Humans ; Parathyroid Neoplasms/diagnostic imaging* ; Single Photon Emission Computed Tomography Computed Tomography ; Parathyroid Glands/diagnostic imaging* ; Technetium Tc 99m Sestamibi ; Radiopharmaceuticals ; Hyperparathyroidism, Primary

BACKGROUND: Clinical observational studies revealed that 99Tc-methylene diphosphonate (99Tc-MDP) could reduce joint pain and swollenness in rheumatoid arthritis (RA) patients. This multicenter, randomized, double-blind, double-dummy study aimed to evaluate the effects of 99Tc-MDP plus methotrexate (MTX) vs. MTX alone or 99Tc-MDP alone on disease activity and structural damage in MTX-naïve Chinese patients with moderate to severe RA. METHODS: Eligible patients with moderate to severely active RA were randomized to receive 99Tc-MDP plus MTX (n = 59) vs. MTX (n = 59) alone or 99Tc-MDP (n = 59) alone for 48 weeks from six study sites across four provinces in China. The primary outcomes were the American College of Rheumatology 20% improvement (ACR20) response rates at week 24 and changes in modified total Sharp score at week 48. RESULTS: At week 24, the proportion of participants achieving ACR20 was significantly higher in the MTX + 99Tc-MDP combination group (69.5%) than that in the MTX group (50.8%) or 99Tc-MDP group (47.5%) (P = 0.03 for MTX + 99Tc-MDP vs. MTX, and MTX + 99Tc-MDP vs.99Tc-MDP, respectively). The participants in the MTX + 99Tc-MDP group and the 99Tc-MDP group had significantly less important radiographic progression than the participants in the MTX group over the 48 weeks (MTX + 99Tc-MDP vs. MTX: P = 0.03, 99Tc-MDP vs. MTX: P = 0.03, respectively). There was no significant difference in terms of adverse events (AEs) among the groups. No serious AEs were observed. CONCLUSIONS: This study demonstrated that the combination of 99Tc-MDP with MTX inhibited structural damage and improved disease activity in RA patients compared with MTX and 99Tc-MDP monotherapies, without increasing the rate of AEs. Additional clinical studies of 99Tc-MDP therapy in patients with RA are warranted. TRIAL REGISTRATION Chictr.org, ChiCTR-IPR-14005684; http://www.chictr.org.cn/showproj.aspx?proj=10088.
Antirheumatic Agents/therapeutic use* ; Arthritis, Rheumatoid/drug therapy* ; China ; Diphosphonates ; Double-Blind Method ; Drug Therapy, Combination ; Humans ; Methotrexate/therapeutic use* ; Technetium/therapeutic use* ; Treatment Outcome

PURPOSE: Urinary tract infection (UTI) is one of the common infectious diseases in children. Several imaging modalities can be used to confirm the presence of acute pyelonephritis (APN). Among them the 99mTcdimercaptosuccinic acid renal scan (DMSA scan) is used as a gold standard for diagnosis. Ultrasonography technology is evolving. Therefore, in this study, we investigated the sensitivity and specificity of Power Doppler ultrasonography (PDU) compared to the results from the previous study. METHODS: There were 260 patients included in this study, aged between 1 and 12 months old. The patients were admitted to the Yeungnam University Medical Center between January 2008 and December 2015. All patients underwent both DMSA scan and PDU within 5days of admission. Voiding cystourethrography (VCUG) was performed in 195 patients with abnormal DMSA scan or PDU. RESULTS: The diagnostic sensitivity of APN using PDU was 45.5% and specificity was 85.5% in 260 patients following detection of a defect on DMSA scan that was defined as APN. The diagnostic sensitivity and specificity of PDU for VUR were 65.5 % and 60.1%, respectively. The diagnostic sensitivity and specificity of DMSA scan for VUR were 95.7% and 14.1%, respectively. CONCLUSION: PDU has a high specificity but low sensitivity, so there are limitations in using it to replace a DMSA scan for the diagnosis of APN in children. DMSA scan and PDU have different sensitivity and specificity in diagnosis of VUR, respectively. Therefore, we suggest that the sensitivity and specificity of each test can be helpful in diagnosing APN and VUR when used in conjunction.
Academic Medical Centers ; Child ; Communicable Diseases ; Diagnosis ; Humans ; Pyelonephritis ; Sensitivity and Specificity ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Ultrasonography, Doppler ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: The availability of intraoperative parathyroid hormone (IOPTH) monitoring allows successful focused parathyroidectomy for primary hyperparathyroidism (pHPT). The objective of this study was to report our initial experience in IOPTH monitoring during parathyroid surgery for primary hyperparathyroidsim. METHODS: Between May 2011 and February 2013, 37 patients underwent focused parathyroidectomy due to pHPT. IOPTH monitoring based on Miami criteria was used to confirm complete excision of hyperfunctioning parathyroid gland during surgery. Medical records of patients were reviewed retrospectively. RESULTS: Preoperative mean maximal calcium level was 11.7 ± 0.9 mg/dL. Preoperative technetium (99mTc) sestamibi scan and ultrasonography identified 32 of 37 (86.5%) and 29 of 37 (78.4%) of abnormal parathyroid glands, retrospectively. Results of the 2 imaging modalities were discordant for 8 cases (21.6%). The mean pre-excision PTH level was 147.2 ± 201.5 pg/mL. At 5- and 10-minute post tumor resection, PTH levels were 65.3 ± 25.4 pg/mL and 47.5 ± 24.3 pg/mL, respectively. In all cases, IOPTH levels fell by at least 50% after removing all suspected abnormal glands. All patients had a successful return to normocalcemia after surgery (mean follow-up period: 60.2 ± 15.4 months). CONCLUSION: Surgeon could confirm complete excision of abnormal hyperfunctioning parathyroid glands by IOPTH monitoring during surgery for pHPT. IOPTH monitoring can maximize performance of successful focused para thyroidectomy for pHPT, especially when preoperative imaging results are discordant.
Calcium ; Follow-Up Studies ; Humans ; Hyperparathyroidism, Primary ; Medical Records ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Retrospective Studies ; Technetium ; Thyroidectomy ; Ultrasonography

We present images of an 83-year-old female with a history of osteoporosis and bilateral total knee replacement arthroplasty, referred for bone scintigraphy and single-photon emission computed tomography (SPECT)/computed tomography (CT), owing to left knee pain. No trauma to, or intense exercise of, the kneewas reported. The bone scan and SPECT/CT revealed a focally increased Tc-99m methylene diphosphonate (MDP) uptake in the medial cortex of the left femoral diaphysis with matched linear radiolucency on CT images. This was misinterpreted as atypical femoral stress fracture; however, focal stress reaction injury to the nutrient foramen was confirmed on contrast-enhanced magnetic resonance imaging.
Aged, 80 and over ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Diaphyses ; Female ; Fractures, Stress ; Humans ; Knee ; Magnetic Resonance Imaging ; Osteoporosis ; Radionuclide Imaging ; Technetium Tc 99m Medronate ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

OBJECTIVE: MicroRNA-155 (miR-155) is significantly highly expressed in breast cancer, lung cancer, liver cancer and other malignant tumors. This study was to design and construct a radiolabeled probe targeting miR-155 for in vivo imaging in breast cancer. METHODS: Anti-miR-155 oligonucleotide (AMO-155) was chemically synthesized with 2' OMe modification. Its 5' end was linked with acetyl amine group. After chelated with a bifunctional chelator NHS-MAG3, AMO-155 was radiolabeled with ^99mTc using stannous chloride. The serum stability was evaluated at cellular level. In vivo imaging was performed in MCF-7 tumor bearing mice after the administration of ^99mTc radiolabeled AMO-155 and scramble control probes, respectively. Furthermore, the blocked imaging of tumor bearing mice was obtained after the injection of unlabeled AMO-155 2 hours ahead. MCF-7 and MDA-MB-231 tumor bearing mice with different expression level of miR-155 were imaged, respectively. Quantitative real-time PCR (qRT-PCR) was used to identify the expression level of miR-155 in the bearing tumors. RESULTS: ^99mTc-AMO-155 was prepared with high radiolabeled efficiency (97%), radiochemical purity (greater than 98%), and radioactive specific activity (3.75 GBq/μg). ^99mTc-AMO-155 was stable in fresh human serum for 12 hours. After the administration via tail vein, ^99mTc-AMO-155 displayed significant accumulation in MCF-7 bearing tumors with high expression level of miR-155, whereas ^99mTc-control showed little accumulation. After blocked with unlabeled AMO-155, the tumor could not be visualized clearly after the administration of ^99mTc-AMO-155. Furthermore, ^99mTc-AMO-155 could show the differential expression of miR-155 in vivo. MCF-7 tumor was shown with significantly higher radioactive accumulation than MDA-MB-231, based on its higher expression level of miR-155, which was verified by qRT-PCR. CONCLUSION ^99mTc-labeled AMO-155 with chemical modification showed good serum stability and in vivo tumor targeting ability. This study provides a potential probe for in vivo imaging of breast cancer.
Animals ; Breast Neoplasms/diagnostic imaging* ; Cell Line, Tumor ; Female ; Humans ; Mice ; MicroRNAs/analysis* ; Oligonucleotides, Antisense ; Oligopeptides ; Radiopharmaceuticals ; Succinimides ; Technetium ; Tissue Distribution

To compare diagnostic value of 4 kinds of target-to-nontarget ratio (T/NT), and to choose a better one to assess thyroid associated ophthalmopathy (TAO) activity.
 Methods: The clinical data were collected for 29 newly-diagnosed patients (58 eyes) with TAO who underwent orbital 99mTc-DTPA single photon emission computed tomography/computed tomography (SPECT/CT) fusion images according to the clinical activity score (CAS). They were divided into an active group (18 cases, 36 eyes), an inactive group (11 cases, 22 eyes), and a control group (9 cases, 18 eyes). Diagnostic value of orbital/occipital lobe radioactive uptake count ratio (T/NT1), orbital/occipital radioactive uptake count ratio (T/NT2), orbital/thalamus radioactive uptake count ratio (T/NT3), and orbital/cerebellar radioactivity uptake count ratio (T/NT4) were calculated, and the CAS of Spearman rank correlation and receiver operating characteristic (ROC) curve were analyzed.
 Results: T/NT1, T/NT2 and CAS were correlated (r1=0.873, r2=0.527; P<0.001), with the better correlation between T/NT1 and CAS and there was no correlation between T/NT3, T/NT4 and CAS (r3=0.039, r4=0.090; P>0.05). Area under the ROC curve of T/NT1 was 0.860, area under the ROC curve of T/NT2 was 0.581, and the accuracy for T/NT1 on TAO activity was good. T/NT1=9.74 could be used as active threshold for judge of TAO in patients.
 Conclusion: There is a good correlation between T/NT1 and CAS. TAO activity assessment possesses high diagnostic value, and SPECT/CT together with imaging anatomical location is more accurate.
Case-Control Studies ; Graves Ophthalmopathy ; diagnostic imaging ; Humans ; Orbit ; diagnostic imaging ; ROC Curve ; Radiopharmaceuticals ; Statistics, Nonparametric ; Technetium Tc 99m Pentetate ; Tomography, Emission-Computed, Single-Photon ; methods

Background: Left ventricular (LV) eccentricity index (EI) is a measure of the LV shapre obtained with a commonly used quantitative software for mycardial perfusion scintigraphy (MPS). However, there are limited studies evaluating its correlation with other MPS parameters, for which this study was done. Methodology: All patients who underwent 99mTc-sestamibi stress MPS from 2013 to 2015 were screened. A total of 353 patients, 228 (65%) males and 125 (35%) females, met the inclusion criteria. One hundred twenty-nine (37%) underwent exercise stress while 224 (63%) were given dipyridamole. Spearman's rho correlation was used to determine the correlation of rest and post-stress EI with the other study variables. Results: Among males, rest EI showed negative correlation with summed stress score (SSS) (rs = -0.182, p<0.005), transient ischemic dilatation (TID) (rs=-0.172, p=0.009), rest LV end-diastolic volume (EDV) (rs=-0.291, p < 0.001), rest LV end-systolic volume (ESV)(rs=-0.316, p < 0.001), p0-st-streSS LVEDV (rs= -0.218, p < 0.001), and post-stress LVESV (rs= -0.331, p < 0.001). There was positive correlation with rest LV ejection fraction (EF) (rs= 0.291,p < 0.001) and post-stress LVEF (r5 = 0. 336, p < 0. 001). No sig11ifico11t relationship with any of the MPS parameters was observed among females. For both exercise and dipyridamole groups. EI exhibited negative correlation with SSS, and rest and stress LVESV; and positive cotrelation with rest and post-stress LVEF. Significant relationship with rest and stress LVEDV was only observed in the dipyridamole group. Conclusions This study shows that EI is correlated with most, if not all, of the MPS parameters with different levels of association depending on the patient's sex and the type of stress employed. More spherical LV is correlated with more severe perfusion defects, larger LV cavity volumes and poorere LV systolic function.
Technetium Tc 99m Sestamibi ; Dipyridamole

PURPOSE: To evaluate clinical features and the effect of parathyroid hormone (PTH) on treatment outcomes of patients with pelvic insufficiency fractures. MATERIALS AND METHODS: Fifteen patients diagnosed with pelvic insufficiency fractures were evaluated retrospectively. All patients had osteoporosis with mean lumbar T score of −3.9 (range, −3.1 to −6.4) and the mean age was 76.5 years. In all cases, simple radiography and computed tomography was used for final diagnosis; additional magnetic resonance imaging and technetium bone scans were used to confirm the diagnosis in 2 and 6 patients, respectively. Initial conservative treatment was used in all cases; treatment with PTH was applied in 5 cases. Radiological follow-up was done every 4 weeks up to 6 months and every 3 months thereafter. Symptom improvement was measured using visual analogue scale (VAS) score. RESULTS: Fractures were located: i) sacrum and pubis (9 cases), ii) isolated sacrum (4 cases) and iii) isolated pubis (2 cases). One case showed fracture displacement and pain aggravation at 4 week follow-up which was treated with percutaneous sacro-iliac fixation using cannulated screws. Duration of bone union was significantly shorter in the patients who used PTH (P<0.05). VAS scores were also lower in the group treated with PTH; however, statistical significance was not reached. CONCLUSION: In patients with osteoporosis, a pelvic insufficiency fracture should be considered if pain is experienced in the pelvic area in the absence of major trauma. While nonoperatic has been shown to be sufficient for treatment, our study shows that PTH therapy shortens treatment period and could be a favorable treatment option.
Diagnosis ; Follow-Up Studies ; Fractures, Stress* ; Humans ; Magnetic Resonance Imaging ; Osteoporosis* ; Parathyroid Hormone ; Pubic Bone ; Radiography ; Retrospective Studies ; Sacrum ; Technetium

BACKGROUND/AIMS: Esophageal dysmotility is associated with gastrointestinal dysmotility in various systemic and neuroregulatory disorders. Hypothyroidism has been reported to be associated with impaired motor function in esophagus due to accumulation of glycosaminoglycan hyaluronic acid in its soft tissues, leading to changes in various contraction and relaxation parameters of esophagus, particularly in the lower esophageal sphincter. In this study we evaluated esophageal transit times in patients of primary hypothyroidism using the technique of radionuclide esophageal transit scintigraphy. METHODS: Thirty-one patients of primary hypothyroidism and 15 euthyroid healthy controls were evaluated for esophageal transit time using 15–20 MBq of Technetium-99m sulfur colloid diluted in 10–15 mL of drinking water. Time activity curve was generated for each study and esophageal transit time was calculated as time taken for clearance of 90% radioactive bolus from the region of interest encompassing the esophagus. Esophageal transit time of more than 10 seconds was considered as prolonged. RESULTS: Patients of primary hypothyroidism had a significantly increased mean esophageal transit time of 19.35 ± 20.02 seconds in comparison to the mean time of 8.25 ± 1.71 seconds in healthy controls (P < 0.05). Esophageal transit time improved and in some patients even normalized after treatment with thyroxine. A positive correlation (r = 0.39, P < 0.05) albeit weak existed between the serum thyroid stimulating hormone and the observed esophageal transit time. CONCLUSIONS: A significant number of patients with primary hypothyroidism may have subclinical esophageal dysmotility with prolonged esophageal transit time which can be reversible by thyroxine treatment. Prolonged esophageal transit time in primary hypothyroidism may correlate with serum thyroid stimulating hormone levels.
Colloids ; Drinking Water ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Hyaluronic Acid ; Hypothyroidism* ; Radionuclide Imaging* ; Relaxation ; Sulfur ; Technetium ; Thyrotropin ; Thyroxine