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

The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and fundoplication is discussed. Detection of columnar-lined esophagus by Tc-99m pertechnetate imaging and of esophageal carcinoma by Ga-67 citrate and Tc-99m glucoheptonate studies also is presented.

Topics: Barrett Esophagus; Deglutition Disorders; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagus; Gallium Radioisotopes; Gastroesophageal Reflux; Humans; Muscular Dystrophies; Organotechnetium Compounds; Radionuclide Imaging; Rhenium; Sodium Pertechnetate Tc 99m; Stomach; Sugar Acids; Technetium; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula

We present a Tc pertechnetate scintigraphy performed in a 64-year-old woman to investigate a mediastinal cystic mass in search of residual gastric mucosa after gastrectomy. She had a history of esophagectomy and gastric pull-up for esophageal cancer. Postoperative leakage necessitated ablation of the gastric pull-up and reconstruction using part of the colon. Oral realimentation resulted in mediastinal pain and brownish discharge within the trachea, raising the suspicion of residual gastric pouch. SPECT/CT demonstrated increased tracer uptake in the median part of the mediastinal cyst, and a biopsy confirmed the presence gastric mucosa.

Topics: Esophageal Neoplasms; Esophagectomy; Female; Gastric Mucosa; Humans; Mediastinal Cyst; Middle Aged; Multimodal Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The value of mucosal protection with sucralfate in cases of gastric ulceration is well documented. Although sucralfate is advocated as treatment of esophageal lesions, we found it to be of limited value in the management of radiation-induced esophagitis; in a pilot study of 10 cases, minor relief of symptoms, with analgetics still required, was noted in 4 patients, and no improvement was seen at endoscopy after 6 weeks of treatment in any patient. To see if this might be the result of inadequate mucosal coating, we administered sucralfate labeled with technetium 99m to 26 patients with endoscopically proven esophagitis secondary to irradiation for esophageal carcinoma. The degree of coating was evaluated according to persistence of the radionuclide in the affected esophageal segment. Scans were performed at regular intervals for 120 minutes after administration of 150 MBq 99mTc-sucralfate. Although scans were positive for radioactivity in 24 of 26 (92%) patients, only 8 (31%) of these represented selective binding of sucralfate to tissue. In the other 16 cases, scans were positive for sucralfate and albumin, indicating nonspecific retention most likely caused by concomitant esophageal stenosis. Residual radioactivity was observed for 30 minutes or more in 11 (42%) patients, but scans were positive for radioactivity after 1 to 2 hours in only 4 (15%). The duration and intensity of tracer accumulation were similar in both acute lesions an chronic radiation damage. These findings suggest that the inability of sucralfate to alleviate irradiation-induced odynophagia may be related to insufficient duration of adherence of this compound to damaged esophageal mucosa.

Topics: Aged; Aged, 80 and over; Esophageal Neoplasms; Esophagitis; Esophagoscopy; Esophagus; Female; Humans; Male; Middle Aged; Pilot Projects; Radiation Injuries; Radionuclide Imaging; Radiotherapy; Sodium Pertechnetate Tc 99m; Sucralfate; Technetium Tc 99m Aggregated Albumin

Topics: Adult; Diagnosis, Differential; Esophageal Neoplasms; False Positive Reactions; Gastric Mucosa; Goiter, Substernal; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach

Five patients with patches of gastric fundal type columnar epithelium in the proximal esophagus at the level of the upper esophageal sphincter diagnosed by upper endoscopy underwent 99mTc-pertechnetate scintigraphy (TcO4-). In all instances, the patches contained both chief cells and mucus-secreting cells. One patient had dysphagia localized to the area of columnar epithelium. Two cases of heterotopic gastric mucosa in the upper esophagus (HGM-UE) were demonstrated by TcO4-. In both, thyroid uptake was absent due to complete suppression of thyroid function by thyroid hormone supplements. TcO4- accumulated in thyroid glands of the other three patients, causing overlapping activity between the thyroid gland and HGM-UE. TcO4- scintigraphy is suitable for the detection of HGM-UE only in those patients who have had a total thyroidectomy or are on suppressive thyroid therapy.

Topics: Adolescent; Adult; Aged; Choristoma; Esophageal Neoplasms; Esophagoscopy; Female; Gastric Mucosa; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Aged; Esophageal Neoplasms; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach; Thyroid Gland

Topics: Adult; Choristoma; Esophageal Neoplasms; Esophagus; Female; Gastric Mucosa; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium