technetium-tc-99m-exametazime and Diabetes-Mellitus--Type-2

Although macrovascular complications are typical for type 2 diabetes mellitus (T2DM), cerebral microvascular damage develops both in type 1 diabetes mellitus (T1DM) and T2DM. Color Doppler ultrasound is widely used for the examination of large- and medium-sized arteries, whereas SPECT and MRI are capable of identifying disturbances in the circulation of microvessels. Former studies using semiquantitative methods showed reduced reactivity and reserve capacity of cerebral vessels in both T1DM and T2DM patients. Our aim was to investigate whether there was any difference in the effects of the 2 types of diabetes mellitus on the global or regional cerebral blood flow, influenced by microvascular damage.. In our study, the circulation and reserve capacity of cerebral arteries was examined using (99m)Tc-hexamethylpropylene amine oxime SPECT. A total of 17 individuals with T1DM and 43 individuals with T2DM were involved in the study.. Both basal and acetazolamide-challenged brain circulation were significantly lower in T2DM patients than in T1DM patients. We did not find a significant difference in the reserve capacity. However, the circulation of the frontal and occipital lobes changed differently in the 2 groups. The ratio of the circulation of the frontal and occipital lobes was significantly reduced both in basal and in acetazolamide-stimulated states in T2DM patients, independently of age (P < 0.0005 and P < 0.017), showing a greater relative decrease in the circulation of the frontal lobe in T2DM patients.. There was a significant association between basal brain circulation and age, body mass index, and high-density lipoprotein (HDL), whereas acetazolamide-stimulated circulation showed a significant association with serum triglyceride and HDL.

Topics: Adult; Cerebrovascular Circulation; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Cerebral blood flow abnormalities are supposed to be potential risk factors for developing cognitive dysfunction in the general population. Aging, obesity and type 2 diabetes mellitus are associated with perfusion abnormalities leading to cognitive impairment, neurodegeneration and future development of dementia. In our study, we aimed at identifying independent factors that contribute to the appearance of regional brain perfusion changes besides those that are already known.. Forty-three type 2 diabetic and twenty-six obese patients were enrolled. After the intravenous administration of 740 MBq 99mTc-hexamethylpropylene amine oxime (HMPAO), all subjects underwent brain perfusion SPECT imaging applying AnyScan S Flex dual-head gamma camera (Mediso, Hungary). Using Philips Achieva 3T scanner brain resting-state functional MRI was also performed. The SPECT and MRI images were co-registered and transformed to the MNI152 atlas space so that data of the following standard volumes of interest (VOIs) could be obtained: frontal lobe, parietal lobe, temporal lobe, occipital lobe, limbic region, cingulate, insula, basal ganglia, cerebrum, limbic system and brain stem. Using the SPSS 25 statistical software package, general linear regression analysis, Student's t-test, and Mann-Whitney U-test were applied for statistical analyses.. Multivariate linear analysis identified that BMI and age are significantly (p < 0.0001) associated with perfusion, and patient group was slightly above threshold (p = 0.0524). We also found that the presence of diabetes was an independent significant predictor of normalized regional brain perfusion only in the insula (p < 0.001). Other independent predictors of normalized regional brain perfusion were: age in the insula (p < 0.001) and in the limbic region (p < 0.01), and BMI in the brain stem (p < 0.01).. Age and BMI proved to be general, and diabetes regional predictor of brain hypoperfusion. BMI appeared to be a novel factor affecting brain perfusion. In one specific region, the insula, we detected a difference between the obese and the diabetic group. These findings may be significant in the understanding of the development of cognitive impairment in metabolic diseases.

Topics: Aging; Body Mass Index; Brain; Diabetes Mellitus, Type 2; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The aims of this study were to evaluate subclinical pulmonary injury in patients with noninsulin-dependent diabetes mellitus (NIDDM) who showed normal chest radiograph and pulmonary function test results by using technetium-99 hexamethylpropylene amine oxime (Tc-99m-HMPAO) scintigraphy and to investigate the relationship between Tc-99m-HMPAO lung uptake and duration of diabetes, glycemic control, and the presence of diabetes-related microvascular complications.. A total of 40 patients with NIDDM (19 men, 21 women; age 56.5 ± 6.8 years; duration of diabetes: 13.1 ± 6.7 years) were included in this study. The pulmonary vascular damage was represented as lung/liver uptake ratios (L/L ratios) calculated by Tc-99m-HMPAO lung scintigraphy. Results were compared with those of age-matched controls.. The L/L ratio was 0.36 ± 0.07 in normal controls and 0.51 ± 0.16 in patients with NIDDM. The L/L ratio was significantly higher in NIDDM patients than in the control group (P=0.002). No correlation was observed between L/L ratio and the presence of diabetic complications, glycemic control, and diabetes duration.. Tc-99m-HMPAO lung scintigraphy is a sensitive and an objective method for the detection of subclinical lung injury in NIDDM patients. Tc-99m-HMPAO lung uptake serves as an indicator of pulmonary injury due to diabetes, regardless of diabetes age, glycemic control, and the presence of other diabetes-related microvascular complications.

Topics: Adult; Aged; Case-Control Studies; Diabetes Mellitus, Type 2; Female; Humans; Liver; Lung Injury; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

The aim of the study was to assess cerebral perfusion (CP) in patients with arterial hypertension in combination with type II diabetes. The subjects were 57 patients with stage II AH (mean age 51.6 +/- 5.7 years), among who there were 33 patients without disturbances in carbohydrate exchange and 24 patients with compensated or subcompensated type II diabetes. All the patients underwent single-photon emission computed tomography of the brain with 99m Tchexamethylpropyleneamineoxime. The study showed that patients suffering from AH with or without type II diabetes had signs of cerebral hypoperfusion and lowered cerebrovascular reserve even in the absence of focal neurological symptoms. Disturbances in cerebral perfusion were more prominent in patients suffering from AH with type II diabetes vs. patients without carbohydrate exchange disorder.

Topics: Adult; Arteries; Brain; Carbohydrate Metabolism; Cerebrovascular Circulation; Diabetes Mellitus, Type 2; Female; Humans; Hypertension; Male; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The alveolar integrity (AI) in 60 patients of noninsulin-dependent diabetes mellitus (NIDDM) who had normal chest X-ray findings and pulmonary function test was measured by technetium-99m (Tc-99m) diethyltriamine pentaacetic acid (DTPA) and Tc-99m hexamethylpropylen amine (HMPAO) radioaerosol inhalation lung scan (lung scan). The degree of AI damage in NIDDM was presented as the clearance rate (%/min) of hydrophilic Tc-99m DTPA and lipophilic Tc-99m HMPAO radioaerosols from the lungs. The AI of NIDDM patients was compared with the AI of 40 normal controls. The results show that (1) the clearance rate of Tc-99m DTPA radioaerosols was faster than those of Tc-99m HMPAO radioareosols in either NIDDM patients or normal controls over any portion of the lungs, (2) the clearance rates of both Tc-99m DTPA and Tc-99m HMPAO radioaerosols were faster in NIDDM patients than those in normal controls over any portion of the lungs. Our findings concluded that (1) at least two different clearance mechanisms of radioaerosols in the lungs are working; and (2) the AI damage in NIDDM patients happened in both hydrophilic and lipophilic parts of the alveoli. In addition, the AI damage found by faster clearance rates of both Tc-99m DTPA and HMPAO radioaerosols may provide the other objective evidence of lung complications in NIDDM patients, which are different from the traditional studies such as chest X-ray or pulmonary function test.

Topics: Administration, Inhalation; Aerosols; Aged; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Polylysine; Pulmonary Alveoli; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Technetium Tc 99m Pentetate

We conducted a prospective study in order to evaluate the contribution of technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled leucocyte scintigraphy to the diagnosis and follow-up of osteomyelitis in the diabetic foot. The study was conducted between October 1992 and November 1996 and included 42 patients (30 men and 12 women; mean age 63 years) with diabetes mellitus (type 1, n = 22, type 2, n = 20) who had a total of 56 diabetic foot ulcers. The initial exploration included standard radiography, three-phase bone scintigraphy and 99mTc-HMPAO labelled leucocyte scintigraphy (HMPAO-LS), performed within a 3-day interval. For the 56 ulceration sites, 26 cases of osteomyelitis were diagnosed: ten on the basis of radiographic and histological/bacteriological criteria after bone biopsy, 11 after radiographic follow-up and five on the basis of biopsy results alone. No osteomyelitis was present at 30 sites, there were seven cases of cellulitis. The sensitivity and specificity of 99mTc-HMPAO-LS were 88.4% and 96.6% respectively (23 true-positives, 29 true-negatives, one false-positive, three false-negatives). The accuracy of radiography, 99mTc-methylene diphosphonate and HMPAO-LS was 69.6%, 62.5%, and 92.9%, respectively. Follow-up scintigraphy (n = 14) 4 months after initial diagnosis and 1 month after antibiotic withdrawal confirmed cure of osteomyelitis despite the absence of complete clinical regression of the ulcers. In conclusion, 99mTc-HMPAO labelled leucocyte scintigraphy was found to be an excellent method for the diagnosis of osteomyelitis in the diabetic foot. It can contribute to follow-up, particularly when clinical regression of perforating ulcers is incomplete and cure of osteomyelitis must be confirmed in order that antibiotic treatment may be discontinued.

Topics: Adult; Aged; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Foot; False Negative Reactions; False Positive Reactions; Female; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

The alveolar integrity (AI) in 17 patients of non-insulin dependent diabetes mellitus (NIDDM) who had normal findings in the chest x-ray and pulmonary function test was measured by Tc-99m DTPA and HMPAO radioaerosol inhalation lung scintigraphies (DTPA and HMPAO). The degree of AI damage in NIDDM was presented as the slopes (%/min) of the time-activity curves from the dynamic of both lung imagings using DTPA and HMPAO. The AI of NIDDM patients was compared with the AI of 23 normal controls. The results show that (1) the slopes of DTPA were larger than those of HMPAO in any portion of either of the lungs for both of the study groups, and that (2) the slopes of DTPA and HMPAO were larger in NIDDM than those in normal controls over any portion of the lungs. The results suggest that (1) at least two different clearance mechanisms for aerosol particles in the lungs are at work; and (2) the AI damage in NIDDM developed in both the hydrophilic and lipophilic parts of the alveoli. In conclusion, the AI damage which appeared as larger slopes of DTPA/HMPAO in our study may be early findings of lung complications in NIDDM patients, which are different from the traditional studies such as chest x-ray or pulmonary function test.

Topics: Administration, Inhalation; Aerosols; Aged; Diabetes Mellitus, Type 2; Humans; Lung; Lung Diseases; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Pentetate

We assessed cerebral blood flow in 78 diabetic patients (40 Type 1 and 38 Type 2) with no previous history of central nervous system disease using 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) single photon emission tomography (SPET) and found areas of severe hypoperfusion in 36% of them. All cerebral anatomical regions showed abnormalities related to hypoperfusion, but they were most frequently seen in the fronto-temporal region, followed by the occipital and parietal regions. 99Tcm-HMPAO SPET has been shown to be able to detect subclinical alterations in blood flow in diabetes, a finding that may account for the high prevalence of cerebrovascular disease seen in these patients. This technique could, therefore, play an important role in future preventative strategies.

Topics: Adult; Aged; Cerebrovascular Circulation; Cerebrovascular Disorders; Diabetes Complications; Diabetes Mellitus; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diabetic Neuropathies; Humans; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon