Biomedical subjects

D B Longmore

Publications and source records attributed to D B Longmore.

At least 37 records · Page 2Linked to original sources

PubMed1991

Magnetic resonance imaging: a method for the assessment of changes in vascular structure and function.

A brief review is made of the history of nuclear magnetic resonance (NMR) and magnetic resonance imaging (MRI). The advantages and disadvantages of MRI are discussed with particular reference to methods of studying the vascular system. Techniques developed to study separately sclerosis and atherosis, the two components of atherosclerotic disease, are discussed in more detail. Finally, in vitro and in vivo results are presented to demonstrate the great wealth of information already available from the NMR signal and hence its considerable potential for the study of vascular disease in the future.

Aorta↗

PubMed1991

Magnetic resonance characterization of pulmonary arterial blood flow after single lung transplantation.

Magnetic resonance imaging has been used to study pulmonary arterial anatomy and to measure pulmonary arterial blood flow in patients with single lung transplantation. Nine patients and nine control subjects matched for age and sex were studied. The anatomy of the main pulmonary artery and its main branches, as well as the site of arterial anastomoses, was identified and measurements of their diameters were taken. There were no significant differences in diameters of these vessels between the patients and the control subjects. Arterial blood flows to the transplanted lung were 2.07 +/- 0.45 L/min/m2 in the group with right lung transplantation and 2.43 +/- 0.60 L/min/m2 in those with left lung transplantation compared with 1.22 +/- 0.22 L/min/m2 and 1.27 +/- 0.41 L/min/m2 in the control group, respectively. The ratio of blood flow in the transplanted and the native lungs in all patients studied was 2.8 +/- 0.83:1. The flow profile in the artery of the transplanted lung showed a wide forward flow during systole and most of diastole, whereas that of the native lung showed a narrow early systolic peak and a reverse flow in most of diastole. These differences in the volume and pattern of flow in the transplanted lung are most likely related to the relative resistance in the native and the transplanted lung and could constitute an additional index for monitoring the condition of patients with lung transplantation and help in the understanding of the physiology of the denervated pulmonary vascular bed.

Adult↗

PubMed1990

The application of phase shifts in NMR for flow measurement.

A brief overview of the history of the application of phase shifts in NMR, and in particular NMR imaging, is presented. The imaging methods include direct phase mapping, Fourier flow imaging (where the flow data are Fourier transformed into one dimension of an image), and alternative methods, where flow-related phase shifts are utilized for flow measurement from the magnitude of the signal. A discussion then follows of the principal errors that can affect the accuracy of the various flow imaging techniques, with particular reference to the phase mapping methods that have been used extensively in our institution. The results from a number of experiments are included to illustrate the extent of the errors and methods of removing or minimizing these effects are suggested.

Blood Circulation↗

PubMed1990

Magnetic resonance velocity mapping.

Magnetic resonance velocity mapping is achieved by encoding velocity at each point in a tomographic imaging plane in the phase of the magnetic resonance signal. Although this can be achieved with almost any imaging sequence, cine gradient echo sequences are particularly suitable because of the high signal from blood and the ability to repeat the sequence rapidly to form a cine image. The technique has been shown to be accurate by in vitro and in vivo validation, with flow measurements in the great vessels having an accuracy of approximately 6%. A potential problem arises from loss of signal from turbulent blood flow, but this can be overcome with the use of even echo rephasing and echo times below 5 ms. Using such sequences, velocities of up to 6 m s-1 have been measured clinically and pressure gradients across valves as great as 16 kPa (120 mmHg) can be computed. Clinical application has centred on the measurement of flow in the pulmonary circulation and in shunts and conduits in patients with congenital heart disease. Other applications include the measurement of valvular regurgitation and stenosis, and flow in coronary artery bypass grafts. Flow in native coronary arteries has been measured but the technique requires further development before such measurements can be considered reliable. Real time imaging using echo planar velocity mapping has been achieved and it is hoped that this will make coronary artery flow measurements more robust.

Blood Flow Velocity↗

PubMed1990

Dipyridamole magnetic resonance imaging: a comparison with thallium-201 emission tomography.

Limitation of space and motion artefact make magnetic resonance imaging during dynamic exercise difficult. Pharmacological stress with dipyridamole can be used as an alternative to exercise for thallium scanning. Forty patients with a history of angina and an abnormal exercise electrocardiogram were studied by dipyridamole thallium myocardial perfusion tomography and dipyridamole magnetic resonance wall motion imaging with a cine gradient refocused sequence. Images for both scans were obtained in the oblique horizontal and vertical long axis and short axis planes before and after pharmacological stress with dipyridamole. The myocardium was divided into nine segments for direct comparison of perfusion with wall motion. Segments were assessed visually into grades--normal, hypokinesis or reduced perfusion, and akinesis or very reduced perfusion. After dipyridamole there were reversible wall motion abnormalities in 24 (62%) of 39 patients with coronary artery disease and 24 (67%) of 36 patients with reversible thallium defects. The site of wall motion deterioration was always the site of a reversible thallium defect. Thallium defects affecting more than two segments were always associated with wall motion deterioration but most single segment thallium defects were undetected by magnetic resonance imaging. There was a significant correlation between detection of wall motion abnormality, the angiographic severity of coronary artery disease, and the induction of chest pain by dipyridamole. There were no significant differences in ventricular volume or ejection fraction changes after dipyridamole between the groups with and without detectable reversible wall motion changes but the normalised magnetic resonance signal intensity of the abnormally moving segments was significantly less than the signal intensity of the normal segments. In nine patients the change was apparent visually and it was maximal in the subendocardial region. Magnetic resonance imaging of reversible wall motion abnormalities in patients with coronary artery disease is feasible during pharmacological stress with dipyridamole and may be associated with a reduced magnetic resonance signal. The failure to show wall motion abnormalities in all cases of reversible thallium defects may be because the defect was small or because dipyridamole caused perfusion defects in the absence of myocardial ischaemia.

Adult↗

PubMed1990

Vena caval flow: assessment with cine MR velocity mapping.

The authors used cine magnetic resonance (MR) velocity mapping to study flow in the superior vena cava (SVC) and inferior vena cava (IVC) of 13 healthy control subjects and 13 patients with right-sided cardiac disease. In the control subjects, peaks of flow in systole and diastole were observed, and mean SVC flow was 35% of the cardiac output. Respiratory gating was used in six control subjects to acquire images at end inspiration and end expiration, and although the systolic peak was reduced at end expiration, total flow was unchanged. A reduced systolic peak and retrograde flow in the IVC were observed in patients with tricuspid regurgitation. A reduced diastolic peak was seen in patients with pulmonary hypertension, pericardial constriction, and right ventricular dysplasia, reflecting reduced diastolic compliance of the right ventricle. In the patient with obstruction of the SVC, absence of flow was confirmed, and retrograde flow was seen in the azygos vein. The authors believe that cine MR velocity mapping is a reliable method of studying vena caval flow noninvasively and that it has important potential applications for the investigation of disorders of the right side of the heart.

Adult↗

PubMed1989

Echo-planar high-resolution flow velocity mapping.

A technique for the very rapid measurement of blood flow with high spatial resolution is described. The method combines the previously validated technique of phase velocity mapping and echo-planar principles. The relatively small diameter of blood vessels enables a high-resolution echo-planar flow measurement to be made with as few as 16 echoes such that the method can be incorporated into a near standard NMR scanner. Two sequence variations are tested and validated in vitro and one is used to demonstrate in vivo blood flow measurement. The results are shown to compare well with a previously validated less rapid method. The technique should enhance the potential of NMR flow imaging by enabling sudden changes in flow to be studied. It should also simplify the measurement of blood flow in small mobile vessels such as the coronary arteries.

Blood Flow Velocity↗

PubMed1989

The function of the aorta in ischemic heart disease: a magnetic resonance and angiographic study of aortic compliance and blood flow patterns.

Regional compliance of the ascending aorta, aortic arch, and the descending aorta was measured in 70 normal subjects at varying ages, in 17 patients with coronary artery disease (10 coronary artery disease patients, 3 with syndrome X), and in 13 trained athletes using magnetic resonance imaging. Ascending aortic compliance was measured angiographically in 22 patients with documented coronary artery disease and in 11 patients with syndrome X. Magnetic resonance velocity mapping was used in six patients with documented coronary artery disease and in three patients with syndrome X to study two-dimensional velocity profiles in the proximal and mid-ascending aorta and to quantify both forward and reverse flow. The measurements were compared with earlier published measurements from 24 normal subjects. It was found that patients with ischemic heart disease or syndrome X had decreased or no measurable aortic compliance and that they had significantly reduced or abnormal ascending aortic reverse flow likely to cause reduced coronary artery flow. A new theory is advanced that decreased myocardial perfusion leading to ischemic heart disease has two sources: (1) insufficient blood flow into the coronary artery inlet due to abnormal aortic function and independent of coronary artery stenosis and (2) local coronary artery stenosis. Observations supporting the theory are presented.

Adult↗

PubMed1989

Pulmonary artery distensibility and blood flow patterns: a magnetic resonance study of normal subjects and of patients with pulmonary arterial hypertension.

Pulmonary artery distensibility was studied with spin-echo magnetic resonance imaging in 20 normal subjects of variable age and in four patients with pulmonary arterial hypertension. The distensibility was found to be significantly lower (8%) in patients with pulmonary arterial hypertension than it was in normal subjects (23%). No age-related difference occurred. Magnetic resonance velocity mapping of the pulmonary artery blood flow was performed in 26 normal subjects--11 had mapping in the mid pulmonary artery, 15 had mapping in the distal pulmonary artery, and mapping in the four patients with pulmonary arterial hypertension was in the mid pulmonary artery. The pulmonary artery flow volume was compared with aortic flow and left ventricular stroke volume and a very good correlation was found. A retrograde flow of 2% occurred in the normal subjects serving to close the pulmonic valve. Antegrade plug flow occurred in most normal subjects but varied among individuals. There were also other variations in the flow pattern among normal individuals. All patients with pulmonary arterial hypertension had a markedly irregular ante- and retrograde flow and a large retrograde flow (average 26%). Magnetic resonance imaging offers a noninvasive way to evaluate pulmonary arterial hypertension as well as to quantitate pulmonary and aortic flows in, for example, left-to-right shunts.

Adult↗

PubMed1989

Quantitation of antegrade and retrograde blood flow in the human aorta by magnetic resonance velocity mapping.

Magnetic resonance velocity mapping was used in 24 normal subjects to study two-dimensional velocity profiles in the proximal and mid-ascending aorta, and to quantify both forward and reverse flow. The aortic flow measurements were validated by comparison with left ventricular stroke volume in all subjects and by comparison with pulmonary flow measurements in 12. Agreement was good with standard errors of the estimate of 7.8 and 7.1 ml, and correlation coefficients of 0.93 and 0.95, respectively. Systolic velocity maps were similar in the proximal aorta and the mid-ascending aorta, with maximum early systolic flow along the left posterior wall. Toward the end of systole and throughout diastole, a channel of reverse flow developed in the same region in the mid-ascending aorta, but in the proximal aorta it split to enter the sinuses of Valsalva, predominantly the left and the right coronary sinuses. Mean percentage ratio of retrograde-to-antegrade flow was 6.3%, with the majority of retrograde flow occurring in early diastole. The findings suggest that the retrograde flow is related to coronary artery flow and it is possible that aortic disease, which is known to influence aortic flow patterns, may also influence coronary flow.

Adolescent↗

PubMed1989

The principles of magnetic resonance.

Magnetic Resonance (MR), which has no known biological hazard, is capable of producing high resolution thin tomographic images in any plane and blocks of 3-dimensional information. It can be used to study blood flow and to gain information about the composition of important materials seen and quantified on dimensionally accurate images. The MR image is a thin tomographic slice or a true three dimensional block of data which can be reconstructed in any desired way rather than a shadowgram of all the structures in the beam. It is the only imaging technique which can acquire data in a 3-dimensional format. CT images can be reconstructed to form a pseudo 3-D image or a hologram but the flexibility conferred by acquiring the data as a true 3-D block gives many advantages. The spatial resolution of MR images are theoretically those of low powered microscopy, the practical limits with the present generation of equipment are voxel sizes of one third by one third by two millimetres. The term Magnetic Resonance Imaging (MRI) is used commonly, particularly in the USA, avoiding association with the term, nuclear, and emphasizing the imaging potential of the technique. The terms Nuclear Magnetic Resonance (NMR) or Magnetic Resonance (MR) more correctly describe the most powerful diagnostic instrument yet devised. The simplified description of the phenomena involved in MR which follows is intended to be comprehensive and does not require foreknowledge of classical physics, quantum mechanics, fluency with mathematical formulae or an understanding of image reconstruction. There are many explanations of MR, some omitting the more difficult concepts. An accurate, comprehensive description is found on the textbook on MR by Gadian, Nuclear Magnetic Resonance and its Applications for Living Systems (Oxford University Press, 1982).

Adult↗

PubMed1989

MRI studies of atherosclerotic vascular disease: structural evaluation and physiological measurements.

The widespread prevalence of atherosclerotic vascular disease has given rise to the need for a noninvasive imaging examination. Magnetic resonance imaging has been shown to allow assessment of early arterial disease non-invasively and without the use of ionising radiation. Arterial compliance, pulse wave velocity, and the pattern of flow within the aorta may all be disturbed by disease and these parameters can be measured by magnetic resonance. In addition, atheroma can be imaged directly, its size measured, its shape described, its lipid content assessed, and its effects upon vascular haemodynamics studied. Magnetic resonance imaging is thus a potential tool not only for the detection of disease but also for studying its natural history and the effects of interventions, such as the control of risk factors and of lipid lowering agents.

Aortic Diseases↗

PubMed1989

Chemical shift magnetic resonance imaging of human atheroma.

Fifteen necropsy specimens of human descending aorta and from eight patients with atheromatous vascular disease were studied by magnetic resonance imaging at 0.5 T. Images were acquired in coronal and transverse planes to localised protruding lesions and then chemical shift imaging was performed by techniques described by Dixon and by Hinks. These techniques produce images in which signal strength is proportional to lipid content. The signal was expressed as a percentage of that from extravascular fat. The total lipid content and its distribution within the plaques were noted. After imaging, the postmortem specimens were examined histologically and the lipid content of the plaque was assessed on a semiquantitative scale. The distribution of lipid within the plaque and between intima and media was also noted. The findings of chemical shift imaging agreed well with histological examination both for total lipid content and for distribution within each plaque. Chemical shift imaging also provided an assessment of the lipid content of the plaques measured in living patients, but validation was more difficult. The usefulness of the technique in routine clinical practice remains to be established.

Aorta, Abdominal↗

PubMed1989

Regional aortic compliance studied by magnetic resonance imaging: the effects of age, training, and coronary artery disease.

Arterial compliance was measured in 70 healthy volunteers, 13 athletes, and 17 patients with coronary artery disease. Magnetic resonance images were acquired at end diastole and end systole through the ascending aorta, the aortic arch, and the descending thoracic aorta. Regional compliance was derived from the change in luminal area in a slice of known thickness and from the pulse pressure. Total arterial compliance was also measured from the left ventricular stroke volume and the pulse pressure. In the volunteers, mean (SD) regional compliance (microliters/mm Hg) was greatest in the ascending aorta (37 (18], lower in the arch (31 (15], and lowest in the descending aorta (18 (8], and it decreased with age. Compliance in the athletes was significantly higher than in their age matched controls (41 (16) versus 22 (11) microliters/mm Hg). In the patients with coronary artery disease it was significantly lower (12 (4) v 18 (10] than in age matched controls. Total arterial compliance also fell with age in those with coronary artery disease although there was more variation. The results suggest a possible role for compliance in the assessment of cardiovascular fitness and the detection of coronary artery disease.

Adult↗

PubMed1989

Coarctation of the aorta: MR imaging in late postoperative assessment.

Thirty-six patients were studied with magnetic resonance (MR) imaging 2-29 years after repair of coarctation of the aorta, and the findings were compared with clinical data and results of echocardiography, catheterization, angiography, and surgery. A satisfactory echocardiographic examination of the isthmus was achieved in 28 patients. Comparison with data from gradient measurements at catheterization and Doppler ultrasound shows that the reduction of lumen diameter correlates well with the gradient and that restenosis at the site of the repair can be suspected when the percentage of stenosis at the isthmus is greater than 50%. MR imaging showed a Dacron patch aneurysm in three patients. Cine MR imaging showed systolic signal loss in the ascending aorta that was presumed to be due, among other factors, to turbulent flow generated from a bicuspid valve. Similar signal loss was seen in the descending aorta distal to the site of the coarctation repair, but this was not related to the presence or absence of a gradient. Aortic compliance measured from transverse MR systolic and diastolic images was abnormally low, suggesting it may be a factor causing systolic hypertension after coarctation repair. MR imaging is a reliable and accurate noninvasive method likely to supersede other methods of assessing the aorta and isthmus following coarctation repair.

Adolescent↗

PubMed1989

[Magnetic resonance tomography flow measurement in cerebral arteriovenous angioma].

A case of cerebral AVM associated with Klippel-Trenaunay Syndrome is presented where Magnetic Resonance (MRI) flow measurement revealed details of the shunt from the cerebral arterial system. The AVM was supplied by two arteries, the main flow came from the left vertebral and internal carotid artery. The arterial blood supply of the AVM was about 268 ml/min, the av-shunt flow was about 18% of the whole carotid and vertebral upstream flow.

Adult↗

PubMed1989

Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls.

It has been suggested that deposition of fat in the soft tissues surrounding the upper airway may be an important factor in the pathogenesis of obstructive sleep apnoea (OSA) in obese subjects. We have used magnetic resonance imaging to determine the site(s) and size(s) of fat deposits around the upper airway in six obese patients with OSA (116-153% of ideal body weight) and five weight-matched controls without OSA (107-152% of ideal body weight). In all subjects, large deposits of fat were present postero-lateral to the oropharyngeal airspace at the level of the soft palate. Significantly more fat was present in these regions in the patients with OSA (p = 0.03). Fat deposits in the soft palate were observed in 4 of the 6 patients with OSA but none of the controls. Fatty streaks were observed in the tongue in 2 of the 5 controls and 3 of the 6 patients with OSA. Fat deposits were observed anterior to the laryngopharyngeal airspace, in submental regions, in all obese subjects. This study shows that more fat is present in those areas surrounding the collapsable segment of the pharynx in patients with OSA, compared to equally obese control subjects without OSA.

Adipose Tissue↗

PubMed1988

Left ventricular volume measured rapidly by oblique magnetic resonance imaging.

Magnetic resonance measurements of left ventricular volume and ejection fraction based on measurements of area and length in a single oblique plane containing the long axis of the ventricle were compared with measurements made by summing the areas of the chamber in multiple contiguous slices. The multislice technique is known to be accurate, but the single slice technique is much quicker; it takes only nine minutes of acquisition time for both volume and ejection fraction. In 25 normal subjects there was good agreement between the two methods of measuring volume with a mean (SD) difference between measurements of 2.0 (6.6) ml. In 20 patients with previous infarction it was less good with a mean (SD) difference of 4.5 (18.1) ml. The mean (SD) difference of ejection fraction measurements was -0.019 (0.038) in the normal subjects and -0.059 (0.106) in the patients, and the discrepancy between the two techniques was greatest in the patients with a pronounced abnormality of wall motion and low ejection fraction. In a further 25 normal subjects, the agreement between single plane volume measurements in the vertical and horizontal long axis planes was good, indicating that either plane is suitable for rapid measurement. Single plane measurements of left ventricular volume and ejection fraction can be made with the accuracies stated, which are sufficient for routine clinical use except in patients with a pronounced abnormality of wall motion. In combination with measurements of regional wall thickness and motion, previously described, the technique offers a rapid non-invasive assessment of both global and regional left ventricular function.

Adult↗