Publications by authors named "Brian P Mullan"

49 Publications

Diuresis-Related Weight Loss Reflects Interstitial Compartment Decongestion with Minimal Impact on Intravascular Volume Expansion or Outcomes in Post-Acute Heart Failure: Metrics of Decongestion and Volume Status.

J Card Fail 2021 Apr 9;27(4):445-452. Epub 2021 Jan 9.

Division of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota.

Background: Findings from heart failure (HF) studies linking diuresis-related weight loss to clinical decongestion and outcomes are mixed. Differential responses of interstitial and intravascular volume compartments to diuretic therapy and heterogeneity in volume profiles may confound the clinical interpretation of weight loss in patients with HF.

Methods And Results: Data were prospectively collected in hospitalized patients requiring diuresis. Plasma volume (PV) was measured using I-131-labelled albumin indicator-dilution methodology. The cohort was stratified by tertiles of weight loss and analyzed for interstitial fluid loss relative to changes in PV and HF-related morality or first rehospitalization. Among 92 patients, the admission PV was expanded +42% (4.7 ± 1.2 L) above normal with significant variability (14% normal PV, 18% mild-moderate expansion, and 68% with large PV expansion [>+25% above normal]). With diuresis there were proportional decreases in interstitial volume (-6.5 ± 4.4%) and PV (-7.5 ± 11%); however, absolute decreases in the PV (-254 mL, interquartile range -11 to -583 mL) were less than 10% of interstitial volume loss (-5040 mL, interquartile range -2800 to -7989 mL); greater interstitial fluid loss did not translate into better outcomes (log-rank P = .430).

Conclusions: Diuresis-related decreases in weight reflect fluid loss from the interstitial compartment with only minor changes in the PV and without an impact on outcomes. Further, the degree of PV expansion at hospital admission does not drive the magnitude of the diuresis response, even with a wide spectrum of body weights; interstitial fluid overload is preferentially targeted and PV relatively preserved. Therefore, greater interstitial fluid loss reflects clinical decongestion, but not better outcomes, and a limited association with intravascular volume profiles potentially confounding weight loss as a prognostic metric in HF.
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http://dx.doi.org/10.1016/j.cardfail.2020.12.006DOI Listing
April 2021

Myocardial Energetics in Heart Failure With Preserved Ejection Fraction.

Circ Heart Fail 2019 10 15;12(10):e006240. Epub 2019 Oct 15.

Department of Cardiovascular Medicine (O.F.A., B.A.B., A.B., S.V.P., M.M.R., P.C.), Mayo Clinic, Rochester, MN.

Background: The role of coronary microvascular disease and its impact on functional and energetic reserve in heart failure with preserved ejection fraction (HFpEF) remains unclear. We hypothesized that in response to submaximal pharmacologic stress (dobutamine), patients with HFpEF have impairment in left ventricular (LV) myocardial mechanical (external work [EW]), energetic (myocardial O consumption [MVO]), and myocardial blood flow (MBF) reserve. We further assessed whether coupling of MBF to EW is impaired in HFpEF and associated with compensatory increases or pathological decreases in myocardial O extraction. Lastly, we assessed whether coupling of MVO to EW (mechanical efficiency) was impaired in HFpEF.

Methods And Results: In prospectively enrolled patients with HFpEF (n=19) and age/sex-matched healthy controls (n=19), we performed C-acetate positron emission tomography assessing MVO and MBF at rest and during dobutamine infusion. EW was calculated as stroke volume (echo)×end-systolic pressure×heart rate. At rest, compared with controls, patients with HFpEF had higher LV EW, MVO, and MBF. With dobutamine, LV EW, MVO, and MBF increased in both HFpEF and controls; however, the magnitude of increases was significantly smaller in HFpEF. In both groups, MBF increased in relation to EW, but in HFpEF, the slope of the relationship was significantly smaller than in controls. Myocardial O extraction was increased in HFpEF. Mechanical efficiency was similar in HFpEF and controls. In a post hoc analysis, HFpEF patients with LV hypertrophy (n=10) had significant reductions in LV mechanical efficiency relative to controls.

Conclusions: In HFpEF during submaximal dobutamine stress, there is myocardial mechanical-, energetic- and flow-reserve dysfunction with impaired coupling of blood flow to demand and slight increases in myocardial O extraction. These findings provide evidence that coronary microvascular dysfunction is present in HFpEF, limits O supply relative to demand, and is associated with reserve dysfunction.
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.119.006240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6863599PMC
October 2019

Analysis of Brain SPECT Images Coregistered with MRI in Patients with Epilepsy: Comparison of Three Methods.

J Neuroimaging 2018 05 10;28(3):307-312. Epub 2018 Jan 10.

Department of Radiology, Mayo Clinic, Rochester, MN.

Background And Purpose: SISCOM and STATISCOM were clinically proved to be effective for ictal/inter-ictal single-photon emission computed tomography (SPECT) analysis coregistered with magnetic resonance imaging (MRI) for seizure localization. Recently, a software package also became available for this analysis. This study aimed to investigate and compare the performance of these analysis methods for seizure localization.

Methods: A total of 378 patients who underwent Tc-ethyl cysteinate dimer (ECD) SPECT scans were retrospectively reviewed and 28 remained after applying exclusion criteria. Their SPECT and MRI images were analyzed with SISCOM (with z-score of 1.5 and 2), STATISCOM, and MIMneuro, resulting in a total of 112 image data sets. Two experienced radiologists participated in the blind review process using a custom tool and they can mark up to two hyper- and/or hypoperfusion regions. Their review results were analyzed using the Jackknife Free Response Receiver-Operating Characteristics (JAFROC) test and the JAFROC figure-of-merit (FoM) was reported for each method. The interobserver agreement was also assessed using Cohen's kappa test.

Results: Based on the readers' two choices, averaged FoM was 85.7%, 83.9%, 66.1%, and 51.8% for STATISCOM, MIMneuro, SISCOM (z-score = 2), and SISCOM (z-score = 1.5), respectively. The average confidence rating was 2.5, 2.3, 1.6, and 1.1 for STATISCOM, MIMneuro, SISCOM (z-score = 2), and SISCOM (z-score = 1.5), respectively. For interobserver agreement, kappa was .742 for STATISCOM, .816 for MIMneuro, .517 for SISCOM (z-score = 2), and .441 for SISCOM (z-score = 1.5; all P < .001).

Conclusion: Our study demonstrated that STATISCOM showed the best performance for seizure localization, which was closely followed by MIMneuro. In addition, MIMneuro was not inferior to SISCOM with either z-score.
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http://dx.doi.org/10.1111/jon.12496DOI Listing
May 2018

C-Choline PET/CT for Detection and Localization of Parathyroid Adenomas.

AJR Am J Roentgenol 2018 Feb 15;210(2):418-422. Epub 2017 Nov 15.

1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Objective: The purpose of this study is to determine the efficacy of C-choline PET/CT for the detection of parathyroid adenomas by retrospectively reviewing a large patient population.

Materials And Methods: In this single-institution retrospective study, 7088 C-choline PET/CT scans performed of 2933 men with prostate cancer from January 2005 through February 2016 were evaluated. Patients with suspected parathyroid adenomas were identified through a review of the electronic medical record and relevant imaging. Patient demographics, laboratory results, and lesion characteristics were noted. Pathologically proven parathyroid adenomas and lesions in patients with imaging or laboratory findings consistent with the diagnosis were considered positive.

Results: Thirteen men (mean [± SD] age, 72 ± 7 years) with pathologically or laboratory-proven parathyroid adenomas were identified. All had abnormally elevated serum calcium and parathyroid hormone levels. All adenomas were tracer avid on C-choline PET/CT (maximum standardized uptake value, 5.6 ± 3.0), with activity averaging 4.2 times that of the blood pool and 2.1 times that of the adjacent thyroid. One case of an ectopic adenoma was identified. Of the six pathologically confirmed cases, none displayed high-grade features such as capsular, vascular, or adjacent tissue invasion. Three additional patients with possible parathyroid adenomas at C-choline PET/CT were ultimately found to have thyroid lesions on the basis of tissue diagnosis; however, none of these patients had abnormal calcium or parathyroid hormone levels.

Conclusion: In our patient population, C-choline PET/CT identified parathyroid adenomas with high specificity. Prospective investigation is warranted to validate this result and delineate the utility of C-choline PET/CT relative to other modalities.
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http://dx.doi.org/10.2214/AJR.17.18312DOI Listing
February 2018

Intravascular Volume Profiles in Patients With Class I and II Systolic Heart Failure: Heterogeneity and Volume Overload Are Common Even in Mild Heart Failure.

J Card Fail 2018 Jul 2;24(7):417-424. Epub 2017 Oct 2.

Division of Diagnostic Radiology/Nuclear Medicine, Mayo Clinic, Rochester, Minnesota.

Background: Although volume overload is a commonly described clinical feature of advanced heart failure (HF), less is known regarding volume profiles of patients with less severe class I and II HF.

Methods: Intravascular volume was quantitated by radiolabeled-albumin indicator-dilution technique in clinic outpatients.

Results: Forty-six patients (age 61 ± 13years, left ventricular ejection fraction 30 ± 8%) were prospectively evaluated with 28 undergoing repeat evaluations at 1 year. There was no difference in averaged total blood volume (TBV) at baseline between class I (N = 26) and II (N = 20) patients (5.6 ± 1.6vs 6.0 ± 1.3 L, P = .368) and at 1-year of follow-up. However, there was marked heterogeneity in plasma volume (-13% to +69% of normal) and red cell mass (RBCM -31% to +50%) profiles with TBV expansion identified in 46% of the cohort, whereas only 48% had a normal TBV. RBCM deficit (true anemia) was common (39%), but a low hemoglobin concentration was accurate in identifying anemia in only 11% of the cohort. RBCM excess (polycythemia) also was identified in 20% of the cohort.

Conclusions: Marked heterogeneity in plasma volume and RBCM volume profiles is present even in mild HF, and identifying volume overload, which was common in early HF, has the potential to help guide therapy in the reduction of HF progression. Intravascular volume as a modifiable risk factor in early HF warrants further study.
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http://dx.doi.org/10.1016/j.cardfail.2017.09.010DOI Listing
July 2018

Volume Overload Profiles in Patients With Preserved and Reduced Ejection Fraction Chronic Heart Failure: Are There Differences? A Pilot Study.

JACC Heart Fail 2016 06 9;4(6):453-9. Epub 2016 Mar 9.

Division of Diagnostic Radiology/Nuclear Medicine, Mayo Clinic, Rochester, Minnesota.

Objectives: This study aimed to characterize volume profiles and their differences in heart failure (HF) patients with preserved (HFpEF) and reduced (HFrEF) ventricular systolic function.

Background: The extent and distribution of volume overload and the associated implications for volume management have not been studied in decompensated HFpEF compared with HFrEF.

Methods: Total blood volume (TBV) was quantitated using a standardized computer-based radiolabeled albumin dilution technique.

Results: Twenty HFpEF and 35 HFrEF patients were evaluated at hospital admission. TBV was expanded by 27 ± 21% (range -5.2% to 77%; p = 0.002) and 37 ± 25% (0% to 107%; p < 0.001), respectively, above normal volumes. Red cell mass (RBCM) was expanded in HFrEF (24 ± 31%; p = 0.004) but within normal limits in HFpEF (8 ± 34%; p = 0.660) with, however, large variability in both groups. RBCM excess was more prominent in HFrEF (63% vs. 45%) than the RBCM deficit in HFpEF (35% vs.14%). With diuresis, TBV decreased to 25 ± 20% (p = 0.029) in HFrEF but was not changed in HFpEF (18 ± 20% [p = 0.173]). Body weight declined 6.6 ± 4.4 kg in HFrEF and 10.5 ± 8.3 kg (p = 0.026) in HFpEF. Interstitial fluid losses accounted for 85 ± 13% (HFrEF) and 93 ± 6% (HFpEF) (p = 0.012) of total volume removed.

Conclusions: TBV profiles differ between HFpEF and HFrEF patients with DCHF. Quantitated volume analysis revealed both significant RBCM (polycythemia) and plasma volume excess in HFrEF, whereas a higher RBCM deficit (true anemia) was demonstrated in HFpEF. Diuresis produced only a modest reduction in intravascular volumes with persistent hypervolemia in both groups at discharge, but overall more total body fluid was lost in HFpEF. These profile differences have implications for individualizing volume management.
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http://dx.doi.org/10.1016/j.jchf.2016.01.005DOI Listing
June 2016

A Multimodal Imaging Protocol, (123)I/(99)Tc-Sestamibi, SPECT, and SPECT/CT, in Primary Hyperparathyroidism Adds Limited Benefit for Preoperative Localization.

World J Surg 2016 Mar;40(3):589-94

Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.

Introduction: Focused parathyroidectomy in primary hyperparathyroidism (1°HPT) is possible with accurate preoperative localization and intraoperative PTH monitoring (IOPTH). The added benefit of multimodal imaging techniques for operative success is unknown.

Method: Patients with 1°HPT, who underwent parathyroidectomy in 2012-2014 at a single institution, were retrospectively reviewed. Only the patients who underwent the standardized multimodal imaging workup consisting of (123)I/(99)Tc-sestamibi subtraction scintigraphy, SPECT, and SPECT/CT were assessed.

Results: Of 360 patients who were identified, a curative operation was performed in 96%, using pre-operative imaging and IOPTH. Imaging analysis showed that (123)I/(99)Tc-sestamibi had a sensitivity of 86% (95% CI 82-90%), positive predictive value (PPV) 93%, and accuracy 81%, based on correct lateralization. SPECT had a sensitivity of 77% (95% CI 72-82%), PPV 92% and accuracy 72%. SPECT/CT had a sensitivity of 75% (95% CI 70-80%), PPV of 94%, and accuracy 71%. There were 3 of 45 (7%) patients with negative sestamibi imaging that had an accurate SPECT and SPECT/CT. Of 312 patients (87%) with positive uptake on sestamibi (93% true positive, 7% false positive), concordant findings were present in 86% SPECT and 84% SPECT/CT. In cases where imaging modalities were discordant, but at least one method was true-positive, (123)I/(99)Tc-sestamibi was significantly better than both SPECT and SPECT/CT (p < 0.001). The inclusion of SPECT and SPECT/CT in 1°HPT imaging protocol increases patient cost up to 2.4-fold.

Conclusion: (123)I/(99)Tc-sestamibi subtraction imaging is highly sensitive for preoperative localization in 1°HPT. SPECT and SPECT/CT are commonly concordant with (123)I/(99)Tc-sestamibi and rarely increase the sensitivity. Routine inclusion of multimodality imaging technique adds minimal clinical benefit but increases cost to patient in high-volume setting.
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http://dx.doi.org/10.1007/s00268-015-3389-6DOI Listing
March 2016

Tumor-Induced Osteomalacia.

Transl Endocrinol Metab 2015 ;7(3)

Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605441PMC
January 2015

Peripheral Venous Hemoglobin and Red Blood Cell Mass Mismatch in Volume Overload Systolic Heart Failure: Implications for Patient Management.

J Cardiovasc Transl Res 2015 Oct 8;8(7):404-10. Epub 2015 Sep 8.

Division of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA.

Peripheral venous hemoglobin (Hb) measurements are considered to accurately reflect circulating red blood cell mass (RBCM). In volume overload decompensated chronic heart failure (DCHF), reliance on Hb values may be misleading. Using quantitative radiolabel blood volume analysis (BVA), we evaluated the relation of RBCM to volume overload and reliability of Hb measurements to reflect RBC status in patients hospitalized for DCHF. Of 32 patients evaluated (LVEF <50 %), 19 met WHO Hb criteria for anemia. By BVA, however, only 4/19 had true anemia (low Hb and low RBCM) while 15/19 demonstrated plasma volume expansion dilution-related "anemia" (6 low Hb/normal RBCM, 9 low Hb/excess RBCM). The remaining 13/32 had normal range Hb (12 with excess RBCM). Overall, 66 % of cohort demonstrated RBCM excess. RBC profiles are highly variable in DCHF, and peripheral Hb values are often misleading in identifying RBC status. These findings have implications for volume management.
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http://dx.doi.org/10.1007/s12265-015-9650-4DOI Listing
October 2015

Understanding the heterogeneity in volume overload and fluid distribution in decompensated heart failure is key to optimal volume management: role for blood volume quantitation.

JACC Heart Fail 2014 Jun 30;2(3):298-305. Epub 2014 Apr 30.

Division of Diagnostic Radiology/Nuclear Medicine, Mayo Clinic, Rochester, Minnesota.

Objectives: This study sought to quantitate total blood volume (TBV) in patients hospitalized for decompensated chronic heart failure (DCHF) and to determine the extent of volume overload, and the magnitude and distribution of blood volume and body water changes following diuretic therapy.

Background: The accurate assessment and management of volume overload in patients with DCHF remains problematic.

Methods: TBV was measured by a radiolabeled-albumin dilution technique with intravascular volume, pre-to-post-diuretic therapy, evaluated at hospital admission and at discharge. Change in body weight in relation to quantitated TBV was used to determine interstitial volume contribution to total fluid loss.

Results: Twenty-six patients were prospectively evaluated. Two patients had normal TBV at admission. Twenty-four patients were hypervolemic with TBV (7.4 ± 1.6 liters) increased by +39 ± 22% (range, +9.5% to +107%) above the expected normal volume. With diuresis, TBV decreased marginally (+30 ± 16%). Body weight declined by 6.9 ± 5.2 kg, and fluid intake/fluid output was a net negative 8.4 ± 5.2 liters. Interstitial compartment fluid loss was calculated at 6.2 ± 4.0 liters, accounting for 85 ± 15% of the total fluid reduction.

Conclusions: TBV analysis demonstrated a wide range in the extent of intravascular overload. Dismissal measurements revealed marginally reduced intravascular volume post-diuretic therapy despite large reductions in body weight. Mobilization of interstitial fluid to the intravascular compartment with diuresis accounted for this disparity. Intravascular volume, however, remained increased at dismissal. The extent, composition, and distribution of volume overload are highly variable in DCHF, and this variability needs to be taken into account in the approach to individualized therapy. TBV quantitation, particularly serial measurements, can facilitate informed volume management with respect to a goal of treating to euvolemia.
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http://dx.doi.org/10.1016/j.jchf.2014.02.007DOI Listing
June 2014

Statistical SPECT processing in MRI-negative epilepsy surgery.

Neurology 2014 Mar 14;82(11):932-9. Epub 2014 Feb 14.

From the Departments of Neurology (V.S., B.H.B., D.T.J., G.D.C., L.C.W.-K., J.W.B., E.L.S., G.A.W.) and Radiology (M.L.S., B.P.M., R.E.W.) and Biomedical Imaging Resource (S.S., D.P.H., D.R.H., R.A.R.), Mayo Clinic, Rochester, MN; International Clinical Research Center (V.S., D.H.), St. Anne's University Hospital, Brno; and the Department of Neurology (V.S.), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.

Objective: To evaluate the benefit of statistical SPECT processing over traditional subtraction methods, we compared ictal-interictal SPECT analyzed by statistical parametric mapping (SPM) (ISAS), statistical ictal SPECT coregistered to MRI (STATISCOM), and subtraction ictal-interictal SPECT coregistered with MRI (SISCOM) in patients with MRI-negative focal temporal lobe epilepsy (nTLE) and extratemporal lobe epilepsy (nETLE).

Methods: We retrospectively identified 49 consecutive cases of drug-resistant focal epilepsy that had a negative preoperative MRI and underwent interictal and ictal SPECT prior to resective epilepsy surgery. Interictal and ictal SPECT scans were analyzed using SISCOM, ISAS, and STATISCOM to create hyperperfusion and hypoperfusion maps for each patient. Reviewers blinded to clinical data and the SPECT analysis method marked the site of probable seizure origin and indicated their confidence in the localization.

Results: In nTLE and nETLE, the hyperperfusions detected by STATISCOM (71% nTLE, 57% nETLE) and ISAS (67% nTLE, 53% nETLE) were more often colocalized with surgery resection site compared to SISCOM (38% nTLE, 36% nETLE). In nTLE, localization of the hyperperfusion to the region of surgery was associated with an excellent outcome for STATISCOM (p = 0.005) and ISAS (p = 0.027), but not in SISCOM (p = 0.071). This association was not present in nETLE for any method.

Conclusion: In an unselected group of patients with normal MRI and focal epilepsy, SPM-based methods of SPECT processing showed better localization of SPECT hyperperfusion to surgical resection site and higher interobserver agreement compared to SISCOM. These results show the benefit of statistical SPECT processing methods and further highlight the challenge of nETLE.
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http://dx.doi.org/10.1212/WNL.0000000000000209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963002PMC
March 2014

The role of autonomic testing in the differentiation of Parkinson's disease from multiple system atrophy.

J Neurol Sci 2012 Jun 14;317(1-2):92-6. Epub 2012 Mar 14.

Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada.

Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat test was greater in MSA (67.4±12.42, p<0.001) versus PD patients (area of anhidrosis, 1.7±2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4±0.40, p=0.025) compared to controls (2.0±0.29), but not in multiple system atrophy (2.0±0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the thermoregulatory sweat test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing is recommended to help differentiate MSA and PD.
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http://dx.doi.org/10.1016/j.jns.2012.02.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340456PMC
June 2012

Measurement of left and right ventricular volumes with tomographic equilibrium radionuclide angiocardiography and cardiac MRI.

Nucl Med Commun 2012 May;33(5):481-5

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.

Objective: We previously developed an operator-interactive method for the measurement of left ventricular (LV) and right ventricular (RV) ejection fraction (EF) and end-systolic volume (ESV) and end-diastolic volume (EDV) using single-photon emission tomographic equilibrium radionuclide angiocardiography (SPECT ERNA). We aimed to compare our SPECT ERNA method with cardiac MRI (CMRI) for the determination of ventricular measures.

Methods: Paired measurements of LV and RV EFs and ESV and EDV were carried out by SPECT ERNA and CMRI in a group of patients who had myocardial infarction due to left anterior descending coronary artery thrombosis.

Results: SPECT ERNA and CMRI provided similar estimations of the mean (SD) LV ESV [61 (23) vs. 61 (32) ml; P=0.99] and LV EDV [134 (29) vs. 141 (44) ml; P=0.28]. The mean (SD) LV EF by SPECT ERNA was slightly but significantly smaller than that by CMRI [0.55 (0.10) vs. 0.58 (0.11) ml; P=0.03]. SPECT ERNA, compared with CMRI, produced similar mean (SD) values of RV ESV [62 (17) vs. 67 (17) ml; P=0.10] and RV EDV [153 (28) vs. 149 (29) ml; P=0.51] and somewhat larger mean (SD) RV EF [0.60 (0.06) vs. 0.55 (0.06) ml; P<0.001]. Excellent correlations were found between SPECT ERNA and CMRI for combined LV ESV and EDV (R=0.85, P<0.001) and combined RV ESV and EDV (R=0.85, P<0.001).

Conclusion: This study further validates SPECT ERNA as a method to measure LV and RV EF, ESV, and EDV.
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http://dx.doi.org/10.1097/MNM.0b013e32835167aeDOI Listing
May 2012

Statistical parametric mapping demonstrates asymmetric uptake with Tc-99m ECD and Tc-99m HMPAO SPECT in normal brain.

J Cereb Blood Flow Metab 2012 Jan 21;32(1):190-8. Epub 2011 Sep 21.

Mayo Systems Electrophysiology Laboratory, Mayo Clinic, Rochester, Minnesota 55905, USA.

Tc-99m ethyl cysteinate diethylester (ECD) and Tc-99m hexamethyl propylene amine oxime (HMPAO) are commonly used for single-photon emission computed tomography (SPECT) studies of a variety of neurologic disorders. Although these tracers have been very helpful in diagnosing and guiding treatment of neurologic disease, data describing the distribution and laterality of these tracers in normal resting brain are limited. Advances in quantitative functional imaging have demonstrated the value of using resting studies from control populations as a baseline to account for physiologic fluctuations in cerebral perfusion. Here, we report results from 30 resting Tc-99m ECD SPECT scans and 14 resting Tc-99m HMPAO scans of normal volunteers with no history of neurologic disease. Scans were analyzed with regions of interest and with statistical parametric mapping, with comparisons performed laterally (left vs. right), as well as for age, gender, and handedness. The results show regions of significant asymmetry in the normal controls affecting widespread areas in the cerebral hemispheres, but most marked in superior parietotemporal region and frontal lobes. The results have important implications for the use of normal control SPECT images in the evaluation of patients with neurologic disease.
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http://dx.doi.org/10.1038/jcbfm.2011.123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323300PMC
January 2012

Prognostic value of 18F-fluorodeoxyglucose-positron emission tomography in patients with differentiated thyroid carcinoma and circulating antithyroglobulin autoantibodies.

Nucl Med Commun 2011 Apr;32(4):245-51

Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Objective: To explore the prognostic value of F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in radioiodine-negative patients with differentiated follicular cell-derived thyroid carcinoma with circulating antithyroglobulin autoantibodies (TgAb).

Methods: We retrospectively reviewed cases of all patients with differentiated thyroid cancer and increased TgAb referred for FDG-PET at Mayo Clinic, Rochester, Minnesota, from August 2001 to December 2004. PET findings were compared with results of other imaging and laboratory studies. Follow-up information was recorded until 19 December 2009.

Results: Of the 17 patients identified, PET results were true positive in 10 and false negative in two. In eight of these 12 patients with confirmed residual or recurrent disease, the increased TgAb level persisted and the disease progressed. In four of the 12 patients, TgAb decreased or disappeared after further treatment. In five patients, no residual or recurrent disease was found during follow-up. PET results were true negative in these five patients; TgAb disappeared spontaneously in four of these patients.

Conclusions: Negative PET results were associated with the absence of active disease and disappearing TgAb over time. FDG-avid residual lesions were associated with more aggressive disease and persistently increased TgAb.
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http://dx.doi.org/10.1097/MNM.0b013e328343a742DOI Listing
April 2011

Symptom improvement after upgrade from right ventricular apical to biventricular pacing: Role of right and left ventricular volumes assessed with single-photon emission computed tomographic equilibrium radionuclide angiocardiography.

J Nucl Cardiol 2011 Feb 3;18(1):43-51. Epub 2010 Dec 3.

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, 55905, USA.

Background: In patients with heart failure and reduced left ventricular ejection fraction (LVEF), the effect of upgrading from right ventricular (RV) apical to biventricular pacing on RV and left ventricular (LV) volumes and ejection fraction (EF) is unknown. Also, the relationship of symptom improvement after biventricular upgrade to RV and LV volumes and EF has not been clarified.

Methods And Results: Nineteen patients with long-standing persistent RV apical pacing who had heart failure symptoms and echocardiographic LVEF of 0.40 or less underwent upgrade to biventricular pacing. Patients had single-photon emission computed tomographic equilibrium radionuclide angiocardiography immediately before and at 3-6 months after the upgrade procedure, to measure RV and LV volumes and EF. Biventricular upgrade was associated with increase in LVEF and decrease in LV end-diastolic and end-systolic volumes; right ventricular ejection fraction (RVEF) and end-diastolic and end-systolic volumes were unaltered. Patients with improvement in New York Heart Association heart failure class of I or more had larger initial LV end-diastolic volumes than patients without an improvement and had decreased LV end-diastolic and end-systolic volumes comparatively. Symptom improvement was not associated with RVEF and volume change.

Conclusion: Symptom improvement with LV remodeling, but not RV remodeling, occurs 3-6 months after biventricular upgrade in patients with heart failure.
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http://dx.doi.org/10.1007/s12350-010-9287-2DOI Listing
February 2011

The prognostic value of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography in patients with suspected residual or recurrent medullary thyroid carcinoma.

Mol Imaging Biol 2010 Oct 1;12(5):547-53. Epub 2009 Dec 1.

Division of Nuclear Medicine, Department of Radiology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.

Purpose: To explore the prognostic value of 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) in patients with suspected residual or recurrent medullary thyroid carcinoma (MTC).

Procedures: This retrospective study included all patients with MTC examined with FDG-PET at Mayo Clinic, Rochester, Minnesota, from October 1999 to March 2008. The PET results were compared with other imaging studies and clinical findings, including carcinoembryonic antigen and calcitonin levels.

Results: Twenty-nine patients with MTC were included. PET was positive in 14 patients, with follow-up information for 11; six died from metastatic disease, four had disease progression, and one remained in stable condition. PET was negative in 15 patients, with follow-up for 12; one had recurrent disease, and 11 had no evidence of clinical disease. Calcitonin doubling time was shorter for PET-positive than for PET-negative patients.

Conclusion: FDG-PET has high prognostic value in patients with suspected residual or recurrent MTC.
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http://dx.doi.org/10.1007/s11307-009-0276-2DOI Listing
October 2010

18F-FDG PET and PET/CT in Burkitt's lymphoma.

Eur J Radiol 2010 Jul 27;75(1):e68-73. Epub 2009 Aug 27.

Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA.

Objective: To explore the value of (18)F fluorodeoxy-glucose (FDG) positron emission tomography (PET) in Burkitt's lymphoma.

Methods: All Burkitt's lymphoma patients referred for FDG PET or FDG PET/computed tomography (CT) exams at our institution from June 2003 to June 2006 were included. Selected patients were followed and clinical information was reviewed retrospectively. Results from FDG PET-PET/CT, as blindly reviewed by a consensus of two experienced readers, were compared with the status of the disease as determined by other laboratory, clinical and imaging exams and clinical follow-up. FDG PET-PET/CT results were classified as true positive or negative and false positive or negative. The degree of FDG uptake in the positive lesions was semiquantified as maximum standard uptake value (SUVmax).

Results: Fifty-seven FDG PET-PET/CT exams were done in 15 patients. Seven exams were done for initial staging, 8 during and 14 after the completion of therapy, and 28 for disease surveillance. For nodal disease FDG PET-PET/CT was true positive in 8, true negative in 47 and false positive in 2 exams (sensitivity 100%, specificity 96%). For extranodal disease FDG PET-PET/CT was true positive in 6, true negative in 48 and false positive in 3 exams (sensitivity 100%, specificity 94%). The mean SUVmax for the positive nodal lesions was 15.7 (range 6.9-21.7, median 18.5) and for extranodal lesions was 14.2 (range 6.2-24.3, median 12.4).

Conclusions: FDG PET-PET/CT is sensitive for the detection of viable disease in Burkitt's lymphoma. Affected areas demonstrated high degree of uptake that was reversible upon successful implementation of treatment.
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http://dx.doi.org/10.1016/j.ejrad.2009.07.035DOI Listing
July 2010

Percutaneous parathyroid ethanol ablation in patients with multiple endocrine neoplasia type 1.

AJR Am J Roentgenol 2008 Dec;191(6):1740-4

Department of Radiology, Mayo Clinic, 200 1st St., SW, Rochester, MN 55902, USA.

Objective: The objective of our study was to show the efficacy and safety of percutaneous ethanol ablation in managing recurrent primary hyperparathyroidism in patients with multiple endocrine neoplasia type 1 (MEN1) after subtotal parathyroidectomy.

Conclusion: Ethanol ablation is a viable alternative to reoperation for the management of recurrent primary hyperparathyroidism in patients with MEN1.
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http://dx.doi.org/10.2214/AJR.07.3431DOI Listing
December 2008

18F-FDG PET in the management of patients with anaplastic thyroid carcinoma.

Thyroid 2008 Jul;18(7):713-9

Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Background: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive solid tumors in humans. The use of positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) in ATC has not been studied, and only a few case reports have been published. The objective of this study was to investigate the potential contribution of 18F-FDG PET to the clinical management of patients with ATC.

Methods: All patients with ATC studied with 18F-FDG PET from August 2001 through March 2007 were included. The PET results were correlated with computed tomography, ultrasound, magnetic resonance imaging, bone scan, histology, and clinical follow-up. The FDG uptake was semiquantified as maximum standard uptake value. Any change in the treatment plan as a direct result of the PET findings as documented in the clinical notes was recorded.

Results: Sixteen patients were included. True-positive PET findings were seen for all primary tumors, in all nine patients with lymph node metastases, in five out of eight patients with lung metastases, and in two patients with distant metastases other than lung metastases. In 8 of the 16 patients, the medical records reported a direct impact of the PET findings on the clinical management.

Conclusions: ATC demonstrates intense uptake on 18F-FDG PET images. In 8 of the 16 patients (50%), the medical records reported a direct impact of the PET findings on the management of the patient. PET may improve disease detection and have an impact on the management of patients with ATC relative to other imaging modalities.
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http://dx.doi.org/10.1089/thy.2007.0350DOI Listing
July 2008

The value of positron emission tomography in the surgical management of recurrent papillary thyroid carcinoma.

World J Surg 2008 May;32(5):708-15

Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota 55905, USA.

Background: Patients with papillary thyroid carcinoma (PTC) may suffer recurrence despite thyroidectomy and complete radioiodine (RAI) ablation. Reoperation is vitally dependent on accurate and complete disease localization, typically utilizing cervical ultrasonography (US) and/or computed tomography. Our aim was to determine the comparative value of F18-fluorodeoxyglucose positron emission tomography (PET) to US for localization of locoregional recurrence in patients who underwent reoperation for recurrent PTC.

Methods: From 1999 to 2004, 30 patients who underwent re-exploration and 100 nonoperated patients who were investigated with PET for possible recurrent PTC were reviewed. The surgical group [9 males, 21 females; mean age=50 years (range=18-84 years)] all had received RAI ablation. Preoperative thyroid-stimulating hormone (TSH), thyroglobulin (Tg), and location of metastasis were recorded for each imaging study and surgical exploration. All separate sites that contained disease pathologically must have been identified by imaging for a patient to be considered true positive (TP).

Results: PET scans were TP in 43%, false positive in 7%, false negative (FN) in 50%, and had a sensitivity of 46%. Comparable US results were 86%, 10%, 3%, and 96%. Of the 15 patients with FN PET scans, 13 had lymph node metastasis less than 2 cm in diameter, 11 had Tg
Conclusions: At least with suppressed TSH, PET scanning in reoperative PTC patients appears to offer modest benefit beyond high-resolution US.
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http://dx.doi.org/10.1007/s00268-007-9361-3DOI Listing
May 2008

18F-FDG PET/CT in primary central nervous system lymphoma in HIV-negative patients.

Nucl Med Commun 2007 Nov;28(11):834-41

Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Objective: To determine the value of F-FDG PET/CT in the different manifestations of primary central nervous system lymphoma (PCNSL) in HIV-negative patients.

Methods: All PCNSL and HIV-negative patients referred for PET/CT in our institution from July 2001 to June 2006 were retrospectively studied. PET/CT examinations were reviewed by two experienced readers and evaluated for each possible anatomical site of nervous system involvement: cerebral, spinal/nerve and ocular. PET/CT results were characterized as true positive or negative and false positive or negative according to the status of the disease, which was determined after the evaluation of biopsies, laboratory, clinical and imaging examinations, and follow-up.

Results: Forty-two PET/CT examinations were carried out in 25 PCNSL patients. For intracerebral disease, PET/CT was true positive in 13 cases, true negative in 27 and false negative in two. For disease involving spinal cord and/or nerves, PET/CT was true positive in four cases, true negative in 37 and false negative in one. For ocular disease, PET was true positive in only one case and false negative in four. The sensitivity of PET/CT in detecting active disease in the brain was 87% (13/15), in the spine/nerves 80% (4/5), and in the eyes only 20% (1/5).

Conclusion: PET/CT seems to be sensitive for the detection of viable intracerebral as well as for spinal and peripheral nerve disease, but not for the detection of ocular involvement.
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http://dx.doi.org/10.1097/MNM.0b013e328264ae7fDOI Listing
November 2007

Focal F-18 fluoro-deoxy-glucose accumulation in the lung parenchyma in the absence of CT abnormality in PET/CT.

J Comput Assist Tomogr 2007 Sep-Oct;31(5):800-5

Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA.

Objective: To demonstrate 3 cases of artifactual focal F-18 fluoro-deoxy-glucose accumulation in the lung parenchyma in the absence of any computed tomographic (CT) abnormality.

Materials And Methods: Three patients were examined: a 30-year-old man who had a positron emission tomography (PET)/computed tomography for restaging a biopsy-proven recurrence of head and neck cancer, a 68-year-old woman who was referred for initial staging of esophageal carcinoma, and a 57-year-old man who had a PET/computed tomography for initial staging of melanoma. In each case, there was intense focal activity in the lung parenchyma with no corresponding CT abnormality. Each patient was further evaluated with a repeat PET scan in days 1 and 3 in the first 2 cases and with a delayed repeat acquisition in the third case. Patients were followed for 24, 10, and 1 month, respectively.

Results: In the first 2 cases, the abnormal focal activity in the lungs had resolved in the repeat study. In the third case, the focus of increased activity in the lung had moved more peripherally in the delayed acquisition. Clinical follow-up was negative for disease in the corresponding pulmonary parenchymal sites.

Conclusions: The finding of significant focal accumulation of fluoro-deoxy-glucose in the lung parenchyma in the absence of corresponding CT abnormality was artifactual. This was likely due to injection technique and the creation of particulate embolus. Positron emission tomography/Computed tomographic readers should be aware of this type of artifact to avoid misinterpretation.
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http://dx.doi.org/10.1097/RCT.0b013e3180340376DOI Listing
November 2007

Trends of radiopharmaceutical use at Mayo Clinic Rochester.

J Nucl Med Technol 2007 Sep 16;35(3):154-8. Epub 2007 Aug 16.

Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MH 55905, USA.

Unlabelled: The field of radiology is continuously changing. The purpose of this study was to identify the effect of technologic advances on nuclear medicine during the past 15 y.

Methods: The number of radiopharmaceutical doses dispensed at Mayo Clinic (Rochester, Minnesota) from 1990 through 2004 was tracked. The number of doses was equivalent to the number of scans performed.

Results: Since 1990, the number of bone scans decreased by 38%. Brain scans using (99m)Tc have increased by 166%. The number of cardiac doses dispensed increased 184% from 1990 through 1999 but decreased 3% between 2000 and 2004. The number of lung scans decreased 52% from 1992 through 1999 and increased 66% from 1999 through 2004. The number of kidney scans decreased 67% since 1990. Since its introduction in 1993, the use of (111)In-pentetreotide has increased 16-fold. PET data showed a 602% increase in the number of procedures from 2001 through 2004.

Conclusion: The number of bone, lung, and kidney scans has decreased because of advances in other imaging modalities. Although the number of cardiac imaging scans increased during most of the study period, the recent rate of growth has declined, possibly because of the availability of alternative procedures such as stress echocardiography. The number of brain and lung scans performed has increased, partially because of the development of new protocols. PET and tumor imaging have shown a substantial increase because of increasing numbers of approved indications and Medicare reimbursement.
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http://dx.doi.org/10.2967/jnmt.106.038992DOI Listing
September 2007

Clinical significance of diffusely increased 18F-FDG uptake in the thyroid gland.

J Nucl Med 2007 Jun 15;48(6):896-901. Epub 2007 May 15.

Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Unlabelled: Our purpose was to determine the clinical significance of diffusely increased (18)F-FDG uptake in the thyroid gland as an incidental finding on PET/CT.

Methods: All patients who were found to have diffuse thyroid uptake on (18)F-FDG PET/CT in our institution between November 2004 and June 2006 were investigated and compared with an age- and sex-matched control group. The (18)F-FDG uptake in the thyroid was semiquantified using maximum standardized uptake value and correlated to the available serum thyroid-stimulating hormone (TSH) and thyroid peroxidase (TPO) antibody levels using regression analysis.

Results: Of the 4,732 patients, 138 (2.9%) had diffuse thyroid uptake. Clinical information was available for 133 of the 138 patients. Sixty-three (47.4%) had a prior diagnosis of hypothyroidism or autoimmune thyroiditis, of whom 56 were receiving thyroxine therapy. In the control group, consisting of 133 patients with no thyroid uptake, there were 13 (9.8%) with a prior diagnosis of hypothyroidism, 11 of whom were receiving thyroxine therapy. In the study group, 38 (28.6%) of 133 patients did not undergo any further investigation for thyroid disease, whereas 32 (24.1%) of 133 patients were examined for thyroid disease after PET. Nineteen were found with autoimmune thyroiditis or hypothyroidism, and replacement therapy was initiated in 12. No significant correlation was found between maximum standardized uptake value and TSH (P = 0.09) or TPO antibody (P = 0.68) levels.

Conclusion: The incidental finding of increased (18)F-FDG uptake in the thyroid gland is associated with chronic lymphocytic (Hashimoto's) thyroiditis and does not seem to be affected by thyroid hormone therapy. SUV correlated neither with the degree of hypothyroidism nor with the titer of TPO antibodies.
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http://dx.doi.org/10.2967/jnumed.106.039024DOI Listing
June 2007

The value of quantifying 18F-FDG uptake in thyroid nodules found incidentally on whole-body PET-CT.

Nucl Med Commun 2007 May;28(5):373-81

Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.

Objective: To determine if quantification of [18F]fluorodeoxyglucose (18F-FDG) uptake in a thyroid nodule found incidentally on whole-body 18F-FDG positron emission tomography-computed tomography (PET-CT) can be used to discriminate between malignant and benign aetiology.

Methods: A retrospective review of all patients with focally high uptake in the thyroid as an incidental finding on 18F-FDG PET-CT from May 2003 through May 2006. The uptake in the nodules was quantified using the maximum standardized uptake value (SUVmax). The aetiology was determined by cytology and/or ultrasound, or on histopathology.

Results: Incidental focally high uptake was found in 79/7347 patients (1.1%). In 31/48 patients with adequate follow-up, a benign aetiology was determined. Median SUVmax for the benign group was 5.6, range 2.5-53. Malignancy was confirmed in 15/48 patients. The malignancies were papillary thyroid carcinoma in 12, metastasis from squamous cell carcinoma in one, and lymphoma in two. Median SUVmax for the malignant lesions was 6.4, range 3.5-16. Cytology suspicious for follicular carcinoma was found in 2/48 patients. No statistical difference (P=0.12) was found among the SUVmax between the benign and malignant groups.

Conclusion: Focally high uptake of 18F-FDG in the thyroid as an incidental finding occurred in 1.1% of the patients. Malignancy was confirmed or was suspicious in 17/48 (35%) of the patients that had adequate follow-up. There was no significant difference in the SUVmax between benign and malignant nodules.
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http://dx.doi.org/10.1097/MNM.0b013e3280964eaeDOI Listing
May 2007

Contribution of F-18 FDG PET-CT in the detection of systemic spread of primary central nervous system lymphoma.

Clin Nucl Med 2007 Apr;32(4):271-4

Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA.

Purpose: Primary central nervous system lymphoma (PCNSL) accounts for approximately 3% of all primary brain tumors and 1% of all non-Hodgkin lymphomas. Detection of systemic spread of PCNSL, although rare (4%), is very important since therapy is usually modified. Contrast-enhanced computed tomography (CT) is commonly used for systemic staging of PCNSL. No previous case report is available in the published literature elaborating the potential contribution of F-18 FDG PET in systemic staging of PCNSL. The purpose of this case report was to document the potential usefulness of F-18 FDG-PET in the detection of occult systemic involvement in PCNSL.

Materials And Methods: A 50-year-old, immunocompetent, male patient completed successful treatment of PCNSL. As part of a routine pretransplant evaluation he had an F-18 FDG PET coregistered with CT (PET-CT). The PET-CT results were then compared with those of contrast-enhanced CT of the chest, abdomen, and pelvis.

Results: The PET-CT examination detected multiple sites of extranodal systemic disease that were not seen in the contrast-enhanced CT of the chest, abdomen, and pelvis (both studies were performed within 24 hours of each other). Percutaneous ultrasound guided biopsy confirmed the presence of systemic spread of PCNSL. The patient's subsequent therapy was modified to include rituximab with cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP). A follow up PET-CT confirmed resolution of systemic spread.

Conclusion: F-18 FDG PET coregistered to CT may be a useful examination in the detection and monitoring for systemic spread of the disease in PCNSL patients.
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http://dx.doi.org/10.1097/01.rlu.0000257269.99345.1bDOI Listing
April 2007

Assessment of pulmonary thromboendarterectomy by tomographic electrocardiogram-gated equilibrium radionuclide angiocardiography compared with electron beam computed tomography.

J Nucl Cardiol 2007 Jan;14(1):92-9

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.

Background: Successful thromboendarterectomy for chronic thromboembolic pulmonary hypertension promptly improves right ventricular (RV) function by decreasing RV volume and increasing ejection fraction (EF). Single photon emission computed tomography (SPECT) equilibrium radionuclide angiocardiography (ERNA) has been validated as a measure of RV and left ventricular (LV) volume and EF.

Methods And Results: Nine patients with chronic thromboembolic pulmonary hypertension underwent electron beam computed tomography (EBCT) and SPECT ERNA cardiac studies before and after thromboendarterectomy. EBCT and SPECT ERNA measures of RV and LV volume and EF were compared. Before thromboendarterectomy, EBCT and SPECT ERNA RV and LV volumes and RV EF were similar. LV EF was within the normal range with both methods but was slightly greater (P = .004) when measured by EBCT (mean +/- SD, 0.61 +/- 0.08) compared with SPECT ERNA (0.54 +/- 0.10). Thromboendarterectomy measured by EBCT and SPECT ERNA produced marked similar and significant decreases in RV end-systolic (-72 +/- 59 mL vs -58 +/- 25 mL) and end-diastolic (-75 +/- 85 mL vs -76 +/- 32 mL) volumes and similar slight increases in RV EF (0.12 +/- 0.07 vs 0.05 +/- 0.06). Slight decreases in mean LV end-systolic (-19 +/- 23 mL vs -5 +/- 13 mL, P = .05) and end-diastolic (-32 +/- 53 mL vs -9 +/- 31 mL, P = .21) volumes occurred, with little change in mean LV EF (0.05 +/- 0.07 vs 0.00 +/- 0.10).

Conclusions: SPECT ERNA is an accurate method for measuring RV and LV volume and EF before and after thromboendarterectomy.
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http://dx.doi.org/10.1016/j.nuclcard.2006.09.009DOI Listing
January 2007

Combined positron emission tomography/computed tomography for evaluation of presumed choroidal metastases.

Clin Exp Ophthalmol 2006 Dec;34(9):846-51

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Background: Choroidal metastases are the most common intraocular malignancy and are the first sign of systemic malignancy in approximately one-third of patients. Of patients with no previous diagnosis of cancer, oncological evaluation fails to find the primary lesion in approximately 50% of cases. Newer imaging modalities such as combined positron emission tomography/computed tomography (PET/CT) may improve the yield of the systemic work-up.

Methods: Consecutive patients presenting with presumed choroidal metastases were evaluated with whole body combined PET/CT scanning.

Results: Four patients presenting to a tertiary referral hospital with choroidal metastases as the first sign of systemic malignancy were evaluated. In all four cases, PET/CT demonstrated the ocular lesion, and the primary malignancy which was confirmed by tissue biopsy. False-negative results were seen in two cases of cerebral metastases. PET/CT demonstrated lesions not visible on CT or magnetic resonance imaging in two cases.

Conclusions: Combined PET/CT is a useful addition to the work-up of patients with choroidal metastases. It provides the opportunity to detect lesions not visible with other imaging modalities and the ability to image patients with contraindications to magnetic resonance imaging. It is essential to correlate PET images with clinical information and the results of other imaging modalities and tissue biopsy remains the gold standard in the diagnosis of malignancy. False positives and negatives can occur with PET/CT, and further research is needed before this promising technology becomes a routine part of the evaluation of patients with choroidal metastases.
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http://dx.doi.org/10.1111/j.1442-9071.2006.01364.xDOI Listing
December 2006