Publications by authors named "Rameshwar Prasad"

13 Publications

  • Page 1 of 1

Infected peri-aortic hematoma diagnosed on F-18 FDG PET/CT imaging.

J Nucl Cardiol 2020 May 7. Epub 2020 May 7.

Rush University Medical Center, Radiology and Nuclear Medicine, 1653 W Congress Pkwy, Chicago, IL, 60612, USA.

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http://dx.doi.org/10.1007/s12350-020-02116-1DOI Listing
May 2020

Insight Into the Ontogeny of GnRH Neurons From Patients Born Without a Nose.

J Clin Endocrinol Metab 2020 05;105(5)

Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina.

Context: The reproductive axis is controlled by a network of gonadotropin-releasing hormone (GnRH) neurons born in the primitive nose that migrate to the hypothalamus alongside axons of the olfactory system. The observation that congenital anosmia (inability to smell) is often associated with GnRH deficiency in humans led to the prevailing view that GnRH neurons depend on olfactory structures to reach the brain, but this hypothesis has not been confirmed.

Objective: The objective of this work is to determine the potential for normal reproductive function in the setting of completely absent internal and external olfactory structures.

Methods: We conducted comprehensive phenotyping studies in 11 patients with congenital arhinia. These studies were augmented by review of medical records and study questionnaires in another 40 international patients.

Results: All male patients demonstrated clinical and/or biochemical signs of GnRH deficiency, and the 5 men studied in person had no luteinizing hormone (LH) pulses, suggesting absent GnRH activity. The 6 women studied in person also had apulsatile LH profiles, yet 3 had spontaneous breast development and 2 women (studied from afar) had normal breast development and menstrual cycles, suggesting a fully intact reproductive axis. Administration of pulsatile GnRH to 2 GnRH-deficient patients revealed normal pituitary responsiveness but gonadal failure in the male patient.

Conclusions: Patients with arhinia teach us that the GnRH neuron, a key gatekeeper of the reproductive axis, is associated with but may not depend on olfactory structures for normal migration and function, and more broadly, illustrate the power of extreme human phenotypes in answering fundamental questions about human embryology.
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http://dx.doi.org/10.1210/clinem/dgaa065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108682PMC
May 2020

Cardiac uptake patterns in routine 18F-FDG PET-CT scans: A pictorial review.

J Nucl Cardiol 2020 Aug 3;27(4):1296-1305. Epub 2020 Feb 3.

Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA.

Broad variability of 18F-Fluoro-2-deoxyglucose (FDG) uptake is noted in myocardium while performing FDG PET-CT scans for viability, infection, or oncologic purposes. While most of the uptakes are considered non-specific, presence of underlying cardiac disease is seldom encountered. With this presentation, our intent is to pictorially highlight the variable FDG uptake patterns associated with the normal variations, benign, and malignant disease.
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http://dx.doi.org/10.1007/s12350-020-02049-9DOI Listing
August 2020

Improvement in Successful Extubation in Newborns After a Protocol-driven Approach: A Quality Improvement Initiative.

Indian Pediatr 2019 09;56(9):749-752

Department of Pediatrics, Tata Main Hospital, Jamshedpur, Jharkhand, India.

Objective: To reduce extubation failure rate by implementing protocol-driven ventilation and extubation strategies.

Methods: Quality improvement project in a level II neonatal care unit from April 2017 to January 2018. Ventilation and extubation protocols implemented from 1 August, 2017. 18 ventilated newborns in the pre-protocol period, 16 in Plan-do-check-act (PDCA) cycle I and 17 in PDCA cycle II. Primary outcome was extubation failure within the first 72 h of extubation.

Results: Extubation failure rate reduced from 41.7% (pre-protocol period) to 23.8% (PDCA 1 and 2, OR 0.44, 95% CI 0.12 to 1.59, P = 0.21). Median time to first extubation attempt significantly decreased (71.5 h to 38 h, P=0.046).

Conclusions: A protocolized approach through quality improvement initiative demonstrated a sustained improvement in successful extubation with a significant reduction in the median time to first extubation attempt in ventilated newborns.
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September 2019

Congenital Arhinia: A Rare Case Report and Review of Literature.

Indian J Otolaryngol Head Neck Surg 2016 Dec 8;68(4):537-539. Epub 2016 Jul 8.

Department of Neonatology, IPGME&R and SSKM Hospital, Kolkata, 700020 India.

Congenital absence of nose (Arhinia) is extremely rare. A male baby was born at term via uncomplicated vaginal delivery and presented with complete arhinia, bilateral microphthalmia, lower eyelid coloboma and feeding difficulty. Reconstructive surgery was postponed until preschool age. On follow up at 1 year of age baby is feeding liquid and semisolid food and growing well.
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http://dx.doi.org/10.1007/s12070-016-1009-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083650PMC
December 2016

Quantitative Analysis of Dynamic 123I-mIBG SPECT Imaging Data in Healthy Humans with a Population-Based Metabolite Correction Method.

J Nucl Med 2016 08 14;57(8):1226-32. Epub 2016 Apr 14.

Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut

Unlabelled: Conventional 2-dimensional planar imaging of (123)I-metaiodobenzylguanidine ((123)I-mIBG) is not fully quantitative. To develop a more accurate quantitative imaging approach, we investigated dynamic SPECT imaging with kinetic modeling in healthy humans to obtain the myocardial volume of distribution (VT) for (123)I-mIBG.

Methods: Twelve healthy humans underwent 5 serial 15-min SPECT scans at 0, 15, 90, 120, and 180 min after bolus injection of (123)I-mIBG on a hybrid cadmium zinc telluride SPECT/CT system. Serial venous blood samples were obtained for radioactivity measurement and radiometabolite analysis. List-mode data of all the scans were binned into frames and reconstructed with attenuation and scatter corrections. Myocardial and blood-pool volumes of interest were drawn on the reconstructed images to derive the myocardial time-activity curve and input function. A population-based blood-to-plasma ratio (BPR) curve was generated. Both the population-based metabolite correction (PBMC) and the individual metabolite correction (IMC) curves were generated for comparison. VT values were obtained from different compartment models, using different input functions with and without metabolite and BPR corrections.

Results: The BPR curve reached the peak value of 2.1 at 13 min after injection. Parent fraction was approximately 58% ± 13% at 15 min and stabilized at approximately 40% ± 5% by 180 min after injection. Two radiometabolite species were observed. When the reversible 2-tissue-compartment fit was used, the mean VT value was 29.0 ± 12.4 mL/cm(3) with BPR correction and PBMC, a 188% ± 32% increase compared with that without corrections. There was significant difference in VT with BPR correction (P = 2.3e-04) as well as with PBMC (P = 1.6e-05). The mean difference in VT between PBMC and IMC was -3% ± 8%, which was insignificant (P = 0.39). The intersubject coefficients of variation after PBMC (43%) and IMC (42%) were similar.

Conclusion: The myocardial VT of (123)I-mIBG was established in healthy humans for the first time. Accurate kinetic modeling of (123)I-mIBG requires both BPR and metabolite corrections. Population-based BPR correction and metabolite correction curves were developed, allowing more convenient absolute quantification of dynamic (123)I-mIBG SPECT images.
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http://dx.doi.org/10.2967/jnumed.115.171710DOI Listing
August 2016

Scatter and crosstalk corrections for (99m)Tc/(123)I dual-radionuclide imaging using a CZT SPECT system with pinhole collimators.

Med Phys 2015 Dec;42(12):6895-911

Department of Diagnostic Radiology, Yale University, New Haven, Connecticut 06520.

Purpose: The energy spectrum for a cadmium zinc telluride (CZT) detector has a low energy tail due to incomplete charge collection and intercrystal scattering. Due to these solid-state detector effects, scatter would be overestimated if the conventional triple-energy window (TEW) method is used for scatter and crosstalk corrections in CZT-based imaging systems. The objective of this work is to develop a scatter and crosstalk correction method for (99m)Tc/(123)I dual-radionuclide imaging for a CZT-based dedicated cardiac SPECT system with pinhole collimators (GE Discovery NM 530c/570c).

Methods: A tailing model was developed to account for the low energy tail effects of the CZT detector. The parameters of the model were obtained using (99m)Tc and (123)I point source measurements. A scatter model was defined to characterize the relationship between down-scatter and self-scatter projections. The parameters for this model were obtained from Monte Carlo simulation using SIMIND. The tailing and scatter models were further incorporated into a projection count model, and the primary and self-scatter projections of each radionuclide were determined with a maximum likelihood expectation maximization (MLEM) iterative estimation approach. The extracted scatter and crosstalk projections were then incorporated into MLEM image reconstruction as an additive term in forward projection to obtain scatter- and crosstalk-corrected images. The proposed method was validated using Monte Carlo simulation, line source experiment, anthropomorphic torso phantom studies, and patient studies. The performance of the proposed method was also compared to that obtained with the conventional TEW method.

Results: Monte Carlo simulations and line source experiment demonstrated that the TEW method overestimated scatter while their proposed method provided more accurate scatter estimation by considering the low energy tail effect. In the phantom study, improved defect contrasts were observed with both correction methods compared to no correction, especially for the images of (99m)Tc in dual-radionuclide imaging where there is heavy contamination from (123)I. In this case, the nontransmural defect contrast was improved from 0.39 to 0.47 with the TEW method and to 0.51 with their proposed method and the transmural defect contrast was improved from 0.62 to 0.74 with the TEW method and to 0.73 with their proposed method. In the patient study, the proposed method provided higher myocardium-to-blood pool contrast than that of the TEW method. Similar to the phantom experiment, the improvement was the most substantial for the images of (99m)Tc in dual-radionuclide imaging. In this case, the myocardium-to-blood pool ratio was improved from 7.0 to 38.3 with the TEW method and to 63.6 with their proposed method. Compared to the TEW method, the proposed method also provided higher count levels in the reconstructed images in both phantom and patient studies, indicating reduced overestimation of scatter. Using the proposed method, consistent reconstruction results were obtained for both single-radionuclide data with scatter correction and dual-radionuclide data with scatter and crosstalk corrections, in both phantom and human studies.

Conclusions: The authors demonstrate that the TEW method leads to overestimation in scatter and crosstalk for the CZT-based imaging system while the proposed scatter and crosstalk correction method can provide more accurate self-scatter and down-scatter estimations for quantitative single-radionuclide and dual-radionuclide imaging.
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http://dx.doi.org/10.1118/1.4934830DOI Listing
December 2015

Scatter characterization and correction for simultaneous multiple small-animal PET imaging.

Mol Imaging Biol 2014 Apr;16(2):199-209

Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland.

Purpose: The rapid growth and usage of small-animal positron emission tomography (PET) in molecular imaging research has led to increased demand on PET scanner's time. One potential solution to increase throughput is to scan multiple rodents simultaneously. However, this is achieved at the expense of deterioration of image quality and loss of quantitative accuracy owing to enhanced effects of photon attenuation and Compton scattering. The purpose of this work is, first, to characterize the magnitude and spatial distribution of the scatter component in small-animal PET imaging when scanning single and multiple rodents simultaneously and, second, to assess the relevance and evaluate the performance of scatter correction under similar conditions.

Methods: The LabPET™-8 scanner was modelled as realistically as possible using Geant4 Application for Tomographic Emission Monte Carlo simulation platform. Monte Carlo simulations allow the separation of unscattered and scattered coincidences and as such enable detailed assessment of the scatter component and its origin. Simple shape-based and more realistic voxel-based phantoms were used to simulate single and multiple PET imaging studies. The modelled scatter component using the single-scatter simulation technique was compared to Monte Carlo simulation results. PET images were also corrected for attenuation and the combined effect of attenuation and scatter on single and multiple small-animal PET imaging evaluated in terms of image quality and quantitative accuracy.

Results: A good agreement was observed between calculated and Monte Carlo simulated scatter profiles for single- and multiple-subject imaging. In the LabPET™-8 scanner, the detector covering material (kovar) contributed the maximum amount of scatter events while the scatter contribution due to lead shielding is negligible. The out-of field-of-view (FOV) scatter fraction (SF) is 1.70, 0.76, and 0.11% for lower energy thresholds of 250, 350, and 400 keV, respectively. The increase in SF ranged between 25 and 64% when imaging multiple subjects (three to five) of different size simultaneously in comparison to imaging a single subject. The spill-over ratio (SOR) increases with increasing the number of subjects in the FOV. Scatter correction improved the SOR for both water and air cold compartments of single and multiple imaging studies. The recovery coefficients for different body parts of the mouse whole-body and rat whole-body anatomical models were improved for multiple imaging studies following scatter correction.

Conclusions: The magnitude and spatial distribution of the scatter component in small-animal PET imaging of single and multiple subjects simultaneously were characterized, and its impact was evaluated in different situations. Scatter correction improves PET image quality and quantitative accuracy for single rat and simultaneous multiple mice and rat imaging studies, whereas its impact is insignificant in single mouse imaging.
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http://dx.doi.org/10.1007/s11307-013-0683-2DOI Listing
April 2014

A cone-shaped phantom for assessment of small animal PET scatter fraction and count rate performance.

Mol Imaging Biol 2012 Oct;14(5):561-71

Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland.

Purpose: Positron emission tomography (PET) image quality deteriorates as the object size increases owing to increased detection of scattered and random events. The characterization of the scatter component in small animal PET imaging has received little attention owing to the small scatter fraction (SF) when imaging rodents. The purpose of this study is first to design and fabricate a cone-shaped phantom which can be used for measurement of object size-dependent SF and noise equivalent count rates (NECR), and second, to assess these parameters for two small animal PET scanners as function of radial offset, object size and lower energy threshold (LET).

Methods: The X-PET™ and LabPET-8™ scanners were modeled as realistically as possible using GATE Monte Carlo simulation platform. The simulation models were validated against experimental measurements in terms of sensitivity, SF and NECR. The dedicated phantom was fabricated in-house using high-density polyethylene. The optimized dimensions of the cone-shaped phantom are 158 mm (length), 20 mm (minimum diameter), 70 mm (maximum diameter) and taper angle of 9°.

Results: The relative difference between simulated and experimental results for the LabPET-8™ scanner varied between 0.7% and 10% except for a few results where it was below 16%. Depending on the radial offset from the center of the central axial field-of-view (3-6 cm diameter), the SF for the cone-shaped phantom varied from 26.3% to 18.2%, 18.6 to 13.1% and 10.1 to 7.6% for the X-PET™, whereas it varied from 34.4% to 26.9%, 19.1 to 17.0% and 9.1 to 7.3% for the LabPET-8™, for LETs of 250, 350 and 425 keV, respectively. The SF increases as the radial offset decreases, LET decreases and object size increases. The SF is higher for the LabPET-8™ compared with the X-PET™ scanner. The NECR increases as the radial offset increases and object size decreases. The maximum NECR was obtained at a LET of 350 keV for the LabPET-8™ and 250 keV for the X-PET™. High correlation coefficients for SF and NECR were observed between the cone-shaped phantom and an equivalent volume cylindrical phantom for the three considered axial fields of view.

Conclusions: A single cone-shaped phantom enables the assessment of the impact of three factors, namely radial offset, LET and object size on PET SF and count rate estimates. This phantom is more realistic owing to the non-uniform shape of rodents' bodies compared to cylindrical uniform phantoms and seems to be well suited for evaluation of object size-dependent SF and NECR.
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http://dx.doi.org/10.1007/s11307-012-0546-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443338PMC
October 2012

NEMA NU-04-based performance characteristics of the LabPET-8™ small animal PET scanner.

Phys Med Biol 2011 Oct 23;56(20):6649-64. Epub 2011 Sep 23.

Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva, Switzerland.

The objective of this study is to characterize the performance of the preclinical avalanche photodiode (APD)-based LabPET-8™ subsystem of the fully integrated trimodality PET/SPECT/CT Triumph™ scanner using the National Electrical Manufacturers Association (NEMA) NU 04-2008 protocol. The characterized performance parameters include the spatial resolution, sensitivity, scatter fraction, counts rate performance and image-quality characteristics. The PET system is fully digital using APD-based detector modules with highly integrated electronics. The detector assembly consists of phoswich pairs of Lu(1.9)Y(0.1)SiO(5) (LYSO) and Lu(0.4)Gd(1.6)SiO(5) (LGSO) crystals with dimensions of 2 × 2 × 14 mm(3) having 7.5 cm axial and 10 cm transverse field of view (FOV). The spatial resolution and sensitivity were measured using a small (22)Na point source at different positions in the scanner's FOV. The scatter fraction and count rate characteristics were measured using mouse- and rat-sized phantoms fitted with an (18)F line source. The overall imaging capabilities of the scanner were assessed using the NEMA image-quality phantom and laboratory animal studies. The NEMA-based radial and tangential spatial resolution ranged from 1.7 mm at the center of the FOV to 2.59 mm at a radial offset of 2.5 cm and from 1.85 mm at the center of the FOV to 1.76 mm at a radial offset of 2.5 cm, respectively. Iterative reconstruction improved the spatial resolution to 0.84 mm at the center of the FOV. The total absolute system sensitivity is 12.74% for an energy window of 250-650 keV. For the mouse-sized phantom, the peak noise equivalent count rate (NECR) is 183 kcps at 2.07 MBq cc(-1), whereas the peak true count rate is 320 kcps at 2.5 MBq cc(-1) with a scatter fraction of 19%. The rat-sized phantom had a scatter fraction of 31%, with a peak NECR of 67 kcps at 0.23 MBq cc(-1) and a peak true count rate of 186 kcps at 0.27 MBq cc(-1). The average activity concentration and percentage standard deviation were 126.97 kBq ml(-1) and 7%, respectively. The performance of the LabPET-8™ scanner was characterized based on the NEMA NU 04-2008 standards. The all in all performance demonstrates that the LabPET-8™ system is able to produce high-quality and highly contrasted images in a reasonable time, and as such it is well suited for preclinical molecular imaging-based research.
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http://dx.doi.org/10.1088/0031-9155/56/20/009DOI Listing
October 2011

Performance evaluation of the FLEX triumph X-PET scanner using the national electrical manufacturers association NU-4 standards.

J Nucl Med 2010 Oct 16;51(10):1608-15. Epub 2010 Sep 16.

Division of Nuclear Medicine, Geneva University Hospital, Geneva, Switzerland.

Unlabelled: The purpose of this work was to evaluate the performance characteristics of the preclinical X-PET subsystem of the FLEX Triumph PET/CT scanner based on the NU 4-2008 standards of the National Electrical Manufacturers Association (NEMA).

Methods: The performance parameters evaluated include the spatial resolution, scatter fraction, count losses and random coincidences, sensitivity, and image-quality characteristics. The PET detector array consisted of 11,520 individual bismuth germanate crystals arranged in 48 rings and 180 blocks, with an axial field of view (FOV) of 11.6 cm and a inner ring diameter of 16.5 cm. The spatial resolution was measured with a small (22)Na point source (diameter, 0.25 mm) at different radial offsets from the center. Sensitivity was calculated using the same source by stepping the source axially through the axial FOV of the scanner. Scatter fraction and counting-rate performances were determined using a mouse- and rat-sized phantom with an (18)F line source insert. The NEMA image-quality phantom and rodent imaging were also performed to access the overall imaging capabilities of the scanner.

Results: Tangential spatial resolution in terms of full width at half maximum varied between 2.2 mm at the center of the FOV and 2.3 mm at a radial offset of 2.5 cm. The radial spatial resolution varied between 2.0 at the center and 4.4 mm at a radial offset of 2.3 cm. The peak system absolute sensitivity was 5.9% at the center of the FOV. The absolute system sensitivity was 0.67 counts/s/Bq, and the relative total system sensitivity was 73.9%. The scatter fraction for the mouse-sized phantom was 7.9%, with a peak true counting rate of 168 kilocounts per second (kcps) at 0.3 MBq/mL and a peak noise-equivalent counting rate of 106 kcps at 0.17 MBq/mL. The rat-sized phantom had a scatter fraction of 21%, with a peak true counting rate of 93 kcps at 0.034 MBq/mL and a peak noise-equivalent counting rate of 49 kcps at 0.02 MBq/mL. Recovery coefficients for the image-quality phantom ranged from 0.13 to 0.88.

Conclusion: The performance of the X-PET scanner based on the NEMA NU 4-2008 standards was fully characterized. The overall performance demonstrates that the X-PET system is suitable for preclinical research.
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http://dx.doi.org/10.2967/jnumed.110.076125DOI Listing
October 2010

Advances in multimodality molecular imaging.

J Med Phys 2009 Jul;34(3):122-8

Geneva University Hospital, Division of Nuclear Medicine, CH-1211 Geneva, Switzerland.

Multimodality molecular imaging using high resolution positron emission tomography (PET) combined with other modalities is now playing a pivotal role in basic and clinical research. The introduction of combined PET/CT systems in clinical setting has revolutionized the practice of diagnostic imaging. The complementarity between the intrinsically aligned anatomic (CT) and functional or metabolic (PET) information provided in a "one-stop shop" and the possibility to use CT images for attenuation correction of the PET data has been the driving force behind the success of this technology. On the other hand, combining PET with Magnetic Resonance Imaging (MRI) in a single gantry is technically more challenging owing to the strong magnetic fields. Nevertheless, significant progress has been made resulting in the design of few preclinical PET systems and one human prototype dedicated for simultaneous PET/MR brain imaging. This paper discusses recent advances in PET instrumentation and the advantages and challenges of multimodality imaging systems. Future opportunities and the challenges facing the adoption of multimodality imaging instrumentation will also be addressed.
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http://dx.doi.org/10.4103/0971-6203.54844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807675PMC
July 2009