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Effects of motexafin gadolinium on DNA damage and X-ray-induced DNA damage repair, as assessed by the Comet assay.

PURPOSE: To investigate the effects of motexafin gadolinium (MGd) on the levels of reactive oxygen species (ROS), glutathione (GSH), and DNA damage in EMT6 mouse mammary carcinoma cells. The ability of MGd to alter radiosensitivity and to inhibit DNA damage repair after X-ray irradiation was also evaluated. METHODS AND MATERIALS: Reactive oxygen species and GSH levels were assessed by 2,7-dichlorofluorescein fluorescence flow cytometry and the Tietze method, respectively. Cellular radiosensitivity was assessed by clonogenic assays. Deoxyribonucleic acid damage and DNA damage repair were assessed in plateau-phase EMT6 cells by the Comet assay and clonogenic assays. RESULTS: Cells treated with 100 mumol/L MGd plus equimolar ascorbic acid (AA) had significantly increased levels of ROS and a 58.9% +/- 3.4% decrease in GSH levels, relative to controls. Motexafin gadolinium plus AA treatment increased the hypoxic, but not the aerobic, radiosensitivity of EMT6 cells. There were increased levels of single-strand breaks in cells treated with 100 mumol/L MGd plus equimolar AA, as evidenced by changes in the alkaline tail moment (MGd + AA, 6 h: 14.7 +/- 1.8; control: 2.8 +/- 0.9). The level of single-strand breaks was dependent on the length of treatment. Motexafin gadolinium plus AA did not increase double-strand breaks. The repair of single-strand breaks at 2 h, but not at 4 h and 6 h, after irradiation was altered significantly in cells treated with MGd plus AA (MGd + AA, 2 h: 15.8 +/- 3.4; control: 5.8 +/- 0.6). Motexafin gadolinium did not alter the repair of double-strand breaks at any time after irradiation with 10 Gy. CONCLUSIONS: Motexafin gadolinium plus AA generated ROS, which in turn altered GSH homeostasis and induced DNA strand breaks. The MGd plus AA-mediated alteration of GSH levels increased the hypoxic, but not aerobic, radiosensitivity of EMT6 cells. Motexafin gadolinium altered the kinetics of single-strand break repair soon after irradiation but did not inhibit potentially lethal damage repair in EMT6 cells.

Animals↗

Lead-in phase to randomized trial of motexafin gadolinium and whole-brain radiation for patients with brain metastases: centralized assessment of magnetic resonance imaging, neurocognitive, and neurologic end points.

PURPOSE: Motexafin gadolinium is a redox mediator that selectively targets tumor cells, is detectable by magnetic resonance imaging (MRI), and enhances the effect of radiation therapy. This lead-in phase to a randomized trial served to evaluate radiologic, neurocognitive, and neurologic progression end points and to evaluate the safety and radiologic response of motexafin gadolinium administered concurrently with 30 Gy in 10-fraction whole-brain radiation therapy for the treatment of brain metastases. PATIENTS AND METHODS: Motexafin gadolinium (5.0 mg/kg/d for 10 days) was administered before each radiation treatment in this prospective international trial. Patients were evaluated by MRI, neurologic examinations, and neurocognitive tests. Prospective criteria and centralized review procedures were established for radiologic, neurocognitive, and neurologic progression end points. RESULTS: Twenty-five patients with brain metastases from lung (52%) and breast (24%) cancer, recursive partitioning analysis class 2 (96%), and an average of 11 brain metastases were enrolled. Neurocognitive function was highly impaired at presentation. Motexafin gadolinium was well tolerated. Freedom from neurologic progression was 77% at 1 year. Median survival was 5.0 months. In 29% of patients, the cause of death was brain metastasis progression. The radiologic response rate was 68%. Motexafin gadolinium's tumor selectivity was established with MRI. CONCLUSION: (1) Centralized neurologic progression scoring that incorporated neurocognitive tests was implemented successfully. (2) Motexafin gadolinium was well tolerated. (3) Local control, measured by radiologic response rate, neurologic progression, and death caused by progression of brain metastasis, seemed to be improved compared with historical results. A randomized phase III trial using these methods for evaluation of efficacy has just been completed.

Adult↗

[Gadolinium for DSA in two patients with azotemia: Images of suitable quality and risk of acute renal failure].

BACKGROUND: Gadolinium is an alternative angiographic contrast agent in patients with impaired renal function and high risk for iodinated contrast adverse reaction. We report two cases of acute renal failure caused by gadolinium (0.6 and 0.9 mmol/kg of body weight) after the execution of digital subtraction angiography (DSA) to produce diagnostic-quality images in two elderly diabetic patients with pre-existing renal insufficiency. Both patients needed dialysis treatments for as long as a few weeks until their renal function improved. In our opinion, and according to the guidelines of European Society of Urogenital Radiology, gadolinium has not been assessed as less nephrotoxic than iodinated contrast agents. In fact, 1.8 to 4.8 g of iodine, equally attenuated with a relatively high dose (0.2 to 0.4 mmol) of a gadolinium chelate, is a low iodine dose and could hardly have any important nephrotoxic effects. CONCLUSIONS: The maximum dose of gadolinium-based contrast agents should never exceed 0.2 to 0.4 mmol/kg in azotemic patients who are undergoing DSA, even though these doses of gadolinium may not provide images of suitable quality for diagnosis and intervention.

Acute Kidney Injury↗

The use of gadolinium in the MR imaging of bone tumors.

Before determining the role of gadolinium in the evaluation of the solitary bone tumor, the practicing radiologist needs to determine which solitary bone lesions merit further evaluation with magnetic resonance imaging and why further imaging is required. A practical approach in applying magnetic resonance imaging to the indeterminate solitary bone lesion is outlined in this article, which serves as a guideline for logical and consistent application of MR imaging for this purpose. Although seemingly widely used, gadolinium appears to add little to the diagnostic sensitivity of specificity of MR with respect to solitary bone lesions. For selective tumors, such as osteosarcoma, gadolinium offers the potential for determining the efficacy of chemotherapy, by evaluating tumor necrosis prior and subsequent to chemotherapy. In select situations, especially sarcomas close to joints, gadolinium may aid and augment other pulse sequences in determining whether tumor resection should be intra- or extra-articular. However, gadolinium has a limited role in the evaluation of the solitary bone tumor, and its use should be the exception rather than the rule.

Antineoplastic Agents↗

Saline versus gadolinium-enhanced magnetic resonance arthrography of porcine cartilage.

RATIONALE AND OBJECTIVES: The authors compared saline and dilute gadopentetate dimeglumine as injectants for magnetic resonance (MR) arthrography. METHODS: Sixty-three lesions were created on the joint surfaces of six pig patellas. MR arthrography (1.5 T) was performed with the specimens in saline and then in 2 mmol gadopentetate dimeglumine by using fat-saturated two-dimensional (2D) and three-dimensional (3D) sequences. Two musculoskeletal radiologists independently interpreted the images. RESULTS: At 2D MR arthrography, reader 1 performed equally well with saline and gadolinium solutes, whereas reader 2 had better sensitivity with the saline solute (P < .05); interobserver agreement was equivalent for saline and gadolinium solutes. With 3D MR arthrography, reader 2 performed equally well with saline and gadolinium solutes, whereas reader 1 had better sensitivity (P < .0001) but poorer specificity (P < .001) with the gadolinium solute; interobserver agreement was significantly better for saline than for gadopentetate dimeglumine (P < .05). CONCLUSION: In this initial evaluation, there was no clear advantage to using gadolinium-enhanced MR arthrography over saline MR arthrography for detecting lesions in porcine hyaline cartilage.

Animals↗

[MRT of experimental liver abscesses: a comparison of a new blood pool contrast medium with gadolinium-DTPA in animal experiments].

PURPOSE: In an experimental pyogenic liver abscess model, the signal intensities were compared intraindividually and interindividually after the application of a new blood pool contrast agent, 24-gadolinium-DTPA (diethylenetriamine-pentaacetic acid) cascade polymer, and after the application of gadopentetate dimeglumine. METHODS: In 20 rabbits with experimentally induced liver abscesses, the relative signal intensities of the liver, abscess centre, abscess wall and portal vein were assessed before and between 30 seconds and 60 minutes after injection of a 25 mumol/kg dose of gadolinium polymer and of 100 mumol/kg of gadolinium-DTPA, respectively. Measurements were performed at 1.5 Tesla, using a head coil and a Flash-2-D sequence. RESULTS: The interindividual comparison (unpaired T-test, p < 0.05) yielded significant differences of the relative signal intensities of the abscess centre (at any time point after contrast-media application), abscess wall (between 15 and 60 minutes after contrast media application), and portal vein (between 30 seconds and 7.5 minutes after contrast media application). The interindividual comparison showed a significantly higher abscess centre-liver contrast (between 30 seconds and 12.5 minutes after contrast media application) and a significantly higher abscess wall-centre contrast (between two and 7.5 minutes after contrast media application) after the application of gadolinium polymer compared with gadopentetate dimeglumine. CONCLUSION: In this animal model, the higher abscess centre-liver contrast after the application of gadolinium polymer was the basis for a better and prolonged visibility of the abscesses, as compared with images acquired after injection of gadopentetate dimeglumine.

Animals↗

Efficacy of gadolinium administration in magnetic resonance imaging screening of patients with complex partial seizures and results of a normal neurologic examination.

RATIONALE AND OBJECTIVES: Magnetic resonance imaging has become a standard screening tool in the evaluation of patients with complex partial seizures. This study prospectively addresses the efficacy, if any, of routinely adding gadolinium-enhanced images to routine T2-weighted images in patients with a normal neurologic examination. METHODS: One hundred consecutive patients with electroencephalogram and clinical evidence of complex partial seizures and no other neurologic abnormalities were examined prospectively with axial and coronal T2-weighted spin-echo images, followed by axial and coronal gadolinium-enhanced T1-weighted scans. RESULTS: The scans in 73 patients were interpreted as normal, 14 had nonspecific white matter lesions, 5 had asymmetry of the temporal horns, and 2 had asymmetric signal intensity in the temporal lobes, and the scans in 6 showed abnormal gadolinium enhancement. Of the lesions in the six patients whose scans showed abnormal enhancement, four were seen well on the T2-weighted images. Of the remaining two, one was a small cerebellar venous angioma, and the other, a probable tiny convexity meningioma. One temporal lobe glioma seen on the T2 scans did not enhance with gadolinium. CONCLUSIONS: Routine administration of gadolinium does not appear to be of benefit in imaging patients with complex partial seizures who are otherwise neurologically normal.

Adult↗

Venous aneurysms: MR diagnosis with the "layered gadolinium" sign.

OBJECTIVE: Our goal was to present MR findings in venous aneurysms and introduce the "layered gadolinium" sign as an ancillary diagnostic finding. METHOD: Gadolinium-enhanced MR images of three patients with retroperitoneal venous aneurysms were retrospectively reviewed. Prior to MRI, venous aneurysm had been suspected clinically in only one patient. Surgical correlation was available in one patient. A phantom was constructed and imaged to investigate the cause of the layered gadolinium sign. RESULTS: A gradation of signal intensity, the layered gadolinium sign, was observed in three patients with venous aneurysms on postcontrast T1-weighted images. The anterior portion of the aneurysms demonstrated high signal intensity separated by a sharp interface from the low signal intensity posterior region. Unenhanced time-of-flight MR venography, color Doppler, and duplex sonography failed to demonstrate flow in the patient with surgical proof. CONCLUSION: The layered gadolinium sign may be helpful in the diagnosis of venous aneurysm and in differentiating these masses from solid neoplasms.

Aged↗

Liver metastases: improved detection with dynamic gadolinium-enhanced MR imaging?

PURPOSE: To compare dynamic gadolinium-enhanced with unenhanced magnetic resonance (MR) imaging in detection of liver metastases. MATERIALS AND METHODS: Two groups of patients were prospectively examined with unenhanced and dynamic gadolinium-enhanced MR imaging. The first group (n = 48) had proved liver metastases; the second group (n = 49) did not. One set of unenhanced and one set of gadolinium-enhanced MR images were selected per patient. Three independent, blinded readers assessed the images for presence, number, location, and conspicuity of lesions. Data were analyzed with receiver operating characteristic curves, and contrast-to-noise ratios were calculated for the images. RESULTS: There was no statistically significant difference between the use of unenhanced and gadolinium-enhanced MR images in the differentiation of patients with from patients without metastases. The numbers of false-positive and false-negative diagnoses of individual lesions were higher (not statistically significant) with dynamic MR images than with unenhanced MR images. At dynamic MR imaging, contrast-to-noise ratio was highest in the early phase (30 seconds after injection of the contrast agent) but was not significantly different from the contrast-to noise ratio of the T2-weighted images. CONCLUSION: Dynamic gadolinium-enhanced MR imaging showed no improvement over unenhanced MR imaging in detectability of liver metastases.

Adult↗

Model for predicting the impact of gadolinium on plasma calcium measured by the o-cresolphthalein method.

BACKGROUND: Gadolinium formulations, which are administered as contrast agents in magnetic resonance imaging examinations, interfere with colorimetric serum calcium determinations. METHODS: We performed an in vitro study to determine the extent to which three gadolinium formulations-gadodiamide (Omniscan), gadopentetate dimeglumine (Magnevist), and gadoversetamide (OptiMARK)-affect measurements by two methods that use o-cresolphthalein (Dade Behring, Inc. and Roche Diagnostics) and one that uses arsenazo dye (Equal Diagnostics). We also compared values from the o-cresolphthalein methods for 116 samples from patients administered gadodiamide. RESULTS: Magnevist did not affect any of the methods evaluated, whereas Omniscan and OptiMARK were identical in their effects. For the Dade method, the differences from the control sample were < or =4.0 and 7.0 mg/L at 0.25 and 0.5 mmol/L gadolinium, respectively. For the Roche method, the differences were 19, 9.0, and 5.0 mg/L at 0.5, 0.25, and 0.125 mmol/L gadolinium, respectively. Falsely increased calcium values were seen when samples were measured by the arsenazo-based method: differences were 6.0 and 3.0 mg/L at 1.0 and 0.5 mmol/L gadolinium. Using patient data collected at our institution, we were able to generate a model for predicting, from a patient's glomerular filtration rate and the time elapsed since administration, the impact of Omniscan on calcium measurements by the o-cresolphthalein method from Roche Diagnostics. CONCLUSIONS: The predictive model can be used to calculate, in patients who have received gadodiamide, the minimum length of time to wait before blood collection to avoid pseudohypocalcemia when the Roche o-cresolphthalein method is used.

Calcium↗

MR imaging of the gastrointestinal tract with i.v., gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT.

OBJECTIVE: To determine an optimal MR imaging technique and pulse sequence for evaluating mural and serosal disease of the gastrointestinal tract, we administered 2% oral barium sulfate and obtained fat-suppressed gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled (FMPSPGR) MR images. We then compared these images with spin-echo T1-weighted and T2-weighted fast spin-echo MR images and with CT images. SUBJECTS AND METHODS: Thirty-one patients with suspected diseases of the gastrointestinal tract were imaged with spin-echo T1-weighted, fast spin-echo T2-weighted, and fat-saturated gadolinium-enhanced FMPSPGR MR imaging. Before undergoing MR imaging, all patients received 1350 ml of 2% barium sulfate oral contrast media. For CT scans, patients received 120 ml of iodinated i.v. contrast material and 2% barium sulfate oral contrast material. CT and MR images were retrospectively and independently reviewed by two radiologists for ability to see normal bowel wall, for the presence of abnormal gastrointestinal tract mural thickening or enhancement, and for overall gastrointestinal tract visualization. Findings were correlated with surgical findings, endoscopy, and barium studies. RESULTS: Ten patients had benign disease, 16 had malignant gastrointestinal tract disease, and five had no gastrointestinal tract abnormalities. In 94% of patients, the gadolinium- and barium-enhanced FMPSPGR MR images were superior to CT and spin-echo MR sequences for depicting the wall of the normal bowel (p < .001). For the two observers, the FMPSPGR MR images with i.v. and oral contrast material were seen as revealing 94% and 95% of bowel segments with malignant or inflammatory mural thickening or serosal tumor. In comparison, CT revealed 64% and 72% (p < .01 and p < .0001, respectively), fast spin-echo T2-weighted MR images revealed 21% and 28% (p < .0001), and T1-weighted MR images revealed 17% and 18% (p < .0001). The gadolinium- and barium-enhanced MR images were preferred for overall gastrointestinal tract visualization in 65% of patients compared with 1% for CT scans (p < .001). In 32% of patients, the enhanced MR images were equivalent to CT images. CONCLUSION: MR evaluation of the gastrointestinal tract requires bowel distention with oral contrast material as well as motion reduction techniques, including glucagon and rapid gradient-echo pulses that allow breath-hold imaging. Fat-suppressed gadolinium-enhanced FMPSPGR MR imaging with diluted barium oral contrast media is effective for imaging benign and malignant mural and serosal abnormalities of the gastrointestinal tract.

Administration, Oral↗

Iliac artery stenosis measurements: comparison of two-dimensional time-of-flight and three-dimensional dynamic gadolinium-enhanced MR angiography.

OBJECTIVE: We compared our ability to make iliac artery measurements on two-dimensional (2D) time-of-flight (TOF) and three-dimensional dynamic gadolinium-enhanced MR angiography with conventional angiography. SUBJECTS AND METHODS: Fifteen patients with lower extremity vascular disease underwent pelvic MR angiography. Parameters of the cardiac-gated axial 2D TOF sequence included a TR/TE of 24/7 msec and a 50 degrees flip angle. Parameters for the three-dimensional MR angiography sequence, in which we obtained 32 coronal 3-mm slices with fat suppression, included a TR/TE of 32/5 msec and a 40 degrees flip angle during infusion of 40 ml of gadolinium-chelated contrast material. Patients then underwent conventional angiography of the iliac arteries. Maximum stenosis in the common iliac, external iliac, and common femoral arteries was then measured. Measurements of stenosis were compared by repeated measures of analysis of variance. Sensitivity and specificity were calculated for identification of greater than or equal to 50% stenosis and less than 50% stenosis. RESULTS: For all vessels studied, we found no significant difference in measurements obtained from the gadolinium-enhanced MR angiography technique and those obtained from conventional angiography (p > .05). However, significantly different stenotic measurements were obtained from the 2D TOF MR angiography sequence and conventional angiography. In the external iliac arteries, 2D TOF MR angiography exaggerated stenoses most substantially. Gadolinium-enhanced MR angiography achieved 100% sensitivity and specificity. CONCLUSION: Dynamic gadolinium-enhanced MR angiography was more accurate than 2D TOF MR angiography when measuring degree of stenosis in the iliac arteries.

Adult↗

Gadolinium enhances the sensitivity of SW-1573 cells for thermal neutron irradiation.

Gadolinium neutron capture therapy (Gd-NCT) is an experimental cancer treatment based on the physical principal that neutron capture by gadolinium-157 ensures the release of focal high-dose radiation, such as gamma-rays and electrons. Survival and induction of chromosomal aberrations of human SW-1573 cells was studied after thermal neutron irradiation without and with gadolinium. After neutron irradiation with Gd-DTPA, an alpha-enhancement factor of 2.3 was obtained compared to thermal neutron irradiation alone. Gd-DTPA could not radioenhance the cells for gamma-ray irradiation. Induction of colour junctions and chromosome fragments by thermal neutron irradiation and Gd-NCT were studied using PCC-FISH. Correlations (r2-value) between survival and chromosome aberrations ranged from 0.81 to 0.94 for colour junctions and from 0.78 to 0.98 for chromosome fragments of chromosomes 18 and 2 respectively. Thermal neutron irradiation with or without gadolinium induced more chromosome aberrations than gamma-ray irradiation. After correction for chromosome length it appeared that both chromosomes were equally sensitive to radiation. It is concluded that Gd-NCT at a non-toxic concentration of gadolinium is effective in inducing cell death and chromosome aberrations in in vitro cell cultures.

Cell Line, Tumor↗

Dose administration of gadolinium-DTPA in MR imaging of intracranial tumors.

Eleven patients with intracranial tumors were investigated with MR imaging at different dose levels of gadolinium-DTPA to determine a safe and effective dose for imaging intracranial tumors. The patients were divided into two groups. Baseline spin-echo images were obtained with a repetition time of 800 msec and an echo time of 35 msec, and a total of 0.1 mmol of gadolinium-DTPA/kg (six patients) or 0.2 mmol gadolinium-DTPA/kg (five patients) was injected according to a fractionated incremental dose regime (0.025, 0.025, and 0.05 mmol/kg and 0.05, 0.05, and 0.1 mmol/kg, respectively). Postcontrast MR was performed after each injection. In group 1 the best visualization was achieved after the third injection in four cases. In one glioblastoma and in a pituitary adenoma tumor margins were well defined at lower dose levels. In group 2, with five patients, the total dose of 0.2 mmol of gadolinium-DTPA/kg (0.05, 0.05, and 0.1) significantly improved tumor visualization after the third injection in only one patient with multiple metastases. No short-term side effects were encountered. In a range of parameters measured in both serum and whole blood, slight transient elevation of serum iron levels was the only appreciable change. As a result of our investigation we conclude that 0.1 mmol of gadolinium-DTPA/kg is a safe and suitable dose for brain-tumor imaging. In selected cases of 0.2 mmol/kg may increase the diagnostic yield.

Adenoma↗

Action of gadolinium complexes on different enzyme systems.

Gadolinium complexes have two advantages: their toxicity is very low and the paramagnetic properties are adequate enough to give a useful signal with magnetic resonance imaging (MRI). The effects of several MRI contrast media on the activity of two brain enzymes, glutamate decarboxylase (GAD) and cholineacetyl transferase (ChAT), were investigated. The study was performed on homogenates of rat striatum with variable concentrations of gadolinium sulphate, EDTA, DTPA, DOTA, Gd-EDTA, Gd-DTPA and Gd-DOTA (from 10(-2) mol/l to 10(-9) mol/l. Gadolinium in its ionic form and the chelators of cation agents such as EDTA, DTPA and DOTA inhibit GAD, a calcium dependent enzyme, whereas they have no inhibiting effect on the activity of ChAT, a calcium independent enzyme. Gadolinium complexes inhibit the GAD activity by about 15 per cent whereas they do not modify that of ChAT. The complex form of gadolinium has the advantage of retaining its paramagnetism while drastically lowering its toxicity.

Animals↗

Gadolinium-DTPA and MR imaging of pituitary adenoma: a preliminary report.

Gadolinium-DTPA MR imaging (Gd-MR), unenhanced MR imaging, and contrast-enhanced CT studies were compared prospectively in six patients with surgically confirmed pituitary adenomas and three patients without sellar pathology to determine the utility of Gd-MR in the diagnosis of pituitary adenoma. In normal patients, the pituitary gland, cavernous sinus, and infundibulum enhanced by T1 shortening after gadolinium. In adenoma patients, two of four focal lesions identified with contrast-enhanced CT were identified with Gd-MR, and one was identified with unenhanced MR. The earliest short repetition-time sequence performed after gadolinium injection was best for focal lesion detection. Normal cavernous sinus enhancement by gadolinium made identification of cavernous sinus extension of adenoma difficult. Infundibulum displacement was better seen with contrast-enhanced CT (two vs one); however, unenhanced and Gd-MR were better than contrast-enhanced CT for demonstrating chiasmal compression (four vs three). Contrast-enhanced CT, Gd-MR, and plain MR were equally able to identify gland enlargement, sellar floor erosion, and abnormalities of the diaphragma sellae. In this preliminary series, we found Gd-MR to be promising for imaging adenomas; however, modifications in Gd-MR technique including thinner slices and immediate scanning after gadolinium injection are necessary for the best detection of focal lesions.

Adenoma↗

Facial nerve enhancement in Bell's palsy demonstrated by different gadolinium-enhanced magnetic resonance imaging techniques.

Twenty-one patients with an acute complete peripheral facial palsy, Bell's palsy, were examined by medium- and high-Tesla magnetic resonance imaging. Three contrast techniques were used: intravenous gadolinium; oral carbohydrate and intravenous gadolinium; and gadolinium, carbohydrate, and readministration of gadolinium. Three to 22 days after the onset of palsy, 12 of the 21 patients demonstrated ipsilateral facial nerve enhancement, most consistently in the meatal region, which is indicative of an inflammatory reaction. Two to 4.5 months after the onset, the enhancement had disappeared in 10 of the 12 patients. For the individual patient, contrast-enhanced magnetic resonance imaging gave little or no help in predicting the outcome of palsy. It is speculated that the intake of carbohydrate and readministration of gadolinium may improve the sensitivity of medium-high-Tesla magnetic resonance imaging in some cases.

Administration, Oral↗

Stomach diseases: MR evaluation using combined t2-weighted single-shot echo train spin-echo and gadolinium-enhanced spoiled gradient-echo sequences.

The aim of this study was to describe the magnetic resonance (MR) appearances of diseases of the stomach using combined T1-weighted spoiled gradient-echo, T2-weighted single-shot echo train spin-echo and gadolinium-enhanced spoiled gradient-echo sequences. All patients with gastric diseases who underwent combined T2-weighted single-shot echo train spin-echo and gadolinium-enhanced conventional and fat-suppressed spoiled gradient-echo imaging between October 1, 1996 and March 1, 1999, and who had histological or other imaging proof of disease, were included in this study. This patient population was comprised of 40 patients with subsequently proven gastric abnormalities, including malignant tumors (25) or benign disease (15). The MRI sequences included T1-weighted, T2-weighted, and early and late gadolinium-enhanced spoiled gradient-echo (SGE) images. Evaluation was made of the following parameters: a) the ability to detect the disease process on MRI, by comparing the original prospective MR reports with the records of the pathology department; b) the MR appearance of a variety of gastric diseases; and c) the sequences that most clearly demonstrated abnormalities by retrospective review of the MR studies. MR images demonstrated 22 of 25 malignant tumors. Evaluation of the extent of the tumor was correctly shown in 22 of 25 tumors. Small-volume tumor (one patient with gastric adenocarcinoma, and one patient with lymphoma) and coexistent infiltrative adenocarcinoma and gastritis (one patient) rendered demonstration of tumor poor on MR images in three patients. Tumors were mildly hypointense on T1-weighted images and mildly hyperintense on T2-weighted images. Tumors enhanced in a heterogeneous fashion compared with background stomach wall, but they ranged from hypointense to hyperintense on early and late post-gadolinium SGE images. Regarding benign diseases, the changes of gastritis were evident in three of four cases. Gastritis appeared as increased mucosal enhancement that ranged from moderate to intense on early and late post-gadolinium SGE images. Imaging findings of the various entities are described in greater detail in the text. MR findings in a variety of neoplastic and non-neoplastic diseases of the stomach are described. Neoplastic diseases were consistently observed in most cases; however, small tumors and tumors coexistent with inflammatory changes were poorly evaluated. The changes of gastritis were demonstrated as increased enhancement of the gastric wall. J. Magn. Reson. Imaging 10:950-960, 1999.

Adenocarcinoma↗