Tumour assessment in advanced melanoma: value of FDG-PET/CT in patients with elevated serum S-100B

Purpose: To evaluate the usefulness of PET/CT in melanoma patients with an elevated serum S-100B tumour marker level. Methods: Out of 165 consecutive high-risk melanoma patients referred for PET/CT imaging, 47 had elevated (>0.2μg/l) S-100B serum levels and a contemporaneous 18F-FDG PET/CT scan. PET/CT scans were evaluated for the presence of metastases. To produce a composite reference standard, we used cytological, histological, MRI and PET/CT follow-up findings as well as clinical and S-100B follow-up. Results: Among the 47 patients with increased S-100B levels, PET/CT correctly identified metastases in 38 (30 distant metastases and eight lymph node metastases). In one patient with cervical lymph node metastases, PET/CT was negative. Eight patients had no metastases and PET/CT correctly excluded metastases in all of them. Overall sensitivity for metastases was 97% (38/39), specificity 100% (8/8) and accuracy 98% (46/47). S-100B was significantly higher in patients with distant metastases (mean 1.93μg/l, range 0.3-14.3μg/l) than in patients with lymph node metastases (mean 0.49μg/l, range 0.3-1.6μg/l, p = 0.003) or patients without metastases (mean 0.625μg/l, range 0.3-2.6μg/l, p = 0.007). However, 6 of 14 patients with a tumour marker level of 0.3μg/l had no metastases. Conclusion: In melanoma patients with elevated S-100B tumour marker levels, FDG-PET/CT accurately identifies lymph node or distant metastases and reliably excludes metastases. Because of the significant number of false positive S-100B tumour marker determinations (17%), we recommend repetition of tumour marker measurements if elevated S-100B levels occur before extensive imaging is use

Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography

Purpose: Combining the functional information of SPECT myocardial perfusion imaging (SPECT-MPI) and the morphological information of coronary CT angiography (CTA) may allow easier evaluation of the spatial relationship between coronary stenoses and perfusion defects. The aim of the present study was the validation of a novel software solution for three-dimensional (3D) image fusion of SPECT-MPI and CTA. Methods: SPECT-MPI with adenosine stress/rest 99mTc-tetrofosmin was fused with 64-slice CTA in 15 consecutive patients with a single perfusion defect and a single significant coronary artery stenosis (≥50% diameter stenosis). 3D fused SPECT/CT images were analysed by two independent observers with regard to superposition of the stenosed vessel onto the myocardial perfusion defect. Interobserver variability was assessed by recording the X, Y, Z coordinates for the origin of the stenosed coronary artery and the centre of the perfusion defect and measuring the distance between the two landmarks. Results: SPECT-MPI revealed a fixed defect in seven patients, a reversible defect in five patients and a mixed defect in three patients and CTA documented a significant stenosis in the respective subtending coronary artery. 3D fused SPECT/CT images showed a match of coronary lesion and perfusion defect in each patient and the fusion process took less than 15min. Interobserver variability was excellent for landmark detection (r = 1.00 and r = 0.99, p < 0.0001) and very good for the 3D distance between the two landmarks (r = 0.94, p < 0.001). Conclusion: 3D SPECT/CT image fusion is feasible, reproducible and allows correct superposition of SPECT segments onto cardiac CT anatom

Use of carbon-11 acetate and dynamic positron emission tomography to assess regional myocardial oxygen consumption in patients with acute myocardial infarction receiving thrombolysis or coronary angioplasty

Carbon-11 (C-11) acetate has been introduced for the noninvasive measurements of myocardial oxygen consumption. This study was designed to assess regional C-11 acetate clearance in patients with acute myocardial infarction. Thirty-one patients were studied within 8 days of acute myocardial infarction. C-11 acetate washout-rate constants were significantly lower in the infarct territory than in the remote myocardium (p &lt; 0.008). The scintigraphic measurements correlated with heart rate-blood pressure product in the remote as well as infarct areas (0.52 and 0.48, respectively). There was no significant correlation to left ventricular ejection fraction. C-11 washout rates were significantly affected by [beta]receptor therapy as assessed by multiple regression analysis. Thus, C-11 acetate kinetics allow noninvasive characterization of regional myocardial oxygen demand, which may be useful in assessing the extent of myocardial injury and myocardial oxygen demand of remote myocardium.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30955/1/0000627.pd

Computer analysis of cardiac radionuclide data

Gamma-camera tomography gives uniform in-plane and cross-plane resolution with propagation of the defect from one plane to another determined only by the usual camera-collimator resolution. These images may be reformatted by computer to portray slices in any orientation. Cross plane resolution is slightly worse than for the other methods, but it is uniform. The efficiency is less than either quadrant slant hole or seven pinhole apertures. Rotating cameras are not portable nor can they be used for dynamic studies.Both slant hole collimators and seven pinhole apertures distort the object in the depth dimension because of the limited viewing angle. The slant hole geometry provides somewhat better sampling and less plane-to-plane cross talk especially for the more distant planes. The full width half maximum of the depth response is not a sensitive indicator of this problem because the depth response function has very long tails.To date, best overall performance of the limited angle methods is offered by the 40[deg] slant hole collimator on a large field-of-view camera. This, however, is not a portable unit and has a field-of-view too small for about 10% of the patients.Seven pinhole imaging offers the advantage of having been well studied by a number of institution.87-90 A large pool of normal patient studies exists and the performance is well documented. Although the seven pinhole alone is suited to dynamic studies, any of the methods may be adapted to multigated studies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25165/1/0000603.pd

Assessment of myocardial oxidative metabolism in aortic valve disease using positron emission tomography with C-11 acetate

C-11 acetate has recently been introduced as a tracer of myocardial oxidative metabolism with the use of positron emission tomography. To evaluate this approach in the pressure- or volume-loaded heart, C-11 acetate clearance rate constants were determined in 22 patients with chronic aortic valve disease and in nine normal subjects. Global myocardial C-11 clearance was significantly higher in patients with predominant aortic stenosis (n = 11) or aortic regurgitation (n = 11) than in normal subjects (0.069 +/- 0.017 min-1 and 0.072 +/- 0.010 min-1 compared with 0.050 +/- 0.004 min-1, p r = 0.73, P = 0.0001) for all studies. However, analysis of patient subgroups demonstrated that this correlation held only for aortic stenosis (r = 0.79, p r = 0.89, p &lt; 0.005) but not in patients with aortic regurgitation. Normalization of C-11 acetate clearance rate constants for gradient-corrected rate-pressure product were significantly lower in patients with loaded ventricles, particularly in the presence of a low ejection fraction, compared to normal subjects. Possible mechanisms include myocardial adaptation through hypertrophy or depressed contractility, which would both tend to reduce oxygen consumption under any given load. Serial comparison of C-11 acetate kinetics and noninvasive indexes of oxygen demand may provide assessment of disease progression in pathologic ventricular loading.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30196/1/0000584.pd

The effect of dobutamine on exercise performance in patients with symptomatic ischemic heart disease

The effect of dobutamine on exercise performance was assessed in 20 patients with ischemic heart disease (CAD) and a positive stress test. These patients had a wide range of resting left ventricular ejection fraction (range 22% to 69%, mean 42%). Each patient entered a double-blind crossover study in which two identical exercise radionuclide ventriculograms were performed in patients on dobutamine, 5 [mu]g/kg/min intravenously, or placebo. Dobutamine increased resting left ventricular ejection fraction. Although ejection fraction fell with dobutamine during submaximal exercise, it remained higher than with placebo. At peak exercise, ejection fraction fell to the same level on dobutamine as with placebo. Dobutamine diminished exercise time and time to ischemia while peak pressure-rate product was unchanged. Four of 20 patients developed complex ventricular premature beats, all while on dobutamine. Although useful when administered to resting patients with acute left ventricular failure, dobutamine's effects may be deleterious in exercising patients with chronic ischemic heart disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24958/1/0000385.pd

Radionuclide evaluation of postextrasystolic potentiation of left ventricular function induced by atrial and ventricular stimulation

Postextrasystolic potentiation of left ventricular function induced by ventricular and atrial stimulation was compared in 10 patients using radionuclide ventriculography. After insertion of pacing wires, a preliminary radionuclide ventriculogram was obtained and then ventricular and atrial trigeminy was induced in random order, each with identical R-R coupling intervals, each for 6 to 10 minutes. During the stimulation studies, radionuclide data were acquired in electrocardiographic gated list mode format. Left ventricular ejection fraction and relative end-diastolic and end-systolic volume changes were measured for each reformatted composite sinus, atrial and ventricular premature beat and potentiated beat. The volume changes were normalized to the count-based values obtained for the sinus beat of the appropriate study. Postextrasystolic potentiation induced by either ventricular or atrial stimulation was characterized by similar significant increases in left ventricular ejection fraction (mean +/- standard deviation 7 +/- 3 percent, p &lt; 0.01 versus 7 +/- 5 percent, p &lt; 0.01; difference not significant [NS]) and decreases in relative end-systolic volume (-12 +/- 12 percent, p &lt; 0.01 versus -12 +/- 8 percent, p &lt; 0.01; NS) but little change in relative end-diastolic volume (+5 +/- 10 percent, NS versus +4 +/- 7 percent, NS; NS). This was despite a longer compensatory pause (1,120 +/- 220 versus 1,050 +/- 190 ms, p &lt; 0.01) after the ventricular premature beat. It is concluded that there is no difference in the postextrasystolic potentiation induced by atrial or ventricular premature stimulation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23931/1/0000177.pd

Assessment of right ventricular oxidative metabolism by positron emission tomography with C-11 acetate in aortic valve disease

Evaluation of right ventricular (RV) oxidative metabolism is limited by the inability to easily determine oxygen extraction by the RV myocardium and the complex morphology of this ventricle. Because left ventricular C-11 clearance rate constants closely correlate with myocardial oxygen consumption, it was postulated that C-11 clearance rate constants for the RV free wall should also reflect its oxygen consumption. Therefore, RV C-11 clearance rate constants were compared with RV loading in 21 patients with aortic valve disease to assess the possible use of this technique for noninvasive evaluation of RV oxidative metabolism. RV free wall C-11 clearance rate constants correlated with the product of systolic pulmonary artery pressure and heart rate for all patients (r = 0.65, P = 0.002), but the relation was stronger if 2 patients with overt RV dysfunction were excluded (r = 0.83, P = 0.001). On the basis of mean pulmonary artery pressures, patients were stratified into subgroups with normal (group I, N = 8) and elevated (group II, N = 13) pulmonary pressures and were compared with 10 normal control subjects. RV C-11 clearance rate constants were significantly higher in group II than in group I and in normal control subjects (p &lt; 0.05). These data suggest that RV C-11 acetate clearance rate constants can provide noninvasive evaluation of RV oxidative metabolism. This technique may allow serial assessment of RV performance in various cardiac and pulmonary diseases, and particularly of changes associated with therapeutic interventions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29408/1/0000482.pd