Investigation of scattered radiation in 3D whole-body positron emission tomography using Monte Carlo simulations

The correction of scattered radiation is one of the most challenging tasks in 3D positron emission tomography (PET) and knowledge about the amount of scatter and its distribution is a prerequisite for performing an accurate correction. One concern in 3D PET in contrast to 2D PET is the scatter contribution from activity outside the field-of-view (FOV) and multiple scatter. Using Monte Carlo simulations, we examined the scatter distribution for various phantoms. The simulations were performed for a whole-body PET system (ECAT EXACT HR+, Siemens/CTI) with an axial FOV of 15.5 cm and a ring diameter of 82.7 cm. With (without) interplane septa, up to one (two) out of three detected events are scattered (for a centred point source in a water-filled cylinder that nearly fills out the patient port), whereby the relative scatter fraction varies significantly with the axial position. Our results show that for an accurate scatter correction, activity as well as scattering media outside the FOV have to be taken into account. Furthermore it could be shown that there is a considerable amount of multiple scatter which has a different spatial distribution from single scatter. This means that multiple scatter cannot be corrected by simply rescaling the single scatter component.     

Evaluation of proton density by magnetic resonance imaging: phantom experiments and analysis of multiple component proton transverse relaxation

The quantitative evaluation of proton density by magnetic resonance imaging (MRI) is limited as a result of non-uniformities in the intensity distribution of the images and by the fact that only part of the protons of the tissue contribute to the image signal. This study was undertaken to estimate the accuracy of proton density measurements using a standard whole-body MR imager operating at 1.5 T. First, phantom experiments were performed to examine the possibility of an intensity correction. For the test phantom the systematical errors in the computed proton densities were reduced from 5 to 1% after correction. Secondly, proton transverse relaxation curves of biological tissues were measured in vitro on an MR spectrometer. A multi-exponential analysis of the data shows that for spin-echo times TE greater than 10 ms in total between 10 and 30% of the protons of the tissue do not contribute to the image signal. In all tissues a proton component with a free induction decay (FID) time T2* less than 32 microseconds was observed. In the time range TE greater than 10 ms two proton components can be distinguished in muscle and fatty tissue. Finally, it will be shown that a pixel-orientated two-exponential analysis of spin-echo images leads to a much more homogeneous density image than one-exponential computation, since tissue-specific biexponentiality and partial volume effects are taken into account. As a conclusion, the hydrogen density of biological tissues can be evaluated at best with an overall error of 10% from MR images for TE greater than 10 ms. This accuracy is insufficient for a pixel-orientated neutron therapy planning.     

Multicompartment analysis of gadolinium chelate kinetics: blood-tissue exchange in mammary tumors as monitored by dynamic MR imaging.

The blood-tissue exchange kinetics of gadopentetate were studied in 49 malignant and benign mammary tumors. Signal enhancement was monitored simultaneously in the aorta and in tumor for 10.5 minutes after the beginning of a 1 minute i.v. infusion of the contrast medium (CM). Kinetic analysis was based on a model with two compartments for systemic pharmacokinetics and up to three kinetically distinct compartments for tumor. Kinetic heterogeneity, ie, two or more compartments with different exchange rate constants in a given tumor, was found in 85% of carcinomas, 38% of fibroadenomas, and 14% of mastopathic tumors. The within-tumor average of CM exchange rates was 1.22 (0.62-1.65) min(-1) in carcinomas, 0.38 (0.26-0.60) min(-1) in fibroadenomas, and 0.16 (0. 12-0.20) min(-1) in mastopathies (median and interquartile distances). The area under the signal enhancement-time curve of the aorta varied 4.5-fold between individuals. It is concluded that individual CM kinetics in arterial blood should be taken into account when CM exchange rates between blood and tumor are to be determined and that a kinetic model for potentially malignant tumors should allow for kinetic heterogeneity.     

Extreme, Progressive Isovolemic Hemodilution with 5% Human Albumin, PentaLyte, or Hextend Does Not Cause Hepatic Ischemia or Histologic Injury in Rabbits

Background: Physicians and their patients are greatly concerned about perioperative blood administration. Although isovolemic hemodilution is utilized to decrease the incidence of transfusion, it is unclear at what degree of hemodilution hepatoenteric ischemia and injury occurs. The authors hypothesized that hepatic ischemia, systemic ischemia, and tissue injury would occur during hemodilution in rabbits, and that the severity of ischemia and injury may be dependent on the fluid administered.

Methods: Rabbits anesthetized with isoflurane were assigned randomly to a sham-operated group (n = 8) or groups that underwent four isovolemic hemodilutions (25% of the blood volume removed at hourly intervals), with blood replaced with one of three solutions: balanced electrolyte solutions containing 6% pentastarch (n = 8), 6% hetastarch (n = 9), or 5% human albumin in normal saline (n = 8). Arterial ketone body ratio and plasma lactate, respectively, served as measures of hepatic and systemic ischemia. Gastric, duodenal, and hepatic histologic injury was assessed post mortem.

Results: Hemodilution from a baseline hematocrit of about 33% to about 8% (third hemodilution) with all three colloids did not result in a significant increase in plasma lactate concentration or decrease in arterial ketone body ratio. At a hematocrit of about 5% (fourth hemodilution), the hetastarch group had a significantly (P < 0.05) greater plasma lactate concentration than the sham-operated and 5% human albumin groups. There were no significant differences in arterial ketone body ratio or histologic injury between the groups.     

Sleep-disordered breathing and effects of non-invasive ventilation on objective sleep and nocturnal respiration in patients with myotonic dystrophy type I

Patients with myotonic dystrophy type I (DM1) may develop nocturnal hypoventilation, requiring non-invasive ventilation. Data on long-term adherence to non-invasive ventilation, or sleep and ventilation outcomes are scarce. We retrospectively collected baseline polysomnography and capnometry results from 36 adult patients with sleep-related symptoms (42.9?±?12.5 years, 20 female), plus follow-up sleep study records from those treated with non-invasive ventilation. Sleep-disordered breathing was found in 33 patients (91.7%) including 8 (22.2%) with daytime hypercapnia. Twenty-six patients (72.2%) showed nocturnal hypoventilation on transcutaneous capnometry. The sensitivity of oximetry to detect nocturnal hypoventilation was only 0.38. Twenty-eight patients (77.8%) showed sleep apnea, which was predominantly obstructive (n?=?8), central (n?=?9), or “mixed” (n?=?11). Thirty-two patients were initiated on non-invasive ventilation which significantly improved ventilation and oxygenation in the first night of treatment. Follow-up revealed stable normoxia and normocapnia without deterioration of sleep outcomes for up to 52 months. Adherence to treatment was low to moderate, with substantial inter-individual variability.Sleep disordered breathing is highly prevalent in adult DM1 patients complaining of daytime sleepiness, and non-invasive ventilation significantly, rapidly and persistently improves nocturnal gas exchange. Capnometry is superior to oximetry for detection of nocturnal hypoventilation. Adherence to non-invasive ventilation remains a major issue in DM1, and long-term treatment benefits should be individually assessed.