ENGLISH ABSTRACT: Background: The detection of bone infection can be very difficult especially in bone with altered structure due to prior trauma or surgical procedures. Complicated osteomyelitis (COM) is becoming a public health problem especially with the difficult choice between, high cost surgery and prolonged courses of intravenous or oral antibiotic therapy, as well as the social and psychological effect of longterm disease and disability of the patient. The correct localisation of especially bone infection is still a challenge for the clinician. The single photon emission computed tomography/low dose computed tomography (SPECT/CT), by fusing the functional information with the anatomical parts, is a wellestablished tool used in many nuclear medicine studies. This improves the overall quality of the study with more clear answers. The aim of the study was to determine the added value of SPECT/CT in the management of complicated osteomyelitis (COM) in patients with endo-prosthesis, post traumatic osteomyelitis with and without metal implants and diabetic foot. Methods: This was a prospective study, between February 2010 and February 2012. Patients with suspected COM who fulfilled the selection and inclusion criteria were included. All had abnormal three phase bone scan followed by infection imaging with 99mTc labelled white blood cells and 99mTc -colloid if the99mTc labelled white blood cell study was abnormal. 67Ga citrate was used in vertebral involvement. Planar and SPECT/CT images were reviewed for presence of abnormal uptake and for its localization in bone and soft tissue. Scan results were defined as positive or negative. Both planar and SPECT/CT images were compared regarding diagnosis and precise localization of infection. The final diagnosis was obtained from surgical specimen or microbiological culture as well as clinical follow-up of all patients. Results: There were 72 patients, 29 male and 43 female with mean age of 57 yrs [range 27-88].There were 24 patients with prosthesis, 16 with hip prosthesis (PH=16), and 8 with knee prosthesis (PK=8). There were 44 patients with post traumatic osteomyelitis, 26 with metal implants (TOM=26) and 18 without metal implants (TOWM= 18). Four patients had diabetic foot (DF= 4). Infection was diagnosed in 19/72 patients on planar images and in 21/72 on SPECT/CT. Infection was diagnosed in 4 patients with prosthesis, 16 patients with post traumatic injury and one diabetic foot patient. The four patients with prosthesis, SPECT /CT added diagnostic value by excluding osteomyelitis in 3 patients and by defining the exact extent and localizing soft tissue and bone infection (STI/OM) in one patient. In 16 patients with post traumatic OM on planar images, SPECT /CT added diagnostic value, by excluding OM in 4 patients and confirming only STI, better localisation of the uptake in bone and soft tissue in 5 patients, of them 2 patient was negative on planar, and in 7 patients, confirmed and defined the exact extent of both OM and STI. One diabetic foot was positive for STI on the planar, the SPECT/CT added diagnostic value by defining the extent of the infection. In summary the added value of SPECT/CT was: a. Overall infection: 1. Exclusion of osteomyelitis by confirming only soft tissue involvement: 7 patients (10%) 2. Better localization in bone and soft tissue: 6 patients (8%) 3. Better delineation of extent of infection: 9 patients (12%) 4. None: 50 patients (70%) b. In positive cases only: 1. Exclusion of osteomyelitis by confirming only soft tissue involvement: 7 patients (33%) 2. Better localization in bone and soft tissue: 5 patients (24%) 3. Better delineation of extent of infection: 9 patients (43%) 4. None: 0 patients The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy for infection, on planar was 90%, 100%, 100%, 97%, 97%, respectively and for SPECT/CT 100%, 100%, 100%, 100%, 100%. For OM on planar, the sensitivity, specificity , positive predictive value, negative predictive value and accuracy was 100%, 89%, 53%, 100%, 90%, respectively and for SPECT/CT 100%, 100%, 100%, 100%, 100%. Conclusion: In complicated osteomyelitis, SPECT/CT is useful in localizing, defining the exact extent of infection where the planar images are abnormal, with no added value if the planar images are negative. We recommend in clinical practice the routine use of hybrid SPECT/CT imaging in complicated osteomyelitis when planar images are abnormal. / AFRIKAANSE OPSOMMING: Agtergrond: Die opspoor van beeninfeksie is veral moeilik in been wat as gevolg van vorige trauma of chirurgiese prosedures misvorm is. Gekompliseerde osteomiëlitis word ‘n gesondheidsprobleem veral as gevolg van die moeilike keuse tussen hoë koste chirurgie en langdurige kursusse binneaarse of orale antibiotika, asook die sosiale en sielkundige gevolge van langstaande siekte en die gestremdheid van die pasiënt. Die korrekte lokalisering van veral beeninfeksie is steeds ‘n uitdaging vir die geneesheer. Enkel foton emissie rekenaartomografie / lae dosis rekenaartomografie (SPECT/CT), die kombinasie van funksionele en anatomiese inligting, is ‘n goed gevestigde metode in baie kerngeneeskunde ondersoeke. Dit verbeter die algemene kwaliteit van die studie met ‘n meer spesifieke antwoord. Die doel van hierdie studie was om die bykomende waarde van SPECT/CT in die hantering van gekompliseerde osteomiëlitis in pasiënte met endo-protese, post traumatise osteomiëlitis met en sonder metaal prosteses asook diabetiese voet te bepaal. Metode: ‘n Prospektiewe studie is tussen Februarie 2010 en Februarie 2012 gedoen. Pasiënte met vermoedelik gekompliseerde osteomiëlitis wat aan die keuse en insluitingskriteria voldoen het, is ingesluit. Almal het abnormale drie-fase beenflikkergramme gehad, gevolg deur infeksiebeelding met 99mTc gemerkte witselle en 99mTc kolloïed indien die 99mTc gemerkte witselstudie abnormaal was. 67Ga sitraat is gebruik wanneer daar werwelaantasting teenwoordig was. Die planare en SPECT/CT beelde is vergelyk ten opsigte van diagnose en presiese lokalisering van die infeksie. Die finale diagnose is met behulp van chirurgiese monsters en mikrobiologiese kweking asook die kliniese opvolg van alle pasiënte bepaal. Resultate: Die studie het 72 pasiënte, 29 mans en 43 vroue, met gemiddelde ouderdom van 57 jaar [27 – 88 ingesluit]. Daar was 24 pasiënte met prosteses, waarvan 16 met heupprosteses (PH= 16) en 8 met knieprosteses (PK= 8). Van die 44 pasiënte met post traumatiese osteomiëlitis, het 26 metaal prosteses (TOM= 26) en 18 geen metaalprosteses gehad nie (TOWM= 18). Vier pasiënte het diabetiese voet gehad (DF= 4). By 19/72 van die pasiënte is infeksie op die planare beelde gediagnoseer en in 21/72 op die SPECT/CT beelde. Die bykomende twee gevalle was 1 met TOM en 1 met TOWM. Infeksie is by 4 pasiënte met prosteses, 16 pasiënte met post traumatiese besering en 1 met diabetiese voet gediagnoseer. In die vier pasiënte met prosteses, het SPECT/CT ‘n diagnostiese bydrae gelewer om osteomiëlitis by 3 van die pasiënte uit te skakel en die presiese omvang en lokalisering van sagte weefsel en beeninfeksie (STI/OM) in een pasiënt te bepaal. In 16 pasiënte met post traumatise osteomiëlitis op die planare beelde, was SPECT/CT van diagnostiese waarde, waar osteomiëlitis in 4 pasiënte uitgesluit is, en slegs STI bevestig is. Beter lokalisering van die opname in been en sagte weefsel was in 5 pasiënte moontlik, van wie 2 op die planare beelde negatief was, en in 7 pasiënte bevestig en die presiese omvang met beide OM en STI gedefinieer is. Een diabetiese voet was positief vir STI op die planare beelde, maar die SPECT/CT het diagnostiese waarde verbeter deur die omvang van die infeksie beter te toon. Ter opsomming, was die waarde van die SPECT/CT: 1. Uitsluiting van osteomiëlitis deur slegs van sagte weefsel aantasting te bevestig: 7 pasiënte 10% 2. Beter lokalisering in been en sagte weefsel: 5 pasiënte 7% 3. Beter definisie van omvang van infeksie: 9 pasiënte 12% 4. Geen bykomende waarde: 51 pasiënte 71% Die algehele sensitiwiteit, spesifisiteit, positiewe voorspellingswaarde, negatiewe voorspellingswaarde en akkuraatheid vir die opspoor van infeksie vir die planare beelde was 90%, 100%, 100%, 97%, 97%, onderskeidelik en vir die SPECT/CT 100%, 100%, 100%, 100% en 100%. Vir osteomiëlitis was sensitiwiteit, spesifisiteit, positiewe voorspellingswaarde, negatiewe voorspellingswaarde en akkuraatheid van planare beelde 100%, 89%, 53%, 100%, 90%, onderskeidelik en die van SPECT/CT 100%, 100%, 100%, 100% , 100%. Gevolgtrekking: SPECT/CT is nuttig in die lokalisering en definiëring van die presiese omvang van die infeksie in gekompliseerde osteomiëlitis in gevalle waar die planare beelde abnormaal is, met geen bykomende waarde wanneer planare beelde negatief is nie. Ons beveel SPECT/CT beelding as roetine in kliniese praktyk aan wanneer planare beelde in gekompliseerde osteomiëlitis abnormaal is.

<p>X-ray mammography has been the gold standard for breast imaging for decades, despite the significant limitations posed by the two dimensional (2D) image acquisitions. Difficulty in diagnosing lesions close to the chest wall and axilla, high amount of structural overlap and patient discomfort due to compression are only some of these limitations. To overcome these drawbacks, three dimensional (3D) breast imaging modalities have been developed including dual modality single photon emission computed tomography (SPECT) and computed tomography (CT) systems. This thesis focuses on the development and integration of the next generation of such a device for dedicated breast imaging. The goals of this dissertation work are to: [1] understand and characterize any effects of fully 3-D trajectories on reconstructed image scatter correction, absorbed dose and Hounsifeld Unit accuracy, and [2] design, develop and implement the fully flexible, third generation hybrid SPECT-CT system capable of traversing complex 3D orbits about a pendant breast volume, without interference from the other. Such a system would overcome artifacts resulting from incompletely sampled divergent cone beam imaging schemes and allow imaging closer to the chest wall, which other systems currently under research and development elsewhere cannot achieve. </p><p>The dependence of x-ray scatter radiation on object shape, size, material composition and the CT acquisition trajectory, was investigated with a well-established beam stop array (BSA) scatter correction method. While the 2D scatter to primary ratio (SPR) was the main metric used to characterize total system scatter, a new metric called ‘normalized scatter contribution’ was developed to compare the results of scatter correction on 3D reconstructed volumes. Scatter estimation studies were undertaken with a sinusoidal saddle (±15° polar tilt) orbit and a traditional circular (AZOR) orbit. Clinical studies to acquire data for scatter correction were used to evaluate the 2D SPR on a small set of patients scanned with the AZOR orbit. Clinical SPR results showed clear dependence of scatter on breast composition and glandular tissue distribution, otherwise consistent with the overall phantom-based size and density measurements. Additionally, SPR dependence was also observed on the acquisition trajectory where 2D scatter increased with an increase in the polar tilt angle of the system. </p><p>The dose delivered by any imaging system is of primary importance from the patient’s point of view, and therefore trajectory related differences in the dose distribution in a target volume were evaluated. Monte Carlo simulations as well as physical measurements using radiochromic film were undertaken using saddle and AZOR orbits. Results illustrated that both orbits deliver comparable dose to the target volume, and only slightly differ in distribution within the volume. Simulations and measurements showed similar results, and all measured dose values were within the standard screening mammography-specific, 6 mGy dose limit, which is used as a benchmark for dose comparisons.</p><p>Hounsfield Units (HU) are used clinically in differentiating tissue types in a reconstructed CT image, and therefore the HU accuracy of a system is very important, especially when using non-traditional trajectories. Uniform phantoms filled with various uniform density fluids were used to investigate differences in HU accuracy between saddle and AZOR orbits. Results illustrate the considerably better performance of the saddle orbit, especially close to the chest and nipple region of what would clinically be a pedant breast volume. The AZOR orbit causes shading artifacts near the nipple, due to insufficient sampling, rendering a major portion of the scanned phantom unusable, whereas the saddle orbit performs exceptionally well and provides a tighter distribution of HU values in reconstructed volumes. </p><p>Finally, the third generation, fully-suspended SPECT-CT system was designed in and developed in our lab. A novel mechanical method using a linear motor was developed for tilting the CT system. A new x-ray source and a custom made 40 x 30 cm2 detector were integrated on to this system. The SPECT system was nested, in the center of the gantry, orthogonal to the CT source-detector pair. The SPECT system tilts on a goniometer, and the newly developed CT tilting mechanism allows ±15° maximum polar tilting of the CT system. The entire gantry is mounted on a rotation stage, allowing complex arbitrary trajectories for each system, without interference from the other, while having a common field of view. This hybrid system shows potential to be used clinically as a diagnostic tool for dedicated breast imaging.</p> / Dissertation

Imaging Iodine-125 requires an increased focus on developing an understanding of how fundamental processes used by imaging systems work to provide quantitative output for the imaging system. Isotopes like I-125 pose specific imaging problems that are a result of low energy emissions as well as how closely spaced those emissions are in the spectrum. This work seeks to characterize the performance of a small animal SPECT-CT imaging system with respect to imaging I-125 for use in a preclinical translational research environment and to understand how the performance of this system relates to critical applications such as attenuation and scatter correction. The specific aims of this work examined several key areas of system function and performance with respect to I-125 imaging. The first aim examined the geometric SPECT calibration routine used for the Inveon imaging system with a particular focus on determining the accuracy of the calibration as well as the robustness of the algorithm under routine and adverse imaging conditions. The second aim was to characterize detector uniformity issues that may arise by comparing the uniformity performance of the system with both I-125 and Co-57 as well as examining the possibility of altering the acquisition method for normalization scans to increase the uniformity performance. The third aim sought to optimize the energy window used for acquisition of I-125 data and to determine the effects the selection of the window had on valid and scatter events. The fourth aim used the optimized windows, determined by the third aim, to assess the performance of a reconstruction algorithm, currently under development, that corrects for attenuation and scatter effects. The fifth and final aim of this work sought to assess the feasibility acquiring SPECT-CT data simultaneously and to assess the quality of data that could be achieved if simultaneous acquisition of the two imaging modalities was, in fact, possible. This work met these aims by performing an extensive series of studies examining the response of the system to I-125 imaging. These included multiple series of phantom imaging using both manufacturer as well as custom-designed sources for use with measurements involving I-125 and Co-57. Statistics from over 60 datasets with analysis in greater than 480 regions of interest were used for the analysis of attenuation and scatter correction data alone. The final study involving simultaneous SPECT-CT acquisition required modification of the imaging hardware to enable this type of data collection as well as development of a reconstruction algorithm to correctly handle the CT data acquired in a step-and-shoot helical mode. A number of key findings resulted from this work including the validation of the calibration routine of this imaging system, even under non-ideal imaging conditions for both the SPECT and CT modalities. Uniformity performance with I-125 was found to be a challenge with this imaging system but reductions in performance compared to other isotopes were not significant enough to introduce severe artifacts into the image data. Optimization of I-125 parameters resulted in improvements of the processed data indicating that the recommended settings provided by the manufacturer could be altered to provide results that better balance between minimizing scatter effects and maximizing detection of valid events. Assessment of the proposed scatter and attenuation correction algorithm for this system showed marked improvement as compared to data processed without these corrections. The final study of simultaneous SPECT-CT imaging proved this acquisition method to be feasible on a commercial system with minimal The primary conclusions drawn from this study indicate that the system is adequate for imaging with I-125 when care is taken to properly maintain the system as well as keeping sources current and properly centered in the scanner field of view during calibration. The study strongly illustrates the necessity of compensating any data collected using I-125 for attenuation and scatter effects; with some regions showing greater than 25% attenuation and approximately 30% improvement in quantitative values for scatter affected regions with the corrections applied. The study also concludes that simultaneous SPECT-CT is feasible with minor adjustments to a commercial platform.

[EN] Idiopathic pulmonary fibrosis (IPF) is the pulmonary disease with higher incidence and worse prognosis. Recent evidence suggests that cucurbitaceae, selective inhibitors of the JAK2/STAT3 pathway, may improve the pathogenesis of IPF, as anti-inflammatory and antioxidative properties have been confirmed in other diseases. However the role in IPF is unknown. Two pharmacological models were investigated in the present study. In the preventive model, Wistar rats were instilled intratracheally with a single dose of bleomycin (BLM)(3.75 U/kg; n=12) to induce lung injury. CuI (20mg/kg/day; n=6) or CuI vehicle (control and IPF group) was administered intraperitoneally daily for 21 days. The therapeutic model was exactly the same starting CuI administration on day 7 until day 21. Animal evolution together with the ventilation-perfusion ratio was controlled through CT/SPECT imaging. Cellular count and characterization was performed in broncoalveolar lavage (BAL) together with the total protein content and the IL-6 and IL-13 concentration in BAL and lung tissue. Hematoxilin-eosin and masson trichrome stains allowed the study of the lung's tissue histology. TGF-ß1, CTGF, COL1A and ET-1 gene and protein expression were both measured by real time PCR and WB as pulmonary vascular remodeling markers. P-STAT3, P-SMAD3 and P-JAK2 proteins were determined by protein and immunohistochemistry quantification. Finally, JAK2 and STAT3 expression and distribution was studied in lung tissue of fibrotic patients with pulmonary hypertension. CT/SPECT quantification showed reduction of the fibrotic areas in the CuI treated group by reestablishing the air space in the lungs back to day 0 levels for the preventive and the therapeutic model. Furthermore, ventilation/perfusion correlation was restored in the therapeutic model after administrating CuI during 14 days. Hematoxilin-eosine stains demonstrated how the group treated pharmacologically presented an improvement in the lung tissue architecture, reversing vascular remodeling and right heart hypertrophy. Masson trichrome stain revealed a reduction of the collagen deposits. Ashcroft score, used to determine the severity of pulmonary fibrosis, was measured and diminished significantly in the CuI treated group. The results showed a gene and protein overexpression of TGF-ß1, CTGF, COL1A and ET-1 in BLM relative to Control rats. This was counteracted with CuI treatment which reduced the expression back to control. In terms of immunohistochemistry, the results demonstrated a decrease in the COL1A deposits in the treated group versus the absence of treatment group. Protein and immunohistochemistry analysis of JAK2, STAT3 and SMAD3 demonstrated an overexpression in bleomycin rats while the protein expression was inhibited in the CuI treated group. In accordance to the results obtained, the immunohistochemistry analysis of the lung parenchyma in patients with pulmonary hypertension related to pulmonary fibrosis showed and overexpression of the phosphorylated forms of JAK2 and STAT3, lacking its expression in healthy lung tissue. The preventive and therapeutic administration of JAK2/STAT3 inhibitor can be a potential treatment for pulmonary fibrosis, as it improves the parameters related to the disease. / [ES] La fibrosis pulmonar idiopática (FPI) es la enfermedad pulmonar con mayor incidencia y peor pronóstico. Estudios recientes sugieren que la familia de las cucurbitaceae, inhibidores selectivos de la ruta JAK2/STAT3, pueden mejorar la patogénesis de la enfermedad, al haberse confirmado sus propiedades antinflamatorias y antioxidantes en otras enfermedades. Sin embargo se desconoce su papel en FPI. En el presente trabajo se estudiaron dos modelos farmacológicos. En el modelo preventivo las ratas Wistar fueron instiladas con una dosis única de bleomicina intratraqueal (BLM)(3.75 U/kg; n=12) para inducir las lesión pulmonar. Durante 21 días se administró CuI (20mg/kg/día; n=6) o vehículo de CuI (control y grupo FPI) por vía intraperitoneal. El modelo curativo se diferencia del preventivo en el comienzo de la administración farmacológica a los 7 días de inducir la enfermedad. El seguimiento de la evolución animal y el ratio de ventilación-perfusión se realizó mediante las técnicas de imagen TC/SPECT. Se realizó el recuento y caracterización de las células totales extravasadas en lavado broncoalveolar (LBA) así como el contenido de proteína total y la concentración de IL- 6 e IL-13 en LBA y tejido pulmonar. Las tinciones de hematoxilina-eosina y masson tricrómico permitieron el estudio de la histología del tejido pulmonar. Se determinó la expresión génica y proteica de TGF-ß1, CTGF, COL1A y ET-1 mediante las técnicas de real time PCR y WB como marcadores de remodelado vascular. Las proteínas P-STAT3, P-SMAD3 y P-JAK2, fueron determinadas mediante cuantificación proteica e inmunohistoquimia. Por último se estudió la expresión y distribución de JAK2 y STAT3 en tejido de pacientes con fibrosis pulmonar e hipertensión pulmonar. La cuantificación de las imágenes TC/SPECT mostraron una reducción de las áreas fibróticas en el grupo tratado con CuI. El tratamiento farmacológico permitió el restablecimiento del espacio aéreo pulmonar hasta valores control en ambos modelos estudiados. El grupo con tratamiento farmacológico restauró el ratio de ventilación/perfusión tras administrar CuI durante 14 días. Las tinciones de hematoxilina eosina revelaron como el grupo animal tratado farmacológicamente presenta una mejora de la histología pulmonar, revirtiendo el remodelado vascular y la hipertrofia del ventrículo derecho. La tinción de masson tricrómico mostró una disminución de los depósitos de colágeno. Se determinó el valor de Ashcroft, evaluador del grado de fibrosis pulmonar, que descendió significativamente en el grupo tratado con CuI. Los resultados presentan una sobrexpresión génica y proteica de TGF-ß1, CTGF, COL1A y ET-1 en los grupos de bleomicina frente a las ratas control. Dicha condición fue revertida mediante el tratamiento con CuI que restableció los valores a niveles control. Los análisis proteicos e inmunohistoquíimicos de JAK2, STAT3 y SMAD3 revelaron una sobreexpresión en las ratas con bleomicina mientras que la expresión proteica fue inhibida en el grupo tratado con CuI. En consonancia con los resultados obtenidos, el análisis inmunohistoquímico del parénquima pulmonar de pacientes con FPI e HP asociada muestran una sobreeexpresión de las formas fosforiladas de JAK2 y STAT3 frente a la ausencia de expresión en tejido pulmonar sano. La administración curativa y preventiva de un inhibidor de la ruta JAK2/STAT3 puede ser un potencial tratamiento para la fibrosis pulmonar, ya que mejora parámetros indicativos de la patología. / [CAT] La fibrosi pulmonar idiopàtica (FPI) és la enfermetat pulmonar amb major incidència i pitjor pronostic. Estudis recents suggereixen que la família de les cucurbitàcies, Inhibidors selectius de la ruta JAK2 / STAT3, poden millorar la patogènesi de la malaltia, en haver-se confirmat les seues propietats antiinflamatòries i antioxidants En altres patologies. No obstant això es desconeix el seu paper en FPI. En el present treball es van estudiar 2 models farmacològics. En el model preventiu les rates Wistar foren instilades amb una dosi única de bleomicina intratraqueal (BLM) (3,75 U / kg; n = 12) per a induir les lesions pulmonars. Durant 21 dies es va administrar CuI (20 mg / kg / dia, n = 6) o Vehicle de CuI (control i grup FPI) per vía intraperitoneal. El model curatiu es diferència del preventiu en el començament de l'administració farmacológica als 7 dies d'induir l'enfermetat. El seguiment de l'evoluciò dels animals i el ratio de Ventilació-perfusió es va realitzar mitjançant tècniques d'imatge TC/SPECT. Es realitzà el recompte i caracterització de les cèl·lules totals extravasades en el llavat broncoalveolar (LBA). Així com el contingut de proteina total i la concentració d'IL-6 i IL-13 en LBA i teixit pulmonar. Les tincions d'hematoxilina-eosina i tricròmic de Masson van permetre l'estudi de la histologia del teixit pulmonar. Es va determinar l'expressió gènica i proteica de TGF-ß1, CTGF, COL1A i Et-1 mitjançant tècniques de PCR en temps real i WB com marcadors de remodelat vascular. Les proteïnes P-STAT3, P-SMAD3 i P-JAK2, varen ser determinades mitjançant quantificació proteica i inmunohistoquimia. Per últim se estudià l'expressió i distribució de JAK2 i STAT3 en teixit de pacients amb fibrosi pulmonar e hipertensió pulmonar. La quantificació de les imatges TC/SPECT mostraren una reducció de les àrees fibrótiques en el grup tractat amb CuI. El tractament farmacològic permet el restabliment de l'espai aeri pulmonar fins valors de control en els dos models estudiats. El grup amb tractament farmacològic va restaurar el ratio de ventilació/perfusió tras administrar Cul durant 14 dies. Les tincions d'hematoxilina eosina van revelar com el grup animal tractat farmacològicament presenta una Millora de la histologia pulmonar, revertint el remodelat vascular i la hipertròfia del ventricle dret. La tinció de tricròmic de Masson va mostrar una disminució dels dipòsits de col·lagen. Es va determinar el valor d'Ashcroft, avaluador del grau de fibrosi pulmonar, que va baixar significativament a el grup tractat amb CuI. Els resultats presenten una sobreexpressió gènica i proteica de TGF-ß1, CTGF, COL1A i Et-1 en els grups de bleomicina en comparacióa les rates control. Aquesta condició va ser revertida mitjançant el tractament amb CuI que va restablir els valors fins a nivel dels control. A nivell immunohistoquímic els resultats mostren una disminució dels dipòsits de COL1A en el grup tractat comparativament al grup sense tractament. Els anàlisi proteics i inmunohistoquíimics de JAK2, STAT3 i SMAD3 van revelar una sobreexpressió en les rates amb bleomicina mentre que l'expressió proteica va ser inhibida en el grup tractat amb CuI. D'acord amb els resultats obtinguts, l'anàlisi immunohistoquímic del parènquima pulmonar de pacients amb FPI i HP associada mostren sobreeexpresió de les formes fosforilades de JAK2 i STAT3 davant l'absència d'expressió en teixit pulmonar sa. La administració curativa i preventiva d'un inhibidor de la ruta JAK2 / STAT3 pot ser un potencial tractament per la fibrosi pulmonar, ja que millora paràmetres indicatius de la patologia. / Hernández Ribes, G. (2016). ESTUDIO DE LA RUTA CELULAR JAK2/STAT3 COMO POTENCIAL INHIBIDOR EN EL MODELO DE FIBROSIS PULMONAR [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/64087 / TESIS

Introduction: Sentinel lymph node biopsy is an established method used to investigate the riskof lymphatic metastasis especially in breast cancer and melanoma patients. SPECT/ CT isconsidered to be an advantageous method in mapping of sentinel nodes. Aim: The aim of this systematic literature review was to investigate the clinical value ofSPECT/ CT in the detection of sentinel lymph nodes in breast cancer patients. Method: Using specific search terms the database PubMed was used to find studies of potentialrelevance for this systematic review. Criteria for inclusions and exclusion were decided todetermine article relevance. Eligibility of articles was determined according to these criteriawhich lead to the selection of the specific articles included in this study. Results: Eleven studies were included in this systematic review. Seven out of 8 studies foundhigher identification rates of sentinel lymph nodes with SPECT/ CT in comparison to planarlymphoscintigraphy. SPECT/ CT could detect additional lymph nodes in 9 out of 9 studies.SPECT/ CT detected additional extra-axillary lymph nodes in 6 out of 7 studies. SPECT/ CTdetected lymph nodes in 9 out of 9 studies where planar lymphoscintigraphy was negative.Information from additional SPECT/ CT lead to changes in surgical treatment plan in 4 out of4 studies. None of the included studies contained information about change in oncologicaltreatment plan due to findings on SPECT/ CT. Conclusion: SPECT/ CT is an imaging technique with much potential as it seems to allow amore accurate SLN mapping and more precise anatomical localization of SLN in breast cancerpatients, specifically in certain clinical situations. Despite this however, the impact of SLNmapping through SPECT/ CT on patient prognosis remains uncertain.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24965号 / 医博第5019号 / 新制||医||1069(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川口 義弥, 教授 波多野 悦朗, 教授 中本 裕士 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Thesis (MSc (Medical Imaging and Clinical Oncology. Nuclear Medicine))--University of Stellenbosch, 2010. / ENGLISH SUMMARY: Introduction: Bone scintigraphy is used extensively in evaluating metastatic disease. There are currently no clear recommendations for the use of SPECT/CT in metastatic bone disease. Existing procedural guidelines from the Society of Nuclear Medicine (SNM) for SPECT/CT do not provide specific indications for use of SPECT/CT in bone scintigraphy, and there are currently no other guidelines for the use of SPECT/CT in bone scintigraphy that the author is aware of. The aim of this study was to investigate the additional value of SPECT/CT, and to identify the clinical indications for which SPECT/CT is most useful in patients with suspected bone metastases. Subjects and Methods: Forty-two patients with equivocal lesions on planar scintigraphy were prospectively recruited and planar imaging, SPECT, and SPECT/CT done on all patients. On reading of SPECT and then SPECT/CT, patients and individual lesions were classified as malignant, benign or equivocal. Radiological studies and available clinical information were also used during reading of scans. Review of clinical information, radiological studies and/or follow-up bone scans were used as gold standard. The results of the SPECT and SPECT/CT were compared in terms of proportion of equivocal findings and accuracy. Results: Forty-two patients with 189 skeletal lesions were examined. There was a diverse variety of primary tumours, although the majority had breast (n=22) or prostate cancer (n=8). Overall, SPECT/CT resulted in a significant reduction in the proportion of equivocal findings on both a patient-wise (p=0.0015) and lesion-wise basis (p<0.0001). The overall accuracy of SPECT/CT was significantly higher than that of SPECT on both a patient-wise (p=0.0026) and lesion-wise basis (p<0.0001). Generally SPECT/CT decreased the proportion of equivocal findings and increased the accuracy independent of the presence of bone pain, type of primary tumour, or skeletal region involved. SPECT/CT did not significantly improve the diagnostic confidence of readers in equivocal lumbar lesions although accuracy was significantly improved in this region. Conclusion: SPECT/CT performs significantly better than SPECT alone for the interpretation of equivocal planar lesions. There is no evidence that the benefit of SPECT/CT is dependent on the type of primary tumour or the presence of bone pain. Where resources are limited, SPECT/CT is indicated only in those patients in whom correct classification of the lesions in question is expected to alter the patient’s management. SPECT/CT images should be interpreted with the aid of a diagnostic radiologist or nuclear medicine physicians should acquire sufficient experience in Computed Tomographic image interpretation in order to optimise diagnostic benefit from SPECT/CT. / AFRIKAANSE OPSOMMING: Inleiding: Beenflikkergrafie word wyd vir die evaluering van metastatiese siekte gebruik. Daar bestaan tans geen duidelike aanbevelings vir die gebruik van Enkelfotonemissie rekenaartomografie gekombineer met rekenaartomografie (EFERT/RT, Engels SPECT/CT) in metastatiese beensiekte nie. Bestaande riglyne van die Amerikaanse Society of Nuclear Medicine (SNM) vir EFERT/RT gee nie spesifieke indikasies vir die gebruik van EFERT/RT in beenflikkergrafie nie, en daar is tans geen ander riglyne waarvan die outeur bewus is nie. Die doel van hierdie studie was om die bykomende waarde van EFERT/RT te ondersoek, en om dié kliniese indikasies waar EFERT/RT in pasiënte met vermoedelike beenmetastases mees nuttig sal wees, te identifiseer. Pasiënte en Metodes: Twee en veertig pasiënte met twyfelagtige letsels op planare skeletflikkergrafie is prospektief geselekteer en planare beelding, EFERT en EFERT/RT is op alle pasiënte gedoen. Tydens beoordeling van EFERT en daarna EFERT/RT beelde is pasiënte en individuele letsels as maligne, benigne of twyfelagtig geklassifiseer. Radiologiese studies en beskikbare kliniese inligting is ook tydens interpretasie van flikkergramme gebruik. Kliniese inligting, radiologiese studies en/of opvolg beenflikkergramme is as goue standaard gebruik. Die resultate van EFERT en EFERT/RT is ten opsigte van die aantal twyfelagtige bevindings en akkuraatheid vergelyk. Resultate: Twee en veertig pasiënte met 189 skeletale letsels is ondersoek. Daar was ‘n verskeidenheid van primêre tumore, maar die meerderheid van pasiënte het borsvi (n=22) of prostaatkanker (n=8) gehad. Die gebruik van EFERT/RT het gelei tot ‘n betekenisvolle afname in die aantal twyfelagtige bevindings, beide op ‘n pasiënt- en ‘n letselbasis (p=0.0015 en p<0.0001 onderskeidelik). Die algehele akkuraatheid van EFERT/RT was betekenisvol hoër as die van EFERT alleen, beide op pasiënt- en op letselbasis (p=0.0026 en p<0.0001 onderskeidelik). Oor die algemeen het EFERT/RT die aantal twyfelagtige letsels verminder en die akkuraatheid verhoog, ongeag die teenwoordigheid van beenpyn, die tipe primêre tumor of die area van die skelet wat betrokke was. In twyfelagtige lumbale letsels het EFERT/RT nie die diagnostiese vertroue van beoordelaars van flikkergramme verhoog nie, alhoewel die akkuraatheid vir hierdie gebied wel betekenisvol toegeneem het. Gevolgtrekking: EFERT/RT vaar betekenisvol beter as EFERT in die beoordeling van twyfelagtige letsels op planare beenflikkergramme. Daar is geen bewys dat die voordeel van EFERT/RT afhanklik is van die tipe primêre tumor of die teenwoordigheid van beenpyn nie. Waar hulpbronne beperk is, is EFERT/RT slegs aangedui in dié pasiënte waar verwag word dat korrekte klassifikasie van die betrokke letsel behandeling sal beïnvloed. EFERT/RT beelde behoort met die hulp van ‘n diagnostiese radioloog beoordeel te word, of kerngeneeskundiges moet genoegsame ondervinding in die interpretasie van rekenaartomografiebeelde hê om die diagnostiese voordeel van EFERT/RT optimaal te kan benut.

Liver cancer ranks the third most common cause of cancer related mortality worldwide. Radiomicrosphere therapy (RMT), a form of radiation therapy, involves administration of Yttrium-90 (90Y) microspheres to the liver via the hepatic artery. 90Y microspheres bremsstrahlung SPECT/CT or PET/CT imaging could potentially identify an extrahepatic uptake. An early detection of such an uptake, thus, could initiate preventative measures early on. However, the quantitative accuracy of bremsstrahlung SPECT/CT images is limited by the wide and continuous energy spectrum of 90Y bremsstrahlung photons. 90Y PET/CT imaging is also possible but limited by the extremely small internal pair production decay. These limitation lead to inaccurate quantitation of microsphere biodistribution especially in small tumors. SPECT/CT and PET/CT acquisition of a Jasczak phantom with eight spherical inserts filled with 90Y3Cl solution were performed to measure the quantitative accuracy of the two imaging modalities. 90Y microsphere SPECT/CT data of 17 patients who underwent RMT for primary or metastatic liver cancer were acquired. Technetium-99m macroaggregated albumin (99mTc-MAA) SPECT/CT scans were also collected, but available for only twelve of the patients. SPECT/CT images from phantoms were used to determine the optimal iteration number for the iterative spatial resolution recovery algorithm. Methods for image based calculation of calibration factors for activity estimation from the patient and phantom 90Y bremsstrahlung SPECT/CT images were developed. Tumor areas were segmented using an active contour method. The 99mTc-MAA and 90Y microsphere SPECT/CT images were co-registered a priori for correlation analysis. Comparison of uptake on 99mTc-MAA and 90Y microsphere SPECT/CT images was assessed using tumor to healthy liver ratios. Furthermore, a three dimensional absorbed dose estimation algorithm was developed using the voxel S-value method. Absorbed doses within the tumor and healthy part of the liver were investigated for correlation with administered activity. Improvement in contrast to noise ratio and contrast recovery coefficients (QH) on patient and phantom 90Y bremsstrahlung SPECT/CT images as well as PET/CT images were achieved. Total activity estimations in liver and phantom gave mean percent errors of -4 ± 12% and -23 ± 41% for patient and phantom SPECT/CT studies. The pre and post-treatment images showed significant correlation (r = 0.9, p < 0.05) with mean TLR of 9.2 ± 9.4 and 5.0 ± 2.2 on 99mTc-MAA and 90Y microspheres SPECT/CT respectively. The correlation between the administered activity and tumor absorbed dose was weak (r = 0.5, p > 0.05), however, healthy liver absorbed dose increased with administered activity (r = 0.8, p < 0.05).

Η διερεύνηση της διαγνωστικής και προγνωστικής αξία της διόρθωσης φωτονιακής εξασθένησης με χάρτες μέσω CT χαμηλής δόσης και ευκρίνειας στη στεφανιαία νόσο. ΠΕΙΡΑΜΑΤΙΚΟ ΣΚΕΛΟΣ Υλικό και Μέθοδος: Σε ομοίωμα Data Spectrum πραγματοποιήθηκαν SPECT/CT απεικονίσεις με 201Tl & 99mTc αφενός χωρίς ελλείμματα στο καρδιακό ένθεμα όπου μετρήθηκε ομοιογένεια εικόνας και κρούσεις και αφετέρου με την τοποθέτηση ελλειμμάτων, «διατοιχωματικών» & «υπενδοκαρδίων» όπου υπολογίστηκαν το μέγεθος (FWHM) και η αντίθεση του ελλείμματος. Κατόπιν οι AC & NAC απεικονίσεις συνεκρίθησαν κατά ζεύγη ως προς τις προαναφερθείσες παραμέτρους. Αποτελέσματα: Στις μετρήσεις χωρίς έλλειμμα ευνοήθηκε η μέθοδος με διόρθωση (AC) αυξάνοντας την ομοιογένεια της φυσιολογικής εικόνας και εξομαλύνοντας το λόγο κρούσεων κατωτέρου/προσθίου τοιχώματος. Στις απεικονίσεις με έλλειμμα η AC μέθοδος εμφάνισε καλύτερο FWHM ενώ η τεχνική χωρίς διόρθωση εξασθένησης (NAC) αποδείχθηκε ανώτερη ως προς την αντίθεση του ελλείμματος. ΔΙΑΓΝΩΣΤΙΚΟ ΣΚΕΛΟΣ Υλικό και Μέθοδος: Διερευνήθηκαν αναδρομικώς 120 εξεταζόμενοι χαμηλού pre-test κινδύνου ΣΝ με αρνητικούς κλινικούς δείκτες και 120 πρώϊμα στεφανιογραφηθέντες (<60 ημέρες μετά MPI με 201Tl + CT-AC). Οι AC & NAC εικόνες εκτιμήθηκαν τυφλά τόσο ποιοτικά όσο και ημιποσοτικά (Summed Stress Score - SSS, Summed Difference Score - SDS). Κατόπιν, υπολογίστηκε το normalcy στον πληθυσμό χαμηλού κινδύνου ενώ στους στεφανιογραφηθέντες με gold standard τα αγγειογραφικά δεδομένα υπολογίστηκαν ευαισθησίες, ειδικότητες και διαγνωστικές ακρίβειες στο γενικό πληθυσμό και κατά φύλο στην επικράτεια του LAD και του συνδυασμού RCA/LCx οι οποίες συνεκρίθησαν με τη McNemar δοκιμασία. Τέλος, σχεδιάστηκαν ROC καμπύλες και έγινε σύγκριση μεταξύ τους κατά ζεύγη. Αποτελέσματα: Στον πληθυσμό χαμηλού κινδύνου η AC τεχνική υπερίσχυσε στο normalcy, ενώ στους στεφανιογραφηθέντες στατιστική σημαντικότητα παρατηρήθηκε στην περιοχή κατανομής της RCA/LCx στο γενικό πληθυσμό και στους άνδρες, όπου η NAC μέθοδος ήταν πιο ευαίσθητη και η AC πιο ειδική, χωρίς να προκύψουν στατιστικώς σημαντικά αποτελέσματα κατά τις συγκρίσεις ως προς τη διαγνωστική ακρίβεια και στις κατά ζεύγη συγκρίσεις των AUC στις ROC καμπύλες. ΠΡΟΓΝΩΣΤΙΚΟ ΣΚΕΛΟΣ Υλικό και Μέθοδος: Πρόκειται για προοπτική μελέτη με 637 συμμετέχοντες στους οποίους πραγματοποιήθηκε SPECT/CT απεικόνιση ρουτίνας και εκτιμήθηκαν ημιποσοτικά οι AC & NAC εικόνες (SSS – τυφλή ανάλυση). Μετά από κλινική παρακολούθηση κατεγράφησαν οι θάνατοι (πρωτεύον καταληκτικό σημείο), καθώς και οι συνδυασμοί θανάτων/ΟΕΜ και θανάτων/ΟΕΜ/οψίμων επαναγγειώσεων (δευτερεύοντα καταληκτικά σημεία). Κατόπιν, ορίστηκαν διαχωριστικές SSS τιμές του πληθυσμού βάσει της συχνότητας συμβαμάτων, και σχεδιάστηκαν Kaplan-Meier καμπύλες επιβίωσης στο γενικό πληθυσμό και στις SSS υποομάδες (AC & NAC) οι οποίες συνεκρίθησαν μεταξύ τους με την LogRank μέθοδο. Τέλος, οι κλινικές και απεικονιστικές παράμετροι αξιολογήθηκαν με την Cox μέθοδο, τόσο στο μονοπαραγοντικό (univariate) μοντέλο όσο και στην πολυπαραγοντική ανάλυση παλινδρόμησης (multivariate regression analysis). Αποτελέσματα: Κατά τη διάρκεια της κλινικής παρακολούθησης (ѱSD = 42.3±12.8 μήνες) σημειώθηκαν 24 θάνατοι (7 καρδιογενείς), 13 ΟΕΜ και 28 επαναγγειώσεις. Από την κατηγοριοποίηση του πληθυσμού προέκυψαν τρεις SSS υποομάδες για κάθε μέθοδο: 0-4, 5-13 και >13 (NAC) και 0-2, 3-9 και >9 (AC). Στην Kaplan-Meier ανάλυση η NAC παρήγαγε στατιστικώς σημαντικά αποτελέσματα μεταξύ των ομάδων 5-13 και >13 ως προς θανάτους και μεταξύ όλων των SSS υποπληθυσμών για αμφότερα τα δευτερεύοντα καταληκτικά σημεία, ενώ η AC κατάφερε να διαχωρίσει μεταξύ 0-2 & >9 ως προς θανάτους/ΟΕΜ και 0-2 & 3-9 ως προς συνολικά συμβάματα. Στο μονοπαραγοντικό Cox μοντέλο η NAC απεικόνιση κατάφερε στατιστική σημαντικότητα τόσο για SSS>4 όσο και >13 ως προς όλα τα καταληκτικά σημεία με την AC να παρουσιάζει ανάλογα αποτελέσματα για SSS>2 ως προς μείζονα και συνολικά συμβάματα και για SSS>9 ως προς το σύνολο των συμβαμάτων. Τέλος, στην πολυπαραγοντική ανάλυση παλινδρόμησης, η NAC αποδείχθηκε ανεξάρτητη προβλεπτική παράμετρος για θανάτους/ΟΕΜ και σύνολο συμβαμάτων, ενώ στην AC δεν παρατηρήθηκαν στατιστικώς σημαντικά αποτελέσματα. Συμπέρασμα: Η διόρθωση φωτονιακής εξασθένησης μέσω χαρτών εξασθένησης με CT δεν φαίνεται να προσαυξάνει τη διαγνωστική ακρίβεια ή την προγνωστική ισχύ του SPECT αιματώσεως μυοκαρδίου και η ανεπίλεκτη χρησιμοποίησή της στην κλινική πράξη μπορεί να οδηγήσει σε υποεκτίμηση της στεφανιαίας νόσου και του κινδύνου καρδιακών συμβαμάτων που αυτή συνεπάγεται. / To investigate the diagnostic and prognostic value of photon attenuation correction through maps derived from low-dose/low-resolution CT in coronary artery disease. EXPERIMENTAL PART Materials and Methods: SPECT/CT 201Tl and 99mTc imaging was performed on a Data Spectrum torso phantom, firstly without “myocardial” defects (assessment of overall and regional image uniformity and counts) and afterwards with the insertion of “subendocardial” and “transmural” defects (measurement of defect FWHM and contrast); subsequently, attenuation corrected (AC) & non-corrected (NAC) images were compared pairwise as regards the aforementioned parameters. Results: AC was favoured in the measurements without defects by increasing image uniformity and optimizing inferior-to-anterior wall count ratio. When defects were imaged, AC was superior at the assessment of FWHM whereas NAC achieved better defect contrast. DIAGNOSTIC PART Materials and Methods: One-hundred and twenty patients with negative clinical markers for CAD as well as 120 patients (90 males, 30 females) who were subjected to coronary angiography within 60 days post-MPI (201Tl SPECT/CT) were retrospectively reviewed. AC & NAC images were evaluated blindly both qualitatively and semi-quantitavely (Overall Summed Stress Score – SSS & Summed Difference Score – SDS as well as corresponding scores for LAD and RCA/LCx vascular domains). In the low-risk population, AC & NAC normalcy rate was assessed and in the population with angiographic reference sensitivity, specificity and diagnostic accuracy were calculated for both AC & NAC MPI which were compared with the McNemar test. Finally, ROC curves were created and the AUC were compared. Results: In the low-risk population AC increased normalcy rate while in the patients with angiographic correlation statistically significant results were obtained in the general and male population in the RCA/LCx territory, where NAC was more sensitive and AC displayed higher specificity without any significant results as regards diagnostic accuracy or ROC AUC comparisons. PROGNOSTIC PART Materials and Methods: 637 unselected patients underwent 201Tl MPI with CT-AC. AC & NAC images were interpreted blindly and summed stress scores (SSS) were calculated. Study endpoints were all-cause mortality and the composites of death/non-fatal acute myocardial infarction (AMI) and death/AMI/late revascularization. On the basis of the event rate distribution across SSS values SSS subgroups were created, Kaplan-Meier curves were drawn and compared by the use of the LogRank test and finally clinical and scintigraphic parameters were entered into the univariete and multivariate Cox regression model. Results: During a follow-up of 42.3±12.8 months 24 deaths, 13 AMIs and 28 revascularizations were recorded. Prognostic SSS groups formed were: 0-4,5-13,>13 for NAC and 0-2,3-9,>9 for AC. Kaplan-Meier functions were statistically significant between NAC SSS groups for all study endpoints. AC discriminated only between SSS 0-2 and >9 for death/AMI and between 0-2 and 3-9 for death/AMI/revascularization. In the univariate Cox regression, abnormal NAC achieved statistical significance for all endpoints whereas AC managed to do so only for SSS >2 & >9 regarding major and all events and for SSS>9 as regards all events. In the multivariate model, abnormal AC yielded no significance for either endpoint whereas abnormal NAC proved independent from other covariates for the composite endpoints. CONCLUSION: Photon attenuation correction with the use of CT-derived attenuation maps does not seem to increase the diagnostic accuracy or prognostic value of myocardial perfusion SPECT and its non-selective utilization in clinical practice may lead to underestimation of coronary artery disease and the subsequent risk of cardiac events.