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1.
Clin Pharmacol Ther ; 81(1): 126-8, 2007 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17186011

RESUMEN

In the first week of October, I announced the launch of a national consortium that will transform how clinical and translational research is conducted; ultimately enabling researchers to provide new treatments more efficiently and quickly to patients. This new consortium, funded through Clinical and Translational Science Awards (CTSAs), begins with 12 academic health centers (AHCs) located throughout the nation. An additional 52 AHCs are receiving planning grants to help them prepare to apply for a CTSA.


Asunto(s)
Centros Médicos Académicos/organización & administración , Investigación Biomédica/organización & administración , Difusión de Innovaciones , Industria Farmacéutica/organización & administración , Distinciones y Premios , Bases de Datos Genéticas , Humanos , Relaciones Interinstitucionales , National Institutes of Health (U.S.) , Estados Unidos
2.
J Am Coll Cardiol ; 36(7): 2339-46, 2000 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11127482

RESUMEN

OBJECTIVES: The goal of this study was to characterize detailed transmural left ventricular (LV) function at rest and during dobutamine stimulation in subendocardial and transmural experimental infarcts. BACKGROUND: The relation between segmental LV function and the transmural extent of myocardial necrosis is complex. However, its detailed understanding is crucial for the diagnosis of myocardial viability as assessed by inotropic stimulation. METHODS: Short-axis tagged magnetic resonance images were acquired at five to seven levels encompassing the LV from base to apex in seven dogs 2 days after a 90-min closed-chest left anterior descending coronary occlusion, followed by reflow. Myocardial strains were measured transmurally in the entire LV by harmonic phase imaging at rest and 5 ig x kg(-1) x min(-1) dobutamine. Risk regions were assessed by radioactive microspheres, and the transmural extent of the infarct was assessed by 2,3,5 triphenyltetrazolium chloride staining. RESULTS: Circumferential shortening (Ecc), radial thickening (Err) and maximal shortening at rest were greater in segments with subendocardial versus transmural infarcts, both in subepicardium (-1.1+/-1.0 vs. 2.5+/-0.6% for Ecc, -0.5+/-1.9 vs. -1.8+/-1.0% for Err, p < 0.05) and subendocardium (-2.0+/-1.4 vs. 2.8+/-0.8%, 2.4+/-1.7 vs. 0.0+/-0.9%, respectively, p < 0.05). Under inotropic stimulation, risk regions retained maximal contractile reserve. Recruitable deformation was found in outer layers of subendocardial infarcts (p < 0.01 for Ecc and Err) but also in inner layers (p < 0.01). Conversely, no contractile reserve was observed in segments with transmural infarcts. CONCLUSIONS: Under dobutamine challenge, recruitment of myofiber shortening and thickening was observed in inner layers of segments with subendocardial infarcts. These results may have important clinical implications for the detection of myocardial viability.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Contracción Miocárdica/fisiología , Infarto del Miocardio/fisiopatología , Miocardio/patología , Función Ventricular Izquierda , Animales , Cardiotónicos , Dobutamina , Perros , Infarto del Miocardio/terapia , Reperfusión Miocárdica
3.
Circulation ; 101(9): 981-8, 2000 Mar 07.
Artículo en Inglés | MEDLINE | ID: mdl-10704164

RESUMEN

BACKGROUND: Tagged MRI of the heart is difficult to implement clinically because of the lack of fast analytical techniques. We investigated the accuracy of harmonic phase (HARP) imaging for rapid quantification of myocardial strains and for detailed analysis of left ventricular (LV) function during dobutamine stimulation. METHODS AND RESULTS: Tagged MRI was performed in 10 volunteers at rest and during 5 to 20 microg(-1). kg(-1). min(-1) dobutamine and in 9 postinfarct patients at rest. We compared 2D myocardial strains (circumferential shortening, Ecc; maximal shortening, E(2); and E(2), direction) as assessed by a conventional technique and by HARP. Full quantitative analysis of the data was 10 times faster with HARP. For pooled data, the regression coefficient was r=0.93 for each strain (P<0.001). In volunteers, Ecc and E(2) were greater in the free wall than in the septum (P<0.01), but recruitable myocardial strain at peak dobutamine was greater in the LV septum (P<0.01). E(2) orientation shifted away from the circumferential direction at peak dobutamine (P<0.01). HARP accurately detected subtle changes in myocardial strain fields under increasing doses of dobutamine. In patients, HARP-determined Ecc and E(2) values were dramatically reduced in the asynergic segments as compared with remote (P<0.001), and E(2) direction shifted away from the circumferential direction (P<0.001). CONCLUSIONS: HARP MRI provides fast, accurate assessment of myocardial strains from tagged MR images in normal subjects and in patients with coronary artery disease with wall motion abnormalities. HARP correctly indexes dobutamine-induced changes in strains and has the potential for on-line quantitative monitoring of LV function during stress testing.


Asunto(s)
Enfermedad Coronaria/fisiopatología , Corazón/fisiopatología , Imagen por Resonancia Magnética/métodos , Miocardio/patología , Adulto , Dobutamina , Femenino , Tabiques Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Valores de Referencia , Estrés Mecánico , Factores de Tiempo
4.
Radiology ; 214(2): 453-66, 2000 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-10671594

RESUMEN

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.


Asunto(s)
Imagen por Resonancia Magnética , Función Ventricular Izquierda/fisiología , Adulto , Algoritmos , Análisis de Varianza , Bases de Datos como Asunto , Endocardio/anatomía & histología , Endocardio/fisiología , Femenino , Tabiques Cardíacos/anatomía & histología , Tabiques Cardíacos/fisiología , Ventrículos Cardíacos/anatomía & histología , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Rotación , Estrés Mecánico , Sístole
5.
Top Magn Reson Imaging ; 11(6): 359-71, 2000 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11153703

RESUMEN

Magnetic resonance imaging with tissue tagging is a noninvasive technique for measuring three-dimensional motion and deformation in the human heart. Tags are regions of tissue whose longitudinal magnetization has been altered before imaging so that they appear dark in subsequent magnetic resonance images. They then move with the underlying tissue and serve as easily identifiable landmarks within the heart for the detailed detection of motion. Many different motion and strain parameters can be determined from tagged magnetic resonance imaging. Strain components that are based on a high density of tag data, such as circumferential and longitudinal shortening, or parameters that are combinations of multiple strain components, have highest measurement precision and tightest normal ranges. The pattern of three-dimensional motion and strain in the heart is important clinically, because it reflects the basic mechanical function of the myocardium at both local and global levels. Localized abnormalities can be detected and quantified if the pattern of deformation in a given heart is compared to the normal range for that region, because normal motion and strain in the left ventricle is spatially heterogeneous. Contraction strains typically are greatest in the anterior and lateral walls and increase toward the apex. The direction of greatest contraction lies along a counter clockwise helix from base to apex (viewed from the base) and approximates the epicardial muscle fiber direction. This fiber geometry also results in long-axis torsion during systole. Ejection is accomplished primarily by radially inward motion of the endocardium and by descent of the base toward the apex during systole.


Asunto(s)
Ventrículos Cardíacos/anatomía & histología , Imagen por Resonancia Magnética/métodos , Marcadores de Spin , Femenino , Humanos , Masculino , Valores de Referencia , Sensibilidad y Especificidad
6.
J Cardiovasc Magn Reson ; 2(2): 123-36, 2000.
Artículo en Inglés | MEDLINE | ID: mdl-11545128

RESUMEN

Brief myocardial ischemia of less than 20 min duration, followed by reperfusion, is known to cause transient contractile dysfunction, often termed myocardial stunning. Tagged magnetic resonance imaging offers a noninvasive method that can be used to quantify this regional mechanical dysfunction in stunned myocardium. To this end, a closed-chest canine model of myocardial stunning was created by short-term (approximately 20-min) coronary occlusion, via inflation of an angioplasty balloon placed fluoroscopically in the left anterior descending (LAD) coronary, followed by reperfusion. Changes in myocardial strain before occlusion, during occlusion, and at 15 and 30 min after reperfusion were determined using repeated-measures analysis of variance. After instrumentation but before coronary occlusion, global reductions in myocardial strain were observed relative to animals that did not undergo coronary catheterization procedures. Declines of 46% and 49% in regional myocardial blood flow in the LAD and left circumflex bed, respectively, from preinstrumentation levels occurred due to coronary angiography and placement of a deflated angioplasty balloon in the LAD for 1 hr. During LAD occlusion, maximum myocardial shortening was significantly reduced in the anterior and anteroseptal regions of the left ventricular apex (i.e., ischemic region) but returned to baseline values by 30 min after reperfusion. No augmentation of myocardial function was observed in the nonischemic regions during occlusion or reperfusion. Thus, this noninvasive technique to evaluate myocardial ischemia demonstrated a graded response in myocardial function to ischemia and persistent regional dysfunction or "myocardial stunning" after short-term coronary occlusion.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Aturdimiento Miocárdico/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Análisis de Varianza , Angioplastia de Balón , Animales , Vasos Coronarios/fisiopatología , Modelos Animales de Enfermedad , Perros , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Microesferas , Contracción Miocárdica/fisiología , Isquemia Miocárdica/fisiopatología , Radioisótopos
7.
Magn Reson Med ; 41(3): 569-74, 1999 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-10204882

RESUMEN

High-resolution breast imaging may improve differentiation between benign and malignant lesions and may be important for refining treatment strategy. This article presents a new, flexible design of a breast-imaging coil capable of providing breast images of a high level of spatial resolution. Referred to as a switchable coil array, the design uses small-diameter surface coils that provide high sensitivity of detection, which, combined with a relatively small field of view, affords a high degree of spatial resolution (up to 200 microm). Remote selection of the coil pair closest to the position of the lesion in the breast permits coverage of the whole breast without changing the position of the coils or the patient. High-resolution MR images of phantom and volunteer patients with benign and malignant breast lesions are presented.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética/instrumentación , Biopsia con Aguja , Enfermedades de la Mama/diagnóstico , Simulación por Computador , Diagnóstico Diferencial , Campos Electromagnéticos , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Fantasmas de Imagen , Sensibilidad y Especificidad
8.
Circulation ; 99(2): 284-91, 1999 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-9892596

RESUMEN

BACKGROUND: To limit ischemic myocardial injury, it is important to differentiate viable from infarcted myocardium. Three dimensional (3D) tagged MRI has the ability to quantify myocardial 3D deformation and strain (noninvasively and precisely), and can achieve a true comparison of contraction not only from region to region, but also at different levels of function. In this study, we investigated whether regional strain mapping obtained by 3D-tagged MRI can differentiate between viable but stunned myocardium and nonviable myocardium. METHODS AND RESULTS: We examined 7 dogs 2 days after a 90-minute closed-chest left anterior descending coronary artery occlusion followed by 48 hours of reperfusion. 3D-tagged MR images spanning the entire left ventricle were acquired both at rest and during dobutamine infusion (5 microg. kg-1. min-1 IV). Regional blood flow was measured with radioactive microspheres and used to define risk regions. Infarcted regions were defined as 2,3,5 triphenyltetrazolium chloride negative regions. Strains in infarcted regions were greatly impaired compared with remote regions (P<0.001) and remained unchanged during dobutamine stress. Risk regions showed a dysfunction at rest, with improved function during dobutamine infusion. Receiver operating characteristics analysis showed that radial strain was more accurate for identifying viable regions. CONCLUSIONS: When coupled with a stress test, 3D strain mapping by the use of tagged MRI is a sensitive and noninvasive method for characterizing ischemic injury. Regional strain can be used to differentiate between viable but stunned and nonviable myocardium within the postischemic injured myocardium.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Daño por Reperfusión Miocárdica/patología , Miocardio/patología , Animales , Circulación Coronaria , Perros , Infarto del Miocardio/patología , Aturdimiento Miocárdico , Factores de Tiempo , Supervivencia Tisular
9.
J Cardiovasc Magn Reson ; 1(3): 207-22, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-11550355

RESUMEN

The purpose of this study was to investigate the relationship between three-dimensional (3D) deformation patterns in the canine left ventricle and localized graded reductions in perfusion. Magnetic resonance (MR) tissue tagging in a clinical scanner was used to determine systolic 3D deformation throughout the left ventricle with 32-msec time resolution. Six dogs were studied at normal and reduced left anterior descending coronary artery flow levels, for a total of 14 studies. Deformation was calculated by fitting a 3D displacement field to tag displacement data from three orthogonal sets of tags and taking spatial derivatives. A novel index of 3D radial mechanical function, calculated from the 3D strain tensor components and the tissue incompressibility constraint, had a higher correlation (R = 0.94) with perfusion (colored microspheres) than any of the 3D Lagrangian finite strain tensor components or wall thickening. As a function of the fraction of baseline perfusion, it was well fit by a linear relationship for subnormal perfusion with a slope of 0.46 +/- 0.05 and an intercept of -0.156 +/- 0.026. Longitudinal strain was lost first with decreasing perfusion (48%), followed by circumferential (40%) and finally radial function (35%). The strain method detected perfusion drops as small as 20%, and early paradoxical strain transients lasting 100 msec were seen only with ischemia. 3D strain changes can be noninvasively measured throughout the left ventricle with MR tissue tagging. MR imaging-derived strain indices, unique to 3D analysis, correlate most sensitively with regional perfusion in the canine left ventricle.


Asunto(s)
Imagenología Tridimensional , Imagen por Resonancia Magnética/métodos , Isquemia Miocárdica/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Animales , Estimulación Cardíaca Artificial , Circulación Coronaria , Perros , Procesamiento de Imagen Asistido por Computador , Sístole/fisiología
10.
J Am Coll Cardiol ; 32(6): 1756-64, 1998 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-9822106

RESUMEN

OBJECTIVES: We aimed to validate contrast-enhanced echocardiography (CE) in the quantification of microvascular obstruction (MO) against magnetic resonance imaging (MRI) and the histopathologic standards of radioactive microspheres and thioflavin-S staining. We also determined the time course of MO at days 2 and 9 after infarction and reperfusion. BACKGROUND: Postinfarction MO occurs because prolonged ischemia produces microvessel occlusion at the infarct core, preventing adequate reperfusion. Microvascular obstruction expands up to 48 h after reperfusion; the time course beyond 2 days is unknown. Though used to study MO, CE has not been compared with MRI and thioflavin-S, which yield precise visual maps of MO. METHODS: Ten closed-chest dogs underwent 90-min coronary artery occlusion and reperfusion. Both CE and MRI were performed at 2 and 9 days after reperfusion. The MO regions by both methods were quantified as percent left ventricular (% LV) mass. Radioactive microspheres were injected for blood flow determination. Postmortem, the myocardium was stained with thioflavin-S and 2,3,5-triphenyltetrazolium chloride. RESULTS: Expressed as % total LV, MO by MRI matched in size MO by microspheres using a flow threshold of <40% remote (4.96+/-3.52% vs. 5.32+/-3.98%, p=NS). For matched LV cross sections, MO by CE matched in size MO by microspheres using a flow threshold of <60% remote (13.27+/-4.31% vs. 13.5+/-4.94%, p=NS). Both noninvasive techniques correlated well with microspheres (MRI vs. CE, r=0.87 vs. 0.74; p=NS). Microvascular obstruction by CE corresponded spatially to MRI-hypoenhanced regions and thioflavin-negative regions. For matched LV slices at 9 days after reperfusion, MO measured 12.94+/-4.51% by CE, 7.11+/-3.68% by MRI and 9.18+/-4.32% by thioflavin-S. Compared to thioflavin-S, both noninvasive techniques correlated well (CE vs. MRI, r=0.79 vs. 0.91; p=NS). Microvascular obstruction size was unchanged at 2 and 9 days (CE: 13.23+/-4.11% vs. 12.69+/-4.97%; MRI: 5.53+/-4.94% vs. 4.68+/-3.44%; p=NS for both). CONCLUSIONS: Both CE and MRI can quantify MO. Both correlate well with the histopathologic standards. While MRI can detect regions of MO with blood flow <40% of remote, the threshold for MO by CE is <60% remote. The extent of MO is unchanged at 2 and 9 days after reperfusion.


Asunto(s)
Circulación Coronaria/fisiología , Ecocardiografía , Imagen por Resonancia Magnética , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Daño por Reperfusión Miocárdica/diagnóstico por imagen , Animales , Benzotiazoles , Colorantes , Medios de Contraste , Perros , Colorantes Fluorescentes , Microcirculación/fisiología , Microesferas , Sales de Tetrazolio , Tiazoles , Factores de Tiempo
11.
Acad Radiol ; 5(2): 93-100, 1998 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-9484541

RESUMEN

RATIONALE AND OBJECTIVES: The authors determined whether blood presaturation of tagged magnetic resonance (MR) images affects identification of left ventricular endocardial borders. MATERIALS AND METHODS: Three healthy volunteers underwent MR imaging performed with a breath-hold segmented spoiled gradient-recalled-echo sequence with tissue tagging. Two saturation pulses (in the basal and apical regions) were used to generate black-blood images. Manual segmentation of endocardial contours on black-blood and white-blood images was performed independently by five observers. RESULTS: Endocardial borders were better identified on black-blood images compared with white-blood images, especially in the early systolic phases. Interobserver variability in contour estimation was significantly higher for white-blood images (P < .001) and was twice that for corresponding black-blood images during early systole. Contour variability appeared to be affected mainly by tag-to-myocardium contrast (P = .009) and myocardium-to-chamber contrast (P = .05). CONCLUSION: Blood presaturation of tagged MR images improves reliability of contour segmentation.


Asunto(s)
Corazón/anatomía & histología , Aumento de la Imagen/métodos , Imagen por Resonancia Cinemagnética/métodos , Adulto , Sangre , Color , Endocardio/anatomía & histología , Femenino , Ventrículos Cardíacos/anatomía & histología , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Variaciones Dependientes del Observador , Músculos Papilares/anatomía & histología , Análisis de Regresión , Reproducibilidad de los Resultados , Sístole
13.
Circulation ; 97(8): 765-72, 1998 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-9498540

RESUMEN

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.


Asunto(s)
Microcirculación/patología , Infarto del Miocardio/patología , Anciano , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Pronóstico , Índice de Severidad de la Enfermedad
14.
Radiology ; 204(2): 562-5, 1997 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-9240553

RESUMEN

The authors evaluated a flow-independent magnetic resonance (MR) imaging technique in extremity veins with slow flow that relies on the prolonged T2 of blood to create angiographic contrast. A commercially available heavily T2-weighted fast-spin-echo sequence was optimized for MR venography in volunteer and phantom studies. Good depiction of venous anatomy was routinely obtained with the optimized method. Fast-spin-echo MR venography allowed evaluation of slow-flow systems such as the calf and forearm veins.


Asunto(s)
Extremidades/irrigación sanguínea , Angiografía por Resonancia Magnética/métodos , Venas/anatomía & histología , Adulto , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Fantasmas de Imagen , Tromboflebitis/diagnóstico
15.
Radiology ; 203(3): 727-32, 1997 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-9169695

RESUMEN

PURPOSE: To determine the natural history of vasculopathy of the thoracoabdominal aorta in patients with Marfan syndrome after composite graft repair of the aortic root. MATERIALS AND METHODS: A total 224 magnetic resonance (MR) images obtained in 48 patients with Marfan syndrome over a period of 2.3-9.4 years (mean, 5.0 years) were retrospectively reviewed. On each image, the diameter of the thoracoabdominal aorta was measured and the presence of dissection or major peripheral artery aneurysms was determined. RESULTS: In 31 (65%) of the 48 patients, no statistically significant change (3 mm or less increase in diameter) in the diameter of the aorta occurred during the study (group 1); in the remaining 17 (35%) patients, a significant change occurred (greater than 3 mm increase) (group 2). The mean initial diameter of the native aorta was slightly larger in group 2 (mean, 27 mm +/- 8 [standard deviation]) than in group 1 (mean, 23 mm +/- 6). In group 1, the mean rate of dilation was 0.07 mm/y +/- 0.2; in group 2, the rate was 2.3 mm/y +/- 3.3. Two patients with aortic dissection were in group 1, whereas 14 such patients were in group 2 (P < .001). Aneurysms that involved major peripheral arteries were present in four (13%) of the 31 group 1 patients and in 12 (71%) of the 17 group 2 patients (P < .001). Surgical intervention was necessary in two group 1 patients and in 14 group 2 patients (P < .001). CONCLUSION: A subset of patients with Marfan syndrome manifested multiple forms of vasculopathy, including progressive aortic dilation, dissection, and peripheral artery aneurysm after composite aortic graft repair of the ascending aorta. Patients with these characteristics merit more frequent MR follow-up since further surgery was often necessary in these individuals.


Asunto(s)
Enfermedades de la Aorta/diagnóstico , Imagen por Resonancia Magnética , Síndrome de Marfan/patología , Adolescente , Adulto , Anciano , Aneurisma/diagnóstico , Aneurisma/patología , Aneurisma/cirugía , Disección Aórtica/diagnóstico , Disección Aórtica/patología , Disección Aórtica/cirugía , Aorta Abdominal/patología , Aorta Abdominal/cirugía , Aorta Torácica/patología , Aorta Torácica/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/patología , Aneurisma de la Aorta Torácica/cirugía , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/cirugía , Niño , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Síndrome de Marfan/cirugía , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/diagnóstico , Enfermedades Vasculares Periféricas/patología , Enfermedades Vasculares Periféricas/cirugía , Estudios Retrospectivos
16.
Circulation ; 95(7): 1877-85, 1997 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-9107176

RESUMEN

BACKGROUND: The ability of the myocyte to maintain an ionic concentration gradient is perhaps the best indication of myocardial viability. We studied the relationship of 23Na MRI intensity to viability and explored the potential of fast-imaging techniques to reduce 23Na imaging times in rabbits and dogs. METHODS AND RESULTS: Eighteen rabbits underwent in situ coronary artery occlusion and reperfusion. The hearts were then either imaged following isolation and perfusion with cardioplegic solution (n = 6), imaged in vivo (n = 6), or analyzed for 23Na content and relaxation times (n = 12). Normal rabbits (n = 6) and dogs (n = 4) were imaged to examine the effect of animal size on 23Na image quality. 23Na imaging times were 7, 11, and 4 minutes for isolated rabbits, in vivo rabbits, and in vivo dogs, respectively. Infarcted, reperfused regions, identified by triphenyltetrazolium chloride staining, showed a significant elevation in 23Na image intensity compared with viable regions (isolated, 42 +/- 5%, P < .02; in vivo, 95 +/- 6%, P < .001), consistent with increased tissue sodium content. Similarly, 23Na MR spectroscopy showed that [Na+] was higher in nonviable than viable myocardium (isolated, 99 +/- 4 versus 61 +/- 2 mmol/L; in vivo, 91 +/- 2 versus 38 +/- 1 mmol/L; P < .001 for both). Image signal-to-noise ratios were higher in dogs than rabbits despite shorter imaging times, primarily due to larger voxels. CONCLUSIONS: Following acute infarction with reperfusion, a regional increase in 23Na MR image intensity is associated with nonviable myocardium. Fast gradient-echo imaging techniques reduce 23Na imaging times to a few minutes, suggesting that 23Na MR imaging has the potential to become a useful experimental and clinical tool.


Asunto(s)
Imagen por Resonancia Magnética , Infarto del Miocardio/patología , Reperfusión Miocárdica , Miocardio/patología , Sodio/análisis , Animales , Supervivencia Celular , Perros , Líquido Intracelular/química , Infarto del Miocardio/metabolismo , Miocardio/química , Conejos , Sales de Tetrazolio
17.
Radiology ; 202(3): 739-44, 1997 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-9051028

RESUMEN

PURPOSE: To assess the diagnostic potential of the rim-to-center differential enhancement ratio in the magnetic resonance (MR) imaging differentiation of benign from malignant musculoskeletal masses. MATERIALS AND METHODS: Dynamic gadolinium-enhanced fast multiplanar spoiled gradient-recalled acquisition in the steady state imaging was performed to evaluate 17 one and soft-tissue masses (10 malignant, seven benign) in 14 patients. The rim-to-center differential enhancement ratio was determined from images at the maximal enhancement rate. The difference in differential enhancement ratios between benign and malignant masses was evaluated and compared with the maximum rate of enhancement for each mass. RESULTS: Nine of 10 malignant masses showed rapid rim enhancement with delayed central fill-in. This enhancement pattern was absent in benign masses. The average rim-to-center differential enhancement ratio was 0.64 +/- 0.26 for malignant masses and -0.16 +/- 0.33 for benign masses (P < .001). This difference was statistically significant. The average maximum rate of enhancement was 3.41%/sec +/- 2.20 for malignant masses and 2.74%/sec +/- 2.46 for benign masses (P > .05). CONCLUSION: Intratumoral enhancement patterns of malignant and benign masses differ because of differences in vascular architecture. These preliminary results suggest that the rim-to-center differential enhancement ratio has potential as an additional parameter for the MR imaging differentiation of indeterminate musculoskeletal masses.


Asunto(s)
Neoplasias Óseas/diagnóstico , Imagen por Resonancia Magnética , Neoplasias de los Músculos/diagnóstico , Adolescente , Adulto , Anciano , Medios de Contraste , Diagnóstico Diferencial , Combinación de Medicamentos , Femenino , Gadolinio , Gadolinio DTPA , Humanos , Masculino , Meglumina , Persona de Mediana Edad , Compuestos Organometálicos , Ácido Pentético/análogos & derivados
19.
Arterioscler Thromb Vasc Biol ; 17(12): 3626-32, 1997 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-9437214

RESUMEN

Magnetic resonance imaging (MRI) may be an excellent tool to define atherosclerotic plaque composition, but surface MRI (SMRI) suffers from a low signal-to-noise ratio and low resolution of arterial images. Intravascular MRI (IVMRI) represents a potential solution for acquiring high-quality in vivo images of atherosclerotic plaques. Isolated segments of 11 thoracic human aortas obtained at autopsy were imaged by IVMRI using an intravascular receiver catheter coil designed and built at our institution. Images obtained by IVMRI were compared with corresponding images obtained by SMRI and with histopathological aortic cross sections. The intensity of intimal thickness and plaque components was graded by IVMRI and histopathology using a score of 1 for mild, 2 for moderate, and 3 for severe intensity. IVMRI had an agreement of 75% with histopathology in fibrous cap grading (37.5% expected, kappa = 0.60, P < 0.001) and of 74% in necrotic core grading (39% expected, kappa = 0.57, P < 0.001). Intraplaque calcification was correctly graded by IVMRI in six of the eight plaques in which histopathology recognized calcium. The analysis of intimal thickness showed 80% agreement between IVMRI and histopathology (52% expected, kappa = 0.59, P < 0.001). IVMRI image features were similar to those of SMRI. In addition, IVMRI accurately determined atherosclerotic plaque size in comparison with histopathology and SMRI (slope = 1.25 cm2, r = 0.99, P < 0.001 for luminal area by IVMRI vs histopathology; slope = 0.97 cm2, r = 0.996, P < 0.001 for luminal area by IVMRI vs SMRI). IVMRI has the potential to provide important prognostic information in patients with atherosclerosis because of its ability to accurately assess both plaque composition and size.


Asunto(s)
Arteriosclerosis/patología , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Arterias/patología , Calcinosis/patología , Humanos , Persona de Mediana Edad , Necrosis
20.
Magn Reson Med ; 36(4): 596-605, 1996 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-8892213

RESUMEN

Potentially important diagnostic information about atherosclerosis can be obtained by using magnetic resonance imaging and spectroscopy techniques. Because critical vessels such as the aorta, coronary arteries, and renal arteries are not near the surface of the body, surface coils are not adequate to increase the data quality to desired levels. A few catheter MR receiver coil designs have been proposed for imaging the walls of large blood vessels such as the aorta. These coils have limited longitudinal coverage and they are too thick to be placed into small vessels. A flexible, long and narrow receiver coil that can be placed on the tip of a catheter and will enable multi-slice high resolution imaging of small vessels has been developed. The authors describe the theory of the coil design technique, derive formulae for the signal-to-noise ratio characteristics of the coil, and show examples of high resolution cross-sectional images from isolated human aortas acquired by using this catheter coil. In addition, high resolution in vivo rabbit aorta images were obtained as well as a set of spatially resolved chemical shift spectra from a dog circumflex coronary artery.


Asunto(s)
Aorta/patología , Vasos Coronarios/patología , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética , Animales , Arteriosclerosis/diagnóstico , Cateterismo/instrumentación , Perros , Humanos , Modelos Teóricos , Conejos
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