300 results on '"R Edward, Coleman"'
Search Results
2. Multifractal texture analysis of perfusion lung scans as a potential diagnostic tool for acute pulmonary embolism.
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Georgia D. Tourassi, Erik D. Frederick, Carey E. Floyd Jr., and R. Edward Coleman
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- 2001
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Catalog
3. Interactive visualization of three-dimensional SPECT cardiac images.
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Mark F. Smith, Ronald J. Jaszczak, Carey E. Floyd Jr., Kim L. Greer, and R. Edward Coleman
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- 1990
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4. Fractal Texture Analysis of Perfusion Lung Scans.
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Georgia D. Tourassi, Erik D. Frederick, Neal F. Vittitoe, and R. Edward Coleman
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- 2000
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5. Bayesian reconstruction and use of anatomical a priori information for emission tomography.
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James E. Bowsher, Valen E. Johnson, Timothy G. Turkington, Ronald J. Jaszczak, Carey E. Floyd Jr., and R. Edward Coleman
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- 1996
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6. Reconstruction of SPECT images using generalized matrix inverses.
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Mark F. Smith, Carey E. Floyd Jr., Ronald J. Jaszczak, and R. Edward Coleman
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- 1992
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7. Solid geometry-based object model for Monte Carlo simulated emission and transmission tomographic imaging systems.
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Huili Wang, Ronald J. Jaszczak, and R. Edward Coleman
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- 1992
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8. Maximum likelihood reconstruction for pinhole SPECT with a displaced center-of-rotation.
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Jianying Li, Ronald J. Jaszczak, and R. Edward Coleman
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- 1995
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9. Type 2 diabetes mellitus, brain atrophy, and cognitive decline
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Paul S. Aisen, Sarah Walter, Kenneth M. Spicer, Stephanie Reeder, Nick C. Fox, Heather Anderson, Chuang Kuo Wu, Teresa Villena, Cynthia M. Carlsson, Paul Malloy, Bonnie S. Goldstein, Stacy Schneider, Po H. Lu, Jeffrey M. Burns, Balebail Ashok Raj, Stephanie Kielb, Adrian Preda, Pierre N. Tariot, Chet Mathis, Christopher H. van Dyck, Maria Carroll, Karen E. Smith, Lon S. Schneider, Velandai Srikanth, Daniel Varon, Nunzio Pomara, Michael Borrie, Eben S. Schwartz, Gaby Thai, Susan De Santi, Dana Nguyen, Daniel C. Marson, Gene E. Alexander, Thomas O. Obisesan, Steven Potkin, Kris A. Johnson, Henry Rusinek, Nigel J. Cairns, Gad A. Marshall, Scott C. Neu, Benita Mudge, Leyla deToledo-Morrell, Jeff D. Williamson, Helen Vanderswag, Howard Chertkow, Sandra W. Jacobson, Dana Mathews, Arthur W. Toga, Saba Wolday, Douglas W. Scharre, Lidia Glodzik, Rob Bartha, Anders M. Dale, Norbert Schuff, Ging-Yuek Robin Hsiung, Rachelle S. Doody, Richard D. King, Vernice Bates, Li Shen, Barton Lane, Kristin Fargher, Chris Moran, Greg Jicha, Dan Bandy, Sara Dolen, Andrew E. Budson, Martha G. MacAvoy, Daniel H.S. Silverman, Anton P. Porsteinsson, Kathleen R. Johnson, Michele L. Callisaya, Betty Lind, Michael D. Devous, Robert C. Green, P. Murali Doraiswamy, Andrew J. Saykin, Joseph F. Quinn, Kristina Lipowski, Raymundo Hernando, Catherine Mc-Adams-Ortiz, Ronald G. Thomas, Jeffrey Kaye, Irina Rachinsky, Donna Munic, Munir Chowdhury, Bruce L. Miller, Les Shaw, Brian R. Ott, Randall Griffith, Kristen Martin-Cook, Marwan N. Sabbagh, Crystal V. Flynn Longmire, Raymond Scott Turner, Karen Blank, Effie M. Mitsis, Charles Bernick, Marilyn S. Albert, John M Olichney, Earl A. Zimmerman, Jared R. Tinklenberg, Robert A. Koeppe, Dick Trost, Howard Feldman, Laura L. Boles Ponto, M. Saleem Ismail, Alan J. Lerner, Kelly M. Makino, Pradeep Garg, Jeffrey R. Petrella, Peter J. Snyder, Norman R. Relkin, Laurel A. Beckett, Allyson C. Rosen, Devon Gessert, MaryAnn Oakley, J. Q. Trojanowki, Lisa Raudin, Stephen Salloway, Paula Ogrocki, Bryan M. Spann, Susan K. Schultz, Adam S. Fleisher, Brigid Reynolds, Jason Karlawish, Michele Assaly, John Q. Trojanowki, Kewei Chen, Enchi Liu, Mary Quiceno, Kaycee M. Sink, Jerome A. Yesavage, Sterling C. Johnson, Curtis B. Caldwell, Heather E. Johnson, Neill R. Graff-Radford, Karen S. Anderson, Richard Frank, John C. Morris, Donna M. Simpson, Tatiana Foroud, Joel P. Felmlee, Zaven Kachaturian, Magdalena Korecka, George Bartzokis, Francine Parfitt, Henry W. Querfurth, Patricia Lynn Johnson, Raj C. Shah, M.-Marsel Mesulam, Howard J. Rosen, Ann Marie Hake, Danielle J Harvey, Hyungsub Shim, Dick J. Drost, Yaakov Stern, Charles DeCarli, Brandy R. Matthews, Geoffrey Tremont, Kim Martin, Robert B. Santulli, Aliza Romirowsky, Joy L. Taylor, Ramon Diaz-Arrastia, Godfrey D. Pearlson, Mark A. Mintun, James J. Lah, Norm Foster, Matt A. Bernstein, Diana R. Kerwin, Virginia M.-Y. Lee, Bojana Stefanovic, Joanne L. Lord, Chris Hosein, Susan E. Molchan, David J. Clark, Leon Hudson, Janet S. Cellar, Karen Crawford, Richard Beare, Franklin Watkins, T. J. Montine, Ronald C. Petersen, Carl H. Sadowsky, David A. Wolk, Steven E. Arnold, Nancy Collins Johnson, Ruth A. Mulnard, Antero Sarrael, John Kornak, Amanda Smith, Owen Carmichael, Beau M. Ances, Clifford R. Jack, Meghan Frey, Martin R. Farlow, William J. Jagust, Ronald J. Killiany, Mony J. de Leon, Sandra E. Black, Javier Villanueva-Meyer, Smita Kittur, Walter Martinez, Sue Leon, Anthony Gamst, James B. Brewer, Hillel Grossman, Eric M. Reiman, Jacobo Mintzer, Stephen Correia, Kyle B. Womack, Maria Kataki, Lawrence S. Honig, Liana G. Apostolova, Peggy Roberts, Christine Belden, Michelle Rainka, Alexander Norbash, R. Edward Coleman, Richard E. Carson, Dzintra Celmins, Lisa Taylor-Reinwald, Scott Herring, Oscar L. Lopez, Michael W. Weiner, Ranjan Duara, Elizabether Finger, Peter A. Hardy, Myron F. Weiner, Horacio Capote, Keith A. Johnson, Karen L. Bell, Allan I. Levey, Steven G. Potkin, Howard Bergman, John A. Rogers, Wei Wang, Connie Brand, Chiadi U. Onyike, Paul M. Thompson, Russell H. Swerdlow, Gloria Chaing, Judith L. Heidebrink, Salome K. Bwayo, Reisa A. Sperling, Michael C. Donohue, Sanjay Asthana, Alice D. Brown, Charles D. Smith, Neil W. Kowall, Andrew Kertesz, Tamie Sather, Evan Fletcher, and Sonia Pawluczyk more...
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Blood Glucose ,Male ,Pediatrics ,medicine.medical_specialty ,endocrine system diseases ,Article ,Alzheimer Disease ,medicine ,Dementia ,Humans ,Cognitive Dysfunction ,Longitudinal Studies ,Cognitive decline ,Cognitive reserve ,Aged ,Aged, 80 and over ,Cerebral Cortex ,business.industry ,Type 2 Diabetes Mellitus ,nutritional and metabolic diseases ,Brain ,Cognition ,Organ Size ,medicine.disease ,Magnetic Resonance Imaging ,Cognitive test ,Diabetes Mellitus, Type 2 ,Cohort ,Female ,Neurology (clinical) ,Alzheimer's disease ,Atrophy ,business ,Factor Analysis, Statistical - Abstract
ObjectiveTo study longitudinal relationships between type 2 diabetes mellitus (T2DM), cortical thickness, and cognitive function in older people with normal cognition, mild cognitive impairment, and Alzheimer disease (AD).MethodsThe sample was derived from the Alzheimer's Disease Neuroimaging Initiative cohort who underwent brain MRI and cognitive tests annually for 5 years. Presence of T2DM was based on fasting blood glucose ≥7.0mml/L or the use of glucose-lowering agents. We used latent growth curve modeling to explore longitudinal relationships between T2DM, cortical thickness, and cognitive function, adjusting for relevant covariates and testing for interactions.ResultsThere were 124 people with T2DM (mean age 75.5 years, SD 6.2) and 693 without T2DM (mean age 75.1 years, SD 6.9) with at least 1 MRI available. AD and lower cortical thickness at study entry was associated with a lower chance of having a MRI available at each follow-up phase (all p < 0.001). T2DM was associated with lower baseline cortical thickness (p = 0.01). We found no direct effect of T2DM on decline in cortical thickness or cognitive function, but there was an indirect pathway linking T2DM and cognitive decline via baseline cortical thickness (β = −0.17, p = 0.022). There was an interaction between T2DM and education whereby the negative effect of T2DM on baseline cortical thickness was reduced in those with greater education (β = 0.34, p = 0.037). These associations changed minimally when adjusted for baseline cognitive diagnosis.ConclusionsIn an older cohort with low cerebrovascular disease burden, T2DM contributes to cognitive decline via neurodegeneration. Prior brain and cognitive reserve may protect against this effect. more...
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- 2018
10. Accuracy of positron emission tomography in identifying hilar (N1) lymph node involvement in non-small cell lung cancer: Implications for stereotactic body radiation therapy
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R. Edward Coleman, Lawrence B. Marks, Jeffrey Crawford, Mark F. Berry, Joseph M. Pepek, Neal Ready, Chris R. Kelsey, Thomas A. D'Amico, and Nathan G. Gee
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Hilum (biology) ,medicine.disease ,Radiosurgery ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,Positron emission tomography ,medicine ,Radiology, Nuclear Medicine and imaging ,Lymph ,Radiology ,Stage (cooking) ,Lung cancer ,business ,Lymph node - Abstract
Purpose To assess the efficacy of preoperative positron emission tomography (PET) to stage the ipsilateral hilum in resected non-small cell lung cancer (NSCLC). Methods and materials All patients who underwent surgery for NSCLC between 1995 and 2008 were evaluated. Patients who underwent preoperative PET imaging at our institution and had hilar nodal sampling were included. Those whose primary tumors extended to the hilum or who received preoperative chemotherapy or radiation therapy were excluded. All PET studies were interpreted by an attending nuclear medicine radiologist and were scored as positive or negative in the hilum or peribronchial area based on visual analysis alone. A 2-sided Fisher exact test compared patient subgroups. Results During the time interval, 1558 patients underwent surgery for NSCLC, of whom 484 were eligible for this analysis. The ipsilateral hilum was positive on preoperative PET in 107 patients. The median number of N1 lymph nodes sampled was 4 (range, 1-31). Positive ipsilateral N1 lymph nodes were identified pathologically in 91 patients (19%). Among the 91 patients with involved N1 lymph nodes, 40 were PET positive resulting in a sensitivity of 44%. Among 393 patients without pathologic involvement of hilar lymph nodes, 326 were PET negative resulting in a specificity of 83%. The positive predictive and negative predictive values were 37% and 86%, respectively. Conclusions Positron emission tomography appears to have limitations in staging the ipsilateral hilar lymph nodes. Invasive sampling is appropriate if treatment would differ based on the nodal status. more...
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- 2015
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11. Florbetapir F 18 amyloid PET and 36-month cognitive decline:a prospective multicenter study
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R. Edward Coleman, Jeff D. Williamson, Gustavo Alva, Michael J. Pontecorvo, Abhinay D. Joshi, Beth Safirstein, K Johnson, Jeanette K Wendt, M N Sabbagh, Eric M. Reiman, Mark A. Mintun, Ron Korn, Terence Z. Wong, Geoffrey L. Ahern, Cynthia A Murphy, Adam S. Fleisher, Dean Wong, Richard Holub, Keith A. Johnson, Crystal V. Flynn Longmire, Carl H. Sadowsky, George Jewell, Mildred Farmer, Daniel Skovronsky, Michael D. Devous, P. Murali Doraiswamy, C H Sadowsky, Ming Lu, Ranjan Duara, Marwan N. Sabbagh, Michael Grundman, Karel D. Kovnat, P. M. Doraiswamy, Danna Jennings, Michael Weiner, Reisa A. Sperling, and Alana Carpenter more...
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Male ,medicine.medical_specialty ,Pediatrics ,Amyloid pet ,Neuropsychological Tests ,behavioral disciplines and activities ,Cellular and Molecular Neuroscience ,Alzheimer Disease ,mental disorders ,medicine ,Humans ,Cognitive Dysfunction ,Longitudinal Studies ,Prospective Studies ,Cognitive decline ,Psychiatry ,Molecular Biology ,Nootropic Agents ,Aged ,Amyloid beta-Peptides ,Aniline Compounds ,Brain ,amyloid ,cognitive decline ,MCI ,Psychiatry and Mental health ,PET ,Multicenter study ,Positron-Emission Tomography ,Disease Progression ,alzheimer's disease ,florbetapir ,Ethylene Glycols ,Female ,Original Article ,Radiopharmaceuticals ,Psychology ,human activities ,Follow-Up Studies - Abstract
This study was designed to evaluate whether subjects with amyloid beta (Aβ) pathology, detected using florbetapir positron emission tomorgraphy (PET), demonstrated greater cognitive decline than subjects without Aβ pathology. Sixty-nine cognitively normal (CN) controls, 52 with recently diagnosed mild cognitive impairment (MCI) and 31 with probable Alzheimer's disease (AD) dementia were included in the study. PET images obtained in these subjects were visually rated as positive (Aβ+) or negative (Aβ-), blind to diagnosis. Fourteen percent (10/69) of CN, 37% (19/52) of MCI and 68% (21/31) of AD were Aβ+. The primary outcome was change in ADAS-Cog score in MCI subjects after 36 months; however, additional outcomes included change on measures of cognition, function and diagnostic status. Aβ+ MCI subjects demonstrated greater worsening compared with Aβ- subjects on the ADAS-Cog over 36 months (5.66 ± 1.47 vs -0.71 ± 1.09, P = 0.0014) as well as on the mini-mental state exam (MMSE), digit symbol substitution (DSS) test, and a verbal fluency test (P0.05). Similar to MCI subjects, Aβ+ CN subjects showed greater decline on the ADAS-Cog, digit-symbol-substitution test and verbal fluency (P0.05), whereas Aβ+ AD patients showed greater declines in verbal fluency and the MMSE (P0.05). Aβ+ subjects in all diagnostic groups also showed greater decline on the CDR-SB (P0.04), a global clinical assessment. Aβ+ subjects did not show significantly greater declines on the ADCS-ADL or Wechsler Memory Scale. Overall, these findings suggest that in CN, MCI and AD subjects, florbetapir PET Aβ+ subjects show greater cognitive and global deterioration over a 3-year follow-up than Aβ- subjects do. more...
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- 2014
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12. Impact of 18F-Fluoride PET in Patients with Known Prostate Cancer: Initial Results from the National Oncologic PET Registry
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R. Edward Coleman, Fenghai Duan, Barry A. Siegel, Anthony F. Shields, Bruce E. Hillner, and Lucy Hanna
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Male ,medicine.medical_specialty ,Medical Oncology ,Development policy ,Cohort Studies ,Prostate cancer ,Fluorodeoxyglucose F18 ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Registries ,Prospective cohort study ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Prostatic Neoplasms ,Bone metastasis ,Cancer ,medicine.disease ,United States ,Bone scintigraphy ,Data Interpretation, Statistical ,Positron-Emission Tomography ,Sodium Fluoride ,Radiology ,Neoplasm Recurrence, Local ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,business ,18f fluoride ,Nuclear medicine - Abstract
Under Medicare’s Coverage with Evidence Development policy, PET using 18F-sodium fluoride (NaF PET) to identify osseous metastasis became a covered service if prospective registry data were collected. The National Oncologic PET Registry (NOPR) developed a NaF PET registry built on the foundation of its prior registry for PET with 18F-FDG. Men with prostate cancer represented 72% of the cases. Methods: Prospective data before and after NaF PET were collected from referring and interpreting physicians. The analysis set consisted of consenting men age 65 y or older with prostate cancer undergoing NaF PET for initial staging (IS, n = 1,024), suspected first osseous metastasis (FOM, n = 1,997), or suspected progression of osseous metastasis (POM, n = 510). Results: Referring physicians indicated that if NaF PET were not available, other advanced imaging (body CT, MR imaging, or 18F-FDG PET) would be their plan in about half of the cases. After NaF PET, the postimaging plan was revised to treatment in 77%, 52%, and 71% for IS, FOM, and POM, respectively. When intended management was classified as either treatment or nontreatment, the overall change in intended management ranged from 44% to 52% and from 12% to 16% if no effect was assumed for those cases with pre-PET plans for other imaging (imaging-adjusted impact). Interpreting physicians recorded definite findings of bone metastasis in 14%, 29%, and 76% for IS, FOM, and POM, respectively. The intended care patterns varied widely across indication and scan abnormality category combinations. Conclusion: NaF PET has high overall impact, principally related to its effect on replacing intended use of other advanced imaging. Its imaging-adjusted impact was similar to that observed with 18F-FDG PET for restaging or suspected recurrence in other cancer types. more...
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- 2014
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13. Neuropathologic Heterogeneity Does Not Impair Florbetapir-Positron Emission Tomography Postmortem Correlates
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Julie A. Schneider, Thomas G. Beach, Michael J. Pontecorvo, Lucia I. Sue, Abhinay D. Joshi, Barry J. Bedell, Brittany N. Dugger, Daniel Skovronsky, P. Murali Doraiswamy, Christopher M. Clark, Ming Lu, Marwan N. Sabbagh, Alan Carpenter, Monica Mariner, Eric M. Reiman, R. Edward Coleman, Geidy E. Serrano, Mark A. Mintun, Adam S. Fleisher, Simone P. Zehntner, and Carl H. Sadowsky more...
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Male ,Aging ,Fluorine Radioisotopes ,Pathology ,TDP-43 ,PET imaging ,Autopsy ,Neurodegenerative ,Alzheimer's Disease ,Vascular dementia ,Argyrophilic grains ,80 and over ,Aged, 80 and over ,screening and diagnosis ,Aniline Compounds ,medicine.diagnostic_test ,beta-amyloid ,White matter ,General Medicine ,Middle Aged ,Detection ,Plaques ,medicine.anatomical_structure ,Neurology ,Positron emission tomography ,Neurological ,Ethylene Glycols ,Female ,Cerebral amyloid angiopathy ,Alzheimer's disease ,Psychology ,4.2 Evaluation of markers and technologies ,medicine.medical_specialty ,Amyloid ,Clinical Sciences ,Paired comparison ,Article ,Pathology and Forensic Medicine ,Cellular and Molecular Neuroscience ,Alzheimer Disease ,Acquired Cognitive Impairment ,medicine ,Humans ,Aged ,Leuko-araiosis ,Neurology & Neurosurgery ,Neurosciences ,Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD) ,medicine.disease ,Brain Disorders ,Positron-Emission Tomography ,Neuropathogenesis ,Dementia ,Neurology (clinical) ,Lewy bodies - Abstract
Neuropathologic heterogeneity is often present among Alzheimer disease (AD) patients. We sought to determine whether amyloid imaging measures of AD are affected by concurrent pathologies. Thirty-eight clinically and pathologically defined AD and 17 nondemented patients with quantitative florbetapir F-18 (F-AV-45) positron emission tomography (PET) imaging during life and postmortem histological β-amyloid quantification and neuropathologic examination were assessed. AD patients were divided on the basis of concurrent pathologies, including those with Lewy bodies (LBs) (n = 21), white matter rarefaction (n = 27), severe cerebral amyloid angiopathy (n = 11), argyrophilic grains (n = 5), and TAR DNA binding protein-43 inclusions (n = 18). Many patients exhibited more than 1 type of concurrent pathology. The ratio of cortical to cerebellar amyloid imaging signal (SUVr) and immunohistochemical β-amyloid load were analyzed in 6 cortical regions of interest. All AD subgroups had strong and significant correlations between SUVr and histological β-amyloid measures (p μ 0.001). All AD subgroups had significantly greater amyloid measures versus nondemented patients, and mean amyloid measures did not significantly differ between AD subgroups. When comparing AD cases with and without each pathology, AD cases with LBs had significantly lower SUVr measures versus AD cases without LBs (p = 0.002); there were no other paired comparison differences. These findings indicate that florbetapir-PET imaging is not confounded by neuropathological heterogeneity within AD. more...
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- 2014
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14. Are discordant positron emission tomography and pathological assessments of the mediastinum in non–small cell lung cancer significant?
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Daniel J. Tandberg, Junzo Chino, Thomas A. D'Amico, Nathan G. Gee, R. Edward Coleman, Neal Ready, and Chris R. Kelsey
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,Biopsy ,medicine.medical_treatment ,Standardized uptake value ,Kaplan-Meier Estimate ,Risk Assessment ,Pneumonectomy ,Predictive Value of Tests ,Risk Factors ,Carcinoma, Non-Small-Cell Lung ,North Carolina ,medicine ,Humans ,Lung cancer ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Fluorodeoxyglucose ,medicine.diagnostic_test ,business.industry ,Hazard ratio ,Mediastinum ,Middle Aged ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Positron emission tomography ,Lymphatic Metastasis ,Positron-Emission Tomography ,Mediastinal lymph node ,Multivariate Analysis ,Lymph Node Excision ,Female ,Surgery ,Lymph Nodes ,Radiology ,Neoplasm Recurrence, Local ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,medicine.drug - Abstract
Objective Many patients with non–small cell lung cancer have positive mediastinal lymph nodes on preoperative positron emission tomography (PET) but do not have mediastinal involvement after surgery. The prognostic significance of this discordance was assessed. Methods This Institutional Review Board–approved study evaluated patients treated with upfront surgery at Duke Cancer Institute (Durham, NC) for non–small cell lung cancer from 1995 to 2008. Those staged with PET with pN0-1 disease after negative invasive mediastinal assessment were included. Mediastinal lymph nodes were scored as positive or negative based on visual analysis of the preoperative PET. Clinical outcomes of the PET-positive and PET-negative cohorts were estimated using the Kaplan-Meier method and compared using a log-rank test. Prognostic factors were assessed using a multivariate analysis. Results A total of 547 patients were assessed, of whom 105 (19%) were PET positive in the mediastinum. The median number of mediastinal lymph node stations sampled was 4 (range, 1-9). The 5-year risk of local recurrence was 26% in PET-positive versus 21% in PET-negative patients ( P = .50). Patterns of local failure were similar between the 2 groups. Distant recurrence (35% vs 29%; P = .63) and overall survival (44% vs 54%; P = .52) were comparable for PET-positive and PET-negative patients. On multivariate analysis, a positive PET was not significant for local recurrence (hazard ratio [HR], 1; P = 1), distant recurrence (HR, 0.82; P = .42), or overall survival (HR, 1.08; P = .62). Conclusions Patients with positive mediastinal lymph nodes on preoperative PET, but negative on histologic analysis, are not at increased risk of disease recurrence. Pathologic staging remains the standard. more...
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- 2013
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15. Does the Preparation and Utilization of 99mTc-Sulfur Colloid Affect the Outcomes of Breast Lymphoscintigraphy?
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R. Edward Coleman, Kingshuk Roy Choudhury, Terence Z. Wong, Kasey P. Nelson, Steven Shipes, William Hubble, and William L. Siler
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medicine.medical_specialty ,Sentinel lymph node ,Breast Neoplasms ,Radiation Dosage ,Vial ,Dosage form ,Colloid ,Breast cancer ,Sulfur colloid ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Breast ,Retrospective Studies ,Radiological and Ultrasound Technology ,business.industry ,General Medicine ,medicine.disease ,Surgery ,body regions ,Lymphatic Metastasis ,Technetium Tc 99m Sulfur Colloid ,Technetium Tc-99m Sulfur Colloid ,Lymph Nodes ,Lymph ,Nuclear medicine ,business ,Lymphoscintigraphy - Abstract
The purpose of this study was to determine whether certain factors in the preparation and use of 99mTc-sulfur colloid affected the number of sentinel lymph nodes (SLNs) detected during SLN mapping and during intraoperative SLN identification. The factors that were investigated included the use of a dry heat block versus a hot water bath to heat the 99mTc-sulfur colloid bulk vial, amount of 99m TcOH4 2 added to form the sulfur colloid particles, time between the unit dose calibration and the injection of the dose, and breast quadrant in which the injection occurred. Methods: Data were collected retrospectively and quantitatively analyzed from images and reports of 488 patients with breast cancer who had undergone SLN mapping and intraoperative SLN identification from January 1, 2008, to June 30, 2011, inclusive. The dependent variables assessed were the number of SLNs visualized during lymphoscintigraphy, number of radioactive SLNs removed during surgery, and total number of lymph nodes removed intraoperatively. Results: There was no significant difference in outcomes when comparing the amount of 99m TcOH4 2 added during the preparation process to form the sulfur colloid particles, time between the unit dose calibration time and the time that the unit doses were injected, or location in the breast tissue in which the unit dose was administered. Initially, there were observed significant differences in outcomes when the heating methods used to prepare the 99m Tc-sulfur colloid were compared. When the increased number of patients who were administered a calibrated unit dose activity of 74 MBq in the group using a dry heat block preparation method was taken into account, however, the findings were not significant. Conclusion: The use of a dry heat block versus a hot water bath to heat the 99mTc-sulfur colloid bulk vial, amount of 99m TcOH4 2 added to form sulfur colloid particles, time between the unit dose calibration and the injection of the dose, and breast quadrant in which the injection occurred do not affect the number of SLNs detected during SLN mapping and during intraoperative SLN identification. more...
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- 2013
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16. Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging
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R. Edward Coleman, Leonard R. Prosnitz, Jennifer A. Dorth, Louis F. Diehl, Anne W. Beaven, Gloria Broadwater, and Chris R. Kelsey
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Male ,Cancer Research ,Vincristine ,Cyclophosphamide ,medicine.medical_treatment ,CHOP ,Disease-Free Survival ,Antibodies, Monoclonal, Murine-Derived ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Retrospective Studies ,Chemotherapy ,Radiation ,business.industry ,Hazard ratio ,Neoplasms, Second Primary ,Radiotherapy Dosage ,Induction Chemotherapy ,Middle Aged ,medicine.disease ,Tumor Burden ,Radiation therapy ,Oncology ,Doxorubicin ,Positron-Emission Tomography ,Multivariate Analysis ,Prednisone ,Female ,Rituximab ,Lymphoma, Large B-Cell, Diffuse ,Tomography, X-Ray Computed ,business ,Nuclear medicine ,Diffuse large B-cell lymphoma ,medicine.drug - Abstract
Purpose While consolidation radiation therapy (i.e., RT administered after chemotherapy) is routine treatment for patients with early-stage diffuse large B-cell lymphoma (DLBCL), the role of consolidation RT in stage III-IV DLBCL is controversial. Methods and Materials Cases of patients with stage III-IV DLBCL treated from 1991 to 2009 at Duke University, who achieved a complete response to chemotherapy were reviewed. Clinical outcomes were calculated using the Kaplan-Meier method and were compared between patients who did and did not receive RT, using the log-rank test. A multivariate analysis was performed using Cox proportional hazards model. Results Seventy-nine patients were identified. Chemotherapy (median, 6 cycles) consisted of anti-CD20 antibody rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 65%); cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP; 22%); or other (13%). Post-chemotherapy imaging consisted of positron emission tomography (PET)/computed tomography (CT) (73%); gallium with CT (14%); or CT only (13%). Consolidation RT (median, 25 Gy) was given to involved sites of disease in 38 (48%) patients. Receipt of consolidation RT was associated with improved in-field control (92% vs. 69%, respectively, p = 0.028) and event-free survival (85% vs. 65%, respectively, p = 0.014) but no difference in overall survival (85% vs. 78%, respectively, p = 0.15) when compared to patients who did not receive consolidation RT. On multivariate analysis, no RT was predictive of increased risk of in-field failure (hazard ratio [HR], 8.01, p = 0.014) and worse event-free survival (HR, 4.3, p = 0.014). Conclusions Patients with stage III-IV DLBCL who achieve negative post-chemotherapy imaging have improved in-field control and event-free survival with low-dose consolidation RT. more...
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- 2012
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17. Cerebral PET with florbetapir compared with neuropathology at autopsy for detection of neuritic amyloid-β plaques: a prospective cohort study
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Mark A. Mintun, Christopher M. Clark, Adam S. Fleisher, Alan Carpenter, Daniel Skovronsky, P. Murali Doraiswamy, Ming Lu, Marwan N. Sabbagh, Michael J. Krautkramer, Carl H. Sadowsky, Thomas G. Beach, R. Edward Coleman, Eric M. Reiman, Matthew Flitter, Michael J. Pontecorvo, Abhinay D. Joshi, Barry J. Bedell, Julie A. Schneider, and Anupa Arora more...
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medicine.medical_specialty ,Amyloid pathology ,Amyloid ,Amyloid β ,business.industry ,Amyloid pet ,Autopsy ,Neuropathology ,medicine ,Neurology (clinical) ,Radiology ,business ,Nuclear medicine ,Prospective cohort study ,Florbetaben - Abstract
Summary Background Results of previous studies have shown associations between PET imaging of amyloid plaques and amyloid-β pathology measured at autopsy. However, these studies were small and not designed to prospectively measure sensitivity or specificity of amyloid PET imaging against a reference standard. We therefore prospectively compared the sensitivity and specificity of amyloid PET imaging with neuropathology at autopsy. Methods This study was an extension of our previous imaging-to-autopsy study of participants recruited at 22 centres in the USA who had a life expectancy of less than 6 months at enrolment. Participants had autopsy within 2 years of PET imaging with florbetapir ( 18 F). For one of the primary analyses, the interpretation of the florbetapir scans (majority interpretation of five nuclear medicine physicians, who classified each scan as amyloid positive or amyloid negative) was compared with amyloid pathology (assessed according to the Consortium to Establish a Registry for Alzheimer's Disease standards, and classed as amyloid positive for moderate or frequent plaques or amyloid negative for no or sparse plaques); correlation of the image analysis results with amyloid burden was tested as a coprimary endpoint. Correlation, sensitivity, and specificity analyses were also done in the subset of participants who had autopsy within 1 year of imaging as secondary endpoints. The study is registered with ClinicalTrials.gov, number NCT 01447719 (original study NCT 00857415). Findings We included 59 participants (aged 47–103 years; cognitive status ranging from normal to advanced dementia). The sensitivity and specificity of florbetapir PET imaging for detection of moderate to frequent plaques were 92% (36 of 39; 95% CI 78–98) and 100% (20 of 20; 80–100%), respectively, in people who had autopsy within 2 years of PET imaging, and 96% (27 of 28; 80–100%) and 100% (18 of 18; 78–100%), respectively, for those who had autopsy within 1 year. Amyloid assessed semiquantitatively with florbetapir PET was correlated with the post-mortem amyloid burden in the participants who had an autopsy within 2 years (Spearman ρ=0·76; p Interpretation The results of this study validate the binary visual reading method approved in the USA for clinical use with florbetapir and suggest that florbetapir could be used to distinguish individuals with no or sparse amyloid plaques from those with moderate to frequent plaques. Additional research is needed to understand the prognostic implications of moderate to frequent plaque density. Funding Avid Radiopharmaceuticals. more...
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- 2012
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18. Amyloid- assessed by florbetapir F 18 PET and 18-month cognitive decline: A multicenter study
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Mark A. Mintun, Alan Carpenter, Daniel Skovronsky, Adam S. Fleisher, Christopher M. Clark, Reisa A. Sperling, Michael J. Pontecorvo, Eric M. Reiman, Abhinay D. Joshi, Michael Grundman, P. Murali Doraiswamy, Marwan N. Sabbagh, Mat D. Davis, Carl H. Sadowsky, R. Edward Coleman, and Keith A. Johnson more...
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Male ,Risk ,Oncology ,medicine.medical_specialty ,Pathology ,Amyloid ,Standardized uptake value ,Neuropsychological Tests ,Alzheimer Disease ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Dementia ,Cognitive Dysfunction ,Longitudinal Studies ,Cognitive decline ,Aged ,Psychiatric Status Rating Scales ,Amyloid beta-Peptides ,Aniline Compounds ,medicine.diagnostic_test ,Brain ,Cognition ,medicine.disease ,Positron emission tomography ,Positron-Emission Tomography ,Predictive value of tests ,Ethylene Glycols ,Female ,Neurology (clinical) ,Radiopharmaceuticals ,Alzheimer's disease ,Cognition Disorders ,Psychology ,Psychomotor Performance ,Follow-Up Studies - Abstract
Florbetapir F 18 PET can image amyloid-β (Aβ) aggregates in the brains of living subjects. We prospectively evaluated the prognostic utility of detecting Aβ pathology using florbetapir PET in subjects at risk for progressive cognitive decline.A total of 151 subjects who previously participated in a multicenter florbetapir PET imaging study were recruited for longitudinal assessment. Subjects included 51 with recently diagnosed mild cognitive impairment (MCI), 69 cognitively normal controls (CN), and 31 with clinically diagnosed Alzheimer disease dementia (AD). PET images were visually scored as positive (Aβ+) or negative (Aβ-) for pathologic levels of β-amyloid aggregation, blind to diagnostic classification. Cerebral to cerebellar standardized uptake value ratios (SUVr) were determined from the baseline PET images. Subjects were followed for 18 months to evaluate changes in cognition and diagnostic status. Analysis of covariance and correlation analyses were conducted to evaluate the association between baseline PET amyloid status and subsequent cognitive decline.In both MCI and CN, baseline Aβ+ scans were associated with greater clinical worsening on the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog (p0.01) and Clinical Dementia Rating-sum of boxes (CDR-SB) (p0.02). In MCI Aβ+ scans were also associated with greater decline in memory, Digit Symbol Substitution (DSS), and Mini-Mental State Examination (MMSE) (p0.05). In MCI, higher baseline SUVr similarly correlated with greater subsequent decline on the ADAS-Cog (p0.01), CDR-SB (p0.03), a memory measure, DSS, and MMSE (p0.05). Aβ+ MCI tended to convert to AD dementia at a higher rate than Aβ- subjects (p0.10).Florbetapir PET may help identify individuals at increased risk for progressive cognitive decline. more...
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- 2012
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19. Variable-time positron emission tomography leg protocol to equalize noise for positron emission tomography/computed tomography acquisitions
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R. Edward Coleman, Joshua M. Wilson, and Timothy G. Turkington
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Adult ,Protocol (science) ,Physics ,Leg ,Image fusion ,Time Factors ,medicine.diagnostic_test ,Phantoms, Imaging ,Image quality ,business.industry ,Variable time ,Tapering ,General Medicine ,Noise ,Positron emission tomography ,Positron-Emission Tomography ,Image Processing, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Artifacts ,Tomography, X-Ray Computed ,Nuclear medicine ,business ,Positron Emission Tomography-Computed Tomography - Abstract
OBJECTIVES Positron emission tomography protocols conventionally use a constant scan time per bed position (BP). It may be optimal to spend more time scanning some body sections, particularly the more attenuating sections. The relatively consistent tapering of legs may allow a single, variable-time protocol that could reduce or redistribute time and equalize image quality throughout the leg. Reducing the total scan time will limit the opportunity for motion, which can reduce imaging artefacts and improves image fusion, will improve a patient's experience, and will yield the biggest gains in time for the tallest patients. METHODS Leg dimensions were studied in 55 adult positron emission tomography/computed tomography scans. Image quality versus size was parameterized using bottle phantoms (diameters, 4.5-19.7 cm) filled with identical 18F-fluorodeoxyglucose concentrations, positioned as legs and imaged. An exponential relationship of diameter to noise was fit to the data, which defined the noise-equalizing, variable-time protocol. RESULTS Of 55 patient leg studies, 94.5% (52/55) had leg diameters that were less than ± 7.5% of the mean leg diameter for other patients of similar height. To equalize noise throughout the leg, relative scan times from superior to inferior as a function of BP are (1, 0.65, 0.45, 0.36, 0.30, and 0.25). CONCLUSION Variable time compared with a constant-time protocol can require 75% less time for some BPs and half the total acquisition time. A variable-time protocol to reduce time has been implemented. more...
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- 2011
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20. Uric acid is a danger signal of increasing risk for osteoarthritis through inflammasome activation
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Susan J. Kelly, Anna E. Denoble, Michael S. Hershfield, Virginia B. Kraus, R. Edward Coleman, Kim M. Huffman, Thomas Stabler, and G. McDaniel
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Male ,NALP3 ,Osteoarthritis ,Severity of Illness Index ,Pyrin domain ,Cohort Studies ,chemistry.chemical_compound ,Risk Factors ,NLR Family, Pyrin Domain-Containing 3 Protein ,medicine ,Humans ,Synovial fluid ,Knee ,Aged ,Multidisciplinary ,biology ,business.industry ,Interleukin-18 ,Interleukin ,Inflammasome ,Middle Aged ,Biological Sciences ,medicine.disease ,Uric Acid ,chemistry ,Immunology ,biology.protein ,Uric acid ,Female ,Interleukin 18 ,Carrier Proteins ,business ,Interleukin-1 ,medicine.drug - Abstract
Uric acid (UA) is known to activate the NLRP3 (Nacht, leucine-rich repeat and pyrin domain containing protein 3) inflammasome. When activated, the NLRP3 (also known as NALP3) inflammasome leads to the production of IL-18 and IL-1β. In this cohort of subjects with knee osteoarthritis (OA), synovial fluid uric acid was strongly correlated with synovial fluid IL-18 and IL-1β. Synovial fluid uric acid and IL-18 were strongly and positively associated with OA severity as measured by both radiograph and bone scintigraphy, and synovial fluid IL-1β was associated with OA severity but only by radiograph. Furthermore, synovial fluid IL-18 was associated with a 3-y change in OA severity, on the basis of the radiograph. We conclude that synovial fluid uric acid is a marker of knee OA severity. The correlation of synovial fluid uric acid with the two cytokines (IL-18 and IL-1β) known to be produced by uric acid-activated inflammasomes and the association of synovial fluid IL-18 with OA progression, lend strong support to the potential involvement of the innate immune system in OA pathology and OA progression. more...
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- 2011
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21. Impact of Dedicated Brain PET on Intended Patient Management in Participants of the National Oncologic PET Registry
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Bruce E. Hillner, Ilana F. Gareen, R. Edward Coleman, Lucy Hanna, Fenghai Duan, Barry A. Siegel, and Anthony F. Shields
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Medicine(all) ,Cancer Research ,medicine.medical_specialty ,medicine.diagnostic_test ,Brain Neoplasms ,business.industry ,Patient management ,Oncology ,Positron emission tomography ,Positron-Emission Tomography ,Brain positron emission tomography ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Registries ,business - Abstract
This study seeks to assess the impact of dedicated brain positron emission tomography (PET) with 2-deoxy-2-[(18)F]fluoro-D-glucose on intended management of patients with primary and metastatic brain tumors.We analyzed demographic characteristics and evaluated change in intended management after PET, using previously described metrics, for patients in the National Oncologic PET Registry (NOPR) undergoing dedicated brain PET. For cases of primary brain tumors, comparisons to the overall NOPR cohort were made. PATIENT PROFILE: Between December 2006 and April 2009, 509 dedicated brain PET scans were done on 479 patients--367 (72.1%) for suspected or proven primary brain tumors and 142 (27.9%) for brain metastases. Compared with the overall NOPR cohort, subjects in the dedicated brain cohort were younger (41.3% less than 65 years vs. 10.5% overall, p0.0001) and more frequently had functional limitations from their cancers (78.6% vs. 62.3% overall; odds ratio (OR) 2.2, 95% CI 1.8-2.8).The pre-PET patient management plans in the primary brain tumor and metastasis subgroups were similar. A pre-PET plan of tissue biopsy was slightly more frequent than one of the treatments (31.3% vs. 28.6%) in the primary brain tumor subgroup and was more common than in the overall NOPR cohort (14.2%; OR 2.8, 95% CI 2.2-3.5). Changes from treatment to non-treatment also were more frequent than in the overall NOPR cohort (13.4% vs. 7.7%; OR 1.9, 95% CI 1.3-2.5).Among NOPR patients, dedicated brain PET was associated with similar net changes in intended management as in the overall NOPR cohort. However, brain PET patients were younger, more likely to be symptomatic, and less likely to have a change in management from non-treatment to treatment as a post-PET plan. more...
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- 2010
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22. Combination of Converging Collimators for High-Sensitivity Brain SPECT
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R. Ter-Antonyan, Ronald J. Jaszczak, Kim L. Greer, James E. Bowsher, R. Edward Coleman, and Scott D. Metzler
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Tomography, Emission-Computed, Single-Photon ,Physics ,business.industry ,Statistical noise ,Noise (signal processing) ,Brain ,Reproducibility of Results ,Collimator ,Equipment Design ,Image Enhancement ,Sensitivity and Specificity ,Collimated light ,Imaging phantom ,law.invention ,Equipment Failure Analysis ,Optics ,Data acquisition ,Sampling (signal processing) ,law ,Humans ,Radiology, Nuclear Medicine and imaging ,business ,Image resolution - Abstract
The objective of this study, which is related to human brain SPECT, was to increase the sensitivity of a triple-camera SPECT system and reduce statistical noise in reconstructed images using a combination of converging collimators. The reason for combining collimators is to ensure both high sensitivity and sufficient sampling without trading off spatial resolution. Methods: A high-sensitivity half-cone-beam (HCB) collimator, designed specifically for brain imaging, was combined with other collimators and compared with conventional parallel-beam and fanbeam circular orbit acquisitions. For comparison, previously studied HCB collimation with a circle-and-helix data acquisition trajectory was also included in this study. Simulations of the Hoffman 3-dimensional brain phantom were performed to calculate the efficiencies of collimators and their combinations and to quantitatively evaluate reconstruction bias, statistical noise, and signal-to-noise ratios in the reconstructed images. Experimental brain phantom data were also acquired and compared for different acquisition types. Finally, a patient brain scan was obtained with a combination of HCB and fanbeam collimators and compared with a triple-fanbeam circular orbit acquisition. Results: A combination of 2 HCB collimators and 1 fanbeam collimator, compared with a triple-fanbeam collimator, can increase the photon detection efficiency by 27% and by more than a factor of 2, compared with triple-parallel-hole collimation, with equal spatial resolution measured on the axis of rotation. Quantitative analysis of reconstruction bias and visual analysis of the images showed no signs of sampling artifacts. Reconstructed images in the simulations, experimental brain phantom, and patient brain scans showed improved quality with this collimator combination due to increased sensitivity and reduced noise. Lesion visibility was also improved, as confirmed by signal-to-noise ratios. Alternatively, triple-HCB circle-and-helix acquisition has also shown competitive results, with a slight disadvantage in axial sampling and implementation procedure. Conclusion: Combined HCB and fanbeam collimation is a promising approach for high-sensitivity brain SPECT. more...
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- 2009
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23. CT Metrics of Airway Disease and Emphysema in Severe COPD
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James Walter, David Godwin, Joyce Canterbury, Thomas E. Hartman, Yen Pin Chiang, Jeanne Smith, John J. Reilly, Hope Livingston, Abby M. Krichman, Mahasti Rittinger, Karma L. Kreizenbeck, Kymberley Anable, Ameena Al-Amin, Colleen Witt, Karen McVearry, Claude Deschamps, Selim M. Arcasoy, Liz Roessler, James K. Stoller, Yahya M. Berkmen, Paul J. Friedman, Enrique Fernandez, Laura Kotler-Klein, Chris Piker, Robert E. Hyatt, Mark J. Krasna, Priscilla McCreight, Jo Anna Baldwin, Jennifer M Lamb, Francisco Alvarez, Janet R. Maurer, Rodney Simcox, Gerald O'Brien, Iris Moskowitz, Marianne C. Fahs, Judd Gurney, A. Mark Fendrick, Mike Mantinaos, Sanjay Kalra, Robert M. Kaplan, Kevin R. Flaherty, Timothy Gilbert, James K. Garrett, Kathy Mieras, Kapreena Owens, Trina Limberg, Patricia Belt, Rolf D. Hubmayr, Roger Barnette, James Carter, Phillip M. Boiselle, Brian Woodcock, Anne Marie Kuzma, Brian F. Mullan, Dean Follmann, Mary Ellen Kleinhenz, Judith Harle, Ubaldo J. Martin, Bonnie Edwards, Fernando I. Martinez, Sandy Do, Alejandro A. Diaz, F.C. Sciurba, William Russell, David J. Sugarbaker, Theresa Alcorn, Susan Borosh, Patricia McDowell, Carolyn Wheeler, Blake Wood, Edwin K. Silverman, Alan J. Moskowitz, John F. Plankeel, William F. Bria, Susan Clark, Patricia Ward, Scott D. Ramsey, Barry J. Make, David H Kupferberg, Chinh T. Q. Nguyen, Stanley Aukberg, Elisabeth L. George, Steven Piantadosi, Geoffrey McLennan, Carl D. Mottram, Martin Zamora, Marvin Pomerantz, Ella A. Kazerooni, Jennifer Propst, Bessie Kachulis, Carol Fanning, Valentina Yegyan, Kenneth Silver, James P. Kiley, Sabine Duffy, David H. Harpole, Junfeng Guo, Donald C. Oxorn, Andrew L. Ries, Paramjit Gill, Bruce H. Culver, Todd M. Officer, Catherine Wood Larsen, John Hansen-Flaschen, Patrick Ross, Mindi Steiger, Lori Hanson, Rose Butanda, Paul F. Simonelli, Neil W. Brister, Amy Chong, Charles L. White, Eric A. Jensen, Cynthia Raymond, Mark K. Ferguson, Moulay Meziane, Mary Milburn-Barnes, James D. Luketich, Douglas E. Wood, A. John McSweeny, Woo Jin Kim, Kim Stavrolakes, John A. Waldhausen, Gregory L. Aughenbaugh, Chul Kwak, Sara L. Bartling, Joan Osterloh, Larry R. Kaiser, John S. Howe, Michael I. Lewis, Andrew Bowdle, Mark A. Gerhardt, Richard O'Connell, Brian R. Lawlor, Neil R. MacIntyre, David A. Lynch, Milton Joyner, Louie Boitano, James P. Utz, Everett Hood, Paul J. Smith, Joshua O. Benditt, John Apostolakis, Frances L. Brogan, Robert McKenna, Berend Mets, Phyllis Dibbern, Kevin Carney, Joan M. Lacomis, Kevin McCarthy, A. Laurie Shroyer, Mitchell K. O’Shea, Barry Make, Dora Greene, Janice Willey, Catherine Ramirez, Gwendolyn B. Vance, Philip R. Karsell, David DeMets, Angela DiMango, Peter Rising, Erik J. Kraenzler, Michael F. Keresztury, Laurie Ney Silfies, Michael Magliocca, Vivian Knieper, Betsy Ann Bozzarello, Marlene Edgar, Madelina Lorenzon, Deb Andrist, Sophia Chatziioannou, Darryl Atwell, Sally Frese, Ruth Etzioni, Stephen I. Marglin, Maria Shiau, Thomas Schroeder, Vincent J. Carey, Vladmir Formanek, Robert Levine, Cindy Chwalik, David Rittinger, Kenneth Martay, Brett A. Simon, Nancy Kurokawa, Anne L. Fuhlbrigge, Peter J. Julien, Michelle T. Toshima, Sean D. Sullivan, Joanne Deshler, Margaret Wu, Anthony Norris, David A. Lipson, Scott J. Swanson, Diane Lockhart, Omar A. Minai, Joseph l. Reeves-Viets, Raed A. Dweik, Keith S. Naunheim, Angela Delsing, Minnie Ellisor, Jane Whalen-Price, Victor F. Tapson, Leonard Rossoff, Susan M. Peterson, Deborah Nowakowski, David M. Shade, Susanne Snedeker, Susan Craemer, Anne Marie G. Sykes, Jennifer Norten, Manmohan S. Biring, Diane C. Strollo, Beth Elliot, Kedren Williams, Heather Sheaffer, Sheila Shearer, Robert P. Hoffman, Robert Quaife, J. Mendez, Donald A. Mahler, Janice Cook-Granroth, Scott Marlow, Zab Mosenifar, Malcolm M. DeCamp, Paul J. Christensen, Rosetta Jackson, Wissam Chatila, Robert Schilz, Glenda DeMercado, Peter B. O'Donovan, Kimberly Dubose, Robert J. Keenan, Satoshi Furukawa, Theodore Kopp, Gerald T. Ayres, Betty Collison, Stephen J. Swensen, Jennifer Stone-Wynne, Nicole Jenson, Stanley S. Siegelman, Tina Bees, Owen B. Wilson, R. Duane Davis, Pierre A. DeVilliers, Marcia Katz, Carolyn M. Clancy, Eddie L. Hoover, Bryan Benedict, Karen Kirsch, Philip M. Hartigan, Simon C. Body, Mark Stafford-Smith, David A. Zisman, Jeanne M. Hoffman, Fernando J. Martinez, Clarence Weir, Jeffrey D. Edelman, William Stanford, Zab Mohsenifar, Michael P. Donahoe, Michele Donithan, Catherine A. Meldrum, William A. Slivka, Lori Zaremba, Michael W. Smith, Martin D. Abel, Robert B Gerber, Sarah Hooper, Steven M. Scharf, Karen A. Hanson, Katherine P. Grichnik, J. Sanford Schwartz, Margaret L. Snyder, Charles J. Hearn, Joe Chin, Tammy Ojo, Gregory D.N. Pearson, Vera Edmonds, George R. Washko, Christine Young, Jennifer Minkoff-Rau, Ron Daniele, Chun Yip, Gregory L. Foster, Harold I. Palevsky, Joan E. Sexton, Dev Pathak, Pamela Fox, Paul E. Kazanjian, Karen King, Jacqueline Pfeffer, Imran Nizami, Judith Wagner, Catherine Wrona, John H. M. Austin, Karla Conejo-Gonzales, Sharon Bendel, Amir Sharafkhaneh, Carol Geaga, Denise Vilotijevic, Thomas H. Sisson, Steven H. Sheingold, Ryan Colvin, Elaine Baker, Karen Collins, Charles F. Emery, Mark Ginsburg, Abass Alavi, David D. Frankville, Joseph M. Reinhardt, Jan Drake, John M. Travaline, Rafael Espada, Kathy Lautensack, Leslie E. Quint, Jeffrey T. Chapman, Rosemary Lann, Steven M. Berkowitz, Alice L. Sternberg, Thurman Gillespy, Nadia Howlader, Frank J. Papatheofanis, Robert Frantz, Manuel L. Brown, Sarah Shirey, Yvonne Meli, Andra E. Ibrahim, Patricia A. Jellen, Rebecca Crouch, Warren B. Gefter, Michael J. Reardon, Jonathan B. Orens, Neal S. Kleiman, Marilyn L. Moy, Daniel L. Miller, Julie Fuller, Reuben M. Cherniack, Claudette Sikora, Lynn Bosco, Harry Handelsman, R. Edward Coleman, Judith M. Aronchick, James Tonascia, Delmar J. Gillespie, Patricia Berkoski, David P. Kapelanski, Cesar A. Keller, Amanda L. Blackford, Charles C. Miller, Kelly M. Campbell, Jill Meinert, Carl R. Fuhrman, Gordon R. Bernard, Connie Hudson, Roger Russell, Lewis Poole, Dale Williams, Magdy Younes, Shing Lee, Steven L. Sax, Martin Carlos, Diane C. Saunders, John Dodge, Matthew N. Bartels, Amy Jahn, Karen Taylor, Gregg L Ruppel, Wallace T. Miller, Mary Gilmartin, Tanisha Carino, Alfred P. Fishman, Gerene Bauldoff, Frank C. Sciurba, Gerard J. Criner, John Haddad, Mark D. Iannettoni, Terri Durr, Gordon F. Harms, Susan Golden, Norman E. Torres, Lisa Geyman, Alan Hibbit, Paul Rysso, Gilbert E. D'Alonzo, Henry E. Fessler, Mark L. Van Natta, Peter Wahl, James H. Harrell, Willard Chamberlain, Roger D. Yusen, Boleyn Hammel, Dawn E. Sassi-Dambron, Mark S. Allen, Jennifer Cutler, Shangqian Qi, Susan Rinaldo-Gallo, John D. Newell, June Hart, Raúl San José Estépar, Kerri McKeon, Staci Opelman, Eric S. Edell, Kathy Winner, Joe R. Rodarte, Mark A. King, Eric A. Hoffman, Laura A. Wilson, Phil Cagle, Jennifer Meyers, Kristin Berry, Mark P. Steele, Katherine Hale, Peter Barnard, Charles Soltoff, Melissa Weeks, Arfa Khan, Cary Stolar, Jeanine P. Wiener-Kronish, Jeannie Ricketts, Nancy Battaglia, Francine L. Jacobson, Satish G. Jhingran, Robert B. Teague, Mary Louise Dempsey, Leighton Chan, Philip T. Diaz, David Hicks, David E. Midthun, Charlene Levine, Andetta R. Hunsaker, Tomeka Simon, Jered Sieren, Susan Lubell, Scott A. Schartel, H P McAdams, Francis Cordova, Kris Bradt, Jeffery J. Johnson, Kenneth White, Mercedes True, Erin A. Sullivan, Byron Thomashow, Gail Weinmann, Robert A. Wise, Donna Tsang, Robert M. Kotloff, Atul C. Mehta, Gregory Tino, and Angela Wurster more...
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Pathology ,Critical Care and Intensive Care Medicine ,Risk Assessment ,Sensitivity and Specificity ,Severity of Illness Index ,Cohort Studies ,Pulmonary Disease, Chronic Obstructive ,Predictive Value of Tests ,Forced Expiratory Volume ,Internal medicine ,medicine ,Humans ,Lung volumes ,Respiratory system ,Aged ,Probability ,Original Research ,Analysis of Variance ,Univariate analysis ,COPD ,business.industry ,Total Lung Capacity ,Respiratory disease ,Middle Aged ,respiratory system ,Airway obstruction ,medicine.disease ,Respiratory Function Tests ,respiratory tract diseases ,Airway Obstruction ,Dyspnea ,medicine.anatomical_structure ,Pulmonary Emphysema ,Multivariate Analysis ,Cardiology ,Female ,Pulmonary Ventilation ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Airway ,Respiratory tract - Abstract
Background CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear. Methods Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of −950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV 1 and percent predicted value of FEV 1 with CT scan measures of emphysema and airway disease. Results In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT ( r = −0.28, p = 0.0001) and SRWA ( r = −0.19, p = 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV 1 % predicted (R = −0.12, p = 0.02). Multivariate analysis showed significant associations between either WT or SRWA (β = −5.2, p = 0.009; β = −2.6, p = 0.008, respectively) and %LAA-950 (β = −10.6, p = 0.03) with the postbronchodilator FEV 1 % predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p = 0.007 for WT and p = 0.0006 for SRWA). Conclusions Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema. more...
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- 2009
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24. Radiation Dosimetry, Pharmacokinetics, and Safety of Ultratrace™ Iobenguane I-131 in Patients with Malignant Pheochromocytoma/Paraganglioma or Metastatic Carcinoid
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R. Edward Coleman, Norman LaFrance, John W. Babich, Miguel de la Guardia, John A. Barrett, and James B. Stubbs
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Adult ,Male ,Cancer Research ,medicine.medical_treatment ,Metastatic carcinoid ,Adrenal Gland Neoplasms ,Pheochromocytoma ,Radiation Dosage ,Iodine Radioisotopes ,Paraganglioma ,chemistry.chemical_compound ,Pharmacokinetics ,Iobenguane ,medicine ,Humans ,Dosimetry ,Radiology, Nuclear Medicine and imaging ,In patient ,Radiometry ,Pharmacology ,business.industry ,Dose-Response Relationship, Radiation ,General Medicine ,medicine.disease ,Radiation therapy ,3-Iodobenzylguanidine ,Oncology ,chemistry ,Female ,Radiopharmaceuticals ,business ,Nuclear medicine - Abstract
This is a first of many phase 1 study of Ultratrace Iobenguane I-131 (Ultratrace 131I-MIBG; Molecular Insight Pharmaceuticals, Inc., Cambridge, MA). High-specific-activity Ultratrace 131I-MIBG may provide improved efficacy and tolerability over carrier-added 131I-MIBG. We investigated the pharmacokinetics (PK), radiation dosimetry, and clinical safety in 11 patients with confirmed pheochromocytoma/paraganglioma (Pheo) or carcinoid tumors. A single 5.0-mCi (185 MBq) injection of Ultratrace 131I-MIBG, supplemented with 185 microg of unlabeled MIBG to simulate the amount of MIBG anticipated in a therapeutic dose, was administered. Over 120 hours postdose, blood and urine were collected for PK, and sequential whole-body planar imaging was performed. Patients were followed for adverse events for 2 weeks. Ultratrace 131I-MIBG is rapidly cleared from the blood and excreted in urine (80.3% +/- 2.8% of dose at 120 hours). For a therapeutic administration of 500 mCi (18.5 GBq), our estimate of the projected dose is 1.4 Gy for marrow and 10.4 Gy for kidneys. Safety results showed 12 mild adverse events, all considered unrelated to study drug, in 8 of 11 patients. These findings support the further development of Ultratrace 131I-MIBG for the treatment of neuroendocrine tumors, such as metastatic Pheo and carcinoid. more...
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- 2009
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25. Increasing Uptake Time in FDG-PET: Standardized Uptake Values in Normal Tissues at 1 versus 3 h
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Bennett B. Chin, Edward D. Green, Timothy G. Turkington, Thomas C. Hawk, and R. Edward Coleman
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Cancer Research ,Time Factors ,Metabolic Clearance Rate ,Adipose tissue ,Spleen ,Standardized uptake value ,Malignancy ,Fluorodeoxyglucose F18 ,medicine ,Humans ,Tissue Distribution ,Radiology, Nuclear Medicine and imaging ,Retrospective Studies ,Analysis of Variance ,Lung ,medicine.diagnostic_test ,business.industry ,medicine.disease ,medicine.anatomical_structure ,Oncology ,Positron emission tomography ,Positron-Emission Tomography ,Analysis of variance ,Bone marrow ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,Nuclear medicine ,business - Abstract
Positron emission tomography (PET) imaging at more than 1 h after 2-deoxy-2-[18F]fluoro-d-glucose (FDG) administration may result in less blood pool activity and possibly decreased normal FDG uptake in tissues such as liver. Lower normal background activity could be an important component of improved image contrast on delayed imaging. Increasing FDG uptake in normal organs, however, may mitigate the beneficial effects of blood pool clearance. The purpose of this study is to determine the normal tissue and blood pool FDG uptake at 1 and 3 h after injection. Ninety-nine patients with known or suspected malignancy referred for FDG-PET–computed tomography (CT) were retrospectively evaluated. PET imaging was performed at either 1 h (60 ± 15 min; n = 50) or at 3 h (180 ± 15 min; n = 49) after FDG administration. Normal tissue FDG uptake without involvement by malignancy or influenced by artifact (misregistration, “brown fat,” focal muscle uptake, focal atherosclerotic disease) was confirmed by inspection of both the PET and CT scans. Aortic blood pool, adipose tissue, bone marrow, cerebellum, liver, lungs, muscle, and spleen were quantitatively evaluated by CT-guided region of interest analysis in three contiguous slices. Mean standardized uptake values (SUVs) were analyzed using one-way analysis of variance. Mean SUVs on the 3- versus 1-h images were significantly lower for aortic blood pool 13% (p more...
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- 2008
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26. 18-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY IN CHILDREN AND ADOLESCENTS WITH TRAUMATIC BRAIN INJURY
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John M. Hoffman, W. Jerry Oakes, Raymond S. Kandt, Sophia L. Kalman, Cesar Santos, S S Paine, Gordon Worley, Michael W. Hanson, R. Edward Coleman, Susan J. Claerhout, and Orest B. Boyko
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Male ,Traumatic brain injury ,Deoxyglucose ,Fluorodeoxyglucose positron emission tomography ,Developmental Neuroscience ,Fluorodeoxyglucose F18 ,Humans ,Medicine ,Child ,business.industry ,Outcome measures ,Infant ,Hospitals, Pediatric ,medicine.disease ,Hospitalization ,Glucose ,Treatment Outcome ,Brain Injuries ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Normal children ,Regression Analysis ,Female ,Neurology (clinical) ,business ,Nuclear medicine ,Tomography, Emission-Computed - Abstract
SUMMARY Twenty-two previously normal children and adolescents who suffered a severe, non-penetrating traumatic brain injury had PET during rehabilitation at a median of 1–5 months after the injury. Outcome was assessed at a median of 25 months after brain injury. 16 subjects had CT or MRI within 24 days of PET and 11 subjects had a second PET at the point of outcome (median 28 months after first PET). The PET score (obtained by adding the score of 15 brain regions: normal metabolism = 1; reduced = 0) was significantly associated with the clinical outcome measure. PET earlier than 12 weeks after head trauma correlated with outcome, but later PET did not. PET scores improved significantly between rehabilitation and outcome for the 11 subjects who had two PETs, but improvement was not associated with improvement in clinical condition. PET score did not add to the amount of variance explained in the last regression model for prediction of outcome when the results of contemporaneous CT/MRI and clinical condition were taken into account. The data suggest that routine PET during rehabilitation is no more useful than contemporaneous CT or MRI for prediction of outcome. RESUME Tomographies aemission de positrons 18-fiuoroglucose (PET) chez des enfants et adolescents, apres un traumatisme cerebral Des PET ont ete pratiques durant la reeducation, en moyenne 1–5 mois apres l'accident, chez 22 enfants et adolescents normaux avant l'accident, ayant subi un traumatisme cerebral grave sans penetration. Le devenir fut evaluea une moyenne de 25 mois apres la lesion cerebrale. Un scanner ou une LR.M. furent pratiques dans les 24 jours du PET chez 16 sujets, et 11 sujets beneficierent d'un second PET lors de l'evaluation du denenir (en moyenne 28 mois apres le premier PET). Le score PET (obtenu en additionnant les scores de 15 regions cerebrales: metabolisme normal = 1, metabolisme reduit = 0) etait significativement correle avec l'evaluation clinique du devenir. Les PET de moins de 12 semaines apres le truamatisme crânien etaient correles avec le devenir, mais non les PET plus tardifs. Les scores PET s'amelioraient significativement entre la reeducation et l'evaluation du devenir pour les 11 sujets ayant eu deux PET, mais l'amelioration n'etait pas associee a une amelioration de l'etait clinique. Ces donnees suggerent que le PET durant la reeducation n'est pas plus utile que des scanners ou IRM aux memes dates, dans la prediction du devenir. ZUSAMMENFASSUNG 18 Fluoro-D-Glukose Positronen-Emissionstomographie bet Kindern und Jugendlichen mil Hirntraumen 22 zuvor gesunde Kinder und Jugendliche, die ein schweres nicht penetrierendes Hirntrauma hatten, wurden wahrend der Rehabilitation etwa 1–5 Monate nach der Verletzung durch ein PET untersucht. Durchschnittlich 25 Monate nach dem Hirntrauma wurde der Outcome beurteilt. 16 Patienten hatten innerhalb von 24 Tagen nach dem PET ein CT oder MRI und 11 hatten ein zweites PET bei der Abschlusuntersuchung (im Mittel 28 Monate nach dem ersten PET). Der PET Score (errechnet durch Addition der Scores von 15 Hirnregionen: normaler Stoffwechsel = 1; verminderter = 0) hatte eine signifikante Relation zum klinischen Abschlusbefund. PET bis zu 12 Wochen nach dem Schadeltrauma korrelierte mit dem Outcome, spatere PETs jedoch nicht. Bei den 11 Patienten, die zwei PETs hatten, besserten sich die PET Scores signifikant in dem Zeitraum von der Rehabilitation bis zur Abschlusuntersuchung, aber dies war nicht gleichbedeutend mit eincr Besserung des klinischen Befundes. Die Daten zeigen, das das Routine-PET wahrend der Rehabilitation fur die Prognose des Outcomes keine weitere Aussagekraft hat als ein zur gleichen Zeit angefertigtes CT oder MRL RESUMEN Tomografia por emision de positrons con 18-fluorodesoxiglucosa en ninos y adolescentes con lesion traumatica cerebral Veintidos ninos y adolescentes previamente normales, que sufrieron un trauma cerebral no penetrante, fueron examinados con PET durante la rehabilitacion, un promedio de 1,5 meses despues de la lesion. El curso fue evaluado un promedio de 25 meses despues de la lesion. 16 individuos fueron examinados con TAC o con IRM a los 25 meses de la PET y a 11 se les aplico de nuevo la PET a los 28 meses de promedio despues de la primera PET. El puntaje de la PET (obtenida sumando los puntajes de 15 regiones cerebrales. metabolismo normal = 1; reduciodo = 0) estaba significativamente asociado a la medicion clinica de la recuperacion. Una PET realizada antes de las 12 semanas despues del trauma cerebral, se relacionaba con el curso, pero hecha mas tarde y no. Los puntajes de la PET mejoraban significativamente entre la rehabilitation y la recuperacion en los 11 casos con dos PET, pero la mejoria no se acompanaba de una mejoria clinica. Los datos sugieren que la exploracion rutinario con PET no es mas util que la TAC o la IRM, realizados contemporaneamente, con respecto a la prediction del curso posterior. more...
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- 2008
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27. Diagnosis and therapy of carcinoid tumors—current state of the art and future directions
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Mazhar U. Khan and R. Edward Coleman
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High concentration ,Oncology ,endocrine system ,Cancer Research ,medicine.medical_specialty ,Pathology ,biology ,Somatostatin receptor ,business.industry ,Carcinoid tumors ,Urinary system ,Chromogranin A ,medicine.disease ,digestive system diseases ,Somatostatin ,Internal medicine ,medicine ,biology.protein ,Molecular Medicine ,Plasma serotonin ,Radiology, Nuclear Medicine and imaging ,business ,Carcinoid syndrome - Abstract
Carcinoid tumors account for less than 1% of all malignancies and the majority arise in the gastrointestinal system. These tumors are slow growing compared with adenocarcinomas and they differ from the other neuroendocrine malignancies by their protean clinical presentation. Carcinoid tumors were previously considered indolent, but they can manifest malignant characteristics with metastatic spread which often results in a poor prognosis. Although there have been advances in diagnostic and treatment modalities, carcinoid tumors are still often diagnosed late, often when the tumor has metastasized and patients develop carcinoid syndrome. Diagnosis, prognosis and treatment options are based on biochemical markers and imaging investigations. High concentration of urinary 5-HIAA, elevated plasma serotonin and chromogranin A levels help to establish the initial diagnosis of carcinoid tumors. In addition to the CT and MRI, molecular imaging modalities such as OctreoScan, MIBG imaging and more recently PET imaging are vital in detection of primary malignancy and metastatic involvement. Surgery is the mainstay of treatment of nonmetastatic carcinoid tumors. Cytotoxic chemotherapy is not beneficial due to the chemoresistant nature of these tumors. Because carcinoid tumors express somatostatin receptors, somatostatin analogues, which inhibit the release of serotonin and other neuroendocrine peptides, are often used, but their use is limited to symptom control. Treatment using high doses of radionuclides such as radiolabeled somatostatin analogues and MIBG is a more recent option which offers a definite advantage in management. In this article, we review typical features of the carcinoid tumors, examine contemporary methods of detecting and assessing carcinoid tumors and discuss the role of various diagnostic and therapeutic options. more...
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- 2008
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28. Radioiodinated MIBG in paraganglioma and pheochromocytoma: previous results and early experiences using no-carrier-added MIBG
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Olga James and R. Edward Coleman
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Malignant Pheochromocytoma ,endocrine system ,Cancer Research ,Pathology ,medicine.medical_specialty ,endocrine system diseases ,business.industry ,No carrier added ,Gene mutation ,Neuroendocrine tumors ,medicine.disease ,Malignancy ,Metastasis ,Pheochromocytoma ,Paraganglioma ,medicine ,Molecular Medicine ,Radiology, Nuclear Medicine and imaging ,business - Abstract
The majority of pheochromocytomas and paragangliomas are benign, with malignancy occurring in approximately 10% of pheochromocytoma patients. The malignancy rate among paragangliomas is 15–35% or higher if associated with succinate dehydrogenase B gene mutations. The 5-year mortality rate in malignant pheochromocytoma and paraganglioma is nearly 50%. Malignancy of both pheochromocytoma and paraganglioma is determined by the existence of metastasis or local invasion and not by the cellular characteristics. There are no known clinical, biochemical or histopathological differences between pheochromocytoma and paraganglioma. Metaiodobenzylguanidine (MIBG) radiolabeled with either 123 I or 131 I has been used to diagnose neuroendocrine tumors such as paraganglioma and pheochromocytoma, and 131 I-MIBG has been used to treat these tumors. The role of radioiodinated MIBG in treating neuroendocrine tumors is still being evaluated. More recently, no-carrier-added (nca) MIBG has become available, and the advantages of nca MIBG over ca MIBG are being demonstrated. This article reviews the biology of paragangliomas and pheochromocytomas, the role of MIBG imaging in the diagnosis of these tumors and the role of both ca and nca 131 I-MIBG in the treatment of these tumors. New data on nca 131 I-MIBG in the therapy of these tumors are included. more...
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- 2008
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29. A pilot study: 131I-Antitenascin monoclonal antibody 81c6 to deliver a 44-Gy resection cavity boost
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Allan H. Friedman, Terence Z. Wong, Jeanette M. Dowell, Renee H. Raynor, Susan Boulton, James E. Herndon, Henry S. Friedman, Gamal Akabani, Darell D. Bigner, Charles N. Pegram, R. Edward Coleman, Roger E. McLendon, David A. Reardon, Annick Desjardins, Michael R. Zalutsky, Xiao Guang Zhao, James J. Vredenburgh, Sridharan Guruangan, Jennifer A. Quinn, and Jeremy N. Rich more...
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Adult ,Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,Pathology ,medicine.medical_treatment ,Clinical Investigations ,Pilot Projects ,Kaplan-Meier Estimate ,Injections, Intralesional ,Neutropenia ,Iodine Radioisotopes ,Mice ,Catheters, Indwelling ,Internal medicine ,Glioma ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Animals ,Humans ,Aged ,Temozolomide ,Brain Neoplasms ,business.industry ,Antibodies, Monoclonal ,Tenascin ,Middle Aged ,Radioimmunotherapy ,medicine.disease ,Combined Modality Therapy ,Chemotherapy regimen ,Radiation therapy ,Tumor progression ,Female ,Neurology (clinical) ,business ,Anaplastic astrocytoma ,medicine.drug - Abstract
Adults with primary malignant glioma have an unacceptably poor outcome. Although temozolomide plus radiotherapy improves survival of newly diagnosed glioblastoma multiforme (GBM) patients,1 most patients develop tumor progression within 1 – 2 years. Outcome following recurrence is poor.2 Most tumors recur at or adjacent to the site of origin, indicating that failure to eradicate local tumor growth is a major factor contributing to poor outcome.3 For this reason, we have focused on augmenting local control to improve overall outcome by administering tumor-associated radiolabeled monoclonal antibodies (mAbs) directly into spontaneous tumor cysts, surgically created resection cavities (SCRCs), the intrathecal space, and solid tumors.4–8 Tenascin, an extracellular matrix hexabrachion glycoprotein, is expressed ubiquitously in several cancers, including high-grade gliomas, but not in normal brain.9,10 mAb 81C6, a murine isotype 2b immunoglobulin G (IgG2b) that binds to an alternatively spliced region of tenascin,9–12 reacts specifically with tenascin-expressing tumors.13 When labeled with 131I, 81C6 delays tumor growth and prolongs survival in flank and intracranial human xenograft models.14,15 An initial human experience demonstrated the specificity of 131I-labeled murine 81C6 (131I-81C6) mAb compared to 125I-labeled nonspecific IgG2b mAb but also revealed limited intratumor penetration following intravenous or intraarterial administration.16 Hence, subsequent studies incorporated administration into an SCRC, tumor cyst, or intrathecal space. Prior phase I studies established the maximum tolerated dose (MTD) of 131I-81C6 injected into the SCRC of patients with newly diagnosed and recurrent malignant brain tumors to be 120 mCi and 100 mCi, respectively.7,8 Phase II studies demonstrated that patients treated with 131I-81C6 had favorable overall survival compared to established historical controls.4,5 Based on constraints of our U.S. Food and Drug Administration (FDA)-approved phase I and II studies, patients received a “fixed” dose of 131I-81C6 in which the administered level of radioactivity was the same among groups of patients. As a result of this design, 131I dosages were not adjusted to compensate for patient-specific variables such as SCRC volume and SCRC residence time. Dosimetry of patients treated on these studies revealed a wide range of radiation absorbed doses at the SCRC margin. Moreover, outcome correlated with delivered radiation dose to the SCRC. Specifically, patients who received less than 44 Gy were more likely to develop recurrent tumor, whereas those who received significantly more than 44 Gy were more likely to develop radionecrosis. Therefore, a 44-Gy boost to the SCRC margin was considered optimal.17 We now report a pilot study using a novel, patient-specific dosing strategy of 131I-81C6 designed to achieve a 44-Gy boost to the 2-cm SCRC margin in adults with newly diagnosed malignant gliomas. more...
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- 2008
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30. Quantitative Effects of Contrast Enhanced CT Attenuation Correction on PET SUV Measurements
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R. Edward Coleman, John Wilson, Terence Z. Wong, Timothy G. Turkington, James G. Colsher, and Tira Bunyaviroch
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Cancer Research ,PET-CT ,Materials science ,medicine.diagnostic_test ,Phantoms, Imaging ,business.industry ,Attenuation ,Contrast Media ,For Attenuation Correction ,Imaging phantom ,Emission scan ,Oncology ,Positron emission tomography ,Positron-Emission Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Tomography ,Tomography, X-Ray Computed ,Nuclear medicine ,business ,Correction for attenuation ,Algorithms - Abstract
The presence of contrast materials on computed tomography (CT) images can cause problems in the attenuation correction of positron emission tomography (PET) images. These are because of errors converting the CT attenuation of contrast to 511-keV attenuation and by the change in tissue enhancement over the duration of the PET emission scan. Newer CT-based attenuation correction (CTAC) algorithms have been developed to reduce these errors. To evaluate the effectiveness of the modified CTAC technique, we performed a retrospective analysis on 20 patients, comparing PET images using unenhanced and contrast-enhanced CT scans for attenuation correction. A phantom study was performed to simulate the effects of contrast on radiotracer concentration measurements. There was a maximum difference in calculated radiotracer concentrations of 5.9% within the retrospective data and 7% within the phantom data. Using a CTAC algorithm that de-emphasizes high-density areas, contrast-enhanced CT can be used for attenuation mapping without significant errors in quantitation. more...
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- 2007
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31. Clinical Experience with α-Particle–Emitting 211At: Treatment of Recurrent Brain Tumor Patients with 211At-Labeled Chimeric Antitenascin Monoclonal Antibody 81C6
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Roger E. McLendon, R. Edward Coleman, Allan H. Friedman, Terence Z. Wong, Gamal Akabani, Michael R. Zalutsky, David A. Reardon, Henry S. Friedman, and Darell D. Bigner
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Adult ,Male ,Oncology ,Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,Oligodendroglioma ,Brain tumor ,Astrocytoma ,Article ,Internal medicine ,Glioma ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Survival rate ,Aged ,Radioisotopes ,Brain Neoplasms ,business.industry ,Antibodies, Monoclonal ,Tenascin ,Middle Aged ,Radioimmunotherapy ,Alpha Particles ,Debulking ,medicine.disease ,Survival Rate ,Isotope Labeling ,Feasibility Studies ,Female ,Neoplasm Recurrence, Local ,Radiopharmaceuticals ,Glioblastoma ,business ,Astatine ,Anaplastic astrocytoma ,Blood sampling - Abstract
alpha-Particle-emitting radionuclides, such as (211)At, with a 7.2-h half-life, may be optimally suited for the molecularly targeted radiotherapy of strategically sensitive tumor sites, such as those in the central nervous system. Because of the much shorter range and more potent cytotoxicity of alpha-particles than of beta-particles, (211)At-labeled agents may be ideal for the eradication of tumor cells remaining after surgical debulking of malignant brain tumors. The main goal of this study was to investigate the feasibility and safety of this approach in patients with recurrent malignant brain tumors.Chimeric antitenascin monoclonal antibody 81C6 (ch81C6) (10 mg) was labeled with 71-347 MBq of (211)At by use of N-succinimidyl 3-[(211)At]astatobenzoate. Eighteen patients were treated with (211)At-labeled ch81C6 ((211)At-ch81C6) administered into a surgically created resection cavity (SCRC) and then with salvage chemotherapy. Serial gamma-camera imaging and blood sampling over 24 h were performed.A total of 96.7% +/- 3.6% (mean +/- SD) of (211)At decays occurred in the SCRC, and the mean blood-pool percentage injected dose wasor = 0.3. No patient experienced dose-limiting toxicity, and the maximum tolerated dose was not identified. Six patients experienced grade 2 neurotoxicity within 6 wk of (211)At-ch81C6 administration; this neurotoxicity resolved fully in all but 1 patient. No toxicities of grade 3 or higher were attributable to the treatment. No patient required repeat surgery for radionecrosis. The median survival times for all patients, those with glioblastoma multiforme, and those with anaplastic astrocytoma or oligodendroglioma were 54, 52, and 116 wk, respectively.This study provides proof of concept for regional targeted radiotherapy with (211)At-labeled molecules in oncology. Specifically, the regional administration of (211)At-ch81C6 is feasible, safe, and associated with a promising antitumor benefit in patients with malignant central nervous system tumors. more...
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- 2007
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32. Left Ventricular Functional Assessment in Mice: Feasibility of High Spatial and Temporal Resolution ECG-gated Blood Pool SPECT
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Anthony Lemaire, Ronald J. Jaszczak, Kim L. Greer, Timothy G. Turkington, Antonio Curcio, Neil A. Petry, R. Edward Coleman, Sreekanth Vemulapalli, Scott D. Metzler, Bennett B. Chin, and Howard A. Rockman more...
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Myocardial Infarction ,Hemodynamics ,Single-photon emission computed tomography ,Sensitivity and Specificity ,Electrocardiography ,Mice ,Ventricular Dysfunction, Left ,medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Tomography, Emission-Computed, Single-Photon ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Gated Blood-Pool Imaging ,Image Enhancement ,medicine.disease ,Mice, Inbred C57BL ,Feasibility Studies ,End-diastolic volume ,Myocardial infarction complications ,business ,Nuclear medicine - Abstract
To prospectively determine feasibility of evaluating murine left ventricular (LV) function with electrocardiographically (ECG)-gated blood pool single photon emission computed tomography (SPECT).All animal studies had institutional animal care and use committee approval. SPECT was performed with conventional time-binned acquisition (eight frames per ECG cycle) in normal mice (normal group A, n = 6) and mice with myocardial infarction (MI) (n = 8). To determine feasibility of high temporal resolution and rapid data acquisition, another group of normal mice (normal group B, n = 4) underwent imaging with conventional (eight-frame) time-binned and list-mode (LM) acquisitions. LM acquisitions were reconstructed with eight and 16 frames per ECG cycle and 10 minutes of data (short LM). SPECT images were assessed visually, and LV-to-lung background activity ratios were calculated. LV end-systolic and end-diastolic volumes were defined with a phase analysis and threshold method. LV ejection fraction (LVEF) was calculated from LV volumes and count-based methods (n = 18 mice). Fractional shortening (FS) at echocardiography defined MI dysfunction (mild MI: FSor = 50%; severe MI: FS50%). Group means were compared for significant differences with analysis of variance.ECG-gated blood pool SPECT demonstrated normal, concentric LV contraction in all normal mice (n = 10). LV-to-lung background ratio was more than 10:1 (range, 10.3-29.4; n = 18). Focal wall motion abnormalities were detected at SPECT both visually and with phase analysis in all mice with severe MI (n = 5). Mice with severe MI had significantly lower LVEF than normal group A mice (32% +/- 14 [standard deviation] vs 64% +/- 8%; P.001). All mice with mild MI (n = 3) had normal contraction and LVEF. In paired acquisitions in normal group B mice, all reconstructions (n = 16) showed normal LV contraction. LVEF was not significantly different (P = .88) between time-binned (71% +/- 12), eight-frame LM (71% +/- 12), 16-frame LM (77% +/- 10), and short LM (73% +/- 14) reconstructions.Murine LV functional assessment is feasible with high spatial and temporal resolution ECG-gated blood pool SPECT. LV dysfunction can be quantified and focal wall motion abnormalities detected in the MI model of heart failure. more...
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- 2007
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33. Clinical utility of a patient-specific algorithm for simulating intracerebral drug infusions
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Terence Z. Wong, Allan H. Friedman, Philipp Tanner, John H. Sampson, James M. Provenzale, R. Edward Coleman, Martin Brady, Maria Inmaculada Rodriguez-Ponce, Christoph Pedain, Darell D. Bigner, David Croteau, James E. Herndon, David A. Reardon, Raj K. Puri, Ira Pastan, and Raghu Raghavan more...
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Adult ,Diagnostic Imaging ,Male ,Cancer Research ,Recombinant Fusion Proteins ,Clinical Investigations ,Exotoxins ,Antineoplastic Agents ,Pilot Projects ,Single-photon emission computed tomography ,Sensitivity and Specificity ,Drug Delivery Systems ,Infusion Procedure ,Medical imaging ,Humans ,Medicine ,Distribution (pharmacology) ,Injections, Intraventricular ,Volume of distribution ,Interleukin-13 ,medicine.diagnostic_test ,Brain Neoplasms ,business.industry ,Glioma ,Middle Aged ,Confidence interval ,Catheter ,Oncology ,Drug delivery ,Female ,Neurology (clinical) ,Neoplasm Recurrence, Local ,business ,Algorithm ,Algorithms ,Software - Abstract
Convection-enhanced delivery (CED) is a novel drug delivery technique that uses positive infusion pressure to deliver therapeutic agents directly into the interstitial spaces of the brain. Despite the promise of CED, clinical trials have demonstrated that target-tissue anatomy and patient-specific physiology play a major role in drug distribution using this technique. In this study, we retrospectively tested the ability of a software algorithm using MR diffusion tensor imaging to predict patient-specific drug distributions by CED. A tumor-targeted cytotoxin, cintredekin besudotox (interleukin 13–PE38QQR), was coinfused with iodine 123–labeled human serum albumin (123I-HSA), in patients with recurrent malignant gliomas. The spatial distribution of 123I-HSA was then compared to a drug distribution simulation provided by the software algorithm. The algorithm had a high sensitivity (71.4%) and specificity (100%) for identifying the high proportion (7 of 14) of catheter trajectories that failed to deliver drug into the desired anatomical region ( p = 0.021). This usually occurred when catheter trajectories crossed deep sulci, resulting in leak of the infusate into the subarachnoid cerebrospinal fluid space. The mean concordance of the volume of distribution at the 50% isodose level between the actual 123I-HSA distribution and simulation was 65.75% (95% confidence interval [CI], 52.0%–79.5%), and the mean maximal in-plane deviation was less than 8.5 mm (95% CI, 4.0–13.0 mm). The use of this simulation algorithm was considered clinically useful in 84.6% of catheters. Routine use of this algorithm, and its further developments, should improve prospective selection of catheter trajectories, and thereby improve the efficacy of drugs delivered by this promising technique. more...
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- 2007
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34. Head and Neck Cancer: Dedicated FDG PET/CT Protocol for Detection—Phantom and Initial Clinical Studies
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Timothy G. Turkington, R. Edward Coleman, Yuka Yamamoto, Thomas C. Hawk, and Terence Z. Wong
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Adult ,Male ,medicine.medical_specialty ,Biopsy ,Sensitivity and Specificity ,Imaging phantom ,Fluorodeoxyglucose F18 ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Head and neck ,Aged ,Retrospective Studies ,Protocol (science) ,medicine.diagnostic_test ,Phantoms, Imaging ,business.industry ,Head and neck cancer ,Middle Aged ,medicine.disease ,Emission scan ,ROC Curve ,Head and Neck Neoplasms ,Positron emission tomography ,Positron-Emission Tomography ,Female ,Tomography ,Radiology ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,Nuclear medicine ,business - Abstract
To retrospectively compare the sensitivity of a dedicated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) protocol versus a standard whole-body PET/CT protocol for detection of head and neck cancer, with biopsy and follow-up as reference standards.Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. Dedicated and standard PET/CT protocols were performed in a phantom and in 55 patients suspected of having head and neck cancer (28 men, 27 women; age range, 21-79 years). The neck phantom contained four 4.4-9.8-mm-diameter spheres. Standard protocol consisted of a midcranium to proximal thigh emission scan of 2-4 minutes per bed position. Dedicated protocol was an 8-minute head and neck scan. Reconstructed field of view and pixel size, respectively, were 30 cm and 2.34 mm for the dedicated and 50 cm and 3.91 mm for the standard protocol. FDG uptake was evaluated visually and semiquantitatively by using standardized uptake values (SUVs). Mean SUV was compared between dedicated and standard protocols with a t test modified for clustered sampling. Receiver operating characteristic (ROC) curves were calculated. A two-tailed P value was used.In the phantom study, a larger percentage difference (20%-27%) in sphere-to-background ratios with the dedicated than with the standard protocol was observed for 6.0-9.8-mm spheres. In the clinical study, a total of 149 lymph nodes were identified. Five malignant and six benign lymph nodes (mean diameter, 7.1 mm) were visually identified with the dedicated protocol only. SUVs with the dedicated protocol were significantly higher than those with the standard protocol (P.001). Area under the ROC curve was 0.94 for the dedicated and 0.92 for the standard protocol (P=.56).FDG PET with either the standard or dedicated protocol was more sensitive than CT for evaluating head and neck lymph nodes. The dedicated protocol improved the detectability of smaller nodes. more...
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- 2007
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35. 3′-Deoxy-3′-[F-18]Fluorothymidine Positron Emission Tomography in Patients with Recurrent Glioblastoma Multiforme: Comparison with Gd-DTPA Enhanced Magnetic Resonance Imaging
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R. Edward Coleman, Terence Z. Wong, Timothy G. Turkington, Thomas C. Hawk, Yuka Yamamoto, and David A. Reardon
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Adult ,Gadolinium DTPA ,Male ,Fluorine Radioisotopes ,Cancer Research ,medicine.medical_specialty ,Standardized uptake value ,Pathologic correlation ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Retrospective Studies ,medicine.diagnostic_test ,Brain Neoplasms ,business.industry ,Recurrent glioblastoma ,Contralateral hemisphere ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Tumor Burden ,Oncology ,Positron emission tomography ,Positron-Emission Tomography ,cardiovascular system ,Female ,Radiology ,Radiopharmaceuticals ,Glioblastoma ,business ,Nuclear medicine ,Thymidine ,circulatory and respiratory physiology - Abstract
The accumulation of 3′-deoxy-3′-[F-18]fluorothymidine (FLT) on positron emission tomography (PET) images in patients with glioblastoma multiforme was evaluated and correlated with gadopentetate dimeglumine (Gd-DTPA) enhancement in magnetic resonance images (MRIs). FLT studies in 10 patients with recurrent glioblastoma multiforme were retrospectively investigated. Dynamic emission data were acquired for 60 minutes immediately after injection of FLT. The standardized uptake value (SUV) for tumor and reference tissue (contralateral hemisphere and ipsilateral cerebellum) was calculated. The volumes of the metabolically active part of the tumor (V PET) and that of the Gd-DTPA enhancing part of the tumor (V MR) were calculated. FLT uptake in tumors peaked before 5 minutes and sometimes as early as 0.5 minutes, and reached a constant level at approximately 10 minutes after injection. The reference tissue time–activity curves had an early peak and reached a constant low background level. All tumors had increased FLT uptake and showed Gd-DTPA enhancement. The SUV in tumor was significantly higher than that in the reference tissue (P more...
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- 2006
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36. Changes in plasma volume associated with mental stress ischemia in patients with coronary artery disease
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James A. Blumenthal, R. Edward Coleman, Alan L. Hinderliter, Robert A. Waugh, Simon L. Bacon, and Andrew Sherwood
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Male ,medicine.medical_specialty ,Endothelium ,Myocardial Ischemia ,Ischemia ,Blood Pressure ,Coronary Disease ,Radionuclide ventriculography ,Plasma volume ,Coronary artery disease ,Angina ,Ventricular Dysfunction, Left ,Risk Factors ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Aged ,Blood Volume ,business.industry ,General Neuroscience ,Gated Blood-Pool Imaging ,Middle Aged ,medicine.disease ,Vasodilation ,Neuropsychology and Physiological Psychology ,medicine.anatomical_structure ,Circulatory system ,Cardiology ,Female ,Endothelium, Vascular ,Arousal ,business ,Stress, Psychological ,Blood vessel - Abstract
Psychological stress has been shown to trigger angina and myocardial ischemia in patients with coronary artery disease. However, the mechanisms by which stress may trigger cardiac events has yet to be fully elucidated. Twenty five patients underwent radionuclide ventriculography during a multiple stress challenge. Plasma volume was assessed during rest and at the end of the stress task. Flow-mediated dilatation was also measured. Controlling for endothelial function and medications, patients with ischemia had greater reductions in plasma volume than non-ischemic patients. Reduced plasma volume may be one mechanism by which mental stress may increase the risk for acute coronary events. more...
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- 2006
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37. Salvage Radioimmunotherapy With Murine Iodine-131–Labeled Antitenascin Monoclonal Antibody 81C6 for Patients With Recurrent Primary and Metastatic Malignant Brain Tumors: Phase II Study Results
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David A, Reardon, Gamal, Akabani, R Edward, Coleman, Allan H, Friedman, Henry S, Friedman, James E, Herndon, Roger E, McLendon, Charles N, Pegram, James M, Provenzale, Jennifer A, Quinn, Jeremy N, Rich, James J, Vredenburgh, Annick, Desjardins, Sridharan, Gururangan, Sri, Guruangan, Michael, Badruddoja, Jeanette M, Dowell, Terence Z, Wong, Xiao-Guang, Zhao, Michael R, Zalutsky, and Darell D, Bigner more...
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Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Pathology ,Gliosarcoma ,Biopsy ,medicine.medical_treatment ,Phases of clinical research ,Salvage therapy ,Gastroenterology ,Metastasis ,Iodine Radioisotopes ,Internal medicine ,Glioma ,medicine ,Humans ,Neoplasm Metastasis ,Aged ,Salvage Therapy ,Chemotherapy ,Brain Neoplasms ,business.industry ,Antibodies, Monoclonal ,Tenascin ,Middle Aged ,Radioimmunotherapy ,medicine.disease ,Oncology ,Female ,Neoplasm Recurrence, Local ,business ,Anaplastic astrocytoma - Abstract
Purpose To assess the efficacy and toxicity of intraresection cavity iodine-131–labeled murine antitenascin monoclonal antibody 81C6 (131I-m81C6) among recurrent malignant brain tumor patients. Patients and Methods In this phase II trial, 100 mCi of 131I-m81C6 was injected directly into the surgically created resection cavity (SCRC) of 43 patients with recurrent malignant glioma (glioblastoma multiforme [GBM], n = 33; anaplastic astrocytoma [AA], n = 6; anaplastic oligodendroglioma [AO], n = 2; gliosarcoma [GS], n = 1; and metastatic adenocarcinoma, n = 1) followed by chemotherapy. Results With a median follow-up of 172 weeks, 63% and 59% of patients with GBM/GS and AA/AO tumors were alive at 1 year. Median overall survival for patients with GBM/GS and AA/AO tumors was 64 and 99 weeks, respectively. Ten patients (23%) developed acute hematologic toxicity. Five patients (12%) developed acute reversible neurotoxicity. One patient (2%) developed irreversible neurotoxicity. No patients required reoperation for radionecrosis. Conclusion In this single-institution phase II study, administration of 100 mCi of 131I-m81C6 to recurrent malignant glioma patients followed by chemotherapy is associated with a median survival that is greater than that of historical controls treated with surgery plus iodine-125 brachytherapy. Furthermore, toxicity was acceptable. Administration of a fixed millicurie dose resulted in a wide range of absorbed radiation doses to the SCRC. We are now conducting a phase II trial, approved by the US Food and Drug Administration, using patient-specific 131I-m81C6 dosing, to deliver 44 Gy to the SCRC followed by standardized chemotherapy. A phase III multicenter trial with patient-specific dosing is planned. more...
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- 2006
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38. Positron Emission Tomography Diagnosis of Alzheimer's Disease
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R. Edward Coleman
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medicine.medical_specialty ,Early detection ,Disease ,Diagnosis, Differential ,Alzheimer Disease ,Fluorodeoxyglucose F18 ,medicine ,Brain positron emission tomography ,Humans ,Dementia ,Radiology, Nuclear Medicine and imaging ,Radiation ,medicine.diagnostic_test ,business.industry ,Brain ,General Medicine ,medicine.disease ,Positron emission tomography ,Positron-Emission Tomography ,Neurology (clinical) ,Radiology ,Radiopharmaceuticals ,Abnormality ,Nuclear medicine ,business ,Frontotemporal dementia - Abstract
Positron emission tomography (PET) imaging of [18F]-2-fluoro-2-deoxy-D-glucose (FDG) is accurate in the early detection of Alzheimer's disease (AD) and in the differentiation of AD from the other causes of dementia. FDG-PET imaging is available widely and performed easily. Different patterns of abnormality with the various causes of dementia are well described. Semiquantitative methods of image interpretation are available. Medicare covers FDG-PET imaging for the narrow indication of differentiation of possible AD from frontotemporal dementia. more...
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- 2005
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39. Concurrent PET/CT with an Integrated Imaging System: Intersociety Dialogue from the Joint Working Group of the American College of Radiology, the Society of Nuclear Medicine, and the Society of Computed Body Tomography and Magnetic Resonance
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Michael P. Federle, Jeffrey C. Weinreb, Henry D. Royal, Dominique Delbeke, Peter S. Conti, Milton J. Guiberteau, Lincoln L. Berland, R. Edward Coleman, Barry A. Siegel, and David W. Townsend
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Diagnostic Imaging ,medicine.medical_specialty ,Technology Assessment, Biomedical ,Joint working ,Credentialing ,Neoplasms ,Health care ,Humans ,Medicine ,Image acquisition ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Practice Patterns, Physicians' ,Societies, Medical ,PET-CT ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Image Enhancement ,Magnetic Resonance Imaging ,United States ,Systems Integration ,Positron-Emission Tomography ,Subtraction Technique ,Practice Guidelines as Topic ,Radiation Oncology ,Imaging technology ,Interdisciplinary Communication ,Tomography ,Radiology ,Nuclear Medicine ,Tomography, X-Ray Computed ,business ,Nuclear medicine ,Total Quality Management - Abstract
Rapid advances in imaging technology are a challenge for health care professionals, who must determine how best to use these technologies to optimize patient care and outcomes. Hybrid imaging instrumentation, combining 2 or more new or existing technologies, each with its own separate history of clinical evolution, such as PET and CT, may be especially challenging. CT and PET provide complementary anatomic information and molecular information, respectively, with PET giving specificity to anatomic findings and CT offering precise localization of metabolic activity. Historically, the acquisition and interpretation of the 2 image sets have been performed separately and very often at different times and locales. Recently, integrated PET/CT systems have become available; these systems provide PET and CT images that are acquired nearly simultaneously and are capable of producing superimposed, coregistered images, greatly facilitating interpretation. As the implementation of this integrated technology has become more widespread in the setting of oncologic imaging, questions and concerns regarding equipment specifications, image acquisition protocols, supervision, interpretation, professional qualifications, and safety have arisen. This article summarizes the discussions and observations surrounding these issues by a collaborative working group consisting of representatives from the American College of Radiology, the Society of Nuclear Medicine, and the Society of Computed Body Tomography and Magnetic Resonance. more...
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- 2005
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40. Sustained radiographic and clinical response in patient with bifrontal recurrent glioblastoma multiforme with intracerebral infusion of the recombinant targeted toxin TP-38: Case study
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John H. Sampson, David A. Reardon, Henry S. Friedman, Allan H. Friedman, R. Edward Coleman, Darell D. Bigner, Roger E. McLendon, and Ira Pastan
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Cancer Research ,Pathology ,medicine.medical_specialty ,TGF alpha ,medicine.diagnostic_test ,biology ,business.industry ,Fusion protein ,Oncology ,Refractory ,Positron emission tomography ,Tumor progression ,Cancer research ,biology.protein ,Medicine ,Pseudomonas exotoxin ,Neurology (clinical) ,Epidermal growth factor receptor ,business ,Transforming growth factor - Abstract
Glioblastoma multiforme remains refractory to conventional therapy, and novel therapeutic modalities are desperately needed. TP-38 is a recombinant chimeric protein containing a genetically engineered form of the cytotoxic Pseudomonas exotoxin fused to transforming growth factor (TGF)-α. TGF-α binds with high affinity to the epidermal growth factor receptor, which is uniformly overexpressed in malignant gliomas, often because of gene amplification. Prior to therapy with TP-38, the patient described here was completely refractory to multiple other therapies, with radiographic and pathologic evidence of tumor progression. After therapy, she improved clinically, was weaned off steroids and anticonvulsants, and experienced a progressive decrease in enhancing tumor volume. Despite multiple prior recurrences, she has not progressed for >43 months after TP-38 therapy. Small remaining areas of enhancement demonstrate no evidence of tumor histologically and are hypometabolic on positron emission tomography. This report describes a dramatic and sustained clinical and radiographic response in a patient with a bifrontal glioblastoma multiforme treated with intratumoral infusion of a novel targeted toxin, TP-38. more...
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- 2005
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41. [18F]Fluorodeoxyglucose-Positron Emission Tomography in Patients with Medulloblastoma
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Timothy M. George, R. Edward Coleman, Eugene Hwang, Herbert E. Fuchs, Sridharan Gururangan, and James E. Herndon
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Adult ,Male ,Adolescent ,Whole-Body Counting ,Neuroimaging ,Fluorodeoxyglucose F18 ,Biopsy ,medicine ,Humans ,Cerebellar Neoplasms ,Child ,Survival rate ,Qualitative Research ,Fluorodeoxyglucose ,Medulloblastoma ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Survival Rate ,Treatment Outcome ,Positron emission tomography ,Child, Preschool ,Positron-Emission Tomography ,Female ,Surgery ,Neurology (clinical) ,business ,Nuclear medicine ,Progressive disease ,medicine.drug - Abstract
OBJECTIVE: We evaluated the [18F]fluorodeoxyglucose (FDG) accumulation during positron emission tomography (PET) in patients with medulloblastoma and examined the relationship of intensity of uptake with patient outcome after the initial scan. METHODS: Magnetic resonance imaging and FDG-PET scans of brain and spine were used to assess FDG uptake by visual grade (qualitative analysis) and metabolic activity ratios (Tmax/Gmean and Tmax/Wmean). Patients were divided into two groups based on either confirmation of tumor by biopsy and/or death resulting from progressive disease after the initial FDG-PET scan (Group A) or no intervention for the suspected lesion shown on magnetic resonance imaging after the initial FDG-PET scan but currently alive without evidence of disease (Group B). RESULTS: Twenty-two patients with either recurrent (n = 21) or newly diagnosed (n = 1) medulloblastoma underwent brain (n = 18) or whole-body (n = 4) FDG-PET scans after magnetic resonance imaging evidence of suspected tumor. The median qualitative analysis was 3 (range, 0–4) in 17 Group A patients compared with 0 (range, 0–1) in 5 Group B patients (P = 0.0003). The mean Tmax/Gmean and Tmax/Wmean ratios for 16 Group A patients were 1.3 (range, 0.1–3.8) and 2.10 (range, 0.4–5.2), respectively, compared with 0.80 (range, 0.20–1.5) and 1.3 (range, 0.5–1.9) in 5 Group B patients (P = 0.2 for both parameters, not significant). There was a significant negative correlation between increased FDG uptake and survival. Higher qualitative analysis and Tmax/Wmean were associated with significantly poorer 2-year overall survival after the initial scan (71% versus 15% for qualitative analysis grade of CONCLUSION: Increased FDG uptake is observed in medulloblastoma and is correlated negatively with survival. more...
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- 2004
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42. Outcome Prediction in Patients at High Risk for Coronary Artery Disease: Comparison between99mTc Tetrofosmin and99mTc Sestamibi
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R. Edward Coleman, Linda K. Shaw, William T. Smith, David J. Whellan, Robert H. Tuttle, Salvador Borges-Neto, and Diwakar Jain
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Male ,Technetium Tc 99m Sestamibi ,medicine.medical_specialty ,Adenosine ,medicine.medical_treatment ,Stress testing ,Coronary Disease ,Risk Assessment ,Coronary artery disease ,Organophosphorus Compounds ,Coronary Circulation ,Dobutamine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Aged ,Proportional Hazards Models ,Cardiac catheterization ,Tomography, Emission-Computed, Single-Photon ,business.industry ,Proportional hazards model ,Dipyridamole ,Organotechnetium Compounds ,Middle Aged ,Prognosis ,99mTc Sestamibi ,medicine.disease ,SSS ,Cardiovascular Diseases ,Exercise Test ,Female ,Radiology ,business ,Technetium-99m - Abstract
To determine if there was any difference in the ability of physicians to predict prognosis with technetium 99m ((99m)Tc) sestamibi or (99m)Tc tetrofosmin in a large consecutive series of patients at high risk for coronary artery disease who underwent coronary angiography.This study included 1,818 consecutive patients who underwent a rest and stress single photon emission computed tomographic (SPECT) examination with either (99m)Tc sestamibi (n = 915) or (99m)Tc tetrofosmin (n = 903) and cardiac catheterization. A clinical index was generated and consisted of clinical and demographic variables. Information concerning death, cardiovascular death, and nonfatal myocardial infarction was 93% complete during the 1.5-year study period. Cox proportional hazards models were generated to help determine the incremental contribution of SPECT sum stress score (SSS) and the imaging agent variable to the clinical index.Exercise was used for stress testing in 473 (52%) patients who received (99m)Tc tetrofosmin and 519 (57%) patients who received (99m)Tc sestamibi (P =.06). Cardiovascular death or myocardial infarction occurred in 130 patients. Resulting P values for chi(2) differences between models for the end points of (a) death from any cause, (b) cardiovascular death, and (c) cardiovascular death or myocardial infarction showed that SSS combined with clinical index was a significantly better model than adjusting for only baseline characteristics (P =.001, P.001, P =.004, respectively). Incremental addition of either (99m)Tc tetrofosmin or (99m)Tc sestamibi to those models containing SSS and the clinical index did not show further significant improvement (P =.87, P =.88, and P =.26 for death from any cause, cardiovascular death, and cardiovascular death or myocardial infarction, respectively).This study shows that the type of clinically available (99m)Tc-labeled myocardial perfusion agents should not affect interpretation of results for risk stratification and prognostic assessment. more...
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- 2004
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43. Positron emission tomography with 2-deoxy-2-[18F]fluoro-D-glucose for evaluating local and distant disease in patients with cervical cancer
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R. Edward Coleman, Ellen L. Jones, and Terence Z. Wong
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Adenoma ,Adult ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Foley catheter ,Uterine Cervical Neoplasms ,Surgical pathology ,Fluorodeoxyglucose F18 ,Biopsy ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Neoplasm Metastasis ,Cervical cancer ,medicine.diagnostic_test ,business.industry ,Carcinoma ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Radiation therapy ,Oncology ,Positron emission tomography ,Localized disease ,Female ,Radiology ,business ,Tomography, Emission-Computed - Abstract
Purpose To assess the accuracy of positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) for evaluating local and distant disease in patients with cervical cancer. Methods The PET imaging database maintained at our institution was used to identify patients who received FDG-PET scans for the clinical indication of cervical cancer for the past four years. Patients were followed for a minimum of six months following the PET study. Results of the FDG-PET studies were correlated with surgical pathology, biopsy results, and/or clinical follow up to assess the accuracy of FDG-PET in evaluating local and distant disease. Results A total of 61 FDG-PET studies performed in 41 patients were included in this retrospective study. Nine FDG-PET studies were performed for initial staging of cervical cancer, and 52 PET scans were performed in 35 different patients as restaging studies following therapy. For the initial staging, the local primary disease was identified in all nine FDG-PET studies, and PET distinguished the patients which had localized disease (four patients) from those with distant metastases on follow-up (five patients) with 100% accuracy. For restaging cervical cancer, FDG-PET had a sensitivity of 0.82 and specificity of 0.97 (accuracy 0.92) for evaluation of local recurrence. For evaluating distant disease in these patients, PET had a sensitivity of 1.00 and specificity of 0.90 (accuracy 0.94). In the evaluation of local disease, focal rectal activity caused false-positive results in two cases. Three false-positive studies for distant disease were caused by inflammatory adenopathy. Conclusion FDG-PET is an accurate modality both for initial staging and restaging of patients with cervical cancer. PET is particularly sensitive for detecting distant metastases, allowing stratification of patients into those with locally confined disease and those with distant disease. These results were achieved by using a standardized PET imaging protocol without the use of bowel preparations, lasix administration, or Foley catheter drainage. Evaluation of local disease can be challenging due to adjacent rectal and bladder activity, and the use of hybrid PET/computed tomography (CT) scanners in the future may further improve evaluation of local disease. more...
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- 2004
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44. Regional Cardiac Sympathetic Innervation Early and Late After Transmyocardial Laser Revascularization
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Anne M. Pippen, Timothy R. DeGrado, Brian H. Annex, Carolyn K. Landolfo, James E. Lowe, Dmitri V. Baklanov, R. Edward Coleman, Shankha S Biswas, Kevin P. Landolfo, and G. Chad Hughes
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Pathology ,Sympathetic Nervous System ,Time Factors ,medicine.medical_treatment ,Blotting, Western ,Coronary Disease ,Sensitivity and Specificity ,Angina ,Random Allocation ,Internal medicine ,Biopsy ,Myocardial Revascularization ,medicine ,Animals ,Circumflex ,Sympathectomy ,Probability ,Denervation ,Hibernating myocardium ,Analysis of Variance ,Tyrosine hydroxylase ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,Heart ,Recovery of Function ,medicine.disease ,Immunohistochemistry ,Nerve Regeneration ,Disease Models, Animal ,Cardiology ,Swine, Miniature ,Surgery ,Laser Therapy ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Prior experimental and clinical studies have drawn disparate conclusions regarding the effects of transmyocardial laser revascularization (TMR) on regional cardiac innervation in the treated regions. Regional afferent denervation has been proposed as a potential mechanism of action of the procedure, although this as yet remains unproven. The purpose of the present study was to evaluate regional myocardial sympathetic innervation both early (3 days) and late (6 months) after TMR.Mini-swine in the early group were randomized to be sacrificed 3 days after holmium:YAG TMR (n = 5) or sham thoractomy (n = 3). In the late group, mini-swine with hibernating myocardium in the left circumflex (LCx) region were randomized to sham redo-thoracotomy (n = 5), TMR of the LCx distribution with a carbon dioxide (n = 5), holmium:YAG (n = 5), or excimer (n = 5) laser. Six months postoperatively the animals were sacrificed. Additional animals in both the early (n = 2) and late (n = 2) groups served as age- and weight-matched normal controls. Immunohistochemistry and Western blot analysis for tyrosine hydroxylase (TYR-OH), a neural-specific enzyme found in sympathetic efferent nerves and a commonly used anatomic marker of regional innervation, were performed on lased and nonlased LCx and septal regions.Immunohistochemical staining for TYR-OH was markedly diminished in the lased myocardial regions 3 days after TMR. This staining was significantly reduced compared to untreated septal regions, sham-operated, and normal LCx myocardium. Quantitative immunoblotting confirmed a significant reduction in TYR-OH (p0.05) protein concentration in the lased regions 3 days after TMR. On the contrary, TYR-OH staining was present in LCx myocardium surrounding the laser channels of all animals in all groups 6 months postoperatively. Staining was not different from controls. Similarly, there was no difference in LCx TYR-OH protein concentration between the normal, sham, or 6 months postoperative lased groups (p0.2 by one-way ANOVA).TMR-treated myocardium demonstrates anatomic evidence of regional sympathetic denervation 3 days postoperatively, although myocardium lased with each of the three lasers currently in clinical use is reinnervated by 6 months as evidenced by immunoblotting and immunohistochemistry for TYR-OH. These results suggest that mechanisms other than denervation may account for the long-term reductions in angina seen after TMR. more...
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- 2004
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45. Neuroimaging and Early Diagnosis of Alzheimer Disease: A Look to the Future
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Jeffrey R. Petrella, P. Murali Doraiswamy, and R. Edward Coleman
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Diagnostic Imaging ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Magnetic Resonance Imaging ,Diagnosis, Differential ,Atrophy ,Neuroimaging ,Alzheimer Disease ,Predictive Value of Tests ,Positron emission tomography ,medicine ,Medical imaging ,Humans ,Dementia ,Radiology, Nuclear Medicine and imaging ,Alzheimer's disease ,Differential diagnosis ,Tomography, X-Ray Computed ,Nuclear medicine ,business ,Tomography, Emission-Computed - Abstract
Alzheimer disease (AD), a progressive neurodegenerative disorder, is the most common cause of dementia in the elderly. Current consensus statements have emphasized the need for early recognition and the fact that a diagnosis of AD can be made with high accuracy by using clinical, neuropsychologic, and imaging assessments. Magnetic resonance (MR) or computed tomographic (CT) imaging is recommended for the routine evaluation of AD. Coronal MR images can be useful to document or quantify atrophy of the hippocampus and entorhinal cortex, both of which occur early in the disease process. Both volumetric and subtraction MR techniques can be used to quantify and monitor dementia progression and rates of regional atrophy. MR measures are also increasingly being used to monitor treatment effects in clinical trials of cognitive enhancers and antidementia agents. Positron emission tomography (PET) and single photon emission CT offer value in the differential diagnosis of AD from other cortical and subcortical dementias and may also offer prognostic value. In addition, PET studies have demonstrated that subtle abnormalities may be apparent in the prodromal stages of AD and in subjects who carry susceptibility genes. PET ligands are in late-stage development for demonstration of amyloid plaques, and human studies have already begun. Functional MR-based memory challenge tests are in development as well. more...
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- 2003
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46. [Untitled]
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Douglas A. Drossman, Timothy G. Turkington, Barbara H. Bradshaw, R. Edward Coleman, Shrikant I. Bangdiwala, William E. Whitehead, Thomas C. Hawk, and Yehuda Ringel
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medicine.medical_specialty ,Physiology ,business.industry ,Gastroenterology ,Rectum ,Distension ,Hepatology ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Cerebral blood flow ,Sexual abuse ,Internal medicine ,medicine ,Rectal Balloon ,business ,Irritable bowel syndrome ,Anterior cingulate cortex - Abstract
Previous studies have demonstrated alterations in brain response to rectal distension in patients with irritable bowel syndrome (IBS) compared to controls. Our aim was to compare regional brain activity in response to rectal balloon distension in patients with IBS and healthy controls. We studied six patients with IBS and six healthy controls. Positron emission tomography scans were obtained during rectal balloon distensions. Statistical parametric mapping and region of interest analysis were performed to identify and compare differences in regional cerebral blood flow (CBF) for each distension pressure within and between the groups of interest. In post-hoc analyses, patients with a history of sexual or physical abuse were compared to patients without abuse. In response to rectal distension, controls exhibit a greater increase in anterior cingulate cortex (ACC) activity compared to the IBS group (Z = 3.2, P = 0.001). Thalamic activity was higher in the IBS patients relative to the control group (Z = 3.3, P < 0.001). Increased ACC activity was observed in IBS patients with no history of abuse (Z = 5.2, P < 0.001) similar to controls, whereas no such increased activity was noticed in the abused group. In conclusion, this study replicates previous findings showing alterations in brain response to rectal distension in patients with IBS. The observations on the effect of abuse suggest a possible modulating role of abuse history on this brain response. more...
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- 2003
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47. Screening for Cerebral Metastases with FDG PET in Patients Undergoing Whole-Body Staging of Non–Central Nervous System Malignancy
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R. Edward Coleman, Daniel P. Barboriak, James M. Provenzale, and Eric M. Rohren
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Adult ,Male ,Adolescent ,Malignancy ,Sensitivity and Specificity ,Metastasis ,Lesion ,Central nervous system disease ,symbols.namesake ,Fluorodeoxyglucose F18 ,medicine ,Humans ,False Positive Reactions ,Radiology, Nuclear Medicine and imaging ,Fisher's exact test ,Aged ,Neoplasm Staging ,Aged, 80 and over ,medicine.diagnostic_test ,Brain Neoplasms ,business.industry ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Positron emission tomography ,symbols ,Regression Analysis ,Female ,Tomography ,medicine.symptom ,Nuclear medicine ,business ,Tomography, Emission-Computed - Abstract
To compare fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) with the current standard, magnetic resonance (MR) imaging, to determine the sensitivity and specificity of FDG PET for detection of cerebral metastases and to determine the factors that may affect lesion conspicuity.Forty patients underwent brain PET and contrast material-enhanced brain MR imaging, with a maximum of 30 days between examinations. PET and MR images were each retrospectively reviewed by two independent readers who were blinded to the clinical history and results of the other technique. Presence of metastatic disease was recorded for each modality. Sensitivity and specificity of FDG PET were determined with MR imaging as the standard. Statistical analysis was performed with the Fisher exact test and the logistic regression model.Sixteen patients had cerebral metastases at MR imaging, and in 12 of these, PET scans were interpreted as showing metastatic disease (in four, scans were false-negative). Twenty-four patients had no cerebral metastases at MR imaging, and 20 of these had PET scans interpreted as normal (in four, scans were false-positive). For identification of patients with cerebral metastases, FDG PET had a sensitivity of 75% (12 of 16) and a specificity of 83% (20 of 24). Thirty-eight metastatic lesions were seen at MR imaging; 23 (61%) of these were identified at PET. Size was a statistically significant factor that influenced lesion detection at PET (P.001).Only 61% of metastatic lesions in the brain were identified at PET. In particular, detection of small lesions was difficult. more...
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- 2003
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48. Bayesian reconstruction for SPECT: Validation with monte carlo simulation, experimental phantom, and real patient data.
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Z. Liang, Ronald J. Jaszczak, Carey E. Floyd Jr., Kim L. Greer, and R. Edward Coleman
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- 1989
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49. Time course of tetrahydrocannabinol-induced changes in regional cerebral blood flow measured with positron emission tomography
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Timothy R. DeGrado, James M. Provenzale, William H. Wilson, Timothy G. Turkington, R. Edward Coleman, Roy J. Mathew, and Thomas C. Hawk
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Adult ,Male ,Time Factors ,medicine.medical_treatment ,Neuroscience (miscellaneous) ,Hemodynamics ,Placebo ,mental disorders ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Dronabinol ,Tetrahydrocannabinol ,medicine.diagnostic_test ,business.industry ,organic chemicals ,Brain ,Middle Aged ,Magnetic Resonance Imaging ,Psychiatry and Mental health ,medicine.anatomical_structure ,nervous system ,Cerebral blood flow ,Positron emission tomography ,Cerebral cortex ,Cerebrovascular Circulation ,Anesthesia ,Hallucinogens ,Female ,Cannabinoid ,business ,Perfusion ,psychological phenomena and processes ,Tomography, Emission-Computed ,circulatory and respiratory physiology ,medicine.drug - Abstract
While several studies are available on the immediate effects of marijuana and its active ingredient tetrahydrocannabinol (THC) on regional cerebral blood flow (rCBF), we examined the effects of intravenous infusion of THC on rCBF and behavior over a 120-min. period using positron emission tomography. Indices of rCBF, intoxication and physiology were measured at baseline and 30, 60, 90 and 120 min. after a 20-min. intravenous infusion of 0.15 or 0.25 mg/min. of THC, or placebo given to 47 subjects. The rCBF remained increased up to 120 min. after the high-dose THC infusion. Significant increases were seen in global perfusion and in the frontal, insular and anterior cingulate regions. Changes were greater in the right hemisphere. After the high dose, cerebellar flow was increased at both 30 and 60 min. The anterioposterior ratio of cortical rCBF increased in both hemispheres, and remained significantly greater than in the placebo condition until 120 min. in the right hemisphere. Intoxication peaked at 30 min. and remained elevated at 120 min. THC had significant effects on global CBF and rCBF, and feeling intoxicated accounted for changes in rCBF better than plasma level of THC. more...
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- 2002
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50. Positron emission tomography imaging of brain tumors
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R. Edward Coleman, Terence Z. Wong, and Gert J van der Westhuizen
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Pathology ,medicine.medical_specialty ,Stereotactic biopsy ,Malignancy ,Neuroimaging ,Fluorodeoxyglucose F18 ,Biopsy ,Image Processing, Computer-Assisted ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiation treatment planning ,Blood Volume ,medicine.diagnostic_test ,Brain Neoplasms ,business.industry ,Magnetic resonance imaging ,General Medicine ,Prognosis ,medicine.disease ,Magnetic Resonance Imaging ,Primary tumor ,Positron emission tomography ,Cerebrovascular Circulation ,Neurology (clinical) ,Radiopharmaceuticals ,business ,Tomography, Emission-Computed - Abstract
A wide variety of metabolic features of brain tumors can be imaged using PET, including glucose metabolism, blood flow, oxygen consumption, amino acid metabolism, and lipid synthesis. Currently, FDG is the most widely available PET tracer for body imaging and brain imaging. Malignant brain tumors, like many other soft tissue tumors, show increased glucose metabolism, which is reflected on FDG-PET imaging. FDG-PET imaging of brain tumors provides information on tumor grade and prognosis. Compared with other organ systems, FDG-PET imaging of the brain presents unique challenges because of the high background glucose metabolism of normal gray matter structures. Coregistration of the MRI (or CT) and FDG-PET images is essential for accurate evaluation of brain tumors and is performed routinely at the authors' institution. The heterogeneous nature of gliomas can result in significant sampling errors when patients are biopsied for primary tumor diagnosis or recurrent disease. FDG-PET can be used to define the most metabolically active targets for stereotactic biopsy. This in turn can improve diagnostic accuracy and reduce the number of biopsy samples required. FDG-PET is also useful for evaluating residual or recurrent tumor following therapy, and can be used to survey patients with low-grade brain tumors for evidence of degeneration into high-grade malignancy. In the case of suspected tumor recurrence or progression, PET can aid in defining appropriate targets for biopsy. One limitation of FDG-PET is the occasional inability to distinguish radiation necrosis from recurrent high-grade tumor. A second limitation is that FDG-PET is less sensitive than contrast-enhanced MRI for detecting intracranial metastases, and it is the authors' experience that brain studies should not be included as part of routine whole-body PET studies. Other tracers, such as 11C-methionine and FCH, also avidly accumulate in brain tumors and have the advantage of low background cortical activity. The relationship between degree of uptake of these agents and tumor grade is not established. These tracers may be useful in specific clinical situations, however, such as tumor localization for treatment planning or evaluation of low-grade tumors. more...
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- 2002
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