An evaluation of the accelerated expectation maximization algorithms for single-photon emission tomography image reconstruction

We previously reported that brain single-photon emission tomography (SPET) images could be improved by using an attenuation coefficient map constructed with transmission data and the iterative expectation maximization (EM) algorithm. However, the conventional EM algorithm (CEM) typically requires 30-80 iterations to provide acceptable results, limiting its clinical applicability. Several methods have been proposed to accelerate the EM algorithm. The purpose of this study was to search for a practical method for accelerating the EM algorithm. The methods investigated here include the accelerated EM algorithm (ACEM) using additive correction, ACEM using multiplicative correction, and Tanaka's filtered iterative reconstruction method (FIR). These methods were assessed by simulated SPET studies of a phantom incorporating nonuniform attenuation and by reference to clinical brain SPET data. In the simulation studies, the above methods were evaluated by using three parameters (root mean square error, log likelihood value, and contrast recovery coefficient); the results showed that FIR had an advantage over other methods in terms of all parameters. The results obtained using the clinical data demonstrated that FIR could reconstruct acceptable images in only five iterations. These results show that FIR offers significant advantages over CEM or other ACEMs, indicating that FIR can make the EM algorithm practical for clinical use in SPET.

Thallium-201/technetium-99m-phytate (colloid) subtraction imaging of hepatocellular carcinoma

This paper evaluates the clinical usefulness of 201Tl to image hepatocellular carcinoma (HCC), using 201Tl, 99mTc-phytate (colloid) and a three-headed SPECT camera.

METHODS

The tumor-to-nontumor ratios (T/N) of 201Tl for different categories of HCC were generated. Tumors were emphasized by image subtraction (201Tl-99mTc-colloid). Thirty-three lesions in 16 patients (18 studies) with HCC were evaluated. There were 19 untreated nodular, five untreated diffuse, five local recurrent and four necrotic lesions after interventional therapy.

RESULTS

The mean T/N were as follows: untreated nodular 1.54 +/- 0.31 (mean +/- s.d.), untreated diffuse 1.28 +/- 0.26, local recurrence 1.50 +/- 0.29 and necrosis 0.22 +/- 0.06. All the tumors (except necrotic areas) were enhanced by the image subtraction.

CONCLUSION

Thallium-201 is useful for liver tumor imaging but 99mTc-phytate (colloid) is essential to discriminate 201Tl tumor uptake from normal liver accumulation. Image subtraction (201Tl/99mTc-colloid) is helpful in detecting HCC.

[A case of subacute stroke with high uptake of 99mTc-HMPAO in the reperfused infarct corresponding to low perfusion area]

We reported a case of subacute stroke which showed high uptake of 99mTc-d,l-hexamethylpropyleneamine oxime (HMPAO) in the reperfused infarct corresponding to slightly decreased perfusion by 133Xe inhalation CBF measurement. In the chronic stage, both SPECT images of 99mTc-HMPAO and 133Xe showed low perfusion in the affected lesion. It was, therefore, considered that the high uptake of 99mTc-HMPAO had represented luxury perfusion. In the subacute stage of stroke, high uptake of 99mTc-HMPAO may imply luxury perfusion but not always hyperperfusion. It is suggested that the fractional fixation of 99mTc-HMPAO temporarily change in the affected lesion and it is essential to take into consideration the clinical stage for the interpretation of SPECT images.

Studies on in vitro paraquat and diquat removal by activated carbon

The adsorption characteristics of paraquat and diquat onto activated carbon in vitro were discussed for the primary treatment of acute poisoning by accidental, suicidal or homicidal ingestion of paraquat containing herbicides. Paraquat was adsorbed onto activated carbon more abundantly and more rapidly in physiological saline solution than that in artificial gastric juice and distilled water. Most suitable solvent for paraquat removal by activated carbon was physiological saline solution (0.9% sodium chloride solution). No significant correlation was observed between the ability of paraquat removal and the properties of adsorbent. Paraquat was preferentially adsorbed onto activated carbon in the mixed solution. The adsorption abilities by activated carbon (the removal ratio, the amount adsorbed and the adsorption rate) for paraquat were larger than those for diquat, and it was enhanced by added sodium chloride and added magnesium sulfate. Enhancing effect for adsorption removal was proportional to the saline concentration. As addition of salts into carbon suspension enhanced the adsorption ability, it will contribute to the effective treatment of acute poisoning.

Comparison of [11C]diprenorphine and [11C]carfentanil in vivo binding to opiate receptors in man using a dual detector system

A simple dual detector coincidence system was used to measure the binding of [11C]carfentanil and [11C]diprenorphine to opiate receptors in normal volunteers before and after the administration of naloxone. Total radioactivity without naloxone and the ratio of total/non-specific radioactivity was 2 times greater for [11C]diprenorphine than [11C]carfentanil. The dose of naloxone required to maximally block specific [11C]diprenorphine binding was 10 times that for [11C]carfentanil, indicating that [11C]diprenorphine labels opiate receptor subtypes in addition to mu opiate receptors.

Evaluation of serum lactate dehydrogenase activity for estimation of energy expenditure in human subjects

We investigated the relationship between serum lactate dehydrogenase (LDH) activity and energy expenditure in young adults, evaluating their serum LDH activities in order to develop an index of energy expenditure. The results obtained were as follows. (1) There were significant correlations between the serum LDH activity and energy expenditure/day, energy expenditure/body weight/day and daily activity index in men. (2) There were significant correlations between the serum LDH activity and energy expenditure/day and daily activity index in women. (3) A group of men who 'rarely' exercised had lower levels of serum LDH activity than those who exercised 'sometimes' or 'usually', but little difference was noted between similar groups of women.

[The evaluation of the newly produced assay kit for the cytokeratin fragment, "ball ELSA CYFRA21-1"]

We evaluated the newly produced tumor marker assay kit, "Ball ELSA CYFRA21-1", which detects cytokeratin 19 fragment in the sera of patients with malignancies, especially lung cancers. The assay procedure is simple based on the one-step radioimmunometric assay method. The measured values depend somewhat on incubation temperature and time. Reproducibility and recovery were good. The minimum measurable level was 1 ng/ml. The dilution test was satisfactory. The CYFRA21-1 levels were gradually decreased by repeated freezing and thawing and after seven such exercises its activity dropped to about 70% of that of first assay. The presence of CYFRA21-1 antigen was strongly correlated with TPA antigen and, although some discrepancies could be observed in clinical samples, CYFRA21-1 activity was completely absorbed by anti-TPA antibody-coated beads in one sample. CYFRA21-1 levels of 44 normal controls were below 1.0 ng/ml. Assuming a cut-off value of 2.0 mg/ml, 32.7% of all cases with benign disease had values greater than 2.0 ng/ml. This fell to 21.4% on exclusion of cases of interstitial pulmonary disease. Those with malignant diseases had high CYFRA21-1 levels whether associated with lung cancer or not. The most high positive ratios were observed in squamous cell lung cancer, small cell lung cancer, and uterine cervical cancer. In conclusion, CYFRA21-1 may be a good tumor marker comparable to TPA not only for lung cancer but also other malignancies as well. High false positives for lung cancer, however, were observed in other pulmonary diseases.

[In vitro adsorption of paraquat onto substituted chitosan beads]

Paraquat removal by chitosan with different substituents was investigated in vitro for evaluation of chitosan as a paraquat adsorbent in emergency treatment for acute paraquat poisoning. Chitosan CM and SU, in which the hydroxyl group at the C6 position is replaced by a carboxymethyl and sulfonic group, respectively, removed paraquat abundantly in purified water. However an inhibitory effect of sodium chloride on paraquat removal by CM and SU was recognized. On the other hand, paraquat removal by cross-linked chitosan (BCW) was accelerated in saline solutions. It was recognized that more paraquat was removed by BCW chitosan when the sodium chloride concentration was less than 1.8%. It was confirmed that some chitosan beads (CM and SU) could function as effective paraquat adsorbents through in vitro experiments.

A study of embolizing materials for chemo-embolization therapy of hepatocellular carcinoma: effects of chitin concentration on cis-diamminedichloroplatinum(II) albumin microsphere properties and antitumor effect in VX2 hepatocellular carcinoma model rabbits

cis-Diamminedichloroplatinum(II) (CDDP) albumin microspheres were prepared with various chitin concentrations and microsphere CDDP contents, specific surface area, surface structure and other microsphere properties. CDDP release in vitro and the antitumor effect in VX2 tumor model rabbits were investigated. CDDP content was increased as the concentration of chitin increased; at a chitin concentration of 6.0% it was about 2 times that without chitin. Specific surface area also increased with chitin concentration. CDDP release rate from various microspheres in vitro was suppressed as chitin concentration increased. Thus, microsphere properties, especially surface structure, are affected by an increase in chitin concentration. In experiments in vivo, various microspheres were injected into the hepatic artery of VX2 hepatocellular carcinoma model rabbits, and the effects of the chitin concentration on the time course of blood platinum (Pt) level and the antitumor effect were assessed. The blood Pt concentration increased with increase in chitin concentration, with a maximum of 0.45 microgram/ml at a concentration of 6.0%, even 7 d following microsphere administration. Tumor growth was suppressed when the chitin concentration was increased. Tissue Pt concentrations also increased in the presence of chitin. These findings suggest that increasing the chitin concentration might promote microsphere decomposition and hence CDDP release in vivo, thus improving immunopotentiating activity and resulting in enhanced CDDP antitumor effect. The detailed mechanisms of the action, however remains to be studied.

[Clinical usefulness of 99mTc-ECD--a multicenter phase 3 study]

A phase 3 clinical study of a newly developed brain perfusion agent, 99mTc-L,L-ethyl cysteinate dimer (99mTc-ECD), was performed in 521 cases of cerebrovascular diseases and impairment of brain function to evaluate the safety, effectiveness and usefulness of the agent as a multi-center study involving 35 institutions in Japan. Out of 510 cases evaluated for the clinical usefulness, valuable information for clinical diagnosis was obtained in 486 cases (95.3%), and 444 cases (87.1%) were judged as "extremely useful" or "useful". Although the positive ratio of abnormalities detected by the agent was as same as that of 99mTc-hexamethylpropyleneamine oxime (99mTc-HM-PAO), the abnormal regions detected by the agent had tendency to be larger in size and to have higher contrast than those detected by 99mTc-HM-PAO. It is concluded that 99mTc-ECD is a safe and useful radiopharmaceutical as a brain perfusion agent for the diagnosis of cerebrovascular diseases and impairment of brain function.

Improvement of brain single photon emission tomography (SPET) using transmission data acquisition in a four-head SPET scanner

Attenuation coefficient maps (mu-maps) are a useful way to compensate for non-uniform attenuation when performing single photon emission tomography (SPET). A new method was developed to record single photon transmission data and a mu-map for the brain was produced using a four-head SPET scanner. Transmission data were acquired by a gamma camera opposite to a flood radioactive source attached to one of four gamma cameras in the four-head SPET scanner. Attenuation correction was performed using the iterative expectation maximization algorithm and the mu-map. Phantom studies demonstrated that this method could reconstruct the distribution of radioactivity more accurately than conventional methods, even for a severely non-uniform mu-map, and could improve the quality of SPET images. Clinical application to technetium-99m hexamethyl-propylene amine oxime (HMPAO) brain SPET also demonstrated the usefulness of this method. Thus, this method appears to be promising for improvement in the image quality and quantitative accuracy of brain SPET.

A study of cis-diamminedichloroplatinum(II) suppositories for the treatment of rabbit uterine endometrial carcinoma

cis-Diamminedichloroplatinum (II) (cisplatin: CDDP) suppositories containing NaCl at different concentrations were prepared as a local chemotherapeutic agent for the treatment of uterine endometrial carcinoma and were administered to rabbits implanted with uterine VX2 tumor. The intrauterine CDDP histological level, as well as the antitumor effects and side effects of the suppositories to the liver and kidney were studied. The results showed high intrauterine tissue CDDP level in all suppository administrations. In particular, the NaCl-added suppositories enhanced the intrauterine CDDP level. As for antitumor effects, while the tumor growth rate of the NaCl-added suppository group was likely to be suppressed, the suppositories could not suppress tumor growth completely. The plasma platinum (Pt) level was 1.5 micrograms/ml or less and that of the liver and kidney was as low as 0.31 to 0.48 micrograms/g. No difference in levels depending on NaCl concentration was observed, nor was any abnormality found in the biochemical analysis including glutamate oxaloacetate transaminase (GOT) and blood urea nitrogen (BUN). Histopathological study revealed the degeneration of tumor cells in the NaCl-added suppository group. Minimal congestion and hemorrhage were observed in the endometria, possibly resulting from CDDP. By adding NaCl to CDDP suppositories, the uterine CDDP level and antitumor effects increased while no serious renal dysfunction was noted. Therefore, we conclude that NaCl-added CDDP suppositories are a useful local chemotherapy for endometrial carcinoma.

A study of embolizing materials for chemo-embolization therapy of hepatocellular carcinoma: antitumor effect of cis-diamminedichloroplatinum(II) albumin microspheres, containing chitin and treated with chitosan on rabbits with VX2 hepatic tumors

As an effective therapy for hepatocellular carcinoma, hepatic arterial chemo-embolization therapy has been widely used, and many embolizing materials have been extensively investigated. In the present study, we prepared various types of cis-diamminedichloroplatinum(II) (CDDP) albumin microspheres using chitin and chitosan, both of which have attracted considerable attention as new non-toxic biological polymer materials having favorable characteristics such as immune adjuvant activity, biological compatibility, and biodegradation. Hepatic artery of rabbit hepatic cancer models, which had transplanted VX2 tumors, were embolized with various types of microspheres. The anti-tumor effects and tumor-targeting of the microspheres, and the effects of the microspheres administration on the hepatic tissue were investigated. As a result, anti-tumor activity of the microspheres was increased by the addition of chitin-containing or chitosan treated materials; tumor growth rates of chitin addition and chitosan treated groups were approximately 160% and 120%, respectively, and were significantly lower than that of the non-treatment groups with a rate of approximately 580%. However, complete inhibition of tumor growth might have been impossible. Anti-tumor activity was increased by the addition of chitin-containing or chitosan treated materials. Whereas the growth inhibitory effect was insufficient, in order to potentiate anti-tumor activity, higher CDDP contents and sustained release of CDDP at a high level from microsphere and so on should be essentially improved for the near future. The CDDP level in hepatic tissue following the administration of microspheres was increased by adding chitin to the microspheres or by treating the microspheres with chitosan.(ABSTRACT TRUNCATED AT 250 WORDS)

[Phase 2 clinical study of 99mTc-ECD--a multicenter study]

A phase 2 clinical study of a newly developed brain perfusion agent, 99mTc-ECD, was performed in 166 cases of cerebrovascular diseases and impairment of brain function to evaluate effectiveness, usefulness, optimum dose and optimum timing of imaging as a multi-center study involving 10 institutions in Japan. All cases were judged as no problems on safety and any side effects due to the administration of the compound were not observed. Out of 163 cases evaluated for the clinical usefulness, valuable information for clinical diagnosis was obtained in 160 cases (98.3%), and 154 cases (94.5%) were judged as "extremely useful" or "useful". Although SPECT imaging was possible from 5 min after injection, images obtained between 60 and 90 min after injection showed relatively better image quality in many cases. Regarding standard administration dose, 400 to 800 MBq were considered to be appropriate. 99mTc-ECD is considered to be a promising radiopharmaceutical as a brain perfusion agent.

[Intraarterial urokinase infusion therapy with superselective catheterization for acute occlusive cerebrovascular disease]

Intraarterial urokinase infusion therapy with superselective catheterization was performed on 11 patients for acute occlusive cerebrovascular disease. The subjects were five men and six women with a mean age of 70 years (range, 48-83 years). Nine of 11 patients had middle cerebral artery occlusion and two had basilar artery occlusion. The interval from onset to infusion ranged from 3.5 to 9 hours, and the total dosage of urokinase from 24 x 10(4) to 150 x 10(4) IU. Recanalization of the occluded artery was achieved in nine patients (82%), and favorable clinical outcome was achieved in seven patients (64%). Six of whom were discharged with no neurologic deficits. Hemorrhagic infarction occurred in two patients without clinical deterioration. Our observations suggest that intraarterial urokinase infusion therapy with superselective catheterization may be very useful in the acute stage of occlusive cerebrovascular disease.

Enhancing effect of sodium chloride on in vitro adsorption of paraquat onto activated carbon

The enhancing effect of sodium chloride addition on the adsorption of paraquat onto activated carbon was discussed from the standpoints of equilibrium amount adsorbed and adsorption rate in vitro. The amount of paraquat adsorbed was increased by the addition of sodium chloride. The amount adsorbed with 0.1% addition was about five times greater than that in sodium chloride-free solution at an equilibrium concentration of 1 mg/L. The adsorption rate of paraquat onto activated carbon was also accelerated by sodium chloride addition. Kinetic constants in 0.1% and 0.9% sodium chloride solution were about 1.4 and 2.0 times greater, respectively, than that in sodium chloride-free solution. It was confirmed that paraquat removal by activated carbon was enhanced by sodium chloride addition. The reason was assumed to be the interrupted dissociation of paraquat in solution caused by sodium chloride addition.

Application of Hilbert transform to radionuclide-gated cardiac studies: analysis of asynchronous emptying and filling in various heart diseases

Fourier phase analysis has generally been used to investigate asynchronous emptying and filling in various heart diseases. A potential limitation of this form of analysis is curve fitting error, since a truncated Fourier series may not adequately describe the shape of a time-volume curve (TVC) and thus may produce errors in indices calculated from the fit. To overcome this problem, we developed a new method using Hilbert transform. Using Hilbert transform, the instantaneous phase (IP) curve was calculated directly from the TVC obtained from multigated cardiac blood pool images. Four parameters [time to maximum IP [T(max)], time to 0 in IP[T(0)], time to minimum IP[T(min)], and time from 0 to minimum IP [T(min-0)]] were extracted from the IP curves for each pixel, and functional images were constructed in 40 patients with ischemic heart disease (IHD), 16 with hypertrophic cardiomyopathy (HCM), 3 with dilated cardiomyopathy (DCM), and 7 normal controls (N). The standard deviations (SD) of these parameters were then calculated for the left ventricle. In IHD patients with a left ventricle ejection fraction (LVEF) of less than 50% and in DCM, the SDs of all parameters were significantly higher than in group N. In IHD patients with an LVEF of greater than 50%, the SDs of T(min), T(0), and T(min-0) were significantly higher than in group N, but there was no significant difference in the SD of T(max). In HCM patients, the SDs of T(min) and T(min-0) were significantly higher than in group N, suggesting the presence of asynchronous filling. In conclusion, this method appears to be promising for the quantitative analysis of asynchronous emptying and filling in various heart diseases.

Kinetic behavior of technetium-99m-HMPAO in the human brain and quantification of cerebral blood flow using dynamic SPECT

The kinetic behavior of 99mTc-hexamethylpropyleneamine oxime (HMPAO) in the human brain was investigated in 11 patients with various brain diseases (176 regions), using dynamic SPECT and a four-compartment model with five parameters (K1: rate constant for the transport of HMPAO from blood to brain, K2: backdiffusion from brain to blood, K3: conversion to a hydrophilic form in the brain, K5: conversion to a nondiffusible form in the blood, and fa: fraction of radioactivity attributable to the vascular compartment). Although K1 correlated well with cerebral blood flow (CBF) measured by the 133Xe inhalation method (Xe-CBF) (r = 0.888), its value was underestimated by 28.9% +/- 11.9%, indicating a low extraction fraction (E) for HMPAO. From E = K1/CBF, a regression equation of E = 0.857 - 0.00335. Xe-CBF was obtained. Significant correlations were observed for K2 versus Xe-CBF (r = 0.679), for K3 versus Xe-CBF (r = 0.483), for K3/(K2 + K3) versus Xe-CBF (r = -0.487), for K3/K2 versus Xe-CBF (r = -0.501), and for K2 + K3 versus Xe-CBF (r = 0.655), but not for K1/K2 versus Xe-CBF (r = 0.005). Thus, this model was useful for elucidating the kinetic behavior of HMPAO in the human brain, and correction for E appears to be indispensable for accurate CBF quantification using HMPAO.

Assessment of systolic thickening with thallium-201 ECG-gated single-photon emission computed tomography: a parameter for local left ventricular function

We measured left ventricular (LV) systolic thickening expressed as a systolic thickening ratio in 28 patients, using 201Tl ECG-gated SPECT. Five normals, 15 patients with prior myocardial infarction, 5 with hypertrophic cardiomyopathy, and 3 with dilated cardiomyopathy were studied. The systolic thickening ratio was calculated as [(end-systolic--end-diastolic pixel counts) divided by end-diastolic pixel counts], using the circumferential profile technique of both end-diastolic and end-systolic short axial images. Functional images of the systolic thickening ratio were also displayed with the "bull's-eye" method. The mean systolic thickening ratio thus calculated were as follows: normals, 0.53 +/- 0.05 (mean +/- 1 s.d.); non-transmural prior myocardial infarction, 0.33 +/- 0.09; transmural prior myocardial infarction, 0.14 +/- 0.05; hypertrophic cardiomyopathy in relatively nonhypertrophied areas, 0.56 +/- 0.11; hypertrophic cardiomyopathy in hypertrophied areas, 0.23 +/- 0.07; and dilated cardiomyopathy, 0.19 +/- 0.02. The systolic thickening ratio analysis by gated thallium SPECT offers a unique approach for assessing LV function.

Digestibility and energy availability of Wakame (Undaria pinnatifida) seaweed in Japanese

The digestibilities of nutrients and energy in Wakame were measured in healthy adult males. A test diet was given for 5 days after 5 days on a basal diet which supplied 40 g/day of protein and 45 kcal/kg/day of energy. The test diet was identical with the basal diet except that Wakame was incorporated. Digestibility was calculated by the difference of fecal output between the test period and the basal period. However the digestibility of its nutrient component was found to be different at each intake level. Therefore the present study simply lists the calculated figures. The results obtained were follows: 1) Composition of Wakame was protein: 20.5%, fat: 1.7%,. Total carbohydrate: 45.1%, gross energy content: 322 kcal/100g. 2) Digestibility of protein was 70.1 +/- 14.0%. 3) Digestibility of fat was 97.5 +/- 59.0%. 4) Digestibility of carbohydrate was 55.8 +/- 14.6%. 5) The ratio of the total available energy to intake energy (Net Energy Availability) was 62.4 +/- 19.4%. Wakame contains proteins and available carbohydrates, and may be consumed as a protein source as well as a good source of vitamins and minerals.

ECG-gated thallium-201 myocardial SPECT in patients with old myocardial infarction compared with ECG-gated blood pool SPECT

We evaluated one of the merits of ECG-gated thallium-201 single photon emission computed tomography (g-T1 SPECT), i.e., the ability to appreciate left ventricular (LV) wall motion. LV wall motion assessed by g-T1 SPECT and by ECG-gated Blood Pool SPECT (g-BP SPECT) was classified into three grades and compared segment by segment. T1-201 uptake by g-T1 SPECT was also classified into three grades and compared with those of wall motion in g-BP SPECT. Fifty patients with prior myocardial infarction were injected intravenously at rest with 111 to 185 M Bq (3 to 5 mCi) of Tl-201. The left ventricular regions were divided into anterior, septal, inferior and lateral segments (50 patients X 4 segments = 200 segments in total). The grades of wall motion and Tl-201 uptake detected by g-Tl SPECT correlated well with those of wall motion in g-BP SPECT (94.5% and 85%, respectively). With g-Tl SPECT it was possible to evaluate left ventricular wall motion, providing clear perfusion images.