Browsing by Subject " diagnostic imaging"

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  • Boss, Marti; Rottenburger, Christof; Brenner, Winfried; Blankenstein, Oliver; Prasad, Vikas; Prasad, Sonal; de Coppi, Paolo; Kuhnen, Peter; Buitinga, Mijke; Nuutila, Pirjo; Otonkoski, Timo; Hussain, Khalid; Brom, Maarten; Eek, Annemarie; Bomanji, Jamshed; Shah, Pratik; Gotthardt, Martin (2022)
    Surgery with curative intent can be offered to congenital hyperinsulinism (CHI) patients, provided that the lesion is focal. Radiolabeled exendin-4 specifically binds the glucagonlike peptide 1 receptor on pancreatic beta-cells. In this study, we compared the performance of F-18-DOPA PET/CT, the current standard imaging method for CHI, and PET/CT with the new tracer Ga-68-NODAGA-exendin-4 in the preoperative detection of focal CHI. Methods: Nineteen CHI patients underwent both F-18-DOPA PET/CT and Ga-68-NODAGA-exendin-4 PET/CT before surgery. The images were evaluated in 3 settings: a standard clinical reading, a masked expert reading, and a joint reading. The target (lesion)-to-nontarget (normal pancreas) ratio was determined using SUVmax. Image quality was rated by pediatric surgeons in a questionnaire. Results: Fourteen of 19 patients having focal lesions underwent surgery. On the basis of clinical readings, the sensitivity of Ga-68-NODAGA-exendin-4 PET/CT (100%; 95% CI, 77%-100%) was higher than that of F-18-DOPA PET/CT (71%; 95% CI, 42%-92%). Interobserver agreement between readings was higher for Ga-68-NODAGA-exendin-4 than for F-18-DOPA PET/CT (Fleiss kappa = 0.91 vs. 0.56). Ga-68-NODAGA-exendin-4 PET/CT provided significantly (P = 0.021) higher target-to-nontarget ratios (2.02 +/- 0.65) than did F-18-DOPA PET/CT (1.40 +/- 0.40). On a 5-point scale, pediatric surgeons rated Ga-68-NODAGA-exendin-4 PET/CT as superior to F-18-DOPA PET/CT. Conclusion: For the detection of focal CHI, Ga-68-NODAGA-exendin-4 PET/CT has higher clinical sensitivity and better interobserver correlation than F-18-DOPA PET/CT. Better contrast and image quality make Ga-68-NODAGA-exendin-4 PET/CT superior to F-18-DOPA PET/CT in surgeons' intraoperative quest for lesion localization.
  • Lundin, Johan; Dumont, Guy (2017)
    Current advances within medical technology show great potential from a global health perspective. Inexpensive, effective solutions to common problems within diagnostics, medical procedures and access to medical information are emerging within almost all fields of medicine. The innovations can benefit health care both in resource-limited and in resource-rich settings. However, there is a big gap between the proof-of-concept stage and implementation. This article will give examples of promising solutions, with special focus on mobile image-and sensor-based diagnostics. We also discuss how technology and frugal innovations could be made sustainable and widely available. Finally, a list of critical factors for success is presented, based on both our own experiences and the literature.