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Else T, Wong KK, Frey KA, Brooks AF, Viglianti BL, Raffel DM. 3-[ 18F]Fluoro- para-hydroxyphenethylguanidine (3-[ 18F]pHPG) PET-A Novel Imaging Modality for Paraganglioma. J Endocr Soc 2024; 8:bvae049. [PMID: 38617812 PMCID: PMC11010306 DOI: 10.1210/jendso/bvae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Indexed: 04/16/2024] Open
Abstract
Context Functional positron emission tomography (PET) imaging for the characterization of pheochromocytoma and paraganglioma (PCC/PGL) and for detection of metastases in malignant disease, offers valuable clinical insights that can significantly guide patient treatment. Objective This work aimed to evaluate a novel PET radiotracer, 3-[18F]fluoro-para-hydroxyphenethylguanidine (3-[18F]pHPG), a norepinephrine analogue, for its ability to localize PCC/PGL. Methods 3-[18F]pHPG PET/CT whole-body scans were performed on 16 patients (8 male:8 female; mean age 47.6 ± 17.6 years; range, 19-74 years) with pathologically confirmed or clinically diagnosed PCC/PGL. After intravenous administration of 304 to 475 MBq (8.2-12.8 mCi) of 3-[18F]pHPG, whole-body PET scans were performed at 90 minutes in all patients. 3-[18F]pHPG PET was interpreted for abnormal findings consistent with primary tumor or metastasis, and biodistribution in normal organs recorded. Standardized uptake value (SUV) measurements were obtained for target lesions and physiological organ distributions. Results 3-[18F]pHPG PET showed high radiotracer uptake and trapping in primary tumors, and metastatic tumor lesions that included bone, lymph nodes, and other solid organ sites. Physiological biodistribution was universally present in salivary glands (parotid, submandibular, sublingual), thyroid, heart, liver, adrenals, kidneys, and bladder. Comparison [68Ga]DOTATATE PET/CT was available in 10 patients and in all cases showed concordant distribution. Comparison [123I]meta-iodobenzylguanidine [123I]mIBG planar scintigraphy and SPECT/CT scans were available for 4 patients, with 3-[18F]pHPG showing a greater number of metastatic lesions. Conclusion We found the kinetic profile of 3-[18F]pHPG PET affords high activity retention within benign and metastatic PCC/PGL. Therefore, 3-[18F]pHPG PET imaging provides a novel modality for functional imaging and staging of malignant paraganglioma with advantages of high lesion affinity, whole-body coregistered computed tomography, and rapid same-day imaging.
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Affiliation(s)
- Tobias Else
- Endocrinology, Metabolism, and Diabetes, University of Michigan, Ann Arbor, MI 48109-5674, USA
| | - Ka Kit Wong
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - Kirk A Frey
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - Allen F Brooks
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - Benjamin L Viglianti
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
| | - David M Raffel
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI 48109-0028, USA
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Bohnen NI, Barr J, Vangel R, Roytman S, Paalanen R, Frey KA, Scott PJH, Kanel P. GABA A Receptor Benzodiazepine Binding Sites and Motor Impairments in Parkinson's Disease. Brain Sci 2023; 13:1711. [PMID: 38137159 PMCID: PMC10741877 DOI: 10.3390/brainsci13121711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Flumazenil is an allosteric modulator of the γ-aminobutyric acid-A receptor (GABAAR) benzodiazepine binding site that could normalize neuronal signaling and improve motor impairments in Parkinson's disease (PD). Little is known about how regional GABAAR availability affects motor symptoms. We investigated the relationship between regional availability of GABAAR benzodiazepine binding sites and motor impairments in PD. Methods: A total of 11 Patients with PD (males; mean age 69.0 ± 4.6 years; Hoehn and Yahr stages 2-3) underwent [11C]flumazenil GABAAR benzodiazepine binding site and [11C]dihydrotetrabenazine vesicular monoamine transporter type-2 (VMAT2) PET imaging and clinical assessment. Stepwise regression analysis was used to predict regional cerebral correlates of the four cardinal UPDRS motor scores using cortical, striatal, thalamic, and cerebellar flumazenil binding estimates. Thalamic GABAAR availability was selectively associated with axial motor scores (R2 = 0.55, F = 11.0, β = -6.4, p = 0.0009). Multi-ligand analysis demonstrated significant axial motor predictor effects by both thalamic GABAAR availability (R2 = 0.47, β = -5.2, F = 7.2, p = 0.028) and striatal VMAT2 binding (R2 = 0.30, β = -3.9, F = 9.1, p = 0.019; total model: R2 = 0.77, F = 11.9, p = 0.0056). Post hoc analysis demonstrated that thalamic [11C]methyl-4-piperidinyl propionate cholinesterase PET and K1 flow delivery findings were not significant confounders. Findings suggest that reduced thalamic GABAAR availability correlates with worsened axial motor impairments in PD, independent of nigrostriatal degeneration. These findings may augur novel non-dopaminergic approaches to treating axial motor impairments in PD.
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Affiliation(s)
- Nicolaas I. Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA;
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Jaimie Barr
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Robert Vangel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
| | - Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
| | - Rebecca Paalanen
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA;
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kirk A. Frey
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Peter J. H. Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
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Saleh JK, Barkmeier D, Frey KA, Davenport MS. Diagnostic yield of whole-body 18F-FDG PET/CT in patients with suspected cardiac sarcoidosis. J Nucl Cardiol 2023; 30:1773-1781. [PMID: 36829085 DOI: 10.1007/s12350-023-03222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/28/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Whole-body F-18 FDG PET has been included in the 2014 Heart Rhythm Society guidelines for cardiac sarcoidosis evaluation to identify alternate sites of biopsy prior to endomyocardial biopsy. The purpose of this study was to evaluate the diagnostic yield of whole-body F-18 FDG PET/CT. METHODS All adult patients with suspected cardiac sarcoidosis undergoing same-day cardiac F-18 FDG PET/CT and whole-body F-18 FDG PET/CT between 10/1/2016 and 6/14/2021 to assess potential biopsy sites were retrospectively identified. Clinical indications, findings, recommendations, and outcomes were assessed. RESULTS Eighty-eight patients were included. Extracardiac PET findings suggestive of sarcoidosis were present in 30 patients (34%), 27 of which had thoracic findings (90%). Sarcoidosis was diagnosed in 11% of patients. Only 1% (1/88) was diagnosed by extrathoracic biopsy of a whole-body PET finding. Incidental findings were common (31%), resulting in 11 additional tests or interventions. Recommendations from extrathoracic findings affected treatment in one case: a drainage catheter placement into an unsuspected pelvic abscess. CONCLUSION Addition of whole-body F-18 FDG PET/CT to cardiac F-18 FDG PET/CT for the identification of extrathoracic sites of biopsy in patients with suspected cardiac sarcoidosis has marginal diagnostic yield but commonly results in incidental findings that rarely affect patient outcome.
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Affiliation(s)
- Jamal K Saleh
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1H4, Canada.
| | - Daniel Barkmeier
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Matthew S Davenport
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
- Department of Urology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
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Segall GM, Watts M, Frey KA. The Future of Nuclear Medicine in the United States. J Nucl Med 2023; 64:1354-1355. [PMID: 37562807 DOI: 10.2967/jnumed.123.265674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/17/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
| | - Maria Watts
- American Board of Nuclear Medicine, St. Louis, Missouri
| | - Kirk A Frey
- American Board of Nuclear Medicine, St. Louis, Missouri
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Peterson AB, Wang C, Wong KK, Frey KA, Muzik O, Schipper MJ, Dewaraja YK. 177Lu-DOTATATE Theranostics: Predicting Renal Dosimetry From Pretherapy 68Ga-DOTATATE PET and Clinical Biomarkers. Clin Nucl Med 2023; 48:393-399. [PMID: 37010563 PMCID: PMC10353839 DOI: 10.1097/rlu.0000000000004599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
PURPOSE Pretreatment predictions of absorbed doses can be especially valuable for patient selection and dosimetry-guided individualization of radiopharmaceutical therapy. Our goal was to build regression models using pretherapy 68Ga-DOTATATE PET uptake data and other baseline clinical factors/biomarkers to predict renal absorbed dose delivered by 177Lu-DOTATATE peptide receptor radionuclide therapy (177Lu-PRRT) for neuroendocrine tumors. We explore the combination of biomarkers and 68Ga PET uptake metrics, hypothesizing that they will improve predictive power over univariable regression. PATIENTS AND METHODS Pretherapy 68Ga-DOTATATE PET/CTs were analyzed for 25 patients (50 kidneys) who also underwent quantitative 177Lu SPECT/CT imaging at approximately 4, 24, 96, and 168 hours after cycle 1 of 177Lu-PRRT. Kidneys were contoured on the CT of the PET/CT and SPECT/CT using validated deep learning-based tools. Dosimetry was performed by coupling the multi-time point SPECT/CT images with an in-house Monte Carlo code. Pretherapy renal PET SUV metrics, activity concentration per injected activity (Bq/mL/MBq), and other baseline clinical factors/biomarkers were investigated as predictors of the 177Lu SPECT/CT-derived mean absorbed dose per injected activity to the kidneys using univariable and bivariable models. Leave-one-out cross-validation (LOOCV) was used to estimate model performance using root mean squared error and absolute percent error in predicted renal absorbed dose including mean absolute percent error (MAPE) and associated standard deviation (SD). RESULTS The median therapy-delivered renal dose was 0.5 Gy/GBq (range, 0.2-1.0 Gy/GBq). In LOOCV of univariable models, PET uptake (Bq/mL/MBq) performs best with MAPE of 18.0% (SD = 13.3%), and estimated glomerular filtration rate (eGFR) gives an MAPE of 28.5% (SD = 19.2%). Bivariable regression with both PET uptake and eGFR gives LOOCV MAPE of 17.3% (SD = 11.8%), indicating minimal improvement over univariable models. CONCLUSIONS Pretherapy 68Ga-DOTATATE PET renal uptake can be used to predict post-177Lu-PRRT SPECT-derived mean absorbed dose to the kidneys with accuracy within 18%, on average. Compared with PET uptake alone, including eGFR in the same model to account for patient-specific kinetics did not improve predictive power. Following further validation of these preliminary findings in an independent cohort, predictions using renal PET uptake can be used in the clinic for patient selection and individualization of treatment before initiating the first cycle of PRRT.
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Affiliation(s)
- Avery B. Peterson
- Department of Radiology, University of Michigan, Ann Arbor
- Department of Radiation Oncology, Wayne State University, Detroit
| | - Chang Wang
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Ka Kit Wong
- Department of Radiology, University of Michigan, Ann Arbor
| | - Kirk A. Frey
- Department of Radiology, University of Michigan, Ann Arbor
| | - Otto Muzik
- Department of Pediatrics, Wayne State University, Detroit, MI
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Bohnen NI, Roytman S, Kanel P, Müller MLTM, Scott PJH, Frey KA, Albin RL, Koeppe RA. Progression of regional cortical cholinergic denervation in Parkinson's disease. Brain Commun 2022; 4:fcac320. [PMID: 36569603 PMCID: PMC9772878 DOI: 10.1093/braincomms/fcac320] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/13/2022] [Accepted: 12/01/2022] [Indexed: 12/03/2022] Open
Abstract
Cortical cholinergic deficits contribute to cognitive decline and other deficits in Parkinson's disease. Cross-sectional imaging studies suggest a stereotyped pattern of posterior-to-anterior cortical cholinergic denervation accompanying disease progression in Parkinson's disease. We used serial acetylcholinesterase PET ligand imaging to characterize the trajectory of regional cholinergic synapse deficits in Parkinson's disease, testing the hypothesis of posterior-to-anterior progression of cortical cholinergic deficits. The 16 Parkinson's disease subjects (4 females/12 males; mean age: 64.4 ± 6.7 years; disease duration: 5.5 ± 4.2 years; Hoehn & Yahr stage: 2.3 ± 0.6 at entry) completed serial 11C-methyl-4-piperidinyl propionate acetylcholinesterase PET scans over a 4-8 year period (median 5 years). Three-dimensional stereotactic cortical surface projections and volume-of-interest analyses were performed. Cholinergic synapse integrity was assessed by the magnitude, k 3, of acetylcholinesterase hydrolysis of 11C-methyl-4-piperidinyl propionate. Based on normative data, we generated Z-score maps for both the k 3 and the k 1 parameters, the latter as a proxy for regional cerebral blood flow. Compared with control subjects, baseline scans showed predominantly posterior cortical k 3 deficits in Parkinson's disease subjects. Interval change analyses showed evidence of posterior-to-anterior progression of cholinergic cortical deficits in the posterior cortices. In frontal cortices, an opposite gradient of anterior-to-posterior progression of cholinergic deficits was found. The topography of k 3 changes exhibited regionally specific disconnection from k 1 changes. Interval-change analysis based on k 3/k 1 ratio images (k 3 adjustment for regional cerebral blood flow changes) showed interval reductions (up to 20%) in ventral frontal, anterior cingulate and Brodmann area 6 cortices. In contrast, interval k 3 reductions in the posterior cortices, especially Brodmann areas 17-19, were largely proportional to k 1 changes. Our results partially support the hypothesis of progressive posterior-to-cortical cholinergic denervation in Parkinson's disease. This pattern appears characteristic of posterior cortices. In frontal cortices, an opposite pattern of anterior-to-posterior progression of cholinergic deficits was found. The progressive decline of posterior cortical acetylcholinesterase activity was largely proportional to declining regional cerebral blood flow, suggesting that posterior cortical cholinergic synapse deficits are part of a generalized loss of synapses. The disproportionate decline in regional frontal cortical acetylcholinesterase activity relative to regional cerebral blood flow suggests preferential loss or dysregulation of cholinergic synapses in these regions. Our observations suggest that cortical cholinergic synapse vulnerability in Parkinson's disease is mediated by both diffuse processes affecting cortical synapses and processes specific to subpopulations of cortical cholinergic afferents.
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Affiliation(s)
- Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson Consortium, Critical Path Institute, Tucson, AZ 85718, USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
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Frey KA. ABNM CertLink: Update and "By the Numbers ". J Nucl Med 2022; 63:13N. [PMID: 36192331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Kirk A Frey
- Associate Executive Director, American Board of Nuclear Medicine
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Wong KK, Frey KA, Niedbala J, Kaza RK, Worden FP, Fitzpatrick KJ, Dewaraja YK. Differences in tumor-to-normal organ SUV ratios measured with 68 Ga-DOTATATE PET compared with 177 Lu-DOTATATE SPECT in patients with neuroendocrine tumors. Nucl Med Commun 2022; 43:892-900. [PMID: 35703269 PMCID: PMC9288505 DOI: 10.1097/mnm.0000000000001592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our goal is to quantitatively compare radiotracer biodistributions within tumors and major normal organs on pretherapy 68 Ga-DOTATATE PET to post-therapy 177 Lu-DOTATATE single-photon emission computed tomography (SPECT) in patients receiving peptide receptor radionuclide therapy (PRRT). METHODS PET/CT at ~ 60 min postinjection of Ga-68 DOTATATE and research 177 Lu-SPECT/CT imaging ~ at 4 h (SPECT1) and ~ 24 h (SPECT2) post-cycle#1 were available. Manual contours of lesions on baseline CT or MRI were applied to co-registered SPECT/CT and PET/CT followed by deep learning-based CT auto-segmentation of organs. Tumor-to-normal organ ratios (TNR) were calculated from standardized uptake values (SUV) mean and SUV peak for tumor, and SUV mean for non-tumoral liver (nliver), spleen and kidney. RESULTS There were 90 lesons in 24 patients with progressive metastatic neuroendocrine tumor. The correlation between PET and SPECT SUV TNRs were poor/moderate: PET versus SPECT1 R 2 = 0.19, 0.21, 0.29; PET versus SPECT2 R 2 = 0.06, 0.16, 0.33 for TNR nliver ,TNR spleen ,TNR kidney , respectively. Across all patients, the average value of the TNR measured on PET was significantly lower than on SPECT at both time points ( P < 0.001). Using SUV mean for tumor, average TNR values and 95% confidence intervals (CI) were PET: TNR nliver = 3.5 [CI: 3.0-3.9], TNR spleen = 1.3 [CI, 1.2-1.5], TNR kidney = 1.7 [CI: 1.6-1.9]; SPECT1: TNR nliver = 10 [CI: 8.2-11.7], TNR spleen = 2.9 [CI: 2.5-3.4], TNR kidney = 2.8 [CI: 2.3-3.3]; SPECT2: TNR nliver = 16.9 [CI: 14-19.9], TNR spleen = 3.6 [CI: 3-4.2], TNR kidney = 3.6 [CI: 3.0-4.2]. Comparison of PET and SPECT results in a sphere phantom study demonstrated that these differences are not attributed to imaging modality. CONCLUSIONS Differences in TNR exist for the theranostic pair, with significantly higher SUV TNR on 177 Lu SPECT compared with 68 Ga PET. We postulate this phenomenon is due to temporal differences in DOTATATE uptake and internalization in tumor as compared to normal organs.
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Affiliation(s)
- Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Kirk A. Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Jeremy Niedbala
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Ravi K. Kaza
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Francis P. Worden
- Department of Endocrine Oncology, University of Michigan, Ann Arbor, Michigan 48109
| | - Kellen J. Fitzpatrick
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
| | - Yuni K. Dewaraja
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109
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Dewaraja YK, Mirando DM, Peterson AB, Niedbala J, Millet JD, Mikell JK, Frey KA, Wong KK, Wilderman SJ, Nelson AS. A pipeline for automated voxel dosimetry: application in patients with multi-SPECT/CT imaging following 177Lu peptide receptor radionuclide therapy. J Nucl Med 2022; 63:1665-1672. [PMID: 35422445 PMCID: PMC9635679 DOI: 10.2967/jnumed.121.263738] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Patient-specific dosimetry in radiopharmaceutical therapy (RPT) is impeded by the lack of tools that are accurate and practical for the clinic. Our aims were to construct and test an integrated voxel-level pipeline that automates key components (organ segmentation, registration, dose-rate estimation, and curve fitting) of the RPT dosimetry process and then to use it to report patient-specific dosimetry in 177Lu-DOTATATE therapy. Methods: An integrated workflow that automates the entire dosimetry process, except tumor segmentation, was constructed. First, convolutional neural networks (CNNs) are used to automatically segment organs on the CT portion of one post-therapy SPECT/CT scan. Second, local contour intensity-based SPECT--SPECT alignment results in volume-of-interest propagation to other time points. Third, dose rate is estimated by explicit Monte Carlo (MC) radiation transport using the fast, Dose Planning Method code. Fourth, the optimal function for dose-rate fitting is automatically selected for each voxel. When reporting mean dose, we apply partial-volume correction, and uncertainty is estimated by an empiric approach of perturbing segmentations. Results: The workflow was used with 4-time-point 177Lu SPECT/CT imaging data from 20 patients with 77 neuroendocrine tumors, segmented by a radiologist. CNN-defined kidneys resulted in high Dice values (0.91-0.94) and only small differences (2%-5%) in mean dose when compared with manual segmentation. Contour intensity-based registration led to visually enhanced alignment, and the voxel-level fitting had high R 2 values. Across patients, dosimetry results were highly variable; for example, the average of the mean absorbed dose (Gy/GBq) was 3.2 (range, 0.2-10.4) for lesions, 0.49 (range, 0.24-1.02) for left kidney, 0.54 (range, 0.31-1.07) for right kidney, and 0.51 (range, 0.27-1.04) for healthy liver. Patient results further demonstrated the high variability in the number of cycles needed to deliver hypothetical threshold absorbed doses of 23 Gy to kidney and 100 Gy to tumor. The uncertainty in mean dose, attributable to variability in segmentation, averaged 6% (range, 3%-17%) for organs and 10% (range, 3%-37%) for lesions. For a typical patient, the time for the entire process was about 25 min (∼2 min manual time) on a desktop computer, including time for CNN organ segmentation, coregistration, MC dosimetry, and voxel curve fitting. Conclusion: A pipeline integrating novel tools that are fast and automated provides the capacity for clinical translation of dosimetry-guided RPT.
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Affiliation(s)
- Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan;
| | | | - Avery B Peterson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiation Oncology, Wayne State University, Detroit, Michigan; and
| | - Jeremy Niedbala
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - John D Millet
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Justin K Mikell
- Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ka Kit Wong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Scott J Wilderman
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Wong KK, Else T, Viglianti BL, Brooks AF, Frey KA, Raffel DM. PET imaging of metastatic paraganglioma using novel 3-[ 18F]fluoro-para-hydroxyphenethylguanidine (3-[ 18F]pHPG) radiotracer. Eur J Nucl Med Mol Imaging 2022; 49:2098-2099. [PMID: 35089374 DOI: 10.1007/s00259-021-05639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/24/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Ka Kit Wong
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA.
| | - Tobias Else
- Endocrinology, Metabolism, and Diabetes, University of Michigan Hospital, Ann Arbor, MI, USA
| | | | - Allen F Brooks
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Kirk A Frey
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA
| | - David M Raffel
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA
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11
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Bohnen NI, Kanel P, Koeppe RA, Sanchez-Catasus CA, Frey KA, Scott P, Constantine GM, Albin RL, Müller MLTM. Regional cerebral cholinergic nerve terminal integrity and cardinal motor features in Parkinson's disease. Brain Commun 2021; 3:fcab109. [PMID: 34704022 PMCID: PMC8196256 DOI: 10.1093/braincomms/fcab109] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 01/21/2023] Open
Abstract
Clinical effects of anti-cholinergic drugs implicate cholinergic systems alterations in the pathophysiology of some cardinal motor impairments in Parkinson’s disease. The topography of affected cholinergic systems deficits and motor domain specificity are poorly understood. Parkinson's disease patients (n = 108) underwent clinical and motor assessment and vesicular acetylcholine transporter [18F]-fluoroethoxybenzovesamicol PET imaging. Volumes-of-interest-based analyses included detailed thalamic and cerebellar parcellations. Successful PET sampling for most of the small-sized parcellations was available in 88 patients. A data-driven approach, stepwise regression using the forward selection method, was used to identify cholinergic brain regions associating with cardinal domain-specific motor ratings. Regressions with motor domain scores for model-selected regions followed by confounder analysis for effects of age of onset, duration of motor disease and levodopa equivalent dose were performed. Among 7 model-derived regions associating with postural instability and gait difficulties domain scores three retained significance in confounder variable analysis: medial geniculate nucleus (standardized β = −0.34, t = −3.78, P = 0.0003), lateral geniculate nucleus (β = −0.32, t = −3.4, P = 0.001) and entorhinal cortex (β = −0.23, t = −2.6, P = 0.011). A sub-analysis of non-episodic postural instability and gait difficulties scores demonstrated significant effects of the medial geniculate nucleus, entorhinal cortex and globus pallidus pars interna. Among 6 tremor domain model-selected regions two regions retained significance in confounder variable analysis: cerebellar vermis section of lobule VIIIb (β = −0.22, t = −2.4, P = 0.021) and the putamen (β = −0.23, t = −2.3, P = 0.024). None of the three model-selected variables for the rigidity domain survived confounder analysis. Two out of the four model-selected regions for the distal limb bradykinesia domain survived confounder analysis: globus pallidus pars externa (β = 0.36, t = 3.9, P = 0.0097) and the paracentral lobule (β = 0.26, t = 2.5, P = 0.013). Emphasizing the utility of a systems-network conception of the pathophysiology of Parkinson's disease cardinal motor features, our results are consistent with specific deficits in basal forebrain corticopetal, peduncupontine-laterodorsal tegmental complex, and medial vestibular nucleus cholinergic pathways, against the background of nigrostriatal dopaminergic deficits, contributing significantly to postural instability, gait difficulties, tremor and distal limb bradykinesia cardinal motor features of Parkinson’s disease. Our results suggest significant and distinct consequences of degeneration of cholinergic peduncupontine-laterodorsal tegmental complex afferents to both segments of the globus pallidus. Non-specific regional cholinergic nerve terminal associations with rigidity scores likely reflect more complex multifactorial signalling mechanisms with smaller contributions from cholinergic pathways.
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Affiliation(s)
- Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA.,Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48105, USA
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA
| | - Carlos A Sanchez-Catasus
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Peter Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Gregory M Constantine
- Department of Mathematics, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Department of Statistics, University of Pittsburgh, Pittsburgh, PA 15260, USA.,The McGowen Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA.,Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48105, USA
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA.,Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48105, USA.,Critical Path Institute, Tucson, AZ 85718, USA
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12
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Raffel DM, Crawford TC, Jung YW, Koeppe RA, Gu G, Rothley J, Frey KA. Quantifying cardiac sympathetic denervation: first studies of 18F-fluorohydroxyphenethylguanidines in cardiomyopathy patients. Eur J Nucl Med Mol Imaging 2021; 49:619-631. [PMID: 34387718 DOI: 10.1007/s00259-021-05517-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE 4-18F-Fluoro-m-hydroxyphenethylguanidine (18F-4F-MHPG) and 3-18F-fluoro-p-hydroxyphenethylguanidine (18F-3F-PHPG) were developed for quantifying regional cardiac sympathetic nerve density using tracer kinetic analysis. The aim of this study was to evaluate their performance in cardiomyopathy patients. METHODS Eight cardiomyopathy patients were scanned with 18F-4F-MHPG and 18F-3F-PHPG. Also, regional resting perfusion was assessed with 13N-ammonia. 18F-4F-MHPG and 18F-3F-PHPG kinetics were analyzed using the Patlak graphical method to obtain Patlak slopes Kp (mL/min/g) as measures of regional nerve density. Patlak slope polar maps were used to evaluate the pattern and extent of cardiac denervation. For comparison, "retention index" (RI) values (mL blood/min/mL tissue) were also calculated and used to assess denervation. Perfusion polar maps were used to estimate the extent of hypoperfusion. RESULTS Patlak analysis of 18F-4F-MHPG and 18F-3F-PHPG kinetics was successful in all subjects, demonstrating the robustness of this approach in cardiomyopathy patients. Substantial regional denervation was observed in all subjects, ranging from 25 to 74% of the left ventricle. Denervation zones were equal to or larger than the size of corresponding areas of hypoperfusion. The two tracers provided comparable metrics of regional nerve density and the extent of left ventricular denervation. 18F-4F-MHPG exhibited faster liver clearance than 18F-3F-PHPG, reducing spillover from the liver into the inferior wall. 18F-4F-MHPG was also metabolized more consistently in plasma, which may allow application of population-averaged metabolite corrections. CONCLUSION The advantages of 18F-4F-MHPG (more rapid liver clearance, more consistent metabolism in plasma) make it the better imaging agent to carry forward into future clinical studies in patients with cardiomyopathy. TRIAL REGISTRATION Registered at the ClinicalTrials.gov website (NCT02669563). URL: https://clinicaltrials.gov/ct2/show/NCT02669563.
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Affiliation(s)
- David M Raffel
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School, 2276 Medical Science I, 1301 Catherine St., Ann Arbor, MI, 48109-5610, USA.
| | - Thomas C Crawford
- Division of Cardiology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Yong-Woon Jung
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School, 2276 Medical Science I, 1301 Catherine St., Ann Arbor, MI, 48109-5610, USA
| | - Robert A Koeppe
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School, 2276 Medical Science I, 1301 Catherine St., Ann Arbor, MI, 48109-5610, USA
| | - Guie Gu
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School, 2276 Medical Science I, 1301 Catherine St., Ann Arbor, MI, 48109-5610, USA
| | - Jill Rothley
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School, 2276 Medical Science I, 1301 Catherine St., Ann Arbor, MI, 48109-5610, USA
| | - Kirk A Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School, 2276 Medical Science I, 1301 Catherine St., Ann Arbor, MI, 48109-5610, USA
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13
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Devasia TP, Dewaraja YK, Frey KA, Wong KK, Schipper MJ. A Novel Time-Activity Information-Sharing Approach Using Nonlinear Mixed Models for Patient-Specific Dosimetry with Reduced Imaging Time Points: Application in SPECT/CT After 177Lu-DOTATATE. J Nucl Med 2021; 62:1118-1125. [PMID: 33443063 DOI: 10.2967/jnumed.120.256255] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
Multiple-time-point SPECT/CT imaging for dosimetry is burdensome for patients and lacks statistical efficiency. A novel method for joint kidney time-activity estimation based on a statistical mixed model, a prior cohort of patients with complete time-activity data, and only 1 or 2 imaging points for new patients was compared with previously proposed single-time-point methods in virtual and clinical patient data. Methods: Data were available for 10 patients with neuroendocrine tumors treated with 177Lu-DOTATATE and imaged up to 4 times between days 0 and 7 using SPECT/CT. Mixed models using 1 or 2 time points were evaluated retrospectively in the clinical cohort, using the multiple-time-point fit as the reference. Time-activity data for 250 virtual patients were generated using parameter values from the clinical cohort. Mixed models were fit using 1 (∼96 h) and 2 (4 h, ∼96 h) time points for each virtual patient combined with complete data for the other patients in each dataset. Time-integrated activities (TIAs) calculated from mixed model fits and other reduced-time-point methods were compared with known values. Results: All mixed models and single-time-point methods performed well overall, achieving mean bias < 7% in the virtual cohort. Mixed models exhibited lower bias, greater precision, and substantially fewer outliers than did single-time-point methods. For clinical patients, 1- and 2-time-point mixed models resulted in more accurate TIA estimates for 94% (17/18) and 72% (13/18) of kidneys, respectively. In virtual patients, mixed models resulted in more than a 2-fold reduction in the proportion of kidneys with |bias| > 10% (6% vs. 15%). Conclusion: Mixed models based on a historical cohort of patients with complete time-activity data and new patients with only 1 or 2 SPECT/CT scans demonstrate less bias on average and significantly fewer outliers when estimating kidney TIA, compared with popular reduced-time-point methods. Use of mixed models allows for reduction of the imaging burden while maintaining accuracy, which is crucial for clinical implementation of dosimetry-based treatment.
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Affiliation(s)
- Theresa P Devasia
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan;
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; and
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; and
| | - Ka Kit Wong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; and
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
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14
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Frey KA, Bohnen NILJ. Molecular Imaging of Neurodegenerative Parkinsonism. PET Clin 2021; 16:261-272. [PMID: 33589385 DOI: 10.1016/j.cpet.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Advances in molecular PET imaging of neurodegenerative parkinsonism are reviewed with focus on neuropharmacologic radiotracers depicting terminals of selectively vulnerable neurons in these conditions. Degeneration and losses of dopamine, norepinephrine, serotonin, and acetylcholine imaging markers thus far do not differentiate among the parkinsonian conditions. Recent studies performed with [18F]fluorodeoxyglucose PET are limited by the need for automated image analysis tools and by lack of routine coverage for this imaging indication in the United States. Ongoing research engages use of novel molecular modeling and in silico methods for design of imaging ligands targeting these specific proteinopathies.
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Affiliation(s)
- Kirk A Frey
- Department of Radiology (Nuclear Medicine and Molecular Imaging), University of Michigan, 1500 East Medical Center Drive, Room B1-G505 UH, Ann Arbor, MI 48109-5028, USA; Department of Neurology, University of Michigan, 1500 East Medical Center Drive, Room B1-G505 UH, Ann Arbor, MI 48109-5028, USA.
| | - Nicolaas I L J Bohnen
- Department of Radiology (Nuclear Medicine and Molecular Imaging), University of Michigan, 24 Frank Lloyd Wright Drive, Box 362, Ann Arbor, MI 48105, USA; Department of Neurology, University of Michigan, 24 Frank Lloyd Wright Drive, Box 362, Ann Arbor, MI 48105, USA; Ann Arbor Veterans Administration Medical Center, Ann Arbor, MI, USA
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15
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Abstract
Two pathologically distinct neurodegenerative conditions, progressive supranuclear palsy and corticobasal degeneration, share in common deposits of tau proteins that differ both molecularly and ultrastructurally from the common tau deposits diagnostic of Alzheimer disease. The proteinopathy in these disorders is characterized by fibrillary aggregates of 4R tau proteins. The clinical presentations of progressive supranuclear palsy and of corticobasal degeneration are often confused with more common disorders such as Parkinson disease or subtypes of frontotemporal lobar degeneration. Neither of these 4R tau disorders has effective therapy, and while there are emerging molecular imaging approaches to identify patients earlier in the course of disease, there are as yet no reliably sensitive and specific approaches to diagnoses in life. In this review, aspects of the clinical syndromes, neuropathology, and molecular biomarker imaging studies applicable to progressive supranuclear palsy and to corticobasal degeneration will be presented. Future development of more accurate molecular imaging approaches is proposed.
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Affiliation(s)
- Kirk A Frey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, The University of Michigan Health System, Ann Arbor, MI.
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16
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Jackson IM, Lee SJ, Sowa AR, Rodnick ME, Bruton L, Clark M, Preshlock S, Rothley J, Rogers VE, Botti LE, Henderson BD, Hockley BG, Torres J, Raffel DM, Brooks AF, Frey KA, Kilbourn MR, Koeppe RA, Shao X, Scott PJH. Use of 55 PET radiotracers under approval of a Radioactive Drug Research Committee (RDRC). EJNMMI Radiopharm Chem 2020; 5:24. [PMID: 33175263 PMCID: PMC7658275 DOI: 10.1186/s41181-020-00110-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/19/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the US, EU and elsewhere, basic clinical research studies with positron emission tomography (PET) radiotracers that are generally recognized as safe and effective (GRASE) can often be conducted under institutional approval. For example, in the United States, such research is conducted under the oversight of a Radioactive Drug Research Committee (RDRC) as long as certain requirements are met. Firstly, the research must be for basic science and cannot be intended for immediate therapeutic or diagnostic purposes, or to determine the safety and effectiveness of the PET radiotracer. Secondly, the PET radiotracer must be generally recognized as safe and effective. Specifically, the mass dose to be administered must not cause any clinically detectable pharmacological effect in humans, and the radiation dose to be administered must be the smallest dose practical to perform the study and not exceed regulatory dose limits within a 1-year period. In our experience, the main barrier to using a PET radiotracer under RDRC approval is accessing the required information about mass and radioactive dosing. RESULTS The University of Michigan (UM) has a long history of using PET radiotracers in clinical research studies. Herein we provide dosing information for 55 radiotracers that will enable other PET Centers to use them under the approval of their own RDRC committees. CONCLUSIONS The data provided herein will streamline future RDRC approval, and facilitate further basic science investigation of 55 PET radiotracers that target functionally relevant biomarkers in high impact disease states.
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Affiliation(s)
- Isaac M Jackson
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
- Present Address: Stanford University, Stanford, CA, USA
| | - So Jeong Lee
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
- Present Address: Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra R Sowa
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Melissa E Rodnick
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Laura Bruton
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Mara Clark
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Sean Preshlock
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Jill Rothley
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Virginia E Rogers
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Leslie E Botti
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Bradford D Henderson
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Brian G Hockley
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Jovany Torres
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - David M Raffel
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Allen F Brooks
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Michael R Kilbourn
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Xia Shao
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA.
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17
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Kramer V, Brooks AF, Haeger A, Kuljis RO, Rafique W, Koeppe RA, Raffel DM, Frey KA, Amaral H, Scott PJH, Riss PJ. Evaluation of [ 18F]- N-Methyl lansoprazole as a Tau PET Imaging Agent in First-in-Human Studies. ACS Chem Neurosci 2020; 11:427-435. [PMID: 31898886 DOI: 10.1021/acschemneuro.9b00639] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Development of positron emission tomography (PET) imaging agents capable of quantifying tau aggregates in neurodegenerative disorders such as Alzheimer's disease (AD) is of enormous importance in the field of dementia research. The aim of the present study was to conduct first-in-man imaging studies with the potential novel tau imaging agent [18F]N-methyl lansoprazole ([18F]NML). Herein we report validation of the synthesis of [18F]NML for clinical use by labeling the trifluoromethyl group via radiofluorination of the corresponding gem-difluoro enol ether precursor. This is the first use of this method for clinical production of PET radiotracers and confirmed that it can be readily implemented at multiple production facilities to provide [18F]NML in good noncorrected radiochemical yield (3.4 ± 1.5 GBq, 4.6% ± 2.6%) and molar activity (120.1 ± 186.3 GBq/μmol), excellent radiochemical purity (>97%), and suitable for human use (n = 15). With [18F]NML in hand, we conducted rodent biodistribution, estimates of human dosimetry, and preliminary evaluation of [18F]NML in human subjects at two imaging sites. Healthy controls (n = 4) and mildly cognitively impaired (MCI) AD patients (n = 6) received [18F]NML (tau), [18F]AV1451 (tau), and [18F]florbetaben or [18F]florbetapir (amyloid) PET scans. A single progressive supranuclear palsy (PSP) patient also received [18F]NML and [18F]AV1451 PET scans. [18F]NML showed good brain uptake, reasonable pharmacokinetics, and appropriate imaging characteristics in healthy controls. The mean ± SD of the administered mass of [18F/19F]NML was 2.01 ± 2.17 μg (range, 0.16-8.27 μg) and the mean administered activity was 350 ± 62 MBq (range, 199-403 MBq). There were no adverse or clinically detectable pharmacologic effects in any of the 11 subjects, and no significant changes in vital signs were observed. However, despite high affinity for tau in vitro, brain retention in MCI/AD and PSP patients was low, and there was no evidence of specific signals in vivo that corresponded to tau. Although it is still unclear why clinical translation of the radiotracer was unsuccessful, we nevertheless conclude that further development of [18F]NML as a tau PET imaging agent is not warranted at this time.
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Affiliation(s)
- Vasko Kramer
- Center for Nuclear Medicine & PET/CT Positronmed, Providencia, 7501068 Santiago, Chile
- Positronpharma SA, Providencia, 7500921 Santiago Chile
| | - Allen F. Brooks
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Arlette Haeger
- Center for Nuclear Medicine & PET/CT Positronmed, Providencia, 7501068 Santiago, Chile
| | - Rodrigo O. Kuljis
- Center for Nuclear Medicine & PET/CT Positronmed, Providencia, 7501068 Santiago, Chile
| | - Waqas Rafique
- realomics SRI, Kjemisk Institutt, Universitetet i Oslo, Sem Sælands vei 26, Kjemibygningen, 0371 Oslo, Norway
| | - Robert A. Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - David M. Raffel
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Kirk A. Frey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Horacio Amaral
- Center for Nuclear Medicine & PET/CT Positronmed, Providencia, 7501068 Santiago, Chile
- Positronpharma SA, Providencia, 7500921 Santiago Chile
| | - Peter J. H. Scott
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Patrick J. Riss
- realomics SRI, Kjemisk Institutt, Universitetet i Oslo, Sem Sælands vei 26, Kjemibygningen, 0371 Oslo, Norway
- Klinik for Kirurgi og Nevrofag, Oslo Universitets Sykehus HF−Rikshospitalet, Postboks
4950 Nydalen, 0424 Oslo, Norway
- Norsk Medisinsk Syklotronsenter AS, Gaustad, Postboks
4950 Nydalen, 0424 Oslo, Norway
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18
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Kanel P, Müller MLTM, van der Zee S, Sanchez-Catasus CA, Koeppe RA, Frey KA, Bohnen NI. Topography of Cholinergic Changes in Dementia With Lewy Bodies and Key Neural Network Hubs. J Neuropsychiatry Clin Neurosci 2020; 32:370-375. [PMID: 32498602 PMCID: PMC10018718 DOI: 10.1176/appi.neuropsych.19070165] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The authors investigated the topography of cholinergic vulnerability in patients with dementia with Lewy bodies (DLB) using positron emission tomography (PET) imaging with the vesicular acetylcholine transporter (VAChT) [18F]-fluoroethoxybenzovesamicol ([18F]-FEOBV) radioligand. METHODS Five elderly participants with DLB (mean age, 77.8 years [SD=4.2]) and 21 elderly healthy control subjects (mean age, 73.62 years [SD=8.37]) underwent clinical assessment and [18F]-FEOBV PET. RESULTS Compared with the healthy control group, reduced VAChT binding in patients with DLB demonstrated nondiffuse regionally distinct and prominent reductions in bilateral opercula and anterior cingulate to mid-cingulate cortices, bilateral insula, right (more than left) lateral geniculate nuclei, pulvinar, right proximal optic radiation, bilateral anterior and superior thalami, and posterior hippocampal fimbria and fornices. CONCLUSIONS The topography of cholinergic vulnerability in DLB comprises key neural hubs involved in tonic alertness (cingulo-opercular), saliency (insula), visual attention (visual thalamus), and spatial navigation (fimbria/fornix) networks. The distinct denervation pattern suggests an important cholinergic role in specific clinical disease-defining features, such as cognitive fluctuations, visuoperceptual abnormalities causing visual hallucinations, visuospatial changes, and loss of balance caused by DLB.
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Affiliation(s)
- Prabesh Kanel
- Department of Radiology (Kanel, Müller, Sanchez-Catasus, Koeppe, Frey, Bohnen) and Department of Neurology (Frey, Bohnen), University of Michigan, Ann Arbor; Neurology Service and Geriatric Research Education and Clinical Center, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Mich. (Bohnen); Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor (Kanel, Müller, Sanchez-Catasus, Bohnen); and Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands (van der Zee)
| | - Martijn L T M Müller
- Department of Radiology (Kanel, Müller, Sanchez-Catasus, Koeppe, Frey, Bohnen) and Department of Neurology (Frey, Bohnen), University of Michigan, Ann Arbor; Neurology Service and Geriatric Research Education and Clinical Center, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Mich. (Bohnen); Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor (Kanel, Müller, Sanchez-Catasus, Bohnen); and Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands (van der Zee)
| | - Sygrid van der Zee
- Department of Radiology (Kanel, Müller, Sanchez-Catasus, Koeppe, Frey, Bohnen) and Department of Neurology (Frey, Bohnen), University of Michigan, Ann Arbor; Neurology Service and Geriatric Research Education and Clinical Center, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Mich. (Bohnen); Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor (Kanel, Müller, Sanchez-Catasus, Bohnen); and Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands (van der Zee)
| | - Carlos A Sanchez-Catasus
- Department of Radiology (Kanel, Müller, Sanchez-Catasus, Koeppe, Frey, Bohnen) and Department of Neurology (Frey, Bohnen), University of Michigan, Ann Arbor; Neurology Service and Geriatric Research Education and Clinical Center, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Mich. (Bohnen); Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor (Kanel, Müller, Sanchez-Catasus, Bohnen); and Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands (van der Zee)
| | - Robert A Koeppe
- Department of Radiology (Kanel, Müller, Sanchez-Catasus, Koeppe, Frey, Bohnen) and Department of Neurology (Frey, Bohnen), University of Michigan, Ann Arbor; Neurology Service and Geriatric Research Education and Clinical Center, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Mich. (Bohnen); Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor (Kanel, Müller, Sanchez-Catasus, Bohnen); and Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands (van der Zee)
| | - Kirk A Frey
- Department of Radiology (Kanel, Müller, Sanchez-Catasus, Koeppe, Frey, Bohnen) and Department of Neurology (Frey, Bohnen), University of Michigan, Ann Arbor; Neurology Service and Geriatric Research Education and Clinical Center, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Mich. (Bohnen); Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor (Kanel, Müller, Sanchez-Catasus, Bohnen); and Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands (van der Zee)
| | - Nicolaas I Bohnen
- Department of Radiology (Kanel, Müller, Sanchez-Catasus, Koeppe, Frey, Bohnen) and Department of Neurology (Frey, Bohnen), University of Michigan, Ann Arbor; Neurology Service and Geriatric Research Education and Clinical Center, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Mich. (Bohnen); Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor (Kanel, Müller, Sanchez-Catasus, Bohnen); and Department of Neurology, University of Groningen, University Medical Center Groningen, the Netherlands (van der Zee)
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Zhou Z, Müller MLTM, Kanel P, Chua J, Kotagal V, Kaufer DI, Albin RL, Frey KA, Bohnen NI. Apathy rating scores and β-amyloidopathy in patients with Parkinson disease at risk for cognitive decline. Neurology 2019; 94:e376-e383. [PMID: 31732566 DOI: 10.1212/wnl.0000000000008683] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/19/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine whether β-amyloidopathy correlates with apathy rating scores independently of mood changes and other neurodegenerative processes in Parkinson disease (PD). METHODS In this cross-sectional study, patients with PD (n = 64, 48 male and 16 female, mean age 69.2 ± 6.7 years, Hoehn & Yahr stage 2.7 ± 0.5, Montreal Cognitive Assessment score 25.3 ± 3.0) underwent [11C]Pittsburgh compound B β-amyloid, [11C]dihydrotetrabenazine vesicular monoamine transporter type 2 (VMAT2), and [11C]methyl 4 piperidinyl propionate acetylcholinesterase brain PET imaging and clinical assessments, including the Marin Apathy Evaluation Scale, Clinician Version. Patients were recruited on the basis of having at least 1 risk factor for PD dementia, but they were excluded if they had dementia. RESULTS Mean apathy rating score was 25.4 ± 6.4, reflecting predominantly subclinical apathy. Apathy rating scale scores correlated with amyloid binding, cognitive, depressive, and anxiety scores but not significantly with age, duration of disease, striatal VMAT2, or cholinergic binding. Multiple regression analysis model (p < 0.0001) showed significant regressor effects for global β-amyloid burden (p = 0.0038) with significant covariate effects for global cognitive z scores (p = 0.028) and for anxiety (p = 0.038) but not with depressive scores. Voxel-based analysis showed robust correlation between apathy rating scale scores and β-amyloid binding in bilateral nuclei accumbens, inferior frontal, and cingulate cortices (family-wise error rate-corrected p < 0.005). CONCLUSION Apathy is independently associated with β-amyloidopathy in patients with PD at risk of dementia. Regional brain findings are most robust for β-amyloidopathy in the nuclei accumbens, inferior frontal, and cingulate regions. Findings may provide an explanation for the often treatment-refractory nature of apathy in advancing PD despite optimized dopaminergic and antidepressant pharmacotherapy. CLINICALTRIALSGOV IDENTIFIER NCT01565473.
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Affiliation(s)
- Zhi Zhou
- From the Department of Radiology (Z.Z., M.L.T.M.M., P.K., K.A.F., N.I.B.), Morris K. Udall Center of Excellence for Parkinson's Disease Research (M.L.T.M.M., P.K., R.L.A., N.I.B.), and Department of Neurology (J.C., V.K., K.A.F., R.L.A., N.I.B.), University of Michigan, Ann Arbor; Department of Geriatrics (Z.Z.), China Japan Friendship Hospital, Beijing, China; Neurology Service and Geriatric Research, Education, and Clinical Center (V.K., R.L.A., N.I.B.), VA Ann Arbor Healthcare System, MI; and Department of Neurology (D.I.K.), University of North Carolina, Chapel Hill
| | - Martijn L T M Müller
- From the Department of Radiology (Z.Z., M.L.T.M.M., P.K., K.A.F., N.I.B.), Morris K. Udall Center of Excellence for Parkinson's Disease Research (M.L.T.M.M., P.K., R.L.A., N.I.B.), and Department of Neurology (J.C., V.K., K.A.F., R.L.A., N.I.B.), University of Michigan, Ann Arbor; Department of Geriatrics (Z.Z.), China Japan Friendship Hospital, Beijing, China; Neurology Service and Geriatric Research, Education, and Clinical Center (V.K., R.L.A., N.I.B.), VA Ann Arbor Healthcare System, MI; and Department of Neurology (D.I.K.), University of North Carolina, Chapel Hill
| | - Prabesh Kanel
- From the Department of Radiology (Z.Z., M.L.T.M.M., P.K., K.A.F., N.I.B.), Morris K. Udall Center of Excellence for Parkinson's Disease Research (M.L.T.M.M., P.K., R.L.A., N.I.B.), and Department of Neurology (J.C., V.K., K.A.F., R.L.A., N.I.B.), University of Michigan, Ann Arbor; Department of Geriatrics (Z.Z.), China Japan Friendship Hospital, Beijing, China; Neurology Service and Geriatric Research, Education, and Clinical Center (V.K., R.L.A., N.I.B.), VA Ann Arbor Healthcare System, MI; and Department of Neurology (D.I.K.), University of North Carolina, Chapel Hill
| | - Jason Chua
- From the Department of Radiology (Z.Z., M.L.T.M.M., P.K., K.A.F., N.I.B.), Morris K. Udall Center of Excellence for Parkinson's Disease Research (M.L.T.M.M., P.K., R.L.A., N.I.B.), and Department of Neurology (J.C., V.K., K.A.F., R.L.A., N.I.B.), University of Michigan, Ann Arbor; Department of Geriatrics (Z.Z.), China Japan Friendship Hospital, Beijing, China; Neurology Service and Geriatric Research, Education, and Clinical Center (V.K., R.L.A., N.I.B.), VA Ann Arbor Healthcare System, MI; and Department of Neurology (D.I.K.), University of North Carolina, Chapel Hill
| | - Vikas Kotagal
- From the Department of Radiology (Z.Z., M.L.T.M.M., P.K., K.A.F., N.I.B.), Morris K. Udall Center of Excellence for Parkinson's Disease Research (M.L.T.M.M., P.K., R.L.A., N.I.B.), and Department of Neurology (J.C., V.K., K.A.F., R.L.A., N.I.B.), University of Michigan, Ann Arbor; Department of Geriatrics (Z.Z.), China Japan Friendship Hospital, Beijing, China; Neurology Service and Geriatric Research, Education, and Clinical Center (V.K., R.L.A., N.I.B.), VA Ann Arbor Healthcare System, MI; and Department of Neurology (D.I.K.), University of North Carolina, Chapel Hill
| | - Daniel I Kaufer
- From the Department of Radiology (Z.Z., M.L.T.M.M., P.K., K.A.F., N.I.B.), Morris K. Udall Center of Excellence for Parkinson's Disease Research (M.L.T.M.M., P.K., R.L.A., N.I.B.), and Department of Neurology (J.C., V.K., K.A.F., R.L.A., N.I.B.), University of Michigan, Ann Arbor; Department of Geriatrics (Z.Z.), China Japan Friendship Hospital, Beijing, China; Neurology Service and Geriatric Research, Education, and Clinical Center (V.K., R.L.A., N.I.B.), VA Ann Arbor Healthcare System, MI; and Department of Neurology (D.I.K.), University of North Carolina, Chapel Hill
| | - Roger L Albin
- From the Department of Radiology (Z.Z., M.L.T.M.M., P.K., K.A.F., N.I.B.), Morris K. Udall Center of Excellence for Parkinson's Disease Research (M.L.T.M.M., P.K., R.L.A., N.I.B.), and Department of Neurology (J.C., V.K., K.A.F., R.L.A., N.I.B.), University of Michigan, Ann Arbor; Department of Geriatrics (Z.Z.), China Japan Friendship Hospital, Beijing, China; Neurology Service and Geriatric Research, Education, and Clinical Center (V.K., R.L.A., N.I.B.), VA Ann Arbor Healthcare System, MI; and Department of Neurology (D.I.K.), University of North Carolina, Chapel Hill
| | - Kirk A Frey
- From the Department of Radiology (Z.Z., M.L.T.M.M., P.K., K.A.F., N.I.B.), Morris K. Udall Center of Excellence for Parkinson's Disease Research (M.L.T.M.M., P.K., R.L.A., N.I.B.), and Department of Neurology (J.C., V.K., K.A.F., R.L.A., N.I.B.), University of Michigan, Ann Arbor; Department of Geriatrics (Z.Z.), China Japan Friendship Hospital, Beijing, China; Neurology Service and Geriatric Research, Education, and Clinical Center (V.K., R.L.A., N.I.B.), VA Ann Arbor Healthcare System, MI; and Department of Neurology (D.I.K.), University of North Carolina, Chapel Hill
| | - Nicolaas I Bohnen
- From the Department of Radiology (Z.Z., M.L.T.M.M., P.K., K.A.F., N.I.B.), Morris K. Udall Center of Excellence for Parkinson's Disease Research (M.L.T.M.M., P.K., R.L.A., N.I.B.), and Department of Neurology (J.C., V.K., K.A.F., R.L.A., N.I.B.), University of Michigan, Ann Arbor; Department of Geriatrics (Z.Z.), China Japan Friendship Hospital, Beijing, China; Neurology Service and Geriatric Research, Education, and Clinical Center (V.K., R.L.A., N.I.B.), VA Ann Arbor Healthcare System, MI; and Department of Neurology (D.I.K.), University of North Carolina, Chapel Hill.
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20
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Abstract
BACKGROUND Disease-induced damage to cardiac autonomic nerve populations is associated with an increased risk of sudden cardiac death. The extent of cardiac sympathetic denervation, assessed using planar scintigraphy or positron emission tomography, has been shown to predict the risk of arrhythmic events in heart failure patients staged for implantable cardioverter defibrillator therapy. The goal of this study was to perform first-in-human evaluations of 4-[18F]fluoro-meta-hydroxyphenethylguanidine and 3-[18F]fluoro-para-hydroxyphenethylguanidine, 2 new positron emission tomography radiotracers developed for quantifying regional cardiac sympathetic nerve density. METHODS AND RESULTS Cardiac positron emission tomography studies with 4-[18F]fluoro-meta-hydroxyphenethylguanidine and 3-[18F]fluoro-para-hydroxyphenethylguanidine were performed in normal subjects (n=4 each) to assess their imaging properties and organ kinetics. Patlak graphical analysis of their myocardial kinetics was evaluated as a technique for generating nerve density metrics. Whole-body biodistribution studies (n=4 each) were acquired and used to calculate human radiation dosimetry estimates. Patlak analysis proved to be an effective approach for quantifying regional nerve density. Using 960 left ventricular volumes of interest, across-subject Patlak slopes averaged 0.107±0.010 mL/min per gram for 4-[18F]fluoro-meta-hydroxyphenethylguanidine and 0.116±0.010 mL/min per gram for 3-[18F]fluoro-para-hydroxyphenethylguanidine. Tracer uptake was highest in heart, liver, kidneys, and salivary glands. Urinary excretion was the main elimination pathway. CONCLUSIONS 4-[18F]fluoro-meta-hydroxyphenethylguanidine and 3-[18F]fluoro-para-hydroxyphenethylguanidine each produce high-quality positron emission tomography images of the distribution of sympathetic nerves in human heart. Patlak analysis provides reproducible measurements of regional cardiac sympathetic nerve density at high spatial resolution. Further studies of these tracers in heart failure patients will be performed to identify the best agent for clinical development. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02385877.
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Affiliation(s)
- David M Raffel
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School (D.M.R., Y.-W.J., R.A.K., K.S.J., G.G., P.J.H.S., J.R., K.A.F.)
| | - Yong-Woon Jung
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School (D.M.R., Y.-W.J., R.A.K., K.S.J., G.G., P.J.H.S., J.R., K.A.F.)
| | - Robert A Koeppe
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School (D.M.R., Y.-W.J., R.A.K., K.S.J., G.G., P.J.H.S., J.R., K.A.F.)
| | - Keun Sam Jang
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School (D.M.R., Y.-W.J., R.A.K., K.S.J., G.G., P.J.H.S., J.R., K.A.F.)
| | - Guie Gu
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School (D.M.R., Y.-W.J., R.A.K., K.S.J., G.G., P.J.H.S., J.R., K.A.F.)
| | - Peter J H Scott
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School (D.M.R., Y.-W.J., R.A.K., K.S.J., G.G., P.J.H.S., J.R., K.A.F.)
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan Medical School, Ann Arbor (V.L.M.)
| | - Jill Rothley
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School (D.M.R., Y.-W.J., R.A.K., K.S.J., G.G., P.J.H.S., J.R., K.A.F.)
| | - Kirk A Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School (D.M.R., Y.-W.J., R.A.K., K.S.J., G.G., P.J.H.S., J.R., K.A.F.)
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21
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Bohnen NI, Kanel P, Zhou Z, Koeppe RA, Frey KA, Dauer WT, Albin RL, Müller MLTM. Cholinergic system changes of falls and freezing of gait in Parkinson's disease. Ann Neurol 2019; 85:538-549. [PMID: 30720884 PMCID: PMC6450746 DOI: 10.1002/ana.25430] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 01/16/2023]
Abstract
Objective Postural instability and gait difficulties (PIGDs) represent debilitating disturbances in Parkinson's disease (PD). Past acetylcholinesterase positron emission tomography (PET) imaging studies implicate cholinergic changes as significant contributors to PIGD features. These studies were limited in quantification of striatal cholinergic synapse integrity. Vesicular acetylcholine transporter (VAChT) PET ligands are better suited for evaluation of high binding areas. We examined associations between regional VAChT expression and freezing of gait (FoG) and falls. Methods Ninety‐four PD subjects underwent clinical assessment and VAChT ([18F]FEOBV) PET. Results Thirty‐five subjects (37.2%) reported a history of falls, and 15 (16%) had observed FoG. Univariate volume‐of‐interest analyses demonstrated significantly reduced thalamic (p = 0.0016) VAChT expression in fallers compared to nonfallers. VAChT expression was significantly reduced in the striatum (p = 0.0012) and limbic archicortex (p = 0.004) in freezers compared to nonfreezers. Whole‐brain voxel‐based analyses of FEOBV PET complemented these findings and showed more granular changes associated with falling history, including the right visual thalamus (especially the right lateral geniculate nucleus [LGN]), right caudate nucleus, and bilateral prefrontal regions. Freezers had prominent VAChT expression reductions in the bilateral striatum, temporal, and mesiofrontal limbic regions. Interpretation Our findings confirm and extend on previous PET findings of thalamic cholinergic deficits associated with falling history and now emphasize right visual thalamus complex changes, including the right LGN. FoG status is associated with reduced VAChT expression in striatal cholinergic interneurons and the limbic archicortex. These observations suggest different cholinergic systems changes underlying falls and FoG in PD. Ann Neurol 2019;85:538–549
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Affiliation(s)
- Nicolaas I Bohnen
- Radiology, University of Michigan, Ann Arbor, MI.,Neurology, University of Michigan, Ann Arbor, MI.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI
| | - Prabesh Kanel
- Radiology, University of Michigan, Ann Arbor, MI.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI
| | - Zhi Zhou
- Radiology, University of Michigan, Ann Arbor, MI
| | - Robert A Koeppe
- Radiology, University of Michigan, Ann Arbor, MI.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI
| | - Kirk A Frey
- Radiology, University of Michigan, Ann Arbor, MI.,Neurology, University of Michigan, Ann Arbor, MI
| | - William T Dauer
- Neurology, University of Michigan, Ann Arbor, MI.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI
| | - Roger L Albin
- Neurology, University of Michigan, Ann Arbor, MI.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI
| | - Martijn L T M Müller
- Radiology, University of Michigan, Ann Arbor, MI.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI
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22
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Viglianti BL, Wale DJ, Ma T, Johnson TD, Bohnen NI, Wong KK, Ky C, Frey KA, Townsend DM, Rubello D, Gross MD. Effects of plasma glucose levels on regional cerebral 18F-fluorodeoxyglucose uptake: Implications for dementia evaluation with brain PET imaging. Biomed Pharmacother 2019; 112:108628. [PMID: 30784923 PMCID: PMC6714976 DOI: 10.1016/j.biopha.2019.108628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose: Hyperglycemia affects FDG uptake in the brain, potentially emulating
Alzheimer’s disease in normal individuals. This study investigates
global and regional cerebral FDG uptake as a function of plasma glucose in a
cohort of patients. Methods: 120 consecutive male patients with FDG PET/CT for initial oncologic
staging (July-Dee 2015) were reviewed. Patients with dementia,
cerebrovascular accident, structural brain lesion, prior oncology treatment
or high metabolic tumor burden (recently shown affecting brain FDG uptake)
were excluded. 53 (24 nondiabetic) eligible patients (age 65.7 ± 2.8
mean ± SE) were analyzed with parametric computer software,
MIMneuro™. Regional Z-scores were evaluated as a function of plasma
glucose and age using multi variable linear mixed effects models with false
discovery analysis adjusting for multiple comparisons. If the regression
slope was significantly (p < 0.05) different than zero, hyperglycemia
effect was present. Results: There was a negative inverse relationship (p < 0.001) between
global brain FDG uptake and hyperglycemia. No regional hyperglycemia effect
on uptake were present when subjects were normalized using pons or
cerebellum. However, regional hyperglycemia effects were seen (p <
0.047–0.001) when normalizing by the whole brain. No obvious pattern
was seen in the regions affected. Age had a significant effect using whole
brain normalization (p < 0.04–0.01). Conclusions: Cortical variation in FDG uptake were identified when subjects were
hyperglycemic. However, these variations didn’t fit a particular
pattern of dementia and the severity of the affect is not likely to alter
clinical interpretation.
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Affiliation(s)
- Benjamin L Viglianti
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA.
| | - Daniel J Wale
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| | - Tianwen Ma
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Timothy D Johnson
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Nicolaas I Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| | - Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Christy Ky
- University of Michigan School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kirk A Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Danyelle M Townsend
- Department of Physiology, Division of New Drugs Development, University of Southern Carolina, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
| | - Milton D Gross
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
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23
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Kaiser A, Davenport MS, Frey KA, Greenspan B, Brown RKJ. Management of Diabetes Mellitus Before 18F-Fluorodeoxyglucose PET/CT: A Nationwide Patient-Centered Assessment of Approaches to Examination Preparation. J Am Coll Radiol 2018; 16:804-809. [PMID: 30348616 DOI: 10.1016/j.jacr.2018.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/06/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The aim of this study was to perform, from the patient's point of view, a nationwide assessment of nuclear medicine practices regarding diabetic management before 18F-fluorodeoxyglucose (FDG) PET/CT for oncologic indications. METHODS This prospective observational study was exempt from institutional review board oversight. Sixty-five nuclear medicine scheduling lines (33 academic, 32 private practice, 12-17 in each of the five US regions) were called using a prewritten script under the guise of a nonexpert patient's family member about scheduling a patient with diabetes with "cancer" for FDG PET/CT. Each center was called three times on three different days. The following data were collected: (1) blood glucose threshold for rescheduling an examination, (2) when or if to stop various medications, (3) fasting requirements, and (4) time-of-day scheduling preferences. Withheld information was not specifically requested. Descriptive statistics were calculated. RESULTS There were 195 phone calls (mean duration, 2.9 min; range, 2-6 min). Relevant information was often withheld; withholding rates were as follows: blood glucose threshold, 71% (138 of 195); short-acting insulin instructions, 30% (59 of 195); long-acting insulin instructions, 99% (193 of 195); metformin instructions, 88% (179 of 195); fasting duration, 37% (72 of 195); and time-of-day scheduling preference, 91% (177 of 195). Mean provided data were as follows: blood glucose threshold, 195 mg/dL (range, 150-210 mg/dL); short-acting insulin withholding, 4.9 hours (range, 4-8 hours); long-acting insulin withholding, 12 hours (range, 12-24 hours); fasting duration, 5 hours (range, 4-8 hours); and preferred examination time, 91% (177 of 195). When specified (n = 18), morning scheduling was preferred (8% [15 of 195] versus 2% [3 of 195]). CONCLUSIONS Diabetes-specific information is commonly withheld by nuclear medicine call centers throughout the United States when discussing oncologic FDG PET/CT despite local and national policies indicating its importance.
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Affiliation(s)
- Andrew Kaiser
- Department of Radiology, University of Michigan, Ann Arbor, Michigan.
| | | | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Bennett Greenspan
- Department of Radiology, Medical College of Georgia, Augusta, Georgia
| | - Richard K J Brown
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Albin RL, Bohnen NI, Muller MLTM, Dauer WT, Sarter M, Frey KA, Koeppe RA. Regional vesicular acetylcholine transporter distribution in human brain: A [ 18 F]fluoroethoxybenzovesamicol positron emission tomography study. J Comp Neurol 2018; 526:2884-2897. [PMID: 30255936 DOI: 10.1002/cne.24541] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
Prior efforts to image cholinergic projections in human brain in vivo had significant technical limitations. We used the vesicular acetylcholine transporter (VAChT) ligand [18 F]fluoroethoxybenzovesamicol ([18 F]FEOBV) and positron emission tomography to determine the regional distribution of VAChT binding sites in normal human brain. We studied 29 subjects (mean age 47 [range 20-81] years; 18 men; 11 women). [18 F]FEOBV binding was highest in striatum, intermediate in the amygdala, hippocampal formation, thalamus, rostral brainstem, some cerebellar regions, and lower in other regions. Neocortical [18 F]FEOBV binding was inhomogeneous with relatively high binding in insula, BA24, BA25, BA27, BA28, BA34, BA35, pericentral cortex, and lowest in BA17-19. Thalamic [18 F]FEOBV binding was inhomogeneous with greatest binding in the lateral geniculate nuclei and relatively high binding in medial and posterior thalamus. Cerebellar cortical [18 F]FEOBV binding was high in vermis and flocculus, and lower in the lateral cortices. Brainstem [18 F]FEOBV binding was most prominent at the mesopontine junction, likely associated with the pedunculopontine-laterodorsal tegmental complex. Significant [18 F]FEOBV binding was present throughout the brainstem. Some regions, including the striatum, primary sensorimotor cortex, and anterior cingulate cortex exhibited age-related decreases in [18 F]FEOBV binding. These results are consistent with prior studies of cholinergic projections in other species and prior postmortem human studies. There is a distinctive pattern of human neocortical VChAT expression. The patterns of thalamic and cerebellar cortical cholinergic terminal distribution are likely unique to humans. Normal aging is associated with regionally specific reductions in [18 F]FEOBV binding in some cortical regions and the striatum.
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Affiliation(s)
- Roger L Albin
- Neurology Service & GRECC, VAAAHS, Ann Arbor, Michigan.,Department of Neurology, University of Michigan, Ann Arbor, Michigan.,University of Michigan Morris K. Udall Center of Excellence for Research in Parkinson's Disease, Ann Arbor, Michigan.,Michigan Alzheimer Disease Center, Ann Arbor, Michigan
| | - Nicolaas I Bohnen
- Neurology Service & GRECC, VAAAHS, Ann Arbor, Michigan.,Department of Neurology, University of Michigan, Ann Arbor, Michigan.,University of Michigan Morris K. Udall Center of Excellence for Research in Parkinson's Disease, Ann Arbor, Michigan.,Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Martijn L T M Muller
- University of Michigan Morris K. Udall Center of Excellence for Research in Parkinson's Disease, Ann Arbor, Michigan.,Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - William T Dauer
- Neurology Service & GRECC, VAAAHS, Ann Arbor, Michigan.,Department of Neurology, University of Michigan, Ann Arbor, Michigan.,University of Michigan Morris K. Udall Center of Excellence for Research in Parkinson's Disease, Ann Arbor, Michigan.,Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, Michigan
| | - Martin Sarter
- University of Michigan Morris K. Udall Center of Excellence for Research in Parkinson's Disease, Ann Arbor, Michigan.,Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Kirk A Frey
- Department of Neurology, University of Michigan, Ann Arbor, Michigan.,Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Robert A Koeppe
- University of Michigan Morris K. Udall Center of Excellence for Research in Parkinson's Disease, Ann Arbor, Michigan.,Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Allred JD, Niedbala J, Mikell JK, Owen D, Frey KA, Dewaraja YK. The value of 99mTc-MAA SPECT/CT for lung shunt estimation in 90Y radioembolization: a phantom and patient study. EJNMMI Res 2018; 8:50. [PMID: 29904808 PMCID: PMC6003896 DOI: 10.1186/s13550-018-0402-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/31/2018] [Indexed: 12/17/2022] Open
Abstract
Background A major toxicity concern in radioembolization therapy of hepatic malignancies is radiation-induced pneumonitis and sclerosis due to hepatopulmonary shunting of 90Y microspheres. Currently, 99mTc macroaggregated albumin (99mTc-MAA) imaging is used to estimate the lung shunt fraction (LSF) prior to treatment. The aim of this study was to evaluate the accuracy/precision of LSF estimated from 99mTc planar and SPECT/CT phantom imaging, and within this context, to compare the corresponding LSF and lung-absorbed dose values from 99mTc-MAA patient studies. Additionally, LSFs from pre- and post-therapy imaging were compared. Results A liver/lung torso phantom filled with 99mTc to achieve three lung shunt values was scanned by planar and SPECT/CT imaging with repeat acquisitions to assess accuracy and precision. To facilitate processing of patient data, a workflow that relies on SPECT and CT-based auto-contouring to define liver and lung volumes for the LSF calculation was implemented. Planar imaging-based LSF estimates for 40 patients, obtained from their medical records, were retrospectively compared with SPECT/CT imaging-based calculations with attenuation and scatter correction. Additionally, in a subset of 20 patients, the pre-therapy estimates were compared with 90Y PET/CT-based measurements. In the phantom study, improved accuracy in LSF estimation was achieved using SPECT/CT with attenuation and scatter correction (within 13% of the true value) compared with planar imaging (up to 44% overestimation). The results in patients showed a similar trend with planar imaging significantly overestimating LSF compared to SPECT/CT. There was no correlation between lung shunt estimates and the delay between 99mTc-MAA administration and scanning, but off-target extra hepatic uptake tended to be more likely in patients with a longer delay. The mean lung absorbed dose predictions for the 28 patients who underwent therapy was 9.3 Gy (range 1.3–29.4) for planar imaging and 3.2 Gy (range 0.4–13.4) for SPECT/CT. For the patients with post-therapy imaging, the mean LSF from 90Y PET/CT was 1.0%, (range 0.3–2.8). This value was not significantly different from the mean LSF estimate from 99mTc-MAA SPECT/CT (mean 1.0%, range 0.4–1.6; p = 0.968), but was significantly lower than the mean LSF estimate based on planar imaging (mean 4.1%, range 1.2–15.0; p = 0.0002). Conclusions The improved accuracy demonstrated by the phantom study, agreement with 90Y PET/CT in patient studies, and the practicality of using auto-contouring for liver/lung definition suggests that 99mTc-MAA SPECT/CT with scatter and attenuation corrections should be used for lung shunt estimation prior to radioembolization.
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Affiliation(s)
- Jonathan D Allred
- Radiotherapy Physics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jeremy Niedbala
- Department of Radiology, University of Michigan, 1301 Catherine, 2276 Med Sci I/SPC 5610, Ann Arbor, MI, 48109, USA
| | - Justin K Mikell
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, 1301 Catherine, 2276 Med Sci I/SPC 5610, Ann Arbor, MI, 48109, USA
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan, 1301 Catherine, 2276 Med Sci I/SPC 5610, Ann Arbor, MI, 48109, USA.
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Viglianti BL, Wale DJ, Wong KK, Johnson TD, Ky C, Frey KA, Gross MD. Effects of Tumor Burden on Reference Tissue Standardized Uptake for PET Imaging: Modification of PERCIST Criteria. Radiology 2018; 287:993-1002. [PMID: 29558296 DOI: 10.1148/radiol.2018171356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To examine the effect metabolic burden (tumor and/or cardiac myocyte uptake) has on fluorine 18 fluorodeoxyglucose (FDG) distribution in organs and tissues of interest. Materials and Methods Positron emission tomographic (PET)/computed tomographic (CT) scans at the Ann Arbor Veterans Affairs hospital from January to July 2015 were reviewed. A total of 107 scans (50 patients; mean age, 64.3 years ± 13.2 [standard deviation]) had metabolic tissue burden assessed by using total lesion glycolysis (TLG) obtained from autosegmentation of the tumor and/or cardiac tissue. Standardized uptake value (SUV) and subsequent normalized SUV uptake in target organs and tissues were compared with 436 FDG PET/CT scans previously reported in 229 patients as a function of TLG to describe the effect(s) that metabolic burden has on reference tissue (blood pool, liver, and brain) FDG uptake. Subsequent regression by using linear mixed-effects models was used. If the slope of the regression was significantly (P < .05) different than zero, then an effect from TLG was present. Results There was a negative inverse relationship (P < .0001) between FDG uptake within reference tissues (blood pool, liver, and brain) and TLG in comparison to the study population at similar blood glucose levels. This TLG effect was no longer statistically significant (P > .05) when FDG uptake was normalized to a reference tissue (eg, blood pool or liver). Conclusion Metabolic tissue burden can have a significant effect on SUV measurements for PET imaging. This effect can be mitigated by normalizing FDG uptake to a reference tissue. © RSNA, 2018.
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Affiliation(s)
- Benjamin L Viglianti
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Daniel J Wale
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Ka Kit Wong
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Timothy D Johnson
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Christy Ky
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Kirk A Frey
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
| | - Milton D Gross
- From the Department of Nuclear Medicine and Molecular Imaging, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, Mich 48109 (B.L.V., D.J.W., K.K.W., K.A.F., M.D.G.); Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, Mich (B.L.V., D.J.W., M.D.G.); Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich (T.D.J.); and University of Michigan School of Medicine, University of Michigan, Ann Arbor, Mich (C.K.)
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Kotagal V, Bohnen NI, Müller MLTM, Frey KA, Albin RL. Cerebral Amyloid Burden and Hoehn and Yahr Stage 3 Scoring in Parkinson Disease. J Parkinsons Dis 2017; 7:143-147. [PMID: 28106566 DOI: 10.3233/jpd-160985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progression to Hoehn and Yahr (HY) stage 3 marks the transition to advanced disease staging and disability in Parkinson disease (PD). OBJECTIVE/METHODS We conducted a case-control study of 36 PD subjects at HY stage 2.5 or 3, with groups matched for gender, age, and disease duration. Positron Emission tomography (PET) imaging included dihydrotetrabenazine [11C]DTBZ and Pittsburgh Compound B [11C]PiB. RESULTS Subjects with HY 2.5 differed from HY 3.0 in mean cortical PiB distribution volume ratio (1.14 vs. 1.23; Wilcoxon two-sample Z = 2.36, p = 0.024) but not striatal DTBZ PET. CONCLUSION Cortical amyloid burden differentiates subjects below and at HY stage 3. These results suggest that cortical amyloid accumulation influences the transition from HY2.5 to HY3 and that cortical amyloidopathy may be a therapeutic target in PD.
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Affiliation(s)
- Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA.,University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Martijn L T M Müller
- University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Kirk A Frey
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA.,University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA
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28
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Kong FM, Ten Haken RK, Schipper M, Frey KA, Hayman J, Gross M, Ramnath N, Hassan KA, Matuszak M, Ritter T, Bi N, Wang W, Orringer M, Cease KB, Lawrence TS, Kalemkerian GP. Effect of Midtreatment PET/CT-Adapted Radiation Therapy With Concurrent Chemotherapy in Patients With Locally Advanced Non-Small-Cell Lung Cancer: A Phase 2 Clinical Trial. JAMA Oncol 2017; 3:1358-1365. [PMID: 28570742 DOI: 10.1001/jamaoncol.2017.0982] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Our previous studies demonstrated that tumors significantly decrease in size and metabolic activity after delivery of 45 Gy of fractionated radiatiotherapy (RT), and that metabolic shrinkage is greater than anatomic shrinkage. This study aimed to determine whether 18F-fludeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) acquired during the course of treatment provides an opportunity to deliver higher-dose radiation to the more aggressive areas of the tumor to improve local tumor control without increasing RT-induced lung toxicity (RILT), and possibly improve survival. Objective To determine whether adaptive RT can target high-dose radiation to the FDG-avid tumor on midtreatment FDG-PET to improve local tumor control of locally advanced non-small-cell lung cancer (NSCLC). Design, Setting, and Participants A phase 2 clinical trial conducted at 2 academic medical centers with 42 patients who had inoperable or unresectable stage II to stage III NSCLC enrolled from November 2008, to May 2012. Patients with poor performance, more than 10% weight loss, poor lung function, and/or oxygen dependence were included, providing that the patients could tolerate the procedures of PET scanning and RT. Intervention Conformal RT was individualized to a fixed risk of RILT (grade >2) and adaptively escalated to the residual tumor defined on midtreatment FDG-PET up to a total dose of 86 Gy in 30 daily fractions. Medically fit patients received concurrent weekly carboplatin plus paclitaxel followed by 3 cycles of consolidation. Main Outcomes and Measures The primary end point was local tumor control. The trial was designed to achieve a 20% improvement in 2-year control from 34% of our prior clinical trial experience with 63 to 69 Gy in a similar patient population. Results The trial reached its accrual goal of 42 patients: median age, 63 years (range, 45-83 years); male, 28 (67%); smoker or former smoker, 39 (93%); stage III, 38 (90%). Median tumor dose delivered was 83 Gy (range, 63-86 Gy) in 30 daily fractions. Median follow-up for surviving patients was 47 months. The 2-year rates of infield and overall local regional tumor controls (ie, including isolated nodal failure) were 82% (95% CI, 62%-92%) and 62% (95% CI, 43%-77%), respectively. Median overall survival was 25 months (95% CI, 12-32 months). The 2-year and 5-year overall survival rates were 52% (95% CI, 36%-66%) and 30% (95% CI, 16%-45%), respectively. Conclusions and Relevance Adapting RT-escalated radiation dose to the FDG-avid tumor detected by midtreatment PET provided a favorable local-regional tumor control. The RTOG 1106 trial is an ongoing clinical trial to validate this finding in a randomized fashion. Trial Registration clinicaltrials.gov Identifier: NCT01190527.
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Affiliation(s)
- Feng-Ming Kong
- Department of Radiation Oncology, University of Michigan, Ann Arbor.,IU Simon Cancer Center, Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor.,Department of Biostatistics, University of Michigan, Ann Arbor
| | - Kirk A Frey
- Division of Nuclear Medicine and Molecular Imaging, University of Michigan, Ann Arbor
| | - James Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Milton Gross
- Division of Nuclear Medicine and Molecular Imaging, University of Michigan, Ann Arbor.,VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Nithya Ramnath
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Khaled A Hassan
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Timothy Ritter
- Department of Radiation Oncology, University of Michigan, Ann Arbor.,VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Nan Bi
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Weili Wang
- Department of Radiation Oncology, University of Michigan, Ann Arbor.,IU Simon Cancer Center, Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark Orringer
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Kemp B Cease
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor
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Bailey JJ, Dewaraja Y, Hubers D, Srinivasa RN, Frey KA. Biodistribution of 99mTc-MAA on SPECT/CT performed for 90Y radioembolization therapy planning: a pictorial review. Clin Transl Imaging 2017; 5:473-485. [PMID: 29423383 DOI: 10.1007/s40336-017-0245-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose To evaluate the frequency of 99mTc-MAA uptake in extrahepatic organs during 90Y radioembolization therapy planning. Methods This retrospective case series of 70 subjects who underwent 99mTc-MAA hepatic artery perfusion studies between January 2014 and July 2016 for 90Y radioembolization therapy planning at our institution involved direct image review for all subjects, with endpoints recorded: lung shunt fraction, extrahepatic radiotracer uptake, time from MAA injection to imaging. Results Combined planar and SPECT/CT imaging findings in the 70 subjects demonstrated lung shunt fraction measurements of less than 10% in 53 (76%) subjects and greater than 10% in 17 (24%) subjects. All patients demonstrated renal cortical uptake, 23 (33%) demonstrated salivary gland uptake, 23 (33%) demonstrated thyroid uptake, and 32 (46%) demonstrated gastric mucosal uptake, with significant overlap between these groups. The range of elapsed times between MAA injection and initial imaging was 41-138 min, with a mean of 92 min. There was no correlation between time to imaging and the presence of extrahepatic radiotracer uptake at any site. Conclusions During hepatic artery perfusion scanning for 90Y radioembolization therapy planning, extrahepatic uptake is common, particularly in the kidney, salivary gland, thyroid and gastric mucosa, and is hypothesized to result from breakdown of 99mTc-MAA over time. Given the breakdown to smaller aggregates and ultimately pertechnetate, this should not be a contraindication to actual Y-90 microsphere therapy. Although we found no correlation between time to imaging and extrahepatic uptake, most of our injection to imaging times were relatively short.
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Affiliation(s)
- J J Bailey
- Department of Radiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48103
| | - Y Dewaraja
- Department of Radiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48103
| | - D Hubers
- Department of Radiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48103
| | - R N Srinivasa
- Department of Radiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48103
| | - K A Frey
- Department of Radiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48103
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Bohnen NI, Haugen J, Ridder A, Kotagal V, Albin RL, Frey KA, Müller MLTM. Color discrimination errors associate with axial motor impairments in Parkinson's disease. Mov Disord Clin Pract 2017; 4:864-869. [PMID: 29226177 DOI: 10.1002/mdc3.12527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Visual function deficits are more common in imbalance-predominant compared to tremor-predominant PD suggesting a pathophysiological role of impaired visual functions in axial motor impairments. Objective To investigate the relationship between changes in color discrimination and motor impairments in PD while accounting for cognitive or other confounder factors. Methods PD subjects (n=49, age 66.7±8.3 years; Hoehn & Yahr stage 2.6±0.6) completed color discrimination assessment using the Farnsworth-Munsell 100 Hue Color Vision Test, neuropsychological, motor assessments and [11C]dihydrotetrabenazine vesicular monoamine transporter type 2 PET imaging. MDS-UPDRS sub-scores for cardinal motor features were computed. Timed up and go mobility and walking tests were assessed in 48 subjects. Results Bivariate correlation coefficients between color discrimination and motor variables were significant only for the Timed up and go (RS=0.44, P=0.0018) and the MDS-UPDRS axial motor scores (RS=0.38, P=0.0068). Multiple regression confounder analysis using the Timed up and go as outcome parameter showed a significant total model (F(5,43)= 7.3, P<0.0001) with significant regressor effects for color discrimination (standardized β=0.32, t=2.6, P=0.012), global cognitive Z-score (β=-0.33, t=-2.5, P=0.018), duration of disease (β=0.26, t=1.8, P=0.038), but not for age or striatal dopaminergic binding. The color discrimination test was also a significant independent regressor in the MDS-UPDRS axial motor model (standardized β=0.29, t=2.4, P=0.022; total model t(5,43)= 6.4, P=0.0002). Conclusions Color discrimination errors associate with axial motor features in PD independent of cognitive deficits, nigrostriatal dopaminergic denervation, and other confounder variables. These findings may reflect shared pathophysiology between color discrimination visual impairments and axial motor burden in PD.
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Affiliation(s)
- Nicolaas I Bohnen
- Radiology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States, 48104.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, United States
| | - Jacob Haugen
- Radiology, University of Michigan, Ann Arbor, MI, United States, 48104
| | - Andrew Ridder
- Neurology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States, 48104
| | - Vikas Kotagal
- Neurology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States, 48104
| | - Roger L Albin
- Neurology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States, 48104.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, United States
| | - Kirk A Frey
- Radiology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology, University of Michigan, Ann Arbor, MI, United States, 48104
| | - Martijn L T M Müller
- Radiology, University of Michigan, Ann Arbor, MI, United States, 48104.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, United States
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Salloway S, Gamez JE, Singh U, Sadowsky CH, Villena T, Sabbagh MN, Beach TG, Duara R, Fleisher AS, Frey KA, Walker Z, Hunjan A, Escovar YM, Agronin ME, Ross J, Bozoki A, Akinola M, Shi J, Vandenberghe R, Ikonomovic MD, Sherwin PF, Farrar G, Smith APL, Buckley CJ, Thal DR, Zanette M, Curtis C. Performance of [ 18F]flutemetamol amyloid imaging against the neuritic plaque component of CERAD and the current (2012) NIA-AA recommendations for the neuropathologic diagnosis of Alzheimer's disease. Alzheimers Dement (Amst) 2017; 9:25-34. [PMID: 28795133 PMCID: PMC5536824 DOI: 10.1016/j.dadm.2017.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Performance of the amyloid tracer [18F]flutemetamol was evaluated against three pathology standard of truth (SoT) measures including neuritic plaques (CERAD “original” and “modified” and the amyloid component of the 2012 NIA-AA guidelines). Methods After [18F]flutemetamol imaging, 106 end-of-life patients who died underwent postmortem brain examination for amyloid plaque load. Blinded positron emission tomography scan interpretations by five independent electronically trained readers were compared with pathology measures. Results By SoT, sensitivity and specificity of majority image interpretations were, respectively, 91.9% and 87.5% with “original CERAD,” 90.8% and 90.0% with “modified CERAD,” and 85.7% and 100% with the 2012 NIA-AA criteria. Discussion The high accuracy of either CERAD criteria suggests that [18F]flutemetamol predominantly reflects neuritic amyloid plaque density. However, the use of CERAD criteria as the SoT can result in some false-positive results because of the presence of diffuse plaques, which are accounted for when the positron emission tomography read is compared with the 2012 NIA-AA criteria. Determination of the accuracy of [18F]flutemetamol image read against Aβ at autopsy. High sensitivity and specificity to 3 neuropathologic criteria as Standards of Truth. Images are 100% specific when the SoT reflects both neuritic and diffuse plaques. This study has the largest autopsy validation cohort for Aβ PET tracers to date.
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Affiliation(s)
- Stephen Salloway
- Neurology and the Memory and Aging Program, Butler Hospital, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Neurology and Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | | | - Carl H Sadowsky
- Division of Neurology, Nova SE University, Fort Lauderdale, FL, USA
| | | | - Marwan N Sabbagh
- Division of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Ranjan Duara
- Mount Sinai Medical Center, Wien Center for Alzheimer's Disease and Memory Disorders, Miami Beach, FL, USA
| | | | - Kirk A Frey
- Department of Radiology (Nuclear Medicine), University of Michigan, Ann Arbor, MI, USA
| | - Zuzana Walker
- Division of Psychiatry, University College London and North Essex Partnership University NHS Foundation Trust, London, UK
| | - Arvinder Hunjan
- Hertfordshire Partnership University NHS Foundation Trust, Essex, UK
| | | | - Marc E Agronin
- Mental Health and Clinical Research, Miami Jewish Health Systems, Miami, FL, USA.,University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joel Ross
- Memory Enhancement Center, Eatontown, NJ, USA
| | - Andrea Bozoki
- Department of Neurology, Cognitive and Geriatric Neurology Team, Michigan State University, East Lansing, MI, USA
| | | | - Jiong Shi
- Division of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Rik Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Gill Farrar
- Life Sciences, GE Healthcare, Amersham, Buckinghamshire, UK
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Mossine AV, Brooks AF, Henderson BD, Hockley BG, Frey KA, Scott PJH. An updated radiosynthesis of [ 18F]AV1451 for tau PET imaging. EJNMMI Radiopharm Chem 2017; 2:7. [PMID: 29503848 PMCID: PMC5824695 DOI: 10.1186/s41181-017-0027-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/29/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND [18F]AV1451 is a commonly used radiotracer for imaging tau deposits in Alzheimer's disease (AD) and related non-AD tauopathies. Existing radiosyntheses of [18F]AV1451 require complex purifications to provide doses suitable for use in clinical imaging studies. To address this issue, we have modified the synthesis of [18F]AV1451 to use only 0.5 mg precursor, optimized the Boc-deprotection step and developed a simplified method for HPLC purification of the radiotracer. RESULTS An optimized [18F]AV1451 synthesis using a TRACERLab FXFN module led to high radiochemical yield (202 ± 57 mCi per synthesis) and doses with excellent radiochemical purity (98 ± 1%) and good specific activity (2521 ± 623 Ci/mmol). CONCLUSION An updated and operationally simple synthesis of [18F]AV1451 has been developed that is fully automated and prepares radiotracer doses suitable for use in clinical tau PET studies.
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Affiliation(s)
- Andrew V. Mossine
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Allen F. Brooks
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Bradford D. Henderson
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Brian G. Hockley
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Kirk A. Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Peter J. H. Scott
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109 USA
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Viglianti BL, Wong KK, Wimer SM, Parameswaran A, Nan B, Ky C, Townsend DM, Rubello D, Frey KA, Gross MD. Effect of hyperglycemia on brain and liver 18F-FDG standardized uptake value (FDG SUV) measured by quantitative positron emission tomography (PET) imaging. Biomed Pharmacother 2017; 88:1038-1045. [PMID: 28192877 DOI: 10.1016/j.biopha.2017.01.166] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Blood glucose is routinely measured prior to 18F-fluorodeoxyglucose (FDG) administration in positron emission tomography (PET) imaging to identify hyperglycemia that may affect image quality. In this study we explore the effects of blood glucose levels upon semi-quantitative standardized uptake value (SUV) measurements of target organs and tissues of interest and in particular address the relationship of blood glucose to FDG accumulation in the brain and liver. METHODS 436 FDG PET/CT consecutive studies performed for oncology staging in 229 patients (226 male) at the Ann Arbor Veterans Administration Healthcare System were reviewed. All patients had blood glucose measured (112.4±34.1mg/dL) prior to injection of 466.2±51.8MBq (12.6±1.4mCi) of FDG. SUV measurements of brain, aortic arch blood-pool, liver, and spleen were obtained at 64.5±10.2min' post-injection. RESULTS We found a negative inverse relationship of brain SUV with increasing plasma glucose, levels for both absolute and normalized (either to blood-pool or liver) values. Higher blood glucose levels had a mild effect upon liver and blood-pool SUV. By contrast, spleen SUV was independent of blood glucose, but demonstrated the greatest variability (deviation on linear regression). In contrast to other tissues, liver and spleen SUV normalized to blood-pool SUV were not dependent upon blood glucose levels. CONCLUSION The effects of hyperglycemia upon FDG uptake in brain and liver, over a range of blood glucose values generally considered acceptable for clinical PET imaging, may have measurable effects on semi-quantitative image analysis.
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Affiliation(s)
- Benjamin L Viglianti
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA.
| | - Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie M Wimer
- Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| | - Aishwarya Parameswaran
- Michigan Institute for Clinical and Health Research (MICHR), University of Michigan, Ann Arbor, MI, USA
| | - Bin Nan
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Christy Ky
- University of Michigan School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Danyelle M Townsend
- Department of Drug Discovery and Pharmaceutical Sciences, Medical University of Southern Carolina, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Clinical Laboratory, Microbiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
| | - Kirk A Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Milton D Gross
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA
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Affiliation(s)
- Kirk A Frey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, The University of Michigan Health System, Ann Arbor, MI.
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Liss AL, Marsh RB, Kapadia NS, McShan DL, Rogers VE, Balter JM, Moran JM, Brock KK, Schipper MJ, Jagsi R, Griffith KA, Flaherty KR, Frey KA, Pierce LJ. Decreased Lung Perfusion After Breast/Chest Wall Irradiation: Quantitative Results From a Prospective Clinical Trial. Int J Radiat Oncol Biol Phys 2016; 97:296-302. [PMID: 27986344 DOI: 10.1016/j.ijrobp.2016.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/09/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To quantify lung perfusion changes after breast/chest wall radiation therapy (RT) using pre- and post-RT single photon emission computed tomography/computed tomography (SPECT/CT) attenuation-corrected perfusion scans; and correlate decreased perfusion with adjuvant RT dose for breast cancer in a prospective clinical trial. METHODS AND MATERIALS As part of an institutional review board-approved trial studying the impact of RT technique on lung function in node-positive breast cancer, patients received breast/chest wall and regional nodal irradiation including superior internal mammary node RT to 50 to 52.2 Gy with a boost to the tumor bed/mastectomy scar. All patients underwent quantitative SPECT/CT lung perfusion scanning before RT and 1 year after RT. The SPECT/CT scans were co-registered, and the ratio of decreased perfusion after RT relative to the pre-RT perfusion scan was calculated to allow for direct comparison of SPECT/CT perfusion changes with delivered RT dose. The average ratio of decreased perfusion was calculated in 10-Gy dose increments from 0 to 60 Gy. RESULTS Fifty patients had complete lung SPECT/CT perfusion data available. No patient developed symptoms consistent with pulmonary toxicity. Nearly all patients demonstrated decreased perfusion in the left lung according to voxel-based analyses. The average ratio of lung perfusion deficits increased for each 10-Gy increment in radiation dose to the lung, with the largest changes in regions of lung that received 50 to 60 Gy (ratio 0.72 [95% confidence interval 0.64-0.79], P<.001) compared with the 0- to 10-Gy region. For each increase in 10 Gy to the left lung, the lung perfusion ratio decreased by 0.06 (P<.001). CONCLUSIONS In the assessment of 50 patients with node-positive breast cancer treated with RT in a prospective clinical trial, decreased lung perfusion by SPECT/CT was demonstrated. Our study allowed for quantification of lung perfusion defects in a prospective cohort of breast cancer patients for whom attenuation-corrected SPECT/CT scans could be registered directly to RT treatment fields for precise dose estimates.
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Affiliation(s)
- Adam L Liss
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Robin B Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Nirav S Kapadia
- Department of Radiation Oncology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Daniel L McShan
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Virginia E Rogers
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - James M Balter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kristy K Brock
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matt J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kent A Griffith
- Biostatistics Unit, University of Michigan, Ann Arbor, Michigan
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kirk A Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Lori J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Ridder A, Müller MLTM, Kotagal V, Frey KA, Albin RL, Bohnen NI. Impaired contrast sensitivity is associated with more severe cognitive impairment in Parkinson disease. Parkinsonism Relat Disord 2016; 34:15-19. [PMID: 27742131 DOI: 10.1016/j.parkreldis.2016.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/30/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Dopaminergic degeneration affects both nigrostriatal projection neurons and retinal amacrine cells in Parkinson disease (PD). Parkinsonian retinopathy is associated with impaired color discrimination and contrast sensitivity. Some prior studies described associations between color discrimination deficits and cognitive deficits in PD, suggesting that contrast discrimination deficits are due, at least in part, to cognitive deficits in PD. We investigated the relationship between cognitive deficits and impaired contrast sensitivity in PD. METHODS PD subjects, n = 43; 15F/28M; mean age 66.5 ± 8.2, Hoehn and Yahr stage 2.6 ± 0.6, and duration of disease of 6.2 ± 5.0 years underwent neuropsychological and Rabin contrast sensitivity testing. RESULTS Mean Rabin contrast sensitivity score was 1.34 ± 0.40. Bivariate analyses showed significant correlation between Rabin contrast sensitivity scores and global cognitive z-scores (R = 0.54, P = 0.0002). Cognitive domain Z-score post hoc analysis demonstrated most robust correlation between Rabin scores and executive functions (R = 0.49, P = 0.0009), followed by verbal learning (R = 0.44, P = 0.0028), visuospatial (R = 0.39, P = 0.001) and attention z-scores (R = 0.32, P = 0.036). CONCLUSIONS Impaired contrast sensitivity in PD is robustly associated with cognitive deficits, particularly executive function deficits. These results suggest that contrast sensitivity may be a useful biomarker for cognitive changes in PD and may have implications for driving safety evaluations in PD.
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Affiliation(s)
- A Ridder
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - M L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA
| | - V Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA
| | - K A Frey
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - R L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA
| | - N I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA.
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Wong KK, Raffel DM, Bohnen NI, Altinok G, Gilman S, Frey KA. 2-Year Natural Decline of Cardiac Sympathetic Innervation in Idiopathic Parkinson Disease Studied with 11C-Hydroxyephedrine PET. J Nucl Med 2016; 58:326-331. [PMID: 27539837 DOI: 10.2967/jnumed.116.176891] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/21/2016] [Indexed: 01/24/2023] Open
Abstract
The objective of this study was to detect regional patterns of cardiac sympathetic denervation in idiopathic Parkinson disease (IPD) using 11C-hydroxyephedrine (11C-HED) PET and determine the denervation rate over 2 y. METHODS We obtained 62 cardiac 11C-HED PET scans in 39 patients (30 men and 9 women; mean age ± SD, 61.9 ± 5.9 y), including 23 patients with follow-up scans at 2 y. We derived 11C-HED retention indices (RIs; mL of blood/min/mL of tissue) reflecting nerve density and integrity for 480 left ventricular (LV) sectors. We compared IPD patients with 33 healthy controls using z score analysis; RI values ≤ 2.5 SDs were considered abnormal. We expressed global and regional LV denervation as the percentage extent of z score severity and severity-extent product (SEP) on 9-segment bullseye maps and decline in cardiac sympathetic innervation as the 2-y difference in SEP (diff-SEP). RESULTS Baseline 11C-HED PET in the 39 IPD patients revealed an RI mean of 0.052 ± 0.022 mL of blood/min/mL of tissue. In comparison with data from normal controls, 12 patients had normal 11C-HED PET, 5 showed mild denervation (percentage extent < 30%), and 22 had moderate to severe denervation (percentage extent > 30%, z score ≤ 2.5 SD). In the 23 paired PET scans, worsening cardiac denervation (global diff-SEP > 9) occurred in 14 of 23 (60.9%) patients over 2 y, including percentage LV abnormality (59% increasing to 66%), z-severity (-2.4 down to -2.5), and SEP (-195 to -227) (P = 0.0062). We found a mean annual decline of 4.6% ± 5.6 (maximum, 13%) in 11C-HED retention from a baseline global RI mean of 0.0481 ± 0.0218 to 0.0432 ± 0.0220 (P = 0.0009). At baseline, 5 patients with normal uptake had no interval change; 3 with mild denervation developed interval decline in lateral and inferior segments (diff-SEP -82 to -99) compared with anterior and septal segments (-65 to -79), whereas the reverse pattern occurred in 15 patients with severe baseline denervation. CONCLUSION Progressive decline in cardiac sympathetic neural integrity in IPD patients occurs at a modest rate over 2 y on 11C-HED scans with marked heterogeneity and a regional pattern of involvement and decline.
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Affiliation(s)
- Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan .,VA Ann Arbor Healthcare System, GRECC, Ann Arbor, Michigan
| | - David M Raffel
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Nicolaas I Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan.,VA Ann Arbor Healthcare System, GRECC, Ann Arbor, Michigan.,Functional Neuroimaging, Cognitive and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, Michigan.,University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, Michigan
| | - Gulcin Altinok
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Sid Gilman
- Department of Neurology, University of Michigan (retired), Ann Arbor, Michigan; and
| | - Kirk A Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan.,Department of Neurology, University of Michigan, Ann Arbor, Michigan
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Scott PJH, Shao X, Desmond TJ, Hockley BG, Sherman P, Quesada CA, Frey KA, Koeppe RA, Kilbourn MR, Bohnen NI. Investigation of Proposed Activity of Clarithromycin at GABAA Receptors Using [(11)C]Flumazenil PET. ACS Med Chem Lett 2016; 7:746-50. [PMID: 27563397 DOI: 10.1021/acsmedchemlett.5b00435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/01/2016] [Indexed: 11/28/2022] Open
Abstract
Clarithromycin is a potential treatment for hypersomnia acting through proposed negative allosteric modulation of GABAA receptors. We were interested whether this therapeutic benefit might extend to Parkinson's disease (PD) patients because GABAergic neurotransmission is implicated in postural control. Prior to initiating clinical studies in PD patients, we wished to better understand clarithromycin's mechanism of action. In this work we investigated whether the proposed activity of clarithromycin at the GABAA receptor is associated with the benzodiazepine binding site using in vivo [(11)C]flumazenil positron emission tomography (PET) in primates and ex vivo [(3)H]flumazenil autoradiography in rat brain. While the studies demonstrate that clarithromycin does not change the K d of FMZ, nor does it competitively displace FMZ, there is preliminary evidence from the primate PET imaging studies that clarithromycin delays dissociation and washout of flumazenil from the primate brain in a dose-dependent fashion. These findings would be consistent with the proposed GABAA allosteric modulator function of clarithromycin. While the results are only preliminary, further investigation of the interaction of clarithromycin with GABA receptors and/or GABAergic medications is warranted, and therapeutic applications of clarithromycin alone or in combination with flumazenil, to treat hyper-GABAergic status in PD at minimally effective doses, should also be pursued.
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Affiliation(s)
- Peter J. H. Scott
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
- The Interdepartmental Program in Medicinal Chemistry, The University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Xia Shao
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Timothy J. Desmond
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Brian G. Hockley
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Phillip Sherman
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Carole A. Quesada
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Kirk A. Frey
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
- Department
of Neurology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Robert A. Koeppe
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Michael R. Kilbourn
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Nicolaas I. Bohnen
- Division of Nuclear Medicine, Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
- Department
of Neurology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, United States
- Neurology Service and Geriatrics Research,
Education, and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan United States
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Albin RL, Frey KA. Reverse Translation in Parkinson Disease. J Nucl Med 2016; 57:1497-1498. [PMID: 27151982 DOI: 10.2967/jnumed.116.175257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roger L Albin
- Neurology Service & GRECC, VAAAHS, Ann Arbor, Michigan Department of Neurology, University of Michigan, Ann Arbor, Michigan University of Michigan Morris K. Udall Center, Ann Arbor, Michigan Michigan Alzheimer Disease Center, Ann Arbor, Michigan; and
| | - Kirk A Frey
- Department of Neurology, University of Michigan, Ann Arbor, Michigan Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Affiliation(s)
- Kirk A Frey
- University of Michigan Hospitals, Ann Arbor, Michigan
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Shah N, Frey KA, Müller MLTM, Petrou M, Kotagal V, Koeppe RA, Scott PJH, Albin RL, Bohnen NI. Striatal and Cortical β-Amyloidopathy and Cognition in Parkinson's Disease. Mov Disord 2015; 31:111-7. [PMID: 26380951 DOI: 10.1002/mds.26369] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although most previous cognitive studies of β-amyloidopathy in PD focused on cortical plaque deposition, recent postmortem studies point to an important role of striatal β-amyloid plaque deposition. The aim of this study was to investigate the relative contributions of striatal and cortical β-amyloidopathy to cognitive impairment in PD. METHODS Patients with PD (n = 62; age, 68.9 ± 6.4 years; H & Y stage: 2.7 ± 0.5; MoCA score: 25.2 ± 3.0) underwent [(11) C]Pittsburgh compound B β-amyloid, [(11) C]dihydrotetrabenazine monoaminergic, and [(11) C]methyl-4-piperidinyl propionate acetylcholinesterase brain PET imaging and neuropsychological assessment. [(11) C]Pittsburgh compound B β-amyloid data from young to middle-aged healthy subjects were used to define elevated [(11) C]Pittsburgh compound B binding in patients. RESULTS Elevated cortical and striatal β-amyloid deposition were present in 37% and 16%, respectively, of this predominantly nondemented cohort of patients with PD. Increased striatal β-amyloid deposition occurred in half of all subjects with increased cortical β-amyloid deposition. In contrast, increased striatal β-amyloid deposition did not occur in the absence of increased cortical β-amyloid deposition. Analysis of covariance using global composite cognitive z scores as the outcome parameter showed significant regressor effects for combined striatal and cortical β-amyloidopathy (F = 4.18; P = 0.02) after adjusting for covariate effects of cortical cholinergic activity (F = 5.67; P = 0.02), caudate nucleus monoaminergic binding, duration of disease, and age (total model: F = 3.55; P = 0.0048). Post-hoc analysis showed significantly lower cognitive z score for combined striatal and cortical β-amyloidopathy, compared to cortical-only β-amyloidopathy and non-β-amyloidopathy subgroups. CONCLUSIONS The combined presence of striatal and cortical β-amyloidopathy is associated with greater cognitive impairment than cortical β-amyloidopathy alone in PD.
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Affiliation(s)
- Neha Shah
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA
| | - Myria Petrou
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,Neurology Service and GRECC, VAAAHS, Ann Arbor, Michigan, USA.,University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA
| | - Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,Neurology Service and GRECC, VAAAHS, Ann Arbor, Michigan, USA.,University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA
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Frey KA. Reply: Alzheimer Disease: Approaches to Early Diagnosis and High-Accuracy Imaging. J Nucl Med 2015; 56:1467. [DOI: 10.2967/jnumed.115.162974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Snider J, Müller MLTM, Kotagal V, Koeppe RA, Scott PJH, Frey KA, Albin RL, Bohnen NI. Non-exercise physical activity attenuates motor symptoms in Parkinson disease independent from nigrostriatal degeneration. Parkinsonism Relat Disord 2015; 21:1227-31. [PMID: 26330028 DOI: 10.1016/j.parkreldis.2015.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/09/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the relationship between time spent in non-exercise and exercise physical activity and severity of motor functions in Parkinson disease (PD). BACKGROUND Increasing motor impairments of PD incline many patients to a sedentary lifestyle. We investigated the relationship between duration of both non-exercise and exercise physical activity over a 4-week period using the Community Health Activities Model Program for Seniors (CHAMPS) questionnaire and severity of clinical motor symptoms in PD. We accounted for the magnitude of nigrostriatal degeneration. METHODS Cross-sectional study. PD subjects, n = 48 (40 M); 69.4 ± 7.4 (56-84) years old; 8.4 ± 4.2 (2.5-20) years motor disease duration, mean UPDRS motor score 27.5 ± 10.3 (7-53) and mean MMSE score 28.4 ± 1.9 (22-30) underwent [(11)C]dihydrotetrabenazine (DTBZ) PET imaging to assess nigrostriatal denervation and completed the CHAMPS questionnaire and clinical assessment. RESULTS Bivariate correlations showed an inverse relationship between motor UPDRS severity scores and duration of non-exercise physical activity (R = -0.37, P = 0.0099) but not with duration of exercise physical activity (R = -0.05, P = 0.76) over 4 weeks. Multiple regression analysis using UPDRS motor score as outcome variable demonstrated a significant regressor effect for duration of non-exercise physical activity (F = 6.15, P = 0.017) while accounting for effects of nigrostriatal degeneration (F = 4.93, P = 0.032), levodopa-equivalent dose (LED; F = 1.07, P = 0.31), age (F = 4.37, P = 0.043) and duration of disease (F = 1.46, P = 0.23; total model (F = 5.76, P = 0.0004). CONCLUSIONS Non-exercise physical activity is a correlate of motor symptom severity in PD independent of the magnitude of nigrostriatal degeneration. Non-exercise physical activity may have positive effects on functional performance in PD.
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Affiliation(s)
- Jonathan Snider
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease, Ann Arbor, MI, USA
| | - Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease, Ann Arbor, MI, USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Kirk A Frey
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA.
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45
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Albin RL, Fisher-Hubbard A, Shanmugasundaram K, Koeppe RA, Burke JF, Camelo-Piragua S, Lieberman AP, Giordani B, Frey KA. Post-Mortem evaluation of amyloid-dopamine terminal positron emission tomography dementia classifications. Ann Neurol 2015; 78:824-30. [PMID: 26183692 DOI: 10.1002/ana.24481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/13/2015] [Accepted: 07/13/2015] [Indexed: 02/02/2023]
Abstract
Clinical classification of early dementia and mild cognitive impairment (MCI) is imprecise. We reported previously that molecular imaging classification of early dementia and MCI with dual amyloid and dopamine terminal positron emission tomography differs significantly from expert clinical classification. We now report pathological diagnoses in a substantial subset of our previously imaged subjects. Among 36 subjects coming to autopsy, imaging classifications and pathological diagnosis were concordant in 33 cases (κ = 0.85). This approach enhanced specificity of Alzheimer's disease diagnosis. The strong concordance of imaging-based classifications and pathological diagnoses suggests that this imaging approach will be useful in establishing more accurate and convenient classification biomarkers for dementia research.
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Affiliation(s)
- Roger L Albin
- Neurology Service & GRECC, VAAAHS, Ann Arbor, MI.,Department of Neurology, University of Michigan, Ann Arbor, MI.,Michigan Alzheimer's Disease Center, Ann Arbor, MI.,University of Michigan Morris K. Udall Center of Excellent for Parkinson's Disease Research, Ann Arbor, MI
| | | | | | - Robert A Koeppe
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - James F Burke
- Neurology Service & GRECC, VAAAHS, Ann Arbor, MI.,Department of Neurology, University of Michigan, Ann Arbor, MI.,Michigan Alzheimer's Disease Center, Ann Arbor, MI
| | | | | | - Bruno Giordani
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Kirk A Frey
- Department of Neurology, University of Michigan, Ann Arbor, MI.,Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI
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Kotagal V, Bohnen NI, Müller MLTM, Koeppe RA, Frey KA, Langa KM, Albin RL. Educational attainment and motor burden in Parkinson's disease. Mov Disord 2015; 30:1143-7. [PMID: 26096339 DOI: 10.1002/mds.26272] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/18/2015] [Accepted: 04/21/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Greater educational attainment is a protective factor for neurodegenerative dementias. If education earlier in life leads to greater cerebral reserve, it may play a similar protective role in Parkinson's disease (PD). METHODS We conducted a cross-sectional clinical imaging study of 142 subjects with PD. All subjects underwent [(11)C]dihydrotetrabenazine PET to confirm nigrostriatal dopaminergic denervation and brain MRI to estimate adjusted cortical gray matter volume (GMV). RESULTS After adjusting for possible confounders, including cognitive and dopaminergic covariates, as well as nonspecific neurodegeneration covariates (age, disease duration, and total adjusted cortical GMV), lower years of education remained a significant predictor of higher total MDS-UPDRS motor score (t = -3.28; P = 0.001). Education level associated inversely with white matter (WM) hyperintensities in a post-hoc analysis (n = 83). CONCLUSIONS Higher educational attainment is associated with lower severity of motor impairment in PD. This association may reflect an extranigral protective effect upon WM integrity.
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Affiliation(s)
- Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USAI
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USAI.,Neurology Service and GRECC, VAAAHS, Ann Arbor, Michigan, USA.,Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA
| | - Martijn L T M Müller
- Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA
| | - Robert A Koeppe
- Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kirk A Frey
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USAI.,Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kenneth M Langa
- Department of Internal Medicine and VA Ann Arbor Center for Clinical Management Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USAI.,Neurology Service and GRECC, VAAAHS, Ann Arbor, Michigan, USA.,University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA
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Curtis C, Gamez JE, Singh U, Sadowsky CH, Villena T, Sabbagh MN, Beach TG, Duara R, Fleisher AS, Frey KA, Walker Z, Hunjan A, Holmes C, Escovar YM, Vera CX, Agronin ME, Ross J, Bozoki A, Akinola M, Shi J, Vandenberghe R, Ikonomovic MD, Sherwin PF, Grachev ID, Farrar G, Smith APL, Buckley CJ, McLain R, Salloway S. Phase 3 trial of flutemetamol labeled with radioactive fluorine 18 imaging and neuritic plaque density. JAMA Neurol 2015; 72:287-94. [PMID: 25622185 DOI: 10.1001/jamaneurol.2014.4144] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE In vivo imaging of brain β-amyloid, a hallmark of Alzheimer disease, may assist in the clinical assessment of suspected Alzheimer disease. OBJECTIVE To determine the sensitivity and specificity of positron emission tomography imaging with flutemetamol injection labeled with radioactive fluorine 18 to detect β-amyloid in the brain using neuropathologically determined neuritic plaque levels as the standard of truth. DESIGN, SETTING, AND PARTICIPANTS Open-label multicenter imaging study that took place at dementia clinics, memory centers, and hospice centers in the United States and England from June 22, 2010, to November 23, 2011. Participants included terminally ill patients who were 55 years or older with a life expectancy of less than 1 year. INTERVENTIONS Flutemetamol injection labeled with radioactive fluorine 18 (Vizamyl; GE Healthcare) administration followed by positron emission tomography imaging and subsequent brain donation. MAIN OUTCOMES AND MEASURES Sensitivity and specificity of flutemetamol injection labeled with radioactive fluorine 18 positron emission tomography imaging for brain β-amyloid. Images were reviewed without and with computed tomography scans and classified as positive or negative for β-amyloid by 5 readers who were blind to patient information. In patients who died, neuropathologically determined neuritic plaque levels were used to confirm scan interpretations and determine sensitivity and specificity. RESULTS Of 176 patients with evaluable images, 68 patients (38%) died during the study, were autopsied, and had neuritic plaque levels determined; 25 brains (37%) were β-amyloid negative; and 43 brains (63%) were β-amyloid positive. Imaging was performed a mean of 3.5 months (range, 0 to 13 months) before death. Sensitivity without computed tomography was 81% to 93% (median, 88%). Median specificity was 88%, with 4 of 5 of the readers having specificity greater than 80%. When scans were interpreted with computed tomography images, sensitivity and specificity improved for most readers but the differences were not significant. The area under the receiver operating curve was 0.90. There were no clinically meaningful findings in safety parameters. CONCLUSIONS AND RELEVANCE This study showed that flutemetamol injection labeled with radioactive fluorine 18 was safe and had high sensitivity and specificity in an end-of-life population. In vivo detection of brain β-amyloid plaque density may increase diagnostic accuracy in cognitively impaired patients.
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Affiliation(s)
| | | | | | - Carl H Sadowsky
- Department of Neurology, Nova SE University, Ft Lauderdale, Florida
| | | | - Marwan N Sabbagh
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Ranjan Duara
- Mount Sinai Medical Center, Wien Center for AD, Miami Beach, Florida
| | - Adam S Fleisher
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona8is now with Eli Lilly and Company, Indianapolis, Indiana9is now with the Department of Neurosciences, University of California, San Diego, San Diego
| | - Kirk A Frey
- Department of Radiology, Nuclear Medicine, University of Michigan, Ann Arbor
| | - Zuzana Walker
- Division of Psychiatry, University College London, England12North Essex Partnership University NHS Foundation Trust, London, England
| | - Arvinder Hunjan
- North Essex Partnership University NHS Foundation Trust, Essex, England
| | - Clive Holmes
- Clinical Experimental Science, University of Southampton, Southampton, Hampshire, England
| | | | | | - Marc E Agronin
- Mental Health and Clinical Research, Miami Jewish Health Systems, Miami, Florida17Department of Psychiatry and Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Joel Ross
- Memory Enhancement Center, Eatontown, New Jersey
| | - Andrea Bozoki
- Cognitive and Geriatric Neurology Team, Neurology and Radiology, Michigan State University, East Lansing
| | | | - Jiong Shi
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Rik Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Milos D Ikonomovic
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul F Sherwin
- Medical Affairs, GE Healthcare-Life Sciences, Princeton, New Jersey
| | - Igor D Grachev
- Medical Affairs, GE Healthcare-Life Sciences, Princeton, New Jersey25is now with Novartis Consumer Health, Parsippany, New Jersey26is now with Genpact Pharmalink, Short Hills, New Jersey
| | - Gillian Farrar
- Life Sciences, GE Healthcare, Amersham, Buckinghamshire, England
| | - Adrian P L Smith
- Life Sciences, GE Healthcare, Amersham, Buckinghamshire, England
| | | | | | - Stephen Salloway
- Department of Neurology and the Memory and Aging Program, Butler Hospital, Providence, Rhode Island30Department of Neurology and Psychiatry, Warren Alpert Medical School, Providence, Rhode Island31Brown University, Providence, Rhode Island
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Petrou M, Dwamena BA, Foerster BR, MacEachern MP, Bohnen NI, Müller ML, Albin RL, Frey KA. Amyloid deposition in Parkinson's disease and cognitive impairment: a systematic review. Mov Disord 2015; 30:928-35. [PMID: 25879534 DOI: 10.1002/mds.26191] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/22/2015] [Accepted: 01/26/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Varying degrees of cortical amyloid deposition are reported in the setting of Parkinsonism with cognitive impairment. We performed a systematic review to estimate the prevalence of Alzheimer disease (AD) range cortical amyloid deposition among patients with Parkinson's disease with dementia (PDD), Parkinson's disease with mild cognitive impairment (PD-MCI) and dementia with Lewy bodies (DLB). We included amyloid positron emission tomography (PET) imaging studies using Pittsburgh Compound B (PiB). METHODS We searched the databases Ovid MEDLINE, PubMed, Embase, Scopus, and Web of Science for articles pertaining to amyloid imaging in Parkinsonism and impaired cognition. We identified 11 articles using PiB imaging to quantify cortical amyloid. We used the metan module in Stata, version 11.0, to calculate point prevalence estimates of patients with "PiB-positive" studies, that is, patients showing AD range cortical Aβ-amyloid deposition. Heterogeneity was assessed. A scatterplot was used to assess publication bias. RESULTS Overall pooled prevalence of "PiB-positive" studies across all three entities along the spectrum of Parkinson's disease and impaired cognition (specifically PDD, PD-MCI, and DLB) was 0.41 (95% confidence interval [CI], 0.24-0.57). Prevalence of "PiB-positive" studies was 0.68 (95% CI, 0.55-0.82) in the DLB group, 0.34 (95% CI, 0.13-0.56) in the PDD group, and 0.05 (95% CI, -0.07-0.17) in the PD-MCI group. CONCLUSIONS Substantial variability occurs in the prevalence of "PiB-positive" studies in subjects with Parkinsonism and cognitive impairment. Higher prevalence of PiB-positive studies was encountered among subjects with DLB as opposed to subjects with PDD. The PD-MCI subjects showed overall lower prevalence of PiB-positive studies than reported findings in non-PD-related MCI. © 2015 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Myria Petrou
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ben A Dwamena
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Veterans Administration Healthcare System, Ann Arbor, Michigan, USA
| | - Bradley R Foerster
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Veterans Administration Healthcare System, Ann Arbor, Michigan, USA
| | - Mark P MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Veterans Administration Healthcare System, Ann Arbor, Michigan, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,Univerity of Michigan Morris K. Udall Center for Excellence in Parkinson's Disease Research, Ann Arbor, Michigan, USA
| | - Martijn Ltm Müller
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Roger L Albin
- Veterans Administration Healthcare System, Ann Arbor, Michigan, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.,Univerity of Michigan Morris K. Udall Center for Excellence in Parkinson's Disease Research, Ann Arbor, Michigan, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
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Bohnen NI, Albin RL, Müller MLTM, Petrou M, Kotagal V, Koeppe RA, Scott PJH, Frey KA. Frequency of cholinergic and caudate nucleus dopaminergic deficits across the predemented cognitive spectrum of Parkinson disease and evidence of interaction effects. JAMA Neurol 2015; 72:194-200. [PMID: 25506674 DOI: 10.1001/jamaneurol.2014.2757] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE Little is known about the relative contributions of multisystem degenerative processes across the spectrum of predemented cognitive decline in Parkinson disease (PD). OBJECTIVE To investigate the relative frequency of caudate nucleus dopaminergic and forebrain cholinergic deficits across a spectrum of cognitively impaired patients with PD to explore their relative, individual, and combined contributions to cognitive impairment in PD. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study at an academic movement disorders clinic that included a predominantly nondemented cohort of 143 patients with PD. The mean (SD) age of patients was 65.5 (7.4) years and the mean (SD) Hoehn and Yahr stage was 2.4 (0.6). MAIN OUTCOMES AND MEASURES Binary classification of carbon 11-labeled [11C]PMP acetylcholinesterase and caudate nucleus [11C]DTBZ monoaminergic positron-emission tomography imaging based on normative data. The frequency of significant degenerative processes based on normative values was determined for consecutive intervals of cognitive impairment, ranging from no or minimal (z > -0.5) to more severe (z ≤ -2) cognitive impairment. RESULTS Across the spectrum from minimal (z > -0.5) to more severe (z ≤ -2) global cognitive impairment scores, caudate nucleus dopaminergic denervation was relatively frequent in individuals with minimal or no cognitive changes (51.1%) and increased in patients with more severe cognitive impairments (χ2 = 12.8; P = .01). Cortical cholinergic denervation frequency increased monotonically with increasing cognitive impairment from 24.7% (z > -0.5) to 85.7% (z ≤ -2); χ2 = 23.2; P = .001). Eighty-seven percent of patients with neocortical cholinergic deficits had caudate nucleus dopaminergic deficits. Multiple regression analysis (F = 7.51; P < .001) showed both independent cognitive predictions for caudate nucleus dopaminergic (F = 7.25; P = .008) and cortical cholinergic (F = 7.50; P = .007) degenerations as well as interaction effects (F = 5.40; P = .02). CONCLUSIONS AND RELEVANCE Cortical cholinergic denervation is a major neurodegeneration associated with progressive declines across the spectrum of cognitive impairment in PD and typically occurs in the context of significant caudate nucleus dopaminergic denervation. Our findings imply that dopaminergic and cholinergic degenerations exhibit both independent and interactive contributions to cognitive impairment in PD.
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Affiliation(s)
- Nicolaas I Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor2Department of Neurology, University of Michigan, Ann Arbor3Neurology Service and Geriatric Research Education and Clinical Center, Veterans Administration Ann Arbor H
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor3Neurology Service and Geriatric Research Education and Clinical Center, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan4Michigan Alzheimer Disease Center, Ann Arbor
| | - Martijn L T M Müller
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor
| | - Myria Petrou
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor
| | - Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor
| | - Robert A Koeppe
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor
| | - Peter J H Scott
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor
| | - Kirk A Frey
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor2Department of Neurology, University of Michigan, Ann Arbor
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Wang J, Wong KK, Piert M, Stanton P, Frey KA, Kong FM(S. Metabolic response assessment with 18F-FDG PET/CT: inter-method comparison and prognostic significance for patients with non-small cell lung cancer. ACTA ACUST UNITED AC 2015; 4:249-256. [PMID: 26366253 PMCID: PMC4559091 DOI: 10.1007/s13566-015-0184-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/29/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to (1) compare the agreement of two evaluation methods of metabolic response in patients with non-small cell lung cancer (NSCLC) and determine their prognostic value and (2) explore an optimal cutoff of metabolic reduction to distinguish a more favorable subset of responders. METHODS This is a secondary analysis of prospective studies. Enrolled patients underwent 18F-PET/CT within 2 weeks before, during, and months after radiotherapy (post-RT). Metabolic response was assessed using both Peter MacCallum (PM) method of qualitative visual assessment and University of Michigan (UM) method of semiquantitative measurement. The agreement between two methods determined response, and their prediction of outcome was analyzed. RESULTS Forty-four patients with median follow-up of 25.2 months were analyzed. A moderate agreement was observed between PM- and UM-based response assessment (Kappa coefficient = 0.434), unveiling a significant difference in CMR rate (p = 0.001). Categorical responses derived from either method were significantly predictive of overall survival (OS) and progression-free survival (PFS) (p < 0.0001). Numerical percentage decrease of FDG uptake also showed significant correlations with survival, presenting a hazard ratio of 0.97 for both OS and PFS. A 75 % of SUV decrease was found to be the optimal cutoff to predict OS and 2-year progression. CONCLUSIONS There was a modest discrepancy in metabolic response rates between PM and UM criteria, though both could offer predictive classification for survival. The percentage decrease provides an ordinal value that correlates with prolonged survival, recommending 75 % as the optimal threshold at identifying better responders.
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Affiliation(s)
- Jingbo Wang
- />Department of Radiation Oncology, University of Michigan, Ann Arbor, MI USA
- />Department of Radiation Oncology, Cancer Hospital & Institute, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, People’s Republic of China
| | - Ka Kit Wong
- />Department of Nuclear Medicine, University of Michigan, Ann Arbor, MI USA
| | - Morand Piert
- />Department of Nuclear Medicine, University of Michigan, Ann Arbor, MI USA
| | - Paul Stanton
- />Department of Radiation Oncology, University of Michigan, Ann Arbor, MI USA
| | - Kirk A Frey
- />Department of Nuclear Medicine, University of Michigan, Ann Arbor, MI USA
| | - Feng-Ming (Spring) Kong
- />Department of Radiation Oncology, University of Michigan, Ann Arbor, MI USA
- />Department of Radiation Oncology, GRU Cancer Center,Medical College of Georgia, Georgia Regents University, 821 St. Sebastian Way, HK 112, Augusta, GA 30912 USA
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