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[18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography is useful for studying glucose metabolism related to brain function. Here, we present a protocol for an [18F]FDG tracer set-up and semiquantitative assessment of the region-of-interest analysis for targeted brain areas associated with clinical manifestations in patients with severe traumatic brain injury.
Patients with severe traumatic brain injury (sTBI) have difficulty knowing whether they are accurately expressing their thoughts and emotions because of disorders of consciousness, disrupted higher brain function, and verbal disturbances. As a consequence of an insufficient ability to communicate, objective evaluations are needed from family members, medical staff, and caregivers. One such evaluation is the assessment of functioning brain areas. Recently, multimodal brain imaging has been used to explore the function of damaged brain areas. [18F]-fluorodeoxyglucose positron emission tomography-computed tomography ([18F]FDG-PET/CT) is a successful tool for examining brain function. However, the assessment of brain glucose metabolism based on [18F]FDG-PET/CT is not standardized and depends on several varying parameters, as well as the patient's condition. Here, we describe a series of semiquantitative assessment protocols for a region-of-interest (ROI) image analysis using self-produced [18F]FDG tracers in patients with sTBI. The protocol focuses on screening the participants, preparing the [18F]FDG tracer in the hot lab, scheduling the acquisition of [18F]FDG-PET/CT brain images, and measuring glucose metabolism using the ROI analysis from a targeted brain area.
Patients with sTBI are presented with unforeseeable neurological difficulties over the course of rehabilitation that include motor deficits, sensory deficits, and psychiatric instability1. Although clinical assessment is generally performed verbally, patients with sTBI such as unresponsive wakefulness syndrome or minimally conscious state have particular difficulty in knowing whether they are accurately expressing their thoughts and emotions because of disorders of consciousness, disrupted higher brain function, and verbal disturbances2,3. Family members, medical staff, and caregivers a....
This study was performed in compliance with the institutional review board (approval No. 07-01) and adhered to the tenets of the Declaration of Helsinki. Informed consent for medical record and brain image use was obtained from the patients’ legal representatives. The study was conducted after approval by the institutional ethics committee (2017-14). This protocol was made following the guidelines of the Japanese Society of Nuclear Medicine and European Association of Nuclear Medicine as a reference
A 63-year-old man who had been run over by a car while cycling was brought to the emergency room via ambulance. The examination revealed a Glasgow Coma Scale score of 7 (eye opening = 1, best verbal response = 2, best motor response = 4), anisocoria (right: 2 mm, and left: 3 mm), and a negative corneal response17. A CT of the head showed subarachnoid and intracranial hemorrhage and a skull fracture of the left zygoma, temporal bones, and parietal bones. Th.......
This protocol provides the means to conduct a series of brain-glucose metabolic assessments with [18F]FDG-PET/CT using self-produced [18F]FDG tracer at a single institution.
The production of [18F]FDG tracer follows the procedure described in the FDG synthesizer operator manual; however, caution is necessary regarding three points. First, the bombardment time and energy (step 2.5) should be adjusted according to the number of patients. Second, attention should .......
The authors wish to thank Dr. Uchino in Sousen hospital for all procedures. The authors also thank Adam Phillips from the Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
....Name | Company | Catalog Number | Comments |
20ml syringe | Terumo | SS-20ESZ | |
10ml syringe | Terumo | SS-10ESZ | |
1ml syringe | Terumo | SS-01T | |
Protective plug | Top | ML-KS | |
Three-way cock L type 180° | Terumo | TS-TL2K | |
Extension tube | Top | X1-50 | |
Indwelling needle 22G or 24G | Terumo | SR-OT2225C | |
Tegaderm transparent dressing | 3M | 1624W | |
Hepaflash 10U/ml 10ml | Terumo | PF-10HF10UA | |
Auto dispensing and injection system | Universal Giken Co., Ltd. | UG-01 | |
Fluid for auto dispensing and injection system | Universal Giken Co., Ltd. | UG-01-001 | |
Millex-GS Syringe Filter Unit | Millipore | SLGSV255F | |
Air needle | Terumo | XX-MFA2038 | |
Check valve | Hakko | 23310100 | |
Saline 500ml | HIKARI pharmaceutical Co., Ltd. | 18610155-3 | |
Yukiban 25x7mm | Nitto | 3252 | |
Elascot No.3 | Alcare | 44903221 | |
Presnet No.3 27x20mm | Alcare | 11674 | |
Steri Cotto a 4x4cm | Kawamoto | 023-720220-00 | |
StatstripXp3 | Nova Biomedical | 11-110 | |
Statstrip Glucose strips | Nova Biomedical | 11-106 | |
JMSsheet | JMS | JN-SW3X | |
Injection pad | Nichiban | No.30-N | |
Stepty | Nichiban | No.80 | |
Advantage Workstation | GE Healthcare | Volume Share 7. version 4.7 | |
Discovery MI PET/CT | GE Healthcare | ||
EV Insite | PSP | ||
GE TRACERlab MXFDG synthesizer reagent kit | ABX | K-105TM | |
TRACERlab MXFDG cassette | GE Healthcare | P5150ME | |
Extension tube | Universal Giken Co., Ltd | AT511-ST-001 | |
TSK sterilized injection needle 18x100 | Tochigiseiko | AT511-ST-004 | |
TSK sterilized injection needle 18x60 | Tochigiseiko | AT511-ST-002 | |
TSK sterilized injection needle 21x65 | Tochigiseiko | AT511-ST-003 | |
Seal sterile vial -N 5ml | Mita Rika Kogyo Co., Ltd. | SSVN5CBFA | |
k222 TLC plate | Universal Giken Co., Ltd. | AT511-01-005 | |
Anion-cation test paper | Toyo Roshi Kaisha | 7030010 | |
Endospecy ES-24S set | Seikagaku corporation | 20170 | |
Sterile evacuated vial | Gi phama | 10214 | |
5ml syringe | Terumo | SS-05SZ | |
Extension tube | Top | X-120 | |
Finefilter F | Forte grow medical Co.Ltd. | F162 | |
Millex FG | Merck | SLFG I25 LS | |
Vented Millex GS | Merck | SLGS V25 5F | |
Injection needle 18x38 | Terumo | NN-1838R | |
Injection needle 21x38 | Terumo | NN-2138R | |
Water-18O | Taiyo Nippon Sanso | F03-0027 | |
Distilled water | Otsuka phrmaceutical | ||
Hydrogen gas G1 | Hosi Iryou Sanki | ||
Helium gas G1 | Hosi Iryou Sanki | ||
Nitrogen G1 | Hosi Iryou Sanki | ||
TRACERlabMXFDG | GE Healthcare | ||
Sep-Pak Light Accell Plus QMA | WATERS | ||
Sep-Pak Plus tC18 | WATERS | ||
Sep-Pak Plus Alumina N | WATERS | ||
HPLC with 3.9 X 300 mm columns | WATERS | ||
US-2000 | Universal Giken CO. Ltd. | ||
Kryptofix222 | Merck | ||
EG Reader SV-12 | Seikagaku Corporation | ||
UG-01 | Universal Giken Co., Ltd. | ||
syngo.via | Siemens Healthineers | ||
Advantage Workstation Volume Share 7, version 4.7 | GE Healthcare | ||
Q clear | GE Healthcare | ||
CRC-15PET dose calibrator | CAPINTEC, INC. |
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