INTRODUÇÃO: A avaliação do mediastino quanto à presença de metástases linfonodais é importante na escolha do tratamento dos pacientes com câncer de pulmão de não pequenas células. Apesar da tomografia computadorizada ser o exame de imagem de escolha no estadiamento do câncer de pulmão, tem limitações conhecidas quanto à avaliação dos linfonodos regionais. O objetivo deste trabalho é avaliar a acurácia do SPECT/TC utilizando o radiofármaco 99mTc-sestamibi no estadiamento linfonodal do mediastino em pacientes com diagnóstico de carcinoma de pulmão de não pequenas células e candidatos a tratamento cirúrgico. MÉTODOS: Foi realizada coleta prospectiva de dados de 41 pacientes entre dezembro de 2006 a fevereiro de 2009. Os pacientes foram submetidos à tomografia computadorizada de tórax e ao SPECT/TC com 99mTc-sestamibi no prazo máximo de 30 dias antes da cirurgia. O SPECT/TC foi considerado positivo quando havia captação no mediastino e a tomografia de tórax, quando havia linfonodos maiores do que 10 mm no menor eixo. Os resultados da interpretação do SPECT/TC com sestamibi e da TC de tórax foram comparados aos encontrados na patologia, definido como método padrão ouro. RESULTADOS: O SPECT/TC identificou de maneira correta seis dos 19 casos com envolvimento dos linfonodos hilares e um dos sete casos com metástases ganglionares no mediastino pela patologia. Os valores de sensibilidade, especificidade, valores de predição positivo e negativo para o 99mTc-sestamibi SPECT/TC na avaliação do hilo foram respectivamente de: 31,6%, 95,5%, 85,7% e 61,8% e para o mediastino de 14,3%, 97,1%, 50% e 84,6%. A tomografia de tórax encontrou sensibilidade para a análise dos linfonodos hilares e mediastinais de 47,4% e 57,1%, especificidade de 95,5%, e 91,2%, valores de predição positivo de 90% e 57,1% e negativo de 67,7% e 91,2%, respectivamente. CONCLUSÃO: Nos pacientes com câncer de pulmão de não pequenas células com doença inicial e ressecável o SPECT/TC com 99mTc-sestamibi no estadiamento linfonodal do mediastino apresentou baixa sensibilidade e acurácia, apesar da alta especificidade. O SPECT/TC não adicionou informações relevantes à TC de tórax, que poderiam justificar o seu emprego no estadiamento pré-operatório do carcinoma de pulmão de não pequenas células / INTRODUCTION: The proper nodal staging of non-small cell lung cancer is important to choose the best treatment modality. Although CT is the first-line imaging test for primary staging of lung cancer, it is well known its limitations on mediastinum nodal staging. The aim was to evaluate the accuracy of SPECT/CT using 99mTc-sestamibi in the nodal staging of patients with non-small cell lung cancer and potential candidates towards surgical treatment. METHODS: A prospective data collection of 41 patients was conducted from December 2006 to February 2009. The patients underwent chest CT and SPECT/CT with 99mTc-sestamibi within 30 days interval before surgery. SPECT/CT was considered positive when there was focal uptake of sestamibi in the mediastinum and CT scan when there was lymph nodes larger than 10 mm in short axis. The results of SPECT/CT and CT were correlated with pathology findings after surgery. RESULTS: SPECT/CT correctly identified six of 19 cases with involvement of hilar lymph nodes and one of seven cases with nodal metastases in the mediastinum. The sensitivity, specificity, positive and negative predictive value for 99mTc-sestamibi SPECT/CT in the assessment of the hilum were respectively: 31.6%, 95.5%, 85.7% and 61.8% and for the mediastinum 14.3%, 97.1%, 50% and 84.6%. Chest tomography showed a sensitivity of hilar and mediastinal lymph nodes of 47.4% and 57.1%, specificity of 95.5% and 91.2%, positive predictive value of 90% and 57.1% and negative predictive value of 67.7% and 91.2%, respectively. CONCLUSION: SPECT/CT with 99mTc-sestamibi showed very low sensitivity and accuracy for nodal staging of patients with non-small cell cancer despite its high specificity. Moreover, the performance of SPECT/CT added no relevant information compared to CT that could justify its use in the routine preoperative staging of non-small cell lung carcinoma

Thesis (Ph. D.)--Ohio State University, 2006. / Available online via OhioLINK's ETD Center; full text release delayed at author's request until 2007 Jun 16

Thesis (D.Tech.: Radiography)-Dept. of Radiography, Durban Institute of Technology, 2006 xxiii, 166 leaves / The purpose of this study was to evaluate 99mTc- methoxyisobutylisonitrile (MIBI) imaging, in terms of sensitivity and specificity, for non invasively detecting extracutaneous involvement of Kaposi’s sarcoma (KS) and for differentiating pulmonary infection from malignancy in acquired immunodeficiency syndrome (AIDS) patients before and after treatment. Current investigations are invasive.

Thesis (D.Tech.: Radiography)-Dept. of Radiography, Durban Institute of Technology, 2006 xxiii, 166 leaves / The purpose of this study was to evaluate 99mTc- methoxyisobutylisonitrile (MIBI) imaging, in terms of sensitivity and specificity, for non invasively detecting extracutaneous involvement of Kaposi’s sarcoma (KS) and for differentiating pulmonary infection from malignancy in acquired immunodeficiency syndrome (AIDS) patients before and after treatment. Current investigations are invasive.

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2015-01-21T10:32:45Z No. of bitstreams: 0 / Made available in DSpace on 2015-01-21T10:32:45Z (GMT). No. of bitstreams: 0 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP / FAPESP:10/04206-4

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2015-01-21T10:32:45Z No. of bitstreams: 0 / Made available in DSpace on 2015-01-21T10:32:45Z (GMT). No. of bitstreams: 0 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A NSECT figura como uma nova técnica espectrográfica capaz de avaliar in vivo a concentração de elementos utilizando a reação de espalhamento inelástico (n,n). Desde sua introdução, várias melhorias vem sendo propostas com o objetivo de investigar aplicações para o diagnóstico clínico e redução da dose absorvida associada à aquisição tomográfica. Neste contexto, são apresentadas duas novas aplicações de diagnóstico utilizando as abordagens espectroscópica e tomográfica da NSECT. Uma nova metodologia também foi proposta para otimizar a amostragem do sinograma que está diretamente relacionado com a qualidade de reconstrução através do protocolo de irradiação. Os estudos realizados foram desenvolvidos com base em simulações com o código MCNP5. O diagnóstico de Carcinoma de Célula Renal (CCR) e a detecção de microcalcificações mamárias foram avaliadas nos estudos conduzidos utilizando um objeto simulador humano. Os resultados obtidos demonstram a habilidade da técnica NSECT em detectar a alteração da composição dos tecidos modelados em função do desenvolvimento das patologias avaliadas. O método proposto para a otimização dos sinogramas foi capaz de simular analiticamente a composição do meio irradiado permitindo que a qualidade de reconstrução e a dose efetiva fossem avaliados em função da taxa de amostragem. Entretanto, futuras pesquisas devem ser conduzidas para quantificar o limiar de detecção de acordo com os elementos selecionados. / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP / FAPESP:10/04206-4

Bone is a remarkable multifunctional tissue with the ability to regenerate and remodel without generating any scar tissue. However, bone loss due to injury or diseases can be a great challenge and affect the patient significantly. Autologous bone grafting is commonly used throughout the world. Autograft both fills the void and is bone inductive, housing the particular cells that are needed for bone regeneration. However, a regenerative complement to autograft is of great interest as the use of biomaterials loaded with bioactive molecules can avoid donor site morbidity and the problem of a limited volume of material. Two such regenerative products that utilise bone morphogenetic protein (BMP)-7 and -2 have been used for more than a decade clinically. Unfortunately, several side effects have been reported, such as severe swelling due to inflammation and ectopic bone formation. Additionally, the products require open surgery and use of supra physiological doses of the BMPs due to poor localisation and retention of the growth factor. The purpose of this thesis was to harness the strong inductive capacity of the BMP-2 by optimising the carrier of this bioactive protein, thereby minimising the side effects that are associated with the clinical products and facilitating safe and localised bone regeneration. We focused on an injectable hyaluronan-based carrier developed through polymer chemistry at the University of Uppsala. The strategy was to use the body’s own regenerative pathway to stimulate and enhance bone healing in a manner similar to the natural bone-healing process. The hyaluronan-based carrier has a similar composition to the natural extracellular matrix and is degraded by resident enzymes. Earlier studies have shown improved properties when adding hydroxyapatite, a calcium phosphate that constitutes the inorganic part of the bone matrix. In Paper I, the aim was to improve the carrier by adding other forms of calcium phosphate. The results indicated that bone formation was enhanced when using nano-sized hydroxyapatite. In Paper II, we discovered the importance of crushing the material, thus enhancing permeability and enlarging the surface area. We wished to further develop the carrier system, but were lacking an animal model with relatively high throughput, facilitated access, paired data, and we were also committed to the 3Rs of refinement, reduction, and replacement. To meet these challenges, we developed and refined an animal model, and this is described in Paper III. In Paper IV, we sought to further optimise the biomaterial properties of the hydrogel through covalent bonding of bisphosphonates to the hyaluronan hydrogel. This resulted in exceptional retention of the growth factor BMP-2. In Paper V, SPECT/PET/µCT was combined as a tri-modal imaging method to allow visualisation of the biomaterial’s in situ action, in terms of drug retention, osteoblast activity and mineralisation. Finally, in Paper VI the correlation between existing in vitro results with in vivo outcomes was observed for an array of biomaterials. The study identified a surprisingly poor correlation between in vitro and in vivo assessment of biomaterials for osteogenesis.

A análise de imagens médicas auxiliada por computador permite a análise quantitativa das anormalidades e garante maior precisão diagnóstica. Esse tipo de análise é importante para medicina nuclear com Single Photon Emission Computed Tomography (SPECT), pois no grupo de dados tridimensionais de imagens, padrões sutis de anormalidades muitas vezes são importantes achados clínicos. Porém, as imagens podem sofrer interferência de artefatos de atenuação da emissão de fótons por partes moles corporais, o que reduz sua acurácia diagnóstica. Desde que se possuam parâmetros de atenuação computados em um modelo que permita a comparação com imagens de um dado paciente, a interferência dos artefatos pode ser corrigida com ganho na acurácia diagnóstica, sem a necessidade de utilização de técnicas de correção que aumentem a dose de exposição à radiação pelo paciente. A proposta desse estudo foi a criação de um atlas de cintilografia de perfusão miocárdica, que foi obtido a partir de imagens de indíviduos normais, e o desenvolvimento de um algoritmo computacional para a detecção de anormalidades perfusionais miocárdicas, através da comparação estatística dos modelos do atlas com imagens de pacientes. Métodos de corregistro de imagens de mesma modalidade e outras técnicas de processamento de imagens foram estudados e utilizados para a comparação das imagens dos pacientes com o modelo apropriado. Pela análise visual dos modelos, verificou-se a sua validade como imagem representativa de normalidade perfusional. Para avaliação da detecção, a situação dos segmentos miocárdicos (normal ou anormal) indicada pelo algoritmo de detecção foi comparada com a situação apontada no laudo obtido pela concordância de dois especialistas, de modo a se verificar as concordâncias e discordâncias da técnica em relação ao laudo e se obter a significância estatística. Com isso, verificou-se um índice de concordância positiva da técnica em relação ao laudo de aproximadamente 50%, de concordância negativa próxima a 82% e de concordância geral próxima a 68%. O teste exato de Fisher foi aplicado às tabelas de contingência, obtendo-se um valor de p bicaudal inferior a 0,0001, indicando uma probabilidade muito baixa de as concordâncias terem sido obtidas pelo acaso. Melhorias no algoritmo deverão ser implementadas e testes futuros com um padrão-ouro efetivo serão realizados para validação da técnica. / The computer-aided medical imaging analysis allows the quantitative analysis of abnormalities and enhances diagnostic accuracy. This type of analysis is important for nuclear medicine that uses Single Photon Emission Computed Tomography (SPECT), because in the group of three-dimensional data images, subtle patterns of abnormalities often are important clinical findings. However, images can suffer interference from attenuation artifacts of the emission of photons by soft parts of the body, which reduces their diagnostic accuracy. Since there are attenuation parameters computed in a template that allows for comparison with images of a given patient, the artifacts interference can be corrected with a gain in diagnostic accuracy, without the need of using correction techniques that increase the radiation exposure dose of the patient. The purpose of this study was to create an atlas of myocardial perfusion scintigraphy, which was obtained from images of normal individuals and the development of a computational algorithm for detection of myocardial perfusion abnormalities by statistical comparison of atlas templates with images of patients. Methods of image registration of same modality and other image processing techniques were studied and used for comparison of patient images with the appropriate template. By the visual analysis of the templates it was found its validity as a representative image of normal perfusion. For the detection evaluation, the situation of myocardial segments (normal or abnormal) indicated by the detection algorithm was compared with the situation indicated in the medical appraisal report obtained by agreement of two specialists in order to determine the agreement and disagreement of the technique regarding the medical appraisal report and obtaining the statistical significance. Thus, there was a positive agreement index of the technique regarding the medical appraisal report of approximately 50%, a negative agreement index close to 82% and a general agreement index near 68%. The Fisher exact test was applied to the contingency tables, yielding a two-sided p-value less than 0.0001, that indicates a very low probability of the agreements have been obtained by chance. Algorithm improvements should be implemented and further tests with an effective gold-standard will be conducted to validate the technique.

La tomographie d'émission monophotonique (TEMP) dédiée au petit animal est une technique d'imagerie nucléaire qui joue un rôle important en imagerie moléculaire. Les systèmes TEMP, à l'aide de collimateurs pinholes ou multi-pinholes, peuvent atteindre des résolutions spatiales submillimétriques et une haute sensibilité pour un petit champ de vue, ce qui est particulièrement attractif pour imager des souris. Une géométrie de collimation originale a été proposée, dans le cadre d'un projet, appelé SIGAHRS, piloté par la société Biospace. Ce collimateur présente des longueurs focales qui varient spatialement dans le plan transaxial et qui sont fixes dans le plan axial. Une haute résolution spatiale est recherchée au centre du champ de vue, avec un grand champ de vue et une haute sensibilité. Grâce aux simulations Monte Carlo, dont nous pouvons maîtriser tous les paramètres, nous avons étudié cette collimation originale que nous avons positionnée par rapport à un collimateur parallèle et un collimateur monofocal convergent. Afin de générer des données efficacement, nous avons développé un module multi-CPU/GPU qui utilise une technique de lancer de rayons dans le collimateur et qui nous a permis de gagner un facteur ~ 60 en temps de calcul, tout en conservant ~ 90 % du signal, pour l'isotope ⁹⁹^mTc (émettant à 140,5 keV), comparé à une simulation Monte Carlo classique. Cependant, cette approche néglige la pénétration septale et la diffusion dans le collimateur. Les données simulées ont ensuite été reconstruites avec l'algorithme OSEM. Nous avons développé quatre méthodes de projection (une projection simple (S-RT), une projection avec volume d'intersection (S-RT-IV), une projection avec calcul de l'angle solide (S-RT-SA) et une projection tenant compte de la profondeur d'interaction (S-RT-SA-D)). Nous avons aussi modélisé une PSF dans l'espace image, anisotrope et non-stationnaire, en nous inspirant de la littérature existante. Nous avons étudié le conditionnement de la matrice système pour chaque projecteur et collimateur, et nous avons comparé les images reconstruites pour chacun des collimateurs et pour chacun des projecteurs. Nous avons montré que le collimateur original proposé est le système le moins bien conditionné. Nous avons aussi montré que la modélisation de la PSF dans l'image ainsi que de la profondeur d'intéraction améliorent la qualité des images reconstruites ainsi que le recouvrement de contraste. Cependant, ces méthodes introduisent des artefacts de bord. Comparé aux systèmes existants, nous montrons que ce nouveau collimateur a un grand champ de vue (~ 70 mm dans le plan transaxial), avec une résolution de 1,0 mm dans le meilleur des cas, mais qu'il a une sensibilité relativement faible (1,32x10⁻² %). / Small animal single photon emission computed tomography (SPECT) is a nuclear medicine imaging technique that plays an important role in molecular imaging. SPECT systems using pinhole or multi-pinhole collimator can achieve submillimetric spatial resolution and high sensitivity in a small field of view, which is particularly appropriate for imaging mice. In our work, we studied a new collimator dedicated to small animal SPECT, in the context of a project called SIGAHRS, led by the Biospace company. In this collimator, focal lengths vary spatially in the transaxial plane and are fixed in the axial plane. This design aims at achieving high spatial resolution in the center of the field of view, with a large field of view and high sensitivity. Using Monte Carlo simulations, where all parameters can be controlled, we studied this new collimator geometry and compared it to a parallel collimator and a cone-beam collimator. To speed up the simulations, we developed a multi-CPU/GPU module that uses a technique of ray tracing. Using this approach, the acceleration factor was ~ 60 and we restored ~ 90 % of the signal for ⁹⁹^mTc (140.5 keV emission), compared to a classical Monte Carlo simulation. The 10 % difference is due to the fact that the multi-CPU/GPU module neglects the septal penetration and scatter in the collimator. We demonstrated that the data acquired with the new collimator could be reconstructed without artifact using an OSEM algorithm. We developed four forward projectors (simple projector (S-RT), projector accounting for the surface of the detecting pixel (S-RT-IV), projection modeling the solid angle (S-RT-SA) of the projection tube, and projector modeling the depth of interaction (S-RT-SA-D)). We also modeled the point spread function of the collimator in the image domain, using an anisotropic non-stationary function. To characterize the reconstruction, we studied the conditioning number of the system matrix for each projector and each collimator. We showed that the new collimator was more ill-conditioned than a parallel collimator or a cone-beam collimator. We showed that the image based PSF and the modeling of the depth of interaction improved the quality of the images, but edge artefacts were introduced when modeling the PSF in the image domain. Compared to existing systems, we showed that this new collimator has a large field of view (~ 70 mm in the transaxial plane) with a resolution of 1.0 mm in the best case but suffers from a relatively low sensitivity (1.32x10⁻² %).

Bone is a remarkable multifunctional tissue with the ability to regenerate and remodel without generating any scar tissue. However, bone loss due to injury or diseases can be a great challenge and affect the patient significantly. Transplanting bone graft from one site in the patient to the site of fracture or bone void, i.e. autologous bone grafting is commonly used throughout the world. The transplanted bone not only fills voids, but is also bone inductive, housing the particular cells that are needed for bone regeneration. Nevertheless, a regenerative complement to autograft is of great interest and importance because the benefits from an off-the-shelf product with as good of healing capacity as autograft will circumvent most of the drawbacks with autograft. With a regenerative-medicine approach, the use of biomaterials loaded with bioactive molecules can avoid donor site morbidity and the problem of limited volume of material. Two such regenerative products that utilize bone morphogenetic protein 7 and 2 have been used for more than a decade in the clinic. However, some severe side effects have been reported, such as severe swelling due to inflammation and ectopic bone formation. Additionally, the products require open surgery, use of supra physiological doses of the BMPs due to poor localization and retention of the growth factors. The purpose of this thesis was to harness the strong inductive capability of the BMP-2 by optimizing the carrier of this bioactive protein, thereby minimizing the side effects that are associated with the clinical products and facilitating safe and localized bone regeneration at the desired site. We focused on an injectable hyaluronan-based carrier. The strategy was to use the body’s own regenerative pathway to stimulate and enhance bone healing in a manner similar to the natural bone-healing process. The hyaluronan-based carrier has a similar composition to the natural extracellular matrix and is degraded by resident hyaluronidase enzymes. Earlier studies have shown a more controlled release and improved mechanical properties when adding a weight of 25 percent of hydroxyapatite, a calcium phosphate that constitutes the inorganic part of the bone matrix. In Paper I, the aim was to improve the carrier by adding other forms of calcium phosphate. The results indicated that the bone formation was enhanced when using nano-sized hydroxyapatite. We wished to further develop the carrier system but were lacking an animal model with high output and easy access. We also wanted to provide paired data and were committed to the 3 Rs of refinement, reduction and replacement. To meet these challenges, we developed and refined an animal model, and this is described in Paper II. In Paper III, we characterized and optimized the handling properties of the carrier. In Paper IV, we discovered the importance of crushing the material, thus enhancing permeability and enlarging the surface area. In Paper V, we sought to further optimize biomaterial properties of the hydrogel through covalently bonding of bisphosphonates to the hyaluronan hydrogel. The results demonstrated exceptional retention of the growth factor BMP-2. In Paper VI, the in vivo response related to the release of the growth factor was examined by combining a SPECT/PET/µCT imaging method to visualize both the retention of the drug, and the in-vivo response in terms of mineralization.