Liver Functional Evaluation Using Gadoxetic Acid Versus the Gold Standard Hepatobiliary Scintigraphy in Patients with Bile Duct Diseases

Objective. To compare liver function assessments using Gd-EOB-DTPA-enhanced MRI and the gold standard hepatobiliary scintigraphy (HBS) in patients with bile duct diseases.

Material and methods. The investigation enrolled 18 patients (male/female = 11/7; age, 29–70 years, Klatskin tumor (n=16), bile duct epithelial dysplasia (n=1), intrahepatic cholangiolithiasis (n=1)) after biliary decompression, who underwent 21 paired MRIs and 99mTc-mebrofenin HBS at a study interval of no more than 3 days. In the same regions of interest with a size of 30–50 pixels located in liver segments II–III, IV, V–VIII, and VI–VII, a MRI signal was measured before MR contrast agent (MRCA) injection into the standard vascular phases and at 10, 20, 30 and 40 minutes, then the signal was expressed as a percentage of intensity compared to the precontrast series. After MR volumetry, the functional volumes of the left and right liver lobes were also defined as the area under the MRCA accumulation curve, which was multiplied by the lobe volume and expressed as a percentage of the similarly calculated function of the entire liver. Similar intensity parameters and functional volumes were estimated for a HBS study.

Results. The lobe functional volumes measured by the two methods were highly correlated (R=0.8; p<0.001) and did not show a significant difference at all when comparing with the Mann–Whitney test (p>0.3). The excretion rate of 99mTc-mebrofenin was also highly correlated with MRI findings (R=0.5–0.9; p<0.05). Conclusion. Gd-EOB-DTPA-enhanced MRI revealed a high correlation with the gold standard; however, additional studies are needed to clarify the possibilities and limitations of replacing one method with another one.><0.05).

Conclusion. Gd-EOB-DTPA-enhanced MRI revealed a high correlation with the gold standard; however, additional studies are needed to clarify the possibilities and limitations of replacing one method with another one.

Complex Monitoring of Biochemical and Radionuclide Parameters in Patients with Metastatic Renal Cell Carcinoma during Immunotherapy

STUDY OBJECTIVE

To study the effectiveness of complex monitoring of the kidney function, based on biochemical and radionuclide methods in patients with metastatic renal cell carcinoma (mRCC).

MATERIALS AND METHODS

41 mRCC patients after nephrectomy received nivolumab (n = 23) and interferon-α (n = 18) from 2015 to 2017. At baseline and 2 months after, all patients underwent blood chemistry, urinalysis, Rehberg test, and ELISA to determine serum levels of IL-17A, TGF-β, and erythropoietin. The monitoring of the renal function and urodynamics by complex renal scintigraphy (CRS) was used for all patients using a dual-detector gamma camera and simultaneous data recording in 2 projections. The interpretation of CRS data used the original SENS CRS technology.

STUDY RESULTS

Statistically significant correlations were established between IL-17A, TGF-β, and D (excretion rate of 99mTc-technephore from the parenchyma) and Rnfsc (a stable sign of nephrosclerosis), respectively. A significant correlation was established between the parameters of the complex functional monitoring with the prognosis for the risk of renal failure (RF) and efficacy of immunotherapy in mRCC.

CONCLUSIONS

All mRCC patients after nephrectomy were recommended to undergo biochemical monitoring with inclusion of TGF-β and IL-17A, as well as radionuclide monitoring (CRS) to determine the RF risk at an early stage.

Modern methods for diagnosis and monitoring of nephrotoxicity during antitumor therapy with platinum derivatives

Chemotherapy is an important method of antitumor therapy. Nephrotoxicity characteristic of many cytostatics, including platinum compounds, is a serious complication limiting the drug dose [4,5,7-9]. Platinum derivatives, in particular, cisplatin, are drugs of choice in the treatment of the majority of solid tumors. However, cisplatin induces a dose-dependent toxic damage to the kidneys [5,7,8,10].

[Nephro-urological monitoring technology based on radionuclide functional tests (tasks of an automated workplace)]

The paper deals with a diagnostic informational and analytical system (DIAS). The system is based on the current concept of a dynamic model of nephro-urological clearance macroregulation under retention factors at the pre-, intra-, and postrenal levels during drug load tests. DIAS includes a package of dynamic renoscintigraphic techniques, as well as original software support. A system for parameters of renal clearance regulation has been developed, which is effective at nephro-urological screening and monitoring at all treatment stages for cancer patients. A two-detector chamber which permits the mounting of a detector at an angle to the patient's body is the optimum diagnostic apparatus for a cancer clinic. The use of functional tests makes it possible to examine the regulatory reserves for each kidney, followed up by the choice of adequate corrective measures to prevent renal failure during treatment. In some cases, DIAS monitoring frequently shows a higher sensitivity to the signs of latent renal failure than does routine clinical and laboratory monitoring. The effective radiation dose taken by a patient during a study by the DIAS technology aimed at reducing radioopaque doses is 100-150 times higher than that at an X-ray study and is an order less than during routine urinary tests.

[High-dose ifosfamide in the treatment of patients with soft tissue sarcoma]

The increasing doses of 2.4-3.5 g/m2 ifosfamide, i/v, dropwise, were administered for 40 min, on days 1-5 each week, for 3 weeks, in 4 courses. Simultaneously, MESNA was given in a dose two-thirds of that of ifosfamide. The maximum single tolerable dose of ifosfamide was 3.2 g/m2. The dose of 3.5 g/m2 proved neurotoxic causing encephalopathy. The other toxic effects were stage III-IV neutropenia (47%), nausea and vomiting (91%) and weakness (33%). No clinical evidence of renal failure was attributed to the high dosage of the drug in the course of assays of biochemical components of the blood, blood- and urine-beta-2-microglobulins, N-acetyl-D-hexoaminidase (NAG) level in urine, creatinine clearance and complex renoscintigraphy data. On days 3-5, ifosfamide treatment was followed by increase in NAG and beta-2-microglobulin levels in urine which pointed to the toxic effect exerted on the epithelium of renal tubules. The antitumor effect was apparent in 5 (29%) patients for 6 months, which testifies to the high effectiveness of ifosfamide treatment for soft-tissue sarcoma.

[A complex of mathematical models in the radionuclide diagnosis of the status of the urinary system]

Various mathematical models describing the process of transport of nephrotropic radiopharmaceutic drugs in the body of patients are used at present on a wide scale in processing the results of radionuclide studies of the urinary system functional status. The authors propose to give an objective quantitative assessment on the basis of a complex consisting of 3 mathematical models.

[Choice of method for determining the individual clearance of the kidneys]

Some criteria for assessment of the adequacy of various radionuclide methods of determination of the separate renal clearance were proposed. Some methods were analyzed according to these criteria: one of them was proposed by S. U. Schlegel et al. and used in the paper by M. E. Karaev and R. N. Samedov, and the other one was proposed by V. Kh. Frenkel' and V. B. Shushkovskiĭ. Both methods were shown to be insufficiently substantiated from physiological and mathematical view-points. A method of assessment of the separate renal clearance in the form of a circulation model was proposed. It was based on the minimal possible number of simplifying allowances and made it possible to define the state of secretory-excretory (or filtration) function and the state of hemodynamics of each kidney as a result of single administration of a transit nephrotropic radiopharmaceutical.