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J F Debatin

Publications and source records attributed to J F Debatin.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

MR characterization of blood flow in native and grafted internal mammary arteries.

In the postoperative patient with anginal symptoms, differentiation between bypass graft compromise and nonischemic causes has until now been accomplished only by means of x-ray angiography. A non-invasive test is clearly desirable. The authors used a cine phase-contrast (PC) magnetic resonance (MR) imaging technique to characterize blood flow in native and grafted internal mammary arteries (IMAs). Ten volunteers and 15 patients who had recently undergone IMA coronary artery bypass grafting were imaged. Cine PC MR imaging was performed in the transaxial plane at the level of the pulmonary artery bifurcation. Flow in both IMAs was quantified and expressed as a percentage of cardiac output measured in the ascending aorta. In the 15 patients, flow analysis was performed in both the native and grafted IMAs. In the volunteers, IMA blood flow ranged from 2.1% to 4.3% of cardiac output on the left (mean, 3.5%) and 2.1% to 5.1% (mean, 3.5%) on the right. There was considerable intersubject variability, with coefficients of variation of 10.7% for the left and 12.3% for the right IMA. Intrasubject variability was limited, with estimated common standard deviations of 0.45% of cardiac output (range, 0.2%-1.1%) for the left and 0.39% (range, 0.1%-0.6%) for the right IMA. Flow in grafted IMAs was identified in 13 of 15 patients. In one of two patients without demonstrable IMA graft flow, cardiac catheterization confirmed lack of flow. IMA graft flow varied from 28 to 164 mL/min (mean, 80.3 mL/min). This study shows the feasibility of using cine PC MR imaging as a quantitative method of evaluating blood flow in IMA coronary artery bypass grafts.

Adult↗
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Single-shot versus interleaved echo-planar MR imaging: application to visualization of cardiac valve leaflets.

Visualization of the cardiac valves with standard magnetic resonance (MR) imaging is not adequate because of long acquisition times. Echo-planar imaging (EPI) can, however, be performed with a temporal resolution (30-50 msec) comparable to that of echocardiography. The authors evaluated the feasibility of real-time imaging of cardiac valve motion with ultrafast MR techniques. Eight healthy volunteers and three patients with mitral stenosis and regurgitation were studied with a 1.5-T whole-body imager. Two different EPI sequences were assessed: a standard single-shot gradient-echo EPI (GEPI) sequence and a fast imaging technique based on multiple-shot EPI with interleaved k-space acquisition (IGEPI). Fat-suppressed images with an in-plane resolution of 3.7 x 3.7 mm were obtained equally spaced through the cardiac cycle. Half-k-space acquisition was used. Morphologic evaluation was superior with IGEPI, owing to the better intracavitary signal homogeneity (P < .01), and the mitral valve leaflets were easier to identify on systolic images. IGEPI provided adequate valve visibility in all three patients.

Adult↗
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Phase-contrast echo-planar MR imaging: real-time quantification of flow and velocity patterns in the thoracic vessels induced by Valsalva's maneuver.

Although the clinical manifestations of Valsalva's maneuver are well known, the associated hemodynamic changes in the great vessels have not been extensively studied and documented. In each of six healthy subjects, we evaluated three "quasi-steady-state" phases of Valsalva's maneuver: (1) during normal respiration, (2) during late strain, and (3) 4 seconds after strain release. Continuous flow, velocity, and cross-sectional area measurements were obtained in the superior vena cava, pulmonary trunk, and thoracic aorta with single-shot echo-planar MR imaging (EPI) with velocity-encoded gradients, which provided 256 images in 5 seconds, yielding 26 velocity-encoded images per second. In the superior vena cava, Valsalva's maneuver induced an 11% decrease in average flow volume, a 102% increase in peak flow velocity, a 156% increase in the time velocity integral, and a 37% decrease in cross-sectional area. MR velocity measurements agreed with echocardiographic data and supplied additional information on flow and morphology. EPI showed a reduction in venous return during Valsalva's maneuver by simultaneously assessing flow, velocity, and vessel morphology; this technique appears to be useful in the analysis of flow dynamics of the great vessels.

Adult↗
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Flow quantitation with echo-planar phase-contrast velocity mapping: in vitro and in vivo evaluation.

We present a multishot echo-planar imaging (EPI) phase-contrast implementation for flow quantitation. The measurement accuracy of this technique was evaluated in vitro and in vivo. A gated eight-shot EPI phase-contrast sequence (TR/TE = 16/7.4, 45 degrees flip angle), with a flow-phase interval of 32 msec and an in-plane resolution of 2 x 2 mm was initially evaluated in a pulsatile flow phantom. Subsequently, EPI phase-contrast flow measurements of the ascending and descending aorta, obtained in 10 volunteers, were compared with flow volume data acquired with a conventional cine phase-contrast sequence (TR/TE = 24/7, 45 degrees flip angle, 48-msec flow-phase interval, 2 x 1 mm in-plane resolution). Comparisons between flow measurements were made using data obtained with the flow probe and cine phase contrast as the standard of reference for in vitro and in vivo measurements, respectively. EPI phase-contrast sequences reduced data acquisition times tenfold compared with cine phase-contrast sequences. EPI phase-contrast flow measurements correlated well with phantom flow (r = .98, slope = 1.1) as well as with aortic cine phase-contrast flow volume determinations (r = .98). A 95% confidence interval of measurement differences between echo-planar and cine phase-contrast imaging, ranging from 2.0 to -1058 mL/min was computed. Ultrafast phase-contrast flow measurements are possible. Multishot EPI phase-contrast imaging provides high measurement accuracy in pulsatile vessels while keeping the image acquisition interval short enough to be accomplished in a comfortable breath-hold.

Adult↗
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Cardiac imaging: comparison of two-shot echo-planar imaging with fast segmented K-space and conventional gradient-echo cine acquisitions.

We compared the cardiac image quality of multishot echo-planar imaging (EPI), segmented K-space, and conventional cine acquisitions. Three techniques were used to obtain gated multiphase acquisitions of an axial section traversing both ventricles in 10 volunteers: two-shot EPI acquired nonsequentially over two heart beats breath-held; segmented K-space cine with eight K-space lines acquired per cardiac trigger over 16 R-R intervals, also breath-held; and 24 cine phases obtained over 256 R-R intervals. Intraventricular SNRs with two-shot EPI were superior to segmented K-space cine acquisitions (P < .005) and not statistically different from conventional cine acquisitions (P < .1). Intraventricular signal was most homogeneous on conventional cine images (P < .05). Coronary artery visualization and myocardial delineation were better on the EPI image set than on segmented K-space cine images (P < .05). Two-shot EPI provides high-quality gated cardiac images with an acquisition time of only 2 seconds.

Adult↗
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Contrast-enhanced, ultrafast 3D pulmonary MR angiography in a single breath-hold: initial assessment of imaging performance.

An ultrafast three-dimensional (3D) sequence was developed, enabling the acquisition of 44 contiguous 2.0- to 2.2-mm thin sections, during intravenous application of paramagnetic contrast, in a single breath-hold. To estimate the potential clinical usefulness, images were assessed qualitatively and quantitatively with regard to visibility of main, lobar, segmental, and subsegmental pulmonary arteries. Five volunteers were examined using a 192 x 192 matrix with an imaging time of 23 seconds and five other volunteers with a 160 x 160 matrix (18 seconds). Each volunteer was imaged in apnea and during shallow respiration. The breath-held 23-second scans revealed excellent image quality and near complete visualization of central and segmental, as well as 81% of subsegmental, pulmonary arteries. Imaging time can be shortened to 18 seconds with only marginal loss in visualization performance (P < .05). Respiratory motion was found to cause significant worsening of image quality and vessel detectability. To maintain relevance in a clinical setting, imaging time can be minimized at the cost of a reduction in spatial resolution.

Adult↗
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Optimization of contrast timing for breath-hold three-dimensional MR angiography.

The purpose of this study was to determine the influence of various factors (age, weight, breathing, saline flush) on the contrast kinetics of a test bolus injection for the purpose of calculating the scan delay for optimized contrast-enhanced three-dimensional MR angiography. Initially, the test bolus administration was optimized by evaluating the influence of breathing (breathing versus breath-hold) and the administration of a saline flush after the contrast injection (no flush versus flush) on the kinetics of a 4-ml Gd-DTPA test bolus injection in three healthy volunteers. Subsequently, in 33 patients referred for three-dimensional MR angiography of the renal arteries, test bolus kinetics were correlated to age, weight, and heart rate. In addition, the image quality of the three-dimensional MR angiograms was assessed on a four-point scale with regard to vessel visibility. The administration of a saline flush after the contrast injection significantly shortened the first appearance time (14 versus 16 seconds, P < .05), as well as the time to maximal signal intensity (SI) (6 versus 10 seconds, P < .05) and increased both maximum (67 versus 151 seconds, P < .05) and the SI slope (6.4 versus 20.5 seconds, P < .05). Breath-holding was shown to have no significant affect on the test bolus kinetics. No correlation was found between physiologic parameters and test bolus kinetics in the patient group. Image quality was graded as sufficient for diagnostic purposes in 32 of 33 patients. The contrast travel time from injection site to the vascular system under consideration cannot be predicted based on physiologic parameters. This time interval can be reliably and accurately determined by a test bolus injection of a small volume of contrast agent followed by a saline flush during normal breathing.

Adult↗
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Active MR visualization of a vascular guidewire in vivo.

The purpose of this study was development of an actively visualized .035-inch vascular guidewire for use in MR-guided interventions. The guidewire was actively visualized by inclusion of a 6-cm-long radiofrequency coil in its tip. A high contrast outline of the distal tip of the guidewire was obtained by acquiring an image with the radiofrequency coil as the receiving antenna. The position of the guidewire relative to the surrounding anatomy was determined by overlaying the guidewire image on a previously acquired road map. The guidewire was evaluated in vivo in the abdominal vessels of a rabbit and swine at 1.5 T. The built-in radiofrequency coil delivered a high contrast signal over its full length, enabling visualization of the position and curvature of the tip of the guidewire. The ability to see the curvature of the guidewire over several centimeters significantly eased manipulation into targeted vessels and represents an important advance toward MR-guided vascular interventions.

Animals↗
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Visualization of vascular guidewires using MR tracking.

MR tracking of a vascular guidewire sized for a .035-inch (.89-mm) catheter lumen was performed. The guidewire was actively tracked by incorporation of a miniature radiofrequency (RF) receive coil built into its tip. After in vitro validation, simultaneous tracking of the guidewire and a catheter was performed in the aortic and abdominal vessels of a swine at 1.5 T. The ability to track such a small device and the ability to simultaneously track multiple devices are significant steps towards vascular interventions under MR guidance.

Animals↗
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Value of image subtraction in 3D gadolinium-enhanced MR angiography of the renal arteries.

The objective of this study was to evaluate quantitatively and qualitatively the effect of image subtraction on the image quality of three-dimensional (3D) gadolinium-enhanced MR angiograms of the renal arteries. Breath-hold 3D gadolinium MR angiography (MRA) as well as conventional contrast angiography of the renal arteries was performed on 20 patients with suspected renovascular hypertension. MR angiograms were acquired before and during dynamic infusion of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Contrast-enhanced images were compared with images that had undergone voxel-by-voxel signal intensity subtraction of contrast-enhanced data from precontrast data. One false positive finding for significant renal artery stenosis was recorded with MRA using conventional angiography as the gold standard. Image subtraction did not alter the diagnosis at MRA in any case. The mean contrast-to-noise ratio (CNR) was significantly higher (P < .05) on the subtraction MR angiograms compared to the nonsubtracted MR angiograms. There was no significant difference in the signal-to-noise ratio (SNR). Qualitative analysis revealed a significant improvement in image quality after image subtraction with respect to visualization of the distal renal arteries. In conclusion, image subtraction improves the quality of renal MRA in terms of both CNR and visualization of the distal renal arteries.

Adult↗
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MR versus fluoroscopic guidance of a catheter/guidewire system: in vitro comparison of steerability.

Our purpose in this study was to evaluate the steerability of a combined catheter guidewire system with MR tracking in an open-configuration .5T MR system and compare it with fluoroscopic guidance. Experiments were performed with an aorta-shaped glass phantom with different-size branches connected to a roller flow pump to simulate pulsatile flow. A .035" guidewire was used in conjunction with a 5F Cobra 2-shaped catheter. For active MR guidance, a small RF coil was incorporated into the tips of all devices. In addition to fluoroscopic guidance, we used MR tracking devices to selectively catheterize all branches in the .5T open magnet (Signa SP, GEMS). Time requirements for the latter were compared with those needed under conventional angiographic conditions using standard catheters and guidewires. Active MR tracking permitted the simultaneous real time (4 updates/sec) guidance of both guidewire and catheter. Under MR guidance, all branch vessels were successfully catheterized. We found no significant differences in time requirements between guidance with the MR tracking device and fluoroscopic guidance. However, cannulation under fluoroscopic guidance with standard angiography devices required significantly less time (P < .05). Selective catheterization of small branch vessels is possible with active MR tracking of a combined catheter/guidewire system. Limitations of MR tracking device material and design result in a considerable lengthening of the cannulation procedures.

Aorta↗
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Advances in vascular echoplanar imaging.

Magnetic resonance (MR) angiography is emerging as an increasingly useful tool for the noninvasive evaluation of the cardiovascular system. Ultrafast echoplanar imaging (EPI) data acquisition strategies are becoming more widely available. When applied to MR angiography, the associated reduction in data collection time allows breathheld acquisitions of entire vascular territories, as well as the exploitation of short-lived flow-enhancing measures. This paper describes technical aspects of EPI, its implementation into vascular imaging sequences, and associated artifacts. This is followed by a discussion of potential EPI MRA applications in the carotid and renal arteries, the portal venous system, and arteries and veins of the lower leg.

Arteries↗
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Fecal tagging: MR colonography without colonic cleansing.

Colorectal cancer, mostly arising (>90%) from preexisting adenomatous polyps, continues to be the second leading cause of cancer death. Magnetic resonance colonography (MRC) permits accurate detection of colonic polyps with a diameter larger than 10 mm. Because residual colonic stool cannot be differentiated from polyps, MRC requires a clean colon. However, the rigors associated with colonic cleansing considerably reduce patient acceptance. The need for colonic cleansing could be eliminated, if stool were to acquire a signal intensity different from polyps and identical to the enema used to fill and distend the colon. In principle, there are two approaches to this concept of fecal tagging: dark polyps surrounded by bright stool and a bright enema, and bright polyps surrounded by dark stool and a dark enema. The first approach has been evaluated with some success. Gadolinium (Gd)-DOTA was administered as an oral contrast agent with meals preceding MRC based on the administration of a Gd-based enema. The high cost of Gd-based contrast has limited the clinical utility of this technique. In the second approach patients are provided with barium as an oral fecal tagging agent to render stool dark, and barium for the enema is used to distend the colon during MRC. The colonic wall and polyps arising from it can be made visible after intravenous administration of Gd-based extracellular contrast. This method provides sufficient contrast between the darkened colonic lumen and the brightly enhanced colonic wall to permit virtual endoscopic rendering. Preliminary results showed an exact correlation with findings of conventional endoscopy and surgery. Fecal tagging obviates bowel cleansing and therefore should enhance patient acceptance for MR colonoscopy. Barium as the tagging agent is promising because it is inexpensive, commercially available, and characterized by an excellent safety profile.

Barium Sulfate↗
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Virtual endoscopic colonography based on 3D MRI.

BACKGROUND: To evaluate the potential of magnetic resonance colonography (MRC) in detecting colorectal mass lesions. METHODS: Twenty patients underwent MR imaging (MRI) before colonoscopy. The colon was filled with a gadolinium (0.5 mol):water mixture (1:100) under MRI control, and patients were imaged while breath-holding imaged with a three-dimensional spoiled gradient echo sequence in the prone and supine positions. Images were interactively analyzed based on the combination of multiplanar reconstruction and virtual colonoscopy by a radiologist blinded to colonoscopic findings and the patient's history. MRC interpretations were correlated with colonoscopic results. RESULTS: Polyps smaller than 5 mm could not be identified with MRC. The sensitivity for detecting polyps of 5-10 mm was 70%, whereas mass lesions larger than 10 mm were all detected (sensitivity = 100). The sensitivity, specificity, and accuracy for identifying polyp-positive patients including the three patients with small (<5 mm) polyps were 64%, 89%, and 75%, respectively. CONCLUSION: Virtual colonoscopy based on MRI data is feasible and should be evaluated in a larger sample of patients.

Adult↗
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Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis.

BACKGROUND: Septic puerperal ovarian vein thrombosis (SPOVT) is one of the underlying etiologies of puerperal fever. A correct diagnosis of this condition is important because adequate treatment requires additional administration of anticoagulants. The purpose of this study was to evaluate the role of duplex color Doppler ultrasound (CDUS), computed tomography (CT), and magnetic resonance angiography (MRA) in the detection of SPOVT. METHODS: Twenty-six patients with puerperal fever suspected to be due to SPOVT and unresponsive to broad antibiotic treatment for at least 48 h were included in a prospective study using CDUS, CT, and MR imaging including MRA. Examinations were analyzed and then correlated to a standard of reference gathered from surgical and clinical follow-up data and from results of imaging. RESULTS: SPOVT was present in nine patients (right side n = 8, bilateral n = 1). CDUS was inconclusive due to gaseous distention of the bowel or obesity in 13 of 26 cases. After counting inconclusive findings as wrong results for statistical purposes, sensitivity, specificity, and accuracy for CDUS were 55.6%, 41.2%, and 46.2%, respectively. CT had a sensitivity of 77.8% with a specificity of 62.5%; accuracy was 68.0%. MRA rendered conclusive results in all evaluated patients, resulting in a sensitivity and specificity of 100%. CONCLUSION: MRA is recommended in all patients with inconclusive CDUS findings and persistent suspicion for SPOVT. CT has the advantage of more rapid access and lower cost and thus will probably remain a sufficiently accurate alternative. Septic puerperal ovarian vein thrombosis (SPOVT)-Computed tomography-Magnetic resonance angiography-Ultrasound.

Adult↗
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Can MR measurement of renal artery flow and renal volume predict the outcome of percutaneous transluminal renal angioplasty?

PURPOSE: Predicting therapeutic benefit from percutaneous transluminal renal angioplasty (PTRA) in patients with renal artery stenosis (RAS) remains difficult. This study investigates whether magnetic resonance (MR)-based renal artery flow measurements relative to renal parenchymal volume can predict clinical outcome following PTRA. METHODS: The data on 23 patients (13 men, 10 women; age range 47-82 years, mean age 64 years) were analyzed. The indication for treatment was hypertension (n = 18) or renal insufficiency (n = 5). Thirty-four cases of RAS were identified: bilateral disease was manifest in 11 and unilateral disease in 12 patients. The MR imaging protocol included a breath-hold, cardiac-gated cine phase-contrast sequence for renal flow measurement and a fast multiplanar spoiled gradient-echo sequence for renal volume measurement. MR measurements were performed on the day prior to and the day following PTRA. Clinical success was defined as (a) a reduction in diastolic blood pressure > 15% or (b) a reduction in serum creatinine > 20%. Kidneys were categorized as normal volume or low volume. A renal flow index (RFI) was calculated by dividing the renal flow (ml/min) by the renal volume (cm3). RESULTS: Clinical success was observed in patients. Twelve patients did not benefit from angioplasty. Normal kidney volume was seen in 10 of 11 responders and in 8 of 12 nonresponders, resulting in a sensitivity of 91%, specificity of 33%, a positive predictive value (PPV) of 56% and a negative predictive value (NPV) of 80%. A RFI below a threshold of 1.5 ml/min/cm3 predicted successful outcome with 100% sensitivity, 33% specificity, 58% PPV, and 100% NPV. The combination of normal renal volume and a RFI below 1.5 ml/min/cm3 identified PTRA responders with a sensitivity of 91%, a specificity of 67%, a PPV of 71%, and a NPV of 89%. PTRA resulted in a greater increase in renal flow in responders compared with nonresponders (p < 0.001). CONCLUSION: A combination of cine phase-contrast MR renal flow and parenchymal volume measurements enables identification of patients benefiting from PTRA with a high sensitivity and NPV, but only moderate specificity and PPV.

Aged↗