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Time course of spirapril-induced structural and functional changes after myocardial infarction in rats followed with magnetic resonance imaging.

Structural alterations after myocardial infarction (MI) in rats are usually examined only after death of the experimental animal. Magnetic resonance imaging (MRI) allows repeated and noninvasive measurements of important structural [left ventricular (LV) mass, LV wall thickness, LV chamber radius] as well as function [LV end-systolic and LV end-diastolic volume, stroke volume (SV), ejection fraction (EF)] parameters for a prolonged period. We describe our experience in a series of experiments in rats. Three weeks after MI, infarct size (IS) was determined by MRI and the rats were divided into two groups with equal IS. Three weeks later, treatment with the angiotensin-converting enzyme (ACE) inhibitor spirapril (10 mg/kg in food) or placebo was started. In both groups, the first MRI scan taken before the treatment showed moderately dilated left ventricles and signs of impaired LV function, i.e., an increase in LV end-systolic and end-diastolic volume and decreased EF. After 3-week treatment, no significant differences with respect to heart structure and function were detected as compared with those of untreated animals. Prolonged treatment for 10 weeks with spirapril resulted in significant reduction of LV dilatation, LV mass, and LV end-systolic and end-diastolic volume, which was accompanied by improved EF. Hemodynamic examinations after treatment for 6 months showed, in contrast to control animals, no increase in right ventricular systolic pressure in animals receiving spirapril. Furthermore, histologic examination of perfusion-fixed hearts at the end of the study demonstrated more pronounced LV dilatation in control animals, thus confirming the in vivo MRI data. Delayed treatment with spirapril proved to have beneficial effects on structure and function of infarcted hearts within 10 weeks. Spirapril limited LV dilatation, reduced LV weight and LV end-systolic and end-diastolic volumes, and improved EF.

Angiotensin-Converting Enzyme Inhibitors↗

Magnetic resonance imaging in the evaluation of abscesses.

Ten patients with percutaneous biopsy or surgically proven abscesses were evaluated with magnetic resonance imaging (MRI) to describe the appearance of abscesses, define the capability of MRI to localize abscesses, and compare the capabilities of MRI and CT for the diagnosis and determination of the extent of an abscess. Comparative CT scans were available in six cases. The most common MRI finding was an abnormal area of low signal intensity, either homogeneous or heterogeneous, on the short repetition rate (500 msec TR) images with a relative increase in signal intensity on the longer repetition rate (1500 or 2000 msec TR) images. MRI demonstrated a more clear delineation of the extent of inflammatory changes than did CT, and MRI demonstrated the abscess as a collection distinct from surrounding structures on at least one repetition rate. Intravenous contrast medium was unnecessary with MRI to evaluate vasculature or to define the capsule around an abscess. With CT, unless an abscess contained air or was of low attenuation, it often blended with the surrounding structures and was difficult to differentiate from them. Surgical clips in the postoperative patient with an abscess did not degrade the MR images as often occurred with CT. This study describes the MRI appearance of abscess and indicates a potential value of the use of MRI to evaluate abscess outside the central nervous system and spine.

Abdomen↗

Comparison of different MRI brain atrophy rate measures with clinical disease progression in AD.

OBJECTIVE: To correlate different methods of measuring rates of brain atrophy from serial MRI with corresponding clinical change in normal elderly subjects, patients with mild cognitive impairment (MCI), and patients with probable Alzheimer disease (AD). METHODS: One hundred sixty subjects were recruited from the Mayo Clinic Alzheimer's Disease Research Center and Alzheimer's Disease Patient Registry Studies. At baseline, 55 subjects were cognitively normal, 41 met criteria for MCI, and 64 met criteria for AD. Each subject underwent an MRI examination of the brain at the time of the baseline clinical assessment and then again at the time of a follow-up clinical assessment, 1 to 5 years later. The annualized changes in volume of four structures were measured from the serial MRI studies: hippocampus, entorhinal cortex, whole brain, and ventricle. Rates of change on several cognitive tests/rating scales were also assessed. Subjects who were classified as normal or MCI at baseline could either remain stable or convert to a lower-functioning group. AD subjects were dichotomized into slow vs fast progressors. RESULTS: All four atrophy rates were greater among normal subjects who converted to MCI or AD than among those who remained stable, greater among MCI subjects who converted to AD than among those who remained stable, and greater among fast than slow AD progressors. In general, atrophy on MRI was detected more consistently than decline on specific cognitive tests/rating scales. With one exception, no differences were found among the four MRI rate measures in the strength of the correlation with clinical deterioration at different stages of the disease. CONCLUSIONS: These data support the use of rates of change from serial MRI studies in addition to standard clinical/psychometric measures as surrogate markers of disease progression in AD. Estimated sample sizes required to power a therapeutic trial in MCI were an order of magnitude less for MRI than for change measures based on cognitive tests/rating scales.

Aged↗

T1 Gd-enhanced compared with CISS sequences in retinoblastoma: superiority of T1 sequences in evaluation of tumour extension.

BACKGROUND: As adequate therapy for retinoblastoma in young children depends on infiltration of extra-retinal structures, diagnostic modalities play an essential role. METHODS: In this widely extended study, 80 children with retinoblastoma were studied with MRI (standard fat-suppressed Gd-enhanced T1, T2 thin-slice sequences (additionally with small loop surface coil), constructive interference in steady state (CISS) sequence covering the orbita). The images were analysed by two blinded neuroradiologists. Histology was used as the gold standard. RESULTS: MRI assumed infiltration of extra-retinal structures in 13 of 80 patients of which ten were confirmed by histology. Affected extra-retinal structures were: optic nerve (five, of which two were on CISS and three on T1 with higher image resolution using the surface coil), scleral infiltration (five, of which four on CISS and T1) and ciliary body infiltration (one on CISS and T1). Another 61 enucleated patients did not have any extra-retinal infiltration in histology. The CISS sequence with multiplanar reconstruction was mainly helpful in revealing exact three-dimensional tumour extension with excellent clinical acceptance and pre-surgical planning but T1 fat-suppressed Gd-enhanced images were superior in revealing exact tumour extension. CONCLUSION: CISS sequences allow to produce excellent anatomical images and to perform multiplanar reconstruction to better demonstrate tumour extension. However, T1-weighted sequences after contrast application are more sensitive (60 versus 40%) in detecting infiltration of the optic nerve but equal in detecting scleral infiltration.

Child↗

Magnetic resonance images of hematospermia.

Seminal vesicles and their adjacent structures were studied using magnetic resonance imaging (MRI) in 7 normal volunteers and 15 patients with hematospermia. Normal seminal vesicles are depicted on T2-weighted images either as a mixture of high- and low-signal granules or as a convolution of tubules with a diameter of less than 0.5 cm. Fourteen of the 15 patients with hematospermia exhibited abnormalities on MRI. Dilatation or cyst formation in the seminal vesicle was observed in 13 patients, and a dilatation of the midline structure was seen in 3 patients. Abnormal signal intensity of the seminal vesicles was seen in 11 patients and was thought to be due to subacute hemorrhage.

Adult↗

[Comparison of magnetic resonance imaging with histopathological correlation in laryngeal carcinomas].

Apart from a clinical examination including direct laryngoscopy and biopsy, pretherapeutic staging for local extension of laryngeal carcinoma requires computed tomography. The role of magnetic resonance imaging (MRI) remains controversial. The aim of this study was to determine its value for detecting invasion of the main laryngeal structures. Histological findings were compared with axial MRI slices to remain in the same plane. A double-blind study of 10 areas of the larynx was performed: vocal muscle, anterior and posterior paraglottic spaces, anterior and posterior laryngeal commissures, anterior and posterior subglottic area, arytenoid, thyroid, and cricoid cartilages. MRI appeared to be the method of choice to detect neoplastic cartilage, and subglottic and commissural invasion. MRI allows a treatment strategy adapted to the areas involved by the laryngeal carcinoma.

Aged↗

Far lateral lumbar disc herniations and associated structural abnormalities. An evaluation in 60 patients of the comparative value of CT, MRI, and myelo-CT in diagnosis and management.

The management of 60 patients with far lateral lumbar disc herniations operated on over a 5-year period are presented. These lesions were located superiorly within the neural foramens beneath or distal to the facet joints. The type of surgery performed in 43 of 60 (72%) of these patients was significantly altered by the presence of diffuse and lateral recess stenosis. This was better appreciated on the myelogram and myelo-CT (M-CT) studies than with the noncontrast CT and MRI examinations alone. Myelo-CT findings were particularly valuable in assessing patients who had previous surgical procedures.

Female↗

MRI-based surface area estimates in the normal adult human brain: evidence for structural organisation.

There are a number of quantitative relationships between geometric parameters describing the structure of the normal human cerebral cortex examined in vivo using volumetric magnetic resonance imaging. A voxel-counting method is used to estimate grey-white interface surface area. The effects of bias associated with the method are considered. In 33 normal controls, the cerebral hemispheres were symmetric in terms of total volume, irrespective of handedness, but not in terms of surface areas for right-handers. The surface area of the grey matter-white matter interface was directly proportional to the cortical grey matter volume, suggesting that growth of the neocortex is primarily tangential, with repetition of a basic structural element rather than gross alterations in the thickness of the cortex. The majority of the surface area of the grey-white interface lies within gyral white matter cores. The mean thickness of the cortex of the right cerebral hemisphere in vivo was 3.0 mm and that of the left 3.3 mm. There was a relationship between the cross-sectional area of the corpus callosum and grey-white interface surface area, suggesting that a fixed proportion and cortical neurons extend interhemispheric axons. These findings suggest that there are general architectural principles governing the organisation of the complex, but ordered, human cerebral cortex.

Adult↗

Water uptake and oil distribution during imbibition of seeds of western white pine (Pinus monticola Dougl. ex D. Don) monitored in vivo using magnetic resonance imaging.

Dry or fully imbibed seeds of western white pine (Pinus monticola Dougl. ex D. Don) were studied using high-resolution magnetic resonance imaging (MRI). Analyses of the dry seed revealed many of the gross anatomical features of seed structure. Furthermore, the non-invasive nature of MRI allowed for a study of the dynamics of water and oil distribution during in situ imbibition of a single seed with time-lapse chemical shift selective MRI. During soaking of the dry seed, water penetrated through the seed coat and megagametophyte. The cotyledons of the embryo (located in the chalazal end of the seed) were the first to show hydration followed by the hypocotyl and later the radicle. After penetrating the seed coat, water in the micropylar end of the seed likely also contributed to further hydration of the embryo; however, the micropyle itself did not appear to be a site for water entry into the seed. A model that describes the kinetics of the earlier stages of imbibition is proposed. Non-viable pine seeds captured with MRI displayed atypical imbibition kinetics and were distinguished by their rapid and uncontrolled water uptake. The potential of MR microimaging for detailed studies of water uptake and distribution during the soaking, moist chilling ("stratification"), and germination of conifer seeds is discussed.

Kinetics↗

Etiology of intellectual impairment in Duchenne muscular dystrophy.

The precise etiology of intellectual impairment in Duchenne muscular dystrophy (DMD) is unknown. Histopathologic and computed tomographic studies have revealed structural brain changes; however, to our knowledge, no cranial magnetic resonance imaging (MRI) studies have been performed on DMD patients to further delineate these structural changes. We prospectively studied 4 DMD patients by cranial MRI, DNA deletion analysis, clinical evaluation, and intelligence testing. There was no significant correlation between verbal intelligence scores and MRI findings, DNA deletion, or the clinical severity of the disease. These first MRI studies of DMD did not reveal any significant anatomic brain alteration, other than mild atrophy in 2 patients. We believe these results must be considered when investigating the etiology of intellectual impairment in DMD in future studies with larger patient samples.

Adolescent↗

Is MRI useful in osteoarthritis?

Magnetic resonance imaging (MRI) can image all the tissues involved in the osteoarthritic joint-not just the cartilage but also the ligaments, synovium, menisci and subchondral bone. Despite these abilities, MRI does not have an established place in the investigation or management of osteoarthritis (OA). This chapter will overview the literature concerning MRI abnormalities in OA, and their relationship to structural progression and symptoms, in order to let the reader decide on the benefits of MRI in their particular practice. The evidence reviewed here will relate to knee OA, reflecting the vast preponderance of MRI studies in the knee.

Diagnosis, Differential↗

The use of MRI in the evaluation of myopathy.

MRI has revolutionized the practice of many branches of medicine. However, within the field of Neurology MRI is used almost exclusively to examine the structure of portions of the central nervous system. Despite a limited number of objective tests, MRI remains an underutilized tool in the examination of the peripheral nervous system. This review will briefly discuss the limitations of current testing, and then summarize how the physics of MRI helps predict normal and abnormal findings in disease affecting skeletal muscle. The cardinal radiologic abnormalities affecting muscle (atrophy, hypertrophy, pseudohypertrophy, mass, and altered signal intensity) are reviewed. Special attention is given to how MRI can be utilized during the evaluation of such disorders. Finally, the roles of MRI as a prognostic tool and as a potential endpoint in long-term management of myopathy are evaluated.

Humans↗

Positron emission tomography imaging of regional cerebral glucose metabolism.

The (F-18) fluorodeoxyglucose (FDG) technique to measure local cerebral metabolic rate for glucose (LCMRglu) is well accepted and widely used by many institutions around the world. A large number of studies has been carried out in normal volunteers and patients with a variety of CNS disorders. Several investigators have noted that no significant age-related changes in cerebral glucose use occur with normal aging. Some important and interesting findings have been revealed following sensory, motor, visual, and auditory stimulations. Functional imaging with FDG in certain neurologic disorders has dramatically improved our understanding of their underlying pathophysiologic phenomena. Some abnormalities detected on the positron emission tomography (PET) images have no corresponding changes on either x-ray computed tomograms (XCT) or magnetic resonance images (MRI). In patients with Alzheimer's disease, primary sensorimotor, visual, and cerebellar metabolic activity appears relatively preserved. In contrast, parietal, temporal, and to some degree, frontal glucose metabolism is significantly diminished even in the early stages of the disease. Patients with Huntington's disease and those at risk of developing this disorder have a typical pattern of diminished CMRglu in the caudate nuclei and putamen. In patients with stroke, PET images with FDG have demonstrated abnormal findings earlier than either XCT or MRI and with a wider topographic distribution. FDG scans have revealed interictal zones of decreased LCMRglu in approximately 70% of patients with partial epilepsy. The location of the area of hypometabolism corresponds to the site of the epileptic focus as determined by electroencephalography and microscopic examination of the resected tissue. Ictal scans during partial seizures demonstrate areas of hypermetabolism corresponding to the sites of seizure onset and spread. Several investigators have reported relative hypofrontal CMRglu in patients with schizophrenia. In our center, FDG scans from patients with schizophrenia were successfully differentiated from those obtained in normal controls. Finally, our preliminary data (using PET, XCT, and MRI) in patients with CNS disorders indicate that MRI provides excellent delineation of the structural abnormalities. It may prove to be superior to XCT in the evaluation of certain diseases such as cerebral ischemia and infarcts, head injury, tumors, and white matter lesions. Metabolic imaging with FDG provides functional information not obtainable with either MRI or NMR spectroscopy. Therefore, PET studies will play a complementary role to the anatomic imaging in the management of patients with CNS disorders.

Aging↗

Muscular involvement in the Holt-Oram syndrome.

Holt-Oram syndrome is an autosomal dominant disorder characterised by radial ray and congenital heart defects. Recently, a gene for this disorder has been identified on chromosome 12q24.1, encoding a T box transcription factor. However, the functional role of the gene product is not completely understood. We present results of neurological, radiological, and muscle magnetic resonance imaging (MRI) investigations in 13 patients from eight unrelated families. Besides heart defects, clinical signs ranged from thenar abnormalities to bilateral phocomelia. The former were present in all patients. MRI showed hypoplasia of discrete muscles which clinically showed as non-progressive weakness. The structural pattern of residual muscles was normal on MRI, which together with normal muscular power, electromyography, and muscle enzyme investigations excluded a progressive neuromuscular disorder. The number and location of hypoplastic muscles correlated with the severity of skeletal involvement. Thus, patients with hypoplasia of large and proximal muscles had phocomelia, and those with mere intrinsic hand muscle hypoplasia had only a triphalangeal thumb or no skeletal malformation. On the basis of these observations, we conclude that disturbed fetal limb muscle development is involved in the bony malformations of the upper limbs.

Adult↗

[Chondrosarcoma of the bone. Differential pre- and postoperative diagnosis using magnetic resonance].

Twelve patients were studied by means of Magnetic Resonance Imaging (MRI) in order to demonstrate either loco-regional recurrence of central chondrosarcomas or degenerative evolutions of exostoses. MRI findings were compared with plain film, scintigraphy, and Computed Tomography. MRI showed loco-regional recurrences by demonstrating their site, extent, and relationship with adjacent structures. In showing the degenerative evolution of exostoses MRI--confirmed at surgery--was superior to plain film in 3 cases out of 7, and to Computed Tomography in 2 cases. The authors discuss MRI findings: chondrosarcomas have low-intensity signal in T1-weighted sequences and high-intensity signal in T2-weighted. Thanks to its high contrast resolution MRI always allowed the detection of the chondrosarcoma. Nevertheless, MRI did not allow the tumor grading--which is due either to a difficult evaluation of the morphology of neoplastic calcifications, or to non-specific-intensity signal.

Adolescent↗

Basic anatomy of the shoulder by magnetic resonance imaging.

An understanding of the normal magnetic resonance (MR) infrastructural details of musculotendinous elements of the rotator cuff forms the basis for analysis of its pathology. The muscular bellies of the teres minor, infraspinatus, supraspinatus, and subscapularis are easily identified in MR images. In their lateral course both the supraspinatus and infraspinatus muscles transition to tendons gradually. Their lateral tendinous portions partially overlap and form a layered appearance on MR images. The subscapularis, with its fan-like tendinous insertional slips at the lesser tuberosity, can be identified easily in all imaging planes. The ligamentous structures of the shoulder, including the coracoacromial and coracohumeral ligaments, are visualized as low signal bands in all imaging planes. The capsuloligamentous structures including the superior, middle, and inferior glenohumeral ligament and glenoid labrum present considerable anatomic variations. This is especially true with respect to the anterior labrum, which varies from absent to a well-formed triangular appearance. Understanding the basic MRI anatomy of all soft tissue structures of the shoulder is essential for appropriate interpretation of lesions related to the shoulder.

Humans↗

[Comparison of magnetic resonance (0,5 T), computed tomography, and endorectal ultrasonography in the preoperative staging of neoplasms of the rectum-sigma. Correlation with surgical and anatomopathologic findings].

Eighteen cases of rectal carcinoma were staged preoperatively with transrectal endosonography (EUS), CT and MRI (0.5 T). The results were compared with surgical specimens and histology to evaluate the accuracy of the imaging modalities in staging rectal carcinomas which had been quantified according to Astler-Coller's classification. All methods identified the lesion (100% sensitivity). EUS and MRI correctly staged 8 cases (44%) and CT 9 cases (50%). CT and MRI mistakes were relative to overstaging, whereas EUS understaged 4 cases (22%) and overstaged 6 cases (33%). In local tumor staging ("T" variable), CT and MRI understaged no lesions, thus exhibiting 100% sensitivity, which was higher than EUS sensitivity (92%). Conversely, CT and MRI more frequently overstaged the lesions, thus demonstrating lower sensitivity than EUS (55% and 50%, respectively, versus 76% for EUS). As for the "N" variable, EUS identified node metastases in one case only (25%) and misdiagnosed as positive 4 cases of negative node involvement. All the C-stage lesions were correctly diagnosed by CT and MRI (whose findings were in agreement) which also overstaged as C three cases with hyperplastic node enlargement. The diagnostic accuracy of EUS, which was highest for the A and B1 stages, progressively decreased for bigger lesions, clearly understaging node involvement. On the contrary, CT and MRI accuracy rates were lower in small tumors involving the rectal wall only, whereas they always identified tumor spread beyond the bowel wall into perirectal fat, and node metastases. Therefore, to conclude, EUS can be used first: in case of extraluminal tumor spread, CT is the method of choice, more accurate than MRI in identifying node involvement and equally effective in evaluating perirectal fat infiltration and pelvic structures involvement. Whenever the pelvic floor is involved, MRI is the best imaging method, thanks to its multiplanar capabilities, for better detailing of musculoskeletal involvement.

Aged↗

Paranasal sinuses and nasopharynx CT and MRI.

Neoplastic disease of the nose, paranasal sinuses, the nasopharynx and the parapharyngeal space requires thorough assessment of location and extent in order to plan appropriate treatment. CT allows the deep soft tissue planes to be evaluated and provides a complement to the physical examination. It is especially helpful in regions involving thin bony structures (paranasal sinuses, orbita); here CT performs better than MRI. MRI possesses many advantages over other imaging modalities caused by its excellent tissue contrast. In evaluating regions involving predominantly soft tissue structures (ec nasopharynx and parapharyngeal space) MRI is superior to CT. The possibility to obtain strictly consecutive volume data sets with spiral CT or 3D MRI offer excellent perspectives to visualize the data via 2D or 3D postprocessing. Because head and neck tumors reside in a complex area, having a 3D model of the anatomical features may assist in the delineation of pathology. Data sets may be transferred directly into computer systems and thus be used in computer assisted surgery.

Angiofibroma↗