The Mark IV system for radionuclide computed tomography of the brain

Molecular and functional imaging in cancer-targeted therapy: current applications and future directions

Targeted anticancer drugs block cancer cell growth by interfering with specific signaling pathways vital to carcinogenesis and tumor growth rather than harming all rapidly dividing cells as in cytotoxic chemotherapy. The Response Evaluation Criteria in Solid Tumor (RECIST) system has been used to assess tumor response to therapy via changes in the size of target lesions as measured by calipers, conventional anatomically based imaging modalities such as computed tomography (CT), and magnetic resonance imaging (MRI), and other imaging methods. However, RECIST is sometimes inaccurate in assessing the efficacy of targeted therapy drugs because of the poor correlation between tumor size and treatment-induced tumor necrosis or shrinkage. This approach might also result in delayed identification of response when the therapy does confer a reduction in tumor size. Innovative molecular imaging techniques have rapidly gained importance in the dawning era of targeted therapy as they can visualize, characterize, and quantify biological processes at the cellular, subcellular, or even molecular level rather than at the anatomical level. This review summarizes different targeted cell signaling pathways, various molecular imaging techniques, and developed probes. Moreover, the application of molecular imaging for evaluating treatment response and related clinical outcome is also systematically outlined. In the future, more attention should be paid to promoting the clinical translation of molecular imaging in evaluating the sensitivity to targeted therapy with biocompatible probes. In particular, multimodal imaging technologies incorporating advanced artificial intelligence should be developed to comprehensively and accurately assess cancer-targeted therapy, in addition to RECIST-based methods.

PET and SPECT Imaging of the Brain: History, Technical Considerations, Applications, and Radiotracers

Advances in nuclear medicine have revolutionized our ability to accurately diagnose patients with a wide array of neurologic pathologies and provide appropriate therapy. The development of new radiopharmaceuticals has made possible the identification of regional differences in brain tissue composition and metabolism. In addition, the evolution of 3-dimensional molecular imaging followed by fusion with computed tomography and magnetic resonance imaging have allowed for more precise localization of pathologies. This review will introduce single photon emission computed tomography and positron emission tomographic imaging of the brain, including the history of their development, technical considerations, and a brief overview of pertinent radiopharmaceuticals and their applications.

Investigation of Axial and Angular Sampling in Multi-Detector Pinhole-SPECT Brain Imaging

We designed a dedicated multi-detector multi-pinhole brain SPECT scanner to generate images of higher quality compared to general-purpose systems. The system, AdaptiSPECT-C, is intended to adapt its sensitivity-resolution trade-off by varying its aperture configurations allowing both high-sensitivity dynamic and high-spatial-resolution static imaging. The current system design consists of 23 detector heads arranged in a truncated spherical geometry. In this work, we investigated the axial and angular sampling capability of the current stationary system design. Two data acquisition schemes using limited rotation of the gantry and two others using axial translation of the imaging bed were also evaluated concerning their impact on image quality through improved sampling. Increasing both angular and axial sampling in the current prototype system resulted in quantitative improvements in image quality metrics and qualitative appearance of the images as determined in studies with specifically selected phantoms. Visual improvements for the brain phantoms with clinical distributions were less pronounced but presented quantitative improvements in the fidelity (normalized root-mean-square error (NRMSE)) and striatal specific binding ratio (SBR) for a dopamine transporter (DAT) distribution, and in NRMSE and activity recovery for a brain perfusion distribution. More pronounced improvements with increased sampling were seen in contrast recovery coefficient, bias, and coefficient of variation for a lesion in the brain perfusion distribution. The negligible impact of the most cranial ring of detectors on axial sampling, but its significant impact on sensitivity and angular sampling in the cranial portion of the imaging volume-of-interest were also determined.

Neuro-SPECT: On the development and function of brain emission tomography in the Copenhagen area

This review describes the development of single-photon emission tomography (SPECT) in the Copenhagen area under the leadership of the internationally renown scientist, Niels A. Lassen, and the history leading up to construction of the tomograph. Measurements of global cerebral blood flow (CBF) in the 1940s and 1950s were performed by Kety & Schmidt and Lassen & Munck. Determination of regional cerebral blood flow (rCBF) by intra-arterial injection of ¹³³ Xe and measurement with a 254-multicrystal scintillation detector and a computer system was a major step forward in the study of physiology and pathophysiology of cortical cerebral blood flow. Tomography with radioisotope ligands, including non-invasive administration, was advanced in different centres during the 1970s. An emission tomograph, the Tomomatic 64, was developed as a result of a multidisciplinary Danish and international collaboration. It was the first emission tomograph to provide dynamic data that could produce cross-sectional rCBF images. The present description of the construction and function of the Tomomatic 64 includes comparison with other contemporary and later brain-dedicated SPECT systems. Basic and clinical application of the Tomomatic 64 in Copenhagen resulted in several hundred important scientific publications and improved diagnostics for patients with a variety of neurological disorders. It is concluded that the development of the Tomomatic 64 was a major step forward in the study and examination of rCBF and brain function related to several brain disorders, in addition to vascular diseases.

The need for nationally accepted guidelines for undergraduate nuclear medicine teaching in MBChB programmes in South Africa

According to the South African Health Professions Act No. 56 of 1974, specific skills outcomes of MBChB programmes are that a medical graduate must be able to utilise diagnostic aids, interpret findings and make diagnoses. Imaging techniques are an integral part of the numerous diagnostic and therapeutic aids used in contemporary medical practice; however, in South Africa, no formal directives exist to guide programme directors or nuclear medicine departments regarding an appropriate undergraduate nuclear medicine educational module. As of 2013, six South African schools of medicine are involved in undergraduate nuclear medicine teaching, in which it forms part of clinical modules taught at varying stages in the academic curriculum. Against this backdrop is the inequitable distribution of nuclear medicine resources, training facilities and staffing in the local state health sector. Inadequate undergraduate teaching and provincial differences in nuclear medicine service provision suggest that many clinicians and graduating medical students are unaware of how radionuclide techniques can facilitate patient management. This high level of imaging illiteracy has been associated with lack of patient referral, poor quality and inadequate referral, poor knowledge of radiation doses and poor awareness of radiation risks. Here we highlight the challenges of undergraduate nuclear medicine teaching in South Africa, emphasising the need for the implementation of guidelines for undergraduate nuclear medicine education. Employing nationally accepted guidelines for undergraduate nuclear medicine teaching in South African MBChB programmes will contribute to the effective utilisation of nuclear medicine and molecular imaging as a diagnostic and therapeutic modality by newly qualified medical practitioners.

PET/Computed Tomography Evaluation of Infection of the Heart

The 2015 European Society of Cardiology guidelines for the management of infective endocarditis included 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the diagnostic work-up of prosthetic valve endocarditis. This article examines the literature from the last 3 years to highlight the additional role 18F-FDG-PET/CT can contribute to an accurate diagnosis of cardiac infections and associated infectious complications. The challenges and pitfalls associated with 18F-FDG-PET/CT in such clinical settings must be recognized and these are discussed along with the suggested protocols that may be incorporated in an attempt to address these issues.

Imaging in oncology--over a century of advances

Over the past 120 years, the discipline of oncology has evolved so that a multitude of anatomical and increasingly complex functional imaging techniques are now applicable in both clinical and research platforms. This Timeline article revisits the achievements of the pioneer techniques in cancer imaging, discusses how these techniques have changed over time, provides some examples of clinical importance, and ventures to explain how imaging will remodel the future of modern oncology.

EEG-fMRI Methods for the Study of Brain Networks during Sleep

Modern neuroimaging methods may provide unique insights into the mechanism and role of sleep, as well as into particular mechanisms of brain function in general. Many of the recent neuroimaging studies have used concurrent EEG and fMRI, which present unique technical challenges ranging from the difficulty of inducing sleep in the MRI environment to appropriate instrumentation and data processing methods to obtain artifact free data. In addition, the use of EEG-fMRI during sleep leads to unique data interpretation issues, as common approaches developed for the analysis of task-evoked activity do not apply to sleep. Reviewed are a variety of statistical approaches that can be used to characterize brain activity from fMRI data acquired during sleep, with an emphasis on approaches that investigate the presence of correlated activity between brain regions. Each of these approaches has advantages and disadvantages that must be considered in concert with the theoretical questions of interest. Specifically, fundamental theories of sleep control and function should be considered when designing these studies and when choosing the associated statistical approaches. For example, the notion that local brain activity during sleep may be triggered by local, use-dependent activity during wakefulness may be tested by analyzing sleep networks as statistically independent components. Alternatively, the involvement of regions in more global processes such as arousal may be investigated with correlation analysis.

Dynamic single photon emission computed tomography--basic principles and cardiac applications

The very nature of nuclear medicine, the visual representation of injected radiopharmaceuticals, implies imaging of dynamic processes such as the uptake and wash-out of radiotracers from body organs. For years, nuclear medicine has been touted as the modality of choice for evaluating function in health and disease. This evaluation is greatly enhanced using single photon emission computed tomography (SPECT), which permits three-dimensional (3D) visualization of tracer distributions in the body. However, to fully realize the potential of the technique requires the imaging of in vivo dynamic processes of flow and metabolism. Tissue motion and deformation must also be addressed. Absolute quantification of these dynamic processes in the body has the potential to improve diagnosis. This paper presents a review of advancements toward the realization of the potential of dynamic SPECT imaging and a brief history of the development of the instrumentation. A major portion of the paper is devoted to the review of special data processing methods that have been developed for extracting kinetics from dynamic cardiac SPECT data acquired using rotating detector heads that move as radiopharmaceuticals exchange between biological compartments. Recent developments in multi-resolution spatiotemporal methods enable one to estimate kinetic parameters of compartment models of dynamic processes using data acquired from a single camera head with slow gantry rotation. The estimation of kinetic parameters directly from projection measurements improves bias and variance over the conventional method of first reconstructing 3D dynamic images, generating time-activity curves from selected regions of interest and then estimating the kinetic parameters from the generated time-activity curves. Although the potential applications of SPECT for imaging dynamic processes have not been fully realized in the clinic, it is hoped that this review illuminates the potential of SPECT for dynamic imaging, especially in light of new developments that enable measurement of dynamic processes directly from projection measurements.

Quantification of radiotracer uptake with a dedicated breast PET imaging system

Tomographic breast imaging techniques can be used to quantify radiotracer uptake in breast and tumor tissue. However, physical processes common to PET imaging can confound accurate quantification. In this investigation, we assessed the effects of these phenomena and tested correction schemes for our new positron emission mammography-tomography system (PEM-PET). The PEM-PET scanner utilizes two sets of rotating planar detector heads. Each unit consists of a 4 x 3 array of Hamamatsu H8500 flat panel position sensitive photomultipliers coupled to a 96 x 72 array of 2 x 2 x 15 mm3 LYSO detector elements (pitch = 2.1 mm). Image reconstruction is performed with a 3D-OSEM algorithm parallelized to run on a multiprocessor computer system. The reconstructed field-of-view is 15 x 15 x 15 cm3. Much of the testing procedures were based on NEMA-NU2/2001 protocols. Count rate losses due to pulse pile-up, image contamination due to acceptance of random coincidences and Compton scatter, and image artifacts produced by photon attenuation were measured. It was found that the system was susceptible to count rate losses when moderate levels of radiation were present in the scanner due to the current design of the event trigger electronics. Application of corrections for Compton scattering, photon attenuation and dead time resulted in improved estimations of 18F concentration in simplified phantom studies. Results from these preliminary studies indicate that the PEM-PET scanner will be useful for the quantification of radiotracer uptake in breast tumors, possibly facilitating early assessment of cancer treatments.

Structural and Functional Imaging Correlates for Age-Related Changes in the Brain

In recent years, investigators have made significant progress in documenting brain structure and function as it relates to aging by using positron emission tomography, conventional magnetic resonance (MR) imaging, advanced MR techniques, and functional MR imaging. This review summarizes the latest advances in understanding physiologic maturation and aging as detected by these neuroimaging modalities. We also present our experience with MR volumetric and positron emission tomography analysis in separate cohorts of healthy subjects in the pediatric and adult age groups respectively. Our results are consistent with previous studies and include the following: total brain volume was found to increase with age (up to 20 years of age). Whole brain metabolism and frontal lobe metabolism both decrease significantly with age (38% and 42%, respectively), whereas cerebellar metabolism does not show a significant decline with age. Defining normal alterations in brain function and structure allows early detection of disorders such as Alzheimer's and Parkinson's diseases, which are commonly associated with normal aging.

The early years of single photon emission computed tomography (SPECT): an anthology of selected reminiscences

The origin of SPECT can be found in pioneering experiments on emission tomography performed approximately 50 years ago. This historical review consists of a compilation of first person recollections from nine trailblazing scientists who shaped the early years of SPECT instrumentation during the 1960s and 1970s.

Normal patterns and variants in single-photon emission computed tomography and positron emission tomography brain imaging

One of the most important issues in evaluating functional brain scans for research or clinical purposes is to be able to identify normal variants. Determining the baseline "normal" state of the brain is not easy to characterize since many normal brain functions and mental processes affect brain activity. This article reviews issues pertaining to the technical and neurophysiological aspects of functional brain imaging that might alter "normal" activity and will also consider how normal brain activity changes throughout the lifespan.

Determination of regional cerebral function with FDG-PET imaging in neuropsychiatric disorders

Functional brain imaging using 18F fluorodeoxyglucose (FDG) and positron emission tomography (PET) has greatly enhanced our understanding of brain function both in normal conditions as well as in a wide variety of neuropsychiatric disorders. We review the uses of FDG PET in the diagnosis, management, and follow-up of patients with neuropsychiatric disorders. This article will also explore what FDG-PET imaging has revealed in these neuropsychiatric disorders and how these findings relate to both research and clinical applications.

Imaging the mind

At the forefront of cognitive neuroscience research in normal humans are the new techniques of functional brain imaging: positron emission tomography (PET) and, more recently, magnetic resonance imaging (MRI). The signal used by PET is based on the fact that changes in the cellular activity of the brain of normal, awake humans and laboratory animals are accompanied almost invariably by changes in local blood flow. This robust, empirical relationship has fascinated scientists for well over a hundred years. PET provided a level of precision in the measurement of blood flow that opened up the modern era of functional human brain mapping. Further, the discovery with PET that these changes in blood flow are unaccompanied by quantitatively similar changes in oxygen consumption has paved the way for the explosive rise in the use of MRI in functional brain imaging. The remarkable success of this enterprise is a fitting tribute to men like Michel Ter-Pogossian. He pioneered the use of positron emitting radionuclides in biology and medicine when most had abandoned them in favor of more conventional nuclear medicine radionuclides. Importantly, also, he welcomed into his laboratory young scientists with a broad range of talents, many of whom subsequently became leaders in imaging the mind in research centers throughout the world.

Recent study on radioiodination of [4-127I]iodoantipyrine via isotope-exchange in dry-states up-to melt

A recent study on the radioiodination of [4-127I]iodoantipyrine with Na131I via no-carrier-added isotope exchange in dry-states up-to melt at 160 degrees C using different inorganic ammonium salts as catalyst was described at different reaction conditions of concentrations and temperatures (100-160 degrees C). A radiochemical yield (%) up to 98.5 of pure [4-131I]iodoantipyrine was obtained in melt (at 160 degrees C) using di-ammonium hydrogen orthophosphate within 2-5 min. The reaction offers a good possibility to label [4-127I]iodoantipyrine with short-lived radioiodine isotopes with no substrate decomposition.

Studies of central nervous system disorders with single photon emission computed tomography and positron emission tomography: evolution over the past 2 decades

Single photon emission computed tomography (SPECT) was introduced in the 1960s to detect breakdowns in the blood-brain barrier and was replaced by x-ray computed tomography in the mid-1970s. The development of the deoxyglucose (DG) technique to measure regional cerebral glucose metabolism by employing either autoradiography, using 14CDG, or positron emission tomography (PET), using 18FDG, added a major dimension to the investigation of brain function. In the late 1970s and early 1980s, the FDG-PET technique was widely used to examine a variety of neuropsychiatric disorders. It soon became apparent that functional imaging was more sensitive than anatomic imaging in detecting abnormalities of the brain related to aging, dementia, tumors, seizures, cerebral vascular accidents, and psychiatric problems. Because of its complexity and the cost involved, PET was used in a limited number of centers in the United States. However, the success of PET resulted in the resurgence of interest in SPECT as an alternative technology after almost a decade. This became possible because of the synthesis of iodine 123- and technetium 99m-labeled radiopharmaceuticals to determine regional cerebral blood flow. Since blood flow and metabolism are coupled in most pathological states, patterns of abnormality noted on SPECT were similar to those seen on PET in many disorders. Since the introduction of high resolution SPECT imaging instruments, the role of SPECT has been further enhanced. The successful synthesis of both positron and single emitting radioligands to image dopamine and other receptors has started a new era in neurosciences and will have a far-reaching impact on the day-to-day practice of neuropsychiatry.

Instrumentation and computers for brain single photon emission computed tomography

Cerebral single-photon emission computed tomography (SPECT) requires attention to the instrumentation because of the anatomical location of the head at one end of the body, with a generally narrower diameter than the rest of the body. For a number of years, there have been SPECT units designed especially for head work, as well as general-purpose units that have performed well in imaging the head. The current emphasis on cerebral perfusion, using either agents that wash in and out with blood flow or agents that reflect blood flow in their static distribution, has allowed a concentration on imaging hardware and computer hardware and software for this purpose.

Quantification of regional cerebral blood flow with IMP-SPECT. Reproducibility and clinical relevance of flow values

Single-photon emission computed tomography with N-isopropyl[123I]-p-iodoamphetamine (IMP-SPECT) was performed in 14 normal volunteers (seven men and seven women aged 25.1 +/- 5.3 years) and 29 patients with cerebrovascular disease (18 men and 11 women aged 54.1 +/- 13.7 years). The fluid microsphere model was used to estimate cerebral blood flow (CBF). Normal subjects were scanned twice, 1 week apart, to determine the reproducibility of the CBF estimates. Hemispheric blood flow (hCBF) was calculated as the mean of regional cerebral blood flow (rCBF) values in 16 gray matter regions per hemisphere. In normal subjects mean hCBF was 68 ml/100 g/min. The highest rCBF was found in the occipital cortex, followed by the frontal, temporal, and parietal cortexes. CBF values were reproducible (p less than 0.001 except the right thalamic region, where p less than 0.01). Intraindividual variation ranged between 0.3% and 15%. Women exhibited significantly higher (16%, p less than 0.02) CBF than men. Patients were subdivided into groups with reversible (n = 19) and persistent (n = 10) symptoms. Significant hCBF differences between the affected and the contralateral hemispheres were recorded only in the group with reversible symptoms (p less than 0.005), whereas the group with persistent symptoms showed a significant bilateral decrease of hCBF compared with normal subjects and patients with reversible symptoms. Focal CBF was significantly lower in patients with completed stroke than in patients with transient symptoms (p less than 0.001). Our results indicate that IMP-SPECT can be used for the routine estimation of CBF in normal and pathologic states.

[123I]iodoamphetamine SPECT imaging

SPECT imaging of [123I]IMP is reviewed. Methods for radiopharmaceutical production are discussed with an emphasis on labeling small quantities of IMP. Limited angle tomography and full angle SPECT with standard cameras and special imaging systems are reviewed. Selection of collimator and methods of reconstruction are discussed. Clinical studies are described with emphasis on stroke, epilepsy and dementia. The efforts to perform quantitative imaging of rCBF with [123I]IMP are reviewed.

The Aberdeen Mark II single-photon-emission tomographic scanner: specification and some clinical applications

The construction, operation and physical characteristics of a single-section multi-detector single-photon-emission scanner are described. The machine has 24 detectors arranged along the sides of a square. Movements and data collection are under the control of a series of distributed microprocessors. Both head and trunk tomograms can be produced. The spatial resolution at the collimator focus is 9 mm in the transverse plane, and the effective slice thickness is 14 mm. The volume sensitivity is 300 counts/s kBq ml with a 20 cm diameter cylindrical phantom filled with 99Tcm solution. The application of this machine to the examination of the brain, liver and heart has been found to be clinically useful.

Improvements in SPECT technology for cerebral imaging

Advancement in three major areas of SPECT (single photon emission computed tomography) technology have resulted in improved image quality for cerebral studies. In the first area, single-crystal camera electronics, extensive use of microprocessors, custom digital circuitry, an data bus architecture have allowed precise external control of all gantry motions and improved signal processing. The new digital circuitry permits energy, uniformity, and linearity corrections to be an integral part of the processing electronics. Calibration of these correlations is controlled by algorithms stored in the camera's memory. In addition, digital signals can be routed directly to interface circuitry of auxiliary computer systems without analog-to-digital conversion. Look-up tables, downloaded to the interface from the central processing unit (CPU), permit computer-controlled real-time processing of coordinate signals, including truncation, magnification, and spatial calibration. The second area of improved SPECT technology is camera collimation and related imaging techniques. In this area, system resolution has been improved without loss of sensitivity by decreasing the air gap between patient and collimator surface. Rotating the detector in close apposition to the head has required various stratagems to avoid detector-shoulder contact: the selective reduction of camera shielding, the use of long bore collimators, and the 30 degrees angulation of the camera head for slant hole collimation. Since cerebral studies characteristically image high-contrast regions less than 1 cm in size, image quality has been improved by increasing collimator resolution even at the expense of sensitivity. Increased resolution also improved image contrast for studies using 123I-labeled pharmaceuticals with 3% to 4% 124I contamination. Such studied acquired with low energy or medium energy collimation and a window centered on the 159 keV 123I photopeak contain appreciable septal breakthrough signals originating from Compton scatter of high energy photons primarily from 124I. The third area of advancements in technology, multidetector instrumentation, offers the promise of increased sensitivity and resolution. For the dynamic computer-assisted tomograph (DCAT) system, which was especially designed for regional blood flow studies with 133Xe or 127Xe, a count rate of 170,000 counts per microCi/cc for three slices has been achieved. This system consists of four detector banks each with 16 rectangular NaI crystals. An alternative system at Harvard uses an array of 12 moving detectors with focused collimators to acquire a single slice.(ABSTRACT TRUNCATED AT 400 WORDS)

Functional brain imaging

Recent advances in brain imaging have allowed a regional examination of brain function using multiple-probe inert gas studies of cerebral blood flow, positron or single photon tomography. Inert gas blood flow methods using inhalation or injection of 133xenon have been used with multiple-probe systems to measure blood flow in 1 to 2 cm regions of lateral cortex. The sensitivity of these systems to neurophysiological stimuli and neurological diseases have been demonstrated in numerous studies of the normal resting state, memory and learning, motor activity and sensory input, dementia, and aphasia, to name some. Positron tomography utilizes cyclotron-produced, short-lived positron-emitting isotopes to label biologically active radiopharmaceuticals. Using positron tomographs capable of quantitative three-dimensional imaging and appropriate tracer-kinetic models, regional metabolic function, including glucose, oxygen, amino acid metabolism, and receptor-binding can be regionally studied throughout the brain. Clinical studies have been performed in dementia, schizophrenia, affective disorders, resting states, and sensory stimulation. Positron tomography offers potentially the greatest variety of studies and highest temporal and spatial resolution of any of the presently available functional brain-imaging modalities. Its principal drawback is the very high cost. Single photon tomography uses gamma-emitting isotopes such as 123iodine and 133xenon to image regional cerebral blood flow and recently receptor function. Although at present it does not have the variety of studies or the technical capabilities of positron tomography, it does provide three-dimensional studies with 1 to 2 cm resolutions throughout the brain at a considerably lower cost than positron tomography. In the future, magnetic resonance studies of blood flow or phosphorus metabolism may add a fourth modality.

Blood-brain barrier to ammonia in humans

We have developed a method to evaluate the diffusion of ammonia across the blood-brain barrier (BBB) in normal humans, based on measures of CBF and the regional cerebral metabolic rate for ammonia, obtained by positron emission tomography. The extraction fraction for ammonia passing through the cerebral capillary bed was a reciprocal function of CBF. The product of the BBB surface area and ammonia permeability, calculated from the Renkin-Crone model, was 0.32 +/- 0.19 cm3 g-1 min-1 (+/- SD) in gray matter and 0.24 +/- 0.16 cm3 g-1 min-1 in white matter. From literature values of the expected capillary surface area ratio, a gray-to-white matter ammonia permeability ratio of 0.37:1.0 was calculated. We speculate that astrocytes may mediate this unexpected difference in permeability, and that the permeability of the BBB to ammonia may be important in the pathogenesis of hyperammonemic brain dysfunction.

Emission and transmission tomography of the brain in cerebrovascular disease

Transmission and emission computed tomography (T-CT and E-CT, respectively) scans of the brain in 149 patients with cerebrovascular disease were compared to establish the diagnostic accuracy of the two methods. The T-CT scan yielded an overall rate of true-positive results of 80.75% in major infarcts, 80% in intracerebral hematomas, and 75.9% in subarachnoid hemorrhage. In contrast, the percentages of true-positive results yielded by the E-CT scan were 92.3, 55, and 34.5%, respectively, in each type of cerebrovascular disease. The false-negative results obtained with the T-CT scan were higher in infarcts but lower in hematomas and subarachnoid hemorrhage; the reverse was true for the diagnoses obtained with the E-CT scan. The false-positive diagnoses produced by the T-CT scan were high for hemorrhagic strokes compared to those of the E-CT scan. The diagnostic sensitivity of each scan was not affected by the location of the lesion. Thus, the E-CT scan is more sensitive for thromboembolic disease and less so for hemorrhagic types of stroke. The reverse is true for the T-CT scan.

Positron emission tomography of the brain: new possibilities for the investigation of human cerebral pathophysiology

In the foregoing an overview of positron emission tomography has been presented. Its theoretical, technical, and methodological implications, as well as its clinical applications have been outlined. The emphasis has been on the quantitative aspects of the method and its usefulness is investigating normal and pathological functions of brain tissue. Although the potential of this new research technique is obvious, many theoretical and practical difficulties still need to be solved. Nevertheless it provides an opportunity to bridge the gap between basic experimental research and clinical medicine.

A study of the image discrepancies due to object time-dependence in transmission and emission tomography

In conventional computed tomography (CT) imaging of a point object, projection filtering causes the back-projected contributions to image positions away from the point to sum to zero. If the point object intensity is time-dependent, and all the projections are not acquired simultaneously, this cancellation cannot be complete and artefacts result. Loss of spatial invariance makes a general linear-systems approach to the problem impossible. We have studied the properties of such artefacts by the computer simulation of decaying exponential time-dependence in three different spatial distributions and four transmission and emission CT geometries. Spatially complex time-dependent objects typically produce artefacts that can be treated as an additional broad-spectrum noise source with a power comparable to that of other CT noises. Artefacts from broad ranges of similar time-dependence can add coherently to cause patches of artefact, particularly in geometries with a strong correlation between projection acquisition time and projection angle. As expected, artefacts are reduced for all geometries as scan duration is reduced. In our model, with a most rapid decay constant of 1.2 min-1, negligible artefacts were observed for a six second scan duration.

Development of a tomographic myelin scan

The principle that myelin can be imaged noninvasively using the emission tomographic distribution of a lipophilic radioactive tracer was investigated. Properties of agents suitable for noninvasive myelin scanning are discussed with specific reference to blood-brain barrier permeability, metabolism, and tracer lipophilicity. The brain distributions of inert tracers are correlated with their partitioning between octanol and saline. A test probe, iodobenzene, was labeled with iodine 125 for preliminary invasive studies in the rabbit. The equilibrium brain distribution, determined either autoradiographically or by regional dissection, corresponded closely to that of myelin. 123I-labeled iodobenzene, a gamma-emitting analog, was then administered to a monkey, and tomographic reconstruction revealed a pattern of brain uptake corresponding to white matter.

Nuclear medicine in clinical neurology: an update

Isotope scanning using technetium 99m pertechnetate has fallen into disuse since the advent of x-ray computerized tomography. Regional brain blood flow studies have been pursued on a research basis. Increased regional blood flow during focal seizure activity has been demonstrated and is of use in localizing such foci. Cisternography as a predictive tool in normal pressure hydrocephalus is falling into disuse. Positron tomographic scanning is a potent research tool that can demonstrate both regional glycolysis and blood flow. Unfortunately, it is extremely expensive and complex to apply in a clinical setting. With support from the National Institutes of Health, seven extramural centers have been funded to develop positron tomographic capabilities, and they will greatly advance our knowledge of stroke pathophysiology, seizure disorders, brain tumors, and various degenerative diseases. Nuclear magnetic resonance imaging is a potentially valuable tool since it creates tomographic images representing the distribution of brain water. No tissue ionization is produced, and images comparable to second-generation computerized tomographic scans are already being produced in humans.

A comparison of three systems for performing single-photon emission tomography

A comparison is made between the performance of three transverse axial single-photon emission tomographic machines, namely a rotating gamma-camera and two different scanning systems. Each system has been evaluation in terms of the spatial resolution, sensitivity and efficiency. The functional dependence of the volume sensitivity on the size of the emitting object has been derived using a theoretical model of the photon emission, attenuation and detection. The model is shown to predict this size dependence well and is consistent with the experimental observations.

Positron computed tomography studies of cerebral glucose metabolism in man: theory and application in nuclear medicine

The capability of positron computed tomography (PCT) to delineate the substructures of the brain and its facility for accurately measuring the local tissue radioactivity concentration allow the application of tracer kinetic models for the study of local cerebral function in man. This principle and an adaptation of the 14C-deoxyglucose (DG) model of Sokoloff et al. with 18F-2-fluoro-deoxy-D-glucose (FDG) is being used at UCLA. Brookhaven National Laboratory, University of Pennsylvania, NIH, and the Massachusetts General Hospital to determine the local cerebral glucose metabolic rate (LCMRGIc) in normal man at rest and during sensory activation and the changes that occur in patients with a variety of cerebral disorders. Kinetic studies with PCT have been employed to measure the rate constants of the model in different gray and white matter structures of the brain in both normal and ischemic states. The precision of the method in normals has been shown to be about +/- 5% for 1.5-2.0 sq cm regions of the brain. Studies in normals have yielded values for hemispheric CMRGIc that are in agreement with measurement using the Kety-Schmidt technique and LCMRGIc values in agreement with values in monkeys using DG autoradiography. Studies in volunteers subjected to visual and auditory stimulation are demonstrating the potential of this technique for investigating the human brain's response to different stimuli. STudies in patients with stroke show excellent correlation between the degree, extent, and particular structures involved and the clinical symptoms. The method consistently detected hypometabolism in cortical, thalamic, and striatal tissues that were dysfunctional due to deactivation or damage but which appeared normal on x-ray CT. Studies in patients with partial epilepsy have shown hypometabolic zones that highly correlated anatomically with interictal EEG spike foci and were associated with normal x-ray CT studies in 77% of the patients studied. The studies on epilepsy at UCLA have resulted in the integration of the LCMRGIc study into the clinical workup of patients with partial epilepsy that are candidates for surgical resection of their epileptogenic focus (effective June 1979). Studies on Huntington's chorea, Parkinson's disease, aphasia, dementia, schizophrenia, and tumors are in early stage of investigation but also are providing exciting new results. Further studies are needed to determine the role of the local function information obtained with the PCT-FDG method in elucidating the basic mechanism and the potential to aid in improving the approach to medical therapy.

Special characteristics and potential of single photon emission computed tomography in the brain

Single photon emission tomographic techniques for evaluation of the brain have as their major advantage the ability to employ readily available radionuclides, such as technetium-99m. With present radiopharmaceuticals, single photon emmision tomography of the brain primarily provides morphological information that may be complimentary to standard gamma camera images. Particular areas of assistance have included detection of basal lesions, delineation of multiplicity of lesions, definition of medial extent of abnormalities, clear separation of skull and intracranial abnormalities, and perhaps improved lesion characterization. Overall, however, the reported improvement in sensitivity has been relatively small. To optimally utilize the tomographic and quantiative capabilities of single emission tomography, new classes of radiopharmaceuticals must be developed that can penetrate the blood-brain barrier and provide information on CNS function and pathophysiology. If such radiopharmaceuticals can be labeled with single emission radionuclides, this technique has the potential to provide critically important information. The ultimate outcome of single emission tomographic techniques for the study of the brain may depend on radiopharmaceutical advances.

Recent developments in instrumentation for emission computed tomography

Equipment for emission tomography is currently undergoing a rapidly changing stage of development, both for single-gamma detection and for tomography using positron emitters. For single-gamma longitudinal tomography, the 7-pinhole collimator has won wide acceptance because of it simplicity and rapid reconstruction times. However, rotating slant-hole collimators overcome some of the disadvantages of the 7-pinhole method and may eventually be used more widely. For transverse single-gamma imaging, rotating gamma cameras are currently attracting the most interest and offer the best prospects for wise-spread application, since such instruments can be used also for routine studies. In the field of positron tomography, development of new positron cameras has moved from the research center to the commerical area, with at least four manufacturers now marketing tomographic units, all of the multiple-ring design. Small cyclotrons suitable for in-hospital use also are being offered by these companies. Most of the new positron tomographic units employ BGO crystals, which offer substantial advantages over Nal for this purpose. However, the recent introduction of cesium fluoride (CsF) as a detector for tomographic cameras offers the exciting possibility of using time-of-flight techniques for positron detection. This should substantially improve the attainable resolution, which presently is slightly less than 1 cm FWHM. The number of institutions involved in research using positron tomography has suddenly increased, in part because of the recent award of substantial research grants from NIH. Thus, a field which has grown very slowly over the past decade has taken a sudden spurt, and we can anticipate further growth during the coming decade as clinical utility improves.

Effects of stroke on local cerebral metabolism and perfusion: mapping by emission computed tomography of 18FDG and 13NH3

By means of emission computed tomography (ECT), we used 18F-fluorodeoxyglucose (18FDG) and 13N-ammonia (13NH3) as indicators of abnormalities in local cerebral glucose utilization (LCMRglc) and relative perfusion, respectively. The ECAT positron tomograph was used to scan normal control subject and 10 stroke patients at various times during recovery. In normal subjects, mean CMRglc was 5.28 +/- 0.76 mg per 100 gm tissue per minute (mean +/- SD; N = 8). In patients with stroke, mean CMRglc in the contralateral hemisphere was moderately decreased during the first week, profoundly depressed in irreversible coma, and normal after clinical recovery. Quantification was restricted by incomplete understanding of tracer behavior in diseased brain, but relative local distributions of 18FDG and 13NH3 trapping qualitatively reflected the increases and decreases as well as coupling and uncoupling expected for local alterations in glucose utilization and perfusion in stroke. Early after cerebrovascular occlusion there was a greater decrease in local trapping of 13NH3, than 18FDG within the infarct, probably because of increased anaerobic glycolysis. Otherwise, 18FDG was a more sensitive indicator of cerebral dysfunction than was 13NH3. Hypometabolism, due to deactivation or minimal damage, was demonstrated with the 18FDG scan in deep structures and broad zones of cerebral cortex that appeared normal on x-ray computed tomography and technetium 99m pertechnetate scans. In its present state of development, the 18FDG ECT method should aid in defining the location and extent of altered brain in studies of disordered function after stroke. With improved knowledge of tracer behaviour in diseased brain, the method has promise for mapping the response to therapeutic intervention and increasing our understanding of how the human brain responds to stroke.

Nuclear imaging: new developments

Tomographic images produced with very short-lived radioisotopes of basic biologic elements can provide a form of moving in vivo autoradiography that delineates the dynamic state of the body constituents. The nuclides must be used at the site of the cyclotron where they are produced, but the day may be at hand when such facilities will be common, at least in the larger teaching hospitals.

A perspective on the usefulness of computers in nuclear medicine

A computer system in clinical nuclear medicine has a wide variety of operations which it can perform. These range from simple data acquisition and tabulation to elaborate temporal and spatial reconstructions. Simultaneous recording of physiological data has also expanded the number of nuclear medical studies possible. The multiple-gated cardiac equilibrium analysis is the primary example of this format which has evolved rapidly with the availability of inexpensive central memory. Decreasing size and cost of processor units recently have led to the development of multiple processor systems. In some cases, the peripheral devices have a microprocessor already built in. The total cost of the computer system is essentially dictated by the number of peripheral devices.