EEG, PET, SPET and MRI in intractable childhood epilepsies: possible surgical correlations.

Magnetic resonance imaging (MRI), single photon emission tomography (SPET), and positron emission tomography (PET) using [18F]fluorodeoxyglucose were used in combination with scalp and scalp-video EEGs in a group of 30 pediatric patients with drug resistant epilepsy (DRE) in order to identify patients who could benefit from neurosurgical approach. Seizures were classified according to the consensus criteria of The International League Against Epilepsy. In three patients infantile spasms (IS) were diagnosed; 13 subjects were affected by different types of generalized seizures, associated with complex partial seizures (CPS) in three. In the other 14 patients partial seizures, either simple (SPS) or complex, were present. A localized abnormality was demonstrated in one patient with IS and in three patients with generalized seizures. Of the group of 14 subjects with CPS, MRI and CT were normal in 7, but SPET or PET indicated focal hypoperfusion or hypometabolism concordant with the localization of the EEG abnormalities. In 5 of the other 7 patients anatomical and functional imaging and EEG findings were concordant for a localized abnormality. It can be concluded that functional imaging combined with scalp EEGs appears to be superior to the use of only CT and MRI for selecting children with epilepsy in whom a surgical approach can be considered, in particular when CPS resistant to therapy are present.

Verification of the integral transformation of the projections technique for scatter correction in positron tomographs.

A scatter correction algorithm, based on the integral transformation of the projections, has been implemented when using the C.N.R. positron tomograph in Pisa. The performance of the method has been evaluated by measurements on ad hoc phantoms. The technique allows a significant average reduction of the reconstructed scatter fraction. The limitations of this approach have also been investigated.

Evaluation of reconstructed scatter fraction on PET images.

This paper describes a procedure proposed for the quantitative evaluation of the influence of the scattering noise on the reconstructed PET images. Applying the same experimental procedure used to evaluate the Scatter Fraction (SF) on the sinograms obtained measuring line sources within a uniform scattering medium, the method here proposed permits the computation, after reconstruction, of a derived index of the SF i.e. the Reconstructed Scatter Fraction (RSF). This offers the advantage of providing an estimate of the scatter noise directly on the images obtained in the same processing conditions as during the in vivo human studies. Comparative data of SF and RSF are reported as well as the effect of varying the filter function and of the measured attenuation correction on the RSF. The preliminary results obtained show that the values of the reconstructed scatter fraction are closer to the SF ones when this last is computed only in the cylinder region and the RSF is computed on images reconstructed with a ramp filter.

User-friendly image processing software tools: general purpose features and application to the correlation of PET-CT brain images.

An interactive software package, performing some useful general purpose image processing operations and being used as a tool for the problem of the anatomical correlation of PET brain images, is under development. The software is developed as a comprehensive tool with a graphic user-interface allowing the display of the processed images through the use of a variety of colormaps. The implemented routines perform a lot of processing operations on the images: a) Local image processing, i.e. smoothing and sharpening, contours extraction, interactive expansion, shrinking and thresholding of the gray scale, histogram equalization. b) ROI handling, i.e., ROI drawing and computing, transformation of an image to a ROI, ROI editing. c) Additional operators include frequency space image processing such as FFT.

Simultaneous in vitro and in vivo validation of nitrogen-13-ammonia for the assessment of regional myocardial blood flow.

Measurement of myocardial blood flow by 13NH3 relies heavily on the assessment of both the input function and the variable tissue extraction fraction. In six open-chest dogs, myocardial and arterial 13NH3 activity was measured both by in vitro sampling and by in vivo positron emission tomography (PET). Regional myocardial blood flow was forced to vary in the range 0.2-5 ml/min/g and actual values were assessed by in vitro counting of 153Gd microspheres. The ammonia input function was processed by: (a) total curve integration; (b) curve integration for 2 min; (c) integral of a fitted curve (gamma variate in vivo and exponential of the downslope in vitro). Method C brought to regional flow values which best approximated microspheres data. The in vitro correlation allows for correcting in vivo values for the flow-dependent extraction fraction. The method can be easily applied for regional myocardial blood flow measurements with PET in human studies.

Assessment of the scatter fraction evaluation methodology using Monte Carlo simulation techniques.

To evaluate scatter fraction and scatter pair spatial distribution, experimental methods are generally used. These methods make use of a line source, placed along the FOV axis, inserted in a cylindrical phantom filled with air or water. The accuracy of these experimental methodologies can be tested by the use of a Monte Carlo method. In fact, the simulation allows the shape of the scatter event projection and the scatter fraction to be defined. An example of this application is the simulation package PETSI (PET SImulation). In this paper the comparison between the predicted scatter fraction and the experimentally evaluated one, obtained using an ECAT III PT 911/02 double ring whole body scanner are presented. PETSI permits additional data to be obtained: a) the true and scatter component of the energy spectrum; b) the spatial distribution, in the FOV plane, of the detected scatter events at different energy thresholds; c) the scatter to total detected events ratio; d) the predicted scatter fraction at both energy thresholds and FOV diameters. This information is very useful for optimizing both energy threshold and FOV size and to improve the accuracy of the currently used methods for the scatter fraction evaluation. Preliminary results of the predicted scatter fraction in a uniform phantom are presented.

Measurement of resolution and recovery in recent generation positron tomographs.

In positron tomographic images, the ability to differentiate closely lying structures, the spillover of activity from a region into adjacent regions and the reduction in apparent isotope concentration in small structures are all dependent on spatial resolution. Resolution in the reconstructed image is affected by (i) detector size, (ii) the spatial sampling used (e.g. stationary, wobble), (iii) the amount of smoothing in the reconstruction process (or subsequent to reconstruction) and (iv) the image pixel size. Under ideal conditions, modern commercial tomographs can produce a reconstructed spatial resolution of 5 mm or less. However, this is rarely realizable in a clinical study due to the inadequacy of counting statistics and the amplification of statistical noise. In practice, a smoother filter has to be used. This paper presents a summary of practical measurements of spatial resolution, and the related count recovery, performed on recent generation positron tomographs. It is intended to contribute to the definition of methods of measuring these parameters which is part of an on going concerted action in positron tomography supported by the European Commission.

Performance characteristics of a whole-body positron tomograph.

This paper describes an investigation of some of the important physical characteristics of a whole-body positron tomograph consisting of two rings of bismuth germanate detectors of dimensions 5.6 mm X 30 mm X 30 mm (512/ring). The resolution applicable to in vivo imaging is six mm or more, depending on radionuclide and reconstruction filter and is very uniform over the field of view normally used. Axial resolution can be varied by moving side collimation (maximum approximately 16 mm FWHM with interplane septa). A simple scheme has been devised to correct for loss of true coincidence events with varying count rate based on the total random and multiple coincidence rates. It is concluded that correction for scattered radiation should be implemented for reliable quantitation.

A critical review of Compton imaging.

This paper reviews the basic aspects, problems, and applications of Compton imaging including those related to nonmedical applications. The physics and technology at the base of this specific methodology are analyzed and the relative differences and merits with respect to other imaging techniques, using ionizing radiations, are reviewed. The basic Compton imaging approaches, i.e., point-by-point, line-by-line, and plane-by-plane, are analyzed. Specifically, physical design and technological aspects are reviewed and discussed. Furthermore, the most important clinical applications of the different methods are presented and discussed. Finally, possibilities and applications of the Compton imaging method to other nonmedical fields, as in the case of the important area of object defects recognition, are analyzed and reviewed.

Arterial blood pressure and the renin-angiotensin-aldosterone system during postural changes in hypertensive patients with unilateral renal mobility.

Unilateral renal mobility was identified in 27 out of 100 essential hypertensive patients by examination of renal scintiphotos. The pattern of response to postural changes of blood pressure (BP), plasma renin activity (PRA) and plasma aldosterone concentration (PAC) was investigated in 11 patients with renal mobility and without treatment and compared with that of an age- and sex-matched group of untreated hypertensives without renal mobility. The patients with renal mobility had higher BP levels (X +/- SD mm Hg: supine 185 +/- 39/112 +/- 18 vs. 149 +/- 18/97 +/- 14; upright 167 +/- 38/108 +/- 17 vs. 144 +/- 7/93 +/- 10; p less than 0.05). Significant correlations were obtained in the patients with renal mobility (but not in those without renal mobility) between upright PRA and PAC (p less than 0.001), their postural variations (p less than 0.01) and between upright PRA (and PAC) and BP levels (p less than 0.05). The high prevalence of renal mobility in hypertension and the relationship observed between the activated renin-angiotensin-aldosterone system and BP in this condition suggest the importance of searching for unilateral renal mobility when examining the renin-angiotensin-aldosterone system in hypertensive patients, particularly during postural manoeuvres.

An electronic "diaphragm" for the gamma camera, with adjustable zooming and offset.

We describe a new device for data acquisition from a gamma camera using an electronic spatial "diaphragm," with variable offset and zooming. The device, mainly applied to cardiac studies, permits selection of the desired part of the field of vision to be digitized and to zoom, before the computer acquisition. The spatial diaphragm spans 0.4-0.9 of the diameter of the FOV, and the amplification factor from 1.1 to 2.5.