Low-uptake Areas Research Articles

Perceptions of a State-Level HPV Vaccine Mandate and Exemption Option in Rural Virginia: A Qualitative Study.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; yet, despite the availability of safe and effective HPV vaccines, only half of eligible adolescents have completed the vaccine series. School-entry requirements are one proven strategy to increase vaccination rates among children and youth and reduce the burden of HPV-related cancer. This study investigated community perceptions of an HPV vaccine school-entry mandate in Virginia and the consequences of a low threshold exemption option included in the legislation. We conducted 40 interviews with community members including 15 interviews with parents, 19 with healthcare providers, and 6 with community leaders. Interviews asked about knowledge, beliefs, and attitudes concerning the HPV vaccine and mandate. Interviews were recorded, transcribed, and thematically analyzed. Despite healthcare provider support for the mandate, there was widespread confusion over the school-entry policy and concern that the exemption option undermined vaccination efforts. Understanding variations in community-level perceptions and response to school-based vaccination mandates is crucial for designing effective public health strategies. Findings suggest statewide vaccination initiatives should preemptively identify low uptake areas and provide targeted information to communities. Future mandates should avoid the use of ambiguous and contradictory language in vaccine-related legislation.

PO-05-100 DETECTION OF THE CRITICAL SUBSTRATE FOR VENTRICULAR TACHYCARDIA ABLATION WITH THE COMBINED IMAGE OF TC-99M SCINTIGRAM AND LATE IODINE ENHANCEMENT CT

Late potentials (LPs) are the important target for ventricular tachycardia(VT) abltion. However, LPs sometimes cannot be observed sufficiently because of intramural localization of VT substrates. Efficacy of CT for prediction of VT substrates even in intramural layer has been reported. On the other hand, Tc-99m scintigram has been reported to determine the viability of myocardium. The uptake of Tc-99m scintigram could quantify the viability of VT substrates and predict the localization of critical VT substrates such as LPs. Moreover, combination of CT and Tc-99m scintigram could show intramural VT substrates. We evaluated the relationship between the localization of LPs and uptake rate of Tc-99m scintigram. Moreover, we evaluated VT substrates with combined image of scintigram and CT. In eight patients (age, 67.5±8.6 years ; left ventricular(LV) ejection fraction, 26.0±8.7%) with ischemic cardiomyopathy and VT, electroanatomical map (EAM) and Tc-99m scintigrafic image of LV were obtained and were divided into twenty segments. LPs were determined as isolated potentials after QRS and were evaluated in EAM. The relationship between LPs and scintigrafic characteristics was evaluated in total of 160 segments. Electrocardiogram gated CT was performed and late iodine enhancement(LIE) was recorded 8 minutes after administration of contrast media. LPs were recorded in 59 segments. According to the Tc-99m uptake rate, cut off value 35% was set for the prediction of the location of LPs with ROC curve. LPs were observed in the lower scintigram perfusion segments with ≤35% uptake rate (n=61) more than the segments with >35% uptake rate (n=99) with statistical significance (78.6% vs 11.1% p<0.0001). With this cutoff value, we performed another VT ablation with intramural substrate. EAM revealed the exit site of VT circuit from endocardium and the existence of intramural substrate (Fig.A). Low Tc-99m uptake area observed around the apical aneurysm and made the borderline between the basal normal voltage area (Fig.B). LIE showed the transmural damaged tissue on the apical aneurysm and the intramural damaged tissue of mid anterior wall(Fig.C). This border zone of Tc-99m uptake and intramural LIE was similar to the exit site of VT circuit. Long cauterization on this area terminated VT. Lower perfusion area of Tc-99m scintigram could be utilized to predict VT substrates in ICM patients and combination of LIE of CT could add the information of the depth of the VT substrate.

Graves’ disease, myxedema and papillary thyroid carcinoma

Graves’ disease (GD) is the leading cause of hyperthyroidism and diffuse toxic goiter in iodine-sufficient geographical areas. GD is associated with classical manifestations such as ophthalmopathy and thyroid dermopathy, in addition to diffuse goiter, which may be the site of carcinomas, as a complication. Case report: A 52-year-old womanpresented with goiter and symptoms compatible with hyperthyroidism, such as heat intolerance, weight loss, fatigue, increased sweat, tachycardia, fine tremors, increased intestinal transit, anxiety, emotional lability, insomnia, exophthalmos, and pretibial myxedema. A complementary investigation confirmed the diagnosis of hyperthyroidism(high free T4 and total T3 levels and low thyroid-stimulating hormone - TSH levels). Ultrasound images showed diffuse enlargement of the thyroid lobes by approximately 10 times and the presence of three thyroid nodules, one of which was larger than 2 cm with heterogeneous echogenicity and vascularization throughout the nodule; ultrasound-guided fine needle aspiration revealed cytology compatible with Bethesda IV; scintigraphy revealed a low uptake area (cold nodule) amid a diffuse high-uptake goiter. A thyroidectomy was performed, and the anatomical specimen diagnosis revealed papillary thyroid carcinoma in the right lobe, with adjacent parenchyma compatible with GD.Histopathological examination of the skin showed the presence of myxedema compatible with Graves’ dermopathy. The patient evolved with the normalization of TSH levels and a reduction of cutaneous manifestations. Conclusion: GD abnormalities may not be restricted to the classic clinical manifestations, and a careful investigation may reveal the coexistence of carcinomas.

Perceived usefulness of Contraceptives among Married Individuals in Rorya District

The increasing use of contraception methods worldwide has allowed couples to choose the number and spacing of their children. Despite impressive achievements, contraceptive use remains low while the need for contraception is high in some of the world's poorest and most populous places. Little is known about the factors contributing to the low utilisation of contraceptives in the Rorya district, particularly among married individuals where the prevalence of contraceptive use was only 28%. A qualitative design was used for six focus group discussions and six in-depth interviews conducted with married individuals to understand the perception of the use of contraceptives in the Rorya District. Respondents believe that contraception is important in reducing the number of pregnancies and improving health, as well as in limiting family size. Interviewees emphasised the need for more accessible outlets for contraceptives. Religious beliefs and myths about contraceptive side effects have been reported to influence contraceptive choice and use. Respondents are aware of the health benefits of contraception for themselves and their children. Limited access, Myth, and religious beliefs continue to influence contraceptive use. Strategies to improve contraceptive use should ensure the availability and accessibility of contraceptives and tailored BCC, especially in low uptake areas.

Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa.

Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.

Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces

ABSTRACT China’s immunization programme is relatively strong, with latest WHO-UNICEF monitoring rates for 2019 showing national vaccination coverage over 90%. However, vaccination coverage is heterogeneous, varying across geographic regions, rural–urban communities, and sub-populations. We conducted a qualitative study from a critical realist perspective, analyzing semi-structured interviews with 26 vaccination providers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. We analyzed data thematically, using deductive and inductive coding. Providers reported vaccination coverage in their areas had increased significantly, but remained lower among migrant and left-behind children. Main coverage determinants were child-related (i.e. gender, number, health status), caregiver-related (i.e. socioeconomic status, role, education level, ethnicity), institution-related (i.e. vaccinator numbers, information system, appointment process), and system-related (i.e. vaccine supply, intersectoral cooperation, vaccine ‘hesitancy’). Potentially effective measures to promote vaccination coverage included using routine maternal and child health-care visits for catch-up vaccination, providing additional health education, conducting follow-up family visits by village doctors, and requiring vaccination verification at school enrollment. This is the first qualitative study to examine potential determinants of low vaccination coverage in these areas of China. Findings can inform policies to strengthen the role of schools, develop the national immunization information system, and promote appointment apps. More consideration is needed to improve service quality and eliminating inequities, such as strengthening health education and service provision for migrant and left-behind children.

Quantitative bone single-photon emission computed tomography imaging for uninfected nonunion: comparison of hypertrophic nonunion and non-hypertrophic nonunion

BackgroundRecently, a standardized uptake value (SUV) has been used to evaluate bone single-photon emission computed tomography (SPECT). The aim of this study was to investigate quantitative SPECT imaging of uninfected nonunion to compare hypertrophic nonunion and non-hypertrophic nonunion using volume-based parameters.MethodsWe evaluated 23 patients with uninfected nonunion who underwent SPECT acquisition 3 h after an injection of 99mTc-hydroxymethylene diphosphonate or 99mTc-methylene diphosphonate from April 2014 to November 2019. We reconstructed the acquired data and performed voxel-based quantitative analysis using the GI-BONE software. Quantitative parameters, maximum SUV (SUVmax), peak SUV (SUVpeak), and mean SUV (SUVmean) in the high and low uptake areas of nonunion were compared between hypertrophic nonunion and non-hypertrophic nonunion. The contralateral limb was used as a control, and the ratios of the quantitative parameters were calculated.ResultsThe values for the quantitative parameters (high uptake area/low uptake area, respectively), SUVmax control ratio (12.13 ± 4.95/6.44 ± 4.71), SUVpeak control ratio (11.65 ± 4.58/6.45 ± 4.64), and SUVmean control ratio (11.94 ± 5.03/6.28 ± 4.95) for hypertrophic nonunion were higher than those for non-hypertrophic nonunion (7.82 ± 4.76/3.41 ± 2.09 (p = 0.065/0.12), 7.56 ± 4.51/3.61 ± 2.23 (p = 0.065/0.22), and 7.59 ± 5.18/3.05 ± 1.91 (p = 0.076/0.23)).ConclusionsSUVmax, SUVpeak, and SUVmean control ratios obtained from bone SPECT images can quantitatively evaluate the biological activity of nonunions and may be an effective evaluation method for treatment decisions, especially the necessity of autologous bone grafting.

Survey of the understanding and interest in the chief registrar scheme from doctors in an area of low uptake

The chief registrar (CR) scheme allows registrars to gain clinical leadership and quality improvement skills. Some regions have low uptake and non-physician CRs are uncommon. This study aims to establish the reasons behind this in one such region. A survey was distributed at two events in a low uptake area; a Royal College of Physicians update in medicine day and a general medicine teaching day. One-hundred and ninety-one clinicians responded; including 103 (53.9%) higher specialty trainees (ST3+) and 74 (38.7%) consultants. Seventy-two (44.5%) respondents were interested or unsure about applying for the role. Several misconceptions were observed, including a need for prior management experience or training in general internal medicine. Fifty (41.3%) respondents, who were not interested in applying, listed not knowing 'what the role entails' as influencing their decision. There was significant interest in the CR role, however, misconceptions were common. Improved information regarding the role may improve recruitment both in areas of low uptake and when attracting applicants from non-physician specialties.

P1459 Flu-like syndrome complicated in a rare form of infective endocarditis

Abstract Background The HACEK group of organisms are one of the infrequent causes of infective endocarditis (IE)(5% of cases in adults).Cultures require long incubation time and clinical presentation may be insidious,delaying final diagnosis.We report a case of subacute atypical presentation of native mitral valve Haemophilus parainfluenzae IE A 33 yo female with no history of cardiac disease was presented in our hospital with malaise,weakness &amp;high fever till 39oC for at about two weeks.The patient was treated with levofloxacin and discharged. The 1st blood culture was negative.After 25 days the patient was presented with prolonged fever,neurological signs of TIA(motor aphasia and septic embolic episode of 2nd level on the right hand&amp;foot).Physical exam normal,no cardiac murmurs. ECG:normal. Echo:TTE-mitral valve with thickened leaflet, presence of structures suggestive for vegetations (15x19 mm) at the posterior leaflet, perforation of the posterior leaflet causing an IM mild-moderate.TEE-mitral valve with small posterior leaflet, big anterior leaflet with mobile vegetations of coral-forms with diameter maximum 20x10 mm,located at A3 scallop of mitral valve at posteromedial commissural,with a perforation at this level causing moderate IM.No other pathological findings.Cranial CT scan-no data of any acute intracranial abnormality.Body CT scan-a low uptake area of the renal parenchyma related to acute pyelonephritis/infarction.Blood tests-elevated CRP &amp; thrombocytopenia.Blood culture(2nd one): Haemophilus parainfluenzae.Treatment-The patient went on ceftriaxone and underwent a surgical mitral valve repair with mitral annuloplasty and patch placement because of the size of the vegetation and the embolic risk.We also respect the desire of the patient to be pregnant.The patient improved, no fever. Follow-up:CRP normal.TTE echo showed no evidence of the previously detected vegetation with a residual mild MR.The patient was discharged home followed up after 6 weeks with full recovery. Discussion We present the case of a young healthy woman without any diseases,admitted with the symptoms of a simple flu-like syndrome with a negative blood culture, but complicated later in one of the rarest forms of IE with Haemophilus parainfluenzae. HACEK organisms are most often associated with IE, although rare, can be extremely serious because of the tendency of big size vegetation and embolic episodes,but outcomes generally are successful if the organism is identified early and treated appropriately.The treatment of a HACEK infection is based on the location of the infection,clinical severity and available susceptibility data.According to the ESC recommendations Ceftriaxone or ampicillin/sulbactam is the therapy of choice for patients with HACEK endocarditis in both native and prosthetic-valve endocarditis.Fluoroquinolones may be considered as alternative therapy.Regardless of the agent chosen,treatment should last 4– 6 weeks,depending upon the type of valve involved Abstract P1459 Figure.

11C-MET-PET/CT guided multi-target biopsy and transcriptome analysis demonstrated the cellular functional heterogeneity in DIPG

Objective To explore the cellular heterogeneity between 11C-methionine (11C-MET) high and low regions in the diffuse intrinsic pontine glioma (DIPG) using 11C-MET-PET/CT guided multiple-target biopsy and transcriptome analysis. Methods Six DIPG patients admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2017 to December 2017 were included in this prospective study. The 11C-MET-PET/CT image was imported into GE AW4.5 workstation software to measure the maximum methionine uptake value (SUVmax) of the tumor, and the tumor area was divided into methionine high uptake zone, middle uptake zone and low uptake zone. Biopsy was performed on the high and low intake areas of methionine. By sequencing the tissue samples, the differentially expressed genes and hotspot mutations in the high and low methionine regions of 6 patients were compared, and gene ontology (GO) analysis and signal pathway enrichment analysis were performed. Results The number of genes up-regulated in the methionine-high uptake area of tumor tissues in 6 patients was 296-1 768, and the expression was down-regulated from 558 to 1 476. The results of detection of common hotspot mutations in methionine high and low uptake areas of 6 patients were as follows: 1 BCOR mutation, 4 H3F3A mutations, 1 PIK3CA mutation, 5 TP53 mutations, and 1 PPM1D mutation (detected only in the 11C-MET low uptake region). GO and signal pathway enrichent analysis showed that compared with the low methionine uptake area of tumor tissue, the genes highly expressed in the high uptake area were mainly involved in tumor proliferation, invasion and neovascularization, while the low expressed genes were mainly involved in immune cell chemotaxis, immune response and biological processes such as the reaction to interferon. Conclusions The heterogeneity of cell function is exhibited in the tissues of DIPG. Compared with the lower uptake region of methionine, high uptake region has high expression of tumor malignant biological behavior-related genes and low expression of immunosuppressive and tumor resistance-related genes. 11C-MET-PET/CT could have diagnostic value in distinguishing the biological functions of tumor cells. Key words: Brain stem neoplasms; Genetic testing; Positron-emission tomography; 11C-methionine; Heterogeneity

Effect of brain atrophy in quantitative analysis of 123I-ioflupane SPECT.

Dopamine transporter (DAT) imaging such as 123I-ioflupane (123I-FP-CIT) SPECT is a useful tool for the diagnosis of parkinsonism and dementia. The Southampton method is the quantitative method for evaluating 123I-FP-CIT SPECT and is less affected by the partial volume effect of the striatum. The method may be vulnerable to contamination by low-uptake areas of cerebrospinal fluid in whole brain, and the threshold of voxel value (threshold method, TM) was developed to correct the contamination. The purpose of this study is to evaluate the TM in the patients with neurological disease. We studied 99 subjects, including 39 patients with Alzheimer's disease (AD), 15 patients with Parkinson's disease (PD) and 10 patients with dementia with Lewy bodies (DLB). Each subject had undergone 123I-FP-CIT SPECT. We calculated the SBR with and without the TM. The SBR laterality was assessed using the asymmetry index (AI). We investigated the relationship between the SBR change with TM and brain atrophy, which were assessed using Evans index (EI), sylvian index (SI) and cerebral atrophy index (CAI). Cutoff value for EI was 0.3, and cutoff values for SI and CAI were the first quartile, respectively. The SBR with TM was 0.53 percentage points lower than the SBR without TM overall (p < 0.01). Positive and negative reversal of AI increased with age. The rate of the SBR change with TM was tended to be lower in groups with brain atrophy. The number of voxels excluded by TM in striatal volumes of interest (VOIs) was larger with high groups for EI, SI and CAI than in low groups. The number of voxels excluded using TM in reference VOIs was related to SI. The SBR was decreased using TM. The effect of TM on the SBR tended to be small in the subjects with severe brain atrophy. The effect of brain atrophy in the TM is larger in the striatal VOIs than in the reference VOIs. Even if quantitative analyses are available, visual assessment of 123I-FP-CIT SPECT is essential for diagnosis.

Radiomics of the primary tumour as a tool to improve 18F-FDG-PET sensitivity in detecting nodal metastases in endometrial cancer

BackgroundA radiomic approach was applied in 18F-FDG PET endometrial cancer, to investigate if imaging features computed on the primary tumour could improve sensitivity in nodal metastases detection. One hundred fifteen women with histologically proven endometrial cancer who underwent preoperative 18F-FDG PET/CT were retrospectively considered. SUV, MTV, TLG, geometrical shape, histograms and texture features were computed inside tumour contours. On a first group of 86 patients (DB1), univariate association with LN metastases was computed by Mann-Whitney test and a neural network multivariate model was developed. Univariate and multivariate models were assessed with leave one out on 20 training sessions and on a second group of 29 patients (DB2). A unified framework combining LN metastases visual detection results and radiomic analysis was also assessed.ResultsSensitivity and specificity of LN visual detection were 50% and 99% on DB1 and 33% and 95% on DB2, respectively. A unique heterogeneity feature computed on the primary tumour (the zone percentage of the grey level size zone matrix, GLSZM ZP) was able to predict LN metastases better than any other feature or multivariate model (sensitivity and specificity of 75% and 81% on DB1 and of 89% and 80% on DB2). Tumours with LN metastases are in fact generally characterized by a lower GLSZM ZP value, i.e. by the co-presence of high-uptake and low-uptake areas. The combination of visual detection and GLSZM ZP values in a unified framework obtained sensitivity and specificity of 94% and 67% on DB1 and of 89% and 75% on DB2, respectively.ConclusionsThe computation of imaging features on the primary tumour increases nodal staging detection sensitivity in 18F-FDG PET and can be considered for a better patient stratification for treatment selection. Results need a confirmation on larger cohort studies.

Involvement of the Septo-Hippocampal Cholinergic Pathway in Association with Septal Acetylcholinesterase Upregulation in a Mouse Model of Tauopathy.

Cholinergic cell loss in the basal forebrain, the major source of hippocampal cholinergic projections, has been implicated in Alzheimer's disease. To examine whether the septohippocampal pathway is involved in tauopathy model mice and to elucidate the tau-associated mechanism underlying cholinergic alteration. Adult (6 to 8 months old) and old (16 to 18 months old) transgenic mice expressing wild-type human tau, Tg601, were examined using Ex vivo diffusion tensor magnetic resonance imaging (DTI) and 2-[18F]fluoro- 2-deoxy-D-glucose positron emission tomography (FDG-PET). Choline acetyltransferase (ChAT)-positive neurons in the medial septum (MS) were counted by stereological methods. Acetylcholinesterase (AChE) activity and AChE mRNA in 6 brain regions were measured. Ex vivo DTI revealed that the number of fractional anisotropy (FA) streamlines in the septohippocampal tract decreased with age in Tg601 mice. The FA value in the septum was lower in old Tg601 mice than in non-tg mice. A voxel-based statistical analysis of FDG-PET revealed the presence of low glucose uptake areas, involving the MS in adults, and spread over regions including the hippocampal dentate gyrus in old mice. In the MS, the number of choline acetyltransferase (ChAT)-positive neurons decreased in old Tg601 mice. AChE activity and AChE mRNA T transcripts were exclusively higher in the septum. The upregulation of AChE in the septum may result in the selective degeneration of the septohippocampal cholinergic pathway in the tauopathy mouse model.

High resolution FDG-microPET of carotid atherosclerosis: plaque components underlying enhanced FDG uptake.

This study sought to discover which atherosclerotic plaque components co-localize with enhanced [(18)F]-fluorodeoxyglucose (FDG) uptake in carotid positron emission tomography (PET) images. Although in vivo PET currently lacks the resolution, high-resolution ex vivo FDG-microPET with histology validation of excised carotid plaque might accomplish this goal. Thirteen patients were injected with FDG before carotid endarterectomy. After excision, the plaque specimens were scanned by microPET and magnetic resonance imaging, and then serially sectioned for histological analysis. Two analyses were performed using generalized linear mixed models: (1) a PET-driven analysis which sampled high and low FDG uptake areas from PET images to identify their components in matched histology specimens; and (2) a histology-driven analysis where specific plaque components were selected and matched to corresponding PET images. In the PET-driven analysis, regions of high FDG uptake were more likely to contain inflammatory cells (p < 0.001) and neovasculature (p = 0.008) than regions of low FDG uptake. In the histology-driven analysis, regions with inflammatory cells (p = 0.001) and regions with loose extracellular matrix (p = 0.001) were associated with enhanced FDG uptake. Furthermore, areas of complex inflammatory cell infiltrate (co-localized macrophages, lymphocytes and foam cells) had the highest FDG uptake among inflammatory subgroups (p < 0.001). In conclusion, in carotid plaque, regions of inflammatory cell infiltrate, particularly complex one, co-localized with enhanced FDG uptake in high-resolution FDG-microPET images. Loose extracellular matrix and areas containing neovasculature also produced FDG signal. This study points to the potential ability of FDG-PET to detect the cellular components of the vulnerable plaque.

High-uptake areas on positron emission tomography with the hypoxic radiotracer (18)F-FRP170 in glioblastomas include regions retaining proliferative activity under hypoxia.

ObjectiveThe aim was to evaluate the proliferative activity of high-uptake areas on positron emission tomography (PET) with the hypoxic cell radiotracer, 1-(2-[18F]fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole (FRP170).MethodsThirteen patients with glioblastoma underwent FRP170 PET before tumor resection. During surgery, tumor specimens were stereotaxically obtained from regions corresponding to high (high-uptake areas, HUAs) and relatively low (low-uptake areas, LUAs) accumulation of FRP170. We compared immunohistochemical staining for Ki-67 and hypoxia-inducible factor (HIF)-1α between HUA and LUA.ResultsHIF-1α index was significantly higher in HUAs than in LUAs. In contrast, mean Ki-67 indices did not differ significantly between HUAs and LUAs.ConclusionsFindings for HIF-1α index clearly indicated that HUAs on FRP170 PET represented hypoxic regions in glioblastoma. However, findings of Ki-67 index suggest that HUAs on FRP170 PET include regions retaining proliferative activity regardless of tissue hypoxia.

NI-01 * GENE PROFILES IN HIGH UPTAKE AREA ON POSITRON EMISSION TOMOGRAPHY WITH A HYPOXIC CELL TRACER, 18F-FRP170

Malignant gliomas include hypoxic cells due to both excessive consumption and insufficient supply of oxygen within the tumor. Intratumoral hypoxic conditions are disadvantageous in term of the production of peroxide radicals, which induces DNA damage under irradiation. Cancer stem cells existing within hypoxic tumor tissue have also been considered to represent a likely cause of radioresistance. In glioblastoma, hypoxic conditions play an important role in the development of tumor progression. Therefore, we performed PET using 11C-methionine for detecting extent of tumor, and using 18F-FRP170 (18F-FRP170 PET) for detecting hypoxic cells in malignant brain tumors. We also examined on 18F-FRP170 PET with intratumoral oxygen pressure (tpO2 ) within glioblastoma measured using oxygen microelectrodes during tumor resection. Furthermore, we analyzed hypoxia-related genes, such as HIF-1 and VEGF, in high or low uptake areas of 18F-FRP170 PET. Mean tpO2 was significantly lower in the high-uptake area than in the low-uptake area. The specimens obtained from high-uptake areas, showed the increased expression of hypoxia-related genes. These findings suggest that high accumulation on 18F-FRP170 PET represents viable hypoxic tissues in glioblastoma.

FDG PET/CT and Enhanced CT Imaging of Tumor Heterogeneity in Hepatocellular Carcinoma

Tumor heterogeneity is used to define the appearance of different histological differentiation within a single neoplasm. We present a case of single hepatocellular carcinoma showing both low and high FDG uptake areas. The low FDG uptake area was corresponding to low-grade HCC, and the high FDG uptake area was corresponding to high-grade HCC. This case indicates that the tumor grades affect intratumoral heterogeneity in FDG distribution. FDG PET/CT can be useful for guiding tissue sampling of the HCC with heterogeneous histological differentiations, and obviating overestimation or underestimation of the proportion of the higher-risk cell population.

Standardized Uptake Value in High Uptake Area on Positron Emission Tomography with 18F-FRP170 as a Hypoxic Cell Tracer Correlates with Intratumoral Oxygen Pressure in Glioblastoma

The aim of this study was to clarify the reliability of positron emission tomography (PET) using a new hypoxic cell tracer, 1-(2-[(18)F]fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole ((18)F-FRP170). Twelve patients with glioblastoma underwent (18)F-FRP170 PET before tumor resection. Mean standardized uptake value (SUV) and normalized SUV were calculated at regions within a tumor showing high (high-uptake area) and relatively low (low-uptake area) accumulations of (18)F-FRP170. In these areas, intratumoral oxygen pressure (tpO2) was measured using microelectrodes during tumor resection. Mean tpO2 was significantly lower in the high-uptake area than in the low-uptake area. A significant negative correlation was evident between normalized SUV and tpO2 in the high-uptake area. The present findings suggest that high accumulation on (18)F-FRP170 PET represents viable hypoxic tissues in glioblastoma.

Fluorine-18-labeled boronophenylalanine positron emission tomography for oral cancers: Qualitative and quantitative analyses of malignant tumors and normal structures in oral and maxillofacial regions

The present study aimed to demonstrate the features of fluorine-18-labeled boronophenylalanine positron emission tomography ((18)F-BPA-PET) to reveal oral cancer, as well as normal structures in the oral and maxillofacial regions. We analyzed (18)F-BPA-PET findings from 8 patients with histologically confirmed recurrent and/or advanced oral cancer scheduled for boron neutron capture therapy. The capacity of (18)F-BPA-PET to delineate tumor and normal structures was assessed qualitatively and quantitatively. Tumors were easily identified as high uptake areas in all cases. Although the eyes, which were depicted as a low uptake area, and tongue musculature were readily identified, major vessels were not noted in any of the cases. Areas corresponding to the surface of the dorsum tongue to middle pharynx were expressed as high uptake areas in all of the cases. Quantitatively, tumors were expressed as the highest uptake area in 6 of the 8 cases, while the dorsum tongue had the highest uptake area in the remaining 2 cases. (18)F-BPA-PET is useful in demonstrating the presence of a tumor. Thus, it is crucial to note the presence of a high uptake area corresponding to the dorsum area of the tongue when diagnosing a tumor using this technique.

Maximising round length in a large National Health Service breast screening unit

Within the National Standards for Breast Screening is the objective to ensure that women are recalled for screening at appropriate intervals. The Manchester Breast Screening Unit has utilised the ability to specify batches from the health authorities in a specific order, to maximise the call and recall system for women eligible for primary screening. The minimum standard for the criterion of the percentage of eligible women whose first offered appointment is within 36 months of their previous screen is ≥ 90%. Using the computer program has maximised the appointment scheduling, but in addition has derived benefits to the Commissioning Primary Care Trusts. The appointment timescales, offering women screening on mobile vans, has enabled the Primary Care Trusts the opportunity to promote breast screening effectively to the eligible women who have failed to attend their first appointment. In low-uptake areas, this has facilitated the efforts to increase uptake to the national standard of 70%.