A Positron Emission Tomography Study of Dopamine Transporter Density in Patients With Bipolar Disorder With Current Mania and Those With Recently Remitted Mania.

Importance: Although dopamine is implicated in the pathophysiology of bipolar disorder (BD), the precise alterations in the dopaminergic system remain unknown. Objective: To assess dopamine transporter (DAT) density in the striatum in patients with BD with current and recently remitted mania in comparison to healthy control individuals and its correlation with severity of manic symptoms. Design, Setting, and Participants: This cross-sectional study conducted in a tertiary care referral center for mood disorders in Vancouver, British Columbia, Canada, recruited 26 patients with BD (9 with current mania; 17 with recently remitted mania) and 21 matched healthy control individuals. DAT density was measured using positron emission tomography with [11C]d-threo-methylphenidate (MP). The differences between the groups in nondisplaceable binding potential (BPND) for DAT was assessed using statistical parametric mapping. The study was conducted from November 2001 to February 2007 and the data were analyzed from November 2020 to December 2021. Main Outcomes and Measures: DAT density as indexed by BPND for MP across groups; manic symptom severity as measured with the Young Mania Rating Scale (YMRS) and correlated with BPND values in patients with BD. Results: Of 47 total participants (mean [SD] age, 37.8 [14.4] years), 27 (57.4%) were female; 26 individuals had BD (9 with current mania and 17 with recently remitted mania) and there were 21 healthy control individuals. MP BPND was significantly lower in patients with BD in the right putamen and nucleus accumbens (mean reduction [MR] = 22%; cluster level familywise error [FWE]-corrected P < .001) as well as left putamen and caudate (MR = 24%; cluster level FWE-corrected P < .001). The reduction in BPND was more extensive and pronounced in patients with current mania, while patients with recently remitted mania had lower BPND in the left striatum but not the right. There was a significant negative correlation between YMRS scores and MP BPND in the right striatum in patients with current mania (ρ = -0.93; 95% CI, -0.99 to -0.69; P < .001) and those with recently remitted mania (ρ = 0.64; 95% CI, -0.86 to -0.23; P = .005) but not in the left striatum in either group. Conclusions and Relevance: These findings indicate that mania was associated with reduced DAT density and remitted mania was associated with DAT levels that approximated those present in individuals without BD. These results have potential implications for drug development for mania.

Determination of gamma camera calibration factors for quantitation of therapeutic radioisotopes.

BACKGROUND: Camera calibration, which translates reconstructed count map into absolute activity map, is a prerequisite procedure for quantitative SPECT imaging. Both planar and tomographic scans using different phantom geometries have been proposed for the determination of the camera calibration factor (CF). However, there is no consensus on which approach is the best. The aim of this study is to evaluate all these calibration methods, compare their performance, and propose a practical and accurate calibration method for SPECT quantitation of therapeutic radioisotopes. Twenty-one phantom experiments (Siemens Symbia SPECT/CT) and 12 Monte Carlo simulations (GATE v6.1) using three therapy isotopes (131I, 177Lu, and 188Re) have been performed. The following phantom geometries were used: (1) planar scans of point source in air (PS), (2) tomographic scans of insert(s) filled with activity placed in non-radioactive water (HS + CB), (3) tomographic scans of hot insert(s) in radioactive water (HS + WB), and (4) tomographic scans of cylinders uniformly filled with activity (HC). Tomographic data were reconstructed using OSEM with CT-based attenuation correction and triple energy window (TEW) scatter correction, and CF was determined using total counts in the reconstructed image, while for planar scans, the photopeak counts, corrected for scatter and background with TEW, were used. Additionally, for simulated data, CF obtained from primary photons only was analyzed. RESULTS: For phantom experiments, CF obtained from PS and HS + WB agreed to within 6% (below 3% if experiments performed on the same day are considered). However, CF from HS + CB exceeded those from PS by 4-12%. Similar trend was found in simulation studies. Analysis of CFs from primary photons helped us to understand this discrepancy. It was due to underestimation of scatter by the TEW method, further enhanced by attenuation correction. This effect becomes less important when the source is distributed over the entire phantom volume (HS + WB and HC). CONCLUSIONS: Camera CF could be determined using planar scans of a point source, provided that the scatter and background contributions are removed, for example using the clinically available TEW method. This approach is simple and yet provides CF with sufficient accuracy (~ 5%) to be used in clinics for radiotracer quantification.

Deadtime effects in quantification of 177Lu activity for radionuclide therapy.

BACKGROUND: The aim of this study was to investigate the deadtime (DT) effects that are present in 177Lu images acquired after radionuclide therapy injection, assess differences in DT based on the full spectrum and the photopeak-only measurements, and design a method to correct for the deadtime losses. A Siemens SymbiaT SPECT/CT camera with a medium energy collimator was used. A 295-mL bottle was placed off-center inside a large cylinder filled with water, and 177Lu activity was sequentially added up to a maximum of 9.12 GBq. The true count rates vs. observed count rates were plotted and fitted to the DT paralyzable model. This analysis was performed using counts recorded in the full spectrum and in other energy windows. The DT correction factors were calculated using the percentage difference between the true and the observed count rates. RESULTS: The DT values of 5.99 ± 0.02 µs, 4.60 ± 0.052 µs, and 0.19 ± 0.18 µs were obtained for the primary photons (PP) recorded in the 113- and 208-keV photopeaks and for the full spectrum, respectively. For the investigated range of count rates, the DT correction factors of up to 23% were observed for PP corresponding to the 113-keV photopeak, while for the 208-keV photopeak values of up to 20% were obtained. These values were almost three times higher than the deadtime correction factors derived from the full spectrum. CONCLUSIONS: The paralyzable model showed to be appropriate for the investigated range of counts, which were five to six times higher than those observed in the patient post-therapy imaging. Our results suggest that the deadtime corrections should be based on count losses in the scatter-corrected photopeak window and not on the deadtime determined from the full spectrum. Finally, a general procedure that can be followed to correct patient images for deadtime is presented.

Preparation of CuONPs@PVDF/Non-Woven Polyester Composite Membrane: Structural Influence of Nanoparticle Addition.

Membrane distillation techniques have appeared as promising options for guaranteeing the availability of potable water in times of scarcity of this essential resource. For membrane preparation, polyvinylidene fluoride (PVDF) is preferred due to the easier synthesis procedures, with respect to other fluorine-based polymers. In this work, copper oxide nanoparticles (CuONPs) of different weight percent (wt %) embedded in PVDF membranes supported on non-woven polyester fabric (NWPET) were prepared by the phase inversion method, and characterized by spectroscopy (ATR-FTIR, Raman) and electron microscopy techniques (SEM). The PVDF deposited onto the NWPET was mostly composed of its polar ß-phase (F(ß) = 53%), which was determined from the ATR-FTIR spectrum. The F(ß) value remained constant throughout the whole range of added CuONP concentrations (2⁻10 wt %), as was determined from the ATR-FTIR spectrum. The absence of signals corresponding to CuONPs in the ATR-FTIR spectra and the appearance of peaks at 297, 360, and 630 cm-1 in the Raman spectra of the membranes suggest that the CuONPs are preferably located in the inner PVDF membrane, but not on its surface. The membrane morphologies were characterized by SEM. From the obtained SEM micrographs, a decrease and increase in the amount of micropores and nanopores, respectively, near the surface and intercalated in the finger-like layer were observed. As a result of the CuONP addition, the nanopores in the sponge-like layer decreased in size. The values of water contact angle (WCA) measurements showed a decreasing trend, from 94° to 80°, upon the addition of CuONPs (2⁻10 wt %), indicating a diminishment in the hydrophobicity degree of the membranes. Apparently, the increase in the amount of nanopores near the surface decreased the membrane roughness, so it became less hydrophobic.

Accuracy of 177Lu activity quantification in SPECT imaging: a phantom study.

BACKGROUND: The aim of the study is to assess accuracy of activity quantification of 177Lu studies performed according to recommendations provided by the committee on Medical Internal Radiation Dose (MIRD) pamphlets 23 and 26. The performances of two scatter correction and three segmentation methods were compared. Additionally, the accuracy of tomographic and planar methods for determination of the camera normalization factor (CNF) was evaluated. Eight phantoms containing inserts of different sizes and shapes placed in air, water, and radioactive background were scanned using a Siemens SymbiaT SPECT/CT camera. Planar and tomographic scans with 177Lu sources were used to measure CNF. Images were reconstructed with our SPEQToR software using resolution recovery, attenuation, and two scatter correction methods (analytical photon distribution interpolated (APDI) and triple energy window (TEW)). Segmentation was performed using a fixed threshold method for both air and cold water scans. For hot water experiments three segmentation methods were compared as folows: a 40% fixed threshold, segmentation based on CT images, and our iterative adaptive dual thresholding (IADT). Quantification error, defined as the percent difference between experimental and true activities, was evaluated. RESULTS: Quantification error for scans in air was better for TEW scatter correction (<6%) than for APDI (<11%). This trend was reversed for scans in water (<10% for APDI and <14% for TEW). For hot water, the best results (<18% for small objects and <5% for objects >100 ml) were obtained when APDI and IADT were used for scatter correction and segmentation, respectively. Additionally, we showed that planar acquisitions with scatter correction and tomographic scans provide similar CNF values. This is an important finding because planar acquisitions are easier to perform than tomographic scans. TEW and APDI resulted in similar quantification errors with APDI showing a small advantage for objects placed in medium with non-uniform density. CONCLUSIONS: Following the MIRD recommendations for data acquisition and reconstruction resulted in accurate activity quantification (errors <5% for large objects). However, techniques for better organ/tumor segmentation must still be developed.

Accuracy, reproducibility, and uncertainty analysis of thyroid-probe-based activity measurements for determination of dose calibrator settings.

PURPOSE: In the nuclear medicine department, the activity of radiopharmaceuticals is measured using dose calibrators (DCs) prior to patient injection. The DC consists of an ionization chamber that measures current generated by ionizing radiation (emitted from the radiotracer). In order to obtain an activity reading, the current is converted into units of activity by applying an appropriate calibration factor (also referred to as DC dial setting). Accurate determination of DC dial settings is crucial to ensure that patients receive the appropriate dose in diagnostic scans or radionuclide therapies. The goals of this study were (1) to describe a practical method to experimentally determine dose calibrator settings using a thyroid-probe (TP) and (2) to investigate the accuracy, reproducibility, and uncertainties of the method. As an illustration, the TP method was applied to determine 188Re dial settings for two dose calibrator models: Atomlab 100plus and Capintec CRC-55tR. METHODS: Using the TP to determine dose calibrator settings involved three measurements. First, the energy-dependent efficiency of the TP was determined from energy spectra measurements of two calibration sources (152Eu and 22Na). Second, the gamma emissions from the investigated isotope (188Re) were measured using the TP and its activity was determined using γ-ray spectroscopy methods. Ambient background, scatter, and source-geometry corrections were applied during the efficiency and activity determination steps. Third, the TP-based 188Re activity was used to determine the dose calibrator settings following the calibration curve method [B. E. Zimmerman et al., J. Nucl. Med. 40, 1508-1516 (1999)]. The interobserver reproducibility of TP measurements was determined by the coefficient of variation (COV) and uncertainties associated to each step of the measuring process were estimated. The accuracy of activity measurements using the proposed method was evaluated by comparing the TP activity estimates of 99mTc, 188Re, 131I, and 57Co samples to high purity Ge (HPGe) γ-ray spectroscopy measurements. RESULTS: The experimental 188Re dial settings determined with the TP were 76.5 ± 4.8 and 646 ± 43 for Atomlab 100plus and Capintec CRC-55tR, respectively. In the case of Atomlab 100plus, the TP-based dial settings improved the accuracy of 188Re activity measurements (confirmed by HPGe measurements) as compared to manufacturer-recommended settings. For Capintec CRC-55tR, the TP-based settings were in agreement with previous results [B. E. Zimmerman et al., J. Nucl. Med. 40, 1508-1516 (1999)] which demonstrated that manufacturer-recommended settings overestimate 188Re activity by more than 20%. The largest source of uncertainty in the experimentally determined dial settings was due to the application of a geometry correction factor, followed by the uncertainty of the scatter-corrected photopeak counts and the uncertainty of the TP efficiency calibration experiment. When using the most intense photopeak of the sample's emissions, the TP method yielded accurate (within 5% errors) and reproducible (COV = 2%) measurements of sample's activity. The relative uncertainties associated with such measurements ranged from 6% to 8% (expanded uncertainty at 95% confidence interval, k = 2). CONCLUSIONS: Accurate determination/verification of dose calibrator dial settings can be performed using a thyroid-probe in the nuclear medicine department.

Neuroprogression and episode recurrence in bipolar I disorder: A study of gray matter volume changes in first-episode mania and association with clinical outcome.

OBJECTIVES: Bipolar I disorder (BD-I) is associated with gray matter volume (GMV) alterations in neural regions important for emotional regulation. Reductions found in patients with multiple episodes are not seen at illness onset, suggesting that changes occur with illness progression, although no prospective studies to date have examined this. In the present study, we assessed GMV at baseline and one year following a first manic episode, examining the impact of episode recurrence on the trajectory of change. METHODS: A total of 41 recently remitted first manic episode patients with BD-I and 25 healthy subjects (HS) underwent 3T magnetic resonance imaging at baseline and one year later. Using voxel-based morphometry, we compared GMV change between HS, patients who experienced a recurrence of a mood episode (BDrecurr ), and patients in sustained remission (BDwell ). RESULTS: The GMV change from baseline to one year did not differ significantly between HS and the full BD-I group or BDwell and HS. However, the BDrecurr group had greater GMV loss than HS in left frontal and bilateral temporal regions, and BDwell patients involving bilateral frontal, temporal and left parietal regions. CONCLUSIONS: GMV change early in the course of BD-I is associated with clinical outcome, such that neuroprogression found in patients who experience a recurrence of a mood episode is not seen in those with sustained remission. These findings have important implications for the treatment of BD-I as they suggest that prevention of recurrence might minimize neuroprogression of the disease, possibly requiring a multipronged early intervention approach to achieve this goal.

Characteristics of Bremsstrahlung emissions of (177)Lu, (188)Re, and (90)Y for SPECT/CT quantification in radionuclide therapy.

PURPOSE: Beta particles emitted by radioisotopes used in targeted radionuclide therapies (TRT) create Bremsstrahlung (BRS) which may affect SPECT quantification when imaging these isotopes. The purpose of the current study was to investigate the characteristics of Bremsstrahlung produced in tissue by three ß-emitting radioisotopes used in TRT. METHODS: Monte Carlo simulations of (177)Lu, (188)Re, and (90)Y sources placed in water filled cylinders were performed. BRS yields, mean energies and energy spectra for (a) all photons generated in the decays, (b) photons that were not absorbed and leave the cylinder, and (c) photons detected by the camera were analyzed. Next, the results of simulations were compared with those from experiments performed on a clinical SPECT camera using same acquisition conditions and phantom configurations as in simulations. RESULTS: Simulations reproduced relatively well the shapes of the measured spectra, except for (90)Y which showed an overestimation in the low energy range. Detailed analysis of the results allowed us to suggest best collimators and imaging conditions for each of the investigated isotopes. Finally, our simulations confirmed that the BRS contribution to the energy spectra in quantitative imaging of (177)Lu and (188)Re could be ignored. CONCLUSIONS: For (177)Lu and (188)Re, BRS contributes only marginally to the total spectra recorded by the camera. Our analysis shows that MELP and HE collimators are the best for imaging these two isotopes. For (90)Y, HE collimator should be used.

Exploring the use of shape and texture descriptors of positron emission tomography tracer distribution in imaging studies of neurodegenerative disease.

Positron emission tomography (PET) data related to neurodegeneration are most often quantified using methods based on tracer kinetic modeling. In contrast, here we investigate the ability of geometry and texture-based metrics that are independent of kinetic modeling to convey useful information on disease state. The study was performed using data from Parkinson's disease subjects imaged with (11)C-dihydrotetrabenazine and (11)C-raclopride. The pattern of the radiotracer distribution in the striatum was quantified using image-based metrics evaluated over multiple regions of interest that were defined on co-registered PET and MRI images. Regression analysis showed a significant degree of correlation between several investigated metrics and clinical evaluations of the disease (p < 0.01). The best results were obtained with the first-order moment invariant of the radioactivity concentration values estimated over the full structural extent of the region as defined by MRI (R(2 )= 0.94). These results demonstrate that there is clinically relevant quantitative information in the tracer distribution pattern that can be captured using geometric and texture descriptors. Such metrics may provide an alternate and complementary data analysis approach to traditional kinetic modeling.

Anterior brain glucose hypometabolism predates dementia in progranulin mutation carriers.

OBJECTIVE: In this prospective cohort study, we investigated cerebral glucose metabolism reductions on [(18)F]-fluorodeoxyglucose (FDG)-PET in progranulin (GRN) mutation carriers prior to frontotemporal dementia (FTD) onset. METHODS: Nine mutation carriers (age 51.5 ± 13.5 years) and 11 noncarriers (age 52.7 ± 9.5 years) from 5 families with FTD due to GRN mutations underwent brain scanning with FDG-PET and MRI and clinical evaluation. Normalized FDG uptake values were calculated with reference to the pons. PET images were analyzed with regions of interest (ROI) and statistical parametric mapping (SPM) approaches. RESULTS: Compared with noncarriers, GRN mutation carriers had a lowered anterior-to-posterior (AP) ratio of FDG uptake (0.86 ± 0.09 vs 0.92 ± 0.05) and less left-right asymmetry, consistent with an overall pattern of right anterior cerebral hypometabolism. This pattern was observed regardless of whether they were deemed clinically symptomatic no dementia or asymptomatic. Individual ROIs with lowered FDG uptake included right anterior cingulate, insula, and gyrus rectus. SPM analysis supported and extended these findings, demonstrating abnormalities in the right and left medial frontal regions, right insular cortex, right precentral and middle frontal gyri, and right cerebellum. Right AP ratio was correlated with cognitive and clinical scores (modified Mini-Mental State Examination r = 0.74; Functional Rating Scale r = -0.73) but not age and years to estimated onset in mutation carriers. CONCLUSION: The frontotemporal lobar degenerative process associated with GRN mutations appears to begin many years prior to the average age at FTD onset (late 50s-early 60s). Right medial and ventral frontal cortex and insula may be affected in this process but the specific regional patterns associated with specific clinical variants remain to be elucidated.

Novel spatial analysis method for PET images using 3D moment invariants: applications to Parkinson's disease.

We present a novel analysis method for positron emission tomography (PET) data that uses the spatial characteristics of the radiotracer's distribution within anatomically-defined regions of interest (ROIs) to provide an independent feature that may aid in characterizing pathological and normal states. The analysis of PET data for research purposes traditionally involves kinetic modeling of the concentration of the radiotracer over time within a ROI to derive parameters related to the uptake/binding of the radiotracer in the body. Here we describe an analysis method to quantify the spatial changes present in PET images based on 3D shape descriptors that are invariant to translation, scaling, and rotation, called 3D moment invariants (3DMIs). An ROI can therefore be characterized not only by the radiotracer's uptake rate constant or binding potential within the ROI, but also the 3D spatial shape and distribution of the radioactivity throughout the ROI. This is particularly relevant in Parkinson's disease (PD), where both the kinetic and the spatial distribution of the tracer are known to change due to disease: the posterior parts of the striatum (in particular in the putamen) are affected before the anterior parts. Here we show that 3DMIs are able to quantify the spatial distribution of PET radiotracer images allowing for discrimination between healthy controls and PD subjects. More importantly, 3DMIs are found to be well correlated with subjects' scores on the United Parkinson's Disease Rating Scale (a clinical measure of disease severity) in all anatomical regions studied here (putamen, caudate and ventral striatum). On the other hand, kinetic parameters only show significant correlation to clinically-assessed PD severity in the putamen. We also find that 3DMI-characterized changes in spatial patterns of dopamine release in response to l-dopa medication are significantly correlated with PD severity. These findings suggest that quantitative studies of a radiotracer's spatial distribution may provide complementary information to kinetic modeling that is relatively robust to intersubject variability and may contribute novel information in PET neuroimaging studies.

Contributions of the mitogen-activated protein kinase and protein kinase C cascades in spatial learning and memory mediated by the nucleus accumbens.

Several studies have reported a role for the nucleus accumbens (NAcc) in learning and memory. Specifically, NAcc seems to function as a neural bridge for the translation of corticolimbic information to the motor system mediating locomotor learning, but the signaling mechanisms involved in this striatal learning await further investigation. The present experiments investigated the role of the mitogen-activated protein kinase (MAPK) and protein kinase C (PKC) cascades within the NAcc of Long-Evans rats in a food-search spatial learning task (FSSLT). First, we used immunoblotting to examine changes in MAPK p42/p44 phosphorylation within the NAcc in the acquisition phase of the FSSLT. Second, we examined the effect on the acquisition and retention phases in the FSSLT of pretraining intra-accumbal microinjections of the MAPK [U0126; 1,4-diamino-2,3-dicyano-1,4-bis(2-aminophynyltio)butadiene, 1 microg/side] or PKC [GF109203X; bisindolylmaleimide or 1-(3-dimethylaminopropyl)-indol-3-yl]-3-(indol-3-yl) maleimide, 0.5 ng/side] inhibitors (four training sessions; one session/day). Third, the potential coupling of PKC and MAPK signaling pathways in the NAcc in spatial learning was studied using microinjections of GF109203X, radioactive activity assays, and immunoblotting. Results showed that 1) MAPK p42/p44 phosphorylation is augmented within the NAcc after spatial learning, 2) MAPK and PKC inhibition caused differential deficits in the acquisition and formation of spatial memories, and 3) inhibition of PKC activity by GF109203X caused a reduction in MAPKs phosphorylation in the NAcc in an early stage of the acquisition phase. Overall, these findings suggest that NAcc-PKC and -MAPK play important roles in spatial learning and that MAPKs phosphorylation seems to be mediated through the activation of the PKC signaling pathway.

Spatial learning in rats is impaired by microinfusions of protein kinase C-gamma antisense oligodeoxynucleotide within the nucleus accumbens.

The nucleus accumbens (NAcc) has been shown to play a role in motor and spatial learning. Protein kinase C (PKC) has been implicated in the mechanisms of initiation and maintenance of long-term potentiation that is thought to be involved in the storage of long-term memory. In the present study, the importance of de novo synthesis of PKC-gamma within the NAcc in the acquisition and retention of spatial discrimination learning was assessed using an antisense knockdown approach. Separate groups of Long-Evans rats were exposed to acute microinfusions (6microg/microl) of PKC-gamma antisense oligodeoxynucleotide (AS-ODN), control oligodeoxynucleotide (C-ODN) or vehicle into the NAcc at 24 and 3h before each training session. Behavioral findings showed that the blockade of NAcc-PKC-gamma translation caused impairments in the early phase of learning and retention of spatial information. Biochemical experiments showed that PKC-gamma expression was reduced and Ca(2+)/phospholipid-dependent protein kinase C (PKC) activity was blocked significantly in the AS-ODN-treated rats in comparison with control rats. The present findings suggest that NAcc-PKC-gamma plays a role during the early acquisition of spatial learning. Also, retention test results suggest that NAcc-PKC-gamma may be working as an intermediate factor involved in the onset of molecular mechanisms necessary for spatial memory consolidation within the NAcc.

La historia clínica como instrumento de método clínico y su importancia en la realización del tratamiento odontológico / The medical history as instrument of clinical methods and importancy in the dentristry treatment

Resalta la importancia que tiene la historia clínica como instrumento administrativo científico y legal para la atención del individuo en el área de la salud y evaluara si a los pacientes que acuden a los servicios clínicos de la Facultad de Odontología de la UCV, se les realizan el tratamiento adecuado de acuerdo a las necesidades encontradas durante la elaboración de la historia clínica

La historia clínica como instrumento de método clínico y su importancia en la realización del tratamiento odontológico / The medical history as instrument of clinical methods and importancy in the dentristry treatment

Resalta la importancia que tiene la historia clínica como instrumento administrativo científico y legal para la atención del individuo en el área de la salud y evaluara si a los pacientes que acuden a los servicios clínicos de la Facultad de Odontología de la UCV, se les realizan el tratamiento adecuado de acuerdo a las necesidades encontradas durante la elaboración de la historia clínica