Radiology

Duerinckx, A J; Grant, E G; Perrella, R R; Szeto, A; Tessler, F N

doi: N/Apmid: 2202011

To better understand portal vein pulsatility in congestive heart failure, the authors compared portal vein spectral patterns to right atrial pressures measured with a Swan-Ganz catheter in 17 adult patients suspected of having congestive heart failure. Portal vein pulsatility was also evaluated in 17 healthy adults. A pulsatility score (scale, 1-5) based on a ratio of minimum to peak portal vein velocity was assigned. A score of 1 indicated continuous, monophasic flow, while a score of 5 indicated that flow reversal was observed with each cardiac cycle. All 17 healthy volunteers had portal vein pulsatility scores of 2 or less. Among the 17 patients suspected of having congestive heart failure, seven had normal right atrial pressure (less than 10 mm Hg) and pulsatility scores of 2 or less. Among the 10 patients with a right atrial pressure of 10 mm Hg or greater, six had pulsatility scores of 3 or greater (sensitivity, 60%; specificity, 100%). Greater than 50% of the variation in portal vein score is explained by changes in right atrial pressure. Review of echocardiograms in 13 of 17 patients showed no significant correlation between the degree of tricuspid regurgitation and portal vein score. Portal vein pulsatility is a sign of elevated systemic venous pressure.

Crass, J R; Cohen, A M; Motta, A O; Tomashefski, J F; Wiesen, E J

doi: N/Apmid: 2389022

The currently accepted mechanism to explain traumatic aortic rupture from rapid deceleration involves a combination of traction, torsion, and hydrostatic forces. The authors hypothesize that aortic isthmus lacerations result from a pinch of the aorta between the spine and the anterior bony thorax (manubrium, clavicle, and first ribs) during chest compression caused by abrupt deceleration. Compression of an articulated, normally moving thoracic skeleton containing a synthetic aorta consistently caused transection of the aorta at the isthmus between the spine and anterior bony structures. Analysis of rotation of the first rib in 10 consecutive patients undergoing computed tomography of the chest demonstrated interposition of the distal aortic arch and isthmus between the vertebrae and anterior bony thorax in each instance. Aortas excised from laboratory dogs were pinched between structures simulating bones to reproduce intimal and medial lesions indistinguishable from lesions associated with naturally occurring traumatic disruptions. Although further studies in cadaveric specimens are necessary to confirm this mechanism of injury, the authors believe that their results support the osseous-pinch mechanism of aortic rupture.

Valk, P E; Jagust, W J; Derenzo, S E; Huesman, R H; Geyer, A B; Budinger, T F

doi: N/Apmid: 2389037

The intrinsic resolution of the Donner 600-crystal positron emission tomograph (PET 600) is 2.6 mm full width at half maximum (FWHM) in-plane and 6 mm FWHM axially. More than 100 patients with glioma, radiation necrosis, Alzheimer disease, or epilepsy have been studied with this system. Approximately 1 million events are acquired in 15 minutes, starting 1 hour after injection of 10 mCi (370 MBq) of fluorine-18-fluorodeoxyglucose. Normal structures as small as the superior colliculi and the external capsule have been resolved. Improved separation of the cortical ribbon from adjacent white matter has allowed more accurate determination of cortical metabolic rate. In two of 15 patients undergoing evaluation for recurrent glioma, the PET 600 images showed tumor uptake that was not apparent on a lower-resolution study. A high-activity orbiting transmission source with electronic collimation allows accurate, short-duration transmission measurements to be made after radiopharmaceutical administration. The anatomic detail seen on the transmission images can be used for reproducible patient positioning with an accuracy of 1-2 mm perpendicular to the image plane. These findings demonstrate the practicality and clinical effectiveness of high-resolution positron emission tomography.

Vock, P; Soucek, M; Daepp, M; Kalender, W A

doi: N/Apmid: 2389050

The authors adapted the transport system of a computed tomographic (CT) scanner with continuous rotation capability to examine complete lung subvolumes during a single breath hold. Twenty-four adult patients underwent scanning with up to 12 continuous 1-second rotations, and data acquisition was synchronized with longitudinal patient motion at one section thickness per second. Interpolated planar raw data were obtained retrospectively from any level within the volume, and these afforded high-quality images that were comparable to standard images. Solitary pulmonary nodules were not omitted, their centers could always be depicted, and secondary reformations as well as three-dimensional reconstructions were obtained easily. The authors conclude that spiral volumetric CT, by completely surveying a subvolume of the lung, is an attractive new application of CT.

Im, J G; Han, M C; Yu, E J; Han, J K; Park, J M; Kim, C W; Seo, J W; Yoon, Y; Lee, J D; Lee, K S

doi: N/Apmid: 2167502

The authors reviewed computed tomographic (CT) scans of 12 patients with lobar bronchioloalveolar carcinoma. Seven patients had consolidation of the entire lobe, and five patients had segmental consolidation. After contrast material was administered intravenously, the consolidated lung typically appeared on the scan as an area of homogeneous low attenuation, within which were enhanced branching pulmonary vessels (the CT angiogram sign). To evaluate the specificity of this sign in the discrimination of bronchioloalveolar carcinoma, CT scans of 26 patients who had lobar consolidation from other diseases were randomly mixed with the CT scans of 11 patients with bronchioloalveolar carcinoma. Two independent observers who were unfamiliar with the cases classified 10 and nine of the 11 patients with bronchioloalveolar carcinoma, respectively, as positive for bronchioloalveolar carcinoma by applying the CT angiogram sign, and classified as negative 25 and 23 of the 26 patients without bronchioloalveolar carcinoma, respectively, for an overall specificity of 92.3%. The angiogram sign appeared on the CT scan because of the low-attenuating consolidation, which was caused by the production of mucin or other fluid and the intact bronchovascular framework within the tumor.

Wright, K C; Kasi, L P; Jahns, M S; Hashimoto, S; Wallace, S

doi: N/Apmid: 2389028

In an effort to improve hepatic uptake of liposomes for drug delivery, empty vesicles were administered by means of selective arterial infusion. Negatively charged, multilamellar liposomes were labeled with technetium-99m and infused into healthy adult dogs. Each dog received 100 mg/m2 of lipid over 10 minutes at 2 mL/min. Liposomes were administered via the common hepatic artery after proximal occlusion of the gastroduodenal artery, via the cranial mesenteric artery, and via the cephalic vein. Distribution (liver, spleen, and lungs) was determined by computer-assisted external imaging techniques. On the average, after arterial infusion, 69.2% of the total activity was located in the liver, 3.6% in the spleen, 3.2% in the lungs, and 3.5% in the general circulation. Following venous injection, 50.7% of the radioactivity was found in the liver, 9.1% in the spleen, 8.6% in the lungs, and 6.7% in the peripheral blood. Once the liposomes entered the systemic circulation, they were cleared at the same rate (half-life beta = 21.5 hours) independent of their route of administration. Increased hepatic liposome uptake should translate into higher local and lower systemic liposomal drug levels.

Anderson, C M; Saloner, D; Lee, R E; Fortner, A

doi: N/Apmid: 2389051

A magnetic resonance imaging coil was developed to improve contrast in direct coronal and sagittal time-of-flight carotid angiograms. The sensitive volume of the coil extends from the carotid origins to the siphons. Angiographic contrast can be optimized for an arterial segment of interest by repositioning the coil to minimize presaturation of blood before it enters the segment.

Sigal, R; Krief, O; Houtteville, J P; Halimi, P; Doyon, D; Pariente, D

doi: N/Apmid: 2389041

The clinical and magnetic resonance (MR) imaging findings in 20 patients with MR evidence of occult cerebrovascular malformations (OCVMs) were retrospectively analyzed. Of 27 lesions followed up throughout a mean period of 18 months, eight showed obvious evolution on MR images (four cases of regression and four cases of new bleeding). Three new independent lesions were disclosed. Clinical evolution was discordant with MR findings in five patients. In the other patients, topography of the lesion, mass effect, and location of the hemorrhage could explain clinical data. The dynamic nature of OCVMs must be considered in decisions on therapeutic management.

Schneider, S; Hoenig, E; Reichenberger, H; Abraham-Fuchs, K; Moshage, W; Oppelt, A; Stefan, H; Weikl, A; Wirth, A

doi: N/Apmid: 2389043

The authors designed a multichannel system for noninvasive measurement of the extremely weak magnetic fields generated by the brain and the heart. It uses a flat array of 37 superconducting magnetic field-sensing coils connected to sophisticated superconducting quantum interference devices. To prevent interference from external electromagnetic fields, the system is operated inside a shielded room. Complete sets of coherent data, even from spontaneous events, can be recorded. System performance was evaluated with phantom measurements and evoked-response studies. A spatial resolution of a few millimeters and a temporal resolution of a millisecond were obtained. First results in patients with partial epilepsy and investigations of the cardiac conductive pathway indicate that biomagnetism is now ready for a systematic clinical evaluation. Interpretation of measurements was facilitated by highlighting biomagnetically localized electrical activity in three-dimensional digital magnetic resonance images.

Hanna, S L; Lemmi, M A; Langston, J W; Fontanesi, J; Brooks, H L; Gronemeyer, S

doi: N/Apmid: 2389046

Verification of the position of an episcleral iodine-125 gold plaque in relation to underlying choroidal melanoma is essential during early radiation therapy to ensure accurate plaque placement and thus optimum dose delivery. The authors used magnetic resonance (MR) imaging to examine 15 patients with choroidal melanoma after plaque placement to assess tumor coverage. The relationship of the plaque to the tumor was well defined in all cases, including two tumors anterior to the ora serrata. MR imaging measurements of the plaques were within 1 mm of the actual plaque sizes, while tumor measurements were within 2 mm of the preoperative ultrasound estimations of tumor dimensions. Tumors as small as 3 mm thick were readily visualized with MR imaging. Associated subretinal effusion was demonstrated in seven cases.