technetium-tc-99m-exametazime and Postoperative-Complications

This article provides a brief overview of the current state of hybrid single-photon emission computed tomography/computer tomography (SPECT/CT) imaging in musculoskeletal infections. SPECT/CT imaging, compared with conventional planar study and SPECT alone, provides improved anatomic localization of infection and more accurate delineation of the extent of infection. This article emphasizes three clinical aspects where SPECT/CT is found to be most useful: differentiating between soft tissue and bone infections, assessing suspected infected sites with underlying structural bone alterations, and defining infective focus when complex anatomy is involved. The accurate assessment of site of infection is vital for selecting the most appropriate therapeutic strategy. Other advantages of SPECT/CT imaging such as reducing the inconvenience of combination planar studies, providing additional CT information, and increasing interobserver agreement are also discussed.

Topics: Bone Diseases; Child; Foot Diseases; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infections; Musculoskeletal Diseases; Postoperative Complications; Soft Tissue Infections; Spinal Diseases; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Wounds and Injuries

Labeled leukocyte scintigraphy is the preferred imaging technique for the evaluation of suspected postoperative orthopedic infections. Labeled leukocyte localization returns to a normal pattern faster than MRI after bone trauma, surgical procedures, and treatment of osteomyelitis. 99mTc HMPAO labeled leukocyte scintigraphy is useful, particularly in children, because less peripheral blood volume is required for labeling. However, delayed 16-20 hour imaging is usually needed to detect low-grade osteomyelitis, and 111In WBC usually provides better images in adults. Combined 111In WBC/99mTc sulfur colloid marrow images improve the specificity for detection of osteomyelitis in regions containing active bone marrow. Simultaneous 111In leukocyte/99mTc bone SPECT imaging is usually necessary in regions such as the skull, spine, and hips, where there is overlapping bone, and soft tissues.

Topics: Bone and Bones; Humans; Indium Radioisotopes; Joint Prosthesis; Leukocytes; Orthopedics; Osteomyelitis; Postoperative Complications; Prosthesis-Related Infections; Radiography; Radionuclide Imaging; Technetium Tc 99m Exametazime

White blood cell (WBC) scintigraphy for diagnosing fracture-related infections (FRIs) has only been investigated in small patient series. Aims of this study were (1) to establish the accuracy of WBC scintigraphy for diagnosing FRIs, and (2) to investigate whether the duration of the time interval between surgery and WBC scintigraphy influences its accuracy.. 192 consecutive WBC scintigraphies with. WBC scintigraphy had a sensitivity of 0.79, a specificity of 0.97, a positive predicting value of 0.91, a negative predicting value of 0.93 and a diagnostic accuracy of 0.92 for detecting an FRI in the peripheral skeleton. The duration of the interval between surgery and the WBC scintigraphy did not influence its diagnostic accuracy; neither did concomitant use of antibiotics or NSAIDs. There were 11 patients with a false-negative (FN) WBC scintigraphy, the majority of these patients (n = 9, 82%) suffered from an infected nonunion. Four patients had a false-positive (FP) WBC scintigraphy.. WBC scintigraphy showed a high diagnostic accuracy (0.92) for detecting FRIs in the peripheral skeleton. Duration of the time interval between surgery for the initial injury and the WBC did not influence the results which indicate that WBC scintigraphy is accurate shortly after surgery.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases, Infectious; Female; Fracture Fixation; Fractures, Bone; Humans; Image Interpretation, Computer-Assisted; Leukocytes; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Soft Tissue Infections; Technetium Tc 99m Exametazime; Young Adult

Topics: Aged; Female; Humans; Inflammation; Postoperative Complications; Radiopharmaceuticals; Surgical Mesh; Technetium Tc 99m Exametazime

Psoas abscess associated with hip arthroplasty infection is a rare entity. The aim of this report was to review our experience.. Patients with computerized tomography (CT) diagnosis of psoas abscess associated with a hip arthroplasty infection from 2004 to 2009 were retrospectively reviewed. Demographics, microbiological data, CT results and outcome of each patient were recorded.. Seven patients out of 214 evaluated by CT due to hip infection suspected were identified. Three women and 4 men, with a mean age of 69 years (range 46-89). Mean abscess diameter was of 62 x 47 mm. In all cases, a direct communication between abscess and prosthesis was observed. The most commonly isolated microorganisms were grampositive cocci. All patients were treated with two-stage revision surgery. After a mean follow-up of 65 months (28-113), six patients were in remission.. The use of CT in the study of suspected infection of a hip arthroplasty identified a psoas abscess in 7 cases out of 214 evaluated. Patients treated with two-stage revision surgery and large debridement was associated with a good clinical outcome.

Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Disease Progression; Female; Follow-Up Studies; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Male; Middle Aged; Polymerase Chain Reaction; Positron-Emission Tomography; Postoperative Complications; Prosthesis-Related Infections; Psoas Abscess; Radiopharmaceuticals; Reoperation; Technetium Tc 99m Exametazime

Hyperperfusion (HP) is a rare but potentially devastating complication after carotid revascularization. This report describes the clinical efficacy of staged angioplasty (SAP) for carotid artery stenosis to prevent HP after carotid revascularization.. Eighteen of 143 patients with high-grade internal carotid artery stenosis scheduled for angioplasty were considered at high risk of postprocedure HP based on their severely impaired cerebral blood flow (CBF) and cerebral vasoreactivity, which were determined using single-photon emission computed tomography with acetazolamide. Nine of the high-risk patients were treated with carotid artery stenting and the other 9 were treated with SAP, which consisted of balloon angioplasty with undersized balloon catheters (Stage 1) followed by carotid artery stenting 1 to 2 months later (Stage 2).. In the regular carotid artery stenting group, 5 of 9 patients (56%) showed HP phenomenon on single-photon emission computed tomography just after stenting, and 1 patient (11%) developed status epilepticus owing to HP. In the SAP group, none of the 8 patients treated by SAP or the 1 patient who required stent placement during the first stage owing to a wall dissection developed postprocedure HP phenomenon or HP syndrome.. SAP decreased the HP phenomenon on single-photon emission computed tomography after performing these procedures in selected patients. Although additional intervention is needed, SAP is considered a relatively simple and effective method to avoid HP in patients at high risk of HP after carotid revascularization.

Topics: Acetazolamide; Aged; Angioplasty, Balloon; Blood Pressure; Carotid Stenosis; Cerebrovascular Disorders; Diuretics; Female; Humans; Intraoperative Care; Iofetamine; Magnetic Resonance Imaging; Male; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Complications; Radiopharmaceuticals; Stents; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

Many arachnoid cysts (AC) are detected incidentally in asymptomatic patients. Current neuroimaging methods provide only morphological details of the cysts, but they do not give information about cerebral function. While surgery is indicated in symptomatic patients, the management of asymptomatic individuals, who present with large cysts, is controversial.. To ascertain the value of cerebral 99 mTc-HMPAO single photon emission computed tomography (SPECT) for detecting brain dysfunction in cases of intracranial ACs, aimed at allocating the patients for surgical or for conservative treatment.. We studied prospectively 11 patients diagnosed with sylvian fissure ACs. The subjects underwent neurological examination, EEG, neuroimaging studies, neuropsychological testing, and cerebral perfusion studies with 99 mTc-HMPAO SPECT.. The patients' ages ranged from 2 to 42 years (median 16 years). The study group consisted of ten symptomatic patients with ACs and one patient with an incidental cyst. Seven patients showed diminished regional cerebral blood flow (rCBF) in their initial cerebral SPECT. Four individuals underwent surgery. Seven patients showed normalization of rCBF after surgical or conservative treatment.. Cerebral SPECT demonstrated impaired brain perfusion in 70% of symptomatic patients. The zone of decreased rCBF corresponded well with clinical symptoms and with neuroimaging findings. Patients exhibiting normal rCBF in SPECT studies remained or became asymptomatic during the follow-up time. Cerebral SPECT constitutes a valuable adjunct tool for correlating regional function with brain anatomy, and may be of help to allocate patients with ACs for surgical treatment or clinical observation. Further research on this field is warranted.

Topics: Adolescent; Adult; Arachnoid Cysts; Brain; Cerebrovascular Circulation; Child; Child, Preschool; Electroencephalography; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Neurologic Examination; Neuropsychological Tests; Patient Selection; Postoperative Complications; Prognosis; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Brain single photon emission computed tomographic (SPECT) images acquired after injecting Tc-99m-HMPAO into the internal carotid artery (ICA) during an intracarotid amobarbital procedure (IAP SPECT) provide anatomical information on the blood flow distribution from the ICA. In this study, probabilistic maps of the distribution of blood supply from the ICA were developed using the IAP SPECT images. Twenty-two sets of basal and IAP SPECT were collected from an existing database. IAP SPECT images were coregistered to basal SPECT images, and spatial normalization parameters used for basal SPECT images were reapplied to IAP SPECT for anatomical standardization. Pixel counts of IAP SPECT images were then normalized, and the probabilistic map of cerebral perfusion distribution (perfusion probabilistic map) for each hemisphere was determined by averaging the spatial/count-normalized IAP SPECT images. Population-based probabilistic maps representing the extent of ICA territory (extent probabilistic map) were also composed by averaging the binary images obtained by thresholding the spatially normalized IAP SPECT images. The probabilistic maps were used to quantify cerebral perfusion and reserve change after arterial bypass surgery in 10 patients with ICA stenosis. In the probabilistic maps, blood supply from the ICA was found to be most likely in the dorsolateral frontal lobe, the anterosuperior portion of the temporal lobe, and in the frontoparietal area. Of the subcortical regions, the striatum was found to be most likely to derive its blood supply from ICA. In patients with cerebral occlusive disease, improvements in basal perfusion and perfusion reserve in the bypass-grafted ICA territory were well identified and were increased by 6.2% and 4.6%, respectively, on average. The probabilistic maps developed in this study illustrate the perfusion distribution and extent of vascular territory for ICA and would be useful for objective evaluations of perfusion status in cerebrovascular disease.

Topics: Adolescent; Adult; Algorithms; Amobarbital; Anterior Temporal Lobectomy; Brain; Carotid Artery, Internal; Carotid Stenosis; Dominance, Cerebral; Epilepsy, Temporal Lobe; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Models, Statistical; Postoperative Complications; Reference Values; Regional Blood Flow; Retrospective Studies; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Citrates; Gallium; Gallium Radioisotopes; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Pancreatitis; Postoperative Complications; Recurrence; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

We designed a prospective study to investigate single photon emission tomography (SPECT) findings in patients with or without mutism who had undergone posterior fossa surgery. These patients had a (99m)Tc-hexamethylpropyleneamine oxime-SPECT scan postoperatively. SPECT was performed between the 1st and 2nd week after surgery. The patients with cerebellar mutism had a second SPECT scan after regaining their power of speech. The patients were evaluated in terms of age, gender, preoperative and postoperative neurological and radiological findings, tumor size and location, vermian incision and histopathology.. Six girls and 5 boys, ranging in age from 3 to 11 years who had undergone posterior fossa tumor surgery were included in this study as controls. Their tumors were located in the vermis and fourth ventricle in 8 patients, in the cerebellar hemisphere in 1, fourth ventricle in 1, and 1 patient had a fourth ventricular tumor extending the cerebello-pontine angle. The histopathology of the tumors was as follows: astrocytoma in 5 patients, ependymoma in 3, medulloblastoma in 1, dermoid tumor in 1, and choroid plexus papilloma in 1 patient. Postoperative cerebellar mutism developed in 2 girls and 1 boy whose ages ranged from 2 to 5 years. Pathological examination revealed 2 medulloblastomas and 1 ependymoma. Mutism developed 2 to 4 days after surgery. All of the patients with cerebellar mutism showed either clinical or radiological signs and symptoms of brain stem involvement. SPECT findings were similar in the patients with cerebellar mutism and in those without.. SPECT findings are not specific enough to explain how cerebellar mutism occurs. Clinical signs of brain stem involvement seem to be a significant risk factor in the development of cerebellar mutism.

Topics: Cerebellar Neoplasms; Child; Child, Preschool; Female; Humans; Infratentorial Neoplasms; Male; Mutism; Postoperative Complications; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Arterial vasospasm after subarachnoid hemorrhage may cause cerebral ischemia. Treatment with hemodilution, reducing blood viscosity, and hypervolemia, increasing cardiac performance and distending the vasospastic artery, are clinically established methods to improve blood flow through the vasospastic arterial bed.. Eight patients with transcranial Doppler verified vasospasm after subarachnoid hemorrhage were investigated with global (two-dimensional (133)Xenon) and regional (three-dimensional (99 m)Tc-HMPAO) cerebral blood flow (CBF) measurements, before and after 1/iso- and 2/hypervolemic hemodilution. Hematocrit was reduced to 0.28 from 0.36. Hypervolemia was achieved by increasing blood volume by 1100 ml.. Isovolemic hemodilution increased global cerebral blood flow from 52.25+/-10.12 to 58.56+/-11.73 ml * 100 g(-1) * min(-1) (p<0.05), but after hypervolemic hemodilution CBF returned to 51.38+/-11.34 ml * 100 g(-1) * min(-1). Global cerebral delivery rate of oxygen (CDRO(2)) decreased from 7.94+/-1.92 to 6.98+/-1.66 ml * 100 g(-1) * min(-1) (p<0.001) during isovolemic hemodilution and remained reduced, 6.77+/-1.60 ml * 100 g(-1) * min(-1) (p<0.001), after the hypervolemic hemodilution. As a test of the hemodilution effect on regional CDRO(2) an ischemic threshold was defined as the maximal amount of oxygen transported by a CBF of 10 ml * 100 g(-1) * min(-1) at a Hb 140 g/l which corresponds to a CDRO(2) of 1.83 ml * 100 g(-1) * min(-1). The brain volume with a CDRO(2) exceeding the ichemic threshold was 1300+/-236 ml before intervention. After isovolemic hemodilution the non-ischemic brain volume was reduced to 1206+/-341 (p<0,003). After hypervolemic hemodilution the non-ischemic brain volume remained reduced at 1228+/-347 ml (p<0.05).. The present study of controlled isovolemic hemodilution demonstrated increased global CBF, but there was a pronounced reduction in oxygen delivery capacity. Both CBF and CDRO(2) remained decreased during further hypervolemic hemodilution. We conclude that hemodilution to hematocrit 0.28 is not beneficial for patients with cerebral vasospasm after SAH.

Topics: Adult; Aneurysm, Ruptured; Blood Volume; Brain; Female; Hemodilution; Humans; Intracranial Aneurysm; Male; Middle Aged; Oxygen Consumption; Postoperative Complications; Subarachnoid Hemorrhage; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Ultrasonography, Doppler, Transcranial; Vasospasm, Intracranial

Patients with cardiovascular disease have cognitive function disturbances that are still evident after heart transplantation (HT). The aim of this study was to evaluate cerebral function in transplant patients and to assess whether cyclosporine therapy was responsible for cerebral abnormalities 1 year after transplantation. Six HT patients, eight liver transplant (LT) patients, and ten age-matched healthy controls underwent regional cerebral blood flow (rCBF) assessment by the (99m)Tc-hexamethyl-propylene-amineoxime ((99m)Tc-HM-PAO) single-photon emission computed tomography (SPECT) technique. The rCBF was correlated with cyclosporine blood levels. rCBF in HT and LT patients was similar to that of controls in all regions assayed, except for the frontal inferior region of HT patients, where it was significantly lower than in controls. No correlations between rCBF and cyclosporine blood levels were found in either HT or LT patients. In conclusion, the cerebral abnormalities seen in patients after HT but not after LT may be due to long-standing cerebral hypoperfusion resulting from severe heart disease, whereas cyclosporine does not account for such functional alterations.

Topics: Adult; Cerebrovascular Circulation; Cerebrovascular Disorders; Cognition Disorders; Cyclosporine; Female; Frontal Lobe; Heart Transplantation; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Inadequate sodium amytal delivery to the posterior hippocampus during the intracarotid Wada test has led to development of selective tests. Our purpose was to show the sodium amytal distribution in the posterior cerebral artery (PCA) Wada test and to relate it to functional deficits during the test. We simultaneously injected 80 mg sodium amytal and 14.8 MBq 99mTc-hexamethylpropyleneamine oxime (HMPAO) into the P2-segment of the PCA in 14 patients with temporal lobe epilepsy. To show the skull, we injected 116 MBq 99mTc-HDP intravenously. Sodium amytal distribution was determined by high-resolution single-photon emission computed tomography (SPECT). In all patients, HMPAO was distributed throughout the parahippocampal gyrus and hippocampus; it was also seen in the occipital lobe in all cases and in the thalamus in 11. Eleven patients were awake and cooperative; one was slightly uncooperative due to speech comprehension difficulties and perseveration. All patients showed contralateral hemianopia during the test. Four patients had nominal dysphasia for 1-3 min. None developed motor deficits or had permanent neurological deficits. Neurological deficits due to inactivation of extrahippocampal areas thus do not grossly interfere with neuropsychological testing during the test.

Topics: Adult; Amobarbital; Aphasia; Brain; Epilepsy, Temporal Lobe; Female; Hemianopsia; Humans; Injections, Intra-Arterial; Male; Memory; Memory Disorders; Middle Aged; Posterior Cerebral Artery; Postoperative Complications; Psychomotor Performance; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Abscess; Aged; Aged, 80 and over; Humans; Intervertebral Disc Displacement; Leukocytes; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Thoracic Vertebrae

Three children with middle fossa arachnoid cysts, presenting with non-specific symptoms and otherwise well, were investigated before and after surgery with magnetic resonance and 99Tc-hexamethylpropyleneamineoxime single photon emission computerised tomography scans, to assess the effect of the cysts on cerebral blood flow. All patients had evidence of a reduction in cerebral blood flow at presentation, even in the hemisphere contralateral to the middle fossa cyst, implied by perfusion defects seen centrally in the deep white matter of both cerebral hemispheres. After successful surgical excision of the cyst, the perfusion defects disappeared. This was associated with general improvement of pre-existing non-specific symptoms. These findings indicate that middle fossa arachnoid cysts may cause global impairment of brain function by interfering with its blood supply. This does not support the generally held view that such cysts are benign in nature when 'asymptomatic'.

Topics: Adolescent; Arachnoid Cysts; Brain Ischemia; Child, Preschool; Dominance, Cerebral; Humans; Magnetic Resonance Imaging; Male; Postoperative Complications; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

For evaluation of potential functional deficits, an intraarterial amobarbital test is performed prior to neurosurgical or neuroradiological interventions. To visualize individual amobarbital perfusion patterns, simultaneous injection of (99m)Tc-HMPAO was performed previously. The present study describes for the first time a method of coregistration of intraarterial SPECT during selective amobarbital test to MRI. Three patients undergoing selective amobarbital test of the posterior cerebral artery were included. SATSCOM (Selective amobarbital test intraarterial SPECT coregistered to MRI) was performed by skull extraction in SPECT and MRI followed by surface matching. In all three patients, SATSCOM revealed accurate matching results. With this functional-anatomical mapping, suppression of higher cortical functions can be correlated to anatomical regions. Furthermore, a more precise mapping of amobarbital effect improves planning invasive interventions, particularly those close to eloquent areas.

Topics: Adult; Amobarbital; Brain Mapping; Cerebral Cortex; Dominance, Cerebral; Epilepsy, Temporal Lobe; Female; Hippocampus; Humans; Image Processing, Computer-Assisted; Injections, Intra-Arterial; Magnetic Resonance Imaging; Male; Mental Recall; Middle Aged; Postoperative Complications; Psychosurgery; Regional Blood Flow; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed, Single-Photon

Lack of an effective treatment for spontaneous intracerebral haemorrhage (ICH) is partly because the mechanism of neuronal damage in ICH is not fully understood. Animal experiments have shown that there is a zone of ischaemia and oedema around the haematoma which can be reduced by early evacuation of the mass lesion. We set out to study Cerebral Blood Flow (CBF) changes in patients with ICH. We present data on 13 patients (mean age 60). SPECT scans were performed within 48 hours of ictus and 4-7 days later. Four patients had surgical evacuation of the clot; 9 were managed conservatively. The ratio of uptake of the isotope in the cerebral hemisphere containing the haematoma to the isotope uptake in the contra-lateral (un-affected) cerebral hemisphere was taken as an index of perfusion of the affected cerebral hemisphere. The perfusion index of the affected hemisphere improved between the first and the second scans in all the surgically treated patients; in the conservatively managed group, it was worse in 6 patients, the same in 1 and very slightly better in 2. There was an overall mean improvement of 3.87% in the surgical group, and an overall mean deterioration of 3.61% in the medical group. This data suggests that surgical evacuation of the clot may improve perfusion in the ipsilateral cerebral hemisphere in ICH. It underlines the importance of a prospective randomised trial to assess the value of surgery in patients with ICH. The Surgical Trial in Intracerebral Haemorrhage (STICH) is currently underway worldwide. We also describe the application of Difference Based Region Growing (DBRG) to SPECT image analysis. This method overcomes the difficulties posed by 1) the presence of a mass lesion and 2) surgical evacuation of haematoma.

Topics: Brain; Brain Edema; Cerebral Hemorrhage; Female; Humans; Male; Middle Aged; Postoperative Complications; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A heart transplant patient treated with OKT3 developed a severe headache which worsened and was accompanied by a sudden decrease in the patient's consciousness level and aphasia when the treatment course was completed. CT was performed and was normal. SPET imaging with 99mTc-HMPAO of cerebral blood flow done 16 hours later revealed multiple and clear focal defects in the blood flow. Analysis of cerebral spinal fluid revealed aseptic pleocytosis. Five days after the completion of treatment, the symptoms remitted and a new control SPET 3 weeks later was completely normal. A diagnosis of neurotoxicity secondary to OKT3 administration was established.

Topics: Adult; Aphasia; Brain Abscess; Brain Edema; Cardiomyopathy, Dilated; Cerebral Hemorrhage; Cerebrospinal Fluid; Cerebrovascular Circulation; Confusion; Diagnosis, Differential; Headache; Heart Transplantation; Humans; Immunosuppressive Agents; Leukocytosis; Lymphocyte Activation; Male; Meningoencephalitis; Muromonab-CD3; Postoperative Complications; Radiopharmaceuticals; T-Lymphocytes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Aneurysm, False; Aortic Aneurysm, Abdominal; Arteritis; Blood Vessel Prosthesis; Diagnosis, Differential; Erythrocytes; Femoral Artery; Humans; Iliac Artery; Leukocytes; Male; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

A 62-year-old woman became progressively ill after aorto-bifemoral graft surgery. A Tc-99m hexamethylpropyleneamine oxime (HMPAO) leukocyte scan was performed because of fever and suspected graft infection. The anterior abdominal and pelvic views demonstrated marked uptake within the sigmoid colon. Follow-up studies, including CT scan and contrast intestinal x-rays, confirmed the presence of an abnormal sigmoid loop. Subsequent surgical resection and pathological examination of the sigmoid colon revealed ischemic changes. To our knowledge, detection of ischemic colitis using Tc-99m HMPAO labeled leukocytes has not been reported. Clinical and routine radiological findings of ischemic colitis are typically nonspecific and may result in delayed diagnosis that can lead to high mortality. Tc-99m HMPAO leukocyte scintigraphy may be helpful in the noninvasive diagnosis of ischemic injury to the colon, especially after aortic graft surgery.

Topics: Aorta, Abdominal; Colitis, Ischemic; Female; Femoral Artery; Humans; Leukocytes; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed

Mutism is an infrequent and transitory complication observed following posterior fossa surgery. Patients become mute in the immediate postoperative period, with restoration of speech within a few weeks in the absence of additional neurological alterations. The anatomical structures thought to be involved are the connections between the cerebellar dentate nucleus, the ventrolateral nucleus of the contralateral thalamus and the supplementary motor area. In an attempt to understand the pathophysiology of this syndrome, and to depict the perfusion of different brain areas semiquantitatively, in two children who had become mute after posterior fossa surgery we performed a Tc99M-HM-PAO SPECT study during the period of mutism and again when normal speech had returned. In one patient, who had a left cerebellar astrocytoma, the SPECT study showed a marked reduction of cerebral perfusion in the right fronto-parietal region, and in the other, who had a medulloblastoma, a left fronto-temporo-parietal perfusion alteration was observed. When the patients regained normal speech, the follow-up SPECT studies revealed normalization of the cerebral perfusion. This study demonstrates the occurrence of a focal dysfunction of cerebral perfusion in children with cerebellar mutism after posterior fossa surgery. These observations are useful in extending our understanding of the pathophysiology of this postoperative clinical syndrome.

Topics: Adolescent; Astrocytoma; Cerebellar Neoplasms; Cerebrovascular Circulation; Child, Preschool; Cranial Fossa, Posterior; Humans; Magnetic Resonance Imaging; Male; Medulloblastoma; Mutism; Postoperative Complications; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Hippocampal damage has been linked to memory impairment. To clarify the relationship between decreased hippocampal blood flow and memory impairment in patients after cardiovascular surgery, the authors compared Tc-99m HMPAO SPECT findings and Mini Mental State Examination (MMSE) scores. Eight patients who had valve replacement, two who underwent aorto-coronary bypass, two who had aortic aneurysm replacement and one who had a ventricular septal defect closure were included in this study. Cerebral perfusion was estimated using reconstructed tomographic images, which were parallel to the longitudinal axis of the hippocampal formations. The hippocampal uptake ratios of Tc-99m HMPAO were calculated and normalized to that of the cerebellum. In three patients whose MMSE score decreased after surgery, the hippocampal uptake ratio was significantly reduced (0.69 +/- 0.09) compared with the remaining 10 patients whose MMSE scores did not decrease after surgery (0.91 +/- 0.02). These data suggest that SPECT imaging parallel to the longitudinal axis of the hippocampus is sensitive to decreased hippocampal blood flow, and decreased hippocampal blood flow is related to memory impairment in some patients after cardiovascular surgery.

Topics: Adolescent; Adult; Aged; Cardiovascular Surgical Procedures; Cerebrovascular Circulation; Female; Hippocampus; Humans; Male; Memory Disorders; Mental Status Schedule; Middle Aged; Postoperative Complications; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Focal neurological deficits after carotid endarterectomy may result from ischemia or hyperperfusion. The usefulness of single photon emission computed tomography (SPECT) for differentiating between these two mechanisms has not been previously emphasized.. An 83-year-old man experienced dysarthria and left-sided weakness immediately after undergoing endarterectomy of the right internal carotid artery. The results of computed tomography of the head were normal, and transcranial Doppler sonography showed symmetrically elevated velocities in both middle cerebral arteries. On the 1st postoperative day, the patient's deficits worsened in parallel with spontaneous increases in blood pressure, and blood pressure reduction with labetalol resulted in clinical improvement.. On the 2nd postoperative day, technetium-99-hexametazime SPECT demonstrated markedly increased flow in the right basal ganglia and inferior frontal cortex, confirming the diagnosis of cerebral hyperperfusion. The patient's deficits continued to improve with antihypertensive therapy, and SPECT performed 7 and 48 days after surgery showed gradual normalization of the focal hyperemia.. SPECT can be used to diagnose and monitor cerebral hyperperfusion after carotid endarterectomy and may be of particular value for differentiating hyperperfusion from ischemia when characteristic computed tomographic and transcranial Doppler sonographic findings are absent.

Topics: Aged; Aged, 80 and over; Blood Flow Velocity; Blood Pressure; Brain; Endarterectomy, Carotid; Humans; Hyperemia; Male; Monitoring, Physiologic; Postoperative Complications; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Atrophy; Brain; Child; Female; Fontan Procedure; Humans; Postoperative Complications; Posture; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

We have reviewed a series of 56 consecutive patients treated by the Ilizarov circular fixator for various combinations of nonunion, malunion and infection of fractures. We used segmental excision, distraction osteogenesis and gradual correction of the deformity as appropriate. Treatment was effective in eliminating 40 out of 46 nonunions and all 22 infections. There were two cases of refracture some months after removal of the frame, both of which healed securely in a second frame. Correction of malunion was good in the coronal plane but there was a tendency to anterior angulation, often occurring in the regenerate bone rather than at the original fracture site, after removal of the frame. This was associated with very slow maturation of regenerate bone in some patients, occurring largely, but not exclusively, in those who smoked heavily. Patients expressed high levels of satisfaction with the outcome, despite relatively modest improvements in pain and function, presumably because their longstanding and intractable nonunion had been treated. None the less, the degree of satisfaction correlated strongly with the degree of improvement in pain and function. We emphasise the importance of a multidisciplinary team in the assessment and support of patients undergoing long and demanding treatment. The Ilizarov method is valuable, but research is needed to overcome the problems of delayed maturation of the regenerate and slow or insecure healing of the docking site.

Topics: Adolescent; Adult; Aged; Female; Fractures, Malunited; Fractures, Ununited; Humans; Ilizarov Technique; Male; Middle Aged; Organotechnetium Compounds; Oximes; Patient Satisfaction; Postoperative Complications; Radionuclide Imaging; Recurrence; Retrospective Studies; Smoking; Technetium Tc 99m Exametazime; Time Factors; Wound Infection

Pulmonary microvascular injury has become a recently studied phenomenon that may be responsible for most of the complications associated with the lungs. Thirty patients undergoing partial hemilaminectomy or discectomy due to hernia of nucleus pulposus underwent Tc-99m HMPAO lung clearance as well as Tc-99m pertechnetate lung scintigraphy pre-operatively, and following general anaesthesia with halothane and isoflurane (third, fourth and tenth post-operative days). The results were compared with conventional techniques and haemodynamic parameters during the peri-operative period. In order to demonstrate acute phase changes under general anaesthesia and to perform pathological examinations, 21 New Zealand rabbits underwent radionuclide studies with Tc-99m HMPAO or Tc-99m pertechnetate. Lung biopsies were also performed. Despite no significant differences in any of the conventional diagnostic techniques, Tc-99m pertechnetate lung scintigraphy was performed for both the halothane and isoflurane groups, and Tc-99m HMPAO lung clearance was performed for the isoflurane group pre- or post-operatively. Tc-99m HMPAO lung clearance was impaired significantly in the halothane group on the third post-operative day (half time: 6.4 +/- 1.6 pre-operative and 13.76 +/- 3.3 s, P < 0.001) decreasing to pre-operative levels on the tenth post-operative day. Acute phase exposure to halothane was characterized with extremely abnormal Tc-99m HMPAO lung clearance in rabbits with respect to isoflurane, diminishing to control levels on the third day (half time: 8.7 +/- 86 control and 28.65 +/- 4.6, P < 0.001). Pathological examinations also demonstrated endothelial damage on acute exposure in the halothane group. General anaesthesia with halothane may give rise to alveolar microvascular injury, which generally seems to be underdiagnosed and may lead to serious post-operative complications.

Topics: Adult; Aged; Anesthesia, General; Anesthetics, Inhalation; Animals; Endothelium, Vascular; Female; Halothane; Humans; Isoflurane; Lung; Male; Metabolic Clearance Rate; Microcirculation; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Pulmonary Circulation; Rabbits; Radionuclide Imaging; Technetium Tc 99m Exametazime

The purpose of this study is to evaluate the effect of brain retraction 1 year or more after intracranial aneurysm clipping, demonstrated by a regional cerebral blood flow (rCBF) imaging technique.. rCBF and cerebrovascular reserve (CV) were evaluated in 40 patients 12-25 months after operation, using single photon emission computed tomography (SPECT) with Tc-99m-hexamethylpropylene amine oxime (HMPAO) combined with acetazolamide test. The images were analysed semiquantitatively, focusing on regions of interest (ROIs) chosen for places retracted during the operation. The regions of hypoperfusion in the retracted tissue were clearly visible in 26 cases. Assymmetry of measured activity, expressed in the Assymmetry Index, reached 12% (SEM +/- 8). After injection of acetazolamide during hypercapnia, the assymmetry decreased.. The results confirm the negative role of brain retraction. However, these consequences seem to be diminished by good vasoreactivity.

Topics: Brain; Cerebrovascular Circulation; Humans; Intracranial Aneurysm; Postoperative Complications; Surgical Instruments; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The main objective of this study was to assess whether 99mTc-HMPAO brain SPECT imaging can identify patients at high risk of developing an infarct following permanent carotid occlusion in the course of brain surgery.. Test balloon occlusion of the internal carotid artery was performed in 44 patients with a variety of head and neck tumors or aneurysms. Technetium-99m-HMPAO was injected intravenously while the balloon was initiated and a SPECT study was obtained 30 min later. Follow-up CT scans were obtained routinely for all patients at 2 wk and 1 mo following surgery, or earlier when necessary. Thirty patients and five normal volunteers had semiquantitative analysis of cerebral perfusion.. Twenty-six patients demonstrated ipsilateral perfusion abnormalities during trial occlusion. Eight patients in this group underwent bypass grafting prior to sacrifice of the artery: two resulting in infarcts. Eighteen patients had symmetric cerebral perfusion during occlusion and four of these patients underwent permanent therapeutic carotid occlusion; three patients had subsequent infarcts and the fourth patient had an impending stroke.. Patients with symmetric cerebral perfusion measured by 99mTc-HMPAO SPECT may still have a high long-term complication rate following carotid sacrifice. The scan findings in these patients were not predictive of the outcome. Patients with asymmetric cerebral perfusion had alternative therapeutic approach to carotid sacrifice and most of them had good surgical outcomes.

Topics: Brain; Brain Neoplasms; Carotid Artery, Internal; Catheterization; Cerebral Infarction; Cerebrovascular Circulation; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Intracranial Aneurysm; Male; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Predictive Value of Tests; Risk Factors; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon

Topics: Brain; Carotid Artery, Internal; Catheterization; Cerebral Infarction; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Predictive Value of Tests; Risk Factors; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

To evaluate the clinical use of radionuclide-labeled white blood cell scintigraphy in the detection of focal sepsis.. Prospective clinical study.. A medical/surgical 12-bed intensive care unit (ICU) in a university hospital.. 26 trauma and surgical patients affected by sepsis of unknown origin were studied.. After the usual diagnostic approach, patients were submitted to a total body scan by using the patient's leukocytes labeled with technetium-99m (99m-Tc) HMPAO; three scintigraphy were performed within 20 h of tracer injection; the result of scan was completed with all clinical and instrumental data, including ultrasound (US) arnd computed tomography (CT), and the diagnostic efficacy was demonstrated for each patient on discharge from the ICU. The scan was able to detect 20 sites of infection; it was possible to rule out 11 suspected sites; only in two cases was the result considered to be false positive or false negative; in two cases the result was considered to be uncertain. These results show the high sensitivity (95%), specificity (91%) and accuracy (94%) of the method.. In ICU patients with sepsis, nuclear medicine can provide additional data, as the injection of radionuclide-labeled white blood cells (WBCs) allows the imaging of sites of infection. Analysis of our results suggests that scintigraphy with 99m-Tc-labeled WBCs can be considered a useful tool in the detection of the source of infection.

Topics: Adult; Aged; Critical Care; Critical Illness; Female; Focal Infection; Humans; Leukocytes; Male; Middle Aged; Multiple Trauma; Organotechnetium Compounds; Oximes; Postoperative Complications; Prospective Studies; Radionuclide Imaging; Reproducibility of Results; Sensitivity and Specificity; Sepsis; Survival Analysis; Technetium Tc 99m Exametazime

With recent descriptions of the modified hemispherectomies and hemicorticectomy, there has been renewed interest in hemispherectomy for treatment of intractable seizures with hemiparesis. Because long-term outcome remains uncertain, patient selection remains difficult. 99mTc-HmPAO brain SPECT has been a helpful adjunct in the evaluation of epilepsy surgery candidates. We report SPECT scan findings in 7 patients who underwent hemispherectomy and compare these results with scalp EEG findings. Six patients had unilateral SPECT findings and all had a favorable outcome, regardless of surface EEG findings.

Topics: Adolescent; Cerebral Cortex; Cerebral Decortication; Child; Child, Preschool; Dominance, Cerebral; Electroencephalography; Epilepsy; Female; Follow-Up Studies; Hemiplegia; Humans; Infant; Male; Monitoring, Physiologic; Organotechnetium Compounds; Oximes; Postoperative Complications; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Serial brain SPECT imaging was performed on patients after subarachnoid hemorrhage and surgical clipping of intracranial aneurysms. A total of 20 HMPAO scans were performed on 9 patients in whom clinical vasospasm did not develop. Areas of diminished regional cerebral blood flow (rCBF) were found near the operative site in 17 of 20 studies, which did not correlate with the patients' neurologic condition and were suggestive of postoperative edema. Brain SPECT imaging has a potentially valuable role to play in the evaluation of postoperative patients susceptible to vasospasm; however, it is important to be aware of postoperative changes in rCBF that are not related to vasospasm.

Topics: Brain; Brain Edema; Cerebrovascular Circulation; Female; Humans; Intracranial Aneurysm; Ischemic Attack, Transient; Male; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Subarachnoid Hemorrhage; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon

99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO) single photon emission computed tomographic (SPECT) brain imaging performed in conjunction with balloon test occlusion of the carotid artery has been used to assess risk of neurologic sequelae that might follow permanent surgical ligation of the artery. The predictive value of cortical hypoperfusion during temporary carotid occlusion for adverse neurologic events has been debated in previous publications. We believe that the risk of an adverse event is greater when a reduction in cortical perfusion during balloon test occlusion is associated with crossed cerebellar diaschisis (CCD). To test our hypothesis we evaluated the results of 27 99Tcm-HMPAO SPECT brain studies obtained in association with balloon test occlusions of the carotid artery. In each case we correlated clinical outcome with the presence or absence of regional decreases in cerebral perfusion and CCD. All of the 27 patients were free of neurologic symptoms during the balloon test occlusion. Seventeen of the 27 scintigraphic studies were felt to be abnormal, showing cortical perfusion defects all on the side of the occlusion. Among these 17 patients, five demonstrated CCD. Four of these five CCD patients showed evidence for cerebral cortical ischaemia on the side of the temporary carotid occlusion either shortly after the procedure or following carotid artery sacrifice. Of the remaining 12 patients with regionally reduced cerebral perfusion and no CCD, none showed evidence for cortical ischaemia in association with balloon test occlusion, and five of these 12 patients had carotid ligation without subsequent neurologic sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Brain; Carotid Artery, Common; Carotid Artery, Internal; Catheterization; Cerebellar Diseases; Cerebral Infarction; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Predictive Value of Tests; Risk Factors; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

In the present study the consequences of administration of low-dose (0.5 mg) OKT3 for respiratory side-effects and pulmonary sequestration of labelled granulocytes are compared with the known effects of 5 mg OKT3. Ten renal transplant patients were studied, of whom five were treated with 0.5 mg OKT3 and five with 5 mg OKT3. None of the patients in the 0.5 mg group and two of the patients in the 5 mg group experienced dyspnoea. Sequestration of labelled granulocytes in the lungs was significantly lower in the patients receiving 0.5 mg OKT3 compared with the patients receiving 5 mg OKT3. The simultaneously occurring peripheral blood granulocytopenia was significantly more severe in the 5 mg group than in the 0.5 mg group. We suppose that this sequestration of circulating granulocytes in the lungs is at least partly mediated by complement activation products. In vitro it is demonstrated that fixation of complement activation products on peripheral blood lymphocytes depends on the concentration of OKT3 present in the culture medium. We conclude that respiratory side-effects shortly following infusion of OKT3 are related to complement-induced pulmonary leucostasis, the degree of which is dependent on the administered dose of OKT3.

Topics: Acute Disease; Adult; Aged; Cell Aggregation; Complement Activation; Dose-Response Relationship, Immunologic; Dyspnea; Female; Graft Rejection; Granulocytes; Humans; Immunosuppression Therapy; Kidney Transplantation; Lung; Male; Microcirculation; Middle Aged; Muromonab-CD3; Organotechnetium Compounds; Oximes; Postoperative Complications; Pulmonary Circulation; Radionuclide Imaging; T-Lymphocytes; Technetium Tc 99m Exametazime

Despite the clinical and pathologic indicators implicating injury to the basal ganglia in children with hyperkinetic movement disorders, we were previously unable to identify lesions in these structures by means of cranial computed tomography or magnetic resonance imaging. We evaluated regional cerebral perfusion measured by single photon emission computed tomography (SPECT) with technetium 99m hexamethyl propylene amine oxime as a technique to localize functional cerebral abnormalities in eleven children who had a movement disorder after hypothermic cardiac surgery. Perfusion defects of the deep gray matter were noted in six of these eleven patients and cortical perfusion defects in nine. For both cortical and subcortical defects a strong right-sided predilection was present. Our findings suggest functional brain injury not detectable by conventional cranial computed tomography and magnetic resonance imaging in these patients. We speculate that these perfusion defects might relate to the behavioral and developmental sequelae in survivors of this syndrome. SPECT may identify subclinical injury in patients at risk for future neurodevelopmental problems and contribute to our understanding of the mechanisms of cerebral injury in the patient operated on for cardiac disease.

Topics: Brain; Cardiac Surgical Procedures; Cerebrovascular Disorders; Child; Child, Preschool; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Movement Disorders; Organotechnetium Compounds; Oximes; Postoperative Complications; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To better identify regions of the brain affected by intracarotid amobarbital injections and to more precisely predict whether resections of specific brain regions will cause postoperative memory deficits.. We modified the standard intracarotid amobarbital procedure by adding a radioactive tracer to the amobarbital injection, thereby providing better correlation between behavior and deactivated brain region.. Tertiary-care hospital center with a dedicated program for medical and surgical treatment of epilepsy.. We studied 39 patients with medically intractable epilepsy drawn from a regional referral base.. Intracarotid injection of 125 mg of sodium amobarbital with 37 MBq of technetium Tc 99m hexamethylpropyleneamine oxime (HMPAO), followed by language and memory testing.. The distribution of amobarbital as measured by single photon emission computed tomographic imaging of HMPAO and patient performance on memory tasks.. Medial temporal regions were irrigated by the amobarbital in only 28% of the injections. Overall, findings suggest that medial temporal and lateral neotemporal cortex play a role in memory.. The regions involved in memory function vary by individual, as does the distribution of amobarbital. Thus, the most accurate method of determining correlation of brain region with memory function during intracarotid amobarbital injection involves the use of a tracer such as HMPAO.

Topics: Adolescent; Adult; Amobarbital; Brain; Carotid Arteries; Cerebrovascular Circulation; Epilepsy; Female; Humans; Injections; Male; Memory Disorders; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Exametazime; Temporal Lobe

Single photon emission computed tomography with technetium-99m-d, l-hexamethylpropyleneamineoxime was used to assess variations in regional cerebral blood flow during temporary clipping in the course of intracranial aneurysm surgery and during the postoperative period in 20 patients, 14 of whom underwent temporary clipping. Of these 14 patients (Group A), 9 had aneurysms of the anterior communicating artery, 2 had aneurysms of the middle cerebral artery, and 3 had aneurysms of the carotid siphon. Temporary clips were applied, according to the site of the lesion, on A1, on the trunk of the middle cerebral artery, or on the trunk of the internal carotid artery. The occlusion time ranged from 2 to 31 minutes. The six patients who did not undergo temporary clipping served as controls (Group B), as follows: three had aneurysms of the posterior communicating artery, one of the anterior communicating artery, one of the middle cerebral artery, and one of the internal carotid artery. All patients were investigated with cerebral single photon emission computed tomography preoperatively, perioperatively, and postoperatively. In all the patients of Group A, the preliminary results of the study show a sharp fall in the perfusion of the territories of the temporarily clipped parent vessel and practically a complete recovery within 2 to 7 days of surgery, with no significant neurological symptoms. No similar disturbance of perfusion was found in the patients of Group B.

Topics: Adult; Aged; Brain; Brain Damage, Chronic; Brain Ischemia; Carotid Artery Diseases; Carotid Artery, Internal; Female; Humans; Intracranial Aneurysm; Intraoperative Complications; Male; Middle Aged; Monitoring, Intraoperative; Organotechnetium Compounds; Oximes; Postoperative Complications; Regional Blood Flow; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon

Aortic graft infection may result in high mortality ranging up to 88%. Therefore, early diagnosis is imperative in the treatment of this serious complication. Computerised tomography (CT) is considered as a sensitive tool in the diagnosis of aortic graft infection. Some findings used as the criteria for infection, such as periprosthetic gas and fluid are, however, normal postoperative findings. The aim of this prospective study was to compare CT-scan and Tc-99m-HMPAO labelled leucocytes in the early diagnosis of aortic graft infection. The present study includes 24 consecutive patients (all men, age 70 +/- 8 years, range 55-85 years), who were operated on for abdominal aortic aneurysm. Prosthetic and suture materials were the same in all operations. Each patient was examined with the aid of CT-scan and imaged with Tc-99m-HMPAO labelled leucocytes 2 weeks and 3, 6 and 12 months after the reconstructive aortic surgery. Two radiologists and two specialists in nuclear medicine examined the data independently without knowing the clinical picture of the results of any other examinations of the patients. Seven patients (7/24; 29%) showed significant accumulation of labelled leucocytes in the first imaging (2 weeks postoperatively) with Tc-99m-HMPAO labelled leucocytes. Three months after the surgery only four patients (4/24; 17%) were positive in this respect. One of these patients had clinically proven aortic graft infection and another positive was a patient with resected and reconstructed mycotic aneurysm. CT-examination in all scans was suggestive for aortic graft infection in two cases (2/24; 8%), but neither of these patients showed any signs of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Diagnostic Imaging; Femoral Artery; Follow-Up Studies; Graft Occlusion, Vascular; Humans; Iliac Artery; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Polyethylene Terephthalates; Postoperative Complications; Prospective Studies; Staphylococcal Infections; Surgical Wound Infection; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed; Wound Healing

Permanent occlusion of the internal carotid artery may be required for en bloc resection of a neck tumor or to treat certain aneurysms. The risk of ischemic infarct is usually assessed with carotid balloon test occlusion and concurrent distal arterial pressure measurement. However, up to 20% of patients who tolerate the test occlusion have delayed neurologic sequelae. We propose enhanced MR imaging and hexamethylpropyleneamine oxime (HMPAO) scintigraphy to detect subclinical signs of ischemia and hypoperfusion as adjuncts to the balloon test occlusion to identify patients at risk for delayed sequelae.. We prospectively examined 12 patients referred for balloon test occlusion of the carotid artery. Serial measurements of distal occluded internal carotid pressure were recorded. 99mTc-HMPAO was injected IV after 2 min of asymptomatic test occlusion, and single-photon emission computed tomographic (SPECT) data acquisition was done 1-6 hr later. Contrast-enhanced MR imaging was performed 1-8 hr after completion of the 30-min test occlusion. Signs of decreased perfusion or ischemia on these tests were compared with the mean distal arterial pressure and neurologic status of the patient during test occlusion.. Seven (58%) of 12 patients had abnormal findings on HMPAO scintigraphy or contrast-enhanced MR imaging. Only one patient had neurologic deficits that corresponded to abnormal MR enhancement. The other 11 patients (92%) remained asymptomatic during the 30-min test occlusion. Of these 11 asymptomatic patients, five (45%) had areas of decreased perfusion on scintigraphy and three (27%) had abnormal MR contrast enhancement suggesting residual focal ischemia as a result of the test occlusion. Mean arterial pressures in the distal occluded artery did not correlate well with the imaging results.. HMPAO scintigraphy can show clinically silent areas of decreased perfusion, while enhanced MR shows signs of acute ischemia (i.e., significant hypoperfusion) associated with asymptomatic balloon test occlusion. Theoretically, such patients would be at increased risk for permanent sequelae after permanent carotid occlusion.

Topics: Adult; Aged; Brain; Brain Ischemia; Carotid Artery, Internal; Catheterization; Cerebrovascular Circulation; Collateral Circulation; Female; Head and Neck Neoplasms; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Prospective Studies; Risk Factors; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Accurate diagnosis is essential for the effective management of suspected bone infection. Current imaging techniques have had limited success and further work is required. Although white cell labelling techniques have been available for many years the radiopharmaceuticals employed have disadvantages, particularly in their availability and suitability for imaging. These problems have been overcome by the use of 99Tcm-HMPAO as an in vitro leukocyte labelling agent. The aims of this study were to assess retrospectively its role and accuracy in imaging orthopaedic infection and to compare the results with three-phase bone imaging. 30 patients with suspected bone infection underwent three-phase methylene diphosphonate (MDP) bone imaging and labelled leukocyte imaging on separate occasions. 16 bone scans were positive for infection, of which 14 were subsequently confirmed, and there were no false negatives. There were no false positive white cell studies and only one infection was not identified. 99Tcm-HMPAO white cell imaging has been shown to be an accurate technique for the diagnosis of bone infection but should be performed only following a positive finding on three-phase bone scanning, since the latter is highly sensitive but significantly less expensive, making it a more appropriate screening procedure.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases; Hip Prosthesis; Humans; Infections; Leukocytes; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

The increasing numbers and survival of children with shunt-treated hydrocephalus make it mandatory to refine the methods for cerebrospinal fluid (CSF) shunt function evaluation. Radionuclide shuntography with 99mTc-DTPA, which has proved to be a safe and effective method, was performed in eight children with suspected CSF-shunt dysfunction. Characteristic shuntography patterns were found for proximal and distal CSF-shunt catheter obstruction as well as for overdrainage and normal CSF-shunt function. Shuntography contributed to the explanation of suspected CSF-shunt dysfunction in all children investigated.

Topics: Adolescent; Cerebral Ventricles; Cerebrospinal Fluid Pressure; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Female; Humans; Hydrocephalus; Infant; Male; Neurologic Examination; Organotechnetium Compounds; Oximes; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed

Topics: Aged; Female; Humans; Infections; Knee Prosthesis; Leukocytes; Organotechnetium Compounds; Oximes; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Exametazime

The author presents an account of the development of scintigraphic methods in the detection of inflammatory processes of the musculoskeletal system. The original method used in vitro 111In labelled separated leucocytes. It was improved by the possibility to label leucocytes by means of HMPAO 99mTc. In vivo leucocytes can be labelled by means of monoclonal antibodies. Nanocolloid offers similar possibilities as regards use and gives a good yield. Its use is simple and the preparation is available. Scintigraphy with nanocolloid must be considered nowadays the first scintigraphic method used when an inflammatory process is suspected, in particular of the extremities. Scintigraphy with nanocolloid can differentiate in planned revision alloplasty septic and aseptic loosening. The mentioned finding can be used for planning, implementation and ensuring the operation. The author was able, in collaboration with the department of nuclear medicine, to test scintigraphy with nanocolloid in five patients with complains after alloplasty of obscure origin. Patients' data are listed in table a and two cases are discussed in more details.

Topics: Aged; Female; Hip Joint; Hip Prosthesis; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Prosthesis Failure; Radionuclide Imaging; Reoperation; Technetium Tc 99m Exametazime

CT scan in a 52-year-old woman, admitted because of grand mal seizure, showed striopallidodentate calcifications due to postoperative hypoparathyroidism. This patient report stresses the possibility of cortical metabolic involvement in this disorder, as shown on Tc-99m HMPAO brain SPECT, despite the absence of cognitive defects.

Topics: Brain; Brain Diseases; Calcinosis; Epilepsy, Tonic-Clonic; Female; Humans; Hypoparathyroidism; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Traumatic intracerebral haematomas are a common neurosurgical emergency. Their management, particularly the role of surgical removal, is controversial. Deterioration often occurs late, and is unpredictable. Eight patients with traumatic intracerebral haematomas were admitted to the neurosurgical unit to monitor their clinical state. All were studied within 48 hours of admission with single photon emission computerised tomography (SPECT), using the recently introduced radionuclide 99Technetiumm-Hexamethyl propylene amine oxime (99Tcm-HMPAO). At the time of the SPECT study, all the patients had been clinically stable. Three patients remained so; in the other five, the conscious level deteriorated, necessitating craniotomy and evacuation of the haematoma. In all the patients, the SPECT studies demonstrated perfusion defects that corresponded to the location of the haematoma, as demonstrated by computerised tomography (CT). However, in the five patients who subsequently deteriorated, the perfusion defects seen on the SPECT scan appeared larger than the haematoma, as seen on the CT scan. In addition, there was widespread poor retention of 99Tcm-HMPAO in the ipsilateral hemisphere. These differences were quantifiable. Interestingly, these differences were present at a time when the patients were clinically stable, before their deterioration. It is concluded that SPECT studies with 99Tcm-HMPAO are of possible use as predictors of late deterioration in the management of traumatic intracerebral haematomas.

Topics: Adolescent; Adult; Aged; Brain Edema; Brain Injuries; Cerebral Hemorrhage; Craniotomy; Follow-Up Studies; Frontal Lobe; Hematoma; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, X-Ray Computed

Early and accurate detection of prosthetic arterial graft infection is important because this serious complication of vascular surgery carries high morbidity and mortality rates. This report describes the use of a new method of isotopic imaging to detect graft infection using 99mTc-hexametazime-labelled leucocytes. Seventeen patients with potentially infected arterial grafts were imaged in addition to routine investigations but were managed according to our normal surgical practice. 99mTc-imaging was positive in eight patients with proven graft infection and falsely positive in one patient with a groin haematoma (89 per cent specificity). There were no false negatives (100 per cent sensitivity) after an average follow-up of 6 months (range 3-9 months). This technique has proved a reliable and rapid method of confirming graft infection.

Topics: Aged; Bacterial Infections; Blood Vessel Prosthesis; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Polyethylene Terephthalates; Polytetrafluoroethylene; Postoperative Complications; Radionuclide Imaging; Reoperation; Technetium Tc 99m Exametazime; Time Factors

Topics: Adult; Graft Rejection; Humans; Middle Aged; Organometallic Compounds; Oximes; Pancreas; Pancreas Transplantation; Postoperative Complications; Radionuclide Imaging; Reperfusion Injury; Technetium; Technetium Tc 99m Exametazime

Single photon emission computed tomography of the brain with Tc-99m labeled hexamethylpropyleneamine oxime was used to evaluate a patient who suffered hypoxic cerebral injury. Hypoperfusion in the right parieto-occipital and left occipital regions was demonstrated on the SPECT images, while both the cranial CT and EEG failed to document the findings.

Topics: Adult; Female; Humans; Hypoxia, Brain; Organometallic Compounds; Oximes; Postoperative Complications; Respiratory Insufficiency; Sterilization, Tubal; Technetium Tc 99m Exametazime; Tomography, Emission-Computed