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Background: Little is known about the pattern of isotope accumulation in the heart on 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography in patients with cardiac sarcoidosis (CS) complicated by ventricular aneurysm (VA).Methods and Results:We prospectively enrolled 82 consecutive patients with CS; 54 patients with active CS (presence of abnormal 18 F-FDG accumulation in the heart) were subdivided into VA (n=17) and non-VA groups (n=37). Strong 18 F-FDG accumulation surrounding the VA and its disappearance in the VA center was observed in all patients with VA, probably because of scar formation at the VA. Peak standardized uptake value was higher around the VA than in the VA center (5.1±2.1 vs. 2.2±0.6, P=0.0003) and the VA center had no 18 F-FDG accumulation (VA center: 2.2±0.6 vs. control area: 2.1±0.6, P=0.37). On the other hand, in non-VA patients with LV wall thinning (n=28), 18 F-FDG accumulation was significantly high, even in the area of LV wall thinning (LV wall thinning area: 3.1±0.8 vs. control area: 2.0±0.6, P=0.00002)., Conclusions: A pattern of strong 18 F-FDG accumulation surrounding the VA and its disappearance in the VA center might be characteristic in patients with CS complicated by VA. Careful attention to FDG uptake would further elucidate CS pathophysiology and aid in the early treatment of VA.

Objective: The purpose is to develop and evaluate the ability of the computer-aided diagnosis (CAD) methods that apply texture analysis and pattern classification to differentiate malignant and benign bone and soft-tissue lesions on 18F-fluorodeoxy-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) images., Methods: Subjects were 103 patients with 59 malignant and 44 benign bone and soft tissue lesions larger than 25 mm in diameter. Variable texture parameters of standardized uptake values (SUV) and CT Hounsfield unit values were three-dimensionally calculated in lesional volumes-of-interest segmented on PET/CT images. After selection of a subset of the most optimal texture parameters, a support vector machine classifier was used to automatically differentiate malignant and benign lesions. We developed three kinds of CAD method. Two of them utilized only texture parameters calculated on either CT or PET images, and the other one adopted the combined PET and CT texture parameters. Their abilities of differential diagnosis were compared with the SUV method with an optimal cut-off value of the maximum SUV., Results: The CAD methods utilizing only optimal PET (or CT) texture parameters showed sensitivity of 83.05 % (81.35 %), specificity of 63.63 % (61.36 %), and accuracy of 74.76 % (72.82 %). Although the ability of differential diagnosis by PET or CT texture analysis alone was not significantly different from the SUV method whose sensitivity, specificity, and accuracy were 64.41, 61.36, and 63.11 % (the optimal cut-off SUVmax was 5.4 ± 0.9 in the 10-fold cross-validation test), the CAD method with the combined PET and CT optimal texture parameters (PET: entropy and coarseness, CT: entropy and correlation) exhibited significantly better performance compared with the SUV method (p = 0.0008), showing a sensitivity of 86.44 %, specificity of 77.27 %, and accuracy of 82.52 %., Conclusions: The present CAD method using texture analysis to analyze the distribution/heterogeneity of SUV and CT values for malignant and benign bone and soft-tissue lesions improved the differential diagnosis on (18)F-FDG PET/CT images.

Unlabelled: The aim of this study was to evaluate impaired lung uptake of (123)I-metaiodobenzylguanidine ((123)I-MIBG) on SPECT, compared with perfusion SPECT and morphologic CT, in patients with pulmonary emphysema (PE)., Methods: (123)I-MIBG SPECT was performed at 15 min and 4 h after intravenous injection of (123)I-MIBG in 36 PE patients with a history of smoking and variable-extent low-attenuation areas on CT, indicative of emphysematous changes, and in 16 controls with no history of smoking and no noticeable low-attenuation areas. The distribution of (123)I-MIBG was compared with that of low-attenuation areas on CT and perfusion on SPECT at the base of the 180 lung lobes of the PE patients. Total-lung (123)I-MIBG kinetics were calculated, including early and delayed lung-to-mediastinum uptake ratios and washout rate., Results: The controls showed a fairly uniform lung (123)I-MIBG distribution nearly consistent with perfusion. PE patients had heterogeneous (123)I-MIBG defects showing frequent discordance with low-attenuation areas or perfusion distribution; (123)I-MIBG defects were more extensive than low-attenuation areas in 76 lobes (42.2%) of 31 patients (86%) and more extensive than perfusion defects in 44 lobes (24.4%) of 22 patients (61%). (123)I-MIBG defects were seen regardless of the absence of noticeable low-attenuation areas and perfusion defects in 19 lobes (10.5%) of 16 patients (44%). All total-lung (123)I-MIBG kinetic parameters in PE patients were significantly lower than the control values (P < 0.0001), with significant correlation with alveolar-arterial oxygen tension gradient but without correlation with the extent of perfusion defects or low-attenuation areas., Conclusion: (123)I-MIBG SPECT allows evaluation of lung pathophysiology in PE independently of perfusion SPECT or morphologic CT, and impairment of lung (123)I-MIBG uptake may be more extensive than perfusion or morphologic abnormalities in PE.

Background: The functional mechanism of lung mosaic computed tomography attenuation (MCA) in pulmonary vascular disease (PVD) and obstructive airway disease (OAD) has not yet been fully clarified., Purpose: To clarify the mechanism of MCA in these diseases by assessing the relationship between regional lung function and CT attenuation change at MCA sites with the use of automated deep-inspiratory breath-hold (DIBrH) perfusion single-photon emission computed tomography (SPECT)-CT fusion images and non-breath-hold Technegas SPECT., Material and Methods: Subjects were 42 PVD patients (31 pulmonary thromboembolism, four primary/two secondary pulmonary hypertension, and five Takayasu arteritis), 12 OAD patients (five acute asthma, four obliterative bronchiolitis, and three bronchiectasis), and 12 normal controls, all of whom had MCA on DIBrH CT. The relationship between regional lung function and CT attenuation change at the lung slices with MCA was assessed using DIBrH perfusion SPECT-CT fusion images and non-breath-hold Technegas SPECT. The severity of perfusion defects with or without MCA was quantified by regions-of-interest analysis., Results: On DIBrH CT and perfusion SPECT, in contrast to no noticeable CT attenuation abnormality and fairly uniform perfusion in controls, 60 MCA and 274 perfusion defects in PVD patients, and 18 MCA and 61 defects in OAD patients were identified, with a total of 77 ventilation defects on Technegas SPECT in all patients. SPECT-CT correlation showed that, throughout the 78 MCA sites of all patients, lung perfusion was persistently decreased at low CT attenuation and preserved at intervening high CT attenuation, while lung ventilation was poorly correlated with CT attenuation change. The radioactivity ratios of reduced perfusion and the intervening preserved perfusion at the 78 perfusion defects with MCA were significantly lower than those at the remaining 257 defects without MCA (P<0.0001)., Conclusion: Although further validation is required, our results indicate that heterogeneous pulmonary arterial perfusion may be a dominant mechanism of MCA in PVD and OAD.

In traditional pulmonary perfusion single photon emission computed tomography (SPECT), respiratory lung motion and cyclically varying changes in lung volume during image acquisition inherently degrade the image sharpness of ill-defined perfusion defects. However, because of the lack of an adequate fast imaging technique, perfusion SPECT has never been acquired under breathhold conditions, whereas breathhold images are commonly used for pulmonary magnetic resonance (MR) and computed tomographic (CT) images. Although a high-speed imaging technique combined with a multidetector SPECT system may enable SPECT images to be obtained during a short period of breathholding, image quality would be degraded owing to decreased radioactivity counts and increased statistical noise. To resolve this problem, we developed an innovative SPECT imaging technique using a triple-head SPECT system and the high-speed-detector rotation-multiplied projection (HSRMP) technique, where a single SPECT image was reconstructed from multiple respiratory dimensional breathhold projection data obtained at the same angle. HSRMP provided noiseless high-quality perfusion SPECT images by compensating for decreased radioactivity counts caused by high-speed imaging, and significantly improved image quality and perfusion defect clarity compared with traditional non-breathhold SPECT images.

Purpose: Respiratory gated perfusion single photon emission computed tomography (SPECT) was applied to reduce respiratory lung motion effects and to reliably assess perfusion impairment in various lung diseases., Methods: After injection of 259 MBq of 99mTc macroaggretated albumin (99mTc-MAA), gating was performed using a triple-headed SPECT unit connected to a physiological synchronizer in a total of 35 patients with either obstructive lung diseases (n = 14), pulmonary embolism (n = 8), small lung nodules (n = 7) or acute interstitial pneumonia (n = 6). Projection data were acquired in a 64 x 64 matrix, with 20 stops over 120 degrees for each detector with a preset time of 15 s for each stop. Inadequate data for the respiratory cycle were automatically eliminated. In addition to end inspiration images and end expiration images derived from 12.5% threshold data centred at peak inspiration and expiration for each respiratory cycle, respectively, an ungated image was obtained from full respiratory cycle data., Results: Gated images were completed for 13.7 +/- 1.8 min in all subjects. Although the total lung radioactivity of the gated images were reduced to approximately 13% of that of the ungated images, these gated images showed uniform perfusion in the unaffected lungs and visualized a total of 94 (21.9%) additional perfusion defects against 429 defects visualized on ungated images in 31 patients with focal perfusion defects. Among the perfusion defects visualized on both gated images, the defect size was occasionally larger on the end inspiration images. The end expiration images showed significantly higher lesion-to-normal lung radioactivity ratios compared with those on the end expiration and ungated images in the affected lower lungs throughout the lung diseases. Radioactivity changes per pixel between end inspiration and end expiration images in the affected lower lungs of the obstructive lung diseases were significantly lower compared with those of pulmonary embolism and acute interstitial pneumonia (P<0.0001 and P<0.01, respectively)., Conclusion: This technique appears to enhance the clarity of perfusion defects, and lung radioactivity changes between end inspiration and end expiration may characterize regionally impaired ventilation status.

This study was a preliminary evaluation of the utility of dynamic lymphoscintigraphy with technetium-99m human serum albumin (HSA) and a load produced by standing in the assessment of lymphatic dysfunction in patients with leg oedema. The 71 subjects investigated included 53 patients with lymphoedema, six with venous occlusion alone and five with lymphovenous occlusion, as well as seven normal subjects. After intradermal injection of 99mTc-HSA into an interdigital space in each foot, dynamic scintigrams were recorded with the patient supine for 15 min. The subjects then stood in place and images were recorded for an additional 15 min. Relative changes in lymphatic tracer transport before and after standing were analysed on time-activity curves (TACs). This test was compared with a conventional test in a supine position in six patients with lymphoedema, and was repeated in five other patients with lymphoedema. It was found that in the normal limbs, a standing load activated tracer transport to the draining lymphatic vessels, resulting in a rapid stepwise increase in tracer activity, large spiking waves and a decreasing phase following a peak in tracer activity on TACs. In 59 lymphoedematous limbs, including some with a mild form of oedema without morphological abnormalities on scintigrams, this load failed to induce a sufficient activation of tracer transport, and the frequencies of each of the three normally appearing changes described above significantly decreased compared with those in the 14 normal limbs (P < 0.0001, P < 0.01 and P < 0.0001, respectively). In addition, there were significant reductions in the relative increases in maximum activity and clearance times after standing (both P < 0.0001). These abnormalities significantly correlated with the grade of severity of oedema. Six limbs with lymphovenous occlusion showed significant reductions in tracer transport compared to six limbs with venous occlusion. Lymphatic dysfunction was accentuated more by this test than by the conventional test, and repeated tests showed consistent results in the same individuals. It is concluded that under a standardized load, this quick test seems of value in providing a sensitive and objective assessment of lymphatic dysfunction in the lower limbs, and is also advantageous for image interpretation since accelerated tracer transport clearly visualizes compromised lymphatics. This test may also be helpful in distinguishing purely venous oedema from mixed lymphovenous disease.

Unlabelled: The alteration of 99mTc-labeled diethylenetriaminepentaacetic acid (DTPA) transalveolar clearance in an initial phase of radiation lung injury was experimentally investigated., Methods: Fourteen dogs were irradiated to the hemithorax with a single dose of 20 Gy. A DTPA radioaerosol study was performed before irradiation and on day 12 after irradiation. On day 14, the DTPA study was repeated again, with seven animals undergoing the study after inhalation of an aerosolized synthetic surfactant. The penetration index (P.I.) and clearance half-time (T(1/2)) of DTPA were measured in each lung. To evaluate the changes in lung surfactant after irradiation, alveolar lipids were stained in the resected lungs (n = 14), and the amounts of alveolar surfactant phospholipid and protein were measured by a bronchoalveolar lavage study in another six irradiated dogs., Results: In all of the 14 irradiated animals, DTPA radioaerosol distributed uniformly throughout the lungs without significant changes in P.I. The T(1/2) values in irradiated lungs were significantly prolonged compared with the matched baseline values and those in nonirradiated lungs (P < 0.05 and 0.001, respectively). The aerosolized synthetic surfactant retarded the DTPA clearance both in the irradiated and in the nonirradiated lungs (P < 0.001) without significant changes in P.I. The histologic and bronchoalveolar lavage studies revealed an increase of alveolar surfactant materials in the irradiated lungs without substantial histologic changes in the alveolar structures., Conclusion: DTPA transalveolar clearance was retarded soon after irradiation. Increased alveolar surfactant may be partly responsible for this retarded DTPA clearance because the aerosolized synthetic surfactant also prolonged the clearance in nonirradiated lungs. A DTPA clearance test is sensitive for the early detection of radiation lung injury and seems helpful for clarifying the association of epithelial integrity changes and lung surfactant in radiation lung injury.

Abnormal hepatic haemodynamics and function in a 43-year-old woman with hereditary haemorrhagic telangiectasia (HHT) were evaluated using 99Tcm-phytate angiography and iodine-123-iodoamphetamine transrectal portal scintigraphy. Radionuclide angiography demonstrated hyperdynamic perfusion of the liver owing to intrahepatic arteriovenous fistulae (AVF), entry of tracer into the systemic circulation through intrahepatic portosystemic shunts and an increase in recirculating blood flow caused by these vascular disorders. Heterogeneous distribution of tracer also suggested the presence of chronic hepatic injury. Transrectal portal scintigraphy showed large portosystemic shunts. Other imaging techniques confirmed the presence of the AVF but failed to identify the portosystemic shunts. Non-invasive radionuclide studies are helpful in the evaluation of hepatic involvement of HHT.

I-131 metaiodobenzylguanidine scintigraphy showed marked accumulation in the walls of a clinically silent, huge cystic adrenal mass with a prominent hemorrhage in a 48-year-old man. Although a careful reexamination of the histologic specimen finally lead to a diagnosis of pheochromocytoma, the appearances of this mass on computed tomography and magnetic resonance imaging were not specific for this neoplasm, and even pathologic analysis initially indicated, incorrectly, that this lesion was a hemorrhagic hemangioma. This case shows that I-131 metaiodobenzylguanidine scintigraphy is useful for correctly diagnosing an adrenal mass with prominent cystic or hemorrhagic degeneration.

The relationships between changes in myocardial uptake of metaiodobenzylguanidine (MIBG) and those in circulating catecholamines and cardiac function after treatment of phaeochromocytoma and neuroblastoma were evaluated. Iodine-123 or iodine-131 MIBG scintigraphy was performed before and after surgical resection and/or chemotherapy for primary tumours in nine patients with phaeochromocytoma and 13 patients with neuroblastoma. Changes in myocardial MIBG uptake after treatment were estimated by the heart-to-upper mediastinum (H/M) uptake ratios on the images obtained 24 h after MIBG injection, which were compared with serum levels of noradrenaline (NA) and adrenaline (A). Cardiac function was assessed by echocardiography, with measurements of the left ventricular ejection fraction (LVEF). Before treatment, eight patients with phaeochromocytoma and three with neuroblastoma showed poor myocardial MIBG uptake, with highly elevated circulating NA and A. Echocardiography, however, did not show cardiac dysfunction in these patients with the exception of two patients with phaeochromocytoma. With normalization of NA and A levels after treatment, all of these patients except for the two with persistent cardiac dysfunction showed restoration of myocardial MIBG uptake. The H/M ratios increased significantly after treatment in both patient groups, i.e. with phaeochromocytoma and with neuroblastoma (P<0.0001 and P<0.05, respectively), and these ratios correlated inversely with circulating NA and A before and after treatment. By contrast, there was no significant correlation between H/M ratios and LVEF in these two groups. These results indicate that suppression of myocardial MIBG uptake usually may not be related to cardiac dysfunction and may be reversible following normalization of excess catecholamine levels after treatment in patients with neuroadrenergic tumours. However, the suppression may persist in the presence of catecholamine-induced cardiac dysfunction. The assessment of myocardial MIBG uptake can be a helpful adjunct in monitoring the normalization of circulating catecholamine levels and also in identifying the presence of cardiac dysfunction in treated patients with neuroadrenergic tumours.

A 3-year-old child presented with severe type-7 adenoviral pneumonia, after the resolution of diffuse pulmonary infiltrates of the pneumonia. Xenon-133 ventilation and Tc-99-m macroaggregated albumin (MAA) perfusion studies revealed a localized airflow obstruction and matched perfusion defect, and marked air trapping in the remaining lungs, and these abnormalities were not detected and not suspected even with CT. Thereafter, in a relatively short period, the child developed persistent bronchiectatic changes and pulmonary hyperinflation throughout the lungs. However, the scintigraphic findings were not significantly changed. This is the first description of radionuclide scintigraphic findings which clearly showed an irreversible long-term functional effect of adenoviral pneumonia.

A 49-year-old woman with ovarian teratoma received 131I treatment three times for an unresectable mass containing malignant thyroid tissue after surgery. Repeated 131I treatment effectively reduced serum thyroglobulin (Tg) level and tumour uptake of 131I, despite absence of any change in size of the treated tumour. Treatment did not inhibit the increase of serum CA-125 and tumour 201Tl uptake, associated with progression of a radioresistant intratumoral hyper-perfused tissue component, detected by colour Doppler ultrasound. Serum CA-125 level and tumour 201Tl uptake were not significantly changed despite temporary increases in serum Tg level after each 131I treatment. These observations indicate the importance of diagnostic measures using combined functional imaging and tumour markers in managing this rare tumour.

The potential of iodine-123 metaiodobenzylguanidine (MIBG) to detect functional abnormalities of the pulmonary neuroadrenergic system (PNS) in irradiated lung areas (ILAS) was preliminarily explored using single-photon emission tomography (SPET). The subjects included five healthy subjects and a total of 31 patients with peripheral-type lung cancer treated by radiation; 15 patients (group A) had received a dose of less than 36 Gy (mean +/- SD: 28.2 +/-6.2 Gy), and 16 patients (group B) had received a higher dose (mean +/- SD: 51.2 +/- 3.5 Gy) at the time of examination. MIBG SPET scans acquired 15 min and 3 h after injection were used to measure the MIBG uptake ratio (count ratio of the ILA to the contralateral non-ILA) and the clearance rate [percentage of (early counts - delayed counts)/early counts] from the ILAs without noticeable abnormal opacities on chest computed tomography scan. Lung perfusion changes were also assessed by technetium-99m macroaggregated albumin SPET. By contrast to the homogeneous MIBG uptake in the lungs of the healthy subjects, MIBG uptake was folcally decreased in correspondence with the ILAs in all patients, including 11 patients (73.3%) of group A with relatively preserved lung perfusion. The reduction MIBG uptake was significant (P<0.0001), and the MIBG clearance rate from the ILAs was also significantly faster than the clearance rates from the normal lungs and contralateral non-ILAs (both P<0.01). Group B patients showed significantly lower MIBG uptake and faster clearance from the ILAs than group A patients (P<0. 001 and P<0.05, respectively), although there was no significant difference in the clearance from the non-ILAs. Overall, MIBG uptake/clearance from the ILAs correlated significantly with the radiation dose in the 31 patients (r = -0.656; P<0.0001 and r = 0. 387; P<0.05, respectively). Perfusion changes were inversely correlated with the clearance from the ILAs (r = -0.432, P<0.05), but did not correlate with MIBG uptake. These preliminary results suggest that MIBG may have the potential to be a marker of abnormal functional status of the PNS produced by irradiation and may facilitate investigation of irradiation lung injury independently of morphological or lung perfusion changes.

Unusual, intense splenic radioactivity was seen on bone scintigraphy with Tc-99m HMDP in a 14-year-old boy with alveolar rhabdomyosarcoma complicated by disseminated intravascular coagulation. Abnormal splenic radioactivity was resolved after recovery from the disseminated intravascular coagulation. During treatment of disseminated intravascular coagulation and tumors, the patient received repeated blood transfusions, resulting in iron overload, but this did not prevent the abnormal splenic uptake from resolving. This case indicates that disseminated intravascular coagulation may be a cause of splenic accumulation of bone-seeking agents, and that abnormal splenic uptake can be resolved.

Two patients with multiple benign and malignant tumors associated with neurofibromatosis underwent radionuclide imaging with Tc-99m DTPA, Tl-201, and Ga-67. In these patients, Tc-99m DTPA accumulated intensively in both the benign and malignant tumors and localized and defined the extent of every tumor. In contrast, Ga-67 and Tl-201 uptake was seen only in focal areas of tumor where there was malignant transformation or at sites that showed progressive tumor growth. Tc-99m DTPA imaging accurately demonstrated areas of neoplastic involvement and identified the areas that would be seen with the other two tracers in individual tumors. Tc-99m DTPA may not always be used for the differential diagnosis of malignant and benign tumors of neurofibromatosis, but it can provide a reference pattern for imaging to evaluate accurately the distribution of Tl-201 and Ga-67 by mapping out the anatomic extent of these tumors.

Splenic inflammatory pseudotumor is extremely rare and may mimic splenic neoplasms, such as lymphomas or hamartomas, clinically and radiologically. A case of a surgically proved splenic inflammatory pseudotumor is presented in which Tc-99m colloid SPECT and Ga-67 scintigraphy characterized the changes in the spleen, but the findings of ultrasound and unenhanced CT and MRI were nonspecific. This report indicates the utility of radionuclide imaging for diagnosing splenic inflammatory pseudotumor.

We report on six patients with chronic pulmonary embolism who underwent 123I-IMP and 99Tcm-MAA lung SPET before and after thromboendarterectomy. 123I-IMP lung SPET can assess the viability of lung parenchyma, because it is a non-particulate agent that accumulates in the endothelial membranes of pulmonary capillaries. Chronic pulmonary thromboembolism accompanied by pulmonary hypertension has a poor prognosis that may be improved only by thromboendarterectomy. We compared 123I-IMP and 99Tcm-MAA lung SPET in terms of functional improvement after such surgery. After thromboendarterectomy, all six patients were functionally improved, according to the criteria of the New York Heart Association. The pre- and post-surgery percentage of vascular obstruction did not differ significantly with 99Tcm-MAA lung SPET (44.8 +/- 11.2% and 32.5 +/- 15.6% pre- and post-surgery, respectively). In contrast, 123I-IMP lung SPET revealed a significant pre- versus post-surgery difference (15.5 +/- 9.5% and 3.3 +/- 5.9% pre- and post-surgery, respectively). 123I-IMP lung SPET could be useful for evaluating thromboendarterectomy because pulmonary parenchymal viability owing to arterial microvasculature can be estimated.

This paper describes abnormal brain perfusion unexpectedly demonstrated by Tc-99m MAA total-body imaging in two children with intracardiac right-to-left shunt (RLS) associated with complex congenital heart disease. One child was a 12-year-old girl with asplenia cardiac syndrome and multiple cerebral infarctions caused by thromboembolism in the internal carotid artery, and the other child was a 6-month-old boy who developed focal cerebral infarction following shunt operation. In both children, the total-body imaging depicted the brain due to RLS, where radioactivity decreased unilaterally in the cerebral hemisphere. In the first patient, radioactivity also decreased in the contralateral cerebellum, suggesting the crossed cerebellar diaschisis phenomenon. These abnormalities in brain perfusion were confirmed by Tc-99m HMPAO brain SPECT. Careful review of the distribution of the radiotracer in the depicted brain on Tc-99m MAA total-body imaging may provide important information regarding brain perfusion in some patients with a high risk of stroke complication associated with RLS.

The cases of two patients with surgically proven splenic hamartomas with "hot spots" on Tc-99m phytate SPECT imaging are presented. There was intense radiocolloid accumulation in the peripheral portion of a large single tumor in one patient, and in each of three isolated tumors in the other patient. The intense uptake might be related to the function of proliferated reticuloendothelial cells in the tumors. These unique findings were not clearly identified on the planar images.

Unlabelled: To establish the effect of an aerosolized synthetic surfactant (Exosurf) on pulmonary 99mTc-diethylenetriamine pentaacetic acid (DTPA) aerosol deposition and clearance, radioaerosol studies were performed at varying times and under varying conditions after surfactant inhalation in canine lungs., Methods: Twenty-three dogs had a baseline 99mTc-DTPA study; 2 days later the study was repeated after inhalation of a 1.5-ml/kg dose of Exosurf aerosolized by an ultrasonic nebulizer. The clearance half-time (T1/2) of 99mTc-DTPA from each lung was measured at different times (from 10 min to 3 hr) after Exosurf inhalation. For comparison, five animals had a 99mTc-DTPA study 10 min after inhalation of the same dose of saline as Exosurf. An additional five animals inhaled a 99mTc-DTPA-Exosurf mixture to investigate the distribution of Exosurf., Results: Technetium-99m-DTPA distributed uniformly without significant changes in penetration indexes before and after inhalation of Exosurf and the 99mTc-DTPA-Exosurf mixture. After Exosurf inhalation, 99mTc-DTPA clearance at 10 min (T1/2; 35.6 +/- 8.7 min; n = 6) and 40 min (29.4 +/- 6.3 min; n = 4) was significantly prolonged compared with the matched baseline values (24.7 +/- 6.4 min, p < 0.0001; and 21.7 +/- 8.9 min, p = 0.01, respectively). However, later clearance times were not prolonged. By contrast, after saline inhalation, 99mTc-DTPA distributed inhomogeneously, and clearance times T1/2) were not altered from the matched baseline values., Conclusion: Aerosolized Exosurf distributes homogeneously in the lungs. Exosurf initially retards 99mTc-DTPA aerosol clearance, but 99mTc-DTPA transalveolar clearance returns to baseline rates within 1-2 hr. Technetium-99m-DTPA aerosol clearance measurements can be used to monitor the effect of inhaled Exosurf on pulmonary epithelial integrity.

The findings of radionuclide studies in two adult men with systemic arterial supply to the basal segment of the left lung without sequestration are reported. Radionuclide angiography with Tc-99m human serum albumin-diethylenetriamine showed that the lung was perfused by the systemic circulation rather than by the pulmonary artery. Ventilation and perfusion scans with Xe-133 and Tc-99m MAA showed a V/Q mismatch in this area, suggesting the presence of normal bronchial communication without a pulmonary arterial supply. These results also suggest the presence of a left-to-left shunt in the well-ventilated lung in this area. MRI and conventional angiography showed an aberrant artery arising from the descending thoracic aorta, supplying the basal segment of the left lung without a pulmonary artery. In both patients, left lower lobectomy showed normal alveobronchial structures without sequestration. Radionuclide angiography and ventilation/perfusion imaging appear to be reliable noninvasive methods for diagnosing this rare anomaly with a left-to-left shunt.