|Year : 2011 | Volume
| Issue : 5 | Page : 55-58
|Date of Web Publication||9-Dec-2011|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Miscellaneous. Indian J Nucl Med 2011;26, Suppl S1:55-8
Analysis of quantitative parameters and its comparison, between physical and pharmacological stress, obtained on myocardial perfusion spect imaging
Prafful Jatale, Ramesh Asopa, Sandip Basu
Radiation Medicine Center, B. A. R. C., Tata Memorial Centre Annexe, Parel, Mumbai, India
Introduction: ECG-gated myocardial perfusion SPECT is now routinely used to assess, in addition to myocardial perfusion, global and regional left ventricular function. The main parameter of global function that is measured is left ventricular ejection fraction. Other important parameters of global function that are measured are end-diastolic volume, end-systolic volume, stroke volume and myocardial mass. For assessment of regional LV function both myocardial wall motion and wall thickening are determined (1). Here, we review the parameters and compare it between physical and pharmacological stress, obtained on myocardial perfusion SPECT imaging (ECTB SOFTWARE)". Objective: To study the quantitative parameters such as LVEF, EDV, ESV and SV obtained on Gated MPI SPECT on ECTB software and compare them (fall in quantitative parameters) in patients undergoing physical stress with those who had undergone pharmacological (adenosine) stress myocardial perfusion imaging. Materials and Methods: In this retrospective analysis, 130 patients (60 females, 70 males) who had undergone 99 Tc-Sestamibi myocardial perfusion imaging following physical stress pharmacological (adenosine) stress myocardial perfusion imaging were included. 60 patients (38 females, 22 males) were grouped in control category on the basis of the fact that there were no defects and no evidence of reversible ischemia seen on the rest and stress MPI. This was compared vis-a-vis another data of 70 patients (22 females, 58 male) having defects and reversible ischemia were grouped together (STUDY GROUP). Changes in quantitative parameters such as LVEF, EDV, ESV and SV obtained from ECTB SPECT software were compared between physical stress MPI and pharmacological stress MPI. Patients were grouped into three categories on the basis of Summed Difference score (SDS) GROUP 1:-SDS 1-4, GROUP 2:- SDS 5-8, GROUP:- 9 and above, depicting the extent of defects and reversible ischemia seen on rest and stress myocardial perfusion SPECT analysis. Student "t" test was applied on the given observations and p0 value less than <0.05 was considered significant difference between the means in two categories. Results: There was no significant difference in fall in quantitative parameters i.e LVEF, ESV and SV measurements between those who had undergone physical stress MPI versus those who had undergone adenosine stress MPI in control group i.e no defects and reversible ischemia except in EDV which showed significant difference. Conclusion: The present finding suggests that the fall in quantitative parameters from physical stress (exercise) and physical rest MPI and comparison with pharmacological stress MPI from pharmacological rest MPI show similar trend except in EDV which shows significant difference and the reason needs further elucidation which may make management change. It can be concluded that gated MPI SPECT (ECTB software) using both physical and pharmacological stress can be used to obtain reliable quantitative information about Left ventricle functioning.
Phytochemical screening, free radical scavenging and antioxidant effect of Solanum xanthocarpum
D Priya, P Aarthy, S Arokiya Raj
Department of Biotechnology, Veltech Hightech Dr. Rangarajan Dr. Sakunthala Engineering College, Avadi, Chennai, India
Introduction: Free radicals contribute to more than one hundred disorders in humans. Plant products or herbal extracts have been reported to be Radical Scavengers and inhibitors of Lipid Peroxidation The present study was designed to investigate the free radical scavenging potential of methanloic extract of Solanum xanthocarpum. Objective: To evaluate the free radical scavenging potential of Solanum xanthocarpus. Materials and Methods: The estimation was carried out by total antioxidant activity (thiocyanate method), diphenyl-picryl-hydrazyl (DPPH) assay and nitric oxide (NO) assay. Results: Of the present study disclosed that S. Xanthocarpum showed remarkable and concentration dependent free radical scavenging activity. Phytochemical analysis showed the presence of tannin, alkaloids, phytosteroids and carbohydrates. Conclusion: The present work indicated that the methanolic extract of Solanum xanthocarpum was capable of scavenging the free radicals, suggested the potential antioxidant effect.
Patterns of salivary scintigraphy and correlation with duration of symptoms in Sjogren's syndrome
Rahul Parghane, Kashyap Raghav, Kuruva Manohar, Aman Sharma 1 , Anish Bhattacharya, BR Mittal
Departments of Nuclear Medicine, Internal Medicine 1 , PGIMER, Chandigarh, India
Introduction and Objective: This retrospective study was carried out to analyze the patterns of Tc99m salivary scintigraphy in patients with Sjogren's syndrome according to duration of symptoms. Materials and Methods: Retrospective analysis of scintigraphy data of 40 patients who underwent salivary scintigraphy as a part of investigative work up of Sjogren's syndrome was done. Patients were divided into two groups based on durations of symptoms of dry mouth into early group (less than an year) and delayed group (more than an year). All the included patients underwent dynamic salivary scintigraphy after injection of 10 mCi of Tc99m with lemon juice administered 20 min after the dynamic study and the study continued for 10 more minutes. Patterns of uptake and drainage were interpreted by both qualitative and quantitative analyses for four major salivary glands. Results: Total of 40 patients (36-female and 4 male) were included in this study. Age ranged from 17-71 years with a mean of 46.7 years. 19 patients included had early stage disease and 21 patients had delayed stage of disease. 35/40 patients had abnormal salivary scintigraphy and 5 had normal scintigraphic findings on both qualitative and quantitative analysis (all the five patients being in early stage of disease). Parotid gland involvement was noted in 2/19 patients with early stage disease with asymmetric involvement noted in one patient, whereas in patients with delayed stage of disease parotid gland involvement was noted in 10/21 patients. Submandibular gland involvement was noted in 8/19 patients with early stage disease and in 15/21 patients with delayed stage of disease. Abnormal patterns of salivary scintigraphy were more commonly observed in submandibular glands than parotid glands in early stage of disease. In later stage of disease both parotid and submandibular salivary gland involvement was observed. Thus, salivary scintigraphy findings represent the natural course of Sjogren's syndrome as parotid gland involvement by autoimmune process occurs in later stage of disease. Conclusion: Submandibular glands are involved more commonly and early during course of disease in patients with Sjogren's syndrome. Moreover submandibular gland involvement is usually symmetrical. Parotid gland involvement more commonly occurs during later stage of disease and tends to be asymmetrical in few patients. These salivary scintigraphy findings reflect natural course of disease process. Knowledge of these patterns of involvement helps in better interpretation of the studies.
Analysis of team viewer software for PET / SPECT images by receiver operating characteristic curves
Balakrishnan Santhanaraj, K Poovendiran
Velalar College of Engineering and Technology, Erode, India
Introduction: Teamviewer software is a powerful tool in networking different PCs and gives a secure platform for data access globally via internet. Simultaneous data transfer and access between the networked PC opened a new style of managing the work at convenient. It has wide application and being used by millions. However it is not explored in medical field particularly in the imaging owing to its poor quality in the image display in the earlier versions. The recent version Teamviewer 6 provides better image quality. The potential applications of image data transfer and image data access at remote location instantaneously is not much studied in medical field. PET/SPECT provides 2D / 3D images of internal organs based on physiology. They are very sensitive and due to improvements in radiopharmaceuticals, their specificity is commendable. ROC analysis is considered the most reliable method for evaluating the diagnostic ability of the medical images. Objectives: The objective of the study is to access the nuclear imaging data from remote location through team viewer software and analyze the accuracy by ROC analysis. Materials and Methods: The SPECT/PET images are obtained by phantom studies mimicking the real diagnostic situation and also various normal and patient images viz. planner, tomography and cine. The images are accessed from remote location through teamviewer software with different versions including the current version 6. The images were accessed and studied at the remote PCs as well as from the neighboring computer systems across various browsers viz Internet Explorer, Mozilla Firefox, Google Chrome and Opera. The studies were also carried out with the different internet service providers, BSNL, Airtel, and Reliance. The images accessed were studied by ROC analysis. Results and Conclusion: The images accessed through teamviewer version 6 shows good images for reporting where as the earlier versions show blurred images with horizontal grid lines. The image intensity at remote PCs are slightly reduced which can be increased by increasing the intensity settings of it. The data transfer / access time is almost instantaneous with the current version of the teamviewer. By optimizing the PC performance and the internet parameters the nuclear images can be reported from anywhere. Further our study shows that the teamviewer could be useful for reporting any medical images thereby reducing the need of specialists' visits to the diagnostic centre for reporting. Multiple imaging centres could also be connected via teamviewer and from central facilities the diagnostic reporting as well as operation of the medical equipments are possible.
Estimation of left ventricular function and dyssynchrony using equilibrium radionuclide angiography in patients with right ventricular outflow tract pacing - A six month follow up study
Harmandeep Singh, Chetan Patel, Gautam Sharma 1 , Salman Salahuddin 1 , Vinay Kumar Bahl 1 , Arun Malhotra
Department of Nuclear Medicine, 1 Department of Cardiology, AIIMS, New Delhi, India
Introduction: Chronic right ventricular apical pacing is known to adversely affect left ventricular (LV) function due to abnormal electrical activation of the ventricles. Right ventricular outflow tract (RVOT) is being explored as an alternative pacing site, as it allows a more physiological activation of the ventricles. However, Studies have shown heterogeneous outcomes with RVOT pacing. Objective: We sought to have an objective assessment of LV function and dyssynchrony in patients with RVOT pacing using equilibrium radionuclide angiography (ERNA). Materials and Methods: Thirty three consecutive patients with permanent pacemakers in the RVOT position having normal LV function at baseline were enrolled. Sixteen of the 33 patients who completed 6 month follow up were included in the study. LV ejection fraction (LVEF) was obtained using ERNA during forced ventricular pacing at a rate of 100/min. Phase analysis using ERNA was used to evaluate the left intraventricular dyssynchrony quantitatively by measuring standard deviation of LV mean phase angle (SD LV mPA) which computes the degree of dispersion of LV contraction. LVEF and SD LV mPA were assessed 1 week after implantation and at 6-months follow up. Paced QRS duration on surface electrocardiogram was analyzed in all patients. Results: Mean age of the patients was 57.8±10.3 years (11 males). LVEF showed no significant difference at baseline and at 6 months (51.6% vs 52.9%, P-0.47). LV dyssynchrony at baseline by SD LV mPA (14.9±5.8°) worsened significantly at 6 months (16.5±5.4°) (P-0.05). Sub-group analysis was done based on paced QRS duration (pQRSd). 9/16 patients with pQRSd <130ms had no difference in LVEF and dyssynchrony at baseline and 6 months (LVEF-51.2% vs. 54.6%, P-0.18; SD LV mPA-14.1° vs. 14.4° , P-0.75). In the 7/16 patients with pQRSd >130ms, LVEF was not significantly different at baseline and follow up (52.1% vs 50.7%, P-0.56), but dyssynchrony significantly worsened over 6 months (15.9° vs. 19.1°, P-0.01). Conclusion: RVOT pacing results in preservation of LV function at 6 months as assessed by ERNA. However, LV dyssynchrony worsens with time in patients with broader paced QRS duration.
Development of IRMA for serodiagnosis of human C-peptide
Rasmi RR, KB Shenoy, Jayula Sarnaik 1 , VB Kadwad 1 , HM Somashekarappa, N Sivaprasad 1
Introduction: Centre for Application of Radioisotopes and Radiation Technology, Mangalore University, Mangalagangothri, 1 Radiopharmaceuticals Production Programm, Board of Radiation and Isotope Technology, BRIT, Vashi Complex, Sector 20, Vashi, Navi Mumbai, India
Quantitative measurement of C-peptide in human serum is widely used as a marker of insulin secretion in patients with diabetes mellitus. In cases where insulin levels are not helpful due to interference by exogenous insulin or insulin antibodies often present in patients on insulin therapy, the determination of C-peptide provides an accurate assessment of residual endogenous insulin secretion Furthermore, though Insulin and C-Peptide are secreted into portal circulation in equimolar concentrations the metabolic clearance rate for C-peptide is quite low compared to insulin which gets rapidly removed from the circulation. The aim of the present work was to develop an Immunoradiometric assay (IRMA) for estimation of C-peptide in human serum. The developed assay makes use of a pair of monoclonal antibodies from commercial sources, screened and epitopically matched along with ready-to-use C-peptide standards (0-30 ng/mL) to cover diagnostically relevant range. Materials and Methods: Monoclonal antibody for C-Peptide, identified as capture antibody was covalently linked to magnetizable cellulose manufactured and patented by BRIT. Immobilization of the antibody on magnetizable cellulose was carried out by carbonyldiimidazole method. Other monoclonal antibody for C-peptide, identified as detector antibody was radioiodinated with 125 I using chloramine-T oxidation method and purified by gel filtration to obtain a tracer with specific activity of about 12 μCi/ μg. A set of seven C-peptide standards in charcoal treated bovine serum containing sodium azide were prepared with following concentrations: 0, 0.3, 1.2, 6, 12, 18 and 30 ng/L. In brief the optimized assay protocol makes use of 200 μl of standard/sample, 100 μl of 125 I labelled anti C-Peptide monoclonal antibody and 100 μl anti C-peptide monoclonal antibody coupled to magnetizable cellulose with overnight incubation at room temperature with shaking. At the end of the incubation, the tubes were placed on a magnetic rack for 20 minutes after the addition of wash buffer and decanted. The wash procedure was repeated and finally the tubes were counted for one minute in a γ counter calibrated for 125 I. The developed assay procedure was validated statistically by studying assay parameters such as precision profile, assay variations, analytical recovery etc. Results: Different dilutions of the anti C-peptide antibody coupled to magnetizable cellulose were tested with the 125 I- anti C-peptide antibody. 1:2 and 1:4 diluted magnetic particles gave maximum binding (%B/T for 20ng/ml) of 33% and 29% respectively. Hence, dilution of 1:3 was selected for the further study. Sensitivity of the assay was found to be 0.17ng/ml. The intra assay and inter assay variations were found to be less than 8% and 10% respectively. The recovery varied from 90% to 115%. Parallelism of the C-peptide standard concentration varied linearly between 89% to 114% with one-fold, four-fold and eight-fold dilution. The second wash resulted in better precision and sensitivity. Conclusion: The developed assay system with sensitivity of 0.17 ng/mL and standard range of 0-30 ng/mL can be used for regular sample analysis of C-peptide in human serum.
Dacryoscintigraphy: A valuable tool in management of epiphora
Santhi Bhushan Murari, Tejonath G, Ranadheer, VVS Prabhakar Rao
Department of Nuclear Medicine, Nizam's Institute of Medical Sciences, Hyderabad, India
Introduction: Epiphora is one of the common symptoms encountered in clinical ophthalmology and is usually due to an obstruction of the lacrimal drainage apparatus. Epiphora without hyper secretion and normal findings on syringing test is usually due to functional lacrimal duct obstruction. We evaluated the possible clinical role of dacryoscintigraphy as an easy and non-invasive method in the diagnosing etiology of epiphora. Objective: To study the utility of dacryoscintigraphy regarding surgical decision making in patients with epiphora. Materials and Methods: 40 patients mean age of 35 years comprising of 23 male and 17 female patients presenting with epiphora were evaluated using 4MBq of Tc99m-DTPA dacryoscintigraphy. High specific activity Tc99m-DTPA was instilled into both eyes and anterior planar images in sitting position were acquired at 1 frame per minute for 30 minutes and followed by delayed images at 45 min and 1hour. Tc99m-DTPA dacryoscintigraphy was done and compared pre and post therapeutic intervention. Results: Naso lacrimal duct (NLD) obstruction is a frequent cause of epiphora. A complete clinical examination and diagnostic evaluation is required to rule out other common causes of epiphora such as lower lid horizontal laxity or conjunctival inflammation. An accurate diagnosis is essential because the traditional treatment of nasolacrimal duct obstruction is surgical correction. Irrigation of the lacrimal system and dye testing has inherent limitation and are not physiological, but dacryoscintigraphy is physiological since it depicts the natural flow of tears better. We studied 40 patients with epiphora using Tc99m-DTPA dacryoscintigraphy, of which 24 patients had bilateral functional obstruction, 10 patients had unilateral naso lacrimal duct obstruction and 6 patients had bilateral naso lacrimal duct obstruction. Out of 24 patients with functional obstruction, 20 patients underwent silicon tube placement of which 18 showed improvement. Among 16 patients of Unilateral/Bilateral NLD obstruction, 14 underwent dacryocystorhinostomy of which 10 showed improvement in drainage. Conclusion: Dacryoscintigraphy is a useful diagnostic test to evaluate patients with epiphora and suspicious of functional naso lacrimal duct obstruction providing valuable independent information and also guides in accurate management decisions.
Sentinel lymph node detection by intra operative gamma probe
R Krishnakumar, GK Rangarajan, MC Vinod kumar, Bulkis Begum, Arasu, Sridevi 1 , N Kadiresan 1
Departments of Nuclear Medicine, 1 Surgical Oncology, Cancer Institute (WIA), Chennai, India
Introduction: A successful sentinel node biopsy procedure in melanoma or breast cancer patient requires an accurate map of the pattern of lymphatic drainage. Lymphoscintigraphy can provide such a map in each patient. This requires an understanding of lymphatic physiology, an appropriate small particle radio colloid, high resolution collimators and imaging protocols that detect all sentinel nodes in every patient regardless of their location. The sentinel node is not always found in the nearest node field and is best defined as "any lymph node receiving direct lymphatic drainage from a primary tumor site". Interval nodes are not uncommon as sentinel node especially on the trunk. In the breast although 94% of patients have a sentinel node in the ipsilateral axilla, 46% also have sentinel node outside the axilla, especially in the internal mammary region (40%). Micrometastatic disease can be present in any sentinel node regardless of its location and for the sentinel lymph node biopsy procedure technique to be accurate, a biopsy must be performed on all true sentinel nodes in every patient. Lymphoscintigraphy (LS) is an important first step to ensure that this goal is achieved. Objective: Sentinel Lymph Node Detection by intraoperative gamma probe, and by lymphoscintigraphy have helped us in more accurate and less unnecessary surgery and probably better patient survival. Materials and Methods: The technique requires one or more interstitial injection into appropriate tissue plane. We have done sentinel node biopsy procedure on 46 patients (44 patients with cancer breast and 2 patients with malignant melanoma). Blue dye was used along with isotope technique and for the sentinel lymph node biopsy procedure technique to be accurate, a biopsy must be done for all sentinel true nodes in every patient. Tc-99m Sulfur colloid was injected peritumorally and imaging done 45-90 minutes to look for axillary nodes in cancer breast and inguinal and popliteal nodes in melanoma of lower limb. The nodal areas with the tracer uptake were localized on the skin with marking pencil. Results: Out of 44 patients with cancer breast 12 patients showed metastases in the sentinel ndes and had routine axillary detection However in 4 patients sentinel node alone was positive. (Rest of the axillary nodes were negative). In 2 melanoma patients one had sentinel nodal metastases and had ilioinguinal block dissection. In the other patient sentinel node was negative for metastases and no further surgery was done. Conclusion: Preoperative lymphoscintigraphy with a small particle radiocolloids allows lymphatic vessel to be visualized draining directly to the sentinel nodes.
Initial data from a first PET/SPECT-CT small animal imaging system and its applications in preclinical studies
Pradip Chaudhari, Sandipto Ghosh, Saikat Nandy 1 , MGR Rajan 1
Small Animal Imaging Facility, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai, 1 Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Mumbai, India
Dedicated small animal imaging modalities such as microPET (Positron Emission Tomography), microSPECT (Single Photon Emission Computed Tomography) and microCT (X-ray Computed Tomography) are emerged for high resolution in vivo imaging to cater the need for preclinical research. Over the last couple of years molecular and functional imaging has become a powerful approach for studying spatial and temporal distribution of new drugs and their target affinity non-invasively in animal models. We have established a preclinical PET/SPECT-CT facility after obtaining the necessary regulatory approvals, GMI's FLEX Triumph trimodality PET/SPECT/CT platform from WIPRO GE, India was installed. This system is capable of imaging laboratory animals such as mouse, rat and hamsters; which are commonly used in cancer research as well as new drug discovery studies. We have performed several PET studies using 18 F-FDG, 18 F-FLT, 18 F-NaF, 18 F-MISO, 18 F-FAZA in normal and tumor bearing animals. Simultaneously several CT studies were performed utilizing various living and non-living subjects. These studies were carried out mainly for standardization of the various PET and CT imaging protocols and other related logistics such as anesthesia procedures (drugs and route), radiotracer dose calculations and dose administration and for ongoing research studies. Similarly several SPECT studies were performed using Tc99m, 177 Lu and 125 I for standardizing the protocols and ongoing research needs. Various software explored for data quantitation and analysis. PET-CT and SPECT-CT images of mice and rats were fused together for studying the tracer distribution on anatomical map.
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