Caspase-9 inhibitor Z-LEHD-FMK enhances the yield of in vitro produced buffalo (Bubalus bubalis) pre-implantation embryos and alters cellular stress response

The present investigation was done to study the effect of caspase-9 inhibitor Z-LEHD-FMK, on in vitro produced buffalo embryos. Z-LEHD-FMK is a cell-permeable, competitive and irreversible inhibitor of enzyme caspase-9, which helps in cell survival. Buffalo ovaries were collected from slaughterhouse and the oocytes were subjected to in vitro maturation (IVM), in vitro fertilization (IVF) and in vitro culture (IVC). The culture medium was supplemented with Z-LEHD-FMK at different concentrations i.e. 0 μM (control), 10 μM, 20 μM, 30 μM and 50 μM during IVM and IVC respectively. After day-2 post-insemination, the cleavage rate was significantly higher (74.20 ± 5.87% at P<0.05) in the group treated with 20 μM of Z-LEHD-FMK than at any other concentration. Same trend was observed in the blastocyst production rate which was higher at 20 μM (27.42 ± 2.94% at P<0.05). The blastocysts obtained at day-8 of the culture at different concentrations were subjected to TUNEL assay, to determine the level of apoptosis during the culture medium supplied with 20 μM Z-LEHD-FMK which showed apoptotic index significantly lower (1.88 ± 0.87 at P<0.05). There was a non-significant increase in total cell number in all Z-LEHD-FMK treated blastocysts. The quantitative gene expression of CHOP and HSP10 genes showed significant increase (P<0.05) in the group treated with 50 μM Z-LEHD-FMK, while, HSP40 showed significant increase (P<0.05) at 30 μM and 50 μM Z-LEHD-FMK concentrations. From the afore mentioned results we conclude that, Z-LEHD-FMK at 20 μM increased the cleavage and blastocyst rate of buffalo pre-implantation embryos also affecting the rate of apoptosis and cellular stress at various concentrations.

Early diagnosis of skin cancer based on segmentation and measurement of vascularization and pigmentation in Nevoscope images

This work presents techniques developed for automated image segmentation and classification of skin lesions as malignant or benign based on the ground truth. For each skin lesion two images are obtained, one in each of two different modalities of epiluminescence microscopy (ELM): side-transillumination which highlights the subsurface vasculature and surface pigmentation, and cross polarization, which only highlights the details of skin surface pigmentation. The automated procedure consists of three steps: i) Segmentation of images, using three segmentation methods; ii) Selection of the most accurate segmentation results based on a weighted scoring technique; and iii) classification of the lesion as malignant or benign by verifying the presence of a ring of hypervascularity around the lesion in the side transillumination images. The segmentation results were validated against manual segmentation by an expert and the malignancy results were validated against the result from pathology.

A precise, three-dimensional atlas of myocardial perfusion correlated with coronary arteriographic anatomy

To map precise myocardial perfusion anatomy, we correlated detailed coronary arteriographic anatomy for every coronary artery and all secondary branches in the heart that had flow-limiting stenosis with corresponding specific, circumscribed, myocardial perfusion defects by positron emission tomography. Eight hundred ninety-five patients with abnormal coronary arteriograms showing any visible coronary artery narrowing of greater than 10% diameter stenosis underwent positron emission tomography perfusion imaging at rest and after dipyridamole stress; the data obtained were processed automatically into 3-dimensional topographic displays of relative radionuclide uptake in anterior, septal, left lateral, and inferior quadrant views, without attenuation artifacts, depth-dependent resolution, or spatial distortion of polar displays. The selection criterion for detailed anatomic analysis was the presence of a discrete, localized, moderate to severe, dipyridamole-induced perfusion defect, defined by automated algorithms as 1 quadrant view outside 2 SDs of healthy control subjects with which a specific stenotic coronary artery and/or its secondary branches could be correlated unequivocally on the coronary arteriogram for mapping precise perfusion anatomy, not for determining sensitivity or specificity. Because the anatomy of myocardial perfusion is inherently not statistical data, the results are presented as a summary atlas and series of individual cases that illustrate myocardial perfusion anatomy. Because the patterns of myocardial perfusion anatomy were derived from a large number of subjects, the atlas provides generalized information, not previously published, that correlates detailed arteriographic anatomy with perfusion anatomy including secondary diagonal, marginal, and posterior descending branches of the coronary arteries.

9:45-10:00. Superimposition of EBCT Determined Coronary Calcium Deposits onto Myocardial PET Perfusion Images by Rubidium-82 and Nitrogen-13 Ammonia for Assessment of Flow Limiting Defects

Calcium localization by Electron Beam CT (EBCT) in the coronary arteries is becoming an important non-invasive method for screening asymptomatic patients for early coronary atherosclerosis. However, the relationship between coronary artery calcium deposits and myocardial perfusion abnormalities has not been established. We have developed software to superimpose location of coronary calcium by EBCT onto PET myocardial perfusion images, so that we can determine the role of location and amount of calcium in the arteries to flow-limiting perfusion defects by PET.EBCT and PET transaxial images are each first converted to three-dimensional arrays of 1 mm voxels. The resulting two image volumes sets are displayed so that a vertical line can be drawn from the clavicle to the spine for proper rotation of the body. The rotated images are then displayed superimposed and are shifted in the vertical, horizontal, and the long axis directions to co-register the EBCT and PET images. The EBCT images are windowed for calcium Houndsfield numbers and calcium location is added to the PET images as a maximum intensity value in the image. The modified PET image volume is then translated back to the PET data format and reprocessed using cardiac analysis software such that the calcium location is superimposed on the PET myocardial perfusion images.Preliminary results of the PET-EBCT superimposition program correlate with location of coronary calcium by EBCT and PET perfusion defects following stress. This technique may be useful for identifying flow-limiting calcium deposits in the coronary arteries.

Frequency and clinical implications of fluid dynamically significant diffuse coronary artery disease manifest as graded, longitudinal, base-to-apex myocardial perfusion abnormalities by noninvasive positron emission tomography

BACKGROUND

Diffuse coronary atherosclerosis is the substrate for plaque rupture and coronary events. Therefore, in patients with mild arteriographic coronary artery disease without significant segmental dipyridamole-induced myocardial perfusion defects, we tested the hypothesis that fluid dynamically significant diffuse coronary artery narrowing is frequently manifest as a graded, longitudinal, base-to-apex myocardial perfusion abnormality by noninvasive PET.

METHODS AND RESULTS

In this study, 1001 patients with documented coronary artery disease by coronary arteriography showing any visible coronary artery narrowing underwent rest-dipyridamole PET perfusion imaging. Quantitative severity of dipyridamole-induced, circumscribed, segmental PET perfusion defects was objectively measured by automated software as the minimum quadrant average relative activity indicating localized flow limiting stenoses. Quantitative severity of the graded, longitudinal, base-to-apex myocardial perfusion gradient indicating fluid dynamic effects of diffuse coronary artery narrowing was objectively measured by automated software as the spatial slope of relative activity along the cardiac longitudinal axis.

CONCLUSIONS

In patients with mild arteriographic disease without statistically significant dipyridamole-induced segmental myocardial perfusion defects caused by flow-limiting stenoses compared with normal control subjects, there was a graded, longitudinal, base-to-apex myocardial perfusion gradient significantly different from normal control subjects (P=0. 001) that was also observed for moderate to severe dipyridamole-induced segmental perfusion defects (P=0.0001), indicating diffuse disease underlying segmental perfusion defects; 43% of patients with or without segmental perfusion defects demonstrated graded, longitudinal, base-to-apex perfusion abnormalities beyond +/-2 SD of normal control subjects, indicating diffuse coronary arterial narrowing by noninvasive PET perfusion imaging.

Simple and Patlak models for myocardial blood flow measurements with nitrogen-13-ammonia and PET in humans

The Simple and Patlak models for estimating myocardial blood flow with 13N-ammonia have become attractive for clinical applications with PET because of their simplicity and ease of implementation. However, these models are sensitive to factors such as the data acquisition times and data integration times, which can cause errors in the estimation of myocardial blood flow, as demonstrated in this study. Limiting the application of these models to specific conditions can minimize the errors.

METHODS

Dynamic PET images of the uptake of 13N-ammonia in the heart were obtained in seven humans under rest and dipyridamole stress. Myocardial blood flow was estimated using the Simple and Patlak models for different data acquisition times and data integration times. Blood flow values were compared to flow values computed with the two-compartment model as a reference.

RESULTS

Blood flow values calculated with the Simple and Patlak models during the first 2 min of data acquisition were closely correlated to the two-compartment model values. Longer acquisition times resulted in significant underestimation of blood flow for the Simple model. Long integration times of greater than 60 sec also resulted in significant underestimation of blood flow for both models.

CONCLUSION

The Simple and Patlak models produce estimates of myocardial blood flow that are well correlated with the two-compartment model estimated blood flows for the integration time of 60 sec from 60 to 120 sec postinjection. Because of the errors associated with longer data acquisition times and longer integration times, use of these models should be limited to a well-documented data acquisition paradigm.

Coronary flow and flow reserve by PET simplified for clinical applications using rubidium-82 or nitrogen-13-ammonia

To validate routine, noninvasive determination of absolute myocardial perfusion and coronary flow reserve (CFR), cardiac PET was performed in animals using a simplified imaging protocol, high-dose dipyridamole and a simplified quantitative algorithm specific for 82Rb and 13N-ammonia.

METHODS

One hundred thirty-five PET scans were obtained in eight dogs after intravenous 13N-ammonia or 82Rb using serial dynamic PET or a simple two-image dataset. A simple flow model using the two-image dataset was developed for each radionuclide to account for varying arterial input function, flow-dependent myocardial extraction and increased permeability surface area (PS) product due to capillary recruitment at high flows not incorporated into previous models. Myocardial perfusion by the simple model was compared to standard, complete, two-compartment kinetic models validated by comparison to electromagnetic flow meter.

RESULTS

For 13N-ammonia, myocardial perfusion by the simple PET model correlated with that by complete compartmental analysis of multiple serial PET images with r = 0.94, slope = 0.96; CFR by compartmental analysis correlated with CFR by electromagnetic flow meter with r = 0.94, slope = 0.97. For 82Rb, myocardial perfusion determined by the simple model correlated with that determined by complete compartmental analysis of multiple serial PET images with r = 0.98, slope = 1.06; CFR determined by compartmental analysis correlated with CFR by electromagnetic flow meter with r = 0.88, slope = 1.13.

CONCLUSION

A simplified PET protocol using 13N-ammonia or 82Rb and simple flow models provide noninvasive measurement of CFR up to six times baseline flow throughout the heart and diagnostic image quality for routine clinical application.

Demonstration of hypoperfusion surrounding intracerebral hematoma in humans

We undertook this study to determine whether ischemic regions are present that may contribute to poor outcome after intracerebral hemorrhage (ICH) in humans. Hypoperfusion around an ICH has not been reported in humans. Brain computed tomography (CT) and (99m)Tc-HMPAO brain single photon emission computed tomography (SPECT) perfusion studies were carried out 51 +/- 12 hours after supratentorial ICH in seven patients selected from a referral hospital over an 8-month period. The widest diameters of the hematoma on CT and of reduced perfusion on SPECT were measured and compared. The diameters of reduced perfusion were measured at the 40% and 20% reduced count levels compared with the contralateral side. Reduced perfusion in and around the hematoma was seen in all seven cases. The diameters of ICH on CT (mean, 53 +/- 12 mm) were comparable to the diameters of 40% reduction of counts (mean, 61 +/- 14 mm) measured by SPECT. The mean diameter of brain demonstrating 20% reduction in counts was 76+/-19 mm, which was 43% greater than the hematoma diameter on CT (p = .004). In conclusion, substantial regions of reduced perfusion surround ICH in humans, which might contribute to poor outcome and be amenable to anti-ischemic therapy.

Brain glucose metabolism in chronic marijuana users at baseline and during marijuana intoxication

Despite the widespread abuse of marijuana, knowledge about its effects in the human brain is limited. Brain glucose metabolism with and without delta 9 tetrahydrocannabinol (THC) (main psychoactive component of marijuana) was evaluated in eight normal subjects and eight chronic marijuana abusers with positron emission tomography. At baseline, marijuana abusers showed lower relative cerebellar metabolism than normal subjects. THC increased relative cerebellar metabolism in all subjects, but only abusers showed increases in orbitofrontal cortex, prefrontal cortex, and basal ganglia. Cerebellar metabolism during THC intoxication was significantly correlated with the subjective sense of intoxication. The decreased cerebellar metabolism in marijuana abusers at baseline could account for the motor deficits previously reported in these subjects. The activation of orbitofrontal cortex and basal ganglia by THC in the abusers but not in the normal subjects could underlie one of the mechanisms leading to the drive and the compulsion to self-administer the drug observed in addicted individuals.

Brain glucose metabolism in violent psychiatric patients: a preliminary study

Positron emission tomography with 18F-deoxyglucose was used to evaluate regional brain glucose metabolism in eight normal subjects and eight psychiatric patients with a history of repetitive violent behavior. Seven of the patients showed widespread areas of low brain metabolism. Although the location of the abnormal regions varied among patients, they showed significantly lower relative metabolic values in medial temporal and prefrontal cortices than did normal comparison subjects. These regions have been implicated as substrates for aggression and impulsivity, and their dysfunction may have contributed to the patients' violent behavior.

Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification

OBJECTIVE

To quantify changes in size and severity of myocardial perfusion abnormalities by positron emission tomography (PET) in patients with coronary artery disease after 5 years of risk factor modification.

DESIGN

Randomized controlled trial.

SETTING

Outpatient community setting.

INTERVENTION

Randomization of patients to risk factor modification consisting of very low-fat vegetarian diet, mild to moderate exercise, stress management, and group support (experimental group, n = 20) or to usual care by their own physicians, consisting principally of antianginal therapy (control group, n = 15).

MAIN OUTCOME MEASURES

Quantitative coronary arteriography and PET at baseline and 5 years after randomization. Automated, objective measures of size and severity of perfusion abnormalities on rest-dipyridamole PET images and of stenosis severity on arteriograms were made by computer algorithms.

RESULTS

Size and severity of perfusion abnormalities on dipyridamole PET images decreased (improved) after risk factor modification in the experimental group compared with an increase (worsening) of size and severity in controls. The percentage of left ventricle perfusion abnormalities outside 2.5 SDs of those of normal persons (based on 20 disease-free individuals) on the dipyridamole PET image of normalized counts worsened in controls (mean +/- SE, + 10.3% +/- 5.6%) and improved in the experimental group (mean +/- SE, -5.1% +/- 4.8%) (P = .02); the percentage of left ventricle with activity less than 60% of the maximum activity on the dipyridamole PET image of normalized counts worsened in controls (+13.5% +/- 3.8%) and improved in the experimental group (-4.2% +/- 3.8%) (P = .002); and the myocardial quadrant on the PET image with the lowest average activity expressed as a percentage of maximum activity worsened in controls (-8.8% +/- 2.3%) and improved in the experimental group (+4.9% +/- 3.3%) (P = .001). The size and severity of perfusion abnormalities on resting PET images were also significantly improved in the experimental group as compared with controls. The relative magnitude of changes in size and severity of PET perfusion abnormalities was comparable to or greater than the magnitude of changes in percent diameter stenosis, absolute stenosis lumen area, or stenosis flow reserve documented by quantitative coronary arteriography.

CONCLUSIONS

Modest regression of coronary artery stenoses after risk factor modification is associated with decreased size and severity of perfusion abnormalities on rest-dipyridamole PET images. Progression or regression of coronary artery disease can be followed noninvasively by dipyridamole PET reflecting the integrated flow capacity of the entire coronary arterial circulation.

PET and SPECT imaging for stereotactic localization

Stereotactic localization using PET and SPECT has been used together with the Leksell stereotactic frame and the other imaging tools routinely provided to Gamma Knife radiosurgery sites. The accuracy of the measurements has been confirmed with CT and MR using a Radiation Analog Dosimetry phantom. The activity of the radionuclide solution placed in the tubes of Elekta Radiosurgery's MR imaging box is somewhat critical because the window levels chosen for the scan will affect the apparent size of the lesion. A technique is presented to resolve areas of activity more than about 12-14 mm apart, and it may prove useful in targeting epileptogenic sites in patients with medically intractable epilepsy.

Cerebellar metabolic activation by delta-9-tetrahydro-cannabinol in human brain: a study with positron emission tomography and 18F-2-fluoro-2-deoxyglucose

We investigated the effects of acute i.v. administration of 2 mg of delta 9-tetrahydrocannabinol (THC) on regional brain glucose metabolism using 18F-2-fluoro-2-deoxyglucose and positron emission tomography (PET) in eight normal subjects. Subjects were tested twice: during baseline conditions and 30-40 min after THC administration. Changes in global cerebral glucose metabolism in response to THC were variable: three subjects showed an increase, three showed a decrease, and two showed no change. In contrast, all subjects showed an increase in normalized metabolism in the cerebellum following THC administration. Cerebellar changes were the only significant regional metabolic changes due to THC administration. The increase in metabolic activity in the cerebellum was correlated with the subjective sense of THC intoxication and with plasma THC concentration. Cerebellar localization of metabolic effects due to THC administration corresponds well with the high density of cannabinoid receptors known to be in this area.

Sensitivity of measurements of regional brain activation with oxygen-15-water and PET to time of stimulation and period of image reconstruction

Measurement of oxygen-15- (15O) water uptake with positron emission tomography (PET) is a sensitive technique to monitor regional brain activation secondary to stimulation paradigms. In order to investigate data acquisition times that show maximal changes in regional activation and to assess the optimal time for stimulus presentation, we investigated 10 controls with 15O-water and PET during baseline and stroboscopic light stimulation. Sequential scans were done varying the time of stimulus presentation. The images were reconstructed using three different periods of data acquisition: uptake phase (initial 30-35 sec), washout phase (40 sec following peak activity in brain), and total activity (3 min). The images reconstructed during the uptake phase showed the largest changes in occipital cortex from stimulation. Maximal changes in occipital cortex were obtained when the visual stimulus was maintained during the uptake phase only.

Automated quantitation of three-dimensional cardiac positron emission tomography for routine clinical use

Visual comparison of rest/stress cardiac positron emission tomography indicates coronary flow reserve for diagnosing and assessing severity of coronary artery disease. An accurate, rapid, automated method for comparison and quantitation of paired cardiac PET studies has been developed to analyze size, intensity, statistical significance of and changes in perfusion or metabolism. The method utilizes polar coordinate maps derived from circumferential profiles of true short axis slices; from the short axis data algorithms determine mean and minimum activity levels in the anterior, septal, lateral, inferior and apical regions of the myocardium, percent of the cardiac image in specific ranges of activity levels or their changes and the percent of myocardium beyond 1.5, 2.0, and 2.5 standard deviations from the normal range with blackout display of the areas beyond these statistical limits for rest, stress, and stress/rest ratio polar maps. Additional applications include comparing stress-stress images to evaluate progression/regression of stenoses, early and late resting rubidium images for determining myocardial viability based on rubidium washout kinetics, and perfusion-metabolic comparisons for quantifying ischemia, viability and necrosis after acute myocardial infarction.

Cerebral blood flow in chronic cocaine users: a study with positron emission tomography

Occurrence of cerebrovascular accidents has been associated with cocaine abuse. We investigated the relative distribution of cerebral blood flow (CBF) in groups of chronic cocaine users, and of normal controls. Relative CBF was measured using positron emission tomography and 15 oxygen-labelled water. The cocaine users showed areas of deranged CBF as evidenced by patchy regions of defective isotope accumulation throughout their brain. The chronic cocaine users showed decreased relative CBF in the prefrontal cortex when compared with normal subjects. The repeated scans of some cocaine users, after 10 days of cocaine withdrawal, continued to show decreased relative CBF of the prefrontal cortex. We hypothesise that some of the widespread defects in CBF in the cocaine users could reflect the effects of vasospasm in cerebral arteries exposed chronically to the sympathomimetic actions of cocaine.

Effects of acute alcohol intoxication on cerebral blood flow measured with PET

Regional distribution of cerebral blood flow was assessed in a group of 13 normal social drinkers under baseline conditions and after acute alcohol intoxication. Blood flow measurements were done using 15O-labeled water and positron emission tomography (PET). Each subject underwent two control sessions under baseline conditions and two sessions after alcohol. Seven of the subjects were given 0.5 g/kg of alcohol and six were given 1 g/kg of alcohol p.o. The first and second post-alcohol scans were done 40 and 60 min after alcohol ingestion. The studies revealed that both the high and the low doses of alcohol reduced blood flow to the cerebellum. This effect was significant only for the high doses of alcohol, which also increased blood flow to the right temporal and the prefrontal cortex. The decrease in blood flow of the cerebellum could account for the muscular incoordination induced by alcohol.

A multigrid expectation maximization reconstruction algorithm for positron emission tomography

The problem of reconstruction in positron emission tomography (PET) is basically estimating the number of photon pairs emitted from the source. Using the concept of the maximum-likelihood (ML) algorithm, the problem of reconstruction is reduced to determining an estimate of the emitter density that maximizes the probability of observing the actual detector count data over all possible emitter density distributions. A solution using this type of expectation maximization (EM) algorithm with a fixed grid size is severely handicapped by the slow convergence rate, the large computation time, and the nonuniform correction efficiency of each iteration, which makes the algorithm very sensitive to the image pattern. An efficient knowledge-based multigrid reconstruction algorithm based on the ML approach is presented to overcome these problems.

Skeletal muscle blood flow in vivo: detection with rubidium-82 and effects of glucose, insulin, and exercise

In order to assess the effects of glucose, insulin, and exercise on skeletal muscle blood flow in vivo, we measured positron emission from the thigh muscle of anesthetized rabbits after simultaneous aortic bolus injection of 82Rb and radiolabeled microspheres (15 micron diameter). Estimates of flow with 82Rb were based on first-pass regional extraction of 82Rb by skeletal muscle. Flow estimates were made serially as a function of variations in plasma glucose and insulin and changing the muscle contractile state by electrical stimulation. Flow ranged from 3.1 ml/min/100 g at rest to 71 ml/min/100 g during stimulation. There was good agreement between the two methods of flow measurement over the entire range of flows (r = 0.96 at a slope of 0.90). Flow measured by either method did not vary significantly from baseline over a range of plasma glucose from 5 to 30 mM and plasma insulin from 0 to 20 microU/ml. When flow was increased up to 20-fold by electrical stimulation there was a decrease in extraction of 82Rb proportional to the increase in flow. However, at pharmacologic levels of insulin (greater than 150 microU/ml) flow was increased twofold as measured by radiolabeled microspheres, but not as measured by rubidium. There was no apparent decrease in extraction of 82Rb with high insulin. The discrepancy between the microsphere measured flow and rubidium measured flow with high plasma insulin levels can be explained by the assumption that the expected decrease in the extraction fraction was counteracted by an increase in Na+/K+-ATPase activity. It is concluded that the first-pass flow model gives valid estimates of skeletal muscle blood flow in vivo with 82Rb, provided that plasma insulin levels are normal.

Routine clinical positron emission tomography for diagnostic cardiac imaging--a review

Positron emission tomography, advanced through technical developments, has now evolved into a routinely applicable method for clinical investigation. The rubidium-82 generator, without the need for a cyclotron, provides a source of positron radionuclide which enables delineation of cardiac structures. Three characteristics of positron cameras are particularly essential for cardiac imaging: overlapping image planes to provide uniform sampling between detector rings, a high sensitivity to acquire high count rates, and clinically oriented software that is user-friendly. The most useful indications for positron emission tomography include assessment of myocardial perfusion (for which the diagnosis of coronary artery disease can be established with a sensitivity of 95 to 98% and specificity of 99 to 100%), assessment of the physiologic severity of coronary artery stenoses and the influence of interventions such as PTCA or thrombolysis, myocardial infarct imaging, assessment of viability of reversibly injured or ischemic cells, assessment of regional or global left ventricular function and analysis of collateral flow. The radiation burden to the patient is generally lower than that of standard cardiac nuclear tracer such as Tl-201. Thus, cardiac positron emission tomography provides information not previously available for better diagnosis and management of cardiac disease. This technique may obviate the need for other routinely-applied nuclear imaging techniques. Should the services of a cyclotron be available, the method offers, in addition, the possibility to perform complex studies of myocardial metabolism.