- CROATIAN MEDICAL ASSOCIATION CROATIAN SOCIETY OF NUCLEAR MEDICINE
INIS-mf—14931 HR9600009 FIRST CROATIAN INTERNATIONAL CONGRESS OF NUCLEAR MEDICINE
October 13 -15,1994. Zagreb - Croatia CROATIAN MEDICAL ASSOCIATION CROATIAN SOCIETY OF NUCLEAR MEDICINE
FIRST CROATIAN INTERNATIONAL
CONGRESS
OF NUCLEAR MEDICINE
October 13 - 15, 1994. Zagreb - Croatia
BOOK OF ABSTRACTS
The Congress has been organized under the high patronage of
Prof, dr Andrija Hebrang Minister of Health of the Republic of Croatia SCIENTIFIC COMMITTEE
Ivan5evid D., Zagreb, Croatia - President Assi A., Legnano, Italy Av£inL, Ljubljana, Slovenia Burid A., Rijeka, Croatia Czernay P., Budapest, Hungary Henze E., Kiel, Germany Hoeffer R., Vienna, Austria Kusid Z., Zagreb, Croatia Popovid S., Zagreb, Croatia
ORGANIZING COMMITTEE
Dodig D., Zagreb, Croatia - President Halbauer M., Zagreb, Croatia Jaklin M., Varazdin, Croatia Kasal B., Zagreb, Croatia Lokner V., Zagreb, Croatia Poropat M., Zagreb, Croatia Ugarkovid B., Zagreb, Croatia
CONTACT ADDRESS
CLINICAL DEPT. OF NUCLEAR MEDICINE AND RADIATION PROTECTION, KBC-REBRO, KIS>ATICEVA 12, 41000 ZAGREB, CROATIA Tel.: (++385)/41 23 38 50 Fax: (++385)/41 23 57 85 HR9600012 HR9600010
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-S C i> P ? u VI I SILENT ISCHEMIA IN PATIENTS AFTER V2 | A COMPARISON OF QUALITATIVE AND UNCOMPLICATED MYOCARDIAL INFARCTION QUANTITATIVE ANALYSIS OF THALLIUM REINJECTION IMAGES Samarziia M.'. Tezak S.2, Jembrek M.3 \i'f'QfaQ&-)t <1 Piinda A.1. Markovic" V.1, Stannic" A.1, Lukin A.2, Bozid I.2, 'University Hospital - Jordanovac, 2University Hospital - Rebro, Giunio L.2 institute for prevention and rehabilitation of cardiovascular diseases, Zagreb, Croatia 'Department of Nuclear Medicine and 'Clinic of Internal Medicine, Clinical Hospital Split, Croatia The purpose of this study was to determine the frequency and importance of silent ischemia in patients (pts) after the acute It is well known that Tl-201 reinjection imaging myocardial infarction (AMI) as well as to establish diagnostic and contributes in verifying myocardial viability. 20 patients were prognostic value of exercise stress test (EST), Holter (H) monitoring and thallium-201 (Tl) scintigraphy. All the three tests were performed studied, 4 females and 16 males, aged 43 to 67 years (average 2-4 months following the AMI. The criterion for diagnosing 56.5 years). In 6 patients coronary ischaemia was suspect myocardial ischemia on EST and H is 1 mm or more of horizontal or clinically, while in the remaining 14 patients myocardial infarction down-sloping ST depression. Additional criteria for Holter imply the was verified by ECG and enzymes at least three months earlier. ischemic episode should last one minute and be separated from other One patient had previously undergone PTCA. 2 mCi of Tl-201 episodes by at least one minute. Planar thallium images were performed 5-10 minute after the stress test; the delayed images were were injected during stress test on a treadmill (Bruce protocol). obtained after 3-6 hours. Visual and quantitative methods were Imaging was started within 9 minutes of injection, and employed in the analysis of Tl-scintigraphy. Scintigraphy was redistribution imaging was performed 4 hours after injection. All considered positive if exercise-induced perrusion defects showed our patients had one or more persistent defects on stress- redistribution. The study included 74 asymptomatic patients after the redistribution imaging. 1 mCi of Tl-201 was reinjected AMI. The patients were divided into two groups by results of quantitative Tl-scintigraphy: Group I - 44 pts with silent ischemia, immediately following redistribution imaging and reinjection Group II - 30 pts without ischemia. In Group I, out of 44 pts, 9 had images were performed 30 minutes later. The studies were a positive exercise stress, 4 showed a painless ST depression on Holter analyzed qualitatively and quantitatively by two independent and 7 had both tests positive, whereas 24 pts had only scintigraphy observers. Altogether, there were 28 irreversible defects on stress- positive. In Group II one patient had positive EST and H. Sensitivity and specificity were determined by results of coronary arteriography redistribution scintigraphy. On qualitative analysis 10 of 28 (36%) performed on 33 pts: EST (Se=40%, Sp = 80%), H (Se=21%, showed an increase in Tl-201 uptake, while 18(64%) showed no Sp=100%) and scintigraphy (Se=93%, Sp =80%). During the changes. Quantitative analysis showed 4 (14%) defects with an follow-up period lasting at least 12 months, in Group I 3 pts died, 1 increase of thallium uptake after reinjection, while 24 (86%) of developed a new myocardial infarction and 15 pts had painful ischemic irreversible defects in stress-redistribution imaging showed no occurrences. In Group II only 3 pts developed symptoms of angina pectoris. Tl-scintigraphy was the only non-invasive test showing change. The qualitative analysis is superior as compared to significant correlation with the follow-up autocomes. The diagnostic quantitative because of the problems related primarily to the and prognostic superiority of Tl-scintigraphy justifies its value as the background correction on reinjection images. initial screening method for all patients after the acute myocardial infarction. Holter did not show any additional contribution in relation to exercise stress test.
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V3 FOURIER ANALYSIS OF HEART SPECT SLICES: VIP/SOMATOSTATIN RECEPTOR SCANNING FROM REMODELATION TO FUNCTION? Virgolini I.. Kurtaran A., Angelberger P. M.. Prpid H., Lokner V. H?C%OOO 12, University of Vienna, Department of Nuclear Medicine and the C.H. "Sestre milosrdnice", Dpt. of Oncology & Nuclear Ludwig Boltmann Institute for Nuclear Medicine, Austria. Medicine, Zagreb, Croatia Various tumors co-express specific receptors for VIP The aim of this study was to determine character of the (vasoactive intestinal peptide) and somatostatin. We found that spatial distribution of marked erythrocytes in heart chambers, VIP may bind to somatostatin receptors with considerable affinity lungs and great blood vessels in relation to function of the left and indicating Kd and IC50 values in the lower nanomolar range. Vice right heart. versa, also somatostatin recognizes VIP receptors. On this basis Investigation included total of 142 subjects, 28 of which we developed the noval '"I-VIP receptor scanning technique using were without subjective and clinical signs of heart disease as well a very high specific activity (200 MBq; less than 300 picomoles as 56 after myocardial infarction (30 of anterior localization, 26 of inferior infarction), 35 with predominant left heart disease VIP/patient; dissolved in 3 milliliters NaCl 0.9%). After (aortic valve disease, dilatative myocardiopathy, etc.) and 23 with intravenous injection, the lungs were the primary organ of VIP in predominant right heart disease (atrial septal defect, mitral valve vivo-binding. In patients with adenocarcinomas of the intestine disease). (gastric, pancreatic, colonic, rectal adenocarcinomas) as well as in Radionuclide ventriculography (RNV) at rest, and thorax patients with endocrine tumors (carcinomas, insulinomas, SPECT were performed in all subjects with 740 MBq ""Tc after VIPomas) of the intestine, VIP receptor scanning provided in vivo erythrocyte labelling with pyrophosphate. Ultrasound excellent visualization of primary tumors and of spread metastases investigation was performed on all the subjects with heart disease (liver, lung, lymph nodes). Tumors/metastases became visible and 87 of them underwent invasive cardiac investigation. RNV during the early phase of 3 hours and remained usually visuable analysis revealed scintigraphic data on left and right ventricle: up to 24 hours after i.v.-injection. The results obtained in 200 global ejection fraction (GEF), end-systolic volume (ESV), end- patients with intestinal adenocarcinomas and endocrine tumors, diastolic volume (EDV), fast filling rate (FFR), fast emptying rate (FER) as well as regional wall motion shortening. Reconstruction metastatic melanomas, lymphomas and Kaposi sarcomas are of 64x64x8 SPECT images resulted in 3x64 slices (transversal, discussed. In conclusion, our noval VIP/somatostatin receptor coronal and sagittal slices). Fourier analysis of 20-32 scanning technique might be of advantage over CT scanning, reconstructed slices in all three dimensions gave amplitude image especially in patients with tumors of the intestine. of the intensity distribution of marked erythrocytes in heart chambers, lungs and great blood vessels as well as phase display of spatial localization of regional amplitude values. Results of joint ROC curves constructed for detection, localization and character of heart disease in all subjects revealed significant clinical information content of SPECT data. Evaluation of RI retention using amplitude images in 3D provides insight in regional changes of volume, particular for atrial and lung involvement. V 5 I SOMATOSTATIN RECEPTOR SCINTIGRAPHY IN EVnvrUNOSCINTIGRAPHY OF OVARIAN CANCER —IHODGKIN- (HL) AND NON-HODGKIN Q TH INDIUM-111 LABELED B72.3 LYMPHOMAS (NHL) MONOCLONAL ANTIBODY
Ivančević V.'. Nauck C.1, Wörmann B.2, Sandrock D.1, Težak S1.. Eljuga D2., Dodig D1., Žuvić M1., Marié M2., Hiddemann W.2, Munz D.L.', Emrich D.1 Chylak V2., Predanić A2., Čepulić E3., Jurin M4., Krušić" J.3
'Div. of Nuclear Medicine and 2Div. of Haematology and 'Department of nuclear medicine and radiation protection, Oncology, University of Göttingen, Germany University hospital - Rebro, 'University hospital for tumors, Up to now, there are conflicting reports on the usefulness 'Center for gynecologic oncology - Gynecologic university of the somatostatin receptor scintigraphy (SRS) in malignant hospital, lymphomas. We therefore investigated the scintigraphy with 4"Ruđer Bošković" Institute, Zagreb, Croatia [In-lll-DTPA-(D)Phe-l]-octreotide, a somatostatin analogue in the diagnostic management of 20 patients with HL and NHL. 5 Imunoscintigraphy with Indium-Ill labeled monoclonal patients suffered from HL (1 remission), 8 from low-grade (1 antibody B72.3 directed against TAG-72 antigen was performed remission), and 7 from high-grade NHL. CT scans revealed a total in 8 patients with suspect or proven ovarian carcinoma. Four of 100 lesion. Planar images were taken 4 and 24 hours after patients with ovarian carcinoma were evaluated with intravenous infusion of 110 MBq of [In-lll-DTPA-(D)Phe-l]- immunoscintigraphy soon after the recurence of desease was octreotide. The patient-based analysis yielded an overall sensitivity established or before second look operation. Three patients with of 89%. 4 of 5 patients with HL were true positive, 1 was true malignant ascytes and one patient with ovarian tumor were negative. 12 of 15 patients with NHL were true positive, 1 false evaluated preoperatively. Immunoscintigraphy was compared with positive, and 2 false negative. The lesion-based analysis showed operative reports and pathohistological diagnoses in 6 patients and different results; in the low-grade NHL group there were 17 true with CT and ultrasound in two patients with proven recurrence. positive, 2 false positive and 29 false negative lesions yielding a The following results were obtained: TP = 6, FP = 1, FN = 1, sensitivity of 37%. The respective results in the high-grade NHL no TN patients were included in study population. In addition group were 10, 0, 27, and 27%, and in the HL group 10, 0, 7, measurements of urine excretion of radiopharmaceutical were and 59%. According to the Ann Arbor-classification, after SRS, 3 performed and a trend of higher retention was noted in patients patients would have been upstaged and 12 downstaged. with large tumor masses. In conclusion, SRS does not seem to be useful in the Although results in this small study group preclude diagnostic work-up of malignant lymphomas. This may be due to conclusions of value of immunoscintigraphy with Indium-Ill low receptor densities or to the presence of receptor subtypes for labeled B72.3 antibody in patients with ovarian cancer they are which [In-lll-DTPA-CDJPhe-lJ-octreotidehas low affinities. discussed in the frame of current literature.
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SOMATOSTATIN RECEPTOR SCINTIGRAPHY IN V8 I DIAGNOSTIC CRITERIA FOR MALIGNANT GASTROENTEROPANCREATIC TUMOURS (GEP) I THYROID TUMORS
Ivančević V.'. Nauck C.2, Sandrock D.1, Kögloer A1, Bence-Žigman Z.'. Žigman M.2, Lokner V.2, Prpić H.:, Münz D.L.1, Creutzfeldt W.2, Emrich D.' Haibauer M.1, Knežević A.1, Radetić M.3, Šarčević B.3, Tomić Brzac H.1 'Division of Nuclear Medicine and 'Department of Medicine, Georg- August-University, Göttingen, Germany 'Clinical Dept. of Nuclear Medicine and Radiation Protection, University Hospital Zagreb, Scintigraphy of somatostatin receptors now represents an 2Clinical Hospital "Sestre Milosrdnice" Zagreb, interesting diagnostic tool in patients with GEP. We examined a group 'University Hospital for Tumors, Zagreb of 36 patients with proven GEP in order to establish the sensitivity of the method and evaluated the contribution of the usual imaging times 4 Since thyroid nodules are common in the thyroid gland it and 24 hours p.i. The significance of SPECT imaging of the upper is very important to find suitable diagnostic criteria for malignant abdomen was also investigated. Planar scintigraphy was performed 4 and 24 hours after i.v. injection of 111 and 222 MBq 111-In-pentetreotide. thyroid tumors (MTT). In 635 operated patients ROC analysis with SPECT of the upper abdomen was done 24 hours p.i. In 32 out of 36 various diagnostic criteria was used for simultaneous testing of patients we obtained positive scans, yielding a sensitivity of 89%. The echographical, cytological, scintigraphical and clinical methods in total of 59 true positive lesions after 4 hours significantly rose to 76 diagnosis of MTT. Malignant tumors were found in 266 of the 635 after 24 hours (p<0.02). SPECT revealed liver métastases in 4 cases operated patients. The ultrasonically guided fine needle biopsy was with negative liver findings on planar scans. Further, a binary analysis found to be the most specific and sensitive method in diagnosis of of organ systems per patient was conducted (positive/negative), the MTT. The echographical method is highly specific (96.8%) when organ systems being liver, abdomen without liver, bones, and diagnostic criterion according to which hypoechogenic nodes with miscellaneous (e.g. lung, lymph nodes): irregular contours or with regular contours but inhomogeneous echo pattern (small calcifications) are considered to be a positive findings Organ system. for MTT. Sensitivity is then 65.9%. The scintigraphic method is Sensitivity (%) Liver Abdomen Bones Miscella- Overall highly specific (100%) only when a diagnostic criterion according without liver neous to which scintigraphic findings of extrathyroid accumulation of MmTc
4h 73 67 50 46 65 pertechnetate and '"I in the neck are considered to be positive findings for MTT but then the sensitivity is very low (8.2%). Our 24h ( + ECT) 81 (94) 73 80 50 73 (79) preliminary results with color doppler are also presented. Conclusion: Although ultrasonically guided cytological We conclude that 24-hour images are indispensable in method is most specific and sensitive in diagnosis of MTT it is very 111-In-pentetreotide scintigraphy of GEP. In cases of negative important to have a good knowledge about diagnostic criteria of the liver findings on planar scans SPECT should be performed 24 other methods because in some cases echography, or scintigraphy, hours p.i. The discrepancy between patient-based and organ or the clinical examination is more specific then cytology. Some of system-based analysis of sensitivity might indicate heterogeneity these cases will also be presented. in somatostatin receptor expression within a patient, i.e.
HR9600016 V9 | ECHOGRAPHIC EXAMINATION OF THE V1 0 I ARE THERE ANY MORPHOLOGICAL CHANGES THYROID IN ADOLESCENTS OF THYROID GLAND IN PERSONNEL WORKING IN DEPARTMENT OF NUCLEAR MEDICINE Knezevid-Obad A.'. Knezevid J.2, KuSter Z.\ Tomid Brzac H.1, Knezevid I.3 Tomid Brzac H.. Bence Zigman Z., Bracid I., Horvatid G., Rozman B. 'Department of Nuclear Medicine and Radiation Protection, University Hospital, Zagreb, Clinical Department of Nuclear Medicine and Radiation 2Private medical praxis, Novi Marof, Protection, KBC Rebro 'Medical Faculty, University of Zagreb (medical student) Because of specific working circumstances in the presence The thyroids of 204 children aged 14-15 years were of radioactivity, especially exposition to 1-131 and frequent thyroid examined by ultrasound and the gland volume was determined. At disease (including one case of carcinoma) in personnel working in the same time body weight and height were measured. The aim of Department of Nuclear Medicine and Radiation Protection, KBC the study was to determine the possible correlation between the Rebro, we decided to investigate the frequency of thyroid changes thyroid volume and body weight and height. in our employees. We found that the average thyroid volume in the studied We have examined most of the 99 coworkers of our group was 8±3.2 cm3 with no difference between boys and girls. department with ultrasound (Diasonics Prisma with 10 MHz No statistically significant difference in thyroid volume was found probe) and correlated age, sex and duration of work in department between the girls with and these without menstrual cycle. Diffuse of nuclear nuclear medicine with changes found in thyroid gland. changes in the thyroid were found in 4.2% of boys and 7.3% of All coworkers with echographical changes of thyroid gland have girls. Nodose changes in the thyroid were not found. been refered to further examinations. We can conclude that the thyroid disease in adolescents The obtained results will be compared with similar is rare, more often diffuse and it does not affect the gland volume. control group of same age and sex who are not working with radioactive material.
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V11 I SERUM THYROGLOBULIN DETERMINATION, V1 2 I SURGICAL AND 1-131 TREATMENT OFTHYROID ' INECK ULTRASONOGRAPHY AND 1-131 WHOLE CARCINOMA DISTANT METASTASES BODY SCINTIGRAPHY IN THE FOLLOW-UP OF PATIENTS WITH DIFFERENTIATED THYROID Bradid I.. Kusa£id-Kuna S., Horvatid G., Medvedec M., CARCINOMA Bence-Zigman Z., Tomid-Brzac H., Pavlinovid Z., Dodig D.
Franceschi M.. Lukinac Lj., Rondevid S., Lechpammer S., Department of Nuclear Medicine and Radiation Protection, Kusid Z. University Hospital Rebro, Zagreb, Croatia
Nuclear Medicine Department, University Hospital "Sestre It is generally accepted that differentiated thyroid carcinoma Milosrdnice", Zagreb, Croatia has good prognosis. Blood born dissemination is responsible for worse prognosis in the group of the patients (pts) with distant The purpose of the study is to evaluate serum thyroglobulin metastases. Distant metastases were found in 212 (6.1%) of 340 pts measurement, neckultrasonography with ultrasound guided biopsy, and treated in our department. Pathological pattern of the cancer was 1-131 whole body scintigraphy in 359 patients with differentiated follicular in 13 pts, papillary in 7 pts and mixed (both papillary and thyroid carcinoma. All patients had undergone surgical thyroidectomy medullary) inonept. 11 (54%) of them had pulmonary, 4(19%) had and subsequent radioiodine ablation of the thyroid remnant. Serum bone and 6 (28%) had metastases (mts) in both localizations. Bone thyroglobulin levels were determined and considered abnormal when mts appeared mostly in older pts (80% over 60 years) and were the the values were > 5 ng/mL. Ultrasonography over entire neck region presenting symptom in 4 (40%) cases with bone involvement. 11 and fine needle aspiration biopsy of the mass or enlarged lymph nodes (64%) of pulmonary mts and 9 (90%) of bone mts were demonstrated were obtained using 5 and 7.5 MHz transducers and 23 gauge needles. by x-ray studies. All pts underwent total thyreoidectomy with Whole body scintigraphy was performed after oral administration of additional neck dissection in 11 pts for the cervical lymph node 185 MBq (5 mCi) 1-131. Increased thyroglobulin levels were measured involvement proved by ultrasound and fine needle aspiration biopsy. in 40 of 55 (73%) patients with metastases or local recurrence (ranging Surgery was followed by radioablation of the thyroid remnants. from 12 to > 600 ng/mL). Elevated thyroglobulin levels were measured Doses varied from 2960-11100 MBq. 1-131 uptake was present in 16 in 27 of 28 patients with functional metastases and in 13 of 27 patients (94%) pulmonary and 8 (80%) of bone mts. These pts were treated with nonfunctional metastases. Use of ultrasonography provided the with repeated doses of I-131 that varied between 5550-11100 MBq. tool to reveal by other methods occult neck masses. Neck The largest total dose was 62900 MBq in pt with follicular carcinoma ultrasonography and ultrasound guided biopsy was positive for and both pulmonary and bone involvement, during a period of ten malignancy in 23 patients. Thyroglobulin levels were undetectable in years. Three patients with bone mts were treated by orthopedic 12 (52%) patients and 1-131 whole body scintigraphy was negative in surgery followed by 1-131 therapy. 1-131 cured 7 (43%) pts having 19 (83%) of these 23 patients. pulmonary and 1 having bone mts taking up 1-131.1-131 therapy was Our experience suggests that combined use of three diagnostic successful in the treatment of pts with pulmonary involvement, but modalities: serum thyroglobulin measurement, neck ultrasonography we are also satisfied with results of surgical and 1-131 treatment of with ultrasound guided biopsy forthe detection of carcinoma recurrence pts with bone mts because it largely improved the quality of their life in the neck region, and 1-131 whole body scintigraphy gives the best despite persistent disease. results in the follow-up of patients with differentiated thyroid carcinoma. V13IPLASMA RENIN ACTIVITY IN V14 LRADIOIODINE-131 TREATMENT OF 1HYPERTHYROIDISM •••—JMETASTATIC DIFFERENTIATED THYROID CANCER HR9600019 Clinical Hospital Osijek Lechpammer S.. Dakovic" N. BoSnjak B., Kusid Z. Department of Nuclear Medicine and Oncology, UH "Sestre This investigation involved PRA (plasma renin activity) Milosrdnice", Zagreb, Croatia at rest and after exercise in a selected group of 35 women patients whose age varied from 20 to 40 years and who suffered from the Between 1963 and 1994, 617 thyroid cancer patients were floride Grave's disease. The control examines (N=35) treated at our department. Among them 73 patients (12%) developed corresponded with the diseased group in age and sex. distant metastases to the lungs, bone and other viscera. Out of these 73 patients, 46 had metastatic well differentiated thyroid cancer and their The exercise was done by means of bike ergometer in therapeutic response to radioiodine treatment was studied. There were duration of 10 minutes with the intensity of 50 to 75 W in the 24 patients with papillary (PTC) and 22 patients with follicular thyroid supine position. cancer (FTC). Follow-up range was from 1-17 years. 75% of PTC The PRA in the hyperthyroid group was higher in rest patients had metastases at the time of primary tumor diagnosis, while 6 with a tendency of increasing in exercise. The application of the patients had post-operative disease-free interval from 0.5-1 year. Only beta adrenergic blocators reduces significantly the PRA both in 3 FTC patients (13%) did not have distant metastases at the time of rest and in exercise. This makes us conclude that the increased primary tumor diagnosis. Their postoperative disease-free periods lasted value of the PRA is the effect of the increased activity of the up to 6 months. Ten PTC patients and 14 FTC patients died. Lungs only sympathic system in hyperthyroidism. were involved in 26/46 (56.5%) patients, and bones only in 15/46 (32.5%). 6/46 (13%) patients had pulmonary and skeletal metastases, and 2/46 (4%) patients had multiple organ involvement. 34 of these patients were treated with '"I, dose range from 60-1135 mCi (average: 301 mCi). Remaining 12/46 patients were treated with TCT and chemotherapy. Approximately 50% of pulmonary metastases (10/20) were resolved after '"I therapy, with some improvement in another 25% (5/20), but with no apparent benefit at all in the remaining 25%. Skelatal metastases were rarely "cured" by "'I therapy (1/9), although 2/9 (20%) patients have demonstrated some clinical improvement. 66% (6/9) patients with skeletal metastases had no benefit from "'I administration. Patients with metastatic thyroid cancer do better and success from radioiodine therapy can be expected when the disease is limited to pulmonary metastases that accumulate '"I. Poor prognosis can be expected when recurrent thyroid metastases do not concentrate iodine or when pulmonary metastases are associated with other distant metastases of skeletal metastases alone are present. In such cases radioiodine treatment my have only palliative role.
HASHIMOTO THYROroiTIS ASSOCIATED WITH (V16J SCLEROSATION OF THYROID CYSTS WITH THYROID CANCER ETHANOL, A SAFE AND SUCCESSFUL METHOD OF THERAPY Horvatic" G.. Torrid Brzac H., Bratfc" I., GroSev D., Kusaftd-Kuna S., Bence-Zigman Z., Knezevid-Obad A. Radovig D.1. Stanittd A.1, Marinkovic" M.2
Department of Nuclear Medicine and Radiation Protection, 'Department of Nuclear Medicine and ^Department of Internal University Hospital Rebro, Zagreb, Croatia Medicine, Clinical Hospital Split, Croatia
The increased incidence of thyroid carcinoma (TC) in 17 patients with thyroid cysts (8 with pure cysts and 9 patients with Hashimoto's thyroiditis (HT) is well established in with mixed, but predominantly cystic lesions) have undergone the literature. The previous investigations were based mainly on sclerosation. The procedure consisted of evacuating cysts to the pathohystological findings and only palpable and scintigraphic diameter of 1 cm so that the position of the needle tip within the "cold" nodules were suspected as possible TC. In our study HT cyst could be easily controlled. 5 ml of 96% ethanol were then was diagnosed in 945 patients (pts) and in 36 of them TC injected. After one minute the contents of the cyst was evacuated associated with HT was found. In all cases ultrasound (US) and again to the diameter of 1 cm. Only two cysts out of 17 did not US guided fine needle aspiration biopsy (FNAB) were performed. show any change of volume after sclerosation. Their volume In the group of 36 pts the mean age was 47, with 2 males and 34 before sclerosation was 37 and 45 ml. The other cysts, whose females. TC appeared in 30 cases as hypoechogenic nodule, in 4 volume before sclerosation was 23.2± 19.6 ml were reduced to cases as isoechogenic, in 1 pt as cystic and in 1 as calcified 3.6±3.7 ml two months after sclerosation. They all were smaller nodule. TC were more frequent in the right lobe than in the left than 10 ml and 10 were smaller than 5 ml at that time. one. The size of carcinoma was < 1 cm in diameter in 16 cases, We conclude that sclerosation with ethanol is a simple, 1-2 cm in 11 and > 2 cm in 9 cases. Intraglandular dissemination safe and successful means of therapy for thyroid cysts. and/or neck lymph nodes metastases were present in 19% pts, and in case of small carcinomas (< lcm) in 37% pts. 30 pts underwent total thyrotdectomy because of cytological finding of TC. Papillary carcinoma amounted to 27 cases, follicular to 3 and medullary to 1 case. 5 pts have not been operated yet. Conclusions: 1) We recommend careful US follow-up examinations of pts with HT. 2) US-guided FNAB has to be performed in all pts with nodular form of HT (especially if the nodules are echographically displayed as hypoechogenic). 3) Small nodules (< lcm) must not be neglected because they also tend to metastasize locally. V17 I THYROID HORMONES AS INHIBITORS OF V18 COMPARISON OF CLINICAL AND [PROLACTIN SECRETION AFTER TRH RADIOLOGICAL FINDINGS IN PATIENTS WITH STIMULATION IN HYPERTHYROEDISM RETROSTERNAL AND CERVICAL GOITRES
Vrklian M.. Vilibić T., Vizner B., Posavec Lj., Bečejac B. 1 1 2 t', Vilibić T.', Šikić E. , Sekso M. , Hat J. , VrMtfan Kusić Z.
Dept. of Endocrinology, Diabetes & Diseases of Metabolism, and 'Department of endocrinology, diabetes and diseases of Dept. of Nuclear Medicine & Oncology, UH "Sestre methabolism Milosrdnice", Zagreb, Croatia department of radiology and computed tomography, Clinical Hospital "Sestre milosrdnice" We analyzed serum prolactin (PRL) levels in basal state and after TRH stimulation in 35 patients with Graves' disease and We analyzed the correlation of clinical and radiological clinical symptoms of hyperthyroidism. Regarding the serum T3 findings in the diagnosis of large cervical and retrosternal nodular levels, patients were classified into two groups. The first group goitres. Fourteen symptomatic patients were studied (12 female (group A) included 16 patients with severe hyperthyroidism and and 2 male). Nine of them had retrosternal goitre. All underwent T3 levels >5.0 nmol/L and the second group (group B) included computed tomography (CT) of the neck and upper mediastinum, 19 patients with mild hyperthyroidism and T3 levels <5.0 thyroid scintigraphy using "Te pertechnetate and contrast nmol/L. The results were compared with the control group of 20 radiology of the oesophagus. Problems with respiration (stridor) healthy volunteers. The mean basal T3 levels in both groups of were present in five patients, but four of them had CT findings of patients (group A: 6.0±0.3 nmol/L, group B: 3.7±0.08 nmol/L) trachéal compression. The other nine patients had no respiratory were significantly higher than in the control group (1.0±0.1 problems, and CT revealed trachéal compression in two cases. nmol/L). All patients had normal basal PRL levels that did not Nine patients had the dislocation of the trachea on CT. Dysphagia differ significantly from the control group. After TRH stimulation, was present in eight cases but only three patients had radiological we found statistically significant correlation between maximal PRL signs of oesophageal narrowing. These patients also had the response and basal T3 levels (r= -0.84, p<0.001) and significant dislocation of the oesophagus, revealed by contrast radiology, just but lower correlation between maximal PRL response and basal as five others without any swallowing problems. The results T4 levels (r= -0.73, p<0.01). The intensity of PRL response demonstrate that all patients with respiratory problems do not after TRH stimulation is in correlation with the degree of necessary have trachéal compression (indicating the possible hyperthyroidism. The correlation increases with the increase of T3 affection of the phrenic nerve). On the other hand, some patients levels which means that T3 has an important role in controlling can have trachea! narrowing without any respiratory problems. PRL secretion after TRH stimulation in patients with hyperthyroidism.
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V19 I THYROID HORMONE AUTO ANTIBODIES IN A V20 THE ANALYSES OF SOME THYROID GLAND I PATIENT WITH HASHIMOTO THYROBDITIS DISEASES ACCORDING TO ANTHROPOLOGICAL PARAMETERS Vrklian M.. Vilibić T., Posavec Lj., Solter M., Vizner B., Kusić Z. 1 J Šarčević B. . Halbauer M.
Dept. of Endocrinology, Diabetes & Diseases of Metabolism, and 'University Hospital for Tumors Zagreb Dept. of Nuclear Medicine & Oncology, UH "Sestre 2University Hospital Rebro, Clinical Department of Nuclear Milosrdnice", Zagreb, Croatia Medicine and Radiation Protection Zagreb
A 40-years old women was admitted to the Department of The frequency of the diseases is determined not only with Nephrology with dyspnea, and chronic renal failure. Clinical genetical factors but also with geographical and racial factors. symptoms of hypothyroidism were in correlation with low serum They have great influence on the distribution of the disease. T3 (0.75 nmol/L) and T4 levels (31.5 nmol/L) and high TSH In this study we analyzed some anthropological (99.3 mU/L). Titers of thyroglobulin and peroxidase antibodies parameters in the patients with thyroid gland diseases. The were positive (> 1:6400). During hospitalization therapy with presumption is that some diseases like struma or cancer of the levothyroxine was started but normalization of thyroid hormones thyroid gland are more frequent in the different somatotype of the and TSH occured only after taking 300 y.% of levothyroxine daily human race. for seven months. For identification of thyroid antibodies, A group of thyroid carcinoma patients and a group of immunoelectrophoresis and chromatography were applied. After precipitation with IgG, IgAand IgM, the maximum percentage of healthy controls were examined. Pal m print dermatogliphae pattern binding was in IgA class. Also, chromatography on Q-sepharose was determined and according to that pattern we tried to establish showed peak of radioactivity in IgG fraction. Our results the possible correlation between thyroid carcinoma and palm print demonstrate that serum of our patients showed the presence of pattern. antibodies of IgG and IgA class, but unknown type of light chain. The need for determination of thyroid hormone antibodies remains debatable in all patients with Hashimoto thyroiditis who failed to achieve euthyroid state after long-term therapy with high levothyroxine doses. V21 I DIFFERENTIAL DIAGNOSIS OF THE THYROID V22 I THE INFLUENCE OF IMMUNOSUPRESSIVE —J GLAND CYSTS BY DETERMINING THE "TREATMENT ON THE PROGRESSION OF THYROID HORMONES, THYROTROPIN, GRAVES' DISEASE AFTER RADIOIODINE THYROGLOBULIN AND THE PARATHYROID HORMONE IN ASPIRATE Jurca T.,; i, Hojker S., Av< Bonefa&g B.. Valkovif-Mika A., Neiic'-Legac P., Univ. Medical Centre, Dept. Clinic for Nuclear Medicine, MudrovCid M. Ljubljana, Slovenia Clinical Hospital Centre Rijeka Radioiodine therapy (RIT) for Graves' disease could produce a rise in autoimmune activity expressed as elevation of Ultrasound examination of the thyroid gland may antibody against TSH receptors (TSI). In our retrospective study demonstrate whether the nodule is of a solid structure, solid-cystis the influence of different immunosuppressive therapy on or a cyst. The incindence of cystic changes in the thyroid gland is autoimmune activity was studied. 30-40%. With standard diagnostic procedures the differentiation Patients, treated with radioiodine or surgery for the first between a thyroid cyst and a parathyroid cyst is not possible. time, between January 1989 and March 1992 were included in the In 40 patients with cystic changes of the thyroid gland, study, divided in the 5 groups (patients after thyroidectomy, and we have determined the levels of thyroid hormones in the aspirate patients after RIT divided into groups according to treatment with after cytological punction. Additionally, in some of the aspirates different combinations of corticosteroids and cyclosporine A). we determined the thyroglobulin and the parathyroid hormone. We Patients were examined and TT4, TT3, TSH and TSI were compared the obtained results with the results of the serum collected before and 3, 6 and 9 months after treatment. There was hormone, the ultrasound findings, the scintigraphy results and no differences between groups before and according to the thyroid finally with the cytological analysis and appearance of the aspirate. status the patients of all groups received antithyroid drugs or Our intention in this study was to ascertain whether differentiation substitution therapy after the RIT or surgery. Immunosuppressive between the thyroid and the parathyroid cysts is possible by the therapy was indicated because of Graves' ophthalmopathy. appearance of the cyst contents and by evaluating the hormone After surgery, the progressive fall of TSI and no relapses of the concentration in the aspirate, and to determine the incidence of the disease were stated. After first 3 months the situation was very parathyroid cyst in the thyroid gland. similar in group of patients treated with cyclosporine A after RIT, later after the cessation of treatment, there were a slight elevation of TSI. In all other groups of patients after RIT there was a constant positive trend of TSI and the significant correlation was found between log TSI before and after treatment. We conclude, that autoimmune response after RIT is a consequence of activity of T cells and therefore cyclosporine A could be taken in mind when we want to prevent it. Corticosteroids on the other hand had no such an effect. HR9600021 V23IPULSE TREATMENT OF GRAVES' I V24ISUBACUTE LYMPHOCYTIC (POSTPARTUM) _J OPHTHALMOPATHY WITH 300 mg OF I ITHYROEDITIS FLUOROCORTOLONE ORALLY Smoie J.. Karner I. Ugrai V. Molnar H.'. Jaki P.1, Zupancic" I.2, Hojker S.1 Department of Nuclear Medicine and Patophysiology, Clinical 'Univ. Medical Centre, Dept. Clinic for Nuclear Medicine, Hospital Osijek Ljubljana, 2Eye Clinic Ljubljana, Slovenia Fourteen patients, all with subacute lymphocytic 39 consecutive patients, 37 females and 2 males between thyroiditis developed during several months postpartum, were 18 and 70 years old, with the recent onset of Graves' disease (GD) studied. The average follow-up period of the patients was 25 with Graves' ophthalmopathy (GO - class to Ilia ATA)and without months (6-94 months). In most of patients rapid thyroid previous treatment either for GD or GO were randomly divided enlargement postpartum was noticed, while goitre was reducing in into two groups. The duration of GO was between 1 and 3 months, course of illness. Significant high level of titar of micromosal 6 months at the most. The first group was given 300 mg of antibody was also found in most of patients, as well as persuasive Fluocortolone orally (100 mg daily, every other day, 3 times). In cytological finding for chronic lymphocytic thyroiditis. In only 4 the second group no specific treatment was administered. GD was patients low iodine uptake in the beginning of illness was found. cured with thiamazole according to standard procedure in both The course of illness was variable; in half of patients shorter or groups. The complete ophthalmologic investigation including longer hyperthyreotical phase of illness was established. At the end ultrasonography of the extraocular muscles was carried out on the of follow-up period latent of manifest hypothyroidism was noticed first visit, 6 weeks, 3 months and 6 months later. The result of the in most of patients. study proves the effectiveness of the bolus Fluorocortolone therapy if given early after the onset of the disease. It can be successfully repeated later if the relapse occurs. Subjective symptoms, inflammatory signs and thickness of the extraocular muscles are thus significantly reduced. In first group there was complete remission of GO after pulse treatment and no relapse for 6 months with 11 patients (55%) was noticeable. With 7 patients (35%) the pulse treatment was successfully repeated up to three times because of relapse of GO during observation. Two patients received Cy A, systemic corticosteroids and radiotherapy because of the acute worsening of GO. In the second group there was spontaneous improvement of GO with 6 patients (31 %). With 13 patients (68%) evident a clear worsening of the GO was observed, because of which bolus Fluocortolone therapy (47%) or systemic corticosteroid, Cy A, or the orbital radiotherapy was applied. No severe side effects were observed. V25|Tc-99m-DTPA RENAL SCINTIGRAPHY AND V26 IVESICOURETERAL REFLUXED VOLUME AND 1 DETECTION OF INTRARENAL REFLUX I RENAL FUNCTION M.Poropat1. D.Batinid2, M.BaSid1, D.Dodig1, Lj.Nizid2 Markovid V.. Capkun V., Eterovid D., Stanicid A., Saraga M.1 'Dep. of Nucl. med and Radiation Protection and 2Dep. of Nephrology of Pediatric Clinic, University Hospital Center, Department of Nuclear Medicine and 'Pediatric Clinic, Clinical Zagreb, Croatia Hospital Split, Split, Croatia The intrarenal reflux plays the key role in the etiology of The therapeutical approach to vesicoureteral reflux (VUR) reflux nephropathy and its detection is of utmost importance in depends on assessment of the renal involvement. The effective evaluating possible damage in kidney with reflux. renal plasma flow (ERPF) and parenchymal mean transit time of In 176 kidneys (113 children) with different degree of radiotracer (pMTT) of the affected kidney are sensitive functional vesicoureteric reflux (VUR), dynamic renal scintigraphy with Tc- parameters. We investigated the association of these functional 99m-DTPA in zoom mode was performed. From each study 6 indices with the volume of refluxed urine. In 64 children (mean functional images of mean time were generated, kidney contour age 6.4 yrs) the presence of VUR was confirmed with direct superimposed on each, and time activity curves (TAC) over radionuclide cystography in 80 ureters (48 unilateral and 32 possible areas of increased mean time were generated. In these bilateral) and the maximal volume of refluxed urine (MVRU) was study we analyzed only areas of increased mean time over the determined for each uretero-renal unit. All patients also underwent outer contour of the kidney which corresponds to the renal dynamic renal scintigraphy with l3'I-hippuran, providing the values parenchyma. of pMTT and relative renal hippuran clearances of the respective In later functional images of the mean time we found 53 kidneys by deconvolution analysis. In 37 of the affected kidneys focal retentions over the part of the kidney which corresponds to ERPF was also determined by combining the latter results with the renal cortex (33 in upper, 5 in middle and 15 in lower part of total ERPF, determined by plasma clearance of hippuran. Using the kidney). TAC-s generated over these areas exhibited a sharp the borderline value of MVRU of 4 ml, the group with higher increase of activity on the descending part of the curves. We MVRU exhibited significantly lower ERPF of the affected kidney propose that the return of activity from the collecting system to (194±93 vs. 270±77 ml/min/l.73 m2, p=.002) and significantly the kidney cortex represents intrarenal reflux. higher proportion of pMTT's over 3.5 min (31/33 vs. 17/47, In our opinion, analysis of functional images of the mean p=.003). The negative linear correlation between MVRU and time could be a method for more accurate detection of intrarenal ERPF was found (r=-.45, p=.006). We conclude that quantitative reflux and indicating the children with high risk to acquire renal radionuclide cystography, aside from diagnosis and follow-up of scarring. VUR, may also provide insight in the function of the affected kidney and thus contribute in designing the therapeutical approach. HR9600022 HR9600023 V271 PROCEDURES AND METHODS THAT INCREASE V28l SCINTIGRAPHIC DIAGNOSIS OF OVERUSE 1 RELIABILITY AND REPRODUCIBILITY OF THE ' INJURIES OF THE LOCOMOTOR SYSTEM TRANSPLANTED KIDNEY PERFUSION INDEX Boianid I.. Pedina M., Dodig D.* Smokvina A. Department of Orthopaedic Surgery and Clinical Department of Department of Nuclear Medicine, Clinical Hospital Center Rijeka Nuclear Medicine and Radiation Protection*, University Hospital Zagreb, Croatia At different times following surgery and during various complications, 119 studies were performed on 57 patients. In Overuse injuries, cumulative microtraumatic lesions of the many patients studies were repeated several times. Twenty-three locomotory system, pose an ever increasing problem in studies were performed in as many patients, in whom a normal orthopaedic surgery, particularly with respect to treatment function of the transplanted kidney was established by other efficiency. The rate of success in treatment depends primarily on diagnostic methods and retrospective analysis. early diagnosis, and in this regard the contribution of scintigraphic Comparison was made of the perfusion index results diagnosis is irreplaceable. obtained by the Hilson et al. method from 1978 and the ones The authors present the results obtained in the use of obtained by my own modified method, which for calculating the scintigraphic diagnosis primarily in stress fractures, but also in index also takes into account: the time difference in appearance of cases involving overuse injuries of muscles and tendons, and of the initial portions of the artery and kidney curves; the positioning the myotendinous apparatus generally. The advantages of three- of the region of interest over the distal part of the aorta; the bolus phase scintigraphy are listed, especially in differential diagnosis of injection into the arteriovenous shunt of the forearm with high overuse injuries. Through long-standing cooperation between specific activity of small volumes of 99mTc labelled agents; a fast orthopaedic surgeons and nuclear medicine specialists in the 0.5 seconds study of data collection; and a standard for diagnosis of overuse injuries of the locomotory system, primarily normalization of numerical data. in active athletes, the authors have been able to establish their own The reliability of one or the other method tested by criteria in the treatment of these injuries based on their own simulated time shift of the peak of arterial curves shows that the scintigraphic diagnosis. Scintigraphic diagnosis has also been deviation percentage from the main index value in the unmodified compared with the results obtained by other diagnostic methods, method is 2-5 times greater than in the modified method. The such as radiology, ultrasound and thermography, and with the normal value of the perfusion index applying the modified method results obtained by magnetic resonance. On the basis of their long- is 91-171. standing experience, the authors have concluded that scintigraphy is and irreplaceable diagnostic method in stress fractures of both long tubular bones and short spongioid bones. It also offers the HR9600024 possibility of staging the changes on the affected bone, which in their turn bear upon the modality and length of treatment. V29 ITHREE-PHASE BONE SCAN, Ga-67 AND 99raTc- LONG TERM FOLLOW-UP AFTER INANOCOLL SCAN IN DETECTION OF SYNOVIECTOMY WITH 90-Y IN PATIENTS WITH OSTEOMYELITIS CAUSED BY WAR INJURIES ARTHRITIS ek T.. Dodig D., Reljica-Kostid Z., PrediC P., Kurnik G. Budihna N.V.. Golja-Kos M., Batagelj I. General Hospital, Zagreb, Dept. of Nucelar Med., University University Medical Center, Ljubljana, Slovenia Hospital Zagreb, Croatia Hospital Celje, Slovenia The purpose of the study was to evaluate the success rate of synoviorthesis in 273 patients with painful and swollen large Thirtythree injured soldiers were surgically treated joints (jts), up to nine years after the intraarticular application of because of pierce wounds of extremities. Treatment was either 90-Y. 402 knees, and 64 shoulders or ankles were treated. osteosynthesis of external fixation. Two to four weeks post Rheumatoid arthritis was present in 449 jts, 64 jts were afflicted treatment clinical signs of osteomyelitis appeared. X-ray was by osteoarthritis or other rheumatic diseases. negative in all patients. Three-phase bone scan was performed in Onehundredeightyfive MBq were applied in knees and shoulders order to establish diagnosis. Bone scan was positive in all patients. and 111 MBq of 90-Y in ankles. The effect of therapy was For 11 patients only bone scan was sufficient for decission of evaluated considering the degree of morning stiffness, pain and further treatment. In 22 patients Ga-67 or 99mTc-nanocoll or both swelling. The effect of therapy was moderate in 42.5%, good in examinations were performed on surgeon's request. In 2 patients 30.6% and very good in 14.9% of jts. There was no improvement out of 5 with additional Ga-67 scan, Ga-67 scan showed more noted in 11.8% of jts. The duration of improvement was in lesions than it was seen on bone scan. In 3 patients out of 5 with average 2.8 years. In 11 % of pts the improvement lasted 6-9 years additional 99mTc-nanocoIl scan, 99mTc-nanocoll scan showed after therapy. more lesions than it was see on bone scan. In 12 patients with Transient side effects were noted in 5.6% of pts, pain and positive bone scan and negative or unclear Ga-67,99mTc-nanocoll swelling were most frequent. Malignant diseases developed during scan was performed. In 5 out of 12 patients 99mTc-nanocoll scan the follow-up period (less than 4 years) in three pts. established diagnosis in others confirmed finding on bone and Ga- We conclude that radioisotopic synoviorthesis mostly has a 67 scan. satisfactory effect with mean duration of 2.8 years. Serious side Our results showed that in one third of our causes bone effects were rare. scan was sufficient for diagnosing of osteomyelitis caused by war injuries. In selected cases where bone scan was not sufficient for diagnosis and decission for treatment 99mTc-nanocoll was more sensitive than Ga-67. In our experience three-phase bone scan is HR9600027 more sensitive than Ga-67. In our opinion three-phase bone scan is the method of choice for diagnosing osteomyelitis in war situation with a lot of causalties. HR9600025 HR9600029 V31 THE USE OF DUAL X-RAY ABSORPTIOMETRY V32 I SOFT TISSUE APPEARANCE OF A BONE-SEEK FOR THE DETERMINATION OF SKELETAL ' ER RADIOPHARMACEUTICAL CALCIUM ACCRETION Kertfez L.. Hafenscher I. and Baranyai T. Z., Skugor M., Matkovid V. Municipal Hospital, Dept. of Radiology and Isotopes, Sopron, The Ohio State University, Columbus, OH, USA Hungary The neutron activation analysis is considered the "gold In the course of our routine whole body skeletal imaging - standard" method for the measurement of total body calcium mainly done for metastatic screening - we were often faced with (TBCa). The disadvantage of this method is that there are only a the nonosseous appearance of the polyphosphate-bound technetium few centers that can perform the measurements with good /Foszfon/ as the tracer. precision, accuracy and relatively low radiation exposure. The A Toshiba GCA-901A/SA digital camera has been used in whole measurement of TBCa gives the information about Ca skeletal body scan mode. accretion which is important for the determination of Ca The paradoxity of bone-seekers' accumulation in soft requirements. The purpose of our study was to measure TBCa in tissues leads to the asumption that not only osteoblasts are able to adolescent females during different time periods. The TBCa was incorporate the radiotracer but also cells in excited phagocytic measured by the use of dual X-ray absorptiometry (DXA), on state, too. Such states can be induced by inflammatory processes - Lunar DPX-L densitometer (LUNAR Corp., Madison WI). The no matter whether sterile or not - accompanied by some increase in-vivo precision of the instrument for TBCa measurements was in local perfusion. 0.93%. The study population included 364 healthy, Caucasian Documentative cases of mastopathy, indurative trombo females. An average age at baseline was 10.8+0.8 years phlebitis, subacute and chronic postoperative wound healing will (mean±SD) and 11.9±0.8 years after 1 year. The subjects be shown with quite different imaging intensity. This should call uderwent pubertal stage (PS) changes of PS 2 to PS 3 in their also attention to avoid misinterpretations. sexual development. The TBCa was 506±91 g (mean+SD) at baseline and 614±122 g after 1 year, with 21.3% change. Assuming that Ca comprises -38% off bone mineral, there was -108 g of Ca accumulated in 1 year or -296 mg Ca/day. In addition, we compared Ca accretion measured by DXA (over the 6 months period) and 2 weeks Ca balance study on a subsample of 26 girls. The accumulation of Ca by DXA method was 52g/6 months and the one estimated from balance study was 50g. We conclude that DXA is a suitable noninvasive method for the measurement of TBCa accretion during rapid growth and for clinical intervention trials in adults. HR9600028 V33J THERAPEUTICAL EFFECTS ON BLOOD-FLOW SPECT SCINTIGRAPHY WITH HDP AND Mab BW IN THREE-PHASE BONE SCANNING IN PRIMARY 250/183 OF LOOSENED HBP ENDOPROTHESIS MALIGNANT TUMORS AND ACUTE OSTEOMYELITIS ', Gregoric E.2, Dodig D.3 KovaCid K.'. Cepulid M.2, Kusid Z.1 'Hospital Celje, 'Hospital Izola, Slovenia, 'University Hospital Rebro, Zagreb, Croatia 'Department of Nuclear Medicine and Oncology, University Hospital "Sestre Milosrdnice", Main problem of the loosened hip endoprothesis is in 2Children's Hospital, Zagreb, Croatia distinguishing between the aseptic and septic loosening of endoprothesis. In the studies where the bone scan was limited only to the The study involved 27 pts with a loosened hip; 15 pts late static image, the main disadvantage was its nonspecifity. With with aseptic and 12 pts with septic loosening. three-phase bone scan the number of false positive findings was The patients were injected 550-770 MBq Tc-99m-HDP and reduced by some peculiar diseases; for instance, acute underwent SPECT scintigraphy of the hips to repeat then the hematogenous osteomyelitis. It is well known that various examination with only 370 MBq Tc-99m-Mab Bw 230/183. diseases, such as nonunion of the fracture, some surgical HDP application evidenced positive accumulation at the interventions, avascular necrosis... can imitate acute osteomyelitis endoprothesis in all paitents with a loosened hip while Mab Bw on the static image. These diseases can only be differentiated from 250/183 only in the patients with septic loosening. inflammation by blood-flow. Therefore, in all patients with the Conclusion: SPECT scintigraphy of hip endoprothesis diagnosis of primary bone disease tumor, inflammation, trauma, with HDP and Mab BW 250/183 allows differential diagnosing aseptic necrosis... three-phase bone scintigraphy is performed. between septic and aseptic hip loosening and hereby a correct Here, only the patients with acute osteomyelitis and primary therapeutical approach. malignant bone tumors will be presented: the basic scintigram was done before the therapy started, and the second one as a part of the follow-up - in some patients during the therapy and in some after its ending. We noticed that the most reliable part of three- phase bone scan responding to the therapy is angioscintigraphy (blood-flow) and in some cases early static (blood-pool) image. HR9600031 These two phases, especially the first one, are in good correlation with the clinic, in contrast to the third phase which is delayed. From the presented cases it could be concluded that in acute osteomyelitis and primary malignant tumors, blood-flow and blood-pool images are unavoidable phases of the bone scanning when we want to correctly evaluate the effects of the therapy. HR9600030 HR9600032 V35 I ULTRASOUND IN PATIENTS TREATED FOR I V361 EFFECTS OF IONIZING RADIATION ON I SARCOMA BY RADIOTHERAPY I * GASTROINTESTINAL FUNCTION Pichler E.'. BiScan M.1, Mihajlovic L.1, Stojanovid J.1, Kusid 2 Berlin C, Dublineau I., Griffiths N.M.. Joubert C, Z. Linard C, Martin J.M., Mathe D., Scanff P., Valette P. 'Clinic for Tumors, and department of Nuclear Medicine and Laboratoire de Radiobiologie Digestive, IPSN, D.P.H.D., Oncology, University Hospital "Sestre Milosrdnice", Zagreb, SARAM, CEA B.P. 6-92265 Fontenay-aux Roses, France Croatia The aim of this project is to investigate the effects of When treating patients by radiotherapy for sarcoma it is ionizing radiation (< 10 Gy) on several parameters of gastrointestinal function: - (a) regulatory peptides; (b) pancreatic and biliary very important to establish the exact borders and the depth of secretions and (c) electrolyte and lipid transport using both gamma extension of the tumor. Fifteen patients were examined by alone (cobalt-60) and a mixture of gamma/neutron (7/N Silene ultrasound (US) prior to radiotherapy, the depth of the tumor was reactor) in two animal models, the rat and pig. established and its borders were marked on the skin. In the middle Preliminary data in rats following gamma irradiation (2-8 Gy) show that plasma nurotensin, gastrin releasing peptide and of the treatment the US examination was repeated and when there substance P are increased in a dose dependent manner most markedly was tumor involution, new tumor borders were marked on the between two and four days after exposure. In another study in rats skin. At the end of the therapy US guided aspiration cytology was using mixed 7/N (2-4 Gy: 7/N 1:1) intestinal transepithelial resistance was reduced with a concomitant increase in short circuit done at various sites of tumor seen on US. If cytology was still current up to two days after irradiation. Intestinal brush border positive boosting radiotherapy dose was given on residual tumor, marker enzyme activities (sucrase and leucine amino-peptidease were which was again marked on US examination. If cytology was also reduced. Such differences were more marked and persisted longer after 7/N irradiation (2-4 Gy: +Pb: 7/:N =0.2). Following negative despite residual tumor mass, no further irradiation was the latter type of irradiation (4Gy) plasma cholesterol increased as applied and the patient was just followed up. All patients were well as the cholesterol/phosphohpid ratio. Analysis of cholesterol followed up on a regular basis and ultrasound guided aspiration distribution in lipoprotein fractions revealed a large increase in cytology was done repeatedly. cholesterol carried by High Density Lipoprotein-1 (HDL1). In the pig following either type of irradiation the volumes In this way, it was possible to maximally reduce the field of both pancreatic and biliary secretions were reduced. Further of irradiation, determine the exact spot for maximum dose and analysis of pancreatic secretion showed a marked decrease in the depth of irradiation, and to obtain good results with minimum quantity of cnymotrypsinogen, pophospholipase and lipase as well as a decrease in chymotrypsin and elastase activities (after 7 alone, 6 & damage to the surrounding tissues. 8Gy). Irradiation of pigs with either 7 (6 Gy) alone or 7/N (6 Gy: 7/N 1:1) resulted in a marked decrease in both brush border (sucrase: leucine aminopeptidase) and basolateral (sodium pump; adenylate cyclase) enzyme activities. Vasoactive intestinal peptide (VIP) stimulated adenylate cyclase was markedly attenuated and in addition specific VIP binding was modified as shown by a reduction in receptor affinity. The significance of these data will be discussed along with how such result may be of importance vis a vis new therapeutic strategies or indeed new biological markers of radiation-induced gastrointestinal dysfunction. V37| MICRONUCLEUS INDUCTION AS A MEASURE V38 I[DETECTION OF RADIOIODINE-INDUCED OF 131I RADIATION EXPOSURE [CYTOGENETIC ALTERATIONS IN CIRCULATING LYMPHOCYTES OF THYROID PATIENTS KaSuba V.1. Kusid Z.2, Vlatkovid M.3, Horvat D.1 KaSuba V.'. Konra"dy A.2, Koteles G.J.2 Kusid Z.3 'Laboratory for Mutagenesis Institute for Medical Research and Occupational Health Zagreb, 'Institute for Medical Research and Occupational Health, Zagreb, 2Clinical Hospital "Sestre Milosrdnice", Department for Nuclear Croatia, Medicine and Oncology, 2"Fr6de'ric Joliot-Curie" National Research Institute for 'Clinical Hospital Center Rebro, Department for Nuclear Radiobiology and Radiohygiene, Budapest, Hungary, Medicine, Zagreb 3Clinical Hospital "Sestre Milosrdnice", Zagreb, Croatia The change of cell numbers in the peripheral blood Radioiodines are often used for experimental purposes and following irradiation has been studied for many years, particularly for diagnosis and therapy in clinical practice. Human population might in patients undergoing radiotherapy. Recently, attention is directed also be exposed to radioiodines in nuclear accidents. The ionizing towards the use of cytogenetic-mutagenetic methods to estimate energy of radioiodine affects not only the thyroid where it the biological effects of received radiation dose. The aim of our concentrates but also other tissues, especially the lymphocytes during study was to identify the difference in number and distribution of their circulation through and around the gland containing the micronucleus, depending of applied therapeutic dose of iodine- radioisotopes. Therefore, it seemed to be of interest to carry out 131. According to their diagnosis, six patients have received investigations concerning the cytogenetic alterations in blood iodine-131 in range from 80 to 140 mCi, while in the other group lymphocytes of patients treated with Iodine-131. The method of choice of patients the dose values varied from 7 to 32 mCi. On in vitro was the relatively easily performable micronucleus assay in peripheral blood lymphocyte cultures nicronucleus test was cytokinesis-blocked cultures of human peripheral lymphocytes. The applied. Micronucleus analyses were carried out before the test was performed on blood samples of 30 patients before the radioisotope treatment and one, two and four days afterone as well as treatment, 24, 48 and 96 hours after the oral application of 6 and - in a few cases - 12 weeks later. The amounts of Iodine-131 radiopharmac. injected were dependent on the clinical practices to reach the The number of micronucleus is showing increase, therapeutic radiation doses for hyperthyroidism and adenomas and depending on applied radioactivity of iodine-131 and duration of were in the range of 220 and 5180 MBq. it was observed that the exposition. The clear dose response relationship was never found. micronucleus frequency increased in the treated hyperthyroid patients These results illustrate the problem associated with the while in patients with toxic adenomas the radioiodine did not result in inhomogenous distribution of dose which results from the an increase or even as compared to the pretreatment values in a few concentration of incorporated radionuclide into thyroid or other cases decreased values were seen. The results suggest individual tissues. differences in radiosensitivity as well as that the frequency of cytogenetic alterations depend on the physiological or pathological conditions of the thyroid. The significance of this observation will be discussed for dose assessments by cytogenetic techniques due to HR9600034 internal radioiodine. HR9600035 NGA/INSULIN RECEPTOR SCANNING I V401 COMPARISON OF SPECT AND WHOLE-BODY I PLANAR IMAGING IN RADIOIMMUNO- urtaran A.. Angelberger P. and Virgolini I. SCINTIGRAPHY WITH Tc-LABELED ANTIBODIES University of Vienna, Department of Nuclear Medicine and the Ludwig Boltzmann Institute for Nuclear Medicine, Austria. Lacid M.. Bokulid TM Lukac J., Dakovid N., Roncevid S., Kusid Z. "Tc-galactosyl-neoglycoalbumin (NGA) is one of the Department of Nuclear Medicine and Oncology, University first receptor-based radiopharmaceuticals which specifically Hospital "Sestre Milosrdnice", Zagreb, Croatia recognizes the hepatic binding protein (HBP) located on the surface of the hepatocytes. The exclusive interaction of NGA with The authors of some recent clinical studies suggested 20- HBP provided the basis for a kinetic model for the evaluation 24 hours SPECT imaging as a mandatory procedure in hepatocellular function. During the last years we have used NGA radioimmunoscintigraphy with Tc-labeled antibodies. in more than 300 patients with various liver diseases including The aim of our study was to compare whole-body (WB) planar liver cirrhosis (Stages Child A to Child C), viral hepatitis, and imaging versus SPECT as well as 4-6 hours SPECT to 20-24 carcinomas. In these studies, the calculated HBP densities, after hours one. i.v.-injection of "'"Tc-NGA, significantly correlated with the clinical course of the diseases. Furthermore, similar to For this purpose we analyzed 33 lesions in 12 conventional Tc-colloid, NGA provided excellent demonstration of postsurgical patients with colorectal carcinoma. Each patient "cold spots" for hepatic masses. In a further approach we used received intravenously 0.5-1.0 mg anti-CEA BW 431/26 murine another hepatocyte receptor-seeking radioligand, I23I-Tyr-A14- monoclonal IgG-antibodies labeled with Tc-99m (814-1110 MBq). insulin, and found, that its in vitro-binding to hepatocellular WB and SPECT imaging were performed at 4-6 and 20-24 hours carcinomas is greatly enhanced over normal hepatic tissue. On this post infusion. basis, we developed a double-tracer method using NGA and 20-24 hours WB scan imaged more "hot" and less "cold" insulin in a single study. Thus, areas of "cold spots" identifying lesions than 4-6 hours one. SPECT scan showed significantly hepatic masses on NGA scans, take up 123I-Tyr-A14-insulin more lesions than WB scan. 20-24 hours SPECT scan detected immediately after i.v.-injection. This was true for hepatocellular more "hot" lesions than 4-6 hours SPECT. At the same time the hepatomas, but not for adenocarcinomas. In conclusion, number of "cold" lesions decreased in 20-24 hours SPECT in NGA/insulin receptor scanning could be a noval and save method comparison to 4-6 hours one. for the demonstration of hepatocellular hepatomas. As a conclusion we can say that our results suggest a superiority of SPECT imaging in comparison to WB scan. Except that, in our opinion performing of a 20-24 hours SPECT scan in radioimmunoscintigraphy with Tc-labeled antibodies should be mandatory. HR9600036 HR9600037 I V4i| CORRELATION BETWEEN BONE SCAN AND V42|TO SPECT DIAGNOSE THE BRAIN TUMOUR BONE MARROW EVIMUNOSCINTIGRAPHY OF 1 THE SKULL WITH Tc-MIBI 1 U, Bokulid T., Kovadid K., Lukad J., Kusid Z. PrediC P.. Pustovrh I., Pustovrh B., Fettich J. Department of Nuclear Medicine and Oncology, University Hospital Celje, 'University Hospital Ljubljana, Slovenia Hospital "Sestre Milosrdnice" Zagreb, Croatia In spite of the new diagnosing methods developed, the diagnosis of brain tumours - primary and metastasis - still Diffuse increased activity of the skull on bone scan (BS) represents a challenge and diagnosing problem. is usually explained with hyperostosis. We wanted to correlate BS Therefore, we tried in our study to determine the value of Tc- and bone marrow immunoscintigraphy (BMIS) to see if a bone MIBI as a new specific radiopharmaceutical in the tumour marrow expansion could be an explanation for diffuse increased diagnosing. activity of the skull. The examination was carried out by injecting in bolus 370 In that purpose we investigated 23 patients (pts) with MBq-Tc-99m-MIBI under the gamma camera to be followed by a breast cancer. dynamic study on a computer - 60 images in 60 seconds - and the BMIS planar scans were obtained 3-6 hours post injection calculation of relative perfusion in the artery phase 3T out of the of 0.25-0.50 mg murine MAb BW 250/183 (Behringwerke AG) generated curve. After one hour we performed the SPECT study labeled with 370-555 MBq of Tc-99m. BS using Tc-99m MDP (60 images within 360°) and made a reconstruction study of all and BMIS were performed within an interval of 4 weeks. standard sections and generated a 3D picture. BS showed diffuse increased activity of the skull in 6 pts, all of The examination has been performed in 9 pts with brain them had bone marrow expansion on BMIS. In 11 pts BS and tumour and 10 pts with no signs of brain tumour which were BMIS findings of the skull were normal. In 6 pts BS demonstrated directed to the scintigraphy of miocard with MIBI. In patients with focal increased activity of the skull and 4 of these pts had a a tumour 3T was 1.15 and 2.35., i.e. raised. correspondent finding on BMIS - "cold" lesions. We concluded SPECT 3D scintigram evidenced in all patients exactly localized that diffuse increased activity of the skull on BS could be sharp limits of the increased accumulation. explained with bone marrow expansion. In patients without signs of brain tumour 3T was between 0.92 and 1.05 i.e. normal, SPECT 3D scintigram detected no increased accumulation in the brain region. Conclusion: The preliminary study speaks in favour of the fast that a high possibility may be expected to diagnose brain HR9600038 tumours with the SPECT 3D study with Tc-MIBI. HR9600039 HR9600040 HR9600041 I V43 I CEREBRAL ANGIOSCEVTIGRAPHY-STILL A I V44 I DETECTION OF LIVER HEMANGIOMAS BY | IRELIABLE METHOD OF DETECTING L—J99mTC-LABELED RED BLOOD CELLS CEREBROVASCULAR MALFORMATIONS Vudemilovid A.. Burid A., Radid-Wolfl M., Valkovid-Mika A. Valkovid-Mika A.. Willheim K., Bund A., Radid-Wolfl M. Clinical Hospital Center Rijeka Clinical Hospital Center Rijeka The differentiation of hemagiomas and liver cysts (5-15% The most frequent brain diseases are caused by changes in adult population) from single metastases, hepatocellular on the blood vessels. According to various authors, of all carcinomas, adenomas and focal nodular hyperplasia is important intracerebral processes, the incidence of cerebrovascular because of the current aggressive surgical approaches to the malformations is 1-2%. Although malformations may appear in treatment of single malignant lesions. Very vascular lesions (focal any age group they are usually detected between the age of 20 and nodular hyperplasia, some adenomas, some hepatocellular 40, headaches being usually the only sign of disease. carcinomas, and vascular metastases) show radiological contrast At our Institute, in the period from 1990 to 1994, 435 in bolus in the first 30 seconds (the arterial dominant phase). patients underwent cerebral scintiscanning with Tc99m- During the delayed contrast enhancement phase (from 30 to 180 pertechnetate, due to persisting headaches that could not be seconds), some hepatocellular carcinomas, metastases and relieved by standard treatment. Cerebrovascular malformations occasional hemangiomas may be seen. were detected in 2.8% of all patients. The accumulation of tagged red blood cells in the RadionuclideangioscintigraphywithTc99m-pertechnetate hemangioma is much slower than of the contrast, and their activity is gradually being disused with the introduction of computerized persists for a much longer time (30 minutes - 2 hours). Data from tomography and nuclear magnetic resonance. Our results show the literature show that hemangiomas larger than 2 cm are detected in advantages of the radionuclide angioscintigraphy as a valuable, 95% of cases. quick, noninvasive and nonexpensive diagnostic method for the In our study we have labeled the red blood cells in vivo detection of cerebrovascular malformations. with 99mTc PYP or 99mTc DTPA. Planar scintigrams in several projections are made from 3 to 30 minutes, in matrix 256x8. In 11 of 42 cases one or two very vascular lesions, larger than 2 cm, were found. In four cases the increased activity accumulation was marked as suspect, and in others the increased activity accumulation was not detected. V45 IPINHOLE SPECT: HIGH RESOLUTION IMAGING V46ITHE INFLUENCE OF SEROTONIN ON _JoF BRAIN TUMORS IN SMALL LABORATORY * FOLLICULAR CELLS FRTL-5 IN VITRO ANIMALS Gaheršček S,1, Kališnik M.2, Pavlin K.' Franceschi M.'. Weber D.A.2, Ivanović M.2, Franceschi D.2, Strand S.E.3, Erlandsson K.3, Bokulić T.', Kusić Z.1 'University Clinic for Nuclear Medicine, Zaloška 7, 'Institute of Histology and Embryology, Medical Faculty in 'Nuclear Medicine Dept., Clin. Hosp. "Sestre Milosrdnice", Ljubljana, Korytkova 2, Ljubljana, Slovenia Zagreb, Croatia, 2Medical Dept., BNL, Upton, New York, USA, 'Radiation The effect of serotonin in presence and absence of Physics Dept., Lund, Sweden thyrotropin was studied on a cell line of rat follicular cells FRTL- 5 (Fischer Rat Thyroid cells in Low serum) by measuring [3H]- The performance properties of pinhole SPECT and the thymidine incorporation into cell DNA. The cell line was used to application of this technology to evaluate radionuclide uptake in avoid the contamination with serotonin secreted from parafollicular brain in small laboratory animals were investigated. System cells. Results show that serotonin at 3 ^M, 10 /xM, 30 ^M and 3 sensitivity and spatial resolution measurements of a rotating 100 /tM concentrations increases [ H]-thymidine incorporation into scintillation camera system were made for a low energy pinhole cell DNA. Serotonin at a 1000 /xM concentration reduces sharply 3 collimator equipped with 2.0 mm aperture pinhole insert. the [ H]-thymidine incorporation into cell DNA, showing a toxic Projection data were acquired at 4 degree increments over 360° in effect on these cells. As expected, thyrotropin stimulates follicular the step-and-shoot mode using a 4.5 cm radius of rotation. Pinhole cells. Serotonin does not have any influence on that stimulative planar and SPECT imaging were obtained to evaluate regional effect of thyrotropin. uptake of Tl-201, Tc-99m MIBI, Tc-99m HMPAO and Tc-99m DTPA in tumor and control regions of the brain in a primary brain tumor model in Fisher 344 rats. Pinhole SPECT images were reconstructed using a modified cone-beam algorithm developed from a two dimensional fan-beam filtered backprojection algorithm. The reconstructed transaxial resolution of 2.8 FWHM and system sensitivity of 0.086 c/s/kBq with the 2.0 mm pinhole collimator aperture were measured. Tumor to non-tumor uptake ratios at 19-28 days post tumor cell inoculation varied by a factor>20: 1 on SPECT images. Pinhole SPECT provides an important new approach for performing high resolution imaging: the resolution properties of pinhole SPECT are superior to those which have been achieved with conventional SPECT or PET imaging technologies. HR9600042 HR9600043 BIOLOGICAL METHOD FOR TRAb V48 CHARACTERISTICS OF LiF-7 TEFLON DISK DETERMINATION ON FRTL-5 CELLS DETECTORS FOR DOSIMETRY IN NUCLEAR MEDICINE 2 Jaki P.'T Logonder-Mlinšek M. , Pavlin K.' Grošev D.'. Kasal B.1 Popović S.1, Ranogajec-Komor M.2, 'Univ. Medical Centre, Dept. Clinic for Nuclear Medicine, Vidović Ž. Zaloška 7, institute of Histology and Embryology, Medical Faculty in 'Department of Nuclear Medicine and Radiation Protection, Ljubljana, Korytkova 2, Ljubljana, Slovenia University Hospital Rebro, Zagreb, Croatia, 2"Ruđer Bošković" Institute, Zagreb, Croatia TRAb determination on FRTL-5 cells allowed separation of TSAb into stimulating and blocking by way of exploring the We have evaluated performances of the effect of antibodies on the stimulation/inhibition of cAMP thermoluminescence dosimetry system recently installed in our synthesis. Native serum and Ig insulated from the same types of department. System components were examined to find optimal serum in three different ways: FPLC method, Sephadex column, annealing and measuring cycle for LiF-7 teflon disk detectors. and PEG, have been used. At the outset, buffer with NaCl was Parameters such as dose at lower detection limit, lowest possible used to measure the amount of cAMP in ECS. In such a way, the digital reading in units of dose (mGy) were evaluated. Calibration serum and Ig insulated by FPLC and Sephadex were tested. The with high energy gamma source, as well as with most common effect of TRAb on the cAMP synthesis was detectable but not nuclear medicine radionuclides was performed. strong enough to confirm the presence of stimulating/blocking By interlaboratory comparison, dose rate of system antibodies. calibration source (depleted 238U) was accurately determined. We have found out that the amount of cAMP is more Finally, we assessed linearity of dosimeter system in two easily measured in ECS; more-over, the results produced are dose ranges: higher in figures, especially if buffer without NaCl is used. The a) One expected in nuclear medicine occupational exposures experiment has been carried out under these conditions to prove (<10mGy) the effect of TSAb and TBIAb in hyperthyrotic as well as b) One which might be needed in case of nuclear power hypothyrotic types of serum as the result of the effect of Ig plant accidents (acute exposures up to 2 Gy). insulated from these types of serum with PEG. The intra-assay is less satisfactory. Therefore it is possible to maintain that every testing necessitates the simultaneous measurement of the effect of buffer, serum or Ig from healthy persons, and TSH, for the purpose of modifying the results produced after the effect of the substances has been tested. With respect to this modification, inter-assay results are also favourable. DECONVOLVING OUT INDICATOR SMEARING V5OI SYNTHESIS OF STEREO (R AND S) AND IN THE RIGHT VENTRICLE FACILITATES LEFT- 1 GEOMETRIC (E AND Z) [I8F]FLUORO-0- TO RIGHT SHUNT QUANTITATION FLUOROMETHYLENE-M-TYROSINE DERIVATIVES: SPECIFIC PET PROBES FOR Eterovig D.'. Popovic" S.\ Dujifi Z.3 CENTRAL DOPAMINERGIC SYSTEM 'Department of Nuclear Medicine, Clinical Hospital Split, Split Latan G.. Barrio J.R., Satyamurthy N., Yu D.C., Huang 2Clinical Department of Nuclear Mededicine and Radiation S.C., Phelps M.E. Protection, Clinical Hospital Rebro, Zagreb department of Physiology, Zagreb University Medical School in UCLA School of Medicine, The Laboratory of Structural Biology Split, Split and Molecular Medicine, Los Angeles, CA 90024, U.S.A. A simple algorithm is developed to enhance the resolution Racemic /3-fluoromethylene-m-tyrosine (FMMT) was of components of multimodal pulmonary radiohistogram. Based on developed as an aromatic amino acid decarboxylase (AAAD)- the assessed right ventricular ejection fraction (RVEF), it activated monoamine oxidase (MAO) suicide inhibitor. Direct [1SF] deconvolves out the effect of indicator smearing in the right fluorination of pure enantiomers, R and S- (E) -/3-fluoromethylene- ventricle on the heart rate samples of the pulmonary m-tyrosine (E-FMMT) and the racemic geometric isomer R,S 18 radiohistogram, ck. The output is the ideal curve, c-^q/RVEF- (Z)-/3 fluoromethylene-m-tyrosine (Z-FMMT) with [ F] 18 (l-EF)xck.,/RVEF, that would be obtained if RVEF equalled unity. acetylhypofluorite, afforded 6- and 2[ F] fluoro positional isomers Since the formula is not a recursive one it does not suffer from as the major products. Regioselective radiofluorodestannylation of I8 error propagation pertinent to numerical deconvolution. Once the respective 4-trimethylstannyl R,S-(E) - FMMT with [ F]F2 RVEF is known, implementation of the algorithm is trivial. If yielded the 4[18F] fluoro derivative, thus allowing for the RVEF is not known accurately it may be replaced with its upper systematic evaluation of the regio- and stereo radiofluorinated estimate, RVEFU1,P> RVEF, yielding a partial deconvolution of the AAAD probes. Macacca nemestrina monkeys were injected iv curve. When applied to patients with left-to-right shunt the method with purified radiofluorinated FMMT analogs and the distribution improves the accuracy and lessens the interobserver variation of of activity in the central dopaminergic system was studied with the Maltz-Treves method. positron emission tomography (PET). Radiofluorinated stereo and geometric FMMT derivatives showed significant differences in their in vivo striatal localization, with radioprobe localization decreasing in the order: 6F-S-(E)-FMMT > 2F-S-(E)-FMMT > HR9600044 4F-R,S-(E)-FMMT. Neither radiofluorinated analogs of R-(E)- FMMT and R,S-(Z)-FMMT showed any significant striatal localization in vivo. HR9600045 HR9600046 MEASUREMENT OF Mo-99-COLUMN ACTIVITY V52| UP-TO-DATERADIOPHARMACEUTICALS, R & D IN THE EVALUATION OF Mo-99/Tc-99m I AS WELL AS PRODUCTION IN INSTITUTE OF GENERATOR ISOTOPES KuSter Z. Kornvei.!.. Antalffy M. Department of Nuclear Medicine and Radiation Protection, Institute of Isotopes Co. Ltd., Budapest, Hungary University Hospital, Zagreb, Croatia In contrast to competitive methods, nuclear medicine is In order to calculate the real elution efficiency of Mo- the unique tool when organ functions under physiological 99/Tc-99m generator the Mo-99 content on the column has to be conditions should be determined. Among such dynamic studies, previously determined. As found in this work, the external renal tubular function evaluated with Tc-99m-Ethylens-Dicystein measurement of Mo-99-column activity by means of Geiger- (EC) came into focus of interest. Kit formulation of and clinical Muller counter is a simple, fast and reliable method. experience with EC will be presented. Generally, Mo-99-column is placed slightly out of the center of Wide range of N-S ligands other than EC were labeled with the generator; therefore the externally measured flux of photons alternative method ensuring tin-free final solutions and W>) is an angular-dependent function. If the thickness of the lead pharmacokinetics of them were determined. container is radially uniform, the flux measured at some distance On the other hand, preparation of copper-free 1-131 MTBG was from the generator (which is rotated in 2ir/3 steps) is given by the elaborated using inorganic polymer catalyst providing equation environment-comfort technology. RECOVERY RATE AND TIME OF RECOVERY OF GAMMA CAMERA LYMPHOSCINTIGRAPHY IN LEFT VENTRICULAR SYSTOLIC AND THE EARLY DIAGNOSIS OF METASTASIS IN DIASTOLIC FUNCTION AFTER EXERCISE LYMPHOID NODES IN CASE OF SEMINOMA TESTIS GroSeli C. Fettich J.J., Fidler V. Radeva M. University Medical Centre Ljubljana, Slovenia Medical Faculty Hospital Saint Ivan Rilski Nuclear Centre, Sofia, In this study, the recovery rate and time of recovery of Bulgaria left ventricular (LV) systolic and diastolic function after maximal exercise in 22 hypertensive (AH) (54+7 yrs), 24 coronary artery Fifteen patients were investigated with gamma camera disease (CAD) patients (56 ±8 yrs) and in a group of 20 healthy scintigraphy with seminomatestis, 99mTc-Lymphoscint "Soco" and subjects (H) (52+5) was studied. All examined subjects underwent 99Tc-Nano-albomon "Izinta" were applied percutaneously. In 11 rest and stress radionuclide gated ventriculography, with additional eleven patients of the examined men were discovered metastasis imaging started in 2., 10., 20., 30. min after exercise. The stress in the lymph nodes that was proved surgically and histologically. and recovery changes of left ventr. ejection fraction (LVEF), peak ejection rate (PER), peak filling rate (PFR), time to peak filling rate (TPFR) and heart rate (HR) were monitored. Conclusions: 1. The rate of LV systolic and diastolic recovery parameters significantly differ between the groups. Additional monitoring after exercise promises contribution to the diagnostic information. 2. All stress dependent changes in LV function occur within first 15 minutes after exercise in all groups. The values of parameters in 20. minute after exercise do not statistically differ from the rest values. 3. The monitoring further than 15 min. after exercise does not obtain any additional diagnostic information. P5 IMERCAPTOACETYLTRIGLYCINE IN RADIONUCLIDE CISTERNOGRAPHIC IEVALUATING THE COMPLICATIONS AFTER DEMONSTRATION OF ARACHNOID CYST KIDNEY AND PANCREAS TRANSPLANTATION - EXTENDING INTO THE NASAL CAVITY OUR FIRST EXPERIENCE Stanicic A.'. Bradarid N.2, Lahman M.3 Smokvina A.'. Bui-ic" A.1, Zelid M.2, Orlid P.2, Uravid M.2 'Department of Nuclear Medicine, department of Infectious 'Department of Nuclear Medicine, Diseases and 'Department of Radiology, Clinical Hospital Split, department of Surgery, Clinical Hospital Centre Rijeka Croatia The first kidney and pancrease transplantation in Croatia A 33 years old female patient had clinically suspect were performed on December 21, 1993, on a 36 year old male rhinoliquorrhoea during the period of one year after surgical patient. Until May 31, 1994, other two females underwent correction of nasal septum deviation. She was on a constant transplantation, which is a total of three patients. prophylaxis with extencillin. The patient was admitted to the In evaluating the complications after transplantation we hospital because of meningitis which was found to be purulent. A used "re mercaptoacetyltriglycine ("To MAG3) and performed bone defect in lamina cribrosa was demonstrated by CT. a total of 18 investigations. We were able to observe the changes Meningitis was cured, and rhinoliquorrhoea apparently ceased. In in kidney and pancreas perfusion and assist in the diagnosis of the 111-DTPA cisternography was performed to demonstrate rejection crisis in both transplanted organs, and in the early rhinoliquorrhoea. An extension of the CSF space into the nasal thrombosis of the transplanted pancreas. We demonstrated a minor cavity was shown. There was no visible tracer pooling in the urinary fistula at the duodenal anastomosis of the transplanted nasopharynx, and the counts of cotton pledgets placed in the nasal pancreas and the bladder of the patient, which could not be proved cavity were at the level of background. So, no CSF leak could be by other diagnostic procedures. demonstrated. Metrizamide CT cisternography demonstrated an Experience so far demonstrates that "°'MAG3 is suitable arachnoid cyst extending into the superior part of the right nasal for similar assessments, especially because it enables observation cavity through a bone defect. Rhinoliquorrhoea could not be of the transplanted kidney and bladder excretion system, where demonstrated too. The patient was scheduled to neurosurgery for frequent changes occur related to the stimulus of the mucous dural plastics. membrane from the enzymatic secretion of the transplanted pancreas. P7 POSTOPERATIVE FOLLOW UP OF PATIENTS LONG TERM EFFECT OF 1-131 THERAPY OF WITH WELL DIFFERENTIATED THYROID HYPERTHYROIDISM CARCINOMA BY ULTRASOUND GUIDED BIOPSY .', Vrkjjan M.2, Solter M.2, Kusid Z.' HorvatT.. Lechpammer S., Roncevid S., Franceschi M., Culig Z., Kusid Z. 'Department of Nuclear Medicine and Oncology, department of Endocrinology, Diabetes and Diseases of Department of Nuclear Medicine and Oncology, UH "Sestre Metabolism, University Hospital "Sestre Milosrdnice", Zagreb, Milosrdnice", Zagreb, Croatia Croatia In the last decade at our department 209 patients who had One hundred and six patients (93 female and 13 male), undergone thyreoidectomy and radioiodine remnant ablation for well differentiated thyroid carcinoma (DTC) were followed up for recurrences with the mean age of 55 years (range: 40-83 years) underwent by periodical examinations with high-frequency (7.5 MHz) sonography. radioiodine therapy for hyperthyroidism. Hyperthyroidism with One hundred and sixty four of these patients (78.4%) had papillary diffuse goiter was diagnosed in 82 patients and in 24 with toxic thyroid carcinoma and 45/209 patients had follicular type (21.5%). nodular goiter. The majority of patients (97; 88%) was previously Follow up periods varied from 1 to 5 years. Eighty six of examined treated with antithyroid drugs. The median therapeutic radioiodine patients (41.1%) had cervical lymphadenopathy or a mass in the thyroid dose was 444 MBq (range: 148-2085 MBq). In dose calculation bed, or both, for which biopsy with ultrasound guidance was performed. the following parameters were respected: evaluated thyroid Our examinations results were evaluated to determine the benefit of weight, 24-hour radioiodine uptake test, age and cardiac status of high-frequency sonography in the postoperative follow up of patients the patients. The patients were followed up over the period of 1- with DTC. Malignant cells were obtained in 20 of 86 suspicious neck 10 years. Therapeutic response was obtained in 75 patients (71 %), findings detected by ultrasonographic examination, from which biopsy while radioiodine therapy had to be repeated in 31 patients (29%) specimens were taken (23.2%). Out of them in 3 cases (3.4%) the 6-14 months after the first treatment. recurrence in the thyroid bed was confirmed, in another 3 cases, beside the recurrence, also the metastatically involved lymph nodes were found On the basis of elevated TSH hypothyroidism was and in 14 cases (16.2%) lymphatic metastases were diagnosed. Negative observed in 38 patients: in 15 patients 6 months and in 7 patients biopsy had 66/86 patients (76.7%). Among them in 36 cases thyroid one year after radioiodine therapy. In 8 patients hypothyroidism cells hyperplasia was found and in 30 cases biopsy yielded only developed 2 years, in 6 patients 5 years, and in 2 patients 10 years peripheral blood. In this group of patients, during follow up, no after radioiodine therapy. recurrences or metastases were found. The criterion for effectiveness of One third of patients treated with radioiodine developed radioiodine therapy is cure of DTC, once total ablation is achieved. hypothyroidism during 10 years follow-up. High-frequency (7.5 MHz) sonography has been reported to be sensitive in the detection of recurrent DTC, what our results seems to support. In our follow up by periodical ultrasonographic examinations, positive ultrasound guided biopsies were obtained in 10.1 % of 209 DTC patients. This emphasizes high-frequency sonography as a complementary diagnostic tool in follow-up of patients with DTC. P9 luLTRASONOGRAPHIC AND REGENERATION OFPITUITARY LACTOTROPHS IANGIOSCINTIGRAPHIC METHOD IN THE AND THYROTROPHS AFTER LEVOTHYROXINE DIAGNOSIS OF LATERAL CERVICAL CYSTS THERAPY IN PATIENTS WITH HYPOTHYROIDISM Mihaljevid I.. Smoje J., Karner I. Vrklian M., Vilibid T., Posavec Lj. Vizner B., Sekso M., Department of Nuclear Medicine and Pathophysiology, Clinical Kusid Z. Hospital Osijek Dept. of Endocrinology, Diabetes & Diseases of Metabolism, and Branchiogenic or lateral cervical cysts can be in front of Dept. of Nuclear Medicine & Oncology, UH "Sestre sternocleiomastoid muscle, next to and in front of big blood Milosrdnice", Zagreb, Croatia cervical vessels, next to the furca of carotid artery and medially from it towards to pharynx wall. The cases of branchiogenic cysts We analyzed the regeneration of pituitary lactotrophs and at a 15 month baby and a 75 year old man, diagnosed by thyrotrophs after levothyroxine therapy (100 y.% daily) in 20 ultrasonographic and angioscintigraphic method, have been shown. patients with Hashimoto thyroiditis and clinical symptoms of Their ultrasonographic characteristics have been described, as well hypothyroidism. All patients had positive thyroglobulin and as the differential diagnosis compared to the thyroid cysts and peroxidase antibodies and TSH levels more than 8.0 nmol/L. aneurisms of big blood cervical vessels. Ultrasonographic and Seven, 14, 30 and 45 days after beginning of therapy serum PRL angioscintigraphic examinations are complement in setting the and TSH levels in basal state were measured and after TRH diagnosis of branchiogenic cysts and point to their origin stimulation (200 gamma TRH i.v.). The mean basal TSH level according to their place on the neck. before therapy was 12.2 + 1.1 mU/L and normalization was achieved only after 30 days of therapy (3.9±0.7 mU/L). The maximal TSH response to TRH was 23.3±2.6 mU/L. The mean basal PRL level before therapy was 42.0±4.4 ng/mL, after 14 days 40.0±4.7 ng/mL and after 30 days of therapy 37.4+4.6 ng/mL. Normalization was achieved only after 45 days of therapy (15.7+7.3 ng/mL). The maximal PRL response to TRH before therapy (delta PRL) was 76.0±8.9 ng/mL and normalized 14 days after therapy (22.0±4.3 ng/mL), while the basal PRL levels remained elevated for 45 days. We conclude that levothyroxine has inhibitory effect on pituitary lactotrophs after TRH stimulation, but not on basal secretion. Our results suggest that therapy with levothyroxine modifies differently the response of lactotrophs and thyrotrophs after TRH stimulation in patients with hypothyroidism. WHOLE-BODY COUNTING AND URINE ASSAY IN I P12 I PROFILE SCANNING WITH WHOLE-BODY POSTSURGICAL PATIENTS WITH THYROID |«_J COUNTER CANCER Medvedec M.. Popovid S., Kasal B., GroSev D. Medvedec M.. Zuvid M., Huid D., GroSev D., Popovid S., Pavlinovid Z., Dodig D. Department of Nuclear Medicine and Radiation Protection, University Hospital Rebro, Zagreb, Croatia Department of Nuclear Medicine and Radiation Protection, University Hospital Rebro, Zagreb, Croatia The object of profile, or linear scanning is determination of the radioactivity distribution in a subject in one dimension. The The aim of this work was to compare whole body results of each measurement performed with Accuscan Horizontal counting and urine assay as two methods for assessing retained Bed Whole Body Counter are energy spectra for 10.2x10.2x40.6 whole body radioiodihe. These methods are part of modified cm NaI(Tl) and HPGe detector and profile spectrum for NaI(Tl) preablation diagnostic protocol of patients after surgical detector. We investigated several profile measurement capabilities. thyroidectomy which is being established in our department. In our studies we used gamma reference point sources Whole body counts were performed with Accuscan placed on bed in air and in thyroid, lung or GI cavity of Horizontal Bed Whole Body Counter 2, 24, 48 and 72 hours after Canberra/RMC Transfer phantom. Measurements were performed oral administration of approximately 74 MBq (2mCi) of 1-131. with and without parallel slit collimator. The collimator opening During the same period activity of excreted urine was measured was varied from 1 to 10 cm. An equation of profile spectrum with Low Level Germanium Gamma Spectroscopy System on each calibration line was determined from measurements of point of two successive 24-hour urine collection. The study included 10 sources at different distances from the foot plate. Bell shaped patients. functions were used to describe point spread function and linear For each patient data appropriate fit was performed giving interpolation to determine FWHM. r=0.98+0.01 and r=0.96+0.03 for whole body counting and The calculated calibration line is given by urine assay respectively. The mean effective half-life of whole y(cm) = -0.46(cm/ch)x+205.83 (r=0.99). The spatial resolution body retention was 13.5 + 1.9 hours for whole body counting and using collimator with 1 cm slit width is up to 20 times better than 17.1+5.3 hours for urine assay. The coefficient of correlation the spatial resolution without collimator. For energies up to 400 between in vivo and in vitro measured retention was r=0.83, keV is better than 40 mm. The sum of straight line, Gaussian and although results of indirect method were on the average 1.6 to 4.8 Lorentzian distribution(s) gives the best fit of point spread times greater. Considering initial retention as 100%, the summ of function. retention and excretion of each day measurements was The use of specially designed slit collimator and precise approximately 87%. description of point spread function improves to a large extent There are several steps of potential error in the urine originally very limited capabilites of the radioactivity localisation. assay procedure and this method appears to be inferior in comparison with whole body counting as direct in vivo technique for assessing patient body burden. P13 I EXPERIMENTAL DETERMINATION OF THE P14 COMPARISON OF PRE-TREATMENT WITH I TOTAL LINE SOURCE RESPONSE FUNCTION POST-TREATMENT RETENTION OF 1-131 IN AND SCATTER FRACTION ABLATION OF THYROID REMNANT Lokner V.. Bokulid T. Kusid Z. Huig P.. Medvedec M., GroSev D., Dodig D., Popovid S., Pavlinovid Z. Department of Nuclear Medicine and Oncology, UH "Sestre Milosrdnice", Zagreb, Croatia Department of Nuclear Medicine and Radiation Protection, University Hospital Rebro, Zagreb, Croatia One mechanism of image degradation and inaccurate quantification in nuclear medicine is the inability of image The quantitative diagnostic dosimetry approach to processing algorithms to compensate exactly for Comptom radioiodine ablation treatment of thyroid remnant has many scattering. Various approximative techniques have been proposed advantages but sometimes could result in overestimation of the but most of them assume system's linearity and shift-invariance, or true radiation dose. postulate that scatter contribution in the photopeak energy window The 1-131 retention in 12 patients (11 women, 1 man) can simply be expressed as linear combination of the images after total thyroidectomy for thyroid carcinoma was measured by acquired in lower energy windows. In order to implement the whole body counter. The whole body and thyroid remnant convolution-subtraction method on our gamma camera system a set retention were calculated from profile scans performed 2, 24, 48 of measurements with point and line sources in water filled phantom and 72 hours after administration of the diagnostic activity (74 as well as in the air were performed. Total line (point) source MBq - 2 mCi) and 72 hours after administration of the ablation response functions (TLSRF, TPSRF) and depth dependant scatter activity (4.4 GBq - 120 mCi) of 1-131. fractions were determined. Several fitting functions of gradual The mean effective half-life of the diagnostic activity was degree of approximation were tested with parabolic grid search and 13.4± 1.6 hours (range 11.3-16.8) for whole body and 34.2 + 19.1 Levenberg-Marquart nonlinear least-square fit in order to describe hours (range 15-69) for residual thyroid tissue. The mean 1-131 the behaviour of the TLSRF-s tails. Several functions (e.g. pure retention of the ablation activity was 77+31 % of the retention Gaussian function, the sum of the two Gaussians, predicted by the diagnostic study for whole body and 47±41 % exponential-!-Gaussian etc.) were evaluated in terms of residual fit for thyroid remnant. values and chi-square of the fit. This procedure determines depth A possible explanation for these differences might be dependence and asymmetry of the TLSRF. For accurate scatter line suppressed thyroid remnant after pre-ablation diagnostic treatment source response function (SLSRF), Monte Carlo modelling is required. Observed asymmetry of the TLSRF (expressed as a ratio and damaged thyroid tissue during the first three days after of areas under the left and right portion of the TLSRF) was small application of the ablation activity. The shortened effective half- due to the large geometric response and source depth dependence. life after radioiodine ablation treatment is the reason for a lower In order to obtain complete parametric description of the scatter absorbed dose in thyroid remnant and should be taken into account response function further investigation and modelling is needed in a radioiodine ablation dose planning. focused on the stationarity of the SLSRF which is the fundamental assumption of the convolution-subtraction technique. (PISJTHE PATIENT WITH DIFFUSE TOXIC GOITER P1 6 I SERUM THYROGLOBULIN LEVELS MEASURED AND THROMBOCYTOPENIA —J BY IRMA METHOD IN THE FOLLOW-UP OF PATIENTS WITH DIFFERENTIATED THYROID Kuggid-.Turetig Lj.. Eterovid D., Capkun V. CANCER Department of Nuclear Medicine, Clinical Hospital Split Greguric" N.. Pavlinovid Z., Buchberger K. We report the female patient with two autoimmune Department of Nuclear Medicine and Radiation Protection, Zagreb diseases: diffuse toxic goiter and thrombocytopenia. It is known University Clinical Hospital, Zagreb, Croatia that thyreostatic drugs may induce granulocytopenia and rarely thrombocytopenia, but our patient presented with The determination of serum thyroglobulin (Tg) level is a thrombocytopenia and was taking corticosteroids before the simple test indicating the presence of metastatic disease or tumor thyreostatic therapy commenced. The plasma level of recurrence in patients with differentiated thyroid cancer. The aim thrombocytes was followed for 2 years, 1 year during the of the study was to assess the reliability of measurements of Tg in thyreostatic therapy and 1 year following the definite radioiodine the group of patients with differentiated thyroid carcinoma who therapy. Initially the thrombocyte count was 38xlO'/L and did not 9 had passed routine control after the surgical and radioiodine change significantly (38-46xl9 /L) during 12 months of thyroidectomy. The serum Tg was measured in 273 patients after thyreostatic and corticosteroid therapies. Then the patient received withdrawal of thyroid suppression therapy by IRMA method using 14 mCi (518 MBq) of !31I. Unexpectedly, 2 weeks afterwards the 9 commercially available kit (HTGK-Biomedica). The cut-off limit thrombocyte count increased from 46 to 76xlO /L and varied from which was used to distinguish pathological from nonpathological 64-90xl0'/L during the following 12 months. We think that these values was 5 ng/ml. Patients with antithyroglobulin antibodies findings are an example of autoimmune reaction between two were not included in this study. different immunoreactive antibodies, in this case the antibodies to On the basis of the whole-body scan results, as well as of TSH receptors and thrombocyte antibodies. Our hypothesis is that clinical, radiological and ultrasonography criteria 250 out of 273 the observed increase in thrombocyte count following radioiodine patients were considered free of the disease. In this group of therapy was related with the radiation induced suppression of that patients serum Tg were below 5 ng/ml in 243 patients. In the immunologic reaction. group of 23 patients with recurrence of tumour or metastases measured Tg values were above the cut-off limit in 20 patients. Results of our study confirm that serum Tg levels are of considerable value in the follow-up of patients with differentiated thyroid cancer. Patients without evidence of tumour recurrence or metastases and without thyroid tissue remnants, in whom measured Tg values exceed cut-off limit (5 ng/ml), should be submitted to a strict follow-up. P17 IIN-HOUSE RADIAL IMMUNODIFFUSION IN-HOUSE BRMA-TSH METHOD - PRELIMINARY IMETHOD FOR DETERMINATION OF RESULTS THYROXINE BINDING GLOBULIN LukinacLi.'. Zubdid A.2, Krilid D.1, Nothig-Hus D.', Kusid Z.1 Lukinac Lj.. Dermol A., NSthig-Hus D., Kusid Z. 'Department of Nuclear Medicine and Oncology and department Department of Nuclear Medicine and Oncology, University of Medical Biochemistry, University Hospital "Sestre Hospital "Sestre Milosrdnice", Zagreb, Croatia Milosrdnice", Zagreb, Croatia The objective of this study was to set up a sensitive and Radial immunodiffusion method (RID) is based on an precise TSH method applicable to routine and scientific work immune precipitate reaction formed by combination of antigen and which would be much cheaper than foreign commercial IRMA- antibody at equivalence. By using this principle we developed in- TSH kits. house RID method for measuring serum concentration of thyroxine In-house IRMA-TSH method was developed by using binding globulin (TBG). Gel plate was prepared of 0.9% agar in rabbit anti-TSH serum (BioMakor, Israel) coated onto polystyrene 0.05 mol/L barbital buffer, pH 8.6 which contained 140 ^L of balls (Northumbria Biologicals, UK) in reaction to monoclonal rabbit anti-human TBG (code A 158, DAKOPATTS) in total anti human TSH antiserum labeled with '"I (ImunoloSki Zavod, volume of 8 mL. Wells are made by gel punches of 4 mm Zagreb, Croatia and TSH standards (The 2nd International diameter. Standards (human TBG, code: 8970-1004, Biogenesis) Reference Preparation coded 80/558, NBSB, UK). were prepared in 0.05 mol/L phosphate buffer, pH 7.4 in In the reaction tube with coated ball 100 /xL serum or concentrations 40, 30, 20, 10 and 5 mg/L. All standards and serum TSH standards (range: 0.19-100 mU/L) and 100 pL mI anti TSH samples should be prediluted (3:1) in the same buffer before (100000 cpm) were added and icubated overnight (25°C) on the loading (volume 10 juL). Diffusion time correlated with shaker. After washing steps (3 times 2.5 mL 0.15 mol/L NaCl temperature (2 days at 37°C, 3 days at 25°C, 5 days at 4°C) and the with o.5% tween-20) the bound radioactivity was measured in the standard curve was the straight line. For control serum A gamma counter. intraassay variability (n=7, mean =26 mg/L) and interassay Intraassay variability (CV) for control sera A (n=8, variability (n=ll, mean=26 mg/L) were 1.4% and 7% (CV). mean=0.27 mU/L), B (n=9, mean =0.74 mU/L), and C (n = 10, This method was applied in several groups of patients (patients mean=4.86 mU/L) were 17%, 12% and 6%. with liver metastases: n=20, mean 27, range: 17-39; patients with chronic renal failure: n=18, mean = 18, range: 11-25; patients Our method was compared to IRMA-TSH kit (coated tube assay, dependant on drugs: n=6, mean=30, range: 16-40; pregnant Kodak, UK) by measuring TSH in serum of 33 outpatients women: n=39, mean=31, range: 17-40; and compared with the (r=0.98). control euthyroid subjects (n=31, mean=23, range: 15-31). In spite of overnight incubation, we do think that under We consider that the presented method is very suitable for the these circumstances the presented IRMA-TSH method is the determination of TBG in a small.number of serum samples. The method of choice. method is also simple, precise and cheap. P19 I DIAGNOSIS OF THYROID CARCINOMA, A I P20 IENDOGENOUSLY LABELED THYROID I REVIEW OF OUR EXPERIENCES IN A SIX YEAR I I HORMONES ("'I - T3/T4) IN SERUM OF PERIOD PATIENTS WITH DIFFERENTIATED THYROID CARCINOMA Pranid-Kragid A.1, Punda A.'. Stanidid A.1, Markovid V.1, 2 Marinkovid M. Liikinac Li.. Franceschi M., Nothig-Hus D., Lechpammer S., Kusid Z. 'Department of Nuclear Medicine and ^Department of Internal Medicine, Clinical Hospital Split, Croatia Department of Nuclear Medicine and Oncology, University Hospital "Sestre Milosrdnice", Zagreb, Croatia In a six year period (1988-1994) the diagnosis of thyroid carcinoma was established by histopathologic findings in 76 Recently it has been presented that circulating "'I-T3/T4, patients (53 female and 23 male). 54 of the neoplasms were produced after administration of radioiode, can be detected papillary, 17 follicular and 5 were medullary carcinomas. On chromatographically. ultrasound all of the lesions were identified: 10 were sonolucent, The objective of this preliminary study was to evaluate 57 hypoechoic, 7 had the same echoes as the normal thyroid whether this new method could improve the management of patients tissue, 1 was hyperechoic and in 1 only a calcification was found with differentiated thyroid carcinoma after thyroidectomy. in the thyroid. Scintigraphy showed 63 cold, 4 warm and one hot This method is based on chromatographic separation of patient's nodules in what was later identified as thyroid carcinoma. 8 of the serum (72 hours after administration of 5 mCi '"I for whole body nodules could not be discerned by scintigraphy. There were 2 scintigraphy (WBS) onto the Sephadex-G 25 fine column (CHROM)). cases of papillary carcinoma in a diffuse toxic goiter. Endogenously labeled thyroid hormones Echographically guided cytologic aspiration correctly identified 56 ("'I-T3/T4, peak 3) are separated with normal serum after iodoprotein lesions as malignant, 12 findings were suspect for malignancy, and (peak 1) and free iodine (peak 2) were eluated from the column. All in 8 cases cytologic aspiration found benign lesions in what was fractions were counted in the gamma counter. later identified as follicular (4 cases) and papillary (4 cases) Our first results included 23 patients with differentiated thyroid carcinoma. At the time of the first postoperative whole body carcinoma after surgery. Patients were classified according to the scintigraphy with 1-131 10 patients with differentiated thyroid results of WBS, ultrasound (US), thyroglobulin (Tg) and CHROM into 4 groups. Group I: patients without signs of thyroid tissue, n=7 carcinoma had metastases in the cervical lymph nodes, and 3 had (in 2 patients CHROM were positive, other methods were negative); distant metastases. Group II: patients with thyroid remnants before '"I ablation, n=11 (in all 11 patients only Tg was negative); Group III: patients with recurrence in the thyroid bed or neck lymph node metastases, n=2 (in one patient Tg was negative, in another WBS was negative); Group IV: patients with distant metastases, n=3 (all tests were positive). We believe that this simple in vitro method could be used as an additional method for monitoring of patients with differentiated thyroid carcinoma after thyroidectomy. P21 I ACUTE SUPPURATIVE THYROEDITIS CAUSED I P22 ITHYROID PAPILLARY CARCINOMA. THE ' BY SALMONELLA ENTERITIDIS I—i—IDIAGNOSTIC VALUE OF INTRANUCLEAR VugiCevif Z-. SoljaCid H., SuSkovic" T., Cabryan T. INCLUSIONS IN ASPIRATION CYTOLOGY Department of Internal Medicine, "Sestre milosrdnice" University Gregoric E., Vrh I.'. Predic P.2 Hospital, Zagreb, Croatia 'Department of cytopathology, Hospital Izola. department of Nuclear Medicine, Hospital Celje A patient with acute suppurative thyroidits is reported. Diagnosis had been made by clinical examination and confirmed Intranuclear inclusions are useful citomorphologic features by ultrasound, CT scan and cytological punction. Considering the in the diagnosis of papillary carcinoma of the thyroid. localisation, an interesting and rare agent was isolated - Ultrastructurally are invagination into the nucleus. In distinction Salmonella enteritidis. The patient had no signs of nodular goiter from intranuclear grooves, present both in neoplastic lesions and or communication with piriform sinus. In spite of our efforts, the in benign lesions of the thyroid, intranuclears inclusions only source and modality of infection remained unclear. However, rarely can be found in benign lesions of the thyroid. According to hematogenic way seems to be the most plausibile one. The the majority of authors, describing intranuclear inclusions these imunologic status was normal. Nevertheless, a certain influence of features are present in a very high percent in papillary carcinomas diabetic disease can not be excluded. The incision and drainage and less in nonpapillary neoplasms. To assess the diagnostic value besides antibiotics have stopped the suppuration completly. Three of nuclear inclusions we evaluated the presence of this feature in weeks after the beginning of the disease, the left lower pole of the 46 fine needle aspirates, of which 18 papillary carcinomas of the gland could not be defined on a scintiscan using 99mTc as thyroid, 2 follicular carcinomas, 2 medullary carcinomas, 1 pertechnetate. So far, a considerable lesion of the gland requires anaplastic carcinoma, 1 oncocitoma, 2 follicular adenomas, 10 substitution with low doses of levothyroxine. nodular goiters and 10 cases of chronic lymphocytis thyroiditis. Each case had a final tissue diagnosis. Sixteen of 18 papillary carcinomas (88%) showed intranuclear inclusions, none of nonneoplastic lesions contained inclusions and only one of 8 nonpapillary neoplasms of the thyroid (12.5%) contained inclusions. This occurred in one case of follicular adenoma. Inclusions appeared to be more specific and less sensitive index in diagnosing papillary carcinoma. This findings suggest that nuclear inclusions can be considered a reliable criterion for the diagnosis of papillary carcinoma in fine needle aspiration cytology of the thyroid. P23 I IODINE DEFICIENCY OF THE POPULATION OF P24| PROSTATE CANCER: COMPARATIVE ANALYSIS lTHE CITY AND THE DISTRICT OF ZAGREB THE VALUES OF PROSTATIC SPECIFIC ANTIGEN (PSA) AND BONE SCINTIGRAPHY IN Ztivic" M.. Skreb F., Vlatkovic" M. PATIENTS WHO RECEIVE ANTIANDROGENE THERAPY University Hospital Zagreb, Clinical Dept. of Nuclear Medicine and Radiation Protection sig A.. 2Koprol«ec D., 2Galic" J., 'Topuzovid N., 'Ugrai V., 'KrstonoSid B., "Karner I. Urinary iodine excretion (spot urine samples) was determined in 282 adults from the city and district of Zagreb. The 'Department of Nuclear medicine, department of Urology- mean concentration was 103.1+91.9 jig iodine/g creatinine, Clinical Hospital Osijek, Croatia median 54.4 fig iodine/g creatinine, or 111.4+100.5 /ig iodine/L urine, respectively. Three (1 %) subjects had iodine excretion > The aim of this study is to asses the diagnostic value of 600 tig iodine/g creatinine of 400 /*g/L urine, which cannot be PSA in follow-up in the group of 59 patients who receive reached by normal nutrition. The iodine/creatinine index when antiandrogene therapy. All of the patients have skeletal compared with iodine concentration alone did not improve the dissemination of the prostate cancer which is demonstrated by the epidemiological picture (r = 0.76, p < 0.01). The iodine intake skeletal scintigraphy. In 21 patients (35.6%) concentration of the of the population is still below the minimum set by WHO PSA was in normal range (< 5ng/ml). All other patients have a recommendation. pathological values of PSA. Spearman Rank correlation between the values of PSA and bone scintigraphy was r=0.26 (p<0.5). In spite of relatively good correlation between PSA values and bone scintigraphy, and the fact that 21 cases had the normal values of PSA, authors conclude that the carefulness is needed in estimation of diagnostic reliability of PSA value in patients who receive antiandrogene therapy. We also conclude that the bone scintigraphy is still the best diagnostic procedure in follow-up of this group of patients. P25I CHANGE IN BLOOD VOLUME FOLLOWING A UNIFORM PROTOCOL FOR SCINTIGRAPHY 1 CORRECTION OF ANEMIA WITH OF THE MYOCARDIUM WITH 201-T1 IN AUSTRIA RECOMBINANT HUMAN ERYTHROPOIETIN IN PATIENTS ON MAINTENANCE HEMODIALYSIS Fritzsche H.. Bergmann H., Fridrich L., Kohn H., Lind P., Mostbeck A., Mlczoch J., Porenta G. 'Topuzovic" N.. JRup£i6 V., "BrloJic" R., 2Jakid M., 'Rusic" A., •KrstonoSid B., "Karner I. 19851 heart studies were performed in Austria in 1993. •Department of Nuclear medicine, department of Hemodialysis- Because of different developments, traditions, education and Osijek Clinical Hospital, Osijek, Croatia training in Nuclear Medicine multiple protocols for 201-T1 scintigraphy of the myocardium exist in the 41 departments of The aim of this study is was to evaluate the effect of Nuclear Medicine in Austria. recombinant human erythropoietin (rHuEPO) therapy on blood Therefore results of 201-T1 scintigraphy of the volume in 19 patients (12 male, 7 female, mean age 39± 11 years) myocardium may vary considerably in sensitivity, specificity and with severe renal anemia (hematocrit<0.25), and having regular clinical findings. Referring physicians not familiar with this hemodialysis (mean duration 5.0+3.4). Blood volume was technique are confused, and heart studies are often repeated measured using method adjusted in our laboratory as by-product during routine equilibrium radionuclide ventriculography with 740 unnecessarily. A uniform protocol for scintigraphy of the Mbq Tc-99m-human serum albumin twice: 1) before rHuEPO myocardium with 201-T1 after exercise or pharmacological stress- treatment and 2) at the time when target hemoglobin (Hb) reached testing would enable to compare the results obtained. 100 g/1. Time elapsed to reach target Hb was 3.4±1.4 months; Furthermore, it would avoid repetition of heart imaging and save Hb increased from 73+6 to 111 + 11 g/l,(p<0.0001). Red-cells time of examination and at least costs. volume was significantly increased from 16±3 prior therapy to To overcome these problems a workshop was organized 26+6 ml/kg(p < 0.001) after therapy. Despite significant decrease by the Austrian Society of Nuclear Medicine November 26th, in plasma volume (53 + 10 before vs. 48± 11 ml/kg after, p < 0.01) 1993 in Vienna. The aim was to establish a uniform protocol for total blood volume was increased from 69±12 to 73±16 201-T1 heart studies after exercise and pharmacological stress- ml/kg(p<0.01) after correction of anemia. Significant fall in cardiac index was found after treatment due to reduction of left testing. A consent was reached and therefore this uniform protocol ventricle end-diastolic volume(p<0.01) and heart rate(p<0.05), will be used from the beginning of 1995. while ejection fraction and blood pressure remained unchanged This protocol describes indications for 201-T1 scintigraphy of the during rHuEPO treatment. We concluded that increase in red-cell myocardium, the methods of stress-testing, acquisition and volume occurs within short time period through correction of processing of the studies and quality control of the cameras. anemia, along with decrease in plasma volume, but increase in total blood volume. HR9600047 HR9600048 F2 ICARDIOVASCULAR NUCLEAR MEDICINE: F3 I PHYSIOLOGIC BASICS AND CLINICAL EXPERIENCE WITH SOMATOSTATIN- _—JSTATE OF THE ART RECEPTOR-SCENTIGRAPHY Milflnski M. Henze E.. Eberhardt J.U., Bohuslavizki K.H. University Medical Centre, Nuclear Medicine, Ljubljana, Slovenia Clinic of Nuclear Medicine, Christian-AIbrechts-University of Evaluation of myocardial function: first pass studies can be Kiel, Germany obtained at time of almost every investigation. Assessment of myocardial function is improved using short living isotopes and The introduction of radiolabelled octreotide, an analogon repeated stress studies as well as gated tomographic imaging and to the receptor binding hormone Somatostatin, has markedly technetium perfusion agents. Nonimaging probes have limited value in increased the ability to detect structures and tumours carrying continuos monitoring of cardiac function. Stress-echo somatostatin receptors by nuclear medicine imaging with high (transoesophageal) is competitive to nuclear techniques in assessment sensitivity and specifity. It has been shown that in vitro receptor of contractility. density and in vivo scintigraphic results correlate well in particular Myocardial perfusion imaging using knowledge from PET in tumours of neuroendocrine origin of the GI tract such as and available tomographic or planar imaging modalities gives unique insulinomas, gastrinomas, glucagonomas, carcionoids, but also in possibilities to detect viable myocardium. Thallium remains the tracer paragangliomas, small cell lung cancer and meningeomas. As for myocardial viability evaluation on convenient systems when new receptors were also shown to be present on so called activated imaging protocols are applied. New technetium labeled leucocytes granulomas, lymphomas and autoimmune disease have radiopharmaceuticals allow better imaging possibilities for SPECT been imaged with octreotide successfully. techniques. Several pharmacological agents are available in addition to The specific tracer (In-111-DTPA-D-PHE-Octreotide, Octreoscan") traditional physical stress for assessing hemodynamic importance of coronary artery stenoses for diagnosis and in treatment evaluation. is rapidly cleared from the blood pool by the kidneys and, partially, via the liver providing a high target to background ratio. Imaging myocardial necrosis is marginal in confirmation of Physiologic uptake is usually observed in the pituitary and thyroid majority of acute myocardial infarctions. It is used to assess area at risk after thrombolytic therapy for evolving myocardial infarction glands, in spleen and liver. Optimum tracer accumulation for using dual-isotope techniques (perfusion agent with infarct-avid tracer tumour scintigraphy is seen on the 24-h-images with the best target in dual isotope technique). Antimyosin antibodies are useful also for to background ratios. Additional SPECT-imaging is recommended confirmation of subacute or remote infarction, myocarditis or rejection in particular in the abdominal regions. after cardiac transplantation. The sensitivity in imaging the above named tumours ranges Metabolic and receptor imaging are promising in evaluation of from 70 up to 100%. In-Ill octreotide imaging is of diagnostic cardiomyopathies and myocardial viability not only on positron impact both for the primary diagnostic evaluation as well as for emission tomography but also on available imaging systems. detecting or excluding secondary manifestations in known tumour In conclusion, new techniques and new radiopharmaceuticals for sites. Of specific value is the information on relative receptor cardiovascular imaging allow more accurate answers to clinical density in the tumour to be treated as may be obtained by problems. As the possibilities for research and clinical PET are quantitative In-Ill octreotide imaging for decision making whether limited, further transfer of PET-results to convenient imaging or not to use cold octreotide (SandostatinR) as a receptor blocking modalities is promising. drug for therapy as well as for treatment follow-up studies. MEDULLARY THYROID CANCER: A F5 I STRATEGIC PLANNING OF TREATMENT FOR I MORPHOLOGICAL, HISTOCHEMICAL AND » HYPERTHYROID DISEASE IMMUNOHISTOCHEMICAL STUDY ON 53 CASES. H5ffer R. Assi A.1. Dottorini M.E.2, Sironi M.1, Sangalli G.3 Ludwig Bolzmann Inst. of Nuclear Medicine and Department of Nuclear Medicine, University of Vienna, Austria 'Department of Pathology, General Hospital, Legano, Italy, 2Dept. of Nuclear Medicine, General Hospital, Busto Arsizio, Strategic planning of treatment of hyperthyroid disease Italy,3 Dept. of Pathology, General Hospital, Busto Arsizio, Italy. must correspond to the pathophysiological mechanism of elevation of thyroid hormone serum concentration, i.e. excess stimulation, In the period from 1095 to 1992 eighty one patients (pts) autonomous thyroid function, destruction induced were treated and followed up for medullary thyroid carcinoma hyperthyoroxinemia. (MTC) in the Busto Arsizio and Legnano General Hospital. From In cases of excess stimulation one should go to extremes to save this group of pts we collected fifty three pts surgically treated and the essentially "normal" thyroid gland and life-long antithyroid with available macroscopic specimens. The aim of this study was drug treatment confronts with total ablation of the thyroid gland to evaluate the value of presurgical diagnosis of MTC by fine in non remitting disease. needle aspiration biopsy (FNAB)and the importance as prognostic Size and quantity of regions of autonomously functioning factor of some immunohistochemical markers. In this series, fifty follicles/cells will be the determinant of therapeutic strategy in two cases of MTC and one case of follicular-parafollicular cases of autonomous thyroid function. Selective surgery confronts carcinoma, were morphologically evaluated. Out of these cases, with Radioiodine treatment aiming at "restitutio ad integrum". 31 presurgical diagnosis were carried out by FNAB, with clot In destruction induced hyperthyroxinemia antiinflammatory and microinclusion and with application of immunohistochemical symptomatic measures may help to bridge the time to the return staining by anti-calcitonin, anti-thyroglobulin and anti-CEA of normal hormone concentrations. monoclonal antibodies. In all the fifty three cases where the gross Based on these considerations a detailed therapeutic strategy for specimens were present and available, we performed: I/a hyperthyroid disease can be designed. morphological study, 2/a histochemical study, 3/ an immunohistochemical study with monoclonal and polyclonal antibodies with PAP method and 4/ an ultrastructural study when a presurgical diagnosis of medullary cancer was available. Cytological and histological examinations were concordant in 29 cases, in one case the cytological specimen was inadequate and in HR9600049 one other case the cytological specimen resulted negative. Cell morphology did not seem correlated with a different prognosis. F6 | ENDOCRINE OPHTALMOPATHY F7 IRADIONUCLIDE VOIDING CYSTOGRAPHY: •..•JTECHNIQUE AND ITS CLINICAL SIGNIFICANCE Avfin .T. Fettich ,T.. Kenda R.B. University Medical Centre, Nuclear Medicine, Ljubljana, Slovenia University Medical Centre Ljubljana, Department of Nuclear Medicine, Ljubljana, Slovenia Endocrine ophtalmopathy is an eye disease which is closely related with the autoimmune thyroid disease. It may precede it, usually The purpose of the study was to improve the sensitivity appears simultaneously, but can rarely develop also after the of radionuclide cystography (RVC) in detecting vesicoureteral thyroid disease. Its etiology is not yet clearly understood, but it is reflux (VUR) in small children, and to determine its importance. widely believed to be an autoimmune disease of the orbital For this purpose we evaluated: a) cyclic RVC and compared its content. results to the conventional (one cycle only) RVC, and b) a group Inflamed and swollen extraocular muscles, deposits of fat, fibrosis of 105 asymptomatic siblings of children with VUR. and accumulation of glycosaminoglycans in the retrobulbar tissue 428 patients (856 renal units), 0.3 to 7 years old, were are responsible for the development of exophtalmus, periorbital studied, 161 VURs were detected in the first cycle, which is less edema, chemosis, corneal ulcers and conjunctivitis. (p<0.02) than in the second cycle (185) and in both cycles Patients are suffering from pain, impaired vision, double pictures, combined (cyclic RVC), where 231 VURs were found (p<0.01). photophobia and excessive lacrimation, eventually, because of the The overall agreement between the results of the first and the ophtalmic nerve traction, even blindness may occur. second cycle in detecting VUR was 45%, the lowest being in Detailed ophtalmological examination, combined with the detecting VUR I (36%), and the highest in detecting VUR III ultrasound of external eye muscles, CT and (or) MR are the key (86%). If we used a conventional RVC (the first cycle only) 29% stones of the endocrine ophtalmopathy diagnostics. VUR I, 36% VUR II and 9% VUR III, which were detected in Different treatments, that also depend on the stage of the disease, the second cycle only, would be missed. are suggested by different authors. Local retrobulbar or systemic Among 105 asymptomatic siblings of children with VUR, glucocorticoids and orbital radiotherapy are widely used. VUR was detected by RVC in 47/105 (45%). In 43 of these99m Tc- Immunosuppressive therapy might be successful in the early active DMSA scan was performed and renal scars were found in 10 stage of the disease. In the worst cases, especially when vision is (23% of siblings with VUR and 10% of all siblings studied). in danger, orbital decompression might be required. The RVC is aimed at detecting VUR, and avoiding false negative results is of utmost importance for the patient. Early identifying of VUR could possibly prevent renal damage, which was already present in 10% of our asymptomatic patients. The cyclic RVC detected 43% more VURs than the conventional (first cycle only) RVC. This seems high enough to recommend its use as a standard procedure to detect VUR, instead of the conventional RVC. RADIOLOGICAL PROTECTION AND NUCLEAR j F9 I FOLLOW-UP OF THE STRUCTURAL AND MEDICINE i » FUNCTIONAL CHANGES CAUSED BY THE ACUTE PHOTON OR NEUTRON EXPOSURE Piechowski T. fiiirakovid A. Inst. de Protection et Surete Nucleaire, 92265 Fontenay-aux Roses, France Nuclear Medicine Service, Wilmington VA Medical Center, USA The initial assessment of the acute radiation illness frequently remains beyond the reach of conventional diagnostic methods because of the considerable complexity of multiorgan response and nonspecific manifestation of the symptoms. The estimation of the magnitude of radiation induced alterations of the function and morphology of the organism necessitates the use of accessible quantitative techniques for an objective evaluation of a dynamic morphology of radiation casualties. In our studies of photon and fission neutron induced alterations in the living organism include Nuclear Medicine quantitative evaluation of the disease process on the levels ranging from cellular, neuroreceptor, tissue and organ kinetics of tissue and organ-specific radiopharmaceutical agents, predominantly using rodent, canine and primate animal model. Different experimental protocols include neuroendocrine, cardiovascular, gastrointestinal, hepatobiliary, pulmonary and skeletal systems, studied with a broad range of specific radiopharmaceuticals. Nuclear Medicine techniques utilized in this experimental work include in-vitro gamma spectrometry, quantitative autoradiography and planar as well as Single Photon Emission Computerized Tomography. F1O I TUMOR MARKER RESULTS IN A MULTICENTER F11 I AN OVERVIEW OF NUCLEAR ACCIDENT BREAST CANCER STUDY I CONTINGENCY PLANNING WITH EMPHASIS ON THE PROBLEMS ASSOCIATED WITH van Dalen A. (Gouda), Barak V. (Jerusalem), Cremaschi A. IMPLEMENTING THYROID-RELATED (Romano di Lombardia), Gion M. (Venice), Molina R. COUNTERMEASURES (Barcelona), Namer M. (Nice), Stieber P. (Munich), Sturgeon C. (Edinburgh) and Einarsson R. (Stockholm) Nimmo-Scott W..I. Serum tumor markers CA 15-3, CEA and TP were Nuclear Environmental and Emergency Services Ltd., Pewsey, determined in 132 breast cancer patients during treatment of distant Wiltshire, United Kingdom metastases. 129 patients fulfilled the entrance criteria of the study i.e. serum sampling before the start or change of therapy in The presentation will open with a definition of the metastatic disease and a follow-up for 6 months. The patients were meaning of nuclear safety and continue by emphasizing the divided into 4 groups according to clinical criteria (UICC) during importance of engineered safeguards and the secondary nature of treatment: 1. After 3 months PR (SD) and 6 months PR (CR) contingency planning as a contribution to public protection. It will (N=29); 2. After3 months SD and 6 months SD (N=39); 3. After be explained that the purpose of contingency planning is to avert 3 months PR (SD) and 6 months PD (N=27) and 4. Anytime PD potential dose. ICRP 63 recommendations in this field will be as the first follow-up diagnosis (N=34). reviewed and set in context. The planning process will be The number of patients with elevated levels of CA 15-3 explained and the importance of devising an optimum plan will be and TPS was significantly higher than of CEA. No significant stressed. Emphasis will be given to the problem of thyroid uptake difference was seen between CA 15-3 and TPS. In groups 1 +2 the of radioactive iodine in the event of a reactor accident and the number of patients with decreasing levels of TPS (more than 50%) difficulties associated with implementing thyroid-related was significantly higher than of CA 15-3 and CEA. Also the countermeasures. The presentation will conclude by considering median time when this decrease was reached was significantly the the importance of reassurance monitoring for those who might shortest for TPS. The number of patiens with increasing levels of have had an uptake of radioactive iodine. TPS (more than 25%) was singificantly higher than of CA 15-3 and CBA. There was no significant difference between the median time of the markers when this increase was reached. Also no difference was registered between the median lead-time (about 2 months) of the different markers as related to the clinical diagnosis progressive disease (PD). We concluded that tumor marker changes indicate the positive effect of therapy in stable disease (SD) and partial remission (PR) better and earlier than indicated by UICC criteria. TPS is reacting in more patients and faster than CA 15-3 and CEA. When PD is developed during treatment tumor markers indicate progression earlier than UICC criteria. F12J MULTIMODALITY IMAGING: TRANSFER AND F13 I MULTIMODALITY IMAGING: TRANSFER AND FUSION OF SPECT AND MRI DATA 1 FUSION OF SPECT AND MRI DATA KneJSaurek K. KneSnurek K. The Mount Sinai Medical Center, New York, USA The Mount Sinai Medical Center, New York, USA Image fusion is a technique which offers the best of both Image fusion is a technique which offers the best of both worlds. It unites the two basic types of medical images: functional worlds. It unites the two basic types of medical images: functional body images(PET or SPECT scans), which provide physiological body images(PET or SPECT scans), which provide physiological information, and structural images (CT or MRI), which provide information, and structural images (CT or MRI), which provide an anatomic map of the body. an anatomic map of the body. Control-point based registration technique was developed and Control-point based registration technique was developed and used. Tc-99m point sources were used as external markers in used. Tc-99m point sources were used as external markers in SPECT studies while, for MRI and CT imaging only anatomic SPECT studies while, for MRI and CT imaging only anatomic landmarks were used as a control points. The MRI images were landmarks were used as a control points. The MRI images were acquired on GE Signa 1.2 system and CT data on a GE 9800 acquired on GE Signa 1.2 system and CT data on a GE 9800 scanner. SPECT studies were performed lh after intravenous scanner. SPECT studies were performed lh after intravenous injection of the 740 Mbq of the Tc-99m HMPAO on the triple- injection of the 740 Mbq of the Tc-99m HMPAO on the triple- headed TRIONIX gamma camera. B-spline and bilinear headed TRIONIX gamma camera. B-spline and bilinear interpolation were used for the rotation, scaling and translation of interpolation were used for the rotation, scaling and translation of the images. In the process of creation of a single composite image, the images. In the process of creation of a single composite image, in order to retain information from the individual images, MRI (or in order to retain information from the individual images, MRI (or CT) image was scaled to one color range and a SPECT image to CT) image was scaled to one color range and a SPECT image to another. In some situations the MRI image was kept black-and- another. In some situations the MRI image was kept black-and- white while the SPECT image was pasted on top of it in "opaque" white while the SPECT image was pasted on top of it in "opaque" mode. Most errors which propagate through the matching process mode. Most errors which propagate through the matching process are due to sample size, imperfection of the acquisition system, are due to sample size, imperfection of the acquisition system, noise and interpolations used. Accuracy of the registration was noise and interpolations used. Accuracy of the registration was investigated by SPECT-CT study performed on a phantom study. investigated by SPECT-CT study performed on a phantom study. The results has shown that accuracy of the matching process is The results has shown that accuracy of the matching process is better, or at worse, equal to 2mm. better, or at worse, equal to 2mm. HR9600050 ODREDIVANJE FUNKCIJE BUBREGA POMOCU UTJECAJ UCINKOVITOSTI BROJENJA NA NUKLEARNO - MEDICINSKIH METODA TOCNOST RADIOKEMIJSKE ANALIZE Mikulic" T.. KovacSevic" I., Huic" D. , Marjanovid S., KuSter Z. Klinifiki zavod za nuklearnu medicinu i zaStitu od zrafenja, KBC Klinidki zavod za nuklearnu medicinu i zaStitu od zra£enja, KBC "Rebro", Zagreb, Hrvatska "Rebro", Zagreb, Hrvatska Na naSem Zavodu uveli smo metodu pomoc'u koje se RadiokemijskomanalizomTc-99m-radiofarmakaodrecIuje jednom injekcijom 5 mCi Tc 99m DTPA moze odrediti protok se sadrzaj pojedinih Tc-99m-specija u pripravku. krvi kroz bubreg, izraien kao postotak efektivnog volumena srca Toinost rezultata analize, izmedu ostalog, ovisi o todnosti te istovremeno glomerulska filtracija bubrega. mjerenja aktivnosti pojedinih segmenata Tc-99m kromatograma. Protok krvi kroz bubreg raiuna se iz krivulje prvog prolaza Zbog smanjene udinkovitosti brojenja impulsa pri vedim generiranih nad desnim pludem, lijevim ventriklom i aortom u aktivnostima uzoraka, potrebno je izvrSiti nuzne ispravke prvom dijelu studije koji traje 60 sec. Glomerulska filtracija izmjerenih vrijednosti. racuna se na osnovu krvnih uzoraka izvadenih 2, 3 i 4 h nakon U radu je prikazan utjecaj ufiinkovitosti brojenja na todnost injiciranja radiofarmaka. Ta metoda je ispitana kod bolesnika s rezultata standardne radiokemijske analize, te na&n rjeSavanja dugogodisnjim dijabetesom i usporedena s vrijednostima kreatinina problema u Odsjeku za radiofarmake naSeg Zavoda. u serumu, kreatinin klirensa i rezultatima dobivenim pomoc'u UZV - Dopplera. UČESTALOST LIMFOMATOZNE STRUME TROETAPNI SKEN KOSTI KOD HASHIMOTO U BOLESNIKA PREGLEDANIH JLJ OSTEOMUELITISA ULTRAZVUKOM TIJEKOM 1993. GODINE Landeka N.. Jurašinović Ž. Šimeg L.. Medvedec M. Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC "Rebro", Zagreb, Hrvatska "Rebro", Zagreb, Hrvatska U razdoblju 1992. do srpnja 1994. u naš je Zavod Limfomatozna struma je autoimuna bolest štitnjače. upućeno 39 bolesnika sa kliničkom dijagnozom gnojne upale kosti Klinički tijek je često asimptomatski pa se bolest često otkriva (osteomijelitisa) kojima je učinjena troetapna scintigrafija kosti. slučajno, iako se može javiti i sa simptomima pojačanog U našoj skupini bilo je 21 muškarac i 18 žena. metabolizma ili pak znacima smanjene funkcije štitne žlijezde. U 25 (60%) bolesnika nalaz troetapne scintigrafije bio je pozitivan Česti je uzrok hipotireoze u odraslih. i upućivao je na upalni proces. Tijekom 1993. god. u ultrazvučnom laboratoriju Zavoda za Na osnovu naših rezultata možemo zaključiti da je troetapna nuklearnu medicinu i zaštitu od zračenja, pregledano je 6618 scintigrafija kosti kod osteomijelitisa osjetljiva metoda koja je bolesnika od čega njih 589 (7,3%) s ehografskim znacima korisna u neinvazivnoj dijagnostici upalnih procesa koštanog limfomatozne strume. Bilo je 35 muškaraca i 554 žene (93%). sustava. Bolest se najčešće javljala između 40. i 50. god. života (kod 184 - 31% bolesnika). Već se ehografskim pregledom može s velikom vjerojatnošću postaviti sumnja na limfomatoznu strumu. Takvi bolesnici se upućuju na određivanje vrijednosti perifernih hormona štitnjače, TSH te TAA čiji je povišen titar karakterističan za ovu bolest. Dijagnoza se potvrđuje ciljanom citološkom punkcijom. U radu se komentira naš materijal i ističe važnost ultrazvučnog praćenja bolesnika s limfomatoznom strumom. PRIMJENA RAČUNALA U RUTINSKOJ T6 IciTOLOŠKI NALAZI SCINTIGRAFSKI KONTROLI MUNOANALIZA I "HLADNIH11 ČVOROVA Horvat Ž.. Gregurić N. Grbić K.. Horvatić G., Grošev D. Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC "Rebro", Zagreb, Hrvatska "Rebro", Zagreb, Hrvatska Statistička obrada podataka dobivenih analizom kontrolnih Scintigrafski "hladni" čvor je područje smanjenog uzoraka je jedan od najznačajnijih postupaka u sveukupnoj kontroli nakupljanja radiofarmaka na scintigramu štitnjače, a može biti kvalitete pribora za imunoanalizu. Danas se u tu svrhu koriste hipofunkcionalan ili afunkcionalan u odnosu na okolno tkivo računala i gotovi programi za statističku obradu podataka. štitnjače. Kontrola kvalitete pribora za imunoanalizu provodi se pomoću U radu je prikazano 114 bolesnika (9 muških i 105 ženskih) sa stabilnog materijala (komercijalni i vlastiti uzorci kontrola) kroz scintigrafski "hladnim" čvorom. Srednja dob bolesnika je 48 dulji period vremena, a podaci obrađeni na računalu prikazuju se godina. Svaki čvor je ciljano punktiran pod kontrolom ultrazvuka. Shewart, odnosno Levey-Jennings kontrolnim kartama. Kontrolna Tumorska lezija je nađena u 41,6% "hladnih" čvorova (13,2% karta je grafički prikaz statistički obrađenih podataka za veći broj karcinoma štitnjače, 28% tumora, adenoma i sumnje na adenom). izmjerenih koncentracija pojedinog kontrolnog uzorka (y - os) u Netumorska lezija nađena je u 58,4% "hladnih" čvorova (36 serijama analiza (x - os). proliferacija tireocita, 22,8% struma). Odluka o prihvaćanju, odnosno odbacivanju jedne serije analize Scintigrafija štitnjače je korisna metoda za uvid u funkcionalnu donosi se na osnovi točno određenih pravila i statistički obrađenih morfologiju čvorova štitnjače, ali nije dovoljno specifična za podataka prikazanih na kontrolnoj karti. prepoznavanje tumorskih od netumorskih lezija, te je potrebno učiniti citološku punkciju tih čvorova. T7 ISCINTIGRAFSKA DETEKCIJA KRVARENJA U T8 I MJERENJE PROTOKA KRVI KROZ BUBREGE - ABDOMENU 1 NORMALNE VRIJEDNOSTI Habiianec B.. Podgorelec S., Ugarković B. Herek S.. Orežić B., Huić D. Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC "Rebro", Zagreb, Hrvatska "Rebro", Zagreb, Hrvatska U radu su prikazane scintigrafske metode za dijagnostiku Protok krvi kroz bubreg (PKKB), izražen kao postotak krvarenja u gastrointestinalnom traktu. Opisane su metode pomoću efektivnog volumena srca (PKKB/EVS), izmjeren je kod 41 in vitro i in vivo obilježenih eritrocita, te metoda pomoću bolesnika, kod kojih je urađena scintigrafija skeleta zbog različitih obilježenog koloida. Raspravljene su prednosti i nedostaci svake razloga. Tc-99m-MDP injiciran je u bolus tehnici, a iz krivulja od opisanih metoda, te iznesena usporedba scintigrafske aktivnosti, generiranih nad desnim plućem, lijevim ventrikulom, dijagnostike s drugim dijagnostičkim postupcima (angiografija, aortom i oba bubrega, izračunat je PKKB/EVS. U obzir su uzeti endoskopija). Na osnovu vlastitog iskustva na velikom broju samo ispitanici koji nisu preboljeli neku bubrežnu bolest te oni sa bolesnika kojima je u našem Zavodu učinjena ova pretraga urednim vrijednostima kreatinina u serumu. Srednja vrijednost zaključili smo da je scintigrafska dijagnostika pouzdana PKKB/EVS za desni bubreg je iznosila 9,8%±1,9, a za lijevi neinvazivna metoda koja u najvećeg broja bolesnika može 10,6%±2,2, te za oba normalna bubrega 20,9%±3,4. detektirati i lokalizirati krvarenje u gastrointestinalnom traktu. Na taj način smo dobili normalne vrijednosti PKKB/EVS, bez suvišnog izlaganja zračenju zdravih dobrovoljaca. Naši rezultati se slažu sa rezultatima iz literature, pa smo zaključili da je ova metoda potencijalno korisna u svakodnevnom radu. EVALUACIJA REZULTATA RADA U T101 MJERENJE RETENCIJE J-131 SA CILJEM DIJAGNOSTICI BOLESTI ŠTITNJAČE - I OPTIMALIZACIJE RADIO-ABLACIJSKE DOZE CITOLOŠKOG LABORATORIJA KLINIČKOG ZAVODA ZA NUKLEARNU MEDICINU I ZAŠTITU Vahtarić M.. Huić D. OD ZRAČENJA Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC Turčin N„ Kurtanjek S., Kušter Ž., Knežević-Obad A. "Rebro", Zagreb, Hrvatska Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC Našim ispitivanjem obuhvaćeni su bolesnici kod kojih je "Rebro", Zagreb, Hrvatska izvršena totalna tireoidektomija zbog karcinoma štitnjače. Mjerenje retencije J-131 u organizmu i u ostatnom tkivu štitnjače radi se U razdoblju od 1.6.1993. - 31.5.1994. u ambulanti za tako da su bolesnici snimani pomoću gama kamere i brojača UZV štitnjače pregledano je 6262 bolesnika. Zbog ehografskih cijelog tijela 2 sata, 24 sata, 48 i 72 sata nakon oralne primjene promjena u štitnjači kod 2672 bolesnika učinjena je ultrazvučno dijagnostičke doze J-131 (2 mCi). Isto tako pratimo i aktivnost u vođena-citološka punkcija i to svakog promijenjenog dijela izlučenom urinu kroz isti vremenski period, te određujemo T3, štitnjače, tako daje u tom periodu u citološkom laboratoriju našeg T4, T3 kv, TSH, Tg, TAAi PVJ. Zavoda analizirano 5055 punktata, odnosno 15271 razmaz. U Dobiveni podaci će poslužiti kao baza na osnovu koje će se procesu "skrininga" izdvojeno je 15% punktata kao neadekvatan svakom sljedećem bolesniku odrediti optimalna ablacijska doza materijal za ekološku analizu, a preostali punktati su klasificirani radiojoda. u dvije skupine; netumorske koje čine 75% punktata i tumorske lezije koje čine 10% punktata. Uspoređujući UZV nalaz punktirane promjene sa citološkim nalazom tumorske lezije (naročito malignih tumora) u većini slučajeva radilo se o hipoehogenim čvorovima neravnih vanjskih kontura. Iz toga proizlazi da posao citoskrinera nije samo izdvojiti neadekvatan materijal nego usporediti taj nalaz sa nalazom UZV i upozoriti liječnika kod kojih punktata je obavezno ponoviti citološku punkciju. T11 I VAŽNOST ODREĐIVANJA RENINSKE T12 SCINTIGRAFIJA MIOKARDA S REINJEKCIJOM AKTIVNOSTI U PLAZMI VEZANO UZ 201-TALUA KAPTOPRELSKI TEST Pasnrić P.. Valenta B., Težak S. Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC Klinički zavod za nuklearnu medicinu i zaštitu od zračenja, KBC "Rebro", Zagreb, Hrvatska "Rebro", Zagreb, Hrvatska Planarna scintigrafija miokrda pomoću 201-Talija je Preliminarno iskustvo pokazuje da je primjena rutinska klinička metoda za otkrivanje i procjenu proširenosti kaptoprilskog testa jedno korisno i važno pomagalo u kliničkoj koronarne bolesti. dijagnostici renovaskulame hipertenzije (RVH), koja nastaje zbog U bolesnika s koronarnom bolesti i značajnije oštećenom suženja jedne ili obje bubrežne arterije. Najčešće izlječenje je funkcijom lijeve klijetke važno je procijeniti da li segmenti kirurškim putem, te zato pravovremeno i točno postavljanje miokarda koji se ne kontrahiraju prestavljaju ožiljak ili još uvijek dijagnoze ima veliku važnost. živi srčani mišić tzv. vijabilni miokard. Talijska planama Sigurna metoda za postavljanje dijagnoze je renalna angiografija, scintigrafija miokarda nakon opterećenja i u mirovanju uz ali zbog rizika provođenja metode ne može biti "scrining" test, te reinjekciju radifarmaka nakon što su snimljeni scintigrami u zato kaptoprilski test koji je lagano izvodljiv je vrlo koristan i ima mirovanju jedna je od više raznih metoda za otkrivanje vijabilnog sve veću primjenu. Dijagnostička vrijednost ovog testa proizlazi miokarda. Bit ove metode je u tome da se onim bolesnicima koji iz značajnog porasta reninske aktivnosti u plazmi nakon primjene imaju ireverzibilni defekt na scintigramu u redistribuciji injicira kaptoprila u bolesnika sa RVH, a ne pad tlaka koji je jednak i kod dodatna aktivnost talija kako bi se poboljšala detekcija RVH i esencijalne hipertenzije. reverzibilnosti defekta. Pri provođenju ove metode težište pažnje Reninsku aktivnost u plazmi, tj. postotak angiotenzina I u plazmi treba usmjeriti na slijedeće točke: u našem laboratoriju određujemo RIA metodom sa SORIN- - planiranje pretrage BIOMEDICA RENCTK-COATED-TUBE TEHNICK. Najviša - pozicioniranje bolesnika točka određivanja je 50 ng/ml što je za dijagnostiku nedovoljno, - procjena reverzibilnosti odn. ireverzibilnosti efekta te je zbog toga određivanje u visokim koncentracijama potrebno Zbog svoje zahtjevnosti ovu pretragu provodimo samo u bolesnika kako za kaptoprilski test tako i za separatne renine. kod kojih se razmatra zahvat na koronarnim žilama. PRIMJENA RADIOIMUNOLOŠKIH METODA U T14 I METABOLIČKA OBRADA U OBOLJELIH OD BOLESNIKA S UROLITIJAZOM NEFROLITIJAZE Dokonal Z.. Ugrai V., Gali D., Karner I. , Karner I. Odjel za nuklearnu medicinu, zaštitu od radioaktivnog zračenja i Odjel za nuklearnu medicinu, zaštitu od radioaktivnog zračenja i opću patološku fiziologiju, Klinička bolnica Osijek, Hrvatska patofiziologiju, Klinička bolnica Osijek, Hrvatska Prema podacima iz literature 90% bolesnika s U radu je prikazana važnost metaboličke obrade u nefrolitijazom ima neku vrstu metaboličkog poremećaja. U 2-17% oboljelih od povratnog stvaranja bubrežnih kamenaca. Prikazani bolesnika s nefrolitijazom nađen je primarni hiperparatireoidizam su postupci diferenciranja različitih tipova metaboličkog (qHPT). Do nedavno osnovni parametar na temelju kojeg se poremećaja koji se mogu otkriti u oko 90 % oboljelih. Posebno je postavljala sumnja na qHPT bila je hiperkalcemija. Međutim, dan naglasak na ulogu med. sestre/med, tehničara kao važnog u nakon uvođenja radioimunoloških analiza (RIA) za određivanje dijagnostičkom timu. paratireoidnog hormona ((PTH), cikličkog adenozin-monofosfata (cAMP), kalcitonina (CT), osteokalcina (BGP-bone G la proteina) te radioreceptorskih analiza za određivanje 25-hidroksivitamina D (25-OH-D), 1,25-dihidroksivitamina D (1,25- (OH)2D), prokolagena tip I (PICP) i telopeptida (ICTP) omogućeno je rutinsko određivanje funkcije paratireoidnih žlijezda i poremećaja homeostaze kalcija. T15| TEST APSORCUE 4SCa KOD OBOLJELIH OD EVALUACJJA ALERGOLOŠKIH TESTOVA NA KALCIJSKE UROLITIJAZE I ODJELU ZA NUKLEARNU MEDICINU Fosić M.. Brlošić R., Ugrai V., Karner I. Mariianović V.. Gali D., Ugrai V. Odjel za nuklearnu medicinu, zaštitu od radioaktivnog zračenja i Odjel za nuklearnu medicinu, zaštitu od radioaktivnog zračenja i opću patološku fiziologiju, Klinička bolnica Osijek, Hrvatska opću patološku fiziologiju, Klinička bolnica Osijek, Hrvatska Kod oboljelih od dokazane povratne kalcijske urolitijaze Prikazane su alergološke metode za određivanje ukupnih učinjen je test apsorpcije 45Ca. U radu se prikazane srednje (IgE) i specifičnih imunoglobulina (RAST), te imunoglobulina na vrijednosti apsorpcije 45Ca kod oboljelih te kod normalnih osoba. inhalacijske alergene (PHADIATOP),a koje se izvode u Odjelu za Diskutira se o primjeni testa u patogenezi urolitijaze. nuklearnu medicinu Kliničke bolnice Osijek. Dane su karakteristike prikazanih testova i evaluirani dobiveni rezultati za razdoblje od 1991-e do kraja 1992-e godine. Naše referentne vrijednosti komparirane su s drugim autorima. Izvedeno je ukupno 1218 IgE testova. Od toga 595 (48,S pozitivnih i 623 (51,1%) negativnih. Ukupno je izvedeno 571 RAST i 131 PHADIATOP testova. T1 7|NAČELA AMBULANTNOG PRAĆENJA I T18 I DETEKCIJA UPALNIH PROCESA KOSTI I TIREOLOŠKOG BOLESNIKA | I ZGLOBOVA S Tc-99m NANOCOLLOM Mikuš M.. Smoje J. Strnad D.. Fligić Ž., Grdić J. Odjel za nuklearnu medicinu, zaštitu od radioaktivnog zračenja i Odjel za nuklearnu medicinu, zaštitu od radioaktivnog zračenja i patofiziologiju, Klinička bolnica Osijek, Hrvatska patofiziologiju, Klinička bolnica Osijek, Hrvatska Praćenje kroničnog tireološkog bolesnika zahtijeva U radu prikazujemo scintigrafiju kostiju i zglobova s Tc- pedantno evidentiranje svih anamnestičkih podataka, rezultata 99m Nanocollom u detekciji upalnih promjena. U 33 bolesnika mjerenja raznih testova i pretraga i objektivnih kliničkih nalaza. učinjena je scintigrafija s Tc-99m MDP-Om i Tc-99m Nanocollom. U radu smo prikazali kako, po našem mišljenju, pregledno i Ovaj posljednji radioobilježivač pokazao se diferentnijim u kontinuirano pratimo bolesnike u našem Odsjeku za bolesti dijagnostici upalnih procesa kostiju i zglobova. štitnjače. T19 I VEZANJE POLIKLONSKOG TSH ANTISERUMA T20 | PRIPRAVA AGAR PLOČICA ZA ODREĐIVANJE —INA POLISTIRENSKE KUGLICE U TSH-IRMA KONCENTRACIJE TBG POSTUPKOM RADIJALNE METODI LABORATORIJSKE IZVEDBE EvrUNODIFUZUE Dennol A. Klinika za nuklearnu medicinu i ontologiju, KB "Sestre Klinika za nuklearnu medicinu i ontologiju, KB "Sestre milosrdnice", Zagreb, Hrvatska milosrdnice", Zagreb, Hrvatska U našem laboratorijskom postupku imunometrijske Za određivanje koncentracije TBG u serumu moguće je metode određivanja TSH u serumu (IRMA-TSH) primjenili smo primjeniti metodu radijalne imunodifuzije (RID) na agar gelu. postupak vezanja poliklonskog TSH antitijela na polistirenske Postupak priprave agar pločica bio je slijedeći. kuglice. Agar (0.108g) smo otopili u 6 mL barbitalnog pufera, pH 8.6 s Postupak se sastojao u sljedećem. Antiserum (anti-TSH Co 5503, dodacima (0.1 % NaN3, 0.1 % HSA) i epruvetu stavili u termostat Bio Makor, Israel) otopili smo u 0.05 Mol/L bikarbonatnom na 54 °C. puferu pH 9.6 u titru 1:500 (20 jtL ad 10 mL). Polistirenske Antiserum (anti TBG, Co: A158, Dakopatts, Danska) u volumenu kuglice (dijametar 6.5 mm Code: P201, Northumbria, UK) stavili od 140 fiL otopili smo u epruveti s 4.1 mL istog barbitalnog smo u plastične epruvete, i u njih dodali 300 /xL otopine TSH pufera i ugrijali, na 54°C. Jednake volumene (4.1 mL) otopine antiseruma i sadržaj inkubirali 2 dana na sobnoj temperaturi, bez agara i TBG antiseruma dobro smo izmješali i homogeni sadržaj potresivanja. Kuglice smo zatim isprali sa 3 x 1 mL 0.15 Mol/L (8.2 mL) naglo izlili u plastičnu pločicu volumena 8 mL. Pločicu NaCl i 1 x 1 mL 0.15 Mol/L NaCl (0.5% BSA, 0.01 % mertiolat). smo stavili na ravnu plohu da bismo dobili jednaku debljinu sloja Osušene kuglice skladištili smo u hladnjaku na 4 C do uporabe u na čitavoj površini (34 cm2). Agar gel se učvrstio nakon 5 minuta TSH-IRMA postupku. stajanja na sobnoj temperaturi. Pločicu smo zatvorili poklopcem i uz dodatni ovlaživač uskladištili u hladnjaku na temperaturi od 4°C. T21 I ISPITIVANJE FUNKCUE CEREBRO-SPINALNIH T22 | USPOREDNO ODREĐIVANJE KONCENTRACIJE 1 ŠANTOVA POMOĆU 99mTc PERTEHNETATA SVEUKUPNOG TIROKSINA I TRUODTIRONINA U SERUMU RADIOIMUNOLOŠKOM I Šabulič !.. Curkan S. FLUOROIMUNOLOŠKOM METODOM Zavod za nuklearnu medicinu, Klinički bolnički centar Rijeka, Hrvatska Zavod za nuklearnu medicinu, Klinički bolnički centar Rijeka, Ispitivanje funkcije cerebro spinalnih šantova pomoću Hrvatska 99mTc pertehnetata je jednostavna i brza metoda. Ne zahtjeva nikakvu prethodnu pripremu ispitanika, pa se može izvoditi i U skupini od 60 ispitanika određena je koncentracija ambulantno. sveukupnog tiroksina i trijodtironina radioimunološkom i U djece s hidrocefalusom je od velikog interesa a djetetu ne prijeti fluoroimunološkom metodom. Dobiveni rezultati su iscrpno nikakva opasnost. Za razliku od uobičajenih metoda (digitalna statistički obrađeni. Raspravljena je i uspoređena specifičnost, palpacija, rdg kontrastna metoda) ne mijenja normalne fiziološke osjetljivost i točnost obiju metoda. Ukazano je na pojavu lažno uvjete za prolaz cerebrospinalne tekućine. pozitivnih i lažno negativnih rezultata i na način kojim ih se može U rezervoar valvule unosi se strogo aseptičkim postupkom izbjeći. aktivnost od 3,7 MBq 99mTc pertehnetata u volumenu od 0,1 ml. Rezultati učinjenih usporednih ispitivanja pokazuju da se Kod normalno prohodnog i efikasnog santa već se u prvoj minuti koncentracija tiroksina i trijodtironina u serumu određena gama kamerom registrira aktivnost u rezervoaru i distalnom radioimunološkom metodom značajno ne razlikuje: kateteru. - između dviju metoda postoji vrlo visok stupanj korelacije Rezultat ispitivanja je odmah dostupan i nije težak za tumačenje. - osjetljivost jedne i druge metode je između 80% i 90% - ispitivanje specifičnosti metoda je pokazalo da razlike nema - test točnosti za jednu i drugu metodu pokazuje točnost od oko - kod obiju metoda javljaju se lažno pozitivni i lažno negativni rezultati zbog istog razloga, najčešće je to promjena u količini serumskog nosača za hormone štitnjače. U rutinskom kliničkom radu, za određivanje koncentracije ovih hormona jedna se metoda bez oklijevanja može zamijeniti drugom. INDEX OF AUTHORS The symbols at the upper left corner box of each abstract have the meanings as follows: V= oral presentation, P= poster, F= invited lecture, T= technologist paper Angelberger P. V4, V39 Dublineau I. V36 AntalffyM. V52 Dujić Ž. V49 Assi A. F4 Duraković A. F9 Avčin J. V22, F6 Đaković N. V14, V40 Basic M. V25 Eberhardt J.U. F3 BabeliA. T22 Einarsson R. F10 Banek T. V29, P2 Eljuga D. V6 Barak V. F10 Emrich D. V5, V7 Baranyai T. V32 Erlandsson K. V45 Batagelj I. V30 Eterović D. V26, V49, P15 BatinićD. V25 Fettich J. V42, P3, F7 BaznikJ. T14 Fid I er V. P3 Bečejac B. V17 FligićŽ. T18 Bence-Žigman Z. V8, VIO, V12, FosićM. T15 V15 Franceschi M. V45, P7, P20 Bergmann H. FI Fridrich L. Fl BerićLj. Til FritzscheH. Fl Bertin C. V36 Gaberšček S. V46 BišćanM. V35 GalićJ. P24 Božici. V2 Gali D. T13, T16 Bošnjak B. V14 Gion M. F10 Bohuslavizki K.H. F3 Giunio L. V2 BojanićI. V28 Golja-Kos M. V30 Bokulić T. V40, V41, V45, P13 GrbićK. T6 BonefačićB. V21 GrdićJ. T18 BorkovićZ. P2 Gregorič E. V34, P22 Bračić I. VIO, V12, V15 Gregurić N. P16, T5 Bradarić N. P6 Griffiths N.M. V36 Brlošić R. P25, T15 Grošelj C. P3 Buchberger K. P16 Grošev D. V15, V48, Pll, P12, P14, BudihnaN. V3Ö T6 Burić A. V43, V44, P5 Habijanec B. T7 ChylakV. V6 Hadjikostova Chr. Pl Cremaschi A. F10 Hafenscher I. V32 Creutzfeldt W. V7 Halbauer M. V8, V20 CurkanS. T21, T22 HatJ. V18 Čabrijan T. P21 Henze E. F3 Čapkun V. V26, P15 Herek S. T8 ČepulićE. V6 Hiddemann W. V5 ČuligZ. P7 Höffer R. F5 ĆepulićM. V33 Hojker S. V22, V23 Dermol A. P18, T19 Horvat Ž. T5 Dodig D. V6, V12, V25, V28, V29, HorvatĐ. V37 V34, Pli, P14 Horvat T. P7 Dokonal Z. T13 Horvatić G. VIO, V12, V15, T6 Huang S.C. V50 Lačan G. V50 Huić D. Pil, P14, TI, T8, T10 Labar Ž. P8 IlichJ.Z. V31 Lacić M. V40, V41 Ivančević V. V5, V7 Lahman M. P6 Ivanović M. V45 Landeka N. T4 Jaki P. V23, V47 Lechpammer S. VI1, V14, P7, P20 Jakić M. P25 Lekić S. T2 Jembrek M. VI Linard C. V36 JoubertC. V36 Lind P. Fl Jurašinović Ž. T4 Logonder-Mlinšek M. V47 Jurca T. V22 Lokner V. V3, V8, P13 Jurin M. V6 LukačJ. V40, V41 Kašuba V. V37, V38 LukinA. V2 Kališnik M. V46 Lukinac Lj. VI1, P17, P18, P20 Karner I. V13, V24, P9, P24, P25, Marić M. V6 T13, T14, T15 Marijanović V. T16 Kasal B. V48, P12 Marinković M. V16, P19 Kenda R.B. F7 Marjanović S. T2 Kertész L. V32 Marković V. V2, V26, P19 Knežević A. V8 Martin J.M. V36 Knežević I. V9 MathéD. V36 Knežević J. V9 MatkovićV. V31 Knežević-Obad A. V9, VI5, T9 Medvedec M. V12, Pll, P12, P14, Knešaurek K. F12 T3 Kögloer A V7 Mihajlović L.6 V35 Köhn H. FI Mihaljević I. P9 Konrâdy A. V38 Mikuš M. T17 Koprolčec D. P24 MikulićT. TI KörnyeiJ. V52 Milčinski M. F2 Kostadinova I. PI Milanov S. Pl Köteles G.J. V38 Mlczoch J. Fl Kovačević I. TI Molina R. F10 Kovačić K. V33, V41 Molnar H. V23 Krilić D. P17, T20 Mostbeck A. Fl Krstonošić B. P24, P25 Mudrovčić M. V21 KrušićJ. V6 Munz D.L. V5, V7 Kuščić-Juretić Lj. P15 Namer M. F10 KušterŽ. V9, V51, T2, T9 Nauck C. V5, V7 Kurnik G. V29, P2 Nežić-Legac P. V21 Kurtanjek S. T9 NižićLj. V25 Kurtaran A. V4, V39 Nimmo-Scott W.J. Fl 1 Kusačić-Kuna S. V12, V15 Nöthig-Hus D. P17, P18, P20 Kusić Z. VI1, V14, V17, V19, V33, Orešić B. T8 V35, V37, V38, V40, V41, Orlić P. P5 V45, P7, P8, P16, P13, P17, Pasarić D. T12 P18, P20 Pavlin K. V46, V47 Strand S.E. V45 PavlinovićŽ. V12, Pil, P14 Strnad D. TI8 Pećina M. V28 Sturgeon C. F10 Phelps M.E. V50 ŠabulićI. T21 Pichler E. V35 Šarčević B. V8, V20 Piechowski J. F8 ŠikićE. V18 PirnatE. V22 Šimeg L. T3 Podgorelec S. T7 Škreb F. P23 Popović S. V48, V49, Pll, P12, P14 ŠkugorM. V31 Porenta G. Fl ŠuškovićT. P21 Poropat M. V25 Težak S. VI, V6, T12 Posavec Lj. V17, V19, PIO Tomić Brzac H. V8, V9, VIO, V15 Pranić-Kragić A. P19 Tomić-Brzac H. V12 Predanić A. V6 Topuzović N. P24, P25 Predič P. V29, V34, V42, P22 Turčin N. T9 Prpić H. V3, V8 Ugarković B. T7 Punda A. V2, P19 Ugrai V. V24, P24, T13, T15, T16 Pusto vrh B. V42 Uravić M. P5 Pustovrh I. V42 VahtarićM. T10 Radetić M. V8 ValentaB. T12 Radeva M. P4 Valette P. V36 Radic-Wolfl M. V43, V44 Valković-Mika A. V21, V43, V44 RadovićD. V16 van Dalen A. F10 Ranogajec-Komor M. V48 VidovićŽ. V48 Reljica-Kostić Z. V29 VilibićT. V17, V18, V19, PIO Rožman B. VIO Virgolini I. V4, V39 RončevićS. VI1, V40, P7 Rupčić V. P25 Vizner B. V17, V18, V19, PIO Rusić A. P24, P25 Vlatković M. V37, P23 Samaržija M. VI VrhJ. P22 Sandrock D. V5, V7 Vrkljan M. V17, V18, V19, P8, PIO Saraga M. V26 Vučemilović A. V44 Satyamurthy N. V50 VučičevićŽ. P21 ScanffP. V36 Weber D.A. V45 Sekso M. V18, PIO Willheim K. V43 SmojeJ. V24, P9, T17 Wörmann B. V5 Smokvina A. V27, P5 YuD.C. V50 SoljačićH. P21 ZelićM. P5 Solter M. V19, P8 Zubčić A. P17 Staničić A. V2, V16, V26, P6, P19 ZupančićI. V23 Stieber P. F10 Žigman M. V3, V8 StojanovićJ. V35 Žuvić M. V6, Pil, P23