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

Topics: Acute Disease; Adult; Age Factors; Analgesics; Epididymitis; Genital Diseases, Male; Gonorrhea; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium; Testicular Neoplasms; Testis; Tetracycline; Trachoma; Ultrasonography

We have studied 181 patients with germ-cell tumours of the testis. The first group comprised 80 persons without evidence of metastasizing into retroperitoneal lymph nodes; the second group included 101 patients with germinal testicular tumours metastasizing into regional lymph nodes. Eighty patients were subjected to transperitoneal lymphadenectomy which allowed comparison of the results of lymphoscintigraphy (negative radionuclide diagnosis with colloid agents labelled with gold and technetium positive radionuclide diagnosis with 99mTc-pertechnetate) with the findings of histologic examination. We demonstrated high significance of lymphoscintigraphic methods: sensitivity 83%, specificity 90.9%, significance 86.2%. It was found that information obtained with lymphoscintigraphy can serve as clinical guidelines in determining the site, size and spread of metastasizing, which is very important in choosing fields of irradiation. Lymphoscintigraphy in testicular tumours enables more accurate staging and radicality of lymphadenectomy at different time intervals after surgery.

Topics: Adolescent; Adult; Combined Modality Therapy; Follow-Up Studies; Germinoma; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Radionuclide Imaging; Reproducibility of Results; Retroperitoneal Neoplasms; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Testicular Neoplasms

Topics: Angiography; Diagnosis, Differential; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sex Cord-Gonadal Stromal Tumors; Sodium Pertechnetate Tc 99m; Testicular Neoplasms; Tomography, X-Ray Computed

Testicular scanning with technetium-99m sodium pertechnetate was performed on 152 patients with a variety of intrascrotal lesions. Scrotal images were obtained serially in the perfusion, tissue phase, illustrating the features of each phase in various clinical conditions. The relationship of scrotal imaging to the overall clinical presentation and evaluation of these patients is emphasized in testicular torsion of the testicular appendix, epididymitis, abscess, trauma, tumor, spermatocele, and varicocele. Technical problems of the scanning are also discussed.. Testicular scanning with technetium-99m sodium pertechnetate was performed on 152 patients with various intrascrotal lesions. Prior to scanning, the patients were given an oral dose of 200 mg KD104 to control thyroid gland's exposure to radiation. Scrotal images were obtained 16 times with 2 seconds' interval in the perfusion phase and twice with 5 minutes' interval in the tissue phase. The rate of correct diagnosis by scrotal images were 100% for testicular torsion and acute epididymitis, significantly high for scrotal abscess and varicocele, 40-50% for testicular tumor, and low in the cases of hydrocele, testicular trauma and spermatocele. In testicular torsion, a rounded cold area and a halo of dartos perfusion were observed. Scrotal imaging proved to be useful for post-operative diagnosis of testicular vascularity also. In "missed" testicular torsion, scrotal scan showed a "halo sign" in the tissue phase due to intensified vascularity in the dartos, and a "nubbin sign" in the perfusion phase due to the increased perfusion of spermatic cord vessels. In acute epididymitis scrotal scan showed increased activity spanning spermatic cord vessels and scrotum in the perfusion phase, and increased curvilinear activity in the tissue phase. In scrotal abscess increased perfusion from spermatic cord vessels and pudendal artery were observed in the perfusion phase. In the tissue phase increased dartos perfusion and a cold area due to the formation of abscess was observed. In varicocele, increased perfusion in the location which corresponded to the pampiniform plexus of the vein was observed in venous phase.

Topics: Adult; Epididymitis; Genital Diseases, Male; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testicular Neoplasms; Testis

Two patients who originally presented with clinical symptoms of epididymo-orchitis, with compatible findings on the Tc-99m pertechnetate scrotal images, had temporary remission of their symptoms with antibiotic therapy. After two months, both patients had repeat scrotal images, because of persistent testicular enlargement. Both now demonstrated a "cold spot" in the otherwise increased activity on the affected side. Both patients underwent orchiectomy; patient 1 had a tissue diagnosis of malignant mixed germ cell tumor and patient 2 showed teratocarcinoma.

Topics: Adult; Castration; Humans; Male; Neoplasms, Germ Cell and Embryonal; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Technetium; Teratoma; Testicular Neoplasms

Scrotal imaging with technetium-99m sodium pertechnetate consists of a radionuclide angiogram and static scrotal scans. Utilization of this study in patients presenting with an acute scrotum can dramatically reduce the number of surgical explorations for acute epididymitis. It can also aid in other aspects of differential diagnosis in patients presenting with either an acutely enlarged and/or painful scrotum or a scrotal mass. Ambiguities in previous descriptions of perfusion through the spermatic and extraspermatic cord vessels are described and distinguished from scrotal perfusion. The clinical and scintigraphic spectrum of testicular torsion, including spontaneous detorsion, early acute testicular torsion, midphase testicular torsion, and late phase or "missed testicular torsion," is discussed and illustrated. The variety of patterns seen in acute epididymitis, including lateral and medial epididymal location, and focal epididymitis are described, as is the appearance of hydrocele as both a primary and secondary entity. The relationship of scrotal imaging to the overall clinical presentation and evaluation of these patients is emphasized in testicular torsion, torsion of the testicular appendages, epididymitis, abscess, trauma, tumor, spermatocele, and varicocele. The techniques, clinical utility, and relationship to radionuclide imaging of Doppler ultrasound and gray scale ultrasound scanning are reviewed. Doppler ultrasound results in many false negative studies in testicular torsion. Gray scale ultrasound is useful in clarifying the nature of scrotal masses.

Topics: Abscess; Epididymitis; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Spermatocele; Technetium; Testicular Hydrocele; Testicular Neoplasms; Ultrasonography; Varicocele