On the appearance of bile in clinical MR cholangiopancreatography.

PURPOSE: To study the appearance of bile in clinical MR cholangiopancreatography (MRCP) with special reference to its chemical and physical properties. MATERIAL AND METHODS: Gallbladder bile was collected during surgery from 38 patients and studied with respect to chemical constituents. The relaxation rates 1/T1 and 1/T2 of bile were also determined in vitro. In 16 of these 38 patients, abdominal imaging was performed using MRCP as well as T1-weighted GE sequences. RESULTS: For 9 of the 13 chemical parameters studied, a positive significant correlation with 1/T1 as well as 1/T2 was found. The median relaxation rates 1/T1 and 1/T2 were 0.76 and 1.48 s-1, respectively. The corresponding ranges were 0.38-3.13 s-1 and 0.70-5.75 s-1, respectively. On the MRCP images a few patients showed gallbladder of poor visibility due to low signal-to-noise ratio. This coincided with a high relaxation rate 1/T2 of bile. On the T1-weighted GE sequences a few patients showed hyperintense gallbladder relative to liver, coinciding with high relaxation rates 1/T1 of bile. CONCLUSION: Bile was found to show a large interindividual variation with respect to relaxation rates 1/T1 and 1/T2. The relaxation rates increased with increasing amounts of substances in the bile. For some patients (11%) MRCP imaging is unsuccessful due to high relaxation rate of bile.

A multidimensional partition analysis of SSFP image pulse sequences.

The k-space description, of MRI pulse sequences, has been combined with a partition model in order to model the image reconstruction and the contrast behaviour found in SSFP pulse sequences. A partition represents the magnetisation created, due to excitation by a given rf pulse. In the present model, it is visualised as a set of parameters rather than a vector sum taken over a collection of spins. A multidimensional parameter space, where each dimension is associated with one of the partition parameters, is introduced in order to describe the interaction between partitions and pulse sequence events (e.g., rf pulses and gradients). The three k-space dimensions form the first three dimensions and higher orders are used to handle phase dispersions due to diffusion and main field inhomogeneities. The model makes it possible to perform fast simulation of images resulting from general SSFP pulse sequences. A computer implementation generates images (256 matrix), containing more than 10 different T1/T2 combinations, in less than 45 s on a 120 MHz Pentium computer. The contrast behaviour and signal intensities found in simulated images show excellent agreement with data generated using a clinical MRI scanner system.

Dosimeter gel and MR imaging for verification of calculated dose distributions in clinical radiation therapy.

A dosimeter gel, based on an agarose gel infused with a ferrous sulphate solution and evaluated in a magnetic resonance scanner, was used for complete verification of calculated dose distributions. Two standard treatment procedures, treatment of cancer in the urinary bladder and treatment of breast cancer after modified radical mastectomy, were examined using pixel-by-pixel and dose volume histogram comparison. The dose distributions calculated with the dose planning system was in very good agreement with the measured ones. However, in the case of the more complicated breast cancer treatment, some discrepancies were found, mainly at the beam abutment region. This may be explained by field displacements errors and by a small limitation of the dose planning utilising small electron beams in this region. The dosimeter gel system have proven to be a useful tool for dosimetry in clinical radiation therapy applications.

The physical performance of different x-ray contrast agents: calculations using a Monte Carlo model of the imaging chain.

A Monte Carlo computational model of the imaging chain has been used to investigate the performance of x-ray contrast agents with atomic number, Z, 53 < or = Z < or = 90 with respect to physical image quality descriptors (contrast and signal to noise ratio, SNR) and patient mean absorbed dose. Contrast agents of equal molar concentrations were used within a water slab (simulating the patient). The imaging conditions were chosen to represent adult and paediatric examinations. For all tube potentials studied (40-140 kV), the contrast agents with the highest atomic numbers (bismuth and thorium) gave the highest contrast. In analogue screen-film imaging, several other contrast agents could produce a higher image contrast than iodine in a limited range of tube potentials. This advantage could alternatively be effected as a reduced amount of administered contrast agent, or as a reduced mean absorbed dose in the patient. In digital imaging, a lower mean absorbed dose for a constant SNR than that with iodine can be achieved for ranges of tube potentials and contrast agents. Bismuth and thorium yield a lower dose than iodine at all studied tube potentials. Gadolinium and erbium could alternatively be used at a broad range of tube potentials above 90 kV with a dose penalty of only 5-20%.

MRI simulation using the k-space formalism.

An MRI simulation method, together with a corresponding computer program, using the k-space formalism has been developed. It uses a FFT algorithm to generate the ideal NMR signal from a user defined object. The k-space trajectory given by a pulse sequence is calculated. And it is used to select elements from the ideal NMR signal. This selection of elements mimic the sampling of the signal in an actual MRI experiment. During the sampling procedure changes in signal amplitude due to relaxation and excitation are introduced as well as signal phase changes due to movement or flow. Artifacts due to stimulated echoes and transversal magnetization that propagate through several repetition periods are also handled. The usefulness of the method is demonstrated by calculations using standard spin-echo sequence as well as modifications introduced in order to generate angiographical images and flow phase images. Further more a fast pulse sequence, echo planar imaging (EPI), is also simulated. The method is faster than previously presented ones. It is capable of generating images (128 x 128 matrix), including more than eight different T1 and T2 combinations, in less than 3 min on a standard 386/387 type IBM compatible PC.

Nickel-doped agarose gel phantoms in MR imaging.

A method for the production of a tissue-mimicking phantom material for MR imaging is described. The material consists of a nickel-doped agarose gel. The T1 and T2 values of the gel can be varied independently by changing the relative amounts of nickel and agarose. Practically any T1 and T2 combination of clinical interest can be obtained. The long-term stability was studied and found to be good. The relaxation times were estimated using an MR analyzer. The accuracy and the reproducibility of these measurements were evaluated and found to be reassuring. Gel phantoms were also scanned in an MR unit. The signal strength of an inversion recovery sequence was evaluated using the gel phantoms in order to verify their usefulness. These measurements were compared to theory with good agreement. Furthermore, tissue-equivalent phantoms were made. Gels resembling gray matter, white matter, and CSF were scanned. Comparisons with clinical in vivo scans, as well as calculated levels were made. It is anticipated that the gel phantoms described here will be useful in quality assurance as well as in pulse sequence optimization.

Kinetics of lead in bone and blood after end of occupational exposure.

In 14 retired lead workers, followed for over 18 years after end of exposure, repeated analyses of lead levels in finger bone by an in vivo X-ray fluorescence method revealed a decrease of lead concentration. The data were analysed using an exponential retention model. For the whole group the biological half-time was 16 (asymptotic 95% confidence interval, CI 12,23) years. The median of the estimated bone lead levels at the end of exposure was 85 micrograms.g-1 above the "background" (3 micrograms.g-1). A simultaneous follow-up of blood lead levels displayed a decrease, which could be described by a tri-exponential retention model with group half-times of 34 (CI 29,41) days, 1.2 (CI 0.9,1.8) years, and 13 (CI 10,18) years, respectively. The median of the estimated blood lead levels at the end of exposure for the three components were 0.49, 0.61, and 1.1 mumol.l-1 above the "background" (0.38-0.56 mumol.l-1), respectively. The well-documented decrease of lead exposure in the general population over the years, urged the use of a decreasing "background" of blood lead during the time of the study. The slowest of the three components represented the skeleton (probably mainly cortical bone), as did mainly probably also the intermediate one (trabecular bone). The data show the rather slow turnover of lead in the skeleton, the usefulnes of in vivo skeletal lead measurements as a long-term exposure index, and the importance of bone as a source of "endogenous" lead exposure.

Lead in vertebral bone biopsies from active and retired lead workers.

Samples of vertebral bone were obtained by skeletal biopsy and lead concentrations were determined by atomic absorption spectroscopy. The median level of lead in bone in 27 active lead workers was 29 micrograms/g wet weight (range 2-155), corresponding to 370 micrograms/g calcium (range 30-1,120). In 9 retired workers, the corresponding levels were 19 micrograms/g (5-76) and 250 micrograms/g calcium (60-700); in 14 reference subjects without occupational exposure, 1.3 micrograms/g (1-4) and 13 micrograms/g calcium (8-40). The bone lead content rose with time of exposure. Comparison of levels in vertebra with those in fingerbone, as measured by in vivo x-ray fluorescence in the same subjects, strongly suggested the presence of lead pools with different kinetics. The accumulation pattern, as well as the relation between levels in vertebra and fingerbone, suggests a much shorter half-time of lead in the mainly trabecular vertebral bone as compared to the mainly cortical fingerbone. Further, there was an association between vertebral and blood lead levels in the retired workers, which shows a considerable endogenous lead exposure from the skeletal pool.

Kinetics of lead in blood after the end of occupational exposure.

The sum of two exponential functions was fitted to the decay of blood lead (PbB) level after the end of lead exposure. For two subjects who had not formerly been occupationally exposed to lead but who had been exposed to a single short heavy dose, the fast compartment (probably soft tissues) had a biological half-time of 27 and 44 d, respectively. For 20 lead workers after the end of occupational exposure, the corresponding median was 29 (range 7-63) d. For 21 ex-lead workers, the median biological half-time of the slow compartment was 5.6 (range 2.3-27) years. There was significant interindividual variation in both the fast and the slow half-time. This finding probably means a considerable variation in risk at a certain exposure level. In the lead workers, the PbB fraction corresponding to the slow compartment had a median as high as 1.8 (range 0.7-2.7) mumol/l, which constituted more than half of the total PbB. This fraction was associated with exposure history, and with the lead level in the skeleton, the latter determined in vivo by an X-ray fluorescence method. The data thus indicate a rather rapid turnover of the skeletal lead pool, a phenomenon which may affect the PbB level considerably.

Cadmium concentration in the kidney cortex of occupationally exposed workers measured in vivo using X-ray fluorescence analysis.

A method for in vivo X-ray fluorescence analysis of the cadmium concentration in the kidney cortex has been improved and tested in 20 selected male occupationally cadmium-exposed workers (duration of exposure 7-39 years). The concentration of cadmium in kidney cortex ranged from 47 to 317 (median 141) micrograms/g. The concentration of cadmium in blood was 32-160 (median 64) nmole/liter, cadmium in urine was 2.5-13 (median 5.4) nmole/mmole creatinine, and beta 2-microglobulin in urine was 3.3-68 (median 14) micrograms/mmole creatinine. In individuals, the relationship between duration of exposure, time-integrated exposure, and cadmium level in urine on the one hand and cadmium level in the kidney on the other varied considerably. Direct in vivo analysis of the concentration of cadmium in the kidney cortex is therefore valuable as a complement to the other tests when monitoring cadmium exposure. Our method is sensitive, practically free from risk, and can b performed by routine at low costs.

Chelatable lead versus lead in human trabecular and compact bone.

In active and retired lead workers there was a close correlation between urinary excretion of lead during 6 h after intake of a single oral dose of 0.5 g penicillamine, and the excretion during 24 h. In chelation tests it is thus sufficient to collect urine for only a few hours. There was a close correlation between the amount of chelatable lead and the blood-lead level, as well as the lead level in biopsies of trabecular bone from vertebrae, but there was no association with lead in compact bone, as measured in finger-bone by in vivo X-ray fluorescence. The chelatable lead probably mainly reflects the soft tissue lead pool and a fraction of the trabecular bone lead pool, which has a relatively rapid turnover. It is not a valid indicator of the pool of lead which has slowly accumulated in the compact bone, and it is thus not useful as a time-integrated index of the exposure over a long period of time.

Biological monitoring, by in vivo XRF measurements, of occupational exposure to lead, cadmium, and mercury.

In vivo X-ray fluorescence (XRF) techniques were used for biological monitoring of lead, cadmium, and mercury. Lead accumulates in bone, the level of which may thus be used for monitoring of exposure. However, there was no close association between lead levels in bone and exposure time, partly because of differences in exposure patterns and partly, probably, because of variations in the toxicokinetics of lead. There are at least two separate bone lead compartments. The average over-all half-time is probably 5-10 yr. The finger bone level may be an index of the lead status of the total skeleton. In lead workers, the mobilization of bone lead causes an "internal" lead exposure and affects the blood lead level considerably. In cadmium workers, in vivo XRF is a sensitive and risk-free method for assessment of accumulation in kidney cortex, the critical tissue as to toxic effects; workers displayed increased levels. However, there was no clear association with duration and intensity of exposure, cadmium levels in urine, or microglobulinuria. Determinations of kidney cadmium may add important information on the state of accumulation and, thus, risk of kidney damage. Workers exposed to elemental mercury vapor, as well as fishermen exposed to methyl mercury, had mercury levels in bone below the detection limit of the XRF method.

Decrease of skeletal lead levels in man after end of occupational exposure.

Lead levels in finger bone were monitored using an in vivo X-ray fluorescence technique in retired lead workers. Eight subjects followed for 2-5 yr directly after end of exposure all displayed a decrease. Their average half-time was 7 (range 3-15) yr. In a second group of six persons, followed from year 7 to year 13 after finishing lead work, a decrease was seen in all but one. The average half-time for this group was 8 (range 2 infinity) yr. The mean value for both groups was 7 yr. The results show that there is a decrease of lead in bone after the end of exposure and that it is considerably faster than estimated earlier from various data on lead metabolism.

Lead in finger-bone analysed in vivo in active and retired lead workers.

In 75 active lead workers the median lead level in finger-bone (bone-Pb), as determined in vivo by an X-ray fluorescence method, was 43 micrograms/g (range less than 20-122). In 32 retired workers the median level was even higher, 59 micrograms/g (range less than 20-135), which indicates a slow turnover rate of lead in finger-bone. This was confirmed in 18 of the "active" workers, in whom bone-Pb was studied in connection with an exposure-free period. In spite of a significant decrease in blood-lead levels (B-Pb), no systematic change of bone-Pb occurred. There was an increase of bone-Pb with time of employment, but with a large interindividual variation. No association was found between bone-Pb and present B-Pb in the active lead workers. However, in the retired ones, B-Pb rose with increasing bone-Pb. The bone-lead pool thus causes an "internal" lead exposure.

Polarised X-rays in XRF-analysis for improved in vivo detectability of cadmium in man.

A technique is described for the in vivo XRF-analysis of cadmium in the kidney cortex of man using plane polarised photons for excitation. The polarised photons are produced by scattering the radiation from an X-ray tube (W anode, 150 kV, 15 mA) in a polymethylmethacrylate disc at a 90 deg angle. The beam paths (X-ray tube to scatterer, scatterer to sample, sample to detector) must represent three mutually orthogonal directions. The minimum detectable concentration for a counting time of 1800 s and a skin-kidney distance of 30 mm is 8 micrograms g-1. This is a factor of 2.5 lower than our earlier method with direct excitation using the 59.5 keV photons from 241Am. The energy imparted has also been lowered from 0.4 to 0.2 mJ. The cadmium concentration in the kidney cortex of six occupationally exposed persons varied between 15 and 170 micrograms g-1.