Effect of blood glucose level on standardized uptake value (SUV) in F-18- FDG PET-scan : a systematic review and meta-analysis of 20,807 individual SUV measurements

Objectives To evaluate the effect of pre-scan blood glucose levels (BGL) on standardized uptake value (SUV) in F-18-FDG-PET scan. Methods A literature review was performed in the MEDLINE, Embase, and Cochrane library databases. Multivariate regression analysis was performed on individual datum to investigate the correlation of BGL with SUVmax and SUVmean adjusting for sex, age, body mass index (BMI), diabetes mellitus diagnosis, F-18-FDG injected dose, and time interval. The ANOVA test was done to evaluate differences in SUVmax or SUVmean among five different BGL groups (200 mg/dl). Results Individual data for a total of 20,807 SUVmax and SUVmean measurements from 29 studies with 8380 patients was included in the analysis. Increased BGL is significantly correlated with decreased SUVmax and SUVmean in brain (p <0.001, p <0.001,) and muscle (p <0.001, p <0.001) and increased SUVmax and SUVmean in liver (p = 0.001, p = 0004) and blood pool (p=0.008, p200 mg/dl had significantly lower SUVmax. Conclusion If BGL is lower than 200mg/dl no interventions are needed for lowering BGL, unless the liver is the organ of interest. Future studies are needed to evaluate sensitivity and specificity of FDG-PET scan in diagnosis of malignant lesions in hyperglycemia.Peer reviewe

Abstract 154: Training Independent Artificial Intelligence Models for the Detection of Intracranial Pathology

Introduction Intracranial hemorrhage (ICH) and brain parenchymal midline shift (MLS) are medical emergencies and require timely diagnosis for early triage to lifesaving care. Artificial intelligence (AI) has shown potential in shortening the time to diagnosis. Although most of models have been compromised with the need of training sample resulting in overfitting as an obstacle to generalizability of models. In this study we introduce independent training models for the early detection of intracranial pathologies in imaging. Methods The software was developed using Python version 3.11.3. Software packages NumPy, scipy, skimage, stardist, and matpotlib were used for imaging intensity, color, and a shape‐based auto segmentation of intracranial objects. Results The current AI model is able to auto segment the Pineal gland for measurement of MLS (Figure‐1), and can detect imaging evidence of the hyperdense vessel sign (Figure‐2), and demonstrative large intracranial vessel (Figure‐3). Conclusion Our auto segmentation model is based on objects features instead of training models, thus providing a fast, generalizable, and feasible AI model. This tool has adjacent utility for detection and segmentation of intracranial vessels, hemorrhage, and midline shift

Abstract 050: Intraarterial cooling combined with mechanical thrombectomy in acute stroke patients: systematic review and meta‐analysis

Introduction Mechanical thrombectomy (MT) plays an important role in the treatment of intracranial large vessel occlusion (LVO) with recanalization success rate of 60%‐95%. Although the restoration of blood flow can ensue excess generation of reactive oxygen species (ROS) and inflammation which leads to cellular damage known as reperfusion injury. Recent studies have shown promising neuroprotection by reducing body temperature with the mechanism of limiting ROS and immune cells’ response. Although systemic hypothermia is associated with several adverse events and limited hypothermia affecting the specific ischemic brain tissue. Intra‐arterial cooling (IAC) combined with mechanical thrombectomy is a novel method for localized cooling. Methods Embase, and Web of Science were screened for English‐language papers including case reports/series, cohort studies and clinical trials. Studies were reviewed by 2 independent reviewers for inclusion criteria as patients with the age of >18 years old who had LVO and underwent mechanical thrombectomy combined with cold Saline infusion during mechanical thrombectomy (before or after recanalization). Statistical analyses were performed using R software version R‐4.3, P Value of <0.05 was considered significant. Results Four studies were included from initial 1177 studies, including 204 cases with MT combined with IAC (intra‐arterial 4°C saline infusion before or after recanalization) and 219 control with MT. Patients with MT+IAC had lower final infarct volume (MD=25, 95%CI [‐34.02, ‐15.98], P <0.0001), and better modified Rankin scale (mRS) after 90 days (RR=1.42, 95%CI [1.14, 1.77, P= 0.0015). There was no significant difference between MT+IAC and IAC group regarding deterioration of NIHSS in 24 hours(RR=1.09, 95%CI [0.42, 1.3, P=0.287), recanalization at 24 hours (RR=1.03, 95%CI [0.93, 1.14], P= 0.622), vascular spasm in 10 minutes (RR=2.90, , 95%CI [0.78, 10.80], P= 0.111), symptomatic intracranial hemorrhage (RR=0.78, 95%CI [0.48, 1.27], P= 0.322), coagulation abnormality (RR=0.94, , 95%CI [0.35, 2.54], P= 0.902), pneumonia (RR=1.09, 95%CI [0.79, 1.50], P= 0.585), and mortality in 90 days (RR=0.78, 95%CI [0.51, 1.20], P= 0.265). Conclusion Preliminary data is showing Intraarterial cooling combined with mechanical thrombectomy in acute stroke is a feasible and safe method for localized brain tissue cooling to prevent reperfusion injury and maximize long term outcome of MT

Radioimmunotherapy as the first line of treatment in non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy. The estimated deaths and new cases of NHL in the USA in 2018 have reached 19,910 and 74,680, respectively, with 5-year survival rate of 71%. Therapeutic interventions for NHL consist of chemotherapy, radiation therapy and immunotherapy. Radioimmunotherapy (RIT) is a potential alternative treatment for NHL that is currently used in different lines of treatment. Studies show that nuclear medicine physicians and radiation oncologists are not yet certain about the proper line for administration of RIT. Herein, we have reviewed the efficiency and toxicity of RIT as the first line of treatment, and discussed potential novel indications, and strategies such as modifying induction therapy and using rituximab maintenance to optimize the efficiency of RIT as the first line of treatment. Our review indicates that it is more logical to postpone conventional therapies to the second or third lines of treatment instead of RIT

Radioimmunotherapy in non-Hodgkin lymphoma: Prediction and assessment of response

International audienceNon-Hodgkin lymphoma (NHL) is one of the most common malignancies and a major cause of morbidityand mortality. Radioimmunotherapy (RIT) is a novel modality for treating NHL which offers the combineduse of monoclonal antibodies for specific targeting of malignant cells and radiation for killing these cells.Despite the promising results favoring RIT in several clinical studies in different target populations andNHL types, Food and Drug Administration (FDA) approval for RIT agents is restricted to a limited numberof indications and agents, maybe because of several ambiguities that still exist in the field. One of theseambiguities are the lack of evidence-based prognostic factors that determine what patient populationwould benefit most from RIT, which is essential to know in order to optimize the efficacy and safetyof treatment with RIT. As well as selecting the best patient population for RIT, it is important to assessthe response to RIT in order to provide further treatment strategies or avoid unnecessary therapies anddiagnostic procedures. In this review we have explored the details of how to predict the efficiency of RIT

Abstract Number ‐ 122: Minimally symptomatic left M1 occlusion from carotid web

Introduction Minimally symptomatic large vessel occlusion (LVO) is an area of prognostic and management uncertainty. Current guidelines recommend thrombectomy only for patients with NIHSS of 6 or greater when additional timeline and imaging criteria are met. However, patients with initial mild or rapidly improving symptoms with LVO can eventually deteriorate, raising the question of whether all patient with acute LVO should be offered thrombectomy. Methods We present a case of minimally symptomatic M1 occlusion due to ipsilateral carotid web managed without thrombectomy. Results A 42‐year‐old woman with Systemic Lupus Erythematosus (SLE) and hypertension presented to an outside hospital with sudden transient left monocular vision loss, aphasia, right‐side weakness, and dizziness. At the time of presentation (1h from LKW) exam revealed only mild aphasia (NIHSS 1) with normal blood pressure. CTA demonstrated left M1 occlusion with reconstitution of flow at the M2 bifurcation. She was given IV Alteplase and transferred to our center. On 7 h from LKW repeat imaging demonstrated persistence of the left M1 occlusion with an ipsilateral near‐occlusion suspicious for carotid web at the ICA origin, but exam was without deficit. She was monitored closely for neurological deterioration, but remained without significant symptoms. MRA taken the next day demonstrated complete recanalization of the left M1. She was taken to the angiography suite on an outpatient basis for stenting of the carotid web at the origin of the internal carotid artery. Initial diagnostic angiogram revealed near occlusion of the ICA at the origin with post‐stenotic dilation, which was treated with angioplasty and stenting with distal embolic protection. She has remained stable to 8‐month follow‐up with no recurrent stroke. Conclusions Minimally symptomatic LVO presents significant endovascular management uncertainty. While clinical trials support the use of mechanical thrombectomy for significantly symptomatic patients, there is no consensus to guide treatment decisions for patients with minimal symptoms. This uncertainty is driven at least in part by an inability to reliably distinguish between patients who are likely to progress and would benefit from intervention before their collateral circulation fails, and those who will recanalize or develop a compensated chronic occlusion. In this case, our patient received tPA and saw symptom improvement, but this did not remove her M1 occlusion. Angiographic investigation was limited as the patient was asymptomatic, however non‐invasive imaging revealed robust collateralization including reconstitution of MCA flow and left ICA injection failed to opacify the ipsilateral ACA despite patency in recent CT angiography, indicating a right to left flow dominance in circle of Willis collaterals. We opted for close monitoring with follow‐up imaging and outpatient correction of the carotid web, which resulted in a positive outcome. More work is needed to establish criteria to predict which patients with minimally symptomatic LVO are likely to progress

Abstract 080: Continuous Automated Stroke Screening Software for Early Detection of Neurological Impairment

Introduction Stroke is the second leading cause of death worldwide leaving up to 50 % of Survivor chronically disabled after their event. Early diagnosis and treatment can significantly lower mortality and morbidity, significantly reducing the economic burden of long‐term disability. Due to the painless nature of most stroke events, many lack the stimulus to seek emergency assistance, further compounded by a symptomatology of deficit resulting in being unaware of the symptoms or lacking the ability to call for help when needed. A continuous automated stroke screening software tool was developed to address these pitfalls in prehospital care, allowing for the early detection of neurological impairment and the release of a medical emergency alert to facilitate emergency medical care. Methods Python version 3.11.3, NumPy, OpenCV, and mediapipe were used for facial and hand land marking with mathematical models employed to detect eye gaze direction, facial symmetry, eyelid closure and left or right hand detection. Results We were able to demonstrate consistent performance of the final software to continuously detect the eye gaze deviation, or center in real time video capturing (Figure‐1). Software is also capable of detecting lower facial palsy through facial symmetry recognition of smiling to demonstrate a right or left sided palsy (Figure‐2). The ability to blink can be detected to differentiate motor neuron palsy and used as a measure of mental status demonstration of the ability to follow a simple midline command (Figure‐3). Detection of lateralizing hand presentation to the camera allows the software to be used in detecting hemi‐neglect, and antigravity muscle strength in upper extremity. (Figure 1‐3). Conclusion Our developed automated stroke screening software can be used for continuous, physician independent, monitoring of neurologic patients and the detection of acute deficits and emergency alert to facilitate early care. The software is designed for use in medical emergency alert systems, tele stroke assessments, and remote surveillance of the neurological examination in intensive care unit or patients in isolation. Here we present the initial software development and capability, we are currently studying our detection models on patients with neurological deficits in varied practice settings

Novel Methods to Improve the Efficiency of Radioimmunotherapy for Non-Hodgkin Lymphoma

Radioimmunotherapy (RIT) is a novel strategy for treating non-Hodgkin lymphoma (NHL). Several studies have shown the promising results of using RIT in NHL, which have led to FDA approval for two RIT agents in treating low grade NHL. In spite of these favorable results in low-grade NHL, most of the aggressive or relapsed/refractory NHL subjects experience relapses following RIT. Although more aggressive treatments such as myeloablative doses of RIT followed by stem cell transplantation appear to be able to provide a longer survival for some patients these approaches are associated with significant treatment-related adverse events and challenging to deliver in most centers. Therefore, it seems reasonable to develop treatment approaches that enhance the efficiency of RIT, while reducing its toxicity. In this paper, novel methods that improve the efficiency of RIT and reduce its toxicity through various mechanisms are reviewed. Further clinical development of these methods could expand the NHL patient groups eligible for receiving RIT, and even extend the use of RIT to new indications and disease groups in future