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Summary[177Lu-DOTA0, Tyr3]-octreotate (177Lu-octreotate) in peptide receptor radionuclide therapy (PRRT) offers direct intra-therapeutic dosimetry. The aim of this study was to compare tumour and non-tumour parameters and assess intra-individual variations. Patients, methods: Retrospective analysis of 53 consecutive PRRT treatment cycles (mean activity of 7.53 ± 0.46 GBq 177Lu-octreotate, intended four cycles at intervals of 10–14 weeks, standard nephroprotection) in 27 GEP NET patients. Extended planar dosimetry with serial wholebody imaging on selected, non-superimposed tumour and non-tumour regions; liver (LM), bone (BM), and other (OM) metastases. The per-cycle variation was compared with posttreatment response (CT/MRI three months post-treatment, modified SWOG criteria). Results: Residence time in tumor lesions (133–147 h) exceeded that in kidneys (93 h). Tumour-to-kidney absorbed dose ratios ranged from 14 to 28 (LM, BM, OM). Intra-individual per-cycle dose variation was insignificant for kidneys, but significant for metastases (LM, BM, and OM; p < 0.05). The mean per-cycle decrease of tumour absorbed dose (_D/A0[%]) was linked to morphologic response after PRRT. A mean decrease of >20% was predictive of a partial or minor remission in all 11 evaluable patients, while absent significant dose reduction indicated stable or progressive disease in 4/5 patients. The dose decrease was unrelated to volume effects and also observed for BM. Conclusion: Besides confirmation of a favourable tumour-to-kidney parameter relation for 177Lu-octreotate, stepwise intra-lesional comparison seems to imply a prognostic impact of tumor dosimetry: The early per-cycle change _D/A0 between treatment cycles may predict the outcome after PRRT. Larger studies are needed to confirm this finding.

Selection of candidates for peptide receptor radionuclide therapy (PRRT) is increasingly based on receptor positron emission tomography (PET) imaging, including the common tracer 68Ga DOTATOC. However, no studies have yet compared standardized uptake values (SUVs) and absorbed doses in this field.We retrospectively analyzed a consecutive cohort of 21 patients with 61 evaluable tumor lesions undergoing both pretherapeutic 68Ga DOTATOC-PET/CT (Biograph Duo [Siemens Medical Solutions, Erlangen, Germany]; PET acquisition, 75.3 ± 15.4 minutes postinjection; 117.3 ± 33.9 MBq 68Ga DOTATOC) and PRRT with Lu octreotate (7.47 ± 1.39 GBq; intratherapeutic tumor dosimetry with serial whole-body scans; 1, 2, and 4 days postinjection) at our institution. SUVs were compared with the tumor-absorbed doses per injected activity (D/A0) of the subsequent first treatment cycle.The correlation of SUV and D/A0 was r = 0.72 (SUVmean) and r = 0.71 (SUVmax), both P0.001. Pancreatic origin and hepatic localization were associated with higher D/A0, and chromogranin A level and Ki-67 index had no influence on SUV or D/A0. High-SUV lesions (SUVmean15; SUVmax25) resulted in high D/A0 (10 Gy/GBq) in 66.7% to 70.8% and low D/A0 (5 Gy/GBq) in only 8.3% to 12.5% on subsequent PRRT. The mentioned low D/A0 range, on the other hand, was achieved by all lesions with SUVmean7 or SUVmax9.Somatostatin receptor PET imaging may predict tumor-absorbed doses. The ability to indicate insufficient target irradiation by a low SUV could aid in selection of appropriate candidates for PRRT. However, larger series are needed to confirm and validate these initial findings.

The present study is aimed to assess the availability and use of complementary medicine (CM) therapies in Italian palliative care hospices, and the support services available to caregivers and hospice staff.A national sample of 30 hospices meeting study criteria provided data by means of telephone interviews.All hospices offered spiritual assistance and at least one other form of CM, with the most common being massage therapy (n = 24) and relaxation therapy (n = 10). When offered complementary therapies, 65% or more of the patients accepted them. Twenty-nine hospices provided spiritual and psychological support to caregivers during patient stays, but only 12 offered support at home. All hospices offered support services to their staff, both in individual and group formats.Despite limited empirical support, CM has become an important part of palliative care for end-of-life patients in Italy, as in many other countries.

The present study aimed to identify, in a large Italian sample of young, novice drivers, specific subtypes of drivers on the basis of combinations of self-reported personality traits (i.e., driving anger, anxiety, angry hostility, excitement-seeking, altruism, normlessness and driving locus of control) and to evaluate their high-risk driving behaviors not only in terms of traffic rule violations and risk-taking behaviors, but also in terms of driving errors and lapses as measured by the Manchester Driver Behavior Questionnaire. Participants were 1008 high school students between the ages of 18 and 23 years, with valid driver's licenses. On the basis of a cluster analysis of the personality variables, three easily interpretable driver subgroups were identified (risky drivers, worried drivers and careful drivers) that differed on self-reported accident involvement, attitudes toward traffic safety and risk perception, as well as on driving violations, errors, and lapses. The inclusion of internal and external driving locus of control, variables not previously considered in similar cluster studies, provided a relevant contribution to the final cluster solution. Further, the use of the Driving Behavior Questionnaire permitted the differentiation between deliberate deviations from safe driving practices and mistakes due to misjudgments or lapses in attention. This distinction was critical for understanding the behavior of each of the three identified subgroups of drivers, and for planning interventions to promote safe driving.

Eight patients with drug-resistant complex-partial seizures were subjected to left- and right-sided intracarotid sodium amytal (ISA) procedures during preoperative investigations for surgical treatment. Regional changes of cerebral and cerebellar blood flow during barbiturization were measured by [99mTc]-HMPAO-SPECT. Crossed cerebellar diaschisis (CCD) was observed in 13 out of 16 tests (81%) as well as ipsilateral cerebral hypoperfusion (87%). Thus CCD occurred more frequently in ISA procedures than in previously studied patients with cerebral infarctions and tumors. Since intracarotid injections of sodium amytal lead to hypoperfusion mainly in those areas of the brain that are supplied by the middle cerebral artery, functional suppression of these regions is supposed to be one of the main preconditions of CCD. Our findings suggest that CCD as demonstrated by the SPECT-technique is a common phenomenon in ISA procedures.

To evaluate the associations between weight-based stigmatization, psychological distress, and binge eating behavior in a treatment-seeking obese sample.Ninety-three obese adults completed three questionnaires: 1) Stigmatizing Situations Inventory, 2) Brief Symptoms Inventory, and 3) Binge Eating Questionnaire. Correlational analyses were used to evaluate the association between stigmatizing experiences, psychological distress and binge eating behavior.Stigmatizing experiences predicted both binge eating behavior (R(2)=.20, p.001) and overall psychological distress (R(2)=.18, p.001). A substantial amount of the variance in binge eating predicted by weight-based stigmatization was due to the effect of psychological distress. Specifically, of the 20% of the variance in binge eating accounted for by stigmatizing experiences, between 7% and 34% (p.01) was due to the effects of various indicators of psychological distress.These data suggest that weight-based stigmatization predicts binge eating behavior and that psychological distress associated with stigmatizing experiences may be an important mediating factor.

SummaryAim: Dosimetry in 131I-lipiodol therapy for hepatocellular carcinoma (HCC) in the hitherto largest existing patient cohort. Patients, methods: 38 courses of intra-arterial 131I-lipiodol therapy with a total activity up to 6.7 GBq were performed in 18 patients with HCC. Liver and tumour volume were measured by computed tomography (CT) and 131I activity by scintigraphy on day 3, 6, 14, 28 and 42 after injection. Lipiodol deposition in tumour nodules as shown by CT rendered definite attachment to scintigraphic data possible. The radiation dose in tumour nodules, liver and lungs was calculated according to the MIRD concept and the tumour dose related to pre-therapeutic tumour volume, response and survival. Results: Mean tumour dose was 23.6 ± 3.6 Gy (14.2 ± 2.1 mGy/MBq) with maximal 162 Gy (90.1 mGy/MBq) after one and 274 Gy after three courses. The dose to nontumourous liver was 1.9 ± 0.2 Gy (1.2 ± 0.1 mGy/MBq) and the mean dose ratio of tumour / nontumourous liver 11.1 ± 1.7 (max. 82). The pulmonary dose was 25.9 ± 1.8 mGy (16.3 ± 1.2 μGy/MBq) and therefore much lower. There was a reciprocal relation between tumour dose and pretherapeutic tumour volume. Tumour dose had no effect on response or survival. Conclusion: High radiation doses are particularly in small tumour nodes achievable but not necessarily related to tumour response. The dose of non-tumourous liver and lungs is much lower.

Objective: This study evaluated the relation among weight-based stigmatization, ideological beliefs about weight, and psychological functioning in an obese, treatment-seeking sample. Research Methods and Procedure: Ninety-three obese, treatment-seeking adults (24 men and 69 women) completed a battery of self-report questionnaires measuring psychological adjustment, attitudes about weight, belief in the controllability of weight, and the frequency of weight-based stigmatization. Results: Weight-based stigmatization was a common experience for participants. Frequency of stigmatizing experiences was positively associated with depression, general psychiatric symptoms, and body image disturbance, and negatively associated with self-esteem. Further, participants’ own negative attitudes about weight problems were associated with their psychological distress and moderated the relation between the experience of stigmatization and body image. Discussion: Weight-based stigmatization is a common experience for obese individuals seeking weight loss treatment and appears to contribute to poor mental health adjustment. The negative effects of these experiences are particularly damaging for those who hold strong antifat beliefs.

Objective: The aim of this study was to evaluatel-3[123I]-iodo-α-methyl tyrosine (IMT)-SPECT and FDG-PET in pulmonary lesions suspected to be lung cancer.Methods: Whole body PET (measured transmission corrected emission scans) was performed 45 minutes after i.v. injection of 222–370 MBq (6–10 mCi)18F-FDG on a Siemens PET scanner (ECAT EXACT 47) including 5–6 bed positions.123I-IMT-SPECT (chest) was performed after injection of 370 MBq (10 mCi) with a dual head camera (Picker Prism 2000) and commercially available reconstruction algorithms. Ten patients (6 male and 4 female) with suspected lung cancer were investigated. The results were compared to histological findings after surgery or bronchoscopic biopsies and CT.Results:123I-IMT-SPECT and FDG-PET were able to detect all 9 cases of lung cancer (1–8 cm in diameter). One case was true negative. Both imaging methods were true positive with respect to mediastinal lymph node metastases in one patient. The tumor/background ratio was higher with PET (8.20vs. 2.84).Conclusion: Despite the limited number of patients it may be concluded that IMT-SPECT as well as FDG-PET are suited to correctly diagnose lung cancer. Nevertheless, FDG-PET, if available, seems to be better suited because of the higher tumor/background ratio and better resolution.

FRIEDMAN, KELLI E., SIMONA K. REICHMANN,PHILIP R. COSTANZO, AND GERARD J. MUSANTE.Body image partially mediates the relationship betweenobesity and psychological distress. Obes Res. 2002;10:33Ð 41.Objective: Body image is considered as a potential mediatorof the relationship between obesity and psychological dis-tress.Research Methods and Procedures: One hundred ten menand women in a residential weight control facility com-pleted the Multidimensional Body Self-Relations Question-naire, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the Binge Eating Scale.Results: For both men and women, body-image satisfactionpartially mediated the relationship between degree of over-weight and depression/self-esteem.Discussion: Sociodemographic factors that may influencethe relationships among weight, body image, and depres-sion/self-esteem are discussed.Key words: adults, body-image dissatisfaction, depres-sion, self-esteem Introduction The nature of the relationship between obesity and psy-chological distress continues to be debated by researchersand clinicians alike. Studies of nonclinical samples of obesepersons have consistently shown that obese individuals donot differ from their non-obese counterparts in psycholog-ical symptoms, psychopathology, or personality overall (1).However, studies do indicate that subgroups within theobese population, such as obese individuals presenting forclinical weight-loss treatment and obese binge-eaters, showelevated psychopathology (2Ð 4). Individuals seeking treat-ment for weight loss have consistently demonstrated ahigher prevalence of distress than their nontreatment-seek-ing counterparts. For instance, it has been found that obesetreatment seekers show elevated levels of depression (5),binge eating (2), general psychiatric symptoms (2), andbody-image distress (6). Goldsmith et al. (5) reported that55.6% of their participants who were seeking weight-losstreatment met criteria for current or past psychiatric illness,especially major depression and dysthymia. Binge eating,which occurs in ! 30% of obese individuals seeking weight-loss treatment (7), also has been linked to elevated levels ofdepression. Marcus et al. (8) found that obese binge-eatershad substantial depressive symptomatology compared withtheir nonbinging counterparts. Additionally, Kuehnel andWadden (9) reported that individuals diagnosed with binge-eating disorder had significantly higher levels of depressionthan both nonbingers and problem eaters. This binge eating-mediated pattern of results has been confirmed in numerousadditional studies (10,11). The results of these studies sug-gest that when attempting to understand the relationshipbetween obesity and symptoms of psychological distress, itseems useful to consider mediating variables, such as treat-ment-seeking status or binge eating, to explain the presenceof psychological symptomatology.With respect to potential mediators, Friedman andBrownell (12) have proposed several additional risk factorsthat may determine which obese individuals will suffernegative psychological consequences. These include socialclass, degree of obesity, and body-image dissatisfaction. Inthis study one of the proposed risk factors, body-imagedissatisfaction, is investigated as a potential mediator of therelationship between dysphoric psychological states (e.g.,depression and low self-esteem) and obesity in a treatment-seeking population.Body image is an individualOs psychological experienceof the appearance and function of his/her body and is oneaspect of an individualOs mental representation of him/herself (13,14). Although it was long assumed that bodyimage was a unidimensional construct, recent research has

The diagnostic potential of technetium-99m hexamethylpropylene amine oxime (HMPAO) following systemic administration of the cerebral vasodilator acetazolamide (acetazolamide test) was evaluated by regional cerebral blood flow (rCBF) single-photon emission tomography (SPET) in patients with Alzheimer’s disease (AD) or vascular dementia (VD). An initial, high-resolution SPET study was performed with 99mTc-HMPAO, and after 2 days the patients were re-evaluated with 99mTc-HMPAO following systemic administration of acetazolamide. Reconstructed SPET slices were evaluated visually and semiquantitatively by a semi-automatic rCBF map method. When 99mTc-HMPAO alone was used, bilateral hypoperfusion was found in the temporal and/or parietal regions in 33% (6/18) of the VD patients and in 70% (23/33) of the AD patients. The corresponding data obtained by quantitative evaluation were 41% (7/17) and 71% (15/21), respectively. The vascular reserve capacity, as determined with the acetazolamide test, was preserved visually in 22% (4/18) and quantitatively in 29% (5/17) of the VD patients, but in 73% (24/33) and 76% (16/21) of the AD patients. The differences in the perfusion patterns between the VD and AD patients were statistically significant (P

Objective : The purpose of this study was to compare the binding of various typical and atypical neuroleptics to striatal D 2 dopamine receptors in schizophrenic patients. Method : Fifty-six inpatients with schizophrenia, including 14 with schizoaffective disorder and one with schizophreniform disorder, were evaluated. Fourteen patients were neuroleptic free. Single photon emission computed tomography (SPECT) was performed 90 minutes after intravenous injection of [ 123 I]benzamide ([ 123 I]IBZM). Subsequent semiquantitative analysis of D 2 receptor binding was done with the use of the basal ganglia (striatum)/frontal cortex (BG/FC) ratio of activity. Clinical symptoms were rated with the Positive and Negative Syndrome Scale and the Hamilton Depression Rating Scale. Results : The BG/FC ratios in patients taking typical neuroleptics were significantly lower than those in the neuroleptic-free subjects but not lower than those in the patients taking atypical neuroleptics (clozapine, remoxipride). For atypical antipsychotics, a dose-dependent relationship with striatal D 2 receptor binding could not be demonstrated. BG/FC ratios were not significantly correlated with clinical symptoms or with duration of illness. Conclusions : The results indicate that [ 123 I]IBZM SPECT is useful for semiquantitative imaging of striatal D 2 dopamine receptors and for estimating their blockade by neuroleptics. Thus, it may improve drug monitoring in psychiatric patients. Furthermore, the findings suggest a complex relationship between the antipsychotic effect of atypical neuroleptics and D 2 receptor blockade.

To evaluate the efficacy and tolerance of iodine-131-lipiodol ((131)I-lipiodol) for hepatocellular carcinoma (HCC) in German long term patients and comparison with medically treated controls.38 courses of intra-arterial (131)I-lipiodol therapy with a total activity up to 6.7 GBq were performed in 18 patients with HCC (6 with portal vein thrombosis). Liver and tumour volume and lipiodol deposition were measured by computed tomography and (131)I activity by scintigraphy. Therapeutic efficacy was determined by tumour volume change and matched-pairs analysis in comparison to medically (i.e. tamoxifen or medical support) treated patients.Tumour volume decreased in 20/32 index nodules (63%) after the first course. Repeated therapy frequently resulted in further tumour reduction. Overall response to treatment was partial in 11 nodules, minor response in 4 nodules, and disease was stable in 12 and progressive in 5. Significant response was associated with pretherapeutic nodule volume up to 150 ml (diameter of 6.6 cm). Survival rate after 3, 6, 9, 12, 24 and 36 months was 78, 61, 50, 39, 17, and 6%. Matched-pairs analysis of survival revealed (131)I-lipiodol to be superior to medical treatment. The most important side effect was a pancreatitis-like syndrome whereas overall tolerance was good.The long term results confirm that HCC therapy with (131)I-lipiodol is effective and probably superior to medical treatment. Tumour nodules of up to 6 cm diameter are well suited for this therapy even in the presence of portal vein thrombosis.

Background As single-head data acquisition for thallium-201 myocardial SPECT is a frequently used method mainly in the outpatient medical care as well as in smaller hospitals, comparison to dual-head data collection is a still discussed issue mainly with regard to quality control and -assurance. Methods A total of 1334 patients undergoing thallium-201 myocardial SPECT for diagnosis of myocardial ischemia and/or viability have been retrospectively analyzed. In 554 patients, a single-head gamma camera (360° rotation) has been applied, whereas a dual-head gamma camera (180° rotation) has been used in 780 patients. Four hundred twenty-six patients received both myocardial SPECT as well as coronary angiography. The diagnostic value of both applied acquisition techniques has been analyzed. Results Regarding myocardial viability, positive predictive value for the diagnosis of myocardial scar tissue was significantly higher for dual-head- as compared to single-head acquisition. Among the 426 patients undergoing diagnosis of myocardial ischemia, significant differences have only been found with regard to specificity being higher in the single-head acquisition. Diagnosis of myocardial ischemia related to a distinct myocardial perfusion region showed a significantly higher sensitivity of dual-head acquisition for the left anterior descending perfusion area, whereas specificity was significantly higher for single-head acquisition. Conclusions Our results indicate a beneficial effect of dual-head data collection with regard to sensitivity of the diagnosis of myocardial ischemia. In contrast, single-head data acquisition was superior with regard to specificity. However, it is justified to preferably apply dual-head data collection in clinical routine due to the shorter acquisition time leading to an evident time benefit of this acquisition technique.

Background: The human 5-HT 2 C receptor gene has been localized on the X chromosome and is expressed in two genetic variants. Whereas previous investigations have suggested that the 5-HT 2 C receptor gene polymorphism is critically involved in the pathogenesis of affective and eating disorders, as yet the functional consequences being associated with the rare serine variant of the 5-HT 2 C receptor in humans are unclear. Methods: We explored by HMPAO-SPECT if a challenge with the serotonin agonist mCPP, that interacts mainly with the 5-HT 2 C receptor, provokes different patterns of regional cerebral bloodflow (rCBF) as a function of the genetic variant of the receptor. Thus we studied its action in 16 healthy male volunteers carrying the common 5-HT 2 C -cys-23 receptor gene and 16 healthy male volunteers carrying the less frequent 5-HT 2 C -ser-23 receptor gene. Results: We found significant differences in rCBF between the two genotypes after mCPP infusion compared to placebo: In the cysteine group rCBF was increased in the left medial prefrontal cortex and decreased in the left anterior cingulate and right medio-temporal cortex, whereas the serine group showed an increase of rCBF in the left medio- and superior-temporal cortex and in cerebellum and a reduced rCBF in the right medial prefrontal cortex. In addition, there was a significant disordinal interaction of the genotype factors and challenge with an increase of rCBF in the serine group and a decrease in the cysteine group in the left motor cortex and calcarine cortex. Additionally, a decrease of rCBF in the serine-group and a simultaneous increase in the cysteine group was found in the right anterior and the left posterior cingulate cortex. Conclusion: These findings suggest that differences in the 5-HT 2 C receptor gene polymorphism has functional consequences due to a different responsiveness of the expressed 5-HT 2 C receptor variants.

To evaluate the usefulness of combined PET/CT examinations for detection of malignant tumors and their metastases in head and neck oncology.51 patients received whole body scans on a dual modality PET/CT system. CT was performed without i.v. contrast. The results were compared concerning the diagnostic impact of native CT scan on FDG-PET images and the additional value of fused imaging.From 153 lesions were 97 classified as malignant on CT and 136 on FDG/PET images, as suspicious for malignancy in 33 on CT and 7 on FDG-PET and as benign in 23 on CT and 10 on FDG-PET. With combined PET/CT all primary and recurrent tumors could be found, the detection rate in patients with unknown primary tumors was 45%. Compared to PET or CT alone the sensitivity, specifity and accuracy could be significantly improved by means of combined PET/CT.Fused PET/CT imaging with [F18]-FDG and native CT-scanning enables accurate diagnosis in 93% of lesions and 90% of patients with head and neck oncology.

Scintigraphy with technetium-99m labeled antigranulocyte antibodies including planar and SPECT imaging demonstrated areas of inflammation in bone and soft tissue of the thigh of a 38-year-old man who had a fracture of the femur 20 years earlier. The clinical potential of this imaging modality in the diagnostic assessment of inflammatory diseases is discussed.

Therapeutic means for patients with painful bony metastases are strongly limited. In these patients, a systemic therapy with isotopes can be helpful. The aim of this study was to evaluate the efficacy of rhenium-186 HEDP for pain palliation in patients with disseminated bone metastases.30 patients taking analgesics because of bone pain received one or more injection of 1295 MBq 186Re HEDP for pain palliation.In 70% of the patients, therapy resulted in a significant reduction of pain. The average duration of pain relief was 4 weeks (1 week-2.5 months). The main side effects of therapy were a decrease of platelets (aver. 30000/microliters) and an increase of pain for 1-2 days (flare-phenomenon).Therapy with rhenium-186 HEDP can be used complementarily to analgesic therapy in patients with painful, disseminated bone metastases.

Interictal rCBF-SPECT is frequently being used as an adjunctive method for localization of an epileptogenic area during presurgical evaluation of patients suffering from medically refractory temporal lobe epilepsy. This study retrospectively evaluates interictal rCBF-SPECT using Tc-99m-HMPAO in comparison to the results of MRI. The final results of surface EEG and ECoG and the postsurgical clinical results as to seizure frequency were used a a 'gold-standard' for the evaluation of both imaging procedures. As spatial resolution is discussed to be the major reason for higher sensitivity of F-18-DG-PET compared to rCBF-SPECT, special attention has been paid to the spatial resolution of the different SPECT systems being used in this study. In 55 patients the complete data set could be obtained retrospectively, 36 of them being evaluated using SPECT systems with relatively low spatial resolution (Picker Dyna 2000, Elscint Helix) and 19 pt. being evaluated using moderate- to high-resolution SPECT systems (ADAC Genesys, DSI Ceraspect). Overall sensitivity of the interictal rCBF-SPECT was 75%, with 69% for low-resolution systems and 84% for high-resolution systems. Approximately at the same time when our institution installed the ADAC Genesys, the MRI equipment was changed form the 1.5 T Philips Gyroscan S15 to the 1.5 T Philips Gyroscan ACS II, the latter allowing superior imaging opportunities. Overall sensitivity of MRI was 60%, with 56%, for the Gyroscan S15 and 68% for the Gyroscan ACS II. The overall positive predictive value (PPV) was 87% for the interictal rCBF-SPECT and 87% for the MRI. Due to the lack of true negative studies in this population specificity was not calculated. False lateralization using rCBF-SPECT occurred in 5 pts. (9%), however, in 3 pts. the area of hypoperfusion correlated with a detectable MRI pathology, yet EEG/ECoG revealed the epileptogenic focus to be elsewhere. In conclusion, the interictal rCBF-SPECT revealed reasonable sensitivity and PPV in pt. suffering from focal temporal lobe epilepsy and modern SPECT systems showed significantly improved results. Since there is a variety of possible reasons for regional cortical hypoperfusion, the interictal SPECT could add significant information prior to the application of ECoG. This specially appeared to be useful in patients with abnormal MRI scan. Furthermore, in patients presenting with a clear pathology on MRI and a corresponding EEG focus, ECoG could be avoided if the interictal rCBF-SPECT additionally showed localized and singular involvement of the affected temporal lobe. ECoG was mainly applied in those patients with relatively wide-spread hypoperfusion additionally involving frontal or parietal cortical areas.

The aim of this study was to evaluate the use of 99mTc-ethyl cysteinate dimer (ECD), also known as 99mTc-bicisate, in the presurgical evaluation of patients suffering from medically intractable epilepsy.Twenty-three brain SPECT studies (8 ictally and 15 interictally) were performed on 16 patients with a high-resolution annular SPECT system (CERASPECT). For the ictal studies, the tracer was injected in the very early phase of the seizure. The delay between seizure onset and 99mTc-ECD injection was 2-20 sec.Interictally, all patients showed circumscribed hypoperfusions. In four patients, the SPECT lesion represented only structural defects. Circumscribed increased tracer uptake was observed in all ictal studies. For all patients with temporal lobe epilepsy without significant mass lesion, in whom an interictal and ictal 99mTc-ECD-SPECT study could be obtained, the asymmetry index was 0.88 +/- 0.03 for the interictal and 1.23 +/- 0.08 for the ictal studies.The data suggest that 99mTc-ECD is an effective marker of cerebral perfusion imaging in epilepsy. In comparison to other tracers, it has a high in vitro stability and is therefore particularly useful for ictal studies in the very early phase after seizure onset.

The clinical application of technetium-99m bicisate (ethyl cysteinate dimer, ECD) for ictal and interictal studies of regional cerebral blood flow (rCBF) in a patient suffering from medically intractable simple and complex partial seizures is reported. The interictal study was performed 60 min p.i. and the ictal studies were performed at 60 min p.i. using an annular crystal single photon emission tomography (SPET) system dedicated for high-resolution brain SPET imaging. Visual evaluation of the studies was carried out, as well as semiquantitative measurement of regional tracer uptake. Magnetic resonance imaging (MRI) scans revealed atrophy of almost the complete left frontal lobe and the ventral parts of the left temporal lobe, including in part the temporomesial structures. The left parietal and occipital structures and the right hemisphere were normal. The interictal study showed a large perfusion defect involving the whole left frontal lobe as well as the left temporal lobe with remaining small areas of normal cortical tracer uptake. The ictal studies detected circumscribed hyperperfusion within the left mesial temporal lobe (ventral part of the hippocampus). Additionally an increase in perfusion could be seen within the entire remaining left temporal lobe. Semiquantitative evaluation of tracer uptake comparing both studies detected markedly increased uptake within the focus compared to the remaining left temporal lobe. On this basis the newly available tracer for studies of rCBF, 99mTc-bicisate, seems to be of value for the detection of epileptogenic foci. Additionally, the value of ictal rCBF studies in the presurgical evaluation of those patients presenting severe morphological alterations on MRI is clearly underlined by this case.

The striatal dopamine-D2-receptor uptake of 123I-IBZM in 32 patients (18 without and 14 under therapy with typical neuroleptics) was measured semiquantitatively using different ROI techniques. The aim of the study was to evaluate the influence of these techniques on the different ratios (striatum/cortex) found by various examiners. Using the same SPECT system no major differences were found between rectangular and manually drawn ROIs of the same size. All ROI techniques could differentiate between patients with and without therapy on a highly significant level. Therefore, the resulting ratio is mainly dependent on the spatial resolution of the camera system and only to a relatively minor extent on the ROI technique. Ratios obtained by different observers are not comparable quantitatively.

A prospective, controlled and randomised trial was started to detect the effectivity of a "single-shot" antibiotic prophylaxis in thoracic surgery using cefuroxime. Therefore 200 unselected patients, consecutively scheduled for major thoracic surgery except endoscopic procedures or mediastinoscopy were enrolled in this study and randomized into either the control group (no antibiotics perioperatively; n = 100) or the prophylaxis group (one dose of 1.5 g cefuroxime i.v. at induction of anaesthesia; n = 100). Clinical signs correlated with infection, radiological findings and the results of repeated microbiological examinations were recorded and a comparative statistical analysis was done. Compared to controls the prophylaxis group had fewer (not significant) infections of the wound, the pleural cavity and the urinary tract and fewer patients of this group showed "pronounced infiltration" in daily taken chest roentgenograms (significant), clinical signs for pneumonia and pathologic sputum findings, or new bacterial colonisation of sputum specimens on the first postoperative day, whereas bacteria, isolated from tracheal aspirates, immediately taken after intubation disappeared more often. Specimens of pleural fluid taken postoperatively were less often positive for bacteria. Fewer patients were treated with antibiotics in the postoperative course and the courses were shorter in the prophylaxis group compared to controls. Considering the risk factor "positive microbiological culture" in preoperative tracheal aspirates, patients of the prophylaxis group showed much more seldom new radiological "infiltration" (statistically highly significant) and, in addition, had lower white blood cell counts (significant) and lower mean maximal body temperatures. The results of our trial confirm the preventive effect of "single-shot" antibiotic prophylaxis in thoracic surgery against infections.

Forty-two patients (6 women, 36 men; mean age 55 [39-69] years), with one-, two- or three-vessel disease on coronary angiography, were studied using single-photon emission computer tomography with 15-p-123I-iodophenyl-pentadecanoic acid (IPPA), in order to evaluate this new method of demonstrating abnormalities of myocardial perfusion. The reference range for fatty acid turnover was determined in eleven controls (4 women, 7 men; mean age 41 [20-51] years) with no coronary stenosis. 185 MBq (5 mCi) of IPPA was administered intravenously during submaximal stress on a bicycle ergometer. Comparison between different regions of the tomograms revealed changes in fatty acid utilization typical of ischaemia. The sensitivity, specificity and predictive value of a positive result compared with coronary angiography were 95%, 89% and 93%, respectively, for the area supplied by the anterior interventricular artery, 92%, 91% and 93% for the circumflex branch and 89%, 91% and 90% for the right coronary artery. In 25 out of 31 patients (81%) with myocardial infarction, IPPA scintigraphy infarct localization agreed with the clinical findings. In two cases with unremarkable scintigrams left ventriculography showed hypokinesia, while in four cases neither method demonstrated any abnormality. There was one false-positive scintigram. IPPA scintigraphy has greater sensitivity and specificity than conventional nuclear medicine techniques in the demonstration of coronary heart disease.

A total of 29 patients with coronary artery disease (CAD) were investigated with 15-(p-[123I] iodophenyl)pentadecanoic acid (123I-IPPA) and sequential single photon emission tomography (SPET). Of these, 19 were studied after aorto-coronary bypass graft surgery. Some 13 patients without evidence of CAD served as a control group. Two SPET studies (early and late) were carried out within 45 min after intravenous administration of 200 MBq 123I-IPPA at peak sub-maximal exercise. Semi-quantification of uptake (related to perfusion) and turnover (linked to metabolism) was obtained by segmental comparison of oblique slices. Taking coronary arteriography as the “gold standard”, 123I-IPPA scintigraphy had the following figures of merit for sensitivity and specificity in the diagnosis of CAD: for the left anterior descending artery territory 93% and 95%, for the left circumflex artery region 96% and 92%, and for the right coronary artery territory 77% and 92%, respectively. In all, 90% of the reperfused myocardial segments showed an improvement of uptake. Of these, 61% exhibited increased turnover after revascularization and 39% had pathologic turnover and thus a dissociation of improvement of perfusion and oxidative metabolism after surgery.

Brain single photon emission computed tomography (SPECT) was performed in 16 patients with focal epilepsy, as well as EEG, using 99m Tc-HM-PAO SPECT and a rotating gamma camera system. Pathological Tc-HM-PAO SPECT findings were registered in 75%. CT was positive in 25%. MRI was positive in 76%. The results of Tc-HM-PAO SPECT findings were compared with those of CT and MRI. 61% of the MRI findings correlated with the pathological SPECT findings with respect to the side of the hemisphere, and in 75% of the patients the focal EEG abnormality and the pathological Tc-HM-PAO-SPECT findings were localized in the same hemisphere.

The lipophilic brain SPECT agent [99mTc]hexamethyl propylene amine oxime (HM-PAO) was used in three cases before and during unilateral anesthesia of one hemisphere for lateralization of speech dominance (Wada test). This procedure led to a decrease of regional cerebral blood flow (rCBF) in each of the hemispheres to 55 and 90%, respectively. Diminution of rCBF was significantly more pronounced in the dominant hemisphere. A second phenomenon observed during the Wada test was crossed cerebellar diaschisis. These findings support the assumption that HM-PAO allows monitoring of brain perfusion, as rapid changes of rCBF due to decreased neuronal activity cause respective alterations of cerebral and cerebellar uptake of this new brain agent.

Derivatives of propylene-amine-oxime (PnAO) have been synthesized which form a neutral lipid-soluble complex with 96mTc and can be supplied as freeze-dried kits. The complexes cross the intact blood-brain barrier. This report shows the brain uptake, early kinetics and biodistribution in normal adult baboons of 5 99mTc-PnAO derivatives and 2 isomers of one of the tested derivatives (HM-PAO). The brain uptake of the favoured dl-isomer of HM-PAO reaches its maximum of 4.3% (whole brain/whole body) 1 min p.i. and a clearance of less than 8% was observed 23 min p.i.

To examine the capacity of detecting regional cerebral blood flow (rCBF) disturbances in stroke, measurements with 133Xe inhalation and 123I-amphetamine (IMP) SPECT were performed within 1–2 days in 19 patients. IMP SPECT images in transverse sections consisting of outer and inner areas were correlated with 32 regions of 133Xe rCBF. 133Xe rCBF was assessed by ISI, CBF15, and F1. Inter hemispheric ratio correlation showed outer IMP uptake correlated better with 133Xe CBF indices than the inner one. With higher ratios of 133Xe rCBF, IMP uptake ratios were variable, suggesting less usefulness of this parameter in evaluation of mild ischemia. Values of IMP in outer regional hypo and hyperemic areas correlated better with those of 133Xe rCBF than the inner ones. In regional ratios of hypo and hyperemic areas from hemispheric mean, outer IMP uptake correlated with 133Xe CBF indices, reflecting regional disturbances of fast clearing tissue perfusion. Regression lines between ratios in 133Xe CBF and IMP uptake were located below one to one correlation, and dissociated more for hyperemic regions. IMP SPECT correlated better with 133Xe rCBF for tissues with reduced perfusion but underestimated hyperemic regions as measured with the 133Xe method. The data suggest outer cerebral IMP uptake evaluated by SPECT could reflect flow disturbances in the brain cortex.

In 31 patients with completed stroke (n = 30) or PRIND (n = 1) a brain SPECT with 123I-labeled amphetamines was performed. In 14 (= 45%) of the respective patients--suffering from long-lasting hemiplegia--crossed cerebellar diaschisis was present. The interval between onset of the disease and time of examination varied between 1 week and 7 years. On the other hand, patients without crossed cerebellar diaschisis did not, with one exception, suffer from hemiplegia. It is likely that this phenomenon is caused by the reduction of spino-cerebellar stimuli due to the paresis of the respective extremities.