Comparing apples with addled pears. The need to optimize study protocols to compare imaging modalities for assessing myocardial perfusion.
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Electrocardiography↗
Biomedical subjects
U Büll
Publications and source records attributed to U Büll.
[FDG PET as an early nuclear medical diagnostic tool for aseptic wear-induced loosening of hip joint endoprostheses--a report of two cases].
To date, 2-[F-18]fluoro-2-deoxy-D-glucose PET (FDG PET) is used as a tool in oncology as well as myocardiological and cerebral functional diagnostics in the clinical routine. False positive results of tumor search imply new possibilities for use in diagnostics of inflammation. The two case reports presented here on aseptic loosening of endoprostheses caused by the rub of polyethylene with histological and immunohistological refurbishing call attention to the possible diagnostic valency of FDG PET as an early warning system regarding aseptic artificial limb loosening induced by the rub of polyethylene. By quantification of glucose metabolism with the "standard uptake value" (SUV) as well as specific storage samples from around the artificial limb, it is the aim of our study group in further examinations to develop an algorithm which permits to distinguish between septic and aseptic loosening.
Acetabulum↗
[Analysis of (18)F-FDG uptake patterns in PET for diagnosis of septic and aseptic loosening after total hip arthroplasty].
AIM: Identification of typical patterns for fluorodeoxy-glucose (FDG) uptake in positron emission tomography (PET) to detect aseptic loosening of hip prosthesis (ace-tabular and/or femoral component) and prosthetic infection. METHODS: 18 patients with painful hip prosthesis underwent PET using a dedicated full ring scanner after application of 200-300 MBq FDG. The interface between bone and surrounding soft tissue or bone as displayed on coronal slices was divided into 12 segments in accordance with the classifications of Delee and Gruen. FDG uptake in each of the segments was scored (0-3) by two independent observers. Intraoperative findings were regarded as the gold standard. RESULTS: After surgical revision 14 acetabular components and 9 femoral components were found to be loose and prosthetic infection was present in 7 prostheses. Loosening of the acetabular component was correlated to enhanced uptake in the middle of the acetabular interface, while loosening of the femoral component was correlated to enhanced uptake in the proximal and middle segment of the lateral femoral interface and the proximal segment of the medial femoral interface. A similar pattern was found in prosthetic infection with high uptake along the middle portion of the lateral femoral interface. In 6 of 7 infected prostheses loosening of the acetabular and of the femoral component was present. Taking the typical uptake patterns as criteria for loosening and grade 3 uptake as an additional criterion for septic loosening the accuracy of PET imaging in the detection of loosening of the acetabular or the femoral component and of prosthetic infection was 72, 78 and 89%, respectively. CONCLUSION: This pilot study presents FDG-PET as a promising diagnostic tool for patients with painful hip prostheses. Its clinical value should be evaluated in a larger patient population.
Aged↗
Combined image interpretation of computed tomography and hybrid PET in head and neck cancer.
AIM: Evaluation of potential synergistic effects of combined image interpretation of FDG PET using a gamma camera modified for coincidence detection (hybrid PET) and computed tomography (CT) and comparison of the diagnostic accuracy of hybrid PET and dedicated PET in patients with head and neck cancer. METHODS: Forty-two patients with suspected primary or recurrent cancer were included. Twenty-four patients underwent dedicated PET in addition to attenuation-corrected hybrid PET using a one-day protocol. RESULTS: Sensitivity, specificity and accuracy for detection of primary or recurrent head and neck cancer were 74, 73, and 74% for hybrid PET, 52, 82, and 60% for CT and 77, 82, and 79% for combined reading. With the combination of CT and hybrid PET all cases of recurrent disease were detected. The largest tumour not detected was 1.7 cm in diameter. Sensitivity, specificity and accuracy for the detection of neck sides with lymph node metastases were 69, 88, and 85% for hybrid PET, 62, 88, and 84% for CT, 69, 99, and 94% for combined image interpretation. With combined interpretation four involved neck sides were missed including two cases of microscopic metastases. Hybrid PET revealed concordant results to dedicated PET in all patients with respect to the detection of primary or recurrent tumour and in 45 of 48 neck sides (94%) with the same number of false negative findings. CONCLUSION: The combination of functional information of hybrid PET and morphological information of CT by the simple approach of combined image interpretation improves the sensitivity for the detection of primary/recurrent head and neck cancer and increases the specificity of lymph node staging compared to CT alone. The accuracy of hybrid PET and dedicated PET was almost identical.
Carcinoma, Squamous Cell↗
[Advances in surgery -- without advance in medical technology?].
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Female↗
Pulsed tissue Doppler imaging to assess myocardial viability by quantification of regional myocardial functional reserve.
Dobutamine stress echocardiography (DSE) is used widely to evaluate myocardial viability, but is limited by the subjective nature of test interpretation. Assessment of systolic function by pulsed tissue Doppler imaging (TDI) during dobutamine stimulation may allow a more objective evaluation of myocardial functional reserve and, thus, myocardial viability. In 30 patients (58 +/- 9 years) with prior myocardial infarction, pulsed TDI with low dose dobutamine stress (10 microg/kg/min) was performed to assess myocardial viability. Qualitative assessment of two-dimensional (2-D) DSE and positron emission tomography (PET) were used for comparison. Peak systolic myocardial velocity was measured for each left ventricular segment (16 segments) at baseline and low dose dobutamine stress using pulsed TDI. The absolute and relative increases of peak systolic velocity from rest to low dose dobutamine stress were calculated. Three hundred sixty-four segments with adequate pulsed TDI tracing were divided according to either 2-D DSE or PET findings into normal, viable (mismatch), and nonviable (match) segments. The increase of peak systolic myocardial velocity from baseline to low dose dobutamine was significantly different between segments defined as normal, viable, and nonviable by 2-D DSE (2.71 +/- 1.91 cm/sec, 1.86 +/- 2.15 cm/sec, and 0.99 +/- 1.16 cm/sec, respectively; P < 0.001). The increase of peak systolic myocardial velocity from rest to low dose dobutamine for normal, mismatch, and match segments defined by PET was 2.72 +/- 1.96, 1.01 +/- 0.96 and 0.80 +/- 1.07 cm/sec, respectively (P < 0.001). In conclusion, the increase of peak systolic myocardial velocity during low dose dobutamine stimulation determined by pulsed TDI distinguishes between different myocardial viability states. It complements the standard interpretation of stress echocardiograms.
Aged↗
Optimizing ventilation-perfusion lung scintigraphy: parting with planar imaging.
AIM: Of the study was to introduce and verify a ventilation-perfusion (V/Q) acquisition protocol that incorporates new developments in scintigraphy in order to allow for a more balanced comparison with other diagnostic procedures. METHODS: In 103 patients suspect of having pulmonary embolism, V/Q scans were acquired exclusively with SPECT technique. Ventilation was done with ultrafine aerosol. Planar images in eight directions were reconstructed through addition of three consecutive SPECT projections. Three referees examined the scans in regard to type, localization, and extent of V/Q defects. RESULTS: Using this protocol, significantly more defects, especially of subsegmental size, were detected (p < 0.01). Sensitivity, and diagnostic accuracy were also significantly improved (p < 0.01) to 0.96, and 0.99, respectively. Furthermore, kappa values were increased up to 0.82--a relevant enhancement in the ability to precisely localize V/Q defects. CONCLUSION: In conclusion this protocol provides high-resolution tomographic scans as well as high-quality planar images within a short acquisition time. Due to the significant increase in lesion detection, sensitivity, diagnostic accuracy, and anatomical localization of defects, it is a substantial improvement in the diagnosis of pulmonary embolism that will put V/Q scintigraphy on a par with other tomographic methods.
Adolescent↗
[Characterization of therapy failures in radioiodine therapy of Graves' disease without simultaneous antithyroid agents].
UNLABELLED: Aim of this study was a characterization of radioiodine therapy (RIT) failures in Graves' disease without simultaneous carbimazole. METHOD: 226 patients with a confirmed diagnosis of Graves' disease received 686.8 +/- 376.4 MBq of iodine-131 orally for thyroid ablation. Target dose was 250 Gy. All patients were followed up for 6 months. Therapy failures were compared with successes regarding possible influencing variables initial thyroid volume, thyroid function, immune activity (TRAb), I-131 uptake, effective half-life, absorbed energy dose, age and gender. RESULTS: 212 of 226 patients (93.8%) were treated successfully, 14 (6.2%) showed a hyperthyroidism relapse within 6 months which required a second radioiodine therapy. A success rate of 92.5% (62/67) could also be achieved with 67 patients who were hyperthyroid at the time of RIT. Compared to the therapy successes, the 14 failures achieved significantly lower absorbed doses (223.8 +/- 76.6 Gy vs. 285.2 +/- 82.1 Gy, p < 0.005), but with no significant differences regarding age, thyroid volume, function or TRAb (all p > 0.2). Of the 14 failures, n = 8 reached an absorbed dose < 200 Gy and n = 1 a dose < 250 Gy, although 5 of the failures reached an absorbed dose of > 250 Gy. Stepwise logistic regression revealed only absorbed energy dose as a variable significantly influencing therapy success (p < 0.005), but no influence of initial thyroid volume, function, TRAb value, age (all p > 0.2) or gender (p = 0.13). Two-tailed Fisher's exact test showed no significant influence of gender on success rates (failures/successes: male 1/36, female 13/176, p = 0.48). CONCLUSIONS: Except for the absorbed energy dose, no other significant variable influencing the outcome of radioiodine therapy in Graves' disease without simultaneous carbimazole could be found. It should be noted, though, that 5 therapy failures (2.2%) reached an absorbed energy dose of > 250 Gy.
Adult↗
Prognostic significance of positron emission tomography using fluorine-18-fluorodeoxyglucose in patients treated for malignant lymphoma.
AIM: To evaluate the prognostic significance of positron emission tomography (PET) using fluorine-18-[2]-fluoro-2-deoxyglucose (FDG) in patients treated for Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) compared to conventional restaging (CRS). METHODS: Fifty-six patients with either HD (n = 22), high-grade NHL (n = 26) or centrocytic-centroblastic NHL (n = 8) were included. PET was performed in 41 patients for treatment reevaluation up to three months after therapy and in patients with persisting residual masses (n = 10) or suspected relapse (n = 5) four to twelve months after treatment. The scans were evaluated qualitatively and quantitatively using standardised uptake values (SUV). Progression-free survival (PFS) was estimated to assess the prognostic value of FDG PET and clinical follow-up was taken as gold standard. RESULTS: PET was positive in nineteen of 41 patients studied for treatment reevaluation. Progression was observed after a median interval of two months (range 0-15) in sixteen of 19 patients after a positive PET scan and in three of 22 patients after a negative scan (p < .001). Median duration of follow-up in progression-free patients was 21 months (range 6-72). In patients with a partial remission in CRS progression was more common in PET-positive than in PET-negative patients (5 of 7 vs. 1 of 14; p < .01) and positivity with PET was associated with poorer PFS (p < .0025). PET studies performed four to twelve months after treatment were true negative in seven, true positive in five and false-positive in three patients. SUV > 11.35 of lymphoma lesions was associated with poorer PFS than SUV < 11.35 (p < 0.025). CONCLUSION: We conclude that FDG PET after treatment of malignant lymphoma has a high prognostic value and should be recommended in patients with persistence of residual masses.
Adolescent↗
[An approach for comparative quantification of myocardial blood flow (O-15-H2O-PET), perfusion (Tc-99m-tetrofosmin-SPECT) and metabolism (F-18-FDG-PET)].
AIM: In the present study a new approach has been developed for comparative quantification of absolute myocardial blood flow (MBF), myocardial perfusion, and myocardial metabolism in short-axis slices. METHODS: 42 patients with severe CAD, referred for myocardial viability diagnostics, were studied consecutively with 0-15-H2O PET (H2O-PET) (twice), Tc-99m-Tetrofosmin SPECT (TT-SPECT) and F-18-FDG PET (FDG-PET). All data sets were reconstructed using attenuation correction and reoriented into short axis slices. Each heart was divided into three representative slices (base, midventricular, apex) and 18 ROIs were defined on the FDG PET images and transferred to the corresponding H2O-PET and TT-SPECT slices. TT-SPECT and FDG-PET data were normalized to the ROI showing maximum perfusion. MBF was calculated for all left-ventricular ROIs using a single-compartment-model fitting the dynamic H2O-PET studies. Microsphere equivalent MBF (MBF_micr) was calculated by multiplying MBF and tissue-fraction, a parameter which was obtained by fitting the dynamic H2O-PET studies. To reduce influence of viability only well perfused areas (> 70% TT-SPECT) were used for comparative quantification. RESULTS: First and second mean global MBF values were 0.85 ml x min-1 x g-1 and 0.84 ml x min-1 x g-1, respectively, with a repeatability coefficient of 0.30 ml x min-1 x g-1. After sectorization mean MBF_micr was between 0.58 ml x min-1 x ml-1 and 0.68 ml x min-1 x ml-1 in well perfused areas. Corresponding TT-SPECT values ranged from 83% to 91%, and FDG-PET values from 91% to 103%. All procedures yielded higher values for the lateral than the septal regions. CONCLUSION: Comparative quantification of MBF, MBF_micr, TT-SPECT perfusion and FDG-PET metabolism can be done with the introduced method in short axis slices. The obtained values agree well with experimentally validated values of MBF and MBF_micr.
Coronary Circulation↗
[Results of pretherapeutic lymph node diagnosis in head and neck tumors. Clinical value of 18-FDG positron emission tomography (PET)].
BACKGROUND: Histological studies demonstrate that there is a high percentage of occult nodal metastasis in head and neck malignomas. Patients with positive lymph nodes have a comparatively worse prognosis. A neck dissection is required in these cases. By demonstrating morphological abnormalities, imaging procedures like ultrasound, computer tomography (CT), and magnetic resonance imaging (MRI) can provide important initial informations about possible malignant alteration of the lymph nodes. Positron emission tomography (PET) allows functional metabolic imaging of a suspected tumor site. The aim of this study was a comparative evaluation of different diagnostic procedures with special emphasis on the value of PET in the pretherapeutic diagnosis of nodal spread in head and neck cancer. PATIENTS AND METHODS: Forty patients (28 male and 12 female) with a suspected malignoma in the head and neck region underwent clinical examination including palpation of the neck sides, ultrasound, CT, and PET to detect a nodal spread of the malignancy. Fifty neck dissections were performed in 28 patients. Lymph node biopsies were performed in the remaining patients. The results of the diagnostic procedures were compared to the histology and the clinical course of the patients. The mean follow-up period was 12.5 months. RESULTS: A nodal metastasis was verified in 35% of all cases. Sensitivity of all imaging procedures including PET was 82%. Palpation had a sensitivity of only 61%. Specificity was 85% for ultrasound, 94% for CT and palpation, and 87% for PET. PET produced false negative results in 13.4% of all cases. Inflammation was detected in these cases. The positive predictive value was marginally better for PET than for ultrasound (77% vs. 75%). It proved to be lower than the values for palpation (86%) and CT (88%). Negative predictive value was 90-91% for all imaging procedures. CONCLUSION: In the primary diagnosis of nodal alterations in the head and neck region, a PET scan has the same diagnostic value as ultrasound or CT. By imaging the metabolism of a suspected nodal metastasis, PET can help to improve the assessment of regions with uncertain anatomic features. To avoid false positive results, acute and chronic inflammatory alterations have to be ruled out before the PET imaging.
Aged↗
[Combination systems for SPECT, coincidence, PET and CT. Technical spectrum, operating assumptions and possible areas of application].
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Humans↗
One-year follow-up of neuropsychology, MRI, rCBF and glucose metabolism (rMRGlu) in cerebral microangiopathy.
BACKGROUND: MRI shows lacunar infarctions (LI), deep white matter lesions (DWML) and atrophy in cerebral microangiopathy, which is said to lead to vascular dementia. In a first trial series on 57 patients with confirmed pure cerebral microangiopathy (without concomitant macroangiopathy), neuropsychological impairment and (where present) brain atrophy correlated with decreased rCBF and rMRGlu. LI and DWML did not correlate with either neuropsychological impairment or decreased rCBF/rMRGlu. This study was done one year later to detect changes in any of the study parameters. METHODS: 26 patients were re-examined for rCBF, rMRGlu, LI, DWML, atrophy and neuropsychological performance (7 cognitive, 3 mnestic, 4 attentiveness tests). Using a special head holder for exact repositioning, rCBF (SPECT) and rMRGlu (PET) were measured and imaged slice by slice. White matter/cortex were quantified using MRI-defined ROIs. RESULTS: After one year the patients did not show significant decreases in rCBF or rMRGlu either in cortex or in white matter (p > 0.05), nor did any patient show LI, DWML or atrophy changes on MRI. There were no significant neuropsychological decreases (p > 0.05). CONCLUSIONS: Cerebral microangiopathy ought to show progressive neuropsychological, functional (rCBF, rMRGlu) and morphological deterioration over periods > 1 year. It is unlikely that direct cortical damage (e.g., incomplete infarction) is responsible for neuropsychological impairment since one-year follow-up of our patients revealed no progression of brain atrophy or any other cortical damage.
Adult↗
[Comparison of different methods for attenuation correction in brain PET: effect on the calculation of the metabolic rate of glucose].
AIM: There are several approaches for correcting the effects of photon scatter or absorption by body tissues on positron emission tomography (PET). We examined the influence of cold, hot and segmented transmission as well as of a mathematical procedure on attenuation correction using regional cerebral glucose metabolism (rMRGlu). METHODS: 6 patients with different cerebral diseases were examined under resting conditions using an ECAT Exact 922/47. The attenuation-corrected data (corrected by means of cold, hot and segmented transmission as well as a mathematical procedure) were then quantified absolutely for assessment of regional glucose metabolism in 16 regions of interest (ROIs). RESULTS: Using absolutely quantified glucose metabolism in 16 ROIs, no significant differences were found between cold transmission and the mathematical procedure except for three regions (left and right temporal occipital and right parietal occipital). Unlike the mathematical procedure, both hot and segmented transmission showed a significantly lower value for regional glucose utilization in all 16 ROIs than did cold transmission. The left and the right hemisphere both showed metabolic values (rMRGlu) in the same decreasing order: cold transmission, the mathematical procedure, hot or segmented transmission. There was no significant difference between global cerebral glucose metabolism values for cold transmission and the mathematical procedure (p = 0.25) while those for hot (p = 0.03) and segmented transmission (p = 0.03) did show a significant difference. CONCLUSIONS: Except for 3 regions (temporo-occipital left, temporo-occipital right and parieto-occipital right) attenuation correction procedures used for brain PET studies on patients show no significant quantitative differences between cold transmission and the mathematical procedure. rMRGlu of images corrected for attenuation using hot and segmented transmission is significantly lower than of attenuation corrected images where cold transmission was employed. For clinical routine examinations, the mathematical procedure seems the best alternative to cold transmission for a faster brain PET acquisition.
Adult↗
[Quantification in bone scintigraphy with Tc-99m-phosphonates: determinants and data points].
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Bone and Bones↗
Active and remitted schizophrenia: psychopathological and regional cerebral blood flow findings.
Single photon emission computed tomography with technetium-99m-d,l-hexamethylpropyleneamine oxime (99mTc-HMPAO) was used to assess regional cerebral blood flow (rCBF) during both florid and remitted stages of schizophrenia. Forty schizophrenic patients in an active phase of illness (diagnosis by DSM-III-R) were examined in two clinical states (ill vs. improved). At study entry, 24 patients were drug-naive, five were currently drug-free, and 11 were being treated with antipsychotic medication. Twenty medical patients who suffered from non-specific headaches but were free of neurological and psychiatric symptoms served as control subjects. At initial examination during the active phase of illness, cerebral perfusion patterns in the schizophrenic patients were characterized by both hypofrontality and hypotemporality. After remission, hypofrontality was no longer apparent in two of four frontal regions, and hypotemporality disappeared completely. As assessed with the Positive and Negative Syndrome Scale (PANSS), formal thought disorders, hallucinations, and ideas of grandiosity correlated with rCBF in the active phase of illness, but not after remission. In the remitted but not in the florid state, blunted affect, difficulties in abstract thinking, lack of spontaneity, and stereotyped thoughts correlated with rCBF. Correlations of five symptoms with rCBF changed significantly from first to second examination. The present study suggests that correlations between single psychotic symptoms and rCBF differ significantly in florid vs. remitted phases of schizophrenia.
Adult↗
[Bone marrow recovery after irradiation of the spine].
BACKGROUND: Imaging of bone marrow by radio labeled antibodies against NCA-95 antigen of human granulocytes offers the possibility to visualize granulopoietic activity. After radiotherapy, a reduced uptake delineates the radiation field. Aim of our investigation was the study of strength and duration of this effect. PATIENTS AND METHODS: We analyzed 80 cases of patients irradiated for different primary or metastatic malignancies including parts of the spine who received a bone marrow scan for re-staging or during follow-up. Activity uptake of vertebrae inside and outside the irradiation portal was evaluated by ROI and the ratio was taken as measure of bone marrow suppression. RESULTS: A depression of granulopoietic bone marrow activity was seen even after a few fractions of 1.8 or 2 Gy (Figure 1). Depending on time since irradiation (Figure 2), we found a bone marrow recovery. In patients without bone metastasis, regeneration could be complete, whereas in patients treated for metastases, it was incomplete in all cases (Figure 3). CONCLUSIONS: For a certain time after irradiation, radioimmunoimaging delineates the irradiation portal by showing depression of granulopoiesis. Later on, it also shows bone marrow regeneration after radiotherapy. This may be helpful in reconstruction of radiation portals or in toxicity estimation during multimodal cancer therapy.
Adult↗
Neurometabolic effects of psilocybin, 3,4-methylenedioxyethylamphetamine (MDE) and d-methamphetamine in healthy volunteers. A double-blind, placebo-controlled PET study with [18F]FDG.
The neurometabolic effects of the hallucinogen psilocybin (PSI; 0.2 mg/kg), the entactogen 3,4-methylenedioxyethylamphetamine (MDE; 2 mg/kg) and the stimulant d-methamphetamine (METH; 0.2-0.4 mg/kg) and the drugs' interactions with a prefrontal activation task were investigated in a double-blind, placebo-controlled human [F-18]fluorodeoxyglucoseFDG-positron emission tomographicPET study (each group: n = 8). Subjects underwent two scans (control: word repetition; activation word association) within 2-4 weeks. Psilocybin increased rMRGlu in distinct right hemispheric frontotemporal cortical regions, particularly in the anterior cingulate and decreased rMRGlu in the thalamus. Both MDE and METH induced cortical hypometabolism and cerebellar hypermetabolism. In the MDE group, cortical hypometabolism was more pronounced in frontal regions, with the exception of the right anterior cingulate, which tended to be hyperactive. Cognitive activation-related increases in left frontocortical regions were attenuated under all three psychoactive substances, but less so under MDE. Taking into account performance data and subjective reports on task difficulty, these effects may result from different mechanisms across the three groups. Our PSI data are in line with studies on acute schizophrenic patients suggesting frontal overactivity at rest, but diminished capacity to activate prefrontal regions upon cognitive demand. The MDE data support the hypothesis that entactogens constitute a distinct psychoactive substance class, which takes an intermediate position between stimulants and hallucinogens.
3,4-Methylenedioxyamphetamine↗