Usefulness of thallium-201 muscle scan to investigate perfusion reserve in the lower limbs of patients with systemic lupus erythematusus

Patients with systemic lupus erythematosus (SLE) may develop premature atherosclerosis, notably peripheral vascular disease presenting with intermittent claudication or gangrene. This study evaluates the usefulness of thallium-201 muscle perfusion scan (Tl-201 muscle scan) for investigating perfusion reserve in the lower limbs of 25 asymptomatic, female SLE patients without peripheral ischemia findings. The patients showed no evidence of peripheral arterial disease in history, physical examination, or Doppler ultrasonography. A control group consisted of 24 healthy, age-matched women. Each subject flexed her right foot maximally both dorsally and plantarly 60 times. In the middle of this exercise, 2 mCi of Tl-201 was injected intravenously. Three minutes after the injection, a posterior image of both calves was obtained using a gamma camera. Rectangular regions of interest were symmetrically drawn over both calves. The total count in the resting calf was subtracted from the total count in the exercising calf, and the percentage of increase, termed the perfusion reserve, was determined. A significant difference was found between the perfusion reserves of the SLE patients and control groups (75.3+/-8.9% and 99.6+/-9.0%, respectively, P <0.05). In conclusion, perfusion reserve in the lower limb muscles of SLE patients may be measured by Tl-201 muscle perfusion scan.

P-Glycoprotein and multidrug resistance-related protein expressions in relation to technetium-99m methoxyisobutylisonitrile scintimammography findings

The purpose of this study was to retrospectively study 48 patients with infiltrating ductal breast cancer to evaluate the relationship between the degree of accumulation of technetium-99m methoxyisobutylisonitrile (Tc-MIBI) and P-glycoprotein (Pgp) or multidrug resistance-related protein (MRP) expression in breast cancer tissues. Before surgery or biopsy, all 48 patients underwent scintimammography started 10 min after the injection of Tc-MIBI. Tumor:background (T:B) ratios were calculated from the Tc-MIBI scintimammography. Immunohistochemical analysis was performed on the pathological specimens of the 48 breast tumors to determine Pgp and MRP expression. According to the results of immunohistochemical analysis, the 48 breast cancers were separated into four groups: (a) group 1, 12 cancers with both positive Pgp expression and positive MRP expression; (b) group 2, 12 cancers with positive Pgp expression and negative MRP expression; (c) group 3, 12 cancers with negative Pgp expression and positive MRP expression; and (d) group 4, 12 cancers with both negative Pgp expression and negative MRP expression. Among the four groups, the T:B ratio was lowest in group 1 (1.13+/-0.10) and highest in group 4 (2.17+/-0.14), respectively (P < 0.05). The T:B ratios of groups 2 (1.30+/-0.25) and 3 (1.32+/-0.26) were between those of groups 1 and 4. Our data confirmed that Tc-MIBI scintimammography is useful for determining Pgp and MRP expression in patients with breast cancers.

Comparison of 18-fluoro-2-deoxyglucose positron emission tomography and computed tomography in detection of cervical lymph node metastases of nasopharyngeal carcinoma

Neck lymph nodes (LNs) from 18 patients with nasopharyngeal carcinoma (NPC) were evaluated with 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET). Eighteen NPC patients underwent head and neck FDG-PET and computed tomography (CT) for detection of suspected neck LN metastases. For final diagnosis, biopsies were taken from neck LNs with discordant findings between FDG-PET and CT. Meanwhile, standard uptake values (SUVs) of the FDG-PET images were calculated to differentiate metastatic LNs from benign LNs. A total of 90 neck LNs found on either FDG-PET or CT were evaluated. In addition to 27 concordant positive results and 42 concordant negative LN results, biopsy findings revealed 11 metastatic LNs that were detected by FDG-PET but not by CT. However, the SUVs of the 11 metastatic LNs and 7 benign LNs were not significantly different. The CT scanning showed positive findings for I metastatic LN with negative FDG-PET findings. In addition, the tumor stage was upgraded in 5 patients on the basis of FDG-PET findings. In comparison with CT, FDG-PET has a higher potential for detecting neck LN metastases of NPC and assessing NPC tumor stage.

Using 99mTc-DTPA radioaerosol inhalation lung scintigraphies to detect the lung injury induced by consuming Sauropus androgynus vegetable and comparison with conventional pulmonary function tests

Consuming Sauropus androgynus, a Malaysian plant, to reduce body weight began to become fashionable in Taiwan in 1994. According to some reports, people consuming this vegetable developed lung injuries. From July to November 1995, there were 81 nonsmoking women admitted to our hospital. Thirty-six cases had respiratory symptoms/signs and the remaining 45 had no symptoms/signs. We investigated these patients with pulmonary function tests (PFT) and technetium-99m DTPA radioaerosol inhalation lung scintigraphies (DTPA lung scan), a test to evaluate the lung ventilation and alveolar epithelial permeability. Eighteen patients had abnormal results in PFT, including obstructive type (n = 17), restrictive type (n = 5), and both (n = 4). There were 33 patients with abnormalities in DTPA lung scans, including unhomogeneous deposition of DTPA radioaerosols (n = 19), faster clearance of radioaerosols from lung (n = 26), and both (n = 12). Analyzing the results, we found that the patients with respiratory symptoms had a higher incidence of abnormal results of PFT and DTPA lung scans than the patients without respiratory symptoms (p < 0.05). Besides, we found that the DTPA lung scan was more sensitive than chest x-ray and PFT in detecting the lung injuries related to the consumption of S. androgynus (p < 0.05). Consuming S. androgynus can result in symptomatic or asymptomatic lung injuries, manifested as obstructive or restrictive ventilatory impairment, unhomogeneous radioaerosol distribution, and increased alveolar epithelial permeability. In addition, measurement of the 99mTc-DTPA clearance is the most sensitive test to detect the lung injuries caused by consuming S. androgynus.

Evidence for decreased salivary function in patients with reflux esophagitis

It has been speculated that impaired salivary flow contributes to abnormal acid clearance of the esophagus in gastroesophageal reflux and results in reflux esophagitis (RE). To test this hypothesis, salivary functions were measured by quantitative salivary scintigraphies in patients with RE and in age- and sex-matched controls for comparison. Nineteen patients with RE and 36 healthy volunteers were enrolled in the study. After an intravenous injection of 5 mCi Tc-99m pertechnetate, sequential images of 1 min/frame were acquired for 30 min. The 1- and 15-min uptake ratios (UR) of the tracer in the four major salivary glands over the backgrounds were calculated. Saliva excretion was stimulated by 1 tablet of 200 mg ascorbic acid given orally 15 min after injection of the tracer, then the maximal excretion ratios (ER) of the four major salivary glands were calculated for the sialagogue stimulation. RE patients had lower values of 1st and 15th min UR and maximal ER than controls in the 4 major salivary glands. Poor salivary functions which represented a decrease in both UR and ER for patients with RE have been confirmed by quantitative salivary scintigraphy in this study.

Detecting alveolar epithelial injury following volatile anesthetics by (99m)Tc DTPA radioaerosol inhalation lung scan

BACKGROUND

Many volatile anesthetics have long been thought to affect alveolar epithelial permeability.

OBJECTIVE

The purpose of this study was to examine the acute effects of volatile anesthetics on the permeability of the alveolocapillary barrier to (99m)Tc DTPA.

METHODS

Twenty-seven patients (24 females, 3 males, age 29-73 years) undergoing operation were enrolled in this study and grouped according to the type of anesthesia received. Group 1 patients were administered 1% halothane. Group 2 patients were given 1.5% isoflurane. Intravenous anesthesia without volatile anesthetics were used for group 3 patients. Before and after anesthesia, (99m)Tc DTPA radioaerosol inhalation lung scans were performed to detect alveolar epithelial injury due to volatile anesthetics. The negative slope of the regression line was designated as the (99m)Tc DTPA pulmonary clearance rate and was expressed in terms of percentage decrease in radioactivity per minute.

RESULTS

In group 1, the (99m)Tc DTPA clearance rates were 1.26 +/- 0.34 and 1.29 +/- 0.38 before and after anesthesia, respectively. The difference was not significant (p > 0.05). In group 2, the rates were 0.76 +/- 0.20 and 1.10 +/- 0. 37, before and after anesthesia, respectively. The difference was significant (p < 0.05). In group 3, the clearance rates were 1.07 +/- 0.38 and 1.21 +/- 0.48, before and after anesthesia, respectively. The difference was not significant.

CONCLUSIONS

Following isoflurane administration, the more rapid pulmonary clearance of (99m)Tc DTPA indicates that isoflurane increases the permeability of the alveolo-capillary barrier.

Evaluation of regional cerebral blood flow with 99mTc-HMPAO in primary antiphospholipid antibody syndrome

In this study, 99mTc-hexamethyl propyleneamine oxime (HMPAO) SPECT was used to evaluate the regional cerebral blood flow (rCBF) of the brain in patients with primary antiphospholipid antibody syndrome (PAPS).

METHODS

Twenty-two women who were PAPS patients, aged 28-60 y, with mild neuropsychiatric manifestations and normal brain MRI findings were enrolled in this study. Brain HMPAO SPECT was performed to detect brain abnormalities. Meanwhile, serum anticardiolipin antibodies (ACA) and lupus anticoagulant (LA) were measured.

RESULTS

HMPAO SPECT revealed hypoperfusion lesions in 16 of 22 (73%) PAPS patients. Cerebral cortex and cerebellum were the most and the least commonly involved areas, respectively. Eighteen of 22 (82%) and 14 of 22 (64%) patients had positive ACA and positive LA, respectively. ACA and LA results were related to HMPAO SPECT findings.

CONCLUSION

HMPAO SPECT is a sensitive tool for detecting brain abnormalities in PAPS patients with only mild neuropsychiatric manifestations and normal brain MRI findings.

The role of FDG-PET, HMPAO-SPET and MRI in the detection of brain involvement in patients with systemic lupus erythematosus

Involvement of the brain is one of the most important complications of systemic lupus erythematosus (SLE); however, its diagnosis is difficult due to the lack of effective imaging methods. We combined three brain imaging modalities - positron emission tomography with fluorine-18 2-fluoro-2-deoxy-d-glucose (FDG-PET), single-photon emission computed tomography with technetium-99m hexamethylpropylene amine oxime (HMPAO-SPET) and magnetic resonance imaging (MRI) - in order to detect brain involvement in SLE. Thirty-seven SLE patients, aged 22-45 years, were divided into three groups. Group 1 (G1) consisted of ten patients with major neuropsychiatric manifestations; group 2 (G2) consisted of 15 patients with minor manifestations; and group 3 (G3) consisted of 12 patients without manifestations. FDG-PET findings were abnormal in 51% of patients: 90% of G1, 67% of G2 and 0% of G3 patients respectively. HMPAO-SPET findings were abnormal in 62% of patients: 100% of G1, 73% of G2 and 17% of G3 patients respectively. MRI findings were abnormal in 35% of patients: 70% of G1, 40% of G2 and 0% of G3 patients respectively. Grey matter was more commonly involved than white matter; 62% of patients presented with lesions in the cerebral cortex, 27% with lesions in the basal ganglion, 5% with lesions in the cerebellum, and 19% with lesions in white matter. No white matter lesions were found on FDG-PET or HMPAO-SPET. However, in 19% of patients, MRI demonstrated abnormally high signal lesions in white matter. Forty-three percent of cases had positive serum anticardiolipin antibodies (ACA). However, ACA was not related to FDG-PET, HMPAO-SPET or MRI findings. It may be concluding that HMPAO-SPET is a more sensitive tool for detecting brain involvement in SLE patients when compared with FDG-PET or MRI. However, MRI is necessary for detecting lesions in white matter.

Detection of recurrent or persistent nasopharyngeal carcinomas after radiotherapy with 18-fluoro-2-deoxyglucose positron emission tomography and comparison with computed tomography

PURPOSE

The effectiveness of positron emission tomography (PET) with 1 8-fluoro-2-deoxyglucose (FDG) for detecting suspected recurrence of nasopharyngeal carcinomas (NPC) was evaluated and compared with computed tomography (CT).

PATIENTS AND METHODS

FDG-PET studies were performed on 36 NPC patients 4 months after radiotherapy. The images were interpreted visually and quantitatively by calculating standardized uptake values (SUVs).

RESULTS

The sensitivity, specificity, and accuracy of visually interpreted FDG-PET images, for differentiation of recurrent or persistent NPC from benign lesions, were 100%, 96%, and 97%, respectively. Cases with recurrent or persistent NPC (1.6 to 5.8) had significantly higher SUVs than cases with benign lesions (0.8 to 1.5). The sensitivity, specificity, and accuracy of CT for detecting recurrent or persistent NPC were 72%, 88%, and 83%, respectively.

CONCLUSION

FDG-PET is a better tool than CT for the detection of recurrent or persistent NPC. Either visual interpretation or SUV can be used to differentiate benign lesions from recurrent or persistent NPC.

Technetium-99m-HMPAO SPECT and MRI of brain in patients with neuro-Behçet's syndrome

Involvement of the brain is one of the most important complications of Behçet's disease (BS). It is difficult to diagnose, however, because of the lack of effective imaging methods.

METHODS

Thirteen BS patients with neuropsychiatric symptoms or signs [Neuro-Behçet's syndrome (NBS)] were included in this study. We combined two routine brain imaging modalities-brain SPECT with 99mTc-hexamethyl propyleneamine oxime (HMPAO) and brain MRI-with clinical manifestations to diagnose brain involvement.

RESULTS

Technetium-99m-HMPAO brain SPECT findings were abnormal in 100% (13/13) of patients. Brain MRI findings were abnormal in 31% (4/13) of patients. Gray matter was involved more commonly than white matter. In the gray matter, the cerebral cortex was the most commonly involved area and the cerebellum was the least commonly involved area in NBS.

CONCLUSION

SPECT is a more sensitive and useful tool in detecting brain involvement in NBS patients compared with brain MRI. The combination of HMPAO and MRI is necessary to detect brain lesions in both gray and white matter in NBS.

Gastric emptying in male neurologic trauma

Prolonged gastric emptying half-time (GET1/2) has been observed in several neurological disorders. Most patients with moderate to severe neurologic trauma (NT) initially do not tolerate enteral or nasogastric feedings. However, previous findings of altered gastric emptying (GE) in patients with NT have been questionable. Quantitative measurements of GE, to determine a possible mechanism for intolerance to enteral feeding, are lacking. In this study, we measured GET1/2 sec of solid and liquid meals by radionuclide imaging in men who were neurologic trauma patients.

METHODS

A prospective study was conducted to assess GET1/2 in 30 men who were patients with spinal cord injuries (SCIs) and 20 men who were patients with head injuries (HIs) using radionuclide-labeled solid and liquid meals, respectively. Meanwhile, 18 and 14 male control subjects underwent the same imaging techniques for solid and liquid meals, respectively, to evaluate the normal ranges of solid and liquid GET1/2 sec (84.5 +/- 16.7 and 29.2 +/- 3.7 min).

RESULTS

In the 30 SCI patients, GET1/2 of solid meals was significantly prolonged (138.3 +/- 49.2 min, p < 0.05), and 53% (16/30) of patients had abnormal GET1/2. A more prolonged GET1/2 and a higher incidence of abnormal GET1/2 were observed in patients with high-level injury, when compared with patients with low-level injury (p < 0.05). In the 20 HI patients, GET1/2 of liquid meals was prolonged significantly (51.7 +/- 24.8 min, p < 0.05), and 65% (13/20) of patients had abnormal GET1/2. Coma, as indicated by the Glasgow Coma Scale score, was not a statistically significant factor influencing GET1/2 (p >0.05).

CONCLUSION

NT can cause significantly prolonged GE, especially in patients with high-level SCI.

Regional cerebral blood flow and glucose metabolism in Sjögren's syndrome

Involvement of the brain is one of the most important complications of Sjögren's syndrome (SS). However, diagnosis of brain involvement in SS patients is difficult due to the lack of effective imaging methods. In this study, we compared two updated brain imaging modalities, 18F-2-fluoro-2-deoxy-D-glucose (FDG) PET and 99mTc-hexamethyl propyleneamine oxime (HMPAO) SPECT, in SS patients with neuropsychiatric manifestations, to detect glucose metabolism of the brain and regional cerebral blood flow.

METHODS

Sixteen primary female SS patients with normal brain MRI findings were enrolled in this study.

RESULTS

Technetium-99m-HMPAO SPECT findings were abnormal in 13 (81%) patients. Parietal and temporal lobes were the most common areas of brain involvement. Fluorine-18-FDG PET findings were abnormal in 3 (19%) patients. Temporal lobes were the most common areas of brain involvement.

CONCLUSION

We conclude that brain HMPAO SPECT has better correlation with clinical manifestations than brain FDG PET or CT/MRI.

Gastric emptying in head-injured patients

OBJECTIVE

Most patients with moderate to severe head injury (HI) initially do not tolerate enteral feedings. Intolerance to nasogastric feeding is also commonly observed after HI. Quantitative measurements of gastric emptying (GE), to determine a possible mechanism for intolerance to enteral feeding, are lacking.

METHODS

We prospectively evaluated gastric emptying half-time (GET1/2) of liquid meals in 35 patients with moderate to severe HI.

RESULTS

In comparison with 16 age-matched healthy control subjects (29.4 +/- 3.7 min), GET1/2 was significantly prolonged (57.2 +/- 20.8 min, p < 0.05) and abnormal in 80% of the HI patients. A prolonged GET1/2 and higher incidence of abnormal GET1/2 were observed in female patients, older patients, and patients with low Glasgow coma scale (GCS) scores, when compared with male patients, younger patients, and patients with high GCS scores. However, the differences for the means of GET1/2 and the incidences of abnormal GET1/2 between the subgroup patients were not significant (p > 0.05). In addition, significantly prolonged GET1/2 and higher incidence of abnormal GET1/2 (p < 0.05) were observed in patients with short injury duration, in comparison with patients with long injury duration.

CONCLUSION

Head injury can cause significant prolonged GE of liquid meals, especially in patients with short injury duration.

Technetium-99m methoxyisobutylisonitrile chest imaging of small cell lung carcinoma: relation to patient prognosis and chemotherapy response--a preliminary report

BACKGROUND

The purpose of this preliminary study was to evaluate retrospectively the relation between chemotherapy response and survival time, using technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) uptake in small cell lung carcinoma (SCLC) to detect the expression of multidrug resistance (mdr)-mediated 170-kDa P-glycoprotein (PgP).

METHODS

Before the administration of chemotherapy (which consisted of cisplatin 25 mg and etoposide 125 mg every day per 3-day course), 15 male patients (ages 54-64 years) with SCLC were enrolled in this study to undergo Tc-99m MIBI chest imaging, including single photon emission computed tomography (SPECT) and planar imaging, for qualitative and quantitative assessments of PgP in their SCLC.

RESULTS

In 12 of 15 cases (80%), SCLC could be detected by visual interpretation of the Tc-99m MIBI chest SPECT images. In 13 of 15 cases (87%), Tc-99m MIBI chest SPECT images (either positive SPECT with good response or negative SPECT with poor response) correctly predicted chemotherapy response. The correlation between tumor uptake ratios obtained by planar images (total counts in the region of interest [ROI] of the tumor divided by total counts in the same size ROI of the contralateral normal lung) and survival days (from the time of SCLC diagnosis to the time of the patient's death) was both positive and good (correlation coefficient=0.83).

CONCLUSIONS

Tc-99m MIBI chest images have the potential to demonstrate mdr-PgP expression in SCLC and to predict patient prognosis and chemotherapy response.

Technetium-99m-HMPAO brain SPECT in Sjögren's syndrome

Technetium-99m-hexamethylpropylene amine oxime (HMPAO) brain images with fanbeam SPECT, in combination with surface three-dimensional display, were used to detect basal ganglion and cerebral cortex anomalies in Sjögren's syndrome patients.

METHODS

Forty-eight female Sjögren's syndrome patients with normal brain CT or magnetic resonance imaging findings were enrolled in this study and were investigated using 99mTc-HMPAO brain images with fanbeam SPECT and surface three-dimensional display. These patients were separated into two subgroups. Group 1 consisted of 38 patients with definite neuropsychiatric symptoms/signs and Group 2 consisted of 10 patients without any neuropsychiatric symptoms/signs.

RESULTS

Fanbeam SPECT demonstrated unilateral or bilateral hypoactivity of basal ganglia and thalamus in 14% and 0% of patients in Groups 1 and 2, respectively. Using surface three-dimensional display of the brain, local hypoactivity anomalies were found in the brain cortex of 53% and 20% of patients in Groups 1 and 2, respectively. In Group 1 patients, parietal lobes were the most common areas of brain involvement. The cerebellum and thalamus were the least common areas of brain involvement. In Group 2 patients, parietal and temporal lobes were the most common areas of brain involvement.

CONCLUSION

This study suggests that 99mTc-HMPAO brain imaging with fanbeam SPECT, in combination with surface three-dimensional display, is a sensitive tool for detecting regional cerebral anomalies in Sjögren's syndrome patients with and without neuropsychiatric symptoms/signs.

HMPAO brain SPECT in acute carbon monoxide poisoning

Technetium-99m-hexamethylpropylene amine oxime (HMPAO) brain images with fanbeam SPECT, in combination with surface three-dimensional display, were used to detect basal ganglion and cerebral cortex anomalies in the acute phase of carbon monoxide (CO) poisoning.

METHODS

Ten patients, aged 16-29 yr, with acute CO poisoning and no past history of neurologic disorders were enrolled in this study. After oxygen treatment, all 10 patients were investigated using 99mTc-HMPAO brain images with fanbeam SPECT and surface three-dimensional display. Meanwhile, 6 of 10 patients also received a brain CT scan.

RESULTS

CT scan findings were negative in all 6 patients. Fanbeam SPECT demonstrated unilateral or bilateral hypoactivity of basal ganglia in 6 patients. Local hypoactivity anomalies were found in the brain cortex of 7 patients, using surface three-dimensional display of the brain. Only 2 of 10 patients had normal 99mTc-HMPAO brain images.

CONCLUSION

This study suggests that, in comparison with traditional brain imaging techniques, 99mTc-HMPAO brain imaging with fanbeam SPECT in combination with surface three-dimensional display is a better tool for early detection of regional cerebral anomalies in acute CO poisoning.

Normal data for lumbar spine bone mineral content in healthy Chinese men

The aim of this study was to evaluate the influence of age on bone mineral density (BMD) of teh lumbar spine for health Chinese men. In 430 healthy Chinese men (ages 20-92 years) living on Taiwan, BMD at the level of the 2nd to 4th lumbar vertebraes (L2-L4) was determined with a commercial dual-energy X-ray absorptiometer (DXA). Our study found that the peak BMD value of lumbar spines of healthy Chinese men was 1.056 +/- 0.127 g/cm2 which occurs from age 20 to 29. The results show that a linear correlation between the age and BMD of lumbar vertebraes for healthy Chinese is notable. Only slight decreases of BMD values in the different age groups are found. In comparison with the normal data of white men and Asian men from Japan and Korea, the mean BMD values of lumbar spines of Chinese men seem to be lower than those of the white, Japanese, and Korean men of the same ages. Our findings indicate that the influence of age and ethnicity may exist in the BMD values for healthy Chinese males.

Technetium-99m-tetrofosmin SPECT imaging of lung masses: a negative study

Technetium-99m-tetrofosmin has emerged as a new radiopharmaceutical for myocardial imaging, in competition with 201Tl and 99mTc-MIBI. In this study, 99mTc-tetrofosmin was evaluated for its ability to detect malignant and benign lesions from single solid lung masses.

METHODS

Forty-nine patients with a single solid lung mass based on chest radiograph findings received 99mTc-tetrofosmin SPECT of the chest to evaluate the value of 99mTc-tetrofosmin SPECT for detecting malignant and benign lesions.

RESULTS

Only 61% of the lung malignancies were detected by 99mTc-tetrofosmin SPECT of the chest, including 53% of epidermoid carcinoma (ca), 67% of adeno ca, 75% of small-cell ca, 0% of undifferentiated large-cell ca and 100% of other lung malignancies. In addition, 50% of the benign lesions were detected by chest 99mTc-tetrofosmin SPECT. The probability of tetrofosmin uptake in the mass was not related to mass size. The diagnostic sensitivity, specificity and accuracy were 61%, 50% and 59%, respectively, for differentiating malignant and benign lesions when diagnosing a single solid lung mass.

CONCLUSION

Technetium-99m-tetrofosmin SPECT of the chest is of little or no value for the detection of lung ca from single solid lung masses.

The relationship of alveolar permeability and pulmonary inflammation in patients with systemic lupus erythematosus

The alveolar epithelium permeability (AP) in 34 patients with systemic lupus erythematosus (SLE) was measured by Tc-99m DTPA radioaerosol inhalation lung scintigraphy. The degree of AP damage in SLE was represented as the slope of the time-activity curve from the dynamic lung imagings. The patients were divided into two subgroups according to the following two criteria. [A] clinical feature: they were separated as stable or flare stage; and [B] chest X-ray findings: they were separated as positive or negative results. Meanwhile, the quantitative Gallium-67 (Ga) lung scan was performed as Ga uptake index (GUI) to evaluate the severity of inflammation in the lungs in SLE. The results show that [1] there were no significant statistical differences in the degree of AP damage between the two subgroups according to clinical features or chest X-ray findings, and [2] no good correlation between the degree of AP damage and inflammation of the lungs was found. In conclusion, the change of AP in SLE may be a mechanism not related to the presentation of clinical features or chest X-ray findings, and the degree of AP damage in SLE is not related to the severity of pulmonary inflammation.

Effects of oral erythromycin on esophageal motility in patients with noninsulin-dependent diabetes mellitus

Fifteen patients with non-insulin dependent diabetes mellitus (NIDDM) were included in the study. Esophageal motility, including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI), was evaluated and calculated by the radionuclide esophageal transit test (RETT). The baseline study was performed before the oral erythromycin therapy. After a 2-week course treatment, the subjects underwent a second study. The results showed that (A) in the baseline study, 93% (14/15) of NIDDM patients had a longer MTT, 67% (10/15) had a higher RF and 80% (12/15) had a higher RI; and (B) after treatment with erythromycin, 73% (11/15) of the patients had a shorter MTT and a lower RF, and 60% (9/15) of the patients had a lower RI. We conclude that (1) most of the NIDDM patients had esophageal motility disorders and (2) a 2-week oral erythromycin therapy can improve diabetic esophagoparesis, as evaluated by non-invasive REET.

Effects of corticosteroid inhalation therapy on lung ventilation and alveolar permeability in asthma using TC-99M DTPA radioaerosol inhalation lung scintigraphy

This study evaluates the effects of steroid inhalation on lung ventilation (LV) and alveolar permeability (AP) in 26 patients with asthma. The homogeneity of LV was evaluated as the inhalated Tc-99m diethylene triamine pentaacetic acid (DTPA) radioaerosol depositing ratios of the central 1/3 over peripheral 1/3 of the left lung. It is shown as a distribution factor (DF) in this study. The damage in AP was measured from the speed of Tc-99m DTPA radioaerosol clearance curves from the peripheral alveoli of the left lung and is represented as a slope in this study. The baseline LV and AP were calculated before an inhalation therapy of 0.05 mg beclomethasone dipropionate four times daily for one week, then the studies were repeated after treatment to evaluate the effects of inhalation therapies. The results revealed a significantly improved homogeneity of LV in 16/26 (62%) cases (DF: 0.79 +/- 0.32 vs 0.59 +/- 0.22, P = 0.0001), but no apparent change in AP (slope: 1.18 +/- 0.78 vs 1.25 +/- 0.88, P = 0.052) after the treatment. In conclusion, a corticosteroid inhalation therapy for asthma can improve the peripheral LV, but can not change the AP according to the findings of Tc-99m DTPA radioaerosol inhalation lung scintigraphy. We suggest that the widely available Tc-99m DTPA radioaerosol inhalation lung scintigraphy, coupled with the evaluation of LV and AP could contribute to any disorder involving both alveoli and airways.