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PubMed2005

Thalamic hypofunction in alcohol hallucinosis: FDG PET findings.

We report findings obtained with positron emission tomography with fluorodeoxyglucose-F18 (FDG PET) as tracer in two patients with acute alcohol hallucinosis. In line with previous findings, both patients had a significant hypometabolism in the left relative to the right thalamus. When the second patient was retested after clinical recovery, FDG PET findings were normalized, suggesting the probable thalamic dysfunction to be a functional rather than a structural abnormality.

Adult↗
PubMed1995

Detection of scalene lymph node metastases from lung cancer. Positron emission tomography.

Preliminary data indicate that positron emission tomography (PET) following injection of fluorodeoxyglucose F18 (FDG) is sensitive and specific for detecting malignant cells in chest tumors and mediastinal lymph nodes. We report a case of non-small cell lung cancer metastatic to clinically normal scalene lymph nodes that was correctly staged by FDG-PET.

Carcinoma, Non-Small-Cell Lung↗
PubMed1999

Positron emission tomography in patients with benign essential blepharospasm.

PURPOSE: To identify possible abnormalities in regional cerebral glucose metabolism in patients with benign essential blepharospasm or Meige syndrome using positron emission tomography. METHODS: Ten patients with benign essential blepharospasm and one patient with Meige syndrome were examined using positron emission tomography with deoxyglucose labeled with fluorine 18. The severity of muscle spasm at the time of positron emission tomography was recorded in each patient. In five patients, positron tomography was performed on two occasions (once before and again 1 to 2 weeks after botulinum injection) to look for reproducibility of the findings on positron emission tomography also to see if there was any correlation between the severity of symptoms and positron emission tomography findings. RESULTS: The mean reference ratio for fluorodeoxyglucose F18 metabolism was significantly elevated in the striatum compared with the frontal, temporal, or parietal regions. Glucose metabolism was also elevated in the thalami. There was no correlation between the severity of blepharospasm and the degree of hyperactivity in the striatum. In the patients who underwent positron emission tomography scanning on two occasions, there was no significant difference between the two studies in any of the regions analyzed. CONCLUSIONS: The authors' findings support the hypothesis that benign essential blepharospasm and Meige syndrome may be associated with overactivity of the striatum and the thalamus. Positron emission tomography may prove to be a useful research tool and a possible adjunct diagnostic technique for benign essential blepharospasm and Meige syndrome.

Aged↗
PubMed2005

Gender differences in a fenfluramine-activated FDG PET study of borderline personality disorder.

Neuroimaging studies of impulsive-aggressive subjects with borderline personality disorder (BPD) demonstrate hypometabolism in areas of prefrontal and frontal cortex, and a blunted cortical metabolic response to challenge with serotonergic agonists. Neuroendocrine responses to serotonergic challenge are known to vary greatly by gender, and may be related to sex differences in expression of impulsive aggression. We conducted single-blind, placebo-controlled fenfluramine-activated positron emission tomography (PET) studies in impulsive male and female subjects with BPD to look for gender differences in cortical response. The sample comprised 22 BPD (15 female, 7 male) and 24 control subjects (10 female, 14 male) who received placebo on Day 1 and d,l-fenfluramine on Day 2 before PET neuroimaging. In response to placebo, female, but not male, controls had areas of increased uptake of fluorodeoxyglucose-F18 in prefrontal cortex compared with BPD subjects, with greatest uptake in the medial orbital frontal cortex, bilaterally. Male, but not female, BPD subjects, showed areas of increased glucose utilization compared with controls in large areas of parietal and occipital cortex, bilaterally. In response to fenfluramine (relative to placebo), significant decreases in glucose uptake were found in male, but not female, BPD subjects, centered in the left temporal lobe. Female, but not male, control subjects showed significantly decreased uptake in areas of right frontal and temporal cortex. Covarying for impulsive-aggression rendered nonsignificant the gender differences in responses to placebo or fenfluramine. Gender differences in serotonergic function may mediate differences in behavioral expression of impulsive aggression in subjects with BPD.

Borderline Personality Disorder↗
PubMed2006

Positron emission tomography predicts survival in malignant pleural mesothelioma.

OBJECTIVES: Recent studies suggest that standard uptake value on fluorodeoxyglucose positron emission tomography scan can predict mediastinal lymph node status in malignant pleural mesothelioma. Because mediastinal nodal metastasis is known to be associated with poor prognosis, we hypothesized that standard uptake value on fluorodeoxyglucose positron emission tomography might independently predict survival. METHODS: Patients with pathologically proven mesothelioma underwent fluorodeoxyglucose positron emission tomography scanning. Patients fasted and received a minimum of 10 mCi of F18-fluorodeoxyglucose. Whole-body emission studies were acquired, followed by whole-body transmission scans with iterative reconstruction. On the basis of the maximal chi-square method, a standard uptake value of 10 was chosen to classify patients as low versus high standard uptake value. Survival probabilities for both standard uptake value groups were estimated by the Kaplan-Meier method. A Cox proportional hazards model assessed the joint influence of standard uptake value, histology, and stage on survival. RESULTS: From 1998 to 2005, 137 patients with malignant pleural mesothelioma underwent positron emission tomography scans. The median follow-up for all surviving patients was 24 months. Median survivals were 9 and 21 months for the high and low standard uptake value groups, respectively (P = .02). In a multivariable analysis, high standard uptake value tumors were associated with a 1.9 times greater risk of death than low standard uptake value tumors (P < .01). Mixed histology carried a 2.9 times greater risk of death than epithelioid histology (P < .01), and stages III and IV had a 1.8 times greater risk of death than stages I and II (P = .05). CONCLUSIONS: Standard uptake value greater than 10, mixed histology, and stages III and IV are poor risk factors in malignant pleural mesothelioma. These findings suggest that fluorodeoxyglucose positron emission tomography can be used to stratify patients for treatment and clinical trials.

Adult↗
PubMed2004

The thalamus as the generator and modulator of EEG alpha rhythm: a combined PET/EEG study with lorazepam challenge in humans.

BACKGROUND: Purpose of this study was to investigate the functional relationship between electroencephalographic (EEG) alpha power and cerebral glucose metabolism before and after pharmacological alpha suppression by lorazepam. METHODS: Ten healthy male volunteers were examined undergoing two F18-fluorodeoxyglucose (18-FDG) positron emission tomography (PET) scans with simultaneous EEG recording: 1x placebo, 1x lorazepam. EEG power spectra were computed by means of Fourier analysis. The PET data were analyzed using SPM99, and the correlations between metabolism and alpha power were calculated for both conditions. RESULTS: The comparison lorazepam versus placebo revealed reduced glucose metabolism of the bilateral thalamus and adjacent subthalamic areas, the occipital cortex and temporo-insular areas (P < 0.001). EEG alpha power was reduced in all derivations (P < 0.001). Under placebo, there was a positive correlation between alpha power and metabolism of the bilateral thalamus and the occipital and adjacent parietal cortex (P < 0.001). Under lorazepam, the thalamic and parietal correlations were maintained, whereas the occipital correlation was no longer detectable (P < 0.001). The correlation analysis of the difference lorazepam-placebo showed the alpha power exclusively correlated with the thalamic activity (P < 0.0001). CONCLUSIONS: These results support the hypothesis of a close functional relationship between thalamic activity and alpha rhythm in humans mediated by corticothalamic loops which are independent of sensory afferences. The study paradigm could be a promising approach for the investigation of cortico-thalamo-cortical feedback loops in neuropsychiatric diseases.

Adult↗
PubMed1995

Myocardial scintigraphy.

Nuclear cardiology continues to be of particular importance in nuclear medicine. In this domain, myocardial scintigraphy has become the eminent diagnostic tool in the diagnosis of cardiac disorders like coronary artery disease, myocarditis, heart transplant rejection, chemotherapy-induced cardiotoxicity, and others. In a comparison of the latest worldwide trends, European investigators seem to be more interested in recently developed myocardial tracers than those in the US. Besides research into antimyosin monoclonal antibodies for the detection of myocardial damage, the technetium 99m-labeled perfusion markers are being studied as potential substitutes for thallous chloride TI 201. In recent years, the dual use of 201TICI/99mTc-sestamibi taught us the comparable clinical value of these two radiopharmaceutics in the detection of coronary artery disease. In the future, additional 99mTc-labeled perfusion markers may contribute to the ongoing decrease in thallium's widespread use. In the area of viability (ie, the preinterventional detection of potentially reversible myocardial wall-motion abnormalities), 201TICI is still not fully accepted. The most reliable diagnostic tool for this procedure is 13N-NH3 (ammonia)/fluorine F18 fluorodeoxyglucose (FDG) positron emission tomography because of its options for quantification and high-resolution imaging. In the near future, the limited number of these sophisticated but expensive positron emission tomography centers will not satisfy the growing clinical demand for viability studies. Thus, European nuclear cardiologists are developing alternative techniques for positron imaging. They have shown that by means of a conventional gamma camera with special high-energy collimators, a reliable perfusion/viability assessment is feasible.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed2000

Comparison of FDG-PET and Bone Scans for Detecting Skeletal Metastases in Patients with Non-small Cell Lung Cancer.

Purpose: Positron Emission Tomography (PET) with F18-fluorodeoxyglucose has been proven useful for staging non-small cell lung cancer. Bone scans are frequently performed for suspected skeletal metastases. The purpose of this study was to evaluate if bone scans compared to PET scans provide additional information that changes the stage of disease.Procedures: Nineteen patients with non-small cell lung cancer had PET and bone scans done for staging of the malignancy. The results of both studies were compared.Results: Bone and PET scans agreed on the presence or absence of skeletal metastases in all nineteen patients. The addition of a bone scan to a PET scan did not change the stage of the disease or the management in any of the patients. Bone scans allowed for more precise localization of the lesions in some patients.Conclusions: Bone scans do not change the stage of disease when performed in addition to PET scans, but provide more precise localization of skeletal abnormalities.

Journal Article↗
PubMed2006

Assessing the use of FDG-PET in the detection of regional and metastatic nodes in alveolar rhabdomyosarcoma of extremities.

Alveolar rhabdomyosarcoma (ARS) accounts for 20% to 30% of childhood rhabdomyosarcoma and is known to have a worse prognosis than embryonal rhabdomyosarcoma. Metastatic disease is more frequent in patients with alveolar tumors and these children with metastatic disease fare poorly, with a 5-year survival between 20% and 30%. Therefore, ARS represents a significant diagnostic and therapeutic challenge that requires techniques to provide better assessment of the disease than provided by traditional means. F18 fluorodeoxyglucose-positron emission tomography (FDG-PET) depicts the increased metabolism in abnormal tissues, enabling accurate evaluation of suspicious regional and metastatic disease. The new combined PET/CT systems can further improve PET interpretation and affect patient management. The value of FDG in patients with soft tissue sarcomas has been demonstrated in several series, but none specifically in ARS. This report assesses the use of FDG-PET/CT in the detection of regional and metastatic nodes in 3 children diagnosed with ARS of the extremities. All the 3 patients we present had focally increased tracer uptake in nodal stations on a pretherapy PET performed at diagnosis. Tissue confirmation available in 2 patients was negative in 1 patient and positive for metastatic nodal spread in the other. Metastatic axillary disease was possibly also present in the third patient according to his later course of disease.

Child, Preschool↗
PubMed2004

Evidence of thymic reconstitution after highly active antiretroviral therapy in HIV-1 infection.

OBJECTIVES: We aimed to provide evidence of thymic reconstitution after highly active antiretroviral therapy (HAART) in HIV-1 infected patients and to correlate this with the restoration of peripheral naïve T cells. METHODS: Positron emission tomography (PET) enables definitive evidence of thymic activity, indicating functional potential. In this case study, a single patient who initiated HAART demonstrated reconstitution of the naïve T-cell pool and underwent thymic PET scans at baseline and 2 and 6 months following initiation of therapy. Two patients who failed to demonstrate such reconstitution acted as controls. These patients (mean age 27 years) had chronic HIV infection with low CD4 T-cell counts (mean 82, range 9-160 cells/microL blood). Increased function of the thymus visualized by PET was correlated with phenotypic changes in CD4 and CD8 T cells in the periphery measured by flow cytometry, and with numbers of recent thymic emigrants measured by quantification of the numbers of T-cell receptor excision circles (TRECs) in peripheral cells. RESULTS: In one patient, clear correlations could be drawn between visible activity within the thymus, as measured by increased [F18]fluorodeoxyglucose (FDG) uptake, and regeneration of naïve CD4 (CD45RA/CD62L) T cells, increased numbers of CD4 T cells, controlled viraemia and increased numbers of recent thymic emigrants. A second patient displayed no increase in peripheral CD4 count and no increase in thymic activity. The third patient elected to stop therapy following the 2-month time point. CONCLUSIONS: The use of PET suggests that thymic activity may increase after HAART, indicating that the thymus has the potential to be functional even in HIV-1 infected persons with low CD4 T-cell counts.

Adult↗
PubMedDate not supplied

[Ovarian and para-aortic recurrence from cervix cancer detected by PET/CT].

We present the case of a 34-year-old woman diagnosed of an adenosquamous carcinoma of the uterine cervix, stage IIB of the FIGO classification (International Federation of Gynecology and Obstetrics), treated with quimiotherapy, radiotheraphy and brachytheraphy with posterior hysterectomy. A recurrence of the disease was suspected due to the progressive rise of CEA levels. A PET/CT revealed abnormal foci in both ovaries, that had been transposed to avoid lesions due to radiation, and in a left para-aortic adenopathy. The diagnosis of recurrence in these sites was confirmed by biopsy. PET with FDG (F18-fluorodeoxyglucose) is useful in the staging of primary tumour and in the detection of recurrence in uterine cervical carcinoma, with better sensitivity and specificity than CT and MRI. PET/CT improves anatomic resolution and helps to resolve the origin of unclear foci like in the case presented in which ovaries were not in their normal situation due to transposition.

Adult↗
PubMed2004

Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis.

BACKGROUND: Extensive left ventricular (LV) remodeling may not allow functional recovery after revascularization, despite the presence of viable myocardium. METHODS AND RESULTS: Seventy-nine consecutive patients with ischemic cardiomyopathy (left ventricle ejection fraction [LVEF] 29+/-7%) underwent surgical revascularization. Before revascularization, viability was assessed by metabolic imaging with F18-fluorodeoxyglucose and SPECT. LV volumes and LVEF were assessed by resting echocardiography. LVEF was re-assessed by echocardiography 8 to 12 months after revascularization. Three-year clinical follow-up (events: cardiac death, infarction, and hospitalization for heart failure) was also obtained. Forty-nine patients had substantial viability; 5 died before re-assessment of LVEF. Of the remaining 44 patients, 24 improved > or =5% in LVEF after revascularization, whereas 20 did not improve in LVEF. LV end-systolic volume was the only parameter that was significantly different between the groups (109+/-46 mL for the improvers versus 141+/-31 mL for the nonimprovers; P<0.05). The change in LVEF after revascularization was linearly related to the baseline LV end-systolic volume, with a higher LV end-systolic volume associated with a low likelihood of improvement in LVEF after revascularization. During the 3-year follow-up, the highest event-rate (67%) was observed in patients without viable myocardium with a large LV size, whereas the lowest event rate (5%) was observed in patients with viable myocardium and a small LV size. Intermediate event rates were observed in patients with viable myocardium and a large LV size (38%), and in patients without viable myocardium and a small LV size (24%). CONCLUSIONS: Extensive LV remodeling prohibits improvement in LVEF after revascularization and affects long-term prognosis negatively, despite the presence of viability.

Aged↗
PubMed1998

[Scintigraphic imaging of stage III non-small-cell bronchial cancer].

Scintigraphic imagery is a functional image based on the difference of the in vivo concentration of injected radio-active traces as a function-of the metabolic characteristics of the tissues. A positive emission tomography (TEP) relies on an injection of substances which reflect the metabolic activity of the tissues and consist of protein renewal with 11C-methionine or glucose metabolism with F18-fluorodeoxyglucose (FTG). The imagery by TEP enables 85-90% of solitary pulmonary nodules to be detected. The degree of capture of the tracer enables some differentiation of a malignant lesion from a benign lesion which fixes less. In the assessment of the degree of extension in the mediastinal nodes of non-small cell Stage III cancers imagery by TEP has a sensitivity ads specificity which appears superior to those of computed tomography (TEM). The interpretation of the image is simplified by carrying out fusion images between TEM and TEP. The application of TEP in the research into thoracic recurrence has shown a cumulated specificity of 81% and a reliability of 91%. The imagery by TEP is only practised in a few centres. It should be developed in pulmonary pathology if the cost of the apparatus diminishes and if FTG is available. Radioscintigraphy is losing ground in the precise domain of non-small cell carcinoma although it shows up well as a technique in neuro-endocrine tumours. Few studies have shown a decisive value in the radioimmunoscintigraphic evaluation of the extension of mediastinal nodes. A gallium 67 scintigraphy has weak specificity and on account of this has been abandoned for the staging of tumours. Another approach has been isotopic imagery of macrophages but is major inconvenience is a lack of specificity. Scintigraphic studies coupled with ventilation/perfusion remains a useful pre-operative test above all in patients with chronic airflow obstruction with gross tumours at the borderline of operability.

Carcinoma, Non-Small-Cell Lung↗
PubMed1998

Successful treatment of invasive aspergillosis in chronic granulomatous disease by bone marrow transplantation, granulocyte colony-stimulating factor-mobilized granulocytes, and liposomal amphotericin-B.

X-linked chronic granulomatous disease (X-CGD) is a primary immunodeficiency with complete absence or malfunction of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase in the phagocytic cells. Life-threatening infections especially with aspergillus are common despite optimal antimicrobial therapy. Bone marrow transplantation (BMT) is contraindicated during invasive aspergillosis in any disease setting. We report an 8-year-old patient with CGD who underwent HLA-genoidentical BMT during invasive multifocal aspergillus nidulans infection, nonresponsive to treatment with amphotericin-B and gamma-interferon. During the first 10 days post-BMT, the patient received granulocyte colony-stimulating factor (G-CSF)-mobilized, 25 Gy irradiated granulocytes from healthy volunteers plus G-CSF beginning on day 3 to prolong the viability of the transfused granulocytes. This was confirmed in vitro by apoptosis assays and in vivo by finding nitroblue tetrazolium (NBT)-positive granulocytes in peripheral blood 12 and 36 hours after the transfusions. Clinical and biological signs of infection began to disappear on day 7 post-BMT. Positron emission tomography with F18-fluorodeoxyglucose (FDG-PET) and computed tomography (CT) scans at 3 months post-BMT showed complete disappearance of infectious foci. At 2 years post-BMT, the patient is well with full immune reconstitution and no sign of aspergillus infection. Our results show that HLA-identical BMT may be successful during invasive, noncontrollable aspergillus infection, provided that supportive therapy is optimal.

Amphotericin B↗
PubMedDate not supplied

Positron emission tomography imaging in evaluation of cancer patients.

Positron emission tomography (PET) is a diagnostic imaging technique that has progressed rapidly from being a research technique in laboratories to a routine clinical imaging modality. The most widely used radiotracer in PET is Fluorine18-fluorodeoxyglucose (F18-FDG), which is an analogue of glucose. The FDG uptake in cells is directly proportional to glucose metabolism of cells. Since glucose metabolism is increased many fold in malignant tumors PET has a high sensitivity and a high negative predictive value. PET with FDG is now the standard of care in initial staging, monitoring the response to the therapy, and management of lung cancer, colonic cancer, lymphoma, melanoma, esophageal cancer, head and neck cancer and breast cancer. Other indications of PET like bone tumor, ovarian cancer and cancer of unknown primary (CUP) has also been discussed in brief. The aim of this review article is to review the clinical applications of PET in various malignancies and only limited number of important studies will be discussed for this effort.

Fluorodeoxyglucose F18↗
PubMed2006

Perceived loss of memory ability and cerebral metabolic decline in persons with the apolipoprotein E-IV genetic risk for Alzheimer disease.

CONTEXT: Concerns about age-related memory loss are greater in persons who have the apolipoprotein E-IV (APOE4) genetic risk for Alzheimer disease, but the correlation between the degree of concerns and future cerebral metabolic decline is unknown. OBJECTIVE: To investigate whether the degree of self-perceived memory loss is associated with regional cerebral metabolic decline. DESIGN: Longitudinal study. SETTING: Aging and Memory Research Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles. PARTICIPANTS: Thirty right-handed, cognitively intact, middle-aged and older adults (age range, 50-82 years) with age-associated memory complaints, 14 of whom were carriers of the apolipoprotein E-IV allele, were recruited for longitudinal study. MAIN OUTCOME MEASURES: At baseline, we administered a standardized neuropsychological battery and assessed self-appraisal of memory functioning using the Memory Functioning Questionnaire, which yields 4 factor scores indicating frequency of forgetting, seriousness of forgetting, retrospective functioning, and mnemonics use. Regional cerebral glucose metabolism was determined using fluorodeoxyglucose F18-positron emission tomography at baseline and after 2 years. RESULTS: At baseline, APOE4 carriers and noncarriers did not differ significantly on objective memory measures or on Memory Functioning Questionnaire factor scores. However, the factor score for frequency of forgetting significantly correlated with global cerebral metabolic decline in all subjects regardless of APOE4 genetic risk (P = .01). By contrast, the factor score for mnemonics use significantly correlated with metabolic decline in the temporal regions in APOE4 carriers but not in noncarriers (P = .03). CONCLUSIONS: The degree of perceived memory loss correlates with subsequent global cerebral metabolic decline for APOE4 carriers and noncarriers; hence, memory complaints may reflect underlying cerebral metabolic changes. Compensatory strategies, as reflected by more frequent mnemonics use in APOE4 carriers, may reflect underlying metabolic changes in the brain regions associated with prodromal Alzheimer disease. Self-reported mnemonics use may be helpful in identifying persons for clinical monitoring.

Aged↗