Development and assessment of an automatic quantitative cerebral vascular reserve estimation tool for use with triple-injection 99mTc-ECD SPECT

In nuclear medicine, cerebral vascular reserve(CVR) is evaluated using technetium-99m ethyl cysteinate dimer [99mTc-ECD] and acetazolamide(ACZ). We developed a protocol involving the intravenous injection of 99mTc-ECD in three divided doses(TIE method), and have found that the cerebrovascular response to ACZ depended on time after ACZ administration. However, it was difficult to obtain high-precision quantitative SPECT images by the conventional method because of complicated image processing and image degradation accompanying image subtraction. We recently developed software known as the Automatic Quantitative CVR Estimation Tool(hereinafter referred to as Triple AQCEL), which, after the input of simple parameters, enables us to carry out automatic reconstruction of quantitative SPECT images without image degradation due to subtraction. Triple AQCEL was determined to reduce image degradation caused by subtraction and to provide valid quantitative data. Because Triple AQCEL does not require manual determination of ROI or image selection for the reconstruction of quantitative SPECT images, reproducibility of regional cerebral blood flow by 3DSRT is ensured. Since all analyses in evaluation by the TIE method are automated and the operator plays no part in them, with the resulting increase of throughput, this software will contribute to improved reproducibility of regional cerebral blood flow data, and will be useful in clinical pathophysiological assessment both preoperatively and during postoperative follow-up.     

Preoperative RFA simulation for liver cancer using a CT virtual ultrasound system

We developed a computed tomography (CT) virtual ultrasound system (CVUS) as an imaging system to support treatment under percutaneous ultrasound (US) guidance. This prototype clinical system, produced in collaboration with Tokyo Medical University, uses display software developed by Toshiba Medical Systems. We examined the utility of this system by scheduling treatment plans preoperatively and simulating puncture and radiofrequency ablation (RFA) for liver cancer. The study enrolled 51 liver cancer patients with 66 nodules 0.8-8cm in diameter in which RFA was performed between June 2004 and December 2004. Virtual US and multiplanar reconstruction (MPR) images were constructed on the basis of DICOM CT data and puncture and ablation of liver cancer were simulated. The following were evaluated: (1) how to avoid complications and determine an appropriate puncture route by simulating puncture with C-mode MPR images; (2) determination of the three-dimensional location of the tumor for ablation, as well as the adjacent organs and vessels, by MPR rotation 360 degrees around the center of the tumor (center lock); and (3) how to determine the center and volume of ablation and avoid injuries to nearby organs and vessels by simulating ablation procedures. C -mode MPR images were effective for (1) determining and modifying the puncture route in 35 of 51 cases (69.6%) and (2) determining the spatial location of vessels and nearby organs in 50 of 51 cases (98.0%) by the center lock; and (3) simulating the ablation helped determine the center and volume of ablation by avoiding injuries to vessels and nearby organs in 45 or 51 cases (88.2%). Taken together, the CVUS allowed easy simulation of local treatment of liver cancer under US guidance using CT data alone and the preoperative simulation predicted an improvement in the safety of local therapy of liver cancer.     

Preliminary study: color map of hepatocellular carcinoma using dynamic contrast-enhanced 256-detector row CT

To distinguish hepatocellular carcinoma (HCC) from normal liver tissue, a color map was made by dynamic contrast-enhanced 256-detector row CT developed at our institute. Dynamic enhanced CT of the liver of three patients with HCC was studied. The CT has 912 (transverse) x 256 (cranio-caudal) elements, each measuring approximately 0.5 mm x 0.5mm at the center of rotation. Scanning for 10 s (1.0 s/rotation) was started 30 s after intravenous injection of contrast medium. The reconstruction increment was 0.62 mm with a time interval of 0.1s and a matrix size of 512 x 512 x 256. Color maps were generated to show the gradient of the regression line of the time-density change. Due to volume acquisition, the 3D color map can be created using continuous 10-s scanning. The densities of the HCC and liver were decreased and increased during scanning, respectively. The HCC was detected clearly in the color map as a downward-sloping region. Dynamic enhanced 256-detector row CT could be useful for detecting malignant tumors in the liver with a short scan time.     

Scatter correction based on an artificial neural network for99mTc and123I dual-isotope SPECT in myocardial and brain imaging

The aim of this study was to elucidate the clinical usefulness of scatter correction with an artificial neural network (ANN) in 99mTc and 123I dual-isotope SPECT. METHODS: Two algorithms for ANN scatter correction were tested: ANN-10 and ANN-3 employing 10 and 3 energy windows for data acquisition, respectively. Three patients underwent myocardial or brain SPECT with one of the following combinations of radiopharmaceuticals administered: 99mTc-tetrofosmin and 123I-metaiodobenzylguanidine (MIBG), 99mTc-methoxyisobutylisonitrile (MIBI) and 123I-beta-methyl-paraiodophenyl-pentadecanoic acid (BMIPP), or 99mTc-ethyl-cistainate dimmer (ECD) and 123I-iomazenil. The patients were also referred for single-isotope imaging incorporating conventional triple-energy window (TEW) scatter correction. Crosstalk- and scatter-corrected 99mTc- and 123I-SPECT images in dual-isotope acquisition with ANN were compared with those in single-isotope acquisition. RESULTS: The ANN method well separated 123I and 99mTc primary photons. Although ANN-10 yielded images of poor quality, ANN-3 offered comparable image quality with the single-isotope scan without significant increase of acquisition time. CONCLUSION: The proposed method is clinically useful because it provides various combinations of information without anatomical misregistration with one acquisition.     

Effect of multislice acquisition on T1 and T2 measurements of articular cartilage at 3T

PURPOSE: The aim of this study was to investigate the effect of magnetization transfer on multislice T1 and T2 measurements of articular cartilage. MATERIALS AND METHODS: A set of phantoms with different concentrations of collagen and contrast agent (Gd-DTPA2-) were used for the in vitro study. A total of 20 healthy knees were used for the in vivo study. T1 and T2 measurements were performed using fast-spin-echo inversion-recovery (FSE-IR) sequence and multi-spin-echo (MSE) sequence, respectively, in both in vitro and in vivo studies. We investigated the difference in T1 and T2 values between that measured by single-slice acquisition and that measured by multislice acquisition. RESULTS: Regarding T1 measurement, a large drop of T1 in all slices and also a large interslice variation in T1 were observed when multislice acquisition was used. Regarding T2 measurement, a substantial drop of T2 in all slices was observed; however, there was no apparent interslice variation when multislice acquisition was used. CONCLUSION: This study demonstrated that the adaptation of multislice acquisition technique for T1 measurement using FSE-IR methodology is difficult and its use for clinical evaluation is problematic. In contrast, multislice acquisition for T2 measurement using MSE was clinically applicable if inaccuracies caused by multislice acquisition were taken into account.     

Women with mitochondrial haplogroup N9a are protected against metabolic syndrome

To identify mitochondrial haplogroups that confer resistance against or susceptibility to metabolic syndrome, we performed a large-scale association study on 1,337 unrelated Japanese individuals, including 871 subjects with metabolic syndrome and 466 control subjects. Metabolic syndrome was diagnosed according to modified National Cholesterol Education Program Adult Treatment Panel III guidelines, using the cutoff point for obesity as a BMI of >/=25 kg/m(2) instead of waist circumference. The genotypes for 25 polymorphisms in the coding region of the mitochondrial genome were determined, and the haplotypes were classified into 10 major haplogroups, i.e., F, B, A, N9a, M7a, M7b, G1, G2, D5, and D4. Multivariate logistic regression analysis revealed that the haplogroup N9a was significantly associated with resistance against metabolic syndrome in women with an odds ratio (OR) of 0.21 (95% CI 0.07-0.58, P = 0.0042). Women with haplogroups G1 and D5 tended to be resistant against metabolic syndrome with an OR of 0.22 (0.06-0.68, P = 0.0129) for G1 and with an OR of 0.32 (0.10-0.96, P = 0.0469) for D5, respectively. These results indicate that mitochondrial haplogroup N9a may be a protective factor against metabolic syndrome in Japanese women.     

Genetic reconstitution of autoimmune type 1 diabetes with two major susceptibility genes in the rat

The Komeda diabetes-prone (KDP) rat is an animal model of human autoimmune type 1 diabetes. We have previously shown that two major susceptibility genes, the major histocompatibility complex (MHC) RT1(u) haplotype and Cblb (Casitas B-lineage lymphoma b) mutation, are responsible for the development of diabetes in KDP rats, suggesting a two-gene model for development of the disease. To confirm the two-gene model, we produced a congenic strain carrying mutated Cblb alleles of the KDP rat on a non-KDP genetic background harboring the RT1(u) haplotype on its MHC. Despite the low incidence and delayed onset of diabetes, the congenic strain did develop the disease, indicating that type 1 diabetes can be reconstituted on a non-KDP genetic background with the RT1(u) haplotype and Cblb mutation. Similar to observations in KDP rats, the congenic strain showed insulitis and thyroiditis, symptoms of autoimmunity. The low incidence and delayed onset of the disease strongly suggest involvement of genetic modifiers; the congenic strain established in this study should be useful for the mapping and identification of such modifiers.     

Significance of platelet counts in patients who underwent surgical treatment for lung metastasis

Many studies have asserted that thrombocytosis has a prognostic impact in various malignancies. To date, there has been no report of platelet value in patients with pulmonary metastasis. We retrospectively reviewed the medical charts of 143 patients with resection for lung metastasis. The thrombocyte cut-off was 22 x 10(4) /ml, which was the average count in this study, and we separated patients into two groups (high group versus low group). Cases of larger-size (>2-0.5 cm) pulmonary metastasis showed a significant increase compared with cases of smaller size (-2 cm; P = 0.0040). In univariate analysis, location in the bilateral lung and higher platelet count were significantly associated with prognosis. Multivariate analysis showed that only the high platelet group (P = 0.0334) showed significant independent prognostic factors. Platelet count may be a valuable marker in patients with pulmonary metastasis and for surgical indication with higher count.     

Issues on package inserts of percutaneous tracheostomy kits

BACKGROUND: Percutaneous tracheostomy using a dedicated kit, which has been a common surgical procedure in intensive care settings, must be carefully performed with sufficient knowledge regarding both the technique and the kit. The aim of this study was to investigate the accuracy and adequacy of information contained in package inserts of kits, as the primary official documents for providing information on safe and sure performance of the procedure. METHODS: We investigated the contents of package inserts for three percutaneous tracheostomy kits available in Japan, and ascertained whether the distributors of the kits showed the contents on the Internet. RESULTS: Package inserts did not necessarily provide accurate and sufficient information in terms of generic names, warnings, contraindications, indication for use, instructions for use and/or handling, cautions or clinical records. Not all distributors followed the ordinance from the Pharmaceuticals and Medical Devices Agency to show this information to the public. CONCLUSIONS: The importance of package inserts in safety measures related to medical devices has been growing since the enforcement of the revised Pharmaceutical Affairs Law in 2005. The significance of package inserts must be emphasized, and distributors of kits need to be encouraged to improve inserts.