Validation of a Fast-Helical Free-Breathing CT-Based Ventilation Technique Using Ventilation/Perfusion SPECT Imaging

PURPOSE/OBJECTIVE(S)

In radiotherapy, the lung is considered one homogenous organ at risk during planning. However, avoiding dose to functional lung could help preserve lung function after treatment. This could be possible with ventilation mapping, which is traditionally done with SPECT imaging. Having an accurate, CT-based approach could allow for ventilation mapping within the radiotherapy workflow. In this study, we aim to compare a novel, CT-based ventilation mapping approach to SPECT-based ventilation images.

MATERIALS/METHODS

We acquired both CT-based and SPECT-based ventilation scans for one patient. For the SPECT-based images, the patient inhaled 8.8 mCi Tc-99m DTPA aerosol before scan acquisition with a dual headed SPECT/CT. For the CT-based approach, we acquired 25 fast-helical free-breathing CTs as part of our 5DCT protocol with simultaneous monitoring of the breathing pattern using a respiratory bellows surrogate. We chose one scan as the reference scan, and deformably registered the other 24 scans to it. The Jacobian expansion of each registration was calculated for each voxel and linearly related to the bellows amplitude. The slope of the linear fit, dJ/dA, represented the ventilation for each voxel. To compare the resulting ventilation maps from each method, we first calculated the normalized cross-correlation (NCC) and Spearman correlation coefficient. We also created masks of ventilation greater than various thresholds to see how we could accurately define high and low functioning lung. For example, greater than 50th percentile ventilation being 1 (high functioning) and less than 50th percentile being 0 (low functioning). We calculated Dice scores to compare these threshold masks between the CT-based and SPECT-based ventilation images.

RESULTS

The NCC between the ventilation images was 0.810, and the Spearman correlation between them was 0.587. When comparing volumes of ventilation greater than 50th percentile, the Dice score was 0.730. However, when the threshold was increased, the Dice scores were reduced. Qualitatively, we noted that the lobar ventilation agreed in general, but there was more detail throughout the CT-based image, as opposed to the more precisely defined, high ventilating areas in the SPECT image.

CONCLUSION

We were able to compare our novel, CT-based ventilation approach against a more conventional technique in ventilation SPECT imaging. The resulting ventilation images were qualitatively similar. Analyzing different thresholds showed that we can reasonably separate high and low functioning tissue into greater than or less than 50th percentile ventilation, respectively. In future work, we will aim to expand this study over a larger cohort of patients and also examine longitudinal changes to ventilation after SBRT and lung brachytherapy.

A 6-month randomized, double-blind, placebo-controlled trial of weekly exenatide in adolescents with obesity

BACKGROUND

Pharmacological treatment options for adolescents with obesity are very limited. Glucagon-like-peptide-1 (GLP-1) receptor agonist could be a treatment option for adolescent obesity.

OBJECTIVE

To investigate the effect of exenatide extended release on body mass index (BMI)-SDS as primary outcome, and glucose metabolism, cardiometabolic risk factors, liver steatosis, and other BMI metrics as secondary outcomes, and its safety and tolerability in adolescents with obesity.

METHODS

Six-month, randomized, double-blinded, parallel, placebo-controlled clinical trial in patients (n = 44, 10-18 years, females n = 22) with BMI-SDS > 2.0 or age-adapted-BMI > 30 kg/m² according to WHO were included. Patients received lifestyle intervention and were randomized to exenatide extended release 2 mg (n = 22) or placebo (n = 22) subcutaneous injections given once weekly. Oral glucose tolerance tests (OGTT) were conducted at the beginning and end of the intervention.

RESULTS

Exenatide reduced (P < .05) BMI-SDS (-0.09; -0.18, 0.00), % BMI 95th percentile (-2.9%; -5.4, -0.3), weight (-3 kg; -5.8, -0.1), waist circumference (-3.2 cm; -5.8, -0.7), subcutaneous adipose tissue (-552 cm³ ; -989, -114), 2-hour-glucose during OGTT (-15.3 mg/dL; -27.5, -3.1), total cholesterol (11.6 mg/dL; -21.7, -1.5), and BMI (-0.83 kg/m² ; -1.68, 0.01) without significant change in liver fat content (-1.36; -3.12, 0.4; P = .06) in comparison to placebo. Safety and tolerability profiles were comparable to placebo with the exception of mild adverse events being more frequent in exenatide-treated patients.

CONCLUSIONS

Treatment of adolescents with severe obesity with extended-release exenatide is generally well tolerated and leads to a modest reduction in BMI metrics and improvement in glucose tolerance and cholesterol. The study indicates that the treatment provides additional beneficial effects beyond BMI reduction for the patient group.

SU-E-J-169: 4D-PET for Abdominal Tumor Target Volume Generation

PURPOSE

To examine the impact of 4D-PET on target volume delineation of upper-abdominal tumors, versus conventional un-gated PET.

METHODS

Four patients with upper-abdominal tumors underwent respiratory-correlated FDG PET/CT scanning (4D-PET) as part of a continuing IRB-approved research protocol. Internal target volumes of FDG-avid tumors were contoured on the 4D-PET and conventional un-gated PET by a radiation oncologist who is a specialist in gastro-intestinal tumors. To create the 4D-PET ITV, the end-inhale and end-exhale 4D-PET phases were used. The relative volumes and volumetric overlaps of the 4D and un-gated target volumes were examined. Additionally, 4D-PET was used to measure the motion of the tumors.

RESULTS

Of the four patients who were imaged, one showed minimal motion (〈 3 mm in any direction) and one showed minimal FDG avidity; these were removed from further analysis. Of the two tumors which showed significant motion and FDG uptake, 4D-PET volumes were 28% and 21% larger than un-gated PET volumes. The un-gated PET volumes were almost entirely contained within the 4D-PET volumes (95% and 93% for the two tumors). Tumors appeared to deform as well as translate with breathing, although this could be due to varying intra-gate motion rather than actual physiological deformation. The superior-inferior borders of the tumors exhibited the most motion, with displacements of 5.6 mm and 6.4 mm.

CONCLUSIONS

4D-PET can be used to estimate the motion of FDG-avid upper-abdominal tumors. Use of 4D-PET increases the size of target volumes compared to un-gated PET in a subset of upper-abdominal cancer patients. Direct measurement of tumor motion and deformation by 4D-PET imaging could allow the use of patient-specific margins rather than population-based margins, potentially leading to increased target coverage and reduced normal tissue irradiation.

Seroprevalence of canine herpesvirus-1 and Brucella canis in Finnish breeding kennels with and without reproductive problems

We compared the serological status of Brucella canis and canine herpesvirus-1 (CHV-1) in Finnish breeding kennels with and without reproductive problems. Dogs from kennels with reproductive problems had significantly higher CHV-1 titres than dogs from kennels having no reproductive problems (p < 0.001). In dogs from kennels with reproductive problems 100% (32/32) had positive titres, whereas in dogs from kennels without reproductive problems 65% (22/34) had positive titres. The median titre for dogs from kennels with reproductive problems was 1 : 160 and for dogs from kennels without reproductive problems 1 : 80. The high prevalence of positive CHV-1 titres in this study indicates that prevention of the disease is difficult and reinforces the need to minimize the reproductive problems caused by CHV-1. All 388 dogs from 94 kennels had negative B. canis titres.

Pregnancy Rates in Lactating Holstein-Friesian Cows after Artificial Insemination with Sexed Sperm

The effects of artificial insemination (AI) using sexed sperm on pregnancy rates have seldom been studied in lactating dairy cows on commercial dairy farms. We evaluated pregnancy results after AI of 306 lactating dairy cows, of which 157 were inseminated with 2x10(6) frozen/thawed sexed sperm and 149 with 15x10(6) frozen/thawed unsexed sperm. The average pregnancy and calving rates were 21.0% and 20% for the sexed-sperm AIs and 46% and 45% for the unseparated control-sperm AIs respectively (p<0.001). The proportion of female calves derived from sexed-sperm AI was 82% compared with 49% for control AI (p<0.01). The proportion of live and healthy calves in single births was 100% for sexed-sperm AI and 97% for control AI (p>0.05). Our results indicate that AI with low-dose sexed sperm under field conditions in commercial dairy herds without oestrus synchronization results in significantly reduced pregnancy rates compared with normal-dose AI. Improved insemination strategies combined with increased sperm doses are needed before the use of sexed sperm can be of any significant benefit for the dairy and beef industry.

An improved analytical detector response function model for multilayer small-diameter PET scanners

The optimization of spatial resolution is a critical consideration in the design of small-diameter positron emission tomography (PET) scanners for animal imaging, and is often addressed with Monte Carlo simulations. As a faster and simpler solution, we have developed a new analytical model of the PET detector response function, and implemented the model for a small single-slice, multilayer PET scanner. The accuracy of the model has been assessed by comparison with both Monte Carlo simulations and experimental measurements published in the literature. Results from the analytical model agreed well with the Monte Carlo method, being noise free and two to three orders of magnitude faster. The only major discrepancy was a slight underestimation of the width of the point spread function by the analytical method as inter-crystal scatter is neglected. We observed good agreement between the predictions of the model and experimental measurements. For two large-diameter scanners additional discrepancies were seen due to photon acollinearity, which is not considered in the model. We have shown that the simple and fast analytical detector response function model can provide accurate estimates of spatial resolution for small-diameter PET scanners, and could be a useful tool for several applications, complementing or cross-validating other simulation methods.

Impaired semen quality of AI bulls fed with moldy hay: a case report

The daily quality control of semen at a Finnish artificial insemination (AI) bull station is based on subjective motility and sperm morphology of young bulls entering the semen collection program. Semen quality dropped suddenly in autumn 1998. During 5 consecutive months, the number of rejected ejaculates and discarded frozen semen batches due to poor motility increased, and the number of all forms of abnormal spermatozoa increased. However, for the accepted ejaculates, a 60 day nonretum rate was normal. The summer of 1998 in Finland was rainy, and the hay used in the AI station was visibly moldy. Immunoassay and gas chromatography-mass spectrometry (GC-MS) detected Fusarium mycotoxins HT-2 and T-2, but no zearalenone in the hay. Occurrence of mycotoxins such as T-2 and HT-2 in the moldy hay coincided with, and may have been responsible for the impaired semen quality in AI bulls. This case report will draw the attention to the possible hazards when feeding moldy hay.

A novel automated fluorometric assay to evaluate sperm viability and fertility in dairy bulls

The artificial insemination (AI) industry is in need of an objective and rapid, but inexpensive method to evaluate frozen thawed bull semen ejaculates. This study presents a new fluorescence method that uses an automatized fluorometer and fluorophore stain propidium iodide that stains only those cells with damaged membranes. The fluorescence of the semen sample and the totally killed subsample were measured simultaneously, and viability was calculated. Every semen batch was analyzed before use in AI. For fertility evaluation, the nonreturn rates (NR%) obtained from 92,120 inseminations with the analyzed batches were recorded from 166 bulls (436 batches). This study confirms a 3.9% better NR% for the Finnish Holstein-Friesian breed than for Finnish Ayrshire. There was a clear seasonality in NR%: it differed (5.3%) significantly, being best in summer to autumn (June to October) and lowest in winter (January to March). The fluorometer method was fast and easy. The correlation between the total number of viable spermatozoa in an insemination dose and field fertility was low but significant (r = 0.051, P = 0.016), suggesting that the plasma membrane integrity evaluation can serve as a cost-beneficial quality control method of frozen-thawed semen at bull stations.

Human pharmacokinetic and dosimetry studies of [(18)F]FHBG: a reporter probe for imaging herpes simplex virus type-1 thymidine kinase reporter gene expression

9-[4-[(18)F]fluoro-3-(hydroxymethyl)butyl]guanine ([(18)F]FHBG) has been used as a reporter probe to image expression of herpes simplex virus type-1 thymidine kinase (HSV1-tk) reporter gene in living animals. Our aim was to study the kinetics, biodistribution, stability, dosimetry, and safety of [(18)F]FHBG in healthy human volunteers, preparatory to imaging patients undergoing HSV1-tk gene therapy.

METHODS

[(18)F]FHBG was synthesized with a specific activity of 37,000--444,000 GBq/mmol and a radiochemical purity > 99%. Ten healthy volunteers consented to participate in the study. A transmission scan was obtained before bolus injection of 70.3--229.4 MBq [(18)F]FHBG into a hand vein, followed by dynamic PET imaging with 4 consecutive emission scans. Warmed hand-vein blood was withdrawn at various times after injection for blood time--activity measurements. Electrocardiography, blood pressure, and blood and urine pharmacologic parameters were measured before and after injection of the [(18)F]FHBG tracer (n = 5). The stability of [(18)F]FHBG in the urine was analyzed. Attenuation-corrected images were reconstructed using the ordered-subsets expectation maximization algorithm. Image region-of-interest time-activity data were used with the MIRD program to estimate absorbed radiation dosages.

RESULTS

[(18)F]FHBG had rapid blood clearance; only 8.42% +/- 4.76% (mean +/- SD) of the peak blood activity remained at approximately 30 min. The average ratio of plasma activity to whole-blood activity during the study was 0.91 +/- 0.04. Penetration of [(18)F]FHBG across the blood-brain barrier was not observed. The primary routes of clearance were renal and hepatobiliary. High activities were observed in the bladder, gut, liver, and kidneys, but <0.0002% of the injected dose per gram was observed in other tissues. In the urine, 83% of activity 180 min after injection was stable [(18)F]FHBG. Blood and urine pharmacologic parameters did not change significantly after injection of the [(18)F]FHBG tracer. The bladder absorbed the highest radiation dose.

CONCLUSION

[(18)F]FHBG has the desirable in vivo characteristics of stability, rapid blood clearance, low background signal, biosafety, and acceptable radiation dosimetry in humans. This study forms the foundation for using [(18)F]FHBG in applications to monitor HSV1-tk reporter gene expression.

A comparison of normalization effects on three whole-body cylindrical 3D PET systems

Normalization coefficients in three-dimensional positron emission tomography (3D PET) are affected by parameters such as camera geometry and the design and arrangement of the block detectors. In this work, normalization components for three whole-body 3D-capable tomographs (the GE Advance, the Siemens/CTI962/HR+ and the Siemens/CTI951R) are compared by means of a series of scans using uniform cylindrical and rotating line sources. Where applicable, the manufacturers' normalization methods are validated, and it is shown that these methods can be improved upon by using previously published normalization protocols. Those architectural differences between the three tomographs that affect normalization are discussed with a view to drawing more general conclusions about the effect of machine architecture on normalization. The data presented suggest that uniformity of system response becomes easier to achieve as the uniformity of crystal response within the detector block is improved.

Phase I/II 90Y-Zevalin (yttrium-90 ibritumomab tiuxetan, IDEC-Y2B8) radioimmunotherapy dosimetry results in relapsed or refractory non-Hodgkin's lymphoma

Dosimetry studies in patients with non-Hodgkin's lymphoma were performed to estimate the radiation absorbed dose to normal organs and bone marrow from 90Y-Zevalin (yttrium-90 ibritumomab tiuxetan, IDEC-Y2B8) treatment in this phase I/II, multicenter trial. The trial was designed to determine the dose of Rituximab (chimeric anti-CD20, Rituxan, IDEC-C2B8, MabThera), the unlabeled antibody given prior to the radioconjugate to clear peripheral blood B cells and optimize distribution, and to determine the maximum tolerated dose of 90Y-Zevalin [7.4, 11, or 15 MBq/kg (0.2, 0.3, or 0.4 mCi/kg)]. Patients received (111)In-Zevalin (indium-111 ibritumomab tiuxetan, IDEC-In2B8 ) on day 0 followed by a therapeutic dose of 90Y-Zevalin on day 7. Both doses were preceded by an infusion of the chimeric, unlabeled antibody Rituximab. Following administration of (111)In-Zevalin, serial anterior/posterior whole-body scans were acquired. Major-organ radioactivity versus time estimates were calculated using regions of interest. Residence times were computed and entered into the MIRDOSE3 computer software program to calculate estimated radiation absorbed dose to each organ. Initial analyses of estimated radiation absorbed dose were completed at the clinical site. An additional, centralized dosimetry analysis was performed subsequently to provide a consistent analysis of data collected from the seven clinical sites. In all patients with dosimetry data (n=56), normal organ and red marrow radiation absorbed doses were estimated to be well under the protocol-defined upper limit of 20 Gy and 3 Gy, respectively. Median estimated radiation absorbed dose was 3.4 Gy to liver (range 1.2-7.8 Gy), 2.6 Gy to lungs (range 0.72-4.4 Gy), and 0.38 Gy to kidneys (range 0.07-0.61 Gy). Median estimated tumor radiation absorbed dose was 17 Gy (range 5.8-67 Gy). No correlation was noted between hematologic toxicity and the following variables: red marrow radiation absorbed dose, blood T(1/2), blood AUC, plasma T(1/2), and plasma AUC. It is concluded that 90Y-Zevalin administered at nonmyeloablative maximum tolerated doses results in acceptable radiation absorbed doses to normal organs. The only toxicity of note is hematologic and is not correlated to red marrow radiation absorbed dose estimates or T(1/2), reflecting that hematologic toxicity is dependent on bone marrow reserve in this heavily pretreated population.

Web-based video for real-time monitoring of radiological procedures

A web-based video transmission of images from CT and MRI consoles was implemented in an Intranet environment for real-time monitoring of ongoing procedures. Images captured from the consoles are compressed to video resolution and broadcast through a web server. When called upon, the attending radiologists can view these live images on any computer within the secured Intranet network. With adequate compression, these images can be displayed simultaneously in different locations at a rate of 2 to 5 images/s through a standard local-area network. While the quality of the images was insufficient for diagnostic purposes, our users survey showed that they were suitable for supervising a procedure, positioning the imaging slices, and for routine quality checking before completion of a study. The system was implemented at UCLA to monitor nine CT's and six MRI's distributed in four different buildings. This system significantly improved the radiologists productivity by saving valuable time spent in trips between reading rooms and examination rooms. It also improved patient care and throughput by reducing the time spent waiting for the radiologists to check a study before removing the patient from the scanner.

Fertility parameters in male Irish wolfhounds: a two-year follow-up study

The reproductive performance of 25 male Irish wolfhounds was examined in a two-year follow-up study. Results of a previous study showed that 37 Irish wolfhounds had lower libidos, smaller testicles and poorer semen quality than 67 control dogs examined. This study was undertaken to determine whether fertility parameters had changed after a further two years. Forty-four dogs of 21 breeds were used as controls. No change in libido was observed in either group after two years; the Irish wolfhounds still exhibited lower libidos than the control dogs. In both studies, the Irish wolfhounds showed a softening of testicular tissue with a significantly higher incidence than control dogs. This difference became more marked after two years. Semen quality had declined in Irish wolfhounds and the differences between the two groups became more accentuated. Inbreeding coefficients for the Irish wolfhounds were low, suggesting that this was a factor contributing to the poor reproductive function. However, several Irish wolfhounds had been ill during the follow-up period which, together with the decline in reproductive efficiency, may reflect a change due to ageing.

Testicular fine needle aspiration cytology as a diagnostic tool in dog infertility

The results of testicular aspirate cytology taken from clinical patients with a history of infertility were compared with the clinical and histological findings. Azoospermia was the most common and the most rewarding indication for the examination. Samples were also taken from cases with suspected testicular tumours, orchitis, epididymitis, severe oligo- and teratozoospermia, lack of libido and unilateral testicular atrophy. Histological and cytological findings were found to correlate well. Identification of cell types from normal germinal epithelium was relatively easy. No immediate adverse effects of aspiration were noted. Five normospermic dogs were monitored for two to six months after aspiration, and there were no marked deleterious effects on testicular consistency, testicular histology or semen characteristics. Testicular cytology obtained by fine needle aspiration may, at least to some extent, be used to assist clinical diagnosis, especially in azoospermic dogs and dogs with palpable changes of testicular tissue.

Morphometry of normal and teratozoospermic canine sperm heads using an image analyzer: work in progress

Combining the traditional morphologic evaluation of spermatozoa with computer assisted image analysis adds randomness, objectivity, repeatability and accuracy to morphometric measurements. We collected semen from 10 fertile, normospermic dogs aged 1 to 7 yr and from 3 teratozoospermic breed-matched dogs. Sperm head morphology was examined in Giemsa-stained smears by light microscopy, using a computer-assisted image analyzer and by transmission electron microscopy. We found significant variation in sperm head area, length, width and degree of roundness among normospermic individual dogs, indicating that it would be necessary to examine many more dogs before the size and shape of normal dog spermatozoa could be determined. The normospermic dogs were used as controls for the teratozoospermic cases. Case 1: A 2-yr-old subfertile Cavalier King Charles Spaniel had semen with small and narrow-based sperm heads and a proximal cytoplasmic droplet in most of the spermatozoa. With the image analysis system, sperm heads were shown to be smaller and more oval than in normospermic dogs. The variatons in size and shape were similar in magnitude to those of control dogs. An examined infertile half-brother had similar semen quality. Case 2: A 3-yr-old Petit Basset Griffon Vendeen with 2 unsuccesfull matings exhibited spermatozoa with severe abnormalities. Measured by image analyzer, sperm heads were irregular in shape and very small in area. One of the two littermates examined had semen of the same quality as the case dog. Case 3: A 3-yr-old fertile Golden Retriever had semen with giant sperm heads in about 50% of spermatozoa. Image analyzing results revealed 2 populations of different sized sperm heads. Giant heads consisted of 52.2% of all spermatozoa. The results of the study reported here suggest that the image analysis technique may be useful in evaluating structural changes in sperm morphology, supplementing visual assessment that is used in conventional methods.

Whole-body FDG-PET imaging for staging of Hodgkin's disease and lymphoma

Accurate staging of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) is important for treatment management. In this study, the utility of 2-[18F]fluoro-2-deoxy-D-glucose (FDG) whole-body PET was evaluated as an imaging modality for initial staging or restaging of 7 HD and 11 NHL patients.

METHODS

Whole-body PET-based staging results were compared to the patient's clinical stage based on conventional staging studies, which included combinations of CT of the chest, abdomen and pelvis, MRI scans, gallium scans, lymphangiograms, staging laparatomies and bone scans.

RESULTS

Accurate staging was performed in 17 of 18 patients using a whole-body PET-based staging algorithm compared to the conventional staging algorithm in 15 of 18 patients. In 5 of 18 patients, whole-body PET-based staging showed additional lesions not detected by conventional staging modalities, whereas conventional staging demonstrated additional lesions in 4 of 18 patients not detected by whole-body PET. The total cost of conventional staging was $66,292 for 16 CT chest scans, 16 CT abdominal/pelvis scans, three limited MRI scans, four bone scans, five gallium scans, two laparotomies and one lymphangiogram. In contrast, scans cost $36,250 for 18 whole-body PET studies and additional selected correlative studies: one plain film radiograph, one limited CT, one bone marrow scan, one upper GI and one endoscopy.

CONCLUSION

A whole-body FDG-PET-based staging algorithm may be an accurate and cost-effective method for staging or restaging HD and NHL.

Probable spermatozoal diploidy in the semen of a golden retriever

The semen of a 3-year-old golden retriever was examined for breeding purposes. When the morphology of the spermatozoa was analysed for the first time, 37% were observed to have giant heads. In most of the giant heads, a diadem defect was also found. The dog was successfully used for breeding. On re-examination, the percentage of giant heads was found to be greater than before. The right testicle exhibited tissue softening. To determine the reason for the defect, an aspiration needle biopsy was performed and ultrasound examination undertaken. In the biopsy smears, both normal spermatozoa and spermatozoa with giant heads were found. On ultrasonography, the echogenicities of both testicles were the same, and normal. DNA flow cytometry was performed to determine the DNA content of the spermatozoa. Two populations of sperm cells were detected, one having a median fluorescent intensity twice as high as that of normal spermatozoa, suggesting a diploid DNA content. Transmission electron microscopy (TEM) was performed to find out whether the altered intensity correlated with the ultrastructure of the spermatozoa. The nuclei of the sperm heads showed a normal chromatin condensation. Semen quality became worse over a period of 2 years, with 60% giant heads in the last sample. The process was considered to be progressive spermatogenic degeneration with diploidy. Relatives examined did not suggest any hereditary predisposition to the problem. The male was still fertile at the time of the last sample collected and sired a litter of 10 healthy puppies.

Poor semen quality in Irish wolfhounds: a clinical, hormonal and spermatological study

On the basis of clinical observations, Irish wolfhounds were suspected as being subject to a relatively high incidence of soft testicular consistency and low semen quality. Thirty-seven Irish wolfhounds and 67 dogs of other breeds (control group) were therefore examined. Conventional andrological studies were performed in both groups, these included libido testing, palpation and measurement of testes and semen evaluation. Semen evaluation was performed both manually and by videomicrographic analysis. Testosterone concentrations were measured both before and after human chorionic gonadotropin challenge in the Irish wolfhounds. The Irish wolfhounds had lower libidos than the control group. More Irish wolfhounds (21.2 per cent) exhibited low semen quality than the control group (6.1 per cent). Soft testicular consistency occurred more frequently in Irish wolfhounds (25.7 per cent) than in the control group (10.5 per cent). In the control group, bodyweight correlated significantly with total sperm count. Serum testosterone concentration did not correlate with semen quality parameters.

Simultaneous dual-isotope technetium-99m/thallium-201 cardiac SPET imaging using a projection-dependent spilldown correction factor

A spilldown correction method is proposed for the thallium-201 window image in simultaneous dual-isotope technetium-99m/thallium-201 single-photon emission tomographic (SPET) imaging based on a single acquisition into three energy windows. In this method, images are simultaneously acquired in two standard energy windows over the 99mTc and 201Tl photopeak regions and a third spilldown window adjacent to the 201Tl window. Using a Monte Carlo simulation of SPET, the fractional amount of 99mTc and 201Tl spilldown in the 201Tl window with respect to the total counts from the spilldown window, k12, was calculated for simulated images of point sources at varying depths within a water-filled elliptical tub phantom. When applied to experimental acquisitions, k12, multiplied by the total counts from the spilldown window, is then subtracted from the 201Tl window image to produce the corrected image. However, for successful applications in SPET, k12 must be determined on a projection-by-projection basis since k12 is depth dependent. Thus, a regression relation was obtained between k12 and the total count ratio of the spilldown to 99mTc windows, k23. The spilldown correction method was applied to 201Tl photopeak images of an extended source distribution in uniform and nonuniform attenuating media with dual-isotope 99mTc/201Tl and single-isotope 201Tl. A marked improvement in image contrast was observed between the corrected and uncorrected 201Tl window images. The average count ratio of uncorrected dual-isotope 201Tl/single-isotope 201Tl was 3.08 for uniform and 2.99 for non-uniform attenuating media.(ABSTRACT TRUNCATED AT 250 WORDS)

Methodological aspects of brain activation studies: cerebral blood flow determined with [15O]butanol and positron emission tomography

In this methodological study, a procedure for measuring regional CBF (rCBF) with positron emission tomography and 15O-labelled tracers is optimized. Four healthy volunteers were subjected to eight studies with use of [15O]butanol as a tracer: four times while reading aloud and four times while reading silently from a phonologically balanced list of single words. The gain from these repeated intra-individual studies of the same activation state (fractionation) was demonstrated in terms of noise-equivalent counts in a phantom study. A computerized brain atlas was used to reformat the images to a common anatomical representation, thereby minimizing the effects of inter- and intra-individual anatomical and positional variations. This allowed the formation of inter- and intra-individual average subtraction images with error estimates. Differences between the two activation states were detected with use of an exploratory significance map based on a paired Student's t test. The results compared well with Friston's method of determining levels of statistical significance. No difference was obtained when comparing results from rCBF images and images generated from measurement of uptake of the tracer. The paradigm chosen for activation was shown to yield a constant activation level during the repeated measurements (i.e., no habituation).

The ECAT EXACT HR: performance of a new high resolution positron scanner

OBJECTIVE

The ECAT EXACT HR is a newly designed CTI-Siemens PET scanner with high spatial resolution. Its physical performance with respect to resolution, count rate efficiency, and scatter was investigated and evaluated with phantom studies.

MATERIALS AND METHODS

The new tomograph consists of three rings of 112 BGO block detectors (50 mm x 23 mm x 30 mm deep) each, covering an axial field of view of 15 cm with a patient port of 56 cm diameter. Each block is sawed into an 8 x 7 matrix giving 24 detector rings with 784 crystals each.

RESULTS

Total sensitivity for a 20 cm cylinder phantom is 177 kcps/microCi/ml in two-dimensional (2D) mode and increases to 1.46 Mcps/microCi/ml in 3D mode. Count rate performance was investigated for different low energy discriminator thresholds. Smaller detector blocks improve noise equivalent counts by approximately 50% compared with the EXACT system both in 2D and in 3D mode. Scatter fractions vary in 2D from 0.09 to 0.13 for energy thresholds from 450 to 250 keV for line sources in a 20 cm diameter phantom. In 3D mode an increase of scatter by a factor of 3 is observed. Transaxial spatial resolution varies from 3.6 mm full width at half-maximal (FWHM) at the center to 4.5 mm FWHM tangentially and 7.4 mm FWHM radially at R = 20 cm. Average axial resolution changes from 4.0 mm FWHM at center to 6.7 mm FWHM at R = 20 cm.

CONCLUSION

Due to its special properties, the EXACT HR can be equally applied to routine clinical brain and whole-body imaging and to noninvasive experimental studies of regional tracer concentrations in medium-sized animals.

Automated iterative three-dimensional registration of positron emission tomography images

Two types of image similarity measures, the sum of absolute differences (SAD) and the stochastic sign change (SSC), were compared for three-dimensional registration of images from PET. To test the accuracy of both registration methods, 30 FDG brain studies, 40 13N-ammonia cardiac studies and 20 FDG liver tumor studies (where each image set contained 15 image planes, 128 x 128 pixels per plane) were made into worse case conditions by creating image sets of low counts and extreme defects. These images were then registered to the reference images that had been moved in three dimensions into a random set of known translations, rotations and normalization factors (x, y, z, theta, rho, sigma, nf). Neither method required any external fiduciary markers or operator interventions to register a set of images. The optimization of the image similarity (using the SAD or SSC) was performed with the simplex method and registration was completed within 10 min of computation time on a low-end workstation. Overall, the SAD method had an average inplane (x, y) registration error of 0.5 +/- 0.5 mm, a z-axis registration error of 1.1 +/- 1.1 mm, an inplane rotational error of 0.5 +/- 0.4 degrees, an out-of-plane rotational error of 1.1 +/- 1.2 degrees and a normalization factor error of 0.015 +/- 0.016. The SSC method had an average inplane (x, y) registration error of 0.6 +/- 0.5 mm, a z-axis registration error of 1.1 +/- 1.1 mm, an inplane rotational error of 0.7 +/- 0.5 degrees, an out-of-plane rotational error of 1.0 +/- 1.2 degrees and a normalization factor error of 0.014 +/- 0.014. This study demonstrates that either the SAD or SSC method for measuring image similarity, combined with the simplex method for function optimization, are accurate methods for registration of a wide variety of PET images including low count studies and those with marked interval changes in the pattern of count distribution.

Cancer detection with whole-body PET using 2-[18F]fluoro-2-deoxy-D-glucose

OBJECTIVE

This study was done to determine the feasibility and potential utility of whole-body PET using the glucose analogue 2-[18F]fluoro-2-deoxy-D-glucose (FDG) for the detection of primary malignancies and metastatic lesions.

MATERIALS AND METHODS

This was a prospective, nonrandomized study of whole-body FDG-PET imaging carried out at a large university teaching hospital in Los Angeles, CA, U.S.A. The study group consisted of all patients referred for PET imaging (87) with a suspected diagnosis of primary or recurrent malignancy and who had eventual histological confirmation of their lesions.

RESULTS

In the 87 patients, whole-body PET studies were positive (presence of focal FDG uptake relative to surrounding tissues uptake) in 61 of 70 patients (87%) with subsequent biopsy-confirmed primary or recurrent malignant lesions, including carcinomas of breast, lung, ovary, prostate, colon, urinary bladder, and gallbladder origin, as well as malignant melanoma, carcinoid, osteosarcoma, lymphoma, and spinal cord astrocytoma. The PET images revealed no focal hypermetabolism at the known site of tumor in patients with primary prostate carcinoma (two), microscopic ovarian carcinoma (two), breast carcinoma (one), low-grade carcinoid tumors (two), and one patient with recurrent microscopic osteogenic sarcoma. The PET studies detected the primary lesion in 15 of 17 patients with breast carcinoma and in 6 of 6 patients with primary lung carcinoma. Of the 17 patients with benign biopsies, 13 patients had FDG-PET studies without focal areas of uptake.

CONCLUSION

Because of the high glycolytic rate of malignant tissue, the whole-body FDG-PET technique has promise in the detection of a wide variety of both primary and metastatic malignancies. The presence of FDG uptake in benign inflammatory conditions may limit the specificity of the technique. The sensitivity for the detection of malignant lesions was 87% and the positive predictive value was 94%. The whole-body FDG-PET method is promising both in determining the nature of a localized lesion and in defining the systemic extent of malignant disease.

Imaging of pulmonary mass lesions with whole-body positron emission tomography and fluorodeoxyglucose

BACKGROUND

The clinical staging and management of both primary and metastatic lung lesions depends on accurate imaging techniques. Biochemical imaging with positron emission tomography, (PET), and the glucose analog 2-[18F]-fluoro-2-deoxy-D-glucose, (FDG), complements anatomic imaging with conventional radiologic methods.

METHODS

A new "whole-body" PET FDG technique that produces two-dimensional, nontomographic and tomographic longitudinal images of the entire body has been developed at UCLA. Sixteen patients with known pulmonary nodules who had undergone thoracic computed tomography (CT) were studied with whole-body PET FDG imaging at the UCLA Medical Center.

RESULTS

This PET FDG imaging method identified metabolically active tumor foci in all eight patients with bronchogenic carcinomas, four patients with metastatic lesions to the thorax, and two patients with Hodgkin disease. All diagnoses were confirmed histologically. Additionally, the PET FDG technique detected extrathoracic metastases in 4 of 16 patients. Thoracic CT was not diagnostic of neoplasm in two of the eight patients with bronchogenic carcinomas. In one patient with an ACTH-producing bronchial carcinoid, the lesion ultimately was detected on high-resolution CT but was not metabolically active on PET FDG imaging.

CONCLUSIONS

This is the first report of whole-body PET FDG imaging in patients with thoracic lesions. PET FDG imaging accurately detected metabolically active tumor (both intrathoracic and extrathoracic) in patients with bronchogenic carcinoma, pulmonary metastatic disease, and Hodgkin lymphoma. Because lung cancer is characteristically a multisystem disease, this whole-body PET FDG technique has significant implications for treatment planning.

A simplified method for quantification of myocardial blood flow using nitrogen-13-ammonia and dynamic PET

The utility of Patlak graphical analysis was investigated for quantification of regional myocardial blood flow (MBF) and for generating parametric images of MBF with 13N-ammonia and dynamic PET imaging in dogs and humans. MBF was estimated by a two-compartment model fit of the initial 2 min of the kinetic data and by Patlak graphical analysis of the initial 2, 3, or 4 min of data. In 11 dog studies, MBF by compartmental model fitting linearly correlated with MBF by microspheres (correlation coefficient (r) = 0.99, slope = 0.92) and by Patlak graphical analysis (r = 0.99, slope = 0.90). In 10 normal human studies, MBF obtained by the Patlak graphical analysis agreed well with MBF obtained by the compartmental model fitting (r = 0.96, slope = 1.04). Good agreement of the MBF estimates was also observed in 10 coronary artery disease patient studies (r = 0.96). Patlak graphical analysis permitted generation of parametric images of MBF. The parametric images of MBF, in units of ml/min/g, are of good image quality and have relatively low noise levels. We conclude that regional MBF can be noninvasively and conveniently measured with dynamic 13N-ammonia PET using either a two-compartment model or Patlak graphical analysis. MBF parametric images generated with the Patlak graphical analysis both map the distribution and quantitate the magnitude of myocardial perfusion abnormalities.

Attenuation correction using count-limited transmission data in positron emission tomography

Poisson noise in transmission data can have a significant influence on the statistical uncertainty of PET measurements, particularly at low transmission count rates. In this paper, we investigate the effect of transmission data processing on noise and quantitative accuracy of reconstructed PET images. Differences in spatial resolution between emission and transmission measurements due to transmission data smoothing are shown to have a significant influence on quantitative accuracy and can lead to artifacts in the reconstructed image. In addition, the noise suppression of this technique is insufficient to greatly reduce transmission scan times. Based on these findings, improved strategies for processing count-limited transmission data have been developed, including a method using segmentation of attenuation images. Using this method, accurate attenuation correction can be performed using transmission scan times as low as 2 min without increasing noise in reconstructed PET images.

Whole body skeletal imaging with [18F]fluoride ion and PET

Using our recently reported whole body PET imaging technique, we performed whole body PET studies of the skeletal system with [18F]fluoride ion in 19 patients with a range of malignant and benign skeletal conditions and in 19 normal male volunteers. The technique produces two-dimensional projection images of the entire skeletal system ("a PET bone scan"), in addition to coronal, sagittal, and axial tomographic images of the skeletal system. The tomographic images had a 13% higher lesion detection sensitivity than the projection images. Whole body PET skeletal imaging with [18F]fluoride ion is technically feasible, provides images of excellent quality, and may be coupled with more quantitatively precise kinetic PET [18F]fluoride ion studies (over limited regions of the body) when numerical estimates of skeletal [18F]fluoride ion uptake are desired. The method is potentially useful in clinical applications where the high resolution and numerical precision of PET are of particular value (e.g., in accurately defining the anatomic location and extent of lesions and in assessing changes in bone metabolism on serial studies).

The role of positron emission tomography in oncology and other whole-body applications

Imaging and quantifying biochemical and physiological processes with PET clearly has major potential significance for all organ systems and many disease states. Although the full utility and potential of emerging new applications of PET in organs other than the heart and brain must be demonstrated in basic and clinical research studies, the rapidly accumulating aggregate experience in oncology in particular, and in other organ systems and disease states as well, indicates that PET is now truly becoming a modality of both clinical and investigative use for the body as a whole as well as for specific organ systems. Whole-body PET FDG imaging (Fig 9) illustrates the potential of biochemical imaging to map the distribution of cancer throughout the body. With the growing list of radiopharmaceutical and quantitative techniques applicable to cancer studies with PET, this field will continue to realize significant growth.

The application of positron emission tomographic imaging with fluorodeoxyglucose to the evaluation of breast disease

Positron emission tomography (PET) is a computer-aided tomographic imaging technique that uses positron-emitting compounds to trace biochemical processes of tissue, and construct images based on them. The authors applied a whole-body PET imaging technique to patients with breast masses or mammographic abnormalities using the isotope 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG), in a clinical trial to evaluate the feasibility of using PET to identify primary breast cancer, axillary lymph node involvement, and systemic metastases, before surgical resection. Fourteen patients have been entered on this study, 10 of whom proved to have breast cancer. Positron emission tomography correctly predicted the nature of 12 of the 14 primary breast lesions, and correctly determined the lymph node status of 11 of the 14 patients. The authors conclude that PET with FDG has potential as a diagnostic modality for detection of primary breast cancer, particularly in the patient with radiodense breasts by conventional mammography, and that it has potential for the preoperative identification of axillary lymph node metastases.

Whole-body positron emission tomography: Part I. Methods and performance characteristics

Methods for whole-body PET imaging have been developed to provide a clinical tool for the detection and evaluation of primary and metastatic cancers. The axial FOV of the PET system is extended by imaging at multiple bed positions to cover the whole body. In typical rectilinear PET scans, only a small fraction of the data is collected to form two-dimensional projection images. In this work, 100% of the projection data was collected to form the two-dimensional projection images. These projection images were generated for continuous angles over 180 degrees by resorting sinogram data. In addition, tomographic images were formed by using filtered backprojection reconstruction without attenuation correction. Coronal and sagittal cuts were then extracted from the three-dimensional data set. The tomographic images were reconstructed to a resolution of 10.8 mm in all dimensions because of statistical limitations of the data. Both methods of image formation resulted in images of high quality with the tomographic reconstruction providing the highest contrast and resolution. An acquisition time of 1-2 min/bed position after a 10-mCi injection of [18F]fluoride ion or [18F]FDG was found to give a sufficient number of counts for producing images of good resolution and contrast, from a total scanning time of 32-64 min.

Evaluation of the skeletal kinetics of fluorine-18-fluoride ion with PET

To evaluate the feasibility of quantitatively assessing regional skeletal fluoride uptake in humans in focal and generalized bone disease, we investigated the skeletal kinetics of [18F]fluoride ion with dynamic PET imaging. Dynamic image sets were acquired over a 60-min interval in a multiplane PET device, and input functions (plasma 18F time-activity curves) were measured directly from arterialized blood and, in some cases, determined from image-derived left ventricular cavity activity measurements. Our results indicate: 1. A steady-state ratio of [18F]fluoride ion concentration in plasma to whole blood greater than unity (1.23 for plasma to directly assayed whole blood and 1.44 for plasma to left ventricular cavity imaged concentrations. This concentration difference produces a scaling factor that must be considered when using image derived or directly measured input functions. 2. The preferred tracer kinetic model configuration for [18F]fluoride ion skeletal kinetics is a three compartment model that includes a "bound" and "unbound" bone [18F]fluoride ion compartment. 3. The rate constant for forward transport of [18F]fluoride ion from plasma to the extravascular space of bone (K1) and the regional blood volume parameter generate estimates of bone blood flow and vascular volume, respectively, that are in the physiologic range of reported for mammals. Estimates of the uptake constant for fluoride in bone, using nonlinear regression (KNLR = 0.0360 +/- 0.0064 ml/min/ml), are in very good agreement with an estimate of the same parameter obtained with Patlak graphical analysis (KPAT = 0.0355 +/- 0.0061 ml/min/ml). 4. Generating parametric images of KPAT facilitates quantification of regional bone [18F]fluoride ion kinetics. The method is computationally practical, and, with either the parametric imaging approach or with standard region of interest analysis, can be used to generate quantitative estimates of fluoride uptake (a "bone metabolic index") in focal skeletal regions or in more generalized distributions.

Evaluation of a 3D reconstruction algorithm for multi-slice PET scanners

A fully 3D reconstruction algorithm based on filtered backprojection was evaluated for the reconstruction of data obtained with multi-slice positron emission tomography (PET) scanners which have had the septa removed. This algorithm uses forward-projection through the reconstructed images of a 2D subset of the data to complete the 3D dataset thus satisfying the condition of shift invariance. This is followed by 3D filtered backprojection. Axial sampling was doubled by combining adjacent polar angles, thus improving reconstructed axial resolution. The algorithm was tested using real and simulated datasets and gave high quality reconstructions without artifacts over a wide range of imaging conditions. Events are placed accurately throughout the imaging volume as determined by measurements with a MRI/PET registration phantom. The forward-projection step leads to degradation in image resolution due to insufficient axial and transaxial sampling. This effect is amplified if multiple iterations of the algorithm are used, with little decrease in image noise. Changing the filter employed in the initial 2D reconstruction can be used to alter the noise and resolution characteristics of the 3D images. This algorithm has proved very robust at reconstructing 3D PET data and is relatively fast. Those small problems which exist can be attributed to detector sampling problems, especially in the axial direction, which is a consequence of the geometry of these scanners, which are designed primarily for 2D data acquisition.

3D PET using a conventional multislice tomograph without septa

A conventional multislice positron emission tomography scanner was modified to operate without interplane septa to evaluate its performance in collecting and reconstructing data in a three-dimensional (3D) format, thereby significantly increasing system sensitivity. A 3D filtered backprojection algorithm was implemented and tested, using both computer simulations and phantom measurements. No artifacts were apparent in the test images, although the algorithm was shown to lead to a 11% degradation in transaxial resolution in the outer planes. Following septa removal, sensitivity was found to increase by a factor of 7 with an increase in scatter fraction from 16 to 41%. Axial resolution degraded from 6.9 to 7.7 mm full width at half maximum at the center of the field of view. The maximum count rate without septa was 2.4 x 10(5) cps, at a concentration of 0.4 microCi/ml, compared with 1.3 x 10(5) cps at 1.5 microCi/ml with septa. Brain studies were performed with volunteers using 18F-fluorodeoxyglucose, 18F-fluorodopa, and H2 15O to compare noise-equivalent count rates and qualitatively assess image quality over a wide range of imaging conditions.

Geometric mispositioning in positron emission tomography

The phenomenon of geometric mispositioning (defined as having a geometric proper plus a parallax component) was studied and characterized on Neuro- and whole body PET systems employing 2-D modular detectors (CTI/Siemens ECAT-831/08 and 931/08) as well as an older system (CTI ECAT-911). Measurements taken with precisely spaced line sources showed image distortions of objects away from the center of the field of view (FOV), with global mispositionings of -1.4, 1.5 and 14 mm (931 and 911), and -0.5, 10 mm (831) at 10, 20 and 30 cm (931 and 911) and 10, 20 cm (831) from the center of the FOV. Structures as close as 5 cm (931/911) or 4 cm (831) to the center of the FOV are mispositioned by more than 1 mm. This is clearly inacceptable in cases where accurate correlation of PET and NMR images is needed to acquire anatomical information in neurological studies, or when gated cardiac studies are performed in order to precisely determine myocardial wall thickness. A fast, on-line geometric correction was performed by creating new, uniformly spaced sinograms to be mapped to the original sinograms. Geometric mispositioning was mathematically derived, while parallax mispositioning was estimated by a linear fit of the data partially corrected for sampling non-uniformity. Our correction technique can be easily tailored to any PET system available on the market.

Positron emission tomography--a new technique for studies of the central nervous system

Positron emission tomography (PET) has become an important tool to study the central nervous system. Examples of such studies are cerebral blood flow and metabolism and determination of receptor characteristics of the brain. In the following the basic principles and the physics behind PET are given. Different aspects are discussed such as detector design, image reconstructions and data analyses. Since quantification is essential in PET, data have to be corrected for absorption, scatter and random coincidences. These corrections and their influence on image data are discussed. A review of state-of-the-art PET research of the brain is given.

The C15O2 build-up technique to measure regional cerebral blood flow and volume of distribution of water

A new method to measure regional CBF (rCBF) and volume of distribution of water is presented. It centres on recording the tissue build-up and retention of 15O-labelled water during the continuous inhalation of 15O-labelled carbon dioxide. Simultaneously, the arterial concentration is continuously monitored, and corrections for delay and dispersion in the recorded response are made by curve fitting. The values for the volume of distribution of water obtained in four normal subjects were close to reported in vitro values. Using the same fixed distribution volumes for both build-up and steady-state studies resulted in comparable rCBF values for both techniques.

A preliminary evaluation of the Scanditronix PC2048-15B brain scanner

The PC2048-15B is the brain version of the new generation of Scanditronix positron camera systems. It is based on a detection unit with 16 scintillating crystals mounted on 2 dual photomultiplier tubes. A system description is given and preliminary test results including spatial resolution, sensitivity to true and random coincidences, scatter correction, and count rate linearity are presented.

Scatter fraction: measurement and correction

The concept of scatter in Positron Emission Tomography is reviewed regarding origin and influence on data. Different ways to measure and correct for scatter are discussed.

Validation of PET-acquired input functions for cardiac studies

To validate the determination of the arterial input function by noninvasive dynamic PET imaging, measurements of blood-pool activity in canine LV by PET were compared to beta probe measurements of arterial blood withdrawn directly from the LV. PET scans were done during intravenous bolus injections of [13N]ammonia or 82Rb, while the activity of blood withdrawn continuously from a catheter inserted in the LV was measured with a beta probe. PET determinations of LV blood-pool activity were compared with dispersion-corrected beta probe time-activity curves. In 15 experiments involving four dogs under a wide range of physiologic conditions, LV time-activity curves obtained with PET matched well in shape with those obtained with the beta probe. Linear regression yielded slopes within 10% of unity (95% confidence interval) and high correlation (r greater than 0.968, p less than 0.001). We conclude that noninvasive measurement of the arterial input function by dynamic PET imaging is valid.