In vitro evaluation of the imaging accuracy of C-arm conebeam CT in cerebral perfusion imaging.

PURPOSE: The authors have developed a method to enable cerebral perfusion CT imaging using C-arm based conebeam CT (CBCT). This allows intraprocedural monitoring of brain perfusion during treatment of stroke. Briefly, the technique consists of acquiring multiple scans (each scan comprised of six sweeps) acquired at different time delays with respect to the start of the x-ray contrast agent injection. The projections are then reconstructed into angular blocks and interpolated at desired time points. The authors have previously demonstrated its feasibility in vivo using an animal model. In this paper, the authors describe an in vitro technique to evaluate the accuracy of their method for measuring the relevant temporal signals. METHODS: The authors' evaluation method is based on the concept that any temporal signal can be represented by a Fourier series of weighted sinusoids. A sinusoidal phantom was developed by varying the concentration of iodine as successive steps of a sine wave. Each step corresponding to a different dilution of iodine contrast solution contained in partitions along a cylinder. By translating the phantom along the axis at different velocities, sinusoidal signals at different frequencies were generated. Using their image acquisition and reconstruction algorithm, these sinusoidal signals were imaged with a C-arm system and the 3D volumes were reconstructed. The average value in a slice was plotted as a function of time. The phantom was also imaged using a clinical CT system with 0.5 s rotation. C-arm CBCT results using 6, 3, 2, and 1 scan sequences were compared to those obtained using CT. Data were compared for linear velocities of the phantom ranging from 0.6 to 1 cm∕s. This covers the temporal frequencies up to 0.16 Hz corresponding to a frequency range within which 99% of the spectral energy for all temporal signals in cerebral perfusion imaging is contained. RESULTS: The errors in measurement of temporal frequencies are mostly below 2% for all multiscan sequences. For single scan sequences, the errors increase sharply beyond 0.10 Hz. The amplitude errors increase with frequency and with decrease in the number of scans used. CONCLUSIONS: Our multiscan perfusion CT approach allows low errors in signal frequency measurement. Increasing the number of scans reduces the amplitude errors. A two-scan sequence appears to offer the best compromise between accuracy and the associated total x-ray and iodine dose.

Cerebral CT perfusion using an interventional C-arm imaging system: cerebral blood flow measurements.

BACKGROUND AND PURPOSE: CTP imaging in the interventional suite could reduce delays to the start of image-guided interventions and help determine the treatment progress and end point. However, C-arms rotate slower than clinical CT scanners, making CTP challenging. We developed a cerebral CTP protocol for C-arm CBCT and evaluated it in an animal study. MATERIALS AND METHODS: Five anesthetized swine were imaged by using C-arm CBCT and conventional CT. The C-arm rotates in 4.3 seconds plus a 1.25-second turnaround, compared with 0.5 seconds for clinical CT. Each C-arm scan had 6 continuous bidirectional sweeps. Multiple scans each with a different delay to the start of an aortic arch iodinated contrast injection and a novel image reconstruction algorithm were used to increase temporal resolution. Three different scan sets (consisting of 6, 3, or 2 scans) and 3 injection protocols (3-mL/s 100%, 3-mL/s 67%, and 6-mL/s 50% contrast concentration) were studied. CBF maps for each scan set and injection were generated. The concordance and Pearson correlation coefficients (ρ and r) were calculated to determine the injection providing the best match between the following: the left and right hemispheres, and CT and C-arm CBCT. RESULTS: The highest ρ and r values (both 0.92) for the left and right hemispheres were obtained by using the 6-mL 50% iodinated contrast concentration injection. The same injection gave the best match for CT and C-arm CBCT for the 6-scan set (ρ = 0.77, r = 0.89). Some of the 3-scan and 2-scan protocols provided matches similar to those in CT. CONCLUSIONS: This study demonstrated that C-arm CBCT can produce CBF maps that correlate well with those from CTP.

Interventional 4D motion estimation and reconstruction of cardiac vasculature without motion periodicity assumption.

Anatomical and functional information of cardiac vasculature is a key component in the field of interventional cardiology. With the technology of C-arm CT it is possible to reconstruct static intraprocedural 3D images from angiographic projection data. Current approaches attempt to add the temporal dimension (4D). In the assumption of periodic heart motion, ECG-gating techniques can be used. However, arrhythmic heart signals and slight breathing motion are degrading image quality frequently. To overcome those problems, we present a reconstruction method based on a 4D time-continuous B-spline motion field. The temporal component of the motion field is parameterized by the acquisition time and does not assume a periodic heart motion. The analytic dynamic FDK-reconstruction formula is used directly for the motion estimation and image reconstruction. In a physical phantom experiment two vessels of size 3.1mm and 2.3mm were reconstructed using the proposed method and an algorithm with periodicity assumption. For a periodic motion both methods obtained an error of 0.1mm. For a non-periodic motion the proposed method was superior, obtaining an error of 0.3mm/0.2mm in comparison to 1.2mm/1.0mm for the algorithm with periodicity assumption. For a clinical test case of a left coronary artery it could be further shown that the method is capable to produce diameter measurements with an absolute error of 0.1mm compared to state-of-the-art measurement tools from orthogonal coronary angiography. Further, it is shown for three different clinical cases (left/right coronary artery, coronary sinus) that the proposed method is able to handle a large variability of vascular structures and motion patterns. The complete algorithm is hardware-accelerated using the GPU requiring a computation time of less than 3min for typical clinical scenarios.

[Compliance of the normal-sized aorta in adolescents with Marfan syndrome: comparison of MR measurements of aortic distensibility and pulse wave velocity]. / Compliance der morphologisch unauffälligen Aorta bei Jugendlichen mit Marfan Syndrom: Vergleich von MR-Messungen der aortalen Dehnbarkeit und der Pulswellengeschwindigkeit.

PURPOSE: To compare the aortic compliance of the normal-sized aorta of adolescents with Marfan syndrome and healthy controls using MR measurements of the aortic distensibility and pulse wave velocity. MATERIALS AND METHODS: Fourteen patients (median age: 15 years) and 11 healthy subjects (23 [12 - 32] years) were examined at 1.5 T. The MR protocol included 2D steady-state free precession (SSFP)-CINE MRI of the aortic distensibility and PC-MRI of the pulse wave velocity. All measurements were positioned perpendicular to the descending aorta at the level of the diaphragm for assessing the changes in the aortic cross-sectional areas and additionally above and below this plane for assessing the pulse wave velocity. In addition contrast-enhanced 3D-MR angiography was performed in adolescents with Marfan syndrome to exclude morphologic changes and to prove normal-sized aorta. RESULTS: Compared with control subjects, adolescents with Marfan syndrome had significantly decreased distensibility and significantly increased pulse wave velocity (chi (2)-test, p = 0.0002) using an age-related non-linear regression analysis. The related aortic compliance was significantly decreased (chi (2)-test, p = 0.0002). There was a good correlation between the two methods (r = 0.86). A low intraobserver variability was found for both methods (< or = 2 %). CONCLUSIONS: MRI allows detecting abnormal elastic aortic wall properties already in the normal-sized aorta of adolescents with Marfan syndrome. Monitoring of these properties could be relevant for evaluating disease onset and progression. MRI has the potential value of compliance measurements for the follow-up and to guide therapy indications.

Perfusion CT in patients with advanced bronchial carcinomas: a novel chance for characterization and treatment monitoring?

Advanced bronchial carcinomas by means of perfusion and peak enhancement using dynamic contrast-enhanced multislice CT are characterized. Twenty-four patients with advanced bronchial carcinoma were examined. During breathhold, after injection of a contrast-medium (CM), 25 scans were performed (1 scan/s) at a fixed table position. Density-time curves were evaluated from regions of interest of the whole tumor and high- and low-enhancing tumor areas. Perfusion and peak enhancement were calculated using the maximum-slope method of Miles and compared with size, localization (central or peripheral) and histology. Perfusion of large tumors (> 50 cm3) averaged over both the whole tumor (P = 0.001) and the highest enhancing area (P = 0.003) was significantly lower than that of smaller ones. Independent of size, central carcinomas had a significantly (P = 0.04) lower perfusion (mean 27.9 ml/min/100 g) than peripheral ones (mean 66.5 ml/min/100 g). In contrast, peak enhancement of central and peripheral carcinomas was not significantly different. Between non-small-cell lung cancers and small-cell lung cancers, no significant differences were observed in both parameters. In seven tumors, density increase after CM administration started earlier than in the aorta, indicating considerable blood supply from pulmonary vessels. Tumor perfusion was dependent on tumor size and localization, but not on histology. Furthermore, perfusion CT disclosed blood supply from both pulmonary and/or bronchial vessels in some tumors.

Quantitative and qualitative assessment of left ventricular volume with ECG-gated multislice spiral CT: value of different image reconstruction algorithms in comparison to MRI.

PURPOSE: To assess the value of different image reconstruction algorithms for assessment of the left ventricular function using retrospectively ECG-gated multislice spiral computed tomography (MSCT) of the heart. MATERIAL AND METHODS: MSCT and cine magnetic resonance (MR) imaging of the heart were performed in 15 patients. For MSCT, standard and multisegmental image reconstruction with improved temporal resolution were used. Standardized multiplanar reformats in the short axis and long axis views were reconstructed from MSCT data. End-systolic (ESV) and end-diastolic volume (EDV), stroke volume (SV), ejection fraction (EF) and myocardial mass (MM) were calculated. Left ventricular wall motion was assessed qualitatively. RESULTS: MSCT was in acceptable agreement with MR imaging for quantification of the ventricular function. According to the Bland-Altman approach the mean differences for the left ventricular volumes (ESV, EDV, SV) ranged from -9.6 ml to 3.1 ml with standard image reconstruction and from -0.6 ml to 1.9 ml utilizing multisegmental image reconstruction with limits of agreement ranging from -26.6 ml to 12.5 ml and -15.6 ml to 15.0 ml, respectively. Applying the multisegmental image reconstruction algorithm, a significantly improved agreement with the MR data was found for EDV, SV and EF. For wall motion analysis, standard image reconstruction showed a significant difference to MR imaging with a correspondence in 83.75% of the 240 assessed segments, while multisegmental image reconstruction agreed with MR imaging in 92.5% of the segments. CONCLUSION: Multisegmental image reconstruction improves the quantitative assessment of left ventricular function when compared to standard image reconstruction. Multisegmental image reconstruction allows qualitative wall motion analysis.

Aortic elasticity measurement using ECG-gated multi-slice computed tomography.

Vessel elasticity is a functional parameter of the vessel wall which is correlated with cardiovascular disease. Non-invasive measurement of elasticity is difficult. The aim of this project was to develop a method to measure aortic elasticity using multi-slice computed tomography (CT). The method is based on the reconstruction of time-resolved images of the aortic cross-section from CT raw data and ECG data. It can be integrated into a standard CT angiography examination without the need for additional radiation dose. The method was validated using a phantom set-up with porcine aortic specimens. Results show a good agreement between an optical reference and the CT measurement. Patient examinations show that changes in aortic wall distension can be measured and that these changes are reduced in patients with atherosclerosis.

Estimation of aortic compliance using magnetic resonance pulse wave velocity measurement.

A method for compliance estimation employing magnetic resonance pulse wave velocity measurement is presented. Time-resolved flow waves are recorded at several positions along the vessel using a phase contrast sequence, and pulse wave velocity is calculated from the delay of the wave onsets. Using retrospective cardiac gating in combination with an optically decoupled electrocardiogram acquisition, a high temporal resolution of 3 ms can be achieved. A phantom set-up for the simulation of pulsatile flow in a compliant vessel is described. In the phantom, relative errors of pulse wave velocity estimation were found to be about 15%, whereas in a volunteer, larger errors were found that might be caused by vessel branches. Results of pulse wave velocity estimation agree with direct aortic distension measurements which rely on a peripheral estimate of aortic pressure and are therefore less accurate. Studies in 12 volunteers show values of pulse wave velocity consistent with the literature; in particular the well-known increase in pulse wave velocity with age was observed. Preliminary results show that the method can be applied to aortic aneurysms.

[Optimizing temporal resolution in CT with retrospective ECG gating]. / Optimierung der Zeitauflösung in der CT mittels retrospektivem EKG-Gating.

PURPOSE: Spiral CT of the heart using the established ways of ECG synchronization is hampered by the relatively long acquisition times of 250 to 500 ms. This only allows to acquire diastolic images in patients with moderate heart rates. In this work, algorithms for time-optimized retrospective cardiac gating are presented, and their potential to improve temporal resolution is investigated. MATERIAL AND METHODS: These algorithms use data from multiple gantry rotations for image reconstruction, which is possible for multi-scans at fixed slice positions as well as for overlapping spiral scans. Temporal resolution was quantified using computer simulations and compared to experimental data from pigs. RESULTS: Using a conventional sub-second CT scanner, considerably higher temporal resolutions are possible with spiral scanning. A temporal resolution of 170 ms already provides systolic images with little motion artifacts. Higher temporal resolutions of up to 70 ms are demonstrated for multi-scans, which allows to depict ventricle wall movement over the complete cardiac cycle. DISCUSSION: The method of time-optimized retrospective cardiac gating broadens the spectrum of conventional spiral-CT for cardiac imaging. It can be directly transferred to multi-slice scanners. Here it can be used clinically because of reduced scan time. Potential applications are the determination of functional cardiac parameters like ejection fraction and the detection of disorders of ventricle wall movement.

General relation between variance-time curve and power spectral density for point processes exhibiting 1/f beta-fluctuations, with special reference to heart rate variability.

Counting statistics in the form of the variance-time curve provides an alternative to spectral analysis for point processes exhibiting 1/f beta-fluctuations, such as the heart beat. However, this is true only for beta < 1. Here, the case of general beta is considered. To that end, the mathematical relation between the variance-time curve and power spectral density in the presence of 1/f beta-noise is worked out in detail. A modified version of the variance-time curve is presented, which allows us to deal also with the case beta > or = 1. Some applications to the analysis of heart rate variability are given.

Improved reagent for detection of allantoin in thin-layer chromatographic method for urine stains on foods and packaging.

Ten detection reagents known to react with either primary amine groups or indole derivatives were tested to improve sensitivity for allantoin (ALN) and indican (IND) in the official AOAC thin-layer chromatographic method for urine metabolites (44.175-44.177). The lowest levels found using the official method were 500 ng ALN and 6 ng IND. The best reagent was p-dimethylaminocinnamaldehyde (pDMAC), which yielded intensely colored spots with both compounds. The lowest amounts consistently found were 125 ng ALN and 13 ng IND. pDMAC was also used as an overspray for ALN after the spray specified in the official method, p-dimethylaminobenzaldehyde (pDMAB), was applied. This resulted in a detection limit of 250 ng. The overspray procedure was incompatible with IND detection, but provided an easy way to gain slightly greater sensitivity for ALN when use of pDMAB gave negative or borderline results. The combined use of pDMAC for ALN, and the official sprays (pDMAB and sodium acetate) for IND, maximized sensitivity for both compounds.

Improved spray reagent for thin layer chromatographic method for detecting uric acid: collaborative study.

A collaborative study was conducted to validate the substitution of an improved single spray in the official AOAC thin layer chromatographic method for identifying uric acid (UA) from bird and insect excreta. The proposed reagent, which is a dilute aqueous solution of ferric chloride and potassium ferricyanide, requires neither a heating step nor a pH indicator. Its preparation time, specificity, and sensitivity to low levels (5-50 ng) of UA were compared with those of the official sprays. The improved spray took 1/5 as long to prepare as the official sprays. Neither the proposed spray nor the official sprays gave false positive reactions with compounds similar to UA. For bird and insect excreta samples, at the 95% confidence limits, the false negative rate was between 0 and 9.7% for the proposed spray and between 0.7 and 18.7% for the official sprays. Sensitivity results showed that the proportion positive for the proposed spray was significantly higher (P less than 0.05) than for the official sprays at the 15 ng UA level. The proposed changes have been adopted official first action.

Extraction of light filth from whole peppermint leaves: collaborative study.

Results are reported for a collaborative study of a method for the extraction of light filth from whole peppermint leaves. A 5 g sample is defatted with isopropanol in a simple reflux appartus. Rat hairs, insect fragments, and whole insects are isolated by wet sieving on a No. 230 sieve, a deaerating boil in 40% isopropanol solution, flotation with Tween 80-Na4EDTA (1 + 1) and mineral oil-heptane (85 + 15), and trappings in a Wildman trap flask. Average recoveries obtained by 6 collaborators for 3 spike levels of rat hairs (5, 10, 15) were 83.3, 87.5, and 82.2%, respectively. For whole insects (5, 10, 15) recoveries averaged 85.0, 80.0 and 77.2% respectively; for insect fragments (20, 30, 50) recoveries averaged 79.6, 88.3, and 84.8%, respectively. The average recoveries for the 3 levels of each analyte were not significantly different. The method has been adopted official first action.

Extraction of light filth from canned green leafy vegetables: collaborative study.

The official first action method, 44.108, for the extraction of light filth from whole or chopped canned greens specifies a water-heptane flotation that results in the flotation of an excessive amount of interfering plant material and in low recoveries. A new method has been developed using a 40% isopropanol-water-mineral oil flotation. The new method yielded a decreased amount of plant material and 84.9% recovery of the aphid spike compared with 42.5% recovery of the spike by the official method. The new method has been adopted as official first action to replace the existing method, except for broccoli.

Investigations into the determination of the cytotoxicity of quartz dust by physical methods.

The methods of thermally stimulated luminescence (t.s.l), thermally stimulated exoelectron emission (t.s.e.e.), electron spin resonance (e.s.r), and infrared spectroscopy (i.r.) have been used to investigate whether the specific cytotoxic activities of SiO2 dust of various origins can be attributed to physical parameters. After interaction of toxic dusts with water an increase in the intensity of the t.s.l. peaks below room temperature has been detected whereas no effect could be observed in the case of inert materials. Dusts of weak cytotoxicity have been characterized by infrared absorption bands at 3610 cm-1 and 3685 cm-1. The results of the present studies emphasize the significance of silanol groups and adsorption properties in relation to the fibrogenic activity of quartz dusts.

Modification of antityphus antibodies on passage through the gut of the human body louse with discussion of some epidemiologic and evolutionary implications.

Evidence is presented to indicate that proteolytic and perhaps other enzymes of the louse midgut, essential to the nutrition of the louse, perform molecular dissection on the antirickettsial antibodies present in the blood of a typhus-immune host that selectively destroys, along with other functions, the portion of the antibody that determines the only known function by which antirickettsial antibodies may operate in host defense mechanisms, namely, opsonization of rickettsiae for enhanced ingestion by professional phagocytes and subsequent destruction. The epidemiologic significance of these findings is discussed in relation to the progressive destruction of cells that produce digestive enzymes of the louse midgut that occurs with progressive rickettsial infection, and the possibility of a negative feedback mechanism in transmission is introduced. Speculations that involve evolutionary concepts of both convergent and divergent varieties with respect to rickettsiae, potentially operational in a system that consists of an obligate blood-sucking arthropod vector and a vertebrate host capable of adaptive responses to both vector and rickettsial agent, are presented.