(1/608) Whole body positron emission tomography/computed tomography (PET/CT) tumour staging with integrated PET/CT colonography: technical feasibility and first experiences in patients with colorectal cancer.

AIM: The aim of this study was to implement an imaging protocol for positron emission tomography/computed tomography (PET/CT) colonography and to combine this protocol with whole body PET/CT tumour staging for a single whole body examination for routine clinical use. SUBJECTS AND METHODS: A whole body PET/CT protocol for tumour staging and a protocol for PET/CT colonography were integrated into one examination. Fourteen prospective patients with suspected colorectal cancer underwent whole body PET/CT after aqueous bowel distension and pharmacological bowel relaxation. Colonoscopy and histopathology served as the standards of reference in all patients. RESULTS: The modified PET/CT examination detected all but one lesion in the colon. One additional lesion was detected in a patient with incomplete colonoscopy due to high grade luminal stenosis. One polyp with malignant conversion was identified with the modified PET/CT protocol. PET/CT colonography proved accurate in local lymph node staging and staged nine out of 11 patients correctly. Six additional extracolonic tumour sites were detected based on the whole body staging approach. CONCLUSION: Whole body PET/CT with integrated colonography is technically feasible for whole body staging in patients with colorectal cancer. Based on these initial diagnostic experiences, this integrated protocol may be of substantial benefit in staging patients with colorectal cancer, focusing on patients with incomplete colonoscopy and those with small synchronous bowel lesions.  (+info)

(2/608) Whole body MRI for detecting metastatic bone tumor: comparison with bone scintigrams.

PURPOSE: To compare the effectiveness of whole body MRI (WB-MRI [magnetic resonance imaging]) and bone scintigram (BS) at detecting bone metastasis. MATERIALS AND METHODS: WB-MRI was performed on 16 patients for detecting bone metastasis (6 breast carcinoma, 7 prostatic carcinoma, 1 renal cell carcinoma [RCC], 1 hepatocellular carcinoma [HCC], and 1 primary unknown). BS was also performed in all cases. Patients were placed on a table top extender (Philips Medical Systems). The maximal longitudinal field of view (FOV) was 200 cm. At first, the total spine was imaged in the sagittal plane with a three-station approach for two image sets (fast spin-echo [SE] T1-weighted images [T1WI] and short tau inversion recovery [STIR] images). The whole body was then imaged in the coronal plane with a seven-station approach for two image sets (fast field echo [FFE] T1WI and STIR). Total examination time, including patient positioning, was within 40 min. Three independent radiologists interpreted the imaging data. RESULTS: WB-MRI identified 5 cases of 24 lesions as bone metastasis, while BS identified 3 cases of 25 lesions. Concordance between WB-MRI and BS was seen in 3 cases of 22 lesions (81%). For two cases of 2 lesions, which were identified only with WB-MRI, the lesions were located in the sacrum and thoracic spine. For one case of 3 lesions, which was identified only with BS, the lesions were located in the skull and rib. CONCLUSION: WB-MRI was an excellent method for screening bone metastasis, especially the vertebral body.  (+info)

(3/608) Continuously moving table MRI with SENSE: application in peripheral contrast enhanced MR angiography.

An integration of SENSitivity Encoding (SENSE) with continuously moving table (CMT) MRI for extended field-of-view (FOV) acquisitions is described. In this work, the approach in which receiver coils are attached to the object and move in synchrony with the scanner table is considered. Technical issues dealing with the implementation of SENSE-CMT are addressed, including coil calibration, correction for non-uniform magnetic gradients, and specific reconstruction steps. An explanation of combining SENSE with gradient non-linearity correction is given, as the latter becomes necessary in CMT acquisitions where a large sampling FOV is used. It is hypothesized that SENSE can provide at least a 2-fold improvement in lateral spatial resolution compared to non-accelerated CMT acquisitions. The hypothesis is tested in phantoms, where the effectiveness of both SENSE and gradient non-linearity correction to improve spatial resolution is shown. The SENSE-CMT technique is further demonstrated in vivo with contrast-enhanced MR angiography of the peripheral vasculature.  (+info)

(4/608) Whole-body imaging of sequestration of Plasmodium falciparum in the rat.

The occlusion of vessels by packed Plasmodium falciparum-infected (iRBC) and uninfected erythrocytes is a characteristic postmortem finding in the microvasculature of patients with severe malaria. Here we have employed immunocompetent Sprague-Dawley rats to establish sequestration in vivo. Human iRBC cultivated in vitro and purified in a single step over a magnet were labeled with 99mtechnetium, injected into the tail vein of the rat, and monitored dynamically for adhesion in the microvasculature using whole-body imaging or imaging of the lungs subsequent to surgical removal. iRBC of different lines and clones sequester avidly in vivo while uninfected erythrocytes did not. Histological examination revealed that a multiadhesive parasite adhered in the larger microvasculature, inducing extensive intravascular changes while CD36- and chondroitin sulfate A-specific parasites predominantly sequester in capillaries, inducing no or minor pathology. Removal of the adhesive ligand Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1), preincubation of the iRBC with sera to PfEMP1 or preincubation with soluble PfEMP1-receptors prior to injection significantly reduced the sequestration. The specificity of iRBC binding to the heterologous murine receptors was confirmed in vitro, using primary rat lung endothelial cells and rat lung cryosections. In offering flow dynamics, nonmanipulated endothelial cells, and an intact immune system, we believe this syngeneic animal model to be an important complement to existing in vitro systems for the screening of vaccines and adjunct therapies aiming at the prevention and treatment of severe malaria.  (+info)

(5/608) The role of imaging with (111)In-ibritumomab tiuxetan in the ibritumomab tiuxetan (zevalin) regimen: results from a Zevalin Imaging Registry.

The ibritumomab tiuxetan therapeutic regimen consists of a dose of rituximab, 250 mg/m(2), followed by (111)In-ibritumomab tiuxetan, for imaging, on day 1 and a dose of rituximab followed by (90)Y-ibritumomab tiuxetan, for therapy, on day 7, 8, or 9. Treatment with the Food and Drug Administration-approved regimen also requires that scans be performed at 2-24 h and at 48-72 h after the (111)In-ibritumomab tiuxetan, with an optional third scan at 90-120 h, to confirm appropriate biodistribution. In the clinical trials before the approval of the regimen, only 1 patient (of approximately 400) was not treated with (90)Y-ibritumomab tiuxetan after imaging with (111)In-ibritumomab tiuxetan, because of altered biodistribution. The Zevalin Imaging Registry was established by Biogen Idec Inc. to identify cases of potential altered biodistribution and to collect clinical information in cases in which the regimen was not completed after imaging. METHODS: The registry surveyed treating physicians to verify completion of treatment with the ibritumomab tiuxetan therapeutic regimen in patients treated with (111)In-ibritumomab tiuxetan between March 27, 2002, and March 31, 2003. RESULTS: Survey data were collected on 953 of an estimated 1,144-1,192 patients in whom ibritumomab tiuxetan therapy was initiated (case capture rate of 80%-83%). Thirty-eight cases were reported in which a decision not to treat was made after imaging with (111)In-ibritumomab tiuxetan (4.0% of all cases captured); 16 of these were for imaging reasons, and 22 were for medical reasons. Twelve of the 16 imaging cases met the criteria for altered biodistribution (1.3%). Of these 12 cases, 6 (0.6%) were suspected to be true altered biodistribution and 6 appeared to be due to the use of a procedure for radiolabeling (111)In-ibritumomab tiuxetan that differed from that in the prescribing information. All cases of altered biodistribution were seen on the first image (2-24 h) after the administration of (111)In-ibritumomab tiuxetan. The 22 cases in which decisions not to treat were made for medical reasons accounted for 2.3% of the cases. The majority of these cases (19/22) were in patients who had an expected biodistribution but had a rapid change in their clinical condition that precluded treatment. CONCLUSION: The rate of true altered biodistribution was 0.6% in the Zevalin Imaging Registry, which collected treatment decisions based on data from approximately 80% of all patients treated commercially in the first year after drug approval. All cases of altered biodistribution were apparent on the first image, obtained at 2-24 h after the administration of (111)In-ibritumomab tiuxetan.  (+info)

(6/608) Optimizing injected dose in clinical PET by accurately modeling the counting-rate response functions specific to individual patient scans.

To optimize the injected dose of radiopharmaceutical in PET, one needs to know its relationship to some metric of data quality for individual patient scans, such as noise-equivalent counting rate (NECR). In this paper, we show how one may accurately model the clinical NECR response corresponding to specific patient scans much as if a counting-rate test had been performed on each patient. We apply this technique to patient data and show how it can lead to improved clinical scanning protocols. METHODS: True and random coincidence rates expressed as functions of an appropriate measurable system parameter such as the detector single-event rate have functional forms that are largely independent of the object being scanned. Thus, reference true and random response functions may be scaled directly to the specific counting rates measured on a clinical scan, thereby yielding a curve of NECR versus injected dose. We have applied this technique to 2 groups of 163 clinical (18)F-FDG scans each. One of the groups was obtained on a lutetium oxyorthosilicate PET/CT scanner with conventional front-end electronics, and the other was obtained on a lutetium oxyorthosilicate PET/CT scanner with a new digital data processing system (Pico-3D). RESULTS: At 90%-95% of maximum signal-to-noise ratio (SNR), the mean optimal dose for a 60-min uptake period ranged from 366 to 717 MBq depending on the electronics and randoms processing method. There was only a slight (1 MBq/kg) dependence of optimal dose on patient weight but a larger dependence on position in the body. Pico-3D electronics improved optimal data SNR by 35% for a 70-kg person, but in both cases NECR fell rapidly with increasing weight (1.4%/kg). For an equivalent data SNR, a 120-kg person would have to be scanned 2.3 times longer than a 60-kg person. Over this range of weight, the mean scatter fraction increased by 12% whereas the ratio of mean randoms to trues increased by 48%. CONCLUSION: The methodology developed here allows one to directly estimate the optimal dose to inject for specific clinical scans and permits a detailed analysis of the sources of noise in PET data and of their variation with parameters such as patient weight.  (+info)

(7/608) Evaluation of novel whole-body high-resolution rodent SPECT (Linoview) based on direct acquisition of linogram projections.

Studies of the biodistribution of radiolabeled compounds in rodents frequently are performed during the process of development of new pharmaceutical drugs. This article presents the evaluation of a new whole-body animal SPECT system, called the Linoview SPECT system. METHODS: Linoview SPECT is based on the linear orbit acquisition technique associated with slit-aperture collimators mounted on 4 pixelated CsI(Na) detectors composed of an array of small, individual crystal elements. Sliding iridium rods allow variation of the collimator aperture. Hot-rod and cold-rod phantoms filled with (99m)Tc were imaged. Mice were imaged, and kidney radioactivity was measured after injection of (99m)Tc-dimercaptosuccinic acid and (111)In-diethylenetriaminepentaacetic acid-d-Phe(1)-octreotide ((111)In-pentetreotide; Octreo-Scan(111)). RESULTS: Phantom studies showed that hot rods separated by 0.35 mm can be distinguished and that 0.65-mm-diameter cold rods can be visualized, both at low-counting-rate acquisitions (111 and 59 MBq x h, respectively). In both mouse studies, the SPECT images allowed a clear delineation of the radioactivity concentrated over the cortex area of the kidneys, whereas the pelvis and the pelviureteral junction (1 mm) appeared as cold areas. The quantitative data derived from SPECT were in good agreement with the radioactivity counting obtained with a gamma-counter after isolation of the kidneys. In addition, in the mouse injected with (111)In-pentetreotide, the kidney radioactivity distribution seen with SPECT was in agreement with the ex vivo autoradiograms of the isolated kidneys. CONCLUSION: The phantom studies showed a clear improvement of the spatial resolution over the results reported in the literature with other dedicated small-animal SPECT systems, especially in cold-rod phantom studies. The increased performance can be ascribed to the high stability of the system with regard to the statistical noise present in the acquired data. The mouse studies showed that this system will be most useful for in vivo high-resolution SPECT and quantitative biodistribution studies in rodents, even with medium-energy radioisotopes that are difficult to image, such as (111)In.  (+info)

(8/608) Biodistribution and radiation dosimetry estimates of 1-(2'-deoxy-2'-(18)F-Fluoro-1-beta-D-arabinofuranosyl)-5-bromouracil: PET imaging studies in dogs.

This study reports on the biodistribution and radiation estimates of 1-(2'-deoxy-2'-(18)F-fluoro-1-beta-d-arabinofuranosyl)-5-bromouracil ((18)F-FBAU), a potential tracer for imaging DNA synthesis. METHODS: Three normal dogs were intravenously administered (18)F-FBAU and a dynamic PET scan was performed for 60 min over the upper abdomen followed by a whole-body scan for a total of 150 min. Blood samples were collected at stipulated time intervals to evaluate tracer clearance and metabolism. Tissue samples of various organs were analyzed for tracer uptake and DNA incorporation. Dynamic accumulation of the tracer in different organs was derived from reconstructed PET images. The radiation dosimetry of (18)F-FBAU was evaluated using the MIRD method. RESULTS: At 60 min after injection, blood analysis found >90% of the activity in unmetabolized form. At 2 h after injection, (18)F-FBAU uptake was highest in proliferating tissues (mean SUVs: marrow, 2.6; small intestine, 4.0), whereas nonproliferative tissues showed little uptake (mean SUVs: muscle, 0.75; lung, 0.70; heart, 0.85; liver, 1.28). Dynamic image analysis over 60 min showed progressive uptake of the tracer in marrow. Extraction studies demonstrated that most of the activity in proliferative tissues was in the acid-insoluble fraction (marrow, 83%; small intestine, 73%), consistent with incorporation into DNA. In nonproliferative tissue, most of the activity was not found in the acid-insoluble fraction (>84% for heart, muscle, and liver). CONCLUSION: These results demonstrate that (18)F-FBAU was resistant to metabolism, readily incorporated into DNA in proliferating tissues, and showed good contrast between organs of variable DNA synthesis. These findings indicate that (18)F-FBAU may find use in measuring DNA synthesis with PET.  (+info)