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- Danielsson, Rimma
(författare)
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Nuclear medicine imaging of breast cancer and regional lymph nodes
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore the role of nuclear medicine in diagnosis of primary breast carcinoma and regional lymph node involvement. The introduction includes a review over nuclear medicine techniques currently under investigation. Methods: In paper I, II, III and V patients were preoperatively investigated by scintimammography with 99m-Tc-Sestamibi. Ninety-six patients were imaged in prone position as a standard. All patients were routinely assessed by triple diagnosis (TD), i.e., physical investigation, mammography and fine-needle aspiration cytology. The results of TD had led to the decision that the patient was to be operated upon. Twenty-six patients were additionally imaged with single photon emission tomography (SPECT). Paper I, II and V evaluated Sestamibi uptake in breasts and paper III uptake in axillary lymph nodes. In paper IV detection of sentinel node (SN) in patients with breast carcinoma was studied. Lymphoscintigraphy with 99m-Tc-Nanocolloid, preoperative injection of Patent blue dye and peroperative use of gamma probe were applied on 75 patients. Results and Implications: Scintimammography with 99m-Tc-Sestamibi showed a sensitivity of 84 % and specificity of 74 % (Paper II and V), which was not improved by the additional use of SPECT (Paper 1). The sensitivity of scintimammography in the detection of primary breast lesion depends on tumour size, site and histological features. Furthermore, also benign lesions showed increased Sestamibi uptake, which lead to false- positive findings. The method had unsatisfactory diagnostic accuracy in the detection of axillary lymph node metastases (Paper III). Complementary use of scintimammography to TD improved the sensitivity in diagnosing cancers, and was specialty valuable in patients with mammographically dense breast parenchyma (Paper V). The combined use of preoperative lymphoscintigraphy, injection of blue dye and the peroperatively use of a gamma probe resulted in a detection rate of SN of 92% in all patients. SN correctly predicted the axillary status in 96% of the cases and might therefore be a potential concurrent to axillary lymph node dissection (Paper IV). Conclusions: Scintimammography can be recommended as a complementary method to TD, especially in patients with mammographically dense breasts. Biopsy of SN can be used instead of axillary lymph node dissection in selected patients.
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| 2. |
- Sundström, Torbjörn, 1967-
(författare)
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Human brain function evaluated with rCBF-SPECT : memory and pain related changes and new diagnostic possibilities in Alzheimer’s disease
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this doctoral thesis was to study the influence of memory, pain, age and education on the regional cerebral blood flow (rCBF), i.e. brain function, in early Alzheimer's disease (AD) and in chronic neck pain patients in comparison to healthy controls and in healthy elderly per se. This was done by optimizing single photon emission computed tomography (SPECT) as a method to study rCBF with the tracer Technetium-99m (99mTc) hexamethylpropyleneamine oxime (HMPAO) and by matching all image data to a brain atlas before evaluation. The rCBF-SPECT was evaluated and developed to obtain higher diagnostic accuracy in AD and in chronic neck pain patients it was used to study basic pain related cerebral processes in chronic pain of different origin. A new semimanual registration method, based on fiducial marker, suitable for investigations with low spatial resolution was developed. The method was used to reconstruct images with an improved attenuation and scatter correction by using an attenuation-map calculated from the patients' previously acquired CT images. The influence of age and education on rCBF was evaluated with statistical parametric mapping, SPM in healthy elderly. The main findings were age related changes in rCBF in regions close to interlobar and interhemispheric space but not in regions typically affected in early AD, except for the medial temporal lobe. The theory of a 'cognitive reserve' in individuals with a longer education was supported with findings in the lateral temporal lobe, a region related to semantic memory, and in the frontal lobe. A cross-sectional study of chronic neck pain patients showed extensive rCBF changes in coping related regions in a non-traumatic pain patients compared to both healthy and a pain group with a traumatic origin, i.e. whiplash syndrome. The whiplash group displayed no significant differences in rCBF in comparison with the healthy controls. This suggests different pain mechanisms in these groups. The AD-patients showed a significantly lower rCBF in temporoparietal regions including left hippocampus. These changes were associated to episodic memory performance, and especially to face recognition. The diagnostic sensitivity for AD was high. The face recognition test (episodic memory) was used in AD patients to improve the sensitivity of method, i.e. memory-provoked rCBF-SPECT (MP-SPECT). The results were compared to healthy controls and the reductions of rCBF in temporoparietal regions were more pronounced in mild AD during provocation. Memory provocation increased the sensitivity of AD-related rCBF changes at group level. If a higher sensitivity for AD at the individual level is verified in future studies, a single MP-SPECT study might then be of help to set diagnosis earlier. In conclusion rCBF in temporoparietal regions are associated to an impaired episodic memory in early AD. Changes in these regions do not have a strong connection to chronological age. The diagnostic sensitivity of rCBF-SPECT in AD is high and there is a potentially higher sensitivity if memory provoked investigations are used. The findings in this thesis have given an increased knowledge of underlying cerebral pain processing in non-traumatic and traumatic (whiplash) neck pain. Preliminary results supporting the theory of 'cognitive reserve' by showing a correlation between long education and preserved rCBF was found in healthy elderly.
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| 3. |
- Östberg, Per, et al.
(författare)
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A temporal lobe factor in verb fluency
- 2007
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Ingår i: Cortex. - 0010-9452 .- 1973-8102. ; 43:5, s. 607-615
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Tidskriftsartikel (refereegranskat)abstract
- Verb fluency requires self-sustained verb retrieval. The brain correlates of this task are virtually unknown. We investigated the relations between verb and noun (semantic) fluency and regional brain perfusion in subjects with varying degrees of cognitive decline, ranging from very mild subjective impairment to Alzheimer's disease (AD). Data consisted of single-photon emission computed tomography (SPECT) data and temporally resolved verb and noun fluency scores from 93 participants. Impaired verb fluency was predicted by a temporal lobe hypoperfusion factor and low education, whereas high age and low perfusion in the parietotemporal-occipital region predicted impaired noun fluency. Analysis of perfusion within the temporal region indicated primary involvement of the temporal pole and medial temporal lobe in AD. This might reflect pathology of the anterior parahippocampal region, which appears early in neurodegenerative disease. Although temporal lobe structures have not usually been implicated in verb processing, early temporal pathology thus appears to contribute to impaired verb fluency in cognitive decline.
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