Technetium-99m-MIBI in primary and recurrent head and neck tumors: contribution of bone SPECT image fusion.

UNLABELLED: We prospectively investigated 200 patients with the clinical suspicion for head and neck tumors. The final diagnoses were 94 primary and 56 (37 confirmed, 19 excluded) recurrent squamous cell carcinomas (SCCs), 3 primary and 7 (4 confirmed, 3 excluded) recurrent adenoid cystic carcinomas (ACCs), 6 non-Hodgkin's lymphomas, 10 distant metastases, 6 other malignancies, 10 inflammatory and 8 other nonmalignant conditions. METHODS: Bone (600 MBq 99mTc-3,3-diphosphono-1,2-propane dicarboxylic acid tetrasodium salt) and hexakis-2-methoxyisobutyl isonitrile (MIBI) (600 MBq 99mTc-MIBI) SPECT were both performed under identical conditions (triple-head gamma camera; ultra-high-resolution, parallel-hole collimators; three-dimensional postfiltering) and judged independently and after superimposition. The results were compared to the results of biopsy, surgery and CT. RESULTS: The overall sensitivity/specificity of MIBI was 90%/78% for tumor detection and 90%/95% for the identification of malignant lymph node involvement (CT: 79%/66%, respectively 90%/79%). In the subgroup of recurrent SCC and ACC the sensitivity/specificity for tumor detection was 95%/71% for MIBI versus 78%/68% for CT. The isolated assessment of bone SPECT had a sensitivity/specificity of 100%/17% for osseous tumor spread. Image fusion of MIBI and bone SPECT differentiated between regio-local bone involvement and inflammatory changes and increased the specificity of bone SPECT to 100% in primary staging. Tumor size, stage, histology and pretreatment had no statistically significant effect on tracer uptake or diagnostic utility of scintigraphy. CONCLUSION: We propose the combined 99mTc-MIBI and bone ultra-high resolution SPECT as a highly useful imaging approach in the primary and secondary staging in patients with suspected malignancies in the head and neck region. The high specificity for malignancies in the head and neck region may be used in the differential diagnosis between head and neck malignancies and inflammatory disease in patients with the accidental finding of enlarged lymph nodes and no clinical signs of a primary tumor. Image fusion with bone scanning is mandatory for the topographical orientation and increases the specificity of bone scanning to differentiate between inflammatory or malignant causes of increased bone metabolism.

Quantification of intensity variations in functional MR images using rotated principal components.

In functional MRI (fMRI), the changes in cerebral haemodynamics related to stimulated neural brain activity are measured using standard clinical MR equipment. Small intensity variations in fMRI data have to be detected and distinguished from non-neural effects by careful image analysis. Based on multivariate statistics we describe an algorithm involving oblique rotation of the most significant principal components for an estimation of the temporal and spatial distribution of the stimulated neural activity over the whole image matrix. This algorithm takes advantage of strong local signal variations. A mathematical phantom was designed to generate simulated data for the evaluation of the method. In simulation experiments, the potential of the method to quantify small intensity changes, especially when processing data sets containing multiple sources of signal variations, was demonstrated. In vivo fMRI data collected in both visual and motor stimulation experiments were analysed, showing a proper location of the activated cortical regions within well known neural centres and an accurate extraction of the activation time profile. The suggested method yields accurate absolute quantification of in vivo brain activity without the need of extensive prior knowledge and user interaction.

Experimental comparison of data transformation procedures for analysis of principal components.

Results of principal component analysis depend on data scaling. Recently, based on theoretical considerations, several data transformation procedures have been suggested in order to improve the performance of principal component analysis of image data with respect to the optimum separation of signal and noise. The aim of this study was to test some of those suggestions, and to compare several procedures for data transformation in analysis of principal components experimentally. The experiment was performed with simulated data and the performance of individual procedures was compared using the non-parametric Friedman's test. The optimum scaling found was that which unifies the variance of noise in the observed images. In data with a Poisson distribution, the optimum scaling was the norm used in correspondence analysis. Scaling mainly affected the definition of the signal space. Once the dimension of the signal space was known, the differences in error of data and signal reproduction were small. The choice of data transformation depends on the amount of available prior knowledge (level of noise in individual images, number of components, etc), on the type of noise distribution (Gaussian, uniform, Poisson, other), and on the purpose of analysis (data compression, filtration, feature extraction).

Bronchial reactivity in hyperresponsive patients and healthy individuals: demonstration with high resolution computed tomography.

OBJECTIVE: High resolution computed tomography (HRCT) was used to assess the extent of bronchial reactivity after inhalative bronchoprovocation and dilation in hyperresponsive patients and healthy subjects. PATIENTS AND METHODS: Patients with mild intermittent asthma, 15 with a >20% decrease in FEV1 and a >10 mmHg (PC20+) in PaO2, 12 with a <20% decrease in FEV1 and a >10 mmHg (PC20-) in PaO2 after provocation, and eight healthy humans were included in the study. Changes in cross-sectional area in a total of 1256 bronchi and in bronchial wall area (792 bronchi) were evaluated after histamine-triggered bronchoprovocation and salbutamol-induced bronchodilation at high lung volumes (FVC 80%). Data were compared with the results of pulmonary function tests (FEV1, PaO2, PaCO2). RESULTS: In all groups, a significant decrease in bronchial cross-sectional area (P<0.001) and a significant increase in bronchial wall area (P<0.001) were observed subsequent to bronchoprovocation. After bronchodilation, the increase in cross-sectional area (P<0.001) and the further increase in airway wall area (P<0.01) were significant in all groups. In PC20+ and PC20- asthmatics, significant differences (P<0.05) in PaO2, >10 mmHg between baseline and provocation were observed. In healthy persons, the PaO2 decrease was <10 mmHg (P>0.05). After histamine provocation, the decrease in FEV1 was measured in the PC20+ group, whereas a <20% FEV1 decrease was found in the PC20- and the control groups, respectively. No significant correlations were observed between radiological data and the results of pulmonary function tests. CONCLUSIONS: HRCT demonstrated bronchial reactivity in hyperresponsive patients and, unexpectedly, in healthy subjects. The applied pulmonary function tests failed to characterize bronchial reactions in the healthy subjects. Based on these results, HRCT is a useful tool by which to achieve a comprehensive understanding of the pathophysiological processes in asthmatic patients.

[HRCT and bronchial asthma: visualization of the pathophysiologic changes of the pulmonary parenchyma after inhalation provocation]. / HRCT und Asthma bronchiale: Visualisierung pathophysiologischer Veränderungen des Lungenparenchyms nach inhalativer Provokation.

PURPOSE: To characterize parenchymal lung affections morphologically in patients with asthma and healthy subjects by high -resolution computed tomography (HRCT) subsequent to histamine-triggered inhalation bronchoprovocation and salbutamol-induced broncholysis, and to compare the results with pulmonary function tests. MATERIALS AND METHODS: Fifteen asthmatics with bronchial hyperreactivity, with a > 20% decrease in FEV1 and a > 10 mmHg decrease in PaO(2) after bronchoprovocation (PC20%+), twelve asthmatics with a < 20% decrease in FEV1 and a > 10 mmHg decrease in PaO(2) after bronchoprovocation (PC20%-), and eight healthy persons without bronchial hyperreactivity underwent inhalation bronchoprovocation and broncholysis. Spirometer-triggered HRCT at high lung volumes was performed, and total and peripheral lung densities and the amount of solid lung structures, representing predominantly vessels, were measured. RESULTS: After bronchoprovocation, we observed significant decreases in total and peripheral lung densities in all groups (p < 0.0005), and a significant increase in lung densities subsequent to bronchodilation (p < 0.0002). The morphological alterations in solid lung structure were not significantly different after bronchoprovocation or broncholysis (p > 0.05), as compared to the baseline measurements. In hyperreactive patients, PaO(2) significantly decreased after provocation and significantly increased after lysis (p < 0.05). In PC20%+ asthmatics, a mean reduction of 27.8% in FEV1 was observed, which was < 20% in the other groups. No significant correlations were observed between radiological data and the results of pulmonary function tests. In healthy persons, we demonstrated highly significant parenchymal response to bronchoprovocation and broncholysis, which was not otherwise documented by pulmonary function tests. CONCLUSION: In both PC20%+ and PC20%- patients as well as in healthy individuals, HRCT was efficient in the evaluation of pathoanatomical alterations of the lung parenchyma subsequent to inhalation provocation. In healthy individuals, these parenchymal alterations were not documented by pulmonary function tests.

[Analysis of the convergence relation of reconstructed algorithms disregarding local and global visual evaluations]. / Analyse des Konvergenzverhaltens von Rekonstruktionsalgorithmen anhand lokaler und globaler Bildparameter.

Tomographic reconstruction methods used in positron emission tomography are classified in two major groups: the traditionally and still widely applied filtered backprojection, and the iterative methods based on statistical models. This study focused on the objective comparison of different reconstruction algorithms, excluding criteria based on pure visual evaluation. The evaluation criteria were mathematically defined parameters, i.e., mean square error, standard deviation, signal-to-noise ratio and contrast recovery. The methods used for comparison were the classical filtered backprojection, the maximum likelihood expectation maximization algorithm, the maximum a-posteriori reconstruction model based on the Bayes Theorem, as well as the acceleration algorithms based on ordered subsets and high over-relaxation. These algorithms were evaluated by means of a mathematical brain phantom and of a physical spherical phantom. In terms of the applied parameters, the majority of the experiments showed a quantifiable superiority of the iterative methods compared the filtered backprojection.

Quantification of statistical type I and II errors in correlation analysis of simulated functional magnetic resonance imaging data.

The potential of statistical analyses of functional magnetic resonance images using various threshold strategies in combination with correlation analysis was studied by simulating brain activation. Differences in statistical Type I (alpha) and II (beta) errors are substantial for the various thresholds. Absolute thresholds and individualized thresholds based on the assumption of a gaussian noise distribution are producing constant alpha-errors and thus do not sufficiently improve discrimination of "truly" activated pixels even for very high contrast-to-noise ratios (CNR). Only relative threshold strategies related to the maximum correlation coefficient and thus the individual data quality and activation level, i.e., a data-driven approach, can perfectly discriminate true positives, at least for CNR > 2.5. To further improve discrimination of activated and non-activated pixel in studies with lower CNR, additional prior knowledge would be necessary. From the data presented, one would also expect that the best performing threshold strategy in this simulation study would perform best under in vivo conditions.

A computer-based method for calculation of orbital floor fractures from coronal computed tomography scans.

PURPOSE: A computer program recently developed for the calculation of the orbital floor and fracture areas from coronal computed tomography (CT) scans was used in a study to evaluate the accuracy and ability of this new method. MATERIAL AND METHODS: The size of orbital floors and fabricated fractures in 14 dried, anatomic specimens were measured in coronal CT scans by 3 independent observers. Based on this data set, the orbital floor and fracture regions were calculated with the newly developed computer program. These calculated regions were then compared with a direct measurement of the specimens that had been obtained by digital photography. The accuracy of the computer-based calculations was assessed using Lin's concordance correlation coefficient. RESULTS: The size of the orbital floor (mean +/- SD) was found to be 5.21 +/- 0.39 cm(2) by direct measurement of the specimens and 5.30 +/- 0.52 cm(2) by calculation with the computer program. The region of the fracture (mean +/- SD) was 1.05 +/- 0.64 cm(2) by direct measurement and 1.01 +/- 0.62 cm(2) by computer calculation. The between-method mean difference (direct measurement minus computer based calculation) was -0.09 cm(2) (or 1.7% of mean orbital floor region) for orbital floor region and 0.04 cm(2) (or 3.8% of mean fracture region) for fracture region. CONCLUSIONS: This accurate and time-saving method is practicable for determining the size and location of orbital floor fractures. This calculation program can be advantageously applied in the clinical management of blowout fractures of the orbit.

Three-dimensional reconstruction of the liver venous system using the preservation solution as contrast agent.

To investigate whether MRI without using artificial contrast agents can provide sufficient image contrast to visualize the venous tree in the cold stored liver graft, two pig liver grafts were scanned with a multislice turbo spin-echo sequence with long TE (200 msec). The quality of the data obtained at 1-T field strength was sufficient for three-dimensional reconstruction of the hepatic vascular system, potentially useful for liver splitting surgery.