Biomedical subjects

M V Knopp

Publications and source records attributed to M V Knopp.

At least 19 recordsLinked to original sources

PubMed2003

[Multiphasic MR angiography as an intra-individual comparison between the contrast agents Gd-DTPA, Gd-BOPTA, and Gd-BT-DO3A].

QUESTION: The availability of new MR contrast agents having either a protein binding effect or higher concentration leads to the question if they differ from standard compounds in their vascular contrasting properties. METHODS: By intraindividual comparison five volunteers were examined (1.5 T MR system) with a multi-phasic MRA of the abdomen each receiving three different contrast agents (gadopentetate dimeglumine 0.5 M; gadobenate dimeglumine 0.5 M, and gadobutrol 1.0 M). The dose (0.15 mmol/kg body weight) and flow rate (3.0 ml/s) were kept identical. All images were quantitatively and qualitatively evaluated by blinded assessment. RESULTS: Significantly higher maximum signal intensity was found in the arteries for the protein interacting gadobenate dimeglumine (p = 0.05). No significant difference in vascular enhancement was demonstrated in the comparison of gadobutrol to gadopentetate dimeglumine. CONCLUSION: Gadobenate dimeglumine was shown to be a favorable contrast agent for multi-phasic MRA. A higher concentrated Gd-chelate does not automatically lead to improved vascular contrast if standard imaging protocols are used.

Abdomen↗

PubMed2003

Assessment of brain metastases with dynamic susceptibility-weighted contrast-enhanced MR imaging: initial results.

PURPOSE: To assess if preradiation and early follow-up regional cerebral blood volume (CBV) measurements can help predict treatment outcome in patients with cerebral metastases and to evaluate regional CBV changes in tumor and normal tissue after radiosurgery. MATERIALS AND METHODS: In 18 patients, dynamic susceptibility-weighted contrast material-enhanced magnetic resonance (MR) imaging was performed with a 1.5-T unit, which allowed an absolute quantification of the regional CBV. Measurements were performed prior to and at 6 weeks and 3 months after therapy. Treatment outcome was classified according to tumor volume changes at 6 months. The regional CBV of the metastases and the normal adjacent brain tissue were determined with a region-of-interest analysis. Regional CBV values were correlated with the patient outcome to assess the sensitivity and specificity of dynamic susceptibility-weighted contrast-enhanced MR imaging. RESULTS: The pretherapeutic regional CBV was not able to help predict a treatment outcome; however, the method proved to be highly sensitive and specific for treatment outcome prediction at the 6-week follow-up. A decrease of the regional CBV value helped predict the treatment outcome with a sensitivity of more than 90%. The tumor volume change alone had a sensitivity of only 64%. The measured regional CBV values of normal brain tissue and their ratio were comparable to physiologic data and remained unchanged with therapy. CONCLUSION: The results suggest that dynamic susceptibility-weighted contrast-enhanced MR imaging is a useful method for the assessment of radiosurgically treated brain metastases. The implemented technique with determination of the arterial input function enables an absolute quantification of the regional CBV and prediction of tumor response.

Adult↗

PubMed2002

Evaluation of neoadjuvant chemotherapeutic response of breast cancer using dynamic MRI with high temporal resolution.

The aim of this study was to evaluate changes in both size and contrast enhancement of breast tumors during neoadjuvant chemotherapy, using dynamic MRI with high temporal resolution. Patients with advanced breast cancer (n=21) underwent a 1.5-T MRI scan prior to and following neoadjuvant chemotherapy with four cycles. Dynamic contrast enhancement was measured using a fast turbo-FLASH sequence and quantified using a two-compartment model with the parameters k(ep) and amplitude. Image analysis was done on images overlayed with a color map of parameters. The correlation between tumor diameter measured by histopathology and MRI was 0.7 (p<0.003). A reduction of tumor size after chemotherapy of more than 25% was associated with a decrease of both analyzed contrast enhancement parameters (k(ep): p<0.002; amplitude: p<0.006), where k(ep) began to drop already after the first cycle of chemotherapy (p<0.008). A clear reduction of tumor size was only noted after the third cycle (p<0.008). In patients without tumor regression there was also a trend towards an early reduction of contrast enhancement. We assume that MRI with high temporal resolution and color mapping is a novel tool to assess therapeutic effects of neoadjuvant chemotherapy in breast tumors, which deserves further prospective evaluation.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2002

Cerebral arteriovenous malformations: morphologic evaluation by ultrashort 3D gadolinium-enhanced MR angiography.

The purpose of this study was to evaluate the usefulness of a new ultrashort contrast-enhanced (CE) MR angiography (MRA) for the morphologic evaluation of cerebral arteriovenous malformations (AVMs). The method was compared with conventional X-ray digital subtraction angiography (DSA) and time-of-flight (TOF) MRA in 22 patients to assess the angioarchitecture of the malformations which is essential for treatment planning and follow-up. Two experienced MR readers independently evaluated both techniques with regard to the assessment of feeding arteries, AVM nidus, and venous drainage patterns. Contrast-enhanced MRA was able to detect all AVMs seen on DSA, whereas the TOF MRA failed in 1 patient with a very small AVM. In the assessment of the different vessel components of the AVM there was no difference for the detection and delineation of feeding arteries and the AVM. The venous drainage patterns could always be clearly delineated in the CE MRA, whereas TOF MRA could demonstrate the exact venous drainage in only 9 patients. Contrast-enhanced MRA was found to be superior to conventional TOF MRA in the assessment of the angioarchitecture of cerebral AVMs especially regarding the assessment of the venous drainage patterns. The superiority is supported by the improved vessel-to-background contrast and contrast-to-noise ratios. The major limitations of this new technique consist of a low spatial resolution at the used time resolution which can be improved by further sequence modifications. Contrast-enhanced MRA is thus an important additional imaging technique for treatment planning and follow-up of AVMs.

Adult↗

PubMed2002

[Comparison of methods for quantifying contrast enhancement exemplified by dynamic MRI mammography].

AIM: Aim of this study was to demonstrate and compare different quantification techniques to assess contrast enhancement in dynamic MRI studies. The diagnostic potential of dynamic MRI studies is increasingly appreciated and already used in different organ systems. METHOD: A patient population of 314 histologically verified breast lesions (138 malignant, 176 benign) were evaluated using a high temporal resolved dynamic sequence. Different quantification techniques such as the use of a cutoff line, time dependent and pharmacokinetic assessment were comparatively evaluated. RESULTS: Time dependent quantification methods revealed higher diagnostic potential which was further improved by in vivo normalization of the contrast availability in the vascular system. Significant differences in the enhancement characteristics were determined between malignant and benign as well within the different histological entities. CONCLUSION: Time dependent quantification methods enable an angiogenic characterization of lesions to improve diagnostic interpretation as well as monitoring during therapy. They are also the basis for automated, color-coded visualization of dynamic studies.

Breast↗

PubMed2002

Dynamic susceptibility contrast-enhanced echo-planar imaging of cerebral gliomas. Effect of contrast medium extravasation.

PURPOSE: To assess the influence of the degree of contrast medium extravasation on different DSC EPI MR sequences for perfusion MR imaging. MATERIAL AND METHODS: 60 patients with cerebral gliomas were examined by either an FID EPI or an SE EPI DSC MR sequence. The acquired images were evaluated on a qualitative and quantitative basis. For qualitative assessment, the homogeneity of the signal time curve, image artifacts, the degree of signal drop and the degree of enhancement were evaluated. The quantitative assessment included the percentage of signal drop and the contrast-to-noise ratio of the different EPI sequences was analyzed. RESULTS: FID EPI presented a more homogeneous signal time curve and a more pronounced susceptibility effect than the SE EPI sequence. Due to the lesser susceptibility effect, the SE EPI sequence was not as sensitive to contrast media extravasation. The signal returned to baseline in all patients. In patients with strongly enhancing lesions, the FID EPI sequence suffered from considerable T1 effects, causing problems in the quantification of perfusion data. CONCLUSION: FID EPI sequences were preferred for perfusion MR imaging in patients without strong enhancing lesions, e.g. in ischemia or tumors with intact blood-brain barrier. In patients with suspected strong enhancing lesions, an SE EPI sequence should be used.

Brain Neoplasms↗

PubMed2002

Assessment of gadobenate dimeglumine for magnetic resonance angiography: phase I studies.

RATIONALE AND OBJECTIVES: To assess the vascular contrasting properties of a new MR contrast agent (gadobenate dimeglumine [Gd-BOPTA]), which presents higher relaxivity because of reversible, weak protein interaction, and, to compare these properties with a standard gadolinium agent. MATERIALS AND METHODS: Two phase I trials compared intraindividually: (A) the vascular contrasting properties of Gd-BOPTA at three doses (0.0125, 0.05, and 0.2 mmol/kg body weight) and two flow rates (0.5 and 2.0 mL/s) in 10 volunteers; and (B) 0.1 mmol/kg body weight doses of Gd-BOPTA and Gd-DTPA at 2.0 mL/s using a modified magnetic resonance angiography (MRA) sequence with a temporal resolution of 1 s/f. Quantitative (ROI analysis) and fully blinded qualitative (reader review) assessment of images was performed. RESULTS: A dose of 0.2 mmol/kg resulted in higher maximum intensities, longer median peak widths, and larger areas under the curve than did the lower doses (0.0125 mmol/kg and 0.05 mmol/kg). In the intraindividual comparison, Gd-BOPTA demonstrated significantly better vascular enhancement characteristics in terms of signal peak duration (p < 0.05), maximum signal intensity (p < 0.05), and area under the enhancement curve (p < 0.01). The multireader assessment for overall vascular contrast preferred Gd-BOPTA at p < 0.03. CONCLUSIONS: Gd-BOPTA was shown to exhibit preferential and different vascular enhancement properties as compared with Gd-DTPA for MRA.

Adult↗

PubMed2001

Dynamic contrast-enhanced MRI using Gd-DTPA: interindividual variability of the arterial input function and consequences for the assessment of kinetics in tumors.

Gd-DTPA kinetics in arterial blood was investigated by dynamic MRI in 47 patients with malignant and benign mammary tumors. Signal enhancement was monitored for 10 min after the beginning of a 1-min infusion of 0.1 mmol/kg Gd-DTPA. Kinetics in blood was biexponential with median half-lives of 21 sec and 11.1 min, respectively. Peak signal enhancement and the area under the signal enhancement-time curve varied 2.5- and 3.7-fold between patients. The shortest mean residence time in one of up to three tumor compartments, MRT*, was estimated using either the individual (reference) or a mean population (surrogate) arterial input function (AIF). MRT* (reference estimate) was 1.0 (0-1.5), 1.9 (1.5-2.3), and 2.5 (2.3-2.8) min in carcinomas, fibroadenomas, and mastopathies, respectively (median and interquartile distance). Surrogate estimates were unbiased but differed from the reference estimates 1.5-fold or more in 23% of cases. AIFs should be monitored individually if accurate estimates of individual MRT* are desired.

Breast Neoplasms↗

PubMed2001

[Administration of MR contrast agents outside of approved indications (off-label use].

PURPOSE: The use of MRI contrast agents outside their labeled indications is routine in radiology. However, physicians feel frequently at unease. It is the aim of this paper to introduce the medical, juridicial and billing relevant issues in order to improve the knowledge on this topic. METHODS: The basis for off-label use is the physician's prerogative, which finds its basis in the "declaration of Helsinki". RESULTS: Off-label use is allowed under special conditions and might be even the medical state of the art. CONCLUSION: The necessity for off-label use will continue to increase for MR-contrast agents, as clinical trials for registration purpose are quite costly and manufactures continuously will concentrate on the essential indications.

Clinical Trials as Topic↗

PubMed2001

[Comparison of contrast behavior of gadobenate-dimeglumine and Gd-DTPA in intra-axial brain tumors. A double-blind randomized intraindividual cross-over study].

The purposes of the study was to assess intra-axial brain tumors by a blinded comparison of gadobenat-dimeglumine and Gd-DTPA. 27 patients with known cerebral gliomas or metastases were included into an intra-individual randomized double-blinded cross-over study. The protocol included T1 SE, T2 FSE and after contrast a series of five T1 SE sequences followed by T1 SE with MT, T1 SE, and 3D GRE sequences. Imaging data acquired at two centers were assessed on-site by the investigators and off-site by two experienced readers using quantitative and qualitative criteria. For a quantitative analysis tumor contrast and contrast-to-noise ratios were determined out of ROI in tumor, unaffected white matter, a region outside the head, and an external reference tube. For the qualitative assessment on- and off-site readers were asked to compare both MR scans for lesion contrast, lesion delineation and information upon the internal morphology and structure. In the quantitative analysis lesions examined with gadobenat-dimeglumine present a maximal 26% increase of the lesion contrast. In both, the on-site, as well as the off-site assessment the intensity of enhancement and the lesion contrast were found to be significantly better with gadobenat-dimeglumine enhanced MRI. There was a trend towards gadobenat-dimeglumine for the delineation of the lesion from the surrounding tissue and the internal lesion morphology. Based on our observations gadobenat-dimeglumine proved to be a safe and valuable contrast media for the assessment of CNS neoplasms. Compared with Gd-DTPA it provides a more intense contrast enhancement and a better tumor contrast which might be of importance for the further management of these patients.

Brain↗

PubMed2001

Postoperative fluid-attenuated inversion recovery MR imaging of cerebral gliomas: initial results.

Fluid-attenuated inversion-recovery (FLAIR) imaging has shown to be a valuable imaging modality in the assessment of intra-axial brain tumors; however, no data are available about the role of this technique in the clinically important postoperative stage. The purpose of this study was to evaluate the diagnostic potential of FLAIR MR imaging in residual tumor after surgical resection of cerebral gliomas. Fifteen patients with residual cerebral gliomas were examined within the first 18 days after partial surgical resection of cerebral gliomas. The imaging protocol included T1-weighted spin echo, T2- and proton-density-weighted fast spin echo, and FLAIR imaging with identical slice parameters. T1 and FLAIR were repeated after contrast media application. Detection and delineation of residual tumor were the primary parameters of the image analysis. Additionally, the influence of image artifacts on the image interpretation was assessed. On FLAIR images residual signal abnormalities at the border of the resection cavities were observed in all patients, whereas T2- and T1-weighted images present residual abnormalities in 13 of 15 and 10 of 15 patients, respectively. The FLAIR imaging was found to be superior to conventional imaging sequences in the delineation of these changes and comparable to contrast enhanced T1-weighted imaging in the delineation of residual enhancing lesions. Because of protein cell components and blood byproducts within the resection cavity, FLAIR imaging was unable to suppress the cerebrospinal fluid (CSF) in 4 patients. After the decomposition of proteins and blood, CSF could again be completely suppressed and residual or recurrent tumors were clearly identified. Our preliminary study has shown that FLAIR may be a valuable diagnostic modality in the early postoperative MR imaging after resection of cerebral gliomas due to its better delineation of residual pathologic signal at the border of the resection cavity. It should therefore be integrated into the early and/or intraoperative MR imaging protocol.

Adolescent↗

PubMed2001

Comparison of pharmacokinetic MRI and [18F] fluorodeoxyglucose PET in the diagnosis of breast cancer: initial experience.

It was the aim of this methodology-oriented clinical pilot study to compare the potential of dynamic MRI and 2-[18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) for the detection and characterization of breast cancer. Fourteen women with suspicious breast lesions were examined. The MRI data were acquired with a turbo fast low-angle shot sequence and analyzed using a pharmacokinetic model. Emission data were detected in the sensitive 3D modus, iteratively reconstructed, and superimposed onto corresponding transmission images. In the 14 patients, 13 breast masses with a suspicious contrast enhancement and FDG uptake were detected. For these lesions, no statistically significant correlation between evaluated MR and PET parameters was found. Of the 9 histologically confirmed carcinomas, 8 were correctly characterized with MRI and PET. Two inflammatory lesions were concordantly classified as cancer. Moreover, dynamic MRI yielded another false-positive finding. In 6 patients, PET detected occult lymph node and/or distant metastases. Although both functional imaging techniques provide independent tissue information, the results concerning the diagnosis of primary breast lesions were almost identical. An advantage of PET, however, is its ability to localize lymph node involvement and distant metastases as an integral part of the examination.

Adult↗

PubMed2001

Classification of signal-time curves from dynamic MR mammography by neural networks.

The aim of this study was to test the performance of artificial neural networks for the classification of signal-time curves obtained from breast masses by dynamic MRI. Signal-time courses from 105 parenchyma, 162 malignant, and 102 benign tissue regions were examined. The latter two groups were histopathologically verified. Four neural networks corresponding to different temporal resolutions of the signal-time curves were tested. The resolution ranges from 28 measurements with a temporal spacing of 23s to just 3 measurements taken 1.8, 3, and 10 minutes after contrast medium administration. Discrimination between malignant and benign lesions is best if 28 measurement points are used (sensitivity: 84%, specificity: 81%). The use of three measurement points results in 78% sensitivity and 76% specificity. These results correspond to values obtained by human experts who visually evaluated signal-time curves without considering additional morphologic information. All examined networks yielded poor results for the subclassification of the benign lesions into fibroadenomas and benign proliferative changes. Neural networks can computationally fast distinguish between malignant and benign lesions even when only a few post-contrast measurements are made. More precise specification of the type of the benign lesion will require incorporation of additional morphological or pharmacokinetic information.

Adult↗

PubMed2001

Contrast-enhanced magnetic resonance angiography: technical considerations for optimized clinical implementation.

Contrast-enhanced magnetic resonance angiography (CE MR angiography) has benefited from advancements in MR imaging speed, pulse sequence design, and dedicated equipment and algorithms for its performance. These improvements have greatly expanded the number of options available to the operator and enabled the application of CE MR angiography to a broader range of clinical applications. In this article, the various timing options, pulse sequence innovations, and contrast administration concerns related to clinical CE MR angiography are reviewed. Pertinent issues related to multiphase and multistation bolus chase CE MR angiography also will be discussed.

Contrast Media↗

PubMed2001

Dynamic contrast-enhanced magnetic resonance imaging in oncology.

Dynamic contrast-enhanced MRI (DCE-MRI) is the acquisition of sequential images during the passage of a contrast agent within a tissue of interest. The current gadolinium chelate agents enable visualization of lesion vasculature and, due to their small size, can be used to assess vascular permeability. Recent studies demonstrated that the temporal evolution of gadolinium-induced signal intensity changes within a tumor reflects the angiogenic properties of the tumor. These can be quantified and are related to vascular density and other angiogenic characteristics of lesions, such as the level of vascular endothelial growth factor. DCE-MRI provides noninvasive characterization of antiangiogenic response of tumor during therapeutic intervention to monitor and predict response. This article reviews the fundamental pathophysiological basis of DCE-MRI and the technical aspects necessary for successful implementation DCE-MRI. The role of DCE-MRI in tumor detection, characterization, and therapy monitoring is reviewed.

Contrast Media↗

PubMed2001

Bile-tagged 3d magnetic resonance colonography after exclusive intravenous administration of gadobenate dimeglumine, a contrast agent with partial hepatobiliary excretion.

RATIONALE AND OBJECTIVES: Imaging of the colon is an important diagnostic procedure. Endoscopic colonoscopy and x-ray barium enemas are currently the standard diagnostic procedures. Magnetic resonance (MR) and computed tomographic colonography have been recently introduced with true three-dimensional (3D) cross-sectional imaging. Up to now, all imaging techniques have required the use of oral and/or aboral contrast agents for luminal enhancement and commonly, a relaxation medication (glucagon or N-butylscopolamine). While performing several phase I, II, and III studies with a new partially hepatobiliary excreted gadolinium-based MR contrast agent, we noted substantial intraluminal enhancement within the colon and investigated its potential for imaging. METHODS: Three-dimensional MR angiographic techniques enable imaging of large volumes. We have used these sequences to detect contrast enhancement within the hepatobiliary and gastrointestinal systems. A 3D volume of 40 x 32 x 12 cm with 42 images was acquired under breath-hold. Six volunteers were studied according to the protocol. No bowel preparation was performed and no medication given. Subsequent follow-ups of the abdomen were performed at 1, 12, 24, 36, 48, 70, and 105 hours postinjection. Gadobenate dimeglumine at 0.1 mmol/kg body weight was given intravenously. Images were assessed quantitatively and by blinded reader analysis. RESULTS: Intense intraluminal contrast enhancement within the colon was seen within 24 hours in all subjects. The homogeneous enhancement was of sufficient intensity to enable 3D visualization and virtual endoscopy. The optimal time window for imaging was determined to be 16 to 50 hours postinjection. CONCLUSIONS: We report for the first time the feasibility of exclusively bile-tagged MR colonography with the use of only an intravenous MR contrast that exhibits partial hepatobiliary excretion. This new diagnostic procedure will enable not only morphological assessment of the colon but also functional and pathophysiological studies on the transport kinetics of bile and stool without any preparation of the patient.

Adult↗

PubMed2000

Radiation-induced regional cerebral blood volume (rCBV) changes in normal brain and low-grade astrocytomas: quantification and time and dose-dependent occurrence.

PURPOSE: New tumor-conformal radiation-treatment modalities have been established with the intention to spare normal tissue while maintaining or improving local tumor control. To document radiation-induced changes in normal brain and low-grade astrocytoma we measured regional cerebral blood volumes (rCBV) using a dynamic susceptibility-weighted contrast-enhanced MR technique (DSC-MRI). We attempted to assess pretherapeutic rCBV values and time- and dose-dependent changes following radiotherapy. METHODS AND MATERIALS: For prospective and longitudinal assessment of rCBV in normal brain and low-grade astrocytoma, 25 patients with histologically proven fibrillary astrocytoma (WHO Grade II) were examined before radiotherapy and during follow-up. Based on CT- and MR-data sets in a stereotactic setup, three-dimensional (3D) treatment planning was done. Radiotherapy was delivered using fractionated stereotactic radiotherapy (FSRT) to mean and median total doses of 60.9 and 60 Gy, respectively (range, 55.8-66 Gy). During MR imaging for treatment planning and follow-up examinations, 55 T2-weighted gradient echo images were acquired before, during, and after intravenous contrast bolus injection. The acquired signal-time curves were converted into concentration-time curves. The area under the tissue concentration-time curve was calculated and normalized to an integrated arterial input function. Thus, absolute rCBV values could be calculated. RESULTS: Pretherapeutic mean rCBV for normal gray (GM) and white brain matter (WM) were 7.2 +/- 2.7 and 3.6 +/- 1.5 mL/100 g tissue, respectively. Mean rCBV for astrocytoma was 6.5 +/- 3.7 mL/100 g tissue. After radiotherapy, rCBV for GM and WM was significantly reduced (p < 0.01) in high-dose areas (40-100% of total dose). A nonsignificant reduction was measured in low-dose areas (up to 40% of total dose). Reduction of rCBV in astrocytomas to a plateau level of 4.6 +/- 0.4 mL/100 g tissue was measured at 6 months after radiotherapy and remained stable in locally controlled tumors. CONCLUSION: Monitoring of rCBV changes in normal brain and low-grade astrocytoma was feasible using a DSC-MRI technique. The method was able to document radiation effects in low-grade astrocytoma, even if the majority of tumors showed no change in diagnostic MR-imaging. Radiation induced decrease of rCBV in GM and WM was correlated to total dose delivered to a tissue area, with high doses causing a significant decrease. Minor decline of rCBV in GM and WM outside high-dose areas after stereotactic radiotherapy confirms the efficacy to spare normal brain tissue by the use of modern conformal radiotherapy techniques. Nonetheless, a critical minimal dose initiating rCBV changes is yet unknown.

Adult↗

PubMed2000

Elastic matching of dynamic MR mammographic images.

Dynamic magnetic resonance imaging (MRI) carried out with paramagnetic contrast media has been proven to increase sensitivity and specificity in the detection of breast cancer. Due to movements of the patients and changes in the shape of the breasts during the measurement period, a coregistration (matching) of the acquired data volumes is necessary to obtain higher accuracy for the localization of lesions. In this study, an algorithm for the elastic matching of dynamic MRI volume data is presented. The approach includes automatic feature extraction along with the analysis of corresponding features between the data sets. The matching is actually slice-oriented, even though information on displacement vectors in adjacent slices is taken into account. An extension of the procedure to fully three-dimensionally (3D) matching is straight forward. Up until now, the approach has been applied to 20 dynamic MRI studies. The matching time for two image data sets with 256 x 256 x 15 voxels each was about 4 min using a PC (Pentium Pro, 200MHz).

Algorithms↗