Automated identification of minimal myocardial motion for improved image quality on MR angiography at 3 T

OBJECTIVE: Imaging during a period of minimal myocardial motion is of paramount importance for coronary MR angiography (MRA). The objective of our study was to evaluate the utility of FREEZE, a custom-built automated tool for the identification of the period of minimal myocardial motion, in both a moving phantom at 1.5 T and 10 healthy adults (nine men, one woman; mean age, 24.9 years; age range, 21-32 years) at 3 T. CONCLUSION: Quantitative analysis of the moving phantom showed that dimension measurements approached those obtained in the static phantom when using FREEZE. In vitro, vessel sharpness, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were significantly improved when coronary MRA was performed during the software-prescribed period of minimal myocardial motion (p < 0.05). Consistent with these objective findings, image quality assessments by consensus review also improved significantly when using the automated prescription of the period of minimal myocardial motion. The use of FREEZE improves image quality of coronary MRA. Simultaneously, operator dependence can be minimized while the ease of use is improved.

MR connectomics: a conceptual framework for studying the developing brain.

THE COMBINATION OF ADVANCED NEUROIMAGING TECHNIQUES AND MAJOR DEVELOPMENTS IN COMPLEX NETWORK SCIENCE, HAVE GIVEN BIRTH TO A NEW FRAMEWORK FOR STUDYING THE BRAIN: "connectomics." This framework provides the ability to describe and study the brain as a dynamic network and to explore how the coordination and integration of information processing may occur. In recent years this framework has been used to investigate the developing brain and has shed light on many dynamic changes occurring from infancy through adulthood. The aim of this article is to review this work and to discuss what we have learned from it. We will also use this body of work to highlight key technical aspects that are necessary in general for successful connectome analysis using today's advanced neuroimaging techniques. We look to identify current limitations of such approaches, what can be improved, and how these points generalize to other topics in connectome research.

Understanding diffusion MR imaging techniques: from scalar diffusion-weighted imaging to diffusion tensor imaging and beyond.

The complex structural organization of the white matter of the brain can be depicted in vivo in great detail with advanced diffusion magnetic resonance (MR) imaging schemes. Diffusion MR imaging techniques are increasingly varied, from the simplest and most commonly used technique-the mapping of apparent diffusion coefficient values-to the more complex, such as diffusion tensor imaging, q-ball imaging, diffusion spectrum imaging, and tractography. The type of structural information obtained differs according to the technique used. To fully understand how diffusion MR imaging works, it is helpful to be familiar with the physical principles of water diffusion in the brain and the conceptual basis of each imaging technique. Knowledge of the technique-specific requirements with regard to hardware and acquisition time, as well as the advantages, limitations, and potential interpretation pitfalls of each technique, is especially useful.

Validation of tissue modelization and classification techniques in T1-weighted MR brain images

We propose a deep study on tissue modelization andclassification Techniques on T1-weighted MR images. Threeapproaches have been taken into account to perform thisvalidation study. Two of them are based on FiniteGaussian Mixture (FGM) model. The first one consists onlyin pure gaussian distributions (FGM-EM). The second oneuses a different model for partial volume (PV) (FGM-GA).The third one is based on a Hidden Markov Random Field(HMRF) model. All methods have been tested on a DigitalBrain Phantom image considered as the ground truth. Noiseand intensity non-uniformities have been added tosimulate real image conditions. Also the effect of ananisotropic filter is considered. Results demonstratethat methods relying in both intensity and spatialinformation are in general more robust to noise andinhomogeneities. However, in some cases there is nosignificant differences between all presented methods.

Sentence de la prévôté de l'Hôtel du roi, et grande prévôté de France, rendue au profit de Mr de la Roche, garde de la porte de Mgr le comte d'Artois, contre les curé et marguillers de Séve (Sèvres) près Saint-Cloud...

[Acte. 1778-09-30. Paris]

Flow-targeted inversion-prepared b-TFE coronary MR angiography: initial results in patients.

PURPOSE: Visualization of coronary blood flow in the right and left coronary system in volunteers and patients by means of a modified inversion-prepared bright-blood coronary magnetic resonance angiography (cMRA) sequence. MATERIALS AND METHODS: cMRA was performed in 14 healthy volunteers and 19 patients on a 1.5 Tesla MR system using a free-breathing 3D balanced turbo field echo (b-TFE) sequence with radial k-space sampling. For magnetization preparation a slab selective and a 2D selective inversion pulse were used for the right and left coronary system, respectively. cMRA images were evaluated in terms of clinically relevant stenoses (< 50 %) and compared to conventional catheter angiography. Signal was measured in the coronary arteries (coro), the aorta (ao) and in the epicardial fat (fat) to determine SNR and CNR. In addition, maximal visible vessel length, and vessel border definition were analyzed. RESULTS: The use of a selective inversion pre-pulse allowed direct visualization of the coronary blood flow in the right and left coronary system. The measured SNR and CNR, vessel length, and vessel sharpness in volunteers (SNR coro: 28.3 +/- 5.0; SNR ao: 37.6 +/- 8.4; CNR coro-fat: 25.3 +/- 4.5; LAD: 128.0 cm +/- 8.8; RCA: 74.6 cm +/- 12.4; Sharpness: 66.6 % +/- 4.8) were slightly increased compared to those in patients (SNR coro: 24.1 +/- 3.8; SNR ao: 33.8 +/- 11.4; CNR coro-fat: 19.9 +/- 3.3; LAD: 112.5 cm +/- 13.8; RCA: 69.6 cm +/- 16.6; Sharpness: 58.9 % +/- 7.9; n.s.). In the patient study the assessment of 42 coronary segments lead to correct identification of 10 clinically relevant stenoses. CONCLUSION: The modification of a previously published inversion-prepared cMRA sequence allowed direct visualization of the coronary blood flow in the right as well as in the left coronary system. In addition, this sequence proved to be highly sensitive regarding the assessment of clinically relevant stenotic lesions.

Platelet-activating factor causes ventilation-perfusion mismatch in humans

We hypothesized that platelet-activating factor (PAF), a potent inflammatory mediator, could induce gas exchange abnormalities in normal humans. To this end, the effect of aerosolized PAF (2 mg/ml solution; 24 micrograms) on ventilation-perfusion (VA/Q) relationships, hemodynamics, and resistance of the respiratory system was studied in 14 healthy, nonatopic, and nonsmoking individuals (23 +/- 1 [SEM]yr) before and at 2, 4, 6, 8, 15, and 45 min after inhalation, and compared to that of inhaled lyso-PAF in 10 other healthy individuals (24 +/- 2 yr). PAF induced, compared to lyso-PAF, immediate leukopenia (P < 0.001) followed by a rebound leukocytosis (P < 0.002), increased minute ventilation (P < 0.05) and resistance of the respiratory system (P < 0.01), and decreased systemic arterial pressure (P < 0.05). Similarly, compared to lyso-PAF, PaO2 showed a trend to fall (by 12.2 +/- 4.3 mmHg, mean +/- SEM maximum change from baseline), and arterial-alveolar O2 gradient increased (by 16.7 +/- 4.3 mmHg) (P < 0.02) after PAF, because of VA/Q mismatch: the dispersion of pulmonary blood flow and that of ventilation increased by 0.45 +/- 0.1 (P < 0.01) and 0.29 +/- 0.1 (P < 0.04), respectively. We conclude that in normal subjects, inhaled PAF results in considerable immediate VA/Q inequality and gas exchange impairment. These results reinforce the notion that PAF may play a major role as a mediator of inflammation in the human lung.

Platelet-activating factor causes ventilation-perfusion mismatch in humans

We hypothesized that platelet-activating factor (PAF), a potent inflammatory mediator, could induce gas exchange abnormalities in normal humans. To this end, the effect of aerosolized PAF (2 mg/ml solution; 24 micrograms) on ventilation-perfusion (VA/Q) relationships, hemodynamics, and resistance of the respiratory system was studied in 14 healthy, nonatopic, and nonsmoking individuals (23 +/- 1 [SEM]yr) before and at 2, 4, 6, 8, 15, and 45 min after inhalation, and compared to that of inhaled lyso-PAF in 10 other healthy individuals (24 +/- 2 yr). PAF induced, compared to lyso-PAF, immediate leukopenia (P < 0.001) followed by a rebound leukocytosis (P < 0.002), increased minute ventilation (P < 0.05) and resistance of the respiratory system (P < 0.01), and decreased systemic arterial pressure (P < 0.05). Similarly, compared to lyso-PAF, PaO2 showed a trend to fall (by 12.2 +/- 4.3 mmHg, mean +/- SEM maximum change from baseline), and arterial-alveolar O2 gradient increased (by 16.7 +/- 4.3 mmHg) (P < 0.02) after PAF, because of VA/Q mismatch: the dispersion of pulmonary blood flow and that of ventilation increased by 0.45 +/- 0.1 (P < 0.01) and 0.29 +/- 0.1 (P < 0.04), respectively. We conclude that in normal subjects, inhaled PAF results in considerable immediate VA/Q inequality and gas exchange impairment. These results reinforce the notion that PAF may play a major role as a mediator of inflammation in the human lung.

Role of nuclear medicine during isolated limb perfusion

Aim:Isolated limb perfusion (ILP) is a technique consisting in administrating doses of chemotherapy up to 20 times higher than via systemic route in a limb affected by melanoma or sarcoma to maximise tumour reduction. ILP is performed in <50 centres worldwide and leads to partial or complete response, however without effect on overall survival. As an alternative to amputation, it improves patient quality of life. We report our >10-year single centre experience on the role of nuclear medicine in ILP. Material and method:From 2000 to 2012, we performed 77 ILP (45 women, 32 men; aged 62±16 years) for 49 melanoma (64%), 25 sarcoma (32%) and 3 others tumors (2 desmoid tumours and 1 aggressive fibromatosis) (3%). The affected limb vascularisation is isolated from the systemic circulation (SYS) using extracorporeal circulation, and chemotherapy (usually TNF and Melphalan) is administered. Peroperatively, limb isolation and eventual leakage from ILP to SYS are monitored by continuous measurement using a gamma-probe placed over the heart (150MBq of 99mTc-human serum albumin in ILP and 4MBq in SYS). The maximum acceptable leakage to the systemic circulation is 10% (maximum tolerated systemic TNF dose). Results:In total, 47 patients (61%) had positive leaks from the ILP to SYS of 4.1±14.5% (median 1% interquartile range 0.4% to 3.2%, range 0 to 100%) and 30 patients (39%) had negative leaks from the SYS to ILP of -0.9±1.2% (median -0.5%, interquartile range -0.8% to -0.2%, range -4.8% to -0.1%). In only 2 patients (2.6%), leaks >10% were observed leading to interrupting ILP. Conclusion:Nuclear Medicine has a crucial role for the safety and quality of ILP in monitoring leakage peroperatively and help deciding whether the procedure should be interrupted to minimize systemic toxicity.

Navigator-gated and real-time motion corrected free-breathing MR Imaging of myocardial late enhancement.

PURPOSE: A new magnetic resonance imaging approach for detection of myocardial late enhancement during free-breathing was developed. METHODS AND RESULTS: For suppression of respiratory motion artifacts, a prospective navigator technology including real-time motion correction and a local navigator restore was implemented. Subject specific inversion times were defined from images with incrementally increased inversion times acquired during a single dynamic scout navigator-gated and real-time motion corrected free-breathing scan. Subsequently, MR-imaging of myocardial late enhancement was performed with navigator-gated and real-time motion corrected adjacent short axis and long axis (two, three and four chamber) views. This alternative approach was investigated in 7 patients with history of myocardial infarction 12 min after i. v. administration of 0.2 mmol/kg body weight gadolinium-DTPA. CONCLUSION: With the presented navigator-gated and real-time motion corrected sequence for MR-imaging of myocardial late enhancement data can be completely acquired during free-breathing. Time constraints of a breath-hold technique are abolished and optimized patient specific inversion time is ensured.