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Biomedical subjects

M C Gilardi

Publications and source records attributed to M C Gilardi.

At least 55 records · Page 3Linked to original sources

Intrapleural fluid movements described by a porous flow model.

We injected technetium-labeled albumin (at a concentration similar to that of the pleural fluid) in the costal region of anesthetized dogs (n = 13) either breathing spontaneously or apneic. The decay rate of labeled activity at the injection site was studied with a gamma camera placed either in the anteroposterior (AP) or laterolateral (LL) projection. In breathing animals (respiratory frequency approximately 10 cycles/min), 10 min after the injection the activity decreased by approximately 50% on AP and approximately 20% on LL imaging; in apneic animals the corresponding decrease in activity was reduced to approximately 15 and approximately 3%, respectively. We considered label translocation from AP and LL imaging as a result of bulk flows of liquid along the costomediastinal and gravity-dependent direction, respectively. We related intrapleural flows to the hydraulic pressure gradients existing along these two directions and to the geometry of the pleural space. The pleural space was considered as a porous medium partially occupied by the mesh of microvilli protruding from mesothelial cells. Solution of the Kozeny-Carman equation for the observed flow velocities and pressure gradients yielded a mean hydraulic radius of the pathways followed by the liquid ranging from 2 to 4 microns. The hydraulic resistivity of the pleural space was estimated at approximately 8.5 x 10(5) dyn.s.cm-4, five orders of magnitude lower than that of interstitial tissue.

Animals↗

Normalisation and reconstruction of PET data acquired by a multi-ring camera with septa retracted.

Emission scan data acquired by a multi-ring PET camera operated with septa retracted must be corrected for (1) geometrical and detector sensitivity variations between the different lines of response (normalisation), (2) photon attenuation, and (3) mispositioned events due to photon scattering. These corrections must be applied to the full 3-D set of lines of response before reconstruction. The standard normalisation and attenuation correction procedures for 2-D scans increase the statistical noise in the emission scan, a problem which becomes even more serious in 3-D because of the large number of LORs involved (approximately 8 million). This paper will describe a fully 3-D reconstruction algorithm for multi-angle PET data incorporating a practical normalisation and attenuation correction procedure which minimises the increase in emission scan statistical noise. The correction factors are derived from 2-D, septa extended scans. The algorithm is currently used to reconstruct 3-D emission data from an ECAT 953B, a sixteen-ring PET camera with retractable septa.

Algorithms↗

In vivo metabolism and kinetics of 99mTc-HMPAO.

The cerebral distribution of 99mTc-labeled d, l, hexamethyl-propylene-amine-oxime (99mTc-HMPAO) as a function of rCBF and time was examined in rats and in man. The results of this study confirm that 99mTc-HMPAO is distributed in brain in proportion to rCBF. However, the rapid systemic breakdown of the tracer in blood results in considerable difficulties in the assessment of the arterial concentration of the parent compound; incomplete extraction of 99mTc-HMPAO from blood to brain and significant efflux from brain represent further limitations in the use of this tracer for quantification of rCFB. Despite these limitations 99mTc-HMPAO is of potential interest for a qualitative assessment of rCBF in specific clinical conditions.

Animals↗

Aspects of three dimensional reconstruction for a multi ring positron tomograph.

An important feature of multi ring positron tomographs is the inter plane septa, the purpose of which is to reduce random and scattered coincidences. In general, such septa also eliminate the coincidence lines of response between pairs of detectors more than one ring apart. The operation of a camera without septa must result in an increase not only in the true coincidence rate, but also in the singles, and therefore in the dead time and randoms rate, and in the scattered coincidences. A configuration option in the coincidence hardware of the 8 ring, 15 slice ECAT 931/08-12 enables a full set of 64 sinograms to be acquired when the septa are removed. The detector normalisation and transmission data for studies with the septa out can be obtained using a rotating pin source. To take maximum advantage of the additional signal, the emission data must be reconstructed using a fully three dimensional reconstruction algorithm. This paper presents an analysis of some phantom studies acquired without septa and reconstructed in three dimensions. The results are compared with data acquired with septa for the same phantoms imaged under similar conditions. It is found that, with the septa removed, the signal to noise for a uniform, 20 cm diameter cylinder improves by a factor of 2.8 in the centre of the field of view, whereas in regions distant from the centre in the axial direction, the signal to noise decreases due to the increase in scatter and randoms. An improvement in signal to noise is observed in 6 cm of the 10 cm axial length of the tomograph.

Image Processing, Computer-Assisted↗

Remote effects of subcortical cerebrovascular lesions: a SPECT cerebral perfusion study.

The remote effects of small unilateral cerebrovascular lesions confined to subcortical structures were evaluated by single photon emission computerized tomography (SPECT) and a CBF tracer, I-123 HIPDM. A CBF study was performed in 34 patients presenting with subcortical stroke either in the acute or in the chronic stages. Twenty-one of the 34 patients showed areas of cortical hypoperfusion ipsilateral to the subcortical lesion. In 14 patients, asymmetry of perfusion was also observed at the cerebellar level, perfusion being significantly reduced in the cerebellar hemisphere contralateral to the lesion. There was no correlation between the degree and extension of these remote effects and the type of stroke (ischemic or hemorrhagic), the patency of cerebral arteries, or the size and site of the lesion by transmissive computerized tomography (TCT). Subcortical hematomas showed a correlation between occurrence of remote effects and time interval from the onset of stroke, occurring more frequently in the acute phase. A correlation was observed between cortical and cerebellar remote effects and the severity of clinical presentation. The causes of remote effects are still unclear and have been extensively debated. Our data indicate that there is a relationship of remote effect to the neurological status. It is possible to show, by noninvasive, low-cost methods, remote CBF effects after stroke that may contribute to the assessment of brain functional impairment.

Acute Disease↗

Intrapleural liquid flow down a gravity-dependent hydraulic pressure gradient.

We studied the vertical movement of 2 mg technetium-labeled albumin injected intrapleurally in 0.5 ml saline (15% of pleural liquid volume) in eight spontaneously breathing anesthetized dogs subject to a sudden change in posture (prone to supine or vice versa). The albumin movements were evaluated through a large field gamma camera placed laterally to the animal and detecting total (AT) and regional activities from two superimposed equal areas (At and Ab, top and bottom, respectively). The At/Ab ratio decreased from 2.1 to 1.3 in four animals up to 20 min from the change in posture and from 0.9 to 0.5 in four more animals studied from 50 to 90 min from turning maneuver. The rate of change in At and Ab was similar in the two groups of animals and unaffected by the acquisition posture. AT decreased by 7.7 and 3.5% for the two groups, respectively, reflecting albumin clearance from the pleural space. The opposite time course of regional activities and the independence of their rate of change of the At/Ab ratio and of the animal posture suggest a top-to-bottom albumin transfer occurring through a bulk flow of liquid estimated at 0.006 ml.kg-1.h-1. The data are consistent with a measured vertical pleural liquid pressure gradient that does not reflect a hydrostatic condition.

Animals↗

Assessment and comparison of three scatter correction techniques in single photon emission computed tomography.

The detection of scattered radiation is recognized as one of the major sources of error in single photon emission computed tomography (SPECT). In this work three scatter correction techniques have been assessed and compared. Scatter coefficients and parameters characteristic of each technique have been calculated through Monte Carlo simulations and experimentally measured for various source geometries. Their dependence on the source/matter distribution and their spatial non-stationarity have been described. Each of the three scatter correction methods has then been tested on several SPECT phantom studies. The three methods provided comparable results. Following scatter compensation, both image quality and quantitative accuracy improved. In particular a slight improvement in spatial resolution and a statistically significant increase in cold lesion contrast, hot lesion recovery coefficient, and signal/noise ratio have been demonstrated with all methods.

Models, Structural↗

Abnormal cardiovascular response to exercise in young asymptomatic diabetic patients with retinopathy.

Heart rate, blood pressure, and left ventricular ejection fraction (LVEF) were measured by means of Au 195 m first-pass angiocardiography, during maximal supine bicycle exercise in 20 young asymptomatic patients with insulin-dependent diabetes (IDD) (10 retinopathic and 10 uncomplicated) and in 10 control subjects. Five patients with retinopathic IDD also had mild subclinical autonomic neuropathy. Exercise capacity was diminished, although not significantly, in patients with retinopathic IDD. Heart rate and LVEF were similar in all groups at rest and at submaximal exercise. At peak exercise patients with retinopathic IDD had significantly lower heart rate (134 +/- 4 bpm) and LVEF (62.9 +/- 3.7%) than those with umcomplicated IDD (158 +/- 8 bpm and 76.6 +/- 2.4%, respectively) and control subjects (152 +/- 6 bpm and 73.5 +/- 1.9%, respectively). LVEF increased vs baseline in all control subjects and patients with uncomplicated IDD, but in only three with retinopathic IDD. Leg muscle blood flow (MBF) was also evaluated at rest and during exercise by 133Xe washout. Exercise MBF was significantly lower in patients with retinopathic IDD (40.5 +/- 2.23 ml X min-1 X 100 gm-1) than in control subjects (49.9 +/- 1.87 ml X min-1 X 100 gm-1) and in those with uncomplicated IDD (49.0 +/- 1.87 ml X min-1 X 100 gm-1). Diffuse microangiopathy, alone or in combination with neuropathy, might be responsible for the impairment of cardiovascular function in diabetes.

Adult↗

Evaluation in dogs and humans of three potential technetium-99m myocardial perfusion agents.

The biodistribution of the three cationic 99mTc complexes [99mTc(TMP)6]+, [99mTc(POM-POM)3]+, and [99mTc(TBIN)6]+--where TMP represents trimethylphosphite, POM-POM represents 1,2-bis(dimethyoxyphosphino)ethane, and TBIN represents t-butylisonitrile--have been evaluated in humans and dogs. Each agent was studied in three normal volunteers at rest, while [99mTc(POM-POM)3]+ and [99mTc(TBIN)6]+ were each studied in one normal volunteer at exercise. Even though all three agents yield good myocardial images in dogs, none appear suitable for clinical use as myocardial perfusion imaging radiopharmaceuticals. In humans, [99mTc(TMP)6]+ and [99mTc(POM-POM)3]+ clear very slowly from the blood and provide myocardial images only several hours after injection. [99mTc(TBIN)6]+ clears rapidly from the blood, but accumulation in the lung obscures the myocardial image for the first hour after injection; at later times, activity in the liver and spleen masks the apical wall. These results correlate with the blood-binding properties of the three complexes. [99mTc(TMP)6]+ and [99mTc(POM-POM)3]+ bind tightly to the plasma of human blood, but not to the plasma of dog blood; [99mTc(TBIN)6]+ does not bind tightly to the plasma of either dog or human blood. Among the Tc(I) complexes studied to date in humans, [99mTc(TBIN)6]+ appears to be unique in biodistribution pattern, blood-binding properties, and the fact that exercise improves the ultimate myocardial image. All the Tc(I) complexes appear to undergo myocardial accumulation by a mechanism different from that utilized by Tc(III) complexes. Animal studies alone are not adequate to evaluate the potential utility of 99mTc cationic complexes for myocardial perfusion studies.

Animals↗

Quantitative radionuclide angiocardiography using gold-195m.

A limitation of first-pass radionuclide angiocardiography is the limited repeatability because of the relatively long half-life of technetium-99m (Tc-99m). The feasibility, reproducibility and validity of multiple sequential quantitative first-pass studies were assessed in humans using the short-lived isotope gold-195m (Au-195m) (half-life of 30.6 seconds, 262 keV), which can be directly obtained from a generator made of its parent isotope, mercury-195m (half-life of 41.6 hours). Thirty-three subjects (13 normal volunteers and 20 cardiac patients) were studied using a large-field gamma camera equipped with a medium-energy collimator. After Au-195m intravenous injections, repeat first-pass studies were performed in the left anterior oblique projection. A left anterior oblique study was then obtained after i.v. injection of Tc-99m. Left ventricular ejection fraction calculations were performed separately by 2 observers. Reproducibility of Au-195m first-pass studies was excellent. The correlation coefficients for left ventricular ejection fraction from the first and the second Au-195m injections were 0.93 and 0.98 for observers 1 and 2, respectively. The correlation coefficients between Au-195m and Tc-99m first-pass studies were 0.95 and 0.98, respectively.

Adult↗

Tomographic assessment of regional cerebral perfusion using intravenous I-123 HIPDM and a rotating gamma camera.

The feasibility of assessing regional cerebral perfusion using the new brain imaging agent N,N,N'-trimethyl-N'-(2)-hydroxy-3-methyl-5-(123I) iodobenzyl)-1,3-propanediamine 2 HCl (I-123 HIPDM) and single photon emission computed tomography (SPECT) was evaluated in normal subjects and patients with cerebrovascular disorders. Following intravenous injection, I-123 HIPDM was rapidly extracted from the circulating blood by the brain (6.7%) and other organs. Its intracerebral distribution, as tomographically assessed by SPECT with a rotating gamma camera, reflected the distribution of blood flow within brain structures (gray and white matter, basal ganglia, etc.). Asymptomatic patients with history of transient ischemic attacks or minor stroke and angiographic evidence of internal carotid artery occlusion showed large cortical areas of reduced I-123 HIPDM distribution with normal or slightly positive CT. After extracranial-intracranial bypass surgery, reperfusion could be shown in previously ischemic areas. This study indicates the clinical usefulness of using I-123 HIPDM and gamma camera SPECT for the functional evaluation of brain disorders.

Adult↗

Correlation of SPECT and PET cardiac images by a surface matching registration technique.

Complementary information provided by Single Photon and Positron Emission Tomography (SPECT and PET) in nuclear cardiology allows a better comprehension of the physiopathology of the heart. In this work a surface matching registration technique is evaluated in the spatial correlation of SPECT and PET cardiac images. The method is based on matching correspondent anatomical surfaces extracted from transmission (TR) SPECT and PET studies, usually performed for attenuation correction. The accuracy of the technique was evaluated by phantom experiments and on patient data (201Tl SPECT and 13NH3 PET perfusion studies). An application of the method is presented for the correlation of SPECT 201Tl perfusion and PET 18FDG metabolic studies in the evaluation of myocardial viability.

Ammonia↗

Head holder for PET, CT, and MR studies.

A new head holder for the fixation and repositioning of the patient head in PET, CT, and MR scanners has been designed and tested. With this device, a bidimensional correlation between functional and anatomical brain images can also be obtained. Head fixation and repositioning are achieved using the patient's dental morphology as an anatomical reference. With a dentistic material, a mold of the patient's teeth is obtained in a few minutes. The molding substance rests on a plastic support, fixed to the head holder. Each time the patient undergoes a new study, his/her personal mold is used, ensuring accurate head repositioning. External markers fixed on the head holder (made visible in lateral PET and CT projection images, midsaggital MR images, and also on the axial images) make it possible to record and recognize the angular orientation and the position of the brain in the three-dimensional space, to correlate images of the same patient obtained with different neuroimaging modalities, and to accurately reposition patients for follow-up studies. The head holder was tested on several subjects. Fixation and repositioning accuracy of within 2.5 mm were achieved in the three-dimensional space. Orientation accuracy was 1 degree.

Equipment Design↗

Positron emission tomography for the assessment of myocardial viability: a synopsis of methods and indications.

An improvement of regional and global left ventricle dysfunction can be achieved in patients with coronary artery disease either by coronary revascularization with percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Several techniques have been developed to identify dysfunctional but viable myocardium. In the last decade, positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) has been used for the detection of hibernating myocardium. It can accurately predict the recovery of abnormal wall motion in hibernating segments prior to surgery. In particular, assessment of viability with 18F-FDG is indicated in high-risk surgical candidates being considered for revascularization or transplantation. Moreover, patient selection criteria and economic consideration are also relevant for cost-effective use of the technique.

Angioplasty, Balloon, Coronary↗

[Correction measured by attenuation in tomographic heart studies with single photon emission with thallium 201. Comparison with positron- emission tomographic studies with ammonium marked with nitrogen].

PURPOSE: We investigated 201Tl myocardial uptake with(out) nonuniform attenuation compensation in ischemic myocardiopathy patients. The segmental patterns of the two types of SPECT images were compared with PET [13N]NH3 studies performed in the same patient. PET images were taken as reference and the diagnostic accuracy of SPECT with(out) attenuation correction was evaluated. MATERIAL AND METHODS: During the SPECT study transmission and emission data were simultaneously recorded by a triple head gamma camera equipped with fan beam collimators and a 99mTc transmission line source (740MBq). SPECT and PET images, the former reconstructed with(out) attenuation correction, were corecorded and reoriented along the short axis. The left ventricular wall was divided into 11 segments and segmental activity normalized to maximum in each study. RESULTS: Statistically significant differences were found between PET/(un)corrected SPECT ratios in posterior and septal segments. In these myocardial regions, attenuation correction compensates for attenuation artifacts, by correcting the underestimation of radioactivity concentration caused by radiation absorption. A statistically significant difference was also found in midventricular anterior and apical segments (p < .05). However, in these regions attenuation correction results in a decrease in corrected relative to uncorrected SPECT activity. The agreement rate with PET data is higher for corrected SPECT (mean differences were 3.12 +/- 11.51 and 2.19 +/- 8.63 for uncorrected versus corrected SPET). We had 50% positive and 77% negative predictive value without attenuation correction, versus up to 69% and 90%, respectively, with attenuation correction. CONCLUSIONS: The attenuation correction procedure with simultaneous transmission-emission effectively reduces attenuation artifacts in SPECT myocardial imaging. While diagnostic accuracy increases in posterior and septal myocardial regions, anterior and apical data need careful interpretation because a relative decrease in radioactivity concentration can be observed after attenuation correction.

Adult↗