EFFECTS OF THE BRADYKININ B2 RECEPTOR ANTAGONIST ICATIBANT ON MICROVASCULAR PERMEABILITY AFTER THERMAL INJURY IN SHEEP

Peptide kinins are potent vasoactive agents in the microcirculation that might be released after burn injury. The present study was designed to test the hypothesis that Icatibant (JE 049), a potent, selective peptidomimetic bradykinin-B2 receptor antagonist, would reduce the cardiovascular pathology occurring in sheep exposed to 40% total body surface area (TBSA), third-degree burn. Female sheep were surgically prepared for chronic study. After 5 to 7 days' recovery from the operative procedure, they were randomized to five groups: sham (n = 6, noninjured, nontreated), medicated sham (n = 4, noninjured, treated with 20 microg kg h Icatibant), control (n = 7, 40% TBSA third-degree burn, nontreated), Icatibant-4 (n = 6, 40% TBSA third-degree burn, treated with 4 microg kg h Icatibant [low dose]), Icatibant-20 (n = 8, 40% TBSA third-degree burn, treated with 20 microg kg h Icatibant [high dose]). Prefemoral lymph flow (milliliters per hour) remained constant in the sham and medicated sham groups but increased after injury: control (0 h, 3.9 +/- 0.5; 24 h, 28 +/- 4.2; 48 h, 33.0 +/- 8.1). The increased fluid flux was associated with enhanced protein flux. Both low and high doses of Icatibant significantly reduced the microvascular fluid flux: Icatibant-4 (0 h, 5.3 +/- 0.6; 24 h, 17.5 +/- 3.5; 48 h, 20.3 +/- 3.4); Icatibant-20 (0 h, 5.3 +/- 1.1; 24 h, 15.2 +/- 2; 48 h, 17.6 +/- 4.1). Total prefemoral protein leak was reduced in all treatment groups. The low dose of Icatibant significantly reduced prefemoral lymph flow without adversely affecting the hemodynamic changes observed after burn injury in sheep, suggesting that the bradykinin antagonist would reduce edema formation and improve fluid management of thermally injured patients.

Back to the beginning--the quest for thymic epithelial stem cells

Stem cell-based therapies hold much promise for the rejuvenation of aged or damaged tissues; however, before such cells can be used therapeutically, they must first be accurately identified. In this issue of the European Journal of Immunology it is reported that MTS24, a marker previously associated with progenitor cells of the thymic epithelium, fails to accurately identify epithelial cell populations with the ability to reconstitute a functional thymus. This finding demonstrates that much progress needs to be made before thymic epithelial stem cells can be harnessed for clinical benefit.

Image quality of the aortic and mitral valve with CT: relative versus absolute delay reconstruction

RATIONALE AND OBJECTIVE

The purpose of this study was to compare image quality and artifacts of 16-detector row CT imaging of the aortic and mitral valve when performing ECG-gated synchronization using relative and absolute reconstructions.

MATERIALS AND METHODS

Cardiac CT was performed in 22 consecutive patients; 20 data sets per RR interval were reconstructed with relative and absolute reconstructions. Mean and variability of heart rate during data acquisition were noted. Two readers assessed contrast media-related artifacts, calcification-related artifacts, ECG gating-related artifacts, and image quality in parallel and perpendicular planes.

RESULTS

Contrast media-related and calcification-related artifacts similarly occurred with both reconstruction techniques. ECG gating-related artifacts occurred in both valves more often with relative reconstructions than with absolute reconstructions (p = .001). Image quality was significantly better for absolute reconstructions for the open aortic cusp surface (p = .014) and edge (p = .008) in both planes, and of the closed mitral valve leaflets (p = .003) and apposition zone (p = .003) in perpendicular planes. Occurrence of ECG gating-related artifacts in both valves significantly correlated (p = .01) with heart rate variability for relative reconstructions, whereas no correlation was found using the absolute technique.

CONCLUSION

Absolute reconstructions allow CT imaging of the aortic and mitral valve with fewer artifacts and are less sensitive to heart rate variability as compared to relative reconstructions.

The evolutionary history of lymphoid organs

Lymphoid organs are important regulators of lymphocyte development and immune responses. During vertebrate evolution, primary lymphoid organs appeared earlier than secondary lymphoid organs. Among the sites of primary lymphopoiesis during evolution and ontogeny, those for B cell differentiation have differed considerably, although they often have had myelolymphatic characteristics. In contrast, only a single site for T cell differentiation has occurred, exclusively the thymus. Based on those observations and the known features of variable-diversity-joining gene recombination, we propose a model for the successive specification of different lymphocyte lineages during vertebrate evolution. According to our model, T cells were the first lymphocytes to acquire variable-diversity-joining-type receptors, and the thymus was the first lymphoid organ to evolve in vertebrates to deal with potentially autoreactive, somatically diversified T cell receptors.

Computational fluid dynamics: hemodynamic changes in abdominal aortic aneurysm after stent-graft implantation

The aim of this study was to demonstrate quantitatively and qualitatively the hemodynamic changes in abdominal aortic aneurysms (AAA) after stent-graft placement based on multidetector CT angiography (MDCT-A) datasets using the possibilities of computational fluid dynamics (CFD). Eleven patients with AAA and one patient with left-side common iliac aneurysm undergoing MDCT-A before and after stent-graft implantation were included. Based on the CT datasets, three-dimensional grid-based models of AAA were built. The minimal size of tetrahedrons was determined for grid-independence simulation. The CFD program was validated by comparing the calculated flow with an experimentally generated flow in an identical, anatomically correct silicon model of an AAA. Based on the results, pulsatile flow was simulated. A laminar, incompressible flow-based inlet condition, zero traction-force outlet boundary, and a no-slip wall boundary condition was applied. The measured flow volume and visualized flow pattern, wall pressure, and wall shear stress before and after stent-graft implantation were compared. The experimentally and numerically generated streamlines are highly congruent. After stenting, the simulation shows a reduction of wall pressure and wall shear stress and a more equal flow through both external iliac arteries after stenting. The postimplantation flow pattern is characterized by a reduction of turbulences. New areas of high pressure and shear stress appear at the stent bifurcation and docking area. CFD is a versatile and noninvasive tool to demonstrate changes of flow rate and flow pattern caused by stent-graft implantation. The desired effect and possible complications of a stent-graft implantation can be visualized. CFD is a highly promising technique and improves our understanding of the local structural and fluid dynamic conditions for abdominal aortic stent placement.

Noninvasive Coronary Angiography with 64-Section CT: Effect of Average Heart Rate and Heart Rate Variability on Image Quality

PURPOSE

To evaluate prospectively the effect of average heart rate and heart rate variability on image quality at 64-section computed tomographic (CT) coronary angiography.

MATERIALS AND METHODS

The study protocol had local ethics committee approval; written informed consent was obtained. There were 125 patients (45 women, 80 men; mean age, 59.9 years +/- 12.9 [standard deviation]; 79 receiving beta-blockers) who underwent 64-section CT coronary angiography with retrospective electrocardiographic gating. Data sets were reconstructed in 5% steps from 20% to 80% of R-R interval. Heart rate variability was calculated as 1 standard deviation from mean rate during scanning. Two observers rated image quality of each coronary segment at least 1.5-mm diameter (1 = no motion artifacts, 5 = not evaluative). Repeated analysis of variance measurements were performed to evaluate quantitative parameters. Pearson correlation analysis was performed to compare image quality in each patient with average heart rate and heart rate variability.

RESULTS

Average heart rate was 63.3 beats per minute +/- 13.1, with variability of 3.2 beats per minute +/- 2.1. Diagnostic image quality (score < or = 3) was attained in 1821 of 1836 segments at the best reconstruction interval. There was no correlation between mean heart rate and image quality for all segments of the right coronary and left anterior descending arteries, but there was a significant correlation for left circumflex artery (r = 0.33, P < .05). Heart rate variability was correlated with image quality overall (r = 0.75, P < .001) and for each coronary artery. Heart rate was less variable and image quality was better (P < .05) in patients receiving beta-blockers. Best image quality was obtained in diastole with heart rate less than 80 beats per minute and in systole with faster heart rate.

CONCLUSION

Coronary angiography with 64-section CT provides diagnostic image quality within a wide range of heart rates. Reducing average heart rate and heart rate variability is beneficial for reducing artifacts.

Visualization of congenital thoracic vascular anomalies using multi-detector row computed tomography and two- and three-dimensional post-processing

Anomalies of the vascular system are caused by false embryogenesis and are therefore present from birth. Single-detector row spiral computed tomography angiography (CTA) and multi-detector row computed tomography angiography (MDCTA) have gained increasing importance in the non-invasive assessment of vascular pathologies and replace conventional angiography in many cases. High-resolution volumetric datasets that are acquired during a single breath-hold give the possibility of two- (2D) and three-dimensional (3D)-post-processing. Due to post-processing, even complex vascular malformations are visualized in an understandable way. Furthermore, CTA, in contrast to conventional angiography, depicts not only the vascular structures but also allows assessment of the surrounding anatomical structures. We present cases of rare congenital anomalies of the thoracic vessels using MDCT with special respect to 2D- and 3D-post-processing.

Thymus-homing precursors and the thymic microenvironment

T cells develop in the thymus from precursors that are generated in the bone marrow and continuously seed the thymus through the blood. During evolution, 'outsourcing' the development of one blood lineage, namely the T-cell lineage, to an anatomically distinct hematopoietic organ required the generation of migratory precursors in the bone marrow, their homing to specialized, precursor-retaining thymic niches and their subsequent differentiation. Niche building and precursor homing are therefore intricately linked and should be viewed in context. In this review, we discuss recent findings on the developmental and genetic events that prepare the thymic epithelial microenvironment for its complex tasks, and highlight recent progress in the definition of the thymus-settling cells and the homing process that leads them into the thymus.

Conserved functions of Ikaros in vertebrate lymphocyte development: genetic evidence for distinct larval and adult phases of T cell development and two lineages of B cells in zebrafish

Zebrafish has been advocated as an alternative animal model to study lymphocyte development, although the similarities in the genetic requirements of lymphopoiesis between fish and mammals have not yet been investigated. In this study, we examine the role of the transcription factor Ikaros in zebrafish lymphopoiesis. In fish larvae homozygous for an ikaros allele predicted to lack the C-terminal zinc fingers, T lymphopoiesis is absent; the presence of V(H)DmuJmu rearrangements in adolescent fish is delayed in mutants. In adolescent mutant fish, T cells expressing tcrb and tcrd and B cells expressing igm are formed with low efficiency and display an oligoclonal Ag receptor repertoire. By contrast, B cells expressing the igz isotype do not develop, providing genetic evidence for two separate B cell lineages in zebrafish. Thus, Ikaros appears to play similar roles in fish and mammalian lymphopoiesis.

[Influence of body mass index on coronary artery opacification in 64-slice CT angiography]

PURPOSE

To evaluate the influence of the body mass index (BMI) on coronary artery opacification in 64-slice CT.

MATERIAL AND METHODS

Sixty-two patients retrospectively underwent ECG-gated 64-slice CT coronary angiography (tube potential 120 kV, tube current time product 650 mAs) after intravenous injection of 80 ml of iodinated contrast agent (320 mg/ml, 5 ml/s). Attenuation values (HU) were measured and contrast-to-noise ratios (CNR) were calculated in the right coronary artery (RCA) and left main artery (LMA). The CNR was defined as the difference between the mean attenuation in the vessel and the mean attenuation in the perivascular fat tissue divided by the image noise in the ascending aorta. The height and weight of the patients at the time of the CT scan were recorded and the BMI was calculated.

RESULTS

The mean BMI was 26.2 +/- 3.2 kg/m (2) (range 19.7 - 32.2 kg/m (2)), the mean attenuation in the LMA was 330 +/- 64 HU, and the mean attenuation in the RCA was 309 +/- 68 HU. The CNR in the LMA was 16.7 +/- 3.8, and the CNR in the RCA was 15.9 +/- 3.6. The image noise in the ascending aorta significantly correlated with the BMI (r = 0.36, p < 0.01). A weak negative correlation was found between the BMI and LMA attenuation (r = - 0.28, p < 0.05), whereas no significant correlation was found for the RCA (r = - 0.21, p = 0.12). A significant negative correlation was found between the BMI and the CNR in the RCA (r = - 0.41, p < 0.05) and the LMA (r = - 0.47, p < 0.001).

CONCLUSION

With constant scan parameters and a constant contrast medium amount, the CNR in both coronary arteries decreases while the BMI increases. This implies a modification of previously standardized and fixed examinations with respect to individually adapted protocols with variable parameters for CT coronary angiography.

Quality control in self/nonself discrimination

Unicellular eukaryotes primarily employ self/nonself discrimination to avoid self-mating, whereas multicellular organisms also use self/nonself discrimination in immune defense. Recent advances in understanding self/nonself discrimination in eukaryotes shed new light on the emergence of the most sophisticated self/nonself discrimination system known, the antigen receptors employed in the adaptive immune system.

Aortic Stenosis: Comparative Evaluation of 16–Detector Row CT and Echocardiography

PURPOSE

To prospectively evaluate whether planimetric measurements of aortic valve area (AVA) with 16-detector row computed tomography (CT) allow classification of aortic stenosis (AS).

MATERIALS AND METHODS

The study had institutional review board approval; patients gave informed consent. Twenty patients (11 men, nine women; mean age, 63 years) with AS and 20 patients (10 men, 10 women; mean age, 65 years) without underwent transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and retrospectively electrocardiographically gated 16-detector row CT. Twenty CT data sets were reconstructed in 5% steps of R-R interval; data analysis was performed with four-dimensional software. Maximum AVA in systole planimetrically measured with CT (AVA(CT)) was compared with AVA planimetrically measured with TEE (AVA(TEE)), AVA calculated with the continuity equation and TTE (AVA(TTE)), and transvalvular pressure gradients determined with the Bernoulli equation and TTE. Correlations among AVA(CT), AVA(TTE), AVA(TEE), and transvalvular pressure gradients were tested with bivariate regression analysis; agreement between methods was assessed with the Bland-Altman method.

RESULTS

In patients without AS, mean AVA(CT) was 3.56 cm2 +/- 0.66 and mean AVA(TEE) was 3.43 cm2 +/- 0.69. In patients with AS, mean AVA(CT) was 0.89 cm2 +/- 0.35; mean AVA(TEE), 0.86 cm2 +/- 0.35; and mean AVA(TTE), 0.83 cm2 +/- 0.33. Mean transvalvular pressure gradient was 51 mm Hg +/- 22. Significant correlations were present between AVA(CT) and AVA(TEE) (r = 0.99, P < .001), AVA(CT) and AVA(TTE) (r = 0.95, P < .001), and AVA(CT) and transvalvular pressure gradients (r = -0.74, P < .01). Mean differences were -0.08 cm2 (limits of agreement: -0.32, 0.16) for AVA(CT) versus AVA(TEE) and 0.06 cm2 (limits of agreement: -0.15, 0.26) for AVA(CT) versus AVA(TTE).

CONCLUSION

Planimetric measurements of AVA with retrospectively electrocardiographically gated 16-detector row CT allow classification of AS that is similar to that achieved with measurements by using echocardiographic methods.

Formation of a functional thymus initiated by a postnatal epithelial progenitor cell

The thymus is essential for the generation of self-tolerant effector and regulatory T cells. Intrathymic T-cell development requires an intact stromal microenvironment, of which thymic epithelial cells (TECs) constitute a major part. For instance, cell-autonomous genetic defects of forkhead box N1 (Foxn1) and autoimmune regulator (Aire) in thymic epithelial cells cause primary immunodeficiency and autoimmunity, respectively. During development, the thymic epithelial rudiment gives rise to two major compartments, the cortex and medulla. Cortical TECs positively select T cells, whereas medullary TECs are involved in negative selection of potentially autoreactive T cells. It has long been unclear whether these two morphologically and functionally distinct types of epithelial cells arise from a common bi-potent progenitor cell and whether such progenitors are still present in the postnatal period. Here, using in vivo cell lineage analysis in mice, we demonstrate the presence of a common progenitor of cortical and medullary TECs after birth. To probe the function of postnatal progenitors, a conditional mutant allele of Foxn1 was reverted to wild-type function in single epithelial cells in vivo. This led to the formation of small thymic lobules containing both cortical and medullary areas that supported normal thymopoiesis. Thus, single epithelial progenitor cells can give rise to a complete and functional thymic microenvironment, suggesting that cell-based therapies could be developed for thymus disorders.

Optimal image reconstruction intervals for non-invasive coronary angiography with 64-slice CT

The reconstruction intervals providing best image quality for non-invasive coronary angiography with 64-slice computed tomography (CT) were evaluated. Contrast-enhanced, retrospectively electrocardiography (ECG)-gated 64-slice CT coronary angiography was performed in 80 patients (47 male, 33 female; mean age 62.1+/-10.6 years). Thirteen data sets were reconstructed in 5% increments from 20 to 80% of the R-R interval. Depending on the average heart rate during scanning, patients were grouped as < 65 bpm (n = 49) and > or = 65 bpm (n = 31). Two blinded and independent readers assessed the image quality of each coronary segment with a diameter > or = 1.5 mm using the following scores: 1, no motion artifacts; 2, minor artifacts; 3, moderate artifacts; 4, severe artifacts; and 5, not evaluative. The average heart rate was 63.3 +/- 13.1 bpm (range 38-102). Acceptable image quality (scores 1-3) was achieved in 99.1% of all coronary segments (1,162/1,172; mean image quality score 1.55 +/- 0.77) in the best reconstruction interval. Best image quality was found at 60% and 65% of the R-R interval for all patients and for each heart rate subgroup, whereas motion artifacts occurred significantly more often (P < 0.01) at other reconstruction intervals. At heart rates < 65 bpm, acceptable image quality was found in all coronary segments at 60%. At heart rates > or = 65 bpm, the whole coronary artery tree could be visualized with acceptable image quality in 87% (27/31) of the patients at 60%, while ten segments in four patients were rated as non-diagnostic (scores 4-5) at any reconstruction interval. In conclusion, 64-slice CT coronary angiography provides best overall image quality in mid-diastole. At heart rates < 65 bpm, diagnostic image quality of all coronary segments can be obtained at a single reconstruction interval of 60%.

CT angiography of peripheral arterial bypass grafts: Accuracy and time-effectiveness of quantitative image analysis with an automated software tool

RATIONALE AND OBJECTIVES

Qualitative analysis of computed tomography (CT) angiography data often is limited by intra- and interobserver variability. The purpose of this study was to evaluate the time-effectiveness and accuracy of a quantitative CT angiography data analysis using automated software in comparison with qualitative axial and coronal CT image reading in patients with peripheral bypass grafts.

MATERIALS AND METHODS

Twenty-eight patients with 33 saphenous bypass grafts underwent 4-channel (n = 21) and 16-channel (n = 7) CT angiography. Two readers evaluated in consensus the CT data qualitatively on axial and coronal reconstructions and with the software regarding the presence of graft stenoses, aneurysmal changes, and arteriovenous fistulas. The time for data analysis was taken and the accuracy was compared with the results from digital subtraction angiography (DSA).

RESULTS

No significant difference was present between data analysis time using axial and coronal CT images (4.9 +/- 1.5 minutes) and when using the software tool (5.5 +/- 1.4 minutes). Good (kappa = 0.652) to excellent (kappa = 1.000) intermodality agreement was present between qualitative and quantitative CT analysis regarding graft-related abnormalities. Sensitivity and specificity for diagnosing stenoses, aneurysms, and fistula did not differ significantly (P > .025) between qualitative CT image reading and the automated software tool.

CONCLUSIONS

CT angiography analysis of peripheral bypass grafts using an automated software tool is similar regarding time-effectiveness and accuracy when compared with qualitative CT data analysis on axial and coronal images. It may assist in determining the significance of an abnormality and can yield objective morphometric data of vessel calibers.

Essential role of the main olfactory system in social recognition of major histocompatibility complex peptide ligands

Genes of the major histocompatibility complex (MHC), which play a critical role in immune recognition, influence mating preference and other social behaviors in fish, mice, and humans via chemical signals. The cellular and molecular mechanisms by which this occurs and the nature of these chemosignals remain unclear. In contrast to the widely held view that olfactory sensory neurons (OSNs) in the main olfactory epithelium (MOE) are stimulated by volatile chemosignals only, we show here that nonvolatile immune system molecules function as olfactory cues in the mammalian MOE. Using mice with targeted deletions in selected signal transduction genes (CNGA2, CNGA4), we used a combination of dye tracing, electrophysiological, Ca2+ imaging, and behavioral approaches to demonstrate that nonvolatile MHC class I peptides activate subsets of OSNs at subnanomolar concentrations in vitro and affect social preference of male mice in vivo. Both effects depend on the cyclic nucleotide-gated (CNG) channel gene CNGA2, the function of which in the nose is unique to the main population of OSNs. Disruption of the modulatory CNGA4 channel subunit reveals a profound defect in adaptation of peptide-evoked potentials in the MOE. Because sensory neurons in the vomeronasal organ (VNO) also respond to MHC peptides but do not express CNGA2, distinct mechanisms are used by the mammalian main and accessory olfactory systems for the detection of MHC peptide ligands. These results suggest a general role for MHC peptides in chemical communication even in those vertebrates that lack a functional VNO.

Co-evolution of a primordial peptide-presentation system and cellular immunity

How did early vertebrates survive when their lymphocytes began to use antigen receptors with random specificities, despite their potential for extensive self-reactivity? Here, I propose that the quality-control mechanisms that tame self-reactivity in the adaptive immune system were derived, at least in part, from an ancient mechanism that guided sexual selection on the basis of evaluating genetic relatedness.

Evidence for a functional second thymus in mice

The thymus organ supports the development of T cells and is located in the thorax. Here, we report the existence of a second thymus in the mouse neck, which develops after birth and grows to the size of a small lymph node. The cervical thymus had a typical medulla-cortex structure, was found to support T cell development, and could correct T cell deficiency in athymic nude mice upon transplantation. The identification of a regular second thymus in the mouse may provide evolutionary links to thymus organogenesis in other vertebrates and suggests a need to reconsider the effect of thoracic thymectomy on de novo T cell production.

Mitral Regurgitation: Quantification with 16–Detector Row CT—Initial Experience

PURPOSE

To prospectively determine if retrospectively electrocardiographic (ECG)-gated multi-detector row computed tomography (CT) with a 16-detector row CT scanner can depict mitral regurgitation and enable quantification of the severity of the disease.

MATERIALS AND METHODS

The study had institutional review board approval, and patients gave informed consent. Nineteen patients with mitral regurgitation (10 men, nine women; mean age, 66 years +/- 9 [standard deviation]; range, 41-83 years) and 25 patients without mitral regurgitation (14 men, 11 women; mean age, 68 years +/- 9; range, 43-83 years) as determined with transesophageal color Doppler echocardiography and ventriculography underwent retrospectively ECG-gated 16-detector row CT. Twenty CT data sets covering the entire mitral valve apparatus were reconstructed in 5% steps of the R-R interval for each patient, and data analysis was performed with four-dimensional software. Using planimetry, two readers measured in consensus the area of the regurgitant orifice during systole. These measurements were compared with semiquantitative data from transesophageal echocardiography and ventriculography by using Spearman rank order correlation coefficients.

RESULTS

In the 25 patients without mitral regurgitation, no regurgitant orifice during systole could be detected with multi-detector row CT. In the 19 patients with mitral regurgitation, a regurgitant orifice could be visualized in all cases. The mean regurgitant orifice area at CT-45 mm(2) +/- 34 (range, 10-148 mm(2))-correlated significantly with the results at transesophageal echocardiography (r = 0.807, P < .001) and ventriculography (r = 0.922, P < .001).

CONCLUSION

Planimetric measurements of the regurgitant orifice area at retrospectively ECG-gated 16-detector row CT enable quantification of mitral regurgitation.

Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography

The purpose of this study was to evaluate the influence of ejection fraction (EF), stroke volume (SV), heart rate, and cardiac output (CO) on coronary artery opacification with 64-slice computed tomography (CT). Sixty patients underwent, retrospectively, electrocardiography-gated 64-slice CT coronary angiography. Left ventricular EF, SV, and CO were calculated with semi-automated software. Attenuation values were measured and contrast-to-noise ratios (CNRs) were calculated in the proximal right coronary artery (RCA) and left main artery (LMA). Mean EF during scanning was 61.5+/-12.4%, SV was 63.2+/-15.6 ml, heart rate was 62.5+/-11.8 beats per minute (bpm), and CO was 3.88+/-1.06 l/min. There was no significant correlation between the EF and heart rate and the attenuation and CNR in either coronary artery. A significant negative correlation was found in both arteries between SV and attenuation (RCA r=-0.26, P<0.05; LMA r=-0.34, P<0.01) and between SV and CNR (RCA r=-0.26, P<0.05; LMA r=-0.26, P<0.05). Similarly, a significant negative correlation was found between the CO and attenuation (RCA r=-0.42, P<0.05; LMA r=-0.56, P<0.001) and between the CO and CNR (RCA r=-0.39, P<0.05; LMA r=-0.44, P<0.001). The actual hemodynamic status of the patient influences the coronary artery opacification with 64-slice CT, in that vessel opacification decreases as SV and CO increase.

BMP signaling is required for normal thymus development

The microenvironment of the thymus fosters the generation of a diverse and self-tolerant T cell repertoire from a pool of essentially random specificities. Epithelial as well as mesenchymal cells contribute to the thymic stroma, but little is known about the factors that allow for communication between the two cells types that shape the thymic microenvironment. In this study, we investigated the role of bone morphogenetic protein (BMP) signaling in thymus development. Transgenic expression of the BMP antagonist Noggin in thymic epithelial cells under the control of a Foxn1 promoter in the mouse leads to dysplastic thymic lobes of drastically reduced size that are ectopically located in the neck at the level of the hyoid bone. Interestingly, the small number of thymocytes in these thymic lobes develops with normal kinetics and shows a wild-type phenotype. Organ initiation of the embryonic thymic anlage in these Noggin transgenic mice occurs as in wild-type mice, but the tight temporal and spatial regulation of BMP4 expression is abrogated in subsequent differentiation stages. We show that transgenic Noggin blocks BMP signaling in epithelial as well as mesenchymal cells of the thymic anlage. Our data demonstrate that BMP signaling is crucial for thymus development and that it is the thymic stroma rather than developing thymocytes that depends on BMP signals.

MHC peptides and the sensory evaluation of genotype

Social interactions, such as finding and identifying a mate, often rely on the ability to sense molecular cues carrying information about genetic relationship and individuality. We summarize recent evidence for an unexpected mechanistic link between the immune and olfactory systems in enabling this identification process. In addition to their established role in the immune response, peptide ligands of major histocompatibility complex (MHC) molecules constitute a previously unknown family of social recognition signals detected by specific subsets of sensory neurons in the mammalian nose. This sensing of MHC peptides can be viewed as a form of functional genome analysis by the nose. Behavioral studies in mice and fish show that MHC peptides are accepted as olfactory cues that influence mate choice decisions and selective pregnancy failure. These findings provide a molecular mechanism by which an individual can sense the composition and compatibility of vital immune system molecules of a conspecific, with direct consequences for social behavior.

Coronal thick CT reconstruction: an alternative for initial chest radiography in trauma patients

It has been proposed that the imaging workup of trauma patients be accelerated by omitting the initial chest radiography (CR) and directly performing a computed tomography (CT); however, the baseline CR is then lacking. The purpose of this study was to assess if coronal thick reconstructions generated from chest CT could present an adequate alternative for CR. Sixty trauma patients underwent bedside CR and multidetector row chest CT in the emergency room. The image quality of thoracic anatomical structures, the diagnostic accuracy for chest pathology, and the depiction of indwelling devices were assessed on both modalities. Main pulmonary arteries and perihilar bronchi were equally visualized with both modalities. Central bronchi, retrocardial lung parenchyma, diaphragm, descending aorta, and vertebral pedicles were better visualized on thick CT reconstructions, whereas peripheral lung vessels were better depicted on CR (p<0.05). The accuracy to delineate various pathological findings did not differ between both modalities, except for a higher sensitivity to diagnose bronchial cuffing on CR (p<0.05). The location of indwelling devices was similarly and correctly depicted with both modalities. Coronal thick CT reconstructions provide a similar image quality and diagnostic accuracy compared with CR. These reconstructions may serve as an equivalent baseline image in trauma patients in whom emergency radiological evaluation has to be accelerated.

Comparison of retrospectively ECG-gated and nongated MDCT of the chest in an emergency setting regarding workflow, image quality, and diagnostic certainty

PURPOSE

This study aims to assess the influence of ECG-gated acquisition on workflow and to compare image quality and diagnostic certainty for retrospectively ECG-gated and nongated multidetector computed tomography of the chest in the emergency suite.

MATERIALS AND METHODS

Thirty-two consecutive patients were referred for both an ECG-gated and a nongated CT to rule out traumatic thoracic injury (n=15) or acute aortic dissection (n=17). The time from the start of the transportation from the emergency suite to the CT room until the start of the CT scan was recorded. Using a scoring system, the image quality of axial images and multiplanar reformats, the presence of disease, and the subjective diagnostic certainty were assessed with regard to the vascular structures, the bone structures, and the lung parenchyma.

RESULTS

The time needed for transportation and patient preparation was 12.1+/-1.7 min (8.1-14.5 min). The motion artifacts of the thoracic aorta and the supra-aortic vessels were significantly reduced in the ECG-gated data acquisition compared with the nongated technique (P<0.001). Subjective diagnostic certainty for assessment of the aorta was significantly better using ECG gating. The image quality of the lung parenchyma (P<0.005), the spine (P<0.005), and the ribs (P<0.002) was inferior in the ECG-gated data sets but did not compromise the detection rate of traumatic lesions and fractures.

CONCLUSION

Performing ECG gating in the emergency room did not slow down the diagnostic workup. ECG-gated acquisition performed better in the assessment of the aorta, but image quality for lung and bone structures was slightly reduced. Further studies are required to assess the influence of the imaging technique on the diagnostic outcome.

Sixteen–Detector Row CT Angiography for Lower-Leg Arterial Occlusive Disease: Analysis of Section Width

Institutional review board approval and written informed consent from all patients were obtained. Diagnostic accuracy of three reconstructions of 16-detector row computed tomographic (CT) angiography data with different section widths and increments (2.0 and 1.0 mm [CT data set 1], 1.0 and 0.5 mm [CT data set 2], and 0.75 and 0.4 mm [CT data set 3]) was compared with that of digital subtraction angiography (DSA) in 163 arterial segments in 17 patients with occlusive peripheral arterial disease (PAD). Arterial visibility was superior with CT as compared with DSA (P < .008). Sensitivity for stenosis detection did not differ between the CT reconstructions, whereas specificity was significantly improved when CT data set 3 was used (P < .017). Stenosis length did not differ significantly between CT angiography and DSA. Accuracy of stenosis detection was 88.2%, 90.8%, and 96.1% with CT data sets 1, 2, and 3, respectively. CT angiography has excellent diagnostic accuracy in the assessment of lower-leg PAD provided that the thinnest possible section width is used.

Benefit of Echocontrast-Enhanced Transcranial Arterial Color-Coded Duplex Ultrasound

OBJECTIVES

Proper assessment of the intracranial arteries by transcranial color-coded duplex sonography (TCCD) is occasionally made difficult by an insufficient temporal bone window, an unfavorable insonation angle, or low flow velocity or volume. In these cases, echocontrast could be helpful to increase the diagnostic confidence or to make the diagnosis at all.

MATERIAL AND METHODS

We investigated 67 temporal windows of 47 patients with insufficient native transtemporal insonation conditions before and after the application of the second-generation (gas-filled) microbubble contrast agent Sonovue (in 20 patients out of these 47, both temporal windows were insufficient, in the remaining 27 only one side).

RESULTS

As compared to the precontrast scans, echocontrast allowed for more segments to be evaluated by pulsed Doppler sonography (p < 0.0001) and for longer lumen segments to be displayed on color mode (p < 0.0001). With the help of contrast medium, flow velocity in the middle cerebral artery could be measured through 65 windows as compared to only 26 windows before contrast was applied (p < 0.0001).

CONCLUSIONS

In patients with poor precontrast visualization of intracranial arteries, echocontrast-enhanced TCCD is very helpful.

Dynamic Cine Mode Imaging of the Normal Aortic Valve Using 16-Channel Multidetector Row Computed Tomography

BACKGROUND

We investigated the feasibility and image quality of dynamic cine-mode imaging of the normal aortic valve using multidetector row computed tomography (MDCT).

MATERIALS AND METHODS

We acquired contrast-enhanced retrospectively echocardiography (ECG)-gated cardiac MDCT datasets of 35 patients (mean age, 62 years; range, 53-77) who received a transoesophageal echocardiography (TOE) precedent to cardiac bypass graft surgery. Twenty data sets in 5% steps of the R-R interval were reconstructed, and data analysis was performed using a 4D software. Read-out of the MDCT data was performed in parallel and perpendicular planes, similar to TOE standard planes, by 2 independent, blinded readers using a 4-point Likert scale (best score: 4) for the following parameters: image quality of the aortic valve components, contrast media enhancement, contrast media inflow related artifacts, and ECG gating-related artifacts. The aortic valve area (AVA) was measured planimetrically and was compared between TOE and MDCT.

RESULTS

The best phase for assessing the open valve using MDCT was at 5% and the closed valve at 65% of the cardiac cycle. The mean image quality scores for cine-mode MDCT ranged between 3.26 and 3.75, with inter-reader agreements ranging between good (kappa = 0.723) and excellent (kappa = 1.00). They did not differ significantly from TOE scores for assessment of the closed and open valve. In transitional phases (close-to-open and open-to-close) TOE performed significantly better when compared with static MDCT images, whereas no significant difference was present between cine-mode presentation of MDCT and TOE. Planimetric AVA measurements correlated significantly between TOE and MDCT (Pearson correlation coefficient, r = 0.96; P < 0.0001). Contrast media inflow-related and ECG gating related artifacts were rated as slightly compromising (scores 3.24 and 3.21).

CONCLUSION

Retrospectively ECG-gated MDCT offers a noninvasive, accurate, and dynamic imaging method for quantitative and qualitative evaluation of the normal aortic valve allowing determination of morphology and function throughout the cardiac cycle. Further studies regarding assessment of diseased valves are necessary.

Diagnostische Abklärung der schmerzlosen Mikrohämaturie: Prospektive Studie zum Vergleich von Bildqualität, Beurteilbarkeit und diagnostischer Sicherheit von MDCT und IVU in einem Untersuchungsgang

PURPOSE

The purpose of this study is to prospectively compare intravenous pyelography (IVP) and combined unenhanced and excretory phase multidetector-row CT (MDCT) with respect to image quality, diagnostic certainty and diagnostic concordance with the final clinical diagnosis in patients with painless microhematuria.

MATERIALS AND METHODS

Unenhanced MDCT, IVP and excretory phase MDCT were performed in 59 consecutive patients (21 women, 38 men, mean age 56 +/- 19 years, range 23 - 83 years) with painless microhematuria of unknown origin during a single examination with a single contrast media application (100 ml, non-ionic iodinated contrast media). Images were assessed by two experienced urogenital radiologists in consensus for image quality, diagnostic certainty of stone detection, obstruction, parenchymal lesions and morphological distinctive features. Imaging diagnoses of MDCT and IVP were compared with the final clinical diagnoses. In case of failure to detect an relevant pathology, the final clinical diagnosis was established after a mean follow-up period of 18 +/- 6 months (10 months to 2 years). Costs and radiation exposure of IVP and MDCT were compared.

RESULTS

MDCT scan performed better than IVP in terms of image quality for all regarded variables. Image quality of MDCT was rated in all parameters as very good or good; the image quality of IVP differed in a wide range. MDCT and IVP reached a sensitivity of 100 % and 50 % for stone detection (n = 14, p = 0.008), respectively. Two bladder stones were not detected by IVU but correctly seen with MDCT. MDCT and IVP were unsatisfactory for detecting transitional cell carcinomas (n = 4, 2 of 4 detected with MDCT, 0 of 4 detected with IVU). One false positive transitional cell carcinoma was detected with IVP, none with MDCT. Additional relevant pathological changes (one teratoma, one abdominal aortic aneurysma and one abscess) were detected using MDCT but missed with IVP. In 38 of 59 patients (64 %) imaging and clinical follow-up over up to 24 months did not reveal any pathology to explain the microhematuria. The costs of the IVP (283 Euro) were lower compared with non-enhanced MDCT (380 Euro) or combined non-enhanced and contrast-enhanced MDCT (560 Euro). The radiation exposure was 23 - 27 mSv for MDCT and 2.3 mSv for IVP.

CONCLUSION

MDCT performed better regarding image quality, subjective diagnostic certainty and diagnostic results with respect to stone detection. Since urolithiasis is a frequent cause of painless microhematuria MDCT is recommended as the initial imaging modality rather than IVU.

Coronal Ultra-Thick Multiplanar CT Reconstructions (MPR) of the Pelvis in the Multiple Trauma Patient: An Alternative for the Initial Conventional Radiograph

PURPOSE

Multiple trauma patients with clinically suspected pelvic fractures often directly undergo a CT scan. However, the initial portable pelvis film (PPF) for further follow-up is then not available. This study examines whether coronal ultra-thick multiplanar reconstructions from CT data are similar when compared with the initial PPF, thus having the potential to serve as an alternative baseline image.

MATERIALS AND METHODS

Initial PPF and coronal ultra-thick multiplanar CT reconstructions of 33 multiple trauma patients with pelvic fractures were retrospectively analyzed by two independent radiologists with regard to image quality, visualization of anatomical landmarks, and diagnostic accuracy. The primary diagnosis of pelvic fractures was made by using thin axial CT images and thin slice coronal and sagittal reconstructions and served as the standard of reference.

RESULTS

Coronal ultra-thick multiplanar CT reconstructions were superior to PPF regarding image adjustment (p < 0.02), absence of overlaying structures (p < 0.05), and overall image quality (p < 0.01). Visualization of most anatomical landmarks was similar with both modalities, except of the iliosacral joint and acetabular lines which were more accurately depicted on ultra-thick multiplanar CT reconstructions (p < 0.05). Diagnostic accuracy of coronal ultra-thick CT reconstructions was similar to PPF regarding most fracture types, except of a higher accuracy of coronal ultra-thick CT reconstructions for iliosacral joint and acetabular column fractures (p < 0.05).

CONCLUSION

Coronal ultra-thick multiplanar CT reconstructions of the pelvis provide similar image quality and diagnostic accuracy compared to PPF and are therefore suited as alternative baseline image in multiple trauma patients who directly undergo CT.

Dynamic Cine Imaging of the Mitral Valve with 16-MDCT: A Feasibility Study

OBJECTIVE

Our aim was to assess the feasibility and image quality of dynamic cine-mode imaging of the mitral valve using retrospectively ECG-gated 16-MDCT.

SUBJECTS AND METHODS

Contrast-enhanced MDCT was performed in 37 patients who have a normal mitral valve, as shown on transesophageal echocardiography. Twenty CT data sets covering the valve apparatus were reconstructed every 5% step of the R-R interval. Multiplanar reconstructions were performed in the parallel short axis and perpendicular long axis of the left ventricle. Two independent blinded reviewers evaluated the image quality for dynamic cine-mode visualization of the valve components in systole and diastole and during the transitional phases in between.

RESULTS

Interobserver agreement for image quality ratings of valve components in all cardiac cycle phases ranged from good to excellent. Image quality for the visualization of valve leaflets, apposition zone, commissures, and mitral annulus (ranging from adequate to excellent) was significantly superior on perpendicular plane images than on parallel plane images for all cardiac phases (p < 0.05). Tendinous cords were visualized on both perpendicular and parallel planes with bad to adequate quality, whereas visualization of the papillary muscles was adequate to excellent on both imaging planes. Visualization of each valve component was superior in systole and diastole in both imaging planes as compared with the transitional phases (p <0.001).

CONCLUSION

Noninvasive cine-mode imaging of the mitral valve using retrospectively ECG-gated MDCT is feasible and allows accurate visualization of the moving valve. Perpendicular long-axis reconstructions yield images of superior quality when compared with the short-axis reconstructions and enable a determination of its functional morphology.

Cardiac arrest in a soccer player: a unique case of anomalous coronary origin detected by 16-row multislice computed tomography coronary angiography

Anomalous origin of the coronary arteries may be present in otherwise normal subjects without clinical significance, but can also be the cause of myocardial ischemia and sudden death in both adults and teenagers. In particular, the origin of the left main coronary artery or left anterior descending artery from the right sinus of Valsalva or right coronary artery may result in compression of the vessel during or immediately after exercise. We present a unique case of coronary anomaly with four separate coronary ostia originating from the right coronary sinus in a soccer player with sudden cardiac arrest. Multislice contrast-enhanced computed tomography has emerged as a valid noninvasive method for the diagnosis of coronary artery anomaly.

Coarctation and aorto-aortic bypass: three-dimensional post-processing using multidetector row computed tomography

We present the case of a 61-year-old man with a history of dyspnea and disparity in blood pressure of the arms and legs due to a stenotic biscupid aortic valve and a hemodynamically relevant restenosis of a resected coarctation. The coarctation was treated with an extra-anatomic transdiaphragmal aorto-aortic bypass graft. At the same time, the biscupid aortic valve was replaced. Postoperative follow-up contrast-enhanced multidetector row computed tomography (MDCT) and three-dimensional (3D) postprocessing of the axial data sets using the volume-rendering technique was performed. This case of complex vascular structures demonstrates the potency of MDCT combined with the 3D visualization technique.

Mate choice decisions of stickleback females predictably modified by MHC peptide ligands

Sexual selection has been proposed as one mechanism to explain the maintenance of high allelic diversity in MHC genes that control the extent of resistance against pathogens and parasites in natural populations. MHC-based sexual selection is known to involve olfactory mechanisms in fish, mice, and humans. During mate choice, females of the three-spined stickleback (Gasterosteus aculeatus) use an odor-based selection strategy to achieve an optimal level of MHC diversity in their offspring, equipping them with optimal resistance toward pathogens and parasites. The molecular mechanism of odor-based mate-selection strategies is unknown. Because peptide ligands for MHC class I molecules function as individuality signals in mice, we hypothesized that female sticklebacks might assess the degree of MHC diversity of potential partners by means of the structural diversity of the corresponding peptide ligands in perceived odor signals. We show that structurally diverse MHC ligands interact with natural odors of male sticklebacks to predictably modify MHC-related mate choice. For a mating pair with suboptimal numbers of MHC alleles, peptides increase the attractiveness of male water, whereas for a mating pair with superoptimal numbers, attractiveness is decreased. Our results suggest that female sticklebacks use evolutionarily conserved structural features of MHC peptide ligands to evaluate MHC diversity of their prospective mating partners.

Image quality of volume rendering of the bronchial tree: Kymogram-gated versus retrospectively ECG-gated and non-gated multi-row detector CT

RATIONALE AND OBJECTIVE

To compare the image quality of three different heart-cycle-synchronized computed tomography (CT) reconstruction algorithms for volume-rendered (VR) 3D visualization of the bronchial tree.

MATERIALS AND METHODS

Kymogram-gated, retrospectively ECG-gated, and non-ECG-gated reconstructions of the bronchial tree were performed from 4-detector-row CT data in 10 subjects. The raw data were reconstructed in 10 phases of the cardiac cycle using ECG-gated and kymogram-gated technique, respectively. For both reconstructions, the optimal artifact-free diastolic phase was determined. VR reconstructions of the bronchial tree were generated from these two data sets and from the non-gated data. Stairstep artifacts of the main bronchi, artifacts in the lung parenchyma, and the extent of bronchial tree visualization were rated by two blinded, independent readers.

RESULTS

Kymogram-gated reconstruction showed stairstep artifacts in the main bronchi to the same extent as non-gated reconstruction, but less compared to ECG-gated reconstruction (P < .001). Artifacts in the lung parenchyma were similar with kymogram-gated and non-gated reconstruction, but less compared to ECG-gated reconstruction (P < 0.01). Kymogram-gated reconstruction showed no differences in visualization of segmental and subsegmental bronchi compared to ECG-gated reconstruction, but was inferior to the non-gated reconstruction (P < 0.05).

CONCLUSION

Kymogram-gated reconstruction of CT data results in fewer artifacts when compared to the ECG-gated algorithm. Best visualization of the bronchial tree at a low artifact level is obtained with non-gated CT data. It remains therefore the method of choice for VR 3D data post-processing of the bronchial tree.

[Application of multislice spiral CT (MSCT) in multiple injured patients and its effect on diagnostic and therapeutic algorithms]

The initial diagnostic work-up of trauma victims with multiple injuries is currently a combination of conventional radiography (CR), ultrasound (US), and computed tomography (CT). This article reviews the diagnostic quality of the different imaging modalities regarding detection and classification of injuries. CT performs better than US in detecting traumatic lesions of abdominal parenchymal organs. Furthermore, CT is better than CR in detecting therapeutically relevant chest and bone injuries. MSCT may replace CR and US under the condition that it is faster than or at least as fast as the conventional approach to diagnose life threatening injuries. This can be achieved only by changing the work-flow for the entire trauma team including radiologist. Furthermore, certain prerequisites must be fulfilled including integration of a MSCT scanner into the emergency room. An optimized whole body CT protocol for the assessment of trauma victims using MSCT as well as a two-step algorithm for reporting the imaging findings depending on their clinical significance is presented.

MHC class I peptides as chemosensory signals in the vomeronasal organ

The mammalian vomeronasal organ detects social information about gender, status, and individuality. The molecular cues carrying this information remain largely unknown. Here, we show that small peptides that serve as ligands for major histocompatibility complex (MHC) class I molecules function also as sensory stimuli for a subset of vomeronasal sensory neurons located in the basal Gao- and V2R receptor-expressing zone of the vomeronasal epithelium. In behaving mice, the same peptides function as individuality signals underlying mate recognition in the context of pregnancy block. MHC peptides constitute a previously unknown family of chemosensory stimuli by which MHC genotypic diversity can influence social behavior.

Vascular Emergencies of the Thorax after Blunt and Iatrogenic Trauma: Multi–Detector Row CT and Three-dimensional Imaging

Multi-detector row computed tomographic (CT) angiography is an effective modality for vascular imaging in the thorax. It allows acquisition of high-resolution data sets during a single breath hold, making it the preferred method for evaluation of patients with acute vascular disease. In contrast to conventional angiography, multirow CT angiography not only depicts the vessels but also allows assessment of adjacent structures. Multirow CT angiography with two- and three-dimensional reformation can be used to diagnose vascular emergencies of the thorax after blunt and iatrogenic trauma. These include incomplete and complete aortic rupture; traumatic aortic dissection; arterial dissection and rupture after minor trauma in patients with Ehlers-Danlos syndrome; traumatic intramural hematoma; pseudoaneurysm after endovascular repair; injuries due to Swan-Ganz catheters; complications of central venous cannulation, pacemaker implantation, and percutaneous pericardial drainage; and foreign-body embolism. The diagnoses can be established with multirow CT angiography in the emergency department. Thus, the time to diagnosis can be considerably decreased by obviating conventional angiography. Knowledge of the CT findings in various vascular conditions is essential to make use of multirow CT angiography in combination with two- and three-dimensional reformation as an efficient and accurate diagnostic tool in emergency radiology.

Morpholino oligonucleotide-triggered knockdown reveals a role for maternal E-cadherin during early mouse development

We report that gene silencing via intracytoplasmic microinjections of morpholino-modified antisense oligonucleotides is an effective and reproducible method to study both maternal and zygotic gene functions during early and late stages of mouse preimplantation development. The zygotic expression of the beta-geo transgene in the ROSA26 mouse strain could be inhibited until at least the early blastula stages. Thus morpholino-triggered gene inactivation appears to be a useful method to study the functional role of genes in preimplantation development. Using this approach, we have investigated a potential role of maternal expression of Cdh1, the gene encoding the cell-adhesion molecule E-cadherin. Inhibition of translation of maternal E-cadherin mRNA causes a developmental arrest at the two-cell stage. BrUTP incorporation assays indicated that this developmental defect cannot be explained by a general failure in transcriptional activity. This defect is reversible since E-cadherin mRNA can rescue the affected embryos, suggesting that a functional adhesion complex, present at the junction between blastomeres, is a prerequisite for the normal development of the mouse preimplantation embryo. Our study thus reveals a previously unanticipated role of maternal E-cadherin during early stages of mouse development.

Effects of ECG Gating and Postprocessing Techniques on 3D MDCT of the Bronchial Tree

OBJECTIVE

Our goal was to determine the impact of ECG gating and different postprocessing techniques on 3D imaging of the bronchial tree. SUBJECTS AND METHODS. Retrospective ECG-gated MDCT and non-ECG-gated MDCT of the chest were performed in 25 patients. ECG-gated MDCT data were reconstructed mid diastole using a fixed interval of -400 msec in 25 patients and then additionally at -200, -300, and -500 msec in 10 of those patients. Shaded surface display and volume rendering of the bronchial tree combined with virtual bronchoscopy were performed using all data sets. The extent of bronchial tree visualization in shaded surface display-virtual bronchoscopy and volume rendering-virtual bronchoscopy and the presence of artifacts in volume-rendered images were scored by three blinded reviewers. The effective radiation doses of the ECG-gated and nongated acquisitions were compared.

RESULTS

The summary scores of all bronchial segments for gated shaded surface display-virtual bronchoscopy and gated volume rendering-virtual bronchoscopy did not differ significantly. The summary scores for nongated shaded surface display-virtual bronchoscopy and nongated volume rendering-virtual bronchoscopy were not significantly different. Non-gated acquisition yielded significantly better visualization of the bronchial tree for both post-processing techniques, regardless of the time interval used for reconstruction of the ECG-gated series. Artifact scores in volume-rendered images were significantly higher for ECG-gated MDCT compared with nongated MDCT. Effective radiation dose was significantly higher for the ECG-gated acquisition.

CONCLUSION

Given the advantage of volume rendering for representing the entire data set and given the lower radiation dose and better 3D image quality of nongated acquisition, volume rendering performed on nongated MDCT data is the method of choice for 3D visualization of the bronchial tree.