Joint EANM/SNMMI guideline on radiomics in nuclear medicine : Jointly supported by the EANM Physics Committee and the SNMMI Physics, Instrumentation and Data Sciences Council.

PURPOSE: The purpose of this guideline is to provide comprehensive information on best practices for robust radiomics analyses for both hand-crafted and deep learning-based approaches. METHODS: In a cooperative effort between the EANM and SNMMI, we agreed upon current best practices and recommendations for relevant aspects of radiomics analyses, including study design, quality assurance, data collection, impact of acquisition and reconstruction, detection and segmentation, feature standardization and implementation, as well as appropriate modelling schemes, model evaluation, and interpretation. We also offer an outlook for future perspectives. CONCLUSION: Radiomics is a very quickly evolving field of research. The present guideline focused on established findings as well as recommendations based on the state of the art. Though this guideline recognizes both hand-crafted and deep learning-based radiomics approaches, it primarily focuses on the former as this field is more mature. This guideline will be updated once more studies and results have contributed to improved consensus regarding the application of deep learning methods for radiomics. Although methodological recommendations in the present document are valid for most medical image modalities, we focus here on nuclear medicine, and specific recommendations when necessary are made for PET/CT, PET/MR, and quantitative SPECT.

Glucose-level dependent brain hypometabolism in type 2 diabetes mellitus and obesity.

BACKGROUND: Metabolic syndrome and its individual components lead to wide-ranging consequences, many of which affect the central nervous system. In this study, we compared the [18F]FDG regional brain metabolic pattern of participants with type 2 diabetes mellitus (T2DM) and non-DM obese individuals. METHODS: In our prospective study, 51 patients with controlled T2DM (ages 50.6 ± 8.0 years) and 45 non-DM obese participants (ages 52.0 ± 9.6 years) were enrolled. Glucose levels measured before PET/CT examination (pre-PET glucose) as well as laboratory parameters assessing glucose and lipid status were determined. NeuroQ application (NeuroQTM 3.6, Syntermed, Philips) was used to evaluate regional brain metabolic differences. [18F]FDG PET/CT (AnyScan PC, Mediso) scans, estimating brain metabolism, were transformed to MNI152 brain map after T1 registration and used for SPM-based group comparison of brain metabolism corrected for pre-PET glucose, and correlation analysis with laboratory parameters. RESULTS: NeuroQ analysis did not reveal significant regional metabolic defects in either group. Voxel-based group comparison revealed significantly (PFWE<0.05) decreased metabolism in the region of the precuneus and in the right superior frontal gyrus (rSFG) in the diabetic group as compared to the obese patients. Data analysis corrected for pre-PET glucose level showed a hypometabolic difference only in the rSFG in T2DM. Voxel-based correlation analysis showed significant negative correlation of the metabolism in the following brain regions with pre-PET glucose in diabetes: precuneus, left posterior orbital gyrus, right calcarine cortex and right orbital part of inferior frontal gyrus; whilst in the obese group only the right rolandic (pericentral) operculum proved to be sensitive to pre-PET glucose level. CONCLUSIONS: To our knowledge, this is the first study to perform pre-PET glucose level corrected comparative analysis of brain metabolism in T2DM and obesity. We also examined the pre-PET glucose level dependency of regional cerebral metabolism in the two groups separately. Large-scale future studies are warranted to perform further correlation analysis with the aim of determining the effects of metabolic disturbances on brain metabolism.

Performance evaluation of a novel multi-pinhole collimator for dopamine transporter SPECT.

There is a tradeoff between spatial resolution and count sensitivity in SPECT with conventional collimators. Multi-pinhole (MPH) collimator technology has potential for concurrent improvement of resolution and sensitivity in clinical SPECT of 'small' organs. This study evaluated a novel MPH collimator specifically designed for dopamine transporter (DAT) SPECT with a triple-head SPECT camera. Count sensitivity was measured with a 99mTc point source placed on the lattice points of a 1 cm grid covering the whole field-of-view (FOV). Spatial resolution was assessed with a Derenzo type hot rod phantom. An anthropomorphic striatum phantom was scanned with total activity representative of a typical patient scan and different striatum-to-background activity concentration ratios. Recovery of striatum-to-background contrast was assessed by the contrast-recovery-coefficient. Measurements were repeated with double-head SPECT with fan-beam or low-energy-high-resolution-high-sensitivity (LEHRHS) collimators. A patient referred to DAT SPECT because of suspicion of Parkinson's disease was scanned with both LEHRHS and MPH collimators after a single tracer injection. The axial MPH sensitivity profile was approximately symmetrical around its peak, although it was shifted 7 cm towards the patient to simplify positioning. Peak sensitivity of the triple-head MPH system in the center of the FOV was 620 cps MBq-1 compared to 225 cps MBq-1 for the double-head fan-beam system. Sensitivity of the MPH system decreased towards the edges of the FOV. The full width of the sensitivity profile at 200 cps MBq-1 was 21 cm transaxially and 11 cm axially. In MPH SPECT of the Derenzo phantom all rods with ≥ 5 mm diameter were clearly visible. MPH SPECT improved striatal contrast recovery by ≥ 20% compared to fan-beam SPECT. The patient scan demonstrated good image quality of MPH SPECT with almost PET-like delineation of putamen and caudate nucleus. SPECT with dedicated MPH collimators provides considerable improvement of the resolution-sensitivity tradeoff in DAT SPECT compared to SPECT with fan-beam or LEHRHS collimators.

A plaster containing DHEP and heparin for mild to moderate contusions and sprains with haematoma: a double-blind randomized study.

OBJECTIVE: This prospective, randomized, double-blind, three-arm study was performed to investigate the efficacy of a medicated plaster containing the combination of diclofenac epolamine (DHEP) 180 mg and heparin 5600 IU in the treatment of unilateral blunt soft tissue injuries involving the upper or lower limb, complicated by severe local haematoma. RESEARCH DESIGN AND METHODS: Patients with mild-to-moderate injuries complicated by local haematoma (< or =140 cm(2)) were included and randomly treated once daily with plasters containing DHEP/heparin, DHEP only, or placebo. Plasters were applied for at least 12 hours daily for 10 consecutive days. MAIN OUTCOME MEASURES: The time to complete haematoma dissolution was the primary efficacy endpoint; secondary endpoints were spontaneous pain reduction, pain on movement, muscle swelling and use of rescue analgesia. RESULTS: A total of 185 patients (90 males and 95 females, aged 18-80 years) were evaluated for efficacy. Baseline clinical and demographic characteristics were similar across the treatment groups. The time to complete haematoma dissolution was significantly shorter with the DHEP/heparin plaster compared with both the DHEP and placebo plasters (p < 0.05). Patients in the DHEP/heparin group had a 60% probability of achieving complete haematoma dissolution within the 10-day treatment period compared with patients receiving either DHEP or placebo plasters. Patient-rated reductions in pain on movement were significantly (p < 0.05) greater in the two active treatment groups compared with placebo. Overall, the DHEP/heparin, DHEP and placebo plasters were well-tolerated. While a reliance on patient self-reporting had the potential to limit the usefulness of some data obtained in this study, the investigators accounted for this accordingly. CONCLUSIONS: The plaster formulation combining DHEP and heparin relieves pain and induces faster dissolution of superficial haematomas, and may therefore contribute to a more rapid and complete recovery.

Analgesic efficacy of a lecithin-vehiculated diclofenac epolamine gel in shoulder periarthritis and lateral epicondylitis: a placebo-controlled, multicenter, randomized, double-blind clinical trial.

Diclofenac epolamine (2-hydroxyethyl-pyrrolidine) (DHEP) is a diclofenac salt endowed with enhanced cutaneous permeation. To optimize its absorption after topical application, a lecithin-enriched DHEP 1.3% gel has been developed (DHEP lecithin gel) and investigated in patients with shoulder periarthritis and lateral epicondylitis in a placebo-controlled, multicenter double-blind clinical trial. One hundred fifty-eight patients were randomized to a 10-day treatment with DHEP lecithin gel or placebo (5 g t.i.d. applied on the painful area). The efficacy criteria were pain measured by visual analog scale (VAS) while performing a specific standardized movement, intake of rescue medication (paracetamol), and the disabilities of the arm, shoulder and hand (DASH) questionnaire. VAS scores indicated a consistently higher analgesic activity of DHEP lecithin gel. At day 3, pain was reduced by -20.1 +/- 20.2 and -9.9 +/- 12.7 mm in the DHEP lecithin gel- and placebo-treated patients, respectively (p < 0.001); at day 6 of treatment, DHEP lecithin gel induced a pain reduction of -33.2 +/- 26.1 mm, while the reduction achieved with placebo was only -21.2 +/- 18.8 mm (p < 0.001). The mean changes in DASH questionnaire indicated that DHEP lecithin gel was more effective than placebo in improving patient well-being and reducing difficulties in performing the activities most severely impaired by rheumatism, while no difference was observed between the two treatments in consumption of rescue medication. In conclusion, these results indicate that DHEP lecithin gel is a topically effective analgesic product in patients with shoulder periarthritis or lateral epicondylitis and provide further evidence on the use of topical nonsteroidal anti-inflammatory drugs as an optimal approach to the treatment of localized musculoskeletal disorders.

[Mesenteric B-cell immunoblastoma successfully treated after a long-term preoperative observation]. / Mezenteriális B sejtes immunoblastoma hosszú ideig követett és sikerrel kezelt esete.

Diagnostics of abdominal tumours is radically changing. The number of diagnostic laparotomies has decreased, while the role of interventional radiological investigations and diagnostic laparoscopies are increasing. We present a case of a patient who had a mesenteric tumour of unknown origin. He refused any kind of interventional radiological investigation or surgery for 17 mounts. The radiological size and character of the tumour have changed, and clinical symptoms developed during the observation period. After the patient consented to surgery a tumour of a size of 15 x 11 x 9 cm-s was radically excised from the mesentery. The result of histology was B cell type immunoblast lymphoma. Neither pre- nor postoperative investigations verified other manifestations of the lymphoma. Radical chemotherapy was started and 20 month after the operation he is symptom and tumour free. It is our opinion that beside chemotherapy, radical surgery has great importance in successful treatment of solid lymphomas.

[The role of knowledge about breast-feeding and infant nutrition in selecting the method of feeding]. / A szoptatással és a csecsemótáplálással kapcsolatos elózetes ismeretek szerepe a csecsemó táplálási módjának megválasztásában.

Attitudes and believes towards primipara breast-feeding in the 2nd and 3rd trimesters were examined with a questionnaire survey in 91 cases. The questionnaire included 60 true and false statements about breast-feeding which were placed on a 5-grade Likert scale by the respondents based on to what extent they agreed with the particular statement. Significant differences could be detected in the evaluation of statements between women who stopped breast-feeding before the 6th month and those who did not, according to the appraisal of the next items: 1. If a baby is breast-fed too long it will find it difficult later to detach from its mother and will be less independent. 2. The same kind of relationship can be created with the baby during feeding it from a feeding bottle as during breast-feeding. 3. The baby has to be prevented from falling asleep during breast-feeding and has to be made active again with gentle pinches. 4. If the baby falls asleep during breast-feeding, it will suckle poorly. 5. The baby can be easily made give up crying at night, if it does not get used to being taken into its mother's arms. 6. The father is excluded from the intimate relationship formed during breast-feeding. The correction of these false beliefs can extend the time of breast-feeding.

[Surgical management of reflux disease--laparoscopy: renaissance of fundoplication?]. / A reflux-betegség sebészeti kezelése--laparoszkópia: a fundoplicatio reneszánsza?

The importance of the surgical treatment of the gastroesophageal reflux disease have been increased in recent years. After the medical treatment has spread, the minimally invasive procedures were developed. Testing these procedures clinically and applying them on several numbers of patients, the surgical solution has become conspicuous again and the good results proved reason for the existence of the surgical methods that are effective, safe, cost-effective and load to limited complications. The goal of this article is to sum up the advance of the antireflux-surgery, to give a summary about the tendencies of surgical therapies and representating the new results on this topic.

[The importance of gender in the gynecologist-patient relationship]. / A nem jelentösége nögyógyász és betege kapcsolatában.

One of the focal interest of medical psychology is the quality of doctor-patient relationship. The sex of physician and patient have an important impact on their interaction. From this point of view, the contact of gynaecologist and client has a proper character. The authors review the references of this topic. They list the differences between male and female physicians, they also list the factors which determine the patient's choice of one or an other gynaecologist, finally authors deal with the motivations to become a gynaecologist. Both the male and female gynaecologist apply psychological egodefence mechanisms to elaborate sexual-erotic impulses. The adequate relationship needs a convergent, complementer interaction between doctor and patient. According to observations, patients are more satisfied by the female gynaecologists. Obstetricians have to give up the traditional and rigid view of gender and doctor's role. Balint-groups could help to develop and maintain more adequate doctor-patient relationship.

[A case of unusual complication of diaphragmatic herniation of transverse colon following transhiatal esophagectomy]. / Colon transversum mellkasi herniatiójának esete transhiatalis oesophagectomia ritka szövödményeként.

The authors report a rare complication observed after transhiatal esophagus extirpation performed for esophageal cancer. In this case the transverse colon herniated into the pleural cavity through the esophageal hiatus. Herniation completed on the 6.th. postoperative day and caused mechanical ileus. In the first few postoperative days, radiology pointed to a basal pulmonal infiltrate, later it resembled relaxation of the diaphragm, which was rather misleading. Recognition of the real situation was possible only on the 6.th.postoperative day. The patient was reoperated and the pathological state could be reversed. The esophageal hiatus was reconstructed. In the opinion of the authors the complication may have developed partly due to the opening of the left pleural cavity in the course of extrathoracal esophagectomy, and partly to the fact that the spleen was removed during operation. The outcome after reoperation was uneventful. The authors consider this as a rather rare and instructive case.

Prevalence of eating disorders and minor psychiatric morbidity in central Europe before the political changes in 1989: a cross-cultural study.

The prevalence of culture-bound syndromes such as eating disorders in the countries of Central and Eastern Europe is unclear and comparative epidemiological studies are lacking. Before the political changes in 1989 we therefore investigated eating disorders, eating attitudes and psychological health in two Eastern European countries and in one Western democracy. A total of 1225 female and male medical students in Hungary, the German Democratic Republic (GDR) and Austria were surveyed. The instruments included the Eating Disorder Inventory and the GHQ. The prevalence of eating disorders was calculated on the basis of simulated DSM-III-R diagnosis. In females, bulimia nervosa prevalence rates of 0.6% (95% CI 0.02, 3.46), 1% (0.2, 2.95) and 0% (0, 2.07) were calculated for Austria, Hungary and the GDR, respectively. For subclinical bulimia nervosa, the rate for Hungary (3.8%; 1.95, 6.72) was twice as high as for Austria (1.9%; 0.39, 5.5) and the GDR (1.7%; 0.36, 4.88). Hungarian subjects indicated more psychiatric 'caseness' than their GDR or Austrian counterparts. We conclude that eating disorders represented at least as common a problem in Eastern as Western Europe before the changes in political organization. This may be due to an identification process with Western values. A further increase of eating disorders in these countries induced by the recent changes may be possible.

[Grief related to perinatal loss]. / Perinatális gyászreakció.

Findings of the retrospective questionnaire survey with 45 mothers who experienced perinatal loss show fairly higher residual anxiety scores 1-2 years after the death than it can be experienced in the case of normal population. The results suggest that the Hungarian clinical practice hardly helps the mothers' requested grief work. More than the half of women satisfied with the support from the medical staff, but 17 mothers did not get any kind of advice with respect of the next pregnancy. Nineteen women saw her died baby, while this opportunity was not offered for the others. The risks from the strengthened self-accusation of the mothers and from the "replacement child" syndrome are argued as well.

[Epidemiologic data on eating disorders in Hungary: recent results]. / A táplálkozási magatartás zavarainak hazai epidemiológiai adatai: újabb eredmények.

The authors carried out a two-stage survey (screening and interview phase) among 538 medical students (248 males, 290 females) relating to eating attitudes and eating disorders. In the screening phase detection of eating disorders based upon body weight data, the Anorexia Nervosa Inventory for Self-rating, the Eating Disorder Inventory, and the Eating Behaviour Severity Scale. The screening did not revealed anorectic subjects, while subclinical anorexia nervosa could be found in 0.4% of males, and in 0.3% of females. The prevalence of bulimia nervosa was 0% in males, 0.3% in females, that of subclinical bulimia nervosa was 1.2% in males, 3.8% in females. Interview was performed with 38 high risk subjects, corroborating screening data. The results correspond well to former Hungarian data, and reach the morbidity of Western industrialized countries.

[Psychosomatic aspects of sterility and assisted reproduction]. / A meddöség és az asszisztált reprodukció pszichoszomatikája.

The authors survey the literature of psychosomatic aspects of infertility, in-vitro-fertilization and embryo transfer. They emphasize the most important thesises of psychosocial and psychodynamical approaches. The changing of sexual and marital relationship of infertile couples are analysed as well. They call readers' attention to some critical points of doctor-patient and psychotherapeutical relationship.

[The role of gastroesophageal reflux in the hemorrhaging of esophageal varices. Effect of endoscopic sclerotherapy]. / A gastrooesophagealis reflux szerepe a nyelöcsövarix-vérzésben. Az endoscopos scleroterápia refluxcsökkentö hatása.

From January 1st to December 31st 1987, 51 prospectively selected patients underwent 24-hour intraesophageal pH monitoring before, and 5 weeks after endoscopic paravariceal sclerotherapy (ESCL). Patients were divided into two groups: in group I. first pH monitoring was done 24 hours after acute variceal bleeding; in group II. one month after a previous bleeding episode. Gastroesophageal reflux (GER) was expressed by percentage of time below pH 4, and by average number of reflux episodes, lasting longer than 5 seconds, per hour. In group I. the time below pH 4 (10.3 +/- 2.05%) and the number of reflux episodes (24.4 +/- 4.2/h) were significantly higher, than those in group II. (2.57 +/- 0.14%; 2.39 +/- 0.31/h). Pathologic GER parameters were significantly more frequent in group I. (50% and 73%), than in group II. (16.7% and 29.1%). ESCL significantly reduced GER in both groups of patients. In group I. GER remained pathologic at 12.5% and 20.8% of patients. In group II. time below pH 4 became normal at all of the patients, and only one of them has pathologic number of reflux episodes. Our data give evidence of GER having a possible causative role in initiating variceal bleeding. ESCL significantly reduces GER. This effect might contribute to long term results of ESCL.

[Anxiety and the presence of the father at childbirth]. / Az együttszülés és a szorongás.

The authors give a report of a follow-up the anxiety of 363 couples whereby the husband decided to be present at the childbirth and took part in the childbirth preparation courses. The anxiety state and anxiety trait in men was found to be significantly lower than in women. The data of women were compared to a matched control group consisting of 135 pregnant women. In cases where the husband was present at childbirth the anxiety state and anxiety trait of the women was considerably lower than in the control group. The degree of anxiety was found independent of age, educational level, occupation but depended of parity. During the childbirth preparation the anxiety state of the husbands reduced considerably, whereas in the women the trend of increasing anxiety state could be prevented. In the group where the husband was present at childbirth the authors did not find any close relationship between the degree of anxiety and the examined obstetrical parameters (gestational age at labour, outcome and duration of labour, and the birth-weight.

Study of metabolism and growth limitation of human leukemia cell lines.

The relationship between proliferation and metabolism of four leukemia cell lines (BALL-1, JOK-1, Jurkat, and MOLT-4) in batch culture was studied. The maximum cell density (1.5-2.3 x 10(6) cells/ml) without change of medium was observed on days 6-8 of cultivation. At the same time, the original concentration of glucose in the medium (10 mmol/l) fell to 3.5-4 mmol/l. While BALL-1 and MOLT-4 cells, on day 4 of cultivation, converted 82% of glucose into lactate, on day 7 this value was 50%, or there was no lactate production (MOLT-4), respectively. On the other hand, the values of the coefficient of glycolysis showed that Jurkat and JOK cells converted also other compounds into lactate. Part of the utilized glutamine was employed by all four cell lines: 1. as a precursor of glutamic acid, and 2. as a source of energy. BALL-1 and JOK-1 cells converted part of arginine into ornithine. At the time when the proliferation of the cells ceased, the level of ammonia reached a toxic concentration of 2.0-3.6 mmol/l. Since these cell lines utilized only a part of carbon and nitrogen sources in the medium, it was suggested that the final cell density was limited by a growth inhibitor (i.e. ammonia) and not by a lack of nutrients.

The study of cytotoxic effect of benfluron.

The efficiency of benfluron (B-F) was measured by determining the inhibition of cell proliferation in HeLa and V/79 cells. B-F induced an acute cytotoxic reaction in dependency on the concentration applied. A biphasic unbalanced growth was an integral part of this reaction. In connection with the decrease in cell proliferation which followed B-F treatment at micromolar concentrations, the protein:cell volume ratios increased while at nanomolar concentrations decreased. These variations must be taken into account when expressing and interpreting the results of cell metabolism. The glucose and amino acid metabolism of treated V/79 cells differed markedly when expressed as a function of cell number or as function of protein content per cell.

Development of an inactivated vaccine against infectious laryngotracheitis (ILT)--serological and protection studies.

The strain of infectious laryngotracheitis (ILT virus utilised for these vaccine-development studies was isolated from an outbreak of the disease in Hungary. Inactivating agents tested included beta-propio-lactone, methyleneimine, ethyleneimine EI and formalin. ILT virus preparations inactivated with EI appeared to be the most antigenic when inoculated into chickens in the absence of adjuvant. For formulation of a trial oil-emulsion ILT vaccine for experimentation, ILT virus inactivated with 1200 mug/ml of EI was mixed with an equal volume of 50% incomplete Freund's adjuvant and then homogenised. Experimental vaccination of chickens with inactivated ILT vaccine elicited satisfactory serological response and protection to challenge both under laboratory and field conditions. Although only minor increases in antibody titres could be achieved by repeated vaccination with inactivated ILT vaccine at 2 to 5 weeks after primary vaccination at 10-weeks-old with attenuated or inactivated ILT vaccines, the protection conferred by vaccination with a single dose of the trial inactivated ILT vaccine appeared to be effective for at least 12 months. Hence, there would appear to be potential for inactivated-ILT vaccines in control of ILT, especially on sites that are regularly affected by this infection.