Clinical Value of Pet with 18F-Fluorodeoxyglucose and L-Methyl-11C-Methionine for Diagnosis of Recurrent Brain Tumor and Radiation Injury

We studied 15 patients clinically suspected to have recurrent brain tumor or radiation injury, using positron emission tomography (PET) with 18F-fluorodeoxyglucose (18FDG) and L-methyl-11C-methionine (11C-Met). PET with 11C-Met (Met-PET) clearly delineated the extent of recurrent brain tumor as focal areas of increased accumulation of 11C-Met, and was useful for early detection of recurrent brain tumor. PET with 18FDG (FDG-PET) showed focal 18FDG-hypermetabolism in one patient with malignant transformation of low grade glioma, and demonstrated its usefulness for evaluation of malignant transformation. 18FDG-hypometabolism was observed in all patients with radiation injury, but was also found in one patient with recurrent malignant brain tumor. 11C-Met uptake in 3 patients with radiation injury was similar to that of the normal cortical tissue. FDG-PET can be used to initially exclude recurrent brain tumor which is seen as 18FDG-hypermetabolism. The combined use of Met-PET in addition to FDG-PET can improve the accuracy of differentiation of recurrent brain tumor with 18FDG-hypometabolism from radiation injury.

Deuterium MR in Vivo Imaging of the Rat Eye Using 2H2O

In vivo euterium MR imaging (2H MR) was investigated in rats after intraperitoneal administration of deuterated saline, and a dynamic study of the water movement in rat eyes was performed. Deuterium MR imaging was carried out by means of a gradient-echo (GRE) and a spin-echo (SE) pulse sequence. The rat eye was imaged in 2H MR more selectively by SE than by GRE, but a lower signal-to-noise ratio was obtained in 2H MR imaging using the SE sequence. The MR signal intensity of the rat eye was followed by a 3-compartment model, which enabled determination of the flow rate constant of the water in the eye (0.359/min). Deuterium MR imaging is useful to visualize the dynamic change of water in rat eyes using 2H MR at the same magnetic field (2 T) that can also be used for conventional MR imaging in humans.

Age-related decline of cerebral oxygen metabolism in normal population detected with positron emission tomography

Using positron emission tomography (PET), cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were measured in 32 healthy volunteers aged from 27 to 67 years. In bilateral putamen, left supratemporal, left infrafrontal and left parietal cortices, CMRO2 showed a significant decline during aging. The age-related decline of CBF was seen only at the left superior temporal cortex. The mean CMRO2 was significantly lower in the elder group (over 51 years old) than in the younger group (under 50 years old), whereas no significant difference in mean CBF between the two groups. The poor correlation of CBF to the age could be explained partly by the fact that CBF is easily influenced by the physiological, psychological and/or environmental factors. The age-related changes of CMRO2 were more marked in the association cortices of the left hemisphere than in that of the right hemisphere.

Dynamic 3D-CT angiography

BACKGROUND AND PURPOSE

3D-CT angiography (3D-CTA), a vessel-cast technique, is useful in the diagnosis of patients with brain lesions and cerebrovascular disease. However, it provides no information on blood-flow dynamics. Therefore, we developed a new technique, dynamic 3D-CTA (d3D-CTA), that yields 3D images of the vasculature and allows assessment of the hemodynamics and of the cerebral perfusion.

METHODS

We subjected 12 patients to d3D-CTA; 7 had brain tumors, 4 had arteriovenous malformations (AVMs), and 1 presented with cervical internal carotid artery occlusion. d3D-CTA was performed with a multidetector-row CT scanner with 64 detectors; the parameters were 0.5-mm section thickness, 0.5 seconds per rotation, 135 kV, and 150 mA. Contrast medium (total volume, 30-35 mL) was injected at 6-7 mL/s; scanning was started after a 5-second delay. Scans were generated with volume-rendering reconstruction and displayed in cine mode.

RESULTS

We succeeded in obtaining d3D-CTA scans in all cases. The scans yielded 3D information on the vascular structures and hemodynamics and on the status of the cerebral perfusion.

CONCLUSION

d3D-CTA facilitates the acquisition of information on the vascular and cerebral dynamic blood flow on 3D-CTA images. Despite the relatively high radiation exposure and contrast injection speed and its limited scan range, this technique is useful for the diagnosis of patients with brain tumors or cerebrovascular disease and for treatment planning.

Sentinel node biopsy with technetium-99m colloidal rhenium sulphide in patients with breast cancer

Background

Sentinel node biopsy is emerging as a technique to replace routine axillary lymph node dissection. The lymphatic mapping technique is still at a developmental stage and no standard technique exists. This study used technetium-99m colloidal rhenium sulphide with a mean particle size of 100 (range 50–200) nm for sentinel node mapping.

Methods

Eighty-seven patients with breast cancer, but no clinical evidence of axillary metastasis, were studied. One day before operation technetium-99m colloidal rhenium sulphide was injected at four points into breast tissue surrounding the tumour. Lymphoscintigraphy was performed 2 h after injection, and surgery was usually performed after 20 h. A hand-held γ probe guided sentinel node biopsy.

Results

Lymphoscintigraphy revealed axillary hot spots in all patients. During operation, the sentinel node was identified in all 87 patients (100 per cent). The number of sentinel nodes per patient ranged from 1 to 5 (mean 2). Metastatic sentinel nodes were identified in 37 of 87 patients. There were no false negatives.

Conclusion

This study suggests that technetium-99m rhenium sulphide is a suitable agent for sentinel node mapping in patients with breast cancer.

[Support system for cancer patients in the north area of Fukushima]

The purpose of this study was to elucidate the support system for cancer patients in the north area of Fukushima. The support system includes 3 general hospitals, 2 clinics with home-care hospice, 4 self-help groups, 5 volunteer groups, 3 doctors and nurses from special interest groups and 7 home-care medical services. We displayed this system on Internet (http://www.fmu.ac.jp/home/kanwa).

New plasma-reduced synthetic media, Fukushima cocktails, for the storage of platelets for transfusion

BACKGROUND

Donor plasma proteins are associated with non-hemolytic allergic reactions, such as urticaria or laryngeal edema, in platelet-transfusion recipients. Replacement of plasma with synthetic media from platelet concentrates (PCs) is considered to be effective in preventing such reactions. However, platelets preserved in media depleted of less than 10% plasma are reported to have functions inferior to those preserved in plasma.

METHODS

Fukushima Cocktails (FCs) contain glycerol (25, 50 or 100mM), sodium acetate, glucose and other components. To test the effect and determine the most suitable concentration of glycerol for platelet preservation, functions of platelets including aggregation, hypotonic shock response and swirling pattern and released biochemicals were measured with platelets preserved in Fukushima Cocktails. The effects of residual plasma on platelet functions were also evaluated. Autologous platelets stored for 3 days in solution containing 50 mM glycerol were transfused into healthy volunteer donors to evaluate their safety and survival.

RESULTS

The functions (aggregation and hypotonic shock response) of platelets preserved in Fukushima Cocktails with 10% residual plasma were preserved for 5-7 days as well as plasma controls, whereas platelets stored for 9 days in a medium lacking glycerol became swollen and beta-thromboglobulin and thromboxane B(2) increased. When the residual plasma was more than 5%, platelet functions including aggregation, hypotonic shock response and swirling pattern were well preserved for 7 days. The in vivo platelet survival rates at 24 and 48 h after transfusion of platelets stored for 3 days in Fukushima Cocktail were 77% and 60%, respectively, which were not less than autologous plasma-stored platelets.

CONCLUSION

Glycerol at a concentration of around 50 mM has a beneficial effect on platelet preservation for more than 7 days. The results of these experiments indicate that platelets stored in Fukushima Cocktail should be useful clinically.

[Endoscopic pointing device for virtual bronchoscopy]

Virtual bronchoscopy is useful for understanding the morphology of tracheobronchial space. Because it is difficult to operate the system, we developed a new pointing device simulating the grip of a flexible bronchofiberscope. With this device, it was possible to simulate the handling of a bronchofiberscope (in or out, clockwise or counterclockwise rotation, arbitrary angle of view). We conclude this type of pointing device could prove to be a useful tool in endoscopic simulation.

[Measurement of cerebral blood flow using phase-contrast MRI]

The development of phase-contrast magnetic resonance imaging(P-C MRI) provides a noninvasive method for measurement of volumetric blood flow(VFR). The VFR of the left and right internal carotid arteries and basilar artery were measured using P-C MRI, and total cerebral blood flow(tCBF) was calculated by summing up the VFR values in three vessels. We investigated the changes in these blood flows as influenced from age, head size, height, weight, body surface area and handedness. Moreover, regional CBF(rCBF) was measured by combining with the single photon emission computed tomography(SPECT) of 123I. The blood flows were 142 +/- 58 mL/ min(mean +/- SD) in the basilar artery, 229 +/- 86 mL/min in the left, 223 +/- 58 mL/min in the right internal carotid artery, and tCBF was 617 +/- 128 mL/min(Ref. Magn Resn Imaging 14:P. 1143, 1996). Significant increases were observed in head-size-related change of VFR in the basilar artery and height-related change of tCBF. The value of rCBF was easily acquired in combination with SPECT. Phase-contrast MRI is useful for a noninvasive and rapid analysis of cerebral VFR and has potential for clinical use.

[Metabolic imaging of human brain tumors: H-1 chemical shift imaging and PET]

Positron Emission Tomography(PET) and Proton Chemical Shift Imaging(1H-CSI) has provided a cerebral metabolism. The glucose analog fluorine-18 fluorodeoxy-glucose(FDG) and amino acid analog 11C-L-methionine is the most commonly used PET tumor tracer. This time we compare with 1H-CSI and PET in gliomas and metastatic brain tumor with computer-assisted fusion images. We experienced some cases of the brain tumor. One case is metastatic brain tumor after radiation therapy, localized in right parietal hemisphere, with hemorrhage, and slightly accumulated Gd-DTPA in tumors. 11C-methionine PET demonstrates defects in tumors, but slight accumulated surrounding tumors. Accumulation of PET lesion is not elevated choline in CSI, but lactate is accumulated in tumors. Choline signal elevation seen in brain neoprasms, associated with increased cellular proliferation. Accumulation of PET and another accumulation of lactate in tumor are not demonstrate recurrence. Fusion image of PET and CSI is useful in understanding metabolism of brain tumor.

[Effectiveness of the radioactive strontium (89Sr) chloride agent, SMS.2P for pain palliation in patients with metastatic bone tumor in phase III multicenter clinical trial]

The phase III clinical trial of strontium-89 chloride agent (SMS.2P) was performed in 90 patients with painful bone metastases secondary to prostate (53), breast (18) and other types of cancer (19). Some patients experienced a transient increase in pain or nausea and vomiting. However both symptoms subsided and serious side effects were not observed in any of the patients. As reported, we confirmed some abnormal changes in peripheral blood picture. A decrease in the number of white blood cells and platelets was considered to be partly a result of bone marrow suppression due to 89Sr irradiation. Pain was substantially improved after 89Sr therapy in 58% of the patients and there was some alleviation in 12%. The release from pain was accompanied by an improved quality of life for these patients including sleep patterns and morbidity. Some patients were able to resume their former life styles. Most of the improved patients experienced pain relief from days to one week following 89Sr therapy and in half cases, this remained effective for 2 or 3 months. There were even cases in which the pain relief continued over an observation period of time of clinical study.

Cerebral oxygen and glucose metabolism and blood flow in mitochondrial encephalomyopathy: a PET study

Cerebral blood flow (CBF), oxygen metabolism (CMRO2), and glucose metabolism (CMRGlc) were measured using positron emission tomography in five patients diagnosed as having mitochondrial encephalomyopathy. The molar ratio between the oxygen and glucose consumptions was reduced diffusely, as CMRO2 was markedly decreased and CMRGlc was slightly reduced. The CBF showed less changes. The CBF increase on hypercapnia was smaller than normal, though this was not significant. CBF with hypocapnia demonstrated a significant reduction compared with the normal. These results suggest that oxidative metabolism is impaired and anaerobic glycolysis relatively stimulated, due to a primary defect of mitochondrial function, and that mild lactic acidosis occurs in brain tissue because of impaired utilisation of pyruvate in the TCA cycle. As these findings appear to indicate directly a characteristic of this disease, such measurements may be a useful tool for assessment of the pathophysiology and for diagnosis of mitochondrial encephalomyopathy.

Three-vessel study of cerebral blood flow using phase-contrast magnetic resonance imaging: effect of physical characteristics

The development of phase-contrast magnetic resonance imaging (P-C MRI) provides a noninvasive method for measurement of volumetric blood flow (VFR). We performed P-C MRI to study the effects of physical characteristics on cerebral blood flow. VFR of the left and right internal carotid arteries and basilar artery were measured using P-C MRI and total cerebral blood flow (tCBF) was calculated by summing up the VFR values in the three vessels. Moreover, we investigated the changes in these blood flows as influenced by age, head size, height, weight, body surface area, and handedness. The blood flows were 142 +/- 58 ml/min (mean +/- standard deviation) in the basilar artery; and 229 +/- 86 ml/min in the left, and 223 +/- 58 ml/min in the right internal carotid artery; and tCBF was 617 +/- 128 ml/min. Significant increases were observed in head size-related change of VFR in the basilar artery (p = .028) and height-related change of tCBF (p = .045). The other characteristics did not significantly influence any VFR. The results suggest that head size and height may reflect CBF, and that these effects should be considered when changes of CBF are diagnosed. Phase-contrast MRI is useful for a noninvasive and rapid analysis of cerebral VFR and has potential for clinical use.

Deuterium MR in vivo imaging of the rat eye using 2H2O

In vivo deuterium MR imaging (2H MR) was investigated in rats after intraperitoneal administration of deuterated saline, and a dynamic study of the water movement in rat eyes was performed. Deuterium MR imaging was carried out by means of a gradient-echo (GRE) and a spin-echo (SE) pulse sequence. The rat eye was imaged in 2H MR more selectively by SE than by GRE, but a lower signal-to-noise ratio was obtained in 2H MR imaging using the SE sequence. The MR signal intensity of the rat eye was followed by a 3-compartment model, which enabled determination of the flow rate constant of the water in the eye (0.359/min). Deuterium MR imaging is useful to visualize the dynamic change of water in rat eyes using 2H MR at the same magnetic field (2 T) that can also be used for conventional MR imaging in humans.

Discrepant 99mTc-ECD images of CBF in patients with subacute cerebral infarction: a comparison of CBF, CMRO2 and 99mTc-HMPAO imaging

Three patients with subacute ischemic cerebral infarction examined by SPECT with 99mTc-ECD and PET within the same day showed signs of luxury perfusion in the subacute phase, which is between 9 to 20 days after the onset. A 99mTc-HMPAO SPECT study was also performed within 2 days of the ECD-SPECT study. ECD-SPECT images of three patients displayed a focal decreased uptake in the infarcted lesions, while in infarcted foci, there was almost equivalent or increased CBF compared to normal and unaffected areas, decreased CMRO2, and high HMPAO uptake. The ECD-SPECT results were similar to those of CMRO2 rather than CBF, though the HMPAO-SPECT image was similar to that of CBF. In one patient, HMPAO images revealed hyperfixation of the tracer. In the chronic phase and in the acute phase before 5 days after the onset, there were no discrepancies among the ECD-SPECT, CBF, HMPAO-SPECT, and CMRO2 images. These observations indicated that 99mTc-ECD is a good indicator of damaged brain tissues in subacute ischemic infarction. They also suggested that 99mTc-ECD is a potential agent with which to evaluate cerebral tissue viability in some pathological states of cerebrovascular disease. The characteristics may be suitable for confirming the effects of thrombolytic therapy in acute ischemia, because these conditions often show signs of luxury perfusion when the therapy is successful.

Hypersensitivity of cortical muscarinic receptors in Parkinson's disease demonstrated by PET

The status of muscarinic receptors (mAChRs) is not clear in Parkinson's disease (PD). We measured mAChR binding in the brain of eight patients with PD and eight, age-matched, healthy controls by positron emission tomography (PET) and [11C]N-methyl-4-piperidyl benzilate ([11C]NMPB). PD patients were not demented according to DSM III criteria but showed significant frontal lobe dysfunction in the Modified Wisconsin Card Sorting Test. A mean K3 value, which is an index of mAChR binding calculated by a graphical method, was 20% higher in the frontal cortex of PD patients than controls (p < 0.05). Hypersensitivity of mAChRs in the frontal cortex of PD patients may be a response to a loss of ascending cholinergic input to that region, and may relate to frontal lobe dysfunction in PD.

Serial water changes in human skeletal muscles on exercise studied with proton magnetic resonance spectroscopy and imaging

In vivo 1H-magnetic resonance imaging (MRI) enabled us to study the distribution of water in living tissues and to document changes in human skeletal muscles during physical exercise. The purpose of the present study was to determine the total muscle water changes after exercise using water in 1H-MR spectroscopy and to compare these changes to the signal intensity change on T2*-weighted images and/or to the T2 value change. Seven young male volunteers were positioned in a 1.5 T Philips MR imaging system. They were then asked to dorsiflex their ankle joint against a 2 kg weight once every 2 seconds for 2 minutes. The peak height of water declined according to the clearance curve after exercise in all seven cases with the 1H-MRS similar to the signal intensity. The increasing rate at peak height of total muscle water exceeded both the signal intensity and the T2 value because the water peak height on the 1H-MRS included the extracellular water. In addition, we measured the changes in signal intensity in both calf muscles after walking race exercise. The time intensity curves were used to draw a clearance curve for each muscle group after exercise. It was possible to discern which muscle was used most from the T2*-weighted image that was obtained once after exercise.

[Circulation time determined by carotid angiography in patients with chronic internal carotid artery occlusion: comparison with cerebral blood flow and oxygen metabolism measured by PET]

The degree of collateral circulation in patients with unilaterally chronic internal carotid artery occlusion was estimated by mean transit time of contrast material in rapid sequence carotid angiography (Angiographic MTT), and compared with cerebral blood flow and oxygen metabolism measured by PET. In normal density region on X-ray CT, a significant negative correlation was observed between Angiographic MTT and cerebral blood flow (CBF). This indicates that cerebral blood flow can be estimated by Angiographic MTT. It has been reported that the ratio of cerebral blood volume (CBV) to CBF (CBV/CBF), i.e., mean transit time determined by PET well agreed with OEF, and is good indicator for brain circulation reserve. In this study, no significant correlation was observed between Angiographic MTT and CBV/CBF. However, a significant positive correlation was observed between Angiographic MTT and oxygen extraction fraction (OEF), and no significant correlation was observed between Angiographic MTT and oxygen consumption rate (CMRO2). These indicates that Angiographic MTT may be indicator for brain circulation reserve.

Perfusion and metabolism in predicting the survival of patients with cerebral gliomas

BACKGROUND

Noninvasive measurements of cerebral circulation and metabolism may be useful for diagnosis in patients with brain tumors. The authors tested the prognostic significance of circulatory and metabolic values or ratios determined by positron emission tomography (PET) in patients with gliomas.

METHODS

The subjects were 23 patients, who underwent a complete PET study of cerebral circulation and metabolism with long-term follow-up of at least 57 months. Regional cerebral blood flow (rCBF), blood volume (rCBV), oxygen extraction fraction, and the metabolic rates of oxygen (rCMRO2) and glucose (rCMRGl) were measured before treatment. Data regarding tumors, the contralateral gray matter and white matter, and the ratio between tumor and gray matter or between tumor and white matter were compared with survival time from the time of the PET study. Prognostic factors were tested using Cox's regression analysis.

RESULTS

Among clinical parameters, histologic grade and performance status were important variables regulating survival. When survival times of patients with values or ratios equal to or higher than the median were compared to those of patients with values or ratios lower than the median, significant determinant PET measurements were tumor rCMRGl and the ratios of tumor:gray rCMRGl and tumor:white rCMRGl. Median survival time in the patients with an rCMRGl value of 4.4 mg/100ml/minute (median value) or more indicated 9 months, which was significantly shorter than greater than 113 months in the patients with a value lower than the median (P = 0.003 by the generalized Wilcoxon test). Patients with a higher value of gray rCBF, rCBV, or rCMRO2 had significantly longer survival times than those with a lower value.

CONCLUSIONS

Cerebral circulation and metabolism as determined by PET can be of ancillary significance in predicting the prognosis of patients with gliomas.

Cerebral uptake of 99mTc-bicisate in patients with cerebrovascular disease in comparison with CBF and CMRO2 measured by positron emission tomography

The regional brain uptake of 99mTc-N,N'-(1,2-ethylenediyl)bis-L-cysteine diethyl ester (99mTc-bicisate) measured by single photon emission computed tomography (SPECT) was compared with the regional CBF and CMRO2 measured by positron emission tomography in patients with cerebrovascular disease. Nine patients with the diagnosis of cerebral ischemic disorders (n = 7) or cerebral hemorrhage (n = 2) were studied. 99mTc-Bicisate brain uptake correlated with CBF and CMRO2. However, 99mTc-bicisate uptake did not reflect CBF in the single lesion showing luxury perfusion, which seemed to resemble a CMRO2 image. Though quantitative analysis showed the nonlinear correspondence of 99mTc-bicisate brain uptake with CBF and CMRO2, this correspondence could be corrected into a more linear relationship using a correction factor. 99mTc-Bicisate washout from the brain had no correlation to CBF and CMRO2. This diffuse decreasing washout rate was approximately 15% during the first hour after injection. By using the lipophilic fraction of arterial blood and a linearized correction of 99mTc-bicisate SPECT images, the feasibility of obtaining a factor-related CBF and CMRO2 was suggested from our data. These results suggested that 99mTc-bicisate had good characteristics for routine clinical use with SPECT to display the brain function in patients with neurological disorders.

Effects of fasudil hydrochloride on cerebral blood flow in patients with chronic cerebral infarction

To evaluate the effect of the novel intracellular calcium antagonist fasudil hydrochloride, cerebral blood flow (CBF) was measured quantitatively with positron emission tomography following the intravenous administration of fasudil in five patients with chronic cerebral infarction. The hemispheric mean CBF increased significantly on both hemispheres 30, 60, and 90 min after the administration of fasudil when the CBF values were corrected according to PaCO2 level, although there was no significant change in raw CBF data. A significant increase of CBF was seen in the cerebellar hemisphere and thalamus at 30 min and in the occipital cortex at 90 min. There was no significant fall in the systemic blood pressure after the administration of fasudil.

Increased blood flow in human brain tumor after administration of angiotensin II: demonstration by PET

To evaluate the changes of regional cerebral blood flow (CBF) in artificial hypertensive state, we investigated vascular responses to changes of arterial carbon dioxide tension (PCO2) and blood pressure by means of positron emission tomography (PET). The subjects were eight brain tumors which were histologically proven. We calculated CBF changes in hypercapnic and hypocapnic state, and then using those results, CBF changes in hypertensive state were corrected. Every patient represented a selective increase of tumor blood flow in hypertensive state induced by angiotensin II, demonstrating a loss of autoregulation in tumor. Our results suggested the possibility of enhancement of chemotherapy for brain tumors.

[A new headholder for positron emission tomography]

We developed a new headholder for the fixation and repositioning of patient head in PET study. The device consists of acryl frame and headrest of thermoplastic resin. Special gel is placed on the headrest to adapt different shape of occipit a in each patient. Individual face mask was made with thermoplastic resin just before the PET study and was fixed with the holder using plastic taper. It took about 2-3 min to fix the patient head using these system. Immobilization of the patient's head during PET study was good. Accuracy of repositioning in the same patient was relatively good between separate PET studies.

Evaluation of critically perfused area in acute ischemic stroke for therapeutic reperfusion: a clinical PET study

To evaluate critically perfused areas in the acute ischemic brain, 9 patients were studied by positron emission tomography (PET) within 7-32 hours after the onset. The cerebral blood flow (CBF) and oxygen metabolic rate (CMRO2) were evaluated and compared with sequential change in CT findings. In all the regions developing subsequent necrosis on CT, CBF dropped below 17 ml/100 g/min. But in some of these lesions, CMRO2 remained above the minimum value for regions in which infarction did not develop, and the tissue density on CT obviously remained normal for several hours after PET scan. The mean CBF in these lesions (14.0 ml/100 g/min, range: 9.9-17.3 ml/100 g/min) was significantly higher than that in ischemic areas with low density on CT before or just after PET study (approximately 10 ml/100 g/min, range: 7.7-14.1 ml/100 g/min). These findings suggest that a part of the tissue with CBF between 10-17 ml/100 g/min is still viable at least 7 hours after the onset of ischemia, but becomes non-viable in a longer period of ischemia. These lesions should respond to effective treatment, including therapeutic reperfusion.

Case report: radiation-induced vasculopathy implicated by depressed blood flow and metabolism in a pineal glioma

A case of radiation-induced vasculopathy of a pineal glioma was presented with haemodynamic and metabolic changes before and after radiotherapy. After radiation of 60 Gy with conventional fractionation (1.8-2.0 Gy daily, 5 days per week), regional blood flow, oxygen extraction fraction, metabolic rate of oxygen, kinetic metabolic rate of glucose and the rate constants (K2, K3) were markedly depressed (20% or greater) compared with the pre-irradiated study. 7 months after radiotherapy, the patient developed transient transient episodes of both right and left upper limb convulsion, terminating in generalized convulsion. When she developed status epilepticus, computed tomography showed extensive low density areas in the territory supplied by the right middle cerebral and the right posterior cerebral arteries. Cerebral angiography revealed diffuse stenosis at both carotid bifurcations and at the origins of the right posterior communicating and posterior cerebral arteries. Haemodynamic and metabolic depression therefore implicated radiation-induced vasculopathy in the present case.

Recurrent oligodendroglioma diagnosed with 11C-L-methionine and PET: a case report

A benign oligodendroglioma was removed in a young patient who had temporal epileptic seizures. He then became free of any fit until 15 months after the operation, when he developed seizures progressively less controlled by therapy. All investigations were normal (including CT scan and MRI) except a PET study which showed a high uptake of 11C-L-methionine in the area of the previous tumor. The second operation revealed that this area was indeed a tumor recurrence. We briefly discuss the potential usefulness of PET for the follow-up of low grade gliomas.

Cerebral glioma: evaluation with methionine PET

The authors examined 50 patients with cerebral glioma with use of positron emission tomography (PET) and L-[methyl]-[11C]methionine to assess the grade of malignancy and the extent of cerebral glioma. Carbon-11 methionine was highly accumulated in the lesion in 31 of 32 patients with high-grade glioma and 11 of 18 patients with low-grade glioma. The rate of uptake of C-11 methionine in high-grade glioma was significantly higher than in low-grade glioma (P < .001). However, in individual cases it was difficult to evaluate the grade of malignancy only from the degree of C-11 methionine accumulation. In most cases, the area of increased accumulation of C-11 methionine did not correspond to the abnormalities seen at computed tomography (CT). Surgical intervention confirmed that methionine PET delineated the extent of cerebral glioma more clearly than did CT. The authors concluded that methionine PET has greater utility in assessing the extent rather than the grade of malignancy of cerebral glioma.

High-energy phosphate metabolism of the myocardium in normal subjects and patients with various cardiomyopathies--the study using ECG gated MR spectroscopy with a localization technique

Nuclear magnetic resonance spectroscopy (MRS) is a new technique for the evaluation of myocardial metabolism. Recently, localized MRS has been clinically available to measure by a non-invasive method the relative concentrations of the high-energy phosphate metabolites in the myocardium. We performed ECG gated P-31 MRS using ISIS (image-selected in vivo spectroscopy) in 15 normal volunteers, 12 patients with hypertrophic cardiomyopathy, 12 with left ventricular hypertrophy, 6 with dilated cardiomyopathy and 11 with specific heart muscle disease. Myocardial peak height ratios of PCr/gamma-ATP, Pi/gamma-ATP and PCr/Pi were measured. Myocardial P-31 MRS demonstrated a significant decrease in the ratio PCr/ATP in patients with hypertrophic cardiomyopathy and specific heart muscle disease as compared with normal subjects, indicating myocardial metabolic disturbance in these patients. The ratio of PCr/ATP in patients with dilated cardiomyopathy did not differ significantly from that of normal subjects. However, exercise MRS revealed a marked decrease of PCr peak in an asymptomatic patient with dilated cardiomyopathy, which may indicate a latent metabolic disturbance in the myocardium of dilated cardiomyopathy.

Uncoupling between CBF and oxygen metabolism in a patient with chronic subdural haematoma: case report

The regional cerebral blood flow (rCBF) and oxygen metabolism of a patient with a chronic subdural haematoma were examined quantitatively, using positron emission tomography (PET). Before operation, the rCBF was decreased slightly throughout the brain, whereas the regional oxygen extraction fraction (rOEF) was increased throughout the brain, with values ranging from 0.36 to 0.60. One month after operation, the rCBF had recovered remarkably in almost all regions and rOEF had decreased to within the normal range.

STA-MCA bypass surgery for internal carotid artery occlusion--comparative follow-up study

Sixty-three patients with internal carotid artery occlusion manifesting as transient ischemic attack or minor stroke received superficial temporal artery-middle cerebral artery bypass surgery and medical treatment (n = 27) or medical treatment only (n = 36). Long-term follow-up showed that there was no significant difference in the outcomes. However, positron emission tomography studies suggested that patients with misery perfusion in the chronic stage benefited from extracranial-intracranial bypass surgery.

Intracranial plasma cell granuloma evaluated by positron emission tomography

A 50-year-old farmer with plasma cell granuloma had PET scans showing marked accumulation of C-11 Met. The PET had superiority in imaging the existence and extent of the lesion and monitored therapeutic response as compared with CT and MR imaging. PET yields information on hemocirculatory and metabolic aspects of this rare disease.

[Arterial clearance and cerebral uptake of Tc-99m ECD in patients with cerebrovascular disease compared with PET]

Technetium-99m ethyl cysteinate dimer (ECD) has recently developed for SPECT imaging in assessment of cerebral perfusion. We evaluated the arterial blood clearance and the regional brain uptake of Tc-99m ECD compared with the regional CBF measured by PET in patients with cerebrovascular disease. Nine patients with diagnosis of cerebral ischemic disorders (N = 7) and cerebral hemorrhage (N = 2) were studied. PET study was performed with HEADTOME IV by O-15 steady state inhalation method. Immediately after the PET study, 555-740 MBq (5-20 mCi) of Tc-99m ECD was injected intravenously. After injection arterial blood sampling was performed sequentially, and we separated lipophilic fraction from whole blood using ethyl acetate in two cases. The SPECT imaging with Tc-99m ECD (ECD-SPECT) was started 5 min (first imaging) and 60 min (second imaging) after the administration using a high resolution ring type SPECT system (HEADTOME II). Several ROIs were placed on practically the same anatomical location on both SPECT and PET images. Clearance of the tracer in arterial whole blood and lipophilic fraction was rapid. Concerning to the distribution pattern of ECD-SPECT images there was no differences between the 1st imaging and the 2nd imaging, although about 15% of diffuse decrease of Tc-99m ECD uptake was shown in the 2nd images. The brain distribution of ECD-SPECT was comparable to the pattern of CBF image by PET. The regional relative counts of ECD-SPECT corresponded closely to the CBF value by PET, but it was no linear correlation between brain uptake of ECD-SPECT and PET-CBF.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of radiotherapy determined by 11C-methyl-L-methionine positron emission tomography in patients with primary cerebral malignant lymphoma

Two cases of histologically proven primary cerebral malignant lymphoma were examined serially with positron emission tomography (PET) using 11C-methyl-L-methionine (11C Met). Lesions delineated by 11C Met accumulation extended beyond enhancing areas on either X-ray computed tomography (CT) or magnetic resonance imaging. High uptake of 11C Met accurately showed biologically active and residual tumours, at a time when disappearance of a contrast-enhancing lesion on CT seemed to indicate involution. PET provides valuable information on the extent of tumour and assessment of radiotherapy in malignant lymphoma.

Dynamic human glycogen and glucose metabolism detection utilizing in vivo 13C NMR

The dynamic detection studies of glucose-glycogen metabolism of the human liver were performed with normal volunteers. A single tuned surface coil of 20-cm diameter was used for 13C (at 16.04 MHz). Natural glucose 100 g was administered for the natural abundance 13C MR dynamic study and 13C enriched (99%) 1-13C-D-glucose 1 g mixed 75 g glucose was administered to study the 13C enrichment effect. The total scan time of this dynamic study was 1 hr and each single scan time was 20 min. We did not use proton decoupling for the human 13C MR study. Localized (PRIME) proton shimming was performed and the shim value was less than 20 Hz. Glucose and glycogen spectra were clearly visible at 120 to 80 ppm and about 3 hr later both peaks almost disappeared. These data demonstrate that dynamic hepatic glucose-glycogen metabolism should be possible to detect which should allow for the direct diagnosis of hepatic glucose-glycogen metabolic disorders.

[Magnetic resonance imaging of aneurysmal subarachnoid hemorrhage]

Magnetic resonance imaging of subarachnoid hemorrhage (SAH) due to aneurysm rupture was evaluated in relation to CT findings in nine patients. Six patients were studied within 3 days and the other three patients were studied 4 to 6 days from the ictus of SAH using a 0.5 Tesla superconducting unit. In all of the patients, hematoma in the subarachnoid space and ventricles was demonstrated by the proton density-weighted spin echo sequence, which showed that bloody cerebrospinal fluid (CSF) had a higher signal intensity than brain tissue or normal CSF. Magnetic resonance imaging was more sensitive in detecting SAH and more informative as to the site of the ruptured aneurysm than CT. Despite some limitations in applying it to patients with acute SAH, magnetic resonance imaging has clear advantages in the diagnosis of SAH.

[The quantitative evaluation of myocardial blood flow and myocardial FDG uptake in the infarcted lesions with Q-wave and without Q-wave determined by O-15 water, FDG and PET]

Cardiac PET elicits an accurate relationship between myocardial blood flow (MBF) and tissue viability, which is evaluated by myocardial FDG uptake (MFU). To differentiate reversible tissue from necrotic tissue after the ischemic event, we from necrotic tissue after the ischemic event, we measured absolute MBF and MFU in patients with myocardial infarction. The MBF obtained by O-15 water and dynamic PET was accurately corrected by employing a tissue fraction (a) for the partial volume effect, including wall-motion effect. MFU was also corrected by using the tissue fraction. The subjects consisted of 5 patients with non-Q-wave infarction and 7 patients with Q-wave infarction. The regions of interest were selected from the infarcted area, each corresponding to regions with Q-wave or non-Q-wave. The MBFs in regions with Q wave (0.36 +/- 0.14 ml/min/g) were lower than those without Q wave (0.74 +/- 0.29 ml/min/g) (p less than 0.005). MFUs in regions without Q-wave (0.061 +/- 0.028) were higher than those with Q-wave (0.038 +/- 0.017) (p less than 0.05). The highest threshold of MBF in regions where Q-wave was detected was 0.55 ml/min/g. It is concluded that we will able to find the threshold of electrophysiological dysfunction in the infarcted region with this method.

Comparison of the clinical results of STA-MCA anastomosis and the medical treatment in the cerebral low perfusion patients with viable brain tissue

The long-term clinical results of STA-MCA anastomosis as well as the medical treatments were compared in cases that were confined as having a focal cerebral perfusion deficit with viable brain tissue, based on either the drug induced EEG and evoked potential test (DEE test) and/or by positron emission tomography (PET). The criteria for viable cerebral tissue was determined by the following four conditions: (1) functional reversibility could be confirmed by the DEE test; (2) a haemodynamic process could be found in the DEE test; (3) a haemodynamic compromise could be confirmed in the PET study; (4) misery perfusion could be confirmed in the PET study. From 1975 to 1989, 55 cases were confirmed as having viable brain tissue according to the DEE test and the PET study. Of the 55 cases, bypass surgery was performed on 35. Conservative treatment was given to the other 20 cases. There were 3 cases of perioperative neurological deterioration. One was permanent and the other 2 were transient. Results of the long-term follow up are as follows, Ipsilateral attack: 1 case (2.0%) received surgery, and 7 cases (35%) received conservative treatment. Re-attack in the contralateral or posterior circulation: 6 cases (17.2%) received surgery, and 1 case (5%) received conservative treatment. Seventy-seven per cent of the surgical cases improved or had no change in the final functional status, while only 55% of the conservative group either improved or showed no change. The incidence of ipsilateral cerebral ischaemia was significantly low in the surgical group. Contralateral and/or posterior circulation ischaemia tended to be high in this group, however.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical value of PET with 18F-fluorodeoxyglucose and L-methyl-11C-methionine for diagnosis of recurrent brain tumor and radiation injury

We studied 15 patients clinically suspected to have recurrent brain tumor or radiation injury, using positron emission tomography (PET) with 18F-fluorodeoxyglucose (18FDG) and L-methyl-11C-methionine (11C-Met). PET with 11C-Met (Met-PET) clearly delineated the extent of recurrent brain tumor as focal areas of increased accumulation of 11C-Met, and was useful for early detection of recurrent brain tumor. PET with 18FDG (FDG-PET) showed focal 18FDG-hypermetabolism in one patient with malignant transformation of low grade glioma, and demonstrated its usefulness for evaluation of malignant transformation. 18FDG-hypometabolism was observed in all patients with radiation injury, but was also found in one patient with recurrent malignant brain tumor. 11C-Met uptake in 3 patients with radiation injury was similar to that of the normal cortical tissue. FDG-PET can be used to initially exclude recurrent brain tumor which is seen as 18FDG-hypermetabolism. The combined use of Met-PET in addition to FDG-PET can improve the accuracy of differentiation of recurrent brain tumor with 18FDG-hypometabolism from radiation injury.

Innovative approach in the diagnosis of gliomatosis cerebri using carbon-11-L-methionine positron emission tomography

A case of gliomatosis cerebri was studied with positron emission tomography (PET). Carbon-11-L-methionine (11C-Met) accumulated in the diffusely infiltrative tumorous area more widely and accurately than the lesion detected by conventional x-ray computerized tomography (CT) or magnetic resonance (MR) imaging. Autopsy findings three months after the time of the PET study showed good anatomical correspondence between the extent of densely aggregated tumor cells and the region with high uptake of 11C-Met. PET may offer an innovative approach in the delineation of gliomatosis cerebri, which has not been clearly recognized by CT or MR.

Demonstration of cerebral radiation injury with metabolic positron emission tomography images

A 2-year-old girl with medulloblastoma who had postoperative radiotherapy and intrathecal administration of methotrexate is reported. Five months after radiation and chemotherapy, she developed involuntary movement. Positron emission tomography (PET) demonstrated that the metabolic rate of glucose was depressed markedly in the temporal and occipital lobes, indicative of metabolic depression induced by radiation. Prompt initiation of steroid therapy ameliorated the patient's neurological symptoms. Follow-up PET revealed an increase in 18F-fluorodeoxyglucose uptake in the entire brain, including temporal and occipital lesions. No areas with high accumulation of (11C-methyl)-L-methionine were detectable. We concluded that PET may be useful in establishing an early diagnosis of radiation injury of the brain and in monitoring metabolic changes following radiation in brain tumor patients.

Analysis of bone scintigram data using a speech recognition reporting system

A total of 649 bone scintigram reports were stored using a voice pattern recognition system in a general-purpose medium-sized computer ACOS-650, and bone scintigraphy carried out in this institute was examined by analysing these data. The results showed that the introduction of the system made it possible to analyse all the data quickly, whereas previously the amount of information that could be analysed was restricted because of the complexity of the data. The results also showed that the system would be useful for understanding the examinations carried out in the whole hospital as well as for analysing metastatic tumours and the numbers of patients receiving examinations. Furthermore, it would be helpful in the logical analysis of reports prepared by doctors.