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Antimyosin imaging in acute transmural myocardial infarctions: results of a multicenter clinical trial.

Murine monoclonal antimyosin antibody has been shown experimentally to bind selectively to irreversibly damaged myocytes. To evaluate the safety and efficacy of monoclonal antimyosin for identifying acute transmural infarction, 50 patients with acute Q wave myocardial infarction were entered into a phase I/II multicenter trial involving three clinical sites. Indium-111 antimyosin was prepared from an instant kit formulation containing 0.5 mg of diethylene triamine pentaacetic acid (DTPA)-coupled Fab fragment (R11D10) and 1.2 to 2.4 mCi of indium-111. Average labeling efficiency was 92%. Antimyosin was injected 27 +/- 16 h after the onset of chest pain. Planar or tomographic imaging was performed 27 +/- 9 h after injection in all patients, and repeat imaging was done 24 h later in 39 patients. Of the 50 patients entered, 46 showed myocardial uptake of antimyosin (sensitivity 92%). Thirty-one of 39 planar scans performed at 24 h were diagnostic; 8 showed persistent blood pool activity that cleared by 48 h. Focal myocardial uptake of antimyosin corresponded to electrocardiographic infarct localization. No patient had an adverse reaction to antimyosin. In addition, 125 serum samples, including 21 collected greater than 42 days after injection, were tested for human antimouse antibodies, and all samples were assessed as having undetectable titers. Intensity of antimyosin uptake was correlated with infarct location and the presence or absence of collateral vessels. There was a significant correlation between faint uptake and inferoposterior infarct location. In 21 patients who had coronary angiography close to the time of antimyosin injection, there was a significant correlation between faint tracer uptake and closed infarct-related vessel with absent collateral flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Evidence that nitric oxide- and opioid-containing interneurons innervate vessels in the dorsal horn of the spinal cord of rats.

In the dorsal horn of the spinal cord, activation of small fibre nociceptive afferents leads to the release of nitric oxide and enkephalins by interneurons. In this work we encountered unexpected relationships among local spinal cord dorsal horn blood flow, specific forms of afferent input, nitric oxide and intrinsic opioids. Selective rises in rat lumbar dorsal cord blood flow using laser Doppler flowmetry and microelectrode hydrogen clearance polarography were generated by ipsilateral, 'nociceptive' low (3 Hz) frequency stimulation of sciatic afferents. Inhibitors of nitric oxide synthase (NOS) prevented rises in flow during stimulation without influencing baseline flow. Ipsilateral hindpaw intradermal injection of capsaicin, a nociceptive activator, also generated large rises in flow sensitive to NOS inhibition. During NOS blockade or morphine administration there were unexpected acute declines in the dorsal cord blood flow strictly confined to low frequency stimulation epochs. This acute vasoconstrictive effect was prevented by administration of an opioid receptor antagonist. Using immunohistochemistry, terminals apparently innervating dorsal spinal cord blood vessels were labelled with antibodies against neuronal NOS and met-enkephalin. We conclude that local nitric oxide and opioids, probably from interneurons, have competitive actions on dorsal horn microvessels once interneurons are activated during a nociceptive barrage. Collateral innervation of blood vessels may explain this property.

Animals↗

[The role of oscillometric, oscillographic and rheographic methods in assessing arteriopathy of the legs].

The oscillometric method records arterial wall oscillations during pulse wave and index pressure. Sensitivity increases with reactive hyperemia but many artefacts influence his technic. Electronic oscillography is more sensitive but has similar limits and a very high cost. This two methods detect easily arterial occlusive lesions but give only few information about the severity of arterial disease. On the opposite, Irrigraphy (impedance plethysmography) is a functional non invasive technic. Perfected by R. Sarrazin, J. F. Picard and A. Franco, it consists in recording the signal generated by electrical impedances variations related to pulse volume and heart rate. The pulse volume curve is recorded at six different positions of the leg. This method permits the evaluation of collateral vessels. Automatization of this non invasive technic increased reliability, and saves time examination.

Arteries↗

The pathophysiology of acute myocardial infarction.

Recent work has now clearly established that coronary arterial thrombosis is the direct cause of acute myocardial infarction. This thrombotic event occurs when a pre-existing atherosclerotic plaque ruptures or fissures, thereby exposing underlying thrombogenic material to the circulation. Platelets are thus activated and the clotting cascade is initiated. It is as yet unclear why a previously stable atherosclerotic plaque should fissure or rupture. However, suggested mechanisms include release of vasoactive substances from activated platelets, coronary arterial vasomotion, mechanical stress fatigue of the atherosclerotic plaque, and rupture of vasa vasorum within the atherosclerotic plaque. The resultant cessation of myocardial blood flow produces specific biochemical and physiological alterations secondary to myocardial ischemia. Intracellular acidosis, loss of high-energy phosphates, reduced sensitivity of contractile proteins to calcium, and accumulation of inorganic phosphate and lipid, all occur within the ischemic myocyte. Diastolic compliance is markedly reduced by ischemia followed by cessation of systolic contractile activity. Most of these alterations are reversible if ischemia is relieved promptly. Prolonged ischemia leads to delayed biochemical and physiological recovery and/or cell necrosis.

Collateral Circulation↗

Actual problems of the cerebrospinal fluid-contacting neurons.

Cerebrospinal fluid (CSF)-contacting neurons form a part of the circumventricular organs of the central nervous system. Represented by different cytologic types and located in different regions, they constitute a CSF-contacting neuronal system, the most central periventricular ring of neurons in the brain organized concentrically according to our concept. Because the central nervous system of deuterostomian echinoderm starfishes and the prochordate lancelet is composed mainly of CSF-contacting-like neurons, we hypothesize that this cell type represents ancient cells, or protoneurons, in the vertebrate brain. Neurons may contact the ventricular CSF via their dendrites, axons, or perikarya. Most of the CSF-contacting nerve cells send their dendritic processes into the ventricular cavity, where they form ciliated terminals. These ciliated endings resemble those of known sensory cells. By means of axons, the CSF-contacting neurons also may contact the external CSF space, where the axons form terminals of neurohormonal type similar to those known in the neurohemal areas. The most simple CSF-contacting neurons of vertebrates are present in the terminal filum, spinal cord, and oblongate medulla. The dendritic pole of these medullospinal CSF-contacting neurons terminates with an enlargement bearing many stereocilia in the central canal. These cells are also supplied with a 9 x 2 + 2 kinocilium that may contact Reissner's fiber, the condensed secretory material of the subcommissural organ. The Reissner's fiber floating freely in the CSF leaves the central canal at the caudal open end of the terminal filum in lower vertebrates, and open communication is thus established between internal CSF and the surrounding tissue spaces. Resembling mechanoreceptors cytologically, the spinal CSF-contacting neurons send their axons to the outer surface of the spinal cord to form neurosecretory-type terminals. They also send collaterals to local neurons and to higher spinal segments. In the hypothalamic part of the diencephalon, neurons of two circumventricular organs, the paraventricular organ and the vascular sac, of the magnocellular neurosecretory nuclei and several parvocellular nuclei, form CSF-contacting dendritic terminals. A CSF-contacting neuronal area also was found in the telencephalon. The CSF-contacting dendrites of all these areas bear solitary 9 x 2 + 0 cilia and resemble chemoreceptors and developing photoreceptors cytologically. In electrophysiological experiments, the neurons of the paraventricular organ are highly sensitive to the composition of the ventricular CSF. The axons of the CSF-contacting neurons of the paraventricular organ and hypothalamic nuclei terminate in hypothalamic synaptic zones, and those of magno- and parvocellular neurosecretory nuclei also form neurohormonal terminals in the median eminence and neurohypophysis. The axons of the CSF-contacting neurons of the vascular sac run in the nervus and tractus sacci vasculosi to the nucleus (ganglion) sacci vasculosi. Some hypothalamic CSF-contacting neurons contain immunoreactive opsin and are candidates to represent the "deep encephalic photoreceptors." In the newt, cells derived from the subependymal layer develop photoreceptor outer segments protruding to the lumen of the infundibular lobe under experimental conditions. Retinal and pineal photoreceptors and some of their secondary neurons possess common cytologic features with CSF-contacting neurons. They contact the retinal photoreceptor space and pineal recess, respectively, both cavities being derived from the third ventricle. In addition to ciliated dendritic terminals, there are intraventricular axons and neuronal perikarya contacting the CSF. Part of the CSF-contacting axons are serotoninergic; their perikarya are situated in the raphe nuclei. Intraventricular axons innervate the CSF-contacting dendrites, intraventricular nerve cells, and/or the ventricular surface of the ependyma. (ABSTRACT TRUNCATED)

Animals↗

Activity-dependent pH shifts in hippocampal slices from normal and carbonic anhydrase II-deficient mice.

The type II isoform of carbonic anhydrase is abundant in astrocytes and oligodendroglia. To explore whether the expression of the type II isoform is required for interstitial carbonic anhydrase activity, we studied extracellular pH transients in hippocampal slices from mutant mice devoid of carbonic anhydrase type II and from wild-type littermates. Stimulation of the Schaffer collateral afferents evoked similar extracellular pH transients in the CA1 stratum pyramidale, consisting of a predominant alkaline shift and little or no subsequent acidosis. After 5-s stimulus trains at 10 Hz, alkaline shifts were not significantly different in carbonic anhydrase II-deficient and wild-type preparations, averaging 0.09 +/- 0.04 and 0.08 +/- 0.04 unit pH, respectively. Addition of 1.5 microM benzolamide amplified the alkaline shifts by 385 +/- 146 and 345 +/- 75% in the mutant and wild-type preparations, respectively. Dose response studies with benzolamide displayed similar sensitivity to this carbonic anhydrase inhibitor over a concentration range of 0. 03-10 microM. These data indicate that interstitial carbonic anhydrase activity is effectively unaltered in brains devoid of carbonic anhydrase type II. The results are consistent with the interpretation that a distinct extracellular isoform of carbonic anhydrase exists in brain.

Action Potentials↗

The anterior inferior cerebellar arterial network supplying the rat cochlea and its role in autoregulation of cochlear blood flow.

The sensitivity of the cochlea is dependent upon maintenance of a delicate homeostatic environment. One mechanism which participates in providing this environment is the autoregulation of cochlear blood flow. This autoregulation is ensured through the interaction of sympathetic, peptidergic and hemodynamic mechanisms. The current study demonstrates an adaptation that also participates in cochlear blood flow autoregulation. Specifically, an anterior inferior cerebellar arterial network is described and the relative contributions of each of its vessels to total cochlear blood flow is measured using laser Doppler flowmetry. The results show that each collateral vessel contributes to the blood supply of the cochlea and that reperfusion is accompanied by hyperemia. These findings suggest an adaptation that provides stable blood flow through redundancy and compensatory potential. Additionally, these observations have implications for experimental models of ischemia.

Animals↗

Pertussis toxin pretreatment antagonizes the actions of mu- and delta-opiate agonists in hippocampal slices.

The effect of pertussis toxin pretreatment on electrophysiological responses to selective delta- and mu-opioid receptor agonists was examined in rat hippocampal brain slices. The evoked population spike response in the CA1 region following activation of the Schaffer collateral and commissural afferents was increased following perfusion with the delta-selective agonist [D-Pen2,D-Pen5]enkephalin (DPDPE), and with the mu-selective agonist [D-Ala2,NMe-Phe4,Gly(O)5ol]enkephalin (DAGO). Both effects were significantly reduced or abolished in brain slices obtained from animals that had been pretreated with pertussis toxin 2-3 days earlier. These findings suggest that the excitatory responses to opioid agonists in hippocampus are the result of interactions with receptors that are coupled via pertussis toxin sensitive GTP-binding proteins to their respective effector mechanisms.

Action Potentials↗

Magnetic resonance first-pass myocardial perfusion imaging: clinical validation and future applications.

Clinical studies suggest that magnetic resonance first-pass (MRFP) perfusion imaging is comparable to current diagnostic tests that are used clinically for the assessment of myocardial perfusion. In addition, magnetic resonance imaging (MRI) perfusion imaging is a noninvasive method for determining myocardial blood flow. The spatial resolution (in-plane spatial resolution < 3 mm) is sufficient to differentiate between subendocardial perfusion and subepicardial perfusion. The measurement can be repeated regularly without any adverse effects for the patient. MRI perfusion measurements can be combined with the evaluation of global function and regional wall thickening. Currently, there is no other imaging technique that offers similar advantages. The MRI perfusion measurements can be carried out during baseline conditions and during maximal hyperemia induced with either adenosine or dipyridamole. The ratio of the measured myocardial blood flows provides an estimate of the absolute and relative myocardial perfusion reserve. The perfusion reserve determined with MRFP imaging is a quantitative measure for the assessment of the collateral-dependent myocardial flow. Based on the available data using MRFP perfusion imaging, the current clinical first-line perfusion imaging tests are going to be challenged in the near future. J. Magn. Reson. Imaging 1999;10:676-685.

Coronary Circulation↗

Morphology of central terminations of low-threshold trigeminal primary afferents from facial skin in the cat--intra-axonal staining with HRP.

Intra-axonal recording and horseradish peroxidase (HRP) injection techniques were employed to examine the response properties of low-threshold mechanoreceptive afferents and the morphological characteristics of their axon arbors in the main sensory nucleus (Vp) and oral nucleus (Vo). Thirteen afferents were characterized and recovered. One gave fast or rapidly adapting (FA) and 3 slowly adapting (SA) responses to mystacial vibrissa deflection, 5 were sensitive to deflection of non-vibrissae hairs or hair (4 were guard hair afferents and the other responded to deflection of a long hair in slowly adapting fashion) and two were responsive to indentation of the hairy skin. The remainder were responsive to indentation of the glabrous skin on the lower lip: one was of FA type and the other of SA type. All of the axons had bifurcating fibers that ascended in the ascending tract (ascending fiber) and descended in the trigeminal spinal tract (descending fiber). The main collaterals given off from the ascending fiber and rostral segment of the descending fiber terminated in the Vp, and the other collaterals from the descending fiber projected to the Vo. Terminal arbors produced by the main collaterals formed a rostrocaudally continuous column, but generally the adjacent arbors did not overlap except when pairs of collaterals arose near each other on the ascending and descending fibers. Projections of collaterals to Vp and Vo were organized topographically. The head was represented in an inverted fashion with its anteroposterior axis in a mediolateral sequence, but the lower glabrous lip was represented more dorsally than the other mandibular facial regions. Vibrissa afferents formed a rostrocaudally continuous, densely packed terminal column throughout the length of Vp and Vo. SA vibrissa afferents gave rise to more dense and roundish arbors in Vp than the FA afferent, while the Vo.c arbors were more compact and smaller than those of the FA afferent. Guard hair afferents had arbors that were highly variable throughout the nuclei and were characterized by less developed arbors in Vp than in Vo. Unlike vibrissa afferents, hairy skin afferents gave rise to sparse and widespread arbors characterized by a string-like appearance, while the Vo collaterals were more stringy. Facial lip afferents were characterized by a great difference in collateral morphology between FA and SA type.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Unique presynaptic and postsynaptic roles of Group II metabotropic glutamate receptors in the modulation of thalamic network activity.

The thalamic reticular nucleus (TRN) is a sheet of GABAergic neurons that project to other TRN neurons and to associated thalamocortical relay nuclei. The TRN receives glutamatergic synaptic inputs from cortex as well as reciprocal inputs from the collaterals of thalamocortical neurons. In addition to ionotropic glutamate receptors, metabotropic glutamate receptors (mGluRs) are present in the TRN circuitry. Using whole cell voltage clamp recordings, we pharmacologically characterized unique pre- and postsynaptic functions for Group II mGluRs (mGluR 2 and mGluR 3) within the TRN circuitry in ferrets. mGluR 2 was found on presynaptic cortical axon terminals in the TRN, where it reduced glutamate release, while mGluR 3 acted postsynaptically on TRN cells to increase membrane conductance. Using miniature inhibitory postsynaptic current analysis, we also found that picrotoxin-sensitive intra-TRN GABA-mediated neurotransmission was not affected by administration of a Group II mGluR agonist, indicating that neither mGluR 2 nor 3 acts on presynaptic GABA-containing terminals within the TRN. Because strong corticothalamic activation is implicated in abnormal thalamic rhythms, we used extracellular recordings in the lateral geniculate nucleus to study the effect of Group II mGluR agonists upon these slow oscillations. We induced approximately 3 Hz spike-and-wave discharge activity through corticothalamic stimulation, and found that such activity was reduced in the presence of the Group II mGluR agonist, (-)-2-oxa-4-aminobicyclo[3.1.0]hexane-4,6-dicarboxylate (LY379268). These data indicate that Group II mGluR reduce the impact of corticothalamic excitation, and that they may be a useful target in the reduction of absence-like rhythms.

Amino Acids↗

[Value of computerized tomography and nuclear magnetic resonance tomography in preoperative diagnosis of meniscus lesions and ligamentous lesions of the knee joint].

In a prospective study, 53 patients with chronic complaints and acute injuries of the knee joint, were evaluated by clinical examination, CT-scanning and magnetic resonance imaging (MRI). Subsequently, arthroscopy or an open surgical procedure was performed. A total of 21 patients suffered from meniscal lesions. There were 17 ruptures of the medial and 4 ruptures of the lateral meniscus. In patients with meniscus ruptures, the sensitivity of both MRI and CT-scan was 86%, whereas the specificity of MRI was slightly lower than that of CT-scan. The accuracy and the predictive value were also slightly lower, although the difference was not significant. Fifteen patients suffered from acute or chronic ligament ruptures. In patients with anterior cruciate ligament (ACL) ruptures, all complete ACL ruptures had correctly been diagnosed by CT and MRI. Two out of four partial ACL ruptures were missed by MRI; only one was missed by CT-scan. Three medial collateral ligament ruptures were documented by MRI and two by CT-scanning. The high negative predictive value of CT and MRI can realize a reduction of the amount of diagnostic arthroscopies.

Anterior Cruciate Ligament↗

Ocularpneumoplethysmography (OPG-Gee) and oculoplethysmography (OPG-Kartchner). Review and perspectives.

A review is given of 95 publications on OPG-Gee and OPG-Kartchner in order to compare both techniques and to determine the present value and perspectives. Both techniques are valuable in the evaluation of the hemodynamic significance of carotid lesions, but OPG-G has a better sensitivity than OPG-K. Specificities are comparable. OPG has delivered new knowledge on the natural history of carotid disease, pre- as well as postoperatively and is helpful in recognizing stroke-prone patients. It provides in a simple way useful physiologic information.

Blood Pressure↗

[Examination of myocardial perfusion with positron emission tomography: a clinically useful and valid method?].

Positron emission tomography (PET) of the heart has gained widespread scientific and clinical acceptance with regard to 2 indications: 1. the detection of perfusion abnormalities by qualitative and semiquantitative analyses of perfusion images at rest and during physical or pharmacological stress using well validated perfusion tracers such as N-13 ammonia, Rb-82 rubidiumchloride, or O-15 labeled water, 2. Viability imaging of myocardial regions with reduced contractility by combining perfusion measurements with substrate metabolism as assessed from F-18 deoxyglucose utilization. This overview summarizes the use of PET as a perfusion imaging method. With a sensitivity > 90% in combination with a high specificity, PET is today the best available nuclear imaging technique for the diagnosis of coronary artery disease (CAD). The short half-life of the perfusion tracers in combination with highly sophisticated hard- and software enables rapid PET studies with high patient throughput. The high diagnostic accuracy and the methological advantages as compared to conventional scintigraphy allows to use PET perfusion imaging for detection of subtle changes of the perfusion reserve for detection of CAD in high risk but asymptomatic patients as well as in patients with proven CAD undergoing various treatment forms such as risk factor reduction or coronary revascularization. In patients following orthotopic heart transplantation, evolving transplant vasculopathy can be detected at an early stage. Quantitative PET imaging at rest allows for detection of myocardial viability since cellular survival is based on maintenance of a minimal perfusion and structural changes correlate to the degree of perfusion reduction. Furthermore, quantitative assessment of the myocardial perfusion reserve detects the magnitude and competence of collaterals in regions with occluded epicardial arteries and thus, imaging of several coronary distribution territories in one noninvasive study. The cost of PET in combination with the cost of a cyclotron facility together with the demanding methological problems have limited the availability of PET to a few but sophisticated centers. Therefore, quantitative PET investigations have been performed predominantly for scientific purposes and the cost-effectiveness of PET in the everyday clinical setting is not yet finally proven. However, the unique possibilities of PET to study noninvasively and quantitatively myocardial perfusion and metabolism as well as cardiac innervation and pharmacokinetics of cardiac drugs have established cardiac PET as a scientific tool of highest quality for the future.

Coronary Circulation↗

Screening of novel epilepsy-related genes and isolation and identification of cDNAs.

Twenty cDNA differential fragments were isolated from the hippocampus of rats in epileptic state using mRNA differential display technique. Four fragments were sequenced and compared with the known sequences in the Genebank, which showed that ERG8, ERG11, ERG12 had no significant identity to any known sequences; ERG14 had 64%-69% identity to microtubulin-associated protein of the rat. Because the differential expression of these genes was caused by epilepsy inducer coriaria lactone (CL) and anti-epilepsy drug MK-801 and ERG8 might be a novel candidate epilepsy gene; ERG11 and ERG12 might be novel candidate anti-epilepsy genes. Since the microtubulin-associated protein is closely associated with the collateral sprouting of mossy fibers in the hippocampus of seizured rat, the high expression of ERG14 in the early stage of epilepsy might predict the growth of axon and formation of synapse.

Animals↗

Physical hemodynamic interaction between portal venous and hepatic arterial blood flow in humans.

OBJECTIVE: The hepatic arterial end-diastolic velocity (HAEDV) is normally equal to portal vein peak velocity (PVPV). However, there is no report of quantitative measurement that HAEDV was equal to PVPV. We investigated the interaction in PVPV and HAEDV in both chronic and acute hepatic hemodynamic changes. METHODS: One hundred and nineteen patients (54 with cirrhosis, 23 with chronic hepatitis, and 42 with no diffuse liver disorder) were enrolled. We investigated the differences in PVPV and HAEDV among the patients with and without liver disorder. In addition, we measured the intraindividual changes in HAEDV when PVPV was mechanically changed by percutaneous isolated hepatic perfusion in six patients and by percutaneous transhepatic portal embolization (PTPE) in six more. RESULTS: HAEDV was nearly equal to PVPV not only in patients with both normal and hepatitis but also in those with cirrhosis (PVPV-HAEDV = 3.0 +/- 5.2, 2.2 +/- 5.4, 2.3 +/- 6.5 cm/s, respectively). In the intraindividual study, both PVPV and HAEDV decreased during hepatic mechanical perfusion and HAEDV was equal to PVPV (8.2 +/- 2.8, 10.5 +/- 1.5 cm/s, respectively). After PTPE, PVPV was increased and hepatic arterial peak systolic velocity was reciprocally decreased. However, HAEDV was nearly equal to PVPV 7 days after PTPE (PVPV-HAEDV = 5.9 +/- 5.1 cm/s). CONCLUSIONS: Since arterial end-diastolic velocity depends on the downstream vascular resistance, lower HAEDV in patients with cirrhosis was considered to reflect a high outflow resistance. If there is no collateral pathway, we consider that HAEDV may actually reflect sinusoidal resistance to the same degree as PVPV.

Analysis of Variance↗

[Assessing myocardial perfusion with positron emission tomography].

Positron emission tomography (PET) of the heart has gained widespread scientific and clinical acceptance with regard to two indications: 1) The detection of perfusion abnormalities by qualitative and semiquantitative analyses of perfusion images at rest and during physical or pharmacological stress using well-validated perfusion tracers, such as N-13 ammonia, Rb-82 rubidium chloride, or O-15 labeled water. 2) Viability imaging of myocardial regions with reduced contractility by combining perfusion measurements with substrate metabolism as assessed from F-18 deoxyglucose utilization. This overview summarizes the use of PET as a perfusion imaging method. With a sensitivity > 90% in combination with high specificity, PET is today the best-validated available nuclear imaging technique for the diagnosis of coronary artery disease (CAD). The short half-life of the perfusion tracers in combination with highly sophisticated hard- and software enables rapid PET studies with high patient throughput. The high diagnostic accuracy and the methological advantages as compared to conventional scintigraphy allows one to use PET perfusion imaging to detect subtle changes in the perfusion reserve for the detection of CAD in high risk but asymptomatic patients as well as in patients with proven CAD undergoing various treatment forms such as risk factor reduction or coronary revascularization. In patients following orthotopic heart transplantation, evolving transplant vasculopathy can be detected at an early stage. Quantitative PET imaging at rest allows for detection of myocardial viability since cellular survival is based on maintenance of a minimal perfusion and structural changes correlate to the degree of perfusion reduction. Furthermore, quantitative assessment of the myocardial perfusion reserve detects the magnitude and competence of collaterals in regions with occluded epicardial collaterals and, thus, imaging of several coronary distribution territories in one noninvasive study. The cost of PET in combination with the cost of a cyclotron facility together with the demanding methological problems have limited the availability of perfusion PET to a few sophisticated centers. Therefore, quantitative PET investigations of myocardial perfusion have been performed predominantly for scientific purposes, and the cost-effectiveness of PET in the everyday clinical setting is not yet finally proven. However, the unique possibilities of PET to study non-invasively and quantitatively myocardial perfusion and metabolism as well as cardiac innervation and pharmacokinetics of cardiac drugs have established cardiac PET as a scientific tool of the highest quality for the future.

Coronary Circulation↗

[Meniscus and ligament injuries].

The knee is one of the major weight-bearing joints and is relatively exposed to trauma. Capsuloligamentous structures are essential to provide joint stability and -- in turn -- persistent instability bears a risk for osteoarthritis that needs timely and comprehensive diagnosis. Using MRI it may be beneficial to routinely apply (T)SE sequences in all three major planes as a basic protocol and to add additional sequences according to the clinical information available and imaging findings in the basic protocol. Especially fat-suppressed sequences (STIR, T2w/PDw FS TSE) are very useful because they sensitively depict bone marrow edema pattern (BMEP)-like changes. This finding often alerts the reader to -- sometimes only discrete -- underlying pathologies and may -- if found in typical locations -- give information about the mechanism of injury and thus lead the radiologist to look for specific concomitant capsuloligamentous, cartilage, and/or meniscal injury. BMEP is quite prominent in contusion injury, whereas often it is but discrete in avulsion lesions. There is extensive literature about the signs, possible pitfalls, and the accuracy of MRI for the diagnosis of specific pathologies such as meniscal tears or cruciate or collateral ligament ruptures. However, combined injuries of more than one structure are frequent and affect the therapeutic approach. Thus, the primary goal of the radiologist is to go beyond the description of any isolated lesion and to give a comprehensive description of (or to reliably exclude) any injury to other structures. A necessary prerequisite to accomplish this is a thorough knowledge of the -- in some locations -- complex anatomic relationships, pitfalls, and locations where lesions typically occur and where they may be overlooked.

Humans↗