Performance assessment of O-18 water purifier.

In the synthesis of 18F-FDG by the nucleophilic substitution method, 18O-H2O is usually used as target water. The target water should be recovered after synthesis and reused, because it is expensive, but recovered water contains impurities such as organic substances, and it must be purified before reuse. For this reason Sumitomo Heavy Industries, Ltd. developed an O-18 water purifier for elimination of organic substances in recovered water. This instrument consists of a UV irradiation unit and low-temperature distillation unit. Our institution had an opportunity to test use this instrument and evaluated its performance. The concentrations of organic substances after UV irradiation was greatly reduced, and recovery efficiency after distillation by the low-temperature distillation unit was very satisfactory at 99.3 +/- 0.5%. Furthermore, the yield of 18F-FDG from 18O-H20 purified with this instrument was sufficient for the clinical use.

In vivo assessment of glucose metabolism in hepatocellular carcinoma with FDG-PET.

UNLABELLED: The present study was designed to assess glucose metabolism in hepatocellular carcinoma (HCC) with PET and [18F]fluorodeoxyglucose (FDG) and to compare the results with the measured in vitro enzymatic activity of glucose metabolism and the histologic grading of HCC. METHODS: Dynamic FDG-PET scans were obtained in 17 preoperative patients with HCC. From the serial tissue and arterial radioactivities obtained by dynamic PET, FDG kinetic rate constants (K1 to k4) were obtained. The standardized uptake value (SUV) was also determined from the images acquired 48 to 60 min after FDG administration. These PET results were compared with hexokinase and glucose-6-phosphatase (G6Pase) activities and histologic grading of HCC in surgically resected tumor materials. According to histologic grading, the tumors were divided into low-grade and high-grade HCCs. RESULTS: The k3 and SUV of high-grade HCCs were significantly higher than those of low-grade HCCs (p < 0.005, each). In addition, high correlations were observed between the hexokinase activities and these two parameters (r = 0.715 0.768, respectively). In some HCCs, relatively high G6Pase activities and k4 values modified tumor FDG uptake. CONCLUSION: FDG PET is a valuable method for assessing glucose metabolism and histologic grading of HCC.

Assessment of coronary vasodilator reserve by N-13 ammonia PET using the microsphere method and Patlak plot analysis.

UNLABELLED: Noninvasive quantification of regional myocardial blood flow (MBF) has been successfully achieved with N-13 ammonia. The microsphere method as a simple method for quantifying regional myocardial blood flow was reevaluated in comparison with Patlak graphical analysis. In addition coronary vasodilator reserve (CVR) was estimated by both methods. METHODS: Dynamic N-13 ammonia PET studies were performed in 10 healthy volunteers and 10 patients with coronary artery disease at baseline and after dipyridamole infusion (0.56 mg/kg). MBF was estimated by the microsphere method at various times and by Patlak graphical analysis. In order to reduce the noise level in the microsphere method, MBF estimates were also performed after data in 10-40 seconds were averaged. RESULTS: In the studies on normal subjects MBF (ml/min/g) determined by the microsphere method significantly differs from time to time. However, MBF determined by the modified microsphere method [with average (Extraction fraction) x MBF values obtained between 100 and 120 sec] linearly correlated well with MBF by Patlak graphical analysis (r = 0.97, slope = 0.98, intercept = 0.20). In the studies on patients with coronary artery disease a good agreement of the MBF estimates was also observed (r = 0.97, slope = 0.98, intercept = 0.22). In the studies on the normal subjects and patients with coronary artery disease, CVR obtained by the modified microsphere method after correcting the overestimated MBF values also correlated well with that by Patlak graphical analysis (r = 0.90, slope = 1.14, intercept = -0.15, and r = 0.92, slope = 0.82, intercept = 0.25, respectively). CONCLUSION: The modified microsphere method is a very simple and reliable approach for quantifying MBF with N-13 ammonia PET which is comparable to Patlak graphical analysis. It also makes possible CVR assessment as accurate as Patlak graphical analysis.

Radionuclide assessment of myocardial fatty acid metabolism by PET and SPECT.

Although fatty acid is a major energy source in the normal myocardium, fatty acid oxidation is easily suppressed in a variety of cardiac disorders. Therefore assessment of fatty acid metabolism may hold an important role for early detection of myocardial abnormalities and provide insights into cardiac pathologic states. C-11 palmitate is a well-established PET tracer to probe myocardial fatty acid metabolism. On the other hand, a variety of iodinated fatty acid compounds have been introduced for assessment of fatty acid metabolism with conventional gamma cameras. These include straight-chain, such as iodopheyl pentadecanoic acid (IPPA), and branch-chain fatty acid compounds, such as beta-methyl iodopheyl pentadecanoic acid (BMIPP). This review article includes the characterization of these tracers and clinical experiences with these tracers for detection and characterizing patients with ischemic heart disease and cardiomyopathy.

Radioiodinated nordiazepam analog for in vivo assessment of benzodiazepine receptors by single photon emission tomography.

2'-Iodo-nordiazepam (2'-IND), a nordiazepam analog iodinated at the 2'-position of the C-5 phenyl ring, was synthesized and evaluated as a potential radiopharmaceutical for investigating brain benzodiazepine receptors by SPECT. [125I]2'-IND was synthesized by the halogen exchange reaction and purified by HPLC. In an in vitro competitive binding study using [3H]diazepam and rat cortical synaptosomol membranes, 2'-IND showed an almost equal affinity for benzodiazepine receptors as diazepam. In a saturation binding study using rat cortical synaptosomal membranes, 2'-IND displayed a Kd of 1.10 nM and a Bmax of 1.87 pmol/mg protein. Biodistribution and metabolism studies in mice showed that [125I]2'-IND exhibited rapid and high accumulation in the brain, and that the cerebral uptake and distribution of this compound occurred in the intact form. Furthermore, the administration of diazepam and flumazenil reduced cortical uptake by approx. 20%, suggesting that the uptake of 2'-IND occurred at least partly in association with benzodiazepine receptors.

[Three-dimensional assessment of myocardial blood flow and glucose metabolism using oblique-angle tomograms and polar map displays of cardiac PET images].

To evaluate clinical value of three-dimensional assessment of cardiac PET image, oblique-angle tomograms and polar map displays were reconstructed from transaxial PET images using 18F-2-fluoro-2-deoxyglucose and 13N-ammonia in 19 patients with coronary artery disease. Short-axis and vertical long-axis images enabled to evaluate extent and severity of perfusion abnormality easily in the anterior and inferior regions which were tangential in the transaxial images. Using polar map displays, perfusion/metabolism mismatch may be more easily assessed. Thus, semiquantitative analysis of ischemic and infarcted myocardium may be permitted with PET studies.

Assessment of myocardial fatty acid metabolism with positron emission tomography at rest and during dobutamine infusion in patients with coronary artery disease.

The myocardial clearance rate of C-11 palmitate as an index of fatty acid oxidation was assessed by means of positron emission tomography (PET) at rest and during dobutamine infusion in seven normal subjects and 10 patients with coronary artery disease. In the normal subjects the clearance half time was homogeneous in the left ventricle at rest and uniformly shortened during dobutamine infusion. In the myocardium at risk, clearance half time tends to be longer in the segments with an abnormal Q wave on ECG, exhibiting regional wall motion abnormality, and supplied by severely stenosed coronary arteries, particularly during dobutamine infusion. These data indicate that fatty acid oxidation may be decreased in infarcted myocardium and associated with regional asynergy. Such an abnormality was most striking in those with severe coronary stenosis during dobutamine infusion. We conclude that PET with the use of C-11 palmitate at rest and during dobutamine is a useful means of identifying impaired fatty acid oxidation and decreased metabolic reserve in patients with coronary artery disease.

Assessment of pancreatic blood flow with positron emission tomography and oxygen-15 water.

Dynamic positron emission tomography (PET) was performed following an intravenous bolus injection of 15O-water for the assessment of regional pancreatic blood flow in 4 normal volunteers and 11 patients with pancreatic cancer. The regional pancreatic blood flow index (PFI) was calculated by the autoradiographic method assuming the time-activity curves of the aorta as an input function. The mean PFI value was 0.514 +/- 0.098 in the normal pancreas but it was decreased in pancreatic cancer (0.249 +/- 0.076) (p less than 0.01), with a concomitant decrease in the pancreatic region distal to the tumor. On the other hand, in cases with body or tail cancer, the part proximal to the tumor (nontumorous head region) had a similar PFI value (0.554 +/- 0.211) to that of normal cases. Thus, a PET study with 15O-water permits quantitative assessment of pancreatic blood flow which decreased in both pancreatic cancer and concomitant obstructive pancreatitis distal to the tumor.

Relation of change in wall motion and glucose metabolism after coronary artery bypass grafting--assessment with positron emission tomography.

Regional myocardial glucose metabolism was assessed by positron emission tomography (PET) in stunned myocardium. PET perfusion and metabolic imaging using N-13 ammonia and F-18 deoxyglucose (FDG) was performed before and 5-7 weeks after coronary artery bypass grafting (CABG) in 23 patients with coronary artery disease. Of 22 asynergy segments showing increased FDG uptake preoperatively, the postoperative PET showed a decrease in FDG uptake in 16 segments (73%) and persistent uptake in 6 segments (27%). The improvement in asynergy was observed in all of the segments showing postoperative decrease in FDG uptake, while it was observed in only 50% of those with persistent FDG uptake (p less than 0.01). On the other hand, 4 of 5 segments showing a new FDG uptake postoperatively revealed deterioration of wall motion abnormality. These data suggest that an increase in exogenous glucose utilization may often persist in postischemic myocardium. Improvement in regional function seems to be associated with the improvement in metabolic abnormality after CABG.

[Assessment of myocardial viability by quantitative analysis of stress Tl-SPECT--comparison with FDG-PET].

Stress Tl-201 tomography (SPECT) is widely used for evaluating myocardial viability. To assess its value, redistribution (RD) on SPECT was compared with metabolic imaging using FDG. Thirty patients with coronary artery disease underwent stress-3 hour Tl-201 SPECT and PET using N-13 ammonia and FDG. RD was classified into 4 grading, including complete RD (CR), incomplete RD (IR), persistent defect (PD) and additional minimal RD (MR) defined as no definite RD on visual analysis but faint RD with Bull's eye quantitative analysis (QNT). All but one segment with CR or IR were viable regions (normal or ischemic regions) by PET. Of 74 segments without RD on visual analysis, 31 segments (42%) had RD by QNT (MR). All of them were viable regions by PET. Thus, QNT identified 31 segments (63%) of the metabolically viable segments which the visual Tl-201 analysis did not show RD and classified as myocardial scar. However, even such QNT cannot detect ischemic myocardium in 18 segments (42%) containing metabolic activity on PET. These data indicate that QNT of RD on Tl-201 SPECT is considered as a valuable means for assessing myocardial ischemia.