Quantitative measurement of brain perfusion with intravoxel incoherent motion MR imaging.

PURPOSE: To evaluate the sensitivity of the perfusion parameters derived from Intravoxel Incoherent Motion (IVIM) MR imaging to hypercapnia-induced vasodilatation and hyperoxygenation-induced vasoconstriction in the human brain. MATERIALS AND METHODS: This study was approved by the local ethics committee and informed consent was obtained from all participants. Images were acquired with a standard pulsed-gradient spin-echo sequence (Stejskal-Tanner) in a clinical 3-T system by using 16 b values ranging from 0 to 900 sec/mm(2). Seven healthy volunteers were examined while they inhaled four different gas mixtures known to modify brain perfusion (pure oxygen, ambient air, 5% CO(2) in ambient air, and 8% CO(2) in ambient air). Diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (f), and blood flow-related parameter (fD*) maps were calculated on the basis of the IVIM biexponential model, and the parametric maps were compared among the four different gas mixtures. Paired, one-tailed Student t tests were performed to assess for statistically significant differences. RESULTS: Signal decay curves were biexponential in the brain parenchyma of all volunteers. When compared with inhaled ambient air, the IVIM perfusion parameters D*, f, and fD* increased as the concentration of inhaled CO(2) was increased (for the entire brain, P = .01 for f, D*, and fD* for CO(2) 5%; P = .02 for f, and P = .01 for D* and fD* for CO(2) 8%), and a trend toward a reduction was observed when participants inhaled pure oxygen (although P > .05). D remained globally stable. CONCLUSION: The IVIM perfusion parameters were reactive to hyperoxygenation-induced vasoconstriction and hypercapnia-induced vasodilatation. Accordingly, IVIM imaging was found to be a valid and promising method to quantify brain perfusion in humans.

Computed tomography- and fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults: a new technique.

OBJECTIVES: To evaluate the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous screw fixation for the treatment of low-grade isthmic spondylolisthesis in adults. METHODS: Ten consecutive adult patients (four men and six women; mean age: 57.1 [range, 44-78 years]) were prospectively treated by percutaneous screw fixation for low-grade (six grade 1 and four grade 2) isthmic spondylolisthesis of L5. For each patient, two 4.0-mm Asnis III cannulated screws were placed to fix the pars interarticularis defects. All procedures were performed under local anaesthesia by using CT and fluoroscopy guidance. Post-operative outcome was assessed using the visual analogue scale and Oswestry Disability Index (ODI) scores. RESULTS: The procedure time ranged from 45 to 60 min. The mean screw length was 27 mm (range, 24-32 mm). The VAS and ODI measurements ± SD decreased from 7.8 ± 0.9 preoperatively to 1.5 ± 1.1 at the last 2-year follow-up, and from 62.3 ± 17.2 to 15.1 ± 6.0, respectively (P < 0.001 in both cases). Neither slip progression nor screw failure was noted. CONCLUSIONS: This feasibility study showed that CT- and fluoroscopy-guided percutaneous screw fixation could be a rapid, safe and effective method of treating low-grade isthmic spondylolisthesis. KEY POINTS: CT- and fluoroscopy-guided percutaneous screw fixation of isthmic spondylolisthesis is feasible. It could become an effective method to treat low-grade isthmic spondylolisthesis. Percutaneous trans-isthmic screw fixation can be performed under local anaesthesia. This new technique can be performed as an outpatient procedure.

Assessment of in vivo chemotherapy-induced DNA damage in a p53-mutated rat tumor by micronuclei assay.

Production of DNA damage is the basis of cancer treatments such as chemo- and radiotherapy. Such treatments induce mitotic catastrophe, a form of cell death resulting from abnormal mitosis and leading to the formation of interphase cells with multiple micronuclei. In this study, we compared apoptosis induction and micronuclei formation to assess the DNA damage provoked in vivo by cytotoxic agents in established 9L rat gliosarcoma tumors expressing a mutated p53 gene. Results from TUNEL assays revealed the efficiency of local gamma-irradiation at the tumor site to induce apoptosis within 9L tumor mass. However, little or no apoptosis was detected after systemic (ip) injection of cisplatin (1 mg/kg). Interestingly, the micronuclei assays showed that not only gamma-irradiation but also cisplatin treatment led to an increase in the emergence of binucleated cells with micronuclei. Apoptosis induction and micronuclei emergence are thus not absolutely correlated. However, micronuclei assays, rarely performed on solid tumors, appear more sensitive than apoptosis assays in evaluating DNA damage linked to chemotherapy.

Percutaneous screw fixation of a vertebral pedicle fracture under CT-guidance: a new technique.

We report on a new minimally invasive technique for the vertebral pedicle fracture after placement of a prosthetic disc. This intervention is an adaptation of CT-guided sacroiliac and acetabular fracture screw fixation. This type of procedure enables the perfect placement and measurement of the screw, as well as an extremely small incision under local anesthesia. CT guided Transpedicular fixation could be a useful strategy in the treatment of future cases involving poorly healing pedicle fractures causing persistent symptoms. This intervention confirms the range of capacities of CT scan-controlled interventions in terms of precision, safety, speed, minimal invasiveness, rapid return to everyday activity and consequently, economical management.

MP2RAGE multiple sclerosis magnetic resonance imaging at 3 T.

OBJECTIVES: Lesion detection and characterization in multiple sclerosis (MS) are an essential part of its clinical diagnosis and an important research field. In this pilot study, we applied the recently introduced two inversion-contrast magnetization-prepared rapid gradient echo sequence (MP2RAGE) to patients with early-stage MS. MATERIALS AND METHODS: The MP2RAGE is a 3-dimensional (3D) magnetization-prepared rapid gradient echo derivative providing homogeneous T1 weighting and simultaneous T1 mapping. The MP2RAGE performance was compared with that of 2 clinical routine sequences (2D fluid-attenuated inversion recovery [FLAIR] and 3D magnetization-prepared rapid gradient echo [MP-RAGE]) and 2 state-of-the art clinical research sequences (the 3D FLAIR-SPACE [sampling perfection with application-optimized contrasts by using different flip-angle evolutions], a fluid-attenuated variable flip-angle fast spin echo technique, and the 3D double-inversion recovery SPACE). A cohort of 10 early-stage female MS patients (age, 31.6 ± 4.7 years; disease duration, 3.8 ± 1.9 years; median expanded disability status scale score, 1.75) and 10 age- and gender-matched controls were enrolled after approval of the local institutional review board was obtained. Multiple sclerosis lesions were identified and assigned to brain locations and tissue types by two experienced physicians in all 5 contrasts. Subsequently, lesions were manually delineated for comparison and statistical analysis of lesion count, volume and quantitative measures. RESULTS AND CONCLUSIONS: The results show that the 3D T1-weighted high-resolution MP2RAGE contrast provides a sensitive means for MS lesion assessment. The additional quantitative T1 relaxation time maps obtained with the MP2RAGE provide further potential diagnostic and prognostic information that could help (a) to better discriminate lesion subtypes and (b) to stage and predict the activity and the evolution of MS. Results also indicate that the T2-weighted double-inversion recovery and FLAIR-SPACE contrasts are attractive complements to the MP2RAGE for lesion detection.

Transformation of a microprolactinoma into a mixed growth hormone and prolactin-secreting pituitary adenoma.

Combined prolactin (PRL) and growth hormone (GH) secretion by a single pituitary tumor can occur in approximately 5% of cases. However, in all previously reported patients, combined secretion of both hormones was present at the time of diagnosis. Here we describe a patient initially diagnosed with a pure prolactin-secreting microadenoma, who experienced the progressive apparition of symptomatic autonomous GH secretion while on intermittent long term dopamine agonist therapy. She was operated on, and immunohistochemical analysis of tumor tissue confirmed the diagnosis of pituitary adenoma with uniform co-staining of all cells for both GH and PRL. This patient represents the first documented occurrence of asynchronous development of combined GH and PRL secretion in a pituitary adenoma. Although pathogenic mechanisms implicated remain largely speculative, it emphasizes the need for long term hormonal follow up of patients harboring prolactinomas.