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Biomedical subjects

C B Higgins

Publications and source records attributed to C B Higgins.

At least 235 records · Page 13Linked to original sources
PubMed1989

Demarcation of myocardial ischemia: magnetic susceptibility effect of contrast medium in MR imaging.

Dysprosium diethylenetriamine-pentaacetic acid-bis (methylamide) (DTPA-BMA), a new nonionic contrast medium for magnetic resonance (MR) imaging, produces signal loss on T2-weighted images because of induced magnetic field gradients. The potential of this agent to delineate myocardial ischemia was investigated in 10 rats with acute (30 minutes) occlusion of the left coronary artery. T2-weighted MR images were acquired before and for 1 hour after intravenous administration of 1 mmol/kg of Dy-DTPA-BMA. Before administration of the contrast medium, signal intensity (SI) in the ischemic region was significantly greater than that in the normal myocardium; however, the borders of the ischemic region were not consistently distinct. The contrast medium caused marked decrease in SI of normal myocardium (18% +/- 3% of the control value), only slight decrease in the jeopardized region (76% +/- 6% of the control value), and no discernible effects on heart rate or blood pressure. Substantial contrast between normal and ischemic myocardium persisted for 1 hour. Moderate signal loss was observed in skeletal muscle. Dy-DTPA-BMA has the potential to demarcate the myocardial area in jeopardy as a region of high signal intensity because it erases signal preferentially in the normal myocardium.

Animals↗
PubMed1989

Verapamil preserves myocardial performance and energy metabolism in left ventricular hypertrophy following ischemia and reperfusion. Phosphorus 31 magnetic resonance spectroscopy study.

While calcium entry blockers have a beneficial influence on the postischemic recovery of the nonhypertrophied heart, their influence on the hypertrophied heart has not been determined. The aim of this study was to assess postischemic recovery of myocardial performance and energy metabolites in rat hearts with left ventricular hypertrophy pretreated either chronically or acutely with verapamil. Left ventricular hypertrophy was induced by suprarenal constriction of the abdominal aorta. Hemodynamics and phosphorus 31 magnetic resonance spectra were monitored simultaneously in the isolated hearts during control perfusion, after 30 minutes of global ischemia, and after 30 minutes of reperfusion. All hypertrophied hearts had significantly higher rate-pressure products than normal hearts. Compared with normal hearts, oxygen consumption was significantly lower in all hypertrophied hearts, especially untreated hypertrophied hearts. Also, before ischemia all normal or hypertrophied hearts (treated or untreated) began with comparable phosphorylation potentials (i.e., the supply of energy was not significantly different). Postischemic recovery was not related to energy supply-oxygen demand before onset of ischemia. Furthermore, it was not related to energy levels or intracellular pH during ischemia. For postischemic recovery, the rate-pressure product was 40 +/- 5% in the hypertrophied heart, 83 +/- 5% in the normal, 100 +/- 3% in the hypertrophied heart chronically treated with verapamil, and 82 +/- 5% in the hypertrophied heart acutely treated with verapamil. The degree of recovery was related to coronary flow both before and after ischemia. The latter is important for flushing deleterious metabolites and ions from the interstitial space as well as for delivery of oxygen and substrate to the myocardium.

Adenosine Triphosphate↗
PubMed1989

Comparison of cine MR imaging with Doppler echocardiography for the evaluation of aortic regurgitation.

Regurgitant blood flow is associated with localized signal loss of the blood pool within the recipient chamber on cine MR images, which may be useful for assessing regurgitant valvular disease. To evaluate the potential of this technique for determining the severity of aortic regurgitation, multilevel cine MR imaging was performed in 10 normal volunteers and in 25 patients with aortic regurgitation documented and graded for severity by Doppler echocardiography. Cine MR images were analyzed to obtain cardiac chamber volumes and to measure the extent of the signal loss associated with regurgitation. All regurgitant lesions were visualized on cine MR images as areas of diastolic signal loss extending from the aortic valve into the left ventricle. The extent of signal loss and the regurgitant volume determined from analysis of MR images correlated with the echocardiographic severity of the lesion. The total area of diastolic left ventricular signal loss was 0 cm2 in 10 normal volunteers, 24 +/- 13 (+/- SD) cm2 in eight patients with mild aortic regurgitation, 49 +/- 11 cm2 in nine patients with moderate aortic regurgitation, and 62 +/- 20 cm2 in eight patients with severe aortic regurgitation (p less than .05 for moderate and severe vs mild). Left ventricular volumes calculated from MR images correlated well with echocardiographic volumes (r = .92, SEE = 30 ml, p less than .0001). Regurgitant fraction calculated from analysis of cine MR images was 4 +/- 7% in normal volunteers and 31 +/- 8% in mild, 45 +/- 11% in moderate, and 56 +/- 9% in severe aortic regurgitation (p less than .05 for moderate and severe vs mild and normal). Thus, cine MR imaging can provide useful qualitative and quantitative data regarding cardiac dimensions and regurgitant valvular flow in patients with aortic regurgitation.

Adult↗
PubMed1989

Detection of thrombus by using phase-image MR scans: ROC curve analysis.

Spin-echo phase images have been shown to be sensitive to blood flow and have been used to differentiate slow flow from thrombus, with an apparent advantage in comparison with spin-echo intensity images alone. In order to quantify the diagnostic efficacy of phase images, a study was performed comparing the sensitivity and specificity of MR imaging in identifying intravascular thrombus using spin-echo magnitude images alone and combined with phase images. In 45 subjects, 66 vessels with questionable intraluminal signal were reviewed in a blinded manner by four radiologists using seven levels of certitude for the diagnosis of thrombus. Vessels in the thorax, abdomen, and pelvis were included in the evaluation and were selected on the basis of the presence of intraluminal signal, which raised the possibility of intravascular disease. Corroborative studies were available in all cases. Receiver-operator-characteristic curves were constructed for the accuracy of the decision of intraluminal thrombus vs flow signal when using magnitude images alone and when using magnitude plus phase images. Magnitude images identified thrombus with a sensitivity of 35% at a specificity of 90%. On the other hand, combining magnitude image and phase images yielded sensitivities of 85% and 83% at specificities of 90% and 95%, respectively. We conclude that addition of phase images substantially increases the level of confidence in detecting intravascular thrombosis.

Adolescent↗
PubMed1989

MR signal intensity of parathyroid adenomas: correlation with histopathology.

Recent experience has shown that parathyroid adenomas vary in their MR signal intensity, which raises the question of whether the signal intensity is related to different histologic characteristics. In order to address this question, 10 patients who had MR imaging studies (four at 0.35 T, six at 1.5 T) showing large- to medium-sized parathyroid adenomas and who subsequently underwent surgery with histologic proof of the lesion were evaluated. The MR appearance was compared with histologic characteristics. The adenomas were classified into three groups according to the MR appearance: group I, low signal intensity on short TR/TE images, high signal intensity on long TR/TE images (n = 5); group II, low signal intensity on short and long TR/TE images (n = 3); group III, high signal intensity on short and long TR/TE images (n = 2). Histologic analysis revealed that the major features of each group were different. High cellularity without degeneration or fibrosis was observed for all five adenomas from group I. In group II, all three adenomas showed cellular degenerative changes, old hemorrhage with hemosiderin-loaded macrophages, and/or fibrosis. In group III, both adenomas showed evidence of acute hemorrhage without significant degenerative or fibrotic changes. These data suggest that the signal intensity of parathyroid adenomas on T1- and T2-weighted images corresponds at least in part to differences in histologic composition.

Adenoma↗
PubMed1989

Cine magnetic resonance imaging: tomographic analysis of left ventricular function.

Cine magnetic resonance imaging has the attributes that enable its use as a method for quantitating the three-dimensional functional geometry of the ventricles. The completely noninvasive nature of this technique is advantageous for sequential studies needed to monitor evolution of cardiac disease and response to therapy. This article reviews the authors' experiences with this technique for the evaluation of left ventricular and valvular function.

Aortic Valve Insufficiency↗
PubMed1988

Coronary angiography: a decade of advances.

Coronary angiography remains the definitive diagnostic technique for determining appropriate therapy of obstructive coronary artery disease, as well as for assessing the therapeutic results of surgery, angioplasty or thrombolytic therapy. Technologic improvements over the last 5 to 10 years have significantly enhanced both the diagnostic quality and the safety of coronary angiography. Among these improvements are the use of double-angulated vessel views, digital enhancement and postprocessing maneuvers and the use of low-osmolality contrast media. Newer noninvasive imaging techniques, such as cine-computered tomography, magnetic resonance imaging and digital echocardiography continue to play a very limited role in establishing the pathoanatomy of the coronary circulation.

Animals↗
PubMed1988

Reversibility of acute alcohol cardiac depression: 31P NMR in hamsters.

Isolated hamster hearts were perfused with 2% ethanol for 30 min and then reequilibrated with control medium. One group of hamsters was pretreated with verapamil. Another group received diltiazem. Myocardial verapamil levels were 9.5 +/- 0.7 mg/g dry wt; diltiazem levels were 22 +/- 7 mg/g dry wt. Energy metabolites were assessed by using 31P NMR standardized with high-pressure liquid chromatography of freeze-clamped tissue. Intracellular calcium was measured by atomic absorption spectrophotometry, marking the extracellular space with K(CoEDTA). After 30 min of perfusion, untreated hamster hearts showed a 74% decrease in developed pressure, a marked increase in end-diastolic pressure, a decrease of ATP from 9.8 to 8.8 mmol, and an increase of Pi from 6.7 to 9.8 mmol, but no change of phosphocreatine (PCr) or intracellular pH (pHi). Verapamil pretreatment partially prevented cardiac depression during alcohol perfusion. Whereas diltiazem had no protective effect. After reequilibration, developed pressure and oxygen consumption significantly exceeded control values. ATP decreased to 8 mmol; pHi, PCr, and Pi showed no significant change. Verapamil-pretreated hearts showed better performance than untreated hearts without change in PCr and Pi, whereas ATP dropped slightly to 8.7 mmol. Thus, functional cardiac depression resulting from acute alcohol exposure is reversible. Increased intracellular calcium levels during alcohol exposure normalized after the removal of alcohol. There was no major change in high-energy phosphates during alcohol exposure or after the removal of alcohol. Verapamil protects the heart from functional depression during alcohol exposure without affecting energy resources.

Adenine Nucleotides↗
PubMed1988

Functional evaluation of the heart with magnetic resonance imaging.

This review examines the capability of cine MRI for evaluation of cardiovascular function and shows early results in valvular, ischemic, and congenital heart disease. MR assessment of left and right ventricular volumes is independent of geometrical models; dimensional values have been defined for normal individuals. Noninvasive measurement of peak and end systolic pressure along with cine MR imaging can be used to calculate left ventricular meridional wall stress which can be used for monitoring of myocardial diseases and evaluation of therapeutic intervention. Cine MR may be more accurate than angiography for identifying regional LV dysfunction since it can measure wall thickening as well as inward wall motion. Regurgitant jets due to valvular lesions are readily seen and their characteristics may be used to define the severity of aortic or mitral regurgitation. Calculation of the regurgitant volume separates patients with mild, moderate, or severe disease. Likewise, the shunt flow across ventricular and atrial septal defects has been visualized in cine MR images and shunt flow calculated. Cine MRI serves as a three-dimensional imaging technique with high temporal resolution. It extends the capability of MRI in cardiac disease beyond the depiction of anatomy and renders a comprehensive cardiac imaging technique for quantitation of cardiac anatomy and function.

Aortic Valve Stenosis↗
PubMed1988

Characterization of high-energy phosphate compounds during reperfusion of the irreversibly injured myocardium using 31P MRS.

Phosphorus-31 magnetic resonance spectroscopy (MRS) was used to monitor regional changes in high-energy phosphorus compounds and intracellular pH during 60 min of acute regional ischemia (acute occlusion of left anterior descending artery) and reperfusion in open-chest cats using a 1.2-cm two-turn coil sutured to the myocardium. During the 60-min ischemic phase, phosphocreatine (PCr) intensity was reduced to 47 +/- 4.9% (mean +/- SE) of control (p less than 0.01) by 15 min postocclusion while adenosine triphosphate (ATP) intensity decreased more slowly with the decrease (66 +/- 5.6%) achieving significance (p less than 0.05) only at 60 min postocclusion. Inorganic phosphate (Pi) increased to a maximum of 397 +/- 42% of control (p less than 0.01) while the pH decreased progressively from 7.36 +/- 0.02 to 6.02 +/- 0.14 (p less than 0.01). After release of occlusion PCr intensity recovered to 86 +/- 12% of the initial control value at 15 min postreperfusion but showed a subsequent downward trend to 79 +/- 8.8%. The ATP did not recover but tended to decline further during reperfusion. The Pi intensity decreased to 260 +/- 38% of control while the pH increased to 7.01 +/- 0.23 by 15 min postreperfusion. Thus, the reperfused irreversibly injured myocardium is characterized by persistent depletion of PCr and ATP and elevation of Pi. Phosphorus-31 MRS provides a nondestructive method for characterizing the reperfused irreversibly damaged myocardium.

Animals↗
PubMed1988

31P and 1H magnetic resonance spectroscopy of acute alcohol cardiac depression in rats.

Cardiac depression in the isolated rat heart perfused with 4% ethanol was correlated with intracellular phosphate energetics and tissue water distributions. Energy metabolites were assessed using 31P magnetic resonance spectroscopy (MRS) and correlated to the mitochondrial redox state using epicardial surface fluorometry. Changes in myocardial water compartmentation were measured by using 1H NMR spectroscopy with an extracellular chemical-shift reagent (DyTTHA) and correlated to results of 2D echocardiography (2DE). During alcohol perfusion there was a significant decrease in developed pressure and in coronary flow. No change was seen in ATP, PCr, pHi, Pi, or NADH. After withdrawal of alcohol from the perfusate cardiac function reverted to control values without a depletion of energy levels. During alcohol perfusion 1H MRS showed a marked redistribution of water from the intra- to the extracellular space, corresponding to a 35% left ventricular wall thinning confirmed by 2DE. The results indicate that acute alcohol cardiac depression is related to a dehydration of myocardial cells, but is not associated with intracellular acidosis or energy depletion.

Acute Disease↗
PubMed1988

Beneficial effects of verapamil during metabolic acidosis in isolated perfused rat hearts.

Metabolic acidosis was produced in two groups of isolated, glucose-perfused beating rat hearts. The first group (control) was untreated whereas the second group was pretreated for 48 h by the addition of verapamil (1.2 g/L) to the drinking water. Untreated hearts all developed asystole during a 30 min perfusion with an acidotic substrate (pH = 6.8) or during subsequent reequilibration with physiologic substrate (pH = 7.4). Prior to asystole, all untreated hearts showed evidence of severe mechanical and biochemical deterioration evaluated by 31 P NMR spectroscopy. In contrast, hearts of treated rats showed less mechanical and metabolic deterioration, and all recovered during reequilibration. The mechanism of protection of verapamil against the effects of metabolic acidosis is unclear but appears to be related to preserved mitochondrial function by the drug and not to a reduced demand for energy.

Acidosis↗
PubMed1988

Segmental evaluation of left ventricular wall motion after myocardial infarction: magnetic resonance imaging versus echocardiography.

To assess relative capabilities of magnetic resonance (MR) imaging and two-dimensional echocardiography (2DE) for evaluating regional contractile dysfunction in the left ventricle after a myocardial infarction, results from 22 concurrent MR (orthogonal-transaxial, ECG-gated, multiphasic, single-spin echo) and 2DE examinations were compared. By means of the same 11-segment LV description, MR and 2DE examinations were independently scored segment by segment for residual wall motion (point scores: 2 = normal, 1 = hypokinesia, 0 = akinesia, and -1 = dyskinesia). Significant correlation between MR and 2DE scoring was found throughout most of the left anterior descending (LAD) distribution, but right coronary artery (RCA) distribution (i.e., middle-posterior segment not well seen) could not be fully evaluated by MR imaging. When cumulative scores for the 10 segments mutually evaluated were used to derive measures of global residual LV function (i.e., score quotient [SQ] = accumulated points divided by 20 total possible points), MR SQ correlated well overall with both 2DE SQ (r = 0.82; p less than 0.05) and ejection fraction (EF) from ventriculography (r = 0.86, p less than 0.05 vs r = 0.88, p less than 0.05 for 2DE SQ compared with EF). MR evaluation of segmental wall motion was relatively stronger in the LAD distribution (MR SQ compared with 2DE SQ: r = 0.86, p less than 0.05; MR SQ compared with EF: r = 0.96, p less than 0.05) than in the RCA distribution (r = 0.06, p greater than or equal to 0.05 and r = 0.62, p greater than or equal to 0.05, respectively). For 2DE, regional variations were not as evident (2DE SQ compared with EF: r = 0.90, p less than 0.05 for LAD and r = 0.81, p less than 0.05 for RCA). For segmental evaluation of wall motion after myocardial infarction, MR imaging (transaxial, multiphasic) appears to be comparable to 2DE overall but superior in LAD distribution and inferior in RCA distribution.

Adult↗
PubMed1988

Estimation of the functional and anatomic extent of myocardial infarction using magnetic resonance imaging.

This study assesses magnetic resonance (MR) imaging for the evaluation of both the functional and anatomic extent of damage to the left ventricle (LV) from myocardial infarction (MI). This was accomplished by blinded region-of-interest analysis of 36 MR examinations (orthogonal-transaxial, electrocardiographically-gated, multiphasic, single spin-echo) for determination of ejection fraction (EF) and relative MI volume (i.e., percent of total LV myocardial volume). Comparison of the results was then made with a measure of global residual LV function (i.e., score quotient or SQ) derived from segmental scoring of LV wall motion on a two-dimensional echocardiogram (Echo) and with an EF value from a left ventriculogram (LVG), both performed relatively concurrently with MR. Significant (p less than 0.01) overall correlations were noted between MR-EF and both Echo-SQ (r = 0.56) and LVG-EF (r = 0.78), and these relationships were relatively stronger when MI was located in the right coronary artery (RCA) than when it was found in the left anterior descending (LAD) distribution (e.g., MR-EF compared with LVG-EF: r = 0.87, p less than 0.05 for RCA; and r = 0.48, p = NS for LAD). The best expression of relative MI volume appeared to be based upon absolute volume of regionally-thinned LV wall multiplied by a correction factor for its residual contractility and then the addition of a volume correcting for the amount of regional wall thinning by necrosis (i.e., "total-Fxn" MI volume).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Evaluation of pulmonary blood supply by nuclear magnetic resonance imaging in patients with pulmonary atresia.

Nuclear magnetic resonance (NMR) imaging defines the blood pool without the need for contrast medium. Consequently, it may be useful for defining the pulmonary circulation in patients with pulmonary atresia, in whom opacification of these vessels can be problematic. Ten patients with pulmonary atresia were evaluated by gated NMR imaging. The morphology of the right ventricular outflow tract, the size and the course of the central pulmonary vessels and the source of the collateral supply to the lung were assessed. Central pulmonary arteries were identified and measured in 9 of the 10 patients. One patient had no detectable central pulmonary arteries. Angiography confirmed the NMR findings in all but two patients, in whom NMR scanning visualized a main pulmonary artery that was not seen on angiography. Collateral arteries arising from the aorta or the arch vessels, as well as intracardiac malformations and aortic arch anomalies, were identified in all 10 patients. In six patients with palliative surgery, NMR imaging correctly demonstrated all patent shunts. Nuclear magnetic resonance imaging appears to be an effective noninvasive technique for evaluating patients with pulmonary atresia. However, tomographic thickness and spatial resolution are still limiting factors for this technique in infants.

Bronchial Arteries↗
PubMed1988

Aortic dissection: sensitivity and specificity of MR imaging.

Gated transverse magnetic resonance (MR) images of 54 patients (35 male, 19 female; aged 16-90 years) with suspected or known aortic dissection were reviewed by three cardiac radiologists without knowledge of clinical details. The reviewers independently determined the presence or absence and the type of aortic dissection. A confidence level was assigned for each diagnosis, and receiver operating characteristic curves were generated. The reviewer with extensive MR experience correctly identified 96% of the proved aortic dissections and all of the normal cases; the reviewer with moderate experience identified 96% and 84%, respectively; and the reviewer with minimal experience, 78% and 94%. The sensitivity at a specificity level of 90% was determined for each reviewer (100%, 96%, and 83%, respectively). MR imaging is highly sensitive and specific in the diagnosis of aortic dissection but does require considerable experience because of the need to recognize flow artifacts.

Adolescent↗