Esophageal scintigraphy: reproducibility and normal ranges.

Esophageal scintigraphy has been rather widely used, but much debated as a simple screening method of esophageal dysfunction. However, reports of normal ranges, age dependence and reproducibility are very limited. We studied 60 healthy subjects with a mean age of 43 yr (26, 19, 15 subjects aged 20-39, 40-59, and 60-79 yr) to establish normal ranges and variations of esophageal mean transit time and residual activity measured by a radionuclide method using [99mTc] pertechnetate labeled water. Mean transit time was calculated by Zierler's formula. The median values and 95% percentiles of single measurements of MTT and residual activity in the supine position were 6.1 (3.2-11.5) sec and 11.5 (3.0-50)%, respectively. The coefficients of variation (CV) were 20%-35% for mean transit time and 85%-120% for residual activity in the sitting and supine positions. When double measurements were used, the CVs were reduced to 10% for MTT and 40% for residual activity in the supine position. The values did not change with age except for a higher frequency of spikes in subjects over 40 yr. The study has demonstrated that mean transit time for radiolabeled water in the esophagus of healthy subjects, measured by double determinations, has rather low, age-independent, interobserver and intersubject variabilities. In contrast, measurements of residual activity shows unacceptably high variations.

A two-compartment phantom for VOI profile measurements in small-bore 31P MR spectroscopy.

A two-compartment gel phantom for VOI profile measurements in volume-selective 31P spectroscopy in small-bore units is presented. The phantom is cylindrical with two compartments divided by a very thin (30 microm) polyethene film. This thin film permits measurements with a minimum of susceptibility influences from the partition wall. The phantom was used for evaluation of the volume selection method ISIS (image-selected in vivo spectroscopy). The position of the phantom was fixed in the magnet during the measurements, while the volume of interest (VOI) was moved stepwise over the border. The signal from the two compartments was measured for each position and the data were evaluated following differentiation. We have found this phantom suitable for VOI profile measurements of ISIS in small-bore systems. The phantom forms a useful complement to recommended phantoms for small bore-spectroscopy.

In vivo magnetic resonance diffusion measurement in the brain of patients with multiple sclerosis.

Measurement of water self-diffusion in the brain in 25 patients with multiple sclerosis was performed by magnetic resonance imaging. Quantitative diffusion measurements were obtained using single spin-echo pulse sequences with pulsed magnetic field gradients of different magnitude. Twenty-two of these patients also underwent measurement of the transverse relaxation time (T2). Only one plaque was evaluated in each patient. Based on prior knowledge, 12 plaques were classified as being 3 mo or less in age, and 7 plaques were classified as being more than 3 mo old. In all 25 plaques, water self-diffusion was found to be higher than in apparently normal white matter. Furthermore, water self-diffusion was found to be higher in acute plaques compared with chronic plaques. Finally, a slight tendency toward a relationship between the diffusion capability and T2 was found. We believe that an increased diffusion capability signifies an increase of the extracellular water space, which probably is related to the degree of demyelination. Thus, measurement of water self-diffusion in multiple sclerosis plaques may contribute to the study of pathogenesis of demyelination.

The concentration of N-acetyl aspartate, creatine + phosphocreatine, and choline in different parts of the brain in adulthood and senium.

The fully relaxed water signal was used as an internal standard in a STEAM experiment to calculate the concentrations of the metabolites: N-acetyl aspartate (NAA), creatine + phosphocreatine (Cr + PCr), and choline (Cho) containing compounds in four different parts of the brain in two age groups of healthy volunteers (20-30 yr, n = 8) and (60-80 yr, n = 8). Furthermore, T1 and T2 relaxation time of the metabolites and signal ratios: NAA/Cho, NAA/Cr + PCr, and Cho/Cr + PCr at TE = 272 msec were calculated. The experiments were carried out using a Siemens Helicon SP 63/84 wholebody MR-scanner at 1.5 T. In the younger age group, the concentration of NAA was significantly higher in the occipital part than in the other three parts of the brain. No significant regional variation was found for any other metabolite concentration. There was a significantly higher concentration of NAA in the occipital part of the brain in the younger age group compared to the older one. No significant regional or age dependent variation was found concerning the T1 and T2 relaxation times.

In vivo quantification of brain metabolites by 1H-MRS using water as an internal standard.

The reliability of absolute quantification of average metabolite concentrations in the human brain in vivo by 1H-MRS using the fully relaxed water signal as an internal standard was tested in a number of in vitro as well as in vivo measurements. The experiments were carried out on a SIEMENS HELICON SP 63/84 wholebody MR-scanner operating at 1.5 T using a STEAM sequence. In vitro studies indicate a very high correlation between metabolite signals (area under peaks) and concentration, R = 0.99 as well as between metabolite signals and the volume of the selected voxel, R = 1.00. The error in quantification of N-acetyl aspartate (NAA) concentration was about 1-2 mM (6-12%). Also in vivo a good linearity between water signal and selected voxel size was seen. The same was true for the studied metabolites, N-acetyl aspartate (NAA), creatine/phosphocreatine (Cr/PCr), and choline (Cho). Calculated average concentrations of NAA, Cr/PCr, and Cho in the occipital lobe of the brain in five healthy volunteers were (mean +/- 1 SD) 11.6 +/- 1.3 mM, 7.6 +/- 1.4 mM, and 1.7 +/- 0.5 mM. The results indicate that the method presented offers reasonable estimation of metabolite concentrations in the brain in vivo and therefore is useful in clinical research.

A method for MR quantification of flow velocities in blood and CSF using interleaved gradient-echo pulse sequences.

The aim of this study was to establish a rapid method for in vivo quantification of a large range of flow velocities using phase information. A basic gradient-echo sequence was constructed, in which flow was encoded along the slice selection direction by variation of the amplitude of a bipolar gradient without changes in sequence timings. The influence of field inhomogeneities and eddy currents was studied in a 1.5 T interleaved sequences for calibration and in vivo flow determination were constructed, and flow information was obtained by pairwise subtraction of velocity-encoded from velocity non-encoded phase images. Calibration was performed in a nongated mode using flow phantoms, and the results were compared with theoretically calculated encoding efficiencies. In vivo flow was studied in healthy volunteers in three different areas using cardiac gating; central blood flow in the great thoracic vessels, peripheral blood flow in the popliteal vessels, and flow of cerebrospinal fluid (CSF) in the cerebral aqueduct. The results show good agreement with results obtained with other techniques. The proposed method for flow determination was shown to be rapid and flexible, and we thus conclude that it seems well suited for routine clinical MR examinations.

Effect of sucralfate on gastroesophageal reflux in esophagitis.

Gastroesophageal reflux was assessed in 18 patients with endoscopically and histologically verified esophagitis, and 15 asymptomatic normal subjects, by a portable receiving system. The qualitative evaluation of the frequency of reflux episodes, normalized mean pH, normalized mean [H+] and the acid clearance rate is found to be indicative of gastroesophageal reflux. Twelve weeks of treatment with sucralfate in an open clinical trial resulted in a significant reduction of gastroesophageal reflux and the elimination of esophageal mucosal damage. Barrett++'s epithelium was found in a rather high proportion and proved to be resistant to treatment. It is suggested that the observed improvement is due to the barrier protecting properties of sucralfate restoring the motor function of the distal esophagus.

Changes in eye position during growth and adult life as based on exophthalmometry, interpupillary distance, and orbital distance measurements.

The association between eye position and age is analysed in a material comprising 267 subjects aged 5-20 years and 187 aged 21-80. The study was prompted by a previous longitudinal finding of a 3 mm increase in exophthalmometry value from age of 10 to 18 years, and by a literature almost devoid of similar investigations in young age groups. The increase in Hertel value during growth could be confirmed. An adult mean value of 16.0 mm in females and 16.6 mm in males was achieved in late teen-age years, the level being stable after that. The adult range was 11-23 mm. After a similar marked increase in the young, interpupillary distance and orbital width also showed some slight trends in adults. A suggested decrease in orbital width towards old age was consistent with a secular trend, while a concomitant increase in interpupillary distance was unexpected, the combined result being a more divergent (relative) eye position with age (P less than 0.01). There was no significant correlation between exophthalmometry and refractive value. Fixed upper Hertel value limits of normal are hard to give; clinically it is the changes that matter. Modelling of facial bony structures and soft tissue contours is discussed.

Changes in refraction and corneal curvature during growth and adult life. A cross-sectional study.

A cross-sectional analysis was performed regarding refractive value (spherical equivalent) and keratometry in a sample comprising 454 subjects aged 5-80 years. The refractive range was + 5.5 to -6.75D. According to the requirements of a parallel study of eye position and age, eyes with excessive ametropia had been excluded, but otherwise the sample was considered refractively unselected. Concerning refractive distribution, the present data supplement previous investigations of adults by the first author. Myopia increased from 6% in the age group 5-10 years to a peak level about 35% in adults aged 20-40, with a subsequent decrease towards old age, where hypermetropia showed a significantly increasing share. Concerning corneal curvature radius, male and female mean values (7.93 and 7.75 mm) showed no variation through the age span under study, however with a tendency of decreasing at old age (significantly in males only). The possible association with refractive change by age is discussed. Corneal astigmatism showed the established shift from predominantly with-rule in the very young to more against-rule and oblique astigmatism cases in older subjects.

In vivo quantification of the unidirectional influx constant for Gd-DTPA diffusion across the myocardial capillaries with MR imaging.

The authors present an in vivo method for measuring the unidirectional influx constant (Ki) for gadolinium diethylenetriaminepentaacetic acid (DTPA) diffusion across the capillary membrane in the human myocardium with magnetic resonance imaging. Ki is related to the extraction fraction (E) and the perfusion (F) by the equation Ki = E.F.Ki was obtained by using the longitudinal relaxation rate (R1) as a measure of the myocardial concentration of Gd-DTPA in the mathematical model for transcapillary transport across capillary membranes. Myocardial enhancement after Gd-DTPA injection was followed by using inversion-recovery Turbo-FLASH (fast low-angle shot) images obtained in real time. The results were comparable to those obtained from studies with positron emission tomography in humans and invasive studies in animals. A method for obtaining the input function noninvasively is also presented. Comparison with direct arterial blood sampling showed that the noninvasive input function may be even more accurate with regard to timing and curve shape than the invasive input function. The procedure may therefore prove useful in clinical studies.

A new H+ suppressor: RP 40 749 versus placebo and cimetidine. Ambulatory 48-hour intragastric pH monitoring in normal men.

Six normal male test persons had nasogastric glass electrodes placed in the antrum for four periods of 48 h each, separated by wash-out periods of 9 days. The electrodes were connected to a portable pH-monitoring system enabling continuous pH recording and storing during and after four different drug or placebo treatments arranged in a double-blind, cross-over experimental design. Data were read out and stored in a computer for later analysis. RP 40 749, a new gastric acid secretion inhibitor acting within the parital cell, raised the median 24-h intragastric pH significantly not only during medication but also during the day after its discontinuation. It also proved to be a significantly more potent H+ suppressor than cimetidine. The same was true for inhibition of nocturnal intragastric acidity, for which cimetidine seemed comparably ineffective. The efficacy of RP 40 749 is comparable to that of omeprazole.

Fourier analysis of cerebrospinal fluid flow velocities: MR imaging study. The Scandinavian Flow Group.

An interleaved pseudocinematographic FLASH (fast low-angle shot) sequence with additional pulsed gradients for flow encoding was used to quantify cerebrospinal fluid (CSF) flow velocities and CSF production. Flow-dependent phase information was obtained by subtracting two differently encoded phase images. The phase information in the resultant image was converted to flow velocity with a calibration curve with the slope 26.5 radian.m-1.sec. The velocity versus time function was Fourier transformed and a continuous curve was fitted to the measured data with use of the first three harmonics. The in vivo measurements showed a significant variation in flow velocities in the cerebral aqueduct (range, 6-51 mm/sec). Calculated CSF production was in the range of 0.6-1.2 L/24 h. The present method gives valuable information about CSF hydrodynamics in an imaging time of less than 8 minutes.

Combined left and right ventricular volume determination by radionuclide angiocardiography using double bolus and equilibrium technique.

Eighteen patients with ischaemic heart disease were studied. Left and right ventricular volumes including cardiac output (forward flow) were determined by radionuclide angiocardiography using a double bolus and equilibrium technique. As reference, cardiac output was simultaneously measured by indicator dilution. The radionuclide technique comprised four steps: (1) a first-pass study of right ventricle; (2) a bolus study of left ventricle; (3) an equilibrium study of left ventricle; (4) determination of the distribution volume of red blood cells. Absolute volumes of left ventricle were determined from steps 2 + 3 + 4. Absolute volumes of right ventricle were calculated from stroke volume and right ventricular ejection fraction (EF) which in turn was determined from step 1 by creating composite systolic and composite diastolic images. There was an acceptable agreement between stroke volume determinations by radionuclide angiocardiography and indicator dilution (r = 0.74; P less than 0.001). Stroke volume determination by radionuclide was 83 +/- 20 ml (mean +/- SD) and by indicator dilution 84 +/- 20 ml with a difference of -1 +/- 15 ml (NS). Cardiac output determination by radionuclide was 5.24 +/- 1.37 l min-1 and by indicator dilution 5.28 +/- 1.23 l min-1 with a difference of -0.04 +/- 0.95 l min-1 (NS). Left ventricular EF was 0.44 +/- 0.14 and right ventricular EF 0.57 +/- 0.10. The intra-observer coefficient of variation for duplicate calculations of the radionuclide determinations was 5.5% for stroke volume, 2.5% for left ventricular EF and 4.8% for right ventricular EF.

Evaluation of right ventricular volumes measured by magnetic resonance imaging.

Right ventricular volumes were determined in 12 patients with different levels of right and left ventricular function by magnetic resonance imaging (MRI) using an ECG gated multisection technique in planes perpendicular to the diastolic position of the interventricular septum. Right ventricular stroke volume was calculated as the difference between end-diastolic and end-systolic volume and compared to left ventricular stroke volume and to stroke volume determined simultaneously by a classical indicator dilution technique. There was good agreement between right ventricular stroke volume determined by MRI and by the indicator dilution method and between right and left ventricular stroke volume determined by MRI. Thus, MRI gives reliable values not only for left ventricular volumes, but also for right ventricular volumes. By MRI it is possible to obtain volumes from both ventricles simultaneously in a noninvasive way and without exposing the patient to radiation.

Determination of flow velocities from magnetic resonance multiple spin-echo images. A phantom study.

The purpose of this study was to evaluate a method for the quantification of through-plane flow velocities by magnetic resonance imaging (MRI) from the flow characteristics of conventional multiple spin-echo (MSE) signals. Simulated inflow-outflow-dependent signals, as well as images of a flow phantom were generated and the logarithm of the flow-dependent signal value was plotted against echo time. The normalized slope of the resulting curve was calculated using a least-square fit to simulated and experimental data and was corrected for T2 relaxation effects by subtraction of a slope obtained at zero flow. After this correction, and with certain restrictions regarding the flow velocity (v), maximum number of echoes in the slope calculation and slice thickness (L), the normalized slope of the MSE signal becomes equal to the quotient v/L, and from this relation the flow velocity can be determined. The validity of the proposed method was examined for different flow velocities and for two opposite flow directions. The influence of the size of the region of interest and the number of spin echoes used in the calculation of the slope on the accuracy of the velocity determination was also studied. The sensitivity of the method to flow-induced phase changes was examined in the phantom by comparing the results obtained with different strengths of the slice-selective gradient as well as by comparing results from even-echo data with those from odd-echo data.(ABSTRACT TRUNCATED AT 250 WORDS)

Simultaneous electromyography and 31P nuclear magnetic resonance spectroscopy--with application to muscle fatigue.

The electromyogram (EMG) is often used to study human muscle fatigue, but the changes in the electromyographic signals during muscle contraction are not well understood in relation to muscle metabolism. The 31P NMR spectroscopy is a semi-quantitative non-invasive method for studying the metabolic changes in human muscle. The aim of this study was to develop a method by which EMG and NMR spectroscopy measurements could be performed simultaneously. All measurements were performed in a whole body 1.5 Tesla NMR scanner. A calf muscle ergometer, designed for use in a whole body NMR scanner, was used. The subject had the left foot strapped to the ergometer. The anterior tibial EMG was recorded by bipolar surface electrodes. A surface coil was strapped to the anterior tibial muscle next to the EMG electrodes. Simultaneous measurements of surface EMG and surface coil 31P NMR spectroscopy were performed in the scanner during an isometric submaximal voluntary contraction until exhaustion, in 6 normal volunteers. Concentrations of phosphocreatine (PCr), inorganic phosphate (P(i)) and pH were analysed together with root mean square (RMS) and median frequency of the EMG. The fatiguing contractions (endured 5-13 min) produced a rapid decline in PCr and pH accompanied by a rapid rise in P(i). The RMS was approximately constant until the normalized PCr concentration declined below 0.6-0.7 and the pH declined below 6.75-6.85; exceeding these metabolic limits was associated with a rapidly increasing RMS value (2-3 times the previous level by exhaustion). The median frequency declined linearly with time and was found to be highly linearly correlated with the pH value (r = 0.82).(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of relaxation time measurements by magnetic resonance imaging. A phantom study.

Several circumstances may explain the great variation in reported proton T1 and T2 relaxation times usually seen. This study was designed to evaluate the accuracy of relaxation time measurements by magnetic resonance imaging (MRI) operating at 1.5 tesla. Using a phantom of nine boxes with different concentrations of CuSO4 and correlating the calculated T1 and T2 values with reference values obtained by two spectrometers (corrected to MRI-proton frequency = 64 MHz) we found a maximum deviation of about 10 per cent. Measurements performed on a large water phantom in order to evaluate the homogeneity in the imaging plane showed a variation of less than 10 per cent within 10 cm from the centre of the magnet in all three imaging planes. Changing the gradient field strength apparently had no influence on the T2 values recorded. Consequently diffusion processes seem without significance. It is concluded that proton T1 and T2 relaxation times covering the majority of the biologic range can be measured by MRI with an overall accuracy of 5 to 10 per cent. Quality control studies along the lines indicated in this study are recommended.