A tailored approach to abdominoperineal resection for rectal cancer: multicentre analysis of short-term outcomes and impact on oncological survival.

PURPOSE: Abdominoperineal resection of the rectum has evolved over the last century, with few modifications until 2007, when extralevator abdominoperineal resection was introduced, which improved local disease control but resulted in a significant rise in perineal complications. We adopted a modified approach in which dissection was tailored according to magnetic resonance-defined tumour involvement. The aim of this study was to assess short-term and long-term oncological outcomes following a tailored abdominoperineal resection (APR) approach. METHODS: This study was a retrospective review of prospectively maintained databases at three centres: Portsmouth NHS Trust (UK), Poole General Hospital (UK) and Champalimaud's Cancer Foundation, Portugal. The study included consecutive patients who underwent abdominoperineal resection from October 2008 until April 2018 under the supervision of the senior author. Oncological outcomes, including overall survival and disease-free survival, were used as the main outcome measures. RESULTS: A total of 584 patients underwent rectal cancer surgery during the study period. The APR ratio was 65/584 (11%). The median age was 66 years. Neoadjuvant treatment was administered to 74% of patients. Of the patients, 91% underwent surgery via a minimally invasive approach. The median hospital stay was 7 days. Patients were followed up for a median of 41 months. Only four patients had positive resection margins. The 5-year overall and disease-free survival rates were 64% and 62%, respectively. CONCLUSION: Our data suggest that tailored APR has similar short-term and long-term oncological outcomes compared with extralevator abdominoperineal resection but reduced perineal wound complications. We believe this approach could be a safe alternative but recommend a larger sample size to accurately assess its effectiveness.

[Human genetics of tuberculosis]. / Génétique humaine de la tuberculose.

Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major public health problem worldwide, resulting in 8.7 million new cases and 1.4 million deaths each year. One third of the world's population is exposed to M. tuberculosis and, after exposure, most, but not all, individuals become infected. Among infected subjects, only a minority (∼10%) will eventually develop clinical disease, which is typically either a primary, often extra-pulmonary, TB in children, or a reactivation, pulmonary TB in adults. Considerable genetic epidemiological evidence has accumulated to support a major role for human genetic factors in the development of TB. Numerous association studies with various candidate genes have been conducted in pulmonary TB, with very few consistent results. Recent genome-wide association studies revealed only a modest role for two inter-genic polymorphisms. However, a first major locus for pulmonary TB was mapped to chromosome 8q12-q13 in a Moroccan population after a genome-wide linkage screen. Using a similar strategy, two other major loci controlling TB infection were recently identified. While the precise identification of these major genes is ongoing, the other fascinating observation of these last years was the demonstration that TB can also reflect a Mendelian predisposition. Following the findings obtained in the syndrome of Mendelian susceptibility to mycobacterial diseases, several children with complete IL-12Rß1 deficiency, were found to have severe TB as their sole phenotype. Overall, these recent findings provide the proof of concept that the human genetics of TB involves a continuous spectrum from Mendelian to complex predisposition with intermediate major gene involvement. The understanding of the molecular genetic basis of TB will have fundamental immunological and medical implications, in particular for the development of new vaccines and treatments.

Evaluation of whole-body MR to CT deformable image registration.

Multimodality image registration plays a crucial role in various clinical and research applications. The aim of this study is to present an optimized MR to CT whole-body deformable image registration algorithm and its validation using clinical studies. A 3D intermodality registration technique based on B-spline transformation was performed using optimized parameters of the elastix package based on the Insight Toolkit (ITK) framework. Twenty-eight (17 male and 11 female) clinical studies were used in this work. The registration was evaluated using anatomical landmarks and segmented organs. In addition to 16 anatomical landmarks, three key organs (brain, lungs, and kidneys) and the entire body volume were segmented for evaluation. Several parameters--such as the Euclidean distance between anatomical landmarks, target overlap, Dice and Jaccard coefficients, false positives and false negatives, volume similarity, distance error, and Hausdorff distance--were calculated to quantify the quality of the registration algorithm. Dice coefficients for the majority of patients (> 75%) were in the 0.8-1 range for the whole body, brain, and lungs, which satisfies the criteria to achieve excellent alignment. On the other hand, for kidneys, Dice coefficients for volumes of 25% of the patients meet excellent volume agreement requirement, while the majority of patients satisfy good agreement criteria (> 0.6). For all patients, the distance error was in 0-10 mm range for all segmented organs. In summary, we optimized and evaluated the accuracy of an MR to CT deformable registration algorithm. The registered images constitute a useful 3D whole-body MR-CT atlas suitable for the development and evaluation of novel MR-guided attenuation correction procedures on hybrid PET-MR systems.

Dual-Centre Harmonised Multimodal Positron Emission Tomography/Computed Tomography Image Radiomic Features and Machine Learning Algorithms for Non-small Cell Lung Cancer Histopathological Subtype Phenotype Decoding.

AIMS: We aimed to build radiomic models for classifying non-small cell lung cancer (NSCLC) histopathological subtypes through a dual-centre dataset and comprehensively evaluate the effect of ComBat harmonisation on the performance of single- and multimodality radiomic models. MATERIALS AND METHODS: A public dataset of NSCLC patients from two independent centres was used. Two image fusion methods, namely guided filtering-based fusion and image fusion based on visual saliency map and weighted least square optimisation, were used. Radiomic features were extracted from each scan, including first-order, texture and moment-invariant features. Subsequently, ComBat harmonisation was applied to the extracted features from computed tomography (CT), positron emission tomography (PET) and fused images to correct the centre effect. For feature selection, least absolute shrinkage and selection operator (Lasso) and recursive feature elimination (RFE) were investigated. For machine learning, logistic regression (LR), support vector machine (SVM) and AdaBoost were evaluated for classifying NSCLC subtypes. Training and evaluation of the models were carried out in a robust framework to offset plausible errors and performance was reported using area under the curve, balanced accuracy, sensitivity and specificity before and after harmonisation. N-way ANOVA was used to assess the effect of different factors on the performance of the models. RESULTS: Support vector machine fed with selected features by recursive feature elimination from a harmonised PET feature set achieved the highest performance (area under the curve = 0.82) in classifying NSCLC histopathological subtypes. Although the performance of the models did not significantly improve for CT images after harmonisation, the performance of PET and guided filtering-based fusion feature signatures significantly improved for almost all models. Although the selection of the image modality and feature selection methods was effective on the performance of the model (ANOVA P-values <0.001), machine learning and harmonisation did not change the performance significantly (ANOVA P-values = 0.839 and 0.292, respectively). CONCLUSION: This study confirmed the potential of radiomic analysis on PET, CT and hybrid images for histopathological classification of NSCLC subtypes.

A novel energy mapping approach for CT-based attenuation correction in PET.

PURPOSE: Dual-energy CT (DECT) is arguably the most accurate energy mapping technique in CT-based attenuation correction (CTAC) implemented on hybrid PET/CT systems. However, this approach is not attractive for clinical use owing to increased patient dose. The authors propose a novel energy mapping approach referred to as virtual DECT (VDECT) taking advantage of the DECT formulation but using CT data acquired at a single energy (kV(P)). For this purpose, the CT image acquired at one energy is used to generate the CT image at a second energy using calculated kV(P) conversion curves derived from phantom studies. METHODS: The attenuation map (µ-map) at 511 keV was generated for the XCAT phantom and clinical studies using the bilinear, DECT, and VDECT techniques. The generated µ-maps at 511 keV are compared to the reference derived from the XCAT phantom serving as ground truth. PET data generated from a predefined activity map for the XCAT phantom were then corrected for attenuation using µ-maps generated using the different energy mapping approaches. In addition, the generated µ-maps using the above described methods for a cylindrical polyethylene phantom containing different concentrations of K(2)HPO(4) in water were compared to actual attenuation coefficients. Likewise, CT images of five clinical whole-body studies were used to generate µ-maps using the various energy-mapping approaches were compared with µ-maps acquired at 511 keV using (68)Ge/(68)Ga rod sources for the clinical studies. RESULTS: The results of phantom studies demonstrate that the proposed method is more accurate than the bilinear technique. All three µ-maps yielded almost similar results for soft and lung tissues whereas for bone tissues, the DECT and the VDECT methods produced a much smaller mean relative difference (3.0% and 2.8%, respectively) than the bilinear approach (11.8%). Likewise, the comparison of PET images corrected for attenuation using the various methods showed that the proposed method provides better accuracy (6.5%) than the bilinear method (13.4%). Clinical studies further demonstrated that, compared to the bilinear method, the VDECT approach has better agreement for bony structures with the DECT technique (1.5% versus 8.9%) and transmission scanning (8.8% versus 17.7%). CONCLUSIONS: It was concluded that the proposed method outperforms the bilinear method especially in bony structures. Further evaluation using a large clinical PET/CT database is underway to evaluate the potential of the technique in a clinical setting.

Accurate Monte Carlo modeling and performance assessment of the X-PET subsystem of the FLEX triumph preclinical PET/CT scanner.

PURPOSE: X-PET is a commercial small animal PET scanner incorporating several innovative designs to achieve improved performance. It is employed as a PET subsystem in the FLEX Triumph preclinical PET/CT scanner, the first commercial small animal PET/CT scanner worldwide. The authors report on a novel Monte Carlo (MC) model designed for the evaluation of performance parameters of the X-PET METHODS: The Geant4 Application for Tomographic Emission (GATE) MC code was used as a simulation tool. The authors implemented more accurate modeling of the geometry of detector blocks and associated electronic chains, including dead-time and time-independent parameters, compared to previously presented MC models of the X-PET scanner. Validation of the MC model involved comparison between simulated and measured performance parameters of the X-PET, including spatial resolution, sensitivity, and noise equivalent count rate (NECR). Thereafter, various simulations were performed to assess scanner performance parameters according to NEMA NU 4-2008 standards with the aim to present a reliable Monte Carlo platform for small animal PET scanner design optimization. RESULTS: The average differences between simulated and measured results were 11.2%, 33.3%, and 9.1% for spatial resolution, sensitivity, and NECR, respectively. The average system absolute sensitivity was 2.7%. Furthermore, the peak true count rate, peak NECR, and scatter fraction were 2050 kcps, 1520 kcps, and 4.7%, respectively, for a mouse phantom and 1017 kcps, 469 kcps, and 18.2%, respectively, for a rat phantom. Spatial resolution was also measured in ten different positions at two axial locations. The radial, tangential, and axial FWHM ranged from 1.31 to 1.96 mm, 1.17 to 2.11 mm, and 1.77 to 2.44 mm, respectively, as the radial position varied from 0 to 25 mm at the centre of the axial field-of-view. CONCLUSIONS: The developed MC simulation platform provides a reliable tool for performance evaluation of small animal PET scanners and has the potential to be used in other applications such as detector design optimization, correction of image degrading factors such as randoms, scatter, intercrystal scatter, parallax error, and partial volume effect.

Histological and chemical damage induced by microcystin-LR and microcystin-RR on land snail Helix aspersa tissues after acute exposure.

Microcystins (MCs) are the most common cyanotoxins with more than 200 variants. Among these cyanotoxins, microcystin-LR (MC-LR) and microcystin-RR (MC-RR) are the most studied congeners due to their high toxicity and frequent occurrence in surface waters. MC-LR has been detected in more than 75% of natural cyanobacteria bloom, along with other toxic and less toxic congeners. Accumulation of several microcystins variants (MC-LR and MC-RR) has been confirmed in aquatic snails exposed naturally or in the laboratory to toxic blooms. Thus, this paper aims to compare the biochemical and histological impact of both toxic variants (microcystin-LR and microcystin-RR) and their mixed form on a bioindicator, the land snail Helix aspersa. During experiments, snails were gavaged with a single acute dose (0.5 µg/g) of purified MC-LR, MC-RR, or mixed MC-LR + MC-RR (0.25 + 0.25 µg/g). After 96 h of exposure, effects on the hepatopancreas, kidney, intestine and lungs were assessed by histological observations and analysis of oxidative stress biomarkers. The results show that a small dose of MCs variants can increase the non-enzymatic antioxidant glutathione (GSH), inhibit glutathione-s-transferase (GST) level and trigger a defense system by activating glutathione peroxidase (GPx), catalase (CAT) and superoxide dismutase (SOD). Microcystin-RR causes serious anomalies in the hepatopancreas and kidney than Microcystin-LR. The organ most affected is the kidney. The damage caused by MC-LR + MC-RR is greater than that caused by single variants.

Expanding the medical physicist curricular and professional programme to include Artificial Intelligence.

PURPOSE: To provide a guideline curriculum related to Artificial Intelligence (AI), for the education and training of European Medical Physicists (MPs). MATERIALS AND METHODS: The proposed curriculum consists of two levels: Basic (introducing MPs to the pillars of knowledge, development and applications of AI, in the context of medical imaging and radiation therapy) and Advanced. Both are common to the subspecialties (diagnostic and interventional radiology, nuclear medicine, and radiation oncology). The learning outcomes of the training are presented as knowledge, skills and competences (KSC approach). RESULTS: For the Basic section, KSCs were stratified in four subsections: (1) Medical imaging analysis and AI Basics; (2) Implementation of AI applications in clinical practice; (3) Big data and enterprise imaging, and (4) Quality, Regulatory and Ethical Issues of AI processes. For the Advanced section instead, a common block was proposed to be further elaborated by each subspecialty core curriculum. The learning outcomes were also translated into a syllabus of a more traditional format, including practical applications. CONCLUSIONS: This AI curriculum is the first attempt to create a guideline expanding the current educational framework for Medical Physicists in Europe. It should be considered as a document to top the sub-specialties' curriculums and adapted by national training and regulatory bodies. The proposed educational program can be implemented via the European School of Medical Physics Expert (ESMPE) course modules and - to some extent - also by the national competent EFOMP organizations, to reach widely the medical physicist community in Europe.

Quantifying the effect of anode surface roughness on diagnostic x-ray spectra using Monte Carlo simulation.

PURPOSE: The accurate prediction of x-ray spectra under typical conditions encountered in clinical x-ray examination procedures and the assessment of factors influencing them has been a longstanding goal of the diagnostic radiology and medical physics communities. In this work, the influence of anode surface roughness on diagnostic x-ray spectra is evaluated using MCNP4C-based Monte Carlo simulations. METHODS: An image-based modeling method was used to create realistic models from surface-cracked anodes. An in-house computer program was written to model the geometric pattern of cracks and irregularities from digital images of focal track surface in order to define the modeled anodes into MCNP input file. To consider average roughness and mean crack depth into the models, the surface of anodes was characterized by scanning electron microscopy and surface profilometry. It was found that the average roughness (Ra) in the most aged tube studied is about 50 pm. The correctness of MCNP4C in simulating diagnostic x-ray spectra was thoroughly verified by calling its Gaussian energy broadening card and comparing the simulated spectra with experimentally measured ones. The assessment of anode roughness involved the comparison of simulated spectra in deteriorated anodes with those simulated in perfectly plain anodes considered as reference. From these comparisons, the variations in output intensity, half value layer (HVL), heel effect, and patient dose were studied. RESULTS: An intensity loss of 4.5% and 16.8% was predicted for anodes aged by 5 and 50 microm deep cracks (50 kVp, 6 degrees target angle, and 2.5 mm A1 total filtration). The variations in HVL were not significant as the spectra were not hardened by more than 2.5%; however, the trend for this variation was to increase with roughness. By deploying several point detector tallies along the anode-cathode direction and averaging exposure over them, it was found that for a 6 degrees anode, roughened by 50 microm deep cracks, the reduction in exposure is 14.9% and 13.1% for 70 and 120 kVp tube voltages, respectively. For the evaluation of patient dose, entrance skin radiation dose was calculated for typical chest x-ray examinations. It was shown that as anode roughness increases, patient entrance skin dose decreases averagely by a factor of 15%. CONCLUSIONS: It was concluded that the anode surface roughness can have a non-negligible effect on output spectra in aged x-ray imaging tubes and its impact should be carefully considered in diagnostic x-ray imaging modalities.

Combined evaluation of myocardial perfusion and coronary morphology in the identification of subclinical CAD. Radiation exposure of 13N-ammonia PET/CT.

PURPOSE: to evaluate the mean effective radiation dose of 13N-ammonia PET/CT and ECG-pulsing CT angiography (CTA) in the evaluation of myocardial perfusion, myocardial blood flow (MBF) and coronary morphology for the identification of subclinical CAD. PATIENTS, MATERIAL, METHODS: following rest-stress 13N-ammonia PET/CT perfusion imaging and MBF quantification, ECG-pulsing CTA at a pulse window of 70% of the R-R cycle was performed in ten healthy controls and in sixteen individuals with cardiovascular risk factors. Individual radiation dose exposure for ECG-pulsing CTA was estimated from the dose-length product. RESULTS: PET demonstrated normal perfusion in all study individuals, while hyperemic MBFs during dipyridamole stimulation and the myocardial flow reserve (MFR) in cardiovascular risk individuals were significantly lower than in healthy controls (1.34±0.26 vs. 2.28±0.47 ml/g/min and 1.48±0.39 vs. 3.24±0.81, both p≤0.0001). Further, ECG-pulsing CTA identified mild calcified and non-calcified coronary plaque burden in 7 (43%) individuals of the cardiovascular risk group. Rest-stress 13N-ammonia PET/CT perfusion study yielded a mean effective radiation dose of 3.07±0.06 mSv (2.07±0.06 mSv from the rest-stress 13N-ammonia injections and 1.0 mSv from the 2 CT transmission scans), while ECG-pulsing CTA was associated with 5.57±2.00 mSv. The mean effective radiation dose of the combined 13N-ammonia PET/CT and ECG-pulsing CTA exams in the evaluation of myocardial perfusion and coronary morphology was 8.0±1.5 mSv. CONCLUSION: 13N-ammonia PET/CT and ECG-pulsing CTA affords cardiac hybrid imaging studies in the evaluation of subclinical CAD with a relatively low mean effective radiation exposure of 8.0±1.5mSv.

Clinical predictive factors of histological chorioamnionitis: case-control study.

INTRODUCTION: Histological chorioamnionitis or "intrauterine inflammation or infection" (Triple I) it is an acute inflammation of amniotic membrane, chorionic plate and umbilical cord. SUBJECT: To assess in the event of the clinical predictive factors associated to histological chorioamnionitis. METHODS: Prospective examination of 50 placentas from aberrant pregnancies, and 50 placentas from 'normal' deliveries. The Placentas analyzed by the conventional histopathology method, and the severity of chorioamnionitis was classified histologically according to the intensity and the topography of placental inflammation.The clinical and histopathological features of the study groups were introduced into the SPSS 13 database (License University Mohammed V-Rabat). RESULTS: 36/50 placentas of aberrant pregnancies showed a histological chorioamnionitis often associated to a funisitis, and 11/50 normal placentas have shown some lesions of histological chorioamnionitis mainly grade one without funisitis.On the other hand we noted a statistically significant association between histological chorioamnionitis and premature rupture of the membranes (PROM) over than 12h (p < 0.001). CONCLUSIONS: Our study confirmed the predominance of histological chorioamnionitis lesions in clinically suspected cases of chorioamnionitis with 72% versus 22% in the controls group.Among the clinical parameters studied, only the premature rupture of the Membranes was shown a statistically significant association with the appearance of histological signs of chorioamnionitis.In conclusion, chorioamnionitis is sometimes clinically silent. Morphological placental study could be a confirmation of this pathology, which is predominantly associated to PROM over than 12 h.

Radiomics for classification of bone mineral loss: A machine learning study.

PURPOSE: The purpose of this study was to develop predictive models to classify osteoporosis, osteopenia and normal patients using radiomics and machine learning approaches. MATERIALS AND METHODS: A total of 147 patients were included in this retrospective single-center study. There were 12 men and 135 women with a mean age of 56.88±10.6 (SD) years (range: 28-87 years). For each patient, seven regions including four lumbar and three femoral including trochanteric, intertrochanteric and neck were segmented on bone mineral densitometry images and 54 texture features were extracted from the regions. The performance of four feature selection methods, including classifier attribute evaluation (CLAE), one rule attribute evaluation (ORAE), gain ratio attribute evaluation (GRAE) and principal components analysis (PRCA) along with four classification methods, including random forest (RF), random committee (RC), K-nearest neighbor (KN) and logit-boost (LB) were evaluated. Four classification categories, including osteopenia vs. normal, osteoporosis vs. normal, osteopenia vs. osteoporosis and osteoporosis+osteopenia vs. osteoporosis were examined for the defined seven regions. The classification model performances were evaluated using the area under the receiver operator characteristic curve (AUC). RESULTS: The AUC values ranged from 0.50 to 0.78. The combination of methods RF+CLAE, RF+ORAE and RC+ORAE yielded highest performance (AUC=0.78) in discriminating between osteoporosis and normal state in the trochanteric region. The combinations of RF+PRCA and LB+PRCA had the highest performance (AUC=0.76) in discriminating between osteoporosis and normal state in the neck region. CONCLUSION: The machine learning radiomic approach can be considered as a new method for bone mineral deficiency disease classification using bone mineral densitometry image features.

Three-phase 18F-fluorocholine PET/CT in the evaluation of prostate cancer recurrence.

AIM: Contribution of 3-phase 18F-fluorocholine PET/CT in suspected prostate cancer recurrence at early rise of PSA. PATIENTS, METHODS: Retrospective analysis was performed in 47 patients after initial treatment with radiotherapy (n=30) or surgery (n=17). Following CT, 10 minutes list-mode PET acquisition was done over the prostate bed after injection of 300 MBq of 18F-fluorocholine. Three timeframes of 3 minutes each were reconstructed for analysis. All patients underwent subsequent whole body PET/CT. Delayed pelvic PET/CT was obtained in 36 patients. PET/CT was interpreted visually by two observers and SUVmax determined for suspicious lesions. Biopsies were obtained from 13 patients. RESULTS: Biopsies confirmed the presence of cancer in 11 of 13 patients with positive PET for a total of 15 local recurrences in which average SUVmax increased during 14 minutes post injection and marginally decreased in delayed scanning. Conversely inguinal lymph nodes with mild to moderate metabolic activity on PET showed a clearly different pattern with decreasing SUVmax on dynamic images. Three-phase PET/CT contributed to the diagnostic assessment of 10 of 47 patients with biological evidence of recurrence of cancer. It notably allowed the discrimination of confounding blood pool or urinary activity from suspicious hyperactivities. PET/CT was positive in all patients with PSA>or=2 ng/ml (n=34) and in 4/13 patients presenting PSA values<2 ng/ml. CONCLUSION: 18F-fluorocholine 3-phase PET/CT showed a progressively increasing SUVmax in biopsy confirmed cancer lesions up to 14 minutes post injection while decreasing in inguinal lymph nodes interpreted as benign. Furthermore, it was very useful in differentiating local recurrences from confounding blood pool and urinary activity.

Analysis of the effect of swimmer's head position on swimming performance using computational fluid dynamics.

The aim of this numerical work is to analyze the effect of the position of the swimmer's head on the hydrodynamic performances in swimming. In this initial study, the problem was modeled as 2D and in steady hydrodynamic state. The geometry is generated by the CAD software CATIA and the numerical simulation is carried out by the use of the CFD Fluent code. The standard k-epsilon turbulence model is used with a specific wall law. Three positions of the head were studied, for a range of Reynolds numbers about 10(6). The obtained numerical results revealed that the position of the head had a noticeable effect on the hydrodynamic performances, strongly modifying the wake around the swimmer. The analysis of these results made it possible to propose an optimal position of the head of a swimmer in underwater swimming.

Robustness of post-reconstruction and direct kinetic parameter estimates under rigid head motion in dynamic brain PET imaging.

OBJECTIVE: Dynamic PET imaging is extensively used in brain imaging to estimate parametric maps. Inter-frame motion can substantially disrupt the voxel-wise time-activity curves (TACs), leading to erroneous maps during kinetic modelling. Therefore, it is important to characterize the robustness of kinetic parameters under various motion and kinetic model related factors. METHODS: Fully 4D brain simulations ([15O]H2O and [18F]FDG dynamic datasets) were performed using a variety of clinically observed motion patterns. Increasing levels of head motion were investigated as well as varying temporal frames of motion initiation. Kinetic parameter estimation was performed using both post-reconstruction kinetic analysis and direct 4D image reconstruction to assess bias from inter-frame emission blurring and emission/attenuation mismatch. RESULTS: Kinetic parameter bias heavily depends on the time point of motion initiation. Motion initiated towards the end of the scan results in the most biased parameters. For the [18F]FDG data, k4 is the more sensitive parameter to positional changes, while K1 and blood volume were proven to be relatively robust to motion. Direct 4D image reconstruction appeared more sensitive to changes in TACs due to motion, with parameter bias spatially propagating and depending on the level of motion. CONCLUSION: Kinetic parameter bias highly depends upon the time frame at which motion occurred, with late frame motion-induced TAC discontinuities resulting in the least accurate parameters. This is of importance during prolonged data acquisition as is often the case in neuro-receptor imaging studies. In the absence of a motion correction, use of TOF information within 4D image reconstruction could limit the error propagation.

Novel approach to stationary transmission scanning using Compton scattered radiation.

Transmission scanning-based estimation of the attenuation map plays a crucial role in quantitative radionuclide imaging. X-ray computed tomography (CT) reconstructs directly the attenuation coefficients map from data transmitted through the object. This paper proposes an alternative route for reconstructing the object attenuation map by exploiting Compton scatter of transmitted radiation from an externally placed radionuclide source. In contrast to conventional procedures, data acquisition is realized as a series of images parameterized by the Compton scattering angle and registered on a stationary gamma camera operating without spatial displacement. Numerical simulation results using realistic voxel-based phantoms are presented to illustrate the efficiency of this new transmission scanning approach for attenuation map reconstruction. The encouraging results presented in this paper may suggest the possibility of proposing a new concept for emission/transmission imaging using scattered radiation, which has many advantages compared to conventional technologies.

Assessment of 18F-FDG-leukocyte imaging to monitor rejection after pancreatic islet transplantation.

AIM: We sought to investigate the feasibility of 18F-FDG-leukocyte imaging to detect islet rejection. METHODS: Two thousand Sprague-Dawley (SD, syngeneic group) or Lewis (allogeneic group) islet equivalents were intraportally injected into SD rat recipients. Four and 7 days after transplantation, 10(8) 18F-FDG-labeled splenocytes were injected into the jugular vein. Splenocytes were harvested from naïve or sensitized (12 days after intraportal transplantation of 2000 Lewis IEQ) SD rats. Positron emission tomography (PET) imaging was started 5 minutes after splenocyte infusion and performed hourly for 4 hours. RESULTS: One hour after splenocyte injection, FDG was mainly detected in the heart and lungs. It was then further distributed to other organs, and from the second hour, the highest tracer concentration was located in the abdomen. Liver FDG uptake was similar between syngeneic, allogeneic, and sensitized allogeneic groups at 4 and 7 days after islet transplantation. DISCUSSION: No islet rejection was detected by 18F-FDG-leukocyte imaging. The amount of transplanted tissue was only few millilitres and the additional related inflammation in case of rejection is small and difficult to detect. The liver showed a relatively high spontaneous tracer uptake; the related background prevented detection of a potential increase in tracer uptake in cases of islet rejection.

Impact of time-of-flight on indirect 3D and direct 4D parametric image reconstruction in the presence of inconsistent dynamic PET data.

Kinetic parameter estimation in dynamic PET suffers from reduced accuracy and precision when parametric maps are estimated using kinetic modelling following image reconstruction of the dynamic data. Direct approaches to parameter estimation attempt to directly estimate the kinetic parameters from the measured dynamic data within a unified framework. Such image reconstruction methods have been shown to generate parametric maps of improved precision and accuracy in dynamic PET. However, due to the interleaving between the tomographic and kinetic modelling steps, any tomographic or kinetic modelling errors in certain regions or frames, tend to spatially or temporally propagate. This results in biased kinetic parameters and thus limits the benefits of such direct methods. Kinetic modelling errors originate from the inability to construct a common single kinetic model for the entire field-of-view, and such errors in erroneously modelled regions could spatially propagate. Adaptive models have been used within 4D image reconstruction to mitigate the problem, though they are complex and difficult to optimize. Tomographic errors in dynamic imaging on the other hand, can originate from involuntary patient motion between dynamic frames, as well as from emission/transmission mismatch. Motion correction schemes can be used, however, if residual errors exist or motion correction is not included in the study protocol, errors in the affected dynamic frames could potentially propagate either temporally, to other frames during the kinetic modelling step or spatially, during the tomographic step. In this work, we demonstrate a new strategy to minimize such error propagation in direct 4D image reconstruction, focusing on the tomographic step rather than the kinetic modelling step, by incorporating time-of-flight (TOF) within a direct 4D reconstruction framework. Using ever improving TOF resolutions (580 ps, 440 ps, 300 ps and 160 ps), we demonstrate that direct 4D TOF image reconstruction can substantially prevent kinetic parameter error propagation either from erroneous kinetic modelling, inter-frame motion or emission/transmission mismatch. Furthermore, we demonstrate the benefits of TOF in parameter estimation when conventional post-reconstruction (3D) methods are used and compare the potential improvements to direct 4D methods. Further improvements could possibly be achieved in the future by combining TOF direct 4D image reconstruction with adaptive kinetic models and inter-frame motion correction schemes.