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Gandy K, Koscik TR, Alexander T, Steinberg JD, Krull KR, van der Plas E. Characterization of brain development with neuroimaging in a female mouse model of chemotherapy treatment of acute lymphoblastic leukemia. Transl Pediatr 2024; 13:408-416. [PMID: 38590373 PMCID: PMC10998997 DOI: 10.21037/tp-23-458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/31/2023] [Indexed: 04/10/2024] Open
Abstract
Background Survivors of pediatric acute lymphoblastic leukemia (ALL) exhibit abnormal neurocognitive outcomes that are possibly due to exposures to neurotoxic chemotherapy agents. This study aimed to determine the feasibility of characterizing long-term neuroanatomical changes with in vivo neuroimaging in a preclinical model of treatment for ALL. Methods Female mice (C57BL/6) were randomly assigned to a saline control group (n=10) or a treatment group (n=10) that received intrathecal methotrexate and oral dexamethasone (IT-MTX + DEX). Mice were subsequently scanned three times on a 7T MRI at ages 3, 6, and 12 months (T1, T2, and T3, respectively), which corresponds with human age-equivalents spanning early to late adulthood. Regional brain volumes were automatically segmented, and volume change between timepoints (i.e., T1 to T2; and T2 to T3) were compared between groups (i.e., saline vs. IT-MTX + DEX). Results Five mice in the IT-MTX + DEX group, and seven mice in the saline group completed all three scans. Between T1 and T2, volumetric change was significantly different between groups in total gray matter [estimate =2.06, 95% confidence interval (CI): 0.27-3.84], the cerebrum (estimate =1.62, 95% CI: 0.14-3.09), claustrum (estimate =0.06, 95% CI: 0.02-0.09), amygdala (estimate =0.16, 95% CI: 0.03-0.29), and striatum (estimate =0.18, 95% CI: 0.01-0.35), with the IT-MTX + DEX group exhibiting a more robust increase in volume than the saline-treated group. Between T2 and T3, group differences in structural brain development were evident for total white matter (estimate =-0.14, 95% CI: -0.27 to -0.01), and the corpus callosum (estimate =-0.09, 95% CI: -0.19 to 0.00) and amygdala (estimate =-0.05, 95% CI: -0.10 to 0.00). In contrast to the rapid brain growth observed earlier in development (i.e., T1 to T2), the IT-MTX + DEX group exhibited an attenuated increase in volume relative to the saline-treated group between T2 and T3. Conclusions The results demonstrate feasibility of modeling pediatric ALL treatment in a preclinical model and highlight the potential of using preclinical neuroimaging models to gain insight into brain development throughout survivorship.
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Affiliation(s)
- Kellen Gandy
- Psychology and Biobehavioral Sciences, St. Jude’s Children’s Research Hospital, Memphis, TN, USA
- Department of Humanities and Social Sciences, University of Houston-Downtown, Houston, TX, USA
| | - Timothy R. Koscik
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Neurology, Arkansas Children’s Hospital, Little Rock, AR, USA
| | - Tyler Alexander
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jeffrey D. Steinberg
- Center for In Vivo Imaging and Therapeutics, St. Jude’s Children’s Research Hospital, Memphis, TN, USA
| | - Kevin R. Krull
- Psychology and Biobehavioral Sciences, St. Jude’s Children’s Research Hospital, Memphis, TN, USA
| | - Ellen van der Plas
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Hematology/Oncology, Arkansas Children’s Hospital, Little Rock, AR, USA
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Jelvehgaran P, Steinberg JD, Khmelinskii A, Borst G, Song JY, de Wit N, de Bruin DM, van Herk M. Evaluation of acute esophageal radiation-induced damage using magnetic resonance imaging: a feasibility study in mice. Radiat Oncol 2019; 14:188. [PMID: 31666092 PMCID: PMC6822441 DOI: 10.1186/s13014-019-1396-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Thoracic and head and neck cancer radiation therapy (RT) can cause damage to nearby healthy organs such as the esophagus, causing acute radiation-induced esophageal damage (ARIED). A non-invasive method to detect and monitor ARIED can facilitate optimizing RT to avoid ARIED while improving local tumor control. Current clinical guidelines are limited to scoring the esophageal damage based on the symptoms of patients. Magnetic resonance imaging (MRI) is a non-invasive imaging modality that may potentially visualize radiation-induced organ damage. We investigated the feasibility of using T2-weighted MRI to detect and monitor ARIED using a two-phased study in mice. METHODS The first phase aimed to establish the optimal dose level at which ARIED is inducible and to determine the time points where ARIED is detectable. Twenty four mice received a single dose delivery of 20 and 40 Gy at proximal and distal spots of 10.0 mm (in diameter) on the esophagus. Mice underwent MRI and histopathology analysis with esophageal resection at two, three, and 4 weeks post-irradiation, or earlier in case mice had to be euthanized due to humane endpoints. In the second phase, 32 mice received a 40 Gy single dose and were studied at two, three, and 7 days post-irradiation. We detected ARIED as a change in signal intensity of the MRI images. We measured the width of the hyperintense area around the esophagus in all mice that underwent MRI prior to and after irradiation. We conducted a blind qualitative comparison between MRI findings and histopathology as the gold standard. RESULTS/CONCLUSIONS A dose of 40 Gy was needed to induce substantial ARIED. MRI detected ARIED as high signal intensity, visible from 2 days post-irradiation. Quantitative MRI analysis showed that the hyperintense area around the esophagus with severe ARIED was 1.41 mm wider than with no damage and MRI-only mice. The overall sensitivity and specificity were 56 and 43% respectively to detect any form of ARIED. However, in this study MRI correctly detected 100% of severe ARIED cases. Our two-phased preclinical study showed that MRI has the potential to detect ARIED as a change in signal intensity and width of enhancement around the esophagus.
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Affiliation(s)
- Pouya Jelvehgaran
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Physics and Astronomy, Institute for Laser Life and Biophotonics Amsterdam, Amsterdam, the Netherlands
| | - Jeffrey D. Steinberg
- Mouse Clinic for Cancer and Aging (MCCA) Imaging Unit, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Artem Khmelinskii
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Gerben Borst
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Ji-Ying Song
- Department of Experimental Animal Pathology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Niels de Wit
- Mouse Clinic for Cancer and Aging (MCCA) Imaging Unit, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Daniel M. de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel van Herk
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Manchester Cancer Research Centre, Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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Jelvehgaran P, de Bruin DM, Khmelinskii A, Borst G, Steinberg JD, Song J, de Vos J, van Leeuwen TG, Alderliesten T, de Boer JF, van Herk M. Optical coherence tomography to detect acute esophageal radiation-induced damage in mice: A validation study. J Biophotonics 2019; 12:e201800440. [PMID: 31058437 PMCID: PMC7065648 DOI: 10.1002/jbio.201800440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 05/19/2023]
Abstract
Radiation therapy for patients with non-small-cell lung cancer is hampered by acute radiation-induced toxicity in the esophagus. This study aims to validate that optical coherence tomography (OCT), a minimally invasive imaging technique with high resolution (~10 μm), is able to visualize and monitor acute radiation-induced esophageal damage (ARIED) in mice. We compare our findings with histopathology as the gold standard. Irradiated mice receive a single dose of 40 Gy at proximal and distal spots of the esophagus of 10.0 mm in diameter. We scan mice using OCT at two, three, and seven days post-irradiation. In OCT analysis, we define ARIED as a presence of distorted esophageal layering, change in backscattering signal properties, or change in the esophageal wall thickness. The average esophageal wall thickness is 0.53 mm larger on OCT when ARIED is present based on histopathology. The overall sensitivity and specificity of OCT to detect ARIED compared to histopathology are 94% and 47%, respectively. However, the overall sensitivity of OCT to assess ARIED is 100% seven days post-irradiation. We validate the capability of OCT to detect ARIED induced by high doses in mice. Nevertheless, clinical studies are required to assess the potential role of OCT to visualize ARIED in humans.
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Affiliation(s)
- Pouya Jelvehgaran
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Department of Radiation OncologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Department of Physics and AstronomyInstitute for Laser Life and Biophotonics AmsterdamAmsterdamthe Netherlands
| | - Daniel M. de Bruin
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Department of UrologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Artem Khmelinskii
- Department of Radiation OncologyThe Netherlands Cancer Institute (NKI)Amsterdamthe Netherlands
| | - Gerben Borst
- Department of Radiation OncologyThe Netherlands Cancer Institute (NKI)Amsterdamthe Netherlands
| | - Jeffrey D. Steinberg
- Mouse Clinic for Cancer and Aging (MCCA) Imaging UnitThe Netherlands Cancer InstituteAmsterdamthe Netherlands
| | - Ji‐Ying Song
- Department of Experimental Animal PathologyThe Netherlands Cancer Institute (NKI)Amsterdamthe Netherlands
| | - Judith de Vos
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Ton G. van Leeuwen
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Tanja Alderliesten
- Department of Radiation OncologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Johannes F. de Boer
- Department of Physics and AstronomyInstitute for Laser Life and Biophotonics AmsterdamAmsterdamthe Netherlands
| | - Marcel van Herk
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Manchester Cancer Research Centre, Division of Cancer Sciences, Faculty of Biology, Medicine, and HealthUniversity of Manchester, Manchester Academic Health Sciences CentreManchesterUK
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Steinberg JD, Vogel W, Vegt E. Factors influencing brown fat activation in FDG PET/CT: a retrospective analysis of 15,000+ cases. Br J Radiol 2017; 90:20170093. [PMID: 28590773 DOI: 10.1259/bjr.20170093] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Brown fat can exhibit high uptake of fluorine-18 fludeoxyglucose (18F-FDG) on positron emission tomography (PET) and interferes with interpretation of the scan. The goal of this study was to identify factors that may influence brown adipose tissue (BAT) activation. METHODS A retrospective study of 18F-FDG PET scans was performed using a database of 15,109 PET/CT reports. BAT activation reported by nuclear medicine physicians and factors influencing BAT activation were gathered. The data were analyzed using in-house software. RESULTS The total reported BAT activation was 3.6%. BAT activation was reported significantly more often in patients who were female (p < 0.0001), younger (p < 0.0001), with lower body mass index (p < 0.0001), with lower blood glucose levels (p = 0.01), indicated for breast cancer (p = 0.004), not administered chemotherapy recently before the scan (p < 0.0001) and shown to have BAT activation in a previous scan (p < 0.0001). BAT activation was also reported significantly more for lower outdoor temperatures (p < 0.0001) and for late morning scans than for afternoon (p = 0.005) and early morning (p = 0.001) scans. CONCLUSION This retrospective study of 15,109 scans highlights multiple factors contributing to BAT activation on 18F-FDG PET. The identification of new factors influencing BAT and confirmation of previously identified factors with a larger data set can be used to more accurately identify patients at risk for BAT activation so that prevention strategies can be implemented. Advances in knowledge: This study presents new factors associated with higher incidence of BAT activation, such as time of day, previous BAT activation and breast cancer. Conversely, recent chemotherapy was associated with reduced incidence of BAT activation.
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Affiliation(s)
- Jeffrey D Steinberg
- 1 Mouse Clinic for Cancer and Aging (MCCA) Imaging Unit, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wouter Vogel
- 2 Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Erik Vegt
- 2 Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands
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Smith GC, McEwen H, Steinberg JD, Shepherd PR. The activation of the Akt/PKB signalling pathway in the brains of clozapine-exposed rats is linked to hyperinsulinemia and not a direct drug effect. Psychopharmacology (Berl) 2014; 231:4553-60. [PMID: 24800899 DOI: 10.1007/s00213-014-3608-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/21/2014] [Indexed: 01/01/2023]
Abstract
The second generation antipsychotic drug clozapine is a much more effective therapy for schizophrenia than first generation compounds, but the reasons for this are poorly understood. We have previously shown that one distinguishing feature of clozapine is its ability to raise glucagon levels in animal models and thus causes prolonged hyperinsulinemia without inducing hypoglycaemia. Previous studies have provided evidence that defects in Akt/PKB and GSK3 signalling can contribute to development of psychiatric diseases. Clozapine is known to activate Akt/PKB in the brain, and some studies have indicated that this is due to a direct effect of the drug on the neurons. However, we provide strong evidence that elevated insulin levels induced by clozapine are in fact the real cause of the drug's effects on Akt/PKB and GSK3 in the brain. This suggests that the elevated levels of insulin induced by clozapine may contribute to this drug's therapeutic efficacy.
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Affiliation(s)
- G C Smith
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand,
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Steinberg JD, Raju A, Chandrasekharan P, Yang CT, Khoo K, Abastado JP, Robins EG, Townsend DW. Negative contrast Cerenkov luminescence imaging of blood vessels in a tumor mouse model using [68Ga]gallium chloride. EJNMMI Res 2014; 4:15. [PMID: 24606872 PMCID: PMC3974015 DOI: 10.1186/2191-219x-4-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/21/2014] [Indexed: 01/14/2023] Open
Abstract
Background Cerenkov luminescence imaging (CLI) is an emerging imaging technique where visible light emitted from injected beta-emitting radionuclides is detected with an optical imaging device. CLI research has mostly been focused on positive contrast imaging for ascertaining the distribution of the radiotracer in a way similar to other nuclear medicine techniques. Rather than using the conventional technique of measuring radiotracer distribution, we present a new approach of negative contrast imaging, where blood vessel attenuation of Cerenkov light emitted by [68Ga]GaCl3 is used to image vasculature. Methods BALB/c nude mice were injected subcutaneously in the right flank with HT-1080 fibrosarcoma cells 14 to 21 days prior to imaging. On the imaging day, [68Ga]GaCl3 was injected and the mice were imaged from 45 to 90 min after injection using an IVIS Spectrum in vivo imaging system. The mice were imaged one at a time, and manual focus was used to bring the skin into focus. The smallest view with pixel size around 83 μm was used to achieve a sufficiently high image resolution for blood vessel imaging. Results The blood vessels in the tumor were clearly visible, attenuating 7% to 18% of the light. Non-tumor side blood vessels had significantly reduced attenuation of 2% to 4%. The difference between the attenuation of light of tumor vessels (10% ± 4%) and the non-tumor vessels (3% ± 1%) was significant. Moreover, a necrotic core confirmed by histology was clearly visible in one of the tumors with a 21% reduction in radiance. Conclusions The negative contrast CLI technique is capable of imaging vasculature using [68Ga]GaCl3. Since blood vessels smaller than 50 μm in diameter could be imaged, CLI is able to image structures that conventional nuclear medicine techniques cannot. Thus, the negative contrast imaging technique shows the feasibility of using CLI to perform angiography on superficial blood vessels, demonstrating an advantage over conventional nuclear medicine techniques.
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Affiliation(s)
- Jeffrey D Steinberg
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore, Singapore.
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Affiliation(s)
- Justin Chakma
- From Thomas, McNerney & Partners, La Jolla, CA (J.C.); the Robert Wood Johnson Foundation Clinical Scholars Program (G.H.S., R.J.), the Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System (G.H.S.), the Center for Bioethics and Social Sciences in Medicine (R.J.), and the Departments of Otolaryngology-Head and Neck Surgery (G.H.S.) and Radiation Oncology (R.J.), University of Michigan Health System - all in Ann Arbor; the Singapore Bioimaging Consortium, Agency for Science, Technology, and Research, Singapore (J.D.S.); and the Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia (S.M.S.)
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Kao YH, Steinberg JD, Tay YS, Lim GK, Yan J, Townsend DW, Budgeon CA, Boucek JA, Francis RJ, Cheo TS, Burgmans MC, Irani FG, Lo RH, Tay KH, Tan BS, Chow PK, Satchithanantham S, Tan AE, Ng DC, Goh AS. Post-radioembolization yttrium-90 PET/CT - part 2: dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI Res 2013; 3:57. [PMID: 23885971 PMCID: PMC3733999 DOI: 10.1186/2191-219x-3-57] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/16/2013] [Indexed: 12/25/2022] Open
Abstract
Background Coincidence imaging of low-abundance yttrium-90 (90Y) internal pair production by positron emission tomography with integrated computed tomography (PET/CT) achieves high-resolution imaging of post-radioembolization microsphere biodistribution. Part 2 analyzes tumor and non-target tissue dose-response by 90Y PET quantification and evaluates the accuracy of tumor 99mTc macroaggregated albumin (MAA) single-photon emission computed tomography with integrated CT (SPECT/CT) predictive dosimetry. Methods Retrospective dose quantification of 90Y resin microspheres was performed on the same 23-patient data set in part 1. Phantom studies were performed to assure quantitative accuracy of our time-of-flight lutetium-yttrium-oxyorthosilicate system. Dose-responses were analyzed using 90Y dose-volume histograms (DVHs) by PET voxel dosimetry or mean absorbed doses by Medical Internal Radiation Dose macrodosimetry, correlated to follow-up imaging or clinical findings. Intended tumor mean doses by predictive dosimetry were compared to doses by 90Y PET. Results Phantom studies demonstrated near-perfect detector linearity and high tumor quantitative accuracy. For hepatocellular carcinomas, complete responses were generally achieved at D70 > 100 Gy (D70, minimum dose to 70% tumor volume), whereas incomplete responses were generally at D70 < 100 Gy; smaller tumors (<80 cm3) achieved D70 > 100 Gy more easily than larger tumors. There was complete response in a cholangiocarcinoma at D70 90 Gy and partial response in an adrenal gastrointestinal stromal tumor metastasis at D70 53 Gy. In two patients, a mean dose of 18 Gy to the stomach was asymptomatic, 49 Gy caused gastritis, 65 Gy caused ulceration, and 53 Gy caused duodenitis. In one patient, a bilateral kidney mean dose of 9 Gy (V20 8%) did not cause clinically relevant nephrotoxicity. Under near-ideal dosimetric conditions, there was excellent correlation between intended tumor mean doses by predictive dosimetry and those by 90Y PET, with a low median relative error of +3.8% (95% confidence interval, -1.2% to +13.2%). Conclusions Tumor and non-target tissue absorbed dose quantification by 90Y PET is accurate and yields radiobiologically meaningful dose-response information to guide adjuvant or mitigative action. Tumor 99mTc MAA SPECT/CT predictive dosimetry is feasible. 90Y DVHs may guide future techniques in predictive dosimetry.
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Affiliation(s)
- Yung-Hsiang Kao
- Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Kao YH, Steinberg JD, Tay YS, Lim GK, Yan J, Townsend DW, Takano A, Burgmans MC, Irani FG, Teo TK, Yeow TN, Gogna A, Lo RH, Tay KH, Tan BS, Chow PK, Satchithanantham S, Tan AE, Ng DC, Goh AS. Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting. EJNMMI Res 2013; 3:56. [PMID: 23883566 PMCID: PMC3726297 DOI: 10.1186/2191-219x-3-56] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/16/2013] [Indexed: 11/15/2022] Open
Abstract
Background Yttrium-90 (90Y) positron emission tomography with integrated computed tomography (PET/CT) represents a technological leap from 90Y bremsstrahlung single-photon emission computed tomography with integrated computed tomography (SPECT/CT) by coincidence imaging of low abundance internal pair production. Encouraged by favorable early experiences, we implemented post-radioembolization 90Y PET/CT as an adjunct to 90Y bremsstrahlung SPECT/CT in diagnostic reporting. Methods This is a retrospective review of all paired 90Y PET/CT and 90Y bremsstrahlung SPECT/CT scans over a 1-year period. We compared image resolution, ability to confirm technical success, detection of non-target activity, and providing conclusive information about 90Y activity within targeted tumor vascular thrombosis. 90Y resin microspheres were used. 90Y PET/CT was performed on a conventional time-of-flight lutetium-yttrium-oxyorthosilicate scanner with minor modifications to acquisition and reconstruction parameters. Specific findings on 90Y PET/CT were corroborated by 90Y bremsstrahlung SPECT/CT, 99mTc macroaggregated albumin SPECT/CT, follow-up diagnostic imaging or review of clinical records. Results Diagnostic reporting recommendations were developed from our collective experience across 44 paired scans. Emphasis on the continuity of care improved overall diagnostic accuracy and reporting confidence of the operator. With proper technique, the presence of background noise did not pose a problem for diagnostic reporting. A counter-intuitive but effective technique of detecting non-target activity is proposed, based on the pattern of activity and its relation to underlying anatomy, instead of its visual intensity. In a sub-analysis of 23 patients with a median follow-up of 5.4 months, 90Y PET/CT consistently outperformed 90Y bremsstrahlung SPECT/CT in all aspects of qualitative analysis, including assessment for non-target activity and tumor vascular thrombosis. Parts of viscera closely adjacent to the liver remain challenging for non-target activity detection, compounded by a tendency for mis-registration. Conclusions Adherence to proper diagnostic reporting technique and emphasis on continuity of care are vital to the clinical utility of post-radioembolization 90Y PET/CT. 90Y PET/CT is superior to 90Y bremsstrahlung SPECT/CT for the assessment of target and non-target activity.
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Affiliation(s)
- Yung-Hsiang Kao
- Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Steinberg JD, Velan SS. Measuring glucose concentrations in the rat brain using echo-time-averaged point resolved spectroscopy at 7 tesla. Magn Reson Med 2012; 70:301-8. [PMID: 22987321 DOI: 10.1002/mrm.24493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 07/19/2012] [Accepted: 08/20/2012] [Indexed: 12/15/2022]
Abstract
Glucose has multiple functions in the brain, and there is interest in estimating in vivo concentrations rather than merely the uptake determined by nuclear medicine. Glucose can be estimated using magnetic resonance spectroscopy, but measurement is difficult due to its multiple J-coupled proton signals overlapping with other metabolite signals. To minimize the effect of interfering signals, echo time (TE) values between 60 and 95 ms were averaged, and the loss in signal due to the T2 effect was corrected in both the estimation of glucose concentration and in creation of the basis files for fitting. The effectiveness of the TE-averaging method was evaluated by measuring the glucose concentration in fasted rats before and after feeding. The brain glucose in all rats increased after feeding with fasted and fed glucose-to-creatine ratios of 0.15 ± 0.03 and 0.24 ± 0.04, respectively. Data at a short TE of 13 ms measured ratios of 0.30 ± 0.16 and 0.36 ± 0.24 for the fasted and fed rats, respectively, demonstrating the difficulty in obtaining reliable glucose measurements at short TE. Overall, TE averaging minimizes the influence of macromolecular signals and nearby peaks to give precise, consistent estimates of glucose.
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Affiliation(s)
- Jeffrey D Steinberg
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore, Singapore.
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Affiliation(s)
- Gordon H Sun
- Robert Wood Johnson Foundation Clinical Scholars Program, and Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
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Aleman TS, Duncan JL, Bieber ML, de Castro E, Marks DA, Gardner LM, Steinberg JD, Cideciyan AV, Maguire MG, Jacobson SG. Macular pigment and lutein supplementation in retinitis pigmentosa and Usher syndrome. Invest Ophthalmol Vis Sci 2001; 42:1873-81. [PMID: 11431456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
PURPOSE To determine macular pigment (MP) in patients with inherited retinal degeneration and the response of MP and vision to supplementation of lutein. METHODS Patients with retinitis pigmentosa (RP) or Usher syndrome and normal subjects had MP optical density profiles measured with heterochromatic flicker photometry. Serum carotenoids, visual acuity, foveal sensitivity, and retinal thickness (by optical coherence tomography [OCT]) were quantified. The effects on MP and central vision of 6 months of lutein supplementation at 20 mg/d were determined. RESULTS MP density in the patients as a group did not differ from normal. Among patients with lower MP, there was a higher percentage of females, smokers, and light-colored irides. Disease expression tended to be more severe in patients with lower MP. Inner retinal thickness by OCT correlated positively with MP density in the patients. After supplementation, all participants showed an increase in serum lutein. Only approximately half the patients showed a statistically significant increase in MP. Retinal nonresponders had slightly greater disease severity but were otherwise not distinguishable from responders. Central vision was unchanged after supplementation. CONCLUSIONS Factors previously associated with lower or higher MP density in normal subjects showed similar associations in RP and Usher syndrome. In addition, MP in patients may be affected by stage of retinal disease, especially that leading to abnormal foveal architecture. MP could be augmented by supplemental lutein in many but not all patients. There was no change in central vision after 6 months of lutein supplementation, but long-term influences on the natural history of these retinal degenerations require further study.
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Affiliation(s)
- T S Aleman
- Department of Ophthalmology, Scheie Eye Institute, 51 N. 39th Street, University of Pennsylvania, Philadelphia, PA 19104, USA
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Abstract
From a series of 135 patients (146 prostheses) who had had primary hip replacement in 1975 and 1976 we reported the outcome at ten years in 83 surviving patients in 1988 and that at 15 years in 44 surviving patients in 1994. Now, 22 years after the operation, we have reviewed the 21 patients who are still alive. Nineteen (20 hips) of these 21 patients (22 hips) with a mean age of 85.7 years still had their original prosthesis. Most patients were satisfied with the result, although the level of activity in many was reduced because of increasing age and other medical problems. The stem was stable in all 20 hips. Only one cup was definitely loose. Wear was observed in 40% of the cups but this was not a clinical problem. At the 22-year follow-up the cumulative survival rate of the prosthesis was 85%, of the stem 91% and of the cup 88%. Since 1975, 11 (7.5%) of the original 146 prostheses have been revised.
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15
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Czeisler CA, Dumont M, Duffy JF, Steinberg JD, Richardson GS, Brown EN, Sánchez R, Ríos CD, Ronda JM. Association of sleep-wake habits in older people with changes in output of circadian pacemaker. Lancet 1992; 340:933-6. [PMID: 1357348 DOI: 10.1016/0140-6736(92)92817-y] [Citation(s) in RCA: 247] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Many elderly people complain of disturbed sleep patterns but there is not evidence that the need to sleep decreases with age; it seems rather that the timing and consolidation of sleep change. We tried to find out whether there is a concurrent change in the output of the circadian pacemaker with age. The phase and amplitude of the pacemaker's output were assessed by continuous measurement of the core body temperature during 40 h of sustained wakefulness under constant behavioural and environmental conditions. 27 young men (18-31 years) were compared with 21 older people (65-85 years; 11 men, 10 women); all were healthy and without sleep complaints. The mean amplitude of the endogenous circadian temperature oscillation (ECA) was 40% greater in young men than in the older group. Older men had a lower mean temperature ECA than older women. The minimum of the endogenous phase of the circadian temperature oscillation (ECP) occurred 1 h 52 min earlier in the older than in the young group. Customary bedtimes and waketimes were also earlier in the older group, as was their daily alertness peak. There was a close correlation between habitual waketime and temperature ECP in young men, which may lose precision with age, especially among women. These findings provide evidence for systematic age-related changes in the output of the human circadian pacemaker. We suggest that these changes may underlie the common complaints of sleep disturbance among elderly people. These changes could reflect the observed age-related deterioration of the hypothalamic nuclei that drive mammalian circadian rhythms.
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Affiliation(s)
- C A Czeisler
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115-5817
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16
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Vierboom MA, Steinberg JD, Mooyaart EL, van Rijswijk MH. Condensing osteitis of the clavicle: magnetic resonance imaging as an adjunct method for differential diagnosis. Ann Rheum Dis 1992; 51:539-41. [PMID: 1586258 PMCID: PMC1004710 DOI: 10.1136/ard.51.4.539] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Condensing osteitis of the clavicle is a benign disorder leading to osteosclerosis of the medial end of the clavicle. The differential diagnosis between condensing osteitis of the clavicle and ischaemic necrosis of the medial clavicular epiphysis (Friedrich's disease), osteoid osteoma, and low grade osteomyelitis can be difficult. In the case history reported here, magnetic resonance imaging was a useful non-invasive procedure for the diagnosis of condensing osteitis of the clavicle.
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Affiliation(s)
- M A Vierboom
- Department of Rheumatology, University Hospital, Groningen, The Netherlands
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17
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Abstract
The aim of this study was to determine in young, healthy men the relative contribution of pharmacodynamic factors inherent between two groups known to respond differently to hypertensive therapy. Black (n = 10) and white (n = 10) men received an isoproterenol sensitivity test before and after propranolol (0.1 mg/kg, then 50 micrograms/min). There were greater increases (twofold) in systolic BP following the 1.0- and 1.5-microgram isoproterenol dose (P less than 0.05) in the black group. During propranolol there were no differences in free (1)-propranolol concentrations between the groups; however, propranolol decreased resting heart rate in the white group more than in the black group (P less than 0.05). Cardiac index decreased less in the black group compared to the white group (P less than 0.05). Following the second isoproterenol challenge, there again were greater increases in systolic BP in the black group at both the 10- and the 20-micrograms isoproterenol dose (P less than 0.05). Our study has highlighted the importance of cross-racial studies in evaluating drug effects.
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Affiliation(s)
- D R Rutledge
- Department of Pharmacy Practice, College of Pharmacy, Wayne State University, Detroit, Michigan 48202
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18
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Abstract
Beta-adrenergic receptor agonists and antagonists are among the most widely used classes of agents in the US today. Heterogeneity in pharmacologic response among humans exists. This article reviews the influence of age on lymphocyte beta 2-adrenergic receptor responses. Evidence obtained in humans indicates that beta-adrenergic receptor numbers on peripheral blood cells may differ, although the direction of the change is not consistent among laboratories. Drug-induced regulation of receptors either up or down appears to be similar among age groups. The affinity of beta-adrenoceptor binding sites for isoproterenol decreases with aging. Events distal to the receptor recognition site itself exhibit age-related differences, presumably due to a decrease in the coupling of beta-adrenoceptors to adenylate cyclase. Mechanisms of decreased catecholamine responsiveness during aging remain to be defined. The precise definition of these alterations may contribute useful insights into the changes that occur with aging in response to catecholamines, other hormones, and neurotransmitters.
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Affiliation(s)
- D R Rutledge
- Department of Pharmacy Practice, College of Pharmacy, Wayne State University, Detroit, MI 48202
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19
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Waite NM, Rybak MJ, Krakovsky DJ, Steinberg JD, Warbasse LH, Edwards DJ. Influence of subject age on the inhibition of oxidative metabolism by ciprofloxacin. Antimicrob Agents Chemother 1991; 35:130-4. [PMID: 2014968 PMCID: PMC244953 DOI: 10.1128/aac.35.1.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Case reports suggest that the magnitude of inhibition of oxidative metabolism produced by ciprofloxacin may be greater in elderly subjects. We examined the effect of oral ciprofloxacin on antipyrine disposition in 13 young (ages, 23 to 34 years) and 9 elderly (ages, 65 to 82 years) healthy volunteers. Ciprofloxacin decreased antipyrine oral clearance in young and elderly subjects (P less than 0.05), with the average decreases being similar in both groups (23.3% for the young subjects and 27.9% for the elderly subjects). Ciprofloxacin concentrations in serum were significantly higher (mean, 57%) in the elderly. The formation clearance of 4-hydroxyantipyrine and 3-hydroxymethylantipyrine was also significantly decreased in both groups of subjects; however, norantipyrine formation, accounting for 15 to 20% of antipyrine clearance, was reduced only in the elderly. These results suggest that elderly subjects are not more sensitive to the inhibitory effect of ciprofloxacin on antipyrine metabolism. However, careful clinical monitoring is necessary with all patients, irrespective of age, taking ciprofloxacin concomitantly with drugs primarily eliminated by the cytochrome P-450 system.
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Affiliation(s)
- N M Waite
- College of Pharmacy & Allied Health Professions, Wayne State University, Detroit, Michigan 48202
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20
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Steinberg JD, Bambang Oetomo S, Martijn A. Asymmetrical pulmonary changes in premature infants with surgical closure of a persistent ductus arteriosus. Br J Radiol 1990; 63:22-5. [PMID: 2306584 DOI: 10.1259/0007-1285-63-745-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The chest radiographs of 57 premature infants admitted consecutively with hyaline membrane disease and receiving respirator therapy were reviewed, comparing right and left pulmonary abnormalities. Fifteen infants (Group I) did not develop a persistent ductus arteriosus (PDA). Forty-two infants developed a PDA, which was successfully treated with indomethacin in 17 infants (Group II), while in 25 infants (Group III) the ductus was closed surgically. Analysis of the three groups showed that infants who had undergone surgical closure of their PDA developed significantly more asymmetrical broncho-pulmonary damage. Statistically significant fewer radiological findings of broncho-pulmonary damage were found on the left side in comparison with the right side in the group treated surgically.
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Affiliation(s)
- J D Steinberg
- Department of Radiology, University Hospital Groningen, The Netherlands
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21
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Abstract
It was the purpose of this study to investigate racial alterations in beta-adrenoceptor response. Two groups of healthy, male volunteers gave their consent. There were eight black Americans (mean age, 26.1 +/- 2.5 years) and eight white/Caucasian Americans (mean age 24.4 +/- 1.8 years). Each subject underwent an isoproterenol sensitivity test. There was a significant (P less than 0.05) decrease in the ratio of Emax to ED50 in the white group (25.3 +/- 6.4) compared with the black group (37.1 +/- 12.4). Over the dose range of 0.1 to 1.0 micrograms there was a significant increase in response at both the 0.25- and the 0.5-microgram dose (P less than 0.05), with the black American group appearing to respond with a greater rate of rise in heart rate following the initial doses.
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Affiliation(s)
- D R Rutledge
- Department of Pharmacy Practice, Wayne state University, College of Pharmacy Detroit, Michigan 48202
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22
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Steinberg JD. Problems with normative contrast sensitivity functions. Am J Optom Physiol Opt 1987; 64:960-1. [PMID: 3445893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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23
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Abstract
The mean absolute heart weight and mean heart weight to body weight ratio of a group of 43 alcoholics, screened from 1,970 consecutive autopsy reports at the Detroit General Hospital by selecting alcoholics with only ethyl alcohol abuse as an etiology of heart disease, are compared to those of a group of similarity selected age-matched nonalcoholic controls. None of the alcoholics was clinically suspected of having had cardiomyopathy. The statistically significant increased mean absolute heart weight and heart weight to body weight ratio of the alcoholic group reflected the presence of subclinical alcoholic cardiomyopathy. In addition, several of the patients in the alcoholic group displayed gross and microscopic cardiac pathologic changes consistent with alcoholic cardiomyopathy occurring in the absence of cardiomegaly.
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