sodium-pertechnetate-tc-99m and Lacrimal-Duct-Obstruction

Lacrimal scintigraphy (LS) or dacryoscintigraphy can demonstrate abnormalities in 80%-95% of patients with symptoms of epiphora and a patent lacrimal system on syringing and up to 40% asymptomatic individuals. Precise localization of the site of delay may not always be possible due to lack of anatomic detail on LS. LS is considered useful in patients with epiphora with delayed tear clearance and patency to syringing and suspected to have either nasolacrimal duct (NLD) stenosis or lacrimal pump failure. It remains unclear, however, as to whether LS can reliably distinguish between the two. The literature reports considerable variation in the technique, normative data, analysis, and interpretation of LS. Qualitative or visual analysis is simpler to perform and to our knowledge used more frequently in comparison to quantitative analysis. There is little extra information to be gained from LS in cases with complete NLD obstruction or severe NLD stenosis on syringing.

Topics: Data Interpretation, Statistical; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Obstruction of the lacrimal drainage apparatus may result in excessive tearing or epiphora. This may occur as a result of a traumatic injury or accumulation of debris, mucus, or pus. In nuclear dacryoscintigraphy, a radioactive solution is introduced into the conjunctival sac by pipette and allowed to follow the flow of the tear solution through the lacrimal drainage system. This article will review normal lacrimal anatomy and indications for nuclear dacryoscintigraphy in oral and maxillofacial surgery.

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

Assessment of lacrimal resistance in patients with patent lacrimal systems is important in determining whether dacryocystorhinostomy (DCR) surgery is appropriate. Current techniques, including lacrimal syringing and dacryoscintigraphy (DSG), can be unreliable. We compare the results of a manometric tear duct test (mTDT) irrigation technique with DSG in these patients.. All symptomatic patients in a specialist lacrimal clinic had full work-up apart from syringing. Lacrimal resistance was assessed using mTDT which applies a fixed head of fluid pressure via a cannula sealed to punctum. Conventional syringing was also performed in cases with abnormal mTDT. Symptomatic patients with delayed tear clearance, no external cause for watering and patent lacrimal systems had DSG. MTDT and DSG results were compared, including in asymptomatic fellow eyes.. 105 tear ducts were examined, 85 symptomatic. Symptomatic eyes had a significantly higher mean mTDT resistance (. In contrast to DSG, the mTDT provides valuable, objective information on lacrimal resistance that can guide a decision to DCR surgery.

Topics: Adult; Aged; Aged, 80 and over; Dacryocystorhinostomy; Female; Humans; Lacrimal Duct Obstruction; Male; Middle Aged; Nasolacrimal Duct; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Therapeutic Irrigation

To measure tear clearance values in patients with meibomian gland dysfunction (MGD) with a dynamic nuclear medicine method, namely, dacryoscintigraphy (DSCI).. Twenty-four MGD patients and 24 healthy volunteers were examined. During DSCI one drop of a solution with 100 MBq/mL. The T½ values were 29.91 ± 11.61 min in MGD patients and 6.26 ± 1.5 min in healthy controls. Tear osmolarity parameters were 308 ± 9.41 mOsm/L and 288.9 ± 6.4 mOsm/L, tBUT values were 5.54 ± 2.73 s and 11.4 ± 2.7 s, while the ST. Although the MGD patients' lacrimal drainage systems were patent their tear clearance values were significantly higher than those of healthy volunteers, which may be caused by decreased drainage of tears from the eyes towards the nasal cavity. The understanding of new features regarding the altered physico-chemical characteristics of MGD tears has been augmented by the results of this study.

Topics: Adult; Aged; Aged, 80 and over; Female; Healthy Volunteers; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Male; Meibomian Gland Dysfunction; Middle Aged; Osmolar Concentration; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tears; Tomography, Emission-Computed

We reported a 6-year-old girl with a history of left-eye epiphora since 2 years ago who was referred to our nuclear medicine center for dacryoscintigraphy imaging. The scan showed obstruction in the proximal portion of the nasolacrimal duct in the left eye. Imaging also showed patent nasolacrimal duct of the right eye. Tc pertechnetate activity was seen in the esophagus and stomach owing to swallowing of the excreted tracer in the nasal cavity. This was an unequivocal sign of patent lacrimal apparatus.

Topics: Child; Esophagus; Female; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Stomach

We report a 37-year-old patient with the history of bilateral epiphora, who was referred to our department for dacryoscintigraphy imaging. The patient had bilateral obstruction of the lacrimal apparatus at the sac-duct level on the scintigraphy images. Delayed imaging showed Tc-99m pertechnetate uptake in the thyroid due to systemic absorption of the tracer from the conjunctiva. We recommend using tracers with large particle size and lower possibility of mucosal absorption for dacryoscintigraphy in order to decrease unnecessary thyroid radiation.

Topics: Absorption; Adult; Humans; Lacrimal Duct Obstruction; Male; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland

Dacryoscintigraphy is a noninvasive method frequently used for assessment of the lacrimal drainage system. Sometimes conflicting results with patients' complaints are obtained, which have no clear explanation. In our hypothesis, follow-up of patients evaluated with dacryoscintigraphy could be helpful in determining possible explanations for these conflicting results.. Thirty-eight consecutive patients (76 eyes) who had not previously undergone dacryocystorhinostomy or probing were entered in the study. Following instillation of 4 MBq (99m)Tc-pertechnetate, a routine procedure of dacryoscintigraphy was performed. After a mean follow-up time of 1.2 +/- 0.3 years (range 0.9-1.6 years), all patients were reassessed clinically.. Using initial patients' symptoms as the gold standard, the sensitivity, specificity, NPV, and PPV of dacryoscintigraphy were calculated to be 82.1%, 75%, 60%, and 90.1%, respectively. The kappa value as a measure of agreement was 0.52. Considering the follow-up study as the gold standard, the sensitivity, specificity, NPV, and PPV were calculated as follows, respectively: 96.3%, 90.4%, 96.3%, and 90.4%. The kappa value was 0.86. There were three initially symptom-free eyes with obstructive pattern on the scans, which developed epiphora on the follow-up. In fact, these eyes were initially classified as false positive, but follow-up assessment showed that they were true-positive scans in a subclinical state.. Despite certain drawbacks inherent to the technique, dacryoscintigraphy provides valuable independent information and allows more accurate management decisions. In some patients, data obtained from lacrimal scintigraphy could be predictive, and it makes possible determination of subclinical nasolacrimal duct obstructions.

Topics: Adult; Aged; Dacryocystorhinostomy; Female; Follow-Up Studies; Humans; Lacrimal Duct Obstruction; Male; Middle Aged; Nasolacrimal Duct; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

To study the discriminatory ability of dacryoscintigraphy in differentiating between patients with epiphora and volunteers using a simple method.. Twenty eyes in ten volunteers and 66 eyes in 55 patients with severe epiphora were studied. Dacryoscintigraphy (15 frames of 1 min) was performed after administration of 4 MBq (99m)Tc-pertechnetate (10 mul) in both eyes. By mapping a single region of interest (ROI) over the conjunctival sac we determined T1 (%dose in first minute) and linear clearance rate (LCR, defined as [see text] from the tracer disappearance curve. Reproducibility was determined in volunteers. Conjunctival resorption was determined from completely obstructed systems. Sensitivity and specificity were calculated and receiver operating characteristics (ROC) analysis was conducted.. In volunteers mean T1 was 52.8+/-11.9% (95% CI 47.1-58.4%), and LCR was 74.2+/-11.1% (95% CI 69.0-79.4%). Reproducibility was good (mean difference 4.1+/-13.3% for T1 and 0.7+/-17% for LCR). Epiphora patients had clearly higher T1 (82.1+/-15.2%, P<0.0001) and lower LCR (38.9+/-22.5%, P<0.0001) values. Tracer resorption was 24%. Based on ROC analysis 70% for T1 and 50% for LCR were considered optimal cut-off levels to separate patients from volunteers. Sensitivity/specificity were 77/95% for T1 and 71/100% for LCR. T1 and LCR values did not correlate with symptom scores or Anel test results.. Dacryoscintigraphy, using LCR and T1 as parameters, is a reliable and objective method to detect tear-flow abnormalities.

Topics: Adult; Aged; Aged, 80 and over; Dacryocystorhinostomy; Female; Humans; Lacrimal Duct Obstruction; Male; Middle Aged; Nasolacrimal Duct; Radionuclide Imaging; Radiopharmaceuticals; ROC Curve; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

To find the right diagnostic test through checking the drainage of lacrimal ducts.. Dacryocystography of lacrimal ducts was performed in 25 patients by using 0.5-1 ml of Lipidiol and conducting X rays in different head positions--3-4 photograph in A-P projection (exposition's parameters 85-90 kV and 12-15 mAs, distance lamp-table: 100-130 cm, Philips Diagnose 93). For stereo estimation--2 oblique photographs of head, deviated at 45 towards central body line. Patient is brought on vertical position and after 5 minutes radiography in A--P projection can show remaining contrast in lacrimal duct. Dacroscintigraphy was done in 200 patients by dropping in conjunctival sac 1 drop of sterile 99mTc, in dose 3.7-7.4 MBq (100-200 uCi). The patients head is immobilized on the support, close to detection head of gamma camera (ediso Nucline TH) with LEHR. Distribution of this drug was visible on the monitor and saved in the computer's memory. Data was registered during 10 minutes, summed up into end picture and then evaluated by sight.. Many authors consider dacryoscintigraphy and dacryocystography as methods of choice in establishing correct diagnosis. High sensitiveness and mutual completion of both methods lets us quickly explain the reasons of epiphora and settle further management.

Topics: Aged; Contrast Media; Female; Humans; Iodized Oil; Lacrimal Duct Obstruction; Male; Middle Aged; Observer Variation; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Paranasal sinus infections and nasolacrimal duct obstructions are commonly encountered problems. However the relationship between these two conditions is not yet clear. Trauma, surgery, tumors, and systemic diseases are among the causes of acquired nasolacrimal duct obstructions but most of the cases are idiopathic. In this study patients diagnosed with chronic paranasal sinus infection were examined with 99mTc lacrimal dacryoscintigraphy to assess their nasolacrimal duct function.. Twenty-four patients diagnosed with chronic paranasal sinus infection are included in the study. These patients were observed for at least three months awaiting surgical treatment following unsuccessful medical treatment. The control group included 16 persons admitted to the ophthalmology department without any nasolacrimal duct disease. Nasal endoscopy and paranasal sinus CT revealed normal findings. The age of the patients with chronic paranasal sinus infection and examined in regard to nasolacrimal duct function was between 15 to 17 with a mean age of 34.2 years. Fourteen patients were male and 10 patients were female. The control group included 9 male and 7 female patients between 18 to 60 years with a mean of 30.5 years.. The dacryoscintigraphic examination of 48 nasolacrimal ducts in 24 patients with chronic paranasal sinus infection revealed 7 complete and 18 partial obstructions of the duct, and 23 normal findings. In the control group with 32 nasolacrimal ducts of 16 patients, there was no complete obstruction. Partial obstruction (10.6, 12.0, 14.7 minutes) was be observed in three cases. The statistical workup resulted in a significant difference between paranasal sinus patients and control group (x2 = 15,840 p < 0.001). The paranasal sinus CTs of the patients with paranasal sinus disease were staged using the Lund-Mackay staging system: There is no correlation between the staging score of the paranasal sinus infection and the degree of the obstruction the nasolacrimal duct.. This study shows that chronic paranasal sinus disease plays an important role in the pathogenesis of nasolacrimal duct obstructions. The presence of infection has an influence on the nasolacrimal drainage system, but the distribution (staging) of the infection does not appear to correlate with the degree of nasolacrimal duct obstruction. Partial obstruction cases that may progress to complete obstruction may be detected by dacryoscintigraphy, and the treatment of chronic paranasal sinus disease may help to overcome the lacrimal drainage problems in these cases.

Topics: Adolescent; Adult; Aged; Chronic Disease; Female; Humans; Lacrimal Duct Obstruction; Male; Middle Aged; Radionuclide Imaging; Sinusitis; Sodium Pertechnetate Tc 99m

Between November 1990 and November 1993, 580 children with lacrimal outflow obstruction were examined at the Children's Hospital of Philadelphia. After excluding patients previously treated for nasolacrimal duct obstruction, we obtained a prospectively selected series of 20 children for this study. These patients underwent dacryoscintigraphy before and immediately after lacrimal sac massage to investigate the effect of external compression on fluid movement within the lacrimal outflow system. In 12 patients, tracer did not enter the lacrimal outflow system on the side(s) of obstruction. The absence of radiopharmaceutical correlated with clinical obstruction. In eight patients, tracer was noted to enter the lacrimal sac. After massage of the lacrimal sac, we observed progression of the tracer in five of the eight subjects. In these eight subjects, the pre- and postmassage tear column measurements showed a relative increase of 34.3%. Massage of eight clinically normal ducts showed a relative increase of 2.4% (p = 0.06). We conclude that progression of the tear column after lacrimal massage can be demonstrated on dacryoscintigraphy.

Topics: Child, Preschool; Female; Humans; Infant; Lacrimal Duct Obstruction; Male; Massage; Nasolacrimal Duct; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Tears; Treatment Outcome

Topics: Adult; Diagnosis, Differential; Humans; Lacrimal Duct Obstruction; Male; Mucocele; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Lacrimal dacryoscintigraphy facilitates definite diagnosis of obstructions and stenosis of the lacrimal drainage system with little stress to the patient. Together with x-ray dacryocystography it is an important diagnostic tool especially for pre- and postoperative evaluation of the drainage apparatus. Dacryoscintigraphy is the best method for measuring the dynamics of tear drainage especially in the canaliculi. Although it is not a substitute for other methods in general use, it complements them and expands their diagnostic accuracy.

Topics: Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Tears; Technetium

Nuclear dacryocystography is simple, relatively harmless method of evaluating patients suspected of having abnormalities of the nasolacrimal drainage system. A group of normal saline containing approximately 100 muCi of 99mTc-pertechnetate is placed on the conjunctiva near the lateral canthus, and serial scintigrams are obtained as the pertechnetate flows along the tear strips, through the nasolacrimal drainage system, into the nasal fossa. By using a pinhole collimator with a very small aperture (1mm), the canaliculi, the nasolacrimal sac, and the nasolacrimal duct are readily visualized. When flow is impaired, the site of obstruction can often be identified. Contrast dacryocystography provides similar information but requires the injection of contrast material directly into a canaliculus. Nuclear dacryocystography provides good functional assessment of nasolacrimal drainage but has serious shortcomings in defining pathologic anatomy. Contrast dacryocystography outlines the anatomy well but often misses minor obstructions. The two studies are complementary and together provide an effective means of evaluating the nasolacrimal drainage system.

Topics: Ethiodized Oil; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Radiography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Aged; Female; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium