3.0 Tesla breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail.

OBJECTIVES: To compare 3.0 Tesla breast magnetic resonance imaging (MRI) with galactography for detection of benign and malignant causes of nipple discharge in patients with negative mammography and ultrasound. METHODS: We prospectively evaluated 56 breasts of 50 consecutive patients with nipple discharge who had inconspicuous mammography and ultrasound, using 3.0 Tesla breast MRI with a dedicated 16-channel breast coil, and then compared the results with galactography. Histopathological diagnoses and follow-ups were used as reference standard. Lesion size estimated on MRI was compared with the size at histopathology. RESULTS: Sensitivity and specificity of MRI vs. galactography for detecting pathologic findings were 95.7 % vs. 85.7 % and 69.7 % vs. 33.3 %, respectively. For the supposed concrete pathology based on MRI findings, the specificity was 67.6 % and the sensitivity 77.3 % (PPV 60.7 %, NPV 82.1 %). Eight malignant lesions were detected (14.8 %). The estimated size at breast MRI showed excellent correlation with the size at histopathology (Pearson's correlation coefficient 0.95, p < 0.0001). CONCLUSIONS: MRI of the breast at 3.0 Tesla is an accurate imaging test and can replace galactography in the workup of nipple discharge in patients with inconspicuous mammography and ultrasound. KEY POINTS: • Breast MRI is an excellent diagnostic tool for patients with nipple discharge. • MRI of the breast reveals malignant lesions despite inconspicuous mammography and ultrasound. • MRI of the breast has greater sensitivity and specificity than galactography. • Excellent correlation of lesion size measured at MRI and histopathology was found.

Phase-labeled reference EPI for frequency-segmented inhomogeneity corrections (PREFICS).

PURPOSE: To develop a method to correct for geometric distortions in non-Cartesian echo planar imaging using data acquired in a fast prescan. METHODS: Echo planar images were obtained using a non-Cartesian density weighted k-space trajectory. In contrast to linear Cartesian acquisition, distortions arising in non-Cartesian acquisitions can only be corrected using conjugate phase-based methods. Up to now these methods require a time consuming field map acquisition in undistorted coordinates. In this work, a phase-labeled reference EPI scan was performed in a very short time, yielding a displacement map in distorted coordinates. Subsequently, this map was applied to itself and thus transformed into undistorted coordinates. The echo planar images were then corrected with a frequency-segmented conjugate phase method. The results were compared with corrections based on a multi-echo reference field map acquired in undistorted coordinates. RESULTS: Uncorrected density weighted EPI exhibited geometric distortions and severe ringing artifacts. These distortions could be successfully corrected using the novel method. The quality was comparable to corrections based on the multi-echo reference field map. The novel method shortens the field map acquisition duration by a factor of 64. CONCLUSION: The method presented allows correcting non-Cartesian EPI from a reference scan consisting of only two phase-labeled echo planar images.

SElf-gated Non-Contrast-Enhanced FUnctional Lung imaging (SENCEFUL) using a quasi-random fast low-angle shot (FLASH) sequence and proton MRI.

Obtaining functional information on the human lung is of tremendous interest in the characterization of lung defects and pathologies. However, pulmonary ventilation and perfusion maps usually require contrast agents and the application of electrocardiogram (ECG) triggering and breath holds to generate datasets free of motion artifacts. This work demonstrates the possibility of obtaining highly resolved perfusion-weighted and ventilation-weighted images of the human lung using proton MRI and the SElf-gated Non-Contrast-Enhanced FUnctional Lung imaging (SENCEFUL) technique. The SENCEFUL technique utilizes a two-dimensional fast low-angle shot (FLASH) sequence with quasi-random sampling of phase-encoding (PE) steps for data acquisition. After every readout, a short additional acquisition of the non-phase-encoded direct current (DC) signal necessary for self-gating was added. By sorting the quasi-randomly acquired data according to respiratory and cardiac phase derived from the DC signal, datasets of representative respiratory and cardiac cycles could be accurately reconstructed. By application of the Fourier transform along the temporal dimension, functional maps (perfusion and ventilation) were obtained. These maps were compared with dynamic contrast-enhanced (DCE, perfusion) as well as standard Fourier decomposition (FD, ventilation) reference datasets. All datasets were additionally scored by two experienced radiologists to quantify image quality. In addition, one initial patient examination using SENCEFUL was performed. Functional images of healthy volunteers and a patient diagnosed with hypoplasia of the left pulmonary artery and left-sided pulmonary fibrosis were successfully obtained. Perfusion-weighted images corresponded well to DCE-MRI data; ventilation-weighted images offered a significantly better depiction of the lung periphery compared with standard FD. Furthermore, the SENCEFUL technique hints at a potential clinical relevance by successfully detecting a perfusion defect in the patient scan. It can be concluded that SENCEFUL enables highly resolved ventilation- and perfusion-weighted maps of the human lung to be obtained using proton MRI, and might be interesting for further clinical evaluation.

High resolution myocardial first-pass perfusion imaging with extended anatomic coverage.

PURPOSE: To evaluate and to compare Parallel Imaging and Compressed Sensing acquisition and reconstruction frameworks based on simultaneous multislice excitation for high resolution contrast-enhanced myocardial first-pass perfusion imaging with extended anatomic coverage. MATERIALS AND METHODS: The simultaneous multislice imaging technique MS-CAIPIRINHA facilitates imaging with significantly extended anatomic coverage. For additional resolution improvement, equidistant or random undersampling schemes, associated with corresponding reconstruction frameworks, namely Parallel Imaging and Compressed Sensing can be used. By means of simulations and in vivo measurements, the two approaches were compared in terms of reconstruction accuracy. Comprehensive quality metrics were used, identifying statistical and systematic reconstruction errors. RESULTS: The quality measures applied allow for an objective comparison of the frameworks. Both approaches provide good reconstruction accuracy. While low to moderate noise enhancement is observed for the Parallel Imaging approach, the Compressed Sensing framework is subject to systematic errors and reconstruction induced spatiotemporal blurring. CONCLUSION: Both techniques allow for perfusion measurements with a resolution of 2.0 × 2.0 mm(2) and coverage of six slices every heartbeat. Being not affected by systematic deviations, the Parallel Imaging approach is considered to be superior for clinical studies.

Reproducibility of manual and semi-automated late enhancement quantification in patients with Fabry disease.

BACKGROUND: Late enhancement (LE) imaging is increasingly used for diagnosis of non-ischemic cardiomyopathy. However, the mostly patchy appearance of LE in this context may reduce the reproducibility of LE measurement. PURPOSE: To report intra- and inter-observer variabilities of LE measurements in Fabry disease using manual and semi-automated quantification. MATERIAL AND METHODS: Twenty MRI data-sets of male patients aged 44 ± 7 years were analyzed twice (interval 12 months) by one observer and additionally once by a second observer. Left ventricular (LV) parameters were determined using cine MRI. Gradient-echo LE images were analyzed by manual planimetry and by a semi-automatic prototype software. Variabilities were determined by Bland-Altman analyses and additionally intra-class correlation coefficient (ICC) values were calculated to survey intra- and inter-observer reproducibility. RESULTS: The amount of LE was 5.2 ± 5.1 mL or 2.8 ± 2.6 % of LV mass (observer 2). LE was detected predominantly intramurally in a patchy pattern. All patients had LE restricted to the basal infero-lateral parts of the LV. The extent of LE correlated to LV mass (207 ± 70 g, P < 0.05, r = 0.6). The intra- and inter-observer variabilities were -0.6 to 1.0 mL and -0.7 to 1.6 mL, respectively (95% confidence intervals). ICC values were 0.981-0.999. The semi-automatic software allowed quantification of LE areas in all patients. The comparison of LE amount determined by semi-automatic software versus manual planimetry yielded an intra-observer variability ranging from -1.9 to 2.3 mL. CONCLUSION: Semi-automatic planimetry of patchy LE in patients with Fabry disease is feasible. The determined intra- and inter-observer variabilities for manual and semi-automatic planimetry were in the range of 20-40% of LE amount with high ICC values.

Model-based Acceleration of Parameter mapping (MAP) for saturation prepared radially acquired data.

A reconstruction technique called Model-based Acceleration of Parameter mapping (MAP) is presented allowing for quantification of longitudinal relaxation time and proton density from radial single-shot measurements after saturation recovery magnetization preparation. Using a mono-exponential model in image space, an iterative fitting algorithm is used to reconstruct one well resolved and consistent image for each of the projections acquired during the saturation recovery relaxation process. The functionality of the algorithm is examined in numerical simulations, phantom experiments, and in-vivo studies. MAP reconstructions of single-shot acquisitions feature the same image quality and resolution as fully sampled reference images in phantom and in-vivo studies. The longitudinal relaxation times obtained from the MAP reconstructions are in very good agreement with the reference values in numerical simulations as well as phantom and in-vivo measurements. Compared to available contrast manipulation techniques, no averaging of projections acquired at different time points of the relaxation process is required in MAP imaging. The proposed technique offers new ways of extracting quantitative information from single-shot measurements acquired after magnetization preparation. The reconstruction simultaneously yields images with high spatiotemporal resolution fully consistent with the acquired data as well as maps of the effective longitudinal relaxation parameter and the relative proton density.

Density weighted turbo spin echo imaging.

PURPOSE: To optimize the spatial response function (SRF) while maintaining optimal signal to noise ratio (SNR) in T2 weighted turbo spin echo (TSE) imaging by prospective density weighting. MATERIALS AND METHODS: Density weighting optimizes the SRF by sampling the k-space with variable density without the need of retrospective filtering, which would typically result in nonoptimal SNR. For TSE, the T2 decay needs to be considered when calculating an optimized sampling pattern. Simulations were carried out and T2 weighted in vivo TSE measurements were performed on a 3 Tesla MRI system. To evaluate the SNR, reversed centric density weighted and retrospectively filtered Cartesian acquisitions with identical measurement parameters and SRFs were compared with TE(eff) = 90 ms and a density weighted k-space sampling optimized to yield a Kaiser function for SRF side lobe suppression for white matter. RESULTS: Density weighting of a reversed centric reordering scheme resulted in an SNR increase of (43 ± 13)% compared with the Cartesian acquisition with retrospective filtering while maintaining comparable contrast behavior. CONCLUSION: Density weighting is applicable to TSE imaging and results in significantly increased SNR. The gain can be used to shorten the measurement time, which suggests applying density weighting in both time and SNR constrained MRI.

Percutaneous image-guided implantation of totally implantable venous access ports in the forearm or the chest? A patients' point of view.

PURPOSE: This study aimed to compare patients' satisfaction and impact on daily life after implantation of totally implantable venous access ports (TIVAP) in the forearm and the chest. METHODS: In this prospective study, 50 patients (mean age, 55.8 ± 15.4 years) received three questionnaires on days 1, 30, and 90 after implantation in the forearm (n = 25) or the chest (n = 25). Knowledge concerning device function, comfort perception, and impact of TIVAP on daily activities were evaluated. Ratings were dichotomized depending on whether statements were agreed with or contradicted. Fisher's exact test was used to determine differences between the forearm port (FP) and chest port (CP) groups. RESULTS: There was no significant difference between the two groups with regard to unpleasant feelings (p = 0.09) and discomfort while puncturing (p = 0.06). Main fears in both groups were dysfunction and infection. The possibility of high-pressure injections via the TIVAP was rated important in both groups. More CP patients feared dislocation of their TIVAP during sleep (p < 0.05). CP patients experienced more negative perceptions while driving a car and wearing brassieres (p < 0.05) than FP patients. All patients would recommend their device. CONCLUSIONS: During certain activities, the FP device seems to be favorable, since it causes less discomfort than the CP.

Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI.

BACKGROUND: Small-bowel MRI based on contrast-enhanced T1-weighted sequences has been challenged by diffusion-weighted imaging (DWI) for detection of inflammatory bowel lesions and complications in patients with Crohn disease. OBJECTIVE: To evaluate free-breathing DWI, as compared to contrast-enhanced MRI, in children, adolescents and young adults with Crohn disease. MATERIALS AND METHODS: This retrospective study included 33 children and young adults with Crohn disease ages 17 ± 3 years (mean ± standard deviation) and 27 matched controls who underwent small-bowel MRI with contrast-enhanced T1-weighted sequences and DWI at 1.5 T. The detectability of Crohn manifestations was determined. Concurrent colonoscopy as reference was available in two-thirds of the children with Crohn disease. RESULTS: DWI and contrast-enhanced MRI correctly identified 32 and 31 patients, respectively. All 22 small-bowel lesions and all Crohn complications were detected. False-positive findings (two on DWI, one on contrast-enhanced MRI), compared to colonoscopy, were a result of large-bowel lumen collapse. Inflammatory wall thickening was comparable on DWI and contrast-enhanced MRI. DWI was superior to contrast-enhanced MRI for detection of lesions in 27% of the assessed bowel segments and equal to contrast-enhanced MRI in 71% of segments. CONCLUSION: DWI facilitates fast, accurate and comprehensive workup in Crohn disease without the need for intravenous administration of contrast medium. Contrast-enhanced MRI is superior in terms of spatial resolution and multiplanar acquisition.

Interplatform reproducibility of CT coronary calcium scoring software.

PURPOSE: To investigate whether coronary artery calcium (CAC) scoring performed on three different workstations generates comparable and thus vendor-independent results. MATERIALS AND METHODS: Institutional review board and Federal Office for Radiation Protection approval were received, as was each patient's written informed consent. Fifty-nine patients (37 men, 22 women; mean age, 57 years±3 [standard deviation]) underwent CAC scoring with use of 64-section multidetector computed tomography (CT) with retrospective electrocardiographic gating (one examination per patient). Data sets were created at 10% increments of the R-R interval from 40%-80%. Two experienced observers in consensus calculated Agatston and volume scores for all data sets by using the calcium scoring software of three different workstations. Comparative analysis of CAC scores between the workstations was performed by using regression analysis, Spearman rank correlation (rs), and the Kruskal-Wallis test. RESULTS: Each workstation produced different absolute numeric results for Agatston and volume scores. However, statistical analysis revealed excellent correlation between the workstations, with highest correlation at 60% of the R-R interval (minimal rs=0.998; maximal rs=0.999) for both scoring methods. No significant differences were detected for Agatston and volume score results between the software platforms. At analysis of individual reconstruction intervals, each workstation demonstrated the same score variability, with the consequence that 12 of 59 patients were assigned to divergent cardiac risk groups by using at least one of the workstations. CONCLUSION: While mere numeric values might be different, commercially available software platforms produce comparable CAC scoring results, which suggests a vendor-independence of the method; however, none of the analyzed software platforms appears to provide a distinct advantage for risk stratification, as the variability of CAC scores depending on the reconstruction interval persists across platforms.

SAR-reduced spin-echo-based Bloch-Siegert B(1)(+) mapping: BS-SE-BURST.

Fast and accurate B(1)(+) mapping is possible using phase-based Bloch-Siegert (BS) methods. Importantly, the off-resonant pulses needed for BS B(1)(+) mapping methods can easily be implemented in multiple MR sequences. BS-based B(1)(+) mapping has thus been introduced for gradient echo (BS-FLASH), spin-echo (BS-SE), and Carr, Purcell, Meiboom, Gill (CPMG)-based multi-SE and turbo-SE sequences. When using SE and multi-SE/turbo-SE-based BS sequences, however, the high intrinsic specific absorption rates must be considered in clinical situations. This study introduces a fast BS B(1)(+) mapping method based on a SE-BURST sequence (BS-SE-BURST). With SE-BURST sequences, multiple low-magnitude excitation pulses are applied prior to the refocusing pulse. Thus, multiple and different phase-encoded echoes can be acquired per excitation cycle. Compared with a SE sequence, this excitation strategy results in a similar signal-to-noise ratio (SNR) per unit time but with reduced specific absorption rate. The proposed BS-SE-BURST sequence was implemented on a conventional 3 T whole body MRI scanner and applied successfully.

Resolution evaluation of MR images reconstructed by iterative thresholding algorithms for compressed sensing.

PURPOSE: Magnetic resonance imaging systems usually feature linear and shift-invariant (stationary) transform characteristics. The point spread function or equivalently the modulation transfer function may thus be used for an objective quality assessment of imaging modalities. The recently introduced theory of compressed sensing, however, incorporates nonlinear and nonstationary reconstruction algorithms into the magnetic resonance imaging process which prohibits the usage of the classical point spread function and therefore the according evaluation. METHODS: In this work, a local point spread function concept was applied to assess the quality of magnetic resonance images which were reconstructed by an iterative soft thresholding algorithm for compressed sensing. The width of the main lobe of the local point spread function was used to perform studies on the spatial and temporal resolution properties of both numerical phantom and in vivo images. The impact of k-space sampling patterns as well as additional sparsifying transforms on the local spatial image resolution was investigated. In addition, the local temporal resolution of image series, which were reconstructed by exploiting spatiotemporal sparsity, was determined. Finally, the dependency of the local resolution on the thresholding parameter of the algorithm was examined. RESULTS: The sampling patterns as well as the additional sparsifying transform showed a distinct impact on the local image resolution of the phantom image. The reconstructions, which were using x-f-space as a sparse transform domain showed slight temporal blurring for dynamic parts of the imaged object. The local image resolution had a dependence on the thresholding parameter, which allowed for optimizing the reconstruction. CONCLUSIONS: Local point spread functions enable the evaluation of the local spatial and temporal resolution of images reconstructed with the nonlinear and nonstationary iterative soft thresholding algorithm. By determining the influence of thresholding parameter and sampling pattern chosen on this model-based reconstruction, the method allows selecting appropriate acquisition parameters and thus improving the results.

Endovascular treatment of popliteal artery segments P1 and P2 in patients with critical limb ischemia: initial experience using a helical nitinol stent with increased radial force.

PURPOSE: To evaluate efficacy, safety, and midterm patency of a helical, self-expanding nitinol stent after failed percutaneous transluminal angioplasty (PTA) of popliteal artery segments P1 and P2 in patients with chronic critical limb ischemia (CLI) or lifestyle-limiting claudication. METHODS: Between February 2009 and March 2011, 40 patients (23 men; mean age 77±10 years) classified as Rutherford category 3 (n = 10) or 4/5 (n = 30) underwent PTA of the proximal and mid popliteal artery followed by implantation of a SUPERA stent for elastic recoil, residual stenosis, or flow-limiting dissection. All patients had an elevated operative risk. Before and after the procedure and during the 12-month follow-up, a clinical investigation, ankle-brachial-index (ABI) measurement, and color-coded duplex sonography and/or digital subtraction angiography were performed. Primary endpoints were limb salvage and anatomical patency at 12 months. RESULTS: Stent implantation was successful in all patients. The major complication rate was 7.5% (an access-site pseudoaneurysm, 2 retroperitoneal hematomas, and 1 death from retroperitoneal bleeding). Mean follow-up was 15.9 months (range 0.5-27.9). The mean baseline ABI of 0.37 significantly increased to 0.91 at 12 months (p<0.01). Three (7.5%) patients underwent bypass surgery owing to lack of clinical improvement (<0.10 improvement in ABI). Primary and secondary patency rates at 12 months in the 34 patients eligible for follow-up were 68.4% and 79.8%, respectively. The major amputation rate was 5% at 1 year. Five (12.5%) in-stent stenoses and 1 of 2 (5.0%) in-stent occlusions were successfully recanalized (the second occlusion was asymptomatic). CONCLUSION: Implantation of this helical stent into segments of the popliteal artery at the knee joint in CLI patients is a safe and clinically effective bailout method with acceptable intermediate patency.

Acute thromboembolic occlusion of the superior mesenteric artery following covered stent occlusion in the superior mesenteric artery: endovascular therapy using mechanical rotational thrombectomy.

Acute thromboembolic occlusion of the superior mesenteric artery is a rare and often fatal condition in which surgery represents the golden standard in therapy. We present a case in which a patient was treated with covered stent implantation for acute bleeding from the superior mesenteric artery following pancreatic resection, radiation, and embolization of a hepatic artery pseudoaneurysm. Some weeks later clinical signs were suggestive of acute thromboembolic occlusion of the superior mesenteric artery and digital subtraction angiography showed occlusion of the previously implanted covered stents. The patient was successfully treated transfemorally with percutaneous mechanical instent thrombectomy using a 6F Rotarex® catheter. We conclude that in selected cases percutaneous mechanical thrombectomy may represent a minimally-invasive alternative to open surgical thrombectomy for treatment of acute thromboembolic occlusion of the superior mesenteric artery.

CAIPIRINHA accelerated SSFP imaging.

Exciting multiple slices at the same time, "controlled aliasing in parallel imaging results in higher acceleration" (CAIPIRINHA) and "phase-offset multiplanar" have shown to be very effective techniques in 2D multislice imaging. Being provided with individual rf phase cycles, the simultaneously excited slices are shifted with respect to each other in the FOV and, thus, can be easily separated. For SSFP sequences, however, similar rf phase cycles are required to maintain the steady state, impeding a straightforward application of phase-offset multiplanar or controlled aliasing in parallel imaging results in higher acceleration. In this work, a new flexible concept for applying the two multislice imaging techniques to SSFP sequences is presented. Linear rf phase cycles are introduced providing both in one, the required shift between the slices and steady state in each slice throughout the whole measurement. Consequently, the concept is also appropriate for real-time and magnetization prepared imaging. Steady state properties and shifted banding behavior of the new phase cycles were investigated using simulations and phantom experiments. Moreover, the concept was applied to perform whole heart myocardial perfusion SSFP imaging as well as real-time and cine SSFP imaging with increased coverage. Showing no significant penalties in SNR or image quality, the results successfully demonstrate the general applicability of the concept.

Optimized density-weighted imaging for dynamic contrast-enhanced 3D-MR mammography.

PURPOSE: To increase the spatial coverage and to reduce slice crosstalk combined with an optimal signal-to-noise ratio (SNR) in 3D dynamic contrast-enhanced (DCE) magnetic resonance (MR) mammography. MATERIALS AND METHODS: Asymmetric sampling schemes and a new reconstruction strategy based on virtual coils are presented for density-weighted (DW) 3D imaging. Additionally, for MR mammography an alternating DW (ADW) sampling along the k(y) direction shifts the undersampling artifacts out of the signal reception region. Virtual coils for effective DW (VIDED) imaging suppresses the aliasing in undersampled DW imaging. VIDED and ADW were compared to the conventional Cartesian imaging in phantom and in vivo MR mammography studies. RESULTS: The slice crosstalk was significantly reduced by VIDED and compared to Cartesian imaging the SNR increased by 16%. Additionally, VIDED and ADW provided a substantially increased field of view (FOV) in the slice direction and allowed the spatial resolution to be improved (up to 60% for ADW and 30% for VIDED) without lengthening the scan time. CONCLUSION: VIDED and ADW improve the image quality in 3D DCE MR mammography by enhancing the spatial resolution, reducing the slice crosstalk at nearly optimal SNR, and increasing the FOV in the slice direction. For VIDED no lengthening of the scan time or usage of multichannel receiver coils is necessary.

Comparison of intravascular and extracellular contrast media for absolute quantification of myocardial rest-perfusion using high-resolution MRI.

PURPOSE: To use the contrast agent gadofosveset for absolute quantification of myocardial perfusion and compare it with gadobenate dimeglumine (Gd-BOPTA) using a high-resolution generalized autocalibrating partially parallel acquisition (GRAPPA) sequence. MATERIALS AND METHODS: Ten healthy volunteers were examined twice at two different dates with a first-pass perfusion examination at rest using prebolus technique. We used a 1.5 T scanner and a 32 channel heart-array coil with a steady-state free precession (SSFP) true fast imaging with steady state precession (trueFISP) GRAPPA sequence (acceleration-factor 3). Manual delineation of the myocardial contours was performed and absolute quantification was performed after baseline and contamination correction. At the first appointment, 1cc/4cc of the extracellular contrast agent Gd-BOPTA were administered, on the second date, 1cc/4cc of the blood pool contrast agent (CA) gadofosveset. At each date the examination was repeated after a 15-minute time interval. RESULTS: Using gadofosveset perfusion the value (in cc/g/min) at rest was 0.66 ± 0.25 (mean ± standard deviation) for the first, and 0.55 ± 0.24 for the second CA application; for Gd-BOPTA it was 0.62 ± 0.25 and 0.45 ± 0.23. No significant difference was found between the acquired perfusion values. The apparent mean residence time in the myocardium was 23 seconds for gadofosveset and 19.5 seconds for Gd-BOPTA. Neither signal-to-noise ratio (SNR) nor subjectively rated image contrast showed a significant difference. CONCLUSION: The application of gadofosveset for an absolute quantification of myocardial perfusion is possible. Yet the acquired perfusion values show no significant differences to those determined with Gd-BOPTA, maintained the same SNR and comparable perfusion values, and did not picture the expected concentration time-course for an intravasal CA in the first pass.

Remodeling of the infarct territory in the time course of infarct healing in humans.

OBJECT: To analyze the remodeling processes of the infarct territory in the time course of infarct healing. MATERIALS AND METHODS: Serial late enhancement (LE) studies were performed in 30 patients following reperfused myocardial infarction (MI) in the first and second week post-MI and after 3 months. To characterize infarct remodeling over time, the following variables were derived and analyzed in a blinded fashion: Infarct size (IS, in mm(3)), maximum infarct thickness (IT(max), mm), mean infarct thickness (IT(mean), mm) and the variability of infarct thickness (VIT=IT(max)/IT(mean)). Further, a new parameter for the assessment of infarct remodeling, the infarct extent (IE, mm(2)) was computed. IE quantifies IS in two dimensions along the heart's circumferential and longitudinal directions. IS was divided by the IE to obtain IT(mean). RESULTS: Overall infarct thickness was highly variable. Infarct shrinkage due to infarct thinning and IE reduction was found in the first months of healing. IS, IT(mean) and IT(max) significantly decreased during follow-up. There was a less consistent change of the IE: IE decreased in 75% of all infarcts from the first week up to 3 months post-MI, whereas 25% of infarcts expanded. Infarct thinning was found in almost all patients (92%), hence occurring in patients with infarct expansion and in patients without infarct expansion. CONCLUSION: Infarct thinning and-to a lesser extent-IE reduction, contribute to infarct shrinkage in the time course of infarct healing. Infarct thinning may occur without infarct expansion.

Feasibility of power contrast injections and bolus triggering during CT scans in oncologic patients with totally implantable venous access ports of the forearm.

BACKGROUND: Conventional totally implantable venous access ports (TIVAPs) are not approved for power contrast injections but often remain the only venous access site in oncologic patients. Therefore, these devices can play an important role if patients with a TIVAP are scheduled for a contrast-enhanced computed tomography (ceCT) as vascular access may become more difficult during the course of chemotherapy. PURPOSE: To evaluate the feasibility and safety of power injections in conventional TIVAPs in the forearm and to analyze the feasibility of bolus triggering during CT scans. MATERIAL AND METHODS: In this retrospective study we analyzed 177 power injections in 141 patients with TIVAPs in the forearm. Between October 2008 and March 2010 all patients underwent power injections (1.5 mL/s, 150 psi) via the TIVAP for ceCT because conventional vascular access via a peripheral vein had failed. Adequate functioning and catheter's tip location after injection were evaluated. Peak injection pressure and attenuation levels of aorta, liver and spleen were analyzed and compared with results of 50 patients who were injected via classical peripheral cannulas (3 mL/s, 300 psi). Feasibility of automatic scan initiation was evaluated. In vitro the port was stressed with 5 mL/s (300 psi). RESULTS: One TIVAP showed tip dislocation with catheter rupture. Three (2.1%) devices were explanted owing to assumed infection within 4 weeks after the injection. Mean injection pressure was 121.9 +/-24.1 psi. Triggering with automatic scan initiation succeeded in 13/44 (29.6%) scans. Injection via classical cannulas resulted in significantly higher enhancement (p < 0.05). In vitro the port system tolerated flow rates of up to 5 mL/s, injection pressures of up to 338 psi. CONCLUSION: Power injection is a safe alternative for patients with TIVAPs in the forearm if classic vascular access ultimately fails. Triggering was successful in one-third of the attempts. Image quality in the arterial phase scan may be hampered. In vitro results suggest that the device tolerates even higher flow rates.

Optimizing of preoperative computed tomography for diagnosis in patients with peritoneal carcinomatosis.

BACKGROUND AND OBJECTIVE: This study evaluates whether Computer Tomography is an effective procedure for preoperative staging of patients with Peritoneal Carcinomatosis. METHOD: A sample of 37 patients was analyzed with contrast enhanced abdominal Computer Tomography, followed by surgical staging. All Computer Tomography scans were evaluated 3 times by 2 radiologists with one radiologist reviewing 2 times. The efficacy of Computer Tomography was evaluated using the Spearman correlation coefficient. Correlations were analyzed by abdominopelvic region to assess results of the Peritoneal Carcinomatosis Index (PCI) aggregating the 13 regions. Surgical findings were compared to radiological findings. RESULTS: Results indicate high correlations between the surgical and radiological Peritoneal Carcinomatosis Indices. Analyses of the intra-class correlation between the first and second reading of one radiologist suggest high intra-observer reliability. Correlations by abdominopelvic region show higher values in the upper and middle regions and relatively lower values in the lower regions and the small bowel (correlation coefficients range between 0.418 and 0.726, p < 0.010; sensitivities range between 50% and 96%; and specificities range between 62% and 100%). CONCLUSION: Computer Tomography represents an effective procedure in the preoperative staging of patients with PC. However, results by abdominopelvic region show lower correlation, therefore suggest lower efficacy. These results are supported by analyses of sensitivity and accuracy by lesion size. This suggests that Computer Tomography is an effective procedure for pre-operative staging but less for determining a tumor's accurate extent.