<p>This thesis research builds upon prior work that developed separate SPECT and CT (computed mammotomography, or breast CT) devices that were independently capable of imaging an uncompressed breast in 3D space. To further develop the system as a clinically viable device, it was necessary to integrate the separate imaging systems onto a single gantry, and to simultaneously design a patient-friendly bed that could routinely and effectively position the patient during dual-modality imaging of her uncompressed breast in the system's common field of view. This thesis describes this process and also investigates practical challenges associated with dedicated breast imaging of a prone patient using the integrated SPECT-CT device.</p> <p>We initially characterized the practicability of implementing the novel x-ray beam ultra-thick K-edge filtration scheme designed for routine use with the breast CT system. Extensive computer simulations and physical measurements were performed to characterize the x-ray beam produced using K-edge filtration with cerium and to compare it to beams produced using other filtration methods and materials. The advantages of using this heavily filtered x-ray beam for uncompressed breast CT imaging were then further evaluated by measuring the dose absorbed by an uncompressed cadaver breast during the course of a routine tomographic scan. It was found that the breast CT device is indeed capable of imaging uncompressed breasts at dose levels below that of the maximum utilized for dual-view screening mammography.</p> <p>To prepare the separate SPECT and CT systems for integration onto a single platform, the cross contamination of the image of one modality by primary and scattered photons of the complementary modality was quantified. It was found that contamination levels of the emission (SPECT) image by the x-ray transmission source were generally far less than 2% when using photopeak energy windows up to ±8%. In addition, while there was some quantifiable evidence of a variation in the transmission image in response to the presence of <super>99m</super>Tc photons in the patient, the effect of primary and scattered <super>99m</super>Tc photons on the visibility of 5 mm acrylic photons in a low contrast x-ray transmission environment was negligible. </p> <p>A novel, tiered, stainless steel patient bed was then designed to allow dual-modality imaging using the integrated SPECT-CT system. The performance of the hybrid SPECT-CT system was evaluated during early stage dual-modality patient imaging trials with particular emphasis placed on the performance of the patient bed. The bed was successful in its primary task of enabling dual-modality imaging of a patient's breast in the common field of view, but practical challenges to more effective patient imaging were identified as well as some novel solutions to these challenges.</p> <p>In the final section of the thesis research, the feasibility of using two of these solutions was investigated with a view to imaging more of the patient's posterior breast volume. Limited angle tomographic trajectories and trajectories that involve raising or lowering the patient bed in mid tomographic acquisition were initially investigated using various geometric phantoms. A very low contrast imaging task was then tested using an observer study to quantify the effect of these trajectories on the ability of observers to maintain visibility of small geometric objects. </p> <p>This initial integrated SPECT-CT imaging system has demonstrated its ability to successfully perform low dose, dual-modality imaging of the uncompressed breast. Challenges and solutions have been identified here that will make future SPECT-CT designs even more powerful and a clinically relevant technique for molecular imaging of the breast.</p> / Dissertation

<p>On-board imaging is useful for guiding radiation to patients in the treatment position; however, current treatment-room imaging modalities are not sensitive to physiology - features that may differentiate tumor from nearby tissue or identify biological targets, e.g., hypoxia, high tumor burden, or increased proliferation. Single photon emission computed tomography (SPECT) is sensitive to physiology. We propose on-board SPECT for biological target localization.</p><p>Localization performance was studied in computer-simulated and scanner-acquired parallel-hole SPECT images. Numerical observers were forced to localize hot targets in limited search volumes that account for uncertainties common to radiation therapy delivery. Localization performance was studied for spherical targets of various diameters, activity ratios, and anatomical locations. Also investigated were the effects of detector response function compensation (DRC) and observer normalization on target localization. Localization performance was optimized as a function of iteration number and degree of post-reconstruction smoothing. Localization error patterns were analyzed for directional dependencies and were related to the detector trajectory. Localization performance and the effect of the detector trajectory were investigated in a hardware study using a whole-body phantom.</p><p>Typically targets of 6:1 activity were localized as accurately using 4-minute scans as those of 3:1 activity using 20-minute scans. This trend is consistent with the relationship between contrast and noise in the contrast-to-noise ratio (CNR) and implies that higher contrast targets are better candidates for on-board SPECT because of time constraints in the treatment room. Using 4-minute scans, mean localization errors were within 2 mm for superficial targets of 6:1 activity that were proximal to the detector trajectory and of at least 14 mm in diameter. Localization was significantly better (p < 0.05, Wilcoxon signed-rank test) with than without observer normalization and DRC at 5 of 6 superficial tumor sites. Observer normalization improved localization substantially for a target proximal to the much hotter heart. Localization error patterns were shown to be anisotropic and dependent on target position relative to the detector trajectory. Detector views of close approach and of minimal attenuation were predictive of directions with the smallest (magnitude) localization bias and precision. The detector trajectory had a substantial effect on localization performance. In scanner-acquired SPECT images, mean localization errors of a 22-mm-diameter superficial target were 0.8, 1.5, and 6.9 mm respectively using proximal 180°, 360°, and distal 180° detector trajectories, thus demonstrating the benefits of using a proximal 180° detector trajectory.</p><p>In conclusion, the potential performance characteristics of on-board SPECT were investigated using computer-simulation and real-detector studies. Mean localization errors < 2 mm were obtained for proximal, superficial targets with diameters >14 mm and of 6:1 activity relative to background using scan times of approximately 5 minutes. The observed direction-dependent localization errors are related to the detector trajectory and have important implications for radiation therapy. This works shows that parallel-hole SPECT could be useful for localizing certain biological targets.</p> / Dissertation

In the current thesis, spatio-temporal evaluation of the endogenous angiogenic response to ischemia was perfomed. After vascular occlusion, ischemic angiogenesis is an important reparative mechanism and can ameliorate the outcome of ischemic disease. Diabetic foot ulcers affect almost 15% of diabetic patients and are the leading cause of amputations worldwide (Yoon et al., 2005). Diminished blood flow because of atherosclerotic occlusive disease of the peripheral arteries of diabetic patients, in conjunction with anatomic and functional microcirculatory impairments contribute to development of trophic ulcerations, infections and gangrene of the lower extremities, frequently requiring amputation of the leg (Sasso et al., 2005). Numerous studies have confirmed the impaired post-ischemic angiogenesis in diabetes (Yoon et al., 2005; Sasso et al., 2005). Consequently, wound healing patterns are disturbed in diabetes mainly due to decreased ischemia-driven angiogenesis (Yoon et al., 2005). Integrin ανβ3 is a promising imaging target of angiogenic activity which is up-regulated on activated endothelial cells (ECs) but not on quiescent ones. Molecular imaging (MI) of ανβ3 integrin expression with the aid of a dedicated high resolution gamma camera, is a very sensitive imaging approach for the evaluation of angiogenesis in the rabbit hindlimb ischemia model. Furthermore, diabetes mellitus (DM) was induced, to study the effects of this pathology on the spatio-temporal distribution of angiogenesis. In order to evaluate the whole spectrum of endogenous process of collateralization after occlusion of an artery, Digital Subtraction Angiography (DSA) was also used for the visualization of larger collaterals. During the first part of the study DM experimental protocol was investigated in order to find the appropriate protocol for the induction of long-term diabetic animal model, as it is a methodology that has not yet been standardized. At the same time a cohort of animals underwent endovascular embolization for the establishment of hindlimb ischemia and were imaged with the aid of a MI radiotracer technique in order to deal with unresolved issues and establish the imaging protocol. The study included seven New Zealand White (NZW) rabbits that underwent unilateral percutaneous endovascular embolization of the femoral artery, for the establishment of hindlimb ischemia that triggers the endogenous process of collateralization. The contralateral limb was not embolized and served as a control. The employed radiotracer for angiogenesis imaging, was a 99mTc labeled cyclic RGD peptide [c RGDfk-His]-99mTc that binds specifically to ανβ3 integrin via the three amino acid sequence Arginine-Glycine-Aspartic acid or RGD. Image acquisition was performed with a high resolution gamma camera and all animals underwent molecular imaging on the 3rd and the 9th day post-embolization. In all animals DSA was performed on the 9th day post-embolization. The acquired images demonstrated that retention of the radiotracer at the ischemic tissue is remarkably increased compared to the non-ischemic hindlimb (normal limb) (16020 ± 2309 vs. 13139 ± 2493 on day 3; p=0.0014 and 21616 ± 2528 vs. 13362 ± 2529 on day 9; p<0.0001, respectively). In addition, radiotracer retention in normal limbs seems to be increased at day 9 in normal limbs compared to day 3 (p=0.0112). DSA at day 9, demonstrated that the mean vessel length detected was significantly superior in the normal compared to the ischemic limb (mean value 3680 ± 369.8 vs.2772 ± 267.7; p< 0.0001, respectively). Angiogenesis was successfully detected using a 99mTc labeled cyclic RGD peptide MI technique and was significantly more pronounced in the ischemic compared to normal limbs, both at day 3 and day 9 after embolization. The peak of the phenomenon was detected at day 9. Increased mean vessel length in the normal compared to the ischemic limb demonstrates that although angiogenesis is pronounced in day 9, arteriogenesis is not sufficiently pronounced and that the phenomenon of arteriogenesis has just initiated. The study of the angiogenic response to ischemia, has not yet been completed as MI of diabetic animals with hindlimb ischemia is underway and not completed due to many difficulties and delay in different phases of the experiment. With the conclusion of the MI of diabetic animals with hindlimb ischemia, the study will be completed and we expect to demonstrate the effect of DM on the spatio-temporal pattern of angiogenesis, providing a valuable tool in clinical practice for the precise and early diagnosis and therapy assessment of the ‘diabetic foot’. / Σκοπός της παρούσας μελέτης ήταν η χωρο-χρονική εκτίμηση της ενδογενούς αγγειογενετικής διαδικασίας ως απόκριση στο ερέθισμα της προκλητής ισχαιμίας. Μετά από απόφραξη αρτηρίας, η επαγόμενη αγγειογένεση είναι ένα σημαντικός μηχανισμός αποκατάστασης που μπορεί να περιορίσει το αποτέλεσμα της ισχαιμίας. Το έλκος του ‘διαβητικού ποδιού’ εμφανίζεται στο 15% περίπου των ασθενών που πάσχουν από διαβήτη και αποτελεί την κύρια αιτία ακρωτηριασμού του κάτω άκρου, μετά τα ατυχήματα (Yoon et al., 2005). Η μειωμένη αιματική ροή λόγω της αποφρακτικής αρτηριοπάθειας που οφείλεται στην αθηροσκληρωτική προσβολή των περιφερικών αρτηριών των διαβητικών, σε συνδυασμό με ανατομική και λειτουργική φθορά του αγγειακού δικτύου της μικροκυκλοφορίας, οδηγούν στην ανάπτυξη ελκών, μολύνσεων και γάγγραινας των κάτω άκρων που πολύ συχνά οδηγεί στον ακρωτηριασμό του ποδιού (Sasso et al., 2005). Πολυάριθμες μελέτες όμως έχουν δείξει ότι η αγγειογένεση που επάγεται από κρίσιμη ισχαιμία, στην παθολογία του διαβήτη δεν είναι φυσιολογική (Yoon et al., 2005; Sasso et al., 2005). Συνεπώς στον διαβήτη και ο μηχανισμός επούλωσης πληγών δεν συμβαίνει φυσιολογικά κυρίως λόγω ελαττωματικής ενδογενούς αγγειογένεσης ως απόκριση στην ισχαιμία (Yoon et al., 2005). Το μόριο της ιντεγκρίνης ανβ3 υπερεκφράζεται στα ενεργοποιημένα ενδοθηλιακά κύτταρα που συμμετέχουν στην αγγειογενετική διαδικασία αλλά όχι στο ανενεργό ή αλλιώς «σιωπηλό» ενδοθήλιο. Συνεπώς αποτελεί έναν πολύ καλό μοριακό στόχο για απεικόνιση και δείκτη της αγγειογενετικής δραστηριότητας. Η Μοριακή Απεικόνιση (ΜΑ) του επιπέδου έκφρασης του μορίου ιντεγκρίνης ανβ3 με τη χρήση ραδιοϊσοτοπικών τεχνικών έχει το πλεονέκτημα υψηλής ευαισθησίας ανίχνευσης πολύ χαμηλών συγκεντρώσεων του ραδιοϊχνηθέτη σε σχέση με τις συμβατικές τεχνικές (x-ray computed tomography (CT) angiography, contrast-enhanced ultrasound και high-resolution magnetic resonance angiography). Ο σκοπός της μελέτης μας ήταν να ερευνήσουμε τις δυνατότητες της ΜΑ με την βοήθεια γ-κάμερας υψηλής διακριτικής ικανότητας και πειραματικού μοντέλου κονίκλου με ίσχαιμο οπίσθιο άκρο. Επιπλέον ένα σημαντικό μέρος της μελέτης αφορούσε την εφαρμογή του πρωτοκόλλου για τη πρόκληση διαβήτη ώστε να γίνει μελέτη της επίδρασης της συγκεκριμένης παθολογίας στην χωρο-χρονική κατανομή της αγγειογένεσης. Προκειμένου να αποδοθεί μία συνολική εκτίμηση του ενδογενούς μηχανισμού αποκατάστασης του αγγειακού δικτύου, εφαρμόστηκε Ψηφιακή Αφαιρετική Αγγειογραφία για την εκτίμηση της δημιουργίας παράπλευρου δικτύου. Στη πρώτη φάση της μελέτης, έγινε διερεύνηση του πρωτοκόλλου πρόκλησης διαβήτη δεδομένου ότι η μεθοδολογία παρουσιάζει έλλειψη προτυποποίησης. Παράλληλα εφαρμόστηκε το πρωτόκολλο ισχαιμίας σε μια ομάδα λευκών κονίκλων Νέας Ζηλανδίας για την διερεύνηση του πρωτοκόλλου ΜΑ. Στην μελέτη, χρησιμοποιήθηκαν συνολικά επτά κόνικλοι Νέας Ζηλανδίας οι οποίοι υπεβλήθησαν σε εμβολισμό της μηριαίας αρτηρίας ενός από τα δύο οπίσθια άκρα για την πρόκληση οξείας ισχαιμίας. Στους κόνικλους έγινε ενδοφλέβια έγχυση του κυκλικού επισημασμένου πεπτιδίου [c RGDfk-His]-99mTc που περιέχει την αλληλουχία τριών αμινοξέων Αργινίνης-Γλυκίνης-Ασπαρτικού οξέος (Arginine-Glycine-Aspartic acid or RGD), μέσω της οποίας δεσμεύεται το πεπτίδιο στο μόριο της ιντεγκρίνης ανβ3. Η απεικόνιση του επιπέδου έκφρασης του μορίου ιντεγκρίνης ανβ3 πραγματοποιήθηκε με γ-κάμερα υψηλής διακριτικής ικανότητας την 3η και την 9η ημέρα μετά την απόφραξη της μηριαίας αρτηρίας. Ψηφιακή Αφαιρετική Αγγειογραφία πραγματοποιήθηκε την 9η ημέρα μετά την απόφραξη της μηριαίας αρτηρίας. Τα δεδομένα από την ποσοτικοποίηση των απεικονιστικών δεδομένων, έδειξαν ότι υπάρχει αυξημένη πρόσληψη του ραδιοϊχνηθέτη στη περιοχή ισχαιμίας σε σχέση με τη περιοχή φυσιολογικής αιμάτωσης του ετερόπλευρου άκρου (16020 ± 2309 έναντι 13139 ± 2493 την 3η ημέρα, p=0.0014 και 21616 ± 2528 έναντι 13362 ± 2529 την 9η ημέρα, p<0.0001, αντίστοιχα). Επιπλέον η πρόσληψη του ραδιοϊχνηθέτη στα φυσιολογικά άκρα φαίνεται να είναι αυξημένη την 9η ημέρα σε σχέση με την 3η ημέρα (p=0.0112), γεγονός που μπορεί να αποδοθεί στην σταδιακή συγκέντρωση ενεργοποιημένου ενδοθηλίου και στους φυσιολογικούς ιστούς. Η Ψηφιακή Αφαιρετική Αγγειογραφία έδειξε ότι την 9η ημέρα που έγινε η λήψη δεδομένων, το μέσο μήκος αγγείων στα φυσιολογικά άκρα ήταν αρκετά μεγαλύτερο σε σχέση με τα ίσχαιμα άκρα (μέση τιμή 3680 ± 369.8 έναντι 2772 ± 267.7, p< 0.0001, αντίστοιχα). Η ραδιοϊσοτοπική τεχνική που εφαρμόστηκε για την απεικόνιση του επιπέδου έκφρασης του μορίου ιντεγκρίνης ανβ3 στη παρούσα μελέτη, έδειξε ότι υπάρχει αυξημένη πρόσληψη του ραδιοϊχνηθέτη στη περιοχή ισχαιμίας σε σχέση με τη περιοχή φυσιολογικής αιμάτωσης του ετερόπλευρου άκρου, την 3η ημέρα και την 9η ημέρα μετά την απόφραξη της μηριαίας αρτηρίας. Τα πειραματικά δεδομένα δείχνουν επίσης ότι το φαινόμενο της αγγειογένεσης κορυφώνεται την 9η ημέρα μετά την πρόκληση ισχαιμίας. Επιπλέον τα δεδομένα από τη Ψηφιακή Αφαιρετική Αγγειογραφία την 9η ημέρα, δείχνουν ότι ο ενδογενής μηχανισμός σχηματισμού παράπλευρου δικτύου αν και έχει πυροδοτηθεί δεν έχουν σχηματιστεί ακόμα μεγαλύτερα αγγεία και γι αυτό το λόγο η αρτηριογένεση υπολείπεται της αγγειογένεσης σε αυτή τη φάση. Για την ολοκλήρωση της μελέτης, εκκρεμεί η απεικόνιση των διαβητικών κονίκλων με ίσχαιμο οπίσθιο άκρο η οποία καθυστέρησε λόγω επιμέρους δυσκολιών στη διαδικασία των πειραμάτων. Η ΜΑ δεικτών της αγγειογένεσης σε άκρο που πάσχει από ισχαιμία παρουσία διαβήτη, δύναται να έχει τεράστια εφαρμογή στην κλινική πράξη για την ιατρική παρακολούθηση του ‘διαβητικού ποδιού’.

Στην παρούσα εργασία μελετήθηκαν 15 ασθενείς με νόσο Parkinson (8 γυναίκες, 7 άνδρες, μέσος όρος ηλικίας τα 62χρόνια, μέση διάρκεια της νόσου από τη διάγνωση τα 11 χρόνια), σε διάφορα στάδια της νόσου (τέσσερις ασθενείς σταδίου 2, δύο ασθενείς σταδίου 2.5, 2 ασθενείς σταδίου 3, πέντε ασθενείς σταδίου 4, ένας σταδίου 4.5 και ένας ασθενής σταδίου 5 κατά Hoehn & Yahr ). Και στους 15 ασθενείς πραγματοποιήθηκε διπλός απεικονιστικός έλεγχος με τομογραφία εκπομπής μονήρους φωτονίου (SPECT). Στην πρώτη SPECT απεικόνιση μελετούμε τον βαθμό της ακεραιότητας της μελανοραβδωτής οδού, με τη χρήση ειδικού ραδιοφαρμάκου που προσδένεται εκλεκτικά στον μεταφορέα της ντοπαμίνης (DA Transporter – DAT). Στη δεύτερη SPECT απεικόνιση μελετούμε την αιματική εγκεφαλική ροή των ασθενών σε συνθήκες ηρεμίας, η οποία αντικατοπτρίζει και το βαθμό μεταβολικής ενεργότητας της κάθε περιοχής του εγκεφάλου. Για την αντικειμενική εκτίμηση της μελέτης αιμάτωσης πραγματοποιήθηκε στατιστική παραμετρική σύγκριση με βάση δεδομένων φυσιολογικών ατόμων της ίδιας ηλικίας. Σκοπός μας ήταν να δούμε ποιες περιοχές του εγκεφάλου υποαιματώνονται και συνεπώς επηρεάζονται, στη νόσο του Parkinson. Πράγματι είδαμε ότι η διαταραχή που προκαλείται στο κύκλωμα των βασικών γαγγλίων από την έλλειψη της ντοπαμίνης (DA), προκαλεί διαταραχές στη φλοιοραβδωτή οδό κάτι που αντικατοπτρίζεται στην υποαμάτωση κυρίως του μετωπιαίου λοβού και ειδικότερα της προκινητικής και συμπληρωματικής περιοχής και των συνειρμικών περιοχών του μετωπιαίου λοβού. Επίσης στα πιο προχωρημένα στάδια της νόσου, παρατηρήθηκε στατιστικά σημαντική υποαιμάτωση και σε περιοχές του βρεγματικού και κροταφικού λοβού. Τα ευρήματα αυτά είναι πολύ σημαντικά και μας βοηθούν να κατανοήσουμε καλύτερα τα κινητικά και μη-κινητικά συμπτώματα (διαταραχές της νόησης) στη συγκεκριμένη νόσο. / In the present study we examined 15 Parkinson disease patients (8 females, 7 males, mean age = 62years, mean duration of the disease from diagnosis = 11years) in various stages (according to Hoehn & Yahr staging system) of the disease (stage2: 4 pts, stage2.5: 2 pts, stage3: 2pts, stage 4: 5pts, stage 4.5:1pt, stage 5: 1 pt). Each patient underwent two different SPECT studies. First was performed a SPECT study with the radiopharmaceutical DaTSCAN, that is specifically bind to the Dopamine Transporter (DAT), a protein on the presynaptic dopaminergic nerve terminal. In that way we can image and also quantify the degeneration of the nigrostriatal pathway, that is afflicted in PD. Secondly we performed a brain perfusion SPECT study with the radiopharmaceutical ECD, in order to find out if there were regions of hypoperfusion in the cerebral cortex of the patients. We used an objective and dependable statistical program that enables the comparison of each perfusion study with an age-matched data base o normal perfusions. We found in all 15 patients statistically significant differences in areas of Frontal lobes and especially in the PRE-SMA (pre-motor and supplementary motor cortex) and association areas of frontal cortex. In progressive stages of the disease there were also other areas of the cerebral cortex hypoperfused (parietal and temporal lobes). These findings seem to be very useful for better understanding motor and non-motor (cognitive and affective) symptoms in PD.

For all medical imaging systems using X-rays or γ-rays, radiation detector development in general and scintillator development in particular are in full progress. There is a strong interest in the introduction of new dense, high-atomic-number inorganic scintillation crystals with a high light yield and a fast response, especially for PET and SPECT. Powder scintillators are of interest for projection X-ray imaging. For PET, research is focused on CeP3+P doped scintillators, employing the 5d → 4f transitions. A high light yield is expected in the visible region. The time response in PET/CT applications will be in the 25–100 ns range. Improved energy resolution will also be a point of interest. For CT, time response requirements are at the microsecond level for decay time and the afterglow should be well below 10P−4Ps. For X-ray screens light spreading should be kept under control, e.g. by denser material like LSO:Ce, or columnar phosphors (CsI:TI) and by shorter luminescence emission wavelength which shows higher light attenuation of laterally directed photons. In this study we examine, both in powder and in crystal form, the detection efficiency of LuB2BSiOB5B:Ce, the absolute luminescence efficiency, the X-ray to luminescence efficiency, the spectral compatibility and the effective efficiency using various optical detectors. All these measurements were conducted in the X-ray energy range from 22 to 140 kVp used in medical X-ray imaging. In conclusion the X-ray quantum detection efficiency and the X-ray energy absorption efficiency of a LSO:Ce powder scintillator screen of 25 mg/cmP2 Pcoating thickness were found higher than currently employed materials (e.g. GdB2BOB2BS: Tb and CsI:Tl) for detection of X-rays used in mammographic applications. The absolute luminescence efficiency of this screen maintains high values, within the mammographic energy range and the intrinsic conversion efficiency was found close to that of CsI:Tl but lower than that of GdB2BOB2BS:Tb. In ragiographic energy range the screen of 172.5 mg/cmP2P exchibit the higher values of ALE and XLE. The emission spectrum of LSO:Ce screens showed excellent spectral compatibility with currently used digital detectors and taking also into account its very fast response it could be considered for applications in digital X-ray imaging systems. The LSO:Ce scintillator crystal shows higher absolute luminescence efficiency values (17,86 at 140kVp) than the corresponding of BGO crystal (3,40 at 140 kVp). LSO:Ce X-ray luminescence efficiency was found higher than the corresponding of BGO crystal in the whole range of energies used in our study. The higher value of DOG, 2430 gain units, showed at 140 kVp X-ray tube voltage for the LSO:Ce scintillator when the corresponding value at the same energy of the BGO is 1670 units. In the mammographic energy range the difference between the above measured values was smaller than the ones obtained in the radiographic energy region. This lead us to the assumption that LSO:Ce crystal can be efficiently used for X-ray energy imaging (under 100 kVp) as those used in CT applications. The intrinsic conversion efficiency was estimated to be significantly higher for LSO:Ce, which in addition is higher than more of the currently employed scintillators. The light emission spectrum of the LSO:Ce scintillator, peaking at about 420 nm, was found compatible to many currently employed optical photon detectors. Its very short scintillation decay time and its high detection efficiency, both in terms of QDE and EAE, they can be crucial for the applications of this scintillator in modern fast image producing X-ray computed tomography systems, especially those employed in combined PET/CT devices. 12/−−⋅⋅smRmWμ12/−−⋅⋅smRmWμ The comparison of the ALE and the XLE of the LSO:Ce single crystal scintillator with that of the efficient powder LSO:Ce scintillator shows that the LSO:Ce screens can be used: i) in modern scinti-mammography/ X-ray mammography systems in which one common fast scintillator in powder form may satisfy the requirements of both modalities and the strict requirements in spatial resolution and ii) in applications where single crystals have to be replaced by powder or ceramic scintillators in order to improve spatial resolution (eg. in ring type SPECT detectors and in combined SPECT/CT detectors). In addition, this comparison may be of interest since powder scintillators are of lower cost than the corresponding single crystals. / -

Preclinical single-photon emission computed tomography (SPECT) is an essential tool for studying progression, response to treatment, and physiological changes in small animal models of human disease. The wide range of imaging applications is often limited by the static design of many preclinical SPECT systems. We have developed a prototype imaging system that replaces the standard static pinhole aperture with two sets of movable, keel-edged copper-tungsten blades configured as crossed (skewed) slits. These apertures can be positioned independently between the object and detector, producing an anamorphic image in which the axial and transaxial magnications are not constrained to be equal. We incorporated a 60 mm x 60 mm, millimeter-thick megapixel silicon double-sided strip detector that permits ultrahigh-resolution imaging. While the stopping power of silicon is low for many common clinical radioisotopes, its performance is sufficient in the range of 20-60 keV to allow practical imaging experiments. The low-energy emissions of ¹²⁵I fall within this energy window, and the 60-day half life provides an advantage for longitudinal studies. The flexible nature of this system allows the future application of adaptive imaging techniques. We have demonstrated ~225-μm axial and ~175-μm transaxial resolution across a 2.65 cm³ cylindrical field of view, as well as the capability for simultaneous multi-isotope acquisitions. We describe the key advancements that have made this system operational, including bringing up a new detector readout ASIC, development of detector control software and data-processing algorithms, and characterization of operating characteristics. We describe design and fabrication of the adjustable slit aperture platform, as well as the development of an accurate imaging forward model and its application in a novel geometric calibration technique and a GPU-based ultrahigh-resolution reconstruction code.

1. INTRODUCTION Lung cancer is the most common malignancy in the world and accounts for 1.09 million new cases with 972 000 deaths per year. In Lithuania too, lung cancer is the most commonly diagnosed cancer in men with nearly 1500 new cases each year. Lung cancer is five times more common in men than in women. At present, most patients who receive an initial diagnosis of lung cancer have advanced stage disease (stage IV – 30.2%), making cure with currently available therapies unlikely. The main prognostic information with regard to survival is associated with the biological characteristics of the primary tumour (histological subtype, aggressiveness, differentiation, etc.), the extent of spread to regional or distant lymph nodes or to the other structures, and the operability of the patient (age, function of residual lung, co-morbidity). Because the outcome is associated with the histological subtype and stage of the lung cancer at the diagnosis, there has been persistent interest in designing and testing various radiological methods for early detection of lung cancer. Chest radiography, computed tomography (CT), magnetic resonance imaging (MRI) can not only identify specific features in lung nodules, but add important information about the localisation, size and extent of the primary tumour (T), detect invasion of major mediastinal structures and chest wall, and locoregional (N) and distal spread of the tumour. Although theoretically features such as nodal shape... [to full text]

Corticobasal Syndrome (CBS) is a rare movement and cognitive disorder. There is significant heterogeneity observed in it clinical presentation, neuroimaging, pathology and genetics. Understanding this heterogeneity is a priority and may help to shed light on underlying pathogenic mechanisms. We first demonstrated that truncating mutations in the progranulin gene (PGRN) can cause familial CBS associated with frontotemporal lobar degeneration (FTLD)-ubiquitin pathology. This study identified a mutation in PGRN (Intervening Sequence 7+1 guanine > adenine [IVS7+1G>A]) that segregated with CBS in a family. The mutation was predicted to result in a shortened messenger RNA (mRNA) sequence and the absence of the mutant PGRN allele was confirmed in the reverse transcriptase-polymerase chain reaction (RT-PCR) product, which supported the model of haploinsufficiency for PGRN-linked disease. In a second familial study, clinical, radiological, genetic, and pathological studies were performed to contrast clinical features of the affected members. Sequencing PGRN revealed a novel, heterozygous cytosine-adenine dinucleotide deletion in exon 11 (g.2988_2989delCA, P439_R440fsX6). The proband`s clinical diagnosis was frontotemporal dementia and parkinsonism (FTDP). The proband’s brother with the same mutation presented initially as a progressive non-fluent aphasia (PNFA), and later evolved into a CBS. Pathological analysis revealed Frontotemporal Lobar Degeneration-Ubiquitin (FTLD-U)/ TAR DNA-binding protein 43 (TDP43) positive pathology. The next studies shift away from pathogenic mechanisms to focus on brain-behavioural correlations and phenotypic heterogeneity in a prospective sample of 31 CBS cases. We provide the first direct correlative analysis between the severity of ideomotor apraxia, a common sign in CBS, and cerebral SPECT perfusion imaging. Reductions in perfusion within the left inferior parietal lobule (t=5.7, p=0.03, Family-Wise Error [FWE] corrected), including the left angular gyrus (t=5.7, p=0.02, FWE corrected), were associated with more severe ideomotor apraxia. We stratified the sample into CBS presenting with early motor features (CBS-M; n=9) or early dementia (CBS-D; n=22), which identified that CBS-M were more likely to have cortical sensory loss than CBS-D (p=0.005). In contrast, the presence of aphasia was found to be more common and severe in CBS-D compared to CBS-M (p=0.02). CBS-M patients had significantly reduced perfusion in the right supplementary and premotor areas compared to CBS-D (p<0.05).

Corticobasal Syndrome (CBS) is a rare movement and cognitive disorder. There is significant heterogeneity observed in it clinical presentation, neuroimaging, pathology and genetics. Understanding this heterogeneity is a priority and may help to shed light on underlying pathogenic mechanisms. We first demonstrated that truncating mutations in the progranulin gene (PGRN) can cause familial CBS associated with frontotemporal lobar degeneration (FTLD)-ubiquitin pathology. This study identified a mutation in PGRN (Intervening Sequence 7+1 guanine > adenine [IVS7+1G>A]) that segregated with CBS in a family. The mutation was predicted to result in a shortened messenger RNA (mRNA) sequence and the absence of the mutant PGRN allele was confirmed in the reverse transcriptase-polymerase chain reaction (RT-PCR) product, which supported the model of haploinsufficiency for PGRN-linked disease. In a second familial study, clinical, radiological, genetic, and pathological studies were performed to contrast clinical features of the affected members. Sequencing PGRN revealed a novel, heterozygous cytosine-adenine dinucleotide deletion in exon 11 (g.2988_2989delCA, P439_R440fsX6). The proband`s clinical diagnosis was frontotemporal dementia and parkinsonism (FTDP). The proband’s brother with the same mutation presented initially as a progressive non-fluent aphasia (PNFA), and later evolved into a CBS. Pathological analysis revealed Frontotemporal Lobar Degeneration-Ubiquitin (FTLD-U)/ TAR DNA-binding protein 43 (TDP43) positive pathology. The next studies shift away from pathogenic mechanisms to focus on brain-behavioural correlations and phenotypic heterogeneity in a prospective sample of 31 CBS cases. We provide the first direct correlative analysis between the severity of ideomotor apraxia, a common sign in CBS, and cerebral SPECT perfusion imaging. Reductions in perfusion within the left inferior parietal lobule (t=5.7, p=0.03, Family-Wise Error [FWE] corrected), including the left angular gyrus (t=5.7, p=0.02, FWE corrected), were associated with more severe ideomotor apraxia. We stratified the sample into CBS presenting with early motor features (CBS-M; n=9) or early dementia (CBS-D; n=22), which identified that CBS-M were more likely to have cortical sensory loss than CBS-D (p=0.005). In contrast, the presence of aphasia was found to be more common and severe in CBS-D compared to CBS-M (p=0.02). CBS-M patients had significantly reduced perfusion in the right supplementary and premotor areas compared to CBS-D (p<0.05).

The growing understanding of tumor biology and the identification of tumor specificgenetic and molecular alterations, such as the overexpression of human epidermal growthfactor receptor 2 (HER2), opens up for personalization of patient management using targeted therapies. However, this puts stringent demands on the diagnostic tools usedto identify patients that are likely to respond to a particular treatment. Radionuclide molecular imaging is a promising non-invasive method to visualize and characterize the expression of such targets. This thesis, based on five papers, is focused on the development of radiolabeled Affibody molecules for imaging of HER2-expression in malignant tumors. Affibody molecules, which represent a rather novel class of affinity proteins developed by combinatorial protein engineering of the protein A derived Z-domain, display manyfeatures that make them promising tracers for molecular imaging applications. The aim of the work presented here was to further develop the tracer format for improved in vivo properties and flexibility in the choice of radionuclide. In paper I, the development of an assay that enables quantitative studies of the internalization rate and cellular processing of high affinity Affibody molecules is described. The assay was applied to a HER2-binding Affibody variant that was efficiently retained by HER2-expressing cells, although characterized by a slow internalization rate. This may have implications for the choice of label for Affibody molecules since high affinity to the target may be equally, or more, important for good imaging quality than residualizing properties of the radiolabel. In paper II, a HER2-binding Affibody molecule and the monoclonal antibody trastuzumab were labeled with positron emitting 124I, for a head-to-head in vivocomparison of the two tracer formats. The effects of tracer size and presence of an Fc region on the biodistribution profile were investigated. In paper III, a HER2-binding Affibody molecule was site-specifically labeled with radiocobalt and evaluated in vitro and in vivo.A head-to-head in vivo comparison with the well-studied 111In-labeled counterpart was performed, revealing promising potential for the cobalt-labeled molecule as a PET-tracerfor visualization of HER2. Paper IV describes the in vitro and in vivo evaluation of a panel of Affibody molecules with different C-terminal peptide-based chelators for the coordination of 99mTc. Even small changes in the C-terminal sequence had appreciable impact on the biodistribution of the Affibody molecules and by optimizing the design of the chelator, the kidney uptake of 99mTc could be significantly reduced. Finally, in paper V we describe the development of a HER2-targeting Affibody variant equipped with a Sel-tag for site-specific labeling with the short-lived positron emitter 11C. This novel Affibody tracer could be used to image HER2-expressing tumors in vivo within one hour after injection. Taken together, Affibody molecules show great promise as targeting tracers for radionuclide molecular imaging of HER2. Careful design and optimization of the tracer protein is important and can be used to improve the biodistribution and targeting properties of Affibody molecules. / QC 20110922