Abstract

IJNM

Indian Journal of Nuclear Medicine

0972-3919

Society of Nuclear Medicine, India

ijnm-20-4-oral004

Oral 4

122004

204109115

ijnm-20-4-oral004-001

Diffuse Hepatic Disease - Prognostic Role of The Liver Scan

Pawaskar

Alok

Krishna

P. D. Hinduja National Hospital and MRC, Mahim, Mumbai

AbstractBackground

The liver scan, which used to be one of the primary investigations for liver diseases, is now hardly performed in evaluation of the patients with diffuse hepatic disease (DHD). Though the USG and CT scan do not quantify the loss of hepatocyte function, they are commonly used as the first modality of investigation. However, we feel functional evaluation by isotope liver scan would be superior to these modalities in the patients of DHD. Hence we undertook a study to assess the clinical utility of the liver scan in this context.

Method and Results

Totally 25 patients with clinical suspicion of DHD were included in the study. The liver scans performed with ^99mTc-Sulphur Colloid in these patients were evaluated and compared with either USG or CT scan. Seventeen patients showed evidence of moderate to severe degree of diffuse hepatic disease on the scan. Out of these, 9 patients died of the complications related to liver cirrhosis over a follow up period of 3 months to 1 year. In remaining 8 patients where USG or CT scan demonstrated evidence of cirrhosis, liver scan showed near normal status. All these patients were asymptomatic and were doing well at the end of 2 yrs of follow up.

Conclusion

We conclude from our small data that the isotope liver scans in > 30 % of the patients suspected for liver cirrhosis ruled out the possibility of cirrhosis and showed favorable prognosis. In > 50 % patients with DHD, the liver scan correctly prognosticated bad prognosis. Hence we feel that isotope liver scan should be revived in investigation of DHD and should be one of the primary investigations for assessing liver function.

ijnm-20-4-oral004-002

Use of ^99mTC-Mannitol for Determination of Cell Monolayer Integrity

Shah

Pranav

¹Mishra

Pushpa

²Sharma

²Misra

Ambikanandan

¹Mishra

Anil Kumar

¹Department of Pharmacy, The Maharaja University of Baroda, Vadodara, Gujarat, India²Institute Of Nuclear Medicine And Allied Sciences, Brig. S.K. Majumdar Road, Delhi, India

Abstract

Caco-2 and Madine Darby Canine Kidney (MDCK) cells originating from the human colon and dog kidney carcinoma respectively have been widely used in recent times as models for intestinal permeability screening of drugs. These cells when grown on permeable supports form monolayers which are used to study the transport of hydrophilic and lipophilic drugs, characterize the drug transport pathway and efflux systems.

Once the monolayer is formed, it is necessary to determine the integrity of monolayers prior to their use. Till date, paracellular probes used for determining the integrity of monolayers include ¹⁴C-Mannitol, ³H-Mannitol, ¹⁴C-PEG4000. Mannitol and PEG 4000 are metabolically inert and highly hydrophilic in nature. Mannitol has been used previously to monitor changes in epithelial integrity of mucosal cells. However, ¹⁴C-Mannitol, ³H-Mannitol, ¹⁴C-PEG 4000 are all positron (â⁺) emitters having long half lives leading to greater chances of toxicity. ¹⁴C and ³H being cyclotron products, their availability, and cost effectiveness limit their widespread use. ^99mTc is a suitable radionuclide due to its excellent radiation characteristics. We, for the first time, successfully employed ^99mTc-Mannitol for determining the integrity of Caco-2 and MDCK monolayers. Mannitol with labeled with ^99mTc-by simple reduction method with >98 % labeling efficiency and excellent stability characteristics. The labeling conditions were optimized by studying various parameters. We employed ^99mTc-Mannitol for studying changes in the permeability of antiviral drug, acyclovir in presence of absorption enhancers like Di Methyl a Cyclodextrin (DMâCD) (1-5 %), sodium lauryl sulfate (SLS) (0.15-0.4 mM) and chitosan (0.1-0.5 %) across confluent Caco-2 and MDCK cell monolayers. DMâCD, SLS and Chitosan led to maximum 9.17,8.03 and 4.75 in Caco-2 & 9.79,8.57 and 4.9 times improvement in permeability as compared to control in MDCK cell monolayers respectively. These enhancers cause opening of the tight junctions, which led to significant increase in permeability of paracellular marker ^99mTc-Mannitol, as compared to control wherein no enhancer was employed. This study explores the potential of ^99mTc-Mannitol,in detecting changes in studies of absorption enhancement across cell monolayers.

ijnm-20-4-oral004-003

Utility of FDG PET in the Detection of Bone Marrow Involvement in Malignant Lymphoma

Kand

¹Tiwari

¹Nair

¹Kumar

¹Gupta

¹Radiation Medicine Centre (BARC), Tata Memorial Centre Annex, Jerbai Wadia Road, Parel, Mumbai-400 012²Department of Medical Oncology, Tata Memorial Hospital, Jerbai Wadia Road, Parel, Mumbai 400 012

Abstract

Malignant lymphomas arise from neoplastic transformation of lymphoid cells in lymph nodes, spleen or thymus gland. The disease is known to demonstrate a multifocal, hematogenous dissemination with bone marrow involvement. Malignant Lymphomas being the most curable forms of cancer, treatment and prognosis is significantly influenced by the histologic subtype/grade and the stage.

Bone marrow involvement is considered as a very important factor in the staging and prognostication of malignant lymphomas. The involvement of bone marrow in malignant lymphomas is seen commonly even at presentation in aggressive variants of Non Hodgkin's Lymphoma (NHL) while less commonly in Hodgkin's Disease (HD).

Bone marrow biopsy (BMB), an important investigation used in the evaluation of marrow involvement may be rendered unreliable due to a number of pitfalls in the standard procedure. This has a significant impact in the initial staging, prognostication and treatment of the disease.

Literature reveals that 18 F FluroDeoxyGlucose Positron Emission Tomography (FDG PET) is an effective procedure in the staging of lymphoma and assessment of bone marrow involvement. The purpose of this study was to evaluate the utility of FDG PET in the detection of bone marrow involvement during routine staging of the disease in untreated confirmed cases. FDG PET scan of 40 patients of lymphoma (HD 19, NHL 21) was evaluated by experienced Nuclear Medicine Physicians. The uptake of the tracer in the marrow was graded as normal or positive using visual grading system. Bone marrow biopsy reports were obtained from the case notes of the referring hospitals.

19 cases of HD with an age range of 10-55 years which included 15 males and 4 females demonstrated concordance between the FDG PET findings and the BMB report in 11 cases (58%) whereas in 8 cases (42%) a discordance of PET positive and BMB negative was seen.

21 cases of NHL with an age range of 16-55 which included 16 males and 5 females showed concordant results in 17 cases (81%). 3 cases were positive on FDG PET with normal BMB. One case was normal FDG PET with a positive BMB. As the results indicate FDG PET demonstrated higher positivity than BMB in HD and comparable results were seen in NHL.

Thus in the work up of bone marrow involvement, FDG PET is very efficient for demonstrating bone marrow involvement either focal or diffuse, which in case of focal infiltration may be missed by bone marrow biopsy if the site is distant from that of the biopsy. Hence, FDG-PET and bone marrow biopsy can be considered to be indeed complementary in the management of Lymphomas.

Key wordsFDG PETBone marrow biopsyLymphoma

ijnm-20-4-oral004-004

Labeling of 2-Methyl-5-Nitroimidazole-IDA Derivative with [^99mTc (CO)₃(H₂O)₃]⁺ for Possible use in Targeting Tumor Hypoxia

Mallia

Madhava B

Subramanian

Suresh

Banerjee

Sharmila

Sarma

H.D.

Venkatesh

Meera

Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai - 400085, India

Abstract

Available techniques for the detection of tumor hypoxia being invasive have their own inherent drawbacks. In such a scenario use of suitable radiopharmaceuticals for the detection of tumor hypoxia is gaining importance. Nitroimidazoles are known to accumulate and bind to viable hypoxic cells in tumor. Their mechanism of binding to the intracellular matrix is well established. Earlier, in our lab, we had radiolabeled the xanthate derivative of metronidazole (a 5-nitroimidazole) with 99m-technetium nitrido core¹. The biodistribution in fibrosarcoma tumor bearing Swiss mice showed steady retention of the complex in tumor throughout the period of study (3h). However, significant blood binding and significant retention and slow clearance from liver posed difficulty towards its use.

Retention in liver possibly be attributable to the high lipophilicity of the complex. To circumvent this problem, in the present study, a less lipophilic iminodiaceticacid (IDA) derivative (L1) of 2-methyl-5-nitroimidazole (2M5N) has been synthesized and labeled with 99m-technetium tricarbonyl core. L1 was synthesized (Scheme 1) by reacting 2M5N with N, N-bis (tert-butoxycarbonylmethyl)-bromoethylamine in presence of anhydrous potassium carbonate in acetonitrile. The purified product was then hydrolyzed with 6N HCl to yield the ligand L1. The technetium tricarbonyl core (^99mTc (CO)₃(H₂O)₃]⁺) was synthesized from freshly eluted ^99mTcO₄⁻ and carbonmonoxide gas following a reported procedure. Under optimized conditions 1 mg of the ligand was dissolved in 0.5 mL of saline followed by addition of 0.5 mL of freshly prepared [^99mTc (CO)₃(H₂O)₃]⁺ was added. The reaction mixture was vortexed for two minutes and then incubated at room temperature for 30 min. The complex was characterized by HPLC (Fig 1). The stability of the complex in blood serum was studied at 37°C and the results indicate that the complex exhibits significant stability with retention of radiochemical purity up to an extent of 90% for 3 h.

Preliminary evaluation of the complex was carried out in Swiss mice bearing fibrosarcoma tumor. 0.1 mL of the labeled product (~2500 kBq) was injected into the animal via the tail vein. The animals were sacrificed at various time points of 30,60 and 180 min post injection (p.i.) following which relevant organs were excised for measurement of associated activity. The maximum tumor uptake of 0.84% ID was observed at 30 min p.i. after which the activity decreased with time. The complex showed hepatobiliary clearance with less retention in liver and low level of blood binding. There was no significant accumulation of activity in other vital organs. The results of the present study could be a starting point to synthesize new molecules with improved tumor uptake while retaining the desirable properties of low blood binding and faster clearance from other vital organs.

Key wordsHypoxia imagingNitroimidazolestechnetium carbonyliminodiacetic acidtumor

References1Mallia

M.B.

, Bioorg. Med. Chem. Lett., 15 (2005), 3398-3401.

ijnm-20-4-oral004-005

Scintimammography in Carcinoma Breast

Panda

Samir

Mahapatra

Subash

Nuclear Medicine Dept., Berhampur Orissa

AbstractMaterials

25 cases of clinically suspected Ca breast screened out of 190 breast lumps were subjected to mammoscintigraphy followed by histopathological studies. Age, early menarche, late menopause, nulliparous state, delayed pregnancy (>30 yrs) and positive family history were important risk factors. Nipple discharge and retraction, axillary lymphadenopathy, hard lumps of 15-30 mm diameter were seen.

Methods

20mci Tc99m MDP intravenous in contralateral arm and aquisation of static images at 5 min, 20 min and 2hrs in supine position (ant view), prone position (lat. Oblique view). Scan time was fixed for 60 secs duration

Control

contralateral healthy breast

Data analysis

In display module the images were visualized and ROI were drawn to record tumour to background ratio and generate time activity curve. Steep gradient between tumour and bkg (highT/B ratio) were considered as evidence of malignant lesion. Increase focal tracer uptake of 62.95±0.69 cpm/pixel at 5 min and 105.4 ± 1.23cpm/pixel at 20 min were observed in neoplastic lesion, which is significantly higher compared to background uptake of 18.32 ± 0.17 cpm/pixel at 5 min and 25.36± 1.01 cpm/pixel at 20 min (p<0.001). Peak activity was observed at 20 min in present study. However early images at 5 min also had significantly uptake in malignant lesion. Observation on pattern of 20 min uptake permitted to distinguish between benign and malignant lesion basing on T/B ratio. In malignant lesion T/B ratio at 20 min were 4.02± 0.05 whereas it was 1.04± 0.1 in benign lesion. Histological study proved 20 cases as malignant and 5 cases as benign. Out of them 18 malignant and 4 benign cases were SMM positive (Scintimammography positive). 5 out of 8 histoilogically proved metastatic lymph node showed isotope uptake. One case had bone metastasis.

Summary and Conclusion

Larger malignant lesion above 3 cm were diagnosed with 100% accuracy. It also helped to recognize extent of disease by localizing bone and lymph gland metastasis The sensitivity, specificity, positive predictive value and overall accuracy of the test were 90%,80%,94.4% and 88% respectively. By this simple, cheap and easy procedure one can avoid possibility of needle tract seedling of FNAC procedure with better results of localizing primary and metastatic lesion in same sitting. Though Tc99m MIBI SMM is being currently used for both planar and spect imaging in various advanced centers, the present study using Tc99m MDP is found to be highly informative and useful for early diagnosis of Carcinoma of Breast

Key wordsTc99m MDP/MIBIPlanar and Spect SMM

References1

Diggles

Optimized breast imaging using Tc99m sestamibi-clin. Nucl. Med, 1992, 17: 7612

Komibuchi

Tc99m HMDP accumulation in Breast tumour

Annu. Nucl. Med, 1993, 7: 51

ijnm-20-4-oral004-006

External Irradiation: Effect on Serum Levels of Tumour Markers

Hazra

P Khanna

Hazra

Gupta

Gangwar

Nuclear Medicine Unit, S.N. Medical College & Boston Medical Centre, Agra-282005

AbstractObjective

The very small fraction of the administered RB localizing in the tumours is one of the important limitations in using RB for therapy as contrasted to merely diagnostic scintigraphy. The present study was designed to study the effect of external irradiation not only on tumour uptake but also the circulating levels of a proliferation tumour antigen marker, Tissue Polypeptide Specific Antigen (TPS)which had earlier been observed by us to be a useful marker related not only to histology and grade of various cancers in North India, but also related to clinical course and prognosis. We were particularly interested in the effect if any of these circulating levels on tumour uptake of the radiolabelled M3 antibody directed against this antigen.This communication is confined to describing the effect of external irradiation on tumour markers.

Methods

External radiotherapy group (30 patients): Blood samples were collected in cancer patients (breast/gynaecologic/head and neck) prior to radiotherapy in the Cobalt 60 TelecobaltUnit,and again 1 hour,1 day and 7 days after the first fraction.The fractions administered were as per the advice of the treating radiotherapist and were usually 2 Gy daily over a 5 day Monday to Friday period.

Tumour Marker Assay:

TPS was estimated in the sera of patients by a sandwich immunoassay. When sufficient material had accumulated for running a 96 well/tube assay inclusive of standards, the samples were assayed either by Immunoradiometric assay or by ELISA using the M3 antibody very kindly provided by Prof Bjorklund,President Swedish Cancer Council

Unitage

The level of TPS is expressed as arbitrary international Units/Litre based on a reference preparation originally supplied by M/sBEKI Diagnostics AB, Sweden. The upper limit of normal is 80 units/Litre.

Results

Mean elevations of 10.81+ −3.71% at 1 hour and 11.05 + −3.06% at 1 day were observed, but at 7 days the levels decline, with a mean decrease of 1.96+ −1.12 %.

In the patients since the XRT is delivered in fractions 5 days a week,Monday to Friday each week,the later samples reflect in addition the effect of the second to fifth radiation fractions,albeit the third sample was obtained on Monday after the Saturday and Sunday gap.

Conclusions

These patient studies conform to studies in animals being reported separately that show similar shortlived rises in tumour markers after tumour irradiation. The effect on tumour uptake is being analysed.

Key wordsTumour markersExternal irradiationTPS

ijnm-20-4-oral004-007

Radiolabeling and Biological Evaluation of Tc99m Labeled Cyclophosphamide as a Tumor Marker

Mishra

Anil Kumar

Mishra

Pushpa

Tyagi

Pooja

Chuttani

Krishna

Tiwari

Anjani K

Kumar

Nitin

Sharma

Rajneesh

Institute of Nuclear Medicine and Allied Sciences, Brig. S.K. Mazumdar Marg, Delhi-110054

AbstractIntroduction

Cyclophoshamide, an alkylating agent have alkyl group that can form covalent bonds with cell substituents; a carbonium ion is a reactive intermediate. Most have two alkylating groups and can cause cross-link two nucleophilic sites such as the N7 of guanine in DNA. Their effect occurs during DNA synthesis; the resulting DNA damage triggers apoptosis. Cyclophosphamide is the most commonly used alkylating agent for the systemic therapy of breast, ovary, lung and acute & chronic lymphocytic leukemia's. The wide therapeutic utility of the drug as an anticancer agent implies its preferential accumulation at the tumor site and a wide safety range. We report labeling of Cyclophosphamide with Tc-99m and evaluation of its potentials to mark the tumor.

Methods

Cyclophosphamide was successfully labeled with Tc-99m using reducing agent to lower the oxidation states of Tc. The labeling conditions were optimized by studying the effect of reducing agents concentration, pH, and incubation time etc. to attain maximum radiolabeling. Finally, the product was characterized by instant thin layer chromatography using ITLC-SG with different solvent conditions. The pharmacokinetics and scintigraphic studies were carried out in rabbits and EAT bearing mice respectively.

Results & Conclusion

Radiolabeled Cyclophoshamide exhibited more than 98% labeling efficiency with less than 1% colloid formation. The complex was sufficiently stable in vitro conditions and under physiological conditions for 24 hr. The protein binding and lipophilicity values obtained were 87% and 20% respectively. The pharmacokinetics of Tc-99m Cyclophosphamide revealed biphasic pattern. Biodistribution studies in mice showed the major accumulation of activity in liver, kidneys and tumor. The biodistribution data shows a very significant accumulation at tumor site.

Radiolabeling and biological evaluation of Cyclophosphamide shows substantial promise as an early tumor-imaging agent. As it is reported to be an anticancer drug, the radiolabeling moiety can be used to evaluate the sensitivity of a particular tumor towards Cyclophosphamide chemotherapy.

ijnm-20-4-oral004-008

Development of Frequency Domain Filters for Research Applications

Devakumar

Allen

Moses

Victor

D Raj

Regi

Oommen

¹Department of Nuclear Medicine, Christian Medical College, Vellore, India²Formerly the student of M.Sc. (Physics), Voorhees College, Vellore, India

AbstractIntroduction

Commercial implementations of frequency domain filters are common in Nuclear Medicine and used for clinical purpose. Values of filter parameters like cutoff frequency can be changed and a filter from the available list of filters can be used in commercial implementations. Modifications in filter function and implementation of new filters are not possible in commercial implementations, which are essential for research in image processing in Nuclear Medicine. We have developed our own implementation of frequency domain filters which could be used for research.

Methods

Two types of images were used for this study. First type of image was a simple digital image created in the computer. It was a bright square signal in the dark background. Second type of images was acquired in gamma camera as static images. The images were in spatial domain when they were created. Images were converted to frequency domain using Fast Fourier Transform (FFT). High frequency components were observed in the center of the frequency domain images and applying filters on these images was difficult. So the low frequency components were shifted towards the center and the high frequency components towards the corner of the frequency domain image. When the frequency components were shifted like this, we observed a direct relationship between the frequency and the radius of individual pixels. The radius was calculated as the diagonal distance between the center of the image to the position of the particular pixel in the image.

Butterworth low-pass filter and Gaussian low-pass filter were constructed, which can be used in frequency domain. The filter function use the value of the radius of a particular pixel and the new value for the that pixel was calculated. These new values were stored as a separate image in the corresponding pixel locations. The calculation of new pixel value is affected by the selection of order and cutoff frequency values of Butterworth filter. In Gaussian filter the calculation of new value is affected by the selection of the number of standard deviation. The filters were applied to both types of images. The new image was the filtered image in the frequency domain. This image was then converted back to spatial domain using the Inverse Fast Fourier Transform (IFFT).

Results

It was observed in Gaussian filter that when the number of standard deviation value was reduced from 3 to 0.5, the high frequency components were reduced in the filtered image. Similar effect was observed when the cutoff frequency of Butterworth filter was reduced, as observed in the commercial implementations. When the order of the Butterworth filter was increased above 10, ringing artifacts were observed in the filtered images.

Conclusion

The Butterworth filter and Gaussian filter were implemented and applied for nuclear medicine images. The FFT and IFFT were used for the conversion of images from spatial domain to frequency domain and vice-versa respectively, which allowed the filter to be used in frequency domain. The FFT, IFFT and frequency domain filters implemented in this study could be used in Filtered Back Projection (FBP).

Key wordsButterworth filterGaussian filterFast Fourier Transform

ijnm-20-4-oral004-009

Evaluation of 99mTc-Nitrido Intermediate in Experimental Animals

Shimpi

Radiation Medicine Centre, BARC, Annexe Tata Memorial Centre, Parel Mumbai-12

AbstractObjective

A new class of 99mTc-complexes based on 99mTc-nitrido core [99mTcºN]²⁺ have been introduced in late eighties, which forms highly stable 99mTc-complexes as compared to conventionally obtained from Tc-oxo core [Tc=O]³⁺. The isoelectronic [99mTc-N]²⁺ has the relative advantage over [Tc=O]3+ in that the core exhibits highly chemical stability towards both oxidation reduction. Recently 99mTc-complexes containing a terminal TcºN multiple bond are easily produced with improved chemical methods for getting [99mTcºN]²⁺ intermediate with high radiochemical purity. In the literature, details of pharmacokinetic patterns of [99mTcºN]²⁺ intermediate has not been given, therefore we have evaluated [99mTcºN]²⁺ intermediate in normal and experimental animals.

Methods

The 99mTc-nirido intermediate was prepared by reacting succinic dihydrazid and EDTA in the presence of about 50mg of Sn ion. The radiochemical assay and stability of the product was determined by using ITLC (SG) strips in acetone, saline and ethanol:chloroform:tolune:0.5M ammonium acetate (6:3:3:1) solvent systems. The pharmacokinetic study was carried in experimentally induced infection using E. Coli (EC) in rats. Sterile inflammations were also induced by i. m. injection of 0.1mL of turpentine oil (TURP). Twenty-four h after the induction of infection/inflammation animals were injected i.v. with 99mTc-nitrido intermediate. At 2 h post injection blood samples were collected by cardiac puncture and animals sacrificed. The major organs were dissected including infected/inflamed thigh muscle and normal thigh muscle.

Results

The results of radiochemical assay demonstrated that 99mTcºN remained at origin and free 99mTc migrated at solvent front with acetone and saline solvent system. Radiochemical efficiency was about 98% with longer stability. 99mTc-ºN intermediate mainly excreted through urinary pathways. The ratios of bacterial infected thigh or sterile inflamed thigh/contralateral thigh was then evaluated. At 2 h the ratio was 1.35 ± 0.15 for EC, while ratio for sterile inflammation was 3.44 ± 0.69. Also 99mTc-ºN intermediate showed significantly high accumulation in the kidneys and, low accumulation in the liver.

Conclusion

Very good uptake in infection/inflammation with lower liver and lower hepatobiliary accumulation suggests that, the 99mTc-nirido intermediate core could be good radiopharmaceutical for evaluation of infection and inflammation.

Key words99mTc-nirido intermediateinfection/inflammation imaging

ijnm-20-4-oral004-010

“Paradox of Thin Cortex on Ultrasonography and Non-functioning Kidney on Intravenous Pyelography in relation to Relative GFR in Hydronephrotic Kidney”

Soni

Manmohan K.

Vyas

Madhusudan

Joshi

Pradeep

Dept. of Nuclear Medicine, Choithram Hospital & Research Centre, Indore

AbstractObjective

Evaluation of Relative and Split GFR with Tc-99m-DTPA are the hallmark of renal function in a hydronephrotic kidney's salvageability. The present study is an analysis of the status of this nuclear medicine technique in relation to the finding of thin cortex (TC) in ultrasonography (USG) and Non-function kidney (NFK) in intravenous pyelography (IVP).

Material and Methods

29 patients, 16 males, 13 females in the age range of 9 months to 70 year were analysed. Of these 18 patients belonged to a group of non-lithiasic hydronephrotic (HN) kidney with PUJ obstruction, 5 lithiasic HN kidney with PUJ obstruction, 4 HN with pyeloplasty, 1 HN with percutaneous nephrolithotomy (PCNL), 1 operated case of Horse shoe kidney. Single head GE millennium Gamma camera was used with Gate's method of evaluation for relative GFR (RGFR) and split GFR (SGFR). I/V dose of Tc - 99m-DTPA was injected in paediatric patient using Websters rule and adult dose was 4 to 5 mCi. RGFR and SGFR of all patients were compared and relation to the finding of TC in USG and NFKinI.V.P.

Results

4 patients (14%) had 0% RGFR in accordance with TC in USG and NFK in I.V.P., 8 patients (28%) had RGFR in range of 0 to 10% (Average SGFR =2.2 ml/min), 8 patients (28%) had RGFR of 10 to 20% (Average SGFR = 11.35ml/min), 3 patients (10%) had RGFR of 20 to 30% (Average SGFR = 15 ml/min.), 3 patients (10%) had RGFR of 30 to 40% (Average SGFR = 27.3ml/min), 3 patients (10%) had RGFR of 40 to 50% (Average SGFR = 43 ml/min). RGFR and SGFR were in concordance in only 4 patients (14%). Rest of the patients (86%) were discordant to variable degree in relation to TC in US G and NFK in I. V.P. Report of NFP and IVP were available for upto RGFR of 25%, whereas TC on USG were reported in all the above mentioned patients.

Conclusion

Applying the Urologist's criteria for HN renal salvageability of RGFR of 15% approximately and SGFR of more than 10 ml/min, it is observed that about 45% of these patients with TC and NFK have salvageable HN kidneys. This fact indicates the importance of functional component of Tc-99m-DTPArenogram in decision making of urologist. Additional measures of evaluating such HN kidneys with Tc-99m-DTPA scan after PCNL or stenting should be done to find realistic RGFR and SGFR, which also provides indirect information of anticipated improvement after either pyeloplasty or pyelolithotomy.

Key wordsRelative GFRSplit GFRThin CortexHydronephrotic KidneyNon-functioning kidney

ijnm-20-4-oral004-011

Gallium-67 Scintigraphy in Sarcoidosis

Chauhan

Department of Nuclear Medicine, Command Hospital Pune, India

Abstract

Diagnosis of sarcoidosis is still a challenge in view of its clinical, radiological and histo-pathological features mimics with many other diseases. Many a time invasive procedures like, BAL/TBLB/biopsy results are inconclusive, patient refuses for invasive procedures and at times invasive procedure is risky inview of severe pulmonary function impairment. In such difficult and confusing cases the whole body Ga-67 scan helps in clinching the diagnosis and provides greater degree of confidence in making diagnosis of sarcoidosis. Reported sensitivity of Ga-67 scanning in detecting pulmonary sarcoidosis varies from 60%-90% though the specificity is not very high. The unique pattern of Ga-67 uptake is highly suggestive of sarcoidosis. The Ga-67 uptake by right paratracheal and bilateral hilar lymph nodes produce a picture which resembles the Greek letter Lambda, classified as lambda sign.The images produced by a Gallium-67 uptake in nasopharynx, parotids and lacrimal glands resembles the face of Panda bear named as panda sign. Isreal at all found lambda pattern in only 29% sarcoidosis cases but no patients of lymphoma⁹.In our centre 90 known patients of lymphoma were taken up for Ga-67 whole body scanning, lambda pattern was not seen in any case of lymphoma. Where as out of 15 cases of suspected sarcoidosis,lambda pattern was seen in four cases. Thus suggesting high specificity of lambda sign in sarcoidosi.

Gallium scan has been used for years in sarcoidosis as a marker of activity, a determiner of the extent and distribution of disease, diagnostic support and aid in therapeutic management. It is currently used mainly to assist in diagnosis in difficult cases, particu-larly in those with isolated extra thoracic sarcoidosis. The findings of typical lambda and panda pattern support the diagnosis. Detection of clinically silent extra-thoracic uptake may provide sites for biopsy.

ijnm-20-4-oral004-012

FDG PET + CT Scan in the Follow up of Patients with Colorectal Carcinoma

Singh

Natasha

Krishna

Department of Nuclear Medicine, P.D. Hinduja National Hospital & Medical Research Centre, V.S.Marg, Mahim, Mumbai 400 016, India.

AbstractAim

To assess the role of FDG PET + CT FUSION imaging in patients of colorectal carcinoma for the detection of recurrence and upstaging of disease in known recurrence patients.

Materials and Methods

We studied a total of 32 patients of colorectal carcinoma from June 2003 to August 2005 who were on follow up in the post treatment period with CEA levels and routine CT scans. 6 patients (in group I) had rising CEA levels with negative CT scans, while in (group II) 14 patients had raised CEA levels with suspicious lesions on CT scans. In (group III) 12 patients had normal CEA levels with suspicious lesions on CT scan of inconclusive significance. Whole body PET imaging was performed with 10mCi FDG.

Results

In all the 6 patients of group I, the PET scan revealed presence of disease in the following sites - retroperitoneal lymph nodes, liver, lung, mediastinum, vertebrae, femur, scapula. In group II of 14 patients, the FDG PET scan was positive in all 14 patients. In 5 of these patients there was upstaging of the disease, while in 8 patients the suspicious lesions on CT scan were strongly positive with no evidence of disease elsewhere, and in 1 patient the scan was false positive. In group III patients, PET was positive in 9 patients, of which 3 were false positive. The remaining 3 patients had negative PET scans, of which one was false negative.

Conclusion

Our study demonstrated detection sensitivity of 96% in the context of recurrence, and changed the management approach in 49% of the patients.