New real-time interactive cardiac magnetic resonance imaging system complements echocardiography

OBJECTIVES: We conducted an initial clinical trial of a newly developed cardiac magnetic resonance imaging (CMRI) system. We evaluated left ventricular (LV) function in 85 patients to compare the clinical utility of the CMRI system with echocardiography, the current noninvasive gold standard. BACKGROUND: Conventional CMRI systems require cardiac-gating and respiratory compensation to synthesize a single image from data acquired over multiple cardiac cycles. In contrast, the new CMRI system allows continuous real-time dynamic acquisition and display of any scan plane at 16 images/s without the need for cardiac gating or breath-holding. METHODS: A conventional 1.5T Signa MRI Scanner (GE, Milwaukee, Wisconsin) was modified by the addition of an interactive workstation and a bus adapter. The new CMRI system underwent clinical trial by testing its ability to evaluate global and regional LV function. The first group (A) consisted of 31 patients with acceptable echocardiography image quality. The second group (B) consisted of 31 patients with suboptimal echocardiography image quality. The third group (C) consisted of 29 patients with severe lung disease or congenital cardiac malformation who frequently have suboptimal echo study. Two independent observers scored wall motion and image quality using the standard 16-segment model and rank-order analysis. RESULTS: CMRI evaluation was complete in less than 15 min. In group A, no significant difference was found between ECHO and CMRI studies (p = NS). In group B, adequate visualization of wall segments was obtained 38% of the time using ECHO and 97% of the time using CMRI (p < 0.0001). When grouped into coronary segments, adequate visualization of at least one segment occurred in 18 of 30 patients (60%) with ECHO and in all 30 patients (100%) with CMRI (p < 0.0001). In group C, adequate visualization of the wall segments was obtained in 58% (CI 0.53-0.62) of the time using echocardiography and 99.7% (CI 0.99-1.0) of the time using CMRI (p < 0.0001). CONCLUSIONS: The new CMRI system provides clinically reliable evaluation of LV function and complements suboptimal echocardiography. In comparison with the conventional CMRI, the new CMRI system significantly reduces scan time, patient discomfort and associated cost.     

Multipolar laminated electromagnet for low-field magnetic resonance imaging and electron paramagnetic resonance imaging

A cylindrical 16-pole electromagnet (EM) for electron paramagnetic resonance imaging (EPRI) and low-field magnetic resonance imaging (MRI) has been designed by means of two-dimensional and three-dimensional (3-D) finite element analysis (FEA). The use of an automatic procedure that combines FEA with a minimization routine allowed the optimization of the design, in order to improve the homogeneity along the axis of the EM. A prototype has been built by using electrical steel sheets that were cut by laser; this solution reduced significantly the manufacturing cost. The EM operates with a maximum flux density, in the bore, of 0.08 T and has a homogeneity along the axis of about 40 parts per million (ppm) in a spherical region 10 cm in diameter. It generates the main field and two of the three field gradients required in the 3-D image reconstruction. Good agreement was found between the results of simulation and the measured values.     

Breast magnetic resonance imaging

Breast MRI is becoming an important tool for the improved management of breast cancer. The technical attributes of high contrast, high-resolution breast MRI acquisitions are summarized. The fundamentals of image interpretation are outlined, including lesion enhancement, morphological features, and extent categories. The indications for breast MRI include compromised mammography, staging of disease within the breast and adjacent structures, difficult histology, and other special diagnostic situations. Patients with compromised mammography include previous surgery, radiographically dense breasts, and silicone augmentation. The improved determination of disease extent aids in the management of breast conservation treatment. Certain lesions, particularly lobular carcinoma and ductal carcinoma in situ, can be better managed with the information available with breast MRI. Other potential indications are also discussed, including patients presenting with positive axillary nodes and no known primary, women with a high risk of malignancy, and recently postoperative breasts with positive margins. The need for MRI stereotaxis is reviewed, with indications and potential solutions. The potential future roles for MRI-directed interstitial hyperthermia are outlined.     

Use of functional magnetic resonance imaging

It has been the goal of this article to provide the reader with a brief background of fMRI, a basic understanding of the techniques of fMRI, and, more importantly, the potential for clinical and experimental studies using fMRI. In contrast to the limited number of installed PET and MEG units, the large installed base of MR imaging scanners (over 1000 installed at least at 1.5 T in the United States) makes fMRI potentially widely available. Initial studies (both clinical and experimental) have been validated and are reproducible in mapping the sensorimotor and visual cortices. The areas of language lateralization and memory are still preliminary at best. As methods to reduce the effects of head motion (due to both bulk head motion and physiologically induced motion) arise, the reliability of fMRI should improve, allowing for more definitive identification of task activation.     

A method for functional magnetic resonance imaging of olfaction

A method for generating olfactory stimuli for humans within a functional magnetic resonance imaging (fMRI) experimental design is described. The system incorporates a nasal-mask in which the change from odorant to no-odorant conditions occurs in less than 500 ms and is not accompanied by visual, auditory, tactile, or thermal cues. The mask provides an ordorant-free environment following prolonged ordorant presence. Specific imaging parameters that are conducive to the study of the human olfactory system are described. In a pilot study performed using these methods, the specific patterns of activation observed converged with published experimental and clinical findings.     

Blount''s disease: magnetic resonance imaging

He often begins to answer before you have finished asking your question, but his replies are to the point. He speaks with emotion about the people he hopes to help, particularly children with fatal genetic diseases. 'I prefer to do something: the outcome of doing nothing is perfectly clear', he says. He began sequencing human genes while others were discussing how and when to do so. His methods have been called inelegant, redundant, wasteful, and too 'industrial'. Will his method fail to detect some infrequently transcribed genes? That's all right with him. He is not concerned with finding all the human genes, but rather with the fastest possible route to a useful catalog of most human genes.     

New multimeric magnetic resonance imaging agents

RATIONALE AND OBJECTIVES: The authors investigated the effect of multimerization on the relaxivity of macrocyclic gadolinium (Gd) chelates. The objective was to develop more sensitive magnetic resonance imaging (MRI) contrast agents to study biochemical processes. METHODS: Covalently linked nonionic, macrocyclic, multimeric lanthanide chelates that belong to the classes of dimers, trimers, tetramers, hexamer, and octamer, in the molecular weight range approximately 1 to 5 KDa, were synthesized. The chemical linkage was based on either the amide bond or the 2-hydroxypropylidene bond. Relaxivity values, 20r1, on Gd3+ chelates and hydration numbers, Q, on Tb3+ chelates were determined. RESULTS: Relaxivity values increased with molecular weight and Q values were not affected, the increase in r1 in attributable to the expected increase in the overall rotational correlation time, tau r with an increase in molecular weight. The rigidity of the linkers, which is expected to affect the intrachelate rotational correlation time tau r* that makes a contribution to the overall correlation time, tau r, exerted a noticeable effect. The hydroxyl-based chelates generally had lower r1 values than the amide-based chelates. This is rationalized as arising from the longer and thereby rate-limiting effect of the tau m value for the hydroxyl chelates compared with that reported of the amide-based chelates. This rate limiting effect of tau m becomes a dominant factor controlling attainable enhanced relaxivity when multimers based on traditional chelate designs are used for MRI applications. CONCLUSIONS: Approaches aimed at enhancing relaxivity by modulating the water relaxation time, tau m, will be important for the future development of functional MRI contrast agents for the imaging of biochemical processes.     

Multifunctional magnetic resonance imaging of cerebrovascular disease

Over the last few years magnetic resonance imaging (MRI) has developed into a multipurpose imaging technique. In addition to anatomical information, data can be obtained on perfusion, metabolism and imaging of the vascular anatomy. Especially in the field of neuroradiology the possibilities for obtaining multifunctional information from combined MR examinations are promising. In particular, stroke or stroke-related research benefits from these developments. This article reviews the current status and the potential of newly developed MR techniques with regard to the intracranial hemodynamic changes in patients with severe stenosis or occlusion of the internal carotid artery. The combination of MR angiography, perfusion-weighted MRI and MR spectroscopic imaging seems especially useful in the management of the individual patient.     

Hemodynamic tolerance of intravascular contrast agents for magnetic resonance imaging

RATIONALE AND OBJECTIVES: Intravascular contrast agents for magnetic resonance imaging (MRI) facilitate the quantification of tissue perfusion. The authors determined the hemodynamic tolerance of these agents. METHODS: Doses of 0.05, 0.15, and 0.45 mmol/kg of the polymeric intravascular contrast agent gadolinium-DTPA-polylysine, and di-nitrobenzyl-gadolinium-DTPA, a non-polymeric intravascular contrast agent with high protein binding, and gadolinium-DTPA dimeglumine, a paramagnetic contrast agent with extracellular distribution, were injected into 18 normal male rats as a peripheral intravenous bolus. Systolic, diastolic, and mean blood pressure, left ventricular end-diastolic and developed pressure, positive rate of pressure change (+dP/dt), dP/dt, the rate-pressure product, and heart rate were recorded during a period of 20 minutes. Hemodynamic effects were established by analysis of variance for repeated measurements. RESULTS: There was a transient increase of all blood pressure parameters and contractility for Gd-DTPA-polylysine at the dose of 0.45 mmol/kg only. Di-nitrobenzyl-Gd-DTPA increased blood pressure parameters at 0.45 mmol/kg only. At doses of 0.05 and 0.15 mmol/kg, no significant hemodynamic effects were observed. CONCLUSIONS: The authors conclude that Gd-DTPA-polylysine is hemodynamically safe at doses to 0.15 mmol/kg and acts like a plasma expander at higher doses after peripheral bolus injection in normal rats. Additional investigations are indicated to elucidate the mechanism of a nonsignificant and satiable transient hemodynamic depression after injection of 0.05 mmol/kg DNB-Gd-DTPA.     

Functionality and connectivity analysis by magnetic resonance imaging

Magnetic resonance (MR is a remarkably versatile technology applicable to various aspects of medical science. Currently, there are three categories of MR techniques available for probing human brain function in detail. The first category comprises the most widely utilized techniques which make use of the metabolic effects of brain activation, represented by BOLD (blood oxygenation level dependent) functional magnetic resonance imaging (fMRI). The second category of techniques deals with apparent diffusion tensor probing the axonal connectivity and is represented by three dimensional anisotropy contrast (3DAC) axonography. The third category of techniques is a biological application of classical nuclear magnetic resonance (NMR) spectroscopy capable of providing biochemical information in vivo and is represented by spectroscopic imaging (SI). As techniques directly applicable to clinical medicine, BOLD fMRI and 3DAC axonography possess the highest potential.     

Electrodynamic headphones and woofers for application in magnetic resonance imaging scanners

Electrodynamic speakers compatible with (functional) magnetic resonance imaging (MRI) are described. The speakers magnets are removed, their function is replaced by the scanner's magnetic field, resulting in an uncommon but efficient operation. The method can be used with headphones as well as woofers. Functional MRI is not associated with any known biological risks, but as a method for visualization of task-specific activation of brain regions it is undesirably noisy. Thus, it requires both noise protection and efficient sound transmission systems for delivering acoustic stimuli to subjects. Woofers could possibly be used in active noise-control systems. The speakers described in this paper can be used for either task.     

Spatial and temporal resolution of functional magnetic resonance imaging

Functional magnetic resonance imaging has become an invaluable tool for cognitive neuroscience, despite the fact that many of the physiological mechanisms giving rise to the effect are not well understood. We review the known biochemical and physiological basis of the technique and discuss how, within the noted limits, one might fully exploit the spatial and temporal resolution that is intrinsic to the very high magnetic fields that we use for human studies. This noninvasive brain mapping technique relies on the changes in blood oxygenation, blood volume, and blood flow, and we discuss some of the issues influencing the effects of these hemodynamic parameters on image intensity.     

Human magnetic resonance imaging at 8 T

BACKGROUND: Antibodies to Epstein Barr Virus (EBV) antigens have been used for the diagnosis of nasopharyngeal carcinoma (NPC). While immunofluorescence assays (IFA) of IgA antiviral capsid and early antigens have been the mainstay of this diagnosis, enzyme immunoassays (ELISA) of various EBV antigens are now available. However in almost all of these assays, the sensitivities and specificities have been calculated using blood donors and normal hospital staff as controls, who may not be the most appropriate controls. We wanted to evaluate the usefulness of IFA and ELISA of various EBV antigens in a clinical setting to distinguish between patients with NPC and those suspected of NPC but being biopsy negative. METHODS: Between January 1987 and June 1988, 322 consecutive patients suspected of NPC and who had a post-nasal biopsy were studied. Blood was taken for EBV tests before diagnosis. Tests included IFA and ELISA IgA anti-VCA and anti-EA and ELISA IgA and IgG anti-ribonucleotide reductase, a cloned EA antigen. RESULTS: IFA IgA anti-VCA together with IFA IgA anti-EA both at a cut-off of 1:10 gave the best discrimination between patients with NPC and those suspected of NPC but were biopsy negative. CONCLUSION: The ELISA IgG anti-ribonucleotide reductase test is convenient to perform and looks very promising. An ELISA using a cocktail of cloned EA peptides may be even better.     

Functional magnetic resonance imaging in macaque cortex

The ability to use fMRI in a monkey model would bridge the gap between the fMRI demonstration of cerebral activation in humans and the cumulative wealth of monkey data on the functional organization of the brain from single electrode mapping, radioisotope and histology studies. We report a new technique for fMRI in an awake co-operative rhesus macaque (Macaca mulatta) in a conventional clinical 1.5T MR scanner and present the first fMRI images from a macaque. Good resolution, signal-to-noise ratio and BOLD response (2.6-4.6%) have been achieved using the manufacturer's standard volume knee coil. T1 values of macaque gray and white matter (1490 ms, 1010 ms respectively) are higher than human brain, whereas T2 values are lower (55 ms, 48 ms respectively). An MR-compatible design for restraining the monkey is also described, along with a suitable EPI sequence for BOLD images, optimized for monkey T2, with voxel sizes from 29 to 61 microl, and MPRAGE sequence for anatomical studies with 0.8 mm isotropic resolution, optimized for monkey T1.