Feasibility and kinetic characteristics of 68Ga-NOTA-RGD PET for in vivo atherosclerosis imaging

Objective

In this study, the feasibility and kinetic characteristics of the ⁶⁸Ga-NOTA-RGD, a recently developed RGD peptide agent, were investigated for atherosclerosis imaging in comparison with ¹⁸FDG.

Methods

ApoE^?/? mice were fed a high-fat diet for more than 20 weeks. To evaluate the feasibility, tissue uptakes of ⁶⁸Ga-NOTA-RGD and ¹⁸FDG in the major organs were measured and compared between ApoE^?/? and control mice. Animal PET imaging was also performed and relative uptake values in the thoracic aorta were compared between ApoE^?/? and control mice. In humans, the kinetic characteristics and feasibility of ⁶⁸Ga-NOTA-RGD PET were assessed in 4 patients with known coronary artery disease.

Results

In the tissue uptake study, the thoracic aorta showed higher uptake in ApoE^?/? than in control mice with both ⁶⁸Ga-NOTA-RGD and ¹⁸FDG (P < 0.001). On PET scans, the relative uptake values of the thoracic aorta were significantly higher in ApoE^?/? with both ⁶⁸Ga-NOTA-RGD (P = 0.024) and ¹⁸FDG (P = 0.038). In human PET, the appropriateness of reversible binding model and Logan plotting was clearly demonstrated. The aorta-to-jugular ratios were measured up to 1.25 and showed a tendency to correlate with the serum high-sensitivity C-reactive protein level (r = 0.899, P = 0.102).

Conclusions

⁶⁸Ga-NOTA-RGD has potential as an in vivo atherosclerosis imaging agent. However, the lower imaging contrast and sensitivity of ⁶⁸Ga-NOTA-RGD PET compared with ¹⁸FDG PET may be a limitation for clinical application.     

Correlation of VEGF with contrast enhancement on dual-phase dynamic helical CT in liver tumors: preliminary study

The purpose of this preliminary study is to elucidate that vascular endothelial growth factor (VEGF) influences contrast enhancement of hepatic tumors on computed tomography (CT). Fourteen patients with hepatic tumors (11 hepatocellular carcinomas; 3 metastatic cancers) underwent a dual-phase dynamic helical CT or computed tomographic hepatic arteriography. The attenuation of each mass was determined as hyperattenuation, isoattenuation or hypoattenuation with respect to the adjacent nontumorous parenchyma. Gun-needle biopsy was done for each tumor, and paraffin sections were immunostained with anti- VEGF antibody by the avidin-biotin-peroxidase complex method. The pathologic grade was made by intensity (1 +, 2+, 3+) and area (+/-, 1 +, 2+). The tumor ranged 2.0-14.0 cm in size (mean, 5.8 cm). In arterial phase, the intensity was not correlated with the degree of enhancement (p=0.086). However, the correlation between the attenuation value of hepatic arterial phase and the area of positive tumor cells was statistically significant (p=0.002). VEGF may be the factor that enhances the hepatic mass with water-soluble iodinated contrast agent in CT.     

Behavior and Awareness of Thyroid Cancer Patients in Korea Having Non-Hospitalized Low-Dose Radioiodine Treatment with Regard to Radiation Safety

Purpose

With the recent increase in incidence of thyroid cancer, non-hospitalized low-dose (NH-LD) radioiodine treatment (RIT) has also increased rapidly. The radioactivity limit that is allowed to be administered without hospitalization depends on individual calculation, based partly on patients’ behavior. In this study, Korean patients’ behavior in relation to radiation safety in NHLD RIT was surveyed.

Methods

A total of 218 patients who underwent NH-LD RIT of 1.1 GBq ¹³¹I in a single center were surveyed. The patients underwent RIT with a standard protocol and the survey was performed by interview when they visited subsequently for a whole-body scan. The survey questionnaire included three parts of questions: general information, behavior relating to isolation during RIT, and awareness of radiation safety.

Results

After administration of radioiodine, 40% of patients who returned home used mass transportation, and another 47% went home by taxi or in car driven by another person. Isolation at home was generally sufficient. However, 7% of patients did not stay in a separate room. Among the 218 patients, 34% did not go home and chose self-isolation away from home, mostly due to concerns about radiation safety of family members. However, the places were mostly public places, including hotels, resorts, and hospitals. About half of the patients replied that access to radiation safety information was not easy and their awareness of radiation safety was not satisfactory. As a result, 45% of patients wanted hospitalized RIT.

Conclusions

In many countries, including Korea, RIT is continuously increasing. Considering the radiation safety of patients’ family members or the public and the convenience of patients, the pretreatment education of patients should be enhanced. In addition, the hospitalization of patients having low-dose therapy is recommended to be seriously considered and expanded, with the expansion of dedicated treatment facilities.     

Midterm results of percutaneous CT-guided aspiration of symptomatic lumbar discal cysts

OBJECTIVE: Lumbar intervertebral discal cysts are rarely reported. To our knowledge, only 12 cases have been reported in the literature. The symptoms are indistinguishable from those of typical discal herniation. Our aim is to report the imaging characteristics, method of percutaneous CT-guided aspiration, and clinical outcome after management of lumbar intervertebral discal cysts. CONCLUSION: Percutaneous CT-guided aspiration is an effective method for the management of lumbar intervertebral discal cysts.     

Simultaneous determination of cannabidiol, cannabinol, and \gD9-tetrahydrocannabinol in human hair by gas chromatography-mass spectrometryin human hair by gas chromatography-mass spectrometry

An analytical method was developed for evaluating the cannabidiol (CBD), cannabinol (CBN), and delta9-tetrahydrocannabinol (delta9-THC) level in human hair using gas chromatography-mass spectrometry (GC-MS). Hair samples (50 mg) were washed with isopropyl alcohol and cut into small fragments (< 1 mm). After adding a deuterated internal standard, the hair samples were incubated in 1.0 M NaOH for 10 min at 95 degrees C. The analytes from the resulting hydrolyzed samples were extracted using a mixture of n-hexane-ethyl acetate (75:25, v/v). The extracts were then evaporated, derivatized, and injected into the GC-MS. The recovery ranges of CBD, CBN, and delta9-THC at three concentration levels were 37.9-94.5% with good correlation coefficients (r2 >0.9989). The intra-day precision and accuracy ranged from -9.4% to 17.7%, and the inter-day precision and accuracy ranged from -15.5% to 14.5%, respectively. The limits of detection (LOD) for CBD, CBN, and delta9-THC were 0.005, 0.002, and 0.006 ng/mg, respectively. The applicability of this method of analyzing the hair samples from cannabis abusers was demonstrated.     

Significance of 18F-FDG PET Parameters According to Histologic Subtype in the Treatment Outcome of Stage III Non–small-cell Lung Cancer Undergoing Definitive Concurrent Chemoradiotherapy

Purpose

We analyzed positron emission tomography-computed tomography (PET-CT) in patients with stage III non–small-cell lung cancer (NSCLC) undergoing concurrent chemoradiotherapy (CRT) to examine the prognostic value of PET-CT parameters according to histologic subtypes (squamous cell carcinoma [SqCC] and adenocarcinoma [ADC]).

Heterogeneity index evaluated by slope of linear regression on <Superscript>18</Superscript>F-FDG PET/CT as a prognostic marker for predicting tumor recurrence in pancreatic ductal adenocarcinoma

Purpose

¹⁸F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been investigated as a method to predict pancreatic cancer recurrence after pancreatic surgery. We evaluated the recently introduced heterogeneity indices of ¹⁸F-FDG PET/CT used for predicting pancreatic cancer recurrence after surgery and compared them with current clinicopathologic and ¹⁸F-FDG PET/CT parameters.

Methods

A total of 93 pancreatic ductal adenocarcinoma patients (M:F = 60:33, mean age = 64.2 ± 9.1 years) who underwent preoperative ¹⁸F-FDG PET/CT following pancreatic surgery were retrospectively enrolled. The standardized uptake values (SUVs) and tumor-to-background ratios (TBR) were measured on each ¹⁸F-FDG PET/CT, as metabolic parameters. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were examined as volumetric parameters. The coefficient of variance (heterogeneity index-1; SUVmean divided by the standard deviation) and linear regression slopes (heterogeneity index-2) of the MTV, according to SUV thresholds of 2.0, 2.5 and 3.0, were evaluated as heterogeneity indices. Predictive values of clinicopathologic and ¹⁸F-FDG PET/CT parameters and heterogeneity indices were compared in terms of pancreatic cancer recurrence.

Results

Seventy patients (75.3%) showed recurrence after pancreatic cancer surgery (mean recurrence = 9.4 ± 8.4 months). Comparing the recurrence and no recurrence patients, all of the ¹⁸F-FDG PET/CT parameters and heterogeneity indices demonstrated significant differences. In univariate Cox-regression analyses, MTV (P = 0.013), TLG (P = 0.007), and heterogeneity index-2 (P = 0.027) were significant. Among the clinicopathologic parameters, CA19–9 (P = 0.025) and venous invasion (P = 0.002) were selected as significant parameters. In multivariate Cox-regression analyses, MTV (P = 0.005), TLG (P = 0.004), and heterogeneity index-2 (P = 0.016) with venous invasion (P < 0.001, 0.001, and 0.001, respectively) demonstrated significant results.

Conclusions

The heterogeneity index obtained using the linear regression slope, could be an effective predictor of pancreatic cancer recurrence after pancreatic cancer surgery, in addition to ¹⁸F-FDG PET/CT volumetric parameters and clinicopathologic parameters.

     

Spatial Normalization Using Early-Phase [18F]FP-CIT PET for Quantification of Striatal Dopamine Transporter Binding

PurposeThe precise quantification of dopamine transporter (DAT) density on N-(3-[¹⁸F]Fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl) nortropane positron emission tomography ([¹⁸F]FP-CIT PET) imaging is crucial to measure the degree of striatal DAT loss in patients with parkinsonism. The quantitative analysis requires a spatial normalization process based on a template brain. Since the spatial normalization method based on a delayed-phase PET has limited performance, we suggest an early-phase PET-based method and compared its accuracy, referring to the MRI-based approach as a gold standard.MethodsA total of 39 referred patients from the movement disorder clinic who underwent dual-phase [¹⁸F]FP-CIT PET and took MRI within 1 year were retrospectively analyzed. The three spatial normalization methods were applied for quantification of [¹⁸F]FP-CIT PET-MRI-based anatomical normalization, PET template-based method based on delayed PET, and that based on early PET. The striatal binding ratios (BRs) were compared, and voxelwise paired t tests were implemented between different methods.ResultsThe early image-based normalization showed concordant patterns of putaminal [¹⁸F]FP-CIT binding with an MRI-based method. The BRs of the putamen from the MRI-based approach showed higher agreement with early image- than delayed image-based method as presented by Bland-Altman plots and intraclass correlation coefficients (early image-based, 0.980; delayed image-based, 0.895). The voxelwise test exhibited a smaller volume of significantly different counts in putamen between brains processed by early image and MRI compared to that between delayed image and MRI.ConclusionThe early-phase [¹⁸F]FP-CIT PET can be utilized for spatial normalization of delayed PET image when the MRI image is unavailable and presents better performance than the delayed template-based method in quantitation of putaminal binding ratio.     

Usefulness of Intraoperative Monitoring during Microsurgical Decompression of Cervicomedullary Compression Caused by an Anomalous Vertebral Artery

We report a case of cervicomedullary compression by an anomalous vertebral artery treated using microsurgical decompression with intraoperative monitoring. A 68-year-old woman presented with posterior neck pain and gait disturbance. MRI revealed multiple abnormalities, including an anomalous vertebral artery that compressed the spinal cord at the cervicomedullary junction. Suboccipital craniectomy with C1 laminectomy was performed. The spinal cord was found to be compressed by the vertebral arteries, which were retracted dorsolaterally. At that time, the somatosensory evoked potential (SSEP) changed. After release of the vertebral artery, the SSEP signal normalized instantly. The vertebral artery was then lifted gently and anchored to the dura. There was no other procedural complication. The patient''s symptoms improved. This case demonstrates that intraoperative monitoring may be useful for preventing procedural complications during spinal cord microsurgical decompression.