Contrast-enhanced ultrasound monitoring of perfusion changes in hepatic neuroendocrine metastases after systemic versus selective arterial 177Lu/90Y-DOTATOC and 213Bi-DOTATOC radiopeptide therapy.

AIM: Radiopeptide therapy with beta emitter labeled (177)Lu/(90)Y- DOTA(0)-Phe(1)-Tyr(3)-octreotide (DOTATOC) and more recently also alpha emitting (213)Bi-DOTATOC are promising new treatments for neuroendocrine tumors. No early predictors for treatment response have been recognized and tumor-shrinkage after radiation therapy appears slowly. In some solid tumors a decline in tumor perfusion was found predictive of final treatment response but the gold standard multiphase computed tomography (CT) has a high radiation burden. Therefore we evaluated the ability of contrast-enhanced ultrasound (CEUS) to evaluate tumor perfusion as a response criteria. MATERIALS AND METHODS: 14 patients with hepatic neuroendocrine tumor (NET) metastases were enrolled in the retrospective study. Eleven patients were treated with beta-emitting (177)Lu/(90)Y-DOTATOC, either intravenous (i.v.) (n = 5) or intra-arterial (i.a.) (n = 6) and three patients received alpha-emitting (213)Bi-DOTATOC (i.a.). CEUS and contrast-enhanced CT (CE-CT) were performed before and 3 months after treatment. RESULTS: CE-CT and CEUS presented comparable results in the baseline study and in the assessment of perfusion changes due to the different treatment regimes. A therapy related decrease in tumor perfusion is an early predictor of longterm morphologic response. CONCLUSION: CEUS is available and radiation free technique which showed comparable results for perfusion and diameter of liver metastases compared to CE-CT. Intensity reduction in an arterial phase CEUS can be seen as a positive sign indicating long term tumor response to treatment. Therefore CEUS may be considered as an imaging modality for monitoring early treatment after focal alpha and beta targeted therapy.

Comparison of neuroendocrine tumor detection and characterization using DOTATOC-PET in correlation with contrast enhanced CT and delayed contrast enhanced MRI.

PURPOSE: We evaluated the rate of successful characterization of gastroenteropancreatic neuroendocrine tumors (NETs) present with an increased somatostatin receptor, comparing CE-CT with CE-MRI, each in correlation with DOTATOC-PET. METHODS AND MATERIALS: 8 patients with GEP-NET were imaged using CE-MRI (Gd-EOB-DTPA), CE-CT (Imeron 400) and DOTATOC-PET. Contrast-enhancement of normal liver-tissue and metastasis was quantified with ROI-technique. Tumor delineation was assessed with visual-score in blind-read-analysis by two experienced radiologists. RESULTS: Out of 40 liver metastases in patients with NETs, all were detected by CE-MRI and the lesion extent could be adequately assessed, whereas CT failed to detect 20% of all metastases. The blind-read-score of CT in arterial and portal phase was median -0.65 and -1.4, respectively, and 2.7 for delayed-MRI. The quantitative ROI-analysis presented an improved contrast-enhancement-ratio with a median of 1.2, 1.6 and 3.3 for CE-CT arterial, portal-phase and delayed-MRI respectively. CONCLUSION: Late CE-MRI was superior to CE-CT in providing additionally morphologic characterization and exact lesion extension of hepatic metastases from neuroendocrine tumor detected with DOTATOC-PET. Therefore, late enhanced Gd-EOB-DTPA-MRI seems to be the adequate imaging modality for combination with DOTATOC-PET to provide complementary (macroscopic and molecular) tumor characterization in hepatic metastasized NETs.

A mass spectrometry and electron paramagnetic resonance study of photochemical and thermal aging of triterpenoid varnishes.

Photochemical and thermal aging of triterpenoid dammar and mastic resins used as varnishes on paintings were studied using graphite-assisted laser desorption/ionization mass spectrometry. This extends an earlier study on similar materials (Zumbühl et al., Anal. Chem. 1998, 70, 707-715) that focused on photoaging. Progressive aging results in development of groups of signals spaced by 14 and 16 Da, indicating incorporation of oxygen as well as simultaneous loss of hydrogen. Oligomers up to tetramers are formed, while cleavage reactions lead to increased signal intensities in the mass ranges between the oligomers and below the monomers. No major differences were found between the mass spectra of samples aged in light or darkness, except that deterioration was faster in light. Electron paramagnetic resonance spectroscopy revealed similar and significant amounts of radicals in films of dammar stored either in light or in darkness. It is concluded that oxidative radical reactions also take place in darkness and that differences in light and dark aging pathways are minor, although rates may differ. These findings lead to a unified explanation for yellowing of natural resin varnishes, one of the major degenerative changes in the appearance of paintings. It is also shown that the commercially available, nominally fresh resins are already in an advanced stage of oxidation and degradation. Energy-rich substances are formed upon irradiation with sunlight and are believed to restart the autoxidative chain reactions, regardless of storage conditions. As a result, varnishes are oxidized quite quickly (months) even when kept in darkness.

[Reconstruction of the lateral tibial plateau using a vascular pedicled patellar transplant]. / Wiederherstellung des lateralen Tibiaplateaus durch gefässgestieltes Patellatransplantat.

A case of surgical reconstruction in posttraumatic necrosis of the lateral tibial plateau after impression fracture is presented. Joint reconstruction was performed by transposition of the distally pedicled lateral third of the patella combined with a cancellous bone graft. The surgical procedure is described and the indications for it are discussed.