Tetrofosmin

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A Lahiri - One of the best experts on this subject based on the ideXlab platform.

  • enhanced detection of reversible perfusion defects by tc 99m sestamibi compared to tc 99m Tetrofosmin during vasodilator stress spect imaging in mild to moderate coronary artery disease
    Journal of the American College of Cardiology, 2001
    Co-Authors: Prem Soman, Raymond Taillefer, Gordon E Depuey, James E Udelson, A Lahiri
    Abstract:

    Abstract OBJECTIVES We prospectively compared dipyridamole single-photon emission computed tomography (SPECT) imaging with Tc-99m sestamibi and Tc-99m Tetrofosmin for the detection of reversible perfusion defects in patients with mild-to-moderate coronary artery disease. BACKGROUND Tc-99m Tetrofosmin has a lower first-pass myocardial extraction fraction compared to Tc-99m sestamibi and thus could underestimate mild perfusion defects. METHODS Eighty-one patients with 50% to 90% stenosis in one or two major epicardial vessels without previous myocardial infarction, and seven with RESULTS Tc-99m sestamibi detected reversible perfusion defects in a greater number of segments (total 363 and 285, p CONCLUSIONS These differences between two commonly used tracers may have significant diagnostic and prognostic implications.

  • technetium 99m Tetrofosmin myocardial imaging a comparison with thallium 201 and angiography
    The Journal of Nuclear Medicine, 1994
    Co-Authors: Pierre Rigo, A Lahiri, Roland Itti, Brigitte Leclercq, Simon Braat
    Abstract:

    UNLABELLED: Images recorded after intravenous administration of 99mTc-Tetrofosmin were compared to those obtained with 201Tl in a series of 40 patients with angiographically documented coronary artery disease. These patients were part of a Phase II Tetrofosmin study and presented anamnestic or laboratory evidence suggestive of ischemic heart disease. METHODS: Thirty-seven patients had one or more coronary obstructions greater or equal to 70% of luminal diameter. Three patients studied after bypass surgery or angioplasty had patent grafts, absence of disease progression or no significant restenosis. Twenty-six patients had evidence of previous myocardial infarction. All images were processed into a common display format by a core laboratory. They were identified by code and read by concensus of four investigators. Each segment was classified as normal or abnormal and these readings were combined and categorized into normal, reversible, fixed or mixed regional defects. RESULTS: There was good segmental correspondence between thallium and Tetrofosmin (kappa values ranged from 0.43 to 1.00). The ability of thallium and Tetrofosmin to recognize and localize myocardial infarction was excellent, since corresponding abnormalities were present in respectively 24 and 25 of the 26 patients with previous myocardial infarction. Abnormalities in noninfarcted territories were recognized with both tracers in 16 of 28 patients presenting with coronary lesions involving vessels unrelated to the infarct. CONCLUSION: In comparison to rest Tetrofosmin, thallium redistribution shows more reversibility in areas with myocardial infarction but less reversibility in areas of myocardial ischemia. Current Phase II results suggest that Tetrofosmin is a sensitive and reliable tracer for detecting myocardial infarction and ischemia. Results should be confirmed in a larger group of patients.

  • technetium 99m Tetrofosmin myocardial imaging a comparison with thallium 201 and angiography
    The Journal of Nuclear Medicine, 1994
    Co-Authors: Pierre Rigo, A Lahiri, Brigitte Leclercq, R Itti, Simon H Braat
    Abstract:

    Images recorded after intravenous administration of 99mTc-Tetrofosmin were compared to those obtained with 201Tl in a series of 40 patients with angiographically documented coronary artery disease. These patients were part of a Phase II Tetrofosmin study and presented anamnestic or laboratory evidence suggestive of ischemic heart disease. Methods: Thirty-seven patients had one or more coronary obstructions greater or equal to 70% of luminal diameter. Three patients studied after bypass surgery or angioplasty had patent grafts, absence of disease progression or no significant restenosis. Twenty-six patients had evidence of previous myocardial infarction. All images were processed into a common display format by a core laboratory. They were identified by code and read by concensus of four investigators. Each segment was classified as normal or abnormal and these readings were combined and categorized into normal, reversible, fixed or mixed regional defects. Results: There was good segmental correspondence between thallium and Tetrofosmin (kappa values ranged from 0.43 to 1.00). The ability of thallium and Tetrofosmin to recognize and localize myocardial infarction was excellent, since corresponding abnormalities were present in respectively 24 and 25 of the 26 patients with previous myocardial infarction. Abnormalities in noninfarcted territories were recognized with both tracers in 16 of 28 patients presenting with coronary lesions involving vessels unrelated to the infarct. Conclusion: In comparison to rest Tetrofosmin, thallium redistribution shows more reversibility in areas with myocardial infarction but less reversibility in areas of myocardial ischemia. Current Phase II results suggest that Tetrofosmin is a sensitive and reliable tracer for detecting myocardial infarction and ischemia. Results should be confirmed in a larger group of patients.

  • comparison of myocardial perfusion imaging with technetium 99m Tetrofosmin versus thallium 201 in coronary artery disease
    American Journal of Cardiology, 1993
    Co-Authors: Bangalore S Sridhara, A Lahiri, Pierre Rigo, Simon H Braat, R Itti, Paul Cload, Joseph Foulon
    Abstract:

    Technetium-99m (Tc-99m) Tetrofosmin, a new myocardial perfusion imaging agent, was evaluated at exercise and rest in 50 patients with documented coronary artery disease to determine myocardial kinetics, redistribution and ideal imaging time. Planar imaging was performed at 5, 30, 60, 90, 120 and 240 minutes after an injection of Tc-99m Tetrofosmin (8 to 10 mCi) at peak graded ergometric exercise. Reinjection (24 to 30 mCi) was performed at rest, 4 hours after the stress injection and also on a separate day, and imaging was repeated. All patients underwent thallium-201 (Tl-201) exercise and redistribution (4-hour) imaging. Perfusion defect to normal, and heart to lung ratios were calculated for exercise Tc-99m Tetrofosmin images at each time point. The mean +/- SD defect to normal ratios were 0.75 +/- 0.10, 0.75 +/- 0.10, 0.74 +/- 0.09, 0.73 +/- 0.10, 0.73 +/- 0.10 and 0.72 +/- 0.10 at 5, 30, 60, 90, 120 and 240 minutes, respectively (p = NS), suggesting absence of redistribution. There was a significant increase in lung uptake of Tl-201 during exercise (p < 0.05), but not with Tc-99m Tetrofosmin (p = NS). Washout of Tc-99m Tetrofosmin was calculated in a subset of patients (n = 23). Rapid background clearance enabled postexercise diagnostic imaging as early as 5 minutes after injection. Myocardial retention curves after rest injection suggested that the optimal time for imaging was approximately 30 minutes later. Slow myocardial washout (4%/hour after exercise and 0.6%/hour after rest injection) enabled diagnostic images to be obtained up to 4 hours after each study.(ABSTRACT TRUNCATED AT 250 WORDS)

  • comparison of myocardial perfusion imaging with technetium 99m Tetrofosmin versus thallium 201 in coronary artery disease
    American Journal of Cardiology, 1993
    Co-Authors: Bangalore S Sridhara, A Lahiri, Pierre Rigo, Roland Itti, Simon Braat, Paul Cload, Joseph Foulon
    Abstract:

    Abstract Technetium-99m (To-99m) Tetrofosmin, a new myocardial perfusion imaging agent, was evaluated at exercise and rest in 50 patients with documented coronary artery disease to determine myocardial kinetics, redistribution and ideal imaging time. Planar imaging was performed at 5, 30, 60, 90, 120 and 240 minutes after an injection of Tc-99m Tetrofosmin (8 to 10 mCi) at peak graded ergometric exercise. Reinjection (24 to 30 mCi) was performed at rest, 4 hours after the stress injection and also on a separate day, and imaging was repeated. All patients underwent thallium-201 (TI-201) exercise and redistribution (4-hour) imaging. Perfusion defect to normal, and heart to lung ratios were calculated for exercise To-99m Tetrofosmin images at each time point. The mean ± SD defect to normal ratios were 0.75 ± 0.10, 0.75 ± 0.10, 0.74 ± 0.09, 0.73 ± 0.10, 0.73 ± 0.10 and 0.72 ± 0.10 at 5, 30, 60, 90, 120 and 240 minutes, respectively (p = NS), suggesting absence of redistribution. There was a significant increase in lung uptake of TI-201 during exercise (p

Andreas Fotopoulos - One of the best experts on this subject based on the ideXlab platform.

  • detecting myocardial ischemia with 99mtechnetium Tetrofosmin myocardial perfusion imaging in ischemic stroke
    The Neurohospitalist, 2017
    Co-Authors: Sotirios Giannopoulos, Andreas Fotopoulos, Sofia Markoula, Chrissa Sioka, Sofia Zouroudi, Maria Spiliotopoulou, Katerina K Naka, Lampros K Michalis, Athanassios P Kyritsis
    Abstract:

    Background:To assess the myocardial status in patients with stroke, employing myocardial perfusion imaging (MPI) with 99mTechnetium-Tetrofosmin (99mTc-TF)-single-photon emission computed tomography...

  • comparison of diffusion tensor dynamic susceptibility contrast mri and 99m tc Tetrofosmin brain spect for the detection of recurrent high grade glioma
    Magnetic Resonance Imaging, 2014
    Co-Authors: George A Alexiou, Spyridon Tsiouris, Athanasios P Kyritsis, Anna Goussia, Spyridon Voulgaris, Anastasia K Zikou, Paraskevi Kosta, Athanasios Papadopoulos, P Tsekeris, Andreas Fotopoulos
    Abstract:

    Abstract Introduction Treatment induced necrosis is a relatively frequent finding in patients treated for high-grade glioma. Differentiation by imaging modalities between glioma recurrence and treatment induced necrosis is not always straightforward. This is a comparative study of diffusion tensor imaging (DTI), dynamic susceptibility contrast MRI and 99mTc-Tetrofosmin brain single-photon emission computed tomography (SPECT) for differentiation of recurrent glioma from treatment induced necrosis. Methods A prospective study was made of 30 patients treated for high-grade glioma who had suspected recurrent tumor on follow-up MRI. All had been treated by surgical resection of the tumor followed by standard postoperative radiotherapy with chemotherapy. No residual tumor had been found on brain imaging immediately after the initial treatment. All the patients were studied with dynamic susceptibility contrast brain MRI and, within a week, 99mTc-Tetrofosmin brain SPECT. Results Both 99mTc-Tetrofosmin brain SPECT and dynamic susceptibility contrast MRI could discriminate between tumor recurrence and treatment induced necrosis with 100% sensitivity and 100% specificity. An apparent diffusion coefficient (ADC) ratio cut-off value of 1.27 could differentiate recurrence from treatment induced necrosis with 65% sensitivity and 100% specificity and a fractional anisotropy (FA) ratio cut-off value of 0.47 could differentiate recurrence from treatment induced necrosis with 57% sensitivity and 100% specificity. A significant correlation was demonstrated between 99mTc-Tetrofosmin uptake ratio and rCBV (P = 0.003). Conclusions Dynamic susceptibility contrast MRI and brain SPECT with 99mTc-Tetrofosmin had the same accuracy and may be used to detect recurrent tumor following treatment for glioma. DTI also showed promise for the detection of recurrent tumor, but was inferior to both dynamic susceptibility contrast MRI and brain SPECT.

  • correlation of diffusion tensor dynamic susceptibility contrast mri and 99mtc Tetrofosmin brain spect with tumour grade and ki 67 immunohistochemistry in glioma
    Clinical Neurology and Neurosurgery, 2014
    Co-Authors: George A Alexiou, Spyridon Tsiouris, Athanasios P Kyritsis, Anna Goussia, Spyridon Voulgaris, Andreas Fotopoulos, Anastasia K Zikou, Paraskevi Kosta, Athanasios Papadopoulos, Maria I Argyropoulou
    Abstract:

    Abstract Objective Assessment of the grade and type of glioma is of paramount importance for prognosis. Tumour proliferative potentials may provide additional information on the behaviour of the tumour, its response to treatment and prognosis. The purpose of this study was to investigate the correlation between diffusion tensor imaging (DTI), dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) and 99m Tc-Tetrofosmin brain single-photon emission computed tomography (SPECT), and the tumour grade and Ki-67 labelling index in newly diagnosed gliomas. Methods Study was made of patients with suspected glioma on brain MRI between December 2010 and January 2012, by DTI, DSC MRI and 99m Tc-Tetrofosmin brain SPECT. The proliferative activity of each tumour was measured by deriving the Ki-67 proliferation index from immunohistochemical staining of tumour specimens. Results Glioma was newly diagnosed in 25 patients (17 men, 8 women, aged 19–79 years, median 55 years). The Ki-67 index ranged from 1% to 80% (mean 19.4%). On evaluation of the relationship between the 99m Tc-Tetrofosmin tumour uptake by gliomas was found to be significantly correlated with cellular proliferation (rho=0.924, p p =0.0087). Significant correlation was also observed between the fractional anisotropy (FA) ratio and the Ki-67 index (rho=0.489, p =0.02). Strong correlation was found between relative cerebral blood volume (rCBV) and Ki-67 index (rho=0.853, p 99m Tc-Tetrofosmin lesion-to-normal (L/N) uptake ratio and rCBV (rho=0.808, p ≤0.0001). Significant negative correlation was demonstrated between the 99m Tc-Tetrofosmin L/N ratio and ADC ratio (rho=−0.513, p =0.014). These imaging techniques were able to distinguish between low-grade and high-grade gliomas. Conclusions Findings on DSC MRI and brain SPECT with 99m Tc-Tetrofosmin metrics were more closely correlated with glioma cellular proliferation.

  • myocardial perfusion imaging with 99 mtc Tetrofosmin spect in breast cancer patients that received postoperative radiotherapy a case control study
    Radiation Oncology, 2011
    Co-Authors: Chrissa Sioka, Thomas Exarchopoulos, Ifigenia Tasiou, Eftychia Tzima, Nikolaos Fotou, Antonio Capizzello, Vasilios Ragos, Periklis Tsekeris, Andreas Fotopoulos
    Abstract:

    Purpose To evaluate the cardiac toxicity of radiotherapy (RT) in breast cancer (BC) patients employing myocardial perfusion imaging (MPI) with Tc-99 m Tetrofosmin - single photon emission computer tomography (T-SPECT).

  • the value of 99mtc Tetrofosmin brain spect in predicting survival in patients with glioblastoma multiforme
    The Journal of Nuclear Medicine, 2010
    Co-Authors: George A Alexiou, Spyridon Tsiouris, Athanasios P Kyritsis, George Fotakopoulos, Anna Goussia, Spyridon Voulgaris, Andreas Fotopoulos
    Abstract:

    99mTc-Tetrofosmin brain SPECT has been reported as a useful tool for the evaluation of glioma proliferation. In the present study, we set out to investigate the prognostic value of 99mTcTetrofosmin brain SPECT in patients with glioblastoma multiforme. Methods: We prospectively studied 18 patients (13 men, 5 women; mean age 6 SD, 60.8 6 7.79 y) who were operated on for glioblastoma multiforme. All patients underwent preoperative 99m Tc-Tetrofosmin brain SPECT, and surgical excision was performed within a week after SPECT. All patients received postoperative radiotherapy and chemotherapy. Results: By calculating the lesion-to-normal (L/N) 99m Tc-Tetrofosmin uptake ratio, we found that patients with an L/N ratio of more than 4.7 had significantly worse survival than did patients with an L/N ratio of 4.7 or less. Furthermore, patients with a Karnofsky Performance Score more than 90 had a significantly better survival rate. Although patients with near-total tumor resection who were younger than 60 y survived longer, the difference did not reach statistical significance. In the multivariate analysis, 99m Tc-Tetrofosmin uptake and Karnofsky Performance Score were identified as factors with independent prognostic power. Conclusion: 99m Tc-Tetrofosmin brain SPECT may be an

Arend F L Schinkel - One of the best experts on this subject based on the ideXlab platform.

  • what is the value of stress 99m tc Tetrofosmin myocardial perfusion imaging for the assessment of very long term outcome in obese patients
    Journal of Nuclear Cardiology, 2013
    Co-Authors: Rebecca S Korbee, Roelf Valkema, Henk J Boiten, Machiel J M Ottenhof, Ron T Van Domburg, Arend F L Schinkel
    Abstract:

    There are no data regarding the long-term prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in obese patients. The aim of this study was to examine the value of stress 99mTc-Tetrofosmin MPI findings for the prediction of very long-term outcome in obese patients. The study population consisted of 261 patients with a body mass index ≥30 kg/m2 who underwent exercise or pharmacological stress 99mTc-Tetrofosmin MPI for the assessment of known or suspected coronary artery disease. Endpoints during follow-up were all-cause mortality, cardiac death, nonfatal infarction, and coronary revascularization. Kaplan-Meier survival cures were constructed and univariate and multivariate analyses were performed to identify predictors of very long-term outcome. The mean age was 59 ± 10 years, 42% of the patients was male, and the body mass index was on average 37 ± 7 kg/m2. MPI findings were normal in 109 patients (42%). Myocardial perfusion abnormalities were fixed in 62 patients (24%) and reversible in 90 patients (34%). During a median 12-year follow-up, 91 (35%) patients died, and 27 (10%) had a nonfatal myocardial infarction. Survival curves were compared using the log-rank test at subsequent follow-up durations. Obese patients with a normal stress 99mTc-Tetrofosmin study had a significantly better prognosis as compared with those with an abnormal study, up to 6 years after the test was performed. Stress 99mTc-Tetrofosmin MPI provides valuable prognostic information for the prediction of outcome in obese patients. Obese patients with a normal stress 99mTc-Tetrofosmin study have a significantly better prognosis as compared with those with an abnormal study, up to 6 years after the test is performed.

  • long term prognostic value of exercise technetium 99m Tetrofosmin myocardial perfusion single photon emission computed tomography
    Journal of Nuclear Cardiology, 2012
    Co-Authors: Henk J Boiten, Roelf Valkema, Ron T Van Domburg, Johannes N Van Der Sijde, Pauline R Ruitinga, Marcel L Geleijnse, Eric J G Sijbrands, Arend F L Schinkel
    Abstract:

    Background Exercise 99mTc-Tetrofosmin single-photon emission computed tomography (SPECT) is a useful tool for short- and medium-term risk stratifications. Currently, the long-term prognostic application of this technique has not been evaluated.

  • prognostic implications of a normal stress technetium 99m Tetrofosmin myocardial perfusion study in patients with a healed myocardial infarct and or previous coronary revascularization
    American Journal of Cardiology, 2006
    Co-Authors: Arend F L Schinkel, Roelf Valkema, Jeroen J Bax, Ron T Van Domburg, Abdou Elhendy, Vittoria Rizzello, Aukje Huurman, Elena Biagini, Harm H H Feringa, Eric P Krenning
    Abstract:

    Previous studies have shown a good outcome for patients who present with normal findings on stress myocardial perfusion imaging. Currently, the prognostic implications of a normal study in patients who have a history of coronary artery disease (CAD) are not clear. This study investigated the long-term prognosis after a normal finding on stress technetium-99m (Tc-99m)–Tetrofosmin single-photon emission computed tomography in patients with a history of CAD. The study included 147 consecutive patients with a history of CAD (previous myocardial infarction and/or myocardial revascularization), who underwent exercise bicycle or high-dose dobutamine-atropine stress Tc-99m–Tetrofosmin single-photon emission computed tomography, and had normal perfusion results during stress and at rest. Follow-up was completed in all patients. During a follow-up of 6.5 ± 1.9 years, 20 patients (14%) died, 10 (7%) of whom died due to cardiac causes, and 12 (8%) had a nonfatal myocardial infarction. Annual cardiac death rates were 0.5% during the first 3 years of follow-up and 1.3% in the subsequent 3 years. Independent predictors of cardiac death were male gender, rate–pressure product at rest, and rate–pressure product at peak stress. In conclusion, patients who have a history of CAD have a very low cardiac death rate during the 3 years after a normal finding on stress Tc-99m–Tetrofosmin single-photon emission computed tomography. Repeated testing should be reconsidered 3 years after the initial evaluation and when a change in symptoms or clinical condition occurs.

  • incremental value of exercise technetium 99m Tetrofosmin myocardial perfusion single photon emission computed tomography for the prediction of cardiac events
    American Journal of Cardiology, 2003
    Co-Authors: Arend F L Schinkel, Roelf Valkema, Jeroen J Bax, Ron T Van Domburg, Abdou Elhendy, Eleni C Vourvouri, M Bountioukos, Vittoria Rizzello, Eustachio Agricola, Jos R T C Roelandt
    Abstract:

    Technetium-99m (Tc-99m) Tetrofosmin single-photon emission computed tomography (SPECT) is a useful alternative to thallium-201 scintigraphy for the assessment of myocardial perfusion. This study assessed the incremental value of exercise Tc-99m Tetrofosmin SPECT for the prediction of cardiac events in patients with known or suspected coronary artery disease. Exercise Tc-99m Tetrofosmin SPECT imaging was performed in 655 consecutive patients. Follow-up was successful in 648 patients (98.9%). Ten patients underwent early coronary revascularization and were excluded. End points were cardiac death, nonfatal infarction, and late (>60 days) coronary revascularization. An abnormal study was defined as the presence of fixed and/or reversible perfusion defects. A summed stress score (SSS) was derived to estimate the extent and severity of perfusion defects. An abnormal scan was detected in 344 patients (54%). During a mean follow-up period of 4 +/- 1.3 years, 56 patients (9%) died (22 cardiac deaths). Nonfatal myocardial infarction occurred in 19 patients (3%), and 89 patients (14%) underwent late coronary revascularization. An abnormal scan was an independent predictor of cardiac death (hazard ratio 3.5, confidence intervals [CI] 1.1 to 12.2) and provided incremental information over clinical and exercise test data (log-likelihood -133 to -125, p <0.05). The SSS provided incremental prognostic information over clinical data as well (log-likelihood -133 to -127, p <0.05) (hazard ratio 1.23, CI 1.10 to 1.38). An abnormal scan (hazard ratio 3.3, CI 1.1 to 12.2)) and the SSS (hazard ratio 1.25, CI 1.07 to 1.45)) were powerful independent predictors of the combined end point of any cardiac event. Thus, exercise Tc-99m Tetrofosmin myocardial perfusion SPECT provides information incremental to clinical data for the prediction of cardiac events in patients with known or suspected coronary artery disease.

  • prognostic value of dobutamine atropine stress 99mtc Tetrofosmin myocardial perfusion spect in patients with known or suspected coronary artery disease
    The Journal of Nuclear Medicine, 2002
    Co-Authors: Arend F L Schinkel, Jeroen J Bax, Jos R T C Roelandt, Ron T Van Domburg, Abdou Elhendy, Don Poldermans
    Abstract:

    99mTc-Tetrofosmin is a recently introduced radioactive isotope for the assessment of myocardial perfusion. Data regarding the prognostic value of stress imaging using this isotope are scarce. The aim of this study was to assess the prognostic value of dobutamine-atropine 99mTc-Tetrofosmin SPECT for the prediction of late cardiac events in patients with known or suspected coronary artery disease. Methods: A total of 721 consecutive patients with limited exercise capacity underwent dobutamine-atropine stress 99mTc-Tetrofosmin SPECT. Follow-up was successful in 719 of 721 patients (99.7%). Twenty-eight patients who underwent early revascularization were excluded. Results: Myocardial perfusion abnormalities were detected in 381 patients (55%) and included fixed defects in 190 patients (27%) and reversible defects 191 patients (28%). During a mean follow-up period of 37 ± 17 mo, there were 150 deaths (22%), of which 62 (41%) were attributed to cardiac causes. Nonfatal myocardial infarction occurred in 23 patients (3%), and late (>3 mo) coronary revascularization was performed on 21 patients (3%). The cardiac death rate was 1%/y in patients with a normal scan and 5.1%/y in patients with an abnormal scan (P

P Lind - One of the best experts on this subject based on the ideXlab platform.

  • comparison between 99mtc Tetrofosmin pertechnetate subtraction scintigraphy and 99mtc Tetrofosmin spect for preoperative localization of parathyroid adenoma in an endemic goiter area
    Investigative Radiology, 2000
    Co-Authors: Hans Jurgen Gallowitsch, Peter Mikosch, E Kresnik, O Unterweger, P Lind
    Abstract:

    Gallowitsch HJ, Mikosch P, Kresnik E, Unterweger O, Lind P. Comparison between 99mTc-Tetrofosmin/pertechnetate subtraction scintigraphy and 99mTc-Tetrofosmin SPECT for preoperative localization of parathyroid adenoma in an endemic goiter area. Invest Radiol 2000;35:453–459.RATIONALE AND OBJECTIVES.T

  • comparison between 99mtc Tetrofosmin pertechnetate subtraction scintigraphy and 99mtc Tetrofosmin spect for preoperative localization of parathyroid adenoma in an endemic goiter area
    Investigative Radiology, 2000
    Co-Authors: Hans Jurgen Gallowitsch, Peter Mikosch, E Kresnik, O Unterweger, P Lind
    Abstract:

    Rationale and objectives Technetium-99m-((99m)Tc-) Tetrofosmin, a cationic, lipophilic complex like (99m)Tc-sestamibi, has proved to be a potential tracer for parathyroid scintigraphy despite some differences in washout behavior from the thyroid gland. Previous results comparing a double-phase technique with single-proton emission computed tomography (SPECT) or with subtraction techniques demonstrated a high detection rate, especially when SPECT and subtraction techniques were used, whereas the double-phase protocol revealed only moderate results. In this study, a direct comparison was made between (99m)Tc-Tetrofosmin/pertechnetate subtraction and SPECT to elucidate the optimal protocol for Tetrofosmin parathyroid imaging. Methods Twenty-three patients who were biochemically suspected of parathyroid adenoma or hyperplasia due to primary or tertiary hyperparathyroidism were included in our study. In all patients, serum calcium, phosphate, and intact parathormone levels were analyzed in a single blood sample before (99m)Tc-Tetrofosmin/pertechnetate subtraction scintigraphy and SPECT. Ultrasound of the neck was performed in all patients to exclude false-positive results due to thyroid adenomas. All patients underwent parathyroidectomy with intraoperative revision of all parathyroid glands, and the histological results were compared with preoperative findings. Results Both imaging modalities, ie, subtraction scintigraphy and SPECT, correctly identified 20 of 23 (87%) histologically confirmed adenomas preoperatively. The positive predictive value was calculated to be 95% and 100%, respectively, for these two methods. Subtraction scintigraphy and SPECT showed concordant results in 19 patients (18 positive, 1 false-negative) and discordant results in 4 patients (2 positive with subtraction, 2 with SPECT). The combined use of subtraction scintigraphy and SPECT techniques revealed a sensitivity of 95.7% (22/23) and a positive predictive value of 95%. The whole procedure can be performed in less than 90 minutes per patient. Whereas subtraction scintigraphy tended to show more false-positive retentions due to thyroid adenomas, the interpretation of SPECT may be difficult in small adenomas with missing thyroid/parathyroid differential washout. Conclusions Both imaging modalities, subtraction scintigraphy with pertechnetate and SPECT, are highly sensitive methods for parathyroid adenoma localization with (99m)Tc-Tetrofosmin. However, our study did demonstrate that a combination of both modalities can further improve the diagnostic accuracy. Especially in an endemic goiter area, additional ultrasound may be required to avoid false-positive results due to thyroid adenomas.

  • thyroglobulin and low dose iodine 131 and technetium 99m Tetrofosmin whole body scintigraphy in differentiated thyroid carcinoma
    The Journal of Nuclear Medicine, 1998
    Co-Authors: Hans J Gallowitsch, E Kresnik, Peter Mikosch, I Gomez, O Unterweger, P Lind
    Abstract:

    Determination of thyroglobulin (Tg) levels, determined under endogenous thyroid-stimulating hormone stimulation after withdrawal of L-thyroxin treatment (off-T4), has been proven to be the most senstive method for evaluation of patients with recurrent malignancy or distant metastases. This study uses a comparative approach between low-dose 131 I scan and the previously reported highly sensitive 99m Tc-Tetrofosmin whole-body scintigraphy, using Tg-off-T4 as a basis for comparison. Methods: Fifty-eight consecutive patients of our follow-up program with primary thyroid carcinoma ablated with thyroidectomy and radioiodine therapy were examined after L-thyroxin withdrawal over 3-4 wk with 131 I (185 MBq) and 99m Tc-Tetrofosmin whole-body scintigraphy and Tg determination (off-T4) within 5 days. Patients with Tg levels above 0.5 ng/ml were defined as Group A (n = 29). Group B (n = 29) comprised patients who had Tg levels (off-T4) below 0.5 ng/ml. Results: Iodine-131 revealed only 19 of 44 tumor sites (43.18%). Additionally, three remnants could be demonstrated. Sensitivity showed decreasing values for local recurrences (4 of 7, 57.1%), bone lesions (7 of 13, 53.85%) and mediastinal (2 of 4, 50%), lung parenchymal (3 of 7, 42.85%) and lymph node (2 of 9, 22.2%) metastases. Whole-body scintigraphy with 99m Tc-Tetrofosmin revealed a total of 39 of 44 malignant lesions (88.6%). Sensitivity was superior for lung parenchymal metastases (9 of 9, 100%), mediastinum (4 of 4, 100%) and lymph nodes (9 of 10,90%) and inferior for bone metastases (11 of 13, 84.6%). Local recurrences could be detected in 6 of 7 patients (85.7%), and thyroid remnants were detected in 2 cases (2 of 11, 18.2%). One liver metastasis could not be detected because of the physiologic tracer distribution of 99m Tc-Tetrofosmin. Thyroglobulin-off-T4 detected malignant recurrence or metastases in 18 of 19 patients (94.7%) when a cutoff of 3 ng/ml was used and in 16 of 19 patients (84.2%) when a cutoff of 10 ng/ml was used. Specificity was calculated as 71.8% when a cutoff of 0.5 ng/ml was used, 89.7% when a cutoff of 3 ng/ml was used and 100% when a cutoff of 10 ng/ml was used. Conclusions: Scintigraphy with 99m Tc-Tetrofosmin showed clear advantages concerning sensitivity in most metastatic lesions when compared with low-dose 131 I scan. Despite a slight lower specificity, 99m Tc-Tetrofosmin whole-body scintigraphy has, therefore, been proven to be a useful tool in the assessment of metastatic lesions in differentiated thyroid carcinoma.

  • technetium 99m Tetrofosmin whole body scintigraphy in the follow up of differentiated thyroid carcinoma
    The Journal of Nuclear Medicine, 1997
    Co-Authors: P Lind, Hans J Gallowitsch, Werner Langsteger, E Kresnik, Peter Mikosch, I Gomez
    Abstract:

    The purpose of this study was to evaluate prospectively the reliability of the new nonspecific tumor-searching tracer Tetrofosmin in the postoperative follow-up of differentiated thyroid carcinoma (DTC) during TSH suppressive thyroid hormone treatment. Methods: Whole-body scintigraphy was performed in 114 patients under TSH suppressive L-T4 treatment 20 min after intravenous injection of 370 MBq 99m Tc-Tetrofosmin by means of a dual-head gamma camera followed by three-dimensional SPECT in case of suspicious tracer uptake. The results of serum thyroglobulin, ultrasonography of the neck, 131 I whole-body scintigraphy, chest radiograph, transmission CT or MRI, and bone scintigraphy were also available. Results: A group of 68 patients without thyroid remnants who were tumor free and had no history of metastases or tumor recurrence showed a negative 99m Tc-Tetrofosmin whole-body scan. Another 24 patients (papillary carcinoma pT1NOMO) were also in complete remission, but had sonographically proven remnants (echonormal). Sixteen of them (67%) exhibited 99m Tc-Tetrofosmin accumulation in the thyroid bed, which corresponded excellently to the localization of the remnant. The third group comprises seven cases of local recurrence confirmed by histopathology after reoperation or by cytology after fine-needle aspiration where Tetrofosmin scintigraphy clearly revealed relapse of malignancy in all cases. A total of 17 patients had distant metastases (11 pulmonary, 3 bone, 2 bone and pulmonary, 1 bone and soft tissue) discovered by different modalities, resulting in 44 lesions to be evaluated. Of the 23 radioiodine negative metastases, 17 were detected by Tetrofosmin (74%), whereas all 21 radioiodine accumulating lesions also showed Tetrofosmin positive scans. The overall sensitivity of 99m Tc-Tetrofosmin in detecting distant metastatic lesions was 86%. Four additional cases with radioiodine-negative disseminated lung metastases showed diffuse pulmonary Tetrofosmin uptake. Conclusion: Technetium-99m-Tetrofosmin is a promising tracer to detect malignant recurrence and distant metastases in the follow-up of DTC without the necessity of thyroid hormone withdrawal.

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  • technetium 99m Tetrofosmin as a new radiopharmaceutical for myocardial perfusion imaging
    The Journal of Nuclear Medicine, 1993
    Co-Authors: Duncan J Kelly, Alan M Forster, Brian Higley, Colin M Archer, Fong S Booker, Lewis R Canning, Wai K Chiu, Barbara Edwards, Harjit Kaur Gill, Mary Mcpartlin
    Abstract:

    A new cationic complex, [99mTc(Tetrofosmin)2O2]+, where Tetrofosmin is the ether functionalized diphosphine ligand 1,2-bis[bis(2-ethoxyethyl)phosphino]ethane, has been synthesized and evaluated for potential use in myocardial perfusion imaging. The structure of the complex has been determined by x-ray crystallography of the 99Tc analog. In comparison with previously reported 99mTc complexes of alkyl-phosphines, the Tetrofosmin species shows substantially increased clearance from nontarget tissue, especially blood and liver. A freeze-dried kit formulation has been developed. The kit provides a product of high radiochemical purity up to 8 hr after reconstitution at room temperature.

  • technetium 99m 1 2 bis bis 2 ethoxyethyl phosphino ethane human biodistribution dosimetry and safety of a new myocardial perfusion imaging agent
    The Journal of Nuclear Medicine, 1993
    Co-Authors: Brian Higley, F W Smith, Terry Smith, H G Gemmell, Prabir Das Gupta, Dragouten V Gvozdanovic, David L Graham, David Hinge, J Davidson, A Lahiri
    Abstract:

    A novel 99m Tc complex (1,2-bis[bis(2-ethoxyethyl)phosphino] ethane, 99m Tc-Tetrofosmin) has been developed to replace 201 Tl in myocardial perfusion imaging. Biodistribution, safety and dosimetry of 99m Tc-Tetrofosmin were studied in 12 male volunteers, each at rest and during exercise. Safety parameters measured to 48 hr postinjection revealed no clinically significant long-term drug-related changes. Biodistribution was studied by acquiring whole-body or serial static images up to 48 hr postinjection. Technetium-99m-Tetrofosmin shows good heart uptake (1.2%) with retention

  • technetium 99m 1 2 bis bis 2 ethoxyethyl phosphino ethane human biodistribution dosimetry and safety of a new myocardial perfusion imaging agent
    The Journal of Nuclear Medicine, 1993
    Co-Authors: Brian Higley, F W Smith, Terry Smith, H G Gemmell, Prabir Das Gupta, Dragouten V Gvozdanovic, David Hinge, J Davidson, David I Graham, A Lahiri
    Abstract:

    A novel 99mTc complex (1,2-bis[bis(2-ethoxyethyl)phosphino] ethane, 99mTc-Tetrofosmin) has been developed to replace 201Tl in myocardial perfusion imaging. Biodistribution, safety and dosimetry of 99mTc-Tetrofosmin were studied in 12 male volunteers, each at rest and during exercise. Safety parameters measured to 48 hr postinjection revealed no clinically significant long-term drug-related changes. Biodistribution was studied by acquiring whole-body or serial static images up to 48 hr postinjection. Technetium-99m-Tetrofosmin shows good heart uptake (1.2%) with retention. Clearance is excellent from blood (< 5% by 10 min), liver (< 4.5% by 60 min) and lung. Sequestration of activity by skeletal muscle is enhanced during exercise. Radiation dosimetry calculations indicate that the effective dose, assuming a 3.5 hr bladder voiding period, is 32.9 x 10(-3) rad/mCi (8.9 x 10(-3) mSv/MBq) at rest and 26.7 x 10(-3) rad/mCi (7.1 x 10(-3) mSv/MBq) after exercise. Technetium-99m-Tetrofosmin can produce high quality myocardial images from 5 min to several hours postinjection.

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