sodium-pertechnetate-tc-99m and Head-and-Neck-Neoplasms

Nuclear medicine studies often play a significant role in the diagnosis and treatment of oral and maxillofacial diseases. While not commonly used in everyday dental practice, the dental provider should have a conversational knowledge of these imaging modalities and understand the indications and limitations of these studies. The purpose of this review is to discuss the nuclear medicine studies that have applications in the head and neck region as well as their indications, limitations, and diagnostic conclusions that can be drawn from these studies.

Topics: Citrates; Gallium; Head and Neck Neoplasms; Humans; Jaw Diseases; Radionuclide Imaging; Radiopharmaceuticals; Salivary Gland Diseases; Sentinel Lymph Node Biopsy; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

Hemangiomas are congenital vascular tumors frequently referred for Tc-99m RBC imaging. A case of soft tissue cavernous hemangioma located in the right side of the face and neck is presented. The importance of the Valsalva maneuver in outlining this lesion is described, and a brief review of the literature is presented.

Topics: Adult; Erythrocytes; Female; Head and Neck Neoplasms; Hemangioma, Cavernous; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Valsalva Maneuver

Thyroid cancer is uncommon, with an incidence of 10,300 new patients each year and a mortality of 1,100 patients each year. Patient survival correlates with many factors, including tumor pathology, age, primary lesion size, distant metastases, extent of surgery, and radioiodine therapy. Deaths from thyroid cancer may occur many years after diagnosis, and such an indolent course has hampered the analysis of the multiple treatment programs advocated. Thyroid imaging continues to play an important role in the initial detection and follow-up management of thyroid cancer, but the search for a specific tracer for the primary lesion continues. The complementary role of serum thyroglobulin and radioiodine in the follow-up of the thyroidectomized patient is discussed. Radioiodine therapy has proven effectiveness in those patients with radioiodine-avid distant metastases and/or regional metastases. Whether radioiodine ablation of residual thyroid bed activity is beneficial remains controversial.

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Head and Neck Neoplasms; Humans; Iodine Radioisotopes; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy

To estimate dose-response relationship using dynamic quantitative (99m)Tc-pertechnate scintigraphy in head-neck cancer patients treated with parotid-sparing conformal radiotherapy.. Dynamic quantitative pertechnate salivary scintigraphy was performed pre-treatment and subsequently periodically after definitive radiotherapy. Reduction in salivary function following radiotherapy was quantified by salivary excretion fraction (SEF) ratios. Dose-response curves were modeled using standardized methodology to calculate tolerance dose 50 (TD50) for parotid glands.. Salivary gland function was significantly affected by radiotherapy with maximal decrease in SEF ratios at 3-months, with moderate functional recovery over time. There was significant inverse correlation between SEF ratios and mean parotid doses at 3-months (r = -0.589, p<0.001); 12-months (r = -0.554, p<0.001); 24-months (r = -0.371, p = 0.002); and 36-months (r=-0.350, p=0.005) respectively. Using a post-treatment SEF ratio <45% as the scintigraphic criteria to define severe salivary toxicity, the estimated TD50 value with its 95% confidence interval (95% CI) for the parotid gland was 35.1Gy (23.6-42.6Gy), 41.3Gy (34.6-48.8Gy), 55.9Gy (47.4-70.0Gy) and 64.3Gy (55.8-70.0Gy) at 3, 12, 24, and 36-months respectively.. There is consistent decline in parotid function even after conformal radiotherapy with moderate recovery over time. Dynamic quantitative pertechnate scintigraphy is a simple, reproducible, and minimally invasive test of major salivary gland function.

Topics: Adult; Aged; Dose-Response Relationship, Radiation; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Longitudinal Studies; Male; Middle Aged; Neoplasm Staging; Organ Sparing Treatments; Parotid Gland; Prognosis; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy, Conformal; Radiotherapy, Intensity-Modulated; Scintillation Counting; Sodium Pertechnetate Tc 99m; Tissue Distribution

To study the efficacy of coumarin/troxerutine for the protection of salivary glands and mucosa during irradiation.. Prospective, randomized, placebo-controlled, double-blind trial.. University hospital, Germany.. 48 patients who had radiotherapy to the head and neck.. Salivary gland scintigraphy and acute side-effects of radiotherapy (Radiation Therapy Oncology Group (RTOG) score).. 23 patients (11 experimental, 12 placebo) completed the study. The global efficacy measure combining scintigraphy and RTOG score favoured the experimental arm (P=0.07). The RTOG score showed significantly fewer acute side-effects of radiation in the experimental arm (P<0.05).. The results suggest that coumarin/troxerutine have a favourable effect in the treatment of radiogenic sialadenitis and mucositis.

Topics: Adult; Aged; Coumarins; Cranial Irradiation; Double-Blind Method; Drug Combinations; Female; Head and Neck Neoplasms; Humans; Hydroxyethylrutoside; Male; Middle Aged; Mouth Mucosa; Prospective Studies; Radiation Injuries; Radiation-Protective Agents; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Sialadenitis; Sodium Pertechnetate Tc 99m; Treatment Outcome; Xerostomia

Salivary gland scintigraphy (SGS) is used to depict salivary gland dysfunction after radiotherapy (RT). The aim of this study was to investigate the utility of SGS combined with single photon emission computed tomography (SPECT). Twenty-one patients with a carcinoma of head and neck underwent SGS before and 1 month after RT. After injection of 370 MBq 99Tcm-pertechnetate, a biplanar dynamic acquisition (12 x 1 min) was started, followed by a SPECT acquisition during 4 min. Carbachol was then injected and a second dynamic study (16 x 1 min) was performed, again followed by a SPECT acquisition. The salivary excretion fraction (SEF) was calculated both from the geometric mean planar image for each parotid and from the SPECT data for each transverse plane through the parotids. The RT-induced changes in the SEF (dSEF) were correlated with the mean radiation dose calculated using tomography-based dosimetry. The mean radiation dose to the parotids was 44 Gy (range 4.4-68.1 Gy). The mean range of the variation in radiation dose to the transverse slices within the parotids of a patient was 24 Gy (range 6.2-51.9 Gy). Considering all transverse planes through the parotids in all patients, a linear correlation was found between the dSEF calculated using SGS-SPECT and the radiation dose (r=0.45, P=0.0001). Thirteen patients had a variation in radiation dose within the parotids of more than 20 Gy. In nine of these a significant intra-individual correlation between radiation dose and the dSEF of the transverse parotid slices was found (r range 0.55-0.97; P value range 0.037-0.0001). In conclusion, SGS-SPECT can be used for monitoring radiation-induced parotid gland dysfunction. It offers the unique possibility for the assessment of intra-individual dose-dysfunction curves in patients with large variations in the radiation dose within the parotids.

Topics: Adult; Aged; Algorithms; Carcinoma, Squamous Cell; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Parotid Gland; Radiometry; Radiopharmaceuticals; Radiotherapy; Reproducibility of Results; Salivary Gland Diseases; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

Based on in vivo evidence of radioprotection of the salivary glands using WR-2721, a pilot study was undertaken to determine the feasibility, toxicity, and salivary function of patients receiving WR-2721, while undergoing radiation therapy to the head and neck.. Patients undergoing radiation therapy for cancer of the head and neck were eligible if the major salivary glands received more than 45 Gy. WR-2721 was administered over 6 min IV, 10-15 min prior to each dose of radiation five times per week. Saliva was collected and measured prior to radiation therapy, weekly during radiation therapy, 1 month postradiation therapy, and every 3 months thereafter. Flow rates of unstimulated whole saliva, stimulated whole saliva, and stimulated parotid saliva were measured using standard techniques. 99mTc salivary scintiscans were performed prior to radiation therapy, 1 month postradiation therapy and every 3 months thereafter. Nine patients are presently enrolled on the first dose level (100 mg/m2) of this study. Eight completed per protocol, two with minor decreases of total WR-2721 doses. Two patients progressed with distant metastases soon after completion of therapy. All available data are included in the analysis. Median follow-up for all patients is 18 months.. Flow rates of unstimulated whole saliva decreased significantly during radiation therapy reaching 5.6% of baseline at 9 months postradiation therapy, subsequently recovering to 20% of baseline, then remaining stable over time. Stimulated whole salivary flow rate similarly decreased during radiation therapy and reached its nadir (11% of baseline) at 3 months postradiation therapy, improving to 27% of baseline by 2 years. The stimulated parotid flow rate decreased during radiation therapy to 1.4% of pretreatment levels. Significant recovery took place 6 months postradiation therapy and by 18 months values had recovered to 54% of baseline. 99mTc salivary scintiscans confirmed this rebound of parotid function postradiation therapy. Toxicity was minimal with the exception of one patient who received only 27% of the planned total drug dose due to grade 3 hypotension after the eighth treatment. No recovery of salivary function has been seen in this patient; flow rates remain zero in all three areas tested 21 months after radiation.. Administration of WR-2721 prior to each dose of radiation was feasible and without significant toxicity at 100 mg/m2. Salivary gland function improved over time after completion of radiation, particularly the parotid. Future directions include escalation of WR-2721 dose to 200 mg/m2 and then 300 mg/m2, and a Phase III randomized trial will be undertaken once the optimal dose is established.

Topics: Amifostine; Feasibility Studies; Head and Neck Neoplasms; Humans; Parotid Gland; Pilot Projects; Radiation Protection; Radiotherapy Dosage; Salivary Glands; Secretory Rate; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

To investigate the effect of intratumoral administration of collagenase-2 on liposomal drug accumulation and diffusion in solid tumor xenografts.. Correlation between tumor interstitial fluid pressure (IFP) and tumor physiological properties (size and vessel fraction by B-mode and Doppler ultrasound, respectively) was determined. IFP response to intravenous or intratumoral collagenase-2 (0.1%) treatment was compared with intratumoral deactivated collagenase-2. To evaluate drug accumulation and diffusion, technetium-99 m-((99m)Tc)-liposomal doxorubicin (Doxil) was intravenously injected after collagenase-2 (0.1 and 0.5%, respectively) treatment, and planar scintigraphic images acquired and percentage of the injected dose per gram tissue calculated. Subsequently, tumors were subjected to autoradiography and histopathology.. IFP in two-week-old head and neck squamous cell carcinoma xenografts was 18 ± 3.7 mmHg and not correlated to the tumor size but had reverse correlation with the vessel fraction (r = -0.91, P < 0.01). Intravenous and intratumoral collagenase-2 use reduced IFP by a maximum of 35-40%. Compared to the control, the low IFP level achieved through intratumoral route remained for a long period (24 vs. 2 h, P < 0.05). SPECT images and autoradiography showed significantly higher (99m)Tc-Doxil accumulation in tumors with intratumoral collagenase-2 treatment, confirmed by %ID/g in tumors (P < 0.05), and pathological findings showed extensive distribution of Doxil in tumors.. Intratumoral injection of collagenase-2 could effectively reduce IFP in HNSCC xenografts for a longer period than using intravenous approach, which allowed for more efficient accumulation and homogeneous diffusion of the Doxil within the tumor interstitium.

Topics: Animals; Antibiotics, Antineoplastic; Autoradiography; Dose-Response Relationship, Drug; Doxorubicin; Extracellular Fluid; Female; Head and Neck Neoplasms; Liposomes; Matrix Metalloproteinase 8; Radionuclide Imaging; Radiopharmaceuticals; Rats; Rats, Nude; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Ultrasonography, Doppler; Xenograft Model Antitumor Assays

Preoperative scintigraphic visualization of metastases from well-differentiated thyroid microcarcinoma in patients with Graves disease is extremely rare, as is the scintigraphic visualization of poorly differentiated thyroid carcinoma as a warm nodule. We present a patient with Graves disease and both of these rare entities.. A 47-year-old woman complained of a growing left-side neck mass and symptoms of thyrotoxicosis. On clinical examination, the thyroid was palpable without discernible nodularity, while the left side of the neck was occupied by 3 gross, painless nodules. She also had signs of thyrotoxicosis and biochemical parameters of Graves hyperthyroidism. Ultrasound examination showed moderately hypoechogenic thyroid with a small hypoechogenic nodule in the upper pole of the left lobe and 3 gross, almost normoechogenic nodules on the left side of the neck. On Tc-99m-pertechnetate pinhole scintigraphy there was a small, warm nodule in the upper pole of the left lobe and 3 gross metastatic nodules on the left side of the neck. Fine needle aspiration of the neck nodules was consistent with metastases from thyroid papillary carcinoma. After thyrostatic preparation a total thyroidectomy with left modified radical neck dissection was done.. Histopathologic examination disclosed 2 carcinomas in the left thyroid lobe. One of them was a tall cell variant of papillary carcinoma in the upper pole of the left lobe that measured 5 mm and corresponded to the small warm nodule, and the second one was a classic form of papillary microcarcinoma that measured 2 mm. Metastases accrued from the classic form of papillary microcarcinoma. Although the patient had 2 thyroid carcinomas, one with metastases and the other of more aggressive form, which is consistent with advanced stage and aggressiveness, she is now disease-free, 4 years after the operation and radioiodine ablation.

Topics: Carcinoma, Papillary; Female; Graves Disease; Head and Neck Neoplasms; Humans; Middle Aged; Neoplasm Metastasis; Preoperative Period; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

To evaluate salivary gland scintigraphy in prediction of salivary flow following radiation therapy.. Twenty patients diagnosed with head and neck cancer were treated with intensity modulated radiation therapy with an intention to spare the salivary gland function. The total quantitative saliva secretion was measured prior to and 6 and 12 months after therapy, and the function of the major salivary glands was monitored using Tc-99m-pertechnetate scintigraphy. Two models were designed for prediction of the post-treatment salivary flow: an average model, based on the average proportions of saliva produced by each of the four major glands in healthy subjects, and an individual model, based on saliva produced by each gland as measured by scintigraphy prior to therapy. These models were compared with volume-based (Lyman) normal tissue complication probability models using two published sets of model parameters.. The D(50) for the parotid and the submandibular gland function assessed at 6 and 12 months after radiotherapy was approximately 39Gy. The scintigraphy-based individual model predicted well the measured post-treatment saliva flow rates. The correlation coefficient between the predicted stimulated and the measured saliva flow rate was 0.77 (p<0.0001) at 6 months and 0.55 (p=0.034) at 12 months after completion of radiotherapy. The relative changes in unstimulated and stimulated salivary flow rates showed similar dependency on the cumulative radiation dose.. Salivary gland function assessed by scintigraphy prior to radiotherapy is useful in prediction of the residual salivary flow after radiotherapy.

Topics: Adult; Aged; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy, Intensity-Modulated; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m

The aim of this study was to compare changes in salivary gland function after intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (RT), with or without Amifostine, for tumors of the head-and-neck region using quantitative salivary gland scintigraphy (QSGS).. A total of 75 patients received pre- and post-therapeutic QSGS to quantify the salivary gland function. In all, 251 salivary glands were independently evaluated. Changes in the maximum uptake (DeltaU) and relative excretion rate (DeltaF) both pre- and post-RT were determined to characterize radiation-induced changes in the salivary gland function. In addition, dose-response curves were calculated.. In all groups, maximum uptake and relative excretion rate were reduced after RT (DeltaU

Topics: Adult; Aged; Amifostine; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Logistic Models; Male; Middle Aged; Parotid Gland; Radiation-Protective Agents; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy, Intensity-Modulated; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m; Xerostomia

To evaluate salivary gland function after inversely planned stereotactic intensity-modulated radiotherapy (IMRT) for tumors of the head-and-neck region using quantitative pertechnetate scintigraphy.. Since January 2000, 18 patients undergoing IMRT for cancer of the head and neck underwent pre- and posttherapeutic scintigraphy to examine salivary gland function. The mean dose to the primary planning target volume was 61.5 Gy (range 50.4-73.2), and the median follow-up was 23 months. In all cases, the parotid glands were directly adjacent to the planning target volume. The treatment planning goal was for at least one parotid gland to receive a mean dose of <26 Gy. Two quantitative parameters (change in maximal uptake and change in the relative excretion rate before and after IMRT) characterizing the change in salivary gland function after radiotherapy were determined. These parameters were compared with respect to the dose thresholds of 26 and 30 Gy for the mean dose. In addition, dose-response curves were calculated.. Using IMRT, it was possible in 16 patients to reduce the dose for at least one parotid gland to < or =26 Gy. In 7 patients, protection of both parotid glands was possible. No recurrent disease adjacent to the protected parotid glands was observed. Using the Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer scoring system, only 3 patients had Grade 2 xerostomia. No greater toxicity was seen for the salivary glands. The change in the relative excretion rate was significantly greater, if the parotid glands received a mean dose of > or =26 Gy or > or =30 Gy. For the change in maximal uptake, a statistically significant difference was seen only for the parotid glands and a dose threshold of 30 Gy. For the end point of a reduction in the parotid excretion rate of >50% and 75%, the dose-response curves yielded a dose at 50% complication probability of 34.8 +/- 3.6 and 40.8 +/- 5.3 Gy, respectively.. Using IMRT, it is possible to protect the parotid glands and reduce the incidence and severity of xerostomia in patients. Doses <26-30 Gy significantly preserve salivary gland function. The results support the hypothesis that application of IMRT does not lead to increased local failure rates.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy Dosage; Radiotherapy, Conformal; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m; Statistics, Nonparametric; Xerostomia

Xerostomia is the most debilitating side effect induced by irradiation of head and neck tumours and is caused by irradiation damage to the salivary glands. The aim of this study was to correlate structural histomorphological damages and sialoscintigraphical findings during fractioned radiotherapy. The head and neck area of 27 WAG/RijH rats was irradiated with 60Co-gamma rays (60 Gy/30f 6 weeks). To evaluate salivary gland function, a port system was implanted, and 99mTc-pertechnetate was applied at different stages of irradiation (0, 16, 30, 46, 60 and 6 months post-irradiation). In the course of treatment the parotid glands were examined histopathologically. Rat salivary glands developed a dose-dependent radiosialadenitis. After a dose of 16 Gy an intra- and extra-cellular oedema developed in the salivary glands. Progressive vacuolisation (30 Gy) developed into lipomatosis (46 Gy) and necrotic changes (60 Gy) in the parotid glands. Six months after irradiation treatment, the chronic histomorphological damages corresponded to stage II according to Seifert. The corresponding loss in gland function investigated by measurement of the 99mTc-pertechnetate uptake of the salivary glands was 13% (16 Gy), 26% (30 Gy), 57% (46 Gy), 75% (60 Gy) and 66.5% (6 months post-irradiation). The presented animal model is suitable to demonstrate the correlation of histomorphological and sialoscintigraphical findings.

Topics: Animals; Cobalt Radioisotopes; Disease Models, Animal; Dose Fractionation, Radiation; Dose-Response Relationship, Radiation; Gamma Rays; Head and Neck Neoplasms; Male; Radiation Injuries; Radiation Tolerance; Radionuclide Imaging; Radiotherapy, Adjuvant; Rats; Salivary Glands; Sialadenitis; Sodium Pertechnetate Tc 99m; Xerostomia

This study was undertaken to determine whether standard salivary gland scintigraphy may be used for the objective assessment of salivary gland sialogogues, in particular oral pilocarpine, in the treatment of post-radiotherapy xerostomia. Nine patients, with xerostomia following radiotherapy to the head and neck region underwent salivary gland scintigraphy with technetium-99m pertechnetate (40 MBq) both before and following 1 month of oral pilocarpine (5 mg tds). For each scan, the percentage uptake in the first 14 min, the peak uptake, time to peak uptake and the percentage of activity excreted following lemon juice stimulation were calculated. The results were correlated with the subjective response as assessed by questionnaire and visual analogue scale. We found no correlation between subjective response and any of the four scan parameters analysed. We could not identify any parameter that predicted those patients who would respond to pilocarpine. In addition, only one parameter, the percentage of activity excreted following stimulation, correlated with previous dose of radiotherapy to the gland. In conclusion, in this study salivary gland scintigraphy did not appear to correlate with or predict response to oral pilocarpine. However, future studies might consider performing salivary gland scintigraphy prior to radiotherapy as well as at differing time points following the commencement of pilocarpine.

Topics: Administration, Oral; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Parasympathomimetics; Pilocarpine; Pilot Projects; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Sodium Pertechnetate Tc 99m; Xerostomia

Knowledge of possible lymphatic drainage may facilitate planning of surgery for patients with head and neck tumors. Therefore, the aim of this study was to present a method of lymphoscintigraphy with special attention to an accurate correlation of lymphatic drainage to anatomic regions.. Lymphoscintigraphy was performed using a double tracer technique before surgery in a total of 75 patients with squamous cell carcinoma of the head and neck. All patients received 100 MBq 99mTc-colloid at three to four peritumoral sites. A perchlorate solution (2 mL) was given orally to block salivary glands and the thyroid gland. Patients received 50 MBq 99mTc-pertechnetate intravenously for body contouring 20 min postinjection. Planar images were obtained over 5 min each, at 30 min and 4 h postinjection from anterior, right lateral and left lateral views with a large-field-of-view gamma camera. Lymphatic drainage was assessed by visual inspection and assigned to six cervical compartments.. Neither the salivary glands nor the thyroid gland were seen in any of the patients. In 22 of 75 patients (29.3%), the injection site was the only focal tracer uptake seen. In contrast, lymphatic drainage was identified in the remaining 53 patients (70.7%), and lymph nodes could be assigned easily to the six cervical compartments. Of 75 patients, 36 (48%) exhibited ipsilateral lymphatic drainage. In addition, 17 patients (22.7%) with unilateral tumor showed bilateral (n = 12), contralateral (n = 2) or retropharyngeal (n = 3) lymphatic drainage. In 3 of these 17 patients, bilateral lymph node metastases were proven. A subgroup of 12 patients (16%) exhibited N2c nodal status, despite a unilateral localized primary tumor. In 3 of these 12 patients, surgery was extended as a result of scintigraphic findings from unilateral toward bilateral neck dissection, and histology confirmed nodal involvement in these patients.. Lymphoscintigraphy using the double tracer technique allows an accurate correlation of lymphatic drainage to the six cervical compartments. This may provide the basis for a re-evaluation of its impact in treatment planning of patients with head and neck tumors.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Lymphoscintigraphy; Male; Middle Aged; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin

A 31-year-old man is reported with the rare occurrence of a neurogenic tumor simulating a thyroid nodule. A growing nodule of the right neck was the only clinical symptom. Ultrasonography revealed a hypoechogenic nodule on the right side of the thyroid gland. Technetium (Tc)-99m pertechnetate showed a normal thyroid scintiscan. Due to ultrasonography-guided fine-needle aspiration biopsy, a schwannoma (neurilemmoma) was suspected. Surgical intervention removed the nodule and histology confirmed a schwannoma with Antoni A structures. To avoid unnecessary or inappropriate surgical intervention in cases of hypoechogenic nodules in connection with the thyroid gland, other nonthyroidal structures that may cause hypoechogenic patterns with ultrasonography should also be considered. The key preoperative investigations in such cases are ultrasonography and sonographically guided fine-needle aspiration biopsy.

Topics: Adult; Diagnosis, Differential; Head and Neck Neoplasms; Humans; Male; Neurilemmoma; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule; Tomography, X-Ray Computed; Ultrasonography

Salivary gland scintigraphy with technetium-99m pertechnetate was used to follow changes in the excretion and uptake function of the major salivary glands until 1 year after irradiation. Twenty-five patients who received radiotherapy for head and neck tumours were included in the study. Seventy-nine salivary glands (39 parotid and 40 submandibular) were evaluated in relation to the average received radiation dose. Salivary gland scintigraphy was performed before and 1, 6 and 12 months after radiotherapy. For each gland the excretion response to carbachol, evaluated by calculation of the salivary excretion fraction (SEF), the cumulative gland uptake (CGU) and the absolute excreted activity (AEA) at various intervals after radiotherapy were compared with the baseline values. The excretion response decreased in 20 of 25 patients at 1 month after radiotherapy. One month after radiotherapy both SEF and AEA decreased significantly in relation to the radiation dose. These decreases in excretion parameters persisted during the follow-up period. Parotid excretion was affected significantly more than submandibular excretion. CGU values did not change significantly until 6 months after radiotherapy, but at 12 months a significant decrease related to radiation dose was observed. Xerostomia was assessed during radiotherapy and on the days of the scintigraphic tests. The incidence of xerostomia did not correspond to the effects observed in the scintigraphic studies. It is concluded that radiotherapy induces early and persistent impairment of salivary gland excretion, related to the radiation dose. This impairment is stronger in parotid glands than in submandibular glands.

Topics: Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Radiation Injuries; Radionuclide Imaging; Salivary Gland Diseases; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m; Time Factors; Xerostomia

Topics: Adult; Erythrocytes; Head and Neck Neoplasms; Hemangioma; Humans; Male; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Time Factors

Both loss of the secretory function and impairment of the excretion may play a role in radiation-induced injury of the major salivary glands after radiotherapy for head and neck malignancies. Therefore, quantitative 99mTc-pertechnetate (99mTc) salivary scintigraphy to assess trapping, secretion, and excretion, was used to analyze irradiation-induced changes in relation to the radiation dose and the time interval after radiotherapy.. Salivary scintigraphy was performed on 25 patients who had been irradiated to the neck and head for various malignancies with irradiation of the major salivary glands and in 6 nonirradiated patients. Excretion was induced by stimulation with carbachol (Carbacholum, Pharmachemie BV, Haarlem, The Netherlands). As a parameter for salivary glandular trapping and secretion, the cumulative 99mTc-pertechnetate glandular uptake in the first 12 minutes was used. Scintigraphic data were analyzed for each patient and for each individual gland at three radiation dose levels (range, 5-70 Gy), and at short (range, 2-7 months) and long (range, 10-50 months) intervals after radiotherapy.. The excretion response to the stimulant carbachol was totally or partially disturbed in 84% of the irradiated patients. For individual glands, excretion was maintained in all glands irradiated with 25 Gy or less, in nearly half of the glands at doses of 25-45 Gy, and was almost invariably impaired at doses higher than 45 Gy, regardless of the time interval after radiotherapy. Although cumulative 99mTc glandular uptake tended to decrease at higher radiation dose levels (z = -3.059, P < 0.0022), at 45 Gy or more, cumulative 99mTc uptake was considerably higher in glands examined at a short postirradiation interval compared with glands examined after a long time interval (P = 0.0001). This tendency, seen for both parotid and submandibular glands, was not observed at doses lower than 45 Gy.. These data suggest that in the first period after high dose irradiation, xerostomia is based predominantly on the failure of the gland to excrete saliva, whereas in the later period, a decreased trapping ability together with loss of secretory function play an additional role. Salivary scintigraphy using 99mTc-pertechnetate is a suitable method to assess radiation-induced salivary gland injury. The test is able to detect salivary glandular dysfunction in an early phase and may be useful to predict which patients will respond symptomatically to salivary stimulants.

Topics: Adolescent; Adult; Aged; Carbachol; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Radiation Injuries; Radionuclide Imaging; Radiotherapy; Radiotherapy Dosage; Saliva; Salivary Glands; Sodium Pertechnetate Tc 99m; Time Factors

Topics: Carcinoma, Papillary; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Neoplasms

Topics: Female; Head and Neck Neoplasms; Humans; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sarcoma; Sodium Pertechnetate Tc 99m; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Gland

Neck metastases secondary to thyroid cancer are rarely visualized scintigraphically in the presence of a functioning thyroid gland. We present a patient with cervical lymph node metastases that take up 99mTc pertechnetate in the presence of hyperfunctioning thyroid tissue and discuss the pathophysiology of this phenomenon.

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

Topics: Adolescent; Adult; Arteriovenous Malformations; Child; Head and Neck Neoplasms; Hemangioma; Humans; Middle Aged; Radiography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Veins

Among numerous methods utilized for preoperative localization of hyperfunctioning ectopic parathyroid tissue, the technetium-thallium scan appears to be a major advance. Eight patients are presented where this method located ectopic parathyroid tissue in the neck, in the mediastinum, within the pericardium, and within the thyroid gland. To date, these findings have been confirmed operatively in five of the eight patients. On the basis of our limited experience, the authors believe that this is a valuable method in the preoperative localization of ectopic parathyroid tissue, especially in patients with persistent or recurrent hyperparathyroidism following a thorough neck exploration.

Topics: Adenoma; Aged; Female; Head and Neck Neoplasms; Humans; Male; Mediastinal Neoplasms; Middle Aged; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Reoperation; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium

A total of 216 99mTc-pertechnetate-sialographies, by applying stimulations by citric acid, were performed for studying radiation effects on the salivary glands in 145 patients. From a scintigram of the salivary gland, the time-activity-curves were obtained for analysis of salivary function. The shape of the time-activity-curve with respect to stimulus-response pattern was classified into four types according to the degree of radiation-induced dysfunction. We found that the acid stimulation was enhancing accumulation of the isotope into the salivary gland as well as influencing salivary discharge. A ratio (Rc) of pre- and post-stimulation counts permitted a construction of quantitative dose-response curves; the curve for the parotids had a slight rise of Rc's over 0-20 Gy, whereas that for the submandibular glands had a significant rise over 10-30 Gy; in both glands the rise of Rc's was followed by a steep fall. The parotids appeared to be more sensitive to radiation than the submandibular glands at 0-3 months following 20-70 Gy, but after 3 months both glands were similarly impaired. The gland volume irradiated was also of great importance in determining the degree of salivary dysfunction. The maximum uptakes averaged per unit area (salivary-to-background ratio) and determined during the initial 30 minutes were greater in the submandibular than in the parotid glands following greater than 20 Gy. In both glands the maximum uptakes were gradually impaired with time over 3-36 months following 50-70 Gy.

Topics: Adult; Aged; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Radionuclide Imaging; Radiotherapy; Salivary Glands; Sodium Pertechnetate Tc 99m

A young man with papillary-follicular thyroid carcinoma demonstrated clear visualization of cervical metastases from thyroid cancer on Tc-99m pertechnetate scintigraphy while exhibiting a palpably and scintigraphically normal thyroid gland. This is a very rare occurrence which demonstrates that Tc-99m pertechnetate scintigraphy is capable of detecting cervical metastases from thyroid carcinoma before the appearance of palpable thyroid nodules or defects on scintigraphy.

Topics: Adenocarcinoma; Adult; Head and Neck Neoplasms; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

We correlated scintigraphy and histological findings in 40 cases of nodular goiter in which two or more kinds of scintigraphy were performed preoperatively. 201Tl scintigraphy for imaging thyroid carcinoma showed a diagnostic agreement of 80% for thyroid lesions and 82% for metastatic lesions in the cervical lymph nodes. These agreements were higher than with 99mTc-bleomycin scintigraphy. Thus, 201Tl scan can be used to evaluate 'cold' thyroid nodules and to visualize metastatic lesions. 201Tl scan was also found valuable as a diagnostic measure for local recurrence of thyroid carcinoma. However, there were a few false-positive and false-negative results.

Topics: Adenoma; Adult; Carcinoma; Female; Head and Neck Neoplasms; Humans; Middle Aged; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Thyroid Neoplasms