Scott Britz-Cunningham

Harvard Medical School, Boston, Massachusetts, United States

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Publications (10)41.59 Total impact

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    ABSTRACT: To investigate a new modified computed tomographic (CT) ellipsoid method of split renal function and to compare results from this method with other CT-derived metrics. Thirty-eight potential renal donors with both CT and nuclear renography were retrospectively evaluated for estimated split function using 6 CT methods to determine accuracy. For the CT methods, correlation, reproducibility, ease in image post-processing, and the ability of CT-derived methods to determine the dominant kidney before renal transplantation were evaluated using a nuclear renography reference standard. Four of the 6 CT methods (split renal volume, modified ellipsoid method, parenchymal area, attenuation capacity) showed similar strong correlation (r = 0.84-0.79). Bland-Altman analysis revealed similar performance in differences (SDs <3.0%) between those CT measures and reference standard, as well as good interobserver agreement for the modified ellipsoid and parenchymal area methods. The technically simpler methods had inferior performance. Post-processing time for the modified ellipsoid method was significantly shorter than semiautomated split renal volume or parenchymal area method (P < 0.01). Each CT-based method showed excellent agreement (100% or 97.4%) with renography regarding the determination of dominant kidney. Excellent correlation with nuclear split renal function supports the use of CT alone for the imaging assessment for many potential renal donors, including the decision of which kidney to harvest. Among the CT-based methods, the modified ellipsoid method can be performed rapidly with high accuracy and reproducibility.
    No preview · Article · May 2012 · Journal of computer assisted tomography
  • Benjamin S Halpern · Scott H Britz-Cunningham · Chun K Kim
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    ABSTRACT: Lower F-18 fluorodeoxyglucose (FDG) uptake on PET/CT is generally expected on the side of a paralyzed vocal cord (VC). The contrary pattern of increased uptake can raise concern for metastasis or a primary VC malignancy. We present a case showing paradoxical development of intense FDG uptake in the paralyzed VC, unrelated to malignancy. History revealed injection of calcium hydroxylapatite microspheres for treatment of VC paralysis. This new synthetic material can stimulate local fibroblast activity and macrophage accumulation, leading to increased FDG uptake. The case illustrates the importance of obtaining accurate history before interpreting intense FDG uptake in a paralyzed VC.
    No preview · Article · Nov 2011 · Clinical nuclear medicine
  • Paul B. Shyn · Koenraad J. Mortele · Scott Britz-Cunningham · Stuart G. Silverman
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    ABSTRACT: PURPOSE To evaluate the impact of FDG PET in a combined low dose PET/CT Enterography protocol for the assessment of Crohn’s disease. METHOD AND MATERIALS Thirteen patients (4M, 9F, ages 23-78, mean 49) with Crohn’s disease were prospectively enrolled in this IRB-approved study. All patients underwent combined PET/CT enterography (PET/CTE) on a GE VCT PET/CT scanner with a single CT acquisition (kVp 120, mean mA patients 1-4 = 250, patients 5-13 = 137). Neutral oral contrast, 1350 ml, and IV contrast, 150 ml, 300 mgI/ml, at 3 ml/sec were used. Mean FDG dose for the first four patients was 14.3 mCi and for the last nine patients 5.3 mCi, with a mean uptake period of 71 minutes. Six patients had surgical resection of bowel within 4-17 days after PET/CTE and seven patients had colonoscopy with biopsies within 5-27 days of PET/CTE. In all patients, a CTE index of inflammation and SUVmax were correlated with severity of inflammation as scored on surgical or biopsy pathology specimens. Spearman’s correlation was calculated per patient and by subanalysis of 54 bowel segments. RESULTS The correlation coefficient per patient for pathology inflammation score was slightly greater with SUVmax (0.67, p = .013) than CTE index (0.62, p = .024). Pathology inflammation subanalysis for 54 bowel segments yielded better correlation with CTE index (0.79, p < .0001) than for SUVmax (0.48, p < .0001). In three of 13 (23.1%) patients, FDG uptake on PET detected active inflammation not evident on CTE in a bowel segment (n=2) or led to the detection of an enterocolic fistula only visible in retrospect on CTE (n=1). Both CTE and FDG PET detected all bowel segments with inflammation of moderate or greater severity as scored at pathology. The effective dose from combined PET/CTE in the first four patients was 17.7 mSv and in the last nine patients was 8.31 mSv. CONCLUSION SUVmax and CTE index both correlate well with inflammation at pathology, however, FDG PET/CTE can detect findings of active Crohn’s disease not evident on CTE alone with minimal added radiation dose. CLINICAL RELEVANCE/APPLICATION Combining FDG PET into a PET/CT enterography protocol provides additional diagnostic information over CTE alone and can be accomplished with a reasonable radiation dose.
    No preview · Conference Paper · Nov 2010
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    ABSTRACT: The purpose of this study was to evaluate the diagnostic efficacy of low-dose, combined (18)F-FDG PET/CT enterography (PET/CTE), compared with CT enterography (CTE) alone, in the assessment of patients with Crohn disease. Thirteen patients with Crohn disease were prospectively enrolled in this pilot study and underwent abdominal-pelvic (18)F-FDG PET/CTE using neutral oral and intravenous contrast medium. The effective dose from PET/CTE was 17.7 mSv for the first 4 patients and 8.31 mSv for the last 9 patients. Six patients underwent surgical resection of the bowel, and 7 patients underwent colonoscopy with biopsies within 27 d (mean, 12 d) of PET/CTE. PET/CTE and CTE images were each visually assessed for Crohn disease involvement in 54 bowel segments with pathology correlation. Extraintestinal findings were recorded. A CTE severity score, maximum standardized uptake value (SUVmax), SUVmax ratio, simplified endoscopic score, and clinical parameters were correlated with pathology inflammation grade, on a per-patient basis and on a per-bowel-segment basis, using Spearman correlation. In 3 (23.1%) of 13 patients, (18)F-FDG uptake using PET/CTE revealed active inflammation in a bowel segment not evident using CTE (n = 2) or revealed an enterocolic fistula missed with CTE (n = 1). Visual interpretation of both PET/CTE and CTE images detected the presence of disease in all bowel segments with more than mild inflammation (sensitivity, 100%; specificity, 89.7%; positive predictive value, 78.9%; and negative predictive value, 100%). Correlation to inflammation grade per patient was the strongest for the SUVmax ratio (0.735, P = 0.004) and SUVmax (0.67, P = 0.013), as compared with the CTE score (0.62, P = 0.024). Correlation with inflammation per bowel segment was higher for the CTE score (0.79, P < 0.0001) than the SUVmax ratio (0.62, P < 0.0001) or SUVmax (0.48, P < 0.0001). SUVmax correlated strongly with serum C-reactive protein (0.82, P = 0.023), but CTE score did not. Low-dose (18)F-FDG PET/CTE, compared with CTE, may improve the detection and grading of active inflammation in patients with Crohn disease. PET/CTE also may reveal clinically significant findings, such as enterocolic fistula, not evident on PET or CTE alone.
    Full-text · Article · Nov 2010 · Journal of Nuclear Medicine
  • Victor H Gerbaudo · Scott Britz-Cunningham

    No preview · Article · Nov 2009 · Molecular imaging and biology: MIB: the official publication of the Academy of Molecular Imaging
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    Victor Gerbaudo · Scott Britz-Cunningham

    Preview · Article · Sep 2009 · Molecular imaging and biology: MIB: the official publication of the Academy of Molecular Imaging
  • Scott H Britz-Cunningham · John W Millstine · Victor H Gerbaudo
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    ABSTRACT: This study demonstrates a simple background correction method, which improves the discrimination of benign from malignant lesions on FDG PET-CT imaging, using activity ratios compared with brain, basal ganglia, or cerebellum. Standardized uptake values (SUVs) and comparative activity ratios (CARs) were determined for FDG uptake in 92 lesions (39 benign and 53 malignant) in 49 patients. Reference tissues included cerebral cortex, basal ganglia, cerebellum, lung, liver, and aortic blood pool. Discriminant power for each CAR was evaluated as malignant-to-benign ratio of mean uptake and ratio of intermediate-likelihood lesions to total number of lesions. Uncorrected SUV varied widely for malignant and benign lesions, with considerable overlap. Ratio of mean uptake for malignant lesions versus benign lesions was lowest for uncorrected SUVAVG and SUVAVG/liver (1.92), and highest for SUVMAX/cerebral cortex (3.52). Lesions could be separated into very high (> 90%), very low (< 10%), and intermediate (> or = 10% and < or = 90%) likelihood of malignancy. The ratio of intermediate-likelihood lesions to the total number of lesions was greatest for SUVAVG (0.42) and lowest for SUVMAX/basal ganglia (0.22). Ability to discriminate malignant from benign lesions was enhanced by using CARs derived from cerebral cortex, basal ganglia, or cerebellum. Using a 3-tiered diagnostic schema, most lesions could be assigned to categories of very high or very low likelihood of malignancy, with a significant reduction in indeterminant lesions, compared with uncorrected SUV.
    No preview · Article · Oct 2008 · Clinical nuclear medicine
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    Scott H Britz-Cunningham · S James Adelstein
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    ABSTRACT: Inherent in the application of advances in biomedical science to nuclear medicine is the concept of molecular targeting: the in vivo concentration of labeled tracer by a gene, its transcribed DNA, or its protein product. This mechanism of localization has been and is being exploited for both nuclear imaging and radioisotopic therapy. Agents, such as antisense molecules, aptamers, antibodies, and antibody fragments, can be aimed at molecular targets. Tumor and nerve cell receptors provide such targets. So do certain cellular physiologic activities, including metabolism, hypoxia, proliferation, apoptosis, angiogenesis, response to infection, and multiple drug resistance. In this article we review the principles of molecular targeting based on radioisotopic methods and provide examples from the literature. We discuss applications to imaging and therapy and point out the hurdles that must be overcome in bringing molecular targeting to clinical reality.
    Preview · Article · Jan 2004 · Journal of Nuclear Medicine
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    V H Gerbaudo · S Britz-Cunningham · D J Sugarbaker · S T Treves
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    ABSTRACT: Malignant pleural mesothelioma is an aggressive neoplasm with a highly variable course. This pilot study evaluated the significance of the pattern, intensity and kinetics of 18F-FDG uptake in mesothelioma in the context of histopathology and surgical staging. Sixteen consecutive patients with pleural disease on CT scan underwent 18F-FDG imaging. Imaging was performed with a dual detector gamma camera operating in coincidence mode. Semiquantitative image analysis was performed by obtaining lesion-to-background ratios (18F-FDG uptake index) and calculating the increment of 18F-FDG lesion uptake over time (malignant metabolic potential index (MMPi)). Twelve patients had histologically proven malignant mesotheliomas (10 epithelial, two sarcomatoid). Thirty two lesions were positive for tumour. Patterns of uptake matched the extent of pleural and parenchymal involvement observed on CT scanning and surgery. Mean (SD) 18F-FDG uptake index for malignant lesions was 3.99 (1.92), range 1.5-9.46. Extrathoracic spread and metastases had higher 18F-FDG uptake indices (5.17 (2)) than primary (3.42 (1.52)) or nodal lesions (2.99 (1)). No correlation was found between histological grade and stage. The intensity of lesion uptake had poor correlation with histological grade but good correlation with surgical stage. 18F-FDG lesion uptake increased over time at a higher rate in patients with more advanced disease. The MMPi was a better predictor of disease aggressiveness than the histological grade. This pilot study suggests that the pattern, intensity, and kinetics of 18F-FDG uptake in mesothelioma are good indicators of tumour aggressiveness and are superior to the histological grade in this regard.
    Full-text · Article · Jan 2004 · Thorax
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    ABSTRACT: Malignant pleural mesothelioma is an aggressive primary neoplasm for which early detection and accurate staging are known diagnostic challenges. The role of (18)F-FDG dual-head gamma-camera coincidence imaging ((18)F-FDG-CI) is yet to be defined. The purpose of this study was to evaluate the usefulness of (18)F-FDG-CI in the assessment of malignant pleural mesothelioma using histopathology as the gold standard. Fifteen consecutive patients with CT scan evidence of pleural thickening, fluid, plaques, or calcification underwent (18)F-FDG imaging 1.5 h after the intravenous administration of 370 MBq (18)F-FDG. Imaging was performed with a dual-head gamma camera equipped with 2.54-cm-thick NaI crystals operating in coincidence mode. Using an iterative algorithm, whole-body images were reconstructed as transaxial, sagittal, and coronal images. No attenuation correction was applied. The results of (18)F-FDG-CI scans were compared with CT and with histopathologic diagnosis. Eleven of 15 patients had histologically proven malignant mesotheliomas (10 epithelial, 1 sarcomatoid). All 11 primary tumors were detected by (18)F-FDG, and absence of disease was confirmed in the 4 patients who were disease free. Thirty-four lesions were biopsied; among these, 29 were found to be positive for tumor. (18)F-FDG was true-positive in 28 lesions, true-negative in 4, false-negative in 1 (0.5 cm in diameter), and false-positive in 1 (inflammatory pleuritis). The smallest lesion detected was 0.8 cm. For biopsied lesions, overall sensitivity, specificity, and accuracy for (18)F-FDG-CI were 97%, 80%, and 94% respectively, compared with 83%, 80%, and 82% for CT. Twenty-one of 29 positive lesions involved the pleura, lung parenchyma, or chest wall and were all (18)F-FDG avid. In the mediastinum, (18)F-FDG-CI detected 7 of 8 biopsy-positive lesions (88%), whereas CT was positive in 6 of 8 lesions (75%). (18)F-FDG identified extrathoracic metastases in 5 patients, excluding them from surgical therapy. These preliminary results suggest that (18)F-FDG-CI appears to be an accurate method to diagnose and to define the extent of disease in patients with diffuse malignant pleural mesothelioma.
    No preview · Article · Oct 2002 · Journal of Nuclear Medicine