Reliability of visual and quantitative hepatobiliary scintigraphy in the follow-up of patients who have undergone cholecystectomy and transduodenal sphincteroplasty

A noninvasive scintigraphic technique to assess the efficacy of a surgical procedure (e.g., cholecystectomy and transduodenal sphincteroplasty) depends on the development of reliable and accurate qualitative or quantitative diagnostic criteria that allow early recognition of the occurrence and site of complications. For this purpose, the authors divided biliary flow into a four-step progression process and analyzed transit times from the peripheral vein to the gallbladder, common bile duct, and duodenum and the transit time from the common bile duct to the duodenum. These quantitative parameters were assessed in nine healthy volunteers and 31 asymptomatic patients who had previous cholecystectomy to validate their reliability. The results indicate that the four-step Tc-99m HIDA progression analysis provides a reliable, noninvasive evaluation of biliary flow, so that it can be applied to patients who have had cholecystectomy.

99m Tc MIBI prone scintimammography in breast Paget's disease: a case report

A 99m Tc MIBI prone scintimammography (PSM) was performed in a case of underlying Paget's disease of the breast. 99m Tc MIBI PSM showed a diffuse scintigraphic image like a spread of uptake from the deeply located zones of the breast toward epidermis. In vivo, 99m Tc MIBI PSM represents the spread of neoplastic Paget's cells probably attracted by chemotactic factors released by keratinocytes. This spread in Paget's disease is correlated to neu oncogene overexpression which increases the metastatic activity as a consequence of motility enhancement and growth stimulation effect. These scintigraphic images suggest that 99m Tc MIBI PSM could be relevant in management of Paget's disease of the breast.

99mTc SESTAMIBI scintigraphic evaluation of skeletal muscle disease in patients with systemic sclerosis: diagnostic reliability and comparison with cardiac function and perfusion

The diagnosis of skeletal muscle involvement in patients with systemic sclerosis (SSc) is usually based on clinical, laboratory, electromyographic, and bioptic evidence of muscle disorder, whereas SSc cardiac disease is well established by nuclear medicine techniques (radionuclide ventriculography and myocardial scintigraphy). Previous reports have retrospectively hypothesized a possible relationship between cardiac and muscle involvement in scleroderma patients. In order to improve overall diagnostic accuracy in the qualitative/quantitative assessment of skeletal muscle involvement in these patients and to compare these results with those obtained at the cardiac level, diethylenetriaminepentaacetic acid (DTPA)-99mTc radionuclide ventriculography and 99mTc SESTAMIBI myocardial and muscular scintigraphic examinations were performed in 10 SSc patients and in five healthy subjects. Muscular radioactivity, as assessed at thigh and calf levels by means of a segmental score, was significantly decreased in SSc patients in comparison with healthy subjects (global score value 15.6+/-2.2 vs 22.7+/-1.6, p<0.001), as well as right ventricular ejection fraction (RVEF, 34.3%+/-5.3 vs 53.6%+/-4.2, p<0.001) and myocardial segmental perfusion (global score value, 19.6+/-2 vs 25.9+/-1.1, p<0.01). The results show a high frequency of skeletal muscle involvement in patients with SSc. Moreover, scleroderma patients with muscle disorders, as evidenced by scintigraphy, show a comparable occurrence of cardiac involvement, even in the absence of clinical signs of cardiac dysfunction.

99mTc MIBI prone scintimammography in patients with suspicious breast cancer: relationship with mammography and tumor size

99mTc MIBI prone scintimammography (PSM) is reported to be a specific examination in order to assess the nature of breast lesions. Fifty-three patients whose mammography was stratified according to the breast imaging reporting and data system (BI-RADS), the five category classification of mammography approved by the American college of radiology, were studied with prone scintimammography, with the aim of assessing the accuracy of this exam and its usefulness in clinical practice. Thirty-five out of forty-one patients with BI-RADS category V (high probability of cancer) showed cancer at histology. Thirty-one of them had positive PSM. Three out of the six patients with mammo-graphic features of category IV indicated malignancy. PSM was positive in all of them and negative in the three benign lesions. One of the five patients with category III mammography showed cancer and positive PSM. The PSM was negative in 12/13 patients with benign patology (specificity 92.3%). When the cancers were stratified for T-category significant differences were found between the sensitivity for tumors larger or smaller than 1 cm. The sensitivity was 50% for the cancers smaller than 1 cm and 96.9% for those larger than 1 cm. PSM is a very specific method to determine the nature of breast lesions. Its sensitivity is also high but has to be improved when tumors smaller than 1 cm have to be detected. From a clinical point of view PSM can at the moment be considered as an accurate method for the study of borderline lesions of IV and also of III BI-RADS category. In this case a positive PSM indicates an impact in clinical decision making.

[Breast scintigraphy with 99mTc-MIBI in the study of breast cancer]

BACKGROUND

The literature latest data point out the 99mTc-MIBI scintimammography role as a mammography diagnostic complement for a better nosologic definition of the breast nodular pathology. The object of this study is to evaluate the device sensibility and specificity with reference to the several dimensions of the neoplastic nodule.

METHODS

A group of 50 patients, with breast nodule has been studied comparing scintimammography, mammography, echography and istological examination of the removed nodule.

RESULTS

38 nodules out of 50 were carcinomas, 22 were T1 and 16 T2. As far as scintimammography is concerned, the sensibility is 86% in T1 grade and 100% in T2 grade. The specificity is 91.6%.

CONCLUSIONS

Since the mammography often need integration with invasive examinations, (aspiration biopsy, and biopsy) scintigraphy-mammography, global specificity 92%, is suggested as a second level examination in the mammary nodule diagnosis, for the simple performance and for the little risk for the patient.

99mTc-MIBI prone scintimammography in patients with high and intermediate risk mammography

Mammographic lesions can be classified into categories of high (HR), intermediate (IR) and low risk of breast cancer. We have performed 99mTc MIBI scintimammography on 85 patients with high or intermediate risk lesions in order to verify its ability to diagnose cancer before biopsy. The scintimammography was performed in prone lateral view; all the patients were submitted to excisional biopsy. HR lesions showed 86% of cancers and scintigraphic accuracy of 0.81. The accuracy of scintimammography was 0.97 in lesions larger than 1 cm. IR lesions showed 47% of cancer with scintigraphic accuracy of 0.95. The scintigraphic sensitivity was 0.97 lesions larger than and 0.50 in lesion smaller than 1 cm, whereas the specificity was always about 90%. Our results suggest that scintimammography can substantially decrease the need of biopsy for breast cancer diagnosis.