Clinical value of triple-energy window scatter correction in simultaneous dual-isotope single-photon emission tomography with 123I-BMIPP and 201Tl

To improve the image quality in simultaneous dual-isotope single-photon emission tomography (SPET) with iodine-123 labelled 15-(p-iodophenyl)-3-methylpentadecanoic acid (BMIPP) and thallium-201, we applied the triple-energy window method (TEW) for correction of the cross-talk and scatter artifact. Seventy-one patients with coronary artery disease were included. 201Tl cross-talk into the 123I acquisition window (group 1, n = 30) and 123I cross-talk into the 201Tl window (group 2, n = 41) were studied. In group 1, 123I images were first obtained (single-isotope images), followed by 201Tl injection and SPET acquisition using dual-isotope windows (dual-isotope images). In group 2, the order was reversed. The dual-isotope SPET images with and without TEW were compared with the single-isotope images. Qualitative evaluation was performed by scoring the segmental defect pattern. Detectability of the mismatched fatty acid metabolism on dual-isotope SPET was evaluated by receiver operating characteristic (ROC) curve analysis. Segmental defect pattern agreement between dual and corrected single images was significantly improved by TEW correction (P<0.01). The agreement was particularly improved in segments with absence of uptake. There was no significant difference between TEW-corrected dual-isotope SPET and corresponding single-isotope SPET with regard to either % defect count or background activity. Mismatched fatty acid metabolism depicted by dual-isotope SPET predicted abnormal wall motion more accurately with TEW than without TEW. With TEW, a practical method for scatter and cross-talk correction in clinical settings, simultaneous dual 123I-BMIPP/201Tl SPET is feasible for the assessment of myocardial perfusion/metabolism mismatch.     

Myocardial perfusion and function imaging at rest with simultaneous thallium-201 and technetium-99m blood-pool dual-isotope gated SPECT

We present a simultaneous gated SPECT (G-SPECT) dual-isotope technique using 201Tl for perfusion and 99mTc blood-pool labeling for function imaging. METHODS: Seventeen patients (13 with previous myocardial infarction, MI) and a control group of three normal volunteers were investigated. They received, 15 min after a 201Tl stress/redistribution protocol with reinjection, 900-950 MBq 99mTc-HSA for blood-pool labeling. Eight frames per R-R interval were recorded in the G-SPECT mode with three windows: window A with 20% centered at 71 keV for 201Tl, window B with 10% centered at 105 keV for Tc scatter contamination and window C centered at 140 keV with 20% for 99mTc. Nongated, crosstalk-corrected 201Tl SPECT perfusion images were reconstructed according to normalized projection-by-projection subtraction from data from windows A and B. G-SPECT data from window C were reconstructed with the same reconstruction limits to allow topographic correlations of left ventricular perfusion and wall motion abnormalities. Polar maps of perfusion and function were used to divide the myocardium into 20 segments. Perfusion was expressed as the percentage of thallium uptake and function corresponding to diastolic to systolic shortening normalized by end diastolic volume. RESULTS: Segmental comparison of uncontaminated-to-contaminated and corrected 201Tl patient images demonstrated an overall agreement score of 93%, with a kappa statistic of 0.76 +/- 0.06 when normal perfused segments were excluded. Segmental matching of perfusion against function at rest showed no correlation for the 10 patients with preserved ejection fraction of 59% +/- 8% nor for the control group. For the remaining seven patients with an ejection fraction of 34% +/- 10%, there was linear correlation between perfusion and function (r2 = 0.61). CONCLUSIONS: The feasibility of dual TI-Tc G-SPECT was examined at rest and suggests low perfusion hypokinesis that matches linear dependence for CAD patients with low ejection fraction.     

Transmission imaging for nonuniform attenuation correction using a three-headed SPECT camera

ACTH (1-24) induces cell shape changes in the immunocytes of the bivalve mollusc, Mytilus galloprovincialis. Using computer-assisted microscopic image analysis, we have found that the G protein antagonist suramin sodium, the adenylate cyclase inhibitor 2',5'-dideoxyadenosine, and the protein kinase inhibitor staurosporine inhibit this effect. The highly specific inhibitors H-89 (for protein kinase A) and calphostin C (for protein kinase C) only inhibited partially the morphological alterations. In contrast, the simultaneous action of H-89 and calphostin C completely blocked these changes. The above findings indicate that ACTH (1-24) induces cell shape changes in molluscan immunocytes via adenylate cyclase/cAMP/protein kinase A pathway, as well as the activation of protein kinase C.     

ECG-gated dual-isotope myocardial SPECT with 201Tl and 99mTc-tetrofosmin: simultaneous assessment of stress/rest myocardial perfusion and left ventricular function

ECG-gated dual-isotope acquisition protocol involving rest imaging with 201Tl and stress 99mTc-tetrofosmin (TF) SPECT was designed for the simultaneous assessment of rest/stress myocardial perfusion and rest ventricular systolic function. This study assessed the feasibility and diagnostic accuracy of this protocol. Forty-five patients underwent the dual-isotope SPECT protocol. Twenty minutes after resting injection of 111 MBq of 201Tl, 370 MBq of 99mTc-TF was administered at a peak exercise. The dual-isotope gated SPECT acquisition was performed 1 hour later. Then, the regional count increase rate (%WT) of 99mTc-TF from end-diastole end-systole was calculated using an automated method which was developed for quantification of regional wall thickening based on circumferential profile analysis in our laboratory. Myocardial perfusion and contractility analysis was carried out using 8 segments of left ventricle with comparison of coronary angiographical findings. The sensitivity and specificity for the detection of diseased coronary vessels (> = or 75% stenosis) were 76% and 94%, respectively. Infarcted regions showing reversible defect had significantly greater %WT as compared with those with fixed defects (63 seg; 12.7 +/- 6.1% vs. 36 seg; 8.9 +/- 7.2%, p < 0.01). In conclusion, this dual-isotope protocol has some advantages; i.e., shortening an examination time, having the exact registration of stress/rest perfusion, and simultaneous evaluation of resting regional wall thickening.     

201Tl myocardial SPECT. First experiences with a simultaneous transmission-emission acquisition protocol for patient-specific attenuated correction

AIM: In this study our first clinical experiences with simultaneous transmission and emission acquisition in 201 TI myocardial SPECT (T/E-SPECT) are discussed. METHODS: The non-uniform attenuation (AK) was carried out with a triple-head camera (PRISM 3000, Picker Inc.) correction equipped with fanbeam collimators. A line source of 750 MBq 99mTc was used to construct the transmission profile. Prior to investigation patients got 80-120 MBq 201TI-chloride intravenously injected. RESULTS: The study comprises the evaluation of 40 patients, derived from the clinical routine. The investigation followed an usual one day protocol. Our results using T/E-SPECT reveal an almost equilibrated activity distribution between anterior and posterior myocardial wall. CONCLUSION: For this reason it is to be expected that T/E-SPECT provides more reliable information about the posterior myocardial wall, than the usual SPECT technique without attenuation correction.     

Characterization of and correction for eddy current artifacts in echo planar diffusion imaging

Magnetic resonance diffusion imaging is potentially an important tool for the noninvasive characterization of normal and pathological tissue. The technique, however, is prone to a number of artifacts that can severely affect its ability to provide clinically useful information. In this study, the problem of eddy current-induced geometric distortions that occur in diffusion images acquired with echo planar sequences was addressed. These geometric distortions produce artifacts in computed maps of diffusion parameters and are caused by misalignments in the individual diffusion-weighted images that comprise the diffusion data set. A new approach is presented to characterize and calibrate the eddy current effects, enabling the eddy current distortions to be corrected in sets of interleaved (or snapshot) echo planar diffusion images. Correction is achieved by acquiring one-dimensional field maps in the read and phase encode direction for each slice and each diffusion step. The method is then demonstrated through the correction of distortions in diffusion images of the human brain. It is shown that by using the eddy current correction scheme outlined, the eddy current-induced artifacts in the diffusion-weighted images are almost completely eliminated. In addition, there is a significant improvement in the quality of the resulting diffusion tensor maps.     

A simple method for the correction of endorectal surface coil inhomogeneity in prostate imaging

The mechanism of repression of the beta-glucoside utilization (bgl) operon of Escherichia coli by a carboxy-terminally truncated derivative of the nucleoid-associated protein H-NS which is defective in DNA binding was investigated. The DNA-binding function of the H-NS-like protein StpA was found to be necessary for repression, which is consistent with a role for StpA as a DNA-binding adapter for mutant derivatives of H-NS.     

Significance of nonuniform attenuation correction in quantitative brain SPECT imaging

The purposes of this study were to develop a method for nonuniform attenuation correction of 123I emission brain images based on transmission imaging with a longer-lived isotope (i.e., 57Co) and to evaluate the relative improvement in quantitative SPECT images achieved with nonuniform attenuation correction. METHODS: Emission and transmission SPECT scans were acquired on three different sets of studies: a heterogeneous brain phantom filled with 1231 to simulate the distribution of dopamine transporters labeled with 2beta-carbomethoxy-3beta-(4-123I-iodophenyl)tropane (123I-beta-CIT); nine healthy human control subjects who underwent transmission scanning using two separate line sources (57Co and 123I); and a set of eight patients with Parkinson's disease and five healthy control subjects who received both emission and transmission scans after injection of 123I-beta-CIT. Attenuation maps were reconstructed using a Bayesian transmission reconstruction algorithm, and attenuation correction was performed using Chang's postprocessing method. The spatial distribution of errors within the brain was obtained from attenuation correction factors computed from uniform and nonuniform attenuation maps and was visualized on a pixel-by-pixel basis as an error image. RESULTS: For the heterogeneous brain phantom, the uniform attenuation correction had errors of 2%-6.5% for regions corresponding to striatum and background, whereas nonuniform attenuation correction was within 1%. Analysis of 123I transmission images of the nine healthy human control subjects showed differences between uniform and nonuniform attenuation correction to be in the range of 6.4%-16.0% for brain regions of interest (ROIs). The human control subjects who received transmission scans only were used to generate a curvilinear function to convert 57Co attenuation values into those for 123I, based on a pixel-by-pixel comparison of two coregistered transmission images for each subject. These values were applied to the group of patients and healthy control subjects who received transmission 57Co scans and emission 123I scans after injection of 123I-beta-CIT. In comparison to nonuniform attenuation correction as the gold standard, uniform attenuation with the ellipse drawn around the transmission image caused an approximately 5% error, whereas placement of the ellipse around the emission image caused a 15% error. CONCLUSION: Nonuniform attenuation correction allowed a moderate improvement in the measurement of absolute activity in individual brain ROIs. When images were analyzed as target-to-background activity ratios, as is commonly performed with 123I-beta-CIT, these outcome measures showed only small differences when Parkinson's disease patients and healthy control subjects were compared using nonuniform, uniform or even no attenuation correction.     

PilT mutations lead to simultaneous defects in competence for natural transformation and twitching motility in piliated Neisseria gonorrhoeae

Neisseria gonorrhoeae, the Gram-negative aetiological agent of gonorrhoeae, is one of many mucosal pathogens of man that expresses competence for natural transformation. Expression of this phenotype by gonococci appears to rely on the expression of type IV pili (Tfp), but the mechanistic basis for this relationship remains unknown. During studies of gonococcal pilus biogenesis, a homologue of the PilT family of proteins, required for Tfp-dependent twitching motility in Pseudomonas aeruginosa and social gliding motility in Myxococcus xanthus, was discovered. Like the findings in these other species, we show here that gonococcal PilT mutants constructed in vitro no longer display twitching motility. In addition, we demonstrate that they have concurrently lost the ability to undergo natural transformation, despite the expression of structurally and morphologically normal Tpf. These results were confirmed by the findings that two classes of spontaneous mutants that failed to express twitching motility and transformability carried mutations in PilT. Piliated PilT mutants and a panel of pilus assembly mutants were found to be deficient in sequence-specific DNA uptake into the cell, the earliest demonstrable step in neisserial competence. The PilT-deficient strains represent the first genetically defined mutants that are defective in DNA uptake but retain Tfp expression.     

Experimental study on the location of energy windows for scatter correction by the TEW method in 201Tl imaging]

To investigate validity of scatter correction by the TEW method in 201Tl imaging, we performed an experimental study using the gamma camera with the capability to perform the TEW method and a plate source with a defect. Images were acquired with the triple energy window which is recommended by the gamma camera manufacturer. The result of the energy spectrum showed that backscattered photons were included within the lower sub-energy window and main energy window, and the spectral shapes in the upper half region of the photopeak (70 keV) were not changed greatly by the source shape and the thickness of scattering materials. The scatter fraction calculated using energy spectra and, visual observation and the contrast values measured at the defect using planar images also showed that substantial primary photons were included in the upper sub-energy window. In TEW method (for scatter correction), two sub-energy windows are expected to be defined on the part of energy region in which total counts mainly consist of scattered photons. Therefore, it is necessary to investigate the use of the upper sub-energy window on scatter correction by the TEW method in 201Tl imaging.     

Planar imaging quantification using 3D attenuation correction data and Monte Carlo simulated buildup factors

A new method to correct for attenuation and the buildup of scatter in planar imaging quantification is presented. The method is based on the combined use of 3D density information provided by computed tomography to correct for attenuation and the application of Monte Carlo simulated buildup factors to correct for buildup in the projection pixels. CT and nuclear medicine images were obtained for a purpose-built nonhomogeneous phantom that models the human anatomy in the thoracic and abdominal regions. The CT transverse slices of the phantom were converted to a set of consecutive density maps. An algorithm was developed that projects the 3D information contained in the set of density maps to create opposing pairs of accurate 2D correction maps that were subsequently applied to planar images acquired from a dual-head gamma camera. A comparison of results obtained by the new method and the geometric mean approach based on published techniques is presented for some of the source arrangements used. Excellent results were obtained for various source-phantom configurations used to evaluate the method. Activity quantification of a line source at most locations in the nonhomogeneous phantom produced errors of less than 2%. Additionally, knowledge of the actual source depth is not required for accurate activity quantification. Quantification of volume sources placed in foam, Perspex and aluminium produced errors of less than 7% for the abdominal and thoracic configurations of the phantom.     

Electronic portal imaging with on-line correction of setup error in thoracic irradiation: clinical evaluation

PURPOSE: To analyze setup errors and the feasibility of their on-line correction using electronic portal imaging in the irradiation of lung tumors. METHODS AND MATERIALS: Sixteen patients with lung cancer were irradiated through opposed anteroposterior fields. Localization images of anteroposterior fields were recorded with an electronic portal imaging device (EPID). Using an in-house developed algorithm for on-line comparison of portal images setup errors were measured and a correction of table position was performed with a remote couch control prior to treatment. In addition, residual errors were measured on the EPID verification image. Global and individual mean and standard deviation of setup errors were calculated and compared. The feasibility of the procedure was assessed measuring intra- and interobserver variability, influence of organ movement, reproducibility of error measurement, the extra time fraction needed for measuring and adjusting and the fraction of dose needed for imaging. RESULTS: In two setups the procedure could not be finished normally due to problems inherent to the procedure. The reproducibility, intraobserver variability, and influence of organ movements were each described by a distribution with a mean value less than or equal to 1 mm and a standard deviation (SD) of less than 1.5 mm. The interobserver variability showed to be a little bit larger (mean: 0.3 mm, SD: 1.7 mm). The mean time to perform the irradiation of the anteroposterior field was 4 +/- 1 min. The mean time for the measurement and correction procedure approximated 2.5 min. The mean extra time fraction was 65 +/- 24% (1 SD) with more than half of this coming from the error measurement. The dose needed for generation of EPID images was 5.9 +/- 1.4% of total treatment dose. The mean and SD of setup errors were, respectively, 0.1 and 4.5 mm for longitudinal and -2.0 and 5.7 mm for transversal errors. Of 196 measured translational errors 120 (61%) exceeded the adjustment criteria. For individual patients systematic and random setup errors can be as high as, respectively, 15.8 and 7.5 mm. Mean residual error and SD were for longitudinal direction 0.08 and 1.2 mm and for transversal direction -0.9 and 1.0 mm (pooled data). For individuals, the mean residual errors were smaller than 1 mm, with a typical SD per patient of less than 2 mm. CONCLUSION: Setup errors in thoracic radiation therapy are clinically important. On-line correction can be performed accurately with an objective measurement tool, although this prolongs the irradiation procedure for one field with 65%.     

Multifrequency interpolation for fast off-resonance correction

Field inhomogeneities or susceptibility variations produce blurring in images acquired using non-2DFT k-space readout trajectories. This problem is more pronounced for sequences with long readout times such as spiral imaging. Theoretical and practical correction methods based on an acquired field map have been reported in the past. This paper introduces a new correction method based on the existing concept of frequency segmented correction but which is faster and theoretically more accurate. It consists of reconstructing the data at several frequencies to form a set of base images that are then added together with spatially varying linear coefficients derived from the field map. The new algorithm is applied to phantom and in vivo images acquired with projection reconstruction and spiral sequences, yielding sharply focused images.     

Skeletal anchorage system for open-bite correction

A skeletal anchorage system was developed for tooth movements. It consists of a titanium miniplate that is temporarily implanted in the maxilla or the mandible as an immobile anchorage. In this article, we introduce the skeletal anchorage system to intrude the lower molars in open-bite malocclusion and evaluate the results of treatment in two severe open-bite cases that underwent orthodontic treatment with the system. Titanium miniplates were fixed at the buccal cortical bone around the apical regions of the lower first and second molars on both the right and left sides. Elastic threads were used as a source of orthodontic force to reduce excessive molar height. The lower molars were intruded about 3 to 5 mm, and open-bite was significantly improved with little if any extrusion of the lower incisors. No serious side-effects were observed during the orthodontic treatment. The system was also very effective for controlling the cant and level of the occlusal plane during orthodontic open-bite correction.     

Critical limit for massive transformation

In order to understand the mechanism of the massive type of phase transformation, it is essential to study its critical limit in the phase diagram and to analyze the results with theoretical models. The model, based on the interaction between solute atoms and the migrating interface, is described in detail and applied to binary alloys. The importance of the relation between the mobility of the interface relative to the atomic mobilities inside the interface is emphasized. Specimens with a constant heat or carbon content offer valuable experimental variables. It is, thus, possible to force the interface to advance slowly. This article is based on a presentation made at the symposium entitled “The Mechanisms of the Massive Transformation,” a part of the Fall 2000 TMS Meeting held October 16–19, 2000, in St. Louis, Missouri, under the auspices of the ASM Phase Transformations Committee.     

Schematic transformation diagrams for steel

This paper examines the diffusional transformations of austenite and concludes that separateC-curves are required for pearlite, upper bainite, lower bainite and isothermal martensite. A schematic isothermal transformation diagram incorporating the four curves is presented for a plain carbon eutectoid steel and used to develop a schematic continuous cooling transformation diagram. These diagrams are shown to be more compatible with the available experimental information than are the usual diagrams based on a single transformation curve.