PURPOSE: The aim of this study was to evaluate whether intravenous injection of an ultrasound contrast agent aids in the visualization of focal liver lesions on power Doppler images. METHODS: Fifty patients with focal liver lesions were studied by B-mode and power Doppler sonography before and after intravenous injection of the contrast agent Levovist (galactose-based microbubbles; 10 ml of a concentration of 300 mg/ml). Thirty-two patients had malignant liver lesions (19 metastases, 12 hepatocellular carcinomas, 1 cholangiocellular carcinoma), while 18 had benign lesions (12 hemangiomas, 2 focal nodular hyperplasias, 4 others). RESULTS: After contrast medium injection, the number of lesions with no intralesional flow dropped from 18 to 9. Flow signal intensity was rated subjectively as marked on contrast-enhanced images in 17 patients; only 4 patients had marked flow on precontrast images. On precontrast studies, central flow in 10 lesions and peripheral flow in 29 lesions could be observed. After enhancement, the numbers increased to 18 and 34 lesions, respectively. CONCLUSIONS: On power Doppler images, a greater number of intratumoral vessels are seen in focal liver lesions after contrast medium administration.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Gd-DTPA-polylysine-enhanced pulmonary time-of-flight MR angiography.

The enhancing effect of gadolinium diethylenetriaminepentaacetic acid (DTPA) polylysine (a macromolecular paramagnetic contrast agent) in time-of-flight magnetic resonance (MR) angiography of isolated perfused sheep lungs was studied. Unilateral lung damage was induced with hydrochloric acid in eight sheep. The heart and lungs were removed from the thoracic cavity, and after cannulation of the trachea and both ventricles, pulsatile perfusion and ventilation were initiated. The heart-lung preparations were placed in the head coil of a 1.5-T imager. Time-of-flight pulmonary MR angiography was performed during respiratory arrest, before and after administration of 0.02 mmol/kg Gd-DTPA-polylysine. On the postcontrast angiograms, the signal intensity increased by 120% in pulmonary arteries (P < .01). The contrast-to-noise ratio between pulmonary arteries and parenchyma increased significantly (P < .01). The number of visualized generations of pulmonary artery branches increased from four to six in normal lungs and from three to five in edematous lungs. Low-dose Gd-DTPA-polylysine significantly improves the conspicuity of the pulmonary vascular tree in time-of-flight pulmonary MR angiography.

Animals↗

PubMedDate not supplied

Evaluation of portal MR angiography using superparamagnetic iron oxide.

The purpose of our research was to determine the effects of superparamagnetic iron oxide on MR imaging of the portal venous system. Eight piglets were examined in deep anaesthesia and respiratory arrest using a time-of-flight magnetic resonance fast low angle shot, two-dimensional angiography sequence at 1.5T, MR angiograms were acquired precontrast and after intravenous administration of a cumulative dose of 10, 20 and 40 mumol/kg SHU 555A, a superparamagnetic iron oxide contrast agent for MR imaging with a particle size of 60 nm. For each dose, two subsequent sets of scans were obtained and reconstructed by a maximum-intensity-projection algorithm. Hepatic parenchymal and portal venous signal intensities were measured, and portal vein contrast calculated for each set of scans. All examinations were visually rated as to portal vein contrast and homogeneity by two blinded observers. Receiver operating characteristics of both observers were analyzed. The contrast agent reduced hepatic parenchymal signal in a dose-dependent way. After a cumulative dose of 10 mumol iron oxide, hepatic parenchymal signal intensity decreased to 63 +/- 6% (average of measurements at 4 and 14 minutes, mean +/- standard error of the mean), after 20 mumol to 24 +/- 3%, and after 40 mumol to 12 +/- 1% of control. Intravascular signal in the left main portal vein branch increased to 117 +/- 6%, 127 +/- 10%, and 133 +/- 9% of control, respectively. The contrast-to-noise ratio of the portal vein improved (521 +/- 90%, 891 +/- 178%, and 995 +/- 201% of control in the left portal vein main branch). Intravascular signal intensities increased slightly. The combined effect improved contrast of the portal vein stem and its branches. Receiver operating characteristics analysis documented dose-dependency of contrast medium effects on portal venous contrast and intravascular homogeneity. Visual rating also indicated a positive effect on portal venous contrast. The superparamagnetic iron oxide agent improved portal venous contrast with surrounding hepatic parenchyma in this normal animal model, and could potentially result in more accurate diagnosis of portal venous pathology.

Animals↗

PubMedDate not supplied

Three-dimensional monitoring of small temperature changes for therapeutic hyperthermia using MR.

Radiofrequency hyperthermia of deep-seated pelvic tumors requires noninvasive monitoring of temperature distributions in patients. Methods of MR thermography were reported to be a promising tool in solving this problem. However, to be truly useful for monitoring hyperthermia treatments, MR thermography should be able to cover the entire pelvis in acquisition times no longer than for a breath-hold (< or = 15 seconds) and to resolve small temperature differences (< 1 degrees C). Three methods exploiting the temperature dependence of spin-lattice relaxation time (T1), of self-diffusion coefficient (D), and of chemical shift of proton resonance frequency (PRF) were applied in phantom experiments; the pulse sequences were the T1-weighted gradient echo, the pulsed diffusion gradient spin echo made faster through the keyhole technique, and the gradient echo with the phase reconstruction, respectively. The high planar resolution was compromised, and instead, coarse and more isotropic voxels were used. Experiments were performed in two consecutive steps, thus imitating a possible scenario for monitoring hyperthermia. In the first step, calibration curves were recorded, which were then used in the second step to obtain maps of temperature changes. The results show a clear superiority of the PRF method, followed by the D and the T1 methods. The uncertainty of temperature changes predicted both from calibration curves and from maps was less than 1 degrees C only with the PRF and the D-based methods.

Calibration↗

PubMedDate not supplied

Drug smuggling by ingested cocaine-filled packages: conventional x-ray and ultrasound.

PURPOSE: To evaluate the imaging characteristics and the diagnostic value of both abdominal ultrasound and conventional abdominal x-ray in identifying ingested drug packages in "body packers." MATERIALS AND METHODS: Twelve individuals were studied prospectively by abdominal ultrasound and by abdominal x-ray to rule out incorporated drug containers. RESULTS: Both abdominal ultrasound and abdominal x-ray correctly identified the 7 of 12 individuals who had ingested multiple drug packages. In 5 of the 12 individuals, ultrasound as well as abdominal x-ray were correctly unremarkable with regard to abdominal foreign bodies. CONCLUSIONS: Abdominal ultrasound and abdominal x-ray both represent valuable diagnostic tools in the assessment of ingested drug packages. Abdominal x-ray is superior to ultrasound in differentiating ingested drug-filled condoms from "pseudocondoms."

Adult↗

PubMedDate not supplied

MRI diagnosis and staging of rectal carcinoma.

Explore the source record for details and available documents.

Adenoma, Villous↗

PubMedDate not supplied

Use of semiflexible applicators for radiofrequency ablation of liver tumors.

PURPOSE: To evaluate the feasibility and potential advantages of the radiofrequency ablation of liver tumors using new MRI-compatible semiflexible applicators in a closed-bore high-field MRI scanner. METHODS: We treated 8 patients with 12 malignant liver tumors of different origin (5 colorectal carcinoma, 2 cholangiocellular carcinoma, 1 breast cancer) under MRI guidance. Radiofrequency ablation (RFA) was performed using 5 cm Rita Starburst Semi-Flex applicators (Rita Medical Systems, Milwaukee, WI, USA) which are suitable for MR- and CT-guided interventions and a 150 W RF generator. All interventions were performed in a closed-bore 1.5 T high-field MRI scanner for MRI-guided RFA using fast T1-weighted gradient echo sequences and T2-weighted ultra-turbo spin echo sequences. Control and follow-up MRI examinations were performed on the next day, at 6 weeks, and every 3 months after RFA. Control MRI were performed as double-contrast MRI examinations (enhancement with iron oxide and gadopentetate dimeglumine). All interventions were performed with the patient under local anesthesia and analgo-sedation. RESULTS: The mean diameter of the treated hepatic tumors was 2.4 cm (+/-0.6 cm, range 1.0-3.2 cm). The mean diameter of induced necrosis was 3.1 cm (+/-0.4 cm). We achieved complete ablation in all patients. Follow-up examinations over a duration of 7 months (+/-1.3 months, range 4-9 month) showed a local control rate of 100% in this group of patients. All interventions were performed without major complications; only 2 subcapsular hematomas were documented. CONCLUSION: RFA of liver tumors using semiflexible applicators in closed-bore 1.5 T scanner systems is feasible. These applicators might simplify the RFA of liver tumors under MRI control. The stiff distal part of the applicator facilitates its repositioning.

Aged↗

PubMedDate not supplied

Percutaneous transjugular direct porto-caval shunt in patients with Budd-Chiari syndrome.

The purpose of the study was to evaluate the feasibility and effectiveness of direct porto-caval shunts in patients with Budd-Chiari syndrome (BCS) in whom there is no access to the hepatic veins during transjugular intrahepatic portosystemic shunt (TIPSS). We included six consecutive patients with fulminant/acute Budd-Chiari syndrome (mean age: 35 years) in whom a conventional TIPSS was not possible due to inaccessible hepatic veins. We performed a direct porto-caval shunt via a transhepatic approach. Patients were followed up by means of clinical examination, laboratory investigations, and Doppler ultrasound. TIPSS implantation from the inferior vena cava (IVC) was successful in all six patients (100%). The median transhepatic shunt length was 9 cm (8-10 cm). No procedure-related complications were observed in our patients. Early shunt occlusion occurred in three out of six patients (50%). In all three of these patients, the stent used to stabilize the shunt ended 1-2 cm before reaching the IVC. All occlusions were successfully recanalized. One of these patients developed recurrent early shunt as well as mesenteric and splenic vein occlusions. She died 7 days after TIPSS placement due to an unmanageable coagulation disorder. The remaining five patients were followed up by planned clinical examination and laboratory investigations (mean follow-up time was 15 months; patient 1 was followed up for 13 months, patient 2 for 14 months, patient 3 for 15 months, and patients 4 and 5 for 16 months) and all displayed a complete and durable resolution of liver failure and ascites without reintervention. In patients with acute liver failure originating from BCS and inaccessible hepatic veins, a direct transhepatic porto-caval shunt can be performed safely and effectively under ultrasound guidance. Future studies in larger patient groups should investigate if the patency of transcaval TIPSS with long transhepatic shunt segments is similar compared to conventional TIPSS via the hepatic vein.

Adult↗

PubMedDate not supplied

Volume changes of experimental carotid sidewall aneurysms due to embolization with liquid embolic agents: a multidetector CT angiography study.

Iodine-containing polyvinyl alcohol polymer (I-PVAL) is a novel precipitating liquid embolic that allows for artifact-free evaluation of CT angiography (CTA). As accurate aneurysm volumetry can be performed with multidetector CTA, we determined volumes of experimental aneurysms before, immediately after, and 4 weeks after embolization of 14 porcine experimental carotid sidewall aneurysms with this liquid embolic. An automated three-dimensional software measurement tool was used for volumetric analysis of volume-rendering CTA data. Furthermore, intra-aneurysmal pressure changes during liquid embolization were measured in four silicone aneurysms and potential polymer volume changes within 4 weeks were assessed in vitro. Liquid embolic injection was performed during temporary balloon occlusion of the aneurysm neck, resulting in a mean occlusion rate of 98.3%. Aneurysms enlarged significantly during embolization by 61.1 +/- 28.9%, whereas a significant shrinkage of 5.6 +/- 2.7% was observed within the follow-up period. Histologic analysis revealed an inflammatory foreign body reaction with partial polymer degradation. In silicone aneurysm models, intra-aneurysmal pressure remained unchanged during liquid embolic injection, whereas balloon inflation resulted in a mean pressure increase of 31.2 +/- 0.7%. No polymer shrinkage was observed in vitro. The aneurysm enlargement noted was presumably due to pressure elevation after balloon inflation, which resulted in dilatation of the weak venous wall of the newly constructed aneurysm--another shortcoming of this experimental aneurysm model. The volume decrease after 4 weeks expressed partial polymer degradation.

Angiography, Digital Subtraction↗

PubMedDate not supplied

Initial experience with SPECT examinations using [123I]IBZM as a D2-dopamine receptor antagonist in Parkinson's disease.

[123I]IBZM is a new radioactive labelled ligand which has a high affinity and specificity to D2-dopamine receptors. The in vivo kinetics of [123I]IBZM were studied in patients with unilateral and bilateral accentuated idiopathic Parkinson's disease. The uptake in the basal ganglias and the imaging properties of this D2 receptor antagonist as a radiopharmaceutical for SPECT examinations had to be investigated. 5 patients, aged 42-66 years, (2 m/3 f) were examined. Each patient received 185 MBq [123I]IBZM intravenously. Blood samples were taken 0-120 min post injection (p.i.) and time activity curves were plotted. Three SPECT examinations were performed (I: 30-50 min; II: 50-70 min; and III: 70-90 min p.i.). The count rates (counts/pixel) in the basal ganglias and the cerebellum were measured for each SPECT series on transverse slices using the region-of-interest technique. The time-activity curve of [123I]IBZM shows a rapid decline in plasma during the first 10 min followed by a plateau until 120 min after injection. The SPECT examinations demonstrate the highest count rate in the basal ganglia during SPECT series III (i.e., 70-90 min p.i.). The side-to-side difference of the count rates were in the range of 3% in four patients, and 10% in one patient. The biokinetic data of [123I]IBZM make this substance capable as a radiopharmaceutical for SPECT examinations. The basal ganglia are best visualized 70-90 min p.i., thus [123I]IBZM seems to be a promising imaging agent for diseases of the D2-dopaminergic receptor system.

Adult↗

PubMedDate not supplied

Spinal cord cavities: differential-diagnostic criteria in magnetic resonance imaging.

MRI examinations of 30 patients with idiopathic syringomyelia and 10 patients with cavities associated with an intramedullary neoplasm were evaluated with respect to typical MRI features in both groups. All tumor-associated cases resembled the idiopathic syringomyelias in some portions of the cavity. At the tumor site, however, tumor-associated cases demonstrated typical findings: the cavities showed abrupt changes of diameter (10/10) and position (8/10) and the surrounding spinal cord demonstrated an uneven thickness (10/10), an increased signal intensity on T2-weighted images (10/10) and pathological contrast enhancement (7/7). Displacement of cerebellar tonsils below the level of the foramen magnum (21/30) and enlargement of the spinal canal (7/29) were characteristic features of idiopathic cases. In conclusion, MRI provides valuable criteria to differentiate between idiopathic and tumor-associated cavities.

Adolescent↗