In 65 type I diabetic patients we prospectively evaluated brain perfusion by means of single-photon emission tomography after the injection of 740- 1110 MBq of technetium-99m hexamethylpropylene amine oxime. Thirty-five of the patients presented complications secondary to their diabetes. None showed CNS symptoms. A semiquantitative analysis was performed drawing 50 symmetrical regions of interest (ROIs) per patient. The relative contribution of each ROI to the total blood flow in each slice was compared with the relative contribution of the same ROI in a control group of ten healthy volunteers. Relative values of any ROI in the study group higher or lower than the mean +/-2 SD in respect of the same ROI in the control group were considered abnormal. The results revealed hypoperfusion in 207 ROIs in the 65 patients with diabetes mellitus: of these ROIs, 113 were frontal, 10 frontotemporal, 20 temporal, 18 parietal, 11 occipital and 35 cerebellar. A total of 137 ROIs showed hyperperfusion: 17 frontal, 3 frontotemporal, 19 temporal, 18 parietal, 19 parieto-occipital, 29 occipital and 32 cerebellar. Out of 65 type I diabetic patients, 61 showed at least one hypoperfused ROI (P = 0.0064 vs. controls) and 25 showed more than three hypoperfused ROIs. None of the control subjects showed more than three hypoperfused regions (P<0.001). The results obtained demonstrate the existence of subclinical abnormalities of brain blood perfusion in patients with type I diabetes mellitus and no history of cerebrovascular disease, thereby allowing the initiation of intensive preventive measures.
Sternal infection is a rare complication of median sternotomy but is associated with considerable morbidity and mortality, particularly in the case of deep sternal infection (mediastinitis). Successful treatment depends on early diagnosis and on the location (deep or superficial) of the infection. Radiological techniques have many limitations, and although 67Ga scintigraphy is effective, it delays diagnosis by 48 h. We assessed the diagnostic capacity of planar scintigraphy and single photon emission computed tomography (SPECT) with 99mTc-hexamethylpropylene amine oxime (HMPAO)-labelled leukocytes in deep sternal infections after median sternotomy. We prospectively studied 41 patients with clinical suspicion of deep sternal infection 4 and 20 h after administration of the tracer. The final diagnosis was deep sternal infection in nine patients and superficial sternal infection in 10, with infection being ruled out in 22 patients. Planar scintigraphy did not detect any of the deep sternal infections at either 4 h or 20 h. SPECT correctly identified eight of the nine deep sternal infections at 4 h and all seven at 20 h, with no false positive results. Planar scintigraphy identified 16 of the 18 superficial sternal infections at 4 h and all of them at 20 h. SPECT identified 17 of these 18 infections at 4 h and all of them at 20 h. Other infections unrelated to the sternotomy were identified in seven patients. Leukocytes labelled with 99mTc-HMPAO are a highly reliable method for the early diagnosis of sternal infections after median sternotomy. Use of SPECT allows determination of the depth of the infection and differentiation of superficial from deep sternal infections. It is also possible to detect other sites of infection, thus providing alternative diagnoses.
The purpose of this study was to evaluate the contribution of technetium-99m methoxyisobutylisonitrile (MIBI) scintimammography to the early diagnosis of breast cancer in 78 patients with non-palpable breast lesions detected by mammography. In all cases biopsy was indicated and they were classified into three groups according to the mammographic findings: high (28), intermediate (30) and low (20) mammographic probability of malignancy. Histological diagnosis confirmed 37 benign and 41 malignant lesions. In the high-probability group 99mTc-MIBI scintimammography changed the four false-positives into true negatives at the expense of two false-negatives; in the intermediate group it changed nine of the 17 false-positives into true-negatives at the expense of one false-negative, and in the low-probability group it changed five of the 16 false-positives into true-negatives without false-negatives. Applying scintimammography to patients included in the intermediate and low-probability groups together, 14 of the 33 mammographic false-positives were changed into true-negatives with 1 false-negative; thus, 41% of the unnecessary biopsies would have been avoided. When MIBI scintimammography was applied to the low-probability group, the negative predictive value was 100% and the unnecessary biopsies would have been reduced by 31%.
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