M Schreckenberger

Publications (53)183.83 Total impact

• Article: PET Lung Ventilation/Perfusion Imaging Using (68)Ga Aerosol (Galligas) and (68)Ga-Labeled Macroaggregated Albumin.

  S J Ament, S Maus, H Reber, H G Buchholz, N Bausbacher, C Brochhausen, F Graf, M Miederer, M Schreckenberger
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  ABSTRACT: Pulmonary imaging using ventilation/perfusion (V/P) single-photon emission tomography (V/P scan) with Tc-99m-labeled radiotracers is a well-established diagnostic tool for clinically suspected pulmonary embolism (PE). Ga-68 aerosol (Galligas) and Ga-68-labeled macroaggregated albumin (MAA) are potential tracers for positron emission tomography (PET) lung V/P imaging and could display an advantage over conventional V/P scans in terms of sensitivity and specificity. After radiochemical and animal studies, the clinical applicability of Ga-68 aerosol (Galligas) and Ga-68-labeled MAA was investigated in an exploratory study in patients with clinical suspicion of PE. PET scans were acquired using a 16-slice Gemini TF positron emission tomography/computed tomography (PET/CT) scanner. The acquisition protocol included low-dose computed tomography (CT) for attenuation correction (AC). Dosimetry calculations and continuative phantom measurements were performed. Structural analyses showed no modification of the particles due to the labeling process. In addition, in vitro experiments showed stability of Ga-68 MAA in various media. As expected, Ga-68-labeled human serum albumin microspheres (HSAM) were completely retained in the lung of the animals. In clinical use, PET lung ventilation and perfusion imaging using Ga-68 aerosol (Galligas) and Ga-68-labeled MAA was successful in all cases. In one case a clinically suspected PE could be detected and verified. The administered activity of Ga-68 aerosol (Galligas) and Ga-68-labeled MAA may be reduced by more than 50%, resulting in comparable radiation exposure to conventional V/P scans. In conclusion, Ga-68 aerosol (Galligas) and Ga-68-labeled MAA are efficient substitutes for clinical use and could be an interesting alternative with high accuracy for lung V/P imaging with Tc-99m-labeled radiotracers, especially in times of Mo-99 shortages and increasing use and spread of PET/CT scanners and Ga-68 generators, respectively.
  Recent results in cancer research. Fortschritte der Krebsforschung. Progrès dans les recherches sur le cancer 01/2012; 194:395-423.
• Article: Stage-dependent agreement between cerebrospinal fluid proteins and FDG-PET findings in Alzheimer's disease.

  Igor Yakushev, Matthias J Muller, Hans-Georg Buchholz, Ulrike Lang, Heidi Rossmann, Harald Hampel, Mathias Schreckenberger, Andreas Fellgiebel
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  ABSTRACT: Cerebral hypometabolism and abnormal levels of amyloid beta (Aβ), total (t-tau) and phosphorylated tau (ptau) proteins in cerebrospinal fluid (CSF) are established biomarkers of Alzheimer's disease (AD). We examined the agreement between these biomarkers in a single center study of patients with AD of severity extending over a wide range. Forty seven patients (MMSE 21.4 ± 3.6, range 13-28 points) with incipient and probable AD underwent positron emission tomography with [18F]-fluorodeoxyglucose (FDG-PET) and lumbar puncture for CSF assays of Aβ1-42, p-tau181, and t-tau. All findings were classified as either positive or negative for AD. Statistical analyses were performed for the whole sample (n=47) and for the subgroups stratified as mild (MMSE > 20 points, n=30) and moderate (MMSE < 21 points, n=17) AD. In the whole patient sample, the agreement with the FDG-PET finding was 77% (chance-corrected kappa [κ]=0.34, p=0.016) for t-tau, 68% (κ=0.10, n.s.) for p-tau181, and 68% (κ=0.04, n.s.) for Aβ1-42. No significant agreement was found in the mild AD subgroup, while there was a strong agreement for t-tau (94%, κ=0.77, p=0.001) and p-tau181 (88%, κ=0.60, p=0.014) in the moderate AD group. A significant agreement between the FDG-PET and CSF tau findings in patients with AD supports the view that both are markers of neurodegeneration. CSF tau proteins and FDG-PET might substitute each other as supportive diagnostic tools in patients with suspected moderate-to-severe Alzheimer's dementia, while this is not the case in subjects at an earlier disease stage.
  Current Alzheimer research 10/2011; 9(2):241-7. · 4.97 Impact Factor
• Article: Estimation of further disease progression of Parkinson's disease by dopamin transporter scan vs clinical rating.

  Thomas Vogt, Katrin Kramer, M Gartenschlaeger, M Schreckenberger
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  ABSTRACT: Imaging techniques like ß-CIT Scan are valuable diagnostic tools for Parkinson's disease (PD) and correlate in most cases with clinical symptoms. In some patients, however, clinical and imaging data are conflicting. It has not yet been evaluated, which parameter provide more information about severity and disease progression in those patients. To estimate the predictive value of UPDRS and ß-CIT in PD on clinical impairment at follow up. In a longitudinal study, 44 PD patients who underwent ß-CIT Scan for diagnostic purpose were followed up for a mean of 44 months. At baseline we assessed UPDRS motor score as well as the subtype of PD, presence of dementia or motor complications. Disease staging at follow up was displayed by UPDRS II (ADL) and III (motor score) as well as by Hoehn & Yahr classification. ß-CIT could significantly discriminate PD patients from controls and the tracer uptake ratios (UR) correlated well with UPDRS motor score at baseline. There was, however, only a weak correlation between UR and staging parameters at follow up, whereas UPDRS at baseline was highly correlated with impairment at follow up. The data suggest a more significant predictive value of UPDRS motor score on disability in the course of disease progression than ß-CIT Scan. Low receptor binding may not be mistaken for a bad prognosis.
  Parkinsonism & Related Disorders 07/2011; 17(6):459-63. · 3.80 Impact Factor
• Article: [German guidelines for brain tumour imaging by PET and SPECT using labelled amino acids].

  K-J Langen, P Bartenstein, H Boecker, P Brust, H H Coenen, A Drzezga, F Grünwald, B J Krause, T Kuwert, O Sabri, K Tatsch, W A Weber, M Schreckenberger
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  ABSTRACT: For the primary diagnosis of brain tumours, morphological imaging by means of magnetic resonance imaging (MRI) is the current method of choice. The complementary use of functional imaging by positron emitting tomography (PET) and single photon emitting computerized tomography (SPECT) with labelled amino acids can provide significant information on some clinically relevant questions, which are beyond the capacity of MRI. These diagnostic issues affect in particular the improvement of biopsy targeting and tumour delineation for surgery and radiotherapy planning. In addition, amino acid labelled PET and SPECT tracers are helpful for the differentiation between tumour recurrence and non-specific post-therapeutic tissue changes, in predicting prognosis of low grade gliomas, and for metabolic monitoring of treatment response. The application of dynamic PET examination protocols for the assessment of amino acid kinetics has been shown to enable an improved non-invasive tumour grading. The purpose of this guideline is to provide practical assistance for indication, examination procedure and image analysis of brain PET/SPECT with labelled amino acids in order to allow for a high quality standard of the method. After a short introduction on pathobiochemistry and radiopharmacy of amino acid labelled tracers, concrete and detailed information is given on the several indications, patient preparation and examination protocols as well as on data reconstruction, visual and quantitative image analysis and interpretation. In addition, possible pitfalls are described, and the relevant original publications are listed for further information.
  Nuklearmedizin 01/2011; 50(4):167-73. · 1.28 Impact Factor
• Article: Investigation for extrahepatic shunt before SIRT by PET/CT with 68Ga-MAA.

  M Gartenschlaeger, S Maus, H Buchholz, H Reber, N Pitton, M Schreckenberger
  Nuklearmedizin 01/2011; 50(4):N37-8. · 1.28 Impact Factor
• Article: Central opioidergic neurotransmission in complex regional pain syndrome.

  A Klega, T Eberle, H-G Buchholz, S Maus, C Maihöfner, M Schreckenberger, F Birklein
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  ABSTRACT: Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by sensory, motor, and autonomic symptoms. It develops after limb trauma and may be associated with relevant psychiatric comorbidity. As there is evidence for central pathophysiology which might be related to an altered opioidergic neurotransmission, we investigated the cerebral opioid receptor status under resting conditions in this patient population. In this case-control study, 10 patients with CRPS and 10 age- and gender-matched healthy subjects underwent a PET scan using the subtype-nonselective opioidergic radioligand [(18)F]fluoroethyl-diprenorphine. As a surrogate for regional cerebral opioid receptor availability, the opioid receptor binding potential (OR-BP) was assessed by means of the modified Logan plot with reference region input for categorical group comparison and correlation with clinical data in the patient group. Patients with CRPS showed reduced OR-BP in contralateral amygdala and parahippocampal gyri and increased OR-BP in contralateral prefrontal cortical areas. When OR-BP in the midcingulate cortex and the ipsilateral temporal cortex was low, the McGill pain rating index was high. In general, when anxiety and depression scales were high, contralateral temporal OR-BP was high as well. In addition, the anxiety scale decreased with increasing OR-BP in the contralateral parahippocampal cortex. These results demonstrate altered central opioidergic neurotransmission in CRPS. The correlation of regional opioid receptor availability to measures of pain, anxiety, and depression underlines the clinical importance of these findings.
  Neurology 07/2010; 75(2):129-36. · 8.31 Impact Factor
• Article: Cortical control of thermoregulatory sympathetic activation.

  M Fechir, A Klega, H G Buchholz, N Pfeifer, S Balon, T Schlereth, C Geber, M Breimhorst, C Maihöfner, F Birklein, M Schreckenberger
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  ABSTRACT: Thermoregulation enables adaptation to different ambient temperatures. A complex network of central autonomic centres may be involved. In contrast to the brainstem, the role of the cortex has not been clearly evaluated. This study was therefore designed to address cerebral function during a whole thermoregulatory cycle (cold, neutral and warm stimulation) using 18-fluordeoxyglucose-PET (FDG-PET). Sympathetic activation parameters were co-registered. Ten healthy male volunteers were examined three times on three different days in a water-perfused whole-body suit. After a baseline period (32 degrees C), temperature was either decreased to 7 degrees C (cold), increased to 50 degrees C (warm) or kept constant (32 degrees C, neutral), thereafter the PET examination was performed. Cerebral glucose metabolism was increased in infrapontine brainstem and cerebellar hemispheres during cooling and warming, each compared with neutral temperature. Simultaneously, FDG uptake decreased in the bilateral anterior/mid-cingulate cortex during warming, and in the right insula during cooling and warming. Conjunction analyses revealed that right insular deactivation and brainstem activation appeared both during cold and warm stimulation. Metabolic connectivity analyses revealed positive correlations between the cortical activations, and negative correlations between these cortical areas and brainstem/cerebellar regions. Heart rate changes negatively correlated with glucose metabolism in the anterior cingulate cortex and in the middle frontal gyrus/dorsolateral prefrontal cortex, and changes of sweating with glucose metabolism in the posterior cingulate cortex. In summary, these results suggest that the cerebral cortex exerts an inhibitory control on autonomic centres located in the brainstem or cerebellum. These findings may represent reasonable explanations for sympathetic hyperactivity, which occurs, for example, after hemispheric stroke.
  European Journal of Neuroscience 06/2010; 31(11):2101-11. · 3.63 Impact Factor
• Article: 6-18F-fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to 123I-metaiodobenzyl-guanidine scintigraphy in the detection of extraadrenal and hereditary pheochromocytomas and paragangliomas: correlation with vesicular monoamine transporter expression.

  C Fottner, A Helisch, M Anlauf, H Rossmann, T J Musholt, A Kreft, S Schadmand-Fischer, P Bartenstein, K J Lackner, G Klöppel, M Schreckenberger, M M Weber
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  ABSTRACT: Pheochromocytomas (PHEOs) and paragangliomas (PGLs) may be better detected by (18)F-fluorodihydroxyphenylalanine-positron emission tomography (FDOPA-PET) than (123)I-metaiodobenzyl-guanidine (123-I-MIBG) scintigraphy. The objective of the study was to correlate functional imaging results with immunohistochemical, molecular-genetic, and biochemical findings. Thirty consecutive patients with suspected PHEO/PGL presenting at a tertiary referral centre were investigated in a prospective study. Twenty-five patients had confirmed PHEO/PGL. Thirteen of 25 patients had a hereditary PHEO/PGL syndrome (two multiple endocrine neoplasia II, six succinate dehydrogenase complex, subunit D, two succinate dehydrogenase complex, subunit B, one von Hippel Lindau tumor suppressor protein, two Neurofibromatosis-1), and 12 of 25 were classified as sporadic. Five patients had hormonally inactive adrenal incidentalomas. In all patients computed tomography scan and/or magnetic resonance imaging as well as both 123-I-MIBG scintigraphy and FDOPA-PET were performed. Resected tumors were examined by immunohistochemistry for expression of the vesicular monoamine transporter (VMAT)-1 and -2 and other markers. A total of 64 lesions were found with both functional imaging modalities. FDOPA-PET detected 62 lesions, whereas only 34 lesions were detected by 123-I-MIBG scintigraphy. This resulted in an overall sensitivity and specificity for FDOPA-PET of 98 and 100% and for MIBG of 53 and 91%, respectively. Comparable sensitivities were found for adrenal and extraadrenal abdominal lesions (94 vs. 97%), whereas in thoracic/cervical lesions, the sensitivity for 123-I-MIBG scintigraphy (15%) was inferior to that of FDOPA-PET imaging (100%). Immunohistochemistry demonstrated a lack of VMAT-1 expression in all MIBG-negative tumors. Clinical predictors for MIBG negativity were a predominant norepinephrine/normetanephrine secretion, an age less than 45 yr, and a hereditary cause. FDOPA-PET is superior to 123-I-MIBG scintigraphy in patients with extraadrenal, predominantly noradrenaline-secreting, and hereditary types of PHEO/PGL. The lack of VMAT-1 expression predicts negativity for MIBG-scintigraphy.
  The Journal of clinical endocrinology and metabolism 04/2010; 95(6):2800-10. · 6.50 Impact Factor
• Article: In vivo molecular imaging of somatostatin receptors in pancreatic islet cells and neuroendocrine tumors by miniaturized confocal laser-scanning fluorescence microscopy.

  C Fottner, E Mettler, M Goetz, E Schirrmacher, M Anlauf, D Strand, R Schirrmacher, G Klöppel, P Delaney, M Schreckenberger, P R Galle, M F Neurath, R Kiesslich, M M Weber
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  ABSTRACT: The aim of the study was to evaluate real time in vivo molecular imaging of somatostatin receptors (sstrs) using a handheld miniaturized confocal laser scan microscope (CLM) in conjunction with fluorescein-labeled octreotate (OcF) in healthy mice and murine models of neuroendocrine tumors. For CLM a small rigid probe (diameter 7 mm) with an integrated single line laser (488 nm) was used (optical slice thickness 7 mum; lateral resolution 0.7 mum). OcF was synthesized via Fmoc solid-phase peptide synthesis and purified by HPLC showing high-affinity binding to the sstr2 (IC(50) 6.2 nmol). For in vitro evaluation, rat and human pancreatic cancer cells were used and characterized with respect to its sstr subtype expression and functional properties. For in vivo confocal imaging, healthy mouse pancreatic islet and renal tubular cells as well as immunoincompetent nude mice harboring sstr-expressing tumors were evaluated. Incubation of sstr-positive cells with OcF showed a specific time- and dose-dependent staining of sstr-positive cells. CLM showed rapid internalization and homogenous cytoplasmatic distribution. After systemic application to mice (n = 8), specific time-dependent internalization and cytoplasmatic distribution into pancreatic islet cells and tubular cells of the renal cortex was recorded. After injection in tumor-harboring nude mice (n = 8), sstr-positive cells selectively displayed a cell surface and cytoplasmatic staining. CLM-targeted biopsies detected sstr-positive tumor cells with a sensitivity of 87.5% and a specificity of 100% as correlated with ex vivo immunohistochemistry. CLM with OcF permits real-time molecular, functional, and morphological imaging of sstr-expressing cell structures, allowing the specific visualization of pancreatic islet cells and neuroendocrine tumors in vivo.
  Endocrinology 03/2010; 151(5):2179-88. · 4.46 Impact Factor
• Article: Visual-motion suppression in congenital pendular nystagmus.

  P Schlindwein, M Schreckenberger, M Dieterich
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  ABSTRACT: Patients with a congenital pendular nystagmus are known not to experience oscillopsia in a normal visual environment. The data of a 31-year-old female patient suffering from a congenital pendular nystagmus are presented. The aim of the fluorodeoxyglucose positron emission tomography (FDG-PET) experiment was to analyze the regional cerebral glucose metabolism (rCGM) during minimal as well as maximal nystagmus. Video-oculography showed a maximum in frequency of the horizontal pendular nystagmus during gaze to the left, whereas the zone of minimal nystagmus was 10 degrees to the right. Two sessions with an 18F-fluorodeoxyglucose tracer were performed to analyze cerebral blood-glucose utilization when fixating an object in the areas of maximal and of minimal nystagmus. A structural MRI in a clinical 1.5-T scanner was acquired to superimpose the PET results onto the unique anatomy of the patient. By statistical analysis a significant increase in the rCGM in the cerebellar nodulus and a relative decrease in the area of MT/V5 bilaterally during maximal nystagmus were found. When the patient was looking in her null zone, rCGM was increased in V1 and MT/V5 bilaterally. To the best of the authors' knowledge, this is the first proof by means of functional imaging of a suppression of oscillopsia in higher-order visual cortex areas in a patient with a congenital nystagmus.
  Annals of the New York Academy of Sciences 06/2009; 1164:458-60. · 3.15 Impact Factor
• Article: Sympathetic activity at rest and motor brain areas: FDG-PET study.

  P Schlindwein, H-G Buchholz, M Schreckenberger, P Bartenstein, M Dieterich, F Birklein
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  ABSTRACT: Although recent studies identified brain areas which are involved in short term activation of the sympathetic nervous system, little is known about brain mechanisms which generate the individual variability of basal autonomic activity. In this fluorodeoxyglucose positron emission tomography study (FDG-PET), we aimed to identify brain regions, which covary with function parameters of the autonomic nervous system at rest. Therefore, FDG-PET (Siemens, Germany) was performed twice in 14 healthy resting subjects (7 m, 7 f; mean age 29.5 years) while different parameters of autonomic function were assessed simultaneously: Blood pressure, heart rate, power spectra of heart rate variability (HF/LF ratio) and plasma catecholamines. In order to control for attention, subjects had to focus visual affective neutral presentations during the experiment. Correlation analysis was performed as a region of interest analysis using SPM2 software (p<0.001 uncorrected). Sympathetic activity at rest varied substantially between subjects. There were significant positive correlations between increase of regional cerebral glucose metabolism (rCGM) of the heads of caudate nuclei on both sides and the HF/LF ratio of heart rate variability. Furthermore, significant negative correlations between both heart rate and plasma catecholamines and rCGM decreases of caudate nuclei heads were found. In addition, there was a positive correlation between plasma catecholamines and primary motor cortex activation. Autonomic nervous system at rest seems to be partially interlocked with activity of motor brain regions - the caudate nuclei and the motor cortex. This might have clinical implications for the understanding of stress-related disorders, which are frequently accompanied by increased sympathetic activity as well as muscle tone.
  Autonomic neuroscience: basic & clinical 09/2008; 143(1-2):27-32. · 1.82 Impact Factor
• Article: Antiamphiphysin-positive stiff-person syndrome associated with small cell lung cancer.

  B K Nguyen-Huu, P P Urban, M Schreckenberger, M Dieterich, Konrad J Werhahn
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  ABSTRACT: The paraneoplastic amphiphysin(+) stiff-person syndrome (SPS) has so far only been described in women with breast adenocarcinoma. Here, we describe the rare case of a female patient with antiamphiphysin(+) SPS due to small cell cancer of the lung.
  Movement Disorders 09/2006; 21(8):1285-7. · 4.51 Impact Factor
• Article: FDG-PET in the initial staging of squamous cell oesophageal carcinoma.

  I Buchmann, T Hansen, C Brochhausen, W Kneist, K Oberholzer, T Junginger, M Schreckenberger, P Bartenstein
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  ABSTRACT: Squamous cell oesophageal carcinoma is the most common carcinoma of the oesophagus worldwide. The tumour stage as most important prognostic factor determines the clinical management. of this study was to evaluate the value of FDG-PET 1. in imaging the primary tumour and 2. in N- and M-staging of squamous cell oesophageal carcinoma. In 20 patients with histological proven squamous cell carcinoma of the upper and middle oesophagus, FDG-PET was performed in standard technique prior to therapy. FDG uptake in the primary was determined by calculation of the SUVmax. NM-staging due to PET findings was performed as designated by the AJCC/UICC group classification and was compared with pathological and clinically based staging. Sensitivities, specificities and accuracies were calculated. In 19 of 20 patients, primary squamous cell oesopohageal carcinoma was detected by FDG-PET findings with a maximum SUV of 12.5 (mean) +/- 5.1 (median 11.5; range 4.8-23.8). One carcinoma in situ was missed. The sensitivity of FDG-PET in imaging the primary tumour was 96%. The sensitivities, specificities and accuracies were 20%, 100%, 58% for N-staging, and 60%, 86% and 93% for M-staging. PET findings caused changes of therapy in 5% (1 patient). FDG-PET was excellent in imaging the primary of squamous cell oesophageal carcinoma in stage T1-T4 and was efficient in M-staging. The low sensitivity in N-staging is of inferior clinical importance. The efficacy of FDG-PET seems to be not significantly be influenced by the histological subtype of oesophageal carcinoma.
  Nuklearmedizin 02/2006; 45(6):235-41. · 1.28 Impact Factor
• Article: In vitro and in vivo evaluation of novel glibenclamide derivatives as imaging agents for the non-invasive assessment of the pancreatic islet cell mass in animals and humans.

  S Schneider, P J Feilen, M Schreckenberger, M Schwanstecher, C Schwanstecher, H G Buchholz, O Thews, K Oberholzer, A Korobeynikov, A Bauman, S Comagic, M Piel, E Schirrmacher, C Y Shiue, A A Alavi, P Bartenstein, F Rösch, M M Weber, H H Klein, R Schirrmacher
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  ABSTRACT: Pancreatic islet cell mass (PICM) is a major determinant of the insulin secretory capacity in humans. Currently, the only method for accurate assessment of the PICM is an autopsy study. Thus, development of a technique allowing the non-invasive quantification of PICM is of great interest. The aim of this study was to develop such a non-invasive technique featuring novel fluorine- and (99m)Tc-labelled glibenclamide derivatives. Despite the structural modifications necessary to introduce fluorine into the glibenclamide molecule, all derivatives retained insulin stimulating capacity as well as high affinity binding to human SUR1 when compared to the original glibenclamide. Contrastingly, the lipophilicity of the fluorine-labelled derivatives was altered depending on the particular modification. In the human PET-study a constant but weak radioactive signal could be detected in the pancreas using a fluorine-labelled glibenclamide derivative. However, a reliable assessment and visualisation of the PICM could not be obtained. It can be assumed that the high uptake of the fluorine-labelled tracer e.g. into the the liver and the high plasma protein binding leads to a relatively low signal-to-noise ratio. In case of the presented fluorine-labelled glibenclamide based compounds this could be the result of their invariably high lipophilicity. The development of a (99 m)Tc-labelled glibenclamide derivative with a lower lipophilicity and differing in vivo behaviour, glibenclamide based compounds for non-invasive imaging of the pancreatic islet cell mass may be possible.
  Experimental and Clinical Endocrinology &amp Diabetes 08/2005; 113(7):388-95. · 1.69 Impact Factor
• Article: The unpleasantness of tonic pain is encoded by the insular cortex.

  M Schreckenberger, T Siessmeier, A Viertmann, C Landvogt, H-G Buchholz, R Rolke, R-D Treede, P Bartenstein, F Birklein
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  ABSTRACT: Muscle pain differs from skin pain with respect to quality, accuracy of localization, and unpleasantness. This study was conducted to identify the brain regions associated with the affective-motivational component of tonic skin and muscle pain. Forty healthy volunteers were investigated in three groups with different F-18 fluorodeoxyglucose PET activation scans. A verbal rating scale (VRS) was used to quantify pain intensity and unpleasantness. One group was investigated during painful infusion of an acidified phosphate buffer (pH 5.2) into either muscle or skin for 30 minutes. Muscle and skin infusions were adjusted to achieve pain intensity rating of VRS = 40. The second group received sham stimulation of muscle and skin by infusion of non-acidified phosphate buffer (pH 7.3 to 7.4, pain intensity = 0). The third group underwent only one PET scan without sensory stimulation. Unpleasantness ratings were higher (VRS 38.3 vs 25.5) during IM compared to intracutaneous stimulation, despite the same pain intensity (VRS = 40). Sham stimulation revealed no pain or unpleasantness. Regional cerebral glucose metabolism during sham stimulation showed similar findings for intracutaneous and IM infusions with significant activations of the bilateral anterior cingulate, bilateral frontal (premotor) cortex, and the ipsilateral parietal operculum. The comparison of pain vs sham stimulation revealed activations of the bilateral insula for IM but not intracutaneous stimulation. The unpleasantness perception in skin and muscle stimulation was positively correlated to the bilateral insular metabolism. The data suggest that the insula represents one main structure where the unpleasantness of tonic pain perception is encoded.
  Neurology 05/2005; 64(7):1175-83. · 8.31 Impact Factor
• Article: [Positron emission tomography for preoperative lymph node diagnosis in esophageal carcinoma].

  W Kneist, M Schreckenberger, P Bartenstein, F Grünwald, K Oberholzer, Th Junginger
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  ABSTRACT: Exact preoperative staging is a prerequisite for the indication and the choice of appropriate operative technique for patients with esophageal carcinoma. The objective of this prospective study was to assess whether positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) increases the accuracy of preoperative lymph node staging with standard computed tomography (CT) and thus leads to a different surgical approach. Fifty-eight patients with carcinoma of the esophagus (46 men and 12 women) with a median age of 61 years underwent FDG-PET imaging of the neck, chest, and abdomen as well as CT of the chest and abdomen. Sensitivity, specificity, and accuracy were calculated for both imaging techniques to evaluate the detection of histologically verified lymph node metastases. The FDG-PET showed higher specificity, whereas CT proved to be more accurate for detecting lymph node metastases not only of the abdomen (73% vs 59%) but also of the thorax (73% vs 63%). Resections were transhiatal in 23 patients and transthoracal in 16. As a supplement to conventional CT diagnostic procedure, FDG-PET was not decisive for the surgical approach. Altogether, pretherapeutical PET imaging did not increase the accuracy of lymph node staging for our patients with esophageal carcinoma, which had already been defined through CT. Therefore, no new consequences resulted for the surgical procedure. Due to the high costs involved with PET investigation, lymph node staging with it is momentarily indicated mainly for clinical studies and when CT does not offer unequivocal results. Increased sensitivity of the already advantageous whole-body FDG-PET imaging by means of tumor-affinitive radiopharmaceuticals and optimized apparatus resolution could lead to new indications for this staging procedure.
  Der Chirurg 11/2003; 74(10):922-30; discussion 929-30. · 0.70 Impact Factor
• Article: Die Positronenemissionstomographie zur präoperativen Lymphknotendiagnostik bei Ösophaguskarzinom

  W. Kneist, M. Schreckenberger, P. Bartenstein, F. Grünwald, K. Oberholzer, Th. Junginger
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  ABSTRACT: HintergrundVorraussetzung fr Indikation und Wahl des geeigneten operativen Verfahrens bei Patienten mit sophaguskarzinom ist ein genaues properatives Staging. Ziel der prospektiven Studie war es, zu klren, ob eine Positronenemissionstomographie mit 18F-Fluoro-Deoxyglukose (FDG-PET) die Genauigkeit des properativen Lymphknotendiagnostik gegenber der Computertomographie (CT) erhht und die Wahl des operativen Zugangs zur sophagusresektion beeinflusst.Patienten und Methodik58 Patienten, 46Mnner und 12 Frauen (Alter 61Jahre im Mittel), erhielten bei histologisch gesichertem sophaguskarzinom im Rahmen des Stagings ein FDG-PET von Hals, Thorax und Abdomen sowie ein CT von Thorax und Abdomen. Sensitivitt, Spezifitt und Genauigkeit bei der Erkennung histologisch gesicherter Lymphknotenmetastasen mit FDG-PET und CT wurden berechnet.ErgebnisseBei grerer Spezifitt der FDG-PET war die Genauigkeit des CT sowohl fr die Erkennung abdominaler (73% vs. 59%) als auch thorakaler Lymphknotenmetastasen (73% vs. 63%) hher. Bei 23 Patienten wurde die Indikation zur transhiatalen und bei 16 Patienten zur transthorakalen sophagusresektion gestellt. FDG-PET bestimmte die Verfahrenswahl dabei nicht.SchlussfolgerungIn der vorliegenden Studie hat die FDG-PET die Genauigkeit des herkmmlichen Lymphknotenstagings (CT) bei Patienten mit sophaguskarzinom nicht erhht. Fr die Verfahrenswahl ergaben sich keine neuen Konsequenzen. Auch wegen der hohen Kosten wird die PET-Untersuchung hauptschlich im Rahmen von Studien oder bei fraglichen CT-Befunden indiziert sein. Steigerung der Sensitivitt durch tumoraffinere Radiopharmaka und optimierte Gerteauflsung kann bei dem prinzipiellen Vorteil der Ganzkrperuntersuchung durch die PET neue Indikationen schaffen.BackgroundExact preoperative staging is a prerequisite for the indication and the choice of appropriate operative technique for patients with esophageal carcinoma. The objective of this prospective study was to assess whether positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) increases the accuracy of preoperative lymph node staging with standard computed tomography (CT) and thus leads to a different surgical approach.Patients and methodsFifty-eight patients with carcinoma of the esophagus (46 men and 12 women) with a median age of 61years underwent FDG-PET imaging of the neck, chest, and abdomen as well as CT of the chest and abdomen. Sensitivity, specificity, and accuracy were calculated for both imaging techniques to evaluate the detection of histologically verified lymph node metastases.ResultsThe FDG-PET showed higher specificity, whereas CT proved to be more accurate for detecting lymph node metastases not only of the abdomen (73% vs 59%) but also of the thorax (73% vs 63%). Resections were transhiatal in 23 patients and transthoracal in 16. As a supplement to conventional CT diagnostic procedure, FDG-PET was not decisive for the surgical approach.ConclusionsAltogether, pretherapeutical PET imaging did not increase the accuracy of lymph node staging for our patients with esophageal carcinoma, which had already been defined through CT. Therefore, no new consequences resulted for the surgical procedure. Due to the high costs involved with PET investigation, lymph node staging with it is momentarily indicated mainly for clinical studies and when CT does not offer unequivocal results. Increased sensitivity of the already advantageous whole-body FDG-PET imaging by means of tumor-affinitive radiopharmaceuticals and optimized apparatus resolution could lead to new indications for this staging procedure.
  Der Chirurg 09/2003; 74(10):922-930. · 0.70 Impact Factor
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  Available from: Ulrich T Egle

  Article: Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome.

  T Siessmeier, W A Nix, J Hardt, M Schreckenberger, U T Egle, P Bartenstein
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  ABSTRACT: To evaluate cerebral glucose metabolism, assessed by 18-fluorodeoxyglucose positron emission tomography (FDG-PET), in patients with chronic fatigue syndrome (CFS), using an observer independent analytical approach; and to characterise any observed alterations by correlating them with neuropsychological deficits. 26 patients (13 female, 13 male) were examined. They all fulfilled the CDC diagnostic criteria for CFS. Their ages ranged from 26 to 61 years (mean (SD) age, 43 (9.3) years). They underwent extensive psychometric testing including the hospital anxiety and depression scale (HADS) and the short form 36 item health questionnaire (SF-36). Brain FDG-PET was done in all the subjects. After stereotactic normalisation, single subject comparisons with an age and sex matched normal database (n = 18) and a group comparison between the patients and normal controls were undertaken, along with additional correlation analyses between brain metabolism and psychometric test scores. 12 of the 26 patients showed no significant decrease in FDG uptake compared with the controls. Of the remaining 14, 12 showed hypometabolism bilaterally in the cingulate gyrus and the adjacent mesial cortical areas. Five of these 12 patients also had decreased metabolism in the orbitofrontal cortex. The two remaining patients had hypometabolism in the cuneus/praecuneus. Correlation analyses showed significant correlations between some test scores (anxiety, depression, health related quality of life) but not fatigue and regional reductions in glucose metabolism. Although abnormalities in FDG-PET were only detectable in approximately half the CFS patients examined, and no specific pattern for CFS could be identified, PET may provide valuable information in helping to separate CFS patients into subpopulations with and without apparent alterations in the central nervous system.
  Journal of Neurology Neurosurgery &amp Psychiatry 08/2003; 74(7):922-8. · 4.76 Impact Factor
• Article: Preoperative motor system brain mapping using positron emission tomography and statistical parametric mapping: hints on cortical reorganisation.

  P T Meyer, L Sturz, O Sabri, M Schreckenberger, U Spetzger, K S Setani, H-J Kaiser, U Buell
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  ABSTRACT: This study investigated the applicability of statistical parametric mapping (SPM) for analysing individual preoperative brain mapping studies in patients with cerebral mass lesions for neurosurgical planning. The study further investigated if hints on functional reorganisation processes can be found. Nine adult patients with cerebral mass lesions underwent activation [(15)O]water-PET under stimulation by finger (n=9) and foot (n=4) movement. Individual SPM-t-maps were computed without anatomical normalisation and coregistered to the individual magnetic resonance imaging. Relative cerebral blood flow change maps were calculated for comparison. The spatial relation between the sensorimotor cortex and the lesion could be determined in all cases. Additional activations covered the ipsilateral sensorimotor cortex and the bilateral cerebellum, premotor cortices and supplementary motor areas. Patients with motor symptoms of the stimulated hand (paresis, focal seizures) activated the ipsilateral premotor cortices and contralateral cerebellum more often than patients without motor symptoms. The SPM results for p<0.005 and cerebral blood flow change maps showed considerably overlapping motor area activations. For p<0.001, SPM missed three sensorimotor cortex activations depicted by cerebral blood flow change maps and by SPM for p<0.005 in typical localisation. SPM analyses showed less activations probably unrelated to task performance. It is concluded that SPM provides an efficient method for analysing individual preoperative PET activation studies. Activations of the ipsilateral premotor cortices and contralateral cerebellum may indicate an enhanced recruitment of ipsilateral motor pathways evoked by functional reorganisation processes. However, this changed activation pattern was not necessarily associated with a better neurological status.
  Journal of Neurology Neurosurgery &amp Psychiatry 04/2003; 74(4):471-8. · 4.76 Impact Factor
• Article: [Positron emission tomography for the preoperative staging of esophageal carcinoma].

  Th Junginger, W Kneist, M Schreckenberger, C Menzel, K Oberholzer, P Bartenstein
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  ABSTRACT: Exact preoperative staging is a prerequisite for the indication as well as the choice of the appropriate operative technique for patients with esophageal carcinoma. In this prospective study we assessed whether positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) increases the accuracy of staging compared to standard computer tomography (CT) and leads to a different therapeutic approach. 30 patients (25 men, 5 women, median age 63 years) with histologically identified carcinoma of the esophagus (n =29) and the cardia (n = 1), respectively, were studied. All patients underwent FDG-PET imaging of the neck, chest, and abdomen as well as CT of the chest and abdomen. Sensitivity, specificity and accuracy were calculated for FDG-PET and CT to evaluate the detection of histologically identified lymph node metastases and distant metastatic disease. FDG-PET showed higher specificity whereas the accuracy of the CT proved to be higher not only for the detection of abdominal lymph node metastases (67 % vs. 46 %), but also for lymph node metastases of the thorax (71 % vs. 50 %). Furthermore, the accuracy of the CT for the detection of blood-bone and lymphatic distant metastases was also higher than that of FDG-PET (72 % vs. 68 %). FDG-PET was more specific (100 % vs. 71 %) albeit less sensitive than CT-imaging (27 % vs. 73 %). In our study, FDG-PET did not increase the accuracy of standard staging (CT) in patients with carcinoma of the esophagus. Therefore, no new consequences resulted for the operative indication as well as therapeutic procedure. Due to the high costs involved with PET investigation, this form of staging is momentarily indicated mainly for use in clinical studies, and in cases where CT does not offer unequivocal results. Increase in sensitivity of the already advantageous whole-body FDG-PET imaging by means of tumor-affinitive radiopharmaceuticals as well as optimized apparatus resolution could lead to new indications for this staging procedure.
  DMW - Deutsche Medizinische Wochenschrift 10/2002; 127(38):1935-41. · 0.53 Impact Factor