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We previously have developed a non-steady-state method for in vivo measurement of radioligand-receptor binding in brain using positron emission tomography (PET) and 18F-spiperone (18F-SP). This method has proven to be highly sensitive to the detection of decreases in the apparent number of available specific binding sites. The purposes of this investigation are to demonstrate the specificity of this PET assay and compare findings to in vitro binding assays. Three to six studies were performed in each of five male baboons. Each animal was pretreated with either ketanserin [serotonergic (S2)], eticlopride [dopaminergic (D2)], or unlabeled SP to compete with 18F-SP for specific binding sites. Sequential PET scans and arterial-blood samples were collected for 3 hr after intravenous injection of 18F-SP. Data were analyzed with a three-compartment model that considered the accumulation of radiolabeled metabolites in arterial blood. Five baboons were killed, and radioligand-receptor binding in vitro was measured by homogenate techniques. There was no detectable in vitro or in vivo specific binding of SP in cerebellum. The specific binding of SP in striatal tissue in vitro was approximately 74% to D2 sites and 26% to S2 sites, whereas ketanserin displaced all specific binding in frontal cortex. In close agreement, specific binding measured in vivo with PET revealed that 68% of apparent striatal binding could be blocked by pretreatment with eticlopride, and 34% by ketanserin. The small apparent difference between receptor binding in vitro and in vivo may result from the relatively poor resolution of PET.(ABSTRACT TRUNCATED AT 250 WORDS)

We have developed a method to measure task-related regional cerebral blood flow (BF) responses in an awake, trained monkey using positron emission tomography (PET) and H215O. We trained an animal with operant conditioning using only positive reinforcement to climb unassisted into a modified primate chair that was then positioned in the PET scanner. A special headholder and acrylic skull cap permitted precise placement and accurate repositioning. We measured BF qualitatively with bolus injection of H215O and 40-s scan. Each session included scans at rest interposed with scans during vibration of a forepaw. Regional responses were identified using subtraction image analysis. After global normalization, a resting image was subtracted on a pixel-by-pixel basis from a comparable image collected during vibration. The region of peak response occurred in contralateral sensorimotor cortex with a mean magnitude of 11.6% (+/- 3.2%) of the global mean value for 10 separate experiments, significantly greater than the mean qualitative BF change (0.4 +/- 3.6%; p less than 0.00001) in the same region for seven rest-rest pairs. This newly developed technique forms the basis for a wide variety of experiments.

N-omega-[18F]fluoroethylketanserin ([18F]FEK), an 18F-labeled analogue of the serotonin S2 antagonist ketanserin, was evaluated for use with positron emission tomography (PET). PET imaging of a baboon brain following injection of [18F]FEK indicated that the fluorinated ligand rapidly localized in vivo within S2 receptor-rich tissues (frontal cortex/cerebellum radioactivity ratio = 2.5 after 15 min), and selective localization was retained for as long as 3 h post injection. Pretreatment with unlabeled ketanserin (15 mg/kg, i.v.) 1 h prior to [18F]FEK completely abolished selective localization of the radiotracer, whereas regional cerebral blood flow, cerebral blood volume, and the free fraction of [18F]FEK in arterial blood were unaltered. [18F]FEK has several advantages compared to previously used PET radiopharmaceuticals, and may be an excellent radioligand for non-invasive evaluation of S2 binding in vivo.

Generator produced positron-emitting radionuclides could potentially expand the application of positron emission tomography (PET) to centers that do not have access to a local cyclotron. The zinc-62/copper-62 radionuclide generator system could serve as a source of positron-emitting copper-62 (62Cu) (t1/2 = 9.74 min) for physiologic imaging. Accordingly, we have prepared zinc-62/copper-62 generators capable of high output (greater than 300 mCi) and used the no-carrier-added eluate in a rapid high yield synthesis of [62Cu] Cu(PTSM) that provides the radiopharmaceutical in a form suitable for intravenous injection (where Cu(PTSM) = pyruvaldehyde bis(N4-methylthiosemicarbazonato) copper(II]. We then demonstrated in pilot studies that [62Cu]Cu(PTSM) provides high quality brain and heart images with PET, accurately delineating cerebral and myocardial perfusion in both experimental animals and in humans (corroborating results of previous experimental studies utilizing longer-lived copper isotopes). The results of this work demonstrate that 62Cu can be conveniently obtained from high-level generators and, when used to label Cu(PTSM), provides a generator-produced radiopharmaceutical capable of providing estimates of cerebral and myocardial perfusion independent of cyclotron-produced radionuclides.

Regional cerebral blood flow responses to vibrotactile stimulation were studied in 11 patients with predominantly unilateral idiopathic focal dystonia and 18 normal subjects using PET and H2(15)O. Stimulation produced a consistently localized and robust peak response in primary sensorimotor cortex contralateral to hand vibration in normal subjects (averaged hemisphere response 10.97 ml/(100 g.min) +/- 2.53). The sensorimotor response in dystonic patients was also consistently localized to the same area, but significantly reduced in magnitude whether vibrating the affected (8.35 ml/(100 g.min) +/- 2.29) or unaffected hand (8.40 ml/(100 g.min) +/- 2.15). Furthermore, vibration induced a dystonic cramp in the stimulated arm/hand in 6 patients, but not in any normal subjects. To determine whether the cocontraction of agonist and antagonist muscles could, in itself, attenuate the regional blood flow response, 10 normal subjects were studied with vibration during voluntary cocontraction of appropriate hand and forearm muscles, as well as with vibration alone. Vibration with voluntary cocontraction (mean = 12.57 ml/(100 g.min) +/- 2.13) produced a significantly greater response than vibration alone (mean = 10.30 ml/(100 g.min) +/- 2.20, P less than 0.00008). This abnormal sensorimotor response may have important implications for understanding the pathophysiology of idiopathic dystonia.

We present a patient with hemidystonia and an abnormality of the contralateral basal ganglion seen only with positron emission tomography. A 50-year-old sinistral man suffered minor trauma to the right side of his head and neck. Within 20 minutes he developed paroxysmal intermittent dystonic posturing of his right face, forearm, hand, and foot, with weaker contractions of the left foot, lasting several seconds and recurring every few minutes. Neurological findings between spells were normal. The following were also normal: electrolyte, calcium, magnesium, and arterial blood gas levels, and findings of drug screen, cerebrospinal fluid examination, electroencephalography with nasopharyngeal leads, computed tomographic scanning (initially and four weeks later), and cerebral angiography. Positron emission tomographic scanning revealed abnormalities in the left basal ganglion region, including decreased oxygen metabolism, decreased oxygen extraction, increased blood volume, and increased blood flow.

Positron emission tomography (PET) and 15O-labeled radiotracers were used to measure regional CBF, cerebral blood volume (CBV), CMRO2, and oxygen extraction in 32 right-handed subjects at rest. Mean left hemispheric CBF (46.2 +/- 6.8 ml/100 g/min) and CMRO2 (2.60 +/- 0.59 ml/100 g/min) were significantly lower than right hemispheric values (47.4 +/- 7.2 and 2.66 +/- 0.61 ml/100 g/min, respectively; p less than 0.0001 for both), whereas left and right hemispheric CBV and oxygen extraction were not significantly different. We further investigated these asymmetries by comparing left- and right-sided values for specific cortical and subcortical regions. We found that left-sided CBF and CMRO2 were significantly lower than right-sided values for sensorimotor, occipital, and superior temporal regions, whereas only left-sided CBF values were lower for anterior cingulum. CBV was asymmetric for the anterior cingulate and mid-frontal regions, and oxygen extraction was asymmetric for the sensorimotor area. No asymmetries were observed in inferior parietal cortex, thalamus, putamen, or pallidum. Knowledge of these normal physiological asymmetries is essential for proper interpretation of PET studies of physiology and pathology. Furthermore, the ability to detect asymmetries with PET may lead to a better understanding of the lateralization of specific functions in the human brain.

Dopaminergic ligands labeled with positron-emitting radionuclides have been synthesized for quantitative evaluation of dopaminergic binding in vivo. Two different methods, the explicit method and an operationally simplified ratio method, have been proposed for analysis of these positron emission tomographic (PET) data. The basis for both methods is the same three-compartment model. The two methods differ in the assumptions necessary for practical implementation. We have compared these two approaches using PET data obtained in our laboratory. Sequential scans and serial arterial blood samples from a baboon following intravenous injection of [18F]spiroperidol were collected. Application of the two methods to the same data yielded different values for corresponding parameters. Values calculated by the ratio method for the specific rate constant describing receptor binding varied depending upon the time after tracer injection, thus demonstrating an internal inconsistency in this approach. Tracer metabolism markedly affected the binding measurements calculated with either method and thus cannot be ignored. Our results indicate that the adoption of simplifying assumptions for operational convenience can lead to substantial errors and must be done with caution. Alternatively, we present simple new analytical solutions of the tracer conservation equations describing the complete, unsimplified three-compartment model that vastly reduce the computations necessary to implement the explicit method.

We previously developed a non-steady-state technique using positron emission tomography (PET) and the radioligand 18F-spiperone (18F-SP) for the measurement of in vivo radioligand-receptor binding in brain. The purpose of this investigation is to determine the sensitivity of this method to alterations in the apparent number of available specific binding sites. Nine studies were performed on the same baboon. The animal was pretreated with varying doses of unlabeled SP (15-600 micrograms) to compete for specific binding sites. The experimental procedure included measurement of regional cerebral blood flow, cerebral blood volume, and the protein binding of 18F-SP in arterial blood. At least 3.5 hr after pretreatment, no-carrier-added 18F-SP (containing less than 3 micrograms SP) was administered intravenously. Sequential PET scans and measurements of arterial-blood radioactivity due to radioligand and its labeled metabolites continued for 3 hr. A 3-compartment model representing the in vivo behavior of radioligand was used to analyze the data. As expected, we found that an index of binding called the combined forward rate constant (which equals the product of the apparent maximum number of available specific binding sites and the association rate constant of radioligand for receptor) declined with increasing dose of unlabeled SP. Other estimated variables including the dissociation rate constant did not change. This demonstrates that our non-steady-state method for estimating radioligand-receptor binding kinetics can detect a decrease in the apparent number of available specific binding sites. This is an important step in the validation of this in vivo receptor binding assay and its subsequent application.

Positron emission tomography was used to measure global and local blood flow in 11 patients with hemiparkinsonism (before and after an acute oral dose of L-dopa) and in 26 normal subjects. Global hemispheric blood flow was not significantly different between the patients [45 +/- 11 ml/(min X 100 g)] and the controls [49 +/- 8 ml/(min X 100 g)]. After L-dopa, the patients' mean global hemispheric flow did not change. Measurements of local blood flow from specific, anatomically defined cortical and basal ganglia regions were performed using a newly developed stereotactic localization technique. Before L-dopa, mesocortical blood flow contralateral to the patients' symptoms was significantly less than controls (p less than 0.003), suggesting a specific abnormality in the cortical dopaminergic projection from the ventral tegmental area. In addition, right and left pallidal blood flow were significantly less tightly coupled in patients than controls (p = 0.0312). After L-dopa, the mesocortical blood flow remained below normal, whereas pallidal blood flow was no longer significantly different from controls (p greater than 0.05).

We measured in vivo dopaminergic receptor binding using positron emission tomography and 18F-spiperone in an untreated symptomatic subject with MPTP-induced parkinsonism. Our technique determines four variables related to entry of 18F-spiperone into brain tissue and subsequent binding to receptors: (1) the combined forward-rate constant k1' (equal to the product of the maximum number of available specific binding sites, Bmax, times the association rate constant [ka] of 18F-spiperone and receptor); (2) the binding site dissociation rate constant k-1; (3) the free fraction of radioligand not specifically bound in brain tissue, f2; and (4) the regional permeability-surface-area product (PS) of the blood-brain barrier for spiperone. PS and f2 in the patient were not different from that of 10 normal volunteers, whereas the combined forward-rate constant (left caudate: k1' = 67.6 sec-1, normal = 0.140 +/- 0.056) and the dissociation rate constant (left caudate: k-1 = 0.116 sec-1, normal = 0.000339 +/- 0.000149) were evaluated. These findings provide potential new insights not only into the pathophysiology of this disease but into the clinical importance of dopamine receptor function as well.

Given the low spatial resolution of positron emission tomography (PET), regional measurements of neural tissue are often inaccurate because of the presence of non-neural elements and to mixtures of different tissue types within the volume of space influencing the measurements. These effects are significant in scans of brains both with and without atrophy, but are particularly significant when comparing measurements of brains with atrophy with those of normals, as is typically done in studies of aging and dementia. Previous attempts to correct for cerebral atrophy have been limited to global measurements. Using computer simulations, we illustrate the effects of atrophy and describe a method for correcting regional PET data to represent units of actual neural tissue volume.

We investigated swallowing abnormalities in patients with Parkinson's disease, the relationship between these abnormalities and general parkinsonian signs, as well as the response to therapy. Twenty patients and 13 controls were evaluated with clinical rating scales and modified barium swallows before and after oral levodopa (in combination with carbidopa). Fifteen patients, but only 1 control, had abnormal swallows (chi 2 = 11.722, df = 1, p less than 0.001). Abnormalities included disturbances of oral and pharyngeal phases of swallowing. Patients without dysphagia frequently had abnormal swallows, including silent aspiration. Seven patients had improved swallowing after levodopa, whereas 1 worsened. Improvement in general parkinsonian signs was not a reliable indicator of improved swallowing.

Extant methods for anatomical localization within a physiological image are inadequate for precise regional correlations between anatomy and physiology. We have developed a method for determining the location of any region of interest within a positron emission tomographic (PET) image by transformation of the tomographic location coordinates into coordinates within a stereotactic atlas of the human brain. The specific anatomical assumptions of this approach were identified and validated within groups of normal subjects by means of measurements made from lateral skull radiographs and nuclear magnetic resonance proton images. A high degree of accuracy and reproducibility was demonstrated when this technique was applied to groups of normal subjects by determining the anatomical location of two physiologically defined PET areas: the cavernous sinus and visually responsive cortex. This method is simple to implement and highly objective. Generalization of the localization procedure for use with structural tomography is readily accomplished.

A new "mean regional" method for calculating global hemispheric values of blood flow, blood volume, and metabolism with positron emission tomography is presented. It is based on a standardized set of regions defined according to coordinates in a stereotactic atlas of the brain. Region locations in each individual scan were determined by a localization technique that is independent of the appearance of the physiological images. Measurements obtained with this mean regional method minimize contributions from nonbrain structures such as ventricles or venous sinuses and provide the necessary basis for comparisons among different subjects and laboratories.

The ligands currently used for PET studies of the dopamine receptor are fluorine-18-labeled spiperone (FSp) and carbon-11 or fluorine-18-labeled N-methyl-spiperone. All three of these ligands have drawbacks in either their chemical preparation or their biological behavior. We have previously prepared a series of N-fluoroalkyl-spiperone derivatives which are simple to prepare in high radiochemical yield. N-[18F]fluoropropyl-spiperone (3-F-Pr-Sp) and N-[18F]fluoroethyl-spiperone (2-F-Et-Sp) were the most promising ligands. In vitro competitive binding studies showed affinities for the dopamine receptor of 3-F-Pr-Sp greater than FSp greater than 2-F-Et-Sp. Brain extraction studies in a primate model showed that FSp, 2-F-Et-Sp, and 3-F-Pr-Sp were not completely extracted by the brain. High bone uptake and kidney clearance was observed with 3-F-Pr-Sp, while 2-F-Et-Sp cleared through the intestine in rats. This is in contrast to FSp where clearance is through the kidney. Studies to evaluate the extraction of metabolites in the brain were carried out by administering large doses (10 mCi) of FSp, 2-F-Et-Sp and 3-F-Pr-Sp to rats and reinjecting the metabolites in blood into other rats. These experiments showed that less than 0.02% of the metabolites from FSp and 3-F-Pr-Sp entered the brain, while 0.5% of the metabolites from 2-F-Et-Sp entered the brain. The majority of the activity present in the cerebellum after the administration of 2-F-Et-Sp is metabolites; therefore 2-F-Et-Sp is unsuitable for PET imaging studies. PET imaging studies in baboons and in one normal human volunteer with 3-F-Pr-Sp showed a high striatum-to-cerebellum ratio, showing that 3-F-Pr-Sp can replace ligands currently in use to study dopamine receptors.

We have revised our methods for calculating regional blood volume, flow, oxygen extraction, and oxygen utilization from positron emission tomography data obtained using 15O-labeled radiotracers. These revisions include radioactive decay explicitly within the model equations instead of requiring all measured activity to be corrected for decay prior to incorporation in the equations. The revised equations yield small but significant differences in the computed values.