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Unlabelled: Most efficacy studies of cardiac PET in demonstrating myocardial ischemia and viability have been performed using one or more transversal static images of the heart. In contrast, in this paper we describe a method of functional imaging of the complete left ventricular myocardium for perfusion with nitrogen-13-ammonia, both at rest and during a dipyridamol stress test, and of glucose metabolism with 18F-fluorodeoxyglucose (18FDG)., Methods: This was performed by using the data of each of 48 radial segments of 10 short-axis images as tissue data and LV cavity data of three basal planes as blood pool data. The study describes the results of 19 normal volunteers and 36 patients with coronary artery disease. From the data of the normal volunteers a 95% normal confidence interval was calculated for each imaging modality. These intervals were then used to describe the patient data as normal, ischemic or infarcted., Results: The results of analysis of the parametric images was compared with the results of static analysis of the same patient data and found to be less dependant on the detection threshold used., Conclusion: The described method enables the routine application of functional PET imaging of the total myocardium by the semi-automatic construction of parametric flow and metabolism polar maps. It thus provides an increased performance in the diagnosis, quantification and localization of myocardial ischemia and viability over conventional PET imaging.

A survey is given of the principles underlying the diagnosis of brain tumours. Traditionally diagnosis and localization of brain tumours have been based upon morphological criteria. Currently unsurpassed levels in imaging of anatomical details and topographical relations by the techniques of computed tomography (CT) and magnetic resonance imaging (MRI) have been achieved. The techniques of positron emission tomography (PET) and of magnetic resonance spectroscopy (MRS), which depict also metabolic and blood flow aspects, provide a refinement of our knowledge on the metabolism, structure and pathophysiological relations of a tumour to the surrounding parenchyma. Recent advances in the recording of function-related changes of the cerebral electro-magnetic field allow a better definition of critical functional areas.

Proton magnetic resonance spectroscopic imaging (1H-MRSI) and positron emission tomography with the tracer L-[1-11C]tyrosine (11C-TYR) were used to localize gliomas for biopsy or resection. This is especially helpful in cases of low-grade gliomas, if these lesions are not visualized by contrast-enhanced computed tomographic and magnetic resonance imaging scans. The clues to improved localization are provided by changes in tissue metabolite contents, such as elevation of phosphocholine, indicating cellular proliferation; decrease of N-acetylaspartate, denoting loss of neurons (as these are replaced by tumor cells); and elevation of lactate, pointing to the prevalence of glycolysis, as observed in many tumors. These data on tissue metabolite content have been obtained in vivo in the patient by proton magnetic resonance spectroscopy; metabolite maps derived from these data then visualize the distribution of the various metabolites over the section of the brain under investigation. Alternatively, localization of a tumor may be achieved by means of positron emission tomography depicting the pattern of uptake of the amino acid tracer 11C-TYR, as it tends to be incorporated in the process of cellular proliferation and protein biosynthesis. Five cases are presented as examples.

Methods: The treatment of a patient with soft-tissue sarcoma was evaluated with FDG-PET. A limb-saving complete remission of a locally advanced liposarcoma of the left thigh was achieved with isolated regional perfusion of the limb with tumor necrosis factor alpha, interferon gamma and melphalan., Results: PET with 18F-FDG before perfusion showed high glucose consumption in the tumor. After perfusion, glucose metabolism in the tumor was absent. Subsequent excision confirmed complete necrosis of the tumor., Conclusion: FDG-PET may be useful in evaluating the results of isolateral regional limb perfusion for soft-tissue sarcomas.

An overview of the criteria that are currently being used for the selection of liver donors is presented. The validity of the different criteria is discussed. The potential benefits of introducing other modalities is dealt with.

In a clinical setting, the effect of Eurocollins (EC) and University of Wisconsin solution (UW) on liver grafts were studied in the early reperfusion phase of liver transplantation. Blood samples were drawn before and after declamping of the portal vein in a group of 11 transplants with EC-perfused livers, and a group of 12 transplants with UW-perfused livers. Parenchymal damage was assessed by the LDH, AST, and ALT, and purine degradation by measuring the uric acid levels. Metabolic function was determined by the serum bile acids and the plasma amino acids, i.e. (valine + leucine + isoleucine)/(phenylalanine + tyrosine) ratio. Donor and pretransplant recipient parameters were almost identical. The cold ischemia time of both groups differed significantly. The results show the following: a significant difference between both the LDH and the uric acid levels in the two groups was revealed, with a smaller increase of the LDH levels and no increase of the uric acid levels in the UW group. Metabolic activity, as measured from the bile acids and the amino acid profile in the peripheral blood, was identical in both groups. We conclude that both EC-stored and UW-stored liver grafts show immediate metabolic function after reperfusion. The amount of metabolic function was equal in both groups, notwithstanding longer cold ischemia time in the UW group. In addition, more parenchymal damage occurred in the EC group.

Safely harvesting the liver as well as the whole pancreas from a single donor is not yet common practice in transplantation surgery, since these organs have a partially common blood supply. Two harvesting procedures are described followed by successful transplantation of five solid organs from each donor, including liver and whole pancreas. Important details of the preferred surgical technique are the division of the hepatic artery just distal to the splenic artery and keeping the aortic patch, including superior mesenteric artery and coeliac trunk with the pancreas graft. Using this technique the liver and the whole pancreas could be transplanted without extra vascular anastomoses, while vascular grafts were not necessary. The risk of thrombosis during pancreas and liver transplantation is minimized in this way, while the primary function of each of the five harvested organs was excellent.