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Thomas Beyer

Publications and source records attributed to Thomas Beyer.

At least 19 recordsLinked to original sources
PubMed2006

Diagnostic accuracy of colorectal cancer staging with whole-body PET/CT colonography.

CONTEXT: Staging of patients with colorectal cancer often requires a multimodality, multistep imaging approach. Colonography composed of a combined modality of positron emission tomography (PET) and computed tomography (CT) provides whole-body tumor staging in a single session. OBJECTIVES: To determine the staging accuracy of whole-body PET/CT colonography compared with the staging accuracies of CT followed by PET (CT + PET) and CT alone and to evaluate the effect of PET/CT colonography on therapy planning compared with conventional staging (CT of the abdomen and thorax and optical colonoscopy). DESIGN, SETTING, AND PATIENTS: Prospective study of 47 patients enrolled between May 2004 and June 2006 with clinical findings and optical colonoscopy that suggested primary colorectal cancer (mean [SD] age, 71 [11] years; range, 47-92 years). Patients underwent whole-body PET/CT colonography 1 day after colonoscopy. The study was conducted at a university hospital with a mean (SD) follow-up of 447 (140) days (range, 232-653 days). MAIN OUTCOME MEASURES: Correct classification of overall TNM stage using PET/CT colonography compared with CT + PET and CT alone. Secondary outcome measures were the accurate assessment of T-stage, N-stage, and M-stage by PET/CT colonography compared with CT + PET and CT alone and the effect of PET/CT colonography on therapy planning. RESULTS: Of the 47 patients with a total of 50 lesions, the overall TNM stage was correctly determined for 37 lesions with PET/CT colonography (74%; 95% confidence interval [CI], 60%-85%), 32 lesions with CT + PET (64%; 95% CI, 49%-77%), and 26 lesions with CT alone with a 0.7-cm node threshold (52%; 95% CI, 37%-66%). Compared with optimized abdominal CT staging alone, PET/CT colonography was significantly more accurate in defining TNM stage (difference, 22%; 95% CI, 9%-36%; P=.003), which was mainly based on a more accurate definition of the T-stage. Differences were not detected for defining N-stage between PET/CT colonography and CT alone with a threshold of 0.7 cm for malignant nodes but were detected with a threshold of 1 cm. Differences were not detected in defining M-stage separately or when comparing the accuracies of PET/CT colonography with CT + PET. PET/CT colonography affected consecutive therapy decisions in 4 patients (9%; 95% CI, 2.4%-20.4%) compared with conventional staging (CT alone and colonoscopy). CONCLUSIONS: In this preliminary study, PET/CT colonography is at least equivalent to CT + PET for tumor staging in patients with colorectal cancer. Thus, PET/CT colonography in conjunction with optical colonoscopy may be a suitable concept of tumor staging for patients with colorectal cancer.

Aged↗
PubMed2006

Accuracy of combined PET/CT in image-guided interventions of liver lesions: an ex-vivo study.

AIM: Positioning of interventional devices in liver lesions is a challenging task if only CT is available. We investigated the potential benefit of combined PET/CT images for localization of interventional devices in interventional liver studies. METHODS: Thirty lesions each of hyperdense, isodense and hypodense attenuation compared to normal liver parenchyma were injected into 15 ex-vivo pig livers. All lesions were composed of the same amounts of gelatine containing 0.5 MBq of (18)F-FDG. Following lesion insertion, an interventional needle was placed in each lesion under CT-guidance solely. After that, a PET/CT study was performed. The localization of the needle within the lesion was assessed for CT alone and PET/CT and the root mean square (RMS) was calculated. Results were compared with macroscopic measurements after lesion dissection serving as the standard of reference. RESULTS: In hypo- and isodense lesions PET/CT proved more accurate in defining the position of the interventional device when compared with CT alone. The mean RMS for CT and PET/CT differed significantly in isodense and hypodense lesions. No significant difference was found for hyperdense lesions. CONCLUSION: Combined FDG-PET/CT imaging provides more accurate information than CT alone concerning the needle position in FDG-PET positive liver lesions. Therefore combined PET/CT might be potentially beneficial not only for localization of an interventional device, but may also be beneficial for guidance in interventional liver procedures.

Animals↗
PubMed2006

Prevalence of behavioural and emotional problems among six-years-old preschool children: baseline results of a prospective longitudinal study.

OBJECTIVE: To study the prevalence of behavioural and emotional problems and the scope of symptoms in preschool children. The results serve as baseline in a 4-year follow-up study. METHOD: The sample consisted of 1887 preschool children who started primary level education within 6 months upon data collection. The sample represented the complete 1-year intake of all first year primary school children in a northern German town of 254,000 residents. The data were collected with standardized parent questionnaires. RESULTS: The 6-month prevalence of behavioural and emotional symptoms was 12.4%. The overall score for internalizing symptoms (INT) was significantly higher than the score for externalizing symptoms (EXT). The disturbed children had the highest mean scores on the syndrome scale "Anxious or Depressed". CONCLUSIONS: The level of psychopathology in preschool children was already as high as levels seen elsewhere in school children. The predominant role of INT was unexpected, particularly for boys. The attention of child mental health services need to focus on preschool children as on school children and on INT as much as on EXT, especially in boys.

Catchment Area, Health↗
PubMed2006

Whole-body 18F-FDG PET/CT in the presence of truncation artifacts.

UNLABELLED: We investigated the effect of CT truncation in whole-body (WB) PET/CT imaging of large patients, and we evaluated the efficacy of an extended field-of-view (eFOV) correction technique. METHODS: Two uniform phantoms simulating a "torso" and an "arms-up" setup were filled with (18)F-FDG/water. A third, nonuniform "body phantom was prepared with hot and cold lesions. All 3 phantoms were positioned in the center of the PET/CT gantry with >or=10% of their volume extending beyond the maximum CT FOV. An eFOV algorithm was used to estimate complete CT projections from nonlinear extrapolation of the truncated projections. CT-based attenuation correction (CT AC) of the phantom data was performed using CT images reconstructed from truncated and extended projections. For clinical validation, we processed truncated datasets from 10 PET/CT patients with and without eFOV correction. RESULTS: When using truncated CT images for CT AC, PET tracer distribution was suppressed outside the transverse CT FOV in phantom and patient studies. PET activity concentration in the truncated regions was only 10%-32% of the true value but increased to 84%-100% when using the extended CT images for CT AC. At the same time, the contour of phantoms and patients was recovered to the anatomically correct shape from the uncorrected emission images, and the apparent distortion of lesions near the maximum CT FOV was reduced. CONCLUSION: Truncation artifacts in WB PET/CT led to visual and quantitative distortions of the CT and attenuation-corrected PET images in the area of truncation. These artifacts can be corrected to improve the accuracy of PET/CT for diagnosis and therapy response evaluation.

Algorithms↗
PubMed2006

Optimized contrast-enhanced CT protocols for diagnostic whole-body 18F-FDG PET/CT: technical aspects of single-phase versus multiphase CT imaging.

UNLABELLED: The purpose of this study was to compare various PET/CT examination protocols that use contrast-enhanced single-phase or contrast-enhanced multiphase CT scans under different breathing conditions. METHODS: Sixty patients with different malignant tumors were randomized into 4 different PET/CT protocols. Single-phase protocols included an intravenous contrast-enhanced (Ultravist 370; iodine at 370 mg/mL) single-phase whole-body CT scan (90 mL at 1.8 mL/min; delay, 90 s) during shallow breathing (protocol A) or during normal expiration (NormExp; protocol B). Multiphase protocols included 2 separate CT scans in the arterial contrast enhancement phase (90 mL at 2.5-2.8 mL/min; bolus tracking; scan range, base of the skull to the kidneys) and the portal-venous contrast enhancement phase (delay, 90 s; scan range, base of the lungs to the proximal thighs) during shallow breathing (protocol C) or during NormExp (protocol D) followed by a low-dose CT scan during shallow breathing for attenuation correction and whole-body PET. Feasibility was assessed by comparing the misalignment of the upper abdominal organs quantitatively by means of the craniocaudal, lateral, and anterior-posterior differences on coregistered PET/CT images. For image quality, the occurrence of CT artifacts and mismatching of rigid body points were evaluated qualitatively. RESULTS: Misalignment was significantly lower for protocol B in almost all organs and represented the best coregistration quality. Surprisingly, protocol A showed significantly better alignment than the multiphase CT scans during NormExp. Misalignment values between the multiphase protocols were not significantly different, with a trend toward lower values for protocol D. The best CT image quality, with a significantly lower occurrence of artifacts, was found for protocols B and D (NormExp). The levels of mismatching of rigid body points because of patient movement in between the transmission and emission scans were similar for all protocols. CONCLUSION: Multiphase CT protocols presented a technical disadvantage represented by suboptimal image coregistration compared with single-phase protocols. Nevertheless, multiphase protocols are technically feasible and should be considered for patients who will benefit from a contrast-enhanced multiphase CT examination for diagnosis.

Artifacts↗
PubMed2005

Respiration artifacts in whole-body (18)F-FDG PET/CT studies with combined PET/CT tomographs employing spiral CT technology with 1 to 16 detector rows.

PURPOSE: Co-registration accuracy in combined whole-body (WB) PET/CT imaging is impaired by respiration-induced mismatches between the CT and the PET. Furthermore, PET/CT misregistration may bias the PET tracer distribution following CT-based attenuation correction (CT-AC). With the introduction of multi-row CT technology of up to 16 detector rows into PET/CT designs, we investigated the incidence of respiration artifacts in WB PET/CT examinations of patients who were unable to follow any breath-hold instructions. METHODS: A total of 80 WB studies from six international sites operating PET/CT tomographs with 1-, 2-, 4-, 6-, 8-, and 16-row spiral CT were included. PET/CT examinations were acquired with the patients breathing normally during both the CT and the PET scan, and CT-AC was performed routinely. All studies were anonymized and reviewed independently by three radiologists and three nuclear medicine specialists. We report the frequency and severity of artifacts on CT and PET for the thorax and the abdomen. RESULTS: In WB PET/CT imaging of normally breathing patients, significant gains in diagnostic image quality can be expected from employing CT technology with six or more detector rows. In our study, fewer PET images appear distorted than corresponding CT images, which is due to the limited propagation of only mild CT image artifacts after the resampling of the CT-based attenuation map during CT-AC. CONCLUSION: In whole-body PET/CT imaging of normally breathing patients, respiration-induced artifacts are reduced in both magnitude and prominence for PET/CT systems employing CT components of six or more detector rows.

Adolescent↗
PubMed2005

An optimized conditional suicide switch using doxycycline-dependent expression of human tBid.

We have examined in a HeLa model system whether tight doxycycline-dependent expression of human tBid can be used as a fast and efficient suicide switch. A stably transfected cell line expressing human tBid in a strictly dox-dependent manner showed fast and efficient killing with up to 98 % specific cell death 24 h after induction. The survival rate was only 0.6 % after eleven days of dox treatment. Very low amounts of tBid were sufficient to induce apoptosis indicating that stringent control of the dox-dependent suicide gene is essential for cell survival in the absence of inducer. Using human tBid, an endogenous effector protein with low immunogenic potential, and doxycycline, an inducer with low cytotoxicity and a long record of safe use in humans, this conditional suicide switch provides a tool for various applications, e.g., adoptive immune transfer.

Apoptosis↗
PubMed2005

Contrast-enhanced dark lumen PET/CT and MR colonography in a rodent polyp model: initial results with histopathologic correlation.

OBJECTIVE: The objective of this study was to assess the feasibility of PET/CT for the detection of colorectal masses in a rodent polyp model in an intraindividual comparison with dark-lumen MR colonography. CONCLUSION: Detection of small tumors with PET/CT and MR colonography is possible in a rodent model. The technique thus warrants further evaluation in animal studies as well as in patients with suspected colorectal disease.

Animals↗
PubMed2005

Optimized intravenous contrast administration for diagnostic whole-body 18F-FDG PET/CT.

UNLABELLED: Standard application of CT intravenous contrast agents in combined PET/CT may lead to high-density artifacts on CT and attenuation-corrected PET. To avoid associated diagnostic pitfalls, we designed and compared different intravenous contrast injection protocols for routine whole-body PET/CT. METHODS: Whole-body PET/CT included a topogram and a single spiral CT scan (2-row) with or without intravenous contrast, followed by an emission scan. The CT scan was used for attenuation correction of the emission data. Four groups of 10 whole-body PET/CT referrals each were investigated: (A) no intravenous contrast agent, (B) biphasic injection (90 and 50 mL at 3 and 1.5 mL/s, respectively) of intravenous contrast (300 mg/mL iodine) and CT in the craniocaudal direction with a 30-s delay, (C) triple-phase injection (90, 40, and 40 mL at 3, 2, and 1.5 mL/s, respectively) in the craniocaudal direction with a 50-s delay, and (D) dual-phase injection (80 and 60 mL at 3 and 1.5 mL/s, respectively) in the caudocranial direction with a 50-s delay. CT image quality was assessed on a scale from 1 to 3, and CT and attenuation-corrected PET images were reviewed separately for contrast-induced artifacts. RESULTS: Average CT image quality was poorest for protocol A (1.0) but improved to 2.8 when using intravenous contrast agents (protocols B-D). Only protocols B and C resulted in contrast-induced image artifacts that were limited to the thorax. The most homogeneous intravenous contrast enhancement without high-density image artifacts on either CT or PET after CT-based attenuation correction was achieved with protocol D. CONCLUSION: Dual-phase intravenous contrast injection and CT in the caudocranial direction with a 50-s delay yields reproducible high image quality and is now used routinely for combined diagnostic PET/CT at our hospital.

Contrast Media↗
PubMed2005

On the use of positioning aids to reduce misregistration in the head and neck in whole-body PET/CT studies.

UNLABELLED: Involuntary patient motion from insufficient patient preparation may lead to local misregistration of PET/CT images and, thus, can invalidate the attempt to fuse the resulting images. We estimate the efficacy of selected patient support structures in reducing the likelihood of patient motion in the area of the head and neck during whole-body PET/CT studies. METHODS: Motion of the head and neck was estimated in 51 healthy volunteers during simulated whole-body PET/CT studies using an infrared camera-based tracking system. Four patient positioning schemes (arms down) were studied, with the neck placed on a standard PET head holder with no support at the sides (setup A), on a special head holder fitted with a subject-specific mold from construction foam (setup B), on a vacuum-lock bag (setup C), and on a special head holder fitted with a vacuum-lock bag (setup D). We report the average motion of the head and neck as the difference in the position of a set of target points between the simulated CT image and PET image of the head and neck. To estimate the efficacy of additional patient support measures in clinical practice, we reviewed the misregistration of the head and neck in whole-body PET/CT studies of 10 patients each who were imaged using setups A and C by comparing the mean translational and rotational alignment parameters from a semiautomatic linear registration approach needed to realign the CT and PET images. RESULTS: Average translational and rotational misalignment of the head and neck was highest for setup A, at 7 mm and 1 degrees , respectively. Misalignment was reduced to a minimum of 1.4 mm and 0.3 degrees for setup D. Setup B resulted in a similar reduction in patient motion of the head and neck: 2.4 mm and 0.4 degrees , whereas setup C provided only somewhat improved support, with a resulting average misalignment of 4.5 mm and 0.7 degrees. In clinical PET/CT, we found setup C to reduce translational misalignment of the CT and PET images of the head and neck to 2 mm, compared with 6 mm for setup A, whereas no significant reduction of rotational misalignment was observed. CONCLUSION: Average motion of the head and neck in unrestrained subjects during whole-body PET/CT examinations can be reduced by use of rigid positioning aids, such as foam molds, or vacuum-lock bags. Vacuum-lock bags are reusable, quickly adaptable, and olfactory neutral and can be used routinely, either alone or in combination with a head holder, in whole-body PET/CT for high-quality examinations.

Equipment Failure Analysis↗
PubMed2005

Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations.

UNLABELLED: We investigated radiation exposure of patients undergoing whole-body 18F-FDG PET/CT examinations at 4 hospitals equipped with different tomographs. METHODS: Patient doses were estimated by using established dose coefficients for 18F-FDG and from thermoluminescent measurements performed on an anthropomorphic whole-body phantom. RESULTS: The most relevant difference between the protocols examined was the incorporation of CT as part of the combined PET/CT examination: Separate low-dose CT scans were acquired at 2 hospitals for attenuation correction of emission data in addition to a contrast-enhanced CT scan for diagnostic evaluation, whereas, at the other sites, contrast-enhanced CT scans were used for both purposes. Nevertheless, the effective dose per PET/CT examination was similar, about 25 mSv. CONCLUSION: The dosimetric concepts presented in this study provide a valuable tool for the optimization of whole-body 18F-FDG PET/CT protocols. Further reduction of patient exposure can be achieved by modifications to the existing hardware and software of PET/CT systems.

Body Burden↗
PubMed2005

1 + 1 = 3.

Explore the source record for details and available documents.

Austria↗
PubMed2004

Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET.

PURPOSE: To assess the accuracy of positron emission tomography/computed tomography (PET/CT) when staging different malignant diseases. PATIENTS AND METHODS: This was a retrospective, blinded, investigator-initiated study of 260 patients with various oncological diseases who underwent fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT for tumor staging. CT images alone, PET images alone, PET + CT data viewed side by side, and fused PET/CT images were evaluated separately according to the tumor-node-metastasis system. One hundred forty patients with tumors not staged according to the tumor-node-metastasis system or a lack of reference standard were excluded from data analysis; 260 patients were included. Diagnostic accuracies were determined for each of the four image sets. Histopathology and a clinical follow-up of 311 (+/- 125) days served as standards of reference. RESULTS: PET/CT proved significantly more accurate in assessing tumor-node-metastasis system stage compared with CT alone, PET alone, and side-by-side PET + CT (P < .0001). Of 260 patients, 218 (84%; 95% CI, 79% to 88%) were correctly staged with PET/CT, 197 (76%; 95% CI, 70% to 81%) with side-by-side PET + CT, 163 (63%; 95% CI, 57% to 69%) with CT alone, and 166 (64%; 95% CI, 58% to 70%) with PET alone. Combined PET/CT had an impact on the treatment plan in 16, 39, and 43 patients when compared with PET + CT, CT alone, and PET alone, respectively. CONCLUSION: Tumor staging with PET/CT is significantly more accurate than CT alone, PET alone, and side-by-side PET + CT. This diagnostic advantage translates into treatment plan changes in a substantial number of patients.

Adolescent↗
PubMed2004

Advantages and limitations of FDG PET in the follow-up of breast cancer.

18F-Fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) has been evaluated in breast cancer for the characterisation of primary tumours, lymph node staging and the follow-up of patients after surgery, chemotherapy and/or external radiotherapy. In contrast to both the low sensitivity and moderate specificity of FDG PET in the initial detection and characterisation of breast cancer and the low lesion-based sensitivity for lymph node staging, the results from use of FDG PET in re-staging breast cancer patients are very promising. A major advantage of FDG PET imaging compared with conventional imaging is that it screens the entire patient for local recurrence, lymph node metastases and distant metastases during a single whole-body examination using a single injection of activity, with a reported average sensitivity and specificity of 96% and 77%, respectively. In most studies the sensitivity of FDG PET is higher than that of a combination of conventional imaging methods. Limitations of FDG PET in the follow-up of breast cancer patients include the relatively low detection rate of bone metastases, especially in case of the sclerotic subtype, and the relatively high rate of false positive results. The rather low specificity of FDG PET can be improved/increased by utilising combined anatomical-molecular imaging techniques, such as a PET/CT tomograph. First results using PET/CT imaging in the follow-up of breast cancer patients demonstrate increased specificity compared with FDG PET alone. Both imaging modalities, however, offer to detect recurrent and metastatic breast cancer disease at an early stage and thus continue to demonstrate the efficacy of molecular imaging in patient management, despite the limited therapeutic options in recurrent and metastatic breast cancer.

Breast Neoplasms↗
PubMed2004

Dual-modality PET/CT scanning with negative oral contrast agent to avoid artifacts: introduction and evaluation.

The authors qualitatively and quantitatively assessed a solution containing 0.2% locust bean gum (LBG) and 2.5% mannitol (mannitol-LBG) dissolved in water to provide a negative oral contrast material in dual-modality positron emission tomography (PET)/computed tomography (CT) scanning. PET/CT was performed in 60 patients with cancer after oral administration of barium, water, or mannitol-LBG. Qualitative and quantitative analyses were conducted to determine bowel distention and a potential influence of the contrast agents on the PET data. Intestinal distention with mannitol-LBG proved superior to that with water or barium. Findings at both quantitative and qualitative analysis revealed apparently increased tracer uptake in the small bowel with barium in comparison to that with mannitol-LBG or water. Mannitol-LBG may, therefore, be used as a negative oral contrast agent at PET/CT scanning because it provides excellent bowel distention while avoiding contrast material-induced PET artifacts.

Administration, Oral↗
PubMed2004

Acquisition protocol considerations for combined PET/CT imaging.

UNLABELLED: Since its introduction in 1998, dual-modality PET/CT imaging has received great attention in the medical community. For the first time, patients can be examined with both CT and PET in a single examination. A whole-body survey is the standard mode of acquisition. The CT images are used for anatomic reference of the tracer uptake patterns imaged in PET, as well as for attenuation correction of the PET data. The routine use of CT-based attenuation correction and user preferences for the quality and type of the CT examination have led to the introduction of different PET/CT scanning protocols. DISCUSSION: Two general approaches to PET/CT imaging can be distinguished today. One uses CT as a fast transmission source with little additional information for anatomic labeling. The other uses CT as a fast transmission source as well as a state-of-the-art diagnostic tool to maximize image quality using optimal acquisition parameters together with oral and intravenous contrast agents. Variations of these approaches share common concerns about image artifacts that result from mismatches in respiration and patient positioning between the CT and the PET examinations. Protocol requirements for the more complex radiologic PET/CT scenario also include alternative contrast application schemes or modifications to the attenuation correction procedure to handle CT contrast agents appropriately. CONCLUSION: High-quality PET/CT studies can be provided routinely with existing PET/CT technology that is used efficiently by trained and motivated technologists and physicians. Only then will the potential diagnostic benefit of this new imaging modality be explored fully.

Artifacts↗
PubMed2004

To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT.

UNLABELLED: In combined PET/CT imaging, functional data provided by 18F-FDG increase diagnostic accuracy over conventional PET and CT in a variety of malignancies. The question to be raised is: how much is CT needed in PET/CT imaging? DISCUSSION: In stand-alone CT imaging, contrast agents are applied to aid differentiation of anatomic structures, improve lesion localization, and support lesion characterization. Based on our experience, the most important benefit when applying CT contrast agents in PET/CT imaging relates to more precise anatomic localization of pathology by differentiation of the lesion from its surrounding structures on CT. This benefit must be considered most profound in the head and neck as well as the abdomen and pelvis, where delineation of pathology from muscles, vascular structures, or the intestine is critical. CT contrast agents can be of additional value in tumors with only mild or no increase in 18F-FDG uptake by supporting lesion detection and characterization. The complementary role of CT contrast agents and molecular contrast for PET/CT imaging is addressed in this review. The authors provide specific indications as to which contrast-enhanced CT data provide additional diagnostic value. CONCLUSION: Functional contrast aids lesion detection and characterization, whereas morphologic contrast improves lesion localization. CT contrast agents and PET tracers do not compete but rather are complementary in combined PET/CT imaging.

Contrast Media↗