Left-ventricular innervation assessed by I-SPECT/CT is associated with cardiac events in inherited arrhythmia syndromes
Siebermair J, Lehner S, Sattler SM, Rizas KD, Beckmann BM, Becker A, Schiller J, Metz C, Zacherl M, Vonderlin N, Rassaf T, Dobrev D, Rischpler C, Kääb S, Hacker M, Todica A and Wakili R
Left-ventricular innervation assessed by I-SPECT/CT is associated with cardiac events in inherited arrhythmia syndromes
Siebermair J, Lehner S, Sattler SM, Rizas KD, Beckmann BM, Becker A, Schiller J, Metz C, Zacherl M, Vonderlin N, Rassaf T, Dobrev D, Rischpler C, Kääb S, Hacker M, Todica A and Wakili R
Impaired myocardial sympathetic innervation assessed by Iodine-Metaiodobenzylguanidine (I-MIBG) scintigraphy is associated with cardiac events. Since regional disparities of structural abnormalities are common in inherited arrhythmia syndromes (iAS), a chamber-specific innervation assessment of the right (RV) and left ventricle (LV) could provide important insights for a patient-individual therapy. Aim of this study was to evaluate chamber-specific patterns of autonomic innervation by Single-photon emission computed tomography/computed tomography (SPECT/CT) in patients with iAS with respect to clinical outcome regarding cardiac events.
Left ventricular mechanical dyssynchrony analzyed by Tc-99m sestamibi SPECT and F-18 FDG PET in patients with ischemic cardiomyopathy and the prognostic value
Tian Y, Zhao M, Li W, Zhu Z, Mi H, Li X and Zhang X
Left ventricular mechanical dyssynchrony analzyed by Tc-99m sestamibi SPECT and F-18 FDG PET in patients with ischemic cardiomyopathy and the prognostic value
Tian Y, Zhao M, Li W, Zhu Z, Mi H, Li X and Zhang X
To compare the left ventricular (LV) phase dyssynchrony parameters obtained from Tc-99m Sestamibi SPECT (GSPECT) and F-18 FDG PET(GPET), as well as the prognostic values in patients with ischemic cardiomyopathy (ICM). Consecutive ICM patients referred for myocardial viability assessment were retrospectively evaluated and were followed-up for 21 ± 5 months. Phase parameter from both GSPECT and GPET were analyzed by QGS software, including histogram bandwidth (BW), standard deviation (SD) and entropy. Independent predictor for cardiac death was analyzed by Cox regression analysis. The estimated cardiac survival curve was analyzed by and was compared with the log-rank test. Eight-eight (mean age 56 ± 10, male 94%, LVEF23 ± 10%) ICM patients were included for analysis. Moderate correlations were observed for BW (r = 0.65; p < 0.001), SD (r = 0.63; p < 0.001) and entropy (r = 0.73; p < 0.001) between GSPECT and GPET. Among all covariates, the extent of myocardial scar was significantly associated with the differences of SD (r = 0.22; p < 0.05) and entropy (r = - 0.7; p < 0.05), whereas the extent of myocardial viability was not (all p > 0.05). Entropy measured by GSPECT was the predictor for cardiac death (p = 0.037) while QRS duration was not. The cardiac survival of patients with a high entropy (≥ 59%) was significantly lower than that of patients with low entropy (< 59%) (p < 0.05). GSPECT and GPET-derived phase parameters were not interchangeable in ICM patients. Patients with LV dyssynchrony measured by gated SPECT were associated with a worse outcome.
What scans we will read: imaging instrumentation trends in clinical oncology
Beyer T, Bidaut L, Dickson J, Kachelriess M, Kiessling F, Leitgeb R, Ma J, Shiyam Sundar LK, Theek B and Mawlawi O
What scans we will read: imaging instrumentation trends in clinical oncology
Beyer T, Bidaut L, Dickson J, Kachelriess M, Kiessling F, Leitgeb R, Ma J, Shiyam Sundar LK, Theek B and Mawlawi O
Oncological diseases account for a significant portion of the burden on public healthcare systems with associated costs driven primarily by complex and long-lasting therapies. Through the visualization of patient-specific morphology and functional-molecular pathways, cancerous tissue can be detected and characterized non-invasively, so as to provide referring oncologists with essential information to support therapy management decisions. Following the onset of stand-alone anatomical and functional imaging, we witness a push towards integrating molecular image information through various methods, including anato-metabolic imaging (e.g., PET/CT), advanced MRI, optical or ultrasound imaging.This perspective paper highlights a number of key technological and methodological advances in imaging instrumentation related to anatomical, functional, molecular medicine and hybrid imaging, that is understood as the hardware-based combination of complementary anatomical and molecular imaging. These include novel detector technologies for ionizing radiation used in CT and nuclear medicine imaging, and novel system developments in MRI and optical as well as opto-acoustic imaging. We will also highlight new data processing methods for improved non-invasive tissue characterization. Following a general introduction to the role of imaging in oncology patient management we introduce imaging methods with well-defined clinical applications and potential for clinical translation. For each modality, we report first on the status quo and, then point to perceived technological and methodological advances in a subsequent status go section. Considering the breadth and dynamics of these developments, this perspective ends with a critical reflection on where the authors, with the majority of them being imaging experts with a background in physics and engineering, believe imaging methods will be in a few years from now.Overall, methodological and technological medical imaging advances are geared towards increased image contrast, the derivation of reproducible quantitative parameters, an increase in volume sensitivity and a reduction in overall examination time. To ensure full translation to the clinic, this progress in technologies and instrumentation is complemented by advances in relevant acquisition and image-processing protocols and improved data analysis. To this end, we should accept diagnostic images as "data", and - through the wider adoption of advanced analysis, including machine learning approaches and a "big data" concept - move to the next stage of non-invasive tumour phenotyping. The scans we will be reading in 10 years from now will likely be composed of highly diverse multi-dimensional data from multiple sources, which mandate the use of advanced and interactive visualization and analysis platforms powered by Artificial Intelligence (AI) for real-time data handling by cross-specialty clinical experts with a domain knowledge that will need to go beyond that of plain imaging.
Sorbitol as a Polar Pharmacological Modifier to Enhance the Hydrophilicity of Tc-Tricarbonyl-Based Radiopharmaceuticals
Giammei C, Balber T, Benčurová K, Cardinale J, Berroterán-Infante N, Brandt M, Jouini N, Hacker M, Mitterhauser M and Mindt TL
Sorbitol as a Polar Pharmacological Modifier to Enhance the Hydrophilicity of Tc-Tricarbonyl-Based Radiopharmaceuticals
Giammei C, Balber T, Benčurová K, Cardinale J, Berroterán-Infante N, Brandt M, Jouini N, Hacker M, Mitterhauser M and Mindt TL
The organometallic technetium-99m tricarbonyl core, [Tc][Tc(CO)(HO)], is a versatile precursor for the development of radiotracers for single photon emission computed tomography (SPECT). A drawback of the Tc-tricarbonyl core is its lipophilicity, which can influence the pharmacokinetic properties of the SPECT imaging probe. Addition of polar pharmacological modifiers to Tc-tricarbonyl conjugates holds the promise to counteract this effect and provide tumor-targeting radiopharmaceuticals with improved hydrophilicities, e.g., resulting in a favorable fast renal excretion in vivo. We applied the "Click-to-Chelate" strategy for the assembly of a novel Tc-tricarbonyl labeled conjugate made of the tumor-targeting, modified bombesin binding sequence [Nle]BBN(7-14) and the carbohydrate sorbitol as a polar modifier. The Tc-radiopeptide was evaluated in vitro with PC-3 cells and in Fox-1 mice bearing PC-3 xenografts including a direct comparison with a reference conjugate lacking the sorbitol moiety. The glycated Tc-tricarbonyl peptide conjugate exhibited an increased hydrophilicity as well as a retained affinity toward the Gastrin releasing peptide receptor and cell internalization properties. However, there was no significant difference in vivo in terms of pharmacokinetic properties. In particular, the rate and route of excretion was unaltered in comparison to the more lipophilic reference compound. This could be attributed to the intrinsic properties of the peptide and/or its metabolites. We report a novel glycated (sorbitol-containing) alkyne substrate for the "Click-to-Chelate" methodology, which is potentially of general applicability for the development of Tc-tricarbonyl based radiotracers displaying an enhanced hydrophilicity.
Dose Calculations and Dose-Effect Relationships in 177Lu-PSMA I&T Radionuclide Therapy for Metastatic Castration-Resistant Prostate Cancer
Barna S, Haug AR, Hartenbach M, Rasul S, Grubmüller B, Kramer G and Blaickner M
Dose Calculations and Dose-Effect Relationships in 177Lu-PSMA I&T Radionuclide Therapy for Metastatic Castration-Resistant Prostate Cancer
Barna S, Haug AR, Hartenbach M, Rasul S, Grubmüller B, Kramer G and Blaickner M
Dose response of 22 patients experiencing mCRPC (metastatic castration-resistant prostate cancer) to Lu-PSMA I&T radionuclide therapy was investigated. Dosimetry calculations are used to assess correlations between dosimetric quantities and biomarker values.
Nuclear Cardiology in Asia
Hatazawa J, Sabih D, Li Y, Pradhan PK and Paez D
Nuclear Cardiology in Asia
Hatazawa J, Sabih D, Li Y, Pradhan PK and Paez D
Nuclear cardiology for patients with ischemic heart disease and cardiac failure is expanding in Asia, although quite heterogeneously. In Asia, Israel showed the highest utilization with more than 1000 scans/100,000 inhabitants a year followed by Korea, Japan, UAE, Turkey, Australia (250-999 scans/100,000). Saudi Arabia, Kuwait, Jordan, Lebanon, Iran, and Pakistan practiced 60-99 scans/100,000. Most of South East Asian countries, China, India, and Bangladesh practiced 1-50 scans/100,000 per year. Countries in Central Asia, Mongolia, Vietnam, Cambodia, Lao, Myanmar, Nepal, and Bhutan showed limited use or no nuclear cardiology practice. Myocardial perfusion imaging (MPI) in Asia was characterized by more frequent use of Tl, less use of weight-based Tc dosing, and a trend toward a lower rate of stress-only imaging. Accordingly, the effective dose in nuclear cardiology practices was higher than those of the rest of the world. Mo-Tc generators are available in most countries, relying mainly on the global supply chain because there is little supply chain beyond countries within the region. In practice, the threshold values of left ventricular ejection fraction, end-systolic volume, and end-diastolic volume between normal and pathologic states were set based on the regional normal database in China and Japan because these values were dependent on age, gender, and body weight. The purpose of the MPI SPECT study was to evaluate myocardial ischemia in symptomatic patients with chest pain, effects of percutaneous coronary intervention and coronary artery bypass-graft, and cardiac function in patients with chronic heart failure. The ability of Tc-based MPI for predicting hard cardiac events was confirmed in Asian inhabitants with low risk of ischemic heart disease. Human resource development of nuclear medicine professional and public awareness of nuclear medicine is key issues to promote nuclear cardiology in Asia. International organizations such as the International Atomic Energy Agency and academic organizations in the region such as Asia Oceania Federation of Nuclear Medicine and Biology, Asia Regional Cooperative Council for Nuclear Medicine, East Asia Nuclear Medicine Association, and Arab Society of Nuclear Medicine have an important role in addition to national Societies of Nuclear Medicine in each country and region.
Technical aspects of gated SPECT MPI assessment of left ventricular dyssynchrony used in the VISION-CRT study
Jimenez-Heffernan A, Butt S, Mesquita CT, Massardo T, Peix A, Kumar A, Patel C, Alexanderson E, Pabon LM, Karthikeyan G, Gutierrez C, Marin V, Garcia E and Paez D
Technical aspects of gated SPECT MPI assessment of left ventricular dyssynchrony used in the VISION-CRT study
Jimenez-Heffernan A, Butt S, Mesquita CT, Massardo T, Peix A, Kumar A, Patel C, Alexanderson E, Pabon LM, Karthikeyan G, Gutierrez C, Marin V, Garcia E and Paez D
Pre-Ablation rhTSH-Stimulated F-18 FDG PET/CT Changes Patient Management in Increased-Risk Thyroid Cancer
Rendl G, Rettenbacher L, Schweighofer-Zwink G, Hehenwarter L and Pirich C
Pre-Ablation rhTSH-Stimulated F-18 FDG PET/CT Changes Patient Management in Increased-Risk Thyroid Cancer
Rendl G, Rettenbacher L, Schweighofer-Zwink G, Hehenwarter L and Pirich C
The aim of the study was to evaluate the clinical impact of pre-ablation rhTSH-stimulated fluorine-18 fluorodeoxyglucose (F-18 FDG) PET/CT in addition to post-therapeutic whole body radioiodine scanning in patients with intermediate to high risk differentiated thyroid carcinoma (DTC). This was a retrospective single center study including 73 patients with thyroid cancer (44 females, mean age 43.2±16.2 years, 62% papillary, 31% follicular, 7% poorly differentiated). All patients underwent ablative radioiodine treatment (mean activity: 3661±673 MBq I-131) using rhTSH after thyroidectomy and lymph node (LN) dissection (01/2013-10/2016) and TSH-stimulated F-18 FDG PET/CT (4 MBq/kg body weight, low dose CT). Post-treatment I-131 whole body scan (I-131 WBS) was obtained 9 days afterwards in planar technique and in case of equivocal or abnormal findings using SPECT/CT. Thirty-one patients (42%) showed F-18 FDG avid lesions, 14 patients showed more FDG than iodine positive lesions and 5 patients more iodine positive lesions in I-131 WBS, respectively. Fifty-three patients showed identical F-18 FDG PET/CT and I-131 WBS. The initial treatment plan was changed from follow-up to therapy (surgery, systemic therapy using tyrosine-kinase inhibition) in 11 patients (15%) on the basis of F-18 FDG PET/CT imaging. Six of these 11 patients had papillary thyroid cancer. Three patients with histologically proven LN metastases had stimulated thyroglobulin-levels<2.0 ng/ml. Our study demonstrated a clinical benefit of pre-ablation rhTSH-stimulated F-18 FDG PET/CT imaging in about 20% of patients with intermediate to high risk DTC, leading to change in patient management in 15%.
[Association between brain glucose metabolism and cardiac dysfunction in patients with ischemic heart disease undergoing (18)F-FDG PET/CT imaging]
Lu X, Nie BB, Yun MK, Zhu ZW, Xie XF, Mou TT, Mi HZ, Wei YX, Li X, Shan BC and Zhang XL
[Association between brain glucose metabolism and cardiac dysfunction in patients with ischemic heart disease undergoing (18)F-FDG PET/CT imaging]
Lu X, Nie BB, Yun MK, Zhu ZW, Xie XF, Mou TT, Mi HZ, Wei YX, Li X, Shan BC and Zhang XL
To evaluate the relationship between the brain glucose metabolism and left ventricular function parameters, and to explore the cerebral glucose metabolism reduction regions in patients with ischemic heart disease (IHD). A total of 110 consecutive IHD patients who underwent gated (99)Tc(m)-sestamibi (MIBI) SPECT/CT myocardial perfusion imaging, gated (18)F-fluorodeoxyglucose (FDG) PET/CT myocardial and brain glucose metabolic imaging within three days in Beijing Anzhen Hospital from April 2016 to October 2017, were enrolled in this study. Left ventricular functional parameters of SPECT/CT and PET/CT including end-diastolic volume (EDV), end-systolic volume (ESV) and left ventricular ejection fraction (LVEF) were analyzed by QGS software. Viable myocardium and myocardial infarction region were determined by 17-segment and 5 score system, and the ratio of viable myocardium and scar myocardium was calculated. According to the range of viable myocardium, the patients were divided into viable myocardium<10% group (n=44), viable myocardium 10%-<20% group (=36) and viable myocardium≥20% group (=30). Pearson correlation analysis was used to analyze the correlation between the range of viable myocardium and scar myocardium and the level of cerebral glucose metabolism. Brain glucose metabolism determined by the mean of standardized uptake value (SUV(mean)) was analyzed by SPM. The ratio of SUV(mean) in whole brain and SUV(mean) in cerebellum were calculated, namely taget/background ratio (TBR). Differences in cerebral glucose metabolism among various groups were analyzed by SPM. There were 101 males, and age was (57±10) years in this cohort. The extent of viable myocardium and the extent of scar, LVEF evaluated by SPECT/CT and PET/CT were significantly correlated with TBR (=0.280, =-0.329, =0.188, =0.215 respectively,all <0.05). TBR value was significantly lower in viable myocardium<10% group, compared with viable myocardium 10%-<20% group (1.25±0.97 vs. 1.32±0.17, <0.05) and viable myocardium≥20% group (1.25±0.97 vs. 1.34±0.16, <0.05). Furthermore, in comparison with viable myocardium≥20% group, the hypo-metabolic regions of viable myocardium<10% group were located in the precuneus, frontal lobe, postcentral gyrus, parietal lobe, temporal lobe, and so on. There is a correlation between impaired left ventricular function and brain glucose metabolism in IHD patients. In IHD patients with low myocardial viability, the level of glucose metabolism in the whole brain is decreased, especially in the brain functional areas related to cognitive function.
Comparison of MRI and VQ-SPECT as a Screening Test for Patients With Suspected CTEPH: CHANGE-MRI Study Design and Rationale
Lasch F, Karch A, Koch A, Derlin T, Voskrebenzev A, Alsady TM, Hoeper MM, Gall H, Roller F, Harth S, Steiner D, Krombach G, Ghofrani HA, Rengier F, Heußel CP, Grünig E, Beitzke D, Hacker M, Lang IM, Behr J, Bartenstein P, Dinkel J, Schmidt KH, Kreitner KF, Frauenfelder T, Ulrich S, Hamer OW, Pfeifer M, Johns CS, Kiely DG, Swift AJ, Wild J and Vogel-Claussen J
Comparison of MRI and VQ-SPECT as a Screening Test for Patients With Suspected CTEPH: CHANGE-MRI Study Design and Rationale
Lasch F, Karch A, Koch A, Derlin T, Voskrebenzev A, Alsady TM, Hoeper MM, Gall H, Roller F, Harth S, Steiner D, Krombach G, Ghofrani HA, Rengier F, Heußel CP, Grünig E, Beitzke D, Hacker M, Lang IM, Behr J, Bartenstein P, Dinkel J, Schmidt KH, Kreitner KF, Frauenfelder T, Ulrich S, Hamer OW, Pfeifer M, Johns CS, Kiely DG, Swift AJ, Wild J and Vogel-Claussen J
The diagnostic strategy for chronic thromboembolic pulmonary hypertension (CTEPH) is composed of two components required for a diagnosis of CTEPH: the presence of chronic pulmonary embolism and an elevated pulmonary artery pressure. The current guidelines require that ventilation-perfusion single-photon emission computed tomography (VQ-SPECT) is used for the first step diagnosis of chronic pulmonary embolism. However, VQ-SPECT exposes patients to ionizing radiation in a radiation sensitive population. The prospective, multicenter, comparative phase III diagnostic trial TEP diosis urope - MRI (CHANGE-MRI, ClinicalTrials.gov identifier ) aims to demonstrate whether functional lung MRI can serve as an equal rights alternative to VQ-SPECT in a diagnostic strategy for patients with suspected CTEPH. Positive findings are verified with catheter pulmonary angiography or computed tomography pulmonary angiography (gold standard). For comparing the imaging methods, a co-primary endpoint is used. (i) the proportion of patients with positive MRI in the group of patients who have a positive SPECT and gold standard diagnosis for chronic pulmonary embolism and (ii) the proportion of patients with positive MRI in the group of patients with negative SPECT and gold standard. The CHANGE-MRI trial will also investigate the performance of functional lung MRI without i.v. contrast agent as an index test and identify cardiac, hemodynamic, and pulmonary MRI-derived parameters to estimate pulmonary artery pressures and predict 6-12 month survival. Ultimately, this study will provide the necessary evidence for the discussion about changes in the recommendations on the diagnostic approach to CTEPH.