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Regional cerebral blood flow (CBF) was measured by single photon emission computerized tomography of inhaled 133-Xe in 20 chronic alcoholic men. Mean CBF was 51 ml/(100 g x min) compared with 53 ml/(100 g x min) in 20 normals. Reduced cerebellar blood flow correlated both to structural abnormalities seen on CT scan and to cognitive dysfunction. Slight abnormalities of the regional CBF was observed in the alcoholics. They had a higher incidence of regional low flow areas than a control group. Low flow areas were found in frontal and posterior parts of the brain not only in patients with atrophia, but also in patients without CT abnormalities, suggesting neuronal dysfunction. The occurrence of regional low flow areas was associated with the severity of alcoholism, cerebral atrophy and intellectual impairment.

The relation between angiographically determined cerebral vasospasm following a subarachnoid hemorrhage and regional cerebral blood flow (CBF) was studied in 63 investigations of 45 patients. The CBF was measured using the intra-arterial 133-Xe clearance technique within one hour of angiography. A positive correlation between regional CBF and diameter of major supplying vessel was observed. However, in the 13 cases with focal vasospasm the reduction in CBF was global and not restricted to the area of the spastic vessel. The cerebral oxygen extraction was reduced but independent of the degree of vasospasm, speaking against vasospasm as the cause for the reduction in CBF. The observed association between reduction in CBF and vasospasms could be caused by a common factor responsible for development of both. Thus, it is proposed that the amount of blood escaping at time of aneurysm rupture determines 1) the amount of reduction in cerebral oxygen uptake and thereby the reduction in CBF and 2) the degree of vasospasm. If so a correlation, yet not causal, between reduction in CBF and degree of vasospasm, will be observed.

Regional and mean cerebral blood flow (rCBF, CBF) were measured by tomography of inhaled 133Xe in 18 hemiparkinsonian patients before and after levodopa (L-dopa). Baseline mean CBF was 55 ml/ (100 g X min) after an L-dopa-free interval of at least 10 h (range 10-13) and remained unchanged at 56.1 ml/ (100 g X min) after optimal clinical improvement was achieved by L-dopa. However, L-dopa reduced rCBF significantly (P less than 0.05) in the striatum contralateral to the symptomatic limbs. In patients with adverse reactions such as hyperkinesias and on/off symptoms, flow tended to increase bilaterally in striatum and often markedly in midline structures anatomically related to globus pallidus and thalamus. Compared with a normal population, the subcortical rCBF distribution was asymmetrical with a reduced flow (-18%) in the striatum contralateral to the symptomatic limbs and in midline structures anatomically related to globus pallidus and thalamus (-12%). Cortical CBF was inverse related to the duration of Parkinson's disease (P less than 0.05), probably reflecting an increasing mental deterioration with time.

Atmospheric radioactivity is monitored for the verification of the Comprehensive Nuclear-Test-Ban Treaty, with xenon isotopes 131m Xe, 133 Xe, 133m Xe and 135 Xe serving as important indicators of nuclear explosions. The treaty-relevant interpretation of atmospheric concentrations of radioxenon is enhanced by quantifying radioxenon emissions released from civilian facilities. This paper presents the first global radioxenon emission inventory for nuclear power plants, based on North American and European emission reports for the years 1995–2005. Estimations were made for all power plant sites for which emission data were unavailable. According to this inventory, a total of 1.3 PBq of radioxenon isotopes are released by nuclear power plants as continuous or pulsed emissions in a generic year.

Summary. A new method to calculate the tissue/blood partition coefficient (Λ) for xenon in studies on the subcutaneous adipose tissue blood flow was compared with a previously reported method based on local skinfold thickness (ΛLSt). The former method included needle biopsies from the abdominal and femoral subcutaneous adipose tissue, and the mean fat cell diameter was measured (ΛECT)- The extracellular tissue fraction in subcutaneous tissue was then estimated from a diagram. The tissue lipid content was approximated to equal the relative intracellular volume and Ostwald's solubility coefficients for 133Xe, based on the distribution of xenon in lipid, albumin and 0.9% saline were applied. Estimated Λ-values based on needle biopsies from the abdominal site were: 8.6±0.1 versus 9.9±0.4 ml g-1 (meanae) (P

UNLABELLED Lung volume reduction (LVR) is an effective therapy for end-stage emphysema. Preliminary and postprocedure imaging is usually limited to CT for anatomic delineation of the location and severity of the most acutely affected lung zones. The purpose of this study was to investigate the potential of using a new quantitative gas trapping index (GTI) derived from a (133)Xe ventilation scan to assess the severity of emphysema. METHODS Using the equilibration and washout phases of a (133)Xe ventilation study, a GTI was compared with visual National Emphysema Treatment Trial (NETT) CT scoring, semiautomated CT densitometry, and (99m)Tc perfusion scintigraphy in 28 patients being evaluated for LVR. The GTI was calculated as the percentage of (133)Xe gas retention in a 3-min washout image compared with the peak equilibrium image for 6 lung zones. RESULTS The GTI correlated best with the percentage of perfusion (-0.39, P

A novel system has been developed for the detection of low radioactivity levels using coincidence techniques. The device combines a phoswich detector for a/b/g ray recognition with a fast digital card for electronic pulse analysis. The detector is able to discriminate different types of radiation in a mixed a/b/g field and can be used in a coincidence mode by identifying the composite signal produced by the simultaneous detection of b particles in a plastic scintillator and g rays in an NaI(Tl) scintillator. Use of a coincidence technique with phoswich detectors was proposed recently to verify the Nuclear Test Ban Treaty, which made it necessary to monitor the low levels of xenon radioisotopes produced by underground nuclear explosions. Previous studies have shown that combining CaF2(Eu) for b ray detection and NaI(Tl) for g ray detection makes it difficult to identify the coincidence signals because of the similar fluorescence decay times of the two scintillators. With the device proposed here, it is possible to identify the coincidence events owing to the short fluorescence decay time of the plastic scintillator. The sensitivity of the detector may be improved by employing liquid scintillators, which allow low radioactivity levels from actinides to be measured when present in environmental samples. The device developed is simpler to use than conventional coincidence equipment because it uses a single detector and electronic circuit, and it offers fast and precise analysis of the coincidence signals by employing digital pulse shape analysis. r 2007 Elsevier B.V. All rights reserved. PACS: 29.30.Kv; 29.40.Mc

The presence of noble gas and other short-lived radionuclides in air borne effluents from RBMK-1500-type reactor has been investigated using experimental and theoretical instrumentation for detection purposes. Activity concentrations of (85m)Kr, (87)Kr, (88)Kr, (135m)Xe, (135)Xe, (133)Xe and (41)Ar were measured in air emissions from Ignalina NPP using a special method and special equipment. Theoretical detection of reactor-borne radionuclides and investigation of their behaviour in a nuclear fuel during operation of nuclear reactor was performed using an analytical model based on reactor physics. An innovative method for the estimation of noble gas flow time from the defective nuclear fuel element through the ventilation stack of NPP to the atmosphere based on comparison of the experimentally and theoretically evaluated activity ratios of (88)Kr/(85m)Kr; (135)Xe/(133)Xe has been proposed. The estimated flow time of noble gas provides an excellent possibility to obtain modelling-based information about the qualitative and quantitative content of atmospheric releases from NPP.

Background: Attempts to retrieve absolute values of cerebral blood flow (CBF) by dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) have typically resulted in overestimations. Purpose: To improve DSC-MRI CBF estimates by calibrating the DSC-MRI-based cerebral blood volume (CBV) with a corresponding T1-weighted (T1W) steady-state (ss) CBV estimate. Material and Methods: 17 volunteers were investigated by DSC-MRI and 133Xe SPECT. Steady-state CBV calculation, assuming no water exchange, was accomplished using signal values from blood and tissue, before and after contrast agent, obtained by T1W spin-echo imaging. Using steady-state and DSC-MRI CBV estimates, a calibration factor K = CBV(ss)/CBV(DSC) was obtained for each individual. Average whole-brain CBF(DSC) was calculated, and the corrected MRI-based CBF estimate was given by CBF(ss) = K×CBF(DSC). Results: Average whole-brain SPECT CBF was 40.1±6.9 ml/min·100 g, while the corresponding uncorrected DSC-MRI-based value was 69.2±13.8 ml/min·100 g. After correction with the calibration factor, a CBF(ss) of 42.7±14.0 ml/min·100 g was obtained. The linear fit to CBF(ss)-versus-CBF(SPECT) data was close to proportionality ( R = 0.52). Conclusion: Calibration by steady-state CBV reduced the population average CBF to a reasonable level, and a modest linear correlation with the reference 133Xe SPECT technique was observed. Possible explanations for the limited accuracy are, for example, large-vessel partial-volume effects, low post-contrast signal enhancement in T1W images, and water-exchange effects.

Background Vasospasm is a frequent complication in the early clinical course after SAH. Although various methods have been used to measure cerebral perfusion including PET, SPECT, xenon CT, and TCD, these require the patients to remain still for a long period. In addition, TCD is operator dependent. The current study aimed to clarify the convenience of CTP for the assessment of cerebral vasospasm caused by SAH. Methods Nineteen patients with SAH aged 44 to 85 years (mean, 64 years) were recruited with informed consent. All patients were treated with the prevailing therapy and underwent CTP on days 6 to 9, followed by DSA and 3D-CTA to detect cerebral vasospasm. In each patient, we measured the MTT, CBF, and CBV. The reliability of CTP data was verified by comparing the data from CTP and xenon CT between the controls, and the average was calculated. Six ROIs were located symmetrically in the frontal, temporal, and occipital lobes. Results An MTT value more than 20% greater than the average indicated the progression of cerebral vasospasm, and patients with vasospasm-related infarcts exhibited an MTT more than 47% greater than the mean value (odds ratio, 50). Patients with delayed cerebral infarcts had a significantly lower mean CBF and CBV and higher MTT than patients who did not develop CI. Conclusion Significant correlations between MTT and CBF values and neurovascular findings were obtained. Computed tomography perfusion can be performed in a short time and on a regular basis, and it therefore has the potential to identify cerebral vasospasm because of SAH.

In 10 healthy subjects, skin blood flow rate was measured in the thumb pulp by the heat-washout method, and in the skin fold between the thumb and the forefinger by the 133Xe-washout method. The former but not the latter skin area contains arteriovenous anastomoses (AVAs). In response to 10 min moderate bicycle exercise, an instantaneous decrease in flow was seen in the thumb pulp followed after about 4.6 min by an increase to resting levels. Blood flow in the skin fold remained constant. The results indicate that the initial reduction in blood flow rate and later increase observed in the finger at the onset of moderate exercise take place in the AVAs and not in the capillaries.

A mobile radioxenon gas processing system (XESPM-III) was developed for on-site inspections—targeting deployment in the Integrated Field Exercise in Jordan 2014 (IFE14)—in order to monitor radioxenon isotopes (131m,133,133m,135Xe) from the subsoil and atmosphere. XESPM-III is composed of primarily three units, the sampling unit, the purification unit and finally the quantification unit. The function of the sampling unit is to pre-enrich xenon by removal of impurities in the gas sample, while the purification unit further purifies, separates impurities and prepares a small-volume sample with relatively high concentration of xenon gas—both stable and radioactive xenon (if present). The quantification unit quantifies the stable xenon which provides information of the gas recovery (yield) of the gas sampling and purification process. In one cycle (7.5 h) XESPM-III can process either two 4 m3 volume samples or two pairs 2 m3 samples each; 24 h maximum throughput is thus twelve 2 m3 samples or six 4 m3 samples; final purified gas sample volume is approx. 7 cm3 (Xe + N2 used as carrier gas); gas recovery (yield) is >70%; radon removal coefficient is 10−6; cross contamination between subsequent samples is

Four of the radioactive xenon isotopes ((131m)Xe, (133m)Xe, (133)Xe and (135)Xe) with half-lives ranging from 9 h to 12 days are produced from nuclear fission and can be detected from days to weeks following their production and release. Being inert gases, they are readily transported through the atmosphere. Sources for release of radioactive xenon isotopes include operating nuclear reactors via leaks in fuel rods, medical isotope production facilities, and nuclear weapons' detonations. They are not normally released from fuel reprocessing due to the short half-lives. The Comprehensive Nuclear-Test-Ban Treaty has led to creation of the International Monitoring System. The International Monitoring System, when fully implemented, will consist of one component with 40 stations monitoring radioactive xenon around the globe. Monitoring these radioactive xenon isotopes is important to the Comprehensive Nuclear-Test-Ban Treaty in determining whether a seismically detected event is or is not a nuclear detonation. A variety of radioactive xenon quality control check standards, quantitatively spiked into various gas matrices, could be used to demonstrate that these stations are operating on the same basis in order to bolster defensibility of data across the International Monitoring System. This paper focuses on Idaho National Laboratory's capability to produce three of the xenon isotopes in pure form and the use of the four xenon isotopes in various combinations to produce radioactive xenon spiked air samples that could be subsequently distributed to participating facilities.

The radionuclide network of the International Monitoring System comprises up to 80 stations around the world that have aerosol and xenon monitoring systems designed to detect releases of radioactive materials to the atmosphere from nuclear explosions. A rule of thumb description of plume concentration and duration versus time and distance from the release point is useful when designing and deploying new sample collection systems. This paper uses plume development from atmospheric transport modeling to provide a power-law rule describing atmospheric dilution factors as a function of distance from the release point. Consider the plume center-line concentration seen by a ground-level sampler as a function of time based on a short-duration ground-level release of a nondepositing radioactive tracer. The concentration C (Bq m(-3)) near the ground varies with distance from the source with the relationship C=R×A(D,C) ×e (-λ(-1.552+0.0405×D)) × 5.37×10(-8) × D(-2.35) where R is the release magnitude (Bq), D is the separation distance (km) from the ground level release to the measurement location, λ is the decay constant (h(-1)) for the radionuclide of interest and AD,C is an attenuation factor that depends on the length of the sample collection period. This relationship is based on the median concentration for 10 release locations with different geographic characteristics and 365 days of releases at each location, and it has an R(2) of 0.99 for 32 distances from 100 to 3000 km. In addition, 90 percent of the modeled plumes fall within approximately one order of magnitude of this curve for all distances.

The present study aimed to evaluate adipose tissue blood flow (ATBF) by means of laser-Doppler flowmetry (LDF) in humans. Lower body negative pressure (LBNP) and straining known to affect epidermal blood flow through the autonomic nervous system were performed in 11 lean and 11 obese female volunteers. ATBF changes were compared between both groups and also discriminated from skin blood flow (SBF) responses of the immediate vicinity. Additionally, LDF measurements were compared with flow measurements using 133xenon washout in 10 lean subjects during whole body cooling. LDF estimations of SBF and ATBF showed a positive correlation to 133Xe during cooling. SBF and ATBF were reduced to the same extent in both lean and obese subjects during LBNP. Straining induced divergent changes in SBF and ATBF: initially SBF decreased while ATBF increased, but toward the end of straining SBF increased above baseline and ATBF returned down to baseline level. Those changes were similar in both weight groups. Interestingly, only in obese subjects, both LBNP and straining were followed by ATBF augmentation, while SBF levels remained stable. In conclusion, LDF compares with 133Xe washout in monitoring ATBF during tonic perfusion changes. Its strength, however, lies in the detection of rapid flow alterations within the subcutaneous tissue, allowing the evaluation of reflex responses of the subcutaneous microcirculation. Interestingly, those rapid changes in SBF and ATBF can be both concordant and discordant. With regard to ATBF, vasoconstrictor components of the reflex responses were similar in lean and obese subjects, whereas vasodilatory responses were more pronounced in obese volunteers.

AIM: To assess the usefulness of SPECT images using (99m)Tc-Technegas (Technegas) and (133)Xe dynamic single photon emission computed tomography (SPECT) (Xe gas) and high-resolution computed tomography (HRCT), as compared with pathological assessment in the detection of small-airway disease including pulmonary emphysema. METHODS: Seventeen patients with lung cancer were studied. All patients who had undergone both Technegas and Xe gas and CT prior to surgery were examined. SPECT and HRCT results were compared with the results of pathological findings. Histopathological analysis was performed in an area distant from cancer in lobectomy specimens obtained at surgery. Pathological analysis was performed in relation to bronchitis, bronchiolitis, fibrosis of the alveoli and disruption in walls of the alveoli. RESULTS: Pathological abnormality (mild-to-moderate abnormal change) was seen in all 17 cases. Three patients showed low attenuation areas on CT, and abnormal patterns in SPECT images. In 11 of 14 patients who showed normal findings on CT, SPECT imaging depicted abnormal findings. The remaining three patients had no abnormal findings on CT and both SPECT imaging. CONCLUSION: Technegas and (133)Xe SPECT imaging is useful for evaluating small-airway disease including pulmonary emphysema. Furthermore, SPECT imaging is more useful than morphological HRCT imaging in the evaluation of small-airway disease including pulmonary emphysema.

High-resolution dual X and γ spectrometry has been optimized to improve the sensitivity in analyzing radioxenon from environmental samples, especially for the metastable isotopes (131Xem and 133Xem). The full-energy peak (FEP) efficiency curve in the 20–700 keV range has been established with a global uncertainty better than ±3% using a Monte Carlo simulation. The minimum detectable activity concentrations (MDC) achievable at the laboratory for 131Xem, 133Xem, 133Xe and 135Xe are presented and the influence of 133Xe activity on the metastable radioxenon MDCs is evaluated.

A study was carried out to investigate the predictive value of 81-metastable-krypton (81mKr) distribution, high-size 99-metastable-technetium (99mTc) aerosol deposition and low-size 99mTc aerosol (Technegas) deposition on the pulmonary ventilation evaluated by 133-xenon (133Xe) lung scintigraphy, and to assess the correlation between the 81mKr distribution, the 99mTc aerosols deposition, and the respiratory parameters of patients with chronic obstructive pulmonary disease (COPD). Twenty COPD patients were included. The 81mKr, 133Xe, and 99mTc aerosol lung scintigraphies were successively carried out. The 81mKr distribution and 99mTc deposition were compared to the 133Xe distribution at equilibrium and to the 133Xe clearance. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 81mKr and Technegas lung scintigraphies to detect alterations in ventilation revealed by 133Xe were defined. The 81mKr distribution and 99mTc deposition according to respiratory parameters were described using a principal component analysis. Compared to 133Xe distribution, a significantly higher distribution of 81mKr in the upper parts of the lungs in the more severe patients (p = 0.05), a significantly higher deposition of Technegas in the lower parts of the lungs (p = 0.0008), and a significantly higher deposition in the central parts of the high-size 99mTc aerosol were observed (p = 0.0001). The PPV and the NPV were, respectively, 0.54 and 0.58 for 81mKr and 0.54 and 0.55 for Technegas. There was a significant negative correlation between 81mKr distribution and 133Xe clearance (p = 0.0001) between Technegas deposition and 133Xe clearance (p = 0.0007), and between 99mTc diethylene-triamino-penta-acetate (DTPA) deposition and 133Xe clearance (p = 0.001). Both the 81mKr peripheral distribution and Technegas peripheral deposition correlated negatively with increased obstruction, as measured by forced expiratory volume in 1 sec (FEV1). Peripheral deposition of the high-size 99mTc aerosol deposition correlated with the inspiration/expiration time ratio. In conclusion, 81mKr and 99mTc aerosols' lung scintigraphies do not reflect exactly the pulmonary ventilation as measured by 133Xe scintigraphy.

Purpose: This study sought to determine whether 133Xe-radiospirometry (XRS) successfully selects patients able to undergo lung resection without postoperative respiratory complications and whether perfusion lung scintigraphy (PLS) is likely to provide a similar selection of patients for certain tumour stages. Methods: Two hundred and eighty-four patients with resectable lung cancer underwent preoperative assessment of postoperative forced expiratory volume in 1 s (FEV1) by XRS and PLS. Correlations, Bland and Altman analysis and contingency tables were used to analyse the difference between the two predictive techniques. Results: One hundred and sixty patients underwent lung resection on the basis of XRS preoperative testing only. None of them developed respiratory insufficiency. Despite a close correlation, the limits of agreement between predicted FEV1 by XRS and PLS exceeded ±0.3 l/s. For tumour stages T1Nx and T2N0, PLS underestimated postoperative FEV1 whereas it overestimated this parameter for stage III. Conclusion: XRS accurately selects patients able to undergo lung resection without postoperative pulmonary insufficiency. The agreement between XRS and PLS is unacceptable. When only PLS is available, higher thresholds for patients with stage III cancers and lower thresholds for those with stage I cancers should be used to decide on operability.

Oxygen extraction fraction (OEF) and cerebrovascular reserve (CVR) are both proven predictors of stroke risk in symptomatic patients with carotid occlusion. Accordingly, hemispheric comparisons of CVR and OEF are significantly correlated. However, there was also substantial disagreement: hemispheres identified as compromised by CVR were normal by OEF. Our aim was to determine whether regional comparisons could resolve the CVR-OEF discordance. We also studied the relationship between white matter (WM) infarction and hemodynamic compromise.Quantitative CVR and OEF were measured in 12 symptomatic patients with internal carotid artery occlusion. CVR and OEF comparisons were made in the anterior watershed (AWS), middle cerebral artery (MCA) and WM territories using various thresholds for hemodynamic compromise. Associations with WM infarction were also recorded.Comparison of CVR and OEF for the AWS and MCA showed high sensitivity (100%) with specificities of 83 and 40%, respectively. There was also agreement (k=Cohen's Kappa) for the AWS (k=0.83) and MCA (k=0.39) territories. CVR-OEF discordance was reduced with regional analysis. Hemodynamic compromise was more often found in patients with WM infarction.Regional comparison of CVR and OEF reduced the discordance compared with hemispheric analysis, especially for the AWS territory. Despite the persistence of some regions with compromised CVR and normal OEF, CVR is able to identify all regions with elevated OEF making it a useful screening technology. Future studies are needed to understand whether those remaining regions with compromised CVR are also at increased stroke risk despite normal OEF.

Purpose We wanted to assess the prevalence of pulmonary dysfunction as the underlying reason for inoperability among patients with non–small-cell lung cancer (NSCLC) who were considered for surgical treatment at the time of diagnosis. Patients and Methods This is a retrospective analysis of all patients with NSCLC referred to our pulmonary function laboratory for preoperative evaluation between January 2001 and November 2001. Pulmonary function testing consisted of measurement of spirometric indices (forced expiratory volume in 1 second [FEV1]), lung volumes and diffusing capacity for carbon monoxide, Xenon-133 quantitative ventilation and perfusion studies, and exercise testing when indicated. Patient demographics and clinical characteristics at the time of the evaluation were reviewed. Results The group comprised 206 consecutive potential surgical candidates (mean age, 64.7 years ± 10.1 years) with NSCLC. Nearly half (45.6%) of the patients had early-stage (I/II) disease, and the remainder had late-stage disease at the time of pulmonary evaluation. The average predicted FEV1 among all patients was 70.3% ± 19.6% (range, 25%-123%). One hundred eight patients (52.4%) were deemed surgically inoperable after the preoperative assessment. Severe pulmonary function impairment was identified as the reason for surgical inoperability in more than one third of these patients (40 of 108). Conclusion A substantial number of patients with anatomically resectable NSCLC are deemed surgically ineligible based on poor lung function. Recognition of the magnitude of this problem is fundamental to the development of effective treatment options, which might include preoperative management strategies that could better prepare patients for surgery or, alternatively, aggressive nonsurgical approaches.

In subarachnoid hemorrhage (SAH) with cerebrovascular instability, hyperventilation may induce a risk of inducing or aggravating cerebral ischemia. We measured cerebral blood flow (CBF) and cerebral metabolic rates of oxygen (CMRO2), glucose (CMRglc), and lactate (CMRlac) at different PaCO2 levels after experimental SAH in rats (injection of 0.07 mL of autologous blood into the cisterna magna). Four groups of Sprague-Dawley male rats were studied at predetermined PaCO2 levels: group A: normocapnia (5.01-5.66 kPa [38.0-42.0 mm Hg]); group B: slight hyperventilation (4.34-5.00 kPa [32.5-37.5 mm Hg]); group C: moderate hyperventilation (3.67-4.33 kPa [27.5-32.4 mm Hg]); group D: profound hyperventilation (3.00-3.66 kPa [22.5-27.4 mm Hg]). Each of the four groups included eight rats with SAH and eight sham-operated controls. CBF was determined by the intracarotid 133Xe method; CMRo2, CMRglc, and CMRlac were obtained by cerebral arteriovenous differences. In both SAH rats and controls, hyperventilation decreased CBF in proportion to the decrement in PaCO2 without affecting either CMRO2, CMRglc, or CMRlac. In groups C and D, CBF decreased by 20%-35%, but CMRs were maintained by a compensatory increase in oxygen extraction fraction (OEF). The results show that even profound hyperventilation in this model of SAH is associated with an adequate increase in OEF so that CMRs of oxygen, glucose, and lactate remain similar to levels observed in normocapnic conditions.

A method is presented for estimating 41 Ar, 85,88 Kr and 131m,133 Xe dose rates to terrestrial wildlife without having to resort to comparisons with analogue radionuclides. The approach can be used to calculate the dose rates arising from external exposures to given ambient air concentrations of these isotopes. Dose conversion coefficient (DCC) values for a range of representative organisms are calculated, using a Monte Carlo approach to generate absorbed fractions based on representing animals as reference ellipsoid geometries. Plume immersion is the main component of the total DCC. DCC values calculated for a human-sized organism are compared with human dose conversion factors from ICRP Publication 119, demonstrating the consistency of the biota approach with that for humans. An example of application is provided for hypothetical nuclear power plant atmospheric discharges with associated exposures to birds and insects. In this example, the dose rates appear to be dominated by 133 Xe and 88 Kr, respectively. The biota considered would be protected from the effects of noble gas radiation from a population protection perspective.

The verification of the Comprehensive Nuclear-Test-Ban Treaty (CTBT) includes, beside three different waveform techniques, global monitoring of radioactive aerosols and noble gases. The noble gases are difficult to contain for the illicit tester and are therefore of particular importance to identify signals from underground or underwater nuclear tests. Several isotopes of xenon are sufficiently produced in fission and a few have suitable half-lives and radiations to be detected. These are 131mXe, 133mXe, 133Xe and 135Xe and they have been selected for continuous monitoring. Four different systems have been developed to sample and measure them. Three of them use cryogenic or room-temperature gas chromatography processes and one a membrane technology. One measures by gamma spectroscopy, two by beta–gamma coincidence spectroscopy and one by beta-gated gamma spectroscopy. These systems are now undergoing trials at worldwide locations in the so-called International Noble Gas Experiment (INGE). In parallel, specific analytical software is being developed to examine the spectra produced by these different systems. This paper presents results from data acquired both from regions having a high radioxenon background and from remote low background stations.

EEG feedback methods, which link the occurrence of alpha to the presentation of repeated visual stimuli, reduce the relative variability of subsequent, alpha-blocking event durations. The temporal association between electro-cortical field activation and regional cerebral blood flow (rCBF) led us to investigate whether the reduced variability of alpha-blocking durations with feedback is associated with a reduction in rCBF variability. Reduced variability in the rCBF response domain under EEG feedback control might have methodological implications for future brain-imaging studies. Visual stimuli were randomly presented to seven subjects, contingent upon the occurrence of alpha (alpha-contingent stimulation (ACS)) or alpha-blocking (not-alpha-blocking-contingent stimulation (NACS)) events. We employed a within-subjects design. rCBF was measured from multiple, cortical and sub-cortical regions. The primary dependent variables were the Mean, Standard Deviation and the ratio of Mean/Standard Deviation of: 1) the alpha-blocking response durations and 2) the temporally summated rCBF responses within the Visual Associative regions of interest (ROIs). Additional within-subjects rCBF measures were derived to quantify the variance-reducing effects of ACS across multiple, distributed areas of the brain. Both EEG and rCBF measures demonstrated decreased variability under ACS. This improved control was seen for localized as well as anatomically distributed rCBF measures.

Until recently, primary headache disorders such as migraine and cluster headache were considered to be vascular in origin. However, advances in neuroimaging techniques, such as positron emission tomography, single photon emission computerized tomography, and functional magnetic resonance imaging, have augmented the growing clinical evidence that these headaches are primarily driven from the brain. This review covers functional imaging studies in migraine, cluster headache, rarer headache syndromes, and experimental head pain. Together with newer techniques, such as voxel-based morphometry and magnetic resonance spectrometry, functional imaging continues to play a role in elucidating and targeting the neural substrates in each of the primary headache syndromes.

The temperature-induced shape transition of poly( N -isopropylacrylamide) gels of different cross-link densities was investigated by a combination of NMR techniques allowing the characterization of both the macroscopic collapse as well as the changes on a molecular scale related to the expulsion of water from the gel network. The proton-containing gel phase was visualized by swelling in heavy water, and the volume change was monitored by proton imaging for cross-link densities between 0.5% and 2.5%. Above the transition temperature of 35°C, gel collapse led to a volume change of up to a factor of 17 for the gel of smallest cross-link density. Two spectral lines of 129 Xe are found in the gel state and are assigned to the hydrophobic and hydrophilic parts of the network. In the collapsed state, the hydrophobic peak shows a strong shift while the hydrophilic peak disappears. A considerable shortening of both T 1 and T 2 of the gel protons upon collapse was found at a field of 4.7 T. At lower fields, the effect becomes more pronounced and qualitatively different dispersion behaviors between the swollen and the collapsed states are observed.

Cyclic AMP (cAMP) appears extracellularly in a variety of tissues including brain, liver, and kidney; whether it appears in adipose tissue and responds to physiological perturbation is unknown. The purpose of this study was to examine adipose tissue extracellular cAMP appearance and metabolism in situ and in vitro in physiologically challenged animals. Littermate swine were either sedentary or exercise trained on a treadmill for 3 months and subjected to acute exercise on experiment day. In situ, microdialysis probes in subcutaneous back fat were perfused before, during, and after animals performed 20 mins of acute exercise, and dialysate was analyzed for cAMP and adenosine. In vitro, isolated adipocytes were hormonally stimulated to provoke cAMP synthesis and efflux, and plasma membrane phosphodiesterase and 5′-nucleotidase activities were measured. Extracellular cAMP and adenosine levels in adipose tissue of sedentary swine averaged 5.2 ± 1.7 and 863 ± 278 nM, respectively. Exercise training tended to increase extracellular cAMP (11.3 ± 1.7 n/lf) and reduce extracellular adenosine (438 ± 303 n/lf), although neither change was statistically significant. Acute exercise caused a significant 3-fold and 16-fold increase in extracellular cAMP and adenosine, respectively, compared to rest. These changes occurred despite a 2- to 3-fold increase in adipose tissue blood flow during acute exercise. In vitro, cAMP efflux from exercise-trained swine was 42% greater than that from adipocytes of sedentary swine, yet adipocyte plasma membranes from exercise-trained and sedentary swine did not differ in maximal phosphodiesterase and 5′-nucleotidase activities. We conclude that cAMP appears extracellularly in swine adipose tissue and that the levels of extracellular cAMP and adenosine in intact swine adipose tissue are influenced by both acute and chronic exercise. The subsequent impact of the changes in these biochemicals on local cellular metabolism and growth remains to be determined.

Summary: Purpose: To study separately the functional value of each cerebral hemisphere in hemimegalencephaly (HME). HME is a unique model of unilateral hemispheric lesion, but one suspects that the non-HME hemisphere also could be functionally impaired because the postsurgery outcome is less favorable than expected. Methods: We performed simultaneous prolonged EEG and 133-xenon SPECT (single-photon emission computed tomography); we measured the absolute values of cerebral blood flow (CBF) in both hemispheres and compared them with the normal values previously acquired. Thirteen patients (aged 5–38 months) underwent 31 examinations, 20 before surgery (hemispherotomy) and 11 after. Results: In the HME hemisphere, we confirmed the presurgical mixture of increased and decreased CBF due to intermittent ictal discharges. After surgery, CBF was decreased in most cases. In the non-HME hemisphere, presurgery CBF was abnormal in 60% of the patients, increased and related mostly to diffuse interictal spikes on the same side, whereas normal CBF cases had focal spikes. After surgery, CBF was normal in 82% of cases, corresponding to an EEG without diffuse spikes. In the six patients longitudinally studied, CBF dramatically decreased after surgery in the HME hemisphere, whereas in the non-HME hemisphere, CBF was mostly normal very early (three fourths before 2 months), increased as soon as 3 months, and normalized only after hemispherotomy, the more rapidly the child was operated on, the earlier it was. Conclusions: This study shows that the function of the nonmalformed hemisphere is impaired as soon as the first months of the course of HME but can be restored after surgery. Our data support the recommendations to operate on the children as early as possible.

Background: caffeine is present in a variety of beverages and food and is widely consumed. In a previous study of patients recovering from an acute ischaemic stroke using transcranial Doppler ultrasound we demonstrated a fall in middle cerebral artery blood velocity of 12% following ingestion of 250 mg caffeine. The aim of this study was to investigate if this velocity change reXected a change in cerebral blood Xow. Methods: the study used a randomised, double blind, cross-over design. Nineteen patients recovering from an acute ischaemic stroke in the middle cerebral artery territory and 10 controls attended two sessions, having abstained from caffeine for 48 hours previously. At each session cerebral blood Xow was measured four times using xenon clearance, twice before the oral administration of 250 mg caffeine or matched placebo, and twice after. Similarly, three middle cerebral artery blood velocity readings using transcranial Doppler were made prior to administration and four after. Results: the caffeine resulted in a signiWcant fall in cerebral blood Xow and middle cerebral artery blood velocity compared to placebo. Conclusions: since caffeine is present in the diet of most patients recovering from an acute ischaemic stroke this effect may have adverse clinical consequences.

Background The authors determined the segmental effects of intracarotid verapamil in human subjects by using a novel method of measuring proximal and distal cerebrovascular resistance. Their hypothesis was that intracarotid verapamil, a calcium channel-blocking drug that augments cerebral blood flow and reverses arterial spasm, would decrease both the proximal-conductance and the distal-arteriolar resistance. Methods Coaxial catheters were transfemorally floated into internal carotid and middle cerebral arteries during cerebral angiography. Pressures were recorded in the femoral, internal carotid, and middle cerebral arteries. Hemispheric cerebral blood flow was measured by the intracarotid Xe injection technique. Cerebrovascular resistance was measured for the proximal and distal arteries. Cerebral blood flow and hemodynamic data were recorded during intracarotid infusion of saline and verapamil (1 mg/min) for 5 min. Transcranial Doppler blood flow velocity in the middle cerebral artery was also recorded. Results Intracarotid verapamil increased in 133Xe cerebral blood flow from 43 +/- 11 to 59 +/- 11 ml.100 g(-1).min(-1) (P = 0.001; n = 9). The cerebrovascular resistance measured for the proximal and distal arteries decreased from 0.17 +/- 0.95 to 0.12 +/- 0.75 and from 1.63 +/- 0.78 to 1.03 +/- 0.33 mmHg.ml(-1).100 g(-1).min(-1) (P < 0.01), respectively. The calculated proximal-conductive and distal-arteriolar (pial plus parenchymal) resistances showed a similar decrease. Transcranial Doppler measurements (n = 5) underestimated the effects of intracarotid verapamil that were consistent with an increase in middle cerebral artery diameter. Conclusions Intracarotid verapamil decreases both the proximal-conductance and the distal-arteriolar resistance. Furthermore, it is feasible to investigate segmental effects of drugs in human subjects by measuring changes in pressure gradients within the cerebral arteries and simultaneous Xe cerebral blood flow measurements.

We evaluated the respiratory functions of patients with pulmonary emphysema who underwent lung volume reduction surgery (LVRS) by the mean transit time (MTT) with Xe-133 lung ventilation scintigraphy, forced expiration volume in 1 sec (FEV1.0), residual volume (RV), distance walked in 6 min (6-min walk), and the Hugh-Jones classification (H-J classification) before and after LVRS. In 69 patients with pulmonary emphysema (62 men, 7 women; age range, 47-75 years; mean age, 65.4 years +/- 6.1, preoperative H-J classification, III (two were II)-V) who underwent LVRS, all preoperative and postoperative parameters (MTT 3 weeks after LVRS and the others 3 months after LVRS) were judged statistically by the Wilcoxon signed-ranks test and Odds ratio. Every postoperative parameter was improved with a significant difference (P < 0.05) compared to preoperative parameters. MTT at 3 weeks after LVRS was not associated with %FEV1.0 and the H-J classification at 3 months after LVRS, but was associated with RV and a 6-min walk at 3 months after LVRS. MTT was useful for the clinical evalution of aerobic capability after LVRS.

Neural networks have been successfully applied to brain perfusion images to classify patients with Alzheimer’s disease from normal or other patient populations. Given the recognition that Alzheimer’s disease constitutes a heterogeneous disorder, the identification of subgroups sharing common functional brain deficits would constitute a further improvement in the utility of such methods. Therefore, we aimed to investigate whether neural networks could discriminate cortical perfusion deficits of patients with Alzheimer’s disease from normal brain perfusion. A second step was to identify subgroups of patients sharing similar perfusion deficits. The study population consisted of one group of 92 normal healthy subjects and one group of 132 patients with mild-to-moderate Alzheimer’s disease. The patients were diagnosed according to established criteria (DSM-IV and NINCDS-ADRDA). Regional cerebral blood flow was assessed by the non-invasive 133Xe inhalation method, using a 64-detector system for measurements of blood flow in superficial cortical areas. The regional blood flow values were used as the only input to artificial neural networks with multilayer Perceptron architecture. The networks were trained using the back-propagation updating algorithm. A fourfold cross validation procedure was used in order to obtain the most reliable performance of the networks. The performance of the neural network, measured as the area under the receiver-operating characteristic curve, was 0.94, with a sensitivity for Alzheimer’s disease of 86% at a specificity of 90%. An analysis of the relative importance of cortical areas in the discrimination showed that left parietal areas were more important than the right homologous ones. A clustering analysis of the Alzheimer patients identified three or four subgroups of patients with clearly different combinations of blood flow pathology. A consistent finding in all subgroups was a significant deficit in temporoparietal blood flow of both hemispheres. Distinct group differences were seen in frontal, central and occipital areas with different combinations of involvement. This is the first study in which neural networks have been applied to brain perfusion images obtained with the 133Xe inhalation method. The results demonstrate that a classification of patients with Alzheimer’s disease obtained with this method is compatible with the best results obtained with other brain imaging methods. The identification of clearly distinguishable patterns of blood flow pathology in subgroups of patients lends further support to the notion that Alzheimer’s disease is a heterogeneous disorder.

The objectives of this study were to determine if diagnostic certainty on angiography correlates with scintigraphic probability for the diagnosis of pulmonary embolism. From a total of 160 consecutive patients who underwent both nuclear imaging and invasive selective pulmonary angiography, we reviewed the xenon-133 ventilation images in 2 posterior oblique views and the Tc-99m macroaggregated serum albumin perfusion scans and angiograms of 40 patients (15 men, 25 women; average age 57 years) who were discharged from the hospital on anticoagulants with a diagnosis of pulmonary embolism. The angiograms were reviewed and the diagnosis of embolism was considered certain in the presence of an intraluminal filling defect, a trailing embolus, or a branch occlusion equal to or larger than a segmental branch (n = 29; 73%), and uncertain when the studies were reinterpreted as either equivocal or negative or in the presence of a single, small subsegmental filling defect of questionable clinical significance. The ventilation-perfusion scans were read as high (n = 18; 45%), intermediate (n = 10; 25%), or low (n = 12; 30%) probability. The proportion of patients with diagnostic certainty on angiography in the high-, intermediate-, and low-probability scintigraphic subgroups was, respectively, 100% (18 of 18), 70% (7 of 10), and 33% (4 of 12) (P = 0.004). In patients diagnosed with pulmonary embolism based on selective angiography, a lower probability of pulmonary embolism on ventilation-perfusion scintigraphy correlates with a lesser degree of diagnostic certainty on angiography and a higher incidence of single subsegmental emboli.

A system for automatic sampling, processing, and analysis of atmospheric radioxenon has been developed. From an air sample of about 7 m 3 collected during 12 h , 0.5 cm 3 of xenon is extracted, and the atmospheric activities from the four xenon isotopes 133 Xe , 135 Xe , 131m Xe , and 133m Xe are determined with a beta–gamma coincidence technique. The collection is performed using activated charcoal and molecular sieves at ambient temperature. The sample preparation and quantification are performed using preparative gas chromatography. The system was tested under routine conditions for a 5-month period, with average minimum detectable concentrations below 1 mBq / m 3 for all four isotopes.

Changes in hepatic blood flow reflect adaptive responses of the liver to injury, regeneration, and the development of disease states. The measurement of hepatic blood flow is, however, technically challenging and although theoretically useful has not become routine in clinical work. The different techniques that have been developed for quantitative measurement of hepatic blood flow require careful interpretation of the results obtained but are frequently applied without careful considerations of their technical limitations. In particular, many noninvasive techniques depend on good hepatocellular function and are thus irrelevant under most clinical conditions. Many other potentially useful techniques are poorly validated and standardized and there is a need for further research into smethodology. This review summarizes the salient technical features of the different techniques for quantitative measurement of hepatic blood flow. The techniques are divided into invasive, minimally invasive, and noninvasive categories and the relevance of each technique to both routine clinical application or research is discussed.

Background During cerebral angiography, intracarotid infusion of sodium nitroprusside (SNP), an endothelium-independent nitric oxide donor, fails to increase cerebral blood flow (CBF) of human subjects. A confounding effect of intracranial pathology or that of radiocontrast could not be ruled out in these experiments. The authors hypothesized that, if nitric oxide was a significant regulator of CBF of primates, then intracarotid SNP will augment CBF of baboons. Methods In studies, CBF (intraarterial (133)Xe technique) was measured in healthy baboons during isoflurane anesthesia at (1) baseline and during (2) induced hypertension with intravenous phenylephrine, (3) concurrent infusions of intravenous phenylephrine and intracarotid SNP, and (4) intracarotid verapamil (positive control drug). In studies, the authors measured tissue cyclic guanosine monophosphate (cGMP) by radioimmunoassay after incubating vascular rings obtained from freshly killed baboons (1) with increasing concentrations of SNP and (2) after SNP exposure following preincubation with the radiocontrast agent, iohexhol. Results In the studies, coinfusion of intravenous phenylephrine and intracarotid SNP did not increase CBF. However, intracarotid verapamil significantly increased CBF (from 26 +/- 7 to 43 +/- 11 ml x 100 g(-1) x min(-1); P < 0.0001) without a change in mean arterial pressure. In the studies, incubation of intracranial arterial rings in SNP resulted in dose-dependent increases in cGMP concentrations. A similar increase in cGMP content was evident despite iohexhol preincubation. Conclusions Collectively, these results suggest that, in healthy baboons, intracarotid SNP does not decrease arteriolar resistance, although SNP could affect proximal arterial tone, as demonstrated by the increase in cGMP content of these vessels.

The aim of this prospective study was to investigate whether decreased cerebrovascular reactivity to acetazolamide, as determined by single-photon emission computed tomography (SPECT), is an independent predictor of the 5-year risk of subsequent stroke in patients with symptomatic major cerebral artery occlusion. Cerebrovascular reactivity to acetazolamide in the middle cerebral artery (MCA) territory ipsilateral to the occluded artery was determined on the basis of two different methodologies: cerebral blood flow (CBF) percent change obtained quantitatively from xenon-133 (133Xe) SPECT, and asymmetry index (AI) percent change obtained qualitatively from N-isopropyl- p-[123I]-iodoamphetamine (IMP) SPECT. Seventy patients with unilateral internal carotid artery or MCA occlusion were divided into two groups within each SPECT methodology (normal or decreased CBF percent change and AI percent change) and followed up for 5 years. Cumulative recurrence-free survival rates for patients with decreased CBF percent change were significantly lower than for those with normal CBF percent change ( P = 0.0205). There was no significant difference in cumulative recurrence-free survival rates between patients with decreased AI percent change and those with normal AI percent change. Only decreased CBF percent change was a significant independent predictor of stroke recurrence ( P = 0.0051). The present study demonstrated that decreased cerebrovascular reactivity to acetazolamide determined quantitatively by Xe SPECT is an independent predictor of the 5-year risk of subsequent stroke in patients with symptomatic major cerebral artery occlusion, and that the qualitative method using I-IMP SPECT is a poor predictor of the risk of subsequent stroke in this type of patient.

Background— Ionizing radiation administered intraluminally via catheter-based systems using solid β and γ sources or liquid-filled balloons has shown reduction in the neointima formation after injury in the porcine model. We propose a novel system that uses a 133-Xenon ( 133 Xe) radioactive gas-filled balloon catheter system. Methods and Results— Overstretch balloon injury was performed in the coronary arteries of 33 domestic pigs. A novel 133 Xe radioactive gas–filled balloon (3.5/45 mm) was positioned to overlap the injured segment with margins. After vacuum was obtained in the balloon catheter, ≈2.5 cc of 133 Xe gas was injected to fill the balloon. Doses of 0, 7.5, 15, and 30 Gy were delivered to a distance of 0.25 mm from the balloon surface. The dwell time ranged from 1.0 to 4.0 minutes, depending on the dose. Localization of 133 Xe in the balloon was verified by a γ camera. The average activity in a 3.5/45-mm balloon was measured at 67.7±12.1 mCi, and the total diffusion loss of the injected dose was 0.26% per minute of the injected dose. Bedside radiation exposure measured between 2 and 6 mR/h, and the shallow dose equivalent was calculated as 0.037 mrem per treatment. Histomorphometric analysis at 2 weeks showed inhibition of the intimal area (intimal area corrected for medial fracture length [IA/FL]) in the irradiated segments of 0.26±0.08 with 30 Gy, 0.07±0.24 with 15 Gy, and 0.12±0.89 with 7.5 Gy versus 0.76±0.08 with control P Conclusions— 133 Xe gas–filled balloon is feasible and effective in the reduction of neointima formation in the porcine model and safe for use in coronary arteries.

To investigate the antilipolytic effect of insulin in skeletal muscle and adipose tissue in vivo, the rates of glycerol release from the two tissues were compared in 10 nonobese women during a two-step euglycemic hyperinsulinemic clamp. Tissue interstitial glycerol levels were determined by microdialysis, and tissue blood flow was assessed with the 133Xe clearance technique. Absolute rates of glycerol release were estimated according to Fick's principle. In both adipose tissue and muscle, glycerol levels decreased significantly already during the low insulin infusion rate. The fractional release of glycerol (difference between interstitial glycerol and arterialized venous plasma glycerol) was reduced by more than one-half in adipose tissue ( P < 0.0001) in response to insulin, whereas it remained unaltered in skeletal muscle. Muscle blood flow rates increased by 60% ( P < 0.02) during insulin infusion; in adipose tissue, blood flow rates did not change significantly in response to insulin. The basal rate of glycerol release from skeletal muscle amounted to ∼15% of that from adipose tissue. After insulin infusion, the rate of adipose tissue glycerol release was markedly suppressed, whereas in skeletal muscle the rate of glycerol mobilization did not change significantly in response to insulin. It is concluded that insulin does not inhibit the rate of lipolysis in skeletal muscle of nonobese women.

Endoscopic sinus surgery (ESS) is today a common method for the treatment of chronic rhinosinusitis. Assessment of the results has been based mainly upon subjective evaluation, and only a few reports present objective measurements. In the present study, the 133-xenon washout technique was used for preoperative and postoperative evaluation of paranasal sinus ventilation in 12 patients selected for ESS. The postoperative half-times (T1/2) of 133-xenon washout were lower in the sinuses with abnormal preoperative half-times (T1/2), especially in the maxillary sinuses, where the postoperative T1/2 was 44 (22 to 150) minutes (median and quartiles, Q1–Q3) as compared with a preoperative T1/2 of 202 (94 to 278) minutes. The postoperative evaluation included a questionnaire and a follow-up visit with endoscopy and measurements of nasal nitric oxide. The results showed that patients who declared a marked reduction in symptoms exhibited significantly improved sinus ventilation. However, no direct correlation was found between improvement in ventilation and symptom improvement. Nine of the 12 patients showed improvement on endoscopy, and these patients also exhibited improved sinus ventilation. The postoperative nasal nitric oxide levels were within the normal range in 11 of the 12 patients; the other patient showed pathological T1/2 values for all paranasal sinuses. The 133-xenon washout technique is thus a method that can be used for objective evaluation of the ventilation of the paranasal sinuses before and after ESS procedures. However, the technique cannot be used to evaluate sinuses with totally obstructed ostia or postoperative sinuses with very wide neo-ostia, as rapid washout may lead to no activity remaining at the time of measurement.

Background and Purpose — The present study prospectively evaluated relationships among baseline characteristics, cerebral hemodynamics, and outcome of patients with symptomatic major cerebral artery occlusion, by quantitative measurement of cerebral blood flow using xenon-133 ( 133 Xe) inhalation and single-photon emission computed tomography (SPECT). Methods — Regional cerebrovascular reactivity (rCVR) to acetazolamide was calculated at entry to the study using 133 Xe SPECT. Seventy consecutive patients aged less than 70 years with unilateral internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion were divided into 2 groups: normal or reduced rCVR, and prospectively followed up for a period of 24 months. Results — During the follow-up period, recurrent strokes occurred in 8 of the 23 patients with reduced rCVR at entry and in 3 of 47 patients with normal rCVR. Cumulative recurrence-free survival rates in all patients, and in each subgroup of patients with ICA or MCA occlusion and reduced rCVR on entry, were significantly lower than in those with normal rCVR ( P =0.0030, P =0.0404, and P =0.0310, respectively; Kaplan-Meier analysis). Among the factors considered, only lower rCVR and resting regional cerebral blood flow values were significantly associated with the risk of stroke recurrence ( P =0.0019 and P =0.0080, respectively; Cox regression multivariate analysis). Conclusions — The present study demonstrated that reduced rCVR to acetazolamide as determined by 133 Xe SPECT is significantly associated with an increased risk of stroke recurrence in patients with symptomatic MCA or ICA occlusion.

Summary: Brain arteriovenous malformation (BAVM) resection can result in an acute increase in cerebral blood flow (CBF) of unclear etiology. This observational study investigated the relationship between changes in CBF and cardiac output (CO) in patients undergoing microsurgical resection of BAVMs. In 20 patients undergoing a BAVM resection during an isoflurane-based anesthesia, we measured CBF and systemic cardiovascular parameters immediately before and after BAVM resection. CBF was measured on the hemisphere ipsilateral to the lesions and on the contralateral side, using intravenous cold 133Xe washout. Cardiac output was measured using thermodilution technique via a pulmonary artery catheter. There was an increase in global CBF after resection (25 ± 8 versus 31 ± 13 mL/100 g/min, preresection versus postresection, mean ± SD, P = .002), ipsilateral CBF (25 ± 8 versus 31 ± 13 mL/100 g/min, P = .002), and contralateral CBF (24 ± 7 versus 30 ± 13 mL/100 g/min, P = .003). There was no change in CO, mean systemic arterial pressure, central venous pressure, or pulmonary artery diastolic pressure. The change in CBFGLOBAL was not correlated with changes in CO (r = .154, P = .517). BAVM resection resulted in global increases in CBF that was not substantially related to changes in CO or other systemic parameters.

This paper describes the recent advances in technical and analytical methods in pulmonary ventilation SPECT studies, including a respiratory-gated image acquisition of Technetium-99m (99mTc)-labeled Technegas SPECT, a fusion image between Technegas SPECT and chest CT images created by a fully automatic image registration algorithm, and a three-dimensional (3D). display of xenon-133 (133Xe) gas SPECT data, and new analytical approaches by means of fractal analysis or the coefficient of variations of the pixel counts for Technegas SPECT data. The respiratory-gated image acquisition can partly eliminate problematic effects of the SPECT images obtained during non-breath-hold. The fusion image is available for routine clinical use, and provides complementary information on function and anatomy. The 3D displays of dynamic 133Xe SPECT data are helpful for accurate perception of the anatomic extent and locations of impaired ventilation, and the assessment of the severity of ventilation abnormalities. The new analytical approaches facilitate the objective assessment of the degrees of ventilation abnormalities.

The purpose of this study was to examine the 133xenon washout technique as a viable method for measuring adipose tissue blood flow (ATBF) in swine. Using a total of 32 female Yucatan miniature swine (Sus scrofa), the partition coefficient for 133xenon in swine subcutaneous adipose tissue was determined and ATBF was measured at rest and under various physiological conditions. These conditions included feeding, anesthesia, epinephrine infusion, and acute exercise. The effects of epinephrine and acute exercise were examined in both sedentary and exercise-trained swine. The partition coefficient value for 133xenon in swine subcutaneous adipose tissue was 9.23+/-0.26 mL/g (mean +/- SD, n = 10). The average value for resting ATBF in swine was 3.98+/-2.72 mL/(100 g tissue-min) (n = 19). Feeding increased ATBF by approximately fivefold over fasting values, and isoflurane anesthesia significantly decreased ATBF compared to rest (1.64+/-1.12 vs 3.92+/-4.22 mL/[100 g x min], n = 10). A 30-min epinephrine infusion (1 microg/[kg BW x min]) significantly increased ATBF from a resting value of 3.13+/-2.61 to 10.35+/-5.31 mL/(100 g x min) (n = 12). Epinephrine infusion into exercise-trained swine increased ATBF to the same extent as when infused into sedentary swine. An acute, 20-min bout of exercise significantly increased ATBF in swine, and the sedentary swine showed a larger increase in ATBF than their exercise-trained littermates relative to rest: 7.83 vs 2.98 mL/(100 g x min). In conclusion, the 133xenon washout technique appears to be a viable method for measuring ATBF in swine; our findings are comparable to swine ATBF values reported using the microsphere method and are consistent with values reported in animal and human studies.

The iodinated cocaine derivative [(123)I]PE2I is a new selective ligand for in vivo studies of the dopamine transporter (DAT) with single-photon emission tomography (SPET). The aim of the present study was to describe a method for accurate quantification of binding data following a bolus injection of [(123)I]PE2I. Six healthy subjects (age 51+/-24 years) underwent xenon-133 SPET for quantification of regional CBF and [(123)I]PE2I SPET for quantification of DAT binding. rCBFs were within normal limits in all subjects. Fitting data to a two-tissue compartment model resulted in striatal K(1) values of 0.39+/-0.08 ml ml(-1) min(-1), equal to a first-pass extraction fraction of 0.72+/-0.13. Distribution volumes (DVs) were calculated using compartment analysis, area under the curve analysis and Logan analysis. Logan analysis is preferred since stable DV values were already obtained 120 min after [(123)I]PE2I injection. Mean striatal DV was 37.9+/-9.6 ml ml(-1) and mean occipital cortex DV was 5.5+/-0.7 ml ml(-1). In the absence of local pathology in a reference tissue, Logan analysis without blood sampling is an attractive method for accurate quantification of striatal [(123)I]PE2I binding. The distribution volume ratio (DVR) (6.6+/-1.4) was in good agreement with the DVR calculated with blood (6.7+/-1.4).

For the past 10 y Health Canada has operated a Fixed Point Surveillance Network of NaI(Tl) detectors across Canada. Deployed for both emergency response and daily monitoring of airborne radiation in the environment, a spectral stripping method allowed measurement of certain isotopes well below the ambient dose rate. These include (133)Xe, (135)Xe and (41)Ar, typical of emissions from operating nuclear reactors. In an effort to increase the number of isotopes measured at these low levels a new technique of spectral fitting using spectral templates is being implemented. However, this requires very accurate spectral templates that can be difficult or impossible to obtain empirically for environmental measurements of airborne radio-isotopes. Therefore, a method of efficiently using Monte Carlo techniques to create these templates was developed.

Purpose: This report describes quantitative SPECT cerebral blood flow (CBF) changes in a patient with the confirmed Heidenhain variant of Creutzfeldt-Jakob disease. Materials and Methods: A 60-year-old man reported visual disturbances, including left hemianopsia. An electroencephalogram, magnetic resonance imaging, cerebral arteriogram, and quantitative SPECT CBF imaging with Xe-133, with and without acetazolamide, were performed. After the patient's death, an autopsy was performed. Results: The electroencephalographic findings were nonspecific, those of magnetic resonance imaging were normal, and the cerebral arteriogram showed minimal atherosclerosis. However, the SPECT scan revealed marked depression of perfusion in the parietal and occipital cortices that did not change with the administration of acetazolamide. Autopsy results were consistent with CJD. Conclusions: Although there is no consistent pattern of CBF changes that is characteristic of Creutzfeldt-Jakob disease, the Heidenhain variant of that disease may be an exception. Clinical symptoms include profound changes in vision, and the pattern of CBF changes in the patient described here included depression of perfusion in areas of primary and associated visual cortex. Also of interest is the finding that although other imaging did not reveal an abnormality, the CBF changes were marked. In addition, vasoreactivity is poor in response to acetazolamide, a finding that occurs only late in other neuronal degenerative conditions such as Alzheimer disease.

Ventilation of the paranasal sinuses is of great importance in sinus pathophysiology. Therefore, methods of measuring sinus ventilation are important for the evaluation of patients with sinus disease. In the present study, a 133-xenon washout technique was used to evaluate the ventilation of the paranasal sinuses in 34 healthy subjects and in 13 subjects with sinus disease (5 patients with nasal polyposis and 8 patients with chronic sinusitis). For this purpose, a 133-xenon-air mixture was insufflated in each nostril and the washout of the radioactive gas from the paranasal sinuses was monitored with a dynamic single-photon-emission computed tomography camera. The half-time (±SD) was found to be 18 ± 18 minutes for the maxillary sinus, 10 ± 8 minutes for the frontal sinus, and 18 ± 23 minutes for the posterior ethmoid and sphenoid sinuses in the healthy subjects. Repeated measurements in 18 of the healthy subjects indicated that the method had acceptable reproducibility according to a Bland-Altman plot. The 133-xenon washout was not influenced by insufflation pressure, nasal patency, or body position. The subjects with sinus disease exhibited half-times of 77 ± 101 minutes for the maxillary sinus, 91 ± 124 minutes for the frontal sinus, and 60 ± 60 minutes for the posterior ethmoid and sphenoid sinuses. For patients with nasal polyposis, the half-time was significantly longer than that in healthy subjects, while patients with chronic sinusitis did not differ from healthy subjects in this respect.