Proliferative myositis: a case of a pseudomalignant process.
A case of proliferative myositis, an unusual inflammatory pseudotumor of a skeletal muscle, is presented. Often it is erroneously misdiagnosed as a malignant neoplasm.
Adolescent↗
Biomedical subjects
L Mortelmans
Publications and source records attributed to L Mortelmans.
Human brain regions involved in direction discrimination.
To obtain further evidence for the functional specialization and task-dependent processing in the human visual system, we used positron emission tomography to compare regional cerebral blood flow in two direction discrimination tasks and four control tasks. The stimulus configuration, which was identical in all tasks, included the motion of a random dot pattern, dimming of a fixation point, and a tone burst. The discrimination tasks comprised the identification of motion direction and successive direction discrimination. The control tasks were motion detection, dimming detection, tone detection, and passive viewing. There was little difference in the activation patterns evoked by the three detection tasks except for decreased activity in the parietal cortex during the detection of a tone. Thus attention to a nonvisual stimulus modulated different visual cortical regions nonuniformly. Comparison of successive discrimination with motion detection yielded significant activation in the right fusiform gyrus, right lingual gyrus, right frontal operculum, left inferior frontal gyrus, and right thalamus. The fusiform and opercular activation sites persisted even after subtracting direction identification from successive discrimination, indicating their involvement in temporal comparison. Functional magnetic resonance imaging (fMRI) experiments confirmed the weak nature of the activation of human MT/V5 by successive direction discrimination but also indicated the involvement of an inferior satellite of human MT/V5. The fMRI experiments moreover confirmed the involvement of human V3A, lingual, and parietal regions in successive discrimination. Our results provide further evidence for the functional specialization of the human visual system because the cortical regions involved in direction discrimination partially differ from those involved in orientation discrimination. They also support the principle of task-dependent visual processing and indicate that the right fusiform gyrus participates in temporal comparison, irrespective of the stimulus attribute.
Acoustic Stimulation↗
Nuclear cardiology, Part I: Anatomy and function of the normal heart.
This is the first article of a four-part series on nuclear cardiology. This article introduces and reviews the anatomy and function of the normal heart. Future articles will develop the contribution of nuclear medicine techniques in evaluating myocardial perfusion, function and viability. This article describes the external and internal features of the heart and its vascularization, conducting system and physiological function. After reading this article, the reader should understand the anatomy and the function of the normal heart.
Heart↗
Nuclear cardiology, Part II: Scintigraphic evaluation of cardiac function.
OBJECTIVE: Different methods are currently available to assess cardiac function, especially left ventricular ejection fraction, using either planar or tomographic imaging, first-pass or equilibrium techniques, and blood-pool or myocardial perfusion agents. This is the second article of a four-part series on nuclear cardiology. In this article the authors review the most widely used radiopharmaceuticals and methodologies.
Coronary Circulation↗
Pulmonary tumor microembolism.
Pulmonary tumor embolism is an often missed antemortem diagnosis in patients with cancer and respiratory failure. Although rare, this complication is an important cause of additional morbidity. Referred for radionuclide pulmonary perfusion and ventilation scintigraphy, a typical pattern of multiple subsegmental peripheral defects on perfusion lung scanning without matching ventilation defects, suggesting a high probability of pulmonary thromboembolism, often leads to false conclusions. We present a case of bilateral multiple subsegmental mismatched defects in lung ventilation perfusion scintigraphy, where autopsy confirmed the diagnosis of pulmonary tumor embolism, secondary to an undifferentiated ductal type adenocarcinoma of the pancreas. Pulmonary tumor embolism is an entity to keep in mind in patients treated for carcinoma presenting with (sub) acute dyspnea.
Adenocarcinoma↗
Nuclear cardiology, Part III: Scintigraphic evaluation of cardiac perfusion.
OBJECTIVE: After reading Part III of this series of nuclear cardiology articles, the technologist should be able to: (a) compare and contrast radiopharmaceuticals used for myocardial perfusion imaging; (b) describe imaging protocols used for detecting coronary artery disease; and (c) describe imaging patterns seen following reconstruction of myocardial images.
Coronary Circulation↗
Positron-emission tomography imaging of long-term shape recognition challenges.
Long-term visual memory performance was impaired by two types of challenges: a diazepam challenge on acquisition and a sensory challenge on recognition. Using positron-emission tomography regional cerebral blood flow imaging, we studied the effect of these challenges on regional brain activation during the delayed recognition of abstract visual shapes as compared with a baseline fixation task. Both challenges induced a significant decrease in differential activation in the left fusiform gyrus, suggesting that this region is involved in the automatic or volitional comparison of incoming and stored stimuli. In contrast, thalamic differential activation increased in response to memory challenges. This increase might reflect enhanced retrieval attempts as a compensatory mechanism for restoring recognition performance.
Adult↗
Attention to one or two features in left or right visual field: a positron emission tomography study.
In human vision, two features of the same object can be identified concurrently without loss of accuracy. Performance declines, however, when the features belong to different objects in opposite visual fields. We hypothesized that different positron emission tomography activation patterns would reflect these behavioral results. We first delineated an attention network for single discriminations in left or right visual field and then compared this with the activation pattern when subjects divided attention over two features of a single object or over two objects in opposite hemifields. When subjects attended to a single feature, parietal, premotor, and anterior cingulate cortex were activated. These effects were strongest in the right hemisphere and were, remarkably, unaffected by the direction of attention. In contrast, direction of attention affected occipital and frontal activity: right occipital and left lateral frontal activity were higher with attention to the left, whereas right lateral frontal activity was higher with attention to the right. When subjects identified two features of the same object, parietal, premotor, and anterior cingulate activity was enhanced further, predominantly this time in the left hemisphere. Again, there was no direction sensitivity. Direction-sensitive activation of lateral frontal cortex also was increased. Finally, when subjects divided their attention over opposite hemifields, activity in the direction-sensitive occipital and frontal regions fell to a level midway between those seen during exclusively leftward or rightward attention. Thus, the behavioral efficiency with which we attend to multiple features of a single peripheral object is paralleled by enhanced activity in structures generally active during peripheral selective attention as well as in structures that depend on the specific direction of attention, most notably lateral frontal cortex. In addition, in the direction-sensitive regions, dividing attention over hemifields causes a compromise pattern between the extreme levels obtained during unilateral attention.
Adolescent↗
PET scan predicts recovery of left ventricular function after coronary artery bypass operation.
BACKGROUND: Viable but hypocontractile myocardium can show functional improvement after revascularization (hibernation). It is sometimes difficult, however, to predict viability and recovery in patients with severe left ventricular function. This study sought to identify possible predictive factors of recovery of cardiac function after revascularization in patients with three-vessel disease. METHODS: Positron emission tomography (fluoro-18-deoxyglucose uptake for metabolism; nitrogen 13-labeled ammonia for flow) and equilibrium-gated nuclear angiography (for the global ejection fraction) were performed in 59 patients with three-vessel disease before and after undergoing coronary artery bypass grafting. The positron emission tomographic data were expressed as match normal (flow and metabolism normal), mismatch (low flow, high metabolism), match viable (moderate decrease in flow and metabolism), and match necrosis (low flow and metabolism). RESULTS: Stepwise logistic regression analysis showed that only mismatch regions played a significant role in predicting postoperative improvement in function (p = 0.019). There were 1.7 +/- 1.5 mismatch regions in 31 patients who showed an improvement in their ejection fraction (0.47 +/- 0.14 versus 0.58 +/- 0.11; mean +/- standard deviation) versus 0.8 +/- 1.0 mismatch regions (p = 0.017) in patients who did not show recovery. There was more pronounced functional improvement with increasing numbers of mismatch regions, and patients with at least one mismatch region had a high likelihood of recovery (p < 0.001). In patients with a very low preoperative ejection fraction and two or more mismatch regions, there was early significant recovery (0.27 +/- 0.08 versus 0.46 +/- 0.06; p = 0.009). CONCLUSIONS: At least one mismatch region must be present for there to be a postoperative functional benefit. When a low left ventricular ejection fraction is associated with mismatch, early recovery is substantial.
Adult↗
Evaluation of carbon-11-labelled phenoxy bridged fatty acids for studying myocardial fatty acid metabolism with PET.
A phenylene moiety in the chain of fatty acids was expected to impair metabolic degradation. Three phenoxy-containing [11C]carboxyl-labelled fatty acids were synthesized and evaluated in mice and an in vivo tissue distribution study. Of these three, 1[11C]-3-(p-dodecyloxyphenyl)propionic acid (C12C3) showed the most favourable uptake in the myocardium: 1.2% of the injected dose at 30 min p.i., vs. 0.6% for [11C]palmitate. The metabolic stability of C12C3 and [11C]palmitate was assessed by determining the amount of exhaled [11C]CO2 during a 30-min interval after injection. It was found that the phenoxy moiety in the gamma-position did not prevent the metabolic degradation of C12C3: After 30 min 20.7% of the injected dose was exhaled as [11C]CO2 vs. 12.7% for [11C]palmitate.
Animals↗
Importance of flow/metabolism studies in predicting late recovery of function following reperfusion in patients with acute myocardial infarction.
AIMS: Positron emission tomographic imaging is known to be a reliable indicator of viable myocardium in chronic heart disease. Its value in acute myocardial infarction has not been studied extensively. METHODS AND RESULTS: Sixty-two patients receiving thrombolytic therapy were studied. Myocardial tissue flow and metabolism were measured at 5 days and 3 months. Recovery of left ventricular function was investigated with echocardiography or radionuclide ventriculography. In eight patients, normal flow was found in the infarct area at 5 days with no significant changes in flow, metabolism or function over the next 3 months. In 54 patients, impaired regional myocardial blood flow in the infarct zone was observed at 5 days. In 39 patients, there was a matching positron emission tomographic pattern, while in 15 the pattern was mismatched. None of the patients with a TIMI flow grade < 3 revealed recovery of left ventricular function. In seven out of 11 patients with TIMI 3 flow and a mismatching pattern, additional angioplasty was performed with functional improvement in six. CONCLUSIONS: Recovery of ventricular function is exclusively found in patients with a TIMI flow grade 3. Patients with a positron emission tomographic mismatching pattern reveal functional recovery only after subsequent angioplasty.
Aged↗
Human brain activity related to orientation discrimination tasks.
In order to relate regional activity in the human brain to the different components of discrimination tasks, we compared regional cerebral blood flow, measured with positron emission tomography, under four conditions: successive orientation discrimination, orientation identification, detection and passive viewing. By adding successive discrimination and passive viewing at a second, lower rate we were able to investigate the main effects and interaction between task and presentation rate. Four occipital regions--the posterior calcarine region bilaterally, the right lingual gyrus and the right interior occipital cortex--displayed a main effect of presentation rate. Two regions--a right posterolateral occipital region and a right posterior fusiform region--displayed a significant main effect of task. The involvement of this posterior fusiform region in successive discrimination was also revealed by the subtraction of detection from successive discrimination, as was that of the right middle fusiform gyrus. Finally, a more anterior right middle fusiform region was differentially active in successive discrimination compared to identification, suggesting that activity in this region is related to the temporal comparison of orientation.
Adult↗
Mycotic pseudo-aneurysm of the extracranial carotid artery.
A rare case of mycotic pseudo-aneurysm of the common carotid artery as a complication in an immunosuppressed paediatric patient is presented. Treatment of pseudo-aneurysms of the common carotid artery is generally considered to be an emergency, necessitating quick and accurate diagnosis. In patients with septicemia, angiography has to be avoided. We were able to provide the surgeon with the exact diagnosis and accurate topographical information with helical CT with 3D reformation.
Aneurysm, False↗
Fluoride kinetics of the axial skeleton measured in vivo with fluorine-18-fluoride PET.
UNLABELLED: The aim of this study was to quantify regional bone blood flow and influx rate with PET and [18F]fluoride in patients with metabolic bone disorders. METHODS: Dynamic imaging of the spine or pelvis was performed after administration of 300-370 MBq of 18F-. Plasma clearance of 18F- was determined in blood sampled from the radial artery. A three-compartment model was used to estimate the regional flow and fluoride influx rate. RESULTS: In this preliminary study, fluoride flux (in micromol/min/liter) could be measured regionally. The flux was consistent with the pathophysiology of the studied metabolic disorders and allowed the various disease states to be distinguished. Bone blood flow and influx rate were low in osteoporosis (in the "normal-appearing" bone) and high in Paget's disease. CONCLUSION: With PET and [18F]fluoride, local bone blood flow and fluoride influx rate can be quantified in patients in vivo. Metabolically active zones have an increased influx rate and an accordingly increased flow. In principle, this technique permits classification of bone disorders and has potential for the monitoring of therapy response in metabolic bone disease.
Adult↗
Visualisation of loss of 5-HT2A receptors with age in healthy volunteers using [18F]altanserin and positron emission tomographic imaging.
We used [18F]altanserin and positron emission tomography (PET) to image serotonin 5-HT2A receptors in humans. The highest [18F]altanserin uptake is found in the cerebral cortex, with specific-to-nonspecific binding ratios varying from 0.53 to 1.91 in humans between 24 and 48 years of age. In all neocortical regions studied, [18F]altanserin uptake correlates negatively with age. No correlations were found between age and uptake in the cerebellum, the regional cerebral blood flow, or the time course of metabolization of [18F]altanserin. The reduction in cerebral 5-HT2A receptor binding thus directly reflects the loss of specific 5-HT2A receptors with age.
Adult↗
Only hibernating myocardium invariably shows early recovery after coronary revascularization.
BACKGROUND: The aims of this study were to identify hibernating myocardium (hypocontractile, hypoperfused viable myocardium that regains contractility after revascularization) in the clinical setting and to predict functional outcome in patients with coronary artery disease after coronary revascularization. METHODS AND RESULTS: Preoperative data related to the anterior free wall of the left ventricle were collected in 50 coronary bypass surgery candidates (positron emission tomography [PET], [13N]NH3 for flow, and [18F]FDG for metabolism [MET]; equilibrium-gated nuclear angiography [EGNA] for regional ejection fraction [REF]; and histological data from myocardial biopsies for percentage fibrosis and viable myocytes). Three months after surgery, the patients had follow-up PET and EGNA investigations. A principal-components analysis identified four patient clusters. Cluster 1 (n = 9) had normal viable myocardium. Cluster 2 (n = 18) had viable hypocontractile myocardium (REF, 39 +/- 12%) showing a PET mismatch pattern. Cluster 3 (n = 16) had viable hypocontractile myocardium associated with morphological myocyte injury showing a matched moderate decrease in flow (66 +/- 11%) and MET (70 +/- 11%). Cluster 4 (n = 7) had hypocontractile myocardium with mainly scar tissue (fibrosis, 74 +/- 12%). After surgery, only cluster 2, with hibernating myocardium, showed significant improvement in REF (from 39 +/- 12% to 50 +/- 13%, P < .05). Cluster 3, with sites of morphological myocyte injury, showed no recovery. The stepwise logistic regression showed a combination of low preoperative REF and high MET to be the best predictor of functional recovery (P < .008). CONCLUSIONS: Multivariate analysis identifies hibernating myocardium showing early postrevascularization recovery, as opposed to viable but myolytic myocardium with no early recovery. Postrevascularization recovery can be predicted (combination of low REF and high MET) by noninvasive techniques.
Adult↗
Chronic osteomyelitis: diagnosis with technetium-99m-d, l-hexamethylpropylene amine oxime labelled leucocytes.
To evaluate the diagnostic value of technetium-99m d, l-hexamethylpropylene amine oxime (HMPAO) labelled leucocytes in combination with a 99mTc-methylene diphosphonate (MDP) bone scan in the detection of chronic osteomyelitis, we retrospectively reviewed 55 patients. Prior to the 99mTc-d,l-HMPAO labelled leucocyte scan, all patients underwent a 99mTc-MDP bone scan. The correct diagnosis was confirmed by long-term clinical follow-up (n=29) or by bacteriological cultures (n=26). We found an overall sensitivity of 94%, a specificity of 91% and an accuracy of 92% for 99mTc-d,l-HMPAO labelled leucocyte scintigraphy in the diagnosis of chronic osteomyelitis. When the patients were divided into three groups according to the location of the infection, our study results showed a sensitivity and specificity for the central location (containing active bone marrow) of 94% and 100% respectively; for the peripheral location (hands and feet) both parameters were 100%, and for the middle location (all sites between the central and the peripheral location) the values were 92% and 81% respectively. Specificity and accuracy were significantly lower in the middle location than in the central and peripheral locations. The results of our study confirm that a 99mTc-d,l-HMPAO labelled leucocyte scan in combination with an 99mTc-MDP bone scan is a reliable way to diagnose chronic osteomyelitis, except for vertebral osteomyelitis.
Case-Control Studies↗
Task dependency of visual processing in the human visual system.
In this review we contrast passive, attribute driven processing in the visual system with an active, task-dependent view and summarize the evidence from our Positron Emission Tomography (PET) work supporting the task-dependent view. The PET studies involved comparison of regional Cerebral Blood Flow (rCBF) in closely related detection and discrimination tasks. The major finding reported is that the same retinal input or input containing only a single cue activates different extrastriate areas depending on the task.
Adult↗