Atsushi Iio

Availability of tumor-antigen 4 as a marker of squamous cell carcinoma of the lung and other organs

The serum level of tumor‐antigen 4 (TA‐4) was measured in 401 patients with squamous cell carcinoma (SCC) of various organs (76 lung, 82 esophagus, and 234 head and neck). The mean serum level of TA‐4 in patients with lung SCC was 3.6 times higher than that in healthy controls and even higher in the advanced stages of disease (III, IV). In patients with benign diseases or other types of lung cancer, however, the TA‐4 serum level was not different from the controls regardless of the clinical stage. During radiation therapy, the TA‐4 levels in patients with lung SCC decreased with reduction in tumor size. It increased again markedly during recurrence. Similarly, patients with SCC of the esophagus and head and neck also showed elevated TA‐4 levels but only at advanced stages and in recurrence. It was concluded that TA‐4 is highly related to SCC not only of the uterine cervix but also of other organs and that serum level determinations are useful for monitoring therapeutic effects and recurrence of these diseases, despite some limitations.

A comparative study of attenuation correction algorithms in single photon emission computed tomography (SPECT)

A computer based simulation method was developed to assess the relative effectiveness and availability of various attenuation compensation algorithms in single photon emission computed tomography (SPECT). The effect of the nonuniformity of attenuation coefficient distribution in the body, the errors in determining a body contour and the statistical noise on reconstruction accuracy and the computation time in using the algorithms were studied. The algorithms were classified into three groups: precorrection, post correction and iterative correction methods. Furthermore, a hybrid method was devised by combining several methods. This study will be useful for understanding the characteristics, limitations and strengths of the algorithms and searching for a practical correction method for photon attenuation in SPECT.

Simulation and experimental study of respiratory motion effect on image quality of single photon emission computed tomography (SPECT)

The effect of respiratory motion on the image quality of single photon emission computed tomography (SPECT) was investigated by computer simulation and experimentation. In the computer simulation, the phantom was assumed to be cylindrical with a uniform background and a spherical cold or hot spot. To simulate respiratory motion, a cyclic linear motion parallel to the axis of rotation of a gamma camere was assumed. The contrast in the transaxial images was calculated for various respiratory amplitudes and its dependence on lesion size and object contrast was investigated. In the experiments, a moving phantom was used to simulate respiratory motion. The simulation and the experimenal results were in good agreement within the range of statistical error. The effect on the lesion detectability was investigated using receiver operating characteristics (ROC) analysis, and a method for correcting respiratory motion was devised.

Diffuse gallium-67 uptake in radiation pneumonitis

To evaluate the clinical usefulness of Ga-67 imaging for the assessment of radiation pneumonitis, 12 patients who had developed radiation pneumonitis after receiving radiotherapy alone for non-small-cell lung cancer from 1979 through 1988 were reviewed. Diffuse bilateral Ga-67 uptake occurred in 5 out of the 12 cases; in the other 7 cases, Ga-67 uptake was confined to the irradiation lung. Conversely, chest radiography showed infiltrates only in the irradiated lung. Histopathology of the lung in four out of the five cases that showed diffuse Ga-67 uptake in the lung, however, revealed that the lung outside the radiation field with Ga-67 uptake was consistent with interstitial pneumonitis induced by radiation. These results suggest that radiation pneumonitis could extend beyond the irradiated lung and that Ga-67 imaging is more useful than chest radiography for the assessment of the spatial extent of radiography pneumonitis.

Validity of microsphere model in cerebral blood flow measurement using N-isopropyl-p-(I-123) iodoamphetamine

A microsphere model is sometimes used when calculating cerebral blood flow (CBF) using N-isopropyl-p-[I-123]iodoamphetamine (IMP), and is based on the assumption that there is essentially no washout of IMP. The validity of a microsphere model was investigated by comparison with the values of CBF obtained by means of a model which takes into consideration the diffusion of IMP from brain tissue to blood (nonmicrosphere model). When calculating CBF by the latter model, the look-up table method was used with expression of the double integral in the model equation by the recursion relations, a method which is useful for obtaining pixel-by-pixel values. The average rate constants for diffusion from brain to blood of gray and white matter were 0.021 and 0.0016 min-1, respectively. The values of CBF obtained by applying a microsphere model to the data acquired from 0 to 3.2 min after IMP injection were overestimated by approximately 23% compared with those values obtained using a nonmicrosphere model. This is considered to be due to the effect of the IMP activity in the vascular space. Values obtained using the data acquired from 3.2 to 6.4 min were underestimated by approximately 15%. When the values of CBF obtained by a microsphere model were interpolated, they became nearly equal to those obtained using a nonmicrosphere model at about 4 to 5 min after injection. This is suggested to be the reason why the underestimation due to diffusion from brain to blood is cancelled out by the overestimation due to the IMP in the vascular space. Our preliminary results suggest that it is necessary to take the diffusion of IMP from brain tissue to blood into account for the quantification of CBF using IMP.

ECG-gated thallium-201 myocardial SPECT in patients with old myocardial infarction compared with ECG-gated blood pool SPECT

We evaluated one of the merits of ECG-gated thallium-201 single photon emission computed tomography (g-T1 SPECT), i.e., the ability to appreciate left ventricular (LV) wall motion. LV wall motion assessed by g-Tl SPECT and by ECG-gated Blood Pool SPECT (g-BP SPECT) was classified into three grades and compared segment by segment. T1-201 uptake by g-Tl SPECT was also classified into three grades and compared with those of wall motion in g-BP SPECT.Fifty patients with prior myocardial infarction were injected intravenously at rest with 111 to 185 MBq (3 to 5 mCi) of Tl-201. The left ventricular regions were divided into anterior, septal, inferior and lateral segments (50 patients × 4 segments=200 segments in total). The grades of wall motion and Tl-201 uptake detected by g-Tl SPECT correlated well with those of wall motion in g-BP SPECT (94.5% and 85%, respectively).With g-Tl SPECT it was possible to evaluate left ventricular wall motion, providing clear perfusion images.

Single photon emission computed tomography (SPELT) using N-isopropyl-p-(123I)iodoamphetamine (IMP) in the evaluation of patients with epileptic seizures

To evaluate the clinical usefulness of IMP SPECT in the diagnosis of epilepsy, 6 normals and 52 patients in the interictal phase were studied. Thirty min after an intravenous injection of 111 MBq IMP, SPECT was performed using a rotating gamma camera. Of 21 patients with simple partial seizures, a localized decrease of uptake was shown in 16, and an increase in 3. Topologically, these findings corresponded well to the ictal symptoms. Nine of 13 patients with localized epileptic EEG had a good correspondence between the findings on EEG and IMP SPELT. In 20 of 23 with complex partial seizures, the coronal images showed laterality of uptake in the temporal lobes, whereas the CT was normal in 14. However, these findings on IMP SPECT agreed with the EEG in the temporal leads in only 5 cases. Of 8 patients with primary generalized seizures, a diffuse cerebral decrease was shown in 3 of 4 patients with convulsive seizures (grand mal), and a normal uptake in 3 of 4 patients with non-convulsive seizures (petit mal). However, 2 patients showed a localized decrease, therefore, we determined that they suffered from partial seizures evolving to secondarily generalization. From these data, we concluded that IMP SPELT could be a useful method in the diagnosis of epilepsy.

SPECT volume measurement using an automatic threshold selection method combined with a V filter

The volume measurement of various organs by single photon emission computed tomography (SPECT) has generally been performed by summing up the voxels lying within the outer edge of the organ determined by thresholding as a function of the maximum reconstructed counts within a volume of interest. The optimum threshold level, however, is influenced by various factors. To eliminate this problem, Mortelmans et al. (1986) proposed to use an automatic threshold selection method (ATSM) based on discriminant criteria and to correct the errors induced by the imperfect system response using the method based on linear regression analysis, which has some problems in practical application. We tried to use ATSM combined with a V filter. The correlation coefficient (r) and the regression equation between the true (x) and the calculated volume (y) obtained by experimentation using 22 phantoms with a volume ranging between 26 ml and 380 ml were as follows: r=0.994 and y(ml)=1.015x+1.09 using ATSM combined with a V filter, while r=0.993 and y(ml)=1.110x+30.55 using only ATSM. The relative error between the true and the calculated volumes decreased significantly (P<0.01) from 37.7%±26.9% to 5.5%±4.2%. The results suggest that ATSM combined with a V filter is useful for correcting the errors caused by an imperfect system response, and is available and reliable for SPECT volume determination even when the organ volume is small.

A unified computer program for assessment of attenuation correction and data acquisition methods in single photon emission computed tomography (SPECT).

A computer based simulation program was developed to assess the usefulness of various attenuation correction algorithms and data acquisition methods in single photon emission computed tomography (SPECT) in a unified approach. The program analytically calculated projection ray sums from a mathematical model with various distributions of activities and either uniform or non uniform attenuation coefficients by using the line integrals including the effect of attenuation. Data acquisition starting at arbitrary angles, various acquisition angles, including a 180° scan and a non circular orbit of a gamma camera, including an elliptical orbit can readily be taken into consideration in our simulation program. To simulate non circular orbit data acquisition, the resolution dependence on the object distance from the collimator surface was incorporated into the simulation. This computer based simulation program allows various combinations of attenuation correction algorithms such as hybrid methods, and data acquisition methods can be evaluated under a large number of study conditions. The usefulness of this computer based simulation program is shown with several representative examples.

Assessment of hepatic excretory function in chronic liver disease by hepatobiliary scintigraphy

Hepatobiliary scintigraphy was performed in 23 normal subjects and 47 patients with chronic liver disease (chronic hepatitis; n=27, liver cirrhosis; n=20) to evaluate its availability as a test of liver function. After intravenous administration of Tc-99m N-pyriodxyl-5-methyl-tryptophan, the data were acquired for 60 min and the time-activity curves of ROIs (the heart and liver) were generated. In two compartment model simulation, the early blood clearance rate (kl), late blood clearance rate (km), hepatic uptake rate (ku), hepatic excretion rate (ke), and hepatic excretion T 1/2 were calculated. There was no significant difference in those fourk values in normal and chronic hepatitis. However, in liver cirrhosis each of them, exceptkm, was lower than in normal subjects. Thekl value correlated closely with the indocyanine green plasma clearance test, whereas theke and T 1/2 values were closely correlated with the level of serum bilirubins. Only hepatobiliary scintigraphy showed the excretory function of the liver quantitatively and theke value was helpful in detecting hepatic excretory dysfunction early in chronic liver disease before serum bilirubins increased.