ACR–ABS–ACNM–ASTRO–SIR–SNMMI practice parameter for selective internal radiation therapy or radioembolization for treatment of liver malignancies

PurposeThe American College of Radiology (ACR), American Brachytherapy Society (ABS), American College of Nuclear Medicine (ACNM), American Society for Radiation Oncology (ASTRO), Society of Interventional Radiology (SIR), and Society of Nuclear Medicine and Molecular Imaging (SNMMI) have jointly developed a practice parameter on selective internal radiation therapy (SIRT) or radioembolization for treatment of liver malignancies. Radioembolization is the embolization of the hepatic arterial supply of hepatic primary tumors or metastases with a microsphere yttrium-90 brachytherapy device.Materials and MethodsThe ACR -ABS -ACNM -ASTRO -SIR -SNMMI practice parameter for SIRT or radioembolization for treatment of liver malignancies was revised in accordance with the process described on the ACR website (https://www.acr.org/ClinicalResources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters—Interventional and Cardiovascular Radiology of the ACR Commission on Interventional and Cardiovascular, Committee on Practice Parameters and Technical Standards—Nuclear Medicine and Molecular Imaging of the ACR Commission on Nuclear Medicine and Molecular Imaging and the Committee on Practice Parameters—Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with ABS, ACNM, ASTRO, SIR, and SNMMI.ResultsThis practice parameter is developed to serve as a tool in the appropriate application of radioembolization in the care of patients with conditions where indicated. It addresses clinical implementation of radioembolization including personnel qualifications, quality assurance standards, indications, and suggested documentation.ConclusionsThis practice parameter is a tool to guide clinical use of radioembolization. It focuses on the best practices and principles to consider when using radioemboliozation effectively. The clinical benefit and medical necessity of the treatment should be tailored to each individual patient.     

Mass spectrometric differentiation of the isomers of mono-methoxyethylamphetamines and mono-methoxydimethylamphetamines by GC–EI–MS–MS

Mass spectrometric differentiation of the six isomers of mono-methoxyethylamphetamines (MeO-EAs) and mono-methoxydimethylamphetamines (MeO-DMAs) by gas chromatography–electron ionization–tandem mass spectrometry (GC–EI–MS–MS) was investigated. Based on their EI-mass spectra, the fragment ions at m/z 121 and 72 were selected as precursor ions for their regioisomeric and structurally isomeric differentiation, respectively. Collision-induced dissociation provides intensity differences in product ions among the isomers, enabling mass spectrometric differentiation of the isomers. Furthermore, high reproducibility of the product ion spectra at the optimized collision energy was confirmed, demonstrating the reliability of the method. To our knowledge, this is the first report on mass spectrometric differentiation of the six isomers of MeO-EAs and MeO-DMAs by GC–EI–MS–MS. Isomeric differentiation by GC–EI–MS–MS has a high potential to discriminate isomers of newly encountered designer drugs, making GC–MS–MS a powerful tool in the forensic toxicology field.     

Pulmonary function–morphologic relationships assessed by SPECT–CT fusion images

Pulmonary single photon emission computed tomography-computed tomography (SPECT-CT) fusion images provide objective and comprehensive assessment of pulmonary function and morphology relationships at cross-sectional lungs. This article reviewed the noteworthy findings of lung pathophysiology in wide-spectral lung disorders, which have been revealed on SPECT-CT fusion images in 8?years of experience. The fusion images confirmed the fundamental pathophysiologic appearance of lung low CT attenuation caused by airway obstruction-induced hypoxic vasoconstriction and that caused by direct pulmonary arterial obstruction as in acute pulmonary thromboembolism (PTE). The fusion images showed better correlation of lung perfusion distribution with lung CT attenuation changes at lung mosaic CT attenuation (MCA) compared with regional ventilation in the wide-spectral lung disorders, indicating that lung heterogeneous perfusion distribution may be a dominant mechanism of MCA on CT. SPECT-CT angiography fusion images revealed occasional dissociation between lung perfusion defects and intravascular clots in acute PTE, indicating the importance of assessment of actual effect of intravascular colts on peripheral lung perfusion. Perfusion SPECT-CT fusion images revealed the characteristic and preferential location of pulmonary infarction in acute PTE. The fusion images showed occasional unexpected perfusion defects in normal lung areas on CT in chronic obstructive pulmonary diseases and interstitial lung diseases, indicating the ability of perfusion SPECT superior to CT for detection of mild lesions in these disorders. The fusion images showed frequent "steal phenomenon"-induced perfusion defects extending to the surrounding normal lung of arteriovenous fistulas and those at normal lungs on CT in hepatopulmonary syndrome. Comprehensive assessment of lung function-CT morphology on fusion images will lead to more profound understanding of lung pathophysiology in wide-spectral lung disorders.     

Simple and rapid analysis of amatoxins using UPLC–MS–MS

Amatoxins, such as α-amanitin and β-amanitin, are highly toxic bicyclic octapeptides present in Amanita mushrooms. We present a simple and rapid sensitive determination of α-amanitin, β-amanitin, and phalloidin in body fluids (serum, plasma, and urine) using an ultraperformance liquid chromatography (UPLC)–tandem mass spectrometry (MS–MS) system. After extraction from serum, plasma, and urine samples by an Oasis HLB column, the three compounds were subjected to an UPLC–MS–MS system with an electrospray ionization interface. All three compounds were completely separated within 4.5 min. The calibration curves for serum, plasma, and urine samples showed good linearities in the range of 2–420 ng/ml, using virginiamycin B as internal standard. Their detection limits were as low as 0.5–1.5 ng/ml. The present method was validated; the coefficients of variation (CV) were: intraday for serum, plasma, and urine samples, less than 9.9, 13.2, and 11.5 %, respectively; interday for serum, plasma, and urine samples, less than 15.0, 10.4, and 15.3 %, respectively. The influence of matrix effects, especially in urine, was observed in human and rat samples; however, the difference in matrix effects between individuals were low. Therefore, each calibration curve was prepared for each biological specimen type. Furthermore, we succeeded in determining the compounds in rat urine samples, obtained 6 or 24 h after intraperitoneal administration. The present method is applicable in forensic and clinical toxicology because of its simplicity and rapidness with high sensitivity.     

Bilateral retinal detachment in a patient with Vogt–Koyanagi–Harada syndrome

We present a 38-year-old woman with bilateral serous retinal detachments and bilateral panuveitis on fundoscopic exam. CT of the orbits and MRI scans revealed bilateral ocular choroidal thickening and bilateral retinal detachments; however, no other CNS or meningeal lesion was detected. This patient met the clinical criteria for Vogt–Koyanagi–Harada (VKH) Syndrome. Review of VKH syndrome as well as the radiographic findings will be discussed.     

Heinrich Zangger 1874–1957

Ohne Zusammenfassung     

Hermann Merkel 7.6.1873–27.5.1957

Ohne Zusammenfassung     

Joseph Dettling 1890–1959

Ohne Zusammenfassung

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Joseph Dettling 1890–1959