Cold Lesion Research Articles

Effects of enriched environment on barrel cortex and hippocampus function following somatosensory damage in rat.

This study investigated the effects of environmental enrichment (EE) on the behavior and histological alterations of rats with barrel cortex damage. Forty-eight adult male rats were divided into Control (Ctrl), Lesion, Lesion+EE.S (Lesion+Standard Enriched Environment, and Lesion+EE.T (Lesion+Tactile Enriched Environment) groups. The animals were first anesthetized, and then, a cold lesion model was performed on the parietal cortex. After surgery, the rats were exposed to a standard enriched environment or enriched environment with tactile for 30 days. Their cognitive behaviors were assessed using an open field, novel texture discrimination, and Morris water maze (MWM) tests. In addition, a histological investigation was conducted to determine the degree of degeneration of hippocampal and somatosensory cortex neurons. The results demonstrated that rats with barrel cortex lesions revealed impairments in novel texture discrimination and MWM tests (P<0.001). Moreover, lesions increased neuronal degeneration in rats' barrel cortex and hippocampus (P< 0.001). Environmental enrichment improved behavioral deficits and decreased neuronal degeneration in the barrel cortex and hippocampus of rats with barrel cortex lesions (P<0.05). The current study suggests that barrel cortex lesions create cognitive and behavioral deficits and neural degeneration in the barrel cortex and hippocampus; however, environmental enrichment could reverse these impairments.

Amelioration of behavioral and histological impairments in somatosensory cortex injury rats by limbal mesenchymal stem cell transplantation.

Cortical lesions can cause major sensory and motor impairments, representing a significant challenge in neuroscience and clinical medicine. Limbal mesenchymal stem cells (LMSCs), renowned for their remarkable ability to proliferate and distinct characteristics within the corneal epithelium, offer a promising opportunity for regenerative treatments. This study aimed to assess whether the transplantation of LMSCs could improve tactile ability in rats with lesions of the barrel cortex. In this experimental study, we divided 21 rats into three groups: a control group, a lesion group with cortical cold lesion induction but no stem cell treatment, and a group receiving LMSC transplantation following cold lesion induction. We conducted 3-week sensory assessments using a texture discrimination test and an open-field test. We also performed Nissl staining to assess changes on the cellular level. Rats in the LMSC transplantation group demonstrated significant improvements in their ability to discrimination textures during the second and third weeks compared to those in the lesion group. The open-field test results showed an increased exploratory behavior of rats in the LMSC transplantation group by the third week compared to the lesion group. Additionally, Nissl staining revealed cellular alterations in the damaged cortex, with a significant distinction observed between rats in the LMSCs and lesion group. The findings suggest that LMSC transplantation enhances sensory recovery in rats with cortical lesions, particularly their ability to discriminate textures. LMSC transplantation benefits brain tissue reparation after a cold lesion on the somatosensory cortex.

CD8 radiomics signature to assess inter-lesion spatial heterogeneity and cold liver lesions in advanced non-small cell lung cancers treated with durvalumab.

2511 Background: The objective of this study was to assess whether a validated CD8 radiomics signature may help to evaluate patient inter-lesion heterogeneity and to predict the clinical outcome of advanced non-small cell lung cancers (NSCLC) patients treated with durvalumab in Study 1108 phase I/II trial (NCT01693562). Methods: Clinical data and imaging data from patients with naïve and pretreated advanced NSCLC who received durvalumab monotherapy were used. Radiomic features were extracted on contrast-enhanced CT scans and a validated CD8 radiomics signature was applied. A progressive lesion was defined by an increase in lesion longest diameter of 20% at 8 weeks. Dispersion metrics of the radiomics signature were estimated to evaluate the impact of inter-lesion heterogeneity on patient’s response. Results: A total of 188 patients were included in this study, accounting for a total of 1137 lesions (median [IQR] = 4 [3 - 9] lesions per patient) evaluated at baseline using a radiomics approach. A low CD8 radiomics score at baseline was associated with a significantly higher risk of progression at the lesion-level (AUC=0.59, P-value&lt;0.0001), and was especially performant for liver lesions (AUC=0.66, P-value=0.0002). At the patient level, the least infiltrated lesion of a patient according to the radiomics score of CD8 T-cells was positively associated with OS (HR=0.70, P-value=0.029) and PFS (HR=0.68, P-value=0.014), the highest values being associated with the best outcomes. 55 patients had liver lesions, with worse prognosis than patients without liver lesion (HR=2 for OS and PFS, P-value = 0.00012 and 0.00022 respectively). In these patients, the CD8 radiomic score enabled the stratification of patients according to hot and cold liver metastasis (HR=0.6, P-value=0.072 and HR=0.54, P-value=0.038 for OS and PFS respectively). A 4-class stratification of the whole cohort based on the least infiltrated (cold/hot) and liver or non-liver lesion was independently associated with clinical outcomes. These radiomics approaches have shown independent prognostic values when adjusting for PD-L1 status in multivariate analyses (Table). Conclusions: These results confirm the predictive value at a lesion level and the patient level of the biologically inspired CD8 radiomics score for advanced NSCLC patients treated with durvalumab. It has shown interesting results in discriminating outcomes of patients with liver lesions by identifying hot and cold lesions. [Table: see text]

Incidental osteonecrosis in the distal left femur in a case of beta-thalassemia with COVID-19: Role of [99mTc]Tc-MDP whole-body bone scan.

Secondary anemia in hemoglobinopathies like thalassemia can cause expansion of the bone marrow cavities because of compensatory marrow hyperplasia. This case demonstrates spontaneous osteonecrosis of the distal left femur in a patient with β-thalassemia that may be secondary to ischemic infarction secondary to occlusion of the microvasculature within the expanded cancellous bone. This subject was referred to Hazrat Rasool Akram Hospital because of fever, cough, and bone pain. In the CT scan she had scattered peripheral CGO in both lungs due to COVID-19 with two paravertebral masses due to extramedullary hematopoiesis. The patient had also generalized bone pain so the physician asked for a whole-body bone scan and incidentally, we found a cold lesion with a rim of increased uptake in the distal left femur that with bone biopsy it was consistent with osteonecrosis. This case illustrates the importance of performing a whole-body bone scan in β-thalassemia for the management of patients and diagnosis of occult osteonecrosis.

Platelets from 13-lined ground squirrels are resistant to cold storage lesions.

During torpor in a 13-lined ground squirrel heart rate and blood flow decrease, increasing the risk of blood clot formation. In response, cells involved in clotting called platelets are sequestered in the liver, stored in the cold for months, and released back into circulation upon arousal. This is in contrast to non-hibernating mammals, including humans, in which chilled platelets undergo cold storage lesions and phagocytosis, leading to rapid clearance from circulation post-transfusion. Because of this, human platelets must be stored at room temperature, limiting their shelf life to 7days due to the increased risk of microbial contamination at warmer temperatures. Human and ground squirrel platelets were stored at room temperature or 4°C before being analyzed for cold storage lesions. Human platelets stored at 4°C displayed progressive increases in phosphatidylserine surface exposure and caspase activation, while ground squirrel platelets showed minimal change. Following cold storage, sialic acid residues on human platelets were cleaved, leading to increased phagocytosis of human platelets by HepG2 cells. Ground squirrel platelets stored in the cold showed no changes in desialylation and phagocytosis, with Taxol-treated ground squirrel platelets showing the lowest phagocytosis rates between both species and all treatments. These results suggest that ground squirrel platelets may be resistant to cold storage lesions seen in human platelets. Although these experiments were done in vitro, they suggest a mechanism by which ground squirrel platelets are adapted to be stored during hibernation and remain functional following arousal. Other hibernating species may employ similar adaptations to retain functional platelets following torpor.

Pernio — the least severe local cold injury (scientific literature review)

Local cold injury is a certain problem of peacetime and all-out military invasion. In modern guidelines, almost no attention is paid to the least severe local cold lesion of perniosis. However, such a variant of local cold injury should not be underestimated, although it can be a safe transient condition, since we cannot exclude its rather serious consequences and complications, which are sometimes accompanied by chronicity of the process and even disability.

Is 99m Technetium (Pertechnetate) More Efficient in Clinical Evaluation of Thyroid Lesions Compared to 123 Iodine? A Scoping Review

Background: This research aims to find out which radiopharmaceutical is more efficient to evaluate thyroid lesions, such as hyperthyroidism, Graves' disease (GD), or even cold or hot thyroid nodule identification (is 99mtechnetium [99mTc] or 123iodine [123I] suitable in this case?). Materials and Methods: An extensive computerized search was done by the authors, revealing 61 studies in total. 49 studies were excluded for various reasons, so only 12 were eligible for inclusion in this review. Results: Majority of the studies suggested that the use of 99mTc over 123I. 99mTc is a suitable choice to evaluate thyroid disorders. However, 123I can be broadly used in assessing thyroid functions, detecting malignancy and causes of thyrotoxicosis, calculating therapeutic dosages of 131I, and identifying cold or hot lesions effectively due to its superior accumulation in thyroid. Conclusion: 99mTc is a nonphysiologic compound widely used to evaluate thyroid abnormalities, and it has a noticeably low biodistribution in the thyroid. On the other hand, 123I is an organic compound with excellent biodistribution that is used to gather further information on thyroid functions and susceptibility and prevalence of toxic adenoma, GD, and cold or hot thyroid nodule evaluation.

Beyond the single average tumor: Understanding IO combinations using a clinical QSP model that incorporates heterogeneity in patient response.

A quantitative systems pharmacology model for metastatic melanoma was developed for immuno‐oncology with the goal of predicting efficacy of combination checkpoint therapy with pembrolizumab and ipilimumab. This literature‐based model is developed at multiple scales: (i) tumor and immune cell interactions at a lesion level; (ii) multiple heterogeneous target lesions, nontarget lesion growth, and appearance of new metastatic lesion at a patient level; and (iii) interpatient differences at a population level. The model was calibrated to pembrolizumab and ipilimumab monotherapy in patients with melanoma from Robert et al., specifically, waterfall plot showing target lesion response and overall response rate (Response Evaluation Criteria in Solid Tumors [RECIST] version 1.1), which additionally considers nontarget lesion growth and appearance of new metastatic lesions. We then used the model to predict waterfall and RECIST version 1.1 for combination treatment reported in Long et al. A key insight from this work was that nontarget lesions growth and appearance of new metastatic lesion contributed significantly to disease progression, despite reduction in target lesions. Further, the lesion level simulations of combination therapy show substantial efficacy in warm lesions (intermediary immunogenicity) but limited advantage of combination in both cold and hot lesions (low and high immunogenicity). Because many patients with metastatic disease are expected to have a mixture of these lesions, disease progression in such patients may be driven by a subset of cold lesions that are unresponsive to checkpoint inhibitors. These patients may benefit more from the combinations which include therapies to target cold lesions than double checkpoint inhibitors.

A validated Geant4 model of a whole-body PET scanner with four-layer DOI detectors

The purpose of this work is to develop a validated Geant4 simulation model of a whole-body prototype PET scanner constructed from the four-layer depth-of-interaction detectors developed at the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Japan. The simulation model emulates the behaviour of the unique depth of interaction sensing capability of the scanner without needing to directly simulate optical photon transport in the scintillator and photodetector modules. The model was validated by evaluating and comparing performance metrics from the NEMA NU 2-2012 protocol on both the simulated and physical scanner, including spatial resolution, sensitivity, scatter fraction, noise equivalent count rates and image quality. The results show that the average sensitivities of the scanner in the field-of-view were 5.9 cps kBq−1 and 6.0 cps kBq−1 for experiment and simulation, respectively. The average spatial resolutions measured for point sources placed at several radial offsets were 5.2± 0.7 mm and 5.0± 0.8 mm FWHM for experiment and simulation, respectively. The peak NECR was 22.9 kcps at 7.4 kBq ml−1 for the experiment, while the NECR obtained via simulation was 23.3 kcps at the same activity. The scatter fractions were 44% and 41.3% for the experiment and simulation, respectively. Contrast recovery estimates performed in different regions of a simulated image quality phantom matched the experimental results with an average error of -8.7% and +3.4% for hot and cold lesions, respectively. The results demonstrate that the developed Geant4 model reliably reproduces the key NEMA NU 2-2012 performance metrics evaluated on the prototype PET scanner. A simplified version of the model is included as an advanced example in Geant4 version 10.5.

Added value of hybrid SPECT with CT imaging for predicting poor therapeutic efficacy of 89Sr in patients with bone metastasis

To utilize single-photon emission computed tomography/computed tomography (SPECT/CT) scanning to investigate the usefulness of nerve root compression (NRC) and radioactive cold zone lesions (RCZLs) for predicting poor therapeutic efficacy of strontium-89 chloride (Sr-89) in patients with bone metastasis. Patients with bone metastatic neoplasms who had undergone baseline bone SPECT/CT scanning before Sr-89 therapy (148 MBq Sr-89 chloride by an intravenous injection for each patient) between July 2011 and July 2018 were included. Bone SPECT/CT images were assessed by two readers independently. Associations between imaging features and therapeutic efficacy were obtained via multivariate logistic regression analysis. Of 231 patients analyzed, 50 (21.6%) had NRC at baseline. Of 31 patients who experienced poor therapeutic efficacy, 29 (93.5%) had NRC. In multivariate logistic regression analysis baseline NRC independently predicted poor therapeutic efficacy. The sensitivity of NRC for predicting poor therapeutic efficacy was 93.5%, specificity was 89.5%, positive predictive value was 58.0%, and negative predictive value was 98.9%. RCZLs were detected in17 patients (7.4%), of whom 14 experienced poor Sr-89 therapeutic efficacy. The sensitivity of the presence of RCZLs for predicting poor therapeutic efficacy was 45.2%, specificity was 98.5%, positive predictive value was 82.4%, and negative predictive value was 92.1%. After adjusting for age, bone metabolism and lesion type, the significant independent predictors of poor Sr-89 therapeutic efficacy were presence of NRC (p < 0.001) and RCZL (p = 0.001). NRC and RCZL on baseline bone SPECT/CT are reliable independent predictors of poor Sr-89 therapeutic efficacy in patients with bone metastasis. These associations may facilitate the administration of more effective therapeutic interventions.

Abstract 3331: Role of innate immune cells in the development of vessel co-opting CRC liver metastases

Abstract Approximatively 50 % of patients who undergo resection for primary colorectal cancer will develop liver metastases. Liver metastases present as two major histopathological growth patterns (HGP) the desmoplastic and the replacement HGP. In the desmoplastic HGP, the cancer cells are surrounded by a desmoplastic stromal ring preventing their contact with the normal liver. In the replacement HGP, the cancer cells infiltrate the normal liver and replace hepatocytes near the tumour periphery. We have found that the desmoplastic HGP tumors derive their blood supply through angiogenesis while the replacement HGP tumors are non-angiogenic and co-opt the blood vessel of the liver they invade. Furthermore, we have published that patients under chemotherapy presenting with a vessel co-opting phenotype have a worse pathological response and five-year overall survival compared to patients presenting with angiogenic liver metastases. Their prognosis is worse when treated with bevacizumab an anti-VEGF antibody used alongside chemotherapy. CRCLM are considered immunologically cold lesions, with low numbers of infiltrating T-cells, and thought to be unlikely to benefit from immunotherapies. We have recently found that neutrophils and macrophages but not lymphocytes infiltrate vessel co-opting lesions to a greater extent than angiogenic lesions. Using flow cytometry and the Nanostring GeoMx spatial protein profiling platform capable of detecting up to 96 proteins simultaneously on FFPE tissue slices, we established the immunoprofile of immune cells recruited to angiogenic or vessel co-opting CRCLM lesions in chemonaive and treated patients. Many studies have demonstrated that neutrophils and macrophages play an important role in tumor progression, modification of the ECM, angiogenesis, and immunosuppression. We hypothesize that innate immune cells can facilitate blood vessel co-option of CRCLM lesions and contribute to an immunosupressive environment favorable to tumor growth. Fully understanding the role of the innate immune system in the developmend of vessel co-opting CRCLM tumors could allow for the development of immunotherapies capable of converting vessel co-opting lesions into angiogenic lesions that are more successfully treated with chemotherapy and anti-angiogenic therapies. Citation Format: Thomas Z. Mayer, Diane H. Kim, Miran Rada, Stephanie Petrillo, Anthoula Lazaris, Peter Metrakos. Role of innate immune cells in the development of vessel co-opting CRC liver metastases [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3331.

Dominant-negative mutations in human IL6ST underlie hyper-IgE syndrome.

Autosomal dominant hyper-IgE syndrome (AD-HIES) is typically caused by dominant-negative (DN) STAT3 mutations. Patients suffer from cold staphylococcal lesions and mucocutaneous candidiasis, severe allergy, and skeletal abnormalities. We report 12 patients from 8 unrelated kindreds with AD-HIES due to DN IL6ST mutations. We identified seven different truncating mutations, one of which was recurrent. The mutant alleles encode GP130 receptors bearing the transmembrane domain but lacking both the recycling motif and all four STAT3-recruiting tyrosine residues. Upon overexpression, the mutant proteins accumulate at the cell surface and are loss of function and DN for cellular responses to IL-6, IL-11, LIF, and OSM. Moreover, the patients' heterozygous leukocytes and fibroblasts respond poorly to IL-6 and IL-11. Consistently, patients with STAT3 and IL6ST mutations display infectious and allergic manifestations of IL-6R deficiency, and some of the skeletal abnormalities of IL-11R deficiency. DN STAT3 and IL6ST mutations thus appear to underlie clinical phenocopies through impairment of the IL-6 and IL-11 response pathways.

Pre-existing inflammatory immune microenvironment predicts the clinical response of vulvar high-grade squamous intraepithelial lesions to therapeutic HPV16 vaccination

BackgroundVulvar high-grade squamous intraepithelial lesion (vHSIL) is predominantly induced by high-risk human papilloma virus type 16 (HPV16). In two independent trials, therapeutic vaccination against the HPV16 E6 and E7 oncoproteins...

Counter examples for unmatched projector/backprojector in an iterative algorithm.

It is rather controversial whether it is justified to use an unmatched projector/backprojector pair in an iterative image reconstruction algorithm. One common concern of using an unmatched projector/backprojector pair is that the optimal solution cannot be reached. This concern is misleading and must be clarified. We define a figure-of-merit in the image domain as the distance between the reconstructed image and the true image, as the normalized mean-squared-error (NMSE). The NMSE is used to determine whether an unmatched matched projector/backprojector pair can provide a better image than a matched projector/backprojector pair. Hot and cold lesion's contrast-to-noise ratio is also used as an alternative secondary figure-of-merit for algorithm comparison. Computer-generated counterexamples are used to test the performance for matched and unmatched projection/backprojection pairs for different reconstruction algorithms. The projectors are ray-driven, and the backprojectors are ray-driven and pixel-driven. For the attenuation-free data examples, the unmatched pixel-driven backprojector outperforms the matched ray-driven backprojector. For the attenuated data example, the matched ray-driven backprojector performs better. The ray-driven backprojector can be slightly improved by using an attenuation coefficient that is larger than the true one; in this case the backprojector becomes unmatched. Unmatched projector/backprojector pairs are fairly flexible. If the backprojector is properly chosen, good results can be obtained. However, we have not found a general rule to select a good backprojector.

Multicenter integrated positron emission tomography/computer tomography imaging quality assurance accreditation interobserver reliability study with the American College of Radiology phantom

Integrated positron emission tomography/computer tomography (PET/CT) image quality assurance ensures accurate, reproducible, and quantitative assessment of comparable scanner performance. We performed a preliminary multicenter PET/CT imaging quality assurance test with a fillable tomographic phantom in six medical centers in Taiwan. The phantom was filled with fixed proportions of fluorine-18 radionuclide solution in the background and with different spheres to simulate cold and hot lesions, and body background radioactivity. Imaging acquisitions were performed by using recommended parameters in different sites according to different brand names of the instrument. All imaging was subjectively scored by eight experienced nuclear medicine physicians as the spatial resolution of four hot vials (score 0-4), six cold spheres (score 0-6), and six cold rod areas (score 0-6), and overall satisfaction (score 0-5). Interobserver correlation and receiver operating characteristic (ROC) curve were analyzed. The detection ability of hot vials, cold spheres, and cold rods was 4.0 ± 0.1, 5.2 ± 0.8, and 3.8 ± 0.9, respectively. Overall satisfaction was 4.0 ± 0.8. The ROC analysis revealed that the area under the curve for hot vials, cold spheres, and cold rods was 0.984, 0.887, and 0.928 respectively. The interobserver correlation for detectability of cold spheres and cold rods was 0.88 and 0.96, respectively. The results of the study indicated that (1) PET/CT imaging quality assurance for comparable scanner performance could be established on the basis of a standard phantom and (2) good interobserver correlation can be observed for those with accurate and interpretable results.

Study of Image Contrast Recovery Coefficient (CRC) of a Large Ring PET Scanner

Image contrast recovery coefficient (CRC) of a large ring PET scanner “macroPET” was studied with septa and without septa configuration by ac-quiring data from a laboratory made 35.7 cm square phantom filled with 18-F. Images were reconstructed with simple 2D filtered back projection using Hann, Hamming and Parsen filters with different cut-off frequencies aiming to investigate the influence of filter and cut-off frequency on image contrast with septa and without septa mode. Results indicate that the CRC, for both hot and cold lesions, is excellent for diameters ≥ 3 cm using cut-off frequencies > 0.4. For a 2 cm hot lesion CRC is around 0.8 to 0.9. CRC for 1 cm hot and cold lesions is ~0.3, as expected. There is surprisingly little difference between results with and without septa. For hot lesions, septa appear to improve CRC slightly, but for cold lesions CRC is slightly poorer using septa.

FROM A SIMPLE COLD SORE TO SEVERE CYSTIC LUNG DISEASE

SESSION TITLE: Chest Infections 2 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Necrotizing fasciitis, septic embolic, and tension pneumothorax are all individually a cause of significant morbidity and mortality. When combined, they pose a significant treatment dilemma, as options in critically ill patients are limited. Here we present a case of a cold sore leading to multiple pneumothoraces from septic emboli causing severe cystic lung disease. CASE PRESENTATION: A 57-year-old healthy male presented with fever, facial swelling, and dyspnea. He reported a cold sore lesion that rapidly progressed into right facial and neck swelling. A CT of the head and neck showed extensive edema involving the facial plane extending to the parapharyngeal space suggestive of necrotizing fasciitis. He underwent emergent debridement in the operating room, blood and wound cultures grew methicillin sensitive S.aureus. His course progressed to hypoxic respiratory failure complicated by a spontaneous tension pneumothorax (PTX) requiring chest tube placement. Despite lung protective ventilation he developed diffuse cystic lung lesions and moderate bilateral loculated PTXs with tension physiology that led to cardiac arrest. He was ultimately revived, however required seven chest tubes, each with persistent air leaks. Pleurodesis or surgical/endoscopic procedures were not attempted, as he was too unstable. During the course of 2 months, he was maintained on mechanical ventilation via tracheostomy, IV antibiotics, and dialysis. As he gradually improved he was weaned from mechanical ventilation, allowing his air leaks to resolve and his chest tubes removed. DISCUSSION: A tension pneumothorax secondary to septic emboli is a rare yet possibly fatal disease. Here we present a case of necrotizing fasciitis from a simple cold sore progressing to multiple pulmonary septic emboli. This led to severe cystic lung disease from the multiple loculated and tension pneumothoraces. Multiple pneumothoraces with persistent air leaks posed a significant challenge to management, where preferred treatment is surgical repair. These air leaks make ventilation and oxygenation incredibly difficult, leading the inability to wean from the ventilator. Such critically ill patients are too high risk for surgical intervention, however this case demonstrates where conservative management led to the patients ultimate recovery. Endobronchial valves may still be promising in such dilemmas shown by recent observational studies. However there are no controlled studies to compare these new approaches, and therefore the clinician’s best judgment must be used. CONCLUSIONS: Diffuse cystic lung diseases (DCLD) present from varying pathophysiologic mechanisms. DCLD do not have a homogenous distribution, but they do share pneumothoraces. Management with positive pressure ventilation was cumbersome in this patient when the risk for recurrence remains high past this hospitalization. Reference #1: Okabe M, Kasai K, Yokoo T. Pneumothorax Secondary to Septic Pulmonary Emboli in a Long-term Hemodialysis Patient with Psoas Abscess. Internal Medicine. 2017;56(23):3243-3247. https://doi.org/10.2169/internalmedicine.9050-17. Reference #2: Cystic Lung Diseases: Algorithmic Approach. Raoof S., Bondalapati P., Vydyula R., Ryu J.H., Gupta N., Raoof S., Galvin J., (…), Naidich D. (2016) Chest, 150 (4) , pp. 945-965. DISCLOSURES: No relevant relationships by Hassan Al Khalisy, source=Web Response no disclosure on file for Ioana Amzuta; No relevant relationships by Marsha Antoine, source=Web Response No relevant relationships by Ritu Modi, source=Web Response No relevant relationships by Bashar Sharma, source=Web Response

The Impact of Varying Number of OSEM Iterations on Standardized Uptake Value and Image Quality of Discovery STE PET/CT Scanner

Background: In PET imaging both quantitative and qualitative interpretations are used. Qualitative and quantitative interpretations depend upon PET/CT image quality that along with many biologic factors strongly depends upon image reconstruction parameters. Aim: The objective of this experimental work was to study the impact of one of the key reconstruction parameter, i.e., number of reconstruction iteration, on standardized uptake value and image quality of PET/CT scan. Methods: Images of NEMA IEC Image Quality Phantom were acquired in list mode for 10 mins on Discovery STE PET/CT scanner, using tumor to background ratio of 4:1 and 18F-FDG as radiotracer. List mode data were further transformed into data sets of varying acquisition time (0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0 mins) per bed position. Transformed data set of 5.0 mins were used to study the impact of varying number of iterations (2, 3, 4, 5, 7, 10, 15, 20) using OSEM approach of iterative reconstruction. Standardized uptake value (SUV) and underestimation in SUV were calculated as quantitative measures, while hot lesion contrast, cold lesion contrast and background variability were calculated as qualitative measures. Results: Standardized uptake value, hot and cold lesion contrast, image spatial resolution and background variability showed increasing trend with increase in reconstruction iterations. Maximum increase of 20.25%, 16.33%, 9.79% and 6.88% was observed in SUV for 10 mm, 13 mm, 17 mm and 22 mm lesions as number of iteration change from 2 to 3. Smallest and the largest diameter lesions showed maximum underestimations of 54.67% and 8.20% at 2 iterations respectively. Percentage hot lesion contrast showed rapid increase as the number of iteration change from 2 to 7 and increased slowly afterward. Background variability range from 4.4% to 6.4%, 4.1%–5.7%, 3.6%–4.6%, 3%–3.8%, 2.7%–3.2%, 2.4%–2.7% for 10.0 mm, 13.0 mm, 17.0 mm, 22.0 mm, 28.0 mm and 37.0 mm sphere respectively. Conclusion: Optimized reconstruction parameters for routine clinical studies 3 iterations with image matrix size of 128 × 128 with filters FWHM of 6 mm and for high resolution studies 3 iterations image matrix size of 256×256 with filters FWHM of 6 mm.

Role of Baseline Bone Scintigraphy in the Evaluation of Skeletal Metastases of Newly Diagnosed Lung Carcinoma Patients

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Lung carcinoma is the most common cancer worldwide with high potentiality of being metastasized to bone. Technetium-99m methylene diphosphonate (99mTc MDP) bone scintigraphy is a sensitive nuclear medicine imaging study to detect the skeletal metastases. The utilization of bone scan upon diagnosis of lung cancer appears to help in accurate staging of patients and planning treatment. The aim of the present study was to see the role of baseline bone scintigraphy in the newly diagnosed lung carcinoma patients and also to see the number, pattern and sites of involvement of bone as well as to evaluate the skeletal metastases according to the different histological types of lung carcinoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt; This observational study was carried out at the Institute of Nuclear Medicine &amp;amp; Allied Sciences (INMAS), Sylhet during the period of July 2014 to June 2015. A total number of 59 lung carcinoma patients who attended at the scintigraphy division of INMAS, Sylhet within three months of their histopathological diagnosis were included in this study. Clinical staging was done from clinical evaluation (history and physical examination) and also form available investigation reports. Skeletal scintigraphy was performed by dual-head gamma camera using low-energy all purpose collimator, 2-3 hours after IV administration of 20-30 mCi of 99mTc MDP. Interpretation was done by recording the distribution of radiotracer within the skeleton along with correlation of history, physical examination, FNAC or biopsy reports and other relevant investigation findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 59 patients, 43 (72.9%) were male and 16 (27.1%) were female. The age range of the patients was from 37 to 85 years with a mean (± SD) of 59.10 ± 10.43 years. The rate of lung carcinoma was highest in the age group of 55-64 years (45.7%), followed by 45-54 years (27.1%) and 65-74 years (11.9%). Incidence was lowest in patients below 45 years (6.8%) and above 75 years (8.5%). Skeletal metastases were detected in 52.54% of lung carcinoma patients where multiple lesions were seen in 87.1% of cases and solitary lesion in 12.9%. Among the metastatic lesions, 82.9% lesions were distributed in axial skeleton and 17.1% lesions were distributed in appendicular skeleton. Spine was the most frequent site of metastatic involvement in the present study which was 37.8% followed by ribs 28.0%, sternum 9.7% and pelvic bones 7.3%. Thoracic spine was found to be involved more (58.1%). Regarding patterns of metastatic lesions, 23 patients (74.1%) showed hot lesions, two patients (6.5%) showed cold lesions, four patients (12.9%) showed superscan and two patients (6.5%) showed pattern of hypertrophic osteoarthropathy. Bone metastasis was found in 75% cases of small cell lung carcinoma (SCLC) and 49.2% cases of non-small cell lung carcinoma (NSCLC). Among NSCLC, adenocarcinoma showed 62.9% metastases followed by 36.8% squamous cell carcinomas and 20.0% large cell carcinomas. In this series, clinical staging was done and 11 patients ( 18.6% ) were found in stage I, 21 patients ( 35.6% ) in stage II, 23 patients ( 39.0% ) in stage III and 04 patients ( 6.8 % ) in stage IV. Skeletal scintigraphy detected metastatic lesions in six of 11 cases (54.5 %) in clinical stage I, five of 21 cases (23.8 %) in clinical stage II, 16 of 23 cases (69.6 %) in clinical stage III and in all patients (100%) with clinical stages IV showing higher rate of bone metastases with advanced clinical stages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: In this study, skeletal scintigraphy changed clinical staging of 27 patients. Early diagnosis of lung carcinoma, followed by bone scanning without delay helps to diagnose skeletal metastases, the presence of which is a major determinant in subsequent pathological staging and treatment planning.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 19(2): 111-115, July 2016&lt;/p&gt;

Gastroprotective effect of ethanol extracts of cladodes and roots of Pilosocereus gounellei (A. Weber ex K. Schum.) Bly. Ex Rowl (Cactaceae) on experimental ulcer models

Ethnopharmacological relevancePilosocereus gounellei Cactaceae), popularly known as “xique xique”, is a species native from Caatinga region of Northeast Brazil, which is used by traditional communities in folk medicine for a variety of health problems, especially inflammatory processes and gastritis. Aim of the studyThe present study investigates the possible gastric antiulceractivity of ethanol extracts obtained from the cladodes and roots of Pilosocereus gounellei (EECPG and EERPG, respectively) and mechanisms of action underlying this effect. Materials and methodsMice were used for the evaluation of the acute toxicity, and mice and rats to study the gastroprotective activity. The gastroprotective action of EECPG and EERPG was analyzed in the absolute ethanol in mice, ischemia-reperfusion and cold restraint stress in rats. In the investigation of the gastroprotective mechanisms of EECPG and EERPG, the participation of the NO and prostaglandins, the levels of the non-protein sulfhydril groups (NP-SH) and the catalase activity using the ethanol-induced gastric mucosa lesion model and the quantification of the gastric mucus and the antisecretory activity through pylorus ligature model in rats were analyzed. ResultsThe animals did not present any signs of acute toxicity for the EECPG and EERPG, and it was not possible to calculate the DL50. EECPG and EERPG (200 and 400 mg/kg) exhibited a significant gastroprotective effect in absolute ethanol, ischemia-reperfusion-induced and cold restraint stress gastric lesion models. Gastroprotection of EECPG and EERPG (200 mg/kg) was significantly decreased in pre-treated mice with L-NAME. Our studies revealed that EECPG and EERPG (200 mg/kg) prevented the decrease of the non-protein sulfhydril groups (NPSH) and increased the catalase levels in ethanol-treated animals. However, the gastric secretion parameters (volume, [H+], pH) did not show any alteration. ConclusionsOur results indicate that the ethanolic extract from the cladodes and roots of Pilosocereus gounellei exhibits a significant gastroprotection, because it inhibits the formation of gastric lesions using different models. The participation of the nitric oxide, prostaglandins, the non-protein sulfhydril groups (NP-SH), catalase seem to be involved in the gastroprotection activity of the EECPG and EERPG. Nevertheless, this activity does not seem to be related to antisecretory mechanisms.