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project numbers
Z01 CL-00073-01 DRG
Use of Hypocalcemic Intraarterial Infusion into the Thyroid/
Parathyroid Bed to Localize Occult Parathyroid Adenomas
Z01 CL-00074-01 DRG
Diagnostic Efficacy of Virtual Bronchoscopy
Z01 CL-00075-01 DRG
Morphologic Characterization of Carotid Artery Plaque
Using Virtual Angioscopy
INTRAMURAL RESEARCH PROJECT
Z01 CL-00073-01 DRG
October 1, 1996 to September 30, 1997
Title of Project: Use of Hypocalcemic Intraarterial Infusion into
the Thyroid/
Parathyroid Bed to Localize Occult Parathyroid Adenomas
Principal Investigator: J.L. Doppman, M.D.
DTR, CC, NIH, Bethesda, MD 20892
Other Personnel: M. C. Skarulis, M.D., NIDDK
A. M. Spiegel, M.D., NIDDK
S.J. Marx, M.D., NIDDK
R. Chang, M.D., DR, CC
H.R. Alexander, M.D., NCI
S. Libutti, M.D., NCI
Collaborating Units: NCI, Surg. (H.R. Alexander, M.D., S. Libutti,
M.D.);
NIDDK (A. Spiegel, M.D., S. Marx, M.D., M.C. Skarulis, M.D.);
DRD (J.L. Doppman, M.D., R. Chang, M.D.)
Staff-Years:
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
x (a1) Minors
(a2) Interviews
Summary of Work: Patients with failed parathyroid surgery require
localization prior to subsequent operation. When the noninvasive studies
(computer tomography, US, magnetic resonance imaging, sestamibi) are negative,
arteriography and venous sampling are performed. Venous sampling is the
most accurate of the localizing studies, but it is quite tedious and involves
25 to 30 blood samples. In an attempt to simplify the procedure, we have
begun
to measure elevated levels of parathyroid hormone (PTH) following selective
arteriogram
as a means of localizing parathyroid pathology without the need for parathyroid
venous sampling. Preliminary laboratory evidence demonstrated that nonionic
contrast material perfusing a parathyroid vascular bed results in a similar
release of PTH hyperplastic and adenomatous parathyroid tissue response.
A catheter placed in the SVC obtains samples before and at 20, 40, and 60
seconds after selective arteriography of the internal mammary artery, inferior
thyroid artery and superior thyroid artery. A 1.4 x elevation of PTH on
the 20- to 40-second samples localizes parathyroid pathology to the distribution
of the injected vessel.
We have just reported results for our first 20 patients. The test was positive in 15 (75%), which could have obviated the need for parathyroid venous sampling. However, all patients will undergo routine venous sampling until the specificity of the arterial stimulation is determined. There have been no complications associated with this protocol and continued accrual of all patients needing invasive parathyroid localization is planned. (Return to project list.)
Z01 CL-00074-01 DRG
October 1, 1996 to September 30, 1997
Title of Project: Diagnostic Efficacy of Virtual Bronchoscopy
Principal Investigator: J. Shelhamer, M.D.
CCM, CC, NIH, Bethesda, MD 20892
Other Personnel: R.M. Summers, M.D., Ph.D., DR, CC
M. Sneller, M.D., NIAID
S. Holland, M.D., NIAID
Collaborating Units: NIAID; CCM, CC; Depart. of Pulmonary Medicine,
DC Veteran's Administration Hospital
Staff-Years:
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors
(a2) Interviews
Summary of Work: This project is a test of the efficacy of a new
diagnostic method for imaging the airways known as virtual bronchoscopy.
Virtual bronchoscopy is performed
by acquiring thin-section computed tomography (CT) images of the chest.
These images
are used to generate a three-dimensional model of the tracheal and bronchial
walls on a graphics workstation. The model can be manipulated to allow the
viewer to "fly through"
the tracheobronchial tree providing views similar to those obtained during
bronchoscopy.
The technique produces a display of the human bronchial system in a readily
understood format. Moreover, it allows investigation of post-stenotic portions
of the bronchial tree that are beyond the reach of fiber-optic bronchoscopy.
The patients in this protocol have inflammatory, infectious, or neoplastic
pulmonary processes and would have had chest CT for clinical reasons. Over
the past 2 years, we have developed software techniques for navigating inside
virtual bronchoscopy studies and have developed image processing techniques
to improve the efficiency and accuracy of these studies. We are also in
the process of accruing patients who have had both fiber optic bronchoscopy
and virtual bronchoscopy in order
to compare the two methods. We have performed a descriptive analysis of
cavitary lung lesions. Finally, we have developed automated techniques to
assist physicians in locating
and characterizing endobronchial lesions. We anticipate that virtual bronchoscopy
will
be diagnostically efficacious for disorders that produce a morphologic alteration
of
bronchial anatomy. (Return to project list.)
Z01 CL-00075-01 DRG
October 1, 1996 to September 30, 1997
Title of Project: Morphologic Characterization of Carotid Artery
Plaque Using
Virtual Angioscopy
Principal Investigator: R.M. Summers, M.D., Ph.D.
DR, CC, NIH, Bethesda, MD 20892
Other Personnel: P. Choyke, M.D., DRG, CC
M. Gomes, M.D.
J. Hoeg, M.D., NHLBI
Collaborating Units: NHLBI (J. Hoeg, M.D.); Depart. of Surgery,
Georgetown Univ.
(M. Gomes, M.D.)
Staff-Years:
Human Subjects: x (a) Human subjects x (b) Human tissues (c) Neither
(a1) Minors
x (a2) Interviews
Summary of Work: This project is an exploratory study of the efficacy
of a new diagnostic method for evaluating the vasculature known as virtual
angioscopy (VA). VA is
performed by acquiring high-resolution images of the blood vessels of interest,
using
either computed tomography (CT) or magnetic resonance (MR) images. These
images
are used to generate a three-dimensional (3-D) model of the blood vessel
wall on a graphics workstation. The model can be manipulated to allow the
viewer to "fly through" the blood vessel, providing views similar
to those obtained during angioscopy. The technique produces a display of
human arterial and venous anatomy in a readily understood format. Moreover,
it may allow investigation of vascular stenosis and atherosclerotic plaques.
Research in the literature suggests that plaque morphology may be an important
determinant of the incidence of stroke and transient ischemic attack. Patients
studied in this protocol will have known atherosclerotic plaque in the region
of the carotid bulb and will have been referred for carotid endarterectomy.
The surgery will be done at Georgetown University Hospital and the imag-
ing will be done in the NIH Clinical Center Department of Radiology. The
study design consists of high-resolution MR scanning of the neck followed
by 3-D surface rendering of the carotid arteries. Plaque morphology determined
by virtual angioscopy will be compared with detailed pathologic analysis
and with carotid ultrasound and angiography. This will be the first evaluation
of the sensitivity and specificity of MRI VA, and it is a necessary step
for later evaluations of plaque morphology. We anticipate that VA will yield
new insights
into plaque morphologic features that may relate to acute cerebral events.
This project was approved in July 1997 and has not yet accrued patients.
(Return to project list.)
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Questions about the Clinical Center? OCCC@nih.gov Or call: (301) 496-2563 National Institutes of Health, Warren Grant Magnuson Clinical Center, Bethesda, Maryland 20892. Last Modified 3/98 |