sodium-pertechnetate-tc-99m and Lacrimal-Apparatus-Diseases

This study assesses the interobserver agreement on dacryocystography (DCG) and dacryoscintigraphy (DSG) findings.. There are no standard grading criteria to guide the interpretation of conventional DCG and DSG findings and therefore there may be a degree of subjectivity. This study evaluates the level of interobserver agreement in the interpretation of DCG and DSG findings.. A retrospective observational study at the Royal Adelaide Hospital.. A total of 165 patients who presented with epiphora with 276 DCGs and 290 DSGs performed were included in this study.. DCG and DSG images were obtained, anonymized, randomized and interpreted by three independent oculoplastic surgeons. Standard grading criteria were set for both DCG and DSG images. Data from all observers were analysed for interobserver agreement using Kappa (κ) statistics, generated using a variation of Cohen's kappa for multiple observers.. Level of interobserver agreement (κ values) in the grading of DCG and DSG findings.. There was an overall moderate interobserver agreement for DCG findings (κ = 0.55), with the highest agreement on interpreting canalicular obstruction (κ = 0.80), followed by proximal nasolacrimal duct obstruction (κ = 0.67) and normal patency (κ = 0.63). There was an overall fair interobserver agreement for DSG findings (κ = 0.36), with the best being moderate agreement (κ = 0.42-0.50) for interpreting pre-sac delay and post-sac proximal delay.. DCG offers good reliability in interpreting patent and obstructed systems. On the other hand, DSG has poor agreement and highlights some of the limitations in the ability to guide epiphora management.

Topics: Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Contrast Media; Data Interpretation, Statistical; Female; Humans; Iohexol; Lacrimal Apparatus Diseases; Male; Middle Aged; Nasolacrimal Duct; Observer Variation; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Current dacryoscintigraphy methods have several potential pitfalls, the most important of which is the outflow of tears. Another is the difficulty in fixing the head with the patient seated. To overcome these difficulties, a new method was applied.. The study included 77 persons: 43 controls and 34 patients with epiphora. Two methods were applied to the two groups. In the first, protocol 1 (the current conventional protocol), the patient was seated in front of a gamma camera and one drop (50 microl) Tc-99m pertechnetate containing 50 to 100 microCi radioactivity was instilled in the inferior fornix or outer canthus of the eye and dynamic and static images were obtained for approximately 15 to 20 minutes. In the other, protocol 2 (our protocol), 100 microCi (10 microl) Tc-99m pertechnetate was instilled in the outer canthus of the eye using a micropipette with the patient in the supine position under the gamma camera. Dynamic images were taken for only 5 minutes.. The pitfalls and difficulties seen with protocol 1 were lessened to a great degree in protocol 2.

Topics: Adult; Female; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Dacryoscintigraphy is a grossly underutilized nuclear medicine procedure for assessing the patency of nasolacrimal ducts. It is an alternate noninvasive modality requiring no added expertise when compared with dacryocystography, an invasive radiological counterpart. Dacryocystorhinostomy (DCR) is a surgical procedure in which a patent rhinostomy is made so that a low-pressure lacrimal bypass system is created, thus relieving epiphora, dacryocystitis or mucocele. DCR has been accepted as a highly successful procedure in the management of epiphora from nasolacrimal duct obstruction; however, adverse local effects can reproduce epiphora. This study highlights the utility and simplicity of dacryoscintigraphy in the postoperative setting of DCR, apart from showcasing its high sensitivity and accuracy in localizing the sites of lacrimal drainage obstruction.. Fifty-five postoperative patients of DCR were screened. Ten volunteers constituted the control group. One drop (10 μl) of technetium pertechnetate (TcO4) was instilled simultaneously in the outer canthus of both eyes (50-100 μCi). Upright dynamic (8 min) and anterior static images of the eyes (up to 20 min) were acquired on a gamma camera fitted with a high-resolution collimator. Physiological interventions that were used in this study were eye blinking, saline intervention, and lacrimal sac massaging.. Out of 40 symptomatic DCR patients, 22 had complete obstruction at the presac level and 18 patients had partial obstruction. Quantitative parameters like tear transit time and lacrimal sac half-life were also calculated. After massage of the lacrimal sac, progression of the tracer was observed in five patients. Premassage and postmassage tear column measurements showed a relative increase of 30.1%. Massage of eight clinically normal ducts showed a relative increase of 2.4% (P=0.06). Statistical analysis using the Fisher test shows very significant concordance between clinical symptoms and dacryoscintigraphy findings in postoperative DCR patients (P<0.0001). The modified McNemar's pair test did not show statistically significant differences between dacryoscintigraphy and the syringing irrigation test.. Dacryoscintigraphy is a simple and easy-to-perform investigation providing high sensitivity in epiphora detection in patients after DCR. Interventions play a role in further enhancing the sensitivity of the technique. This study demonstrates the utility of dacryoscintigraphy in detecting subclinical and partial lacrimal duct obstruction with good patient compliance. It provides an easy and effective way of screening families, enabling an early diagnosis. During imaging, a high-resolution collimator is found to be an efficient substitute for the conventional pinhole collimator.

Topics: Adolescent; Adult; Aged; Case-Control Studies; Dacryocystorhinostomy; Female; Humans; Lacrimal Apparatus Diseases; Male; Middle Aged; Nasolacrimal Duct; Postoperative Complications; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Treatment Outcome; Young Adult

The transit of Tc-99m pertechnetate through 122 lacrimal drainage systems was quantified. Systems were categorized as having presac, preduct, intraduct, or no delay. Scintigraphy indicated an obstruction in 81.3% of eyes with epiphora. Of the 18 eyes in whom only scintigraphy revealed an obstruction, all 3 who underwent surgery experienced symptom relief. In patients presenting with unilateral epiphora the mean canthus half-time (12.9 vs. 7.2 minutes), time-to-peak activity at the sac (11.6 vs. 3.1 minute), and sac half-time (19.0 vs. 10.3 minutes) were significantly prolonged in the symptomatic eye. Similarly, the sac-to-canthus (0.32 vs. 0.72), duct-to-canthus (0.32 vs. 0.99), and duct-to-sac ratios (0.48 vs. 0.79) of peak activity were all significantly reduced in the symptomatic eye. When compared with "no delay," "presac," "preduct," and "intraduct" delay were significantly associated with attenuated clearance times or reduced ratios of peak activity corresponding to the level of obstruction. We conclude that there is a significant association between symptomatic epiphora and quantitative variables at the canthus and sac in lacrimal scintigraphy. Quantitative variables help locate the level of an obstruction.

Topics: Algorithms; Female; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

At the present time, only visual analysis is implemented on dacryoscintigraphic images and quantitative assessments are not routinely obtained. The authors have designed a novel, simple, quantitative method for the diagnosis of sac and post-sac obstructions based on the dacryoscintigraphic images.. Fifty-nine patients with severe unilateral epiphora were included and the contralateral asymptomatic eyes were used as controls. After ocular instillation of 0.1 cc isotonic saline containing 4 MBq 99mTcO4, dynamic images were obtained for 20 minutes. Visual interpretation was done by two blinded specialists in nuclear medicine. A Time-Activity Curve (TAC) was generated for each eye and its pattern was divided to plateau type, shallow-down sloping and deep-down sloping. The excretion ratio (expressed as the percentage of drained activity) in the 2nd, 3rd, 5th, 7th, 10th, 15th and 20th minute of the study was calculated based on the following formula: (the total count in the region of interest (ROI) in the 1st minute - the total ROI count in the 2nd, 3rd, 5th, 7th, 10th, 15th or 20th minute/the total ROI count in the 1st minute) x 100. The results of the quantitative analysis were compared with the clinical symptoms, visual analysis and TAC pattern.. At the optimal cut-off points for the 2nd, 3rd, 5th and 7th minute, the sensitivity of the prediction of obstruction was 76%, 72%, 71% and 69%, respectively. The correlation between visual interpretation and the TAC pattern was statistically significant.. The quantitative evaluation of dacryoscintigraphic images would contribute greatly to achieving an easier and more objective interpretation of the scintigraphic results and also provides a reliable tool for inter-individual comparison and the follow-up of patients. As it is the first time that this innovative method has been examined clinically, it will be necessary to investigate its clinical utility in a larger series of patients.

Topics: Adult; Aged; Aged, 80 and over; Female; Gamma Cameras; Humans; Lacrimal Apparatus Diseases; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; ROC Curve; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

The objective is to evaluate the technique of microvascular autologous submandibular gland transfer for the treatment of severe keratoconjunctivitis sicca. From August 1999 to April 2002, 38 patients with severe keratoconjunctivitis sicca were treated by autologous submandibular gland transfer to the temporal region of the skull. The related vessels were anastomosed to the superficial temporal artery and vein. When the vein was too small, venous bridging was applied. Prior to cutting off the gland, the facial artery was preserved and infused with heparin in normal saline after the gland had been freed to allow inspection of the blood oozing from the three veins. This would be helpful in the selection of a relevant vein for anastomosis. Wharton's duct was transplanted to the upper lateral conjunctiva fornix, and the gland was left denervated. Postoperative scintigraphy with Tc99m pertechnetate, follow-up studies, and management of complications were performed. The transplantations were successful in 33 cases, their symptoms of xerophthalmia disappeared. The discomfort resulting from bright light and wind was also relieved. These patients could stop applying artificial tears. In five patients the transplanted glands did not survive. Epiphora occurred in eight cases. They were successfully treated by reducing the size of the graft. Obliteration of Wharton's duct took place in two cases and was treated by the reconstruction of the duct or duct orifice. Microvascular autologous submandibular gland transfer is a lasting and effective solution for severe cases of keratoconjunctivitis sicca.

Topics: Adolescent; Adult; Aged; Anastomosis, Surgical; Child; Conjunctiva; Female; Follow-Up Studies; Graft Survival; Humans; Keratoconjunctivitis Sicca; Lacrimal Apparatus Diseases; Male; Microsurgery; Middle Aged; Postoperative Complications; Radiopharmaceuticals; Salivary Ducts; Sodium Pertechnetate Tc 99m; Submandibular Gland; Temporal Arteries; Temporal Muscle; Transplantation, Autologous; Treatment Outcome; Veins

Topics: Aged; Artifacts; Gamma Cameras; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate

Dacryoscintigraphy used for diagnosing the lacrimal apparatus pathology in 27 patients has revealed the advantage of this method over the previously used methods (the West's color test, X-ray contrast dacryoscintigraphy, diagnostic washing of tear passages) having a number of shortcomings. Of a special value is dacryoscintigraphy for diagnosing functional disturbances in the lacrimal apparatus. However, a full information about the state of tear passages can be received only by complex usage of all the mentioned methods.

Topics: Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Radionuclide dacryoscintigraphy is an accurate physiologic method for evaluating the nasolacrimal drainage apparatus. The following case report illustrates the role of this procedure in the initial workup of epiphora, as well as its value in assessing response to therapy with pseudoephedrine.

Topics: Aged; Ephedrine; Female; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Time Factors

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Humans; Lacrimal Apparatus Diseases; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium