Biomedical subjects

L R Schad

Publications and source records attributed to L R Schad.

At least 19 recordsLinked to original sources

PubMed1997

[Functional MR urography in patients with kidney transplantation].

PURPOSE: To assess the value of functional magnetic resonance urology for the noninvasive postoperative evaluation of renal transplants. METHODS: A saturation inversion projection sequence allows the selective imaging of strongly T1 weighted signal from the MR contrast agent. A control slab leads to images comparable to conventional urography which can be acquired as a sequence with four images per minute. RESULTS: 15 patients with urologic questionable findings after renal transplantation were studied. FMRU revealed in 6 patients normal findings, in 6 moderate dilatation of the renal pelvis without any urodynamic relevant obstruction. 3 pathologic findings, ureteral leak, ureteropelvic-junction obstruction and ureteral stenosis were diagnosed and consequently surgically treated. The imaging quality in all studies was diagnostic and urologically relevant. CONCLUSION: FMRU can be used as a noninvasive technique for the assessment of renal transplant in cases with suspicion of complication in the excretory system.

Adult↗

PubMed1997

[Morphologic MR imaging with T1-weighted sequences for radiotherapy goal volume definition of intracranial tumors. Comparison with FLASH-Turbo-FLASH and SE sequences].

INTRODUCTION: The goal of this study was to compare contrast-enhanced T1-weighted Flash and Turbo-Flash sequences with conventional spin-echo sequences as a basis for planning high-precision radiotherapy. METHODS: A total of 25 consecutive patients with different intracranial tumors and a disrupted blood-brain barrier were studied. T1-weighted Flash, Turbo-Flash and conventional spin-echo images were evaluated after controlled 30-s infusion of 0.1 mmol/kg body weight of Gd-DTPA. The evaluation of the three sequences included the measurement of the spinal- and contrast-to-noise ratios, the visual inspection of the tumors and artifacts, and the measurement of tumor size. RESULTS: The signal- and contrast-to-noise ratios were significantly (P < 0.05-0.01) lower for Flash and Turbo-Flash than for conventional spin-echo sequences. However, visual inspection of the contrast-enhancing tumors revealed in 23 and 24 of 25 lesions on Flash and Turbo-Flash images, respectively, good or very good tumor visibility when compared with conventional spin-echo images with a reduction of imaging time by a factor of 7-8. Flash and Turbo-Flash sequences were more prone to susceptibility artifacts, conventional spin-echo sequences more to pulsation artifacts in the posterior fossa. Tumor sizes were comparable in all three techniques. CONCLUSION: At present, conventional spin-echo images are superior to fast Flash and ultrafast Turbo-Flash sequences as a basis for accurate target volume definition in high-precision radiotherapy. However, fast Flash and Turbo-Flash images may be a practicable alternative to conventional spin-echo images for tumors in the posterior fossa or in patients unable to tolerate a stereotactic fixation device. Despite some limitations, Turbo-Flash sequences enable fast dynamic MR imaging combined with an acceptable morphology, which may be sufficient to target volume planning in high-precision radiotherapy.

Adult↗

PubMed1997

Quantitative magnetic resonance imaging in geriatric depression and primary degenerative dementia.

Quantitative magnetic resonance imaging (MRI) was used to investigate volumes of different brain structures in 19 patients with late-onset major depression (DSM-III-R), 27 patients with Alzheimer's disease (NINCDS-ADRDA criteria) and 13 age matched controls. 3-D MRI sequences were acquired using a Siemens 1.5 T scanner. Whole brain volume, CSF volume, volume of the frontal and temporal lobes and the volume of the amygdala-hippocampus complex were assessed using the software NMR Win. Compared to the controls, depressed patients showed a significantly lower whole brain volume and a significantly higher CSF volume, whereas volumes of the frontal and temporal lobes as well as the amygdala-hippocampus complex volumes were not significantly decreased. In addition, depressed patients exhibited a higher ventricle-brain ratio suggesting a higher degree of central atrophy compared to healthy individuals. In contrast, Alzheimer patients showed significantly lower volumes than depressed patients and controls with respect to all volumetric parameters. Although the findings indicate the presence of brain atrophy in patients with late-onset depression, the pattern of volumetric changes in these patients differs markedly from that observed in patients with primary degenerative dementia.

Aged↗

PubMed1997

Quantitative magnetic resonance imaging and neuropsychological functions in dementia of the Alzheimer type.

BACKGROUND: The aim of the present study was to investigate neuropsychological functions in dementia of the Alzheimer type (DAT) with respect to morphological changes that were revealed by quantitative magnetic resonance imaging (MRI). METHODS: Twenty patients with DAT (NINCDS-ADRDA criteria) and 10 healthy age and sex matched controls were included. The neuropsychological function was evaluated on a test battery covering the severity of dementia, verbal and visual memory, concentration and attention, language skills and general intelligence as well as activities of daily living. 3D MRI sequences were acquired using a 1.5 T Siemens MAGNETOM. Whole brain volume, total intracranial volume (TIV), volume of the frontal and temporal lobes and volumes of the amygdalahippocampus complex (AHC) were assessed using the newly developed software NMR Win. RESULTS: Apart from TIV all morphometric parameters differed significantly between the diagnostic groups. AHC volumes discriminated best between the groups, with only a small overlap. AHC atrophy exceeded generalized atrophy. These findings were confirmed when the data were reanalysed after dividing the DAT patients into a mildly and moderately affected group. The severity of dementia was significantly correlated with the volumes of the AHC and the volumes of the temporal lobes bilaterally, but not with the whole brain volume and the volumes of the frontal lobes. CONCLUSIONS: These results underline the important role of the temporal substructures for aetiology and progression of DAT. They indicate that the volume of the AHC can be monitored by MRI and may be used to follow up the disease process.

Aged↗

PubMed1996

Nuclear magnetic resonance imaging with hyperpolarised helium-3.

BACKGROUND: Magnetic resonance imaging (MRI) relies on magnetisation of hydrogen nuclei (protons) of water molecules in tissue as source of the signal. This technique has been valuable for studying tissues that contain significant amounts of water, but biological settings with low proton content, notably the lungs, are difficult to image. We report use of spin-polarised helium-3 for lung MRI. METHODS: A volunteer inhaled hyperpolarised 3He to fill the lungs, which were imaged with a conventional MRI detector assembly. The nuclear spin polarisation of helium, and other noble gases, can be greatly enhanced by laser optical pumping and is about 10(5) times larger than the polarisation of water protons. This enormous gain in polarisation easily overcomes the loss in signal due to the lower density of the gas. FINDINGS: The in-vivo experiment was done in a whole-body MRI scanner. The 3He image showed clear demarcation of the lung against diaphragm, heart, chest wall, and blood vessels (which gave no signal). The signal intensity within the air spaces was greatest in lung regions that are preferentially ventilated in the supine position; less well ventilated areas, such as the apices, showed a weaker signal. INTERPRETATION: MRI with hyperpolarised 3He gas could be an alternative to established nuclear medicine methods. The ability to image air spaces offers the possibility of investigating physiological and pathophysiological processes in pulmonary ventilation and differences in its regional distribution.

Adult↗

PubMed1996

Nuclear magnetic resonance imaging of airways in humans with use of hyperpolarized 3He.

The nuclear spin polarization of noble gases can be enhanced strongly by laser optical pumping followed by electron-nuclear polarization transfer. Direct optical pumping of metastable 3He atoms has been shown to produce enormous polarization on the order of 0.4-0.6. This is about 10(5) times larger than the polarization of water protons at thermal equilibrium used in conventional MRI. We demonstrate that hyperpolarized 3He gas can be applied to nuclear magnetic resonance imaging of organs with air-filled spaces in humans. In vivo 3He MR experiments were performed in a whole-body MR scanner with a superconducting magnet ramped down to 0.8 T. Anatomical details of the upper respiratory tract and of the lungs of a volunteer were visualized with the FLASH technique demonstrating the potential of the method for fast imaging of airways in the human body and for pulmonary ventilation studies.

Adult↗

PubMed1996

Improved target volume definition in radiosurgery of arteriovenous malformations by stereotactic correlation of MRA, MRI, blood bolus tagging, and functional MRI.

In this methodological paper the authors report the stereotactic correlation of different magnetic resonance imaging (MRI) techniques [MR angiography (MRA), MRI, blood bolus tagging (STAR), and functional MRI] in 10 patients with cerebral arteriovenous malformations (AVM) and its application in precision radiotherapy planning. The patient's head was fixed in a stereotactic localization system that is usable at the MR and the linear accelerator installations. By phantom measurements different materials (steel, aluminium, titanium, plastic, wood, ceramics) used for the stereotactic system were tested for mechanical stability and geometrical MR image distortion. All metallic stereotactic rings (closed rings made of massive metal) led to a more or less dramatic geometrical distortion and signal cancellation in the MR images. The best properties-nearly no distortion and high mechanical stability-are provided by a ceramic ring. If necessary, the remaining geometrical MR image distortion can be "corrected" (reducing displacements to the size of a pixel) by calculations based on modeling the distortion as a fourth-order two-dimensional polynomial. Using this method multimodality matching can be performed automatically as long as all images are acquired in the same examination and the patient is sufficiently immobilized. Precise definition of the target volume could be performed by the radiotherapist either directly in MR images or in calculated projection MR angiograms obtained by a maximum-intensity projection algorithm. As a result, information about the hemodynamics of the AVM was provided by a three-dimensional (3D) phase-contrast flow measurement and a dynamic MRA with the STAR technique leading to an improved definition of the size of the nidus, the origin of the feeding arteries, and the pattern of the venous drainage. In addition, functional MRI was performed in patients with lesions close to the primary motor cortex area leading to an improved definition of structures at risk for high-dose application in radiosurgery. The different imaging techniques of MR provide a sensitive, noninvasive, 3D method for defining target volume, critical structures, and for calculating dose distributions for radiosurgery of cerebral arteriovenous malformations, because dose calculation of radiosurgery at sufficient accuracy can be based on 3D MR data of the geometrical conformation of the patient's head.

Algorithms↗

PubMed1996

[Image-oriented planning of minimally invasive conformal irradiation of the head-neck area].

Modern imaging techniques are a substantial part of treatment planning for minimally invasive radiotherapeutic procedures. The aim is three-dimensional assessment of the target volume and adjacent critical structures. In this paper, we report on our clinical experience with a precise system for stereotactic image correlation. Hereby, the advantages of each imaging modality can be combined. Precise immobilization of the patient is a prerequisite. The immobilization method has an accuracy of less than 1 mm. This method was evaluated in a clinical study in which a tumor control rate of 93% was achieved in patients with brain metastases after stereotactic single high dose radiotherapy. This indicated the excellent reliability of this treatment planning method. The integration of functional image information, such as blood flow or activation of cerebral cortical areas, will be evaluated in the future.

Brain↗

PubMed1996

Monitoring of task performance during functional magnetic resonance imaging of sensorimotor cortex at 1.5 T.

Functional magnetic resonance imaging (fMRI) has found widespread clinical interest. Difficulties in clinical use of the fMRI technique arise, considering the lack of knowledge about activation task performance. This accounts especially for sensorimotor activation studies, in which performance of the sensorimotor activation task is-if at all-usually rated visually by subjective or semiquantitative methods (i.e., defining categories of performance such as neurological soft signs scales). Recently, instrumental methods for the measurement and analysis of motor performance have been developed. Pronation/supination (hand rotation) movement was shown to be an easily measurable and promising motor task. We have adapted a mechanic device (pronation/supination device, PSD) to monitor motor performance during the fMRI experiment. In a feasibility study, an investigation of fMRI activation strength dependence of sensorimotor cortices and supplementary motor area upon task frequency (25, 50, and 75 cycles/min) was carried out on 10 right-handed healthy volunteers. Furthermore, the authors report the observation of stimulus-induced activation changes in the cerebellum during pronation/supination movement.

Hand↗

PubMed1996

A comparison of magnetization prepared 3D gradient-echo (MP-RAGE) sequences for imaging of intracranial lesions.

In a pilot study including 64 patients with different types of brain tumors we investigated four types of MP-RAGE sequences. The sequences differ in the length of the recovery period and the data acquisition mode (sequential vs. centric phase-encoding). The sequence with sequential encoding and a short recovery period provided images that reached the quality and reliability of spin-echo images. The other MP-RAGE sequences failed in providing equivalent information. In particular, a considerable number of small lesions identified in spin-echo images were not detected in MP-RAGE images. The impact of the evolving magnetization on the point spread function was analyzed by performing simulation calculations. It was found that lesions with short T1 times are rendered with low spatial resolution when sequence parameters are not set appropriately. The low overall quality of images obtained by sequences applying centric encoding may be explained by eddy current effects as reported in other recently published studies.

Brain Neoplasms↗

PubMed1996

Cerebral arteriovenous malformations: improved nidus demarcation by means of dynamic tagging MR-angiography.

Our purpose was to further improve the target volume definition for radiosurgical treatment of cerebral arteriovenous malformations (AVMs) by means of dynamic MRA (dMRA) using a blood bolus tagging sequence. We therefore compare this technique with 3D-TOF-MRA and transfemoral high resolution angiography in plain film technique. Twenty patients with angiographically proven cerebral AVMs were investigated by dMRA, TOF-MRA, and conventional angiography during the MR-assisted radiosurgical planning protocol. The patient's head was fixed in an MR-compatible stereotactic device. The different angiography techniques were evaluated by consensus of two radiologists. AVMs were characterized by the number and origin of feeding arteries, the maximum diameter of the AVM nidus, and the venous drainage pattern. Dynamic MRA was able to demonstrate the complete AVM characteristics and hemodynamics in 12 out of 20 patients. In three patients with an AVM nidus smaller than 1 cm in diameter the technique could not reliably depict the malformation. Technical problems due to steel screws and pins in the initially used stereotactic frame occurred in five patients. Due to reduced vessel overlap and the lack of disturbances caused by formations with short T1 time, dMRA was superior to TOF-MRA in the detection and the exact localization of the AVM nidus in four patients. We conclude that dMRA is able to demonstrate reliably AVM characteristics and hemodynamics in AVMs with a nidus larger than 1 cm in diameter. Because of the improved demarcation of the AVM nidus, this technique may be a valuable adjunct to radiosurgery planning of cerebral AVMs.

Adult↗

PubMed1996

Functional MR imaging of visual and motor cortex stimulation at high temporal resolution using a FLASH technique on a standard 1.5 Tesla scanner.

Functional magnetic resonance imaging (fMRI) was performed on a conventional 1.5 T scanner by means of a modified FLASH-technique at temporal resolutions of 80 and 320 ms. The method's stability was assessed by phantom measurements and by investigation of three volunteers resulting in a low amplitude (3%) periodic (4 s) signal modulation for the in vivo measurements, which was not observable in the phantom experiments. fMRI activation studies of motor and visual cortices of four adjacent slices were carried out on 12 healthy right-handed volunteers. Stimulation was performed by a triggered single white light flash or single finger-to-thumb opposition movement, respectively. Event-related response of visual and motor activation was traced over 10.24 s with a temporal resolution of 320 ms for the four slice measurements. Brain activation maps were calculated by correlation of measured signal time course with a time-shifted boxcar function. Activation was quantified by calculation of percentual signal change in relation to the baseline. Observed signal magnitudes were about 5-7% in visual and about 8-12% in primary motor cortex. While photic response was delayed by about 2 s, motor stimulation showed an instantaneous increase of the MR signal. MR signal responses for both stimuli had decayed completely after about 5 s. Our results show that event-related fMRI enables mapping of brain function at sufficient spatial resolution with a temporal resolution of up to 80 ms on a conventional scanner.

Adult↗

PubMed1996

Functional magnetic resonance imaging in a stereotactic setup.

The localization of critical structures within the brain is important for the planning of therapeutic strategies. Functional MRI is capable to assess functional response of cortical structures to certain stimuli. The authors present two techniques for functional MRI (fMRI) in a stereotactic set-up. The skull of the patients has been immobilized for stereotactic treatment planning either with a self developed stereotactic ceramic frame and bony fixation or with an individual precision mask system made of light cast. It has been shown that this frame does not produce any image distortion. fMRI was performed using a modified FLASH sequence on a conventional 1.5 T MRI scanner with a specially developed linear polarized head coil. The imaging technique used was an optimized conventional 2D and 3D, first order flow rephased, gradient echo sequence (FLASH) with fat-suppression and reduce bandwidth (16-28 Hz/pixel) and TR = 80-120 ms, TE = 60 ms, flip angle = 40 degrees, matrix = 128 x 128, FOV = 150-250 mm, slice-thickness = 2-5 mm, NEX = 1, and a total single scan time for one image of about 7 sec. The motor cortex stimulation was achieved by touching each finger to thumb in a sequential, self-paced, and repetitive manner. Statistical parametric maps based on student's test were calculated. Pixels with a highly significant signal increase (p < 0.001) are overlaid on T1w SE images. The primary motor and sensory cortex could be visualized with this method in all 10 patients that were imaged in this study. Due to tight fixation of the patient's skull there have been no motion artifacts. These results show that functional MRI is feasible in an stereotactic set-up with an standard 1.5 T scanner. This is a prerequisite for the exact pre therapeutic assessment of the function of cortical centers.

Brain↗

PubMed1996

Low-grade astrocytoma: treatment with conventionally fractionated stereotactic radiation therapy.

PURPOSE: To assess the efficacy of fractionated stereotactic radiation therapy for low-grade astrocytoma in terms of improvements to therapeutic ratio, patient survival, and quality of life. MATERIALS AND METHODS: Since 1987, 32 patients with inoperable grade II astrocytoma were irradiated. Stereotactic radiation therapy was given only to patients with progressive symptoms. The mean total dose applied was 59.8 Gy (range, 54.0-65.0 Gy). RESULTS: Four years after therapy, the overall survival rate calculated with Kaplan-Meier analysis was 76%. Median progression-free survival was 48 months. On the basis of clinical symptoms, 91% (29 of 32) of patients showed improvement or stable disease after stereotactic radiation therapy. Eleven local failures were observed, 10 of which were within the planning target volume; one patient had a continuously enlarging mass. Acute toxic effects of radiation did not exceed grade II of the World Health Organization classification. Two patients developed reversible contrast enhancement without clinical symptoms on MR images within 1 year after stereotactic radiation therapy. CONCLUSION: Stereotactic radiation therapy for grade II astrocytoma appears to improve patients' quality of life or stabilize disease and is not correlated with marginal misses.

Adult↗

PubMed1996

[Quantitative magnetic resonance tomography and the severity of deficits in dementia of the Alzheimer type].

The aim of the present study was to investigate the severity of dementia of the Alzheimer type (DAT) with respect to morphological changes revealed by quantitative magnetic resonance imaging (MRI). Seventeen patients with DAT (NINCDS-ADRDA guidelines) and 10 healthy elderly controls were included. The severity of dementia was evaluated on the Mini Mental State Examination (MMSE), the Global Deterioration Scale (GDS) and the Brief Cognitive Rating Scale (BCRS). Three-dimensional MRI sequences were acquired using a 1.5-T Siemens Magnetom. Whole-brain volume and the volume of the amygdala-hippocampus complex (AHC) were assessed using the newly developed software NMRWin. This software provides a semi-automated measure of the whole brain volume, while measurement of substructures requires manual guidance. In addition, the ventricle-brain ratio (VBR) was assessed. All morphometric parameters differed significantly between the two groups. AHC volumes discriminated best between them with only a small overlap. These findings were confirmed when only the data of the mildly demented patients were included in the analysis. The degree of AHC atrophy exceeded that of generalized cerebral atrophy. The severity of dementia as indicated by the MMSE, GDS and BCRS scores was correlated significantly with the volumes of the AHC bilaterally, but not with whole-brain volume or with VBR. These results underline the importance of the mesial temporal substructures in the etiology and progression of DAT and indicate that the volume of the AHC can be monitored by MRI and may be used to follow up the disease process.

Aged↗

PubMed1995

Pulsewave velocity measurement using a new real-time MR-method.

A new, one-dimensional method for the measurement of pulsewave velocities using real-time magnetic resonance (MR) imaging is presented. The measurement sequence is essentially of a RACE-type (Real Time Acquisition and Evaluation) with interleaved acquisition in two not necessarily parallel slices. In each slice the blood flow velocity perpendicular to the slice orientation was monitored. From the relative time difference of blood flow activity and the slice distance, pulsewave velocities were calculated. With a time resolution of 13 ms an overall acquisition time of 3.3 s was achieved. A method for suppression of signal contributions from stationary tissue along the axis of projection is discussed on the basis of a simplified mathematical model. Preliminary volunteer studies show that pulsewave velocities in the range of 1-10 m/s can be measured with an uncertainty of about 0.6 m/s at a conventional 1.5 T imager with a gradient system of maximal 10 mT/m.

Adult↗

PubMed1995

Postprocessing of functional MRI data of motor cortex stimulation measured with a standard 1.5 T imager.

Functional magnetic resonance imaging (fMRI) is usually based on acquisition of alternating series of images under rest and an activation task (stimulus). Brain activation maps can be generated from fMRI data sets by applying several mathematical methods. Two methods of image postprocessing have been compared: (i) simple difference of mean values between rest and stimulation, and (ii) Student's t-test. The comparison shows that the difference method is very sensitive to arbitrary signal fluctuations as seen mainly in large vessels (e.g., in the sagittal sinus), leading to insignificantly activated spots in brain activation maps. In contrary, Student's t-test maps show strongly reduced sensitivity for fluctuations and have the advantage of giving activation thresholds by setting significance levels. This allows the comparison of activation strength between patient collectives by using a grid overlay technique leading to an observer independent quantification of the stimulation effects. The method was able to reproduce previous findings of activation differences between healthy volunteers and schizophrenic patients. Moreover, a simple algorithm for the correction of slight head movements during the functional imaging task is presented. The algorithm is based on shifting the fMRI data set relative to a reference image by maximizing the linear correlation coefficients. This leads to a further reduction of insignificant brain activation and to an improvement in brain activation map quality.

Adult↗

PubMed1995

Event-related functional MR imaging of visual cortex stimulation at high temporal resolution using a standard 1.5 T imager.

The authors report the technical feasibility of measuring event-related changes in blood oxygenation for studying brain function in humans at high temporal resolution. Measurements were performed on a conventional whole-body 1.5 T clinical scanner with a nonactive-shielded standard gradient system of 1 ms rise time for a maximum gradient strength of 10 mT/m. The radiofrequency (RF) transmitting and receiving MR unit consists of a commercially available circular polarized head coil. Magnet shimming with all first-order coils was performed to the volunteer's head resulting in a magnetic field homogeneity of about 0.1-0.2 ppm. The measuring sequence used was a modified 3D, first-order flow rephased, FLASH sequence with reduced bandwidth = 40 Hz/pixel, TR = 80 ms, TE = 56 ms, flip angle = 40-50 degrees, matrix = 64 x 128, field-of-view = 200-250 mm2, slice thickness = 4 mm, NEX = 1,128 partitions, and a total single scan time of about 10 min. In this sequence the 3D gradient table was removed and the 3D partition-loop acts as a time-loop for sequential measurement of 128 or 32 consecutive images at the same slice position. This means that event-related functional MRI could be performed with an interscan delay of 80 ms for a series of 128 sequential images or with an interscan delay of 320 ms for a simultaneous measurement of four slices with a series of 32 sequential images for each slice. We used a TTL signal given by the gradient board at the beginning of every line-loop in the measuring sequence and a self-made "TTL-Divider-Box" for the event triggering. This box was used to count and scale down the TTL signals by a factor of 128 and to trigger after every 128th TTL signal a single white flash-light, which was seen by the volunteer in the dark room of the scanner with a period of 10.24 s. As a consequence, the resulting event-related scan data coincide at each line of the series of 128 sequential images, which were repeated in 128 x 80 ms or 32 x 320 ms for the single- or four-slice experiment, respectively. Visual cortex response magnitude measured was about 5-7% with an approximate Gaussian shape and a rise time from stimulus onset to maximum of about 3-4 s, and a fall time to the baseline of about 5-6 s after end of stimulus. The reported data demonstrate the feasibility of functional MRI studies at high temporal resolution (up to 80 ms) using conventional MR equipment and measuring sequence.

Brain↗