bluuebunny/crossref_metadata_2025 huggingface dataset:
Vergleichende Funktionsbeurteilung unbehandelter Nierentransplantate der Katze
Authors: Müller-Beissenhirtz P. , Althoff J. , Mohr U. , Klinke J.-D.
Published: March 2018

Die Darstellung der Zusammenhänge zwischen Verlauf, Ausscheidungsuro-gramm, Serienszintigraphie und Histo-Morphologie im vereinfachten Modell der unbehandelten Transplantatniere der Katze zeigt, daß von diesen Funktions-untersuchungen nur auf das histologische Substrat der Schädigung geschlossen werden kann, sofern Daten des Verlaufes sowie die Ausscheidungsleistung durch Kontrollen in kurzen zeitlichen Abständen gemeinsam berücksichtigt werden.

Trotz der hohen Konzentrationsleistung der Katzennieren reicht die Filtrationsleistung gegenüber Röntgenkontrastmitteln nach i.v. Applikation nur zu einer beschränkten Funktionsbeurteilung in den früheren und weniger fortgeschrittenen Stadien der Abstoßungsreaktion aus, während die morphologische Darstellung der ableitenden Harnwege bei noch ausreichender Filtration der Serienszintigraphie überlegen ist. Bei der Serienszintigraphie setzt eine sichere Beurteilung nach ätiologischen Gesichtspunkten eine noch erkennbare Gliederung des Ausscheidungsvorganges in die Phasen der Aktivitäts-Anflutung, -Aufnahme, -Passage und -Exkretion voraus. Diese ist — sofern keine Gefäßkomplikationen vorliegen — bis in das Stadium der subtotalen Nekrose des Transplantates erhalten.
Röntgenologische und szintigraphische Befund-Diskrepanz bei „Wabenlunge“ (Kasuistische Mitteilung)
Authors: Choné B.
Published: March 2018

Röntgenbefund und szintigraphisches Untersuchungsergebnis sind wertvolle Hilfsmittel für die Funktionsdiagnostik von pulmonalen Affektionen. Der spezielle Aussagewert wird im Einzelfall mitbestimmt von pathogenetischen Faktoren. Der eigene Beitrag bezieht sich auf die eigenartige Befunddissonanz von Röntgenbild und Perfusionsszintigramm bei einem 60jährigen Mann mit chronisch-obstruktivem Lungenemphysem und lokalisierter Wabenlunge.
Die Anwendung simultaner Doppelisotopenuntersuchungen auf Funktionsstudien
Authors: Schenck P. , Lange D.
Published: March 2018

Der zeitliche Verlauf der Anreicherung eines Radioisotops oder Pharmakons, gemessen mit externen Detektoren, wird mathematisch formuliert. Bei Kenntnis der Durchblutung des untersuchten Gewebebereiches und des darin enthaltenen Intravasalvolumens kann der Extraktionskoeffizient explizit ermittelt werden. Da Durchblutung und Intravasalvolumen selten mit dem dem Stoffwechsel bzw. der Clearance unterliegenden Radiopharmakon selbst bestimmt werden können, auch Kontrollen dieser Größen nicht möglich sind, muß ein zweites Isotop bzw. Pharmakon simultan appliziert werden.

Der Sonderfall der zeitkonstanten Clearance liefert die schon bekannten Zusammenhänge zwischen Clearance bzw. Extraktionskoeffizient und Halbwertszeit der Aktivitätskonzentration im Blut. Allgemeine mathematische Lösungen für ein oder auch zwei — simultan applizierte — Isotope werden angegeben.

Wegen der nahezu abstandsunabhängigen Nachweiswahrscheinlichkeit der Anger-Kamera und der Möglichkeit, mit diesem Gerät bei gegebener morphologischer Darstellung zielgerichtete Untersuchungen der Clearance und des Extraktionskoeffizienten durchzuführen, wird diesem Gerät für die neuerdings möglichen simultanen Doppelisotopenuntersuchungen der Vorzug gegeben.
Postural Changes in Essential Hypertension under Treatment and their Effect on the Renogram
Authors: Alexandrou C. , Papadakis E. , Gyftaki E. , Darsinos J.
Published: March 2018

Radioisotope renograms were obtained in the upright and prone position in 9 normal subjects, in 5 patients with untreated essential hypertension and in 21 hypertensives under treatment, showing moderate postural hypotension.

No significant renographic change were seen in the two positions in normal subjects and untreated hypertensives. Treated hypertensives with postural hypotension showed significant impairment of renal function in the upright position in 15 cases and no change in 6. Renal creatinine clearance was lower in the group that showed renographic changes. Renography in the upright position is suggested as a convenient test for early diagnosis and follow-up of the adverse effects of antihypertensive treatment.
A Study of Simultaneous Radioactive Gold and Cytostatic Therapy in the Treatment of Malignant Effusions
Authors: Schenck P. , Lange D. , Varmas K. D.
Published: March 2018

I. A combination of radiogold and cytostatic drugs appears to give the best results in the treatment of malignant effusions.

II. No correlation could be found between the type of tumour and the response to therapy.

III. Asymptomatic patients seem to respond better to either forms of therapy.

IV. The lasting relief may occur after 6–12 instillations of cytostatic drugs following 198Au therapy.

V. The longest relief experienced in the present study lasted 2 years and 4 months and occured after a single application of 198Au.
Nierensequenzszintigraphie mit 113mIn-EDTA und Simultan-Bestimmung des Glomerulumfiltrates
Authors: Falkensammer M. , Höllwarth M. , Riccabona G. , Bauer H.
Published: March 2018

Bei 36 Patienten wurde versucht, mit 113mIn-EDTA in einem die glomeruläre Filtrationsrate zu bestimmen und eine Sequenzszintigraphie der Nieren durchzuführen. Die Werte der glomerulären Filtration wurde mit denen von 125J Jothalamat verglichen, die Aussagefähigkeit der Szintiphotos wurde der von 131J Hippuran-Scans gegenübergestellt. Die Ergebnisse zeigen, daß bei Blutentnahmen 35, 50 und 65 Minuten nach Applikation von 2 mC 113mIn-EDTA das Glomerulumfiltrat in durchaus befriedigender Weise errechnet werden kann. Die Kombination dieser funktionellen Nierenuntersuchung mit der Sequenzszintigraphie ermöglicht in einem Untersuchungsgang bei sehr geringer Strahlenbelastung auch eine morphologische Beurteilung der Nieren, in manchen Fällen auch eine Artdiagnostik von Nierenläsionen. Dies ergibt sich durch Aufnahmen von Szintiphotos in der Initialphase der Untersuchung zur Erfassung der Durchblutungsverhältnisse, während in der Folge das Nierenparenchym szintigraphisch beurteilt werden kann.

Bei den bekannten Vorzügen von 113mIn scheint daher die geschilderte Kombinationsuntersuchung eine wertvolle Bereicherung der nuklearmedizinischen Nierendiagnostik zu sein.
Untersuchung des Pfortadersystems nach intrasplenischer Applikation von Radionukliden unter Anwendung einer Szintillationskamera
Authors: Seidlová V. , Kuba J.
Published: March 2018

Die Autoren berichten über Erfahrungen mit einer neuen Untersuchungsmethode der Isotopen-Splenoportographie. Sie applizieren dabei intrasplenisch 5-10 mCi 99mTc-Pertechnetat, wobei das Durchströmen des radioaktiven Bolus durch das Pfortadersystem mit Hilfe einer Szintillationskamera in Verbindung mit Video-Rekorder und Kernspeicher verfolgt wird. Simultan applizieren sie intrasplenisch MAA-131J und auf dem Schirm des Kernspeichers bewerten sie deren Deposition in den Lungen, die ein Vorhandensein portosystemischer Shunts anzeigt. Anhand eines Krankenguts von 61 untersuchten Patienten wird auf die Eignung dieser Methode zum Nachweis eines kollateralen Kreislaufs, zur Bestimmung des Typs portosystemischer Shunts, ferner auf den Beitrag dieses Untersuchungsverfahrens in der Diagnostik prähepatischer portaler Hypertension und bei Durchgängigkeitsbeurteilung chirurgisch durchgeführter Anastomosen hingewiesen.
Szintigraphische Lymphabflußstudien am Penis mit 198Au-Kolloid
Authors: Lichtenauer P. , Scheer K. E. , Georgi P.
Published: March 2018

Durch subkutane Injektion von 100 bis 200 μCi 198Au-Kolloid lassen sich die Lymphabflußbahnen des Penis darstellen. Da nach Injektion von Radiogoldkolloid in das Praeputium und in die Glans dieselben Lymphknotenketten dargestellt werden, kann auf die schwierige Applikation in die Glans verzichtet werden. Bei den hier vorgenommenen Untersuchungen hatte es sich gezeigt, daß der Lymphabfluß nicht immer symmetrisch erfolgt. In der Mehrzahl der Fälle war der linksseitige Lymphabfluß bevorzugt. Der vorgestellten Untersuchungsmethode kommt deshalb bei der Bestimmung der Lage und der Richtung der Lymphabflußbahnen bei malignen Peniserkrankungen eine Bedeutung zu, da sie eine wesentliche Hilfe für die Diagnostik und die Therapieplanung beim Peniskarzinom darstellt.
Studies in Nitrogen-Cold Stabilized Polyphosphates
Authors: Halpern S. , Alazraki N. , Ashburn W. , Turner F.
Published: March 2018

Wir präsentieren ein neues Verfahren für die Vorbereitung von PPO4-Vorrichtungen, die sich für 99mTc-Kennzeichnung eignen. Die von uns vorgeschlagene Methode benutzt die N2-Stabilisierung der Polyphosphat-Vorrichtung anstelle der Trockenfriermethode, über die berichtet wurde. Die auf diese Art vorbereiteten (N2-stabilisierten) Polyphosphat-Vorrichtungen zeigten eine chromatographische Bindungseffizienz zwischen 87 und 96% bei der Benutzung von Dünnschicht-Chromatographie mit verschiedenen Lösesystemen. In-vivo-Studien an Tieren zeigten für diese Methode eine 6wöchige Stabilität. Auch erscheint eine sehr gute Korrelation zwischen in-vitro-Bindeeffizienz und in-vivo-Wirksamkeit zu bestehen. Nachweislich kann PPO4 auf intravenösem, intramuskulärem oder intraperitonealem Wege zugeführt werden, wobei der Qualitätsunterschied der Studien gering ist.
Compartment Analysis of 131I-Iothalamate and Glomerular Filtration in the Rat
Authors: Seeber Alejandro , Sallemi Maria , Pecorini Victorio , Henry André
Published: March 2018

Dans le but d’obtenir une méthode permettant la détermination du volume de filtration glomérulaire (GFR) chez des petits animaux sans qu’il soit nécessaire de recueillir les urines, nous avons étudié la distribution et l’excrétion du 131Iiothalamate (IOT) chez le rat. Le volume de distribution théorique (VD) est de 44.49 ± 5 ml/100 gr et le GFR de 0.91 ± 0.09 ml/min/100 gr. Le VD du IOT chez le rat préalablement néphrectomisé est de 24.49 ± ml/100 gr, ce résultat n’est pas significativement différent du VD de l’inuline. Le volume plasmatique mesuré avec du Bleu d’Evans est de 6.49 ± 0.5 ml/100 gr. L’espace interstitiel de l’IOT determiné a partir de la différence entre le VD chez le rat nephrectomisé et son volume plasmatique est de 18 ml/100 gr. La valeur du GFR déterminée par cette méthode est similaire aux résultats obtenus par d’autres procédés, ce qui nous pousse a penser qu’elle peut être d’une certaine utilité.
Vergleichende quantitative szintigraphische Untersuchungen mit 99mTc-Pyrophosphat und 85Sr bei pathologischen Knochenumbauprozessen
Authors: Schmitt G. , Strötges M. W. , Reinecke V.
Published: March 2018

In einer Vergleichsstudie von 99mTc-Pyrophosphat- und 85Sr-Szintigrammen an 22 erwachsenen Patienten mit metastatischen Knochenumbauprozessen wurde versucht, die von verschiedenen Autorengruppen hervorgehobene bessere Qualität der 99mTc-Pyrophosphatszintigramme gegenüber 85Sr-Szintigrammen auch quantitative zu belegen:

Wegen der Möglichkeit der höheren Dosierung und der für das Auflösungsvermögen der verwendeten Kollimatoren günstigeren Photonenenergie des 99mTc waren bei den 99mTc-Pyrophosphatszintigrammen 97 einzelne pathologische Anreicherungsherde abzugrenzen gegenüber 58 Anreicherungsherden bei den 85Sr- Szintigrammen.

Quantitative Aussagen über das Anreicherungsverhalten beider Nuklide in pathologischen Knochenumbauprozessen sowie in normal speichernden Skelettabschnitten wurden mit Hilfe von Densitometerkurven getroffen. Hierbei wurden die Steilheit des Aktivitätsanstieges, die maximale Kurvenhöhe und die Untergrundaktivität berücksichtigt. Die entsprenchenden, rechnerisch ermittelten Werte der 99mTc-Pyrophosphat- und 85Sr-Szintigramme zeigten signifikante Unterschiede.
67Ga-Citrate Accumulation by Staphylococcal Abscesses and by Tumors
Authors: Anghileri Leopoldo
Published: March 2018

The in vivo uptake of 67Ga-citrate by staphylococcal abscesses in rats has been studied. The high accumulation of calcium and magnesium in the abscess and in the surrounding tissues appears to be responsible for the accumulation of 67Ga. The role of the mast cells in the inflammatory process which leads to a calcification (calciphylaxis) is discussed and related to their possible involvement in the case of tumor transplants.
Isotope Profile Investigations for the Detection of Venous Thrombosis in the Legs with the Use of 131I-MAA
Authors: Ogiński Michał , Olejnik Jadwiga , Surma Marian , Pertyński Tomasz
Published: March 2018

Twenty patients were tested with an isotope profile method for the detection of venous thrombosis in the leg.

131I-MAA was introduced into the dorsal vein of the foot. The results of the test agreed with the results of phlebography. The authors stress the simplicity and accuracy of the above method.
Ergebnisse der Zysternoszintigrafie
Authors: Glanzmann Ch. , Rau H. , Yonekawa Y. , Piroth H. D.
Published: March 2018

In einer retrospektiven und prospektiven Studie wird die szintigraphisch meßbare Kinetik intrathekal applizierter Tracersubstanzen der durch Zusatzuntersuchungen und den klinischen Verlauf endgültig gesicherten klinischen Diagnose zugeordnet und klassifiziert.

Das Ergebnis der Studie zeigt eine chrakteristische, gut klassifizierbare Tracer-Dynamik bei nicht neurologisch kranken Patienten, während bei verschiedenen neurologischen Krankheitsbildern demgegenüber typisch abnormale Verläufe registriert werden.
Indium (111In)-Labelled Bleomycin for the Detection of Intracranial Lesions
Authors: Merrick M. V. , Chaucer B. , Clay B. , Lavender J. P. , McCready V. R. , Thakur M. L. , Walter L. H.
Published: March 2018

Brain scans with 99mTc pertechnetate were compared with scans made after administration of 111Indium bleomycin in 38 patients scanned on 41 occasions. They gave similar results in 34 pairs of examinations, including cases in which both failed to detect the tumour. In seven cases, the two agents differed. In two of these bleomycin distinguished residual tumour from the effects of craniotomy more clearly than did pertechnetate; in three bleomycin apparently detected tumour not seen with pertechnetate, and in two the differences may have been due to technical factors, or are unexplained.
Determination of Placental Blood Flow by External Monitoring of 113mIn
Authors: Olkkonen H. , Suonio S. , Haring P.
Published: March 2018

A simple and noninvasive technique was developed to evaluate the blood perfusion rate within human placenta. The method is based on monitoring the accumulation of the isotope 113mIn in the placental intervillous space using a single detector as a measuring device. The result was expressed as an accumulation index calculated from the tracer appearance curve. The In accumulation index was significantly lower in preeclamptic patients than in the controls, but with a marked overlapping. The In index was significantly correlated with the simultaneously recorded maternal minute volume, 24-hour estrogen excretion and birthweight. No correlation was found with the placental weight or Laakso’s perfusion index. Uterine contractions induced a significant decrease in the In index. The authors conclude that the In accumulation index can be used as an objective measure of the placental blood flow.
Evolution of Autonomy in Idiopathic Non-Toxic Goiter, Evaluated by Regional Suppressibility of 99mTc-Uptake and TSH Response to TRH
Authors: Clemmensen O. J. , Hummer L. , Dige-Petersen H.
Published: March 2018

Seventeen euthyroid patients with non-toxic goiter were studied, 7 had diffuse goiters and 10 had nodular goiters. The TSH response to TRH and the 99mTc-uptake were measured before and after T3 suppression. The uptake, measured with a gamma camera, was calculated for the whole gland and for a maximum of 6 regions within the thyroid gland.

The suppressibility of 99mTc-uptake (percent change of uptake) ranged from 0 to 95%, it was significantly greater in patients with diffuse than in those with nodular goiters, and was alike in nodular and inter-nodular tissue. The patients with diffuse goiter were significantly younger than those with nodular goiter. Abolished TSH response to TRH was seen in 2 patients with negative T3 suppression tests. In another 2 patients impaired TSH response was associated with impaired suppressibility. In 13 patients with normal TRH tests, the suppression of uptake was normal in 8 and subnormal in 5.

The results suggest that nodularity and functional autonomy may develop in non-toxic goiters. In some of these goiters the mass of autonomous tissue may be large enough to cause negative TRH tests, probably indicating hypersecretion of thyroid hormones, although not necessarily above the normal range.
Zur Häufigkeitsverteilung eines Index für freies Thyroxin nach Alter und Schilddrüsenstatus
Authors: Leb G. , Goebel R.
Published: March 2018

Es wurden die FT4I von Kollektiven verglichen, die auf Grund des Radiojodtestergebnisses gebildet wurden. Eine von anderer Seite berichtete Erhöhung des FT4I bei älteren Frauen konnte nicht nachgewiesen werden. Auch die „Grauzone” zwischen Eu- und Hyperthyreosen ist nicht so breit gefunden worden, wie anderwärts berichtet, was möglicherweise mit Auswahl und Zusammensetzung der Kollektive zusammenhängt. Beim Kollektiv mit erniedrigten Speicherwerten im Radiojodtest zeigte sich ein unerwartet großer Prozentsatz von erhöhtem FT4I, wahrscheinlich also von Hyperthyreosen. Die Zahl der Hypothyreosen in diesem Kollektiv ist gegenüber den jodprämedizierten Patienten relativ gering. Fälle mit normalem Radiojodtest und pathologischem Hemmtest dürften mehrheitlich einen normalen FT4I aufweisen, also euthyreot sein, zu einem kleineren Teil aber tatsächlich an einer Hyperthyreose leiden. Bei den Fällen mit Status nach Radiojodtherapie fordert die Häufigkeit von erhöhten FT4I-Werten eine breitere Untersuchung des Verlaufs solcher Erkrankungen in Zusammenschau mit der verabreichten Dosis.
Schlafwandeln oder nächtliche epileptische Anfälle?
Authors: MÖddel Gabriel , Dag Ramazan , Jafarpour Amir-Arsalan , Heidbreder Anna
Published: March 2018

Nächtliche Verhaltensauffälligkeiten treten bei ca. 4% aller Erwachsenen auf. Die Differenzialdiagnosen sind zahlreich und beinhalten neben Verhaltensauffälligkeiten, die z.B. assoziiert sind mit respiratorischen Ereignissen (z.B. bei obstruktivem Schlafapnoe-Syndrom), vor allem Parasomnien. Davon abzugrenzen sind schlafassoziierte Epilepsien.
Schlafsucht & eine bunte Psychopathologie
Authors: SchwerthÖffer Dirk , Wiegand Michael H.
Published: March 2018

Wir beschreiben den Fall einer 19-jährigen Frau, die wegen periodisch auftretender hypersomnischer (d.h. mit einem übermäßigen Schlafbedürfnis verbundenen) Episoden sowie produktivpsychotischer Symptomatik in unsere stationäre Behandlung gegeben wurde; die Einweisung wurde von ihrer Mutter veranlasst.
Hypoglossusnerv-Stimulation für Patienten mit obstruktiver Schlafapnoe
Authors: Hofauer Benedikt , Heiser Clemens
Published: March 2018

Obstruktive Schlafapnoe ist eine der am häufigsten auftretenden Erkrankungen in Industrieländern. Als Standardverfahren zur Behandlung ist die nächtliche Überdruckbeatmung über eine Maske etabliert. Alternative konservative Behandlungsverfahren sind unter anderem Unterkieferprotrusionsschienen oder Therapien zur Rückenlageverhinderung. Im Bereich der chirurgischen Therapien ist eine Vielzahl verschiedener Eingriffe möglich, doch liegen nur wenige Langzeitdaten mit größeren Fallzahlen vor. Mit der Hypoglossusnerv-Stimulation wurde nun ein weiteres Verfahren in die klinische Routine eingeführt.
Is there a benefit of 131I-MIBG therapy in the treatment of children with stage 4 neuroblastoma?
Authors: Simon T. , Hero B. , Eschner W. , Dietlein M. , Sudbrock F. , Bongartz R. , Berthold F. , Schicha H. , Schmidt M.
Published: March 2018

Aim: 131I-meta-iodobenzylguanidine (131I-MIBG) therapy has been used in neuroblastoma treatment for many years but its value in high intensive first line treatment protocols is not exactly known. Patients, methods: Stage 4 neuroblastoma patients >1 year with 123I-MIBG positive residual disease (primary tumour and/or metastasis) after complete induction chemotherapy according to the German neuroblastoma trial NB97 were retrospectively analyzed. Results: One-hundred-eleven patients had 123I-MIBG positive residual disease after complete induction chemotherapy. Forty patients received 131I-MIBG therapy using a median activity of 0.44 GBq/kg body weight. By univariate analysis, patients who underwent 131I-MIBG therapy had a better 3-year event free survival (3-y-EFS 46±8%) and 3-year overall survival (3-y-OS 58±9%) than 71 patients without 131I-MIBG therapy (3-y-EFS 19±5%, p=0.003; 3-y-OS 43±6%, p=0.037). However, subgroup analysis of 66 patients who underwent high dose chemotherapy with autologous stem cell transplantation (ASCT) during treatment found a very similar outcome with 131I-MIBG therapy (3-y-EFS 49±9%, 3-y-OS 59±10%) and without 131I-MIBG therapy (3-y-EFS 33±9%, p=0.171; 3-y-OS 59±9%, p=0.285) due to the dominating effect of ASCT. By multivariate analysis, 131I-MIBG therapy had no impact on EFS (p=0.494) and OS (p=0.891). Only ASCT, external beam radiation therapy and MYCN amplification were important for EFS and OS. Conclusions: An independent advantage of I-131-MIBG therapy could not be proven in this retrospective analysis. The ongoing German Neuroblastoma Trial NB2004 will address the influence of 131I-MIBG therapy with emphasis on tumour dosimetry.
Prevention, screening and therapy of thyroid diseases and their cost-effectiveness
Authors: Moka D. , Schmidt M. , Theissen P. , Schicha H. , Dietlein M.
Published: March 2018

Cost-effectiveness analyses focused on benign thyroid diseases are under-represented in the literature. The calculation of costs per additionally gained life year is difficult: The benefit of prevention is shifted into the distant future. The influence of an untreated subclinical thyroid disease on life expectancy can only be demonstrated by a long-term follow-up and by epidemiological databases. Iodine supplementation and programs for the prevention of tobacco smoking (primary prevention) are very cost-effective. Smoking increases the risk both of multinodular goiter and of Graves’ disease. Screening programs (secondary prevention) are discussed for the laboratory parameters thyrotropin (TSH), calcium and calcitonin. TSH testing seems to be very cost-effective for epidemiological considerations in a certain lifespan (newborn, pregnancy, postpartal, older persons, hospitalisation due to acute diseases) and in persons with previously elevated TPO-antibodies or TSH-values >2 mU/l, but dedicated cost-effectiveness analyses are lacking. On the other hand, the cost-effectiveness of a routine TSH testing beyond the age of 35 years has been shown by a high-quality decision analysis. Therapeutic strategies (tertiary prevention) aim at the avoidance of complications (atrial fibrillation, myocardial infarction, death for cardiac reasons) and of iatrogenic complications. Examples of a tertiary prevention are: firstly the definitive therapy of Graves’ disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), secondly the radioiodine therapy for subclinical hyperthyroidism and the radioiodine therapy of large goiters in older patients or in patients suffering from a relevant comorbidity. Cost-effectiveness analyses for different therapeutic strategies of Graves’ disease were published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%.
Time consumption and quality of an automated fusion tool for SPECT and MRI images of the brain
Authors: Platsch G. , Schwarz A. , Schmiedehausen K. , Tomandl B. , Huk W. , Rupprecht Th. , Rahn N. , Kuwert T. , Fiedler E.
Published: March 2018

Aim: Although the fusion of images from different modalities may improve diagnostic accuracy, it is rarely used in clinical routine work due to logistic problems. Therefore we evaluated performance and time needed for fusing MRI and SPECT images using a semiautomated dedicated software. Patients, material and Method: In 32 patients regional cerebral blood flow was measured using 99mTc ethylcystein dimer (ECD) and the three-headed SPECT camera MultiSPECT 3. MRI scans of the brain were performed using either a 0,2 T Open or a 1,5 T Sonata. Twelve of the MRI data sets were acquired using a 3D-T1w MPRAGE sequence, 20 with a 2D acquisition technique and different echo sequences. Image fusion was performed on a Syngo workstation using an entropy minimizing algorithm by an experienced user of the software. The fusion results were classified. We measured the time needed for the automated fusion procedure and in case of need that for manual realignment after automated, but insufficient fusion. Results: The mean time of the automated fusion procedure was 123 s. It was for the 2D significantly shorter than for the 3D MRI datasets. For four of the 2D data sets and two of the 3D data sets an optimal fit was reached using the automated approach. The remaining 26 data sets required manual correction. The sum of the time required for automated fusion and that needed for manual correction averaged 320 s (50-886 s). Conclusion: The fusion of 3D MRI data sets lasted significantly longer than that of the 2D MRI data. The automated fusion tool delivered in 20% an optimal fit, in 80% manual correction was necessary. Nevertheless, each of the 32 SPECT data sets could be merged in less than 15 min with the corresponding MRI data, which seems acceptable for clinical routine use.
Value of combined XCT/SPECT technology for avoiding false positive planar 123I-MIBG scintigraphy
Authors: Özer S. , Dobrozemsky G. , Kienast O. , Beheshti M. , Becherer A. , Niederle B. , Kainberger F. , Dudczak R. , Kurtaran A.
Published: March 2018

Aim: The clinical value of combined XCT/SPECT technology in a single device in patients undergoing 123I-MIBG scintigraphy was analyzed. Methods: 31 patients (19 men, 12 women; mean age 55 years, range: 31-79 years) demonstrating focal accumulation in planar 123I-MIBG scan were further investigated with a double headed gamma camera with an X-ray tomograph mounted on the same gantry (GE Medical Systems, Millennium VG with Hawkeye, Milwaukee, USA) for anatomical definition of the focal 123I-MIBG uptake. The patients were referred to 123I-MIBG scintigraphy because of biochemically (81%) and/or clinically (19%) suspected pheochromocytoma. Results: In 23 out of 31 patients (74%) the fused images demonstrated physiological accumulation (i. e. intestinal, renal) of 123I-MIBG. In two patients (6%) suspected adrenal MIBG-accumulation was caused by inhomogeneous liver uptake. In two patients (6%) focal abdominal accumulation was correctly localised in the adrenal glands. Furthermore, the differentiation of bone metastasis from a local recurrence for phaeochromocytoma was accurately possible for two patients (6%). Adrenal lesions mimicking liver foci were correctly localised in the remaining two patients (6%). Conclusion: Our study demonstrates the clinical value of XCT/SPECT in a single device in patients demonstrating focal 123I-MIBG uptake in planar scintigraphy. The combined XCT/SPECT technology provides a higher diagnostic accuracy.
Gender dependent rate of metabolism of the opioid receptor-PET ligand [18F]fluoroethyldiprenorphine
Authors: Spilker M. E. , Sprenger T. , Hauser A. I. , Platzer S. , Boecker H. , Toelle T. R. , Wester H.-J. , Henriksen G.
Published: March 2018

Aim: The morphinane-derivate 6-O-(2-[18F]fluoroethyl)- 6-O-desmethyldiprenorphine ([18F]FDPN) is a nonselective opioid receptor ligand currently used in positron emission tomography (PET). Correction for plasma metabolites of the arterial input function is necessary for quantitative measurements of [18F]FDPN binding. A study was undertaken to investigate if there are gender dependent differences in the rate of metabolism of [18F]FDPN. Methods: The rate of metabolism of [18F]FDPN was mathematically quantified by fitting a bi-exponential function to each individual’s dynamic metabolite data. Results: No statistically significant gender differences were found for age, weight, body mass index or dose. However, significant differences (p <0.01) in two of the four kinetic parameters describing the rate of metabolism were found between the two groups, with women metabolizing [18F]FDPN faster than men. These differences were found in the contribution of the fast and slow kinetic components of the model describing the distribution of radioactive species in plasma, indicating a higher rate of enzyme-dependent degradation of [18F]FDPN in women than in men. Conclusion: The findings reinforce the need for individualized metabolite correction during [18F]FDPN-PET scans and also indicate that in certain cases, grouping according to gender could be performed in order to minimize methodological errors of the input function prior to kinetic analyses.
Thallium-201 scan in evaluating thyroid nodules following equivocal fine-needle aspiration cytology
Authors: Lee J. K. , Liu R. S. , Wu S. Y. , Chou M. C. , Huang W. S.
Published: March 2018

The aim of this prospective study was to evaluate the usefulness of the thallium-201 (201Tl) thyroid scan in the detection of malignancy in cold thyroid nodules whose status was equivocal following palpation fine-needle aspiration cytology (FNAC). Patients, methods: Fifty-one patients with clinically palpable solitary cold thyroid nodules classified as non-diagnostic or suspicious following biopsy underwent 201Tl thyroid scans. Each scan was performed 15 min (early scan) and 3 h (delayed scan) after an intravenous administration of 74 MBq 201Tl. Thallium uptake in the nodules was visually assessed and scored on a three point scale, with a grade of three defining malignancy. All patients underwent surgery and the histopathology of nodule tissues were compared with results of the scans. Results: Fifty-one nodules were examined. Forty were benign and 11 were malignant. For early scans, the diagnostically relevant parameters were: sensitivity (100%), specificity (75%), and accuracy (80%). Corresponding findings for the delayed scan were: 91%, 98%, and 96%. Conclusion: The 201Tl scan is useful for detecting malignancy in cold thyroid nodules classified as nondiagnostic or suspicious lesions by FNAC.
Comparison of dobutamine-stress magnetic resonance imaging and dipyridamole-Tl-201-SPECT as alternative strategies for the detection of coronary artery disease in patients not suitable for stress-echocardiography
Authors: Jochims M. , Theissen P. , Baer F. M. , Crnac J. , Voth E. , Schneider C. A. , Erdmann E. , Schicha H. , Schmidt M.
Published: March 2018

Aim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutami-ne-MRI) with dipyridamole-Tl-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echocardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-seg-ment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPECT studies, which were evaluated using a 28-segment modeli. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis >50%.) Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. Eor dipyridamole-SPECT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPECT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer.
High-activity samarium-153-EDTMP therapy followed by autologous peripheral blood stem cell support in unresectable osteosarcoma
Authors: Bielack S. , Flege S. , Eckardt J. , Sciuk J. , Jürgens H. , Schober O. , Franzius Ch.
Published: March 2018

Purpose: Despite highly efficacious chemotherapy, patients with osteosarcomas still have a poor prognosis if adequate surgical control cannot be obtained. These patients may benefit from therapy with radiolabeled phosphonates. Patients and Methods: Six patients (three male, three female; seven to 41 years) with unresectable primary osteosarcoma (n = 3) or unresectable recurrent sites of osteosarcomas (n = 3) were treated with high-activity of Sm-153-EDTMP (150 MBq/kg BW). In all patients autologous peripheral blood stem cells had been collected before Sm-153-EDTMP therapy. Results: No immediate adverse reactions were observed in the patients. In one patient bone pain increased during the first 48 hrs after therapy. Three patients received pain relief. Autologous peripheral blood stem cell reinfusion was performed on day +12 to +27 in all patients to overcome potentially irreversible damage to the hematopoietic stem cells. In three patient external radiotherapy of the primary tumor site was performed after Sm-153-EDTMP therapy and in two of them polychemotherapy was continued. Thirty-six months later one of these patients is still free of progression. Two further patients are still alive. However, they have developed new metastases. The three patients who had no accompanying external radiotherapy, all died of disease progression five to 20 months after therapy. Conclusion: These preliminary results show that high-dose Sm-153-EDTMP therapy is feasible and warrants further evaluation of efficacy. The combination with external radiation and polychemotherapy seems to be most promising. Although osteosarcoma is believed to be relatively radioresistant, the total focal dose achieved may delay local progression or even achieve permanent local tumor control in patients with surgically inaccessible primary or relapsing tumors.
Overtherapy or undertherapy for papillary thyroid microcarcinoma?
Authors: Schober O. , Schicha H. , Dietlein M.
Published: March 2018

Papillary thyroid microcarcinomas £1 cm have an excellent prognosis both in terms of overall and relapse-free survival. Their high prevalence in autopsy series suggests that most papillary microcarcinomas do not progress to clinically relevant cancer. The extent of surgery is still controversial. Lobectomy or subtotal resection are standard procedures, but multifocal microcarcinomas or lymph node metastases might be overlooked. The pros and cons of completion thyroidectomy and ablative radioiodine therapy are based on limited evidence due to heterogenous inclusion criteria in published series. The retrospective data analyses included subgroups with infiltration of the thyroid capsule, lymph node metastases or multifocal microcarcinomas at the primary staging. The local relapse rate reached approximately 7% after different therapeutic regimes. Radioiodine ablation decreased the recurrence rate in some retrospective studies, but data are inconsistent. Successful radioiodine ablation is possible also after less radical surgery without complete thyroidectomy with postoperative 131I uptake of 10 to 20% or remnants of 3-8 ml. This concept was evaluated successfully in a monocentric series of patients with multifocal microcarcinomas. The therapeutic consideration should include the diameter of the carcinoma, neigh-bourhood to the thyroid capsule, histopathologic subgroups, age, familiar occurrence, patient’s informed consent and in future moleculargenetic tests, too. Therefore, limited surgical procedures for small papillary carcinomas as therapeutic standard, respectively thyroidectomy, lymph node dissection in the central compartment of the neck and ablative radioiodine therapy for individual cases are options for experienced surgeons and specialized tumour centers.
Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 2)
Authors: Dressler J. , Farahati J. , Grünwald F. , Leisner B. , Moser E. , Reiners Chr. , Schicha H. , Schober O. , Dietlein M.
Published: March 2018

The procedure guidelines for radioiodine therapy (RIT) of differentiated thyroid cancer (version 2) are the counterpart to the procedure guidelines for 131I whole-body scintigraphy (version 2) and specify the interdisciplinary guidelines for thyroid cancer of the Deutsche Krebs-gesellschaft and the Deutsche Gesellschaft für Chirurgie concerning the nuclear medicine part. Compared with version 1 facultative options for RIT can be chosen in special cases: ablative RIT for papillary microcarcinoma ≤1 cm, ablative RIT for mixed forms of anaplastic and differentiated thyroid cancer, and RIT in patients with a measurable or increasing thyroglobulin concentration but without detectable metastases by imaging. The description of the pretherapeutic dosimetry now includes the isotopes 123I and 124I as well as a broader range of the activity of 131I. Activities of 2-5 GBq 131I are recommended for the first ablative RIT. If high accumulative activities of 131I are expected, men who have not yet finished their family planning should be advised to the option of sperm cryoconservation. An interdisciplinary consensus is necessary whether the new TNM-classification (UICC, 6th edition, 2002) will lead to modified recommendations for surgical or nuclear medicine therapy, especially for the surgical completeness and for the ablative RIT of pT1 papillary cancer.
Quantitative thyroid scintigraphy for the differentiation of Graves’ disease and hyperthyroid autoimmune thyroiditis
Authors: Sahlmann C. O. , Siefker U. , Lehmann K. , Harms E. , Conrad M. , Meller J.
Published: March 2018

Aim: The TCTUs (global 99mTc-pertechnetate thyroid uptake under suppression) can be used as an estimate of the iodine clearance of non-TSH regulated tissue. High TCTUs levels are characteristic for Graves’ disease (GD). Decreased uptake has been described in autoimmune thyroiditis (AIT). However, systematically investigated data in a larger series of AIT-patients with subclinical or overt hyperthyroidism are not published so far. The purpose of this study is the evaluation of the TCTUs in the differentiation between AIT and GD in patients with hyperthyroidism. Methods: We determined the TCTUs in 59 patients with untreated hyperthyroid GD and in 51 patients with AIT who had subclinical or manifest hyperthyroidism without medication. Patients with GD were characterized by the presence of hyperthyroidism, decreased echogenicity of the thyroid, elevation of TSH-receptor autoantibodies (TRAb). AIT was defined by a decreased echogenicity of the thyroid, absence of elevated TSH-receptor autoantibodies (TRAb), autoantibodies against the thyroid peroxidase (anti-TPO) and spontaneous remission or development of subclinical hypothyroidism within 3 months. Results: Thyroid volumes of patients with AIT were significantly lower than those of patients with GD (p <0.05). TRAb levels were significantly higher in GD-patients (median: 19.5 U/ml; range: 15.3-35 U/ml) than in AIT-patients (median: 1.3 U/ml; range: 0-4.1 U/ml). 73% (38/59) of patients with GD had elevated anti-TPO levels. In these patients anti-TPO levels (median: 768 U/l; range: 83-6397 U/l) were not significantly different from anti-TPO levels of patients with AIT (median: 834 U/l; range: 107-8675 U/l; p = 0.17). TCTUs values of patients with AIT were significantly lower (p <0.05; median: 0.9%; range: 0.1-3.2%) than those of patients with GD (median: 5.7%; range: 1.9-28.3%). Conclusion: In our patients quantitative thyroid scintigraphy with 99mTcO4
- offered rapid and reliable differentiation between hyperthyroid GD and AIT.
Results of a risk adapted and functional radioiodine therapy in Graves’ disease
Authors: Neumann V. , Staub U. , Groth P. , Künstner H. , Schümichen C. , Dunkelmann S.
Published: March 2018

Aim of this study was to find out, if results of a functional orientated radioiodine therapy in Graves’ disease could be optimized using a risk adopted dose concept. Patients, method: 351 patients with Graves’ disease were treated for the first time between 11/97 and 8/01. The basic dose was 125 Gy, which was increased up to 250 Gy in a cumulative manner depending on clinical parameters (initial thyroid metabolism, thyroid volume, immunoreactivity). Two different methods of dosimetry were used. Occasional thyreostasis was withdrawn two days before the radioiodine test was started. Follow up was done on average 8 ± 2,4 (4-17,2) months. TSH ≥0,27 μIU/mL confirmed as a measure of the success. Results: With improved pretherapeutic dosimetry and a mean target dose of 178 ± 31 Gy (n=72) therapeutic success occurred in 66,7%, in 51,4% euthyreosis was restalled and in 15,3% of patients hypothyroidism was seen (TSH >4,20 μIU/mL). With simplified pretherapeutic dosimetry and a mean target dose of 172 ± 29 Gy (n=279) results were moderately impaired (63,8%, 40,1% and 23,7%). With increasing target dose therapeutic failure increased, as unsufficiently adopted risk factors for therapeutic failure turned out the initial thyroid metabolism, the TcTU(s) as the (h)TRAb titer. Conclusion: Functional orientated RIT can be optimized by including illness specific characteristics, principal limitations are a high initial thyroid metabolism, a large thyroid volume and a high (h)TRAb-titer.
Diagnostic 123I and 131I activities and radioiodine therapy
Authors: von Hof K. , Genina E. , Deisting W. , Meller J. , Richter E. , Baehre M. , Meller B.
Published: March 2018

Aim: Urinary iodine excretion (UIE) provides information about iodine supply and release. In the present study we investigated effects of the application of different radioiodine isotopes on UIE in patients with differentiated thyroid carcinoma (DTC). Patients, methods: In 91 consecutive patients with DTC UIE, measured as iodine/creatinine ratio, was determined before and after application of 123I and 131I for diagnostic or therapeutic purposes. Additionally, remnant volume (V) was determined prior to therapy. Group A consisted of 33 patients with supposed successful ablation of DTC. These patients received 370 MBq 131I for diagnostic use and served as controls. 58 patients (group B) with remnants, relapses and metastases received 370 MBq 123I for diagnostics prior to therapy with 1.5-22.2 GBq 131I. Factors influencing individual changes in urinary iodine excretion (ΔUIE) were investigated by using non-parametric tests. Results: In group A UIE did not change significantly after application of 131I. As well, UIE remained unchanged after diagnostic application of 123I in group B. In contrast, UIE increased significantly already 24 h after therapeutic application of 131I in this group. In patients with small remnants (V < 2.5 ml) a significant but only moderate increase of UIE could be observed (average increase: 47 μg I/g crea). In patients with larger remnants, with relapses or metastases increase of UIE values was significant and more pronounced. Conclusions: It was confirmed that UIE increased significantly during radioiodine therapy in patients with DTC and radioiodine-accumulating tissue. The increase of UIE after therapeutic administration of radioiodine can be explained by the disintegrated thyroid follicles in thyroid remnants. The radioiodine-induced iodine release may be one reason for thyroid “stunning” even after application of diagnostic amounts of 131I.
Graves’ disease and toxic nodular goiter – radioiodine therapy
Authors: Dietlein M. , Schicha H.
Published: March 2018

At the 15th conference on the human thyroid in Heidelberg in 2001 the following aspects of the radioiodine therapy of benign thyroid disorders were presented: General strategies for therapy of benign thyroid diseases, criterions for conservative or definitive treatment of hyperthyroidism as first line therapy and finally preparation, procedural details, results, side effects, costs and follow-up care of radioiodine therapy as well as legal guidelines for hospitalization in Germany.

The diagnosis Graves’ hyperthyroidism needs the decision, if rather a conservative treatment or if primary radioiodine therapy is the best therapeutic approach. In the USA 70–90% of these patients are treated with radioiodine as first line therapy, whereas in Germany the conservative therapy for 1–1.5 years is recommended for 90%.

This review describes subgroups of patients with Graves’ disease showing a higher probability to relapse after conservative treatment. Comparing benefits, adverse effects, costs, and conveniences of both treatment strategies the authors conclude that radioiodine therapy should be preferred as first line therapy in 60–70% of the patients with Graves’ hyperthyroidism.
Komplikationen durch Piercings und Tattoos
Authors: Müller Heidrun , Dietz Andreas , Mozet Christian
Published: March 2018

Das Tragen von Körperschmuck in Form von Piercings und Tattoos erfreut sich in der heutigen Zeit zunehmender Beliebtheit. Man schätzt, dass in Deutschland ca. 2–3 Mio. Menschen an anderer Stelle als dem Ohrläppchen gepierct sind, in den USA sollen ca. 10–20% der Teenager und jüngeren Erwachsenen ein Tattoo tragen.

Da es sich bei diesen Methoden um teils invasive Verfahren handelt, können Missachtung geeigneter Hygiene- und Sterilitätsmaßnahmen, Verwendung ungeeigneter Materialien, Unkenntnis anatomischer Bedingungen und Vernachlässigung erforderlicher Nachsorge und Pflegemaßnahmen schwerwiegende Komplikationen zur Folge haben. Mit der steigenden Anzahl gepiercter und tätowierter Personen steigt auch die Liste der Kasuistiken mit entsprechenden Komplikationen in der Literatur an.

Dieser Artikel stellt mögliche Komplikationen nach Piercing und Tätowierung vor und belegt die Zahlen mit Literaturangaben.

Besondere Berücksichtigung findet dabei die Otitis externa, die zumeist als bakterielle Infektion durch Pseudomonas aeruginosa, Staphylokokken und Streptokokken häufig als Folge von Piercings im Bereich des äußeren Ohres zu schwerwiegenden Komplikationen führen kann.

Eine eigene Untersuchung der Abstrichergebnisse zum Erregerspektrum an Patienten mit Otitis externa (n = 51) belegt diese Angaben.
Pulmonary thromboembolism: a retrospective study on the examination of 991 patients by ventilation/perfusion SPECT using Technegas
Authors: Pohlabeln H. , Lemb M.
Published: March 2018

Purpose: Conventional planar ventilation/perfusion (V/P)- imaging in those patients suspected of suffering from pulmonary thromboembolism (PTE) is of limited diagnostic value. It is the purpose of this retrospective study to determine whether the use of V/P- SPECT using Technegas might reduce the rate of those diagnostic uncertainties and might lead to better results. Methods: 991 patients (660 female, 331 male, age 18-90, mean 60), referred to our laboratory with suspected PTE, were examined as follows: patients inhaled 37 MBq of Technegas in the supine position and a SPECT-acquisition was started. Following SPECT-completion, 185 MBq 99mTc-MAA was injected intravenously. SPECT was then repeated. Coronal and transverse ventilation and perfusion SPECT-slices were reconstructed and compared section by section. 85 patients underwent control scans by the same technique at a mean interval of 22 months after the original scans. Results: As the SPECT images in almost all cases made a clear match/mismatch decision possible, we categorized all patients as embolic (PTE+) if there was at least one mismatching defect, and as non embolic (PTE-) if there were none. Our results were: PTE +: 178 patients (18%), PTE-: 808 patients (81%), uncertain: 5 patients (0.5%), if 34 triple-match defects are included: 39 patients (3.9%). 46 patients, categorized as PΪE+ underwent a control V/P scan after anticoagulant therapy. In 44 of these patients, PTE was confirmed by the controls. In a control group of 39 PTE- patients, control scans were unchanged in 38 cases. From these observations we can calculate a sensitivity of 96% and a specificity of 97%. Conclusion: We conclude that V/P imaging can be improved significantly by V/P SPECT using Technegas.