Relationships of Bone Mineral Density to Whole Body Mass, Fat Mass and Fat-free Mass in Long-term Survivors of Acute Lymphoblastic Leukemia in Childhood.

Body size influences bone mineral density (BMD) in health. Relationships of BMD with body mass index, fat mass (FM), fat-free mass, and appendicular lean mass were explored in acute lymphoblastic leukemia (ALL) survivors (n=75; 41 males; 45 standard risk ALL) >10 years from diagnosis. Dual energy radiograph absorptiometry performed body composition analysis. Relationships were assessed by regression analyses and Pearson correlation coefficients (r). Twenty subjects (26.3%) were osteopenic; lumbar spine (LS) BMD Z score <-1.00. Age at diagnosis, sex, ALL risk-category, type of post-induction steroid or cranial radiation did not correlate with LS or whole body (WB) BMD. Body mass index correlated significantly with LS BMD (r=0.333, P=0.004) and WB BMD (r=0.271, P=0.033). FM index (FM/height²) Z score showed no significant correlation with LS or WB BMD. Fat-free mass index Z score correlated strongly with LS BMD (r=0.386, P=0.013) and WB BMD (r=0.605, P<0.001) in males but not in females. The appendicular lean mass index, a surrogate for skeletal muscle mass, correlated significantly with LS BMD (r=0.367, P=0.018) and WB BMD (r=0.604, P<0.001) in males but not in females. Future studies to evaluate interventions to enhance BMD focused on improving body composition particularly skeletal muscle mass are warranted.

Body composition in long-term survivors of acute lymphoblastic leukemia diagnosed in childhood and adolescence: A focus on sarcopenic obesity.

BACKGROUND: The late effects of treatment for acute lymphoblastic leukemia (ALL) include disordered body composition, especially obesity. Less attention has been focused on the loss of skeletal muscle mass (SMM) and the combined morbidity of sarcopenic obesity. METHODS: A cross-sectional study of body composition was undertaken via dual-energy x-ray absorptiometry in 75 long-term survivors of ALL (more than 10 years after the diagnosis). Measures were obtained of the fat mass (FM), fat-free mass (equivalent to the lean body mass [LBM]), and whole-body bone mineral content. Health-related quality of life (HRQL) was measured with the Health Utilities Index. RESULTS: The sum of the FM, LBM, and whole-body bone mineral content matched the total body weight measured directly (r = 0.998). The appendicular lean mass (ALM) was derived from the LBM in all 4 limbs and accounted for approximately 75% of the SMM. According to the fat mass index (FMI; ie, FM/height2 ), 12% of females and 18% of males were frankly obese by World Health Organization criteria. The median FMI z score was + 0.40, whereas the median z score for the appendicular lean mass index (ALMI; ie, ALM/height2 ) was -0.40. Sarcopenic obesity, defined as a positive FMI z score with a negative ALMI z score, was present in 32 subjects (43%). There were statistically significant and clinically important differences in overall HRQL between subjects with and without sarcopenic obesity. CONCLUSIONS: Sarcopenic obesity is prevalent in long-term survivors of ALL, and this places them in double jeopardy from excess body fat and inadequate SMM (eg, a combination of metabolic and frailty syndromes). It is associated with an adverse impact on overall HRQL. Cancer 2018;124:1225-31. © 2017 American Cancer Society.

A Kernel Density Estimator-Based Maximum A Posteriori Image Reconstruction Method for Dynamic Emission Tomography Imaging.

A novel maximum a posteriori (MAP) method for dynamic single-photon emission computed tomography image reconstruction is proposed. The prior probability is modeled as a multivariate kernel density estimator (KDE), effectively modeling the prior probability non-parametrically, with the aim of reducing the effects of artifacts arising from inconsistencies in projection measurements in low-count regimes where projections are dominated by noise. The proposed prior spatially and temporally limits the variation of time-activity functions (TAFs) and attracts similar TAFs together. The similarity between TAFs is determined by the spatial and range scaling parameters of the KDE-like prior. The resulting iterative image reconstruction method is evaluated using two simulated phantoms, namely the extended cardiac-torso (XCAT) heart phantom and a simulated Mini-Deluxe Phantom. The phantoms were chosen to observe the effects of the proposed prior on the TAFs based on the vicinity and abutments of regions with different activities. Our results show the effectiveness of the proposed iterative reconstruction method, especially in low-count regimes, which provides better uniformity within each region of activity, significant reduction of spatiotemporal variations caused by noise, and sharper separation between different regions of activity than expectation maximization and an MAP method employing a more traditional Gibbs prior.

A standardized infrared imaging technique that specifically detects UCP1-mediated thermogenesis in vivo.

The activation and expansion of brown adipose tissue (BAT) has emerged as a promising strategy to counter obesity and the metabolic syndrome by increasing energy expenditure. The subsequent testing and validation of novel agents that augment BAT necessitates accurate pre-clinical measurements in rodents regarding the capacity for BAT-derived thermogenesis. We present a novel method to measure BAT thermogenesis using infrared imaging following ß3-adrenoreceptor stimulation in mice. We show that the increased body surface temperature observed using this method is due solely to uncoupling protein-1 (UCP1)-mediated thermogenesis and that this technique is able to discern differences in BAT activity in mice acclimated to 23 °C or thermoneutrality (30 °C). These findings represent the first standardized method utilizing infrared imaging to specifically detect UCP1 activity in vivo.

Correlative single photon emission computed tomography imaging of [123I]altropane binding in the rat model of Parkinson's.

INTRODUCTION: This study used the dopamine transporter (DAT) probe, [(123)I]-2ß-carbomethoxy-3ß-(4-fluorophenyl)-N-(3-iodo-E-allyl)nortropane ([(123)I]altropane), to assess the DAT levels in the 6-hydroxydopamine rat model of Parkinson's disease. We sought to assess if the right to left [(123)I]altropane striatal ratios correlated with dopamine content in the striatum and substantia nigra and with behavioural outcomes. METHODS: [(123)I]altropane images taken pre- and postlesion were acquired before and after the transplantation of neural stem/progenitor cells. The images obtained using [(123)I]altropane and single photon emission computed tomography (SPECT) were compared with specific behavioural tests and the dopamine content assessed by high-performance liquid chromatography. RESULTS: [(123)I]altropane binding correlated with the content of dopamine in the striatum; however, [(123)I]altropane binding did not correlate with the dopamine content in the substantia nigra. There was a significant correlation of altropane ratios with the cylinder test and the postural instability test, but not with amphetamine rotations. The low coefficient of determination (r(2)) for these correlations indicated that [(123)I]altropane SPECT was not a good predictor of behavioural outcomes. CONCLUSION: Our data reveal that [(123)I]altropane predicts the integrity of the striatal dopamine nerve terminals, but does not predict the integrity of the nigrostriatal system. [(123)I]altropane could be a useful marker to measure dopamine content in cell replacement therapies; however, it would not be able to evaluate outcomes for neuroprotective strategies.

Isostructural fluorescent and radioactive probes for monitoring neural stem and progenitor cell transplants.

A construct for tagging neurospheres and monitoring cell transplantations was developed using a new technology for producing luminescent and radiolabeled probes that have identical structures. The HIV1-Tat basic domain derivatives NAcGRKKRRQRRR(SAACQ)G (SAACQ-1) and [NAcGRKKRRQRRR(Re(CO)3SAACQ)G]+ (ReSAACQ-1) were prepared in excellent yields using the single amino acid chelate-quinoline (SAACQ) ligand and its Re(I) complex and conventional automated peptide synthesis methods. The distribution of the luminescent Re probe, using epifluorescence microscopy, showed that it localized primarily in the cell nucleus with a significant degree of association on the nuclear envelope. A smaller amount was found to be dispersed in the cytoplasm. The 99m Tc analogue was then prepared in 43+/-7% (n=12) yield and very high effective specific activity. Following incubation, average uptake of the probe in neurospheres ranged between 10 and 20 Bq/cell. As determined by colorimetric assays, viability for cells labeled with high effective specific activity 99m TcSAACQ-1 was 97+/-4% at 2 h postlabeling and 85+/-25% at 24 h postlabeling for incubation activities ranging from 245 to 8900 Bq/cell. DNA analysis showed that at these levels, there was no significant difference between the extent of DNA damage in the treated cells versus control cells. A series of preliminary SPECT/CT studies of transplants in mice were performed, which showed that the strategy is convenient and feasible and that it is possible to routinely assess procedures noninvasively and determine the number of cells transplanted.

Accelerated SPECT Monte Carlo Simulation Using Multiple Projection Sampling and Convolution-Based Forced Detection.

Monte Carlo (MC) is a well-utilized tool for simulating photon transport in single photon emission computed tomography (SPECT) due to its ability to accurately model physical processes of photon transport. As a consequence of this accuracy, it suffers from a relatively low detection efficiency and long computation time. One technique used to improve the speed of MC modeling is the effective and well-established variance reduction technique (VRT) known as forced detection (FD). With this method, photons are followed as they traverse the object under study but are then forced to travel in the direction of the detector surface, whereby they are detected at a single detector location. Another method, called convolution-based forced detection (CFD), is based on the fundamental idea of FD with the exception that detected photons are detected at multiple detector locations and determined with a distance-dependent blurring kernel. In order to further increase the speed of MC, a method named multiple projection convolution-based forced detection (MP-CFD) is presented. Rather than forcing photons to hit a single detector, the MP-CFD method follows the photon transport through the object but then, at each scatter site, forces the photon to interact with a number of detectors at a variety of angles surrounding the object. This way, it is possible to simulate all the projection images of a SPECT simulation in parallel, rather than as independent projections. The result of this is vastly improved simulation time as much of the computation load of simulating photon transport through the object is done only once for all projection angles.The results of the proposed MP-CFD method agrees well with the experimental data in measurements of point spread function (PSF), producing a correlation coefficient (r(2)) of 0.99 compared to experimental data. The speed of MP-CFD is shown to be about 60 times faster than a regular forced detection MC program with similar results.

Convolution-Based Forced Detection Monte Carlo Simulation Incorporating Septal Penetration Modeling.

In SPECT imaging, photon transport effects such as scatter, attenuation and septal penetration can negatively affect the quality of the reconstructed image and the accuracy of quantitation estimation. As such, it is useful to model these effects as carefully as possible during the image reconstruction process. Many of these effects can be included in Monte Carlo (MC) based image reconstruction using convolution-based forced detection (CFD). With CFD Monte Carlo (CFD-MC), often only the geometric response of the collimator is modeled, thereby making the assumption that the collimator materials are thick enough to completely absorb photons. However, in order to retain high collimator sensitivity and high spatial resolution, it is required that the septa be as thin as possible, thus resulting in a significant amount of septal penetration for high energy radionuclides. A method for modeling the effects of both collimator septal penetration and geometric response using ray tracing (RT) techniques has been performed and included into a CFD-MC program. Two look-up tables are pre-calculated based on the specific collimator parameters and radionuclides, and subsequently incorporated into the SIMIND MC program. One table consists of the cumulative septal thickness between any point on the collimator and the center location of the collimator. The other table presents the resultant collimator response for a point source at different distances from the collimator and for various energies. A series of RT simulations have been compared to experimental data for different radionuclides and collimators. Results of the RT technique matches experimental data of collimator response very well, producing correlation coefficients higher than 0.995. Reasonable values of the parameters in the lookup table and computation speed are discussed in order to achieve high accuracy while using minimal storage space for the look-up tables. In order to achieve noise-free projection images from MC, it is seen that the inclusion of the RT implementation for septal penetration increases the speed of the simulation by a factor of about 7,500 compared to the conventional SIMIND MC program.

Simultaneous assessment of cardiac perfusion and function using 5-dimensional imaging with Tc-99m teboroxime.

BACKGROUND: Dynamic single photon emission computed tomography (SPECT) acquisition and reconstruction of early poststress technetium 99m teboroxime washout images has been shown to be useful in the detection of coronary disease. Assessment of poststress regional wall motion may offer additional use in assessing coronary disease. Our goal was to investigate the feasibility of simultaneously imaging myocardial ischemia and transient poststress akinesis using gated-dynamic SPECT. METHODS AND RESULTS: A gated-dynamic mathematical cardiac torso (MCAT) phantom was developed to model both teboroxime kinetics and cardiac regional wall motion. A lesion was simulated as having delayed poststress teboroxime washout together with a transient poststress wall motion abnormality. Gated projection data were created to represent a 3-headed SPECT system undergoing a total rotation of 480 degrees . The dynamic expectation-maximization reconstruction algorithm with postsmoothing across gating intervals by Wiener filtering, and the ordered-subset expectation maximization reconstruction algorithm with 3-point smoothing across gating intervals were compared. Compared with the ordered-subset expectation maximization with 3-point smoothing, the dynamic expectation-maximization algorithm with Wiener filtering was able to produce visually higher-quality images and more accurate left ventricular ejection fraction estimates. CONCLUSION: From simulations, we conclude that changing cardiac function and tracer localization possibly can be assessed by using a gated-dynamic acquisition protocol combined with a 5-dimensional reconstruction strategy.

Assessment of scatter compensation strategies for (67)Ga SPECT using numerical observers and human LROC studies.

UNLABELLED: 67Ga citrate is an oncologic SPECT imaging agent often used to diagnose or stage patients with non-Hodgkin's lymphoma. As (67)Ga decay involves the emission of multiple-energy gamma-rays, significant photon downscatter will be present within each photopeak energy window. We have previously shown that the inclusion of these scattered photons significantly degrades lesion detectability. The goal of this study was to investigate the extent to which this decrease in detectability can be reversed by applying scatter compensation strategies. METHODS: We have compared 5 different scatter compensation methods to the case of no scatter compensation in iterative SPECT image reconstruction. The strategies consisted of (a). perfect scatter rejection, (b). ideal scatter compensation, (c). triple-energy window (TEW) scatter estimation, (d). effective scatter source estimation (ESSE), and (e). postreconstruction scatter subtraction. Reconstruction parameters used for each method were first optimized using a channelized Hotelling numerical observer. Strategies were then ranked in terms of lesion detectability using a human observer localization receiver operating characteristic (LROC) study. An additional comparison was made comparing the human LROC rankings with a recently developed channelized nonprewhitening (CNPW) LROC numerical observer. RESULTS: Using the area-under-the-LROC-curve (A(LROC)) as the assessment criterion, our results indicate that the TEW and ESSE scatter compensation methods are able to significantly improve lesion detectability over no compensation (A(LROC) = 0.75 and 0.73 vs. 0.67, respectively). However, these compensations failed to achieve the same detectability as perfect scatter rejection (A(LROC) = 0.84). Both ideal scatter compensation and postreconstruction scatter subtraction resulted in numerical increases in detection accuracy that were not statistically significant from no scatter compensation. Good agreement is seen between the CNPW observer and human LROC studies (Spearman rank order coefficient, r(s) = 0.74), thus indicating that the LROC observer may be a good predictor of human observer performance in (67)Ga SPECT. CONCLUSION: Scatter compensation in (67)Ga SPECT imaging using techniques such as TEW or ESSE is able to improve lesion detectability compared with no scatter compensation. A recently developed numerical observer model appears to be a good predictor of human observer performance and may be used to perform imaging optimizations, thereby reducing the need for human LROC studies.