Phillip H Kuo
- Professor
- Professor, Biomedical Engineering
- Professor, Medicine
- Professor, Cancer Biology - GIDP
- Member of the Graduate Faculty
- (520) 626-7368
- AHSC, Rm. 1343
- TUCSON, AZ 85724-5067
- pkuo@arizona.edu
Biography
Phillip H. Kuo M.D., PhD. graduated in chemistry from Harvard and then earned an MD/PhD from the University of Virginia. Post-graduate training included residency in Internal Medicine at UCLA, fellowship in Nuclear Medicine and residency in Radiology at Yale. He has board certifications in Nuclear Medicine, Radiology, Internal Medicine, and Nuclear Cardiology. He joined the University of Arizona in 2008 and is now Professor of Medical Imaging and also faculty in Medicine and Biomedical Engineering. He currently serves as the Chief of Nuclear Medicine and Director of the Fellowship in Nuclear Radiology. Scientific interests span basic, translational and clinical research in molecular imaging.
Degrees
- M.D. Medicine
- University of Virginia, Charlottesville, Virginia, United States
- Ph.D. Molecular Physiology and Biological Physics
- University of Virginia, Charlottesville, Virginia, United States
- Molecular Mechanism of the FOF1 ATP Synthase
- M.S. Molecular Physiology and Biological Physics
- University of Virginia, Charlottesville, Virginia, United States
- B.A. Chemistry
- Harvard University, Cambridge, Massachusetts, United States
- Atmospheric carbon dioxide concentrations before 2.2 billion years ago
Work Experience
- Southern Arizona Veterans Administration Hospital (2008 - 2010)
- Yale New Haven Hospital (2005 - 2008)
Awards
- Please see attached list
- Spring 1990
- Certificate of Merit award for education exhibit “Signs and Artifacts in Amyloid PET” at 104th Scientific Assembly and Annual Meeting of the Radiological Society of North America
- RSNA, Winter 2018
- Best Clinical Paper Award at the World Molecular Imaging Congress 2018
- World Molecular Imaging Congress, Summer 2018
- Grand Saguaro Award for Outstanding Teaching of Medical Students
- UA, Summer 2018
- Sixth Annual Dr. Tapan K. Chaudhuri Lecturer at Eastern Virginia Medical School
- EVMS, Spring 2018
- Plenary speaker for 2017 IEEE Nuclear Science Symposium and Medical Imaging Conference
- IEEE, Winter 2017
- Castle Connolly “Top Doctors” in Diagnostic Radiology
- Castle Connolly, Spring 2016
- Grand Saguaro Award for Teaching of Medical Students
- University of Arizona Department of Medical Imaging, Spring 2014
Licensure & Certification
- Diplomate of Special Certification (CAQ) in Nuclear Radiology, American Board of Radiology (2013)
- Diplomate of the Certification Board of Nuclear Cardiology, Certification Board of Nuclear Cardiology (2006)
- Diplomate of the American Board of Nuclear Medicine, American Board of Nuclear Medicine (2004)
- Diplomate of the American Board of Internal Medicine, American Board of Internal Medicine (2003)
- Diplomate of the American Board of Radiology, American Board of Radiology (2008)
Interests
Teaching
Radiology, nuclear medicine, contrast agent utilization and safety, theranostics, neurodegenerative diseases
Research
Development of contrast agents for magnetic resonance and nuclear medicine, biological effects of contrast agents, Parkinson’s disease, Alzheimer’s disease, Radiation dose reduction, Nephrogenic Systemic Fibrosis, Breast Imaging, Translational research utilizing imaging to accelerate development of therapeutics, pH imaging, PET/CT, Geology
Courses
2021-22 Courses
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Cnrtst Agnt Imaging+Kint
BME 522 (Spring 2022)
2020-21 Courses
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Cnrtst Agnt Imaging+Kint
BME 522 (Spring 2021) -
Cnrtst Agnt Imaging+Kint
OPTI 522 (Spring 2021)
2019-20 Courses
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Cnrtst Agnt Imaging+Kint
BME 522 (Spring 2020) -
Cnrtst Agnt Imaging+Kint
CBIO 522 (Spring 2020) -
Cnrtst Agnt Imaging+Kint
OPTI 522 (Spring 2020)
2018-19 Courses
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Cnrtst Agnt Imaging+Kint
BME 522 (Spring 2019)
2017-18 Courses
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Cnrtst Agnt Imaging+Kint
BME 524 (Spring 2018) -
Senior Capstone
BIOC 498 (Spring 2018) -
Senior Capstone
BIOC 498 (Fall 2017)
2016-17 Courses
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Cnrtst Agnt Imaging+Kint
BME 524 (Spring 2017) -
Cnrtst Agnt Imaging+Kint
CBIO 524 (Spring 2017)
2015-16 Courses
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Cnrtst Agnt Imaging+Kint
BME 524 (Spring 2016) -
Cnrtst Agnt Imaging+Kint
CBIO 524 (Spring 2016)
Scholarly Contributions
Chapters
- Zukotynski, K., Kuo, P. H., Kim, C. K., & Subramaniam, R. M. (2020). Molecular and Functional Imaging in Oncology Therapy Response. In Molecular Targeting in Oncology. Springer. doi:10.1007/978-3-030-31171-1_15More infoMolecular and functional imaging aims to assess oncologic therapy response by integrating molecular and functional tumor biology in order to assess therapeutic efficacy and improve patient outcome. Most oncologic processes reflect heterogeneous disease both functionally and morphologically. Further, clonal proliferations of cells may evolve with time becoming resistant to specific therapies. It is important to identify those cancer patients who derive benefit from therapy, such that expensive, toxic, or futile treatment is avoided in those who will not respond. The ultimate goal is to offer the right treatment to the right patient over time. Molecular and functional imaging either using positron emission tomography (PET) or gamma cameras often through hybrid scanners that also include computed tomography (CT) and/or magnetic resonance imaging (MRI) are sensitive techniques with a major role in the precision medicine algorithm of oncology patients. These modalities provide insight prior to, during, and following therapy. Further, they often serve as a biomarker of tumoral heterogeneity helping to direct the selection of appropriate treatment, and detect early response to therapy. Also, molecular and functional imaging is a powerful prognostic biomarker in oncology that can suggest patient outcome based on treatment response.
- Choudhary, G., & Kuo, P. H. (2017). Nuclear Medicine Imaging. In Nuclear Medicine Imaging. Cambridge University Press. doi:10.1017/9781316084304.010
Journals/Publications
- Warhadpande, D., Kuo, P. H., Kay, M. D., & Frazzitta, A. E. (2022). Diagnosis of Pulmonary Embolism on 99mTc-Labeled Macroaggregated Albumin Lung Imaging After Hepatic Arterial Injection for Planning of Radioembolization.. Clinical nuclear medicine, 47(3), e246-e248. doi:10.1097/rlu.0000000000004026More infoA 54-year-old man with hepatocellular carcinoma from alcohol-induced cirrhosis presented with hepatic encephalopathy and refractory ascites related to decompensated liver disease. MRI confirmed disease progression adjacent the site of prior radiofrequency ablation, performed 2 years prior, with associated right hepatic vein tumor thrombus. 99mTc-labeled macroaggregated albumin lung shunt imaging performed before 90Y radioembolization identified a left lower lobe wedge-shaped defect, confirmed as pulmonary embolism on CT pulmonary angiography and MRI.
- Bega, D., Kuo, P. H., Chalkidou, A., Grzeda, M. T., Macmillan, T., Brand, C., Sheikh, Z. H., & Antonini, A. (2021). Clinical utility of DaTscan in patients with suspected Parkinsonian syndrome: a systematic review and meta-analysis. NPJ Parkinson's disease, 7(1), 43.More infoImages of DaTscan (ioflupane [123I] SPECT) have been used as an adjunct to clinical diagnosis to facilitate the differential diagnosis of neurodegenerative (ND) Parkinsonian Syndrome (PS) vs. non-dopamine deficiency aetiologies of Parkinsonism. Despite several systematic reviews having summarised the evidence on diagnostic accuracy, the impact of imaging results on clinical utility has not been systematically assessed. Our objective was to examine the available evidence on the clinical utility of DaTscan imaging in changing diagnosis and subsequent management of patients with suspected PS. We performed a systematic review of published studies of clinical utility from 2000 to 2019 without language restrictions. A meta-analysis of change in diagnosis and management rates reported from each study was performed using a random-effects model and logit transformation. Sub-group analysis, meta-regression and sensitivity analysis was performed to explore heterogeneity. Twenty studies met the inclusion criteria. Thirteen of these contributed to the meta-analyses including 950 and 779 patients with a reported change in management and change in diagnosis, respectively. The use of DaTscan imaging resulted in a change in management in 54% (95% CI: 47-61%) of patients. Change in diagnosis occurred in 31% (95% CI: 22-42%) of patients. The two pooled analyses were characterised by high levels of heterogeneity. Our systematic review and meta-analysis show that imaging with DaTscan was associated with a change in management in approximately half the patients tested and the diagnosis was modified in one third. Regardless of time from symptom onset to scan results, these changes were consistent. Further research focusing on specific patient subgroups could provide additional evidence on the impact on clinical outcomes.
- Cox, T., Vance, C., Daley, S., Papendieck, C., McGregor, H., Kuo, P. H., & Witte, M. H. (2021). Imaging of lymphatic dysplasia in Noonan syndrome: Case studies and historical atlas. Lymphology, 54(1), 23-40.More infoTo determine the historical use and utility of various lymphatic imaging modalities in Noonan syndrome (NS) patients, we performed a comprehensive literature review by collecting the published medical imaging of NS lymphatic dysplasias. We correlated imaging findings with clinical phenotypes and treatment. Our analysis of lymphatic imaging modalities provides an algorithmic approach to imaging and patient care across the spectrum of NS developmental defects. A total of 54 NS cases have been published since 1975. Using the observations reported in 15 reviewed publications, an association was made between disruptions in central lymphatic flow and poor clinical presentations/outcomes in NS patients.
- Kuo, P. H. (2021). Cleaning the brain through turbulent glymphatic flow: The washing machine hypothesis. Lymphology, 54(3), 133-139.More infoIn a thought experiment, a "washing machine" model is proposed based on turbulent flow from complex multi-dimensional forces to characterize fluid dynamics in the brain. The glymphatic system's hypothetical role in this system is illustrated in a series of diagrams. Implications of this model are discussed in terms of normal physiology and a variety of pathologic conditions such as brain atrophy and Alzheimer disease.
- Könik, A., Zeraatkar, N., Kalluri, K. S., Auer, B., Fromme, T. J., He, Y., May, M., Furenlid, L. R., Kuo, P. H., & King, M. A. (2021). Improved Performance of a Multipinhole SPECT for DAT Imaging by Increasing Number of Pinholes at the Expense of Increased Multiplexing. IEEE transactions on radiation and plasma medical sciences, 5(6), 817-825.More infoSPECT imaging of dopamine transporters (DAT) in the brain is a widely utilized study to improve the diagnosis of Parkinsonian syndromes, where conventional (parallel-hole and fan-beam) collimators on dual-head scanners are commonly employed. We have designed a multi-pinhole (MPH) collimator to improve the performance of DAT imaging. The MPH collimator focuses on the striatum and hence offers a better trade-off for sensitivity and spatial resolution than the conventional collimators within this clinically most relevant region for DAT imaging. Our original MPH design consisted of 9 pinholes with a background-to-striatal (Bkg/Str) projection multiplexing of 1% only. In this simulation study, we investigated whether further improvements in the performance of MPH imaging could be obtained by increasing the number of pinholes, hence by enhancing the sensitivity and sampling, despite the ambiguity in reconstructing images due to increased multiplexing. We performed analytic simulations of the MPH configurations with 9, 13, and 16 pinholes (aperture diameters: 4-6mm) using a digital phantom modeling DAT imaging. Our quantitative analyses indicated that using 13 (Bkg/Str: 12%) and 16 (Bkg/Str: 22%) pinholes provided better performance than the original 9-pinhole configuration for the acquisition with 2 or 4 angular views, but a similar performance with 8 and 16 views.
- Mustacich, D. J., Lai, L. W., Bernas, M. J., Jones, J. A., Myles, R. J., Kuo, P. H., Williams, W. H., Witte, C. L., Erickson, R. P., & Witte, M. H. (2021). Digenic Inheritance of a FOXC2 Mutation and Two PIEZO1 Mutations Underlies Congenital Lymphedema in a Multigeneration Family. The American journal of medicine.More infoThe lymphatic system is essential for maintaining the balance of interstitial fluid in tissues and for returning protein-rich fluids (lymph) to the bloodstream. Congenital lymphatic defects lead to accumulation of lymph in peripheral tissues and body cavities, termed primary lymphedema. To date, only a limited number of individual genes have been identified in association with primary lymphedema. However, variability of age of onset and severity of lymphatic abnormalities within some families suggests that multiple mutations or genes may be responsible, thus hampering efforts to identify individual associated genes.
- Neill, M., Fisher, J. M., Brand, C., Lei, H., Sherman, S. J., Chou, Y. H., & Kuo, P. H. (2021). Practical Application of DaTQUANT with Optimal Threshold for Diagnostic Accuracy of Dopamine Transporter SPECT. Tomography (Ann Arbor, Mich.), 7(4), 980-989.More infoEvaluation of Parkinsonian Syndromes (PS) with Ioflupane iodine-123 dopamine transporter single photon emission computed tomography (DaT-SPECT), in conjunction with history and clinical examination, aids in diagnosis. FDA-approved, semi-quantitative software, DaTQUANT (GE Healthcare, Chicago, IL, USA) is available to assist in interpretation. This study aims to evaluate the optimal variables and thresholds of DaTQUANT to yield the optimal diagnostic accuracy. It is a retrospective review with three different patient populations. DaT-SPECT images from all three study groups were evaluated using DaTQUANT software, and both single and multi-variable logistic regression were used to model PS status. The optimal models were chosen via accuracy, sensitivity, and specificity, then evaluated on the other study groups. Among single variable models, the posterior putamen yielded the highest accuracy (84% to 95%), while balancing sensitivity and specificity. Multi-variable models did not substantially improve the accuracy. When the optimal single variable models for each group were used to evaluate the remaining two groups, comparable results were achieved. In typical utilization of DaT-SPECT for differentiation between nigrostriatal degenerative disease (NSDD) and non-NSDD, the posterior putamen was the single variable that yielded the highest accuracy across three different patient populations. The posterior putamen's recommended thresholds for DaTQUANT are SBR ≤ 1.0, z-score of ≤-1.8 and percent deviation ≤ -0.34.
- Winegar, B. A., Winegar, B. A., Morris-wiseman, L. F., Morris-wiseman, L. F., Kuo, P. H., Kuo, P. H., Kay, M. D., Kay, M. D., Caskey, J. S., & Caskey, J. S. (2021). 99mTc-Sestamibi Scintigraphy Reveals Parathyroid Adenoma Masquerading as Esophageal Diverticulum.. Clinical nuclear medicine, 46(3), e159-e161. doi:10.1097/rlu.0000000000003399More infoA 74-year-old woman with primary hyperparathyroidism diagnosed from routine laboratory tests described symptoms of fatigue and difficulty with concentration. During surgical consultation, the cervical and thoracic spine MRI scans from the preceding 10-year period, performed for relapsing-remitting multiple sclerosis, were reviewed. In this clinical context, the slowly enlarging left upper paraesophageal lesion, reported as a lateral proximal esophageal (Killian-Jamieson) diverticulum, was reevaluated for a potential parathyroid adenoma. 99mTc-sestamibi SPECT/CT demonstrated focal uptake in the paraesophageal lesion with surgical resection, confirming it to be a large parathyroid adenoma.
- Woodhead, G., Patel, M., Mcniel, D. B., Mcgregor, H., Kuo, P. H., Hennemeyer, C., Brunson, C., & Boros, D. (2021). Abstract No. 3 ▪ FEATURED ABSTRACT Clinical predictors of Yttrium-90 uptake in hepatocellular carcinoma: toward personalized dosimetry to maximize response to therapy. Journal of Vascular and Interventional Radiology, 32(5), S3. doi:10.1016/j.jvir.2021.03.414
- Woodhead, G., Struycken, L., Patel, M., Mcgregor, H., Kuo, P. H., & Hennemeyer, C. (2021). Abstract No. 34 Planar scintigraphy overestimates hepatopulmonary shunt fractions compared with quantitative SPECT/CT. Journal of Vascular and Interventional Radiology, 32(5), S16. doi:10.1016/j.jvir.2021.03.450
- Zeraatkar, N., Kalluri, K. S., Auer, B., May, M., Richards, R. G., Furenlid, L. R., Kuo, P. H., & King, M. A. (2021). Cerebral SPECT imaging with different acquisition schemes using varying levels of multiplexing versus sensitivity in an adaptive multi-pinhole brain-dedicated scanner. Biomedical physics & engineering express, 7(6).More infoApplication of multi-pinhole collimator in pinhole-based SPECT increases detection sensitivity. The presence of multiplexing in projection images due to the usage of multiple pinholes can further improve the sensitivity at the cost of adding data ambiguity. We are developing a next-generation adaptive brain-dedicated SPECT system -AdaptiSPECT-C. The AdaptiSPECT-C can adapt the multiplexing level and system sensitivity using adaptable pinhole modules. In this study, we investigated the performance of 4 data acquisition schemes with different multiplexing levels and sensitivities on cerebral SPECT imaging. Schemes #1, #2, and #3 have
- Zukotynski, K., Black, S. E., Kuo, P. H., Bhan, A., Adamo, S., Scott, C. J., Lam, B., Masellis, M., Kumar, S., Fischer, C. E., Tartaglia, M. C., Lang, A. E., Tang-Wai, D. F., Freedman, M., Vasdev, N., & Gaudet, V. (2021). Exploratory Assessment of K-means Clustering to Classify 18F-Flutemetamol Brain PET as Positive or Negative. Clinical nuclear medicine, 46(8), 616-620.More infoWe evaluated K-means clustering to classify amyloid brain PETs as positive or negative.
- Auer, B., Zeraatkar, N., Goding, J. C., Konik, A., Fromme, T. J., Kalluri, K., Furenlid, L. R., Kuo, P. H., & King, M. A. (2020). Inclusion of quasi-vertex views in a brain-dedicated multi-pinhole SPECT system for improved imaging performance. Physics in medicine and biology.More infoWith brain-dedicated multi-detector systems employing pinhole apertures the usage of detectors facing the top of the patient's head (i.e., quasi-vertex views) can provide the advantage of additional viewing from close to the brain for improved detector coverage. In this paper, we report the results of simulation and reconstruction studies to investigate the impact of the quasi-vertex views on the imaging performance of AdaptiSPECT-C, a brain-dedicated stationary SPECT system under development. In this design, both primary and scatter photons from regions located inferior to the brain can contribute to SPECT projections acquired by the quasi-vertex views, and thus degrade AdaptiSPECT-C imaging performance. In this work, we determined the proportion, origin, and nature (i.e., primary, scatter, and multiple-scatter) of counts emitted from structures within the head and throughout the body contributing to projections from the different AdaptiSPECT-C detector rings, as well as from a true vertex view detector. We simulated phantoms used to assess different aspects of image quality (i.e., uniform sphere and Derenzo), as well as anthropomorphic phantoms with multiple count levels emulating clinicalI activity distributions (i.e., DaTscan and perfusion). We determined that attenuation and scatter in the patient's body greatly diminish the probability of the photons emitted outside the volume of interest reaching to detectors and being recorded within the 15% photopeak energy window. In addition, we demonstrated that the inclusion of the residual of such counts in the system acquisition does not degrade visual interpretation or quantitative analysis. The addition of the quasi-vertex detectors increases volumetric sensitivity, angular sampling, and spatial resolution leading to significant enhancement in image quality, especially in the striato-thalamic and superior regions of the brain. Besides, the use of quasi-vertex detectors improves the recovery of clinically relevant metrics such as the striatal binding ratio and mean activity in selected cerebral structures.
- Chen, N., Chou, Y., Stuehm, C., Zhang, X., & Kuo, P. H. (2020). Functional Magnetic Resonance Imaging Reveals Taiji’s Real-time Effects on Neuronal Networks of the Brain. The Journal of Chinese Health Practices, 1(1).
- Chen, N., Chou, Y., Stuehm, C., Zhang, X., & Kuo, P. H. (2020). Functional Magnetic Resonance Imaging Reveals Taiji’s Real-time Effects on Neuronal Networks of the Brain. The Journal of the International Society of Chinese Health Practices, 1.
- Kay, M. D., Morris-Wiseman, L. F., Caskey, J., Winegar, B. A., & Kuo, P. H. (2020). 99mTc-Sestamibi Scintigraphy Reveals Parathyroid Adenoma Masquerading as Esophageal Diverticulum. Clinical nuclear medicine.More infoA 74-year-old woman with primary hyperparathyroidism diagnosed from routine laboratory tests described symptoms of fatigue and difficulty with concentration. During surgical consultation, the cervical and thoracic spine MRI scans from the preceding 10-year period, performed for relapsing-remitting multiple sclerosis, were reviewed. In this clinical context, the slowly enlarging left upper paraesophageal lesion, reported as a lateral proximal esophageal (Killian-Jamieson) diverticulum, was reevaluated for a potential parathyroid adenoma. Tc-sestamibi SPECT/CT demonstrated focal uptake in the paraesophageal lesion with surgical resection, confirming it to be a large parathyroid adenoma.
- Mushtaq, R., Kay, M. D., Steinmeyer, L., Warhadpande, D., & Kuo, P. H. (2020). Pearls and Pitfalls of Quantitative Software Analysis of Dopamine Transporter SPECT. Clinical nuclear medicine, 45(11), e469-e476.More infoDopamine transporter SPECT with I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane (I-ioflupane) aids in the diagnosis of parkinsonian syndrome by demonstrating loss of striatal dopamine transporters, proportional to nigrostriatal dopaminergic neuronal loss. Quantitative software analysis (QSA) is a helpful adjunct to visual interpretation. An atlas of pearls and pitfalls of QSA is presented. Examples include correction for head tilt/orientation, scaling artifacts, and detection of balanced loss of activity. Additional examples are provided where QSA can potentially fail such as patient variation and vascular disease.
- Pawson, A., Ghumman, Z., Kuo, P. H., Jadvar, H., Bartel, T., Shayegan, B., & Zukotynski, K. (2020). A review of prostate cancer imaging, positron emission tomography, and radiopharmaceutical-based therapy. Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 14(4), 130-138.
- Sawyer, D. M., Sawyer, T. W., Eshghi, N., Hsu, C., Hamilton, R. J., Garland, L. L., & Kuo, P. H. (2020). Pilot Study: Texture analysis of PET imaging demonstrates changes in F-FDG uptake of the brain after prophylactic cranial irradiation. Journal of nuclear medicine technology.More infoProphylactic cranial irradiation (PCI) is used to decrease the probability of developing brain metastases in patients with small cell lung cancer and has been linked to deleterious cognitive effects. While no well-established imaging markers for these effects exist, previous studies have shown that structural and metabolic changes of the brain can be detected with magnetic resonance imaging and positron emission tomography (PET). This study utilized an image processing technique called texture analysis to explore whether global changes in brain glucose metabolism could be characterized in PET images. F-FDG PET images of the brain from patients with small cell lung cancer, obtained before and after the administration of PCI, were processed using texture analysis. Texture features were compared between the pre- and post-PCI images. Multiple texture features demonstrated statistically significant differences before and after PCI, when texture analysis was applied to the brain parenchyma as a whole. Regional differences were also seen but were not statistically significant. Global changes in brain glucose metabolism occur after PCI and are detectable using advanced image processing techniques. These changes may reflect radiation-induced damage and thus may provide a novel method for studying radiation-induced cognitive impairment.
- Schwartz, F. R., James, O., Kuo, P. H., Witte, M. H., Koweek, L. M., & Pabon-Ramos, W. (2020). Lymphatic imaging: Current noninvasive and invasive techniques. Seminars in Interventional Radiology, 37(3), 1-13.
- Schwartz, F. R., James, O., Kuo, P. H., Witte, M. H., Koweek, L. M., & Pabon-Ramos, W. M. (2020). Lymphatic Imaging: Current Noninvasive and Invasive Techniques. Seminars in interventional radiology, 37(3), 237-249.More infoAfter nearly disappearing, invasive lymphangiography not only has resurged, but new approaches have been developed to guide lymphatic interventions. At the same time, noninvasive lymphatic imaging is playing a larger role in the evaluation of lymphatic pathologies. Lymphangioscintigraphy, computed tomography lymphangiography, and magnetic resonance lymphangiography are increasingly being used as alternatives to invasive diagnostic lymphangiography. The purpose of this article is to review current invasive and noninvasive lymphatic imaging techniques.
- Woodhead, G. J., Mcmillan, N. A., Kuo, P. H., Kay, M. D., & Caskey, J. S. (2020). Miscalculated Lung Shunt Fraction for Planning of Hepatic Radioembolization.. Journal of nuclear medicine technology, 48(2), 184-186. doi:10.2967/jnmt.119.234385More info90Y radioembolization is a safe and efficacious treatment option for many patients with unresectable hepatocellular carcinoma. Potential candidates for radioembolization, based on clinical criteria, undergo 99mTc-labeled macroaggregated albumin imaging to determine the extent of hepatopulmonary shunting. Dose selection is based on results from shunt imaging and can exclude patients from radioembolization therapy. We present a case of miscalculated lung shunt fraction and the circumstances that led to the critical error.
- Zeraatkar, N., Kalluri, K. S., Auer, B., Konik, A., Fromme, T. J., Furenlid, L. R., Kuo, P. H., & King, M. A. (2020). Investigation of Axial and Angular Sampling in Multi-Detector Pinhole-SPECT Brain Imaging. IEEE transactions on medical imaging, 39(12), 4209-4224.More infoWe designed a dedicated multi-detector multi-pinhole brain SPECT scanner to generate images of higher quality compared to general-purpose systems. The system, AdaptiSPECT-C, is intended to adapt its sensitivity-resolution trade-off by varying its aperture configurations allowing both high-sensitivity dynamic and high-spatial-resolution static imaging. The current system design consists of 23 detector heads arranged in a truncated spherical geometry. In this work, we investigated the axial and angular sampling capability of the current stationary system design. Two data acquisition schemes using limited rotation of the gantry and two others using axial translation of the imaging bed were also evaluated concerning their impact on image quality through improved sampling. Increasing both angular and axial sampling in the current prototype system resulted in quantitative improvements in image quality metrics and qualitative appearance of the images as determined in studies with specifically selected phantoms. Visual improvements for the brain phantoms with clinical distributions were less pronounced but presented quantitative improvements in the fidelity (normalized root-mean-square error (NRMSE)) and striatal specific binding ratio (SBR) for a dopamine transporter (DAT) distribution, and in NRMSE and activity recovery for a brain perfusion distribution. More pronounced improvements with increased sampling were seen in contrast recovery coefficient, bias, and coefficient of variation for a lesion in the brain perfusion distribution. The negligible impact of the most cranial ring of detectors on axial sampling, but its significant impact on sensitivity and angular sampling in the cranial portion of the imaging volume-of-interest were also determined.
- Zubal, G., Wanner, M., Varrone, A., Tossici-bolt, L., Semah, F., Seibyl, J., Penuelas, I., Pappata, S., Morbelli, S., Law, I., Lammertsma, A. A., Laere, K. V., Kuo, P. H., Herscovitch, P., Giessen, E. V., Garibotto, V., Esposito, G., Ekmekcioglu, O., Dubroff, J., , Drzezga, A., et al. (2020). EANM practice guideline/SNMMI procedure standard for dopaminergic imaging in Parkinsonian syndromes 1.0.. European journal of nuclear medicine and molecular imaging, 47(8), 1885-1912. doi:10.1007/s00259-020-04817-8More infoThis joint practice guideline or procedure standard was developed collaboratively by the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The goal of this guideline is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of dopaminergic imaging in parkinsonian syndromes..Currently nuclear medicine investigations can assess both presynaptic and postsynaptic function of dopaminergic synapses. To date both EANM and SNMMI have published procedural guidelines for dopamine transporter imaging with single photon emission computed tomography (SPECT) (in 2009 and 2011, respectively). An EANM guideline for D2 SPECT imaging is also available (2009). Since the publication of these previous guidelines, new lines of evidence have been made available on semiquantification, harmonization, comparison with normal datasets, and longitudinal analyses of dopamine transporter imaging with SPECT. Similarly, details on acquisition protocols and simplified quantification methods are now available for dopamine transporter imaging with PET, including recently developed fluorinated tracers. Finally, [18F]fluorodopa PET is now used in some centers for the differential diagnosis of parkinsonism, although procedural guidelines aiming to define standard procedures for [18F]fluorodopa imaging in this setting are still lacking..All these emerging issues are addressed in the present procedural guidelines for dopaminergic imaging in parkinsonian syndromes.
- Zukotynski, K., Gaudet, V., Kuo, P. H., Adamo, S., Goubran, M., Scott, C. J., Bocti, C., Borrie, M., Chertkow, H., Frayne, R., Hsiung, R., Laforce, R., Noseworthy, M. D., Prato, F. S., Sahlas, D. J., Smith, E. E., Sossi, V., Thiel, A., Soucy, J. P., , Tardif, J. C., et al. (2020). The Use of Random Forests to Identify Brain Regions on Amyloid and FDG PET Associated With MoCA Score. Clinical nuclear medicine, 45(6), 427-433.More infoThe aim of this study was to evaluate random forests (RFs) to identify ROIs on F-florbetapir and F-FDG PET associated with Montreal Cognitive Assessment (MoCA) score.
- Banks, K. P., Peacock, J. G., Clemenshaw, M. N., & Kuo, P. H. (2019). Optimizing the Diagnosis of Parkinsonian Syndromes With I-Ioflupane Brain SPECT. AJR. American journal of roentgenology, 213(2), 243-253.More infoThe purpose of this article is to provide a review of I-ioflupane SPECT in the evaluation of suspected parkinsonian syndromes (PSs). This collection of diseases presents frequent diagnostic challenges, even by movement disorder and dementia specialists. The I-ioflupane scan serves as an imaging biomarker of the status of presynaptic dopamine transporters (DATs) in the striatum. As a result of neuronal death, DATs are greatly reduced in patients with PS neurodegenerative disorders, whereas clinical mimics generally do not show striatal DAT loss. This provides a tremendous opportunity for I-ioflupane to aid in the accurate and timely diagnosis of these patients and optimize their management.
- Carson, R. E., & Kuo, P. H. (2019). Brain-Dedicated Emission Tomography Systems: A Perspective on Requirements for Clinical Research and Clinical Needs in Brain Imaging. IEEE Transactions on Radiation and Plasma Medical Sciences, 3(3), 254-261.
- Caskey, J. S., Kay, M. D., McMillan, N. A., Kuo, P. H., & Woodhead, G. J. (2019). Miscalculated Lung Shunt Fraction for Planning of Hepatic Radioembolization. Journal of nuclear medicine technology.More infoYttrium-90 radioembolization is a safe and efficacious treatment option for many patients with unresectable hepatocellular carcinoma. Potential candidates for radioembolization, based on clinical criteria, undergo technetium-99m labeled macroaggregated albumin imaging to determine the extent of hepatopulmonary shunting. Dose selection is based on results from shunt imaging and can exclude patients from radioembolization therapy. We present a case of miscalculated lung shunt fraction and the circumstances that led to the critical error.
- Erickson, R. P., Lai, L. W., Mustacich, D. J., Bernas, M. J., Kuo, P. H., & Witte, M. H. (2019). Sex-limited penetrance of lymphedema to females with CELSR1 haploinsufficiency: A second family. Clinical genetics, 96(5), 478-482.More infoA second multigeneration family with hereditary lymphedema (LE) secondary to a variant in the planar polarity gene, CELSR1, is described. Dominant inheritance of the variant was discovered using whole-exome sequencing and confirmed by Sanger sequencing. In contrast to heterozygous males, all heterozygous females showed LE during physical examination albeit variable in severity and age of onset. Lymphscintigraphy in affected females showed previously undescribed lymphatic abnormalities consistent with lymphangiectasia, valve dysfunction, and thoracic duct reflux.
- Erickson, R. P., Lai, L., Mustacich, D., Bernas, M. J., Kuo, P. H., & Witte, M. H. (2019). Sex-limited penetrance of lymphedema to females with CELSR1 haploinsufficiency: A second family.. Clinical Genetics, 96(5), 478-482. doi:10.1111More infoA second multigeneration family with hereditary lymphedema (LE) secondary to a variant in the planar polarity gene, CELSR1, is described. Dominant inheritance of the variant was discovered using whole-exome sequencing and confirmed by Sanger sequencing. In contrast to heterozygous males, all heterozygous females showed LE during physical examination albeit variable in severity and age of onset. Lymphscintigraphy in affected females showed previously undescribed lymphatic abnormalities consistent with lymphangiectasia, valve dysfunction, and thoracic duct reflux.
- Kay, M. D., Morris-Wiseman, L. F., Beazer, A., Winegar, B. A., & Kuo, P. H. (2019). Primary nasolacrimal duct obstruction visualized on I pre-ablation scan for papillary thyroid carcinoma. Journal of nuclear medicine technology.More infoA 56-year old male received a total thyroidectomy, bilateral central and right lateral neck dissection for papillary thyroid carcinoma with lymph nodes metastases. Prior to radioiodine ablation the pre-therapy I scan established the diagnosis of primary nasolacrimal duct obstruction (dacryostenosis).
- Kay, M. D., Pariury, H. E., Perry, A., Winegar, B. A., & Kuo, P. H. (2019). Extracranial Metastases From Glioblastoma With Primitive Neuronal Components on FDG PET/CT. Clinical nuclear medicine.More infoA 17-year-old girl with World Health Organization grade IV glioblastoma with primitive neuronal components (histone H3 G34-mutant and IDH1 wild type) underwent whole-body FDG PET/CT staging due to vertebral metastases on initial MRI. PET/CT revealed extracranial metastatic disease with spinal leptomeningeal dissemination, osseous metastases, and peritoneal seeding via a ventriculoperitoneal shunt. Glioblastoma is uncommon in pediatric patients and particularly those with primitive neuronal components. Extracranial metastases from glioblastoma are more common in those with primitive neuronal components. This case demonstrates the utility of FDG PET/CT for revealing distant metastases from glioblastoma.
- Kylathu, R., Kuo, P. H., Barber, B. J., Klewer, S. E., Bernas, M. J., Behan, S., Moedano, L., Mustacich, D., & Witte, M. H. (2019). Whole Body Lymphangioscintigraphy and SPECT-CT in Infants and Children with Lymphatic Congestion after Surgical Repair of Complex Congenital Heart Disease. 27th World Congress of Lymphology Abstract Booklet.
- Lundeen, T. F., Seibyl, J. P., Covington, M. F., Eshghi, N., & Kuo, P. H. (2019). Signs and Artifacts in Amyloid PET. Radiographics : a review publication of the Radiological Society of North America, Inc, 38(7), 2123-2133.More infoEstablishing a diagnosis of Alzheimer dementia can be challenging, particularly early in the course of the disease. However, with disease-modifying therapies on the horizon, it is becoming increasingly important to achieve the correct diagnosis as soon as possible. In challenging presentations of dementia, such as patients with clinically atypical features or early-age onset of mild cognitive impairment, amyloid PET is a valuable tool in determining the diagnosis of Alzheimer dementia. Furthermore, preliminary data show that amyloid PET findings alter clinical management in patients who meet the appropriate use criteria. There are currently three U.S. Food and Drug Administration (FDA)-approved fluorine 18 (F)-labeled radiopharmaceuticals that allow in vivo detection of cerebral amyloid deposition, which is a hallmark pathologic feature of Alzheimer dementia. Knowledge of the common imaging features among these three F-labeled radiopharmaceuticals in the normal and abnormal brain will enable the radiologist to more accurately interpret amyloid PET studies. As in other subspecialties of radiology, imaging signs in amyloid PET are helpful to distinguish if a region is normal or abnormal. This article reviews appropriate use criteria for amyloid PET, introduces the properties of the radiopharmaceuticals, explains the algorithmic approach to interpretation with examples of normal and abnormal amyloid PET scans with MRI correlation, and provides an atlas of regional amyloid PET signs and common artifacts. RSNA, 2018.
- Lundeen, T., Covington, M., Krupinski, E., Avery, R., Lei, H., Sherman, S., & Kuo, P. (2019). Accuracy of Dopamine Transporter Imaging with I-123 Ioflupane in Hispanic and Non-Hispanic Patients. Journal of nuclear medicine technology.More infoRacial and ethnic disparities in the prevalence of neurodegenerative diseases exist. This study examines the agreement between gold standard diagnosis and visual assessment of dopamine transporter (DaT) imaging in Hispanic and non-Hispanic patients being evaluated for Parkinsonian syndromes (PS).
- Posch, M., Kay, M., Harhash, A., Huang, J., Krupinski, E., Abidov, A., McMillan, N., & Kuo, P. (2019). Daily Caffeine Consumption is Associated with Decreased Incidence of Symptoms and Hemodynamic Changes During Pharmacologic Stress with Regadenoson. Journal of nuclear medicine technology.More infoRegadenoson is an adenosine A2A receptor agonist widely used as a pharmacologic stress agent for myocardial perfusion imaging (MPI). Approximately 3.4 million regadenoson pharmacologic stress tests were performed annually as of 2011. Caffeine is a competitive antagonist of all adenosine receptor subtypes, thus caffeine is typically withheld 12-24 hours before stress with regadenoson. However, the effects of daily caffeine intake on regadenoson stress are unknown. This study assesses the effects of daily caffeine intake on symptoms and hemodynamic changes during stress testing with regadenoson. Patients presenting for regadenoson stress MPI were asked their amounts of daily caffeine intake. Chart review was used to collect data on demographics, comorbidities, and use of beta blockers. Data collected from the regadenoson stress test included symptoms, administration of aminophylline, heart rate (HR), blood pressure (BP) and arrhythmias. Chi-squared test and analysis of variance were used to analyze data divided into three categories of caffeine intake (< 200, 200-400, > 400 mg daily). Chi-squared test was used for nominal data and unpaired t-test for continuous data. A total of 101 patients were enrolled with 53% men and 47% women. Of the 101 patients, 89% reported caffeine intake, with 13% reporting heavy caffeine intake (> 400mg daily). Last intake of caffeine was at least 12 hours prior to the test. During the test, 63% of patients reported symptoms, but the test was completed successfully in all patients. Compared to those who do not use caffeine, intake was associated with less chest pain ( = 0.0013), less aminophylline administration ( = 0.0371), lower resting and peak heart rate ( = 0.0497 and 0.0314, respectively) and lower diastolic BP response ( = 0.017) for caffeine users. No associations were found between caffeine intake and arrhythmia or systolic BP response. Caffeine consumers receiving regadenoson stress MPI was very common, and use of regadenoson for MPI in caffeine consumers is safe and associated with lower incidence of certain symptoms compared to non-caffeine consumers. Specifically, caffeine intake was associated with less aminophylline use and chest pain.
- Posch, M., Kay, M., Harhash, A., Huang, J., Krupinski, E., Abidov, A., McMillan, N., & Kuo, P. H. (2019). Daily Caffeine Consumption is Associated with Decreased Incidence of Symptoms and Hemodynamic Changes During Pharmacologic Stress with Regadenoson.. J Nucl Med Technol. doi:10.2967/jnmt.118.225219
- Widrick, K., Li, X., King, M., Kuo, P. H., & Furenlid, L. (2019). Photon-transport Simulations of a Curved Gamma-Ray Detector for use in a dedicated Brain SPECT System. J Nucl Med, 60(no. supplement 1 1393). doi:http://jnm.snmjournals.org/content/60/supplement_1/1393.abstract
- Witte, M. H., Erickson, R. P., Kuo, P. H., Lai, L., Mustacich, D., Bernas, M. J., Mustacich, D., Bernas, M. J., Lai, L., Kuo, P. H., Erickson, R. P., & Witte, M. H. (2019). Sex-limited penetrance of lymphedema to females with CELSR1 haploinsufficiency: A second family.. Clin Genet., 96(5), 478-482. doi:10.1111More infoA second multigeneration family with hereditary lymphedema (LE) secondary to a variant in the planar polarity gene, CELSR1, is described. Dominant inheritance of the variant was discovered using whole-exome sequencing and confirmed by Sanger sequencing. In contrast to heterozygous males, all heterozygous females showed LE during physical examination albeit variable in severity and age of onset. Lymphscintigraphy in affected females showed previously undescribed lymphatic abnormalities consistent with lymphangiectasia, valve dysfunction, and thoracic duct reflux.
- Zeraatkar, N., Auer, B., Kalluri, K., Momsen, N., Furenlid, L., Kuo, P. H., & King, M. (2019). Effect of truncated overlapping projection data in a multi-pinhole brain SPECT system with temporal shuttering of apertures. J Nucl Med, 60(no. supplement 1 39). doi:http://jnm.snmjournals.org/content/60/supplement_1/1393.abstract
- Zukotynski, K., Gaudet, V., Kuo, P. H., Adamo, S., Goubran, M., Scott, C., Bocti, C., Borrie, M., Chertkow, H., Frayne, R., Hsiung, R., Laforce, R., Noseworthy, M. D., Prato, F. S., Sahlas, D. J., Smith, E. E., Sossi, V., Thiel, A., Soucy, J. P., , Tardif, J. C., et al. (2019). The Use of Random Forests to Classify Amyloid Brain PET. Clinical nuclear medicine, 44(10), 784-788.More infoTo evaluate random forests (RFs) as a supervised machine learning algorithm to classify amyloid brain PET as positive or negative for amyloid deposition and identify key regions of interest for stratification.
- Eshghi, A., Klein, R., Eshghi, N., & Kuo, P. H. (2018). F-FDG PET/CT for the Evaluation of Primary Eosinophilic Granuloma of the Hypothalamus. Journal of nuclear medicine technology, 46(3), 290-291.More infoA 21-y-old man who presented with polyuria and polydipsia was discovered to have diabetes insipidus due to eosinophilic granuloma of the hypothalamus. F-FDG PET/CT, which was performed as a metastatic work-up, revealed an intensely F-FDG-avid hypothalamic mass and no other sites of disease.
- Eshghi, N., Garland, L. L., Choudhary, G., Hsu, C. C., Eshghi, A., Han, J., Hamilton, R. J., Krupinski, E., & Kuo, P. H. (2018). Regional Changes in Brain F-FDG Uptake After Prophylactic Cranial Irradiation and Chemotherapy in Small Cell Lung Cancer May Reflect Functional Changes. Journal of nuclear medicine technology, 46(4), 355-358.More infoChemotherapy followed by prophylactic cranial irradiation (PCI) is associated with increased survival in patients with small cell lung cancer but is associated with fatigue and cognitive impairment. This retrospective study evaluated regional differences in F-FDG uptake by the brain before and after PCI. The null hypothesis was that direct toxic effects on the brain from PCI and chemotherapy are symmetric; thus, asymmetric deviations may reflect functional changes due to therapy. Electronic medical records from 2013 to 2016 were reviewed for patients with small cell lung cancer, MRI of brain negative for metastasis, and F-FDG PET/CT scans before and after PCI. As the standard of care, patients received first-line chemotherapy or chemoradiation to the thorax followed by PCI. The F-FDG PET/CT scans nearest the PCI were selected. Sixteen patients met these initial criteria. Commercially available PET software was used to register and subtract the PET scans before and after PCI to obtain difference maps. Occipital and cerebellar regions were excluded from the final statistical analysis given the known high variability and misregistration. The χ test was used to analyze the data. Two patients had F-FDG uptake differences only in the occipital and cerebellar regions. The software registration failed on 1 patient's scans. Therefore, 13 patients were included in the final analysis. Nine of 13 patients demonstrated significant unilateral changes in only 1 region of the brain, and 3 of 13 showed significant changes unilaterally in 2 regions. The χ test revealed a significant unilateral regional difference on a patient level (χ = 6.24, = 0.025). The most commonly affected brain region was the frontal lobe. Significantly more patients had unilateral than bilateral regional differences (both increases and decreases) in F-FDG uptake in the brain before and after PCI. This finding suggests that differences in unilateral distribution are related to functional changes, since direct toxicity alone from PCI and chemotherapy would be symmetric. The frontal region was the most commonly affected, suggesting a potential contributing etiology for cognitive impairment and decreased executive function after therapy.
- Eshghi, N., Garland, L. L., Nia, E., Betancourt, R., Krupinski, E., & Kuo, P. H. (2018). F-FDG PET/CT Can Predict Development of Thyroiditis Due to Immunotherapy for Lung Cancer. Journal of nuclear medicine technology, 46(3), 260-264.More infoOur primary purpose was to determine whether increased F-FDG uptake in the thyroid gland predicts development of thyroiditis with subsequent hypothyroidism in patients undergoing immunotherapy with nivolumab for lung cancer. Secondarily, we determined whether F-FDG uptake in the thyroid gland correlates with number of administered cycles of nivolumab. Retrospective chart review over 2 y found 18 lung cancer patients treated with nivolumab who underwent F-FDG PET/CT before and during therapy. SUV, SUV, and total lesion glycolysis of the thyroid gland were measured. SUVs were also measured for the pituitary gland, liver, and spleen. Patients underwent monthly thyroid testing. PET/CT parameters were analyzed by unpaired testing for differences between 2 groups (patients who developed hypothyroidism and those who did not). Correlation between development of thyroiditis and number of cycles of nivolumab was also tested. Six of 18 patients developed hypothyroidism. The test comparing the 2 groups demonstrated significant differences in SUV ( = 0.04), SUV ( = 0.04), and total lesion glycolysis ( = 0.02) of the thyroid gland. Two of 4 patients who developed thyroiditis and had increased F-FDG uptake in the thyroid gland had a normal TSH level at the time of follow-up F-FDG PET/CT. Patients who developed thyroiditis with subsequent hypothyroidism stayed longer on therapy (10.6 cycles) than patients without thyroiditis (7.6 cycles), but the trend was not statistically significant. No significant difference in PET/CT parameters was observed for pituitary gland, liver, or spleen. F-FDG PET/CT can predict the development of thyroiditis with subsequent hypothyroidism before laboratory testing. Further study is required to confirm the positive trend between thyroiditis and duration of therapy.
- Eshghi, N., Lundeen, T. F., & Kuo, P. H. (2018). Dynamic Adaptation of Tumor Immune Response With Nivolumab Demonstrated by 18F-FDG PET/CT. Clinical nuclear medicine, 43(2), 114-116.More infoA 61-year-old woman with lung adenocarcinoma failed first-line treatment and was placed on immunotherapy with nivolumab. FDG-PET/CT before immunotherapy showed metastases to thoracic nodes, liver, adrenal gland, and skeleton. Seven weeks after starting nivolumab, FDG-PET/CT showed mild residual activity in thoracic nodes and otherwise complete response. After 15 weeks, enlarged and FDG-avid axillary lymphadenopathy and worsening supraclavicular lymphadenopathy developed. After 20 weeks, FDG-PET/CT demonstrated marked improvement of axillary and supraclavicular lymphadenopathy. This case demonstrates that later progression of disease can still respond to continuing immunotherapy, hypothetically because of dynamic adaptations in the tug-of-war between the immunotherapy-augmented immune system and tumor.
- Eshghi, N., Lundeen, T. F., MacKinnon, L., Avery, R., & Kuo, P. H. (2018). 18F-FDG PET/CT for Monitoring Response of Merkel Cell Carcinoma to the Novel Programmed Cell Death Ligand 1 Inhibitor Avelumab. Clinical nuclear medicine, 43(5), e142-e144.More infoAn 85-year-old man with stage IIIA Merkel cell carcinoma of the left arm was initially treated with local excision and axillary node dissection followed by radiation therapy. Eight months after surgery, whole-body FDG PET/CT demonstrated intensely hypermetabolic hepatic metastases and abdominal lymphadenopathy. Given his age and comorbidities, he was considered a poor candidate for chemotherapy, and therefore the novel programmed cell death ligand 1 inhibitor avelumab was initiated. FDG PET/CT after 4 cycles showed complete resolution of hepatic and nodal metastases. Whole-body FDG PET/CT can be used for monitoring response of multisystem metastases from Merkel cell carcinoma to active immunotherapy.
- Frankl, J. A., Bose, S., & Kuo, P. H. (2018). False-Positive Findings on Dopamine Transporter SPECT Due to Therapeutic Dextroamphetamine and Amphetamine. Journal of nuclear medicine technology, 46(2), 149-150.More infoDopamine transporter SPECT is an accurate adjunct to clinical evaluation for Parkinson disease when the diagnosis is difficult. Dopaminergic medications may significantly affect dopamine transporter availability and, thus, uptake of dopamine transporter tracers. A patient had a false-positive dopamine transporter SPECT result while she was taking dextroamphetamine and amphetamine for attention-deficit hyperactivity disorder. The SPECT findings normalized after amphetamine therapy was withheld. An accurate medication history combined with knowledge of drugs that interfere with dopamine transporter imaging is critical to ensure accuracy.
- Kuo, P. H., Eshghi, N., Tinaz, S., Blumenfeld, H., Louis, E. D., & Zubal, G. (2018). Optimization of Parameters for Quantitative Analysis of I-ioflupane SPECT Images for Monitoring of Progression of Parkinson's Disease. Journal of nuclear medicine technology.More infoQuantitative assessment of dopamine transporter (DAT) imaging can aid in diagnosing Parkinson's disease (PD) and assessing disease progression in the context of therapeutic trials. Previously, the software program SBRquant was applied to I-ioflupane SPECT images acquired on healthy controls and subjects with PD. Earlier work on optimization of the parameters for differentiating between controls and subjects with dopaminergic deficits is extended here for maximizing change measurements associated with disease progression on longitudinally acquired scans. Serial I-ioflupane SPECT imaging for 51 subjects with PD (conducted approximately 1 year apart) were downloaded from the Parkinson's Progression Markers Initiative database. The software program SBRquant calculates the Striatal Binding Ratio (SBR) separately for the left and right caudate and putamen regions of interest (ROI). Parameters were varied to evaluate the number of summed transverse slices and the positioning of the striatal ROIs for determining signal to noise associated with their annual rate of change in SBR. The parameters yielding the largest change of the lowest putamen's SBR from scan 1 to scan 2 were determined. For the change from scan 1 to scan 2 in the 51 subjects, the largest annual change was observed when the putamen ROI was placed 3 pixels away from the caudate and by summing 5 central striatal slices. This resulted in an 11.2 ± 4.3% annual decrease in the lowest putamen's SBR for the group. Quantitative assessment of DAT imaging for assessing progression of PD requires specific, optimal parameters different than those for diagnostic accuracy.
- Kuo, P. H., Stuehm, C., Squire, S., & Johnson, K. (2018). Meningeal Lymphatic Vessel Flow Runs Countercurrent to Venous Flow in the Superior Sagittal Sinus of the Human Brain. Tomography (Ann Arbor, Mich.), 4(3), 99-104.More infoThe recent report of the existence of meningeal lymphatic vessels (MLVs) in human and nonhuman primates used both histology and magnetic resonance imaging (MRI). Many questions about the physiology and function of these lymphatic vessels remain unanswered. Through the combination of appropriately positioned saturation bands and time-of-flight angiography sequences, MRI can resolve direction of flow within vessels without the use of exogenous contrast agent. Six healthy volunteers underwent high-resolution MRI of the MLVs running alongside the superior sagittal sinus to determine the direction of the lymphatic flow. In all subjects, the lymphatic flow was posterior to anterior, countercurrent to the direction of venous flow in the superior sagittal sinus and alongside the superior sagittal sinus. This flow strongly supports that a large proportion of the CNS lymphatic flow in humans is directed to the cribriform plate. The countercurrent direction of flow in the MLVs relative to venous flow in the superior sagittal sinus has implications for modeling flow of fluid and solutes across the various compartments of the CNS. A hypothetical compartmental model incorporating countercurrent flow is presented here.
- Manning, M. A., Kuo, P. H., & Yeager, A. M. (2018). Disseminated coccidioidomycosis masquerading as recurrent lymphoma. BMJ case reports, 2018.
- Sawyer, D. M., & Kuo, P. H. (2018). "Occipital Tunnel" Sign on FDG PET for Differentiating Dementias. Clinical nuclear medicine, 43(2), e59-e61.More infoPET using FDG is a critical tool for evaluation of dementias, with characteristic patterns of hypometabolism suggesting specific diagnoses. Hypometabolism in the occipital region is recognized as an important finding associated with dementia with Lewy bodies and posterior cortical atrophy. We describe here the novel "occipital tunnel" sign, which results from relative sparing of FDG uptake in the medial occipital (primary visual) cortex compared with more severe loss in the surrounding lateral occipital (visual association) cortex. This sign is useful for recognizing the occipital findings of dementia with Lewy bodies and posterior cortical atrophy, especially when viewing sagittal projections.
- Sawyer, D. M., & Kuo, P. H. (2018). Top-Down Systematic Approach to Interpretation of FDG-PET for Dementia. Clinical nuclear medicine, 43(6), e212-e214.More infoDementia is an important cause of morbidity and mortality worldwide and encompasses a very heterogenous group of disease processes. Positron emission tomography (PET) of the brain using fluorodeoxyglucose (FDG) is a useful modality for differentiating types of dementia. Because FDG does not bind to pathologic proteins, FDG-PET requires that the reader recognize characteristic patterns of glucose hypometabolism to identify pathology. These patterns have been documented in the literature for both primary neurodegenerative disorders and secondary causes of dementia. This article presents an algorithm for organizing these findings and systematically applying them to interpret FDG-PET brain imaging for dementia.
- Zukotynski, K., Kuo, P. H., Mikulis, D., Rosa-Neto, P., Strafella, A. P., Subramaniam, R. M., & Black, S. E. (2018). PET/CT of Dementia. AJR. American journal of roentgenology, 211(2), 246-259.More infoIn this article, we review the literature on PET/CT in the management of dementia, present evidence for best clinical practices, and discuss recent advances in the field.
- Booij, J., Dubroff, J., Pryma, D., Yu, J., Agarwal, R., Lakhani, P., & Kuo, P. H. (2017). Diagnostic Performance of the Visual Reading of 123I-Ioflupane SPECT Images With or Without Quantification in Patients With Movement Disorders or Dementia. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 58(11), 1821-1826.More infoVisual interpretation of 123I-ioflupane SPECT images has high diagnostic accuracy for differentiating parkinsonian syndromes (PS), from essential tremor and probable dementia with Lewy bodies (DLB) from Alzheimer disease. In this study, we investigated the impact on accuracy and reader confidence offered by the addition of image quantification in comparison with visual interpretation alone. Methods: We collected 304 123I-ioflupane images from 3 trials that included subjects with a clinical diagnosis of PS, non-PS (mainly essential tremor), probable DLB, and non-DLB (mainly Alzheimer disease). Images were reconstructed with standardized parameters before striatal binding ratios were quantified against a normal database. Images were assessed by 5 nuclear medicine physicians who had limited prior experience with 123I-ioflupane interpretation. In 2 readings at least 1 mo apart, readers performed either a visual interpretation alone or a combined reading (i.e., visual plus quantitative data were available). Readers were asked to rate their confidence of image interpretation and judge scans as easy or difficult to read. Diagnostic accuracy was assessed by comparing image results with the standard of truth (i.e., diagnosis at follow-up) by measuring the positive percentage of agreement (equivalent to sensitivity) and the negative percentage of agreement (equivalent to specificity). The hypothesis that the results of the combined reading were not inferior to the results of the visual reading analysis was tested. Results: A comparison of the combined reading and the visual reading revealed a small, insignificant increase in the mean negative percentage of agreement (89.9% vs. 87.9%) and equivalent positive percentages of agreement (80.2% vs. 80.1%). Readers who initially performed a combined analysis had significantly greater accuracy (85.8% vs. 79.2%; P = 0.018), and their accuracy was close to that of the expert readers in the original studies (range, 83.3%-87.2%). Mean reader confidence in the interpretation of images showed a significant improvement when combined analysis was used (P < 0.0001). Conclusion: The addition of quantification allowed readers with limited experience in the interpretation of 123I-ioflupane SPECT scans to have diagnostic accuracy equivalent to that of the experienced readers in the initial studies. Also, the results of the combined reading were not inferior to the results of the visual reading analysis and offered an increase in reader confidence.
- Covington, M. F., Curiel, C. N., Lattimore, L., Avery, R. J., & Kuo, P. H. (2017). FDG-PET/CT for Monitoring Response of Melanoma to the Novel Oncolytic Viral Therapy Talimogene Laherparepvec. Clinical nuclear medicine, 42(2), 114-115.More info61-year-old woman with stage IIIa (T3a N1a M0) left lower leg melanoma with lesions suggestive of in-transit metastases 8 months following wide local excision and femoral nodal dissection. FDG-PET/CT demonstrated 5 FDG-avid in-transit nodal metastases in the distal left leg, confirmed on biopsy. Talimogene laherparepvec (T-VEC) oncolytic immunotherapy consisting of intralesional injections of modified herpes simplex virus-expressing granulocyte-macrophage colony-stimulating factor was completed over 6 months. Subsequent FDG-PET/CT demonstrated reduced or resolved FDG activity in the treated in-transit metastases and a new FDG-avid left thigh in-transit metastasis. FDG-PET/CT can monitor response to T-VEC and potentially other novel viral immunotherapies.
- Eshghi, N., Christoforidis, J., & Kuo, P. (2017). 18F-FDG PET/CT for Monitoring Response to Therapy of Choroidal Metastasis. Journal of nuclear medicine technology.More infoA 38-year-old woman with metastatic breast carcinoma reported seeing "halos and flashes" in her left eye. Funduscopic exam revealed an elevated mass in the choroid of the left globe consistent with metastasis. Subsequent 18F-FDG PET/CT revealed focal uptake in the nasal aspect of the left choroid of the eye corresponding to the mass seen on the funduscopic exam. Through correlation with the PET/CT, the lesion was retrospectively identified on the MRI. 18F-FDG PET/CT post-radiotherapy showed complete response and thus supports that this imaging modality can be used for diagnosis and monitoring response. History of breast cancer and visual symptoms should trigger the nuclear medicine physician to take extra care in reading the initial slices of the PET/CT scan through the orbits in order to make this challenging imaging diagnosis.
- Frankl, J., Eshghi, N., Lundeen, T. F., & Kuo, P. H. (2017). Artifactual Hepatic Metastasis on FDG PET/CT Secondary to Cryoablation for Adrenal Metastasis. Clinical nuclear medicine.More infoA 65-year-old woman with metastatic lung cancer was referred for CT-guided cryoablation of a right adrenal metastasis. For cryoablation, probes were placed into the adrenal region. FDG PET/CT 3 months later showed new activity in hepatic segment 6 initially suspected to be metastasis. Proximity of the hepatic lesion to the adrenal metastasis was a strange coincidence and prompted review of imaging from the cryoablation. CT showed the probe entered the liver, and postablation image demonstrated injury to the liver adjacent to the adrenal metastasis. Careful review of treatment history and imaging from ablation procedures are important to avoid this pitfall.
- Jones, K. M., Stuehm, C. A., Hsu, C. C., Kuo, P. H., Pagel, M. D., & Randtke, E. A. (2017). Imaging Lung Cancer by Using Chemical Exchange Saturation Transfer MRI With Retrospective Respiration Gating. Tomography (Ann Arbor, Mich.), 3(4), 201-210.More infoPerforming chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) in lung tissue is difficult because of motion artifacts. We, therefore, developed a CEST MRI acquisition and analysis method that performs retrospective respiration gating. Our method used an acquisition scheme with a short 200-millisecond saturation pulse that can accommodate the timing of the breathing cycle, and with saturation applied at frequencies in 0.03-ppm intervals. The Fourier transform of each image was used to calculate the difference in phase angle between adjacent pixels in the longitudinal direction of the respiratory motion. Additional digital filtering techniques were used to evaluate the breathing cycle, which was used to construct CEST spectra from images during quiescent periods. Results from CEST MRI with and without respiration gating analysis were used to evaluate the asymmetry of the magnetization transfer ratio (MTR), a measure of CEST, for an egg white phantom that underwent cyclic motion, in the liver of healthy patients, as well as liver and tumor tissues of patients diagnosed with lung cancer. Retrospective respiration gating analysis produced more precise measurements in all cases with significant motion compared with nongated analysis methods. Finally, a preliminary clinical study with the same respiration-gated CEST MRI method showed a large increase in MTR after radiation therapy, a small increase or decrease in MTR after chemotherapy, and mixed results with combined chemoradiation therapy. Therefore, our retrospective respiration-gated method can improve CEST MRI evaluations of tumors and organs that are affected by respiratory motion.
- Kuo, P. H. (2017). Neonatal Lymphedema from Thoracic Duct Obstruction Complicating Percutaneous Intravenous Central Catheterization. Lymphology.More infoKylat RI, Kuo PH, Bedrick AD and Witte MH: Neonatal Lymphedema from Thoracic Duct Obstruction Complicating Percutaneous Intravenous Central Catheterization. Lymphology. 2017; 50:67-72.
- Kuo, P. H. (2017). The “hidden attraction” of cardiac magnetic resonance imaging for diagnosing pulmonary embolism.. Southwest J Pulm Crit Care., 14(5), 230-5. doi:https://doi.org/10.13175/swjpcc057-17More infoHarhash AA, Cassuto J, Avery RJ, Kuo PH: The “hidden attraction” of cardiac magnetic resonance imaging for diagnosing pulmonary embolism. Southwest J Pulm Crit Care. 2017;14(5):230-5. doi: https://doi.org/10.13175/swjpcc057-17
- Kuo, P. H., & Kuo, P. H. (2017). Tip of the iceberg: 18F-FDG PET/CT diagnoses extensively disseminated coccidioidomycosis with cutaneous lesions. Southwest J Pulm Crit Care., 15(1), 28-31. doi:https://doi.org/10.13175/swjpcc069-17More info12. Nia BB, Nia ES, Osondu N, Galgiani JN, Kuo PH. Tip of the iceberg: 18F-FDG PET/CT diagnoses extensively disseminated coccidioidomycosis with cutaneous lesions. Southwest J Pulm Crit Care. 2017;15(1):28-31. doi: https://doi.org/10.13175/swjpcc069-17
- Nia, B. B., Nia, E. S., Avery, R. J., Kuo, P. H., & Hennemeyer, C. T. (2017). Punctate Radiation Dermatitis of the Foot and Ankle Caused by Distal Embolization of 90Y Microspheres During Liver Directed Therapy. Clinical nuclear medicine, 42(9), e422-e423.More infoA 41-year-old man with gastric adenocarcinoma presented with hepatic metastases. The metastases were refractory to systemic chemotherapy, so radioembolization with Y microspheres was performed. Because of stasis or saturation of the tumor with embolic particles, 79% of the microspheres were injected. At follow-up, the patient complained of "red bumps" that had developed on his right foot/ankle the day after the radioembolization. Because a portion of the dose was still in the catheter when withdrawn from the right femoral artery, the interventional radiologist used a Geiger counter to confirm radioactivity in the cutaneous lesions and thus the distal embolization of the microspheres.
- Nia, E. S., Garland, L. L., Eshghi, N., Nia, B. B., Avery, R. J., & Kuo, P. H. (2017). Incidence of Brain Metastases on Follow-up 18F-FDG PET/CT Scans of Non-Small Cell Lung Cancer Patients: Should We Include the Brain?. Journal of nuclear medicine technology, 45(3), 193-197.More infoThe brain is the most common site of distant metastasis from lung cancer. Thus, MRI of the brain at initial staging is routinely performed, but if this examination is negative a follow-up examination is often not performed. This study evaluates the incidence of asymptomatic brain metastases in non-small cell lung cancer patients detected on follow-up 18F-FDG PET/CT scans. Methods: In this Institutional Review Board-approved retrospective review, all vertex to thigh 18F-FDG PET/CT scans in patients with all subtypes of lung cancer from August 2014 to August 2016 were reviewed. A total of 1,175 18F-FDG PET/CT examinations in 363 patients were reviewed. Exclusion criteria included brain metastases on initial staging, histologic subtype of small-cell lung cancer, and no follow-up 18F-FDG PET/CT examinations. After our exclusion criteria were applied, a total of 809 follow-up 18F-FDG PET/CT scans in 227 patients were included in the final analysis. The original report of each 18F-FDG PET/CT study was reviewed for the finding of brain metastasis. The finding of a new brain metastasis prompted a brain MRI, which was reviewed to determine the accuracy of the 18F-FDG PET/CT. Results: Five of 227 patients with 809 follow-up 18F-FDG PET/CT scans reviewed were found to have incidental brain metastases. The mean age of the patients with incidental brain metastasis was 68 y (range, 60-77 y). The mean time from initial diagnosis to time of detection of incidental brain metastasis was 36 mo (range, 15-66 mo). When MRI was used as the gold standard, our false-positive rate was zero. Conclusion: By including the entire head during follow-up 18F-FDG PET/CT scans of patients with non-small cell lung cancer, brain metastases can be detected earlier while still asymptomatic. But, given the additional scan time, radiation, and low incidence of new brain metastases in asymptomatic patients, the cost-to-benefit ratio should be weighed by each institution.
- Woodhead, G. J., Avery, R. J., & Kuo, P. H. (2017). Atlas of Extraosseous Findings Detected by 18F-NaF PET/CT Bone Scan. Clinical nuclear medicine, 42(12), 930-938.More infoF-NaF PET/CT is an evolving technique that provides high sensitivity for detection of osseous metastases. In addition to detecting pathological osseous lesions, F uptake is occasionally detected in extraosseous lesions. However, reporting of extraosseous uptake in the literature is limited, and the increasing use of F-NaF PET/CT dictates that interpreting physicians learn to recognize extraosseous findings. An atlas of extraosseous findings detected by F-NaF PET/CT is presented, which includes cases under 2 broad categories: nonneoplastic and neoplastic.
- Covington, M. F., Choudhary, G., Avery, R. J., & Kuo, P. H. (2016). Pitfalls in the Performance and Interpretation of Scintigraphic Imaging for Pleuroperitoneal Shunt. Clinical nuclear medicine, 41(11), 858-861.More infoAscites can cause pleural effusions when the peritoneal fluid crosses the diaphragm through a pleuroperitoneal shunt in the setting of hepatic cirrhosis (hepatic hydrothorax) or malignant ascites. Scintigraphic imaging for pleuroperitoneal shunt requires intraperitoneal injection of Tc-SC or Tc-macroaggregated albumin followed by planar imaging of the chest and abdomen. Pleuroperitoneal shunt is confirmed by identifying radiotracer crossing the diaphragm from the peritoneal to pleural space. An atlas of pleuroperitoneal shunt imaging pitfalls is presented to facilitate optimal performance and interpretation of nuclear pleuroperitoneal shunt examinations. Examples include cases of nondiagnostic radiotracer injections, processing errors, and nontarget uptake.
- Covington, M. F., Choudhary, G., Avery, R. J., Krupinski, E. A., & Kuo, P. H. (2016). Optimal Time Points for Scintigraphic Imaging of Pleuroperitoneal Shunts. Clinical nuclear medicine, 41(10), 766-8.More infoNuclear imaging can confirm pleuroperitoneal shunt as the cause of pleural effusion. No society guidelines exist for scintigraphic pleuroperitoneal shunt detection. Our institutional protocol was evaluated to determine optimal imaging time points for shunt detection.
- Covington, M. F., McMillan, N. A., & Kuo, P. H. (2016). Impact of Reimbursement Cuts on the Sustainability and Accessibility of Dopamine Transporter Imaging. Journal of the American College of Radiology : JACR, 13(9), 1039-43.More infoDopamine transporter single-photon emission computed tomography imaging utilizing iodine-123 ioflupane is accurate for differentiation of Parkinson disease from essential tremor. This study evaluates how reimbursement for I-123 ioflupane imaging changed between 2011 (year of FDA approval) and 2014 (year after loss of pass-through status for hospital-based outpatient imaging from CMS).
- Jones, K. M., Randtke, E. A., Yoshimaru, E. S., Howison, C. M., Chalasani, P., Klein, R. R., Chambers, S. K., Kuo, P. H., & Pagel, M. D. (2016). Clinical Translation of Tumor Acidosis Measurements with AcidoCEST MRI. Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging.More infoWe optimized acido-chemical exchange saturation transfer (acidoCEST) magnetic resonance imaging (MRI), a method that measures extracellular pH (pHe), and translated this method to the radiology clinic to evaluate tumor acidosis.
- Liu, J., Cranmer, L., Larsen, B. T., Kuo, P. H., & Kopp, L. M. (2016). Recurrent Osteosarcoma Presenting as an Isolated Bone Marrow Relapse. Journal of pediatric hematology/oncology.More infoOsteosarcoma (OS) is a malignant bone tumor which is found primarily in adolescents, with the distal femur as the most common location. OS with a jaw primary is present in only about 10% of cases and the risk of recurrence is considered to be decreased in the jaw versus other primary locations. We present a unique case of a patient with localized OS of the jaw with an isolated recurrence in her bone marrow almost 5 years after completion of initial treatment.
- Covington, M. F., Seibyl, J., & Kuo, P. H. (2015). Adjusting ACR Appropriateness Criteria for Novel Radiopharmaceuticals. Journal of the American College of Radiology : JACR, 12(12 Pt A), 1242-3.
- Covington, M. F., Sherman, S., Lewis, D., Lei, H., Krupinski, E., & Kuo, P. H. (2015). Patient Survey on Satisfaction and Impact of 123I-Ioflupane Dopamine Transporter Imaging. PloS one, 10(7), e0134457.More infoPatients were surveyed to assess the impact of dopamine transporter imaging on diagnostic confidence, change in treatment plan, effect on medication compliance, and subjective well-being. Surveys were sent to 140 patients who completed dopamine transporter imaging an average of 18 months prior. Sixty-five surveys from patients (46%) were returned. Questions assessed patients' perceived impact of the imaging on their care. Increased diagnostic confidence following imaging was reported by 69% of patients. Changes to treatment plan from imaging were reported by 24% of patients. Overall satisfaction with the study and its impact was reported by 70% of patients. Dopamine transporter imaging increased diagnostic confidence among patients and overall patient satisfaction with the impact of imaging on clinical care was high.
- Covington, M., Lewis, D., Krupinski, E. A., Sherman, S. J., Lei, H., & Kuo, P. H. (2015). Patient Survey on Satisfaction and Impact of 123I-Ioflupane Dopamine Transporter Imaging. PLoS One. doi:10.1371/journal.pone.0134457. eCollection 2015.
- Goldberg, M. R., & Kuo, P. H. (2011). Thrombus presents as palpable breast mass. The breast journal, 17(5), 561-3.
- Houghtelin, A. B., Kopp, L. M., Pelayo-Katsanis, L., Kuo, P. H., Yeager, A. M., & Katsanis, E. (2015). Extramedullary Breast Relapse of Acute Lymphoblastic Leukemia Controlled with a Second Allogeneic/Autologous Hematopoietic Cell Transplant. Journal of adolescent and young adult oncology, 4(1), 50-3.More infoRelapse of acute lymphoblastic leukemia (ALL) in the breast is uncommon and often precedes systemic relapse, resulting in poor survival. We report the development of breast involvement of ALL in a 20-year-old woman 32 months after a related allogeneic peripheral blood hematopoietic cell transplantation (PBHCT) in first remission. This extramedullary relapse occurred in the continuous presence of complete donor chimerism. After systemic re-induction chemotherapy and a second PBHCT using donor cells that had been cryopreserved at first transplant, our patient has remained in second complete remission for more than 44 months.
- Kuo, P. H., Carlson, K. R., Christensen, I., Girardi, M., & Heald, P. W. (2015). FDG-PET/CT for the evaluation of response to therapy of cutaneous T-cell lymphoma to vorinostat (suberoylanilide hydroxamic acid, SAHA) in a phase II trial. Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging, 10(6), 306-14.More infoHarnessing the power of molecular imaging in particular positron emission tomography (PET) to assess response to therapy in early clinical trials has the potential to yield crucial data on efficacy and streamline drug development. Vorinostat (also known as SAHA, suberoylanilide hydroxamic acid) is a histone deacetylase (HDAC) inhibitor which alters gene transcription to inhibit proliferation and promote apoptosis.
- Kuo, P. H., McClennan, B. L., Carlson, K., Wilson, L. D., Edelson, R. L., Heald, P. W., & Girardi, M. (2015). FDG-PET/CT in the evaluation of cutaneous T-cell lymphoma. Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging, 10(2), 74-81.More infoThis comprehensive case series illustrates the findings on 2-deoxy-2-[F-18]fluoro-D: -glucose (FDG) positron-emission tomography/computed tomography (PET/CT) of patients with varying stages of cutaneous T-cell lymphoma (CTCL). Patients were imaged with full-body scanning using a General Electric Discovery ST 16-slice PET/CT machine. Patients were assessed by PET/CT for cutaneous, nodal, and solid organ FDG uptake, indicative of highly metabolically active (i.e., putatively malignant cells) disease, and comparisons were made to CT data alone and to the physical examination. Several key observations strongly suggested that information afforded by PET/CT scan may be valuable. Various cutaneous lesions, from thin subtle plaques to thick tumors, were revealed and corresponded accurately to the cutaneous examination. In the case of subcutaneous lesions, PET/CT outperformed physical exam. CT also provided the depth/thickness of lesions. The differing levels of FDG uptake in enlarged nodes found within an individual patient as well as among different patients may potentially distinguish reactive from malignant adenopathy. Additionally, lymph nodes that did not meet staging size criteria (e.g., were not > 1 cm) revealed increased metabolic activity and, therefore, could be targeted for subsequent monitoring or biopsy. In addition, PET/CT identified visceral involvement in cases with advanced disease. In summary, PET/CT can provide physiologic and anatomic information on the wide diversity of external and internal lesions in CTCL and, therefore, may have great potential for improving the staging and monitoring of response to therapy of cutaneous, nodal, and visceral disease.
- Seibyl, J. P., Reininger, C., & Kuo, P. H. (2015). Implications of better signal: Noise properties of 18F NAV4694 PET amyloid imaging for visual interpretation and scan quantitation. Alzheimers & Dementia, 11(7). doi:10.1016/j.jalz.2015.06.1531
- Thai, J. N., Abidov, A., Jie, T., Krupinski, E. A., & Kuo, P. H. (2015). Nuclear Myocardial Perfusion Imaging Versus Stress Echocardiography in the Preoperative Evaluation of Patients for Kidney Transplantation. Journal of nuclear medicine technology, 43(3), 201-5.More infoThe goal of this study was to evaluate the diagnostic accuracy, cost-effectiveness, and appropriate use of SPECT myocardial perfusion imaging (SMPI) versus stress echocardiography in the preoperative evaluation of patients for kidney transplantation.
- Tinaz, S., Chow, C., Kuo, P. H., Krupinski, E. A., Blumenfeld, H., Louis, E. D., & Zubal, G. (2018). Semiquantitative Analysis of Dopamine Transporter Scans in Patients With Parkinson Disease. Clinical nuclear medicine, 43(1), e1-e7.More infoDopamine transporter (DaT) imaging is an adjunct diagnostic tool in parkinsonian disorders. Interpretation of DaT scans is based on visual reads. SBRquant is an automated method that measures the striatal binding ratio (SBR) in DaT scans, but has yet to be optimized. We aimed to (1) optimize SBRquant parameters to distinguish between patients with Parkinson disease (PD) and healthy controls using the Parkinson's Progression Markers Initiative (PPMI) database and (2) test the validity of these parameters in an outpatient cohort.
- Chen, L. Q., Howison, C. M., Jeffery, J. J., Robey, I. F., Kuo, P. H., & Pagel, M. D. (2014). Evaluations of extracellular pH within in vivo tumors using acidoCEST MRI. Magnetic Resonance in Medicine, 72, 1408-1417. doi:10.1002/mrm.25053More infoAbstract: Purpose: A practical, noninvasive method is needed to measure the extracellular pH (pHe) within in vivo tumors to longitudinally monitor tumor acidosis. We have optimized a biomedical imaging method, termed acidoCEST MRI, to provide noninvasive assessments of tumor pHe in preclinical models of mammary carcinoma. Methods: A CEST-FISP MRI method was optimized to detect the chemical exchange saturation transfer (CEST) of two amide protons of a clinically approved CT contrast agent, iopromide. The ratio of the two CEST effects was used to measure pH. Routes of administration of iopromide were evaluated to ensure sufficient delivery of the agent to the tumor. The optimized acidoCEST MRI method was then used to evaluate the change in tumor pHe following alkalinizing bicarbonate treatment. Results: The acidoCEST MRI protocol measured pH between 6.2 and 7.2 pH units. Greater delivery of iopromide was shown to improve the precision of the measurement of tumor pHe, but the agent did not influence the tumor pHe. AcidoCEST MRI was used to longitudinally monitor the effect of bicarbonate treatment on the pHe of tumors and bladders. Conclusion: This study demonstrates that an optimized acidoCEST MRI method is a practical, noninvasive method for assessing changes in tumor acidosis. © 2013 Wiley Periodicals, Inc.
- Chen, L. Q., Howison, C. M., Jeffery, J. J., Robey, I. F., Kuo, P. H., & Pagel, M. D. (2014). Evaluations of extracellular pH within in vivo tumors using acidoCEST MRI. Magnetic resonance in medicine, 72(5), 1408-17.More infoA practical, noninvasive method is needed to measure the extracellular pH (pHe) within in vivo tumors to longitudinally monitor tumor acidosis. We have optimized a biomedical imaging method, termed acidoCEST MRI, to provide noninvasive assessments of tumor pHe in preclinical models of mammary carcinoma.
- Covington, M. F., Krupinski, E., Avery, R. J., & Kuo, P. H. (2014). Classification schema of symptomatic enterogastric reflux utilizing sincalide augmentation on hepatobiliary scintigraphy. Journal of nuclear medicine technology, 42(3), 198-202.More infoEnterogastric reflux (EGR) is the reflux of duodenal contents into the stomach. Hepatobiliary scintigraphy provides physiologic assessment of the biliary system and was used to test the hypothesis that presence and timing of EGR may be associated with infusion of sincalide, a surrogate of endogenous cholecystokinin.
- Cummings, J. L., Fine, M. J., Grachev, I. D., Jarecke, C. R., Johnson, M. K., Kuo, P. H., Oberdorf, J. A., Rezak, M., Riley, D. E., Schaecher, K. L., & Truong, D. (2014). Effective and Efficient Diagnosis of Parkinsonism: The Role of Dopamine Transporter SPECT Imaging With Ioflupane I-123 Injection (DaTscan (TM)). AMERICAN JOURNAL OF MANAGED CARE, 20(5), S97-S109.
- Ho, A. M., Avery, R., Krupinski, E. A., Warneke, J., & Kuo, P. H. (2014). Predictive role of imaging in sentinel lymph node dissection for melanoma. Lymphology, 47(3), 134-41.More infoA retrospective study of 67 patients with metastatic melanoma was performed to evaluate if imaging from lymphoscintigraphy could predict a higher miss rate if only the most radioactive node were removed. Following protocol for sentinel node biopsy, the surgeon resected all lymph nodes containing radioactivity > 10% of the most radioactive node. A correlation was performed between the radioactive counts of the lymph nodes and the presence of metastases. The percentage of cases in which the most radioactive node was negative for metastasis on pathology was calculated. Two nuclear medicine physicians read the images from lymphoscintigraphy specifically to determine if the first lymph node visualized became less intense than other nodes on later images. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. In 13 of 67 (19%) patients, the most radioactive lymph node was negative for metastasis while a less radioactive node contained metastatic disease. Consensus reading by the nuclear medicine physicians determined that in 9 cases, the first lymph node visualized became less intense than another lymph node on later images. Of the 9 cases, 4 were true positive and 5 were false positive when correlated with intraoperative count rate and pathology. Of the cases where the most radioactive node was not positive on histopathology (n = 13), the consensus reading by the nuclear medicine physicians reported 4 of them (31%). Imaging by lymphoscintigram had a sensitivity 31%, specificity 91%, positive predictive value 44%, and negative predictive value 85% for predicting whether the most radioactive lymph node at surgery would be negative for metastasis at pathology. We conclude that in patients with melanoma, lymphoscintigraphy has high specificity and negative predictive value but modest sensitivity and positive predictive value for detecting when the sentinel node will not be the most radioactive lymph node during sentinel lymph node dissection. These findings support that dynamic imaging by lymphoscintigraphy has a role in surgical planning but that the imaging protocol could benefit from further optimization.
- Hur, S., Bauer, A., McMillan, N., Krupinski, E. A., & Kuo, P. H. (2014). Optimizing the ventilation-perfusion lung scan for image quality and radiation exposure. Journal of nuclear medicine technology, 42(1), 51-4.More infoOur purpose was to compare the performance of an initial ventilation-perfusion (V/Q) scan protocol with that of a data-driven modified protocol to improve diagnostic quality without increasing radiation dose to the patient.
- Janicek, A. K., Avery, R. J., & Kuo, P. H. (2014). The pinwheel sign: artifact from head rotation during SPECT acquisition for dopamine transporter imaging. Journal of nuclear medicine technology, 42(1), 75-6.More infoThis case study illustrates the pattern and significance of the pinwheel sign, a SPECT artifact from rotational head motion that can complicate the diagnosis of Parkinson disease. Monitoring the patient during image acquisition is crucial since rotational motion artifacts are difficult to identify on raw or processed images and may lead to incorrect interpretation of findings.
- Kuo, P. H., Lei, H. H., Avery, R., Krupinski, E. A., Bauer, A., Sherman, S., McMillan, N., Seibyl, J., & Zubal, G. I. (2014). Evaluation of an Objective Striatal Analysis Program for Determining Laterality in Uptake of ¹²³I-Ioflupane SPECT Images: Comparison to Clinical Symptoms and to Visual Reads. Journal of nuclear medicine technology, 42(2), 105-8.More infoAn automated objective striatal analysis (OSA) software program was applied to dopamine transporter (123)I-ioflupane images acquired on subjects with varying severities of parkinsonism. The striatal binding ratios (SBR) of the left and right putamina (relative to the occipital lobe) were computed, and the laterality of that measure was compared with clinical symptoms and visual reads. The objective over-read of OSA was evaluated as an aid in confirming the laterality of disease onset.
- Shetty-Alva, N., Novotny, E. J., Shetty, T., & Kuo, P. H. (2014). Positron emission tomography in Rasmussen's encephalitis. PEDIATRIC NEUROLOGY, 36(2), 112-114.
- Symanowski, J. T., Nguyen, B., Naumann, R. W., Kuo, P. H., & Heertum, R. V. (2014). Reliability and reproducibility of 99mTc-etarfolatide for identification of patient folate receptor status. Gynecologic Oncology, 133, 95-96. doi:10.1016/j.ygyno.2014.03.254
- Symanowski, J. T., Nguyen, B., Naumann, R. W., Kuo, P. H., Heertum, R. L., & Bateman, D. (2014). A pilot study assessing interreader variability in the evaluation of folate receptor status of ovarian cancer patients using 99mTc-etarfolatide. The Journal of Nuclear Medicine, 55, 1435-1435.More info1435 Objectives The folate receptor (FR) is a therapeutic target as it is expressed in many tumors, such as ovarian cancer (OC). To identify patients who may respond to FR-targeting cytotoxics, 99mTc-etarfolatide, a folate-99mTc conjugate that can noninvasively identify FR expression by SPECT, was developed. 99mTc-etarfolatide’s utility to guide patient selection for FR-targeted cytotoxics, including vintafolide, a small-molecule drug conjugate of folate and a vinca alkaloid, is currently being assessed in clinical trials. This multireader variability study evaluated the reliability of FR status assessment in OC patients based on 99mTc-etarfolatide imaging. Methods After the etarfolatide training program, 5 nuclear medicine experienced radiologists independently read CT and 99mTc-etarfolatide SPECT scans from 60 patients. 99mTc-etarfolatide uptake in each target lesion (selected using RECIST 1.1) was assessed and an FR score was calculated for each patient (ie, # FR-positive lesions/total # target lesions). The primary objective was to assess interreader agreement by determining Fleiss’ kappa statistic for different FR threshold patient subgroups (FR[%]). The secondary objective was to determine pairwise agreement. Results Results are summarized in the table. The 5-reader agreement and pairwise agreement was substantial for the FR(100%) threshold (77% [0.69 Fleiss’ kappa] and 89% [0.69 Cohen’s kappa], respectively). Conclusions 99mTc-etarfolatide imaging is a reproducible way to identify FR-positive patients. This study supports the real-world applicability of published clinical trial data demonstrating that 99mTc-etarfolatide imaging is a robust tool to identify OC patients who most likely will benefit from vintafolide treatment.
- Symanowski, J. T., Sparks, R. B., Nguyen, B., Kuo, P. H., & Harb, W. A. (2014). Biodistribution and safety of the folate receptor imaging agent 99mTc-etarfolatide: Phase 1 trial in healthy volunteers. The Journal of Nuclear Medicine, 55, 228-228.More info228 Objectives The folate receptor (FR) is a promising molecular target for cancer therapy as it is expressed by many epithelial cancers and not in most healthy cells. Vintafolide, a small-molecule drug conjugate of folate and a potent vinca alkaloid, is currently being evaluated in clinical trials. 99mTc-etarfolatide, a folate-based imaging agent, can noninvasively identify FR-positive lesions and may help to identify patients who could benefit from vintafolide. This phase 1 trial aimed to determine the safety/tolerability and biodistribution/excretion of 99mTc-etarfolatide in the presence/absence of folic acid (FA) preinjections in healthy volunteers. Methods Participants (n=20) received 99mTc-etarfolatide with no FA (0.1 mg IV, 20-25 mCi) on day 1 (image timepoint 1). Before the second dose (on day 5, 6, or 7; image timepoint 2) they received 0.5 mg (n=11) or 1.0 mg (n=9) IV FA. Participants underwent whole-body planar imaging (timepoint 1: at 1 hr; timepoint 2: at 5 min and 1, 4, 6-8, 20-24 hr) and SPECT scan (chest, abdomen, and pelvis; both timepoints: at 1-1.5 hr postinjection). Blood and urine samples for hematology, serum, and urinalysis analyses were obtained at multiple timepoints. Adverse events were registered for 4 days. Results The liver (17%) and red marrow (16%) had the highest peak 99mTc-etarfolatide uptake (timepoint 2). The largest dose equivalent was received by the urinary bladder wall and kidneys (0.026 and 0.025 mSv/MBq). The mean effective dose was 0.0076 mSv/MBq. 99mTc-etarfolatide’s α clearance half-life was 26.9 min. The kidneys were the major route of elimination (41% recovery/24 hr). FA preinjection decreased radiation exposure in most organs, but the higher FA dose did not greatly impact dosimetry values. In all cases, the blinded nuclear medicine radiologist scored the overall global background uptake in organs as lower on scans where patients received FA preinjection. 99mTc-etarfolatide was well tolerated. Conclusions In healthy volunteers,99mTc-etarfolatide distributes mainly to the bladder, kidneys, and liver. A FA pre-injection reduces background uptake in organs and therefore potentially optimizes 99mTc-etarfolatide imaging of tumors.
- Truong, D., Schaecher, K. L., Riley, D. E., Rezak, M., Oberdorf, J. A., Kuo, P. H., Johnson, M. K., Jarecke, C. R., Grachev, I. D., Fine, M. J., & Cummings, J. L. (2014). Effective and efficient diagnosis of parkinsonism: the role of dopamine transporter SPECT imaging with ioflupane I-123 injection (DaTscan™).. The American journal of managed care, 20(5 Suppl), S97-109.More infoParkinson's disease (PD), the second-most common neurodegenerative disease, is characterized by motor and nonmotor symptoms. PD is often misdiagnosed; inappropriate treatment due to misdiagnosis has undesired consequences, as does delayed diagnosis. Unfortunately, most people with PD receive a diagnosis only after motor symptoms have emerged, by which time 40% to 60% of dopamine neurons have already been lost. Advances in imaging techniques have provided clinicians with increasingly sophisticated tools. In 2011, the US Food and Drug Administration approved ioflupane I-123 injection (DaTscanTM) for striatal dopamine transporter visualization using single-photon emission computed tomography (SPECT) imaging, which provides an effective tool for assessing striatal dopaminergic deficiency. Among patients with suspected parkinsonian syndromes, of which PD is one, the diagnostic sensitivity and specificity of DaTscan SPECT imaging are high. In clinical studies that were part of the DaTscan new drug application, no serious drug-related adverse events reported by the 1236 participants were attributed to DaTscan. The introduction of DaTscan imaging and its utility necessitate the development of clinical recommendations for appropriate use; thus, a multidisciplinary panel of experts was convened to develop clinical criteria and algorithms to help guide clinicians and managed care organizations in the application of DaTscan SPECT imaging. Based on the consensus of this expert panel, appropriate use of DaTscan SPECT imaging includes cases where: (1) PD diagnosis is uncertain; (2) tremor of uncertain etiology is present; and (3) nonmotor and/ or supportive symptoms and features associated with PD are present but the classical motor syndrome is absent or atypical.
- Yi, S. K., Kratz, S. L., Gernon, T. J., Erman, A. B., Khan, R., Avery, R. J., Aly, F. Z., Kuo, P. H., Cheung, M. K., & Georgiev, G. (2014). Morbidity Associated with False-Positive Findings in Post-Treatment Positron Emission Tomography/Computed Tomography in Chemoradiation Treated Head and Neck Cancer Patients. J J Rad Oncol, 1(2).
- Kuo, P. H., Avery, R., Krupinski, E., Lei, H., Bauer, A., Sherman, S., McMillan, N., Seibyl, J., & Zubal, G. (2013). Receiver-operating-characteristic analysis of an automated program for analyzing striatal uptake of 123I-ioflupane SPECT images: calibration using visual reads. Journal of nuclear medicine technology, 41(1), 26-31.More infoA fully automated objective striatal analysis (OSA) program that quantitates dopamine transporter uptake in subjects with suspected Parkinson's disease was applied to images from clinical (123)I-ioflupane studies. The striatal binding ratios or alternatively the specific binding ratio (SBR) of the lowest putamen uptake was computed, and receiver-operating-characteristic (ROC) analysis was applied to 94 subjects to determine the best discriminator using this quantitative method.
- Kuo, P., Avery, R., & Kuo, P. H. (2013). 18F sodium fluoride PET/CT detects osseous metastases from breast cancer missed on FDG PET/CT with marrow rebound. Clinical nuclear medicine, 38(9).More infoIntense FDG uptake by bone marrow following recent chemotherapy limits evaluation for osseous metastases. The impact of marrow rebound on accuracy of (18)F-fluoride PET/CT is unclear. A 73-year-old woman with breast cancer presented for restaging FDG PET/CT, which showed intense activity throughout almost the entire axial skeleton and no osseous metastases. An (18)F-fluoride PET/CT performed 7 days later identified multiple osseous metastases in the spine, ribs, and pelvis. This case demonstrates that (18)F-fluoride PET/CT should be considered for the evaluation of osseous metastases in patients with rebound marrow uptake on FDG PET/CT.
- Kuo, P., Covington, M. F., McMillan, N. A., Avery, R. J., & Kuo, P. H. (2013). The semicolon sign: dopamine transporter imaging artifact from head tilt. Journal of nuclear medicine technology, 41(2).More infoDopamine transporter (DAT) imaging is a valuable tool to aid in the diagnosis of Parkinson disease and other Parkinsonian syndromes. DAT imaging is special among clinical nuclear medicine scans in that the already small caudate and putamen are presented in multiple thin axial cuts. Because the imaged basal ganglia are small, slight differences in head tilt may result in a significant artifact that we have termed the semicolon sign. The semicolon sign occurs when forward head tilt creates select images that show the caudate nuclei separate from the putamen. This gives the false impression that DAT activity in the putamen is decreased or absent. To avoid falsely attributing this artifact to loss of putaminal activity, it is imperative that the interpreting physician first recognize the artifact and then mentally integrate all provided images to identify normal activity in the putamen on subsequent levels. Furthermore, quantitative software packages for automated DAT scan interpretation are now available. If images demonstrating the semicolon sign are used for automated interpretation, loss of activity in the putamen may be falsely calculated, thereby contributing to erroneous results. Quality control measures are essential to ensure that technologists correctly position each patient's head to minimize head tilt artifact on DAT scan images. A protocol to obtain optimal head positioning is presented.
- Kuo, P., Kuo, P. H., Anavy, N. D., Desai, C. S., & Avery, R. (2012). Wandering kidney in dual-kidney transplant recipient presents a pitfall in the interpretation of renal scintigraphy. Journal of nuclear medicine technology.More infoA 26-y-old patient with end-stage renal disease and recent dual transplantation of cadaveric kidneys en bloc presented with increasing abdominal pain and a rising level of serum creatinine. An anterior-view (99m)Tc-mercaptoacetyltriglycine renogram demonstrated the typical overlap of the lower pole of the superior kidney and the upper pole of the inferior kidney. The renogram was consistent with vasomotor nephropathy. Subsequent imaging 1 wk later for worsening symptoms demonstrated a single reniform structure in the expected location of the inferior transplanted kidney, which was interpreted as a loss of perfusion to the superior kidney. Correlation with subsequent CT and sonography showed normal perfusion to both transplanted kidneys and that the superior kidney had wandered inferiorly, completely overlapping the inferior kidney on the anterior projection. The increasing prevalence of dual kidney transplantation warrants special attention to the potential for a wandering kidney.
- Kuo, P., Kuo, P. H., Nawas, M. T., & Kubal, W. S. (2012). Decreased cerebellar activity on FDG PET/CT secondary to diffuse idiopathic cerebellar calcification. Clinical nuclear medicine.More infoCerebellar hypometabolism on FDG PET has been described in several conditions, for example, chronic alcohol abuse, antiepileptic medication use, multiple system atrophy, and cerebellar infarction. Corresponding cross-sectional examination is paramount in distinguishing possible etiologies because each condition has a relatively characteristic appearance. We present a case of an asymptomatic patient with diffuse cerebellar hypometabolism found incidentally on FDG PET/CT performed for suspected recurrence of gastric carcinoma. Accompanying CT images demonstrated calcification of the cerebellum and therefore confirmed the etiology of diffuse idiopathic cerebellar calcification. Identifying this diagnosis is critical for using the cerebellum as a standard to evaluate other brain structures.
- Kuo, P. H. (2009). MRI with Gadolinium-based Contrast Agents in the Era of Nephrogenic Systemic Fibrosis: Review, Controversies, and Suggested Protocols.. Applied Radiology, 38(4), 22-33.More infoKuo PH, Abu-Alfa A, Bucala R, Griffith J, Thompson K, Girardi M, Weinreb J, Cowper SE. MRI with Gadolinium-based Contrast Agents in the Era of Nephrogenic Systemic Fibrosis: Review, Controversies, and Suggested Protocols. Applied Radiology. April 2009, 38(4): 22-33.
- Vakil, V., Sung, J. J., Piecychna, M., Crawford, J. R., Kuo, P., Abu-Alfa, A. K., Cowper, S. E., Bucala, R., & Gomer, R. H. (2009). Gadolinium-Containing Magnetic Resonance Image Contrast Agent Promotes Fibrocyte Differentiation. JOURNAL OF MAGNETIC RESONANCE IMAGING, 30(6), 1284-1288.
- Weinreb, J. C., & Kuo, P. H. (2009). Nephrogenic systemic fibrosis. Magnetic resonance imaging clinics of North America, 17(1), 159-67.More infoThere seems to be an association between exposure to intravenous gadolinium-based contrast agents (GBCAs) and nephrogenic systemic fibrosis (NSF), a debilitating and sometimes fatal disease. This article addresses the relationship between GBCAs and NSF and answers some common questions. The policy deployed at Yale-New Haven Hospital for prevention of NSF and screening for patients at risk is delineated and discussed along with recommendations by the Food and Drug Administration.
- Kuo, P. H. (2008). (Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography) FDG-PET/CT for Planning of Radiation Therapy. Applied Radiology, 37(8), 1-23.More infoKuo PH, Chen Z, and Weidhaas J. (Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography) FDG-PET/CT for Planning of Radiation Therapy. Applied Radiology. 37(8), Aug 2008: 1-23.
- Kuo, P. H. (2008). Gadolinium-containing MRI contrast agents: important variations on a theme for NSF. Journal of the American College of Radiology : JACR, 5(1), 29-35.More infoMillions of doses of gadolinium-based contrast agents (GBCAs) are administered annually to improve the clinical utility of magnetic resonance imaging. All the approved agents incorporate one atom of the rare earth metal gadolinium into a chelate to improve the safety of the ordinarily toxic free gadolinium. The undeniable epidemiologic link between GBCAs and nephrogenic systemic fibrosis (NSF) has prompted renewed investigation into the different chemical properties of the GBCAs despite their clinical interchangeability. Gadolinium-based contrast agents can be divided into different categories: linear versus macrocyclic structure, ionic versus nonionic, and non-protein-binding versus protein-binding agents. The GBCAs differ significantly with respect to transmetallation and kinetic and thermodynamic stability and therefore their propensity to release free gadolinium, which is hypothesized to induce NSF. That gadodiamide, with its susceptibility to transmetallation and relatively low thermodynamic and kinetic stability, is associated with the most cases of NSF supports this hypothesis. On the other hand, the greater stability of a macrocyclic agent hypothetically would confer a greater safety margin with regard to NSF. Because few published data on an experimental model of NSF exist, continuing vigilance is necessary to report new cases of NSF, especially with regard to the agents with small market share.
- Kuo, P. H. (2008). NSF-active and NSF-inert species of gadolinium: mechanistic and clinical implications. AJR. American journal of roentgenology, 191(6), 1861-3.
- McEachen, J. C., & Kuo, P. H. (2008). Male primary breast cancer found on FDG-PET/CT. Clinical nuclear medicine, 33(9), 630-2.
- Tomihama, R. T., McEachen, J. C., & Kuo, P. H. (2008). Imaging of systemic mastocytosis by FDG-PET/CT demonstrates increased activity in cortical bone. Clinical nuclear medicine, 33(3), 220-3.
- Hathaway, T., Subtil, A., Kuo, P., & Foss, F. (2007). Efficacy of denileukin diftitox in subcutaneous panniculitis-like T-cell lymphoma. Clinical lymphoma & myeloma, 7(8), 541-5.More infoSubcutaneous panniculitis-like lymphomas (SPTCLs) are a heterogeneous group of diseases characterized by pleomorphic lymphocytes infiltrating the subcutis in a lobular panniculitis-like pattern. Characterization of SPTCL based on T-cell phenotype has prognostic significance in that most patients with the alpha/beta T-cell phenotype of SPTCL demonstrate clinically indolent behavior, whereas those with gamma/delta variant typically manifest more aggressive disease. In the past, traditional therapies have included single-agent or systemic multi-agent chemotherapy with or without radiation therapy, immunosuppressive therapies, or, in refractory patients, bone marrow transplantation. We describe complete clinical regression of disease and a median response duration of > 6 months in 2 patients with SPTCL treated with corticosteroids and denileukin diftitox. Furthermore, the addition of bexarotene to denileukin diftitox restored a clinical response in 1 of the patients after disease progression, suggesting the activity of this combination in patients with SPTCL.
- Kuo, P. H., & Shin, M. S. (2007). Images in clinical medicine. Pulmonary and peritoneal ossification. The New England journal of medicine, 356(17), e16.
- Kuo, P. H., Cowper, S. E., & Bucala, R. (2007). Nephrogenic systemic fibrosis and gadolinium exposure: association and lessons for idiopathic fibrosing disorders.. Arthritis and rheumatism, 56(10), 3173-5. doi:10.1002/art.22926
- Kuo, P. H., Kanal, E., Abu-Alfa, A. K., & Cowper, S. E. (2007). Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology, 242(3), 647-9.
- Shetty-alva, N., Shetty, T., Novotny, E. J., & Kuo, P. H. (2007). Positron emission tomography in Rasmussen's encephalitis.. Pediatric neurology, 36(2), 112-4. doi:10.1016/j.pediatrneurol.2006.07.012More infoThis report presents unusual positron emission tomography findings in an 11-year-old male with Rasmussen's encephalitis. This patient underwent fluorine-18 fluorodeoxyglucose positron emission tomography to localize his ictal focus before surgical consideration. Positron emission tomography disclosed marked hypermetabolism in the left cerebral hemisphere and basal ganglia with subnormal right cerebral activity and crossed cerebellar diaschisis. The heterogeneous distribution of metabolism suggests a combination of areas in different stages of ictal and postictal involvement. The hypermetabolic region in the left hemisphere was larger in size and extent (now including the left frontoparietal lobe) than the sole hypermetabolic left temporal lobe on his positron emission tomography from 2 years ago. While this positron emission tomography pattern of progression appears most commonly in Rasmussen's encephalitis case studies, few serial reports exist. The complex positron emission tomography findings of this case emphasize the importance of knowing the history of recent seizures, seizure type, clinical status at time of injection, and electroencephalographic correlation before interpreting functional neuroimaging studies. Finally, positron emission tomography studies can help clarify whether patients with Rasmussen's encephalitis with dominant hemisphere involvement are appropriate candidates for surgery or not.
- Kuo, P. H., Cooper, D. L., & Cheng, D. W. (2006). Recurrence of lymphoma presenting as asymmetrically increased testicular activity on FDG-PET/CT. Seminars in nuclear medicine, 36(1), 105-7.
- Kuo, P. H., Monchamp, T., & Deol, P. (2006). Imaging of inflammation in Graves' ophthalmopathy by positron emission tomography/computed tomography. Thyroid : official journal of the American Thyroid Association, 16(4), 419-20.
- Kuo, P. H., Spooner, S., Deol, P., & Monchamp, T. (2006). Metastatic inflammatory myofibroblastic tumor imaged by PET/CT. Clinical nuclear medicine, 31(2), 106-8.
- Kuo, P. H., & Cheng, D. W. (2005). Artifactual spinal metastases imaged by PET/CT: a case report. Journal of nuclear medicine technology, 33(4), 230-1.More infoA 55-y-old patient with multiple myeloma presented for restaging after chemotherapy and radiation. The patient had undergone vertebroplasty of multiple thoracic vertebrae because of painful compression fractures. The 18F-FDG PET images showed increased activity at the T8 and T10-T12 vertebral bodies. Comparison of the attenuation-corrected and non-attenuation-corrected images demonstrated that the activity was due to an artifact of attenuation correction. The CT scan correlated the sites of vertebroplasty to the 4 foci of increased uptake of 18F-FDG. The increasing use of vertebroplasty for malignant spinal fractures warrants vigilance for this artifact.
- Kuo, P. H., Cheng, D. W., & Sadar, R. (2005). Diagnosis of septic joint in an immunosuppressed patient by twenty-four hour delayed imaging with Tc-99m HMPAO labeled white blood cell scan. Clinical nuclear medicine, 30(12), 808-9.
- Kuo, P. H., & Nakamoto, R. K. (2000). Intragenic and intergenic suppression of the Escherichia coli ATP synthase subunit a mutation of Gly-213 to Asn: functional interactions between residues in the proton transport site. The Biochemical journal, 347 Pt 3, 797-805.More infoSubunit a of the ATP synthase F(o) sector contains a transmembrane helix that interacts with subunit c and is critical for H(+) transport activity. From a cysteine scan in the region around the essential subunit a residue, Arg-210, we found that the replacement of aGly-213 greatly attenuated ATP hydrolysis, ATP-dependent proton pumping and Delta mu(H)+-dependent ATP synthesis. Various amino acid substitutions caused similar effects, suggesting that functional perturbations were caused by altering the environment or conformation of aArg-210. aG213N, which was particularly severe in effect, was suppressed by two second-site mutations, aL251V and cD61E. These mutations restored efficient coupling; the latter also increased ATP-dependent proton transport rates. These results were consistent with the proposed functional interaction between aArg-210 and cAsp-61, the likely carrier of the transported proton. From Arrhenius analysis of steady-state ATP hydrolytic activity, the transport mutants had large increases in the transition-state enthalpic and entropic parameters. Linear isokinetic relationships demonstrate that the transport mechanism is coupled to the rate-limiting catalytic transition-state step, which we have previously shown to involve the rotation of the gamma subunit in multi-site, co-operative catalysis.
- Peskova, Y. B., Nakamoto, R. K., Kuo, P. H., Ketchum, C. J., & Al-shawi, M. K. (2000). Molecular mechanisms of rotational catalysis in the F(0)F(1) ATP synthase.. Biochimica et biophysica acta, 1458(2-3), 289-99. doi:10.1016/s0005-2728(00)00081-5More infoRotation of the F(0)F(1) ATP synthase gamma subunit drives each of the three catalytic sites through their reaction pathways. The enzyme completes three cycles and synthesizes or hydrolyzes three ATP for each 360 degrees rotation of the gamma subunit. Mutagenesis studies have yielded considerable information on the roles of interactions between the rotor gamma subunit and the catalytic beta subunits. Amino acid substitutions, such as replacement of the conserved gammaMet-23 by Lys, cause altered interactions between gamma and beta subunits that have dramatic effects on the transition state of the steady state ATP synthesis and hydrolysis reactions. The mutations also perturb transmission of specific conformational information between subunits which is important for efficient conversion of energy between rotation and catalysis, and render the coupling between catalysis and transport inefficient. Amino acid replacements in the transport domain also affect the steady state catalytic transition state indicating that rotation is involved in coupling to transport.
- Kuo, P. H., Ketchum, C. J., & Nakamoto, R. K. (1998). Stability and functionality of cysteine-less F(0)F1 ATP synthase from Escherichia coli. FEBS letters, 426(2), 217-20.More infoAll 21 native cysteines in the Escherichia coli F(0)F1 ATP synthase were replaced by alanines. In isolated E. coli membranes, ATP-dependent proton pumping, turnover of ATP hydrolysis and steady-state transition state thermodynamic parameters of the cysteine-less enzyme were similar to wild-type. The cysteine-less enzyme was solubilized in n-octyl beta-D-glucopyranoside, purified by affinity chromatography, and reconstituted into pre-formed liposomes made from E. coli lipids. The properties of the reconstituted, purified enzyme were not significantly different from the membranous enzyme. These data demonstrate that cysteine-less F(0)F1 is biochemically stable and has functionality similar to wild-type.
- Rye, R., Kuo, P. H., & Holland, H. D. (1995). Atmospheric carbon dioxide concentrations before 2.2 billion years ago.. Nature, 378(6557), 603-5. doi:10.1038/378603a0More infoThe composition of the Earth's early atmosphere is a subject of continuing debate. In particular, it has been suggested that elevated concentrations of atmospheric carbon dioxide would have been necessary to maintain normal surface temperatures in the face of lower solar luminosity in early Earth history. Fossil weathering profiles, known as palaeosols, have provided semi-quantitative constraints on atmospheric oxygen partial pressure (pO2) before 2.2 Gyr ago. Here we use the same well studied palaeosols to constrain atmospheric pCO2 between 2.75 and 2.2 Gyr ago. The observation that iron lost from the tops of these profiles was reprecipitated lower down as iron silicate minerals, rather than as iron carbonate, indicates that atmospheric pCO2 must have been less than 10(-1.4) atm--about 100 times today's level of 360 p.p.m., and at least five times lower than that required in one-dimensional climate models to compensate for lower solar luminosity at 2.75 Gyr. Our results suggest that either the Earth's early climate was much more sensitive to increases in pCO2 than has been thought, or that one or more greenhouse gases other than CO2 contributed significantly to the atmosphere's radiative balance during the late Archaean and early Proterozoic eons.
Proceedings Publications
- Auer, B., Zeraatkar, N., De Beenhouwer, J., Kalluri, K., Furenlid, L., Kuo, P. H., & King, M. (2019, June). Investigation of a Monte Carlo simulation and an analytic-based approach for modeling the system response for clinical I-123 brain SPECT imaging. In 15th International Meeting on Fully Three-Dimensional Image Reconstruction in Radiology and Nuclear Medicine, Fully3D 2019, 11072.More infohttps://doi.org/10.1117/12.2534881
- Kalluri, K., Zeraatkar, N., Auer, B., Kuo, P. H., Furenlid, L., & King, M. (2019, June). Preliminary investigation of AdaptiSPECT-C designs with square or square and hexagonal detectors employing direct and oblique apertures. In 15th International Meeting on Fully Three-Dimensional Image Reconstruction in Radiology and Nuclear Medicine, Fully3D 2019, 11072.More infohttps://www.spiedigitallibrary.org/conference-proceedings-of-spie/11072/2534885/Preliminary-investigation-of-AdaptiSPECT-C-designs-with-square-or-square/10.1117/12.2534885.full
- Witte, M. H., Mustacich, D., Moedano, L., Behan, S., Bernas, M. J., Klewer, S. E., Barber, B. J., Kuo, P. H., & Kylathu, R. (2019, September). Whole Body Lymphangioscintigraphy and SPECT-CT in Infants and Children with Lymphatic Congestion after Surgical Repair of Complex Congenital Heart Disease. In 27th World Congress of Lymphology Abstract Booklet.
- Zeraatkar, N., Auer, B., Kalluri, K., Furenlid, L., Kuo, P. H., & King, M. (2019, June). GPU-accelerated generic analytic simulation and image reconstruction platform for multi-pinhole SPECT systems. In 15th International Meeting on Fully Three-Dimensional Image Reconstruction in Radiology and Nuclear Medicine, Fully3D 2019, 11072.More infohttps://doi.org/10.1117/12.2534523
- Zukotvnski, K., Thiel, A., Tardif, J., Soucy, J., Sossi, V., Smith, E. E., Scott, C. J., Sahlas, J. D., Prato, F. S., Noseworthy, M. D., Laforce, R., Kuo, P. H., Hsiung, R., Goubran, M., Gaudet, V. C., Frayne, R., Chertkow, H., Borrie, M., Bocti, C., , Black, S. E., et al. (2019). Non-Binary Approaches for Classification of Amyloid Brain PET. In 2019 IEEE 49th International Symposium on Multiple-Valued Logic (ISMVL), 206-211.More infoMachine learning (ML) is increasingly used in medical imaging. This paper provides pilot data of decision trees and random forests (RFs) to predict if a 18F-florbetapir brain positron emission tomography (PET) is positive or negative for amyloid deposition based on quantitative data analysis. The dataset included 55 18F-florbetapir brain PETs in participants with severe white matter disease and mild cognitive impairment (MCI), early Alzheimer's disease (AD) or transient ischemic events. The Montreal Cognitive Assessment (MoCA) score was known for each participant. All PET images were processed using the MINC toolkit to extract standardized uptake value ratios (SUVRs) for 59 regions of interest (features). Each PET was clinically read by 2 dual certified radiology/nuclear medicine physicians with final interpretation based on consensus. An initial study of RFs using conventional binary decision trees and PET quantitation suggests this is a powerful algorithm for PET classification as positive or negative for amyloid deposition. Preliminary data did not show improved results when a ternary RF approach was used. Finally, a soft-decision approach may be helpful to predict the $\mathbf{MoCA}$ score.
Presentations
- Kuo, P. H. (2019, December). Brain FDG and Amyloid PET/DAT Scans. Radiological Society of North America (RSNA) Annual Meeting. Chicago, IL: RSNA.
- Kuo, P. H. (2019, February). Challenging PET/CT Cases. American College of Radiology PET/CT Course. Reston, VA.
- Kuo, P. H. (2019, June). Challenging PET/CT Cases. American College of Radiology PET/CT Course. Reston, VA.
- Kuo, P. H. (2019, June). Nuclear Medicine Review of CT/MRI Correlation. Society of Nuclear Medicine and Molecular Imaging Annual Meeting. Anaheim, CA.
- Kuo, P. H. (2019, June). Pearls and Pitfalls of DaTQUANT. Society of Nuclear Medicine and Molecular Imaging Annual Meeting. Anaheim, CA.
- Kuo, P. H. (2019, June). Pearls for Interpreting DaTscan. Society of Nuclear Medicine and Molecular Imaging Annual Meeting. Anaheim, CA.
- Kuo, P. H. (2019, June). Review of Molecular Neuroimaging for Neurodegenerative Disorders. Society of Nuclear Medicine and Molecular Imaging Annual Meeting. Anaheim, CA.
- Kuo, P. H. (2019, March). Brain Scintigraphy. American College of Radiology Nuclear Medicine Course. Reston, VA.
- Kuo, P. H. (2019, March). Nuclear Cardiology. American College of Radiology Nuclear Medicine Course. Reston, VA.
- Kuo, P. H. (2019, March). Radium-223 Therapy. American College of Radiology Nuclear Medicine Course. Reston, VA.
- Kuo, P. H. (2019, March). Renal Scintigraphy. American College of Radiology Nuclear Medicine Course.
- Kuo, P. H. (2019, March). VQ scans and Artifacts. American College of Radiology Nuclear Medicine Course.
- Kuo, P. H. (2019, May). PET/CT of GU Malignancy- Prostate Cancer. American Roentgen Ray Society Annual Meeting. Honolulu, HI.
- Kuo, P. H. (2019, May). Radiology Review of Nuclear Medicine: Abdominal and Musculoskeletal Scintigraphy. American Roentgen Ray Society Annual Meeting. Honolulu, HI.
- Kuo, P. H. (2019, November). Connection between the Lymphatics/Glymphatics of the Central Nervous System and Tai Chi. Invited lecturer Beijing University, Beijing, China. Beijing, China.
- Kuo, P. H. (2019, November). Connection between the Lymphatics/Glymphatics of the Central Nervous System and Tai Chi. Invited lecturer Beijing University. Beijing, China.
- Kuo, P. H. (2019, November). Insights from Brain Imaging into the Mechanisms of the Health Effects of Taijiquan. 1st Annual Meeting of the International Society for Chinese Health Practices- Special Symposium on International Tai Chi Research. Beijing, China.
- Kuo, P. H. (2019, October). Current status of 177Lu-PMSA based therapies and where will we be in the near future. SNMMI Therapeutics Conference: Therapies, Theranostics, and Building Your Radionuclide Clinical Practice. Las Vegas, NV.
- Kuo, P. H. (2019, October). Operationalizing your practice for 177Lu-PMSA based therapies. SNMMI Therapeutics Conference: Therapies, Theranostics, and Building Your Radionuclide Clinical Practice. Las Vegas, NV: SNMMI.
- Kuo, P. H. (2019, October). Optimizing the Visual and Quantitative Interpretation of I-123 Ioflupane SPECT Brain Imaging. Society of Nuclear Medicine and Molecular Imaging and American Roentgen Ray Society Joint Webinar.
- Kuo, P. H. (2019, September). Brain Scintigraphy. American College of Radiology Nuclear Medicine Course.
- Kuo, P. H. (2019, September). Challenging PET/CT Cases. American College of Radiology PET/CT Course. Reston, VA.
- Kuo, P. H. (2019, September). Nuclear Cardiology. American College of Radiology Nuclear Medicine Course. Reston, VA.
- Kuo, P. H. (2019, September). Radium-223 Therapy. American College of Radiology Nuclear Medicine Course. Reston, VA.
- Kuo, P. H. (2019, September). Renal Scintigraphy. American College of Radiology Nuclear Medicine Course.
- Kuo, P. H. (2019, September). VQ scans and Artifacts. American College of Radiology Nuclear Medicine Course.
- Kylathu, R., Kuo, P. H., Barber, B. J., Klewer, S. E., Bernas, M. J., Behan, S., Moedano, L., Mustacich, D., & Witte, M. H. (2019, September). Whole Body Lymphangioscintigraphy and SPECT-CT in Infants and Children with Lymphatic Congestion after Surgical Repair of Complex Congenital Heart Disease. 27th World Congress of Lymphology. Buenos Aires and Iguazu, Argentina: International Society of Lymphology.
- Zukotynski, K., Gaudet, V., Kuo, P. H., Adamo, S., Goubran, M., Scott, C., & Black, S. (2019, January). Random Forests of Amyloid PET May Pinpoint Key Brain Regions Predictive of MoCA Score. Human Amyloid Imaging Conference. Miami, FL.
- Zukotynski, K., Gaudet, V., Kuo, P. H., Adamo, S., Goubran, M., Scott, C., & Black, S. (2019, March). The use of random forests to stratify amyloid brain PET in patients with mild cognitive impairment. Aging and Brain Health, Rotman Research Institute Conference. Toronto, Canada.
- Zukotynski, K., Gaudet, V., Kuo, P. H., Adamo, S., Goubran, M., Scott, C., & Black, S. (2019, March). The use of random forests to stratify amyloid brain PET. Society of Nuclear Medicine and Molecular Imaging Mid-Winter Meeting. Palm Springs, CA.
- Kuo, P. H. (2018, April). Highlighting Anatomic Imaging with Radioactivity: SPECT, PET and Correlative Imaging of the Head and Neck. for American Roentgen Ray Society Annual Meeting.
- Kuo, P. H. (2018, April). Molecular Imaging of Dementia. ,” Sixth Annual Dr. Tapan K. Chaudhuri Lecture at Eastern Virginia Medical School.
- Kuo, P. H. (2018, April). Pitfalls and Artifacts in Nuclear Medicine. Sixth Annual Eastern Virginia Medical School and Radiology Services of Hampton Roads Visiting Professor Lecture.
- Kuo, P. H. (2018, April). Radiology Review of Nuclear Medicine: Abdominal and Musculoskeletal Scintigraphy. American Roentgen Ray Society Annual Meeting.
- Kuo, P. H. (2018, Jan). Interpreting PET Amyloid Imaging and Update on Clinical Trials. Los Angeles Radiological Society 70th Annual Midwinter Radiology & Radiation Oncology Conference & Conjoint Nuclear Medicine Seminar.
- Kuo, P. H. (2018, Jan). Optimizing Performance and Interpretation of Dopamine Transporter SPECT Imaging. Los Angeles Radiological Society 70th Annual Midwinter Radiology & Radiation Oncology Conference & Conjoint Nuclear Medicine Seminar.
- Kuo, P. H. (2018, Jan). Systematic Approach to FDG-PET for Dementia. Los Angeles Radiological Society 70th Annual Midwinter Radiology & Radiation Oncology Conference & Conjoint Nuclear Medicine Seminar.
- Kuo, P. H. (2018, January). Interpretative and Technical Challenges in DaT SPECT Imaging. Society of Nuclear Medicine and Molecular Imaging Mid-Winter Meeting.
- Kuo, P. H. (2018, June). Update on Brain PET. Society of Nuclear Medicine and Molecular Imaging Annual Meeting.
- Kuo, P. H. (2018, Nov). Imaging of Dementia. RSNA.
- Kuo, P. H. (2018, November). PET Imaging of Dementia. RSNA.
- Kuo, P. H. (2018, Sept). DaT scans. Eastern Great Lakes Society of Nuclear Medicine and Molecular Imaging Annual Meeting.
- Kuo, P. H. (2018, Sept). PET and Neurodegenerative Disease. Eastern Great Lakes Society of Nuclear Medicine and Molecular Imaging Annual Meeting.
- Kuo, P. H. (2018, nov). Combining Molecular Imaging of the Brain and Wearable Sensor Technology. Center to Stream Healthcare In Place (NSF C2SHIP) Center Planning Meeting.
- Kuo, P. H. (2017, fall). Challenging PET/CT Cases. American College of Radiology PET/CT Course. Reston, VA: ACR.
- Kuo, P. H. (2017, fall). Interpreting F18-FDG and Strategies for Challenging Cases. American Roentgen Ray Society Symposium: Practical PET/CT: What You Need to Know.. Houston, TX (October 2017).: ARRS.More infoKuo PH: “Interpreting F18-FDG and Strategies for Challenging Cases,” Invited lecturer for American Roentgen Ray Society Symposium: Practical PET/CT: What You Need to Know. Houston, TX (October 2017).
- Kuo, P. H. (2017, fall). Neurodegenerative Disease. Radiological Society of North America (RSNA) Annual Meeting, Chicago, IL, (November 2017)..More infoKuo PH: “Neurodegenerative Disease,” Case-based Review of Nuclear Medicine: PET/CT Workshop-Neuro-PET/CT (In Conjunction with SNMMI), Radiological Society of North America (RSNA) Annual Meeting, Chicago, IL, (November 2017).
- Kuo, P. H. (2017, fall). Update on the Role of Amyloid Imaging and Interpretation. American Roentgen Ray Society Symposium: Practical PET/CT: What You Need to Know.. Houston, TX: ARRS.More infoKuo PH: “Update on the Role of Amyloid Imaging and Interpretation,” Invited lecturer for American Roentgen Ray Society Symposium: Practical PET/CT: What You Need to Know. Houston, TX (October 2017).
- Kuo, P. H. (2017, spring). Approaches to PET Brain Amyloid Interpretation. Society of Nuclear Medicine and Molecular Imaging Mid-Winter Meetin. Phoenix, AZ.
- Kuo, P. H. (2017, spring). CT and MRI Case Reviews: Amyloid and FDG Correlation. Society of Nuclear Medicine and Molecular Imaging Mid-Winter Meeting. Phoenix, AZ: SNMMI.
- Kuo, P. H. (2017, spring). Visual versus Quantitative Analysis of Dopamine Transporter Imaging. Society of Nuclear Medicine and Molecular Imaging Mid-Winter Meeting. Phoenix, AZ: SNMMI.
- Kuo, P. H. (2017, summer). Challenging PET/CT Cases. American College of Radiology PET/CT Course. Reston, VA: ACR.
- Kuo, P. H. (2017, summer). Nuclear Medicine Imaging of Osseous Malignancy. 62nd Nordic Congress of Radiology & 23rd Nordic Congress of Radiography. Reykjavik, Iceland.
- Kuo, P. H. (2017, summer). PET Amyloid Imaging. 62nd Nordic Congress of Radiology & 23rd Nordic Congress of Radiography. Reykjavik, Iceland.
- Kuo, P. H. (2017, summer). PET/CT Update on Amyloid Imaging. American Roentgen Ray Society Annual Meeting. New Orleans, LA: ARRS.
- Kuo, P. H. (2017, winter). Clinical Needs in Brain Imaging. Plenary speaker for 2017 IEEE Nuclear Science Symposium and Medical Imaging Conference. Atlanta, GA (October 2017)..More infoKuo PH: “Clinical Needs in Brain Imaging,” Plenary speaker for 2017 IEEE Nuclear Science Symposium and Medical Imaging Conference. Atlanta, GA (October 2017).
- Kuo, P. H. (2017, winter). FDG-PET/CT Predicts Development of Thyroiditis due to Immunotherapy for Lung Cancer. Radiological Society of North America (RSNA) Annual Meeting, Chicago, IL, (November 2017)..More infoEshghi N, Garland L, Nia E, Krupinski EA and Kuo PH: “FDG-PET/CT Predicts Development of Thyroiditis due to Immunotherapy for Lung Cancer,” Invited scientific talk at Radiological Society of North America (RSNA) Annual Meeting, Chicago, IL, (November 2017).
- Kuo, P. H. (2016, April). Hidden Cost of Cancer Attributable to CT Scans. American Roentgen Ray Society Annual Meeting. Los Angeles, CA: American Roentgen Ray Society.
- Kuo, P. H. (2016, April). Imaging of Dementia. American Roentgen Ray Society Annual Meeting. Los Angeles, CA: American Roentgen Ray Society.
- Kuo, P. H. (2016, April). Optimizing Nuclear Pleuroperitoneal Shunt Imaging. American Roentgen Ray Society Annual Meeting. Los Angeles, CA: American Roentgen Ray Society.
- Kuo, P. H. (2016, June). Challenges and Special Considerations for the Optimal Performance of Dopamine Transporter SPECT Imaging. Society of Nuclear Medicine and Molecular Imaging Annual Meeting. San Diego, CA: Society of Nuclear Medicine and Molecular Imaging.
- Kuo, P. H. (2016, June). Diagnostic performance of the visual reading of 123I-ioflupane DaT SPECT images when assessed with or without quantification in patients with movement disorders or dementia. Society of Nuclear Medicine and Molecular Imaging Annual Meeting. San Diego, CA: Society of Nuclear Medicine and Molecular Imaging.
- Kuo, P. H. (2016, June). Vizamyl In-person Reader Training Workshop. Society of Nuclear Medicine and Molecular Imaging Annual Meeting. San Diego, CA: Society of Nuclear Medicine and Molecular Imaging.
- Kuo, P. H. (2016, March). Challenging PET/CT Cases. American College of Radiology PET/CT Course. Reston, VA: American College of Radiology.
- Kuo, P. H. (2016, May). Quantitative PET: Challenges and Role in Immunotherapies. Arizona Cancer Center Cancer Imaging Program Retreat. Tucson, AZ: Arizona Cancer Center Cancer.
- Kuo, P. H. (2016, May). Rapid, fully automated method for quantitative analysis of PET amyloid scans in Alzheimer’s disease. Arizona Alzheimer’s Consortium Scientific Conference. Phoenix, AZ: Arizona Alzheimer’s Consortium.
- Kuo, P. H. (2016, October). Value of 123I-ioflupane DaT SPECT quantification in the assessment of patients with movement disorders or dementia. Annual Congress of the European Association of Nuclear Medicine. Barcelona, Spain: European Association of Nuclear Medicine.
- Kuo, P. H. (2016, September). Challenging PET/CT Cases. American College of Radiology PET/CT Course. Reston, VA: American College of Radiology.
- Kuo, P. H. (2015, Apr). Evaluation of Dementia. American Roentgen Ray Society Annual Meeting. Toronto, Canada: American Roentgen Ray Society.
- Kuo, P. H. (2015, March). Challenging PET/CT Cases. American College of Radiology PET/CT Course. Reston, VA: American College of Radiology.
- Kuo, P. H. (2015, Sep). Challenging PET/CT Cases. American College of Radiology PET/CT Course. Reston, VA: American College of Radiology.
- Kuo, P. H., & Kuo, P. H. (2015, December). List of presentations. Please see attached.
Poster Presentations
- Granados, J., Pagel, M., Yi, S. K., Kuo, P. H., Randtke, E. A., Granados, J., Pagel, M., Yi, S. K., Kuo, P. H., & Randtke, E. A. (2017, September 13-16). Comparisons of Non-linear Bloch Fitting and MRI Fingerprinting for acidoCEST MRI. World Molecular Imaging Congress (WMIC). Philadelphia, PA: World Molecular Imaging Society (WMIS).
- Kuo, P. H. (2017, fall). Lymphangioscintigraphy Patterns of Lymphedema in Gynecologic Cancer and Related Disorders. 26th International Congress of Lymphology.. Barcelona, Spain: 26th International Congress of Lymphology.
- Kuo, P. H. (2017, fall). Whole Body Lymphangioscintigraphy and SPECT-CT in Infants and Children with Chylous Reflux after Surgical Correction of Congenital Heart Disease. Whole Body Lymphangioscintigraphy and SPECT-CT in Infants and Children with Chylous Reflux after Surgical Correction of Congenital Heart Disease. Barcelona, Spain.More infoBehan S, Barber B, Witte M, Kuo P, Bedrick A, Klewer S, Braunhut S, Livingston J, Brown M, Avery R, and Bernas M: “Whole Body Lymphangioscintigraphy and SPECT-CT in Infants and Children with Chylous Reflux after Surgical Correction of Congenital Heart Disease,” 26th International Congress of Lymphology. Barcelona, Spain. Sept. 25-30, 2017.
- Kuo, P. H., & Witte, M. H. (2015, Sep). Whole Body Lymphangioscintigraphy and SPECT-CT in Neonates, Infants and Small Children with Chylous Reflux Syndromes. 25th World Congress of Lymphology. San Francisco, CA.
- Kuo, P. H., Covington, M., & McMillan, N. (2015, may). Trends for Reimbursement of Dopamine Transporter Imaging from Past to Present. American College of Radiology Annual Conference. Washington DC: American College of Radiology.
- Kuo, P. H., Gonzalez, V. J., Grow, J., Choudhary, G., & Livingston, R. B. (2015, Dec). Incidence of Internal Mammary Node, Sternum, and Manubrium Failure as Detected by FDG-18 PET/CT. San Antonio Breast Cancer Symposium. San Antonio, TX.
- Kuo, P. H., John, S., & Reininger, C. (2015, Jan). Early Experience with the High Contrast Novel B-Amyloid Tracer 18F NAV4694 Correlation of Visual Interpretation with Clinical and Quantitative Parameters. Human Amyloid Imaging Conference. Miami, FL.
- Kuo, P. H., Kubal, W. S., & Chaudhary, G. (2015, Sep). Nuclear Imaging for Determination of Brain Death: Primer for the Emergency Radiologist. American Society of Emergency Radiology Annual Meeting. Miami, FL: American Society of Emergency Radiology.
- Kuo, P. H., Thai, J., & Abidov, A. (2015, May). Nuclear Myocardial Perfusion Imaging Versus Stress Echocardiography in the Pre-operative Evaluation of Patients for Kidney Transplantation. American College of Radiology Annual Conference. Washington DC: American College of Radiology.
- Kuo, P. H., Zubal, G., Alexander, G., Krafft, W., Fitzhugh, M., & Bharadwaj, P. (2015, October). Rapid, fully automated method for quantitative analysis of PET amyloid scans in Alzheimer’s disease. Annual Meeting Society for Neuroscience. Chicago, IL: Society for Neuroscience.
Case Studies
- Kuo, P. H., Covington, M. F., & Sherman, S. (2015. Dementia with Lewy bodies(pp July 29, 2015.).
- Kuo, P. H., & Bauer, A. H. (2012. Previous misdiagnosis of Parkinson disease and inappropriate treatment with placement of deep brain stimulation electrodes(pp April 19, 2012).More infoBauer A and Kuo PH. Previous misdiagnosis of Parkinson disease and inappropriate treatment with placement of deep brain stimulation electrodes. ACR Case in Point. April 19, 2012.
Others
- Kuo, P. H., & Fischachs, J. (2019, July). Realization of a 20-year-old Dream: the International Society of Chinese Health Practices. University of Arizona News.More infohttps://uahs.arizona.edu/news/realization-20-year-old-dream-international-society-chinese-health-practices
- Harb, W., Kuo, P., Sparks, R., Binh Nguyen, ., & Symanowski, J. (2014, MAY). Biodistribution and safety of the folate receptor imaging agent Tc-99m-etarfolatide: Phase 1 trial in healthy volunteers. JOURNAL OF NUCLEAR MEDICINE.
- Nawas, M. T., Kubal, W. S., & Kuo, P. H. (2014, SEP). Decreased Cerebellar Activity on FDG PET/CT Secondary to Diffuse Idiopathic Cerebellar Calcification. CLINICAL NUCLEAR MEDICINE.
- Avery, R., & Kuo, P. H. (2013, SEP). F-18 Sodium Fluoride PET/CT Detects Osseous Metastases From Breast Cancer Missed on FDG PET/CT With Marrow Rebound. CLINICAL NUCLEAR MEDICINE.
- Kuo, P., Van Heertum, R., Nguyen, B., Bateman, D., Symanowski, J., & Naumann, R. (2012, MAY). A pilot study assessing interreader variability in the evaluation of folate receptor status of ovarian cancer patients using Tc-99m-etarfolatide. JOURNAL OF NUCLEAR MEDICINE.
- Hur, S., Howell, B., Krupinski, E., & Kuo, P. (2007, MAY). Comparison of three protocols for gallbladder ejection fraction by hepatobiliary scintigraphy. JOURNAL OF NUCLEAR MEDICINE.