DOCSLIB.ORG

Renewed Application of an Old Method Improves Detection of Coronary Ischemia: a Higher Standard of Care

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Renewed Application of an Old Method Improves Detection of Coronary Ischemia: a Higher Standard of Care Renewed Application of an Old Method Improves Detection of Coronary Ischemia: A Higher Standard of Care Richard M. Fleming, MD, Gordon M. Harrington, PhD, Riaz Baqir, MD, Scott Jay, MD, Sridevi Challapalli, MD, Kayla Avery, CNMT, and Jim Green, CNMT The diagnostic utility of traditional nuclear cardiac imaging is enhanced by using modern technology to compare absolute regional radioactive counts at two points in time during stress/stress testing. uclear cardiac imaging began solute radioactive counts—although cardial perfusion measurements fol- in 1927 with the first in a se- the computer software to accomplish lowing a single injection of sestamibi ries of studies by Blumgart this is available. The extra step of to determine ischemia. We compared Nand Yens, which found that quantifying absolute counts allows the results of coronary angiogra- measuring the rate and magnitude of the clinician to better interpret disease phy—used to determine the extent of nuclide transfer from right arm to left by seeing information the computer coronary lumen disease—with (1) arm could diagnose the presence or uses to assign various shades of grey myocardial perfusion imaging (MPI) absence of heart disease.1 This work or color to the image. findings using a redistribution equa- was not only the first nuclear study When applied to multiple images tion we developed (the Fleming- of the heart, but the first description under the same state (namely, five- Harrington equation) to quantify of quantification of disease by using a minutes and 60-minutes poststress), absolute radioactive counts, and (2) Geiger counter. The radioactive tracer quantifiable absolute counts can then results of rest/stress imaging. thallium-201 was introduced in 1975, be compared using today’s single pho- followed by contemporary tracers, ton emission computed tomography BACKGROUND such as technetium-99m sestamibi. (SPECT) cameras. Using these cam- In 1959, Gorlin demonstrated that Many studies have shown that eras, the clinician can look for the resting images were not diagnosti- knowledge of sestamibi redistribu- actual change in isotope concentra- cally useful for ischemia and should tion, as revealed by sequential stress tion that results from various levels of not be used for this purpose.8 Fur- imaging, improves detection of heart ischemia—caused by differences in a ther discussions by Love questioned disease.2–6 While these studies quanti- coronary artery’s ability to vasodilate whether nuclear imaging would fied sestamibi differences in heart to to meet coronary blood flow demands ever be clinically useful due to the lung ratios, they did not quantify ab- and coronary artery blockage (Figure absence of clinically useable iso- 1)7. This clinical information is diag- topes.9 Although the introduction of Dr. Fleming, Dr. Jay, and Ms. Avery are all cardi- nostically important and allows the thallium-201 partially allayed those ologists at the Cardiovascular Institute of South- primary care physician to determine fears, the tracer was plagued with a ern Missouri, Poplar Bluffs, MO. Dr. Harrington is a professor in the department of psychology at whether medical management or an long half-life of 72 hours. None- the University of Northern Iowa, Cedar Falls, IA. invasive cardiac procedure is the next theless, thallium-201 was clinically Dr. Baqir is a cardiologist in the division of cardi- best step in caring for the patient. useable for detecting ischemia by ology at the VA Central Iowa Health Care System (VACIHCS), Des Moines, IA. Dr. Challapalli and To demonstrate the advantages of qualitatively evaluating two post- Mr. Green are both cardiologists at the Sierra Ne- obtaining absolute radioactive counts stress images (at one and four hours). vada Cardiology Associates (SNCA), Reno, NV. In in sequential stress imaging, we de- The unfortunate use of the terms addition, Dr. Fleming is a cardiologist at the SNCA 10 and was a cardiologist in the division of cardiol- signed a study to assess the clinical “stress” and “rest,” however, re- ogy at the VACIHCS. diagnostic utility of time-course myo- sulted in a misunderstanding of the 22 • FEDERAL PRACTITIONER • JUNE 2010 established principles laid out by Blumgart and Yens—that compari- sons should be made under same- state conditions, either stress or rest. Maublant and Crane demonstrated that use of sestamibi had a washout of 28 minutes and that this washout Joe Gorman © 2010. increases under ischemic conditions because of mitochondrial calcium overload; the clinical importance of this finding had been underrecog- nized previously.11,12 Nuclear MPI using SPECT for the detection of ischemia is accomplished by comparing two images of the heart obtained at two points in time. While Blumgart emphasized comparisons under same-state conditions, clini- cians since have emphasized rest/ stress comparisons. The resting image more correctly can be used to determine if myocardial injury has occurred previously, but cannot be utilized to determine if ischemia is present.1,8 Nonetheless, most diagnosticians today compare the rest to stress im- ages and conclude that when the images have identical findings (matching defects) no ischemia is present. However, injury/infarction noted on the resting image in the ab- sence of ischemia (stress image) is in- consistent with the disease process as we know it, and matching defects hours but not after two hours.14,15 ter with today’s SPECT camera to clearly cannot mean that a region of The presence or absence of washin compare radioactive counts, both infarction has no ischemia; rather, it was attributed to cell viability and quantitatively and qualitatively, merely means that the infarction is thus, differentiated ischemia with in- has increased the diagnostic accu- the result of ischemia. In other words, farcted tissue (matched defects) from racy of detecting congestive heart one cannot have myocardial infarc- ischemia with viable tissue (non- failure, cardiomyopathy, coronary tion in the absence of an underlying matched defects). Most clinicians vasospasm, and, as our initial stud- ischemic insult to the region. There- treat contemporary tracers, such as ies established, the relationship fore, matching rest/stress images de- sestamibi, as though they do not un- between “inflammation” and coro- fine ischemia present at the site of dergo redistribution (washin or wash- nary artery disease.2–5,17–25 In recent injury/infarction and not a simplistic out), despite ample evidence to the work, we have better defined the re- absence of ischemia.13 contrary, including a recent investiga- lationship between sestamibi redis- Much controversy followed the tion by Fallahi and Beiki.2–6,10,12,16 tribution and the extent of actual institution of sequential stress imag- Recent research utilizing knowl- coronary artery disease seen in the ing, which found instances of redis- edge of sestamibi redistribution and angiography suite—yielding substan- tribution with thallium-201 after four replacing Blumgart’s Geiger coun- tially increased diagnostic accuracy in JUNE 2010 • FEDERAL PRACTITIONER • 23 DETECTION OF CORONARy IsChEmIA the stress component of the study where they underwent either exercise (treadmill) or pharmacologic stress. Following standard protocols already described in the medical and scien- tific literature, we injected intrave- nously a bolus of sestamibi (28 to 32 mCi, 1036 to 1184 MBq) followed by a bolus of normal saline to ensure adequate delivery of the radioactive isotope into the venous system. Five minutes following delivery of sesta- mibi, a SPECT camera was used to obtain a five-minute image (anterior slice, single-head camera) or images (anterior and lateral slices, multiple- Coronary (stenosis) flow reserve Coronary head camera). Fifty-five minutes later (60-minutes poststress), participants returned to the lab for final images. Cummulative percent narrowing (blue = %DS, red = %ASa) DAtA COlleCtION AND Figure 1.7 Relationship between stenosis flow reserve and percent diameter stenosis ANAlySIS (%DS), demonstrating that as arteries become more critically narrowed they are less able to vasodilate upon demand, requiring a longer time to achieve isotope equilibrium. Image comparisons and a%AS = percent area stenosis. redistribution calculations We evaluated rest/stress images using visual, qualitative slice-to-slice com- the detection and evaluation of coro- Patients arrived at the nuclear lab- parisons. For the redistribution cal- nary ischemia.26,27 The study we pres- oratory in a fasting state according culation, we drew regions of interest ent here is a follow-up to our most to each institution’s approved proto- (ROIs) using the five-minute post- recent work measuring sestamibi cols for MPI. Specific institutional re- stress images to quantify radioactive redistribution and comparing the view board (IRB) requirements were counts, including total heart and findings with results from coronary reviewed. Patients underwent addi- lung, basal and mid anterior, basal angiography and rest/stress images.28 tional imaging, but they did not re- and mid anterolateral, basal and mid ceive further injections of radioactive inferior-posterior, and basal and mid StUDy DeSIGN AND materials nor were they placed under inferoseptal regions (Figure 3). We PARticipantS additional exercise or pharmacologic avoided the issue of cardiac creep (a We studied 120 men and women “stress”; thus, the additional acqui- form of gradual internal heart mo- (aged 25 to 82 years) suspected of sition of redistribution
Load more

Recommended publications
  • Managing Terrorism Or Accidental Nuclear Errors, Preparing for Iodine-131 Emergencies: a Comprehensive Review
    Int. J. Environ. Res. Public Health 2014, 11, 4158-4200; doi:10.3390/ijerph110404158 OPEN ACCESS International Journal of Environmental Research and Public Health ISSN 1660-4601 www.mdpi.com/journal/ijerph Review Managing Terrorism or Accidental Nuclear Errors, Preparing for Iodine-131 Emergencies: A Comprehensive Review Eric R. Braverman 1,2,3, Kenneth Blum 1,2,*, Bernard Loeffke 2, Robert Baker 4, 5, Florian Kreuk 2, Samantha Peiling Yang 6 and James R. Hurley 7 1 Department of Psychiatry, College of Medicine, University of Florida and McKnight Brain Institute, Gainesville, FL 32610, USA; E-Mail: [email protected] 2 Department of Clinical Neurology, PATH Foundation NY, New York, NY 10010, USA; E-Mails: [email protected] (B.L.); [email protected] (F.K.) 3 Department of Neurosurgery, Weill-Cornell Medical College, New York, NY 10065, USA 4 Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA; E-Mail: [email protected] 5 Natural Science Research Laboratory, Museum of Texas Tech University, Lubbock, TX 79409, USA 6 Department of Endocrinology, National University Hospital of Singapore, Singapore 119228; E-Mail: [email protected] 7 Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA; E-Mail: [email protected] * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +1-646-367-7411 (ext. 123); Fax: +1-212-213-6188. Received: 5 February 2014; in revised form: 26 March 2014 / Accepted: 28 March 2014 / Published: 15 April 2014 Abstract: Chernobyl demonstrated that iodine-131 (131I) released in a nuclear accident can cause malignant thyroid nodules to develop in children within a 300 mile radius of the incident.
    [Show full text]
  • Use of Radioactive Iodine As a Tracer in Water-Flooding Operations
    . USE of RADIOACTIVE IODINE as a TRACER In WATER-FLOODING OPERATIONS Downloaded from http://onepetro.org/jpt/article-pdf/6/09/117/2237549/spe-349-g.pdf by guest on 27 September 2021 J. WADE WATKINS BUREAU OF MINES MEMBER AIME BARTLESVILLE, OKLA. E. S. MARDOCK WELL SURVEYS, INC. MEMBER AIME TULSA, OKLA. T. P. 3894 ABSTRACT assumed that the physical conditions in the productive formation are homogeneous. Unfortunately, homogen­ The accurate evaluation of reservoir-performance eous conditions rarely, if ever, exist in oil-productive characteristics in the secondary recovery of petroleum formations. The use of a tracer that may be injected by water flooding requires use of a water tracer that into an oil sand and detected quantitatively, or even may be injected into water-input wells and detected at qualitatively, at offsetting oil-production wells provides oil-production wells to supplement data obtained fronz basic data that may be used in determining more core analyses, wellhead tests, and subsurface measure­ accurately the subsurface rates and patterns of flow ments. Radioactive iodine has been used successfully of injected water between wells than is possible by as a water tracer in field tests to determine: (1) rela­ theoretical calculations based on assumed conditions. tive rates and patterns of flow of injected water between Consideration of the data obtained by using a water water-input and oil-production wells and (2) zones of tracer assists in the application of remedial measures excessive water entry into oil-production wells. to water-input wells, such as plugging of channels, or Laboratory evaluations of potential water tracers, selective plugging of highly permeable zones, thereby previous tracer studies, the value of using a radioactive effecting a more uniform flood and a greater ultimate tracer, general field procedures, and the use of surface oil recovery.
    [Show full text]
  • Procedure Guideline for Tumor Imaging with 18F-FDG PET/CT 1.0*
    Procedure Guideline for Tumor Imaging with 18F-FDG PET/CT 1.0* Dominique Delbeke1, R. Edward Coleman2, Milton J. Guiberteau3, Manuel L. Brown4, Henry D. Royal5, Barry A. Siegel5, David W. Townsend6, Lincoln L. Berland7, J. Anthony Parker8, Karl Hubner9, Michael G. Stabin10, George Zubal11, Marc Kachelriess12, Valerie Cronin13, and Scott Holbrook14 1Vanderbilt University Medical Center, Nashville, Tennessee; 2Duke University Medical Center, Durham, North Carolina; 3Christus St. Joseph Hospital, Houston, Texas; 4Henry Ford Hospital, Detroit, Michigan; 5Mallinckrodt Institute of Radiology, St. Louis, Missouri; 6University of Tennessee, Knoxville, Tennessee; 7University of Alabama Hospital, Birmingham, Alabama; 8Beth Israel Deaconess Hospital, Boston, Massachusetts; 9University of Tennessee Medical Center, Knoxville, Tennessee; 10Vanderbilt University, Nashville, Tennessee; 11Yale University, New Haven, Connecticut; 12Institute of Medical Physics, University of Erlangen-Nurnberg, Erlangen, Germany; 13Mercy Hospital, Buffalo, New York; and 14Precision Nuclear, Gray, Tennessee I. PURPOSE available for several years, the readily apparent and doc- umented advantages of having PET and CT in a single device The purpose of these guidelines is to assist physicians in have resulted in the rapid dissemination of this technology recommending, performing, interpreting, and reporting the in the United States. This Procedure Guideline pertains results of 18F-FDG PET/CT for oncologic imaging of adult only to combined PET/CT devices. and pediatric patients. II. BACKGROUND INFORMATION AND DEFINITIONS Definitions PET is a tomographic scintigraphic technique in which a A. A PET/CT scanner is an integrated device containing computer-generated image of local radioactive tracer dis- both a CT scanner and a PET scanner with a single tribution in tissues is produced through the detection of patient table and therefore capable of obtaining a CT annihilation photons that are emitted when radionuclides scan, a PET scan, or both.
    [Show full text]
  • Radionuclides As Tracers
    XA9847600 Chapter 3 RADIONUCLBDES AS TRACERS R.D. Ganatra Nuclear Medicine is usually defined as a "clinical speciality devoted to diagnostic, therapeutic and research applications of internally administered radionuclides.". Diagnostic implies both in vivo and in vitro uses. In modern times, there is hardly any medical research, where a radioactive tracer is not used in some form or other. Normally basic medical research is not considered as nuclear medicine, but clinical research applications of radioisotopes are considered as an integral part of this speciality. Radioisotopes are elements having the same atomic number but different atomic weights. For example, I3II, I25I, 123I are all isotopes of the same element. Their chemical and biological behaviours are expected to be identical. The slight differences in the weights, that they have, is due to differences in the number of particles that they hold inside the nucleus. Some isotopes are perturbed by this kind of change in the nuclear structure. They become unstable, and emit radiation till they reach stable state. These are called radioisotopes. Radioisotopes have few immutable characteristics: they are unstable, they all disintegrate at a specific rate, and they all emit radiations, which have a specific energy pattern. Importance of radioisotopes in medicine is because of their two characteristics: their biological behaviour is identical to their stable counterparts, and because they are radioactive their emissions can be detected by a suitable instrument. All isotopes of iodine will behave in the same way and will concentrate in the thyroid gland. There is no way of detecting the stable, natural iodine in the thyroid gland, but the presence of radioactive iodine can be detected externally in vivo by a detector.
    [Show full text]
  • THE USE of TECHNETIUM 99M AS a CLINICAL TRACER ELEMENT R
    Postgrad Med J: first published as 10.1136/pgmj.41.481.656 on 1 November 1965. Downloaded from POSTGRAD. MED. J. (1965), 41, 656. THE USE OF TECHNETIUM 99m AS A CLINICAL TRACER ELEMENT R. HERBERT, B.Sc., A.Inst.P. W. KULKE, M.B., B.Ch., D.M.R.T., M.Rad. R. T. H. SHEPHERD, B.M., B.Ch., D.M.R.T., F.F.R. The Liverpool Radium Institute, Liverpool, 7. THE VARIETY of radioactive tracer chemicals Production and Physical Properties currently available for medical use is almost Tc99m is most conveniently produced carrier embarrassingly large and is still increasing. free as a pertechnetate (TcO4) in isotonic saline The value of any proposed new isotopes should from a Mo99 generator which has a half-life of therefore be carefully considered. No apology 67 hours. These generators in which the Mo99 however, need be made for the introduction of is incorporated in an alumina column, are Technetium 99m by Scheer and Maier-Borst regularly available from the Radiochemical (1963) also by Harper, Beck, Charleston and Centre, Amersham, England and other suppliers. Lathrop (1964), since this substance has manv Tc99m decays to Tc99 by isomeric transition advantages in its application to scanning and with a half-life of 6.0 hours emitting a 0.140 in the observation of transients. (Clark, Deegan, MeV gamma ray which is 8-11% converted. McKendrick, Herbert and Kulke, 1965). (Strominger, Hollander and Seaborg, 1958). It has been evident for some time that many Tc99 itself decays by beta emission to stable radioisotopes in common use in medicine are Ru99, and has a half-life of 2.1 x 105 years so not best suited for scanning purposes.
    [Show full text]
  • Physiological Assessment of Coronary Lesions
    CHAPTER 5 Physiological Assessment of Coronary Lesions Akl C. Fahed, MD, MPH1 and Sammy Elmariah, MD, MPH1 1Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine Introduction The treatment of symptomatic coronary artery disease (CAD) depends on the hemodynamic impairment of flow, a physiologic parameter that is not captured with coronary angiography alone. The miniaturization of sensor-guidewires capable of crossing coronary stenoses provided a rationale for physiological assessment of coronary lesions to guide coronary revascularization. Multiple clinical trials have demonstrated the superiority of using invasive physiologic assessment to guide decision-making in intermediate vessel stenosis over angiography alone. 1,2 Current guidelines give a class IA recommendation for use invasive physiological assessment to guide revascularization of angiographically intermediate lesions in patients with stable angina. 3,4 Coronary physiology measurement has therefore become routine practice in every cardiac catherization lab with expanding techniques and indications. This chapter will cover the basic physiologic principles of coronary blood flow, technical aspects of coronary physiology measurements, and the expanding clinical data supporting the use of coronary physiology measurement in every day practice. Understanding Coronary Blood Flow Myocardial blood flow provides oxygen supply in an effort to meet the myocardial oxygen demand (MVO2) and prevent ischemia or infarction. The main determinants of myocardial oxygen demand and supply are highlighted in Table 1. In a healthy coronary and capillary circuit, blood flows from the aorta though an epicardial conduit, then precapillary arterioles and the microvascular capillary bed in a highly regulated process (Figure 1). The resistance (pressure/flow) across the circuit is the sum of the resistances within the circuit: the epicardial coronaries (R epicardial), the precapillary arterioles (R arteriolar), and the microvascular capillary bed (R capillary).
    [Show full text]
  • Thermal Properties of 18F-FDG Uptake and Imaging in Positron Emission Tomography Scans of Cancerous Cells
    PANDION: The Osprey Journal of Research & Ideas Volume 2 Number 1 Article 4 2021 Thermal Properties of 18F-FDG Uptake and Imaging in Positron Emission Tomography Scans of Cancerous Cells Carleigh R. Eagle University of North Florida, [email protected] Faculty Mentor: Dr. Jason T. Haraldsen, Associate Professor Department of Physics Follow this and additional works at: https://digitalcommons.unf.edu/pandion_unf Part of the Biochemical Phenomena, Metabolism, and Nutrition Commons, Biological and Chemical Physics Commons, Biomedical Devices and Instrumentation Commons, Medical Biochemistry Commons, Medical Biophysics Commons, Medicinal-Pharmaceutical Chemistry Commons, and the Other Physics Commons Recommended Citation Eagle, Carleigh R. (2021) "Thermal Properties of 18F-FDG Uptake and Imaging in Positron Emission Tomography Scans of Cancerous Cells," PANDION: The Osprey Journal of Research and Ideas: Vol. 2 : No. 1 , Article 4. Available at: https://digitalcommons.unf.edu/pandion_unf/vol2/iss1/4 This Article is brought to you for free and open access by the Student Scholarship at UNF Digital Commons. It has been accepted for inclusion in PANDION: The Osprey Journal of Research & Ideas by an authorized administrator of UNF Digital Commons. For more information, please contact Digital Projects. © 2021 All Rights Reserved Thermal Properties of 18F-FDG Uptake and Imaging in Positron Emission Tomography Scans of Cancerous Cells Cover Page Footnote I would like to thank Dr. Jason T. Haraldsen for all of his help and guidance. Without his support, I would not have the pleasure of publishing in this journal. This article is available in PANDION: The Osprey Journal of Research & Ideas: https://digitalcommons.unf.edu/pandion_unf/vol2/iss1/4 Thermal Properties of 18F-FDG Uptake and Imaging in Positron Emission Tomography Scans of Cancerous Cells Carleigh Rose Eagle Faculty Mentor: Jason T.
    [Show full text]
  • ST-Elevation Myocardial Infarction Due to Acute Thrombosis in an Adolescent with COVID-19
    Prepublication Release ST-Elevation Myocardial Infarction Due to Acute Thrombosis in an Adolescent With COVID-19 Jessica Persson, MD, Michael Shorofsky, MD, Ryan Leahy, MD, MS, Richard Friesen, MD, Amber Khanna, MD, MS, Lyndsey Cole, MD, John S. Kim, MD, MS DOI: 10.1542/peds.2020-049793 Journal: Pediatrics Article Type: Case Report Citation: Persson J, Shorofsky M, Leahy R, et al. ST-elevation myocardial infarction due to acute thrombosis in an adolescent with COVID-19. Pediatrics. 2021; doi: 10.1542/peds.2020- 049793 This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version. Downloaded from©202 www.aappublications.org/news1 American Academy by of guest Pediatrics on September 27, 2021 Prepublication Release ST-Elevation Myocardial Infarction Due to Acute Thrombosis in an Adolescent With COVID-19 Jessica Persson, MD1, Michael Shorofsky, MD1, Ryan Leahy, MD, MS1, Richard Friesen, MD1, Amber Khanna, MD, MS1,2, Lyndsey Cole, MD3, John S. Kim, MD, MS1 1Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado 2Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado 3Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado Corresponding Author: John S.
    [Show full text]
  • 18F-FDG Labeling of Mesenchymal Stem Cells and Multipotent Adult Progenitor Cells for PET Imaging: Effects on Ultrastructure and Differentiation Capacity
    Journal of Nuclear Medicine, published on January 25, 2013 as doi:10.2967/jnumed.112.108316 18F-FDG Labeling of Mesenchymal Stem Cells and Multipotent Adult Progenitor Cells for PET Imaging: Effects on Ultrastructure and Differentiation Capacity Esther Wolfs1, Tom Struys2,3, Tineke Notelaers4, Scott J. Roberts5, Abhishek Sohni4, Guy Bormans6, Koen Van Laere1, Frank P. Luyten5, Olivier Gheysens1, Ivo Lambrichts2, Catherine M. Verfaillie4, and Christophe M. Deroose1 1Division of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; 2Lab of Histology, Department of Functional Morphology, Biomedical Research Institute, Universiteit Hasselt, Diepenbeek, Belgium; 3Biomedical NMR Unit, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; 4Stem Cell Institute, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; 5Laboratory for Skeletal Development and Joint Disorders, KU Leuven, Leuven, Belgium; and 6Laboratory for Radiopharmacy, KU Leuven, Leuven, Belgium influenced by 18F-FDG labeling. Small-animal PET studies con- Because of their extended differentiation capacity, stem cells firmed the intracellular location of the tracer and the possibility have gained great interest in the field of regenerative medicine. of imaging injected prelabeled stem cell types in vivo. There- For the development of therapeutic strategies, more knowledge fore, direct labeling of MSCs and MAPCs with 18F-FDG is a suit- on the in vivo fate of these cells has to be acquired. Therefore, able technique to noninvasively assess cell delivery and early stem cells can be labeled with radioactive tracer molecules retention with PET. such as 18F-FDG, a positron-emitting glucose analog that is Key Words: mesenchymal stem cell; multipotent adult progenitor taken up and metabolically trapped by the cells.
    [Show full text]
  • PRODUCT MONOGRAPH Fluorohmet
    PRODUCT MONOGRAPH FluorOHmet ([18F]Fluorodeoxyglucose, 18F-FDG) Solution for Injection, 45 - 4240 mCi (1.665-156.88 GBq) per multi-dose vial Diagnostic Radiopharmaceutical University of Ottawa Heart Institute Date of Revision: National Cardiac PET Centre January 28, 2011 40 Ruskin Street Ottawa, ON K1Y 4W7 Submission Control No: 136101 [18F]Fluorodeoxyglucose, 18F -FDG Page 1 of 23 Table of Contents PART I: HEALTH PROFESSIONAL INFORMATION .........................................................3 SUMMARY PRODUCT INFORMATION ........................................................................3 DESCRIPTION....................................................................................................................3 INDICATIONS AND CLINICAL USE ..............................................................................4 CONTRAINDICATIONS ...................................................................................................5 WARNINGS AND PRECAUTIONS ..................................................................................5 ADVERSE REACTIONS ....................................................................................................7 DRUG INTERACTIONS ....................................................................................................8 DOSAGE AND ADMINISTRATION ................................................................................8 RADIATION DOSIMETRY .............................................................................................10 OVERDOSAGE ................................................................................................................12
    [Show full text]
  • The Basic Science of Nuclear Medicine
    BASIC SCIENCE tomography (CT) has been combined with the functional mo- The basic science of dalities of single-photon emission computed tomography (SPECT/CT) and positron emission tomography (PET/CT) in e nuclear medicine integrated hybrid scanners.2 4 Overall, this has led to NM being at the vanguard of technological advancement in medical imag- Michael L Waller ing at the present time. Many of these functional techniques have Fahmid U Chowdhury relevance to modern orthopaedic practice, and the orthopaedic surgeon should, therefore, possess some knowledge of the scope and limitations of modern NM modalities as applied to ortho- Abstract paedic surgery. This article will describe the physical principles behind the basic techniques of NM imaging, and will then go on In the era of increasing utilization of cross-sectional imaging in ortho- paedic patients with computed tomography (CT) and magnetic reso- to demonstrate some of the main clinical applications of NM as applied to orthopaedic practice. nance imaging (MRI), nuclear medicine (NM) techniques continue to occupy a valuable role in the investigation of these patients. It can pro- vide crucial functional information in a variety of clinical settings that The physics of nuclear medicine (NM) imaging are encountered regularly in orthopaedic practice. It is important that the orthopaedic surgeon is aware of the modalities on offer and appre- Common isotopes and radiopharmaceuticals ciates the relative strengths and limitations of these techniques. This The ideal radiopharmaceutical should be specific to the pathway article will describe the physical principles underlying NM imaging of interest, possess the requisite half-life, be sterile and pyrogen with single-photon and positron-emitting radiotracers.
    [Show full text]
  • A Radioactive Tracer Dilution Method for Mass Determination in Licl-Kcl Radioactive Eutectic Salts
    A Radioactive Tracer Dilution Method for Mass Determination in LiCl-KCl Radioactive Eutectic Salts THESIS Presented in Partial Fulfillment of the Requirements for the Degree of Masters of Science from the Graduate School of The Ohio State University By Douglas Ernest Hardtmayer, B.Sc. Welding Engineering Graduate Program in Nuclear Engineering The Ohio State University 2018 Thesis Committee: Dr. Lei. Cao, Advisor Dr. Vaibhav Sinha Copyright By Douglas Ernest Hardtmayer 2018 ABSTRACT Radioactive Tracer Dilution (RTD) is a new method where a radioactive tracer isotope is dissolved in a given substance, and the dilution thereof corresponds to the mass and volume of the substance in which the tracer was dissolved. This method is being considered commercially as a means of measuring the mass of Lithium Chloride-Potassium Chloride (LiCl-KCl) eutectic salt in electrorefiners where spent nuclear fuel has been reprocessed. Efforts have been ongoing to find an effective and efficient way of measuring the mass of this salt inside of an electrorefiner for nuclear material accountancy purposes. Various methods, including creating volume calibration curves with water and molten salt, have been tried but have numerous shortcomings, such as needing to recalibrate the fitted volume curve for a specific electrorefiner every time a new piece of equipment is added or removed from the device. Research at The Ohio State University has shown promise using Na22 as a tracer in LiCl-KCl eutectic salt, and that the interference from a common fission product found in an electrorefiners salt, Eu154, could be accounted for, and an accurate mass measurement could be determined.
    [Show full text]