Nadja Hamscho

Transplantation of progenitor cells after reperfused acute myocardial infarction: evaluation of perfusion and myocardial viability with FDG-PET and thallium SPECT

Clinical outcome after myocardial infarction depends on the extent of irreversibly damaged myocardium. Implantation of bone marrow-/circulating blood-derived progenitor cells has been shown to improve contractile cardiac function after myocardial infarction in both experimental and initial clinical studies. In the present study, first observations of the effect of local intracoronary progenitor cell infusion on the regeneration of infarcted cardiac tissue after acute myocardial infarction was evaluated by means of 18F-fluorodeoxyglucose positron emission tomography (PET) and 201Tl single-photon emission computed tomography (SPECT). Twenty-six patients underwent intracoronary infusion of bone marrow-derived (BMCs) (15 patients) or circulating blood-derived endothelial progenitor cells (EPCs) (11 patients) 4±2 days after acute myocardial infarction. Based on a left ventricular segmentation model (17 segments), mean signal intensities as a parameter of viability and perfusion in the infarct zone and non-infarct areas were calculated quantitatively by PET and SPECT at baseline and at 4 months of follow-up. Transplantation of progenitor cells was associated with a significant increase in the mean signal intensity (MSI) in the infarct zone from 54.5% (25th and 75th percentiles: 47.7%, 60.0%) to 58.0% (52.7%, 66.7%) on PET (P=0.013) and from 58.0% (49.5%, 63.0%) to 61.5% (52.5%, 70.2%) on SPECT (P=0.005). Global left ventricular ejection fraction (LVEF) increased from 53.5% (42.6%, 60.0%) to 58.0% (53.0%, 65.8%) (P<0.001). In the five patients without an increase in MSI on PET, LVEF changed from 60.0% (50.0%, 64.0%) to 72.0% (64.0%, 75.5%) at follow-up. PET and SPECT did not show any significant changes in MSI in the non-infarct areas [from 73% (68.5%, 76.2%) to 73% (69.7%, 78.0%) for PET and from 72.0% (66.5%, 77.6%) to 73.0% (67.5%, 78.2%) for SPECT]. There were no significant differences in myocardial viability and perfusion between BMC and EPC infusion. These preliminary results show that coronary stenting and transplantation of progenitor cells result in a significant increase in myocardial viability and perfusion. Therapeutic effects can be reliably measured by PET and SPECT.

Uterotubal transport disorder in adenomyosis and endometriosis—a cause for infertility

Objective  Uterine hyperperistalsis and dysperistalsis are common phenomena in endometriosis and may be responsible for reduced fertility in cases of minimal or mild extent of disease. Since a high prevalence of adenomyosis uteri has been well documented in association with endometriosis, we designed a study to examine whether hyperperistalsis and dysperistalsis are caused by the endometriosis itself or by the adenomyotic component of the disease.

Diagnostic Value of FDG-PET and HMPAO-SPET in Patients with Mild Dementia and Mild Cognitive Impairment: Metabolic Index and Perfusion Index

Objective: The diagnostic potential of F-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (PET) and technetium-99m hexamethylpropylene amine oxime single-photon emission tomography (SPET) in early detection and differential diagnosis of early dementia was evaluated including a comparison of metabolic and perfusion indices (PI). Methods: Twenty-four patients with initial clinical suspicion of beginning dementia were examined, 12 of them with mild cognitive impairment. All patients underwent SPET and PET within 2 weeks. Data were compared with the final clinical diagnosis at follow-up – 9 with Alzheimer’s disease (AD), 1 with frontotemporal dementia, 1 with vascular dementia (VD), 7 with mixed type of dementia (MIX) and 6 without any type of dementia. Metabolic indices (MI) and PI were compared with each other. The regional cerebral blood flow difference (rCBFdiff) calculated as local uptake difference between the right and left hemisphere was measured for patients with VD and MIX. Results: PET showed higher sensitivity and specificity in identifying the different types of early dementia (44–91 and 78–89%, respectively) than SPET (11–64 and 79–89%, respectively), especially in detecting AD (sensitivity 44%, specificity 83%) and MIX (sensitivity 71%, specificity 78%). Especially in patients with mild cognitive impairment, PET was the superior imaging modality for predicting dementia. Using PET, dementia could be excluded in all patients who did not develop dementia during the follow-up. In all patients, a weak correlation between PI and MI was observed (rho = 0.64, p < 0.002). The rCBFdiff in patients with VD and MIX ranged from 7 to 37%. Conclusion: In this study on patients with initial suspicion of beginning dementia who underwent both imaging modalities, PET and SPET, PET was the superior imaging method, especially in the detection of early AD or MIX.

Diminished pregnancy rates in endometriosis due to impaired uterotubal transport assessed by hysterosalpingoscintigraphy

Objective  To investigate uterotubal transport by means of hysterosalpingoscintigraphy (HSSG) in women with and without endometriosis.

Uterine contractility and directed sperm transport assessed by hysterosalpingoscintigraphy (HSSG) and intrauterine pressure (IUP) measurement

Background.  Uterine peristalsis sustains sperm transport and can be detected by hysterosalpingoscintigraphy (HSSG). This study is the first to be designed to investigate utero‐tubal transport function by HSSG and uterine contractility by intrauterine pressure measurement (IUP) consecutively on the same day in the periovulatory phase.

Sentinel Node Biopsy as Staging Tool in a Multimodality Treatment Approach to Cancer of the Oral Cavity and the Oropharynx

OBJECTIVES: Feasibility of sentinel lymph node (SLN) biopsy in head and neck cancer as a staging tool embedded in a multimodality regimen including neoadjuvant intraarterial chemotherapy. STUDY DESIGN AND SETTING: 39 patients with oral and anterior oropharyngeal cancer classified N0 by [18F]FDG-PET underwent SLN scintigraphy. Selective SLN biopsy without elective neck dissection (ND) was performed, immediately followed by radical resection of the primary tumor. Histopathology included step-serial sections and immunocyto-chemistry. RESULTS: Lymphoscintigraphy detected 104 spots. In 15 patients there was bilateral drainage. 114 SLN were excised due to additional intraoperative discrimination. 95% of visualised SLN could be removed. Histology was positive in 3 patients (8%), all underwent ND which yielded another positive node in 2 cases. Median observation time was 30 months. Two patients (5%) had a neck relapse in combination with a second primary. CONCLUSIONS: SLN biopsy as only surgical staging tool seems to be feasible. SIGNIFICANCE: Method promises reduction of elective ND and morbidity in N0 patients.

The Influence of CA 125 and CEA Levels on the Results of 18F-Deoxyglucose Positron Emission Tomography in Suspected Recurrence of Epithelial Ovarian Cancer

Background and Purpose:The follow-up of epithelial ovarian cancer (OCA) consists of clinical investigation, sonography, and tumor markers (TMs), especially CA 125. If tumor recurrence is suspected, other imaging modalities including positron emission tomography (PET) with 18F-deoxyglucose (FDG) are often used. While there is still no consensus about the method of choice and the timing of its application, this study aims to find a TM threshold at which a PET would be appropriate.Material and Methods:A total of 90 PET studies and the associated CA 125 values (normal value < 35 U/ml) were available in 71 patients during the follow-up after primary therapy for OCA. In 48 studies a CEA value (normal value < 3 ng/ml) was also available. The results of PET imaging were related to the level of TM increase.Results:In 23/90 studies the PET scan was normal. These patients had a median CA 125 of 13.3 U/ml (range 4.2–168 U/ml). In 67/90 studies the PET indicated a potential recurrence of OCA and the median CA 125 was 166.7 U/ml (range 13.3–4,060 U/ml). The TM levels were significantly different (p < 0.001, U-test). With one exception, there were no normal PET scans above CA 125 levels of 30 U/ml; between 20 and 30 U/ml PET was positive in 4/7 studies.Conclusion:In suspected recurrence of OCA, if imaging modalities are to be used, an FDG PET may be considered. Since the costs of this investigation are high, it should be restricted to clinical situations where it is likely to be most effective. In this study a PET indication is worthwhile at CA 125 levels of approximately 30 U/ml.Hintergrund und Ziel:Patientinnen mit epithelialen Ovarialkarzinomen (OCA) werden durch regelmäßige Bestimmungen der Tumormarker CA 125 und CEA verlaufskontrolliert. Bei Rezidivverdacht hat sich hier die 18F-Desoxyglucose-Positronenemissionstomographie (FDG-PET) als eine sensitive und auch spezifische Methode etabliert. In dieser Studie soll untersucht werden, ob sich der Einsatz der PET in Abhängigkeit von der Höhe des CA-125-Spiegels an einem Schwellenwert orientieren kann.Material und Methodik:Es wurden insgesamt 90 PET-Studien von 71 Patientinnen in die Untersuchung eingeschlossen, bei denen der aktuelle CA-125-Wert (Normalwert < 35 U/ml) vorlag. Bei 48 Studien stand zusätzlich der CEA-Wert (Normalwert < 3 ng/ml) zur Verfügung.Ergebnisse:In 23/90 Untersuchungen lag in der PET ein unauffälliger Befund vor. Diese Patientinnen wiesen einen medianen CA- 125-Spiegel von 13,3 U/ml auf (Spannweite 4,2–168 U/ml). In 67/90 Studien konnte in der PET ein tumorsuspekter Befund dargestellt werden. Der mediane CA-125-Spiegel lag hier bei 166,7 U/ml (Spannweite 13,3–4 060 U/ml). Beide Gruppen unterschieden sich hinsichtlich der Tumormarkerspiegel signifikant (p < 0,001, U-Test). Mit einer Ausnahme wurden dabei oberhalb eines CA-125-Spiegels von 30 U/ml keine normalen PET-Befunde mehr erhoben. Im Bereich zwischen 20 und 30 U/ml lieferte die PET in vier von sieben Fällen den Nachweis einer rezidivsuspekten Lokalisation.Schlussfolgerung:Im Fall eines Tumormarkeranstiegs in der Verlaufskontrolle des OCA sollten die Möglichkeiten der FDG-PET frühzeitig berücksichtigt werden. Die PET liefert dabei offenbar in Abhängigkeit von der Höhe des CA-125-Spiegels auf die Tumorlokalisation hinweisende Befunde, wobei die PET überwiegend bereits bei Werten zwischen 20 und 30 U/ml positive Befunde erbringt und ab einem Schwellenwert von 30 U/l nahezu bei jeder Patientin einen Rezidivhinweis darstellen kann.

Positron Emission Tomography in Patients with Hodgkin's Disease: Correlation to Histopathologic Subtypes

The aim of this study was to evaluate the initial staging and restaging of Hodgkins disease (HD) according to histopathologic subtype (HST) using fluorine-18-deoxyglucose-positron emission tomography (PET). Special attention was paid to the accuracy of PET for detection of bone marrow infiltration (BMI). 44 patients with HD (m:f = 28:16, mean age 36 +/- 15 years) underwent PET; 16 were primary stagings and 28 restaging examinations. PET results were compared with methods of conventional staging including computed tomography (CT) and bone marrow biopsy. Viable tumor tissue was detected by PET in 25/44 cases, 16 nodular sclerosis (NS), 4 mixed cellularity (MC), 3 lymphocyte predominance (LP) and 2 cases with a nonclassified subtype (NC). FDG tumor uptake, measured as standard uptake value (SUV), ranged from 1.7 to 13. Maximum SUV in NS was 5.2 +/- 1.5 (2.5-7.3), 3.2 +/- 2.4 for MC, 2.6 +/- 0.7 for LP, and 9.1 +/- 3.8 for NC, respectively. In 7% of all patients (3/44) bone marrow infiltrations were detected by PET. PET is known for its superior detection of viable tissue in HD. In this study it was shown that HST does not influence the intensity of glucose metabolism, although 2 patients with NC showed the highest SUVs. In addition PET accurately detected focal BMI and may thus be applied before BMB to guide its optimal use.

Enchondroma: a benign osseous lesion with high F-18 FDG uptake.

A woman was referred for fluorodeoxyglucose positron emission tomography for the staging of a malignant melanoma. Although no signs of metastatic melanoma were evident on the whole-body scan, focally increased uptake within the femoral metaphysis was noted. Radiographic and magnetic resonance examinations revealed an enchondroma as the cause of the increased uptake. Histopathologic verification was obtained. The final diagnosis was actively proliferating enchondroma. A grade I chondrosarcoma could be ruled out. Enchondromas may be responsible for focally increased FDG uptake in bone lesions and must be considered when positron emission tomographic scans obtained with FDG are evaluated in cancer staging.