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Left ventricular dual-energy digital subtraction angiography: a motion immune digital subtraction technique.

Digital subtraction angiography (DSA) allows quantitative analysis of ventricular function via densitometric and parametric imaging techniques. However, DSA is limited by the artifacts in temporal subtraction images that result from patient and cardiac motion. Dual-energy subtraction imaging is insensitive to motion. This study evaluated the initial application of dual-energy subtraction in cardiac patients. The image quality of dual-energy subtraction left ventriculograms obtained from a pulmonary artery injection of contrast was assessed in 13 patients, ranging in weight from 54 to 100 kg. The dual-energy images were compared with left ventricular images obtained using standard left ventricular injection cine angiography. End-systolic and end-diastolic ventricular volumes calculated from the cine (C) and dual-energy (DE) images using the Area-Length method were compared. The resulting regression line was DE = 0.98 C+ 7.0 ml, and the r value was 0.987. Dual-energy subtraction provided good left ventricular visualization, free from misregistration artifacts, even during patient motion.

Adult

Visualization of mu1 opiate receptors in rat brain by using a computerized autoradiographic subtraction technique.

We have developed a quantitative computerized subtraction technique to demonstrate in rat brain the regional distribution of mu1 sites, a common very-high-affinity binding site for both morphine and the enkephalins. Low concentrations of [D-Ala2, D-Leu5]enkephalin selectively inhibit the mu1 binding of [3H]dihydromorphine, leaving mu2 sites, while low morphine concentrations eliminate the mu1 binding of [3H][D-Ala2, D-Leu5]enkephalin, leaving delta sites. Thus, quantitative differences between images of sections incubated in the presence and absence of these low concentrations of unlabeled opioid represent mu1 binding sites. The regional distributions of mu1 sites labeled with [3H]dihydromorphine were quite similar to those determined by using [3H][D-Ala2, D-Leu5]enkephalin. High levels of mu1 binding were observed in the periaqueductal gray, medial thalamus, and median raphe, consistent with the previously described role of mu1 sites in analgesia. Other regions with high levels of mu1 binding include the nucleus accumbens, the clusters and subcallosal streak of the striatum, hypothalamus, medial habenula, and the medial septum/diagonal band region. The proportion of total specific binding corresponding to mu1 sites varied among the regions, ranging from 14% to 75% for [3H][D-Ala2, D-Leu5]enkephalin and 20% to 52% for [3H]dihydromorphine.

Animals

Subtraction technique in intravenous aortography.

Excretory urography using the subtraction technique (100 ml of 60% urographic media injected in 10-12 seconds) demonstrated the aorta and its major branches well enough to prove useful clinically. The method is fast and graphic, and risk seems no greater than that associated with the standard urographic examination.

Aorta, Abdominal

Nuclide imaging of vascular graft-platelet interactions: comparison of indium excess and technetium subtraction techniques.

Indium-111-labeled platelet adherence to ePTFE thoracoabdominal vascular prostheses in a canine model (n = 10) was quantitated by (1) an indium-111 excess technique, contrasting graft radioactivity to that in a reference region, and (2) a technetium-99m subtraction technique, with radioactivity of circulating platelets eliminated by discounting background blood activity. Variation in graft thrombogenicity was provided by seeding six prostheses with enzymatically derived autologous endothelial cells, and implanting four prostheses without seeding. Grafts were imaged at 1, 4, and 6 weeks postimplantation, with platelet labeling using indium-111-oxine and red blood cell labeling using technetium-99m. At 7 weeks grafts were excised and gamma activity was measured in proximal, middle, and distal segments. Luminal generation of TxB2 and 6-keto-PGF1 alpha from midportions of grafts was assayed. Indium-111 excess ratios at 6 weeks correlated with actual gamma activity of excised grafts (proximal r = 0.80, P less than 0.01; middle r = 0.73, P less than 0.05; distal r = 0.48, ns) but such a correlation did not exist for the technetium-99m subtraction technique (r = -0.05, -0.25, and 0.16, in the three segments, respectively, all ns). The ratio of graft to aortic TxB2 production revealed a positive correlation with graft gamma activity (r = 0.87, P less than 0.01), and the ratio of graft 6-keto-PGF1 alpha to TxB2 production also correlated with gamma counts (r = -0.64, P = 0.05). In this experimental setting technetium-99m subtraction analysis was an imprecise method of detecting graft platelet accumulation, whereas indium-111 excess ratios proved to be a more accurate method of quantitating vascular prosthetic thrombogenicity.

Animals

Rapid determination of cancellous bone mineral loss in ovariectomized rats by a subtraction technique.

We present a rapid technique for determining cancellous bone mineral changes in small experimental animals. We used the distal centimeter of the right femur from ovariectomized (OX) (N = 30) and shamovariectomized (ShOX) (N = 28) rats, aged 90 days at surgery and killed at times from 125-540 days postsurgery. We used dual photon absorptiometry to scan the segment three times: intact, after parasagittal splitting, and after removing all cancellous bone. We equated the difference between the second and third scans to cancellous bone mineral content (Cn.BMC). To validate this, we compared it with histomorphometrically determined bone volume (BV/TV) of the proximal tibial metaphysis of the same rat. Parasagittally splitting the segment removed no detectable mineral. OX rats had 40% less Cn.BMC than ShOX rats. However, OX rats had 80% lower BV/TV than ShOX rats. The subtraction technique not only makes a rapid, reasonable assessment of cancellous bone loss in OX rats but permits a smaller sample size than histomorphometry. The histomorphometric technique finds a greater difference between OX and ShOX rats because it examines a region where cancellous bone loss is more marked than does the scanning technique. The current technique measures bone of not only the central secondary spongiosa but also the juxtacortical region and the primary spongiosa, where OX-related differences are less prominent. The principles of this subtraction technique proved workable. However, for the future, we recommend a two-scan technique using a dual energy X-ray scanner. It is likely to take only 20-30 min per specimen to assess cancellous bone mineral.

Absorptiometry, Photon

[Further possibilities for the application of the digital subtraction technique in neuroradiologic diagnosis].

The article presents, as methods that can be used in addition to digital subtraction angiography, ventriculography, myelography, discography as well as control examinations of shunts and port systems to widen the scope of digital subtraction techniques (DST) in neuroradiological diagnostics. Besides the reduction of amount and concentration of contrast media, more comprehensive and better diagnostic results were achieved for all examination methods with regard to the functional and dynamic aspects, the spatial resolution being of comparable quality.

Anastomosis, Surgical

Subtraction technique for contrast-enhanced MR images of musculoskeletal tumors.

Vascularized malignant tissue, fat and hemorrhage may have similar intensities on Gd-DTPA-enhanced, T1-weighted MRI performed to evaluate musculoskeletal tumors. We describe a simple, rapid post-processing subtraction technique which resulted in improved definition of these tissues in 33 of 42 examinations. While the subtraction process is susceptible to complex patient motion, the improved contrast can be obtained without modifying standard pulse sequences.

Bone Neoplasms

Improved subtraction technique in intravenous digital left ventriculography: comparison with radionuclide studies.

Adequate processing of left ventricular angiograms depends on the visualisation of all segments of the ventricular wall. At the same time, subtraction of different images can enhance different heart segments but commercially available methods do not allow simultaneous viewing of several images masked by different processes. Using our software, for each studied frame, a four quadrant display permits the simultaneous visualisation of a mask mode image, a diastolic-systolic difference image, an image obtained by subtraction of a frame at the same cycle time and a composite mask subtracted image. The composite mask image is obtained by weighting three images according to videodensitometric measurements by reference to previously acquired data. This method facilitates contour delineation and computation of the ejection fraction by area-length method. Correlation with radionuclide estimates of left ventricular ejection fraction is higher (n = 60, r = 0.90, SEE = 8%) than using the classical mask mode display (n = 60, r = 0.82, SEE = 11%). In a subgroup of 30 patients the contrast medium was injected in an antecubital vein and the correlation coefficient remained satisfactory (n = 30, r = 0.89, SEE = 7%) when compared with the classical subtraction technique (n = 30, r = 0.70, SEE = 12%). We therefore conclude that the composite mask method gives comparatively similar values for left ventricular ejection fraction to those acquired by radionuclide angiography.

Angiography, Digital Subtraction

Visualization of myocardial infarction 6 h after injection of 111In-antimyosin antibodies using a blood pool subtraction technique.

111In-antimyosin antibodies are capable of visualizing myocardial infarction (MI). Because of slow blood clearance, images are usually recorded 24 or 48 h postinjection. In this pilot study, a blood pool subtraction technique, which makes it possible to visualize MI 6 h postinjection, is validated. Twenty-five patients with proven MI (16 anterior, 9 inferior) were imaged a few minutes, 6 and 24 h after an injection of 111 MBq 111In-labelled antimyosin antibodies. Three planar views are obtained each time. Using software which performs the geometric registration, the grey level normalization and the subtraction of images, the blood pool image (obtained a few minutes postinjection) is subtracted from the 6 h image. The resulting image is the blood pool corrected 6 h image. The 24 h images and the blood pool corrected 6 h images were interpreted blindly and the number of correct, incorrect and impossible MI localizations was counted. The number of correct localizations is 19/25 for the standard 24 h images and 22/25 for the blood pool corrected 6 h images. Then, with this blood pool subtraction method, it is possible to visualize MI 6 h postinjection. This has to be taken into account when discussing the role of antimyosin scintigraphy in the management of patients with MI.

Antibodies, Monoclonal

Demonstration of pancreatic parenchyma by digital subtraction techniques during endoscopic retrograde cholangiopancreatography.

This paper reports the feasibility of using digital subtraction angiography techniques during endoscopic retrograde cholangiopancreatography to obtain greater detail of pancreatic structure. The pancreatic duct was filled in 23 of 27 cases attempted and in 17 cases parenchymal detail was obtained. Filling defects due to neoplasm were clearly defined and the changes of chronic pancreatitis visualised. The technique seems valuable for small lesions but may carry a higher risk of producing pancreatitis.

Acute Disease

Spectrum subtraction technique for minimizing extracranial influence on cerebral blood flow measurements by 133xenon inhalation.

Estimates of regional cerebral blood flow (rCBF) by the 133Xe inhalation method are influenced by isotope contamination from slow clearing extracerebral tissues. Subtraction of x-ray (31 kev) from gamma-ray counts (81 kev) has been suggested as a means of yielding clearance curves that are relatively free of such contamination. In the present study, rCBF measurements based on the total 133Xe spectrum (x-ray plus gamma) were compared with those derived from the subtracted spectrum (x-ray minus gamma) in 20 young controls, using a two-compartmental analysis of the clearance curves. In comparison with addition, the subtraction data gave substantially higher estimates of blood flow for the slow (second) compartment. This, along with a shift in the relative weights of the two compartments, indicated a decreased contribution of slow tissue components, consistent with a reduction in extracerebral contamination. Blood flow values obtained by subtraction were in good agreement with those reported for the intracarotid injection method. A limitation of the subtraction technique, however, is the relatively high dose of isotope required for adequate signal-to-noise ratios.

Adult

Limitations of the digital image subtraction technique in assessing alveolar bone crest changes due to misalignment errors during image capture.

The digital image subtraction method depends critically on the very precise registration of sequential radiographs. A method of using a single radiograph to form two identical digital images was created, eliminating any potential effects from irradiation or processing variation, to investigate the effects of misregistration between images. These images were displaced by 0.1-0.42 mm in the X, Y and XY directions before subtraction. A total of 35 alveolar crest margins from five bitewing radiographs were investigated for the extent of false bone loss or gain produced in the subtracted images. The mean grey level gradient across the interdental space/crestal margin interface was 3.1 (SD 1.4) grey levels per 0.05 mm pixel. Small displacements between subtracted images of 0.1-0.14 mm in the Y or XY directions caused 20-25% of crestal pixels to vary by greater than or equal to +/- 2.5% of the grey range. Larger displacements of 0.3-0.42 mm caused 65% of crestal pixels to vary by greater than or equal to +/- 2.5% of the grey range. A higher threshold of greater than or equal to +/- 4.1% of the grey range still showed up to 48% of crestal pixels were in this higher deviation band. A high noise threshold of +/- 8% of the grey range should be used to discriminate against false grey values. A visual method for estimating the direction of displacement error between images is discussed together with a method for setting noise thresholds for individual alveolar crest grey level gradients. In any radiograph, a range of alveolar crest gradients will be found and those with the higher gradients will produce the largest subtraction errors for any given displacement between images.

Alveolar Bone Loss

Improved quantification of radionuclide uptake using deconvolution and windowed subtraction techniques for scatter compensation in single photon emission computed tomography.

A comparison of two methods of scatter compensation in single photon emission computed tomography (SPECT) imaging is made on the basis of improvements in quantification. The methods, scatter-window subtraction and constrained deconvolution of an average point source response function (PSRF), are described; the theoretical basis of each method is also briefly assessed. Improvements in relative quantification offered by each method are measured by examining ratios of counts in hot cylinders to counts in a slightly radioactive background. The cylinder/background concentration ratio was varied by a factor of five; the sizes of the cylinders remained constant. Keeping the diameter of the cylinders constant allowed for an assessment of the effect of concentration differences, without the conflicting effect of variation in the size of the hot source. Results showed that while both scatter-window subtraction and constrained deconvolution offer quantification improvements in the final image, the method of prereconstruction deconvolution of a planar PSRF from each planar projection is substantially more successful than either scatter-window subtraction or other methods of implementing the deconvolution procedure.

Biophysical Phenomena

Modified histogram subtraction technique for analysis of flow cytometry data.

Analysis of flow cytometry histogram data by the subjective selection of an integration window can be a tedious and time-consuming task and is often inaccurate. A new method for automated calculation of the percent positive from immunofluorescence histograms is presented. This new method is a modification of the currently used method of channel-by-channel histogram subtraction. Its accuracy is compared to that of the channel-by-channel histogram subtraction method and to another currently used automated method, which selects an integration window by finding the channels that contain the most fluorescent 2% of a control histogram. The new histogram subtraction method is objective, easy to use, and is more accurate than other currently used automated analysis methods. PASCAL source code is given for each method of analysis.

Cell Separation