A simple method to estimate the optimum iodine concentration of contrast material through microcatheters: hydrodynamic calculation with spreadsheet software.

It is important to increase the iodine delivery rate (I), that is the iodine concentration of the contrast material (C) x the flow rate of the contrast material (Q), through microcatheters to obtain arteriograms of the highest contrast. It is known that C is an important factor that influences I. The purpose of this study is to establish a method of hydrodynamic calculation of the optimum iodine concentration (i.e., the iodine concentration at which I becomes maximum) of the contrast material and its flow rate through commercially available microcatheters. Iopamidol, ioversol and iohexol of ten iodine concentrations were used. Iodine delivery rates (I meas) of each contrast material through ten microcatheters were measured. The calculated iodine delivery rate (I cal) and calculated optimum iodine concentration (calculated C opt) were obtained with spreadsheet software. The agreement between I cal and I meas was studied by correlation and logarithmic Bland-Altman analyses. The value of the calculated C opt was within the optimum range of iodine concentrations (i.e. the range of iodine concentrations at which I meas becomes 90% or more of the maximum) in all cases. A good correlation between I cal and I meas (I cal = 1.08 I meas, r = 0.99) was observed. Logarithmic Bland-Altman analysis showed that the 95% confidence interval of I cal/I meas was between 0.82 and 1.29. In conclusion, hydrodynamic calculation with spreadsheet software is an accurate, generally applicable and cost-saving method to estimate the value of the optimum iodine concentration and its flow rate through microcatheters.

Accuracy of attenuation measurement of vascular wall in vitro on computed tomography angiography: Effect of wall thickness, density of contrast medium, and measurement point.

OBJECTIVES: We sought to assess the effects of measurement point, wall thickness, and intravascular density of contrast material on attenuation measurement of vascular wall. MATERIALS AND METHODS: We used vascular models (actual attenuation value of the wall: 83 HU) with wall thicknesses of 1.5, 1.0, or 0.5 mm, filled with contrast material of 254, 325, or 400 HU. The 9 vascular models were fixed in an oil-filled container and scanned with a 16-detector computed tomography. The wall attenuation values were measured at 1 point for 0.5-mm thickness models, 3 for 1.0-mm thickness models, and 5 for 1.5-mm thickness models with the same interval of 0.25 mm. Total 20 measurements were done for each point. RESULTS: For 1.0-mm and 1.5-mm thickness models, wall attenuation progressively increased as the measurement points approached the lumen (P < 0.0001). At all the measurement points for 0.5-mm and 1.0-mm thickness models and the 2 inner measurement points for 1.5-mm thickness models, the densities of contrast material affected the wall attenuations significantly (P < 0.0001). At the midportion for 1.5-mm thickness models, the wall attenuations were not affected by the densities of the contrast material (P = 0.6301), and were 65-68 HU. CONCLUSIONS: The effects of the intravascular density of contrast material, measurement point, and wall thickness should be considered in the attenuation measurement of the wall.

Optimum iodine concentration of contrast material through microcatheters: hydrodynamic analysis of experimental results.

It is important to increase the iodine delivery rate (I), that is the iodine concentration of the contrast material (C) x the flow rate of the contrast material (Q), through a catheter to obtain high quality arteriograms. The iodine delivery rate varies depending on the iodine concentration of the contrast material. The purpose of this study is to estimate the optimum iodine concentration (Copt) of contrast material (i.e. the iodine concentration at which I becomes maximum) through a microcatheter of a given length (L), inner diameter (D) and injection pressure (P). Iohexol, ioversol and iopamidol of 11-12 iodine concentrations (140-350, 160-350 or 160-370 mg cm(-3)) at 37 degrees C are used. I and Reynolds number (Re) of the flow of each contrast material through four microcatheters (0.49-0.68 mm in inner diameter, 1000-1500 mm in length) at injection pressures of 1.38, 2.76, 4.14 and 5.52 x 10(6) Pa (200, 400, 600 and 800 pounds per square inch) are obtained experimentally. The relationships between I and C and between I and Re are examined for each catheter and injection pressure. Copt is 160-280 mg cm(-3) for iohexol, 180-280 mg cm(-3) for ioversol and 200-300 mg cm(-3) for iopamidol. I becomes maximum when Re approximates the critical Reynolds number (Re approximately 2300). Utilizing this principle, we can estimate Copt and its flow rate through a microcatheter of a given L, D and P.

The role of iodine-123-labeled 15-(p-iodophenyl)-3R,S-methylpentadecanoic acid scintigraphy in the detection of local myocardial involvement of sarcoidosis.

PURPOSE: The purpose of this study is to examine the role of Iodine-123-labeled 15-(p-iodophenyl)-3R,S-methylpentadecanoic acid (BMIPP) scintigraphy in patients with cardiac sarcoidosis. METHODS AND MATERIALS: Study materials were six patients with pathologically proven cardiac sarcoidosis. BMIPP and resting Thallium-201 (201Tl) myocardial scintigraphy, echocardiography, were performed within 22 days in each patient. RESULTS: Myocardium was divided into nine areas per one case. A total of 24 areas had involvement by sarcoidosis. A total of 18 areas with defects of BMIPP accumulation and 14 areas with defects of 201Tl accumulation were detected. A total of 12 areas were determined as showing reduced wall motion. The sensitivity, specificity, positive and negative predictive values of wall motion abnormality for the detection of myocardial involvement were 50%, 100%, 100% and 71%. The sensitivities of BMIPP and 201Tl scintigraphy for the detection of local myocardial involvement were 75% and 58%. The specificities of BMIPP and 201Tl scintigraphy were both 100%. The positive predictive values of BMIPP and 201Tl scintigraphy were both 100%. The negative predictive values of BMIPP and 201Tl scintigraphy were 83% and 75%. CONCLUSION: BMIPP scintigraphy was more sensitive and had a higher negative predictive value compared to 201Tl scintigraphy and echocardiography for the detection of myocardial involvement of sarcoidosis.

Assessment of coronary stent in vitro on multislice computed tomography angiography: improved in-stent visibility by the use of 140-kV tube voltage.

OBJECTIVE: To assess the effect of tube voltage on the in-stent visibility of coronary stents in vitro on computed tomography (CT) angiography. METHODS: A total of 6 vascular models (3 models without stenosis and 3 with stenosis) using 3 kinds of stent (Bx Velocity, Express2, and Driver) with an inner diameter of approximately 3.5 mm and filled with contrast material (CT attenuation, 450 Hounsfield units) were scanned by means of a 16-detector row CT. We assessed the visual stenosis evaluation and inhomogeneity of stent lumen in 4 orientations (0-, 30-, 60-, and 90-degree angles) relative to the z-axis of the scanner using 3 imaging techniques (120-kV tube voltage using a medium convolution kernel, 120-kV tube voltage using a convolution kernel for bone, and 140-kV tube voltage using a convolution kernel for bone). Statistical analysis involved F test with a statistical significance of P < 0.05. RESULTS: The convolution kernel for bone made it easier to evaluate the stenosis inside the stents, although it increased the luminal inhomogeneity significantly (Bx Velocity and Express2, P < 0.005; Driver, P < 0.05). The luminal inhomogeneity tended to increase as the strut diameter and the weight per unit length increased. Using 120-kV tube voltage, the luminal inhomogeneity inside the stents was at the minimum in the angle of 0 degree relative to the z-axis, and at the maximum in the angle of 90 degrees, except for Driver. The 140-kV tube voltage was effective for the improvement of luminal inhomogeneity and visibility of in-stent stenosis compared with the 120-kV tube voltage. CONCLUSIONS: The in-stent visibility of coronary stents on CT angiography can be improved by the use of 140-kV tube voltage with the convolution kernel for bone.

Accuracy and efficiency of left ventricular ejection fraction analysis, using multidetector row computed tomography: effect of image reconstruction window within cardiac phase, slice thickness, and interval of short-axis sections.

BACKGROUND: The aim of the present study was to assess the accuracy and efficiency of left ventricular ejection fraction (LVEF) analysis by multidetector row computed tomography (CT). METHODS AND RESULTS: The CT data of 21 patients were analyzed by semi-automated software on a workstation. In analysis of LVEF using systolic volumes in the 6 phases (30-55%), systolic images of 10% interval (35, 45, 55%) were underestimated with a mean measurement error of -0.4% and the standard error of the estimate (SEE) of 0.6%, compared with the LVEF using images of 5% interval. In analysis of LVEF using 3-slice thicknesses of axial images (1, 2, and 3 mm), and 3-slice numbers of short-axis sections (10 14, and 30 slices), there was no significant difference between the SEE of the intraobserver reproducibility and that of the analysis with 30 short-axis sections using axial images of 1-, 2- and 3-mm thickness, and that with 14 short-axis sections using axial images of 1- and 2-mm thickness. The mean analysis times were 96.9 s, 119.8 s, and 227.0 s for the analysis with 10, 14, and 30 short-axis sections, respectively. CONCLUSION: The proper selection of the reconstruction interval in the cardiac phase, the slice thickness of the axial images, and the number of short-axis sections reduces the analysis time, maintaining the accuracy of LVEF analysis. This will be acceptable for practical use at present, although more accurate analysis is preferable.

Evaluation of coronary stents in vitro with CT angiography: effect of stent diameter, convolution kernel, and vessel orientation to the z-axis.

BACKGROUND: The aims of the present study were to assess the effect of the stent diameter, convolution kernel, and vessel orientation to the z-axis on the evaluation of coronary stents, in vitro with computed tomography (CT) angiography. METHODS AND RESULTS: Seven vascular models (2 models without stenosis, 2 with obstruction, and 3 with stenosis) with an approximate inner diameter of 3 or 4 mm, filled with contrast material (79 or 330 HU) were scanned with a 16-detector CT. The diameter measurement of the stent lumen and stenosis evaluation were both done in an orientation parallel to the z-axis of the scanner using 4 convolution kernels. The measured diameters of the stented lumen were 47-57% and 36-45% smaller than the actual inner diameter of the 3- and 4-mm diameter models, respectively. The diameter measurement of the stent lumen and visualization of the in-stent stenosis were improved by using convolution kernels with higher spatial resolution. The in-stent artifacts were evaluated in 4 orientations (0 degrees , 30 degrees , 60 degrees , 90 degrees ) to the z-axis. The artifact was the minimum in 0 degrees to the z-axis, and the maximum in 90 degrees . CONCLUSION: Visualization of the lumen of a stent by CT is affected by its diameter, convolution kernel, and vessel orientation to the z-axis, and these factors should be taken into consideration in the stent evaluation.

Radiation dose to patients and radiologists during transcatheter arterial embolization: comparison of a digital flat-panel system and conventional unit.

OBJECTIVE: The objective of our study was to evaluate the exposure doses to patients and radiologists during transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) using a new angiographic unit with a digital flat-panel system. SUBJECTS AND METHODS: Doses were assessed for 24 procedures: 12 using a new unit with a digital flat-panel system and 12 using a conventional unit. Doses to patients' skin were evaluated with thermoluminescent dosimeters behind the left, middle, and right portions of the liver. The doses to the radiologists were measured by an electronic personal dosimeter placed on the chest outside a lead protector. The maximal skin doses to the patients and the dose equivalents, Hp(0.07), to the radiologists were compared between the two procedure groups with each angiographic unit. RESULTS: For procedures with the new unit, the mean maximal skin dose to the patients was 284 +/- 127 (SD) mGy (range, 130-467 mGy), and Hp(0.07) to the radiologists was 62.8 +/- 17.4 muSv. For procedures with the conventional unit, the maximal skin dose to the patients was 1,068 +/- 439 mGy (range, 510-1,882 mGy), and Hp(0.07) to the radiologists was 68.4 +/- 25.7 muSv. The maximal skin dose to the patients was significantly lower with the new unit than with the conventional unit (p < 0.0005). There was no significant difference in the Hp(0.07) to the radiologists between the two procedure groups. CONCLUSION: The new digital flat-panel system for angiographic imaging can reduce the radiation dose to patients' skin during TAE for HCC as compared with the conventional system.

Measurement of vascular diameter in vitro by automated software for CT angiography: effects of inner diameter, density of contrast medium, and convolution kernel.

OBJECTIVE: This investigation was performed to evaluate the accuracy of diameter measurement of vessels in vitro by automated software for CT angiography. MATERIALS AND METHODS: Vascular models with three inner diameters ( approximately 3, 4, and 6 mm) filled with contrast medium of three different densities ( approximately 460, 350, and 210 H) were scanned with helical CT. Five convolution kernels (soft, standard, detail, bone, and lung) were used. We evaluated the measurement error, defined as the difference between the diameter measured by the automated software and the true inner diameter of the vascular model. Statistical analysis involved three-way analysis of variance with repeated measures. RESULTS: Significant differences occurred in measurement error among the three vascular model inner diameters, among the three densities of intravascular contrast medium, and among the five convolution kernels (p < 0.01). In all the convolution kernels except lung, measurement errors progressively decreased with higher densities of intravascular contrast medium (p < 0.01). In vascular models filled with contrast medium of 350 H, measurement errors were significantly smaller in soft (mean +/- standard deviation [SD], 0.29 +/- 0.16 mm) and bone (0.23 +/- 0.05 mm) than in other convolution kernels (p < 0.01). CONCLUSION: The accuracy of diameter measurement was affected by the vascular model inner diameter, the density of contrast medium, and the convolution kernel. A higher density of intravascular contrast medium and selection of the proper convolution kernel will improve accuracy.

[A case of adenomyosis showing multiple large cysts on MR imaging].

Adenomyosis is a condition characterized by benign invasion of the endometrium into the myometrium associated with reactive hypertrophy of the surrounding musculature. The ectopic endometrium in adenomyosis is of the basalis type, and menstrual bleeding is less common than in endometriosis. We report a rare case of adenomyosis that had multiple, large, adenomyotic cysts. These cysts were located in the outer layer of adenomyosis on MR imaging. Pathologic features consisted of blood-filled cysts of 1 cm to 5 cm in maximum diameter of the functioning endometrial type.

[Accuracy of diameter measurement in vitro using automated software for CT angiography: effect of convolution kernels].

The purpose of this study was to evaluate the accuracy of diameter measurement in vitro using automated software for CT angiography with five convolution kernels. Vascular models with three diameters (about 3, 5, and 8 mm) in three materials (water, oil, and air) were scanned by helical CT. Five convolution kernels were used for reconstruction. The accuracy of diameter measurement was affected by the diameter of the vascular model, material around the model, and convolution kernels. Selection of the proper convolution kernels may improve accuracy.

Effect of superparamagnetic iron oxide-enhanced MRI of the liver with hepatocellular carcinoma and hyperplastic nodule.

PURPOSE: To evaluate the possibility of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) of the liver in predicting the histologic grade of hepatocellular carcinoma (HCC) and differentiating HCC from benign hyperplastic nodule (HPN). MATERIALS AND METHODS: Thirty patients with 31 histologically proved HCC and HPN underwent MRI (1.5 Tesla). HCCs were graded into well-differentiated HCC (HCCw; n = 10) and moderately to poorly differentiated HCC (HCCmp; n = 15). HPN was categorized into dysplastic nodule (DN; n = 1) and focal nodular hyperplasia (FNH; n = 6). T2-weighted fast spin echo images were obtained before and after administration of SPIO. Signal-to-noise ratios (SNR) of the lesion and surrounding liver parenchyma and contrast-to-noise ratios (CNR) were calculated pre- and postcontrast study. Relative enhancement ratios (RER), also known as signal intensity reduction ratios of the lesions, were also calculated. RESULTS: HCCw, HCCmp, DN, and FNH decreased in SNR after injection of SPIO. RER of HCCw was 19.5 +/- 13.3%, that of HCCmp was 6.8 +/- 5.8%, DN was 44.0%, and FNH was 42.9 +/- 4.8%. Significant statistical differences were seen between HCCw and HCCmp and HCC and HPN in RER. HCCw, HCCmp, and DN increased in CNR, and FNH decreased in CNR, but no lesion showed a statistically significant difference in CNR. CONCLUSION: SPIO-enhanced MR images may help to predict the histologic grade of HCC and distinguish HCC from HPN.