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Background: Nutrition and lifestyle have been long established as risk factors for colorectal cancer (CRC). Modifiable lifestyle behaviours bear potential to minimize long-term CRC risk; however, translation of lifestyle information into individualized CRC risk assessment has not been implemented. Lifestyle-based risk models may aid the identification of high-risk individuals, guide referral to screening and motivate behaviour change. We therefore developed and validated a lifestyle-based CRC risk prediction algorithm in an asymptomatic European population. Methods: The model was based on data from 255,482 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study aged 19 to 70 years who were free of cancer at study baseline (1992–2000) and were followed up to 31 September 2010. The model was validated in a sample comprising 74,403 participants selected among five EPIC centres. Over a median follow-up time of 15 years, there were 3645 and 981 colorectal cancer cases in the derivation and validation samples, respectively. Variable selection algorithms in Cox proportional hazard regression and random survival forest (RSF) were used to identify the best predictors among plausible predictor variables. Measures of discrimination and calibration were calculated in derivation and validation samples. To facilitate model communication, a nomogram and a web-based application were developed. Results: The final selection model included age, waist circumference, height, smoking, alcohol consumption, physical activity, vegetables, dairy products, processed meat, and sugar and confectionary. The risk score demonstrated good discrimination overall and in sex-specific models. Harrell’s C-index was 0.710 in the derivation cohort and 0.714 in the validation cohort. The model was well calibrated and showed strong agreement between predicted and observed risk. Random survival forest analysis suggested high model robustness. Beyond age, lifestyle data led to improved model performance overall (continuous net reclassification improvement = 0.307 (95% CI 0.264–0.352)), and especially for young individuals below 45 years (continuous net reclassification improvement = 0.364 (95% CI 0.084–0.575)). Conclusions: LiFeCRC score based on age and lifestyle data accurately identifies individuals at risk for incident colorectal cancer in European populations and could contribute to improved prevention through motivating lifestyle change at an individual level. © 2020, The Author(s).

Piezoelectric, dielectric and ferroelectric properties of a ceramic material greatly influenced by the synthesis technique and prepared condition. In this work, the efforts have been made to prepare barium calcium zirconium titanate (BCZT) ceramics and used to study the effectiveness of conventional sintering (CS) and reactive sintering (RS) methods. Specific composition of BCZT ceramic (Ba0.85Ca0.15Zr0.1Ti0.9O3) was achieved by suitable and verified sintering condition. Phase and structure of ceramics identified by using X-ray Diffraction (XRD). The result confirms the existence of pure perovskite structure and mixture phase of orthorhombic and tetragonal in both CS and RS sintering techniques. Surface morphology and grain size variations for different dwell times were studied using Scanning Electron Microscopy (SEM). In both CS and RS techniques, the optimal sintering condition (1540 °C and 2 h of dwell time) possess gives relatively high density, better electric and piezoelectric properties. RS technique emerged as an alternative for CS technique. The implementation of sintering conditions, driven effects and their role on the above-mentioned properties were discussed. Pre-edge fine structure (PEFS) and X-Ray absorption near edge spectroscopy (XANES) is employed to elucidate the variation and oxidation state of 4+ of Ti and Zr in BCZT ceramics.

Relaxor ferroelectrics (RF) are widely known for their attractive electrical and electromechanical properties, which can be useful for energy storage devices or piezoelectric actuators. They are ferroelectric systems with fragmented or disordered states induced by chemical substitution. However, the origin of relaxor behaviour is still controversial. We attempt here to clarify this in homovalent (Zr4+) and heterovalent (Nb5+) B-site substituted barium titanate (BT) by carefully designed field cooling (FC) experiments. Both homovalent and heterovalent substitutions introduce relaxor behavior in BT over certain concentrations, but the mechanism is expected to be different. Homovalent substituents induce difference in the local polar order as a consequence of local strain fields (due to ionic radii mismatch), whereas heterovalent substituents directly introduce charge imbalances due to the different valence state(s). The effect of the latter in introducing relaxor behavior is expected to be stronger. Being sensitive to the material's short-range order/disorder, Raman spectroscopy (RS) as a function of temperature (T) is a suitable method to study the local structures in the vicinity of vacancies (only in heterovalent substitution) and foreign atoms (any substituted systems). FC experiments have the goal to evidence the presence of long-range ferroelectric states promoted by defect reorientation resulting from the applied electric field, which is expected to occur only in heterovalent-substituted materials. Results on phase transitions sequence and domain orientations will be presented and discussed for both Nb- and Zr-doped BT, in presence and absence of field cooling respectively. Correlation of Raman results with the local structure induced by substituents in the respective materials will be attempted.

Bi3+ with a stereochemically active lone-pair of electrons induces severe lattice strain in BaTiO3 as revealed by a significant Raman shift of the mode associated with the O–Ti–O bonds., In situ Raman spectroscopy shows the simultaneous incorporation of small amounts of Bi3+ and Yb3+ into the lattice of BaTiO3 to break the average symmetry inferred from X-ray powder diffraction analysis and permittivity measurements. In particular, Bi3+ with a stereochemically active lone-pair of electrons induces severe lattice strain and the coexistence of different local crystal symmetries over a wide temperature range, effectively controlling the physical properties, such as the temperature dependence of the permittivity and the Curie temperature. These results show that compositional gradients based in small variations of these two dopants could successfully explain the enhanced thermal stability of the permittivity in core–shell type ceramics, whereas the lower capacitance of the shell can also cap the maximum permittivity at the Curie temperature.

SummaryThe actual number of resin microspheres is approximately 30-60 times higher than glass microspheres per 3 GBq vial. Thus, radioembolization (RE) with resin microspheres exerts an embolization effect besides the radiation effect. This embolization effect can occasionally cause early back flow of the microspheres before application of the entire calculated dose. To avoid these adverse side effects, RE has to be terminated at an earlier time point. Measurement of the residual activity in the delivery box, which includes the v-vial, tube and catheter, to calculate the achieved target dose is often challenging. The aim of the current study was to establish a post-RE measurement method comparable to the glass microspheres method without unnecessary radiation exposure to the staff and risk of contamination. Methods: Two different measurements were performed. First, total radioactivity in the shipping vial was measured in an ion chamber and then it was put in the delivery box and the radiation was measured from a 30 cm distance from the centre of the box with a dosimeter. The required radioactivity was then transferred to the v-vial, and the shipping vial was measured again. After that, the v-vial was measured from the same distance from the centre of the box with dosimeter. Results: Altogether 62 times the shipping vial with different activities were measured with a significant positive correlation between the amount of the activity measured in the iron chamber and the radiation dose, measured with dosimeter (r2 = 0.98; p < 0.001). There was also a strong positive correlation between these measurements of the v-vial (r2 = 0.98; p < 0.001). Conclusion: With measurement of the residual activity in the delivery box using a dosimeter the percentage of the whole injected activity can be easily calculated. This facilitates the calculation of the actual, achieved target and non-target dose in those cases, where therapy had to be stopped because of eminent flow reversal or obstruction.

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.

SUMMARY Purpose: In patients with drug-refractory focal epilepsy, nonlesional magnetic resonance imaging (MRI) or discordant data of presurgical standard investigations leads to failure generating a sufficient hypothesis for electrode implantation or epilepsy surgery. The seizure-onset zone can be further investigated by subtraction ictal singlephoton emission computed tomography (SPECT) coregistered to MRI (SISCOM). This is an observational study of a large consecutive cohort of patients undergoing prospective SISCOM to generate hypothesis for electrode implantation or site of epilepsy surgery. Methods: One hundred seventy-five consecutive patients undergoing presurgical evaluation with either nonlesional MRI or discordant data of standard investigations preventing the generation of hypothesis for seizure onset were evaluated with SISCOM. Results were compared to gold standard for seizure onset detection, either electrocorticography (ECoG) and/or postoperative outcome. Key Findings: One hundred thirty patients had successful SPECT injection. Hypothesis for electrode implantation/ site of surgery was generated in 74 patients. Forty patients had gold standard comparison. Twenty-eight patients underwent resective surgery. SISCOM was concordant to site of surgery in 82%. An additional 12 patients underwent invasive EEG monitoring but were not suitable for surgery. SISCOM was concordant multifocal in 75%. Two years postsurgical follow-up of 26 patients showed favorable outcome in 22 (Engel class I and class II). Significance: SISCOM is a highly valuable diagnostic tool to localize the seizure-onset zone in nonlesional and extratemporal epilepsies. Outcome in this patient group was unexpectedly good, even in patients with nonlesional MRI. The high correlation with ECoG and site of successful surgery is a strong indicator that outcome prediction in this patient group should be adapted accordingly, which may encourage more patients to undergo electrode implantation and subsequent successful surgery. Statistical analysis showed that SISCOM with shorter duration of seizures, focal seizures, and lesional MRI was more likely

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.

Amphetamine is stored by brain tissue and permits its scintigraphic imaging, particularly with the single-photon emission computed tomography (SPECT). A total of 60 scintigraphic investigations in 54 patients were done. Investigations were done using an emission computed tomograph (rotating gamma-camera) after application of 123I-N-isopropyl-amphetamine. In 6 out of 24 patients with epilepsy a focus in agreement with EEG findings could be established despite negative cranial computed tomography (CT). In 4 out of 25 patients with cerebrovascular disease diminished perfusion was demonstrated although cranial CT was normal. In 10 out of 20 cases the extent of functional lesions demonstrated by SPECT was larger than could be assumed by cranial CT findings. Three patients with migraine and negative CT findings showed disorders of perfusion in the amphetamine-SPECT which were in agreement with the EEG. Brain SPECT using 123I-labelled amphetamines thus offers the possibility to demonstrate functional perfusion and metabolic disorders which show no morphologic correlate in the cranial CT. In addition, foci demonstrated in cranial CT can be more precisely defined in their functional extent using the SPECT.

Eleven patients with Alzheimer type dementia were investigated by single-photon-emission computed tomography (SPECT) using 99mTc-hexamethylpropylene-aminoxim (HM-PAO). Nine had a typical, symmetrically reduced enrichment in the parieto-temporo-occipital area. In three of these nine patients a similar pattern was recorded additionally in the frontal, in the remaining two in the temporal or parietal region. In a semi-quantitative evaluation radioactivity concentrations in the cerebrum and cerebellum were compared. It demonstrated that there was in relation to the cerebellum a reduced concentration in seven of the eight studied cerebral regions. The relative blood flow of the parieto-temporo-occipital region was most markedly affected and in patients with Alzheimer type dementia was reduced by 25% below that of normal subjects. The results indicate that cerebral SPECT with HM-PAO is a reasonable method of investigation to confirm the diagnosis of "Alzheimer type dementia" and exclude other cerebral disease, especially if pathognomonic findings are to be obtained.

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.

SummaryAim: To evaluate the efficacy and tolerance of iodine- 131-lipiodol (131I-lipiodol) for hepatocellular carcinoma (HCC) in German long term patients and comparison with medically treated controls. 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 (6 with portal vein thrombosis). Liver and tumour volume and lipiodol deposition were measured by computed tomography and 131I 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. Results: 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 131I-lipiodol to be superior to medical treatment. The most important side effect was a pancreatitis-like syndrome whereas overall tolerance was good. Conclusion: The long term results confirm that HCC therapy with 131I-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.

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.

Die Bestimmung der Wertigkeit der kombinierten PET-CT-Untersuchung zum Nachweis maligner Kopf-Hals-Tumoren und ihrer Metastasen. Bei 51 Patienten wurden Ganzkorperuntersuchungen mit dem kombiniertem PET-CT-System durchgefuhrt. Die CT erfolgte ohne i.v. Kontrastmittelgabe. Die Ergebnisse wurden in ihrer diagnostischen Aussage einerseits getrennt fur native CT- und FDG-PET-Bildgebung und andererseits fur das fusionierte Bild verglichen. Von 153 Lasionen wurden 97 im CT und 136 im FDG-PET als maligne, 33 im CT und 7 im FDG-PET als malignitatsverdachtig, 23 im CT und 10 in der FDG-PET als benigne beurteilt. Die Anzahl der konkordanten Ergebnisse betrug 94 (61%), die der diskordanten 59 (39 %). Mit der PET-CT konnten alle Primartumoren und Rezidive entdeckt werden, die Nachweisrate eines unbekannten Primartumors betrug 45%. Im Vergleich zur alleinigen PET- oder CT-Untersuchung erhohen sich bei der kombinierten PET-CT Sensitivitat, Spezifitat sowie die Treffsicherheit signifikant. Die fusionierte PET-CT-Bildgebung mit [F18]FDG- und nativer CT-Untersuchung ermoglicht eine genaue Diagnose in 93% aller Lasionen und in 90% bei Patienten mit malignen Kopf-Hals-Tumoren.

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.

This study evaluated changes in the self-reported eating behaviors (snacking, binge eating, portion sizes, and meal skipping) of 52 obese adults (33 women and 19 men) attending a residential weight loss facility on two consecutive occasions. For each of the eating patterns studied, subjects reported engaging in the behavior significantly less frequently at the time of their return visit. It is proposed that changes in eating behaviors provide a useful and appropriate nonweight based outcome measure for estimating treatment success in diet-seeking clients.

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

To identify psychological characteristics and eating behaviors associated with weight cycling and binge eating behaviors in overweight women (body mass index27.3).Questionnaires measuring self-esteem, self-efficacy, coping strategies, psychological symptoms, depression, binge eating, restrained eating, disinhibition, and hunger were administered to female weight cyclers who were overweight. Psychological characteristics were compared between subjects grouped by binge eating disorder classification and by binge eating severity.A convenience sample of 62 female weight cyclers who were overweight was recruited from the Chicago, Ill, area. Questionnaires were administered individually or in small groups in subjects' homes or other private settings.Student's t tests or Mann-Whitney U tests were used to assess differences in psychological characteristics.Thirty-six weight cyclers (58%) met the criteria for binge eating disorder and 26 (42%) did not. Weight cyclers with binge eating disorder reported greater severity of binge eating (P.0005) and disinhibition (P.0005) and poorer eating self-efficacy (P.0005) than weight cyclers without binge eating disorder. Weight cyclers with severe binge eating behaviors reported greater psychological distress (P.0005) and depression (P.005) and lower self-esteem (P = .0001) and used less healthful coping strategies (P = .0027) than weight cyclers with no binge eating to moderate binge eating problems. Weight cyclers with severe binge eating behavior also reported more hunger (P.0005) and used less cognitive restraint (P = .0024) than those with no binge eating to moderate binge eating problems.Operational definitions of weight cycling and binge eating are needed to facilitate research on effective weight-loss treatments. Persons seeking to lose weight (especially weight cyclers) should be assessed for binge eating severity, problematic eating behaviors, and psychological symptoms.

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.

Zusammenfassung Ziel: Die effiziente, medikamentöse Behandlung von Patienten mit schmerzhaften, disseminierten Knochemmetastasen stellt ein therapeutisches Problem dar. Die systemische Radionuklidtherapie kommt als Alternative in Frage. In der vorliegenden Studie wurde die Effektivität von Rhenium-186 HEDP zur Schmerztherapie bei disseminierten Knochenmetastasen evaluiert. Methoden: 30 Patienten, die wegen schmerzhafter Knochenmetastasen analgetisch behandelt wurden, erhielten -teilweise mehrfach- Injektionen von jeweils 1295 MBq 186Re HEDP zur Schmerzbehandlung. Ergebnisse: Bei 70% der Patienten ließ sich eine Schmerzreduktion erreichen. Die Dauer des Ansprechens auf die Therapie betrug im Mittel 4 Wochen (1 Wo-2,5 Mon). Die wesentlichen Nebenwirkungen bestanden in einem geringen Abfall der Thrombozyten (durchschnittl. 30000/ul) und einer kurzzeitigen Verstärkung der Schmerzsymptomatik (Flare-Effekt). Schlußfolgerung: Bei Patienten mit schmerzhaften, disseminierten Knochenmetastasen kann die Schmerztherapie mit Rhenium-186 HEDP komplementär zur medikamentösen Therapie eingesetzt werden.

A manufacturing process for crystalline silicon solar cells is presented which consists mainly of electrochemical steps. The deposition of doping glass layers for the front side emitter as well as the back surface field is performed anodically onto the etched and cleaned wafers. The doping atoms, phosphorus or boron, are diffused into the silicon crystal in a furnace at 950 °C in an atmosphere of simply clean air. After the diffusion process the front side doping glass has a blue colour and is suitable to serve as an antireflection coating with a very low surface recombination velocity. For this reason, the doping glass is not etched away on the sun exposed regions of the solar cell. The masking technology for all electrochemical processes provides inherently an edge exclusion and, therefore, no additional processing for preventing shorts on the wafer edge is necessary. For the metallization a reusable rubber mask defines the pattern. First, the mask is used for the doping glass patterning by wet chemical etching. Then, on both sides first nickel is deposited electrolytically directly onto silicon, and in a second step copper electroplating onto the nickel barrier is performed. All three steps, etching, nickel and copper deposition are self adjusting through said rubber mask. A short forming gas anneal finishes the solar cell processing. During all electrochemical processing the wafer is electrically contacted on the opposite surface on a stainless steel plate by the force of vacuum clamping. With this low cost processing 12.5% cell efficiency has been achieved on multi-crystalline 156 mm wafers, which originally have a minority carrier lifetime of 4 μs measured after damage etch and thermal oxidation. In this paper, experiments, surface analysis and physical interpretations are presented.

Activated mitogen-activated protein kinase MAPK cascade leading to ERK1/2 phosphorylation is expressed in the majority of glial neoplasms and negatively correlates with survival time of patients. Here we show that ERK1/2 kinases are constitutively activated in glioma cell lines and stem cell- enriched primary cultures of glioblastoma. Pharmacological targeting of the activated MEK/ERK1/2 module with the MEK inhibitor U0126 attenuates cell cycle progression (11 out of 11 cell lines), impairs single (7 out of 10) and collective cell migration (9 out of 11) and abolishes single cell emigration from monolayers (4 out of 9). Attacking the activated MEK/ ERK1/2 module thus partially blocks the tumorigenic potential of glial cancer cells on different levels and strongly suggests the application of combination molecularly targeted therapies to interfere more efficiently with glial tumor development and progression.

ZusammenfassungDie striatale Dopamin-D2-Rezeptoranreicherung von 123J-IBZM wurde bei 32 Patienten (18 ohne und 14 mit neuroleptischer Therapie) semiquantitativ unter Anwendung verschiedener ROI-Techniken ausgewertet. Ziel der Studie war es, die von verschiedenen Untersuchern gefundenen unterschiedlichen Quotienten (Striatum/Kortex) unter dem Aspekt der angewandten ROI-Technik zu untersuchen. Es konnte gezeigt werden, daß bei Verwendung des gleichen SPECT-Systems keine größeren Unterschiede zwischen Rechteck-ROI und manuell erstellten ROI gleicher Größe auftreten. Eine hochsignifikante Trennung zwischen behandelten und unbehandelten Patienten ergab sich für alle untersuchten Auswerteverfahren. Der ermittelte Quotient wird wesentlich durch das Auflösungsvermögen der Kamera und nur relativ geringfügig durch die verwendete ROI-Technik bestimmt. Die Quotienten verschiedener Arbeitsgruppen sind quantitativ nicht miteinander vergleichbar.

Summary Purpose: This investigation was performed to compare the hemodynamic results of the transjugular intrahepatic portosystemic shunt, a new interventional treatment for portal hypertension, with those observed after the established surgical shunt interventions. Methods: We examined 22 patients with portal hypertension due to liver cirrhosis before and after elective TIPS by liver perfusion scintigraphy. The relative portal perfusion was determined before and after the shunt procedure. Additionally, we measured the portal pressure gradient (PPG: portal-central venous pressure, mmHg). Results: Prior to TIPS, the relative portal perfusion was significantly reduced to 22 ± 9.1%. After the intervention we calculated values of 23.1 ± 10,7% in the TIPS-group (p = 0.67; not significant). In spite of unchanged portal perfusion, the portal pressure was significantly (p

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.

Sedentary lifestyle is one of the ten leading causes of death and disability in the world [1]. Physical inactivity increases all causes mortality and the risk of cardiovascular disease, hypertension, type II diabetes, obesity, osteoporosis, colon and breast cancer, depression, and anxiety [2]. Yet, around the world, physical activity levels are decreasing, particularly among young people. It is estimated that less than 35% of young people are sufficiently active to benefit their present and future health and well-being [1]. This is discouraging for a number of reasons. First, research suggests that patterns of physical activity adopted at a young age are likely to persist into adulthood [3, 4]. Second, involvement in physical activity and sports may encourage the adoption of other health behaviors such as a healthy diet, better safety practices such as seatbelt use, and the avoidance of health risk behaviors such as tobacco and alcohol use [5, 6]. Thus, physical activity may influence health outcomes both directly and indirectly through the encouragement of other behaviors that promote health and reduce the risk of accident and injury.

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.

This study evaluated changes in the self-reported eating behaviors (snacking, binge eating, portion sizes, and meal skipping) of 52 obese adults (33 women and 19 men) attending a residential weight loss facility on two consecutive occasions. For each of the eating patterns studied, subjects reported engaging in the behavior significantly less frequently at the time of their return visit. It is proposed that changes in eating behaviors provide a useful and appropriate nonweight based outcome measure for estimating treatment success in diet-seeking clients.

In this study, we tested the proposition that the emotion-based eating of obese individuals is mediated by the effects of emotional arousal tendencies on brittle dieting self-restraint. Our indices of emotion-aroused eating, overeating, and brittle restraint were derived from a set of measures administered to 632 female and 254 male participants in a residential weight control and lifestyle change program. Mediation analyses indicated that (a) the relationship between positive emotion and overeating was entirely mediated by restraint tendencies and (b) the relationship between negative emotion eating and overeating was only partially mediated by brittle restraint. These findings held for both males and females. The results are discussed in relation to the viability of the psychosomatic hypothesis for understanding the relationship between emotions and overeating.

The diagnostic potential of 99mTc-HMPAO following systemic administration of the cerebral vasodilator acetazolamide (acetazolamide test) was evaluated using regional-cerebral-blood-flow (rCBF) SPECT in patients with Alzheimer's disease (AD) or with vascular-type of dementia (VD).An initial, high-resolution SPELT study was performed with 99mTc-HMPAO, and after 2 days patients were re-evaluated with 99mTc-HMPAO following systemic administration of acetazolamide. Reconstructed SPELT slices were evaluated visually and semiquantitatively by a semiautomatic rCBF map method.Using 99mTc-HMPAO alone, a bilateral hypoperfusion was found in the temporal and/or parietal regions in 33% (6/18) of VD patients and in 70% (23/33) of AD patients. The vascular reserve capacity, as determined with the acetazolamide test, was not impaired in 22% of the VD patients but in 76% of the AD patients. The differences in the perfusion patterns between VD and AD patients were statistically different (p0.01, Fischer's exact test). Of the 6 VD patients with hypoperfusion (bilateral temporal and/or parietal), 4 had a decreased vascular reserve capacity as determined in the acetazolamide test. Decreased reserve capacity was found in only 4 out of 25 patients with AD.The acetazolamide test is helpful in rCBF SPECT to differentiate VD from AD.

The radiation exposure in radiation synovectomy was investigated for technician and therapist using Erbium-169, Rhenium-186 and Yttrium-90 with and without syringe shieldings.Dose rates were measured in relation to the distance of the syringe containing the radionuclide. Measurements were repeated using syringe shieldings which consist of plastic surrounded by a lead layer.The most relevant radiation exposure arises from Yttrium-90. Using syringe shieldings radiation exposure can be reduced by a factor of thousand.This kind of radiological protection is completely sufficient for the therapist. Concerning the technician preparing the radiopharmaceutics, the limit of the official German dosimetry service (500 mSv) might be exceeded if no special radiological protection is established. Thus, special dosimetry is recommended.

One assumption in emission tomograpy is the stability of activity distribution during acquisition. Thus, to detect movement of the patient, acquisition was splitted into two time segments. By calculating and comparing the centers of mass of the projections, evaluation of movement may be performed by means of two movement indicators: integral and total movement index. Depending on the movement of a phantom, iBI had values from 2.6 to 6 and the tBI values from 100 to 300. For Patients we obtained values of the iBI from 2.7 to 16 and of the tBI from 100 to 5000.

With the Compton camera, spatial resolution and efficiency can be in principle improved with respect to today's PET and SPECT techniques. The optimisation of a Compton camera system in terms of efficiency and resolution is a complex multi-parameter problem. The dependence of the efficiency is studied as a function of various detector parameters (material, thickness, positioning etc.). The influence of these parameters on the image reconstruction is investigated for a conventional reconstruction technique in order to find optimum detector parameters. It was found that high energy gamma sources (300 keV and more) are preferable to be used. A Si-detector as a scatter detector and an angular range between 30 and 80 degrees is most useful considering the various physical and experimental constraints. Concerning the scatter detector thickness a suitable compromise between efficiency and resolution has to be made. The case studies are based on a model for a system consisting of a Silicon detector (electron detector) and a scintillator detector (photon detector). Effects of secondary and background processes will be soon fully included. Also a critical review of radionuclides is being made, to assess the applicability of suitable high energy radionuclides in various medical diagnostics.

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.

Brain SPECT with HMPAO or ECD has—due to its short accumulation period—a rather high time resolution of approx. 60 sec. Compared to isopropyl amphetamine (I-123) and FDG-PET, shortlasting interventions may be evaluated by SPECT. Usually, a two-step approach is used, injecting one third of the dose under baseline conditions and two thirds during intervention. The first study is then subtracted from the second study, resulting in a “difference” image which allows to calculate the effect of the intervention. These interventional procedures may include drug, mechanical, and mental intervention as well as ictal, blood pressure and receptor intervention. Moreover, the difference of pCO2 after hyperventilation or hypoventilation may also be used as a stimulus. The above mentioned procedures are described in detail.

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.

Zur tomographischen Aufnahme der Gehirndurchblutung mussen ca. 200 000 Counts (Cts) pro Schicht aufintegriert werden, um einen guten Kompromis zwischen Auflosungsvermogen und Rauschen zu erhalten. Bei einer tolerierbaren Applikation von 500-800 MBq 99mTc und einem Uptake von einigen Prozent in das Gehirn betragt die Aufnahmedauer ca. 30 min. Voraussetzung der transaxialen Tomographie ist jedoch, das wahrend der gesamten Aufnahmedauer das Muster der Aktivitatsanreicherung konstant bleibt. Eine Pharmakokinetik, die das Muster der Gehirndurchblutung fur nur wenige Sekunden oder Minuten aufrechterhalt, ist daher fur hochauflosende Tomogramme nicht geeignet.

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.