Retinol isotope dilution accurately predicts liver reserves in piglets but overestimates reserves in lactating sows.

IMPACT STATEMENT: Vitamin A (VA) deficiency and hypervitaminosis A have been reported in groups of people worldwide. Conventional biomarkers of VA deficiency (e.g. serum retinol concentration, dose response tests) are not able to distinguish between sufficiency and hypervitaminosis A. Retinol isotope dilution (RID) predictions of VA status have been validated in humans and animal models from deficiency through toxicity; however, RID during life stages with unique issues related to isotopic tracing, such as infancy and lactation, requires further evaluation. This study investigated RID in piglets and lactating sows as models for human infants and women. In piglets, RID successfully determined VA deficiency (confirmed with liver analysis), and that the tracer mixes quickly. Conversely, in lactating sows, although serum and milk enrichments were similar, traditional RID equations overestimated VA stores, likely due to losses of tracer and higher extrahepatic VA storage than predictions. These data inform researchers about the challenges of using RID during lactation.

Traceability to a primary reference measurement procedure (ID-LCMS); A key step in validating the clinical accuracy and safety of hospital blood glucose monitoring systems.

OBJECTIVE: A key step in the evaluation of the accuracy of blood glucose monitoring systems (BGMS) is using a comparator method aligned to a high order definitive reference method. We describe how we achieved traceability to an isotope dilution liquid chromatography mass spectrometry (ID-LCMS) method. We used ID-LCMS to evaluate the accuracy and specificity of two hospital BGMS used in China. METHOD: ID-LCMS was used to verify the calibration alignment of the laboratory plasma hexokinase reference method using NIST standard reference material and clinical samples. The ID-LCMS aligned hexokinase method was used to evaluate the clinical accuracy of two BGMS in hospitalized patients. System accuracy was evaluated using Chinese consensus guidelines. BGMS accuracy was also assessed with interference factors known to be present in critically ill patients' blood. RESULTS: The laboratory plasma hexokinase reference method was shown to calibrate closely with ID-LCMS. Two BGMS demonstrated good correlation with this reference method. Only one BGMS met the Chinese guidelines. The interference factors didn't influence this BGMS but adversely affected the clinical accuracy of the other. CONCLUSIONS: We advocate that our IDMS calibration alignment approach for ensuring the accuracy of the glucose reference method should be adopted in evaluations assessing the accuracy of blood glucose monitoring systems.

Accurate analysis of parabens in human urine using isotope-dilution ultrahigh-performance liquid chromatography-high resolution mass spectrometry.

An analytical method that utilizes isotope-dilution ultrahigh-performance liquid chromatography coupled with hybrid quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS or called UHPLC-HRMS) was developed, and validated to be highly precise and accurate for the detection of nine parabens (methyl-, ethyl-, propyl-, isopropyl-, butyl-, isobutyl-, pentyl-, hexyl-, and benzyl-parabens) in human urine samples. After sample preparation by ultrasound-assisted emulsification microextraction (USAEME), the extract was directly injected into UHPLC-HRMS. By using negative electrospray ionization in the multiple reaction monitoring (MRM) mode and measuring the peak area ratios of both the natural and the labeled-analogues in the samples and calibration standards, the target analytes could be accurately identified and quantified. Another use for the labeled-analogues was to correct for systematic errors associated with the analysis, such as the matrix effect and other variations. The limits of quantitation (LOQs) were ranging from 0.3 to 0.6 ng/mL. High precisions for both repeatability and reproducibility were obtained ranging from 1 to 8%. High trueness (mean extraction recovery, or called accuracy) ranged from 93 to 107% on two concentration levels. According to preliminary results, the total concentrations of four most detected parabens (methyl-, ethyl-, propyl- and butyl-) ranged from 0.5 to 79.1 ng/mL in male urine samples, and from 17 to 237 ng/mL in female urine samples. Interestingly, two infrequently detected pentyl- and hexyl-parabens were found in one of the male samples in this study.

Comparison of Assigned Values from Participants' Results, Spiked Concentrations of Test Samples, and Isotope Dilution Mass Spectrometric Results in Proficiency Testing for Pesticide Residue Analysis.

The Hatano Research Institute (HRI) at the Food and Drug Safety Center has recently organized a series of proficiency-testing (PT) programs called the "External Quality Control for Food Hygiene" in order to evaluate the analytical capability of testing laboratories that inspect food samples in accordance with the Food Sanitation Act. In one of these programs, Pesticide I, consensus values calculated from the participants' analytical results were used as assigned values, and the spiked concentrations of the prepared test samples were used for evaluating variation among individual participants. In the present study, the values obtained in the 2013-2015 rounds have been assessed by comparing the analytical results of the target pesticides obtained by using two different isotope-dilution MS (IDMS) methods. These two IDMS methods are based on a combination of different pretreatment protocols and different GC separation columns. The weighted means of the observed analytical results were higher than the corresponding assigned values, but showed good agreement with the spiked concentrations. These results indicate that the spiking concentrations of the test sample from HRI are reliable, and therefore, these values can be used to evaluate the trueness of the participants' analytical method.

Effectiveness of quality control methods for glomerular filtration rate calculation.

PURPOSE: In this work, we aimed to identify the types of errors encountered in glomerular filtration rate (GFR) measurement and test the effectiveness of all published quality control (QC) methods for detection of clinically significant errors. METHODS: A total of 412 GFR tests were carried out on adults and children. The three-point slope-intercept glomerular filtration rate (SI-GFR) was compared with the nine-point 'area under curve' calculation as a gold standard to determine the error in SI-GFR. The Durbin-Watson test was used to characterize the nature of the errors. The sensitivity, specificity and positive predictive value (PPV) of QC methods for detecting clinically significant errors were calculated and receiver operating characteristic curves were constructed. The QC methods were also applied to a dataset of 100 four-point GFR tests from different institutions. RESULTS: Model failure is the dominant cause of clinically significant error in this dataset, with individual point measurement errors only giving rise to clinically significant errors in a small number of cases. No QC test had an acceptable combination of sensitivity, PPV and specificity. The correlation coefficient QC test had the largest area under the receiver operating characteristic curve (0.73). No other QC test had an area greater than 0.57. CONCLUSION: All the QC methods have poor sensitivity and PPV for detecting clinically significant errors and so cannot be relied on to ensure a robust measurement of GFR, underlining the need for careful working practices and a thorough system of measurement checks. We found no evidence for the value of multiple sampling with respect to QC; until such evidence is published, their clinical utility is unproven.

A systematic review of single-sample glomerular filtration rate measurement techniques and demonstration of equal accuracy to slope-intercept methods.

PURPOSE: We aimed to identify the most accurate single-sample glomerular filtration rate (SS-GFR) technique for all patient ages. MATERIALS AND METHODS: We performed a systematic review of all published SS-GFR measurement techniques and compared the results from each test with a gold-standard nine-point 'area-under-curve' measurement of GFR as well as slope-intercept (SI-GFR) methods for 412 GFR tests. RESULTS: We have shown that for patients of all ages the SS-GFR technique developed by Fleming and colleagues delivers the best accuracy and precision, with results equivalent to those calculated by SI-GFR. The median percentage difference from the gold-standard GFR for the Fleming technique is 4.8% (95% confidence interval 3.9-5.7%) and that for the three-point SI-GFR is 5.6% (95% confidence interval 4.9-6.3%). The interquartile range of the distribution of percentage difference from the gold standard is -0.23 to 11% for the Fleming method and 1.6-11% for the three-point SI-GFR. CONCLUSION: The Fleming technique outperforms the method currently recommended by the international guidelines, and is simpler as only one equation is required for all patients instead of separate equations for adults and children. We propose that the SS-GFR technique of Fleming replace the methods currently recommended by the international and BNMS guidelines for routine measurement of GFR for expected results greater than 30 ml/min/1.73 m. A thorough system of measurement checks should be implemented for all methods of GFR assessment; the perceived lack of opportunity for quality control checks to be performed on the result of a single-sample measurement is addressed in the companion paper of this study.

Development of C-reactive protein certified reference material NMIJ CRM 6201-b: optimization of a hydrolysis process to improve the accuracy of amino acid analysis.

To standardize C-reactive protein (CRP) assays, the National Metrology Institute of Japan (NMIJ) has developed a C-reactive protein solution certified reference material, CRM 6201-b, which is intended for use as a primary reference material to enable the SI-traceable measurement of CRP. This study describes the development process of CRM 6201-b. As a candidate material of the CRM, recombinant human CRP solution was selected because of its higher purity and homogeneity than the purified material from human serum. Gel filtration chromatography was used to examine the homogeneity and stability of the present CRM. The total protein concentration of CRP in the present CRM was determined by amino acid analysis coupled to isotope-dilution mass spectrometry (IDMS-AAA). To improve the accuracy of IDMS-AAA, we optimized the hydrolysis process by examining the effect of parameters such as the volume of protein samples taken for hydrolysis, the procedure of sample preparation prior to the hydrolysis, hydrolysis temperature, and hydrolysis time. Under optimized conditions, we conducted two independent approaches in which the following independent hydrolysis and liquid chromatography-isotope dilution mass spectrometry (LC-IDMS) were combined: one was vapor-phase acid hydrolysis (130 °C, 24 h) and hydrophilic interaction liquid chromatography-mass spectrometry (HILIC-MS) method, and the other was microwave-assisted liquid-phase acid hydrolysis (150 °C, 3 h) and pre-column derivatization liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. The quantitative values of the two different amino acid analyses were in agreement within their uncertainties. The certified value was the weighted mean of the results of the two methods. Uncertainties from the value-assignment method, between-method variance, homogeneity, long-term stability, and short-term stability were taken into account in evaluating the uncertainty for a certified value. The certified value and the expanded uncertainty (k = 2) of CRM 6201-b are (40.0 ± 1.6) µmol kg(-1).

Development and co-validation of porcine insulin certified reference material by high-performance liquid chromatography-isotope dilution mass spectrometry.

This article concerns the development and co-validation of a porcine insulin (pINS) certified reference material (CRM) produced by the National Institute of Metrology, People's Republic of China. Each CRM unit contained about 15 mg of purified solid pINS. The moisture content, amount of ignition residue, molecular mass, and purity of the pINS were measured. Both high-performance liquid chromatography-isotope dilution mass spectrometry and a purity deduction method were used to determine the mass fraction of the pINS. Fifteen units were selected to study the between-bottle homogeneity, and no inhomogeneity was observed. A stability study concluded that the CRM was stable for at least 12 months at -20 °C. The certified value of the CRM was (0.892 ± 0.036) g/g. A co-validation of the CRM was performed among Chinese, Japanese, and Korean laboratories under the framework of the Asian Collaboration on Reference Materials. The co-validation results agreed well with the certified value of the CRM. Consequently, the pINS CRM may be used as a calibration material or as a validation standard for pharmaceutical purposes to improve the quality of pharmaceutical products.

Blood volume analysis by radioisotopic dilution techniques: state of the art.

In the last years, there has been a growing recognition of the importance of blood volume abnormalities in the pathophysiology of several conditions and, consequently, a growing interest of accurate and rapid volume status assessment. Accordingly, there has been a surge of interest in blood volume analysis by radioisotopic dilution technique. However, there are still some controversies about this technique, such as the use of the f-cell ratio, the errors associated with the method and the reference values. This review aims to revise and discuss the theoretical and methodological aspects of this technique and also to discuss their controversies. Furthermore, it is questioned whether red cell volume or plasma volume can be accurately estimated once the other quantity has been measured or should red cell volume and plasma volume be directly measured. As a conclusion, blood volume analysis by radioisotopic dilution technique is still valid and very useful.

Synthesis of (13) C2 (15) N2 -labeled anti-inflammatory and cytoprotective tricyclic bis(cyanoenone) ([(13) C2 (15) N2 ]-TBE-31) as an internal standard for quantification by stable isotope dilution LC-MS method.

Tricyclic bis(cyanoenone), TBE-31, one of the most potent activators of the Keap1/Nrf2/antioxidant response element pathway, has been developed as a new anti-inflammatory and cytoprotective agent. (13) C2 (15) N2 -labeled TBE-31 ([(13) C2 (15) N2 ]-TBE-31), which has two (13) C and two (15) N atoms in two cyano groups, was designed to develop a method for quantification of cell, tissue, and plasma levels of TBE-31 that involves chromatography/mass spectrometry coupled with the use of a stable isotope-labeled internal standard. [(13) C2 (15) N2 ]-TBE-31 was successfully synthesized in four steps from a previously reported intermediate, which is prepared in 11 steps from cyclohexanone, by introduction of two (13) C atoms with ethyl [(13) C]formate and two (15) N atoms with hydroxyl[(15) N]amine. The stable isotope dilution liquid chromatography-mass spectrometry method for quantification of TBE-31 was successfully developed using [(13) C2 (15) N2 ]-TBE-31 to compensate for any variables encountered during sample processing and analysis.

Use of (2)H(2)O for estimating rates of gluconeogenesis: determination and correction of error due to transaldolase exchange.

The use of deuterated water as a method to measure gluconeogenesis has previously been well validated and is reflective of normal human physiology. However, there has been concern since the method was first introduced that transaldolase exchange may lead to the overestimation of gluconeogenesis. We examined the impact of transaldolase exchange on the estimation of gluconenogenesis using the deuterated water method under a variety of physiological conditions in humans by using the gluconeogenic tracer [U-(13)C]propionate, (2)H(2)O, and (2)H/(13)C nuclear magnetic resonance (NMR) spectroscopy. When [U-(13)C]propionate was used, (13)C labeling inequality occurred between the top and bottom halves of glucose in individuals fasted for 12-24 h who were weight stable (n = 18) or had lost weight via calorie restriction (n = 7), consistent with transaldolase exchange. Similar analysis of glucose standards revealed no significant difference in the total (13)C enrichment between the top and bottom halves of glucose, indicating that the differences detected were biological, not analytical, in origin. This labeling inequality was attenuated by extending the fasting period to 48 h (n = 12) as well as by dietary carbohydrate restriction (n = 7), both conditions associated with decreased glycogenolysis. These findings were consistent with a transaldolase effect; however, the resultant overestimation of gluconeogenesis in the overnight-fasted state was modest (7-12%), leading to an error of 14-24% that was easily correctable by using either a simultaneous (13)C gluconeogenic tracer or a correction nomogram generated from data in the present study.

Impact of standardization of creatinine methodology on the assessment of glomerular filtration rate in children.

There is a global effort to standardize clinical laboratory serum creatinine measurements to the reference method of isotope-dilution mass spectrometry (IDMS). Creatinine values in serum and urine are frequently used in children to calculate creatinine clearance (mCrCl) or estimate glomerular filtration rate (GFR) by Schwartz's equation (eGFR). The original normative data of mCrCl and eGFR were developed using Jaffe method. To investigate what impact the differences in methodologies of creatinine analysis will have on mCrCl and eGFR, we measured creatinine in random serum and urine samples by three commercially available assays: Jaffe (J), enzymatic (E) and enzymatic method traceable to IDMS (E-IDMS). There was a significant bias in the two enzymatic methods when compared with J method. The theoretical predicted errors in overestimating mCrCl ranged from 1.10 to 1.34 by E and 1.20 to 1.54 by E-IDMS; and in calculating eGFR 1.07-1.16 by E and 1.30-1.46 by E-IDMS, which was further confirmed in children who had formal GFR evaluation. Thus, as the clinical laboratories calibrate their creatinine assays to the gold standard IDMS method, it is important for the pediatric nephrology community to develop new equations for estimation of GFR based on the new creatinine assay.

High accuracy determination of malachite green and leucomalachite green in salmon tissue by exact matching isotope dilution mass spectrometry.

A high accuracy method for the quantification of malachite green (MG) and leucomalachite green (LMG) in salmon is described. Analytical challenges including the effects of analyte instability and matrix suppression were minimised by the use of exact matching isotope dilution mass spectrometry. The developed method included overnight extraction in acidified acetonitrile/ammonium acetate buffer and analysis by LC-MS/MS utilising isotopic internal standards. This method was used to determine the level of MG and LMG in a sample of salmon used in an international inter-comparison organised by the Comité Consultatif pour la Quantité de Matière (CCQM). The sum of MG and LMG was found to be 9.32+/-0.98ngg(-1) at the 95% confidence interval (relative expanded uncertainty 10.5% (k=2)). This encompassed the mean and median of the CCQM inter-comparison.

Measurement of standard uptake value in dual-head coincidence system.

UNLABELLED: The standard uptake value (SUV) is an important semi-quantitative parameter in positron emission tomography (PET). But SUV is not available in dual-head coincidence imaging system (DHC) which is widely used in clinical practice. This study was designed to develop a method for measuring SUV in DHC system, and then compared SUV in DHC and SUV in PET. METHOD: Firstly, the calibration factor (CF) for converting the voxel count rate to radioactivity concentration was determined by a phantom study in DHC. Then the method for calculating SUV in DHC was formulated. Finally, SUV in DHC and SUV in PET were compared through another phantom study. The phantoms used in the comparing study were cylindrical and consisted of several hot lesions. RESULTS: The CF varied with the detected single count rate in a biquadratic polynomial; the lesion's radioactivity concentration was got based on the CF and the voxel count rate. From the lesion's radioactivity concentration, the lesion's SUV in DHC was obtained. The comparison study showed that SUV in PET was higher than SUV in DHC. The SUV in both DHC and PET increased with increasing sizes of lesions and were related with the reconstruction algorithm. CONCLUSIONS: SUV in DHC images could be obtained in our method; the value in DHC images was lower than that in PET image; and many factors, such as system performance, lesion's size, and reconstruction algorithm could influence the SUV accuracy in both DHC and PET.

Implications of the variability in time to isotopic equilibrium in the deuterium dilution technique.

OBJECTIVE: To investigate the variability in isotopic equilibrium time under field conditions, and the impact of this variability on estimates of total body water (TBW) and body composition. DESIGN AND SETTING: Following collection of a fasting baseline urine sample, 10 women and 10 men were dosed with deuterium oxide (0.05 g/kg body weight). Urine samples were collected every hour for 8 h. The samples were analysed using isotope ratio mass spectrometry. Time to equilibration was determined using three commonly employed data analysis approaches. RESULTS: Isotopic equilibrium was reached by 50, 80 and 100% of participants at 4, 6 and 8 h, respectively. The mean group equilibration determined using the three different plateau determination methods were 4.8+/-1.5, 3.8+/-0.8 and 4.9+/-1.4 h. Isotopic enrichment, TBW, and percent body fat estimates differed between early (3-5 h), but not later sampling times (5-8 h). CONCLUSION: Although the three different plateau determination approaches resulted in differences in equilibration time, all suggest that sampling at 6 h or later will decrease the likelihood of error in body composition estimates resultant from incomplete isotopic equilibration in a small proportion of individuals.

Comparison of energy expenditure estimates from 4 physical activity questionnaires with doubly labeled water estimates in postmenopausal women.

BACKGROUND: Physical activity energy expenditure (EE) is an important determinant of health, and epidemiologists have used various methods, such as physical activity and energy intake recalls and records, to estimate energy cost. However, most epidemiologic studies have not validated these methods against the doubly labeled water (DLW) technique for measuring EE. OBJECTIVE: The aim was to compare EE estimated by 4 physical activity questionnaires with that obtained with the DLW technique in free-living postmenopausal women. DESIGN: We measured EE in kcal/d using the DLW method, the Harvard Alumni questionnaire, the Five City Project questionnaire, the Cross-Cultural Activity Participation Study (CAPS) Four Week Activity Recall, and the CAPS Typical Week Activity Survey in 65 healthy postmenopausal women. RESULTS: Compared with DLW, the Harvard Alumni questionnaire, the Five City Project questionnaire, and the CAPS Four Week Activity Recall overestimated (P < 0.05) daily EE by 62%, 16%, and 11%, respectively, whereas the CAPS Typical Week Activity Recall underestimated (P < 0.05) EE by 31%. Both the Harvard Alumni and Five City Project questionnaires overestimated EE in obese and overweight women. CONCLUSIONS: When using 3 of the 4 questionnaire methods, postmenopausal women overestimated EEs. Of all women, obese women overestimated daily EE the most.

Quantitative analysis of the microbial metabolome by isotope dilution mass spectrometry using uniformly 13C-labeled cell extracts as internal standards.

A novel method was developed for the quantitative analysis of the microbial metabolome using a mixture of fully uniformly (U) (13)C-labeled metabolites as internal standard (IS) in the metabolite extraction procedure the subsequent liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) analysis. This mixture of fully U (13)C-labeled metabolites was extracted from biomass of Saccharomyces cerevisiae cultivated in a fed-batch fermentation on fully U (13)C-labeled substrates. The obtained labeled cell extract contained, in principle, the whole yeast metabolome, allowing the quantification of any intracellular metabolite of interest in S. cerevisiae. We have applied the labeled cell extract as IS in the analysis of glycolytic and tricarboxylic acid (TCA) cycle intermediates in S. cerevisiae sampled in both steady-state and transient conditions following a glucose pulse. The use of labeled IS effectively reduced errors due to variations occurring in the analysis and sample processing. As a result, the linearity of calibration lines and the precision of measurements were significantly improved. Coextraction of the labeled cell extract with the samples also eliminates the need to perform elaborate recovery checks for each metabolite to be analyzed. In conclusion, the method presented leads to less workload, more robustness, and a higher precision in metabolome analysis.

Simplified kinetic analysis of tumor 18F-FDG uptake: a dynamic approach.

UNLABELLED: Standardized uptake value (SUV) is often used to quantify (18)F-FDG tumor use. Although useful, SUV suffers from known quantitative inaccuracies. Simplified kinetic analysis (SKA) methods have been proposed to overcome the shortcomings of SUV. Most SKA methods rely on a single time point (SKA-S), not on tumor uptake rate. We describe a hybrid between Patlak analysis and existing SKA-S methods, using multiple time points (SKA-M) but reduced imaging time and without measurement of an input function. We compared SKA-M with a published SKA-S method and with Patlak analysis. METHODS: Twenty-seven dynamic (18)F-FDG scans were performed on 11 cancer patients. A population-based (18)F-FDG input function was generated from an independent patient population. SKA-M was calculated using this population input function and either a short, late, dynamic acquisition over the tumor (starting 25-35 min after injection and ending approximately 55 min after injection) or dynamic imaging 10 or 25 min to approximately 55 min after injection but using only every second or third time point, to permit a 2- or 3-field-of-view study. SKA-S was also calculated. Both SKA-M and SKA-S were compared with the gold standard, Patlak analysis. RESULTS: Both SKA-M (1 field of view) and SKA-S correlated well with Patlak slope (r > 0.99, P < 0.001, and r = 0.96, P < 0.001, respectively), as did multilevel SKA-M (r > 0.99 and P < 0.001 for both). Mean values of SKA-M (25-min start time) and SKA-S were statistically different from Patlak analysis (P < 0.001 and P < 0.04, respectively). One-level SKA-M differed from the Patlak influx constant by only -1.0% +/- 1.4%, whereas SKA-S differed by 15.1% +/- 3.9%. With 1-level SKA-M, only 2 of 27 studies differed from K(i) by more than 20%, whereas with SKA-S, 10 of 27 studies differed by more than 20% from K(i). CONCLUSION: Both SKA-M and SKA-S compared well with Patlak analysis. SKA-M (1 or multiple levels) had lower variability and bias than did SKA-S, compared with Patlak analysis. SKA-M may be preferred over SUV or SKA-S when a large unmetabolized (18)F-FDG fraction is expected and 1-3 fields of view are sufficient.

Measurement of renal function by calculation of fractional uptake of technetium-99m dimercaptosuccinic acid.

BACKGROUND: The purpose of this study was to set up normal values of the fractional uptake (FU) of technetium-99m dimercaptosuccinic acid in adults and in the pediatric population, as well as to evaluate the validity of this parameter at different levels of renal function. MATERIAL AND METHODS: A total of 86 subjects was divided into seven groups. In group A there were 23 potential kidney donors and in group B, 18 children in remission after a first urinary tract infection. Another three groups consisted of patients with diabetes i.e. group C, seven patients with normal values of albuminuria, group D, 16 patients with microalbuminuria and group E, five patients with macroalbuminuria. In group F, there were ten patients with a well-functioning transplanted kidney and in group G, seven patients with suspected acute rejection. The procedure began with the quantification of the doses of 99mTc-DMSA to be injected and the measurement of the empty syringe lying on the gamma camera collimator. Thereafter, four planar views of the kidneys were acquired three hours after the injection. The counts from the posterior and anterior views were subtracted for background and corrected for radioactive decay time and patient thickness. The FU was calculated by the geometric mean of counts per second from the posterior and anterior view. It was expressed as a fraction of the injected dose. RESULTS: The mean values of FU in healthy adults were 0.227 +/- 0.077 for one kidney and 0.454 +/- 0.146 for both kidneys. The mean values of FU for the left and right kidney were 0.225 +/- +/- 0.071 and 0.229 +/- 0.079, respectively. In children, the mean values were 0.220 +/- 0.092 for one kidney and 0.432 +/- 0.094 for both kidneys. The highest values of FU of 0.322 +/- 0.078 (0.644 +/- 0.138 for both kidneys) were measured in group C. In group D, FU was 0.185 +/- 0.065 (0.361 +/- 0.125 for both kidneys) and in group E 0.082 +/- 0.040 (0.163 +/- 0.080 total). In patients with a transplanted kidney, fractional uptake was 0.162 +/- +/- 0.039 in group F and 0.065 +/- 0.021 in group G. There was no significant difference in the values of FU between healthy adults and children. The uptake in group C was 41% higher than in group A and the difference was statistically significant. In groups D and E, the uptake was significantly lower than in A. In both groups of patients with transplanted kidneys, the uptake was significantly lower than in control group. The correlation between FU and biochemical parameters of renal function [blood urea nitrogen (BUN), serum creatinine (Cr) and creatinine clearance (CCr)] was significant: FU/BUN r = -0.86; FU/Cr r = -0.77; FU/CCr r = 0.60. CONCLUSION: Fractional uptake of 99mTc-DMSA could serve as a sensitive parameter of renal function. The mean values of FU in adults were 0.454 and in children 0.432. There was no significant difference between values for the left and right kidney. In diabetes mellitus, fractional uptake correlated well with the degree of diabetic nephropathy. In patients with a well-functioning transplant, the uptake was slightly reduced. Low values of fractional uptake in acute rejection were related to lesions in kidney blood vessels and in tubular cells.

Quantification of brain mu-opioid receptors with [11C]carfentanil: reference-tissue methods.

[(11)C]Carfentanil (CFN) is a mu-opioid agonist used for in vivo positron emission tomography (PET) studies of mu-opioid receptors. Previously, a tissue-ratio method was validated for the quantification of CFN binding. However, since that initial validation, several other blood independent (reference-tissue) methods have become available. To evaluate these methods, CFN PET studies with arterial blood sampling were acquired in six healthy male control subjects. Specific binding estimates obtained from reference-tissue methods were compared to those obtained with a more rigorous blood input modeling technique. It was determined that both a graphical method, and a simplified reference tissue model, were more accurate than the tissue-ratio method for quantification of CFN binding.