Effects of blood ΔR2* non-linearity on absolute perfusion quantification using DSC-MRI: comparison with Xe-133 SPECT.

PURPOSE: To evaluate whether a non-linear blood ΔR2*-versus-concentration relationship improves quantitative cerebral blood flow (CBF) estimates obtained by dynamic susceptibility contrast (DSC) MRI in a comparison with Xe-133 SPECT CBF in healthy volunteers. MATERIAL AND METHODS: Linear as well as non-linear relationships between ΔR2* and contrast agent concentration in blood were applied to the arterial input function (AIF) and the venous output function (VOF) from DSC-MRI. To reduce partial volume effects in the AIF, the arterial time integral was rescaled using a corrected VOF scheme. RESULTS: Under the assumption of proportionality between the two modalities, the relationship CBF(MRI)=0.58CBF(SPECT) (r=0.64) was observed using the linear relationship and CBF(MRI)=0.51CBF(SPECT) (r=0.71) using the non-linear relationship. DISCUSSION: A smaller ratio of the VOF time integral to the AIF time integral and a somewhat better correlation between global DSC-MRI and Xe-133 SPECT CBF estimates were observed using the non-linear relationship. The results did not, however, confirm the superiority of one model over the other, potentially because realistic AIF signal data may well originate from a combination of blood and surrounding tissue.

Subcutaneous adipose tissue metabolism and pharmacology: a new investigative technique.

According to the Fick principle, any metabolic or hormonal exchange through a given tissue depends on the product of blood flow by arteriovenous difference. Because adipose tissue plays dual storage and endocrine roles, regulation of adipose tissue blood flow (ATBF) is of pivotal importance. Monitoring ATBF in humans can be achieved through different methodologies, such as the (133)Xe washout technique, considered to be the "gold standard", as well as microdialysis and other methods that are not well validated as of yet. This report describes a new method, called "adipose tissue microinfusion" or "ATM", which simultaneously quantifies ATBF by combining the (133)Xe washout technique together with variations of ATBF induced by local infusion of vasoactive agents. The most appropriate site for ATM investigation is the subcutaneous adipose tissue of the anterior abdominal wall. This innovative method conveniently enables the direct comparison of the effects on ATBF of any vasoactive compound, drug, or hormone against a contralateral saline control. The ATM method improves the accuracy and feasibility of physiological and pharmacological studies on the regulation of ATBF in vivo in humans.

Intravenous adrenaline infusion causes vasoconstriction close to an intramuscular microdialysis catheter in humans.

AIM: To test if a small muscle injury influences the vascular reactivity to adrenaline in human skeletal muscle. METHODS: Blood flow was measured by ¹³³Xenon clearance in the gastrocnemius muscle of eight male subjects at basal and during i.v. infusion of adrenaline (0.1 nmol kg⁻¹ min⁻¹) or placebo. Measurements were done with (expts 2 and 3) or without (expt 1) the influence of a small muscle injury induced by inserting a microdialysis catheter. ¹³³Xenon was administered either (expt 1) conventionally into the muscle via a fine needle, or (expts 2 and 3) through a fine tube close to the inserted microdialysis catheter. Expt 3 (control expt) was identical to expt 2 except that placebo was infused instead of adrenaline. Mean ± SEM, n= 8. RESULTS: The blood flow tended to increase during the adrenaline infusion in expt 1 (1.17 ± 0.10 to 1.39 ± 0.15, N.S.), whereas it decreased during the adrenaline infusion in expt 2, from 1.39 ± 0.14 to 1.03 ± 0.14 ml min⁻¹ 100 g tissue⁻¹ (P<0.001). The blood flow change in response to adrenaline infusion was significantly different in expt 1 and expt 2 (P<0.05). Blood flow also decreased during the placebo infusion in expt 3 (1.15 ± 0.10 to 1.00 ± 0.09, P<0.01), but this decrease was significantly smaller than in response to the adrenaline infusion in expt 2, P<0.01. CONCLUSION: The present results are consistent with the hypothesis that the small muscle injury caused by the inserted microdialysis catheter influences the vascular reactivity to adrenaline in a vasoconstrictive direction.

Assessment of mean transit time in the engrafted lung with 133Xe lung ventilation scintigraphy improves diagnosis of bronchiolitis obliterans syndrome in living-donor lobar lung transplant recipients.

OBJECTIVE: Staging of bronchiolitis obliterans syndrome (BOS) following lung transplantation is based on declines in forced expiratory volume in 1 s (FEV(1)). The aim of this study was to evaluate the usefulness of (133)Xe ventilation scintigraphy in the early detection of BOS following living-donor lobar lung transplantation (LDLLT), to compare (133)Xe washout imaging with computed tomography (CT) findings for early detection of BOS following LDLLT, and to evaluate (133)Xe washout imaging by quantitative analyses. METHODS: Subjects comprised 30 double-lung recipients and 1 single-lung recipient, who had undergone LDLLT at our institution and survived more than 1 year. Clinically diagnosed BOS developed in six recipients. Declines in graft function were evaluated using a combination of three methods, namely, dynamic spirometry, high-resolution CT (HRCT), and (133)Xe ventilation scintigraphy. Findings for all transplanted lungs were compared between CT and (133)Xe washout imaging. (133)Xe washout imaging was assessed using mean transit time (MTT) of bi-and unilateral lungs. Correlations between MTT of bilateral lungs and FEV(1)% were evaluated. Differences in MTT between BOS and non-BOS lungs, and between non-BOS and donor lungs were also evaluated on unilateral lungs. Appropriate cut-off values of MTT of unilateral lungs were set for the diagnosis of BOS. RESULTS: In all six BOS cases, prolonged-washout images of engrafted lungs revealed early-phase BOS with declines from baseline FEV(1), whereas only one BOS case could be detected using early CT findings of BO (bronchodilatation, decrease in number and size of pulmonary vessels, thickening of septal lines, and volume reduction). A significant correlation was identified between MTT and FEV(1)% (r = -0.346, P < 0.0001). MTT of unilateral lungs was significantly longer in BOS lungs than in non-BOS lungs (P < 0.0001). The cut-off MTT of unilateral lungs for the diagnosis of BOS was set at 64.77 s. CONCLUSIONS: Our data show that (133)Xe washout imaging offers excellent potential for early detection of BOS compared with early CT findings. Using (133)Xe washout imaging and MTT with radioactive tracer offers a noninvasive indication of selective ventilatory function in engrafted lungs following LDLLT. MTT appears useful for identifying BOS following LDLLT and allows quantitative evaluation of graft function in unilateral lungs.

How to get 133Xe into solution for blood flow studies: a technical note with an emphasis on neurosurgical patients.

OBJECTIVE: 133Xe has been widely used for measuring blood flow in various organs. Because an injectable solution of 133Xe is not commercially available, a technique is presented that allows both the production of the radiopharmaceutical and the drawing of individualized patient doses. METHOD: A system was designed to crush ampoules of 133Xe gas inside a sealed cylinder containing sodium chloride injection 0.9%. RESULTS: 133Xe ampoules of different sizes and filled with different activities were crushed within the system. The steel cylinder shielded 98% of the radiation. With 34 GBq 133Xe a total of 20 studies of cerebral blood flow were performed. No bacteriological contamination of the drawn doses was detected. CONCLUSION: The crusher system allows the efficient and safe production of an injectable solution of 133Xe with sodium chloride 0.9%.

Characterization of 133Xe gas washout in pulmonary emphysema with dynamic 133Xe SPECT functional images.

PURPOSE: To characterize regional ventilation impairment of pulmonary emphysema using dynamic 133Xe single photon emission computed tomography (SPECT) functional images, compared with other forms of chronic obstructive pulmonary disease (COPD). METHODS: Dynamic 133Xe SPECT was performed in 34 patients with emphysema and 15 patients with other forms of COPD. Three-dimensional voxel-based functional images of the half-clearance time (T1/2) mainly reflecting the initial rapid washout of 133Xe gas from the large airways, and of the mean transit time (MTT) reflecting 133Xe gas washout from the entire lungs, including the small airways and alveoli, were created based on an area-over-height method. T1/2 and MTT values were compared with the regional extent of low attenuation areas (%LAA) on density-mask computed tomography images and the diffusing capacity of the lungs for carbon monoxide (DLCO). RESULTS: The MTT/T1/2 ratio in each lung in emphysema was significantly higher than that in other forms of COPD (1.60+/-0.74 vs. 1.21+/-0.26; P<0.01). In the selected unilateral lungs with similar T1/2 values, MTT values were also significantly higher in emphysema. MTT values in each lung showed a significantly closer correlation with the corresponding %LAA values compared with T1/2 values in emphysema (R=0.698, P<0.0001 vs. R=0.338, P<0.01; P<0.05); while only the T1/2 values showed a significant correlation in other forms of COPD (P<0.0001). In correlation with DLCO, MTT values showed a significantly closer correlation compared with T1/2 values in emphysema (R=0.909, P<0.0001 vs. R=0.555, P<0.001; P<0.05); while either value did not show a significant correlation in other forms of COPD. CONCLUSION: MTT values are more critically affected in emphysema compared with other forms of COPD without significant alveolar destruction, and MTT and T1/2 values appear to be differently correlated with the regional extent of LAA between these two disorders. Direct comparison of regional T1/2 and MTT values on functional images may contribute to the demarcation of lung pathology of these two disorders.

133Xe contamination found in internal bacteria filter of xenon ventilation system.

OBJECTIVE: We report on (133)Xe contamination found in the reusable internal bacteria filter of our xenon ventilation system. METHODS: Internal bacteria filters (n = 6) were evaluated after approximately 1 mo of normal use. The ventilation system was evacuated twice to eliminate (133)Xe in the system before removal of the filter. Upon removal, the filter was monitored using a survey meter with an energy-compensated probe and was imaged on a scintillation camera. The filter was monitored and imaged over several days and was stored in a fume hood. RESULTS: Estimated (133)Xe activity in each filter immediately after removal ranged from 132 to 2,035 kBq (3.6-55.0 micro Ci), based on imaging. Initial surface radiation levels ranged from 0.4 to 4.5 micro Sv/h (0.04-0.45 mrem/h). The (133)Xe activity did not readily leave the filter over time (i.e., time to reach half the counts of the initial decay-corrected image ranged from <6 to >72 h). The majority of the image counts (approximately 70%) were seen in 2 distinctive areas in the filter. They corresponded to sites where the manufacturer used polyurethane adhesive to attach the fiberglass filter medium to the filter housing. CONCLUSION: (133)Xe contamination within the reusable internal bacteria filter of our ventilation system was easily detected by a survey meter and imaging. Although initial activities and surface radiation levels were low, radiation safety practices would dictate that a (133)Xe-contaminated bacteria filter be stored preferably in a fume hood until it cannot be distinguished from background before autoclaving or disposal.

Quantitation of regional ventilation during the washout phase of lung scintigraphy: measurement in patients with severe COPD before and after bilateral lung volume reduction surgery.

STUDY OBJECTIVES: We sought to investigate the effect of lung volume reduction surgery (LVRS) on regional lung ventilation. DESIGN: Retrospective analysis of routinely acquired data before and after LVRS. SETTING: Large, urban, university medical center. PATIENTS: Twenty-nine patients with severe emphysema. INTERVENTION: Bilateral LVRS. MEASUREMENTS AND RESULTS: (133)Xe washout curves during lung scintigraphy exhibit a biphasic pattern (the first component of the washout curve [m(r)] corresponds to an initial rapid phase in washout that reflects larger airways emptying, and the second component [m(s)] reflects a slower phase of washout that is attributed to gas elimination via smaller airways). We analyzed six standardized regions of the lung (upper, mid, and lower zones of the right and left lung), and calculated m(r) and m(s) for each lung region. The mean (+/- SE) baseline FEV(1) was 0.69+/-0.04 L, total lung capacity (TLC) was 139 +/-4% predicted, and the residual volume (RV)/TLC ratio was 65+/-2%. The mean improvement in FEV(1) 3 months post-LVRS was 38%. Post-LVRS, m(r) and m(s) increased in 79 and 74 lung regions, respectively, and there was no relationship with respect to lung regions that had or had not been operated on. The increase in m(s), however, significantly correlated with the increase in FEV(1) (r = 0.66; p<0.0001) and the decrease in RV/TLC (r = -0.67; p<0.0001). An increase in m(s) also correlated with a decrease in PaCO(2) (r = -0.39; p = 0.03), but m(r) showed no relationship with any parameter. CONCLUSIONS: Small airways ventilation in lung regions that had and had not been operated on is associated with a greater improvement in lung mechanics following LVRS.

Regional cerebral blood flow during hyperventilation in patients with acute bacterial meningitis.

Mechanical hyperventilation is often instituted in patients with acute bacterial meningitis when increased intracranial pressure is suspected. However, the effect on regional cerebral blood flow (CBF) is unknown. In this study, we measured regional CBF (rCBF) in patients with acute bacterial meningitis before and during short-term hyperventilation. In 17 patients with acute bacterial meningitis, absolute rCBF (in ml/100 g min-1) was measured during baseline ventilation and hyperventilation by single-photon emission computed tomography (SPECT) using intravenous 133Xe bolus injection. Intravenous 99mTc-HMPAO (hexamethylpropyleneamine oxime) was subsequently given during hyperventilation. In 12 healthy volunteers, rCBF was measured by SPECT and 99mTc-HMPAO during spontaneous ventilation. Using standard templates to identify regions of interest (ROIs), we calculated rCBF in percentage of cerebellar (99mTc-HMPAO images) or mean hemispheric (133Xe images) flow for each ROI, the degree of side-to-side asymmetry for each ROI, and the anterior-to-posterior flow ratio. On 133Xe images, absolute rCBF decreased significantly during hyperventilation compared to baseline ventilation in all regions, but the relative rCBF did not change significantly from baseline ventilation (n=14) to hyperventilation (n=12), indicating that the perfusion distribution was unchanged. On 99mTc-HMPAO images (n=12), relative rCBF and the anterior-to-posterior flow ratio were significantly lower in patients than in controls in the frontal and parietal cortex as well as in the basal ganglia. Focal perfusion abnormalities were present in 10 of 12 patients. Regional cerebral blood flow abnormalities are frequent in patients with acute bacterial meningitis. Short-term hyperventilation does not enhance these abnormalities.

Noninvasive quantification of cerebral blood flow using 99mTc-ECD and SPECT.

UNLABELLED: The aim of this study was to develop a simple, noninvasive method for quantifying regional cerebral blood flow (rCBF) using 99mTc-ethyl cysteinate dimer (ECD) by a single SPECT scan and single venous sampling. METHODS: Using a three-compartment model, we introduced the regional brain fractionation index (BFI), Cb(Ts)/integral of 0-Ts Ca(tau)dtau [Ca(t), arterial input; Cb(t), brain activity]. Regional BFI obtained at the optimum time Ts (min) was converted to rCBF using an exponential function, which was obtained by analyzing the relationship between regional BFI and rCBF (= F) obtained by the standard 133Xe inhalation SPECT method. The integral of the concentration of 99mTc-ECD in arterial blood corrected for physical decay [Ca(t)] in BFI was estimated from a single venous blood sample obtained at the optimum time Tv using the regression line obtained by analyzing the relationship between the integral of Ca(t) and venous sample data. The data come from three groups of patients. The first group of patients (n = 16) underwent a complete 99mTc-ECD BFI study with measurement of Ca(t) and dynamic SPECT scanning, as well as a 133Xe inhalation study to measure rCBF The results were used to analyze the relationship between regional BFI and rCBF (obtained with 133Xe) and to determine the optimum time Ts for obtaining BFI. Data from the second group of patients (n = 15) were used to analyze the relationship between the integral of Ca(t) and venous sample data and to determine the optimum time Tv for one-point venous blood sampling. Finally, the third group of patients (8 patients, 10 studies) was used to validate the current method by comparing the results with 133Xe inhalation SPECT. RESULTS: Regional BFI obtained at time Ts = 20 min showed good agreement (r = 0.907; a = 0.552, b = 0.962) with rCBF. The venous sample data obtained at time Tv = 6 min showed a good correlation (r = 0.988) with BFI. In comparing rCBF values thus obtained and those obtained by the 133Xe method, we found a good correlation (r = 0.917, slope = 1.01). CONCLUSION: The proposed method has three advantages: (a) accurate quantification of rCBF without underestimation in the high flow range, (b) simplicity and noninvasiveness and (c) the ability to use any type of SPECT camera for the study.

Production of radioactive endovascular stents by implantation of 133Xe ions.

A coronary stent was made radioactive by implantation of 133Xe ions for the purpose of suppressing the renarrowing of the part of blood vessel in which the stent is implanted. Electrons of relatively low energies emitted in the decay of 133Xe may give an antiproliferative effect of ionizing radiation to the intimal cells within a limited range of 1 mm. A 133Xe+ beam accelerated at 40 or 60 keV was directed to several stainless steel stents mounted on a target-holder table that could revolve and move up and down to distribute the 133Xe+ ions within a stent as well as among the stents. The radioactive stents produced contained up to 100 kBq of 133Xe and were implanted into the abdominal aortas of rabbits. Neointimal thickening was analyzed by histomorphometry for samples taken 4 weeks after stent implantation. The results indicate that the radioactive stents have a potential to suppress neointimal hyperplasia in rabbits.

Effect of xenon-induced flow activation on xenon-enhanced computed tomography cerebral blood flow calculations.

Computer simulations of stable xenon ((S)Xe) uptake curves were used to evaluate the effect of xenon-induced flow activation on CBF calculations by xenon-enhanced computed tomography. Estimates of flow activation were based on repeated transcranial Doppler measurements of blood velocity during 4.5 minutes of (S)Xe inhalation. The synthetic curves were generated from a generalized Kety equation that included time-varying blood flow activation. In contrast to the peak 35% increase in blood flow velocity during (S)Xe inhalation, a standard analysis of the flow-varying synthetic curves revealed only minor 3% to 5% increases in calculated CBF. It is concluded that brief xenon inhalations can provide blood flow estimates that contain minimal bias from activation.

Ventilation scintigraphy of the middle ear.

UNLABELLED: In this study, an attempt was made to administer radioactive gas into the tympanic cavity to measure initial gas trappings as well as clearance from the middle ear to evaluate eustachian tube function. METHODS: Twenty-eight patients were administered 50 MBq 133Xe gas. Three different methods for gas application were tested: (a) direct injection through a tympanostomy tube in two patients, (b) administration through a nasopharyngeal catheter combined with Valsalva maneuvers in six subjects without middle ear dysfunction and (c) insufflation into the pharyngeal space through a nose olive performed in 12 patients with normal eustachian tube function and in eight patients with one-sided tube dysfunction. RESULTS: All three approaches were successful in visualizing middle ear ventilation, demonstrating tracer trapping within the tympanic cavities in 20 of 28 patients. Semiquantitative evaluation by region of interest techniques revealed a left-to-right uptake ratio of 48.4%-51.6% in 13 patients without tube dysfunction. Five patients with one-sided tube dysfunction showed a significantly lower median uptake of 31.6% (p = 0.01). The clearance half-lives ranged from 9 to 283 min in normal subjects and 37-64 min in patients with one-sided tube malfunction, demonstrating no statistically significant difference between the two groups and a trend towards increased washout in patients with tympanic dysfunction. CONCLUSION: Middle ear ventilation scintigraphy with 133Xe through a nose olive is an easy-to-perform test to evaluate eustachian tube function and has a success rate of about 70%, thus, reflecting the complex physiological mechanisms involved.

Radiation exposure to human trachea from xenon-133 procedures.

UNLABELLED: The general dosimetry of 133Xe for human studies is well documented, but the resultant radiation exposure to tracheal tissue is poorly known. This organ is of central relevance because the tracer is primarily eliminated through exhalation. METHODS: We report actual 133Xe concentrations in respiratory air during measurement of regional cerebral blood flow (rCBF), when the tracer is administered both by inhalation and intravenous injection. Data were collected from 102 patients, with equal gender representation and an age range of 18-82 yr. Most of the patients had subarachnoid hemorrhage or Alzheimer's disease or were normal control subjects. Average administered doses were 18 +/- 4 mCi by inhalation and 15 +/- 3 intravenously. RESULTS: We found average respiratory concentrations of about 1.80 mCi/liter during a 1-min inhalation and 0.74 mCi/liter following intravenous injection of standard doses. These activities drop rapidly: average respiratory concentrations during the second minute are 0.70 mCi/liter for inhalation and 0.19 mCi/liter for intravenous injection and reach negligible levels thereafter. We calculate that the tracheal absorbed dose from 133Xe procedures is approximately 28 mrad following inhalation and about 11 mrad following intravenous injection. These values reflect the full 11-min exposure, but most of the activity is only present initially. CONCLUSION: These values will agree with previous estimates and indicate an excellent safety margin.

Relationship between lifetime occupation and parietal flow: implications for a reserve against Alzheimer's disease pathology.

We previously reported an inverse relation between parietal cerebral blood flow and years of education in Alzheimer's disease (AD) patients matched for clinical severity. This suggested that the clinical manifestation of advancing AD pathology is delayed in patients with higher educational attainment. Other aspects of life experience may also provide a reserve against the clinical expression of AD. To test this hypothesis, we classified the primary life-time occupations of 51 AD patients using the Dictionary of Occupational Titles, published by the US Department of Labor, and derived six factor scores describing intellectual, interpersonal, and physical job demands. Regional cerebral blood flow was measured using the xenon-133 inhalation method. After controlling for age, clinical dementia severity, and education, there was less relative perfusion in the parietal region in subjects whose occupations were associated with higher interpersonal skills and physical demands factor scores. We conclude that independent of education, aspects of occupational experience may provide a reserve that delays the clinical manifestation of AD.

Perfusion and ventilation scans in patients with extensive obstructive airway disease: utility of single-breath (washin) xenon-133.

UNLABELLED: The presence of extensive obstructive airway disease in many patients leads to an interpretation of intermediate or indeterminate probability for pulmonary emboli using ventilation/perfusion lung scans. We observed that patients with extensive obstructive airway disease having perfusion abnormalities matching those on a single-breath xenon image usually have a normal pulmonary angiogram. This study's objective was to further assess the utility of a single-breath image in evaluating patients with extensive obstructive airway disease and abnormal perfusion studies categorized as having intermediate or indeterminate probability of pulmonary embolism in an attempt to decrease the number of nondiagnostic studies. METHODS: We studied retrospectively 33 patients with extensive obstructive airway disease, with abnormal perfusion scans and no infiltrates on chest x-ray categorized as having intermediate or indeterminate probability of pulmonary embolism. We established the presence or absence of matching ventilation and perfusion abnormalities by comparing perfusion scan and single-breath images. RESULTS: Among 25 patients with perfusion abnormalities matching the initial ventilation pattern on single-breath images, only 1 (4%) had pulmonary emboli as documented by pulmonary angiogram. Four out of the remaining 8 patients with no matching perfusion and single-breath ventilation pattern had pulmonary emboli (50%). CONCLUSION: Patients categorized by ventilation/perfusion scintigraphy as having intermediate or indeterminate probability for pulmonary emboli due to the presence of extensive obstructive airway disease can be further subclassified using single-breath images. Patients with matching perfusion and single-breath ventilation pattern should be categorized as having low probability for pulmonary embolism, regardless of the extent of the ventilation abnormalities.

[Xenon-133 rCBF SPECT by newly designed bolus inhalation method].

Single photon emission computed tomography (SPECT) with 133Xe gas inhalation method enables measurement of regional cerebral blood flow (rCBF) quantitatively. But this method is inferior to the method with 99mTc-HMPAO or 123I-IMP in the quality of images. Efficient administration of 133Xe gas more than usual is supposed to improve quality of SPECT images. In this study we designed bolus inhalation method, a new method to efficiently administer 133Xe gas of usual dose (1,850 MBq), and examined its fundamental aspects and clinical feasibility. The method was initiated by bolus administration of 133Xe gas synchronously in inspiration phase via a small tube connected to a mouthpiece and was followed by steady breathing of the gas in a closed circuit with a spiro-bag. Introduction of this method provided almost twofold increase in count ratio at the head in comparison with a conventional inhalation method. Consequently, considerable improvement in the quality of rCBF images was achieved by optimization of a reconstruction filter of SPECT.

The limitations of posterior view ventilation scanning in the diagnosis of pulmonary embolism.

In the diagnosis of pulmonary embolism some centres using 133Xe for comparison with multiple view 99Tcm perfusion images perform only single-breath posterior view ventilation scans. The purpose of this study was to test the reliability of the posterior view ventilation scan in the detection of lobar and segmental defects in ventilation. Occluding balloon catheters were placed in lobar and segmental bronchi during fibreoptic bronchoscopy to produce defects of known anatomical location and size in normal volunteers. Subjects breathed 81Krm/air during the occlusions and images were acquired in the posterior, posterior/oblique and lateral projections. The posterior view images were classified by three experienced nuclear medicine physicians as normal or abnormal. If abnormal, the observers were asked to state which lobe or segment was involved. Segmental defects were missed in 28% of scan readings. Segmental defects were detected but incorrectly sited in 50% of readings and correctly sited in only 22% of readings. The posterior view scan with a defect involving the entire lingula was judged to be normal by all observers. Defects involving the right and left lower lobes were underestimated. We conclude that ventilation scanning techniques that assess the distribution of ventilation in the posterior view alone are unreliable in the detection of segmental and lobar defects, and are likely to increase the false positive rate in the diagnosis of pulmonary embolism.

Radiopharmacology of inhaled 133Xe in skeletal sites containing deposits of Gaucher cells.

Gaucher's disease is a lysosomal storage disease in which cells of the reticuloendothelial system accumulate the lipid glucocerebroside. It is characterized by slowly progressive visceral and osseous involvement. One of the latter manifestations includes lipid infiltration of bone marrow. We monitored the rate of inhaled 133Xe uptake and wash-out over diseased and normal metaphyseal and epiphyseal areas of the knee. Twenty-two patients (15 adults, 7 children) with various degrees of previously diagnosed Gaucher's disease were positioned supine under a gamma-camera interfaced to a computer system. All patients rebreathed 133Xe gas from a closed system for 10 min followed by 14 min of wash-out. Digitized images of the lung, liver, spleen, bony sites and soft tissue were obtained at 1 min intervals during the wash-in and wash-out phases. Counts for each ROI were normalized per 100 pixels and plotted as a function (time). Maximum uptake was also calculated by relating the counts/ROI/100 pixels to the 10 min integrated lung count during equilibrium (the administered "dose"). There was essentially no 133Xe uptake in liver and spleen involved with Gaucher's disease. Monophasic uptake and biphasic wash-out curves were observed in the limited investigative population. Skeletal Gaucher deposits released the 133Xe at a greater rate relative to soft tissue.

Motor activation by single-photon emission computed tomography. A comparison of xenon-133 and technetium-99m HM-PAO "split-dose" methods.

Single-photon emission computed tomography (SPECT) was used to investigate the feasibility of the technetium 99m-hexamethylpropyleneamineoxime ( 99mTc HM-PAO) split-dose method to evidence changes in regional cerebral blood flow during a motor activation task, in comparison with a quantitative method using the inhalatory xenon-133. Four subjects were studied twice with both methods, at rest and during finger opposition movements. On the activated cerebral hemisphere, a significant increase in regional cerebral blood flow was observed over the motor cortical areas. The average increases were +28.1 +/- 5.6% for the xenon-133 method and +12.3 +/- 5.2% for the 99mTc HM-PAO method. By using the linearization algorithm for the 99mTc HM-PAO method, a mean increase of +22.5 +/- 8.9% was calculated. This study demonstrated that the split-dose method allows the motor activation SPECT studies with 99mTc HM-PAO to be done in a single session.