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Annals of Nuclear Medicine (v.25, #1)

Evaluation of ^99mTc-labeled antibiotics for infection detection by Fatma Yurt Lambrecht (pp. 1-6).

One of the fields of research in nuclear medicine is the development of new radiopharmaceuticals for imaging infection and inflammation in humans. For this development, several antimicrobial peptides, antibiotics, antibiotic peptide and chemotactic peptides, etc., have been radiolabeled with different radionuclides (⁶⁷Ga, ^99mTc, ¹¹¹In, ¹⁸F, ¹³¹I, etc.) and their imaging potentials studied. Actually, it is very important to distinguish between infection and inflammation. In this respect, radiolabeled antibiotics have advantages because many of the properties of the ideal infection-specific agent through antibiotics localizes in infection site. In this review, only ^99mTc-labeled antibiotics are evaluated and discussed.

Keywords: Bacterial infection; Imaging; Radiolabeled antibiotic; Inflammation; Technetium-99m

Predictors of abnormal heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT by Ronaldo de Souza Leão Lima; Luis Machado; Alexandre B. Azevedo; Andrea De Lorenzo (pp. 7-11).

To identify predictors of abnormal HR response to dipyridamole (DIP) in patients undergoing myocardial perfusion SPECT (MPS).Patients with a reduced heart rate (HR) response to DIP have higher cardiac mortality, but the mechanism is unknown.We studied 432 patients who underwent dual-isotope gated MPS. DIP (0.56 mg/kg) was infused over 4 min, and Tc-99m tetrofosmin was injected 3 min after the end of the infusion. MPS was semiquantitatively interpreted. Left ventricular ejection fraction (LVEF) and volumes were automatically calculated. The population was categorized into quartiles according to HR ratio, and characteristics in each quartile were compared. Logistic regression analysis was performed to identify predictors of abnormal HR response, using the lowest quartile as the independent variable.Patients with abnormal HR response were more frequently without chest pain, with a history of chronic renal failure and taking digoxin. Baseline HR was higher and had fewer symptoms during stress. The stress and rest perfusion defects were greater, but reversibility was not; in addition, LVEF was lower. Multivariable logistic regression analysis demonstrated that the independent predictors of abnormal HR response were baseline HR and low LVEF.LV dysfunction is an independent predictor of abnormal HR response to DIP, and the association between low LVEF and low HR ratio may explain the link between abnormal HR ratio and increased mortality.

Keywords: Myocardial perfusion SPECT; Heart rate; Dipyridamole

Usefulness of the automatic quantitative estimation tool for cerebral blood flow: clinical assessment of the application software tool AQCEL by Mitsuhiro Momose; Akihiro Takaki; Tsuyoshi Matsushita; Shin Yanagisawa; Kesato Yano; Tadashi Miyasaka; Yuka Ogura; Masumi Kadoya (pp. 13-19).

AQCEL enables automatic reconstruction of single-photon emission computed tomogram (SPECT) without image degradation and quantitative analysis of cerebral blood flow (CBF) after the input of simple parameters. We ascertained the usefulness and quality of images obtained by the application software AQCEL in clinical practice.Twelve patients underwent brain perfusion SPECT using technetium-99m ethyl cysteinate dimer at rest and after acetazolamide (ACZ) loading. Images reconstructed using AQCEL were compared with those reconstructed using conventional filtered back projection (FBP) method for qualitative estimation. Two experienced nuclear medicine physicians interpreted the image quality using the following visual scores: 0, same; 1, slightly superior; 2, superior. For quantitative estimation, the mean CBF values of the normal hemisphere of the 12 patients using ACZ calculated by the AQCEL method were compared with those calculated by the conventional method. The CBF values of the 24 regions of the 3-dimensional stereotaxic region of interest template (3DSRT) calculated by the AQCEL method at rest and after ACZ loading were compared to those calculated by the conventional method.No significant qualitative difference was observed between the AQCEL and conventional FBP methods in the rest study. The average score by the AQCEL method was 0.25 ± 0.45 and that by the conventional method was 0.17 ± 0.39 (P = 0.34). There was a significant qualitative difference between the AQCEL and conventional methods in the ACZ loading study. The average score for AQCEL was 0.83 ± 0.58 and that for the conventional method was 0.08 ± 0.29 (P = 0.003). During quantitative estimation using ACZ, the mean CBF values of 12 patients calculated by the AQCEL method were 3–8% higher than those calculated by the conventional method. The square of the correlation coefficient between these methods was 0.995. While comparing the 24 3DSRT regions of 12 patients, the squares of the correlation coefficient between AQCEL and conventional methods were 0.973 and 0.986 for the normal and affected sides at rest, respectively, and 0.977 and 0.984 for the normal and affected sides after ACZ loading, respectively.The quality of images reconstructed using the application software AQCEL were superior to that obtained using conventional method after ACZ loading, and high correlations were shown in quantity at rest and after ACZ loading. This software can be applied to clinical practice and is a useful tool for improvement of reproducibility and throughput.

Keywords: ^99mTc-ECD; CBF; 3DSRT; AQCEL

The potential of FDG-PET/CT for detecting prostate cancer in patients with an elevated serum PSA level by Ryogo Minamimoto; Hiroji Uemura; Futoshi Sano; Hideyuki Terao; Yoji Nagashima; Shoji Yamanaka; Kazuya Shizukuishi; Ukihide Tateishi; Yoshinobu Kubota; Tomio Inoue (pp. 21-27).

The aim of this study is to evaluate the potential and limitation of FDG-PET/CT for detecting prostate cancer in subjects with an elevated serum prostate-specific antigen (PSA) level. Although [¹⁸F]-2-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) has limited value in detecting prostate cancer, the potential of PET/CT has not been precisely evaluated, since positron emission tomography/computed tomography (PET/CT) provides accurate localization of functional findings obtained by PET.Subjects with an increasing PSA level suggestive of prostate cancer were enrolled in this study. FDG-PET/CT was performed prior to prostate biopsy and the findings were compared with the pathological results.Fifty subjects with an elevated serum PSA level took part in this study. The sensitivity, specificity and positive predictive value (PPV) of FDG-PET/CT in the prostate were 51.9% (27/52 areas), 75.7% (112/148 areas) and 42.9% (27/63 areas), respectively; those in the peripheral zone were 73.3% (22/30 areas), 64.3% (45/70 areas) and 46.8% (22/47 areas), respectively; and those in the central gland were 22.7% (5/22 areas), 85.9% (67/78 areas) and 31.3% (5/16 areas), respectively. The estimated cut-off values according to the highest odds ratio (OR) were age of 70 years [OR: 7.00, 95% confidence interval (CI): 1.89–25.93] and a PSA value of 12.0 ng/ml (OR: 10.77, 95% CI: 2.78–41.74). The FDG-PET/CT could potentially detect cancer with 80.0% sensitivity and 87.0% PPV in cases with a Gleason score of 7 or greater.FDG-PET/CT was appropriate for detecting peripheral zone prostate cancer in patients at more than an intermediate risk.

Keywords: ¹⁸F-fluorodeoxyglucose; PET/CT; Prostate cancer; PSA; Gleason score

VEGF-A and its isoform VEGF₁₂₁ mRNA expression measured by quantitative real-time RT-PCR: correlation with F-18 FDG uptake and aggressiveness of lung adenocarcinoma: preliminary study by JianFei Guo; Kotaro Higashi; Yoshimichi Ueda; Yasuhito Ishigaki; Tsutomu Sakuma; Manabu Oguchi; Tsutomu Takegami; Yasuhiko Ohta; Lina Zhang; Ke Xu; Hiroto Nishida; Hisao Tonami (pp. 29-36).

To investigate the correlation of vascular endothelial growth factor (VEGF) A and its isoform VEGF ₁₂₁ mRNA expression with F-18 fluorodeoxyglucose (FDG) uptake and aggressiveness in lung adenocarcinoma.Twenty-three patients with lung adenocarcinoma underwent FDG PET before surgery. As semi-quantitative analysis for FDG uptake, partial volume corrected standardized uptake value (PVC-SUV) of the tumor was calculated. Total RNA from lung adenocarcinoma tissue was prepared from the frozen specimens. Using the real-time reverse transcription polymerase chain reaction method, we analyzed the mRNA level of VEGF-A and VEGF-A isoform VEGF₁₂₁ mRNA level. 18S ribosomal RNA was used as an endogenous control.VEGF-A and VEGF₁₂₁ mRNA levels had significantly positive correlation with PVC-SUV in lung adenocarcinoma (r = 0.477, p = 0.021, r = 0.539, p = 0.008, respectively), while they were not correlated with tumor size (≤3 or >3 cm). VEGF-A and VEGF₁₂₁ mRNA levels of the low FDG uptake group were significantly lower than those of the high FDG uptake group (p = 0.005 and p = 0.004, respectively). FDG uptake (PCV-SUV) of aggressive lung adenocarcinoma was higher than that of non-aggressive lung adenocarcinoma (p = 0.01). VEGF-A and VEGF₁₂₁ mRNA levels of aggressive lung adenocarcinoma were higher than those of non-aggressive lung adenocarcinoma (p = 0.0001 and p = 0.0001, respectively).VEGF-A and VEGF₁₂₁ mRNA levels may correlate with FDG uptake and aggressiveness in lung adenocarcinoma. These findings support the hypothesis that VEGF-A and VEGF₁₂₁ may help in predicting the outcome in patients with lung adenocarcinoma.

Keywords: VEGF-A mRNA; VEGF₁₂₁ mRNA; FDG PET; Lung adenocarcinoma; Aggressiveness

Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis by Emilija Jaksic; Radovan Bogdanovic; Vera Artiko; Dragana Sobic Saranovic; Zorica Petrasinovic; Milorad Petrovic; Ljiljana Bojic; Smiljana Pavlovic; Aleksandra Paripovic; Olga Antonovic; Visnja D. Lezaic; Djordjije Saranovic; Nebojsa Petrovic; Vladimir Obradovic (pp. 37-43).

Assessment of the first febrile urinary tract infection (UTI) in children has been the subject of debate for many years. Diagnosis of acute pyelonephritis (APN) is usually based on clinical and biological data. The clinical usefulness of early Tc-99m DMSA scintigraphy remains controversial, although it may influence the type and duration of treatment. The aim of this study was to assess the role of initial cortical scintigraphy in the detection of early renal parenchymal damage in children highly suspected of having APN and to compare the scintigraphic findings with selected clinical/laboratory parameters and ultrasonography.A prospective study was conducted in 34 infants and young children (18 boys, 16 girls), aged 1.5–36 months (mean 9.8 ± 8.7 months), hospitalized with a first episode of clinically suspected APN. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography (US), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC) and urine analyses were performed.DMSA scintigraphy showed changes consistent with APN in 27/34 (79%) patients, with a mean age of 10.9 months, including 12 males (44%) and 15 (56%) females. Out of 9 febrile children with negative urine culture and supportive evidence of UTI, scintigraphy showed parenchymal involvement in 8 children (24% in the whole group, 30% in scintigraphically documented APN). There were no statistically significant correlations between the frequency or size of the initial scintigraphic abnormalities and age, sex, body temperature, CRP levels or ESR. A CRP level of >54 mg/L and a WBC of >13,300/mm³ had sensitivities of 56 and 59% and specificities of 86 and 71%, respectively. US showed changes consistent with APN in 7/34 (21%) in the whole group and in 7/27 (26%) patients with positive cortical scan (p < 0.05).Initial DMSA renal scintigraphy is a sensitive method for the early diagnosis of APN in young children and is useful in the assessment of the severity of kidney injury even in patients with negative urine culture. Clinical, biological and ultrasound parameters do not identify children with renal damage. Normal DMSA study, excluding parenchymal involvement and late sequelae, could minimize the use of scintigraphy in the follow-up and reduce the redundancy of cystography.

Keywords: Acute pyelonephritis; Tc-99m DMSA; Renal cortical imaging

Analysis of various malignant neoplasms detected by FDG-PET cancer screening program: based on a Japanese Nationwide Survey by Ryogo Minamimoto; Michio Senda; Takashi Terauchi; Seishi Jinnouchi; Tomio Inoue; Takeshi Iinuma; Takeshi Inoue; Kengo Ito; Hiroshi Iwata; Kimiichi Uno; Shinya Oku; Kazuhiro Oguchi; Eriko Tsukamoto; Rumi Nakashima; Sadahiko Nishizawa; Hiroshi Fukuda; Takeshi Murano; Tsuyoshi Yoshida (pp. 45-54).

The most distinctive feature of FDG-PET cancer screening program is the ability to find various kinds of malignant neoplasms in a single test. The aim of this survey is to clarify the range and frequency of various malignant neoplasms detected by FDG-PET cancer screening performed in Japan.“FDG-PET cancer screening” was defined as FDG-PET or positron emission tomography and computed tomography (PET/CT) scan with or without other tests performed for cancer screening of healthy subjects. This survey was based on a questionnaire regarding FDG-PET cancer screening. We analyzed the situation of 9 less frequently found malignant neoplasms including malignant lymphoma, malignancy of head and neck, esophagus, hepatobiliary and gallbladder, pancreas, kidney, cervical and uterine, ovary, and bladder.The detailed information of subjects with the suspected 9 kinds of malignant neoplasms mentioned above in the FDG-PET cancer screening program was studied in a total of 1,219 cases from 212 facilities. A statistical significance between PET/CT and PET was found in relative sensitivity and PPV for renal cell cancer. Malignant lymphoma was frequently of indolent type, suspected head and neck cancers had many false-positive results, and pancreatic cancer detected in this program was often in the advanced stage even in asymptomatic subjects. The recommendation of combined screening modality to PET or PET/CT was as follows: gastric endoscopy for assessing early esophageal cancer; abdominal ultrasound for screening hepatobiliary and gallbladder cancer; pelvic magnetic resonance imaging for assessing gynecological and pelvic cancers; and the CA125 blood test for screening ovarian cancer. Delayed image was helpful depending on the type of suspected malignant neoplasm.We analyzed various types of malignant neoplasms detected by the FDG-PET cancer screening program and presented recommended combination of examinations to cover FDG-PET and PET/CT.

Keywords: Cancer screening; FDG; PET; Delayed imaging; Combined examination

Severe vasospastic angina with ventricular fibrillation suggested by iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid in a young woman by Yuka Ohtaki; Taishiro Chikamori; Hirokazu Tanaka; Yuko Igarashi; Masaharu Hirano; Masao Yamada; Satoshi Hida; Akira Yamashina (pp. 55-58).

Iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) imaging is useful to diagnose recent myocardial ischemia. A 27-year-old woman was admitted to our hospital because of aborted cardiac arrest due to ventricular fibrillation. She underwent BMIPP imaging in order to rule out ischemic heart disease. Reduced BMIPP uptake was observed in the inferoseptal segments. Coronary angiography revealed insignificant lesions, and a severe coronary spasm was provoked in the right coronary artery by an intracoronary injection of acetylcholine. The etiology of ventricular fibrillation in this case was considered to be vasospastic angina. The application of BMIPP imaging helped diagnose fatal vasospastic angina in this case.

Keywords: BMIPP; Vasospastic angina; Ventricular fibrillation

Comparative study of anatomical normalization errors in SPM and 3D-SSP using digital brain phantom by Hideo Onishi; Yuki Matsutake; Hiroki Kawashima; Norikazu Matsutomo; Hizuru Amijima (pp. 59-67).

In single photon emission computed tomography (SPECT) cerebral blood flow studies, two major algorithms are widely used statistical parametric mapping (SPM) and three-dimensional stereotactic surface projections (3D-SSP). The aim of this study is to compare an SPM algorithm-based easy Z score imaging system (eZIS) and a 3D-SSP system in the errors of anatomical standardization using 3D-digital brain phantom images.We developed a 3D-brain digital phantom based on MR images to simulate the effects of head tilt, perfusion defective region size, and count value reduction rate on the SPECT images. This digital phantom was used to compare the errors of anatomical standardization by the eZIS and the 3D-SSP algorithms.While the eZIS allowed accurate standardization of the images of the phantom simulating a head in rotation, lateroflexion, anteflexion, or retroflexion without angle dependency, the standardization by 3D-SSP was not accurate enough at approximately 25° or more head tilt. When the simulated head contained perfusion defective regions, one of the 3D-SSP images showed an error of 6.9% from the true value. Meanwhile, one of the eZIS images showed an error as large as 63.4%, revealing a significant underestimation.When required to evaluate regions with decreased perfusion due to such causes as hemodynamic cerebral ischemia, the 3D-SSP is desirable. In a statistical image analysis, we must reconfirm the image after anatomical standardization by all means.

Keywords: Brain SPECT; Anatomical standardization; 3D-SSP; Statistical analysis method; Statistical parametric mapping

Improvement of image resolution of brain SPECT by use of the wide-angle offset acquisition method by Yasuyuki Takahashi; Noboru Oriuchi; Hiroshi Higashino; Hirotaka Shimada; Keigo Endo; Teruhiro Mochizuki; Kenya Murase (pp. 69-74).

Cerebral SPECT images require high spatial and contrast resolution for precise evaluation of the abnormal tracer distribution in the brain. A shorter data acquisition time is preferable so that artifacts due to patient movement are avoided. We tried to shorten data acquisition time applying larger sampling angle and offset acquisition method, in which half degree of the step angle was shifted in the opposite gamma camera of the dual-detector SPECT system.A simulation study was performed with a 3-dimensional mathematical phantom. The phantom studies were performed with a hot-rod phantom and a brain phantom. A clinical study with ^99mTc-ECD SPECT was also performed on a patient who had a cerebral infarction. Reconstruction of images was done for the normal 6° and 12° onset and 12° offset. Data for the 12° offset were acquired by shifting of sampling angles of the opposite detector by half (6°) of the sampling angles of 12°. The MLEM algorithm was used for image reconstruction. Image qualities in the simulation study, the phantom studies, and the clinical study were compared for the 6° and 12° onset, and for the 12° offset by quantitative analysis with use of profile curves.Analysis of the profile curves revealed that the image quality of the 12° offset was better than that of the 12° onset and compared to that of the 6° onset in the simulation study, the phantom studies, and the clinical study.The present study indicates that wide-angle offset data acquisition improves the image resolution of brain SPECT compared to onset data acquisition with the same sampling time.

Keywords: Offset acquisition; Wide angle; Brain SPECT

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Annals of Nuclear Medicine (v.25, #1)