Scaphoid fractures and Kienbock's disease of the lunate: MR imaging with histopathologic correlation.

Thirteen patients with scaphoid fractures and four patients with Kienbock's disease of the lunate underwent magnetic resonance imaging (MRI) prior to surgery. A total of 28 specimens had MR-histologic correlation. Biopsy specimens obtained by curettage provided pathologic correlation. MRI proved accurate in prospective evaluation of bone viability for both scaphoid fractures and Kienbock's disease. Normal marrow signal was shown to correlate with the presence of osteoid and osteocytes on light microscopy and a surface layer of fluorescence reflecting tetracycline uptake in viable bone. Decreased marrow signal corresponded to non-viable trabeculae with scant osteoid, without osteocytes and no tetracycline labeling. By virtue of its accurate identification of avascular necrosis, MRI may prove valuable in predicting prognosis for patients with scaphoid fractures and Kienbock's disease of the lunate.

Blood pool and liver enhancement in CT with liposomal lodixanol: comparison with lohexol.

RATIONALE AND OBJECTIVES: The authors compared the time course and blood pool and hepatic enhancement of three different doses of liposomal iodixanol with those of iohexol. MATERIALS AND METHODS: A liposomal iodixanol formulation was prepared with 200 mg of iodine per milliliter total and 80 mg of iodine per milliliter encapsulated. Twelve normal New Zealand white rabbits divided into four groups received 75-, 100-, or 150-mg encapsulated iodine per kilogram doses of liposomal iodixanol or 2 mL/kg iohexol with 300 mg of iodine per milliliter. A liver section was scanned with serial computed tomography (CT) before the injection, immediately afterward, and at 1-minute intervals for 10 minutes. Region-of-interest measurements of the aorta and liver were plotted at each time point, and contrast enhancement was plotted as a function of time and iodine dose. RESULTS: All liposomal iodixanol doses produced greater liver enhancement than iohexol. Results were significant (P < .05) for 100 mg and 150 mg iodine per kilogram dose groups at time points beyond 2 minutes. Peak hepatic enhancement (change in attenuation) was 54.9 HU +/- 7.6 with iohexol, compared with 59.6 HU +/- 6.1, 73.3 HU +/- 3.6, and 104.1 HU +/- 8.8 for 75, 100, and 150 mg encapsulated iodine per kilogram doses, respectively. Hepatic enhancement increased rapidly after injection of liposomal iodixanol, plateauing 2-3 minutes later. Blood pool enhancement decreased rapidly. Steady-state liver enhancement with liposomal iodixanol increased linearly with dose. Aortic enhancement was greater with iohexol. CONCLUSION: Liposomal iodixanol yielded greater hepatic enhancement at lower total iodine doses than iohexol. Although liver enhancement occurred rapidly after injection, blood pool enhancement was brief.

Interstitial MR and CT lymphography with Gd-dTPA-co-alpha, omega-diaminoPEG(1450) and Gd-dTPA-co-1,6-diaminohexane polymers: preliminary experience.

RATIONALE AND OBJECTIVES: The authors assessed the efficacy of two gadolinium-based polymers used as lymphotrophic contrast media for computed tomography (CT) and magnetic resonance (MR) imaging. MATERIALS AND METHODS: Two gadolinium-based polymers, gadolinium diethylenetriaminepentaacetic acid (DTPA)-co-1,6-diaminohexane (NC 22181) and Gd-DTPA-co-alpha, omega-diamino-polyethylene glycol(1450) (NC-66368), were formulated at a concentration of 80 mmol/L gadolinium. Doses of 0.1, 0.25, 1.0, or 2.0 mL per paw were administered subcutaneously into the hindpaws of normal rabbits. Spin-echo T1-weighted MR imaging (1.5 T) of rabbit popliteal and iliac nodes was performed before and immediately, 10 minutes, 2-3 hours, and 24 hours after injection. CT was performed 2-3 hours after injection of the high doses only. RESULTS: MR imaging revealed prompt enhancement of the popliteal nodes with both polymers at doses of 0.25 mL and above. For doses of 1.0 mL or less per paw, nodal percentage enhancement was maximal at 2 hours and then declined at 24 hours. At the highest doses, however, a reservoir of subcutaneous contrast material remained at the injection site and resulted in peak enhancement at 24 hours. At CT, popliteal node enhancement was faintly visible 2-3 hours after the administration of NC 22181. At lower doses, no enhancement was appreciable at CT. CONCLUSION: At 80 mmol/L formulations, the two gadolinium-based polymers provide excellent popliteal nodal enhancement on MR images. In addition, high doses of one polymer (NC 22181) were sufficiently concentrated in popliteal nodes to be visible on CT scans. Thus, this agent may be useful for both CT and MR lymphography.

Pictorial essay: solitary fibrous tumor of the pleura.

Solitary fibrous tumor of the pleura (previously known as benign fibrous mesothelioma or pleural fibroma) can have a wide variety of appearances on imaging examinations. This essay reviews some of the lesion's more dramatic features.

Tissue harmonic imaging techniques: physical principles and clinical applications.

Tissue harmonic imaging (THI) is a new gray-scale sonographic technique that improves image clarity. Harmonics form within the insonated tissue as a consequence of nonlinear sound propagation. Imaging with endogenously formed harmonics means that the distorting layer of the body wall is traversed only once by the harmonic beam--during echo reception. Both image contrast and lateral resolution are improved in harmonic mode compared with conventional (fundamental mode) sonography. This article summarizes the physics and various implementations of harmonic imaging mode, and reviews the clinical applications that have emerged to date.

Thickened submucosal layer: a sonographic sign of acute gastrointestinal abnormality representing submucosal edema or hemorrhage. 2000 ARRS Executive Council Award II. American Roentgen Ray Society.

OBJECTIVE: We correlated the sonographic appearance of bowel wall thickening with the acuity of the underlying disease process. SUBJECTS AND METHODS: Sonograms of thickened bowel walls were reviewed in 37 patients with proven gastrointestinal abnormalities. Sonographic findings were correlated with clinical presentation, endoscopy, histology, laboratory data, barium studies, and CT. RESULTS: Twenty-eight patients presented acutely, and nine patients had chronic or subacute disease processes. Two of the 28 patients had concurrent acute and chronic processes. In 27 of 28 patients with acute processes, the abnormal bowel segments were characterized by an echogenic submucosal layer thicker than 2.5 mm. In contrast, nine patients with chronic or subacute processes had relatively uniform hypoechoic thickening of the bowel wall with loss of visualization of a discrete echogenic submucosal layer. CT was available for comparison in 30 of 37 patients. Of the 28 patients with acute abnormalities, the thickened echogenic submucosal layer on sonography corresponded to either low-attenuation submucosal edema (n = 25) or acute submucosal hemorrhage (n = 3). CONCLUSION: The finding of a thickened submucosal layer suggests an acute disease process of the bowel and corresponds to either submucosal edema or hemorrhage.

Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas.

OBJECTIVE: The objective of our study was to determine the value of using color and power Doppler sonography to reveal extrathyroidal feeding arteries in the detection of abnormal parathyroid glands. SUBJECTS AND METHODS: Forty-four patients with primary hyperparathyroidism were imaged prospectively with high-resolution gray-scale, color flow, and power Doppler sonography. The presence of extrathyroidal arteries supplying the adenomas was noted. All patients underwent subsequent neck exploration. The locations of the abnormal glands were recorded. RESULTS: At surgery, 51 abnormal parathyroid glands were removed in the 44 patients. Sonography correctly revealed an adenoma in 40 of the 44 patients. Likewise, sonography revealed 42 of the 51 adenomas. Nine false-negative and two false-positive interpretations of the sonograms were made. Thus, overall sensitivity was 83%, specificity was 98%, and accuracy was 94%. Three of the false-negative interpretations were ectopic glands within the superior mediastinum. Excluding these three glands from analysis, the sensitivity for detection of adenomas within the neck was 88%, specificity was 98%, and accuracy was 95%. An extrathyroidal artery leading to a parathyroid adenoma was seen in 35 of the 42 adenomas revealed by sonography. The presence of an extrathyroidal artery leading to an adenoma was found to aid in the detection of an otherwise inconspicuous parathyroid gland in five patients, which improved sensitivity from 73% to 83%. CONCLUSION: Prominent vessels supplying parathyroid adenomas are frequently revealed by color flow and power Doppler sonography. These vessels can serve as "road maps" to abnormal parathyroid glands.

Brachial plexus: correlation of MR imaging with CT and pathologic findings.

Thirty-two patients with symptoms referable to the brachial plexus were evaluated with magnetic resonance (MR) imaging. Sixteen patients had undergone concurrent computed tomography (CT). MR imaging demonstrated normal findings in 16, 12 neoplasms, three cases of trauma, and one case of possible neural edema. Of the 16 patients with normal findings on MR images, eight had CT scans that were also normal. In one patient, MR images showed that the "mass" seen on CT was actually a tortuous blood vessel. In six of the 12 cases of neoplasm in which CT scans were available, MR imaging revealed more extensive disease. In the other six cases of tumor, MR imaging provided sufficient clinical information to obviate the need for CT or any other imaging modality. MR imaging provided definitive diagnoses in the three cases of trauma without further imaging. In one patient with paresthesia, MR imaging showed high signal intensity of the nerves on T2-weighted images, which was compatible with neural edema. A concurrent CT scan was normal.

Dynamics of tumor imaging with Gd-DTPA-polyethylene glycol polymers: dependence on molecular weight.

Macromolecular contrast media offer potential advantages over freely diffusible agents in magnetic resonance (MR) imaging outside the central nervous system. To identify an optimum molecular weight for macromolecular contrast media, the authors studied a novel macromolecular contrast agent, gadolinium diethylenetriaminepentaacetic acid polyethylene glycol (DTPA-PEG), synthesized in seven polymer (average) molecular weights ranging from 10 to 83 kd. Twenty-eight rabbits bearing V2 carcinoma in thighs underwent T1-weighted spin-echo imaging before injection and 5-60 minutes and 24 hours after injection of the Gd-DTPA-PEG polymers or Gd-DTPA at a gadolinium dose of 0.1 mmol/kg. Tumor region-of-interest measurements were obtained at each time point to determine contrast enhancement dynamics. Blood-pool enhancement dynamics were observed for the Gd-DTPA-PEG polymers larger than 20 kd. Polymers smaller than 20 kd displayed dynamics similar to those of the freely diffusible agent Gd-DTPA. Above the 20 kd threshold, tumor enhancement was more rapid for smaller polymers. The authors conclude that the 21.9-kd Gd-DTPA-PEG polymer is best suited for clinical MR imaging.

A multicenter, randomized, double-blind study to evaluate the safety, tolerability, and efficacy of OptiMARK (gadoversetamide injection) compared with Magnevist (gadopentetate dimeglumine) in patients with liver pathology: results of a Phase III clinical trial.

The purpose of this study was to evaluate the safety and efficacy of OptiMARK (gadoversetamide injection) compared with Magnevist (gadopentetate dimeglumine) in hepatic MRI of patients with suspected liver pathology. A Phase III, multicenter, randomized, double-blind, parallel group study was performed in adults with suspected liver pathology. All patients underwent contrast-enhanced computed tomography within 3 weeks prior to magnetic resonance scanning. Ninety-nine patients received OptiMARK, and 94 patients received Magnevist at a dose of 0.1 mmol/kg. Precontrast T1- and T2-weighted spin-echo imaging and T1-weighted gradient-echo imaging were performed, followed by T1-weighted gradient-echo imaging at 15-20 seconds, 1 minute, and 5 minutes after intravenous contrast injection. Three primary efficacy endpoints (confidence in lesion diagnosis, level of conspicuity, and lesion border delineation) were evaluated on the precontrast image set and compared with the pre plus postcontrast image set. Vital signs, physical examination, electrocardiograms (ECGs), and laboratory parameters (chemistry, hematology, and urinalysis) were measured at various time points. Adverse events were recorded. The study design and statistical analyses were chosen to demonstrate presumed equivalence of OptiMARK and Magnevist. There were no statistically significant differences in efficacy between OptiMARK and Magnevist as assessed by either blinded readers or the on-site principal investigators. No serious or unexpected adverse events were noted. Of the 193 patients receiving contrast media, 82 experienced a total of 154 adverse events. Thirty-three (21.4%) of these 154 adverse events were felt by the on-site investigators to be probably related to either study agent: 15 events in 9 patients in the OptiMARK group, and 18 events in 13 patients in the Magnevist group. Headache was the most common adverse event, occurring in 10.1% of the OptiMARK patients and 12.8% of the Magnevist patients. No clinically relevant trends were observed in any laboratory parameter or ECG findings in either treatment group. The results demonstrate the safety, efficacy, and equivalence of OptiMARK and Magnevist at a dose of 0.1 mmol/kg in hepatic magnetic resonance imaging of patients with suspected liver pathology.

Polymeric gadolinium chelate magnetic resonance imaging contrast agents: design, synthesis, and properties.

We have synthesized and evaluated five series of polymeric gadolinium chelates which are of interest as potential MRI blood pool contrast agents. The polymers were designed so that important physical properties including molecular weight, relaxivity, metal content, viscosity, and chelate stability could be varied. We have shown that, by selecting polymers of the appropriate MW, extended blood pool retention can be achieved. In addition, relaxivity can be manipulated by changing the polymer rigidity, metal content affected by monomer selection, viscosity by polymer shape, and chelate stability by chelator selection.