Principles of nuclear magnetic resonance for medical application

Several important components must be combined to create an effective nuclear magnetic resonance (NMR) imaging system. The most imposing component is the magnet itself, which is most often either resistive or superconducting. In addition, the magnetic field gradient, radiofrequency (RF) coil, spectrometer, computer, and display system are critical factors that require special consideration before selecting an NMR system for a particular clinical usage. Although nuclear magnetic resonance and nuclear decay share a common object of interest (the nucleus), a number of differences between resonance and decay phenomena relating to information content and imaging techniques can be discussed. First, in NMR the frequency, and hence energy, of the detected electromagnetic radiation from a given nuclear type is dependent critically on the magnetic and molecular environment of the stimulated nuclei. This is contrasted to the situation in nuclear decay reactions, where the energy of gamma or positron emission is only weakly dependent on local factors. Thus in NMR, molecular information can be acquired without the use of external tracer molecules. In NMR energy exchange mechanisms (relaxation) take place on a microscopic scale, and hence local information is acquired by measuring relaxation times. Furthermore, the frequency output of an NMR experiment is transmitted to the detector with little change from its surroundings. This again differs from nuclear decay, where the observed spread of detected energies is a complex function of numerous interactions among the emitted radiation, the surrounding matter, and the detector, and energy exchange processes are spread in a random fashion over a large volume. However, this relative lack of interaction with matter in NMRs (RF) output comes at a price of sensitivity, since the energy level is orders of magnitude lower than that of gamma photons. In addition, the much longer wavelengths associated with such low energy radiation (on the order of meters) makes simple collimation used in gamma cameras impossible, and hence more complex means need to be used to locate the emitted signal spatially. Overall, the differences between NMR and nuclear decay are likely to lead to a complementary, rather than conflicting, relationship between the two sciences, with advantages to each depending on the questions being investigated. Which problems are best studied with what technique is an open question at this stage of development of NMR.     

Nuclear magnetic resonance imaging in central nervous system disease

From the preliminary work of many investigators, it appears that proton nuclear magnetic resonance (NMR) imaging will have wide application in the diagnostic assessment (and potential management) of patients with vascular, neoplastic, and demyelinating diseases of the central nervous system (CNS). Findings in isolated cases and small series suggest that NMR imaging may play a role in the evaluation of patients with other CNS conditions including hydrocephalus, malformations, infections, developmental and metabolic disorders, and degenerative processes. Because of the dynamic nature of disease processes involving the CNS, the precise meaning of NMR image parameters (rho, T1, and T2) remains unclear. A comprehensive study correlating NMR images in neurologic disease with precise neuropathologic examination is required. In the future, with accurate quantitative measurements of these NMR parameters, in vivo imaging may provide insight into the dynamic nature of neurologic disease.     

Thallium-201 as a myocardial imaging agent

The field of myocardial perfusion imaging has made many advances but still is in its infancy. The limitations in the technology at this time include limited instrument resolution of 6-9 mm, intrinsic at the energy of the mercury x-ray; significant Rayleigh scatter, which is particularly distrubing because this scatter cannot be removed by pulse-height analysis; and an effective half-life of thallium in the myocardium, which makes repeated imaging over a short period of time very difficult. Although hopes for the development of a technetium-labeled myocardial imaging tracer have burnt brightly, no new agents are presently in sight. Resolution with a technetium-labeled tracer would almost double that of thallium, and the dose that could be administered to the patient would increase by at least a factor of 4. The effective half-life of the tracer in the myocardium would permit multiple images to be obtained at least in the same day. Even with the limitations of the current techniques, however, myocardial perfusion imaging can make a real contribution to the care of the patients with heart disease. Thallium is now produced commercially and reasonably easily obtained. Extraction of thallium by the myocardium is probably somewhat, but not exactly, analogous to potassium. The tracer has major applications in defining shape and size of the heart, thickness of muscle, and especially myocardial ischemia and infarction. This review is aimed at providing a current perspective of these uses.     

Positron emission tomography in oncology--the Massachusetts General Hospital experience

Positron tomography has been used to measure blood flow, oxygen utilization, and glucose metabolism in soft-tissue tumors in rabbits and in human tumors in extremities. Both blood flow and oxygen utilization were increased in tumor in contrast to normal muscle tissue. Oxygen extraction fraction was, however, decreased in tumor. The most sensitive indicator of tumor growth was the glucose metabolic rate. The effect of irradiation was observed by blood flow measurements in human tumors and by blood flow and oxygen utilization in tumors in rabbits. Blood flow increased both in tumor and normal muscle tissue during irradiation and decreased afterwards. Oxygen utilization decreased in tumor and increased in normal tissue during irradiation.     

Of linens and laces—The eighth anniversary of the gated blood pool scan

Evaluation of ventricular performance is essential in the diagnosis and long-term management of patients with heart disease. This can be most easily performed clinically using simple tools. When more definitive objective assessment of cardiac function is indicated, the equilibrium gated blood pool study provides reliable angiographic evaluation of the heart. It will continue as a mainstay in the armamentarium of cardiology.