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Biomedical subjects

M Thelen

Publications and source records attributed to M Thelen.

At least 109 records · Page 6Linked to original sources
PubMed2000

[Pressure load of the aneurysm sac after endovascular treatment of aortic aneurysm].

PURPOSE: Stent grafting of aortic aneurysms should result in relief of pressure within the excluded aneurysmal sac, however confirming data are not available. This study evaluates the intra-extraluminal pressure translation and translation of maximum pressure increase (dp/dtmax) into the excluded aneurysmal sac after endovascular treatment of experimental aortic aneurysms. MATERIALS AND METHODS: Experimental autologous aneurysms were created surgically using a patch from the sheath of the rectus abdominis muscle in 12 mongrel dogs. After 12 weeks reconvalescence, endovascular treatment was performed viafemoral access using dacron-covered nitinol stents. Spiral CT and angiography were performed at one week and six weeks follow-up and 6 animals each. Laparotomy was performed for hemodynamic measurements. A manometer-tipped catheter was introduced into the excluded aneurysmal sac. A second manometer-tipped catheter was placed intraluminally within the stent graft. Pressure curves and their first derivative dp/dt were simultaneously recorded to calculate the intra-extraluminal transmembraneous pressure transmission. RESULTS: At one week follow-up systolic blood pressure and mean blood pressure were significantly reduced by factors of 0.60 +/- 0.17 (p < 0.01) and 0.78 +/- 0.3 (p < 0.05), respectively in the excluded aneurysm sac. The maximal pressure increase, dp/dt max, was considerably reduced by a factor of 0.06 +/- 0.05 (p < 0.01). However, the diastolic blood pressure was not significantly changed. There were no hemodynamic differences between one and six weeks follow-up. CONCLUSION: In experimental aortic aneurysms, endovascular treatment with stent grafts significantly reduces the systolic peak pressure and dp/dt max in the excluded aneurysmal sac, and thereby significantly reduces the wall stress in the diseased aneurysm wall. Despite complete exclusion of the aneurysm, a considerable pressure load remains in the excluded aneurysmal sac.

Angiography↗
PubMed2000

[Ultrafast MRI of lung ventilation using hyperpolarized helium-3].

OBJECTIVE: Assessment of the temporal and spatial dynamics of hyperpolarized Helium-3 (3He) distribution in the lung with ultrafast gradient-echo magnetic-resonance imaging. MATERIAL AND METHODS: Coronal images of the lung were acquired using ultrafast gradient-echo pulse sequences with TR/TE = 3.3 ms/1.3 ms (slice thickness, 40 mm) and TR/TE = 2.0 ms/0.7 ms (without slice selection). A series of 80 or 160 projection images was obtained with 210 ms or 130 ms temporal resolution, respectively. Imaging was performed during several respiratory cycles after application of a single bolus of 300 mL hyperpolarized 3He. Measurements were performed in six healthy volunteers (spontaneous breathing). RESULTS: Different phases of in- and expiration could be visualized. During the course of consecutive respiratory cycles the 3He signal decreased due to dilution of 3He in residual alveolar gas and by inspired air, relaxation due to oxygen and the RF pulses, and due to Helium-3 washout. The signal of a single bolus of 3He was detected in the lung for up to four respiratory cycles. Anatomical structures were better visualized on slice selective images than on images without slice selection. CONCLUSION: Distribution of inspired 3He within the tracheobronchial tree and alveolar space and its washout can be visualized by ultrafast imaging of a single bolus of hyperpolarized 3He gas. This method may allow for regional analysis of lung function with temporal and spatial resolution superior to conventional methods.

Helium↗
PubMed2000

[Low-field MRI of the ankle joint: initial experience in children and adolescents using an open 0.2 T MR-system].

PURPOSE: To evaluate the feasibility and diagnostic confidence of MRI with an open low field System (Magnetom open, Siemens, Germany) in children with predominantly traumatic disorders. MATERIAL AND METHODS: Conventional X-rays and MRI examinations have been evaluated in 55 children. MRI was performed at an open 0.2 T MR-unit. The study protocol comprised coronal STIR-sequence, an angulated T2 weighted TSE-sequence and T1 weighted SE-sequence. RESULTS: MRI showed ligamental rupture in 33/50 (60%) cases. Injuries of the ATFL were most frequent (27/33); osseous ligamental tears occurred in approx. 50% of all cases. Fractures of the distal tibia and fibula were diagnosed in 28/55 children. 15/28 cases showed an involvement of the epiphysis. We found occult fractures in 11/28 children. Fractures, diagnosed by conventional x-rays, were excluded in 6 cases. Therapy changed in 35/55 patients on the basis of MRI-findings. CONCLUSION: Low-field MRI of the ankle joint in children and adolescents is able to show numerous pathological conditions. We recommend low-field MRI of the ankle in children with persistent or unclear pain of the ankle joint and inconspicuous conventional x-ray.

Adolescent↗
PubMed2000

[Contrast media enhanced three dimensional MR angiography of the pulmonary arteries in patients with chronic recurrent pulmonary embolism--comparison with selective intra-arterial DSA].

PURPOSE: This study compares contrast-enhanced 3D-MR angiography (MRA) of the pulmonary arteries with selective intra-arterial DSA in patients with chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS: 20 patients preoperatively underwent a contrast-enhanced 3D-MRA of the pulmonary arteries at 1.5 T using the phased-array body coil. For MRA, we used a 3D-Flash-sequence after bolus timing. 2 radiologists analyzed the acquired image material in consensus with respect to the detection of central thromboembolic material and the visualization of the pulmonary arterial tree. Finally, the MR angiograms were compared with selective DSA images using surgical findings as the definitive standard. RESULTS: MRA demonstrated central thromboembolic material, vessel cut-offs and abnormal proximal-to-distal tapering in all patients. Compared to DSA, MRA depicted the pulmonary vessels up to the segmental level in all cases, it was inferior to DSA in delineation of the subsegmental arteries (sensitivity 87%, specificity 100%). The central beginning of the thromboembolic occlusions seen at MRA corresponded to the beginning of the deobliteration procedure during pulmonary thromboendarterectomy in every case. CONCLUSIONS: Contrast-enhanced 3D-MRA of the pulmonary arteries enables the reliable detection of central thromboembolic material in patients with CTPEH. It also allows identification of those patients who may be treated surgically.

Adult↗
PubMed2000

[Rational diagnostic imaging of pelvic and acetabulum injuries].

In spite of the widespread availability of CT scanners, conventional X-ray radiographs remain the basic imaging modality in patients with pelvic and/or acetabular trauma. However, the extent of their use will depend on local utilities (e.g., availability of CT scanners) and on the patient's clinical condition. Regarding the inaccuracy of conventional radiography in the diagnosis of injuries of the dorsal pelvic ring and of the acetabulum, computed tomography represents the most important imaging modality in the clinically stable patient. CT provides an exact staging of the extent of trauma and allows for differentiation of pelvic instabilities. CT clearly demonstrates the severity of acetabular trauma and is superior in the detection of local complicating factors, i.e., impressions fractures and (sub-)luxations of the femoral head as well as free intraarticular fragments. CT findings provide the basis for definite treatment regimens of the injured patient. By extension of the examination, all relevant organs and systems (craniospinal, cardiovascular, gastrointestinal, respiratory, genitourinary) can be imaged during one session. The speed of spiral CT scanners and their diagnostic accuracy will play a major role in the management of, especially, polytraumatized patients. The indication for angiography with the option of therapeutic embolization exists if a pelvic bleeding persists even after reposition and operative fixation of the injury.

Acetabulum↗
PubMed2000

[In vitro investigation of biological and technical prosthetic heart valves using MRI: evaluation of possible deflection and heating of the implants].

PURPOSE: In vitro evaluation of possible deflection and heating of present-day prosthetic heart valves during MR imaging at 1.5 T. METHODS: 17 prosthetic heart valves, 12 technical and 5 biological, were investigated using a 1.5 Tesla Siemens Vision system. Deflection was measured at the edge of a 1.5 Tesla superconducting magnet. Each valve was then submerged in a vial of a 1/1 electrolyte solution and temperature was measured before and after imaging with a turbo-spin-echo sequence (TR 5200 ms, TE 138 ms, Flip angle 180 degrees, acquisition time 10.5 minutes, length of echo train 29). MR imaging was performed with phase encoding parallel and perpendicular to the plane of the valves. RESULTS: None of the investigated prosthetic heart valves were deflected. The maximal observed temperature rise was 0.5 degree C. During MR investigation of the prostheses, artifacts caused by metallic parts were less evident using a spin-echo sequence than a gradient-echo sequence. CONCLUSIONS: Patients with the tested present-day prosthetic heart valves can be safely imaged by MRI.

Bioprosthesis↗
PubMed2000

[Diagnosis of tracheal instability: spiral CT in inspiratory and expiratory and respiratory cine CT].

PURPOSE: In tracheo- and bronchomalacia, localization and determination of collapse is necessary for planning a surgical procedure. We compared inspiratory and spiral CT, cine CT, and bronchoscopy and evaluated the relevance of each method. METHODS: Seventeen patients with suspected or verified tracheal stenosis or collapse underwent paired inspiratory and expiratory spiral CT and cine CT during continuous respiration (temporal increment 100 ms). The tracheal cross-sectional area was calculated and compared. RESULTS: In addition to bronchoscopy, further information concerning localization, extent, collapse, stability of the tracheal wall, distal portions of the stenosis, and extraluminal compressions was obtained. A significantly higher degree of tracheal collapse was seen using cine CT compared to paired spiral CT (p < 0.002). The findings changed the further surgical procedure in 3/17 patients. Further distal stenoses were excluded and bronchoscopy was verified in another 10/17. CONCLUSION: Paired inspiratory and expiratory spiral CT localizes tracheal stenoses and demonstrates clinically relevant extraluminal compression. Improved evaluation of expiratory collapse and further information of localized tracheal instability is provided by cine CT.

Adult↗
PubMed2000

[19F-MRT of pulmonary ventilation in the breath-hold technic using SF6 gas].

OBJECTIVE: Development of a method to analyze lung ventilation by 19F-magnetic resonance imaging (MRI) of inspired SF6 gas during breath hold. MATERIAL AND METHODS: Measurements were performed with a Siemens Magnetom Vision 1.5 T scanner using the conventional gradient overdrive. Coronal images of the lung were acquired using ultrafast gradient-echo pulse sequences with TR/TE/alpha = 1.4 ms/0.48 ms/40 degrees without slice selection. With NEX = 200 averages and MA = 32 x 64 raw data matrix, the acquisition time was 9 s/image. Higher spatial resolution of 4.7 x 6.3 x 15 mm3 was obtained with a three-dimensional pulse sequence (TR/TE/alpha = 1.6 ms/0.48 ms/65 degrees, NEX = 20) running for 49 s. Measurements wer performed in three anesthetized and ventilated pigs (18 kg). RESULTS: A nearly linear relation between SF6 concentration and 19F signal intensity was observed. The signal-to-noise ratio in images obtained without slice selection was 30.9, with slice selection it was 14.9. No differences between SF6 distribution to both lungs were observed in the animals. CONCLUSION: Breath-hold MRI of SF6 gas distribution in the lung was demonstrated for the first time. The low spin-density was compensated for by highly repetitive signal averaging. Breath-hold 19F-MR imaging of ventilated airspaces to assess SF6 distribution in the human lung appears to be an interesting new method, which can be implemented with little technical efforts, and does not rely on radioactive isotopes.

Animals↗
PubMed2000

[Automated detection of spleen volume by spiral CT scans using neural networks and "fuzzy logic"].

PURPOSE: To assess spleen segmentation and volumentry in spiral CT scans with and without pathological changes of splenic tissue. METHODS: The image analysis software HYBRIKON is based on region growing, self-organized neural nets, and fuzzy-anatomic rules. The neural nets were trained with spiral CT data from 10 patients, not used in the following evaluation on spiral CT scans from 19 patients. An experienced radiologist verified the results. The true positive and false positive areas were compared in terms to the areas marked by the radiologist. The results were compared with a standard thresholding method. RESULTS: The neural nets achieved a higher accuracy than the thresholding method. Correlation coefficient of the fuzzy-neural nets: 0.99 (thresholding: 0.63). Mean true positive rate: 90% (thresholding: 75%), mean false positive rate: 5% (thresholding > 100%). Pitfalls were caused by accessory spleens, extreme changes in the morphology (tumors, metastases, cysts), and parasplenic masses. CONCLUSIONS: Self-organizing neural nets combined with fuzzy rules are ready for use in the automatic detection and volumetry of the spleen in spiral CT scans.

Adult↗
PubMed2000

[Possible mutagenic effects of magnetic fields].

AIM: To assess the potential mutagenic effect of static magnetic fields of 1.5 T and 7 T, gradient fields and high frequency magnetic fields. METHOD: We used the Salmonella mutagenicity test (Ames test), which detects mutations in a gene of a histidine-requiring (his-) strain to produce a histidine-independent (his+) strain, Exposure to a static magnetic field of 1.5 T and 7.2 T, in a bipolar magnetic gradient and additionally in a high frequency field took place with and without known genotoxic chemicals. RESULTS: No differences in the number of revertants between the bacterial strains of exposed and control cells could be detected and the exposure with known genotoxic chemicals showed no significant difference in mutagenicity. CONCLUSION: In conclusion our data do not provide evidence that exposure to a static magnetic field exerts effects on the mutagenicity in our standard tester strains and whether the exposure took place in a diagnostic 1.5 T MR scanner which is used in the clinical routine or at 7.2 T which is a much stronger field made no difference. Also an exposure in a gradient field or in a high frequency field did not show any alteration in the number of revertants.

Electromagnetic Fields↗
PubMed2000

[Contrast media-enhanced 3D MR angiography of peripheral arteries using an automatic tracking technique at 1.0 Tesla].

PURPOSE: Assessment of the value of contrast-enhanced MR angiography (ceMRA) using an automatic tracking technique at 1.0 Tesla in comparison with digital subtraction angiography (DSA) of the pelvic and lower limb arteries. MATERIALS AND METHODS: In 15 patients with peripheral arterial occlusive disease a ceMRA (3D FLASH, TR/TE = 6.2/2.3 ms, Flip angle alpha = 30 degrees, Matrix 170 x 256) using a new automatic tracking technique was accomplished. The reference method was DSA. Twenty-one vessel segments of each patient were graded as normal, stenosed (> 50%) or occluded. Image material was evaluated independently by two radiologists. RESULTS: In comparison, the interobserver agreement showed a good (Cohen's kappa > 71%) concordance for 38% of the 21 vessel segments, a moderate (Cohen's kappa between 31%-70%) for 21% and a poor (Cohen's kappa < 30%) concordance for 38% of the 21 vessel segments. Regarding the MRA and DSA results, a good concordance was achieved for 62% of the 21 vessel segments, 14% showed a moderate concordance and 24% only a poor concordance. CONCLUSION: In patients with peripheral arterial occlusive disease ceMRA using an automatic tracking technique enables a reliable evaluation of pelvis and upper limb arteries at 1.0 Tesla. However, a reliable evaluation of lower limb arteries is not yet possible.

Aged↗
PubMed2000

Induction of DNA single-strand breaks by 131I and 99mTc in human mononuclear blood cells in vitro and extrapolation to the in vivo situation.

The radionuclides (131)I and (99m)Tc are frequently used for therapy of benign and malignant thyroid disease ((131)I) and for diagnosis of thyroid and other diseases ((99m)Tc). However, the levels of DNA single-strand breaks (SSBs) induced in cells of patients after administration of (131)I and (99m)Tc are not known. In this study, we measured the number of SSBs per cell induced by (131)I and (99m)Tc in vitro, extrapolated the results to the clinical situation, and assessed their biological relevance by comparing levels of SSBs induced after therapeutic administration of (131)I and (99m)Tc to those induced by endogenous processes or by occupational exposure to genotoxic substances. A linear dose-response relationship between the radioactivity concentrations of (131)I and (99m)Tc and SSBs in human mononuclear blood cells (determined by alkaline elution) was obtained after incubation at 4 and 37 degrees C. At 4 degrees C, where almost no repair of SSBs takes place, (131)I and (99m)Tc induced 81 and 7 SSBs per cell per hour/(MBq/ml), respectively. At 37 degrees C, only 20 and 1.6 SSBs per cell per hour/(MBq/ml) were observed after incubation with (131)I and (99m)Tc. To estimate the induction of SSBs in vivo in cells of patients after administration of 3700 MBq (131)I (oral) or 60 MBq (99m)Tc (i.v.), the rates of induction of SSBs obtained in vitro were extrapolated to the concentrations of (131)I and (99m)Tc measured in blood of patients. The total number of SSBs (mean +/- standard deviation) accumulated after oral administration of 3700 MBq (131)I up to 70 h after administration was calculated as 200 +/- 59 SSBs/cell. After administration of 60 MBq (99m)Tc (i.v.), 0.032 +/- 0.009 SSBs per cell (total SSBs up to 2 h after administration) were cumulated. The induction of SSBs by endogenous processes (estimated 2,000 SSBs per cell per hour) and by occupational exposure to genotoxic substances (125-430 SSBs per cell) has been estimated in earlier studies. In conclusion, the frequency of SSBs induced by thyroid diagnosis with 60 MBq (99m)Tc is approximately 5 orders of magnitude smaller than the frequency of spontaneous SSBs and thus is most probably without biological relevance. Since the frequency of induction of SSBs by therapy with (131)I (3700 MBq) is about 6000-fold higher compared to thyroid diagnosis by (99m)Tc, its biological relevance is more difficult to assess. Nevertheless, the number of SSBs induced by therapy with (131)I is substantially lower than that induced by endogenous processes.

DNA Damage↗
PubMed2000

Diabetes and peripheral arterial occlusive disease: prospective comparison of contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography.

OBJECTIVE: The purpose of this study was to compare contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography (DSA) for identifying and evaluating arteries of the distal calf and foot in diabetic patients with severe arterial occlusive disease who will undergo distal bypass surgery. SUBJECTS AND METHODS: Twenty-four feet of 24 consecutive patients with diabetes and limb-threatening lower extremity ischemia were prospectively imaged using an ultrafast three-dimensional fast low-angle shot sequence on a 1.5-T MR scanner. All patients also underwent DSA of the diseased extremity within 5 days. Images were interpreted in a randomized manner by two observers in conference. Each lower extremity was divided into seven potential arterial segments. Image analysis included the detection of patent, stenosed, or occluded vessel segments. A vascular surgeon formulated treatment plans on the basis of findings from DSA and then formulated treatment plans on the basis of findings from both DSA and MR angiography. RESULTS: MR angiography was significantly better than DSA in revealing peripheral runoff vessels (p < 0.001). In nine (38%) of the 24 patients, MR angiography showed patent pedal vessels suitable for distal bypass grafting that were not revealed by DSA. Because of the results of MR angiography, treatment plans changed in seven of the nine patients in whom patent vessels were subsequently used as target vessels for distal pedal bypass grafts. CONCLUSION: Contrast-enhanced three-dimensional MR angiography is superior to DSA in revealing patent vessel segments of the foot in diabetic patients with severe arterial occlusive disease. Contrast-enhanced three-dimensional MR angiography should be part of the diagnostic algorithm for patients in whom pedal bypass grafting is a therapeutic option.

Aged↗
PubMed2000

Automatic detection and quantification of ground-glass opacities on high-resolution CT using multiple neural networks: comparison with a density mask.

OBJECTIVE: We compared multiple neural networks with a density mask for the automatic detection and quantification of ground-glass opacities on high-resolution CT under clinical conditions. SUBJECTS AND METHODS: Eighty-four patients (54 men and 30 women; age range, 18-82 years; mean age, 49 years) with a total of 99 consecutive high-resolution CT scans were enrolled in the study. The neural network was designed to detect ground-glass opacities with high sensitivity and to omit air-tissue interfaces to increase specificity. The results of the neural network were compared with those of a density mask (thresholds, -750/-300 H), with a radiologist serving as the gold standard. RESULTS: The neural network classified 6% of the total lung area as ground-glass opacities. The density mask failed to detect 1.3%, and this percentage represented the increase in sensitivity that was achieved by the neural network. The density mask identified another 17.3% of the total lung area to be ground-glass opacities that were not detected by the neural network. This area represented the increase in specificity achieved by the neural network. Related to the extent of the ground-glass opacities as classified by the radiologist, the neural network (density mask) reached a sensitivity of 99% (89%), specificity of 83% (55%), positive predictive value of 78% (18%), negative predictive value of 99% (98%), and accuracy of 89% (58%). CONCLUSION: Automatic segmentation and quantification of ground-glass opacities on high-resolution CT by a neural network are sufficiently accurate to be implemented for the preinterpretation of images in a clinical environment; it is superior to a double-threshold density mask.

Absorptiometry, Photon↗
PubMed1999

Stromal cell-derived factor-1alpha associates with heparan sulfates through the first beta-strand of the chemokine.

Biological properties of chemokines are believed to be influenced by their association with glycosaminoglycans. Surface plasmon resonance kinetic analysis shows that the CXC chemokine stromal cell-derived factor-1alpha (SDF-1alpha), which binds the CXCR4 receptor, associates with heparin with an affinity constant of 38.4 nM (k(on) = 2.16 x 10(6) M(-1) s(-1) and k(off) = 0.083 x s(-1)). A modified SDF-1alpha (SDF-1 3/6) was generated by combined substitution of the basic cluster of residues Lys(24), His(25), and Lys(27) by Ser. SDF-1 3/6 conserves the global native structure and functional properties of SDF-1alpha, but it is unable to interact with sensor chip-immobilized heparin. The biological relevance of these in vitro findings was investigated. SDF-1alpha was unable to bind in a CXCR4-independent manner on epithelial cells that were treated with heparan sulfate (HS)-degrading enzymes or constitutively lack HS expression. The inability of SDF-1 3/6 to bind to cells underlines the importance of the identified basic cluster for the physiological interactions of SDF-1alpha with HS. Importantly, the amino-terminal domain of SDF-1alpha which is required for binding to, and activation of, CXCR4 remains exposed after binding to HS and is recognized by a neutralizing monoclonal antibody directed against the first residues of the chemokine. Overall, these findings indicate that the Lys(24), His(25), and Lys(27) cluster of residues forms, or is an essential part of, the HS-binding site which is distinct from that required for binding to, and signaling through, CXCR4.

Animals↗
PubMed1999

Two constituents of the initiation complex of the mannan-binding lectin activation pathway of complement are encoded by a single structural gene.

Mannan-binding lectin (MBL) forms a multimolecular complex with at least two MBL-associated serine proteases, MASP-1 and MASP-2. This complex initiates the MBL pathway of complement activation by binding to carbohydrate structures present on bacteria, yeast, and viruses. MASP-1 and MASP-2 are composed of modular structural motifs similar to those of the C1q-associated serine proteases C1r and C1s. Another protein of 19 kDa with the same N-terminal sequence as the 76-kDa MASP-2 protein is consistently detected as part of the MBL/MASP complex. In this study, we present the primary structure of this novel MBL-associated plasma protein of 19 kDa, MAp19, and demonstrate that MAp19 and MASP-2 are encoded by two different mRNA species generated by alternative splicing/polyadenylation from one structural gene.

Alternative Splicing↗
PubMed1999

Quantification of regional intrapulmonary oxygen partial pressure evolution during apnea by (3)He MRI.

We present a new method to determine in vivo the temporal evolution of intrapulmonary oxygen concentrations by functional lung imaging with hyperpolarized (3)Helium ((3)He-->). Single-breath, single-bolus visualization of (3)He--> administered to the airspaces is used to analyze nuclear spin relaxation caused by the local oxygen partial pressure p(O(2))(t). We model the dynamics of hyperpolarization in the lung by rate equations. Based hereupon, a double acquisition technique is presented to separate depolarization by RF pulses and oxygen induced relaxation. It permits the determination of p(O(2)) with a high accuracy of up to 3% with simultaneous flip angle calibration using no additional input parameters. The time course of p(O(2)) during short periods of breathholding is found to be linear in a pig as well as in a human volunteer. We also measured the wall relaxation time in the lung and deduced a lower limit of 4.3 min.

Adult↗