Quantitative accuracy of Lu-177 SPECT reconstruction using different compensation methods : phantom and patient studies

Background: In targeted radionuclide therapy (TRT), accurate quantification using SPECT/CT images is important for optimizing radiation dose delivered to both the tumour and healthy tissue. Quantitative SPECT images are regularly reconstructed using the ordered subset expectation maximization (OSEM) algorithm with various compensation methods such as attenuation (A), scatter (S) and detector and collimator response (R). In this study, different combinations of the compensation methods are applied during OSEM reconstruction and the effect on the Lu-177 quantification accuracy is studied in an anthropomorphic torso phantom. In addition, the phantom results are reflected to (177) Lu-DOTA-Tyr3-octreotate (Lu-177-DOTATATE)-treated patient data and kidney absorbed dose estimates. Methods: The torso phantom was imaged with nine various sized (0.4-104.4 cm(3)) spherical inserts, filled with known Lu-177 activity ranging from 0.5 to 105.5 MBq. Images were reconstructed using OSEM algorithm using A, AR and ARS compensation method combinations. The compensation method combinations were compared by calculating the concentration recovery coefficient (cRC) for each insert. In addition, ten Lu-177-DOTATATE-treated patient's post-therapy dosimetry acquisitions were reconstructed, and the absorbed dose to kidneys was estimated. Results: cRC values depend on the insert size for all compensation methods. AR and ARS produced significantly higher cRC values than attenuation correction alone. There were no cRC value differences between the methods for the smallest 1-cm-diameter insert, cRC being 0.18. However, the collimator and detector response compensation method (R) made the 1.3-cm-diameter insert clearly visible and improved cRC estimate from 0.19 to 0.43. ARS produced slightly higher cRC values for small- and medium-sized inserts than AR. On the patient data, a similar trend could be seen. AR and ARS produced higher kidney activities than using attenuation correction alone; the total absorbed doses to the right and left kidneys were on average 15 and 20 % higher for AR and 19 and 25 % higher for ARS, respectively. The effective half-life decay estimated from time-activity curves however showed no notable difference between the compensation methods. Conclusions: The highest cRC values were achieved by applying ARS compensation during reconstruction. The results were notably higher than those using attenuation correction alone. Similarly, higher activity estimates and thus higher absorbed dose estimates were found in patient data when all compensation methods were applied. ARS improved cRC especially in small-sized sources, and it thus might aid tumour dosimetry for Lu-177 PRRT treatments.Peer reviewe

Comparison of EQ-5D and 15D instruments for assessing the health-related quality of life in cardiac surgery patients

Peer reviewe

Spectral Entropy Parameters during Rapid Ventricular Pacing for Transcatheter Aortic Valve Implantation

The time-frequency balanced spectral entropy of the EEG is a monitoring technique measuring the level of hypnosis during general anesthesia. Two components of spectral entropy are calculated: state entropy (SE) and response entropy (RE). Transcatheter aortic valve implantation (TAVI) is a less invasive treatment for patients suffering from symptomatic aortic stenosis with contraindications for open heart surgery. The goal of hemodynamic management during the procedure is to achieve hemodynamic stability with exact blood pressure control and use of rapid ventricular pacing (RVP) that result in severe hypotension. The objective of this study was to examine how the spectral entropy values respond to RVP and other critical events during the TAVI procedure. Twenty one patients undergoing general anesthesia for TAVI were evaluated. The RVP was used twice during the procedure at a rate of 185 ± 9/min with durations of 16 ± 4 s (range 8–22 s) and 24 ± 6 s (range 18–39 s). The systolic blood pressure during RVP was under 50 ± 5 mmHg. Spectral entropy values SE were significantly declined during the RVP procedure, from 28 ± 13 to 23 ± 13 (p < 0.003) and from 29 ± 12 to 24 ± 10 (p < 0.001). The corresponding values for RE were 29 ± 13 vs. 24 ± 13 (p < 0.006) and 30 ± 12 vs. 25 ± 10 (p < 0.001). Both SE and RE values returned to the pre-RVP values after 1 min. Ultra-short hypotension during RVP changed the spectral entropy parameters, however these indices reverted rapidly to the same value before application of RVP

Speed and quality in Coronary Artery Bypass Graft (CABG) surgery: is there a connection?

Health service, Surgery, Operation time, Quality, Health-related quality of life,

MicroRNA Profiling of Pericardial Fluid Samples from Patients with Heart Failure

<div><p>Aims</p><p>Multicellular organisms maintain vital functions through intercellular communication. Release of extracellular vesicles that carry signals to even distant target organs is one way of accomplishing this communication. MicroRNAs can also be secreted from the cells in exosomes and act as paracrine signalling molecules. In addition, microRNAs have been implicated in the pathogenesis of a large number of diseases, including cardiovascular diseases, and are considered as promising candidate biomarkers due to their relative stability and easy quantification from clinical samples. Pericardial fluid contains hormones secreted by the heart and is known to reflect the cardiac function. In this study, we sought to investigate whether pericardial fluid contains microRNAs and if so, whether they could be used to distinguish between different cardiovascular pathologies and disease stages.</p><p>Methods and Results</p><p>Pericardial fluid was collected from heart failure patients during open-heart surgery. MicroRNA profiles of altogether 51 patients were measured by quantitative real-time PCR (qPCR) using Exiqon human panels I and II. On the average, 256 microRNAs were detected per sample, and 70 microRNAs out of 742 profiled microRNAs were detected in every sample. The five most abundant microRNAs in pericardial fluid were miR-21-5p, miR-451a, miR-125b-5p, let-7b-5p and miR-16-5p. No specific signatures for cardiovascular pathologies or clinically assessed heart failure stages could be detected from the profiles and, overall, microRNA profiles of the samples were found to be very similar despite the heterogeneity in the study population.</p><p>Conclusion</p><p>Measured microRNA profiles did not separate the samples according to the clinical features of the patients. However, several previously identified heart failure marker microRNAs were detected. The pericardial fluid microRNA profile appeared to be a result of an active and selective secretory process indicating that microRNAs may act as paracrine signalling factors by mediating the local crosstalk between cardiac cells.</p></div

MicroRNA gene family miR-30.

<p>The presence of all mir-30 family members in pericardial fluid was investigated using qPCR. Results are depicted as individual points for each measured sample (<i>n</i> = 51) lines indicating the mean expression for each miRNA.</p