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ABSTRACT: Regional expiratory flow limitation (EFL) may occur during tidal breathing without being detected by measurements of flow at the mouth. We tested this hypothesis by using Technegas to reveal sites of EFL. A first study (study 1) was undertaken to determine whether deposition of Technegas during tidal breathing reveals the occurrence of regional EFL in induced bronchoconstriction. Time-activity curves of Technegas inhaled during 12 tidal breaths were measured in four asthmatic subjects at control conditions and after exposure to inhaled methacholine at a dose sufficient to abolish expiratory flow reserve near functional residual capacity. A second study (study 2) was conducted in seven asthmatic subjects at control and after three increasing doses of methacholine to compare the pattern of Technegas deposition in the lung with the occurrence of EFL. The latter was assessed at the mouth by comparing tidal with forced expiratory flow or with the flow generated on application of a negative pressure. Study 1 documented enhanced and spotty deposition of Technegas in the central lung regions with increasing radioactivity during tidal expiration. This is consistent with increased impaction of Technegas on the airway wall downstream from the flow-limiting segment. Study 2 showed that both methods based on analysis of flow at the mouth failed to detect EFL at the time spotty deposition of Technegas occurred. We conclude that regional EFL occurs asynchronously across the lung and that methods based on mouth flow measurements are insensitive to it.
Journal of Applied Physiology 12/2001; 91(5):2190-8. · 3.75 Impact Factor
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ABSTRACT: We attempted to verify in a group of 101 children with first urinary tract infection whether it was possible to identify groups of patients with different risks of developing renal scarring by taking into account both the extent of kidney involvement documented in the acute phase of infection using a dimercaptosuccinic acid (DMSA) scan, and the presence or absence of vesicoureteral reflux (VUR). The frequency of persistent lesions in kidneys with mild-moderate lesions (less than 50% of kidney involvement) in the presence of VUR or in non-refluxing kidneys was similar (P=0.1447), while the frequency of persistent lesions in kidneys with severe lesions in the presence of VUR was significantly higher than the frequency of persistent lesions in non-refluxing kidneys (P=0.0089). The extent of kidney involvement and the presence of VUR make possible the identification of different categories of risk of scarring: in the "low risk group" (normal kidney with/without VUR) the risk of scarring is 0%; in the "intermediate risk group" (mild lesions with/without VUR; extensive lesions without VUR) the risk of scarring is between 14% and 38%, while in the "high risk group" (extensive lesions with VUR) the risk of scarring is 88%. Quantifying the risk of scarring could help in planning the treatment or in modifying the later strategy.
Pediatric Nephrology 11/2001; 16(10):800-4. · 2.52 Impact Factor
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ABSTRACT: This prospective study, performed in 101 children with a first symptomatic urinary tract infection (UTI), evaluates the diagnostic value of clinical, biological, and ultrasound parameters in detecting children with acute renal infection documented by dimercaptosuccinic acid (DMSA) scintigraphy. In children with a positive DMSA scan, mean C-reactive protein (CRP) was higher than in children with a normal DMSA scan (114+/-64 vs. 67+/-38 mg/dl, mean+/-SD, P=0.0002). The sensitivity and specificity of CRP was 64% and 68%, respectively. In children with severe kidney involvement, mean CRP and white blood count (WBC) were higher than in children with mild/moderate disease (151+/-83 vs. 92+/-55 mg/dl for CRP, P=0.0149; 20,100+/-6,854 vs. 15,023+/-6,145 WBC/ mm3 for WBC, P=0.0131). The sensitivity and specificity was 85% and 20% for CRP, and 77% and 18% for WBC, respectively. One or more areas of abnormal cortical echogenicity were documented in 3% of kidneys with positive DMSA scans. Dilatation of the collecting system was observed in 24% of kidneys. The sensitivity and specificity of ultrasonography was 27% and 89%, respectively. In conclusion, clinical, biological, and ultrasound parameters do not accurately distinguish cystitis from pyelonephritis in children with UTI and do not identify children with severe renal damage. Accordingly, we recommend that DMSA scan should be added to the initial work-up of children with UTI.
Pediatric Nephrology 10/2001; 16(9):733-8. · 2.52 Impact Factor
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ABSTRACT: The purpose of this study was threefold: to evaluate the role of gallium-67 scintigraphy in the staging of low-grade non-Hodgkin's lymphomas (LGNHL), to assess the relationship between the expression of CD71 on the surface of the neoplastic cells and the 67Ga uptake by the tumour, and to establish the contribution of 67Ga scan in defining the prognosis of LGNHL. Forty-eight patients with untreated LGNHL diagnosed in a single institution over a decade were reviewed. The end point of the study was survival of the patients according to the scintigraphic 67Ga score at diagnosis. In addition to 67Ga scan, other prognostic variables were studied, relating to the neoplastic burden, the biology of the tumour and the host. Univariate and multivariate analyses were used. 67Ga scan identified only 116/286 (41%) nodes involved by lymphoma that were detected by clinical examination or computed tomography scan. A scintigraphic scoring system with an arbitrary cut-off value of 3 (high scan score) was able to predict patients with a dismal prognosis: with a mean follow-up of 47 months (range: 1-146 months) the median survival time was 28 months in patients with a high scan score and 74 months in patients with a low scan score (P=0.002). CD71 values were 27. 4%+/-14.9% (mean +/-SD) in the former and 8.9%+/-7.2% in the latter (P=0.0001). Only performance status and extranodal sites were significant variables for prognosis in multivariate analysis. It is concluded that 67Ga scan is inaccurate in staging but might be very important in defining the prognosis in LGNHL, in association with other prognostic variables.
European Journal of Nuclear Medicine 01/1998; 24(12):1499-506.
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ABSTRACT: The evaluation of the anatomical dissemination of lung cancer has a pivotal role in the choice of the most appropriate treatment modality. The techniques of nuclear medicine are founded on the use of different radiopharmaceuticals capable of exploiting the specific characteristics of malignant tissues. They may recognise diverse cell densities, growth rates, metabolic pathways, antigenic and surface receptor expressions. In the past, the use of Co-57-bleomycin and, then, of (67)Gallium has encountered a mixed acceptance among nuclear medicine specialists, with favourable reports claiming their utility, and others with more sceptical opinions. It is generally admitted that both Co-57-bleomycin and (67)Gallium scintigraphies are quite sensitive and rather accurate. Their use, however, is almost abandoned in favour of more innovative and encouraging approaches, including non-specific radio-tracers ((201)Thallium and Tc-99m-sestamibi), substances useful in particular clinical applications (the somatostatin analogues I-123-tyr(3) and the In-111 octreotide for neuronendocrine tumours), radio-labelled monoclonal antibodies, and the recently introduced positron emission tomography. Promising results with each of these techniques need to be further substantiated, before their entering into clinical practice. However, the abundance of choices offered by nuclear medicine might reasonably bring forward the ideal noninvasive test. We review the many scintigraphic methods investigated so far and their clinical significance.
International Journal of Oncology 04/1997; 10(4):847-55. · 2.40 Impact Factor
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ABSTRACT: Thoracic computed tomography (CT) provides most of the staging information needed before operation for lung cancer and can reduce the number of exploratory thoracotomies. In recent years a new immunoscintigraphic technique with anti-carcinoembryonic antigen (CEA) monoclonal antibodies has been shown to be effective in lung cancer staging. This study compares the yields of CT scans and immunoscintigraphy in the preoperative evaluation of the medistinal lymph nodes of patients with non-small cell lung cancer.
One hundred and thirty one patients believed on clinical grounds to have a operable non-small cell lung cancer were photoscanned with the indium-111 labelled F(ab')2 fragments of the antibody FO23C5. Both planar and single photoemission computed tomography (SPECT) thoracic views were recorded. CT scan of the thorax, abdomen, and brain were obtained in all patients. Seventy of the patients eventually underwent surgery, an additional seven underwent mediastinoscopy or mediastinotomy, and a further 10 had both cervical exploration and thoracotomy. Pathological evaluation of the mediastinal nodes was available in all 87 patients, but in only 80 of them was the diagnosis of lung cancer eventually confirmed.
The diagnostic accuracy of planar immunoscintigraphy, SPECT immunoscintigraphy, and CT scanning for N2 disease was 76%, 74%, and 71%, respectively. The corresponding sensitivity and specificity rates were 45%, 77%, 64% and 88%, 72%, and 74%. These were not significantly different.
This study shows that anti-CEA immunoscintigraphy has no advantage over conventional CT scanning in assessing mediastinal lymphoadenopathy in patients with lung cancer. CT scanning remains the gold standard test in these patients.
Thorax 05/1996; 51(4):359-63. · 6.84 Impact Factor
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ABSTRACT: Simultaneous measurements of the clearance rate of chromium-51 ethylene diamine tetra-acetic acid (51Cr-EDTA) and technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA) were performed in 54 patients with a range of function between 9 and 176 ml/min. Using multiple blood samples the two clearance values correlated well (r = 0.97, SEE 8.6 ml/min) and DTPA clearance was higher by 2.9%. For each radiopharmaceutical the plasma clearance rates obtained using multiple blood samples were compared with those obtained with simplified methods, i.e., the 60-180 min two-sample method of Russell and the mono-exponential method with the Brochner-Mortensen correction. For both radiopharmaceuticals the clearance values correlated well with the Russell method (r = 0.99, SEE = 4.1 ml/min for EDTA; r = 0.99, SEE 4.9 ml/min for DTPA) and the mono-exponential method (r = 0.99, SEE 3.6 ml/min for EDTA; r = 0.99, SEE 3.9 ml/min for DTPA). The mean plasma clearance obtained using multiple blood samples did not differ significantly from that obtained with the Russell method, either in patients with a glomerular filtration rate (GFR) < 30 ml/min or in patients with GFR > or = 30 ml/min. The mean plasma clearance obtained using multiple blood samples differed significantly from that obtained with the mono-exponential method because of the great difference observed in patients with GFR > or = 30 ml/min. It is concluded that the Russell two-sample method after injection of 99mTc-DTPA is accurate enough for routine clinical use.
European Journal of Nuclear Medicine 06/1995; 22(6):532-6.
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ABSTRACT: The association of biological markers with cancer has been recognized for many decades. Current interest in markers for cancer arose in the mid 1960s, with the discoveries of alpha-fetoprotein and carcinoembryonic antigen. They were called oncofetal proteins, because of their presence in high concentrations during embryonic development, their virtual disappearance in the neonatal period, and their reappearance with cancers of specific cell types. Essentially, any molecular species may be produced in abnormal amounts or under abnormal circumstances by a tumour, and thereby become useful as a tumour marker. Several tumour markers have been studied in lung cancer. Unfortunately, none of these appear to be sufficiently sensitive and specific to be reliable for screening and diagnostic purposes. However, there is a body of evidence which proves that at least some of these substances may be useful in the evaluation of the course and prognosis of the disease. This review presents data concerning the most studied and interesting tumour markers in lung cancer.
European Respiratory Journal 02/1994; 7(1):186-97. · 5.89 Impact Factor
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ABSTRACT: In patients affected by unbearable pain secondary to peripheral vascular disorders beyond surgical repair such as thromboangitis obliterans, diabetic microangiopathy, arteriosclerosis obliterans, there is a need to establish the degree of micro-circulation functionality before proceeding with invasive pain therapy, such as Spinal Cord Stimulation (SCS). From our series some cases of refractory ischaemic pain subjected to nuclear medicine techniques assessment before and after SCS implant will be presented; these data suggest that the use of radionuclides for quantifying regional perfusion, in view of the information it offers us both in the dynamic angiographic phase and in the later static phase, constitutes a very valid aid in the diagnosis and treatment of chronic pain conditions of ischaemic origin. Cutaneous, musculoskeletal and bone flow scintiscan is a non-invasive procedure which allowed us to make an objective selection of patients who are candidates for prolonged conservative treatment thus limiting the incidence of ineffective permanent SCS implants.
Panminerva medica 01/1994; 35(4):201-8. · 1.11 Impact Factor
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ABSTRACT: While a clinical, plain radiographic, and bronchoscopic assessment yields most of the essential information needed in lung cancer, computed tomography (CT) of the thorax provides diagnostic information previously unobtainable, potentially capable of reducing the number of explorative thoracotomies. In a few recent studies, immunoscintigraphy with anti-carcinoembryonic antigen (anti-CEA) monoclonal antibodies (MA) has shown remarkable staging potential. To compare the diagnostic accuracy of the two techniques, we photoscanned with indium-111 (111In)-labeled-F(ab')2 fragments of the murine anti-CEA MA FO23C5 45 patients, who were pathologically assessed for possible loco-regional extension of lung cancer. Both planar and single photo emission computed tomography (SPECT) images were obtained. Additionally, CT of the thorax (contiguous CT slices, 10 mm thick, from the lung apices to the upper abdomen), and other routine tests of preoperative evaluation were obtained. On the basis of 37 (N1, T3, and T4), 38 (N2), and 12 (N3) pathologically documented sites, an accuracy of 65, 76, 92, 78, and 86 percent (SPECT images), and 62, 68, 42, 78, and 84 percent (CT images) was calculated (figures are relevant to N1, N2, N3, T3, and T4 disease, respectively). Thus, both techniques shared a significant margin of error in almost all the categories of evaluation; however, immunoscintigraphy showed equivalent, and, in the lymph node assessment, superior results to CT. A marginal improvement of diagnostic accuracy was recorded combining the three techniques in one case (SPECT plus planar immunoscintigraphic images), while there was no benefit in any possible integration of CT and immunoscintigraphic images. In patients with peripheral nonsquamous cell cancers, the accuracy of anti-CEA immunoscintigraphy was of 90 percent or higher. Variations in the modality of performing immunoscintigraphy, such as changes in the dose of antibody fragments to be injected, in the percentage of radiolabeling, or in the time of imaging, affected the quality of immunoscintigraphic series, and the consequent interpretation of findings. At the present time, there are very few reliable tests capable of selecting patients to proceed directly to thoracotomy or to receive some intermediate surgical test, such as a prior mediastinoscopy. Traditionally, CT has been this type of "filter-test." If current findings will be confirmed in future studies, anti-CEA immunoscintigraphy might replace CT in the evaluation of particular subgroups of patients, such as patients with peripheral nonsquamous cell bronchogenic carcinoma.
Chest 10/1993; 104(3):734-42. · 5.25 Impact Factor
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ABSTRACT: Anticarcinoembryonic (CEA) monoclonal antibodies are able to react specifically with the antigen and have the potential for the detection of CEA-bearing tumors.
The authors photoscanned with indium 111 (111In)-labeled F(ab')2 fragments of the murine CEA monoclonal antibody FO23C5 63 patients with a newly diagnosed and pathologically documented bronchogenic carcinoma. Planar dual views of the thorax, abdomen, and brain were acquired between the 24th and 144th hour after the radiotracer injection. Patients had a complete pretreatment workup, which included a routine multiorgan computed tomography (CT) scan, and the determination of the serum and tissue CEA concentration. All patients were followed up clinically and radiologically. Nineteen needle aspirations and biopsies, 23 surgical explorations, and 4 mediastinoscopic studies yielded 121 pathologically documented sites of reference.
Fifty-seven of 63 scans were positive for the primary tumor (sensitivity, 0.90). The uptake of the radiotracer correlated significantly with the intensity of tissue CEA expression (Spearman R [Rs], 0.25; P less than 0.05), but not with the serum CEA level or with the histotype. Overall, the sensitivity of the anti-CEA immunoscintigraphy (IS) for the N1, N2, N3, T3, T4, and M1 disease (1987 International Union Against Cancer [UICC] staging classification) was 0.67, 0.64, 0.62, 0.31, 0.29, and 0.86, respectively. Corresponding values of specificity were 0.67, 0.81, 0.90, 1, 1, and 0.93; accuracy values were 0.67, 0.71, 0.85, 0.71, 0.76, and 0.92. The authors limited the analysis to all of the pathologically documented sites and obtained slightly superior values but no meaningful differences. The stage derived from IS readings was correct in 33 patients. The same figure was obtained after an initial clinical workup, which included physical examination, laboratory routine tests, chest radiographs, bronchoscopy, and any diagnostic procedure indicated by those tests.
Anti-CEA FO23C5-F(ab')2 fragments are not yet "magic bullets" for perfect diagnoses; however, their staging potential seems to be remarkable. Technical improvements, single-photo emission CT, and the use of such fragments in combination with other imaging techniques might enable researchers to further improve the current results.
Cancer 09/1992; 70(4):749-59. · 4.77 Impact Factor
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ABSTRACT: Immunoscintigraphy with 111In-labeled anti-CEA-Mab (F023C5i) was carried out in 66 patients strongly suspected for a primary lung cancer and in 8 control patients suffering from different chest diseases. A sensitivity of 0.90, a specificity of 0.45 and an accuracy of 0.85 were calculated. False-negative results were mainly obtained in patients in whom the size of the lesion was below 2 cm and the tumor was centrally located. All patients affected by small-cell carcinoma were correctly identified. In 89% of the patients, a positive immunoscintiscan was associated with the presence of the antigen in the tumor. False-positive results were observed in control patients suffering from different chest diseases due to the nonspecific uptake of the tracer. The tumor definition was generally better after 120 hr than at an earlier time after injection due to the reduction of background activity. SPECT imaging defined the tumor better in each patient but did not reveal any tumor not seen on planar studies.
Journal of Nuclear Medicine 12/1991; 32(11):2064-8. · 6.38 Impact Factor
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ABSTRACT: To assess scintigraphic changes induced by intravenous streptokinase therapy, serial rest redistribution thallium-201 perfusion imaging was performed in 62 patients with acute myocardial infarction lasting less than 6 hours. Twenty-seven patients randomized to treatment with intravenous streptokinase (group A) and 35 to conventional therapy (group B) underwent thallium-201 scintigraphy as soon as possible after admission to the coronary care unit (early study). Regional myocardial perfusion was assessed using thallium-201 scintigraphy 7-9 days later in each patient (late study). The size of the perfusion defect was evaluated using a semi-quantitative score. The size of the perfusion defect decreased in serial scans in both group A (preintervention score: 12.1 +/- 6.8; redistribution score: 11.4 +/- 6.8; late study: 8.8 +/- 7.0) and group B (12.8 +/- 6.5; 12.3 +/- 6.7; 10.6 +/- 7.5, respectively). No statistical difference in myocardial perfusion was found between the two groups, on late study. Peak serum creatine kinase MB (CKMB) was earlier in group A than in group B (1030.8 +/- 326.6 vs 1361.0 +/- 271.1: p less than 0.001). The fast CKMB release group (onset of symptoms-peak of CKBM less than or equal to 900 minutes) exhibited higher thallium-201 uptake when compared to the slow CKMB release group, at the time of late study (perfusion defect score: 6.1 +/- 5.7 vs 10.7 +/- 7.3: p = 0.03). Reversibility was observed in 21/62 patients (34%). Reversibility corresponded to unchanged or improved perfusion defect score on late study in 18/21 patients (86%). Nevertheless 20/41 (49%) patients not showing redistribution of thallium-201 within pre-treatment defect had an improvement in regional perfusion on late study. Reversibility was observed in 9/14 (64%) patients with fast CKMB release and in 12/47 (26%) patients with slow CKMB release. We conclude that the early peak of CKMB is associated with a higher uptake of thallium-201 on late study. Furthermore, the reversibility of perfusion defect on redistribution imaging forecasts evolution of scintigraphic perfusion, but, when this is not present, it doesn't rule out late improvement of thallium-201 myocardial uptake. The low sensitivity and specificity of redistribution imaging and the procedure related delay in instituting therapy make thallium-201 scintigraphy unreliable in the evaluation of myocardial reperfusion following thrombolysis.
Giornale italiano di cardiologia 12/1990; 20(11):997-1006.
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European Journal Of Haematology 06/1990; 44(5):317-8. · 2.61 Impact Factor
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ABSTRACT: 34 patients admitted for suspected acute cholecystitis were evaluated using 99mTc IDA cholescintigraphy. The results of these studies are reviewed and compared with other diagnostic tests and the subsequent clinical diagnosis. Cholescintigraphy proved to be a safe, simple, highly accurate and sensitive technique. Therefore, 99mTc-IDA cholescintigraphy is proposed as the initial procedure of choice in the evaluation of patients with suspected acute cholecystitis.
Minerva chirurgica 02/1990; 45(1-2):75-8. · 0.77 Impact Factor
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Giornale italiano di cardiologia 07/1988; 18(6):532-8.
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Minerva chirurgica 11/1985; 40(20):1407-10. · 0.77 Impact Factor
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ABSTRACT: Radionuclide angiography phase analysis was performed in two patients presenting with recurrent right-sided ventricular tachycardia without angiographic evidence of valvular or ischemic heart disease. A dilated, poorly contracting (EF = 20%) right ventricle with localized dyskinetic areas was found in contrast with normal left ventricular function. The suggested diagnosis of Arrhythmogenic Right Ventricular Dysplasia was confirmed by right ventricular angiography performed in one patient. The diagnostic interest of radionuclide angiography phase analysis in patients with Arrhythmogenic Right Ventricular Dysplasia is stressed.
Giornale italiano di cardiologia 06/1984; 14(5):312-6.
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The Journal of nuclear medicine and allied sciences 28(3):167-79.
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The Journal of nuclear medicine and allied sciences 30(2-3):73-115.
