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Cross GB, O’ Doherty J, Chang CC, Kelleher AD, Paton NI. Does PET-CT Have a Role in the Evaluation of Tuberculosis Treatment in Phase 2 Clinical Trials? J Infect Dis 2024; 229:1229-1238. [PMID: 37788578 PMCID: PMC11011169 DOI: 10.1093/infdis/jiad425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/10/2023] [Accepted: 10/01/2023] [Indexed: 10/05/2023] Open
Abstract
Positron emission tomography-computed tomography (PET-CT) has the potential to revolutionize research in infectious diseases, as it has done with cancer. There is growing interest in it as a biomarker in the setting of early-phase tuberculosis clinical trials, particularly given the limitations of current biomarkers as adequate predictors of sterilizing cure for tuberculosis. PET-CT is a real-time tool that provides a 3-dimensional view of the spatial distribution of tuberculosis within the lung parenchyma and the nature of lesions with uptake (ie, whether nodular, consolidative, or cavitary). Its ability to provide functional data on changes in metabolism, drug penetration, and immune control of tuberculous lesions has the potential to facilitate drug development and regimen selection for advancement to phase 3 trials in tuberculosis. In this narrative review, we discuss the role that PET-CT may have in evaluating responses to drug therapy in active tuberculosis treatment and the challenges in taking PET-CT forward as predictive biomarker of relapse-free cure in the setting of phase 2 clinical trials.
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Affiliation(s)
- Gail B Cross
- Immunovirology and Pathogenesis Program, The Kirby Institute, UNSW, Sydney
- Burnet Institute, Victoria, Australia
| | - Jim O’ Doherty
- Siemens Medical Solutions, Malvern, PA
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Radiography & Diagnostic Imaging, University College Dublin, Dublin, Ireland
| | - Christina C Chang
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Anthony D Kelleher
- Immunovirology and Pathogenesis Program, The Kirby Institute, UNSW, Sydney
- St Vincent's Hospital, Sydney, Australia
| | - Nicholas I Paton
- Infectious Disease Translational Research Programme, National University of Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, UK
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Nieuwland JM, Nutma E, Philippens IHCHM, Böszörményi KP, Remarque EJ, Bakker J, Meijer L, Woerdman N, Fagrouch ZC, Verstrepen BE, Langermans JAM, Verschoor EJ, Windhorst AD, Bontrop RE, de Vries HE, Stammes MA, Middeldorp J. Longitudinal positron emission tomography and postmortem analysis reveals widespread neuroinflammation in SARS-CoV-2 infected rhesus macaques. J Neuroinflammation 2023; 20:179. [PMID: 37516868 PMCID: PMC10387202 DOI: 10.1186/s12974-023-02857-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) patients initially develop respiratory symptoms, but they may also suffer from neurological symptoms. People with long-lasting effects after acute infections with severe respiratory syndrome coronavirus 2 (SARS-CoV-2), i.e., post-COVID syndrome or long COVID, may experience a variety of neurological manifestations. Although we do not fully understand how SARS-CoV-2 affects the brain, neuroinflammation likely plays a role. METHODS To investigate neuroinflammatory processes longitudinally after SARS-CoV-2 infection, four experimentally SARS-CoV-2 infected rhesus macaques were monitored for 7 weeks with 18-kDa translocator protein (TSPO) positron emission tomography (PET) using [18F]DPA714, together with computed tomography (CT). The baseline scan was compared to weekly PET-CTs obtained post-infection (pi). Brain tissue was collected following euthanasia (50 days pi) to correlate the PET signal with TSPO expression, and glial and endothelial cell markers. Expression of these markers was compared to brain tissue from uninfected animals of comparable age, allowing the examination of the contribution of these cells to the neuroinflammatory response following SARS-CoV-2 infection. RESULTS TSPO PET revealed an increased tracer uptake throughout the brain of all infected animals already from the first scan obtained post-infection (day 2), which increased to approximately twofold until day 30 pi. Postmortem immunohistochemical analysis of the hippocampus and pons showed TSPO expression in cells expressing ionized calcium-binding adaptor molecule 1 (IBA1), glial fibrillary acidic protein (GFAP), and collagen IV. In the hippocampus of SARS-CoV-2 infected animals the TSPO+ area and number of TSPO+ cells were significantly increased compared to control animals. This increase was not cell type specific, since both the number of IBA1+TSPO+ and GFAP+TSPO+ cells was increased, as well as the TSPO+ area within collagen IV+ blood vessels. CONCLUSIONS This study manifests [18F]DPA714 as a powerful radiotracer to visualize SARS-CoV-2 induced neuroinflammation. The increased uptake of [18F]DPA714 over time implies an active neuroinflammatory response following SARS-CoV-2 infection. This inflammatory signal coincides with an increased number of TSPO expressing cells, including glial and endothelial cells, suggesting neuroinflammation and vascular dysregulation. These results demonstrate the long-term neuroinflammatory response following a mild SARS-CoV-2 infection, which potentially precedes long-lasting neurological symptoms.
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Affiliation(s)
- Juliana M Nieuwland
- Department of Neurobiology and Aging, Biomedical Primate Research Centre (BPRC), Lange Kleiweg 161, 2288GJ, Rijswijk, The Netherlands
| | - Erik Nutma
- Department of Neurobiology and Aging, Biomedical Primate Research Centre (BPRC), Lange Kleiweg 161, 2288GJ, Rijswijk, The Netherlands
| | - Ingrid H C H M Philippens
- Department of Neurobiology and Aging, Biomedical Primate Research Centre (BPRC), Lange Kleiweg 161, 2288GJ, Rijswijk, The Netherlands
| | - Kinga P Böszörményi
- Department of Virology, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
| | - Edmond J Remarque
- Department of Virology, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
| | - Jaco Bakker
- Department of Radiology, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
| | - Lisette Meijer
- Department of Radiology, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
| | - Noor Woerdman
- Department of Radiology, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
| | - Zahra C Fagrouch
- Department of Virology, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
| | - Babs E Verstrepen
- Department of Virology, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
| | - Jan A M Langermans
- Department of Animal Sciences, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
- Department Population Health Sciences, Unit Animals in Science and Society, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Ernst J Verschoor
- Department of Virology, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, Tracer Center Amsterdam (TCA), Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ronald E Bontrop
- Department of Comparative Genetics and Refinement, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
- Department of Biology, Theoretical Biology and Bioinformatics, Utrecht University, Utrecht, The Netherlands
| | - Helga E de Vries
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Marieke A Stammes
- Department of Radiology, Biomedical Primate Research Centre (BPRC), Rijswijk, The Netherlands
| | - Jinte Middeldorp
- Department of Neurobiology and Aging, Biomedical Primate Research Centre (BPRC), Lange Kleiweg 161, 2288GJ, Rijswijk, The Netherlands.
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Philippens IHCHM, Böszörményi KP, Wubben JAM, Fagrouch ZC, van Driel N, Mayenburg AQ, Lozovagia D, Roos E, Schurink B, Bugiani M, Bontrop RE, Middeldorp J, Bogers WM, de Geus-Oei LF, Langermans JAM, Verschoor EJ, Stammes MA, Verstrepen BE. Brain Inflammation and Intracellular α-Synuclein Aggregates in Macaques after SARS-CoV-2 Infection. Viruses 2022; 14:v14040776. [PMID: 35458506 PMCID: PMC9025893 DOI: 10.3390/v14040776] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
SARS-CoV-2 causes acute respiratory disease, but many patients also experience neurological complications. Neuropathological changes with pronounced neuroinflammation have been described in individuals after lethal COVID-19, as well as in the CSF of hospitalized patients with neurological complications. To assess whether neuropathological changes can occur after a SARS-CoV-2 infection, leading to mild-to-moderate disease, we investigated the brains of four rhesus and four cynomolgus macaques after pulmonary disease and without overt clinical symptoms. Postmortem analysis demonstrated the infiltration of T-cells and activated microglia in the parenchyma of all infected animals, even in the absence of viral antigen or RNA. Moreover, intracellular α-synuclein aggregates were found in the brains of both macaque species. The heterogeneity of these manifestations in the brains indicates the virus’ neuropathological potential and should be considered a warning for long-term health risks, following SARS-CoV-2 infection.
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Affiliation(s)
- Ingrid H. C. H. M. Philippens
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Kinga P. Böszörményi
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Jacqueline A. M. Wubben
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Zahra C. Fagrouch
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Nikki van Driel
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Amber Q. Mayenburg
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Diana Lozovagia
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Eva Roos
- Department of Pathology, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (E.R.); (B.S.); (M.B.)
| | - Bernadette Schurink
- Department of Pathology, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (E.R.); (B.S.); (M.B.)
| | - Marianna Bugiani
- Department of Pathology, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (E.R.); (B.S.); (M.B.)
| | - Ronald E. Bontrop
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
- Department of Biology, Theoretical Biology and Bioinformatics, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Jinte Middeldorp
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Willy M. Bogers
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
- Biomedical Photonic Imaging Group, University of Twente, 7522 ND Enschede, The Netherlands
| | - Jan A. M. Langermans
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
- Department Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
| | - Ernst J. Verschoor
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
- Correspondence:
| | - Marieke A. Stammes
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
| | - Babs E. Verstrepen
- Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands; (I.H.C.H.M.P.); (K.P.B.); (J.A.M.W.); (Z.C.F.); (N.v.D.); (A.Q.M.); (D.L.); (R.E.B.); (J.M.); (W.M.B.); (J.A.M.L.); (M.A.S.); (B.E.V.)
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The Post-Acute Phase of SARS-CoV-2 Infection in Two Macaque Species Is Associated with Signs of Ongoing Virus Replication and Pathology in Pulmonary and Extrapulmonary Tissues. Viruses 2021; 13:v13081673. [PMID: 34452537 PMCID: PMC8402919 DOI: 10.3390/v13081673] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022] Open
Abstract
The post-acute phase of SARS-CoV-2 infection was investigated in rhesus (Macaca mulatta) and cynomolgus macaques (Macaca fascicularis). During the acute phase of infection, SARS-CoV-2 was shed via the nose and throat, and viral RNA was occasionally detected in feces. This phase coincided with a transient change in systemic immune activation. Even after the alleged resolution of the infection, computed tomography (CT) and positron emission tomography (PET)-CT revealed pulmonary lesions and activated tracheobronchial lymph nodes in all animals. Post-mortem histological examination of the lung tissue revealed mostly marginal or resolving minimal lesions that were indicative of SARS-CoV-2 infection. Evidence for SARS-CoV-2-induced histopathology was also found in extrapulmonary tissue samples, such as conjunctiva, cervical, and mesenteric lymph nodes. However, 5–6 weeks after SARS-CoV-2 exposure, upon necropsy, viral RNA was still detectable in a wide range of tissue samples in 50% of the macaques and included amongst others the heart, the respiratory tract and surrounding lymph nodes, salivary gland, and conjunctiva. Subgenomic messenger RNA was detected in the lungs and tracheobronchial lymph nodes, indicative of ongoing virus replication during the post-acute phase. These results could be relevant for understanding the long-term consequences of COVID-19 in humans.
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Maaskant A, Meijer L, Fagrouch Z, Bakker J, van Geest L, Zijlmans DGM, Verstrepen BE, Langermans JAM, Verschoor EJ, Stammes MA. Bronchoalveolar lavage affects thorax computed tomography of healthy and SARS-CoV-2 infected rhesus macaques (Macaca mulatta). PLoS One 2021; 16:e0252941. [PMID: 34242213 PMCID: PMC8270458 DOI: 10.1371/journal.pone.0252941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/25/2021] [Indexed: 12/26/2022] Open
Abstract
Medical imaging as method to assess the longitudinal process of a SARS-CoV-2 infection in non-human primates is commonly used in research settings. Bronchoalveolar lavage (BAL) is regularly used to determine the local virus production and immune effects of SARS-CoV-2 in the lower respiratory tract. However, the potential interference of those two diagnostic modalities is unknown in non-human primates. The current study investigated the effect and duration of BAL on computed tomography (CT) in both healthy and experimentally SARS-CoV-2-infected female rhesus macaques (Macaca mulatta). In addition, the effect of subsequent BALs was reviewed. Thorax CTs and BALs were obtained from four healthy animals and 11 experimentally SARS-CoV-2-infected animals. From all animals, CTs were obtained just before BAL, and 24 hours post-BAL. Additionally, from the healthy animals, CTs immediately after, and four hours post-BAL were obtained. Thorax CTs were evaluated for alterations in lung density, measured in Hounsfield units, and a visual semi-quantitative scoring system. An increase in the lung density was observed on the immediately post-BAL CT but resolved within 24 hours in the healthy animals. In the infected animals, a significant difference in both the lung density and CT score was still found 24 hours after BAL. Furthermore, the differences between time points in CT score were increased for the second BAL. These results indicate that the effect of BAL on infected lungs is not resolved within the first 24 hours. Therefore, it is important to acknowledge the interference between BAL and CT in rhesus macaques.
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Affiliation(s)
| | - Lisette Meijer
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
| | - Zahra Fagrouch
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
| | - Jaco Bakker
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
| | - Leo van Geest
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
| | | | | | - Jan A. M. Langermans
- Biomedical Primate Research Centre (BPRC), Rijswijk, Netherlands
- Department Population Health Sciences, Division Animals in Science and Society, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
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Tölgyesi B, Bakker J, Nagy K, Meijer L, van Geest L, Stammes MA. Refined acquisition of high-resolution chest CTs in macaques by free breathing. Lab Anim 2021; 55:551-559. [PMID: 34210186 PMCID: PMC8669209 DOI: 10.1177/00236772211026562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The use of medical imaging as a non-invasive or minimally invasive method to assess disease or treatment response continues to grow. A similar trend is observed in pre-clinical research, in general, and more specifically in macaques, enabling longitudinal assessment of disease in individual animals. Computed tomography (CT) is such an imaging technique used to obtain clinically applicable data. To acquire a chest CT using a cone beam tomography system, some kind of respiration control is needed. A commonly used technique for this is endotracheal intubation and mechanical ventilation. However, although routinely performed this can increase the risk of impact on welfare in comparison with non-invasive imaging. Therefore, we studied the option of retrospectively gated CTs: acquiring high resolution chest CTs in freely breathing macaques. For this, we compared 748 CTs obtained during free breathing with 881 CTs obtained with mechanical ventilation in combination with a breath-hold procedure predominantly on the appearance of misregistration artifacts. The scans were obtained during different stages of multiple experimentally induced respiratory diseases. The comparison shows that although there are still streaking artifacts present in the retrospective gated scans, the amount of shading artifacts is reduced to such a level that it possibly dominates underlying lesions, causing misdiagnosis. Our data reveal that the use of retrospective gating in high resolution CTs for macaques can be successfully applied. With the use of this technique, artifacts due to free breathing are reduced to a diagnostically appropriate level. Most importantly, this technique makes chest CTs with this instrumentation a non-invasive modality.
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Affiliation(s)
| | - Jaco Bakker
- Biomedical Primate Research Centre, Netherlands
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