Biomedical subjects
Publications and source records attributed to C L Partain.
Several "rules of thumb" are presented here to guide the MRI practitioner in spin echo technique selection and in the interpretation of pathologic changes.
Insoluble paramagnetic compounds in suspension can be used to achieve visualization of the gastrointestinal system on magnetic resonance imaging (NMR). Particulate preparations of these agents decrease the T1 and T2 of solutions to which they are added. Gadolinium oxalate, a prototype of these particulate agents, was evaluated in vitro and in vivo (in rabbits) by NMR imaging. The effect of this compound upon T1 and T2 in vitro was also quantitated by NMR spectroscopy. Opacification of the upper gastrointestinal tract was achieved with gadolinium oxalate following oral administration. The colon was visualized following rectal administration.
Based upon recent development of practical isolation techniques for eosinophils, labeling and in vivo imaging of eosinophils has been achieved. Isolation of cells was performed utilizing a Percoll density gradient. The eosinophils were subsequently labeled by a modified 111In-oxine method. Migration of eosinophils in response to intradermal ear-pinna injections of SEA (soluble schistosoma egg antigen), S. mansoni eggs, E. coli, and turpentine was followed with gamma-ray camera imaging from 4 to 48 h. Maximal localization, determined by Gamma 11 data processing, occurred by 4-h post-injection of radiolabel. SEA and S. mansoni eggs provided a greater stimulus for localization than E. coli or turpentine. Neutrophils did not preferentially accumulate. Tissue distribution of labeled eosinophils was greatest in the spleen, followed by liver and bone. 111In-labeled-eosinophil scans are sensitive to parasitic infections, although somewhat nonspecific.
To provide contrast enhancement in magnetic resonance imaging, a new class of compounds has been developed, the paramagnetic metal ion chelates. Gadolinium (Gd) DTPA, a prototype of this class, shows a sufficiently high in vivo stability and low toxicity for use in initial clinical trials. This type of agent, designed for rapid clearance by glomerular filtration, allows the assessment on MRI of renal function, alterations in tissue perfusion, myocardial ischemia, and perhaps most significantly disruption of the blood-brain barrier (BBB). Research at Vanderbilt has demonstrated these applications, with particular emphasis in three areas. Tissue perfusion changes, such as those produced by ligation of the arterial blood supply to portions of the spleen and kidney, cannot easily be detected on unenhanced MRI. These acute tissue infarcts can be readily identified following the administration of Gd DTPA. The question of field strength dependence of Gd DTPA has been addressed by experimentation at 0.15, 0.5, and 1.5 tesla. Furthermore, the ability to detect an alteration of the BBB, when present without associated edema, has been demonstrated with the application of control enhancement. The use of contrast agents in MRI will enhance both the sensitivity and specificity of magnetic resonance imaging.
ECG gated magnetic resonance images were obtained in six canines prior to and immediately following occlusion of either the LAD or circumflex coronary artery using a surgically placed snare. Multiecho and single-echo acquisition techniques were utilized 0.25 mmol/kg Gd DTPA was injected as an IV bolus 1 hr following coronary artery ligation. In two animals, the region of ischemic myocardium was clearly visualized on multiecho technique without the use of intravenous contrast. The ischemic zone could be best identified on images with a long TE of 120 msec. Contrast enhancement with Gd DTPA enabled visualization of the ischemic myocardium in all six canines. Administration of Gd DTPA, a perfusion agent, improved both detectability and definition of the myocardial lesions.
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Surface areas of the septum pellucidum, corpus callosum and the brain were measured from mid-saggital slices obtained with magnetic resonance imaging in 18 patients with schizophrenia and an equal number of normal volunteers. The patients showed larger septa and septo-brain ratios. These indices correlated with age in both patients and controls. In the patients, septal area also correlated with duration of illness. Changes in the septum pellucidum were unrelated to the intensity of positive and negative symptoms of schizophrenia. The patients had significantly longer corpora callosa, but the two groups did not differ on its size or the ratio between the latter and the mid-saggital slice area. Dimensions of the corpus callosum did not correlate with age, duration of the illness or positive and negative symptoms of schizophrenia. The anteroposterior elongation of the structure seemed to accompany enlargement of the septum pellucidum.
Thirty two children (aged 5-19 years) with no clinical evidence of significant cardiovascular disease undertook continuous staged supine exercise on a bicycle ergometer. Multigated radionuclide ventriculography was performed at rest and during each exercise stage. Exercise duration and total workload both increased with age. Aerobic work correlated better with age than did total work. In most children the ejection fraction for both ventricles increased by at least 5% with exercise. Right ventricular ejection fraction did not decrease with exercise in any subject but left ventricular ejection fraction decreased by 2% and 9% in two. The response of end diastolic volume to exercise was variable, but there was a consistent decrease in mean (SD) end systolic volume of the left (29(22)%) and right (30(19)%) ventricles. Cardiac index (mean (SD)) increased by 234(65)% with exercise. The left ventricular:right ventricular end diastolic volume ratio (mean (SD)) at rest was 1.26(0.26). It is concluded that exercise radionuclide ventriculography is an excellent technique for a combined assessment of exercise capacity and an evaluation of ventricular size and performance in children. These values for supine bicycle exercise in children without significant cardiovascular disease will be useful for future comparisons with other groups.
Measurements of the cerebellar vermis and height of the fourth ventricle made from midsagittal brain images obtained with magnetic resonance imaging did not show any differences between patients with schizophrenia and matched normal control subjects.
The current role of magnetic resonance imaging (MRI) in different organ systems is discussed and compared to nuclear medicine and to other available clinical diagnostic modalities. The value of optimizing radiofrequency pulse sequence selection to provide additional tissue characterization is also described. The results of nuclear medicine and MRI studies in 56 patients are compared to evaluate the clinical diagnostic contribution of each imaging modality for various pathological processes. In addition, the state-of-the-art MRI systems and future development in MRI technology with its potential contribution is defined.
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A quantitative x-ray fluorescent scanning technique has been used routinely to determine iodine content ratios (ICR) of nodule to normal thyroid tissue in patients with solitary "cold" thyroid nodules. A study of 150 patients with histological diagnoses has shown that an ICR above 0.60 is an excellent indicator of benignancy with a sensitivity of 63% and a specificity of 99%. This technique, in conjunction with careful clinical judgment, can be used to identify those patients that are at low risk for malignancy and can probably undergo conservative clinical management.
Alterations in the blood radioactivity affect ventricular volume calculations using count-based radionuclide ventriculography. To study this phenomenon, the effect of time, posture and supine exercise on blood radioactivity, red blood cell count and splenic radioactivity was evaluated. The red blood cell count, and blood, splanchnic and splenic radioactivity remained stable in five patients studied at rest in the supine position. On standing, blood radioactivity increased 10 +/- 3% (standard error of the mean), and abdominal radioactivity decreased 14.5 +/- 6.5% (both p less than 0.05). In 10 patients, splenic radioactivity decreased after supine exercise by 49 +/- 7%, while blood radioactivity increased 10.5 +/- 1.5% and red blood cell count increased 7.5 +/- 1.5% (all p less than 0.001). Splenic radioactivity increased gradually after exercise and decreased after a second exercise period. In the exercising patients, blood radioactivity increased by 14.5% and correlated with an increase in the red blood cell count (r = 0.57, p = 0.01, 19 samples from 10 patients). Reduction in splenic radioactivity also correlated with the increase in red blood cell count (r = -0.51, p = 0.025). The data demonstrate splenic shrinkage in human beings and an inverse relation between changes in splenic and blood radioactivity. These dynamic fluctuations emphasize the need for simultaneous blood sampling for accurate calculation of left ventricular volume and high-light the importance of regional volume shifts during exercise.
False aneurysm of the left ventricle is a rare complication of myocardial infarction with a high propensity for late rupture. Timely diagnosis is important and surgical repair is curative in a high percentage of patients. A case in which a false left ventricular aneurysm was recognized by first pass radionuclide angiography and confirmed by contrast ventriculography is reported. Surgery was then performed successfully. The diagnosis of false left ventricular aneurysm using radionuclide angiography, as well as other diagnostic imaging modalities, is discussed.
Magnetic resonance (MR) imaging was performed in 20 subjects, 10 of whom had benign or malignant renal masses, and 10 were normal volunteers. The purpose of the study was to evaluate the ability of MR to provide significant diagnostic information in the management of renal mass lesions. Ten normal patients were included to supply baseline data. Different pulse sequences were used and their contribution to the diagnosis was evaluated. The emphasis has been placed on evaluating MR against the pathological diagnosis rather than other imaging modalities.
A device for gating the acquisition of magnetic resonance images with chest wall motion was developed, and the effects of respiratory gating upon image quality were studied. Images of respiratory gated examinations were compared with those of ungated examinations in 16 subjects. In a subset of four of those subjects, combined respiratory and cardiac gated images were obtained. Respiratory gating removed gross motion artifacts from magnetic resonance images of the chest and abdomen. Resolution of small normal tissue structures, such as the portal and hepatic veins, is improved. In cardiac studies, respiratory gating improved the visualization and definition of the atria and ventricles.
Chromium EDTA was evaluated as an intravenous contrast agent for magnetic resonance (MR) imaging in vitro and in vivo in rabbits and rats. The effect of Cr EDTA on T1 and T2 values in vitro was first quantitated by spectroscopy at 2.5 MHz, followed by animal trials in which the effects of intravenous injection of Cr EDTA on calculated T1 MR images (obtained by the spin- warp technique at 1.7 MHz) were determined. Following administration of chromium EDTA, differences in T1 values between normal and abnormal kidneys were noted, renal hydronephrosis and renal ischemia were readily identified by the pattern of change in T1, and changes were observed in the normal rabbit brain and in tumors implanted in rats. It is concluded that the use of stable paramagnetic metal ion chelates, such as Cr EDTA, as intravenous contrast agents in MR imaging is feasible and that such agents would make possible the observation of tissue vascularity, breakdown of the blood-brain barrier, and renal function.