Zur Messqualität des Beck-Depressionsinventars (BDI-II) in unterschiedlichen klinischen Stichproben

Zusammenfassung. Theoretischer Hintergrund: Das BDI-II ist ein Selbstbeurteilungsinstrument zur Erfassung des Schweregrads einer Depression. Es liegen kaum Analysen mit Modellen aus der Item-Response-Theorie (IRT) vor. Fragestellung: Wie hoch ist die Messgenauigkeit des BDI-II über die unterschiedlichen Ausprägungen des latenten Traits (Depressivität) hinweg und sind die Kategorien der Items jeweils aufsteigend geordnet? Methode: Anhand von sechs großen Datensätzen aus verschiedenen klinischen Bereichen wurden psychometrische Analysen mit dem Graded Response Model durchgeführt. Ergebnisse: In allen Stichproben fand sich eine hohe interne Konsistenz. Die Schwellenwerte waren mit Ausnahme von Item 6 („Bestrafungsgefühle“) geordnet. Gemäß Testinformationsfunktion misst das BDI-II im mittleren bis hohen Depressionsbereich sehr gut (Reliabilität > .90) und im unteren Bereich gut. Schlussfolgerung: Für das BDI-II ergibt sich eine hohe und relativ gleichbleibende Messpräzision über einen weiten Bereich des latenten Traits, weshalb es insbesondere im klinischen, aber auch im nicht klinisch relevanten Wertebereich zur Erhebung des Schweregrades einer Depression gut geeignet ist.

Appearance-Related Partner Preferences and Body Image in a German Sample of Homosexual and Heterosexual Women and Men

There is evidence that gender as well as sexual orientation can affect body image. In particular, heterosexual women and homosexual men seem to be more vulnerable to a negative body image compared to homosexual women and heterosexual men. One reason for this may be derived from the fact that heterosexual women and homosexual men try to attract male romantic partners: As men place more importance on physical attractiveness than do women, the pressure to fulfill the sociocultural beauty ideal is thus increased. The present online study investigated differences in appearance-related partner preferences and their associations with measures of body image and eating pathology in homosexual and heterosexual women and men. The non-representative sample consisted of 893 participants (n = 201 lesbian women, n = 192 gay men, n = 349 heterosexual women, and n = 151 heterosexual men), who completed silhouette measures assessing their perception and expectations regarding body fat and muscularity of their own body and the body of a potential romantic partner, as well as questionnaires on drive for thinness, drive for muscularity, and eating pathology. Overall, few differences in appearance-related partner preferences emerged between the four groups. However, compared to heterosexual women, homosexual men appeared to prefer higher muscularity in potential romantic partners, which was also associated with increased drive for thinness and muscularity and increased eating pathology. The present findings indicate that, irrespective of sexual orientation, women and men tend to share similar standards regarding their own and a potential partner's physical appearance, potentially suggesting an increased hegemony of heteronormative beauty ideals in women and men in general.

OP0272 68GA-FAPI-04 PET/CT STUDY EXTENSION FOR THE ASSESSMENT OF FIBROBLAST ACTIVATION AND RISK EVALUATION IN SYSTEMIC SCLEROSIS-RELATED INTERSTITIAL LUNG DISEASE

Background:

Interstitial lung disease (ILD) is the most common cause of death in systemic sclerosis (SSc). To date, the progression of SSc-ILD is judged by the accrual of lung damage on computed tomography (CT) and functional decline (forced vital capacity). However, this approach does not directly assess the activity of tissue remodeling. Moreover, prediction of the course of ILD in individual SSc patients remains challenging. Fibroblast Activation Protein (FAP) is a specific, ex vivo validated marker for activated fibroblasts.

Objectives:

The aims of this study were: 1. To assess differences in the uptake of 68GA-FAPI 04 in SSc-ILD patients compared to controls, to analyze 2. whether 68GA-FAPI 04 uptake at baseline correlates with other risk factors of disease progression and 3. Whether 68GA-FAPI 04 uptake is associated with the course of SSc-ILD.

Methods:

Between September 2018 and April 2020, 21 patients with SSc-ILD confirmed by HRCT and onset of SSc-ILD within ≤ 5 years or signs of progressive ILD and 21 controls without ILD were consecutively enrolled. All participants underwent 68Ga-FAPI-04 PET/CT imaging and standard-of-care procedures including HRCT and lung function testing (PFT) at baseline. Patients with SSc-ILD patients were followed-up for 6 months with HRCT and PFT. Follow-up 68Ga-FAPI-04 PET/CT scans were obtained in a subset of patients treated with nintedanib. We compared baseline 68Ga-FAPI-04 PET/CT uptake to standard diagnostic tools and currently used predictors of ILD progression. The association of 68Ga-FAPI-04 uptake with changes in FVC was analyzed using mixed-effects models.

Results:

68Ga-FAPI-04 accumulated in fibrotic areas of the lungs in SSc-ILD compared to controls with a median (q1-q3 interval) wlSUVmean of 0.8 (0.6 to 2.1) in the SSc-ILD group and 0.5 (0.4 to 0.5) in the control group (p<0.0001 with Mann-Whitney test) and a median whole lung maximal standardized uptake value (wlSUVmax) of 4.4 (3.05 to 5.2) in the SSc-ILD group compared to 0.7 (0.65 to 0.7) in the control group (p<0.0001). wlFAPI-MAV and wlTL-FAPI were not measurable in control subjects, as no 68Ga-FAPI-04 uptake above background level was observed. In the SSc-ILD group the median wlFAPI-MAV was 254cm3 (163.4 to 442.3) and the median wlTL-FAPI was 183.6 cm3 (98.04 to 960.7). 68Ga-FAPI-04 uptake was higher in patients with extensive disease, with previous ILD progression or high EUSTAR activity scores. Increased 68Ga-FAPI-04 uptake at baseline was associated with progression of ILD independently of extent of involvement on HRCT scan and the forced vital capacity at baseline. In consecutive 68Ga-FAPI-04-PET/CTs, changes in 68Ga-FAPI-04 uptake was concordant with the observed response to the fibroblast-targeting antifibrotic agent nintedanib.

Conclusion:

Our study presents first in human evidence that 68Ga-FAPI-04-fibroblast uptake correlates with fibrotic activity and disease progression in the lungs of SSc-ILD patients and that 68Ga-FAPI-04-PET/CT may be of potential to improve risk assessment of SSc-ILD.

Figure 1.

A and B:68Ga-FAPI-04 PET/CT scan from a patient with SSc-ILD with selective 68Ga-FAPI-04 uptake in fibrotic areas of the left- and right lower lung lobes (red arrows), but not in non-fibrotic areas such as the middle lobe (green arrow). B Corresponding CT component.

Acknowledgements:

We gratefully acknowledge Prof. Uwe Haberkorn (University Hospital Heidelberg and DKFZ, Heidelberg, Germany) and iTheranostics Inc. (Dulles, VA, USA) for providing the precursor FAPI-04.

Disclosure of Interests:

Christina Bergmann: None declared, Jörg H.W. Distler Speakers bureau: Actelion, Anamar, ARXX, Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, and UCB, Grant/research support from: Anamar, Active Biotech, Array Biopharma, ARXX, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB, Christoph Treutlein: None declared, Koray Tascilar Speakers bureau: Gilead sciences GmbH, Pfizer Turkey, UCB Turkey, Anna-Theresa Mueller: None declared, Armin Atzinger: None declared, Alexandru-Emil Matei: None declared, Johannes Knitza: None declared, Andrea-Hermina Györfi: None declared, Anja Lueck: None declared, Clara Dees: None declared, Alina Soare: None declared, Andreas Ramming: None declared, Verena Schönau: None declared, Oliver Distler Speakers bureau: Arxx Therapeutics, Baecon Discovery, Blade Therapeutics,Bayer, Böhringer Ingelheim, Catenion,Competitive Drug Development International Ltd, Corbuspharma, CSL Behring, ChemomAb, Horizon Pharmaceuticals, Ergonex, Galaapagos NV, Glenmark Pharmaceuticals,GSK, Inventiva, Italfarmaco, IQvia, Kymera, Lilly, Medac, Medscape, MSD, Novartis, Pfizer, Roche, Sanofi, Taget Bio Sciencec, UCB, Grant/research support from: Bayer,Böhringer Ingelheim, Mitsubishi Tanabe Pharma, Olaf Prante: None declared, Philipp Ritt: None declared, Theresa Ida Goetz: None declared, Markus Koehner: None declared, Michael Cordes: None declared, Tobias Baeuerle: None declared, Torsten Kuwert Speakers bureau: Honoraria for occasional lectures by Siemens Healthineers, Grant/research support from: Research grant to the Clinic of Nuclear Medicine by this entity covering projects in the field of SPECT/CT, Georg Schett: None declared, Christian Schmidkonz: None declared

[The German-Language Version of the Muscle Dysmorphia Inventory: Evaluation of the Psychometric Properties in Male Samples]

To assess central aspects of muscle dysmorphia, classified as a subtype of body dysmorphic disorder, the Muscle Dysmorphia Inventory (MDI) is available for the English-speaking areas. The aim of the present study was to evaluate the psychometric properties of the German-language version of the MDI. Therefore, male participants from two separate samples (sample 1: n=143; sample 2: n=71; N=214) completed a questionnaire battery, including the MDI. Using confirmatory factor analysis, the factor structure postulated by the authors of the English-language original version could not be replicated. However, the fit indices were broadly adequate when the model was altered based on the modification indices. The MDI subscales showed acceptable to excellent internal consistencies. The test-retest reliability of approximately 14 days was high. Significant positive correlations of the MDI subscales with other body image and psychopathology measures, and the weight-training frequency per week indicated good convergent and criterion validity. Furthermore, the MDI differentiated between subgroups of men with muscle dysmorphia, weight-training, and non-weight-training men. With the exception of the subscale Pharmacological Use (PU), which showed lower reliability and validity, and the insufficient model fit, the German-language version of the MDI generally displayed adequate psychometric properties. Hence, with restrictions concerning the subscale PU, the administration in clinical-psychological research and a psychotherapeutic context seems to be recommendable.

How do you feel when you check your body? Emotional states during a body-checking episode in normal-weight females

PURPOSE

Cognitive-behavioral theories posit that body checking decreases negative emotions, but increases levels of arousal. However, few studies have investigated the effects of body checking on the course of emotional states. Therefore, the current study examined how normal-weight females with higher and lower eating, weight, and shape concerns feel during a checking episode of their most-liked and least-liked body parts.

METHODS

In an online design, levels of negative emotions and arousal were retrospectively assessed before, during, immediately after, and 15 min after an individually remembered body-checking episode. Participants (N = 355) also rated their subjective satisfaction with specific body parts.

RESULTS

Levels of negative emotions were lower 15 min after the checking episode of most-liked and least-liked body parts than before the episode. However, negative emotions increased during the checking episode of least-liked body parts, but subsided thereafter. The levels of arousal increased during the checking episodes of most-liked and least-liked body parts and decreased afterwards, and females with higher concerns reported greater levels of arousal than females with lower concerns. Furthermore, females with higher concerns reported more body checking than those with lower concerns.

CONCLUSIONS

The results support the assumptions of the cognitive-behavioral theories, as body checking led to a decrease in negative emotions in the longer term, and levels of arousal increased during the checking episode. The greater levels of arousal in females with higher concerns, and their pronounced body-checking behavior, might enhance their existing concerns and increase the risk of disordered eating.

LEVEL OF EVIDENCE

Level V, descriptive study.

Three-dimensional Monte Carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent 177Lu-DOTATOC therapy

Background

Patients with advanced neuroendocrine tumors (NETs) of the midgut are suitable candidates for ¹⁷⁷Lu-DOTATOC therapy. Integrated SPECT/CT systems have the potential to help improve the accuracy of patient-specific tumor dosimetry. Dose estimations to target organs are generally performed using the Medical Internal Radiation Dose scheme. We present a novel Monte Carlo-based voxel-wise dosimetry approach to determine organ- and tumor-specific total tumor doses (TTD).

Methods

A cohort of 14 patients with histologically confirmed metastasized NETs of the midgut (11 men, 3 women, 62.3 ± 11.0 years of age) underwent a total of 39 cycles of ¹⁷⁷Lu-DOTATOC therapy (mean 2.8 cycles, SD ± 1 cycle). After the first cycle of therapy, regions of interest were defined manually on the SPECT/CT images for the kidneys, the spleen, and all 198 tracer-positive tumor lesions in the field of view. Four SPECT images, taken at 4 h, 24 h, 48 h and 72 h after injection of the radiopharmaceutical, were used to determine their effective half-lives in the structures of interest. The absorbed doses were calculated by a three-dimensional dosimetry method based on Monte Carlo simulations. TTD was calculated as the sum of all products of single tumor doses with single tumor volumes divided by the sum of all tumor volumes.

Results

The average dose values per cycle were 3.41 ± 1.28 Gy (1.91–6.22 Gy) for the kidneys, 4.40 ± 2.90 Gy (1.14–11.22 Gy) for the spleen, and 9.70 ± 8.96 Gy (1.47–39.49 Gy) for all ¹⁷⁷Lu-DOTATOC-positive tumor lesions. Low- and intermediate-grade tumors (G 1–2) absorbed a higher TTD compared to high-grade tumors (G 3) (signed-rank test, p =  < 0.05). The pre-therapeutic chromogranin A (CgA) value and the TTD correlated significantly (Pearson correlation:  = 0.67, p = 0.01). Higher TTD resulted in a significant decrease of CgA after therapy.

Conclusion

These results suggest that Monte Carlo-based voxel-wise dosimetry is a very promising tool for predicting the absorbed TTD based on histological and clinical parameters.

Very Recent Advances in Vinylogous Mukaiyama Aldol Reactions and Their Applications to Synthesis

It is a challenging objective in synthetic organic chemistry to create efficient access to biologically active compounds. In particular, one structural element which is frequently incorporated into the framework of complex natural products is a β-hydroxy ketone. In this context, the aldol reaction is the most important transformation to generate this structural element as it not only creates new C-C bonds but also establishes stereogenic centers. In recent years, a large variety of highly selective methodologies of aldol and aldol-type reactions have been put forward. In this regard, the vinylogous Mukaiyama aldol reaction (VMAR) became a pivotal transformation as it allows the synthesis of larger fragments while incorporating 1,5-relationships and generating two new stereocenters and one double bond simultaneously. This review summarizes and updates methodology-oriented and target-oriented research focused on the various aspects of the vinylogous Mukaiyama aldol (VMA) reaction. This manuscript comprehensively condenses the last four years of research, covering the period 2016-2019.

Body Checking bei Frauen mit hohen und niedrigen Figur- und Gewichtssorgen

Zusammenfassung. Theoretischer Hintergrund: Gemäß Theorien zu Essstörungen ist die Aufrechterhaltung von Body Checking (BC)-Verhalten mit zwei divergierenden kognitiv-affektiven Prozessen assoziiert, d. h. Anstieg an Arousal versus Abnahme negativer emotionaler Valenz. Fragestellung: Ziel ist die Replikation einer Online-Studie zur Untersuchung, ob BC mit beiden postulierten Prozessen einhergeht und welche Relevanz die subjektive Attraktivität der kontrollierten Körperpartien hierbei hat. Methode: 125 Frauen mit hohen versus niedrigen Figur- und Gewichtssorgen schätzten ihr Level an Arousal und negativer emotionaler Valenz in erinnerten BC-Episoden der subjektiv unattraktivsten und attraktivsten Körperpartien ein. Ergebnisse: Nur bei Frauen mit hohen Figur- und Gewichtssorgen in BC-Episoden der subjektiv unattraktivsten Körperpartien traten sowohl ein Anstieg an Arousal als auch eine Abnahme negativer emotionaler Valenz ein. Schlussfolgerungen: Beide postulierten Prozesse wurden nachgewiesen.

Affect and worry during a checking episode: A comparison of individuals with symptoms of obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, body dysmorphic disorder, illness anxiety disorder, and panic disorder

Checking behavior (CB) occurs in a variety of disorders such as obsessive-compulsive (OCD), body dysmorphic (BDD), illness anxiety (IA), and panic disorder (PD), as well as anorexia (AN) and bulimia nervosa (BN). Etiological models of these disorders - with the exception of those for PD - postulate that CB mainly occurs in situations characterized by negative affect and serves to regulate it. We aimed to test these assumptions: N = 386 individuals with a self-reported diagnosis of one of the disorders rated their affect at baseline, directly before a remembered CB episode, during, immediately afterwards, and 15 and 60 minutes afterwards, and rated their endorsement of different functions of CB. The results show that transdiagnostically negative affect is significantly higher before CB compared to baseline, and is significantly reduced from before CB to all post-CB assessments. Reduction of negative affect and Attainment of certainty were the sole functions predicting the affective course during CB, and most prominently reported transdiagnostically. Assumptions of the etiological models were confirmed, suggesting that exposure and ritual prevention should be examined across disorders. As attainment of certainty seems to be predictive for the course of CB, this might be targeted in cognitive interventions.

L-18F-DOPA-PET bei Parkinson-Plus-Syndromen zum Nachweis einer gestörten präsynaptischen dopaminergen Funktion

Bei 14 Patienten mit Parkinson-Plus-Syndromen (PPLUS) wurden PET-Unter- suchungen mittels L-18F-DOPA unter Verwendung einer arteriellen Inputfunktion durchgeführt. Aufgrund von Modellannahmen konnte für den radioaktiven Tracer die Influxkonstante Ki in Abhängigkeit von Korrekturen der unspezifischen Aktivität im Kortex oder Zerebellum bestimmt werden. Die Ergebnisse wurden mit denen von 20 gesunden Kontrollen verglichen und im Hinblick auf die Intra- und Interuntersucher-Variabilität ausgewertet. Bei Patienten mit Parkinson-Plus-Syndromen war in allen Fällen die Influxkonstante Ki erniedrigt. Ihr Mittelwert betrug 0,154 (ml/Striatum/min) bei PPLUS gegenüber 0,690 (ml/ Striatum/min) bei Gesunden. Der Korrelationskoeffizient war für die Intraunter- sucher-Variabilität r = 0,973 und die Interuntersucher-Variabilität r = 0,879 bei Gesunden bzw. 0,989 und 0,973 bei PPLUS nach Korrektur der unspezifischen Aktivität über eine kortikale Region. Weder bei Gesunden noch bei PPLUS waren nach Korrektur der unspezifischen Aktivität über eine zerebellare Region Unterschiede der gemessenen Werte für Ki nachweisbar (p = 0,1). PET- Untersuchungen mittels L-18F-DOPA können das Ausmaß der nigrostriatalen Degeneration in vivo sicher erfassen. Aufgrund der irreversiblen Bindung von L-18F-DOPA innerhalb des Striatums läßt sich durch PET eine untersucherunabhängige Quantifizierung der gestörten präsynaptischen dopaminergen Funktion vornehmen.

Vascular Graft Infection: Detection by 123I-Labeled Antigranulocyte Antibody (Anti-NCA95) Scintigraphy

A total of 40 scintigraphic examinations were performed after vascular reconstructive surgery in 27 patients in whom there was a clinical suspicion of vascular graft infection. Whole-body gamma camera images were obtained at 4 and 24 h after i.v. administration of 111 MBq 123I-labeled antigranulocyte antibody Anti-NCA95. Scan results were interpreted without clinical information and were subsequently correlated with computed tomography. Prosthetic vascular graft infection was confirmed in 9 patients and excluded in 18 by surgical findings, bacteriology and/or clinical course. Scintigraphy revealed true-positive results in 16 of 40 and false-negative results in 1 of 40 examinations. True-negative results were found in 19 and 16, false-positive results in 4 and 7 examinations at 4 and 24 h p. i., resp. The sensitivity was calculated to be 94% for both early (4 h) and late (24 h) images whereas the specificity was 83% and 70%, resp. In all cases the application of the murine antibody was safe and no side effects or complications were noted. Limitations of this diagnostic procedure are accumulations of granulocytes in hematomas which may be observed in the non-complicated early course following reconstructive surgery.

Quantitative Estimation of I-123-Iomazenil Receptor Binding in Temporal Lobe Epilepsies Using Two SPECT Acquisitions – Comparison with the Regional Cerebral Blood Flow and a Compartment Model

Aim: To compare published fractional rate constants of I-123-lomazenil (IMZ) and C-11-Flumazenil (three-compartment/four-parameter model) with a I-123-lomazenil receptor index calculated from two SPECT acquisitions and to compare the receptor index of the epileptogenic area with the contralateral side in patients with unilateral temporal lobe epilepsies. Methods: 28 patients were studied. 13/28 patients had a drug-resistant unilateral temporal lobe epilepsy with a successful focus localisation performed by an extensive video/EEG monitoring. 15 other patients with clinically suspected focal epilepsy and a normal MRI and IMZ SPECT scanning were used as controls. SPECT scanning was performed in all patients 15 and 100 min after intravenous injection of 111 MBq IMZ and 10 min after application of 740 MBq Tc-99m-HMPAO. Quantification of the regional uptake was performed using ROI-technique and the specific and non-specific binding of IMZ was calculated. The receptor index was calculated by the difference of the specific binding from 15 to 100 min p. i. divided by the time interval. Results: The receptor index showed a linear correlation with recently published fractional rate constants k 3 (r = 0.69 and 0.67; p = 0.15) and a moderate correlation with the k 4 constant (-0.53 and -0.43; p = 0.28) by the means of C-11 -Flumazenil PET and 1-123-lomazenil SPECT studies, respectively. However, statistical significance was not reached due to the few data points available from the published reports. Furthermore, the IMZ receptor index was lower in the epileptogenic area of patients with unilateral temporal lobe epilepsies compared with their contralateral side (p = 0.02; Wilcoxon-test). The IMZ receptor index showed a weak correlation with the regional cerebral blood flow independent of the evaluated region (r <0.4; p <0.05). Conclusion: The IMZ receptor index indicated to be a simple routine approach to estimate the fractional rate constant k 3 (r = 0.67). The lower value of the receptor index within the epileptogenic area might be due to a lower receptor density. However in further studies, IMZ might be a helpful tool to find out subtle changes of the receptor affinity due to its approximately 30-fold higher ligand-receptor affinity compared to C-11-Flumazenil.

DigiTrain – Entwicklung und Evaluation eines digitalen Trainingsprogramms zur Rehabilitationsnachsorge bei chronischen Rückenschmerzen

Rückenschmerzen gehören zu den häufigsten Beschwerden in der deutschen Bevölkerung und stellen ein großes gesundheitliches wie gesundheitsökonomisches Problem dar. Die in der Rehabilitation von chronischen Rückenschmerzen erzielten Erfolge können nur nachhaltig gesichert werden, wenn die körperlich-sportlichen Aktivitäten im Alltag der Patienten regelmäßig und dauerhaft weitergeführt werden. Deshalb wurde das multimediale Trainingsprogramm „DigiTrain“ entwickelt. Das Programm soll durch einen interaktiven Trainer (Avatar) die weitergehende individuelle Betreuung und Begleitung (Coaching) des Patienten über den stationären Aufenthalt hinaus sicherstellen.

In dem Beitrag werden die Zielgruppe sowie die Inhalte und die Struktur des Programms „DigiTrain“ dargestellt. Ebenso wird ein Einblick in die technische Umsetzung und Produktion des Programms gegeben, bevor abschließend das Studiendesign für die wissenschaftliche Evaluation von DigiTrain vorgestellt wird.

Visual processing of one's own body over the course of time: Evidence for the vigilance-avoidance theory in adolescents with anorexia nervosa?

OBJECTIVE

The vigilance-avoidance theory postulates a specific threat-related pattern of attention deployment, characterized by initial orientation towards fear-evoking stimuli and subsequent directing of attention away from them. The current eye-tracking study was the first to examine the applicability of the theory for patients with eating disorders, who perceive their own body as a highly aversive, threat-evoking stimulus.

METHOD

N = 56 female adolescents with anorexia nervosa (AN) and n = 43 healthy controls (HC) aged 13-18 viewed own-body pictures while their eye movements were recorded. Relative fixation times on self-defined unattractive body areas were compared between the groups by sequencing the overall presentation time of 6,000 ms into six intervals à 1,000 ms.

RESULTS

Participants with AN showed a significantly stronger attentional bias for unattractive body areas than HC within the time intervals 1, 2, and 3. However, for intervals 4, 5, and 6, no significant group differences occurred. Within the AN group, the bias for unattractive body areas was significantly stronger in interval 1 compared to intervals 4, 5, and 6; whereas within the HC group, a stable pattern of attention deployment emerged. In AN, early attention deployment was positively correlated with the negative affect reported after photo presentation.

DISCUSSION

The early vigilance in AN and the subsequent decrease in attention to unattractive body parts is in line with our assumptions. However, no indication of attentional avoidance was found. The current findings partially support the vigilance-avoidance theory for the exposure to one's own body in adolescents with AN.

Effects of the exposure to self- and other-referential bodies on state body image and negative affect in resistance-trained men

Previous body image research suggests that first, exposure to body stimuli can negatively affect men's body satisfaction and second, body concerns are associated with dysfunctional gaze behavior. To date, however, the effects of self- vs. other-referential body stimuli and of gaze behavior on body image in men under exposure conditions have not been investigated. Therefore, 49 weight-trained men were presented with pictures of their own and other bodies of different builds (i.e., normal, muscular, hyper-muscular) while being eye-tracked. Participants completed pre- and post-exposure measures of body image and affect. Results indicated that one's own and the muscular body negatively affected men's body image to a comparable degree. Exposure to one's own body also led to increased negative affect. Increased attention toward disliked own body parts was associated with a more negative post-exposure body image and affect. These results suggest a crucial role of critical self-examination in maintaining body dissatisfaction.

A Novel Mutation of the Calcium Sensing Receptor Gene in a Franconian Kindred: Heterozygous Mutation c.1697_1698delTG Exon 6

Familial hypocalciuric hypercalcemia (FHH) belongs to the disorders of a disturbed calcium homeostasis. Genetically, the disorder is inherited in an autosomal-dominant trait and represents an inactivating mutation of the calcium sensing receptor (CaSR) gene. We identified a Franconian kindred in which 6 individuals could be tested by molecular genetic means. In 5 individuals of 3 generations, the mutation could be classified as c.1697_1698delTG. This novel germline mutation creates a premature stop codon leading to a loss of 510 amino acids of the protein. The detection of CaSR gene mutations is suitable to differentiate states of hypercalcemia and may help to avoid invasive procedures such as parathyroidectomies.

Overestimation of body size in eating disorders and its association to body-related avoidance behavior

Body-related avoidance behavior, e.g., not looking in the mirror, is a common feature of eating disorders. It is assumed that it leads to insufficient feedback concerning one's own real body form and might thus contribute to distorted mental representation of one's own body. However, this assumption still lacks empirical foundation. Therefore, the aim of the present study was to examine the relationship between misperception of one's own body and body-related avoidance behavior in N = 78 female patients with Bulimia nervosa and eating disorder not otherwise specified. Body-size misperception was assessed using a digital photo distortion technique based on an individual picture of each participant which was taken in a standardized suit. In a regression analysis with body-related avoidance behavior, body mass index and weight and shape concerns as predictors, only body-related avoidance behavior significantly contributed to the explanation of body-size overestimation. This result supports the theoretical assumption that body-related avoidance behavior makes body-size overestimation more likely.

„Ich wünschte, ich wäre muskulöser”: Eine teststatistische Überprüfung der deutschsprachigen Fassung der Drive for Muscularity Scale (DMS)

Die Drive for Muscularity Scale (DMS) ist der am häufigsten verwendete Fragebogen zur Erfassung des Muskulositätsstrebens. Ziel der Studie war die psychometrische Überprüfung der deutschsprachigen Version der DMS. 601 Männer aus muskel- und kraftorientierten Sportarten wurden am Computer oder mit der Papierversion der DMS und mit weiteren Skalen befragt. Interne Konsistenz und Retest-Reliabilität der DMS liegen im sehr guten Bereich (>.88), ebenso die Korrelation mit einem Alternativtest (Male Body Attitudes Scale: .81). Muskulositäts- und Schlankheitsstreben lassen sich eindeutig differenzieren (Eating Disorder Inventory-2-DT: .11). Die durchgeführten Faktorenanalysen stützen die Einteilung in eine kognitive und eine korrelierte behaviorale Subskala. Es zeigten sich Zusammenhänge mit körperbezogenem Selbstwert und körperdysmorphen Sorgen. Die deutschsprachige DMS ist ein reliables und valides Instrument zur Erfassung des Muskulositätsstrebens in Forschung und klinischer Einzelfallanwendung.

German version of the Multidimensional Body-Self Relations Questionnaire - Appearance Scales (MBSRQ-AS): confirmatory factor analysis and validation

The Multidimensional Body-Self Relations Questionnaire (MBSRQ) is a widely used questionnaire that measures body image as a multidimensional construct. The Appearance Scales (AS) of the MBSRQ (Appearance Evaluation, Appearance Orientation, Body Areas Satisfaction, Overweight Preoccupation and Self-Classified Weight) are subscales which facilitate a parsimonious assessment of appearance-related aspects of body image. The current study tested the psychometric properties and factor structure of a German translation of the MBSRQ-AS. Participants were n=230 female patients with the SCID diagnosis of an eating disorder and n=293 female healthy controls. In a confirmatory factor analysis, convincing goodness-of-fit indices emerged. The subscales of the questionnaire yielded good reliability and convergent and discriminant validity coefficients, with most items showing excellent characteristics. Like the English version, the German adaptation of the questionnaire can be recommended for a multidimensional assessment of appearance-related aspects of body image in both research and clinical practice.

Metastases of non-thyroidal tumors to the thyroid gland: a regional survey in middle franconia

OBJECTIVE

Metastases of non-thyroidal tumors to the thyroid gland are infrequently diagnosed in the clinical environment. In autopsy studies, however, metastases to the thyroid gland have a frequency of 1.25-24%. The aim of this investigation was to explore the primary tumor and latency of diagnosis in patients who were diagnosed with metastases to the thyroid gland in 70 institutions associated to a scientific board in Middle Franconia during a 12 year period.

DESIGN

Retrospective cross-sectional study.

PATIENTS

After a clinical data base research, 35 patients (21 male, 14 female) with a histological diagnosis of a secondary thyroid malignancy were identified between 2002 and 2013. The mean age of the patients at diagnosis of the metastasis was x=68.2 years (median: 70, standard deviation SD=± 8.4, range 46-85 years). The majority of the patients had metastases from renal cell carcinomas (n=19). In the other patients metastases from gastrointestinal carcinomas (n=2), bronchial carcinomas (n=3), malignant melanomas (n=3), sarcomas (n=2), and other tumors (n=6) were diagnosed. The time interval between the diagnosis of the primary tumor and the metastasis to the thyroid gland was different for patients with metastases from renal cell carcinomas and non-renal cell carcinomas (p<0.001, chi-test).

CONCLUSIONS

In agreement with previous studies, the majority of metastases to the thyroid gland derive from renal cell carcinomas. In patients with non-renal malignancies, metastases to the thyroid gland are diagnosed simultaneously with the primary tumor to a higher proportion compared with metastasis from renal malignancies.

The vinylogous Mukaiyama aldol reaction (VMAR) in natural product synthesis

This review will provide an overview on the recent developments of polyketide synthesis using the vinylogous Mukaiyama aldol reaction for the construction of advanced intermediates. In general, four different motifs can be constructed efficiently using the recent developments of asymmetric variants of this strategy.

[The Concordance of Rater- and Self-Administration of the Osnabrück Profile of Working Abilities (O-AFP)]

OBJECTIVES

The O-AFP can be used as a rater-administered inventory (RAI) and as a self-report scale (SRS). The study analyses the relations between these versions.

METHODS

O-AFP-scales for working abilities and work complexity and SCL-90-R data of 88 vocational therapy patients (psychiatric clinic, PC; addiction clinic, AC).

RESULTS

Only few significant correlations were found, with slightly higher scores in the AC patients. Also, AC patients rated themselves higher, whereas PC patients rated lower compared to the RAI ratings. The discrepancy between SRS and RAI scores decreased with rising work complexity and with a low symptom strain. With high GSI, SRS scores are clearly lower than RAI scores.

CONCLUSIONS

The SRS-version of the O-AFP is not appropriate for economizing the assessment process. Rather, it is helpful in therapist-patient communication on issues of work rehabilitation. Correspondence between SRS and RAI ratings can be improved by increasing work requirements.

Gene expression comparisons performed for biodosimetry purposes on in vitro peripheral blood cellular subsets and irradiated individuals

We examined the benefit of gene expression analysis on peripheral blood cellular subsets of different radiosensitivity to elucidate their utility as biodosimeters for estimation of dose in irradiated individuals. Peripheral mononucleated cells were isolated from 18 healthy volunteers employing density separation in a CPT-NH tube. Peripheral mononucleated cells were cultured in RPMI 1640 medium containing 10% autologous serum and were irradiated with 0.1-1 Gy (240 kV, 13 mA, X rays at 1 Gy/min). A low-dose study was performed with isolated peripheral mononucleated cells from one healthy donor in three independent experiments. Peripheral mononucleated cells were irradiated at 0 (sham), 1, 2.5 and 5 cGy (70 kV, 13 mA X rays at 1 cGy/min) and gene expression was measured 24 and 48 h after irradiation. After irradiation, CD4(+) or CD8(+) cells were isolated by magnetic beads in independent experiments. RNA from lymphocyte subsets and peripheral mononucleated cells was isolated after 24 and 48 h and converted into cDNA. Gene expression of GADD45, CDKN1A, DDB2, PCNA, BAX and ATF3 were determined using RTQ-PCR. Data were analyzed employing linear and logistic regression analysis. The same examinations were performed in 5 individuals either diagnosed using CT scans (up to 4.3 cGy) or by administering (F-18)-fluoro-2-deoxy-d-glucose (F-18 FDG, 0.6 cGy). Methodological, intra- and inter-individual variability in 90-95% of measurements did not exceed the introduced twofold change over sham-irradiated control values in peripheral mononucleated cells and CD4(+) cells, and therefore no false positive results were observed. Dose reconstruction in peripheral mononucleated cells in opposite to CD4(+) lymphocytes required fewer genes and appeared more efficient (R-square = 84.8% compared to 51.8%). In vitro samples exposed to 10 cGy could be completely discriminated from sham-irradiated samples without individual pre-exposure controls, which coincided with our preliminary in vivo results. However, in vitro differential gene expression was measured relative to control values and did not differ significantly at 24 and 48 h after irradiation in contrast to our preliminary in vivo data. In addition, below 5 cGy in vitro data did not show reproducible significant changes in gene expression, which was opposite to our preliminary in vivo data. Therefore a twofold change in gene expression over control sufficiently controls for different sources of variance, and measuring gene expression in peripheral mononucleated cell for biological dosimetry purposes appears superior over measurements in lymphocyte subsets. The increased gene expression measured after low absorbed doses in vivo and in vitro might indicate a particular applicability of this method for a low-level radiation scenario in the absence of individual pre-exposure controls. However, the constant gene expression values measured up to 48 h in our in vitro model at doses >10 cGy, and the absence of reproducible and statistically significant gene expression changes below 5 cGy contrast to the preliminary in vivo results performed at similar doses. Therefore, measurements with our in vitro models should be interpreted cautiously.

Combined thallium-201 and dynamic iodine-123 iodophenylpentadecanoic acid single-photon emission computed tomography in patients after acute myocardial infarction with effective reperfusion

BACKGROUND

Considerable derangements of energy metabolism are to be expected during ischemia and reperfusion. In ischemic myocardium, the oxidative degradation of carbohydrates is shifted toward the anaerobic production of lactate and the oxidation of fatty acids is suppressed.

HYPOTHESIS

The aim of this study was to examine the uptake and metabolism of iodine-123 (123I) iodophenylpentadecanoic acid (IPPA) in stunned myocardium.

METHODS

In 15 patients, SPECT with 201Tl and 123I IPPA as well as echocardiography with low-dose dobutamine stimulation were performed 12 +/- 5 days after myocardial infarction with reperfusion. Follow-up echocardiography was carried out 24 +/- 8 days later for documentation of functional improvement. Uptake of 201Tl and 123I IPPA were obtained in five left ventricular segments, and dynamic SPECT imaging was used for calculation of the fast and the slow components of the biexponential myocardial 123I IPPA clearance.

RESULTS

Wall motion improved in 14 of 26 dysfunctional segments (54%). Stunned segments were characterized by a reduced 123I IPPA extraction, a shorter half-life of the fast, and a longer half-life of the slow clearance component. All parameters of the combined 201Tl/123I IPPA study predicted functional recovery with similar accuracies (area under the receiver operator characteristic curves between 0.68 and 0.76; p = NS). Analysis of 201Tl uptake alone could not predict functional recovery in this study.

CONCLUSIONS

Stunned myocardium is characterized by a disturbance of fatty acid metabolism. For prediction of functional improvement, 123I IPPA imaging added significant diagnostic information.

Computertomographische Diagnostik der akuten linksseitigen Kolondivertikulitis und ihre Differenzialdiagnostik

PURPOSE

This review shows the diagnostic potential of computed tomography (CT) in the diagnosis and differential diagnosis of acute left-sided colonic diverticulitis.

METHODS

Using a single detector spiral CT, standard examination of the entire abdomen is performed after oral and rectal administration of diluted iodinated contrast medium with collimation of 8 mm, pitch of 1.5, and reconstruction increment of 8 mm before and after intravenous contrast injection. Intravenous administration of spasmolytic agents, various patient positions, and the thin-section technique with 3-5 mm slices are beneficial in difficult cases.

RESULTS

The differential diagnosis of acute left-sided colonic diverticulitis includes tumorous, inflammatory, and ischemic diseases of the colon as well as infarctions of epiploic appendages and the omentum majus. The knowledge of the various CT criteria of acute colonic diverticulitis and their differential diagnoses helps to establish a correct diagnosis in a wide majority of cases.

CONCLUSION

At present, CT is the diagnostic procedure of choice for assessing acute diverticulitis. Distinct knowledge of the CT features helps to differentiate the various entities accurately.

Sequence and analysis of chromosome 5 of the plant Arabidopsis thaliana

The genome of the model plant Arabidopsis thaliana has been sequenced by an international collaboration, The Arabidopsis Genome Initiative. Here we report the complete sequence of chromosome 5. This chromosome is 26 megabases long; it is the second largest Arabidopsis chromosome and represents 21% of the sequenced regions of the genome. The sequence of chromosomes 2 and 4 have been reported previously and that of chromosomes 1 and 3, together with an analysis of the complete genome sequence, are reported in this issue. Analysis of the sequence of chromosome 5 yields further insights into centromere structure and the sequence determinants of heterochromatin condensation. The 5,874 genes encoded on chromosome 5 reveal several new functions in plants, and the patterns of gene organization provide insights into the mechanisms and extent of genome evolution in plants.

Sequence and analysis of chromosome 4 of the plant Arabidopsis thaliana

The higher plant Arabidopsis thaliana (Arabidopsis) is an important model for identifying plant genes and determining their function. To assist biological investigations and to define chromosome structure, a coordinated effort to sequence the Arabidopsis genome was initiated in late 1996. Here we report one of the first milestones of this project, the sequence of chromosome 4. Analysis of 17.38 megabases of unique sequence, representing about 17% of the genome, reveals 3,744 protein coding genes, 81 transfer RNAs and numerous repeat elements. Heterochromatic regions surrounding the putative centromere, which has not yet been completely sequenced, are characterized by an increased frequency of a variety of repeats, new repeats, reduced recombination, lowered gene density and lowered gene expression. Roughly 60% of the predicted protein-coding genes have been functionally characterized on the basis of their homology to known genes. Many genes encode predicted proteins that are homologous to human and Caenorhabditis elegans proteins.

Loss of dopamine-D2 receptor binding sites in Parkinsonian plus syndromes

This study analyzed temporal changes of striatal dopamine-D2 receptor binding during the course of different extrapyramidal movement disorders using 123I-iodobenzamide (IBZM) SPECT.

METHODS

Eighteen patients (9 with Parkinson's disease, 9 with parkinsonian plus syndrome) were followed for 11-53 mo. Dopamine-D2 receptor binding was assessed using 123I-IBZM SPECT at the beginning and at the end of the follow-up period. SPECT data were acquired 120 min postinjection of 3-5 mCi 123I-IBZM. A semiautomated algorithm was applied to the raw data for semiquantitative evaluation of regional cerebral receptor binding.

RESULTS

Intraobserver (r = 0.992) and interobserver (r = 0.930) variance was low for the semiautomated interpretation of the SPECT examination of the dopaminergic D2 receptor binding, reflecting a highly reproducible SPECT algorithm. Mean specific dopamine-D2 receptor binding was lower in patients with parkinsonian plus syndrome compared to patients with Parkinson's disease on the initial (p < 0.001) as well as the follow-up study (p < 0.001). In patients with Parkinson's disease, we observed an unaffected receptor binding compared to a reduced binding of radiotracer in patients with parkinsonian plus syndrome during the course of the disease (p < 0.001).

CONCLUSION

During the follow-up, patients with Parkinson's disease showed a constant dopamine-D2 receptor binding. In contrast, patients with parkinsonian plus syndrome revealed a decline of the binding of dopamine-D2 receptor. These findings are in agreement with histopathological data that demonstrated a preserved dopamine-D2 receptor status in patients with Parkinson's disease and a decline of the dopamine-D2 receptors in patients with parkinsonian plus syndrome. SPECT examinations using 123I-IBZM are useful for assessing dynamic changes of dopamine-D2 receptors in extrapyramidal movement disorders. Semiquantitative SPECT evaluations may provide valuable information for clinical management and prognosis of the patient with extrapyramidal movement disorders.

Quantitative estimation of I-123-Iomazenil receptor binding in temporal lobe epilepsies using two SPECT acquisitions--comparison with the regional cerebral blood flow and a compartment model

AIM

To compare published fractional rate constants of I-123-Iomazenil (IMZ) and C-11-Flumazenil (three-compartment/four-parameter model) with a I-123-Iomazenil receptor index calculated from two SPECT acquisitions and to compare the receptor index of the epileptogenic area with the contralateral side in patients with unilateral temporal lobe epilepsies.

METHODS

28 patients were studied. 13/28 patients had a drug-resistant unilateral temporal lobe epilepsy with a successful focus localisation performed by an extensive video/EEG monitoring. 15 other patients with clinically suspected focal epilepsy and a normal MRI and IMZ SPECT scanning were used as controls. SPECT scanning was performed in all patients 15 and 100 min after intravenous injection of 111 MBq IMZ and 10 min after application of 740 MBq Tc-99m-HMPAO. Quantification of the regional uptake was performed using ROI-technique and the specific and non-specific binding of IMZ was calculated. The receptor index was calculated by the difference of the specific binding from 15 to 100 min p.i. divided by the time interval.

RESULTS

The receptor index showed a linear correlation with recently published fractional rate constants k3 (r = 0.69 and 0.67; p = 0.15) and a moderate correlation with the k4 constant (-0.53 and -0.43; p = 0.28) by the means of C-11-Flumazenil PET and I-123-Iomazenil SPECT studies, respectively. However, statistical significance was not reached due to the few data points available from the published reports. Furthermore, the IMZ receptor index was lower in the epileptogenic area of patients with unilateral temporal lobe epilepsies compared with their contralateral side (p = 0.02; Wilcoxon-test). The IMZ receptor index showed a weak correlation with the regional cerebral blood flow independent of the evaluated region (r < 0.4; p < 0.05).

CONCLUSION

The IMZ receptor index indicated to be a simple routine approach to estimate the fractional rate constant k3 (r = 0.67). The lower value of the receptor index within the epileptogenic area might be due to a lower receptor density. However in further studies, IMZ might be a helpful tool to find out subtle changes of the receptor affinity due to its approximately 30-fold higher ligand-receptor affinity compared to C-11-Flumazenil.

[Magnetic resonance tomography in patients with Parkinson's disease and Parkinson-plus syndromes]

PURPOSE

To define characteristic MR-findings in patients with clinically typical extrapyramidal movement disorders.

METHODS

15 patients with Parkinson's disease (PD), 9 with multisystem atrophy (MSA), and 6 with progressive supranuclear palsy (PSP) underwent MRI using a 1.5 T. Magnetom unit. Two investigators analysed the images with special regard to global and/or focal atrophy and to changes in signal intensity of the CNS in the consensus mode. Normal images of 10 subjects served as controls to patient's images.

RESULTS

In all patients with PSP and MSA characteristic pathological findings on MRI were observed including regional changes within the extrapyramidal nuclei. In contrast all patients with PD had an unremarkable MRI study of the CNS.

CONCLUSION

MRI enables us to define characteristic morphological changes of the brain in patients with extrapyramidal movement disorders. Early recognition of these findings avoids misdiagnoses in patients who are difficult to diagnose.

[Cerebral SPECT with iodine-123 IBZM in patients with extrapyramidal system disorders: the evaluation of its sensitivity in therapy with dopaminergic drugs]

The functional integrity of striatal post-synaptic dopamine D2 receptors is requested for an effective pharmacologic treatment in patients with extrapyramidal movement disorders. Iodine-123 IBZM Single Photon Emission Computed Tomography (SPECT) is a noninvasive radionuclide technique for the morpho-functional imaging of post-synaptic dopamine D2 receptors. In this study, the results of iodine-123 IBZM SPECT and those of apomorphine tests were compared in 32 patients with extrapyramidal movement disorders--22 patients with idiopathic Parkinson's disease (IPD) and 10 with Parkinson's plus syndrome (PPS). Iodine-123 IBZM uptake was measured as the ratio between striatum and frontal cortex activities. Twenty of 22 IPD patients (91%) responded to apomorphine administration, while in 8 of 10 PPS patients (80%) the apomorphine test was negative. Iodine-123 IBZM uptake was significantly higher (p < 0.01) in IPD patients (1.39 +/- 0.114) than in PPS patients (1.27 +/- 0.078). Similarly, iodine-123 IBZM uptake was significantly higher (p < 0.01) in the patients with positive than in those with negative apomorphine test (1.38 +/- 0.113 vs. 1.26 +/- 0.078). In conclusion, the results of this study demonstrate that iodine-123 IBZM SPECT is a radionuclide technique capable of characterizing the patients with extrapyramidal movement disorders and of selecting the subjects who may respond to pharmacological dopamine treatment.

[Duplex sonography in functional thyroid diagnosis]

PURPOSE

Assessment of the functional diagnostic value of Doppler sonographic or sonographic parameters, especially of the peak flow velocity in the inferior thyroid artery in patients with newly manifest autoimmunothyroiditis.

MATERIAL AND METHOD

Morphological and Doppler sonographic measurements were done at the inferior thyroid artery on 69 patients suffering from newly manifest Graves' disease or Hashimoto's thyroiditis, as well as on a control group of 18 subjects. The measured data were correlated with thyroid hormone levels and with quantitative scintiscanning.

RESULTS

A linear functional correlation was found between the peak flow velocities in the inferior thyroid artery and the fT3 or fT4 level. If the peak flow velocities were greater than 1.2 m/s, hyperthyroid metabolism prevailed, whereas at velocities below 0.3 m/s latent hypothyroidism was present.

CONCLUSION

These results show that Doppler sonography of the inferior thyroid artery can supply pointers (capable of being recorded) to the state of functioning of the thyroid even before knowing the laboratory parameters.

Iodine-123-iodo-lisuride SPECT in Parkinson's disease

Recently, [123I]iodo-lisuride was synthesized for possible applications in SPECT studies. The purpose of this investigation was to compare the striatal binding and kinetics of this radioligand in patients with Parkinson's disease and normal controls.

METHODS

Six patients with Parkinson's disease and three normal controls were examined. After intravenous injection of 111 MBq [123I]iodo-lisuride, sequential SPECT examinations at 20, 40, 80 and 120 min were performed. For each SPECT series the basal ganglia-to-cerebellum ratio of tracer accumulation was calculated. In one patient a repeat SPECT examination was undertaken under identical conditions to test the reproducibility of the procedure. In two other patients a second SPECT examination was performed after injection of cold lisuride as a receptor saturation study. In addition, the time course of the radioactivity was measured in the plasma and red blood cells in each individual.

RESULTS

In both patients and controls, the highest tracer accumulation was found within the striatum. The basal ganglia-to-cerebellum ratio was 1.182 and 1.303 at 20 min, 1.353 and 1.450 at 40 min, 1.490 and 1.533 at 80 min, 1.550 and 1.583 at 120 min for patients and controls, respectively, which was not statistically different. In the saturation study, 50 micrograms and 100 micrograms cold lisuride led to a 28% and 33% reduction, respectively, of the basal ganglia-to-cerebellum ratio at 120 min. The ligand showed a rapid decline in plasma and red blood cells. The percent injected dose per liter was calculated to be 1.6 and 0.9, respectively, for plasma and red blood cells at 20 min.

CONCLUSION

Iodine-123-iodo-lisuride SPECT seems useful for imaging intact striatal dopamine D2 receptors in patients with Parkinson's disease and may provide clinically relevant information for quantitative assessment of the availability and integrity of dopamine D2 receptors.

[Brain SPECT with 123I-lisuride in patients with Parkinson's disease and controls]

The goal was to visualize cerebral dopamine-D2 receptors in 6 patients with Parkinson's disease and in 3 healthy controls using iodine-123-Lisuride-SPECT. In addition, we performed receptor-replacement studies using 123I-Lisuride and cold Lisuride as competitive ligands. The highest uptake of 123I-Lisuride was observed in the striatum, a region with known high dopamine receptor density. In two patients premedication with cold Lisuride displaced 123I-Lisuride from the dopamine receptor. 123I-Lisuride is valuable as a radiotracer in cerebral dopamine-D2 receptor scintigraphy. Whether or not it is possible to determine dynamic changes of dopamine receptor density or function by receptor replacement studies needs further evaluation in larger patient populations.