Accuracy of accelerated cine MR imaging at 3 Tesla in longitudinal follow-up of cardiac function

The ability of fast, parallel-imaging-based cine magnetic resonance (MR) to monitor global cardiac function in longitudinal exams at 3 Tesla was evaluated. Seventeen patients with chronic cardiac disease underwent serial cine MR imaging exams (n = 3) at 3 Tesla. Data were acquired in short-axis orientation using cine steady-state free precession (SSFP) with a spatial resolution of 2.5 x 1.9 mm(2) at 45 ms temporal resolution. Multislice imaging (three slices/breath-hold) was performed using TSENSE acceleration (R = 3) and standard single-slice cine (non-TSENSE) was performed at identical locations in consecutive breath-holds. End-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF) and myocardial mass (MM) of both cine approaches were compared for individual time-points as well as for longitudinal comparison. TSENSE-cine did not show significant differences for EDV (2.6 ml; P = 0.79), ESV (2.2 ml; P = 0.81), EF (-0.3%; P = 0.95) and MM (2.4 g; P = 0.72) in comparison with non-TSENSE. Longitudinal ANOVA analysis did not reveal significant differences for any parameter, neither for non-TSENSE data (all P > 0.7) nor for TSENSE data (all P > 0.9). Multifactorial ANOVA showed non-significant differences (all P > 0.7) at comparable data variances. Data acquisition was significantly shortened using TSENSE. Threefold accelerated multislice cine at 3 Tesla allows accurate assessment of volumetric LV data and accurate longitudinal monitoring of global LV function at a substantially shorter overall examination time.     

Perfusion CT compared to H<Subscript>2</Subscript><Superscript>15</Superscript>O/O<Superscript>15</Superscript>O PET in patients with chronic cervical carotid artery occlusion

INTRODUCTION: The purpose of this study was to compare the results of perfusion computed tomography (PCT) with those of (15)O(2)/H(2) (15)O positron emission tomography (PET) in a subset of Carotid Occlusion Surgery Study (COSS) patients. MATERIALS AND METHODS: Six patients enrolled in the COSS underwent a standard-of-care PCT in addition to the (15)O(2)/H(2) (15)O PET study used for selection for extracranial-intracranial bypass surgery. PCT and PET studies were coregistered and then processed separately by different radiologists. Relative measurement of cerebral blood flow (CBF) and oxygen extraction fraction (OEF) were calculated from PET. PCT datasets were processed using different arterial input functions (AIF). Relative PCT and PET CBF values from matching regions of interest were compared using linear regression model to determine the most appropriate arterial input function for PCT. Also, PCT measurements using the most accurate AIF were evaluated for linear regression with respect to relative PET OEF values. RESULTS: The most accurate PCT relative CBF maps with respect to the gold standard PET CBF were obtained when CBF values for each arterial territory are calculated using a dedicated AIF for each territory (R (2) = 0.796, p < 0.001). PCT mean transit time (MTT) is the parameter that showed the best correlation with the count-based PET OEF ratios (R (2) = 0.590, p < 0.001). CONCLUSION: PCT relative CBF compares favorably to PET relative CBF in patients with chronic carotid occlusion when processed using a dedicated AIF for each territory. The PCT MTT parameter correlated best with PET relative OEF.     

Giant arachnoid granulation in a patient with benign intracranial hypertension

We report magnetic resonance (MR), computed tomography (CT) and angiographic imaging of an unusual giant arachnoid granulation in the superior sagittal sinus in a man with headache and vertigo. Intrasinus pressure measurements revealed a significant pressure gradient across the lesion. MR imaging is useful to identify giant arachnoid granulation and dural sinus thrombosis, whereas dural sinus pressure measurement in certain cases of giant arachnoid granulations can be used to evaluate the lesion as the cause of the patient's symptoms.     

Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer

OBJECTIVE: To evaluate the diagnostic accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) relative to computed tomography (CT) for detecting metastatic cervical lymph nodes in patients with squamous cell carcinoma of the head and neck (HNSCC), and to ascertain the factors that affect this accuracy. METHODS: A total of 1076 lymph nodes obtained from 35 neck dissections in 26 HNSCC patients who preoperatively underwent both FDG-PET and CT were retrospectively analyzed. For pathological metastatic lymph nodes, the lymph node size (short-axis diameter), the ratio of intranodal tumor deposits, and the size of intranodal tumor deposits (maximum diameter of metastatic foci in each lymph node) were histologically recorded. RESULTS: Forty-six lymph nodes from 23 neck sides were pathologically diagnosed metastases. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET evaluated individually per neck side were 74%, 92%, 80%, 94%, and 65%, respectively, whereas those of CT were 78%, 58%, 71%, 78%, and 58%, respectively. FDG-PET detected 100% of metastatic lymph nodes > or =10 mm, intranodal tumor deposits > or =9 mm, and intranodal tumor deposits with a ratio >75%, whereas no nodes or tumor deposits smaller than 5 mm were detected. The spatial resolution limitations of FDG-PET were responsible for 16 of 20 (80%) false-negative PET results in lymph nodes. CONCLUSIONS: FDG-PET is a useful tool for preoperative evaluation of the neck because it accurately detects metastatic lymph nodes > or =10 mm and has fewer false-positive cases than CT. The high specificity of FDG-PET for lymph node metastases may play an important role in avoiding unnecessary neck dissection.     

Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol

Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.     

Standardized uptake values of uterine leiomyoma with <Superscript>18</Superscript>F-FDG PET/CT: variation with age,size, degeneration,and contrast enhancement on MRI

OBJECTIVE: To assess the effect of age, size, the degree of degeneration, and contrast enhancement on magnetic resonance imaging (MRI) on 18F-fluoro-2-deoxyglucose (18F-FDG) uptake in uterine leiomyomas using quantitative standardized uptake values (SUVs). METHODS: A total of 61 leiomyomas of 41 patients, who underwent combined positron emission tomography/computed tomography (PET/CT) using 18F-FDG and contrast-enhanced MRI were included in this study. Sixty-one leiomyomas were divided into two groups: "non-degenerated" leiomyomas showing distinct low signal intensity on T2-weighted images and intermediate signal intensity on T1-weighted images, and "degenerated" leiomyomas showing other types of signal intensity. Sixty-one leiomyomas were also divided into two groups of "strongly enhancing" leiomyomas and "weakly enhancing" leiomyomas in terms of their degree of contrast enhancement on MRI. RESULTS: The mean values of the maximum and average SUVs for the total of 61 leiomyomas were 2.34 +/- 0.75 (range 1.59-5.15) and 1.74 +/- 0.50 (0.66-3.95), respectively. There was a moderate negative correlation between the maximum and average SUVs and age (r = -0.43 and P = 0.00016, r = -0.31 and P = 0.029, respectively). Although there was a mild positive correlation between maximum SUV and size (r = 0.35 and P = 0.011), there was no significant difference between average SUV and size. Although there was no significant difference in average SUV between "degenerated" and "non-degenerated" leiomyomas, the maximum SUV of "degenerated" leiomyomas was significantly higher than that of "non-degenerated" leiomyomas (P = 0.0012). The degree of contrast enhancement on MRI was not significantly correlated with 18F-FDG uptake. CONCLUSIONS: Mild or moderate uptake of 18F-FDG is often observed in uterine leiomyoma and declines with age, and should not be confused with malignant accumulation.     

The influence of I-131 therapy on FDG uptake in differentiated thyroid cancer

OBJECTIVE: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) [or PET/computed tomography (CT)] is more likely to show false-negative results when it is performed shortly after chemotherapy and/or radiotherapy because of "metabolic stunning". The present study aimed to evaluate the influence of I-131 therapy on FDG uptake and the detection of recurrence or metastasis of differentiated thyroid cancer (DTC). METHODS: We retrospectively enrolled 16 consecutive FDG-PET/CT studies which had been performed in patients with DTC with elevated thyroglobulin (TG) but negative I-131 whole-body scan. All studies were performed under L: -thyroxine suppression. The patients were divided into groups A and B for PET/CT performed within 4 months of I-131 therapy or no such therapy, respectively. Each lesion identified on PET/CT was characterized using a 5-point scale by visual analysis: 0 = definitely benign, 1 = probably benign, 2 = equivocal, 3 = probably malignant, and 4 = definitely malignant. The maximum standardized uptake value (SUV max) in each lesion was also measured for semiquantitative analysis. We compared the visual grading and SUV max of the lesion of highest FDG uptake between groups A and B. RESULTS: For visual analysis, group B had significantly more patients with an uptake score of 3 or 4 than group A (80% vs. 17%, P = 0.01). In addition, there were significantly more equivocal results from group A than from group B (67% vs. 10%, P = 0.02). If the patients with the highest uptake scores of 2, 3, and 4 were considered to be positive for local recurrence or metastasis, there would be no significant difference between the positive rates of groups A and B (83% vs. 90%, P = 0.7). However, the mean SUV max of positive results was significantly lower for group A than for group B (3.1 +/- 0.9 and 6.6 +/- 3.5, respectively, P = 0.02). CONCLUSIONS: The preliminary results suggested that FDG uptake in DTC may be negatively influenced by I-131 therapy within 4 months, resulting in lower FDG uptake and more equivocal results. Further studies are necessary to determine whether it is secondary to "metabolic stunning" caused by I-131 therapy.     

Three-dimensional SPECT reconstruction with transmission-dependent scatter correction

OBJECTIVE: The quality of single-photon emission computed tomography (SPECT) imaging is hampered by attenuation, collimator blurring, and scatter. Correction for all of these three factors is required for accurate reconstruction, but unfortunately, reconstruction-based compensation often leads to clinically unacceptable long reconstruction times. Especially, efficient scatter correction has proved to be difficult to achieve. The objective of this article was to extend the well-known transmission-dependent convolution subtraction (TDCS) scatter-correction approach into a rapid reconstruction-based scatter-compensation method and to include it into a fast 3D reconstruction algorithm with attenuation and collimator-blurring corrections. METHODS: Ordered subsets expectation maximization algorithm with attenuation, collimator blurring, and accelerated transmission-dependent scatter compensation were implemented. The new reconstruction method was compared with TDCS-based scatter correction and with one other transmission-dependent scatter-correction method using Monte Carlo simulated projection data of (99m)Tc-ECD and (123)I-FP-CIT brain studies. RESULTS: The new reconstruction-based scatter compensation outperformed the other two scatter-correction methods in terms of quantitative accuracy and contrast measured with normalized mean-squared error, gray-to-white matter and striatum-to-background ratios, and also in visual quality. Highest accuracy was achieved when all the corrections (i.e., attenuation, collimator blurring, and scatter) were applied. CONCLUSIONS: The developed 3D reconstruction algorithm with transmission-dependent scatter compensation is a promising alternative to accurate and efficient SPECT reconstruction.     

Estimating the age of immature <Emphasis Type="Italic">Chrysomya albiceps</Emphasis> (Diptera: Calliphoridae), correcting for temperature and geographical latitude

Developmental curves for Chrysomya albiceps (Wiedemann) (Diptera: Calliphoridae) were established at 13 different constant temperatures using developmental landmarks and length as measures of age. The thermal summation constants (K) and developmental zeros (D (0)) were calculated for five developmental landmarks using the method described by Ikemoto and Takai (Environ Entomol 29:671-682, 2000). Comparison with the K and D (0) values of our findings to those of three previously published studies of C. albiceps suggests that K is directly proportional to geographic latitude, and D (0) is inversely proportional to both K and geographic latitude. Body size and developmental landmarks have a complex relationship because of trade-offs between mortality risk and female fecundity (as measured by body size) at non-optimal temperatures. This relationship can be summarized using superimposed isomorphen and isomegalen diagrams, which can then be used to make forensic estimates of postmortem intervals from larval body lengths. Finally, we recommend that future studies providing data for precise forensic estimates of postmortem intervals should use a relative temporal precision of about 10% of the total duration being measured. For many blowflies, this translates into a sampling interval of approximately every 2 h before hatching, 3 h before first ecdysis and 6 h before second ecdysis.     

Distal Embolic Protection for Renal Arterial Interventions

Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices. Dr. Murphy has support as follows: supported by grants HL071556-01 and HL077221 from the National Heart, Lung, & Blood Institute, and also received research grants from Boston Scientific, Guidant, Cordis, and Otsuka Pharmaceuticals.