Fat suppression in MR imaging: techniques and pitfalls

Fat suppression is commonly used in magnetic resonance (MR) imaging to suppress the signal from adipose tissue or detect adipose tissue. Fat suppression can be achieved with three methods: fat saturation, inversion-recovery imaging, and opposed-phase imaging. Selection of a fat suppression technique should depend on the purpose of the fat suppression (contrast enhancement vs tissue characterization) and the amount of fat in the tissue being studied. Fat saturation is recommended for suppression of signal from large amounts of fat and reliable acquisition of contrast material-enhanced images. The main drawbacks of this technique are sensitivity to magnetic field nonuniformity, misregistration artifacts, and unreliability when used with low-field-strength magnets. Inversion-recovery imaging allows homogeneous and global fat suppression and can be used with low-field-strength magnets. However, this technique is not specific for fat, and the signal intensity of tissue with a long T1 and tissue with a short T1 may be ambiguous. Opposed-phase imaging is a fast and readily available technique. This method is recommended for demonstration of lesions that contain small amounts of fat. The main drawback of opposed-phase imaging is unreliability in the detection of small tumors embedded in fatty tissue.

Design of a privileging program for diagnostic imaging: costs and implications for a large insurer in Massachusetts

PURPOSE

To evaluate the results of a privileging program aimed to ensure that health care providers and facilities adhere to standards of care.

MATERIALS AND METHODS

Technical and professional privileging applications were mailed to more than 1,800 diagnostic imaging facilities and more than 6,000 professional providers of services to members of a health care plan. Site inspections were used to determine whether facilities met standards of care. Specialty providers were assigned a range of current procedural terminology codes for which they had privileges to bill the payer.

RESULTS

Of 1,004 imaging sites inspected, 197 (20%) failed with the ability to remedy the violation, 106 (10%) failed with fundamental and serious deficiencies, and 701 (70%) passed. Site inspection pass rates varied substantially by specialty. Chiropractors and podiatrists were more likely to fail than medical and surgical specialists. A strong correlation was found between refusal to participate in the inspection and failure rate. Results suggest that reduction of the number of professional claims billed led to a 2% decline in total imaging expenditures, or a more than 10:1 return on the cost of implementing technical and professional privileging programs.

CONCLUSION

Health care plans can positively influence costs and quality by developing, monitoring, and enforcing their own quality standards for diagnostic imaging.

Postoperative interstitial radiotherapy of keloids by iridium 192: a retrospective study of 46 treated scars

BACKGROUND

Keloids are clinically vexacious scars characterized by a high recurrence rate after excision alone (50-100%). Many adjuvant techniques have been used with more or less convincing results.

OBJECTIVE

The aim of this study is to show the efficiency of keloidectomy and postoperative interstitial radiotherapy by an iridium 192 wire.

METHODS

During a 14-year period, 39 patients with keloids (46 keloids) were treated by this regimen. Seven patients had been previously treated by intralesional corticosteroids, surgery alone or postoperative interstitial radiotherapy, without improvement. A dose of 12 Gy (7 keloids) to 15 Gy (22 keloids) was delivered at a point 2.5 mm from the axis of the wire. For 17 keloids the dose schedule was 15 Gy at a point 5 mm to the wire. The median follow-up was 7 months.

RESULTS

The overall success rate is close to 63%. A recurrence occurred in 14 cases without relation to the method used, the age or the localization of the lesions. There were no side effects observed.

CONCLUSIONS

Postoperative interstitial radiotherapy represents an effective, unconstraining and safe treatment for keloids if the contraindications are respected.

[Progress in dosage optimization for stereotactic radiosurgery]

Stereotactic radiosurgery is a technique for treatment of intracranial lesions requiring high precision in all steps--from image acquisition to final irradiation. One of most difficult steps is the treatment planning phase, consisting of determination of irradiation parameters sufficient to cover the target volume by avoiding sensitive volumes. A manual and empirical definition can be very long and difficult, especially in the case of complex target volumes situated in sensitive zones. As in conventional radiotherapy, stereotactic radiosurgery has taken advantages from dosimetric optimization. The question is: "What is the configuration of irradiation parameters used in order to obtain the treatment plan by satisfying defined constraints?". The purpose of this article is to summarize optimization methods used in radiosurgery and to describe the technical alternatives proposed for this treatment as well as the possibilities of plan evaluation between different techniques. This purpose will be illustrated by the optimization methodology used in the Center Oscar Lambret of Lille, France for the radiosurgical treatment with linear accelerator.

[Stereotactic localization in medical imaging. Technical and methodologic aspects]

Stereotactic neurosurgery and stereotactic radiation therapy require the three-dimensional localization of lesions for biopsy or for treatment planning. The aim of this paper is the description of methods used in the different imaging modalities: x-ray teleradiography, digital subtracted angiography, computed tomography, and nuclear magnetic resonance imaging. The simple pin-target locating techniques are distinguished from those serving to the definition of volumes target necessary to treatment planning. Performances and difficulties of these techniques are emphasized. The specific methodology developed in Lille is described as an example. Organizational aspects and necessary quality controls for a good progress of the entire procedure, from imaging to treatment, are also discussed.

[Dosimetric quality control in stereotactic radiotherapy with the aid of radiosensitivity]

Typical dosimeters used in stereotactic radiation therapy, such as ionization chambers, films, and thermoluminescent diodes, allow basic physical measurements. They are, however, neither well suited to discern small target volumes with high dose gradient, nor suitable for three-dimensional (3D) dose measurements. Gel dosimetry is becoming more and more interesting, owing to magnetic resonance imaging (MRI). It permits isocenter position planning verification of accuracy and the precision of the 3D dose mapping in the brain (when irradiated in realistic conditions), especially when several different targets are concerned. Many authors have assessed stereotactic radiation therapy quality control using different gels, and different irradiation procedures. This paper consists of the review of these different methods to assess quality control. Gel dosimetry cannot provide absolute dose measurements. However, gels can be used to check the 3D dose mapping with a high degree of detail. In our experiment, the difference between the stereotactic frame center and the isocenter is about 1 mm. The difference between the theoretical isodoses obtained by the treatment planning system and the experimental isodoses obtained by the MRI gray level calibration is also about 1 mm, the order of magnitude of the MRI pixel size.

[Determination of target volume for dosimetric planning in stereotactic radiosurgery]

Stereotactic radiosurgery needs an accurate determination of the target volumes to be irradiated and of sensitive volumes to be spared: position, external boundaries, internal volume. These parameters can be obtained by using either projection imaging (radiographs, digital angiography), or tomographic imaging (magnetic resonance imaging, computerized tomography). The authors describe the methods used in these different imaging modalities and the problems encountered in target determination. Methods of validations are described. Results obtained on phantoms and on actual target volume are given and discussed.

Visuvalve software: an aid to the diagnosis of shunt failure

Software designed to help the neurosurgeon in the diagnosis of shunt malfunction is presented. This software allows the possibility to record on a 3.5 diskette a patient's clinical information and four views of a CT scan performed when the patient was doing perfectly well with his shunt. This diskette, operated by MS-DOS on any IBM-compatible personal computer, can be read at any time, anywhere. The evaluation of the system demonstrated it was safe, with an excellent adhesion of the patients and of their families.

Mutations that prevent associative learning in C. elegans

The nematode Caenorhabditis elegans offers a promising system for the reductionist study of learning and memory. In this article, classical conditioning in C. elegans is demonstrated with a variety of associative learning assays. These assays allowed for the isolation and behavioral characterization of 2 mutant C. elegans lines impaired in associative learning. Both lines show no short-term or long-term associative conditioning; however, they appear relatively normal in tests of nonassociative learning and sensorimotor function. In combination with the well-described genetics and neuroanatomy of C. elegans, the isolation of mutants selectively, yet completely, blocked in associative learning provides the basis for an effective characterization of the cellular and molecular aspects of associative learning.

Mutations that prevent associative learning in C. elegans

The nematode Caenorhabditis elegans offers a promising system for the reductionist study of learning and memory. In this article, classical conditioning in C. elegans is demonstrated with a variety of associative learning assays. These assays allowed for the isolation and behavioral characterization of 2 mutant C. elegans lines impaired in associative learning. Both lines show no short-term or long-term associative conditioning; however, they appear relatively normal in tests of nonassociative learning and sensorimotor function. In combination with the well-described genetics and neuroanatomy of C. elegans, the isolation of mutants selectively, yet completely, blocked in associative learning provides the basis for an effective characterization of the cellular and molecular aspects of associative learning.

Synthesis and tissue distribution of substituted [125I]iodophenylamine derivatives: possible brain imaging agents

The synthesis and brain uptake in mice of the radioiodinated derivatives of N,N-dimethyl-N'-(iododimethoxyphenyl)-1,3-propanediamine, as well as the N-substituted derivatives of (iodoalkylphenyl)isopropyl, iodoalkylphenylethylamine and 3,4-(methylenedioxy)phenyl-amphetamine (MDA) are described. These compounds contain structural features of both IMP and HIPDM, the cerebral perfusion agents currently in clinical use. The radiolabeled analogs were obtained via the [125I]I exchange method, or by [125I]NaI treatment of the iodo-free precursor in the presence of an oxidant. Following intravenous injection in mice, all compounds showed important radioactivity concentrations in the lungs and kidneys. The N-substituted (iodoalkylphenyl)isopropyl and iodoalkylphenyl-ethylamine derivatives displayed a high initial brain uptake (> 10% IDg-1) followed by a rapid clearance phase, resulting in lower brain-to-blood ratios as those reported for IMP and HIPDM. In contrast, N,N-dimethyl-N'-(iododimethyphenyl)-1,3-propanediamine derivatives featuring the iodo substituent on the benzene carbon adjacent to the methyl amine group and the methoxy substituents on the 2,5- or 2,4-positions, showed low but more persistant brain uptake. Combined with fast blood clearance, this resulted in high brain-to-blood ratios at later time points. Among all compounds tested, the highest brain-to-blood ratio was observed with compound N,N-dimethyl-N'-(6-iodo-3,4-dimethyoxyphenyl)-1,3-propanediamine (27e), reaching a maximum of > 20 at 12 h post-injection.

Assessment of image intensifier and distortion for DSA localization studies

The authors present methods of correcting pincushion and S distortions of an image intensifier, and of measuring the geometrical parameters of the imaging device used for localization from digital subtraction angiography brain studies. Pincushion and S distortions of the image intensifier are corrected by a calibration grid. A test pattern is used to study effectiveness of the corrections. Intrinsic geometrical parameters (source-to-image distance, centre of X-ray projection) of the apparatus are measured by the use of a calibration phantom. Short-range and long-range time drift of the distortion, as well as influence of the parameters of image acquisition on the accuracy of the localization results, are considered. The results obtained successfully demonstrate the accuracy of the correction, provided that the apparatus is warm.

Measurement of tumor vascular damage in mice with 99mTc-MIBI following photodynamic therapy

The clinical perfusion agent 99mTc-MIBI was used to monitor changes in tumor vascular perfusion (TVP) induced by Photofrin (PII)-mediated photodynamic therapy (PDT). BALB/c mice bearing an EMT-6 tumor on each hind thigh were given an intravenous injection of 1, 2 or 5 mg kg-1 PII. Twenty-four hours later, one tumor was illuminated (600-650 nm, 200 mW cm-2, 400 J cm-2) while the other served as a control. At various time intervals after PDT (0, 2 and 24 h) mice received an intravenous injection of 99mTc-hexakismethoxyisobutylisonitrile (MIBI) (0.18 MBq g-1) and were sacrificed 2 min later. The light-treated and the untreated tumors were then dissected, the radioactivity was counted and the percentage of the injected dose per gram of tumor (%ID g-1) was calculated as a measure of TVP. We observed that TVP is drug dose dependent, develops progressively with time post-PDT and is inversely related to PDT efficacy. Our data show that early tumor retention of 99mTc-MIBI is a simple method to assess TVP and vascular damage induced by PDT.

Photodynamic therapy of tumours with hexadecafluoro zinc phthalocynine formulated in PEG-coated poly(lactic acid) nanoparticles

Hexadecafluoro zinc phthalocyanine (ZnPcF16), a second-generation sensitizer for the photodynamic therapy (PDT) of cancer, was formulated in polyethylene-glycol-coated poly(lactic acid) nanoparticles (PEG-coated PLA-NP) and tested in EMT-6 tumour-bearing mice for its photodynamic activity. The tumour response was compared to that induced by the same dye formulated as a Cremophor EL (CRM) emulsion. Formulation in the biodegradable NP improved PDT response of the tumour while providing prolonged tumour sensitivity towards PDT.

Hexadecafluorinated zinc phthalocyanine: photodynamic properties against the EMT-6 tumour in mice and pharmacokinetics using 65Zn as a radiotracer

Hexadecafluorinated zinc phthalocyanine (ZnPcF16), an analogue of zinc phthalocyanine (ZnPc) in which all hydrogen atoms have been substituted by fluorine, was prepared as a single isomeric product via the condensation of tetrafluorophthalonitrile with zinc acetate. Fluorination renders the ZnPc soluble in most common solvents. The photodynamic properties and pharmacokinetics of the ZnPcF16 were evaluated in EMT-6 tumour-bearing Balb/c mice using 65Zn-radiolabelled analogues. Both dyes, administered i.v. at 1 mumol kg-1 as Cremophor emulsions, revealed good tumour uptake [approximately 8-9 per cent of the injected dose per g tissue (%IDg-1)] at 24 h post injection (p.i.), with the fluorinated dye reaching higher concentrations (approximately 11%IDg-1) at 48 h p.i. and subsequently higher tumour-blood ratios due to rapid blood clearance. ZnPcF16 at a dose of 5 mumol kg-1 (4.3 mg kg-1) induced complete tumour regression after phototherapy (24 h p.i., 650-700 nm band, 360 J cm-2, 200 mW cm-1). At a dose of 2 mumol kg-1 and phototherapy at 24 h p.i., the tumour volume doubling time increased to 11 days vs 6 days for the control tumours. A similar tumour growth delay was observed when phototherapy was conducted at 48 h or 72 h after dye injection implying that tumour response correlates with tumour dye concentrations rather than serum concentrations. As a result of its low solubility, the administered dose of ZnPc was limited to 1 mumol kg-1 and at this drug level significant tumour response was only observed when the dye was solubilised as the pyridinium salt. Isolation of the neoplastic cells after in vivo dye administration and in vitro exposure to red light followed by a colony formation assay showed that the ZnPcF16 exhibited a 1-2 order of magnitude higher potential for direct cell killing as compared with Photofrin and about a five times lower efficiency than ZnPc. However, all three photosensitisers induced complete occlusion of tumour vasculature immediately after PDT, suggesting that tumour regression mainly resulted from vascular stasis. The ZnPcF16 offers several advantages over ZnPc for clinical applications, including improved solubility in most solvents, resulting in facilitated drug formation, favourable pharmacokinetics as well as the potential use in fluorine magnetic resonance (F-MR) imaging.

Treatment planning optimization by conjugate gradients and simulated annealing methods in stereotactic radiosurgery

PURPOSE

This paper presents a new optimization method of treatment planning in linac stereotactic radiosurgery.

METHODS AND MATERIALS

On a workstation integrating x-rays, computed tomography (CT), magnetic resonance imaging (MRI), and digital subtracted angiography (DSA) images, we first determine the outlines of the target volume and surrounding healthy tissues to spare. To achieve complete optimization of the treatment plans, this method decomposes the optimization process in two steps. The position of the isocenters and the diameter of the collimators are first deduced by a conjugate gradients method, from the position and size of ellipsoids or spheres modeling the target volume. The other irradiation parameters, such as the isocenter dose, the aperture, and the weight of each irradiation plane and of their irradiation sectors are finally deduced by a simulated annealing optimization algorithm.

RESULTS

The system can perform multitarget/multisector treatment plans that are automatically obtained in a satisfactory time (as a rule, 20 min for a two-target irradiation), much faster than the time needed for a manual treatment planning. We present the results in two cases: the simulation of a single-target treatment and a two-target real treatment with constraints. In these two cases, we can control the dose received by target and sensitive volumes.

CONCLUSION

This method achieves an excellent conformation of the estimated isodose curves with the outlines of the target volume, which allows us to avoid the surrounding healthy tissues, thanks to the different weighting factors given on each volume concerned according to the importance we grant to each of them.

PEG-coated poly(lactic acid) nanoparticles for the delivery of hexadecafluoro zinc phthalocyanine to EMT-6 mouse mammary tumours

Hexadecafluoro zinc phthalocyanine (ZnPcF16), a second generation sensitizer for the photodynamic therapy of cancer, was incorporated in three vehicles: poly(D,L-lactic acid) (PLA) nanoparticles, polyethylene glycol (PEG)-coated nanoparticles and a Cremophor EL (CRM) oil-water emulsion. Nanoparticles were prepared by the salting-out procedure. Biodistribution of the dye was assessed by fluorescence in EMT-6 mammary tumour bearing mice after intravenous injection of 1 mumol kg-1 ZnPcF16. Plain nanoparticles were rapidly retained by the reticuloendothelial system (RES) as reflected by the low area under the blood concentration-time curve (AUC0-168, 57 micrograms h g-1). Little tumour uptake of the dye was observed with this formulation. In contrast, PEG-coated nanoparticles displayed a reduced RES uptake, leading to significantly higher blood levels over an extended period (t1/2 30 h; AUC 0-168 227 micrograms h g-1) and enhanced tumour uptake. At 48 h post injection, tumour to skin and tumour to muscle concentration ratios reached 3.5 and 10.8, respectively. Blood levels of ZnPcF16 after administration as a CRM emulsion decreased faster than with PEG-coated nanoparticles (t1/2 12 h), but since no early liver uptake was observed, the AUC0-168 and the tumour uptake were only slightly lower. However, with the CRM formulation, a late liver uptake was observed, reaching 51% of the injected dose after 7 days.

A frameless stereotaxic localisation system using MRI, CT and DSA

The authors present a method of stereotaxic localisation using magnetic resonance imaging (MRI) computerized tomography (CT) and digital subtracted angiography (DSA) which does not require localisation frams fixed to the patient's skull, but uses only four cranial landmarks corresponding to the holders of the neurosurgical stereotaxic frame. The method presents no major constraints in routine examinations. The geometrical distortions of the imaging devices are corrected. Three-dimensional localisation is performed using sagittal and axial slices in MRI, axial slices in CT and only two associated frontaly and lateral views in DSA. The images data are transferred to a PC-based system. By locating the landmarks on the images, the transformation matrixes can be computed to obtain the 3D coordinates of a target in the stereotaxic space and in any imaging modality. The results obtained show the precision of the corrections and the millimetre accuracy of pin-point target localisation.

RF-transmitted CsI radio-isotopic ambulatory recorder for left ventricular ejection fraction monitoring

We have developed a CsI multidetector probe in order to produce a nuclear ambulatory recorder to study simultaneously cardiac electric activity and the left ventricular ejection fraction. To make the device lighter, the electronics were designed with surface-mounted technology, and a serial data RF transmission system was used. The data are processed on a real-time basis using a portable microcomputer. Unlike other commercially available devices, this monitor avoids the problems of volume, weight, recording time capacity and slow off-line data processing. Our device permits global and regional analysis of the ejection fraction for a moderate manufacturing cost. It is intended primarily for ambulatory use and can easily be adapted to perform a monitoring function. The first tests on patients conducted using the prototype demonstrate the technical reliability and satisfactory operation of the device.

Evaluation of a 99mTc-antimyosin kit for myocardial infarct imaging

The Fab fragment of a mouse monoclonal antibody AM(3-48) that recognizes alpha and beta-heavy chains of human atrial and ventricular myosin and beta-heavy chain of human slow skeletal muscle myosin [CardioVisionTM] was labeled with 99mTc using stannous reductant in a simple, instant kit method. The infarcted heart uptake in dogs of 99mTc-AM(3-48)Fab' was compared with that of established radiopharmaceuticals routinely used for cardiac imaging in humans. The dog infarct was induced by bringing a catheter from the femoral artery to the coronary artery where an artificial blood clot was generated. The 99mTc-AM(3-48)Fab' preparation was selectively taken up by infarcted myocardium, resulting in diagnostic quality images of the infarcted area as early as 6 hour post-injection, rendering CardioVisionTM particularly useful for SPECT imaging. Good agreement was found between the images obtained with 99mTc-Pyrophosphate and those obtained with 99mTc-AM(3-48)Fab', while the infarcted area was clearly delineated as a cold spot with 99mTc-MIBI or 201 Tl-thallous chloride. The biodistribution of 99mTc-AM(3-48)Fab' was also studied in healthy and isoproterenol-infarcted rats, from which dosimetry values in man were extrapolated. The data indicate that the kidneys will receive the highest radiation dose and that they will be the main contributors to the total radiation burden, which was estimated at 0.005 rad/mCi.