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Biomedical subjects

S N Reske

Publications and source records attributed to S N Reske.

At least 19 recordsLinked to original sources
PubMed1995

Diagnosis of pancreatic cancer by 2[18F]-fluoro-2-deoxy-D-glucose positron emission tomography.

The detection of pancreatic cancer or the discrimination between pancreatic cancer and chronic pancreatitis remains an important diagnostic problem. The increased glucose metabolism in malignant tumours formed the basis for this investigation, which focused on the role of positron emission tomography (PET) with 2[18F]-fluoro-2-deoxy-D-glucose (FDG) in the detection of pancreatic cancer and its differentiation from chronic pancreatitis. Eighty patients admitted for elective pancreatic surgery received preoperatively 250-350 mBq FDG intravenously and emission scans were recorded 45 minutes later. Intense focal activity in the pancreatic region was taken at the time of scanning as showing the presence of pancreatic cancer. The presence of cancer was later confirmed by histological examination of the surgical specimens and histological findings were compared with the preoperative PET results. Forty one patients with pancreatic cancer (group I: n = 42) had a focally increased FDG uptake in the pancreatic region. Two patients with a periampullary carcinoma (group II: n = 6) failed to develop FDG accumulation. In 28 patients with chronic pancreatitis (group III: n = 32) no FDG accumulation occurred. Overall sensitivity and specificity of PET for malignancy (group I + II) were 94% (45 of 48) and 88% (28 of 32), respectively. The standard uptake value of the patients with pancreatic carcinoma was significantly higher than in patients with chronic pancreatitis (3.09 (2.18) v 0.87 (0.56); p < 0.001; median (interquartile range)). These findings show that FDG-PET represents a new and non-invasive diagnostic procedure for the diagnosis of pancreatic cancer and to differentiate pancreatic cancer from chronic pancreatitis. However, the diagnostic potential of this technique requires further evaluation.

Adult↗
PubMed1995

2-(fluorine-18)-fluoro-2-deoxy-D-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation.

PURPOSE: To evaluate use of positron emission tomography (PET) versus computed tomography (CT) in detection of pancreatic cancer and determine the value of quantitative and visual image interpretation of these techniques. MATERIALS AND METHODS: Within 8 weeks before surgery, 73 patients with suspected pancreatic cancer or chronic pancreatitis underwent imaging with CT and with static PET after injection of 250-350 MBq of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG). Focal FDG uptake, considered a sign of malignancy, was calculated with standardized uptake values (SUVs) 60 minutes after injection. RESULTS: With FDG PET, pancreatic carcinoma was correctly diagnosed in 41 (95%) of 43 patients, and chronic pancreatitis in 27 (90%) of 30 patients. With an SUV cutoff value of 1.53, both sensitivity and specificity for detection of malignancy were 93%. With CT, pancreatic cancer was correctly diagnosed in 33 (80%) of 41 patients, whereas results in seven (26%) of 27 patients with chronic pancreatitis were false-positive (specificity, 74%). CONCLUSION: FDG PET enabled reliable differentiation of pancreatic adenocarcinoma from chronic pancreatitis. The sensitivity and specificity of visual image interpretation with FDG PET was statistically significantly higher (P < .05) than with CT.

Adenocarcinoma↗
PubMed1995

[Positron emission tomography. Introduction of a new procedure in diagnosis of urologic tumors and initial clinical results].

Correct preoperative staging of malignant tumors is a prerequisite for an adequate therapy. This is not always possible with the imaging techniques available. Often, only an exploratory laparotomy can give the final diagnosis. Therefore, the search is on for a non-invasive technique for staging. Positron emission tomography (PET) is a new method in nuclear medicine; it is used for the diagnosis of primary tumors, for staging, and for follow-up after therapy. With PET, biochemical pathways and physiological functions are studied, in contrast to CT and MRI, with which anatomy and morphology are examined. In our department PET was used in 26 patients with invasive bladder cancer, in 11 patients with renal cell carcinoma and in 1 patient for follow-up after testicular cancer. The primary bladder tumor was found in 85% of cases; in 4 a non-organ-confined tumor was diagnosed preoperatively. Specificity in staging of lymph nodes was 86% (18/21); in 3 patients lymph nodes were false-positive on PET. However, in 5 patients all lymph node metastases were found by PET. Renal cell carcinoma were found in 8 out of 9 patients; in 2 patients with high-grade tumors an FDG-uptake defect was found. Lymph node staging was accurate in 9 patients without metastases and in 2 with metastases. One patient had a slightly enlarged retroperitoneal lymph node in the follow-up of a non-seminomatous germ cell tumor, which was positive on PET. Histology confirmed that it was the only positive lymph node within the whole specimen after retroperitoneal lymphadenectomy. PET gives new insights in uro-oncology by examination of the metabolism. Our initial results are promising and warrant further studies.

Adult↗
PubMed1991

Single photon emission tomography imaging of myocardial oxidative metabolism with 15-(p-[123I]iodophenyl) pentadecanoic acid in patients with coronary artery disease and aorto-coronary bypass graft surgery.

A total of 29 patients with coronary artery disease (CAD) were investigated with 15-(p-[123I] iodophenyl)pentadecanoic acid (123I-IPPA) and sequential single photon emission tomography (SPET). Of these, 19 were studied after aorto-coronary bypass graft surgery. Some 13 patients without evidence of CAD served as a control group. Two SPET studies (early and late) were carried out within 45 min after intravenous administration of 200 MBq 123I-IPPA at peak sub-maximal exercise. Semi-quantification of uptake (related to perfusion) and turnover (linked to metabolism) was obtained by segmental comparison of oblique slices. Taking coronary arteriography as the "gold standard", 123I-IPPA scintigraphy had the following figures of merit for sensitivity and specificity in the diagnosis of CAD: for the left anterior descending artery territory 93% and 95%, for the left circumflex artery region 96% and 92%, and for the right coronary artery territory 77% and 92%, respectively. In all, 90% of the reperfused myocardial segments showed an improvement of uptake. Of these, 61% exhibited increased turnover after revascularization and 39% had pathologic turnover and thus a dissociation of improvement of perfusion and oxidative metabolism after surgery.

Adult↗
PubMed1991

Recent advances in bone marrow scanning.

Interest in bone marrow scanning has been renewed as the result of the development of radiopharmaceuticals for evaluating specific aspects of bone marrow anatomy, physiology and pathology. This article provides a brief review of bone marrow structure, blood flow and function essential to the understanding of basic principles of bone marrow radionuclide imaging. The prospects and limitations of imaging haematopoietic bone marrow in man using indium 111 chloride, technetium-99m (99mTc)-labelled microcolloid or 99mTc-labelled monoclonal antigranulocytic and antimyelocytic antibodies are discussed in more detail. The technical aspects of bone marrow scintigraphy are presented. Results of more recent studies evaluating bone marrow scanning in circulatory, inflammatory and in systemic haematological disorders are summarized. Special attention is paid to the concept of bone marrow micrometastases and its implications for the follow-up of patients with malignant tumours. Recent results suggest that immunoscintigraphy of bone marrow may provide a novel and sensitive approach for establishing the presence and extent of bone marrow infiltration.

Antibodies, Monoclonal↗
PubMed1990

Reduced technetium 99m labelled NCA-95/CEA-antibody uptake in liver due to gentle antibody reconstitution. Technical note.

The influence of reconstituting a murine monoclonal IgG1 antibody kit with pertechnetate technetium 99m on antibody distribution in the liver, spleen and sternal bone marrow of patients was examined. The 99mTc-labelled antibody used is directed against non-specific cross-reacting antigen (NCA-95) and carcinoembryonic antigen (CEA) and has been successfully applied for imaging tissue inflammation and bone marrow scanning. Radioactivity uptake was determined in the liver, spleen, bone marrow and a precordial background region in a consecutive series of 25 patients, examined with an antibody preparation, routinely radiolabelled according to the manufacturer's recommendations and in 14 patients, in whom the antibody was reconstituted with special care, avoiding bubble formation and dropping of buffer into the antibody-containing vial. Gentle compared with routine antibody reconstitution caused a highly significant reduction of the antibody uptake in the liver, as determined by count densities, normalized to injected dose and acquisition time (13.2 +/- 5.5 vs 20.1 +/- 6.0 cpm per pixel, means +/- SD, P = 0.008). The liver to background ratio was reduced from 3.4 +/- 1.4 to 1.9 +/- 0.5 (P less than 0.001). Spleen, sternal bone marrow and precordial background count rates were not significantly affected. These results clearly demonstrate that gentle antibody reconstitution can decrease non-specific antibody uptake in the liver by 34% +/- 6.4% (means +/- SEM). Thus, scan quality is improved, and the potential deleterious camouflage of underlying structures is avoided.

Antibodies, Monoclonal↗
PubMed1990

[Detection of bone marrow involvement in breast cancer and malignant lymphoma using immunoscintigraphy of the hematopoietic bone marrow].

Radioimmunoimaging of bone marrow was performed for non-invasive detection of skeletal involvement in 15 patients with carcinoma of the breast and 17 patients with malignant lymphomas. Bone marrow scans were performed by means of a monoclonal 99mTc-labelled antibody, directed against NCA-95 and CEA. The presence and extent of skeletal involvement were controlled by skeletal scintigraphy, plain radiographs and CT; bone marrow biopsies were obtained in 19 patients as well. 20 subjects without suspected malignant disease served as controls. Haematopoietic bone marrow was imaged homogeneously and with high contrast in all controls. 15/15 patients with carcinoma of the breast and 10/17 patients with malignant lymphomas had multifocal bone marrow defects due to skeletal metastases. Bone marrow scans revealed significantly more lesions than skeletal scintigraphy both in carcinoma of the breast (p = 0.027) and malignant lymphomas (p = 0.015). Thus, radioimmunoscintigraphy of bone marrow may provide a new, sensitive approach for non-invasive detection of metastatic spread to the skeletal system.

Adult↗
PubMed1990

99Tcm-methoxy-isobutyl-isonitrile SPECT to evaluate a perfusion index from regional myocardial uptake after exercise and at rest. Results of a four hour protocol in patients with coronary heart disease and in controls.

In 70 patients with angiographically confirmed coronary heart disease and in 10 controls, a 4 h exercise (E) (injection of 150 MBq 99Tcm-MIBI) rest (R) (800 MBq) protocol was employed. Of these, 10 patients with 21 myocardial defects after E received a third injection 24 h after. SPECT was used to image myocardial distribution, and visual findings separated three patterns of perfusion defects after E v. R (reversible [REV], partial reversible (PREV), irreversible (IRR)). Relative regional uptake was obtained from a target-like (33 ROIs) evaluation of short-axis cuts, establishing a perfusion index (PI) by relating the defect uptake to individual maximum uptake (100%) after exercise (PIE), at rest (PIR) and the respective differences Delta PI (PIR-PIE, i.e. filling in by the second 99Tcm-MIBI injection). Visually, the sensitivity was 86% in patients or 69% in involved vessels (stenoses of greater than 33%). Vascular supply areas revealed minimal PIE values of 74.7 +/- 10.6% (control), 62.4 +/- 9.2% (REV), 46.1 +/- 7.7% (PREV) and 33.5 +/- 9.9% (IRR) (p less than 0.01). Delta PI was +13.2% or +10.1% in REV or PREV (n.s.) and +2.1% in IRR (p less than 0.01) or -0.2% in controls. PIE values did not correlate to the degree of stenosis. In areas with old myocardial infarction, the same sequence of significant decrease of PIE with reversibility occurred, independent of the patency of the supplying vessel. 33 of 35 IRR defects (94.3%) revealed PIE of less than 45%, thus predicting IRR already after the E examination. PIR values from the 4 h protocol correlated to PIR values 24 h thereafter with r = 0.94 (n = 21). 99Tcm-MIBI may be employed in a short one day E-R protocol in clinical routine. Evaluation of PI seems to be a promising tool to quantify visual defects aimed at describing the perfusional state of the terminal vascular supply area.

Adult↗
PubMed1989

Radioimmunoimaging for diagnosis of bone marrow involvement in breast cancer and malignant lymphoma.

Granulopoietic bone-marrow was scintigraphically imaged in 15 patients with carcinoma of the breast and known skeletal metastases, 10 patients with malignant lymphomas, and 15 controls without suspected malignant disease, with a technetium-99m labelled murine monoclonal IgG1 antibody directed against nonspecific cross-reacting antigen (NCA-95) and carcinoembryonic antigen. Immunoscintigraphy revealed more lesions than did bone scanning in both patient groups. This method offers a sensitive, cost-effective, and easy-to-perform whole body technique for evaluating metastatic spread.

Antibodies, Monoclonal↗
PubMed1989

[Reduced myocardial fatty acid utilization in coronary heart disease following symptom limited ergometric stress. Detection of pathologic metabolic patterns using iodine-123-phenylpentadecanoic acid and sequential SPECT].

Regional cardiac free fatty acid metabolism of 41 patients with coronary artery disease (CAD) and of 10 controls with normal coronary arteries was studied by means of I-123 phenylpentadecanoic acid (IPPA), a radioiodinated palmitic acid analog, and sequential single photon emission tomography (SPECT). All patients and controls underwent symptom--limited bicycle exercise, with the tracer being injected at peak stress. More than 99% of left ventricular segment of controls showed homogeneous tracer uptake and release, indicating homogeneous free fatty acid turnover in normal myocardium. Homogeneous postexercise uptake was followed by decreasing segmental activity in 75.1% of normally perfused segments in patients with CAD. Sixty-five percent and 88.6% of segments, assigned to the perfusion bed of 50%-75% and greater than 75% obstructed vessels had decreased IPPA release and/or reduced IPPA uptake. Patients with exercise induced ischemia had focal metabolic abnormalities in jeopardized myocardium for significantly longer time than clinical or electrocardiographic signs of ischemia (p less than 0.01). All patients with CAD and a negative stress test had metabolic abnormalities, but exhibited, compared to ECG--positive patients, less pronounced segmental metabolic aberrations. These findings indicate reduced cardiac utilization and delayed oxidation of IPPA, associated with exercise-induced ischemia in CAD. The metabolic changes suggest a marked sensitivity to ischemia as well as prolonged postischemic abnormalities of cardiac fatty acid metabolism in jeopardized myocardium.

Angina Pectoris↗
PubMed1986

Effect of myocardial perfusion and metabolic interventions on cardiac kinetics of phenylpentadecanoic acid (IPPA) I 123.

The effect of regional myocardial perfusion and flow-independent adrenergic stimulation, as well as lactate-mediated inhibition of cardiac lipolysis, on cardiac IPPA uptake and metabolism was examined in canine hearts (flow studies) and in the isolated perfused Langendorff rat heart (metabolic interventions). In both normal and ischaemic myocardium, local perfusion is a major determinant of cardiac IPPA uptake. In pacing-induced hyperaemia, the strict flow-dependence of cardiac IPPA uptake is not preserved. Adrenergic stimulation raises the rate of oxidation of both palmitic acid 14C and IPPA. This change is reflected by increased metabolite production released into the perfusate and radioactivity clearance recorded externally. Lactate in high concentrations exerts the opposite effect on cardiac free fatty acid oxidation. IPPA is stored in this condition preferentially in tissue phospholipids and triglycerides.

Animals↗
PubMed1986

Reticuloendothelial system Fc-receptor function in patients with immune thrombocytopenia after treatment with high dose intravenous immunoglobulin.

Reticuloendothelial system Fc-receptor (FcR) function was measured in 4 healthy controls and 9 patients with immune thrombocytopenia before and after therapy with high dose i.v. gammaglobulin (HDIg). Idiopathic thrombocytopenic purpura (ITP) was diagnosed in 5 patients. 2 patients with hemophilia A, 1 with acute tuberculosis and 1 with psoriasis vulgaris had thrombocytopenia that clinically resembled ITP. 4 out of 9 patients received prednisone prior to or during the study. FcR blockade was observed only in patients with ITP not receiving prednisone. In all other patients, HDIg did not induce a measurable FcR blockade. However, all except 1 patient (with acute tuberculosis) showed a marked rise in platelet counts for 2 to 12 wk. This is consistent with therapeutic efficacy of HDIg in various clinical settings of immune thrombocytopenia. All platelets were fully hemostatic and clinically no difference could be observed. This indicates that the effect of HDIg cannot be due to FcR blockade alone.

Adolescent↗
PubMed1986

Experimental basis of metabolic imaging of the myocardium with radioiodinated aromatic free fatty acids.

For the investigation of myocardial perfusion and left ventricular pump function, advanced radioisotopic techniques have been established. New developments in radiopharmacology and single-photon emission computed tomography have recently enabled the investigation of parameters of regional energy metabolism in well defined areas of the heart muscle. For this purpose, various iodine (123I)-labeled free fatty acids (FFA) have been synthesized. The diagnostic application of labeled FFA in heart disease may be important, since FFA are the preferred substrates for cardiac energy production at rest in the fasting state. In addition, regional myocardial FFA uptake and regional myocardial blood flow are tightly coupled in normal myocardium with beta-oxidation which is extremely sensitive to oxygen deprivation. This article outlines the basic physiologic pathways of FFA in normal and ischemic myocardium and reviews the results of animal experiments validating the application of these principles for metabolic imaging of the heart by means of the aromatic radioiodinated FFA, 15-(p-iodophenyl)pentadecanoic acid. In addition, the development, physiologic properties, and potential applications of a new generation of 3-methyl-substituted radioiodinated fatty acids that show high myocardial uptake but prolonged retention are discussed.

Animals↗
PubMed1986

[Results of fatty acid SPECT of the myocardium in coronary disease].

New developments in radiopharmacology of 123I-labeled metabolic tracers and single-photon emission computerized tomography (SPECT) allow now-a-days the assessment of parameters of cardiac energy metabolism in well-defined areas of the heart muscle. This article will present a brief outline of the basic pathophysiological principles used in the application of 123I-labeled phenyl fatty acids for the evaluation of CAD. First clinical results suggest an important application of cardiac fatty acid metabolic imaging to the detection, localisation and conceivable quantitation of myocardial ischemia, myocardial infarction and assessment of tissue viability. In addition to the diagnostic applications in CAD, cardiac fatty acid metabolic imaging may provide new perspectives to pathophysiological investigations of the coupling of local flow and substrate utilisation in vivo and the effect of therapeutic interventions.

Coronary Disease↗
PubMed1985

Metabolism of 15 (p 123I iodophenyl-)pentadecanoic acid in heart muscle and noncardiac tissues.

The uptake and turnover of omega(p 123I iodophenyl-)pentadecanoic acid (I-PPA), a radioiodinated free-fatty-acid analog, was examined in the heart, lung, liver, kidneys, spleen, and skeletal muscle of rats. At 2 min post injection, a high cardiac uptake of 4.4% dose per gram had already been achieved; this was followed by a rapid, two-component, tracer clearance. The kinetics of tissue concentrations of labeled hydrophilic catabolites indicated a rapid oxidation of I-PPA and the subsequent washout of I-PPA catabolites from heart-muscle tissue. The fractional distribution of the labeled cardiac lipids compared favorably with previously reported values for 3H-oleic- or 14C-palmitic-acid-labeled myocardial lipids. Typical patterns of I-PPA metabolism were observed in tissues depending on primary fatty-acid oxidation, lipid metabolism regulation, or I-PPA-catabolite excretion. The tissue concentrations and kinetics of I-PPA and its metabolites in the heart muscle indicated that general pathways of cardiac-lipid metabolism are traced by this new gamma-emitting isotope-labeled radiopharmaceutical.

Animals↗