Time domain reconstruction of sound speed and attenuation in ultrasound computed tomography using full wave inversion.

Ultrasound computed tomography (USCT) is a non-invasive imaging technique that provides information about the acoustic properties of soft tissues in the body, such as the speed of sound (SS) and acoustic attenuation (AA). Knowledge of these properties can improve the discrimination between benign and malignant masses, especially in breast cancer studies. Full wave inversion (FWI) methods for image reconstruction in USCT provide the best image quality compared to more approximate methods. Using FWI, the SS is usually recovered in the time domain, and the AA is usually recovered in the frequency domain. Nevertheless, as both properties can be obtained from the same data, it is desirable to have a common framework to reconstruct both distributions. In this work, an algorithm is proposed to reconstruct both the SS and AA distributions using a time domain FWI methodology based on the fractional Laplacian wave equation, an adjoint field formulation, and a gradient-descent method. The optimization code employs a Compute Unified Device Architecture version of the software k-Wave, which provides high computational efficiency. The performance of the method was evaluated using simulated noisy data from numerical breast phantoms. Errors were less than 0.5% in the recovered SS and 10% in the AA.

Sensitivity estimation in time-of-flight list-mode positron emission tomography.

PURPOSE: An accurate quantification of the images in positron emission tomography (PET) requires knowing the actual sensitivity at each voxel, which represents the probability that a positron emitted in that voxel is finally detected as a coincidence of two gamma rays in a pair of detectors in the PET scanner. This sensitivity depends on the characteristics of the acquisition, as it is affected by the attenuation of the annihilation gamma rays in the body, and possible variations of the sensitivity of the scanner detectors. In this work, the authors propose a new approach to handle time-of-flight (TOF) list-mode PET data, which allows performing either or both, a self-attenuation correction, and self-normalization correction based on emission data only. METHODS: The authors derive the theory using a fully Bayesian statistical model of complete data. The authors perform an initial evaluation of algorithms derived from that theory and proposed in this work using numerical 2D list-mode simulations with different TOF resolutions and total number of detected coincidences. Effects of randoms and scatter are not simulated. RESULTS: The authors found that proposed algorithms successfully correct for unknown attenuation and scanner normalization for simulated 2D list-mode TOF-PET data. CONCLUSIONS: A new method is presented that can be used for corrections for attenuation and normalization (sensitivity) using TOF list-mode data.

Improved quantification for local regions of interest in preclinical PET imaging.

In Positron Emission Tomography, there are several causes of quantitative inaccuracy, such as partial volume or spillover effects. The impact of these effects is greater when using radionuclides that have a large positron range, e.g. (68)Ga and (124)I, which have been increasingly used in the clinic. We have implemented and evaluated a local projection algorithm (LPA), originally evaluated for SPECT, to compensate for both partial-volume and spillover effects in PET. This method is based on the use of a high-resolution CT or MR image, co-registered with a PET image, which permits a high-resolution segmentation of a few tissues within a volume of interest (VOI) centered on a region within which tissue-activity values need to be estimated. The additional boundary information is used to obtain improved activity estimates for each tissue within the VOI, by solving a simple inversion problem. We implemented this algorithm for the preclinical Argus PET/CT scanner and assessed its performance using the radionuclides (18)F, (68)Ga and (124)I. We also evaluated and compared the results obtained when it was applied during the iterative reconstruction, as well as after the reconstruction as a postprocessing procedure. In addition, we studied how LPA can help to reduce the 'spillover contamination', which causes inaccurate quantification of lesions in the immediate neighborhood of large, 'hot' sources. Quantification was significantly improved by using LPA, which provided more accurate ratios of lesion-to-background activity concentration for hot and cold regions. For (18)F, the contrast was improved from 3.0 to 4.0 in hot lesions (when the true ratio was 4.0) and from 0.16 to 0.06 in cold lesions (true ratio = 0.0), when using the LPA postprocessing. Furthermore, activity values estimated within the VOI using LPA during reconstruction were slightly more accurate than those obtained by post-processing, while also visually improving the image contrast and uniformity within the VOI.

Primary T-Cell Non-Hodgkin Lymphoma of the Vagina.

The primary vaginal T-cell non-Hodgkin lymphoma is a rare form of lymphoma. Most of the previously published cases were about B-cell non-Hodgkin lymphomas. We present the case of a vaginal mass in an 82-year-old patient presenting vaginal bleeding. The results of the immunohistological studies of the mass revealed the presence of a cytotoxic T-cell non-Hodgkin lymphoma, which is the least common subtype.

Phase space determination from measured dose data for intraoperative electron radiation therapy.

A procedure to characterize beams of a medical linear accelerator for their use in Monte Carlo (MC) dose calculations for intraoperative electron radiation therapy (IOERT) is presented. The procedure relies on dose measurements in homogeneous media as input, avoiding the need for detailed simulations of the accelerator head. An iterative algorithm (EM-ML) has been employed to extract the relevant details of the phase space (PHSP) of the particles coming from the accelerator, such as energy spectra, spatial distribution and angle of emission of particles. The algorithm can use pre-computed dose volumes in water and/or air, so that the machine-specific tuning with actual data can be performed in a few minutes. To test the procedure, MC simulations of a linear accelerator with typical IOERT applicators and energies, have been performed and taken as reference. A solution PHSP derived from the dose produced by the simulated accelerator has been compared to the reference PHSP. Further, dose delivered by the simulated accelerator for setups not included in the fit of the PHSP were compared to the ones derived from the solution PHSP. The results show that it is possible to derive from dose measurements PHSP accurate for IOERT MC dose estimations.

Simulation of triple coincidences in PET.

Although current PET scanners are designed and optimized to detect double coincidence events, there is a significant amount of triple coincidences in any PET acquisition. Triple coincidences may arise from causes such as: inter-detector scatter (IDS), random triple interactions (RT), or the detection of prompt gamma rays in coincidence with annihilation photons when non-pure positron-emitting radionuclides are used (ß(+)γ events). Depending on the data acquisition settings of the PET scanner, these triple events are discarded or processed as a set of double coincidences if the energy of the three detected events is within the scanner's energy window. This latter option introduces noise in the data, as at most, only one of the possible lines-of-response defined by triple interactions corresponds to the line along which the decay occurred. Several novel works have pointed out the possibility of using triple events to increase the sensitivity of PET scanners or to expand PET imaging capabilities by allowing differentiation between radiotracers labeled with non-pure and pure positron-emitting radionuclides. In this work, we extended the Monte Carlo simulator PeneloPET to assess the proportion of triple coincidences in PET acquisitions and to evaluate their possible applications. We validated the results of the simulator against experimental data acquired with a modified version of a commercial preclinical PET/CT scanner, which was enabled to acquire and process triple-coincidence events. We used as figures of merit the energy spectra for double and triple coincidences and the triples-to-doubles ratio for different energy windows and radionuclides. After validation, the simulator was used to predict the relative quantity of triple-coincidence events in two clinical scanners assuming different acquisition settings. Good agreement between simulations and preclinical experiments was found, with differences below 10% for most of the observables considered. For clinical scanners and pure positron emitters, we found that around 10% of the processed double events come from triple coincidences, increasing this ratio substantially for non-pure emitters (around 25% for (124)I and > 50% for (86)Y). For radiotracers labeled with (18)F we found that the relative quantity of IDS events in standard acquisitions is around 18% for the preclinical scanner and between 14 and 22% for the clinical scanners. For non-pure positron emitters like (124)I, we found a ß(+)γ triples-to-doubles ratio of 2.5% in the preclinical scanner and of up to 4% in the clinical scanners.

Positron range estimations with PeneloPET.

Technical advances towards high resolution PET imaging try to overcome the inherent physical limitations to spatial resolution. Positrons travel in tissue until they annihilate into the two gamma photons detected. This range is the main detector-independent contribution to PET imaging blurring. To a large extent, it can be remedied during image reconstruction if accurate estimates of positron range are available. However, the existing estimates differ, and the comparison with the scarce experimental data available is not conclusive. In this work we present positron annihilation distributions obtained from Monte Carlo simulations with the PeneloPET simulation toolkit, for several common PET isotopes ((18)F, (11)C, (13)N, (15)O, (68)Ga and (82)Rb) in different biological media (cortical bone, soft bone, skin, muscle striated, brain, water, adipose tissue and lung). We compare PeneloPET simulations against experimental data and other simulation results available in the literature. To this end the different positron range representations employed in the literature are related to each other by means of a new parameterization for positron range profiles. Our results are generally consistent with experiments and with most simulations previously reported with differences of less than 20% in the mean and maximum range values. From these results, we conclude that better experimental measurements are needed, especially to disentangle the effect of positronium formation in positron range. Finally, with the aid of PeneloPET, we confirm that scaling approaches can be used to obtain universal, material and isotope independent, positron range profiles, which would considerably simplify range correction.

Improved dead-time correction for PET scanners: application to small-animal PET.

Pile-up and dead-time are two main causes of nonlinearity in the response of a PET scanner as a function of activity in the field of view (FOV). For a given scanner and acquisition system, pile-up effects depend on the material and size of the object being imaged and on the distribution of activity inside and outside the FOV, because these factors change the singles-to-coincidences ratio (SCR). Thus, it is difficult to devise an accurate correction that would be valid for any acquisition. In this work, we demonstrate a linear relationship between SCR and effective dead-time, which measures the effects of both dead-time (losses) and pile-up (gains and losses). This relationship allows us to propose a simple method to accurately estimate dead-time and pile-up corrections using only two calibration acquisitions with, respectively, a high and low SCR. The method has been tested with simulations and experimental data for two different scanner geometries: a scanner with large area detectors and no pile-up rejection, and a scanner composed of two full rings of smaller detectors. Our results show that the SCR correction method is accurate within 7%, even for high activities in the FOV, and avoids the bias of the standard single-parameter method.

Measurements of the electric form factor of the neutron up to Q2=3.4 GeV2 using the reaction 3He(e,e'n)pp.

The electric form factor of the neutron was determined from studies of the reaction 3He(e,e'n)pp in quasielastic kinematics in Hall A at Jefferson Lab. Longitudinally polarized electrons were scattered off a polarized target in which the nuclear polarization was oriented perpendicular to the momentum transfer. The scattered electrons were detected in a magnetic spectrometer in coincidence with neutrons that were registered in a large-solid-angle detector. More than doubling the Q2 range over which it is known, we find G(E)(n)=0.0236±0.0017(stat)±0.0026(syst), 0.0208±0.0024±0.0019, and 0.0147±0.0020±0.0014 for Q(2)=1.72, 2.48, and 3.41 GeV2, respectively.

PeneloPET, a Monte Carlo PET simulation tool based on PENELOPE: features and validation.

Monte Carlo simulations play an important role in positron emission tomography (PET) imaging, as an essential tool for the research and development of new scanners and for advanced image reconstruction. PeneloPET, a PET-dedicated Monte Carlo tool, is presented and validated in this work. PeneloPET is based on PENELOPE, a Monte Carlo code for the simulation of the transport in matter of electrons, positrons and photons, with energies from a few hundred eV to 1 GeV. PENELOPE is robust, fast and very accurate, but it may be unfriendly to people not acquainted with the FORTRAN programming language. PeneloPET is an easy-to-use application which allows comprehensive simulations of PET systems within PENELOPE. Complex and realistic simulations can be set by modifying a few simple input text files. Different levels of output data are available for analysis, from sinogram and lines-of-response (LORs) histogramming to fully detailed list mode. These data can be further exploited with the preferred programming language, including ROOT. PeneloPET simulates PET systems based on crystal array blocks coupled to photodetectors and allows the user to define radioactive sources, detectors, shielding and other parts of the scanner. The acquisition chain is simulated in high level detail; for instance, the electronic processing can include pile-up rejection mechanisms and time stamping of events, if desired. This paper describes PeneloPET and shows the results of extensive validations and comparisons of simulations against real measurements from commercial acquisition systems. PeneloPET is being extensively employed to improve the image quality of commercial PET systems and for the development of new ones.

FIRST: Fast Iterative Reconstruction Software for (PET) tomography.

Small animal PET scanners require high spatial resolution and good sensitivity. To reconstruct high-resolution images in 3D-PET, iterative methods, such as OSEM, are superior to analytical reconstruction algorithms, although their high computational cost is still a serious drawback. The higher performance of modern computers could make iterative image reconstruction fast enough to be viable, provided we are able to deal with the large number of probability coefficients for the system response matrix in high-resolution PET scanners, which is a difficult task that prevents the algorithms from reaching peak computing performance. Considering all possible axial and in-plane symmetries, as well as certain quasi-symmetries, we have been able to reduce the memory requirements to store the system response matrix (SRM) well below 1 GB, which allows us to keep the whole response matrix of the system inside RAM of ordinary industry-standard computers, so that the reconstruction algorithm can achieve near peak performance. The elements of the SRM are stored as cubic spline profiles and matched to voxel size during reconstruction. In this way, the advantages of 'on-the-fly' calculation and of fully stored SRM are combined. The on-the-fly part of the calculation (matching the profile functions to voxel size) of the SRM accounts for 10-30% of the reconstruction time, depending on the number of voxels chosen. We tested our approach with real data from a commercial small animal PET scanner. The results (image quality and reconstruction time) show that the proposed technique is a feasible solution.

Artritis tuberculosa periférica / Peripheral tuberculous arthritis

No disponible

Un paciente con poliartritis en atención primaria

Las enfermedades reumatológicas constituyen uno de los motivos más frecuentes de consulta en atención primaria. Dentro de los procesos degenerativos, la artrosis ocupa el primer lugar tanto por el número de consultas que genera como por los recursos terapéuticos que consume, así como por las repercusiones en el ámbito laboral de los pacientes. Por otro lado, las monoartritis y poliartritis son los cuadros de presentación aguda y subaguda más frecuentes y con mayor trascendencia en lo que se refiere al diagnóstico y tratamiento. Por tanto, la evaluación de un paciente con poliartritis supone un desafío para el clínico, siendo muy importante una correcta aproximación al paciente para llegar a un diagnóstico preciso (AU)

Cuadro cutáneo y articular en un varón de 52 años de edad / Cutaneous and joint in 52-year old male

No disponible

Glucose-dependent insulinotropic peptide signaling pathways in endothelial cells.

Glucose-dependent insulinotropic peptide (GIP) potentiates glucose-induced insulin secretion. In addition, GIP has vasoconstrictive or vasodilatory properties depending on the vascular bed affected. In order to assess whether this effect could be related to differences in GIP receptor expression, several different endothelial cell types were examined for GIP receptor expression. GIP receptor splice variants were detected and varied depending on the endothelial cell type. Furthermore, stimulation of these cells with GIP led to cell type dependent differences in activation of the calcium and cAMP signaling pathways. To our knowledge this is the first physiological characterization of receptors for GIP in endothelial cells.

[The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: a safe and advisable technique]. / Derivación cavopulmonar (Glenn) bidireccional sin circulación extracorpórea: una técnica segura y recomendable.

The bidirectional cavopulmonary (Glenn) shunt is almost a routine first step procedure for total cavopulmonary connection in children with single-ventricle cardiac anomalies. It is usually performed with cardiopulmonary bypass, of which adverse effects can be especially deleterious in these cardiac conditions. To avoid these adverse effects, we performed the cavopulmonary shunt in 5 children through sternotomy without cardiopulmonary bypass. There was no mortality nor morbidity. We think that this technique is safe, reproducible, and even advisable in children with single-ventricle anomalies.

Functional parathyroid hormone receptors are present in an umbilical vein endothelial cell line.

Acute parathyroid hormone exposure induces vascular smooth muscle relaxation. In contrast, continuous infusion of parathyroid hormone leads to vasoconstriction and an elevation of blood pressure. Despite the known effects of parathyroid hormone on vascular smooth muscle, possible direct effects on the vascular endothelium have not previously been investigated. Using a human umbilical vein endothelial cell line, we found that parathyroid hormone increased both intracellular calcium and cellular cAMP content in these endothelial cells. Furthermore, exposure of these cells to increasing concentrations of parathyroid hormone stimulated both [(3)H]thymidine incorporation and endothelin-1 secretion. Parathyroid hormone/parathyroid hormone-related peptide receptor mRNA could be detected at low levels in these cells. In summary, these data demonstrate that endothelium-derived cells contain functional parathyroid hormone receptors. The potential physiological role of these receptors remains to be determined.

Novel effect of insulin: insulin-stimulated Na+ transport is mediated by hydrolysis of phosphoinositides.

Previous studies showed that insulin stimulation of electrogenic Na+ transport in renal epithelial cells is mediated by a calcium-dependent signal transduction mechanism. The present study was performed to determine whether the insulin-induced increase in intracellular Ca2+ (Cai2+) was mediated by hydrolysis of phosphatidylinositol and release of inositol trisphosphate. Experiments were conducted with cultured A6 cells, derived from Xenopus Laevis, grown on permeable supports. Addition of insulin resulted in 2 to 3 fold increases in inositol trisphosphate and a 50% increase in 1,2 diacylglycerol within 10s, which corresponded to the time-course, previously reported, of insulin stimulated increases in Na+ transport and Cai2+. Further studies showed that aldosterone, previously shown to stimulate an increase in 1,4,5-inositol trisphosphate at onset of the rise in Na+ transport, also increased DAG levels during the initial phase of stimulation of Na+ transport. These studies provide the first evidence that a biological response induced by insulin is mediated by hydrolysis of phosphatidylinositol 4,5-bisphosphate (PIP2) which results in two products, inositol trisphosphate which causes the release of Ca2+ from intracellular stores and 1,2 diacylglycerol. In addition this study provides further support for the proposal that a common signal transduction mechanism mediates electrogenic Na+ transport by multiple agonists.