Physiological background parenchymal uptake of 18F-FDG in normal breast tissues using dedicated breast PET: correlation with mammographic breast composition, menopausal status, and menstrual cycle.

OBJECTIVE: This study aimed to quantitatively evaluate the effects of age, mammographic density, menopausal status, and menstrual cycle on background parenchymal uptake (BPU) using ring-shaped dedicated breast positron emission tomography (dbPET). METHODS: This study included 186 adult women who underwent mammography and dbPET on the same day and had no abnormalities classified as Breast Imaging Reporting and Data System (BI-RADS) category 1 on both examinations. The volume of interest (VOI) was placed in the glandular tissue of both breasts, and the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and metabolic breast volume (MBV) were measured as indicators of BPU. We analyzed the correlation between BPU and age, mammographic density, menopausal status, and menstrual cycle. RESULTS: The SUVmax and SUVmean for normal breast tissue were inversely correlated with age (both p < 0.001). The SUVmax, SUVmean, and MBV of mammographically dense breast tissues were significantly higher than those of non-dense breast tissues (all p < 0.001). The SUVmax, SUVmean, and MBV of normal breast tissue in premenopausal women were significantly higher than those in postmenopausal women (p < 0.001, p < 0.001, p = 0.002, respectively). In the study, 59 premenopausal women, the SUVmax of normal breast tissue in the menstrual-follicular phase was significantly lower than that in the periovulatory-luteal phase (p = 0.02). When we sorted the premenopausal women by mammographic breast composition, the SUVmax and SUVmean of normal breast tissues in the menstrual-follicular phase were significantly lower than those in the periovulatory-luteal phase in the 44 premenopausal women with dense breasts (p = 0.007, and p = 0.038, respectively), whereas no statistically significant difference was found between the menstrual-follicular phase and the periovulatory-luteal phase in the 15 premenopausal women with non-dense breasts. CONCLUSIONS: BPU in normal breast tissues assessed using ring-shaped dbPET was associated with mammographic density, menopausal status, and women's menstrual cycle. The menstrual cycle was significantly associated with BPU in premenopausal women with dense breasts but not in women with non-dense breasts.

Retraction: 'Effect of blonanserin on cognitive function in antipsychotic-naïve first-episode schizophrenia'.

The above article from Human Psychopharmacology, first published on 25 January 2012 in Wiley OnlineLibrary (onlinelibrary.wiley.com), and in Volume 90, pp. 90-100, has been retracted by agreement between the authors, the journal Editor in Chief, David Baldwin, and John Wiley & Sons Ltd. The retraction has been agreed following an investigation by the St Marianna University Ethics Committee which determined that the paper was not as originally designed and approved. REFERENCES: Tenjin, T., Miyamoto, S., Miyake, N., Ogino, S., Kitajima, R., Ojima, K., … Yamaguchi, N. (2012). Effect of blonanserin on cognitive function in antipsychotic-naïve first-episode schizophrenia. Hum. Psychopharmacol Clin Exp, 27, 90-100. https://doi.org/10.1002/hup.1276.

Attenuation correction of (111)In planar images by use of dual energy, fundamental study by Monte Carlo simulation.

In this study, we devised and evaluated a method for attenuation correction of the hot spot in (111)In planar images. By use of the difference in transmittance between two energies (171 and 245 keV), the depth of the hot spot was calculated. Planar images of point sources in a numerical phantom (water) with depths from 0 to 20 cm at 2 cm intervals were prepared by Monte Carlo simulation. From the linear attenuation coefficient of the two energies and the 171/245 keV count ratio-depth relationship, the depth of the point source was calculated, and an attenuation correction was performed. A simulation was made under conditions taking into account both attenuation and scatter (A(+)S(+)) and attenuation alone (A(+)S(-)). The attenuation correction was evaluated with use of corrected and true counts obtained from homogeneous phantoms mimicking attenuation in soft tissue, bone, and the lungs, and heterogeneous phantoms prepared by combining them. In the A(+)S(+) condition, images were affected markedly by scattered photons in all phantoms at depths of 4-8 cm. The errors at depths of 10 cm or greater were within ±10 % in water and within ±6 % in soft tissue. However, the errors were about -30 % in bone and about +70 % in lung, indicating that scatter distributions different from those in water increased the errors. In the A(+)S(-) condition, the errors were within ±5 % in all homogeneous and heterogeneous phantoms, and satisfactory results were obtained. Precise attenuation correction of scatter-corrected planar images was confirmed to be possible with this method.

(89)Sr bremsstrahlung single photon emission computed tomography using a gamma camera for bone metastases.

OBJECTIVE: Strontium-89 chloride ((89)Sr) bremsstrahlung single photon emission computed tomography (SPECT) imaging was evaluated for detecting more detailed whole body (89)Sr distribution. METHODS: (89)Sr bremsstrahlung whole body planar and merged SPECT images were acquired using two-detector SPECT system. Energy window A (100 keV ± 50 %) for planar imaging and energy window A plus adjacent energy window B (300 keV ± 50 %) for SPECT imaging were set on the continuous spectrum. Thirteen patients with multiple bone metastases were evaluated. Bone metastases can be detected with (99m)Tc-HMDP whole body planar and merged SPECT images and compared with (89)Sr bremsstrahlung whole body planar and merged SPECT images. Based on the location of metastatic lesions seen as hot spots on (99m)Tc-HMDP images as a reference, the hot spots on (89)Sr bremsstrahlung images were divided into the same bone parts as (99m)Tc-HMDP images (a total of 35 parts in the whole body), and the number of hot spots were counted. We also evaluated the incidence of extra-osseous uptakes in the intestine on (89)Sr bremsstrahlung whole body planar images. RESULTS: A total of 195 bone metastatic lesions were detected in both (99m)Tc-HMDP whole body planar and merged SPECT images. Detection of hot spot lesions in (89)Sr merged SPECT images (127 of 195; 66 %) was more frequent than in (89)Sr whole body planar images (108 of 195; 56 %), based on metastatic bone lesions in (99m)Tc-HMDP whole body planar and merged SPECT images. A large intestinal (89)Sr accumulation was detected in 5 of the 13 patients (38 %). CONCLUSIONS: (89)Sr bremsstrahlung-merged SPECT imaging could be more useful for detailed detection of whole body (89)Sr distribution than planar imaging. Intestinal (89)Sr accumulation due to (89)Sr physiologic excretion was detected in feces for 4 days after tracer injection.

Effect of blonanserin on cognitive function in antipsychotic-naïve first-episode schizophrenia.

OBJECTIVE: The purpose of this study was to evaluate the effects of blonanserin, a novel antipsychotic, on cognitive function in first-episode schizophrenia. METHODS: Twenty-four antipsychotic-naïve patients with first-episode schizophrenia participated in the study. Blonanserin was given in an open-label design for 8 weeks. The Brief Assessment of Cognition in Schizophrenia-Japanese language version (BACS-J) was administered as the primary outcome measure at baseline and 8 weeks. Clinical evaluation included the Positive and Negative Syndrome Scale (PANSS), the Schizophrenia Quality of Life Scale-Japanese language version (SQLS-J), and the Clinical Global Impression-Severity of Illness Scale (CGI-S). To exclude the possibility of retest effects on the BACS-J, 10 age-matched patients with chronic schizophrenia treated with blonanserin were tested at baseline and after an 8-week interval. RESULTS: Twenty first-episode patients completed the study. Repeated measures analysis of covariance revealed a significant group-by-time interaction effect on the letter fluency task due to better performance in the first-episode group, but not in the control group. Main effect of time or group-by-time interaction effect on the Tower of London task was not significant; however, the first-episode group, but not the control group, showed substantial improvement with a moderate effect size. All items on the PANSS, SQLS-J, and CGI-S significantly improved after 8 weeks of treatment. CONCLUSIONS: These results suggest that blonanserin improves some types of cognitive function associated with prefrontal cortical function.

Effects of tapering of long-term benzodiazepines on cognitive function in patients with schizophrenia receiving a second-generation antipsychotic.

BACKGROUND: The high use of long-term benzodiazepines (BZDs) with second-generation antipsychotics (SGAs) has been identified as an important issue in the treatment of schizophrenia in Japan. The aim of this study was to evaluate the effects of gradual reduction or discontinuation of daytime BZD use on cognitive function and quality of life (QOL) in patients with chronic schizophrenia receiving an SGA. METHODS: Thirty schizophrenic patients who had received an SGA with concomitant BZDs for at least 3 months were enrolled. Before and 4 weeks after tapering of daytime BZDs, the Brief Assessment of Cognition in Schizophrenia Japanese-language version (BACS-J) and the Schizophrenia Quality of Life Scale Japanese-language version (SQLS-J) were administered. Clinical evaluation also included the Positive and Negative Syndrome Scale (PANSS). To compare for practice effects on the BACS-J, 10 patients with chronic schizophrenia were assessed without tapering BZDs. RESULTS: BZDs were reduced or discontinued safely in most patients, and no emergent withdrawal symptoms were observed. Significant improvements were shown in verbal memory, working memory, and composite score, as measured by the BACS-J without practice effects. In addition, the motivation/energy score on the SQLS-J, the negative symptoms and total scores on the PANSS significantly improved after tapering BZDs. CONCLUSION: Reduction or discontinuation of long-term daytime use of BZDs may be warranted in patients with schizophrenia treated with SGAs, as it may improve cognitive function, subjective QOL, and psychiatric symptoms with no significant adverse effects.

[A trial of 89Sr bremsstrahlung SPECT].

OBJECTIVE: 89Sr bremsstrahlung SPECT imaging has been evaluated for detecting the more detailed whole body 89Sr distribution. METHODS: 89Sr bremsstrahlung whole body planar and merged SPECT images were acquired by using two detectors type SPECT system. Energy window A (100 keV +/- 50%) for planar imaging, and energy window A plus adjacent energy window B (300 keV +/- 50%) for SPECT imaging were set on the continuous spectrum. Those images were compared with 99mTc-H-MDP whole body planar and merged SPECT images. To verify the accumulation obtained by bremsstrahlung whole body planar and merged SPECT image, we made original phantom based on the counts of clinical study imaging. RESULTS: On 89Sr bremsstrahlung merged SPECT image, focal accumulations were recognized in the parts of 99mTc-H-MDP merged SPECT accumulation. Focal accumulations were much clearer on 89Sr bremsstrahlung merged SPECT imaging than those of whole body planar image of 89Sr bremsstrahlung. In phantom study, counts of each concentration linearly increase as acquisition time and number of rotation increase on planar and SPECT images. CONCLUSIONS: 89Sr bremsstrahlung merged SPECT imaging would be useful for detecting the more detailed whole body 89Sr distribution.

Effects of discontinuation of long-term biperiden use on cognitive function and quality of life in schizophrenia.

BACKGROUND: The high use of long-term antiparkinsonian anticholinergic drugs with antipsychotics has been identified as an important issue in the treatment of schizophrenia in Japan. The aim of this study was to evaluate the effects of gradual discontinuation of biperiden, an anticholinergic drug, on cognitive function and quality of life (QOL) in schizophrenia. METHODS: Thirty-four schizophrenic patients who had received a second-generation antipsychotic (SGA) with concomitant biperiden for at least 3 months were enrolled. Before and 4 weeks after discontinuation of biperiden, the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J) and the Schizophrenia Quality of Life Scale (SQLS-J) were administered. Clinical evaluation also included the Positive and Negative Syndrome Scale (PANSS). To compare the practice effect on BACS-J, 10 chronic patients with schizophrenia were assessed without tapering biperiden. RESULTS: Biperiden was discontinued safely in most patients, and no emergent extrapyramidal symptoms were observed. Significant improvements were shown in attention, processing speed, and composite score, as measured by the BACS-J without practice effect. In addition, the psychosocial condition score on the SQLS-J and the general psychopathology score on the PANSS significantly improved after biperiden discontinuation. CONCLUSION: Discontinuation of long-term biperiden use may be warranted in patients with schizophrenia treated with SGAs, as it may improve cognitive function, subjective QOL, and psychiatric symptoms with no significant adverse effects.

Diagnostic whole-body scanning before radioiodine therapy for pulmonary metastases of differentiated thyroid cancer: predictive value and recommendations.

RATIONALE: Radioiodine therapy improves the survival of patients with pulmonary metastases of differentiated thyroid cancer (DTC). It is controversial whether the diagnostic whole-body I-131 scan (DWS) before therapy is essential. We determined whether DWS could predict the efficacy of I-131 therapy for pulmonary metastases. METHODS: We undertook a retrospective review of records of 42 patients (28 women and 14 men, mean age 52.7 years). The patients had received 62 rounds of I-131 therapy for lung metastases of DTC at our institution between June 2002 and June 2006. On the same day that the DWS (dose of 185 MBq) (5 mCi) was completed, the patient received I-131 therapy (dose of 3700-7400 MBq) (100-200 mCi). Post-therapy whole-body scans (PWS) were performed after 3 to 4 days and 7 to 8 days. For all therapies, chest CT images were obtained before I-131 therapy, and 3 and 6 months after therapy for evaluation of therapeutic effectiveness. In addition, serum thyroglobulin (Tg) values were measured before and after the radioiodine therapy for all treatments. RESULTS: In the group demonstrating I-131 accumulation for pulmonary metastases on DWS, 72% of patients showed a reduction of pulmonary metastases on follow-up CT. On the other hand, in the group that failed to accumulate I-131 on DWS, only 5% of patients showed a reduction of pulmonary metastases. After therapy, serum Tg levels decreased significantly in the group that initially showed accumulation of I-131 in DWS (P = 0.045). In contrast, no remarkable changes between pre- and post-therapy Tg levels were observed in patients who failed to accumulate I-131 in DWS. CONCLUSION: A whole-body I-131 diagnostic scan before I-131 therapy has a predictive value for the efficacy of therapeutic radioiodine treatment for pulmonary metastases of differentiated thyroid cancer.

Comparison of 18F-FDG PET and bone scintigraphy in detection of bone metastases of thyroid cancer.

UNLABELLED: We compared the efficacies of (18)F-FDG PET and (99m)Tc-bone scintigraphy for the detection of bone metastases in patients with differentiated thyroid carcinoma (DTC). METHODS: We examined 47 patients (32 women, 15 men; mean age +/- SD, 57.0 +/- 10.7 y) with DTC who had undergone total thyroidectomy and were hospitalized to be given (131)I therapy. All patients underwent both whole-body (18)F-FDG PET and (99m)Tc-bone scintigraphy. The skeletal system was classified into 11 anatomic segments and assessed for the presence of bone metastases. Bone metastases were verified either when positive findings were obtained on >2 imaging modalities--(201)Tl scintigraphy, (131)I scintigraphy, and CT--or when MRI findings were positive if vertebral MRI was performed. RESULTS: Bone metastases were confirmed in 59 of 517 (11%) segments in 18 (38%) of the 47 study patients. The sensitivities (visualization rate) for bone metastases on a segment basis using (18)F-FDG PET and (99m)Tc-bone scintigraphy were 50 of 59 (84.7%) and 46 of 59 (78.0%), respectively; the difference between these values was not statistically significant. There were only 2 (0.4%) false-positive cases in a total of 451 bone segments without bone metastases when examined by (18)F-FDG PET, whereas 39 (8.6%) were false-positive when examined by (99m)Tc-bone scintigraphy. Therefore, the specificities of (18)F-FDG PET and (99m)Tc-bone scintigraphy were 449 of 451 (99.6%) and 412 of 451 (91.4%), respectively; the difference between these values was statistically significant (P < 0.001). The overall accuracies of (18)F-FDG PET and (99m)Tc-bone scintigraphy were 499 of 510 (97.8%) and 458 of 510 (89.8%), respectively; the difference between these was also statistically significant (P < 0.001). CONCLUSION: The specificity and the overall accuracy of (18)F-FDG PET for the diagnosis of bone metastases in patients with DTC are higher than those of (99m)Tc-bone scintigraphy, whereas the difference in the sensitivities of both modalities is not statistically significant. In comparison with (99m)Tc-bone scintigraphy, (18)F-FDG PET is superior because of its lower incidence of false-positive results in the detection of bone metastases of DTC.

Low efficacy of 18F-FDG PET for detection of uveal malignant melanoma compared with 123I-IMP SPECT.

UNLABELLED: Earlier investigations showed that N-isopropyl-p-123I-iodoamphetamine SPECT (123I-IMP SPECT) is useful for the diagnosis of uveal malignant melanoma, whereas the feasibility and usefulness of 18F-FDG PET in uveal malignant melanoma have not yet been established. We compared the usefulness of 123I-IMP SPECT and 18F-FDG PET for the detection of uveal malignant melanoma on the same subjects. METHODS: Nineteen patients (10 men, 9 women) with suspected uveal malignant melanoma were examined by 123I-IMP SPECT. Thirteen of them were also examined by 18F-FDG PET. 123I-IMP SPECT was performed at 15 min or at 3 and 24 h after intravenous administration of 123I-IMP. RESULTS: In 12 of 19 study patients, 123I-IMP SPECT obtained at 24 h after intravenous administration of 123I-IMP delineated an area of increased uptake in the site corresponding to the ocular tumor. All of the ocular tumors in the 12 123I-IMP SPECT-positive patients were confirmed histopathologically and clinically to be uveal malignant melanoma. The other 7 123I-IMP-SPECT-negative patients have been monitored under the diagnosis of choroidal nevus, choroidal hemangioma, hyperplasia of the pigment epithelium of the retina, or idiopathic inflammatory lesions without any complications. In a total of 13 patients examined by 18F-FDG PET, 9 of whom were 123I-IMP SPECT positive and 4 were negative, only 1 patient showed abnormal uptake of 18F-FDG PET in the site corresponding to the ocular tumor. Therefore, 8 of 9 patients with uveal malignant melanoma showed false-negative results in 18F-FDG PET. The 18F-FDG PET-positive patient with uveal malignant melanoma had the largest tumor mass with a short diameter of 12 mm, a long diameter of 17 mm, and a height of 7 mm. In the other 8 18F-FDG PET-negative patients, the tumors had a dimension of 11 x 13 x 7 mm or less. CONCLUSION: 123I-IMP SPECT is a sensitive and accurate method for the detection of uveal malignant melanoma, whereas the efficacy of 18F-FDG PET for this purpose is low because of a high incidence of false-negative results. 123I-IMP SPECT is far more superior in comparison with 18F-FDG PET in detecting uveal malignant melanoma.

Solitary pulmonary nodules: optimal slice thickness of high-resolution CT in differentiating malignant from benign.

The purpose of this study was to determine an optimal slice thickness that was efficient in differentiating malignant from benign solitary pulmonary nodules (SPNs) on high-resolution computed tomography (HRCT) images. For a total of 92 SPNs, four radiologist indicated their confidence level for the malignant or benign SPN on the CT images presented in 1-, 3-, and 5-mm slice thickness. HRCT could be used to differentiate more accurately the malignant nodules from the benign ones using 1-mm-thick sections than 3- or 5-mm-thick sections.

Prognostic value of positron emission tomography in cryptogenic West syndrome.

The relationship between positron emission tomography (PET) findings and developmental or seizure outcome was examined in 17 infants (11 males, six females; mean age at onset of spasms 7 months, range 3 to 26 months) with newly diagnosed cryptogenic West syndrome. The predictive value of PET in these infants was assessed. PET was performed in the infants at the onset of spasms and 3 months after initial therapy using 18F-labelled 2-deoxy-2-fluoro-D-glucose. A third PET was performed at 18 months of age if the second scan was abnormal. All infants were followed up until at least 3 years of age. Cortical hypometabolism was detected in 11 infants on the first PET and in five infants on the second. Rate of developmental delay at the last follow-up was significantly higher in infants with hypometabolism on the second PET than in those without PET abnormalities (p<0.05). Rate of seizure occurrence after initial treatment was higher in infants with cortical hypometabolism on the second PET, but the difference was not statistically significant. Results suggest that when PET after the initial treatment shows no abnormalities, even though the first PET shows hypometabolism, infants with cryptogenic West syndrome may have a favourable developmental or seizure outcome. PET may be a useful tool in evaluating the prognosis in infants with cryptogenic West syndrome.

Changes of neural activity correlate with the severity of cortical ischemia in patients with unilateral major cerebral artery occlusion.

BACKGROUND AND PURPOSE: In major cerebral arterial steno-occlusive diseases, there can be remarkably decreased hemodynamic reserve without marked neurological impairments. In such settings, it is not known whether the neural activity is well maintained or disturbed according to the severity of cerebral ischemia. The present study was therefore undertaken to examine the neural activity under mild cerebral ischemia resulting from major cerebral arterial occlusion. METHODS: Seven patients with minor neurological impairment as well as either unilateral internal carotid artery or middle cerebral artery occlusion were studied. The severity of the cortical ischemia was assessed by measuring regional cerebral blood flow (rCBF) with positron emission tomography. The change in neural activity in the ischemic brain was then evaluated by means of somatosensory evoked magnetic field with magnetoencephalography. RESULTS: The rCBF in the primary sensory area and the strength of the initial component of somatosensory evoked magnetic field (N20 m) were significantly reduced (P<0.01) and the second component (P30 m) was significantly augmented (P<0.05) in the lesioned cerebral hemisphere as compared with the nonlesioned hemisphere. The asymmetry indexes for N20 m were positively correlated (r=0.78) and those for P30 m were inversely correlated (r=-0.92) with asymmetry indexes for rCBF. CONCLUSIONS: In patients with either unilateral internal carotid artery or middle cerebral artery occlusion and minor neural impairments, there was a reduction of afferent signal and an augmentation of the secondary response of the neurons in the primary sensory area. This showed correlation with the severity of cortical ischemia.