HOPE, an open platform for medical data management on the grid

The paper describes a platform developed for the secure management and analysis of medical data and images in a grid environment. Designed for telemedicine and built upon the EGEE gLite middleware and particularly the metadata catalogue AMGA as well as the GridSphere web portal, the platform provides to healthcare professionals the capacity to upload and query medical information stored over distributed servers. A job submission environment is also available for data analysis. Security features include authentication and authorization by grid certificates, anonymization of medical data and image encryption. The platform is currently deployed on several sites in Europe and Asia and is being customized for applications in the field of telemedicine and medical physics.

[Impact of computed tomography on patient's care in nontraumatic acute abdomen: 90 patients]

OBJECTIVES

To determine the contribution of computerized tomography (CT) to the management of nontraumatic acute abdomen, to evaluate interobserver agreement and the contribution of CT to cost control, to look for the predictive factors of CT.

PATIENTS

and method. Ninety prospectively included patients, admitted for nontraumatic acute abdomen and examined by a surgeon, received CT examination. Diagnosis and treatment 1) envisioned before and 2) defined after CT, and 3) finally retained were compared, and the interobserver agreement was calculated after the second reading. The predictive value of the clinical and biological criteria as well as the radiological criteria characterizing these patients was sought.

RESULTS

CT was contributive in 68.9% of cases, with a reliable diagnosis and treatment strategy, defined after CT examination, for 92.2% and 90%, respectively. Interobserver agreement was 93.3%. CT contributed to reducing costs in 15.5% of patients, for an additional cost estimated at 104-139 euros. The positive predictive factors of the CT contribution were age over 70 years, localized symptoms, fever, and high CRP.

CONCLUSION

In agreement with the literature, in our study CT appears to be a choice examination to guide patient care in nontraumatic acute abdomen.

Synthesis of a functional information with anatomical landmarks by multiresolution fusion of brain images

In order to help clinicians with the diagnosis of neurodegenerative diseases, we provide a synthetic functional information located in relation with anatomical structures. The final image is processed by multimodal data fusion between SPECT and MR images. We propose a new method for the management of such multiresolution data, in which a geometrical model allows an accurate correspondence of voxels from both images, while preserving at best both original pieces of information. We use this matching method to replace the interpolation step in the compulsory image registration of the data fusion process. The geometrical model is first built from registration parameters. Computational geometry algorithms, applied to this model, allow the computation of numerical values used to process the final information. The method has been applied to brain perfusion and neurotransmission SPECT images.

Localization of Target Structures through Data Fusion Applied to Neurostimulation

Symptoms of Parkinson's Disease can be relieved by Deep Brain Stimulation (DBS), which is based on an accurate positionning of electrodes in specific structures of the Basal Ganglia, e.g. the SubThalamic Nucleus (STN) and the Internal Globus Pallidus (GPi), and of the thalamus. We planned to develop an automatized method for the identification of these structures, deeply located in the brain, through data fusion. Information, provided by both anatomical MR images and expert knowledge, was managed in a possibilist frame by a fuzzy logic approach. A multi-scale graph-based virtual atlas, modeling the theoretical anatomical knowledge, was matched to each patient's data (MRI), in order to compute an estimation of the structures' location,thus assisting the physician in the definition of the target. The method has been tested on several images with promising results. In the long run, it might open opportunities to a fully automatized surgical planning.

[Femoral superficial artery angioplasty: long term results, initial predictive factors. 101 patients]

OBJECTIVE

To evaluate immediate results, clinical improvement, long-term patency and predictive factors of long-term outcome after superficial femoral artery percutaneous angioplasty.

PATIENTS AND METHODS

Restrospective monocentric study of 101 patients (142 lesions: 105 stenoses and 37 occlusions) technical results, long-term patency (19 months), and clinical improvement (27,5 months) were analyzed. A multifactorial analysis was performed.

RESULTS

Technical success was obtained in 99%, complications and mortality rates were respectively 3% and 2%. At the end of follow-up, 55 patients were clinically improved (20 lost to follow-up), and femoral artery remained patent in 62 patients (10 to follow-up). Statistical analyses revealed 8 significant predictive factors of a good outcome (P<0.05): female gender, non-diabetic, at least one patent artery below the knee, AHA classification <2, no stent, treatment of an occlusion, number of dilatations<3, treatment by statins for hypercholesterolemia.

CONCLUSION

Femoral superficial artery angioplasty is usually achieved with low complication rate. We found eight factors predictive of long-term outcome, to keep in mind when indications are discussed.

Monitoring of polyethylene wear in nonmetal-backed acetubular cups by digitized anteroposterior pelvic radiography

The aim of this study was to assess polyethylene wear in a total hip prosthesis by digitized radiography of the whole pelvis in the anteroposterior (AP) plane. The three-dimensional (3-D) pose of the nonmetal-backed acetubular cup, materialized by its metal ring and the femoral head made of metal or ceramic, was estimated using iterative algebraic algorithms with inner bias correction and bootstrapping for variance reduction. Points of interest were obtained by maximizing the correlation between sampled density profiles and 3-D geometric models degraded by the modulation transfer function (MTF) of the radiographic system and the film scanner. The error in the maximal correlation estimate were inferred from noise power spectra (NPS) and allowed the calculation of the point covariance matrix. Both NPS and MTF were modeled for each stage and estimated using least-square fitting of the overall NPS model to the autospectral density function calculated in stationary regions. Comparison of the radiographic time series was made possible by the high accuracy level and 3-D matching from the cup orientation. The feasibility of the full 3-D measurement, the assumption of negligible lateral wear and its influence on AP wear are discussed on simulated and real radiographic data.

Slow pressure waves in the cranial enclosure

Slowly varying pressure oscillations in the cranial enclosure are well known, especially intracranial pressure waves as best described by the pioneering works of Janny and Lundberg. Nevertheless, in spite of over twenty five years research on intracranial pressure waves, their origin and regulation remain unclear but are often considered only as pathological. Our aim was to review data on these phenomena to clarify their biological status and the role that they could play in the management of patients suffering from such intracranial neurosurgical diseases as intracranial hypertension, severe head injury, and hydrocephalus. It appears that these pressure waves reveal important information on the function of the cerebral vasculature and as such have significance for influencing intracranial compliance. Pressure waves are also closely associated with autoregulation, in particular dynamic autoregulation. It seems evident that they are not only pathophysiological but also physiological, linked with other biological parameters such as the neurovegetative cardiovascular system, breathing, and sleeping. This study shows that it is not only important to continue to explore these slow waves, but also the methods of analysis in order to more fully clarify their clinical significance.

Fusion in medical imaging: theory, interests and industrial applications

The accumulation of several data coming from medical images and signals, expert knowledge and databases is becoming very common for the study of a given pathology. The aggregation of all this information is mentally performed by a clinician, and generally allows for a better medical decision in clinical studies. We propose in this article a fusion method that models this aggregation process. This method is a three step scheme, that first transforms all the available information in a common theoretical frame, then aggregates these data using their redundancy and their conflicts, and finally computes a new information synthesizing all the initial knowledge. We first introduce in this article the fusion scheme and its theoretical aspects, and we particularly focus on the three steps of the process. We then detail the software implementation of this concept, achieved in collaboration with SEGAMI Corporation Inc. We finally apply this concept to a real clinical problem, the study of Alzheimer's disease using MR and SPECT images, and we show very encouraging preliminary results.

Blood flow velocity estimation from x-ray densitometric data: an efficient numerical scheme for the inverse advection problem

In previously published studies, blood flow velocity from x-ray biplane angiography was measured by solving an inverse advection problem, relating velocity to bolus densities summed across sections. Both spatial and temporal velocity variations were recovered through a computationally expensive parameter estimation algorithm. Here we prove the existence and uniqueness of the solution on three sub-domains of the plane defined by the axial position along the vessel and the time of the angiographic sequence. A fast direct scheme was designed in conjunction with a regularization step stemming from the volume flow conservation law applied on consecutive segments. Its accuracy and immunity towards noise were tested on both simulated and real densitometric data. The relative error between the estimated and expected velocities was less than 5% for more than 90% of the points of the spatiotemporal plane with simulated densities normalized to 1.0 and a Gaussian additive noise of standard deviation 0.01. For densities reconstructed from a biplane angiographic sequence, increase in velocity is used as a functional index for the stenosis ratio and to characterize the sharing of flow at bifurcation.

Three-dimensional tracking of coronary arteries from biplane angiographic sequences using parametrically deformable models

A new method for coronary artery tracking in biplane digital subtraction is presented. The dynamic tracking of nonrigid objects from two views is achieved using a generalization of parametrically deformable models. Three-dimensional (3-D) Fourier descriptors used for shape representation are obtained from the two-dimensional (2-D) descriptors of the projections. A new constraint inferred from epipolar geometry is applied to the contour model. Direct 3-D tracking is compared with the classical approach in two steps: independent 2-D tracking in each of the two projection planes; 3-D reconstruction using the epipolar constraint. Convergence quality and accuracy of the 3-D reconstruction are analyzed for several sequences showing different displacement amplitudes, deformation rates and image contrasts.

Automatic segmentation of subcortical brain structures in MR images using information fusion

This paper reports a new automated method for the segmentation of internal cerebral structures using an information fusion technique. The information is provided both by images and expert knowledge, and consists in morphological, topological, and tissue constitution data. All this ambiguous, complementary and redundant information is managed using a three-step fusion scheme based on fuzzy logic. The information is first modeled into a common theoretical frame managing its imprecision and incertitude. The models are then fused and a decision is taken in order to reduce the imprecision and to increase the certainty in the location of the structures. The whole process is illustrated on the segmentation of thalamus, putamen, and head of the caudate nucleus from expert knowledge and magnetic resonance images, in a protocol involving 14 healthy volunteers. The quantitative validation is achieved by comparing computed, manually segmented structures and published data by means of indexes assessing the accuracy of volume estimation and spatial location. Results suggest a consistent volume estimation with respect to the expert quantification and published data, and a high spatial similarity of the segmented and computed structures. This method is generic and applicable to any structure that can be defined by expert knowledge and morphological images.

Benefit of endurance training in elderly people over a short period is reversible

The present study assessed daily activity, physical capacity and body composition in 11 initially sedentary healthy subjects [5 men and 6 women, mean age 62.8 (SD 2.7) years] before training (T(o)), after completion of 7 (T(7w)) and 14 (T(14w)) weeks of training, and again 6 (T(6m)) and 12 (T(12m)) months after training. The mean daily activity index decreased from T(7w) to T(12m) reaching a lower level than at T(o) [T(12m) - T(o) = -1.5 (SD 4.6) units, P = 0.18]. Mean maximal oxygen uptake (VO(2max)) and its corresponding mean power output (Wdot(max)) were increased by 12.5 (SD 6.6)% (P = 0. 003) and 22.8 (SD 12.8)% (P = 0.003), respectively, at T(14w), and returned to their T(o) levels within 1 year. Mean body mass (m(b)) remained stable until T(6m) but increased significantly by 2.6 (SD 3. 7)% from T(6m) to T(12m) (P < 0.05). Mean fat mass (m(f), from bioelectrical impedance analysis measurements) tended to decrease [-2.0 (SD 4.2)%, P = 0.10] during the training period but increased by 7.8 (SD 10.9)% between T(6m) and T(12m) (P < 0.05). The mean fat free mass did not vary during the study period (P = 0.81) but magnetic resonance imaging (MRI) showed that mean thigh muscle volume decreased between T(7w) and T(12m) to less than at T(o) [T(12m) - T(o) = -2.3 (SD 3.6)%, P = 0.05]. Therefore, this study confirmed the favourable effects of endurance training on the physical capacity and body composition of elderly people, but demonstrated that the training programme would have to be continued to maintain the training-related benefits (i.e. increased VO(2max) and Wdot(max)) which would otherwise be lost within 1 year. After training, m(b) and m(f) were found to be increased. Furthermore, a fast and reproducible MRI protocol was validated for study of small intra-individual variations in tissue volumes in longitudinal studies.

Tissue segmentation on MR images of the brain by possibilistic clustering on a 3D wavelet representation

An algorithm for the segmentation of a single sequence of three-dimensional magnetic resonance (MR) images into cerebrospinal fluid, gray matter, and white matter classes is proposed. This new method is a possibilistic clustering algorithm using the fuzzy theory as frame and the wavelet coefficients of the voxels as features to be clustered. Fuzzy logic models the uncertainty and imprecision inherent in MR images of the brain, while the wavelet representation allows for both spatial and textural information. The procedure is fast, unsupervised, and totally independent of any statistical assumptions. The method is tested on a phantom image, then applied to normal and Alzheimer's brains, and finally compared with another classic brain tissue segmentation method, affording a relevant classification of voxels into the different tissue classes.

Spiral CT quantification of aorto-renal calcification and its use in the detection of atheromatous renal artery stenosis: A study in 42 patients

PURPOSE

To investigate whether a correlation exists between aortic and renal arterial calcifications detected with spiral CT and significant angiographic renal artery stenosis (RAS).

METHODS

Forty-two patients (mean age 67 years, range 37-84 years), of whom 24 were hypertensive, prospectively underwent abdominal helical CT and aortic and renal arteriography. The 3-mm thickness CT scans (pitch = 1) were reconstructed each millimeter. A manual outline of the renal artery including its ostial portion was produced. Calcific hyperdensities were defined as areas of density more than 130 HU. CT data were compared with the presence or absence of RAS on angiography (24 cases); hypertension and age were taken into account (Mann-Whitney U-test).

RESULTS

CT detection and quantification appeared to be reliable and reproducible. We did not find any correlation between aortic and renal arterial calcifications and RAS, even for the patients above 65 years, with or without hypertension. There was no correlation either between calcifications and hypertension in patients without RAS.

CONCLUSION

In this population, aortic and renal arterial calcifications have no predictive value for RAS.

Direct stereotactic MRI location in the globus pallidus for chronic stimulation in Parkinson's disease

We evaluated the direct location in the globus pallidus (GP) under stereotactic MRI (sMRI) guidance in five parkinsonians treated with chronic deep brain stimulation (four bilaterally). The sMRI consisted of three orthogonal (horizontal, frontal, sagittal) sets of images obtained with a stereotactic frame and its localiser. The sMRI was coupled with ventriculography to compare the location with the classic indirect method based on commissural landmarks. The target was defined on T2-weighted slices in the anterior part of the medial GP, at the vertex of the nucleus. It was reached via one track with a semi-micro-electrode and step by step high frequency stimulation, then replaced by a quadripolar electrode once we located the site enabling the optimal clinical improvement. Stereotactic x-rays localised the final position of the electrode. A company software matched sMRI, ventriculography, and peroperative (perop) x-rays, with reference to the stereotactic location boxes. We analysed the effects of acute (perop) and chronic (six-month follow-up) stimulation of active plots (acplots), i.e. leading to optimal clinical improvement. Three distances with reference to the acplots were measured both on sMRI and ventriculography: the laterality from the median sagittal plane of the third ventricle; the anterior position from the midpoint of the intercommissural line (Icl), and the vertical position with regard to the Icl. We then compared the differences in measurements (n = 64) with the Bland and Altman method. The mean difference was 0.09 mm with 95% of the values between +/- 1 mm, but only the laterality had a statistically significant agreement (all the differences included between +/- two times the standard deviation of the mean). The acplots distances from the dorsal, ventral, and medial boundaries of GP (defined by manual surrounding on frontal and horizontal planes) were measured on sMRI. With one exception, the acplots were all included in the nucleus. The six-month acplots were located dorsally with reference to the perop ones. Clinical benefit at six-months follow-up showed results comparable to the literature. Direct location of GP target based on sMRI seems a simple and reliable method.

MRI-SPECT fusion for the synthesis of high resolution 3D functional brain images: a preliminary study

Medical imaging being a fast-expanding field, multimodal data fusion appears more and more as a key element for the optimal use of images. By fusion, we mean the combination of several information sources (in particular images), with the aim of providing either more condensed or more pertinent information. The long term scope of this work would be to improve the interpretation of 3D brain images, providing extra elements for the diagnosis and patient follow up. This preliminary study is part of a wider context: the medical follow up of patients suffering from probable Alzheimer disease observed in single photon emission tomography by fusion after registration with magnetic resonance images. Several information combination techniques based on the possibility theory are presented. A new operator, more specifically adapted to the fusion of anatomical and functional images, as well as a high resolution functional image synthesis technique are proposed. A first comparative study of fusion techniques is then proposed. Although no thorough test protocol has been defined, these preliminary results are encouraging, giving access to a wide field of potential clinical applications.

Proteolipoprotein gene analysis in 82 patients with sporadic Pelizaeus-Merzbacher Disease: duplications, the major cause of the disease, originate more frequently in male germ cells, but point mutations do not. The Clinical European Network on Brain Dysmyelinating Disease

Pelizaeus-Merzbacher Disease (PMD) is an X-linked developmental defect of myelination affecting the central nervous system and segregating with the proteolipoprotein (PLP) locus. Investigating 82 strictly selected sporadic cases of PMD, we found PLP mutations in 77%; complete PLP-gene duplications were the most frequent abnormality (62%), whereas point mutations in coding or splice-site regions of the gene were involved less frequently (38%). We analyzed the maternal status of 56 cases to determine the origin of both types of PLP mutation, since this is relevant to genetic counseling. In the 22 point mutations, 68% of mothers were heterozygous for the mutation, a value identical to the two-thirds of carrier mothers that would be expected if there were an equal mutation rate in male and female germ cells. In sharp contrast, among the 34 duplicated cases, 91% of mothers were carriers, a value significantly (chi2=9. 20, P<.01) in favor of a male bias, with an estimation of the male/female mutation frequency (k) of 9.3. Moreover, we observed the occurrence of de novo mutations between parental and grandparental generations in 17 three-generation families, which allowed a direct estimation of the k value (k=11). Again, a significant male mutation imbalance was observed only for the duplications. The mechanism responsible for this strong male bias in the duplications may involve an unequal sister chromatid exchange, since two deletion events, responsible for mild clinical manifestations, have been reported in PLP-related diseases.

[Hepatocellular carcinoma in cirrhosis: semeiology and performance of magnetic resonance imaging and lipiodol computed tomography]

OBJECTIVES

a) Describe hepatocellular semiology in magnetic resonance imaging and lipiodol computerized tomography in patients with cirrhosis, who are candidates for surgery; b) Clarify the respective roles of magnetic resonance imaging and lipiodol computerized tomography in hepatocellular detection.

METHODS

Twenty four patients with suspected hepatocellular carcinoma underwent successive magnetic resonance imaging and lipiodol computerized tomography. Thirty-four of the 67 lesions seen by lipiodol computerized tomography and 28 of 52 lesions seen by magnetic resonance imaging were confirmed histologically.

RESULTS

In lipiodol computerized tomography, 44% of hepatocellular carcinomas had a dense and homogeneous pattern; 24% had a homogeneous but slightly dense pattern. Sixteen distinct deposits were described: 4 were confirmed as hepatocellular carcinoma and 12 were not controlled histologically. In magnetic resonance imaging 57% of hepatocellular carcinomas have a high intensity on T1 and T2 weighted spin echo images, 38% were hyperintense on T2 and hypo or isointense on T1 weighted images. Eighty-six percent of hyperintense T1 and T2 weighted images were hepatocellular carcinoma. When the gold standard was histology, lipiodol computerized tomography sensitivity (81%) was higher than magnetic resonance imaging (68%). When the gold standard was lipiodol computerized tomography, the sensitivity of magnetic resonance imaging was 47 +/- 12%.

CONCLUSIONS

a) The sensitivity of lipiodol computerized tomography was better than resonance magnetic imaging; b) the homogeneous and slightly dense pattern corresponded to a hepatocellular carcinoma in 50% of cases; c) on magnetic resonance imaging any lesions with high intensity on T1 and T2 spin echo images strongly suggests hepatocellular carcinoma; d) if surgical resection after ultrasonography is being considered, the second step should be an magnetic resonance imaging.

[Influence of alleles of apolipoprotein E on restenosis after coronary angioplasty in women]

Although coronary stenting reduces the incidence of post-angioplasty restenosis, it remains a problem. The influence of lipoproteins on the development of atherosclerosis has been demonstrated but their role in restenosis is controversial. Contradictory results have been published on the subject of the influence of the APO E genotype. In an initial study, the authors showed a closer correlation between Lp (a) and coronary artery disease in women than in men. A sub-group of women who underwent angioplasty and whose lipid profile had been well established, was analysed with respect to APO E alleles. The 59 patients who underwent angioplasty included 35 single, 20 twin and 4 triple vessel diseases. Control coronary angiography was performed in 40 of these women. A telephonic interview was carried out between 12 and 22 months after dilatation on the whole population. The apolipoproteins A1, B, Lp (a) and Lp A1 were measured by immunological, turbidimetric or electroimmunological techniques. The APO E genotyping was performed with the Inno-Lipa kit. The results showed 18 angiographic restenoses (Group A), 20 coronary artery disease without restenosis (Group B), 41 without angiographic (20) or clinical (21) restenosis (Group C). In Group A, the Lp (a) was well above the threshold value of 0.30 g/l. The e4 allele was associated with the highest values of total and LDL cholesterol fractions. There was no significant difference between the APO E genotype of the different groups or with respect to the severity of lesions. The authors conclude that if the e4 is more commonly associated with high LDL-cholesterol and Lp (a), its role in the process of restenosis remains unproven. A greater number of patients is required and further studies are desirable to determine the inflammatory and/or immunological mechanisms through which APO E could influence restenosis.

Assessment of stenosis severity using a novel method to estimate spatial and temporal variations of blood flow velocity in biplane coronarography

The authors present a novel method to estimate absolute blood flow velocity in coronary arteries from biplane angiograms. Spatial and temporal velocity variations are derived giving simultaneously a direct geometric and an indirect functional index of stenosis severity, stenosis ratio and coronary flow reserve. No prior assumption concerning stenosis geometry is made. Deformable models are used to track a coronary artery segment dynamically in three dimensions. A densitometric map is obtained by summing densities across sections at every position along the previously calculated path and at every time of the cardiac cycle. An advection relationship between density and velocity is observed. The spatiotemporal velocity map is a solution of a nonlinear least-squares scheme. A simulation protocol based on simple geometric conformations and blood flow properties is used to assess numerical stability and immunity towards noise. Predicted results for temporal velocity variations are compared with the intracoronary Doppler recordings to test the model assumptions for basal state and hyperaemia examinations of the same patient. The stenosis ratio was accurate to within 3% for a simulated additive Gaussian noise with a standard deviation of 0.14. The limits of agreement between angiographic and Doppler velocities were -11.4 and 11.8 cm s-1 for a peak value of 23 cm s-1 (basal state) and -16.8 and 13.5 cm s-1 for a peak value of 52 cm s-1 (hyperaemia), corresponding to 18 and 3.5% errors on the average peak values and a 16% error on the coronary flow reserve. To summarize, the advection model derivation and its solution are presented. Simulated and experimental results corroborate the validity of the numerical schemes and support clinical applicability.

A novel tool for rapid prototyping and development of simple 3D medical image processing applications on PCs

A 32-bit PC-based 3D medical image processing software package is presented. Its basic functions are the display and manipulation of medical images and the inclusion of user-written processing routines in C language. This software runs on inexpensive hardware and is easy to learn. It means the current needs of many research teams working in medical image processing.

Application of textural features to the detection of ocular melanomas in scintigraphy

A method for automated detection of ocular melanoma in scintigraphic images is described. The algorithm first performs an automatic segmentation of the eyes on specific reference images. The images of the eyes are then analyzed using textural parameters computed in several directions and averaged to damp directional information. Assuming that only one eye per patient will be pathological, the ratio of the textural parameters of the two eyes is computed. A statistical analysis is performed over these ratios to select the most highly discriminating textural parameters and detect the pathological patients. The method has been tested successfully on a population of 23 individuals and we found significant differences between pathological and normal patients.

T2 maximum likelihood estimation from multiple spin-echo magnitude images

An optimal maximum likelihood (ML) method is described for an unbiased estimation of monoexponential T2 from magnitude spin-echo images. The algorithm is based on a Gaussian assumption of noise distribution. The validity of this assumption was checked by a statistical chi 2 test on spin-echo and fast low-angle shot surface coil images. Monte-Carlo simulations of magnitude data showed that the ML estimate standard deviation is lower than that produced by a weighted least-squares fitting on signal logarithm. Correction schemes are proposed to reduce bias deriving from magnitude reconstruction. The variance of the ML estimate converged rapidly toward the theoretical algebraic expression of the Cramér-Rao lower bound.

Monitoring sodium methohexital distribution with [99mTc]HMPAO with single photon emission computed tomography during Wada test

Twenty-five consecutive patients being considered for surgery for intractable epilepsy had intracarotid sodium methohexital procedures (ISM) as part of their evaluation. The lipophilic brain SPECT agent, [99mTc]hexamethylpropylene aminoxime (HMPAO), was administered intravenously during the procedure to determine the intracerebral distribution of methohexital. The validity of the ISM depends on consistent delivery of the anesthetizing agent to one hemisphere, including the mesial structures of the temporal lobe. To prevent postoperative language and memory deficits, correct interpretation of the test results supposes a reliable knowledge of which regions of the brain have been anesthetized. Currently, no absolute criteria allow determination of the level and topographical extent of the anesthesia. We compared results of HMPAO-SPECT with clinical and EEG video-monitoring data and with results of digital subtraction angiography (DSA) performed during the test. In all patients, the effect of SM was ipsilateral cerebral hypoperfusion on SPECT and crossed cerebellar diaschisis. The distribution of HMPAO varied from patient to patient. The delivery of SM to mesial temporal lobe structures was not constant. Using nonparametric tests, we demonstrated a statistically significant relationship between hypoperfusion on SPECT and duration of hemiplegia but not with the duration of aphasia. Hypoperfusion on SPECT was also related to the onset and duration of drug-induced delta activity on EEG. SPECT showed a statistically different distribution of SM in the brain from that predicted with DSA. We present our experience with HMPAO-SPECT use for mapping the distribution of methohexital's effects during the ISM (Wada test). We confirm the results of previous studies that SPECT assessment may be an excellent way of determining the distribution of barbiturate during the examination. It increases confidence in interpreting results of speech and memory testing by detecting either contralateral diffusion of the drug due to crossflow between hemispheres or insufficient quantitative delivery to the homolateral hemisphere.

Synthesis, radiolabeling, and preliminary evaluation in mice of some (N-diethylaminoethyl)-4-iodobenzamide derivatives as melanoma imaging agents

N-(2-Diethylaminoethyl)-4-iodobenzamide (BZA) is a radiopharmaceutical recently developed in our laboratory for the scintigraphic detection of melanoma and metastases. Optimal time for imaging was between 18-24 h p.i. of [123I] BZA. With a view to selecting compounds able to provide quality images shortly after the injection, synthesis of an initial series of BZA derivatives and their evaluation in B16 melanoma bearing mice have been carried out. The [125I] radiolabeled products were obtained by a simple isotopic exchange procedure with high radiochemical yields (85-95%). After i.v. administration of the compounds we observed a good tumoral targeting ability. Tumoral activity peaked at 2.6 to 7.70% injected dose per g within 1 h post-injection. One of the benzamides with a blood clearance faster than that of BZA--0.06 vs. 0.2% I D/g--6 h p.i. gave the same tumor to blood and to organ ratios as BZA at 12-18 h p.i. Based on these preclinical data we hope to obtain good tumoral images 6 h p.i. in scintigraphic studies in man.

A computer software for frequential analysis of slow intracranial pressure waves

A microcomputer program to analyse ICP signal in the frequential domain is described. It allows the detection and quantification of especially slow pressure waves (A, B, and C). 212 ICP data recordings were analysed with our software, and gave pertinent frequential informations. The status report and lessons learned are discussed.

3D modeling in myocardial 201TL SPECT

A method to model the left ventricular myocardium in thallium-201 Single Photon Emission Computed Tomography (SPECT) is presented. This method is based on the fitting of the morphological skeleton of the left ventricle to a truncated bullet. This automatic approach would provide a more reproducible visualization of the organ for clinical applications.

Reinjection as an alternative to rest imaging for detection of exercise-induced ischemia with thallium-201 emission tomography

Exercise thallium-201 single photon emission computed tomography images were compared prospectively with 4-hour redistribution images, with 4-hour reinjection images, and with images obtained at rest on a separate day in 37 patients with documented coronary artery disease. Exercise images were abnormal in 35 patients (95%). On the basis of an improvement in thallium-201 distribution between exercise and nonexercise images, overall sensitivity for the detection of coronary artery stenosis was significantly higher with reinjection at 4 hours (p < 0.05) or with a rest injection on a separate day (p < 0.05) than with redistribution imaging (84%, 83%, and 70%, respectively). Reinjection and rest injection were positive more frequently in patients with a wall-motion abnormality (76% and 80%, respectively, vs 64% at redistribution; p < 0.05 for both) or with > 90% stenosis (77% and 76%, respectively, vs 58% at redistribution; p < 0.05 for both). Among the 11 patients who had no evidence of redistribution at 4 hours, five (45%) demonstrated ischemia with reinjection and five demonstrated ischemia in the separate rest study; a total of seven patients showed improvement either at reinjection or rest. Among these 86% had a wall-motion abnormality associated with stenosis of > 90%, whereas in the other 30 patients these two conditions were observed concomitantly in only 43%. This study demonstrates that the thallium-201 4-hour postexercise reinjection technique is as sensitive as the 2-day rest/exercise method for the detection of coronary artery stenosis and provides additional information when a severe stenosis is associated with a wall-motion abnormality.

Automatic detection of the left ventricular myocardium long axis and center in thallium-201 single photon emission computed tomography

A new method for centering and reorienting automatically the left ventricle in thallium-201 myocardial single photon emission computed tomography (SPET) is proposed. The processing involves the following steps: (a) the transverse sections of the left ventricle are segmented, (b) the three-dimensional skeleton of the left ventricle is extracted using tools of mathematical morphology, (c) the skeleton is fitted to a quadratic surface by the least-squares method, (d) the left ventricle is reoriented and centered using the long axis and the coordinates of the centre of the quadratic surface. A series of 30 consecutive exercise and redistribution 201Tl SPET studies were centered and reoriented by two operators twice with this method, and twice manually. There was no significant difference in the mean realignment performed by the automatic and the manual methods while centering differed moderately in some instances. In all cases and for all parameters, the reproducibility of the automatic method was 1.00, while it ranged between 0.74 and 0.98 with the manual centering and reorientation. This automatic approach provides a fast and highly reproducible method for the reconstruction of short- and long-axis sections of the left ventricle in 201Tl SPET.

Comparison between thallium-201 and technetium-99m methoxyisobutyl isonitrile defect size in single-photon emission computed tomography at rest, exercise and redistribution in coronary artery disease

Defect size on myocardial tomograms was measured in 30 patients who underwent 2 separate studies, 1 with thallium-201 (TI-201), the other with technetium-99m-methoxyisobutyl isonitrile (MIBI). A group of 15 patients with myocardial infarction was studied at rest and received both tracers on the same day. The other 15 patients had documented coronary artery disease. They were were given injections of TI-201 at peak exercise and underwent imaging immediately after exercise and again 4 hours later. They then received a dose of MIBI for imaging at rest. A week later they underwent a second exercise test with the same work load and received a second dose of MIBI. Defect size on single-photon emission computed tomographic images was measured and repeated twice. Results were expressed in percentage of the volume of the whole myocardium. Reproducibility of the defect size measurement was high for TI-201 (r = 0.978; SEE = 1.59) as well as for MIBI (r = 0.981; SEE = 0.80). In patients with coronary artery disease the mean size of the defects was significantly larger with TI-201 than with MIBI at exercise (6.7 +/- 5.2 vs 4.6 +/- 5.2%, respectively, p less than 0.05) and at redistribution (5.1 +/- 4.4 vs 2.8 +/- 3.2%, respectively, p less than 0.05), where no difference was seen in patients with myocardial infarction studied only at rest (11.2 +/- 10.4 vs 12.0 +/- 11.5%, respectively, p = not significant). Smaller MIBI defect sizes, when compared with TI-201, in the exercise and redistribution studies were not due to technical artefacts since there was no difference when they were compared at rest.

Synthesis and evaluation of new iodine-125 radiopharmaceuticals as potential tracers for malignant melanoma

The synthesis, labeling, and biodistribution of four 125I radiopharmaceuticals designed to localize in melanoma were tested. Uptake in tumors was demonstrated by autoradiography of whole-body sections and quantitated by measurement of radioactivity of selected tissues and tumors using melanoma-bearing mice. N-(2-diethylaminoethyl)-4-iodobenzamide was selected for its highest melanoma uptake: 60 min after IV injection of 6.5% and 4% ID/g, respectively for murine B16 and human melanotic melanoma. Tumor uptake showed the highest values of all analyzed tissues from 6 to 24 hr after injection. High uptake in melanotic tumor tissue with relatively low uptake in blood, muscle, brain, lung, and liver tissue resulted in high tumor/nontumor ratios (at 24 hr for B16, tumor/blood = 37, tumor/brain = 147, tumor/muscle = 95). This agent was compared with iodoamphetamine. Scintigraphic images of the tumor confirmed that external detection of melanoma is possible with this new radiopharmaceutical.

Diffusion of the retinal layers of the living human eye

We measured the modulation depth of an interference pattern after double passage through the eye with different entry positions of the linearly polarized incident beam in the pupil plane. This shifting of the incident beam greatly modifies the mean irradiance and the modulation depth of the aerial image, whatever the direction of the polarizer. These measurements give a better understanding of the respective contributions of the retinal layers to the formation of the aerial image. Consequently, the modulation transfer function of the optics of the eye deduced from measurements with the aerial image must be considered cautiously.