Three-dimensional systolic strain patterns in the normal human left ventricle: characterization with tagged MR imaging.

PURPOSE: To present a database of systolic three-dimensional (3D) strain evolution throughout the normal left ventricle (LV) in humans. MATERIALS AND METHODS: In 31 healthy volunteers, magnetic resonance (MR) tissue tagging and breath-hold MR imaging were used to generate and then detect the motion of transient fiducial markers (ie, tags) in the heart every 32 msec. Strain and motion were calculated from a 3D displacement field that was fit to the tag data. Special indexes of contraction and thickening that were based on multiple strain components also were evaluated. RESULTS: The temporal evolution of local strains was linear during the first half of systole. The peak shortening and thickening strain components were typically greatest in the anterolateral wall, increased toward the apex, and increased toward the endocardium. Shears and displacements were more spatially variable. The two specialized indexes of contraction and thickening had higher measurement precision and tighter normal ranges than did the traditional strain components. CONCLUSION: In this study, the authors noninvasively characterized the normal systolic ranges of 3D displacement and strain evolution throughout the human LV. Comparison against this multidimensional database may permit sensitive detection of systolic LV dysfunction.

Cystic fibrosis: spectrum of thoracic and abdominal CT findings in the adult patient.

Cystic fibrosis (CF) is an autosomal recessive disorder that is characterized by an abnormality of exocrine gland function. Adult patients represent a rapidly growing percentage of the CF population. Pulmonary changes are seen in nearly every case and are the most serious complication of CF. In advanced lung disease, bronchiectasis, emphysematous bullae, and subpleural blebs can frequently develop. Although pulmonary disease is the most common cause of death and morbidity among CF patients, there also can be involvement of other groups, particularly in adults, which show characteristic signs on CT and spiral CT. Pancreatic abnormalities are present in 85-90% of CF patients. The degree of pancreatic involvement varies, ranging form accumulations of mucus in the small ducts to totally plugged ducts, which can cause atrophy of the exocrine glands and progressive fibrosis. Pancreatic dysfunction on CT is demonstrated as fatty replacement and fibrosis of the pancreas. However, there may be scattered foci of pancreatic calcifications that can be detectable on plain radiographs. Hepatobiliary involvement follows the same pattern as pancreatic abnormalities. Bile canaliculi are plugged by mucinous material and when this plugging is of long duration, biliary cirrhosis with diffuse hepatic nodularity may develop. Such severe hepatic involvement is see in only about 2-5% of patients, although minor hepatic alterations, such as diffuse fatty changes, are fairly common. Hepatobiliary involvement is characterized by hepatic nodularity, compatible with cirrhosis, splenomegaly, and ascites. Complete obstruction of the ileum by meconium occurs in approximately 10% of newborns with CF. Intestinal findings on CT include obstruction, although this is more common in children. These CT signs should be evaluated carefully in adult patients since they may be suggestive of CF. Computed tomography offers unique information about organ involvement (other than pulmonary) that can alter diagnosis and patient management.

Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction.

BACKGROUND: The extent of microvascular obstruction during acute coronary occlusion may determine the eventual magnitude of myocardial damage and thus, patient prognosis after infarction. By contrast-enhanced MRI, regions of profound microvascular obstruction at the infarct core are hypoenhanced and correspond to greater myocardial damage acutely. We investigated whether profound microvascular obstruction after infarction predicts 2-year cardiovascular morbidity and mortality. METHODS AND RESULTS: Forty-four patients underwent MRI 10 +/- 6 days after infarction. Microvascular obstruction was defined as hypoenhancement seen 1 to 2 minutes after contrast injection. Infarct size was assessed as percent left ventricular mass hyperenhanced 5 to 10 minutes after contrast. Patients were followed clinically for 16 +/- 5 months. Seventeen patients returned 6 months after infarction for repeat MRI. Patients with microvascular obstruction (n = 11) had more cardiovascular events than those without (45% versus 9%; P=.016). In fact, microvascular status predicted occurrence of cardiovascular complications (chi2 = 6.46, P<.01). The risk of adverse events increased with infarct extent (30%, 43%, and 71% for small [n = 10], midsized [n = 14], and large [n = 14] infarcts, P<.05). Even after infarct size was controlled for, the presence of microvascular obstruction remained a prognostic marker of postinfarction complications (chi2 = 5.17, P<.05). Among those returning for follow-up imaging, the presence of microvascular obstruction was associated with fibrous scar formation (chi2 = 10.0, P<.01) and left ventricular remodeling (P<.05). CONCLUSIONS: After infarction, MRI-determined microvascular obstruction predicts more frequent cardiovascular complications. In addition, infarct size determined by MRI also relates directly to long-term prognosis in patients with acute myocardial infarction. Moreover, microvascular status remains a strong prognostic marker even after control for infarct size.

What is the optimum phased array coil design for cardiac and torso magnetic resonance?

To determine the optimum configuration of a phased array MR coil system for human cardiac applications, the sensitivity of 10 flexible array designs operating under ideal conditions was calculated at 13 points circling the myocardium of a model torso whose geometry was determined from healthy volunteers. The array geometries that were evaluated included continuous strips of 2, 4, 6, and 10 circular coils of diameter equal to half the torso thickness wrapped laterally around the torso, 2 pairs of coils located on the left side of the chest and back, clusters of 3 coils in 2 orientations, clusters of 4 and 6 coils, and a hybrid cross of 6 coils. The 4-, 6-, and 10-coil strip arrays out-performed the other designs for a given number of coils, yielding average theoretical sensitivity improvements of 45%, 53%, and 55% relative to a single flexible coil positioned at the point closest to the anterior myocardium, compared with about 30% for 4- and 6-coil clusters and the 2-pair geometry (P < 0.02). A flexible 4-coil strip array was constructed for a clinical 1.5 T scanner with 15-cm diameter circular surface coils on flexible circuit board. The signal-to-noise ratio (SNR) of this coil at the 13 cardiac locations was measured in 15 normal volunteers and compared with the SNR measured in images acquired with standard commercial MR coils: a body coil, a flexible torso array, a general purpose flexible coil, and, in 4 subjects, a dual array coil. In the prone orientation, the average myocardial SNR improvement of the 4-coil strip array was 650% relative to the whole body coil, compared with 310-340% for the other commercial coils (P < 0.00005). The twofold advantage over the commercial coils persisted in supine studies (P < 0.00005, n = 5). Thus, flexible circumferential phased arrays of strips of surface coils of diameter comparable with the depth of the heart generally out-perform many other standard geometries for a given number of coils, and can yield dramatically improved SNR over coils available for general use in the torso.

Fluid-fluid levels in injured knees: do they always represent lipohemarthrosis?

PURPOSE: To determine if fluid-fluid levels on horizontal-beam radiographs of posttraumatic knee joints always represent lipohemarthrosis. MATERIALS AND METHODS: The files of 41 patients with tibial plateau fracture were reviewed retrospectively. Twelve with fluid-fluid levels on radiographs who underwent computed tomography (CT) or magnetic resonance (MR) imaging were selected; CT attenuation and MR signal intensity patterns were used to assess fluid-fluid levels. Simulated hemarthrosis and lipohemarthrosis underwent plain radiography, CT, and MR imaging. RESULTS: Eight patients showed no evidence of fat in the supernatant fluid with either CT (n = 7) or CT and MR imaging (n = 1). Fluid levels resulted from blood separating into cellular elements and supernatant serum. Four patients showed evidence of lipohemarthrosis with either CT (n = 3) or MR imaging (n = 1); in one of these patients, a double fluid-fluid level could be demonstrated retrospectively on plain radiographs. CONCLUSION: Single fluid-fluid levels in posttraumatic knee joints do not necessarily represent a lipohemarthrosis. Double fluid-fluid levels are a more specific finding.

Physiological basis of myocardial contrast enhancement in fast magnetic resonance images of 2-day-old reperfused canine infarcts.

BACKGROUND: Contrast-enhanced fast magnetic resonance (MR) images of acute, reperfused human infarcts demonstrate regions of hypoenhancement and hyperenhancement. The relations between the spatial extent and time course of these enhancement patterns to myocardial risk, infarct, and no-reflow regions have not been well characterized. METHODS AND RESULTS: The proximal left anterior descending coronary artery was occluded in 11 closed-chest dogs for 90 minutes followed by 2 days of reperfusion. Regional blood flow was determined by use of radioactive microspheres. The animals were studied at the 2-day time point with contrast-enhanced fast MRI (Signa 1.5 T, General Electric). Thioflavin-S was administered to demarcate no-reflow regions. The hearts were then excised, sectioned into five base-to-apex slices, stained with 2,3,5-triphenyltetrazolium chloride (TTC), and photographed under room light (for TTC) and ultraviolet light (for thioflavin). The spatial extents of thioflavin-negative, TTC-negative, and risk regions were compared planimetrically with MRI hypoenhanced and hyperenhanced regions. The spatial locations of subendocardial hypoenhancement in MR images correlated closely with those of thioflavin-negative regions. Microsphere blood flow in these regions was significantly reduced compared with remote regions (0.37 +/- 0.09 versus 0.88 +/- 0.10 mL/min per gram, respectively, P < .001) and with baseline (0.37 +/- 0.09 versus 0.87 +/- 0.15 mL/min per gram, P < .01). The spatial extent of hyperenhancement was smaller than the risk region (r = .64, slope = 0.48, P < .001) but highly correlated with TTC-negative regions and were, on average, 12% larger (r = .93, slope = 1.12, P = .035). CONCLUSIONS: In contrast-enhanced MR images of 2-day-old reperfused canine infarcts, myocardial regions of hypoenhancement are related to the no-reflow phenomenon. Approximately 90% of the myocardium within hyperenhanced regions is nonviable.

CT differentiation of large abdominal lymphangioma from ascites.

Abdominal lymphangiomas are uncommon benign tumors, usually presenting in early childhood as a palpable abdominal mass. Their sonographic and CT appearance has been well described, and usually consists of well-defined, thin-walled cysts which can be unilocular, or multiloculated, and may contain septations. Rarely, these cysts may be large enough to be confused with ascites on physical exam. We present such a case to emphasize the imaging features that may help in the differentiation between ascites and large mesenteric lymphangiomas.