Recently, technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) has been used to image thyroid carcinoma. A prospective study was performed to compare the efficacy of 99mTc-MIBI to thallium-201 (201Tl) scintigraphy in patients with differentiated thyroid carcinoma. The clinical utility of all radionuclide imaging modalities, i.e., 99mTc-MIBI, 201Tl, and iodine-131 Na (131I-Na), as well as serum thyroglobulin estimation, was evaluated. Thirty-four post-thyroidectomy patients (age range: 26-76 years) underwent 45 studies. Histopathologies studied included fourteen papillary, eight papillary-follicular, ten follicular, one Hürthle cell, and one medullary carcinoma of the thyroid. Following optimal stimulation of endogenous thyroid stimulating hormone (i.e, TSH 50 mU/ml), the patients underwent 201Tl and 99mTc-MIBI scintigraphy. Concomitant 131I-Na scintigraphy was performed and serum thyroglobulin levels were measured. Sixteen scan sets were performed prior to 131I-Na ablation therapy. Twenty-nine scan sets were performed following 131I-Na ablation therapy. The presence or absence of thyroid cancer was established by clinical, biochemical, radiologic, and/or biopsy findings. There was no significant difference in sensitivity and specificity of 201Tl scintigraphy versus 99mTc-MIBI scintigraphy in pre- and postablation studies. 131I-Na scintigraphy with determination of thyroglobulin level was sufficient in preablation studies. Among postablation patients, the addition of 99mTc-MIBI or 201Tl offered a higher diagnostic yield. Between the 201Tl and 99mTc-MIBI studies, there was a concordance of 69% in preablation and 97% among postablation patients (P=0.027). It is concluded that 99mTc-MIBI is a suitable alternative to 201Tl scintigraphy in thyroid carcinoma, especially following thyroidectomy and 131I-Na therapy. 131I-Na scintigraphy with serum thyroglobulin is adequate in both pre- and postablation patients. Among the post-131I-Na ablation patients, 99mTc-MIBI or 201Tl is extremely valuable for tumor localization, especially when the 131I-Na whole-body scan is negative. The combination of 99mTc-MIBI or 201Tl scintigraphy with 131I-Na and serum thyroglobulin offers the highest diagnostic yield.
Twenty-six adult patients more than 6-months post-lumbar spinal fusion were studied. Flexion and extension radiographs showing motion or bone scintigrams showing focal areas of increased activity within the fusion mass were considered positive for pseudarthrosis. Patients were classified as either symptomatic or asymptomatic. Among the 15 symptomatic patients, scintigraphy had a sensitivity of 0.78 and a specificity of 0.83 which was superior to the 0.43 sensitivity and 0.50 specificity of radiography. Six of the 11 asymptomatic patients had focal areas of increased activity in the bony fusion mass, possibly reflecting painless pseudarthrosis. Planar imaging was substantially enhanced by SPECT in 14 of the 26 cases. It is concluded that for the patient who remains symptomatic after lumbar spinal fusion, bone scintigraphy with SPECT is of significant value in detecting painful pseudarthrosis.
Background. The optimal management of patients with brain tumors requires knowledge of the tumor characteristics upon presentation and the discovery of recurrence after therapy. Thallium‐201 (Tl‐201) chloride has shown varying uptake in tumors, depending on their viability and the type and degree of malignancy. This study explores the diagnostic potential of thallium imaging in patients with brain tumors. Methods. Forty‐three TI‐201 single photon emission computed tomographic scintigrams were performed on 40 patients with intracranial neoplasms, nearly equally divided between patients with no prior treatment and patients who had prior treatment and were suspected to have recurrent tumor and/or radiation necrosis. A thallium tumor index was calculated as the ratio of counts for a region of interest drawn in the lesion area and its mirror image in normal brain tissue. A two‐tailed Student's t test was performed to compare the thallium index and histopathologic findings. Results. A value of 1.5 for the thallium tumor index allowed for the best correlation between the prediction of malignancy and the histopathologic results. In the pretreatment group, a thallium tumor index greater than 1.5 correlated with high grade malignancy, and less than 1.5 correlated with either a well differentiated astrocytoma or benign cyst. In the posttreatment group, a thallium tumor index greater than 1.5 correlated with recurrent and/or residual malignant tumor. Conclusions. For those patients undergoing initial evaluation, the thallium study can help in the differential diagnosis of an intracranial mass lesion and offers confirmation of results of biopsy. For those patients who already have received treatment, the study can be used to detect recurrent or residual tumor.
Background. The monoclonal antibody anti‐epidermal growth factor receptor (EGFr)antibody‐425, against the epidermal growth factor receptor, has the potential to bind specifically to gliomas and not normal brain tissue.1–3 A prospective study was conducted (1986–1988) to evaluate the use of Indium‐111 (111In)‐labeled anti‐EGFr‐425 in the localization of gliomas before radioimmunotherapy with Iodine‐125 (125I)‐labeled anti‐EGFr‐425. Methods. Twenty‐eight patients with intracranial neoplasms were injected intravenously with an average dose of 2.2 mCi 111In‐labeled anti‐EGFr‐425. Planar and single‐photon emission computed tomography scans were performed after 48 and 72 hours. Control studies also were performed in two cases with 111In‐labeled Co 17‐1A (a, *I antibody to colorectal cancer) and in one case with unlabeled 111In chloride. Results. The immunoscintigraphic findings were generally in good agreement with computerized tomographic findings. The definitive diagnosis was established by biopsy findings: 23 gliomas (1 Grade I, 5 Grade II, 6 Grade III, and 11 Grade IV), 1 meningioma, and 4 metastatic lesions. The localization of gliomas with 111In‐labeled anti‐EGF‐425 had a sensitivity of 0.96, a specificity of 0.60 and an accuracy of 0.90. Conclusion. Immunoscintigraphy with 111‐In labeled anti‐EGFr‐425 can be useful in the management of malignant gliomas, especially before radioimmunotherapy with 125I‐labeled anti‐EGFr‐425. Cancer 1994; 73:884–9.
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