18F-FDG small-animal PET for monitoring the therapeutic effect of CT-guided radiofrequency ablation on implanted VX2 lung tumors in rabbits

The primary goals of this study were to investigate the behavior of normal lung tissues after radiofrequency ablation (RFA) and to determine the suitability of 18F-FDG PET, using a dedicated small-animal scanner, for monitoring the early therapeutic effects of RFA on VX2 lung tumors (VX2s) in rabbits.

METHODS

Fourteen Japanese white rabbits with normal lungs underwent RFA, followed by 18F-FDG PET at 1 d and at 1, 2, 4, and 8 wk. In addition, 7 rabbits with untreated VX2s underwent 18F-FDG PET, and 13 rabbits with RFA-treated VX2s underwent 18F-FDG PET at 1 d (n = 7) or 1 wk (n = 6) after the treatment.

RESULTS

After RFA of normal lungs, ring-shaped accumulations of 18F-FDG, which coincided with inflammation caused by ablation, were observed. The mean early- (40-60 min after injection) and delayed (100-120 min)-phase ablated lesion-to-muscle ratios were, respectively, 2.9 +/- 1.0 and 3.3 +/- 0.8 (1 d), 4.1 +/- 0.6 and 5.2 +/- 0.9 (1 wk), 4.1 +/- 1.0 and 5.3 +/- 1.5 (2 wk), 3.1 +/- 0.5 and 3.6 +/- 1.1 (4 wk), and 1.8 +/- 0.1 and 2.3 +/- 0.1 (8 wk). At 4 and 8 wk, the uptake was less than that at 1 and 2 wk (P < 0.05). VX2s showed mean tumor-to-muscle ratios of 6.6 +/- 2.1 and 8.6 +/- 3.3 at the early and delayed phases, respectively. For ablated tumors, the respective ratios were 0.8 +/- 0.4 and 1.1 +/- 0.7 (1 d) and 1.2 +/- 0.5 and 1.5 +/- 0.7 (1 wk). These values were significantly lower than those for nonablated tumors (P < 0.001). Histopathologic examination confirmed the absence of viable tumors. 18F-FDG accumulation around ablated tumors reflected thermally damaged normal tissues and was significantly lower than that of control VX2s (P < 0.01).

CONCLUSION

Our data suggest that 18F-FDG PET is promising for evaluating the therapeutic response of lung malignancies to RFA: Accumulation of 18F-FDG in surrounding normal tissues appears to be time dependent, and the data suggest that, clinically, 18F-FDG PET should be performed 4 wk or more after RFA. Delayed-phase images seem to better distinguish tumor from inflammation than do early-phase images.

Accumulation of glucose in keloids with FDG-PET

OBJECTIVE

Glucose metabolism has not been investigated in human (in vivo) keloids. In the present study, we performed positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (FDG) to examine glucose metabolism in keloids.

MATERIALS AND METHODS

Five patients (2 men and 3 women) with typical keloids having a thickness of more than 5 mm were studied. HEADTOME-IV SET-1400W-10 (Shimadzu, Tokyo, Japan) was employed for PET studies. Transmission scanning was performed on each patient. After fasting for more than 4 hours, the patients were injected intravenously with FDG 185-370 (MBq) following each transmission scan. Emission scans were performed 40-55 min after injection. For quantitative evaluation, the regions of interest (Circles ROIs: 6 mm in diameter) were placed on all the keloid lesions and surrounding tissues, and then their standardized uptake value (SUV = the tissue concentration/the activity injected per body weight) was calculated.

RESULTS

FDG was defined as showing the accumulation in keloids when its uptake was relatively higher in the keloid than that in the surrounding tissue. The SUV of the keloids ranged from 1.0 to 2.74, with a mean of 1.79.

CONCLUSION

FDG-PET was performed in 5 patients with keloids and low-grade accumulation of FDG was observed in all lesions. This indicated that glucose metabolism was accelerated in keloids.

Fluorine- 18-fluorodeoxyglucose positron emission tomography for assessment of patients with unresectable recurrent or metastatic lung cancers after CT-guided radiofrequency ablation: Preliminary results

OBJECTIVES

We compared the diagnostic value of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) with that of computed tomography (CT) following radiofrequency ablation (RFA) of inoperable recurrent or metastatic cancers in the lung.

METHODS

Twelve patients (9 males and 3 females; 5 had recurrent lung cancer and the other 7 had metastatic nodules from a variety of primary cancers) were treated by RFA for 17 pulmonary nodules. FDG-PET was performed before and 2 months after RFA, and the mean standardized uptake value (SUV) was calculated. The response evaluation was based on the percent reduction relative to the baseline and the absolute values of SUV on FDG-PET performed at 2 months after RFA. We compared the response evaluations made based on findings of FDG-PET and CT at 2 and > or =6 months (mean 10.2) after RFA.

RESULTS

The percent reduction in uptake at 2 months was significantly lower in nodules considered progressive (69.6 +/- 18.6%) than nonprogressive disease (38.7 +/- 12.5%; p < 0.01) based on CT findings at > or =6 months after RFA. The absolute SUV at 2 months was significantly higher in nodules considered progressive (2.61 +/- 0.75) than nonprogressive disease (1.05 +/- 0.67; p < 0.01) based on CT findings at > or =6 months post-RFA.

CONCLUSION

Although our pilot study comprised few cases of various histopathological types of cancers in the lung, the results suggest that FDG-PET could predict regrowth on subsequent follow-up CT. Regrowth could be diagnosed earlier by FDG-PET than by CT, and nodules with residual uptake and with <60% reduction of uptake relative to baseline on FDG-PET at 2 months after ablation might require additional therapy.

Retrospective review: Usefulness of a number of imaging modalities including CT, MRI, technetium-99m pertechnetate scintigraphy, gallium-67 scintigraphy and F-18-FDG PET in the differentiation of benign from malignant parotid masses

OBJECTIVE

The aim of this study is to evaluate an imaging approach using computed tomography (CT), magnetic resonance imaging (MRI), technetium-99m pertechnetate scintigraphy (99mTc pertechnetate scintigraphy), gallium-67 scintigraphy (67Ga scintigraphy) and fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET).

MATERIAL AND METHODS

We reviewed retrospectively 59 patients with parotid masses. CT, MRI, 67Ga scintigraphy, 99mTc pertechnetate scintigraphy, and 18F-FDG PET were performed.

RESULTS

All of the benign tumors had smooth margins on CT and MRI. Patients with inflammatory lesions and malignant lesions showed well-defined margins or ill-defined margins. All Warthin's tumors showed high technetium accumulation. Many of malignant tumors showed high FDG accumulation. Both pleomorphic adenomas and Warthin's tumors showed high accumulation in some cases on 18F-FDG PET. Among 15 patients with pleomorphic adenoma, 14 patients showed marked hyperintensity relative to CSF on T2-weighted images and partial enhancement on contrast-enhanced T1-weighted images. Combination of several imaging modarity offered usefulness of differential diagnosis for parotid masses.

CONCLUSION

An efficient combination of imaging methods may be helpful for achieve the correct diagnosis.

Antigenic epitope for sperm-immobilizing antibody detected in infertile women

CD52 is a glycosylphosphatidylinositol (GPI) anchor protein occurring in lymphocytes, the epididymis, seminal plasma and on ejaculated sperm surface. The molecular structure of male reproductive tract CD52 (mrtCD52) is quite different from that of lymphocyte CD52 except for a peptide sequence comprising 12 amino acids. The carbohydrate molecule may thus provide antigenic epitopes to females. The repeated N-acetyllactosamine units of the N-linked carbohydrate present in the mrtCD52 were identified as a pathogenic antigen for infertility using a monoclonal antibody (MAb H6-3C4) generated from an infertile patient's peripheral blood lymphocyte. We suggested also the possible presence of O-linked carbohydrate in human mrtCD52, although it is not known whether this carbohydrate is immunogenic or not. This article gives an overview of the structure and function of mrtCD52 as well as the fertilization-blocking mechanism of the antibody against this molecule.

[Simulation of lung lobe resection with personal computer]

Various patterns of branching are seen for pulmonary arteries and veins in the lung hilum. However, thoracic surgeons usually cannot expect to discern much anatomical detail preoperatively. If the surgeon can gain an understanding of individual patterns preoperatively, the risks inherent in exposing the pulmonary vessels in the hilum can be avoided, reducing invasiveness. This software will meet the increasing needs of them in video-assisted thoracoscopic surgery (VATS) which prefer lesser dissections of the vessels and bronchus of hilum. We have produced free application software, where we can mark on pulmonary arteries, vein, bronchus and tumor of the successive images of computed tomography (CT). After receiving a compact disk containing 60 images of 2 mm CT slices, from tumor to hilum, in DICOM format, we required only 1 hour to obtain 3-dimensional images for a patient with other free software (Metasequoia LE). Furthermore, with Metasequoia LE, we can simulate cut the vessels and change the figure of them 3-dimensionally. Although the picture image leaves much room for improvement, we believe it is very attractive for residents because they can simulate operations.

Dendritic cell expansion occurs in mesenteric lymph nodes of B10.BR mice infected with the murine nematode parasite Trichuris muris

Dendritic cells (DCs) are a crucial element in the immune system and bridge innate and adaptive immunity. CD11c+ B220- DCs residing in Peyer's patches (PPs) have the ability to produce interleukin 10 (IL-10) and induce T helper (Th2) development. Evidence suggests that CD11c+ B220- DCs maintain the gut environment by suppressing Th1 responses with IL-10, resulting in a Th2-dominat gut environment. Th2 effectors are required for protection against the murine nematode parasite Trichuris muris, and thus CD11c+ B220- DCs may be involved in the induction of Th2 cells in T. muris infection. In the present study, the kinetics of CD11c+ B220- DCs were analyzed in mesenteric lymph nodes of B10.BR mice infected with the E-J isolate of T. muris, and the cellular expansion of CD11c+ B220- DCs was also observed. As well, the DC expansion was consistent with the occurrence of worm expulsion augmented by IL-4 and IL-13. The evidence here suggests the involvement of CD11c+ B220- DCs in protective Th2 responses to T. muris infection.

Possible presence of O-linked carbohydrate in the human male reproductive tract CD52

Male reproductive tract CD52 (mrtCD52) is an antigen recognized by a complement-dependent sperm-immobilizing monoclonal antibody (SI-Abs) derived in an infertile patient. The molecule has been shown to contain a unique N-linked carbohydrate that does not cross-react with other tissues. In this study, we have investigated whether O-linked carbohydrate as well as N-linked carbohydrate is present in mrtCD52 using specific lectins and anti-CD52 core peptide antiserum. The lectin PNA, which recognizes O-linked carbohydrate [Galbeta1-3GalNAc], reacted with mrtCD52 and showed a similar polymorphic reaction pattern to that of the anti-peptide antiserum in western blotting analysis on two-dimensional SDS-PAGE. The PNA-reactive spots disappeared after removal of O-linked carbohydrate, but not after removal of N-linked carbohydrate. These results suggest that O-linked carbohydrate is present in mrtCD52. The moiety may possibly contribute to a specific antigenic epitope of mrtCD52.

A new walking orthosis for paraplegics: hip and ankle linkage system

For paraplegics, two major disadvantages of hip-knee-ankle-foot orthotic systems that have a medial single hip joint are the short stride and horizontal rotation of the pelvis. The authors consider the pelvic rotation is caused by two factors; one is the lack of a mechanism to assist hip flexion, and the other is fixed ankle joints that cause instability when the step length becomes longer. Users must rotate their pelvis to initiate a swing in their legs and to achieve stability by making their two legs as parallel as possible in order to avoid losing balance. To overcome those disadvantages, the authors developed a new orthosis named "HALO" (Hip and Ankle Linked Orthosis), which has a linking mechanism that connects both ankle joints with a medial single hip joint. This new orthosis allows users to keep both feet always parallel to the floor while walking, and assists the swinging of the leg when the contralateral ankle is flexed dorsally by loading. Gait analysis revealed that the pelvic rotation with "HALO" either in parallel bars or with Lofstrand crutches was within 20 degrees, which was within the physiologically normal level.

Predicted values of propofol EC50 and sevoflurane concentration for insertion of laryngeal mask Classic and ProSeal

BACKGROUND

A new laryngeal mask airway, the ProSeal (PLMA), is said to be more difficult to insert than the laryngeal mask airway Classic (CLMA) using propofol anaesthesia. Therefore, we expected a greater dose of propofol and sevoflurane to be required to insert the PLMA compared with the CLMA. We determined the effective concentration 50% (EC(50)) of propofol and end-tidal sevoflurane to allow insertion of the PLMA and the CLMA.

METHODS

Seventy-six elective female patients (aged 20-60 yr and ASA I-II) were randomly assigned to one of four groups. Either a PLMA or a CLMA was inserted using either propofol target controlled infusion or sevoflurane. Both propofol and sevoflurane targets were determined with a modified Dixon's up-and-down method. After equilibration between the predetermined blood and effect site concentrations, which had been held steady for more than 10 min, LMA insertion was attempted without neuromuscular block.

RESULTS

The predicted EC(50CLMA) and EC(50PLMA) for propofol were 3.14 (0.33) and 4.32 (0.67) micro g ml(-1). E'(CLMA) and E'(PLMA) of sevoflurane (mean (SD)) were 2.36 (0.22) and 2.82 (0.45)% (P<0.01 and 0.05, respectively).

CONCLUSIONS

The estimated concentration of propofol and the sevoflurane concentration needed to allow insertion of the ProSeal are respectively 38 and 20% greater than those needed for insertion of the Classic LMA.

Role of IL-18 in pathogenesis of endometriosis

BACKGROUND

Endometriosis is a complex disease associated with a wide range of immune responses, including pain, adhesion, exudation of peritoneal fluid, elevation of cytokine levels and generation of autoantibodies. Interleukin (IL)-18 is a strong pleiotropic cytokine known to be involved in various immune diseases. The aim of this study is to elucidate the role of IL-18 in the pathogenesis of endometriosis.

METHODS

IL-18 and IL-1beta concentrations were measured in the peritoneal fluid and sera of 39 endometriosis patients and 15 control women. Expression of IL-18 and IL-18 receptor alpha-chain (IL-18Ralpha) was analysed in endometriotic tissues immunohistochemically. The effects of IL-18 on cyclooxygenase (COX)-II gene expression were analysed in peritoneal fluid monocytes and endometriotic cells of endometriosis patients.

RESULTS

IL-18 concentrations in the peritoneal fluid of endometriosis patients averaged 592.57 +/- 108.27 pg/ml, significantly higher than 260.50 +/- 55.88 pg/ml in non-endometriotic samples. IL-18 concentrations in the serum did not differ significantly between endometriosis and control patients. Similarly, no significant differences were observed in IL-1beta concentrations in either the peritoneal fluid or the serum. IL-18 and IL-18Ralpha were expressed in endometriotic tissues. IL-18Ralpha expression was also observed in cells infiltrating into the inflammatory area of the endometriosis patients. COX-II was induced in peritoneal fluid monocytes and in endometriotic cells in response to IL-18 stimulation.

CONCLUSIONS

The elevation of IL-18 in the peritoneal fluid of endometriosis patients and the induction of COX-II in peritoneal monocytes by IL-18 suggest that IL-18 plays a pathogenic role in endometriosis.

Cancer incidence in children and young adults did not increase relative to parental exposure to atomic bombs

We have examined whether parental exposure to atomic bomb radiation has led to increased cancer risks among the offspring. We studied 40 487 subjects born from May 1946 through December 1984 who were cancer-free in January 1958. One or both parents were in Hiroshima or Nagasaki at the time of the bombing and for childbirth. Using population-based tumor registry data we analyzed cancer incidence data from 1958 to 1997 by Cox regression models, and we examined the effects of both paternal and maternal irradiation with adjustment for city, sex, birth year, and migration. During follow-up, 575 solid tumor cases and 68 hematopoietic tumor cases were diagnosed. Median age at diagnosis was 39.7 years. Median doses were 143 millisierverts for 15 992 exposed (5+ millisierverts or unknown dose) fathers and 133 millisierverts for 10 066 exposed mothers. Cancer incidence was no higher for subjects with exposed parents than for the reference subjects (0–4 millisierverts), nor did the incidence rates increase with increasing dose. For 3568 subjects with two exposed parents, the adjusted risk ratio for all cancer was 0.97 (95% confidence interval 0.70–1.36). Because of the small number of cases, however, we cannot exclude an increase in cancer incidence at this time.

Brachial-ankle pulse wave velocity measured automatically by oscillometric method is elevated in diabetic patients with incipient nephropathy

AIMS

To examine whether brachial-ankle pulse wave velocity (baPWV), a possible early marker of atherosclerotic vascular damage, is associated with albuminuria in patients with Type 2 diabetes.

METHODS

BaPWV was measured by automatic oscillometric method in 346 Type 2 diabetic patients with normoalbuminuria (a mean level of three times measurements of albumin-to-creatinine (ACR)<30 microg/mg creatinine; n=200), incipient nephropathy (a mean level of ACR> or =30 and <300 microg/mg creatinine; n=119), and clinical nephropathy (a mean level of ACR> or =300 microg/mg creatinine; n=27), and without peripheral vascular disease.

RESULTS

BaPWV (cm/s) was significantly higher in patients with incipient nephropathy (1722 +/- 382) and clinical nephropathy (1763 +/- 322) than in patients with normoalbuminuria (1559 +/- 343, P<0.0001, respectively). By univariate analysis it correlated significantly with age (r=0.44, P<0.0001), systolic blood pressure (r=0.55, P<0.0001), diastolic blood pressure (r=0.42, P<0.0001), albuminuria (r=0.24, P<0.0001) and HbA1C (r=0.11, P<0.05). Albuminuria revealed an independent significant association with baPWV (P<0.01) after adjustment for age, sex, smoking, BMI, HbA1C, hyperlipidemia, and hypertension. Multiple regression analysis showed age, diastolic blood pressure and albuminuria were independently associated with baPWV (adjusted R2=0.42, P<0.0001).

CONCLUSIONS

The results might indicate a possible link between the pathogenesis of atherosclerosis and diabetic nephropathy. Future studies are needed to clarify the usefulness and its predictable value.

Poor Labeling of Tc-99m Red Blood Cells In Vivo in a Radionuclide Intestinal Bleeding Study of a Patient Who Had Recently Undergone Frequent Blood Transfusions

The authors report poor labeling of Tc-99m red blood cells (RBCs) in vivo in a radionuclide intestinal bleeding study of a patient who had recently undergone frequent blood transfusions. The existence of RBC antibodies, as a result of the recent blood transfusions in this patient, was one of the causes of the poor labeling. In radionuclide bleeding studies with patients with recent blood transfusion, Tc-99m HSA-D must be chosen instead of Tc-99m RBCs in vivo.