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Biomedical subjects

D D Stark

Publications and source records attributed to D D Stark.

At least 19 recordsLinked to original sources
PubMed1999

Hepatic iron concentration: noninvasive estimation by means of MR imaging techniques.

PURPOSE: To identify a magnetic resonance (MR) imaging method sufficiently sensitive and specific in the estimation of hepatic iron content to obviate liver biopsy. MATERIALS AND METHODS: Thirty-eight patients underwent percutaneous needle biopsy of the liver with chemical measurement of the hepatic iron concentration and hepatic MR imaging with several spin-echo and gradient-recalled-echo (GRE) techniques. Correlations between MR imaging parameters and the hepatic iron concentration were determined. RESULTS: Inverse curvilinear relationships were noted between several MR parameters and hepatic iron concentrations. GRE sequences with short repetition and echo times were more accurate and precise than spin-echo sequences for the estimation of hepatic iron concentration. A GRE sequence with a repetition time of 18 msec, an echo time of 5 msec, and a flip angle of 10 degrees showed close correlation between the hepatic iron concentration and the natural logarithm of the ratio of the signal intensity of liver to the SD of background noise (r = -0.94) and low coefficient of variation (12%). CONCLUSION: MR imaging with these parameters is a rapid, noninvasive, and accurate modality for estimation of hepatic iron concentration; it is sufficiently accurate and precise to obviate liver biopsy for the purpose of measuring hepatic iron concentration.

Adult↗
PubMed1998

Teleradiology: experiences with magnetic resonance imaging using this new technology.

Teleradiology, a term encompassing electronic transmission of images for interpretation, is becoming an important part of telemedicine. Telemedicine is an exciting new electronic means of distributing specific medical knowledge by computer network. Teleradiology allows healthcare providers in locations that previously might not have had this service to access the use of radiology specialists and subspecialists. The combination of more efficiency in interpretation and the availability of high-quality imaging equipment to rural areas will be even more important in the future. The current concepts of teleradiology are discussed, as well as the findings of the authors' investigation of accuracy and agreement of interpretations of magnetic resonance imaging examinations.

Brain Diseases↗
PubMed1993

Orally administered manganese chloride: enhanced detection of hepatic tumors in rats.

To evaluate its potential as a tissue-specific hepatobiliary magnetic resonance (MR) contrast agent, manganese chloride was orally administered to rats in increasing doses of 100-1,500 mumol/kg MnCl2, and the relaxation times of liver, pancreas, kidney, and heart were measured with ex vivo relaxometry and in vivo MR imaging. Two hours after ingestion of 200 mumol/kg MnCl2, liver T1 was decreased by 48%, whereas tumor T1 decreased by only 9%. On spin-echo MR images, the signal-to-noise ratio in liver increased by 54%; the contrast-to-noise ratio in tumor, by 375%. The T1 of pancreas, kidney, and heart decreased by 8%, 23%, and 13%, respectively. At subjective assessment, the signal intensity of the upper gastrointestinal tract was reduced, likely because of the high concentration of manganese in the lumen, and delineation of the intestine from other abdominal structures was improved. These results indicate that orally administered MnCl2 causes substantial, reproducible, and tissue-specific enhancement of liver. Because enhancement of tumor was minimal, orally administered MnCl2 may potentially be used to improve detection of hepatic tumors.

Administration, Oral↗
PubMed1992

Clinical indications for MRI.

Safety considerations for MRI will continue to require careful attention and detailed scientific investigation. As new insights are gained into the hazards of time-varying electromagnetic and static magnetic fields, more sophisticated assessment of the true risk will be possible. At the present time, for established clinical indications, the risk of a mismanagement of disease appears to outweigh the minimal or unknown risks of MRI. Other than the mechanical hazards of implanted or external metallic or electrical devices, MRI seems to be an extraordinarily safe and compatible environment for patients undergoing evaluation of suspected diseases.

Humans↗
PubMed1992

Accumulation of iron oxide particles around liver metastases during MR imaging.

The histologic nature of the bright ring ("peritumoral edema") around some liver metastases on T2-weighted magnetic resonance (MR) images is controversial. In the case reported, particles of the iron oxide contrast agent AMI-25 are retained in the peritumoral zone of a colon cancer metastasis, causing the bright ring to disappear. The location of iron particles in resected specimens could be used systematically to study peritumoral edema.

Adenocarcinoma↗
PubMed1992

Magnetic resonance techniques and artifacts.

One area in which MR imaging can use improvement is the reduction of artifacts due to various physiologic motions during imaging. These artifacts degrade images and can cause misleading interpretations. This paper reviews some of the recent technical advances directed to remove these artifacts, as well as other techniques that improve MR imaging quality in general.

Artifacts↗
PubMed1991

Preclinical evaluation of MnDPDP: new paramagnetic hepatobiliary contrast agent for MR imaging.

Manganese(II)-N,N'-dipyridoxylethylenediamine-N,N'-diacetate-5,5'-bis (phosphate) (MnDPDP) is a paramagnetic complex designed for use as a hepatobiliary agent. The T1 relaxivity of MnDPDP (2.8 [mmol/L]-1.sec-1 in aqueous solution) was similar to that of gadolinium diethylenetriaminepentaacetic acid (DTPA) (4.5 [mmol/L]-1.sec-1) and gadolinium tetraazocyclodecanetetraacetic acid (DOTA) (3.8 [mmol/L]-1.sec-1). However, in liver tissue the T1 relaxivity of MnDPDP (21.7 [mmol/L]-1.sec-1) was threefold higher than that reported for Gd-DOTA (6.7 [mmol/L]-1.sec-1). Maximum liver T1 relaxation enhancement occurred 30 minutes after injection of MnDPDP, at which time 54MnDPDP biodistribution studies indicated that 13% of total body activity was in the liver. Enhanced (MnDPDP, 50 mumol/kg) MR images showed a fivefold increase in tumor-liver contrast-to-noise ratio over baseline unenhanced images. Results of the authors' acute and subchronic toxicity studies suggest that MnDPDP will be safe at the doses necessary for clinical imaging; at 10 mumol/kg, the safety factor (LD50/effective dose) for MnDPDP is 540, significantly greater than the safety factor of Gd-DTPA (ie, 60-100).

Animals↗
PubMed1991

Hepatobiliary MR imaging: first human experience with MnDPDP.

The first human MR imaging results for the hepatobiliary contrast agent manganese(II)N,N'-dipyridoxylethylenediamine-N,N'-diacetate 5,5'-bis(phosphate) (MnDPDP) are reported. MnDPDP is a paramagnetic contrast agent specific for hepatobiliary imaging. An imaging study was performed to investigate the presence of contrast enhancement or facilitated visualization of normal structures. Twelve healthy subjects receiving MnDPDP at doses of 3, 10, or 15 mumol/kg were imaged after injection for approximately 30 minutes at 1-5-minute intervals. Transaxial abdominal images were obtained at 1.5 T in a single breath-hold interval of 21 seconds with use of a spin-echo pulse sequence (repetition time = 150 msec, echo time = 20 msec). Liver parenchyma enhancement was observed 1 minute after injection and persisted for at least 30 minutes. Clearance into the gallbladder was visualized within 15 minutes. Enhancement was dose-dependent; a dose of 10 mumol/kg produced a 75%-100% signal enhancement of the liver at 10 minutes after injection.

Adult↗
PubMed1990

Clinical application of superparamagnetic iron oxide to MR imaging of tissue perfusion in vascular liver tumors.

Previous studies of AMI-25, a particulate iron oxide magnetic resonance contrast agent, imaged liver tumors 1 or more hours after injection, in the retention phase after complete clearance of AMI-25 from the circulation. In the present study, imaging was performed in the distribution phase, during the first 12 minutes after injection while contrast agent remain in circulation, and these images were compared with those obtained in the retention phase. Nineteen patients with cancer were studied, including 15 imaged during the distribution phase. T2-weighted distribution phase images demonstrated 90% of the lesions detected by means of T2-weighted retention phase images, showed a 3.5-fold increase in contrast-to-noise ratio over images obtained before administration of AMI-25, and increased diagnostic confidence by reducing signal from small intrahepatic blood vessels. Distribution phase images showed little contrast agent uptake by cancer tissue. Both distribution and retention phase images demonstrated greater contrast agent uptake by hemangiomas than by malignant neoplasms (P less than .01). The use of both distribution phase and retention phase AMI-25-enhanced images offers improved diagnostic accuracy in the detection and characterization of focal liver lesions.

Adenocarcinoma↗
PubMed1990

Hepatic cirrhosis and hepatitis: MR imaging enhanced with superparamagnetic iron oxide.

Superparamagnetic iron oxide was applied as a reticuloendothelial contrast agent in the diagnosis of cirrhosis and hepatitis in seven patients. Three patients had compensated cirrhosis, and four had active hepatitis. T1- and T2-weighted spin-echo magnetic resonance images were obtained before and 1 hour after the administration of iron oxide. Eight patients without diffuse liver disease served as a control group. Normal liver tissue showed a 75% +/- 9% reduction in signal intensity after the administration of iron oxide, and the liver appeared homogeneously hypointense. Cirrhotic liver tissue showed a smaller response (P less than .05) to iron oxide, with a 52% +/- 13% reduction in liver signal intensity. Inhomogeneous structures could be observed in enhanced images and are thought to represent fibrous bands or regenerating nodules. Liver tissue with active hepatitis showed a markedly reduced response to iron oxide (11% +/- 2%) (P less than .05), and the parenchyma appeared homogeneous. The authors conclude that the uptake of iron oxide particles is inhomogeneously altered in cirrhosis because of structural changes and homogeneously decreased in hepatitis because of functional changes of hepatic parenchyma.

Contrast Media↗
PubMed1990

First clinical trial of a new superparamagnetic iron oxide for use as an oral gastrointestinal contrast agent in MR imaging.

The authors report the results of preclinical testing and initial clinical application of a superparamagnetic iron oxide specifically prepared as a contrast agent for magnetic resonance (MR) imaging of the gastrointestinal tract. MR imaging was performed at 0.6 and 1.5 T in 15 volunteers. Images of the upper abdomen and pelvis were obtained before and after ingestion of the contrast material at doses of 22.5-225.0 mg of iron in 600-900 L. Two readers scored the images. Delivery of contrast material into the proximal and distal small bowel, with obvious loss of signal intensity (T2 enhancement), was achieved in all subjects. Enhanced images showed improved delineation of the head and tail of the pancreas, anterior margins of the kidneys, and paraaortic region. The contrast agent did not generate artifacts, an improvement over prototype formulations evaluated previously in animals. Except for a brief episode of diarrhea in five subjects, the agent was well tolerated. Use of this contrast agent improved the diagnostic quality of abdominal MR images by enabling the distinction of the bowel from nonbowel structures at concentrations that did not produce image distortion.

Adult↗