sodium-pertechnetate-tc-99m and Brain-Neoplasms

The paper presents the experience of application of single-photon emission computed tomography (SPECT) and CT in neurosurgery. Combination of these two techniques in the single system provides higher precision of both methods. The novel technique allows assessment of tumor spread in the brain, differential diagnosis of tumor regrowth and radiation-induced necrosis, evaluation of cerebral perfusion in epilepsy, traumatic brain injury (TBI), and diagnostics of secondary CNS lesions. Examples of primary diagnosis, dynamic follow-up and differential diagnosis of cerebral neoplasms, localization of epileptogenic foci in planning of surgery, prediction of outcome after TBI and evaluation of spread of metastatic skeletal involvement and further application of acquire data are presented.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brain Diseases; Brain Injuries; Brain Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Multimodal Imaging; Neurosurgical Procedures; Positron-Emission Tomography; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

To study the pattern of blood-brain barrier (BBB) permeability changes during whole brain radiotherapy (WBRT) for metastatic brain tumor.. Twenty patients with metastatic brain tumors receiving WBRT by 6 MV X-ray underwent (99)mTc-DTPA brain SPECT before and during WBRT (20, 40 Gy) and at 2 weeks after the end of irradiation. A frame of transverse (99)mTc-DTPA brain SPECT image that best displayed the brain metastasis was chosen, and the regions of interest (ROI) were defined in the tumor foci (T), the contralateral normal brain tissue (N) and the background outside the soft tissues around the cranium (B). The radioactive counts of every ROI were measured and the ratios of the total counts (T/B and N/B) before and during WBRT (20 Gy, 40 Gy) and at 2 weeks after the irradiation were calculated.. The average T/B and N/B in the 20 patients with 30 brain metastases was 142.2-/+51.1 and 82.6-/+42.3 before WBRT, 260.3-/+121.5 and 150.7-/+72.5 during 20 Gy WBRT, 251.6-/+118.3 and 161.8-/+68.4 during 40 Gy WBRT, and 250.3-/+117.2 and 158.6-/+73.5 at 2 weeks after the irradiation, respectively. The measurements during WBRT (20 and 40 Gy) and at 2 weeks after the irradiation group underwent no significant variations (P>0.05), but showed significant differences from those before WBRT (P<0.05).. Irradiation causes direct damage of the BBB function, and the permeability of the BBB increases significantly during and within 2 weeks following 20 and 40 Gy WBRT, which provides the optimal time window for interventions with chemotherapy.

Topics: Adult; Aged; Blood-Brain Barrier; Brain Neoplasms; Capillary Permeability; Cranial Irradiation; Female; Humans; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

We present the case of a 64-year-old man with a presumed diagnosis of extracerebral cavernous hemangioma involving the cavernous sinus. The diagnosis was made on the basis of labeled red cell blood pool scintigraphy findings in conjunction with those of MR imaging. This lesion was not altered in appearance at 6-year follow-up MR imaging. We also present the labeled red cell blood pool scintigraphy findings obtained in three other patients with similar-appearing cavernous sinus lesions at MR imaging who underwent subsequent biopsy; histologic findings confirmed chondrosarcoma, chordoma, and meningioma, respectively.

Topics: Adult; Brain Neoplasms; Carotid Artery, Internal; Cavernous Sinus; Chondrosarcoma; Chordoma; Diagnosis, Differential; Erythrocytes; Female; Hemangioma, Cavernous, Central Nervous System; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

This study was undertaken to assess the contribution of the combination of (201)Tl SPECT and (99m)TcO(4)(-)SPECT to the differential diagnosis of brain tumors and tumor-like lesions. In the 8 patients selected for this study, both (201)Tl SPECT and (99m)TcO(4)(-) SPECT were performed because of clinical or radiological suspicion of brain tumor, no therapy was initiated before either SPECTs, diagnosis was based on biopsy, and MRI findings were stable in the interval between SPECTs. Histological diagnoses consisted of low grade glioma (n=1), high grade glioma (n=2), lymphoma (n=1), metastasis (n=1), multiple sclerosis (n=2) and cavernous angioma (n=1). Two high grade astrocytomas, one malignant lymphoma and one metastatic tumor showed (201)Tl accumulation and were diagnosed as tumor. The combination of (201)Tl and (99m)TcO(4)(-) did not change the diagnosis. One cavernous angioma showed no (201)Tl accumulation and was diagnosed as non-tumor. The combination of (201)Tl and (99m)TcO(4)(-) did not change the diagnosis. One low grade astrocytoma showed faint (201)Tl accumulation and was diagnosed as non-tumor. As (201)Tl uptake was higher than (99m)TcO(4)(-) uptake, the combination of (201)Tl and (99m)TcO(4)(-) changed the diagnosis to tumor. Two multiple sclerosis showed (201)Tl accumulation and were diagnosed as tumor. As (99m)TcO(4)(-) uptake was higher than (201)Tl uptake, the combination of (201)Tl and (99m)TcO(4)(-) changed the diagnosis to non-tumor. In three of the eight patients (38%), the combination of (201)Tl SPECT and (99m)TcO(4)(-) SPECT altered the diagnosis made by (201)Tl SPECT alone. In all of these three cases, the diagnosis made by the combination of (201)Tl SPECT and (99m)TcO(4)(-) SPECT was correct.

Topics: Brain; Brain Neoplasms; Diagnosis, Differential; Humans; Multiple Sclerosis; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

The preferential accumulation of sickle blood cells in tumor vasculature is demonstrated noninvasively using MRI and sickle red blood cells loaded with Gd-DTPA and invasively by two other techniques. The distribution of red blood cells in rat brain tumors relative to normal brains were measured using three separate techniques: MRI of Gd-DTPA loaded cells, fluorescent microscopy detection of Oregon Green 488 fluorescence conjugated to a streptavidin-biotin complex that binds to red blood cell surface proteins, and autoradiography using a technetium (99m)Tc-labeling kit. Labeled red cells were infused intravenously in rats with brain tumors. Sickle cells preferentially accumulated in tumor relative to normal brain, with highest concentrations near the tumor / normal tissue boundary, whereas control normal red cells did not preferentially aggregate at the tumor periphery. This demonstrates the potential of sickle red blood cells to accumulate in the abnormal tumor vessel network, and the ability to detect their aggregation noninvasively and at high spatial resolution using MRI. The application of the noninvasive measurement of sickle cells for imaging tumor neovasculature, or as a delivery tool for therapy, requires further study.

Topics: Anemia, Sickle Cell; Animals; Autoradiography; Brain; Brain Neoplasms; Carboxylic Acids; Cell Line, Tumor; Contrast Media; Erythrocytes; Fluorescent Dyes; Gadolinium DTPA; Glioma; Humans; Magnetic Resonance Imaging; Male; Microscopy, Confocal; Neoplasm Transplantation; Rats; Rats, Inbred F344; Sodium Pertechnetate Tc 99m

(99m)Tc-Sestamibi (MIBI) has been successfully applied in recurrent glioblastoma. The aim of this study was to evaluate the incremental diagnostic information of MIBI as a tumor-avid radiopharmaceutical compared with (99m)Tc-pertechnetate ((99m)Tc) as sole indicator of the integrity of the blood-brain barrier. Twenty-five patients with confirmed recurrent brain tumors were included. MIBI SPET was performed 10 min after injection of 555 MBq MIBI intravenously with a triple-headed gamma camera equipped with LE-UHR-PAR collimators over 360 degrees (3 degrees /step) and stored in a 128(2) matrix. Identical acquisition parameters were used for (99m)Tc SPET, which was acquired 3 h after injection of 740 MBq (99m)Tc. Normalized tumor uptake (NU) was calculated from attenuation-corrected transaxial slices. In addition, tumor/plexus, tumor/nasopharynx, and tumor/parotid gland ratios were assessed in both studies. No statistically significant differences were detected for the mean NU of tumor tissue with MIBI (0.26 +/- 0.10) and (99m)Tc (0.39 +/- 0. 33) and for the tumor/nasopharynx and tumor/parotid gland ratios; only the tumor/plexus ratio was significantly higher for (99m)Tc than for MIBI (p < 0.05). In conclusion, our data indicate that MIBI scintigraphy in brain tumors at 10 min postinjection reveals no additional visual information over that provided by the conventional (99m)Tc-pertechnetate brain scan, and in addition, tracer retention reflects primarily blood-brain barrier damage.

Topics: Adult; Blood-Brain Barrier; Brain Neoplasms; Female; Glioblastoma; Humans; Male; Middle Aged; Oligodendroglioma; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi

The paper is concerned with the results of single-photon emission tomography and gamma-topography in patients with cerebral tumors, cerebral circulatory disorders and pathology of the liquor system. Tomographic investigation was shown to enhance the accuracy and reliability of the detection of cerebral tumors. Single-photon emission computerized gamma-tomography (SPECT) permitted the detection of structural and morphological cerebral changes in disturbed cerebral circulation of various etiology. SPECT together with computerized tomography and radionuclide cisternography was shown to be an auxiliary method for visualization of the cerebral cisterns. Radionuclide tomographic images as compared to gamma-topographic findings of the brain possessed a high statistical significance and good resolution.

Topics: Adult; Brain; Brain Neoplasms; Cerebrospinal Fluid; Cerebrovascular Disorders; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A TESTASCAN single-photon emission multidetector gamma tomograph is a special purpose unit designed to investigate RP distribution in the brain. It permits obtaining transversal tomographic images with the resolution of about 10 mm, the thickness of an emitted layer being about 15 mm. The time of patient's examination during obtaining an image of 10-12 layers does not exceed 30 min. and can be reduced by increasing RP activity and minimizing the number of emitted transversal sections. The clinical testing of the unit has shown that it is reliable in maintenance and simple to operate during radionuclide data collection, reproduction and analysis. Emission computerized tomography in brain tumors can be regarded as a method increasing the accuracy and reliability of radionuclide diagnostic examination of neurosurgical and neurological patients.

Topics: Brain Neoplasms; Encephalitis; Equipment Design; Evaluation Studies as Topic; Humans; Models, Structural; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed

The number of cytoplasmic vesicles in the capillary endothelium was determined by ultrastructural morphometry and correlated with the uptake of technetium-99m pertechnetate used in brain scintigraphy. Ten gliomas were studied for uptake rates of 99mTc pertechnetate. Three gliomas from the different groups of uptake rates were quantitatively analyzed for cytoplasmic vesicle content. Capillaries of tumors without uptake had a low content of cytoplasmic vesicles, which was similar to that obtained in normal brain control. In tumors with low and moderate uptake rates, the cytoplasmic vesicles content increased significantly (p less than 0.05) by about 300% and 400%, respectively, as compared with that found in impermeable tumor and in normal brain. The correlation found between the cytoplasmic vesiculation of the endothelial cells in gliomas' capillaries and the uptake of 99mTc pertechnetate suggests that pinocytosis might be a factor in the uptake of the radionuclide. The present findings might be applicable to treatment with hydrophilic chemotherapeutic agents in moderate and highly permeable tumors.

Topics: Blood-Brain Barrier; Brain Neoplasms; Capillaries; Cytoplasmic Granules; Endothelium, Vascular; Glioma; Humans; Microscopy, Electron; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Brain Neoplasms; Humans; Methods; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m

Computerized emission tomography of the brain is an atraumatic and highly informative technique for diagnosis of metastatic brain tumours. The above method is of major practical significance as a primary test in diagnosing metastases in the brain in cases of clinical neurological symptom complex.

Topics: Brain; Brain Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed; Tomography, X-Ray Computed

The radionuclide brain scans performed on a gamma camera (GC scans) in 146 patients over 65 years of age during a 6-month period are reviewed. Forty-four scans (30.1%) were reported as showing an abnormality. Three patients subsequently underwent surgery and drug therapy was commenced in 11 cases. However, in most cases the GC scan proved unhelpful in the patients' management. The usage and role of GC scanning in elderly patients admitted with a neurological disorder is examined.

Topics: Aged; Brain; Brain Diseases; Brain Neoplasms; Dementia; Diagnostic Tests, Routine; False Negative Reactions; Female; Hematoma, Subdural; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adult; Aged; Astrocytoma; Brain Neoplasms; Cerebrovascular Disorders; Diagnosis, Differential; Female; Glioma; Humans; Male; Meningioma; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Patients were referred to the Department of Nuclear Medicine for brain scintigraphy to be screened for possible intracranial pathology. These referrals were made in order to reduce the heavy load on the transmission computerized tomography (TCT) facilities. Great clinical importance, therefore, has been attached to scintigraphic findings; this emphasizes the need for an accurate assessment of the predictive value of this procedure.

Topics: Adolescent; Adult; Aged; Brain Diseases; Brain Neoplasms; Child; Child, Preschool; False Negative Reactions; False Positive Reactions; Female; Humans; Male; Middle Aged; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; South Africa; Technetium; Technetium Tc 99m Pentetate; Tomography, X-Ray Computed

Through the first 2 hr, uptake of [Tc-99m]pertechnetate and of Co-57 bleomycin were assessed in 29 brain tumors and were correlated with the ultrastructure of the tumor's capillary endothelium. No difference in uptake was found between the two tracers. Permeability of brain tumors to these agents was found to be governed by the same ultrastructural features that determine permeability in experimental brain tumors: the type of junction between contiguous endothelial cells in the capillaries. Meningiomas, which showed very high uptake of the radiotracers, demonstrated open or punctate junctions with short fusion of apposed membranes. They also showed a large number of pinocytotic vesicles and fenestrae. Capillaries of tumors without uptake had a small number of short tight junctions (less than 0.25 mu) between adjacent endothelial cells and a relatively large number of long junctions (greater than 0.5 mu). In intracerebral tumors that showed relatively high uptake, the reverse was true: most of the junctions were short and only a few long junctions were found. That uptake of [Tc-99m]pertechnetate and of Co-57 bleomycin depends on tumor capillary ultrastructure (which determines the permeability) suggests the possibility of the use of radiopharmaceuticals as in vivo indicators of tumor permeability. Brain scintigraphy may help to asses brain-tumor availability to non-lipid-soluble chemotherapeutic drugs.

Topics: Bleomycin; Blood-Brain Barrier; Brain Neoplasms; Capillaries; Cobalt Radioisotopes; Humans; Microscopy, Electron; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adolescent; Brain Neoplasms; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Neoplasm Recurrence, Local; Postoperative Complications; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Ambulatory Care; Brain Neoplasms; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Cyclotron-produced L-(N-13)glutamate was used to visualize malignant intracranial tumors in 12 pediatric patients who had evidence of recurrent disease as documented by computed transaxial tomography (TCT). Imaging was performed using a rectilinear scanner, gamma camera, or a positron-emission tomograph (PET). The results indicate that N-13 is rapidly taken up by a majority of brain tumors following the administration of L-(N-13)glutamate, and that N-13 uptake is correlated with breakdown of the blood-brain barrier as demonstrated by contrast TCT or pertechnetate (Tc-99m) studies. The feasibility of using this agent in conjunction with PET is established.

Topics: Adolescent; Adult; Blood-Brain Barrier; Brain Neoplasms; Child; Female; Glutamates; Glutamic Acid; Humans; Male; Nitrogen Radioisotopes; Sodium Pertechnetate Tc 99m; Technetium; Tomography, Emission-Computed; Tomography, X-Ray Computed

Topics: Adult; Blood-Brain Barrier; Brain Neoplasms; Diphosphates; Humans; Leukemia; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate

Single photon emission computed tomography (ECT) was performed on 67 patients. ECT images were taken with a Shimadzu scintillation camera, LFOV-E, before a delayed scan. Eighteen of 67 patients showed abnormal findings on the ECT images. Fourteen of the 18 had a transmission X-ray CT (TCT) study as well. There were eleven cases with brain metastasis, and a surgical wound. Eleven of forty-nine ECT-negative patients had a TCT study as well, and intracranial lesions were found in five. The smallest lesion found by ECT was 0.5 cm in diameter on the TCT image and the largest lesion missed by ECT was a tumor in the corpus callosum, measuring 4.2 X 2.7 cm. As far as the patients who also received TCT study are concerned, both the ECT and the ordinary scan were thought to be equal in sixteen patients and ECT to be superior in seven whereas the ordinary scintigram was superior in two. At present, ECT is considered to be useful when it is used in addition to the ordinary scans. In the field of clinical nuclear medicine, the development of new radiopharmaceuticals which are labeled with single photon emitters and which can show the metabolic activity of the brain is eagerly awaited.

Topics: Adult; Aged; Brain; Brain Neoplasms; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Pentetic Acid; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pentetate; Tomography, Emission-Computed; Tomography, X-Ray Computed

Topics: Brain Diseases; Brain Neoplasms; Cerebrovascular Disorders; Diphosphonates; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Compounds

The intensity of parenchymal brain lesions was compared using Tc-99m pertechnetate and Tc-99m phosphate. The following conclusions were made: 1. If the Tc-99m phosphate intensity is greater than the intensity of the Tc-99m pertechnetate scan, and the patient is evaluated within four weeks of ictus, the lesion is a CVA (P less than .001). 2. If the Tc-99m phosphate intensity is less than or equal to the intensity of the Tc-99m pertechnetate scan, and the patient is evaluated within four weeks of ictus, the parenchymal lesion is not a CVA (P less than .001). 3. If the evaluation takes place longer than six weeks after ictus, then no evaluation about the nature of the lesion can be made based upon uptake of Tc-99m phosphate and Tc-99m pertechnetate.

Topics: Adult; Brain Neoplasms; Diphosphonates; Glioblastoma; Glioma; Humans; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

This paper summarizes the clinical and diagnostic features of five reports of patients with intracerebral, non-Hodgkin's lymphoma. In three patients the brain lesion was the only evidence of lymphoma, while two patients also had concomitant systemic involvement. Four patients had diffuse histiocytic lymphoma and one had a mixed type of malignant lymphoma. In all patients, Tc-99m and Ga-67 brain scans disclosed discrete areas of increased radionuclide uptake consistent with a mass. In each case, brain blood perfusion studies were normal and brain computerized tomographic (CT) scans and cerebral angiograms produced variable nondiagnostic patterns. Craniotomies in four patients provided histologic confirmation of the non-Hodgkin's lymphoma in the areas of abnormality. The remaining patient had systemic histiocytic lymphoma with concomitant brain lesions that responded to irradiation. The combined use of the above noninvasive modalities in correlation with clinical findings may result in more accurate prebiopsy diagnoses of intracerebral lymphoma.

Topics: Adult; Aged; Brain Neoplasms; Evaluation Studies as Topic; Female; Gallium Radioisotopes; Humans; Lymphoma; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Tomography, X-Ray Computed

The uptake of 99mTc-pertechnetate (TcO4), 99mTc-iron-ascorbic acid (Feasc), 99mTc-Solcocitran (Solcocitran), 99mTc-diphosphonate (HEDP) and 67Ga-citrate (Ga) in various brain lesions was compared. Influence of time from injection was also studied on the first three compounds. A rank correlation method was used to compare the scans which were judged visually by three independent observers. There was good agreement between the observers, as measured by Kendall's tau, but the concordance between rankings within the same type of lesion, as measured by Kendall's W, was rather poor. There was no significant difference in the uptake of TcO4, Feasc and Solcocitran. Ga showed generally poor uptake and its uptake in tumours and infarcts did not differ significantly. However, when HEDP and TcO4 were compared in two groups (I: Infarcts, haemorrhages and bone invading meningiomas, and II: Tumours not invaded into bone) a highly significant difference was obtained with much higher uptake of HEDP in Group I.

Topics: Adult; Ascorbic Acid; Brain Diseases; Brain Neoplasms; Cerebral Hemorrhage; Cerebral Infarction; Citrates; Diphosphonates; Gallium Radioisotopes; Humans; Organotechnetium Compounds; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Compounds

Topics: Brain; Brain Abscess; Brain Diseases; Brain Neoplasms; Cerebrovascular Disorders; Glioblastoma; Humans; Meningioma; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Sugar Acids; Technetium; Tomography, X-Ray Computed; Wounds and Injuries

Topics: Adenocarcinoma; Brain; Brain Neoplasms; Cerebrovascular Disorders; Humans; Meningeal Neoplasms; Meningioma; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Astrocytoma; Brain; Brain Neoplasms; Chlormerodrin; Diuretics; Glioma; Neoplasms; Organomercury Compounds; Radionuclide Imaging; Serum Albumin; Serum Albumin, Radio-Iodinated; Sodium Pertechnetate Tc 99m; Technetium