Attenuation compensation in cerebral 3D PET: effect of the attenuation map on absolute and relative quantitation

It is generally well accepted that transmission (TX)-based non-uniform attenuation correction can supply more accurate absolute quantification; however, whether it provides additional benefits in routine clinical diagnosis based on qualitative interpretation of 3D brain positron emission tomography (PET) images is still the subject of debate. The aim of this study was to compare the effect of the two major classes of method for determining the attenuation map, i.e. uniform versus non-uniform, using clinical studies based on qualitative assessment as well as absolute and relative quantitative volume of interest-based analysis. We investigated the effect of six different methods for determining the patient-specific attenuation map. The first method, referred to as the uniform fit-ellipse method (UFEM), approximates the outline of the head by an ellipse assuming a constant linear attenuation factor (μ=0.096cm−1) for soft tissue. The second, referred to as the automated contour detection method (ACDM), estimates the outline of the head from the emission sinogram. Attenuation of the skull is accounted for by assuming a constant uniform skull thickness (0.45cm) within the estimated shape and the correct μ value (0.151cm−1) is used. The usual measured transmission method using caesium-137 single-photon sources was used without (MTM) and with segmentation of the TX data (STM). These techniques were finally compared with the segmented magnetic resonance imaging method (SMM) and an implementation of the inferring attenuation distributions method (IADM) based on the digital Zubal head atlas. Several image quality parameters were compared, including absolute and relative quantification indexes, and the correlation between them was checked. The qualitative evaluation showed no significant differences between the different attenuation correction techniques as assessed by expert physicians, with the exception of ACDM, which generated artefacts in the upper edges of the head. The mean squared error between the different attenuation maps was also larger when using this latter method owing to the fact that the current implementation of the method significantly overestimated the head contours on the external slices. Correlation between the mean regional cerebral glucose metabolism (rCGM) values obtained with the various attenuation correction methods and those obtained with the gold standard (MTM) was good, except in the case of ACDM (R 2=0.54). The STM and SMM methods showed the best correlation (R 2=0.90) and the regression lines agreed well with the line of identity. Relative differences in mean rCGM values were in general less than 8%. Nevertheless, ANOVA results showed statistically significant differences between the different methods for some regions of the brain. It is concluded that the attenuation map influences both absolute and relative quantitation in cerebral 3D PET. Transmission-less attenuation correction results in a reduced radiation dose and makes a dramatic difference in acquisition time, allowing increased patient throughpu

Iodine-123 metaiodobenzylguanidine scintigraphic assessment of pulmonary vascular status in patients with chronic obstructive pulmonary disease

Background and objective: Lung uptake of iodine-123 metaiodobenzylguanidine ((123)I-MIBG) is used as an indicator of pulmonary endothelial function. Decreased lung uptake of (123)I-MIBG has been demonstrated in patients with COPD as compared with normal subjects. The present study was performed to examine the relationship between lung uptake of (123)I-MIBG and pulmonary artery pressure (Ppa) at rest and during exercise, in patients with COPD. Methods: (123)I-MIBG scintigraphy was performed in 19 patients with COPD. Anterior planar images were acquired 15 min after the injection of (123)I-MIBG, and the total lung to upper mediastinum ratio (LMR) was calculated for both lungs. Right heart catheters were used to monitor Ppa continuously at rest and during exercise. Exercise was performed on an electrically braked bicycle ergometer at a constant workload of 25 W for 3 min. Results: In COPD patients the LMR were not correlated with the pulmonary function parameters measured before exercise, including FEV(1), PaO(2), DL(CO), or Ppa at rest. However, the percentage increase in Ppa during exercise was significantly correlated with LMR. Conclusions: Evaluation of the kinetics of lung uptake of (123)I-MIBG may be a novel scintigraphic tool for the assessment of exercise-induced pulmonary hypertension in patients with COPD.ArticleRESPIROLOGY. 15(8):1215-1219 (2010)journal articl

Reduced lung uptake of Iodine-123 metaiodobenzylguanidine in high-altitude pulmonary oedema

The definitive version is available at www.blackwell-synergy.com.ArticleRESPIROLOGY. 13(6):897-902(2008)journal articl

Asynchrony between the rates of standing height gain and bone mass accumulation during puberty

During puberty, the marked increases in both standing height and bone mass appear to be dissociated in time, the former occurring earlier than the latter. However, the age or pubertal stage at which this dissociation is maximal in girls as opposed to boys, and whether this dissociation is similar at all parts of the skeleton, are not clearly established. Standing height and bone mineral mass, as assessed by measuring areal bone mineral density (BMD), at the levels of the lumbar spine, femoral neck and midfemoral shaft, were measured in 98 females and 100 males between the ages of 9 and 19 years twice at a 1-year interval. In males, the greatest difference between height and BMD gains occurred in the 13-14 year age group and was more pronounced for the lumbar spine and femoral neck than for the midfemoral shaft. In females, the greatest difference was detectable at a younger age (11-12 year age group) and appeared to be of a lower magnitude than in males. In both genders, the maximal difference occurred during the period of peak height velocity, which corresponded to the pubertal stages P2-P3. Such a dissociation between the rates of statural growth and mineral mass accrual could define a state of relatively low bone mass and contribute to the higher incidence of fracture known to occur at the age and/or pubertal stage when this dissociation is maxima

Relation of BMI to a dual-energy X-ray absorptiometry measure of fatness

Dual-energy X-ray absorptiometry (DXA) is a valid technique for measuring the fat, bone and lean (muscle, organs and water) masses of the body. We evaluated relationships of BMI (kg/m2) with independent measurements of fat and lean masses using DXA in 226 adult volunteers. The evaluation was an application of a general approach to compositional data which has not previously been used for describing body composition. Using traditional regression analyses, when lean mass was held constant, BMI varied with fat mass (men r 0·75, P < 0·05 ; women r 0·85, P < 0·05); when fat mass was held constant, BMI varied with lean mass (men r 0·63, P < 0·05; women r 0·47, P < 0·05). In contrast, a regression model for compositional data revealed that BMI was: (a) strongly associated with log fat mass in both sexes (b1 4·86, P < 0·001 for all women and b1 5·96, P < 0·001 for all men); (b) not associated with bone mass, except in older men; (c) related to lean mass in women but not in men (b3 −4·04, P < 0·001 for all women and b1 −2·59, P < 0·15 for all men). Women with higher BMI tended to have more fat mass and more lean mass than women with lower BMI. Men with higher BMI had more fat mass but similar lean mass to men with lower BMI. Investigators need to be alert to the inaccuracy of BMI to assign a fatness risk factor to individuals, especially among wome

Functional imaging studies of cognition using 99mTc-HMPAO SPECT: empirical validation using the n -back working memory paradigm

Purpose: Functional activation protocols are widely applied for the study of brain-cognition relations. Only few take advantage of the intrinsic characteristics of SPECT, particularly those allowing cognitive assessment outside of the camera, in settings close to the standard clinical or laboratory ones. The purpose of the study was to assess the feasibility of a split-dose activation protocol with 99mTc-HMPAO using low irradiation dose. Materials and methods: A two-scans protocol was applied to 12 healthy young volunteers using 270MBq of 99mTc-HMPAO per scan, with each image associated to a particular experimental condition of the verbal n-back working memory task (0-back, 2-back). Subtraction method was used to identify regional brain activity related to the task. Results: Voxel-wise statistical analysis showed left lateralized activity associated with the 2-back task, compared to the 0-back task. Activated regions, mainly prefrontal and parietal, were similar to those observed in previous fMRI and 15O-PET studies. Conclusion: The results support the use of 99mTc-HMPAO SPECT for the investigation of brain-cognition relations and demonstrate the feasibility of optimal quality images despite low radiopharmaceutical doses. The findings also acknowledge the use of HMPAO as a radioligand to capture neuro-energetic modulations linked to cognitive activity. They encourage extending the application of the described activation protocol to clinical population

Contribution of body composition to nutritional assessment at hospital admission in 995 patients: a controlled population study

Body weight, weight changes and BMI are easily obtainable indicators of nutritional status, but they do not provide information on the amount of fat-free and fat masses. The purpose of the present study was to determine if fat-free mass (FFM) and fat mass were depleted in patients with normal BMI or serum albumin at hospital admission. A group of 995 consecutive patients were evaluated for malnutrition by BMI, serum albumin, and 50 kHz bioelectrical impedance analysis and compared with 995 healthy adults, matched for age and height, and then compared with FFM and fat mass percentiles previously determined in 5225 healthy adults. A BMI of ≤20 kg/m2 was noted in 17·3 % of patients and serum albumin of ≤35 g/l was found in 14·9 % of patients. In contrast, 31 % of all patients were below the tenth percentile for FFM, compared with 10·1 % of controls (χ2, P=0·0001), while 73 % of patients with BMI ≤20 kg/m2 and 31 % of patients with BMI 20-24·9 kg/m2 fell below the tenth percentile for FFM. Furthermore, the FFM was lower in patients than controls and the differences with age in FFM (lower) and fat mass (higher) were greater in patients than in controls. BMI and albumin significantly underestimated the prevalence of malnutrition in patients at hospital admission compared with body composition measurements. Optimal nutritional assessment should therefore include objective measurement of FFM and fat mas

Appropriateness of internal digital phantoms for monitoring the stability of the UBIS 5000 quantitative ultrasound device in clinical trials

In bone status assessment, proper quality assurance/quality control is crucial since changes due to disease or therapeutic treatment are very small, in the order of 2-5%. Unlike for dual X-ray absorptiometry, quality control procedures have not been extensively developed and validated for quantitative ultrasound technology, limiting its use in longitudinal monitoring. While the challenge of developing an ideal anthropometric phantom is still open, some manufacturers use the concept of the internal digital phantom mimicking human characteristics to check the stability of their device. The objective of the study was to develop a sensitive model of quality control suitable for the correction of QUS patient data. In order to achieve this goal, we simulated a longitudinal device lifetime with both correct and malfunctioning behaviors. Then, we verified the efficiency of digital phantoms in detecting those changes and subsequently established the in vitro/in vivo relationship. This is the first time that an attempt to validate an internal digital phantom has made, and that this type of validation approach is used. The digital phantom (DP) was designed to mimic normal bone (BUAP2) and osteoporotic bone (BUAP1) properties. The DP was studied using the UBIS 5000 ultrasound device (DMS, France). Diverse malfunctions of the UBIS-5000 were simulated. Several series of measurements were performed on both BUAP1 and 2 and on 12 volunteers at each grade of malfunction. The effect of each simulated malfunction on in vivo and in vitro results was presented graphically by plotting the average BUA values against the percentage change from baseline. The change from baseline in BUA was modeled using linear regression, and the in vivo/in vitro ratio was obtained from the model. All experimentations influenced the measure of BUAP1 and 2 as well as the measure of our 12 volunteers. However, the degree of significance varied as a function of the severity of the malfunction, and the results also differed substantially in magnitude between in vivo and in vitro. Indeed, the DP was about 10 times more sensitive to variations of the transfer function than was the in vivo measurement, which is very reassuring. The sensitivity of the digital phantoms was reliable in the determination of simulated malfunctions of the UBIS-5000. The digital phantoms provided an accurate evaluation of the acoustic performance of the scanner, including the fidelity of transducers. In light of these results, the QC approach of the UBIS-5000 will be extremely simple to implement compared with other devices. Indeed, since the digital phantom was automatically measured during every patient measurement, the QC approach could be built on an individual level basis rather than on an average basi

Defining extreme sport: conceptions and misconceptions

One feature in how sport is defined is the distinction between extreme and non-extreme. BASE jumping is an example of an ‘extreme sport’ because it involves a high degree of ‘risk’, whilst swimming is classified as ‘non-extreme’ because the risks are minimal. This broad definition falls short of identifying the extent of risk and ignores the psychological, social-demographic and life style variables associated with engagement in each sport