sodium-pertechnetate-tc-99m and Thrombophlebitis

We evaluated selection bias in a prospective study of 1,162 consecutive patients with suspected pulmonary embolism. Of these, 983 were eligible, and 627 could actually be included. During two months extensive data were collected on all non-included patients. Finally, our patient characteristics were compared with those of the PIOPED study (1990) and the study of Hull et al. (1994). Compared with included patients, the non-included patients had more often non-diagnostic V/Q scans (50% vs. 36%, p <0.01) and were more often already hospitalized (31% vs. 22%, P = 0.04). The subgroup of patients not included due to refusal or inability to give informed consent (IC) was older (mean age 61 vs. 53 years, P <0.01), more often suffered from malignancies (26% vs. 11%, P <0.01) and frequently had non-diagnostic V/Q scans (57%) as compared to included patients. In our study, 54% of all patients screened was eventually included versus 27% in the PIOPED study. In the PIOPED study patients who had contra-indications for pulmonary angiography were excluded, while in the study of Hull et al. those with inadequate cardiorespiratory reserve were excluded. In studies on new diagnostic technologies, patient selection bias does occur. The potential for such a selection bias should be taken into account when diagnostic strategies are devised to improve their generalizability and acceptability.

Topics: Adult; Aged; Angiography; Comorbidity; Female; Humans; Incidence; Informed Consent; Male; Middle Aged; Patient Selection; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Pulmonary Embolism; Radionuclide Imaging; Radiopharmaceuticals; Risk Factors; Selection Bias; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thrombophlebitis; Tomography, X-Ray Computed; Treatment Refusal; Ultrasonography; Ventilation-Perfusion Ratio

SC-RNV, radionuclide venography by subcutaneous injection of Tc-99m pertechnetate at acupuncture points K-3, a new alternative of lower limb venography, was recently developed in our clinical laboratory. In some of the previous studies, we have proved its superiority to radionuclide venography by intravenous injection. The current investigation was conducted to understand the reliability of SC-RNV in the diagnosis of deep vein thrombosis (DVT). Fifty-seven cases with lower leg edema, from Nov., 1989 through Oct., 1990, received both SC-RNV and duplex US for causative evaluation. As a result of duplex US, 26 were considered normal (non-DVT), 19 were classified as unilateral DVT, and 12 as bilateral DVT. In nineteen cases (61%, 19/31) with DVT also a XCT and/or a CV (contrast venography) was taken, that showed compatible results. All of the non-DVT had a normal pattern of SC-RNV, all of the unilateral DVT had unilateral impairment of deep vein drainage in SC-RNV, and all of the bilateral DVT had impaired deep venous drainage bilaterally in SC-RNV. It is therefore concluded that SC-RNV is one of the best choices among available non-invasive lower-limb venographic methods.

Topics: Acupuncture Points; Adult; Aged; Edema; Female; Humans; Injections, Subcutaneous; Leg; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thrombophlebitis

A new method involves 2 stages: 1st, injection of three 10 ml boluses of 99mTc-pertechnetate through a dorsal vein of the foot with recording of 3 separate dynamic studies of venous flow in the calf, thigh and pelvis; and 2nd, static equilibrium venography (EV), which can be completed 15 min later after 99mTc-RBC labelling in vivo. The method was performed in 100 patients with suspected DVT. Due to the large pertechnetate bolus followed with 20-40 ml flush of normal saline, the flow study provides a significant improvement in filling of major calf veins, which makes this technique more similar to contrast phlebography. The flow study was found much more sensitive than EV, especially for calf DVT. However, EV, providing information about the unaffected leg, plays an important complementary role when the study is negative for DVT. In conclusion, both stages are recommended for routine examination of patients referred with suspected DVT.

Topics: Aged; Erythrocytes; Female; Humans; Male; Middle Aged; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Technetium; Thrombophlebitis

We have proved that subcutaneous injection (SC) of a small dose of Tc-99m pertechnetate (1 to 2 mCi: 37 to 74 MBq) at acupuncture points (K-3 and B-60) may offer an alternative method of radionuclide venography (RNV) of the lower limbs. In this study, we compared intravenous (IV) RNV and SC-RNV in 22 consecutive cases with typical signs and symptoms suggesting venous abnormality of the lower limb(s) from March to May 1988. They are 11 male and 11 female, aged 47.7 +/- 15.7 years. Among the 44 limbs of the 22 cases, 4 were normal, 12 (27.3%) were found to have varicose veins in the legs only, 18 (40.9%) had partial stenosis of the deep veins (14 poplito-tibial and 4 superficial femoral), and 13 (29.6%) had complete stenosis of the deep veins (4 poplitotibial, 1 superficial femoral and 8 ilio-femoral. SC-RNV showed almost the same results as IV-RNV in 21 (47.7%), superior to IV-RNV in 22 (50%) (including 4.6% failure of IV-RNV), and inferior to IV-RNV in 1 (2.3%). We conclude that SC-RNV is definitely an alternative method of lower-limb venography. Since it is in most cases superior to IV-RNV, we suggest that it can take the place of IV-RNV in routine work.

Topics: Acupuncture Points; Adult; Female; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Thrombophlebitis

Topics: Acupuncture Therapy; Adolescent; Adult; Aged; Female; Humans; Injections, Subcutaneous; Leg; Male; Middle Aged; Predictive Value of Tests; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Thrombophlebitis; Varicose Veins; Veins

Angioscintigrams of the deep veins in the legs were obtained in a consecutive series of 119 patients, suspected of deep vein thrombosis. Two nuclear medicine specialists independently read the angioscintigrams for presence of focal-filling defects, increased tissue activity, or collaterals and gave a final diagnosis of deep vein thrombosis. The overall agreement for the four findings were 0.83, 0.74, 0.75, and 0.84, respectively. After adjusting the overall agreement for expected chance agreement, kappa values of 0.56, 0.47, 0.21, and 0.64 were obtained. The interobserver variation of the angioscintigraphic diagnosis for deep vein thrombosis is comparable to that of the radiographic phlebography. As the angioscintigraphic technique is almost without any risk and inconvenience to the patient, it constitutes a relevant diagnostic alternative in the diagnosis of deep vein thrombosis.

Topics: Adult; Aged; Clinical Competence; Female; Humans; Male; Middle Aged; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Thrombophlebitis

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pulmonary Embolism; Radionuclide Angiography; Retrospective Studies; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Thrombophlebitis

The influence of circulatory changes, which are secondary to deep venous thrombosis (DVT) in the leg, on result of radionuclide tests was studied in eight patients. Strain gauge plethysmography, a radionuclide blood-pool test and phlebography were performed both in the acute phase and during recovery up to 6 months after the initial admission. Morphological and functional changes were correlated with results from repeatedly performed 99Tcm-plasmin tests, a test currently used for diagnosis of DVT. In the acute phase, the thrombotic leg showed an increase in pooled blood and, in the case of proximal thrombosis, also impaired venous outflow. During the 6-month follow-up complete recanalization was observed in three patients and partial recanalization in five. The circulatory changes were found to recover progressively and earlier than the morphological changes. The 99Tcm-plasmin test was pathological at admission in all patients. It was normalized in parallel with plethysmography and blood-pool test results, at a time when morphological recovery was still incomplete. These findings confirm that a positive 99Tcm-plasmin test reflects haemodynamic changes which are secondary to the DVT rather than a specific binding of the radiopharmaceutical to the thrombus. The 99Tcm-plasmin test was normalized from 1 to more than 26 weeks after an acute DVT. This finding is of practical importance when using radionuclide tests for evaluation of acute recurrent DVT.

Topics: Aged; Erythrocytes; Female; Fibrinolysin; Follow-Up Studies; Humans; Leg; Male; Middle Aged; Organotechnetium Compounds; Phlebography; Physical Examination; Plethysmography; Regional Blood Flow; Sodium Pertechnetate Tc 99m; Technetium; Thrombophlebitis

Complications of popliteal cysts may closely mimic the clinical features of a deep venous thrombosis. We assessed the sensitivity and specificity of the non-invasive procedures of radionuclide venography and popliteal space ultrasound examination compared with those of contrast venography and arthrography, respectively, and then prospectively studied 23 non-surgical patients with acutely painful, swollen calves to determine the utility of these techniques. The cause of this symptom was popliteal cyst complications in 10 patients, deep venous thrombosis in seven patients, and both conditions in two patients. Radionuclide venography was highly reliable and ultrasound examination was specific but only moderately sensitive in these studies. The painful, swollen calf may be investigated adequately in most cases by means of noninvasive invasive techniques; contrast venography and arthrography should be reserved for only a minority of patients.

Topics: Adult; Aged; Arthrography; Cysts; Diagnosis, Differential; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Evaluation Studies as Topic; Female; Humans; Leg; Male; Middle Aged; Pain; Phlebography; Popliteal Vein; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thrombophlebitis; Ultrasonography

Blood pool radionuclide venography and contrast venography were carried out in 50 patients in whom deep vein thrombosis was suspected. The two procedures were compared on the basis of 198 individual vessel segments. The overall concordance between radionuclide and contrast venography was 92%. Using contrast venography as the standard, the sensitivity of radionuclide venography was 90% and specificity 96%. The predictive accuracy of a positive test was 77% and of a negative test was 97%. The performance of radionuclide venography improved if the calf veins were excluded from analysis. The main limiting factor affecting the performance of radionuclide venography was the moderately poor resolution of the technique. Technical manipulations to improve resolution were time consuming and added little to the accuracy of the test. Radionuclide will not replace contrast venography but may well be used to complement contrast venography when it is technically unsatisfactory or unequivocal, in patients with a history of intolerance to contrast media, and in bedbound patients.

Topics: Adult; Contrast Media; Diagnostic Errors; Humans; Phlebography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thrombophlebitis; Veins

Topics: Erythrocytes; Humans; Methods; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thrombophlebitis

Thirty-four patients who clinically were suspected of having deep venous thrombosis (DVT) underwent Tc-99m red blood cell (RBC) venography followed by contrast venography. The sensitivity (88%) and specificity (94%) of Tc-99m RBC venography for DVT confirmed findings of previous studies. Twenty-four patients who had proved popliteal cysts and swollen calves also were examined using Tc-99m RBC venography. Large cysts (greater than 9 X 4 X 4 cm) showed lack of DVT features, photon deficient cold areas in the popliteal fossa, and diversion of venous flow around the photon deficient area. These features were seen in 25% of the study population (six patients), and assisted in the distinction between the two conditions.

Topics: Adult; Aged; Cysts; Diagnosis, Differential; Erythrocytes; Female; Humans; Knee; Male; Middle Aged; Popliteal Vein; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thrombophlebitis

Topics: Femoral Vein; Humans; Iliac Vein; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Syndrome; Technetium; Thrombophlebitis

Thallium-201, injected as thallous chloride, has been found to adhere to or be taken up by the vein into which it is injected, permitting images to be obtained of human veins up to 4 h following injection. A digoxin-insensitive rat vein model also retained 201Tl but for shorter periods of time. 201Tl uptake is independent of the solution into which it is introduced, whether 5% dextrose or 0.9% sodium chloride. This technique permits multiple delayed views of normal veins to be obtained but is of uncertain value in the evaluation of thrombophlebitis of the calf because of rather poor resolution and high cost.

Topics: Animals; Digoxin; Humans; Radioisotopes; Radionuclide Imaging; Rats; Rats, Inbred Strains; Sodium Pertechnetate Tc 99m; Sodium-Potassium-Exchanging ATPase; Technetium Tc 99m Aggregated Albumin; Thallium; Thrombophlebitis; Time Factors; Veins

Three radiopharmaceutical groups (colloids, specific biomolecules and blood cells) and a control group were investigated with regard to their ability to rapidly diagnose deep venous thrombosis in an experimental rabbit model. An artificial thrombus was induced in the jugular vein and the radiopharmaceuticals were injected either homolaterally or contralaterally relative to the thrombus. The accumulation of the radioactivity in the thrombus 30 min after the induction was determined in vivo from scintillation camera images. After dissection of the jugular vein, the radioactivity of the thrombus was measured in vitro. None of the investigated radiopharmaceutical groups showed any marked high thrombus uptake after contralateral injections, not even the groups that consisted of substances known to be actively involved in coagulation and fibrinolysis. The results exclude a high degree of specific interaction between the radiopharmaceuticals and the thrombus in our model. After homolateral injection only colloids and reduced 99Tcm-pertechnetate showed a high thrombus uptake, thus also excluding a specific binding to thrombus. This investigation shows that none of the specific radiopharmaceuticals had a greater ability to accumulate in the thrombus than the colloids, and it is therefore suggested that the clinical usefulness is due to other mechanisms, like circulatory changes secondary to the DVT.

Topics: Animals; Blood Cells; Blood Platelets; Cadaverine; Colloids; Erythrocytes; Fibrinogen; Fibrinolysin; Indium; Iodine Radioisotopes; Leukocytes; Rabbits; Radioisotopes; Radionuclide Imaging; Serum Albumin; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid; Thrombophlebitis

Topics: Aged; Erythrocytes; Humans; Leg; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thrombophlebitis

Topics: Adult; Aged; Diatrizoate Meglumine; Erythrocytes; Female; Humans; Leg; Male; Middle Aged; Phlebography; Sodium Pertechnetate Tc 99m; Technetium; Thrombophlebitis

Results of vascular radiology and isotope examinations were compared in 48 patients with suspected ileocaval lesions (37 cases) or affections of the veins of the upper limb or superior vena cava (11 cases). Isotopic examination, which can be performed in ambulatory patients, respects normal hemodynamic conditions, is painless, and can be repeated, was found to give valid results, positive correlations with radiological investigation findings being present in 43 cases. Lack of correlation in the remaining 5 patients could have resulted from the period of time elapsed between the two examinations or the techniques employed during each investigation.

Topics: Diagnosis, Differential; Humans; Phlebography; Sodium Pertechnetate Tc 99m; Technetium; Thrombophlebitis

Topics: Adolescent; Adult; Aged; Auscultation; Female; Humans; Leg; Male; Middle Aged; Phlebography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thrombophlebitis; Ultrasonography