P4601Reduced exercise capacity and clinical outcomes following acute myocardial infarction

Background

Reduced exercise capacity is known to be an important predictor of poor prognosis and disability in patients with cardiovascular diseases and chronic heart failure, and even members of the general population. However, data about exercise capacity assessed by cardiopulmonary exercise testing (CPX) in acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) is scarce. The purpose of this study is to assess the associated factors and clinical influence of exercise capacity measured by CPX in AMI patients.

Methods

Among 594 consecutive AMI patients who underwent primary PCI, we examined 136 patients (85.3% men, 64.9±11.9 years) who underwent CPX during hospitalization for AMI. CPX was usually performed five days after the onset of AMI. Reduced exercise capacity was defined as peak oxygen consumption (peak VO2) ≤12. Clinical outcomes including all-cause death, myocardial infarction, and hospitalization due to heart failure were followed.

Results

Among 136 patients, reduced exercise capacity (peak VO2 ≤12) was seen in 38 patients (28%). Patients with reduced exercise capacity were older, more likely to have hypertension, and had lower renal function. In echocardiography, patients with reduced exercise capacity had higher E/e' and larger left atria. Median follow-up term was 12 months (interquartile range: 9–22). The occurrence of composite endpoints of all-cause death, myocardial infarction, and hospitalization due to heart failure was significantly higher in patients with peak VO2≤12 than those with peak VO2>12 (p<0.001). Multivariate logistic analysis showed that E/e' (Odds ratio, 1.19, 95%, confidence interval 1.09 to 1.31, p<0.001) was an independent predictor of reduced exercise capacity (peak VO2≤12).

Cumulative incidence of clinical events

Conclusion

Diastolic dysfunction is associated with reduced exercise capacity following successful primary PCI in AMI patients and may lead to poorer clinical outcomes.

[Basic Investigation of a Cerebral Blood Flow Quantification Method without Blood Sampling Method (Improved Brain Uptake Ratio (IBUR)) Using a Fan-beam Collimator]

We performed a basic evaluation for measuring the input function using a fan-beam collimator. Furthermore, we examined the validity of the brain blood flow quantitative measurement from the input function. Using the fanbeam collimator, we imaged syringes of various diameters containing ^{99 m}Tc as well as a virtual aorta inside a thoracic phantom. We changed the collimator distance and angle in relation to the sources, and the syringe was placed in vertical and horizontal positions as well. For evaluation, we used region of interest (ROI) of various sizes and positions. Furthermore, we conducted clinical evaluation for 19 subjects and calculated whole-brain mean cerebral blood flow using improved brain uptake ratio method by examination of ^{99 m}Tc-ECD cerebral blood flow. For ROIs smaller in size than diameter of the syringes and virtual ascending aorta, amount of change in the ROI counts by fan-beam collimator became smaller as distance to the source became closer, with less than 5% at 175 mm. Also, change with respect to angle of the collimator was less than 5% at 20°. In a clinical study, aortas could be imaged without truncation and input-functions could be measured in all 19 patients. By using ROIs smaller than the aorta diameter and placing the collimator close to the source, it was suggested that fan-beam collimator can be used to determine the input function.

Initial evaluation of the Celesteion large-bore PET/CT scanner in accordance with the NEMA NU2-2012 standard and the Japanese guideline for oncology FDG PET/CT data acquisition protocol version 2.0

Background

The goal of this study was to evaluate the performance of the Celesteion positron emission tomography/computed tomography (PET/CT) scanner, which is characterized by a large-bore and time-of-flight (TOF) function, in accordance with the NEMA NU-2 2012 standard and version 2.0 of the Japanese guideline for oncology fluorodeoxyglucose PET/CT data acquisition protocol. Spatial resolution, sensitivity, count rate characteristic, scatter fraction, energy resolution, TOF timing resolution, and image quality were evaluated according to the NEMA NU-2 2012 standard. Phantom experiments were performed using ¹⁸F-solution and an IEC body phantom of the type described in the NEMA NU-2 2012 standard. The minimum scanning time required for the detection of a 10-mm hot sphere with a 4:1 target-to-background ratio, the phantom noise equivalent count (NEC_phantom), % background variability (N_10mm), % contrast (Q_H,10mm), and recovery coefficient (RC) were calculated according to the Japanese guideline.

Results

The measured spatial resolution ranged from 4.5- to 5-mm full width at half maximum (FWHM). The sensitivity and scatter fraction were 3.8 cps/kBq and 37.3%, respectively. The peak noise-equivalent count rate was 70 kcps in the presence of 29.6 kBq mL⁻¹ in the phantom. The system energy resolution was 12.4% and the TOF timing resolution was 411 ps at FWHM. Minimum scanning times of 2, 7, 6, and 2 min per bed position, respectively, are recommended for visual score, noise-equivalent count (NEC)_phantom, N_10mm, and the Q_H,10mm to N_10mm ratio (QNR) by the Japanese guideline. The RC of a 10-mm-diameter sphere was 0.49, which exceeded the minimum recommended value.

Conclusions

The Celesteion large-bore PET/CT system had low sensitivity and NEC, but good spatial and time resolution when compared to other PET/CT scanners. The QNR met the recommended values of the Japanese guideline even at 2 min. The Celesteion is therefore thought to provide acceptable image quality with 2 min/bed position acquisition, which is the most common scan protocol in Japan.

[Cardiac surgery for renal failure patients;operative and postoperative management]

Chronic kidney disease( CKD) is defined as one of the major risk factors affecting postoperative morbidity and mortality after cardiovascular surgery, and CKD accounts for approximately 9.2~13.7% of the patients undergoing cardiovascular surgery in Japan according to the reports from Japan Adult Cardiovascular Surgery Database (JACVSD). The recent concept on renal dysfunction, recent discussions on the choice of operative procedures[ off-pump coronary artery bypass grafting( CABG)[OPCAB] vs on-pump CABG, bioprosthesis vs mechanical valve prosthesis] and peri-operative managements( electrolyte control, pharmacological management) are also introduced in the text.

[Evaluation of commercial resolution recovery techniques in four state-of-the-art single photon emission computed tomography systems using a digital phantom model]

PURPOSE

This study aims to evaluate the fundamental performance of four leading advanced resolution recovery methods.

METHOD

To evaluate the performance of the resolution recovery algorithm, we carried out the computer simulation with the cone/sphere digital phantoms. These phantoms were used to investigate the basic properties of those algorithms. The software of four packages (advance) were also tested, specifically Astonish(TM) (AST), Evolution(TM) (EVL), Flash-3D(TM) (FL3), and 3D-OSEM (3DOS). The performance was evaluated in the collimator systems (LEHR) reconstruction conditions using the full width at half maxi am (FWHM), aspect ratio (ASR), and artifacts of conical part.

RESULT

In the "without BG," FWHM of the advance method indicated a true-FWHM with SI (subset×iteration)=20, 40. As SI increased, FWHM was composed with over estimate. Each advances of FWHM indicated only 5% of improvement as compared with reference FWHM in the "with BG." The ASR increased 20% to AST, FL3, and ASR of 3DOS remained in 10% in the outside. As for the reproducibility of the conical part, an artifact was caused by the FL3, EVL, and AST methods. This artifact did not occur in 3DOS.

DISCUSSIONS

An SI needs more than 150 to obtain an accurate compensation effect. As for the advance method, the major compensation effect was not demonstrated very much as compared with the OS-EM. The EVL, FL3, and AST overestimated values due to a Gibb's oscillation in the artifacts of the conical part.

A 3-dimensional mathematic cylinder phantom for the evaluation of the fundamental performance of SPECT

Degradation of SPECT images results from various physical factors. The primary aim of this study was the development of a digital phantom for use in the characterization of factors that contribute to image degradation in clinical SPECT studies.

METHODS

A 3-dimensional mathematic cylinder (3D-MAC) phantom was devised and developed. The phantom (200 mm in diameter and 200 mm long) comprised 3 imbedded stacks of five 30-mm-long cylinders (diameters, 4, 10, 20, 40, and 60 mm). In simulations, the 3 stacks and the background were assigned radioisotope concentrations and attenuation coefficients. SPECT projection datasets that included Compton scattering effects, photoelectric effects, and gamma-camera models were generated using the electron gamma-shower Monte Carlo simulation program. Collimator parameters, detector resolution, total photons acquired, number of projections acquired, and radius of rotation were varied in simulations. The projection data were formatted in Digital Imaging and Communications in Medicine (DICOM) and imported to and reconstructed using commercial reconstruction software on clinical SPECT workstations.

RESULTS

Using the 3D-MAC phantom, we validated that contrast depended on size of region of interest (ROI) and was overestimated when the ROI was small. The low-energy general-purpose collimator caused a greater partial-volume effect than did the low-energy high-resolution collimator, and contrast in the cold region was higher using the filtered backprojection algorithm than using the ordered-subset expectation maximization algorithm in the SPECT images. We used imported DICOM projection data and reconstructed these data using vendor software; in addition, we validated reconstructed images.

CONCLUSION

The devised and developed 3D-MAC SPECT phantom is useful for the characterization of various physical factors, contrasts, partial-volume effects, reconstruction algorithms, and such, that contribute to image degradation in clinical SPECT studies.

Vascular allografts are resistant to methicillin-resistant Staphylococcus aureus through indoleamine 2,3-dioxygenase in a murine model

OBJECTIVE

Surgical results have shown the superiority of human heart valve and vascular allografts over artificial prostheses when used for the treatment of infectious cardiovascular diseases. However, the mechanism of infection resistance in these allografts has not been determined. In this study the contribution of the inflammatory response after allogeneic transplantation to the antimicrobial mechanism was assessed, focusing on the induction of indoleamine 2,3-dioxygenase, a tryptophan-metabolizing enzyme.

METHODS

Aortic transplantation was performed with inbred rats, and aortic allografts, isografts, and control grafts were obtained for the following analyses. The extent of inflammatory-related and indoleamine 2,3-dioxygenase gene expression was measured by means of quantitative reverse transcriptase-polymerase chain reaction, and tryptophan metabolite production in the graft was measured by means of liquid chromatographic/tandem mass spectrometric analysis. The bacteriostatic effect of each graft and tryptophan metabolites was determined by using the methicillin-resistant Staphylococcus aureus proliferation assay.

RESULTS

The inflammatory response, including interferon gamma, tumor necrosis factor alpha, and indoleamine 2,3-dioxygenase gene expression, was significant in the allografts but minimal in the isografts and control grafts. Methicillin-resistant S. aureus proliferation was remarkably suppressed when cultured with the allografts but not with the control grafts. Among tryptophan metabolites, the bacteriostatic effect against methicillin-resistant S. aureus was remarkable with 3-hydroxykynurenine, with a minimum inhibitory concentration of 32 mg/L. The 3-hydroxykynurenine level in the allografts was 9-fold greater than that in the control grafts.

CONCLUSION

The bacteriostatic effect of the allografts was acquired by inducing indoleamine 2,3-dioxygenase, which resulted in local production of 3-hydroxykynurenine as an antimicrobial agent. This is the first report to document a mechanism of the allograft's infection-resistant property against methicillin-resistant S. aureus growth.

Development of a collimator blurring compensation method using fine angular sampling projection data in SPECT

Due to the collimator aperture, spatial resolution of SPECT data varies with source-to-detector distance. Since the radius of detector rotation is bigger when scanning larger patients, spatial resolution is degraded in these cases. Emitted gamma rays travel not only along the central axis of the collimator hole but also off-axis due to the collimator aperture. However, an off-axis ray at one angle would be a central-axis ray at another angle; therefore, raw projection data at one angle can be thought of as an ensemble of central-axis rays collected from a small arc equal to the collimator aperture. Thus, fine angular sampling can compensate for collimator blurring. By using a sampling pitch of less than half the collimator aperture angle, compensation was performed by subtracting the weighted sum of the projection data from the raw projection data. Collimator geometry and detector rotation radius determined the weighting function. Cylindrical phantom with four different-sized rods and torso phantom for Tl-201 cardiac SPECT simulation were used for evaluation. Aperture angle of the collimator was 7 degrees. Projection sampling pitch was 2 degrees. In both phantom studies, the proposed method showed improvement in contrast and reduction of partial volume effect, thereby indicating that the proposed method can compensate adequately for image blurring caused by the collimator aperture.

Evaluating performance of a pixel array semiconductor SPECT system for small animal imaging

OBJECTIVES

Small animal imaging has recently been focused on basic nuclear medicine. We have designed and built a small animal SPECT imaging system using a semiconductor camera and a newly designed collimator. We assess the performance of this system for small object imaging.

METHODS

We employed an MGC 1500 (Acrorad Co.) camera including a CdTe semiconductor. The pixel size was 1.4 mm/pixel. We designed and produced a parallel-hole collimator with 20-mm hole length. Our SPECT system consisted of a semiconductor camera with the subject holder set on an electric rotating stage controlled by a computer. We compared this system with a conventional small animal SPECT system comprising a SPECT-2000H scanner with four Anger type cameras and pinhole collimators. The count rate linearity for estimation of the scatter was evaluated for a pie-chart phantom containing different concentrations of 99mTc. We measured the FWHM of the 99mTc SPECT line source along with scatter. The system volume sensitivity was examined using a flood source phantom which was 35 mm long with a 32-mm inside diameter. Additionally, an in vivo myocardial perfusion SPECT study was performed with a rat.

RESULTS

With regards to energy resolution, the semiconductor camera (5.6%) was superior to the conventional Anger type camera (9.8%). In the count rate linearity evaluation, the regression lines of the SPECT values were y = 0.019x + 0.031 (r2 = 0.999) for our system and y = 0.018x + 0.060 (r2 = 0.997) for the conventional system. Thus, the scatter count using the semiconductor camera was less than that using the conventional camera. FWHMs of our system and the conventional system were 2.9 +/- 0.1 and 2.0 +/- 0.1 mm, respectively. Moreover, the system volume sensitivity of our system [0.51 kcps/(MBq/ ml)/cm] was superior to that of the conventional system [0.44 kcps/(MBq/ml)/cm]. Our system provided clear images of the rat myocardium, sufficient for practical use in small animal imaging.

CONCLUSIONS

Our SPECT system, utilizing a semiconductor camera, permits high quantitative analysis by virtue of its low scatter radiation and high sensitivity. Therefore, this system may contribute to molecular imaging of small animals and basic medical research.

[Effectiveness of deep breath-hold SPECT in torso area: examination concerning improvement of resolution]

Because SPECT images are acquired under normal respiration, the respiratory motion induces artifacts and decreases resolution. In this study we developed a novel method of acquiring SPECT data during deep inhalation breath-hold (BrST) and assessed its efficacy in reducing motion artifacts and improving resolution. Reproducibility studies found that variations in SPECT image homogeneity were reduced using the BrST method to within a clinically non-problematic range. An experiment using a custom-built respiration phantom showed almost complete elimination of motion artifacts and significant improvement in resolution using the BrST method. Clinical assessment confirmed a significant reduction in motion artifacts along with the improvement in resolution. The BrST method enabled visualization of lesions that previously had been impossible to detect by standard acquisition under normal respiration. The BrST method is expected to both significantly reduce motion artifacts and improve resolution.

Attenuation correction using combination of a parallel hole collimator and an uncollimated non-uniform line array source

Attenuation correction is very important for quantitative SPECT imaging. We designed an uncollimated non-uniform line array source (non-uniform LAS) for attenuation correction based on transmission computed tomography (TCT) using Tc-99m and compared its performance with an uncollimated uniform line array source (uniform LAS) in a thorax phantom study. This non-uniform LAS was attached to one camera head of a dual-head gamma camera, and transmission data were acquired with another camera head with a low-energy, general purpose, parallel-hole collimator at 50 cm-distance apart from the source. The modified TEW using a subtraction factor of 1.0 was employed to correct scattered Tc-99m photons for transmission data. In the phantom experiment, eight TCT data were acquired with the scanning time changed from 2 minutes to 20 minutes for each LAS. The Tc-99m attenuation coefficient (mu) maps with the non-uniform LAS and uniform LAS improved the statistical count variation in the mediastinum filled with water as the scanning time got longer. The Tc-99m mu-map with the non-uniform LAS and 6 minutes of scanning time had equal quality at the center of the thorax phantom to that with the uniform LAS and 16 minutes of scanning time. In conclusion, for the TCT imaging with combination of the parallel hole collimator and uncollimated Tc-99m external source the non-uniform LAS can reduce the Tc-99m radioactivity or the TCT scanning time compared with the uniform LAS.

Attenuation correction using asymmetric fanbeam transmission CT on two-head SPECT system

For transmission computed tomography (TCT) systems using a centered transmission source with a fan-beam collimator, the transmission projection data are truncated. To achieve sufficiently large imaging field of view (FOV), we have designed the combination of an asymmetric fan-beam (AsF) collimator and a small uncollimated sheet-source for TCT, and implemented AsF sampling on a two-head SPECT system. The purpose of this study is to evaluate the feasibility of our TCT method for quantitative emission computed tomography (ECT) in clinical application. Sequential Tc-99m transmission and Tl-201 emission data acquisition were performed in a cardiac phantom (30 cm in width) with a myocardial chamber and a patient study. Tc-99m of 185 MBq was used as the transmission source. Both the ECT and TCT images were reconstructed with the filtered back-projection method after scatter correction with the triple energy window (TEW) method. The attenuation corrected transaxial images were iteratively reconstructed with the Chang algorithm utilizing the attenuation coefficient map computed from the TCT data. In this AsF sampling geometry, an imaging FOV of 50 cm was yielded. The attenuated regions appeared normal on the scatter and attenuation corrected (SAC) images in the phantom and patient study. The good quantitative accuracy on the SAC images was also confirmed by the measurement of the Tl-201 radioactivity in the myocardial chamber in the phantom study. The AsF collimation geometry that we have proposed in this study makes it easy to realize TCT data acquisition on the two-head SPECT system and to perform quantification on Tl-201 myocardial SPECT.

Truncation correction of fan beam transmission data for attenuation correction using parallel beam emission data on a 3-detector SPECT system

BACKGROUND

When the simultaneous transmission computed tomography (TCT)/single photon emission CT (SPECT) acquisition protocol is applied to myocardial studies using a 3-detector SPECT, the narrow effective field of view of a fan beam collimator used for TCT acquisition may cause truncation artifacts on TCT images. In this paper, we propose a new method of correcting for the truncation of TCT.

METHODS

The truncated parts of the TCT projection data are corrected using quadratic functions, based on the properties that the integral of non-truncated TCT projection data is constant at any projection angle and the position of the centre of gravity is focused on a fixed point. The usefulness of our method was investigated in phantom and human studies using a 3-detector SPECT equipped with one cardiac fan beam collimator for TCT and two parallel beam collimators for SPECT. We used Tl as a tracer for SPECT and Tc as an external source for TCT.

RESULTS

The phantom and human studies showed that our method can adequately correct for the truncation of TCT data acquired using a fan beam collimator in a 3-detector SPECT, as long as there is no truncation in SPECT data.

CONCLUSION

Our method appears to be useful for improving the SPECT images obtained using simultaneous TCT/SPECT acquisition in a 3-detector SPECT. However, further studies will be necessary to establish the clinical usefulness of this method.

Accurate scatter correction for transmission computed tomography using an uncollimated line array source

We investigated scatter correction in transmission computed tomography (TCT) imaging by the combination of an uncollimated transmission source and a parallel-hole collimator. We employed the triple energy window (TEW) as the scatter correction and found that the conventional TEW method, which is accurate in emission computed tomography (ECT) imaging, needs some modification in TCT imaging based on our phantom studies. In this study a Tc-99m uncollimated line array source (area: 55 cm x 40 cm) was attached to one camera head of a dual-head gamma camera as a transmission source, and TCT data were acquired with a low-energy, general purpose (LEGP), parallel-hole collimator equipped on the other camera head. The energy spectra for 140 keV-photons transmitted through various attenuating material thicknesses were measured and analyzed for scatter fraction. The results of the energy spectra showed that the photons transmitted had an energy distribution that constructs a scatter peak within the 140 keV-photopeak energy window. In TCT imaging with a cylindrical water phantom, the conventional TEW method with triangle estimates (subtraction factor, K = 0.5) was not sufficient for accurate scatter correction (micro = 0.131 cm(-1) for water), whereas the modified TEW method with K = 1.0 gave the accurate attenuation coefficient of 0.153 cm(-1) for water. For the TCT imaging with the combination of the uncollimated Tc-99m line array source and parallel hole collimator, the modified TEW method with K = 1.0 gives the accurate TCT data for quantitative SPECT imaging in comparison with the conventional TEW method with K = 0.5.

Attenuation correction of myocardial SPECT images with X-ray CT: effects of registration errors between X-ray CT and SPECT

PURPOSE

Attenuation correction with an X-ray CT image is a new method to correct attenuation on SPECT imaging, but the effect of the registration errors between CT and SPECT images is unclear. In this study, we investigated the effects of the registration errors on myocardial SPECT, analyzing data from a phantom and a human volunteer.

METHODS

Registerion (fusion) of the X-ray CT and SPECT images was done with standard packaged software in three dimensional fashion, by using linked transaxial, coronal and sagittal images. In the phantom study, an X-ray CT image was shifted 1 to 3 pixels on the x, y and z axes, and rotated 6 degrees clockwise. Attenuation correction maps generated from each misaligned X-ray CT image were used to reconstruct misaligned SPECT images of the phantom filled with 201Tl. In a human volunteer, X-ray CT was acquired in different conditions (during inspiration vs. expiration). CT values were transferred to an attenuation constant by using straight lines; an attenuation constant of 0/cm in the air (CT value = -1,000 HU) and that of 0.150/cm in water (CT value = 0 HU). For comparison, attenuation correction with transmission CT (TCT) data and an external gamma-ray source (99mTc) was also applied to reconstruct SPECT images.

RESULTS

Simulated breast attenuation with a breast attachment, and inferior wall attenuation were properly corrected by means of the attenuation correction map generated from X-ray CT. As pixel shift increased, deviation of the SPECT images increased in misaligned images in the phantom study. In the human study, SPECT images were affected by the scan conditions of the X-ray CT.

CONCLUSION

Attenuation correction of myocardial SPECT with an X-ray CT image is a simple and potentially beneficial method for clinical use, but accurate registration of the X-ray CT to SPECT image is essential for satisfactory attenuation correction.

Reduction of mental stress with lavender odorant

The effect of the lavender odorant on a Japanese version of Cox and Mackay's stress/arousal adjective checklist for three groups was studied. One group of 14 was placed into a (2 x 2- x 3 m) sound protected room for 20 min without the presentation of an odor, an analogous group of 15 received the odor oil, and one group of 13 received a nonstressful condition. Analysis suggested that lavender odorants were associated with reduced mental stress and increased arousal rate.

The CdTe detector module and its imaging performance

In recent years investigations into the application of semiconductor detector technology in gamma cameras have become active world-wide. The reason for this burst of activity is the expectation that the semiconductor-based gamma camera would outperform the conventional Anger-type gamma camera with a large scintillator and photomultipliers. Nevertheless, to date, it cannot be said that this expectation has been met.

METHODS

While most of the studies have used CZT (Cadmium Zinc Telluride) as the semiconductor material, we designed and fabricated an experimental detector module of CdTe (Cadmium Telluride). The module consists of 512 elements and its pixel pitch is 1.6 mm. We have evaluated its energy resolution, planar image performance, single photon emission computed tomography (SPECT) image performance and time resolution for coincidence detection.

RESULTS

The average energy resolution was 5.5% FWHM at 140 keV. The intrinsic spatial resolution was 1.6 mm. The quality of the phantom images, both planar and SPECT, was visually superior to that of the Anger-type gamma camera. The quantitative assessment of SPECT images showed accuracy far better than that of the Anger-type camera. The coincidence time resolution was 8.6 ns. All measurements were done at room temperature, and the polarization effect that had been the biggest concern for CdTe was not significant.

CONCLUSION

The results indicated that the semiconductor-based gamma camera is superior in performance to the Anger-type and has the possibility of being used as a positron emission computed tomography (PET) scanner.

Thoracoscopy for minimally invasive axillo-coronary artery bypass

Minimally invasive axillo-coronary artery bypass via a small thoracotomy or a limited sternotomy was performed in five patients. For this approach, videoscopy was used to determine the intrapleural path of each vein graft, which was curved by the expanded lung tissue and had the potential for kinking or distortion. Postoperative angiography confirmed the patency of each graft with no kinking or distortion. Thoracoscopy facilitates this approach, allowing appropriate placement of the vein graft in the chest cavity.

Aortic root replacement and coronary interposition using a cryopreserved allograft and its branch

This communication describes a modified aortic root replacement technique using a cryopreserved allograft consisting of the aortic conduit and its branch. This method was applied in a patient suffering from infective pseudoaneurysm which had developed after aortic root replacement using an artificial graft with a mechanical aortic valve. A piece of the innominate artery obtained from the aortic allograft was used for interposition between the fragile left coronary artery root and the main conduit of the allograft.

[Indications for and results of cryopreserved homograft valve replacement]

The cryopreserved aortic homograft valve is one of the most reliable of the stentless biological prosthesis if implanted properly. Due to the limited availability of homograft valves in Japan, the indications for their use are different from those in other countries. The first indication is active infective endocarditis in the aortic valve position, especially infection surrounding artificial implants. Another indication is for reconstruction of the right ventricular outflow tract during pulmonary autografting. Finally, aortic valve replacement in young women of childbearing age who wish become pregnant is an accepted indication. Since 1992, cryopreserved homograft valves have been used in Japan, and the number of surgeries performed with them has gradually increased. While efforts have been made to expand the homograft bank system in some areas, the supply remains insufficient. Because the demand for homografts is high, it is extremely important to establish a nationwide tissue bank system as soon as possible.

Phantom evaluation of scatter and attenuation correction in thallium-201/technetium-99m acquisition in myocardial perfusion single-photon emission computed tomography

PURPOSE

This phantom study was carried out to evaluate the usefulness of scatter correction combined with transmission-based attenuation correction in separate and simultaneous 201Tl/99mTc myocardial SPECT.

METHODS

An anthropomorphic torso phantom was used in this study. We used the triple-energy-window (TEW) method for scatter correction and transmission computed tomography (TCT) images for attenuation correction. Images without corrections (UC) and images with corrections (SAC) for scatter and attenuation were reconstructed for the evaluation.

RESULTS

The differences in defect size between 99mTc and 201Tl UC images led to interpretation errors in separate (separate protocol) and simultaneous dual-isotope studies (simultaneous protocol). These errors were more prominent in the infero-posterior wall in the simultaneous protocol. Improvement for overestimation in object size and underestimation in defect contrast was visually obtained, and increased contrast was also shown by the myocardium-to-defect count (MD) ratios on SAC images in the separate and simultaneous protocols. However, 201Tl SAC images in the simultaneous protocol still had less defect contrast than the corresponding 201Tl SAC images in the separate protocol.

CONCLUSIONS

From the results of our phantom experiment, separate rest 201Tl/stress 99mTc-sestamibi acquisitions may be recommended in clinical practice. Further clinical and phantom studies will be needed to validate the method using scatter correction combined with transmission-based attenuation correction.

Comparative study on genomes of two Japanese melon necrotic spot virus isolates

Nucleotide sequences of the genomes of two Japanese Melon necrotic spot virus (MNSV) isolates, NH and NK were determined. The open reading frames (ORFs) in both genomes encode five proteins: p29 (the pre-readthrough domain of p89), p89 (the readthrough domain of p89 identified as the putative RNA-dependent RNA polymerase), p14 (the pre-readthrough domain of p7A), p7A (the putative movement protein), and p42 (coat protein, CP). Nucleotide and amino acid sequence identities of the five proteins of NH and NK isolates were estimated at 97.4-99.5% and 97.7-100%, respectively. NK isolate but not NH isolate infected systemically leaves of Cucumis melo plants. When deduced amino acid sequences of p7A proteins of NH and NK isolates were compared, only one difference at position 16 (serine in NH isolate and isoleucine in NK isolate) was observed. p7A protein is considered the putative movement protein. The serine of p7A protein of NH isolates may be involved in systemic infection. In addition, phylogenetic relationships of genes based on nucleotide sequences revealed that NH and NK isolates might form a group, and S isolate, serologically different from NH and NK isolates, might represent a distinct isolate not belonging to this group.

[Feasibility study of SPECT quantification using CdTe semiconductor detector]

Quantification of SPECT using CdTe semiconductors as a detector head in nuclear medicine equipment was investigated. A prototype of semiconductor detectors with an effective field-of-view as small as 2.54 cm x 5.08 cm was constructed, and a cylindrical phantom containing four spherical phantoms with capacities 71, 56, 42, and 15 ml, was used. Water was placed in three of these spherical phantoms (71, 56, and 42 ml), and 8.362 MBq of 99mTc was poured into the remaining 15 ml phantom. In the outer cylindrical phantom, 925 MBq (6200 ml) of 99mTc was placed. A Toshiba LEHR (Low Energy High Resolution) collimator was attached to the semiconductor detectors, and SPECT acquisition with a rotation radius 132 mm was performed. It was found that in the data thus acquired using the semiconductor detector, the amount of scattered gamma-rays decreased by 33% as compared to data acquired using NaI(Tl) scintillators under the same condition. Moreover, when attenuation correction was applied to SPECT data from the CdTe semiconductor detector, the measurement accuracy of radioactivity improved by 16% as compared to SPECT data from NaI(Tl) scintillators with the same acquisition and post-correction conditions. Finally, the CdTe detector data with only attenuation correction was found to have almost the same grade of accuracy as NaI scintillator data with both attenuation and TEW scatter corrections.

[Feasibility study of CdTe Semiconductor detector for gamma camera--evaluation of planar images]

To evaluate the performance of a semiconductor detector for use in a gammacamera system, we assembled a detector with a small field of view--1 inch x 1 inch and 1 inch x 2 inch--made from CdTe (Cadmium telluride). We then compared the planar images and energy resolution of the resulting detectors against those of a conventional gammacamera. Pixel pitch of the detector was 1.6 mm x 1.6 mm, and was manufactured by Acrorad Corporation. Average FWHM of the energy spectrum for the semiconductor detector was 5.11% (SD: 0.80%, Best: 3.26%, Worst: 6.68%). The planar images obtained were of a letter phantom made from pieces of lead and of an IMP brain phantom. Since the field of view of the semiconductor detector was small, the image of the IMP brain phantom was acquired by moving the semiconductor over the collimated detector module until the area of the entire phantom was covered. The images from the semiconductor assembly were compared with those from a conventional gammacamera using the same conditions, and it was found that visual image quality was superior to those of the conventional camera system.

Quantitative planar imaging method for measurement of renal activity by using a conjugate-emission image and transmission data

We are proposing a method to accurately measure renal activity in renography using Tc-99m labeled tracers. This method uses a conjugate-view image and transmission data for attenuation correction, the triple energy window (TEW) method for scatter correction, and background correction techniques that consider the source volume for accurate background activity correction. To examine this method in planar imaging, we performed two renal phantom studies with various uniform background activity concentrations. One study used two ideal box-shaped kidney phantoms with a thickness of 2 or 4 cm in a water tank and the other study employed two real kidney-shaped phantoms in a fillable abdominal cavity. For these studies the kidney phantom-to-background activity concentration ratio (S) was changed from 5 to infinity. The transmission data were obtained with an external Tc-99m line array source. The anterior- and posterior-view emission images were acquired with a dual-headed gamma camera simultaneously and the TEW method was used to correct scatter for the emission and transmission images. The results showed that this method with both the accurate background correction and scatter correction could give depth-independent count rates and could estimate the true count rate with errors of less than 5% for all S values. However, if either accurate background correction or scatter correction was performed alone, the absolute error increased to about 50% for the smaller S values. Our proposed method allows one to accurately and simply measure the renal radioactivity by planar imaging using the conjugate-emission image and transmission data.

Myotonic dystrophy associated with 47 XYY syndrome

A case of myotonic dystrophy with 47 XYY presented with tall stature and mental retardation. The patient was a 37-year-old male. In addition to grip myotonia and percussion myotonia, severe weakness and atrophy were noted in the face and the neck muscles and in the distal muscles of the four limbs. He also had diabetes mellitus, cataracts and sexual behavior abnormalities. He was found to be 47 XYY from chromosomal examinations. The combination of 47 XYY syndrome and myotonic dystrophy has not been reported previously.

[Practical compensation method of downscattered component due to high energy photon in 123I imaging]

We looked into the problem that the quantitative values of 123I data vary according to collimator type. First, we made the assumption that the quantitative values of 123I data are degraded by the scattered photons from the 529 keV component which contaminate the 159 keV imaging data. Then, the 123I Dual Window (IDW) method was proposed to improve the quantitative values of the 123I data. The IDW method uses the energy window on the high-energy side to estimate the amount of scattered 529 keV photons which contaminate the 159 keV data. Since only a dual-energy window acquisition and a simple image processing are needed, the IDW method can be performed in most conventional gamma camera systems. In the torso phantom studies, the IDW method reduced the error in the semi-quantitative value 'heart/mediastinum (H/M) ratio' in 123I-MIBG myocardial scintigraphy from 22% to 1%. The results of the phantom studies indicate that the IDW method can improve the quantitative values of 123I data.

Feasibility of simultaneous stress 99mTc-sestamibi/rest 201Tl dual-isotope myocardial perfusion SPECT in the detection of coronary artery disease

This study assesses feasibility and diagnostic accuracy of simultaneous stress 99mTc-sestamibi/rest 201 TI dual-isotope myocardial perfusion SPECT with Moore's correction method, in which contamination originating from lead x-rays produced in a collimator was subtracted in the 201TI windows.

METHODS

Eighty-one patients with suspected coronary artery disease received exercise 99mTc-sestamibi injection, followed by rest 201TI injection 50 min later, and dual-isotope SPECT was performed (group 1). These results were compared with coronary angiographic findings. Furthermore, to estimate the accuracy of Moore's correction method, 201TI crosstalk into the 99mTc acquisition window (group 2A, n = 20) and 99mTc crosstalk into the 201TI acquisition windows (group 2B, n = 20) were studied. For group 2A, stress 99mTc-sestamibi SPECT (single 99mTc-sestamibi SPECT) was performed, followed by 201TI injection at rest and dual-isotope SPECT acquisition 50 min later. For group 2B, rest 201TI SPECT (single 201TI SPECT) was performed, followed by 99mTc-sestamibi injection at rest and dual-isotope SPECT acquisition 30 min later.

RESULTS

Sensitivity and specificity in group 1 were 83% and 99%, respectively, when > or =75% coronary artery narrowing was considered significant. In groups 2A and 2B, SPECT images were divided into 24 segments, and relative regional uptake in each segment was obtained. In group 2A, relative regional uptake of single 99mTc-sestamibi SPECT correlated well with that of dual-isotope SPECT (r = 0.942). In group 2B, relative regional uptake of single 201TI SPECT correlated well with that of dual-isotope SPECT (r = 0.935). Furthermore, in low 201TI uptake segments with relative regional uptake in both single- and dual-isotope SPECT of < or =70%, the degree of concordance between single- and dual-rest 201TI was considered to be high with Bland-Altman analysis and the kappa statistic. Comparison of perfusion defect type demonstrated that, of 22 stress defects within infarct zones, 95% were irreversible and 5% were reversible. In contrast, of 28 stress defects within stenosed vessel zones in noninfarct zones, 89% were reversible and 11% were irreversible (P < 0.0001 versus infarct zones).

CONCLUSION

Simultaneous dual-isotope imaging with Moore's correction method is feasible, with acceptable accuracy for detection of coronary artery disease and a small amount of crosstalk into each window.

Effects of scatter and attenuation correction on quantitative analysis of beta-CIT brain SPET

The aim of this study was to evaluate the effects of scatter correction (SC) and attenuation correction (AC) on the quantification of dopamine transporters using 123I-beta-CIT brain SPET images. Quantitative analysis was carried out using static SPET images obtained 23 h after injection. We calculated V3" [(striatal-occipital)/occipital ratio] values from images without correction, with AC, and with SC and AC. Two types of regions of interest (ROI) were placed on the striatum: a small square ROI and a larger ROI containing most of the striatum. After validating the correction method in a phantom experiment, a human study was carried out involving eight normal volunteers and 15 patients. The larger ROI yielded smaller V3" values. The effect of attenuation correction was modest, whereas that of scatter correction was marked. It was shown that beta-CIT SPET quantification was affected by the size of the ROI, photon scattering and attenuation, and that scatter and attenuation correction improved the accuracy of the quantification. Methodological standardization in image processing and the type of ROI should be considered when a multi-centre trial is planned.

Estradiol inhibits allograft-inducible major histocompatibility complex class II antigen expression and transplant arteriosclerosis in the absence of immunosuppression

BACKGROUND

The etiology of transplant arteriosclerosis is unknown, but current data point to the alloimmune response. Previously, we found that estradiol-17beta (E2) with immunosuppressant cyclosporine abolishes major histocompatibility complex (MHC) class II expression in the allograft. This study determines the effect of E2 on MHC class II antigen expression in the allograft, in the absence of immunosuppression.

METHODS

Lewis male rats received orthotopic abdominal aorta allografts from male Brown-Norway rats. The recipients were treated continuously subcutaneously with either 20 microg x kg(-1) x day1 of E2 (n=20) or placebo (n=20), from 2 days before transplantation until death on posttransplant days 1, 3, 7, and 14. The allografts were harvested and processed for morphometry and for immunohistochemical staining of MHC class II antigens, macrophages, CD4 and CD8 T lymphocytes, interferon-gamma (IFN-gamma), and IFN-gamma receptor.

RESULTS

With E2 treatment, we observed that inducible MHC class II antigen expression is abolished in the media of the vascular allograft; the expression of IFN-gamma and IFN-gamma receptor is unaffected; and macrophage infiltration of the vascular allograft is inhibited significantly (P<0.01), whereas the CD4 and CD8 T lymphocytes are not significantly (P=0.07) suppressed. The myointimal hyperplasia in the allografts from E2-treated-recipients was 3-4-fold less than that from the placebo-treated recipients.

CONCLUSIONS

Without immunosuppression, E2 inhibition of transplant arteriosclerosis is still associated with inhibition of inducible MHC class II antigen expression in the allografts. The estradiol-17beta abolition of inducible MHC class II antigen expression in the aorta allograft occurs in spite of up-regulation of IFN-gamma ligand and receptor protein.

Simultaneous acquisition of iodine-123 emission and technetium-99m transmission data for quantitative brain single-photon emission tomographic imaging

The aim of this study was to obtain quantitative iodine-123 brain single-photon emission tomographic (SPET) images with scatter and attenuation correction. We used a triple-headed SPET gamma camera system equipped with fan-beam collimators with a technetium-99m line transmission source placed at one of the focal lines of the fan-beam collimators. Four energy windows were employed for data acquisition: (a) 126-132 keV, (b) 132-143 keV, (c) 143-175 keV and (d) 175-186 keV. A simultaneous transmission-emission computed tomography scan (TCT-ECT) was carried out for a brain phantom containing 123I solution. The triple energy window scatter correction was applied to the 123I ECT data measured by means of the windows (b), (c) and (d) acquired by two detectors. Attenuation maps were reconstructed from 99mTc TCT data measured by means of the windows (a), (b) and (c) acquired by one detector. Chang's iterative attenuation correction method using the attenuation maps was applied to the 123I ECT images. In the phantom study cross-calibrated SPET values obtained with the simultaneous mode were almost equal to those obtained with the sequential mode, and they were close to the true value, within an error range of 5.5%. In the human study corrected images showed a higher grey-to-white matter count ratio and relatively higher uptake in the cerebellum, basal ganglia and thalamus than uncorrected images. We conclude that this correction method provides improved quantification and quality of SPET images and that the method is clinically practical because it requires only a single scan with a 99mTc external source.

[The compensation method for the effects of system resolution to the left ventricular volume measurements using QGS program]

We evaluated the accuracy of left ventricular volume calculations performed using the left ventricular function automatic analysis software (QGS program), which automatically extracts the left ventricular profile from ECG-gated myocardial SPECT data and then measures the left ventricular volume. We used a myocardial phantom for this evaluation. The results of our experiments showed that the left ventricular volume was underestimated by up to 13% as the SPECT spatial resolution deteriorated. To overcome this problem, we have developed a method for correcting the left ventricular volume measured by the QGS program according to the SPECT spatial resolution of the detectors. This new correction method permits the left ventricular volume of the phantom to be calculated with an error of less than 1.4%.

Premorbid psychosocial behavior in demented patients

We investigated the premorbid behavioral characters of demented patients in terms of life style, type A behavior, life events and coping behavior. We adopted the case control study. Significant differences were not found in the inventory scores of life style, passive coping behavior and type A behavior between dementia group and normal controls. However, the life events occurred significantly frequent in the vascular dementia group and the score of positive coping behavior was significantly low in dementia group. The results suggest that those life events and positive coping behavior might be related to the onset of dementia.

Exposure of vascular allografts to insulin-like growth factor-I (IGF-I) increases vascular expression of IGF-I ligand and receptor protein and accelerates arteriosclerosis in rats

BACKGROUND

Accelerated arteriosclerosis limits the survival of transplanted hearts. We hypothesized that insulin-like growth factor-I (IGF-I) is crucial in accelerating transplant arteriosclerosis. Recently, we reported that exposure to IGF-I prior to transplantation accelerates transplant arteriosclerosis in the rat aorta allograft model. Here, we studied the mechanism whereby IGF-I exposure accelerates transplant arteriosclerosis.

METHODS

The abdominal aorta was harvested from male Brown Norway rats and exposed to 0, 200, or 500 ng/ml of IGF-I at 37 degrees C for 30 min prior to transplantation to the abdominal position of male Lewis rats. The allografts were harvested 14 days later and processed for immunohistochemical staining for alpha-actin, growth factors (IGF-I, IGF-I receptor, platelet-derived growth factor-BB, and basic fibroblast growth factor), and immunological markers (major histocompatibility complex class II antigen, macrophage, and CD4- and CD8-positive T cells).

RESULTS

By 14 days, the ex vivo IGF-I donor aorta treatment with IGF-I increased in a concentration-dependent manner the expression of IGF-I and IGF-I receptor in both the intima and the adventitia. In contrast, the expression of platelet-derived growth factor-BB was decreased in a concentration-dependent manner in the intima while basic fibroblast growth factor remained unchanged. The cell-mediated immune response was not affected by IGF-I at 14 days after transplantation, which suggests that the immune events associated with acceleration of transplant arteriosclerosis may occur at an earlier time.

CONCLUSION

Acceleration of transplant arteriosclerosis by exposure to IGF-I is associated with increased IGF-I ligand and receptor expression in the allograft vascular wall. These data further suggest that IGF-I may be a major factor in mediating graft arteriosclerosis.

Application of transmission scan-based attenuation compensation to scatter-corrected thallium-201 myocardial single-photon emission tomographic images

A practical method for scatter and attenuation compensation was employed in thallium-201 myocardial single-photon emission tomography (SPET or ECT) with the triple-energy-window (TEW) technique and an iterative attenuation correction method by using a measured attenuation map. The map was reconstructed from technetium-99m transmission CT (TCT) data. A dual-headed SPET gamma camera system equipped with parallel-hole collimators was used for ECT/TCT data acquisition and a new type of external source named "sheet line source" was designed for TCT data acquisition. This sheet line source was composed of a narrow long fluoroplastic tube embedded in a rectangular acrylic board. After injection of 99mTc solution into the tube by an automatic injector, the board was attached in front of the collimator surface of one of the two detectors. After acquiring emission and transmission data separately or simultaneously, we eliminated scattered photons in the transmission and emission data with the TEW method, and reconstructed both images. Then, the effect of attenuation in the scatter-corrected ECT images was compensated with Chang's iterative method by using measured attenuation maps. Our method was validated by several phantom studies and clinical cardiac studies. The method offered improved homogeneity in distribution of myocardial activity and accurate measurements of myocardial tracer uptake. We conclude that the above correction method is feasible because a new type of 99mTc external source may not produce truncation in TCT images and is cost-effective and easy to prepare in clinical situations.

[Determination of energy window width and position for the triple energy window (TEW) scatter compensation method]

Since primary photons can provide information concerning the position of radioisotope (RI) accumulation and the energy of the photons, it would seem reasonable to vary the position and width of the energy window depending on the type of RI and the energy resolution of the detector to collect as many of the primary photons as possible. We propose a method for determining energy window width and position for scintigraphic imaging to collect as many of the primary photons as possible, and studied the influence on the Triple Energy Window (TEW) scatter compensation method of setting such energy window levels for 99mTc (single photopeak) and 201Tl (multiple photopeaks) using detector with different energy resolution through simulation. The Monte Carlo simulations were verified by comparing the regional energy spectrum at the phantom obtained from the simulation against experimental measurements. The energy window with our proposed method for 99mTc is 20% and 47.3% for 201Tl using gamma camera, and 9.8% for 99mTc using a semiconductor detector with a theorized energy resolution of 7.0 keV.