Urban stormwater nutrient and metal removal in small-scale green infrastructure: exploring engineered plant biofilter media optimisation.

The present study evaluated engineered media for plant biofilter optimisation in an unvegetated column experiment to assess the performance of loamy sand, perlite, vermiculite, zeolite and attapulgite media under stormwater conditions enriched with varying nutrients and metals reflecting urban pollutant loads. Sixty columns, 30 unvegetated and 30 Juncus effusus vegetated, were used to test: pollutant removal, infiltration rate, particulate discharge, effluent clarity and plant functional response, over six sampling rounds. All engineered media outperformed conventional loamy sand across criteria, with engineered attapulgite consistently among the best performers. No reportable difference existed in vegetation exposed to different material combinations. For all media, the results show a net removal of NH3-N, PO43--P, Cd, Cu, Pb and Zn and an increase of NO3--N, emphasizing the importance of vegetation in biofilters. Growth media supporting increased rate of infiltration whilst maintaining effective remediation performance offers the potential for reducing the area required by biofilters, currently recommended at 2% of its catchment area, encouraging the use of small-scale green infrastructure in the urban area. Further research is required to assess the carrying capacity of engineered media in laboratory and field settings, particularly during seasonal change, gauging the substrate's potential moisture availability for root uptake.

Resveratrol attenuates NF-κB-binding activity but not cytokine production in mechanically ventilated mice.

BACKGROUND: Mechanical ventilation (MV) can result in inflammation and subsequent lung injury. Toll-like receptor (TLR)4 and NF-κB are proposed to play a crucial role in the MV-induced inflammatory response. Resveratrol (RVT) exhibits anti-inflammatory effects in vitro and in vivo supposedly by interfering with TLR4 signaling and NF-κB. In the present study, we investigated the role of RVT in MV-induced inflammation in mice. METHODS: RVT (10 mg/kg, 20 mg/kg and 40 mg/kg) or vehicle was intraperitoneally administered 1 h before start of MV (4 h, tidal volume 8 ml/kg, positive end-expiratory pressure 1,5 cmH2 O and FiO2 0.4). Blood and lungs were harvested for cytokine analysis. DNA binding activity of transcription factor NF-κB was measured in lung homogenates. RESULTS: MV resulted in elevated pulmonary concentrations of IL-1ß, IL-6, keratinocyte-derived chemokine (KC) and NF-κB DNA-binding activity. RVT at 10, 20 and 40 mg/kg reduced NF-κB's DNA-binding activity following MV compared with ventilated controls. However, no differences in cytokine release were found between RVT-treated and control ventilated mice. Similarly, in plasma, MV resulted in elevated concentrations of TNF-α, KC and IL-6, but RVT did not affect cytokine levels. CONCLUSIONS: RVT abrogates the MV-induced increase in pulmonary NF-κB activity but does not attenuate cytokine levels. This implies a less prominent role for NF-κB in MV-induced inflammation than previously assumed.

Sentinel lymph node detection in patients with vulvar carcinoma; Feasibility of intra-operative mapping with technetium-99m-labeled nanocolloid.

AIMS: Sentinel lymph node (SLN) mapping appears to be feasible in patients with primary vulvar cancer. Previous protocols describe the injection of the technetium-99m-nanocolloid at least 3 h before surgery which involves two invasive procedures for the patient. In this study, we assessed the feasibility, safety, and accuracy of an intra-operative rather than preoperative SLN mapping in patients with primary vulvar cancer. METHODS: Patients with histologically confirmed squamous cell vulvar cancer and clinically FIGO stage Ib disease underwent intra-operative SLN mapping by intradermal injection of the nanocolloid around the tumor. SLN were identified and removed before a complete inguinofemoral lymphnode dissection was performed. Surgical and pathologic data on all patients were prospectively entered into a database. RESULTS: An SLN procedure was performed in 16 patients; 3 patients received unilateral lymphadenectomy, and 13 women underwent surgery on both groins. In all groins but 4 at least one SLN was clearly identified (detection rate 25/29, 86%). A median number of 2 SLN and 4 non-SLN per groin were removed. 3 of 16 patients (19%) had metastatic disease in the lymph nodes. There was no false negative SLN result. CONCLUSION: Intra-operative SLN detection seems feasible in patients with early stage vulvar cancer. More patients need to be enrolled in this ongoing study before this more convenient technique can be considered safe.

Evaluation of FDG-PET for detecting lymph node metastasis in uterine corpus cancer.

BACKGROUND: In order to decrease surgery-related morbidity, we evaluated the reliability of the evaluation of lymph node metastasis in patients with uterine corpus cancer by positron-emission tomography (PET) with 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG) before surgical staging. MATERIALS AND METHODS: Patients with newly diagnosed uterine corpus cancer scheduled for surgical staging, including lymphadenectomy, underwent PET imaging within 30 days before surgery. PET results and postoperative histopathology were compared for each patient and each nodal site. Sensitivity, specificity, positive and negative predictive value (PPV/NPV) as well as accuracy of FDG-PET in predicting nodal disease was determined by joined meta-analysis of the present data and the data available in the literature. RESULTS: Of 21 patients examined, 13 patients were eligible to enter this pilot study. Only one patient had lymph node metastasis, which was preoperatively detected by FDG-PET scan. Additionally, another patient was considered to have lymph node metastasis according to increased focal FDG uptake; however, all lymph nodes were free of malignant disease upon final pathology. In contrast, all other patients without lymph node metastasis upon final pathology showed negative preoperative FDG-PET scans. The meta-analysis yielded a sensitivity, specificity, PPV, NPV and accuracy of 0.53, 0.91, 0.57, 0.90 and 0.84, respectively. CONCLUSION: In patients with uterine corpus cancer, FDG-PET had an insufficient positive predictive value in detecting lymph node metastases, indicating that this method cannot replace surgical staging. However, due to its high NPV, FDG-PET might be beneficial in selected patients who are poor candidates for surgical staging.

Isoflurane attenuates pulmonary interleukin-1beta and systemic tumor necrosis factor-alpha following mechanical ventilation in healthy mice.

BACKGROUND: Mechanical ventilation (MV) induces an inflammatory response in healthy lungs. The resulting pro-inflammatory state is a risk factor for ventilator-induced lung injury and peripheral organ dysfunction. Isoflurane is known to have protective immunological effects on different organ systems. We tested the hypothesis that the MV-induced inflammatory response in healthy lungs is reduced by isoflurane. METHODS: Healthy C57BL6 mice (n=34) were mechanically ventilated (tidal volume, 8 ml/kg; positive end-expiratory pressure, 4 cmH(2)O; and fraction of inspired oxygen, 0.4) for 4 h under general anesthesia using a mix of ketamine, medetomidine and atropine (KMA). Animals were divided into four groups: (1) Unventilated control group; (2) MV group using KMA anesthesia; (3) MV group using KMA with 0.25 MAC isoflurane; (4) MV group using KMA with 0.75 MAC isoflurane. Cytokine levels were measured in lung homogenate and plasma. Leukocytes were counted in lung tissue. RESULTS: Lung homogenates: MV increased pro-inflammatory cytokines. In mice receiving KMA+ isoflurane 0.75 MAC, no significant increase in interleukin (IL)-1beta was found compared with non-ventilated control mice. PLASMA: MV induced a systemic pro-inflammatory response. In mice anesthetized with KMA+ isoflurane (both 0.25 and 0.75 MAC), no significant increase in tumor necrosis factor (TNF)-alpha was found compared with non-ventilated control mice. CONCLUSIONS: The present study is the first to show that isoflurane attenuates the pulmonary IL-1beta and systemic TNF-alpha response following MV in healthy mice.

[Von Hippel-Lindau disease. Interdisciplinary patient care]. / Von-Hippel-Lindau-Erkrankung. Interdisziplinäre Patientenversorgung.

Von Hippel-Lindau disease is an important hereditary tumor syndrome with a clear option for effective treatment if diagnosed in time. Interdisciplinary cooperation is the key to successful management. Major components of the disease are retinal capillary hemangioblastomas, hemangioblastomas of cerebellum, brain stem and spine, renal clear cell carcinomas, pheochromocytomas, multiple pancreatic cysts and islet cell carcinomas, tumors of the endolymphatic sac of the inner ear, and cystadenomas of the epididymis and broad ligament. A well structured screening program should be performed at yearly intervals.

Imaging findings in a 3-year-old girl with type III pleuropulmonary blastoma.

Pleuropulmonary blastoma (PPB) is a rare dysembryonic intrathoracic neoplasm in children. It is a malignant tumour originating from the mesenchyme with a poor prognosis. We report on a 3-year-old girl who presented with respiratory symptoms and was diagnosed as having a type III PPB according to histological results attained by open biopsy. Imaging by CT and MRI revealed the exact size of the tumour involving the left lower lobe with displacement of the mediastinum and the diaphragm. Additional FDG-PET was important to evaluate tumour vitality and to decide the time of surgery, which was performed after 12 weeks of chemotherapy with the CWS2002P protocol. After R0 resection without complications and postoperative chemotherapy, the child continues to be in complete remission. This case underlines the importance of radical surgery of the aggressive neoplasm in combination with chemotherapy and the usefulness of multimodal imaging for the optimal planning of local therapy.

99mTechnetium pyrophosphate scintigraphy in the detection of skeletal muscle disease.

We aimed to assess the specificity and sensitivity of (99m)technetium pyrophosphate muscle scintigraphy in the diagnostic workup of patients with suspected myopathy. We reviewed the charts of 166 patients; 52% of the subjects had myalgias, 36% had muscle weakness, 45% had an elevated serum creatine kinase (CK), and 49% had an increased C reactive protein (CRP). Scintigraphy was positive in 34 patients (20%). The test was more sensitive in the presence of muscle weakness, elevated CK, or increased CRP. The presence of myalgias did not influence the odds. Sensitivity was 60% in patients with the final diagnosis of polymyositis, dermatomyositis, or inclusion body myositis, and 70% in noninflammatory myopathies. Eight percent had false positive scintigrams. In individuals with biopsy-proven myopathy (51 subjects), the diagnostic sensitivity was 43%, and its specificity was 60%. Low positive and high negative likelihood ratios (5.0 and 0.65, respectively) document an only limited diagnostic efficiency of (99m)Tc-PYP scintigraphy in the evaluation of inflammatory and noninflammatory myopathies and suggest that the test is not helpful in the routine diagnostic workup of muscle complaints, even after a priori selection of patients for CK plus CRP abnormalities.

PET with 18F-DOPA in the imaging of parathyroid adenoma in patients with primary hyperparathyroidism. A pilot study.

UNLABELLED: Preoperative localization of parathyroid adenomas (PA) can shorten operation time and improve curative rate; it becomes especially important in minimally invasive surgical techniques. AIM of this study was to investigate whether positron emission tomography (PET) with 3-,4-dihydroxy-6- (18) F-fluorophenylalanine ( (18) F-DOPA), which showed very promising results in other neuroendocrine tumours, also helps to localize PA. PATIENTS, METHODS: Eight patients with proven primary hyperparathyroidism were studied preoperatively with PET. Seven also underwent scintigraphy with (99m) Tc-MIBI and ultrasonography of the neck. All patients were operated and the histological finding was used as a gold standard. RESULTS: All eight patients had a histologically proven PA. None of the PA showed any detectable uptake of (18) F-DOPA. However, ultrasonography detected 5/7 PA, scintigraphy detected 3/7 PA. CONCLUSION: These results suggest that PET with (18) F-DOPA is not useful in the detection of PA in patients with primary hyperparathyroidism.

[Imaging procedures for giant cell arteritis (Horton's disease)]. / Bildgebende Verfahren bei Riesenzellarteriitis (M. Horton).

This review article highlights several diagnostic imaging modalities in giant cell arteritis. Color-coded Duplex sonography is a relatively cost-efficient but strongly observer-dependent imaging modality. It may be difficult to distinguish inflammatory from atherosclerotic mural changes. Positron emission tomography with (18)F-fluoro-2-deoxy-D-glucose is very sensitive in detecting extracranial involvement of large vessel vasculitis. However, it provides no information on inflammatory changes of the superficial cranial arteries. High-resolution MRI is a new observer-independent method that allows visualizing and assessing the superficial cranial arteries in high detail. Extracranial large artery involvement can be evaluated during the same investigation. At present, only single-center experiences with this promising but rather complex procedure exist. A comparative multicenter trial is about to be initiated.

[Innovative antibody-therapies for malignant lymphomas]. / Innovative Antikörper-Therapien bei malignen Lymphomen.

Non-Hodgkin s lymphoma (NHL) includes a group of malignant lymphoproliferative disorders, that particularly occur in the elderly and have an continuously increasing incidence. Because of the age distribution new treatment options with low toxicity and minor side effects - apart from "conventional" therapies like standard or high dose chemotherapy - are needed. Within these novel therapeutic modalities the use of the monoclonal antibody rituximab has been widely established. Other monoclonal antibodies, such as the anti-CD52-antibody alemtuzumab, are available for the treatment of chronic lymphatic leukemia (CLL) and T-cell-lymphomas and are being tested in clinical trials. Furthermore the option of combining targeted therapies, in which antibodies are used with radiotherapy, has led to the development of radio-immunotherapies that are now becoming available for clinical use. Current results in the treatment of advanced indolent lymphomas are promising, and their use in high-grade lymphoma and as first-line therapy is under investigation. This article summarizes the application of these novel immunotherapies and reviews the results of recent clinical trials, with particular emphasis on indications and practical aspects in everyday clinical life.

High grade cardiac lymphoma vitality monitoring by gadolinium-enhanced magnetic resonance imaging (MRI).

Primary cardiac lymphoma (PCL) is a rare disorder with a poor prognosis and response monitoring is often difficult. Delay in the diagnosis and infiltration of cardiac structures contribute to the unfavorable prognosis. We report on a 76-year-old woman who was diagnosed as having an immunoblastic B-cell PCL according to a histology attained by catheter-guided biopsy. Systemic chemotherapy with six cycles of CHOP (Cyclophosphamide, Doxorubicine, Vincristine = Oncovine, Prednisone), combined with the monoclonal anti-CD20 antibody Rituximab induced only a partial remission, based solely on monitoring of tumor size. However, cardiac gadolinium-enhanced magnetic resonance imaging (CMR) disclosed a reduced lymphoma perfusion and, therefore, indicated decreased tumor vitality. Nine months after the final treatment, the cardiac tumor further decreased to 10% of the initial size, and the patient is in sustained remission as monitored by CMR and validated by florine-18 fluorodeoxyglucose positron emission tomography (PET). Determination of PCL perfusion was, in our case, beneficial for clinical decision making on additional therapy.

Diagnostic value of MRI in comparison to scintigraphy, PET, MS-CT and PET/CT for the detection of metastases of bone.

The initial localization of metastases in the bone in patients with solid tumors has a relatively good prognosis in comparison with visceral metastasization. The early detection of bone marrow metastases allows for a rapid initiation of therapy and a subsequent reduction in the morbidity rate. Modern MRI is superior to the 30-year-old skeletal scintigraphy and bone marrow scintigraphy with respect to sensitivity, specificity, as well as the extent of osteal metastasis. MRI provides substantial, therapy-relevant additional information. MSCT plays an important role in the management of cancer patients in clinical routine and gives an excellent survey of the axial skeleton by demonstrating osteolytic and osteoblastic metastases. Extensive comparative studies of MRI with 18F-FDG-PET and 18F-fluoride-PET have not yet been carried out. Whole body MRI is a very promising new staging method for the oncological diagnosis of solid tumors and the detection of osteal metastases. The adoption of 18F-FDG-PET and 18F-fluoride-PET FDG as well as the side by side PET-CT image fusion and the two in one PET/CT examinations appears to be slightly less sensitive to whole body MRI in the detection of osteal metastases. Larger, prospective multicenter studies are necessary to establish these as new, promising methods for the detection of osteal metastases.

Imaging of pheochromocytoma and paraganglioma.

Paragangliomas are tumours that arise within the sympathetic nervous system originating from the neural crest. These tumours can be found anywhere from the neck to the pelvis in locations of sympathetic ganglions. Although in the majority of paragangliomas the diagnosis is based on measuring catecholamines and metabolites in plasma or urine, imaging plays an important preoperative role. Today, there are several morphological and radionuclide imaging methods available that predict tumour localisation and tumour extent and give anatomic information to the surgeon. MRI is the morphological imaging modality of choice in localising pheochromocytomas and extra-adrenal paragangliomas. It provides excellent anatomic detail and has the advantage of lacking ionising radiation. The overall accuracy of computed tomography (CT) in detecting primary adrenal pheochromocytomas is very high, but CT lacks in specificity as difficulties may occur in distinguishing between paragangliomas and other tumour entities. The major advantages of radionuclide imaging are very high specificity and routinely performed whole-body scanning. Furthermore, metabolic imaging is not influenced by artifacts like scar tissue or metallic clips in post-surgical follow-up. Currently, a reported specificity of 99% and a cumulative sensitivity of about 90% in paragangliomas make (123)I-MIBG the most important nuclear imaging method. However, (18)F-DOPA-PET seems to be a very promising procedure which offers higher accuracy. The higher spatial resolution of PET-scanners enables the detection of small lesions not visualised with (123)I-MIBG. Both use of radiolabelled somatostatin analogue like (111)In-pentetreotide and (18)F-FDG is limited due to low specificity of the tracers and should be restricted to MIBG- and F-DOPA-negative cases.

Impact of [18F]FDG-PET on the primary staging of small-cell lung cancer.

PURPOSE: The purpose of this study was to evaluate the impact of [18F]fluorodeoxy-D-glucose positron emission tomography (FDG-PET) on the primary staging of patients with small-cell lung cancer (SCLC). METHODS: FDG-PET was performed in 120 consecutive patients with SCLC during primary staging. In addition, brain examinations with both FDG-PET and cranial magnetic resonance imaging (MRI) or computed tomography (CT) were performed in 91 patients. Results of FDG-PET were compared with those of conventional staging procedures. FDG-PET detected markedly increased FDG uptake in the primary tumours of all 120 patients (sensitivity 100%). RESULTS: Complete agreement between FDG-PET results and other staging procedures was observed in 75 patients. Differences occurred in 45 patients at 65 sites. In 47 sites the FDG-PET results were proven to be correct, and in ten, incorrect. In the remaining eight sites, the discrepancies could not be clarified. In 14/120 patients, FDG-PET caused a stage migration, correctly upstaging ten patients to extensive disease and downstaging three patients by not confirming metastases of the adrenal glands suspected on the basis of CT. Only 1/120 patients was incorrectly staged by FDG-PET, owing to failure to detect brain metastases. In all cases the stage migration led to a significant change in the treatment protocol. Sensitivity of FDG-PET was significantly superior to that of CT in the detection of extrathoracic lymph node involvement (100% vs 70%, specificity 98% vs 94%) and distant metastases except to the brain (98% vs 83%, specificity 92% vs 79%). However, FDG-PET was significantly less sensitive than cranial MRI/CT in the detection of brain metastases (46% vs 100%, specificity 97% vs 100%). CONCLUSION: The introduction of FDG-PET in the diagnostic evaluation of SCLC will improve the staging results and affect patient management, and may reduce the number of tests and invasive procedures.

Impact of FDG-PET for staging of oesophageal cancer.

BACKGROUND AND AIMS: Treatment of oesophageal cancer depends on staging and the general health of the patient. In stages I-II b, as well as in some stage III diseases, surgical resection remains the therapy of choice for cure, but a curative approach is not possible in stage IV. In our hospital we give preoperative radio-chemotherapy to all patients with an oesophageal cancer T>1, Nx, M0. Therefore, the main purpose of the clinical staging of oesophageal cancer is the exclusion of M1 and T4 disease with infiltration into the tracheobronchial system or the aorta. The aim of the investigation was the assessment of positron emission tomography for detection of M1 disease. PATIENTS/METHODS: Between 1998 and 2002, 84 patients with oesophageal cancer (64% squamous cell carcinoma and 36% adenocarcinoma) were enrolled into the study. Of these, 48.8% were operated on; 35.7% of the patients were not operated on, for oncological reasons, 7.1% for medical reasons, 3.6% chose not to be operated on, and, for unknown reasons, 4.8% were not operated on. RESULTS: Twenty-five patients had stage IV disease or additional, synchronous cancer of the head and neck ( n=2). As the only investigational procedure, positron emission tomography revealed M1 stage in 11 of 25 patients (44%). In 13/25 (52%) both computed tomography and positron emission tomography revealed stage IV disease. False positive results by positron emission tomography were observed in three patients. The sensitivity and specificity of positron emission tomography (PET) was 0.96 and 0.95, respectively. Most of the metastases detected by PET only, were localised within the neck, liver and bone. With regard to the 66 of 84 patients deemed medically fit for operation and without local infiltration into the tracheobronchial system (T4) PET as the only imaging procedure changed the therapeutic strategy in 11 of 66 (16.6%) patients with to M1 disease. CONCLUSION: Our results demonstrated clearly the impact of the PET scan for decision-making in patients with oesophageal carcinoma. PET should be performed prior to therapy with curative intention. However, addition of a computed tomography scan of the neck might reduce the rate of unexpected metastases detected by PET.

Effects of neoadjuvant radio-chemotherapy on 18F-FDG-PET in esophageal carcinoma.

AIM: To investigate whether results of [F-18]-fluorodeoxy-d-glucose (FDG) positron emission tomography (PET) of esophageal cancer (EC) before and after neoadjuvant radio-chemotherapy correlate with histopathology after esophageal resection. METHODS: Twenty consecutive patients with EC without distant metastases were examined twice with 18F-FDG-PET during primary staging and after neoadjuvant radio-chemotherapy. FDG standardised uptake values (SUV) were correlated with the histopathological findings (percentage of viable tumour cells, tumour regression grade 1-5). RESULTS: Regression analysis revealed a slight (not significant) positive correlation between SUV(pre) (R=0.41, p=0.08) and SUV(post) (R=0.37, p=0.11) and the percentage of viable tumour cells in the resectate. Although all patients showed a significant decrease in SUV after radio-chemotherapy (p < 0.01) the percentual decrease of the SUV after therapy (DeltaSUV%) did not significantly differ between the TRG-groups. In 12 of 20 patients (60%), therapy-induced esophagitis was detected in post-therapeutic PET images. CONCLUSION: In EC, a higher pre-therapeutic SUV might be correlated with a higher fraction of vital tumour cells remaining after radio-chemotherapy. Applying the neoadjuvant therapy protocol and the study design used in this examination, there is no correlation between decrease in SUV and histopathology.

Regional myocardial perfusion defects during exercise, as assessed by three dimensional integration of morphology and function, in relation to abnormal endothelium dependent vasoreactivity of the coronary microcirculation.

OBJECTIVE: To test the hypothesis that scintigraphic regional myocardial perfusion defects during exercise in patients with normal coronary angiography may be related to abnormal endothelium dependent vasoreactivity of the corresponding myocardial territory in response to cold pressor testing. METHODS: 38 patients were classified into two groups according to the presence or absence of exercise induced scintigraphic myocardial perfusion defects. A cold pressor test was done in all patients during routine coronary angiography, followed by dynamic positron emission tomography to establish coronary blood flow mediated vasoreactivity of the epicardial coronary artery and the myocardial territories supplied by the left anterior descending, left circumflex, and right coronary arteries. RESULTS: 28 patients had regional myocardial perfusion defects while 10 had normal scintigraphic imaging. The three dimensional scintigraphic fusion image revealed 49 regional myocardial perfusion defects with a mean (SD) reversibility of the original stress defect of 20 (3)%. In patients with exercise induced regional myocardial perfusion defects, the responses of epicardial luminal area and regional myocardial blood flow (RMBF) to cold pressor testing were reduced compared with patients with normal perfusion imaging (epicardial luminal area: 5.2 (1.2) to 4.2 (0.86) mm2 v 4.7 (0.5) to 5.8 (0.5) mm2; RMBF: 0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.15) to 1.38 (0.26) ml/g/min; p < or = 0.03, respectively). In patients with regional abnormal scintigraphic perfusion, the corresponding RMBF response to cold pressor testing was more severely impaired than the mean myocardial blood flow in the remaining two vascular territories, but the difference was not significant (0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.10) to 0.87 (0.12) ml/g/min; NS). The endothelium independent increase in RMBF induced by glyceryl trinitrate did not differ between patients with exercise induced myocardial perfusion defects and those with normal perfusion images (0.75 (0.16) to 0.94 (0.09) ml/g/min v 0.75 (0.15) to 0.94 (0.09) ml/g/min; NS). There was a highly significant correlation between the endothelium dependent responses of RMBF to cold pressor testing and the severity of exercise induced scintigraphic regional myocardial perfusion defects (r = 0.95, p = 0.001). CONCLUSIONS: Exercise induced scintigraphic regional myocardial perfusion defects in patients with angina but normal coronary angiography may be related to abnormal endothelium dependent vasoreactivity of the corresponding myocardial territory.

[Appropriate uptake period for myocardial PET imaging with 18F-FDG after oral glucose loading]. / Optimaler Akquisitionszeitpunkt für die Herz-PET mit 18F-FDG nach oraler Glukosebelastung.

AIM: Identification of a rationale for the appropriate uptake period for myocardial (18)F-FDG-PET imaging of patients with and without diabetes mellitus. METHODS: In a subset of 27 patients, static 2D-PET examination was performed of patients with chronic coronary artery disease and known myocardial infarction. The patients fasted (at least 4 h) before examination. (18)F-FDG (330 +/- 20 MBq) was injected intravenously. The image quality was semiquantitativly determined by ROI-analysis and the myocardium-to-blood pool activity ratio (M/B) was calculated. I.) Scans 30, 60, and 90 min p. i. of 10 non-diabetic patients (60 g oral glucose loading one hour before FDG-injection, low-dose intravenous insulin bolus if necessary). II.) Scans 30, 60, and 90 min p. i. of 10 patients with known non-insulin dependent diabetes (20 g glucose, insulin bolus). III.) Scans 90 min p. i. of 7 patients with known non-insulin dependent diabetes and elevated fasting serum glucose level (140-200 mg/dl; insulin bolus, no glucose). RESULTS: I.) The M/B ratio significantly increases in nondiabetic patients with the uptake time (30 min 1.95 +/- 0.20; 60 min 2.96 +/- 0.36; 90 min 3.78 +/- 0.43). II.) In patients with non-insulin dependent diabetes the M/B ratio also significantly increases with uptake time. Compared to non-diabetic patients group II reached smaller M/B values (30 min 1.56 +/- 0.10; 60 min 2.15 +/- 0.14; 90 min 2.71 +/- 0.19). III.) In the group of patients with elevated fasting serum glucose level (who only got insulin but no glucose loading) the M/B activity ratio 90 min p. i. was clearly inferior compared with diabetic patients after oral glucose loading and insulin administration (M/B 2.71 +/- 0.19 versus 2.16 +/- 0.07). CONCLUSIONS: In static myocardial viability PET studies with (18)F-FDG an uptake time of 90 min yields image quality superior to that obtained after shorter uptake time.

Lymph node staging in extracranial head and neck cancer with FDG PET--appropriate uptake period and size-dependence of the results.

AIM: Identification of a rationale for the appropriate uptake period for static clinical extracranial head and neck PET imaging and evaluation of the diagnostic accuracy of such an optimized FDG PET approach for lymph node staging in the head and neck region. METHODS: In a subset of 5 patients, kinetic tumour studies were performed in order to identify the cellular activity plateau phase of FDG accumulation for head and neck cancer. Seventy-eight consecutive patients (11 women, 67 men; mean age +/- SD: 55 +/- 11 years; range, 36-78 years), presenting with histologically proven squamous cell carcinoma and sonographically detected lymph nodes in 86 neck sides, underwent clinically indicated FDG PET imaging. PET results were compared to those derived from histological examinations and follow-up imaging results after 6 months in order to calculate sensitivity and specificity for lymph node staging. RESULTS: FDG kinetics in head and neck cancer indicate that the cellular activity plateau of FDG accumulation is reached after an uptake period of 90 min. Using this protocol metastatic involvement of neck sides with lymph nodes less than 1 cm in diameter was correctly identified with a sensitivity of 71.4% and a specificity of 92.3%. Sensitivity increased with the lymph node diameter (1.1-1.5 cm 83.3%, 1.6-2.0 cm 100%, > 2 cm 88.9%). CONCLUSION: The appropriate uptake period for static clinical extracranial head and neck PET imaging that allows measurements in the activity plateau phase is about 90 min. FDG PET may add some significant information regarding metastatic spread into regional lymph nodes.