Technical Considerations of Phosphorous-32 Bremsstrahlung SPECT Imaging after Radioembolization of Hepatic Tumors: A Clinical Assessment with a Review of Imaging Parameters

Background. Bremsstrahlung (BS) imaging during radioembolization (RE) confirms the deposition of radiotracer in hepatic/ extrahepatic tumors. The aimof this study is to demonstrate 32P images and to optimize the imaging parameters. Materials and Methods. Thirty-nine patientswith variable types of hepatic tumors, treatedwith the intra-arterial injection of 32P,were included. All patients underwent BS SPECT imaging 24–72 h after tracer administration, using lowenergy high resolution (LEHR) (18 patients) or medium energy general purpose (MEGP) (21 patients) collimators. A grading scale from1 to 4 was used to express the compatibility of the 32P images with those obtained from CT/MRI. Results. Although the image quality obtained with theMEGP collimator was visually and quantitatively better thanwith theLEHR(76%concordance score versus 71%, resp.), there was no statistically significant difference between them. Conclusion.The MEGP collimator is the first choice for BS SPECT imaging. However, if the collimator change is time consuming (as in a busy center) or an MEGP collimator is not available, the LEHR collimator could be practical with acceptable images, especially in a SPECT study. In addition, BS imaging is a useful method to confirm the proper distribution of radiotherapeutic agents and has good correlation with anatomical findings

Association of iron overload based quantitative T2* MRI technique and carotid intima-media thickness in patients with beta-thalassemia: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Body iron status has been implicated in atherosclerotic cardiovascular disease. The main hypothesis is that high iron status is associated with increased risk of atherosclerosis. We investigated the potential role of iron as an additional risk factor promoting atherosclerosis among beta-thalassemic patients.</p> <p>Methods</p> <p>In this cross-sectional study, the liver iron load was assessed by quantitative T2* MRI technique and intima-media thickness (IMT) of the common carotid artery by high-resolution ultrasound among 119 patients (62 male, 57 female) with beta-thalassemia (major and intermediate) whose age ranged from 10 to 50 years with a mean of 25.6 years. The patients were divided into three groups according to the severity of iron loading, obtained by T2*MRI technique: group I (normal), group II (mild) and group III (moderate and severe) iron load.</p> <p>For elimination of the effect of age on carotid IMT values, the patients also were divided into four age groups (10-19 y, 20-29 y, 30-39 y and 40-50 y). Mean carotid IMT based on the severity of iron loading were compared at different age groups, using one way ANOVA analysis for assessing the effect of iron loading on carotid IMT. Pearson's coefficient of correlation were used to assess the degree of correlation between studied variables (liver T2*, IMT, age).</p> <p>Results</p> <p>There were significant differences in mean carotid IMT based on the severity of iron loading at different age groups, with P = 0.003 at 20-29 y, P = 0.006 at 30-39 y and p = 0.037 at 40-50 y. Age (p = 0.001) and liver T2*(p = 0.003) had significant correlation with mean carotid IMT independently.</p> <p>At the age group of 10-19 years, there were not significant differences in mean carotid IMT based on the liver iron loading (p = 0.661).</p> <p>No significant differences also are seen in mean carotid IMT between male and female (p = 0.41).</p> <p>Conclusions</p> <p>This study identified a relationship between body iron status and carotid IMT. This relationship support to the hypothesis of a link between body iron load and atherosclerosis.</p

Fibrin sealants in lumbar annuloplasty after endoscopic discectomy as a method to prevent recurrent lumbar disc herniation.

Fibrin sealant as a promising agent for providing scaffold and efficient hemostasis is widely accepted in several specialties. However, the outcome of Fibrin sealants in lumbar annuloplasty after endoscopic discectomy has not been evaluated in patients with disc herniation. The goal of this study was to evaluate the efficacy, response, and probability of future recurrence rates in herniated nucleus pulposus (HNP) with the use of fibrin sealant in conjunction with endoscopic disc surgery. A total of 35 patients (28 men, 7women) were evaluated, including 18 patients who underwent endoscopic discectomy alone and 17 patients that received fibrin sealant at the site of annulus tear and endoscopic discectomy. All patients were followed through both clinical and imaging methods for an average of 10.5 months. Primary outcome measure was defined as lumbar decompression approved by imaging and symptom alleviation after endoscopic spinal discectomy with Visual Analogue Scale (VAS) score ≤ 4 (cut-off point). Median size of annular tearing was significantly lower in the endoscopic discectomy group (median, 3) (minimum, 2; maximum, 5); however, the corresponding factor in the endoscopic discectomy plus fibrin sealant group was significantly larger (median, 6) (minimum, 5; maximum, 10), with P <0.001. Only one patient in the endoscopic discectomy group had an HNP recurrence during follow-up compared to two patients in the endoscopic discectomy plus fibrin sealant group. Due to the temporary effects of fibrin sealant in preventing disc herniation and the observed recurrence rate in both the case and control groups, the results of this study suggest a role of fibrin sealants combined with endoscopic discectomy to prevent early HNP recurrence rate

Survival outcomes and quality of life after percutaneous cryoablation for liver metastasis: A systematic review and meta-analysis

Background Liver metastasis is present in a wide range of malignancies, with colorectal cancer as the most common site. Several minimally invasive treatments have been suggested for managing hepatic metastases, and cryoablation is among them, yet not widely used. In this systematic review, we aimed to assess the effectiveness of percutaneous cryoablation in all types of liver metastases. Methods A systematic search was performed in international databases, including PubMed, Scopus, Embase, and Web of Science, to find relevant studies reporting outcomes for percutaneous cryoablation in liver metastasis patients. In addition to baseline features such as mean age, gender, metastasis origin, and procedure details, procedure outcomes, including overall survival, local recurrence, quality of life (QoL), and complications, were extracted from the studies. Random-effect meta-analysis was performed to calculate the mean difference (MD) and 95% confidence interval for comparison of QoL. Results We screened 2131 articles. Fifteen studies on 692 patients were included. Mean overall survival ranged from 14.5–29 months. The rate of local recurrence in the included studies ranged from 9.4% to 78%, and local control progression-free survival ranged from 1 to 31 months. The total QoL decreased one week after the cryoablation procedure (-3.08 [95% Confidence interval: -4.65, -1.50], p-value Conclusion Cryoablation is an effective procedure for the treatment of liver metastases, especially in cases that are poor candidates for liver resection. It could significantly improve QoL with favorable local recurrence

Three Cuts Method for Identification of COPD

Two main forms of COPD (Chronic Obstructive Pulmonary Disease) refer to a group of lung diseases that block airflow and cause a huge degree of human suffering. A new method for identifying and estimating the severity of COPD from three-dimensional (3-D) pulmonary X-ray CT images would be helpful for evaluation of treatment effects and early diagnosing is presented in this paper. This method has five main steps. Firstly, corresponding positions of lungs in inspiration and expiration are found based on anatomical structures. Secondly, lung regions are segmented from the CT images by active contours. Next, the left and right lungs are separated using a sequence of morphological operations. Then, parenchyma variations of three main cuts which selected by a feed-forward neural network are found based on the inspiratory and expiratory states. Finally, a pattern classifier is used to decide about the disease and its severity. Twenty patients with air-trapping problems and twelve normal adults were enrolled in this study. Based on the results, a mathematical model was developed to relate variations of lung volumes to severity of disease. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the accuracy of our method for right regions were %81.6, %80.5, %87.5, %72.5 and %81.3 respectively. And these parameters for left regions were %90, %83.3, %90, %83.3 and %87.5 respectively. The proposed method may assist radiologists in detection of Asthma and COPD as a computer aided diagnosis (CAD) system

Noninvasive Prediction of Vertebral Body Compressive Strength Using Finite Element Method and An Image Based Technique

peer reviewe

Prediction of Human Vertebral Compressive Strength Using Quantitative Computed Tomography Based Nonlinear Finite Element Method

Introduction: Because of the importance of vertebral compressive fracture (VCF) role in increasing the patients’ death rate and reducing their quality of life, many studies have been conducted for a noninvasive prediction of vertebral compressive strength based on bone mineral density (BMD) determination and recently finite element analysis. In this study, QCT-voxel based nonlinear finite element method is used for predicting vertebral compressive strength. Material and Methods: Four thoracolumbar vertebrae were excised from 3 cadavers with an average age of 42 years. They were then put in a water phantom and were scanned using the QCT. Using a computer program prepared in MATLAB, detailed voxel based geometry and mechanical characteristics of the vertebra were extracted from the CT images. The three dimensional finite element models of the samples were created using ANSYS computer program. The compressive strength of each vertebra body was calculated based on a linearly elastic-linearly plastic model and large deformation analysis in ANSYS and was compared to the value measured experimentally for that sample. Results: Based on the obtained results the QCT-voxel based nonlinear finite element method (FEM) can predict vertebral compressive strength more effectively and accurately than the common QCT-voxel based linear FEM. The difference between the predicted strength values using this method and the measured ones was less than 1 kN for all the samples. Discussion and Conclusion: It seems that the QCT-voxel based nonlinear FEM used in this study can predict more effectively and accurately the vertebral strengths based on every vertebrae specification by considering their detailed geometric and densitometric characteristics

Prediction of Human Vertebral Compressive Strength Using Quantitative Computed Tomography Based Nonlinear Finite Element Method

Introduction: Because of the importance of vertebral compressive fracture (VCF) role in increasing the patients’ death rate and reducing their quality of life, many studies have been conducted for a noninvasive prediction of vertebral compressive strength based on bone mineral density (BMD) determination and recently finite element analysis. In this study, QCT-voxel based nonlinear finite element method is used for predicting vertebral compressive strength. Material and Methods: Four thoracolumbar vertebrae were excised from 3 cadavers with an average age of 42 years. They were then put in a water phantom and were scanned using the QCT. Using a computer program prepared in MATLAB, detailed voxel based geometry and mechanical characteristics of the vertebra were extracted from the CT images. The three dimensional finite element models of the samples were created using ANSYS computer program. The compressive strength of each vertebra body was calculated based on a linearly elastic-linearly plastic model and large deformation analysis in ANSYS and was compared to the value measured experimentally for that sample. Results: Based on the obtained results the QCT-voxel based nonlinear finite element method (FEM) can predict vertebral compressive strength more effectively and accurately than the common QCT-voxel based linear FEM. The difference between the predicted strength values using this method and the measured ones was less than 1 kN for all the samples. Discussion and Conclusion: It seems that the QCT-voxel based nonlinear FEM used in this study can predict more effectively and accurately the vertebral strengths based on every vertebrae specification by considering their detailed geometric and densitometric characteristics

T2* magnetic resonance imaging of the liver in thalassemic patients in Iran

AIM: To investigate the accuracy of T2*-weighted magnetic resonance imaging (MRI T2*) in the evaluation of iron overload in beta-thalassemia major patients