Effect of beta-blocker on left ventricular function and natriuretic peptides in patients with chronic heart failure treated with angiotensin-converting enzyme inhibitor

To evaluate whether or not beta-blockers can improve the condition of patients with heart failure treated with a combination of diuretics, digitalis and angiotensin-converting enzyme inhibitor (ACEI), 52 patients with chronic heart failure who have been treated with ACEI for more than 6 months were enrolled. They were divided into 2 groups: 26 patients continued the same therapy another 6 months or more (group A), and 26 patients were given oral metoprolol for 6 months or more, in addition to the ACEI (group B). Echocardiographic parameters and atrial and brain natriuretic peptides (ANP, BNP) were measured. The left ventricular dimensions at end-diastole and end-systole were significantly decreased and fractional shortening was significantly increased in group B after 6 months' treatment with the beta-blocker, but these parameters remained unchanged in group A. Plasma levels of both ANP and BNP were significantly decreased in group B, but remained unchanged in group A. These results indicate that concomitant beta-blocker therapy can improve left ventricular function and attenuate plasma ANP and BNP levels in patients with chronic heart failure treated with ACEI.

Limbic lobe of the human brain: evaluation with turbo fluid-attenuated inversion-recovery MR imaging

PURPOSE

To determine whether brain cortices have different signal intensities on turbo fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) images.

MATERIALS AND METHODS

Coronal 5-mm-thick turbo FLAIR MR images in 56 neurologically normal patients (27 male and 29 female patients; age range, 12-73 years; mean age, 47 years) were evaluated retrospectively. Cortical signal intensities in the amygdala, hippocampus, cingulate gyrus, subcallosal area, insula, temporal lobe, parietal lobe, and occipital lobe were graded relative to cortical signal intensity in the frontal lobe. Contrast-to-noise ratios were compared for each cortical area.

RESULTS

Increased signal intensity was frequently seen in the amygdala, hippocampus, cingulate gyrus, and subcallosal area, regardless of patient age. Signal intensities of temporal, parietal, and occipital cortices were similar to that of frontal cortex, and signal intensity of the insula was slightly higher than that of frontal cortex. There were no significant differences with respect to sex and laterality, whereas significant differences were found among cortical regions (P <.01). The contrast-to-noise ratios of the amygdala, hippocampus, cingulate gyrus, and subcallosal area were significantly greater than those of all other gray matter structures (P <.05).

CONCLUSION

On turbo FLAIR images, high signal intensities of cortices of the limbic lobe are frequently seen in neurologically normal brain. These findings should not be considered abnormal.

Identification of a response element for vitamin D3 and retinoic acid in the promoter region of the human fructose-1,6-bisphosphatase gene

Fructose-1,6-bisphosphatase (FBPase) is a key gluconeogenic enzyme. The data herein show that both the enzyme activity and mRNA level of the human FBPase gene are enhanced by 9-cis retinoic acid (9cRA) and all-trans retinoic acid (atRA) as well as by 1,25-dihydroxyvitamin D3 (VD3) in human promyelocytic HL60 cells and normal monocytes in peripheral blood, which were used as an alternative source to liver for the DNA diagnosis of FBPase deficiency. To understand the molecular mechanism of this enhancing action, the 2.4 kb 5'-regulatory region of the human FBPase gene was isolated and sequenced. Using luciferase reporter gene assays, a 0.5 kb FBPase basal promoter fragment was found to confer induction by VD3, 9cRA, and atRA that was mediated by the vitamin D3 receptor (VDR), retinoid X receptor (RXR), and retinoic acid receptor (RAR). Within this region, a direct repeat sequence, 5'-TAACCTttcTGAACT-3' (-340 to -326), which functions as a common response element for VD3, 9cRA, and atRA, was identified. The results of electrophoretic mobility shift assays indicated that VDR-RXR and RAR-RXR heterodimers bind this response element. Collectively, these observations indicate that VD3 and RA are important modulators of the expression of the human FBPase gene in monocytic cells.

Apical hypertrophic cardiomyopathy associated with life-threatening paroxysmal atrial flutter with a slow ventricular response: a case report

A 58-year-old male patient had apical hypertrophic cardiomyopathy (HCM) associated with a life-threatening tachycardia due to atrial flutter. Following palpitation and dyspnea for 2-3 h, he became unconscious because of circulatory catastrophe, but was fully resuscitated. An electrocardiogram recorded just before the loss of consciousness revealed atrial flutter at a rate of 260 beats/min with a 2:1 ventricular response. He was diagnosed as having apical HCM based on the echocardiographic and left ventriculographic findings. Atrial stimulation at a rate of 150 pacings/min for 1 min caused a marked drop in systemic systolic blood pressure from 170 to 120 mmHg. The patient was treated with 150 mg of cibenzoline per day to prevent supraventricular tachyarrhythmias and to improve left ventricular diastolic function. At the time of the recent follow-up at 2 and a half years, he felt quite well.

Evaluation of syringomyelia with three-dimensional constructive interference in a steady state (CISS) sequence

The purpose of this study was to evaluate a three-dimensional (3D) constructive interference in steady state (CISS) sequence in the assessment of syringomyelia. Eleven patients with syringomyelia were prospectively studied with magnetic resonance imaging. All patients underwent sagittal imaging with T1- and T2-weighted spin-echo (SE), and 3D-CISS sequences. The SE and 3D-CISS images, as well as multiplanar reconstruction (MPR) images of the 3D-CISS sequence, were analyzed with regard to image quality, degree of artifacts, visualization of the extent and internal structure of the syringomyelia, and contrast-to-noise ratio (CNR) of the fluid within the syringomyelia. Contrast between the spinal cord and cerebrospinal fluid (CSF), as well as delineation was significantly poorer for the T1-weighted SE sequence than for the 3D-CISS sequence (P < 0.01), while there was no significant difference between the T2-weighted SE sequence and the 3D-CISS sequence. Artifacts induced by CSF flow were significantly more for the T2-weighted SE sequence than for the 3D-CISS sequence (P < 0.01). Although the extent of syringomyelia was delineated equally among the three sequences in 9 of 11 patients, it was better for the 3D-CISS sequence than for the SE sequences in the remaining two. Septation and communication between the cavities were best detected by the 3D-CISS MPR images. The CNR of the 3D-CISS sequence was significantly higher than that of the SE sequence (P < 0.01). The 3D-CISS sequence demonstrates the extent and internal structures of syringomyelia better than conventional SE sequences and should be added to SE sequences in the evaluation of syringomyelia.

Renin-dependent cardiovascular functions and renin-independent blood-brain barrier functions revealed by renin-deficient mice

Renin plays a key role in controlling blood pressure through its specific cleavage of angiotensinogen to generate angiotensin I (AI). Although possible existence of the other angiotensin forming enzymes has been discussed to date, its in vivo function remains to be elucidated. To address the contribution of renin, we generated renin knockout mice. Homozygous mutant mice show neither detectable levels of plasma renin activity nor plasma AI, lowered blood pressure 20-30 mm Hg less than normal, increased urine and drinking volume, and altered renal morphology as those observed in angiotensinogen-deficient mice. We recently found the decreased density in granular layer cells of hippocampus and the impaired blood-brain barrier function in angiotensinogen-deficient mice. Surprisingly, however, such brain phenotypes were not observed in renin-deficient mice. Our results demonstrate an indispensable role for renin in the circulating angiotensin generation and in the maintenance of blood pressure, but suggest a dispensable role for renin in the blood-brain barrier function.

Evaluation of dural sinus invasion and extension of extra-axial intracranial tumors. The advantages of a high-resolution postcontrast 3-D gradient-echo technique

OBJECTIVE

To assess the usefulness of a postcontrast 3-D Fourier transform (3DFT) gradient-echo (GRE) technique in dural sinus invasion and extension of extraaxial intracranial tumors in comparison with a conventional spin-echo (SE) technique.

MATERIAL AND METHODS

Fourteen consecutive patients with 15 extra-axial tumors in contiguity with the dural sinus, including 14 meningiomas and 1 adenoid cystic carcinoma, underwent postcontrast T1-weighted SE and GRE MR studies. Detectability of dural sinus invasion and extension was evaluated using two sequences by two neuroradiologists in a blinded manner and compared with surgical results. Quantitative analysis was also performed to calculate the contrast-to-noise ratio (CNR) between lesion and dural sinus on SE and GRE images. The data were analyzed statistically using a matched paired t-test.

RESULTS

In the qualitative evaluation, the detectability of dural sinus invasion in 3DFT-GRE images was superior to that using SE images. The mean CNR for all lesions was 3.86 on SE images and 5.63 on 3DFT-GRE images (p = 0.03).

CONCLUSION

For evaluation of dural sinus invasion and the extension of extra-axial tumors, postcontrast 3DFT-GRE MR images were superior to conventional SE images.

Regulated expression of human angiotensinogen gene by hepatocyte nuclear factor 4 and chicken ovalbumin upstream promoter-transcription factor

We previously identified various upstream and downstream regulatory elements and factors important for hepatic expression of the human angiotensinogen (ANG) gene, the precursor of vasoactive octapeptide angiotensin II. In the present study, to further investigate the molecular mechanism of human ANG transcriptional regulation, we generated transgenic mice carrying the fusion gene composed of the 1. 3-kilobase promoter of the human ANG gene, its downstream enhancer, and the chloramphenicol acetyltransferase reporter gene. Because expression of the chloramphenicol acetyltransferase gene was observed strongly in the liver and weakly in the kidney, we suspected that hepatocyte nuclear factor (HNF) 4 with a tissue expression pattern similar to that of the reporter gene would regulate ANG transcription. In vitro assays indicated that HNF4 bound to the promoter elements and strongly activated the ANG transcription, but that chicken ovalbumin upstream promoter transcription factor (COUP-TF), a transcriptional repressor, dramatically repressed human ANG transcription through the promoter elements and the downstream enhancer core elements. Furthermore, COUP-TF dramatically decreased the human ANG transcription in the mouse liver by the Helios Gene Gun system in vivo. These results suggest that an interplay between HNF4 and COUP-TF could be important in hepatic human ANG transcription.

3D TOF turbo MR angiography for intracranial arteries: phantom and clinical studies

This work investigated whether turbo magnetic resonance angiography (MRA) can replace conventional MRA in screening examination of intracranial arteries. A phantom was used to evaluate the effect of the zero-filling interpolation (ZFI) technique on spatial resolution and partial volume effect. Thirty-one consecutive patients underwent both turbo MRA with a slice thickness of 0.7 mm (data were measured as 1.33 mm sections) and conventional MRA with 1.0 mm sections. In the phantom studies, ZFI did not improve the spatial resolution, but the partial volume effect was somewhat reduced. In the clinical evaluation, turbo MRA showed better signal-to-noise and contrast-to-noise ratios of the intracranial major vessels than conventional MRA. The lesions included cerebral aneurysms less than 3 mm in diameter, occlusive vascular disease, arteriovenous malformations, and arteriovenous fistulas. These were all depicted on both turbo MRA and conventional MRA. Turbo MRA is a useful screening procedure because of its capability of delineating lesions in approximately half the usual imaging time. J. Magn. Reson. Imaging 1999;10:939-944.

Serum creatinine level underestimates hypertensive renal involvement in elderly patients with essential hypertension

It is well recognized that serum creatinine level provides a quick general assessment of renal function. However, we frequently encounter elderly hypertensive patients with renal involvement whose serum creatinine levels are within normal limits. The aim of this study was thus to determine whether serum creatinine level is a sensitive indicator of renal function in elderly hypertensive patients. Study groups were classified according to age: 82 elderly patients (aged 65 yr or older) and 98 middle-aged patients (aged 40-65 yr) with essential hypertension. To assess hypertensive renal involvement, serum creatinine and serum uric acid levels were measured. We also measured the left ventricular mass (LVM) index by using echocardiography as a marker of hypertensive target organ damage. There was no age-related difference in the LVM index, but the serum creatinine level in elderly hypertensive patients was significantly lower than that in middle-aged hypertensive patients. There was no significant difference in serum uric acid level between the two groups. In addition, the LVM index was correlated with the serum uric acid level (r = 0.46, p = 0.0001) but not with the serum creatinine level in elderly hypertensive patients. In middle-aged hypertensive patients, the LVM index was related to both serum uric acid level (r = 0.41, p = 0.007) and serum creatinine level (r = 0.43, p = 0.003). In conclusion, serum creatinine level may underestimate hypertensive renal involvement in elderly hypertensive patients. In contrast, serum uric acid level may be a sensitive indicator of hypertensive target organ damage irrespective of age.

Hypertrophic cardiomyopathy with mid-ventricular obstruction and splenic infarction associated with paroxysmal atrial fibrillation: a case report

A 54-year-old woman had been treated for hypertrophic cardiomyopathy and paroxysmal atrial fibrillation since 1992. She was admitted with paroxysmal atrial fibrillation which was resolved by medical treatment. However, on the next day, left lateral chest pain appeared. Computed tomography disclosed a low density area in the spleen. She received anticoagulant therapy under a diagnosis of splenic infarction, and the pain disappeared. Echocardiography showed hypertrophic cardiomyopathy with mid-ventricular obstruction. She was treated with cibenzoline to prevent paroxysmal atrial fibrillation attack and attenuate the hemodynamic load. After treatment, the pressure gradient decreased from 41 to 7 mmHg. This patient with hypertrophic cardiomyopathy suffered a rare isolated splenic infarction associated with paroxysmal atrial fibrillation.

Rest-redistribution thallium-201 myocardial scintigraphic study in cardiac amyloidosis

BACKGROUND

Histopathological study in amyloid heart demonstrates that myocyte destructed by the extracellular deposition of amyloid protein together with viable myocyte is present. We hypothesized that rapid thallium washout may be found in amyloid heart as in regions which have a mixture of viable myocyte and scar tissue in patients with myocardial infarction. Thus, the purpose of this study was to evaluate the extent and severity of myocardial damage due to amyloid deposits using the washout rate of the tracer on rest-redistribution thallium-201 (201Tl) myocardial scans in cardiac amyloidosis patients.

METHODS

Rest-redistribution 201Tl myocardial scintigraphy was performed in 5 patients with biopsy-proved systemic amyloidosis with cardiac involvement (amyloidosis group). The initial and delayed images were obtained 15 min and 4 h, respectively, after intravenous injection of the tracer of 111 MBq. Washout rate of the tracer was calculated. Twelve patients with no apparent heart disease served as controls (control group).

RESULTS

Mean washout rate of the whole heart was higher in the amyloidosis group than in the control group (56 +/- 9% vs 36 +/- 6%, p < 0.001). Particularly, 4 of the 5 patients in the amyloidosis group presented a very high rate of thallium clearance which ranged from 57 to 61%, and died in less than a year. In the remaining 1 patient who had a normal washout rate of the tracer in the first study, it changed from 40 to 53% during the 5-year follow-up period.

CONCLUSIONS

Washout rate in the setting of rest and delayed 201Tl images may represent the severity of amyloid depositions in the myocardium and may provide prognostic information.

Detection of intracranial hemorrhage with susceptibility-weighted MR sequences

BACKGROUND AND PURPOSE

Detection of hemorrhage is important in the diagnosis and management of a variety of intracranial diseases. We evaluated the sensitivity of the following sequences for depicting chronic hemorrhagic foci associated with susceptibility dephasing: gradient-recalled echo (GRE) imaging, GRE-type single-shot echo-planar imaging (GRE-EPI), spin-echo-type single-shot echo-planar imaging (SE-EPI), turbo spin-echo (TSE) imaging, half-Fourier single-shot turbo spin-echo (HASTE) imaging, and segmented HASTE (s-HASTE) imaging. To our knowledge, no previous comparison has been made with these techniques in the same patient.

METHODS

Fifty patients with suspected chronic hemorrhage were examined prospectively with the above six sequences. Contrast-to-noise ratio (CNR), sensitivity to detection of lesions, conspicuity of internal architecture, and sensitivity to small hemorrhagic foci were evaluated.

RESULTS

Hemorrhagic foci were found in 35 patients. The CNR of the GRE, GRE-EPI, SE-EPI, TSE, s-HASTE, and HASTE sequences was 30.9, 23.7, 3.6, 6.1, -29.3, and -13.1, respectively; the number of small hemorrhagic foci detected was 85, 96, 44, 22, two, and one, respectively, for the supratentorial white matter; 70, 40, 19, four, zero, and zero, respectively, for the supratentorial cortical/subcortical region; and 73, 50, 26, 37, zero, and zero, respectively, for the infratentorial/skull-base region.

CONCLUSION

The GRE sequence was best for detecting susceptibility dephasing associated with chronic intracranial hemorrhage. GRE-EPI, while comparable to GRE in the supratentorial compartment, was reduced in its sensitivity near the skull base, and may be used as an alternative to GRE in uncooperative, unsedated, pediatric, or claustrophobic patients. SE-EPI should not be used in screening for intracranial hemorrhage.

Contrast enhancement of intracranial lesions: conventional T1-weighted spin-echo versus fast spin-echo MR imaging techniques

BACKGROUND AND PURPOSE

The T1-weighted fast spin-echo (T1-FSE) MR imaging sequence is not used routinely, since the speed advantage is not as dramatic as it is in T2-weighted imaging. We evaluated the T1-FSE sequence to determine whether this technique can replace the conventional T1-weighted spin-echo (T1-SE) sequence for routine contrast-enhanced imaging.

METHODS

Sixty-nine patients with intracranial enhancing lesions underwent both T1-SE and T1-FSE sequences in a random order after administration of contrast agent. Acquisition time was 55 seconds for the T1-FSE sequence and 2 minutes 38 seconds for the SE sequence. The conspicuity of enhancing lesions, peritumoral edema, and gray-to-white matter contrast as well as motion and flow artifacts were analyzed. Signal-to-noise ratios of enhancing lesions, gray matter, and white matter as well as contrast-to-noise ratios (CNRs) of enhancing lesions, with gray matter with white matter as the standard, were calculated.

RESULTS

The conspicuity of enhancing lesions was better on T1-FSE sequences than on T1-SE sequences, although the difference in the CNRs of enhancing lesions did not reach significance. Images obtained with the T1-FSE sequence showed less flow and motion artifacts than did those obtained with the T1-SE sequence. The conspicuity of peritumoral edema and gray-to-white matter contrast was lower on the T1-FSE images than on the T1-SE images.

CONCLUSION

The T1-FSE sequence reduces imaging time and has the potential to replace the conventional T1-SE sequence for the evaluation of enhancing lesions in the brain when time is a consideration.

Brain lesions: when should fluid-attenuated inversion-recovery sequences be used in MR evaluation?

PURPOSE

To compare qualitatively and quantitatively the contrast of brain lesions detected with fluid-attenuated inversion-recovery (FLAIR) and intermediate-weighted sequences at magnetic resonance (MR) imaging.

MATERIALS AND METHODS

In this prospective study, 47 patients suspected of having a brain lesion underwent MR imaging with FLAIR, intermediate-weighted, and T2-weighted sequences. Qualitative assessment was performed of lesion conspicuity, detection, overall image artifact, and additional clinical information. Contrast and contrast-to-noise ratio (CNR) were calculated between lesions and the normal brain or cerebrospinal fluid (CSF).

RESULTS

FLAIR images were equal to intermediate-weighted images for overall lesion conspicuity and detection but were associated more often with image artifacts. Lesion-to-background contrast was significantly higher on FLAIR than on intermediate-weighted images. FLAIR images failed to demonstrate multiple sclerosis (MS) plaques located in the basal ganglia and brain stem.

CONCLUSION

Although FLAIR images provided additional information in some cases, they did not have distinct advantages over intermediate-weighted images. When cases of MS are evaluated, intermediate-weighted images are preferable to FLAIR images. Except in cases of MS, either FLAIR or intermediate-weighted sequences should be added to T2-weighted sequences at MR imaging.

Modifications in electrospray tandem mass spectrometry for a neonatal-screening pilot study in Japan

In a neonatal-screening pilot study for inherited disorders in organic acid and amino acid metabolism, we analyzed butyrated acylcarnitines and amino acids in blood spots of more than 20,000 newborns by electrospray tandem mass spectrometry. In order to screen urea cycle disorders, we performed multiple scanning functions with additional stable isotope-labelled internal standards, since such reported functions as neutral loss of m/z 102 or 109 for butyrated amino acids were not sufficient. Arginine levels were measured with arginine-13C6. Hypocitrullinemia for the screening of some urea cycle disorders was detectable by measurement with synthesized citrulline-d6, although we did not find any such disorders. In the acylcarnitine analysis, we found a patient with propionic acidemia, who has been treated effectively. The increasing false positive rate due to the use of pivalic acid-containing antibiotics in the diagnosis of isovaleric acidemia was a problem in Japan.

Mass screening for Wilson's disease: results and recommendations

Wilson's disease is a treatable inherited disorder of copper metabolism. Established treatments include the use of oral chelating agents and the establishment of a minimum copper diet, although prognosis mainly depends on the extent of liver or nervous system damage present before treatment. Once irreversible damage has occurred, the effect of these treatments is diminished and the patient's quality of life compromised. Therefore, the establishment of a mass screening system able to detect Wilson's disease patients presymptomatically has been discussed. Recently, a monoclonal antibody specific to holoceruloplasmin has been developed. This antibody was used in a nationwide screening trial of 126,810 newborn infants, but no Wilson's disease patients were identified. However, three patients out of 24,165 were diagnosed with Wilson's disease using this specific antibody in a screening performed during the period from late infancy to elementary school. The age of 3 years is thought to be the best point for Wilson's disease mass screening. In this paper, a review of mass screening for Wilson's disease in Japan using a specific monoclonal antibody to holoceruloplasmin is presented.

Effect of antihypertensive therapy on aortic distensibility in patients with essential hypertension: comparison with trichlormethiazide, nicardipine and alacepril

To assess the effect of antihypertensive drugs on aortic distensibility, we evaluated the aortic distensibility of 33 hypertensive patients before and after antihypertensive treatment by using cine magnetic resonance imaging. Thirty three hypertensive patients were divided into three groups and treated for 12 weeks with 2-4 mg trichlormethiazide per day (n = 10), 80 mg nicardipine per day (n = 13) and 50 mg alacepril per day (n = 10). There were no significant differences in mean age and mean blood pressure among the three groups. Cine magnetic resonance was performed at ascending and descending aortic levels. Aortic area was measured at the maximum and minimum frames. The effect of antihypertensive therapy on aortic distensibility was evaluated as the percent change from before treatment to after treatment. There were no significant differences in pulse pressure before and after treatment with trichlormethiazide, nicardipine and alacepril. After treatment with these drugs, mean blood pressure in all groups decreased (trichlormethiazide and nicardipine, P < .01; alacepril, P < .05), (the maximum area--the minimum area) and aortic distensibility in all groups increased significantly (each P < .01). Percent changes in aortic distensibility after treatment were significantly higher with nicardipine (ascending, 346.6 +/- 255.9%; descending, 338.8 +/- 246.5%, each P < .05) and alacepril (ascending, 369.7 +/- 238.8%, P < .05; descending, 306.9 +/- 123.3%, P < .01) than with trichlormethiazide (ascending, 146.0 +/- 139.6%; descending, 129.3 +/- 97.5%). In conclusion, nicardipine and alacepril have a beneficial effect on aortic distensibility.

Clinical implications of circulating soluble Fas and Fas ligand in patients with acute myocardial infarction

BACKGROUND

Apoptotic cell death is the major form of myocardial damage produced by coronary ischemic events.

OBJECTIVE

To assess whether circulating levels of soluble Fas (sFas), an inhibitor of apoptosis, and sFas ligand, an inducer of apoptosis, in patients with coronary artery disease are greater than normal.

METHODS

Forty-seven patients [acute myocardial infarction (AMI) in 17, old myocardial infarction (OMI) in 15, stable angina in 15] and 10 normal control subjects participated in this study. Serum levels of sFas and sFas ligand in all patients were measured, and cardiac catheterizations were performed.

RESULTS

Serum levels of sFas were greater than normal only in patients with AMI (4.6 +/- 1.6 ng/ml); the levels were significantly higher than those in patients with OMI (2.1 +/- 0.6 ng/ml) and stable angina (2.2 +/- 0.5 ng/ml), and in normal subjects (2.0 +/- 0.6 ng/ml; P < 0.0001). However, there was no difference among serum levels of sFas ligand for all groups. For patients with AMI, there was no significant correlation between serum levels of sFas and peak levels both of plasma creatine phosphokinase and of plasma myosin light chain type I as clinical indexes of infarct size. However, there were significant correlations between serum levels of sFas and both pulmonary artery wedge pressure (r = 0.767, P = 0.0003) and left ventricular end-diastolic pressure (r = 0.629, P = 0.03).

CONCLUSIONS

Circulating sFas increases in concentration in relation to the severity of hemodynamic conditions in patients with AMI, but it is independent from size of infarct. Therefore, circulating sFas could play an important role as the marker of pathophysiologic conditions associated with cardiomyocyte apoptosis in AMI.

Ultrafast FLAIR imaging with single-shot echo-planar technique in evaluation of intracranial lesions

We evaluated the detection of the brain lesions with single-shot echo-planar FLAIR imaging (EP-FLAIR) relative to fast spin-echo FLAIR imaging (fast-FLAIR). In 30 patients with variety of intracranial lesions, a prospective comparison of EP-FLAIR and fast-FLAIR was performed. Data acquisition time per image was 0.1 s with EP-FLAIR. Quantitative and qualitative criteria as well as lesion detectability were evaluated. EP-FLAIR provided almost same tissue contrast and CSF suppression as fast-FLAIR did. In the quantitative analysis, contrast and contrast-to-noise ratio (C/N) of EP-FLAIR were comparable to those of fast-FLAIR, and there was no significant difference between them. The increased magnetic susceptibility effect was useful in screening for subtle hemorrhage. However, EP-FLAIR was degraded by susceptibility artifacts at the skull base and posterior to the frontal sinuses. Motion artifacts were not encountered owing to the very short imaging time, and EP-FLAIR was particularly useful in screening for the lesions in uncoorporative patients.

Value of dynamic susceptibility contrast magnetic resonance imaging in the evaluation of intracranial tumors

The degree of tumor malignancy generally correlates to tumor grade, and the direct measurement of tumor vasculature is desired. Dynamic susceptibility contrast magnetic resonance imaging can provide relative cerebral blood volume and, therefore, is one of the most reliable methods to evaluate tumor vasculature in vivo. Tumor vessel size is extremely variable due to complex tumor angiogenesis, and the gradient-echo echo-planar imaging (GE-EPI) technique, which is sensitive to the total vascular bed, is well suited for this purpose. As many studies have shown, dynamic susceptibility contrast magnetic resonance imaging is more useful for grading glioma than conventional magnetic resonance imaging. We found that this technique can also provide supplementary information to differentiate between malignant lymphoma and glioma because the absence of tumor neovascularization of malignant lymphoma leads to low rCBV, which is in contrast to those of malignant gliomas. Indeed, this technique can be used for the differentiation of extra-axial tumors such as between meningioma and neurinoma. Recently, this technique has been focused toward determining the stereotactic biopsy site, monitoring the embolization of effect in meningioma, or evaluation of treatment effects after radiation therapy. However, the value of tumor rCBV is affected by many conditions such as the T1 relaxivity effects of gadolinium in the extravascular space. To establish the usefulness of this technique, further examination will be needed.