a t e d from, b a s e u p o n both, p r o t o n d e n s i t y and relaxation times T a n d To. A c c o r d i n g to the c h o i c e of ~he RF ~ u l s e seq u e n c e s , image q u a l i t y d e p e n d s on t h e s e t h r e e p a r a m e t e r s . Thus, d e s p i t e of a high spatial resolution pathological c h a n g e s of t i s s u e e i t h e r c a n be s e e n w i t h a v e r y h i g h c o n t r a s t or a r e l o s t due to m i s s i n g c o n t r a s t . T h e r e f o r e d i s c r i m i n a t i o n a n d d e l i n e a t i o n of d i f f e r e n t tissues may become difficult. E x t e n s i v e v a r i a t i o n s of t h e p u l s e sequences during a patient's examination in o r d e r to a c h i e v e an o p t i m a l c o n t r a s t of the r e g i o n of i n t e r e s t to its e n v i r o n m e n t a n d so u s i n g t h e p u l s e s e q u e n c e s as " e l e c t r o n i c c o n t r a s t m e d i a " h a r d l y w i l l be a c c e p t e d b e c a u s e of the t i m e needed. T h i s l e c t u r e is m e a n t to p r e s e n t a p r o c e d u r e w h i c h , b a s i n g u p o n two m e a s u r e m e n t s p e r c r o s s - s e c t i o n , p e r m i t s the c a l c u l a t i o n a n d c o m p a r i s o n of i m a g e s r e presenting measurements with different p u l s e s e q u e n c e s in a c o m p u t e r in order to o p t i m i z e the c o n t r a s t . E v e n v i r t u a l i m a g e s c a n b e c r e a t e d w h i c h h a v e some great advantages. O n e a l s o c a n u s e the c a l c u l a t e d p a r a m e t e r images as a b a s e f o r t i s s u e c h a r a c t e r i z a t i o n in a c o l o r c o d e d mode.

Trace amounts of par~agnetic metal ions have been shown to reduce the sp~%-lattice relaxation time (TI) of nuclei in the surrounding environment because of the strong electron-nuclear magnetic moment interaction. By incorporating paramagnetic metal ions into stable c~nplexes, toxicity can be dr~natically reduced while maintai~ting a significant par~nagnetic effect. We studied the T 1 reducing properties of FO because iron is c~ra~only occurring in the body fluids and is bound tightly to desferrioxsmine B and because the presence of ferrioxamine B in thousands of individuals has rarely been associated with adverse effects. Water hydrogen T l values were detenained for invitro specimens utilizing the inversion recovery medlodwith a 2.35 Tesla JEOLFXIOO ~iR spectrometer operating at 21 ~ 0.5 =C. T 1 values were 2.0 + 0.I sec, 1.9 sec, 1.7 sec, 1.4 sec, 0.4 s e c ~ n s e r l ~ w i t h F O concentrations of 0, 5 x 10-6, 9 x 10-6, 9 x i0-5, and 10-3 moles/liter, respectively, qhe corresponding T 1 measurements in saline FO solutions yielded longer T 1 values. Preliminaryphant<~ studies in a Technicare 0.15 Tesla whole body imaging system with a resistive magnet showed pronounced contrast enbancanent using the inversion recovery mode in saline FO solutions with concentrations of 10-3 and 10-2 moles/liter. It seems possible that the administration of FO in appropriate doses will be nontoxic and will enhance tissue contrast in hydrogen and phosphorus magnetic resc~lance imaging. This will be evaluated in further experiments. Furthe~or% the potential of FO to shorten T 1 might facilitate the perfommance of in-vivo magnetic resonance spectroscopy by reducing acquisition time~

* s u p p o r t e d by the F e d e r a l M i n i s t r y of Research and Technology N M R R e s e a r c h Group, D e u t s c h e K l i n i k f ~ r D i a g n o s t i k , A u k a m m a l l e e 33, D 6200 W i e s baden, W - G e r m a n y

Departments of Organic Chemistry and Nuclear Medicine, University of A~twerpen, Groenenborgerlaan 171, B2020 Antwerpen, Belgium.

Nuclear Magnetic Resonance (NMR) techniques are in use to measure the free water concentration and the relaxation times of the protons in-vivo. The NMR signal strength is proportional to the difference in the population of the ~pin states. In thermal equilibrium the states are populated according to the Boltzmann distribution, resulting in a difference which is very close to zero. This very small difference in the population of both states at room temperature results in an inherently 10w sensitivity of NMR. In NMR spectroscopy certain rules exist for the m i n i m ~ amount of sample material required.lf a ~Ag imaging device is used the same rules apply for the amount of material required per volume element of the image if the imaging device has the same sensitivity as a NMR spectroscopy apparatus. Based on equal sensitivity far both devices, the minimum amount of carbon-13 nuclei per volume element required can be calculated. These numbers can be compared with the normal levels present in the human body for metabolic compounds. Theoretically it is possible to make carbon-l/ labeled compounds carrier-free. In practise very high specific activities can be obtained for application in positron Emission Tomography (PET). This is due to the fact that for the production of carbon ii pure nitrogen can be used, so all carbon nuclei present in the irradiated sample are carb0n-ll nuclei, prom the injected amount the concentration in the body can be calculated per volume element. When the numbers for NMR and PET are compared it can be concluded that imaging of metabolic compounds using carbon-13 with NMR techniques will not be possible without disturbance of physiological levels while in the case of labeling with earh0n-ll, using the PET technique, images ca~ be obtained without influencing the physiological levels. Department of Nuclear Hospital, Oostersingel The Netherlands.

Medicine. University 59, 9713 EZ Groningen,

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THE ROLE OF PULMONARY ANGIOGRAPHY IN PATIENTS UNDERGOING VPNTILATION/PERFUSION SCINTIGRAPHY FDR SUSPECTED PULMONARY EMBOLISM. E. Sacs, P. Fray, R. Lerch~ J.C. C h e v r o l e t

IMPlE)V~D DIAGNOSTIC ACCURACY OF LUNG P]~FUSION IMAGING USING Tc-99m ~.kAA SPECT. J.K. 0'Donnell, J.A. Golish, R.T. Go, B. MisSus, R.A. Grant, W.J. Maclntyre, D.H. Feiglin.

Ga-67 CITRATE VS. Tc-99m CITRATE IN PULMONARY PATHOLOGY. Dr. Y.JACQUES (x), Dr. J. HUTSEBA UT (xx), Dr.P. CABOLET (xx), Dr.J.F.NYST (xx)

Between july 1979 and july 1983 43 patients(pts) underwent both ventilation/perfusion scintigraphy (V/P) and pulmonary angiography (PA) for suspected pulmonary embolism. The i n t e r v a l b e t ween the two examinations was less than 48 hours in 35 pts (81%), 3 to 7 days in 5 pts (12%) and more than 7 days i n 5 p t s (7%). The p e r f u s i o n study was performed in A standard views(anterior posterior, left posterior oblique, right posterior oblique) after i.v. injection of 1 mCi of Tc-99m-labeled macroaggregated a l b u m i n . V e n t i l a t i o n images were obtained in the posterior view after inhalation of Xe-133. Scintigraphle images were classified as: "normal", "low probability" for pulmonary embolism (matched defects) "medium probability" (one segmental defect with mismatch) and"high probability" (multiple defects with mismatch). PA was considered positive for pulmonary embolism in the presence of a filling d e f e c t or vascular a m p u t a t i o n .

The addition of emission tomography (SPECT) to pulmonary perfusion imaging should improve diaZ~lostic accuracy by detecting- perfusion defects otherwise masked by superimposition of normal lung activity and by reducing problems with interpretation of defects that result from overlying soft tissue or pleural effusions. In order to examine the contribution of SPRCT in the seintigraphic evaluation for pulmonary ~nbolus (bE), we have obtained both planar and SPECT studies in 94 cases of suspected bE. All studies employed 3-4 mCi of Tc-tgm ~%A and standard six-vie~ planar Lm~ze acquisition. SPECT raw data of 64 inmges were then acquired over a 360 degree trsnsaxial rotation with subsequent computer reconstruction. Xe-133 ventilation studies were performed when clinically indicated ~nd tolerated by the patient. For 19 studies angiographic (AN) correlation was obtained within 24 hours. In 16/19 plsn~r and both have a high probability of P~ but SPECT gave better se~ental localization and showed better ~reenlent with the ntm93er of defects seen at AN. In 3 indeterminate pl~u~ar scans, 2 were low probability with SPECT and negative AN. The third, a patient with Wegener's v~culitis, remained indeterminate zdth SPECT s/]d had negative AN. Five patients with PE had repeat pI~nar/SPECT/AN studies to evaluate response to treatment. S~ECT correlated better with AN findings in each case. We conclude that S~ECT perfusion imaging provides better anatomic accuracy for defects representing PE and is the non-invasive technique of choice for documenting response to therapy.

(x) DEPARTEME/JT RADIOISOTOPES, IMC Ixelles (Dr. ABRAMOVICI) [xx) DEPARTE~M~NT ~DECINE INTERNE, IMC Ixelles (Dr. DRLCOURT)

There was no positive result for pulmonary embolism at PA in ~ p t s with negative V/P. 2/iSpts (]3%) with "low probability" at V/P and 3/8 pts (]7%) with "medium probability" exhibited pulmonary embolism at Pg. But pulmonary embolism was not confirmed at PA in 5/16 pts (19%) with "high probability" at V/P. The number and localization of the emboli was correctly identified by V/P in 9/10 pts (90%) with perfusinn defects in beth studies. In summary the r e s u l t of PA was (i) concordant in all patients with normal V/P;(2) discordant in i0 to 20% of the patients with either "low probability" or "high probability" at V/P. "Medium probability" was Son diagnostic. There was excellent correlation between the two methods for the number and localization of perfusion defects. Dlvision of Nuclear Medicine, University Hospital of Geneva 1211 Geneva 4 Switzerland

Cleveland Clinic Foundation Department of Nuclear Medicine 9500 Euclid Avenue Cleveland, Ohio 44106

The study was aimed at assessing Tc-99m Citrate in benign ~nd malignc~t p~Zmonai~ disease ~ d to compare its effisienay with Ga-62 Citrate. Of a total of 180 investigated patient8 a 23 were eliminated for incompleteness of their files. The others ~nderwent Tc-99m Citrate scintigraphy 4 hrs p.i. and the results were compared with radiological evidence, fibroscopy, CT scans and histology. A cross-over study with Ga-67 Citrate performed 48 hrs p.i. involved 32 patients. Scintigrc~hy was .found to be in full agreement with radiology when the former was positive. With negative seintigraphy, positive radiological findings were obtained in th~ presence of e.g. sequelae of tuberculosis or hemodyncenlc pleural effusion among other cases where neither infleonmatory processes of hypervascularisation Were

found. The Ga-6? Vs. Tc-ggm Oitrate crossover 8tud~ showed full agreement in malignancy detection. Ben{6~n afflictions were seen more frequently with Tc-ggm citrate~ probably because of the shorter time interval between injection and sao~, hence higher blood activity levels, in combination with hypervascularisation and inflar~natory react~Lons. Wi#h a sensitivity of 89 %, u negative predictive value of 9~ %, and a specificity of 57 %, Tc-ggm Citrate and Ga-67 Citrate seem to ~e ~ufficiently analogous in behavio~r to permit substitution of the latter by the Tc-99m compound. In practice, this would improve da{ly availability, cost, radiation dosim~try considerations, ~nd provide faster results.

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LUNG KINETICS OF RADIOACTIVE HIPDM:AMETHOD TO DETECT LUNG CELLULAR DAMAGE IN MAN. M. Pistolesi, M. Mimiati, N. Mazzuca, L. Chelarducci, C. Giuntini, P. Gerundini and F. Fazio

RADIONUCLIDE STUDIES IN PNHUMOCYSTIS CARINII PNEI~IONIA IN AQUIREU IMMUNg DEFICIENCY SYNDNOM~ V,M. Varma, C,U. Tuazon, R,C. Reba.

SCINTIGRAPHIC EVALUATION OF A D U L T R E S PIRATORY DISTRESS SYNDROME (ARESI. H.Ereutzig and J.Sturm

Serial Gallit~-67 (Ga) scans were performed in 12 patients at a high risk for having Aquired Lr~une Deficiency Syndrome (AIDS). All patients were subjected to fiberoptic bronchoscopy (FOg), segmental bronchial washings (DW) ana transbronchial Biopsy (TUB). Ten of 12 patients with positive Ga scans had abnormal chest x-ray with bilateral interstitial infiltrates in 8 and lobar infiltrates in 2. ~ o patients with normal chest x-ray had increased uptake of Ga in the lungs. Diagnosis of Pneumocystis Carinii Pnetnnonia (PCP) was made by Fog in 11/12 patients and by open lung biopsy in I patient. Pneumocystis garinii (PC) was demonstrated by BW in Ii/ii patients; 7/11 patients had PC demonstrated in lung tissue ohtailed by TBB. ill pgtients were treated with pentami~ine (Y) and/or trimethorprimsulfamethoxazole (T~-SMX); 8 with P and TMP-SMX and 1 received only P. 3/12 patients died 15-17 days after admission, 2 from PCP and i from superimposed fungal infection. Ga scans returned to normal i~ 4 patients after 4 weeks (wks) of treatment (trt), In 3 patients with severe PCP, Ga scans were normal 6-8 wks post trt. Repeat FOg was performed in IO/i2 patiez~ts after 2-4 wks of trt; PC was demonstrated by BW in 4/12 patients, Tug was negative for PC in b/9 patients. Ga scans in patients at high risk for AiDS will be important for the diagnosis of PCP. Ga scans may not He useful to predict therapy response and prognosis.

Progressive loss of l u n g f u n c t i o n is l i m i t i n g t h e s u r v i v a l of p a t i e n t s w i t h polytrauma. Clinioal s i g n s of A N D S w i l l be p r e c e e d e d by pulmonary capillary protei~ leakage (PCPL),The a m o u n t of P C P L c a n be e s t i m a t e d nonivasivly by measuring intrapulmonary albumin kinetics.Regional ventilation and perfusion abnormalities c a n be e s t i m a t e d by u s u a l lung s¢intigraphy.The clinical usefuln e s s of t h e s e t e c h n i q u e s for detection of A N D S , h o w e v e r , a r e s t i l l in q u e s t i o n

In order to assess the non respiratory functions of the lung a~d their relevance in the clinical setting we studied the lung distribution and kinetics of N,N,N'-trimethyl-N'-(2-hydroxy-3-methyl-S-iodobenzyl)-l,3-propanediamine(HIPDM),labeled with 1-123 or 1-131. This compound, currently evaluated for brain perfusion studies, is extracted and metabolized Hy the lung like vaso active amines. Kinetic analysis of radioactive HIPDM time/acfivity curves, recorded by gamma camera over the lung fields up to 3 hrs from i~, injection, showed that HIPDM lung dismission is described by three exponential components; the first two are completed by 40 min and may reflect early redistribution. The third component exhibits a slow decay with a mean time(t) of several hrs, compatible with a cellular metabolic process. To detect lung cellular damage we measured t of NIPDM time/activity curves in 25 subjects: 8 normal non smokers(NS), 9 smokers of 20 sigarctics/day(S), 4 patients with cardiec pulmonary edema(CPE) and 4 patients with adult respiratory distress syndrome(ARDS). NS 8 EPE AP~DE tZgD(hrs) 7.4!i.6 14.6~2.5 9.4!1.2 22.0!6.6 S versus NS p<.OOl; AEDS versus CPE p<.Ol HIPDM lung dismission is delayed in asymptomatic smokers and to a greater extent in ARDS. Hence, smoking and ARDS may impair HIPDM lung metabolism. We conclude that external counting of radl oactive H I P D M m a y be used as a clinical method to detect lung cellular damage and to differenti ate ANDS from CPE.

George Washington University Hospital, Division of Nuclear Medicine, 901 23rd Street, N.W. Washington, D,C. 20037, USA.

CNR Institute of Clinical Physiology, Nuclear Medicine Service, University of Pisa, Pisa, and San Raffaele Hospital, University of Milan, Milan, Italy

A250 DEFINITION OF PRESSURE DEPENDENTRENOGRAM CHANGES AFTER EXPERIMENTAL URETERAL OBSTRUCTION. B.Rehmann, J.Th. Locher, P . S t i e r l i , R.Tscholl. Gamma camera renography with deconuolution analysis has been shown to be a sensitive and valuable method to define altered renal function in ob structive nephropathy. However,diagnostically relevant parameters d i f f e r e n t i a t i n g a true obstruction from slow elimination through capacious pelvis are hardly to prove,since other renal disorders may influence the renogram-values in the same manner.Separating parenchyMatous areas from the pelvis we analysed some characteristic parameters in d i f f e r e n t renogram-phases a f t e r standardized increase of the i n t r a p e l v i c pressure. In 20 minipigs (20 kg) an infusion system was applied by ureterostamy allowing a stepwise pressure change by raising the water level in a connecting tube. I23J-Hippuran renograms were recorded twice 2 and 3 hours after pressure increase by the ROltechnique and stored in a computer. The back ground corrected and smoothed curves were mathematically evaluated f o r : a ) i n i t i a l ascent (tan gens), b)max-peak and t h i r d phase turning-point times, c)ascent of tangent-curve through the l a t t e r , d)calculation of parenchymal renal t r a n s i t time (RTT) by decunvolution analysis using the bloodpool clearance as input function. Results: Depending on pelvic pressure (y)the RTT~ - x ) changed in a s t a t i s t i c a l l y good correfated manner (x=O,O9y-ll,27; r=O,8G).Even better corelated peak-time (x) to pressure (y):(x:O,48y +180,55; r:O,90) and peak-time ( x ) t o RTT ( y ) : ( x = 0,44y+176,41; r=0,93). Bad correlations were found f o r parameters of the i n i t i a l renogram phase:for tangens 40-120 sec(x)to p r e s s u r e ( y ) : ( x : 0,Iy+38,44; r=0,62) and time of the 3rd-phase turning point (x) to pressure (y): (x=O,O2y+8,08; r=0,59). The values of the late renogram-phase are suspectable f u r influencing effects of pelvic wall compliance:significant changes are only seen after exceeding an ( i n d i v i d u a l } pressure limit (ca 35 cm N20). For c l i n i c a l purposes the measured parameters, especially RTT, may be sens i t i v e indicators f o r both deterioration of renal function needing operation and f o r postoperative recovery. Dept's of Nuclear Medicine and Urology, Kantonss p i t a ] , CH-500I Aarau, Switzerland.

In a p r o s p e c t i v e s t u d y we i n v e s t i g a t e patients with polytrauma and suspected ARDS. A conventional V / P s t u d y is d o n e e v e r y s e c o n d day, f o l l o w e d by the m e a surement of r e g i o n a l E S A k i n e t i c s for 3Omin. S c i n t i l l a t i o n probes are than placed over heart and lungs and ESA uptake registered w i t h the r e s i d u a l acitivity for a n o t h e r 24 h o u r s . S t u d i e s are repeated untill demission from the intensive c a r e u n i t or d e a t h . S c i n t i graphic findings are correlated with total lung water estimation and clinical a n d x - r a y f i n d i n g s . In all p a t i e n t s with ARDS the PCPL proc e e d e d an i n c r e a s e in l u n g w a t e r a n d first clinical s i g n s f o r a b o u t 24 h, while lung scintigraphy d i d not. In p a t i e n t s with suspected ANDS the P C P L s h o u l d he e x c l u d e d immediately after admission to t h e i n t e n s i v e care unit. T h i s c a n be d o n e by m e a s u r e m e n t of l o c a l H S A k i n e t i c s w i t h s i m p l e bed-sided equipment.

Abt. N u k l e a r m e d i z i ~ und Unfallchirurgische Klinik der Medizinischen Mochschule Hannover, 3 Hannover 61FRG

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Combined diuretic renogram ~DR) and determination of mean parenchymal transit times (tmean-p) to evaluate equivocal upper urinary tract (gUT) obstruction.

CYSTO-URETEROSCINTIGRAPHY (CUSG) FOR THE ASSESSMENT OF VEEICO-URETENAL REFLUX (VER) N. Mazzuca, M. Tuoni, M. G. Toni, M. Giganti, D. Pistolesi, M. Di Nillo, C.R. Eellina, P.L. Uiannotti, G. Mariani and R. Bianchi

W. K a n i t z 1, R.M. Klzntz 2, I . H . Wolf 1, W. s c h g t z 2, H. Langhammer I , H.W. Pabst 1 I Nuklearmed. Klinik u. Poliklinik d. Technischen Universit~t Mdnchen (Dir.: Prof. Dr. m.w. Pabst) 2 Urolog. Klinik u. Poliklinik d. Technischen Universitat M~nchen (Dir.: Prof. Dr. W. Mauermayer) mon-invasive DE and determination of tmean-p have been used as an alternative to invasive pressure/ flow-studies (PEg) in the diagnostic evaluation of equivocal UUT-obstruction. In the past clinical studies revealed disagreeing results when PFS and DR or PFS and determination of tmean-p were performed on the same patients. Material and methods. In 32 patients with roentqenological gUT-dilatation a combined study including PFS (perfusion rate iOml/min), DR and tmean-p determination (Gan~na-camera, 1-123-oIg) was performed (n=50). The results were correlated with the morphology of pyelo-ureteric junction specimens of patients who underwent AndersonEynes pyeloplasty add with the clinical course of operated and non-operated patients. Results. PFS revealed reliable results in 90% (n ~45, obstructive and non-obstructive results). NO false-positive or -negative results have been obtained; g times the results were equivocal. DR revealed reliable results in 28% (n=14, obstructive results). False-negative results have been obtained. Determination of tmean-p revealed reliable results in 42% (n=21, non-obstructive results). False-positive results have been obtained. By combination of DE and tmean-p reliable results have been obtained in 70% (n=35, obstructive and non-obstructive results). COnclusions. Based on these results the following clinical diagnostic scheme for the evaluation of equivoeal gUT-obstruction is recommanded: 2. Combined use of non-invasive DR and determination of tmean-p as one radioisotope study. When both show obstructive (non-obstructive) results, obstruction (non-obstruction) is reliably diagnosed. 2. When the results of both disagree, PFS are necessary. 3. When PFS reveal eqivocal results, short-term follow-up examinations should be performed.

The accuracy of CUSG in the detection of VUR was assessed in 42 patients (pts) in whom x-ray micturition cystourethrography {MCG) was performed. A small catheter was inserted to fill the bladder with 500 ml saline containing 0.2 mOi ggmTc-~YPPA. The patiezt wa~ then asked to void while seated; a computerized 7-camera served to record scintigraphic data during micturition (6 frames/min for 15 miD). The recorded images were analyzed as follows: i) generation of activity profiles on the added-on sequential images, to select adequate ROIs over the ureters and kidneys; 2) generation of activity/time curves for the selected ROIs, to evidentiate and quantitate VURs. CUSG and MCG were both positive or negative in 18 pts each, with an 85.7% overall agreement. Two pts were VUR-positive at MCG and negative at CUSG (10% false negative with CUSU). The remaining 4 pts were VUR-positive at CUSG and negative at MCG (83.3% apparent specificity for CUSG as referred to MCG). In 5 out of 18 VUR-positive pts at MCG, CUSG detected more £U0normalities than NCG itself (menD- or hilaterality, and severity of VUR). These results indicate the usefulness of CUSG, and emphasize the necessity for a critical reappraisal of MCG as the "gold standard" for VUR detection. As to the 2 false negative findings at CUSG, intermittent VUR is the most likely cause. EUSG is particularly advantageous for the precise quantitation D I V E R in the postoperative follow-up, especially if performed with a tubular excretion tracer given iv, combined with furosemide-induced hyperdiuresis, so totally avoiding invasiveness. Nuclear Medicine Center, and Institute of General Surgery of the University of Pisa; C.N.R. Institute of Clinical Physiology, Via Savi 8, 1-56100 Pisa, Italy.

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QUANTITATIVE MEASUREMENT OF RENAL TRANSPLANT PERFUSlON (ml/min/10O g) USING TRANSFER FUNCTION AND A RANDOMWALK MODEL. Z. SzabO, L . N y i t r a i , H. Vosberg, C. Wilcke and L.E. Feinendegen

DIAGNOSIS OF ACUTE REJECTION IN RENAL ALLOGRAFT BY MEASUREMENTS OF THE TUBULAR TRANSIT INDEX. N.Y. Oei, R.F.M. Jessurun and A. Struyvenberg.

99m Tc-APROTININ AND SEPARATE KIDNEY FUNCTION : CORRELATION WITH 131-10IH CLEARA/~CE R A T E S C.Aprile,R.Saponaro, G.Villa,F.Lunghi,M.R.Bernardo Strada, M.Carena and A.Salvade0

Renal perfusinn i s , i f at a l l , maiuiy quantified with 133-Xenon. The present study reports a new approach using 99mTc. A f t e r intravenously i n j e c t i n g I0 mCi 99mTc-DTPA, s e r i a l renal scintJgraphy by a conventional gamma camera (i2O frames in one minute) permitted generation o f t i m e - a c t i v i t y curves from aorta and kidney. Computer assisted sequential d i g i t a ] f i l t e r i n g of the curves was followed by deeonvolution in the frequency domain with an appropriate f i l t e r function. A f t e r reverse Fouriertransformation of the obtained t r a n s f e r function the mean c i r c u l a t i o n time (MCT) was calculated from the d i s t r i b u t i o n of t r a n s i t times. The regional blood volume rBV was estimated using Sheppard's nonlinear formula based on the p a r a l l e l random walk model. The regional blood flow is given by rBF = rBV/MCT. Interference by s t a t i s t i c a l noise and the e f f e c t of f i t t e r i n g and smoothing on measured data were tested by computer simulation; MCT was less affected than rBV. This method was c l i n i c a l l y applied to 45 renal transplants. In patients with s a t i s f a c t o r y transplant f u n c t i on, rBF was found to be cemparable to renal plasma flow measured by hippuran clearance (r= 0.67). In patients with acute or subacute transplant r e j e c t i o n the hippuran clearance was very s i g n i f i c a n t t y decreased to about I / 3 of rBF ( r = 0.92). Thus renal transptant r e j e c t i o n can c l e a r l y be distinguished noninvasively by decreased c o r r e l a t i o n between tubular function and renal perfusJon. Nuklearmedizinische K l i n i k der U n i v e r s i t ~ t DBsseldorf, Moorenstr. 5, g-4OOO D~sse]dorf I

The Tubular Transit Index (TTI) is a measure of hippuran excretion determined during gammacamera renograDhy using 1-131-hippuran performed after administration of furosemide. This index is calculated by dividinq the bladder activity in the 6th-10th min by the sum of the kidney and bladder activities in the Ist-5th miD. In patients with renal allografts showing a stable renal function the TTI amounts to 1.39+0.18 (range 1.09-1.80l. In this stndy we evaluate the use of TTI for the diagnosis of acute rejection within a 3 weeks observation period after the diuresis >i 1/day. When diuresis is I 1/day and the remaining Ii initially had oliguria. Group 2: 11 patients, in whom acute rejection occurred within the observation period. Five had immediate diuresis; the remaining 6 initially had oliguria. 0nly 2 patients of group i, who showed immediate diuresis, had a normal TTI-value on the first examination. The remaining 15 initially had a low TTZ, which increased with time and reached the normal lower limit between the 10th and 15th day. Renal alloqraft function became adequate when TTI had reached 0.3, so that hemodialysis could be discontinued. In 10 of the ii patients of group 2 at the beginning of ~n rejection episode the TTI decreased and became less than i; in S patients this occurred before serum creatinine incmeased. In the remaining patient of group 2 the decl'ease of the TTI occurred later. We conclude that serial measurements of the TTI are useful for the detection of acute rejection, in particular in cases in w h o m serum creatinine does not decrease as expected.

We previously reported higher fixation in the t a r g e t , f a s t e r blood clearance and lower urine excretion of the r e n a l agent 99m Te-ApP0tinin(Tc-A) in c o m p a r ~ son with 99m Tc-DMSA. A i m of t h i s w o r k w a s to c o r r e l a t e the n e t k i d n e y u p t a k e 9 0 , 1 8 0 a n d 3 6 0 m i d p. i . ( g - 5 mCi) w i t h t h e s e p a r a t e E R P F s de tePmination(i31-I 0 I H c l e a r a n c e rates, Meldolesi's method)carried o u t in a se p~rste r u n , i n 90 p t s e i t h e r w i b h i n t a c t or impaired renal function;22 pts were also studied with DMSA. Results: 1 - T h e r e is a s i g n i f i c a n t corre lation(p<.001)between n e t k i d n e y u p t a k e 6 h r p.i. a n d s e p a r a t e E R P F s . 2 - T c - A correlates better than DMSA,even if we consider pts with severe impairment in whom DMSA correlates very poorly. 3-Shortening the time p.i.(i.e. 90 a n d 180 min)the correlation remains signifi c a n t at the s a m e l e v e l , e v e n if the i n t e rcept o n the y - a x i s is s l i g h t l y h i g h e r . Our results indicate t h a t T c - A is a l e a sible i n d i c a t o r o f s e p a r a t e k i d n e y f u n c tion n o t o n l y at 6 h r , b u t a l s o 90 m i n p. i. w h e n it is e a s i l y c a r r i e d o u t e v e n o n an o u t p a t i e n t s basis. F o n d . C l i n i c a del L a v o r o , N u c l e a r Med. Serv.-26,v. Boezio,27100 Pavia-ltaly SORIN Biomedica,i3040 SaluggiaVC,Italy

Dept. of Nuclear Medicine, University Hospital, Catharijnesingel i01, Utrecht, q~ne Netherlands.

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COMPARATIVE STUDY OF FOUR ggmTc-LABELLED MICROCOLLOIDS,USED FOR LYMPHOSCINTIGRAPHY.J.FrUhling.

LYMPHOSCINTIGRAHY : ITS CONTRIBUTION TO THE DEFINITION OF RADIATION THERAPY FIELDS IN BREAST CANCER. L Nicol, JY Herry, J Le C l o i r e c , C Chenal, M Ben Hassel

I N T B R E S T OF USING THE S E D I II I N THE D E T E C T I O N OF B R O N C H I A L NEOPLASM. G. G O D A R T A N D Y.J. ROBIENCE.

The following four reagents, destinated to instant preparation f o r radionuclide lymphatic studies underwent an in v i t r o and in v i v o study : A : s u l f u r - m i c r o c o l l e i d (Solco); 8 : human-serum albumin m i c r o c o l l o i d (Nanocoll, Solco);C : a n t i mony s u l f i d e c o l l o i d (BYK); D : rhenium s u l f u r c o l l o i d (IRE).The IRE Mo/Tc generator was used in combinaison with a l l tested products. Stabii i t y , pH, amount o f free 99mTcOa (as seen by chromatography) were quite simiTar whereas concentration of dry substance and osmolality as c r i t e r i a gave r a t h e r discordant results during in v i t r o testing.The dianleter o f elementary part i c u l e s o f a l l 4 products, as seen by negative staining on electromicroscopical level varied between 8 and 36 rim,with a general tendeREe to form agglomerates constituted by 2 to 4 subun i t s . In the famework o f in vive analysis, pain f o l l o w i n g i n j e c t i o n (depending on the osmolalit y ) , image-quality, number o f v i s u a l i z e d lymph nodes, target/background r a t i o , lymph node and l i v e r uptake and e x t r a c t i o n from i n j e c t e d depos i t have been evaluated,based on q u a l i t a t i v e and q u a n t i t a t i v e c r i t e r i a o f bipedal, i n t e r n a l mammary and a x i l l a r y ]ymphoscintigrams (140 cases studied). Registered by a whole body scanning camera connected to a computer, t o t a l lymph node a c t i v i t y has been expressed as c/sec/mCi i n j e c ted and measured 3 h a f t e r i n j e c t i o n over lymph node areas, l h i s parameter allowed to character i z e the differences among the 4 products,according to age, to presence or absence of edema, to previous i r r a d i a t i o n o r to morphologically cont r o l l e d lymphatic pathology. The greatest migrat i o n speed and, p a r a l l e l , t h e highest t o t a l a c t i v i t y over the v i s u a l i z e d lymph node areas (40 % e x t r a c t i o n from the deposits a f t e r 3 hours in normal cases and 25 Z in pathological ones) has been obtained by the product B; whereas A and D showed the most d i s c r i m i n a t i n g difference (2,8 to 2,9 times higher f i x a t i o n s - q u o t i e n t ) between normal and pathologic lymph nodes. Laboratoire des Radio-lsotopes, I n s t i t u t Jules Border, U n i v e r s i t ~ f i b r e de Bruxelles, 1000 Bruxelles, Belgium.

The role of lymphoscintigraphy in determining irradiation fields for breast cancer is assessed. Lymphoscintigraphy associated with 99mTc MDP imaging is the only non-invasive method of obtaining a precise representation o f internal mammary lymphatic drainage routes. The f i r s t step in t h i s e x p l o r a t i o n protocol is a chest scintigram realized a f t e r subcostal i n j e c t i o n on the same side as the tumour of i mCi of 99m-Tc antimomy s u l f i d e . The second step is a scintigram obtained 1,5 hours a f t e r a cont r o l a t e r a l i n j e c t i o n of the same radionuclide. A t h i r d scintigram is taken 1,5 hours a f t e r intravenous i n j e c t i o n of i 0 mCi of 99m-Tc MDP. Of the 76 breast cancer patients studied, lymphoscintigraphy i d e n t i f i e d cross-drainage in 19 cases. In 4 cases, there was no lymphatic v i s u a l i z a t i o n . The s u l f i d e c o l l o i d was injected again i n t o these 4 patients to make sure that the f a i l u r e was not due to technical reasons. In a l l the cases of cross-drainage and in 13 cases where the mammary chain was homolateral to the tumour and was situated more than 4 em from the median l i n e (the l i m i t e usually adopted in i r r a d i a t i o n p r o t o c o l s ) , r a d i a t i o n therapy f i e l d l i m i t s had to be changed as a r e s u l t of lymphoscintigraphic i n v e s t i g a t i o n . This study confirms the great v a r i e t y of i n t e r nal mammary drainage pathways and emphasizes the importance of t h e i r being p r e c i s e l y localized p r i o r to radiotherapy. Exact anatomical l o c a l i z a t i o n in r e l a t i o n to the sternum and ribs is r e a l i z e d with bone scan associated lymphoseintigraphy. When s c i n t i g r a p h i c i n v e s t i gation is extended to the whole body, possible bone metastases can also be i d e n t i f i e d . Centre Anticanc4reux - H6pital 35011 RENNES FRANCE

de Pontchaillou

We h a v e d e v e l o p e d a m a c h i n e a l l o w z n g to realize in an optimal way a 99mTc-DTPA d e p o s i t i o n into the b r o n c h i a l tree in r e s p e c t with the v e n t i l a tion rate. This m a c h i n e is c a l l e d "SEDI IE". As it h a s b e e n d e s c r i b e d in the literature, it is well k n o w n that this k i n d o f s t u d y o f f e r s a great s e n s i t i v i t y in the d e t e c t i o n of small b r o n c h i a l disorders. This s e n s i t i v l t y is very low when we use r a r e gases such as 81mKr or 133xe. The h i g h s e n s i t i v i t y o f l a b e l l e d aerosol to detect b r o n c h i a l a r t e f a c t s is d e m o n s t r a t e d by a special k i n d o f d e p o s i t i o n where there exist several a c c u m u l a t i o n s o f the traceur which a r e c a l l e d "hot spots". These h o t spots in f a c t c o r r e s p o n d to the local h y p e r v e n t i l a ~ i o n exist i n g in s a m e cases such as in s e v e r e CORD. The a s p e c t o f these images is c a l l e d a s p o t t y deposition. In cases o f b r o n c h i a l neoplasm, we h a v e noted the e x i s t e n c e of o n l y one h o t spot. Generally, this h o t spot is s i t u a t e d in a bronc h u s g o i n g to a n u n v e n t i l a t e d area. This hot s p o t is the r e s u l t of a n i m p a c t i o n or a turbulence p a r t i c l e d e p o s i t i o n at the level o f the stenosis. The e x i s t e n c e o f a b r o n c h i a l a r t e f a c t on this s i t e is a l w a y s p r o v e d b y the e n d o s c o p y technique. The a d v a n t a g e o f a r a d i o l a b e l l e d a e r o s o l when n e b u l i z e d with the S E D I BI r e s i d e s in the fact that the technique is n o t invasive a n d Js very sensitive. The e x i s t e n c e o f o n l y one h o t s p o t is a l s o v e r y s p e c i f i c of a b r o n c h i a l n e o p l a s m a n d in m a n y cases a l l o w e d the c o n f i r m a t i o n o f the diagnosis. INSTITUT MEDICAL SPECIALISE Service de M 4 d e c i n e N u c l 4 a i r e 230, R o u t e de M o n s 7320

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N U C L E O M E D I C A L C L A S S I F I C A T I O N OF LUNG CANCER USING Q U A N T I T A T I V E =°ZTl AND ~ G a SCANS. T. Togawa, A. Suzuki, K. Kate, K. Kobayashi, T. Higuchi, Y. Ito and K. K i m u r a *

INTATHORACIC STAGING OF LL~G CANCER(LC) WITH PLANAR SCINTZGRAPHY(PS) AND Si:r~72 USING TC-99M~ ~ ( ~ ) :A C O , ARISeN WITH CA-67 PLANAR SCAN(GA-67 PS). R. Perelli, G.Ferlin, F. Marti~elli, B. Saitta and N. Borsato

The p o s s i b i l i t y of n u c l e o m e d i c a l class i f i c a t i o n of lung cancer was studied by e s t i m a t i n g the d i f f e r e n c e b e t w e e n ~°XTl and S?Ga uptakes into tumor. Both scans w e r e p e r f o r m e d on 31 patients w i t h p r i m a r y lung cancer; 13 a d e n o c a r c i n o m a s , I0 e p i d e r m o i d carcinomas, 4 i n t e r m e d i a t e cell carcinomas, 2 oat cell carcinomas, and 2 adenosquamous carcinomas. After Regions of Interest(ROls) w e r e set on the tumor and the n o r m a l lung, the mean counts(T: at the tumor, N: at the n o r m a l lung) for ROls w e r e m e a s u r e d on b o t h scans, and the Crude U p t a k e Ratio(CUR) of 2°~Tl to ~Ga(both crude uptakes: T-N/N) w a s calculated. A d e n o c a r c i n o m a s had a CUR of 1.95±1.41, many of them taking up more =°~Tl than ~VGa. Compared with a d e n o c a r c i n o m a s , e p i d e r m o i d carcinomas had a s i g n i f i c a n t l y lower C U R of 0.36± 0.26(p<0.01), t a k i n g up m o r e ~ G a than 2°1Ti. C o m p a r e d w i t h adenocarcinomas, oat cell carcinomas also h a d a significantly lower C U R of 0 . 3 7 ± 0 . 0 7 ( p < 0 . 0 2 ) , a value similar to e p i d e r m o i d carcinoma. A d e n o s q u a m o u s carcinomas had an i n t e r m e d i a t e CUR of 0.9510.19. The 31 patients showed a continuous arrangement from low-CUR e p i d e r m o i d c a r c i n o m a to h i g h - C U R adenocarcinoma. Also, it was found that the m e a s u r e m e n t of =°~Tl and ~ G a uptakes into tumo~ enables not only a n u c l e o m e d i c a l c l a s s i f i c a t i o n but a p r e s u m p t i o n of v a r i o u s h i s t o g e n e s e s in lung cancer.

(~d is avidly acclaaulated by LC(Vorne,01~4 23:250 1982). This work was lhndertaken to evaluate the efficacy of (~H in detecting intrathoracic metastatic spread of LC. In 37 pts.with proven LC we have performed both (~ PS and ~A-67 PS. Each patient received 20 mCi of Tc-99m-~d. The scan was performed 6h. after the injection in Ant.,Post. and Lat.views. In 11 cases ~ SPECT was performed after GH PS. The same day 5 ~Ci of Ga-67 were injected and scan was performed 48h. later in the sane views as with ~H. Both (~ and Ca-67 were positive for metastases in 17 cases. In 5 of these pts. ~4 SPEC~ was performed and it was positive in all of t/le~. In i I pts. both ~H PS and GA-67 PS ~5re negative for metastases and in 2 of them also (~ SPECT was negative. In 9 pts. ~ PS was negative and GA-67 PS was positive. In 3 of these SPEC2 with showed mediastinal and/or hilar involvement and in I it was negative. From these results we can conclude that: 1) C~-67 PS is superior to GH PS in detection of intrathoracic metastases from LC ((~ PS was positive in 65% of pts.with GA-67 PS positive, with an overall accuracy of 76%), 2) SpECT i~oroved mediastinal and hilar a~eg~astases detectability to 77% and overall accuracy of (~ scan to 84%, 3) (~ can be therefore used as a preliminary tool in staging LC. It reduces costs and time and~when positive,can avoid Ca67 scan and other more invasive procedures. SPECT,when available,lowers False Negative Rate giving a better separation between cardiac blood pool activity and mediastinal nodes uptake.

SCINTIGRAPHIC IMAGING OF NEUROBLAS T O M A W I T H 13 I - I - M I B G ( M E T A ] O D O B E N ZYLGUANIDINE). C o l l a b o r a t i v e s t u d y in 16 children from Strahlenklinik | , Kinderklinik 2 U n i v . H e i d e l b e r g , K i n d e r k l inik3~ N u k l e a r m e d . 4 U n i v . T{JbJngerl Med. K I i n i k M~3nst er5~ N u k l . Med. K] irlik D~Jsseldorf 6 B . K i m m i g U . F e i n e 4 M. F i s c h e r S ~ H. Vosber,g6, W. M Q H e r , - S c h a u e n burgg~ D. Niethammep3~ d. T r e u n e r 3 K . Z u m W i n k e l l ~ W . E . Brar~deis g

D e p a r t m e n t s of N u c l e a r M e d i c i n e and • Radiology, F u k u s h i m a M e d i c a l School, 4-45 Sugitsuma-cho, F u k u s h i m a city 960, Japan

Servizio di Medicina Nucleane, Ospedale Civile di Bell~no, Viale Europa 32100 Belluno, Italy

S c i n t i g r a p h i c i m a g i n 9 of n e u r o b l a s t o m a u s i n 9 1 3 1 - I - M I B G was f i r s t r e p o r t e d in t h e l i t e r a t u r e b y K i m r n i g in ,January 1984, T r , e u n e r , F e i n e and c o w o r k e r s r e p o r t e d /4 a d d i t i o n a l cases in L a n cet ( F e b r . 11~ 1 9 8 4 ) . P r , e v i o u s l y S h a p i r o et a]. had d e s c r i b e d t w o cases w i t h m i s s i n g s c i n t i g r a p h i c i m a g i n g w i t h 131 I - M I B G . In o u r c o l l a b o r a t i v e s t u d y w e d e s c r i b e 16 children w i t h neur,oblastoma~ w h o wer,e i n v e s t i g a t e d w i t h 131 I - oP 123 I - M I B G r e s p e c t l v i l y . S o m e patiet~ had been t r e a t e d w i t h c h e m o t h e r a p y a c c o r d i n g to the n e u r ' o b l a s t o m a t r i a l N B L - 8 2 of the G e r man S o c i e t y of P e d i a t r i c O n c o l o g y . In 1o of t h e s e c a s e s e n r , i c h m e n t of up to 7o% of 131 I M I B G was d e m o n s t r , a t e d in the t u m o r as w e l l as u p t a k e of t h e r a d i o i s o t o p e in m e t a s t a s e s . In a l l t h e s e cases 24h u r i n a r y c a t e c h o l a m i n e l e v e l s w e r e h i g h l y i n c r e a s e d . Incontr,ast 5 of 6 cases with tlegative scintigpaphic results showed a n o r m a l e x c r , e t i o n of c a t e c h o l a m i n e s ~ some of t h e s e w i t h and some w i t h o u t e v i d e n c e of a t u m o r . O n l y in t c h i l d w h h i n c r e a s e d l e v e l s of c a t e c h o l a m i n e s and a d e m o n s t r a b l e tumor- t h e s c i n t i g r - a p h i c e x a m i n a t i o n was n e g a t i v e . U s i n g t h e r , e s u l t s of s c i n t i g r a p h y , t h e b i o c h e m i c a l v a l u e s ( e x c r e t i o n of c a t e c h o l a m f n e s ) ~ the h i s t o l o g y and t h e s t a g e of the tumor' as w e l l as the t h e r a p y w e s h a l l t r y to f i n d a c o r r e l a t i o n b e t w e e n t h e s e panameter,s and t h e t u m o r u p t a k e of 131 I - M I B G . S p e a k e p : P r , o f . U. Feine~ N u k l e a r m e d . A b t e i l u n g R 6 n t g e n - W e g 1 I , ?400 T~ibingen F R G

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ASSESSMENT OF MYOCARDIAL VIABILITY IN PATIENTS WITH CORONARY ARTERY DISEASE (CAD) BY USING TI 201 AND 1-123 HEPTADECANOIC ACID (HDA) FOR MYOCARDIAL SCINTIGRAPHY. R.Dudczak, R.Sehmoliner, K.Kletter, R.Homan and H.Frischauf

C H A R A C T E R I Z A T I O N OF ISCHEMIC BUT V I A B L E MYOCARDIUM E A R L Y AFTER M Y O C A R D I A L INFARCTION USING POSITRON EMISSION TOMOGRAPHY. D. Raets, C, De Landsheere, M, GuiBaume, C. Del Fiore, J . M . Peters, D. Lamotte, 14. K u l b e r t u s , P. Rioo.

SHORT TER}~ FOLLOWUPPERFUSION DEFECTS AND EJECTION FRACTION BY SINGLE PHOTON EMISSION CO}~UTED TOMOGRAPHY (SPECT) AND RADIONUCLIDE ANOIOGRAPHY (RNA) IN PATIENTS WITH ACUTE MY0CARDTAL INPAEHTION I~DER STANDARD THERAPY G. Karcher, M. Amor, A. Bertrand, C. Hocquard, P. Aug, J.P. Godenir, D. Vaillant.

Residual ischemia is a f r e q u e n t and serious comp l i c a t i o n o f myocardial i n f a r c t i o n ( M I ) . Its d e m o n s t r a t i o n , at rest, r e q u i r e s t h e combination of p e r f u s i o n and metabolic c r i t e r i a to d i f f e r e n t i a t e between i n f a r c t i o n and viable ischemic tissues. The p u r p o s e of t h i s s t u d y was to assess the importance o f residual ischemia at rest in a selected g r o u p of patients between 10 days to 2 months a f t e r the acute MI and to document t h e r e v e r s i b i l i t y of the ischeraic lesions. 5 p a t i e n t s ( g m a l e s , t female, averaoe aoe 61.5) were s t u d i e d . 4 p a t i e n t s s u f f e r e d anant~erior transraural MI, I an i n f e r i o r MI. Four had m u l t i vessels disease [5 LAD + 4 RCA + 4 L C X ) . A p e r f u s i o n s t u d y was p e r f o r m e d f i r s t u s i n o 82 Rb o r 13 N ammonium as t r a c e r s . T w o or-3 t r a n s v e r s e p l a n e s , c o r r e c t e d for a t t e n u a t i o n were a c q u i r e d . A f t e r four h a l f - l i f e for decay (40 rain for 13 N ammonium), 18 FDG, 8 to 10 mCi was injected i n t r a v e n o u s l y , Successive 300 sec. scans were perforraed e v e r y 10 minutes at t h e mid level plane to follow t h e u p t a k e o f t r a c e r from blood pool to m y o c a r d i u m . A f t e r 40 r a i n . , all planes -were a c q u i r e d in succession. In all p a t i e n t s , MI was v i s u a l i z e d as a combined defect o f p e r f u s i o n and metabolism. In 4 patients a r e g i o n of decreased p e r f u s i o n had e p a r a d o x i c a l increase of 18 FDG s u g o e s t i n ~ a s h i f t to anaerobic glucose utilization T w o p a t i e n t s were analyzed a f t e r r e v a s c u l a r i z a t i o n . On b o t h cases, the p e r f u s i o n o f the ischemic but viable myocardium improved. We conclude t h a t combined FOG and cation, metabolic and p e r f u s i o n studies can detect ischemic b u t v i a b l e m y o c a r d i u m soon a f t e r acute M I . These ischemic reoions can be salvaged b y early revascularization.

Given that several treatments are under evaluation in order to reduce the size oF acute myocardial infarction (AMI), it seems useful to evaluate the effect of standard therapy (ST) (rest, heparin, lidoca{ne) in patients with AMI. 56 patients (PTS) (M : 47, P : 9, Mean age : 45 yr~ with proven AMI (typical EKG, modification of cardiac enzymes) underwent the following protocol : SPECT and RNA at admission and 2 weeks later. RNA allows the determination of ejection fraction (EF). The reconstruction by SPECT of oblique slices oriented according to the long axis of the heart ("short-axis", "long-axis"~ "4-chambers" slices) allows the study of perfusion defects (PD) for each wall (anterior, septal, inferior, lateral, apical). The EKG showed 3] inferior (INF), ]5 anterior (ANT), ]0 ANT and INF AMI. N~IA showed that EP increased significantly (by more than 5 %) in 24 PTS (43 %), decreased in 8 PTS (]4 %) and remained stable in 24 PTS (43 %). SPECT showed that PD decreased in 25 PTS (45 %), increased in 4 (6 %) and remained stable in 27 FTS (48 %). The patients with increasing or stable PD had a stable HF and the patients with decreasing PD had a significant (P< 0.1) increase in EF (41 + 14-+ 48 ~ 17). SPECT showed that the reduction in PD oeeured mostly in the neighboring walls of the AMI. Thus the inferior wall is involved in 75 % of PTS with ANT-AMI at admission and in only 50 % three weeks later, likewise in INF-AMI septal and lateral involvement frequency decreased (SEPT : 55 % --->18 %, L~T : 55 % --->27 E). Given that large variability of the evolution of AMl under ST, the evaluation of any intervention in AMl needs to be carrefully studied.

35 patients with angiographically proven CAD (IVD: n=29, 9/MI; 2VD: n=5, 2/MI; 3VD: n=10, 8/MI) were investigated. Nuclear medicine procedures consisted of TI 201 scintigraphy after dipyridamol stress and 4h later and 1-123 HDA scintigraphy. All patients were studied fasted in a I-2 week interval. TI 201 scintigrams after interpolative background correction were visually analyzed. In HDA studies data were recorded for 70 min. Images and regional myocardial time activity curves (biexponential fit with calculation of: the elimination half time of the initial phase: T; and the relative size of both phases: C) were interpreted. TI 201 showed a sensitivity of 80% in diagnosing CAD, and a regional sensitivity of 65% in identifying the number of narrowed vessels (scar: 17/19; ischemic: 22/41). In HDA studies done at rest uptake was reduced in 35 regions (scar: ~9/19; ischemie 16/41). T was prolonged (scar: 19/19; ischemic: 18/41) and g decreased (sear: 19/19; ischemie: 29/4|) in diseased regions compared with normally perfused regions (p< 0.01). Thus coronary artery stenosis induced frequently an impairment in HDA utilization not always associated with an abnormal TI 201 finding. Various combinations of HDA and T1 201 findings were obtained which may enhance grading of myocardial viability. THus, e.g. in patients who manifest an abnormal TI 201 finding in association with an impairment in EDA utilization at rest, the degree of myocardial damage is probably a greater one than in those regions with normal T1 201 and an abnormal HDA finding or normal results in both studies. l.Medizinische Universit~tsklinik, Wien (Vorstand: Prof.Dr.Dr.hc.E.Deutseh), Abteilung fEr Nuklearmedizin 1090 Vienna, Lazarettgasse t4 Austria

C y c l o t r o n Research C e n t e r , U n i v e r s i t y of Liege, LIEGE, Beloium.

Gra~t from the French Society of Cardiolo~j. Service de Mddecine Nucldaire CHU NANBY-B~OIS 54500 VANDOEUVRE FRANCE

A45 A265 VALU~ OF PHASE ~NALYSIS FOR SPECIFYING REGIONAL WALL MOTION #~NORY~LITIES ON RADIONUCLIDE VENTRICULOGRAY~ (RYV) IN CAD- AND NON-CAD PATIENTS. E. Nenze, D. M~ller, Ch. Delagardelle, F. Bitter~ M. Staueh, W,E. Adam Regional wall motion abnormalities (H%~MA) are zhought to he highly specific for CAD although they have been described in aortic regurgitation (AN) and in patients on daunorubicin (DAU) as well. In an attempt to further specify non-CAD RWMA~ consecutive exercise RNV of 17 petients with proven severe CAD were compared with resting ~TV of 24 patients with transmittal myocardial infarction (MI), B8 patients on a critical dose of DAU and 25 ~R patients. Ff~Y~ were defined ob3actively from paraaletric images by a decreased seegorial amplitude of more than 2 standard deviations of normal. In 15/17 CAD patients (88%) and in 19/24 ~ patients (79%) a significantly decreased regional amplitude was found. Importantly, in all abnormal CAD ~nd MI amplitude scans (100%) a significantly abnormal phase shift in the ssm~e region could be noted. In 6/28 patients on DAU (21%) an apical hypokinesis could he verified. In contrast to CAD, however, the phase distribution was normal in all these DAU patients. The patients with ~/q demonstrated a very inhomogenious pattern. A normal image was seen in 5 patients, 6 p~tients had an infarctlike pattern with regionally decreased ~unplitudes and phase shifting~ 7 patients showed a normal amplitude image with yet regional ph~sic delay, and the remainder 7 patients h~d an apical hypokinesis with normal phase distribution. In eonclusion~stamdardized phase analysis of ~NV data provides a powerful tool for specifying R W ~ . It allows a highly specific separation of HWZ~ between CAD and DAU patients. The inhomogenious pattern in AR patients can in Dart he explained by increased ~all stress and/or incomplete left bundle conduction abnormalities and awaits further evaluation. Nuclear Medicine Division, University of U]an, D-ygoo ULM, Germany

A266 EFFICACY OF THE SYSTEMIC THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION (AMI) ASSESSED B~ THALLIUM -201 PERFUSION SCAN. G.F.Camuzzini, P. Tortore, A.Biggi, M.C.garinelli, B.D'Angeli~.G.Aragno.To evaluate the efficacy of systemic thrombolys~ s(ST)in limiting infarct size,24 patients (pts) with early AMI were studied by planar thalliumgO1 scintigraphy.12/24 pts underwent ST(group A) and 12/24 received conventional therapy(group B) The time between symptoms and admission/Tl scanning was on average 3.9 fl hrs for both groups.A st 1 slngle-injection(g mCi,i.v.)Tl-sc was perfo[ med prior ST in group A,and for all pts ~epeated 4 hrs later.A second rest-redistribution study was carried on 8 days later.In each pt was deter mined the peak time of CPK from the onset of the symptoms (P-CPK)by serial sampling.Tl-sc was assessed for presence of T1 defect {Tl-d),extension of Tl-d (Tl-~e),evidence of reversibility (TI - r ) ~ d improvement from initial to late study(if -i).Tl-d and Tl-de for each view (ANT,LAO45°,LL) were described by a semiguantitative analysis ha sad on visual classiflcation (N grades).In group A 4/12 pts demonstrated Tl-r and 5/12 Tl-i;5/8 pts with extensive defects had significant impro vement in myocsJ^dial perfusion. In group B 5/12 pts demonstrated mild Tl-r or Tl-i. In pts with extensive defects (S/12) no significant improvement has been observed.Significant difference in P-CPK between pts who had Tl-r or Tl-i and the others was observed:lS°2~4.5 vs 2~.7~4.1 hrs (p<.001).From these preliminary results we conclude that:l)ST in early AMI is associated with significEunt scintigraphic improvement in respect of the control ~2~oup particul~n~ly dn l ~ g e Tl-de on initial Tl-sc;2)before ruling out m y o c ~ d i a l salvage a late study as to be performed;g)a better evaluation of the efficacy of ST needs more investigation to clear up the signifies/toe of Tl-r and Tl-i in pts of group R with earlier P-CPK. Nuclear Medicine Service and Intensive Coronary Unit,0spedale "S.Crooe",Cuneo,Italy.-

A267 THE ELIMINATION RATE OF INTRACORONARY INJECTED RADIOIODINATED FFA; I N D I C A T I O N S F O R A N A L T E R E D F F A M E T A B O L I S M A T R E S T IN PATIENTS WITH CORONARY ARTERY DISEASE. F.C. V i s s e r , M.J. v a n E e n i g e , E.E. v a n d e r W a l l , J,P. R o o s . T h e e l i m i n a t i o n r a t e s - e x p r e s s e d in m i n halftime (T½)- o f i n t r a v e n o u s l y (i.v.) administered radioiodinated heptadecanoic acid (I-123-EDA) may distinguish between normal and transiently ischemic m y o c a r d i u m b y the m e a s u r e m e n t of i n c r e a s e d T½ v a l u e s in i s c h e m i c m y o c a r d i a l r e g i o n s c o m p a r e d to n o r m a l r e g i o n s . H o w e v e r , t h e T½ v a l u e s m e a s u r e d a f t e r i.v. i n j e c t e d 1 - 1 2 3 - H D A w i l l b e i n f l u enced by a high background activity. Therefore, we compared the elimination rates from different myocardial regions after intracoronary injection of 1-123IDA. S i x p a t i e n t s (pts) w i t h c o r o n a r y a r t e r y d i s e a s e (CAD) w e r e s t u d i e d d u r i n g c o r o n a r y a n g i o g r a p h y . T h e p r e s e n c e of s i g n i f i c a n t l e s i o n s in t h e l e f t a n t e r i o r d e s c e n d i n g b r a n c h (LAD) a n d c i r c u m f l e x a r t e r y {CX) w a s n o t e d . A f t e r i n j e c t i o n of 0.1 m C i I ~ 1 2 3 - H D A in t h e l e f t c o r o nary artery, scintigraphy was performed d u r i n g 30 m i n in L A G 40 p o s i t i o n a n d T½ v a l u e s of t h e r e g i o n s p e r f u s e d b y t h e LAD and CX were calculated. Results: (meandSD) T½ v a l u e s o f t h e 6 L A D r e g i o n s w e r e : 2 2 . 3 ± 4 . 5 min. T½ v a lues of the 6 CX regions 24.0±3.0 min. T½ v a l u e s o f m y o c a r d i a l p e r f u s e d b y n o r m a l L A D o f C X a r t e r i e s (n=5) w e r e s i g n i f i c a n t l y l o w e r t h a n T½ v a l u e s of r e g i o n s perfused by stenosed arteries: (n=7) 1 9 . 8 ± 2 . 9 m i n v s 2 5 . 6 ± 1 . 8 m i n (p< 0 . 0 1 ) . T h e r e s u l t s c a n b e e x p l a i n e d by: I) a l t e r e d F F A m e t a b o l i s m a t r e s t in p t s w i t h CAD. 2) s l o w w a s h o u t o f t h e r a d i o iodide after metabolic degradation of 1 - 1 2 3 - H D A d u e to d i m i n i s h e d f l o w in t h e stenosed arteries. Dept. of Cardiology, Free University H o s p i t a l , d e B o e l e l a a n 1117, 1007 M H A m s t e r d a m , T h e N e t h e r l a n d s

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A 269

A 270

DETERMINATION OF RIGHT VENTRICULAR EJECTION FRACTION IN CHILDREN WITH CYSTIC FIBROSIS, USING KRYPTON-BIm. A. Piepsz, H.R. Ham, E. MiLLet, I. Dab.

ESTIMATION OF RIGHT VENTRICULAR PRESSURE USING 123-I-HDA MYOCARDIAL SCINTIGMAPSY. J. Kinser, F.P. Stocker, J.W. Weber and H. Rgsler

STUDY OF REFLUX GASTRO-OESOPHAGEAL SCINTISCANNING IN CHILDREN WITH RESPIRATORY DISEASES. J. Bonafous, M. Meyer, A. Labbg, C. Poldermann and A. Veyre.

The diagnosis of cot pulmonaLe and incipient heart failure remains difficuLt to assess ;n cystic fibrosis (CF} on the bas(s of the c[[nical as weLL as the biologica[ parameters. The measurement of the right venfricu[ar ejection fraction has been faciLitated these Last years by the introduction of the radionucLide methods. MeihodoLogica( difffcuLties are however encountered when Tc-99m RBC are used, and are mainly related fo heart chambers superpositlon (equiLibrium method) or the low count density (first pass method). Few papers have been published on RVEF in cystic fibrosis and the results are somewhat contradictory. We have recently introduced a new method for the determination of RVEF, using equilibrium study during continuous injection of Kr-81m in glucose solution. This method offers several advantages related to an increased accuracy and a favorable dosimetry. In 25 patients aged 2 to 23 years with CF, one or more RVEF studies were performed. The severity of the disease was evaluated on the basis of the cLinicaL 5chwachman score, the lung function tests, the ventilation scan and the pa02. RVEF fended to decrease with the progression of the lung disease, although, owing to the spread of the results, no RVEF could be predicted on the basis of the other parameters. The decrease of RVEF in patients with advanced Lung disease was moderate and terminal lung disease was sometimes associated with normal right heart

contractility, Dept. Radioisotopes and P a e d i a f r i c s , St Peter HospitaL, Free University o f BrusseLs, BeLgium.

The problem of the non-invasive assessment of ventricular and pulmonary artery pressures has not yet been solved. The extent of visualization of the right ventricle during myocardial scintigraphy with 201-Thalliu/n Chloride (201-TI) has been shown An adults and ehildxen to correlate with the pressure of the right ventricle. We replaced 201-TICI with 123-I- ~-heptadecanoic acid (123-I-HDA) for myocardial scintigraphy. 123-I has a much shorter half-life than 201-TI and no beta enmlission. This allows administration of a higher dose which gives better counting statistics and, thus, better results. In fourteen children with congenital heart disease, IS3-1-SDA myocazdial scintigraphy was performed within i to 6 days of cardiac catheterization. The age varied from 5/12 to ii9/12 years, the weight from 5.1 to 29.6 kg. After intravenous injection of the radionuclide (i mCi/10 kg), scintigrams of the heart in the left anterior oblique projection with 5 degrees of caudal tilt were recorded over i0 to 20 minutes. The activity in the region of the free wall of the right ventricle and of the left ventricle was analyzed using a computer. The quotient of IV- activity to LV-activity was compared to the ratio of IV-pressure to LVpressure during catheterization. Statistical analysis of these results gave a correlation of 0.84 (p
The study was performed on 1OO patients aged 6 weeks to 16 years who all showed pulmonary diseases. Several procedures including T. O.G.D, intraluminal pE, and radionuclide were used in order to detect reflux. 22 children undergoing the three tests. Patients drink IO ml of apple juice or milk containing 7.4 to II MBq of Tc 99m sulfar colloid which behaves as a non absorbable marker. After radiotracer administration, the patient is placed on supine under the g a l a - c a mera for a 15 mn acquisition. Only oesophagus and the superior part of stomach activity are visnalised on monitor oscilloscope. There the patient drinks additionnal apple juice or milk and undergoes a new 30 mn recording.At the same time~ 20 seconds data set are recorded on Informatek Simis 3 Computer. No physical means are used in an attempt to cause reflux. The registered pictures are visualised on monitor oscilloscope after two 9 points weight smoothing. As a matter of fact a comparative study showed that existing reflux on the whole oesophagus leads to a significative pick activity on radioactivity vs time curves. Every scintiscan presenting one or several activity picks all along oesophagus is considered as positive. On purpose we do not search for eventual pulmonary contamination. Results. 46 out of I00 patients presented positive scintiscan. Up to now, OUt of the 22 children who underwent the three examinations. 15 presented positive results through intra-lnmlnal pH examination and II through scintiscan,all of them verified by pH examination, 7 children showed both pH test and scintiscan negative which attests the specificity of the method. The authors give a R.g.O positive classification of pulmonary diseases (Recurrent respira~ry infection, apneic episode, bronchitis and serious asthma. Services de Mddecine Nucl@aire et Pddiatrie. Centre Jean Perrin - ggtel-Dieu - DHRU Place Henri Dunant - 63000 CLERMONT-FERRAND PRANCE

A46

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A272

ANALYTICAL SENSITIVITY OF MILK SCANNING IN THE DETECTIONOF G.O.R.

DETERMINATION OF REGIONAL T R A N S I T IN C H I L D R E N BY M E A N S 81m. A.Piepsz, H.R.Ham, M.H.Delaet, S.Eadranel.

P.S. Cosgriff, J.Y. Paton, C.S. Nanayakkara Dept. Medical Physics, Leicester Royal I n f . & Dept. Child Health, Leicester University. I t has been reported that radionuclide milk scanning is capable of detecting volumes of gastro-oesophageal r e f l u x (GOR) of the order of 0.025mi ( I ) . We have performed milk scans on 57 infants and on 23 occasions (15 infants) have been surprised to observe vomiting in the absence of discernable activity in the oesophagus. We therefore conducted a controlled simulation to establish the analytical sensitivity of the test. A plastic wash bottle fitted with various extension tubes (int. dia. 0.4, O.6cm) was f i l l e d with a 200mi solution of Tc99m (conc. 1.2, 2.3, 5.3~Ci/ml) and positioned in front of a gamma camera behind various layers of absorber (0,I,2cm). GORwas simulated by compressing the bottle and f i l l i n 9 the extension tube to a level of 20cm. A count densityin the extension tube of 0.6 counts/pixel was found to be just discernable. Using this cut-off a detection threshold (DT) was defined which depends on volume and duration of 'reflux'. For a gamma came'----ra sensitivity (NEMA) of 6.0 counts/ sec/#Ci, absorber thickness of lcm and concentration of 1.2pCi/ml the DT worked out to IOml. sec. i.e. a Iml 'reflux' n~st be present for at least 10 seconds to be detected. Depending on the clinical objectives the required DT can be defined at the outset. Appropriate collimation and amount of activity can then be chosen accordingly. { I ) Heyman S, e t a l . 1979, 131 : ~79 - 482. Radiology.

A273 ESOPHAGEAL OF K R Y P T O N B.Georges,

Badionuclide methods using Tc-99m have been developed in t h e l a s t f e w y e a r s f o r the q u a n t i t a t i v e assessment of the e s o p h a g e a l t r a n s i t . T h e m e t h o d is p h y s i o l o gic, e a s y to p e r f o r m and g i v e s i n t e r e s ting information c o n c e r n i n g the s e v e r i t y o f t h e d i s e a s e as w e l l a s t h e e f f e c t o f the applied treatment. In children, however, o n e is l i m i t e d by radiation protection considerations, and the results are often of poor quality, due to the low count rate. Furthermore, the risk of external contamination and the impossibility of repeating the test constitute significant disadvantages, particularly in young children. These p r o b l e m s are c o m p l e t e l y a v o i d e d by u s i n g Krypton-81m diluted in a glucose solution. For each swallowing, about 8 mCi of Kr-81m are administrered. Sixty onesecond frames are recorded and several parameters of regional transit can be extracted in a f e w m i n u t e s , using time activity curves and parametric images. T h e t e s t is v e r y s e n s i t i v e in d e t e c t i n g minor regional transit alterations. The reproducibility of the t e s t is g o o d and phenomena like interourrent gastroe s o p h a g e a l r e f l u x or a s y n e r g i c p e r i s t a l tic waves can easily be d e t e c t e d . The test has been applied to 7 7 c h i l d r e n , a g e d I w e e k t o 19 y e a r s , and provided helpful information c o n c e r n i n g the l o c a lization and the importance of transit abnormalities in c a u s t i c and peptic esophagitis, postoperative eases (atresia or anti-reflux plasty) and in patients with neuromuscular disorders. Dept. of R a d i o - I s o t o p e s , Paediatrics and Paediatric Surgery, Free University Brussels.

THE RESULTg 0F DII~ESIS RADIOISOTOPE RENOGRAPHY ~N PRESENCE 0P UPPER URINARy TRACT DILATATION/ COMPARISON WITH SL~GICAL EXPLORATION OR CLINICAL POLLOW-UP C. BAILLE~, W. NAHAS, F. LESTAGE, N. URDANETA~ P. de VERNEJOU[~ J. CIrClER We examined 27 nephroureteral units in 22 patients with radiologioal dilatation of the upper urinary tract due to diverse causes . Two groups are studied . In the first group are 15 patients (18 units) who underwent Diuresis Renography prior to surgery so that direct operative observation is available .The second group consists of 7 patients (9 unit~ with a clinical a~d radiologic follow up ranging from 1.5 to 12 years (mean 3.5 years) . Radiology indicating improvement or stabilization of the dilatation confirmed the diagnosis of residual dilatation or atenicity without obstruction at the time of Renog~aphy . Diuresis renog~aphy is performed with the injection of 5.5.M~q/Kg Tc 99m DTPA followed 17 min.later by 0.5[fBq/Kg frusemide IV . The kidney time-activity curve following the diuretic injection is classified according to 3 patterns : normal, dilated withsut obstruction (atonic), obstructed . In ease of severe renal impairment however, the curve is flat and cannel be classified . In the first group the result of diuresis renography is confirmed peroperatirely in 17 units (9 eases of obstruction and 8 0f atonicity) . In I unit renography is ±neonelusive (renal impairment) . In the second group renography gives the right diagnosis of atonicity in 6 units . 5 units cannot be classified because of poor renal function • Thus the results of Diuresis renography agree with the surgical or clinical observation in all the 25 units with sufficient renal function. In the impaired 5 other u~its ren0graphy is of no diagnostiG help . Clinique Urologique . HSpital Necker . Paris . ~erviee de Bi0physique . NSpital Necker . Paris.

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RADIONUCLIDE EVALUATION OF THE LEFT VENTRICLE FOLLOWING CORONARY ARTERY BTRARS SURGERY. F. Iorio, F. Ecopinaro,M. Clemente,Q. Caretta, B. Marino,A. Centi Colella.

EVALUATION OF LONG TERM LEFT VENTRICDLAR pERFORMANCE AFTER SELECTIVE INTEACORONARY T}~O~OLYSIS IN ACUTE MYOCARDIAL INFARCTION USING REST AND EX~RCISE NUCLEAR ANGIOCARDIO~ GRAFHY. J.L. Barat, A.J. Brendel, E.

S C I N T I G R A E H I C P A T T E R N OF R E J E C T I O N IN CARDIAC TRANSPLANTS - A PROSPECTIVE C L I N I C A L S T U D Y . H. C r e u t z i g ~ R. G r o t e , R. E e t z e r , W. L a n g , W. D a n i e l , and O. Schober

20 patients under~ent elective aerie coronary by pass grafting. A me,an of 2.9 grafts per patient was inserted (27 grafts in left 8nterior descend enting coronary artery, 17 in ~he circumflex, 14 in the right coronary artery). Operations were performed in sistemic hypotermia (2g-28 ~) cold potassit~ eardioplegia (4 ~) and surface cooling. Myocardial damage was diagnosed by the eontempo[ az~ positivities of EKG, CK-MB and 99m-Te-pyroph osphate scans (TcPPi) performed 1 day befot~ and 3-5 days after surgery. Gated cardiac blood pool studies were carried out within 5 days before and 3 to 5 months after surgery. LVEF and regional wall motions were evaluated in LAO view at rest and during hsndgrip. Each patient was s y ~ tomless after syrgery. All preoperative TcPPi im ages were megative; postoperative control showed 1 positive case (perioperative d ~ a g e ) . Mean LV EF at rest was unchanged by coronary bypass surgery (55 ~ lg vs 56 ± ii); during h a n d ~ i p there was s slight improvment (53 ± 12 vs 55 ± 13). In feroapical, inferolatersl and posterolateFal kin esis i/gproved after surgery; on the perioperative damage ease only e marked reduction of the m~ t i l i t y w a s observed in the infe~olateral wail. Postoperative septal motion was paradox in 6 cases; seven addictional cases showed also Teduct~ on of contractility. Althou~ht global and regi~ hal left ventricular reserve is improved by core nary bypass surgery, the high incidence of abno~ mality Of septal motion makes difficolt the evaluation of this area and, in some eases, it gives rise to obscure the real response of the other walls and the global ejection fraction.

Aouizerate, J.P. Cello, J. Isidore, V. Magimel-Pelo~nier, Besse and D. Ducasseu.

Chair of Nuclear Medicine. Institute of RadioloEY, University "La gapienza", 00161 Rome, Italy

Ohayon, M.P. F. Leccia, P.

The purpose of this study was to evaluate after six months the efficiency of intracoronary streptokinase in the treatment of acute myocardial infarction (MI). The study population consisted of 58 patlents, divided in four Kroups :

i) LADp (10 patients) with successful reperfusion of the left anterior descending artery in the first five hours after ME. ii) L~Dc (15) a control group of mI patients admitted after 5 hours, who had single vessel disease with LAD thrombosis of similar location on a n g l o , a m performed at 3 weeks, iii) RCAp (18) and iv) NCAc (15) farmed identical successfully treated and control groups for Ml involving the right

coronary artery. The left ventricle (LV) f ~ c t i o n was evaluated at rest and during exercise u s i ~ equilibrium gated

nuclear

angiocardio~aphy

in

45 °

LAO

view. The measured parameters were global ejection fraction (EF). regional EF, double product, and their change du~ing exercise with respect to the resting value. Also were tested the change in end diastolic and systolic v o l ~ e s 8~Id cardiac out]~ut. The only difference noted between LAPp and LADe ~ o u p s was the resting EF (29 ± 12 % vs 41 ± 18 ~, p < 0.01) but ~ e s of patients could explain this difference (59 ± 6 vs 49 ± 12, p < O.OZ). There was no s i ~ i f i c a n t difference between all parameters measured at exercise. In RCA groups no differences were shown at rest and during exercise (a~es were comparable). In conclusion, no s i ~ i f i c a n t benefit on LV performance at rest and during exercise could be demonstrated slx months after LAD or RCA recanalization in acute ME.

h~Sp.Univ, gaut-L@vEque. France.

33600 Bordeaux-Pessac,

Radionuclide t e c h n i q u e s are w i d e l y u s e d in the f o l l o w - u p of p a t i e n t s w i t h r e n a l or l i v e r t r a n s p l a n t s ; t y p i c a l s c i n t i g r a p h i c p a t t e r n s for a c u t e or s u b a c u t e rej e c t i o n are w e l l e s t a b l i s h e d . L i t t l e is k n o w n , h o w e v e r , a b o u t c a r d i a c g r a f t s alt h o u g h m o n i t o r i n g of p u m p f u n c t i o n b y MUGA will be very simple. We t h e r e f o r e s t a r t e d a p r o s p e c t i v e s t u d y : M U G A s t u d i e s w e r e d o n e o n c e to t w i c e a w e e k , and w e r e c o r r e l a t e d w i t h histological findings, coronary cath d a t a s , c l i n i c a l f i n d i n g s , and C y c l e A l e v e l s in at p r e s e n t six p a t i e n t s . F i r s t in a c u t e r e j e c t i o n an a c u t e d r o p in g l o b a l e j e c t i o n f r a c t i o n (EF) to less t h a n 30% was seen, f o l l o w e d by r e g i o n a l alterations: phase shift and hypokinesis predominantly in the s e p t a l w a l l r e g i o n . The c o r o n a r y a r t e r i e s w e r e n o r m a l . T h e s u c c e s s of t r e a t m e n t w a s f i r s t s e e n in global EF while regional abnormalities r e s t e d for some days.

Abteilung Nuklearmedizin, K l i n i k f~r H e r z - , T h o r a x - und G e f ~ a c h i r u r g i e , Kard i o l o g i s c h e K l i n i k und P a t h o l o g i s c h e s ~nstitut der medizinischen Kochschule, D - 3 O O O R a n n o v e r 61, F.R. G e r m a n y

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INTEREST OF PRE AND POST-OPERATIVE RADIONUCLIDE STUDIES FOR DETECTING POST-ISCHENIC LEFT VENTRICULAR DYSFUNCTION AFTER NON CARDIAC SURGICAL PROCEDURES IN CORONARY ARTERY DISEASE. O.Mundler, N. Eauchet~ g. Ourand, A.C. Rods, P. Coriat.

DETERIORATION OF LEFT VENTRICULAR FUNCTION AFTER GENERAL ANESTHESIA FOR NON CARDIAC SURGICAL PROCEDURE IN CORONARY ARTERY DISEASE DETECTED BY CARDIAC RADIONUCLIDE STUDIES.O.Mundler,M.Fauehet, C.Ourand, A.C.Rous~ P.Coriat.

EVALUATION OF ACUTE AND CHRONIC EFFECTS OF VERAPAMIL AND PROPRANOLOL IN HYPERTROPHIC CARDIOMYOPATHY BY EQUILIBRIUM RADIONUCLIDE VENTRICULOGRAPHY. R.Giubbini, C.Pizzocaro, P.guerra, A.Terzi, G.Bisseli*, G.ta Canna*, A.faobelli*.

After brief periods of isohemia the structural, metabolic and functional property of reversibly injured myocardium remains severely disturbed for several days before recovering. The purpose of this study is to demonstrate the presence~ 24 hours after non cardiac surgical procedure, of post-ischemie ventricular dysfunction, using radionuclide studies. Consequently Thallium201 myocardial scintigraphy after dipyridamole infusion and gated blood pool imaging were performed b e f o r e and 24 hours after the intervention in 20 patients with history of angina pectoris. Per-operative myocardial isohenia was detected by continuous electrocardiogram recording. In 6 patients post-operative Thallium 201 scintigraphy and/or radionuclide ventriculography were worsened : - Thallium 201 scintigraphy revealed an increased and/or obviously enlarged lsohemic deficit in the lateral myocardial segment in 5 ; - in 5 patients lateral segment becane hypokin~tie and we noted an important de~ crease in global ejection fraction. The continuous electrocardiogram monitoring revealed the oceurence of episodes of myocardial ischemia : in one out of 14 patients with unchanged postoperative studies ; in the 5 patients in whom an obvious impairment of left ventricular function appeared post-operatively. That underline the role played by per-operative ischemia in the occurence of post-operative modification. These results point out the interest of cardiac radionuclide studies in coronary patient who underwent non cardiac surgical procedure, to detect the consequencies of per-operative myocardial ischemia. SERVICE CENTRAL DE BIOPHYSIQUE ET MEDECINE NUCLEAIRE (Pr M. BURGEAT) H a p i t a l LARIBOISIERE 2 r u e Ambroise Pard, 75010 PARIS - FRANCE

The increased cardiac work which characterise the recovery from general anesthesia is well documented. However its effects on left ventrieuler function are unknown. The purpose of this study is to test the hypothesis that after general anesthesia for non cardiac surgical proeedures~ hemodynanic responses of recovery induce wall motion and ejection fraction (EF) abnormalities in patients suffering from mi]d angina pecforis. Consequently gated radionuclide angiography (GRA) was used to assess EF and regional wall motion under standardized general anesthesia (Tl), 3 minutes it2) and 3 hours itS) after extubation in 24 patients :- 8 patients free from symptom of coronary artery disease (group i) - 16 patients with mild angina pectoris history (group 2). ~8 hours later Thallium 201 myocardial scintigraphy after dfpyridamole infusion and GRA (Td) were performed in all patients. No ischemic ST segment depression was detected by continuous monitoring of ECG performed i n ell patients d u r i n g the study. Thallium 201 seintigraphy was normal in group 1 and abnormal in group 2. EF remain unchanged at T l , T g , T 3 and T4 i n group 1. I n group 2 EF responded abnormaly to recovery : EF decreased from 553 9% (Tl) to 453 8% it2) (p<0.001);ho~ever at T3 EF 54 ~ 8~ ~as not statistically different from Tl. If we conaidere the totality of the analyzed segments at T2 we noted in group i that 4~ of these segments present e decrease of 15 % in relation to the Tl value. In contrast in group 2 at T2 12% of the segments present a decrease of 15% and 24% a decrease of 25%~in relation to Tl~localized in the myocardial area in which myocardial activity was decreased at Thallium 201 dipyridamol study. These results demonstrate that recovery from general anesthesia cause abnormalities in left ventricular regional function and EF in patients suffering from mild angina peetoris. These abnormalities occur even if these patients do not experience myocardial ischemia. SERVICE DE NEOECINE NUCLEAIRE Hop. LARIBOISIERE 2 r u e Ambroise Par6 75010 PARIS - FRANCE

The effects of acute e.v. and chronic oral theraphy with Verapamil iv) and PropranoLol (P) were t e s t e d i n 18 s u b j e c t s a f f e c t e d by h y p e r t r o p h i c c a r d i o m y o p a t h y . Each p a t i e n t was s t u d i e d by g a t e d r a d i o n u c l l d e ventricuLography (RV) a t r e s t and a f t e r e . v . i n f u s i o n of V; t h e RV was t h e n performed a f t e r t h r e e months of o r a l t h e r a p h y (240 m g / d a y ) . One month l a t e r t h e same p r o c e d u r e was r e p e a t e d f o r t e s t i n g t h e P effects. The f o l l o w i n g p a r a m e t e r s were a n a l y zed: h e a r t r a t e (HR), e j e c t i o n f r a c t i o n and r a t e (EF, ER), f i l l i n g r a t e (FR) and t i m e to peak f i l l i n g r a t e (TTPFR). FR was i n c r e a s e d from 3.35±0.87 to 3.63±0.71 (P:O.OS) after e.v.infusion of V, while it wasn't modified during oral treatment. TTPF2 was decreased either during e.v. or oral theraphy (186±24 164±31 172±21 prO.D5 and 0.05). NR, EF and ER were never modified. On the contrary P didn't modify FR, either in acute, or in chronic treatment and TTPFR was increased during oral therapy (192±14 201±18). RR was decreased from 65.05t12 to 60.5±9.3, EF from 78.8±9.9 to 71.5±9.3 (P=0.05 ) and ER from 4±0.64 to 3.56±0.59 (P=O.OOl) after e.v. infusion of P; these parameters were not modified after chronic oral therapy. In conclusion our data demonstrate that V improves Left ventricular diastolic filling without induclng alterations in systolic emptying, while P decreases systolic contractility without any evident benefits on filling phase. Servizi di Medicine Nucleare e Policardiografie*, Ospedale Regionale, 25100 Brescia, Italy

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SERIAL Tl 201 IMAGES AFTER HIGH DOSE DIPYRIDA~OL: DIAGNOSTIC UTILITY OF Tl 201 WASHOUT ANALYSIS. R.Dudczak, R.gehmoliner, R.Homan, K.Kletter and H.Frischauf

O~PA~LISON OF 2 o l - ~ P~RFUSION SCA~ AND 99m-TO CINE-VG ON IHD P A T I ~ T S UNDER ERGOM~TRIC S'z'P~SS AND DIPYREDA~OL~ INPUSION M .Horv&th,E.Beszgrmlnyi,~.K~rm~n,L.Nlmeth A.Pszota,K.Rahdl

NIFEDIPINE IN CORONARY ARTERY DISEASE (CAD) R.Bauer, O.Lauer, L.Lutilsky, H.Stettmeier, R.~bening, R.gangha~er, H.W. Pabst

Recently the quantitation of regional Tl 201 clearance after maximal exercise has been shown to increase the sensitivity of detection of CAD. However, clearance is affected by the exercise level. Also pharmacological induced stress in Tl 201 studies has proven its clinical feasibility for diagnosing CAD. Although patient cooperation is not necessary in such studies Tl 201 clearance might be expected to be reproducable, this relationship has not been explored. We therefore evaluated the rate of decrease in myocardial Tl 201 activity following dipyridamol (0.5 mg/kg) in repeated studies one week apart in 4 patients with normal coronary arteries and 5 patients with CAD. Serial scintigrams (10', 2h, and 4h) were obtained following iv Tl 201. Following interpolative background correction regional Ti-20[ washout was calculated. In controls Tl 201 washout was homogenous in both studies (29.8%~8.4% and 37.9%!~1.4%). However, there was an individual variation in regional Tl 201 washout averaging 37% (range: -14% - +120%). In patients with CAD Tl 201 washout was prolonged from ischemic regions in both studies (14.6%~3.9% and 17.9%Z11.8%) and regional differences were maintained in both investigations. However, as in controls individual washout levels were different between experiments (range: -90% - +115%). Our data indicate that clearance of T1 201 is not reprodueable. These findings pose stringent limitations in washout evaluation in Tl 201 studies after high dose dipyridamol.

l.Medizinische Universitgtsklinik, Wien (Vorstand: Prof.Dr.Dr.hc.E,Deutsch) Abteilung fdr Nuklearmedizin 1090 Vienna, Lazarettgasse 14 Austria

The investigations have been carried out on the Hung. gamma camera /Gsmma Works/, the evaluation after Supersegams program of the Szeged School of Nucl.Med,~ for check up of the perfuslon o ~ semi-automatlc program has been developed. The Supersegams program was focused on regional wall motion abnormalities The abnormal /AN/, uormai /N/ decision criteria satisfied the international requirements On 30 pato-S,~rlth v a ~ o u s stages of IHD, the A~/N ratio /~/ did/1't differ wlth s t ~ s s /24/6/ a/id with DIP /22/8/. On 36,partially identical pa%o-S the AN/N r increased on DIP 12p.o., fom the wall motion pattex~ 9p.Oo The IX[P-provoked perfusion A~-S were essenti a l l y higher /29/36/ th n the DIP-provoked wall motion AN-s /19/36/. The basal and the DIP-provoked ~N-S occured mostly accompanied by a ~ 4 ~ and steal, in the cases of stenosis of the m~in s u p p l y i ~ coroD~cry &rtex~ amd LAD in remote e x t . a n t . i ~ u ~ o ~ o ~ o For control of the percentual DIP-redistribution changes, double 2ol-Tl techr~que of guglhara and cow. has been in several cases also performed. ~ithln this scope the global heart/right lower fang regiom pixel-eounts r proved to be sUltable. The r on 3 remote ext. ant. i m f K ~ t i o ~ pat.-s was lower /1.74/ tha~ on 3 hypertensives ~ g i n o u s pat.-s /1.94/. The DIP-effect i~creased the r in both groups /to 1.85 and 2.00 reSpo/, but %b~S increment didn't concerned the pathologicm/ hea~% sectoz~. The h e ~ t / l u D ~ r i n accordance ~rith the 2ol-Tl first pass curve~supported that the pat.-s was work-lngin c o m p e ~ a t o ~ stage. ~q%e DIP-blood level has bee~ dete~mined with o ~ fluorometric method. In the group of the remote ext.eJ~t, inf. pat.-s,the accidental angina &pperaed already on o.5mg/kg/4mi~ dose contrasting the hypertensive stenocardiacS with o°75mg/kg/4min dose. State Hosp.Cardlcl.,Balatonf~r~d,Kttugar~

The efficacy of Adalat R 5/15 , a new oral combination of 5 mg fast and 15 mE retarded released Nifedipine, was tested in 7 patients (P) with CAD, documented invaslvely or by history and EKG. Heart function was tested at rest and under exercise by means of radionuclide ventriculography, quantifying ejection fraction (EF) and maximal rates of volume change in systole and diastole (VS and VD). Regional wall motion was assessed by means of amplitudes and phases and from acine mode representation Following the control study (C), Adalat 5/15 ~ was administered and heart f~nction was tested again at rest and exercise lh and 5h later. Following drug application, heart rate was slightly elevated and blood pressure reduced, these changes were not significant. EF was 55% (C), 55% (lh) and 57% (bh) at rest. Under exercise, EF dropped to 52% (C), whereas under medication an increase to 61% lib) and 59% (5h) was observed. ~he increase from 52 to 61% was significant. In the control study, the increase in VS from 2.6 at rest to 2.9 (I/s) ~ d e r exercise was pathologically reduced, ~fnereas lh and 5h after drug application an increase from 2.8 to 3.8 and from 2.8 to 3.9 (I/s) was observed. Without drug, all P had exercise induced wall motion abnomalities, indicative for critical coronary artery stenoses. I and 5h after Nifedipine, no wall motion abnormality was seen in 2 P, and in 2 P the motion irregularities were markedly reduced. The combination of fast and retarded released Nifedipine resembles a potential drug in P with CAD with a fast onset and a long lasting duration of efficiency. The improvement of global and regional heart function might partially be caused by preventing exercise induced spasms of coronary arteries. Nuklearmedizinisehe und 1.~diziniscbe ~inik l~J ~nchen, D-8000 ~nehen 80

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MYOCARDIAL STUDIES IN PATIENTS ON MAINTENANCE EEMUNIALYSIS (HD). R.Nudczak, K.Derfler, R.Homan, N.Kletter, H.Frischauf and J.Zazgornik

qLO3AL A~IO RESIO~AL [JECTIO~ FRACTION IN ~ATIE~!TS WITH M!D WITHOUT INTRACORONAR¥ STREPTOLYSIS THERAPY-A RADIONUCLID~ STUOY WITH £9-TC.R.Schnelde~,~.5olde, W.Rutsch,H.Sclmlutzie~ and R . F e l i x

RADIONUCLIDE ASSESSMENT OF RIGHT VENTRIC ULAR INVOLVEMENT IN INFERIOR ACUTE MYOC~ RDIAL INFARCTION: CLINICAL CORRELATIONS AND IN-HOSPITAL FOLLOW-UP. B.Palagi,R.B~ refTio,R.Picozzi,A.Ricci,G.L.Tarolo,M.Arosic and G.Zatta. We studied 43 patients ~ith first inferi or acute myocardial infarction (AMI) by first pass (FP) and equilibrium gated r~ dionuclide angiography (EGRA) within 4d~ ys From acute event.Eight normal volunts ers were studied by EGRA. The parameters (Ejection £raction(EF~peak ejection rate (PER);peak filling rate(PFR~Of the timeactivity curve(TAG)Of both ventricles(l~ ft ventricle (LV);right ventricle (RV)~_e re computed.The regional wall m o t i o n ~ w ~ was evaluated by parametric images (amP! itade and phase).In 45~ o£ patients with AMI we Found a depressed RVEF,while the LVEF was decreased in only 35%.The sensi tivity o£ diastolic parameters appeared clearly superior(RVPFR:84%; LVPFR:91%). The abnormalities of the overall performance o£ both ventricles were significa~ tly correlated with those of the EWM.Th~ abnormalities of global Function parameters allowed us to di#Perentiate the nec retie involvement o£ the RV from the im£ airmen% at its sole compliance on an isc hemic basis.Congestive heart failure and shock syndrome were significantly corre! ated with depressed RV parameters,while the LVEF was in the normal range,despite RWM abnormalities.EGRA with computation of the TAG parameters of both ventricles appeared to be useful to the in-hospital prognostic evaluation o£ the patients w ~ th inferior myocardial infarction.

Myocardial perfusion with Tl 201 after dipyridamal was evaluated in 33 patients on HD therapy. In addition radionuclide angiography (RNA) was performed following HD. RNA was done at rest in 31 patients and repeated in ]3 after isometric exercise. All patiests studied showed no signs of congestive heart failure (x: age: 52y; HD:3y). 53% of the patients had abnormal Tl 20~ scintigrams, whereas coronary artery disease (CAD) was underestimated from clinical symptoms alone (33%) The incidence of an abnormal Tl 201 finding increased with the duration of ND treatment. However, in the symptomatic patients angina appeared already in the first or second year of HD therapy. 39% of patients with abnormal Tl 201 findings died within a year following the scintigraphic examination. From 15 patients with normal T1 201 scans 26% died. Mortality rate was above that as reported in asymptomatic or mildly symptomatic patients with CAD, averaging 7.7%/y. The main causes of death were cardiovascular complications in patients w~th abnormal TI 201 findings. LVEF was within the normal range in all patients. Thus in our pstients LYEF appeared not as an important prognostic charscteristie. However, left ventrieular function can be impaired following exercise. LVEF decreased in patients with normal as well as abnormal T1 201 findings,whichwas slightly more pronounced in the latter. Thus, besides CAD uremic compounds may contribute to alterations in ventricular performance, possibly deteriorating under stress ~he influences of ischemia on the myocardium. Thus cardiac abnormalities, detectable by noninvasive nuclear medicine procedures are common in patients on maintenance hemodialysis, which may have prognostic implications.

l.Medi~inische Universitgtsklinik,Wien (Vorstand: Prof.Dr.Dr.hc.E.aeutsch) Abteilnng f~r Muklearmedlzin 1090 Vienna, Lazarettgasse 14 Austria

To evaluate the possible b e n e f i t of i . c . s t ~ a p t o l y s i s therapy on myocardial func t i o n , g l o b a l (GEF)and r e c i o n ~ l e j e c t i o n fractlon(REF)were studied in 77 ~ a t i e [ ~-B seeks a f t e r admission,30 pat~ with i . c . l y s ~ s at;d 29 pat. w i t h o u t were evaluated by r a d i o n u c l i d e angiography(RNA). 18 p a t . w i t h o u t cardiac d~sease served as c o n t r o l 9oup. GEF was c a l c u l a t e d aut o m a t i c a l l y by edge deteotlon(2nd de~.) For REF the l e f t v e n t r i c l e was d~vided in the a n t e r o s e p t a i , t h a 4 n f e r o a p i c a l aud the o o s t e r o l a t e r a l segment. G£F was in the c o n t r o l gou9 66.5$g%,REF was a n t e r o s e p t a l 40+11%,inferoapical 7058% and p o s t e r o l a t e ~ a l 63511%~G£F in pat. w i t h o u t lys~s was 45515% vers 47+ 15% in pat. with i . c . l y s i s . l n anterior myocardial ~nfarct~on(AMl)GEF was 37510 vers 39+13%.h% i n f e r i o ~ i n f a r c t ~ o n ( I M l ) G£F was 55513% vers 55510%.REF ~n AMI was w i t h o u t lys~s a n t e r o s e p t a l ~1+2Z vers 20;10% w i t h o u t l y s ~ s , ~ n f e r o a p i c a l 31+12% v e r s 23510% and p o s t e r o l a t e r a l 42+13% vers 46$16%.In IMI REF was anteroseptal 3559%_vers 33+7%,inferoapic~l ~l$1a% vers 49+17% and p o s t e r o l a t e r a 50513% ve~s 48513%.The most s i g n ~ f l c a n t d i f f e r e n c e was seen ~n AMI with GEF and R[F in the anteroseptal and i n f e r s apical segment in comparison to the c o n t r o l ~roup.ln IMI s i g n i f i c a n t d i f Ferences were ~iven with REF in the p o s t e r o l a t e r a l and i n f e r o a p i c a l segment. We conclude t h a t GEF and REF can be evaluated n o n i n v a s i v e l y by RNA in pat. with and w i t h o u t l y s i s 4-3 weeks a f t e r admission. Dep.of Radiology + C a r d i o l o g y , K l . C h a r lottenburg,FU Berlln,Spandauer Damm 13O,D-lOOO-~er]in-lg,Germany

Servizio di Medicina Nucle~re-Osoedale di Saronno 21047 Saronno (VA) I~ALY

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QUANTITATIVE DETErmINATION OF LEFT-TORIGHT SHUNTS BY TRkNS~ER FUNCTION /TF/ AND C E P S T ~ L TRANS~OR/~ATION /GET/ . L. Nyitrai and ZS. Negy

TadA~DS ABSOLL~E CARDIAC (~AMHER ~OLL~ MEAS[~E~/qT-DIRECT MEASURE OF AE~2EN~TION BY T~D ~THO[S. B.F. Hutton, G. BautGvi~, D. Bailey, R. Fulton, H. Patterson, P. Coo~.

ASSESSPLY~T OF RIGHT VENTRICULAR FUNCTl0~ BY INTP~VENOUS KR-81M IN CO[,~ARISON WITH TC-99M LABELLED ERYTHROCYTES. R.P. Spielmann, C.Nienaber, G.Wasmus, P. Stritzke, W.Bleifeld and R.Montz

The determination of the Qp/Qa ratio by gamma variety /G/ functions is unreliable - even after e deconvclution. M u c h is up to subjective decisions. There sre meny problems especially with fitting G-functions characteristic of the given shunt. He, ever the cenvolved end superpesed lung,shunt and recirculeties phases can computed automaticell~ from T~ by GET. Our CET works in s wa~ that the smaller the Qp/Qs rati0:is, the more accurate the result is. This fast counterbalances the relatively high computation errors in the cases of small QD/QB reties. The d e o e m p o s i % i 0 n o f lung, s~unt end recirculation components in the quefrenoy domain is similar to the d a t e l i n e % i o n of the echo time of seismic signals. Simulating l e f t - t e - r i ~ shunts with known Qp/Qs ratios, we obtained the following results: In the cases of Qp/Qs&I.2 the detection of shunts is absolutely unreliable without using a T~, W i t h TF the detection of shunts is reliable also below 1.2 /till about 1.05/, but the Q~/Qs ratio is still not computed accuretel~. Our new method /TF+CET/ enabled us to compute the Qp/Q~ rstio accurately without any subjectlve intervention, The relative errors of Qn/Qa computations were 3-7%. Ours is a ndn-invasive method, the processing time is short, so it de suitable for routine diagnostics. Its accuracy and objectiveness can be e great step forward in the diagnostics of left-to-right shunts.

with a view to im~ eying absolute volume n~aslrement in ro~tine practice, two separate mef~ for directly measuring the attenuation ~or counts originating frcrnthe cardiac chambers have been developed. Absolute volume may be calculated with the cQT~li/led ~ e of first pass kinetics and an eq~ili ~ i%~m g a t e d s t u d y inde~endent of attenuation effects. The attenuation factor for an individual patient may also be calculated frma the first pass study by dividing the integral under the first pass curve by the ~rcduct of the inhered dose, camera sensitivity and the m~an res~ual time for activity within the d%a~her ~ i c h may be calculated fr~l a subsequent equililri~ gated study. In a groip of 16 studies the mean attenuation coefficient was calculated to be 0.100/c~ (SD=0.019). TO fllrther substantiate these results a second method of directly estimating attenuation has b e e n developed using a transn~ssion tcmographic study. A Tc99m flood tank is mounted on a gantry attad~ed to the heed of a rotating camera and data collected for 64 angles using standard collection soft%ELre. The dRta are transfon~ed prior to reconstruction and attenuation ~ps produced ~or slices corresponding to the nodified LAO vie~. The mean attenuation for counts orig~ting in the c~nplete cardiac voll~ne may be calculated, internal calibration being carried out by imaging a perspex blo~k near the patient. In studies on phantoms w i t h known attenuation coefficients, ~cel lent correlation with measured attenuation values was denDnstrated {r--0.996). In a snell group of patient studies the effective attenuation coefficient ~es 0.100/crn (SD = 0.012) for left ventricle and 0.115/ca (ED = 0.013) for right ~ntricle.

be

Jdsa AndrOs Hospital, Radiniaotope Department, Pf.159. H-4401 Nyiregyhlze, Hungary

Deparhnent of Nudiear Medicine, R ~ I A/fred Hospital, Sydney, Australia.

Prince

Gated equilibrium scintignaphy of the right ventricular (RV) blood pool was penfozmed at rest and during subm~ximal bicycle exercise in patients with various cardiopulmonary disorders. In all patients, two different methods were applied:continuous intravenous infusion of Kr-81m an~ in vivo labelling of erythrocytes w i t h Te-99m. Due to lack of activity in the left side of the heart Kr-81m allows imaging in RAO position which provides best separation between the RV and the right atrium (RA). Determination of RV ejection fraction (RVEF) involved the definition of an enddiastolic and an endsystolia nsgion of interest (ROl). In a previous investigation Kr-81m RV~F correlated well with biplane cineangiographie RVEF (r=0.82). The double ROI method was also applied to evaluate Te-99m seintigrams which were obtained in a modified LAO view. The overall correlation between Kr-81m RVE~ and Tc-99m RVEF was poor (r=O.55, n=15). If~ however, those patients were excluded, whose endsystolic LAO image ezDaibited a considerable displacement of the atrioventricular border into the enddiastolic RV KOI, a m u c h better ~r~slation was found (r=O.91, n=9), w i t h the Kr-81m RVEF tending to higher valt~s than the Tc-99m RVEF. In avoiding RA overlap w i t h RV, Kr-81m appears to be a reliable tool for serial assessment of RYfunction. Dept. Nuclear Mad. and Dept. Cardiolog~ University Hospital Hamburg-Eppsndorf M~rtinistr. 52, D-2000 Hamburg 20 F.R. Germany

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A293

LACE OF CORRELATION BETWEEN EXERCISE-INDUCED STSEGMENT DEPRESSION AND EXERCISE-INDUCED CHANGES OF LEFT VENTRICULAR EJECTION FRACTION. S.Silber, K. Krause and K. Theisen,

EXEBCISE RADIONqJC~IDE ~ C U L O G R A P H Y BEFORE HOSPITAL DISCHARGE AFTER UNCO~iDLICAT~9 MYO~IAL INFARCTION : A RELIABLE PP~DICIOR OF FUPtLRE CARDIAC EVENTS ? J.A. Melin, M.E. Nannan, A.M. Dhondt, P. De Coster, J. Col, J.M.R. Detry and C. Beckers.

FACTOR ANALYSIS OF EQUILIBRIUM GATED STUDIES: USEFULNESS IN REGIONAL WALL MOTION ABNORMALITIES. D. G. Pavel. J. Sychra, P. Briandet, R. Fang, K, golnierczyk, S. Virupannavar, J. Shanes.

E~ercise (Ex)Electrocardiography (ECG) and Ex-RadlonuclideV~nt/iculograf~ly(N~Vl are w~dely used for the detectzcn of corcn~y arterf disease (CAD). There is, ho~ver, little informat/on whe~lez- both methods agree ~ t h respect to the degree of isd~la, in order to a n ~ this clinically important question ~e invest/gated 31 consecutive patients with chromic stable angina, angiographically ~ t e d C~D without any signs of prior myocardial infarctiQn. Cnly pats with significant ST-sec~nt depressicn (i.e. __~_ir~n) after a 4 days" period of discontinuat/cn of all snti-ischemic drugs were included. Tee amount of the Fx-i~ced ~ s e ~ t depression, as determined 0.08 sac after the J point, ~as c o ~ e d with the extent of the changes of left vemtricu]~r ejection fraction (LV-EF), as measured by the sLaulta~eoosly recorded ENV. ~qiS was pezfozn~d after RHC's in-vivo labeling !*ith ~J~out 20 mCi (7,4xi0 Hq)ggm-Tc, 5~JGA~92~d!ihrJ~z, technique (21 frames ~er cycle,64x64 r~atrix) using a Icw energy high sensitivity collimator. LV-EF was calcutlated by s~mi-auto~atic variable regic~ of interest d e ~ t i o n . Results: 6 o~t of li p~te with slight ST-segment-depres~icn (i.~1.5 nm) s h ~ no significant change of LV-~ (~_ 5%), whereas 3 pate of this group ted a msderate decrease of LVEF (6%-14%) and 2 pate a severe drop of LV-EF [~_15%). in the group of pats with a moderate ST-segment-depression (I.6 -2.5 ~m) 5 shewed no change, 5 a moderate and 2 a severe decrease of LV-EE. 3 out of 8 pats with severe S T - s e ~ t depaessi~n (nora than 2.5 ~ did ~ t sh~w a significant decrease of LV-~, whereas 2 developed a mmderate and 3 a severe decrease of LV-EF. Concl~isn: As the results sbcw, the changes of leftventricu/ar ejection fraction durlng exercise are unrelated to the degree of the sin~itaneously recorded ~f-segment-depressisn in pate with c o r c ~ artery disease without pri~r r ~ dial infarcticn. SinCe there is no clinical reference msthod for the assessm~qt of myocardial isc/~a, the different and indei~ent informaticns of both methods must be considered, when change~ of the a~n~ont of n~ardial i s c ~ are measured for example b~fore and after pharmacological or mechanical intsrventic~s.

The prediction of future cardiac events by suhmaximal exercise (ex) testing and radionuclide ventriculography was evaluated prospectively in 49 consecutive patients with uncc~iolicated acute myocardial infarction and of less than 75 years old. These patients were studied a mean of 14 days after acute myocardial infarction and the following parameters were oonsidered ~ predictive of cardiac events : exercise ST segment depression >, 1 rml, resting left ventricular ejection fraction (LVEF <25%), failure to increase L V ~ by at least 5 units during exercise. The patients were followed for a mean of 7 (range 4-10) months (34 for > 6 months and 15 for > 6 months) to determine the incidence of cardiac events (cardiac death, acute myocardial infarction, congestive failure, bypass surgery). Eight of 49 patients (16%) developed new cardiac events during the follow-up. The positive and negative predictive values ~ V + and PV-) for the occurence of new cardiac events are :

PV + PV -

ex ECG

rest LVEF

ex LVEF

38% (5/16) 94% (31/33)

33% (3/9) 88% (36/40)

23% (5/22) 89% (24/27)

The prelininary results of this prospective study indicate that exercise LVEF before hospital discharge after uno~nplicated acute myocardial infarction does not yield additional predictive information beyond the resting LVE~ and tlle exercise ECG. University of Louvain Medical School, Brussels, B e l g i e .

Medizinische Klinik Inne~stadt, Cardiology, University of Munich, Ziemssenstr. i, FRG.

A 294 THE INFLUENCE OF PREDNISOLONE

ON 1251-THYROXINE

BIOKINEIICS. C. Sawas-Dimopou]ou, N, Toubanakis, I . Iordanou, M. Lyra, K. Papavasiliou I t is well-known that c o r t i c o s t e r o i d s decrease t h y r o x i n e - l e v e l in serum. The mechanism by which Predeisolone administration induces the above e f f e c t in pathological conditions as well as in normal volunteers, has not yet been f u l l y investigated. In an attempt to define the role of c o r t i c o s t e r o i d s on organ-T 4 concentrations, we studied the b i o d i s t r i b u t i o n o f 1251-thyroxine in mice a f t e r d i f f e r e n t time-dose applications o f Predniselone. In a group o f mice Prednisolone was administered i , p . in three doses of 2.5 mg during the 24 hrperiod o f time before 1251-T4 i n j e c t i o n , Another group o f animals received four doses o f 2.5 mg in the 3 hr-period o f time f o l l o w i n g 1251-T4 injection. Control animals received only i n j e c t ions o f saline. Results of the 3 hr b i o d i s t r i b u t i o n study o f 1251-T4 were the following: Prednisolone a d m i n i s t r a t i o n in three doses o f 2.5 mg during the 24 hr period preceding 1251-T4 i n j e c t ion, s i g n i f i c a n t l y increased l i v e r concentration o f r a d i o a c t i v i t y from 17.60±I.62% to 23.57+1,09% and i n t e s t i n e concentration from 13.44±0.99% to 18,53±1.37± (p < 0.05) whereas blood concentration was decreased from 20.68±1.08% to 14.70±1.61% (p < 0.05). Repeated doses o f Prednisolone from 2 min to 2 hr a f t e r the i n j e c t i o n of 1251-T4 s i g n i f i c a n t l y increased the concentration o f r a d i o a c t i v i t y in stomach from 1.86+0.26% to 3,36±0.37Z and i n i n t e s t i n e from 13.44±0.99% to 17.69±1.21% whereas blood concentration decreased from 20.68+1.08% to 14.5±1,11% (p<0,05). I t i s thus suggested that high doses of Prednisolone increase s i g n i f i c a n t l y the g a s t r o i n t e s t i n a l excret i o n o f 1251-T4, Lab. o f Radiopharmacology, N.R.C. Demokritos, 153 41 Aghia Paraskevi, A t t i k i and Nuclear Medicine Dept., U n i v e r s i t y o f Athens, Areteion Hospital, Athens, Greece.

We have attempted to determine the usefulness of Factor Analysis (FA) in conjunction with the Amplitude image (A) obtained during Phase analysis (PhA). Methods: 13 normals (NL) and 19 patients (pts) all with RI4MA documented by contrast angiography (CA) and 8/19 had in addition T1-2Ol, surgery or autopsy, The algorithm developed by Basin and DiPaola is Based on Barber's calculation of ohlique factors (F) and submitted to a positivity constraint which gives them physiologic significance. Only the ROI corresponding to ventricles was evaluated. A valid result (2,3, or 4F) was considered when no significant negative image was present, nor any zero amplitude type image (corresponding in effect to a Blood pool image). Results: 8/13 NL had 2F and 5/13 had 3F. In all 13 the ventricular F image was identical to the A image and the second F image corresponded to a flat curve and had a LV base "peninsula" or "crescent" and also identified the area of pulmonary outflow tract, In cases with 3F no further split of the ventricular F image was seen and no interpretable pattern emerged from the split of the second image. Abnormals: all but one had 3F. The ventrieular F image of the 2F display was similar to A in 9/19. Those were eases without dyskinesia. In all cases the combined 2F and 3F displays correlated with all or most of the RWMA sites. In 13/19 correlation was Better than phase analysis as far as number of locations and in 18/19 better as far as type of abnormality suggested. In no case was FA worse. This improvement was particularly striking for septal abnormalities and for small dyskinetic areas. FA also suggested abnormality ~n 2 pts where extensive hypokinesia was not detected at all By PhA. Conclusion: FA images used in conjunction with phase and A images improve significantly the detection of RWMA. University of Illinois Medical Center Section of Nuclear Medicine 1740 W. Taylor, Room 2500 Chicago, Illinois 60612, USA

A 295

A296

PERIPHERAL METABOLISM OF THYROID HORMONES IN PATIENTS WITH ALTERED THYROID STATES R. Bianchi, G. Mariani, N. Molea, A. Pllo, F. Cazzuola, L. Fusani, G. Iervasi, P. Bertelli, M.G. Toni and M. Ferdeghini

HYPERFUNCTIONING THYROID NODULE (HTN) ASSOCIATED TO LOW N0~MAL SERUM THYROID HORMONE (TN) CONCEN TRATIONS, A.Carpi, A.Nicolini, G.Iervasi, R. Bianchi

Peripheral metabolism of thyroxine (T4) and 3,5, 3'-triiodothyronine (T3) and the peripheral conversion ratio (CR) of T 4 to T 3 were determined in S hypothyroid patients (Hypos), 4 hyperthyroid {Hypers), 3 hyperthyroxinemic patients {HyperT4s , 2 familial, 1 amiodarone-induced), and in 13 control subjects with normal thyroid function. 1251T 4 and 131I-T 3 were injected iv as a single bolus, and plasma activities of ~251-T4, 131I-T3, and of 12SI-T3 newly formed in vivo from labeled T 4 were determined after chromatographic separation on Sephadex G-25. Common turnover and distribution parameters of T 4 and T 3 were determined by noncompartmental analysis, while the convolution method was used to calculate the CR of T 4 to T 3 . AS expected, Hypos had a significantly reduced metabolic clearance rate (NCR) of T 3 (P<0.O0J as compared with the normal controls), while Eypers had significantly raised MCR of both T 4 and T 3 (P<0.0I). HyperT4s showed a reduced MCR of T 4 (P<0.001] and nearly normal T 3 MCR. The T 4 to T 3 CR was markedly increased in Hypos (P<0.0Oll, and nearly norr~al in Hypers and in the 2 familial MyperT4s, while it was markedly suppressed in the amiodarone-induced EyperT 4 subjBct. These results indicate the occurrence in hypothyroidism of some adaptative mechanism(s), whereby the peripheral tissues metabolize T 4 by preferentially producing the more active hormone, T 3. By increasing the T 4 to T 3 CR, the small amounts of available T 4 are thus utilized in the most efficient way.

5th Medical Pathology of the University of Piss, and C.N.R. Institute of Clinical Physiology, Via Savi 8, 1-56100 Pisa, Italy

We report this association in two series of retrospectively analysed patients (pts). The first series consists of 28 clinically euthyroid pts showing at ]31I thyroid scan a HTN inhibiting at variable extent extranodular tissue function. Surgical excision of the nodule was performed in all these pts and postoperative histology showed a mierofollicular structure. Serum T 4 concentration was low normal in 5 of these pts (4.7 to 5.4 pg/dl) and quite normal in the remaining pt& T 3 resin uptake was normal in all the pts. The 2nd series consists of 73 clinically eutbyroid not operated pts with NTN at 1311 scan, examined by TSH stimulation, TH inhibition and TRN test& 16 of these pts had relatively ]ow serum TT and TT 3 levels (4.5ei.3 ~g/dl and 1.5+0.I ng/ml~. Six of these pts had serum TT levels lower than normal (2 to 3.7 ~g/dl) and T~. levels from 1,4 to 1.8 ng/ml. Ten years follow~up was performed in one of these pts; TT was constantly low or low normal for 8 years 43.4 to 5.5 Mg/dl) associated to normal TT levels (I.3 ng/ml) Recently 3 serum TT 4 and TT levels were 10 ~g/dl and 2.2 ng/ml respectively; no TSH response to TP~ was observed. The following hypotheses can explain these findings: a) a relative T 3 hypersecretion occurs early in the HTN and inhzbits T secretion by nhe extranodular tissue i 5) HT~ might grow in a hypofunctioning gland and TSH inhibition occurs when TH levels produced by the nodule became equal or higher than those extranodular tissue.

Nuclear Medicine Service, University of Pisa CNR Institute of Clinical Physiology, Via Savi, 8;56100 Pisa, Italy

A50 A297 DIFFERENT BIOKINETIC BEHAVIOUR IN M A L I G N A N T AND BENIGN TUMORS THYROID.

0F 2OITL OF THE

F.D.Maul,H.J.C.Wenisch,G.Bittner,U.Wanner,P.-M.Schumm,R,Standke,A.Emcke,G.S~r. Div. Nucl. N e d . , D e p a r t e m e n t s of Radiology, Surgery and Internal Medicine, Univ. Frankfurt, FRG, According to Palermo et al (Nucl. Med. 21,1982) the diagnostic key of 201T1tumorscintigraDhy(TLTS) is a d e c r e a s e d wash-out of nO±T1 in malignancies. It was our aim to classify malignant and benign tumors a c c o r d i n g to their biokinetie behaviour. In 35 consecutive pts. with s u s p i c i m o~la malignant tumor of the thyroid a 2 T1 s c i n t i g r a p h i e sequence up to 40 min were performed. Tn 13 pts,ths final h i s t o l o g i c a l diagnosis was performed. 4 p a p i l l a r y thyroid carcinomas were found, 2 with regional lymphatic spread. In 1 pt. with lymph node metastases of a m a l i g n a n t p h e o c h r o m o c y t o m a a normal thyroid correctly was d i a g n o s t e d before operation. In 2 pts. with PAP IV cytology, which was not proofed by histology TLTS was normal. Between 3o-40 min al kinds of thyroid tumors aRd metastasis reached a plateau in the 2U±T1 kinetic. The maximal uptake (UTmax) i~ relation to the ~0 min uptake was calculated. As further kinetic parameter peak invasion rate (PIR) and Tmax were defined. A malignant tumor is c h a r a c t e r i s e d by a lower UTma x as well as PIR. In m a l i g n a n t a n d benign lesions at least 2 different groups of v i t a l i t y (UTma x) can be d i f f e r e n t i a t e d . Benign tumors with normal (307=51) and increased vitality (686+_268%) and m a l i g n a n t tumors with n o r m a l (163~9) and d e c r e a s e d (106~96) vitality. In conclusion malignant und benign thyroid tumors can be d i f f e r e n t i a t e d and classified a c c o r d i n g to their 2OIT1biokinetic, Further i n v e s t i g a t i o n s must be u n t e r t a k e n to judge the p r o g n o s t i c value of the d e s c r i b e d tumor v i t a l i t y groups.

A298

A299

NORMAL VALUES OF THYROID VOLUME IN CHILDREN AND ADOLESCENTS

ULT~ASON0eRAPHY IN THE DIFFERENTIAL DIAmN0~I~ OF COLD NODULE~ nv TME TSY=QID. G.Sara~a, a.I. Pinedo, J. de HarD, I.Castejan, J qamos, m.0rt~z ~e~rot~l.

8.Leisner, G.Hutter, D.Knorr Thyroid mass estimates based on palpation and scintigraphy are misleading especially in young subjects. Therefore ultrasound methods became widely used f o r objective ~olume determination. Normal in vivo-values f o r subjects below age 18 are not yet available. Patients and methods: The thyroid volume of 185 euthyroid children (40-210 months) without palpable thyroid enlargement, but l i v i n g in the iodine deficiency area (WHO I I ) of Bavaria, was measured by sonography with a maximal e r r o r of 11%. Thyroid volume, age, sex, weight, height, basal TSH, T4/TBG-ratto were tested f o r c s r r e l a t i o n and analyzed by multiple regression, and prediction ranges (95%) were calculated. Results: Thyroid volumes were normally distributed only a f t e r transformation of the data (~ VoI). Girls had s l i g h t l y greater glands than boys in a l l age groups, even before puberty. As expected there was a correlation between thyroid volume and body weight (r=0,733), height (r=0,745), body surface (r=0,767) and age (r=0,634). The best prediction of the normal thyroid volume was given by the combination of the parameters age, sex, body weight and height. Nevertheless the combination of the parameters sex and height was only s l i g h t l y i n f e r i o r but has the great advantage that the relatioeship can easily be displayed in a two-dimensional diagram. For routine use nomograms of the upper l~mlt of thyroid volume based on these two parameters are presented. Conclusion: The data indicate that at least in a region of mild iodine deficiency the pediatric rule of thumb f o r thyroid mass evaluation ( i . e . t h y r o i d mass in grams : years of age) understimates the gland dimension, especiaJly in g i r l s above age 13. Radiol.Po]iklinik und P~diatrische Klin;k der Universit~t M~nchen Ziemssenstr. 1 D 8000 MOnchen 2 FRG

Nistolog{cal examlnation of cold sc~ntizraphic nodules of the thyroid is the definite diasnostic test for the differential diaKnosis of malignancies from non-malimnancies. Non-invas[ve tests, such as ultrasonoKraphy (US) have been used to provide a dla~nosJs before surgery. In this study we have attemoted to evaluate retrospectively the efficacy of I~ appearances as an approach to the assessment and management of cold nodules, lan patients with a scintigraphic diagnosis of cold nodules of the thyroid have been examined with fie. All the patients underwent surgery. We re-evaluated their data usin~ clinical records and U~ to compare them with the results of the histological diagnoses at surgery. There were 27 carcinomas (18%] and 121 benign lesions. The US appearances of the nodules were considered essentially for two parameters: the edge of the nodules and the appearances of the texture. The first parameter has not shown any relationship to the malignancy; in fact, of the carcinomas, 30% had a well defined edge, and of the benign lesions~ 47% had an undetectable edge. Multiolicity has not shown to be a criterion for non-maliznancy; in our serie, it had not significative differences between both eaarcinomas and benizn lesions (52% v.s. 3e%). Cystic changes were observed ~n any type of pathology, mainly in benign diseases, hut it was not a typical finding. ~imple cysts were never seen in carcinomas. Decreased echogenicity was commoner in carcinomas, but did not favour maliznancy. Increased or normal echcgenicity was never found in carcinomas. We concluded that: US alone can not be used for distinguishing malignancies from non-malignancies and the demonstration of a simple cyst by US excludes the possibility of maliKnancy; in fact, US alone was a useful but limited test for differential diagnosis. We believe that the use of clinical data, US and scintigraphy combined together is the most reliable way to screen a nodule of the thyroid. Cl~nlca Puerta de Hierro. Madrid. Spain.

A 300

A301

A302

THE F U N C T I O N I N G THYROID ADENOM~ - (FTA): S U R G E R Y A N D R A D I O M E T A B O L I C 131-I T H E R A P Y Ronga G . , T o d i n o V . , L i m a G . , E s p o s i t o M., Fragasso G.,Poti C,,Baschieri I.:Nuclear M e d . , 2 n d M e d . C l i n , , U n i v e r s i t y of Rome.

T c - g t m S C I N T I G R A P H Y IN THE L O C A L I S A T I O N OF HOT SPOTS OF THE T H Y R O I D GLAND FOR H I S T O L O G I C A L STUDY, h. Jarvi, M. Yorne

T H Y R O I D 99m-Tc UPTAKE M E A S U R E M E N T WITH PINHOLE P L A N A R N O N - U N I F O R M I T Y C O R R E C T I ON. S. Lonaaria, M. Samar~Jja, S. Popovi~, S. Te~ak, N. Krpan

F o r the t r e a t m e n t of FTA, the results and e o m p l i e a t i o n s of s u r g e r y and 13i-I t h e r a p y are compared. 998 patients suff e r i n g from FTA were observed from Jan. 1960 to M a y 1981: Of these, 88 were not treated, 170 had d r u g therapy, 163 surgery, 577 (all above age 35) 13l-I thera p y (dose 517,63 MBq!147.26). S u c c e s s f u l results d i f f e r e d significantly b e t w e e n above g r o u p s (Tritest p<0.05) Of the 163 surgery patients, only i30 returned f o r a f o l l o w - u p cheek. C o n s i d e r ing also d i f f e r e n t types of operation, 95 of these (73.0%) had recovered completely. Of the r a d i o i o d i n e patients, only 483 were f o l l o w e d - u p a n d 408(84.5%) were well again. The h i g h e r success rate of r a d i o m e t a b o l i c t h e r a p y is s t a t i s t i c a l ly vet7 significant ( t w o - t a i l e d t test p
A method was d e v e l o p e d for the localisation of hot spots of the thyroid gland for h i s t o l o g i c a l study. Goitre patients w i t h single or multiple small hot spots of the thyroid in OUtp~tient scintigrams and to be operated on were selected for the study. % mCi of T o - 9 9 p e r t e e h n e t a t e was given i n t r a v e n o u s l y f-2 hr preoperatively. P h o t o g r a p h s and a s c i n t i g r a m were taken of the t h y r e o i d e o t o m y specimen Io-2o man p o s t o p e r a t i v e l y to roughly localize the hot spots. The specimen or part of it was then sliced to 2-4 mm slices. P h o t o g r a p h s and scintigrams were taken of the slices. The hot spots were d i s s e c t e d for formalin fixation and further histological study. 63 hot spots from 32 c o n s e c u t i v e thyre o i d e c t o m i e s were examired histologically. M a t e r i a l from adjacent thyroid tissue was u s e d as c o n t r o l . 2-1o mm b e n i g n nodes were detected in which the size of the follicles and their topography were d i f f e r e n t f r o m and the epithelial cells lar~er than in the surrounding tissue. In control areas some very similar structures were detected. In repeated p r e o p e r a t i v e sointigrams of some patients hot spots were found in d i f f e r e n t locations On different o c c a sions.

It is c o n c l u d e d that the hot spots are functional h y p e r a c t i v e ~re~s. T h e i r h i s t o l o g i c a l s t r u c t u r e indicates sharply d e m a r c a t e d hyperactivity. Hyperactive spots occur at different IDeations at different times. H i s t o l o g i c a l study with immunohistologic~l methods is to be done, P ~ i j ~ t - H i m e Central Lahti, F i n l a n d

Hospital,

A m e t h o d for s i m u l t a n e o u s d e t e r m l n a t i o n of thyroid structure and f u n c t i o n that uses 99m-Tc pertechnetate, gamma camera and computer has been developed. Twenty m i n u t e s after intravenous i n j e c t i o n the s c i n t i g r a m is taken. Pinhole c o l l i m a t o r is p o s i t i o n e d at optimal distance over the p a t i e n t ' s neck which depends on the thyroid size. The u p t a k e is c a l c u l a t e d by means of F O R T R A N p r o g r a m that makes all n e c e s s a r y c o r r e c t i o n s for p i n h o l e non-uniformity, e x t r a t h y r o i d a l activity and decay. This p r o c e d u r e equalizes the w e i g h t of all m a t r i x elements w h a t is essential for correct "background" subtraction. The system response to a flood source is used f o r n o n - u n i f o r m i t y correction. The i n f l u e n c e of non-uniformity on the c a l c u l a t e d value was studied using computer s i m u l a t e d thyroid s c i n t i g r a m and scint~grams of the thyroid phantom. Data corrected for u n i f o r m i t y give r e s u l t that is in very good a g r e e m e n t w i t h true value, while n o n - c o r r e c t e d data give result that differs c o n s i d e r a b l y and depends on the thyroid volume. A n o t h e r p r o g r a m is used for system callibration: using p h a n t o m c a l l J b r a t i o n images it a u t o m a t i c a l l y g e n e r a t e s the third degree p o l y n o m i a l that d e s c r i b e s e f f i c i e n c y - t o - d i s t a n c e dependance. For the group of 40 e u t h y road patients we got normal range (defined by m e a n +- 2 s.d.) for 99m-Tcuptake from 0.3% to 3.7% and results show that it correlates better w i t h clinical d i a g n o s i s than 24h 131-J-uptake does. The d e v e l o p e d m e t h o d enables one to d e t e r m i n e total as w e l l as regional uptake. D e p a r t m e n t of Nuclear Medicine, KBC - Rebro, K i ~ p a t i d e v a 12, 41000 Zagreb, Y u g o s l a v i a

A51

A304

A 3O3 FT4 AND FT3 IN LATE PREGNANCY. Sommerfeld and H.W. Pabst

I.G. Bdttger, V.

FT4 AND FT3 IN POLYTRAUMA. gchneck** and E.W. Pabst*

A305 I.G. B~ttger*,

H.J.

Previous work from our clinic has demonstrated a very high clinical value of FT4 and FT3 as determined by radioligand assay (RLA) in various groups of patients. The purpose of this study was to study more carefully free thyroid hor~ motes in pregnancy, still a matter of controversy. Patients: this study includes a total of 157 sera of women during thei£ last trimenon of pregnancy, seen by our gynecologists. We had no evidence for thyroid disease. All women had determinations of f~ee estriol in regular intervals. Analytical methods: free estriol (bmersham RIA), FT4/T4 and FTS/T3 (Corning kinetic two-tube RLAI, FT4 (Corning and Amersham single-tube RIA with 1-125-T4 analogue), FT3 (Amersham single-tube RIb using 1-125-T3 analogue) and TBG ( C o m i n g NLA). T4/TBG and T3/TBG ratios were calculated. Results: free estriol was found to he in the respective normal range. FT4 levels were medium to low but decreased in 0 of 17 (week 27 ~ 31)/ I of 38 (week 32 - 36)/ 2 of 102 (week 37 - 41) and slightly increased in 0/0/2 of the sera (Coming two-tube P~LA), decreased in 0/3/3 (Coming single-tube RIA), furthermore in 6/12/ 26 and increased in 0/i/4 (A/nersham RIb) of the cases. This was contrasted by the T4/TBG ratio being decreased in 6/22/45 of the sofa. FT3 levels were low normal to decreased with 9 of 19/ ll of 41/ 17 of 93 (Coming) and 3/5/10 (~Jnersham). The T3/TBG ratio was with 15/40/90 of the cases decreased in most of the sera. Conclusions: in general, FT4 (medium to lower normal range) and FT3 (lower normal range to decreased) by all RLAS used demonstrated the behaviour anticipated for late pregnancy though FT4 levels by the Amersham RIA were decreased in 28 % of the sera which is most likely due to technical differences between the assays. On contrast, the T4/THG ratio was decreased in about half and the T3/TBG ratio in almost all of the se~a which probably exaggerates the physiological situation being present in late pregnancy.

Curing the last years we reported a very high clinical value of FT4 and FT3 as determined by radioligand assay (RLA). This study was designed to further validate these assays by investigating patients with severe non-thyroidal illnesses (NTII. Patients: 58 intensive-care patients with severe trauma were studied cross-sectionally and a total of 125 with polytrauma, 29 of whome did not survive, longitudinally on admission, in-between and prior to discharge or death. Analytical methods: FT4/T4 and FT3/T3 by kinetic P~A, TBG by RLA (Coming), Tgu (Abbott), TSH by DAB-RIA (Henning-Eerlin) and rT3 by RIA (Serene). FT4-/FT3-indices and T4-/Tg/TBG ratios were calculated Results: The cross-sectional study showed parameters for FT4 generally to be low normal to decreased and those for FT3 to be predominantly decreased in face of increased rT3. The longitudinal study revealed FT4 and T4/TBG as well as FT3 and T3/TBG to he in the lower normal range or decreased, mainly FT3, in both groups of patients. Basal TSH was in the lower normal range. Prior to discharge from intensivecare these parameters were significantly higher in the survivors (RT4 in the normal, TSH in the upper normal and FT3 partially in the normal range) as compared to the non-survivors. Conclusions: the clinical ~alue of FT4 and FT3 determination by RLA has been confirmed in the difficult-to-diagnose gronp of patients with severe NTI as judged from the similar performance of the indirect parameters. FT4, FT3 and basal TSH are generally rather low in severe NTI, together with the known partial inhibition of TRH-induced TEH secretion, resembling secondary hypothyroidism, most likely a secondary phenomenon to NTI. Persistence of low or decreased FT4 and FT3 and of low basal TSH may be taken as one of the indications reflecting bad prognosis in polytraum&.

Nuklearmedizinische Klinik und Poliklinik, nische Cniversitat M~nchen, Ismaningerstr. D-8000 Manchen 80, F. R. G.

* muklearmedizinische Klinik und Poliklinik, ** Institut f~r Anaesthesiologie, Technische Universitat Manchen, Ismaningerstr. 22, D-8000 M~nchen 80, F. R. G.

Tech22,

RADIONUCLIDE THYROID ANGIOGRAPHY - REVIEW OF A FIVE YEAR STUDY. A. Chacko, R. Moe~ S. Frankel and M. Clark Static thyroid scans are routinely used to evaluate thyroid nodules, Sodit~n pertechnetate or radioactive iodine studies are effective in demonstrating non-functioning nodules. They ho~ever, cannot differentiate benign from malignant disease. Twenty percent of all cold nodules are found to be carcinomas. Various other radionuclide studies have proved ineffective in improving on the specificity of static scans. Conventional contrast angiography of the thyroid has demonstrated that the vascularity of thyroid nodules correlates with their underlying pathology. A simpler, non-invasive procedure to delineate thyroid vascularity is Hadionuclide Angiography or Dynamic Thyroid Flow Studies. From August 1977 to the present, all patients requiring thyroid scans at this institution had both static and dynamic flow studies performed with s o d i ~ 99m perteehnetate. Of the 1,276 patients scanned, 142 later underwent surgery, In this paper, we have reviewed the scans and the definitive histopathologic diagnoses in this group of patients. The addition of evaluating the vascularity of the thyroid by dynamic flow studies in addition to the static scans increases the sensitivity in differentiating benign conditions from thyroid cancer. From our data, we have found that 65% of patients with cold nodules which were hypervascular proved to be malignant. Further, 96% of patients presenting with hypovascular cold nodules were benign. The addition of radionuclide thyroid angiography has in our experience provided to be a valuable tool in our diagnostic armamentarium in differ~ entiating between benign and malignant nodules in the thyroid. Nuclear Medicine Service, Tripler Army Medical Center, Tripler AMC, Hawaii 96859

A306

A307

A308

IN-VIVO IMAGING OF THE HUMAN THYROID WITH A HIDAC-POSITRON CAMERA USING l-ig4. P. Fray,

THYROID SCREENING DURING RADIONUCLIDE VENTRICULOGRAPHY WITH LABELED RBC. J.Spitz

Comparison of G a m m a I m a g i n g and U l t r a sonography in C h r o n i c A u t o i m m u n e Thyroiditis:the Superiority of U l t r a sonography. L.P~yh~nen and H.Oksa

D. Townsend,

A. Donath,

A. Jeavons

A high density avalanche chamber(HIDAE)positron camera has been used for tomographic imaging of

the human thyroid i n - v i v o .

Images are made 7

and 24 hours after oral adminlsfratzon of the positron emitting radionuclide 1-12~ with activities varying between 0.4 to 1.O mCi to patients scheduled for either partial thyroidectomy or radioiodine treatment. AS a consequence

of the high spatial resolution

o f the camera (2,5 mm FWHM) the functional volume of the thyroid may be estimated from 2mm thick transve£se tomogrsphio sections to w i t h i n

about 15N . This paper presents the technique of PEIfhyroid imaging performed on 26 patients. The results

obtained and t h e i r c l i n i c a l

relevance are d i s -

cussed. In particular the most promising application of this new technique offering real 5dimensional information is to estimate the resi dual thyroid volume following partial thyroidecfomy. For this purpose 0.i to 0.2 mCi of ligq is administered. In order to improve the radioiodine treatment of Graves' disease, the therapeutic dose of 1-131 is calculated according to the functional volume of the thyroid estimated from the 1-124 tomographic images. It is hoped to reduce the incidence of hypothyroidism from I-]51 treatment by adopting a scale relating the 1-131 dose to the measured lunatic nal volume. AS an illustration included.

3 typical patient eases are

Nuclear Medicine Divzsion, University Hospital of Geneva

i Z i l Geneva 4, Switzerland

As there e x i s t only few reports about the thyroid trapping of Tc-9gm during in vivo labeling of RBC we prospectively checked 200 routine heart studies. To calculate the Tc-99m uptake of the thyroid a gamma camera picture (15K matrix) of the neck was made 20 minutes p.i.. The labeling e f f i c i e n c y was estimated from a blood sample drawn 30 minutes p , i . . We found that the Tc-99m uptake of the thyroid in general is neglectable small. There i s no c o r r e l a t i o n between thyroidal uptake and I abeling e f f i c i e n c y of RBC. But the visual i n t e r p r e r a t i o n of the camera pictures allows a separat i o n i n t o three groups: I . no special a c t i v i t y w i t h i n the gland I ] . moderate uptake in the gland,corresponding to the i n t e n s i t y of the great vessels , I I I . i n t e n s i v e regional or d i f f u s e uptake in the gland. Group I and I I dominate (85%) and have no c l i n i c a l relevance. The findings of the t h i r d group (n=30) are highly s i g n i f i c a n t f o r thyroid disease : even though only half of the patients with atypical uptake in the gland could be followed up, I0 of them proved to have thyroid disease : 2 cases of hyperthyroidism and 8 cases of autonomous adenoma of the thyroid gland. So the thyroid screening during RNV was able to show in 5% of all patients signs of thyroid disease which was unknown at that time. As thousands of RNV's are done a l l over the world each day, the screening of Tc-ggm uptake in the thyroid seems to be a simple and usefull method to detect unknown thyroid disease without additional costs. I n s t i t u t f u r Nuklearmedizin St~dt.Klinikum Wiesbaden, t . - E r g a r d - S t r . D6200 Wiesbaden, Germany

I00

The material consists of 60 c a s e s of chronic autoimmune thyroiditis diagnosed by thyreoglobulin and thyroidal microsomal antibodies and t h i n n e e d l e b i o p s y , T h e m o s t u s u a l f i n d i n g in the g a m m a imaging was enlarged lobes with hypo/ hyperactive a r e a s or o n l y n o r m o / h y p e r active nodules,Every third thyroid showed one cold nodule only. Two times t h e r e w a s no u p t a k e , o n e time a diffuse goitre. The ultrasonography s h o w e d in g0 % a very typical finding consisting of e n larged very echopoor lobes whose poster i o r s u r f a c e s w e r e u n e v e n d u e to s o m e nodularity,The finding was usually most prominent in t h e i n f e r i o r p o l e s of the l o b e s . In f o u r p a t i e n t s this echopoor finding was erroneously diagnosed as a cystic degeneration of t h e n o d u l a r g o i t r e . In t w o o t h e r p a t i e n t s a cyst was diagnosed i n s t e a d of the c h r o n i c t h y r o i d i t i s . In t w o p a t i e n t s the ultrasonographic finding was estimated for chronic thyroiditis when thin needle biopsy showed a subacute thyroiditis, As well k n o w n , t h e g a m m a i m a g i n g is v e r y undiagnostic in t h e c h r o n i c a u t o i m m u n e t h y r o i d i t i s . Its f i n d i n g is u s u a l l y that of the d e g e n e r a t i v e nodular goitre. I n s t e a d of t h a t , t h e u l t r a s a n o g r a p h y can usually s h o w a v e r y t y p i c a l f i n d i n g of a chronic autoimmune thyroiditis,ln s o m e c a s e s of v e r y c i r c u m s c r i b e d forms the u ] t r a s o n o g r a p h i c picture can give suspicion of a m a l i g n a n c y . University Central Tampere 52,Finland

Hospital,33520

A52 A 309

A310

A311

SEQUENTIAL MEASUREMENTS OF THYROGLOBULIN (TO) IN PATIENTS WITH SUBACUTE THYR01DITIS(SAT).Q.Madeddu A.R.Casu,C.Costanza,M.L.Arras,M.Piga,O.Ma~ras, M.Langer.

P~ECLINICAL HYPOIHYROIDISK IN PATIENTS

PROCOLLAGEN-III-PEPTIDE IN THYROID DISORDERS. J.Th.Locher, M.Oberleitner

In order to evaluate if TG can be a useful parameter in diagnosing and monitoring SAT,serum TG levels were determined by RIA,(normal range 15-50 ng/ml)in 40 patients with SAT in the early stage and in 55 controls. They were found above the normal range in 92% of the patients and the mean value was significantly higber(262~iE5.4) than in the controls(34±lO.4)independent of the apparent diffusion of the disease and thyroid hormone concentrations.In 27 patients controlled after 2 months of corticosteroid treatment TG levels were significantly lower(El.izS.2)than in the acute phase(220~lS7.F~O.OOl)but still above control values(P~O,OOl),although their ti~yroid function parameters had ~everted to normal.ln 14 of these patients TG was also determined sequentially for 3-Amonths. Twelve of them showed an identical trend:the high initial values(302~213) dropped rapidly t o normal levels(43121.elP~O.O01) which were maintained for about 20days .Then they rose ~radually~peaked(£8,2iS.6;P
WITH 6 THALNSSAEMIN MAJOR. De S a n c t l s Cavalllnl

V.,

B.,

Bagni

A.R,,

gullo

8 a n n e ~ t l C.~

- Divislone

C,

Pediatrlca-Arcispedale

S.Anna-Ferrara

Thyroid

in

gland

function

thalasseemla

major has been reported as ranging From n ~ r m a l , to d e c r e a s e d r e s e r v e ( n o r m a l FT # and i n c r e a s e d TSH), to p r l m a r y hyp~ thyr~idlsm, cy

of

the

lhe

tbme o f

preclinlcal

o n s e t and f r e q u e n

hypothyroidism

( n o r m a l b a s a l T# and FTD, normal or e l e v a t e d TSH l e v e l s and enhanced r e s p o n s e to TRH a d m i n i s t r a t i o n i n the absence f clinical m a n i f e s t a t i o n s of h y p o t h y r o i dism) i n t h a l a s s a e m l c p a t l e n t s are n o t known.

To a s s e s s ,

the

p r e v a l e n c e of

preclinleal transfuslon tients wltN

hypothyroidism, 4A randomly dependent t h a l a s s a e m l c panormal serum l e v e l s of F]4 and TSH were e v a l u a t e d . All N a t i e n t s were i n r e g u a l e iron c h e l a t i n g theragy w i t h d e s f e r i o x a m l n e m e s y l a t e by s u b c u t a neous i n £ u s i o n , In t h e s e p a t l e n t s FT3,

7BG,rI3,IG

in

basal

~onditions

and TSH

a £ t e r TNH i n j e c t i o n were measured by RId. P r e c l i n l c a l h y p o t h y r o h d ~ s m ~as pre~ sent

in

7-18

years).

13 (30%)

thyroidlsm Iron

of the p a t l e n t s ( r a n g e F a c t o r s which cause hype-

in

t h a l a s s a e m i a are

deposition

results strate t h a t

The

Raised prczcilagen-111 serum levels has been seen in d i f f e r e n t pathophysiologic conditions, espec i a l l y in l i v e r diseases (chronic active hepatit i s , f i b r o s i s , c i r r h o s i s ) . The molecule i s f o r med in f i b r o b l a s t s as a b i o s y n t h e t i c precursor o f collagen. Therefore the N- terminal propeptide measured in the blood by a new RIA- t e s t could be considered as an i n d i c a t o r f o r the collagen synthesis, because i t is released into the c i r c u l a t i o n in equimolar proportion to the collagen type I I I production. We studied the influence of thyroxin on t h i s process supposing that procollagen I I I formation could be i n d i c a t i v e f o r the peripheric physiologic action of the t h y r o i d hormones. In a l l cases of active hyperthyroidism, independently of i t s e t i o l o g y , we observed s i g n i f i c a n t l y raised serum levels of prccollagen I I I , whereas normal values were found in euthyroid or hypothyroid patients and in cases of thyroid carcinoma. During subs t i t u t i o n therapy with thyroxin the values r a i sed in case of overdosage. Thus t h i s easely performed t e s t o f f e r s some c l i n i c a l advantages in problematic cases when other parameters of thyr o i d function are inconclusive or altered by some reasons (e.g. f a l s e p o s i t i v e TSH- suppression a f t e r radioiodine therapy or in elder patients.

might

play

unknown,

Department of Nuclear Medicine, Kantonsspital, CH- 5001Aarau, Switzerland

a role.

0f the present study demonTG d e t e r m l n a t l o n and TRH

t e s t m i g h t be of v a l u e i n d e t e c t i n g m l n i mal t h y r o i d f a i l u r e i n s u b j e c t s who have TA,FT4 and TS8 c o n c e n t r a t i o n s i n t h e no D mal r a n g e . Long term £ o l l o w - u p w i l l r e v e a l the p r o g n o s t i c s i g ~ i f i c a n c e o8 t h e f l n d l n g of a d l m l n l s h e d t h y r o l d r e s e r v e i n thalas-

saemlc

patients.

A312

A313

A314

QUANTITATIVE BONE IMAGING IN PATIENTS WITH HYPERPARATHYROIDISM (HPT),

COMPARISON BETWEEN 99mTc/201TL-SCINTIG R A P H Y AND 5 M H Z - S O N O G R A 2 H Y OF P A R A T H Y R O I D GLANDS. H.W.Mfiller, H.-P. Kruse, V . S c h u m p e l i c k , R.Montz, C. Schneider

ANALYSIS OF DIGESTIVE ABSORPTION OF CALCIUM IN 50 PATIENTS WITH CHRONIC RENAL FAILURE. H.YTHIEH *,M.BEVEAUX*,D.PAGNIEZ **, J.RGUSSEAU *,A.TACQUET **,X.MARCHANDISE*.

25 p a t i e n t s with p r i m a r y h y p e r p a r a t h y r o i d i s m h a v e b e e n e x a m i u e d by a c i n t i g r a p h y and s o n o g r a p h y . The l o c a l i z a t i o n of p a r a t h y r o i d a d e n o m a s or h y p e r p l a sias by s c i n t i ~ r a p h y ( G . F e r l i n st el. 1983i A . E . Y o u n ~ et a1.1983) was right p o s i t i v e in 18 cases (64%), twice (7%) r i g h t n e g a t i v e , four times (14%) q u e s t i o n a b l y right, three times (11%) false p o s i t i v e and once (4%) f a l s e negative; all false r e s u l t s (n=4) o c c u r e d in m u l t i n o d u l a r goiter; three of the f o u r q u e s t i o u a b l y right r e s u l t s w e r e chief cell h y p e r p l a s i a s w i t h c o r r e c t v i s u a l i z a t i o n of the l a r g e s t gland. The s o n o g r a p h i e a l l o c a l i z a t i o n of e x t r a t h y r o l d a l p a r a t h y r o i d s was right p o s i t i v e in 65%, right n e g a t i v e in 22%, q u e s t i o n a b l y right in 5% a n d false n e g a t i v e in 18%; s c i u t i g r a p h y was in three cases s u p e r i o r to soncgraphy, n e v e r s o n 0 g r a p h y was s u p e r i o r to s c i n t i g r a p h y .

After having checked in patients with chronic renal failure the identity of the evolution of blood levels of Calcium and Strontium during the six hours following an intraveinous injection, we use a double isotope (47Ca per as, 85Sr intraveinously) inverse convolution method to determine, both quickly and precisely, the absorption of calcium - expressed as the percentage of ingested calcium absorbed per hour - plotted against time. Beside the diminution of the global calcium absorption frequently occuring in patients with chronic r e n a l failure, our method individalized several profiles of absorption curve, suggesting various pathophysiological explanations. Some curves had a normal shape with a decreased peak, others have an apparently bimodal shape, suggesting the diminution of the proximal vitamin D dependant absorption, more or less compensated by an increase of the distal absorption. To further characterize these curves, we studied various parameters, among which the mean transit time of calcium through the intestinal wall, and its standard deviation, the time and value of peak absorption, and the percentages of absorption at various times, Furthermore, in case of a bimodal curve, a modelization made it possible to individualize the proximal and distal absorption. These parameters were studied by a statistical analysis method in 50 patients with chronic renal failure, compared to a control population, Our results state the relative interest of these parameters, as regards their informative and discriminating value.

D. Brecht-KrauD. E. Henze, D. Zenkner, W.E. Adam The determination of parathormone in plasma, X-ray and other laboratory tests are often of Hmited value in diagnosing HPT. In particular with secondary HPT, the most reliable examination for this purpose is bane biopsy. But even the histological examination of bone specimen might be insufficient in individual cases, too. It was the aim of this prospective study to deterrnine quantitatively the expected increased bone metabolism and perfusion in HPT. In order to minimize the influence of kidney function bone up take was quantitafed only 6 hrs after i.v. of 0.3 mCi/ kg Te ?gin MDP in 25 normals (age 17-73 yrs) and in 15 patients (age 44-70 yrs) with histologically proven HPT. Individual ROI's were assigned to the right and left femur cesulting in c count density index: diaphysis/soFt tissue (D/S). In normals, this D/S index averaged 3.66 + 0.94 and was significantly (p<0.001) different to that of HPT patients averaging 6.37 * 1.64. This latter value is somewhat greater than reported in previous studies, which could be explained by the more accurate assignment of ROI's and the 6 hrs delayed aquisition in this study. No correlation between the serum parathormone levels and D/S index was found. Thus, quantitative bone imaging may contribute substantially and with a high specificity in diagnosing HPT, especially in cases of controversial results of standard diagnostic tests. Nuclear Medicine Division, University of Uim, D-7900 Ulm, Germany

The 9 9 m T c / 2 0 q - s c i n t l g r a p h y is a q u a l i fied m e t h o d to l o c a l i z e paratlkyroid a d e n o m a s . A p p l i c a t i o n is n e c e s s a r y if a s o n o g r a p h i c a l r e s u l t is a b s e n t or d o u b t f u l and it is useful to c o n f i r m a p o s i t i v e s o u o g r a p h i c a l result. Universitits-Eramkeuhaus Abteilung Nuklearmedizin M a r t i n i s t r . 52 D - 2 0 0 0 H a m b u r g 20 West-Germany

Eppendorf (Radiologie)

* Service Associ@ de MAdecine Nucldaire, Place de Verdun, CHU,59037 LilleCodex, FRANCE. ** Service de Md=deeine GdnArale et NAphrologie A, Hopital Calmette ,LBle, FRANCE.

A53 A317

A315

A316

INTESTINAL CALCIUM ABSORPTION IN HAEMO- D I A L Y S I S PATIENTS : A SPECIFIC METHOD FOR DIAGNOSTIC WITH SINGLE 47CA ISOTOPE G. MAUREL, 3. FONROGET, P. MORINIERE and A. FOURNIER

CUSHING'S SYNDROMEDUE TO BILATERAL NODULAR HYPERPLASIA: ROLE OF ADRENAL SCINTIGRAPHY. C.Macri, F.Bui, M.Boscaro, M.Vigo, F.Mantero

An o r i g i n a l method for measuring calcium absor p t i o n during d i a l y s i s run i s proposed, and preliminary results are presented. Material used consists in a large volume holethrough Nal (TI) crystal holding a bulb on the extracorporeal blood circult with two opposite photomultipliers, a dual channels analyzer, a eoicidenee module and a microcomputer for data storage and calculation. Blood radioactivity is continuously counted throughout the dialysis run. At first, 37 kBq of 47Ca are injected ~nto the venous line and 2.5 hours later an oral dose of 300 kBq of 47Ca is given. Resolving an integral equation from the counting data we obtain the spectrum of transit time of Ca from gut lumen to plasma. The effects of compartments' voJumie variations and of maesurement uncertainties are take into account. This curve allow to calculate the fraction of the ingested caIeium absorbed during 3 hours, the time of maximal absorption and the mean transit time. Using this method, Ca absorption was found between 7 and 16 % in 8 patients receiving no vitamin D supplements, at 38-4~% i n 2 of these patients after g months of administration of 1,25 (OH)2 D3. I n conclusion, t h i s simple and accurate method causes no supplementary discomfort nor time consumption neither blood losses f o r the p a t i e n t s . Moreover the radiation dose is io~er than the classical method's ones. Hence this test can be repeated and is partieulary well adapted to follow the efficiency of vitamin D metabolites therapy for renal osteodystrophy. Department of Medical Physics, Universite de Picardie, U.E.R, de Medeeine, 80000 AMIENS FRANCE, Department of Nephralogy HSpital Nord 80000 AMIENS. FRANCE.

Together w i t h the classical forms of Cushing's syndrome (CS) due to b i l a t e r a l adrenal hyperplasia and to adrenocortical tumors, mixed forms w i t h one or more adrenal nodules (~ 2.5 cm) associated w i t h b i l a t e r a l adrenocortical hyperplasia have also been reported. Unfortun a t e l y , usual hormonal tests are o f d i f f i c u l t i n t e r p r e t a t i o n in these cases and therefore i t becomes of primary importance the use of adrenal morphologic procedures ( s c i n t i g r a p h y , CT, e t c ) . 4 out of the 80 cases of CS t h a t we have studied were of t h i s kind. In 3 of them laboratory data were t y p i c a l of ACTH-dependant CS; i n the 4th case they were suggestive of presence of cortical secreting adrenal adenoma. In a l l

cases adrenal 75-Se-norcholestero1 scintigraphy (AS) visualized both glands, but with strong prevalence of radiocholestero] uptake in one gland compared with the other. In all cases CT demonstrated presence of a large nodule in the gland which had the highest concentration of radiocholesteroi. In one case CT showed a small adenoma in the controlateral gland as well. The diagnosis of adrenal adenoma with bilateral hyperplasia was confirmed by surgery. In conclusion, in cases with CS presenting confuse laboratory data, i t becomes important to complement the morphologic information of CT with the functional information of AS. In fact, a bilateral asymmetric concentration of radiocholesterol may suggest the presence of bilateral hyperplasia with adenoma, which should be confirmed by CT. On the other hand, the finding of an adrenal adenoma through CT has to be followed by AS in order to evaluate the function of the controlaferal gland.

TB]~ ROLE OF S C I N T I G R A P H Y IN T H E DIA G N O S I S OF TH~ A D R E N A L CORTEX A N D i~ DULLA DISEASES W,Grablun,W.Jakubowski,T.Feltynowski S c i n t i g r a p h i c e x a m i n a t l o n s were made in 89 p a t i e n t s with v a r i o u s diseases of the adrenal cortex a n d the r n e d u l l ~ . ~ i s group of p a t i e n t s i n c l u d e d 25 s c i n t i g r a p h i c e x a m i n a t i o n s in p a t i e n t s with the C u s h i n g syndreme,79 e x a m l n a t l o n s in 60 p a t i e n t s with the p r i m a r y a l d o s t e r o n i s / 60 standard e x a m i n a t i o n s and 19 after dsxamethasorn s u p p r e s l o ~ a n d 6 in p h e o c h r o c y t o ma. In cases of the c o r t e x adrenal d l s e a ses 1 - 1 3 1 - 1 9 - 1 o d o c h o l e s t e r o l and S c l n t a dren w e r e u s e d a n d in pheochrocytorna 1-131-metaiodobenzylguanldyna. I n ~ 6 p a t i e n t s an operation was p e r f o r m e d ! 20 with prlrnary ~Idosterondsrn,10 with C u s h i n g s y n d r o m e , 6 with pheoohromo-

oytorna/. In all 6 pheoohrornocytoma oases the oper a t i o n c o n f i r m e d the s o l n t l g r a p h l o re mults, ln 50 p a t i e n t s w l ~ t h e c o r t e x adrenal diseases the o p e r a t i o n s c o n f i r m e d the sclntigraphlc r e s u l t s in 25 cases

/ 83,4 S / .

D e p a r t m e n t of N u c l e a r M e d i ¢ i n e , M e d l c a l A c a d e m y , 0 2 - 0 9 7 W a r s a w , u l . B a n a c h a IA, and H y p e r t e n s i o n a n d A n g i o l o g y Clinic, Medical Academy,Warsaw ul,Mowogrodzka 2 t

P~land

Ist. di Semeiotica Medico, Nuclear Medicine Service, University of Padua, Italy

A318

319

A 320

E X P E R I M E N T A L S T U D Y ON T H E No+AND K + DEPENDENT CONFORMATIONAL EQUILI BRIUM OF A D R E N A L I N E USING NMR S P E C T R O S C O P Y . ~ ' . R o d r i g u e z Farr~s O. Bu[bena~ @ M. E l lenberger`, V. Cohen

SO~TOMEDIN C ( SM ) AND GROWTH HOPJ~ONE ( GH ) IN A C R O M E G A L Y AND GROWTH HORMONE DEFICIENCY. S-L. K a r o n e n and R. P e l k o n e n

SERUM HPL, TOTAL ESTRIOL, AND FREE ESTRIOL iN PREGNANT WOMEN WITH GESTOSIS. G. Crass and D. Glaubitt

A d r e l q a l i n e is a f l e x i b l e molecule that occurs in aqueous s o l u t i o n as a roixture of d i f f e r e n t confor`mePs, w h i c h geometry and r e l a t i v e population are dependent or1 the NO+or K ' p r e s e n c e . The c h a r a c t e r i z a t i o n of these features is of i n t e r e s t , since the inter'action of adr'enaline w i t h its s p e c i f i c r e c e p t o r s is h i g h l y ster'eose÷ l e c t i v e and No÷or K c o n c e n t r a t i o n s change d u Ping the membrane d e p o l a r i z a t i o n . A d r e n a l i n e conformations, in presence of No+or K÷ions wer`e determined by T 1 r e l a x a t i o n time measurements p e r f o r m e d at 30£0 in a 250 MHz NMR s p e c t r o m e t e r and analysed w i t h the D E S C A R T E S p r o g r a m . Oonformational energy maps and those of the r e ] a t i v e d e v i a t i o n about the mean value of the c o r r e l a t i o n time ape c o m p l e mentary and lead to the proposal of f o u r c o n f o r m a t i o n s in presence of K÷;two extended and two folded. In presence of Na+there is only one conformation h a l f - f o l d e d . These r e s u l t s point out that the conforrnationa{ equilibr`ium of a d r e n a l i n e is per`turhed in the presence of either No÷or K+ions. S i n c e a d r e n a line r e g u l a t e s the ion f l o w t h r o u g h the sodium c h a n n e l s , a c t i v a t e d by b i o g e n i c amines, its action t h r o u g h the change in No+and K+cor~cen t r a t i o n might induce a s h i f t to adrenaNne cornformation states w i t h d i f f e r e n t a f f i n i t i e s for the adremergJc r e c e p t o r , The m u l t i p l e c o n f o r mation model may account f o r many o b s e r v e d phenomena in conexion w i t h a d r e n a l i n e effects. • D@partemen£ de B i o l o g i e , CEN, S a c l a y . France and Unidad de Medicina E x p e r i m e n t a l C. S. 1. C. Ba rcelona-34. Spain

We have m e a s u r e d serum s o m a t o m e d i n (SM) and growth hormone (GH) levels w i t h a new m e t h o d in patients with active acrornegaly and GH-deficiency. Since SM is b o u n d to carrier proteins p r e - e x t r a t ion of SM before the r a d i o i m m u n o a s s a y (RIA) is necessary. In the previous m e t h o d s both acetic acid release of SM and g e l f i l t r a t i o n have b e e n used b e f o r e c o m p e t i t i v e p r o t e i n - b i n d i n g assay or RIA. In the p r e s e n t m e t h o d h e p a r i n was used to liberate SM from the complex in the RIA. A n t i b o d i e s were r a i s e d against a synthetic peptide chain w h i c h is a part of human SM m o l e c u l e and the same peptide was used as a standard (calibrated against human native somatornedin C ). S e p a r a t i o n was carried out w i t h double antibody precipitation. I n t r a - a s s a y v a r i a t i o n was 4 % and i n t e r - a s s a y variation was 8 % in RIA, w i t h p r e - e x t r a c t ion step above i0 %. F a s t i n g s e r u m level in 16 h e a l t h y adults was 15-33nmol/l(24±4nn~i/l ,mean~SD). All 7 patients w i t h active acrornegaly (serum fasting GH-level ii-48 ~g/l) had also e l e v a t e d seru/n SM-level ( 46-72 nrnol/l). In contrast 3 of 4 patients w i t h GHd e f i e c i e n c y ( s t i m u l a t e d G H - v a l u e less than I pc/l) had normal aM-level ( 2325 nrnol/l) and only one low value ( 8 nmol/l). S e r u m SM level seems to be a reliable indicator of i n c r e a s e d p r o d u c t i o n of GH. In h y p o p i t u i t a r i s m on the other hand serLt~ a M - l e v e l may be normal in spite of GH-defieiency. SM kit was p r o d u c e d by Sorin, Italy.

by INC,

USA,

GH kit

Dept of Clinical C h e m i s t r y and III Dept of Medicine, U n i v e r s i t y of Helsinki, Helsinki.

Monitoring of serum HPL (human placenta lactogen)and total estr]ol has become a common procedure in women with risk of pregnancy. We compared the serum level of HPL as well as of total and free estrlol under consideration of obstetrical findings. Among 1141 pregnant women aged 15 to 44 years who were treated within a period of time from 9 to 42 weeks of pregnancy, 181 had EPH gestosis and 53 monosymptomatlc gestosis° Daily or with longer intervals, a blood sample was drawn for radioirnmunoassay of serum HPL, total estrlol, and free estrlol. The serum concentration of these hormones was monitored in 176 women up to 17 weeks during gestation. Serum HPL was lowered in 11 gestotic women, total estriol in 30, and free esh'iol in 66 gestotic women. A concomitant reduction of HPL and total estrio[ was noted in ] woman, of HPL and total estrlol in nonebut of total estrlol and free estriol in 18 women whereas all 3 hormones had declined in 4 women. Serum HPL was raised in 11 gestotic patien~ but total and free estrlol in only 5 each, in the latter group being 2 women who delivered gemlni. In 3 women, however, serum HPL was elevated with total and free estriol being normal or reduced. The simultaneous determination of HPL, total estriol, and free estriol in the serum of pregnant women with gestosis considerably substantiated diagno~tlc information and was of greater significance for early recognition of complications of pregnancy than was the measurement of only one of these hormones. In conclusion, risks of gestation may be early diagnosed and cIosely watched as follow-up using radloimmunoassay of serum HPL, total estHol, and free estrlol concomltantly so that treatment can be initiated rapidly. Department of Gynaecology and ObstestHcs, St.-Josefs-Hospital Uerdlngen, and Department of Nuclear Medicine, Academic Teaching Haspltal, D-4150 Krofeld, Federal Republic of Germany

A54

A323

A321

A 322

T H E V A L U E OF H Y S T E R O S A L P I N G O S C I N T I G R A P H~ IN T H E FI~AALE'S I N F E R T I L I T Y . T . P o p , BoMarinescu, M.Nisulesou, Doini~a Dumit r a c h e and E . P e t o u

tIc-LABELLED AMINO ACIDS AND PEPTIDES B. L&ngstrbm, G. Antoni, G. Bergson, C. Halldin, S.-B. Jigerius, K. N~gren, P. Malmhorg, U. R a g n a r s s o n and H. Sv~rd

The u t e r o - t u b a l p a t h o l o g ~ is one of the most f r e q u e n t reasons of f e m a l e ' s in f e r t i l i t N . T h e methods of u t e r o - t u b a l pstensy i n v e s t i g a t i o n a~e b a s e d sn r e lax of u t e r a - t u b a l tract h a v i n g am inv a s i v e and nonp.~/siolsgicsl c h a r a c t e r g i v i n g way to a more p r e c i s e method, predominant physiologically - hysterosalpingoscintigrap}~. To the 63 p a t i e n t s w i t h i n f e r t i l i t y w e made, in a d ~ i t l o n %o the k n o w n i n v e s t i g a t i o n s , this t e c h n i q u e that consist in: p o s i t i o n i n g of the p a t i e n t in the T r e d e l e n b u r g p o s i t i o n , e x p o s l n g of c e r v i x and p o s t e r i o r f o r n i x w i t h a v a g i n a l s p e c u l u m and a d m i n i s t r a t i o n of 2 m O i T o - 9 9 m h u m a n a l b u m i n m i c r o s p h e r e s in a v o l u m e of less t h a n 1 ml. T h e p a t i e n t kept this p o s i t i o n fo~ the next 3 hours and t h e n w e r e c o r d e d the three-ho~tr and p o s s i b l y the 2 4 - h e a r s image u s i n g a s c i n t i l l a t i s n oamme~a c o n n e c t e d to a h i g h capacity c o m p u t e r S c i n t r o n 5, that h a v e the p o s s i b i l i t y to r e c o r d the i m a ges on P o l a r o i d ( b l a c k and w h i t e , c o l o r ) or x - r a y film. T h e h ~ s t e r o s s l p i n g o s c i n t i g r m p h y is a simple, n o n i n v s s i v e c o n f e r r a b l e method, b e i n g able to be done w i t h o u t h o s p i t a l i s a t i o n , o b t a i n i n g f u n c t i o n a l l y images ve~ u s e f u l l i n order to e v a l u a t e the female r e p r o d u c t i v e s y s t e m p a t h w a y s .

The w o r k p r e s e n t e d has dealt with the development of rapid synthesis of 11Clabelled aromatic and a l i p h a t i c amino acids for studies of protein syntheses and n e u r o t r a n s m i s s i o n in human using PET. Furthermore the synthesis of some small 11C-labelled peptides opens new ways of studying their in vivo d i s t r i b u t i o n due to the high specific r a d i o a c t i v i t y which can be o b t a i n e d w i t h 11C. The syntheses of aromatic and aliphatic amino acids and n e u r o p e p t i d e s are carried out from a c c e l e r a t o r - p r o d u c e d 11C-carbon dioxide or other s y n t h e s i z e d ]1C-labelled precursors like ]1C-labelled alkyl halides and aldehydes, using organic or e n z y m a t ic synthetic methods. So far the amino acids 11C-L or D methionine, 11C-D/L-selenomethionine, [3-11Clalanine, [2- or 3-11c]phenylala nine, [3-11C]tyrosine, [3-11C]DOPA, [2-11C]phenylglycine, [3-11C]serine, have been p r e p a r e d in good r a d i o c h e m i c a l yields w i t h i n 25-60 min. The synthesis of 1 1 C - m e t e n k e p h a l i n e and some of its m e t a b o l i t e s and a few d e r i v a t i v e s have been carried out in 40-60 % radiochemical yields w i t h i n 40 min. The further development of synthetic methods and synthetic techniques opens f a s c i n a t i n g p e r s p e c t i v e s for the use of PET as a tool for in vivo studies of humans and animals.

O l i n i o H o s p i t a l Panduri 7 6 2 3 1 S o s . P a n d ~ r i 20, B u c h a r e s t R O M A NIA

Department of Organic Chemistry, U n i v e r s i t y of Uppsala, Box 531, S-751 21 Uppsala, Sweden

Karolinska Pharmacy, Box 60024, S-I04 01

A324

A325

A326

tIc-LABELLING OF A T R I P H E N Y L E T H Y L E N E DERIVATIVE WITH POTENTIAL ANTIOESTROOENIC ACTIVITY. M.Haaparanta, R. Paul, D. Roeda~ H. Sipili, O. Solin, K. N&gren, S. L&ngstrbm.

RADIOCHEMICAL PURITY TESTING OF IODINATED N-ISOPROPYL-P-IODOA~HET/~Ik~. J. Hiltu/len and H. gorpela

PURE 1231Mr, SHOWING HIG~ BRAIN UPTAKE, BY ~ A N S OF PREPARATIVE HPLC. * , * ** J.Mertens , W. Vanrilckeghem , A.Bossuyt ,

The purpose of this work was to find a suitable method for testing the radiochemieal purity in routine quality control.

R. Verbruggen .

The new synthetic t r i p h e n y l e t h y l e n e derivative Fc1157a ( t r a n s - ( 1 - p - ~ - d i m e t h y ~ aminoethoxyphenyl) 1,2-diphenyl-4chloro-but-l-ene) has been assumed to possess therapeutic properties in the treatment of breast cancer. Fc1157a was labelled with the short ~ v e d positron emitting radioisotope C(T~/p=20,3 min) for in rive tissue distrlb~tien studies. The N-alkylation reaction with (1]C)methyl i ~ i n e was used as a labelling method. C was p r o d u c ~ at th91Abo Akademi cye¼~tron by the N(p,~) C reaction as CO 2 which was converted to ( C ) ~ e t h y l iodine i91the usual way via ( C)-methanol. { C ) - F c I I 5 7 a has been synthesized from ~ e c o r r e s p o n d i n g N - d e s m e t h y l - F c 1 1 5 7 a . ( "C)-methyl iodine was trapped into the solution of Nd e s m e t h y l - F e 1 1 5 7 a - c i t r a t e and 3 4t e t r a m e t h y l p i p e r i d i n ~ in DMF at'-40°C. After heating at 120 C for 5 min pure labelled product was obtained after s e m i p r e p a r a t i v e - H P L C . Current productions result in a radiochemical yield of about 20% in a synthesis time of 60 min from EOB. Preliminary animal experiments were made with DMBA-induced tumour rats. Tissue dis%{ibution and specific activity of the r C-labelled compound Fc1157a will be described. Turku Medical Cyclotron Project, P o r t h a n i n k a t u 3-5, SF-2O500 Turku 50, Finland

N-isopropyl-p-iodeamphetamine was synthesized by the method of Carlson and Andresen (1982) and it was iodinatedby exchange reaction in weakly acidic medium in the presence of Cu(II). The radiochemical purity was determined by various chromatographic methods: - by liquid chromatography (~LC) using reverse phase C18 analytical c o l ~ a~d the following eluents i) acetonitrile/5OmMasetate buffer containing 0.12 % triethylamine, 2) methanol/ water containing 50 n~nol/l pentanesulfonic acid - by thin layer chromatography (TLC) on silica gel 60 using two eluents I)CH~OH:CNCI~:CH~COOH (15:g5:1) (Baldy,s e t el., 1982) 2) CH~OH: CMCI~:CHICOOH (85:15:1) (Noretti et ai., 1983) - by paper chromatography (PC) with ethanol: ethyl acetate:NH~ (49:49:2) serving as eluent. The activity distribution on TiC and PC was determined using autoradiogrephy, scintillation counting and seaoning with a proportional counter. When ~ L C was used fractions were collected end their aetivitywas measured with a gan~na counter. The results of different methods are in quite good agreement with each other. The radioehemieel yields determined by both HPLC-methods, PC and the second TLC-method are all of the same order of ma~itude. When the TLC-method 2) used the free iodine was found to have the greatest Rf-value which differs from what Moretti et al. h ~ e reported. The TiC-method i) seems to give lower values for free iodine t h ~ the other methods. Technical Research Centre of Finland, Reactor Laboratory, Otakasri 3 A, SF-02150 Espoo 15, Finland.

C-11-ISOPROPYLANTIPYRINE AS A POSSIBLE BLOOD FLOW TRACER IN PET-STUDIES-SYNTHESIS AND EVALUATION. 5. StoneElander, M. Ingvar, P. JohnstrSm, M.L. Smith, E. Ehrin, J.L.G. Nilsson, B. Resul, B. Garmel i u s , L. Eriksson, L. Widen and T. Greitz. Alkylation of the secondary nitrogen of a

pyrazelone ring was achieved by stirring together C-11-methyl iodide, synthesized from C-II-CO2, powdered potassium hydroxide, and 1-phenyl-3-methyl-4-isopropyl-5-pyrazolone in dimethylsulfoxide. The labelled compound was subsequently purified by HPLC. C-14-1sopropylastipyrine (IpA) was similarly prepared from commercially-available NaH14C03.

Its partition

c o e f f i c i e n t was determined and, using autoradiographic techniques, local CBF measured with C-14-1pA in male Wistar rats showed excellent correlation with those determined with C-14-iodoantipyrine.

Stimulation with CO2

indicated that diffusion l i m i t a t i o n

is as l i t t l e

a problem f o r IpA as f o r iodoantipyrine.

These

results indicate that C-11-]pA is a promising tracer f o r measuring local CBF in vivo and i t w i l l be compared with O-15-water as a f r e e l y d i f f u s i b l e tracer f o r PET studies.

Stockholm,

Sweden

123IMP has been advocated as a promising radiotracer for assessing regional cerebral perfusion. A major drawback of this radiopharmaceutical is a rather poor brain to lung activity ratio. When applying an efficient HPLC separation, based on a complex blend of ACN, Me0H, H 0, TMA and HAC, on reaction mixtures obtaine~ with earlier described labeling methods, the ahromatograms show several cold and labeled side products which are less lipophllic than IMP. When only a ether-water extraction is applied as purification step or when a kit-preparation, containing Cu(II), is used, the radiopharmaeeutieal compounding may contain these side products. They may at least in part be responsible for a decreased uptake of activity in the brain due to preferential receptor mediated lung uptake. Pure 1231MP allows the injection of lower activities (fmCi) than reported until now but resuiting in good brain uptake. An optimised labeling method, based on the use of a Cu(1)/Sn(ll) couple as catalyst, is described. It allows a yield of > 95% to be obtained and to reduce the side products to negligible amounts. VUB-Cyelotron, AZ-VHB, VRIJE UNIVERSITEIT BRUSSHL, Laarbeeklaan, ]03, 1090 BHUSSEL, Belgie.

A55 A327

A328

A329

RESIN BOUND TECNNETIUM-ggm FOR GASTROINTESTINAL 8CINTIGRAPHY A NEW PREPARATION. P.M. Pojer and A.C. Jakovljevic

QUANTIFICATION OF BIOKINETIC DISTRIBUTION OF Tc-99m-SULPHUR-COLLOIDS. H.Herzog, G,Spohr, G.Notohamiprodjo, L,E,Feinendegen

CHEMICAL

-

Preparations of technetium-99m bound resin suggested for use in gastrointestinal scintigraphy have involved lengtNy manipulations and stannous chloride reductions and the preparations have therefore been susceptible to a~r oxidation anu hydrolysis. We have coeverted cation exchange resin to tae "nickel" form simply by mixing the resin with a solution of nickel s a l t . Treatment of the nickel resin with a solution of sodium borohydride and washing the resultant resin with water, gave a material which readily reduced 99mTc-pertecbnetate ann labelled (>90°/° ) even 24 hours after preparation. The labellea resin was stable to both pH 7.51 (approximate pH of duodenum) and pH 1.38 (pN of stomach). Mice fed with the agent confirmed its suitability for gastrointestinal scintigraphy. Imtestinal t r a n s i t and gastric emptying times could be determined, while even after 7 hours carcass background was consistently low (approximately 2 ° / ° ) . Australian Radiation Laboratory, Lower Plenty Road, YaIlambie, 3085, Australia.

STRUCTURE

K.F.Nakken,

OF 99MTC-HIDA.

R.Fjellskaalnes,

T.Nakken

and B.Valland.

Commercially supplied kits f o r sulphur colloids demand either l y o p h i l i s a t i o n or heating f o r colloid production. There is some controversy over the degree of quantitative uptake and turnover of such colloids in the l i v e r . One k i t with lyophilisate (A), and two kits f o r heating (B and C), were used for q u a n t i t a t i v e l y measuring tracer uptake and turnover in l i v e r , spleen, lung and peripheral blood, a f t e r i . v . injection into patients free from l i v e r disease. Labelling yields of colloids were controlled by chromatography and p a r t i c l e size was measured. Tracer uptake in l i v e r , spleen and lung was quantified with an Anger-type gamma-camera, and an algorithm f o r attenuation correction showed a r e l a t i v e error of measurement smaller than 10% using an Alderson phantom. Successive blood samples yielded tracer kinetic data f o r the peripheral circulation.

For 9 9 m T c - g I D A ( F r o s s t ) e l e c t r o p h o r e s i s , HPL and mass

spectrometry

methyliminodiazetate) i,e.[Tc(III) chelate

Burns

of the same kit and

evidence

G 15 Chromatography,

The data indicate uptake values lower than gen e r a l l y assumed for tracers of the reticuloendothelial system. The quantification reported here permits revision of calculated doses to target tissue from various labelled sulphur colloids.

[Tc(III)(HIDA)3] 3-

species

4.2 and 5.6

in kits with (40-70%

to 100% when

give

is diluted

increased to 6.1

in

When

the kit

with

serum

is transformed

[Tc(III)(HIDA)2]-

for nearly

the

pH-values

yield,

pH is raised

preparations).

subsequently into

of Golco HIDA

at pH 5.2 and 6.1,

for [Ta(III)(NIDA)3]3-as.

main

good kit

and

Our studies that

in e l e c t r o p h o r e s i s and Sephadex

(Loherg

et ai,1981

et ai.1983.

(III)

as the main

in kit p r e p a r a t i o n s

et ai.1978, Costello

technetate

(HIDA)2 ] -

Liver uptake of colloid A was 62%; of B 70%; of C 73% of the amount i . v . injected. Spleen uptake was 15-17% f o r A, B, and C, Lung uptake, only observed f o r 8, was 2.5%. Mean blood a c t i v i t y was found to be 17% f o r A, 2.4% f o r B and 4% f o r C.- There was a correlation between the d i f ferent d i s t r i b u t i o n patterns and p a r t i c l e size.

I n s t i t u t e of Medicine, Nuclear Research Center Juelich, D-5170 Juelich, West-Germany

suggest

his N - ( 2 . 6 - D i m e t h y l p h e n y l - c a r b a m o y l -

, accounting

100% of the 9 9 m T c - c h e l a t e s

present.

Dep.

of Radiology,

Hospital,

Ullevaal

University

City

of Oslo,

Oslo,

Norway.

A 330

A331

A332

~ A D I O L A B E L I N G A N D P H A R M A C O K I N E T I C S OF 2-(p-IODOPHENYL)- AND 3-(p-IODOPHENYL)P E N T A D E C A N 0 1 C ACID~ J. L i e f h o l d p M. E i s e n h u t , D. N. T a y l o r 9 P. ~eorgi~ K. zum W i n k e l

BIOLOGICAL EVALUATION 0F Tc-99m COMPLEXES 0F ~ N 0 - AND DI-IOD0-BENZOYL CYSTEIME AS HEPATOBILIARY AGENTS. M,A. Antar and S.N. ganerjee

pHARMACOKINETICS AND BIODISTRIBUTION OF A NEW TC 99m RADIOLABELLED HEPARIN FRAGMENT IN NORMAL RATS. N. Colas-Linhart, B. Bok, J.L. Berthelot, A. Petiet. Facult6 de Medecine Xavier-Bichat, Paris,France

long c h a i n w - p h e n y l f a t t y acids have b e e n p r o p o s e d as radiopharmaoeubieals for t h e s e t h % i g r a p h i c i m a g i n g of the m y o c a r d i u m . While ~-iodophenylated f a t t y acids are metabolized via B-oxidation~ fatty acids w i t h the i o d o p h e n y l s u b s t i f u e n t in the side c h a i n are e x p e c t e d to i n h i b i t S - o x i d a t i o n . W i b h the i n h i b i t i o n of enzymes i n v o l v e d in ~ - o x i d a t i o n t r a p p i n g of the p a r t i a l l y m e t a b o l i z e d m o l e c u l e occurs° The a c t i v i t y therefore is ~ e t a i n e d in the h e a r t m u s c l e cells f o r a l o n g e r p e r i o d w h i c h m a y p r o d u c e b e t t e r m y o c a r d i a l images. Radioiodinated

2-phenylpentadecanoio acid and 3-phenylpentadecanoic a c i d were syllt h e s i z e d a n d i o d i n a t e d . The para isomers of the r e s u l t i n g i o d o p h e n y l p e n t a d e c a n o i c acids (IPPA's) w e r e s e p a r a t e d and r a d i o l a b e l e d b y i o d i n e i s o t o p e exchange w i t h 125-I and I~I-I r e s p e c t i v e ly° V a r i o u s l a b e l i n ~ teclnliques were e x a m i n e d w i f h r a d i o c h e m i c a l y i e l d s of up to 9o%. The b i o d i s t r i b u t i o n in rats has b e e n s t u d i e d w i t h 1 3 1 - I - I P P A ' s w h i l e scintig r a p h i e s of r a b b i t s w e r e p e r f o r m e d w i t h 1 2 3 - I - I P P A ' s . The r e s u l t s are d i s c u s s e d ~nd c o m p a r e d w i t h r a d i o d o d i n a t e d 15-(piodophenyl)pentadecanoic acid. K l i n i k u m der U n i v e r s i t ~ t H e i d e l b e r g Zentrum Radiolo~ie Forsehtn%~sgx~/ppe S f r a h l e n k l i n i k Im N e u e n h e i m e r F o l d 328 6900 H e i d e l b e r g F.RoG.

Various substituted imino-diacetic acids labeled with Tc-99m have been developed as hepatobiliary agents. Another class of compounds based on benzoyl-cysteine moiety has been developed and tested. The analogs mono-iodo-derivative N-

(2'-iodo-benzoyl)-cysteine (MIBC), 2',S'-diiododerivative (DIBC) and N-(benzoyl)cysteine were synthesized and successfully complexed with Tc99m at high specific activity (i0 mCi/mg). Sequential ganuna camera imaging up to 60 minutes in rabbits showed greatest concentration in the hepatobiliary system and rapid clearance from the gallbladder into the intestine. Their biological distributions were compared with that of Tc-99m-N,m~(2,6-dimethylacetanilide)-iminodiacetic acid (HIDA) in 17 different rabbit tissues at IS and 30 minutes after i/v administration. At 15 minutes, the mono-iodo-derivative MIBC showed a greater secretion into the intestine and bile (76.9 2 5.4% dose) than that of the diiodo-derivative DIBC (54.6 ± 4.8%) and even better than the currently used HIDA (60.0 ± 3.3%). The monoiodo analog has higher mean liver activity of 18.0 i 5.4% dose than that of HIDA (13.5 + 2.1%) but lower liver activity than that of DIBC (28.5 ± ].0%). In addition, the kidney and urine activity for both derivatives was similar (5.2% at 15 minutes), but it was four-fold lower than that of HIDA (19.9%). Ttest for differences of hepatobiliary secretion and urinary activity between MIBCand HIUA were highly significant [P<0.001]. It appears that the monoiodo analo~ (MIBC) has better hepatobiliary secretion characteristics compared to both the diiodo analog DIBC and NIDA. It also exhibits less interference from the urinary system. (Univ. of Conn. Invention Disclosure) Univ. of Conn. Sch. of Mad., Farmington, CT and V.A. Medical Center, Newington, CT U.S.A.

PKIO,169 is a low molecular weight heparin fragment (4,5OOD), obtained from porcine mucosal heparin. This fragment shows an important anti-Xa activity associated with a low inhibition of thrombin. Ladled drug was obtained using stanno~s chloride and Tc 99m pertechnetate. This method is very similar to the routinely used heparin labeling technique. In vitro studies showed a high labeling efficiency (98 %}. Stability of the labeled drug was excellent during 24 H and labeling homogeneity tested by gel permeation was satisfactory. There was no significant difference in Anti-Xa activities of labeled or unlabeled heparin fragment in plasma. In rive in rats, after I.V. infusion of the Tc 99m labeled drug, there was no difference between anti-Xa activity measurements or radioactive countings, beth displaying a plasmatic biexponential pattern (T1 being 3.04 min, T 2 being 157.5 min). T 2 of the fragment is thus longer than heparin T 2 (66 min). Biodistribution studies showed no thyroid uptake but there are some differences with heparin studies with an important and fast accumulation in liver. This method has the potential of studying various experimental and pathological situations. Since it uses a p~re gamma emetter, short half life radiopharmaceutical, it might be used for pharmacokinetic studies even in human patients, as shown in a volunteer subject.

A56

A333

A 334

TOXIC OIL SYNDROME AND FATTY ACID ANILIDES:IN VIVO STUDIES OF LINOLEIC ACID ANILIDE DISPOSITION USING RADIONUCLIDE TECHNIQUES AND KINETIC ANALYSIS. E.Rodriguez F a r r ~ A.Planas and L. Cam6n. Fatty acid anilides (FAA) contained in adulterated oils have been involved in the ethiopathogenesis of the toxic oil syndrome occurred in Spain in I981. However, their mechanism of a c t i o n is unknown. In previous work we have reported the kinetic and metabolic aspects of elsie acid anilide(0A). The aim of the present investigation was to define the biological kinetics of linoleic acid anilide(LA). The fate of 3E-LA, given intragastrleally to mice~ was studied using radiotracer procedures and radiokinetic analysis. About 54% of 3E-LA was absorbed. The remaining fraction was detected in 24h feces mainly as parent compound (97%). A fraction of radiotraeer was absorbed via the lymphatic system.3H-LA radioactivity was largely distributed in the organism.Computer-fitted time activity curves showed different tissue affinities (Cmax = 164-14 ng/g of 3H-LA equivalents) followed by a slow monoexponential elimination phase, very similar for most of the organs (30 to 4Oh). 6% of the label remained in the body 4 days after dosing (tl/2 Kel = 62h). Tritium was excreted mainly in urine (40% of the dose). Biliar excretion was of minor importance. TLC autoradiography of urine showed at least 5 LA metabolites. 35% of hidrolyzed urine co-chromatographied with marked paraeetamol. These results are very similar to the previously described for 3H-CA. FAA amide bond are largely hidrolyzed by first-pass effect. Kinetic and metabolic data suggest that the tissue retention might be due to the incorporation of FAA-radioactivity to the cell membrane. Unidad de Medicina Experimental. cgIg. Barcelona-34. Spain.

A335

AITODZC DISSOLU~IOi~ AS A ~ O P ~ I ~ L ~THOD

OF I ~ T R O D U O I N G Sn ++ IITTO 7~IDIO-

2~L%C~UTICAL3.

TWO METHODS OF ESTIMATING THE RADIOTOXICITY OF 11 C-COMPOUNDS C.-G. St~Inacke, S.Sundell-Bergma,, strum, H. Lundqvist and P. Malmborg

S.Tustano~/:~ki aund

E. Dsm"tko~i a k

The estimation of r a d i a t i o n hazard

of

and d u r i n g p r e p e ~ i n g l a b e l l i n g k i t s , t i n

c a l c u l a t i o n of the physically absorbed dose from

is i n t r o d u c e d as a s o l u t i o n Of S n O l 2 i n

measured spatial and temporal r a d i o a c t i v i t y d i s 11 tributions i n the body only. However, C-

H C I . T i n a d s o r b e d r e s i n is u s e d m o r e

sel-

d o m . T h e i n t r o d u c t i o n of t i n a s p r o d u c t

labelled

of a n o d i o dissolufion,~zhich ~e # r o p 0 s e ~

l u l a r metabolism might cause an enhanced

h a s the f o l l o w i n ~ a d v a n t a g e s :

biological

- the i n t ~ o d a s e d

t i n is of h i g h

Sn++ions

introduced into solution

e f f e c t due t o c r i t i c a l

distribution. estimate

purity -

biomolecules which p a r t i c i p a t e in c e l -

ne

in

Two d i f f e r e n t methods were used to 11 e f f e c t s of C-methioni-

radiotoxic vitro

and

in

vivo.

i)

The number of

at p r o p e r pH~alloi~s us to e l i m i n a t e

induced unrepaired DNA strand breaks was estima-

n e u t r a l i z a t i o n of the a c i d

ted as a function of dose. Mammalian c e l l s were 11 incubated in C-methionine containing me-

- nascent Sn++is

e o m p l e x e d i n the p r e -

s e n c e of the e x c e s s of c h e l a t i n g

dium f o r 60 minutes at 37°C

agent,which prevents hydrolysis

by

- SnO12%.zeighing is r e p l a c e d by curr e n t ~ n d time m e a s u r e m e n t s

the

and

then

incorporation of the DNA precursor 3H-thymidinethe biological

e f f e c t of r a d i a t i o n on the DNA synth-

O u r r e s u l t s i n d i c a t e t h a t the d e s c r i -

esis rate was i n v e s t i g a t e d .

b e d i n l i t e r a t u r e p r o c e s s am e l e c t r o -

mice

l y t i c l a b e l l i n g is n o t c a t h o d i c r e d u c -

methionine. The small

t i o n of p e r t e c h n e t a t e b u t it d o e s p r o -

and

o e e d t h r o u g h the r e d u c t i o n

measured. For comparison also external

of ~ e 0 ~ i o n

intestine the

amount

of

i.v. 3

was

injection

intestine

was

heart kidney liver spleen

49.1 28.8 0.9 i.O

10.3 60.1 4.3 2.9

1.8 89.4 2.8 1.1

0.44 95.9 1.2 0.5

I n s t i t u t e of I s o t o p e s of t h e H u n g a r i a n Academy of Sciences, Quality Control D e p a r t m e n t , H - 1 5 2 5 B u d m p e s t , P . O . B o x 77, Hungary

of

in 11 C-

dissected

H - a c t i v i t y per ug DNA was irradia-

The r e l a t i v e b i o l o g i c a l

t i o n of t i n

e f f e c t i v e n e s s , RBE, was estimated to be about i . The Gustaf Werner I n s t i t u t e , U n i v e r s i t y of sala, Box 531, S-751 21 Uppsala, Sweden.

A 338

3 hrs

done

tions

D e p a r t a m e n t of R a d i o i s o t o p e s ?omer~lim.la M e d i c a l Academy ul.Unii Luhelskiej I PL 70-544 Szczecin-Polend

performed.

This

w i t h S n + + f o r m e d d u e to a n o d i c d i s s o l u electrode.

were

after

M O S S B A U E R S P E C T R O S C O P Y S T U D Y ON DEXTRANS J.V.Stevovid, P.Delcroix

1 hr

examined

DNA unwinding method 2) By studying the

~DIONUCLIDIC PURITY CONTROL ON A GAMMA-It. A.M.J. paans, W. Vaalburg and M.G. Noldring.

iO m i n

radio-

intracellular

A337

RPD 3 min

adminis-

tered radiopharmaceuticals i s usually based on a

P R E P A R A T I O N OF 9 9 T 0 TM L A B E L L E D K - S T O P H A N T O S I D A N D ITS B I O D I S T R I B U T I O N IN RATS. F. K e c s k @ s , S.U. K e l e c s @ n y i a n d T. S z a r v a s

organ

L~ng-

In the p r o c e J u of label!ling ~:itb T c - 9 ~

A336

K - S t r o p h a n t o s i d , /K-Str/ c o n v e n t i o n a l in'ection solution was labelled with ~ 9 T c m in p r e s e n c e o f S n C 1 2 a t p H = 2. A f t e r l a b e l l i n g t h e s o l u t i o n w a s k e p t at r o o m t e m p e r a t u r e for o n e hour. F i n a l l y the pH was adjusted to 7 with NaHCO 3 s o l u t i o n . T h e l a b e l l i n g y i e l d a n d the r a d i o c h e m i c a l p u r i t y of t h e l a b e l l e d p r o d u c t w e r e d e t e r m i n e d by p a p e r c h r o m a tography. Both values were higher than 96%. B i o d i s t r i h u t i o n s t u d i e s w e r e p e r f o r m e d o n h e a l t h y C F Y rats. The i.v. a p p l i e d d o s e s w e r e 200 k B q 9 9 T c m - K - S t r in 0.2 m l saline. T h e r a t s w e r e s a c r i f i c e d at 3, io, 60 a n d 1 8 0 min, a f t e r i n j e c t i o n . The d e p o s i t e d a c t i v i t y in t h e d i f f e r e n t o r g a n s w a s d e t e r m i n e d b y d i s s e c t i o n a n d c o u n t i n g in y - s p e c t r o m e t e r / B e r t h o l d G a m m a s c i n t B F 5300/. T h e d i s t r i b u t i o n of 9 9 T c m - K - S t r in t h e o r g a n s e x p r e s s e d as r e l a t i v e p e r c e n t a g e d o s e / g /RPD/ is s u m m a r i z e d in the t a b l e .

B.

The availability of a gamma-ll (PDP-II/34) computer system has urged us to couple a ge(Li) detector to this computer for radionuclidie purity control. The ADC system used is a AR-ll, incorporated in the processor box of the PDP-II. The AR-II comprises a I0 bits 16 fold multiplexed ADC system and, in fact is present on all older Oamma-]l systems. To adapt the output of the main amplifier of the Ge(Li) detector to the characteristics of the AR-II a pulse stretcher is used. The conversion of the stretched pulses is started by pulses delivered by a timing single channel analyzer. Since the conversion time of a AR-II is 28 us, the maximum count rate is limited by the hardware to 35 kNz. The data acquisition and analysis program is a modular flexible program which takes advantage of the real time features the RT-II operating system offers. The program is written in Fortran except for the ADC routine which is written in Macro for reason of speed. The maximum data rate the program car handle is 32 kHz. At such data rate the maximum resolution of a Ge(Li) detector is already lost. Since the program is watching the input buffer of the retinal commands can always be given to the program. After data acquisition the spectrum can be stored on disk. For the analysis of the spectra a Tektronix 611 storage oscilloscope is used. The oscilloscope is driven by the program via hardware incorporated in the AR-II module. A set of commands is available to add, subtract~ multiply or divide spectra. Also peak contents, with background subtraction, can be obtained by giving the channel numbers. Due to the modular feature of the program new commands can be defined easily. The 1O bits resolution proved to be enough for our applications. The program showed its value and versatility in the setting up of the production of bromine-75. Department of Nuclear Hospital, Oostersingel The Netherlands.

Medicine, University 59, 9713 EZ Groningen,

Upp-

(Sn)-

Recently 99m-Tc(Sn)dextrans have been p r o p o s e d for l y m p h o s c i n t i g r a p h y a n d radionuclide angiocardiography. As w e h a v e p r e p a r e d the l y o p h i l i z e d (Sn)d e x t r a n k i t for l a b e l l i n g by 9 9 m - T c at pH>6, for p r o d u c t i o n of h i g h q u a l i t y r a d i o p h a r m a c e u t i c a l s it is i m p o r t a n t to k n o w the c h e m i c a l f o r m of tin in lyophilized stannous chleride-dextran preparations. The M ~ s s b a u e r s p e c t r o s c o p y has b e e n app l i e d for e x a m i n a t i o n s of tin b o n d i n g in l y o p h i l i z e d s t a n n o u s c h l o r i d e - d e x trans m i x t u r e p r e p a r e d u n d e r d i f f e r e n t c o n d i t i o n s : pH, 6% d e x t r a n c o n c e n t r a t i on, d e x t r a n m o l e c u l a r w e i g h t s (40000 and fOOD00). The M b s s b a u e r p a r a m e t e r s of h y p e r f i n e i n t e r a c t i o n - the i s o m e r s h i f t s and the q u a d r u p o l e s p l i t t i n g s - are d e t e r m i n e d . F r o m t h e s e v a l u e s it m a y c o n c l u d e d t h a t in l y o p h i l i z e d S n - d e x t r a n s the tin app e a r s in two v a l e n c e states: as Sn(II) a n d Sn(IV). T h e S n ( I I ) i s o m e r shift in p r o d u c t s p r e p a r e d a t p N 6,5 a r e of lower v a l u e t h a n t h a t (value) f o u n d for the p r o d u c t s p r e p a r e d at p H 2,5. The r e l a t i v e d i s t r i b u t i o n of two t i n forms (It a n d IV) m a y be e s t i m a t e d . The d i s s c u t i o n s d e a l s w i t h the i m p o r t a n c e of t h e s e d a t a for p o s s i b l e c h a r a c t e r i s t i c s of 9 9 m - T c ( S n ) - d e x t r a n r a diopharmaceuticals. B o r i s K i d r i ~ I n s t i t u t e of N u c l e a r S c i e n c e s - V i n ~ a , I n s t i t u t e for R a d i o i s o t o p e s ll0Ol B e o g r a d , Y u g o s l a v i a * U n i v e r s i t 4 d e N a n c y I, N a n c y , F r a n c e

A57 A339

A340

A341

STUDIES OF UNWANTED COMPOUNDS IN NON LYOPHILIBED MDP FORMULATIONS STABILIZED WITH GENTISiC ACfD. F. Mata ( + ) , A. P e B a f l e l ( + ) , Grasses, F. (++) and March, J ( + + ) .

SPECIES DIFEERENCES IN M Y O C A R D I A L UPTAKE OF Tc-B9m DMPE. C.SchQmichen, P.Bergmann~ M.Hatl, S.8chmidt

CORPARI5ON OF DIFFERENT CELL LABELLING LIGANDS. W.Th. Goedemans, M.M.Th. de Jong and A.A. van Dulmen

The introduction of air (oxygen) in the reaction vial during technetium labeling of phosphonate bone imaging agents, may generate pharmaceuticals with low radiochemica] purity. The addition of an antioxldant, such as ascorblc acid or gentlsic acid (GA), has satisfactorily minimized pertechnetate contamination for a long period of time. In our laboratory, when GA (0.56 mg/vial) was used in the formulation of non lyophilized MDP (5 mg MDP acid form, I mg SnCl 2 2N20), coloured compounds appeared when the syntesis of MDP was done at gH=7 and quality control techniques showed and almost to tal failure for ]abeling with Tc-99m, obtainln~ nx>re than 90% of free perteohnetate. We present t h e s t u d i e s in o r d e r to c h a r a c t e r i z e those compounds in different experimental conditions, such as spectrophotometry and speetrofluorimetry. We found that the above mentioned compound appears quickly in MDP formulations stabilized with GA in presence of an atmosphere of oxygen, showing different chemical features in a pH ran ge between I and 9. Compound does not appear in a pH range between 3 and 6, in an atmosphere of nitrogen or when GA was not added to the MDP formulation. In summary, the liquid preparation of MDP stabi]ized with GA should be formulated at an acid pH and kept in an atmosphere of nl ~ trogen. Otherwise, we risk the formation of oxidatlve compounds with the direct participation of the GA that will preclude labelling MOP with To-gEm. This situation should always be kept in mind in those Nuclear Medicine laboratories that prepare their own home-made kits of MDP-Sn. (+) Nuclear Medicine Section. Residencia Sanitaria "Virgen del Lluch". C/Andrea Ooria Palms de Ma]]orca. SPAIN (++) Analytlcal Chemistry Department. Facultad de C i e n c i a s . U n i v e r s [ d a d de Palma de Ma] l o r c a . SPAIN

]n the dog, Tc 99m UMPD proved to be a promi sing myocardial imaging agent. However, f u r t h e r investigations c l e a r a l y demonstrated, t h a t the b i t d i s t r i b u t i o n of T c - g g m DMPE is strongly species dependend_ U n f o r t u n a t e l y unsatisfactory results w e r r e obtained in man. This investigation was focussedon the origin of the species differences in biokinetics of these agent. Tc-gBm DMPE was prepared recording to Oeutsch et ab: 1 mi p e r t e c h n e t a t e , 1 ml ethylalcohol~ 0.25 ml 1,0 MHC[ and 0.3 ml DMPE (Stream Chemicals, N e w b u r y p o r t , Massachussetts) were heated up to 145 °C for 2 hours. Small amounts of this pro potation was added to plasma of the rat (Wistar and Sprague O a w l e y ) , dog~ cat~ swine and man. Relative protein binding of Tc-Bgm was evaluated by f r a c t i o n a l p r e c i p i t a t i o n w i t h a m o n i u m s u l f a t e . The DMPE c o n c e n t r a t i o n in plasma was adopted to t h a t achieved in rive a f t e r injection of 3 mg DMPE/kg bodyweight. The same plasma (pH s t a b i lized to 7.4 by phosphate b u f f e r ) was i n j e c t e d in rats and the b i o d i s t d b u t i o n of Tc-ggm DMPE was assessed q u a n t i t a t i v e l y . Both in man and animal plasma the t o t a l relative protein binding of Tc-99m was nearly 100%. The ratio of myocardial and liver uptake in the rat correlated well w i t h the relative protein binding of T c - g g m to plasma globulins. Best results were obtained with rat plasma, where 87.3 % of Tc-Bgm was bound to globuNns and only poor r e sults in man~ were only 1.2% of T c - 9 9 m was bound to globulins. Hence also in man myocardial uptake of Tc-99m DMPE m i g h t be increased by binding to globulins prior to i n j e c t i o n .

B y k - M a l l i n c k r o d t CIL 8 . V . P.O. Box 5 1755 ZG Petten, Holland

Dept. of Nuclear Medicine, A [ b e r t - l u d w i g s University, D-7800 F r e i b u r g , H u g s t e t t e r Str. 55~ Federal Republic of Germany

A343

I M M U N O R E A C T I V I T Y OF M O N O C L O N A L ANTIMELANOMA ~TIBODIES AND F R A G M E N T S A F T E R RADIOIODINATION. S. Matzku, H. K i r c h g e B n e r , W. Tilgen, and J. B r ~ g g e n

P R O D U C T I O N OF HIGH A C T I V I T Y G E N E R A T O R S FOR HUMAN USE S.M.Milenkovid, J . L . V u ~ i n a

I n s t i t u t e of N u c l e a r Medicine, German Cancer Research Center, D - 6 9 O O Heidelberg, and D e r m a t o l o g i c a l Clinic, U n i v e r s i t y of Heidelberg, and Department of E x p e r i m e n t a l Dermatology, M ~ n s t e r

Mere inhibited leukocyte motility in concentrations needed to obtain high labelling efficienties.

Species differences in myocardial uptake of ]-c-ggm DMPE are obviously related to differences in plasma protein binding of this agent. These results c l e a r l y show, t h a t Tc-ggm lobe/led myocardial imaging agent has to be especially d e signed for its use in man. For this purpose the rat model shown here may be useful.

A342

It is r e p o r t e d on recent e x p e r i m e n t s with F P L C - b a s e d p u r i f i c a t i o n of monoclonal a n t i b o d i e s out of ascites and of a n t i b o d y f r a g m e n t s out of e n z y m a t i c digests. Irmmunoreactivity after radioi o d i n a t i o n was d e t e r m i n e d by e x h a u s t i v e absorption w i t h a n t i g e n - p o s i t i v e melanoma cells. It was found that F(ab')2 fragments r e s e m b l e d very closely to intact IgG, w h i l e Fab s h o w e d lower b i n d i n g rates, e s p e c i a l l y in antigena n t i b o d y systems i n v o l v i n g m o d u l a t i o n and internalization. The s e n s i t i v i t y of several m o n o c l o n a l a n t i b o d i e s to r a d i o i o d i n a t i o n damage (IODO-GEN method) was e v a l u a t e d as a function of the amount of iodine a t t a c h e d to the molecule. T w o types of antibodies w e r e encountered, one of which showing i m p a i r m e n t of intmunoreactivity even at average s u b s t i t u t i o n ratios b e l o w one atom of iodine per a n t i b o d y molecule, the other t o l e r a t i n g h i g h e r s u b s t i t u t i o n ratios. P r e p a r a t i o n s with p o o r immunor e a c t i v i t y as d e t e r m i n e d in vitro l o c a l i z e d very p o o r l y to t u m o r tissue in vivo. The b e n e f i t of m o d e l experiments for d e t e r m i n i n g the q u a l i t y of a r a d i o i o d i n a t e d antibody p r e p a r a t i o n is discussed.

In d o i n g paired comparisons in ln-l]l tell labelling with oxine Cox), aeetyl acetone (ae), tropol0ne (Crop) and 2-mereapfopyridine-]oxide (mere) using different kinds of blood eells~ ox, Crop and mere proved to be the most potent cell labelling agents. Cell labelling in most cases was carried out on mleroseale: 0.5 ml cell suspension was added to a i0 ml Weaton vial. Under gently mixing 0.15 ml labelling complex was added. Incubation lasted 20 minutes at room temperature. After incubation a sample was collected with a hemafocrit capillary and centrifuged at 500 g. The capii laries were cut with a glass saw just above the packed cells and the radioactivity of the pieces was measured in order to determine labelling efficiency. Labelling effioieoeies presented were average values of duplicate incubations. The differences between ox, Crop and mere were small with regard boche obtained labelling yields in a sallne as well as in a plasma environment. This was in clear contradistinction to statements from literature claiming a better labelling ability for trop and mere i n plasma.

A344 Tc-99m

The wide medical a p p l i c a t i o n of T c - 9 9 m g e n e r a t o r s stimulates a new research. It is crucial to get a g e n e r a t o r with high e l u t i o n y i e l d s in the smallest volume of the eluate and with high p e r c e n t a g e of pertechnetate. The hydrated electrons f o l l o w i n g the nuclear decay of Mo-99 can d i s t u r b e l u t i o n even in the "dry" column. The redox p o t e n t i a l of the h y d r a t e d electrons is rather high and it has been found that cupric ion can serve as a proper scavenger for them. The m i x t u r e of silica gel and alumina is a good a b s o r b e n t for T c - 9 9 m generators. This a b s o r b e n t can be ~mproved w i t h silica gel c o n t a i n i n g adsorbed copper in the q u a n t i t y of about 50~g Cu/g. The T c - 9 9 m g e n e r a t o r s activities up to 74 G B q p r o d u c e d by this m e t h o d e x h i b i t high elution yields and e s p e c i a l l y f a v o u r a b l e elution profile, T c - 9 9 m being eluted in only 3 ml of eluate. The e l u a t e is free from o x i d i zing agents and contains 98% of T c - 9 9 m pertechnetate.

The "Boris Kidri~" Institute Sciences, Vinda Institute for R a d i o i s o t o p e s llO0l Belgrade, P.O.Box 522 Yugoslavia

of N u c l e a r

SIMPLE PRODUCTION ~4ETHOD FOR TF~ Rb-81/Kr-Blm GENERATOR WITH CARRIER R b P.Blbuenstein, I Huszar, C.Bajo, 0 Gasser, P A Schubiger There are different routes known to produce the Rb/Kr-Generator Here we show, that good results can be obtained applying a new sir~ple technical procedure _Th_e_Ta{_g_et__w_as_p_re_p_a~e_dby- pressing 7 g RbCI (Merck, analytical grade) and packing the obtained wafer in a hollow Aluminium disk. The irradlation at the SIN Cyclotron with 70--80-[A-for-[-h yields between 1.5 and 2 Ci (50-78 GBq) Rb-81 at EOB. The main accompanying nuclides are Rb-8gm, Sr-82, Br-82. There are 15 other nuclides which are clearly identified, but less irc~ortant, because the respective activities never exeed i0 mCi.After the irradiation the Al-disk is cut into two halves and the HbCl is dissolved in distilled water. _The___C~__ner_ato_r__!_s_loadedby passing a measured aliquot of the Rb-81 solution through the colurml, which contains Dowex 50 W cation exchanger and is supplied with two needles allowing the elutien of the generator. This procedure allows the production of 28 generators with i0 mCi at noon Negligible breakthroughs and an elution yield of 80-100% Kr-81m axe the most ia~portant properties of this generator

~ i s s Federal Institute for Reactor Research, C~-5303 k~renlingen, Switzerland.

A58

A347

A345

A 346

195m-Hg/195m-Au GENERAIOR. TWO

YEARS OF EXPERIENCE. K.J. Panek, J. Lindeyer and B.C. van der Vlugt.

IMMEDIATE STATIC NUCLIDE VENOOP~PHY I.S. S E O

Although the potentially interesting generators For the ultra short-lived radionuelides have been studied for a decade, almost none of them reached the point of routine clinical application, except of 81-Rb/81m-Kr and 195m-Hg/195mAu generators. Ihe latter, developed by the authors of this paper, proved to be a very v~luable tool for dynamic studies, particularly in cardiology. The generator consists of s miniature column containing silica gel coated with zinc sulphide on what is adsorbed 580-400 mCi 195m-Hg (f½ 41.6 h). 195m-Au (f½ 30.6 see.) is obtained by eluting the generator with a solution of sodium thiosulphate and sodium nitrate. The performance of the generator (yield oa 29% of theory and radionuclidic purity
A 21" W F O V w a s u s e d in o b t a i n i n g 528 a n t e r i o r ISI u s i n g the large v o l u m e 9 9 m T c 0 4 - technique. A d d i t i o n a l l y 351 of 528 s t u d i e s had " f r o g - l e g " IBI. The ISI w e r e c o n t r a s t e d and i n t e r p r e t e d in the c o n t e x t of the f e a t u r e s n o t e d in the d y n a m i c p h a s e of RNV. In the ISI the t r i b u t a r i e s of the legs w e r e e a s i e r t o i d e n t i f y , and the s u p e r f i c i a l and d e e p v e i n s w e r e e a s i e r to d i s t i n g u i s h , p a r t i c u l a r l y in t h e p r e s e n c e of disease. The "frog-leg" view g a v e a larger field of e x p o s u r e s i n c e the limb's AP d i a m e t e r is g r e a t e r t h a n its m e d i o l a t e r a l diameter. Pecorded d i s o r d e r s of the s u p e r f i c i a l v e i n s inc l u d e d m o s t l y variceS, p h l e b i t i s , and postphlebitic syndrome.(194/528 studies). S c i n t i g r a p h i c f e a t u r e s of t h e s e d i s o r d e r s w e r e noted, but w h e n p h l e b i t i s and v a r i c e s c o - e x i s t e d , this w a s not a l w a y s r e s o l v a b l e . T h r o m b o p h l e b i t i s of the d e e p v e n o u s s y s t e m w a s r e c o r d e d in 91 of 528. In acute o c c l u s i o n s , the ISI a p p e a r e d "smudgy". V a r y i n g d e g r e e s of a b n o r m a l c o l l a t e r a l s w e r e s e e n at the o c c l u s i o n s , but a p p e a r e d less g r a p h i c ~ l l y in 9 0 % t h a n the d y n a m i c p h a s e of the P~V. O n l y in 10% w e r e the c o l l a t e r a l s c o m p a r a b l y or b e t t e r d e f i n e d in t h e ISI. P h l e b i t i s a p p e a r e d as w e l l d e f i n e d segTnents of i n c r e a s e d activity. In 15, c e l l u l i t i s w a s r u l e d in at t h e e x c l u s i o n of t h r o m b o p h l e b i t i s as the c a u s e of c o m p l a i n t . C e r t a i n n o n - v e n o u s d i s o r d e r s w e r e s u g g e s t e d to h a v e a c a u s e / e f f e c t r e l a t i o n s h i p in t h e g e n sis of p h l e b i t i s . ISI are recon~nended s i n c e i m p o r t a n t diagnostic data were derivable at minimal cost and sans patient discomfort.

Mallinckrodt Diagnostics B.V., Cyclotron & Isotope Laboratories, P.O. Box 3, 1755 ZG Patten, Holland

IMAGES (ISI) IN (EN¥). W.M.Sy

RADIOand

9 9 m T C - P L A S M I N TEST IN DEEP VENOUS T H R O M B O S I S OF THE LEG. H. Aronen, H. S u o r a n t s and M. T a a v i t s a i n e n

99mTc-plasmin

test

and p h l e b o g r a p h y

~ere p e r f o r m e d on 45 c o n s e c u t i v e u n s e l e c t e d p a t i e n t s with s u s p e c t e d deep vein t h r o m b o s i s of the leg. Phlebography showed t h r o m b o s i s in 15 cases. F o u r t e e n of these p a t i e n t s had a positive finding in the p i a s m i n test. E l e v e n other p a t i e n t s had a p o s i t i v e plasmin test result as well. The most c o m m o n causes for false p o s i t i v e p l s s m i n test r H s u l t s in the d i a g n o s i s of deep vein t h r o m b o s i s were acute i n f l a m m a t o r y d i s e a s e s and d i s t u r b a n c e s in v e n o u s flow w i t h o u t fresh thrombosis. The s e n s i t i v i t y of p l a s m i n test in the d i a g n o s i s of deep vein t h r o m b o s i s was 93 per sent and the s p e c i f i c i t y 63 per cent. It is c o n c l u d e d that p l a s m i n test can be used for the s c r e e n i n g of deep vein thrombosis. D e p a r t m e n t of D i a g n o s t i c R a d i o l o g y Hslsinki University Central Hospital Meilahti Hospital SF 00290 Hslsinki 29, F i n l a n d

T h e B r o o k l y n H o s p i t a l , 121 D e K & l b A v e nue, B r o o k l y n , N e w Y o r k 11201

A348 ADVANTAGESAND LIMITATIONS OF

Tc-99m-FIBRINO-

GEN IN THE DIAGNOSIS OF THROMBOSIS R. Berberich, A. Steinstr~sser, H.-J. Schroth, J. Felbel Since nearly two years ~e have Tc-99m-Fibrinogen in routinely use for the primary diagnosis of thrombosis. In course of an investigation one can see in a first phase the flow of the radiopharmacon injected into a peripheral vein ~ith a possible narroeing of the lumen or stop in the vessel. The second phase of an invesestigation sho~s fibrinogen having added to an active thrombus. The biokinetic measured in blood and urine and over lung, liver and spleen of the patients is discussed. We sho~ the influence of an early heparin administratzon on the second phase of the investigation, ~here the active build-in of fibrinogen to the thrombus is diminished. Conclusion: Tc-99m-Fibrinogen is a usefull tool in the primary diagnosis of thrombosis. It gives information about the morphology of the vessels and the floridity and extend of thrombotic changes. In case of longer heparin administration the labeling of a thrombus is largely diminished. But even in this case Tc-99m-Fibrinogen is superior to other substances (e.g. HSA or labeled thrombocytes) because of lack of artefacts by dusters or by activity fixed to the venous valves. Nuklearmed. Abtlg. der Radiol. Univ.Klinik, D-6650 Homburg/Saar, Nest Germany

A349

A350

QUANTIFICATION OF THE VARICOCELE-BLOODPOOL. J.W.Arndt, H.Y.Oei, W.P.Th~mali, J.Yccemer, B.L.R.A.Coolsaet.

R A D I O N U C L I D E A R T E R I O O R A P H Y IN D E T E C T I O N OF O C C L U S I O N S IN A O R T O I L I A C AND P R O X I M A L F E M O R A L REGIONS. R . H ~ r k g n e n , S.Sakki, S.V~h~talo, I.Toivio and M.Vorne

The reliability of Vayicocelescintigraphy (VS) is shown in our previous study, which describes the method in detail. By this method, performed without Valsalva and using a LFOV-gammacamera, two groups of patients can be differentiated: pts with spontaneous retrograde flow in the testicular vein, in whom dynamic images are abnormal (DY+) and pts with normal dynamic i~ages (DY-). In most pts the dilated plexus pampiniformis is visualized on the static image (ST) 7-12 min p.i. of 5mCi Tc99m in-vivo-l~Joeled erythrocytes. In this study quantification of the bloodpool in the plexus is described using the digital image of ST in 64x64 matrix. Two regions are chosen, each 2 pixels wide, A: over scrotum caudal of bulbus penis 4-10 adjacent pixels with highest counts, where number of counts in pixel with minimal counts must be equal o£ more than half of counts in pixel with maximal counts~ B: over right iliac vessels I0 adjcent pixels with maximal counts. Bloodpool value (BP) is counts/pixel in A divided by counts/pixel in B. Mean BP in 16 normals is 0.3+0.08 (0.2-0.47. Mean BP in 72 DY+ pts is 0.89+0.28 and is higher than the mean BP in Ii DY- pts (0.61+_0.19). Only 4 varicocele pts are within' the range of normals. Varicocele was in all pts confirmed by X-ray-Dhlebography. In 48 varicocele pts VS is repeated after either embolisation or ligation. SP-value in 8 DY- pts (0.58!0.i3) and 29 bY+ pts (0.90±0.36),who after treatment became DY-, decreased to the same mean value, reap. 0.36+0.14 and 0.37+0.13. In the remaining 11 pts, who still were DY+ after treatment, BP decreased from 1.01+_0.38 to 0.76+0.28. The post-treatment values in these 11 pts are higher than the values of the 37 pts who became DY-. These results strongly suggest that BP is a useful measure for the varicocele-size. In pts, who after treatment still have BP>0.4, control VS probably has to be performed with valsalva. Dept. of Nuclear Medicine, University Hospital, Catharijnesingel 101, Utrecht, The Netherlands.

The p u r p o s e of the s t u d y was to e v a l u a t e r a d i o n u c l i d e a r t e r i o g r a p h y in d e t e c t i o n of p r o x i m a l a r t e r i a l o c c l u s i o n s in lower limbs by c o r r e l a t i n g it to X - r a y c o n t r a s t a n g i o g r a p h y , 42 p a t i e n t s (83 lower limbs) with clinically suspected arterial oce~siva d i s e a s e w e r e included. A 4 0 c m ~ inf i e l d g a m m a c a m e r a w a s p l a c e d o v e r the p e l v i c and f e m o r a l r e g i o n i n c l u d i n g the aortic bifurcation. A rapid antecubital i n j e c t i o n (12 mCu) of T e 9 9 m - p e r t e c h n ~ e was done. S e r i a l i m a g i n g was p e r f o r m e d in i n t e r v a l s of three seconds. X - r a y a r t e r i o g r a p h y was p e r f o r m e d u s i n g Seldinger percutaneous transfemoral t e c h n i q u e or t r a n s l u m b a r a o r t o g r a p h y . The r e s u l t s in d e t e c t i o n of s i g n i f i c a n t (over 50 per cent) s t e n o s e s in the a o r t o iliac r e g i o n are as follows. S e n s i t i v i t y was 27/35 (0.77) and s p e c i f i c i t y 32/47 (0.68). In case of t o t a l o c c l u s i o n sensit i v i t y was 13/13 (1.00) and s p e c i f i c i t y 64/68 (0.94). In the u p p e r p a r t of the f e m o r a l r e g i o n the s e n s i t i v i t y a n d specif i c i t y in d e t e c t i o n of s i g n i f i c a n t stenoses w e r e 0.57 abd O . 8 0 , r e s p e c t i v e l y . The m a i n r e a s o n s for low s e n s i t i v i t y in f e m o r a l r e g i o n are t h a t the a d d u c t o r chanal r e m a i n e d o u t s i d e of the g a m m a c a m e r a field, and the p r o x i m a l o c c l u s i o n s i n t e r f e r e d the v i s u a l i s a t i e n of the f e m o r a l region. C o n c l u s i o n : The r a d i o n u c l i d e a r t e r i o g r a p h y is a u s e f u l n o n i n v a s i v e m e t h o d for d e t e c t i o n of t o t a l a r t e r i a l o c c l u s i o n s in the a o r t o - i l i a c region. D e p a r t m e n t of C l i n i c a l P h y s i o l o g y , North Karelia Central Hospital, g F - 8 0 2 1 0 Joensuu, F i n l a n d

A59 A351

A352

~ R I P H E R A L BLOOD FLOW STUDIED WITH 99mTc-ALBUMIN, mTc-ERYTHROCYTES IN COMPARISON WITH H AEMATIC ANO PLASMATIC VISCOSITY. I. Indovina, N. Custro, I. Patane!la, V. Sca~idi, V. Di Garbo and G. veilone.

EXERCISE PLACENTAL PREGNANT Rauramo

The diabetic and atherosclerotic patients have shown in previous studies some alterations in ~he ]31I-~b. build up curves executed on the feet. On the other hand new studies have shown in the same patients an alterated haematic and plasmatic viscosity. In the present work we have @cmpared the results of build up curves with ~BmTc-alb. and with 99mTc-erythrocytes on the feet and the data of haematic and plasmatic viscosity of 30 patients (12 atherosclerotics, 12 diabetics, 6 controls). The build up curves have been evaluated through the time (Ta) at which they go up "plateau". In the control subjects ta resulted 3'30"± ~5" (right foot) and 4'00" ± 45" (lift foot) at the research with marked albumin, and 4'15" 2 20" (r.f.) and 4'00" • 3O" El.f.) at the research with marked erythrocytes. In the atheroselerotles, instead, T a resulted 9'50" • 4'20" (r.f.) and I0'15"*2'50" (l.f.)in the research with marked erythrocytes. In diabetics the T a resulted 13' ± 2'40" (r.f.) and 12'20" ± 2'30" (l.f.) at the research with marked albumin, and 11'30" ± 3'10" (r.f.) and II'25" ± 3'20" (1.f.)at the research with marked erythrocytes. The T a resulted hlgh significantly different both in atherosclerotic and in diabetic patients compared to the control subjects (p ~ 0.0005). A significant correlation between the T a of build up curve~ with marked erythrocytes and the in vitro haematic viscosity has been found in atherosclerotio patients (p • 0.01). A significant correlation between the T a of build up curves ~ith marked erythrocrees and the in vitro red cells filtrability has been also found in diabetic patients (p~

A 353 AND BLOOD WOMEN.

INTERVILLOUS FLOW IN HEALTHY M. F o r s s and I.

The intravenous 133xenon method was used for a s s e s s i n g intervilious placental blood flew (iBF) before, immediately and 30 minutes after submaximai exercise test with a bicycle ergometer. Twenty six healthy pregnant volunteers participated in the study. Their mean age was 26.6 years (range 19-35). Twenty two of them were primiparous, 3 had her second and one her third pregnancy. Fourteen subjects were studied both at 32-3% and at 37-~0 pregnancy weeks. Tweive subjects were studied once at 37-g0 weeks. Totally g0 measurements were done. SubmaximaJ physical exercise did not seem to have an effect on IgF. IBF was 9~_+18(SD) ml/min/100ml before, 97+23 immediately after and 95+16 30 m i n u - t e s after the exercise in t h e whole study group. The type of reaction to exercise a n d the m a g n i t u d e of I B F w e r e s i m i l a r in the both pregnancy phases. The results were similar a l s o in t h o s e s u b i e c t s studied serially. Paired and unpaired students t-test was used to s t a t i s t i c a l a n a l y s i s . Ihe data suggests that short physical exercise does not compromise intervillous placental blood flow and hence the fetus in h e a l t h y p r e g n a n t h u m a n s . I & II Departments ol Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmaninkatu 2, 5 F - 0 0 2 9 0 H e l s i n k i 29, F i n l a n d

0.01). Chair of Medical Pathology of Palermo University, Piazza della Cliniche, 2, 90127 Palermo, Italy.

BONE METASTASES IN P R I M A R Y O P E R A B L E BREAST CANCER. THE ROLE OF SERIAL SCINTIGRAPHY. O l e M u n c k , H e n r i k S. Thomsen, dens Otto Lund, Znud West Andersen, Mikael Steckel and Niels ROBBing. In 1978 a n d 1 9 7 9 , 1 0 6 0 D a n i s h p a t i e n t s with primary operable breast cancer were bone-scanned for osseous metastases b e f o r e e n t e r i n g a nationwide therapeutical trial. A re-reading group interpreted the scans produced in 12 p a r ticipating hospitals. As s consequence standardized guidelines for interpretat i o n w e r e a g r e e d u p o n f r o m 1979. T h e f r e q u e n c y of p o s i t i v e bone scans suggesting bone metastases fell abruptly f r o m 1 9 7 8 t o 1979 as r e a d b o t h l o c a l l y and by the re-reading group. ~he difference between the interpretations of the local and the re-reading groups remained statistically unchanged. Of t h e 1060 p a t i e n t s 760 were followed by repeated pro-scheduled s c a n s 6 a n d 12 months after surgery or until a recurrence was diagnosed. O n l y 37 of t h e 760 patients (4.9%) d e v e l o p e d bone metastases verified by r a d i o l o g y or a u t o p s y during the first 2 years after surgery. A single positive scan, especially if performed 6 or 12 m o n t h s a f t e r s u r g e r y , as w e l l as t w o or t h r e e c o n s e c u t i v e positive scans significantly increase t h e r i s k of d e v e l o p i n g bone metastases w i t h i n 12 m o n t h s a f t e r t h e l a t e s t scan. In 13 o f t h e 37 p a t i e n t s with otherwise subsequently proven bone metastases t h e s c a n s w e r e n e g a t i v e . It is c o n cluded that a fixed schedule of r e p e a t e d b o n e s c a n s in p a t i e n t s with b r e a s t c a n c e r is n o t w a r r a n t e d . Department of C l i n i c a l Physiology and Nuclear Medicine, Herlev Hospital, University of C o p e n h a g e n , DK-273o Harley, Denmark.

A 354

A355

A356

DETECTION AND VISUALIZATION 0F LESIONS OF THE SKULL BY SPECT. A CRITICAL STUDY. M. De non, L. Mortelmans, P. Devos, V. Van Den Maegdenbergh. Department of Nuclear Medicine, Universitaire Ziekenhuizen, g.u. Leuven, Belgium.

METASTATIC DISEASE OF THE SPINE WITH SEGMENTAL ANALYSIS,AS SEEN BY BONE SCINTIGRAPH¥. J. FrUhling.

QUANTITATIVE RADIONUCLIDE IMAGING OF TIBIAL FRACTURES. E A J o n e s , M A S m i t h , P T o t h i l l , S P F Hughes, R K Strachan, J Gormley, J d K Best.

In order to study the usefulness of SPECT for detection and localization of bone lesions within the skull, we explored 200 cases. These patients were studied 3-4 hours after administration of Tc 99m MDP, uslng a dual head gamma camera emission tomographic system. The traeerdistribution was visuzaiized in transverse, sagittal and frontal planes. The normal tomoscintigraphic appearance of the skull and variants will be described. After elimination of special patientgroups (bone grafts, orthodontic cases) the data of 125 patients were available for analysis, yielding 56 cases with negative results and 69 eases representing with a total of iBl lesions. Twenty one localizations (16% of the total group) were only visible on scintitomographlc images, hundred and ten hyperactive zones were visible on both. Discrepancies occur seldom In lesions of the cranium (only 4 out of 71), on the contrary lesions of the facial bones (IO out of 29) and the base of the skull (7 out of 17) are frequently missed on the planar images. ScintiPomography was false negative in only one lesion out of 49 visible on skull radiographs (eosinophilic granuloma). In the same patients however 59 hyperactive zones were found, indicating as expected, a greater sensitivity of the seintigraphic technique. Together with better visualization of skull lesions and their extent. BPECT reveals often unsuspected bone abnormalities especially in the facial bones and the base of the skull.

The d i s t r i b u t i o n of bone metastatic l o c a l i z a tions has been studied in 2532 patients with h i s t o l o B i c a l l y proven neoplasic disease, among them 752 cases of breast-ca, 656 lung carcinomas, 295 melanomas, 257 head and neck-,210 d i gestive t r a c t cancers, 204 lymphomas, 85 prost a t i c and 73 thyroid cancers. The analysis of the obtained data led to the following s t a t e ments : - 1036 cases (40,9 %) preseeted a proven metastatic attempt of the skeleton. - Prost a t i c and breast ca. show the highest percent (73 and 43 %) of metastatic bone disease and the most important incidence of spine i n v o l v e ment (80 to 89 % of a l l metastatic f o c i ) . - Lymphumas, melanomas, head and neck carcinomas exh i b i t about 50 % of metastases localized else ~ where than in the v e r t e b r a l column. - The i n c i dence of pure spinal metastatic bone attempt remains under 10 % in a l l cancers studied, except in lung ca. - In 88 g of a l l p o s i t i v e cases there were multiple pathologic foci in the spine. - 16,1% of a l l spinal metastatic IDealizations (unique or m u l t i p l e ) were i d e n t i f i e d in the c e r v i c a l segment, 45,9 % in the dorsal vertebrae and 38 % in the lumbar spine, corresponding to a "from the top to bottom g r s d i e n t " , t h e incidence expressed as percent metastase p e r i n d i v i d u a l i z e d vertebra being r e s p e c t i v e l y , 2,29 % f o r the c e r v i c a l , 3,82 % f o r the thorac i c and 7,11% f o r the lumbar vertebrae. - The high degree of the spinal metastatic disease, the differences in several cancers encount e r e d and the existence of the above mentionned gradient support the important role of the vertebral venous system in the e t i o l o g y and N s t # i bution of bone metastases in the spine. Laborstoire des Radio-lsotopes, I n s t i t u t Jules Border, Universit~ Libre de Bruxelles, lOOO Bruxelles, Belgium.

In a study to predict fracture healing, quantitative radionuclide imaging has been performed over both lower legs of patients with a tlbial fracture of one leg. Images were collected at 5 minutes after injection o f 2OO MBq Tc99m-MpP ( e a r l y u p t a k e ) , considered to reflect bone b l o o d f l o w , and a t g hours (late uptake), considered indicative of b o t h bone b l o o d f l o w and bone f o r m a t i o n . The r e s u l t s w e r e a n a l y s e d by c h o o s i n g r e g i o n s of interest on b o t h l o w e r l i m b s , "A" b e i n g defined as the total counts, normalised for area, in a region around the fracture and " C " , t h e c o u n t s i n a r e g i o n o f n o r m a l b o n e above t h e f r a c t u r e - "B" a n d "D" a r e l i k e w i s e f o r r e g i o n s a t t h e same l e v e l s b u t i n t h e c o n t r a lateral normal leg.

The m o s t s i g n i f i c a n t difference (P~O.OO1) between the union and non-union groups is d e m o n s t r a t e d u s i n g t h e r a t i o A/C f o r t h e e a r l y uptake at 2 weeks after fracture, with little overlap of the groups. A significant difference (P~O.Ol) between g r o u p s i s a l s o s e e n u s i n g A/B f o r t h e l a t e u p t a k e a t g w e e k s , b u t w i t h a l a r g e amount o f overlap. This is also the case for the ratio A/C x B/D. R e s u l t s so f a r s u g g e s t t h e p o s s i b i l i t y of predicting n o n - u n i o n i n an i n d i v i d u a l patient with a good degree of sensitivity (87%) and specificity (1OO%). Dept of Medical Physics and Medical Engineering~ Orthopaedic Surgery and Medical Radiology, Royal Infirmary, Edinburgh, Scotland.

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LOCAL PERFUSION AND SUBSTRATE UPTAKE B Y TUMORS. W . H . K n a p p , A . B r a u n , K.Rohe, S.Matzku, F.Helus and H.Ostertag

THE POTENTIAL OF POSITRON EMISSION TOMOGRAPHY (PET) AND CARBON-II-LABELED AMINO ACIDS FOR STUDYING PANCREATIC AND OTHER NEOPLASMS. K. F. Hubner, L. C. Washburn, and E.C. Holloway

P O S I T R O N E M I S S I O N T O M O G R A P H Y IN S T U D Y OF E F F E C T O F R A D I A T I O N T H E R A P Y ON S O F T T I S SUE TUMORS. A.-L. K a i r e n t o ~ G . L . B r o w n e l l M.R. Swartz, S. W e i s e a n d D. V a r n u m

M a l i g n a n t t u m o r s h a v e b e e n f o u n d to show high substrate utilization. Using l a b e l e d a m i n o - a c i d s in vivo, t u m o r s e x h i b i t e d i n t e n s e a c t i v i t y uptake. T h i s s t u d y was u n d e r t a k e n to e v a l u a t e whether i n c r e a s e d u p t a k e o f g l u t a m i c a c i d (glu) is d u e to i n c r e a s e d s u b s t r a t e availability b y the b l o o d stream, or w h e t h e r increased uptake reflects cellular a l t e r a t i o n s in m a l i g n a n c y . TI-201 (patients) a n d 1-121-microspheres (MS) or C - 1 1 - b u t a n o l (rats) w e r e u s e d to g i v e a r e l a t i v e m e a s u r e of local perfusion. Glutamic acid was enzymatic a l l y s y n t h e s i z e d and l a b e l e d w i t h N-13. In 25 t u m o r t r a n s p l a n t s of the r a t (5 d i f f e r e n t tumor lines), i d e n t i c a l values w e r e f o u n d for N - 1 3 - g l u u p t a k e a n d for 1 - 1 2 1 - M S r e t e n t i o n up to 4 - f o l d c o n t r o l v a l u e s (r=O.88). A b o v e v a l u e s of 4, N - 1 3 - g l u u p t a k e e x c e e d e d the M S r e t e n tion. However, w h e n a d i f f u s i b l e f l o w t r a c e r w a s u s e d (C-11-butanol) in these t u m o r s (N=4), f l o w p a r a l l e l e d g l u uptake. In 12 p a t i e n t s , N - 1 3 - g l u and i n i t i a l T1-201 u p t a k e b y 9 m a l i g n a n t a n d 3 b e n i g n l e s i o n s w a s d e t e r m i n e d . No systematic differences hetween flow and s u b s t r a t a u p t a k e w a s o b s e r v e d (r=O.92) within a range from 1.5-9.5-fold uptake as c o m p a r e d to a n o r m a l c o n t r o l area. Different from in-vitro conditions, increased substrate utilization by t u m o r s a p p e a r s to be e n a b l e d a n d c o n trolled by vascularization. Therapy c o n d i t i o n s are b e i n g i n v e s t i g a t e d .

Institute of Nuclear Medicine, G e r m a n C a n c e r R e s e a r c h Center, D-6900 Heidelberg, FRG

PET has been shown to provide quantitative information on the biodistribution of positronemitting radiopharmaceuticals. Using carbon-ll labeled amino acids it should he feasible to study metabolic aspects of tumor growth by measuring amino acid transport and possibly utilization. This concept was tested in 74 patients with either cancer of the pancreas or other malignant tumors. Two essential amino acids, tryptophan and valine, as raeemic mixtures and in the natural L-form, and two unnatural amino acids, l-aminoeyclopentaneearboxylie acid (ACPC) and its eyclehutane analog (ACBC), were used for these clinical investigations. A modification of the DdchererStrecker synthesis technique was employed for labeling the amino acids with earbon-ll and an ECAT-II(TM) scanner provided positron tomegraphic images. The results overall gave an 82% true positive rate and indicated that these amino acids appear to be particularly useful for studying cancer of the pancreas and brain tumors. In view of the relatively poor spatial resolution of currently operating PET imaging devices, this technique is not yet likely to be of significant value in the early detection of cancer. However, non-invasive positron tomographie determination of amino acid uptake by tumors lends itself to provide information on tumor growth and may therefore be of therapeutic and prognostic value for the cancer patient. K. F. HHbner, Medical and Health Sciences Division, Oak Ridge Associated Universities, P. 0. Box 117, Oak Ridge, TN 37831. (This is based on work performed under Co~tract Number DE-AC05-760R00033 between the U. S. Department of Energy, Office of Energy Research and Oak Ridge Associated Universities and hy National Pancreatic Cancer Project Grant #CA 29490.)

C150) - and 1 5 0 9 - s t e a d y s t a t e

technique

w a s ~ s e d in f o l l o w u p s t u d i e s of r e g i o n al b l o o d f l o w (RBF) a n d o x y g e n m e t a b o l i c r a t e (ROMR) in s i x r a b b i t s i m p l a n t e d w i t h V 2 - t u m o r in tigh. M e a s u r e m e n t s w e r e d o n e b e f o r e the therapy, one d a y a f t e r the last t r e a t m e n t a n d o n e w e e k later. T h e r a p y c o n s i s t e d of 2400 r e d s g i v ~ in 3 f r a c t i o n s on c o n s e c u t i v e days. C 0 2 t e c h n i q u e w a s a l s o u s e d to s t u d y c h a n g e s in R B F in t u m o r s in 8 p a t i e n t s u n d e r g o i n g therapy. M e a s u r e m e n t s w e r e d o n e before therapy, at t h e d o s e level of 5000 rads and in 2 p a t i e n t s 2 w e e k s a f t e r t h e therapy. B l o o d v o l u m e c o r r e c t i o n w a s d o n e u s i n g e i t h e r I I c o or 6 8 G a C I 3. A c c o r d i n g r a b b i t s t u d i e s the R B E inc r e a s e d in tu/nor f r o m 1 5 . 2 ± 2 . 3 m l / m i n / 100cc to 2 9 . 7 ± 1 7 . 8 m l / m i n / 1 0 0 c c b e c a u s e of r a d i a t i o n . O n e w e e k a f t e r the t h e r a p y the R B F w a s 9 . 8 ± 4 . 3 ml/min/lOOcc. In n o r mal tissue the corresponding values were 4.5±0.5, 9 . 9 ± 4 . 3 a n d 6.3±2.6 m l / m i n / 1 0 0 cc. T h e v a l u e of R O M R d e c r e a s e d in t u m o r d u r i n g r a d i a t i o n f r o m i 0 7 ~ 6 7 to 7 1 ± 4 ~ m o i / m i n / 1 0 0 c c . O n e w e e k a f t e r the t h e r a p y the R O M R w a s 69~38 @mol/min/lOOcc. In normal tissue the corresponding values w e r e 20±9, 4 1 + 2 5 a n d 34~4 ~ m o l / m i n / 1 0 0 c c . In h u m a n s t u d i e s the t u m o r b l o o d f l o w i n c r e a s e d at a r a t e of 4-5 % p e r d a y d u r i n g r a d i a t i o n and in 2 p a t i e n t s s t u d i e d the blood flow decreased after the thera p y to t h e level p r i o r to r a d i a t i o n . T h i s k i n d of a p p r o a c h w i l l g i v e u n d e r s t a n d i n g of b i o l o g i c a l b e h a v i o r of tumor. O n t h e b a s e of r a d i o s e n s i t i v i t y it seems i m p o r t a n t to t a k e a c c o u n t c h a n g e s in R B F a n d R O M R w i t h i n t u m o r d u r i n g r a d i a t i o n therapy. University Central Hospital, Meilahti H o s p i t a l , S F - 0 0 2 9 0 H e l s i n k i 29, F i n l a n d Massachusetts General Hospital, Boston

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PANCREATIC FUNCTIONAL PCT IMAGING USING Zn-62-EDDA. Y.Fujibayashi, A.Yokoyama, I.Yomoda, K . H o r i u c h i , H . S a j i and K . T o r i zuka.

DETECTION OF COLON CARCINOMA WITH 1-123 LABELED F (ab')2 FRAGMENTS OF MONOCLONAL ANTI-CEA ANTIBODIES AND ECT. B.Delaloye, A.Bischof-Delaloye, J.Ph.Grob, F.Suehegger, V.von Fliedner and J.P.Mach.

IMMUNOSCINTIGRAPHY OF COL0-RECTAL CARCINOMA: REMARKS ABOUT AN ONGOING CLINICAL TRIAL. G.L. Buraggi, L. Callegaro, A. Turrin, E. Bomhardieri, L. Gennari, G. Mariani, R. Doci and E. Seregni

ECT with 1-123 (p,5n)[3-4mCi) labeled F(ab') 2 fragments (1.5mg) of monoclonal anti-CEA antibodies (NO 202 and 35) was performed in 14 patients {4 primary, 3 recurrent tumors, ii metastatic diseases) 6,24 and 48h after injection with a dual head rotating camera device. Tumor to normal tissue (mucosa, serosa, fat, blood) activity ratios could be measured on surgically resected material in 4 patients. These ratios were 6/8/15/9 with F(ab')2MAb 202 {n=l) and 1.3-3/4.7-7.7/4.7-15.5/0.5-2.2 with F(ab')2MAb 35 (n=3). All primary and recurrent tt~nors were visualized by ECT, the best images being obtained 24h p.i. 2/2 small lung metastases in a patient under chemotherapy could not be demonstrated. Of the eight patients with liver involvement 4 showed clearly positive, 2 equivocal and 2 negative ECT images. Image contrast was enhanced on the 48h pictures in the positive cases, 2 of them having cold areas on the 6h scan which gradually "filled up" later on. 2 patients presented g bone metastases, 6 of them being detected on the planar images already, 2 dorsal metastases {D6, DE) could be distinguished from thoracic blood pool by ECT only. Thus 19/25 tumor sites were correctly localized whereas 2 remained equivocal and 4 negative. The major advantage of this method rests in the high quality of the images which permits to distinguish tumor accumulation from physiological organ concentration and circulating antibody without artifacts inherent in subtraction techniques.

A clinical trial on the use of anti-CEA monoclonal antibodies (MoAb) in patients bearing colo-rectal tumors was started in our Institute in November 1983. The aim of the study is the evaluation of the cl~nical usefulness of immunoseintigraphy in the detection of tumor relapses. 0nly those patients with primary colo-rectal carcinomas, with or without hepatic metastases, for whom a laparotomy for hepatic surgery or preparation for intraarterial infusion is planned are admitted to the trial. Therefore, in each patient immunoscintigraphy is followed by tumor tissue examinations both by radioactive measurements and by immunostaining. Although the data thus far collected from this ongoing study are insufficient to draw conclusions as regards the main goal of the trial, some remarks may be made about the methods used for such a study. These remarks derive also from our previous experience with anti-melanoma MoAb and F(ah')2. Subtraction techniques are applicable only in particular conditions, whereas SPECT appears ta be a ~ r e suitable technique to study depth localizations, l~munostaining, performed within a short time after scintigraphic examination in our laboratory, makes it possible to quickly establish for each patient a correlation between the scintigraphic results and the reactivity of the examined tumor for the employed MoAb. In this way, it is possible to obtain an accurate selection of true-negative and true-positive cases.

In o u r e a r l y findings, h i g h p a n c r e a s d i s t r i b u t i o n of r a d i o a c t i v e z i n c ( a n ) , if a d m i n i s t e r e d as Z n - E D D A ( E t h y l e n e d i a m i n e N , N ' - d i a c e t i c acid) h a s b e e n a c h i e v e d . As Zn is c l o s e l y a s s o c i a t e d w i t h e x o c r i n e and e n d o c r i n e f u n c t i o n s of p a n c r e as, e x p l o i t a t i o n of Zn m e t a b o l i s m for an a n a t o m i c a l a n d f u n c t i o n a l d i a g n o s i s was c o n c e i v e d , n a m e l y w i t h the r e c e n t a v a i l a b i l i t y of p o s i t r o n e m i t t i n g Zn-62 (half l i f e = 9 hours). In the p r e s e n t paper, r e s p o n s e c h a n g e s in gn b i o d i s t r i b u t i o n (mice) a n d Zn exc r e t i o n t h r o u g h the p a n c r e a t i c d u c t (rats) to the s t i m u l a t i o n of g a s t r o i n t e s t i n a l (GI) h o r m o n e s ( e x o c r i n e stimu l a t i o n ) like s e c r e t i n , C C K - P Z a n d g l u cose (endocrine stimulation) were stud led. U n d e r t h e s e stimulus, t i s s u e b i o d i s t r i b u t i o n in m i c e i n j e c t e d w i t h gn-65 (half life = 270 days) s h o w e d p a n c r e a s s p e c i f i c d e c r e a s e of r a d i o a c t i v e Zn w h e n e v e r GI h o r m o n e w a s p o s t - a d m i n i s tered; w h e r e a s g l u c o s e l a c k e d effect. A l s o the p a n c r e a t i c s e c r e t i o n of r a d i o a c t i v e Zn ( p a n c r e a t i c d u c t c a n n u l a t i o n , L o v e ' s m e t h o d ) s h o w e d i n c r e a s e d Zn sec r e t i o n o n l y u n d e r the C C ~ - P Z effect, 3 h r s p o s t Zn-65 i n j e c t i o n . Thus, the e f f e c t i v e m o b i l i z a t i o n of the i n j e c t e d r a d i o a c t i v e gn, u p o n e x o c r i n e s t i m u l a t i o n , r e p r e s e n t e d by CCK-PZ, fav o r e d the e x p l o r a t i o n of f u n c t i o n a l study of t h e p a n c r e a s w i t h the p o s i t r o n c o m p u t e d t o m o g r a p h (PCT) u s i n g z n - g 2 EDDA, in dog. G r e a t e v i d e n c e of t h e a p p l i c a b i l i t y of this s y s t e m in r e g i o n a l f u n c t i o n s t u d i e s of p a n c r e a s was o b t a i n ed. In v i v o d e m o n s t r a t i o n of Zn p a r t i c i p a t i o n in t h e e x o c r i n e f u n c t i o n of the pancreas holds considerable promise. Radioisotopes Research Laboratory, Kyoto University Hospital, 54 S h o g o i n , K a w a h a r a - c h o , S a k y o - k u , Kyoto, 606 J a p a n

Nuclear Medicine Division CHUV, CR-1011 Lausanne and Ludwig Institute for Cancer Research CH 1066 Spalinges

Nuclear Medicine Department, Istituto Nazionale Tumori, Via Venezian i, 20133 Milano, Italy.

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IM~NOSCINTIGRAPHY OF METASTASISINO PROSTATIC CARCINOMA WITH PROSTATIC ACID PHOSPHATASESPECIFIC POLYCLONAL ANTIBODIES. P. Vihko, J. Heikkil~, M. Kontturi, O. Lukkarinen, L. Wahlberg and R. Vihko

A PROSPECTZ~gE S~JDY 0~ RADI0//IHUNOSCT/~TIGIL~mHY

CLINICAL USEFULNESS OF RADIOiMMUNOSCINTIGRAPHY ( RIS ) IN TUMOR IMAGING OF THE LOWER ABDOMEN USING MONOCLONAL ANTIBODIES N.Pateisky*,K.Philipp*, J. B u r c h e l l * ~ , D.Skodler*. * I s t D e p a r t m e n t o f G y n e c o l o g y and O b s t e t rics, University o f V i e n n a , AUSTRIA **Imperial Dancer R e s e a r c h Fund, Lincoln's Inn F i e l d s , London,ENGLAND

Polyelonal antibodies were raised in rabbits against the main human prostatic acid phosphabase (PAP) (enzyme A, pl 4.9), purified to homogeneity. The antibodies were purified by affinity chromatography using i~obilized pAP, and Feb fragments were purified on protein A Sepharose. The antibodies or their Pab fragments were coupled Co diethylene triamine ? enta-acetic acid, and labelled with 99mTc or illln. The labelled derivatives retained their i~unologieal reactivity with PAP in vitro. The doses of radioactivity and protein injected into patients with prostatic carcinoma were 0.7-11 mCi and 50-500 pg, respectively. The nine patients investigated so far had T3r 4 NxM I prostatic carcinoma. Six patients were injected with an antibody labelled with 99mTc, one with a Feb fragment also labelled with 99mTc, and two with an antibody labelled with lllln. The metastases, including those in the bones, which had been observed in the patients using X-rays or bone seintigraphy, could he visualized with the immunoscintigraphie techniques used. In addition, in one of the patients studied, a distinct incorporation of radioactivity was also observed in the left inferior scapular region, which was not seen by conventional bone scanning, hun was later confirmed by X-ray studies to be a metastatic process. Immunoseintigraphy of prostatic carcinoma is a promising approach and needs further evaluation. Department of Clinical Chem~istry, University of Oulu, SF-90220 Oulu, Finland

~ T H 123-1 MONOOLONAL ANTIBODY IN 26 PATIENTS ~ T H SUSPECTED OVARIAN CANCER G~anowska,M., Shepherd,J., ~ather,S., Carroll, M.J., Flatman, W.D., Nimmon,C.C., Taylor-Papadimitriou, J., Ward,B., Horne,T., and Britton, KoE. Prospective studies a~e needed to evaluate the clinical eIficaoy of radioimmunolooalisation techniques if they are to develop into routine practice. Monoelonal antibody against human milk fat globt~e antigen HI4FG2 is active against an epithelial surface antigen lining ovarian follicles. Using the Iodogen technique HMFGg was labelled with 123i. After completin~ a pilot study in 25 patients successfully, we report a prospective study in a further g6 patients with suspected or oor~firmed ovarian carcinoma. Dynamic imaging was undertaken, then static imaging at 10 mln. 4 h and 22 h usi-~ a computer linked gamma camera. After patient and computer aided ~epositdoning techniques, target to non target ratios were improved where n e c e s s ~ usir~E proportional s~btraobion of the i0 rain f~om the 4 h s/Id 22 h images. Followi/lE the study the patient went for surgel7 and these findings were recorded independently. A good co~relation was fotn%d between radioin~unoseimtigraphy and the sumgioal findir4Es in 17/18 patients with malignant ovarian turnouts. However good uptake occurred in 2 benign ovarian tumolrcs, 1 fibroid and 1 hopetome seconder7. Equivocal uptake was seen in 4 non ovs]0i~n tl~moztrs. The results ~uggest that the technique should not he used to screen pelvic tu~ours but that in known ovarian ca/leer sta~ing is helped and the :seoond look' operation to assess chemotherapeutic response may be avoidable. St B~cctholomew's Hospital, West Smithfield, London, E01. & Impemia~ 0anoer Research Fux~d Lsboratorles, Lineodn~s Inn Fields, London WO2,

Effective t h e r a p y o f c a n c e r depends on accurate detection and l o c a l i z a t i o n of t h e d i s e a s e . R[S p r o v i d e s a new method developed for locating tumors in vivo. It i s based on a p p l i c a t i o n of radioactive labelled antibodies against tumorasso: c i a t e d m a r k e r s . In o u r t r i a l s we used a m o n o c l o n a l a n t i b o d y ( HMFG-2 ) p r o d u c e d by t h e h y b r i d - t e c h n i q u e at the Imperial Dancer R e s e a r c h Fund L a b o r a t o r i e s in London. A f a v o u r a b l e r e g i o n f o r RIS r e p r e s e n t s t h e l o w e r abdomen w i t h i t ' s only slight problems of backgroundactivity. There= fore carcinomas of the genitourinary tract as w e l l as c o l o r e c t a l carcinomas g i v e s a good t a r g e t f o r RIS. All of the patients we i n v e s t i g a t e d were o p e r a t e d a few days a f t e r c a r r i i n g o u t t h e s c a n s . The p a t i e n t s were e i t h e r suspected of having a primary ovarian cancer or a recurrence, respectively. All tumor sites including metastases, w h i c h were r e c o g n i z e d by t h e scans c o u l d be f o u n d at t h e o p e r a t i o n . So t h e p r o dictive v a l u e o f t h e method was v e r y good.

T h i n k i n g on t h e p r o b l e m s o f o v a r i a n c a n c e r d i a g n o s i s and t r e a t m e n t we assume that there will be t h e g r e a t e s t u s e f u l = t e s s o f RIS. Our r e s u l t s showed c l e a r l y , t h a t RIS i s a b l e t o r e v e a l t u m o r s i t e s w h i c h may n o t be d e t e c t e d by o t h e r m e t h o d s , e s p e cially i n t h e r e g i o n o f t h e l o w e r abdomen.

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TISSUE DISTRIBUTION IN MAN OF MONOCLONAL PREPARATIONS FOR TUMOR IMMUNOSCINTIGRApHy O. Mariani, L. Callegaro, N. Mazzuca, E. Cecconato, M. Giganti, N. Molea, S. Colosimo, A, Fatiganti, G.L. Buraggi and R. Bianchi

TUMORDOSES IN THE APPLICATION OF 131I-NETAIODOBENZYLGUANIDINE.

IMPAIRMENT OF SALIVARY GLANDS FUNCTION IN PATIENTS WITH THYROID CARCINOMATREATED WITH RADIOIODINE. D.Franceschi, M.Senjanovld, Z.Kusid and S.Spaventi

The tissue distribution of monoclonal preparations was evaluated in patients (pts) not affected by the ttrmor for which the antibodies were specific. Clone F023C5 (IgG I) was specific for CEA and 16B13 (IgG2a) for human lung tumors. Whole IgGs and F(ab') 2 (Feb) were labeled with 1311 (iodogen moth od), at specific activities of 8-20 mmi/mg. The kinetics of 13tI-F023C5 IgG and Feb were studied in 4 pts each, and 1311-16B13-Fab in 5 pts. Plasma disappearances, whole-body imaging, liver and spleen uptakes were evaluated daily up to 6 days; a computerized gamma-cap,era was utilized. Following similar early kinetics of distribution [=45% of initial activity in plasma at 24 hrs), FO23C5-Fab showed a faster decay than IgG: terminal T~ 50.3 ± 6.2 versus R8.0 ± 11.7 hrs. No significant differences were found in the liver and spleen uptakes, that were moderate for both tracers. With ~40% of initial activity in plasma at 24 hr~, 16B13-Fab had a termin~l T~ of 6Q.2 ± 6.3 brs; t6B]3-Fab consistently showed a relevant uptake in the normal lungs, of approximately the same degree as in the liver and spleen. The results obtained show that no advantages derive from the use of Fab versus whole IgG with clone F023C5. Clone 16Bl3 does not appear to be suitable for lung tumor immunoscintigraphy, due to the important in vivo uptake by normal lung structures, despite the virtually absent cross-reactivity with normal tissues exhibited in vitro. C.N.R. Institute of Clinical Physiology, 5th Medical Pathology, and Institute of Radiology of the University of Pisa; SQRIN Biomedica, Saluggia; Istituto Nazionale Tumori, Milan, Via Savi 8, 1-56100 Pisa, Italy.

B, Kimmig, H. Bihl, B. Bubeck, J, Adolph

The highly s e l e c t i v e uptake of meta-iodobenzylguanidine (MIBG) permits a s p e c i f i c r a d i o i s o topic therapy f o r pheochromocytoma. Except single case reports there are no s p e c i f i c a t i o n s about the achievable r a d i a t i o n dose in the tumor tissue. We therefore performed a systematic analysis to determine these values. During s c i n t i g r a p h i c examination of pheochromocytoma k l"n e t l c" s of 1311 -~IBG were studied in 9 p a t i e n t s , 7 of those s u f f e r i n g from a benign, g from a malignant pheochromocytoma. Maximum uptake and e f f e c t i v e h a l f - l i f e were measured by gamma-camera. The tumor mass was evaluated by CT. Using these data the r a d i a t i o n dose accumulated in the tumor tissue was calculated and related to I mBi of applied a c t i v i t y (20-4o rad/mDi). In the 2 patients with malignant pheochro~Q~ cytoma a therapy with high a c t i v i t i e s of i ~ i l _ MIBG was performed. The values of h a l f - l i f e and r e l a t i v e uptake in the tumor measured during therapy f i t t e d well with the diagnostic data: l i n e a r r e l a t i o n s h i p of applied a c t i v i t y was found when compared with tumor dose. An intensive tumor uptake of 1311-MIBG could also be demonstrated in a patient with neuroolastoma. Measurements using t r a c e r a c t i v i t i e s showed a r e l a t i v e maximum uptake of more than 3o% and a h a l f - l i f e of 56 hours. In that case a s e l e c t i v e r a d i o i s o t o p i c therapy seems to be possible as w e l l . One can even expect a higher therapeutic e f f i c i e n c y as the neuroblastoma is known to be more r a d i o s e n s i t i v e than the pheochromocytoma. Zentrum Radiologie der U n i v e r s i t ~ t Heidelberg ( S t r a h l e n k l i n i k ) , VoBstraBe 3, 69oo Heidelberg, West Germany (F.R.G.)

In the patients with d [ f f e r e n t { a t e d thyroid carcinoma usual procedure a f t e r surgical treatment is rad[oiodine ablation of residual thyroid t i s sue. Metastases which accumuiate iodine are also treated with 131[. In 42 of these patients s a i l vary gland scintlgraphy was performed using 7.qMeq/kg 99mTe~pertechnetate before and a f t e r stimulation by D v i t a m i n , in order to determine possible damage of the s a l i v a r y glands. The pat i e n t s were divided in three groups: the f i r s t group included 15 patients with residual thyroid tissue before redioiodine therapy; the second 20 patients treated with 2.96-3.7 GBq 13]1; the t h i r d - 7 patients who had received over 7.4 GBq I 3 f l . In order to observe the influence of TSH on salivary gland function scintigraphy was perFormed ~n g patients both on and off replacement therapy. In the patients of the first group normel salivary glands function was found. 11 patients in the second group revealed slight deterioration in accumulation in and excretion by the salivary glands. The influence of TSH was not found, In all patients in the third group abnormalities in salivary glands function was observed: from severe functional impairment to complete nonvisua]ization of the glands. In three of seven patients who were followed-up in longitudinal studies slight abnormalities in salivary glands function were established after first radioiodine therapy (2.96-3.7 gBq 1311). We found significant impairment of salivary glands Function which depends of the radioiod[ne dose received. In the study that is under way we intended to reduce the [mpalrment of salivary glands function by frequent stimulation of salivary excretion after rad[oiodlne application. Nuclear Medicine & Ontology Cl[nic~ "Dr. Mladen Stojanovld" C1inlcal Hospital, Vinogradska 29, 4~000 Zagreh, Yugoslavia.

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THE T R E A T M E N T OF D I S T A N T M E T A S T A S E S OF THE T H Y R O I D C A N C E R . E V A L U A T I O N OF O U R E X P E R I E N C E . L.Troncone, M.L.Maussier, O.Carline, P.Mangani, P.Montemaggi.

S~,iE P A C T O R S A 2 2 E O T Z N G SUIIVIVAL O ~ PIIEV E N T I V E TICfROID A B L A T I O N I N G R A D E i T } ~ L 0 1 D C~iICERS. J . N ~ m e c , V . Z a m r a z i l , D. Pahankov~, S.H~hling, V.Holub

NON-INVASIVE ANALYSIS OF FACILITATED TRANSPORT OF HEXOSE IN THE HUMANBRAIN, A STEP NEEDED FOR IMAGING ENERGYMETABOLISM. J.-R. Magloire, K. Vyska, A. Schmid, L.E. Feinendegen

The results obtained with an integrated treatment (I-131-therapy, external radiotherapy,surgery and chemotherapy) in cases of metastatic thyroid cancer over a 15 years period (198e1983) have been evaluated• Out of 258 cases of proven thyroid carcinoma, 56 developed distant metastases. 35 of these cases were histologica! ly differentiated (18 of papillary and 27 of follicular type); io cases were undifferentla ted and 1 case was of medullary type. The metastatic process affected the lung in 40 cases, bone zn 32 cases, brain and liver in 2 and adr~ nals in one. 24 patients had a single lesion, while the remains displayed multiple site metastases. From the therapeutic point of view, the key role of radioiodine therapy in treating lung metastases in which a favourable outcome in almost all cases (87.6%) occurred must be emphasized, as well as the role of the combined 1-131-therapy and telecobalt therapy in skele tel metastases. Also the surgical removal of af fecte@ bone segment was successfully used in 6 cases. Chemotherapy gave some benefit as a complement to 1-131-therapy in patients with reduced oz absent radioiodine uptake. In the undifferentiated and medullary metastatic tumors the integrated treatment was only temporarily effec five. The iO years expected survival rates (actuarial analisys) in the investigated series was as follows: Overall series = 53.4% at 5 years; 49.7% at iO years: Differ.ca.: 77.8% at 5 years; 59.2% at iO years. Undiffer.ca.= 15.7% at 3 years

The e f f e c t of s o m e f a c t o r s a f f e c t i n g s u r v i v a l i n d i f f e r e n t i a t e d t h y r o i d can-c a r e l i m i t e d to the t h y r o i d ( T I - T 3 ITO ~i0 s t a g e s ) f o l l o w i n g p r e v e n t i v e t h y roid ablation was studied in a group of 3 2 6 p a t i e n t s f o l l o w e d f o r I to 26 y e a r s . The a b s e n c e of a n y e x t r a t h y r o i d t u m o r w a s p r o v e d b y surger}j, s c i n t i m r a p h y i n the c o u r s e of t h y r o i d a b l a t i o n , and b~ s c i n t i g r e p h y i n the p h a s e of i n d u c e d a t h y r o i d i s m . ~he c r u d e s u r v i v a l (not c o r r e c t e d f o r s e e ) w a s i n t h e whole group 0.953/5 years, 0.833/10 y e a r s and 0 . 6 1 1 / 1 5 y e a r s . 14 p a t i e n t s d i e d of t h y r o i d c a n c e r I to 15 y e a r s f o l l o w i n g t r e a t m e n t . The e f f e c t s of a g e ( u n d e r and o v e r 4 0 y e a r s ) , TI,K:I c l a s s i f i c a t i o n (T I+2 v S . T3 s y n d r o m e ) , of d o s e a d m i n i s t r e d to t h y r o i d i n O y end t h a t of the t y p e of s u r g e r y ~TTE vs. a l l o t h e r t y p e s ) w e r e f o u n d to be s i g n i f i c a n t at the 5 - and 10y e a r i n t e r v a l s . The i n f l u e n c e s of sex, microscopic classification (papillary v s . f o l l i c u l a r c a n c e r s ) , of ~ q o u n t of 131 I i n G B q f o r t h y r o i d a b l a t i o n and of the p o s t s u r g i c a l s c a n w e r e n o t s i g nificant. It is b e l i e v e d t h a t p r e v s n t i v e t h y r o i d a b l a t i o n is a n i m p o r t a n t s t e p i n the c o m p l e x t r e a t m e n t of d i f f e r e n t i a t e d thyroid cancers, but its limitations s h o u l d be k e p t i n m i n d .

Positron emission tomography (PET) of energy metabolism of the brain in man using 2-18-F-deoxyglucose (YFDG) does not distinguish between local perfusisn, f a c i l i t a t e d transport and enzyme catalysed catabolism. In contrast, l l - C metbylglucose (CMB) permits separate measurements of f a c i l i t a t e d transport (FT) and local perfusion; in conjunction with 2FDG, i t promises information on enzyme catabolised eatabolism. The compound 3FDG is known to behave k i n e t i c a l l y s i m i l a r l y to CMG. This paper reports on FT for CMG and 3FDG.

R e s e a r c h I n s t i t u t e of E n d o c r i n o l o g y , P r a h a , and D e p t . o f N u c l . ~ e ~ . , P a c u l ty H o s p i t a l P r a h a 5 ~ o t o l , C S S R

Istituto di Medicina mucleare,Universit& Cattolice del S.Cuore-Policlinico "A.Gemelli" Largo Gemelli,8 -00168 ROMA (Italy)

After informed consent, twelve patients (P) with ischemic brain disease, 9 P with i n i t i a l and advanced Huntington's chorea and 10 normal i n d i viduals (ND) were examined by PET a f t e r i . v . app l i c a t i o n of 5 mCi of CMG or 3FDG. In each P, 30 transaxial images were registered in I selected plane, image collection time being I min. Timea c t i v i t y curves were created from d i f f e r e n t regions of interest. The r a t i o of tissue concent r a t i o n to tracer steady state between tissue and blood yields the perfusion-independent rate constant of FT from tissue to blood (ky). In ND, k2 f o r CMG was 0.24 + O.O3/min, as expected, and f o r 3FDG, 0.47 + O?O7/min indicating a higher FT capacity for gFDGthan CMG. In acute ischemic brain disease k~ was normal or reduced at the site of insult fob both CMGand 3FOG. In contrast, P with chronic occlusion of the middle cerebral artery had an increased kp. In Huntington's chorea, kp was reduced in th~ basal ganglia but normal br occasionally significantly increased in frontal or occipital cortical areas, for both CMGand 3FDG. Thus, CMGand 3FDGhave different values for k~; however, the relative changes induced by pathology are similar for both. I t is suggested that CMGor 3FDGcan be used for determining the lumped constants necessary to apply 2FDGto analyze energy metabolism of the human brain. Institute of Medicine, Nuclear Research Center Juelich, D-5170 Juelich, West-Germany

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123 J - A M P H E T A M I N E (IMP) S P E C T IN PATIENTS WITH SCHIZOPHRENIA PRELIMINARY REPORT. H. Fill, G, R i c c a b o n a , H. R S s s let, J. S c h w i t z e r a n d H, H i n t e r b u h e r

POSITRON EMISSION TOMOGRAPHY(PET) USING I I - C METHIONINE IN THE EXAMINATION OF INTRACEREBRAL TUMOURS. K. Ericson, M. Bergstr~m, G. Blomqvist, P. Collins, L. Eriksson, H. von Holst, A. L i l j a , H. Lundqvist, B. L~n~str~m, M. Mosskin

SPECT IMAGING OF TECHNETIUM LIPOPHILIC BRAIN AGENTS. T.C. Hill, S.C~ Moore, W.A. Volkert, R.A. Holmes, H.F. Kung, M. Blau_ 5. Mueller, B.L. Holman, M.E. Clouse.

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In e i q h t p a t i e n t s w i t h s c h i z o p h r e n i a in d i f f e r e n t s t a g e s and s e v e r i t y w i t h o u t a n y d e m o n s t r a b l e v a s c u l a r c h a n g e s and normal transmission computed tomography f i n d i n g s as w e l l as n o r m a l n e u r o l o g i c a l e x a m i n a t i o n I M P - S p e c t w a s p e r f o r m e d . In all c a s e s lesions of d i f f e r e n t s i z e and location were observed. Patients whose s y m p t o m s w e r e i m p r o v i n g s h o w e d small loc a l i z e d a r e a s of r e d u c e d u p t a k e of IMP d i s t r i b u t e d all o v e r the brain. In p a t i e n t s w i t h s e v e r e s y m p t o m s of the d i s ease extensive defects involving mainly the s u b c o r t i a l a n d c e n t r a l r e g i o n w i t h o c c a s i o n a l e x t e n s i o n i n t o the c o r t e x a n d in a d d i t i o n i n v o l v i n g the r e g i o n of the basal g a n g l i a w e r e seen, D e f e c t s in the r e g i o n of the h y p o t h a l a m u s s e e m e d to be of special i m p o r t a n c e n o t o n l y for the a s s e s s m e n t of the e x t e n t of the p a t i e n t s d i s e a s e b u t a l s o w i t h r e s p e c t to the pat i e n t s p r o g n o s i s . R e d u c t i o n of the IMPu p t a k e in the h y p o t h a l a m i c r e g i o n c o r r e lated w i t h an u n f a v o u r a b l e p r o g n o s i s of the disease. It is c o n c l u d e d : I M P - u p t a k e d e f e c t s c a n occur without corresponding vascular c h a n g e s o r a n a t o m i c a l d e s t r u c t i o n of the b r a i n in p a t i e n t s w i t h s c h i z o p h r e n i a . The size of these I M P - l e s i o n s c o r r e l a t e s d i r e c t l y w i t h the c l i n i c a l l y s t a t e d sev e r i t y of the p a t i e n t s m e n t a l a b n o r m a l i ties. A l e s i o n in the h y p o t h a l a m i c region may allow prognostic statements. S t u d i e s on s c h i z o p h r e n i a u s i n g I M P - S p e c t s h o u l d t h e r e f o r e be c a r r i e d o u t f u r ~ e r o n U n i v , - K l i n i k f~r N u k l e a r m e d i z i n Innsbruck, A n i c h s t r . 35, A - 6 Q 2 0 I n n s b r u c k

The metabolism of ll-C-methionine has been studied in a small series of patients using the model described by Bustany et c o l l . The metabolic pattern was compared with the findings on CT and PET using 68-Ga-EDTA and also to the histology of the tumours. PET with ll-C-methionine has already become an important method in the c l i n i c a l management of brain tumour patieets. P a r t i c u l a r l y tumours with a high degree of d i f f e r e n t i a t i o n are better delineated with ll-C-methienine than with the other techniques used. The compartment analysis suggests that the accumulation of ll-C-methionine is related to the protein synthesis, which in the majority of the patients was considerably higher in the tumour than in surrounding brain tissue. However, considerable variations were noted in tumours with similar histologic patterns. The implications of the findings on determination of prognosis and on choice of treatment s t i l l remains unclear. I t is probable that increased knowledge of the biologic character of tumours w i l l increase the p o s s i b i l i t i e s of successful t r e a t ment. Department of Neuroradiology, Karolinska Hospital, S-104 gl Stockholm, Sweden.

Tc-99m labeled propyleneamine oxime (PnAO) I, 2-dithia-5-8 diazacyclodecane (BAT) and their analogs are lipophilic radiopharmaeeuticals that cross the blood-brain barrier. These compounds and several analogs were imaged with single photon emission computed tomography. Siuee ~ n y of these current compounds have short residence times in the brain with T~ as low as two minutes, initially a modified Harvard Multidetector brain system was used. This system permits a high sensitivity, high resolution image of a single slice to b e obtained in 54 seconds. Sequential data were collected from the single slice device to generate washout data and slices were summed to obtain images of these agents in baboon and man. Images obtained demonstrate brain uptake early after the IV injection of these compounds, but subsequent redistribution into muscular structures in the baboon model. In the patient studies obtained, early images (1-5 min) show grey matter uptake. One analog, Tc-99m BAT-eyclohexame, with a ~ in brain of 102 min was studied with Siemens ZLC 37005 rotating gamma camera in a monkey model. Work is in progress to investiHste analogs of these compounds with a more favorable residence time in the brain that would warrant further patieat studies. This study emphasizes the need for either a radiopharmaceutical with prolonged brain retention and fixed distribution or a high sensitivity SPECT instrument able to do rapid scans if a Tc-99m labeled radiopharmaaeutical for brain perfusion studies is to replace the 1-123 labeled amines. Ne,~ England Deaconess Hospital, Harvard Medical School 185 Pilgrim Road Boston, Massachusetts 02215, U.S.A.

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FUNCTIONAL IMAGING IN RADIONUCLIDEVEWTRICULOGRAPHY (RNV) U S I N G M U L T I H A R M O NIt FOURIER ANALYSIS OF GATED LIST MODE AQUISITTON DATA

REGISTRATION OF SCINTIGRAPHIC IMAGES : A COMPARISON OF 4 METHODS ON THALLIUM SIMULATED INAGES.

A NEW ATTENUATION CORRECTION METHOD USING A FAST PROJECTOR - BACKPROJECTOR. O.T. Gullherg, N.J. Pelc and J.A. Malko

P.Meidenreich,

G.Graf,

M. Vogt,

J.Kopp

Cardiac functional images, using temporal F o u r i e r a n a l y s i s of gated listmode data, were developed. Listmode data aquisition provides strongly choosen representative heartcycles, e v e n in c a s e o f arrhythmia or pulse drifting under stress condition. The frame generation by R o u r i e r r e s y n t h e s i s with the sum of the first three harmonic w a v e s l e a d s to a marked improvement of image gual&ty. Even with statistically poor data wall motion studies are possible. The analytical tzme-activity c u r v e s , g a i n e d by Rourier resynthesis on a p i x e l b y p i x e l basis, are displayed in f u n c t i o n a l images, s h o w i n g the following parameters: - amplitude and phase image of the fundamental frequency - maximum of contraction and corresponding time during systole - regional ejection fraotion and time of systolic minimum of the volume curve - maximum of relaxation and corresponding time gurlng diastole The paper presents experience out of routinely performed R N V on 1 2 0 0 u n s e l e c ted patients. The value of this method c o m p a r e d to s i n g l e h a r m o n i c analysis a n d M U G A s t u d i e s is s h o w n b y i l l u s t r a tive cases. Institut f~r Muklearmedizin, Radlologisches Zentrum Krankenhauszweckverhand Augsburg Stenglinstr.2 StOO Augsburg, West Germany

J,C. LIEHN, VALEYRE.

A.

VENOT,

M.

VALTON

and

J.

The comparison of scintigraphi¢ images (i.e. stress thallium vs. rest thallium) is a problem frequently met in Nuclear Medicine. Prior to image comparison (i.e. image suhstraction), image registration is an essential step. In order to assess the ability of three classical methods and a new method to correctly register thallium images, we apply those methods to thallium images with artifical defects simulating myocardium lesions, glmulated defects are adjustable in location, size and intensity. Differences in acquisition time and Poisson statistical fluctuations are also simulated. The three classical registratlon methods are based on the maximization of the correlation coefficient, the minimization of the sum of absolute differences and the maximization of the cross correlation of the image profiles. The new method (already described by A. WENOT) is based on the maximization of the number of sign changes in the difference image. For each of those methods and for different types of defects, registration is performed between the original normal thallium image and a late number of simulated images obtained after translation and noise simulation. The results are expressed as the mean error, expressed in interpixel distance units. Results show that the four methods are almost equivalent when the defects are small in size and intensity, albeit the method of profile cross correlation is less efficent. However for very dissimilar images the method based on the number of sign changes performs well, while other methods perform poorly. INSTITUT J. GODINOT, COCHIN, PARIS, FRANCE.

REIMS

and

Iterative attenuation correction algorithms which use projector-baekprojeetors that mode] the attenuation process are found to more accurately quantify the source distribution than presently used filtered backproiection algorithms which use preprocessing or oostprocessing attenuation correction techniques. For an iterative algorithm to be feasible in a clinical setting two things are required of the projection and backprojection operation: i) it must be efficient and 2) it must pronerly model the attenuation process. A new ray driven projector-backprojector has been designed, for hardware implementation, which models the attenuated Radon transform of a source distrihuted within an attenuator as line integrals of discrete pixels representing the source and attenuation distributions, Attenuation factors are calculated for each oixel during the projection and baekprojection operation instead of storing preealculated attenuation factors on disk or in large resident core memory. The attenuation factors are calculated from the digitized transaxial image of the attenuation distribution which is stored in core for efficient access during the projection and baekprojection operation. The reconstruction of the source distribution is obtained by using an iterative algorithm such as the conjugate gradient which requires one projection and one backprojection operation for each iteration. The projector-backprojector can be implemented with enough parallel processing to accomplish multi-slice reconstructions in a few seconds. General Electric Medical P.O. Box 414, NB924 Milwaukee, WI 53201

Systems Group

HOPITAL

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RENAL COMPUTED ANGIOSCINTIGRAPHY (RCA) IN R E N O V A S C U L A R MYPERTENSION: A COMPAR A T I V E S T U D Y OF 4 A N A L Y Z I N G PROGRAMS. M. Z a m b o n i I M. C a v a g g i o n i ~ P. @ i o r g e t t ~ L. Ga;mnaro, M. R e g g i o , A. M a r a b i n i .

COMPUTER ASSISTED DIAGNOSIS OF R E N A L GRAFT REJECTION. P.Schmidlin, J.H.Clorius, E.Lubosch, H.J.Siems, W.J.Lerenz, K.Dreikorn

INFLUENCE OF REGIONS OF INTEREST ON MEASUP~EMENT OF P~LATIVE HIPPURAN UPTAKE IN GAMMACAMERA RENOGRAPHY. D.J. der Kinderen and H.Y. Oei.

The Authors estimate ~ diffement methods of a n a l y z i n g the RCA respectively proposed b y N o e l p p (N), W a s h i d a (W)~ ~ommei (P) a n d H i l s o n (H), in 12 c a s e s of v e r i f i e d renal a#fery stenosis (I)~ compared with homogeneous g r o u p s of n o r m a l s (IT), e s s e n t i a l hypertension (Ili~ unilateral non-stenotic pathology (IV), and finally with a group including all the examined cases. The method N had the best sensitivity for all the considered groups (.92)~ p~obably because it w a s a p p l i e d to t h e early circulation times. All the methods w e m e h i g h l y s p e c i f i c in comparison between I a n d lI~ w h e r e a s , in r e g a m d to the o t h e r g r o u p s , the best m e s u l f s m o s e f r o m t h e m e t h o d F (.9~ in I / I I I a n d I/Y; .85 in I/IV) t h a t e m p h ~ sized also the variations in t h e m e n a l volumes. Therefome the analysis of t h e R C A b y m e a n s of t h e a s s o c i a t i o n of m e thods N and V allows excellent results in t h e s t u d y of r e n o v a s e u l a r hypertension. Servizio di M e d i c i n a Nucleate 7 Oentro Ospedaliemo di B o r g o T m e n t o , P i a z z a l e A. S t e f a n i , I 1-37126 Verona, Italy

Patients with renal transplants were examined by functional scintigraphy. Renal function was estimated following i.v. i n j e c t i o n of Iodine-hippurate, and perfusion by Tc-99m DTPA scintigraphy. Sixteen variables describing different features of the renogram and the flow curve (hippurate uptake and excretion, DTPA perfusion and retention, mean t r a n s i t t i m e s , etc.) w e r e g e n e r a t e d for 500 examinations. The diagnoses were made by experienced physicians, using the following information: curves and sequential images, the c u r r e n t c l i n i c a l d a t a , a n d s o m e of t h e c u r v e v a r i a b l e s . Variables and diagnoses w e r e s t o r e d in a computer. The data were classified using discriminant analysis, in o r d e r to o b t a i n a c o m p u t e r diagnosis. The physician and computer diagnoses were compared for different complications. A s an e x a m p l e , 90% a g r e e m e n t was obtained between physician and computer in t h e d i a g n o s i s of a c u t e r e j e c t i o n , and ruling out this complication. The discrimination of a c u t e r e j e c t i o n from all other findings (normal function, acute tubular necrosis, vascular stenosis, o b s t r u c t i o n , e t c . ) g a v e an a g r e e m e n t of 80%. A v a l i d a t i o n of t h e 16 variables by discriminant analysis showed that some variables n o t u s e d by the physicians were also important for computer diagnosis. The procedures developed can improve subjective diagnostic decisions by additional objective criteria. German Cancer Research Center, Instit u t e of N u c l e a r M e d i c i n e , Im Neuenh e i m e r F o l d 280, D - 6 9 O O H e i d e l b e r g ]

For the management of patients (pts) with unilateral renal artery stenosis (NRAH) the relative hippuran uptake (P~U) of the affected kidney is important. However, P~U depends on the regions of interest (ROT). To elucidate the influence of the size of kidney ROI (KROI) and the place of background ROI (BROI) on RHU, renographic data of 49 by angiography proven URAS-ptS (24 leftand 25 right-sided) and 8 essential hypertensive (EH) pts were reproeessed. These data were obtained using LFOV-ga~nacamera and radiohippuran. ~ROI were generated automatically on the first 5-min frame in 64x6d matrix by determination of the distinctive intensity of the image. RHU of the affected kidney (RRUA) in NP~S-pts and EEU of the right kidney (RHUR) in EH-pts, calculated from the activity in the 2nd min using BROI between the kidneys were 31.4+10.7% resp. 49.9+ 2.3%. When fixed BROI below the kidneys was used, every enlargement of both KROI by one pixel rim resulted in an increase of RHUR by 0.5~0.6%. Compared with BROI between the kidneys, using BROI semilunararound the kidneys, correcting for each corresponding kidney,resulted in a decrease of P~UR by 2.1+2.2%. These findings indicate t h a t the background activity of the right kidney is higher than of the left. Enlarging one KROI by one pixel rim always resulted in an increase in RBU of the corresponding kidney, although the increase is smaller if BROI was chosen between (0.8%0.8%) instead of below the kidneys(1.7+_0.7%) In comparison with BROI below the kidneys, using BROI between the kidneys had no influence on the RHU of EN-pts, but it did decrease the RHUA of URAS-pts by 1.7+i.5%. Thus, the size of KROI has less influence on RHU when BROI between the kidneys is used, moreover the discriminating capacity of ~ U is probably increased. We can recommend this algorithm for the generation of KROI and the use of BROI between the kidneys, which also can automatically be deter~ined. Dept. of Nucleaz Medicine, University Hospital, Catharijnesingel 101,Utrecht, The Netherlands.

A64 A381

A 382

A 383

RADIOI~lTNOPRECIPITATION METHOD FOR TEE MEASUREMENT OF CIRCULATING INSULIN ANTIBODIES: DISCORDANCES12 ~3 ETWEEN THE RESULTS OBTAINED WITH DIFFERENT I-INSULINS (porcine,bovine and human). D.J. Hartmauu,A. Cotisson and G. Ville

CIRCULATING II~MUNE COMPLEXES : OPTIMISATION O~ A [125I]Ciq BINDING TEST.

CLINICAL SI(~IFIC#~CE OF SERUM A ~ $YNOVIAL FLUID FERRITIN IN ]2~FL~ATORY ART~TIDES. 0 Di ~%m%no, M. Fer~e~hini, N.G. Toni, P. Scatena, P. Migliorini, g. Tartarelli and S. 5~nbar dieri

Following parenteral administration of insulin~ insulin antibodies are detectable in the sera of most diabetic patients. We have used a second antibody-PEG precipitation assay specific for human IgG insulin antibody after a first incubation step with different labeled insulins. Monocomponent insulins (porcine,bovine or human) were labeled with iodine 125 using the chloramine T method. 20pl of Ratient's serum were incubated with 100pl of Iz5I-insulin at +4°C for 24h. Then 100pl of anti-human IzG goat serum and I00~I of PEG (final concentration: 2 p.cent,w/v, with 0.04 p.cene Tween 20) were added. After a 5 min incubation at room temperature Iml of distilled water was added. After a ceutrifugation at 2500g for 20 min,the supernatant was discarded and the pellet counted for radioactivity. With the three tracers,we studied normal and diabetic subjects ; sera from ~reaeed patients demonstrated binding ranging from I to 92 p.cent, The antibodies recognized antigenic sites shared by the three insulins: in general a same serum demonstrated similar binding with porcine and human insulins and significantly higher binding (about 4 p.cenC) with bovine insulin. However in few cases (0.8 p.cent from 1954 diabetic patients) a greac discordance was observed: the difference of binding could reach 50 p.cent. For these sara,competitive binding,after the dissociation of immune complexes,showed preferential binding to bovine insulin and partial cross reactivity for human or porcine insulin,in con~rast to ehe other seza which showed total cross reaetivities for the three molecules. The determinations of the antibody affinity constant and the free insulin level can be useful to explain the differences observed on a same sara with the three tracers and to appreciate the changes of the insulin antibody levels after a modification of the therapeutics. Centre de Radioanalyse,Institut rue Dome% 69007 LYON (FRANCE)

Pasteur,13-15

G. Caillot, D.J. Hartma~n and g. Villa The incidence of circulating immune complexes (CIC) has been ascertained in various diseases as autoimmune diseases, infections or malignancies. We report the ootimisation and the characteristics of a ~25I]CIq binding test in liquid phase for the detection of CIC. C1q was isolated from human serum in the presence of ENTA using successive precipitation steps at low ionic strength and was enzymatically radiolabeled with iodine 125 using a ]actoperoxidase method. The iodination yield was about 90 % and the specific radioactivity obtained was between 1 and 2 ~Ci/pg. 50 pl of patient's serum were incubated with 100 pl of 0.2 mol/l EDTA pH 7.5 at +37~C for 30 min and after were placed in anice bath. Then 50 D1 of {128I C1q (SO n g ; 68000 cpm) and I ml of a 3 % polyethylene glycol (PEg) solution in borate buffer pR 8.3 were added. The mixture was left at OOC for 90 min and centrifuged at 1500 g for 20 min at + 4°C. The supernatant was completely discarded and the precipitate counted for radioactivity. The results were expressed as per cent of precipitated 125I C1q as compared with the [1251]Ciq radioactivity precipitated by 20 % TCA. The optimisation of this ~25I]CIq binding test has lead to the following conclusions : I) An 90 miu incubation at O°C is needed to reach the equilibrium of the reaction. 2) A 2.5 % final concentration of PEG must be used to obtain optimal discrimination between aormal donors and patients sere. 3) Blood must be collected without any anticoagulant. 4) Sere can be stored at + 4°C or at room temperature for a week, at - 2O°C for several weeks without any modification of the results. Repeated freezing and thawing can be performed without any damage. Many sera of patients with systemic lupus erythematosus or hepatitis contain detectable levels of CIC. This test is routinely employed, specially in the case of treatment by plasmapheresis.

l~y repor~ indicate la~e qusntitie~ of Fer~itin (Fe) in synovial fluid (of) of patients with ir~fl~tory a ~ i t i des. ~hiS Fe mi~it reflect local hyperproduction of type A reticulo~thellal cells of the synovial membrane or might be released from synovial cells dansged by local flogomis. In this view sf was collected from 2/ P. with 0 6 t e o ~ i s (OA, lbM~)and 73 p. with ~heumathid or Pseriathic Arthritis (RA, PA, 32 M-41F) classified according to ARA criteria. ~mong RA-pA p. on clinical (Ritchie's articular index) and laboratory (abrmrmal ESR, CRP, ~o) 8 ~ c ~ , 39 p. were defined active. The parameters considered were in serum (s) ESR ~nd Hb, in sf (7~50, }~ titre~ cell count and im1~ne complexes. S and sf Fe was determined using a RIA system based cn antibodies ~ i n m t ~k~an liver Fe (Lisop~ Lepetit MiLgn). S Fe was r~otsi~ificsntly different in p. with P~PA (IS6+ 17.5 mg/ml, m~_ SEM) and in CA (I08.2+2/.~, si~ificantly high er levels were found in active vs inactive F~-PA p.(p~O.025). Sf Fe was significantly elevated in RA-PA p. vs OA p. (2/~0,9~+22.8 VS 180.7+28.1, p~O.O2) and in active vs inactive.~ S and sf Fe ~as higher in males vs females RA-PA p. (physiolo~f of C~, ~ t i c Diseases Unit s~d Center of Nuclear Medicine, University of Plea, Pisa, Italy RA-PA p. (pdO.Og).

Centre de Radioanalyse, Institut Pasteur, 13-15 rue Domer 69007 LYON (FE~NCE).

A384

A385

A386

THE CLINICAL SIGNIFICANCE OF SERUM FERRITIN LEVELS IN PATIENTS WITH CHRONIC POLYARTHRITIS. J . S p i t z , K.Miehlke and P.Siemens

QUANTITATION OF A D S O R P T I O N AND DESORPTION 0N PLASTIC SURFACES OF 125I-THYROGLOBULIN AND 125I-THYREOTROPIC HORMONE. J.Seidel,M.Gembicki,J.Kosowicz

I~TERFERENCE OF ANTI~YROGLOBULIN AUTOANTIBODIES I N R A D I O I ~ B . ~ N O A S S A Y 0 F T-4, T-3 A N D rT-3. J. K o s o w l c z a n d M. G e m b i cki.

In 180 persons of both sexes,divided into three groups of i d e n t i c a l size ( I controls, II chronic p o l y a r t h r i t i s of l i t t l e activity, Ill chronic p o l y a r t h r i t i s with high a c t i v i t y ) serum ferritin levels were compared to HB, HBe, Fe, TF, Sed.Rate, p l a t e l e t s , electrophorese, immunoglobuline, rheumatoid antigen, antinuclein factor. The incidence of anemia increased together with the a c t i v i t y degree of c.p. as i t i s well known from l i t e r a t u r e . ( 2 0 - 3 0 % in group I and I I , 60% in group I l l ) . But in contrast to the statements of other authors we found no s i g n i f i c a n t difference between the serum f e r r i t i n level of controls and of those patients with more or less a c t i v e c.p.. I. male I l l ng (36-342), female 56 ng (21-153) I f . male 93 ng (40-218), female 39 ng (15-I00] Ill. male 14] ng (69-288), female 65 ng (27-15g). Serum f e r r i t i n levels therefore do not display the a c t i v i t y degree of c . p . . In consequence to our findings the determination of serum f e r r i t i n is a v a l i d method to establish the diagnosis of iron deficiency also in c . p . p a t i e n t s . Further the knowledge of the serum f e r r i t i n values has to be considered as an important aid f o r the decision wether to substitute iron in a c . p . p a t i e n t or not. By applying three ranges of serum f e r r i t i n levels in the d a i l y routine, the following bounderies may be helpfu]l : iron deficiency is f o r certain with serum f e r r i t i n levels under 30 ng/ml and excluded over I00 ngSF/ml. S t i l l a correct i n t e r p r e t a t i o n of serum f e r r i t i n levels is only possible in combination with a c r i t i c a l i n t e r p r e t a t i o n of the t o t a l c l i n i c a l situation,

[ n s t i t u t f u r Nuklearmedizin ~t~dt.Klinikum Wiesbaden, L.-Erhard-Str. )6200 Wiesbaden, Germany

I00

T h e a i m of p r e s e n t e d s t u d i e s w a s to form a basis for radioimmunoassay and to check possibilities for the control of adsorption processes.Thyroglobulin /Tg/ and thyreotropic hormone /TSH/ were labelled with 125I by the chloramine and iodogan methods.The 125 i o d i d e s w e r e r e m o v e d b y d i a l y s i s and t h e hormones were incubated in t u b e s f o r 20 h o u r s at r o o m t e m p e r a t u r e . After decantation and washing the radioactivity of the test tubes was measured, and the percent of adsorption estimated.Effects of: l a b e l l i n g m e t h o d s , temperature,pH of the solutions,chromatofocusing,as w e l l as g l u t a r a l d e h y de a c t i v a t i o n o n t h e a d s o r p t i o n a n d desorption were studied.The following surfaces were used: polystyrene,polyethylene,polyvinylchloride and glass. The results indicate that the greatest adsorption of 1 2 5 I - T g o c c u r s o n p o l y styrene and greatest adsorption of 125I-TSH on polyethylene surfaces. H i g h l y p u r i f i e d f r a c t i o n s of l a b e l l e d hormones give higher adsorption than fractions of lower purity,especially in g l u t a r a l d e h y d e activated tubes. Activation of plastic tubes by 2% glutaraldehyde markedly reduces desorptlontas a result of incubation with serum samples. Department

~zewskiego

o f EndocrinologypPrzyby49, 60-555 P o z n a ~ , P o l a n d

Laboratory Animals immunized with human thyroglobulln /Tg/ develop antibodies which usually bind also thyroid hormones. The a i m of o u r s t u d i e s was to f i n d whether sara of patients with Tg-autoa n t i b o d i e s s h o w a s i m i l a r b i n d i n g of T-4, T-3 a n d r T - 3 . I n s e r a of 50 p a t ients with anti-Tg antibodies and sere o f 60 c o n t r o l s u b j e c t s w i t h o u t a n t i b o d i e s the b i n d i n g o f 1 2 5 - I - T - 4 , 1 2 5 - I T-3 a n d 1 2 5 - I - r T - 3 w a s s t u d i e d b y 13% polyethyleneglycol precipitation, binding onto Protein A Sepharose minicolumns and immunosorbents o f T-4, T - 3 and rT-3 agarose. Our results revealed that in anti-Tg positive sara the bind l n g o f l a b e l l e d T-4, T-3 a n d r T - 3 is 3 to 1 5 % h i g h e r t h a n i n c o n t r o l s e r a a n d i n 64%, 5 2 % a n d 5 7 % of a n t i - T g p o sitive sera respectively 9 which change the r e s u l t s of t h y r o i d h o r m o n e a s s a y s . The p r e s e n t d a t a d e m o n s t r a t e that high titre anti-Tg autoantibodies s h o w interference in radioimmunoassay o f T-4, T-3 a n d rT-3, h e n c e p r o p e r e v a l u a t i o n of t h y r o i d f u n c t i o n r e q u i r e s d e t e r m i n a t i o n s of t h e s e a n t i b o d i e s . Department of E n d o c r i n o l o g y , Medical A c a d e m y , P L - 6 0 355 P o z n a ~ , AI. P r z y byszewskiego 49, P o l a n d .

A65 A387

A388

A389

CLINICAL VALUE OF TWO NEW LIGAND ASSAYS FOR TSH. I. S~ttger, V. So~amerfeld and H.W. Pabst

A SENSITIVE TBH-RIA ASSAY: A RELIABLE THYROID TEST IN PREGNANCY. L ] . L u k i n a c , N . J u r a s , Z . K u s i ~ and ~. Spaventi

TI~STING O F TII~ V A L I D I T Y O F COMMI~IICI,\L TSII ((ITS. S . - L . K a r o n e ~ , P. J ~ r v e n p ~ H , P. Po]lja a n d K. L i e w e n d a h l

Sensitivity, specificity and practicality are critical for routine serum TSB determinations. This study was designed to clinically evaluate two new TSH ligand assay kits claiming considerable advantages. A total of 174 patients with well established clinical/laboratory diagnoses were studied. Analytical methods: Enzymun-Test TSH, Boehringer Mannheim, a sandwich ELISA assay using antibody coated tubes, and the MAIAclone TSH assay, Serono, a "three site" IRM~ with magnetic separation of S and F. The TSH-RIA "Henning", Yenning-Berlin SmbS, a DAB-RIA, as routinely used in our laboratory, served for intercomparlson. Quality control study: the IRMA showed with 0.4 vs. 0.8, 0.8 mU/l the highest sensitivity, high precision and highest practicality with about 200 determinations within 4 h. Correlation between these assays was very good. Clinical study: euthyroidism (N - 75 - Ii0): the ELISA generated a basal range of ~0.8 - 5.3 mU/l and, following i.v. 200 ~g TRH, a A TSH of 7.3 + 4.4 mU/l (p ~ 0.005 vs. RIA and < 0.001 vs. IRMa), the IRMA a range of 0.5 - 4.0 and a ~ T S H of ~0.8 + 6.3 mU/1 (p < 0.0Ol vs. RIA and ELISA) and the RIA a range of < 0.8 - 4.3 and a ~ TSH of 8.9 + 6.0 mU/l. The median was 2.0 for the ELISA, ~.8 for the IRMA and 0.85 mU/l for the RIA. Hyperthyroidism (N - 18 - 21), 3 - 4 borderline, and TSH-suppression due to (treated) hyperthyroidism or medication with 200 ~g l-T4/day in athyroidism (N = 29): b~sal TSH was beneath the detection limit except for the ELISA with 6 of the 29 patients of the latter group revealing TSH levels between 0.9 and l.B mU/l. All 47 - 50 patients revealed negative T P ~ t e s t s ( TSH nondetectable) by all ~ssays. Hypothyroidism (N = 23), 4 borderline: basal TSH was above i0 mU/1. ~TSH was similar by all three assays. Conclusions: The ELISA has the advantage of being a non-isotopic ir~nunoassay (NIIA), performable daily. The IRMA, technically superior, improves the TSS determination's clinical value by good separation of eu- from hyperthyroidism basally.

In t h e sera of 16 p r e g n a n t women Td~T3,rT3,FT 4 adn TSH c o n c e n t r a t i o n s were d e t e r m i n e d by comm e r c i a l k i t s or by u s i n g home-made r e a g e n t s . Serum samples were taken during the first, the second and t h e t h i r d t r i m e s t e r o f p r e g n a n c y , in each p e r i o d a l l f i v e t e s t s were done and then compared w i t h the c o n t r o l group of 28 e u t h y r o i d s u b j e c t s a t the p r o b a b i l i t y l e v e l of 95%, The r a i s e d T 3 c o n c e n t r a t i o n d u r i n g the f i r s t (2.55) , the second (3.47) and the third trimester (3.92) was found in comparison to the control group (I.97). The )eve~ o f 7 4 was a l s o e l e v a t e d in a?] t r i m e s t e r s (140, 176, 172) i~ c o n t r a s t to t h e mean v a ] u e of e u t h y r o i d group ( 1 0 1 ) . The concent r a t i o n of rT 3 was i n c r e a s e d from t h e l e v e l of e u t h y r o i d group (0.199) to t h e l e v e l of 0.253, 0.68 and 0.65 w h i c h were t h e mean c o n c e n t r a t i o n s of rT 3 i n t h e f i r s t , the second and the t h i r d trimester. On the contrary, FT 4 concentration was decreased during three pregnancy periods (1.04, 0.95, 0.675) and these values were slgnificantly different from the euthyroid level (1.28). The measurement of TSH by a very sensitive method makes it possible to differentiate hyperthyroidism from euthyroidism. During pregnamcy TSH l e v e l was not changed s i g n i f i c a n t l y (1.95, 2 . 0 1 , 2.37) and t h e s i g n i f i c a n t difference to t h e mean v a l u e of the e u t h y r o i d group ( 2 . 1 4 ) was not found. T h i s c o u l d suggest t h a t TSH measurement alone, determined by a precise RIA method, could easily detect hyperthyroidism and prove normal thyroid function in pregnant women in spite of elevated thyroid hormones in blood. The rest of four thyroid tests are of less significance in the thyroid function assessment during pregnancy.

We h a v e e x a m i n e d c o m m e r c i a l TSI[ k i t s for c r o s s - r e a c t i v i t y w i t h hCO, m a t r i x effect and validity of standardization. The kits evaluated were: TSHN-PR (CIS), TSH(125I)radioimmunoassay kit (~a~mos D i a g n o s t i c a ) , P h a d e b & s TS11 ( P h a r m a c i a Diagnosties)~ A m e r l e x 'C~}I R I A k i t (The Radiochemie~l Centre) and Dec-Col TSH (Welleome). Overnight incubation ~ime w a s u s e d f o r a l l k i t s in o r d e r to o b t ain comparable resu±ts. In other respects the manufacturers' instructions were precisely followed. Sera with high TSH concentrations were diluted w i t h 'TS]{ f r e e s e r u m ' ( p o o l e d f r o m p a t i e n t s w i t h v e r y l o w TSI~) a ~ d p r e g n a n c y s e r u m (ird t r i m e s t e r ) . Iligher values f o r TZH i n ' T S I { f r e e serum' were obtained with Amerlex, Dec-De(. a n d TSIIK-PR t h a n w i t h the o t h e r k i t s . It is p o s s i b l e t h a t 'TSI{ f r e e s e r u m ' contains some factor(s) causing nons p e c i f i c b i n d i n ~ i~ s o m e k i t s . T h e r e w a s no s i g n i f i c a n t cross-reaction with h C G in a n y k i t t e s t e d ° D a e - C e i g a v e a b o u t ~0 ~ l o w e r T S R v a l u e s in the above-normal range than did the other kits. Significant differences in T S H reference values were ~iso observed w i t h s o m e o f the k i t s . Conclusions: Cross-reaction with hCG is n o t a p r o b l e m w i t h a n y o f t h e k i t s tested° T h e o b s e r v e d d i f f e r e n c e s with 'TSH free serum' might be caused by matrix effects or lack of an&lyrical specificity. R e - a s s a y of s e r u m T S H in p a t i e n t s r e f e r r e d to m e d i c a l c e n t r e s for suspected t h y r o i d d i s e a s e is n e c e s sary also because of differences in reference values.

Nuclear Medicine & Ontology Clinic, "Dr. Mladen Stojanovi£" Clinical Hospital, Vinogradska 29,

41000 Zagreb, Yugoslavia.

D e p a r t m e n t of C l l m i c a l C h e m i s t r y , U n i versity of Helsinki~ Meilahti Hospital, 0 0 2 9 0 H e l s i n k i 29, F i n l a n d

Nuklearmed. Klinlk u. Poliklin., Techn. Univ., Ismanlnqerstr. 22, D-8000 MGnchen 80, F. R. S.

A390

A391

A392

Analytical variability of TSH assay evaluated from interlaboratory survey results. A.Silo,S.C.Zucchelli,M.A.Piro,M.R.Chiesa

BIOLOGICAL RHYTHMS OF BINDING PROTEINS AND ]HYROID, ADRENAL HORMONES IN FIVE PARASITIC DISEASES. H. SUSINI DE LUCA, H. ZOUAGHI and S . ASKIENAZY

; ; I h l ~ . S !t,ID i{APzD il~rilOD F O R D E T ~ I [ ~ ± S A r i:~G ~'T4 A N D F T 9 FRC[.] A D R Y B L O O D S P O T . P R ~ L ~ k ± ~ARY I E S U L T S . z . F i l i p o v i 4 a n d S. £J l i p o v i £

External quality control surveys allow a quantitative evaluation of the state of the art of a radioimmuno~ssay and provide a basis for the comparison of the performances of the available methods/kits. During a national interlaboratory survey for hormone assays ,about 7000 TSB results have been collected from J~un 82 to Jun 83(51 s~/nples sent in ii monthly despatches to about 150 participating labs).These results have been used to prepare iI monthly reports and 2 end-of-period reports in which the performances(bias and precision)of each participant were evaluated.A cumulative analysis of the data subdivided according to the kit used has been also carried out;since precision was found to be related to concentration, the results were subdivided into 3 concentration ranges (<3;3-5;>5~UI/ml).The figures computed from all results and from results obtained by the 6 ~ s t used kits were: median,~Ul/ml CV% median CV% median CV% all res. 2.6 43 3.9 3~ 14.~ 22 ~.6 54 2.6 29 ~I~2 17 SiC 2.7 36 4.0 29 13.3 21 con 4.2 12 5.0 13 15.3 ii DPC 2.2 37 3.3 35 13.4 19 MAT 2.4 25 3.9 18 13.9 18 SOR 3.5 21 4.8 18 15.4 13 ARA=Secton-Dickinson Amia Zl system;BIO=Biodata; COR-Corning;DPC=Diagnostic Product Corp.;MAT=Mallinkrodt;SOR=Sorin. The between kit component of the variability of all results resulted 26,17 ~ 0 CV% for the low,medium and high concentration samples indicating that systematic between kit differences contributes consistently to the total variability of TSH results,mainly in the low concentration range. Institute of Clinical Physiology CNR, via Savi 8,Pisa,Italy

The biological rhythms of serum concentration of total and free fractions of cortisol, P3, T4 and binding proteins CBG, TBG, albumine~ T8PA were investigated in 14 normal adult males and 24 adult male patients with acute phase parasitlc diseases : amebiasls~ schistosomiasis filariasis~ hydatid0sis, malaria. Each individual was submitted to 3-7 hr blood punctions at fixed hours (04.00, 07.00, 10.00 am ; 02.00, 06.00, 12.00 pm) during 48 hr. The techniques employed were specific radioimmunoassay for total hormones~ rocket immunoelectrophores~s for proteins, equilibrium dialysis for CBG activitzes (H. ZOUAGHI e t a l . Clin Chem 1984 in the Dress) and free hormones. Data obtained revealed evidence of infradian (~ 48 hr for malaria) and czrcadian (~ 24 hr for other parasitic eases) rhythms of each the hormones (with the exception to total TS) and proteins (with the exception to TBPA) as validated by eosinor method ( 0 . 0 1 < p < 0 . 0 0 1 ) : theoretical analysis using computer permits to obtain marked modifications in some biological rhythms of hormones and binding proteins concentrations including Mesor, Amplitude and Acrophase and their 95 Z confidence intervals. Any kinetic studies of these various cycles of parameters indicate, after treatment, a progressive normalization during the recovery process. We suggest that the disorders of the circadian rhythms of the hormones secretions during the acute phase of parasitic diseases involve both modifications of the binding proteins and of the endocrine secretions themselves. H~pita£ S ~ m t e - A n n e S e ~ v i e { de M{deeine N u c l [ a i r e I , r u e @abanis - 75674 PARIS CEDEX 14 - F~ANCE

in o r d e r t o d e v e l o p t h e s c r e e n i n g p r o g ram for comzemital hypothyroidism it was tried to estimate FTg and FT3 from a dry blood spot,using the possibility of t h e d i r e c t e s t i m a t i o n of F T # a n d F T 3 in s e r u m b y F r e e - T d - a n d F r e e - T i - A m e r lex~A[
A66 A393

A 394

A395

COMPgRISON OF F!VF ESTIMATIONS FOR FREE THYROXINE IN SERA WITH DECREASED ALHUMIN CONCENTRATION. W. g l i n g l e r , E. g r a a s and G. V i e r k e

"ATYPICAL SERUMCK-BB" IN A CHRONIC HYPOTHYROID WOMAN. O. Giampietro, A. Clerico, G. guzzigoli, L. Lucchetti, C. gani, M.G. Oel Chicea, G. Mariani.

RADIOI~UNOLOQICAL (RIA) MEASUREMENT OF MYOGLOBIN (M) IN PHYSIOLOGICAL AND ENDOCRINO-METABO LIC CONDITIONS. A. Clerico, O. Giampletro, M.G. Del Chieea, M. Cerri, R. Palla, G. Mariani and R. Navalesi.

D u r i n g r e c e n t y e a r s s e v e r a l a u t h o r s rep o r t e d a b o u t p r o b l e m s of " t r a c e r a n a l o gue" m e t h o d s in m e a s u r i n g free t h y r o x ine i n s e r e w i t h a b n o r m a l i t i e s of binding p r o t e i n s e s p e c i a l l y a l b u m i n . We d e t e r m i n e d free t h y r o x i n e c o n c e n t r a t i o n s in s e r e of 22 c l i n i c a l l y e u t h y r o i d patients with decreased albumin concent r a t i o n ( a l b u m i n 2 3 . 2 ! 3.6; n o r m a l r a n g e 3 3 - 5 1 g/l) u s i n g 5 d i f f e r e n t m e t h o d s : 3 " t r a c e r a n a l o g u e " m e t h o d s (I, II, III) bhe S P A C E T m e t h o d and the c o n v e n t i o n a l T4/T86 ratio. In 5 0 % of the sere t o t a l t h y r o x i n e concentre,ions were decreased. T 4 / T B E ratios, as an e s t i m a t e of fT4 c o n c e n t r a tions~ w e r e n o r m a l in 9 5 % of the sere. D i r e c t fTA m e a s u r e m e n t s , however, gave h i g h l y v a r y i n g r e s u l t s : u s i n g the S P A O ET m e t h o d 95%, the "tracer analogue" a s s a y 1 55%, the " t r a c e r a n a l o g u e " a s s a y II 31% and the " t r a c e r a n a l o g u e " a s s a y Ill only 12% of the s e r e w e r e w i t h i n the normal range. These observations s u g g e s t that d e c r e a sed a l b u m i n c o n c e n t r a t i o n in sere can lead to f a l s e l y low r e s u l t s for fT4 w h e n " t r a c e r a n a l o g u e " m e t h o d s are e m p l o y e d . The t h y r o x i n e a n a l o g u e t r a c e r s may interact with albumin. Diminished albumin concentrations r e d u c e this i n t e r a c t i o n l e a d i n g to low fT4 r e s u l t s . H o w e v e r it s h o u l d be c o n s i d e r e d that n o r m a l l y o n l y a s m a l l p e r c e n t a g e (<1%) of s e r e to be a n a l y z e d for t h y r o i d h o r mones shows decreased albumin duncanconcentration. I n s t i t u f for 8 i o c h e m i s c h e Endokrinolologic, M e d i z i n i s o h e Nochsehule, Ratzeb u r g e r g l l e e 160, 2 A O 0 L O b e c k , F e d . Rep. G e r m a n y

Creatine-kinaseMB (CK-P~), ~nyoeardial isoenzyme of creatine-kinase (CK) is a sensitive marker of heart muscle derangement. In hypothyroid patients, who are prone to coronary heart disease, elevated serum CK levels have been frequently do cumented. In a severe chronic hypothyroid woman (66 years of age) we found high levels of myogl~ bin, CK, LDH. While all routine heart procedures (basal and exercise electrocardiogram, vectoca~ diogram, echocardiogram) excluded a significant myocardial involvement due to the metabolic disorder, elevated serum CK-MB amounts were found (14-15 % of the total CK activity). They remained unchanged during replacement 1-thyroxine treatment, up to represent 100% of the total CK activity and concentration (CK-MB was assayed by a RIA and an In~nunoInhihition technique). After woman's CK-M~ levels were demonstrated to be actually CK-BB by means of a CK-BB RIA and, in addition, by the ITmmunoPrecipitation technique, fi nelly the electrophoresis on cellulose nitrate revealed the presence of an abnormal band between the M M a n d M B position, migrating together with serum ga~aglobulins ("Atypical-CK" or ' ~ cro-CK-gB"). This finding was confirmed by the Sephadex G-200 column chromatography. Note that in this patient the "Macro-CK-Bg" aggregate after two years from diagnosis is still present today at the same level. In chronic hypothyroid patients especially elderly women, serum levels of "dtypieal CK-BB" can he present which can induce to an erroneous diagnosis of heart disease. C.N.R. Clinical Physiology Institute, II Medical Clinic and V Medical Pathology University, Via Savi, 8, 56100 PISA, ITALY.

With the aim of evidentiating the possible factors affecting serum M levels, we measured M by a very sensitive RIA (mean sensitivity 0.30 0.04 ng/tube) in 62 normal adult persons (32 men, 30 women, 16-62 yrs of age), 93 children (up to 12 yrs old), 25 newborns, 9 athletes, i0 hypothyroids, 4 acromegalics and in 25 uremics before and after dialysis. A significant ( p~ 0.01) circadian rhyt~un was found in normals, with higher M levels in the morning hours (zenith 8-10 a.m.). Children showed low M levels (10.6-6.1 ng/ml), while in newborns higher levels were found. Adult men showed significantly higher M levels (26.2 ZIO.3 ng/ml) than women (19.1 Z7.3) at 8-10 a.m. A significant correlation between body mass and M levels was found in non-obese adult men, women and athletes (r= 0.7195, n=60, p
A396

A397

A398

RADIOIMMUNOASSAY OF SEX HORMONE BINDING GLOBULIN. S.Tikanoia , K.Tontti and P.Tanner

EFFECT OF METHODOLOGICAL SIMPLIFICATION ON THE ANALYTICAL RELIABILITY OF STEROID RADIOIMMUNOASSAYS. G.C.Zucchelii~G.F.Bolelli,A.Pilo,A.Albertini and R.Maluano

NONPARALLELISM OF SPI EVALUATION. A.Sand~ J.Vandevivere.

Sex hormone binding globulin (SHBG) is the main carrier protein of estrogens and androgens. Its concentration determines the amount of free, biologically active sex steroids in circulation. Thus the measurement of SHBG is of great clinical value in the evaluation of reproductive dysfunction. To develop a radioimmunoassay, we purified SHBG from human pregnancy serum utilizing chramatographies on cortisol-Sepharose an~ phenyl-gepharose~ and raised antiserum (K=lxlP" l/moO in rabbits. To prepare tracer, we used a modification of the 5olton-Hunter method of r adioiodination: 50 pg of SHaG (in 50 pl of 0.02 m o l / l Tris-MClbuffer, pH g.o, w i t h g.l mol/l NaCI) were incubated with 500 pCi of the iodination reagent ior 3 hours at 0°C. The tracer was purified with successive gel filtrations on 5ephadex G-23 and Sephadex G-iS0. The specilic activity of the tracer was 0.6 pCi/pg and it could be used for four months. For the assay, lO0 #l of diluted serum ( h i 0 , 0.075 mol/l barbital buffer, pH g.6,with 0.25 % bovine serum albumin and 0.05 ~ NaNx) or standards (made either from purified SHBG or diluted pregnancy serum) were incubated with 200 pl o~ antiserum (i:2000, barbital buffer) and 10000 cpm of tracer (in 200 pl of barbital buffer) for 3 hours or overnight a t room temperature. The bound and unbound ligands were separated by double antibody technique. The sensitivity of the assay was 0.09 mg/l and the inter- and intra-assay coefficients of variation 11.0 % and 3.7 %, respectively. In comparison w i t h the commonly used method for estimating SHBG (dihydrotestosterone binding capacity oI serum) a close to perfect correlation was obtained (r=0.958). As measured by this radioimmunoassay, the reference limits of adult nonpregnant women were 2.77.3 mg/l (n=29) and those of males 0.9-3.8 mg/l (n=lO). Our novel radioimmunoassay offers a rapid, precise and reliable alternative Ior the measurement ol human SHBG. Oy Medix Ab, CLinical OOiOl Helsinki, Finland.

Laboratories,

Box

g19,

The e f f e c t of the i n c r e a s i n g use of d i r e c t methods on t h e a n a l y t i c a l r e l i a b i l i t y o f s t e r o i d RIAs has been i n v e s t i g a t e d on the basis of data c o l l e c t e d from an e x t e r n a l q u a l i t y c o n t r o l survey (EQCS) f o r progesterone P ~ e s t r a d i o l E2,and t e s t o s t e rone T ( p e r i o d : J a n ' g l - N o v ' S S l c a 70 p a r t i c i p a t i n g l a b s ; c a 4000 r e s u l t s f o r each assay).The f o l l o w i n g p o i n t s emerge:a)the composition of k i t p o p u l a t i o n shows a r a p i d t u r n o u e r ; b ) t h e number of d i r e c t assays increased up to more than 7O% of t o t a l f o r P and E2,and 50% f o r T i c ) t h e l a r g e between l a b o r a t o r y v a r i a b i l i t y decreased from 42-46CV~3 to 29-33CM~ f o r t h e t h r e e assays(for EQCS samples w i t h c o n c e n t r a t i o n >2 n g / m l , P l > l O O p g / m l , E 2 l > O . b n g / m l , T ) . T h i s r e d u c t i o n of the var i a b i l i t y can be r e f e r r e d to the i n c r e ased use of d i r e c t k i t s and to t h e sel e c t i o n , ~ m o n g t h e s e , o f t h e ones most consistent with the"fraditional"extract i r e 3M-RIA.In f a c t the w i t h i n k i t v a r i a b i l i t y was found s i g n i f i c a n t l y lower f o r d i r e c t assays(20-256V3 as compared w i t h 32-34CUM fo~ e x t r a c t i v e methods) imoreover t h e agreement of r e s u l t s from d i r e c t assays(y) w i t h r e s u l t s f r o m " r e f e r e n c e " e x t r a c t i v e 3M-RIAs{x),was found to be e i t h e r a c c e p t a b l e over t h e e n t i r e EQCS p e r i o d f o r E2 and T ( E 2 , p g / m l : y = l . l x + 4 ; T , n g / m i : y=l.4x-O.O4),or to change,for P,from an initial unacceptable overestimation(P, 1st pe~iod,ng/ml:y=l.3×+0.6,>lO0% overestimation o f f o l i i c u l a r values) t o a v i r t u a l ¢oincidence(P,2nd p e r i o d , n g / m l : y=l,Ogx-O.OG). I n s t i t u t e of C l i n i c a l Physlolo~y,CNR v i a Savi 8,56100 Plsa , I t a l y .

RIA,A E.Van

CLINICAL Royen t

In 16 of 394 pregnancies (4%) n o n parallelism was found with a RIA method (Hoechst). Some samples of these patients were checked using another RIA kit, with a different antiserum (Nordiclab). The same abnormality was shown. This finding is in a g r e e m e n t with other reports(Home et al.). The nonparallelism resulted in a p p a r e n t l y low concentrations, showing almost no variation throughout pregnancy (undiluted: mean concentration: 106 ng/ml, S.D.: 9 ng/ml in 16 s a m p l e s taken over a 6 months period). Neither was there any significant variation between patients (undiluted: mean concentration: 122 ng/ml, S.D.: 26 n g / m l , n = 1 6 p a t i e n t s ] . By means of a clinical study, the relation between the o c c u r r e n c e of t h i s phenomenon and the one of p a t h o l o g i c a l c o n d i t i o n w a s established. 16 Pregnancies, showing nonparallellsm, have been compared with 25 pregnancies with normal SPI concentration, and w i t h 20 pregnancies with decreased SPl level. A statistically significant difference (P<0.O5) could only be demonstrated b e t w e e n the g r o u p with nonparallelism and the one with decreased concentration, the l a t t e r g r o u p having a much higher pathology-rate. TWO consecutive pregnancies could be followed with one patient. The first one y i e l d e d n o r m a l l y r e a c t i n g SPl, whereas the second one showed nonparallelism. If n o n p a r a l l e l i s m g o e s by undiscovered (e.g. if o n l y 1 d i l u t i o n is a s s a y e d ) , these patients will end up in the population with decreased SPl level, w h e r e t h e y o b v i o u s l y do not b e l o n g . Nuclear Medicine Dept., Antwerp, Belgium.

A.Z.Middelheim,

A67 A399 COMPARISON

BETWEEN

CLONAL

AND

A RIA

BODIES

AGAINST

A RIA USING

CEA

USING

POLY-

MONOCLONAL

IN

ANT~'

SERUM.

H.MHller,S.F.Grebe,G.Kovecs,H.Tafazooli

Investigating very

high

essays

(r

includes tients

= 0.99). 837

with

group

of

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and

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of variability variation

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Prof.Dr,H,Mdller,M.D.,Dep.Nuclear Medicine,University, 65

Friedrichstr.25,

Giessen,West-Germany

A400

A401

THERAPEUTIC DRUG MONITORING BY RAD[OIMMUNOASSAY : DETERMINATION OF AM[NOGLYCOSIDE ANTIBIOTICS AND VANCOMYCIN IN PLASMA. D. Glaubltt, H.Jo Dtechs[er, K. Knoch, and K. Siafarlkas

A GENERAL RADIOIMMUNOPRECIPITATION METHOD FOR MONITORING THE SPECIFIC IgG ANTIBODIES LEVELS DURING IMMUNOTHERAPY. L. guilloux and G. V i U e .

Therapeutic drug monitoring may essenNaIly assist to reach the dosage of amlnoglycoside antibiotics and vancomyeln supposed to be required. We investigated the clinical usefulnessof monltoNng the plasma level of these drugs. In the plasma of 804 patients aged 2 to 94 years who were ~n surgical, medical, or paediatNc intensive care, the peak concentration and, if possible, also the trough level after intravenous administration at gentamicln, tobramycln, netiImlcin, amlkacln, or vancomycin was determlned by radioimmunoassay. Doubleantibody methods and 1-125 labeled antigens were used. Gentamycin was measured in 612 analyses, tobramycln in 4593, netHmicln in 2472, amikaeln in480, and vancomycln ~n 627 analyses. In all patients, plasma 62-mlcroglobulln was estimated by radioimmunoassay in order to obtain information about the renal function which may be impaired durlng such antibiotic therapy in a very high dosage. Therapeutic monitoring of these amlnoglycoside antibiotlcs end concomitant determination of 69-mieroglobulln (or creatinine) in plasma helped to kSep thepbsma level of these antibiotics wlthinor near the therapeutic range. This procedure prevented the dosage of these antibiotics from being too low and therefore ineffective or from being too high and thus leading toadverse effects such as deterioration of renal function. In conclusion, the radlolmmunoassay ofamlnoglycoslde antibiotics (gentamlcln, tobramycln, netilmlciiN amlkacln) or vancoraycin in plasma may considerably aid to assesstheir appropriate dosage and, if necessary, to rapidly adjust it to the assumed requirement. bepartmen~of Nuclear Medicine, Anaestheslology, InternaI Medlcine, and Paedla~ics, Academic Teachlng Hospital, D-4150 Krefeld, Federal RepubHc of Germany

Part of the beneficial effect of hyposensitization seems to be due to development of "blocking antibodies" which are mainly of lEG class ; so, monitoring the level of these antibodies in desensitized patients is recommended. We have developed a liquid phase radioi~ununoassay using different labeled antigens (honey bee venom, yelow jacket venom, cocksfoot grass pollen). Crude antigens were labeled with iodine 125 by the standard chloramlne T method. In order to study the major antigenic components, we have fractionned crude labeled antigens by chromatography on an ACA 54 column and tested each fraction for its immun~reactivity. The standard procedure was carried out as follows : to 100ul of each dilution of serum, I00~I of crude 1251-antigen or isolated 125I-component were added. After an incubation step at 25=C, separation of the bound and free fractions was achieved rapidly by the use of a second antibody in combination with polyethylene glycol (PEG). The results are expressed as a "binding index" in reference to a strongly positive IgG serum. gy inhibition experiments the several assays were demonstrated to be specific for the respective IgG antibodies. The isotypic specificity was confirmed by performing absorption experiments with an anti-lgE. The within assay coefficients of variation ranged from 2 p.cent to 6 p.cent, and between assay coefficients from 5 to 15 p.cent. This assay was applied to the determination of specific IgG in the sere of patients submitted to hymenoptera venom or grass pollen immunotherapy. We have found a good correlation between crude extracts and isolated antigens. In hymenoptera venoms therapy we followed the IgG levels as a function of cumulative doses of venom injected to the patients ; a maximum was observed for about 400~g of venom. This assay may be a useful tool to evaluate the efficiency of different hyposensitization regimens (crude~ partially purified or modified antigens, various dose or schedule). Centre de Kadioanalyse, Institut Pasteur, rue Domer, 69007 LYQN (FRANCE)

13-15

A402

A403

A 404

THE RENAL UPTAKE OF 99m-Tc-DMSA: EVIDENCE F0E GLOMERULAR FILTRATION AND TUBULAR REABSORPTION. D.A. Piers, W.H.J. van Luyk, A.J.M. Donker, S, Meyer and W.J. gfuiter.

Tc99m EMSA UPTAKE TEST AS AN INDEX C~ INDIVI~AL KIDNEY FUNCTION IN HYPERTENSIVE PATIENTS WITH N~OPTC81S. E. Forei reel, L. Palla, C. Ross, P. ~coni and S. ~ione

THE USE OF RENOGRAPHY Feb THE MANAGEMENT OF REMOVASCULAN HYPERTENSION. H.Y.eei, G.G.Geyskes, D.J.der Kinderen, C.B.A.J. Puylaert.

99m-Te-DMSA is accumulated for a major part in the proximal tubular cells of the renal cortex. It is assumed generally that this site is reached by extraction of the tracer out of the peritubular capillary blood into the tubular cell. Some data however suggest, that handling of 99m-Tc-DMSA in the kidney takes place by glomerular filtration and subsequent reabsorption in the proximal tubular cell. The following observations support this hypothesis. Clearance studies (CI) of 99m-Tc-DMSA were performed simultaneously with 123-l-iothalamate C1 using a continuous infusion technique. Two groups of patients were studied: (l) a group (C) of 30 patients with different renal disorders, with a wide range of glomerslar filtration rate (GFR) (5-160 ml.min-I/].73 m 2) and without tubular disfunction, as measured by lysozyme CI, and (2) a group of 20 patients with proximal tubulopathy (PT) of different origin, also with a wide range of GFR and with elevated relative CI of ]ysozyme. The relative CI of 99m-Tc-DMSA, expressed as CI 99m-Tc-DMSA/ GFR was in group C 6-13% and in the PT patients ]4-35%. Plotting of U.V (urinary excretion of 99m-Tc-DMSA) versus filtered load results in a lize that passes through the origin. The slope of this line is significantly steeper in the PT group (29%) in comparlso~ with the C group (9%), In case of acutely deminished glomerular filtration pressure, as can be encountered during treatment with captopril the kidney uptake of 99m-Te-DMSA was temporarily absent, as was the 99m-Tc-DTPA uptake, while 123-Ihippurate excretion persisted. These findings are compatible with glomerufar filtration and subsequent tubular reabsorption as the normal pathway of 99m-Tc-DMSA in the kidney.

An association between nephroptcsis (NP) add hypertension hgs been proposed by several studies. A Ooldnlatt mednmnam has been supposed to affect mobile kidney blood flow by slzetdniNg of the renal artery. Aim of the study was to asses~ the posturgl c ~ e s Of l~oal b l ~ flow in hyp~J~ceDsives with ~. TO I~SA uptake test %as performed in 16 essential hyperbsnsives (EH) with ~ and 9 EH ~vitt~at KD. Kidney IN~zes in 128 x 128 nmtmix (60") in the prone position were acquired by a lerze field of view ~smamer-e~zcmpater system, t,~ hours after the dose (2 mCi) injection. Each patient was studied twice, at a few d~ys' interval, re-

Departments of Nuclear Medicine, Pediatrics Internal Medicine, University Hospital, Groningen, The Netherlands.

and

spectively afte~ ~ hours of standing and t~o hours of supine position. By selection of isolevel ROts and b a c ~ d subtraction kidney counts were obtained sad kidney to kidney uptake ratio (UR) was detsru/ned. Compared to supine values a decr~ase of UR after standing v~s observed in the h~ pbs (i.00 + .19 vs .72 + .14 t=5.ON, p<.OO]; mobile vs controlateral kidney) but not in the non NP pta (i.02 + .17 VS 1.04 _+ .16; right vs left kidney), A significant co~relation was observed between UR after standing and an index of k/dney rotation in pte ~th NP (r .87; p<.Ol). The results indicate an orThoststic reduction of ~nilatoral kidney function in f~ertensive pts with ~ which could be due to renal blood flow modifications. ~ e degree of kidney rotation appears to be an important deter~/n~nt of this posture-dep=~ndent effect. ~hza Fo~mei C.N,R. Clg~eal Physiology Institufe~ University of Pied, via Savi, g, 1-561ON Pisa (Italy)

The correlation between renographic parameters and bloadpressure ~esponses on percutaneous transluminal angioplasty (PTA) in 72 patients with unilateral renal artery stenosis (URAS) were studied. All patients had on angiogram stenosis of more than 50%. According to criteria of the Cooperative study of renovascular hypertension these patients were divided into 3 groups (Gr). Grl: 19 patients, who became nor~1otensive; G r 2 : 2 6 patients, who improved and S t 3 : 2 7 patients, who showed no response on PTA. Renography was performed in supine position with large-field qarmnacame£a posteriorly using orthoiodohippurate. Renographic data were collected in 20-see frames and regions of interest were defined with a light-pen. Background areas were chosen below the kidney. From the affected kidney two parameters were obtained. The Relative Hippuran Uptake (RHU), calculated from the integral counts of the second minute and the Difference of Time to Peak (DTP) to the contralateral kidney. DTP <] min was considered to be normal. The results are qiven in the table. Patients with RHU between 35-44% had the best prognosis. Most of the nan responders had RHUvalues >45%; this probably indicates that the stenosis was of no hemodynamic consequence or pathology of the contralateral kidney. In 7 patients with RHU <25% (2 p~tients of Gr3, in whom the stenosis was successfully dilated and in 5 other patients, in whom PTA was not possible) nephrectomy resulted in normalization or improvement of the bloodpressure. We conclude that PJiU is a useful discriminator for the management of URAS-patients, while prolongation of time to peak (DTP ~i min) does not predict the bloodpressure response on PTA.

Orl Gr2 Gr3

>55 O 1 4

45-55 0 2 ii

RHU(%) 35-44 17 14 2

25-34 2 5 5

<25 O 4 5

OTP[min) ~l
Dept. of Nuclear Medicine, University Hospital, Catharijnesingel iOl, Utrecht, The Netherlands.

A68 A405 SCINTIGRAPHIC DETECTION OF VASCULAR AND UROLOGICAL COMPLICATIONS IN THE TRANSPLANTED KIDNEY133 CASSS. M. Melloul, E. Luhin, Z. Shapira and A. Yussim. One hundred a~d thirty-thr~e consecutive kidneys grafted during the last two years were followed by scintigraphy. P~tterns of prerenal, renal and postrenal complications were rec0~nized. Vascular thrombosis diagnosed by photodeficiency of the transplanted kidney was diagnosed and confirmed in all 10 patients. Fourteen patients havin~ postren~l urological complications (12 leaks and 2 urethral obstructions) were all recognized in the late phase of the scintigraphic study. The differentiation between the known parench~nat0se causes of Knuria was less satisfactory. With scintigraphy, we could diagnose all those cases where the complic&tion was due to causes that required surgical intervention. Department of Nuclear Medicine and Kidney Transplant Unit, Reilinson Medical Center and Tel Aviv University Saokler School of Medicine, Israel.

A406 KINETICS OF RADIOACTIVE HIPPURAN ( O I H ) IN TRANSPLANTED KIDNEYS H. Fill, M. Spielberger, M. Margreiter, g. Leidimair In the most frequently observed curve patterns of the OIH renogram five easily measurable parameters = time to maximum (TMAX), time from maximum to 75 % of the maximum (175), PMAXIT7D (TMAW75), maximum counts over kidney per pixe] and minute (CRAX), quotient CMAX:TMAX (C/T) and the time to the intersection point of k ~ d n e y and bladder curve mere evaluated statistically. Data ~ere extracted from 600 renograms performed in lO0 patients. Results: The normal Functioning tramsplant ~ t h serum creatinine levels of 2~0230,81 zs called curve type i. Type 2 represents a p r o l o n g a t i o n of TMAX*T75 and implies an impairment of activity e ~ traction and intrarenal transportation. Type 3 is c h a r a c t e r i z e d by a prolongation of 175 and points out an isolated excretory disturbance. Creatinine revels range at 3.]731.82 for type 2 and 5. Type 4 outlines severe reduction of OIH uptake in combination with disturbed intrarenal activity transport, lhe other parameters support these findings. CMAX is a measure of volume of functioning renal parenchyms. The desribed patterns of ren~l OIH p~ssage describe the functional state of the kidney. Normal transplants can be distinguished most sensitively from o£gans mith disturbed function, although the changes observed are not specific for a kidney rejection. A rejeetiom can be postulated on the base of an impairment of Fens1 function. This can be achieved by a defined judgement of OIH kinetics.

A 408 V A L I D I T Y OF ~ P F , G F R , A A T FF E S T I ~ A T E D IN R E N A L V A S C U I @ ~ D I S O R D E R ~ A N D K I D n e Y T R A N S P L A N T S . A. Oppelt, G. F r a n k e , V.Sllgov~,J.Stglbrn~,~I.Vesel~ and V.Ko6andrle. The p u r p o s e of our s t u d y has b e e n to m e a s u r e v ~ 2 F , G F R a n d FF b y m e a n s of clearance determinations.Measurements using 1-131-Hippurate and Yb-169-DT~A have been compared with classical subs t a n c e s as P A H , I u u l i n or P o l y f r u c t o s a n e . E R P F im h y p e r t e n s i v e p a t i e n t s b e f o re p e r c u t a n n e o u s t r a n s l u m i a a l a n g i o p l ~ s t y has b e e n i n v e s t i g a t e d . F o l l o w - u p s t u d i e s of those s u b j e c t s are b e i n ~ p e r f o r m e d f o r l o n g p e r i o d s of time. A g r o u p of p a t i e n t s a f t e r renal trans p l a n t a t i o n has b e e a the s u b j e c t of our z n v e s t i g a t i o n s as w e l l . V a l i d i t y of clea~a~Q &eter~i~a~i@~i~r@l~$i~ te rejection episodes and other postoper a t i v e c o m p l i c a ~ i o m s h a s b e e n studied~' Furthermore effective renal plasma f l 0 w , g l o m e r u l a r f i l t r a t i o ~ rate azld filtration fraction values have bee= estimated in patients after reconstruction surgery and nephreot0m~. I n s t i t u t e f o r clizLisal a n d e x p e r i m e n tal m e d i c i n e , l ~ 6 22 P~ague-Z~-l(l~ 9 V i d e n s k ~ 800 ~ C z e c h o s l o v a k i a amd Nuklea~-medizi~ische Abteil~ , C a r l GLlstav Car~/s Medizinische Akademie,Dresdem,Fetsoherstrasse s DDR

U n i v . - W l i n i k for N u k l e a £ m e d i z i n Innsbruck, Anichstr. 35, A-6020 Innsbruck

A409 USEFULNESS OF DYNAMIC RENO-SCINTIGRAPHY IN THE FOLLOW-UP OF HYPERTENSIVEPATIENTS SURGICALLY TREATED FOR RENOVASCURARSTENOSIS R i d o l f i P.,Macri C.,Bui F . , V a r o t t o L.,Mantero F. Fallo F.~ Ccomputerized assisted Dynamic Reno-Scintigraphy (DRS) has been shown to be an accurate diagnost i c procedure in the screening f o r renovascular hypertensi'on. Aim of our study was to assess the r o l e of DRS in the follew-up of I I patients who underwent surgical treatment f o r renovascular disease. 7 patients had u n i l a t e r a l (2 fibromusco l a r and 5 a r t e r i o s c l e r o t i c ) and 4 b i l a t e r a l (2 fibromuscolar and 2 a r t e r i o s c l e r o t i c ) r e n a l a r t e ry stenosis,documented by angiography. DRS was recorded f o l l o w i n g i n j e c t i o n of 0 12 mCi/k9 99m-Tc Glucoheptonate i . v . before and I mos.-3 yrs. a f t e r r e c o n s t r u c t i v e vascular surgery(vein or dacron by-pass g r a f t ) . Serial images and renal t i m e - a c t i v i t y were analyzed according to pre v i o u s l y established c r i t e r i a o f i n t e r p r e t a t i o n . DRS was abnormal in a l l patients before surgery, 7 patients (2 with b i l a t e r a l and 5 with u n i l a t e ral stenosis) became normotensive a f t e r surgery; DRS normalized together with blood pressure in thease p a t i e n t s . DRS did not change in 4 p a t i ents who did not respond favourably t o surgery; a l l these patients(Z with b i l a t e r a l and 2 with u n i l a t e r a l stenosis)had a r t e r i o s c l e r o t i c disease Two of them underwent a new angiography which showed in one case a by-pass o c c l u s i o n , i n the anoter one a renoparenchimal disease. In conclusion DRS seems to r e f l e c t well the recovery of renal perfusion a f t e r surgery in hypertensive patients with renal a r t e r y stenosis. This f a c t could be useful in the decision to perform more invasive procedures in patients with residual hypertension suspected of having recurrent or or persistent renal a r t e r y occlusion. Inst.Semeiotica Mediea,University of Padua,ltaly

A410 C O R R E L A T E S OF DIURETIC RENOGP~MS IN E X P E R I M E N T A L CHRONIC E Y D R O N E P H R O S I S . M. Kekom~ki, C. Bert@nyi, E. Rikalainen and P. Ruotsalainen. Rate of g l o m e r u l a r filtration can be a p p r o x i m a t e d c o n v e n i e n t l y in conjunction to renograms. When used to evaluate an e q u i v o c a l e m p t y i n g of the kidney pelvis, s i m u l t a n e o u s use of furosemide increases the clinical a c c u r a c y of DTPA renoqrams. There are to date no observations to link the r e n o g r a p h i c characteristics of the kidney to its tubular function. Growing male rabbits w i t h a solitary p a r t i a l l y o b s t r u c t e d kidney were used to compare ~ e findings of furosemides t i m u l a t e d J ~ m T c - D T P A - r e n o g r a m s to the rate of g r o w t h and to certain indices of g l o m e r u l a r and tubular function. The presence of a s i g n i f i c a n t o b s t r u c t i o n was shown in all animals of the experim e n t a l group by an intravenous pyelograms, done 4 weeks after the obstruction had been created. The diuretic D T P A - r e n o g r a m s , p e r f o r m e d 4 weeks later, were abnormal in all e x p e r i m e n t a l animals. D i s s i m i l a r r e n o g r a p h i c patterns were r e c o r d e d in animals w i t h a normal and abnormal rate of w e i g h t gain. As c o m p a r e d to the e n d o g e n o u s clearance of c r e a t i n i n e and to the s.c. distal nephton index, similar c o r r e l a t i o n s were noted. We conclude that a standard d i u r e t i c r e n o g r a m p r o v i d e s accurate and d e t a i l e d i n f o r m a t i o n on renal function and on kidney's ability to m a i n t a i n growth and body homeostasis. D e p a r t m e n t s of P e d i a t r i c Surgery, R a d i o l o g y and N u c l e a r Medicine, Turku U n i v e r s i t y Central Hospital, SF-20520, Turku 52, F i n l a n d

A411 CLINICAL E V A L U A T I O N OF DYNAMIC R E N O S C I N T I G R A P H Y USING 99m T c - D T P A IN P R A C T I C A L UROLOGY. H. Washida, M. Tsugaya, N. Eirao, Y. Hachisuka, F. Tanaka, H. Fujii and T. Fukushima. We have i n v e s t i g a t e d clinical usefullness of the r e n o s c i n t i g r a p h y using 99m T e - D T P A in p r a c t i c a l u r o l o g y for 666 times (609 cases) for 2 years. In this report, we would like to present e v a l u a t i o n of i) THE RENAL F U N C T I O N D U R I N G THE COLIC A T T A C K INDUCED BY UROLITHIASIS, ii) POLYCYSTIC KIDNEY, iii) HYDRONEPHROSIS. For the dynamic studies, 10 mCi of 99m T c - D T P A was injected i n t r a v e n o u s l y as a rapid bolus and sequential images of the kidney were r e c o r d e d every one second for 25 m i n u t e s using a ga~una scintillation camera and on-line m i c r o c o m p u t e r system. The analysis is p e r f o r m e d a u t o m a t i c a l l y at night by a microcomputer, i) THE RENAL F U N C T I O N DURING THE COLIC ATTACK INDUCED BY UROLITHIASIS; This was p e r f o r m e d in 14 cases whose affected kiddney was not v i s u a l i z e d on intravenous urography. It is suggested that the renal function of the kidney affected w i t h c o l l i e attack is t e m p o r a r i l y d e c r e a s e d f o l l o w i n g the d e c r e m e n t of renal blood flow. ii) P O L Y C Y S T I C KIDNEY; This was done for 5 cases. A remarkable feature of the study is n o n - i n v a s i v e e x a m i n a t i o n for the k i d n e y c o m p a r i n g IVU, as contrast m e d i a is u n f a v o r a b l e f o r renal function. The study is b e n e f i c i a l not only for diagnosis, but also for follow-up, b e c a u s e of d e t e c t i n g renal m o r p h o l o g y and function, simultaneously, iii) HYDRONEPHROSIS; 11 cases were examined. A lot of i n f o r m a t i o n s or renal parenchymal change were o b t a i n e d by the study. It may be c o n c l u d e d that dynamic r e n o s c i n t i g r a p h y w o u l d be the first choice e x a m i n a t i o n in p r a c t i c a l urology. Anjo Kosei Hospital,

Anjo,

446, Japan.

A69

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A413

A414

EVALUATION OF To-99m-GENT~41CIN AS AN AGENT FOR RENAL FUNCTION AND MORPHOLOGY. K. Ozker and I. Urg~nclo~lu

AGEDEPENDENCE OF KIDNEY-FUNCTION A. Steinstr~sser, J, Curschmann

An aminoglycoside ~ntibiotlc~gentamicin is labeled with Tc-99mby the reduction of pertechnotate by stanno~ chloride as described previously. Organ distribution of this agent in rats showed a selective renal localization. Administration of Tc-99m-Gentamicin in rabbits confirmed that scintigraphic delineation of kidneys was highly satisfactory. Gentamicin is excreted almost entirely by glemerular filtration.However the radioactivity is retained in the kidney for a long period s~gesting some tubular reabsorption Of this compound followin H glomerulzr filtration. The whole body images of rabbits injected with 2~0 microCi Tc-9£m-Gentamicin were analysed by a gamma oamer~ interfaced with a c~mp~ter. A~eas of interests were generated on each kidney and time activity curve was obtained. The radioactivity concentration in the kidneys as a function of time was described as the sum of two exponentials.The exact renal mechanism for handling radioactivity is presently unknown. However the excretion by glemerular filtration end subsequent tubular re~bsorption could be responsible for the fast and slow components respectively. Furthermore the reasonably longer retention in the kidneys would result in higher target-ethan to baekgro~znd ratios allowing more adequate renal scans,supplemanta~$ to the simultaneous f~mctional studies. ~ekmece Nuclear Research Center and Nuclear Medicine Repartment~Cerrahpa~a Faculty of Medicine Istanbul University~ Turkey

of . ~ n o . ] . e a z I ~ e ~ d . e ~ n e ~ulg~rJ.a-

Althought the kzdney÷funetion is immature in infants and on the other side is decreasing with increasing age i n adults, an adjustment of the kidney clearance for age besides the conventional surface correction is not in common use. Ne compiled more than thausend studies to get a statistical s i g n i f i c a n t r e l a t i o n between age and k i d n e y - c l e a r a n c e . These studies #ere dzvided into three groups:first children belo1~ 2 years (n=71), second childrens and adolescents from 2 to 15 years (n:64o)/58o) and t h i r d a d u l t s (n:47&o/42&o; age: 16-80 yi). The linear regression of the data in the latter group gave for both sexes a koefficient of correlation of 0.95. The slope of the c u r v e s are similar to that of several authors, but surprisingly no great difference between male and female ~as to be detected. The maximal clearance-values have been found in t h e groups about 8 years, ~here the maturation is finished and the process of a g i n g starts. fhe retrograd prolongation of the regression line calculated for the adults gave a good estimation of clearance-values in the groups between 8 and 16 y e a r s . So one can use a l i n e a r decrease o f c l e a r a n c e s t a r t i n g ~ith 8 years. Discrepancies between maturation age and eaDandar age in children lead to greater deviations than in other groups. In the case of children up to two years the best fit was done by a logarithmic curve. So the total graph of kidney clearance as a function of age consists of three trunks: a logarithmic increase up to t~o years, a slightly increasing linear part from 2 to 8 years in order to get 8 eontinnous connection to the third part, the linear decrease, beginning ~ith 8 years. An inversion and normalisation of this function leads to a correction of individual c l e a r a n c e - v a l u e s to a s t a n d a r d age. Nuklearmed. Abtlg. der Radiol. Oniversit~tsklinik, D-6650 Homburg/Saar, West Germany

A415

A416

A417

VARIATION OF RENAL TUBULAR CLEARANCE WITH ADS AND SEX 0. Lauer, R. Bauer, H. Langhammer, H.W. Pabst

IS THE NONINVASIVE MEASUREMENT OF RENAL CLEARANCE OF LOW MOLECULAR WEIGHT PROTEINS POSSIBLE? PRELIMINARY RESULTS IN MAN. C.Bianchi,C.Donadio,G.Tramonti, F.Lorusso,R.guzzardi

Volume of distribution of OIH derived from camera renography and clearance measuremp_nts.

Since normal values of renal tubular clearance are lacking freguently~we tried to define the normal range of the ortho-iodo-hippurate (OIH) clearance (C). Total renal C was obtained by the OBERHAUSEN technique in conjunction with dynamic renal scintigraphy, using 1-131-01H in adults and 1-123-0IH in children. Data were normalized to 1.73 m 2 surface area. Startirgfrom 1300 clearance studies in adults and 300 ones in children, a normal collective was selected retrospectively by the criteria: a) normal kidney size and morphology as judged by static renal imaging in adults or by IVP in children and b) normal OIH-kinetios of both kidneys. Linear regression analysis was done separately for the age groups 3.5 - 15 and 16 - 75 years and for both sexes. I) Age 16 - 75 years: 243 males and 181 females were considered as normal with respect to renal function. Regression analysis yielded men: C : 670-3.3x (r:-0.38, s:124) (ml/min), women: C = 617-3.3x (r=-0.42, s=I04), x = years, s = standard error. ~he level of signifieanee of the difference in clearance between both sexes was slightly above 5%. 2) Age 3.5 - 15 years: 20 cases were considered as normal. Within this small number no significant correlation of C with age was found. The mean (± s) was C = 577 ± 88 ml/min. 3) Plotting all available data from literature as a function of age, our normal values of tubular clearance fit in quite well. After a steep rise between birth and 3 years there seems to be a plateau until maturity. Thereafter tubular clearance declines gradually, the averages of the females being about 10% less than those of men. 4) A normal range can be deduced as C ± 1.65s, C being the regression line or the constant value in the respective groups(90~ confidence interval). Nuklearmedizinische Klinik, TU ~Onehen Ismaningerstr. 22, D-8000 ~tinehen 80

Many low m o l e c u l a r weight proteins (calc i t o n i n , i n s u l i n , g l u c a g o n , l y s o z y m e , ~2-mic r o g l o b u l i n ) a r e removed from the hlood by the kidney where they accumulate without being eliminated with the urine. The measurement of renal clearance of such molecules needs renal veins catheterization.We are now applying a new noninvasive method for the measurement of the renal clearance of A p r o t i n i n ( A p ) ~ l a belied with Tc99m.Ap is a small protein (6500 dalton) which inhibits some proteo lyric enzymes such as trypsin and k a l l i ~ krein.We have already validated Ap-Tcg£m ~sa tracer for r e D a l s d S n t i g r a p [ , s ~ n c e T t ~ s ~Ig~ly and s ta~-ly accumulated ~n the kidney with minimal urinary excretion.Renal clearance of Ap(and of other low molecular weight proteins with similar renal handling) can be determined during continuous venous infusion of ApTc99m as: AK Cl= t2 P(t) dt w h e r e : ~ K is the increase of the radioactivity ove~ each kidney measured by external counting and corrected fo~ tissue attenuation, and P is the plasma concentration of Ap-Tcggm. We have studied 5 subjects with normal ~enal function and 1 patient with advanced renal failure. In normal suhjeets renal clearance o£ Ap-Tcggm was about half of the ERR.In the patient with renal failure the values of ~enal clearance of Ap-Tcggm and GFR were similar.This method could give n o n i n v a s i v e l y the unilateral renal clea ~anee of low m o l e c u l a r weight proteins-handled by the kidney. CaftedPa di Nefpologia M e d i c s , C l i n i c s Medica 2, Istituto di Fisiologia Clinics C.N.H.~ University of Plea, Plea, Italy.

I.H. Wolf, W. Kanitz, H.W. Pabst Nuklearmed. Klinik und Poliklinik der Technischen U~iversita't F~dnchen DIP.: Prof. Dr. H.W. Pabst A renogram without any excretion of OIH into the bladder is up to a factor equal to the integral of the time activity curve of the c c ~ t i ~ e n t , frc~ which OIH is extracted by the kidneys. An algorythm is proposed, which allowes the mathematical reconstruction of this curve, which is shown to be a two e x ~ t i a l function of time. Using Sapirsteins model of OIH kinetics, the transition rates are calculated.simultaneously, the renal clearance is determined using whole body principles. Thus, the vascular vol~me of OIH is given by the quotient of clearance and clearance transition rate. The extravascular volume is calculated from the vascular volume and the intercoRioartmental transition rates. The renograms of 89 patients are evaluated in the a ~ i~entior~ ~ara~r. The Vascular volume is found to be 4700 +_ 1100 el. The mean body weight (BW) of these patients was 69 + 11 kg, i.e. the vascular volume is 6,8 % of BW. The extravascular volume is determined to 9100 + 360 ml (13,2 % 5W) the total vol~ae of O11{ distributi~ to 13800 + 3200 (20 % BW). From these results we argue,that O ~ is extracted from the whole blood. This assbmptian J/nplies, that the binding of OIH to the red blood cells is a very loose connection, which is solved during the few seconds of red cell passage through the kidneys. The clearance itself was determined, using the p l a ~ concentration of OIH. Assum//~ a }~c of 45 % and a binding of OIH TO the erythrozyts of 35 %, the distribution volumes are increased to a vascular volume of 5500 ml (8 % BW) , a extra%rascular volura~ of 10700 nil (15,5 % BW) and a total volume of 16200 ~i (23,5 % BW). These values agree wall with the corresponding values of blood volume (7-8 %), intersticial space (16 %) and extra cellular space (22 %) , raentic~ed in the literator.

A70

A418

A419

ISOTOPIC EVALUATION OF THE BODY COMPARTMENTS IE DIFFERENT TYPES OF EEMODIALYSIS (HD). M.Gartea*, C.Piera, L.S~nchez, R.Fern~ndez, A.Garcia M.Ca#£e£a*, J.M.Pons*, J.Setoaln, L.Reve~t ~.

THE EFFECT OF "BIOLOGICAL" AND STATISTICAL NOISE ON THE CALCULATEDRENAL RETENTION FUNCTION M. Bagid, S. Lon~ar{d, S. Popovid and I . ~imo-

The purpose of this study has been to examine the effect on plasma volume (PV), extracellulaD volume (EOV) and intracellula£ volume (ICV) of conventional HD and hypertonic HD. We have studied I3 patients. Seven were on conventional HD 4h x 3 times-week with a di~lys~te containing Na ISE mEq/l and a osmola£ity of 305 mOsm/kg. The other 6 patients had been since i month before on a stable regimen of hype~tonic HD 3h x 3 tlmes-week with a dialysate of 130 mEq/l Na and osmola#ity 2g5 mOsm/kg with a pe~fusion du£ing the first hour of 342 mEq of CINa. One hour befo#e HD, the spaces Of RIHSA-125I {PV), 35S04Na 2 (ECV initlal) and 3H20 (tot~l water) we#e determined. The pl~sma albumin was assayed hourly, and at the end of the RD the space of 35S04N~ 2 (ECV final) was agsln detevmined. ZCV = Total W~te£ ECV initial. Results: In conventional HD with a weight loss Of 1900+387 g, the PV diminished 14.5~6.4%,the ECV decreased 19.2+6.3% and the ICV increased 1.7+3.3%, showin6 that the weight loss was due to ~he ECV with h~pe#hldFatetlon of the IDV. In hypertonlc HD, with a weight loss o£ 1860+ 668 g, the PV was Deduced in 5.4~4.D%the ECV diminished 10.4+7.4% and the IBV decreased 3.4+ 3.8%, indioatin~ that the weight loss was due to the ECV in 5a% and to the ICV in 46%. We conclude that the simultaneous isotopic measumement of the body compartments is a useful tool fo~ studying the weight loss duming HD; we have also verified that the use Of hype~tonlc methods allows dehyd~aEion of the intraeellulaF compartment and maintains better the PV duming HD.

The problems associated with deconvolution of the renogram are the following: a) a suitable choice of sampling time, b) statistical noise in the data, c) interference of renal and background activities, d) negative values of the calculated renal retention function (RRF). They are still not fully explained and this work is attempting to clarify them using simulated data and matrix algorithm.

SERVICIO DE NEFROLOOIA*. SERVICIO DE mEDICINA NUCLEAR. HOSPITAL CLINIGO Y PROVINCIAL. UNIVERSIDAD DE BARCELONA.- Casanova, 14S - BARCELONA-3E - SPAIN.

A420

novi~

Statistical

noise in the input curve was reduced

by fitting data to a sum of exponentials, while in the renogram by using third-order smoothing polynomials (Ba~i6 et al, Phys. Med. Biol. 28:731-738, 1983). Since external probes are used for the measure-

ments, " b i o l o g i c a l " noise consisting of e x t r a vascular (£V) and background a c t i v i t i e s is superimposed on plasma and renal a c t i v i t i e s . The c o n t r i b u t i o n of the EV to the plasma a c t i v i t y in the cardiac region causes negative values in the RRF and calculated mean t r a n s i t time (MTT) is underestimated compared to the true one. ~]l points of the RRF, not only the first one, are influenced by the interference of background and renal a c t i v i t i e s . S t i l l the NTT is not dependent on the background a c t l v i t y , c When the minimum transit time is in the range of I-1.5 minutes (it is very often in d i n i c a l practice) the sampling i n t e r v a l should be 10-]2

seconds. There is a hyperbolic r e ] a t i o n s h i p between the c o e f f i c i e n t oF v a r i a t i o n (CV) oF the MTT and the peak value o f the renogram. The e r ror c o f the MTT (expressed as a double CV) w i l l be less than I0~ when there are about 5000 counts in the peak. Department of Nuclear Medicine, C l i n i c a l Hospital Centre Rebro, Kf{patiCeva 12, 41000 Zagreb, Yugoslavfa

COMPUTERIZED RADIOISOTOPIO CISTOGNAPHY (CRC) IN THE EVALUATION OF VEBICO-URETERAL PATHOLOGY.

.O'CnvaLeo,A.N o d a l , L. Troncone, R. 9 ~ c c £ n £ , F. c ~ . Com~te~Ie~ R ~ i o i s o t o ~ c C{z~£o~ap~( CRC) co~t b~ u~tLLLa ed ~ cvaluoAe ~ l l ~ p e ~ o~ m i c t u ~ a 2 i o n ~ l poY~o~o~ : ve~ico-u~te~c~ re£E~x , u~e~ccZ ~te~o,_ i l e ~ c~nduZ~t u ~ J ~ c ~ cLLver~iov . TAe Mu2Ao~ ~ t o u t t o evalaole, ~4 on i n d ~ o~ bladde~ e r u p t i n g , T/2 c a l c u i c ~ e d on ;E~e bc~i4 o~ :&~ ~l o p e o,~ c~. a d = i v ~ / t i m e cu~ve F ~ o ~ [ o r a . j e i e c t e d t e f l o n o~ t n ~ e r ~ o~ ~Ae bladder d u r ~ 9 m i c i u ~ o l i o n . 52 p ~ L L e r ~ , a ~ i monf3z t o 67 ~¢ar~ , ~e r a ~tudLed. YmmedLc~e~ ~oZlo_ wL~9 compu~erL~ ed rad~ot ~o~o p£c r e n a l a n g ~ o g r a p ~ , 6~6 was periZonmed u~&~9 ~ z e ~ame radioac;ttv~ d o ~ . 20 o~ th.e 52 p ~ l i ~ ~ x ~ i ~ ~h.~ed no pc~tJ~lo£4 a t ~-Aeb l a d d ~ level b u i were ~ e c i e d i n ~ £ ~ b~ va.~ou~ [o~,~ o~-~ p / ~ o p ~ . V~tco-~ re flux wa~ ~ u ~ p e ~ on I A e b ~ i ~ o~ c ~ o ~ ~om ia 23 oI~ Y~e r e m a t n ~ 9 32 pcd=Zen~4.T ~ wc~ con~Lrmed i ~ 9 and r u l e d ou~ i ~ 10. Yo~r were ¢ound *to &ave ~ "cte ro~i~ o~ t h e bladder neck, 2 ~A~ed a pic~ur e o~ #o~£o pe~al£ve L l e o l condvi2 ur~nar~ d i v ~ i o n and 3 r e v e e l ~ c o n ~ e n ~ o ~ 4t~nodi4 o~ ~ u r e t h r a . From • h e dora ~hc~ we o b t a i n S , we c ~ conciud~ ~ a ~ ~ e calcu~on o~ T/2 ~ n o ' b i n 9 t o ~Ae evol~tLon o~ VUR, v a i u ~ o b t a i n e d Ln ~J~L~ c a s e d o noZ d ~ e r ~ i @ n i ~ i ~ n l ~ ~rom no.tool( VUR~=25.21~ 12.03 ). Re~2u~ i~ condC~m~di n ~ t e a d b~ ~ e cu~v~ ob~cL~ed d u r ~ 9 micAu~atZon on d 2 ~ t ~ po r~Lon~ o~ ZAe ~ e t e ~ . T12 calcu2oY~Loa Lo u~efa~Z Zn ~Ae evala~tLon o~ Yzde decj~ee o~ eomprom~ o~ ~J~a~xc~eY=o~zf_u~ YcLon i ~ vortous ~ p ~ o[. u r ~ t h r ~ Z s ~ e n o ~ i s and i n • h~ ~oi2~v-up o# t 2 ~ a l condubt u~L~a~q$ d ~ v ~ t o ~ . Yn t ~ c o ~ ~Ae vc~b~e~o b t a i n e d {'~&59 . g ~ i 6 ~7 J d ~ ~ t ~ i ~ i ~ l ~ z ( p=O.005 ) ~ o ~ ~Ao~e ob~cJ~ed i n noamal ~ u b ~ e c ~ ( ~2:2#. 80+ 9 . 9 2 ) . Nue2ear~a~Lcine Y n ~ e - U n i v ~ . i ~ C~.~o~.ca S. Qtore - t . 9~ A. ~ e ~ t t , 8 - Rome- Y ~ a ~

A421

A422

A423

NADIOISOTOPIC CYSTO-URETHEOGNAPNYIN MEDULLARY

CIS-PLATINUM NEPHROTOXICITY: NUCLEAR MED I C I N E S T U D I E S AS I N D I C E S OF R E N A L F U N C T I O N IMPAIRMENT-PRELIMINARY RESULTS. F.C~cL,

MEASUREMENTOF 1311-ORTHOIODOHIPPURATECLEARANCE IN THE DETECTIO~ OF ClSPL~TIN NEPHRO~OXICITY. H. Wi~ler , U. Rabs , R.A. BUrger" and W. Hengst .

INJURI~D PATIENTS.

l,Taddei,F.Benvenuti,C.Bia-

gini,M.Legnaioli,C.Gori,A.Sommavilla

4-D'6~c°,t" Vesico-urethPal d i s f ~ c t i o n is a serious p~oble m in patients with medullary injury as renal sc~ring is the most eommon cause of death i, these patients;heart the impoPt~nce to contPol f~equentI~ the iowep uPinsr x tract function with u~odynamic methods. Since radionuclide essto-urethrog~aphM seems to be a reliable,repetible and sensible method in studying functional "urinary tract diseases,we used this technique to evaluate 15 patients with spinal L n j u ~ . The bladdem was filled with 99mTe-DTPA and sal! ne with a 14 Oh Foley catheter at 100 cmH20 fil ling pressure,in clinostatism.Filling ~/%d voiding phases were studied with g ~ m l a c~mera on line with a computer.Afte~ the catheter was re moved,the minctional flow W~ studied.Urodyn~m ! variables concerning Fillin~ and voiding pres sure and volumes and voiding flow were studied. ResulEs were comparable with those found with conventional u~od~n~smic techniques.Furthermore a morphological i n f o ~ a t i o n concerning vesicoumetheral ~ e f l ~ and bladder diverticula was obtained. Radionuclide c i s t o ~ e t ~ o g r a p h y appeared to me-et well diagnostic needs,to be less time consum~ng and less distressing for patie~ts than the conventional u~rod~n~amie approach. Ospedale G, Casoni, INHCA, Via Inco,t~i n. ~0, 50100 Firenze-ITALIA

Trod~a,A. Nod~g,t.m~iro~£,

Ci~-pl~ ho~ 5 e ~ ~ho~n t o be e~t[ec~iv ~ i~ tAe tree.monet o~ aevenol ~eoplc~m~.J~ oli~Lcel ~ e , h ~ e v ~ , i~ o ~ compZLcoA~ b~ reae~ ~ o × i ~ . The cu~ ~ ¢ of 4" E'h~c~c~tL°~ one~lot o~mo~.Lcdiu~e4i~ b ~ o r e , d u r i a ~ d a~ter ci~-~a~ a~in~ ~ I r o t i o n h ~ t h e p o t ~ i a ~ £o prot~c~ a@~in~t 2 h i s a ~ o ~ £o ~ v ~ e ~he pre~enceo# r ~ c ~ ~ u ~ o n impoi~ ~oli~#~tngi~ ondmuX~tpie do~e ci~pla2~uv~a ~ r a ~ ~ weZl ~ ~he p o s s i b l e n e ~ o t o ~ic c~L~retc~ 6 ~ e e a /cAe2 ~ p e ~ o~ ~ e r a p ~ . 22 pa, O L e r ~ b e a t e n , t h e a~e~ o~ 15and d S ~ e r e ~ v ~ 9c~t~. 12 of~ ~ ¢ r e c ~ L w d ~tmptc do~e o£ c i ~ - p ~ J . E . h ~ d r ~ i o n and o~moZic d i u r ~ c ~ r ~ admini~t~ r ~ £~ 022 c o ~ ~o Zncrec~¢ u~i~e vo2um~w~d ~_iow, ~Juz~ r ~ e _ b t 9 5o,~:Au~i~cu~ conc~'d~wEion ot! ci~-p2a_ ~ u m c~e~&Z c~ ~ze d/uzp% con£act ~ O n e ~ 2A~ r~_ n a i ~ubular ¢ p i ~ i u ~ . Th~ [oJJc~in 9 e~am~ ~ e r e p~__ ~_o~ed t a t do# 5e~[ore and : ~ e da~ af.:te~ ~erap¢~ : c~e ~ e c~le~ace( COl. e~ec/cive re~c~ p~a~ma ~ c ~ ( 6RPF], renograph~( f~j)end compuie~L~Erac~Lonacl!_ r i e ~ ~c~ r e p e a l e d ~ e v e r ~ e e k ~

~o2~ing ~h~a ~. ~Ae r ~ o~ ou~ ~;b~c~, repo~_ed i n t a b l e I, ~u~ ~t ~ %~jAe d ~ e ci~-pWx~Zinum~ a ~ ma~ re_ suJvt t n imported r~c~Z f u n c t i o n ; on ~he cor~tro~ :tAt nep~ro~o×ic~Lt~ o~ ~ e mui~Lpi~ do~ e ~ r a p ~ , ~ a ~ too_ re ~i#n£~ic~.We ~re ~ c o n ~ alo~9~

Tab. i ~ i ~ t e do~e m~t~i~e do~ CC ~ 7@A ~3@/~ 4100Z £RPF ~50% ÷5@A ,86% tlO% ~G ¢ 1#% =7~A ,14% ¢#~A =5~A C?OZ4 ¢ 2~A - 56% "~10% ¢ #~/~ =58~/o A/uc£ea~ /~edicine ond°Rad~olop~ O e p ~ m e a l ~ U.C. 5.L. L . ~ d . ~ e m e l i i - 8 O0168-Rome r~uX2~.

C i s p l a t i n (CP) i s known to be a valuable drug f o r the treatment o f t e s t i c u l a r cancer. Prec l i n i c a l t o x i c o l o g i c studies have predicted the occurence of renal i n j u r y and many i n v e s t i g a tors have found t h a t n e p h r o t o x i c i t y i s the dose l i m i t i n g f a c t o r of t h i s drug. Pathologic examinations o f the kidneys o f patients with CP i n duced n e p h r o t o x i c i t y have demonstrated extensive tubular necrosis, without extensive glomerular damage. This study was designed to i n v e s t i g a t e renal damage in 26 patients with t e s t i c u l a r cancer receiving 20 mg/m CP d a i l y f o r 5 days as a part of combination chemotherapy (3 courses included CP), given with vigorous hyperhydrat i o n { ~ 0 0 ml/d). Renal clearance was studied with l-orthoiodohippurate (method o f OBERHAUSEN). 1311-orthoiodohippurate-clearance was not sign i f i c a n t l y decreased a f t e r treatment with CP. Thus, there was no renal damage of tubular function as evidenced by t h i s parameter, cont r a r y to reports by others, who have described CP induced changes i n other indices of tubular damage. The present r e s u l t s may be due to the youth of the patients besides vigorous hyperhydration during therapy and possibly f o r other reasons not yet understood. I n s t i t u t e of Medicine I , Nuclear Research Center JUlich GmbH, D-5170 JUlich, F.R. Germany, Depts. of Urol ogy 2 and Nucl ear Medicine 3, Bundeswehrzentralkrankenhaus, 0-5400 Koblenz, F.R. Germany.

A71 A424

A425

A426

MONITORING OF DRUG-INDUCED-CHANGESOF EFFECTIVE RENAL PLASMA FLOW (ERPF) USING A CONSTANT INFUSION OF RAD}O-LASELLED HIPPURAN. P. MoLs, H.R. Ham, N. Naeije.

~lAi, l[~ mF qabIo~ncLID ~ ~EGUPCITANT INQEX. J.I.Pinedo, d.,Chamorro, E.de meresa, I.~4~llAn, J.Ort i z Berrocal.

DETECTION AND QUANTIFICATION OF TRICUSPID REGURGITATION BY RADIQNUCLIDE VENTRICULOGRAPHY (RNV). P.Kress, Ch.Delagardelle, H.Seibold, E.Renze, H.Sigel, M.Stauch, W.E.Adam

When the steady-state is achieved during c o n t i nuous infusion of ~-131 hippuran, ERPF can be caLcuLated by d i v i d i n g the quantify of the i r a c e r infused per minute by the plasmatic concentration. As ERPF can be determined af any moment as Long as the sieady-sfate is mainPained, the method can be used in monitor drug ~nduced changes of t h i s parameter. The f e a s i b i l i t y and the v a l i d i t y of t h i s method have been evaluated in 17 healthy voLunteers. In aLL cases, the steady-state was achieved Less than 90 minutes a f t e r the beginning of the infusion ( .2 uCi of 1-131Hippuran/mI, ImL/min). The reproducibility of the catcutaled ERPF was exceLLent as attested by the stability of the oLasmafic concentratieo 4urin 9 the whole procedure i4 hours). The results were weLL correLa

fed with those obtained using the U.V/P method. The e f f e c t s o f the following drugs on ERPF have been invesiigafed : dopamine, subLinguaL isosorbide d i n i f r a t e and vasopressin, alone or in combination with n i f r o p r u s s i d e . In patients with congestive heart failure, dopamine increased the renal blood flow. The effects of subLingual isosorbide dinifrafe was evaluated in cirrhotic paiients. ERPF was shown to decrease during the first 15 minutes then progressively returned #o the base-Line value, l.V. adminis-

i r a f i o n of vasopressin alone reduced the ERPF which was restored compLeteLy by adding nifroprusside. In conclusion, the dederminaiion of ERPF using continuous infusion of 1-131 hippuran is an

easy and reLiabLe method. The method is p a r t i cuLarLy s u i t a b l e fo evaluate the e f f e c t s o f various drugs on ERPF. Oepf of Infernal medicine and Radioisotopes. 5t Peter HospitaL, Free U n i v e r s i t y of BrusseLs, BeLgium.

We have studied ii0 patients to predict the presence of !eft-sided regurgitation~ d8 had mitral reEurgitatdon (MR), aortic regurgitation (AR) or comb!ned MR and AR (19 underwent afterwards valve surgeryl: ~ patients h3d isolated stenosis and 5~ without regurgitation were used as Cont r o l group, gated cardiac blood scans were acqu ! red Jn the LAO 3Q-~£ £ nrojeetion with 15-20 mci o£ Te-99m in vivo labeled RRCs. ,#re calculated the ratio of the ventricular count output (enddiastolic counts minus end-systolic countsl in the LV area over the ventricular count output {n the q~z area. The ratio was obtained with and without background substractlon, in the same end-diastolic 8n4 end-systolic frames for both LV and ~V, and separa~ele for each ventricle at the cenit and nadir of each ventrieular curve. In our experience, good correlation exists between regurgitation index determined by cardiac catheterization (performed within I month) and by radionuclide studies (r=0.871. In the control group, the ratio was 1.22~0.33; the RV ejection ~raction for normal subjects was 0.55# 0 . 1 0 and for LV was o.gd*o.08. The ratio was 2.57+0.90 in MR and 2.~5~0.57 in AR. The sensiti vJ ty was 82~{, the specificity was 89% and the accuracy was 86%. We have not found appreciable discordant index in the 9 patients with a LV ejection fraction of less than 0.30: 7 control patients (ratio: 1.38+0.26; only 2 had a ratio greater than 1.50) an~ g regur~itant patients (none had a ratio of less than 1.80). The stenosis patients had a ratio of 1.11+O.38. The patients with M surgery had 1.45+0.a[ and with A surgery had 1.68+0.72. The nadir of the LV and RV curve oeeured on a different frame in 51.6% of our patients. We have not found differences between results obtained with and without background suhstraction. There is a reduction in the RV stroke counts due to inclusion of a portion Of atrium and incomplete separation of RV from surrondin~ structures. This method provides a significant difference in the ratio between patients with and without regurgitation. Clfnica Pue~ta de Nierro. Madrid.

The diagnosis of tricuspid regurgitation (5~) is difficult and is usually obtained by physical examination, echocardiography and cardiac catheterization. However, theme is no accurate method for cp/antifying TR. RNV provides a relative measurement of left (LV) or right ventricular (HV) volume overload using the so called regurgit~nt index HI = LV stroke counts / RV stroke counts. Because of the right atrial / RV overlap in LAD projection this RI is slightly- higher than 1.0 and averages 1.43 (normal range 0.89 - 1.97) in a greater norlnal group studied in our laboratory using a fully automated e~ge detection algorithm for computing HI. In 13 patients (7 men, 6 women) with proven TR preferably following mitral valve replacement (n=10) RI ranged between 0.29 and 0.92 (mean 0.70-0.19). Only one patient with probably mild TR showed a value for RI = 0.92 slightly higher than the lower limit of normal, thus xesultinq a sensitivity of this approach of 92%. ~n 3 cases examined by RNV recently, TR - in addition to the described method - could be confirmed by documenting the atrium like pattern of the timeactivity curve over a liver ROI. The RI method, however is of limited value in the presence of additional LV regurgitation. The specificity for diaguosing TR from RI is high: in more than 200 consecutive patients without valvelar regurgitation or shunt the range of normal was exceeded in none of the studies (I00%). Among these were also 21 cases with RV enlargement but no RV volume overload. In conclusion, the diagnosis of TR by RNV from a RI below the lower limit is a method with high sensitivity and specificity ~Lnd this approach seems to allow to c~antify TH, although there is no golden standard to proof this. Division of Cardiology, Department of Internal Medicine, and Department of Radiology, Univezsity of Ulm, SteinhCvelstrage g, D-7900 Ulm/Donau, West Gez~e/]y

Spain.

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A428

A430

A SIMPLE NON-INVASIVE METHODFOR ESTIMATING REGURGITATION IN VALVULARHEART DISEASE. Hassan I.M, Mohammed MMJ, Badruddoza.M, and Abdul-Dayem.N., The Departments o f Nuclear Medicine and Cardiology Faculty of Medicine, U n i v e r s i t y o f Kuwait and KECC.

DISSOCIATION BSTWBgN THE ONSET OF LEFT V%NTRIGULAR DYSFUNCTION AND ST SEGMENT DEPRESSION DURING EXERTIONAL MYOCARDIAL ISCHAEMIA. M.d. O'£ara, R.I. Jones, A. Lahiri, @.C.H. Crawley and E.g. Raftery.

CARDIOUOGIC PRESSURE ~OLUME STUDIES BY RABIONUOLIB VENTRICULOGRARHY AND CATHETER TIP MANOMETER DIAGNOSTIC OVER SIMULTANEOUS CARDIAC CYCLES. M.Kindler~ N.gahawar, W.Kramer, J. Thormann, H.Neuss, M.Schlepper

Gated Cardiac Blood Pool 'GBP' scintigraphy was used as a non-invasive technique to distinguish patients with v a l v u l a r disease from normals and ischaemic heart disease (IHD). Phase analysis has been applied to 54 gated studies. F i r s t harmonic Fourier-amplitude r a t i o of the l e f t and r i g h t v e n t r i c l e s was u t i l i s e d to measures the r e g u r g i t a t i o n index ( R I ) . In 9 normal control volunteers the r e g u r g i t a t i o n index from 45 LAO was (1.42 + 0.25 mean + SO, range l . l - l . 9 ) . In 27 patients with isehaemic heart disease without v a l v u l a r i n s u f f i c i e n c y RI was (1.48+0.25 Mean + SD, range 1 . 1 - 1 . 9 ) . In 19 patients w{th valvuTar heart disease with l e f t v e n t r i c u l a r preponderance RI was (3.1 ~ 1.3 Mean ~ SD, range 1.2 - 6 . 3 ) . I n i t i a l c l i n i c a l experience shows that patients with v a l v u l a r r e g u r g i t a t i o n were c l e a r l y distinguished (P 0.001) from 36 (9 control + 27 IHD) without v a l v u l a r disease. The group of 27 patients with IHD were net s i g n i f i c a n t l y d i f f e r e n t from the g normal volunteers (P 0.5). In conclusion the Fourier-amplitude r a t i o derived from the amplitude image appears to provide a r e l i a b l e means f o r i d e n t i f y i n g patients with v a l v u l a r r e g u r g i t a t i o n .

The temporal relationship of changes in left ventrlcular ( L V ) [ u n o ~ i o n t o electrocardiographic changes during exercise is unclear. To examine this relationship we have used a non-imaging nuclear probe (NP) (Eios Inc)~ which can detect the rapid alterations o f LV function which Occur during exercise. Ten patients (8 male, 2 female) with stable angina and >I mm ST depression on treadmill-testlng underwent symptom-limite@ semi-supine cycle ergometry. The blood-pool was labelled in vivo with Tc-99m 740MEg and beat-to-beat LV time activity was detected by NP and traced continuously by a pen recorder. Background counts were recorded at rest and corrected once during exercise. The LV Ejection Fraction (EF) and the ST segment level 80 msec after the J point were deterT~ined every 30 seconds during exercise. Twenty four normal volunteers were studied using the same protocol. In the ]0 patients the mean gF was 0.54 (range 0.46-0.64) at rest and decreased during exercise in all cases by a mean of 0.17 (0.08-0.25). By aontrast~ EF increased in all normals by >0.05. All patients developed >I mm ST segment depression, but in 9 of i0 EF fell by >0.05 before the appearance of I ~ ST depression. Thus, in most patients with stable angina, impail~ent of LV systolic function was detected earlier than the electrocardiographic changes associated with exertional myocardial ischaemia. Department of Cardiology and Division of Radioisotopes, Northwick Park Hospital & Clinical Research Centre, Harrow, Middx. ENGLAND.

The hemodynamic parameters of catheter investiEatzons in 30 studies were combined with radionucllde angioErapby (RNA) parameters. Thereby a correlation of pressure and volume changes was achieved over 300-500 cardiac cycles at different phases of investiEational interventional phases involvin E pacing stress and influence of drugs. A specially developed signal processing system ORPHEUS with a maximal samplin E rate of 10 kHz allows for elective evaluation, compilation and edition of extrasystolic events as well as the evaluation of cardiac arrhytmias at large and any type of cardioloEic interventions, such as Racin E stress and phases of druE influence. By use of list technique in scintiEraphic evaluations a coordination of alterations in pressure, volume and cardiac cycles is possible. The computer-assisted evaluation of pressure-volume relation allows for trend analysis of all significant parameters includinE the estimation of myocardial oxygen consumption according to the BRETSCHNEIDER formula, The calibration of all evaluatinE systems is accomplished by the dynamic cardiac phantom PANDA, the valldisation by manual evaluation of parameters directly from the registration records. Biomedical Engineering in the Kerckhoff-Clinic of the Max-Planck-Oesellschaft, Benekestr. 4-6, D-6350 BAD NAUHEIM (West-Germany)

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A432

A434

CENTRAL HEMODYNAMICS(VOLUME/FLOW-RATIO) IN CHRONIC RENAL FAILURE, MEASUREDBY MINIMAL TRANSIT TIMES. V. Becker, H. Mostafa, G. Ziada, Sh. El Haddad, M.M. Mahfouz, L.E. Feinendegen

EVALUATION OF MYOCARDIAL PRESSURE VOLUME CHARACTERISTICS IN RISK PAT]ENTS USING SEQUENTIAL VOLUME PRELOADING AND RADIONUCLIDE VENTRICULOGRAPHY. E. Henze, D. Spilker, H. Heinrich, Ch. Delagardelle, S. Altunbay, W.E. Adam

MEASURgMENT OF THE BRBATHING R E L A T E D HEART FUNCTION. W. Waters, W. Neeb, U. Buschsieweke, U. Wellner

Chronic renal f a i l u r e (CRF) frequently a f f e c t s cardiac function through various secondary d i s orders such as anemia, hypertension, uremia and f l u i d overload. Hemodialysis p a r t i a l l y reverses these e f f e c t s . This study aimed a t quant i f y i n g such e f f e c t s on central hemodynamics, using the method o f minimal t r a n s i t times (MTTs), which were shown to express the r a t i o volume/flow.

22 patients (P) with CRF were examined before and within 30 min after closure of the arteriovenous fistula used for hemcdialysis. - 10 P were examined before and 12 P after dialysis. Cardiac and segmental central MTTswere measured as previously described, using a multiprobe camera the head of which was placed in AP-view of the chest. Each P had regular clinical examinations including blood pressure, BUN, creatinin and hemoglobin. Number of dialyses per individual P ranged from 30 to 293. 41P without renal or cardiovascular disease served as controls. Of the unselected P with CRF, 40-45 % had prolonged cardiac MTTs prior to dialysis which were very significantly reduced following dialysis. Of P dialysed ]ess than iO0 times only 20 % had prolonged MTTs, versus 50 % o f P with more than 100 dialyses. - 7D % of P with hypertension, but only 45 % of P without hypertension, showed increased prolongation of MTTs by closure o f the shunt. - Pulmonary MTTs r e mained normal in a l l groups. - There was no c o r r e l a t i o n between MTTs and BUN or c r e a t i n i n . These data demonstrate the potential o f MTT measurements f o r monitoring central hemodynam mies in CFR and f o r control of therapy. I n s t i t u t e o f Medicine, Nuclear Research Center J u e l i c h , D-5170 J u e l i c h , West-Germany

For optimum volume substitution therapy in cardiac risk patients during and after greater surgery the estimation of the patients individual LV pressurevolume characteristics (Frank Starling curve) is essential. Because of the complex and non-linear pressure-volume relationship the measurement of the LV filling pressure (PCWP) is not sufficient. Therefore, in this study PCWP was gradually increased up to 15-18 mm Hg by stepwise infusion of 5% albumine in I0 cardiac risk patients in 6 times 200 ml increments. At each volume loading level, PCWP along with the radionuclide equilibrium ejection fraction (iF) and thermodilutlon stroke volume index (SVI) were determined, and the LV enddiastolic volume index (EDVI) was calculated by EDVI=SVI/EF. Unexpectedly, there was a relative uniform preloadvolume-pressure response in all but one patient, with an only moderate but non-significant increase of the EOV[ and SVI and a significant rise of PCWP, despite an always normal EF. The mean values presented as follows:

(PCWSg) (maY}m) ~m~Y~) 7.2+2.4 46.1+6.9 9.772.5 48.8+4.9 11.5+2.9 5 0 , 5 + 4 . 9 12.2 ~ 3.5 50,6 ± 4.7 ]4.8 ± 3.8 51.7 +_ 6.9 I5.3 + 4.0 50.9 + 7.7

66.4+ 16.6 68.4+]3.6 71,6 + 15,8 71.6 ~ 12.0 70.8 +_ 14.0 73.9 + 16.5

~)

71+11 73712 73712 72 + 10 74 + ] l 70 + 12

In conclusion, in the vast majority of this patient group studied the pressure-volume characteristics has shifted to the right on the Frank Starling curve, where volume loading leads to immediate increase of the LV filling pressure without significant increase in EDVI or SVI, while the EF Being normal and remaining relatively stable. In this typ of patients, perioperative volume substitution should be performed with caution.Radionuclide ventriculography along with right heart catheterization allows to dlscover this typ of patients preoperatively.

Nuclear Medicine Division, University of aim, DWgOO Ulm, Germany

As the functions of heart and lungs are closely r e l a t e d , a m e t h o d for the measurement of the breathing r e l a t e d heart function is established. Method ECG triggered multigated e q u i l i b r i u m radionuclide v e n t r i c u l o g r a p h i e s are acquired during different phases of the breathing cycle determined by a second trigger derived from the endinspiratory or the endexpiratory point. Results In normal persons (n=10) the ejection fraction (EF) , the diastolic and the s y s t o l i c c o u n t r a t e s of the l e f t v e n t r i c l e w e r e not s i g n i f i c a n t l y different between the inspiratory and the expiratory phase of the breathing cycle. The right ventricular EF fell from 66m9 % during inspiration to 62~9~ d u r i n g expiration (n.s.). The diastolic count rates did not c h a n g e . The s y s t o l i c count rates were significantly different (p=5%) between i n s p i r a t i o n (43~15%) and e x p i r a t i o n (60._12%)(percent of the inspiratory d i a s t o l i c count rate). Considerable d i f f e r e n c e s of c a r d i a c performance between the inspiratory and the expiratory phase of the breathing cycle were found in pathological states of the heart and the lungs. Conclusion New insights into the pathophysiology of the functional unit of h e a r t and lungs can be achieved by the described method. Its value as a diagnostic tool w i l l be e s t i m a t e d by f u r t h e r i n vestigations. Institut f~r k l i n i s c h e und e x p e r i mentelle Nuklearmedizin der Universit~tskliniken K~in (FRG) (Direktor : Prof. Dr. med. H. Kut z im )

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DETECTION OF RIGHT VENTRICLE PRESSURE OVERLOADING BY THALLIUM 201 MYOCARDIAL SCINTIGRAPHY : RESULTS IN 73 PATIENTS WITH C H R O N I C R E S P I R A T O R Y DISEASES. B.Moyses, E.Weitzenblum and G.Methlin

COMPARISON OF NON-I~VASIVE INVESTIGATIVE ?~THODS IN THE DIAGNOSIS OF LEFT VENTRICULAR ANEUNZSMS. L. P~vics, L. Csernay, J. Mester, L. Fr~ter, M. Csan~dy, T. Ga~l, K. Sz~sz, M. Rajt~r, N. Adam, T. Forster, G. Kov~cs

PANDA, A DYNAMIC CARDIAC PHANTOM FOR SCINTIGRAPHIC STUDIES OF MYOCARDIUM AND VENTRICLES, EVALUATION AND VALIDISATION OF STUDIES INVOLVING DOUBLE NUCLID TECHNIQUE, PRESSURE VOLUME RELATIONS, ECHOCARDIOGRAPHY AND ANGIOORAPHY M.Kindler,N. Bahawar,M. Woellenstein,G.Schumache£ A.Stsbl,R.Kurz,K.KraMer,J. Tbormann, M.Schlepper

Thallium 201(20iTI) myocardial imaging has been successfully used since 1976 :[or the diagnosis of right ventricle hypertrophy (RVH) or right ventricle pressure overloading (RVPO) due to pulmonary a rt erial hypertension (PAH), but important series of chronic obstructive pulmonary disease (COPD) patients were rarely investigated by this method. We ~-6~s decided to study the diagnostic value o:[ - T I myocardial scintigraphy, by comparing the results with hemodynamic findings, in 73 patients with chronic respiratory diseases, mostly COPD (n=59). Patients were investigated at rest in the sitting position. Myocardial sci#~graphy started 10 minutes a:[ter I.V. injection of "TI (2Z~pCi/Kg) and the four projection study was interpreted by 2 independent observers. RV activity was graded from O (no activity) to 3 (activity that o:[ the left ventricle). Patients were divided into 3 groups according to the level of pulmonary artery mean pressure (P-A-P) : P-A-I~20 mmHg (no PAH) = group 1, n=28 ; P ~ ranging :iron 2i to 30 mmHg (mild or moderate PAH) = group II, n=25 ; PA--A'~3g mmHg (marked PAH) = group III, n=20.RV was visualized in 16 patients in group Ill (80%) and in I# patients in group II (56%). For ali the p a t ~ t s with PAH (groups lI and II1) the sensitivity ol T] imaging for the diagnosis o:[ RVPO was ol 67%, higher than that of EGG (53%) and comparable to that o:[ echocardiography (65%). For patients with only mil~01to moderate PAH (group I1), the sensitivity ol TI, even if moderate (56%) was better than that of ECG (36%) or echo (50%). A high RV activity (grade 3) was observed in only ¢ patients (2 in group II, 2 in group III). The speci:[icity o:[ this method was of 75% (RV was visualized in 7 out o:[ 28 patients in group I), as compared to 72% ~ echo and 96% for EGG. The results suggest that ITI myocardial imaging could be of interest for the non-invasive diagnosis of RVPO in COPD patients, but the senshivity of the method is rather weak when PAH is mild (PAP up to 30 mmHg). Centre R&gional de Lutte eontre le Cancer PAUL STRAUSS - 67085 STRASBOURG CEDEX.

Left ventricular angiocardiography, roentgenkymography, eehocardicgraphy and nuclear cardiologieal examinations /Ti-201 myocardial scintigraphy and EGG-gated equilibrium cardiac blood pool scintigraphy/ were performed in 58 patients after myocardial infarction or with isehemie heart disease. Left ventricular ~neurysm was proved in 31 cases, diffuse myocardial lesion in 4 cases, other disturbances of the motility of the chamber wall in 25 patients. The results of the left ventricular angiosardiography, eshecardlography and nuslear earddologieal examinations were in each ease analysed jointly by 3 cbservers. In the detection cf aneurysms, the weakest performance was given by kymography. With echocardicgraphy the accuracy of diagnosis was good, but it was not possible in all cases to take satisfactory exposures /emphysema, obesity/. With nuclear cardio~ogieal examinations most of the left ventricular aneurisms could be diagnosed /sensitivity: 85 %, specificity: 90 %/. The comparative studies indicate that the non-invasive nuclear cardiolcgical methods provide effective help in the recog~itlon of post-infarct aneurysms.

University Medical School, Institute of Nuclear Medicine H-6720 8zeged, Kor~nyi fasor 8. Hungary

For the combined evaluation af several imaEing diaE~ostic techniques ~ dynamic cardiac phantor# for simul~tion of the left ventrialula£ function and its myocardial areas was developed. It consists of ~ chamber with double balloon system in which TC-g@m for ventricular and TL-201 for ~yocardial imaginE can be instilled. This way optimation of double nuclide studies in myocardial and ventrcular scintigraphy are possible. A special pump system allows for imitstion of normal ventricular contraction with any volume parameters or heart rate. This way a calibration of the computer-assisted volume assessment for the requirements of nuclide cardioloEy can be accomplised. Interchangeably contrast media can be used for angioEraphic evaluation and echocardioEraphic parameters can be calibrated. By installation of specially contoured objects defects of perfusion and contra~Cio~ can be simulated with PANDA. For the op~imatlon of pressure volume studies ~be instillation of special catheter tip manometers is possible as well. An echolot technique provides for simultaneous volume signals in each cycle. Biomedical EnEineerin E in the Kerckhoff- Clinic of the Max-Planck-Gesellschaft, Benekestr. 4-6, D-635g BAD NAUNEIM (West-Germany)

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MYOCAPCDIAL METABOLISM STUDY USING ~-1231-16HEXADECANOlC ACID (~-1231-HDA) IN X-SYNDROM : P. Peycelon, J. Machecourt, M.Comet, D.Lamaison, J.E. Wolff, J. Cassagnes, A. Veyre, G. Meyniel.

COMPARATIVE EVALUATION OF 123I-(14-PIODOPHENYL)-#-METHYLTETRADECANOIC ACID A N D 2 0 1 T L IN T H E D E T E C T I O N O F I N F A R C T E D A R E A IN DOGS" H E A R T S U S I N G SPECT. A.-L. K a i r e n t o , E. L i v n ~ , L. P o r k k a , A. H a r j u la, S. M a t t i l a , D. E l m a l e ~ a n d L . L i n d r o t

Sustained I-i~I A c i d (IF) U p t a k e dium.

A comparative study was performed using 2 0 1 T I a n d a m o d i f i e d f a t t y a c i d (MFA), 123I-(14-p-iodophenyl)-~-methyltetradeca n o i c acid. M F A w a s d e s i g n e d w i t h a m e t h y l g r o u p at the @ - p o s i t i o n in o r d e r to i n h i b i t b e t a o x i d a t i o n of the f a t t y acid.

S h o r t t e r m c o n t r o l of m y o c a r d i a l p r o t e c t i o n a f t e r c o r o n a r y repe:'fusion b y r e ~ i o n a l v a n ± t i c k l e r fL~ction is o f t e n d i f f i c u l t d u e to s l o w r e c o v e r y of c a r diac contractile function, Thus restorst i o ~ of c a r d i a c m e t a b o l i c f u n c t i o n (CMF), as a s s e s s e d b y r e g i o n a l T r e e f a t t y a c i d (FFA) u p t a k e , w a s e x a m i n e d in a c o r o n a r y o c c l u s i o n ( 0 ) / r e p e r f u s i g n (R) m o d e l in ~ d o g s . L A D w a s o c c l u d e d f o r ~O m i n . e n d s u b s e q u e n t l y r e p e r f u s e d f o r 20 m i n , R e g i o n a l c a r d i a c u p t a k e of IF, a F F A - a n s l o g , i n c o r p o r a t e d in m y o c s r d i u m p r o p o r t i o n a l to p a l m i t i c acid, w a s d e t e r m i n e d 20 m i n . s l i e r i n i t i a t i o n of R (IO m i n . p , i . ) , R e g i o n a l m y o c a r d i a l b l o o d f l o w (F) was d e t e r m i n e d b e f o r e O t b e f o r e a n d iO m i n . a f t e r s t a r t of R b y m e a n s of the a r t e r i a l r e f e r e n c e t e c h n i c u s i n g Nb-95~ Ru-lO3 and Ce-l~l labeled micros p h e r e s (i0 ~ 1 2/m), F a n d I F - u p t a k e ~ e r e a s s e s s e d q u a n t i t a t i v e l y in t r a n s v e r s e h e a r t s e c t i o n s a n d s t o r e d in computer matrix~ ~hlch provided ~colour c o d e d d i s p l a y of F a n d C M F d i s t ~ i b u tlon. F w a s h o m o g e n o u s b e f o r e 0 l r e d u c e d to 65 % ( r a n g e 48-82%) a f t e r 0 in the L A D - d e p e n d e n t r e g i o n a n d r e s t o r e d to 1 2 0 % of c o n t r o l in this r e g i o n ' a f t e r R, I P - u p ~ k e in l e f t v e n t r i c u lar m y o c a r d i u m w a s h o m o g e n o u s a n d n o t s i g n i f i c a n t l y r e d u c e d in the t e r r i t o r y of L A D . I n 6 d o g s w i t h p e r m a n e n t O a c o n c o r d a n t 2 5 ~ - ~ % r e d u c t i o n of F sad IP-uptske was observed, In conc l u s i o n m s u s t a i n e d I F - u p t a k e is f o u n d in salvaged myocardlumo Evaluation of C M ~ b y m e a n s of I P - u p t a k e m a y p r o vide immediate therapy control aT±or coronary thrombolysi§.

iO patients (Gr I) with chest pain, positive ECG stress-test (occurence of more than I mm ST depression during stress and/or pacing)~but normal coronaro-ventriculography, without methylergometrin-induced spasm were studled.None had an history of myocardial infarction, or valvular disease. Just after IV injection of 74-111MEq ~-123IHDA, 120 images were collected over 30 mr, in basal state, on anterior projection,using a gamma-camera equipped with an all purpose-parallel collimator. Waiting for 30 mn, patients received then the same dose and a new data was collected under pacing during 30 mr. After blood background substraction (using 555 MBq SA-99mTc),tw0 myocardial clearance curves of m-1231-HDA were generated and elimination half-tlme (TI/2) determined. Were also studied: stress-thallium scintigraphy (TI) and rest-pacing coronary lactate metabolism. Results were compared to those of 13 patients with dilated or obstructed ear~iomyopathy (Gr 2) and normal subjects (Gr 3). In Gr i, T1 was normal in all cases but 2 and TI/2 decreased significantly under pacing (37.6±16.1 mn to 31.2d7.0 mn, p
S i x B e a g l e s w e r e i n j e c t e d w i t h 201TI. 3 D - i m a g i n g w a s d o n e 15 m i n a f t e r i n j e c tion. N e x t d a y d o g s w e r e i n f a r c t e d b y o c c l u d i n g the LAD. T w o h o u r s l a t e r t h e dogs were injected with MFA and imaged for 90 min. I m a g i n g w a s p e r f o r m e d u s i n g the g a t e d S P E C T p r o c e d u r e . The gan~nacamera G E - 4 0 0 T and the computer program HFCT (Nuclear D i a g n o s t i c s ) w a s u s e d u n d e r the P D P ll/ 34 G a m m a - l l system. M a x i m u m u p t a k e of M F A in the h e a r t w a s r e a c h e d d u r i n g 2 m i n p o s t i n j e c t i o n and the a c t i v i t y l e v e l r e m a i n e d c o n s t a n t d u r i n g the i m a g i n g p e r i o d . T h e a c t i v i t y r a t i o of the t a r g e t to n o n t a r g e t a r e a in t h e t o m o g r a p h i c s l i c e s w a s s i g n i f i c a n t l y b e t t e r in the M F A - i m a g i n g p 0.01. In a d d i t i o n the a r e a of the h e a r t w i t h d e c r e a s e d a c t i v i t y (infarct) w a s l a r g e r (aDpr 10%) w i t h M F A - i m a g e s t h a n w i t h 201Tl-images. T h i s s t u d y s u g g e s t s t h a t M F A is a p o t e n tial myocardial imaging agent and that fatty a c i d u t i l i z a t i o n is c o u p l e d to p e r f u s i o n in the i n f a r c t e d d o g ' s h e a r t . University Central Hospital, Meilahti H o s p i t a l , S F - 8 0 2 9 0 H e l s i n k i 29, F i n l a n d Massachusetts General Hospital, Boston, M a 02114, U S A

Phenylpentadecanoic

in Salvaged

Myooar-

S,SchSn~S,N.Reske,M,SchmittpH,J°Machulla~ R , K n o p p p C . W i n k l e r , l n s t , N u c , M e d . U n i v , Bonng Rad,Centr. Essen

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NEWTECHNIQUEFOR MULTIPLEVIEW DYNAMICSTUDIES WITH 1-123-HEPTADEDANOICACID (123-1HA) USING SPECT. G. Notohamiprodjo, H. Herzog, G. Spohr and L.E. Feinendegen.

THE I N F L U E N C E OF B A C K G R O U N D A C T I V I T Y ON T H E M Y O C A R D I A L E L I M I N A T I O N R A T E OF IODINATED FREE FATTY ACIDS. M.J. v a n B e n i g e , F.C. V i s s e r , E.E. v a n d e r W a l l and J.P. RODS.

USE OF LIPOPHYLIC CATIONS TO STUDY MYOCARDIAL B L O O D FLOW~ A N E X P E R I M E N T A L STUDY. P. Rigo, T. Tanaka, D. Woo, D. Wong, R. Dannals, L.C. Becker, H.N. Wagner Jr,

Conventional planar imaging of accumulation and release of 1-123 f a t t y acids in the myocardium is usually restricted to one projection. To overccme this limitation single photon emission computed tomography (SPECT) was used. The acquisition software of the single head SPECT-camera (Philips) was programmed for acquiring simultansusly up to 6 synchronized dynamic studies from specified regions of interest (ROI). The camera head rotates around the patient in stepwise fashion to image selected projections sequentially. This procedure is repeated at least 20 times to f i n a l l y produce serial images from each ROI. The data reveal the tracer distribution at peak accumulation and are given in time activity curves for each ROI. ANT, LAO-30 and LAO-60 projections were chosen for this study. The fasting and exercised patients received i.v. 3 mCi 123-INA; correction was made for 123-iodide as described previously. The results clearly delineated regional myocardial tracer accumulation and release, principally comparable to single projection assessment as described before. This new simultanous multiple projection assay (SMPA) of f a t t y acid metabolism in the myocardium promises to enhance the amount of diagnostic information beyond that obtained by single projection planar imaging, Institute of Medicine, Nuclear Research Center Juelich GmbH, D-5170 Juelich, F.R. Germany.

The d e t e r m i n a t i o n of e l i m i n a t i o n rates of i o d i n a t e d free f a t t y acids (I-FFA) is of g r e a t i m p o r t a n c e to d i s t i n g u i s h bet w e e n n o r m a l , t r a n s i e n t l y i s c h e m i c and n e c r o t i c m y o c a r d i a l tissue. H o w e v e r , c a l c u l a t i o n of e l i m i n a t i o n r a t e s is influenced by high background activity due to i n t r a v e n o u s (IV) a d m i n i s t r a t i o n of I - F F A a n d a l s o d u e to the a d d i t i o n a l inj e c t i o n of free i o d i d e 40 m i n u t e s later for a p p l i c a t i o n of a n e c e s s a r y c o r r e c tion procedure. Since in±re-coronary (IC) a d m i n i s t r a t i o n is l i k e l y to be d e v o i d of these i n f l u e n c e , the p u r p o s e of t h i s s t u d y w a s to c o m p a r e the e l i m i n a t i o n r a t e s of IC a n d IV a d m i n i s t e r e d I-FFA. Six p a t i e n t s w i t h c o r o n a r y a r t e r y disease were studied and they had both an IC a n d an IV i n j e c t i o n of I-FFA, 40 m i n u t e s a f t e r e a c h other. T w o m y o c a r d i a l regions and one background region were chosen. E l i m i n a t i o n r a t e s w e r e e x p r e s s e d as h a l f t i m e v a l u e s in m i n u t e s . R e s u l t s : ( m e a n ± SD: IC 2 2 . 6 ± 4.9 m i n IV n o t c o r r e c t e d 45.1 ± 7.3 m i n IV c o r r e c t e d 36.2 ± 8.2 m i n We c o n c l u d e t h a t e l i m i n a t i o n rates a f t e r IC i n j e c t i o n of I - F F A a r e s i g n i f i c a n t l y f a s t e r c o m p a r e d to IV a d m i n i s t r a t i o n , e v e n a f t e r a p p l i c a t i o n o f the c o r r e c t i o n m e t h o d . T h i s m e a n s t h a t the c o r r e c t i o n p r o c e d u r e is p r o b a b l y n o t a c o r r e c t m e t h o d for the p r o p e r e v a l u a t i o n of the e l i m i n a t i o n r a t e s of I-FFA.

D e p t of C a r d i o l o g y , F r e e U n i v e r s i t y H o s p i t a l , d e B o e l e l a a n 1117 1007 M B A m s t e r d a m , The N e t h e r l a n d s

Lipophylic cations labelled with IIC or 123 iodine provide attractive alternative for myocardial imaging in man. In this study, we have evaluated the kinetics of 2 such tracers 125 i-IPBDA (iodophenylbenzyldimethylammonium) and 11C MTP (methyItriphenylphosphonium), their myocardial extraction, their tissue distribution and their relationship to myocardial blood flow. 15 open-chested dogs were studied. IPBDA first pass myocardial extraction was 73% in normal myocardium (mean blood flow 95 ml/min/100g) but decreased to 40% with dipyridamole (mean blood flow 227ml/min/10Og). The tissue IPBDA concentration correlated with myocardial blood flow distribution (r=. 81) but the relationship was curvilinear reflecting a decreased extraction fraction with high flow. IIC MTP distribution was measured by PET and compared to 68 Gallium mierospheres. The normalized distribution of both tracers correlated linearily (r-. 86) and areas of myocardial infarc tion could be identified by both tracers. MTP activity in the myocardium was stable for more than 40 minutes. We conclude that lipophylic cations are myocardial tracers with potentials to evaluate myocardial blood flow distribution in man.

Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A,

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M Y O C A R D I A L IMAGING W I T H FDG U S I N G A CONVENTIONAL GAMMA CAMERA

R A D I O N U C L I D E AND B I O C H E M I C A L ~ T H O D S I~ D I F F E R E N T I A L D I A G N O S I S OF N E C R O T I C AND I S C H E M I C ~ O O A R D I U M L E S I O N . N.M. O g a n e s s i a n , R.S. Mikaeliau, G.M. Tiroyah, M.A. V a r o s s i a n

DEAGNOSIS OF INCFART OF TH~ RIGHT VENTRICLE BY G&MMAGRAPHY WITH 99mTc-PYR0PHOSPHATE. CORRELATION WITH OTHER EXPLORATORY METHODS.O.Caballero, V.Fliqaete, E.Castro and C.Cano. In this work we point out the importance of recognizing the affectation in the right ventricle in p o s t e r o - i n f e r i o r inefarts of the m y o a r d u m to indicate en adequate treatment, we comment on the limitations of conventional exploratory m~ thods and assess the usefulness of gamma graphy with 99mTc-PYP in the detection of RVI. 109 patients with AMI with p o s t - i n f e r i o r localization have been studied to investigate the possible affectation of the right ventricle by; eehocardiogram, mode "M", haemodynamic studies~ enzymes~ EGG and gammagraphy. Gammagraphic exploration was made in 99 cases u s i n g 99mTcPyrophosphate (555MBq) as a nuclide and a conventional gamma camera, obtaining registers in p r o j e o t i o n s A P , OAL and LL two hours after i.v. a d m i n i s t r a t i o n and within 48 hours of the b e g i n n i n g of the symtoms. Gammagraphy has been positive in 89 of the 99 cases under study (89'89%) ad r e g a r d s p o s t e r o - i n f e r i o r incfart, and in 26 cases (29'23%) signs of affectation of the RV were observed, b e i n ~ the more frequent the "wing sing"; these positive indices are superior to those registered by other exploratory methods. It was con e l u d e d that gammagraphy with 99mTc-PYP was a h i g h sensivity exploration for the diagnosis of p o s t e r o - i n f e r i o r incfart and to detect the affectation in the right ventricle.

A. Ahonen, H. WendelinT, J. KuLmala, M. Arstila, E. Engbl~, M. Haap~anta, V. N'~t~, S. Parviainen, D. Roeda, U. Wegelius Knc~ledge of my_ocaxdial Derfusion, metabolism and function is essential for a comprehensive concept of the state of the myocardium. In this study, myocardi~ metabolism was studied with 18-F-2-fluoro-2-deoxy-D-glucose (FDG} and occasionally with 123-1-heptadecanoic acid (HDA). 201-thallium (TI) was used for studies of myocarclial perfusion. We have studied 23 cardiac patients with 10-50 MBq FDG using an ordinary gamma c~m~_rawith a one-inch crystal and a collimator designed for detecting high-energy photons. The patients fasted for approximately 12 hours before the FDO study. _Myocardial perfusion studies were done using 75 - ~ 2Ol-thallium and a rotating dual head ganm~ c/m~ra. The patients suffered frc~ various heart diseases, the largest group consisted of patients with acute and old myocardial infarctions. The patients with acute end old heart infarctions without complications showed decreased acctwaulation of T1, HDA and FDG into the infarction area. Contrary to this, a patient with persistent chest pain treated with intracoronsx streptokinase showed decreased accumulation of TI, }DA and FDG one week after the infarction but one month later FDG images showed increased uptake into the infarction area, whereas T1 and HDA were nearly norn~lly distributed. A patient with hypertrophic cardiomyopathy showed heterogenous myocardial distributions of TI, FEG and HDA. Patients with coronary artery disease showed more pronounced changes in myocardial FDG uptake ~ d to TI. The FDG images produced by an ordinary ganma camera revealed regional FDG changes in the myocerdium. This work shows that an inexpensive gauma camera can be used to roughly depict FDG distribution in the myocardi~m.

In o r d e r ~o d e ~ e r i m i n e ~he d i f f e r e n t i a l d i a g n o s t i c p o s s i b i l i t i e s of r a d i o n u c lide m e t h o d s of i n v e s t i g a t i o n in e s t i m a t i o n of n e c r o t i c and i s c h e m i c camd i a c m u s c l e i n j u r i e s $3~ p a t i e n t s w i @ h a c u t e myocar~lial i n f a r c t i o n (AMI) and c b m o n i c i s c h e m i c heart d i s e a s e (IHD) were iuves@iKa~ed. Mvocardial scin~igraphy with ~9mTc-PT~, radloimmunic m y o g l o b i u (Mgb) d e ~ e r m l n a ~ & o n an~ n u c l e i c acid(NA) c o n ~ e n t d e t e r m i n a t i o n in ~he w h o l e b l o o d w e r e c o n d u c t e d in all p a t i e n t s . In p a t i e n t s w i ~ h A M I a~ scin ~ i g ~ a p h y l o c a l a c c u m u l a t i o n f o c u s of r a d i o p h a w m a c o l o g i c a l p r e p a r a t i o n in myocardial necrosis area compared by i~s i n t e n s i t y w i ~ h a c c u m u l a t i o n in b r e a s t bone w a s d e t e r m i n e d . The same was o b s e r v e d in 85% of all p a t i e n t s . C o i n c i d e n c e of the d a ~ a c o n f i r m i n g n e c r o s i s p r e s e n c e on E C G and s c i n t i g r a m s w a s in 7 % of c a s e s w h e r e l o c a l i z a t i o n c o i n c i d e n c e was iu 87~. C o n s i d e r a b l e i n c r e a s e of Mgb and N A in b l o o d was o b s e r v e d in @he same p a t i e n t s . C o m p l e x e v a l u a t i o n of m ~ o c a m d i a l s c i n ~ i ~ r a p h y data, d e ~ e r m i n a t l o n of Mgb and N A con~en~ in b l o o d a l l o w e d @o put c o r r e c ~ d i a g n o s i s of A M I in 95% of cases. In m i c r o f o c a l m y o c a r d i a l d y s t r o p h y and c h r o n i c f o r m s of IHD c a s e s ~he r e s u l ~ s of @ h e s s l u v e s b i g a t l a n s s i g n i f i c a n t l y d i f f e r e d . T h ~ s , o u ~ i ~ v e s ~ i g a ~ i o n s showed t h a ~ c o m p l e x a n a l y s i s of m y o c a r d i a l s c i n ~ i ~ r a p h y w i ~ h 9 9 m T c - P Y P da~a, d e t e r m i n a t i o n of H~b and N A l e v e l in b l o o d a l l o w e d ~o i n c r e a s e i~s c l i n i c a l value.

Turku Medical Cycl. Project, Turku University Central Hospital, SF-20520 Turku, Finland

I n s @ i ~ u ~ e of Cardiology, H e a l t h M i n i s ~ r y of A ~ m e n i a n SSR, P . E e v a k STR. 5, 3 7 5 0 4 4 Terevan, Armenia, U S E R

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A NEW A P P R O A C H IN THE S T U D Y OF R E S I D U A L M Y O C A R D I A L ISCHEMIA : T H E S r 82 - Rb 82 G E N E R A T O R . D. Raets, C, De L a n d s h e e r e , C. 5 r i h a y e , M. G u i l l a u m e , D. L a m o t t e , H. I < u l b e r t u s , P. Rigo.

FERROKINET]C5: COMPARISON OF THE AMDUNT OF DESTROYED AND PRODUCED ERYTHROCYTES A. S t e i n s t r ~ s s e r , R. B e r b e r i c h

THE L E ~ L

R e s i d u a ] m y o c a r d i a l ischemia is o n e o f t h e most important factors in the prognosis of patients after a myocardial infarction (MI]. The purpose o f o u r s t u d y was to i d e n t i f y r e s i d u a l m y o c a r d i a l ischemia a n d to q u a n t i f y i t s s e v e r i t y u s l n ~ R u b i d i u m 82, a c a t i o n i c t r a c e r w h i c h r e f l e c t s flow x e x t r a c t i o n . 34 p a t i e n t s w e r e s t u d i e d ( 3 2 males, 2 females, mean age : 53 y e a r s ) w i t h i n one m o n t h of i n f a r c t i o n ; t r a n s m u r a l , i n f e r i o r : 14, a n t e r i o r : 12, l a t e r a l : 2; o r s u b e n d o c a r d i a l : i n f e r i o r : 4, a n t e r i o r 2. Coronarography was p e r f o r m e d in 31 p a t i e n t s (91%) a n d r e v e a l e d t h e f o l l o w i n g : one v e s s e l d i s e a s e : 16 p t s ( L A D : 8, L C A : I , RCA : 7 ] ; t w o v e s s e l s disease : 9 p t s ( L A D + R C A : 4, L A D + L C A : 3, L C A + R C A : 2 ) ; m u l t i v e s s e ] s disease: 5 pts and I normal coronarography. MI was v i s u a l i z e d i n 29 p a t i e n t s as a d i m i n u t i o n of cation uptake. A f t e r i s o t m e t r i c e x e r c i s e (n=17) we o b s e r v e d , in 5 p t s a d e c r e a s e d u p t a k e ( o f 19.2%) more s e v e r e ir. t h e i n f a r c t e d a r e a . I n o t h e r 5 p t s t h e d e c r e a s e in Rb 82 u p t a k e o c c u r e d i n a n o n i n f a r c t e d t e r r i t o r y . No p t s s u f f e r e d from c h e s t p a i n a n d t h e r e was no s i o n i f i o a n t ST d e p r e s s i o n on t h e ECG. After er~ometric exercise (n=21), two pts ment i o n n e d c h e s t p a i n a n d t h e r e was a s i g n i f i c a n t ST d e p r e s s i o n i n 13 cases. In 7 p t s , t h e r e was a n a g g r a v a t i o n o f R b 82 c a p t a t i o n d e f e c t (+ 25.3%] in t h e i n f a r c t e d r e g i o n s , a n d , in 6-cases, a d e c r e a s e d o f Rb 82 c a p t a t i o n i n an o t h e r t e r r i t o r y was o b s e r v e d . We c o n c l u d e t h a t a f t e r an a c u t e M I , r e s i d u a l m y o c a r d i a l isohemia i n d u c e d b y e x e r i c s e frequently occurs without angina, both in the area of i n f a r c t i o n a n d i n o t h e r a r e a s . T h i s o b s e r v a t i o n may h a v e i m p o r t a n t i m p l i c a t i o n s i n t h e t r e a t m e n t of p a t i e n t s e a r l y a f t e r a n infarction.

sometimes of interest to measure the degree of deviation of this equilibrium or in the case of an equilibrium to kno~ something about the conditions to keep it on its level. For this calculation it is necessary to measure on the one side individually the dayly h~moglobin destruction and on the other side the h~moglobin formation, lhe first is done using the conventional labeling of erythrocytes with Cr-S1 and correcting for elution of Cr. For th~ second calculation it zs necessary to evaluate the time-activity curve which is given by different blood samples taken during a period of about 14 days of a Fe-59-study. We determined the conventional values: the turnover rate of zron and the degree of utilisation. And using the initial decrease of iron in plasma and the slope of the later reentry of Fe-59 bound to newly formed h~moglobin ~e demonstrate in this paper how one can develope out of a fit of this curves the translt time o f iron through the bone marrow, the dayly h~moglobin formation and the potential lifetime of erythrocytes. On several groups of patients with different anemic disorders: l) h~molytic anemia, 2) primary and secondary h~mochromatosis and 3) e×tramedullary h~moglobin formation this method has been validated.

C y c l o t r o n R e s e a r c h C e n t e r , U n i v e r s i t y o f Lieoe, L l e oe, B e l g i u m .

I n h e a l t h y persons t h e r a t i o between d e s t r o y e d and produced e r y t h r o c y t e s will be b a l a n c e d . But u n d e r t h e t h e r a p y of an an§mia z t i s

Nuklearmed. Abtlg. der Radiol, Univ.-Klinik, D-6650 Homburg/Saar, West Germany

N u c l e a r Medicine Service. Ciudad Sanltaria "La Fe". gvda. Campanar, 21. Valencia. Spain.

L,F ~ R L S T A G L A N D I N S ~ /PGE/,F~ /PGF~.~/ /d~D CYCLIC NUCLECTIDES /'c~,~, c G P ~ T ~ I N THE PLASI,~ OF LEUKA~.IIC PATIeNTS A~D IN THE SUPERNATA~T CF N Y E L O I D L L U K A E M I A C E L L CUL~OEES. B. KiersnowskaRogowska,F. Rogowski,J. GiedrojS,A.~itko, K. Krnpi~ski,M. Bielawiec. The c o n c e n t r a t i o n s of the above substances were d e t e r m i n e d in the p l a s m a and supernatants of leukaemic cell culture from 38 p a t i e n t s with acute myeloblastie l e u k a e m i a /aml/, 2 0 w i t h chronic granulocytic l e u k a e m i a /cgl/ and 20 healthy persons /control group/. The prostaglandin level was d e t e r m i n e d b F means of Clinical Assays /USA/ RIA k i t s and cyclic nucleotide c o n c e n t r a t i o n with Amersham /England/ RIA kits. The results obtained showed that the p l a s m a P G E level was high both in aml and cgl but the P G F t ~ level was only h i g h in cgl and w i t h - % x a e e r b a t i o n of this disease increased considerably. The level of c A ~ was also h i g h in beth diseases but the cGMP level was h i g h e s t in egl /particulary in the states of exac e r b a t i o n / and the lowest in p a t i e n t s with aml. The P G E s u p e r n a t a n t concentration was s i g n i f i c a n t l y higher in aml than in the cgl and in the control. The values of P G F t ~ were h i g h in cgl, but in aml were lowet--than in the control. Contrasting b e h a v i o u r of the cyclic nucleotide c o n c e n t r a t i o n was n o t e d in the supernatants of leukaemie cells; in aml, the highest c A ~ values accomoanied c G ~ values b e l o w these of the controls. The reverse was observed in cgl. It is felt that the findings r e g a r d i n g k n o w n ir~hibitors /PGE,cAt~/ and stimulators /PGFc~, eG~,~/ of cell p r o l i f e r a t i o n have cont~k~buted to our k n o w l e d g e of disturbances in leukaemic cell metabolism, which m a y be of value in diagnostics and treatment monitoring. Department of H a e m a t o l o g y , M e d i c a l School 15-276 Bia~ystok, 2oland.

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2LASI,~ R E N I N A O T I V I T ~ /pra/, 2LASI.~ CONC E N T R A T I O N OF A L D O S T E R C N /pcal/, IRCSTAGLANDIN 6-keto-F~/6-keto-PGF~/ AND T H R O M B O X A N E B o / T ' ~ B m / IN IEUF_~J~NIAS. F. R o g o w s k i , B . X i e r s n ~ w s k a - R o g o w s k a , J.Giedroj6,A. C i t k o , K . K r u p i ~ s k i , A . Rogalewska.

PLATELET FUNCTION STUDIES IN DIABETICS VCITH ~t-THllOMBOCLOHULIN ( 6 - TG), P L A T E LET FACTOR 4 (PFd) A N D T H R O M H O X A N BZ (TXB~) RIA-ASSAY. J. Holan, P. Kubisz, S. Cronberg, M. Parlzek

CLEARANCE SITES OF S I A L I D A E-TREATED ERYTHROCYTES. I . Mononen a ' ~ , L. P o r k k a a and A . - L . g a i r e n t o a

The investigations were carried out in 30 patients w i t h acute m y e l o b l a s t i c leuk a e m i a /~al/,15 w i t h chronic g r a n u l o c y tic l e u k a e m i a /cgl/,18 with chronic lymphocytic l e u k a e m i a /ell/.The c o n t r o l group consisted of 20 h e a l t h y persons. In all p a t i e n t s the values of blood pres s u r e , g l o m e r u l a r f i l t r a t i o n rate,sodium, p o t a s s i u m , c r e a t i n i n e and p r o t e i n levels in the p l a s m a and s o d i u m c o n c e n t r a t i o n in the urine were in the normal range, There were no h a e m o r r h a g e s and e v i d e n t d i s t u r b a n c e s in blood coagulation. The p r a and pcal were d e t e r m i n e d by means of CIS /France/ RIA kits but the c o n c e n t r a t i o n of 6 - k e t o - P G F 1 ~ a n d T X B 2 by the N E N /USA/ R I A kits. The results showed that the p r a and peal d u r i n g r e m i s s i o n periods in the types of l e u k a e m i a studied did n o t d i f f e r f r o m those of the control group but in the pe riods of e x a c e r b a t i o n increased 5-8 times. The c o n c e n t r a t i o n of 6 - k e t o - P G F 1 ~ was high in all the l e u k a e m i a s in compar i s o n w i t h the c o n t r o l group. The highest values were o b s e r v e d in patients w i t h e x a c e r b a t i o n of the disease. The p l a s m a TXB m level was normal in the r e m i s s i o n perihds and increased d u r i n g the periods of exacerbation. It is possible that the increase in n o n s p e c i f i c pro tease a c t i v i t y a c c o m p a n y i n g e x a c e r b a t i o n of leukaemias is the cause of the increase in p r a and peal. The h i g h 6-keto~ G F ~ m v a l u e s indicate a h i g h p r o s t a g l a n d i n ' ~ e v e l which by r a i s i n g the c ~ , ~ level p r o b a b l y p r e v e n t s excessive cell p r o l i f e r a t i o n in cgl and in aml enhances the d i f f e r e n t i a t i o n of cells.

The study was c a r r i e d out in 28 patients with insulin-dependent diabetes and in 33 healthy controis of s i m i l a r age, sex and weight. Diabetic patients exhibited significantly higher plasma levels of bo~h ,6-TG and PF4 in e o m p a r i s m to normal controls and a positive correlation between plasma (~-TG and PF4 was found (r=O.g?, pt0.001, n=28). After addition of araehidonie acid plalelets of diabetics synthetized more T X B 2 than those from the normal controls. Araohidonic acid is rnetabo[ized by stimulated platelets into TXAr, which is a short lived potent platelet aggregator and a vasoconstrictor. It degrades into the biologically inactive product TXH~, which can be assaied. A negative correlation was found between the amount of T X B 2 synthetized by platelets from diabetics and the minimal concentraDon of arachid, ac. ne~ cessary to induce 50 ~ p[atetet aggregation (r=-0.52, p~0.05, n=le). It iS interesting to note that a significant correlation was also found between the levels of B -TG in plasma and the amounts of TXS2 synthetized by platelets in diabetics (r~0.66, p~0.01, n=lS). In connection with hyperreaotivity platelet s t u dies in vitro and in vivo (platelet aggregation, m a londialdehyd assay, evaluation of circulating p l a telet aggregates and 5 kinds of coagulation studies) it is concluded that this findings may be of clinical importance for l a t e r development of vascular c o m plications in this disease.

Lab.of N u c l e a r M e d . , D e p t . o f P h a r m a c o l o g y M e d i c a l School, 24a M. 0 u r i e - S k l o d o w s k i e j 15-276 Bia~ystok, ~oland.

A 454 Bone M a r r o w S t a t u s i n S t a g i n g nant Systemic Diseases A.Hotze,A.L~w,J.Mahlstedt,F.Welf

of Malig-

Scintigraphie i m a g i n g o f bone m a r r o w RES u s i n g a Tc-99m l a b e l l e d s m a l l human albumin colloid (particle size ~80nm) has been shown t o be h e l p f u l in the diagnosis of diseases with probable marrow infiltration. For evaluation of marrow status the following p a r a m e t e r s were obtained from marrow scans: 1,Cold lesions (C.L.,circumscribed decreased or absent phagocytosis of colloid by m a r r o w RES). 2.Marrow expansion (M.E.). 3.Sacroiliacal j o i n t uptake (S.J.U., normal-(~), i n creased-O, decreased- G).In addition(4) bone scans were a s s e s s e d t o be p o s i t i v e ( 8 S + , f o c a l i n c r e a s e d MOP) o r n o r m a l . The c u r r e n t s t u d y c o m p r i s e s 47 p a t i e n t s , 25 f e m a l e s , 2 2 m a l e s , mean a g e : 5 g . 8 y e a r s . Diseases 1 C.L.

Parameters 2 3 M.E. S.J.U.

4 BS+

H o d g k i n ' s d. 12 23 5 @ 17 g n=23 N.Hodg. Lymph. 5 8 1 @ 8 3 n:9 Pl asmocytoma I~ 6 @ 7 ~ 5 n=7 Chr.myel .leuk, 4 4 I 0 3 3 n=4 Acute leuk. @ 2 ¢ 2 ~ n=2 (Polycythemia) ~ 2 ~ 2 @ @ n=2 These f i r s t results s t r e s s the s i g n i f i cance o f bone m a r r o w s t a t u s as an adjunct parameter for staging of respective d i s e a s e s i n a d d i t i o n to the clinical data. Inst. Nucl,Med. Univ. Erlangen-NUrnberg,Krankenhausstr.12 D-8520 E r l a n g e n (West Germany)

Clinics of Nuclear Medicine, Univerzity Hospital, 03601 Martin, Czechoslovakia; Clinics of hematology, ~adca, Czechoslovakia; Lunds Universitet InfektionskIiniker~ MalmS, Sweden

Sialic a c i d i s a common n a t u r a l monosaccharide occupying the terminal position in c e l l s u r f a c e g l y c o c o n j u g a t e s . The treatment of rabbit erythrocytes with sialie acid liberating enzyme sialidase - does not cause any morphological alterations but shortens their ha/f-life from 9-11 days to 7-12 hours. Ne no~ report imaging of the previously unknown clearance sites of sialic acidless erythrocytes. Sequential imaging was performed with a gamma camera GE-4OOT on six rabblts after intravenous injection of sialidasetreated and 99To labelled erythrocytes. Control s t u ~ e s w e r e p e r f o r m e d on four rabbits ~ith untreated cells. The only organ to c o l l e c t sialidase-treated cells was the liver. Thirty mim after the injection, the uptake ratio betmeen liver and spleen was (i.83 ~ 0.66) in the control cases. Using the sialie acid-less cells, the corresponding ratio was significantly higher (p
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INCREASED BONE MARROW BLOOD FLOW IN CHRONIC LYMPHOCYTIC LEUKEMIA. T. Lahtinen, R. Lahtinen, P. Vainio and J. Puittinen

SERUM FERRITIN EVALUATION IN A POPULATION OF 1010 SUBJECTS. J.M. Carril, J.J.L. Cordovilla, E. Mazo, and v. Hermosa

Our previous studies with chronic granulocytie leukemia and m y e l o f i b r o s i s have shown that bone marrow blood flow is dependent on the phase of the dlsease. The purpose of this work was to study the effect of chronic lymphocytic leukemia on bone marrow blood flow and marrow cellularity. An intravenous Xe-133 injection method was used. NaI(T1) s c i n t i l l a t i o n detectors coupled with n a r r o w - a p e r t u r e collimators followed the washout of Xe-133 from the proximal parts of the femurs. Bone marrow blood flow was calculated according to a t w o - e x p o n e n t i a l analysis of the washout curves. Blood picture was analyzed using conventional methods. A point counting method was used to calculate the bone marrow cellularity. There was a positive correlation between the lymphocyte mass of bone marrow and bone marrow blood flow. A highly significant correlation was found between the blood haemoglobin and bone m a r r o w blood flow. If the patients were classified according to RAI classification, there was a positive correlation between the RAI number and bone marrow blood flow except the RAI number IV. The study showed that bone marrow blood flow is increased in chronic lymphocytic leukemia and dependent on the phase of the disease. Furthermore~ the study suggests that in this disease the blood haemoglobin reflects changes in bone marrow blood flow.

D e p a r t m e n t of Radiotherapy, Central Hospital, SF- 70210 Finland

University Kuopio 21,

An evaluation of the iron status in the populat~ on of our reKion in the North of Spain is being carried out. It includes all relevant parameters related to iron matabolism and the aim is to stu dy the prevalence of iron deficiency anemia. We oresent a preliminary work based primarily on the evaluation of iron stores by measuring the serum ferritin (S.F.) by RIA. S.F. was determined in I010 subjects above 18 years of age. They were classified into groups according to sex and age. Results are expresed as mean values of S.F. in each group, and incidence of storage iron deficiency (S.I.D.). S.F. ~ 12 ngrs/ml was considered as S.I.D. The mean value of S.F. in females (489 cases)was 49.3 ~ 69.5 ngrs/ml. The mean 9alue of S.F. in males (521 cases) was 198 ! 24S.2 ngrs/ml. The incidence of S.I.D. in males was 1.3% (7/521)and 19.4% (95/489) in females. When females were cla ssified according to age the following mean levels were obtained: 96.B ngrs/ml (<20 years), 45.3 (20-30), 46.7 (30-40), 52.9 (40-50), 65.1 50). In these ~roups the incidence of S.I.D. were: 18.2% (2/11), 20.4% (44/216), 22.8% (29/ 127), 22.7% (15/66), 7.4% (5/68), respectively. The same classification in males save the foldowin~ mean S.F. values 102.5 ngrs/ml (<20 years), 150.6 (20--30), 217.3 (30-40), 262 (40-50), 196 () 50). The incidence of S.I.O. were 11.1% (i/9l, 1.3% (2/155), O.~A (1/135), 1.0% (1/i02), O.6% (i/118), respectively. S.F. determination is of gremt value to evaluate the iron stores in the population. In this case it has shown the high incidence of S.I.D. in the ~rouD of fenales mainly, in those between 18 and 40 years. Servicio de Medicina Nuclear. Hospital Naeional -Valdeoilla', Santander. Spain

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INVESTIGATION OF Fc-RECEPTOR FDNCTION OF SPLENIC MACROPHAGES WITH 99mTc-SENSITIZED ERYTHROCYTES.V.Dolgova-Korubin, V.Bogdanova,N.Simova,O.Vaskova I n s t i t u t e of p a t h o p h y s i o l o g y and Nuclear M e d i c i n e , F a c u l t y o f Medicine,Skopje

IRON STORES EVAI,UATION IN BLOOD DONORS BY SER~,~ PERRITIN. J.J.L. Cordovilla, J.m. Carril, J.M. Pastor, E. Mazo, C. de la Fuente, and J.I. Banzo

FILRRITIN CONCENTRATION IN SERUM,ERYTHROCSPPES, POLYMORPHS 7~D M O N O N U ~ CELLS IN HEALTHY pEOPLE BY ~4vK~qORADIOMETRIC ASSAYS WITH MONOCLONAL AND POLyCLONAL ANTIBODIES. L. Muylle, p. BiOckx, D. Becquart and F. Van de Vyver.

E r y t h r o c y t e s coated by iecomplete,non complement,binding a n t i b o d i e s are removed by the spleen.Attachment of s e n s i t i zed red c e l l s to s p l e n i c macrophages is accomplished by means ef r e c e p t o r s f o r IgG on the macrophages.The unique m i c r o c i r c u l a t i o n of the spleen f a c i l i t a t e s immune adherence o f s e n s i t i z e d e r y t h r o cytes to Fc-receptor on macrophage membrane.ln this paper the clearance of Anti-Rh sensitized erythrocytes was studied following the a c t i v i t y over the spleen and heart with gamma camera and computer.0ne ml autologous red cells labelled with 99m-Tc and sensitized with one ml Anti-Rh serum(titer ~:256) were injected in healthy persons.Data aquired during 20 min a f t e r the i n j e c t i o n were processed and curves were eonstructed. Coated red cells were removed from circul a t i o n solely by the spleen,as was shown iE splenectsmized patients.The a f f i n i t y of the splenic macrophages to Rh-sensitized red cells was expressed by the slope of th~ spleen surve(%/min).The slope was ~0,14-1,42%/min in J6 persons.Clearance from the blood was expressed by ~be T/2 from th heart curve,which was 3J~8,5 min. There was no cerrelation between these two parameters,but there was ons between T/2 aEd the size of the spleen(r=~0,64}. No correlation was found e i t h e r between the slope and spleen size(r=+O,3J).This suggests that the slope of the a c t i v i t y over the spleen is real index of Fc-receptor function.Clearance of Rh-sensitized erythrocytes from the blood depends On the Fc-receptors function and the s i ze of the spleen as well.

The effect of blood donations on iron stores has been evaluated in 500 donors, 118 males and 382 females, by measuring serum ferritin (S.F.) by R.I.A. The control group included 302 controls, 120 males and 182 females. Values $ 1 2 ngrs/ml we re regarded as indicative of iron stores depletion (I.S.D.). In the male control group, the mean 3.F. was 147.0 ~ 99.7 whereas in the male donors group it was 97 ~ 127 and the significance level of the means was p < 0.001 In females. the mean in the control grouo was 42,g 4 57 and in donors 2g.l ! 3g.l The number of males with S.F. ~ 12 ngrs/ml was 1/120 (0.8%) in the control group and 4/118 (3.a%) in the donors ~roup. The number of females with S.F. ~ ig ngrs/ml was 43/g2 (23.6%) in the control group and 118/382 (30.8%) in the donors group. When the females of the control ~roup were classified according to age, there was a 26.4% with I.S.D. in the sub group below 45 years and 11.8% in the subgroup above that ageo In females of the donors group there was I.S.D. in 34.6% (72/208) in the subgroup below 45 years and gg.4% (46/174) in the subg£oup above 45 years. In the group of females 25 years the incidence was 41.9% (34/81) and 20.3% (13/g4) in the group above 55 years (p < 0.01). gccording to the time interval (months) between donations the incidence of I.S.D. was 42% (< 4 months), 33.5% (4-6), 27.8% (6-8), 23.3% (8-10) and 15.5% (> i0 months). We conclude : I) The incidence of I.S.D. increases as the interval between donations decreases 2) The incidence of I.S.D. is higher in the young groups than i~ old groups, 3) S.F. is a parameter of great value to prevent iron defieie~ cy anemia in blood donor. Servicio de Medicina Nuclear. Hospital Naeional "Valdeeilla". gantander. Spain

Two cc,mercial inwnunoradicmetric assays, one using monoclonal antibodies to spleen ferritin ~/t selected to react with both liver and spleen ferritin, the other using polyclonal antibodies tO liver ferritin, were used to measure ferriti~ content in serb~ and figured blood elements in 20 normal subjects. For sert~n and erythrocyte ferritin a highly significant linear correlation between the results of both assays was found (r>0.95) . For granulocytes end mononuclear cells, hcwever, lower linear correlation coefficients w~re observed (r>0.8). According to the type of sample different reqression slopes were observe~ in sertwa the results for both assays did not differ significantly (slope 1.08) ; in red cells there was a marked decrease in response of the monoclonal antibody (MA) assay oampared to the polyclonal (PA) assay (slope 0.27). These ~sults indicate the nonrecognition of part of the erythrocyte ferritin by the ~lq. It has been shown that red blood cells contain two immunological different ferritins. The difference observed between both assays could be explained by amonospecificity of the M A for tile spleen-type,which is also the most abundant ferritin type in the sezl~n. An additional a r ~ e n t for this is that the median erythrocyte ferritin content found in the present study with the MA is nearly identical to the values obtained by other authors using polyclonsl antiboOties specific for basic ferritin. Ferritin Contents in granulocytes and memonuclear cells were significantly lower with MA. This could be the result of a different cellular isoferritin oclnposition with respect to sertwa and erythrocytes or of a different oanposition ~nonocytes,l~mphocytes) for the mononuclear cell samples. These findings indicate that both assays are equivalent for the assay of seru~ ferritin, but not for figured blood elements. A high specificity of the M A for basic liver type ferritin is also suggested. Bloodtransfusion Center Antwerp end University Hospital Antwerp, wilrijkstraat 8-10, B2520 Edegem, BelgiL~.

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THE QUALITY CONTROL OF ~ITLMIN B-12 SCHILLING TEST VERSUS SERUM g-12. M. Antar

DOSE RESPONSE EFFECT OF OXINE, TROPOLONE AND 2-MERCAPTOPYRIDINE-I-OXIDE ON LEUKOCYTE MOTILITY USING A LEUKOCYTE MIGRATION TEST UNDER AGAR. W.Th. Goedemans and M.M.Th. de Jong

KINETICS 3kq VIVO OF IlI-ln-12kBV~.TR~ PLATELETS IN HEALTHY SUBJECTS. K.G. ScYmddt, J.W. Rasmussen and A.D. Pamnussen.

The accepted standard procedures in a clinical setting for the assessment of vitamin B-12 absorption is Schilling's test and serum vitamin B-12. The latter is in equilibrium with tissue stores and ~s usually a reliable index of the total body vitamin content. We encountered a relatively large number of patients with a normal Schilling (>8% dose), and low serum B-12 (below 180 pg/ml). Therefore, we investigated different aspects of the quality control of both tests and the incidence of these discordant results in a V.A. patient population for three years. Th~ average age was 65 + ]0.5 years old. Serum B-12 was determined using a "R"-protein ~nhibitor in 1,605 consecutive patients. Of these, 116 patients hod standard Schilling test, without istrinslc factor, using purified Ce-57 Vitamin B-I2 capsules. The incidence of T'false" negative for Schilling tests was approximately 28%, (32/115). Mean serum vitamin 8-18 of this group was low; 135.8 + 29.9 pg/ml, (N: 200-950 pg/ml), and Schilling 24-hour urinary radioactivity as % dose was normal, 16.8 + 5.7. Mean plasma radioactivity at 8 hours was 1.03 ± 0.38 (N: >D.5%/liter). In contrast to serum B-12, mean serum Folate was mormal, 7.9 Z 4.8 ng/ml, (N: 1.4-13.7). Megaloblastie anemia was present in 60% of the patients. Cirrhosis or ethanol abuse was the major common factor present (in two-thirds of the patients). Other conditions which may have contributed to this discrepancy are, partial gastrectomy, vagotomy, cimetidine and dilgntin therapy. These findings show that the "false" negative results of the standard Schilling test in the population studied, is relatively high. The physician should be aware of the limitations of the standard Schilling test under certain concomitant conditions. Univ. of Conn. Sch. of Med., Farmington, CT and V.A. Mad. Ctr., Newington, CT U.S.A.

A migration test for leukocytes under blood agar was developed, leukocytes moved quite a distance under anaerobic Blood Agar Base (blood agar), a Gibco product. This medium contains various possible ehemo attraetants and the observed cell motility is built up by random migration and directional migration to the theme attractants in the agar medium.

Migration on stained and coloured plates was visualized by projection with a profile projector~ making the use of a light microscope superfluous, A migratioo index was defined. Reproducibility was good enough, to allow paired comparisons with leukocytes subjected to different treatments. Dose response effects of three eomplexing agents on leukocyte migration were assessed. Those eomplexing agents were oxine (ox), %ropolone (trop) and 2-mercaptopyridinei-oxide (marc) all known as potent cell labelling agents. It appeared that mere seriously affected cell motility in all concentrations tested. ~rop bad the best properties with regard to toxic effects. Concentrations up to 70 ~q/ml labelling preparation (lO ~g/ml ultimate incubation mixture) did not significantly affect leukocyte motility. Ox did not affect leukocyte motility up to a concentration of 25 pg/ml labelling preparation (5 pg/ml ultimate preparation). Results imply that mere should not be the appropriate cell labelling agent to be used in abscess localization studies. Byk-Nallinckrodt CIL B.V. P.O. Box 3 1755 ZG Pet%on, Holland

The kinetics and in rive distribution of lll-Inlabelled autologous platelets were studied in 25 healthy subjects. Using the multiple hit model, platelet mean life time (~uT) averaged 185h, platelet in vivo recovery (IVR) 56%, and platelet turnover 55437 pl./pi/24h, simultaneous stUdies were carried out in 7 subjects with identical platelet suspensions labelled with ill-In and 51-Cr, respectively. The III-In-MLT v/as slightly shorter and III-In-IVR slightly nigher than those of the 51-Cr-platelets, and the lllIn-platelet survival curves tended to be slightly more curvilinear than the 51-Cr-curves. This may be ascribed to a slight elution in vivo of lll-In-activity fran the platelets, judged by t/qe results of c(luparative studies of p l a ~ bound activity in the saraples of ill-In-platelets prior to their injection and in blood samples obtained at intervals following injection. ScintiDra~nic studies: The splenic activity rose in a monoexponential n~qner, reacning equilibriuln ~ithin 30 rain. Followi~g an initial peak at around 10 rain post injection, the hepatic aCtivity showed a rapid initial decline followed by a slower decrease lasting roughly one hour in most subjects, ald accc~oarded by opposite changes in circulating platelet-bound activity. Using a scn~iquantitative approach, the quantities of platelets sequestrated and destructed in the spleen, liver add bone marrow were estimated. Platelet sequestration predc[ninantly occurred in the spleen (a~ound 85%), the regaining prestz~ably being sequestrated in the liver. The contributions to platslet destruction amounted to roughly 40% (spleen), 25% (liver) , and 35% (bone r~arrow), however, with considerable interindividual variation. The bone marrow component may have bee/1 slightly Overestimated as we found scintigraphic signs of slight platelet destruction in the lungs. Department of Nuclear Medicine, Odense University Hospital, DK-5000 Odense C, DerlmD/k.

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PROBLEMS ON THE ALEATORY DESTRUCTION AND SURVIVAL TIME DETERMINATION OF LABELLED (Cr-51)BL00D CELLS(ERYTHROCITES AND PLA TELETS.A.M.Baptista,A.R.Nogueira a n d M.

INSTANT PHOTOGRAPHIC NUCLEAR MEDICINE AND J. M a h l s t e d t

H. Camejo

I m a g i n g t e c h n i q u e s in m e d i c i n e r e q u i r e fast t r a n s f e r o f i m a g e s a n d w r i t t e n inf o r m a t i o n to t h e c l i n i c i a n in o r d e r t o allow immediate decision making. This t a s k is m a r k e d l y a l l e v i a t e d b y u s e o f i n s t a n t f i l m m a t e r i a l w i t h o u t n e e d of darkroom, chemical solutions, time consuming processing procedures or special processing machines which require space and service.

0£ the three equations recommended by t h e I O S H £ o r t h e a d j u s t m e n t o~ e x p e r i m e n t a l d a t a in t h e s t u d y Of O r - 5 1 l a b e l i e d erythrocites survival the form

N=N ° e - k t ( 1 - ~

)

has the advantage o£ a clear physiologi cal meaning £or the parameters k(random-radioactivity disappearance) and T(sur r i v a l t i m e ) . A s it is w e l l k n o w n £ r o m v ~ r i o u s s t u d i e s t h e d a t a a d j u s t m e n t leads-to problems. We present a direct approach that clear_ ly r e v e a l s t h e d i £ £ i c u l t i e s 0 9 t h e m e t h o d s . S i n c e w e c a n w r i t e t h e equation--as N

"-o

ekt=

(i- t

~)

w i t h a computer t o s e l e c t the values o£ k that vith certain values o£ T made the product o£ (N/N~) by the exponential a straight l i n e . T ~ i s a p p r o a c h w a s a p p l i e d to 20 c a s e s o £ h e r e d i t a r y s p h e r o c y t o s i s a n d 17 c a s e s o £ a u t o J i m m u n e h a e m o l i t i e anaemias. Its i n t e r e s t h o w e v e r w a s m o r e c l e a r l y r e vealed in t h e s t u d y 0 £ O r - 5 1 l a b e l l e d platelet survival confirming the condi tions o9 application o9 the method impS_ s e d b y t h e h a l f l i f e o £ t h e C r 51 l a b e l _ led erythrocites. Centro de Medicina Nuclear(INIC)-Labora tdrio de Isdtopos,lnstifuto Portugues d~ Oncologia de Francisco Gentil-1093 Lisboa-Portugal

DOCUMENTATION IN THE USE OF COLOUR.

FAST HIGH YIELD PREPARATION OF 1231-HIPPURAN WITH HIGH SPECIFIC ACTIVITY. R. Verbruggen, J. Mertens, W. Vanrijckeghem.

There are several facilities to have the clinical information on transparency f i l m o r p a p e r f i l m at a l l f i l m sizes. Colour film provides special advantages to s h o w t h e c l i n i c i a n c o n v i n c i n g r e sults, however, up to now colour was o n l y s e l d o m u s e d to s t r e s s t h e s i g n i f i c a n c e of c i r c u m s c r i b e d abnormalities in s c i n t i s c a n s . F u r t h e r m o r e c o l o u r is a f a c i l i t y to c o - o r d i n a t e h e t e r o g e n o u s information providing a basic structure w h i c h is e a s i l y s e i z e d , so t h a t the c o n d u c t i o n of w r i t t e n a n d p i c t o r i a l inf o r m a t i o n t o t h e r e a d e r is g u i d e d by u s e o f c o l o u r ( i d e n t i c a l c o l o u r for ROI, c u r v e , n u m e r i c a l r e s u l t s , w r i t t e n text). 35 m m f i l m ( c o l o u r , b l a c k / w h i t e ) to b e u s e d in e v e r y d a y s t a n d a r d c a m e r a t y p e s a n d p r o c e s s e d w i t h i n 2 m i n is t h e l a s t s t e p f o r a c o m p l e t e c o n c e p t , as it f a c i l i t a t e s the m i n i f i c a t i o n of i m a g e s for l o n g - t i m e d o c u m e n t a t i o n or medical t r a i n i n g {slides) h a v i n g t h e d a t a a l w a y s in t h e d e p a r t m e n t w i t h o u t t h e p o s sibility of data misuse during extern film development.

1231-Hippuran is used for the noninvasive assessement of kidney functions. The use of the more patient friendly but more expensive 1231 requires a high labeling yield. Earlier described methods were tried, hut resulted in the formation of 0-]231-benzoic acid and 12312. This paper describes a labeling method making use of a Cu(I) catalyst. An almost quantitative labeling yield is obtained within 5 minutes. The amount of O-]23I-genzoie acid formed is negligible and the generation of }2312 is avoided. The Cu(I) catalyst in presence of Sn(lI) also allows that only 1 mg can be used in this reaction resulting in a high specific activity. The radiopharmaeeutieal is purified by a fast reversed phase EPLC separation with a Me0N/ HIO/RAC mixture as eluent. The kinetics of the reactlon as well as the clinical applications will be discussed. VUB-Cyclotron, VRIJE UNIVERSITEIT ERUSSEL, Laarbeeklaan ]03, 1090 HRUSSEL,Belgium.

I n s t i t u t fHr N u k l e a r m e d i z i n Universit~t Erlangen-NHrnberg KrankenhausstraBe 12 D-8520 Erlangen (West G e r m a n y )

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201TL-DIETHYLDITHIOC.,~ELBANATE(TS201-DDC)= AN

QUALITY CONTROL OF MONOCLONAL ANTIBODIES AFTER RADIOLABELLING. THE FRACTION OF IM~NOREACTIVE ANTIBODY DETERMINED AT INFINITE ANTIGEN EXCESS T. Lindmo, E. Eoven, F. Cuttitta, J. Fedorko and P.A. Bunn Jr.

EVALUATION OF TWO METHODS FOR DF A~ND DTPA CONJUGATION TO MONOCLONAL ANTIBODIES. C. Motta-Hennessy, S.Eccles, C.J. Dean, M. Barrett, K. Roberts and R.J. 0tt.

ALTERNATIVE TO I123-W ISOPROPYL-P-IODOAMPBETAMINE (II23-IMP)? E.A. van Royen, J.F. de Bruine, A. Vyth, J.M.B. de Jong, J.B. van der Schoot. The limited availability and high cost of 1123IMP is a major drawback in the study of the early events in cerebral ischaemia.201Ti-DDC was developed by us as a highly lipophilic agent with considerable brain uptake. It can be easily prepared at low cost on a daily basis. We here report on a comparative study between 20~fl DDC and II23-IMP in rabbits and dogs. After injection of 0.5 mCi in rabbits, whole-body timeactivity curves were obtained employing a gamma camera and computers for brain, lung, liver, kidneys and background. The brain uptake of TI201-DDC occurred more instantaneously compared to II23-IMP, and the level of activity remained moxe stable. No lung retention was observed for TI201-DDC. Three minutes after injection the following values were obtained.

brain lung liver kidney background

201Ti_DD C 123I_IM P (cts/pixei/mCi/min) 144 75 96 350 144 50 216 175 48 25

The sa/ne favourable results for 201TI-DDC were obtained in dogs. Rabbits were sacrified 45 minutes after injection of TI201-DDC or 1123 amphetamine after perfusion and fixation of the brain, samples of grey and white matter were counted. The grey/ white ratio was comparable for T120i-DDC and I i23 amphetamine (1.5 vs 1.37). Also, autoradiography revealed comparable accumulation in grey and white matter. Awaiting further experiments in humans, T1201DDC may become a readily available inexpensive alte£native to 1123 amphetamine. Dept. Nuclear Medicine and Ext. Neurology, Academic Medical Center, /mlsterdam, Netherlands.

Because radiolabelling may adversely alter the antibody, quality control procedures must be applied to determine important characteristics of the radiolabelled antibody. Based on theoretical considerations, we have developed a radiobinding assay in which the fraction of immunoreactive antibody is determined by linear extrapolation to conditions representing infinite antigen excess. If only a fraction r of the radiolabelled antibody is immunoreactive, the mass equation can be used to show that [T]/[B] = 1/r + i/rKa[F], where [T] is the total concentration of antibody and [B] that of cell-bound antibody in a binding assay set up with a dilution series of cell concentrations. K a is the association constant, and [F] is the concentration of free binding sites~ which is approximately proportional to the cell concentration under conditions of antigen excess. A double-inverse plot of [T]/[B] as a function of I/[F] will yield a straight line. The origin represents infinite antigen excess, and the corresponding value of [T]/[B] is i/r. Thus, by plotting the data according to the above equation, and extrapolating a fitted straight line to its intercept with the ordinate, the fraction of immunoreactive antibody is determined as the inverse of the intercept value. We established the method using 125I and lllln labelling of monocl0nal antlhodies. Normally, immunoreactive fractions about 0.9 were found, but a prolonged ehloramine-T reaction for 125I labelling resulted in an immunoreactive fraction of only 0.6. Natl~nal Cancer Institute, Na~ry~[edical Oneology Branch, Navy Hospltal~ Bethesda, 20814, USA; and The Norwegian Radium Hospital, Montebello, Oslo 3~ NorWay.

As part of our program to evaluate techniques for radiolabelling of antibodies, we have used human IgG as a model system to study the d e s feroxamine (DF) coupling reaction using glutaraldehyde or carbodiimide at various concentrations. Diethylenetriaminepentaacetic acid (DTPA) was conjugated to IgG via the carboxycarbonyl mixed- anhydride or the carbodiimide reaction. The IgG-DF and IgG BTPA conjugates have been labelled with Ga-67 and In-111 with a labelling efficiency of 60-96% with good reproducibility and stability. Radiochemical purity was assayed by sephacril S-300, sephadex-G50 or EPLC using a TSK 30OSW column with similar results. Labelling efficiency in relation with storage time of the conjugate was analysed by sephadex-G50 and paper chromatography using Whatman #I and 85% methanol: with yields ranging from 96-34% after 1-30 days storage at 4°C. The electrophorectic mobility was determined by SDS polyacrylamide gel electrophoresis. The conjugate was found to possess similar electrophoretic mobility as native IgG. As an extension of this work, we have conjugated the rat IgOr b MoAb MI0/76 (which is specific for the chemically induced Mc 24 rat sarcoma) with DF at a M:R 1:40. The plasma clearance in normal rats 48 hours after injection was 4 hours versus 18-24 hours for the I-]25 labelledM10~6. Localization of the antibody into the Mc24 tumour in syngeneic Lister hooded rats is being evaluated and compared with a similar antibody (11/160) with specificity for the rat sarcome HSNt.c. The rapid blood clearance of this rat MoAb precludes high concentrations in the tumour and enables imaging within a shorter time after injection. The Royal Marsden Hospital, Sutton, Surrey. U.K.

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GROSS D~SCREPANCIBS IN BEHAVIOUR BETWEEN HUMAN SERe AND QUALITY CONTROL PREPARATIONS, REVEALED BY CHANGED ANTISERUM SPECIFICITY. P. Blockx, R. Speybrouek and W. Bleys.

SOLID~-PHASE RADIOI~@4LrNOASSAY FOR THE DETECTION OF ANTIBODIES TO COLLAGENS. 0. Charriere, D.J. Hartmann and 0. Ville

RECEPTOR ASSAY OF 1,25(0g) z VITAMIN D AND HPLC OF OTHER VITAMIN P~TABOLITES IN PREGNANCY AND CORD SERUM. J.T. Dabek, O. Ylikorkala*, M. Hgrkgnen, H. Adlercreutz

Changing the antiserum specificity of a RIA system is known to be a potential cause of concern~ by possibly altering the response of calibrators, samples and controls. Most often, patient samples and commercial controls react in a similar manner to this changed specificity. However, this needs not necessarily to be the case. We report two antiserum changes which were accompanied by sometimes dramatic alterations in the apparent analyte content of several control preparations, while the findings for patient serum samples were unaffected. The assays involved were: a direct estradiol assay (EIR, W~renlingen, Switzerland) and a TSH assay (Amersham International, UK). The differences in apparent analyte content, compared to the previous titration, ranged from 85 to 179% for the estradiol kit and from 27 to 123% for the TSH kit. In both cases, no significant difference could be demonstrated regarding the assays of patient serum samples. It is interesting to note that, in the case of TSH, the antiserum change affected not only commercial internal quality control (QC) preparations, but also samples from external QC programs, such as the Wellcome control program and the Belgian official external QC scheme. The assay resul~s being pooled in such programs, important biases are to be anticipated. The reported discrepancies were ascribed to the fact that, in control preparations, analytes may not be present in the native form, but also as a metabolite, a subunit, a degradation product or even as a non-human analog. This difference in composition as compared to true, not degradated human sere must be regarded as a major cause of a different hehaviour of these control preparations with respect to the change in antiserum specificity. Therefore it is obvious that neither the kit manufacturer, nor the performing laboratory can be considered to be responsible for discrepant results generated in this way in both internal and external QC schemes. Dept. of Nuclear Medicine, Antwerp University Hospiaal, B2520 Edegem-Belgium.

Antibodies to different types of collagens are useful tools for studies on connective tissues. describe a solid-phase radioi~Enunoassay using z51-protein A which can be applied to immunochemical analysis of antisera against purified collagens raised in various species. Collagens (human and bovine) were extracted from skin (type I), cartilage (types II, I~2~3~, XI-X 7) and placenta (types III, IV, V), and controled, after purification, by aminoacid analysis and polyacrylamide-gDg gel electrophoresis. Antisera to collagens of different types were raised in rabbits, goats, guinea pigs and mouses. P2otein A was labeled with iodine 125 by the chloramine T method. The test is performed in polystyrene microplates with removable wells. The influences of the pH and the concentration of the coating solution on the adsorption yield of collagen were evaluated. We determinated the effect of varying the amount of collagen used for the coating on the sensitivity of the assay. Optimal conditions were achieved with 25 ~g of collagen in 200 ~I phosphate buffer pH 7,6. After incubation of antiserum overnight at + 4°C in coated wells antigen-antibody complexes were detected by 25p-protein A overnight at + 4°C. Rabbit, guinea pig and even mouse antisera could he assayed directly ; to ensure an accurate detection of goat antibodies, an additional step of incubation with a rabbit anti-goat IgG serum before adding the labeled protein A was required. The assay was reproducible : the within assay coefficient of variation ranged from 3,5 to 7,5 p. cent and the between assay coefficient of variation from I0~9 to 18,5 p. cent. We prepared plates coated with 9 different types of collagens. The specificity of each system was demonstrated by inhibition experiments. This assay is a suitable method for measuring the titer and the cross-reactions of different batches of antibodies to collagens.

A competitive binding receptor radioassay for 1,25(0H) 2 vitamin D, with sufficient sensitivity for studying maternal and foetal (cord serum) levels, from a few millilitres of serum has been developed. High specific activity tritiated tracer 1,25(0H) 2 D and standard or serum e~tract are allowed to react with intestinal receptor in a total volume of 150 U1 10% ethano]ic 0.05 M phosphate buffer, pH 7.4. The reaction is terminated by adding 40% polyethylene glycol, the receptor-ligand complex spun down and the supernatant counted. The standard curve is plotted as free/total counts vs. total assay concentration. The CVs were 11% and 15% (intra-, interassay). Using high pressure liquid chromatography with ~H-tracers for 25-OH D and 24,25(0N) 2 D a total of 21 cord and 82 pregnancy sere were analysed. Foetal 1,25(0H) 2 D levels (mean 77, range 23- 159 pmol/l) were less than normal adult levels (105, 30150+, p< 0.05) and pregnancy levels were higher than both these (169, 39- 291, p< 0.01, and < 0.001). Diabetic mothers had lower 1,25(OH)2D levels than all other mothers taken together (p < 0.01). At cord 1,25(0H) 2 D levels > 110 pmol/l the babies were larger (p < 0.02). Cord 1,25(OH) 2 D levels correlated positively with 25-0H D levels (p< 0.05). These patterns were not seen in pregnancy serum but at higher 25-0H D and 24,25(OH) 2 D levels babies were larger (p< 0.01 to < 0.04). 25-0H D correlated with 24,25(OH)2D (p< 0.001) and the regression of the former on the latter in pregnancy serum showed that 25-OH D was 18 nmol/] when 24,25 (OH)2 D had fallen to zero (p < 0.001). This suggests preferential use by the foetus of the latter, perhaps in the maturing skeleton. Department of Clinical Chemistry, and *I Department of Obstetrics and Gynecology, University of Helsinki, SF-00290 Helsinki 29, Finland

Centre de Radioanalyse, Institut Pasteur, 13-|5 rue Dome~ 69007 LYON (FRANCE)

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CORTISOL ~N SALIVA AND BLOOD. H. Wieler I and W. Hengst

BONE SCINTIGRAPHY AbD RADIOLOGY IN DYSBARIC OEFETNECROSIS. S .Khreisat ,E .S .WilliaE~ ,P.J.EII.

VALUE OF KNEE-SCAN TO RECOVER MENISCUS INOURIES. L . G a l u a k a , l . G r ~ c z y , E . D b m E t E r ,

Specific radioimmunoassays have permitted accurate measurement of variations in plasma hormonal levels over the 24-h-cycle. Free or unbound c o r t i s o l in plasma is the b i o l o g i c a l l y active form at the tissue and c e l l u l a r level. I t moves f r e e l y out of the bloodstream into tissue cells where i t acts. As there are not binding-proteins, the determination of cortisol levels in saliva seems to o f f e r a number of s i g n i f i c a n t advantages as compared with plasma or serum measurements, and radieimmunoassay is the technique of choice.

Dysbaric osteonecrosis is a chronic cc~plication which occurs with deep sea divers and individuals working under cc[~pressed air. Typical sites of bone necrosis include the ht~neral and fersDral beads, shaft of tibia and fibdia. 29 adult n~le divers (age25-58), were i~vestigated. A detailed x-ray survey and whole body bone scan (Tc-99m-NDP) was used to iccalise the disease. X-rays were reported by an exit rne~nber of the Medical Research C o ~ c i l Decompression Sickness Panel and by an expert physician in Nuclear F~dicibe in a blibd fashion.

Direct parallel determinations of c o r t i s o l in human saliva and blood were investigated by a solid phase RIA. The samples (102 male volunteers) were taken at 05.30, i0.00, 15.30 and 22.00 h.

Normal

Circadian patterns of cortisol in saliva and in blood were identical. On the other hand, a f t e r stimulation of saliva secretion (here: sucking a lemon) the saliva level of c o r t i s o l decreased and was s t a t i s t i c a l l y d i f f e r e n t from controls.

Scintigraph[ findings in divers Total 6

Definite lesion in com~Dnest site Suspected lesion in comrsonest site Abnormal lesion in other sites of skeleton Total

These findings suggest that c o r t i s o l can be measured d i r e c t l y from saliva and accurately r e f l e c t s serum unbound c o r t i s o l . The method is simple and accurate, but only when saliva is collected without secretory stimulation which may produce an a l t e r a t i o n of cortisol concentration. 11nstitute of Medicine, Nuclear Research Center JUlich GmbH, D-5170 O~lich, E.R. Germany 2Department of Nuclear Medicine, Bundeswehrzentralkrankenhaus, D-5400 Koblenz, F.R. Germany

% 20.69

8

27.6

5

17.24

~O

34.5

~

ICO%

Radiological findings in divers Total Normal 18

% 62.07

Definite head,neck & shaft lesions

7

24.14

Suspected head,neck g shaft lesicns

2

6.9

Definite Juxtaarticul~r lesions

1

3.45

Suspected Juxtaarticular lesions

1

3.45

29

100%

Total

Conclusion: Bone scintigraphy is the r0ethod of 6hoice in the detection of early dysbaric osteonecrosis. Institute of Nuclear Medicine, Middlesex Hospital Yedical School, London,U.K.

Traditional X - r a y examinations are i n sufficient and c o n t r a s t a r t h r o g r a p h y time and work consuming to d i a g n o s e meniscus i n j u r i e s of knees in orthope= dioso 43 p a t i e n t s were c o n t r o l l e d by arthrotomy to determine s p e c i f i c i t y and ~ e n e i t i v i t y of Gamma Kemera-made 9mTc-EDP k n e e - s c a n s . H o w t o separate method l o c a l meniscus i n j u r i e s from d i f f u s e e y n o v i t i s ? A n t e r i o r p i c t u r e of knees showed "point l i k e " a c c u m u l a t i o n between t i b i a l and femoral condyles i n t y p i c a l cases of meniscus l a e s i o n s . The l a t e r a l image showed " s t r i p like" a c t i v i t y accumulation at the i d e n t i c a l p l a c e . P i c t u r e s were analysed without k n o l e d g e of o t h e r c l i n i c a l r e s u l t s . T h e r e a l i t y of scans was c o n t r o l l e d a f t e r arthrotomy.There were 21 true p o s i t i v e and t 4 true n e g a t i v e , 5 f a l s e p o s i t i v e and 3 f a l s e negative eases. The s e n s i t i v i t y of method w a s 8 7 ~ a n d the s p e c i f i c i t y 73_%. The 5 f a l s e p o s i t i v e scans were caused by "corpus l i b e r u m " , " p l i c a e y n o v i a l i s " a n d circumscript synovitia.The 3 false negative scans were caused by previous i m m o b i l i z a t i o n of patients.The noninvaeive method i s u s e f u l to d i s c o v e r and docume~ meniscus i n j u r i e s of knees and i s v e r y h e l p f u l before i n v a s i v a r t h r o s e o p y to show " d y s f u n c t i o n a l a r e a s " of J o i n t .

I s o t o p d i a g n o e t i c a l Department of County H o s p i t a l B ~ c s - K i s k u n , 6 o o l Keeskem~t N y i r i u t 38 HUNGARY

A79 A476

A477

CONTRIBUtiON OF SCINTIGR~PEZ IN 2EFLEX SZI~ATHETIC DISTROPHY SYNDROME (RSDS). A.BOISDENGHIEN (x),Y.JACQUES(xx),J.ABR~OVID!(xx) IMC Ixelles(Rue Jean Paquot, 63-Br~ssels(Belgium) (x) Department of Surgery; (x~) Department of Radioisotopes.

SCZNTIMETRY OF T H E L A N G E A L J O I N T S . N.

The relative value of scintigraphy, radiography and thermography was assessed in 25 patients suspected of posttra~matic RSDS, examined to establish the diagnosis a~d the ~esponse of Calcitonine therapy. S£~u~n~'~_{c~nti~r~h~ (2 sec/frame) during g minutes following I.V. administration of 5mCi Tc-99m Nanoeolloid.

Static bone scans o~ both hands were obtained 2h~-aT~9-~nj~i~[in ........... of Tc-99m MDP and the relative uptake of the tracer in the affected and controlateral member was d~termined. RSDS was diagnosed on the basis of specifi~ clinical criteria, scintigraphy, radiography ~ d thermography findings. ~££~k~{ : Clinical diagnosis suggested RSDS in 80Z of the cases. Radiography findings were typical in 30Z, non-specific in 25~ and negative in 45Z. Thermography was pos~tip8 in only 35%. Radionuclid~ flow studies, considered positive when the blood flow was asymmetric, were indicative of RSDS in 95% of all cases. Positiv~ bone scans showing increased periartisular activity involving multiple joints of the affected h~nd were found in 55Z of the cases. In gSZ, the activity increase was non-speci~c. 10% were normal. All patients received 100 U Calcitonine I.M.per day during ?ire weeks and were ohecked scintigraphycally in the gd and 6th week ~ft~r the initiation of therapy. The vascular asy~etry decreased in p~rallel to the symptoms, but bone scans showed persistence of bone altemation. The results of our study show that the combined use of vascular and bone seintigraphy is the best approach for the diagnosis of RSDS and the prediction of its response to therapy.

A 479 Significance of B o n e Hip Endoprosthesis A.Lgw, stedt,

A.Hotze, F.Wolf

Scanning

D.Lauermann,

in T o t a l J.Mahl-

For evaluation of the 3 step bone imaging with Tc-99m-MDP in 96 p a t i e n t s (75 f e m a l e , 21 m a l e , m e a n a g e 6 5 . 7 y e a r s ) with total hip endoprosthesis a retrospective study was performed in o r d e r to c o m p a r e t h e h i s t o l o g i c or b i o p t i c results with scintigraphic findings, i.e. a r t e r i a l perfusion (A.P.). b l o o d pool (B.P.) a n d s t a t i c s c a n s (S.S.). A . P . , B.P. a n d S.S. w e r e c l a s s i f i e d as p o s i t i v e when there were significant differencesof the activity pattern in comparison to t h e c o n t r a l a t e r a l limb. 6 o f 14 c a s e s w i t h p r o v e d b o n e , j o i n t or soft tissue infection were positive in A . P . , B.N. a n d S.S. (439), 8 w e r e positive j u s t i n S.S. (57%). O f t h e 68 p a t i e n t s without infection but loosening 70 w e r e p o s i t i v e in S.S. (82%) b u t 16 p a t i e n t s had positive findings in a l l t h r e e p h a s e s (18%). The results show that increased MDP accumulation c a n b e f o u n d in i n f e c t i o n and loosening, however positive A.P. a n d B.P. a r e s l i g h t l y m o r e f r e q u e n t in p r o v e d i n f e c t i o n t h a n in l o o s e n i n g . Thus arterial hyperperfusion and increased blood pool may not be misinterpreted as s p e c i f i c parameters for infection, although u s e f u l to e v a l u a t e the severity of i n f e c t i o n or loosening. A negative static scan can exclude inflammation as w e l l as l o o s e n i n g . Inst. Nucl.Med. Unviversity of H r l a n g e n - N ~ r n b e r g Krankenhausstr. 12 D-8520 Erlangen (West Germany)

A478 PROXIMAL INTERPHAO l s e n a n d P. H a l b e r g .

In a d o u b l e b l i n d s t u d y 36 p a t i e n t s with classical rheumatoid arthritis were investigated before and after medical treatment.Nine patients got levamisol (L),I2 penicillamine (P) a n d 15 a z a t h i o prine {I).99m-Tc-Sn-pyrophosphate scintigraphy of b o t h h a n d s w a s o b t a i n e d by the use of a gamma camera equipped with a parallelhole collimator.Regions of i n t e r e s t w e r e p l a c e d o v e r t h e p r o x i mal interphalageal joints (PIP) a n d t h e proximal phalanges.An index was estimat e d as t h e s u m of t h e 8 r a t i o e s b e t w e e n PIP-activity and phalanx-activity (SD = 4%).Before treatment the patients had a h i g h e r i n d e x t h a n io c o n t r o l s w i t h o u t clinical affections of t h e i r j o i n t s (p< o.ol).After 8 m o n t h s of t r e a t m e n t t h e Pand I-group had a decrease in index,numb e r of c l i n i c a l affected PIP and the total PIP-circumference (p< o . o 5 ) . T h e rat i o of a s i n g l e P I P w a s in P I P w i t h o n ly t e n d e r n e s s h i g h e r t h a n in n o r m a l P i P and smaller t h a n in P I P w i t h s w e l l i n g (p< o . o e 5 ) . C l i n i c a l changes in P I P f r o m swelling to o n l y t e n d e r n e s s or n o r m a l caused a reduced isotop-ratio (p< o . o e l ) The scintimetric method seems valuable to e s t i m a t e affected P I P a n d e f f e c t s of treatment. Department of C l i n i c a l Physiology,Hvidovre Hospital,DX-265o Hvidovre,Denmark.

PARTIAL GROWTH PLATE CLOSURE: APEX VIEW ON BONE SCAN. R.Howman-Giles.,M.Trochei and K. Yeates. Angular deformities of the extremities in children following partial premature closure of the growth plate are well known. The deformities depend on the position of an osseus bridge or fibrous scar which forms between the epiphysis and metaphysis. Several surgical procedures incl~diDg resection of the osseus bridge have been described, however delineation of the site of fusion is difficult to define. The eormnonest site of growth plate arrest is the distal femoral or proximal tibial growth plate. A new technique using the bone scan has been developed which accurately defines the area and position of these ossens bridges or scars. Two hours after injection of technetium 99m methylene diphosphonate apex views of the affected distal femoral growth plate were performed. The knee was flexed into its smallest angle. Using a pinhole collimator the gamma camera was angled at 90 ~ to the affected growth plate plane. The image was collected onto computer and analysed by: (i) regions of interest over segments of the growth plate to calculate the relative area of total growth plate affected; (it) generating histograms; (iii) thresholding or performing isocontours to accentuate abnor~&l areas. The growth plate is normally uniformly increased when compared to the normal shaft of the bone. With a uniformity variation of less than 15%, fusion across the plate appears as an area of diminished uptake. The apex view gives a unique functional map of the gro~cth plate such that abnormal areas are displayed, and the site, size and position of osseus fusion obtained. The technique has the potential for determining the metabolic activity of the growth plate before and after surgery. Serial studies will allow assessment of regeneration of the plate and reformation of new osseus bridges or fibrous scars. Department of Nuclear Medicine, Royal Alexandra Hospital for Children, P.O. Box 34, CAMPERDOWN. N.S.W. AUSTRALIA. 2050.

A480

A481

TL-2Ol TOTAL BODY SCINTIGRAPHY IN POSTOPERATIVE FOLLOW UP OF THYROID CARCINOMA C.A. Hoefnagel, C.C. Delprat, H.R. Marcuse

20J-T1 SCINTIGRAPHY FOR DETECTION OF THYROID CANCER METASTASES.D.A. Piers, N.J. SEtter, A. Vermey and H. Doorenbos.

T I - 2 0 1 - s c i n t i g r a p h y has been reported to be usef u l in the detection of metastases from thyroid carcinoma a f t e r thyroidectomy. To evalmate the r e l i a b i l i t y of t h i s procedure T1-201 t o t a l body scintigraphy was performed in 218 p a t i e n t s , a f t e r t o t a l thyroidectomy f o r h i s t o l o g i c a l l y proven thyroid carcinoma. Results were correlated with 1-131 scintigraphy and tumormarker levels(Tbg or Calcitonin/CEA). TI-201 scintigraphy c o r r e c t l y demonstrated tumor l o c a l i z a t i o n s in 16 of 19 patients with 1-131p o s i t i v e metastases. In 4 cases the T I - 2 0 1 - s c i n tigram and in 4 other cases the 1-131-scintigram showed more l o c a l i z a t i o n s . T]-201 t o t a l body scintigraphy was negative in 150 patients with no evidence of disease,however 9 of these patients had elevated tumormarker l e vels. In 26 patients TI-201 t o t a l body scintigraphy revealed metastases which did not concentrate 1-131. In 16 of these patients only tumormarkers indicated disease. M~tastases have sofar been confirmed in 16 p a t i e n t s . 7 of 13 patients with medullary thyroid carcinoma had elevated levels of Calcitonin and/or CEA. In 5 of these patients metastases were l o c a l i z e d by means of T I - 2 O l - s c i n t i g r a p h y , Comparison of Tl-201, 1-131 and tumormarkers showed that none of these parameters alone i s completely r e l i a b l e in f o l l o w up of thyroid carcinoma. However the combination of a negative TI-201-scintigram with a negative tumormarker was never associated with disease in our series. I t is concluded t h a t : I ) TI-2Ol t o t a l body scintigraphy is a useful parameter in postoperative thyroid carcinoma, especially when a discrepancy of the other parameters e x i s t s ; 2) T I - 2 O l - s c i n tigraphy is of p a r t i c u l a r use in medullary thyroid carcinoma; 3) in f o l l o w up of patients who are unsuspected o f disease a f t e r suceesful therapy f o r thyroid carcinoma one can r e l y on T1201 t o t a l body scintigraphy when tumormarker l e vels are low or undetectable.

In papillary and follicular carcinoma of the thyroid gland scintigraphy with 13]-I and thyreoglohulin (TG) measurements in plasma are unique tools for the detection of recurrence or metastases. Recently the uptake of 20J-T1 in thyroid cancer has been reported as a complementary scintigraphic technique. He did a comparative study of these three diagnostic tests (seintigraphy with 13]-I, measurement of TG and scintigraphy with 201-TI) (n=71) in 60 patients with papillary or follicular carcinoma. This was a selected group of patients with suspicion of recurrence or metastases (elevated TG or suspicious mass) after total thyroidectomy and 131-I ablation therapy. Total body scintigraphy using ]31-I was performed 2 weeks after T-3 withdrawal. 20J-T1 scintlgraphy was done (one day before 131-I scintigraphy) ~0-50 min. after i.v. injection of 30-70 MEg 20[-TICI. TG was measured using a radioin~uunoassay (upper limit of normal : 60 ng/ml off T-3). A total of 31 positive 20]-TI scans were obtained. In ]7 of these 31 cases the 13]-I scan was positive ~nd PG levels varied from ]]0 to 9600 ng/ml (mean 3000 ng/ml). In 14 of the 3] positive 2OI-TI scans a negative 131-I scan was found; in these cases TG varied from 35 to 1000 ng/ml (mean 310 ng/ml). In the patients with a negative 20]-TI scan (n=40), five 131-1 scans were positive. TG in this group ranged from 30-380 ng/ml (mean 110 ng/ml). In 13 patients the finding of a positive 20]-TI scan was crucial for the localization of the metastases. We conclude that 201-TI seintigraphy cannot replace scanning with ]3]-1, but it can be of great help in case of a high TG level or other indication of recurrence when scintigraphy with 13]-1 is negative or cannot be performed because of the risk of temporary T-3 withdrawal.

Dept. of Nuclear Medicine, Netherlands Cancer I n s t i t u t e , Plesmanlaan 121, 1066 CX Amsterdam.

Department of Nuclear Medicine and Internal Medicine, Division of Endocrinology, University Hospital, Groningen, The Netherlands.

A80 A482

A483

A 484

PRELIMINARY RESULTS USING LITHIUM CARBON A T E AS A N A D J U V A N T WHEN STUDYING 1-131 U P T A K E BY M E T A S T A S E S OF W E L L - D I F F E R E N T I ATED THYROID CARCINOMA. F . P o n s P u n s , I. Carrid Gasser, M.Estorch Cabrera.

DIAGNOSTIC VALUE OF CARBOHYDRATANTIGEN (CA19-9)

CLINICAL INTEREST OF A SINGLE OR SIMULTANEOUS

ASSAY. CORRELATION WITH OTHER TUMOR MARKERS. G. EMAUJON, M. DOLY, Ph. CHOLLET, G. GAILLARD. The carbohydrat antigen is a glycolipid secreted by tumor cells. Its serum concentration is evaluated by immunoradiometric assay using a monoclonal antibody called 1116 NS 19-9. This work relates the diagnostic and pronostic facilities of CA 19-9 assay in various types of cancer. Assays have been performed using ORZS-kit and referring to an international standard. Normal values are estimated within 0-25 U/ml (n = 250). We only report about tumors for which CA 19-9 assay presented an interest compared to CEA and AFP. Tumors of the digestive tract :(i) Pani[~aEideni~ai~in39_a (n = 15) : very high values have been found mostly appearing (80 %)when only 60 % of C E A a n d 26 % of AFP rates were found abnormals, the CA 19-9 blood concentration increase being related to the extension, local or not, of the tumor. (ii) ~ l ~ rectal adenocarcinoma without metastases (n = 15): ............................................... 54 % of CA 19-9 rates are high as well as 60 % of CEA ones whereas 7 % of AFP values are pathological. (iii) Colorectal carcinoma with local recurrences

DETERMINATION OF CEA, TPA, CAIg.S AND CAI2S IN PATIENTS WITH CANCER. A. Ruibal, G. Encabo, E. M.Miralles, A. Lafuerzap R. Bodi and F.M. Domeneeh-Torn~

Nine metastatic l e s i o n s in t h r e e p a tients with well differentiated thyroid carcinoma (i c e r e b r a l , i hepatic, i pulmonary, 5 osseous, l abdominal) have been studied. Differences in the 1 - 1 3 1 pattern of u p t a k e in e a c h l e s i o n , p r i o r to a n d a f t e r a t r e a t m e n t with Lithium Carbonate have been observed. After oral administration of 1 - 1 3 1 (74 M H q ) , e a c h patient underwent w h o l e b o d y s c a n s at 24, 48 a n d 168 h o u r s ; for the n e x t seven d a y s , 4 0 0 - 5 0 0 m s / d a y of L i t h i u m C a r bonate were administered a n d the e x a m i nations repeated w i t h the s a m e p r o t o c o l . TSH values were always higher than 60 m U / 1 . Comparing the v a l u e s of 1 - 1 3 1 u p t a k e at 24 a n d 48 h o u r s p r i o r to a n d a f t e r Lithium administration no d e f i n e d p a t tern has been found, hut after Lithium t h e r a p y the v a l u e s of 1 - 1 3 1 u p t a k e at 168 h o u r s h a v e b e e n m u l t i p l i e d by a f a c t o r of 2,5 in the f i r s t p a t i e n t (six lesions), by a f a c t o r of 4 in the s e c ond patient (one l e s i o n ) a n d by a f a c tor o f 2 in the t h i r d p a t i e n t (two lesions). Our results show longer 1-131 biological h a l f - l i f e after Lithium t h e r a p y in the m e t a s t a s e s studied. We h a v e o b s e r v ed t h a t v a l u e s of u p t a k e at 168 h o u r s were enhanced by a d i f f e r e n t factor dep e n d i n g o n the p a t i e n t , b u t we h a v e n o t found any relationship with anatomic localization of the m e t a s t a s e s studied. Servicio de M e d i c i n e Nuclear, Hospital de S a n P a b l o . A v d a . P a d r e C l a r e t n ° 167 Barcelona 25, S p a i n .

values are high whereas only 64 % of CA 19-9 rates are abnormals. Gynaecological tumors :(i) O[ar~an t_um_ors :They are the best indication for CA 19-9 assay. If no metastase have been encountered (n = 75), 80 % of CA 19-9 values are high whereas only 3 1 % of CEA results are abnormals. In liver metastases cases (n = 20), these positive rates respectively increase up to 85 % for CAl9-9 and 50 % for CEA. With non hepatic metastases (n = iO), frequencies of pathological values are 7O % for CA 19-9 and 40 % for CEA. When regrouping these three classes, AFP is subnormal in 60 % of the cases. (iii) u~E~t_u/nsEs_(3_Zj53 : CA 19-9 and CEA rates both are pathological with a frequency of 53 % . C A 1 9 - 9 turns positive prior to C E A o r to the first clinical symptoms apparition. Radioimmunometric CA 19-9 assay displays a better diagnostic power than CEA and AFP in pancreatic cancers and ovarian tumors. For the follow-up of colorectal adenocarcinoma extension, CA 19-9 and CEA are complementary to each other. In fact high CA I9-9 rates are not systematically related to high CEA rates especially without metastases. In most cases, CA19-9 increase preceeds that of CEA. Laboratoire Isotopes, CJP, F-63OOO Clermont-Fd.

A486

TUMOUR MARKERS IN SERUM OF PATIENTS WITH RENAL, PROSTATIC, A N D TESTICULAR TUMOURS. W. Wagner, D. Glaubitt, and C. G~dde

BRAIN TOMOSCINTIGRAPHY PROPYL IODO AMPHETAMINE REVERSIBLE ISCHEMIA.

After new tumour markers in serum had been introduced the question arose whether also patients with turnouts of the urinary tract would benefit from this development. We assessed the clinical value of a series of tumour markers in the serum of 79 patients who had a carcinoma of the kidney, prostatic gland, or testis. During follow-up of 18 patients with renal carcinoma, 30 with prostatic carcinoma, and 31 with testicular carcinoma, the serum level of ferritin, prolactin, 13-HCG, CEA, CA 12-5, CA 19-9, TPA, AFP, and, as a supplement in the patients with prostatic carcinoma, prostatic acid phosphatase was measured by radiolmmunoassay. Among the patients who suffered from renal carcinoma, serum ferdtin had increased in 16, prolactin in 8, TPA in 7, CA 12-5 in 3, AFP in 2, and CEA in one whereas prolactin was reduced in 2 patients. In the patients with prostatic carcinoma, serum TPA was elevated in 22, prolactln in 21, ferritin in 16, CEA in I0, AFP and 8-HCG each in one man; serum prolactin had decreased in one patient. Among the patients who had testlcular carcinoma, serum prolactin was raTsed in all men, TPA and ferritin each in 24, B-HCG in 16, CEA in 13, and AFP in 9. Serum CA 19-9 had not risen in any patient. The follow-up of the patients demonstrated that the most su~tabJe tumour markers in serum were ferritin, prolactln, and TPA in patients with renal carcinoma and those with prostatic carcinoma whereas in addition CEA and AFP should be determined ~n patients with cancer of the testis. In conclusion, radiolmmunoassay of lumour markers in serum of patients with renal, prostatic, or testicu[ar carcinoma promotes cancer control in order to assist in the early detection of turnout growth, recurrence, or metastases.

J.L. J.P.

Department of Nuclear Medicfne, Academic Teaching Hospital, and Department of Urology, St.-JosefsHospltal Uerdlngen, D-4150 Krefeld, Federal Republic of Germany

CA19.S and CA125 i n 1594 patients with cancer. The top values taken as clinical application cut-off levels were 1O ng/ml, 200 U/l, 37 U/ml and 35 U/ml respectively. Our oonelussions were the following: I)C~_0-qECT~_ CARCINOMAS: the percentages of positive values were $5, 6? and 45 ~ respectively for TPA, CEA and CAlS.S;the percentages increased with the simultaneous de termination only in disseminated tumors :10O

(CE~TPA-CA1S.S). 2) GASTRIC TUMORS: p o s i t i v e percentages were 45~34 and 35 ~ f a r TPA, CEA and CAIS.S r e s p e c f i v e l y . I t was nat a clear s i g n i f i c a n t increase with the simultaneous determination TUMORS: tastases positive

of the th . . . . . rkers [6S ~). 3) LIVER In primary liver cancer and liver me-

CAllS showed a great usefullness with percentages oscillatin G between $3 and ?2 ~ .d] PANCREASTUMORS: the best marker was CAIS.S (Sl ~ +); it shown better results than SEA and TPA in making the differential diagnosis with chronic pancreatitis mither or not in the acute phase of disease. S) OVARIANCAN-

CER: the mosf u s e f u l l mmrker was CAllS i n nonmutinous tumors; it was a correlation with cl~

n i c a l stage (OR, 2 . ~ ; PR: 31~; A: 84~) mnd ~) BREAST AND LUNS TUMORS: TPA was the most u s s f u l l s p e c i a l l y i n the follow-up with the s~ multaneous determinmtion of CEA. Repeated increased values over 200 U/1 o f TPA were c o r r e lated with the progression of disease in 74 of the patients. NUCLEAR MEDICINE SERVICE [TUMOR MARKERS UNIT). CIUDAD SANITARIA VALLE DE HFRRON. BARCELONA 3S SPAIN.

A487

A485

W I T H I 123 I S O (I 1 2 3 AMP) IN

MORETTI, P. C E S A R O , NGUYEN, J.D. D E G O S ,

D~partement C H U Henri

In order to find its clinical interest~ we determined the s e r i o coneentrmtions o f CEA,TPA~

A. S E R G E N T , J.P. C A R O N .

de N e u r o s c i e n c e s Clinique Mondor, Paris France.

I 123 A M P w a s e m p l o y e d to s t u d y 20 p a tients, IO w i t h p r o l o n g e d reversible ischemic neurological deficit (PRIND) a n d IO w i t h t r a n s i e n t ischemic attack (TIA). T h e i0 p a t i e n t s with PRIND were 9 males (mean a g e : 61.5) a n d 1 f e m a l e (age 59) a n d t h e iO T I A c o m p r i s e d 8 males (mean a g e : 59.2) a n d 2 f e m a l e s (mean a g e 5 7 . 5 ) . 6 to 7 m C i o f I 1 2 3 A M P (Cis France) were injected intravenously (eyes c l o s e d a n d e a r s p l u g g e d ) . Imaging was performed with a rotating gamma camera (C.G.R.) f r o m 20 to 60 m i n . a f t e r injection. CT was performed o n 18 o f these patients and was normal 9 times u p o n 9 i n T I A , 2 t i m e s u p o n 9 in P R I N D . In t h i s l a t e c a t e g o r y , 4 had capsular l a c u n a e a n d 3, c o r t i c a l hypodensities. I 123 AMP was always abnormal with hypoactivities in r e l a t i o n with neurological pathologies. Controlateral cerebellar d i a s c h i s i s was found 4 times in PRIND patients and never observed in TIA patients. These patients with CT cortical hypodensities d u e to s t r o k e s demonstrated much larger hypoactive areas on tomoscintigraphy, together with other pathologic areas undetected by CT. T o m o s c i n t i g r a p h y p r o v e d to b e a good non invasive diagnostic method to i) a s s e s s i s c h e m i c disease,2)delineate with accuracy suffering parenchymal areas and define the affected arterial territory, 3) g u i d e c o m p l e m e n t a r y arteriographic exploration in view of surgical endarteriectomy or external internal bypass, 4) f o l l o w e f f i c i e n c y of drug therapy.

INITIAL EXPERIENCE WITH 1-123 ISOPROPYL A ~ H E TAMINE CEREBRAL STUDIES - A COMPARISON WITH 99m-To PERTECHNETATE BRAIN SCAN, X-RAY CT AND NMR CT. P.F. Sharp, H.G. G e ~ e l l , N. Evans, J.R. Mallard, D. Lyall, A.P. MacDonald, T. Hope and F.W. Smith. The distribution of 1-123 labelled isopropyl amphetamine has been shown to reflect cerebral perfusion. This study set out to compare amphetamine images with those from X-ray CT and NMR for a range of cerebral pathologies. To date 27 studies have been carried out; 15 on patients suspected of having vascular disease, 8 on patients with tumours and 4 on normal subjects. All radionuclide studies were carried out with a rotating tomographic camera and a high sensitivity tomographic scanner. Patients also had an NMR CT study and an X-ray CT scan within 24 hours of the radionuclide investigation. The 8 patients with tumours had, in addition, a conventional 99m-To pertechnetate brain scan. All 8 tumour patients showed no uptake of amphetamine over the tumour site and in two of these the 99m-To pertechnetate study was negative. In patients with old infarcts, of greater than 2 months duration there was good correlation with the X-ray and NMR images. More recent infarcts appear larger than on the other modalities probably due to the amphetamine study showing the surrounding isehaemic areas. Reproducibility of the technique has also been studied, in particular the effect of different physiological stimuli at the time of injection. Department of Bio-Medical Physics and BioEngineering, University of Aberdeen, Foresterhill, Aberdeen, AB9 2ZD, Scotland.

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MAPPZNG OF CEREBRAL PERFUSIOB WITH SPECT USING 123-I-AMPHETAMINE IN PRE AND POSTOPERATIVE STUDIES

CORTICAL P E R F U S I O N ASSESSMENT WITH ISOPROPYL I-i23 AMPHETAMINE (I-123 AMP) IN NORMAL PRESSURE HYDROCEPHALUS (NPH)

T. Chen, H.M. Mehdorn, K. Balzer, H.-J. Macbulla, J. Knust

3.L. MORETTI, A. SERGENT, F. LOUARN, G. RANCUREL, M. LE PERCQ, R.FLAVIGNY~ 3.D. DEGOS, 3.P. CARON - Oepartement de Neurosciences Ciiniques, CHU H. Mondor, CHU PITIE, France.

VALUE OF SPECT WITH 123 IAMP IN PARTIAL EPILEPSY. S. Askienazy, D. Chauvel, E. Sanabria, A. Dilouya, J.F. Meder, M. Michalski, J.P. Chodkiewicz.

Comparative studies have shown that SPECT 123-I-AMPHETAMINE IAMP) imaging of the brain show perfusion defects more distinctly than X-Ray Computer Tomography. The aim of our study was to establish the clinical value of this method in the follow-up of patients wi~h cerebro-vascular disease after therapy. Patients: 74 with cerebro-vascular disease, 21'before and after surgery. Method: 5 mCi 123-I-AMP i,v. SPECT was started after 3o min. using a rotating gammacamer (G.E. 4ooTl. Results: The tomographie clices show a marked 123-I-AMP accumulation in the grey watter and lower activity in the white matter. Activity in the cerebellum could also be detected. There are typicalpatterns of perfusion defects which correlate to the occluded cerebral arteries. The lesions were usually more pronounced in SPBCT then in CT. Besides showing areas of major infarction seen on CT scaus, SPECT is able to detect the areas of borderline perfusion between different vascular territories. The defects correlated closely to the neurological symptoms. After surgical intervention a better accumulation in the corresponding hemisphere could be registered in the majority of cases. Patients with extra-intra-craniel bypass show local hyperaemia at the site of the anastomosis. We conclude that 123-I-AMP gPECT of the brain is a promising noninvasive method for the follow-up and therapy control of patients with cerebro-vascular disease. Nuklearmedizinische Abteilung, St. Josef-Hospital 0berhausen Neurochirurgisohe Klinik und Institut fdr Med. Strahlenphysik u. Strahleubiologie, Universit~ts-Klinikum gssen Chirurgische glinik gvangelisches Krankenhaus M~lheim

The clinical NPH features usually comprise a disorder of stance and gait, urinary urgency and i n c o n t i n e n c e and intellectual disorders, abulia or psychomotor retardation. In the past years many authors have a t t e m p t e d to define reliable criteria to select patients who might benefit f r o m C S F shunting, Cisternography, showing persistent ventricular reflux, impaired conductance outflow of C.S.F. and, CT demonstrating enlarged ventricles and CSF migration through the wails, were unreliable criteria to predict outcome after shunting. We applied 1-123 IMP tomoscintigraphy to 17 patients (10 females mean age: 70.1, 7 males m e a n age: 6#.5) with suspected NPH. 6 to 7 mCi of 1-123 IMP (CIS France) were injected intravenously (eyes closed and ears plugged) before and after CSF lumbar withdrawal (10 to 60 co). Imaging was performed with a rotating g a m m a camera (CGR) from 20 to 60 rain a f t e r injection. Like MATHEW and GRUB8, our results demonstrated that frontal and frontoparietal regions were affected to a greater extent along with a decrease in basal ganglia activity. After CSF drainage, cortical perfusion was improved on g patients with a good correlation (7/g) with clinical criteria (mental disorders assessed by psychometric tests, gait disturbance and urinary incontinence); the correlation was poor with CT findings except perlventricutar lueency. 9 patients were shunted, one recently, 7 patients upon S were cEnicaliy improved after CSF permanent shunting, had a concomittent improvement of cortical perfusion after CSE drainage test and was a better criterion than clinical appreciation of this drainage, Assessment of regional perfusion with 1-123 IMP before and after CSF drainage may provide objective information concerning the suitability of NPH patients for CSF shunting.

A comparison between 123N-IAMP SPECT and CT was done in 51 patients with severe partial epilepsy. The exact lesional t e r r i t o r i e s were Iocalised by : conventional neuro radiological techniques (carotid angiogram and ventriculography in stereotactic conditions) E.E.G, precise localisation of the epileptic loci were obtained with stereo- £.E.G. (S.E.E.G.). Spect started 30 mn after injection of IAMP. Results were interpreted by a j o i n t Lecture

between

the

neurologist

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the

nuclear

physician. ALL SPECT were performed during interictal phase. AI[ lesions seen on SPECT

had a Lower uptake tha~ the surrounding t e r r i t o r i e s and appeared much larger than with CT. 31 patients had a very clear lesion on SPECT with a very close correlation with electrical and clinical findings (performed during ictal periods). 6 patients had a normal CT, 2 had a first CT considered as normal, and positive afterwards.ln one case Spect was positive, CT negative, but the E.E.G. findings did not correlate topographically with Spect. 10 patients had an uninterpreteble Spect, due to the very Low cerebral uptake. This Low uptake might be due to therapeutic interference, though no precise correlation could be found up to now. IAMP Spect appears to be a powerfull tool for detecting lesional t e r r i t o r i e s of epileptic loci in f n t e r i c t a I phases. A very good correlation between S.E.E.G. and IAMP local i s a t i o n is found. This technique is now being integrated as a new tool to the diagnostic of p a r t i a l epilepsy

Service de Medecine Nucleaire Neurochirurgie, Hopita[ Ste Cabanis, 75014 Paris, France

et Service de Anne, I rue

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111IN-PLATELET SCINTIGRAPHY IN S T R O K E PATIENTS WITH NORMAL ANGIOGRAM H. H e n n i n g s e n , Oh. K e s s l e r , R. R e u t h e r , B. K i m m i g a n d M. R S s c h .

AUTOLOGOUS WBC IN III- 0XINE SCANNING~BESOLTS ON CELLS SEPAEATION AND LABELING; SENSIBILITY AND SPECIFICITY OF THE TECHNIQUE. G.F. Camuzzini, M.G.Aragno, A.L.Viglietti, L.Quaranta, M.Medina.

DIAGNOSIS OF INTRAABDOMINALABSCESS WITH IaZlNDIUM LABELLED AUTOLOGOUSGRANULOCYTES - - A RELIABLE METHOD WITH CERTAIN DRAWBACKS. T. Svenberg, S. yon Krusenstierna, A.-M. Bengtsson and S.A. Larsson

In a b o u t o n e t h i r d o f T I A or s t r o k e pat i e n t s t h e a n g i o g r a p h y is n o r m a l o r shows only slight atherosclerotic lesions. N e v e r t h e l e s s , in t h e s e p a t i e n t s t h e l o n g t e r m p r o g n o s i s is as b a d as for p a t i e n t s w i t h c a r o t i d d i s e a s e . S c i n tigraphy with Indium-t11 labeled platelets p r o v e d t o b e a n e f f e c t i v e m e t h o d in d e t e c t i n g m u r a l t h r o m b i in t h e n e c k v e s s e l s , w h i c h m a y b e t h e s o u r c e of arterio-arterial emboli. We performed platelet scintigraphy in 42 p a t i e n t s (29 TIA, 13 c o m p l e t e d s t r o k e ) w h o s e angiography was normal or showed only diffuz~ atherosclercsis without ev!gence of o c c l u s i o n , s t e n o s i s o r u l c e r a t i o n . In 29 o f t h e 42 p a t i e n t s (69%) o u r results showed pathological platelet accumulations on the side clinically affected. After other possible causes of c e r e b r a l i s c h e m i a e.g. c a r d i a c e m b o l i or hypetensive crisis had been excluded, the pathological platelet deposits p r o v e d to b e t h e c a u s e of t h e a t t a c k s .

Departments of Neurology and Radiology of the Ruprecht-Karls-University Heidelberg, 6 9 0 0 H e i d e l b e r q , V o s s Str. Federal Republic of Germany

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46 examinations in 43 subjects, 20 of them M and 23 F a2ed from 3 to 82 years have been performed. 8 presented fever of unknown origin,19 suspected intraabdominal abscess (15 of which had bad recent abdominal surgery),12 suspected brain abscess,7 patients were referred with other loeali zations. ~/BC were separated by sedimentation addin 2 to SO ml of venous peripheral blood, in a sterile tube, 5 ml of AiD and 1,2 ml of 2% methyleellulose in saline.The leuEoeyte-rich-pla sma was transferred in a second tube and centrifuged st i00 G for 5'.The supernatant was removed and the pellet resuspended in 1 ml of PBS. An average count of 9,41 x 104 WBC/mm S was obtained in the final suspension and the number of administred WBC was nec~rly 0,85 x 108, with approximately 87~ neutrophils. Final suspensionWBC/venous peripheral blood-WBC ~atio was 10,05 (12,22 for the neutrophilic 2ranulocytes). The average number of platelets and RBC was respectively 3,58 x I08 and S,32 x 108(less than 4 RBC per WBC).To this suspension 750 pCi-l,2 mCi (27,75 - 44,40 MBq) of Inlll-0xin e (gmersham) were added. Granulocyte labeling efficiency rangod from 52 to 100% (average 77%).Images were obtained at 6 ~ d 24 hours after administration of approxlmatelm 800 ~Ci (29,6 MBq) In 111-OxineAutologous WBC (adult dose).Results:lO true posltive, 92 true negative, 2 false positive and 1 false negative, with a sensibility of 91%, a spe eifioity of 94% ~ d an accuracy of 93%.Confirmalion of the diagnosis was obtained by operation, autopsy and clinical course.

Nuclear Medicine Service, Ospedale "S.Croce", Cuneo, Italy.-

Postoperative fever i s common a f t e r abdominal operations, often associated with c l i n i c a l signs of intraabdominal or wound abscess. Some patients require a d d i t i o n a l surgery f o r abscess drainage. Others recover without surgical i n t e r vention as t h e i r inflammatory process, presumably of non-abscess nature, i s cured by a n t i b i o t i c s mr resolves spontaneously. The o b j e c t i v e of t h i s study was to find out whether z111n granulocyte scintigraphy could d i s t i n g u i s h between these two p a t i e n t groups, Methods. ZZZln-oxinate autologous granulocytes, p u r i f i e d by means o f density gradient c e n t r i f u gation were used and scans obtained 3-24 hours a f t e r t h e i r r e i n j e c t i o n . 22 patients with f e v e r and c l i n i c a l signs of abscess were investigated with SPECT and/or planar views. Results. 14 patients had to be operated f o r abscess drainage. In 13 of these, the scan corr e c t l y outlined the abscess before surgery. In one p a t i e n t , the scan was negative, operation was performed because ultrasonography had shown a Douglas abscess. At operation, however, a s t e r i l e hematoma was found. 8 patients recovered without surgery. In 7 o f these, scan was negat i v e . One revealed a s l i g h t accumulation in the upper l e f t part of the abdomen after splenectomy. This might have been a small abscess or an accessory spleen. Conclusion. zZIIn granulocyte scintigraphy thus ~ e l i a b l ~ e p i c t s postoperative intraabdominal abscesses that need to be operated. However, due to the comparably high radiation dose from zZiIn, repeated examinations should be avoided, especially on young patients. In addition, iZZln is presently available at our hospital only once a week and t h i s l i m i t s i t s usefulness in acute situations, such as in the diagnosis of abscesses. Department of Surgery, Karolinska Hospital, P.O. Box 60500, S-I04 Ol STOCKHOLM

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Ill-INDIUM LABELLED AUTOLOGDUSLEUCOCYTESIN DIAGNOSIS OF INFLAMMATORYBOWEL DISEASE. J.Trap-Jensen,C.J.Edeling,J.O.Lund,O.Bonnevie, H,Haxholdt,H.C.Jensen,P,Matzen,P.S.Myschetsky, A.M.Mielsen,S.S.Poulsen & d.H.Wandall.

INDIUM-Ill LABELLED LEUCOCYTES IN THE DIAGNOSIS OF BRAIN ABSCESSES. J. Brismar, S. Holt&s and S- Rhencrona

Ill-INDIUM LABELLED PLATELETS IN THROMBOPENIC PURRURA : SURVIVAL AND IN VIVO DISTRIBUTION STUDIED WITH A SCINTILLATION CAMERA. A Meisan, JY Herry, L Le Cloirec, C Ohandour, PY Le Pris~

Leucocytes labelled with l l l - l n d i u m have been used to visualize inflammatory lesions in ulcer a t i v e c o l i t i s (UC) and in Crohn's disease (CD). The aim of this study was to compare findings by scintigraphy, radiology and endoscopy in patients with s l i g h t l y or moderately active d i sease. Material: UC: Twelve patients (median age 36 yrs ~ w e Y e studied. All were non-febrile, 8 recieved sulphasalazine,none steroids. CD: F i f teen patients (median age 46 yrs.F/M:7P3Ywere studied. A11 were non-febrile, two recieved prednisolone 5 mg/daily, 8 sulphasalazine. Methods: Leucocytes were labelled with l l l - l n Oxine (0.15-0.67 mCi) and given i . v . Scintigrams were obtained 3 and 24 hrs. p . i . Double contrast x-ray studies of the colon and small intestine were done a f t e r 2 and 14 days respectively. Colonoscopy with multiple biopsy was done a f t e r 4 days. Results: Active lesions were found in 24 of 27 patients. Location and extension of the lesions were in some cases masked of the intreluminal a c t i v i t y on scintigrams ~4 hrs. p . i . Excretion in the stools were 2.4-25.8% of administered a c t i v i t y , Compared with scintigraphy a corresponding extension and location was found with colonoscopy. In 4 patients with UC x-ray of the colon was normal but scintigraphy and colonoscopy showed active inflammation. Conclusion: Scintigraphy after injection of I l l - I n labelled leucocytes is an atraumatic method f o r v i s u a l i z a t i o n of inflammatory lesions in UC and CD. The location and extension of i n flammatory lesions can be visualized and the method appears more sensitive than conventional x-ray studies. Depts. of Clinical Physiology, Int.Med.B & Radiology, Frederiksberg Hospital ,DK-2000 and I n s t . of Anatomy g, University of Copenhagen, Denmark.

Computed transmission tomogrsphy (CT) has greatly facilitated the diagnosis and localization of brain abscesses and has thus contributed to an improved prognosis in dlis severe condition. The differential diagnosis between brain tumor and brain abscess is, however, not seldom difficult. Scintigraphy with indium labelled autologous leucocytes has proven to be a valuable technique for the demonstration of intraabdominal abscesses. This stwdywas undertaken to evaluate whether this technique could also be used to diagnose brain abscesses and to differentiate between tumor and abscess. Technique. Following cell separation, the leucocytes were incubated with indium-Ill oxinate (10-20 ~mq] and then reinjected intravenously. Detection was performed in 3=5 projections after 24 and 48 hours using a gamma camera with medium energy collimator. Results. 16 patients have so far been examined - all with clinical and CT findings compatible wzth both brain tumor and brain abscess. In 4/5 patients with the final diagnosis of brain abscess leucocyte scintigraphydemonstratedmarkedly increased activity corresponding to the lesion detected by CT - in the fourth patient a small central lesion could not be demonstrated. This patient i~ad, however, been successfully treated with antibiotics for 8 days. In I0/II patients with the final diagnosis of a malignant brain tumor, leucocyte scintigraphy was negative, in one patient with a large superficial malignant tumor with extensive meningeal engagement, activity corresponding to the ttuaor was, however, seen. This gives an overall accuracy of 14/16 (88%). Leucocyte scintigraphy thus has an important role in the differential diagnosis between brain tumor and brain abscess. Department of Diagnostic Radiology, University Hospital, S-221 85 Lund, Sweden

The kinetics of 111-In oxine labelled platelets were studied in thrombopenic purpura. The advantage of 111-1n over 51-Cr is that i t can be used in autotransfusien however severe the thrombocytopenia may be and that sites of plat e l e t destruction can be visualized with a s c i n t i l l a t i o n camera peaked for 170 and 245 key with a 20 % window. Normal autologeus 111-Ie labelled platelet dist r i b u t i o n was tested in 6 volunteer controls. 180 cases of thrombopenic purpura (176 idiopat h i c thrombopenic purpuras ; 4 congenital thrombocytopenias) were investigated. Fourteen patients underwent a double exploration : one with autologous 111-In labelled platelets and the other with donor 51-Cr labelled platelets. The patients entered into this study were investigated at least three weeks after any treatment. The exploration protocol included counting the r a d i o a c t i v i t y of blood samples f o r p l a t e l e t survival. A s c i n t i l l a t i o n camera interfaced with an image processing system was used to study early in viva platelet d i s t r i b u t i o n and late hepato-splenie sequestration. Scintigraphic imaging techniques give a precise description of the early kinetics of hepatosplenic pooling. This is useful when making a differential diagnosis between thrombopenic purpura and hypersplenism. They also enable the r e l a t i v e importance of the sites of destruction to be assessed : in this study purely splenic uptake : 85 % of cases, purely hepatic uptake : 5 Z of cases, mixed hepato-splenic uptake : 10 % of cases. The method is useful in confirming the diagnosis of idiopathic thrombopenic purpure, in quantifying the degree of platelet destruction and in indicating whether the patient is eligible for surgery. H6pital de Pontchaillou

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_WAIqETICS IN vIVa OF AUTOLOCOUS III-In-LAB~.T.~n PLATELETS IN THBOF~fXPfTOpENIC STATES. K.G. Schmidt and J.W. Rasralssen.

PROGRESS WITH THE HIDAC CAMERA FOR POSITRON EMISSION TOMOGRAPHY. A. Jeavons, O. Townsend, M. Wensveen, R. Magnanini, R. Clack, P. Frey and A. Donath

A DUAL

The kinetics of autologous lll-In-labelled platelets (pl.) were studied in 50 patients with thromhocytopenia (idiopathic thrombocytopenic purpura (ITP) : 27 patients; congestive splenomegaly (CS) accc~qganying chronic hepatic disease: 18 patients; splenomegaly frcm other causes: 5 patients) . In the ITP group, pl. mea~_ life thee (MLT) was considerably shortened (x = 45h) , in viva recovery (IVR) was slightly lowered (x = 45%) , and pl. turnover slightly increased (~ = 66700 pl./pl/24h), however, all 3 parametres showing considerable interindividual variation. In the CS group, the mean values were: MLT: 124h; IVR: 31%; pl. turnover: 44477 pl./pl/24h. No correlation was found between MLT and pl. concentration in blood in any of the two groups. Platelet turnover was positively correlated to the pl. concentration in the spler~smegaly group; these two parametres did not correlate in the ITP group, suggesting subnormal tbrc~nbopoiesis in both groups. The pl. concentration was positively correlated to IVR in both groups. This was expected in the splenc~egaly group; in the ITP group it may reflect increased vulnerability of platelets frcrn patients severely affected, resulting in pro{nature removal of labelled platelets from the circulation upon reinjection. Alternatively, it may reflect ir~reased platelet pooling in I~P, contributing to throalbocytopenia. This is supported by a positive correlation between IVR and spleen size in both groups. Scintigraphic studies: In the splenomegaly group, pl. seq~/estration and destruction occurred almost exclusively in the spleen. The ITP patients could be divided into 2 groups; one (n = 15) erdzibited a predc~ninantly splenic platelet destruction, the other showed signs of a ccmbined splenic-hepatic or hepatic pl. destruction. In both groups (ITP and CS) scintigraphic stmdies of the chest revealed signs of pl. destruction in the home rq~rrow as well. Department of Nuclear Medicine, Ode~se University Hospital, DK-5000 Odense C, Denmark.

A new high Density Avalanche Chamber positron camera is now in operation at CERN. It will replace the prototype camera that is in routine use at Geneva Hospital for high resolution ( 2 m m) three-dimensional imaging. The camera is larger (30 x 30 cm 2) and is 16 times more sensitive owing to the use of multiple gammaray converters. Spatial resolution remains at 2-3 ~a and cime resolution 20 as. The construction and performance of this camera will be described and some imaging applications presented. CERN, 1211 Geneva 23, Switzerland

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HEAD ANGER CAMERA WITH COINCIDENCE ELECTRONICS J. K u l m a l a , S. Parviainen and A. A h o n e n This c a m e r a ( S i e m e n s - S e a r l e Rata C a m e r a with two LFOV-ZLC d e t e c t o r heads) has 0.95 cm t h i c k c r y s t a l s whose diameter are 39 cm. A coincidence unit c o n n e c t s the o p p o s i n g d e t e c t o r s . This unit and the n e c e s s a r y c o m p u t e r p r o g r a m s have been d e v e l o p p e d at The U n i v e r s i t y Hospital of G r o n i n g e n (Paans et al, Nucl. Instr. Meth. 1 9 2 , 4 9 1 , 1 9 8 2 ) . The c o i n c i d e n c e count rate c a p a b i l i t y of the p r e s e n t c a m e r a is r e s t r i c t e d by the m a x i m u m s i n g l e s count rate each d e t e c t o r can process. The m a x i m u m count [ m t e of each d e t e c t o r is 90 kHz (95 % e n e r g y w i n d o w ) . 0nly a small a m o u n t of all detected events are a c c e p t e d ss coincidences, g centrally situated p o i n t s o u r c e g i v i n g this this singles count rate gives only 3.4 kHz coincidence count rate. B o t h p a r t i a l e n e r g y d e p o s i t i o n in the thin d e t e c t o r s and the s c a t t e r e d r a d i a t i o n e m e r g i n g from the s o u r c e lead to e v e n t s w h i c h fall b e l o w the e n e r g y window. The l a t t e r contribution can be r e d u c e d by graded a b s o r b e r s in front of the d e t e c t o r s or s i m p l y by not r e m o v i n g the c o l l i m a t o r s . The e f f e c t of v a r i o u s graded absorbers and of the collimators on the c o i n c i d e n c e c o u n t rate c a p a b i l i t y is r e p o r t e d . Medical Cyclotron Laboratory, University of T u r k u and The U n i v e r s i t y C e n t r a l Hospital of Turku, S F - 2 0 5 2 0 Turku, F i n l a n d

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THE USE OF A CONVERGING COLLIMATOR FOR HIGH RESOLUTION SPECT IMAGING S.Webb ~, M.Broderiek+ and M.A.Flower*.

CONTRAST ENHANCE~iENT IN SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY OF THE LIVER. g.Webb and A.P.Long.

A CLINICAL CO~ARISGN OF SPECT AND SCINTIGRAPNY USING ROC ANALYSIS. M.A. Macleod and A.H. Houston

A special purpose gamma camera collimator with holes which converge in the plane of rotation of the camera has been used together with an IGB 4OOA camera and STAR computer system i~ order to achieve high resolution siugle photon emission computed tomography (SPECT). The collimator has been used for high resolution thyroid imaging of patients with pyramidal nodes, enabling the anatomical origin of the nodes to be identified. The resolution of the system has been measured using a line source of activity in a uniformly attenuating medium. A detailed quantitation of the variation in the shape and widths of the llne spread function has been made for six positions of the line source in the field of view and for three radii of revolution of the camera. At the centre of the field of view the line spread function is circular; elsewhere it is elliptical. The exact shape of the ellipse depends on the position in the field of view; in general the major axis of the ellipse is parallel with the line joining the line source to the axis of rotation of the camera. The resolution of the same rotating gamma camera system with both a high resolution parallel hole collimator and a low energy general purpose parallel hole collimator has been measured under identical sets of conditions and the improvement with the use of a converging collimator demonstrated. Typically a full width at half maximum in water of Igmm has been achieved with the converging collimator compared with 18m~, for the high resolution collimator with a radius of rotation of 25cm. A three fold improvement of sensitivity at this distance was also achieved. Reconstruction software is a specially modified convolution and back projection algorithm in which the shape of the frequency filter and the frequency cutoff may be varied. ~ e algorithm has been implemented using the IGE software feature "programmability". In conclusion the experimental conditions for optimum high resolution SPECT have been achieved. *Physics Department, Royal Marsden Hospital, Downs Road, Sutton, Surrey, U.K. SM2 5PT +Department of Biophysics and Bioengineering, Chelsea College, University of London.

The objectives of this study were to determine the optimum conditions for improving images of the liver and spleen obtained by single photon emission computed tomography (SPECT). The aim was to enhance the contrast of cold liver lesions whilst avoiding the simultaneous generation of unacceptable mottle in the normal liver. BPECT tomograms were obtained using an IGE 400T gamma camera with STAR computer system. Contrast was defined as the ratio of the minimum pixel value in a reconstructed cold spot to the mean of pixel values in surrounding normal liver. Mottle was defined as the r.m.s, error divided by the mean of pixel values in normal liver. SPECT tomograms of a London liver phantom containing a 25m~Q diameter cold spot were processed by several filtering techniques including maximum entropy deconvolution, homonmrphie deconvolution, Phillips filtering and inverse filtering. The image processing algorithms were developed inhouse within the ICE software facility "programmability". The changes in tumour or cold spot contrast and normal liver mottle were determined for each technique and for a range of the free parameters available. The unprocessed tomograms had a tumour contrast of 39% and mottle of 14%, Optimum processing increased the contrast by a factor of greater than x2 whilst mottle increased by only xi.1. Choosing other less favourable conditions contrast enhancement by x2.5 was possihle but with x2 (unacceptable) increase in mottle. In conclusion contrast in SPECT liver tomograms can be greatly enhanced under carefully controlled conditions and with defined end points for evaluation.

A Siemens' ZLC 750 'Orbiter' dual purpose gamma camera, operating in the E-CAT mode, is compared with conventional scintigraphy and the respective ability of each system to detect pathology discussed. A total of 100 patients in whom a firm, final clinical diagnosis had been made from surgery post mortem or clinical and biochemical findings, are included in the trial involving brain, liver and bone studies. The ability of the SPECT system to detect pathology which was absent, equivocal or evident o n conventional scintigraphy is evaluated and the sensitivity and specificity of the system calculated. An ROC analysis of the comparative results is presented for 4 observers, 2 of whom had no experience in evaluating SPECT images. The results show conclusively that training and experience in Handling SPECT data enhance true positive detection rate and that SPECT is superior to conventional scintigraphy in the detection of pathology in brain, liver and bone.

Department of Nuclear Medicine, Royal Naval Hospital, Haslar, Gosport, Hampshire PO12 2AA, England.

Physics Department, Royal Marsden Hospital, Downs Road, Sutton, Surrey, U.K. SM2 5PT

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ATTENUATION AND SCATTERCORRECTIONAIMING AT QUANTITATIVE SPECT. B. Axelsson, A. Israelsson, S.A. Larsson and P. Msaki

EFFECTIVE IMAGE FILTRATION OF PEDIATRIC SINGLE PHOTON EMISSION TOMOGRAMS. D,L. Gilday, M.D. Green, R. Puntillo, J.M. Ash.

A DYNAMIC P H A N T O M F O R SII~ULATING GATED B L O O D P O O L STUDIES. V. H u ~ k , J. Erban, K. Kleinbeuer, M. W i e d e r m a n n and O . G r i g a r

Major obstacles in quantitative evaluations using SPECT are accurate attenuation correction and proper handling of scattered radiation. These problems could be treated separately or together.

Single Photon Emission Computed Tomography (SPECT) in children suffers from r e l a t i v e l y poor photon s t a t i s t i c s due to the lower radiopharmaceutical dose when compared with adults. Consequently, we have made a major e f f o r t to improve the resultant temographic images. We compared the e f f e c t that d i f f e r e n t enhancements had on the basic reconstruction, The baseline study was a reconstruction with an internal f i l t e r appropriate to the planar image's photon density. The f i r s t enhancement was to three dimensionally f i l t e r plaear images p r i o r to reconstructing with an intermal "high resolution" f i l t e r . The second was to apply three dimensional f i l t e r to the images which were reconstructed with an internal "high resolution" f i l t e r . The f i l t r a t i o n an~ reconstruction were performed on Both MOS-A , A and GE Star computers. The results showed that planar images Which were of poor photon f l u x produced much better reconstructions when p r o - f i l t e r e d , whereas the difference was not nearly so d~amatic with high photon f l u x studies. Therefore, we recommend routine pre-reconstruction three dimensional f i l t e r i n g on a l l SPECT studies, especially those of poor photon f l u x . In fact in some very low photon f l u x 24 hour CSF, Thallium and Gallium studies, i t was only possible to i n t e r p r e t those images when prefiltered first.

The d e s i g n and initial performance characteristics of the original dynamic p h a n t o m for quality control checks of camera/ computer systems are presented. The phant o m consists of two r u b b e r balloons filled w i t h T c - 9 9 m solution. The balloons - intended to simulate heart chambers are filled and emptied p e r i o d i c a l l y by means of two pistons that are operated by specially shaped cam discs situated on the common shaft d r i v e n by a motor. A n E C G t r i g g e r pulse simalating the R wave in cardiac studies is g e n e r a t e d for each r o t a t i o n at a position equivalent to enddiastole. B o t h balloons are placed in e w a t e r bath in a glass v e s s e l containing T e - 9 9 m to p r o v i d e simulate¢} body background activity. The phase delay in filliDg of balloons can be adjusted by the mutual t u r n i n g the cam discs through an angle desired. K n o w i n g the true characteristics of the p h a n t o m arrangement, e.g. left v e n t r i c u l a r e j e c t i o n fraction, end-diastolic Volume~ end-systollc volume, cardiac output, systolic emptying and diastolic filling rate etc., it is possible to compare these v a l u e s against those observed and computed. E x p e r i e n c e w i t h this dynamic p h a n t o m h a s d e m @ m s t r a t e d that it is a very valuable tool in t e s t i n g overall gated a c q u i s i t i o n system performance, i n c l u d i n g hardware, and c o m p u t e r programs u s e d f o r the analysis of cardiac r a d i o m u c l i d s data. Examples of the u s e of the p h a n t o m a r e g i v e n end its advantages in c o m p a r i s o n w i t h other o n e s d e s c r i b e d in literature are discussed.

A technique f o r subtraction of scattered radiation before correcting f o r attenuation has been developed, The method is based on "deconvolurico" of scatter events from the measured prof i l e data. The functions defining the distribution of scattered radiation were determined from measurements with a line source in a water phantom. The i t e r a t i v e atteeuation correction technique used in this study is based on comparison of measured p r o f i l e data and calculated p r o f i l e data, These are obtained from summation #ixel by pixel along a "ray" in the reconstructed image, Each pixel value is weighted according to an estimated e f f e c t of attenuation. An advantage using this kind of attenuation correction is that information concerning attenuation properties of the object obtained from transmission measurements could be used in the calculations. I f no separate scatter correction is applied the build-up of scattered radiation may be taken into account ie the estimation of the effects of attenuation by modifying the attenuation function. Computer simulations and phantom measurements, with 80 mm long cylindrical sources in a 300 mm diameter cylindrical water phantom, using the techniques described above indicate that the a c t i v i t y concentration could be determined to within ±10% independant of the size and position of the "source" within the body.

Dept of Hospital Physics, Karolinska Hospital, P.O. Box 60500, S-104 01 STOCKHOLM,Sweden

Division of Nuclear Medicine, The Hospital f o r Sick Children, 555 University Avenue, Toronto, Ontario. MSG IX8 CANADA

Department of N u c l e a r Medicine, U n i v e r sity H o s p i t a l and P a l a c k ~ University, 775 20 Olomouc, C z e c h o s l o v a k i a

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3 6 0 0 R O T A T I O N V E R S U S 1 8 c O - E F F E C T S OF A T T E N U A T I O N W I T H A M Y O C A R D I A L P H A N T O M IN SPECT-IMPLECATIONS FOR TL-2OI-SCINTIGRAPHY OF THE HEART.R.Schneider,G.Golde and R.Felix.

COMPARISON OF PLANAR AND AXIAL SPECT SCINTIGRAPHY OF THE MYOCARDIUMUSING A MULTI-CHAMBER PHANTOM OF THE LEFT MYOCARDIUM.

A COMPARISON OF STEP-AND-SHOOT AND CONTINUOUSROTATION MODES OF SPBCT IMAGING. T.C. Hill, P.W. Kasulis, R.G. Lee, M. E. Clouse

F.Gr~tenherdt, R.Th~mmig, K.Schulze, g.P.Pretschner

The Siemen's orbiter 3700S single-photon emission computed tomography (SPECT) system can acquire tomographic images in both step-andshoot and continuous-rotation modes. We have compared these modes in scanning patients and phantoms. For a study requiring 360 ° rotation, a brain scan was selected. After a 20-mCi injection of Tc-99m gl~coheptonate, a continuousrotation study was followed by a step-and-shoot study. The same number of counts were recorded at 2 ° intervals for 180 projections. For the study requiring 180° of rotation, a cardiac exam was selected. After a 2-mOi intravenous injection of thallium-201, continuous rotation through 180 ° was compared to a subsequent study in the step-and-shoot mode. For both modes the same number of counts were recqrded at 20 intervals for 90 projections. The resulting images were the same for both scan modes, but total scanning time was longer with step-and-shoot than with continuous rotation (27 mid vs. 18 for 180 views in 360 ° and 22 mfn vs. 18 for 90 views in 180°). This difference between the modes was due to the time interval required each time the camera head was moved from one angle to another for the step-and-shoot mode. This time difference is directly related to the number of views collected or the total number of angles sampled. In conclusion, the continuous-rotation mode is preferable due to shorter patient imaging time for SPECT study without degrading the image quality. Summation of data from multiple continuous-rotations would be preferable when it is uncertain how long a patient can remain immohile for the exami~atio~ or when distribution of the radiopharmaeeutical being investigated would change during a slower rotation.

T O e v a l u a t e the e f f e c t s o f a t t e n u a t i o n in m y o c a r d i a l S P E C T w e s t u d i e d a D h a n ' o o -t o m w i t h d e f e c t s in 360 a n d 180 r o t a t i o n . The myocardial phantom,filled with 201TL and containing 3 defects-1 "apexnear", I "midventricular" and I "basenear" was i m a g e d in a i r w i t h 3 6 0 ° a n d 1 8 0 ° r e v o l u t i on.After back-projection(Ham/ning-filter) in t r a n s v e r s e s l i c e s a n d r e o r i e n t a t i o n to sagittal,frontal and o b l i q u e p l a n e s , s o m ~ s m a l l b l u r r i n g w a s n o t i c e d in the 1 8 C - d a t a . A l l 3 d e f e c t s c o u l d e a s i l y id e n t i f i e d b y r e d u c t i o n in c o u n t a c t i v i ty to 2 5 - 3 0 % in t h e d e f e c t s c o n t a i n i n g n o a c t i v i t y . In a w a t e r t a n k w i t h s c a t t e r the 360 d a t a s h o w e d w i t h o u t a t t e n u a t i o n correction a decrease of activity from t h e a p e x to the b a s e to 5 5 - 6 0 % . I n the 180°data attenuation caused a activity d e c r e a s e t o 4 0 - 5 0 % i n the b a s e c o m p a r e d to the a p e x . C o n t r a s t h o w e v e r w a s b e t t e r in the 1 8 0 ° d a t a c o m p a r e d to the 3 6 0 ° - d a t a : ~ h e a p e x n e a r d e f e c t s h o w e d in the 1 8 0 - d a t a a d e c r e a s e o f a c t i v i t y to 2535% a n d i n t h e 3 6 0 ° d a t a t o 3 5 - 4 5 % , t h e midventricular d e f e c t s h o w e d in the 180 ° d a t a a d i m i n u t i o n to 3 0 - 3 5 % v e r s 5 0 - 5 5 % in the 360 d a t a , t h e b a s e n e a r d e f e c t w a s lowered to 35-45% in-~e 180°data and to 5 5 - 6 0 % in h h e 3 6 0 ° d ~ t a . A t t e n u a t i o n corv r e c t i o n for t h e 360 d a t a d i d n o t c h a n g e the c o n t r a s t , b u t l o w e r e d the a c t i v i t y l o s s in t h e b a s e t o 80%. In a p r e l i m i n a r y s t u d y o f 12 p a t . w i t h e i ther 9osterior-posterobasal ischemia or infarction,we could clearl X demonstrate t h e s u f f i c i e n c y o f t h e 1 8 0 ~ r o t a t i o n (RAOL P O ) w i t h o u t a t t e n u a t i o n c o r r e c t i o n in TL-2OI-SPECT. We conclude,that myocardial TL-2OI-SPECT can be eva~uated with certain precaution in t h e 1 8 C - - r o t a t i o n o f f e r i n g m o r e c o n trast. Dep.Rad.,KI.Ch,FU Berlin,Germany

The fol]owing experiments were implied by 1 I / 2 years of c l i n i c a l experience with a x i a I SPECT of the myocardium. A model of the l e f t v e n t r i c u ] a r myocardium was used to simulate myocardial scintigraphy with Thallium 201 - C1 in p]anar and SPECT techniques. The device consists of nine segments representing the ) e f t v e n t r i c u l a r wall and a cap representing the apex, a l l to be f i l ] e d with a c t i v i t y . Planar images were recorded from three views, tomograms perpendicular to the m i d v e n t r i c u l a r longitudinal axis were obtained a f t e r t r a n s versal and sag~tal reconstruction of the SPECT study according to our c l i n i c a l routine i n v e s t i g a t i o n s , in both techniques examinations were performed by varying the s p a t i a l p o s i t i o n of the phantom and varying the size and l o cation of a predeflned defect. The examinations are compared in respect of the f o l l o w i n g problems: I . detection of the smallest possib]e cold spot, 2. topographic i n d e n t i f i c a t i o n of a cold spot in regard to the true l o c a t i o n of the experimental defect. The r e s u l t s of the study are correlated with the f i n d i n g s obtained by our c l i n i c a l i n v e s t i gations in a x i a l SPECT of the myocardium which include q u a n t i t a t i v e evaluation of the tomograms.

St.Clemens - Hospital Geldern, Abt.Radiologie und Nuklearmed[zin, D-4170 Geldern,F.R.Germany and Abt. IV (Nuklearmedizin und s p e z i e l l e BiDphysik) im Department Radiologie der Med.Hochschule Hannover, D-3000 Hannover 61, F.R.Germany

New England Deaconess Hospital Harvard Medical School 185 Pilgrim Road Boston, PIA 02215, U.S.A.

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COMPARISON OF VARIOUS FILTERS iN SPECT ON REAL PATIENT DATA. g.Kne~aurek,~.Spaventi and l.Slaus

A SIMPLE METHOD FOR STEREOSCOPIC IMAGING IN N U C L E A R M E D I C I N E S. H y d d y n m a a , J. K u i k k a and P. K a r j a l a i n e n

TRIGGER PULSE GENERATION FOR RESPIRATION SYNCHRONIZED NMR IMAGING H. Hagemann, g. Jordan, G. muller, H. Tiffe, E. Sebwarzrocg, H. Hundeshagen

Stereoscopic imaging has been utilized in d i a g n o s t i c r a d i o l o g y for y e a r s . P o o r r e s o l u t i o n has, h o w e v e r , i n h i b i t e d its use in n u c l e a r m e d i c i n e .

Respiration induced organ motions during NMR data acquisition reduce the contrast of images. Therefore the recording of spin echo sequences is done while the patients hold their breath. The period of stopped respiration has to be detected for controlling data acquisition. Because the patients cannot hold their breath longer than a few seconds only some of the 128 image projections are recorded every nonbreathing period.

Two c la s s ic techniques oF reconstructing an

~mage from i t s projections are i t e r a t i v e m a t r i x inversion (IMI) and F i l t e r e d backprojectfon (FBP) technique, The l a t t e r is Faster since i t does not require i t e r a t i o n but i t has a disadvantage because corrections For attenuation can only be approximated, Also, the FBP technique can be implemented on smaller computer systems while IMI technique requires larger ones. This is the reason t h a t FBP technique is mostly used

in c l i n i c a l routines. In applying FBP technique i t is necessary to convolve projections by an appropriate filter. From the theory it follows that the filter should be ramp function in frequency space with cutoff frequency equal to the highest sampling i.e. Nyquist frequency. Though this Ramp filter gives the best resolution in the reconstructed image it amplifies noise for data with statistical fluctuations and sharp cutoff gives oscillations in regions of sharp contrast. To suppress this ripple artifact this Ramp filter has been multiplied, in frequency space, by various windows (HanD, Hamming, Parzen, Butterworth) or some other filters have been used (Shepp-Logan, modified Shepp-Logan). ]n comparison with Ramp filter all these filters have poorer resolution but the reconstructed image has smoother texture. We have applied and compared all mentioned filters on real patient data and even more, we have constructed our own Karin filter which, as Butterworth filter, can be modified to suit the user. Our prelimlnary results indicate that in many cases it is useful to use filters with narrow central lobe, i.e. "sharp" filters and then, if necessary, to apply smoothing or other methods of image enhancement. Nuclear Medicine a Ontology Clinic, "Dr. M1aden Stojanovid" Clinical Hospital, Vinogradska 29, 41000 Zagreb, Yugoslavia

In t h i s w o r k we d e v e l o p e d a s y s t e m for stereoscopic nuclear medical imaging. The s y s t e m is b a s e d on the use of a h i g h resolution gamma camera (GE 400 A / T ) , w h i c h has an F W H M r e s o l u t i o n of 4.2 m m w i t h a h i g h r e s o l u t i o n c o l l i m a t o r . Two slightly differing views were collected to a G a m m a - t 1 c o m p u t e r w i t h 500 k c o u n t s each. The i m a g e s w e r e d i s p l a y e d side by side o n the dual d i s p l a y b u f f e r of the system, and further photographed on an ordinary slide. The s l i d e was v i e w e d w i t h a c h e a p s t e r e o s c o p i c v i e w e r (Asahi Pentax). For t e s t i n g the s y s t e m p h a n t o m s w i t h active rods in air w e r e i m a g e d w i t h an ang u l a r s e p a r a t i o n of ±g and ±10 d e g r e e s b e t w e e n the v i e w s . B e t t e r d e p t h p e r c e p t i o n w a s o b t a l n e d w i t h the ±5 d e g r e e sep a r a t i o n , w h i c h c o r r e s p o n d s to a viewing d i s t a n c e of 40 c m and m i n i f i c a t i o n of the o r d e r of 2.5. We c o n c l u d e t h a t the s y s t e m g i v e s a d d i t i o n a l i n f o r m a t i o n to p l a n a r s c i n t i g r a m s w i t h a s i m p l e p r o c e d u r e in c a s e s w h e r e s m a l l size i n c r e a s e s of a c t i v i t y are p r e s e n t , e s p e c i a l l y in b o n e s c a n s of the h e a d , t h o r a c i c a n d p e l v i c region. L a c k of d i v e r g e n c e in the i m a g e s due to a parallel hole collimator slightly dist o r t s the s t e r e o s c o p i c e f f e c t .

This paper deals with trigger pulse generation derived from different temperatures of inspired and expired ai~ flow. g small thermistor located inside a breathing mask is used to measure the changing temperature. This sensor type provided with twisted and shielded leads and RF filter circuits has proved to pick up little RF and magnetic field gradient switching noise in NMH environment. Transitions between respiration periods are identified by sudden gradient changes of the measured temperature-time function. Different temperature gradients at transition time are used in the device to distinguisch between normal and non-breathing periods. If respiration is stopped the NMR imbuing procedure is released via ECG trigger channel for an appropriate number of sequences recordings. When imaging the beating heart at the non-breathing period the standard ECG equipment output line is connected via the device to the imaging system ECG channel as long as respiration is stopped. Then each ECG t r i t e r pulse initiates the sequence of one image projection recording. NMR imbues generated with and without respiration motion illustrate the improvement of contrast.

D e p a r t m e n t of C l i n i c a l P h y s i o l o g y University Central Hospital SF-70210 Kuopio, Finland Medizinische Hochschule Hannover, Abteilung Nuklearmesstechnik, D-30OO Hannover Bl, FRG

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THE ~o-~THED TO DETERMINE TI RELAXATION TIMES R. Bauer, 0. Lauer, U. Bauer

I n f l u e n c e of P a r a m a g n e t i c T r a c e E l e m e n t s on N M R S p i n - L a t t i c e R e l a x a t i o n T i m e { T 1 ) in the L i v e r of Rats. J.Schuhmacher, P.Schmidlin and J.H.Clorius.

T L D D O S I m e T E R S IN THE E S T I m a T I O N OF AESOILBED D O S E IN A DYq'~MIC "THYROID" P H A N T O M M I M I C K I N G P E R T E C H N E T A T E UPTAKE. M. Lyra, N. T o u ~ b a n a k i s , S. D o u r a n o u a n d J. K a n d a r a k i s

TI and T2 relaxation times are inherent characteristics of different tissue. It is anticipated that some pathologies and malignancies can be differentiated by their respective relaxation times. A prerequisite to discriminate tissue alterations is an exact and reproducible measurement of TI times. Data published in literature differ widely even when measured at the same field strength. This uncertainty might be due to I) the statistical error which is potentiated in calculating TI times when large numbers are subtracted £r0m each ether 2) the spin lattice relaxation time being not monoexponential but more complex and 3) hence different pulse sequences and repetition times tR result in unequal weighting of the respective TI times, producing deviating 'mean' TI times. Applying inversion echo sequences and 2-dimensional FT reeonstruetion~ we determined the inversion delay ~ at which the resonance signal was zero. From r o , TI was calculated iteratively according to T1i = ~o/in(2-exp(-t/T1i-1)(2-exp(-~e/T1i-1))) with re being the echo delay and t = t~-E=-rm the relaxation period. The '~-method' is insensitive to statistical errors and results in reproducible Imean TI times' when tissue with complex relaxation characteristics is investigated. Measurements were performed at the Hausst~n Clinic, using a resistive system (Teslacon M Technicare) at 0.15 T. Some TI times (ms) are given below (mean ~ SD, n=10): brain~ white gray fat

332 ~ 24 402 ~ 19 139 ~ 8

liver spleen muscle

T l O f w a t e r p r o t o n s in the liver of rats was measured with a pulsed NMR spectrom e t e r o p e r a t i n g at 20 Mgz. C o n c e n t r a t i o n s of p a r a m a g n e h i c t r a c e e l e m e n t s C u , F e , M n w e r e d e t e r m i n e d by m e a n s of n e u t r o n activ a t i o n analysis. L o w e r i n g of the M n - C o n c e n t r a t i o n in the liver by a c h e m i c a l l y induced cirrhosis (thioacetamide,TAA) s h o w e d an i n c r e a s e of T 1 , w h i l e a small i n c r e a s e of M n - c o n c e n t r a t i o n in the liver (after i n j e c t i o n of a h e p a t o b i l i a r y Mn complex) s h o r t e n s T 1 . C h a n g e s in liver Cu h a d o n l y a m i n o r i n f l u e n c e on T I . Rep r e s e n t a t i o n of T 1 and M n ~ o n c e n t r a t i o n of all a n i m a l s (controls, Mn injected, T A A treated) in a d i a g r a m d e m o n s t r a t e d a correlation, which suggests a dependence of l i v e r - T I f r o m M n - c o n c e n t r a t i o n . S t i m u l a t i o n of liver g r o w t h a n d e n z y m e a c t i v i t y by p h e n o b a r b i t a l , however, s h o w e d a correlation between Tland Mn concentration which differs from that described above. B e c a u s e a 30-40 f o l d c h a n g e in p a r a m a g n e t i s m of M n by c o m p l e x i n g the metal w i t h d i f f e r e n t ligands can be dem o n s t r a t e d in vitro, it m a y be assumed, that a d i f f e r e n t d e g r e e of c o m p l e x formation: of M n w i t h e n z y m e s in the liver (mainly d e h y d r o g e n a s e s of the m i c o s o m a ] fraction) w i l l a l s o a f f e c t T 1 in the liver. G e r m a n C a n c e r R e s e a r c h Centre. I n s t i t u t e of N u c l e a r M e d i c i n e , Im N e u e n h e i m e r F e l d 280, D-6900 H e i d e l b e r g i, F.R.G.

2 2 2 ± 13 477±28 323 ~ 17

A d y n a m i c p h a n t o m w a s c o n s t r u c t e d in o r d e r to e v a l u a t e a n d m e a s u r e @/qe a b s o r b e d d o s e in the t h y r o i d t r a p e f t e r pertechnetate thyroid up-takes. T h i s p h a n t o m c o n s i s t s of a p o l y e t h y l e n e c y l i n d e r (thyroidal pool) c o n n e c t e d to tworese~oirs of s a l i n e and sunk in a "neck m i m i c k i n g c y l i n d e r " . ImCi T c - 9 9 m w a s i n j e c t e d i n t o the t o p r e s e r v o i r (blood circulation) and a 2 - c o m p a r t m e n t m o d e l e m p l o y e d i n o r d e r to f i n d the r a t e o f c h a n g e of T c - 9 9 m u p t a k e b o t h in e u t h y r o i d a l or h y p e r t h y r o i d a l s i t u a t i o n s ~ n d be u s e d w i t h o u r e x p e r i m e n t a l system. L i P t h e r m o l u m i n e s c e n t d o s i m e t e r s (TLD) p l a c e d on the " t h y r o i d c y l i n d e r " t o m e a s u r e the "organ" d o s e as w e l l as o n the n e c k p h a n t o m to m e a s u r e t h e "skin" d o s e in a d y n a m i c p r o c e d u r e m i m i c k i n g t h y r o i d ' s p e r t e c h n e t a t e uptake. B y T L D d o s i m e t e r s w e a l s o m e a s u r e d the s k i n d o s e on n o r m a l v o l u n t e e r s a n d h y p e r thyroidal patients. C o m p a r i s o n of o u r d y n a m i c p h a n t o m and in v i v o m e a s u r e m e n t s , w i t h t h e o r e t i c a l l y calculated doses,shows a good approxim a t i o n . A d e v i a t i o n of v a l u e s l e s s t h a n 5% for e u t h y r o i d s a n d 10% for h y p e r h y t o i d s w a s found. W a c e u c l u d e d t h a t w e can r e l y on the v a l u e s of skin d o s e s m e a s u r e d b y T L D to e s t i m a t e t h y r o i d ' s dose. T L D s k i n d o s e m e a s u r e m e n t s c o u l d be e a s y a n d r e l i a b l e m e t h o d for the d o s e e s t i m a t i o n of m a n y organs. Nuclear Med.gect.,Dep.of Radiology, A r a e t e i o n Hosp., Univ. of A t h e n s , 76, Vas. Sophias, A t h e n s , Greece.

Nuklearmedizinische Klinik, TU Mlnchen Ismaningerstr. 22, D-8000 F~nchen 80

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R O U T I N E E V A L U A T I O N OF I N T E R N A L C O N T A M I N A T I O N IN R A D I A T I O N W O R K E R S BY A U T O M A T I C A N A L Y S I S OF S O D I U M I O D I D E S P E C T R A

DUAL PHOTON ABSORPTIOMETRY

Havlik,

E., H. Bergmanna

A.B.

Anden

D i v . o f N u c l . M e d i c i n e , 2nd M e d i c a l Dep a r t m e n t , and L. B o l t z m a n n I n s t i t u t e of N u c l e a r M e d i c i n e , U n i v e r s i t y of V i e n n a M e a s u r e m e n t s of b o d y r a d i o a c t i v i t y as required by radiation protection regulat i o n s in A u s t r i a h a v e b e e n p e r f o r m e d r o u t i n e l y in r a d i a t i o n w o r k e r s u s i n g a s h a d o w s h i e l d w h o l e b o d y c o u n t e r at our department. Spectrum analysis includes identificat i o n of the c o n t a m i n a n t s and q u a n t i f i c a t i o n of t h e i r a c t i v i t y . In o r d e r to i n c r e a s e the a c c u r a c y and to s p e e d up t h e p r o c e s s i n g of the m e a s u r e ments a commercially available spectrum a n a l y s i s p r o g r a m h a s b e e n a d a p t e d and e v a l u a t e d w i t h r e g a r d to the special req u i r e m e n t s of w h o l e b o d y c o u n t i n g . T h e s e are the n e e d for f r e q u e n t a n d r a p i d c a l i b r a t i o n of the s y s t e m a n d the corr e c t i o n for an u n u s u a l l y l a r g e f r a c t i o n of scatter radiation. For e n e r g y c a l i b r a t i o n p o i n t s o u r c e s w i t h at l e a s t 6 d i f f e r e n t g a m m a e n e r g i e s a r e n e c e s s a r y in o r d e r to g i v e the acc u r a c y n e c e s s a r y for, i d e n t i f i e a t i o n p u r poses. Efficiency calibrations have been performed using calibrated radioactive s o l u t i o n s in an a n t r o p o m o r p h i c phantom. The background subtraction algorithm s h o w e d to be r e l i a b l e e v e n in the p r e s e n c e of c o m p l e x g a m m a s p e c t r a to g i v e r e a s o n a b l y a c c u r a t e r e s u l t s (max. 30% deviation from true activity). Our results indicate that fully automat e d a s s e s s m e n t of r a d i o a c t i v i t y in the human body using computerized spectrum p r o c e s s i n g can be p e r f o r m e d w i t h an acc u r a c y s u f f i c i e n t for r a d i a t i o n p r o t e c t i o n p u r p o s e s . The r e s u l t s are a v a i l a b l e i m m e d i a t e l y a f t e r the m e a s u r e m e n t , w h i c h is an a d d i t i o n a l b i g a d v a n t a g e in the c a s e of a r a d i a t i o n a c c i d e n t .

A519 : APPLICATION TO

SPINAL FRACTURAL RISK IN POST MENOPAUSAL

0PTIMISATION OF PULSE HEIGHT ANALYSER WINDOW SETTINGS FOR CLINICAL RADIONUCLIDE IMAGING P.F, Sharp, D.G. Norris and J.R. Mallard.

WOMAN. T. Kiffel, L. Paus, G. Coutris, U.N. Talbot, G. Milhaud. Dual photon densitometry allows determination of bone mineral content of lumbar spine, using a dichromatic, collimated beam (100 keV, 44 keV) emitted from radioactive sealed source 153 64Gd.

of

During scanning, photons are absorbed by bone and

soft tissue. This dichromatic

source

allows a computer to correct soft tissue absorbance (NOVO HMCLAB 22-a system). From the results given by the computer we have designed a new index "crushing index" which significantly improves the estimation of fractural risk. Statistical demonstration is established in

The optimum pulse height analyser window settings for a study depend upon the relative number of scattered and unscattered gamma-rays present within the window. A mathematical model was, therefore, developed to calculate the amount of scattered radiation produced at each stage in the imaging process. Three sources of scatter were considered. The first was scatter produced by the patient's tissue. This was modelled by considering a point source of radioactivity at the centre of a sphere of tissue. Cross-sections derived from the Kleln-Nishina dlfferential crosssection were used to calculate the amount of scatter as a function of energy. The second source of scatter was assumed to be in the collimator. The relative intensity of photons reaching the detector through a collimator hole or by penetrating the septa was calculated. Allowance was also made for the X-rays generated in the lead of the collimator,

78 women with or without vertebral fractures. Results are summarized in the following table : Bone mass expressed as ?ALSE NEGATIVE (% of frae -tured ~reater than X-S) FALSE POSITIVE (% of cont -rols less than X-S)

Finally, scatter in the crystal itself was calculated.

crushing 27%

27%

16%

20%

17%

10%

Service de Mgdecine Nucldaire , Hgpital SalntAntoine , 184 rue du Fg Saint-Antoine , PARIS FRANCE

Good agreement was found between the theoretical and experimentally measured spectra. Using gallium-67, a radiQnuclide emitting gamma-rays at several different photopeak energies, a comparison was made hetween images taken using the predicted optimal analyser window settings and ~hosejudged visually to be of highest quality. Department of Bio-Medical Physics and BioEngineering, University of Aberdeen, Foresterhill, Aberdeen, AB9 2ZD, Scotland.

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DETECTORDEVICE FOR CERENKOVCOUNTINGOF K-42 IN COLOURED BIOLOGICAL SOLUTIONS. A. IURZO, L. MILLOUR~ P.P. MORIN, J.F. MORIN, J.M. LEGENDRE. The color quenching is the main obstacle Ln the

QUANTITATIVE DETERMINATION OF REGIONAL EXTRAVASCULAR LUNG WATER BY PET: ACCURACY AND LIMITATION. G,-J. Meyer, O. Echober, and H. Hundeshagen

Clinical value of the alveolar epithelial pe~mea bility (ALP) in various pulmonary diseases, g_Pa lumbo*,T.TodiscoC*L.Fedeli*and P,Merante~* *Division of Nuclear Medieine.**Institute of gemeiotica Medics. University of Perugia (It.

use of Cerenkov counting of h s r d ~ e m i E t e r s in biological studies. Attempts have been made to overcome this effect by channels ratio corrections, decolourisation and USe of "Cerenkov inserts". The latter were found to eliminate count rate variations due the presence of pigments and the gradual return of colour. His disadvantage is the low efficien cy~is better only for small volume inserts. This investigation was undertaken to improve the efficiency of Cerenkov ~nserts by the construction of a special vial. This is a Perpex vial (diam : 28mm, hight : ABmm~ wall thickness 2,75mm), filled with 10ml Esculin-Water solution (Ig/l) and hold in 3 externally metalized (A1) polystyrene tubes (capacity 0,5ml each, diam : 6,Smm, wall thickness 0,5mm)positioned at 6,Smm from vial axis. The radioactive solution is pipetted into these inserts. The counting efficiency is improved according to reasons : (1) the use of 3 tubes increase the surface/volume ratio compared to same total capacity (1,Sml) single tube, then reduce the self-absocpbion (2) the metalizBtian is favoutable to reflexion of light against absorption on the opaque surface (~) the Perpex vial create itself a Cerenkov spectrum (4) the Esculin convert the U.V. component of light into a visi ble one better matched to photocathode. If the percentage of counting rate, compared to that of a calourless solution without insert, is 28,2~ fnr single opaque (i,5ml) insert in standard plastic vial, its become 53,3% with metslized (1,Sml) tube, ~3,1% with Esculin solution~ 47,9% with 3 metalized (0,Sml) tubes in Esculin solution and 51,1% in our device. With regard t o , counting the efficiency is 11 times greater and the raw counting rate/ background ratio pass from 1,15 to 8,5 for obvious human potassium measurements. Laboratoire de Biophysique, Facult6 de M~deci he, 22 rue Camille Desmoulins, 29200 BRE5T, FRANCE.

The calculation of regional extravascular lung water from equilibrium tomographic images of the total water and blood pool requires three operational steps. 1) normalization of intravascular activities in blood pool and water volume measurements, 2) absolute calibration of the PET system, including absorption correction procedures, and 3) consideration of gradient effects in the steady state distribution of 0-15 labeled water. The errors resulting from these effects and procedures have been evaluated. Absolute intravaseular activities can not be obtained from reconstructed slices because of significant partial volume effects. However, normalization of intravascular activities in independent measurements is possible because of similar partial volume effects in corresponding slices. Absolute calibration requires blood sampling during blood pool measurement and transmission measurement for absorption correction. The gradient effect in equilibrium distribution of 0-15 labeled water ean be calculated by application of a steady state model. Since rate constant determination in compartmental modeling imposes practical problems an approach has been made to calculate the gradient effects ~rom transit times, which are easily accessible. The model can be expanded to a two compartment system which allows correction for variance of permeability and changes of the extraction fraction, thereby covering a wide range of pathological situations. It has been shown that the error on absolute rELW values as obtained by the method of constan~ infusion of 0-15 labeled water and single breath inhalation of C-II Carbonmonoxide is in the order of + 25%, The inter-patient variance is in the range of ~ 20%, 8~d the uncertainty in regional differences is smaller ~ 10%. In view of the clinical relevance and the difficulties in assessing regionally increased extravasular lung water, the accuracy reached so far is sufficient to answer clinical questions.

Acute and chronic damage of alveolar space (smoking habitue), of pulmonary interstitium (diffuse lung fibrosis) can produce an impairment of alveolar impermeability to aerosolized particles The purpose of this study is to verify the value of tbzs parameter (AEP) in other lung diseases such as pulmonari edema (PE).in adult cespiratory distress syndrome (AHDS), acute viral pneumonia and chronic obstructive lung disease (COLD). We chek also the degree of alveolar repair after the cessation of smoking and after a surfactsnt stimulating therapy. Method and subjects: normal non smokii~g subjects n.lOO;Smokers,n.20; COLD,n.12, V.Pneumonia,n.E; interstitial l.dis.(ILD)n.g;Pg,n.4;ARDg n.~aA.E. ~m P. was studied by the radioaeroscl method( TcDTPg)gxposure time,lmin.;delivered dose 15~Ci. After a continous record over the chest by comp~ terized gamma camera the clearance rates from the lungs towards the blood(Tl/2,min.and M%min) were obtained, gesults:Tl/2,min. K%,min. Normals Smokers

COLD Pneumonia ILD PE AHDE

92+30 37 21 sg 23 78 48 50 23 48 15 21 7

0.85+0.31 g,71 4.02 g.40 2.40 8.70 0.7g 2.38 1.E9 i.i0 0.~0 4.00 0.81

Conclusions: the main clinical value of AEP is the control of alveolar repair after smoking cessation and surfactant stimulating drugs.

Institut f~r Nuklearmedizin der Medizinischen Hoehschule Hannover. 3000 Hannover, F.E.Germany

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A526

Perfusion-Ventilation imaging with Tc-99m NAt and Tc-99m aerosols in pulmonary embolism. L. P~yh~nen, A. V i r j o , V. Turjanmaa, t . Karhum~ki and A. U~sitalo

ASSESSvH~T £F PFARFUSION~vIP.AZ~ME~T2~] # A ~ WITH PULMONARy ~MBOLI~4. A. Palla, S. Petruzzelli, V. Doruna~aria, G. Rossi, C. Gi~ntini.

COMBINED PULMONARY AEROSOL SCINTIGRAPHY AND PERFUSION SClNTIGRAPHY IN PATIENTS WITH PULMONARY EMBOLISM. W. Larseille, D. Glaubitt, and M. Cordoni-Voutsas

The sensitivity of the perfusion lung imaging in pulmonary embolism is high but i t s specif i c i t y is low. Combined perfusion/ventilation (Q/V) imaging has proved to be very sens i t i v e and very specific, too. Lung ventilation imaging with radioactive gases is not widespread because either poor physical properties or the limited a v a i l a b i l i t y .

We reqiewed chest radiograph and perfusion lung scan in 115 patients affected by pulnDnary embolism in order to assess whether chest radiograph could assess perfusion inloai~nent as well as lung scan. Patients w e e classified according to the r~diographic appearance of descending pulmonary artery: normal, enlarged,and r~arkedly enlarged with "sausage" shape. The width of the artery was also n~as%~ed . The r ~ of sec~e~tal defects at perfus£on lung scan %~s used to score the degree of vascular obstruction: patients ~qith sausage shape of the artery had the most serious obstruction (10.10+2.46 unperfused lung s e ~ s , i.e. about 56% of the total vascular bed) ; patients with r ~ artery had the s~allest obstruction (4.61+-2o43, i.e. 26%); patients with ernlarged artery hut without sausage shape were intermediate between the two ~ e v i o u s gro/ps (6.99~_2.45, i.e. 39%). Perfusion inlceirsent ~ras significantly differe~it (p
Aerosols of very small particle slze obtained after appropriate nebullzation proved to be highly suitable for inhalation selntigraphy of the lungs. The results of pulmonary ventilation scintlgraphy using Tc-99m aerosol and subsequent perfuslon scintlgraphy are reported, In 29 patients (13 men and 16 women) who were suspected of having pulmonary embolism, a ventilation sclntigraphy was performed in at least 4 views 3 minutes after inhalation of Tc-99m aerosol of human serum albumin microspheres with a partlcle size of 1/urn. Owlng to the comparatively low radioectivi~/ of fhls aerosol, already one hour later a pulmonary perfuslon scinHgraphy in 8 views could follow applying Tc-99m microspheres and a considerably higher radioactivity, Combined ventilation and perfusion sclntigraphy of" the lungs could be achieved within 2 hours or le~s depending on the required extent of seintlgraphy. A mismatch of scintlgraphle results exhibltlng areas oflntact ventl]aGon and reduced perfusion was observed in 22 patients. However, 7 patients suffering from chronic obstructive pulmonary disease demonstsated a reduction of both ventilation end pedusion in corresponding areas so that the confirmation of suspected pulmonary embolism was difficult. As a diagnostic supplement, ventilation scintlgraphy with gaseous Xe-t 33 or Xe-127 in one vlew showed radioxenon retention in 5 patients. Aerosol scintigraphy permitted scintigrams to be taken in several views but incompletely presented a delay of accumulation or of loss of radioactivity in pulmonary areas with poor ventilation. In conclusion, ventilation s¢intigraphy uslng Tc-99m aerosol of very small particle slze may be combined with perfusion scintlgrephy of the lungs in order to facilltate early diagnosis and rapid treatment of pulmonary embolism.

2r~ Medical Clinic, UDiversity of Pisa, and CNR InStitute of Clinical physiology, Pisa, Italy.

Department of Nuclear Medicine, Academic Teaching Hospital, D-4150 Krefeld, Federal Republic of Germany

The cheapest way to perform the combined Q/V imaging is to use Tc-99m labelled macroaggregates and microaerosols, In our procedure the perfusio, imaging is at f i r s t performed with reduced dose of 18 MBq Tc-MAA. After the perfusion imaging the patient inhales aerosol from a commercially available nebulizer. The a i r flow is 8 I/min, dose 955 MBq in 3-5 ml and the particle size less than 1.0 micron in 90%. The inhalation is continued until the count rate exceeds 2-3 times the perfusion count rate. Two point sources are used to match the perfusion and combined Q+V images exactly above each other according to a computer program. The pure ventilation images are l e f t when the contribution of the berfusion is substracted from the combined Q+V images. We studied 35 patients suspected for pulmonary embolism. Only i i of them showed V/Q mismatch typical to pulmonary embolism. 22 patients had as a cause for perfueion defects some other reason, mostly chronic obstructive disease (COPD) (20 pts). These oatients showed typically V/Q match and they also had central aerosol deposits in larger airways. Four pa-tients showed both matching and mismatching defects and in these cases i t was possible to diagnose pulmonary embolism with COPD, University Central Hospital, Dept. of C l i n i - cal Physiology, SF33520 Tampere 52, Finland

A87 A 528

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FIRST CLINICAL EXPERIENCES WITH A NEW TYPE OF TC-99m AEROSOL GENERATORFOR LUNG VENTILATION. J.Spitz and T.Berlad

VENTILATION SCANNING USING Tc-g9m DTPA AEROSOL ~ND A NEW NEBULIZER SYSTEM. P. Peltier I 2 J,L. Tellier I J.F, Chatal I and R. Pommet .

I f lung v e n t i l a t i o n studies have not attained the wide spread use owed to i t s c l i n i c a l importance in the past, there is one common reason : i t is to d i f f i c u l t f o r routine use. Some months ago the SynteVent aerosol system was introduced to the european market. I t consists of a reusable shielding unit and a disposible ventilation kit. The generator delivers a fine aerosol mist of uniform particles, (Tc-99m-DTPA or Tc-99m- Nanocoll) 98% of which have a size under 1 pm. A f t e r the examination the used v e n t i l a t i o n k i t i s removed en bloc from the shielding u n i t and disposed o f f as contaminated waste. We tested the new system on 150 patients between the age of 35 amd 85. In all cases the v e n t i l a t i o n studies were followed by perfusion images. As a rule the v e n t i l a t i o n images obtained were of good q u a l i t y . The system i s easy to handle and always ready to use due to the employment of substances that are on hand in any nuclear medicine department. The use o f the short l i v e d Tc-g9m as t r a c e r and the d i s p o s i b i l i t y of the kit for the aerosol production o f f e r no r a d i a t i o n problems and allows the application of t h i s v e n t i l a t i o n technic even f o r special i s t s outside larger nuclear medicine departments. The examination technic requires only a minimum of cooperation from the p a t i e n t without discomfort to him. Consequently our diagnostic strategy has changed to perform the v e n t i l a t i o n scintigraphy before the lung perfusion as soon as the diagnostic problem or the c l i n i c a l s i t u a t i o n requires the knowledge of the s p e c i f i c v e n t i l a tion study, This hes led to an important improvement in the diagnosis of pulmonary embolism in our d a i l y c l i n i c a l routine both in speed and accuracy. .

To evaluate a new nebulizer system (Venturi with a particle sizer), 37 patients referred for detection of pulmonary embolism had on the same day a ventilation scan followed by a perfusion study (4 mCi of Tc-99m microspheres). 10 mCi of Tc-99m DTPA was nebulized in a volume of 2 ml (Group A : 15 patients) or a volume of I ml (Group B : 22 patients). The time of nebulization was 345 + 54 see. S.D. for Group A and 336 + 114 see. S.D. for Group E. 4 views including Ant, Post., RP0 and LP0 were recorded (200 K counts) with 33 patients (Group A = ]4, Group B = 19) and 5 views including ant., LA0, RAO, RL and LL with the other patients (Group A I, Group B = 3). The efficiency of the aerosol system defined as the ratio between ~he pulmonary activity due to the aerosol and the initial activity in the nebulizer has been estimated for 27 patients (Group A = ~2, Oroum B = ]5), The quality of the scans was independently evaluated by two of us.

VENTILATION FLOW 0AN ~ODIFY NEGIONAL DISTRIBUTIO N OF AIN:A STUDY USING 99mTc-DTPA MONODISPERDED AEBEOSOL SCINTIGRAPHY. l.Taddei.P.Calsini,P.Ferri.

I n s t i t u t f u r Nuklearmedizin St~dt.Klinikum Wiesbaden, L.-Erhard-Str.lO0 D6200 Wiesbaden, Germany

The efficiency for Group A was 3.96 t 1.91 % S.D and for Group B 6.27 ~ 2.43 % S,D. (p < 0.02). The recording time for the posterior view was 67.24 ± 29,96 sec. S.D. in Group B and 137 + 85,87 sec. S.D. in Group A (p < 0.01). The clinical results showed 4 discrepancies (27 %) in Group A between the two reviewers and 2 (10 %) in Group B. 10 scans (66 %) were judged to be very good quality in Group A and 20 (91%) in Group B. In conclusion Tc-99m DTPA aerosol nebulization using a particle sizer shows a satisfactory efficiency and permits to obtain good reproducible images. The efficiency of the system is better when the volume nebuIized is I ml, I. Service de Midecine Nucl4aire - Centre R. Gaudueheau - 44035 Nantes C e d e x - FRANCE and 2. C.E.A, - O.R.I.S. - B.P. n = 21 - 91190 Gif sur Yvette - FRAHCE -

The amount of sir entering every region of the lung is releted to local compliance and local ai r w a y resistence to airflow.These variables resu ! t to be dishomogeneously distributed on the different parts of the lungs.The lower part of the lung seems to be more compliant than the upper part.On the contrary airway resistence is higher in the bottom,because in this region,to arrive at the terminal bronchioles,air goes through a longer way. Using 99mTc-DTPA monodisperded radioaereosol,we studied,using two breathing rates and ventilatio n flows,SO non smoking volunteers with no clinical sign of respiratory disease,A digital static image on posterior view of lungs was collected. We selected two regions of interest in the righ t and left lungs using a semi-automatic method.Region g was composed of the superior lobe;region S was composed of the medium and inferior lobe on the right side,and of the inferior lobe on th e left side.We calculated B/A ratio for both lun g in the two different breathing conditions. All this variables were shown to change altering the ventilation flow and the breathing rate. In all the volunteers variables went down when ventilation flow went up,in the different breath ing conditions.We find a linear relation between B/A ratio and ventilation flow and breathing rate.The knowledge of ventilation flow and breathi ng rate is very important if one is to study co£ rectly regional ventilation,because different c~ nditions are able to introduce significant change in results.g range of normality for variables calculated with our method is presented,by varia tions induced by different ventilation flow and breathing rate. I.N.R.C,A..via

Incontri 30,50100 Firenze,ltalia

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VENTILATION IMAGING WITH 81m KRYPTON AND 99mTe DTPA AEROSOL. COMPARISON OF BOTH METHODS. C. D e r ~ s e , N. G a r z a n i t i , M. G u i l l a u m e , P. B a r t s c h , G. Merchie.

A L T E R A T T O N S OF R E G I O N A L P U L M O N A R Y F U N C T I O N IN P A T I E N T S W I T H M I T ~ L STENOSIS STUDIED WITH Xe-133 FOLLOWING SURGICAL TREATMENT. N. K u r a t a , H. F u j i i , H. N i i n o m i , M. K u s a g a w a .

C O M P A R I O S N B E T W E E N K E F U T BI 12OO L U N G FUNCTION ANALYZER AND COMPUTERIZED GAMMACAMERA IN E V A L U A T I O N OF REGIONAL L U N G P E R F U S I O N . M. V o r n e . S. V ~ h ~ t a l o , P. V a i n i o a n d S, M i e t t i n e n

T h e p u r p o s e o f t h i s s t u d y is to i n v e s tigate the regional pulmonary function in m i t r a l s t e n o s i s u s i n g X e - 1 3 3 b e f o r e and after surgical treatment. For the assessment of the regional pulmonary f u n c t i o n , p e r f u s i o n i n d e x (PI), v e n t i l a t i o n i n d e x (VI) a n d v e n t i l a t i o n - p e r f u s i o n r a t i o (9/0) p e r u n i t l u n g v o l u m e have been calculated using scintilation camera on-line computer system. Results: i) T w e n t y - s e v e n patients with mitral stenosis have been studied, 2) The distribution of PI h a s b e e n c l a s s i fied into four patterns. These four p a t t e r n s h a v e a g o o d r e f e r e n c e to t h e pulmonary capillary wedge pressure (PCW). T y p e I ( P C W < 2 0 m m H g ) , T y p e II ( 2 0 r n m H g < P C W < 2 5 m m H g ) , T y p e I I I (25r~mHg< P C W < 3 0 m m H g ) , T y p e IV (PCW>30rlmHg). The d i s t r i b u t i o n o f PI in T y p e I V h a s d e monstrated fairly uniform throughout t h e lung. 3) T h e d i s t r i b u t i o n of V I h a s s h o w n w i t h i n n o r m a l in m o s t o f t h e patients (PCW<30mmRg). H u t in o a t i e n t s w i t h P C W o v e r 30nunHg, t h e d i s t r i b u t i o n of V I s h o w s f a i r l y u n i f o r m t h r o u g h o u t the lung. 4) In p a t i e n t s w i t h P C W o v e r 3 0 m m H g , V I r e t u r n s to n o r m a l , b u t PI is n o t r e c o g n i z e d t h e i m p r o v e m e n t of t h e distribution e v e n a f t e r 6~12 m o n t h s of surgical treatment. Conclusions: l) PI, V I a n d 9 / 0 a r e v e r y b e n e f i c i a l to e s t i m a t e t h e s e v e r i t y of m i t r a l s t e n o sis b e f o r e s u r g i c a l t r e a t m e n t . 2) It has been considered that these three indices are good markers to estimate t h e i m p r o v e m e n t of r e g i o n a l p u l m o n a r y perfusion and ventilation along with the improvement of hemodynamic data after surgical treatment.

T h e p u r p o s e o f the s t u d y w a s to c o m p a r e the r e s u l t s o b t a i n e d w i t h two d i f f e r e n t regional lung perfusion analysis systems. 62 c o n s e c u t i v e p a t i e n t s w e r e s t u d i e d . At first a perfusion study was made with I mot of Xe-135 using K e f u t RI 1200 device and immediately thereafter with 4 mOt of Te-99m MAA using gammacamera. Perfusion studies with Xe-133 were made w i t h K e f u t BI 12OO r e g i o n a l l u n g f u n c t i o n a n a l y z e ~ in w h i c h t h e r e a r e 16 d e t e c t o r s a r r a n g e d in f o u r p a i r s on b o t h a n t e r i o r a n d p o s t e r i o r s i d e s o f the p a t i e n t a d j u s t able according to l u n g h e i g h t . I n the equipment an automatic data collection and analysis is performed by a m i n i computer. In this study percentual distribution of b l o o d f l o w i n the 16 lung areas was calculated. I n the T c - 9 9 m M A A perfusion studies a l a r g e f i e l d of v i e w g a m m a c a m e r a w i t h a minicomputer was used. Both anterior and posterior projections were imaged, Corresponding 16 l u n g a r e a s as i n the Xe-133 study were selected with ROIp r o g r a m m e a n d %he p e r o e n t u a l d i s t r i b u t i o n of lung perfusion was calculated. P a i r e d S u d e n t ' s t - t e s t w a s u s e d in the statistical analysis. Although the distribution of lung perfusion was rather similar with both methods, some s m a l l but s i g n i f i c a n t d i f f e r e n c e s were f o u n d i n the r i g h t l o w e s t a n d c a r d i a c a r e a s , w h i c h c a n be i n t e r p r e t e d b y the d i f f e r e n c e s in the t e c h n i q u e s a n d a l s o i n the e n e r g i e s o f X e - 1 3 3 a n d T c - 9 9 m . We conclude that both methods yield reliable information about regional lung p e r f u s i o n b u t the u s e of K e f u t BI 1200 l u n g f u n c t i o n a n a l y z e r is m u c h e a s i e r than the computerized gammacamera method.

S c a n s were performed s u c c e s s i v e l y t h e same day with a scintillation camera (4 i n c i d e n c e s : a n t e r i o t , p o s t e r i o r , left p o s t e r i o r oblique, r i g h t post e r i o r oblique). Nebulization was performed with a "SEDI II" a p p a r a t u s ( I . R . E . , Belgium). We f i r s t s t u d i e d control s u b j e c t s with a normal K r y p t o n s e i n t i g r a p h y . Ventilation images are t h e same with both methods e x c e p t an i n c r e a s e d u p t a k e in p o s t e r o - i n f e r i o r r e g i o n s with the aerosol. We t h e n s t u d i e d p a t i e n t s with an abnormal K r y p t o n scan : p a t i e n t s with b r o n c h o emphysema, neoplasms, f i b r o s i s , s a r c o i d o s i s . In case of b r o n c h o - e m p h y s e m a , we noted a disc r e p a n c y between images which is proportional to the r e s p i r a t o r y functional a l t e r a t i o n . Nebulization gives a more h e t e r o g e n e o u s s c i n t i g r a p h y with p e r i h i l a r hot s p o t s . In c a s e of bronchiaI neoplasms, t o p o g r a p h y of d e f e c t s is q u i t e similar. In c a s e of f i b r o s i s , we o b s e r v e d more marked a b n o r m a l i t i e s on aerosol s c a n s . In conclusion, 99mTc DTPA aerosol mainly s t u d i e s v e n t i l a t i o n t r o u b l e s with major a l t e r a t i o n s of l a r g e b r o n c h i a a s s o c i a t e d with a d e c r e a s e of air flow. This method a p p e a r s t h u s complement a r y to t h e 81m K r y p t o n v e n t i l a t i o n s t u d y . In t h e a b s e n c e of b r o n c h o - e m p h y s e m a , both t e c h n i q u e s give similar r e s u l t s . U n i v e r s i t y of Liege, I n s t i t u t e of Medicine and Cyclotron R e s e a r c h C e n t e r , L i e g e , Belgium.

T h e D e p a r t m e n t of T h o r a c i c S u r g e r y , Anjo Kosei Hospital, Miyukihonmachi, A n j o , A i c h i , J A P A N 446

PXij~t-B~me Central Hospital SF-15850 Lahti, Finland

A88 A 534

A535

A536

V O L U M E W E I G H T E D D I S T R I B U T I O N OF X E - 1 3 3 WASHOUT CONSTANTS - AN IMPROVED METHOD FOR MEASURING REGIONAL LUNG FUNCTION S. H y 6 d y n m a a and ~. L ~ n s i m i e s

POSTURE INDUCED VENTILATION CHANGES ASSESSED BY FACTOR ANALYSIS. L. Cinotti, R. DiPaola, M. Meignan, J.P. Bazin, I.G. Zubal, A.B. grill.

SCINTIGRAPHY

W i t h the use o f g a m m a c a m e r a s and comput e r s in d y n a m i c lung f u n c t i o n studies p i x e l - b y - p i x e l c a l c u l a t i o n s of X e - 1 3 3 w a s h o u t h a l f times have b e e n p e r f o r m e d . In this w o r k we c a l c u l a t e d the v o l u m e w e i g h t e d d i s t r i b u t l o n of the w a s h o u t c o n s t a n t s to improve the a n a l y s i s . X e - 1 3 3 (200 MBq) was a d m i n i s t e r e d intrav e n o u s l y and two m i n u t e s of r e b r e a t h i n g w e r e a l l o w e d for e q u i l i b r a t i o n of the gas w i t h r e g i o n a l volume. The w a s h o u t p h a s e was ~ o l l e c t e d to a Gamma-]] computer as 3 s f r a m e s for 3.2 m i n (64x64 m a t r i x ) . The w a s h o u t time c o n s t a n t s were c a l c u l a t e d f r o m the r a t i o of initial v o l u m e and 30 s w a s h o u t images. The d i s t r i b u t i o n of the w a s h o u t c o n s t a n t s was g e n e r a t e d f r o m the w a s h o u t c o n s t a n t image so that e a c h p i c t u r e e l e m e n t contr i b u t e d to the d i s t r i b u t i o n by the~s2ght d e t e r m i n e d b y the v o l u m e image. The m e t h o d was t e s t e d w i t h six vol~mteers. The a v e r a g e ef the m e a n w a s h o u t constant of the d i s t r i b u t i o n was 0.045 ± 0.004 s (±SD), w h i c h c o r r e s p o n d s to a m e a n h a l f time of 15.3 s. We c o n c l u d e that the a n a l y s i s o f f e r s an i m p r o v e d m e t h o d for e x a m i n i n g the regional lung v e n t i l a t i o n g i v i n g the p e r f u sion, lung v o l u m e , w a s h o u t c o n s t a n t image a n d d i s t r i b u t i o n . The v o l u m e weighted d i s t r i b u t i o n of the w a s h o u t c o n s t a n t s also a l l o w s the e s t i m a t i o n of the v o l u me a f f e c t e d w i t h d e c r e a s e d v e n t i l a t i o n t h r o u g h a r e a d e t e r m i n a t i o n f r o m the distribution. D e p a r t m e n t of C l i n i c a l P h y s i o l o g y University Central Hospital S F - 7 0 2 1 0 Rumple, F i n l a n d

ASSESSMENT

OF T H E L U N G S IN THE

OF HEMODYNAMIC

DISTURBANCES

IN CONGENITAL HEART DISEASES. Factor analysis of dynamic structures (FADS) allows to extract the few main components in a set of dynamic data. It associates an activity time curve (factor) with the spatial distribution of the corresponding events (factorial image). We applied FADS to scintigraphic studies of lung ventilation using Kr-glm in 5 normal subjects and 2 patients (COPD and lung cancer). Looking for 3 components, we studied the influence of both lateral decubitus (LD) with respect to dorsal decuhitus (DD) on these components. If the dynamic curve representing each factor received only few variations in normals, their corresponding image was altered. The ist factor associated with a strong ventilation located at both bases in normals in DD posture, almost disappeared in the non-dependent base while the dependent base was reinforced. To a lesser extent, the same type of asymmetry occurred in the 2nd ventilation factor, showing the entire intrathoracic region. The 3rd factor, showing the delivery of the tracer bolus in the large airways and in the lungs, was Rot significantly modified by posture. For patients in DD, the Is% factor involves the whole lungs, as well as the bases. In LD, the asymmetry between the dependent and non-dependent lung is considerably decreased with respect to normals, indicating a decrease of the proportion of ventilation in the dependent lung. The 2nd factor does not show significant redistribution of ventilation in one case and a phase shift of the ventilation between DD and LD in the other study. Interpretation of third factor changes remains difficult since a better understanding of patient data implies the need for a 4th factor. Thus, FADS appears to be a promising tool for the physiological interpretation of the distribution of ventilation, particularly to explain the effect of posture changes.

M.Kh.

Khodzibekov,~.N.Risaev,D.S.Guljamov. Scintigraphy

of the l u n g s w i t h

and 99mTc ~AA was

performed

patients with intracardiac

s e p t a l de-

fects and ductus arteriosus. bility

of u s i n g the m e t h o d

rentiation

of the

A possi-

for diffe-

character

re of the d i s t u r b a n c e s

133Xe

i n 120

and natu-

of p u l m o n a r y

circulation

is e s t a b l i s h e d .

right shunt

c a n be e v a l u a t e d b y the

pulmonary

A left-to-

lower zones ventilation

d e x d e c r e a s i n g w i t h the i n c r e a s e pulmonary extent

blood flow

(r=-0.81).

The

of p u l m o n a r y h y p e r t e n s i o n

a s s e s s e d b y the u p p e r

inof

is

zones psrfusion

index increasing with the elavation of p r e s s u r e

i n the p u l m o n a r y

artery

(r=0.72). ~crphologie

changes

lumens are manifested

by subsegmentnl

defects grams,

of p e r f u s i o n and a diverse

s h u n t is m a n i f e s t e d of e x t r a p u l m o n a r y the k i d n e y s

on the s c i n t i right-to-left by visualization

radioactivity

and

imaging.

T a s h k e n t b r a n c h of A l l - U n i o n Centre

of S u r g e r y

Medical

Science,

700

of t h e i r

Research

of U S S R A c a d e m y 10 F a r c h a d s k a y a

115, T a s h k e n t ,

of St.,

USSR.

grookhaven National Laboratory, Medical Dept., Upton, New York, USA. Work performed under contract DE-ACO2-76CHOOOI6

A538

A 539

CONPARISON OF 99m-Tc-GLUCONEPTONATEAND 67-GALLIUM THORACIC SCANS IN EVALUATION OF MEDIASTINAL AND BILAR INVOLVEMENT IN PRIMARY LUNG CANCER. g. Taillefer, J. L@veill~ and G. Beauchamp.

SINOLE-PHOTON

A 54O

IN THE DETECTION OF LUNG CANCER AND #HDIASTIMAL .TOMO~ : ESPECIALLY

THERE DIMENSIONAL DHTECTIONOFL~PHHOD~ K. Sngimura, I. Narabayashi, R. Nalsui,

MEATSTASES.

Recent studies have demonstrated that 99mTc-Glucoheptonate (Tc-GN) accumulates in primary lung cancer. This study was undertaken to compare the diagnostic usefulness of Te-GH and Gallium-67 (Ga 67) thoracic scintigraphies in detecting hilar and mediastinal spread of lung carcinoma. We prospectively studied 36 consecutive patients with newly diagnosed lung cancer. The primary neoplasms were visible on chest radiographs and were histologically proven (22 squamous-cell, 9 adenocarcinoma, 4 large-cell and 1 small-cell carcinoma). Within a one week period, all patients were evaluated sequentially with Te-GH followed by Ga-67 scan, mediastinoscopy,and, if indicated, thoracotomy. Anterior, posterior and if necessary, oblique thoracic scans were performed using a large-field-of-view camera 6-9 hours after i.v. injection of 25 mCi of TcGH. Immediately after the Tc-GE scan, patients received 6-9 mCi of Ga-67 and images were obtained 48-72 hours later. All primary lung tumors were detected by Ga-67 scans while 32 tumors (89%) accumulated Tc-GH. Using an intensity grading system for tumor uptake of both ragiotracers, Ga-67 showed a better accumulation and higher tumor-to-background ratio in 47% of cases. Fifteen patients had a positive mediastinoscopy: mediastinal spread was detected by Tc-GN in 9 patients (60%) and by Ga-67 in 13 patients (87%). Of the 5 patients having hilar involvement confirmed at thoraeotomy, 4 were visualized by Tc-GH and all 5 were diagnosed by Ga-67. Although the number of cases is limited, these results suggest that Ga-67 is more accurate than Tc-GH for the detection of intrathoracic metastatic spread of primary lung carcinoma. Because of its low sensitivity (60%) Tc-GH cannot he recommended for the clinical staging of primary lung cancer. Hapital HCtel-Dieu de Montreal, Service de M~decine Nucl~aire, 3840 rue St-Urbain, Montreal, Quebec, CANADA H2W IT8

HHISSION GONPUTED TONOOPAPUy WITH GALLIgH-$?

g. Sugimu~a, M. Natsuo, S. Nisbiyala, and g. Rimura. Single-photon emission coeputed to|ngraphy (SPHCT) is a ne~ ~magieg method that offers the edventage of oross-

sectioeal

imaging.

SPEHTstudies eitb g~i]ium-g? for

defection of prixary lesion and get,static lymphrodes in the lung cancer and mediastinal fuz~T are promising. However, quantitative analysis was imposslb]e by these studies, because the prelimizmrySPEgT studies perforzed

no attenuation correction. Me examined the attenuation correction using phantols. The change of radioactivity in the depth could correct using this absorption correo-tion algorithm.

The reconstruction.as derived from 72 projeetinn /=ages collected around the portents by a fuji rotating scintil l a t i o n camera.

Transverse section i ~ g e ~ were recon-

structed by a filtered-bach projection algorithm, with the reconstruction

filter being a ~utlerworth rsnp.

In 20 patients of ]ung eancer, 8 patients of mligna~t.

lymphoma. 3 patients of esophageal c~ncer, 2 patients o~ sarcoldesis, usefulness of gallilm-8? SPHCTfor detectio~ of mediasfinal and hilar nodes letastases was ezaeined. We concluded that SP~;T with Qalliu-g? in lung cancer a~fl mediastinal tumor were more useful in the detection of metastatic lymplmodes than planar image end X ra~ CT. Robe University School of Medicine,

Chuo-hu, Kebe,

7-5-2 gusunohi-oho,

VALUE OF MULTIORGAN SCAN FOR DETECTION OF LUNG CANCER METASTASES. J.l. Uanzo, J.M. Carril, C. de la Fuente, and C. Arnal. Previous reports on the role of multiorgan scan -liver scan (LS), tone scan (US), and brain scan- for the detection of lung cancer metaL tases have s h ~ n no agreement on its value. A retrospective study of lag patients with proved lun~ cancer has been carried out. According to hystology they were classified as: 29 adenocarcinema, 47 squamous, 43 small cell, and 3 large cell. Each patient had the three scans done with a I,FOV camera and the results were compared with the clinical and biochemical data for each organ. The rates of metastases detected were: 11% (13/122) for liver, 13% (16/122) for brain, and 19% (13/122) for bone. Occult metastases were detected in 3,5% (3/86) for LE, 5,6% (6/107) for brain scan, and 9,5% (8/84) for BE. In 31% (38/122) of patients at least one scan was pos! tire, 13.6% being occult metastases. Liver funs tion tests (LFT) and alkaline phosphatase had a high non specificity: 72% (26/36) cf cases with abnormal LFT had normal LS, and 60% (22/38) of cases with elevated alkaline phosphatase had normal BE. According to bye%elegy the detection rate was: 35% (iO BE, 8 LS, 5 brain scans) for small cell, 34% (7 Rg, g L2, S brain scans) for adeno carcinoma, end g5% (5 BE, 2 LS, 6 brain scans) for squamous. These results s u r e s t that multiorgan scan is of value, both detecting occult metastases and showing the non-specificity of LFT and alkaline phosphatase.

Japan

Servieio de Medieina Nuclear. Hospital National "Valdecilla". Santander. Spain.

A89

A541

A542

A543

EVALUATION OF PHASE AND AMPLITUDE IMAGES FROM FIRST PASS CARDIAC STUDIES. P.Bourgeois 1 F.Erbsmann and J.Fruhling.

AN I~TERCOMPARISO~ OF FOUR METHODS OF 0BTAI~ING pHASE IF~GES FROM GATED CARDIAC STUDIES. A.S. Houston and M.A. Macleod

Phase and amplitude images analysis are systematically performed in the famework of the semiautomatic cardiac first pass studies treatment program which has been developped in our department. In order to establish tbeir~value, 67 series of such images obtained from first-pass (FP) studies alone ( 33 ) or combined FP-Multigated (MUGA) studies ( 34 ) have been compared to the corresponding images obtained from classical MUGA studies performed in the same incidence the same day in 34 and later in II cases. All patients underwent also electrocardiographic, echographic and scintigraphic ( 2OITL or 99mTc PP ) investigations as well. Analyzable amplitude images could not be obtained in one case at right and in two at left but with regard to phase images, in 4 at right and in 23 at left. In all cases but four ( 2aneurysms and 2 akdnesias ) out of 45, phase and amplitude images obtained from FP and MUGA studies performed successively were superposable and gave the s~me informations. In the 22 cases of FP alone, phase and amplitude a~nc~n~alities correlated well with other data. Tn two cases, multigated sudies were not contributive owing to arrhytmia but first pass well. Comparison between images obtained at the time of Pyrophosphate scan FP and images from the combined FP-MUGA performed in the same patients (~I) one to two weeks later showed the technique to be reproducible. It is concluded that valuable amplitude and, - at the present stage of the program - to a less extent, phase images can be obtained from first pass cardiac studies. Aneurysms however donot seem to be clearly diagnosed, but well hypokinehic and akinetic segments.

The use of phase images in the analysis of gated cardiac studies is now well established. Of the various methods available for obtaining phase and related images, four were chosen for intercomparison. These were:

CORRELATION OF PHASE AND AMPLITUDE IMAGES WITH MODERATE AND SEVERS CORONARY ARTERY STENOSIS. D. Kyriaki-Manolaraki, S. Rokas, D. lWaintas, C. Zerva, P. Kostamis, S. Moulopoulos and C. Zonstantinidis.

(i) conventional single-Harmonic Fourier phase imaging. (ii) time-to-minimum functional imaging following multi-harmonic Fourier curve-fitting. (iii) Factor imaging following polar transformation (factorial phase imaging). (iv) Factor imaging following oblique transformation (physiological factor imaging). These methods were compared for 100 patients using a perception experiment I in which observers were asked to rate the degree of abnormality in each image. The results were then analysed using receiver operating characteristic curves. Statistical parameters measuring mean~ variance i and co-variance of phase over the left ventricle were calculated and compared for each method. An interpretation of these parameters is included. Factorial methods were shown to he extremely useful but required greater operator training and longer computer times.

Department of Nuclear Medioine~ Royal Naval Hospital t gaslar~ Gosport, Hampshire PO12 2AA, England.

Div. of ihclear Medicine. Dept. of Clinical Therapeutics, Athens University, "Alexandra, Hospital, 80, Vas. Sophias Ave., GR-115 28, GREECE.

Departement autonome des Radioisotopes, Centre Hospitalier J.Bracops, 79, rue Dr Hoot, ~O70, Bruxelles, Belgique.

A 544

A 545

OBJECTIVE EVALUATION OF THE PHASE IMAGE ' A COMPARISON OF DIFFERENT METMODS~

EVALUATION

A 546 OF V E N T R I C U L A R

TERNS IN PATIENTS

PHASE PAT-

WIll W-P-W SYNDROME

J.Eettich,V.Fidler,P.Rakovec,I.Kranjec J.C. LIEHN, DESCHILDRE, J. VALEYRE.

P. HANNEQUIN, S. AMICO, A. J. ELAERTS, A. B A J O L E T and Ventricular

The r e s u l t s of X - r a y LV a n g i o g r a p h y are c o m p a r e d to the r e s u l t s of i00 Equilibrium Gated Cardiac Studies processed by Fourier Analysis and various methods of objective e v a l u a t i o n of the P h a s e Image. T h e s e m e t h o d s c o m b i n e the f o l l o w i n g f e a t u r e s : d e s c r i p t i o n s of the Phase Image by the Phase Histogram or by the Amplitude Weighted Phase Histogram Or b y the V o l u m e W e i g h t e d P h a s e H i s t o g r a m or by the Error Corrected Phase Distribution Function or by the Spatial Variance Weighted Error C o r r e c t e d Phase D i s t r i b u t i o n F u n c t i o n (both p r o p o s e d by SL B A C H A R A C H ) / description of the Histogram or D i s t r i b u t i o n F u n c t i o n by the S t a n d a r d a v i a t i o n or b y the S k e w n e s s or b y the Kurtosis or by the Reflected Area ( d e f i n e d by SL B A C M A R A C H ) / w i t h or w i t h o u t T i m e - S p a c e S m o o t h i n g / w i t h or w i t h o u t D i a s t a s i s F r a m e E x c l u s i o n (as p r o p o s e d by PH VOS). E a c h of those 68 m e t h o d s is c h a r a c t e r i z e d b y the A r e a u n d e r Curve o f the c o r r e s p o n d i n g ROC curve, the X-ray Study being our G o l d e n Standard. R e s u l t s s h o w that the m e t h o d s u s i n g the S t a n d a r d D e v i a t i o n as d e s e r i p tot o f the Histogram Or D i s t r i b u t i o n F u n c t i o n are b e t t e r than any o t h e r m e t h o d s . W i t h i n this g r o u p of methods the differences are probably not significant. The best result is obtained by the Spatial Variance Weighted Error Corrected Phase Distribution Function (Area u n d e r ROC C u r v e =.89). INSTITUT FRANCE.

J.

GODINOT

and

CHR,

REIMS

It is possible for normal wall motion to Occur in the presence of significant coronary artery stenosis. The abi]ity of phase and amplitude parametric images to detect wall motion abnormallties in moderate (60-80%) and severe (81]00%) coronary artery stenosis revealed by coronary angiography (CA) was estimated for patients with ischaemic heart disease. From a total of I00 patients who underwent radionuclide ventriculography (RV) and CA, the results from 33 patients are presented. The RY was performed at rest in the LA0 40 ° projection and the average time between the RVand CA was 7.5 days. The phase and amplitude images were graded as normal, and mild, moderate and severe abnormalities. The areas of the left ventricle studied were: The anterior septum, the anterior, the lateral~ the posterior and the inferior wall. The max sensitivity for the phase image was 77.8% for severe angiographie abnormalities of the anterior wall and the rain was 20.0% for abnormalities in the lateral wall. For amplitude the max was 71.~% for moderate abnormalities in the ant. septum and the min was 0.0% in the inferior wall. For phase and/or amplitude the max was 81.2% in the anterior and the min was 33-3% in the lateral wall_ The specificity ranged from 100% in the lateral wall to 72.2~ in the posterior wall. The Overall sensitivity was 64.3% and the overall specificity 83.6%. It can be concluded that phase and amplitude images derived from RV have a high specificity but only a moderate sensitivity for detecting moderate and severe degrees of coronary stenosis in pts. with ischaemic heart disease.

studied

contraction

in 21 p a t i e n t s

me u s i n g p h a s e dionuclide

images

ventricular

studied.

citation,

con-

phase

The data were compared of e l e c t r o p h y s i o l o g i c

the e a r l i e s t

area appeared

Patients with

contraction,

in the RV,

RV phase proceeded

while

the mean

left-sided

precontraction

the m e a n

LV p h a s e .

preexcitation

in the LV, a n d t h e

of m e a n L V p h a s e .

septal preexcitation

Patients

had normal

or n e a r l y n o r m a l v e n t r i c u l a r patterns

of t h e

o f the e a r l i e s t

In all patients with RV preex-

studies.

with

six LV s e g m e -

to t h e m e a n v e n b r i c u l a r

with the sesults

advance

right

mean phases

as w e l l a s the r e l a t i o n

traction

had

and

by ra-

Differen-

(LV) a n d

(RV) p h a s e s ,

p h a s e o £ the a r e a

were

obtained

left

in t h r e e R V s e g m e n t s nts,

sequence was with WPW syndro-

ventriculography.

ces b e t w e e n m e a n

and no significant

activation

differences

between RV and LV mean phase angles. The procesure noninvasive

s e e m s to be a n a c c u r a t e

m e t h o d of a s s e s s i n g

m a l s i t e s of i n i t i a l

ventricular

abnoracti-

vation. DDiversity Medical Zalo~ka

V A L U E OF THE P H A ~ D I S P L J ~ ~-~THOD F O R D E T E C T I O N OF VENTldlCULaR P H E E X C I T ~ T I O ~ IN P A T I E N T S ~ITH WPW S I ~ D R O M E . J. M a s ter, L. Csernay, Gy. ~larosi, L. RagEs, E. M~td, I. Prdda, Gy. K o z m a n n , Z. A n tal6czy

Centre

- UK~/M

7, 6 1 0 0 0 L j u b l j a n a ,

Yugoslavia

12 p a t i e n t s w i t h W P W and 12 w i t h L G L s y n d r o m e w e r e i n v e s t i g a t e d by E C G - g a t e d b l o o d p o o l v e n t r i c u l o g r a p h y at two d i f f e r e n t p o i n t s of time. The d a t a a c q u i s i t i o n w a s c a r r i e d out f r o m 3 d i f f e r e n t d i r e c t i o n s /LA0-15, LA0-30, I A 0 - 4 5 / b y a H u n g a r i a n c o m p u t e r s y s t e m in e a c h i n v e s t i g a t i o n . The s e c u e n c e of contraction of the v e n t r i c l e w a l l s was a n a l y s e d b y the h e l p of the p h a s e d i s p l a y m e t h o d by two u n d e p e n d i n g o b s e r v e r s . The v e n t r i c u l a r p r e e x c i t a t i o n could be i d e n t i f i e d unambigu/ously in ll c a s e s of 12 p a t i e n t s w i t h W P W s y n d r o m e on the b a s i s of the v e n t r i c l e , c o r r e s p o n d i n g to the 12 lead E C G f i n d i n g s . I n one case the a c c e s s o r y p a t h w a y n e a r the s e p t u m could n o t be i d e n t i f i e d / s e n s i t i v i t y : 92 %/ An e a r l y v e n t r i c u l a r y c o n t r a c t i o n was d i a g n o s t i cated f a l s e l y i n 3 of the 12 p a t i e n t s w i t h L G L s y n d r o m e on the b a s i s of p h a s e d i s p l a y m e t h o d / s p e c i f i c i t y : 7 5 9~/. The r e p r o d u c i b i l i t y of the u s e d m e t h o d was v e r i f i e d b y r e p e a t e d i n v e s t i g a t i o n s . The u s e of s e v e r a l d i r e c t i o n s of d a t a a c q u i s i t i o n p r o v e d to be u s e f u l l e s p e c i a l l y in cases of a c c e s s o r y p a t h w a y s n e a r to the s e p t u m or on the p o s t e r i o r p a r t of the b a s i s of the l e f t v e n t r i c l e . The a u t h o r s in o r d e r to p r o v e t h e i r p r e l i m i n a r y r e s u l t s u s e d the b o d y s u r f a c e m a p p i n g m e t h o d w h i c h a c c o r d i n g to l i t e r a r y d a t a is a l s o s u i t a b l e to l o c a l i s e p r e e x c i t a t i o n in n o n i n v a s i v e way. T h e y draw in their report their conclusions on the b a s i s of e x p e r i e n c e r e c e i v e d f r o m an essentially increased case-number. U n i v e r s i t y M e d i c a l School, I n s t i t u t e of Nuclear Medicine H - 6 7 2 0 Szeged, Kor~tnyi f a s o r 8. H u n g a r y

A90 A 547

A 548

A 549

~ A L U A T I O N OF LEFT VENTRUCULAR (LV) FUNCTION IN PATIENTS W I T H LEFT BUNDLE B R ~ C H BLOCK (LBBB) OR RESPIRATION DEPENDANT PACEMAf[ER (RDP) USING RADIONUCLIDE VENTRICULOGNAPHY (RNVG). J. Happ, F. Beyersdorf, E. Klepzig, Jr.~ R. Pc DSrhSfer, J. Kreuzer, F. D. Maul, R. Standke and G. H~r

RADIONUCLIDE VENTRICULOGRAPHY IN PATIENTS WITH LEFT BUNDLE BRANCH BLOCK (LBBB)-HEMODYNAMICS AND WALL MOTION ANALYSIS OF THE LEFT VENTRICLE. D. E i S n e r , S. H e i d e , K. Hahn a n d T. M e i n e r t z

FC~RIERANALYSIS ON ROI VENTRICULAR AP~EAS IN THE STUDY OF CARDIAC CONDUCTION DISTURBANCES. J.L.Chamorro;J.I.Pinedo;M.D.Mar~n;E.de Teresa; D.Hell[n;J. Ortiz Berrocal

LV function during exercise has been evaluated in 2 patients with LBBB and 6 patients with programmable RDF (RDP 2, alpha, ESln, FRG) implanted for complete AV block, bradyarrhythmia or sick sinus syndrome. Equilibrium RNVG was carried out at rest as well as during exercise (multistage, graded tread mill ECG test) and global (GEF) and sectorial ejection fraction (SEF) were measured. Regional asynchronia was quantified by Fourier's analysis and determination of sectorial phase shift. With increasing heart rate ( ~ ) during exercise, %he LBBB patients presented increasing 8PH and decreasing SEF in the posterolateral (PL) region of the LV wall. This prevented an increase in GEF in I patient and even caused a gradual decrease in GEF in the other patient. M a x i m u m cardiac output (CO) occurred with sub-maximum HR of 115 %o 150 bpm. HR dependant increase of SPH and decrease of the PL wall was also found in 6 patients with RDP. In I of the patients this phenomenon was demonstrated by H R v a r i ation at rest. Different KR were programmed in 4 patients who, during exercisej showed the highest CO values with a moderate increase in RR of approximately 115 bpm. Our ENVG data show thatt in patients with LBBN and RDPp decompensation of the LV due to HE dependant increase of asynchronia and hypocinesda of the PL wall may occur during exercise. This illustrates the value of NNVG for determination of exercise tolerance in the individual patient with LBBB and for individual programming of RDP. Div. of General Nuclear Medicine~ Dept. of Radiology t Div. of Thoracic and Cardiovascular Surgery, Dept. of Surgery and Div. of Cardiology~ Dept. of Internal Medicine, Univ e r s i t y of Frankfurt, Theodor Stern-Kai 7, 6000 Frankfurt/Main, Fed. Rep. G e r m a n y

Ventricular conduction anomalies such a s LBBB l e a d t o d y s s y n e r g i c contract i o n s o f t h e m y o c a r d i u m a n d may - m o r e or less - reduce left ventricular eject i o n f r a c t i o n . The p r e s e n t p a p e r rep o r t s the { e s u l t s of f i r s t p a s s - R N V in 24 p a t i e n t s w i t h L B B B a n d c o m p a r e s t h e r e g i o n a l w a l l m o t i o n a n a l y s i s w i t h the f i n d i n g s of 2 D - e c h o c a r d i o g r a p h y . The r a d i o n u c l i d e v e n t r i c u l o g r a m s were obtained using a multicrystal gamma camera with high count rate capability ( B a i r d A t o m i c S y s t e m 77). 9 9 m - T c - p e r t e c h n e t a t e or - m o r e r e c e n t l y - 1 9 5 m - A u w a s u s e d for b o l u s i n j e c t i o n . 10 pat i e n t s h a d a s u p i n e r e s t s t u d y only, in 14 an a d d i t i o n a l e x e r c i s e i n v e s t i g a tion was performed. C o m m o n f i n d i n g s of w a l l m o t i o n a b n o r m a l i t i e s w e r e h y p o - or a k i n e s i s o f t h e interventricular septum often extending to t h e p o s t e r i o r / i n f e r i o r wall of the left ventricle. Echocardiography showed similar results. In m o s t of t h e p a t i e n t s w i t h s e v e r l y impaired left ventricular function ( e j e c t i o n f r a c t i o n b e l o w 30 %) d y s k i n e t i c a r e a s c o u l d be d e t e c t e d . The exercise response varied with the d e g r e e of l e f t v e n t r i c u l a r f u n c t i o n i m p a i r m e n t at r e s t a n d t h e u n d e r l y i n g disease.

The use of phase analysis,amplitud image,eje~ tion wave and phase histogram obtained by Fourier analysis have allowed to get physiological information concerning to the sequence of ventricular emptied and its modifications due to disturbances of electrical conduction. Material & Method: It has been studied 35 patients,7 with RBBB and 28 with LBBB. 8 normal subjects were used as control group. At a first step The F.analysis was appliedon the total image,beeing the phase histogram very often not demonstrative of the differences between LV & RV emptying. By this reasons a second step was carried out,in which F.analysis was obtained from ROI in each ventricle,showing an indepen~ dent phase histogram. Overlapping both of them was easier to figure out the differences between both ventricular emptying. Results: In the control group the phase histogram showed a difference of less tha 5 ° in 6 cases. In the two remaining ones the differences obtained were 8 ° & 10 ° respectively. In 4 normal subjects the nadir was in the same frame in 3 was delayed one frame in LV and in one was ~alayed one frame in RV. LBBB: from 28 patients studied,18 (64%) showed differences > 20°;S were in the range 15°-20 ° and 2 in the range 10-15 °. RBBB: The differences betweeh both apex histograms (LV&RV) were less significatives. In 5 cases the range was 15°-20 ° and in 2 was I0°-15 ° . ( In all these patients the ventricular activation was delayed in RV ). Conclusions: The ejection wave and phase ima ge obtained by F.analysis from total image ares less demonstrative than those obtained separately from each ventricle mainly if we use ~2 frames instead of 16. Cl~nica Puerta de Mierro. Madrid. Spain.

A b t e i l u n g fur N u k l e a r m e d i z i n Klinikum der Johannes GutenbergUniversit~t Mainz Langenbeckstr.1, D 6500 Mainz

A 55O

A551

A552

A U T O N O M Y IN E U T H Y R O I D G O I T R E : P R E C U R S O R OF N O N - I M M U N O G E N I C HYPERTHYROIDISM IN AN AREA OH IODINE DEFICIENCY

DESIGN AhD EVALL~TION OF AN ASSAY OF THYROID STIPEV~ATING IMMUNOGLOBULINS (TSI). Ph.Sauvage, P. De Coster, E. Avalos, C. Cornette, Ph. De Nayer and C. Mockers.

TIME FOR A NEW CONCEPT IN THYROID ROUTINE IN VITRO DIAGNOSTICS. I. B6ttger and H.W. Pabst

D. E m r i c h ,

H. S c h i c h a

Previous investigations have shown that a g e 2 5 0 y r s . , t h y r o i d w e i g h t > 5 0 g, thyroid nodules and a non-homogeneous thyroid scan are simple but not specific i n d i c a t o r s of a u t o n o m y in pts. w i t h euthyroid iodine-deficient goitre, who s h o w a s u b n o r m a l T R H test. T o g e t h e r w i t h the e x i s t e n c e of e n d o c r i n e o p h t h a l m o p a t h y a n d i n c r e a s e d t i t e r s of m i c r o s o m a l a n t i b o d i e s t h e s e s y m p t o m s w e r e u s e d in a c u m u l a t i v e w a y for a t r i a l to s e p a r a te 326 h y p e r t h y r o i d pts. w i t h o u t a u t o nomous adenoma into those possibly having non-immunogenic (NIM-HY) a n d i n t o those possibly having immunogenic (IMHY) h y p e r t h y r o i d i s m . In o r d e r t o p r o v e t h a t t h i s w a y of separation has a sufficient probability of b e e i n g c o r r e c t T h y r o t r o p h i n d i s p l a c i n g a c t i v i t y (TDA) w a s d e t e r m i n e d in 120 h y p e r t h y r o i d pts. s e p a r a t e d i n d e p e n dently by the symptoms mentioned above. T h e i n c i d e n c e of T D A in 57 pts. c l a s s i f i e d as p o s s i b l y h a v i n g I M - H Y w a s 79 % a n d in 63 pts. c l a s s i f i e d as p o s s i b l y h a v i n g N I M - H Y w a s 3 %. T h e l o w i n c i d e n ce of T D A in N I M - H Y w a s in the s a m e r a n g e as in 237 pts. w i t h e u t h y r o i d goitre and euthyroid or hyperthyroid autonomous adenoma. From

these results we conclude that aug o i t r e m i g h t b e an i m p o r t a n t p r e c u r s o r of N I M - H Y e s p e c i a l ly in a r e a s w i t h i o d i n e d e f i c i e n c y .

tonomy in e u t h y r o i d

Dpt. N u c l e a r M e d i c i n e , U n i v e r s i t y Goettdngen, Robert-Koch-Str. 40, D-3400 Goettingen, F.R.G.

of

It is now well ack~itted that TSI are involved in the pathogenesis of Graves'disease. The aim of this work was to establish an assay of TSI helpful in the clinical diagnosis and follow-up of hyperthyroid patients. The method was developed starting frc~a the method described by Kleinman et al. (J.Lab.Clin.Med., 1980, 95:581) using h~nan thyroid m6s~ranes.Thyroid adenylate cyclase-stimulating activity was detelqnined by the generation of cyclic (32p) AMP after incubation of thyroid m~mbranes, immunoglobulins (IG) and (32p)ATP. IG were purified by ammonil~n sulfate precipitation followed by desalting by chrc~atography on Sephsdex G-50 gel. The results were expressed as percent of basal activity (100%). In 26 assays using 4 different ma~branes preparations, the average basal activity (BA) was 183 pmoles cAMP/rag prot. generated in 15 sin (CV 8.8%). The response to NaF (20 raM) stimulation averaged 743% of the BA (CV 9%). The validity of the test was further ascertained by testing TSI positive IG which yielded a response of 175% (CV 7.6%) versus ~ormal IG (105%, CV 6.7%). Clinical evaluation was perf o x e d in 92 patients referred to the thyroid clinic : 32 patients were found to be negative, 60 positive. All 32 TSI (-) patients did not present any symptc~ of hyperthyroidism. Among the 60 TSI (+) patients, 28 were clinically euthyroid and 32 hyperthyroid. The followup of the euthyroid TSI(+) patients revealed a relapse in 3 cases. The clinical interest of this assay was confixraed by the finding that 12 out of 13 newly diagnosed Graves patients were TSI(+) . In addition, in 23 patients presenting with ophtalroopathy, 19 (83%) were TSI (+) : 12 of these patients were euthyroid and 7 hyperthyroid. These results are in agreesent with recently published data. In conclusion, the proposed method is adequate for evaluation management of patients with Graves' disease and as such useful for routine analysis. Depart6~ent of Nuclear Medicine,University of Louvain Medical School, Brussels, Belgium.

Thyroid routine in vitro diagnostic procedures are developing continuously in direction of higher diagnostic sensitivity/specificity and also simplicity. The latest developments are: FT4, FT3, hTg antibodies (AM), TSM receptor AB and sensitive one-day TSH by radioligand assay (RLA) as well as by enzymeligand assay (ELA). During the past fou~years we presented a series of data especially underscoring the very high laboratory performance and high clinical value of FT4 and FT3 and the very high clinical value of hTg. Up to recently FT4 and FT3 were offered alternatively to the T4/TBG and T3/TBG ratio. hTg by RIA has already substituted 2 - 3 years ago for the routine whole-body scan with 1-13i in otherwise complete follow-up of differentiated thyroid carcinoma. Furthermore, recent evaluation of two new sensitive one-day TEE LA (IRMA and ELISA) on monoclonal antibody basis revealed an especially high laboratory and clinical performance of the IRMA with good separation of eu- from hyperthyroidism by basal TEE. Based upon our experience as well as upon the literature we recently changed our routine diagnostic program as offered to the in- and outpatient clinics of our ~ i v e r s i t y accordingly as presented below: Routine parameters: FT4, FT3, TSH (TRH-test), microsomal and hTg AM, hTg Special parameters: TT4, TT3, rT3, TUG, TT4/TBG and TT3/TBG ratio, TSN receptor AB (TRAM) Indications: I. euthyroidism(confirmation): FT4, FT3; 2.hyperthyroidism: FT3* (+ TRH-test, e.g. in borderline cases, autonomy, iodine application) ; differentiation by ABs, especially TRAM; 3. hypothyroidism: FT4*, basal TSB (TRM-test in borderline cases); differentiation by TRH-test; 4. follow-up: a) euthyroid goiter on I-T4:FT3 (TRH-test); b) hyperthyroidism: FT3, FT4 (+ ABS, especially TP~AB, in Graves' Disease); c) hypothyroidism: FT4, basal TSH (TRH-test); d) differentiated thyroid carcinoma: hTg, hTg AB, TRNtest during TSH suppression. The new TSE IRMA may render some of the TRN-tests unnecessary in 2., 3. and 4. * also emergency Nuklearmed. Klin. TUM, Ismaninger 22, M0nchen 80

A91 A 554

A553 DIAGNOSTIC VALb~ OF EARLy AI{D DELAYED TL-201 THYROID SCINTIGRAPHY IN THE EVALUATION OF COLD NODULES F0R M~LIGNANCY. E. Henze, H. Bthrer~ J. W~itzinger, W. Hansi, W.E. Adem~ Recently, there have been promising reports on the value of T1-2O~ scintigraphy for the evaluation of benign and/or malignant thyroid nodules (R. 0CHI, e t a l . , C~TCER 50:236-240, 1982) showing a 95% sensitivity and a 90% specifity. It was the purpose of this prospective study to test the usefulness of T1-201 thyroid scanning for decision making in patients presenting with cold nodules. 26 consecutive patients with scintigraphically cold nodules underwent quantitative thyroid scanning immediately after i.v. injection of 2.0 mCi TI-201 8nd 3-4 hrs later. ~\l patients subsequently underwent surgery for extirpation of the nodule or thyroidectomy, respectively, so that in all cases the final diagnosis was proven histologically. According to the score given by 0CHI increased uptake in the cold nodules relative to normal thyroid tissue on both the early and the delayed scan was considered malignant (positive), whereas similar or decreased uptake was interpreted as benign (negative). Five of the 26 patients had malignant nodules. However, only 3 of these revealed positive scans (60%), whereas 2 were false negative. Out of the 21 patients with benign nodules 17 had a true negative scan, while h demonstrated a malignant pattern (false positive). In conclusion, the results of this prospective study do not confirm the previous optimistic reports on the usefulness of thyroid T1-201 scintignaphy for the diagnostic evaluation of cold nodules, ~;hieh is in our experience only of limited diagnostic value, with a sensitivity of 60% and a specificity of 80%.

IMPROVING METHODS FOR TH~ LOCALISATION OF PARATHYROID LESIONS. M.L. Wastie, F.D. Smith, A.C. Perkins and J.G. H~rdy. Ten patients ~_th biochemically proven primary hyperparathyroidism were imaged using TI-201 with Tc-99m subtraction. Each patient was imaged 5 minutes after am intravenous injection of 70 MBq Tl-SO1-thallous chloride followed by administration of 70 MBq Tc-99m-sodium pertechnetate through the same canula. After allowing 10 minutes for pertechnetate localisation a Tc-99m image of the thyroid was recorded. To minimise movement artefacts the patient gs head~ neck and shoulders were supported in a vacuum immobiliser. Subtraction of the thyroid image from the thallium image resulted in clear visualisation of the abnormal parathyroid glands in nine patients, These findings were confirmed at surgery. Images of one patient showed abnormal uptake throughout the left lobe of the thyroid which was found to be a psmathyroid carcinoma. Follow-up imaging one month following surgery showed no pathological uptake. Thallium uptake was particularly helpful in locallsing an adenoma in the mediastinum whfch was well demonstrated without the need for background subtraction. T1-201 was administered during surgery and a small sterile radiation probe was used to aid the e x c i s i o n . Departments of Radiology and Medical Physics, UniversityHospital, Nottingham, Englsmd.

Nuclear Medicine Division, University of Ulm, D-7900 ULM, Germany

A555 MODIFIED DETECTION R.Achten, G.Somers,

DATA ACQUISITION PROTOCOL FOR OF PARATHYROID TUMORS. A.Bossuyt, A.Dupont, M.Ingels, M.H.Jonckheer.

TC04/TI-201 substraction scintigraphy h a s b e e n d e s c r i b e d as a s u p e r i o r m e t h o d for the identification of parathyroid tumors in p a t i e n t s with established primary hyperparathyroidism (Ferlin, JNM). Beside the abundant Hg-K--X-rays (66-84KeV), TI-201 emits gamma r a y s at 1 3 6 K e V (2%) a n d 1 6 7 K e V ( 8 ~ ) . We proved that the influence of t h e s e s p a r s e T I 201 g a m m a rays on a TcO 4 thyroid image was negligible. Hence we propose an a l t e r n a t i v e p r o c e d u r e b a s e d on an i n v e r s i o n of the T e O 4 / T 1 - 2 0 1 injections (T1201 before Tc04). As opposed to the original method, this allows a simplified data processing procedure without deteriorating the a c c u r a c y . After injection of ImCi TI-201, the patient is p o s i t i o n e d under a gamma camera. A 300kcts image is a c q u i r e d . W i t h o u t m o v i n g the p a t i e n t , I m C i T c O is i n j e c t e d a n d 10 m i n u t e s l a t e r a 3 0 0 { c t s T c O 4 t h y r o i d i m a g e is taken. B o t h i m a g e s are background-subtracted and normalised. After subtraction of the Tc04 image from the TI-201 image, hot areas were considered parathyroid tumors. Scans in 5 patients showed a total of 8 residual hot areas. Four of these were parathyroid adenomas, two were hypertrophied parathyroid glands, one was a t h y r o i d a d e n o m a and o n e w a s an a r t e f a c t . One hypertrophied g l a n d w a s n o t seen. Beside parathyroid tumors certain other lesions may be visualised: thyroid nodules, a c t i v e l y m p h e n o d e s a n d veins. The m o d i f i c a t i o n of the d a t a a c q u i s i t i o n p r o t o c o l w i l l n o t i n f l u e n c e t h i s l a c k of specificity of T I - 2 0 1 . AZ-VUB,Laarbeeklaan

101,

B-1090

Brussels

A556

A 557

A558

AUTOLOGOUS INDIUM-Ill LABELLED PLATELETS VERSUS Tc-99m FIBRINOGEN IN THE DETECTION OF DEEP VENOUS THROMBOSIS. P.F. Sharp, H.M.A. Towler, D. Hadley, P. Buckler, B. Bennett and F. Smith.

THROMBUS SCINTIGRAPHY WITH BADIOLABELED NONOCLONAL ANTIBODY IN THE DOG. Z.H. Oster, S.C. grivastava, P. Som) G.E. Meinken, B.S. Culler, L.E. Scudder, H.L. Atkins, A.B. Brill.

Tc99m PLASMIN TEST USING PROBE AND G A g ~ CA~AKA FOR DETECTION OF D ~ P VEIN THROMBOSIS. R.A.Vald6s Olelos and H.J. Serdijn.

Both lllln-labelled platelets and 99mTc labelled fibrinogen have been proposed for detecting deep vein thrombosis - D ~ F f - i n the calf, thigh and pelvis. We have compared the two methods in a group of 50 patients to date with either clinically suspected DVT (38 patients) or at risk of DVT following fractured neck of femur (12 patient~ . All patients were scanned 24 hours after injection of autologous lllIn-labelled platelets, then underwent bilateral ascending venography and thereafter 99mTc-fibrinogen scanning. Twenty-five patients were receiving anticoagulants (21 heparin and 4 warfarin) at the time of study, Thrombosis was recorded as being detected in calf, thigh, or pelvis by each method. Venography detected thrombosis in 44 sites in 95 limbs studied, lllIn-platelet scanning detected thromhosis with a sensitivity of 48%, specificity of 97%, positive predictive value PPV - of 75% and ~egative predictive value NPV of 91%. 9 mTc_fihrinogen scanning gave results of sensitivity 39%, specificity 93%, PPV 52%, and NPV 89%, Anticoagulation did not significantly influence the results. -

-

It is concluded that radionuelide imaging with lllln-laballed platelets is a useful technique in the detection of DVT and superior to imaging with 99mTe-fibrinogen. University of Aberdeen, Department of BioMedical Physics and Bio-Engineering, Foresterhill, Aberdeen AB9 2ZD, Scotland.

The current methods of thrombus imaging are less than ideal and essentially limited to the extremities. We have investigated the possibility of imaging thrombi located in the trunk by using an antiplatelet monoclonal (7E3) antibody labeled with 1-123 (chloramine-T method) or In-Ill (antibody - DTPA conjugate). The specific activity of the 1-123 and In-lll preparations was 20-300 pCi/pg and 10-30 ~Ci/Bg, respectively. The antibody is an Egg i that binds to the glycoprotein 2B-3A complex on human platelets and blocks ADP-indueed aggregation of both human and dog platelets by inhibiting the binding of fibrinogen to the platelet surface. When radiolabeled 7E3 antibody was incubated with whole blood (0.13 pg/ml) and the mixture then clotted with thromhin (I U/ml) 68% of the radioactivity remained with the clot despite repeated washing. Initially, uptake was high in the dog liver with subsequent accumulation in the spleen. Blood activity persisted for up to 24 hr. Venous or arterial injury sites were consistently localized but intravenously formed thromhi (isolated vein segment injected with thrombln and formed clot released) was not always reproducible probably due to their low platelet content. However, arterial thrombi produced by placement of a copper wire into s lobar pulmonary artery were easily detected whe~ platelets were labeled exvdvo by incubation of whole blood with radiolabeled antibody (without washing) before relnjecting. No blood pool subtraction was necessary for this procedure. We conclude that radiolabeled antiplateiet monoclonal antibodies should be investigated in humans for iocallzlng arterial thromhl in the pulmonary and coronary elrnulation, intra-cardiac thrombi and sites of suspected vascular damage with clot formation. Medical Dept., grookhaven National Laboratory, Upton, New York, USA. Work performed under contract DE-AC02-76CHOOHI6 with the U.8. Dept. of Energy.

Tc99m plasm//~ test, a rapid and sensitive test in the diagnosis of deep vein thrombosis (DVT) , is usually performed with a NaI probe system (Lysotec) 10-30 minutes after /_njection of 17.5 of Tc99m plasm/J] (Lysofibrin) . Counts are made at 10-15 points on the legs with the lower extremities elevated 45 degrees. An increase in radioactivity is considered to be suggestive of DVr and is expressed in Q units. Criterion of a positive test is at least three points adjacent on the suspected leg with an increase in uptake (>13 or .<-3) , or one poinh with more than 13 or less than -13. We use the probe method as an initial screeningtest for DVT in otrc hospital. In 25 patients with clinical suspected DVT and with a positive probe test we performed consecutively a test using a garsna car~era (LVOF~ siemens). 300-400 k-counts views of ankles, cal yes, ~neeregions (posterior) and thighs/pelvis (~/]terior) were made with the legs elevated between 10 and 30 min. after a second injection of 370 MBq Tc99m plasmin. Dynamical data obtained with a Ganlna 11 system were processed and the Q-expressions were calculated from I 015 symmetrical ROI's delineated on the deep vessels of the legs. Gaalr~ camera test was positive in 24 of 25 patients. Most frawes showed hot spot with or without veinocclusion and were interpreted as ccapatible with DVT. Some studies with c~ly diffuse uptake were considered as low probable U~T. Specificity and sensitivity of this sciztigraphical imaging interpretation using X-ray phlebography as a reference method has yet to be determined. Here we have a prospective study in progress. We conclude that Tc99m plasmin test with garm~ camera and computer processing is a easy,rapid and sensitive test for D~T probable due, among other factors, to a real thrombous uptake of plasmin. Scintigraphical imaging promises a high specificity in the diagnosis. Dept. of Nuclear Medicine, Medical Center ~ar, van Everdingenstraat 18, Alka~ar, %~e Netherlands.

A92 A559

A 560

A561

RADIONUCLIDE VENOGNAPHY ( F N V ) IN T H E MONITOR OF TH~OMBOPHLEBITIS (TP) OF T H E PELVIS AND/OP LOWER LIMBS. W.M. Sy and I.S. S e e

SEQUEN]IAL IOTAL BODY BLOOD POOL SDINIIG R A P H Y FDR MEASUREMENT OF C H A N G E S IN REGIONAL B L O O D V O L U M E S I N D U C E D BY V A S D DILATORS. R- Itti, D. C a s s e t , H. B e n j e l loun, B. C h a ~ b o n n i e r and M. B r o c h i e r .

THE STUDY OF LYMPH FLOW ABNORMALITIES IN CHRONIC LIMB OEDEMA BY EADIONUCLIDE IMAGING. 0. Stewart, J. I. Gaunt, D. N. Croft and N. L. Browse.

890 RNVs using the large v o l u m e 99mTc 04- technique were performed in 795 adults (Aug. 1977-Oct. 1983) who were clinically suspected to have TP of the lower limbs and/or pelvis. Sixty five adults with scintigraphically documented TP had baseline and follow-up PNVs totalling 147. Fifty had unilateral v e n o u s c i r c u l a t o r y impairment, of which 33/50 (63.5%) involved the left side and 19/50 (37.5~) the right side. Eleven had bilateral involvement and in 4 t h e i n f e r i o r y e n & c a v e w a s o c c luded. The higher incidence on t h e left side was attributed to the longer and more horizontal c o u r s e of t h e left common iliac vein. Altogether there were 123 identifiable s i t e s of d e e p venous impairment or o c c l u s i o n . "Normalization" of f l o w p a t t e r n , as characterized by recanalization of previously occluded veins and partial or significant disappearance of abnormal venous collaterals occured in 37. In 22 n o i n t e r v a l changes were recorded 13 of t h e s e p a t i e n t s however had their follow-up BNV performed in l e s s t h a n 14 d a y s . In s i x t h e f l o w p a t t e r n worsened. The results correlated well with the clinical c o u r s e of t h e p a t ients. R N V is an e x c e l l e n t , benign monitor i m a g i n g t o o l in TP of p e l v i s / l o w e r l i m b s a n d is r e c o m m e n d e d for such situations. The Brooklyn Hospital, 121 Avenus, Brooklyn, New York

DeKalb 11201 USA

Changes in r e g i o n a l b l o o d v o l u m e s may be quantitated using repeated total body records and taking advantage of the stability of b l o o d p o o l a c t i v i t y a f t e r "in vivo" labelling with technetium 99m. In a g r o u p of 18 c l i n i c a l l y stable patients referred for a c a r d i a c b l o o d p o o l examination~ the r o u t i n e s t u d y h ~ s b e e n completed, w i t h o u t any f u r t h e r i n j e c t i o n of r a d i o a c t i v i t y , by a s e r i e s of 4 t o t a l body records, at 15 m i n u t e s intervals. Patients have been divided into 3 subgroups: 6 control patients without any intervention d u r i n g the s e q u e n c e of records, 6 patients receiving, a f t e r the first r e c o r d , an intravenous injection of 2 m g m o l s i d o m i n e (CORVASAL) and 6 p a t ients treated with 3mg oral molsidomine. On a counting profile constructed over the total body, after exclusion of arms, areas were selected as m a x i m a or m i n i m a : head, heart, abdomen, bladder, t i g h s and calls. Relative count changes were quantified in ~ of variation with respect to the first record t a k e n as a r e f e r e n c e . In the control g r o u p , mean c h a n g e s were less t h a n 1~ i n a l l sectors, except for the bladder, due to a certain urinary excretion of technetium. After I.E. molsidomine, cephalic and cardiac counts lowered rapidly (-S.]~,p
Irousseau,

37044

TOURS-CEDEX,

France.

Following injections of 99mTc Rhenium Sulphur Colloid into the second interdigital space of 55 limbs, images of the ilio-lnguinal lymph nodes were obtained at 38 mins., I, 2 and 3 hours using a gamma camera. 34 limbs (26 patients) had the clinical and radiological features of primary lympheedema, 10 limbs (8 patients) had venous oedema, and 12 limbs (6 volunteers) were normal. The ilio-inguinal lymph nodes were visuallsed at 30 minutes in all 12 control limbs and in the 10 limbs with venous disease, but in only one of the 34 lymphoedematous limbs. The amount of activity present in each ilio-inginal lymph node chain at 30 minutes, estimated as a percentage of the injected activity was significantly lower in the 34 iymphoedematous limbs (0.042% ~ 0.072) than in the 12 control limbs (1.4% ~ 0.7)*. The 10 limbs mi~h venous disease had a significantly higher intake (2.3% ; 0.84)** than the control limbs. The percentage uptake of the colloid in the ilio-inguinal lymph nodes at I, 2 and 3 hours increased with time in both the venous and control limbs while comparison of the control and venous limbs showed that the venous limbs maintained a statistically higher uptake in the lymph nodes at I, 2 and 3 hours. The 34 lymphoedematous limbs showed a persistently low uptake of the colloid throughout the study. On visual interpretation the sensitivity of this technique in diagnosing lymphoedema was 97% and its specificity 100%. Estimation of the percentage uptake of the colloid has demonstrated the slow lymph clearance associated with lympboedema and the increased lymphatic flow that may be associated with venous oedema. The technique differentiates between normal limbs, lymphoedema and venous oedema and can be used as a simple diagnostic outpatient technique in the investigations of chronic limb oedema. * p <0.001

** p : 0.015

St. Thomas' Hospital,

(unpaired

t-test)

London. England.

A 562

A563

A 564

LOWER LIMB QUANTITATIVE LYMPHOSCINTIGRA PHY M.Carena,C.Aprile,G.Rossi,G.Paroni and C.Donati.

FOLLOW-UP STUDIES IN PATIENTS WITH TRANSPLANTATED LYMPHATIC VESSELS - EVAlUATION OF TRANSPORT KINETICS BY L Y M PHOSCIMTZGRAPHY. E. K l e i n h a n s , R.G.H. Baumeister, D. H a h n , S. S i u d a , U. B ~ l l , E.A° M o s e r

SINGLE PHOTON EMISSION TOMOGRAPHY (SPET) WITH 99TC SULPHUR COLLOID AND 123~ BROMOSULEHTEALEIN USED AS A FUNCTIONAL TEST IN LIVEn DISEASE. E.M. Alstead, J.S.Srime, M.Critchley, A.I. Morris, I.T. Gilmore and J.Ware-

In o r d e r to a s s e s s t h e c l i n i c s ] usefuln ass Of quantitative lymphoscintigraphy in p t s w i t h l i m b o e d e m a , t h e Ketterings' method(1981)was e m p l o y e d w i t h s l i g h t mo difications r e l a t e d to the d i f f e r e n t tr acer(rgmTc-S mierocoll)and device(LFOV camera)used. About imCi in.lml(Lymphoscint Solco)were injected in the i s t a n d 3 r d i n t e r d i g i t a l space bilaterally;45pts were studied:41 with oedema of different aethiology and 4controls(g).ROIs were selected includi ng the injection site(IS),regional nodes (RN)and the limb region between IS a n d RN(Transit Activity,TA)respectively. Semiquantitative data were expressed as % o f t h e IS a c t i v i t y m e a s u r e d at T ~ , T A was normalized to i0 sq cm a r e a . Results:the w a s h o u t r a t e at D h w a s > 2 0 % in 6 / 8 C a n d < 2 0 % in 1 9 / 2 0 l i m b s w i t h l y m p h o e d e m a ( L ) ( p < . O l ) . T h e m e a n T6 v a l u e ( t / h ) w a s g 2% in 1 8 / 2 0 L ( p d . O l ) w h i l e in v e n o u s oedema observed value was not signifioan tly different f r o m C. R N a c t i v i t y at 6 h was:10% in 1 9 / 2 0 L w h i l e in C > 1 0 % ( p < . O 0 ~ T A in C w a s < 5% w h i l e in p a t h o l o g i c a l co nditions m a y be r i s e d . ( W i l c o x o n Sum Rank Test and Kruskal-Wallis Test). This method provided suitable informati on about pathophysiology and morphology o f the l y m p h a t i c system(visualization of RN and main lymphatic vessels)useful for screening pts with lymphoedema a n d in the f o l l o w - u p after mierosurgery. Fond.Clinica del Lavoro,Nuclear 26,v.Boezio,I-27100 Pavia,Italy

Med. Serv.

TO q u a n t i t a t e visual findings in lymphoscintigraphy with 99m-To labelled stannous sulfur colloids, a numeric index of t r a n s p o r t kinetics was designed by combining visual assessment of f i v e criteria: temporal and spatial distribution of the r a d i o n u c l i d e , appearance time of lymphnodes, graded visualization of lymph nodes and vessels. For assessment scores were used, ranging f r o m 0 to 9- T h u s , the r e s u l t i n g Transp o r t I n d e x (TI) r a n g e d f r o m 0 ( h e a l t h y ) to 45 (pathologic). TI in h e a l t h y e x tremities w a s l e s s t h a n i0. In 219 i n v e s t i g a t i o n s of u p p e r a n d lower extremities in 81 p a t i e n t s , TI w a s found to be very sensitive (97,4%). Specificity w a s 9 0 . 3 % . An interohserver s t u d y in 179 i n v e s t i g a t i o n s revealed a high correlation (r=0.96). 23 p a t i e n t s underwent autologous lymphatic transplantation. TI a f t e r v e s sel grafts w a s l o w e r in 18, h i g h e r in 4 and unchanged in one patient. The average decrease of TI w a s 5 . 9 : 3 1 . 1 before and 25.2 after transplantation. This decrease was correlated with a marked decrease of the v o l u m e of the extremities. This m e t h o d of e v a l u a t i o n of t r a n s p o r t kinetics has proven to be v e r y s e n s i tive, reproducible a n d a b l e to m e a s u r e the transport capacity of o n l y t w o or three lymphatic vessel grafts.

Div. of Nuclear Medicine and Surgery, Univ. of M u n i c h , FR Marchioninistr. 15, 8ooo Munich 70

Dep. of Germany

Using 99TO sulphur colloid as a specific Kupffer cell label, we have demonstrated that SPHT can be used to assess liver structure and function. We have now used 123Y BSP as a specific hepatocyte la~el to see if this discriminates better between types and severity of liver disorders. Twenty five patients with histologically proven liver disease had 1231 BSP and 99TO sulphur colloid tomography performed on separate days using an IGE 400T camera interfaced to a PDP 11/34 Digital computer. SPET Software produced 3-dimensional reconstruction of images. Total 123[ BSP and 99Tc sulphur colloid uptake values and liver volume were then derived. Patients with severe liver disease had percentage uptakes of: 38.9(~ 8.8) and 20.7( ! 5) for 1231 ESP and 99TO sulphur colloid respectively. Those with moderate disease: 62.8(~ 6.5) and 42(~ 6) and those with minimal dysfunction 76.5(2 12) and 61.6 (~ 14). These values correlate well with the clinical and histological findings. The study demonstrates the feasability of 1 2 3 1 E S P tomography in the assessment of liver disease. The use of both isotopes provides a means of measuring both hepatocyte and Kupffer cell function as well as structure. Department of Nuclear Medicine, Royal Liverpool Hospital and Departments of Gastroenterology Royal Liverpool Hospital and Walton Hospital, Liverpool, United Kingdom. Postal address: Dr.E.M.Alstead, Department of Medicine, Royal Liverpool Hospital, n.O.Box 147, Liverpool, L69 3BX U.K.

A93 A 565

A566

A 567

HEPATIC UPTAKE AND ELIMINATION OF ~-I-123 HEPTADECANOIC ACID (HA) IN PATIENTS WITH ALCOHOLIC LIVER DISEASE. G. Spohr, A. HSck, G. Notshamiprodjo, H. Herzog, M. Schmitz, Chr. Freundl i e b , R. Porschen, K, Vyska, W,W. Shreeve and L.E. Feinendegen.

PHABMACOKINETICS OF 1 2 3 - 1 - ~ - I H A IN D I S O R D E R S OF H E P A T I C F A T I Y A C I D M E T A B O L I S M . M.Ingels,A.Bossuyt,P.Vander Spek,J.Mertens, R . V a n d e n D r i e s s c h e , M. J o n c k h e e r .

DIAGNOSIS OF ACUTE CHOLECYSTITIS BY TC-99m -IDA CHOLESCINTISRAPHY. L. Lanzberg, S. Lanzberg, M. R. Quastel and G. ~%odadadi.

Changes in l i v e r metabolism following chronic alcoholic consumption were studied by dynamic scintigraphy (DS) a f t e r i . v . injection of 3 mCi HA. Degree of uptake (U) and elimination halftimes (ET) were determined in anterior view for 40 minutes, in 10 patients (P) with f a t t y l i v e r (group I) and 5 P with cirrhosis (group I I ) , 18 P without l i v e r disease were controls. Diagnosis was based on l i v e r biopsy. Regions of interest were selected over cranial and caudal r i g h t lobe, over the l e f t lobe and over the entire l e f t v e n t r i c u l a r myocardium (H). The sum over the l i v e r lobes gave total l i v e r (L), Data were corrected f o r labelled free iodide. Mean count ratios per image element H/L were < 1,25 in controls; a mean H/L of 1.5 indicated moderately reduced U with various degrees of inhomogeneity (group I ) while a mean H/L of 5.2 represented extremely reduced U and inhomogenei t y in l i v e r scans with HA (group I I ) , - In some P of group I Tc-g9m-sulfur c o l l o i d scan was nearly normal. I t was always abnormal in group 11. The mean ET in controls was 21 + 5 min., in group I i t was 25 min. and in group I I i t was f o r the t o t a l l i v e r 120 min,, but 50 min. f o r l e f t lobe and 213 min. f o r r i g h t lobe (range 44 to 881 min.). - An elevated serum cholesterol and t r i g l y c e r i d e s was corrected with a prolonged ET in group I. -

Kinetics of HA (U and ET) permits the d i s t i n c tion between alcoholic f a t t y l i v e r and alcohol i c c i r r h o s i s . There are d i f f e r e n t HA kinetics in cirrhosis f o r r i g h t and l e f t l i v e r lobes. Metabolic alterations concommittant with hyperlipemia are also recognized. I n s t i t u t e of Medicine, Nuclear Research Center Ju'elich GmbH, D-5170 duelich, F.R. Germany.

In this s t u d y we e v a l u a t e d to w h i c h extend global disturbances in 123-I-heptadecanoic acid (IHA) k i n e t i c s reflect alterations in h e p a t i c fatty acid metabolism as t h e y o c c u r in c i r r h o s i s or diabetes. The s t u d y i n c l u d e d 5 n o r m a l s u b j e c t s , 17 patients with liver cirrhosis (12 a l c o holic, 5 postnecrotic) a n d 12 d i a b e t i c patients. After injection of I mCi carrier-free IHA, dissolved in 6% h u m a n serum albumin, serial images with a frame r a t e of I / m i n . w e r e r e c o r d e d in anterior position. The relative hepatic IHA u p t a k e b e t w e e n 5 - 2 0 m i n a f t e r i n j e c tion was measured as the ratio of the m e a n c o u n t r a t e p e r p i x e l in a h e p a t i c R O I to t h e m e a n c o u n t r a t e p e r p i x e l i n a myocardial ROI. IHA e l i m i n a t i o n rate in l i v e r a n d m y o c a r d i u m w a s m e a s u r e d as the disappearance constant of a mono exponential curve fitted through the descending p a r t of t i m e a c t i v i t y c u r v e s c a l c u l a t e d on t h e o r i g i n a l d a t a in b o t h ROI. The m o s t s t r i k i n g a l t e r a t i o n s in h e p a t i c I H A k i n e t i c s w e r e o b s e r v e d in a l c o h o l i c liver cirrhosis: a d e c r e a s e d u p t a k e and elimination r a t e in t h e l i v e r , w h e r e a s myocardial elimination was not significantly different from the control group. In contrast, postnecrotic liver cirrhosis only caused a less importantly delayed hepatic elimination of IHA. D i a betes was characterised by alterations in h e p a t i c as w e l l as in m y o c a r d i a l IHA k i n e t i c s . T h e s e c h a n g e s in I H A k i n e t i c s , e v e n w i t h o u t c o r r e c t i o n for free i o d i n e , c l e a r l y r e f l e c t the e f f e c t o f a l c o h o l on liver metabolism and the effect of an increased pool of unesterified fatty a c i d s in d i a b e t i c p a t i e n t s . T h i s i n f o r mation is n o t d i r e c t l y available by conventional diagnostic modalities. AZ-VUB,Laarbeeklaan I01,B-I090 Brussels.

A 568

A 569

NITROGLYCERIN CROLESCINTIGRA2HY I N TI{E DIAGNOSIS OF BILIARY TRACT DISEASES. I. S z i l v & s i , I. B a l e g h , K. B o r , E. N e mes~nszky a n d I. Sz6/it6

TL-201 PER RECTUM : A NONINVASIVE METHOD FOR EVALUATING PORTOSYSTEMIC SHUNT. X. Verdickt, P. Reding, P. Tshiamata, H.R. Ham.

Portosysfemic shunt is one of the most important A pharmaoodynamic radioisotope method was u s e d to d i a g n o s e f u n c t i o n a l d i s o r d e r s of t h e s p h i n c t e r of O d d i . I m a t o t a l of 60 p a t i e n t s / 1 8 w i t h c h o l e d o c h o lithiasisj ~ with papillary stenosis, 6 after endoscopic papillotomy, Io with liver cirrhosis, 12 with hypertonio dyskinesis of t h e s p h i n e ~ s r of O d d i and lo normal subjects/ y~mTo-HIDA cholesci~tigraphy was performed. Diagnosis was e s t a b l i s h e d by clinical, laboratory d a t a , E R C P , u l t r a s o n o g r a p h y , clinical follow-up and in patients with biliary dyskinesis by m a n o m e t r y a n d / o r oholeoystokinin-oetapeptid test. N i t r o g l y c e r i n was a d m i n i s t e r e d ~H--blingually i hour a f t e r i n j e c t i o n o f ~ J ~ T o - H I D A . Its e f f e c t on the b i l i a r y f l o w w a s s t u d i e d by m a t h e m a t i c a l a ~ a l y s d s of t h e time-activity c u r v e s a n d by p a r a m e t r i c imaging. In patients with organic bile flow obstruction ~o e f f e c t o f n i t r o g l y cerin could be demomstrated. Statistically s i g n i f i c a n t shortening of t h e m e a n t r a n s i t time of the e h o l e d o e h u s w a s o b s e r v e d in p a t i e n t s w i t h h y p e r t o hie dyskinesis of the s p h i n c t e r of O d dieompared to l i v e r p a t i e n t s a n d n o r m a l subjects. O u r r e s u l t s s u g g e s t that nitroglyeeri~ eholesoi~tigraphy is a r e l i a b l e m e t h o d to e v a l u a t e p a t i e n t s with bile flo~ obstruction. This 8impley reproducible, nominvasive pharmae o d y n a m i c t e o h m i q u e may be h e l p f u l in d i f f e r e n t i a t i n g o r g a n i c a n d fumotional compomemts of b i l e f l o w o b s t r u o t i o n ~ in dia~osimg hypertomic biliary dyskinesis.

Postgraduate Medical School Dept. of R a d i Ù l o ~ , H-1389, P . O . E . 112. H u n g a r y

of Budapest Budapest t

complications of Liver cirrhosis. UnfortunateLy, current methods for detecting and quantifying this shunt are either non-specific or associated with significant morbidity. The aim of this work was fo evaluate the cLinicaL value of a new non-traumatic method which consisted of administrating TL-201 per rectum and to monitor the absorbed activity using a camera and a computer system. The method assumes that in the absence of portosystemic shunt, most of the absorbed activity wiLL be fixed in the Liver while in the presence of this shunt,some of the activity wiLL be fixed in the myocardium. The ratio of heart to Liver activity can therefore be used to evaluate the importance of the porfosystemic shunt. 34 subjects have been studied. The ratio of heart to liver activity at the g5th minute after the tracer administration is higher in patients with Liver cirrhosis (n=22, m= .9, s.d.- .37) than in patients with steatosis. (n-t0, m= .28, s.d.= .05). In two healthy subjects investigated the H/L ratio was .27 and .30. The reproducibiLity of the test was evaLuated in 8 subjects and showed a good reproducibility. (mean of difference = .03, range = .01 fo .07). Patients with esophageal varices had always a high H/L ratio white some patients with Liver cirrhosis without esophageal varices had also high H/L ratio due probably to the presence of infrahepatic shunt. In conclusion, our results showed the value of this new non-traumatic test for detecting and quantifying extra-as weLL as intrahepafic portosystemic shunt. Dept. Radioisotope and GastroenteroLogy. St. Peter HospitaL, Free University of BrusseLs, BeLgium.

The rapid and accurate diagnosis of acute cholecystitis is extremely important and sometimes presents a difficult clinical problem. For many years, radiographic evaluation of suspected cholecystitis has depended on the use of iodinated contrast material. More recently, ultrasonography has proven to be of much value for the assessment of cholelithiasi~% An alternative method for the investigation of the flow of bile in the biliarI tree in patie/uts with a clinical picture of suspected acute cholecystitis is the use of the Technetium-99m-IDA scan. This examination offers excellent visualization of the biliary system and supplies functional information as to the patency of the cystic duct. We have studied 116 consecutive patients with abdominal complaints suggestive of acute cholecystitis. Scintigraphic examinations were performed for: 2~ hours following the intravenous administration of 4-5 mci of the agent (HIDA or DIPA). Our results showed that in 46 of these patients, the gall bladder was not visualized by scintigraphy. Of this group of patients, 41 were found to have acute cholecystitis at the time of surgery. Normal IDA scans were observed in the remaining 70 patients, none of whom were subsequently judged to have had acute cholecystitis. According to our results, comparing the scanning results with operative diagnoses, the sensitivity of the IDA scan was near 100%, in that no proven case of acute cholecystitis had visualization of the gall bladder. The specificity was found to be about 90%. In the remaining cases of 5 false-positve IDA scans, 4 patients had chronic cholecystitis, and one pancreatitis. Thus, visualization of the gall bladder by IDA scanning virtually rules out the possibility of acute cholecystitis. Department of Surgery A and Institute for Nuclear Medicine, Scrota Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel

A 570 SCINTIGRAPHIC LOCALIZATION OF G A S T R O INTESTINAL BLEEDING USING III-ln-LABELL E D P L A T E L E T S , A L O N E O R IN C O M B I N A T I O N WITH 99m-Tc SULFUR COLLOID. K.G. S c h m i d t , J.W. R a s m u s s e n , O. G r o v e a n d D. A n d e r s e n . Ill-In-labelled autologous l~latelets were applied for scintigraphic localization of the source of gastrointestinal bleeding. 29 investigations were performed in 25 patients. In 19 studies showing scintigraphic signs of bleeding, the clinical presentation included occult bleeding in 7, melaena in 7, and bloody stools in 5. The time interval between the injection of lllIn-platelets and visualization of bleeding rangad from i0 rain to 142 h, being longest in cases of occult bleeding. In most cases, the scintigrapbic findings were supported by other diagnostic modalities. In l0 studies, without signs of bleeding, a probable source of bleeding was identified in one patient. Difficulties in reaching firm conclusions on delayed scintigran%s because of accelerated transit of the intestinal contents were encountered in a few cases. To circumvent this problem, we introduced a combined scintigraphic approach by adding a sequential 99m-Tc sulfur colloid study at the time an abnormality on the lll-In-platelet scintigram was first noticed. Using this approach, we could pin-point the source of bleeding in the 5 studies carried out. Our findings indicate that the lll-In-platelet method is sensitive, a fact probably related to the low level of background activity, to the incorporation of labelled platelets in the clot formed at the site of bleeding, and to the possibility of repeated imaging for up to one week after the tracer injection. It may prove of special usefulness in cases of OCCUlt or recurrent bleeding. Departments of Nuclear Medicine, Medical Gastroenterology and Surgical Gastroenterology, Odense University Hospital, D K - 5 0 0 0 O d e n s e C, Derm~aZk.

A94 A571

A 572

DIAGNOSTIC IMPACT OF ABDOMINAL BLOOD POOL SCINTIGRAPHY IN GASTROINTESTINAL ELEEDING. N.J. Kelly, V. Kaiff, A.H. van der Vliet, H. Barton.

INDIVIDUAL

We evaluated the diagnostic impact of TC-99m abdominal blood pool scintigraphy (ABPS) in the assessnent of gastrointestinal (GI) bleeding whose cause could not be found by upper GI endoscopy and siQ~s~idoscopy. In the four year period prior to availability of ABPS, 26 patients with acute or intermittent GI bleeding underwent GI contrast angiography; it demonstrated an abnormality in 12 cases (most cca~only angi(~dysplasia), but in only 4 cases (l.0/year) was active bleeding seen. In the first 18 months after the availability of ABPS, 71 scans were ~>~rformed on 43 patients. The ABPS demonstrated active bleeding on >I occasion in 14 patients (33%) (9.3 per year); the site was jejunum in 3, ilet~n in 3, ileocolic in 2, right half of large bowel in 4, and surgical wound site in 2. ABPS localisation was confirmed (within 5-10 c~,s) at subsequent surgery or angiography in all but 1 patient, in %~icm surgery or angingraphy was contra-indicated. Evidence of interval bleeding bet~en delayed images (separated by several hours) was seen in 9/43 patients (21%); in all of these ABPS showed static colonic activity; 1 had carcincrna of the caecum, 3 were found to be bleeding from the upper GI tract, and in 5 no cause could be established. There was no ABPS evidence of any bleeding in 20/43 patients (47%). Eleven patients bad both ABPS and Gl angiography. Is all 5 patients in whom GI angiography showed evidence of active bleeding, ABPS also did. In 2/5 patients without ABPS evidence of active bleeding, GI angiography demonstrated oesophageal varices which may have caused bleeding. conclude that introduction of ABPS markedly increases detection of active GI bleeding in both the ~ a l l and large bowel. It may also increase the yield frc~ GI angiography. Nuclear Medicine Department, Alfred Hospital, Commercial ~d, Melbourne, 3181, Australia

A 574 NEW P O S S I B I L I T I E S FOR Q U A N T T T A T I V E MEAS U R E M E N T S OF R E G I O N A L C E R E B R A L B L O O D FLOW BY THE USE 0F 195m AURUM. P . L i n der and O . N i o k e l The new isotope 195m g o l d allows q u a n t i t a t i v e r C B F measurements, f o l l o w i n g a p r e v i o u s l y p u b l i s h e d t h e o r y by Linder. The e n e r g y - s p e c t r u m of the g e n e r a tor eluate shows two strong p h o t o n peaks, one at 68 keV, the second at 262 keV. B o t h e n e r g y levels have a h a l f life of 30.5 sac. This enables d y n a m i c b r a i n p e r f u s i o n studies not only in dorsal p r o j e c t i o n (262 keV) but also in both l a t e r a l p r o j e c t i o n s (68 keY) w i t h in some m i n w i t h o u t the need of a b a c k ground c o r r e c t i o n and w i t h o u t s i g n i f i cant "look through" effect. It is also p o s s i b l e to g e n e r a t e f u n c t i o n a l images w h i c h show the speed of inflow, the per s i s t i n g time d i s t r i b u t i o n p a t t e r n and a q u a n t i t a t i v e m a p p i n g of c e r e b r a l blood flow. The local r e s o l u t i o n is a b o u t 1-2 om. The a c c u r a c y of the m e t h o d is b e t t e r than 5 %. N o r m a l CBF v a l u e s for adults are 44°5 m l / m i n / l O 0 g Z 5 % . T h e m e t h o d was tested in 40 p a t i e n t s w i t h a n g i o g r a p h i o a l l y p r o v e n carotid stenosis before and a f t e r v a s c u l a r surgery. The r e s u l t s prove that the i n t r a c e r e bral h a e m o d y n a m i c r e l e v a n c e of carotid s t e n o s i s can be q u a n t i f i e d . D y n a m i c p e r f u s i o n studies and the computed trend p i c t u r e s of lateral views of the patients after stroke shows the area of o c c l u d e d v e s s e l and its d e c r e a s e d r e g ional CBF. 8 v o l u n t e e r s h a v e b e e n inves t i g a t e d in left l a t e r a l p r o j e c t i o n twice w i t h i n 5 min: the first study was performed with closed eyesat rest, the second study w i t h o p e n eyes f i x i n g a m o v i n g subject. The results: the local changes in the v i s u a l cortex has b e e n up to 30 %, m e a n h e m i s p h e r i c changes up to 8-10 %. The area of the v i s u a l eortex and a w e a k e r i n c r e a s e in the s t i m u l a t e d m o v e m e m t centers can be clea r l y d e t e o t e d o - M u n i c i p s l H o s p i t a l , Dpt of R a d i o l o g y , D - 8 3 9 0 P a s s a u , W - G e r m a n y

A 573 KIDNEY

GFR~

ERPF

ESTIMATION~ 99mTc-OTPA ~dD 1231-HIPPURAN RENOGEAPHY FOE PRE-0PERATIVE AND FOLLOW-UP EVALUTATION OF "MALIGNANT STAGHORN STONES". B. Bagni, ~L.M.Feggi, PL. Carpers, N. Prandini, (*)A. Reggiani, (*)A. Romano~ (*)C. Danie]e evaluation kidney function

An

stones" based

is on

method in

the

E.R.P.F.

single

kidney

determlnation~

123I-hippuran

and

renography camera

for

the single

"malignant

staghorn

presented, The protocol

using

connected

a on

and the 99mTc-DTPA

on

digital line

is

G.F.R.

to

gamma a data

processor, The computer

programs were ~ritten macrofunctions provided by the system. The evaluation m e t h o d s for GFR a n d ERPF were derived from the original protocols of gates, Oberhausen and Tauxe. The clinical sample consisted of 15 patients aged from 28 t o 68 years with " m a l i g n a n t staghopn stooes" who underwent a conservative renal surgery ~ (with renal artery clamping). The results coming f r o m the examined cases lead to conclude that the method is useful t o evaluate: a) the preoperative global renal function and the residual papenchymal mass; utilizing

b) c)

immediate post-surgery (ischemia effect); least

follow-up

post surgery f o l l o w - u p

tardive 3

months

after)

of

(at renal

{unction recover/ 1 e v e ] . Nuclear

Medicine and (*>Urology S. Anna H o s p i t a l , Corso Ferrara, Italy

Departments, Giovecca

283,

A NEW APPHOACH TO T R A C E R KINETICS. K n e s a u r e k and S. S p a v e n t i

E.

Almost all i n v e s t i g a t i o n s d e a l i n g w i t h the long- and s h o r t - l i v e d isotopes are u s i n $ s i n g l e - c o m p a r t m e n t well mixed model [SCWF[M), though the SCWF~I is only a special case of s t o c h a s t i c approach. The s t o c h a s t i c a p p r o a c h reduces to a ~CWM/~ in the case of constant i n f u s i o n w i t h n e g l i g i b l e decay, and only in such s i t u a t i o n is the a p p r o x i m a t l o n of good m i x i n g r e a l l y valid. This a p p r o x i m a t i on cannot be extended to w a s h - o u t and s h o r t - l i v e d isotopes studies in g e n e r a l because in such s i t u a t i o n s the d e f i n i tion of volume of d i s t r i b u t i o n a n d / o r p a r t i t i o n c o e f f i c i e n t are not s t r i c t l y a p p r o p r i a t e , A s s u m p t i o n of good m i x i n g is e q u i v a l e n t to the a s s u m p t i o n that the impulse r e s p o n s e f u n c t i o n of the c o n s i d e r e d system is m o n o e x p o n e n t i a l (as in K e t y - S c h m i t equation). That cannot be g e n e r a l l y true since shape of impulse r e s p o n s e f u n c t i o n is d i c t a t e d by the e x p e c t a t i o n of the existence of a m i n i m u m tmin, a most p r o b a b l e t D and maximum transit time. Hence, the ~ o n o e x p o n e n t i a l b e h a v i o u r of impulse response f u n c t i o n should be seen as an a p p r o x i m a t i o n , albeit a good one w h e n tmi n ~tD~--O. U n d e r the c i r c u m s t a n c e s which a~e defined by the p h y s i o l o g i c a l p r o p e r t i e s of the system, it may be exp e c t e d that S O W M M is a good a p p r o x i m a t i o n and that c o n s t a n t v o l u m e of dist= r i b u t i o n of tracer may indeed be defined. The q u e s t i o n of whether, in a particular application, an isotope m a y be r e g a r d e d as "long-" or " s h o r t - l i v e d " depends not only on its life-time, but also on t r a n s f e r p r o p e r t i e s of the considered system. The s t o c h a s t i c a p p r o a c h takes into account the t r a n s f e r p r o p e r ties of the c o n s i d e r e d system and the d i s t r i b u t i o n of tracer in the system not r e q u i r i n g a h y p o t h e s i s of good mixing and p r o v i d i n g a p o s s i b i l i t y of eva l u a t i n g c o r r e c t i o n s for decay. Klinicka Rolnisa,Zagreb,Yugoslavia