Quantitative assessment of left ventricular function: steady-state free precession MR imaging with or without sensitivity encoding

Quantitative left ventricular (LV) function was assessed with magnetic resonance imaging in 20 patients by using standard multisection multiphase steady-state free precession (SSFP) imaging and sensitivity encoding (SENSE)-accelerated cine SSFP imaging with identical spatial, contrast, and temporal resolution. The local institutional review board approved the protocol, and all patients gave signed informed consent prior to imaging. The study complied with the Health Insurance Portability and Accountability Act. Results of Bland-Altman analysis showed that both techniques produced similar estimates of LV ejection fraction, LV mass, and blood-to-muscle contrast and demonstrated minimal interobserver variability. The authors showed that it is possible, by combining SENSE with cine SSFP imaging, to reduce acquisition time by 50% without compromising spatial resolution, temporal resolution, or blood-to-muscle contrast-to-noise ratio compared with those achieved by using SSFP imaging without SENSE for quantitative LV function assessment.     

Cardiac sarcoidosis detected by delayed-hyperenhancement magnetic resonance imaging

We report the case of a patient with sarcoidosis and ventricular tachycardia in whom cardiac magnetic resonance imaging provided supportive evidence of cardiac involvement by delineating regions of myocardial inflammation and fibrosis inconsistent with ischemic injury. The identification of cardiac involvement in patients with sarcoidosis is problematic, and the true incidence is unknown. Cardiac magnetic resonance imaging may help establish the actual incidence of cardiac involvement and allow further advances in monitoring and treatment options.     

Parallel imaging in MR angiography

The recently developed techniques of parallel imaging with phased array coils are rapidly becoming accepted for magnetic resonance angiography (MRA) applications. This article reviews the various current parallel imaging techniques and their application to MRA. The increased scan efficiency provided by parallel imaging allows increased temporal or spatial resolution, and reduction of artifacts in contrast-enhanced MRA (CE-MRA). Increased temporal resolution in CE-MRA can be used to reduce the need for bolus timing and to provide hemodynamic information helpful for diagnosis. In addition, increased spatial resolution (or volume coverage) can be acquired in a breathhold (eg, in renal CE-MRA), or in otherwise limited clinically acceptable scan durations. The increased scan efficiency provided by parallel imaging has been successfully applied to CE-MRA as well as other MRA techniques such as inflow and phase contrast imaging. The large signal-to-noise ratio available in many MRA techniques lends these acquisitions to increased scan efficiency through parallel imaging.     

Exenatide decreases hepatic fibroblast growth factor 21 resistance in non-alcoholic fatty liver disease in a mouse model of obesity and in a randomised controlled trial

Aims/hypothesis

Systemic fibroblast growth factor (FGF)21 levels and hepatic FGF21 production are increased in non-alcoholic fatty liver disease patients, suggesting FGF21 resistance. We examined the effects of exenatide on FGF21 in patients with type 2 diabetes and in a diet-induced mouse model of obesity (DIO).

Methods

Type 2 diabetes mellitus patients (n?=?24) on diet and/or metformin were randomised (using a table of random numbers) to receive additional treatment consisting of pioglitazone 45 mg/day or combined therapy with pioglitazone (45 mg/day) and exenatide (10 μg twice daily) for 12 months in an open label parallel study at the Baylor Clinic.

Results

Twenty-one patients completed the entire study and were included in the analysis. Pioglitazone treatment (n?=?10) reduced hepatic fat as assessed by magnetic resonance spectroscopy, despite a significant increase in body weight (Δ?=?3.7 kg); plasma FGF21 levels did not change (1.9?±?0.6 to 2.2?±?0.6 ng/ml [mean±SEM]). However, combined pioglitazone and exenatide therapy (n?=?11) was associated with a significant reduction of FGF21 levels (2.3?±?0.5 to 1.1?±?0.3 ng/ml) and a greater decrease in hepatic fat. Besides weight gain observed in the pioglitazone-treated patients, lower extremity oedema was observed as a side effect in two of the ten patients. Three patients who received pioglitazone and exenatide combination therapy complained of significant nausea that was self-limiting and did not require them to leave the study. In DIO mice, exendin-4 for 4 weeks significantly reduced hepatic triacylglycerol content, decreased hepatic FGF21 protein and mRNA, and enhanced phosphorylation of hepatic AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase, although no significant difference in weight and body fat was observed. Hepatic FGF21 correlated inversely with hepatic AMPK phosphorylation

Conclusions/interpretation

In type 2 diabetes mellitus, combined pioglitazone and exenatide therapy is associated with a reduction in plasma FGF21 levels, as well as a greater decrease in hepatic fat than that achieved with pioglitazone therapy. In DIO mice, exendin-4 treatment reduces hepatic triacylglycerol and FGF21 protein, and enhances hepatic AMPK phosphorylation, suggesting an improvement of hepatic FGF21 resistance. Trial registration number: ClinicalTrials.gov NCT 01432405 Funding: American Diabetes Association, the Ron MacDonald Foundation at St Luke’s Episcopal Hospital, Amylin Pharmaceuticals, Eli-Lilly, NIH Molecular Medicine Scholars Training Grant, NIH Diabetes and Endocrinology Research Center (DERC) at Baylor College of Medicine, and the T.T. and W.F. Chao Foundation.

     

Segmented spin-echo pulses to increase fMRI signal: repeated intrinsic diffusional enhancement.

Since its inception, functional magnetic resonance imaging (fMRI) has seen rapid progress in the application to neuroscience. Common gradient-recalled acquisition methods are susceptible to static field inhomogeneities, resulting in signal loss at the medial temporal area important for memory function or at the basal ganglia area for motor control. In addition, they are susceptible to the contaminating signals of large vein origin, such as the signals from its surrounding cerebrospinal fluid (CSF) leading to false-positive activation. Spin echoes overcome these drawbacks. However, they are less sensitive to blood oxygenation level dependent (BOLD) susceptibility changes because of their refocusing mechanism. A method is presented here to enhance the spin-echo fMRI signal by recruiting more spins to participate in the dynamic BOLD process. This method divided a conventional T(2) weighting period into several segments separated by blocks of extra free diffusion time. Before the extra diffusion time spins are restored to the longitudinal axis preventing rapid transverse relaxation. This process allows more spin access to the regions that experience the BOLD field gradient. Because of the increased spin population that is modulated by the capillary BOLD field gradient, the functional signal is increased. Spin-echo echo-planar imaging (EPI) with this enhancement may be a useful technique for fMRI studies at inhomogeneous areas such as the air/tissue interface. Magn Reson Med 42:631-635, 1999.     

Evidence for current diagnostic criteria of diabetes mellitus

Diabetes mellitus is a non-communicable metabolic derangement afflicting several millions of individuals globally. It is associated with several micro and macrovascular complications and is also a leading cause of mortality. The unresolved issue is that of definition of the diagnostic threshold for diabetes. The World Health Organization and the American Diabetes Association (ADA) have laid down several diagnostic criteria for diagnosing diabetes and prediabetes based on the accumulating body of evidence.This review has attempted to analyse the scientific evidence supporting the justification of these differing criteria. The evidence for diagnosing diabetes is strong, and there is a concordance between the two professional bodies. The controversy arises when describing the normal lower limit of fasting plasma glucose (FPG) with little evidence favouring the reduction of the FPG by the ADA. Several studies have also shown the development of complications specific for diabetes in patients with prediabetes as defined by the current criteria though there is a significant overlap of such prevalence in individuals with normoglycemia. Large multinational longitudinal prospective studies involving subjects without diabetes and retinopathy at baseline will ideally help identify the threshold of glycemic measurements for future development of diabetes and its complications.     

Tissue characterization of myocardial infarction using T1rho: influence of contrast dose and time of imaging after contrast administration

PURPOSE: To determine whether contrast between acutely infarcted and normal myocardia in T1-rho-weighted cine TFE (T1rho-TFE) and delayed-enhancement (DE) images (measured using a metric percent enhancement (PE)) varied with the dose or time of imaging after contrast administration. MATERIALS AND METHODS: Eighteen patients with acute myocardial infarction (AMI) were randomly divided into three groups according to the dose of gadoversetamide (0.1, 0.2, or 0.3 mmol/kg) administered. After contrast administration, T1rho-TFE images were acquired at five and 40 minutes, and DE images were acquired at 10 and 30 minutes. RESULTS: For T1rho-TFE imaging the PE values at 40 minutes were 70+/-14, 98+/-14, and 105+/-41 at 0.1, 0.2, and 0.3 mmol/kg dose levels, which were significantly greater than the corresponding PEs at five minutes after contrast administration (44+/-12, 71+/-14, and 36+/-13). For DE and T1rho-TFE imaging the dose of contrast agent did not significantly affect the PE. However, with DE the PE tended to increase with the dose. At all dose levels, irreversible injury was more conspicuous in T1rho-TFE images acquired at 40 minutes than at five minutes after contrast. CONCLUSION: In T1rho-TFE, acute infarction was more conspicuous in images acquired at a later time point, and the PE did not vary with the contrast dose.