SPECT system optimization against a discrete parameter space

In this paper, we present an analytical approach for optimizing the design of a static SPECT system or optimizing the sampling strategy with a variable/adaptive SPECT imaging hardware against an arbitrarily given set of system parameters. This approach has three key aspects. First, it is designed to operate over a discretized system parameter space. Second, we have introduced an artificial concept of virtual detector as the basic building block of an imaging system. With a SPECT system described as a collection of the virtual detectors, one can convert the task of system optimization into a process of finding the optimum imaging time distribution (ITD) across all virtual detectors. Thirdly, the optimization problem (finding the optimum ITD) could be solved with a block-iterative approach or other nonlinear optimization algorithms. In essence, the resultant optimum ITD could provide a quantitative measure of the relative importance (or effectiveness) of the virtual detectors and help to identify the system configuration or sampling strategy that leads to an optimum imaging performance. Although we are using SPECT imaging as a platform to demonstrate the system optimization strategy, this development also provides a useful framework for system optimization problems in other modalities, such as positron emission tomography and x-ray computed tomography (Moore et al (2009 IEEE Nucl. Sci. Symp. Conf. Rec. pp 4154-7), Freed et al (2008 Med. Phys. 35 1912-25)).

3-D Spatial Resolution of 350 μm Pitch Pixelated CdZnTe Detectors for Imaging Applications

We are currently investigating the feasibility of using highly pixelated Cadmium Zinc Telluride (CdZnTe) detectors for sub-500 μm resolution PET imaging applications. A 20 mm × 20 mm × 5 mm CdZnTe substrate was fabricated with 350 μm pitch pixels (250 μm anode pixels with 100 μm gap) and coplanar cathode. Charge sharing among the pixels of a 350 μm pitch detector was studied using collimated 122 keV and 511 keV gamma ray sources. For a 350 μm pitch CdZnTe detector, scatter plots of the charge signal of two neighboring pixels clearly show more charge sharing when the collimated beam hits the gap between adjacent pixels. Using collimated Co-57 and Ge-68 sources, we measured the count profiles and estimated the intrinsic spatial resolution of 350 μm pitch detector biased at -1000 V. Depth of interaction was analyzed based on two methods, i.e., cathode/anode ratio and electron drift time, in both 122 keV and 511 keV measurements. For single-pixel photopeak events, a linear correlation between cathode/anode ratio and electron drift time was shown, which would be useful for estimating the DOI information and preserving image resolution in CdZnTe PET imaging applications.

Hybrid pixel-waveform CdTe/CZT detector for use in an ultrahigh resolution MRI compatible SPECT system

In this paper, we will present a new small pixel CdTe/CZT detector for sub-500 μm resolution SPECT imaging application inside MR scanner based on a recently developed hybrid pixel-waveform (HPWF) readout circuitry. The HPWF readout system consists of a 2-D multi-pixel circuitry attached to the anode pixels to provide the X-Y positions of interactions, and a high-speed digitizer to read out the pulse-waveform induced on the cathode. The digitized cathode waveform could provide energy deposition information, precise timing and depth-of-interaction information for gamma ray interactions. Several attractive features with this HPWF detector system will be discussed in this paper. To demonstrate the performance, we constructed several prototype HPWF detectors with pixelated CZT and CdTe detectors of 2-5 mm thicknesses, connected to a prototype readout system consisting of energy-resolved photon-counting ASIC for readout anode pixels and an Agilent high-speed digitizer for digitizing the cathode signals. The performances of these detectors based on HPWF are discussed in this paper.

Investigation of the limitations of the highly pixilated CdZnTe detector for PET applications

We are investigating the feasibility of a high resolution positron emission tomography (PET) insert device based on the CdZnTe detector with 350 µm anode pixel pitch to be integrated into a conventional animal PET scanner to improve its image resolution. In this paper, we have used a simplified version of the multi pixel CdZnTe planar detector, 5 mm thick with 9 anode pixels only. This simplified 9 anode pixel structure makes it possible to carry out experiments without a complete application-specific integrated circuits readout system that is still under development. Special attention was paid to the double pixel (or charge sharing) detections. The following characteristics were obtained in experiment: energy resolution full-width-at-half-maximum (FWHM) is 7% for single pixel and 9% for double pixel photoelectric detections of 511 keV gammas; timing resolution (FWHM) from the anode signals is 30 ns for single pixel and 35 ns for double pixel detections (for photoelectric interactions only the corresponding values are 20 and 25 ns); position resolution is 350 µm in x,y-plane and ∼0.4 mm in depth-of-interaction. The experimental measurements were accompanied by Monte Carlo (MC) simulations to find a limitation imposed by spatial charge distribution. Results from MC simulations suggest the limitation of the intrinsic spatial resolution of the CdZnTe detector for 511 keV photoelectric interactions is 170 µm. The interpixel interpolation cannot recover the resolution beyond the limit mentioned above for photoelectric interactions. However, it is possible to achieve higher spatial resolution using interpolation for Compton scattered events. Energy and timing resolution of the proposed 350 µm anode pixel pitch detector is no better than 0.6% FWHM at 511 keV, and 2 ns FWHM, respectively. These MC results should be used as a guide to understand the performance limits of the pixelated CdZnTe detector due to the underlying detection processes, with the understanding of the inherent limitations of MC methods.

First imaging result with an ultrahigh resolution stationary MR compatible SPECT system

In this paper, we will present the design and preliminary performance of an ultrahigh resolution stationary MR compatible SPECT (MRC-SPECT) system that is developed in our lab. The MRC-SPECT system is based on the second-generation energy-resolved photon-counting (ERPC) CdTe detectors and there are several key features associated with this system. Firstly, up to a total of twenty ERPC detectors will be assembled as a very compact ring, which provides an adequate angular sampling capability and a relatively high detection efficiency. The detectors are supported on a gantry made of high strength polyamide structure constructed using 3-D printing. This compact system can be directly operated inside an MR scanner. The detector module used in this system offers an intrinsic resolution of 350μm and an excellent energy resolution of around 3~4kev. Each ERPC detector module consists of four pixelated CdTe detectors with a total dimension of 4.5cm×2.25cm. Secondly, a die-cast platinum pinhole inserts and cast lead apertures are developed for this stationary SPECT system. Four 300/500μm diameter pinholes are used for each detector and all pinholes are mounted around a casted cylinder lead aperture tube. The inner diameter of the lead aperture tube is 6cm and the lead tube thickness is 16mm. The opposite detectors are placed 15.6cm apart and the magnification factor of this SPECT system is about 1.2. Thirdly, a comprehensive charge collection model inside strong magnetic field has been developed to account for the magnetic field induced distortion in the SPECT image. This model can accurately predict the detector's energy and spatial response to gamma ray incident events and then help to compensate for the event position recording error due to the strong magnetic field. In this development, we have made an effort to minimize the amount of magnetic materials in the system to alleviate potential interference to magnetic field inhomogeneity.

X-ray Fluorescence Emission Tomography (XFET) with Novel Imaging Geometries - A Monte Carlo Study

This paper presents a feasibility study for using two new imaging geometries for synchrotron X-ray fluorescence emission tomography (XFET) applications. In the proposed approaches, the object is illuminated with synchrotron X-ray beams of various cross-sectional dimensions. The resultant fluorescence photons are detected by high-resolution imaging-spectrometers coupled to collimation apertures. To verify the performance benefits of the proposed methods over the conventional line-by-line scanning approach, we have used both Monte Carlo simulations and an analytical system performance index to compare several different imaging geometries. This study has demonstrated that the proposed XFET approach could lead to a greatly improved imaging speed, which is critical for making XFET a practical imaging modality for a wide range of applications.

Adaptive Angular Sampling for SPECT Imaging

This paper presents an analytical approach for performing adaptive angular sampling in single photon emission computed tomography (SPECT) imaging. It allows for a rapid determination of the optimum sampling strategy that minimizes image variance in regions-of-interest (ROIs). The proposed method consists of three key components: (a) a set of close-form equations for evaluating image variance and resolution attainable with a given sampling strategy, (b) a gradient-based algorithm for searching through the parameter space to find the optimum sampling strategy and (c) an efficient computation approach for speeding up the search process. In this paper, we have demonstrated the use of the proposed analytical approach with a single-head SPECT system for finding the optimum distribution of imaging time across all possible sampling angles. Compared to the conventional uniform angular sampling approach, adaptive angular sampling allows the camera to spend larger fractions of imaging time at angles that are more efficient in acquiring useful imaging information. This leads to a significantly lowered image variance. In general, the analytical approach developed in this study could be used with many nuclear imaging systems (such as SPECT, PET and X-ray CT) equipped with adaptive hardware. This strategy could provide an optimized sampling efficiency and therefore an improved image quality.

Protective effects of melatonin against oxidative stress in flow cytometry-sorted buffalo sperm

Previous reports of the ability of melatonin to scavenge a variety of toxic oxygen and nitrogen-based reactants suggest that melatonin could be an effective antioxidant for protecting sperm. In this study, flow cytometry and laser tweezers Raman spectroscopy were used to evaluate the effect of melatonin on buffalo sperm quality to optimize sperm sex-sorting procedures. In fresh sperm incubated in the presence or absence of melatonin (10(-4)  m) for 1, 24, 48 h or 72 h at 27°C, the mitochondrial activity was significantly higher than in a non-melatonin control (p < 0.05). Also, during the flow-sorting process, sperm in melatonin-supplemented groups had higher (p < 0.05) mitochondrial activity than the control. The intensity of Raman spectra from sperm frozen in media supplemented with melatonin was significantly weaker than that for non-melatonin-treated groups, except for a band at 1302 per cm. Thus, melatonin helps to protect buffalo sperm from reactive oxygen species induced by staining, sorting and freezing and increases semen quality after the freezing-thawing processes. Furthermore, the results indicate the high potential of the laser tweezers Raman spectroscopy technique for rapid, effective and non-invasive assessment of the quality of sperm cells.

Accelerating X-ray fluorescence computed tomography

This paper presents new approaches to accelerating X-ray fluorescence tomography (XFCT) that are grounded in both novel image acquisition strategies that improve the quality of the data acquired and in image reconstruction strategies that reduce the amount of data acquired. First, we introduce an alternative imaging scheme that uses an emission tomography (ET) system to collect the fluorescence photons representing an entire 2D slice or volumetric projection of the object at one time. Preliminary results indicate that this could achieve a ten to hundredfold improvement in imaging speed. Secondly, novel image reconstruction algorithms are introduced that allow for improved quantitative accuracy as well as for imaging of regions of interest, which will lead to further reduction in data-acquisition time.

Non-Uniform Object-Space Pixelation (NUOP) for Penalized Maximum-Likelihood Image Reconstruction for a Single Photon Emission Microscope System

This paper presents a non-uniform object-space pixelation (NUOP) approach for image reconstruction using the penalized maximum likelihood methods. This method was developed for use with a single photon emission microscope (SPEM) system that offers an ultrahigh spatial resolution for a targeted local region inside mouse brain. In this approach, the object-space is divided with non-uniform pixel sizes, which are chosen adaptively based on object-dependent criteria. These include (a) some known characteristics of a target-region, (b) the associated Fisher Information that measures the weighted correlation between the responses of the system to gamma ray emissions occurred at different spatial locations, and (c) the linear distance from a given location to the target-region. In order to quantify the impact of this non-uniform pixelation approach on image quality, we used the Modified Uniform Cramer-Rao bound (MUCRB) to evaluate the local resolution-variance and bias-variance tradeoffs achievable with different pixelation strategies. As demonstrated in this paper, an efficient object-space pixelation could improve the speed of computation by 1-2 orders of magnitude, whilst maintaining an excellent reconstruction for the target-region. This improvement is crucial for making the SPEM system a practical imaging tool for mouse brain studies. The proposed method also allows rapid computation of the first and second order statistics of reconstructed images using analytical approximations, which is the key for the evaluation of several analytical system performance indices for system design and optimization.

An Ultrahigh Resolution SPECT System for I-125 Mouse Brain Imaging Studies

This paper presents some initial experimental results obtained with a dual-head prototype single photon emission microscope system (SPEM) that is dedicated to mouse brain studies using I-125 labeled radiotracers. In particular, this system will be used for in vivo tacking of radiolabeled T cells in mouse brain. This system is based on the use of the intensified electron multiplying charge-coupled device (I-EMCCD) camera that offers the combination of an excellent intrinsic spatial resolution, a good signal-to-noise ratio, a large active area and a reasonable detection efficiency over an energy range between 27-140keV. In this study, the dual-head SPEM system was evaluated using both resolution phantoms and a mouse with locally injected T cells labelled with I-125. It was demonstrated that for a relatively concentrated source object, the current dual-head SPEM system is capable of visualizing the tiny amount of radioactivity (~12 nCi) carried by a very small number (<1000) of T cells. The current SPEM system design allows four or six camera heads to be installed in a stationary system configuration that offers a doubled or tripled sensitivity at a spatial resolution similar to that obtained with the dualhead system. This development would provide a powerful tool for in vivo and non-invasive tracking of radiolabeled T cells in mouse brain and potentially for other rodent brain imaging studies.

A Vector Uniform Cramer-Rao Bound for SPECT System Design

In this paper, we present the use of modified uniform Cramer-Rao type bounds (MUCRB) for the design of single photon emission tomography (SPECT) systems. The MUCRB is the lowest attainable total variance using any estimator of an unknown vector parameter, whose mean gradient matrix satisfies a given constraint. Since the mean gradient is closely related to local impulse function, the MUCRB approach can be used to evaluate the fundamental tradeoffs between spatial resolution and variance that are achievable with a given SPECT system design. As a possible application, this approach allows one to compare different SPECT system designs based on the optimum average resolution-variance tradeoffs that can be achieved across multiple control-points inside a region-of-interest. The formulation of the MUCRB allows detailed modelling of physical aspects of practical SPECT systems and requests only a modest computation load. It can be used as an analytical performance index for comparing different SPECT system or aperture designs.

An Intensified EMCCD Camera for Low Energy Gamma Ray Imaging Applications

This paper presents the design and feasibility study of a very-high resolution gamma camera for detecting 27-35 keV X and gamma rays emitted by I-125 labelled radiotracers. This detector consists of a newly developed Electron-multiplying CCD (EMCCD) sensor and a de-magnifier tube coupled to a thin layer of scintillator. A prototype detector was developed and experimentally evaluated. This detector has a detection area of ~ 5 cm². It provided an intrinsic spatial resolution of < 60 µm FWHM and a high signal-to-noise ratio for detecting the 27-35 keV photons, which ensures an excellent counting efficiency. This detector will be used as the key component for a single photon emission microscope (SPEM) system that is under development.

Spectroscopic Performance of Thick HgI2 Detectors

This paper presents the spectroscopic performance of two newly developed pixelated HgI₂ detectors. These detectors are 1 × 1 × 0.814 cm³ and 1 × 1 × 1.016 cm³ in size. Each detector has four closely packed 1 × mm² anode pixels at the center of one of the 1 × 1 cm² surfaces. These anode pixels are surrounded by a large anode. All results presented here are based on events from a sub-volume underneath the anode pixels. In these detectors, signals were read out by a discrete electronics based on multiple A-250 pre-amplifiers and a digital oscilloscope for sampling pulse waveforms. Depth sensing technique was used to correct the depth-dependent variation in photopeak amplitude. Main results presented are: (1) energy resolutions of 0.85 ~ 1.3% have been achieved on these detectors; (2) the electron mobility-lifetime product was measured to be ~1 × 10^-2 cm²/V and the measured electron lifetime was ~200 μs and (3) variation in electron drifting properties under different anode pixels were observed. Significant non-uniformity in internal electric field strength was also experimentally demonstrated.

Design and Feasibility Study of a Single Photon Emission Microscope System for Small Animal I-125 Imaging

This paper presents a design study of a single photon emission microscope (SPEM) system for small animal imaging using I-125 labelled radiotracers. This system is based on the use of a very-high resolution gamma camera coupled to a converging non-multiplexing multiple pinhole collimator. This enables one to "zoom" into a small local region inside the object to extract imaging information with a very high spatial resolution and a reasonable sensitivity for gamma rays emitted from this local region. The SPEM system also includes a pinhole (or multiple pinhole) gamma camera that has a full angular coverage of the entire object. The designed imaging spatial resolution for the SPEM system is between 250 μm to 500 μm FWHM.

A modified uniform Cramer-Rao bound for multiple pinhole aperture design

This paper presents a modified Uniform Cramer-Rao bound (UCRB) for studying estimator spatial resolution and variance tradeoffs. We proposed to use a resolution constraint that is imposed on mean gradient vectors of achieved estimators and derived the minimum achievable variance for any estimator satisfies this resolution constraint. This approach partially overcomes the limitations of the former UCRB approach based on a bias-gradient norm constraint. We applied this method in a feasibility study of using multiple pinhole apertures for small animal SPECT imaging applications. The SPECT system studied was based on an existing gamma camera. The achievable spatial resolution and variance tradeoffs for systems with different design parameters, such as number of pinholes and pinhole size, were studied.

A Feasibility Study of Using Hybrid Collimation for Nuclear Environment

This paper presents a feasibility of a gamma ray imager using combined electronic and mechanical collimation methods. This detector is based on the use of a multiple pinhole collimator, a position sensitive scintillation detector with Anger logic readout. A pixelated semiconductor detector, located between the collimator and the scintillation detector, is used as a scattering detector. For gamma rays scattered in the first detector and then stopped in the second detector, an image can also be built up based on the joint probability of their passing through the collimator and falling into a broadened conical surface, defined by the detected Compton scattering event. Since these events have a much smaller angular uncertainty, they provide more information content per photon compared with using solely the mechanical or electronic collimation. Therefore, the overall image quality can be improved. This feasibility study adapted a theoretical approach, based on analysing the resolution-variance trade-off in images reconstructed using Maximum a priori (MAP) algorithm. The effect of factors such as the detector configuration, Doppler broadening and collimator configuration are studied. The results showed that the combined collimation leads to a significant improvement in image quality at energy range below 300keV. However, due to the mask penetration, the performance of such a detector configuration is worse than a standard Compton camera at above this energy.

Feasibility Study of Compton Scattering Enhanced Multiple Pinhole Imager for Nuclear Medicine

This paper presents a feasibility study of a Compton scattering enhanced (CSE) multiple pinhole imaging system for gamma rays with energy of 140keV or higher. This system consists of a multiple-pinhole collimator, a position sensitive scintillation detector as used in standard Gamma camera, and a Silicon pad detector array, inserted between the collimator and the scintillation detector. The problem of multiplexing, normally associated with multiple pinhole system, is reduced by using the extra information from the detected Compton scattering events. In order to compensate for the sensitivity loss, due to the low probability of detecting Compton scattered events, the proposed detector is designed to collect both Compton scattering and Non-Compton events. It has been shown that with properly selected pinhole spacing, the proposed detector design leads to an improved image quality.

Copper(II)-induced conformational changes and protease resistance in recombinant and cellular PrP. Effect of protein age and deamidation

While PrP(C) rearranges in the area of codons 104-113 to form PrP(Sc) during prion infections, the events that initiate sporadic Creutzfeldt-Jakob disease are undefined. As Cu(II) is a putative ligand for PrP(C) and has been implicated in the pathogenesis of Creutzfeldt-Jakob disease and other neurodegenerative diseases, we investigated the structural effects of binding. Incubation of brain microsomes with Cu(II) generated approximately 30-kDa proteinase K-resistant PrP. Cu(II) had little effect on fresh recombinant PrP23-231, but aged protein characterized by conversion of Asn-107 to Asp decreased alpha-helical content by approximately 30%, increased beta-sheet content 100%, formed aggregates, and acquired proteinase K resistance in the presence of Cu(II). These transitions took place without need for acid pH, organic solvents, denaturants, or reducing agents. Since conversion of Asn to Asp proceeds by a spontaneous pathway involving deamidation, our data suggest that covalent variants of PrP(C) arising in this manner may, in concert with Cu(II), generate PrP(Sc)-like species capable of initiating sporadic prion disease.

Progesterone metabolites and bile acids in serum of patients with intrahepatic cholestasis of pregnancy: effect of ursodeoxycholic acid therapy

The concentrations in serum of sulfated metabolites of progesterone are known to be elevated in patients with intrahepatic cholestasis of pregnancy (ICP). The profiles of these metabolites and conjugated bile acids were analyzed in serum from 11 patients with ICP before and during administration of ursodeoxycholic acid (UDCA) (8 patients) or placebo (3 patients). The clinical condition of 7 of the patients given UDCA improved markedly, and 1 patient given placebo had a spontaneous remission of the disease. The total concentration of conjugated bile acids in the 11 patients was 25 +/- 6 micromol/L (mean +/- SEM) and decreased to 6.3 +/- 3.5 micromol/L in the 7 patients responding to treatment with UDCA. The level of 7alpha-hydroxy-4-cholesten-3-one was significantly lower (7.2 +/- 2.2 ng/mL) in patients with ICP than in healthy pregnancy (18 +/- 4.6 ng/mL) (P < .05). The concentrations of 5alpha-pregnane-3alpha,20alpha-diol mono- and disulfates decreased by 52% +/- 7.9% and 68% +/- 5.5%, respectively, in the patients responding to treatment. Similar decreases were observed for the mono- and disulfates of 5alpha-pregnane-3alpha,20alpha,21-triol and 5beta-pregnane-3alpha,20alpha-diol. The disulfate of 5alpha-pregnane-3beta,20alpha-diol showed a smaller decrease, while glucuronidated steroids were not affected. The 3alpha-/3beta-hydroxysteroid ratio and di-/monosulfate ratio decreased significantly during UDCA. The magnitudes of the changes of bile acid and steroid concentrations during UDCA were not correlated to each other. The results suggest that UDCA stimulates the biliary excretion of steroids with a 3alpha-sulfoxy group and disulfates. This effect seems to be independent of the effect on bile acid excretion, indicating the use of different transport proteins. The possibility of an effect of UDCA on the formation of the steroid sulfates cannot be excluded.

Effects of ursodeoxycholic acid on conjugated bile acids and progesterone metabolites in serum and urine of patients with intrahepatic cholestasis of pregnancy

BACKGROUND/AIMS AND METHODS

The mechanism(s) behind the effects of ursodeoxycholic acid on serum steroid sulphate profiles in patients with intrahepatic cholestasis of pregnancy is not clear. Conjugated progesterone metabolites and bile acids have therefore been analysed in serum and urine of patients with intrahepatic cholestasis of pregnancy before and during treatment with ursodeoxycholic acid using chromatographic and mass spectrometric methods.

RESULTS

The concentration of glycine-/taurine-conjugated bile acids decreased from 8.9+/-3 micromol/l (mean+/-SEM) before treatment to 1.8+/-0.6 micromol/l during treatment with ursodeoxycholic acid. The total bile acid excretion in urine decreased from 56+/-14 to 32+/-5.6 micromol/g creatinine. The proportion of cholic acid in serum and urine, and of 1beta-, 2beta- and 6alpha-hydroxylated cholic acids in urine decreased markedly during ursodeoxycholic acid while the percentages of 3alpha,12alpha-dihydroxy-3-oxo-4-cholenoic acid and chenodeoxycholic acid were unchanged. The levels in serum and excretion in urine of sulphated steroids decreased during ursodeoxycholic acid, by 45-49% for disulphates and 33-35% for monosulphates. The ratios of 3alpha- to 3beta-hydroxysteroid disulphates were lowered by ursodeoxycholic acid from 1.1 (mean) to 0.68 in serum, and from 1.2 to 0.70 in urine. The corresponding ratios for monosulphates before and during ursodeoxycholic acid were 6.9 and 4.5, respectively, in serum, and 21 and 5.2, respectively, in urine. The major monosulphates in urine, dominated by 5alpha-pregnane-3alpha, 20alpha-diol, were also conjugated with N-acetylglucosamine. The excretion of these double conjugates decreased from 27+/-8.4 to 15+/-5.3 micromol/g creatinine during ursodeoxycholic acid. In contrast to sulphated steroids, the concentrations of glucuronides were unchanged in serum and their excretion in urine tended to increase during ursodeoxycholic acid. The metabolism of ursodeoxycholic acid was similar to that described in nonpregnant subjects. In addition to metabolites hydroxylated in the 1beta-, 5beta-, 6alpha/beta and 22-positions, a 4-hydroxy-ursodeoxycholic acid was tentatively identified. This occurred predominantly as a double conjugate with glycine/taurine and glucuronic acid, as did other 4-hydroxylated bile acids of probable foetal origin.

CONCLUSIONS

The results are compatible with the contention that ursodeoxycholic acid stimulates the biliary excretion of sulphated progesterone metabolites, particularly those with a 3alpha-hydroxy-5alpha(H) configuration and disulphates. The effect(s) appears to be independent of the stimulation of bile acid secretion. An effect of ursodeoxycholic acid on the reductive metabolism of progesterone cannot be excluded.

Profiles of bile acids and progesterone metabolites in the urine and serum of women with intrahepatic cholestasis of pregnancy

BACKGROUND/AIMS AND METHODS

The etiology of intrahepatic cholestasis of pregnancy (JCP) is unknown. We have performed comprehensive chromatographic and mass spectrometric analyses of progesterone metabolites and bile acids in serum and urine of six patients in order to characterize changes that might be of importance for the development of the disease.

RESULTS

Conjugated bile acids were increased in serum and urine of patients with ICP while the levels of unconjugated bile acids were similar in healthy pregnancies and ICP. Unconjugated and conjugated 7 alpha, 12 alpha-dihydroxy-3-oxo-4-cholenoic acid was excreted in urine both in healthy pregnancies and in ICP, possibly indicating a rate limitation of 3-oxo-delta 4-steroid 5 beta-reductase in pregnancy. The serum levels and urinary excretion of total sulfated progesterone metabolites were increased in ICP while the glucuronides were unchanged or low. Confirming previous results, the fraction of metabolites with 3 alpha-hydroxy-5 alpha(H) configuration was increased. The urinary excretion of 5 alpha-pregnane-3 alpha, 20 alpha-diol 3-sulfate, 20-N-acetylglucosaminide was greatly increased in ICP, as was that of 3 alpha-hydroxy-5 alpha-androstane-17 beta-carboxylic acid, assumed to be a progesterone metabolite.

CONCLUSIONS

The combined results of this and previous studies are compatible with a primary change in the reductive metabolism of progesterone in ICP, resulting in increased formation of metabolites with a 3 alpha-hydroxy-5 alpha(H) configuration and a larger fraction of sulfates. There also seems to be a selective defect in the biliary secretion of sulfated metabolites, particularly disulfates.

High levels of (24S)-24-hydroxycholesterol 3-sulfate, 24-glucuronide in the serum and urine of children with severe cholestatic liver disease

Extracts of urine and serum from children with cholestatic liver disease were analyzed by fast atom bombardment (FAB) mass spectrometry. About half of all spectra showed a peak at m/z 657, compatible with the presence of a glucuronidated cholestenediol sulfate. Separation by ion exchange chromatography before and after solvolysis and treatment with beta-glucuronidase, combined with analyses by gas chromatography-mass spectrometry and FAB mass spectrometry with collision-induced dissociation, showed that the major compound responsible for the peak at m/z 657 was (24S)-24-hydroxycholesterol 3-sulfate, 24-glucuronide. The double conjugate of 27-hydroxycholesterol was also identified and double conjugates of cholestene- and cholestanetriols were also present. Semiquantitative analyses of the double conjugate of 24-hydroxycholesterol in patients whose FAB spectra showed a peak at m/z 657 indicated serum levels of 2-18 microM and a daily urinary excretion of 0.1-2.7 mumol/24 h. Eleven of 13 studied patients with a prominent peak at m/z 657 in the FAB spectra of their serum or urine either underwent liver transplantation or died. It is concluded that double conjugation of hydroxysterols with sulfuric and glucuronic acids can be an important metabolic pathway, particularly for (24S)-24-hydroxycholesterol. It is speculated that serious cholestatic liver disease may induce an increased formation and release of (24S)-24-hydroxycholesterol from brain (Lütjohann et al. 1996, Proc. Nutl. Acad. Sci. USA. 93: 9799-9804) with subsequent extracerebral conjugation with sulfuric and glucuronic acids.