Our purpose was to assess the clinical value and additional benefit of fusion single-photon computed tomography (SPECT) and computed tomography (CT) images in locating the parathyroids in a selected group of patients affected by primary (PHP) and secondary hyperparathyroidism (SHP).

PURPOSE:Brain perfusion abnormalities have recently been demonstrated by single-photon emission computed tomography (SPECT) in rare cases of severe Hashimoto's thyroiditis (HT) encephalopathy; moreover, some degree of subtle central nervous system (CNS) involvement has been hypothesised in HT, but no direct evidence has been provided so far. The aim of this study was to assess cortical brain perfusion in patients with euthyroid HT without any clinical evidence of CNS involvement by means of 99mTc-ECD brain SPECT. Sixteen adult patients with HT entered this study following informed consent.METHODS:The diagnosis was based on the coexistence of high titres of anti-thyroid auto-antibodies and diffuse hypoechogenicity of the thyroid on ultrasound in association with normal circulating thyroid hormone and TSH concentrations. Nine consecutive adult patients with non-toxic nodular goitre (NTNG) and ten healthy subjects matched for age and sex were included as control groups. All patients underwent 99mTc-ECD brain SPECT. Image assessment was both qualitative and semiquantitative. Semiquantitative analysis was performed by generation of four regions of interest (ROI) for each cerebral hemisphere--frontal, temporal, parietal and occipital--and one for each cerebellar hemisphere in order to evaluate cortical perfusion asymmetry. The Asymmetry Index (AI) was calculated to provide a measurement of both magnitude and direction of perfusion asymmetry.RESULTS:As assessed by visual examination, 99mTc-ECD cerebral distribution was irregular and patchy in HT patients, hypoperfusion being more frequently found in frontal lobes. AI revealed abnormalities in 12/16 HT patients, in three of the nine NTNG patients and in none of the normal controls. A significant difference in the mean AI was found between patients with HT and both patients with NTNG (p<0.003) and normal controls (p<0.001), when only frontal lobes were considered.CONCLUSION:These results show the high prevalence of brain perfusion abnormalities in euthyroid HT. These abnormalities are similar to those observed in cases of severe Hashimoto's encephalopathy and may suggest a higher than expected involvement of CNS in thyroid autoimmune disease.

Objective. Since brain perfusion abnormalities have been described by single-photon emission computed tomography in some autoimmune diseases, the aim of the present study was to evaluate the incidence of perfusion abnormalities by brain single-photon emission computed tomography in a group of coeliac disease patients, and to investigate whether gluten intake and associated autoimmune diseases may be considered risk factors in causing cerebral impairment.Methods. Thirty-four adult coeliac patients (16 on a gluten-free diet and 18 on a gluten-containing diet, 18 (53%) with autoimmune diseases) underwent Tc-99m-ethyl cysteinate dimer brain single-photon emission computed tomography and qualitative evaluation of brain perfusion was performed together with a semi quantitative estimation using the asymmetry index. Ten subjects on our database, matched for sex, age and ethnic group, who were proved normal by histology of jejunal mucosa (four males and six females; median age 39 years, range 27-55 years), were included as control group.Results. Twenty-four out of 34 patients (71%) showed brain single-photon emission computed tomography abnormalities confirmed by abnormal regional asymmetry index (>5%; range 5.8-18.5%). Topographic comparison of the brain areas showed that the more significant abnormalities were localised in frontal regions, and were significantly different from controls only in coeliac disease patients on unrestricted diet. The prevalence of single-photon emission computed tomography abnormalities was similar in coeliac disease patients with (74%) and without (69%) associated autoimmune disease.Conclusions. Abnormalities of brain perfusion seem common in coeliac disease. This phenomenon is similar to that previously described in other autoimmune diseases, but does not appear to be related to associated autoimmunity and, at least in the frontal region, may be improved by a gluten-free diet. (C) 2004 Published by Elsevier Ltd. on behalf of Editrice Gastroenterologica Italiana S.r.l.

OBJECTIVES:The purpose of this study is to evaluate the efficiency of a few methodologies in detecting anatomo-functional brain abnormalities in patients with Wilson's disease.MATERIALS AND METHODS:Twenty-three patients with Wilson's disease underwent almost simultaneously brain magnetic resonance imaging (MRI), computerized electroencephalography (EEG), multimodal evoked potentials (EPs) and ECD single photon computerized tomography (SPECT) evaluation. The clinical picture was of the neurologic type in 8 patients and of the hepatic type in 15.RESULTS:MRI was abnormal in 7 patients with neurological manifestations. The EPs proved pathologic in 7 neurologically symptomatic patients and in 4 cases with hepatic form. These results agree with those reported in other case studies. The EEG records were abnormal only in 3 cases. Nevertheless, the most interesting finding of this study is the particular frequency (86%) of diffuse or focal decrease of ECD uptake shown by brain SPECT.CONCLUSION:We highlight the use of this interesting procedure in the therapeutic monitoring of this disease.

Background: Nerve growth factor (NGF), a neurotrophic factor that indirectly induces fibroblast proliferation and collagen production, has been found to be increased in the affected dermis of patients with systemic sclerosis (SSc). To investigate the possibility of a relationship between cutaneous NGF production and pulmonary damage in SSc, we studied seven non-smoking scleroderma patients. Methods: Abnormalities in lung structure were assessed by radiological lung examination, and pulmonary epithelial permeability (PEP) was determined by ventilation lung scintigraphy. All patients underwent skin punch biopsy with NGF immunohistological staining. Results: A statistically significant correlation was found between the PEP values and the cutaneous NGF staining scores, which were markedly increased in all of the patients examined, irrespective of the age, disease duration, or radiologically defined lung abnormalities. Conclusion: These results support the hypothesis that functional and anatomical changes in SSc target organs may be determined by a local tissue hyperproduction of NGF.

Double-phase Tc-99m-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy has been proposed to detect hyperplastic parathyroid tissue, but the clinical usefulness of this technique in secondary hyperparathyroidism is still debated. Methods: Technetium-99m-MIBI parathyroid scintigraphy associated with parathyroid echography and [Tc-99m]pertechnetate thyroid scans were performed on 38 patients with chronic renal failure (CRF) and secondary hyperparathyroidism. In all patients, serum calcium, phosphorus, FT3, FT4, TSH, calcitonin and intact PTH (IPTH) were determined. Nine patients eventually underwent neck exploration and 28 parathyroid glands were removed. Results: Thyroid diseases were excluded in all patients. Echography revealed parathyroid enlargement in 22/38 (58%) patients, while MIBI scintigraphy was positive in 28/38 (74%), including 5-ectopic glands. Mean serum IPTH concentration was significantly higher in MIBI-positive patients compared to MIBI-negative patients. Mean echographic and surgical parathyroid size were significantly higher in MIBI-positive glands compared to MIBI-negative glands, but several discrepancies were observed in single patients. A significant positive correlation between serum IPTH and gland size was observed when MIBI-positive, but not MIBI-negative, parathyroids were considered. A paradoxical positive correlation between serum calcium and IPTH concentrations was found in MIBI-positive patients. Conclusion: Double-phase Tc-99m-MIBI scintigraphy is positive in the majority of patients with uremic hyperparathyroidism. Comparison of scintigraphic data with morphological and functional data strongly suggests that (TC)-T-99m-MIBI scans do not reveal simple parathyroid enlargement but rather, identify the presence of hyperfunctioning (autonomous) parathyroid tissue suggestive of tertiary hyperparathyroidism.

Clinical picture of adult's celiac disease (CD) may be protean, including both organic and functional disturbances such as dyspeptic symptoms that may in part be ascdbed to associated gut dismotility.We studied upper digestive function in 10 consecutive celiac patients (8 F, 2 M; age range 20-64 yr), diagnosed according to Marche's criteria, following a free diet and complaining of dyspepsia.40% had sporadic dysphagia and one als0 had associated scleroderma.Esophageal 24 hour pH-metry, 99Tc Scintigraphic study of gastric emptying of liquid meal, esophageal and gastrointestinal (8 pts) manometric studies, and tests of autonomic function (hearth rate response to deep breathing, cough test, lying-tostanding and Valsalva manoeuvre, according to Ewing's criteria) were performed.Upper gut organic disease, gastric intraepithelial lymphocitic infiltration and Helicobacter pylori gastritis were excluded.Manometric studies were carried out by standard perfused system, and the gastrointestinal ones were conducted for 5 hours during fasting and 1 after feeding.As control group 33 healthy subjects of both sexes (age range 20-35 yr) were recruited.RESULTS: 50% of patients had esophageal motor abnormalities (nutcracker esophagus 20%, nonspecific disorders 20% and scleroderma 10%) and 30% had evidence of pathologic acid reflux.Analysis of gastro-intestinal tracings showed activity fronts (AF) in all subjects, but with a significantly reduced frequence of the antral component (1/8 vs 18/33, p< 0.01); their mean duration was reduced (3,5-,-0.9vs 6.9±1.4 min, p<0.01) and their recurrence was increased (1/195 vs 1/99 min, p<0.01).85% of patients displayed isolated or nonpropagated bursts and/or clusters of contractions (also present in the postprandial period in 3 subjects) and antral postprandial hypomotility.40% of patients showed delayed gastric emptying by scintigraphic study (7/2 > 100 mins) that correlated to manometric picture; 20% of patients had positive autonomic tests (score > 4).We conclude that in untreated CD upper gastrointestinal dismotilities are frequently present, and these may be ascdbed to a visceral neuropathy, although autonomic tests do not show a stdct concordance with the manometric ones.

We determined the tracheo-bronchial mucociliary clearance (MCC) in order to evaluate a possible impairment of this function in patients affected by Sjögren's syndrome (SS) with or without overt clinical symptoms of xerotrachea. The MCC was expressed as flow rate (mm/min) and studied in 22 non-smoking SS patients (10 pSS and 12 sSS) and in 8 control subjects by specifically adapted ventilation lung scintigraphy (VLS). The MCC in the control group was 5.9 +/- 1.1 mm/min. No values were produced for MCC in 16 SS patients (8 pSS and 8 sSS) in the time interval considered and were reduced in the remaining 6 SS patients (3.3 +/- 1.2 mm/min). In all nine cases with clinical evidence of xerotrachea no values for MCC were obtained. A significant correlation was found between the MCC values and the rate of stimulated salivary excretion determined by dynamic scialoscintigraphy in the same patients (p < 0.001). These preliminary data show that the majority of SS patients studied presented with MCC impairment, always found when clinical symptoms of xerotrachea were present.

Sonographic images of liver hemangioma are not specific. Causal detection imposes further investigations (angiography, CT, NMR) which are not always practicable. 99mTc-red blood cells study after 99mTc colloid liver scintigraphy has been already proposed. Ten patients with hepatic hemangiomas were evaluated by simplified, simultaneous in vivo double labelling of the reticuloendothelial system and red blood cells by means of successive i.v. injections of SnCl2, 99mTc colloid albumin and 99mTc-pertechnetate. Focal colloid defects filled with the labelled RBC were revealed in 9/10 liver hemangiomas. Angioscintigraphy showed decreased perfusion and RBC scintigraphy an increased blood volume in the focal colloid defects due to the hemangiomas.

The authors report on their experience with liver hemangioma (LH) diagnosis by means of a simplified method--that is, the simultaneous, in vivo, double labelling of liver reticuloendothelial system (RES) and of red blood cells (RBC) by 99mTc. Twenty-eight patients with US diagnosis of suspected LH and 15 controls were examined after sequential iv injection of SnCl2, of 99mTc-mucolloid albumin and, after liver scintigraphy, of 99mTc-pertechnetate to conclude in vivo RBC labelling. All patients underwent CT and, if necessary, CT-guided biopsy. Focal colloid defects filled after RBC labelling were shown in 20/22 patients with unquestionable LH. No colloid defects were shown in 6/28 cases (expansive process). 15/15 controls showed unchanged non-filling defects after double labelling. Finally, the authors point out that, in the diagnosis of LH, sequential double labelling of liver RES and RBC appears to be a quicker scintigraphic technique than conventional ones. Moreover, this technique has the same high specificity and sensitivity as more time-consuming ones.

The functional alterations in the digestive tract observable during diabetes mellitus are frequent albeit often asymptomatic. They affect several different districts and are still not clearly defined aetiopathogenetically. It was therefore decided to evaluate the gastric transit times of a balanced liquid meal labelled with 99-Tc-colloidal sulphide in a group of patients suffering from insulin-dependent diabetes and in a group of 10 controls. The anatomical integrity of the oesophago-gastro-duodenal tract has been evaluated by endoscopy and histology. Transit times (T/2) proved significantly increased in diabetics (92.38 +/- 33.397 minutes) compared to the controls (48.63 +/- 16.423 minutes), p 0.001. No correlation was observed between gastric transit times, duration of the diabetic disease, degree of glyco-metabolic compensation and presence of autonomous neuropathy.

The Technetium Articular Index (TcAI) is regarded as a parameter of local inflammation in rheumatoid arthritis (RA). We studied TcAI behaviour during 1-year chrysotherapy in a group of fifteen RA patients. In non-responders TcAI showed a gradual decrease up to the 6th month and a return to baseline values within the second semester of the follow-up; conversely, in response patients TcAI remained unchanged during the entire period of the study, thus showing a paradoxical behaviour probably depending on the recovery of normal physical ability and articular activity.