Eur. J. Nucl. Med. 4, 105 - 158 (1979) © by Springer-Verlag 1979
Third European Congress of Nuclear Medicine under the patronage of the European Nuclear Medicine Society sponsored by the Czechoslovak Medical Society J. E. Purkyne May 15-18, 1979, Karlovy Vary
TABLE
OF
CONTENTS
Subjects
Heart
Abstracts
I
Haematology Cerebral
1
-
17
18
-
25
26
-
35
Blood
Flow
Radioimmunoassay
I
37
-
42
Radioimmunoassay
II
43
-
52
53
-
61
62
-
67
68
-
74
75
-
83
Kidney Liver
I
Liver
II
Circulation
and
Thrombosis
Tumours
I
84
-
88
Tumours
II
89
-
102
103
-
109
iiO
-
117
118
-
140
Lung Gastrointestinal
Tract
Instrumentation Radiopharmaceuticals
I
141
-
145
Radiopharmaceuticals
II
146
-
152
153
-
158
159
-
164
Brain Heart
II
Endocrinology
165
-
172
Bone
173
-
176
Miscellaneous
177
-
182
107
L a u s a n n e , F e b r u a r y 14, 1979
Letter of the President I have the great pleasure to present the Third C o n g r e s s of the E u r o p e a n Nuclear Medicine Society to be held in K a r l o v y V a r y f r o m M a y 15 to 18, 1979. This meeting very well organized by the local C o m m i t t e e under the presidence of Z d e n e k Dienstbier c o m p r i s e s , as usual, a social and a scientific part. It is on this latter part that I want to dwell. T h e Scientific C o m m i t t e e (Z. Dienstbier, W . Finck, I. Makaiova, U. Rosa, V . S l o u k a and myself) presided by C. B e c k e r s m e t at P r a g u e f r o m January 18 to 20, 1979. In order to favour the exchange of ideas and knowledge it w a s decided not to organize multiple parallel sessions. 106 abstracts w h i c h s e e m e d to r e s u m e the m o s t original and interesting w o r k s w e r e selected for oral presentation. T h e other papers having b e e n accepted will either be presented as Posters or " R e a d by Title" in a special session. T h e C o n g r e s s will be opened by the authorities of Public Health in C z e c h o s lovakia on Tuesday, M a y 15. E v e r y following m o r n i n g there will be a M a i n Lecture. T h e first will be organized as a R o u n d Table Discussion by C. Kellershohn on "Quantification of Results of E m i s s i o n T o m o g r a p h y " , the second will be held by M. B a k o s o n " O n c o l o g y " and the third by C.J. Fallais on the " E u r o p e a n P h a r m a c o p o e i a " . During the m a i n lectures as well as the other sessions taking place in the m a i n C o n g r e s s Hall there will be simultaneous translation (English, French, G e r m a n and Russian). A s it cannot be guaranteed for all afternoon sessions it is to the interest of the authors to present their paper in English. Looking f o r w a r d to meeting you in Karlovy Vary.
I~laloye
/"
108
'SOCIAL
14.5
15.5
16.5
17.5
18.5
INFORMATION
PROGRAM Kcs 40.-
Folklor Party (evening)
Kcs
i20.-
Spa T o u r (Marianske Lazne, Frantiskovy Lozne, Cheb)
Kcs
144.-
i/2day excursion to Cheb, S O O S
Kcs 70,-
i/2day excursion (afternoon) Zlutice, Rabstejn (the smallest town in E u r o p e urban reservation)
Kcs 70.-
E x c u r s i o n to O r e Mountains and Jachymov
K c s 115.-
i/2day excursion to Castle Loket ( m u s e u m of glass and china)
Kcs 40.-
i/Zday excursion (afternoon) to Gothic M o n a s t e r y Kladruby
Kcs 75.-
Excursion to Plzen, H o r s o v s k y T y n and Stribro
K c s 175.-
Farewell Party (evening)
K c s 135.-
Moser
K c s 40.-
and shopping (morning)
Excursion to Andelska H o r a and picnic (afternoon - evening)
ENMS
9.00 a . m .
TUESDAY
May
15
OPENING
CEREMONY
i0.00 ll.00
Czechoslovak Medical Society J,E. P u r k y n e IIIrd E u r o p e a n C o n g r e s s of Nuclear Medicine Sokolska 31, IZ0 26 P r a h a 2, Czechoslovakia Phone: 29 41 42 Telex: 12 12 93
Sightseeing tour (evening)
HEAR T 9 papers
Kcs
or B. Delaloye, D A M N , CHUV, Switzerland Phone: (021) 41 21 69 Telex: 24 159
I011 Lausanne,
150.-
KARLOVY
VARY
WEDNESDAY
CH-
May
MEETING
16
THURSDAY
May
17
FRIDAY
May
!8
MAIN LECTURE (30') Ter Pogossian M. Present status and perspective in the development of emission c o m p u t e r i z e d scans
MAIN LECTURE (30') Bakos M. Nuclear Medicine in Oncology
MAIN LECTURE(30') Fallais C. J European pharmacopoeia
ROUND TABLE 9.45 Quantification of results of emission t o m o g r a p h y
TUMOURS
RADIOPHAR MACE TICALS 9.45 5 papers ,..... ,,
COFFEE
COFFEE
9.45
5 papers
BREAK
COFFEE
BREAK
BREAK
ii.30 KIDNEY 5 papers
6
IZ. 45 LUNCH
papers ,,,
5 papers
,.,...
LUNCH
LUNCH
LUNCH
2.30 p . m . HAEMATOLOGY 6 papers
RIA I 6 papers
SESSION READ BY TITLE
4.00 COFFEE
BREAK
LIVER
I
6 papers , ,, ,, COFFEE
,i
CEREBRAL BLOOD FLOW 6 papers
R I A II
6 papers
LIVER
II
5 papers
+
LUNG 6 papers
COFFEE
BREAK
4.30
6.00
CIRCULATION THROMBOSIS 6 papers
POSTERS
INSTRUMENTATION 6 pape r s ,,,,, BREAK
BRAIN
6 papers COFFEE
i
G.I. TRACT
6 papers
DELEGATES
HEARTII
ASSEMBLY
6 papers
BREAK
U-
H,
109 AUTHOR--INDEX
Figures
= Abstract
A b a s c a l J. Abrams D.N. A g n e l y J. A g r a n a t V. A h o n e n A. A l m a s i b. A l o n s o J. Alperovitch A. Altenbrunn H.J. A m e t o v A. Antonic B. Anzini F. Arnais B u e n o F. A r t r u Fo A s s o n e F. B abinska E. B agdany S. B a g d y D. B a k o s K. B a l a s u b r a m a n i a n V. Balyura A. B a r e t A. Barritault L. Bartsch P. Beauduin M. Becalski J. Bechyne M. B e c k C. B e c k e r s C. B e e c k m a n P. B e l a n A. B e l o v a E. Bern E . M . Bern H. B e n k 8 Gy. B e n z i L. B e r a n e k I. Berger M. B e r g m a n n H. B e r n i e r J. Bertrand A. Bianc hi C. Bialobr zeski J° Bibr B. Bisset J°P. Bizais Y. B l a h a V. Blanquet P. Blasco A. B l o c k P. Blottne r A. B o k B. Boniolo A. B o s n iakovic V. Bossuyt A. Bouteiller G. Brassinne A. B r e n d e l A. Brothier J.P. Brousil J. B r u A. B r u m e l o v a V. Brunner H.R. B r u n o r i I. Brykalski D. B u c h w a l d I. B u r a c zewski ft. B u r s a r ski W . Buxton-Thomas M.S.
numbers
79 86 24 92 27,35 130 26 157 88 39 74 111 169, 174 30,34 71, 141,146 98 147 78 83 4 92 104 13, 153 106 60, 93 I01 89 17 19,43 125 I0 39 138 138, ]39 148 4Z 12 30,34 134 31 6 56 53 25 45, 9 4 , 167 18 57 178 173 162 87 157 37 151 77, 125 173 11Z 118 118 95 173 40 54 41 91 64 90 158 75
Calderazzi A. Calisto W . C a m e r i n i E. Camporro C a m p o s A. C amuzzini G. Cantar ano G. Castejon I. Castro J.M. C a u w e F. Cavaillol~s F° C e r n o c h V. C h a m b r o n J. C h a m o r r o J.L. Chemama F. C h e y r e t o v a E. Chisci R° C o a k l e y A. J. Collice M . Collignon G. Coltart D. J. Constable A . R . Constantinesco A. Corazziari ]~. Cranage R.W. Crawley J.C.W. Croft D. N . C r o u z e l i~. C sernay L. Csirik J. Cvoric J.
56 79 56 175 164 72 179 65, 79,175 65 Zl 157 14, 129 164 65, 79,175 164 II 41 67 Z9 178 I, 163 99 164 iii 99 4 I, 75, 163 114 128, 130, 131 130, 131 151
Dalle L u c h e A° D a m j anovic M . David B. D e c a m p s J.L. D e c k a r t H. D e c o n i n c k F. Delaloye-Bischof A. Delaloye B. Deleuze R. D e m e y e r G. D e p r e s seux J.C. Dienstbier Z. Diez L. D o b r e v D. Doepp M. D S g e H. D o n ~ V. D o n a d i o C. D o n Carli C. D u c a s s ou D. D u d l e y R . A~ D u m i t r e s c o B° D u p o n t J. CI. D u r ski K.
41, 171 117 43 173 87 77, 125, 127 54 54 30,34 119 31 89,95 169 181 44 155 37 56 18 118 ]22 164 16 98
E g o r o v a I. A. Elizagaray A. E m r i c h D. E n d e r t G. E t h a n J. E s q u e r r e J.P. E s t e b a n J. Estenoz J.
48 104 46 76 137 81 26,36 169
F a b i a n J. F a c o r r o U. Fajndt S. Favella A. Fazio F° F e i n e n d e g e n L. E~ Fekete B. Feltynowski T. F e r r a n d O. F e rrant A . Fichet B .
i0 46 91 73 29, 103 3, 63 i00 170 108 19,21 167
Fie schi C. Eievez C.
29 70
Figdor H° C. Filder V. Fischer J.R. Fischer R.S. Fitzpatrick J° M . F o r t y n o v a J° F r ankiewic z E. F r a n s A. Frenkel Wo F r eundlieb Chr. F r ~hling J. Funovic s J.
122 161 122 iio, 113 99 23 154 105 92 3,63 66 68
G a b e r s e k V. Galle P. O a m b i n i D. Gardiner R.A. G a s p e r H. Gati I. Gatti V. Gatto L. Del G a u n t J. Gauthier J. Gembicki M. G e n s J. G e r a s i m o v a N. P. G i a m p i e t r o O. Gimlette T ° M ° D . G i r y n I. Glisic L. £. G o d a l A° G o m e z E m b u e n a A. G o u r s sies P. Graban W. Graf M. Grossmann V. Grous sin P. Guiraud R. G u r s k y S.
153 177 13 99 8 147 iii 28 1 164 47 84 7 41,42,1 168 149 I02 176 174 178 62, 170 83 96, 142 6 81 123
H a a k Ho L. H a h n L. Hajdukiewic z Z. Havlik E. H a w k i n s F. Heinze H.G. Helus F. Hermans J. H e r n a d i T. H i r s c h J. F. H S c k A. H o c quard C, H~bfer R. M o k k a n e n Eo H o m o l k a J. H o r a k I. H o r v a t h E. Horvath M. H o u r toule P. H r o c h o v a J. H r u s k a K. M u d e c z F. H u p k a S. H u s a k V.
Z0 132 97 8O 169 120 8, 86 60,93 82, 148 153 3,63 6 80, 134 2 7 , 35 23 89 38 3 8 , 3.59 94 180 51 61 8 9 , 176 137
Inocente Ivanov O.
175 11
Jakubowski W. J anoki G . V . J ansens A. J a r k o v s k a I. Jeandot R° Jebavy P. J e w k e s R. Fo
62, 170 82, 148 70 96 178 12 85
110
Jeyasingh K. Jirickova E. J o h a n n s e n B. Jonckheer M . Jordanou Do Jouet J.B. Jovanovic V. Jurgens P.J°
85 14 144 7 7 , 1 2 5 , 162 172 108 151 20
Kagel K.O. Kallanr anta T. Kantlehner R. Karcher G. K a s a t k i n Yu° N . Kasalicky J° K ausitz J. Kellershohn CI. Keroe E.A. K e r t e s z L° l
Kleisbauer J.P. Kloste r G . K n a p p W . H° Knaus E.E. Kocsar L. Kocsar L. T. Hocsar M. Koeppe P. Kolbas J. K o l b e H° Kolinska J. K o n i a r c k B, Konieczny W . Koral V. Koskinen M. K o s o w i c z J, K o s m i d e r A, I-~ovac s ms° Kozlowski P. Kralj H. K r o i s s A. Krotov V . P . H r y s t T. K s elikova M , K u b a A. Hupfe rnagel C° Kusak V. Kutas V°
156 27 120 6 7 I0, 12 176 5, 114 122 i00 59 14, 129 40 156 156 137 94 I15 8 86 78, 82, 152 22, 148 50 136 135 80 57 97 154 57 27,35 47 91 I00 154 135 68 7 33~ 154 25 128 63 96, 142 50, 61
Lachnik E. Lacombe J. Lacroix F. Lahiri A. Lambrecht R. L a n g G° L a r i n a I. Laurens M. H, Leipert K . P . Lelsner B. L e m b e r g e r J, Lembo G.P. L e m o r t J.P. L e n e r L. L e n e r s N. L e n s E. L e o n a r d J.P. L e p o u d r e R° Lesjak M° h i b m a n E, Licins ka I. L i e h n J.C. L i n d e n S, v a n der
62,150 153 118 4 8 156 39 107 46 120 102,117 179 18 25 19 70 43 77 135 102 62,150 108 105
Nintzel D, Kir sch G. Kleinbauer
K.
2 • 97
L i n d s a y Jr. J. Liniecki J. Lins m a u x D. Lissner J. Lorentz C. L o r e nzon D. L u n g h i F.
106, 112 ig0 6 179 71,7Z, 141,146
Machill G. Machulla H. J. McKenzie C.G. Maier-Borst Wo M a j c h r zak K, Majois F, M a k a i o v a I. M a k a y A, M a k l e r P, T. M a k o l s ka J. M a l e e v a A. M a l i n o v s k y N. N. M a l m u d L.S. M a l v a n o R. M a n e s c h i F. M a n n V. Mar ana G. Marcintak M. M a r i k T. M a r i k o v a E. M a t i n M . C, M a r i n o v V, M a r k w a r dt J, Marti J° Martignoni R. Matteis S. de Matteucci E° Mehnert W.H. M e n d e T° M e n i n R. Merchie G. M e s t a n J, Michelas si P. L. Miclutia M . M i k e r o v a T° M ° Milet J. Mises J. M l o d k o w s k a E. M o h a r i 2<. M ° Morcellet J°L° M o r i n J. F. M o r i n P . P. M o s e a R, M o s s a r d J, M. Moyano Jato A. M u e h l A. M u t z O~ J,
I66 3,63 103 86 5Z 6 0 , 93 89,176 131 110,113 90 165 69 110, I13 37 4Z 22
N a g y L. N a p i o r k o w s ka E. N a r dini M ~ N a u b e r G° Navalesi R. N e m e r y B° N e rne s s anyi Z. Ne umann G. N e u m ayr A° Ngeh R o Nicholas G, N i e d e r b e r g e r B. Nikolov P.N. Novakovic R.
38 62 29 116, 121,126 41,42,171 105 130, 131 15 68 153 2 164 158 102, 117
O b r e z I° Offenrn~illier K. Oginski M . Ollivier D° Oppelt A.
161 78 97, 149 45 55 65, 79, 175
Ortiz
Berrocal
J°
65,175 33 25 83,95 65 11 121 Z6,36 28 28 42,171 88 84 113 31, i06, I12 5 56 64 7 31 153 53 50,61,78 104 24 24 71, 146 I64 i75 1zg 122
O r t u n o de Solo B. Osborne M.P.
169,174 85
P age C. Pagano A. Panitz N. P apini E. Pardo F. Parker W.C. P a v o n i P, P e rtynski T . P e schl J. P e t r a s e k R. Pfannenstiel P. Philippon B° "Pic ard J.C. Picar di R. P i e r r e - K a h n A° Pie r s anti ~. Pill Go Pilo A. Pipa V. Piret L. P l a g a U° Pluygers E. Poirier R. Pokorna M. P o l a k J. Pontifex G . R . P o n z o Mo P o p a N° Poppitz R. Porenta M. P o s s a M° P o z z e s s e r e C, Pratt T . A . P r e n a n t C. Pristas Mo Prokopec J. Purizhanskuj I. Pust B.
1 73 46 73 26 140 73 97,98 68 182 46 30, 32, 34 17 73 153 28 72 42 176 I05 121 60, 93 94 57 95 172 73 16,70 181 161 29 ill 173 103 I14 176 57 39 161
R ac ovita L° Radwan M°W, Raftery E, B° R aggueneau D. Rajus z S. R a k o c z i I° R a m o s J. Randall IN. Jo R a s c e n t e G. Rasmussen J°W. Regis H. Reimschils sel W , Rembelska Mo Reneltova I. R h a l y A. A G ° R i c h a r d s o n V. J. Rigo P . R i m b e r t J.N. Ritter H. R o b e r t J. R o b i n s o n P. S. R o d r i g u e z V. R o h a c e k J. R o l a n d J° R o s a U. R o u x F. R o z p r i m o v a L. Rozsival P° R u d k o w ski R. R udnicki S. R u n c zik I. R u n g s Jo R u p n i k Z.
64 132 4 13 78 147 65, 79, 175 I24 28 145 173 138, 139 97 58 167 85 106 153 76 107 i, 163 79 142 162 37 45, 94, 167 4O 180 52 33 14, 129 18 135
Prader e J.
111
Sabatini G. Sabeti M . S a l a m b a s h e v L. San M a r c o J.L. Sastre J° S a u v a n R. S a w a - D i m o p o u l o u Chr. Schapira A. Schauer J. Scheibe J° Schmidt E. Schmidt K° G. Schneider D. Schneider G. Schreivogel Io Schubert J. S c h u m a n E. Schweiger O. Scopinar o F. Sedlak J. Simeons P. S i m o n K° S i m o n i n i N. Simonovits Io Sliz K . Slominski J . M . Slouka V o S m i r n o v V. F. Snajde r J. Sopena R o Sotirov O. Soussana C. Spett B. Spies H° Squire C ° R ° S r a m k o v a J° Stadlerova Vo Staniszewska iv[. Steiner R. E. Stelzer F°
179 80 59 45 114 45,94,167 17Z 79 15 160 88 145 15 15 46 84 76 i00 III, 179 74 107 64 41 22 55 58 4O 7 135 26,36 II 157 8Z 87,144 168 4O 55 91 I03 I13
Stich V. Stoecklin G, Stoll W . Streckenbach B. Studniarek M . S u r m a M. Svihovcova P. Syhre R. Syrota A. Szekerke M ° S z y m e n d e r a J.
95 3, 63 160 166 91 53 95 144 114 61 13Z
T allarico Z. Tanac s ]5. Tarkolev X. Te Velde J. Th@bault B, T h i e m a n O. Thivolle P° Tisljar U. Togola F. Tolin R, D . Tolonen U. T o m c s anyi A. Tonge C. T o s e r o v a m. Totsev N. Toubanakis N. T r a m o n t i G. T r n k a J. r schernoster E. T u r a e v R. Turner J,R,
42 147 49 Z0 157 7 32 ll5 167 Ii0, i13 27,35 I00 75 95 59 172 56 57 57 39 124
Unverricht A° U r b a n e k J.
160 83
Valeyre Jo V antsian E ° N , V a s k o v L.
5, 108 48 109
Vavrejn B. V a z q u e z R. Vernejoul P. de Vigoni F. Villa M . Villar Z. Vinnitsky L.I. Violet M . Virot P. Vizda J. Vlcek J. Voegtlin R. Vogt R. Vopatova M. Vorobjova W . T . V y s k a K. Walter W . W a u t e r s J.P. W ayoff M. Webb-Peploe M.M. Weber A. W i e b e L.I. W i e d e r m a n n M. Williams B . T . W i z a J° Woller P. Wollny G. W o r m s F. W o y n a r o w s k i M. W o y - W o j c i e c h o w s k i J. Wraight E . P . Ydaeva D.N. Zhidkov I.Z. Z i m m e r G. Zivanovic-Stakic D. Z m b o v a B. Zulczyk W .
14, 55,129 36 5, 13,24 Iii, 173 71, 72, 141,146 175 48, 69 141 17 180 14Z 164 88 23 48 3,63 160 54 107 163 166 86 137 163 62,150 133 84 119 33 I01 67 48 69 160 143 143 62, 150
113 I
3
QUANTITATIVE THALLIUM 201 MYOCARDIAL Ih~GING IN CORONARY ARTERY DISEASE P.S. Robinson, J. Gaunt , C. Page, D.J. Coltart D.N. Croft
MYOCARDIAL STUDIES BY USE OF C 7-123-!-HEPTADECANOIC ACID l Chr. Freundlieb, A. H~ck, K. Vyska, L.E. Feinendegen, H.Jo Machulla and ~. Stoecklin
&~yocardial imaging using Thallium 201 (TI 201) was performed in 60 subjects who achieved predicted maximal exercise performance without evidence of cardiovascular abnormality, Computer processing of the images was carried out to provide quantitative information on regional myocardial T1 201 distribution and 'normal' variation was determined. This processing technique was applied to rest and exercise T1 201 myocardial images in 170 patients with exertional chest pain subsequently demonstrated to have anatomically significant coronary artery disease, Exercise T1 201 myocardial images suggestive of ischaemia were seen in 126 patients (74%) compared with iii (65%) who developed chest pain during exercise and 94 (55%) with electrocardiographic evidence of isehaemia, Patients with a history of atypical chest pain had a lower incidence of 'ischaemia' (54%) than patients with classical angina pectoris (80%). The demonstration of defects on exercise TI 201 images increased with the extent and severity of the underlying coronary artery disease but was uninfluenced by the presence of previous myocardial infarction. Abnormal ~xercise T1 201 images were seen in II0 of 144 patients (76%) achieving maximal symptom limited exercise but in only 16 of 37 patients (43%) exercised to submaximal levels.
Previous animal experiments had demonstrated the suitability of ~ -123-I-heptadecanoic acid (IHA) for imaging and for determining the metabolic turnover of fatty acids (FA) in the myecardium. The present paper describes results of imaging and metabolic studies in 10 normal (nl) persons, in 10 patients (pts) suffering from coronary heart disease and 3 pts with old myocardial infarctions. 0.5 - 1.0 mCi IHA dissolved in 2 ml of the pts serum was i.v. injeeted, Activity distribution in the chest was registered with a y-camera. 30 minutes after injection of IHA 500 ~Ci of Na 1-123 were given i,v~ for the purpose of correcting for the iodide that is released during the catabolic degradation of IHA, Thus an optimal contrast between myocardium and other tissue was obtained. Infarcted zones are clearly visualized as defects of activity accumulation; also ischemic regions are detectable. The rate of release of the activity from the myocardium was determined from the time activity curves corrected for free iodine and served as a parameter for the regional metabolic turnover of FA. The average clearance half-time in n l s w a s 25 J 5 min; the values for infarcted zones ranged from 30 to 50 min. IHA seems to be an excellent radiopharmaeeutical for myocardial imaging and for noninvasive assessment of energy metabolism of normal and pathological myocardium. Institute for Medicine and Institute for Nuclear Nuclear Research Center JUlieh, F.R. Germany
Chemistry,
Exercise T1 201 myocardial imaging is more sensitive than other exercise parameters in the detection and assessment of coronary artery disease but this is dependant on achieving maximal symptom limited exercise, Simple quantitation aids the interpretation of these images. St. Thomas' Hospital,
London,
S.E.L.,
England.
2 THE RAOIONUCLIDE CARDIAC VENTRICULOGRAM: EVALUATION OF RESULTS IN ONE THOUSANDCONSECUTIVE PATIENTS
NICHOLAS G. NOLAN, M.D., JOSEPH LINDSAY, JR., M.D. Washington Hospital Center, Washington, D.C., U.S.A. M u l t i p l e EKG gated (MuGa) cardiac l e f t ventriculograms were performed using the technique of Borer, et al~ All pat i e n t s were examined at r e s t . In a d d i t i o n , almost a l l were also exercised on a bicycle ergometer. Stannous pyrophosphate Tc-g9m R.B.C. l a b e l l i n g was used. The L.A.O. proj e c t i o n was employed.Approximately 15% of the patients required cardiac c a t h e t e r i z a t i o n as part of t h e i r c l i n i c a l care: these cases form the basis f o r t h i s r e p o r t . CATHETER PROVEN C.A.D. T r i p l e Vessel Disease Double Vessel Diseas£ Single Vessel Disease
CATHETER PROVEN C.A.D. T r i p l e Vessel Disease Double Vessel Disease Single Vessel Disease
% ABNORMAL PATIENTS
Rest 79 74 38
Stress 90 lO0 69
Deterioration 79 79 69
GLOBAL EJECTION FRACTION % (GEF) MEAN ÷ S.E.M. Rest Stress Deterioration 53m2 48~2 -5 55~3 5153 -4 64~2 60~2 -4
By comparison, a group of c l i n i c a l l y normal subjects had mean resting and stress EF's of 58 and 62%, respectively, with no substantive SWM abnormality observed in any instan ce.
We conclude MuGa ventriculogram is an extremely valuable technique f o r the non-invasive detection and evaluation of l e f t v e n t r i c u l a r dysfunction.
4 EXERCISE-INDUCED ST-SEGMENT ELEVATION AND SERIAL EXERCISE THALLIUM 201 SCINTIGRAPHY IN PATIENTS WITH PREVIOUS MYOCARDIAL INFARCTION.
A. LAHIRI, V. BALASUBRAMANIAN, J.C.W. CRAWLEY, E.B.RAFTERY Northwick Park H o s p i t a l , Harrow, Middx. England. Out of 618 consecutive graded exercise tests(GXT), 36 showed ST-segment e l e v a t i o n on exercise (2 females and 34 males) (mean age = 52 years) and a l l has a previous myocardial i n f a r c t i o n (MI), 33 a n t e r i o r (AMI) and 3 i n f e r i o r ( I M I ) . These patients were i n v e s t i g a t e d a n g i o g r a p h i c a l l y and by means of Thallium (201 Tl) scintigraphy during e x e r c i s e , as an i n d i c a t o r of myocardial ischaemia. Treadm i l l GXTs were c a r r i e d out. Dyspnoea, r a t h e r than chest pain was the e x e r c i s e - l i m i t i n g f a c t o r . 85% of the maximal predicted heart rate f o r the mean age was at t ai ned by the group. 41% has a f a l l in s y s t o l i c blood pressure during exercise and 44% has exercise induced v e n t r i c u l a r ar r h y th mias. Angiography revealed severe i o c a l i s e d dyskinesia in 78% and single vessel disease in 70%.'201 TI s e r i a l scint~graphy showed a perfusion defect in a l l 20 patients who were scanned but there was no change on exercise in those patients with single vessel disease. Exertional ischaemia was demonstrated in 4 of 6 patients with multi ~ ple vessel disease. I t is concluded t h a t exercise-induced ST segment elevation is a r e l i a b l e i n d i c a t o r of underlying v e n t r i c u l a r dyskinesia and is more l i k e l y to be induced by mechanical dysfunction than by myocardial ischaemia.
114
5 CALCULATION OF EJECTION FRACTION, AFTER BACKGROUND DEDUCTION FROM PERIODICAL COMPONENTS OF RADIOCARDIOGRAM p. De Vernejoul, J. Valeyre, J. Mestan, Cl. Kellershohn Rapid data sampling during the first pass of a cardiactracer after intravenous injection gives good curves of ventricular radioactivity. The calculation of the ejec: tion index is as follows: end systolic v o l u m e Ejection index ~ l end diastolic volume ESV EI 1 EDV From experience we know this ejection index is different of ejection fraction measured from near simultaneous angiographic studies. A number of methods using gamma cameras or single probes were proposed to correct the backgroumd counts which mainly produce the difference. A procedure was developed hy Van Dyke and associates to evaluate the ejection fraction. This experimental approach introduces an empiric method of do~ble measurement to obtain a valuable base line for the calculation. One can assume that an explicit procedure will be satisfactory. Theoretically the slope of the left ventricular washout curve is directly due to the effect of successive ejections so: ESV -k --and e EDV (in which k is the slope and the natural unit of time given by E.C.G.) should have been identical, but they are different. From the difference we can calculate a corrective coefficient on the order of 60%. Using this calculation procedure we obtain an excellent correlation with catheterism data.
7 THE ESTIMATION OF CARDIOVASCULIARSYSTEM FUNCTIONAL STATE BY HYXEMIA TEST WITH THE UsE~F RADIONUCLIDE ANGIOCARDIOGRAPHIC DATA. YU.N. KASATKIN, G. THIEMANN, V.P. KROTOV, T.M. MIKEROVA, V.F. SMIRNOV, N.P. GERASIMOVA. Central I n s t i t u t e f o r Advanced Medical Studies, Moscow, USSR. Created by authors s c i n t i g r a p h i c method of repeatedly defined indices of central hemodynamics a f t e r an i n t r a venous i n j e c t i o n of Technetium-99m serum albumin was used f o r the study of these parameters, p a r t i c u l a r l y , e j e c t i o n f r a c t i o n of l e f t v e n t r i c l e of the heart under the influence of hypoxemia. The studies were done on the healthy men at the age of 25-35. Hypoxemia was caused by the i n h a l a t i o n of gaseous mixture containing ll% oxygen. The indices of cardiovascular system state were determined by gamma-camera-GCA-401 with a connected computer at the time of i n d i c a t o r f i r s t passing as well as at the time of i t s regular d i s t r i b u t i o n in c i r c u l a t i n g blood. The report analyses the change of hemodynamics indices and discusses the possible use hypoxemia t e s t f o r the evaluation of cardiac a c t i v i t y in p a t i e n t s .
Lab. M6deeine Nucl@aire et Biophysique, CHU Necker,75015 Paris,France with UFR,OSAV Praha CSSR & CHU I.J.Godinot, Reims, France.
6 EVOLUTION OF EJECTION FRACTION UNDER PACIN~ A~ONG CORONARY ARTERY DISEASE A. Bertrand, P. Groussin, G. Karcher, C. Lorentz and C. Hocquard In this study,
gated blood-pool
the frequency
using the
scan.
By pacing in right atrium, the variations
noninvasively
the authors have studied
of the ejection fraction according among
normal subjects
with coronary artery disease. the ejection fraction
to
and among patients
Among normal
subjects
is more or less close to the
basal state with a frequency of
]50. On the other hand
among some patients havinz showed myocardial
infarction
and whose ejection fraction was the lower limit of the normal values, pacing.
this ejection fraction
collapses
after
This fall can vary from 10 to 5N %, it all
depends on
the cases. After heving stopeed the pacing
and having administered
nitroglycerine,
fraction comes back to its previous
Service de ~ d e c i n e Cardiologie
Nucl6aire
(Pr. Faivre)
F 54500 VANDOEUVRE
the ejection
value.
(Pr. Martin)
W.H. KNAPP, F. HELUS, R. LAMBRECHT, H. GASPER I n s t i t u t e f o r Nuclear Medicine (Deutsches Krebsforschungszentrum) Heidelberg (GFR).
the ejection fraction of the left
ventricle have been determined
8 DETERMINATION OF RIGHT VENTRICULAR EJECTION FRACTION (RVEF) BY USING Kr-81m.
et de
du C.H.U. N~NCV-BP~BOIS
The f u n c t i o n a l anatomy of the r i g h t v e n t r i c l e causes a p e r f e c t separation between r i g h t and l e f t v e n t r i c u l a r c a v i t i e s to be harzadous by radionuclide techniques. Since the u l t r a s h o r t - l i v e d Kr-81m is a v a i l a b l e , the measurement of the important physiological parameter RVEF seems to become accessible. The noble gas ( t l / 2 = 13 sec) is eluted from a Rb-81~>Kr-81m generator by water in which i t becomes solved. The s o l u t i o n is infused i n t o the pat i e n t s vein f o r e,g. 50 sec. During t h i s period i t cont i n o u s l y passes the r i g h t heart and is exhaled by the lungs. The number of counts acquired~ normally exceeds 1.500.000. Data processing: the region of i n t e r e s t (ROI) corresponding to the r i g h t v e n t r i c l e , is defined automatically by subtracting the e n d - s y s t o l i c from the e n d - d i a s t o l i c even% and s e t t i n g a lower theshold. The d i f f e r e n c e between endd i a s t o l i c and e n d - s y s t o l i c counts in t h i s ROI is divided by the e n d - d i a s t o l i c count number. The r e s u l t i n g value represents the RVEF which can a d d i t i o n a l l y be corrected f o r the background. Si'nce the r e s u l t s show that in app r o j e c t i o n the count rate c o n t r i b u t i o n by s c a t t e r from the lungs is only between 5 and I0% in the ROI, t h i s correction does not seem to be required f o r individual cases, The l i m i t e d time r e s o l u t i o n , the short physical decay, and the type o f a p p l i c a t i o n have to be taken into account as f u r t h e r p o t e n t i a l sources of e r r o r . Their influence on the numerical r e s u l t and the r e p r o d u c i b i l i t y of data are analyzed together with f i r s t c l i n i c a l experience.
115 11 MEASUREMENT E. Cheyretova,
OF THE CORONARY BLOOD FLOW G. Ivanov, V. Marinov, G. Sotirov
A n e w m e t h o d for the m e a s u r e m e n t of the coronary blood flow through the simultaneous injection of two radioisotopes with different - energy emission is described. 1 3 1 j _ H S A and 201Tl-chloride are simultaneously injected in the right sub-claverian and the dilution curves are recorded. F r o m the dilution curve of ]31J-HSA, the cardiac blood flow is calculated. A s for the coronary blood flow, this is calculated f r o m the difference between the peaks areas of the peak recorded on the left ventrivule. The beginning of the 201Tl-fixation is determined through the simultaneous recording of E C G . The results s h o w a good correlation between the m e a s u r e d coronary blood flow (expressed in m l / m i n , or as % of the cardiac blood flow) and the clinical state of the patient.
I0 THE EFFECT OF SOME FACTORS ON DETECTION OF REGIONAL MYOCARDIAL PERFUSION DISTURBANCES J. Kasalicky, A. Belan, J. Fabian T h e regional myocardial perfusion w a s m e a s u r e d in dogs by m e a n s of 133-Xe w a s h o u t injected intracoronary with a gammacamera and Scintigraphic Data Analyser. T h e r e w a s an insignificant 10% perfusion decrease only in the heart apex following a left anterior descending coronary artery ligature as c o m p a r e d with a great flow decrease m e a s u r e d directly by a 133-Xe w a s h o u t injected locally. A n increased blood flow w a s observed in the intact left ventricular m y o c a r d i u m , and this h y p e r e m i a b e c a m e even higher after release of ligature. A reactive hyperem i a follows after short period of ischemia. T h e s e both factors m a y dirrlinish the detection possibilities of regional hypoperfusion by g a m m a c a m e r a , if separate areas of interest include both ischemic and h y p e r e m i c m y o c a r dium. T h e n u m b e r of collaterals demonstrated by coronarography m a r k e d l y increased in 146 patients with ischernic heart disease (half of t h e m after myocardial infarction) with increasing severity of coronary artery narrowing and obstruction; simultaneously the total myocardial blood flow decreased only insignificantly. T h u s the regional hypoperfusion m a y be not significantly lower at rest. T h e ratio of regional perfusion in ischem i c and intact m y o c a r d i u m as m e a s u r e d by local 133-Xe injection w a s nearly i:I0 in dogs, w h e r e a s the ratio of 8 6 - R h concentration after intravenous injection w a s only 1:4. W e m a y p r e s u m e that the concentration ratio of radionuclids used for myocardial uptake and scintigraphy in regional ischemia does not correlate exactly to the perfusion differences. Institute for Clinical and E x p e r i m e n t a l Medicine,
Prague
12 QUANTITATIVE EVALUATION OF MITRAL AND AORTIC REGURGITATION B Y 133-Xe I N F U S I O N P. Jebavy, J. Kasalicky, I. B e r a n e k Mitral (14) and aortic (14) regurgitation w a s evaluated in Z5 patients with rheumatic heart disease by angiography, dye dilution m e t h o d (DID) and continuous 133-Xe infusion. A n g i o g r a p h y w a s interpreted semiquantitatively on 4degree scale (0-+++). F o r D D w e injected a bolus of Cardiogreen immediately posterior and anteri()r to the e x a m i n e d valve. Blood w a s w i t h d r a w n f r o m femoral artery. Regurgitation fraction w a s calculated f r o m relations on dilution curves. Dissolved 133-Xe w a s infused behind the e x a m i n e d valve, blood being simultaneously w i t h d r a w n f r o m femoral artery and left atrium and f r o m left ventricle respectively to e x a m i n e the mitral and aortic regurgitation. Activity in the collected blood w a s m e a s u r e d in well crystal. Cardiac output, regurgitation fraction and flow w e r e likewise recorded. Using the Z methods, w e p e r f o r m e d 3 consecutive examinations of all patients. R e p e a t e d m e a s u r e m e n t s s h o w e d g o o d reproductibility of the m e t h o d based on evaluation of mitral and aortic regurgitation and consistently increasing cardiac output evaluated by 133-Xe. Evaluation of cardiac output and mitral regurgitation by D D w a s well reproductible, which did not hold for aortic regurgitation. Isotope m e t h o d c o m p a r e d with D D s h o w e d good agreement, however, there w a s poor a g r e e m e n t betw e e n this m e t h o d and angiography. O w i n g to its simplicity and accuracy examination of regurgitation by this m e t h o d is suitable for quantitative evaluation of regurgitation. Inst. Clin. Exper.
Med.,
Prague,
CSSR
116 13 APPLICATIONS IN E L E C T R I C A L IMPEDANCE PLETHYSMOGRAPHY AND CORRELATION WITH ISOTOPE TECHNIQUE D. Oambini, D. Raggueneau, L. Barritault, P. de V e r nejoul T h e whole body i m p e d a n c e m e a s u r e by m e a n s of subsurface needle electrodes at two different frequencies: I0 KI-Iz and 1 M H z allows to approximate respectively extracellular w a t e r v o l u m e and total body water volume. A comparative study on Z0 patients, between extracellular water i m p e d a n c e m e a s u r e and the diffusion vol u m e determination of D T P A labeled with T e c h n e t i u m 9 9 m shows a good concordance between the two techniques (r = 0,839 a0,Z0). Likewise w e note a good correlation between the diffusion v o l u m e m e a s u r e of the iodoantipyrine labeled with I 131 or I 123 and the i m p e d a n c e m e a s u r e s (r = 0,874 a/i/1000, t = Z, 171 p>0,05). T h e s e types of m e a s u r e useful in post chirurgical reanimation, in obstetrics, allow to follow the hydroelectrolytic variations and to estimate easily the body cell m a s s . • T h e use of i m p e d a n c e m e a s u r e techniques of body segm e n t s with four electrodes at a 100 K H z frequency is possible by m e a n s of a specially developed device auton o m o u s end of small dimensions in cardiology, sporting medicine, and in reanimation ambulance. After the realization for each patient of a calibration by isotopic method, it allows to m e a s u r e plainly the cardiac parameters, and hence to c o m p a r e usefully the techniques and to consider a monitorirg.
15 ~£YOCARDIAL S C i N T I C R A P H Y NATE
RELATED
ENT6 WITH I~0CARDIAL G.NE~M~Ta Dep.
V:ITH 9 9 m T c - D I P H O S P H 0 -
TO I~OCARDIAL
J.SCHAUERj
of N u c l e a r
FUNCTION
D°SCHNEIDER,
Medicine
G.SCH~{EIDER
a n d I~[edical C l i n i c ,
I(arl~}~larx-University, L e i p z i g , Patients
!W PATI-
INFARCTION
GDR
wLth myocard iHfarction were folio9qmz . ~ ~ c-dzphosphonate myocardial
wed up with
scintigraphy with
(~iS). The r e s u l t s
parameters
function
(ergometry,
arterial
pressure,
cal s~nptoms, left
cardial which
MS.
r~iS i n d i c a t e s
"chronical
caution
cliniof the
insufficiency positive
myo-
infarction",
in the t r a i n i n g
MS is a s u i t a b l e m e t h o d
up myocardial
pulmo-
with
disturbances
persistent
like
should cause
programme.
output,
Patients
that persistent
lesions
compared
myocardial
and myocardial
rest showed
We concluse
cardiac
ECG).
functional
ventricle,
during
were
characterizing
%o f o l l o w
infarction.
Laboratoire de M @ d e c i n e Nucl@aire et Biophysique, C . H . U . Necker, Paris, F r a n c e
14 VALIDITY OF THE RADIONUCLIDE VENTRICULOGRAPHY I~. Vavrejn, I. Runczik, V. Cernoch, J. Kidery, E. Yirickova T h e analysis of radionuclide ventriculographic findings in patients with different types of cardiomyopathy has been p e r f o r m e d with special attention to coronary heart disease including examinations after surgery /aortocoronary bypass/. S o m e clinicophysiological and methodological pr oblems are discussed /patient preparation, reproducibility, projection, R O I delineation, background subtraction/. T h e need of even t e m p o r a r y unification of the m e t h o d and further prospective studies is e m p h a s i z e d in order to improve reliability and clinical usefulness of the radionuc fide ve ntriculography. Institute of clinical and experimental medicine, Prague, CSSR. Postgraduate medical and pharmaceutical school, Prague, CSSI~.
16 THE LOCAL ACTUAL-TO-MAXIMUM UPTAKE RATIO IN THE INTERPRETATION OF TL-201 SCINTIGRAMS IN ACUTE MYOCARDIAL INFARCTION N. Pepa and J.C. Dupont
20 minutes dynamic acquisition of TI-201 myocardial uptake in LAO 45 ° projection are registered by means of a gamma-camera (Pho Gamma IV) and a processing and display system (PDS, Philips) a f t e r a bolus i n j e c t i o n of 2-3 mCi of TL-201 chloride (Philips-Duphar) in patients with acute myocardial i n f a r c t i o n (less than ten days of age). Built-up images corresponding to the phase of the f i l l i n g of the c a v i t i e s , the early (3'-10') and the late ( I 0 ' 20') uptake are constructed and processed as follows : non-homogeneity correction and display of the images as square root of the number of counts of each matrix element. Aortic root as well as i n t r a v e n t r i c u l a r septum are d e l i mitated on the treated images, either manually or by means of iso-count lines using the images from the f i l ling phase. The other images are used to define regions of i n t e r e s t over the entire myocardium, including the zone of maximum uptake. Mean heights of the a c t i v i t y curves (cpm/zone) are established for the 3'-10' and 10'-20' time periods and the actual-to-maximum uptake r a t i o s are derived a f t e r background correction. In our experience local decreases below 50% of the maximum reveal acute myocardial i n f a r c t i o n . Laboratoire des Radio-isotopes, Queen Fabiola C l i n i c s , Avenue du Centenaire, 73, 6080 Montignies-sur-Sambre, Belgium.
117 17
19
CLINICAL INTEREST OF Z01-THALLIUM J.C. Picard ):~, C. B e c k )I~, P. Virot ~'<)',<
EVALUATION OF INDIUM-IlL-LABELLED LEUCOCYTES FOR LOCALIZATION OF INFLAMMATORY DISEASE A. Ferrant, IN. Leners, C. B e c k e r s
Previous studies have s h o w n the interest of Z01TI in ischemic heart disease. T h e authors report their experience (two-hundred tests): - to size and to locate myocardial infarction if E . C . G . is biased, - to detect tread-mill transient ischemia, - to check graft by-passes. T h e y try to define the functional value of the method, with or without prior myocardial infarction, and its predictive value about the gravity of lesion, c o m p a r e d with stress testing, c o r o n a r o g r a p h y and ventricular a ng log raphy. T h e y point out the interest of 201TI w h e n stress testing is biased (doubtful or uninterpretable), especially with patients taking adrenergic blocking drugs. ~ Service de M 6 d e c i n e Nuel6aire ~:~ Service de Cardiologie CENTRE HOSPITALIER UNIVERSITAIRE Z, avenue Alexis Carrel 87031 L I M O G E S CEDEX (France)
]DE L I M O G E S
T h e results of scanning after injection of oxine-ln-lll labelled leucocytes according to T h a k u r et al.(1) w e r e evaluated in 70 patients. T h e results m a y be s u m m a rized as follows. O n e or m o r e a b n o r m a l loci w e r e visualized in 45 patients. A m o n g 3Z of these patients, the nature of the loci could be clearly established. In the 13 remaining patients, the a b n o r m a l sites could not be further investigated. A b s e n c e of sites of a b n o r m a l uptake w e r e confirm e d in 13 patients. So far, the test r e m a i n e d technically unsatisfactory in 8 patients. It w a s falsely positive in one patient and falsely negative in another one. In 14 patients referred for fever of completely u n k n o w n origin, oxine-In-]ll labelled leucocytes allowed to localize inf l a m m a t o r y diseases. In 16 other patients with fever of u n k n o w n origin, the test did not s h o w any a b n o r m a l focus. T h e s e results strongly suggest that In-ill-labelled leucocytes are m o s t useful to localize and to confirm the sites of inflammatory disease. T h e sensitivity limits of the m e t h o d have still to be carefully defined for a correct interpretation of the data. F u r t h e r m o r e it remains to be clarified to what extent the uptake of the tracer in the reticulo-endothelial s y s t e m might m a s k any uptake within inflammatory tissue. (I) T h a k u r ( M . L . ) e t
al. J. Nucl. M e d . ,
1977, 18, 101Z.
Centre de M 6 d e c i n e Nucl6aire, University of Louvain, Medical School, A v e n u e Hippocrate, 10/i?.80, B-IZ00 Brussels, Belgium.
18 IRON METABOLISM : COMPARTMENTAL ANALYSIS BY NON LINEAR PROGAMMING
20 INDIUM-Ill BONE MARROWSCINTIGRAPHY: A PROGNOSTIC TEST FOR APLASTIC ANEMIA? E.K.J. PAUWELS, H.L. HAAK, P.J. JURGENS, J. TE VELDE.
J.P. LEMORT, Y. BIZAIS, J. RUNGS, C. DON CARLI.
U n i v e r s i t y Hospital Leiden, The Netherlands. Depts. o f
Service Isotopes, C.H.U., Nantes, France
Diagnostics Radiology, Hematology and Pathology.
We use a 7-compartment model describing f a i r l y
er%thro-
Controversial reports as to whether I n d i u m - I l l - c h l o r i d e
poesis and iron storage.
can be c l i n i c a l l y
Determination of parameters from plasmatic clearance
disorders prompted us to i n v e s t i g a t e bone marrow s c i n t i -
used f o r the depiction of hematological
curve of r a d i o i r o n and i t s globular i n c o r p o r a t i o n i n -
graphy in 26 patients with a p l a s t i c anemia. This study
volves the r e s o l u t i o n of the d i f f e r e n t i a l
was done to develop a t e s t f o r the s e l e c t i o n of pat ie n ts
system by the
generalized T a y l o r ' s method, of which we point out the
f o r bone marrow t r a n s p l a n t a t i o n , which can only be ap-
features.
p l i e d to long term Survivors (60% of the cases).
Afterwards, we minimize a c r i t e r i o n depend-
ing on measure e r r o r s by implementation of the conjuga-
Scintigraphic r e s u l t s were a r b i t r a l y graded according
ge-gradient procedure.
to the v i s i b i l i t y
Confidence i n t e r v a l f o r the various parameters (pool s i -
abnormal extention in e x t r e m i t i e s . These scores were
of the bone marrow and i t s eventual
zes, t r a n s f e r t rates) describing the model is given~
compared with hematological values and bone marrow
some examples of pathologic cases are exposed and d i s -
biopsy r e s u l t s . An u n s a t i s f a c t o r y c o r r e l a t i o n was found
cussed.
with bloodchemical values and only a f a i r c o r r e l a t i o n could be demonstrated with bone marrow h i s t o l o g y . As the l a t t e r two parameters have a proven prognostic value f o r patients with a p l a s t i c anemia, we conclude t h a t Indium-chloride scintigraphy should not be done r e g u l a r l y in these p a t i e n t s .
118 21 THE MEASUREMENT OF ERYTHROPOIESIS 52-Fe A. Ferrant and F. Cauwe
USING
J. FORTYNOVA, M. VOPATOVA, J. HOMOLKA
A m e t h o d for determining quantitatively erythropoiesis using the short-living cyclotron produced 52-iron has been applied to 19 patients suffering f r o m a n a e m i a of various origin. T h e data w e r e derived f r o m quantitative scanning of the erythropoietic areas and the m e a s u r e m e n t of the p l a s m a iron turnover (i). T h e 52-Fe m e a s u r e m e n t of erythropoiesis w a s assessed by c o m p a r i n g the data with those of total m a r r o w iron turnover as determined by the m e t h o d of Ricketts et al. (2). T h e results s h o w that both method~ give similar estimates of erythropoiesis except in patients with severe ineffective erythropoiesis and in one patient with important peripheral haemolysis in w h o m erythropoiesis as m e a s u r e d with the 5 2 - F e technique w a s higher than w h e n determined by the m e t h o d of Ricketts et al. Since the latter m e t h o d rests on the analysis of the p l a s m a iron disappearance curve (which is c o m p l e x in abnormally high ineffective erythropoiesis or severe haemolysis), the estimate of total erythropoiesis in these conditions might be m o r e reliable using the 5 2 - F e quantitative technique than with the 5 9 - E e kinetics. O n the other side, the 5 2 - F e m e t h o d does not distinguish effective f r o m ineffective erythropoiesis and cannot be applied to patients with extramedullary erythropoiesis.
(i) F e r r a n t (A) a n d C a u w e (F) E u r o p . Y. Nucl. M e d . , 1979 (in press). (Z) Ricketts (C)et al. Brit. J. Haematol.,
1975, 31, 65.
Centre de M 6 d e c i n e Nucl4aire, University of Louvain, Medical School, A v e n u e Hippocrate, 10/17.80, B-1200 Brussels, Belgium.
22 MEASUREMENT OF SERUM FERRITIN BY IMMUNORADIOMETRICASSAY V. MANN+ , K, NEMET++, L.T. KOCSAR+, I. SIMUNOVITS++ +Natl.Res.lnst. f o r Radiation Biology and Radiation Hygiene, Budapest. ++Inst. Haematology and Blood Transfusion, Budapest. Serum f e r r i t i n
level is g e n e r a l l y regarded as an i n d i -
cator of the iron stores o f the organism.
A 2 - s i t e im-
munradiometric assay was developed f o r f e r r i t i n .
An t i -
serum coated polystyrene tubes were used as the s o l i d phase. The a n t i f e r r i t i n - a n t i b o d i e s
were l a b e l l e d with
125-iodine by the Chloramin T method on immunadsorbent. Examinations were performed concernin~ the e f f e c t of the storage of the coated tubes as well as the time paramete~ upon the standard curve of the assay.
I t was stated
that a week's storage at +44°C does not a l t e r the measured values. The s e n s i t i v i t y of the method at the optimal time parameters is as low as 2.5 ng/ml and the standard curve can be l i n e a r i z e d up to lO0 ng/ml/log-log t r a n sformation. The serum f e r r i t i n
23 GRANULOCYTE KINETICS WITH 5 l c r .
level was folIowed in
20-29 years o l d , f i r s t - b e a r i n g human females and the
I n s t i t u t e of Haematology and Blood Transfusion, Prague, CSSR Faculty Hospital 2, Prague, CSSR. As compared to the k i n e t i c s of erythrocytes and thrombocytes, the leucocyte k i n e t i c s is s u b s t a n t i a l l y more complex and methodically more complicated. That is why i t has not yet been introduced, even experimentally, i n t o haematological centres, in spite of i t s s i g n i f i c a n t importance in the c l i n i c a l diagnostics, mostly o f suppressive states with peripheral neutropenia. The p e r f e c t mastering of leucokinetics requires team work of a c l i n i c i a n , a transfusion s p e c i a l i s t , isotope chemist and biochemist. Our present communication reports on the preliminary r e s u l t s of l e u c o k i n e t i c examination according to Dresch and Najean, in patients with various disorders of the white blood c e l l s . Besides the sur vi val period and l o c a l i s a t i o n of the d e s t r u c t i o n , we focussed on the values of the granulocyte marginal, c i r c u l a t i n g and t o t a l pool as well as the circadian turnover of granulocytes in the p a t i e n t s . For the determination of granulocyte nitrogen we proposed our own m o d i f i c a t i o n of the microtechnique using B e r t h e l e t ' s reagent.
24 RESTATEMENT ON THE MEASURE ON HEMODYNAMIC VOLUME WITH THE AID OF INDIUM l13m LABELLED TRANSFERRIN J.F. Morin~% J. Agnely ~;<','-',P . P . M o r i n ~, P. de V e r me joul~',~%
A m o n g the short half-life isotopes, Indium l 1 3 m is especially interesting for h e m o d y n a m i c tests and its elective binding is then transferrin. M o s t criticisms this tracer is subject to, c o m e f r o m a confusion between h e m o d y n a m i c v o l u m e and total blood volume. Indeed, if an early blood sampling (5th minute after the injection) is enough to m e a s u r e the first, it is admitted fact that one m u s t wait a longer time or do successive sampling to obtain the second. In the experimental series shown, the h e m o d y n a m i c v o l u m e is independent of the tracer: transferrin Ind i u m l l 3 m on the one hand, s e r u m albumin labelied with 125 I on the other hand. Still there are cases w h e r e a huge difference appears. T h e authors have observed that in m o s t cases transferrin of the explored patients w a s overloaded with iron. So an iron - Indium competition s e e m s to exist then at the expense of this latter element which leaks f r o m the vascular bed. This explains the overestimation of the v o l u m e with the transferrin Indiunn-tracer.
control level was measured in healthy female blood-donors/ f i r s t - d o n o r s of the same age. A s i g n i f i c a n t decrease in the serum f e r r i t i n
level was observed a f t e r the t h i r d
month of the pregnancy.
* C.I-I.U° M o r v a n Brest, F r a n c e ~J( C. }{. U. N e c k e r Paris, ]france
119 25 PERIPHERAL MEMBRANE PROTEINS LABELLING ERYTHROCYTES WITH 99Mo J. Lener, B. Blbr, M . I
OF
While studying the interaction of pentavalent 9 9 M o with blood components its binding of alpha-Z-macroglobulin w a s determined; however, on several times w a s h e d erythrocytes the m i n o r part of radioactivity w a s f o ~ d . This finding led the authors to follow the uptake of Mo to erythrocyte m e m b r a n e prote~Ds. N o interaction w a s found with 9 9 M o VI, while 9 9 M o reacts with t h e m depending on f o r m of the c o m p l e x and p H value of the m e dia. The so-called M o V b r o w n c o m p l e x prepared by reduction of 9 9 M o 0 ~ with ascorbic acid excess exhibited reproducible specific binding on spectrin. In addition to this significantly high binding on spectrin, negligible interactions with s o m e other peripheral m e m b r a n e proteins w e r e observed. Institute of Hygien and Epidemiology, Isotope Laboratory of the Institutes for Biological R e s e a r c h of Czecholovak A c a d e m y of Sciences, Institute of H a e m a t o l o g y and Blood Transfusion, Prague, C S S R .
26 COMPARATION OF RESULTS OF SEVERAL METHODSTO STUDY OF CEREBRAL BLOOD FLOW R. Sopena, O. M a r t i , J. Alonso, F. Pardo and J. Esteban. Q u a n t i t a t i v e information about of the cerebral blood flow with n o n - d i f f u s i b l e t r a c e r s , c l a s s i c a l y have been obtained by determination of d i f f e r e n t s parameters of the hemispheric c i r c u l a t i o n curves. In t h i s studies can be considerer three phenomenae overlap: the dinamica o f the bolus, the input phenomena in the "region of i n t e r e s C The purpose of t h i s paper is to present in 30 normal subjects the c o r r e l a t i o n s of several c l a s s i c a l parameters (uptake slope time, Oldendorf's t r a n s i t time, uptake slope, a c t i v i t y of the f i r s t maximun, i n t e g r a t i o n of a c t i v i t y from f i r s t appearance of the radionuclide to the f i r s t maximun) with the parameters (mean t r a n s i t time - t - ; parabola area input - Q -) obtained with a new method to evaluate the mean t r a n s i t time and an index of regional cerebral blood flow performed as a part of dynamic brain s c i n t i g r a p h y and p r e v i o u s l y presented. Ciud S a n i t a r i a "La F@". Valencia. Spain.
27 FOLLOW UP STUDY OF BRAIN INFARCTION CHANGES IN rCBF CIRCULATION TIME AND Q-EEG-PARAMETERS U. Tolonen, A. Ahonen, M. Koskinen, T. Kallanrania and E. Hokkanen Intravenous 133-Xe- and 99-TcmO4 cerebral blood flow and c i r c u l a t i o n time parameters were studied with gammacamera three times during the f i r s t three months a f t e r hemispheric i n f a r c t i o n in 20 p a t i e n t s . Q u a n t i t a t i v e EEG (GEEG) was also recorded each t i m e . A f t e r i n j e c t i o n of 20 mCi 133 Xe washout curves were analyzed from symmetrical regions of both hemispheres by two-expenential f i t t i n g method including a r e c i r c u l a t i o n c o r r e c t i o n . A f t e r the Xe examination dynamic brain scintigraphy was performed with 20 mCi 99-TcmO4. The time a c t i v i t y curves were analyzed by the modified gamma function f i t t i n g method, Q-EEG parameters were determined by Fourier a n a l y s i s . During acute phase of i n f a r c t i o n the mean c i r c u l a t i o n time was 5.65-1.82 (S.D.)s in the i n f r a c t i o n hemisphere and 4.82 +i.62s in the other hemisphere, which are longer than the ~espective values o f healthy persons (3.9 ~0.7s, J.Kuikka et a l . : Phys. Med.Biol. 5. 958-970, 1977). Ten days l a t e r both values were almost s i g n i f i c a n t l y s h o r t e r (4.67t1.59s on the lesion side and 3.88 + 1.08s on the control s i d e ) , Three months a f t e r the acute-phase c i r c u l a t i o n time was s l i g h t l y prolonged in both hemispheres compared with the second examination, rCBF mean remained low a l l the time and even showed a tendency to reduce during the f o l l o w up time, Also on the control side the mean level of rCBF mean was s l i g h t l y reduced in a l l three examinations. During the whole f o l l o w up time Q-EEG mean frequense (lower on the i n f a r c t i o n side) improved in both hemispheres. I t is i n t e r e s t i n g t h a t in two weeks a f t e r the i n f a r c t i o n c i r c u l a t i o n time c l e a r l y shortened, not only on the i n f a r c t i o n side but also on the other side. Parameters of the control side c l o s e l y followed the changes on the i n f r a c t i o n side during both worsening and improving s t a t e s . During the e a r l y phase a f t e r i n f a r c t i o n QEEG changes did not accompany the changes in blood flow and c i r c u l a t i o n . Dept. of Neurology U n i v e r s i t y of Oulu SF-90220 Finland
28 A COMPUTERPROGRAMFOR THE RADIOISOTOPE STUDY OF THE CEREBRAL FLOW E. P i e r s a n t i , R. ~ a r t i g n o n i , S. De ~ a t t e i s , G. Rascente and L. Del Gatto Through the aid o f On Line System, represented by a gamma camera "Nuclear Chicago", linked with a CINE 200 Intertechnique, we have adapted a simple LEM program in order to study the cerebral flow. We have studied about lO0 p a t i e n t s , f o r whom we have a l so c o l l e c t e d a l l other informations a v a i l a b l e : i . e . c l i nical ecographic, thermographic as well as EEG. Given an i . v . bolus of 99m-Tc-glucoheptonate, which a l lows also a s t a t i c scintigraphy lh l a t e r , we obtain 8 simultaneous curves in sequential i n t e g r a t i o n over the various areas chosen and a f t e r "Lissage". The frame a c q u i s i t i o n at 0.3 sec. i n t e r v a l s f o r 50-60 sec. period allows optimal v i s u a l i z a t i o n of a l l phases of the cerebral c i r c u l a t i o n . The areas chosen are the f o l l o w i n g : l . Common c a r o t i d of both sides; 2. Internal c a r o t i d o f both sides; 3. W i l l i s polygon; 4. Meningeal a r t e r y o f both sides; 5. Longitudinal sims. The present program includes the number of curves to be elaborated, the time i n t e r v a l of image a c q u i s i t i o n and the t o t a l number of images. Through sequential analysis we evaluate q u a n t i t a t i v e l y the f i r s t three parameters : I . A r r i v a l time o f the r a d i o a c t i v e bolus in the area under study; 2. Peak time, which i s the time i n t e r v a l needed to cross the area under study, is determined by the f i r s t d e r i v a t i v e with the tangent method according to Olderderf; and then evaluated the time i n t e r v a l between the minimum and maximum of the d e r i v a t i v e . All cases have been matched against the informations obtained through the other techniques and i t is well poss i b l e to conclude t h a t the r a d i o i s o t o p e method is simple and accurate to measure even e a r l y cerebral flow d e f i c i t . Ospedale "S. L i b e r a t o r e " , A t r i
(TE), I t a l y .
120 29 ASSESSMENT OF REGIONAL CEREBRAL BLOOD FLOW BY CONTINOUS CAROTID INFUSION OF KRYPTON-81m AND EMISSION COMPUTERIZED TOMOGRAPHY F. Fazio, C. Fieschi, M. Nardini, M. C o l l i c e and M. Possa Regional cerebral blood flow can be assessed by: (a) dynamic studies using l o n g - l i v e d r a d i o a c t i v e gases such as 85-Kr or 133-Xe; (b) steady state c a r o t i d i n f u s i o n of 81m-Kr ( 13 seconds h a l f - l i f e ) . Emission computerized tomography (ECT) is a new technical development which provides more d e t a i l e d information on the in vivo d i s t r i b u t i o n of r a d i o a c t i v e isotopes by removing superimposition of information with depth. Requirements f o r ECT are very high counting s t a t i s t i c s , which are d i f f i c u l t to obtain with dynamic flow studies. The aim of t h i s study is to assess the f e a s i b i l i t y of o b t a i ning tomographic images of brain perfusion using the 81m-Kr steady state method, which allows high counting s t a t i s t i c s to be achieved. Patients with various brain diseases were studied. During c a r o t i d i n f u s i o n o f 81m-Kr in s o l u t i o n , the a c t i v i t y over the brain recorded on a y camera equipped with a mechanical gantry s u i t a b l e to allow a 360 ° r o t a t i o n of the detector around the p a t i e n t . Data were recorded on a d i g i t a l computer, sorted out in angular p r o j e c t i o n s , corrected f o r a t t e n u a t i o n , and subsequently reconstructed in both t r a n s a x i a l and l o n g i t u d i n a l sections. Tomographic images seem to show the f o l l o w i n g advantages over convent i o n a l views in two dimensions: (a) v i s u a l i z a t i o n of blood flow d i s t r i b u t i o n w i t h i n brain structures (grey and white matter, basal g a n g l i a ) ; (b) more accurate l o c a l i z a t i o n and evaluation of areas of r e l a t i v e l y reduced or increased p e r f u s i o n ; (c) b e t t e r d e f i n i t i o n o f patterns of c o l l a t e r a l c i r c u l a t i o n ; (d) greater sensit i v i t y and s p e c i f i c i t y in detecting and defining blood flow changes during p h y s i o l o g i c a l a c t i v a t i o n studies.
31 CRITICAL TION OF
STUDY OF THE rCBF WITH THE
PARAMETERS 133 X E N O N
OF EVALUAINHALATION
METHOD
J.__C. D e p r e s s e u x ,
G. M e r c h i e ,
J. Milet, J. B e r n i e r
T h e authors present n o r m a l results of r C B F obtained with the 133 x e n o n inhalation m e t h o d described by Obrist and al. and R i s b e r g and ai. A l rain. inhalation p h a s e of air with 5 m C i of 133 7
Ospedale Niguarda, Milano, I t a l y
30
32
HEMISPHERIC CEREBRAL BLOOD FLOW CEREBRAL PERFUSION PRESSURE AND HEMATOCRITE DURING POST-TRAUMATIC COMA F. A r t r u , B. Philippon, R. Deleuze and M. Berqer
COMPARAISOIN OF BRAIN SCANS AND REGIONAL REBRAL BLOOD FLOW STUDY O N 21 P A T I E N T S AFTER CEREBRAL VASCULAR ACCIDENT B. Philippon, P, Thivolle
Hemispheric cerebral blood flow (H.C.B.F.) measurements were performed b i l a t e r a l l y on 10 severely b r a i n - i n j u r i e d p a t i e n t s . The method used is a m o d i f i c a t i o n o f O b r i s t ' s method : i n j e c t i o n I.V. of Xenon 133. Analysis by a r t e r i a l deconvolution give a i n i t i a l slope index of C.B.F. Simultaneously, with CBF, epidural pressure, a r t e r i a l blood pressure (BP) were recorded. Perfusion pressure (PP) were calculated. Six patients (16 measures) with an interhemispheric CBF d i f f e r e n c e of less then 5 ml/mn/ 100 g. formed a "symmetrical" group ("SYM") (mean HCBF of these group : 33.55 ml/mn/100 g. - 4,3 ; PP = 125 mmHg. Four patients (16 measures) with greather interhemisphe~c CBF f£rmed the "asymetrical" ("ASYM") group (~ower ~ = 30.6 = 5,4 ml/mn/lO0 g. ; higher HCBF : 39.5 L 3.7 ml/mn/ 100 g. ; Pl~= 104 mmHg). HCBF symetry and asymetry were c l e a r l y p a r a l l e l to the hemispheric d i s t r i b u t i o n of l e s ions as revealed by computed tomography and c a r o t i d angi~ graphy. A l i n e a r r e l a t i o n between HCBF and PaCO2 existed (r = 0.88, p < 0.01) allowing c o r r e c t i o n o f a l l HCBF to t h e i r t h e o r e t i c a l values f o r a PaCo2 of 30 mmHg. In the "SYM" group, HCBF c o r r e l a t e d p o s i t i v e l y with B.P. (r = 0.69 ; p < 0.02, n = 16) and perhaps with perfusion pressure ( r = 0.45 ; p <0.07). In the "ASYM" group, HCBF on the l e s s ' p e r f u s e d side is c o r r e l a t e d n e g a t i v e l ~ with P.P. ( r = 0.68 ; p < 0.05 ; n = 8).
Hematocrite and HCBF were c o r r e l a t e d in the SYM group ( r = 0.78 ; p < 0.02). The r e l a t i o n of HCBF with perfusion pressure in the symetrical group may be due to a loss of CBF a u t o r e g u l a t i o n , but no explanation appears f o r t h e i r paradoxical r e l a t i o n s observed in the less perfused hemisphere of asymetrical p a t i e n t s . Neurological Hospital and Department o f Nuclear Medicine Lyon France
CE -
Measurement of regional cerebral blood flow a n d brain scans have b e e n p e r f o r m e d on Zlpatients after strokes. Measurement of r. C B F is p e r f o r m e d by a variant of OBRIST's method. A gamma c a m e r a recording with a data p r o c e s s o r allows the p e r f o r m a n c e of a picture of r. C B F a n d the selection of 7 areas of interest. N o r m a l m e a n values are 4 4 , 5 ! 4 , 7 m l / m n / 1 0 0 g. r. C B F h a v e b e e n p e r f o r m e d about 3 w e e k s after stroke a n d brain scans, a w e e k after or a w e e k before r. C B F . W e consider as a global l o w e r C B F (G type) an h e m i s pheric C B F lower than 2 standard deviations at the norm a l value ( D < 3 4 ) a n d as a focal lower C B F (F type) a r. C B F of one of 7 areas of interest l o w e r than 34 m l / m n / 1 0 0 g. r. C B F h a v e b e e n n o r m a l twice (2 T.I.A.). I n 7 cases there w e r e F type and in 12 cases, there w e r e G type. B r a i n scans have b e e n n o r m a l in Ii cases. Localization of strokes a p p e a r s better on brain scans than on r. C B F but r. C B F informs of the r e p e r c u s s i o n of strokes on the cerebral p a r e n c h y m a . C e n t r e de M 4 d e c i n e Nucldaire, HSpital N e u r o - c a r d i o l o gique, 59 B d Pinel, 69003 L y o n , F r a n c e
t21 33
35
R E G I O N A L C E R E B R A L BLOOD F L O W IN BRAIN TUMORS T. K r y s t , M. W o y n a r o w s k i , M. M a r c i n i a k , S. R u d n i c k i
SENSITIVITY OF BRAIN HELMET EXAMINATION IN DISCOVERING CIRCULATION TIME CHANGES IN CEREBRAL INFARCTION A. A h o n e n , U. Tolonen, M . Koskinen, E. H o k k a n e n
T h e m e a s u r e m e n t s of regional blood flow / r C B F / in c a s e s of brain t u m o r s are v e r y i m p o r t a n t e l e m e n t s of n e u r o r a diological diagnosis for evaluation of possibility a n d degree of coexistent o e d e m a . 5 m C i of 133 X e d i s s o l v e d in isotonic salina w a s injected directly into the internal carotid artey in local anaesthesia. M e a n r C B F w a s d e t e r m i n e d by the 133 X e clearance m e t h o d using S E A R L E L.F.O.V. gammacarnera. Data w e r e r e c o r d e d in disc m e m o r y P D P 11/34 on line during IZ m i n u t e s , according in f r a m e m o d e : in the first 10 sec Z0 h a l f - s e c o n d f r a m e s , a n d after, 40 f r a m e s e a c h 18 sec period. In e x a m i n e d patients w e found that in cases of t u m o r s in w h i c h the pathological vessels w e r e visualised in cerebral angiography, values of r C B F i n c r e a s e d in t u m o r ' s region a n d d e c r e a s e d in other areas of this h e m i s p h e r e . In cases of t u m o r without the pathologicalvessels r C B F in the a r e a of the t u m o r a n d other regions of this h e m i s p h e r e w a s l o w e r than n o r m a l . In 6 patients m e a s u r e m e n t of r C B F post operation w a s p e r f o r m e d too. In period 4 w e e k s after the operation d e c r e a s e d of r C B F in all regions of h e m i s p h e r e w a s observed. It s e e m e d that r C B F m e a s u r e m e n t can reveal the disturbances of c e r e b r a l circulation due to the o e d e m a of the brain. P s y c h o n e u r o l o g i c a l Institute-Warsaw, P o l a n d Postgraduate Medical Education Center-Warsaw,
Poland.
34 HEMISPHERIC CEREBRAL BLOOD FLOW, CEREBRAL PERFUSION PRESSURE AND HEMATROCITE ~ I N G P O S T - T R A ~ T X C COMA F. Artru (IY, B. Philippon- -, R. Deleuze'-'~ M. Berger (2) Hemispheric cerebral blood flow (H.C.B.F.) measurements were performed bilaterally on i0 severely brain-injured patients. The method used is a modification of Obrist's method: injection I.V. of Xenon 133. Analysis by arterial deconvolution give an initial slope index of C.B.F. Simultaneously, whith CBF, epidural pressure, arterial blood pressure (UP) were calculated. Six patients (16 measures) with an interhemispheric CBF difference of less than 5 ml/ran/100 g.formed a "symetrical" group ("SYM") mean HCBF of these group: 33.55 ml/mn/100 g. 4.3;IPP = 125 mmHg. Four patients (16 measures) with greater interhemispheric CBF formed the "asymetrical" ("ASYM") group (lower HCBF= 30.6 5.4 ml/mn/lO0 g.; higher H ~ : 39.5 3.7 ml/mn/100 g.; PP = 104 mmHg). HCBF symmetry and asym metry were clearly parallel to the hemispheric distribution of lesions as revelaed by computed tomography and carotid angiography. A linear relation between HCBF and PaCe 2 existed (r : 0.88, p < 0.01) allowing correction of all HCBF to their theoretical values for a PaCO 2 of 30 mmHg. In the "SYM" group, HCBF correlated positively with B.P. (r = 0.59~ p < 0.02, n = 16) and perhaps with perfusion pressure (r : 0.45; p < 0.07). In the "ASYM" group, H ~ on the less perfused side is correlated negatively with P.P. (r = -0.68; p < 0.05; n = 8). Hematocrite and HCBF were correlated in the SYM group (r = -0.78; p < 0.02). The relation of HCBF with perfusion pressure in the symetrical group may be due to a loss of CBF autoregulation, but no explanation appears for their paradoxical relations observed in the less perfused hemisphere of asymmetrical patients. Neurological Hospital (1) and Department of Nuclear Medicine (2), Lyon, France.
R e g i o n a l cerebral flow p a r a m e t e r s w e r e m e a s u r e d in 74 patients without evidence of organic brain disease and in 49 patients with h e m i s p h e r i c infarction, by using a m u l tidetector device, brain helmet. O u r multidetector device consists of 30 detectors situating s y m m e t r i c a l l y in the h e l m e t a n d of t w o m o b i l e detectors. C e r e b r a l circulations p a r a m e t e r s w e r e determ i n e d f r o m time activity c u r v e s using a m o d i f i e d g a m m a function m e t h o d . (J. K u i k k a et al.;Phys. M e d . Biol. 5, 958-970, 1977). 5-10 m C i 9 9 m - T c 0 4 injected in e a c h m e a s u r e m e n t rapidly into the antecuhital vein. T h e m o s t suitable reference values for the p a r a m e t e r s w e r e d e t e r m i n e d by calculating the specificity (0.96), the sensitivity (0.9Z), a n d the a c c u r a c y (0.94) of the test. T h e sensitivity of the test w a s adjusted to a level as high as possible, for the purp o s e to use the brain h e l m e t e x a m i n a t i o n as a screening test. 45 out of 49 patients with h e m i s p h e r i c infarction h a d one or m o r e pathological values in the circulatory parameters. T r a n s f e r t i m e s e e m e d to the m o s t useful circulation time p a r a m e t e r . W i t h our multidetector device, it is possible to detect subtile c h a n g e s in regional c e r e b r a l circulation and, for e x a m p l e to evaluate the effect of various t r e a t m e n t s on the brain h e m o d y n a m i c s . O u r brain h e l m e t device also is suitable for 133-Xe r C B F - measurements and, furt h e m o r e , isotopes with energies as high as 511 K e V can be used. Dept. Of Clinical C h e m i s t r y a n d N e u r o l o g y , University of Oulu, S F - 9 0 Z Z 0 0 u l u Z2, Finland
36 A NEW METHOD TO EVALUATE THE TRANSIT TIME AND AN INDEX OF REGIONAL CEREBRAL BLOOD FLOW J__t Marti, R. V a z q u e z , R. Sopena, J. E s t e b a n __ T h e p u r p o s e of this p a p e r is to p r e s e n t a n e w m e t h o d to obtain quantitative i n f o r m a t i o n about the c e r e b r a l blood flow after injection i.v. Z0 m C i 9 9 m . T c with a c a m e r a on-line with a c o m p u t e r . I m a g e s are collected at Z fram e s / s e c , during the first minute. T h e m e t h o d is b a s e d on a m a t h e m a t i c a l m o d e l that evaluate the input of the bolus as a parabolic function and the transit as an exponential function. W i t h the p a r a m e t e r s obtained w e c a n isolate the transit p h e n o m e n a (transit time -'[ -) of the input p h e n o m e n a (the p a r a b o l a a r e a - Q -). Transit t i m e (t-)provides information about of the cerebral circulation d i n a m i c a and the relationship b e t w e e n both h e m i s p h e r i c Q c a n be u s e d as an index of regional relative perfusion (I Q). Results of this m e t h o d are p r e s e n t ~ n 30 n o r m a l subjects. T h e ~nean transit time w a s 6.85- I. 16. M e a n I Q was 0.997-0.136. This m e t h o d p e r f o r m e d as a p a r t of d y n a m i c brain scintigraphy. C i u d a d Sanitaria " L a F6", Valencia, Spain.
122 37 RIA AND EIA : A COMPARISON OF METHODOLOGICAL PERFORMANCES IN THE MEASUREMENTOF DRUGS (DPH) AND INFECTION-RELATED ANTIGENS (HBsAg) U. Rosa, R. Malvano, A. Boniolo, V. Don~
39 RADIOIMMUNOASSAY OF ACUTE PHASE ALPHA-2-GLYCOPROTEIN
Both e l i m i n a t i o n of r a d i o a c t i v i t y problems and higher tra cer s t a b i l i t y make enzymoimmunoassay (EIA) gain increasing favour as the most e f f e c t i v e a l t e r n a t i v e to r a d i o immunoassay (RIA). This, in p a r t i c u l a r , f o r a p p l i c a t i v e f i e l d s where RIA is not widespreadly d i f f u s e d as y e t , e.g. in monitoring of t o x i c drugs and i n f e c t i o u s states. However, a d e f i n i t i o n of the RIA and EIA r e l a t i v e merit in terms of s p e c i f i c a n a l y t i c a l performances often remains matter of discussion. As an experimental c o n t r i b u t ion to evaluate the p o t e n t i a l i t y of the newer EIA techni~ ues in respect with RIA, the data obtained with the methods developed f o r two d i f f e r e n t a p p l i c a t i o n s are r e p o r t ed, i . e . assay of diphenylidantoin (DPH : homogeneous EIA, 3 H - a ~ I 2 5 1 - R I A ) and of A u s t r a l i a antigen (HBsAg : ELISA, solid-phase RIA). A p r a c t i c a l equivalence o f p r e d i c t i v e e f f i c a c y was demonstrated f o r EIA and RIA'in HBsAg detect ion. In the case of DPH determination, a close agreement of estimates and comparable levels o f accuracy and prec i s i o n r e s u l t e d , f u r t h e r advantage being associated to the homogeneous EIA v a r i a n t as f o r i t s i n t r i n s i c adequacy to f u l l automation and promptness o f response.
Faculty of [4edicine and Hygiene, Praha, CSSR
Radiochemical Unit SORIN Biomedica - Laboratorio di Fisio logia Clinica C.N.R., v. Savi 8, Pisa ( I t a l y )
I. KE4LOVA, L. ROZPRIMOVA, V. BRUMELOVA, J, SRAMKOVA~ V. SLOUKA
Alpha-2-glycoprotein of acute phase (pregnancy associated p r o t e i n , pregnancy zone p r o t e i n , plpha-2-pregnoglob u l i n , SP3) belongs to acute phase proteins and is present in sera of pregnant women in concentration 40-I00 mg/ml. Low alpha-2-AP glycopreotein serum levels of healthy men and women can be determined s o l e l y by RIA. Serum of healthy men and women contains l-lO0/ug/lO0 ml alpha-2-AP glycoprotein according age and sexL I t is known that t h i s protein plays an important r o l e in malignancy and by checking i t s concentration i t is possible to monitor antitumour therapy. For this reason RIA technique was introduced. Alpha-2-AP glycoprotein wa's prepared from r e t r o p l a c e n t a l sera by zinc sulphate p r e c i p i t a t i o n followed by gel f i l t r a t i o n and p u r i f i c a t i o n o f anti human plasma proteins immunoadsorbent column. Immune serum was prepared by immunization of 70 kg pigs by i n j e c ting 4 times the antigen in Al-span-Oil adjuvant. Balast antibody was eliminated using insoluble antigens. 1251 l a b e l l e d t r a c e r was prepared by the chloramine T technique. Unreacted 125] was removed in two steps by gel f i l t r a t i o n on Sephadex G-50 and Sephadex G-200, The procedure usually y i e l d e d preparations with a s p e c i f i c a c t i v i t y of approximately 30/uCi~ug. Double antibody system was used, standard concentration range was 200 ng lO/ug. Using this method the authors examined blood donoPs sera, sera of pregnant women, amniotic f l u i d and sera of cancer patients.
38
40
A C O M P A R I S O N OF IN V I T R O H I G O X I N D E T E R M I N A T I O N S 86-RB E R Y -
RADIONUCLIDE DIAGNOSTICS OF INITIAL HYPERPARATHYREOSlS
T H R O C Y T E S T E C H N I Q U E , RIA, E L I S A A N D IN V I V O R A D I O C Y C L O G R A PEIC C O N T R A C T I L I T Y INDEXES OF D I G O X I N E F F E C T S
I. PURIZHANSKIJ, A. AMETOV, R. TURAEV, I. LARINA, E.
M. Horv&th, E. Horv&th, L. N a g y
BELOVA On the basis of v a r i a t i o n c o e f f i c i e n t
(VC) in t o x i c b o r d e r -
line zone no sign.diff, was found at the 3ng/ml level bet-
Central I n s t i t u t e f o r Advanced Medical Studies, Moscow,
w e e n C o r n i n g Immophase, P h a d e b a s Dogoxin, the F i n n i s h M e d i -
URSS.
c a t e s t and CIS D i g o k kits. VC v a r i e d a r o u n d 7-8% and e s s e n t i a l l y it was of the same o r d e r w i t h A m e r s h a m , B e c k m a n , C l i n . A s s a y s and S q u i b b clasp kits. The s e p a r a t i o n t e c h n i q u e s are discussed. The 86-Rb t e c h n i q u e b a s e d u p o n the m e m b r a n e A T P ase i n h i b i t i o n u n d e r the i n f l u e n c e of d i g i t a l i s g l y c o s i d e s in the toxic b o r d e r l i n e zone h a v e shown a g o o d c o r r e l a t i o n w i t h RIA, r. 0.945. At lower levels the RIA, at h i g h e r toxic levels the 86-Rb e r y t h r o c y t e m e m b r a n e t e c h n i q u e has p r o v e d to be the m o r e sensible.
In the results o b t a i n e d
w i t h the same b l o o d s a m p l e s b y the use of RIA and S y v a enzyme assay kits,
c o r r e l a t i o n has p r o v e d b e s t in the n o r m a l
zone, in the toxic zone R I A gave s o m e w h a t h i g h e r r e s u l t s t h a n ELISA. y - E L I S A - 0.24 + 0 . 7 8 x-RIA, r. 0.97 F i n a l l y our r a d i o c y c l o g r a p h i c m e t h o d is fit to f o l l o w up the
Combined radionuclide programme of diagnostics of i n i t i ~ hyperparathyreosis consisting of v i s u a l i z a t i o n of adenomas o f parathyroid glands with the help of 75 Se-Methionine, v i s u a l i z a t i o n of skeleton bones with the help o f 99mTc-Pyrophosphate, determination of parathormone content in blood serum has been developed. The data of radionuclide examination have been compared with c l i n i c a l - r a d i o l o g i c a l
and biochemical data (content
o f Calcium in blood serum, phosphorus secretion in u r i -
e f f e c t of d i g o x i n on the c o n t r a c t i o n of m y o c a r d i u m . As the h a e m o d y n a m i c i n s u f f i c i e n c y is p u t i n t o o r d e r the SV i n c r e a s -
ne, content of o x y p r o l i n e ) , 19 pat i ent s with i n i t i a l
es 51-93mi,
hyperparathyreosis have been examined.
the h e a r t cycle lenghts 500-820ms, p a r t i c u l a r l y
the d i a s t o l i c p e r i o d 200-500ms, e j e c t i o n b e c o m e s d y n a m i c a l , the
i/2 p r o p o r t i o n of the fast and slow e j e c t i o n is r e s t o r -
ed to the n o r m a l
Content of parathormone with these patients exceeded
I/3-2/3 r e l a t i o n , the p r e - e j e c t i o n is shor-
t e n e d 150-8Oms, so the p r e - e j e c t i o n / s y s t o l i c time r a t i o w i l l
the normal range as much as ten times. Discovered
be d i m i n i s h e d 0 . 6 2 5 - 0 . 3 3 .
adenomas of parathyroid glands have been v e r i f i e d by
F i n a l l y it is w o r t h of m e n t i o n i n g t h a t in our l a b o r a t o r y L. N ~ m e t h has w o r k e d out on a Texas 59 table c o m p u t e r a i i n e a r ized r e g r e s s i o n f i t t i n g for the e v a l u a t i o n of the c a l i b r a t i o n of d o s a g e s curves. State H o s p i t a l for C a r d i o l o g y , B a l a t o n f ~ r e d , H u n g a r y
the h i s t o l o g i c a l method.
123 41
43
EVALUATION OF PITUITARY RESPONSIVENESS TO LTH IN ANOVULATORY STATUS BY STANDARD RADIOIMMUNOASSAYTECHNIQUE: PHASIC HYPERPROLACTINEMIA AND ITS TREATMENT WITH BROMOCRIPTINE (CB-154). GAIMPIETRO 0., MOGGI G,~ CHISCl R., DALLE LUDHE A., SIMON~ NI N., BRUNORI I . , NAVALESl R. ]-ns-t]tute of O b s t e t r i c s and Gynaeco ogy, nd Medl[cal C l i nic,CNR Clin. Physiol.Laboratory, U n i v e r s i t y of Pisa. In studying FSH, LH,PRL response to LRH in anovulatory sta tes, we performed a standard LRH t e s t (lO0/u e . v . ) in 82 anovQlatory and in 4 normally ovulating wo~en. Blood samples were taken at O' and 20,40,60,80,I00,120 min a f t e r LRH. Serum PRL,FSH were measured with standard RIA techniques (Sorin k i t s ) , T h e i n t e r and i n t r a - a s s a y v a r i a t i o n coef f i c i e n t s , estimated on reference pools,were 21,4% and 9.6~ r e s p e c t i v e l y , f o r PRL, 17% and 5,7% or FSH, 16% and 4.5%, f o r LH.In our l a b o r a t o r y , normal basal PRL values are up to 25 n g / m l , S t a t i s t i c a l analysis was performed by the Student's t t e s t . l O anovulatory patients were basally hyperprolactTnemic and showed no s i g n i f i c a n t change in PRL values a f t e r LRH. Of the remaining 72 normoprolactinemic women 59 showed no PRL modification a f t e r LRH,as did the nor mals.Whereas in 13 a prompt and s i g n i f i c a n t r i s e of PRL concentration above normal levels a f t e r LRH was observed. N o s i g n i f i c a n t d i f f e r e n c e s in gonadotropin concentrations were detected between the three groups of anovulatory patients.The unusual r i s e in PRL l e v e l s dont repmesent an intermediate phase between true normoprolactinemia and chronic hyperprolactinemia. In 5 of the 13 women with a r i s e a f t e r LHR,we performed a second LRH t e s t a f t e r 2~5 mg once a day f o r two days bromocriptine t r e a t m e n t . A f t e r CB we obtained l ) suppresion of the phasic h y p e r p r o ~ i a ; 2) a s i g n i f i c a n t (p
REFERENCE PREPARATION FOR RADIOIMMUNOASSAY OF HUMAN ANTITHYROGLOBULIN ANTIBODY - B.David,J.P.L@onard,C.Beckers
42 A TRACER STUDY OF GLUCOSE-INDUCED INSULIN SECRETION IN DIA BETIC PATIENTS BY DECONVOLUTIONANALYSIS AND ITS RELATIONTO PLASMS GLUCOSE DISAPPEARANCE. NAVALESl R., GIAMPZETRO O, PILO A., MANESCHI F., BENZIL L., TALLARICO L., MATTEUCCI E. ~ C l i n i c and -C~]~.R. C l i n i c a l Physiology L a b o r a ~ ry, U n i v e r s i t y of Pisa, I t a l y . We performed and IVGGT, sampling every minute, in 17 nonk e t o t i c non-obese, f r a n k l y d i a b e t i c patients (D) and in 17 normals (N), in which the plasma disappearance curves of immunoprecipitable 1 2 5 - i n s u l i n , a f t e r i . v . bolus i n j e c t i o n , were determined immediately before the t e s t . By deconvolut i o n analysis of the glucose stimulated IRI curve f o r the disappearance curve o f i n s u l i n i t was possible to recons t r u c t the minute by minute post-hepatic i n s u l i n d e l i v e r y rate (Am.J.Physiol 233:E500, 1977). In the normal subject the pattern of i n s u l i n secretion showed an "early" phase with 2-3 peaks, within the f i r s t 25 min. Which accounted f o r two t h i r d s of the t o t a l glucose, induced i n s u l i n output. The l a t e phase, from 25' to 90', showed no remarkable o s c i l l a t i o n s . Diabetic p a t i e n t s , in comparison to normals; showed: l ) a s i g n i f i c a n t reduction o f to t o t a l glucose-induced i n s u l i n output, ST~ (534386 v. s. 853mI12 mU/m2), 2) a marked dicrease of the f i r s t peak of i n s u l i n s e c r e t i o n , Sl, (from O' to 6 ' ; 31¥15 v.s. 270~34); 3) a smaller second peak, S2,(from 6' to 25'; 134~15 v.s. 223533). The l a t e phase, $3, was s i m i l a r in the two groups (366T59 v.s. 327T64). In normals the Sl but not ST bore a s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n with the Kg. In diabetics the Kg, althought reduced in comparison to normals, showed a p o s i t i v e c o r r e l a t i o n (p
44 THE VALUE OF DIFFERENT METHODS CONSIDERING THE TBG IN TYROID FUNCTION STUDY
A reference preparation of antithyroglobin autoantibodies (Abs) has been obtained from human serum using the method of affinity chromatography,employing Sepharose-hound human thyroglobulin (Tg) as an i~munoadsorbent. The methodology has been modified to avoid the contamination of the preparation with denatured antibody molecules and with Tg from the affinity adsorbent or from circulating Tg-anti Tg immune complexes. The purification steps were monitored hy adding labelled Tg as a tracer in order to detect any contamination with Tg and by the use of a two-site assay for Tg and anti-Tg. Serum rich in anti-Tg was chromatographed on Sepharose 6B to separate Tg immune complexes from free anti-Tg immunoglobulins. Anti-Tg from the immunoglobulin fraction was bound into the immunoadsorbent and eluted with acid solution s of varying ionic strength~ Two peaks of antiTg activity were identified. In the second fraction eluted at lower pH, relatively low amounts of protein were dissociated, but the Abs showed a higher affinity for Tg. The purified preparation formed a single precipitation arc against pure Tg, markedly reacted against anti-human IgG serum and weakly against anti-human IgA and was able to rebind to Tg. Of the anti-Tg added to the immunoadsorbent, 99% were removed by the adsorbent but only 25% were finally recovered. The availability of an anti-Tg reference preparation of high purity may be useful for measuring serum anti-Tg, and detecting sera containing only freee anti-Tg and those with Tg immune complexes, and also in the calibration of laboratory standards under routine conditions. Centre de M6decine Nucl@aire, University of Louvain, Medical School, Avenue Hippocrate, 10/17.80, B-1200 Brussels (Belgium).
M. DOEPP, S.F. GREBE Departments Nuclear Medicine, U n i v e r s i t y of Giessen and ;4unicipal Hospital of Hanau, F.R.G. The c a r r i e r protein TBG must be considered i n t e r p r e t i n g iodine hormone l e v e l s . We compared the diagnostical discrimination of the possible methods: l ) T4/S T3 U, 2) 7 4 / t o t a l TBG capacity, 3) T4/ t ot al TBG concentration, 4) f r e e T4 t e s t ( d i r e c t ) ; 5) (T4 + 30.T3) /S T3 U, 6) (T4 + 30-T3)/TBG capacity, 7)(T4 + 30.T3)/ TBG concentration. Bl4 patients were investigated and c l a s s i f i e d i n t o the groups: A) manifest hypoth., B) l a t e n t hypoth., C) absolute euth., D) l a t e n t hyperth. E) manifest hyperth.; F) euth. cases with estrogens, G) euth. children. Student's F and t t e s t was performed. S i g n i f i c a n t d i f f e rences were found in the f o l l o w i n g sequence: Meth. High - low no (F, G) significances ( h r . ) : 5) 4 0 0 F:D, G:D l) 3 l 0 F:D 6) 2 2 0 F:B/C, G:C 2) 2 l l F:B/C, G:B/C 4) 2 l 1 F:B/C, G:C 7) 2 l l F:B/C/O, G:C/D 3) 2 0 2 F:B/C/D, G:C Conclusions:The balanced summation of fT4 and fT3 indizes ~ ' h e T3 uptake t e s t (S T3U~,~free TBG capacity) is the best diagnostical tool which can be derived from a blood specimen at present. The only disadvantage - the underestimation of elevated TBG levels - can be eliminated by squaring the S T3 U (l.O = normal, augmented i n d i z e s ) . The t o t a l TBG concentration RIA is c l e a r l y i n f e r i o r . The fT4 t e s t is useful but no progress. A standardization with q u a n t i t a t i v e evaluation of the T3 uptake t e s t , however, is required.
124 45 CLINICAL INTEREST OF SERUM FREE TETRAIODOTHYRONINE (F T4) AND FREE TRIODOTHYRONINE (F T3) RADIOIMMUNOASSAY. F. ROUX e, R. SAUVAN ~, J.L. SAN MARCOee, D. OLLIVIERe, Jim. BISSET~. Service de M~decine Nucl@aire (Pr. H. ROUX) C.H.U. Timone, 13385 Marseille C#dex 4, FRANCE. ~ Clinique M~dicale (Pr. R. SIMONIN) C.H.U. Timone, 13385 Marseille C#dex 4, France.
47 THE DIFFICULTIES IN RADIOIMMUNOASSAY
OF SERUM
T-3, T-4 AND rT-5 IN THE PRESENCE OF CIRCULATING ANTIBODIES. J.KOSOWICZ and M. GEMBICKI The aim of our studies was: to perform RIA of T-3 T-4 and rT-5 in animals,18 rabbits and 11 sheep, with circulating T-3 antibodies following immunization with T-3-BSA conjugates. Circulating
Serum F T3 and F T4 assays were performed by radioimmunoassay a f t e r column adsorption chromatography (LEPETIT, I t a l i e ) . In 67 euthyroid subjects, we established F T3 and F T4 mean serum value (m) and 95% confidence l i m i t s (in square brackets): F T3 : ~ = 3.6 pg/ml, [2.0 - 6.4] F T4 : m = 13.0 pg/ml, [7.5 -18.5]. Therefore, we studied c o r r e l a t i o n between F T3 and Free Triodothyronine Index (F T3 I) and between F T 4 and Free Thyroxine Index (F T4 I ) . In 35 hyperthyroid subjects, F T4 and F T3 serum levels were above our upper normal l i m i t , in 32 hypothyroid subjects F T4 and F T3 serum levels were below our lower normal l i m i t . F T3 and F T4 serum levels measured in 30 pregnant women and in I0 women on oral contraception were in normal range. Lastly, some p a r t i c u l a r cases allowed us to show the c l i n i c a l i n t e r e s t of F T3 and F T4 serum measurement: T3 t h y r o t o x i c o s i s , T4 t h y r o t o x i c o s i s , iodine deficiency, thyroxine binding globulin (T.B.G.) deficiency, the follow-up of patients under treatment.
T-3 antibodies disturbed results of RIA; in PEG and double antibody separation techniques serum
46
48 RADIOIMMUNOASSAY TECHNIQUE USED FOR MEASURING HORMONE CONTENT IN SURGICAL PATIENTS
E V A L U A T I O N OF A FREE T 4 - A S S A Y P.Pfannenstiel, N.Panitz, D.Emrich, K.P.Leipert, U.Facorro, I . S c h r e i v o g e l To estimate the e v a l u a t i o n of the free T4 values we comp a r e d the results of the C o r n i n g FT4 assay in 357 p a t i e n t s with n e a r l y all in vivo and in vitro tests. On the basis of these r e s u l t s we c o l l e c t e d ii groups with d i f f e r e n t t h y r e o i d diseases. The n o r m a l range was e s t a b l i s h e d by studying a group of 92 h e a l t h y persons of d i f f e r e n t age and was found to be 6.0 to 9.0 ~ g / d l for the TT4 and l.lO to 1.70 ng/dl for the FT4. The i n t e r a s s a y variance for d i f f e r e n t control sera was b e l o w 8 % for total and free T4. The c o m p a r a t i v e analysis of all tests p e r f o r m e d r e v e a l e d a v e r y e v i d e n t d i f f e r e n t i a t i o n among the normal, hyper-, and h y p o t h y r o i d groups. S i m i l a r results in p a t i e n t s with e u t h y r o i d goiter, latent and m a n i f e s t hyper- and h y p o t h y r o i d i s m were found with total and free T4 assay. In fem a l e s taking oral c o n t r a c e p t i v e s the TT4 was s l i g h t l y elevated d e p e n d i n g on the TBG-rise while the FT4 was not sig n i f i c a n t l y d i f f e r e n t from normal range. In p a t i e n t s with r e c e n t iodine or thyroxine exposure the average v a l u e s of FT4 were found to be h i g h e r than TT4 and the range was wider. L a t e n t disease states could not be d e t e c t e d by TT4 or FT4 w i t h o u t the use of the TRH-test. In 80 % of all i n v e s t i g a t e d p a t i e n t s we o b t a i n e d the same i n f o r m a t i o n by F T 4 - v a l u e s as with TT4, and in only 15 % we o b t a i n e d more i n f o r m a t i o n by FT4. The a d v a n t a g e of the F T 4 - a s s a y used in this study is that one gets the TT4and F T 4 - v a l u e s from one sample d e t e r m i n a t i o n and therefore one can r e c o g n i z e a TBG displacement. T h e r e f o r e this FT4 is a s a t i s f a c t o r y a l t e r n a t i v e for TT4 and thyroid b i n d i n g c a p a c i t y but not for other in vitro and in vivo p a r a m e t e r s in d i a g n o s i n g thyroid diseases. F a c h b e r e i c h N u k l e a r m e d i z i n , Deutsche Klinik stik, A u k a m m a l l e e 33, D-Wiesbaden, FRG
fuer Diagno-
T-3 was very low. Appiication of ethanol extraction procedure of serum samples allowed exact hormone determinations.
In immunized rabbits se-
rum T-5 averaged 118,100 ng/dl /normal N=I05/, serum T-4 5.1 ug/dl /N=5.3/ and rT-3 20.9 ng/dl /N=18.0/. In immunized sheep mean serum T-3 concentration was 67,600 ng/dl /N=112/, T-4 was 42 ug/dl /N=4.8/ and rT-3 416 ng/dl /N=47/. Despite an abnormally high T-5 concentration,
exceeding
500-1000 times normal range, no one symptom of thyrotoxicosis was observed in investigated animals what indicates that circulating antibodies completely abolish biological effects of T-3 excess. Department of Endocrinology, Medical Academy, A1. Przybyszewskiego
49, 60 355 Pozna~, Poland.
VANTSIAN E.N., VINNITSKY L.I.,EGOROVA I . A . , YDAEVA N.D,, VOROBJOVA N.T. All-Union Research I n s t i t u t e of Clinical and Experimental Surgery, Moscow, USSR. High s e n s i t i v i t y , specificy and accurateness of radioimmu noassay technique in measuring hormon content in body l i quids allows to introduce this method into c l i n i c a l pract i c e . This technique finds wide application in diagnosis of d i f f e r e n t diseases, in follow up and treatment of pathologic states and in evaluation of efficacy of surgical treatment. The paper presents d i f f e r e n t aspects of application of radioimmunoassay in measuring hormone content in surgical patients. This study is based on the results of examination of 250 patients with diseases of g a s t r o i n t e s t i n a l t r a c t , with symptomatic a r t e r i a l hypertension, with terminal stage of chronic renal insufficiency. At d i f f e r e n t steps of surgical treatment gastrin, renin, aldosterone and cyclic nucleotides content was measured in these patients. The application of radioimmunoassay technique is c l i n i cally justified.
125 51
49 ULTRAMICROMETHOD INSULIN N. T a r k o l e v
FOR
RADIOIMMUNOASSAY
OF
T h e d e v e l o p m e n t of m i c r o - a n d u l t r a m i c r o m e t h o d s for d e t e r m i n a t i o n of h o r m o n e s is v e r y i m p o r t a n t in clinical screening a n d e x p e r i m e n t a l studies. In the m e t h o d described, a v o l u m e of 0 . 0 Z 0 m l s e r u m or p l a s m a is u s e d for a single determination. The method is c h e c k e d up by c o m p a r i n g the results of serial determinations of a n e x p e r i m e n t a l m o d e l with those obtained by the d e x t r a n - c o a t e d c h a r c o a l m e t h o d , e m p l o y e d in our lab o r a t o r y for m a n y years. T h e differences b e t w e e n . t h e s e results are insignificant. T h e r e h a v e b e e n studied 52 sera, devided into g r o u p s according to their s e r u m insulin concentrations by the s t a n d a r d a n d by the u l t r a m i c r o m e thod. T h e values obtained by the u l t r a m i c r o m e t h o d show e d a n a v e r a g e increase of 3 . 2 6 % c o m p a r e d to those obtained by the s t a n d a r d m e t h o d . Results f r o m the d e t e r m i n a t i o n of IRI in capillary blood by the u l t r a m i c r o m e t h o d are also presented. T h e s e results are c o m p a r e d to the s a m e s a m p l e s f r o m v e n o u s blood, r u n by the s t a n d a r d m e t h o d .
AUTOMATED ASSAY K. H r u s k a
LABORATORY
FOR
RADIOIMMUNO-
T h e a p p a r a t u s e s and i n s t r u m e n t s in the laboratory m u s t be reliable so as to insure its continuous operation. R e ceiving a n d registration of the s a m p l e s , the R I A p r o c e dure as well as the p r o c e s s i n g of results should be s i m ple, but the possibility of a m i x - u p in the s a m p l e s m u s t be prevented. All the p r o c e d u r e s u s e d m u s t be constantly c h e c k e d for accuracy, preferably using standard sera. P r e f e r e n c e should be given to the use of iodine 125 tracers. U s e of highly specific antibodies should allow the m a j o r i t y of analyses to be p e r f o r m e d without previous extraction of the biological material. E s s e n tially the s a m e p r o c e d u r e (buffers, separation of free f r o m b o u n d ligand, p r o c e s s i n g of standards and s a m p l e s , p r o c e s s i n g of results) should be used, if possible, for the determination of various substances. Veterinary Research
Institute, B r n o ,
CSSR.
Institute of R e n t g e n o l o g y a n d Radiobiology, M e d i c a l Academy, Sofia, Bulgaria.
5O
125 *HCS (HPL) LABELING WITH I ISOTOPE AND ITS APPLICATION IN RIA M. Mohari. K., L. Kocsar, V. Kutas
HCS determination with RIA has been performed on a routine w ~ 5 i n obstetrical diagnosis in our days. The radioactive (- I) derivative o f N C S (HPL) is prepared in general with Chloramin-T labeling. In contrast to the methodology used so far we used iodogen (1,2,4,6 - Tetrachloro - 3a,6a - diphenylglycoluril) oxidation agent instead of Chloramin-T. The efficiency of the labeling has been improved significantly as against Chloramin-T labeling, i.e. 90 - 95 %. The 'tracer' obtained is of high specific activity, high purity and can be used on a reliable manner in radioimmunoassay. Standard curves Tracer with Ch.T
%
,-4 20-
\
\
20-
\.
2
"~ 15"
~ 10' ~4
Tracer with iodo-gen
\
10!
|
~
~
T ~6
~.g/ml
~ a e
"LIMITING VALUES" MODEL RADIOIMMUNOASSAYS I<. M a j c h r z a k , R. R u d k o w s k i
~ ~
~
I
~g/ml
The serum HCS (HPL) can be determined in 0-16 ug/ml range by means of the RIA we produced. 'FJC'Natl.Ras. Inst.for Radiobiol.and Radiohyg. Budapest, Hungary
OF
EQUILIBRIA
IN
A m a t h e m a t i c a l m o d e l of equilibria occuring in r a d i o i m m u n o a s s a y s w a s developed. It w a s a s s u m e d that at a sufficiently high value /"limiting v a l u e " / of the equilib r i u m constant K of reaction of an antigen with an antib o d y the c o m p l e x f o r m e d m a y be treated as a stable c o m pound. O n this a s s u m p t i o n equations describing the dilution curve and the standard c u r v e w e r e derived. At I< value l o w e r than the limiting appropriate corrections w e r e m a d e using a quantity called association coefficient w h i c h is a ratio of the c o m p l e x concentration to the concentration of the total antigen or antibody. T h e dilution c u r v e s and standard c u r v e s calculated f r o m this m o d e l as functions of K value and the antigen or antibody concentration, have the s a m e c o u r s e as the e x p e r i m e n t a l c urve s. Institute of N u c l e a r R e s e a r c h ,
o
15,
52
Warsaw,
Poland.
126
53 A POSSIBILITY AND PRECISION OF ESTIMATING THE 13]-JHIPPURATE CLEARANCE/ERPF/FROM DYNAMIC SCINTIGRAPHY USING A GAHMA CAMERAWITH "ON-LINE" COMPUTER E. Mlodkowska, M. Surma and J. Bialobrzeski
55 THE SIGNIFICANCE OF DYNAMIC SCINTIGRAPHY IN POSTOPERATIVE COURSEOF RENAL TRANSPLANTS. K. S l i z , A. Oppelt, B. Vavrejn, V. Stadlerova, I. Reneltova and V. Martinek
P a r a l l e l y with renoscintigraphy performed by means of a gamma camera with o n - l i n e computer a renal clearance of 131-J-Hippurate was determined by c l a s s i c a l methods in 30 p a t i e n t s . From dynamic scintigraphy were obtained : (1) renal curves corrected f o r extrarenal background, (2) a curve representing the a c t i v i t y in blood. Uptake c o e f f i c i e n t was calculated according to the formula :
Up to now 200 renal t r a n s p l a n t a t i o n s approximately have been performed in the Transplantation Research Center. In about 120 patients the postoperative function o f the g r a f t has been investigated by means o f dynamic s c i n t i graphy. Rapid bolus i n j e c t i o n o f sodium pertechnetate f o r perfusion studies is followed by another i n j e c t i o n of sodium 131-I-Hippurate. The p a t i e n t is l yi ng supine under a s c i n t i l l a t i o n camera Pho / Gamma I I I . The data are stored by means of a multichannel analyszer with magnetic tape memory Ampex. In postoperative complications the diagnostic value o f sequential s c i n t i g r a p h y is essential f o r proving a l t e r a t i o n s of the u r i n a r y t r a c t , e s p e c i a l l y the u r i n a r y leakage. Regional parenchymal defects o f inflammatory and noninflammatory o r i g i n may often be seen. The. d i s t r i b u t i o n o f perfusion a f t e r bolus i n j e c t i o n is helpful in recognizing occlusion of major or minor a r t e r i e s . Studies of both f u n c t i o n s , perfusion and t u b u l a r t r a n s port of Hippurate may c o n t r i b u t e to the d i f f e r e n t i a t i o n between acute t u b u l a r necrosis and t r a n s p l a n t r e j e c t i o n .
UC =
N/t1 K/t/dt
where : N/t1 = net renal count rate at time t l p r i o r the peak K/t = "blood" a c t i v i t y vs time. When the uptake c o e f f i c i e n t was co~related with !31-JHippurate clearance determined d i r e c t l y a highly s i g n i f i c a n t c o r e l a t i o n was found : r = 0.95, p< 0.025. A regression l i n e was calculated and confidence l i m i t s of ERPF estimate from the uptake c o e f f i c i e n t were computed. This c o r r e l a t i o n may be used f o r estimating ERPF d i r e c t l y from 131-J-Hippurate r e n o s c i n t i g r a p h i c data without blood sampling.
Institute for Clinical CSSR.
and Experimental Medicine Prague
Dept. of Nuclear Medicine and Radiobiology, Medical Academy of Lodz, Poland.
54 COMPUTER ASSISTED R~]NOGRAPHY : UTILITY AND LIMITATIONS IN A S S E S S M E N T O~ I(IDNEY TRANSPLANT FUNCTION. A. Delaloye-Bischof, J.P. Wauters, H . R . Brunner, B. Delaloye In 34 patients having undergone renal transplantation between 1975 and 1978 close on 200 renal studies have been p e r f o r m e d with the scintillation c a m e r a . T h e tracers w e r e 131 I or 123 I OII-I, occasionnally 9 9 m T c c o m pounds. T h e sequential i m a g e s w e r e e x a m i n e d with re~ a r d to tracer arrival time and distribution in kidney and urinary tract. Analysis of the computerized renog r a m and evaluation of the accumulation indexes ( c o m parison of kidney activity during the first 30 seconds and during the following minute with the injected activity) permitted semiquantitative a s s e s s m e n t of renal function, W h e r e a s it is easy to detect urine stasis and leakage, no specific sign of rejection could be established. Delayed tracer arrival and elimination, increased kidney volume, heterogeneity of tracer distribution, small accumulation indexes, diminished initial amplitude and slope of the often ascending renographic curves are non specific signs of rejection and can also occur in other pathological states. In the experience of the authors this investigation is useful in screening patients with a raise of p l a s m a creatinine after renal transplantation. Together with careful evaluation of clinical and laboratory p a r a m e t e r s it often permits to establish exact diagnosis, in the other cases it has proved to be useful in the choice of the c o m p l e m entary investigations to m a k e final diagnosis. Division a u t o n o m e de M ~ d e c i n e Nucl6aire and Div. de N~phrologie, D @ p a r t e m e n t de M@decine, Centre Hospitaller Universitaire Vaudois, Lausanne, Switzerland
56 ASSESSMENT OF SEQUENTIAL SCINTIGRAPHY RAPID SEQUENCE PYELOGRAPHY AND RENOGRAPHY IN THE SCREENING FOR RENOVASCULAR HYPERTENION C. Bianchi, C. Donadio, G. Tramonti, A. Calderazzi, E. Camerini and P.L. Michelassi A comparison of rapid sequence pyelography and sequential renal scintigraphy was made in 67 hypertensive subjects with u n i l a t e r a l renal disease (43 renovascular hypertension and 9 u n i l a t e r a l p y e l o n e p h r i t i s ) and in 15 patients with essential hypertension. In 44 of these patients renography was also performed. Pyelography seems to be the most e f f e c t i v e procedure in the screening f o r renovascular hypertension. In f a c t i t showed a greater s e n s i t i v i t y (86 %) than scintigraphy (60%) and renography (52%). The p o s i t i v e p r e d i c t i v e v a l ues and accuracies were s i m i l a r f o r the three t e s t s . Pyelography and scintigraphy complement each o t h e r , since in 40% of patients a f f e c t e d by renovascular hypertension whose pyelography was equivocal or negative scintigraphy resulted p o s i t i v e . C l i n i c a Medica Generale 2, Centro Studi N e f r o l o g i c i "Clara Monasterio G e n t i l i " , I s t i t u t o di Radiologia, U n i v e r s i t y o f Pisa, Pisa, I t a l y
127 57 NEW NOMOGRAPHICQUANTITATIVE NEPHROGRAMANALYSIS V. Koral, V, Blaha, J. Kolinska, M. Pokorna, J. Trnka, E. Tschernoster and J. Prokopec A generally used method of nephrogram q u a n t i t a t i v e eval u a t i o n does not e x i s t today. Various ways of analysis seem to i n d i c a t e that commonly used nephrogram timeparametres (as Tmax of TA/2) or t h e i r simple r e l a t i o n s do not r e f l e c t a l l aspects of the hippuran dynamics. For that reason a new a n a l y t i c a l approach describing the nephrogram as a whole has been chosen and the respective homographic method derived. This method is based on assumption t h a t (a) o v e r a l l hippuran k i n e t i c s consists of the f i r s t order steps only, (b) the r a d i o a c t i v i t y measured over the kidney area r e s u l t s from a c t i v i t i e s of a l l compartments geometricaly r e l a t e d , and (c) no changes of renal functions and/or blood c i r c u l a t i o n occur during the measurement. Introducing some s i m p l i f i c a t i o n s and using the set o f p r e f a b r i c a t e d nomograms we can obtain the numeric values of p a r a m e t r e s ~ / , r ~ , which, being b i o l o g i c a l l y meaningfull, control the dynamics of r a d i o hippuran in human body. The method is simple, s e n s i t i v e and need not a u x i l i a r y f a c i l i t i e s , computers etc. Some exemples of c l i n i c a l use are reported and the v a l i d i t y of the method is discussed. I n s t i t u t e of C l i n i c a l and Experimental Medicine Prague CSSR
59 RADIOISOTOPE II~WESTIGATIONS IN P A T I E N T S RENAL TUBERCULOSIS AFTER NEPHREGTOMY L. S a l a m b a s h e v , N. Totsev, S. K e t s k a r o v a
T h e object of the study w e r e 48 patients (17 f e m a l e s a n d 31 m a l e s ) w i t h renal tuberculosis, a g e d 32-92 years. A c c o r d i n g to the t e r m following n e p h r e c t o m y the patients w e r e distributed into 3 groups: 0-5 years ago - 24 patients, 5-10 years ago - 14 patients and m o r e than i0 years ago - I0 patients. T h e results of the radioisotope investigations (131.I-hippuran arid 1 6 9 . Y b - E D T A clearances, isotope n e p h r o g r a p h y , scintillation scanning) w e r e c o m p a r e d with those of the intravenous u r o g r a p h y and the levels of the residual nitrogen c o m p o u n d s in the blood (creatinine, urea). A higher sensitivity of the radioisotope clearances w a s found, as they displayed r e d u c e d values prior to the positivation of the r e m a i n i n g indices. T h e values of the g l o m e r u l a r filtration rate (x = 76.9 m l / m i n / l . 73) . . . . considerably m o r e r e d u c e d as c o m p a r e d with those of the effective renal p l a s m a flow (546 m l / m i n / l . 73) in the three g r o u p s of patients. R e s e a r c h Institute of R a d i o l o g y a n d Radiobiology, Sofia, Bulgaria.
58
6O
THE I M P O R T A N C E OF S C I N T I G R A P H I C A L E X A M I N A TIONS, THE ASSESSMENT OF L A T E S E Q U E L A E ,
USEFULNESS EVALUATION GNANCIES M . Beauduin,
AFTER THE RENAL J.M. Slominski
TRAUMA
T h e study is b a s e d on 104 patients admitted to hospitals in G d a n s k b e t w e e n 1963-1976 with renal t r a u m a associated with h a e m a t u r i a . T h e control examinations i.e. rectilinear scintiscan and additional investigations w e r e m a de at least ig m o n t h s after injury. 36 patients s h o w e d abnormalities in scintigrams - they w e r e m i n o r in Z1 cases, m e d i u m in 13 and m a j o r in Z cases. T h e r e has b e e n found a close correlation betw e e n roentgenographical investigations in the acute renal t r a u m a and scintigrams in a late period after an injury. Kendall's coefficient "tau" u s e d for m e a s u r i n g a correlation w a s higher for renal arteriography a n d s c a n /"tau" = 0.74/ than for infusion u r o g r a m and s c a n
/"tau" = 0.45/. In a case of their safety, e a s y to p e r f o r m a n c e a n d a g o o d estimation of the functional status of the d a m a g e d kidney scintigraphical examinations are of great value particularly for serial follow-up studies after the renal t r a u m a . Isotopic L a b o r a t o r y
of Internal Institute M A ,
Gdansk.
W1 T H
OF ISOTOPIC NEPHROGRAM IN T H E AND FOLLOW-UP OF PELVIC MALIF. Majois,
J. H e r m a n s ,
E. P 1 u y g e r s
A c c u r a t e evaluation of the extent of pelvic malignancies, m a i n l y of cervical uterine origin is of m o s t i m p o r t a n c e in designing p r o p e r treatment. Intravenous u r o g r a p h y represents an important step in the p r e - t r e a t m e n t check-up, as it allows recognition of early ureteral involvement with m i n i m a l ureteral stasis or hydronephrosis. In 50 patients, the results of I-V u r o g r a p h y have b e e n c o m p a r e d to those of the isotopic n e p h r o g r a m using Hippuran-I 131. T h e patient is e x a m i n e d in seated position with a scintillation c a m e r a and receives intravenously 5 m i c r o c u r i e s / k g b o d y weight of Hippuran-I~131, 2 hours after absorbing 1 liter of fluid. Separate recordings are m a d e over e a c h kidney for 30 minutes. A n excellent c o n c o r d a n c e is o b s e r v e d b e t w e e n isotopic n e p h r o g r a m and I-V urography; in e v e r y case an abnormal Hippuran-nephrogram c o r r e s p o n d e d to an a b n o r m a l urography, and w h e n using adequate technique, no false a b n o r m a l n e p h r o g r a m s w e r e observed. T h e s e findings have b e e n applied to the follow-up of treated patients: n o r m a l isotopic n e p h r o g r a m s indicate absence of uretral involvement, whilst a deterioration of the n e p h r o g r a p h i c curves is suggestive of turnout extension, as c o n f i r m e d by I-V u r o g r a p h y and, in s o m e eases, by C . T . scan. T h e isotopic n e p h r e g r a m thus represents an easy, rapid and n o n - a g g r e s s i v e m e t h o d for accurately monitoring the ureters] extension of pelvic t u m o u r s , before and after treatment. Dept. of O n c o l o g y and N u c l e a r Medicine, Jolimont H o s p i tal, 7161 Haine-Saint-Paul, B e l g i u m .
128 61 ORGAN DISTRIBUTION OF POLYPJEPTIDES: SEARC H I N G F O R A N I D E A L A G E N T F O R R E N A L SCINTIGRAPHY V. 14utas, K. Mohari, M, Szekerke, F. Hudecz
W e found previously, that iodine-labeled aprotinin /basic trypsin inhibitor/ a polypeptide of known structure, m.w.6800., when injected i.v., sixty per cent of the injected radioactivity accumulate s in the kidneys within two hours. This c o m p o u n d could be labeled with iodine or with technetium as well, but it is rather expensive. That was the reason, why we investigated the fate of several synthetic polypeptides in the organism of rats. W e tried to elucidate, if the low molecular weight is responsible for the high renal accumulation. The molecular weight of the above mentioned polypeptides were, as follows: 500; I0000; 70000; 145000; 168000; 220000. The results of our experiments show, thht the molecular weight had no influence on the organ distribution. The polypeptides investigated were l, dl and d. W e found, that "d" accumulated in the higher extent in kidneys, but none reached the level of the aprotinin. W e labelled the compounds with 125 I either using "iodogen", or "chloramine-T" method. National Research Institute for Radiobiology and Radiohygiene and Organic Chemistry Institute of E6tvSs L. University, Budapest.
63 C17-123-I-HEPTADFCANOIC ACID - A NEW RADIOPHARMACEUTICAL FOR LIVER SCANNING AND HEPATOCELLULAR FUNCTIONAL STUDIES A . H 6 c k , I~. V y s k a , C h r . F r e u n d l i e b , L . E . F e i n e n d e g e n , H . J . M a c h u l l a , C. K u p f e r n a g e l a n d O~ S t o e c k I i n F r e e f a t t y a c i d s ( F F A ) a r e k n o w n to b e s u b s t r a t e s f o r l i ver metabilism. Therefore labelled fatty acids are exp e c t e d to b e s u i t a b l e r a d i o p h a r m a c e u t i c a l s for liver scans and functional liver studies. - Heptadecanoic acid w a s l a b e l l e d in t h e ~ - p o s i t i o n w i t h I 2 3 - I a n d i n t r a v e n e o u s l y i n j e c t e d in n i c e a n d r a b b i t s . T h e o r g a n s of t h e n i c e w e r e d i s s e c t e d at r e g u l a r i n t e r v a l s a f t e r i n j e c t i o n
and the content of activity in liver and blood was m e a sured. The distribution of indicator in rabbits was continuously determined by means of a~-camera. In the mice experiments the ratio of blood to liver was found to be 1:4 at the time at which the m a x i m u m of activity in the liver was achieved (5 minutes after injection). The half life of indicator elimination was found to be 40 minutes. In the whole body scintigrams of rabbits the liver was clearly recognizable. In the first clinical studies 0.5 to 1 m C i -123-I-heptadecanoic acid was intravenously administered in 7 normals and i0 patients with different liver diseases. A h o m o geneous distribution of the indicator in normal livers was observed. O n the contrary, in patients with different liver diseases, characteristic patterns of indicator distribution were registered. -123-heptadecanoic acid is an excellent indicator for liver scanning and hepatocellular functional studies. Institute of Medicine and Institute for Nuclear Chemistry Nuclear Research Center Jiilich, F.R. Germany.
62 1 1 3 m - I n - P H Y T A T E - C L I N I C A L E V A L U A T I O N OF THE NEW A G E N T F O R A LIVER S C I N T I G R A P H Y W.Jakubowski,E.Napi6rkowska,I.Lici~ska,W.Zulczyk,E.&achnik, J.Wiza,W.Graban
64 THE Tc 99m-Sn-ALIPHATIC ~MINOAClD COMPLEX IN VISUALIZING HEPATIC MESENCHYMAAND PARENCHYMACLINICAL AND EXPERIMENTAL DATA, CONDUCTOMETRICANALYSIS AND ELECTRONMICROSCOPY DATA.
1 1 3 m - I n - P h y t a t e the new agent p r o d u c e d by The R a d i o i s o t o p e P r o d u c t i o n and D i s t r i b u t i o n Centre S w i e r k , P o l a n d was c l i n i c a l l y tested in 10 n o r m a l v o l u n t e e r s and 70 p a t i e n t s s u f f e r i n g from v a r i o u s liver d i s e a s e s . A l l i n v e s t i g a t i o n s were p e r f o r m e d in three p r o S e c t i o n s / A P , PA and right l a t e r a l / using P i c k e r s M a g n a s c a n n e r 1000 and Jumbo T h o s h i b a 202 s c i n t i l a t i o n camera con e c t e d w i t h I n f o r m a t e k S I M I S - 3 data p r o c e s s i n g s y s t e m . T h e agent was a d m i n i s t e r e d by i°v. in j e c t i o n u s i n g 3-5 mCi a c t i v i t i e s . T h e o p t i m a l time span for s c i n t i g r a p h i c e x a m i n a t i o n w a s between 15-30 min. post i n j e c t i o n . A f t e r 10 min. post i n j e c t i o n more than 90% a d m i n i s t e r e d dose ~as a c c u m u l a t e d in the l i v e r . U p t a k e in the s l e e n w a s I-2%.TI/2 from b l o o d was 2 , 8 ! 0 , 6 min. The q u a l i t y of all s c i n t i g r a m s were very good. 20 a d d i t i o n a l patients h a d comparative i n v e s t i g a t i o n s w i t h 9 9 m - T c - s u l f u r colloid and 9 9 m - T c p h y t a t e . I n these comparative studies s o i n t i g r a m s made by 1 1 3 m - l n - p h y t a t e had p r a c t i c l y the same or b e t t e r quality in compare to pictures m a d e by 9 9 m - T c - s u l f u r colloid and 9 9 m - T c - p h y t a t e . In cur o p i n i o n 1 1 3 m - I n - p h y t a t e is a very use ful agent for liver s c i n t i g r a p h y , s p e c i a l l y for children and in the cases w h e n scanning m u s t be r e p e a t e d . T h e p r e p a r a t i o n of this agent is one step and consuming 3 min. time only.
M. MICLUTIA, I. BUCHWALD, L. RACOVITA, K. SIMON. Clinica Medicina Nucleara. Romania. Tin chl or i de is f r e q u e n t l y used f o r reduction of Tc 99m, allowing the formation of c e r t a i n complexes destined to v i s u a l i z e various organs. Clinical~and experimental observations have shown that the complex which had been achieved often presents a microc o l l o i d a l s t r u c t u r e being directed towards the RES. To def i n e the causes of t h i s phenomenon a complex experimental and c l i n i c a l study has been entered upon: a study in conductometric analysis; o p t i c a l and electromicroscopy of the various Tc 99m-Sn.... complexes; the analysis of the t i n c l o r i d e concentration and pH influence on the appearence of c o l l o i d a l state, The f o l l o w i n g r e s u l t s have been obtained: By conductometric analysis t i n chl or i de concentration has been proved to be main f a c t o r c o n t r i b u t i n g to the forma-t i o n of r a d i o c o l l o i d s , C o l l o i d a l st at e formation is also i'nfluenced by the pH. o f the s o l u t i o n . Electron microscopy shows the formation of some smaller size microcolloids (I0-500 A). Experimental i n v e s t i g a t i o n s on rats and studies in man confirm the above mentioned f a c t s . ~n solutions in which t i n chl or i de concentration exceeds a c e r t a i n threshold microcolloids have been achieved in v a r i a b l e proportion to RES v i s u a l i s a t i o n , while decrease below the c r i t i c a l value permits d i r e c t i n g the complex to the t a r g e t organ~ corresponding to i t s metabolic a f f i n i t i e s .
D e p a r t m e n t of N u c l e a r ~ e d i c i n e , M e d i c a l S c h o o l of W a r s a w , C e n t r a l C l i n i c a l H o s p i t a l , W a r s a w , Poland.
129 65 COMPARISON OF COMPUTERISEDTOMOGRAPHYAND NUCLEAR MEDICINE PROCEDURES IN LIVER DISEASE J.M. Castro, I. Castejon, J. Ramos, M.C. Marin, J.L. Chamorro, G. Marana and J. Ortiz Berrocal In order to assess i f C.T. might displace the Nuclear Medicine procedures in l i v e r disease, llm patients with i n i t i a l diagnoses of hepatic space-occupying lesion and/ or d i f f u s e l i v e r disease were studied with C.T. and hepat i c scan. In a l l cases, the l e v e l s of carcino-embryogenic antigen and a l p h a - f e t o p r o t e i n were also assessed by radioimmunoassay. According to the r e s u l t s , the patients are classed into one o f three groups : I - (malignant space-occupying l e sions) - (a) in 8 hepatomas, l i v e r scan was p o s i t i v e in a l l , and C.T. was negative in a l l . In two cases, the a l p h a - f e t o p r o t e i n showed very high l e v e l s ; (b) in 35 cases with p o s i t i v e hepatic metastases, C.T. had 91.4% (32 cases) o f true p o s i t i v e diagnosis, while l i v e r scan had 88.6% (31 cases). The mean values of carcino-embryogenic antigen and a l p h a - f e t o p r o t e i n were d i s t i n c t l y higher than in patients with malignant disease but no hepatic metastases. I I - (benign l i v e r disease) - (a) in 39 cases of space-occupying lesions (echinococcosis, abscesses), C.T. had I00% t r u e p o s i t i v e diagnosis, while l i v e r scan had 97.5% (b) in 12 patients with hepatic c i r r h o s i s , the C.T. was reported as "hepatosplenomegaly", while the l i v e r scan showed a pattern t y p i c a l of c i r r h o s i s . I l l - in 13 pat i e n t s , both procedures ruled out l i v e r disease. The morphological and l a b o r a t o r y procedures o f Nuclear ~edicine are essential f o r the diagnosis of hepatoma. In cases o f hepatic c i r r h o s i s , Nuclear ~edicine represents an important diagnostic complement and a means f o r evolut i v e assessment. In malignant diseases, R.I.A. adds to l i v e r scan a complement beyond the purely morphological. In benign and malignant space-occupying lesions (except hepatoma), C.T. was s l i g h t l y b e t t e r than l i v e r scan. In d i f f u s e benign l i v e r disease, only l i v e r scan was useful.
67 SELENO~!ETHIONINE SUBTRACTION LIVER SCANNING IN THE DIAGNOSIS OF HEPATOmA A.J. Coakley and E.P. Wraight Li ver subtraction scans using 99mTc sulphur c o l l o i d and 75-Se selenomethionine were c a r r i e d out in 58 pat i en ts with suspected hepatoma. Of the 18 pat i ent s with hepatoma proven by h i s t o l o g y 16 showed s e l e c t i v e concentrat i o n of selenomethionine in the tumour giving a true pos i t i v e r a t e of 89%. Of the 40 pat i ent s who did not have hepatoma, 32 scans showed no evidence of s e l e c t i v e conc e n t r a t i o n of selenomethionine giving a true negative rate of 80%. The f a l s e p o s i t i v e rate was 8% in nonc i r r h o t i c pat i ent s with focal disease and of 55% in pat i e n t s with c i r r h o s i s . Reasons f o r the f a l s e negative and f a l s e p o s i t i v e scans are discussed. I t is concluded t h a t combined scanning with t h i s technique is useful in n o n - c i r r h o t i c pat i e n ts in d i s t i n g u i s h i n g hepatoma from other causes of focal disease, but t h a t the technique is not useful and f r e quently misleading in patients with c i r r h o s i s . Department of Nuclear Medicine, Addenbrooke's H o s p i t a l , Cambridge, U.K.
C l i n i c a Puerta de H i e r r o , Madrid, Seain.
66
68
THE ROLE OF SCINTIGRAPHY IN THE DETECTION OF LIVER METASTASES IN CO~PARISON V!ITH OTHER TECHNIQUES J. FrUhling
ESTIMATION OF THE LIVER BLOOD FLOW BY SEQUENTIAL HEPATOSPLENO-SCINTIGRAPHY IN SHUNT PATIENTS A. Kroiss, L. Peschl, J. Funovics and A. Neumayr
Radionuclide imaging has been well established as a sens i t i v e and non-invasive technique f o r detection o f l i v e r metastases f o r the past 20 years. Valuable reports demonstrated a t r u e negative and p o s i t i v e detection r a t e o f about 75-85% during t h i s period, despite various technical improvements as f a r as apparatus and r a d i o pharmaceuticals used are concerned.
A f t e r intravenous a p p l i c a t i o n of i n f l u x o f the t r a c e r in the l i v e r and a computer system. !,!ith t h i s sharp separation of the a r t e r i a l share of the l i v e r blood flow.
The place of s c i n t i g r a p h y being a c t u a l l y challenged as a non-invasive i n - v i v o technique, the f o l l o w i n g facts can be established according to our own experience and to the r e s u l t s reported r e c e n t l y during the Symposium on the diagnosis o f l i v e r metastases organized by the EORTC. I . Echography seems to be s l i g h t l y superior to s c i n t i g r a phy, but not in a l l cases. 2. Scintigraphy and CT-scanning have at l e a s t the same detection accuracy. 3. The combination o f s c i n t i g r a p h y with biochemical t e s t s , or with echography, or at l e a s t these three techniques together gave a true detection r a t e of 90% or higher. Therefore t h i s combination can be recommended as the best choice f o r non-invasive search of l i v e r metastases. 4. In case o f agressive i n f i l t r a t i v e neoplasmas (lymphomas, oat c e l l carcinoma of the lung, melanoma) or when randomized studies are expected, peritoneoscopy must be c a r r i e d out as a complementary technique. Laboratoire des r a d i o - i s o t o p e s , I n s t i t u t J. Bordet, Brussels, Belgium.
99mTc we recorded the with an Anger camera method we got a very and the portalvenous
Preoperative : In normal cases we found an a r t e r i a l blood flow of 25 + 3.9%, whereas in compensated c i r r h o t i c pat i ent s this-percentage rose up to 58.4 + 7.7% and in decomp, c i r r h o t i c pat i ent s up to 73.1 + 4.7. Postoperative : In pat i ent s with portocaval shunt we found an a r t e r i a l share of I00%. % r e i n t e r e s t i n g f o r the c l i n i c i a n s seem the postoperative c o n t r o l l s with our method in patients with a d i s t a l splenorenal shunt (Narren). In these cases, we found an # r t e r i a l share of 81.2 + 4.5% and so we knew t h a t there is s t i l l a small p o r t i o n of portalvenous i n f l u x i n t o the l i v e r . This noninvasive technique gives us a good parameter f o r the state of the l i v e r . For postop, i n v e s t i g a t i o n s i t shows us wheter a surgical anastomosis is patent and hemedynamic e f f e c t i v e or not. ~led. Abteilung, Nucl. Med. I n s t i t u t , Vienna, Austria.
Rudolfstiftung,
130 69 APPLICATION OF Xe-133 CLEARANCETECHNIQUE FOR THE ASSESSMENT OF HEPATIC TISSUE BLOOD FLOW IN MODELING SOME PATHOLOGIC STATES N.N. Malinovsky, L . I . Vinnitsky and I.L. Zhidkov
71 EXPERIMENTAL TRIALS OF A NEW Tc99m-LABELED HEPATOBILIARY AGENT: P-BUTYL-IDA F, Lunghi, R. M o s c a , I~. Assone, M . Villa
The Xe-133 clearance technique allows to assess hepatic tissue blood flow in some pathologic states. The study is based on the results of 300 experiments. Some pathologic states have been modeled in animals such as : acute hepatic ischemia, adrenalectomy, animal poisoning with CCL4, massive acute bleeding, mechanical jaundice. These pathologic states are accompanied by changes in microcirculation. The effect of a number of drugs on these pathologic states has been studied (and adrenergic substances, cholinergic substances, c y c l i c nucleotides, p y r i midine d e r i v a t i v e s ) . The p o s s i b i l i t i e s of microcirculation disturbances correction have been shown.
Tc 9 9 m - Diethyl I D A and Tc 9 9 m - Dimethyl I D A are efficiently cleared through the hepatobiliary system in both animal and h u m a n , nevertheless, w h e n the s e r u m bilirubin level is 10-12 m g % or higher, they have negligible hepatic uptake and strong excretion i~itothe urine. The N - (p-butyl-phenyl-carbamoyl-methyl) iminodiacetic acid (p-butyl IDA) has a very low urinary excretion (0.5 - Z %) and s e e m s m o r e effective than the other derivatives at high bilirubin levels. Synthesis, labelling, identity of the species, blood clearance and distribution in experimental animals, will be presented.
The paper presents the mechanism of effect of these drugs on hepatic microcirculation in normal animals and in animals with disturbances of hepatic hemodynamics. All-Union Research I n s t i t u t e of Clinical and Experimental Surgery, Moscow, USSR.
Sorin B i o m e d i c a S.p.A., Saluggia (VC) Italy
70 SPLEEN-TO-LIVER (S/L) COLLOIDS UPTAKE RATIO IN THE DIAGNOSIS AND CLINICAL MANAGEMENTOF DIFFUSE LIVER DISEASES N. Popa, E. Lens, A. Jansens and C. Fi#vez
72
The s p l e e n - t o - l i v e r c o l l o i d s uptake r a t i o is derived from the spleen and l i v e r uptake curves of 99mTc stanneous c o l l o i d s (Amersham) using a gamma-camera (Pho GammaIV) and a processing and display system (POS, Phil i p s ) . Relative uptake values are calculated between I ' - 4 ' 4 8 " , a f t e r background correction, by using the "area under the curve" technique. More than 400 patients were studied since January 1978 and many of them had several successive investigations. Normal values are below 0.66 since c i r r h o s i s , steatosis or diffuse l i v e r disease of toxique origine (alcoolism, drugs, etc.) give S/L r a t i o s above 0.66. Abnormal values are observed even in cases of ancient v i r a l hemat i t i s with normal actual biology. Good concordance was noticed between abnormal S/L colloids uptake ratios and anatomo-pathological findings as : hepatic cell necrosis, and/or steatosis and i n t e r stitial fibrosis. In follow-up studies the individual values were in Qood agreement with the p a t i e n t ' s actual c l i n i c a l , biolopical and anatomo-pathological data. Laboratoire des Radio-isotopes, Queen Fabiola C l i n i c s , Avenue du Centenaire, 73, 5080 Montignies-sur-Sambre, Belgium.
HHPATO-BILIARY SERIAL SCINTIGRAPHy WITH P-N-BUTYL IDA IN JAUNDICED PATIENTS. G. Camuzzini, M. Villa, E. Lunghi, G. Pill The N-substituted IDA derivatives 2~6 Diethyl~ 2-6 Dimethyl labeled Tc-99m have recently been used successfully in hepato-biliary scanning. However, progressively less diagnostic information is obtainable when the level of the bilirubin in blood rises above i0 mg/100 aad the urinary excretion increases. A significant reduction in hepatocitic uptake nearly always precludes differentiation between total extrahepatic obstruction and hepatocellular disease. Delayed G.I. scanning is therefore ineffective,and the diagnostic value of this technique becomes limited. In order to overcome this problem a study of 40 patients was made using P-n-Butyi IDA, MoI.W.322.4. In normal cases (8 p.) the Target (liver)/no Target ratio at max. uptake was 57 (44-76), T max.(liver)=19.8' (15-23), renal excretion at 1 h = 2.06 (3.1-0.9)% of the dose. The T 1/2 of the hepatic excretion curve : 80.2' (60-95). The time of appearance of GH = 28.3' (15-33), of biliary tree : 19.2' (15-28), of the GI radioactivity = 2i' (15-33). The quality of the hepatic image and therefore the uptake in patients with advanced jaundice (i0 p. with tot .Bil. between ii and 26 mg/100) was clearly superior to that obtained with dimethyl and diethyl IDA, and the urinary excretion (i h) never exceeded ll.6 % (i p. with 22 mg/100 of t.bil.), normally remaining at 3-5 % even with t.hil. of 24-26 mg/100. The superior quality of the delayed (624 h) images provided conclusive evidence of total extrahepatic obstruction in 15 patients. We propose the use of the P-n-Butyl in patients with advanced jaundice and the use of 2-6 Diethyl Or Dimethyl in patients with mild or no jaundice because of their higher hepatic excretion rate. Ospedale Civile S. Croce, Cuneo, Italia Sorin Biomedica, $aluggia, Italia.
131 73 C H O L E R E T I C T E S T W I T H 99m-Tc STASIS. Picardi R.,Papini E.,Pagano H . , a n d P a v o n i P. Differential
diagnosis
Diethyl
IDA
A.,Favella
between
intra
IN C H O L E A.,Ponzo
ane extra
hepatic cholestasis during mild or severe jaund ! ce,presents considerable difficulties i n some c a s e s on a c c o u n t o 9 l i m i t a t i o n in performing and/~r interpreting £undamental investigations £or diagnostic purposes. The A u t h o r s p r o p o s e a new i n v e s t i g a t i o n model,pe~ f o r m e d by m e a n s o£ e v a l u a t i o n o2 k e p a t i c u p t a k e d i s m i s s i o n c u r v e s o f 9 9 m T c - D i e t h y l IDA b o t h i n b a sal condition and f o l l o w i n g p h a r m a c o l o g i c a l stimulation. Fifteen subjects have been evaluated,subdivided into 3 groups:a)Nommal,b)Chronic active hepatitis with intrahepatic cholestasis,c)Extrakepatic cholestasis. On s u c k s u b j e c t s w a s p e r 2 o r m e d , w i t h a ,,double blind" technique,hepatocyte clearance with Diethyl IDA,employing a rectilinear scanner. The i n v e s t i g a t i o n was r e p e a t e d , e m p l o y i n g the same m e t h o d , 3 and 7 d a y s l a t e r , £ o l l o ~ i n ~ treatment w i t h h i g h d o s e s o~ a c h o l e r e t i c drug.Results obtained are evaluated with reference to chemical and X r a y e x a m i n a t i o n s a n d h i s t o l o g i c a l diagnosis.
75 CLINICAL APPLICATION OF 99m-Tc MICROSPHERE VENOGRAPHY M.S. Buxton-Thomas, C. Tonge and D.N. Cr of t Radionuclide venography (RNV) using 99m-Tc human albumin microspheres was c a r r i e d out in 45 p a t i e n t s . In 20 patients with suspected pulmonary embolism, t h i s was combined with v e n t i l a t i o n / p e r f u s i o n lung scans using 133-Xe f o r the v e n t i l a t i o n study. 50% had both p o s i t i v e RNV and lung emboli ( p o s i t i v e lungs)~ 25% had p o s i t i v e lungs and negative RNV's and 25% had p o s i t i v e RNV's and negative scans. Reasons why only h a l f the patients had p o s i t i v e lungs and p o s i t i v e RNV's w i l l be discussed, !~e concluded t h a t the combined leg and lung t e s t was of l i m i t e d value because of the time taken with the procedure. I t was o f some use in pat i ent s with pulmonary embolism of unknow~ o r i g i n , and in e s t a b l i s h i n g whether an embolus was r e cent. 25 patients were studied f o r suspected i l i a c compression syndrome (ICS), in which the l e f t common i l i a c vein is compressed by the r i g h t common i l i a c a r t e r y where they cross. The condition predisposes to i l i o - f e m o r a l thrombosis and can be a l l e v i a t e d by a venous shunt operation. Contrast phlebography was performed in the m a j o r i t y o f the pat i ent s and a good c o r r e l a t i o n was found between the two techniques. In ICS, RNV was b e t t e r than x- r a y phlebography as dynamic information was obtained, the procedure could be r e a d i l y repeated, and the potency o f the shunt could be determined in pat i ent s who had an operation.
Ospedale Regina Apostolorum(Divisione di M e d i c i na)-Via S.Franceseo 58,Albano,Roma. V Clinica Medica dell'UniversitA di roma.
Dept. Nuclear Medicine, St. Thomas' H o s p i t a l , London, England.
74
78 DEMONSTRATION OF SYSTEMIC-PORTAL SHUNTS BY LOB~EREXTREMITY RADIONUCLIDE VENOGRAPHY G. Endert, H. R i t t e r and E. Schumann
CONTRIBUTION OF RADIOIMMUNOASSAY OF SERUM B I L E A C I D S IN D I A G N O S I S O F H E P A T O B I L I A R Y DISEASES J. Sedlak, B. Anionic R a d i o i m m u n o l o g i c a l technique for the estimation of ser u m bile acids with their specificity, sensitivity and accuracy is a great progress in bile acids determination. F o r the determination of glycocholic acid and glycochenodeoxycholic acid w e used the kits f r o m Nordiclab, Finland. In Z9 patients suffering f r o m acute viral hepatitis and 19 patients suffering f r o m extrahepatic cholestasis w e determined out of glycocholic and glycochenodeoxycholic acids also lipoprotein X, lacticodehydrogenase, alkaline pho sphatas e, glutamatdehydrogenas e, leuc inaminopep tidase, aminotransferases , g a m m a - g l u t a m y l - t r a n s f e rase and bilirubin. T h e results w e r e corelated as percentage of pathological findings and as multiple of upper n o r m a l values. W e can conclude that the determination of s e r u m bile acid concentration is one of the m o s t promising n e w clinical-chemical tools for the early diagnosis of hepatobiliary diseases. A n increase in s e r u m bile acids does not usualy occur in diseases other than hepatobiliary disturbanc e s. D e p a r t m e n t of clinical biochemistry, Industrial hospital, Kosice, C S S R .
The r a d i o n u c l i d e venography is an accepted method f o r the i n v e s t i g a t i o n of patients with thrombo-embolic d i sorders. The shunt from systemic veins i n t o the portal c i r c u l a t i o n in thrombosis of p e l v i c veins is seldom observed. But seen under the hemodynamic aspect i t is an important complication. 250 pat i ent s were i n v e s t i o a t e d by radionuclide venography with a s c i n t i l l a t i o n camera a f t e r i n j e c t i o n of 99m-Tc-labelled microspheres. In 9 patients signs o f a shunt i n t o the portal c i r c u l a t i o n could be observed : hepatic hot-spots (4 cases) and l i v e r demonstration (5 cases). The diagnosis was confirmed by contrast-venography or dynamic radionuclide studies. The examinations showed that the shunt had developed from i l i a c veins via e p i g a s t r i c veins and the periumbil i c a l venous group to the portal venous system. The r e s u l t s i n d i c a t e t h a t the thrombosis of p e l v i c veins can cause a volumen loading as well as a pressure loading of portal c i r c u l a t i o n . Medical Academy, Radiological C l i n i c , E r f u r t , GDR.
132 77
79
FUNCTIONAL I M A G I N G IN F I R S T P A S S I S O T O P I C AIWGIOGRAPHY F. Deconinck, A. Bossuyt, M . Jonckbeer and R. L e p o u d r e
EARLY DIAGNOSIS OF THROMBOSIS WITH 99m-Tc RADIOTRACERS J. Ramos, W. C a l i s t o , I. Castejon, V. Rodriguez, J. Abascal, A. Schapira, J.L. Chamorro and J. O r t i z Berrocal
~ourier analysis is a powerful mathematical technique which allows the analysis of any periodic function in t e r m s of a sine and cosine series. I m a g e processing techniques based on Fourier analysis usually involve spatial Fourier analysis. T e m p o r a l Fourier analysis applied to isotopic i m a g e s concentrates on the change in information contained in each picture element as a function of time over the i m a g e series. The temporal ~'ourier transform is very well adapted to the study of periodic p h e n o m e n a as the beating of a heart, but transient p h e n o m e n a as first pass blood flow studies can also be studied after applying the Fourier T r a n s f o r m . Indeed, any function f(x) which is not periodic but defined within an interval (-L,L) can be m a d e periodic by defining f(x + ZL) : f(x). In this paper~we will discuss the experimental technique by which the Fourier transf o r m is obtained, as well as demonstrate the application to the study of regional blood flow. T h e m e t h o d will permit a rapid and sensitive a s s e s s m e n t of vascularisation. T h e functional i m a g e s will always permit a m o r e accurate choice of regions of interest to generate time activity curves. Dept. of Physical and Radiological Sciences, A c a d e m i s c h Ziekenhuis - V . U . B . , L a a r b e e k l a a n i01 1090 Brussel (Belgium).
As the incidence of vascular thrombosis in patients undergoing important surgical i n t e r v e n t i o n s is quite high, and in many cases represents the immediate cause o f the p a t i e n t ' s death, the e a r l y detection of such phenomena has developed i n t o a c l i n i c a l problem of prime importance For the e a r l y detection of thromboses we have used t r a cers marked with 99m-Tc which, due to t h e i r p e c u l i a r char a c t e r i s t i c s , play a r61e in the formation or des tr u c ti o n of the c l o t : P l a t e l e t s , Fibrinogen, Streptokinase (SK) and Urokinase (UK). The one most f r e q u e n t l y used has been 99m-Tc-SK, as the r e s u l t s are s i m i l a r to those achi~ ved with other t r a c e r s , the cost is l ess, and the prepar a t i o n easy. The dosage used is 25,000 UI SK f o r 5-10 uCi 99m-Tc. We have studied two groups of p a t i e n t s : A control group which underwent surgery but received no antocoagulant therapy, and a " p a t i e n t " group in which anticoagulant therapy was i n s t i t u t e d (Heparin or Coumarinics) immediat e l y a f t e r surgery in s p i t e of the r i s k o f possible hemo~ rhage. These two groups comprise several sub-groups depem ding on the actual disease which was the reason f o r surgery. The study procedure involved preoperative lung scan (with 99m-Tc macroaggregates) and lower limb c i r c u l a t o r y system scan (with 99m-Tc-SK), and r e p e t i t i o n o f the same studies 2, 5 and 7 days a f t e r surgery, The r e s u l t s o f these studies have demonstrated the convenience o f i n s t i t u t i n g preventive anticoagulant therapy immediately a f t e r surgery in order to prevent vascular thrombosis. C l i n i c a Puerta de H i e r r o , Madrid
78 A NEW APPROACH FOR IMPROVING THE THROMBOSIS DIAGNOSTICS K. OffenmUlier, K. Mohari, D. Bagdy, S. Rajusz and L. Kocsar I t is well known t h a t the a p p l i c a t i o n of 125-I and 131I - l a b e l l e d f i b r i n o g e n is the best method f o r the time being f o r the e a r l y detection of thrombosis. Since the method has not reached i t s p e r f e c t i o n y e t , research work is in progress to reveal the ideal s o r t o f thrombosis diagnostics. Our experiments based on Lorand's r e s u l t s that a c r o s s l i n k i n g reaction o f f i b r i n is completely i n h i b i t e d by c e r t a i n amines. A l a b e l l e d amine could potent i a l y be incorporated into f i b r i n . Several polypeptides (transamidase, i n h i b i t i n g peptides) were synthetized in the I n s t i t u t e o f Drug Research, Budapest, showing strong i n h i b i t i o n a c t i v i t i e s . Two o f them (n ° 14116 and 14159) were l a b e l l e d with r a d i o i o d i n e s . Yield of l a b e l l i n g e f f i c i e n c y was about 70-80%, and the b i o l o g i c a l a c t i v i t y remained p r a c t i c a l l y unchanged. In v i t r o blood c l o t t i n g experiments proved t h a t the ~belled i n h i b i t i n g f a c t o r was incorporated i n t o the f i b r i n in approx. I0-50% o f the amount given. Animal experiments aimed at studying the uptake of the l a b e l l e d material by the thrombus a f t e r the induction of an a r t i f i c i a l thrombus. Based on Anger scintigraphy t h i s new trend seems to be promising. "FJC" Natl. Res. Inst. f o r Radiobiol. and Radiohyg. Inst. f o r Drug Research, Budapest, Hungary.
80 MEASUREMENT OF THROMBOSIS CAUSED BY PERMANENTCANNULAE WITH 125-I-FIBRINOGEN H.Kolbe, E.Havldk, M.Sabeti and R.Hbfer The aim of the study was to determine the time course of formation of thrombosis at the s i t e of a permanent cannula using 1 2 5 - I - f i b r i n o g e n . 23 patients where studied. 60 lO0/uCi 1 2 5 - I - f i b r i n o g e n were injected intravenously into the'vena dors.ped. Measurements were performed at 4 positions over both arms with a s c i n t i l l a t i o n probe and f l a t f i e l d c o l l i m a t o r : ( i ) proximal upper arm, (2) top of cannul a , (3) cubita, (4) d i s t a l lower arm, at i min, 15 min, 1 hour, 3 hours, 6 hours and 24 hours a f t e r a p p l i c a t i o n of t r a c e r . For each p a i r of measurements the r a t i o of count rates Qv= Zv/Z o was calculated (Zv=cOunt r a t e of arm with cannula, Z = count r a t e at corresponding p o s i t i o n ) . The e r r o r of t~e r a t i o Q. was estimated to be ± 7%,taking into consideration counting s t a t i s t i c s and geometrical e f f e c t s and absorption. In positions 2 and 3 the r a t i o Qv is c o n t i n u a l l y increasing a f t e r a p p l i c a t i o n of 1 2 5 - l - f i b r i n o g e n . The 1.2-1imit f o r the r a t i o i n d i c a t i n g formation of thrombosis is exceeded 2 - 5 hours p . i . At 6 hours and 24 hours p . i . f u r t h e r increase of the r a t i o is observed. To avoid e r r o r s caused by veno puncture measurements where done a f t e r immediate removal of the cannula and here no s i g n i f i c a n t increase of r a d i o a c t i v i t y was observed. Our r e s u l t s show t h a t formation of thrombosis caused by the s i t e of permanent cannulae can be demonstrated as e a r l y as 3 hours a f t e r s e t t i n g the cannula while f i r s t c l i n i c a l symptoms are observed at 2 - 3 days only. Abteilung f u r Nuclearmedizin, I I . M e d . U n i v . K l i n i k , Wien, Garnisongasse 13, A-I090 Wien und Arbeitsgruppe Nuclearmedizin des LBI f u r k l i n . Endokrinologie und Nuclearmedizin, Wien
133 81
83
TECHNETIUM LABELED HEPARIN AND THROMBOEMBOLISM J.P. Esquerr6 and R. Guiraud We used Technetium 99m labeled heparin as an approach to heparin pharmacokinetics which might lead to clinical applications in thromboembolism diagnosis and treatment. We performed kinetics studies in 7 normal subjects. In 17 patients diagnosed as having a leg veinous thrombosis we performed a legs' scintigraphy in order to demonstrate an eventual increased uptake of heparin by damaged blood vessels walls but we were more strongly interested in kinetics studies especially blood clearance as a possible index of thrombotic disease. In normal subjects both external detection and blood samples radioassay showed a biphasie blood clearance curve with fast (t i/2=8~3mn) and slow (T 1/2:240 t 30 mn) components. There was no significant difference in half life of heparin concentration using a i00 U or 5000 U injection. The half life of the anticoagulant effect (60 mn) was different from the half life of ~eparin concentration (240 mn). In 12 cases out of 17 the scintigrams showed a more or less increased uptake by the pathologic limb. The results are inconstant because of a probable saturation of endothelial heparin binding sites by previously injected therapeutic heparin. In thrombotic patients the kinetics studies showed a very significantly increased clearance: the slow component half life was T 1/2 = 120t40 ~in. In addition, we showed that heparin clearance depends on its plasma concentration: the lower the concentration, the higher the clearance. The results of our work suggest that Tc-Heparin is a reliable tool which might he useful to understand better how heparin works. More immediately and practically it should have a value as a means of early diagnosis of thrombotic disease by imaging damaged blood vessels and, more importantly, by showing pathologic changes in heparin kinetics since an increased clearance appears to be a constant and early feature of thromboembolism. Serv. de M6d.Nucl. H6p. Purpan - 31052 Toulouse Cedex
EVALUATION OF UTEROPLACENTAL U S I N G 113 rain J. U r h a n e k , M . Graf, E. M a r i k o v a ,
82 PREPARATION ANF QUALITATIVE ANALYSIS OF Tc-99m EIBRINOGEN B. Spett, Gy. Janoki, L. K o c s a r a n d T. H e r n a d i H u m a n fibrinegen w a s labelled ( K A B I A B . , S t o c k h o l m , S w e d e n ) by c h e m i c a l and electrolytic m e t h o d s . F o r electrolytic labelling z i r c o n i u m a n d tin electrodes, while S n C I .21-I O ( M e r c k ) w e r e u s e d for c h e m i c a l labelling. Labelling efficiency w a s controlled by the following m e thods: i) T h i n - l a y e r c h r o m a t o g r a p h y ( d e v e l o p m e n t in acetone); Z) G r a v i m e t r y ( T C A precipitation). T h e yield of labelling efficiency w a s 85-95~0 in case of all three labelling m e t h o d s . The coagulation activity of the labelling p r e p a r a t i o n w a s e x a m i n e d u n d e r conditions, in vitro using T h r o m b i n solution. (Topostasin L a - R o c h e , Basel. l m g / m l in phys. saline, p H 7. 0-7.Z). V a l u e s obtained w e r e c o m p a r e d with the results of 1-125 Fibrinegen; with respect to all three labelling m e t h o d s it w a s stated that the d e g r e e of coagulation activity (65-80~o) w a s l o w e r than at I-iZ5 F i b r i n o g e n (85-95~0). T h e labelled p r e p a r a t i o n w a s e x a m i n e d in rabbits, i___n vivo. F a s t blood clearance w a s o b s e r v e d in all three cases. i0 rain after the injected activity 35 +- 5~0 w a s left in the circulation, although high liver activity w a s observ e d at the s a m e time. E x p e r i m e n t a l t h r o m b u s w a s ind u c e d in the v e n a jugularia of rabbits. 9 9 m T c - F i b r i n o g e n w a s injected i.v. 4 hr after the induction of the thrombus. Scintigraphic pictures w e r e taken Z.5 hr afterwards. T h e t h r o m b u s a n d the liver are clearly visible o n the picture~. 'FJC' Natl. Res.lnst. for Radiobiol. and Radiobyg. Budapest, Hungary
BLOOD
FLOW
9[. B a k o s
F r o m the point of prevention of fetus h y p o x y , early diagnosis is of the greatest i m p o r t a n c e . D i s o r d e r s in uteroplacental blood flow play a m a i n role in the origin of this hypoxy. T h e m e t h o d of m e a s u r i n g uteroplacental blood flow using 113 rain is described. 37 M B q of 113 rain in a s m a l l v o l u m e being a d m i n i s t e r e d into cubital vein, distribution of radioactivity over the uterus is registered. D y n a m i c studies are p e r f o r m e d in 5 sec. intervals a n d 60 f r a m e s are taken on scintillation camera PHO-GAMMA IV c o n n e c t e d with C L I N C O M . D a t a received are p r o c e s s e d using two different m e t h o d s b a s e d on a l g o r i t h m u s w e developed. Results are in a g o o d a g r e e m e n t with clinical findings. Dept. of N u c l e a r M e d i c i n e , Faculty Hospital I, I. Obstetric Clinic Eac. of Oen. M e d . , C h a r l e s University, P r a g u e .
84 DISTRIBUTION AND KINETIC OF IODINE-LABELLED DIAETHYLSTIb BOESTROLDIPHOSPHATE (CYTONAL) AFTER INTRAVENOUS INJECTION I . Mende, G. Wollny, J. Gens and J. Schubert D i a e t h y l s t i l b o e s t r o l d i p h o s p h a t e is used f o r the t r e a t ment of p r o s t a t i c cancer. Its mode of action has r e c e n t l y been c o n t r o v e r s i a l . Therefore we i n v e s t i g a t e d the behavi our o f the i o d i n e - l a b e l l e d compound. The l a b e l l i n g was done s i m i l a r to a method by TUBIS. The d i s t r i b u t i o n of i o d i n e - l a b e l l e d d i a e t h y l s t i l b o e s t r o diphosphate to various organs of rats and mice with mammacarcinoma transplanted was measured w i t h i n a period of 10 minutes to 7 days p . i . Dynamic imaging of d i s t r i bution in human body and measurements of the concentrat i o n of r a d i o a c t i v i t y in human organs (got during surgical operation) were c a r r i e d out, too. The highest r a d i o a c t i v i t y concentration was found in the l i v e r . The concentration of the r a d i o a c t i v i t y in the prostate was very low. In rats i t amounted to 0.025 per cent of the i n j e c t e d dose per gram t i s s u e , in men with p r o s t a t i c carcinoma to 0.00038 per cent per gram 20 hours p . i . The concentration of r a d i o a c t i v i t y in the tumor of mice ran to 2 per cent of the i nj ect ed dose per gram tissue during the period of 20 minutes to 3 hours p . i . A f t e r that i t decreased. Because of these r e s u l t s the therapy of p r o s t a t i c cancer should be examined again. Dept. of Nuclearmedicine and Urological C l i n i c , Medical Academy Desden, GDR. Central i n s t i t u t e of Nuclear Research Rossendorf, Dresden GDR
134 85 IN-VIVO DISTRIBUTION OF 99mTc-LIPOSOMES K. Jeyasingh, R.F. Jewkes, V.J. Richardson, M.P. Osborne and B.E. Ryman Phospholipi~. Vesicles, liposomes, are being considered widely as p o t e n t i a l c a r r i e r s of drug in chemotherapy(i). The aim of t h i s study was to see i f liposomes are taken up by tumours. Liposomes bearing p o s i t i v e , neutral and negative charges were prepared (2) and l a b e l l e d with 99mTc using stannous c h l o r i d e . Their d i s t r i b u t i o n 24 hours a f t e r i . v . administration was s t u t i e d in normal rats and rats bearing WALKER 256 Carcinoma, by in vivo r a d i o i s o tope imaging and post mortem radioassay o f i n d i v i d u a l organs. Most of the r a d i o a c t i v i t y was found in the l i v e r (12-24% of dose);Kidneys(7-g%) and the guts(4-7%). Negat i v e liposomes were more e f f e c t i v e l y l o c a l i s e d in the tumour(1.3%/g) compared with the other two(O.3-O.6%/g). Studies on patients with various malignant disorders using negative liposomes indicated s i m i l a r d i s t r i b u t i o n in l i v e r and kidneys, but only one of 14 patients showed det e c t a b l e tumour l o c a l i s a t i o n . The, study was extended to determine the d i s t r i b u t i o n a f t e r i n t e s t i t i a l i n j e c t i o n . Normal rats and rats bearing metastasising Rd/3 tumour in the regional lymph nodes were injected with liposomes i n to the footpad and studied 30 hours l a t e r . P o s i t i v e l i p o somes have the highest primary regional lymph node uptake (approx.1.8%). Neutral liposomes 1.4% and negative liposomes 0.3%. All showed the regional lymph nodes c l e a r ly on radioisotope scan. In the presence of tumour the uptake of p o s i t i v e and neutral liposomes was s i g n i f i c a n t l y reduced but negative liposomes unaffected. This study reveals that the tumour l o c a l i s a t i o n o f liposomes depends on t h e i r composition and the type of tumour 99mTc-liposomes could have a place in regional lymph node imaging. References:(1) T y r e l l D.A. et al Biochem.Biophys'.Acta 457 259, 1976. (2) Bangham A,D. et al Methods in Membrane Biology (edited by Korn E.D.) pp 1-68 Plenum Press New York (1974)
87 75-Se-SUBSTITUTED PURINNUCLEOSIDES AS POTENTIAL RADIOPHARMACEUTICALS FOR POSITIVE TUMOURSCANNING H. Deckart, A. B l o t t n e r , H, Spiess Antimetabolites o f DNA-synthesis are known as e f f e c t i v e cancerostatic drugs. We have s y n t h e t i s i z e d 8 purinnucleosides 75-Se-labelled with d i f f e r e n t c o n s t i t u t i o n s (p.e. 75-Se-8-Selenoadenosine, 75-Se-8-seleno-6-methyl2 ' , 3'-isopropylidenadenosine e t c . ) . The paper informs about pharmacokinetics in female AB- and CBA-mice, accumulation in 5 d i f f e r e n t transplantated tumours ( mamacarcinoma, Ehrlich-ascites-carcinoma and 3 types o f sarcoma), and about cell-membrane-penetration examined in cell-suspensions. D i f f e r e n t pharmacokinetic behaviour depending on changed chemical c o n s t i t u t i o n is discussed: preparations containing an isopropylidene group a r e eliminated f a s t e r ; i n t r o d u c t i o n of a l c y l i c groups enhances l i p o p h i l i c behaviour r e s u l t i n g in higher penetration rate of c e l l membranes and higher muscle/tumour-ratios. Similar r e s u l t s we observed with 111-1n-bleomycine. Nucl. Med. C l i n i c , Klinikum Berlin-Buch and Kernforschungszentrum, Radiochem. Dept. Rossendorf - GDR
Chafing Cross Hospital and Medical School London
86
TISSUE UPTAKE AND EXCRETION OF 2'-(I-123)-IOD0 2 ' DEOXYURIDINE IN ANIMAL TUMORMODELS D.N. Abrams, E.E. Knaus, L . I . Wiebe, F. Helus and W. Maier-Borst Iode-123 was produced by the Te-124 (p, 2n) 1-123 reaction and recovered by sublimation of the r a d i o - i o d i n e onto gold, copper or quartz c o l d - f i n g e r s , as described by Helus, Maier-Borst and Sinn (1978). For the synthesis of 2 ' - ( I - 1 2 3 ) - i o d o - 2 ' - d e o x y u r i d i n e , the r a d i o i o d i n e was exchanged with sodium iodide in methanol, followed by evaporation of the solvent. The iodide-123 was taken up in anhydrous dioxane, and 2, 2'-anhydrouridine and TFA were added. The mixture was heated in a sealed tube (145") f o r 15 min., a f t e r which the solvent was evaporated. The residue was taken up in methanol and chromatographed on s i l i c a gel. The appropriate region was eluted to y i e l d the t i t l e compound. A s o l u t i o n o f I in s a l i n e (lOOuCi/ 0.1 ml) was prepared, m i l l i p o r e f i l t e r e d , and checked f o r r a d i o i o d i n e p r i o r to use. Aliquots of the f i n a l s o l u t i o n were injected intravenously i n t o rats bearing Walker tumors; f o r dynamic imaging and s t a t i c scanning, 325-400uCi of I were i n j e c t e d , and f o r terminal tumor and organ d i s t r i b u t i o n studies 9.9uCi were administered. Tissue d i s t r i b u t i o n studies showed l i m i t e d uptake of the r a d i o l a b e l in kidney, l i v e r , i n t e s t i n e , lung, spleen and stomach within 30 min. of i n j e c t ion. A f t e r 4 hours, a l l l e v e l s , except stomach a c t i v i t y , were s i m i l a r t o , or lower than, blood l e v e l s . These data were supported by whole-body imaging studies, which sho+wed r e n a l , hepatic and u r i n a r y concentration of r a d i o activity. The lack of tumor or organ s p e c i f i c i t y observed as explained in terms of in vivo d e i o d i n a t i o n , and s t r u c t u r a l requirements f o r me~T~ate--6-a--transportof pyrimidine nucleosides. U n i v e r s i t y o f A l b e r t a , Canada DKFZ, Heidelberg,
GFR
88 POSITIVE TUMOURSCINTIGRAPHY IN ANIMALS WITH 131j ANTICLOSTRIDIUM - ANTIBODIES H.J. Altenbrunn, A.H. Mehnert, R. Vogt, E. Schmidt and L. Steenbeck Clostridium spores were i nj ect ed to tumour bearing a n i mals. These spores germinate in the acid milieu o f tumour t i s s u e . The general idea is to detect tumours by scintigraphy a f t e r i n j e c t i o n of 131-J - l a b e l l e d a n t i c l o s t r i d i u m a n t i b o d i e s , which w i l l combine with the c l o s t r i d i u m enriched in the tumour in vi t r o- exper im e n ts as well as in v i v o - d i s t r i b u t i o n and k i n e t i c t s of a n t i c l o s t r i d i u m antibodies are reported. Central I n s t i t u t e of Oncology and Central I n s t i t u t e o f Isotope and Radiation Research, Academy of Science o f the GDR, DDR 1115 Berlin-Buch
135
89 EVALUATION OF CLINICAL SIGNIFICANCE OF THE 67 Ga UPTAKE IN HODGKIN'S LYMPHOMASAND IN BRONCHOGENOUSCARCINOMA ANALYSIS OF 363 CASES M. Bechyne, I. Makaiova, Z. D i e n s t b i e r , S. Hupka, I Horak
91 SCINTIGRAPHIC IMAGING IN PATIENTS WITH MALIGNANT LYMPHOMA USING 57-Co-BLEOMYCIN BLM AND 67-Ga CITRATE D. B r y k a l s k i , S. Fajndt, M. Surma, A. Kosmider, M. Studniarek and M. Staniszewska
P o s i t i v e 67 Ga scans of untreated patients with Hodgkin's lymphoma were found in 85,2 %. L o c a l i z a t i o n of the process has been confirmed in 90 % of cases in stagings I A and B, in 76 % in stagings I I A and B, in 86,4 % in stagings I l l A and B in 91,3 % in stagings IV A and B. Mediastinal l o c a l i z a t i o n was found in 83, i %, abdominal in 45, 2 %, cervical in 71,5 % and a x i l a r l o c a l i z a t i o n in 13,6 %. P o s i t i v e scans were found in 47,8 % in grading LP, in 44,4 % in NS, in 61,6 % in MC and in 47,2 % in LD. The uptake of 67 Ga in cases of patients with d i f f e r e n t i a t e d bronchogenous carcinoma was found in 89,1%, in cases of n o n - d i f f e r e n t i a t e d in 90,6 %, in s m a l l - c e l l ca in 3 cases among 4 and in adenocarcinoma in 84,8 %. The c l i n i c a l signifcance of 67 Ga uptake is discussed.
Nine pat i ent s with Hodgkin disease and 23 with other malignant lymphomas were studied a f t e r i n j e c t i o n of 57Co-BLM and 6 7 - G a - c i t r a t e , administered w i t h i n I-4 days each o f another. Scintigraphy was made by images were obtained and compared f o r ? radiopharmaceuticals in a standardized way. V e r i f i c a t i o n o f r e s u l t s on basis o f c l i n i c a l data demonstrated great usefullness of both compounds f o r detection of a f f e c t e d lymphnodes. S c i n t i grams obtained f o r head, neck and a x i l l a r y regions r e vealed t h a t images a f t e r 67-Ga-citrate were superior than those a f t e r 57-Co-BLM. For assessment of i n v o l v e ment o f lymphatic tissues w i t h i n the thorax e i t h e r compounds appeared equally e f f e c t i v e ; f o r abdomen and p e l vis 57-Co-BLM was more i nf or mat i ve due to i n t e r f e r e n c e of 67-Ga accumulated in the skeleton and i t s e l i m i n a t i o n via the gut.
Inst. of Bioph. and Nucl. Med. Prage CSSR
Confidence in the staging of lymphoma and detection o f involved tissue was increased when images obtained with two radiopharmaceuticals were considered. Dept. o f Nuclear Medicine and Radiobiology, Medical Academy o f Lodz and Oncological Centre, Lodz, Poland.
90 SIGNIFICANCE OF SCINTIGRAPHIC Ga-67 EXAMINATIONS FOR EARLY DETECTION OF LYMPHANGITIC SPREAD OF MALIGNANT NEOPLASMS IN LUNGS AND FOR MONITORING THERAPEUTICAL PROCEDURES d. Makolska and J. Buraczewski S c i n t i g r a p h i c Ga-67 symptomatology of e a r l y lymphangitic spread of malignant neoplasms in lungs is discussed. The type of examination permits detection of very e a r l y symptoms and confirms r a d i o l o g i c a l f i n d i n g s . Lymphangitic spread o f malignant neoplasms is frequent, and appears often in e a r l y phases of neoplastic development. C l i n i c a l procedures endeavour to detect and remove regional groups of lymphatic nodes invaded by tumor. I n v e s t i g a t i o n s concerning the mechanism of metast a t i c spread prove t h a t symptoms of lymphangitic spread in lungs can be detected years p r i o r to appearance of evident metastases regarded as "bloodborne". Early lymphangitic spread o f neoplasms explains many phenomena, such as unfavorable r e s u l t s of so called radical t r e a t ment of breast and pulmonary cancer etc. Early detection of symptoms of lymphangitic spread in lungs should i n fluence the therapeutical management both as concerns radicalism and a p p l i c a t i o n o f combined methods. Radiological detection o f e a r l y symptoms o f lymphangitic spread in lungs is possible but d i f f i c u l t in view of s i m i l a r i t y of various abnormalities o f pulmonary pattern. In many cases s c i n t i g r a p h y Ga-67 c a l l s a t t e n t i o n to the abnormal i t y of pulmonary pattern. I t should be a r o u t i n e examination f o r observation and f o r monitoring the treatment o f e a r l y and advanced metastasizing cases. I n s t i t u t e o f Oncology, V!arsaw, Poland.
92 PROBLEMS OF IN VITRO TECHNIQUES IN CLINICAL ONCOLOGY V. Agranat, A. Balyura and N. Frenkel In v i t r o techniques are r e l a t i v e l y succesful in some oncological diagnostic problems ( d i f f e r e n t i a t i o n of l i ver cancer, checking therapy r e s u l t s , detection of chorionepitheliomas and hormone-producing tumors). The in v i t r o determination of DNA-synthesising c e l l s with 3-H-Thymidine and d i f f e r e n t RIA's have prooved to be useful f o r the study of some secondary, but s t i l l important aspects, concerning the development of the tumorous disease. Problems a r i s i n g with the use of in v i t r o techniques in c l i n i c a l oncology and some ways o f t h e i r f u r t h e r development are discussed. I t is emphasized that a combination of in vivo and in v i t r o methods may be useful in diagnostic problems, as well as in the choice of s u i t a b l e therapeutic t a c t i c s . C l i n i c a l Hospital N20 and Oncological Research I n s t i t u t e , Moscow, USSR.
136 93 DETERMINATION OF TUMOURMARKERS IN MALIGNANT DISEASE AND IN EARLY DIAGMOSIS OF CANCER E. Pluygers, M. Beauduin, J. Hermans and F. Majois The aim o f t h i s study is to ascertain the value o f t u mour marker determinations in the plasma o f supposedly healthy screenees, as a screening procedure f o r cancer. The study includes determinations o f f o l l o w i n g markers : CEA, alpha FP, HCG, beta subunit o f HCG, beta-2-microg l o b u l i n ; a l l determinations have been c a r r i e d out using commercially a v a i l a b l e radioimmuno-assay k i t s . The p a t i e n t material includes 2 d i s t i n c t groups : - a f i r s t group o f 216 patients representing a c o n t i nuous series o f cases with h i s t o l o g i c a l l y proven mal i g n a n t primary disease, excluding recurrences or second treatment f o r metastatic disease. - a second group o f 500 supposedly healthy and asymptomatic screenees. In the neoplastic group, 60% had one or more p o s i t i v e marker values, w h i l s t in the screened group 81~ (405/500) had no p o s i t i v e marker; no cancers were discovered in t h i s group despite thorough c l i n i c a l examination. 84 o f the screenees showed one p o s i t i v e marker (no cancer found) and I I showed 2 p o s i t i v e markers; amongst t h i s small group, 2 asymptomatic cancers were found.
95 LUNG CARCINOMA VISUALISATION USING THE TECHNIQUE OF FUNCTIONAL IMAGING COMBINED WITH BLOOD SUBTRACTION V. S t i c h , P . S v i h o v c o v a , J . P o l a k , D. T o s e r o v a , E . M a r i k o v a , J . B r o u s i l , Z. D i e n s t b i e r T h e d y n a m i c studies of chest area of patients with lung c a r c i n o m a w e r e p e r f o r m e d using 99 m T c . T h e blood activity b a c k g r o u n d w a s then subtracted f r o m each of the f r a m e s and tle resulting study w a s p r o c e s s e d in order to obtain the functional image of the chest area, the rate of uptake being the p a r a m e t e r imaged. T h e t u m o r tissue w a s visualised due to its high 99 m T c uptake rate. T h e results w e r e c o m p a r e d with conclusions of other clinical investigations: X - r a y image, bronchoscopy, cytology, etc. and good correlations w e r e found. Institute of Biophysics and Nuclear Medicine, Prague, CSSR.
Thus tumour marker determinations in "healthy" screenees i s o l a t e a small group (2,2%) with at l e a s t 2 p o s i t i v e values; 18% (2/11) o f t h i s group u l t i m a t e l y proved to have cancer. The statement t h a t tumour marker determinations are ent i r e l y useless as a method f o r e a r l y cancer detection should e v e n t u a l l y be reconsidered. Oncology and Nuclear Medicine Department, Jolimont Hosp i t a l , 7 1 6 1 H a i n e - S a i n t - P i e r r e , Belgium.
94 INTEREST OF GEN (C.E.A.) J.P. Bisset, le and J.P.
SIMULTANEOUS ASSAYS OF CARCINOEMBRYONICANTIIN SERUM AND PLEURAL EFFUSION R. P o i r i e r , F. Roux, R. Sauvan, P. HourtouKleisbauer
C.E.A. radioimmunoassay ( C . I . S . , France) was done in serum and pleural e f f u s i o n o f cancerous and non cancerous subjects (tuberculous, cardiac, v i r a l and i n f e c t i o u s p l e u r e s i e s ) . In 30 control subjects, serum and pleural e f f u s i o n C.E.A. l e v e l s were always below the upper normal l i m i t (40 ng/ml). In 40 various cancerous subjects (lung, breast, pancreas, l a r y n x , oesophagus, lymphosarcoma), some (35%) have an increased serum and pleural e f f u s i o n C.E.A. l e v e l , others (53%) have a normal serum and pleural e f f u s i o n C.E.A. l e v e l , others (12%) have a normal serum C.E.A. level but a C.E.A. pleural e f f u s i o n level above the upper normal l i m i t . In t h i s case, where pleural e f f u s i o n level is over the normal range and f a r above serum l e v e l , we always discovered (through pleuroscopy, pleural biopsy or u l t e r i o r e v o l u t i o n ) a pleural metastasis. So, pleural C.E.A. assay has to be done in i n i t i a l pleuresy check-up : i f a normal C.E.A. pleural e f f u s i o n l e vel does not allow to exclude a metastatic pleuresy, an elevated pleural e f f u s i o n C.E.A. level founded in 47% o f cancerous subjects allows to diagnose a pleura tumoral g r a f t even i f C.E.A. serum level is quite normal (12%). Service de M~decine Nucl~aire, C.H.U. Timone, 13385M a r s e i l l e , C~dex 4, France.
96 THE IIZ5-DEOXYURIDINE AS THE DIFFERENTIAL DIAGNOSTIC OF TUMOUR A N D A B S C E S S IN R A T S V. G r o s s m a n n , V. Kusak, I. Jarkovska Using one group of rats bearing W a l k e r c a r c i n o m a during the second w e e k of its growth and the other with "pouche" abscess the cynetics of 185 I~Bq of Ii25-deoxy uridine w a s m a d e after intraperitoneal a d m o estimating the radioactivity of muscle, blood, liver and/of m a s s of turnout or abscess in different time intervals. Optimal difference between t u m o u r s and other tissues w a s found after 48 hours (7-10 times greater radiation of t u m o u r s m a s s ) and contemporaly the accumulation in abscess recalculated to 1 gr of weight w a s the s a m e as in blood or muscle. E v e n though the variations of results w e r e great the difference between the radioactivity of t u m o u r s and abscess w a s statisticaly significant. T h e results would be discussed. Institute of Exp. M e d . , CSSR.
C s a v Olesnice V Orl. hor.
137 97
99
AFFINITY OF 58-Co-BLEOMYCIN, 58-Co A2-BLEOMYGIN AND 58-Co-CITRATE TO EXPERIMENTAL TUMOURS IN M I C E M . R e m b e l s k a , J. Liniecki, T. Pertynski, M . Oginski, B. Koniarek, Z. Hajdukiewicz
RADIONUCLIDE IMAGING OF LYMPH NODES DRAINING THE PROSTATE A . R . Constable, R . A . Gardiner, R . W . Cranage, J_zM . Fitzpatrick
In 157 Swiss femal mice, carrying transplanted Ehrich Ascites t u m o r s and N K / L y lymphonaa, tissue distribution and accumulation in the n e o p l a s m s of activity injected in f o r m of 58-Co-bleomycin, 5 8 - C o - A 2 - b l e o m y c i n and 58-Co-citrate w e r e studied. The labelled drugs w e r e injected intraperitoneally and the animals sacrificed 6, IZ, 24 and 48 hours thereafter. Concentration activity /Activity Distribution Factor/ w a s m e a s u r e d in blood, in the tumours, in liver, intestines, kidneys, m u s c l e s and bones. M i c e injected with 5 8 - C o - b l e o m y cin s h o w e d very high accumulation of activity in both turnouts and high turnout: non tum6ur-ratios for m o s t tissues. 5 8 - C o - A 2 - b l e o m y c i n accumulated slowly in the n e o p l a s m s and w a s slowly eliminated f r o m blood; the resulting tumour: non t u m o u r ratios w e r e very low by c o m p a r i s o n to 58-Co-bleomycin. Activity of 5g-Cocitrate did not cumulate to any significant degree in the t u m o r s as c o m p a r e d with the n o r m a l tissues.
The demonstration of prostatic lymphatic drainage has obvious potential in the assessment a n d f o l l o w - u p of patients with c a r c i n o m a of the prostate. In the present study use has been m a d e of 9 9 m T c Antim o n y Sulphide Colloid and several injection sites have been investigated. Successful imaging of internal iliac l y m p h nodes has been achieved and can be reproduced with reliability. Details of the injection techniques are discussed. Following an initial report further studies are in progress and the technique is being evaluated for patients with prostatic carcinoma. Preliminary results indicate that drainage can be reliably demonstrated but that there are variations in the extent of nodal uptake. Investigations are currently in progress to reduce these variations both by modifying the injection techniques and improving the g a m m a c a m e r a imaging methods. Institute of Urology, Shaftesbury Hospital, London,
U.K.
D e p a r t m e n t of Nuclear Medicine and Radiobiology, Medical A c a d e m y of Zodz, Poland.
98 57Co-BLEOMYCIN / B L M / IN D I A G N O S I S MOUS CELL CANCER OF THE CERVIX T. Pertynski, K. Durski, E. Babinska
100 OF SQUA
-
T h e study w a s m a d e on 30 patients with diagnosed squam o u s cell cancer of the cervix, to each of w h o m 1.5 m C i of 5 7 C o - B L M w a s administered for a s s e s s m e n t of spread of the disease. Applying a coordinate s y s t e m for localisation of cancerous foci static scintigraphy of thorax and pelvis w a s m a d e Z4 h after administration of the labelled drug using g a m m a c a m e r a with "on-line" computer. Additionally hippurate renoscyntygraphy and liver scintigraphy /99Tc-colloid/ w e r e m a d e . T h e findings w e r e verified on basis of gynecological examination, lymphography, fine-needle biopsy and chest radiography. A g r e e m e n t between results of 5 7 C o - B L M scintigraphy and the latter w a s assessed for various localisations and w a s found as follows: I. local changes in cervix and infiltrate - 97~0 Z. abdominal space with pelvis - 87~0 3. peripherial lymphatic nodes - 76% 4. thorax - 60% It appears that 5 7 C o - B L M is useful for a s s e s s m e n t of the spread of cervical s q u a m o u s ceil cancer in the body. Dept. of Nuclear Medicine and Radiobiology Medical A c a d e m y of Lodz, Poland, and Oncological Centre, L o d z
THE DIAGNOSTIC VALUE OF TUMOUR-RELATED R A D I O I M M U N O A S S A Y S IN L U N G C A N C E R A N D C O L D PATIENTS L. I
138 101
103
C E A D E T E R M I N A T I O N IN H E A L T H Y C I G A R E T T E S M O K E R S AS A P R O P H Y L A C T I C F A C T O R J. Becalski, A. Czerwinska, J. W o y - W o j c i e c h o w s k i
REGIONAL VENTILATION AND PERFUSION IN PATIENTS WITH UNRESECTABLE CARCINOHA OF THE BRONCHUSSTUDIED BEFORE AND AFTER RADIOTHERAPY F. Fazio, T.A. P r a t t , C.G. McKenzie and R.E. Steiner
Elevated C E A levels w e r e found not only in cases of entoderm~l cancers; but also in a few reports in healthy cigarette s m o k e r s . This study reports about the C E A levels in the Polish population of cigarette smokers. A n unselected group of 200 s m o k e r s w a s tested, at the age f r o m 21to 59 years, 183 m e n and 17 w o m e n . They s m o k e d f r o m 8 to 60 cigarettes per day. The duration of smoking differed f r o m 5 to above 20 years. T h e control group consisted of 100 persons w h o had never smoked. All determination w e r e m a d e by help of the ABBOTT'S CEA - RIAKIT. Elevated levels of the antigen /all results above Z.5 rig/ m l / w e r e found a m o n g Z 9 % of s m o k e r s and 8% of nons m o k e r s / m o r e than in similar investigations in the USA, Australia and France/. Conclusions: I. The C E A level in s m o k e r s is significantly higher than in n o n s m o k e r s /29:8/. Z. T h e s m o k e r s of s o m e sorts of cigarettes /"Klubowe", "Extra M o c n e " / s h o w e d higher levels of the Carcino E m b r y o n i c Antigen. 3. A m o n g the factors stated in the W H O Report - in our study the m o s t important s e e m s to be the age of the initiation of smoking. 4. The cancerogenic exposition of the Polish s m o k e r s population is greater than in the U S A , Australia and France. 5. Elevated C E A levels b e c a m e n o r m a l after cessation of smoking.
V e n t i l a t i o n / p e r f u s i o n (V/Q) scans were obtained in 45 patients with unresectable carcinoma o f the bronchus. T h i r t y - f i v e patients were r e - i n v e s t i g a t e d f o l l o w i n g r a diotherapy and 17 o f them had f u r t h e r follow-up studies. Both V and ~ were always abnormal in the lung affected by the tumour, ~ being usually more impaired than V. These abnormalities were d i f f i c u l t to detect or to evaluate from an assessment of regional perfusion and vent i l a t i o n derived from the standard chest radiograph. Following radiotherapy, a s i g n i f i c a n t improvement o f both V and Q was observed, which was associated with amelioration of breathlessness. Slow but progressive d e t e r i o r a t i o n of regional V and Q and dyspnoea were subsequently observed. This was often associated with the development of r a d i a t i o n f i b r o s i s . Tests of overall lung function (VC, FEVI O) were moderately impaired at the i n i t i a l assessment (probably due to c o - e x i s t i n g chronic airways o b s t r u c t i o n ) , and did not show s i g n i f i cant changes a f t e r radiotherapy or during the follow-up. Isotope studies of regional perfusion and v e n t i l a t i o n proved more s e n s i t i v e and more s p e c i f i c than tests o f o v e r a l l lung function f o r the functional assessment and follow-up of patients with unresectable carcinoma o f the bronchus. M.R.C. Cyclotron Unit and Departments of Medicine, Diagnostic Radiology and Radiotherapy, Hammersmith Hosp i t a l , London, U.K.
D e p a r t m e n t of Nuclear Medicine, Central Clinical H o s pital, W a r s a w , Poland.
1 O2 RADIOIMMUNOASSAY OF HCG-~ IN PATIENTS WITH CARCINOMA OF DIGESTIVE TRACT J. Lemberzer, R. Novakovic, L.J. GIisic, E. Libman H C G - ~ in the s e r u m of patients with non-malignant and malignant diseases of the digestive tract w a s m e a s u r e d by the r a d i o i m m u n o a s s a y method. A s a positiviLy on H C G - ~ w a s considered everything over I. 5 ng/ml. H C G - ~ w a s not detected in patients with cirrhosis of the liver and colitis, while out of 21 patients with pancreatitis it w a s registered in 2 patients. Positivity incidence of H C G - ~ 3 in patients with h e p a t o m a is 4 0 % , in patients with cancer of pancreas is 3 8 % , in patients with gastric cancer is 2 6 % , while in those with colonic/rectal cancer is 15%. Achieved results suggest that H C G - ~ is a useful p a r a m e t e r for confirmation of malignity, especially that of liver and pancreas. Medical Centre at Subotica and Medical Faculty,University of Belgrade, Yugoslavia.
104 PULMONARY FUNCTIONAL IMAGING WITH 133-Xe. CASE OF PULMONARY BURDEN IN MUCOSITIES J.L. M o r c e l l e t , A. Baret and A. Elizagaray In patients with the lungs burdened with mucosities, we cannot apply a monoexponential model to pulmonary washout a f t e r e q u i l i b r i u m using the spirometric method, because of the s o l u b i l i t y of the Xenon. We propose, in such a s i t u a t i o n a scheme of the pulmonary d i s t r i b u t i o n in two compartments, one (Vm) of the dissolved Xenon which exchanges i t s e l f with the other compartment (V) : the gazeous Xenon compartment, which i s , the one, opened to outside. Ne demonstrate the wash-out time function can be a s s i milated in the f i r s t p o r t i o n , to an exponential with the constant ~r = V + V~ " (~ = v e n t i l a t i o n ) . This method is joined with the dissolved Xenon i n j e c t i o n one which gives, on the wash-out time function, the ~e value : ~ . ~e = V (except. In pulmonary embolism in which le is given by'the single breath method). Thus, in very area of i n t e r e s t , we calculate A = V + Vm V, Vm, g e t t i n g , q u a n t i t a t i v e l y , the d i s t r i b u t i o n o f the a e r i a l spaces and o f the dissolved Xenon zones. The production of functional pulmonary imag@s gives a synt het i cal view o f the c l a s s i c parameters V ( v e n t i l a t i o n ) . Q ( per f usi on) but also f o r the parameters V (aeral spaces) and Vm (dissolved Xenon zones). These l a s t e s t maps are found to be easier to i n t e r p r e t than the map (A) o f the spatial d i s t r i b u t i o n o f the Xenon at equilibrium. The method is worked in mucoviscidosis a f fected c h i l d r e n . Centre d'Etudes de Recherches 8iophysiologiques Appliqu~es a la Marine, N.T.A. Sainte-Anne, 83800 ToulonNaval, France.
139 107
105 EFFECTS OF NITROGLYCERIN EXCHANGES L. Piret, S. V a n der Linden,
ON PULMONARY B. N e m e r y
GAS
a n d A. F r a n s
At rest a n d during exercise nitroglycerin ( N T G ) relaxes the peripheral capacitance vessels and d e c r e a s e s the venous return (I.Z). T h e p r e s e n t study w a s designed in order to d e t e r m i n e the effects of the blood redistribution on p u l m o n a r y gas e x c h a n g e s . In eight n o r m a l subjects, the effects of 3 rng N T G taken sublingually w e r e m e a s u r e d in different positions. B e sides non-isotopic m e t h o d s ( D L C o , physiological d e a d space a n d arterio-alveolar c o g gradient), perfusion and ventilation distribution w e r e m e a s u r e d using 1 3 3 - X e n o n and a g a m m a c a r n e r a . In all positions, the relative perfusion w a s d e c r e a s e d in the u p p e r zones a n d i n c r e a s e d in the l o w e r zones, a n d this without c h a n g e s in regional ventilation. V A / Q bec a m e m o r e u n e v e n after N T G . T h e s e results suggest that N T G induces a blood redistribution within the lungs, p r o b a b l y t h r o u g h a d e c r e a s e of the p u l m o n a r y arterial pressure. M o r e o v e r the X e n o n m e t h o d indicates that N T G d e c r e a s e s the relative perfusion of the u p p e r lung zones. At present time, our results do not allow to a s s e s s w h e t h e r or not this intrapulrnonary blood redistribution is a c c o m p a n i e d by a blood shift f r o m the lungs to the periphery. (i) G o o d m a n (L.S.) et al. T h e p h a r m a c o l o g i c basis of therapeutics. M a c Millan, N e w Y o r k , 1975, 1704 p. (Z) M a s o n ( D . T . ) et al. Circulation, 1965, 3Z, 755. C e n t r e de M 6 d e c i n e Nucl@aire, University of Louvain, M e d i c a l School, A v e n u e Hippocrate, 10/17.80, B - I Z 0 0 Brussels, Belgium.
106
81m
CLINICAL USE OF KRYPTON FOR THE STUDY OF CHRONIC PULMONARY AIRWAY DISEASE AND EMBOLISM D. Linsmaux, P. Rigo, G. Merchie, P. Bartsch This study summarizes our experiences of more than 200 examinations performed since october 1977. The method uses combined perfusion scanning with 99mTclabelled microspheres and ventilation scanning with gazeous 81mKrypton. S~x projections are performed with patient in a sitting position inhaling Krypton through a specially designed mask. All scans were analysed for the presence of matching or non-matching defects. In proven cases of bronchial carcinoma, we compare the sensitivity of chest X-Ray, hilar tomography, fibroscopy and lung scans to detect and to assess the extension of the lesions. Scanning is more sensitive than standard chest X-Ray for the detection of bronchial carcinoma. It defines the extension of the lesions and the presence of hilar involvment with the same accuracy as fibroscopy. Despite its non specificity the scans help to assess operability. In emphysema, we compare lung function tests, where emphysema is measured by Z~FRC (functional residual capacity) and scanning where lesions are estimated by planimetry on the posterior oblique projections. The correlation is good (r = 0.66) and scannings show with more accuracy than standard chest X-Ray the localization of the emphysematous lesions. Dpt of NucZear Medicine, H6pital de Bavi@re, University of Li&ge, Belgium.
STUDY OF THE NASAL MUCO-CILIARY CLEARANCE BY RADIOISOTOPE M . H . L a u r e n s , ft. Robert, P. Sirneons, M . W a y o f f F o l l o w i n g previous studies ( P R O C T O R , GUILLERM), w e p r o p o s e an objective m e t h o d for the investigation of the rnuco-ciliary function of the nasal m u c o s a : w e r e c o r d the m o t i o n of radioactive particles ( s o d i u m phytate techn e t i u m 99rn), w h i c h are put by s o u n d nebulisation on nasal rnucosa. T h e a v e r a g e s p e e d id calculated by m e a n s of the analysis of sequential i m a g e s and by the study of the variation of activity in relation to t i m e in several regions of interest; a clearance rate of the initial activity is also m e a s u r e d . In a g r o u p of ig n o r m a l p e r s o n s ~ the a v e r a g e s p e e d is g,33 m m / r n i n u t e and the clearance rate is 30 ~0/minute; in a g r o u p of patients, the a v e r a g e s p e e d is r e d u c e d to g,36 r n m / m i n u t e and the clearance rate is only 7 % / m i nute: these results s h o w that toxicological a n d infectious factors affect rnuco-ciliary function. F o r 8 subjects with m u c o - c i l i a r y c l e a r a n c e inhibited by xy!ocafne (average s p e e d = 1,37 rnrn/minute), w e c h e c k e d the activator effect of a therapeutic solution (containing trip h o s p h o r i c adenosine acid ( T P A ) ) on the ciliary motion: then the a v e r a g e s p e e d is 5,6 rnrn/rninute. T h u s , this simple, non a g g r e s s i v e m e t h o d allows to m e a s u r e the alteration d e g r e e of the rnuco-ciliary function and to estimate the efficiency of nasal therapeutic solutions. Service de M @ d e c i n e Nucl6aire, 18, rue Lionnois 5 4 0 0 0 - N a n c y - et Service d ' O t o - R h i n o - g a r y n g o l o g i e , C.H.R. Nancy, France.
108 REGIONAL PULMONARY VENTILATION STUDIED WITH MULTIPLE-VIEW LATE XENON WASHOUT IMAGES J.C. Liehn, J. Valeyre, O. Ferrand and J.B. Jouet Late Xenon 133 washout images (LWI) are useful to show abnormalities of regional ventilation (P.O Alderson et al. II WFNMB Congress). Our experience indicates that it is possible to obtain routinely multiple-view LWI. Those images are recorded with a gamma camera following equilibration and early washout (imn) study performed in the posterior view. The first LWI is recorded in the posterior view. The subsequent views are chosen according to the data of the posterior view. As many as six LWI can be obtained (posterior, anterior, lateral and oblique posterior). Those images show the chest wall (blood background activity) and hyperactive areas corresponding to poor ventilated regions. LWI do not give information about absolutely non ventilated regions or about very mild hypoventilated regions. In those cases only equilibrium image and early washout functional image are useful. False positive trappings are commonly seen in the liver and in two cases (among 50 including 30 children) Xenon has been seen in the stomach at the end of the pulmonary washout. The number of LWI we can obtain depends on the speed at which Xenon leaves the abnormal region. In practice, during a 5 ~n period following the early washout study, 4 images (50 000 counts each) are commonly obtained. LWI are routinely compared with multiple view Tc-99m microsphere perfusion images. In case of ventilation-perfusign match hot areas on LWI correspond to cold areas on perfusion images. Ventilation defects are localized more accurately with the help of multiple-view LWI. Up to now about 50 studies have been performed in different circumstances including: endobronchial foreign body, pulmonary viral or bacterial diseases and their sequelae, congenital bronchial malformation, bronchial dilation and cystic fibrosis. Inst.Jean Godinot et Serv. de Pneum. et de P6d. CHR Reims
140 109 X E 133 R A D I O S P I R O G R A P H Y - A CONVENIANT SCREENING METHOD FOR REGIONAL LUNG FUNCTION STUDIES L. Vaskov X e 133 Radiospirography (RSG) is aN easy, useful and fast m e t h o d for wide diagnostic practice. C o m p a r a t i v e clinical studies with R S G and pulmocirculography with l13m InCl applicated intravenously indicated the significance of the "breathe-holding" phase of R S G (the plateau) as an indicator of regional gas-difusion and alveolar filling, and of the ventilation clearance as an indicator of regional airway obstruction. T h e c o m p a r i s o n of R S G as a screening m e t h o d with the clinical, radiological, functional and blood-gas analysis data in 1500 persons s h o w e d the diagnostic possibilities of 1 3 3 X e Radiospirography as a convenient m e t h o d for regional lung function studies. R e s e a r c h Institute of Roentgenology and Radiobiology Sofia, Bulgaria.
111 ROLE OF SCINTIGRAPHY IN THE DETECTION OF SPONTANEOUS GASTROESOPHAGEAL (GE) REFLUX. F. SCOPINARO, A.VIGNONI, V.GATTI, C.POZZESSERE, F. ANZINI, E. CORAZZIARI. Dpts. of Radiology I~and Gastroenterology, Rome. Scintigraphy (S) is s e n s i t i v e to detect GE r e f l u x during intraabdominal pressure increments (1). Aim of t h i s study was to compare the s e n s i t i v i t y of S and of an i n t r a e sophageal pH electrode (IEpH) in the ~etection of spontaneous GE r e f l u x . 28 patients (15M, 13F), complaining of heartburn were investigated. A Beckman g a s t r i c pH probe was located 5 cm proximal t o t h e lower esophageal sphi cter during a standard manometric t e s t . Computerized (KANDY DS) GAMMACAMERA (PHO GAMMAI l l ) , h o r i z o n t a l l y over lying the p a t i e n t , stored data at the rate of l frame min? Tiem a c t i v i t y curves derived from 2 areas of i n t e r e s t : esophagus and stomach. Each p a t i e n t , f a s t i n g and q u i e t l y resting in supine p o s i t i o n , was investigated by IEpH and GE S f o r a 20 min. period on d i f f e r e n t days. Spontaneous refTux was i d e n t i f i e d by the IEpH as pH less than 4 a f t e r i n t r a g a s t r i c admi ni st r at i on of 300 ml HCI O.l N and by the GE S and as increase of time a c t i v i t y curve and visua l i z a t i o n ~Qf the esophageal area a f t e r oral administration of 2 mCi ~mTc-DTPA in 500 ml i s o t o n i c s o l u t i o n . Results: One or more episodes of spontaneous r e f l u x were d ~ in 13 patients (46%) by the IEpH and 2 patients (7%) by the GE S. Conclusions : data indicate the S is s i g n i f i cantly less ~ - - t h a n the IEpH in the detection o f spontaneous GE r e f l u x and suggest that GE S is not rel i a b l e to detect GE r e f l u x in r e s t i n g physTological conditions. Fisher et a l . Gastroenterology 70:301-308, 1976.
R.D. TOLIN, L.S. MALMUD, P.T.MAKLER and R.S. FISHER.
112 MEASUREMENT OF GASTRIC EMPTYING TIME WITH GAMMA-CAMERA: REPRODUCIBILITY, PHYSIOLOGICAL, CLINICAL AND PHARMACOLOGICAL USES.
Temple U n i v e r s i t y H o s p i t a l , Philadelphia, PA., USA.
D. LINSMAUX, A. BRASSINNE and G. MERCHIE
The s e v e r i t y of r e f l u x esophagitis symptoms has been related to delayed esophageal emptying of refluxed mater i a l . Until r e c e n t l y , a s e n s i t i v e , non-invasive t e s t f o r evaluation o f esophageal clearance has not been a v a i l a b l e . The purpose of t h i s study was to evaluate a new q u a n t i t a t i v e technique f o r esophageal clearance in patients with a v a r i e t y of esophageal disorders. Following oral admin i s t r a t i o n 300zuCi Tc-99m s u l f u r c o l l o i d in a IB ml bolus of water, imag@s were obtained over the esophagus using a gamma camera on l i n e to a d i g i t a l computer. The esophageal clearance was expressed as the percent clearance f o r each of the f i r s t IB seconds a f t e r the maximal number o f counts were achieved f o l l o w i n g the i n i t i a l swallow. I t was also expressed as the pr cent clearance a f t e r s e r i a l swallows at 15 second i n t e r v a l s . F i f t y - s e v e n studies were performed including f i f t e e n normal subjects. In 8 patients with achalasia, esophageal clearance was diminished by both the single and m u l t i p l e swallow t e s t s . In lO patients with d i f f u s e esophageal spasm, clearance was delayed, but was q u a n t i t a t i v e l y normal a f t e r 20 swallows. Clearance was normal in the 14 patients with esophagitis and normal manometry, but was decreased by single and multiple swallow analysis in the IO patients with esophagitis and abnormal manometry. We conclude that t h i s non-invasive clearance technique c o r r e l a t e s well with esophageal manometry~ and t h a t impaired esophageal emptying is only a p a r t i a l explanation f o r the development of symtomatic esophagitis, since i t is c l e a r l y not present in a l l patients with esophagitis.
U n i v e r s i t y of Liege, Belgium.
110 ESOPHAGEAL CLEARANCE IN PATIENTS WITH ESOPHAGEAL DISORDE~
This study summarizes the r e s u l t s of 180 g a s t r i c emptying tests on 85 normal volunteers or patients with g a s t r o i n t e s t i n a l diseases. The method uses a y-camera with a computer and d i f f e r e n t l i q u i d meals (water, saline and glucose s o l u t i o n s ) l a b e l l e d with Tc-99m-DTPA or In-ll3mDTPA. The most r e l i a b l e parameter is the emptying time f o r h a l f the ingested volume (T I / 2 ) . The c o r r e l a t i o n coeff i c i e n t o f T I/2 in duplicate studies is 0.726 (p
141 113 CORRELATION OF GASTRIC AND GALL BLADDER EMPTYING BY DUAL ISOTOPE SCINTIGRAPHY.
115 ACCUMULATION OF L-3-1311ODO-~-METHYL-TYROSINE IN PANCREAS OF MICE.
L.S. MALMUD, R. TOLIN, R. MENIN, F. STELZER, P.T. MAKLER, R.S. FISHER. Temple University Hospital, Philadelphia, PA USA.
U. TISLJAR, G. KLOSTER, F. RITZL~, G. STOCKLIN
Coordination between gastric emptying and d e l i v e r y of b i le into the duodenum is important for proper absorption of fats. The purpose of this study was to develop a technique to v i s u a l i z e and quantitate gall bladder (GB) emptying and correlate i t with gastric emptying in normal volunteers (lO), and patients with gallstones (5) and with hemigastrectomy and gastrojejunostomy (lO). One hour following I.V. administration 5 mCi Tc-g9m HIDA, fasting subjects were given a l i q u i d meal consisting of 80 gm f a t , 72 gm protein, 138 gm carbohydrate in 300 ml, and containing 250 uCi i n - I l l DTPA. I n - I l l and Tc-99m a c t i v i t y was recorded at 15 m~nute i~tervals for 2 hours over the stomach and GB using an Elscint gamma camera on line to a d i g i t a l computer. Compared to the normal cont r o l s , patients with gallstone has slow and incomplete GB emptying. In patients with gastrojejunostomy, the GB emptying rate was normal for the f i r s t 15 minutes, but slowed thereafter. The temporal c o r r e l a t i o n of GB emptying and gastric emptying was expressed as the r a t i o (R) of the rate of each: R l in normal: R l at a l l times in patients with jejunostomy and in the second postprandial hour in patients with gallstones. This study suggests that l) normal gallbladder function maybe defined q u a n t i t a t i v e l y usi'ng a gamma camera and computer~ 2) GB emptying is abnormal in patients with gallstones and qastrojejunostomy.
I n s t i t u t fur Chemie l , KFA JUlich, D-5170 JUlich, FRG and mKlinik fur Nuklearmedizin, Klinikum Barmen, D-5600 Wuppertal, FRG. L-3 Iodo-e-methyl-tyrosine, labelled with either 1311 ., pancreas s p e c i f i c i t y in mice. A or 1231 , has a hiah pancreas to l i v e r r a t i o of 8-9 is observed during the first
hour a f t e r an i . v . i n j e c t i o n . Large accumulation
of a c t i v i t y is also found in the kidneys. The elimination of L-3-iodo-~-methyl-tyrosine is rapid, 50% of the a c t i v i t y being eliminated in less than 90 min. Compared to L-75Se-selenomethionine, the compound present l y used for pancreas imaging, 1231-1abelled L-3-iodo-mmethyl-tyrosine has higher pancreas to l i v e r r a t i o , shorter b i o l o g i c a l and physical h a l f - l i v e s and better decay c h a r a c t e r i s t i c s .
114
116
USE OF [IC-METHIONINE AS A MARKER OF EXOCRINE PANCREATIC FUNCTION A. Syrota, M. Crouzel, J. Sastre, C. Prenant and C. Kellershohn
PANCREAS SCINTIGRAPHY: IMPROVED TECHNIQUE AND RESULTS OF HIGH CLINICAL RELEVANCE Joern Markwardt, Nauber Guenter
Pancreatic uptake and secretion of llC-methionine was studied in man by external detection using two different methods : I) Images were obtained in 35 patients after IV injection of 15 to 25 mCi of IC-methionine, using an emission computed tomograph allowing the reconstruction of 4 to 6 sections, each 2 cm wide. 2) Another group of 24 patients was studied with a conventional scintillation camera enabling pancreatic and intestinal activity vs. time curves to be plotted.
The 5 points concept for i m p r o v i n g the technique and the concept of the p a n c r e a s scintigraphy as d e v e l o p e d in this d e p a r t m e n t h a d b e e n successfully p e r f o r m e d in m o r e than 2 5 0 0 investigations. It consists of i n h o m o g e n e i t y correction a n d control, gathering a sufficient n u m b e r of pulses in the p a n c r e a s region, a n e w m o d e of liver elimination, the introduction of topographic aids, a n d the absolute m e a s u r e m e n t of the selenomethionine uptake by the pancreas.
The pancreas was always visible in patients without alteration of exocrine pancreatic function. There was no fixation of ]IC-methionine in cases of chronic pancreatitis. In patients with acute pancreatitis no uptake was observed, but a normal fixation reappeared during recovery. There was also a defect or an absence of uptake in cases of carcinoma of the pancreas, making it impossible to distinguish a pancreatitis from a carcimona. Activity vs. time curves were obtained in 15 patients with normal pancreatic exocrine function and in 9 patients with chronic pancreatitis. They showed a plateau in normal patients and a peak of duration 10 to 15 mn followed by a plateau in patients with pancreatitis. Duodenal aspirates after secretin-pancreozymin showed that the peak was due to passage of l]C-amino acid not incorporated in proteins. Service Hospitalier Fr6d~ric Joliot - HSpital d'Orsay 91406 Orsay, France
T h e p r o c e d u r e enables one for m a k i n g clinical diagnosis in a high p e r c e n t a g e of cases, to exclude c a n c e r or to discriminate it f r o m chronic pancreatitis or p a n c r e a s oedema. C a n c e r m o s t l y is p r e s e n t e d by its o w n protein synthesis as a s e a m of activity or a cloudy field. In m o r e t h a n l 0 0 cases the results w e r e c o m p a r e d with ERCP results.* This study s h o w s the possibility of staging the chronic pancreatit~sby scintigraphy a n d brings further a r g u m e n t s for the high sensitivity of this m e t h o d . * Schulz, H . P . Uhlig, I<. H u m b o l d t Charite, ist M e d i c a l Clinic.
University Berlin,
A c a d e m y of Sciences of the G . D . R . - Central Institute for C a n c e r R e s e a r c h - N u c l e a r M e d i c a l D e p a r t m e n t .
142 117 GASTRIN L E V E L OF GASTRIC AND DUODENAL ULCER P A T I E N T S T R E A T E D BY C I M E T I D I N E R. N o v a k o v i c , J. L e m b e r g e r , M. D a m n j a n o v i c M~ce t h a n h u n d r e d p a t i e n t s w i t h c o n f i r m e d d u o d e n a l o r g a s t r i c u l c e r w e r e t r e a t e d with C i m e t i d i n e ( T a g a m e t ) , d u r i n g s i x w e e k s . The h e a l i n g w a s c h e c k e d by r a d i o i m m u n o l o g i c a l y m e a s u r e d g a s t r i n and by g a s t r o i n t e s t i n a l e n d o s c o p y e x a m i n a t i o n . The a v e r a g e j u m p in g a s t r i n l e v e l a f t e r t r e a t e m e n t of C i m e t i d i n e 100O r a g / d a y for s i x w e e k s w a s 68% +-22%. The h i s t o l o g i c c h a n g e s of g a s tric mucosa during Cimetidine therapy were examined. I t w a s found t h a t h e a l i n g w a s obtained in 86% of d u o d e n a l u l c e r p a t i e n t s v e r s u s 70% of g a s t r i c u l c e r p a t i e n t s . M e d i c a l F a c u l t y U n i v e r s i t y of B e l g r a d e and M e d i c a l C e n t r e of Subotica.
119 APPLICATION OF THE SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY TO VALUATION OF FUNCTIONAL MASSES P. W o r m s , O. D e m e v e r P r e s e n t s y s t e m s by the calculus of m a s s e s , if should be cardiac m a s s e s , renal or hepatic, are b a s e d u p o n study of radiological f r a m e s and identification of investigated organs, c o m p a r e d with g e o m e t r i c a l structures, m o r e or less c o m p l i c a t e d (area length m e t h o d or S i m p s o n ' s rule). A gamma c a m e r a ( O p t i c a m e r a C . G . R . ) on line with a m i n i c o m p u t e r (scintil6) w a s used. Studies w e r e done by rotating the subject in front of the g a m m a camera. 36 f r a m e s e v e r y 10 ° are registered. Z0 t o m o g r a p h i c sec tions of about i0 m m thick are reconstructed f r o m these f r a m e s with filtered-back projection a l g o r i t h m with correcting for attenuation. M a s s e s are then c o m p u t e d f r o m these slices. T h e objective of that w o r k , being toattain to hepatic, renal a n d p u l m o n a r y clearance. A s for the thyroid the m a i n point is to obtain a better value of the dose of I R A therapy. W e give s o m e results of this w o r k . Z a b o r a t o i r e de R a d i o -Isotopes, NSpital Calmette, 76600 Le Havre, France.
118 SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY : CLINICAL VALUE IN BRAIN IMAGING. D. DUCASSOU, A. BRENDEL, J.P. BROTHIER, F. LACROIX We have ~mpared the results of emission computed tomography (E.C.T) performed on the Union Carbide "Cleon 710 Brain imager" with conventional scintillation camera imaging (S.C.I) and transmission computed tomography (T.C.T) on more than 200 patients. The results show : l) ECT shows greater interest compared to SCI, specially because of its better sensitivity : in nearly 10% of the cases a lesion was detected which was missed by SCI. In many other patients, for the regions where camera imaging is unreliable (base of the skull, deep regions), ECT made the interpretation easier. Besides, ECT clearly shows the localization in depth and the shape of the pathologic foci, which can provide information on the etiology. 2) The results of ECT are comparable to thoses of TCT for the vascular and neoplastic intracranial lesions, exeept for the low grade astrocytomas where dens~tometric data are very useful. Morever, TCT provides morphologic informations (brain atrophy, porencephaly, oedema, mass syndrom) and seems to have better value for etiologic orientation. Service de Mgdecine Nucl~aire - HSpital du Haut-L~v~que 33604 Bordeaux-Pessac.
120 THYROIDAL IODINE DETERMINATION USING QUANTITATIVE FLUORESCENT SCINTIGRAPHYx B. Leisner, R. Kantlehner, H.G. Heinze and J. Lissner The topographic d i s t r i b u t i o n and the concentration of stable iodine (I-127) within the thyroid were examined in normals and in 120 patients with euthyroid goiter and with Grave's disease or s o l i t a r y autonomous nodules, using a new technique of q u a n t i t a t i v e fluorescent scanning. An ORTEC fluorescent scanning system with concentric conf i g u r a t i o n of 16 Am-241 sources and a S i - ( L i ) - d e t e c t o r attached to a PICKER Magnascanner was used. The low mean concentration of 1-127 found in normal thyroids (0.38 + 0.07 mg/g thyroid tissue) may be explained by the alime-ntary iodine deficiency in W.Germany. Pat i e n t s with diffuse or nodular euthyroid goiter showed s i g n i f i c a n t l y lower 1-127 concentrations (0.17 + 0.06 mg/ g). In hyperthyroid patients the method a l l o w e ~ t o d i f f e r e n t i a t e between to subgroups with low (0.15 + 0.08 mg/g) and high (0.42 + 0.12 mg/g) 1-127 concentgation respectively. The l a t t e r resulted in our cases from an important exogenous iodine load (e.g. roentgen contras~ media). In s o l i t a r y autonomous nodules the 1-127 concentration was the same as or lower than in the normal extranodular tissue, whereas the radionuclide scintigram f a i l e d to demonstrate any tracer accumulation within the f u n c t i o n a l l y suppressed parts of the thyroid. The qual i t y of the fluorescent scans is dependent on the iodine content of the thyroid tissue and compares well with that obtained by routine radionuclide technique, when the mean 1-127 concentration is above 0.15 mg. Supported by the DFG Clinic of Radiology, University of Munich, W. Germany.
143 121 PROBE GATED DATA ACQUISITION IN LIVER SCINTIGRAPHY : A DEVICE FOR THE ELIMINATION OF THE RESPIRATION MOVEMENTS OF THE LIVER AND FIRST RESULTS U. Plaga, J. Markwardt and G. Nauber Since the r e s p i r a t i o n movements of the l i v e r are a l i m i t a t i o n f o r the r e s o l u t i o n of defects in the l i v e r , a simple method was introduced, which allows the e l i m i n a t i o n of the movement unsharpness. A probe over the cranial r i g h t border of the l i v e r near the p a t i e n t positioned under the s c i n t i l l a t i o n camera is gating the pulse storage of the s c i n t i l l a t i o n camera. The d i f f e r e n t pulse rates o f the probe s t a r t and stop the p i c t u r e construct i o n in c e r t a i n movement increments.
123 PROBLEMS OF COMPLEX DATA PROCESSING IN NUCLEAR MEDICINE S. Gursky The e l e c t r o n i c data processing has becoming an i n t e g r a ted part of a l l nuclear medical methods. I n t e r n a t i o n a l the complex use of process control computers in r e a l time operation f o r a l l kinds of examinations and t e s t assemblies is increasing, much extending over image processing at the s c i n t i l l a t i o n camera. Except of a c q u i s i t i o n and processing of measured values information systems ( p a t i e n t , c l i n i c , s t a t i s t i c s ) are included. Various methods of task s e l e c t i o n , amount of processing, r e a l time behaviour and computer c o n f i g u r a t i o n are discussed.
The probe is caudally shielded to reach a quasi l i n e a r i t y of the pulse rate compared with the movement of the l i v e r . I t w i l l be possible to store incremental pict ur es on a disk and to r e s t o r e the whole p i c t u r e in the end of the i n v e s t i g a t i o n .
The use of microprocessors with t e s t assembly-orientated processing and central process control computer is demons t r a t e d . The p r o p e r t i e s ( l i a b i l i t y to i n t e r f e r e n c e s in the t o t a l run, data p r o t e c t i o n , program o r g a n i s a t i o n ) of r a d i a l and ring systems o f t e s t assembly and computer c o n f i g u r a t i o n are explained.
Phantom and c l i n i c a l f e c t of the method.
Phys.-Techn. Abt. der Radiolog. K l i n i k der Karl-HarxU n i v e r s i t ~ t Lei pzi g, DDR
investigations illustrate
the e f -
Nuclear Medical Department, Central I n s t i t u t e f o r Cancer Research, Academy of Sciences of the G.D.R.
122 INEXPENSIVE WELL SCINTILLATION COUNTER WITH AUTOMATIC SAMPLE-CHANGING AND DATA PROCESSING R.A. Dudley, H.C. Figdor, J.R. Fischer, E.A. Keroe, A. Muehl and O.d. MUTZ A simple well s c i n t i l l a t i o n counter with automatic sample changing and data processing has been developed f o r use in environments t h a t are not t e c h n o l o g i c a l l y advanced. The system makes use of a commercially-available manual well s c i n t i l l a t i o n counter, a Kodak Carousel s l i de p r o j e c t o r as sample changer f o r 80 samples, a HewlettPackard HP-97 programmable p r i n t i n g c a l c u l a t o r as o n - l i n e data processor, and a microcomputer-based i n t e r f a c e to l i n k the foregoing devices. The i n t e r f a c e counts and times, p e r i o d i c a l l y enters the accumulated counts i n t o the c a l c u l a t o r by reed relays p a r a l l e l i n g the c a l c u l a t o r keys, acquires information from the c a l c u l a t o r by sensing the s t a r t o f the p r i n t i n g motor and the duration of i n t e r v a l s between s t a r t s , and t r i g g e r s sample change. The e n t i r e system except f o r the sample changer operates from b a t t e r i e s on f l o a t charge. I f mains power and ther e f o r e automatic sample changing f a i l , the i n t e r f a c e w i l l allow manual sample changing to be s u b s t i t u t e d , with r e t e n t i o n o f automatic data reduction; a l t e r n a t i v e l y , the i n t e r f a c e w i l l r e s t o r e f u l l automatic operation without e r r o r i f mains power returns within 2 hours. The instrument is robust and can in p r i n c i p l e operate with any s u i t a b l y adapted p r i n t i n g c a l c u l a t o r . By v i r t u e of i t s i n c o r p o r a t i o n of mass-produced consumer products i t is p o t e n t i a l l y inexpensive and easy to maintain. Calcul a t o r programs have been developed f o r t y p i c a l i n - v i t r o assays. They a u t o m a t i c a l l y convert counts measured on "unknown" samples to analyte concentration, and perform extensive within-assay q u a l i t y control checks by comparing the s c a t t e r among r e s u l t s on r e p l i c a t e samples with t h a t expected from a p r e v i o u s l y determined " p r e c i sion p r o f i l e " f o r the type o f assay in question. The i n s trument and programs w i l l be demonstrated. Department of Research and Isotopes, I n t e r n a t i o n a l Atomic Energy Agency, Vienna, Austria.
124 R E C O R D I N G GAMMA C A M E R A DATA W I T H O U T A C O M P U T E R J.R. Turner, N.J. Randall The garama camera is an e s t a b l i s h e d imaging device w h i c h has n o w found a p p l i c a t i o n in many small n u c l e a r m e d i c i n e / r a d i o l o g y centres; the latter is not true h o w e v e r for the digital c o m p u t e r which may only be j u s t i f i e d for r e s e a r c h and t e a c h i n g centres. We i n v e s t i g a t e d an alternative to the d i g i t a l computer for image date acquisition. A n a l o g u e data from the gamma camera is r e c o r d e d onto video tape by i n c o r p o r a t i n g the x and y d i s p l a y pulses c o r r e s p o n d i n g to a s c i n t i l l a t i o n into a digital word which also contains information that can be s y n c h r o n i s e d w i t h the h e l i c a l scan r e c o r d i n g system} the digital codes are then w r i t t e n serially onto the tape. Results are p r e s e n t e d s h o w i n g preservation of resolution on 128x128 m a t r i x images at low, m e d i u m and high count densities. The i n c r e a s e d dead time in w r i t i n g each s c i n t i l l a t i o n event onto video tape with this m e t h o d results in a loss of counts at m o d e r a t e and high count rates. This can be a serious factor when p e r f o r m i n g q u a n t i t a t i v e studies on the image data. In the system d e s c r i b e d a loss of 10% of original counts occurs at a count rate of 15,000 cps, but m a n y i m p o r t a n t studies will be below this limit. The m e t h o d d e s c r i b e d is e m i n e n t l y suitable for small dep a r t m e n t s w i s h i n g to r e c o r d and q u a n t i t a t e static and dynamic scintigrams but w i t h o u t access to a computer. The e l e c t r o n i c s a d d i t i o n a l to the video recorder may be constructed in m o s t medical p h y s i c s centres at low cost. The video recorder in its p r e s e n t a d v a n c e d state of d e v e l o p ment is ideal for this a p p l i c a t i o n and is also available at r e l a t i v e l y low cost. The m e t h o d p r o v e s its s u p e r i o r i t y over p r e v i o u s n o n - c o m p u t e r m e t h o d of r e c o r d i n g from the gamma camera by its c a p a b i l i t y of m a i n t a i n i n g image quality even at i n c r e a s i n g count densities. F u r t h e r d e v e l o p ments for i m p r o v i n g the c o u n t - r a t e response are d i s c u s s e d = Depts.of London.
Clin. P h y s i c s &
B i o - E n g i n e e r i n g , S t . Mary's
~osDital
144 125
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DYNAMIC TRANSMISSION DENSITOGRAPHY WITH A GAMMA CAMERA F . D e c o n i n c k , A. B o s s u y t , M. J o n c k h e e r a n d P . Beeckman
OPTIMUM ENERGY TOPE DETECTION
D y n a m i c c h a n g e s in t r a n s m i s s i o n of x or }/ rays through the lungs s t e m principally f r o m local e x p a n s i o n p e r p e n dicular to the direction of the t r a n s m i s s i o n during the respiratory cycle, f r o m o r g a n d i s p l a c e m e n t associated with the respiration and f r o m local variations in blood v o l u m e due to vascular pulsations. T h e quantitation of d y n a m i c changes in t r a n s m i s s i o n of x or )/ rays through the lungs requires another detector than the conventional x ray film. W e obtain the t r a n s m i s s i o n i m a g e s with a 5 m C i T c - 9 9 m source at g m f r o m the crystal plane of an Elscint D y max LF Gamma C a m e r a without collimator. T h e c a m e ra is interfaced to a Simis 3 I n f o r m a t e k S y s t e m for data processing. Using the technique, d y n a m i c changes in t r a n s m i s s i o n due to the above m e n t i o n e d ~[actors are clearly d e m o n s t r a t e d and readily visualised regionally. D y n a m i c studies with C T scanners are strongly limited due to the m e c h a n i c a l and computational constraints as well as to the high radiation e x p o s u r e to the patient. Using the s a m e techniques as d e s c r i b e d above, t o m o g r a phic reconstructions of the lungs are easily obtained. T h e data acquisition for the whole of the above described p r o c e d u r e acquisition lasts less than 30' p e r s o n n e l and patient time. T h e radiatio~ e x p o s u r e to the patient ~ n d p e r s o n n e l is less than i0- tad w h i c h is at least I0 times less than p r o c e d u r e s using x ray tubes. Dept. of Physical and Radiological Sciences, m i s c h Ziekenhuis - V. U . B . L a a r b e e k l a a n i01 - 1090 B r u s s e l (Belgium).
Acade-
WINDOW
In the detection of y rays with a scintillation or s e m i conductor detector, the e n e r g y information about the detected photon is obtained as a pulse with height proportional to the e n e r g y of the photon. In a g a m m a camera, scanner, scintillation counter, .. the single channel analyzer selects pulses c o m i n g f r o m photons, having a n e n e r g y within a c h o s e n e n e r g y w i n d o w . T h e p u r p o s e of this p a p e r is to discuss e n e r g y w i n d o w settings, accor ding to different objective criteria, s u c h as m a x i m u m accuracy, m a x i m u m sensitivity a n d insensitivity to electronic w i n d o w drift. In general optimizing the a c c u r a c y a n d optimizing the sensitivity will require different w i n d o w settings. W h e n maximum sensitivity is needed, the e n e r g y w i n d o w width should be set at W , that is at half m a x i m u m above the b a c k g r o u n d . Then, h o w e v e r , the a c c u r a c y of the measurement will not be optimized. T h e w i n d o w width that m a x i m i z e s the a c c u r a c y is a function of the S / B ratio. In m o s t applications, high a c c u r a c y is m o r e i m portant for low S / B ratios. T h e r e f o r e a w i n d o w width of 1. 5 W s e e m s a g o o d choice. If long t e r m stability without periodic recalibrationis needed, the m i n i m u m w i n d o w widths u s e d will be defined by s y s t e m h a r d w a r e p a r a m e t e r s , and m a y not necessarily r e a c h o p t i m u m levels. Dept. of Physical a n d Radiological Sciences, A c a d e m i s c h Ziekenhuis - V. U . B . , Z a a r b e e k l a a n 101 1090 B r u s s e l (Belgium).
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A METHOD OF DATA PROCESSING FOR TESTING THE EFFECTIVITY OF THE INHOMOGENEITY OF SCINTIGRAMS OF THE SCINTILLATION CAMERA Nauber, Guente r
SIMULATION STUDIES GRAPNY A. K u b a , L. C s e r n a y
T h e availability of a correction m a t r i x is limited by time, B y help of the developed m e t h o d it is possible to find out variations of the r e s p o n s e of the scintillation cam e r a to a h o m o g e n e o u s distribution of radioactivity. B y exceeding a given threshold it is n e c e s s a r y to establish n e w correction matrices. Using this m e t h o d one c a n realize the following steps: i. E s t i m a t i o n of the variation of the selective sensibility of single regions of the detector belonging to the individual photemultiplier tubes. g. E s t i m a t i o n of not c o r r e c t e d scintigrams of a h o m o g e n e o u s distribution of radioactivity registered by a gamma-camera or a scanner. 3. Calculation of a correction matrix. 4. E s t i m a t i o n of c o r r e c t e d scintigrams of a h o m o g e n e ous distribution of radioactivity with respect to the overrunning of a given threshold and in relation to the freq u e n c y of the n u m b e r of counts as a function of spatial frequency. Different p a r a m e t e r s will be evaluated by this p r o g r a m m e , s u c h as radiant energy, countrate and scattered radiation for instance, w h i c h influence the capability of a correction matrix. Academy of Sciences of the G . D . R . , Central Institute for C a n c e r R e s e a r c h , N u c l e a r M e d i c a l D e p a r t m e n t .
SETTINGS IN R A D I O I S O F. D e c o n i n c k
IN R E C O N S T R U C T I O N
TOMO-
In recent years one of the m o s t intensively developed diagnostic m e t h o d s has b e e n the c o m p u t e r i z e d t o m o g r a p h y in the radiology and the nuclear medicine. The a i m of our investigations w a s to m a k e a simulation prog r a m s y s t e m / a n idealised theoretical m o d e l / by w h i c h s o m e aspects of the reconstruction algorithms /e.g. convolution a l g o r i t h m / u s e d in c o m p u t e r i z e d t o m o g r a p h y can be studied. T h u s w e tested the effects of the three m o s t important g e o m e t r i c a l c o m p o n e n t s : the n u m b e r of projections /9-360/, the n u m b e r of m e a s u r e m e n t s p e r projections /9-342/, and the width of the projecting rays. T h e results of the quantitative c o m p a rison of reconstructed i m a g e s are the following: /I/ increasing the n u m b e r of projections and the n u m b e r of m e a s u r e m e n t s the reconstruction c a n be i m p r o v e d only to a certain level and / g / similar i m p r o v e m e n t s c a n be r e a c h e d by n a r r o w i n g the projection rays. D e p a r t m e n t of N u c l e a r Medicine, of Szeged, H u n g a r y .
Univ. M e d .
School
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131
MULTIPARAMETER ANALYSIS OF DYNAMIC SCINTIGRAPHIC STUDIES V. Cernoch, I. Runczik, J. Kidery, B. V a v r e j n
EXPERIENCE WITH AN ON-LINE SYSTEM FOR EVALUATION AND PRESENTATION OF RESULTS L. Csernay, J. Csirik, Z. Nernssanyi, A. M a k a y
In the past several years n e w m e t h o d s are beeing used in nuclear medicine in d y n a m i c studies based on synchronisation of scintigraphic data by the physiological processes in the body. T h e scintigraphic data selection is usually provided by single channel synchronizers.
In the past years w e have developped an automatic syst e m to evaluate and present the results of routinely used diagnostic procedures. Scintigraphic i m a g e s w e r e described by a s y s t e m of p r o g r a m m a t i o n consisting of code sentences or parts of sentences being arranged as tables. T h e n u m b e r of the tables depends on the organ examined. T h e p r o g r a m can be run by the alpha-numeric on-line display. After construction of the text c h a n g e m e n t s and additions can be m a d e . T h e final result can be controlled on the alpha-numeric display and typed in the required n u m b e r . W e obtained favourable results in the daily evaluation of thyroid and liver scans. Besides the uniformation of the i m a g e descriptions the s y s t e m offers an e c o n o m i c recording of data.
In our paper a n e w m e t h o d of multiparameter analysis of scintigraphic data is described. According to the programme control a sequence of physiological data derived f r o m physiological sensors is obtained and transferred to the computer. A n u m b e r of p r o b l e m s of h a r d w a r e and software data processing are discussed: sensor problems, h a r d w a r e preprocessing, time relations of different physiological data with scintigraphic data. S o m e e x a m p l e s of our m e t h o d are presented. Institute of clinical and experimental medicine, Prague, CSSR. Postgraduate medical and pharmaceutical school, Prague, C S S R .
Institute of Nuclear Medicine, Szeged, Hungary.
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132
NEW DISPLAY POSSIBILITIES OF SEGAMS J. C s i r i k , L. A ] m a s i , L. C s e r n a y , Z. N e m e s s a n y i
COMPUTER PROGRAM FOR STANDARD CURVE FITTING AND DOSE INTERPOLATION OF IMMUNORADIOMETRIC "SANDWICH" ASSAY OF CEA: COMPARISON OF TWO FITTING MODELS M a r i a W . R a d w a n , L e s z e k Hahn, Janusz S z y m e n d e r a
The SEGAMS system (Szegeder Gamma-camera system) disposed of two standard possibilities of display: 60x64 matrix and isocount. A s there w a s the h a r d w a r e possibility to use a IZ0xlZ4 matrix, solutions to e m p l o y this possibility w e r e elaborated in order to i m p r o v e the evaluation of images. Following types of display w e r e studied: a. m a x i m u m d a t a i m a g i n g b. s q u a r e r o o t m e t h o d c . is o c o u n t d. i n t e r p o l a t i o n e x t e n s i o n In the first test series 15 different display f o r m s w e r e w e r e examined. 8 observers classified the m e t h o d s at different m o m e n t s in four series and chose the 5 best. M e t h o d s and results are discussed, the m o s t effective m e t h o d illustrated. Institute of Nuclear Medicine, Szeged, Hungary.
Medical University,
Medical University,
W e propose a m e t h o d allowing automatic processing of irnmunoradiometric "sandwich" assay of C E A results, but also applicable to all "two-site" i m m u n o r a d i o m e t r i c assay data. T h e dose response w a s described according to m a t h e m a tical m o d e l based on probability of antigen-antibody collision, and standard curve w a s expressed bv three-param e t e r equation: Y : a X 5 / 4 + b X 3 / 4 + c, wh~ere Y is the r e s p o n s e in c o u n t s , X is d o s e a n d a , b , c a r e t h e f i t t e d parameters. Using this equation a computer program has been developed for standard curve fitting and dose interpolation by least square regression. We c o m p a r e t h e 3 - p a r a m e t e r m o d e l of s t a n d a r d c u r v e f i t t i n g a n d t h i r d - o r d e r polynomiai regression with 4-parameter f i t t i n g p r o c e d u r e of S a l m o n and B a r r o w as w e l l as d i s c u s s the r e l a t i o n s h i p of a s s a y c h a r a c t e r i s t i c s to t h e a p p l i c a b i l i t y of e i t h e r curve fitting model. We c o n s i d e r t h a t t h e 3 - p a r a m e t e r m o d e l is s u p e r i o r f o r "two-site" immunoassay techniques. T h e p r o g r a m h a s b e e n w r i t t e n in F O R T A N IV f o r S I M I S - 3 I n s t i t u t e of O n c o l o g y ,
Warsaw,
Poland.
146
133 INVESTIGATIONS USING THE SUM P. Wolle r
135 ON CURVE FITTING PROCEDURES OF TWO EXPONENTIALS
NEW ASPECTS IN T H E D E S I G N O E C O M P U T E R I S E D DIGITAL WHOLE BODY S CANNER M. L e s j a k , Z . R u p n i k , J . S n a j d e r , H . K r a l j i , J . I K o l b a s
B y using t w o - c o m p a r t m e n t m o d e l s in interpretation of nuclear medicine examinations the time course of radioactivity in at least one c o m p a r t m e n t has to be considered as s u m of two exponentials out of which two half-times and two amplitudes have to be calculated. T h e blood c o m p a r t m e n t , however, permits only few samples with limited accuracy to be taken. This situation was simulated by computer assistance assuming 9 blood samples with a standard error of 2%. 48 s e t s o f p a r a m e t e r s simulating real conditions were evaluated, each set 20-foid with slightly differing samp i e v a l u e s b e c a u s e o f t h e Z% s t a n d a r d d e v i a t i o n . Four methods for calculating the four parameters have been checked. The best results have been o~tained by using an iterative method. The other methods have often fail e d b e c a u s e of n e g a t i v e a r g u m e n t s o f s q u a r e r o o t s o r logarithms. Depending on the parameter values the resulting parameter errors ranged from some per cent up to uselessness. T h e errors of time integrals even extended to t = O ~ have always been lower than the p a r a m e t e r errors especially at low exponential coefficient ratios. T h e r e fore interpretation m e t h o d s using time integrals instead of the p a r a m e t e r s of the exponentials should be preferred.
Close cooperation between the engeneering staff of the Institute's Laboratory for Nuclear Electronics and medical experts from the Oncological Institute in Ljubljana l e d i n t o t h e c o n s t r u c t i o n of u n i q u e c o m p u t e r i s e d digital whole body scanner featuring exact digital positioning of upper and lower sonde, large 200x50 cm scanning area, digital determination of scanned field size, horizontal or vertical double-energy scanning with user-determined channel arithmetic and automatic background subtraction. A s i x - c o l o u r h a r d c o p i e s c a n b e m a d e i n h l o r 1:4 s c a I e on two digital ploters that can be separately set for no operation, direct or matrix-smoothed data representation in 1 to 4 rate bands. Data can be sent out for further processing or can be received from the external computer while scanner acting as inteligent graphical peripheraI. Two handshaking microcomputers are incorporated in the scanner: first dedicated to the control of stepping motors and man-to-device comunication and the other to data aquisition and handling. Optimal man-to-machine relationship, highly accurate and trouble-free operation, conviniency for various types of medical investigations and flexibility to further user's demands are highlights of the design described in the paper.
Medical A c a d e m y , GDR.
Institute Jozef Stefan, Yugoslavia.
Dept. of Nuclear Medicine, Dresden,
134 EFFECT OF SPATIAL RESOLUTION ON THE ACCURACY OF REGIONAL ACTIVITY DETERMINATIONS IN PROFILE SCANNING H. Bergmann, R. Hbfer The accuracy of q u a n t i t a t i v e a c t i v i t y determinations derived from the regional count r a t e depends on the s p a t i a l r e s o l u t i o n of the p r o f i l e scanner. To define the e f f e c t of s p a t i a l r e s o l u t i o n on the q u a n t i t a t i o n of r e g i o nal a c t i v i t y a " s p a t i a l s p i l l o v e r f a c t o r " is used (H.Bergmann, Radioaktive Isotope in K l i n i k und Forschung(1978), p.23), which can be obtained by scanning a step p r o f i l e . A whole body p r o f i l e scanner with p a r a l l e l s l i t c o l l i m a t o r s was used f o r the experiments. Spatial s p i l l o v e r f a c t o r s f o r 99m Tc, 131 1 and 47 Ca sources were measured under a v a r i e t y of experimental conditions including v a r i a t i o n s of c o l l i m a t o r s l i t width, width of counting window and absorber thickness. Results: Spatial s p i l l o v e r is l i n e a r l y dependent on s l i t width. I t is approximately the same f o r "low" and"medium" energy sources, but increases considerably f o r high gamma energies. A wide energy window increases s p a t i a l s p i l l o v e r by a f a c t o r of two as compared to a photopeak window. The measured s p i l l o v e r f a c t o r s were used to c a l c u l a t e the e r r o r introduced in q u a n t i t a t i v e regional a c t i v i t y determinations. Calculations were performed on a c t i v i t y d i s t r i b u t i o n s f r e q u e n t l y encountered in practice. The r e s u l t s can be summarized in t h a t using regions l a r g e r than three FWHM's of the corresponding point spread funct i o n can be measured with less than 10% e r r o r whereas f o r regions smaller than t h a t the e r r o r s u b s t a n t i a l l y depends on the shape of the p r o f i l e . That l a s t point should be considered c a r e f u l l y in q u a n t i t a t i v e p r o f i l e scanning. Abteilung f u r Nuklearmedizin der 2.Med.Univ.Klinik, Garnisong. 13, A-1090 Wien und Arbeitsgruppe Nuklearmedizin des LBI fUr k l i n . Endokrinol o g i e und Nuklearmedizin, Wien
University
of Ljubljana,
136 ON THE F U T U R E USE OF L O W - L E V E L
WHOLE-BODY
COUNTING P. Koeppe Applications of Whole-Body Counting (WBC) can be divided into five main categories: 1. R a d i a t i o n p r o t e c t i o n : A n a l y s i s o f m i n u t e a m o u n t s of gamma-emitting radionuclides unintentionally incorporated. Z. D i a g n o s t i c u s e : E s t i m a t i o n o f W B p o t a s s i u m . 3. D i a g n o s t i c u s e : R e t e n t i o n m e a s u r e m e n t s of administered radioactive substances, f o r s a k e of t h e i n d i v i d u a l patient. 4. R e s e a r c h : Same methodology, but within groups of volunteers known to be "normals" or "abnormals" to evaluate basic metabolic data. 5. R e s e a r c h : Follow-up studies of patients who received radioactive material for diagnostic purposes other than WBC (scintigraphy, for example), to evaluate data on the biokinetics of the material administered. B a s e d u p o n 18 y e a r s o f e x p e r i e n c e o n W B C , the author wiI1 a n a l y s e c u r r e n t t r e n d s a n d f u t u r e u s e of t h i s t e c h nique, referring to the five categories explained. KliniK fiir Radiologie und Nuklearmedizin, Universit~t, Berlin, D-1000 Berlin 45.
Freie
147 137
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DEVICES FOR HANDLING, DISPENSING AND ADMINIST E R I N G Xe-133 G A S IN C L I N I C A L P U L M O N A R Y STUDIES J. Erban, M . W e i d e r m a n n , K. I~leinbauer, V. H u s a k T h e paper deals with the description and the use of devices for handling and dispensing Xe-133 as well as for its administering which w e r e constructed in our department. The apparatus for handling and dispensing X e 133 consists of the following parts: a storage container represented mainly by the original manufacturer's a m p u le, two valves of the storage container, the syringe with fixation of a needle, the lead shielding of the storage container.: The dirnensions of the storage container allow to place it into the well of the ionisation c h a m b e r of the dose calibrator and to check easily the remaining activity after transferring the desired fraction of xenon into syringe. Practically no leakage of gas ~zas observed during long periods of time. Further, the Xe-133 spirometer s y s t e m for routine pulmonary-function tests w a s constructed. A patient breathes f r o m the closed s y s t e m which contains a C O 2 absorber, an oxygen inlet, a rebreathing bag, non-return valves and a double t w o - w a y valve for duty switching. T h e circuit can be filled with Xe-133 through the valve in the mouthpiece, the oxygen consumption is checked by a flowmeter, the changes of a lung v o l u m e are registrated. Rebreathing f r o m the open circuit is p e r f o r m e d so that the double valve opens the inlet of air f r o m the r o o m and the exhalted air is vented outside the r o o m . The lung ventilation is investigated using a scintillation c a m e r a Searle P h o / G a m m a HP. T h e time activity curves are recorded f r o m selected lung zones using the Searle Data-Store/Playback A c c e s sory. Dept. of Nuclear M e d . , University Hospital & Palacky University, O l o m o u c , C S S R .
THE SIMULTANEOUS DETERMINATION OF PHOSPHORUS-32 AND CALCIUM-45 A C T I V I T Y IN B I O L O G I C A L SAMPLES H. Bern, W . Reimschiissel
-
T h e activity of phosphorus-32 and calcium-45 in diffe> rent biological samples /soft tissues, blood, milk, eggs, bone/ w a s determined by the liquid scintillation technique. T h e samples w e r e mineralized with 70~o H C I 0 4 and 30~0 H 2 0 2 at 75°C during 2,5 hours. The activity of samples w e r e m e a s u r e d after addition solgel scintillator Aquasol. T w o m e t h o d s for quenchcorrection~ chanz nels ratio and automatic external standard channels ratio, w e r e c o m p a r e d . T h e channels ratio m e t h o d only w a s succesfully applied for standardization. The good detection efficiencies in m e a s u r i n g channels w e r e obtained for both nuclides: 5 0 ~ and 80~ofor phosphorus3Z and calcium-45, resp. The recoveries of the nuclides varied in the ranges: 95-104% and 9 3 - 9 8 % for phosphorus-32 and calcium-45, resp. Institute of Radiation Chemistry, Technical University, Lodz, Poland.
138
140
DIFFERENTIAL DETERMINATION O F Z03 H G A N D 14 C O R 35 S IN D O U B L E LABELLED BIOLOGICAL SAMPLES "I" E . M . B e m ~ ), H . B e r n (2), a n d W. R e i m s c h i i s s e l (2)
SEMI-AUTOMATIC DETERMINATION O F I O D I N E IN Z4 H O U R U R I N E B Y M E A N S O F N E U T R O N A C T I V A TION ANALYSIS W.C. Parker
T h e differential determination of 203-Hg and 14-C or 35-S in double labelled biological samples is presented. T h e biological samples w e r e mineralized with 70~0 H C I O 4 and 30~0 H O~ in minivials M I L L I - 6 . The activity due to Z0~-~g w a s m e a s u r e d by the well s~cm tillation counter with efficiency equal to 0. 638. The total activity, due to 203-Hg and 14-C or 35-S, w a s m e a sured by the liquid scintillation technique after addition of 5 rnl of Aquasol to the s a m e vials. T h e efficiencies of liquid scintillation technique, determined by the m e t h o d of external standard channel ratio, were: 0.875-0.936 and 0.755-0847 for 203-Hg and 14-C or 35-S, resp. V e r y good recoveries w e r e obtained: i00 0 . 7 % for 203-Hg and 94.6-101. 0~0 for 14-C and 35-S. This m e t h o d could be used for other 1 6 ~ and -active nuclides with similar ~-spectra.
Iodine is separated f r o m 24 hour urine by m e a n s of a rapid ion exchange c o l u m n and together with an iodine stan(~grd irr~adiated for 300 seconds in a neutron flux
(i) D e p a r t m e n t of ToYicological Chemistry, Institute of Environmental R e s e a r c h and Bioanalysis, Medical A c a d e m y , Lodz, Poland. (2) Institute of Radiation Chemistry, Technical University, Zodz, Poland.
of
10*~n/cm~/sec.
T h e two samples are m e a s u r e d simultaneously in two 3"x3" Na(1) "well" crystals connected to two single channel analyzors which feed into a differential scaler with associated print-out. Prior rapid separation of the iodine f r o m the urine c o m b i n e d with short irradiation time and counting time (300 sec.) allow for m o r e than i00 samples per day to be processed by two technicians. The Iodine-I28 energy peaks are monitored by a 1024 channel analyser while sample counting and changing are automatic with the m e a s u r e d result given directly in n a n o g r a m s of iodine. At the time of writing the s y s t e m is being completely automized. Centro de Quimica, Instituto Venezolano de Investigaclones Cientificas, Apartado 1827, Caracas, Venezuela.
148 141 Tc 99m- HSA: THREE DIFFERENT TAGGING PROCEDURES: EXPERIMENTAL AND CLINICAL TRIALS F. Lunghi, M . Violet, F. Assone, M . Villa It has generally been p r e s u m e d that Tc 9 9 m is a poor label for H S A . In order to obtain a Tc 9 9 m h u m a n s e r u m albumin (lISA) with biological behaviour similar to the radioiodinated H S A , the present w o r k shows three different labeling methods a) using stannous ion as the reducing agent (SnCI Z . Z H Z O ) b) using insoluble stannous c o m p o u n d s as reducing agent (SnO, Sn (OH)z) c) labeling albumin-chelate conjugate prepared according to Meares' method. All three systems have been investigated with various assay m e t h o d s including: thin-layer chromatography, trichloroacetic acid precipitation, dialysis, electrophoresis and gel chromatography, in order to evaluate the identity, the purity and the stability of the labeled species. ]Blood clearance data in r a b ~ and distribution data in rats, in c o m p a r i s o n with I - H S A , will be presented. Behaviour in h u m a n , will be presented too. Sorin B i o m e d i c a S.p.A. , Saluggia (VC) Italy
142 THE IN VITRO DETE~41NATION OF BINDING OF 99Tc-Sn-EHDP AND ALBUMIN
143 INTERACTION OF STANNOUS ION WITH PYROLIDINO-METHYL TETRACYCLINE IN THE PREPARATION OF PYRROLIDINOMETHYL TETRACYCLINE-99m-Tc AS RADIOPHARMACEUTICAL. B. ZMBOVA Boris Kidric I nst . Nucl. S c i . , Vinca, Yugoslavia. D. ZIVANOVIC-STAKIC Faculty of Pharmacy, U n i v e r s i t y of Belgrade I. TADZER I n s t i t u t e of Patophysology, U n i v e r s i t y of Skopje The i n t e r a c t i o n of stannous ion with pyrrolidinomethyl t e t r a c y c l i n e (PMT) was i n v e s t i g a t e d by the potentiometric t i t r a t i o n method. A formation o f metal-ligand complex, at a mole r a t i o of l : l was found. The s t a b i l i t y of the complex is pK = 8.4. The i n f r a r e d spectroscopic studies showed that Sn ( I I ) , is bound to the carbonyl group of t e t r a c y c l i n e . Closer i n s i g h t i n t o the mechanism of l a b e l l i n g of PMT-Tc-99m was obtained by the technique of l a b e l l i n g with two isotopes: Sn-ll9 and Tc-99m + Tc-99. I t was found that the PMT-Sn-II9 complex reduces the pertechnetate ion to Tc (IV). Small p o r t i o n of Sn-ll9 is attached to the PMTTc-99m complex, while i t s main portion is i d e n t i f i e d as PMT-Sn-II9 complex. The emission spectrographic analyses o f kidneys a f t e r an i n j e c t i o n with l a b e l l e d PMT-Tc-99m complex showed unambigously a praesence of t i n in kidneys. These studies lead to a conclusion t h a t t i n plays double r o l e in the l a b e l l i n g process: a) i t reduces pertechnetate to Tc ( I V ) , and b) part of Sn is simultaneously f i x e d to the PMT-Tc-99m complex, most probably in the form o f a mixed complex.
144 STUDIES ON COMPLEXATION OF Tc-g9 WITH DIMERCAPTOSUCCINIC ACIDS WITH REGARDS TO ORGAN SPECIFICITY OF TC-99m-RADIOPHARMACEUTICALS.
J. ROHACEK, V. GROSSMANN, V. KUSAK, J. VLCEK Regional I n s t i t u t e o f Radiation Hygiene, Hradec Kralove, CSSR. I n s t i t u t e of Experimental Medicine, Czechoslovak Academy of Sciences, Praha, CSSR. The 4% human serum albumin in the i s o t o n i c s o l u t i o n of sodium chloride was used to which a standard volume of 99 Tc-Sn-EHDP (ethane-l-hydroxy- l , l diphosphonate) was added. The solutions having d i f f e r e n t concentrations of 99 Tc or EHDP were used. A f t e r mixing and shaking the labeled s o l u t i o n with the albumin c a r r i e r and a f t e r lO minute's standing in the f i r s t series and 150 minute's standing in the second s e r i e s , the solvent phase was separated from the protein by the u l t r a f i l t r a t i o n using the c e n t r i f u g a t i o n . In the u l t r a f i l t r a t e the r a d i o a c t i v i t y was determined. The preparation of the radiopharmaceutical was c a r r i e d out e l e ~ r o ~ t i c a l l y employing l o n g - l i v e d 99 Tc. As the check of the s t a b i l i t y of the complex the chromatography was performed. The r e s u l t s were processed according to so c a l l e d "Scatchard's p l o t " and were compared with those f o r 99 Tc and 99 Tc-Sn.
B. JOHANNSEN, H. SPILES, R. SYHRE Central I n s t i t u t e of Nuclear Research, Rossendorf, GDR. In order to assess molecular f a c t o r s governing the organ s p e c i f i c i t y of Tc-radiopharmaceuticals we have i n v e s t i gated radiochemically pure Tc compounds prepared by ligand exchange reactions of Tc-99/Tc-99m-gluconate with meso-DMSA, rac.-DMSA, and t h e i r e s t e r s , r e s p e c t i v e l y . The s t r u c t u r e of t h i s class of compounds is (TcOL2), -n where L= ligand. The animal data obtained in rats i ndi cat e that the o p t i cal c o n f i g u r a t i o n o f the ligands used g r e a t l y influences the behaviour in vivo. In contrast to Tc (V)-rac-DMSA which shows no remarkable uptake in any organ Tc (V)-mes~ DMSA proved to be an o s t e o t r o p i c agent resembling Tc-99mEHDP. E s t e r i f i c a t i o n of the carboxyl group causes substan t i a l a l t e r a t i o n of the excretion pat t er n. The kidney imaging agent Tc-99m-meso-DMSA is assumed to be an anionic polymer.
149 145 LABELING OF HUMANPLATELETS WITH IIIINDIUM-OXIN COMPLEX. A METHODOLOGICALSTUDY.
147 INVESTIGATION OF THE STABILITY OF PGE2-3H IN PHYSIOLOGICAL FLUIDS AND THE EFFECT OF HUMAN PLACENTA.
K.G. SCHMIDT & J. W. RASMUSSEN Dept. Radiophys., Odense Univ. Hosp., Denmark. Using a simple method for preparation of p l a t e l e t suspensions from whole blood in buffer p l a t e l e t s were labeled with l l I I n o x i n e s s e n t i a l l y as described by Thakur et al. (Thromb. Res. 1976:9:345). In the i s o l a t i o n procedure the p l a t e l e t s and a fraction of the erythrocytes are processed simultaneously, whereby the erythrocytes serve as a supporting cushion in the centrifugation steps. In this way large p l a t e l e t yields from whole blood could be achieved (between 90 and 100%). Various factors, which influence the labeling effectiveness were examined, and the method's u t i l i t y was estimated by in vivo studies in rabbits. We are able to conclude from our results that a p l a t e l e t concentration of more than 800 x lO~/l and an oxin-concentration of 4-6/u in a plasma-poor system (transfer of p l a t e l e t s fr6m g/ml plasma to buffer without further washing steps) w i l l y i e l d a high labeling e f f i ciency. I f the p l a t e l e t i s o l a t i o n y i e l d is to be large, a s l i g h t erythrocyte-leucocyte contamination must be accepted. Our experimental results indicated that this is permissible. In vivo investigations of 5 rabbits sho.wed in vivo recoveries of p l a t e l e t s from 61-74% and mean survival times from 75-I04 hours. This allow the assessment that the method of p l a t e l e t i s o l a t i o n and labeling is gentle.
S. BAGDANY, B. TANACS, I. RAKOCZl, I GATI Postgrad. Med. Scholl, Dept. Obstetrics and Gynecology Budapest, Hungary For the investigation of Prostaglandin-binding in d i f f e rent tissues there is necessary to know the s t a b i l i t y of the used Prostaglandin. Our investigations were made by Prostaglandin-E2-3H. There was observed that solution Rinde and Thyrode (pH 7,4) d i d n ' t effect on PGE2-3H at d i f f e r e n t incubation-time from 30 minutes t i l l s i x our. The human placenta d i d n ' t effect on PGE2-3H in f i r s t hour of incubation. The radioactiv PGE2 d i d n ' t dissolved and we d i d n ' t observe change neither placental e x t r a c t i o n , nor in i n c u b a t i o n - f l u i d . After one hour, there was extracted the radioactive material binded by placenta and the radiochromatogram shew only one peack, corresponding to the standard PGE23H. I f the incubation was prolonged through 2-3 hours, there were formed other radioactive substances. A part of PGE2-3H dissolved to 15-keto-PGE2-3H and formed other decomposed substances. These investigations show, that PGE2-3H, made by I n s t i t u t e of Isotopes of Hungarian Acad. of Sci., is a stable compoundand i t is very good for "in v i t r o " examination.
146
t48
USEFULNESS OF Tc 99m- ALBUMIN MILLIMICROSPHERES FOR RES STUDIES: CHEMICAL AND BIOLOGICAL DATA M. V i l l a , F . L u n g h i , R , M o s c a , F . A s s o n e
COMPARATIVE EXPERIMENT OF 2-MPG, PENICILLAMIN 99mTc-LABELING AND THEIR ORGAN DISTRIBUTION Cv. Janoki, Gy. Benk6, L.T. Kocsar and T, Hernadi
A n ideal scintigraphic agent for reticuloendothelial ( R E S ) studies should have the following characteristics: -
particle size h o m o g e n e i t y and constancy non-antigenic and metabolizable m a t r i x availability as a sterile, non-toxic instant kit high labeling yield high r a d i o c h e m i c a l 'Tin vitro" and "in vivo" stability.
Preparation, particle size distqr~bution, labeling yield . . . . . . m and "zn vztro" stab111ty of a Tc - H u m a n S e r u m Alb u m i n M i l l i m i c r o s p h e r e s kit ( M . M . A . ) are, in this paper, reported, in o r d e r to evaluate the usefulness of M.M.A. as a liverspleen scintigraphic agent, biological studies in rats, m i c e and b a b o o n s will be reported.
S i n c e t o t a l a m o u n t of u p t a k e (% i n j e c t e d d o s e ) i n t h e RES and the contrast rations (liver-to-spleen; liver-tomarrow-; spleen-to-marrow) are quite good, M.M.A. a p p e a r s to b e a h i g h l y s a t i s f a c t o r y l i v e r - s p l e e n scintigr aphic agent. Moreover the acute, subacute and immunological studies show that M.M.A. are a safe, tolerable and a non-antigenic product. Sorin Biomedica
S.p.A.,
Saluggia
(VC), Italy.
A u t h o r s p r e p a r e d t h e c o m p o u n d s of 2 - m e r c a p t o p r o p i o n y l -glycin ( Z - M P G ) and 9 9 m T c labeled penicillamin. The labelling reaction w a s e v o k e d at p H = 5 . 6 value by 0. 01 M Z-MPG and penicillamin 1 0 - 5 M S n C I Z . Z H Z O solution, F o r the estimation of labeling efficiency, thin-layer c h r o m a t o g r a p h i c a n d electrophoretic analyses w e r e m a de. In e x p e r i m e n t s the a m o u n t of pertechnetate w a s below 2%. K e p t at + 4 o c a n d under N z - g a s preparations w e r e stable as long as 6 hr. T h e e x a m i n a t i o n of o r g a n distribution of the labeled c o m p o u n d s w a s m a d e in rats a n d mice; the highest o r g a n distribution w a s observable in the liver a n d the bile 4060 rain after the injection. B y i m m e d i a t e collection of bile it w a s stated that a l m o s 3 0 % of the injected activity w a s secreted with r e g a r d to 9 9 m T c - Z - M P G in lhr. It w a s established that the selection of 9 9 m T c - Z M P G is faster than that of 9 9 m T c - p e n i c i l l a m i n , therefore, its concentration in the bile is higher. Its further advantage relies in the fact that 9 9 m T c - Z - M P G m a y be suitable for "kit" preparatior~ the quantity of reducing agent to be u s e d in the "kit" c a n essentially be lessened due to its self-redox-capacity. The Z-MPG is a non-toxic m a terial, its L D s 0 / 7 Z value takes Z100 m g / k g , in mice. 'FJC' Natl. Res. Inst. for Radiobiol. Budapest, Hungary.
and Radiohyg.
150 149
151
99mTc-UNITHIOL COMPLEX, A NEW PHARMACEUTICALFOR KIDNEY SCINTIGRAPHY.
CHEMICAL AND BIOLOGICAL PROPERTIES OF HUMAN SERUM ALBUMIN LABELLED WITH Tc-99m FOR CLINICAL APPLICATION J. Cvoric, V. B o s n j a k o v i c and V.Jovanovic~: ~
IV. AUTORADIOGRAPHICLOCALIZATION OF CELLULAR DISTRIBUTION IN THE KIDNEY. M. OGINSKI, I . GIRYN Dept. of Nuclear Medicine and Radiobiology and Dept. of Oncology, Medical Academy of Lodz, Poland.
Distribution of 99mTc-Unithiol xl complex / Nucl. Med. XV. 282,1976., XVI. 179, 1977/ was studied by macroautoradiography in rats and rabbit kidneys. Presence of a c t i v i t y in the renal cortex was easily demonstrated. Using microautoradiography accumulation of a c t i v i t y in various parts of the nephron was studied; the a c t i v i t y found in cells of proximal tubuli was evidently greater than that in the cells of distal c a n a l i c u l i . In proximal parts of c o l l e c t i v e tubuli a minimal a c t i v i t y was found.
T w o m e t h o d s for labelling of H S A with T c - 9 9 m h a v e b e e n investigated, e.g. (a) electrolytic labelling with Z r under steryle conditions just before the application, and (b) p r e p a r a t i o n of instant lyophilized preparate for labelling of H S A , by Sn(II). T h e r a d i o c h e m i c a l purity of the preparate has b e e n det e r m i n e d by c h r o m a t o g r a p h y , with S e p h a d e x G - 2 5 . In the Instant H S A preparates labelled with Sn(II) a c o m p o nent firmly b o u n d to the S e p h a d e x is present, its content varying f r o m I0 to 3 0 % of the total activity. T h e biodistribution of the H S A T c - 9 9 m c o m p l e x p r e p a r e d by the two m e t h o d s has b e e n studied after an intravenous injection on test animals. T h e p r e p a r a t e s have b e e n u s e d in the clinical applications and the results obtained will be d e s c r i b e d in detail. Boris Kidric Institute of N u c l e a r Sciences, V i n c a R a d i o i s o t o p e L a b o r a t o r y , ~ F a c u l t y of Medicine, Belgrade.
x I Unithiol - 2,3 dimercaptopropane sodiumsulphonate
150 THE CHEMICAL AND BIOLOGICAL INVESTIGATIONS OF CALCIUM-45, INDIUM-II3m AND TECHNETIUM-99m PHYTATES "IN VITRO" AND "IN VIVO". E. LACHNIK, W. ZULCZYK, J. WIZA I n s t i t u t e of Nuclear Research - RPDC - Swierk, Poland I. LICINSKA I n s t i t u t e of Drugs Warsaw, Poland
152 OF RADIOCHEMICAL P U R I T Y O F 9 9 m Tc-Sn-HSA BIOLOGICAL, IMMUNOLOGICAL AND CHEMICAL M E T H O D S GV. Janoki, L. Korosi and L. Kocsar
THE
EXAMINATION
WITH
The radiochemical purity of five commerciaily available Te-Sn-HSA kits was examined with thin-layer chromatographic, organ distribution (according to Rhodes), immunological (agar-; immunoelectrophoresis according to Scheidegger and Ossermann method). Kits
For i n t e r p r e t a t i o n of the role of calcium ions in the phytate preparations the comparative investigations of
A
calcium-45, indium-ll3m and technetium-g9m phytates were
C
performed. The s o l u b i l i t y of calcium phytate "in vitro" and the organ clearances of labeled phytate in mice were evaluated. The results of these investigations indicated the r e l a t i ve high s o l u b i l i t y of calcium phytate in the human serum. Liver clearances of labeled phytates showed t h e i r d i f f e rent biological properties.
B
99free mTco4 % 3-4 2-4 3-4
D~
2-3
D* In E
2-3 1-2
Blood 3491.5 35.3±1.3 49±2 45±2 50±2 47.7±1.2
Tissue distribution ID % Stomach & Liver Kidneys G.I.Tract 12.9±1.0 15.2±1.5 27±2 12.5±0.5 11.5±0.5 18.5±1.5
7.1±1.5 12.6±2.2 7.6±1.0 6.6±i.1 5.1±1.5 7.0±1.2
i0 i0 i0 5-6 5-6 4-6
*Sn-tartrate It was demonstrated by agar electrophoresis that the labeled protein consisted of two components. Immunoelectrophoresis showed in a few cases the content of prealbumin and globulin. The activity of the gastro-intestinal system was always higher than it would have been expected according to the results of thin-layer c h r o m a t o g r a p h y . In C . E and B kits the higher liver activity indicated colloide, in case of B the higher kidney activity indicated Tc-Sn complex or protein fragment. In every kit the blood clearance was fast. The fastest was found in A and B kits. In Du, D m and E kits, labeling was made at pH = 2.5-3 value. In these kits the gastro intestinal activity was lower indicating a m o r e stable labeling. 'FJC' Natl.Res. Inst.for Radiobiol. and Radiohyg., Budapest, Hungary.
151 153 RELATIONSHIP BETWEEN CEREBRAL BLOOD VOLUME (CBV) AND INTRACRANIAL PRESSURE (ICP) DURING RAPID EYE MOVEMENT (REi4) SLEEP IN HYDROCEPHALIC INFANTS.
155 DIAGNOSIS OF MENINGEAL LESIONS USING RADIOACTIVE LABELED COLLOIDS
L. BARRITAULT, J.N. RII4BERT. J.F. HIRSCH, J. LACOMBE, A. PIERRE-KAHN, R. NGEH, J. MISES and V. GABERSEK.
H. DOGE
C.H.U. Necker, Paris, France.
Department of Nuclear Medicine, Medical Academy Dresden, GDR.
The purpose of t h i s work, by measuring CBV and ICP var i a t i o n s at the same running time during sleep, is to demonstrate that the ICP wave which appears during the REM sleep in the s t a b i l i z e d i n f a n t s hydrocephalus is produced by vaso-motor v a r i a t i o n s . The experimental conditions (continous recording of the CBV v a r i a t i o n s in function of time during sleep in the i n f a n t ) requires a CBV measurement method which is non invasive and r e l i a b l e over several hours. The i s o t o p i c technique, using rapid and e f f i c i e n t in vivo labelin g of red c e l l s with (99mTc) - pertechnetate, is enable to perform these CBV measurements, the b i o l o g i c h a l f - t i m e of 99mTc-red c e l l s being about 20 h o u r s . , Nine i n f a n t s with s t a b i l i z e d hydrocephalus, were e x p e r i mented by non invasive means: REM phases are ditinguished with usual polysomnographic electrodes, i n t r a c r a n i a l pres sure was measured with a fontanel palpation transducer and CBV v a r i a t i o n s were obtained by recording 99mTc acti-v i t y with standard gamma camera coupled with a computer. Sequential r a d i o i s o t o p e images, taken is p r o f i l e project i o n , are recorded as d i g i t i z e d 64x64 matrices. They are processed by s e l e c t i o n o f two regions of i n t e r e s t corresponding to i n t r a c e r e b r a l and p a r o t i d areas and then t i m e - a c t i v i t y curves are read out from these areas. Results show that an increased ICP wave occuring during REM period is r e l a t e d with a simultaneous increase o f the blood volume l i m i t e d to the cerebral sector and not to the area of the external c a r o t i d a r t e r y . From these r e s u l t s , i t c l e a r l y appears t h a t ICP wave is produced by i n t r a c e r e b r a l v a s o - d i l a t a t i o n which may he due to an increase of a r t e r i a l blood flow r e l a t i v e l y to veinous flow
Following intrathec&l admi ni st r at i on r a d i o a c t i v e labeled c o l l o i d s are adsorbed at the surfaces of the arachnoid or are absorbed in the meninges. This study wasundertaken to estimate the diagnostic value of the spinal arachnoid scanning using c o l l o i d a l Au-198 and I n - I l l . Three groups of patients were examined: normal subjects; children repeatedly received i n t r a t h e c a l a p p l i c a t i o n s of methotrexate f o r "prophyl a c t i c " central nervous system therapy in acute lymphob l a s t i c leucemia; pat i ent s with d i f f e r e n t neurologic disorders. The patterns of radionuclide imaging showed t y p i c a l d i f f e r e n c e s between normal subjects and patients with meningeal l e s i o n s , whereas normal scans were found using chelates. Such meningeal lesions could be proved in children with chemoarachnoiditis caused by repeated i n t r a t h e c a l methotrexate i n j e c t i o n s and in other neurologic diseases. Space occupying diseases were d i f f e r e n t i a t e d from meningeal lesions by double-nuclide technique using Yb-169-DTPA and r a d i o a c t i v e labeled colloid. The radionuclide scanning with i n t r a t h e c a l c o l l o i d s adsorbed at the arachnoid o f f e r e d a new p o s s i b i l i t y of proving lesions of meninges. This method is an important enlargement of the neurologic diagnosis,
154 RADIOISOTOPES AND CT EXamINATIONS IN CEREBROVASCULAR DISEASES OF THE POSTERIOR CEREBRAL ARTERY SUPPLYING REGION.
156 RADIONUCLIDE CEREBRAL ANGIOGRAPHY IN THE FUNKTIONAL EVALUATION OF EXTRA-INTRACRANIAL SHUNTING OPERATIONS
T. KRYST, E. FRANKIEWICZ, P. KOZLOWSKI, W. KONIECZNY
G. KIRSCH, D. KINTZEL, K.-O. KAGEL, G. LANG
Psychoneurological Institue-Warsaw, P o l a n d - l n s t i t u t e of Radiology, Medical Academy-Warsaw Postgraduate Medical Education Center-Warsaw, Polan. The authors discuss a v a l i d i t y of various methods as c a r o t i d angiography. X-ray computerized tomoqrapht and radioisotopes dynamic study a f t e r intravenous i n j e c t i o n 99mTc-pertechnetate in diagnosis of ischemic areas in cerebral p o s t e r i o r a r t e r y supplying region. The c a r o t i d angiography has not a decisive value in t h i s cases because p o s t e r i o r cerebral a r t e r y is v i s u a l i z e d in about 20% of p a t i e n t s . Using the CT pathological areas with decrease focal density were found in our patients. Radioisotopes dynamic study in v e r t i c a l view showed reduction of perfusion in p o s t e r i o r cerebral a r t e r y region. The comparison of symmetric regions of i n t e r e s t s by using l i n e a r regression c o e f f i c i e n t allowed to estimate local reduction of the perfusion is ischemic area. The evaluation of character of pathology and e l i m i n a t i o n of neoplasm process is necessary f o r proper therapeutic decision. This procedure decreases e r r o r s of rentgenodiagnostic methods and makes possible the diagnosis by using noninvasive neuroradiological methods.
Radiological C l i n i c and Chirurgical C l i n i c , U n i v e r s i t y of Greifswald, GDR.
Radionuclide cerebral angiography (RCA) has been used to demonstrate the changes of regional cerebral blood flow a f t e r e x t r a - i n t r a c r a n i a l shunting operations in cases of thrombosis of great cerebral vessels. RNA, was executed p r e o p e r a t i v e l y and p o s t - o p e r a t i v e l y in d i f f e r e n t time i n t e r v a l s . The i n i t i a l slope analysis of the t i m e - a c t i v i t y - c u r v e s was used to determinate in the r e l a t i v e hemispheriel cerebral blood flow (CBF) s e m i q u a n t i t a t i v e l y . The r e s u l t s show a s i g n i f i c a n t CBF-increase in well funct i o n i n g anastomosis and CBF-decrease in rethrombosis. The increased cerebral blood supply by the external c a r o t i d a r t e r y and anastomosis could be demonstrated. Patients with p r e o p e r a t i v e l y great interhemispheriel d i f f e r e n c e s in CBF show b e t t e r r e s u l t s than others.
152 159
157 CLINICAL
USEFULNESS
OF B R A I N
THE P O S I T I O N
SCINTIGRAMS
F. Cavaillol6s, A. Alperovitch, B. Bok
C. Soussana, B. Th4bault,
SCINTILLATION
OF R A D I O - C I R C U L O G R A P H I C GAmmA-CAMERA
ERA
EXAMINATIONS
IN T H E
~4. HorvAth
Instrumentation in incessant improvement of ever higher
The clinical usefulness of nuclear medicine procedures is often difficult to assess. In this retrospective study, 532 patients' records were reviewed and placed in one of 6 clinical categories. Sensitivity, specificity and predictive value were computed for both the clinical profile and after scintigraphy. Youden's index was 0,57 using only clinical symptoms and 0,55 from scintigraphy alone. The predictive value of scintigraphy is higher than that from the case history. If the clinical opinion was confirmed by scintigraphy, their joint conclusion was 97 % true. On the other hand, if an alternative precise hypothesis was suggested by the scintigrams, the previous clinical diagnosis was true in only 15 %. The role of the scintigraphy was judged as non predictive in 63 cases (12 %), fair in 176 cases (33 %), important or decisive in 288 cases (55 %). When the scintigram was classed as abnormal ( 5 1 % ) , an etiological origin was proposed in 77 % of these and confirmed in 85 % of the latter. Such results show the clinical value of the scintigram in looking for the etiology of the lesion. Bias exist in all such retrospective studies, the causes of which are discussed. The present study is considered as an introduction to a prospective comparison of CT scanning and scintigraphy likewise based on their diagnostic and etiologic contribution in a given clinical situation.
prices raises the question what diagnostic issues, through what paraxleter and of what accuracy can be clarified only by graphical methods. Relying upon experiences gathered in our research work over 15 years, we may state that unequivocal answers can be given with respect to CO and SV, the CBV, PMCT and PMBV. Relation to EF several methodical refinements have been achieved -ours among them- that have brought the EF of the left ventricle into the close vicinity of the reference contrast anglo value of 66 per cent. Radio-cyclography introduced in Freiburg and Balatonf@red, quite similar to the "nuclear stethoscope" suggested for use by some American authors permits the follow-up of the SV
(and EF) in consequence of various sorts of loads yield-
ing, at the same time, the t i m e paramet@rs of contraction dynamics.
Our simplified models
(continuous and pulsatile)
lend themselves to the expression of the quantity of b l o o d in the right and left halves of the heart in terms of the C H V percentages
and to the following up of the changes oc-
curing in connection with commissurotomy,
artificial valves
Besides, RCG techniques are intended, in the first line for self-control, giving important momentary information also in the coronary unit. They have additionally proved to be ~seful as tools of analysis of acute clinicopharmacological effects, particularly when completed by other conventional procedures
(as in our own praxis Ecg, intracardial
pressures). Hosp. Beaujon,
Non-invasive nuclear anglo have become indispensable for
92118 Clichy Codex France.
the refined spatial and temporal resolution of central circulation events, in the regional analysis of myocardial perfusion and ventricular wall motion. State Hospital for Cardiology,
158 BRAIN SCINTIGRAPHY (BS) WITH 99mTc04 - IN COMPARISON WITH COMPUTER AXIAL TOMOGRAPHY (CAT) AND BRAIN ANGIOGRAPHY (BA) IN NEUROSURGIAL DISEASE.
Balatonf~red,
Hungary
160 CLINICAL EXPERIENCE WITH A RADIONUCLID METHOD FOR MEASUREMENT OF CARDIAC PERFORMANCE DURING PROGRESSIVE EXERCISE IN THE SITTING POSITION. W. STOLL, A. UNVERRICHT, J. SCHEIBE, W. WALTER, G. ZINNER
P.M. NIKOLOV AND W. BURSARSKI
Radiol. C l i n i c . , F . - S c h i l l e r - U n i v e r s i t y ,
Medical Academy, Sofia, Bulgaria
I t is well known that the estimation of cardiac performan ce more depends on the response of the heart to exercise than on the ventricular volumes measured during rest. For that reason the authors worked out a device, consisting of a free movable s z i n t i l l a t i o n detector, an ECG-gated computer and a bicycle-ergometer to record radiocardiograms and ECG-gated volume equivalent curves during several levels of submaximal and maximal exercise. After Xray heart localisation the patient takes place on the bicycle in an upright position and the detector is fixed with a special belt. From a radiocardiogram i n i t i a l l y recorded with ll3mlndium stroke volume, cardiac output and ejection fraction are obtained and used for the c a l i bration of the precordia] registrated volume equivalent curves in rest and during exercise (4 or 5 levels of work lead). With this procedure we examinated about 250 untrained subjects, athletes and patients with several heart-diseases. We found that the changes in cardiac output, stroke volume, ejection fraction and ejection rate owing to physical e f f o r t permit a useful estimation of the cardiac performance especially in athletes, and enables the distrimination between physiological and pathological changes in heart size and in electrocardiogram. Furthermore, the test in recommendable to demostrate the positive effect of drugs in patients with heart diseases and to assess the adaptability of persons with a r t e f i c i a l pacemakers to physical e f f o r t . Though the problems , connected with the single detector technique are well known we consider the described method to be useful in cardiolo gy, for i t permits real function-diagnostics of the hemo dynamic response to exercise.
Out of 186 patients 150 were examined with BS, 160 with CAT and l l 7 with BA. 72 patients suffered from brain tumours, 73,7% of which were detected by BS, 88,4% by CAT and 83,3% by BA. From another group of 41 patien~ with brain vascular diseases a l l hematoms and a r t e r i a l venous malformations were i d e n t i f i e d with BS, whereas d i f f e r e n t results were obtained in ischemic insults and atherosclerosis. In a third group 74 patients with d i f f e r e n t diseases were analysed. BS diagnostics was poor in patients without or with l i t t l e
organic a l t e r a t i o n s .
In tumours,
the rate of false negative in this group 26,3%. In neurosurgery diseases diagnostics should start with BS followed by the more expensive CAT and the more risky BA. Positive BS suported by c l i n i c a l data w i l l cause surgial intervention even with negative CAT and BA.
Jena, GDR
153 161
163
TRANSIT OF PERTECHNETATE IN CORONARY ARTERIES M. Porenta, B. Pust, l. Obrez, V. Fidler
A S S E S S M E N T OF THE RESULTS OF A O R T O - C O R O N A R Y BYPASS SURGERY BY T H A L L I U M 201 ~ O C A R D I A L IMAGING. P.S. Robinson, D.J. Coltart, D.N. Croft, M.M. Webb-Peploe, B.T. Williams.
Transit of Tc-99m-pertechnetate injected selectively into the left main coronary artery was measured in the first minute using scintillation camera, parallel hole colimator in LAO and computer HP 5407 A. Radioactivity-time curves were derived from the whole p r e c o r d i u m as well as from 15 equal segments fo the precordium. From each time function the tiem interval t-max and max t 1/2 was signet as the inflow and outflow respectively. Results: i) Inflow of pertechnetate into regions perfused by LCX is faster than into regions perfused by LAD (p < 0°5) 2) The similar inflow delay as i) into regions perfused by LAD exists even if we compare: a) regions with LAD stenosis less than 50% with regions with LCX stenosis less than 50%, b) regions with LAD stenosis more than b0% with regions with LCX stenosis more than 50%. 3)Outflow of pertechnetate seems to be slowe~ than from the regions perfused by LCX. 4) Positive correlation (r = 0.8; 0.5% < p ~ 1%) between inflow and outflow was found only in regions p e r f u s e d by LAD. 5) Positive correlation (r = 0.4, p <0.5) between degree of rtg stenosis and o u t f l o w was found only in regions with stenosis more than 50%. 6) There was no correlation between inflow and degree of rtg stenosis. Conclusions: i) Selective coronary injection of 99m-pertechnetate offers some useful quantitative data: for inflow (t-max) and for o u t f l o w (max-t 1/2) for different myocardial segments. 2) Data obtained uner i) can be assessed only in combination with data obtained with coronary angiography. University Clinical Centre, Ljubljana, Medicine, Cardiology, Radiology.
Dept.
for Nuclear
34 patients with angina pectoris were assessed by exercise t e s t i n g and m y o c a r d i a l imaging using Thallium 201 (T1 201) b e f o r e and after a o r t o - e o r o n a r y bypass surgery. A p p r o x i m a t e l y six months after surgery 28 patients were symptom free, 3 were symptomatically improved and 3 unchanged. On a standard e x e r c i s e protocol, exercise d u r a t i o n averaged 8.23 (+ 3.06) minutes pre-operatively and 10.78 (i 2.66) minutes post-operatively. The exercise ECG showed evidence of i s c h a e m i a in 28 patients preoperatively; after o p e r a t i o n 12 patients had definite e l e c t r o c a r d i o g r a p h i c e v i d e n c e of isehaemia, 2 had new q wave suggesting peri-operative myocardial infarction. P r e - o p e r a t i v e l y , of the 34 patients, 32 had defects on exercise T1 201 imaging consistent with ischaemia. Following operation T1 201 imaging suggested complete r e v a s e n l a r i s s t i o n in 21 patients with partial revascularisation in 9 and evidence of p e r i - o p e r a t i v e myocardial i n f a r c t i o n in 4. TI 201 myocardial imaging proved an accurate p r e d i c t o r of graft status in those patients where coronary a r t e r i o g r a p h y was r e p e a t e d following surgery; in addition TI 201 myocardial imaging appears ro offer c o n s i d e r a b l e advantages c o m p a r e d with other noninvasive techniques in the assessment of the results of a o r t o - e o r o n a r y bypass surgery both to p r o v i d e evidence of relief of myocardial i s e h a e m i a and to d e m o n s t r a t e myocardial damage o c c u r r i n g in the p e r i - o p e r a t i v e period. St. Thomas'
Hospital,
London,
S.E°I.,
England.
162
164
lY2ROVED ASSESSMENT OF REGIONAL LEFT VENTRICULAR WALl, MOTION BY TE_~ORAL F O U R I E R TRANSFORM A.Bossuyt, F.Deconlnck, J.Roland, P.Block and M.Jonckheer Radionuclide angiography has demonstrated the capacity to detect significant alterations in left ventricular contractility appearing during bicycle exercise in patients with CAD. Evaluation of regional wall motion in these studies is usually only qualitative by visual inspection of a cine mode p r e s e n t a t i o n of multigated cardiac blood pool images. Because of the limited resolution of scintillation cameras unambiguous definition of the borders of lefn ventricular blood pool is difficult. To circumvent the latter problems we have developped a temporal Fourier transform method for the construction of two functional images which permit an objective assessment of local hypo- or dyskinetic regions. Each picture element in the first image corresponds to the local amplitude of the periodic change in activity during the heart cycle. The second image shows the local phase of the periodic change in activity. The method results in eliminating all stationary structures which otherwise contribute to the background. In a modified LAO position the amplitude will give a clear delimination of the anteroseptal inferior and posuerolateral borders of the LV. Hypo-, a- or dyskinetic regions will appear as regions with decreased amplitude. The phase image permits an accurate assessment of the time course of changes in activity in the corresponding regions. Phase shifts greater than 90 ° will typically differentiate paradoxically moving ventricular structures from hypokinetic regions. The amplitude in the paradoxically moving segment permits an estimation of the "sequestered blood volume". Furthermore as the method is based on a quantitative analysis of changes in blood volume, wall motion abnormalities in segments which in LAO position are not iocaiised near the border of the LV can be accurately assessed as well.
20J-T1 ~{YOCARDIAL SCiNTIGRAPHY AFteR ]V INJECTION OF A VASODILATATOR DRUG : AN ATTEMPT TO IMPROVE A NEW CARDIAL TEST. J.M.Hossard*,A.Constantinesco**,F.Chemmna*,B.Niederberger* J.Gauthier*,A.Campos*,B.Dumitrasco**,d. Chambron**,R.Voegtlin*.
A.Z.
- V.U.B.,
Laarbeeklaan
i01,
1090 Brussel
(Belgium).
Investigations of myocardial perfusion by physical methods: ZCG~ coronary cineangiography, gamma myocardial imaging are generally performed at rest and their results compared with the same tests performed at p e a k e x e r c i c e s to improve their fitness. With the purpose of avoiding the inconvenience of acute exercices and particularly among the patients suffering from coronary disease, we have suggested to study if the effect of a vasomotor drug (IV injected) at short time before the tests could be a substitute for a controlled exereice. In order to ascertain this new test we have sabmitted a lot of patients with stable angina or o l d m y o c a r d i a l infarction to a comparative serie of these physical trials:including thallium 20] labelled m y o c a r d i u m imaging, in three conditions : at rest, at the peak exercice and after IV injection of dipyridamole. We confirm by the present studies the good agreement between cineangiography, ECG~ and gamma myocardial imaging defects, detected at rest conditions and emphasized by peak exercice. Dipyridamole has local and general effects on the f i x a t i o n o f TI-201. As a rule, the drug displays a faster and more intense fixation, related L o v a s o d i l a t a t i o n and increase of the coronary flow. Horeover locally redistribution of the radiotracer has frequently been observed as seen either by the filling of hypofixant regions at rest or b y the apparition of defects in n e w regions. Dipyridamole could play a role in the collateral circulation and acts perhaps at the level of myocardial metabolism. We think that dipyridamole test is more useful for evaluating the coronary reserve and existence of the collateral circulation in the case of m u l t i v e s s e l s t e n o s i s than for improve diagnosis of coronary deficiency. * Clinique de Cardiologie~ HSpital Civil~ Strasbourg. * * Institut de Physique Biologique, Facult£ de Hgdecine, 4~ rue Kirschlgger - 67085 STRASBOURG Cedex
154 167
165 ALDOSTERONE RELEASE ENDOCRINE DISEASES A. M a l e e v a
IN P A T I E N T S
WITH
VARIOUS
P l a s m a aldosterone level w a s determined by specific r a d i o i m m u n o a s s a y in 105 patients with various endocrine diseases and in 50 healthy persons. T h e results s h o w e d statistically significant increase of aldosterone concentrations in 2 6 % of the patients with obesity. 42 patients with chronical hypocorticismus appeared with statistically decreased aldosterone level. Diminished functional reserve of adrenal gland w a s observed in 14% of all patients. In the patients with prim a r y hyperaldosteronismus the aldosterone level w a s elevated in all patients, while in those with p h e o c h r o m o c y t o m a it w a s increased in 4 3 % . Institute of Rentgenology and Radiobiology, Medical A c a d e m y , Sofia, Bulgaria.
RADIOIMMUNOLOGICAL AND CLINICAL EVALUATION OF GOITROUS POPULATIONS: EPIDEMIOLOGICAL STUDY THROUGH CORRESPONDENCE ANALYSIS METHOD "I" B. Fiche~[~!,) A. A G . Rhal[~)Z), R. Sauvan (I), F. R o u x (I), F. To~ola' ", J.P. Bisset In two malianvillages, Neguela and Koulikoro, affected by e n d e m i c goiters (respectively 72~0 and 50~), every subject w a s submitted to a clinical investigation: sex, age, weight, height, radial pulse, thyroid palpation and general check-up; furthermore, following thyroid function p a r a m e t e r s w e r e m e a s u r e d : total thyroxine (T4), total triiodothyronine (T3), free thyroxine (FT4), free triiodothyronine (FT3), thyroid- stimulating h o r m o n e
(TSH). S o m e of these observations w e r e submitted to a correspondence analysis. F r o m such a m e t h o d of data analysis, it has been possible to c o m p a r e geometrically the responses s t e m m e d f r o m s o m e variables in relation with other variables (CHI square distance for conditional frequencies, principal c o m p o n e n t analysis). The chosen variables w e r e the biological p a r a m e t e r s (T4, T3, F T 4 , F T 3 , TSI-I) c o m p a r e d with residence, sex and size of goiters ( W . H . O . classification). A s correspondence analysis only allows a qualitative data processing , the continuous biological cariables w e r e transformed into discrete variables. T h e correlations between the biological p a r a m e t e r s and the clinical and geographical criteria appeared f r o m a first couple of factorial axis representation. (i) Service de M ~ d e c i n e Nucl6aire (Pr. H. Roux), C . H . U . T I M O N E , 13385 - Marseille C ~ d e x 4, F r a n c e (2) Service de M 6 d e c i n e 4, HSpital point G, B a m a k o , R~publique du Mall
166
168
SCREENING FOR CONGENITAL HYPOTHYROIDISM EXPERIENCES WITH 4 COMMERCIALLY AVAILABLE TSH-ASSAY KITS A . W e b e r , B. Streckenbach, G. Machil]
THE EFFECTS OF PROPANOLOL ON THYROID VITRO TESTS T . M . Do Gimlette and C . R . Squire
T h e r e is no doubt that the m e a s u r e m e n t of T S H in dried blood spot represents the m e t h o d currently m o s t favoutable for discovering a congenital hypothyroidism. B y m e a n s of m o r e than Z000 dried blood spots of the current P K U - s c r e e n i n g s four different c o m m e r c i a l l y available T S H - a s s a y kits (Phadebas, Henning, B y k Mallinckrodt, Calbiochem) w e r e tested for their applicability to mass-screening. Sensitivity and precision of the tests can be considered sufficient, w h e r e a s w o r k and test-time and the costs as well w e r e too high. A test is postulated which can simply be carried out and which m e e t s the requirements of the hypothyroidismscreenings. Clinic of Radiology, University of Greifswald, G D R .
IN
In vitro thyriod function tests w e r e carried out before and after administration of propanolol 40 rag. tds. for 1 week. S e r u m thyroxine (T4), 3, 5, 3' triiodothyronine (T3), 3, 3' , 5' triiodothyronine (rT3) and thyroid stimulating h o r m o n e (TSH) w e r e e s t L m ~ e d by radioimm u n o a s s a y . A T R H stimulation test w a s carried out and resting pulse rate w a s noted. F o u r groups of patients w e r e studied: untreated euthyroid, hyperthyroid, euthyroid an thyroxine replaceme nt and enthyriod on triiodothyr onine replacement. Significant decreases in s e r u m T 3 and increases in s e r u m r T 3 w e r e found in the majority cf patients in the first three groups with no significant change in the group on T 3 r e p l a c e m e n t . There w a s no significant change in T 4 values in any of the groups. There w e r e also no significant changes in resting T S H or response to T R H after propranolol, and the changes in T3 and r T 3 s h o w e d no correlation with the levels of resting T S H or responses to T R H . D e p a r t m e n t of Nuclear Medicine, The Liverpool Clinic, Liverpool L 7 7 D E , England.
155 169
171
CONTROL OF TSH LEVELS WITH THYROID HORMONES USING TRH TEST L. Diez, B. Ortuno, J. Estenoz, F. Hawkins, E . A r n a i s
EARLy DETECTION OF A DIABETIC RISK IN SOME PREGNANT OR OBESE WOMEN WITH NORMAL OGTT BY DISCRIMINANT ANALYSIS: A NEW STATISTICAL APPROACH. Giampietro O., Navalesi R., Dalle Luche A.. Matteucci E. Our purpose was to study if in pregnancy or in obesity exists a characteristic pattern of the glycemic and insulinemic response to the OGTT.We studied 6 groups of women:25 normals (N);30 women with a diabetic history (DN);12 pregnants (P);16 obeses (O);ii pregnant (DP) and 26 obese (DO) women with a history suggestive for diabetes.The OGTTs were performed in the morning,fasting,in bed,with a standard load (100 g of glucose in 200 ml of a water solution),after a five-days of a balanced and in carbohydrates rich diet. Blood samples were taken at 0' and 30,60,90,120, 180' after the glucose load. Plasmatic glucose (Neocuproine meth.) and insulin (RIAssay with charcoal-dextrane boundfree separation) concentrations were measured. The intraassay variation coefficients for insulin RIA,estimated on reference pools,were 6.5 % and 15 %,respectively.All OGTTs were within normal limits according Fajans. Six comparisons were performed:l)N vs. P= both mean glucose and insulin levels were higher in pregnants at all the sampling times;2) DN vs. DP=the glucose curve only was significantly different in the 2 groups;3)N vs. O=both mean glucose and insulin levels were significantly higher in O;4)N vs. DN=the mean glucose curve was significantly higher in DN, whereas the insulin one showed a non significant delayed hyperinsulinism;5)P vs. DP=both mean glucose and insulin curves are not significantly different)6)O vs. DO:the mean glucose curve only was significantly different. Our data confirm that in pregnant and obese women the OGTT glucose and insulin responses are significantly higher than in normals,signifying an insulinoresistance state.Failing to observe a significant difference in the mean insulin curve between DN and DP,it may be suggested that a positive history for diabetes can reduce the pregnancy hyperinsulinism. 2nd Med. Clin.and CNR Clin.Physiol.Lab. Univ. Pisa,Italy
We have i.v. administrated 400 ~g. of T R H on 59 patients m e a s u r i n g T4, T 3 and T S H by RIA. T S H blood levels w e r e obtained at 0, 5, I0, Z0. 30, 40, 60, 90 and IZ0 minutes after T R H . 4 patients had partial thyroideot o m y and w e r e treated with 135 9g. of T 4 and 15 9g. of T 3 dally. Z0 patients had subtotal thyroidectomy and received 180 ~g. of T 4 and 20 [~g. of T 3 daily. I0 patients also with subtotal thyroidectomy w e r e on 270 l~g.of T 4 and 30 ~g. of T3. 8 patients with total thyroidectomy (thyroid cancer) received only 75 ~g. of T 3 daily. 17 nor real subjects w e r e studied as controls. Results: T4, T 3 and T S H basal levels w e r e not statistical significatives in all patients studied. After T R H stimulation there w a s a good suppression in treated patients as c o m p a r e d with controls (p~0, 05 atell minutes). Treated patients response w e r e not statistically different betw e e n the groups. Conclusions: V/e describe a g o o d T S H suppresion after T R H in patients treated with not very high doses of T 3 or a combination of T 4 plus T3. Servicio de Medic{ha Nuclear. C.S. P r i m e r o Madrid, Spain.
de Octubre
172
170 EXA/iINATIONS
OF T H E A D R E N A L
GLANDS
USING
75Se-SELE~OCHOLESTEROL W.Jakubowski,W.Graban,T.Feltynowski Scintigraphy o f t h e a d r e n a l g l a n d s is a v e ry effective method in the examination of the pathology of the adrenal certex,specially f o r t h e d i f f e r e n t i a t i o n between hyperplasia and adenoma.Twenty five patients were studied using 250 ~Ci Se-75-selenocholesterol / Amersham,England/ o n p u r p o s e to d e t e r m i n e value of this agent in the examination of the adrenal glands.The examinations were done using gammacamera T h o s h i b a 202 a n d d a t a p r o c e s o sing system Informatek SIMIS-3.In all cases the b e s t p i c t u r e s w e r e o b t a i n e d i n f i f t h d a y after injection of selenocholesterol.The qual i t y of t h e s e p i c t u r e s a r e b e t t e r t h a n p i c t u res using 19-1-131-iodocholesterol/ in ten patients were done pararelly comparative study/.The scintigraphic diagnosis were compared with final clinical diagnosis confirmed by phlebography and/or operation.In 22 c a s e s w e re c l o s e d c o r e l a t i o n b e t w e e n the scintigraphy examination and final diagnosis of the patients.ln our opinion Se-75-selenocholester o l is a v e r y e f f e c t i v e a g e n t f o r t h e a d r e n a l scintigraphy,very s i m p l y to u s e a n d w i t h l o wer radiation dose than agents labelled iodine-131.Now it is a g e n t o f c h o i s e for the ex~ minations of children and young patients.
AUTORADIOGRAPHIC INSULINE
METABOLISM
N.TOUB~NAKIS,
OF THE
131
I-
IN M I C E
D.JORD~qOU,CHR.SAWA-DIMOPOULOU,
GR.PONTIFEX This
is an e x p e r i m e n t a l
autoradiography with
The main
organs
bolism the
131I
that
participate
are
Insuline
antibodies
131I-Insuline
ed while adrenal Apart
from
and
the
Departments
cortex
animals
in w h i c h
administrated, in the b l o o d appears
an e s s e n t i a l is p l a y e d
takes
an e n z y m a t i c
Greece.
the p r e -
is p r o l o n g -
by
in
liver. role
in the
the k i d n e y
inactivation
place.
of N u c l e a r
Areteion
and
diminished
in the
liver,
probably
most
in the m e t a -
Insuline
where
Insuline
Insuline
adrenal
increased
of
Physics,
are
its d i s t r i b u t i o n cortex
metabolism
of
the
In e x p e r i m e n t a l
sence
of
of
in m i c e .
of I n s u l i n e
liver.
study by whole-body
of the m e t a b o l i s m
labelled
Athens, Department of N u c l e a r m e d i c i n e , M e d i c a l School of W a r s a w , C e n t r a l Clinical Hospital,Banacha I A,Poland.
INVESTIGATION
~[edicine
Hospital,
76,
and Medical Vas.Sophias
Ave,
156 173
175
EXPERIMENTAL BONE BLOOD FLOW I{EASURE~NT : APPLICATION OF RADIO-LABELLED MICROSPHERES TEC}~IQUE.
BONE SCAN IN THE STUDY OF BREAST CANCER J.L. C h a m o r r o , G. M a r a n a , I. Castejon, Z. Villar, Inocente; C a m p o r r o , J. Ortiz B e r r o c a l , J. R a m o s T h e p r e s e n c e of bone m e t a s t a s e s t r a n s f o r m a false Stage I, II or III implying absolutely different therapeutic m e a s u r e s . M a t e r i a l a n d M e t h o d s : W e present our o w n statistic, c o m p r i s i n g patients f r o m two different hospitals, for w h i c h w e p e r f o r m the radioisotopic studies. T h e total n u m b e r of patients studied w a s 264 (122+ 142). T h e results a c h i e v e d in the detection of bone m e tastases has b e e n as follows: In Stage I: 1 4 . 2 / 1 2 . 5 % in the initial study (I.S.) and 28.4/Z5. 0 one y e a r later (L. S.). In the Stage Ih I 0 . 0 / 3 0 (I.S.) and 2 0 . 6 / 4 8 . 2 (L.S.). In the Stage llI: 13.7/21.0 (I.S.) a n d 2 3 . 3 / 4 3 . 5 (L.S.'). In the Stage IV: 20.0/50. 0 (I.S.) a n d 83. 0 (L.S.). T h e r e is a slight d i s c o r d a n c e in the results for the stages II a n d Ill. In the stage IV is quite difficult to o b s e r v e the evolution of the patients. A peculiarity leading to separate of the statistics is that in one of the hospitals, breast c a n c e r is c o n s i d e r e d to be practically a s y s t e m i c disease, thus leading to infrequent use of radiotherapy. O n the contrary, in the other C e n t e r radiotherapy is almost compulsory. T h e positivity ratio b e t w e e n s c a n and X ray has b e e n 113/71. In other w o r d s 37.Z~0 of s c a n positivities has not b e e n e v i d e n c e d roentgenologically. Conclusions: T h e p e r c e n t a g e of positivities increases in m o r e a d v a n c e d stages. In o r d e r ~o establish a staging, the b o n e s c a n is essential. W i t h a single s c a n lesion, b y o p s y should be p e r f o r m e d . T h e sites with grater index of metastatic localisation are spine ( 2 6 . 9 % ) , ribs
A. Bru - A. Blasco - G. Bouteiller ~ F. Vigoni - J~L. Decamps - J. Pradere - H. Regis. In the present experiment, we use Sephadex 58Co labelled microspheres 15 + 3 /um in diameter in order to measure total and region~l N o o d flow (B.F.) in dogs femurs. Moreover, cortex and marrow B.F. are calculated in each segment. In thirteen anesthetized dogs,a thoracotomy is performed and 9 million microspheres are injected into the left atrium, while reference blood samples are whithdrawn from a distal artery for blood flow calculations. After the dogs being killed, femurs are taken out and cleared of soft tissues and cut in 8 segments. For each dog, segments of one femur are dissected into marrow and cortex, and whole segments of the other are ashed. Radioactivity of samples weighed fresh, compared to that of the reference blood samples makes it possihle to calculate tissue blood flows expressed in ml.mn -I. ]OOg-I ~{ean marrow blood flow is 14.6 + 2.5 and cortex B.F, 1.3 + 0.25 . Total femur B.F. is 5.2 + 0.9 The analysis of blood flow distribution into femur segments shows that the highest rate of B.F. is found in the upper metaphysis. Moreover it appears that marrow B.F, is in inverse ratio to the amount of fat in the marrow.
Service de Bicphysique M6dicale - C.H.U. de Rangueil chemin du Vallon - 31054 Toulouse Cedex - France -
(24.5), pelvis 04.2), skull (12.7), sternum (9. 3), lower l i m b (7. 8) and u p p e r limb (4.6). Clinica P u e r t a de Hierro,
Madrid,
Spain.
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176
THE BONE SCANNING IN THE BREAST CARCINOMA: EXTENT, EVOLUTION CONTROL AND POSITIVE DIAGNOSIS OF TUMORS Gomez Embuena A., Moyano Jato A.r Ortuno de Solo B., Arnaiz Bueno F. The bone scanning constitutes a diagnostic method which is indispensable in order to be able to determine the illness extent. 175 female patients with breast cancer have been studied, in which a total of 437 bone explorations have been done. We have tracked a group of 75 patients under chemical treatment, through seriated scintigraphies, analysing scintigraphic changes as a function of therapeutical efficiency. In this group of patients we have determined that in 20 cases with bone metastatic dissemination, scintigraphically tested, the involution of the bone scan has been completed after four months treatment; we also found partial remission in 23 more cases. In this sense, we discuss the discordance between negative radiological findings and the persistence of positive bone scan. Last, we insist that positive uptake at the breast level constitutes a complementary sign that confirms almost definitely the malignant character of the lesions so determinated.
CORRELATION OF BONE SCINTIGRAPHY WITH CEA ESTIMATION IN DETECTION OF DISTANT ]BREAST CARCINOMA METASTASES S. Upka, I. M a k a i o v a , J. liausitz, A. Godal, V. Pipa, M . Pristas In I01 patients with breast c a r c i n o m a w e r e p e r f o r m e d w h o l e - b o d y bone scintigraphy with 99 m T c - p y r o p h o s phate and e s t i m a t e d the value of c a r c i n o e m b r y o n a l antigen in blood s e r u m . T h e a g r e e m e n t of negative or positive findings w e r e in 60, 4 % . In 87, 5 % cases w e r e the results both n e g a tive and in 5 0 % positive one. T h e authors discuss the contribution of this correlation for a c c u r a n c y of early detection of distant breast carcinoma metastases. C h a i r of Oncol., Radiol. and Nucl. Medicine, M e d i c a l Faculty K o m e n s k y University, C h a i r of Nucl. Medicine, P o s t g r a d u a t e M e d i c a l Institute, Institute of Clin. Oncol. B ratis lava, C S S R .
157
177 NUCLEAR IMAGING AT THE MICROSCOPIC LEVEL. P. Galle Proposed in 1962 (R. Castaing and G. Slodzian, d. Microm copie, 1, 255, 1962), "Secondary Ion Emission MicroanalysiT" gives the p o s s i b i l i t y to obtain the d i s t r i b u t i o n of any element at the surface of a given specimen. This method can be applied to study the d i s t r i b u t i o n of a given isotope (stable or r a d i o a c t i v e ) in a section of a b i o l o g i c a l t i s s u e , and to measure an i s o t o p i c r a t i o under a surface of 1 micron (P. Galle, Ann. Phys. B i o l . Med., 84, 94, 1970). An ion beam of a given energy is focused on to the surface o f the section. As a r e s u l t of the bombardment, the atoms of the most s u p e r f i c i a l atomic layers of the section are etched, some of them in an ionized form (secondary ions). These secondary ions are accelerated by a p o t e n t i a l and focused i n t o a bea~ by means of an e l e c t r o s t a t i c lens. This beam, carrying the image of every etched ions, is s p l i t i n t o as many secondary beams as there are ions o f a given s p e c i f i c charge ; f i n a l l y , one o f these beams is selected and the image of the s p e c i f i c isotope appears d i r e c t l y on the screen without the help of any scanning procedure. The resol u t i o n in the image is best than i micron. D i f f e r e n t v a r i e t i e s o f tissues have been studied : bones, t e e t h , kidney, l i v e r , blood c e l l smear, and images of d i s t r i b u t i o n of many elements such as 19F, 27Ai, 39K, 41K, 54Fe, S6Fe, 88Sr, 1151n, 138Ba and 232Th w i l l be presented. Laboratoire de Biophysique de la Facult~ de M6decine de C r f i t e i l , 8, rue du G~n~ral S a r r a i l , 94000 C r ~ t e i l , France.
179 PRELIMINARY REPORT ON BEHAVIOUR OF TOTAL B O D Y K ( T . b . K ) M E A S U R E D BY W H O L E B O D Y C O U N T E R (W.B.C.) IN PATIENTS TREATED BY RADIATION T H E R A P Y ( R . T. ). E. Scopinaro, G. Sabatini, G. Cantarano, G.P. Lembo, D. L o r e n z o n S o m e authors found a d e c r e a s e of total K content in isolated . . . . . li. . . . gans (I) or in plant roots (2) after gamma irradiation. W . b . c . evaluation of 40-K w a s p e r f o r m e d in irradiated patients for H o d g k i n ' s disease R . T . . A w . b . c , having two 5'x5' NaI detectors a n d the g e o m e t r i c a l a r r a n g e m e n t of Marinelli's s t a n d a r d chair has b e e n used. C o u n t s of !.b.40-ll.were referred to a plastic p h a n t o m filled with 65 Lts of a standard K c l solution. T . b . K . w a s m e a s u r e d in 4 patients without any c h e m i o therapy before, during and after the R . T . (3250 fads fractioned in 13 exposures). 4 healthy y o u n g volunteers without a n y kind of therapeutic t r e a t m e n t w e r e u s e d as controls. In irradiated patients T . b , K . s h o w e d a first m o d e r a t e fall, after the 3rd exposure, a m o d e r a t e raise after the 8th dose a n d a m o r e large fall, (15-25%) 8 d a y s after the end of the R. T. In the controls difference of T.b. BI. w e r e less than predictable statistical error. i) G.S. Gupta, S.R. B a w a Radiation R e s e a r c h 7 2 - 2 2 6 1977. 2) A . K . K a s y m o v Radiobiologiia 16 (i) 126, 1976 Department
R a d i o l o g y I University R o m e .
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180
RADIOIMi~UNOLOCICAL ASSAY FOR B2 MICROGLOBULINS IN WORKERS EXPOSED TO INHALATION OF CADMIUM DUST. G. Collignon, R. Jeandot, P. Gourssies and P. Blanquet.
A PILOT STUDY OF APPLICATION OF EUCLID METHOD ON GLAUCOMATOUS P. Rozsival, J. Vizda, ft. H r o c h o v a
Dealing with the zroblem of ~rotection of ~ersonnel eventualy submitted to Cadmium dust (in a Battery factoryl, first we made Cadmium determinations in the atmosphere which ~ermitted us to know the most exposed locations, then radioiramunological assays for B2 microglobulins were performed in blood and urine over a large oo~nlation of workers. We did those assays as some authors, by electro oheretic studies of urinary ~roteins had orevions]y demonstrated in exposed ~ersonnel a high concentration of B2 microglobuiin.
A NEW EYES
RADIO-
The results obtained with this sim~le and very sensitive radioimmunoassay in more than 200 workers have unabled us to establish good correlation between the number of years of presence in an exoosed area and the atmoszheric concentration of Cadmium.
In the c o m m u n i c a t i o n w e a n a l y s e d the results of a pilot study of a hydrocirculation in g l a u c o m a t o u s eyes using a n e w noninvasive radionuclid m e t h o d . T h e m e t h o d consisted in noncontact m e a s u r e m e n t of a half time of a dec r e a s e of radioisotope Z 2 N a in eye by scintillation detector. T h e radioisotope w a s applied to the c o r n e s in a strip of c h r o m a t o g r a p h i c paper. W a s noted a consirable prolongation of a half time 2 2 N a in the eyes with acute attack of angle closure g l a u c o m a . Surprisingly w a s in eyes with absolute g l a u c o m a the half-time 2 2 N a in norm a l values. A n attempt is m a d e in correlating halft i m e with a drug a n d operative therapy, t o n o g r a p h y and intraocular p r e s s u r e .
The value of those 2 oarameters is discussed and interesting conclusions for imoroved ~rotectien are obtained.
Dpt. O p h t a l m o l o g y , Czechoslovakia.
Service Central de M~decine Nucl~aire, HSDital Pellegrin, Place Am~lie Raba Lgen, Bordeaux, and I.N.S.E.R.M. Unit~ 53, Domaine de Carreire, rue Camille Saint-Saens, 33077 Bordeaux Cedex, France.
Dpt. Nucl. M e d . ,
H r a d e c liralove,
158 181
182
IRRADIATION OF THE BULGARIAN POPULATION FROM NUCLEAR MEDICINE DIAGNOSTIC R. Poppitz and D. D o b r e v
T H E U S E O F 14-(; L A B E L L E D VATION OF LIPID METABOLISM R. Petrasek, R. Poledine
T h e collective doses to various organs a n d the per caput doses to organs of the B u l g a r i a n population in 1976 w a s calculated for the m o s t frequently u s e d nuclear m e d i c i n e examinations in this country. A n evaluation of the genetically a n d l e u k e m i a significant dose gives that the respective values are about 1 and 2 m r a d in 1976. O n the basis of the calculated values for e a c h radiopharm a c e u t i c a l (or nuclear m e d i c i n e examination) there h a d b e e n m a d e conclusions about its influence on the radiation e x p o s u r e of the population. T h e conclusions include also r e c o m m e n d a t i o n s for r e d u c e d use of s o m e radiop h a r m a c e u t i c a l s (e.g. 1311- Iodide, 198Au-Colloid, 75Se - L - S ele nomethionine).
In vitro m e t h o d s using 14-C labelled c o m p o u n d s w e r e developed for e x p e r i m e n t a l studies of lipid m e t a b o l i s m disorders with a special v i e w to atherosclerosis. These m e t h o d s p e r m i t to observe f o r m a t i o n of total lipids, fatty acids and cholesterol, oxidation of these lipid fractions, cholesterol transport, etc. T h e m e t h o d s w e r e e m p l o y e d for studies of lipid m e t a b o l i s m in the tissues of e x p e r i m e n t a l animals, h o w e v e r , slight modifications m a k e t h e m fit for use in studies of h u m a n fat m e t a b o lism.
Institute of R o e n t g e n o l o g y and Radiobiology, Academy - B a s e No. 2, Sofia, Bulgaria.
Medical
COMPOUNDS IN THE
Institute for Clinical a n d E x p e r i m e n t a l Prague, CSSR.
IN O B S E R ORGANISM
Medicine,
