In vivo human myocardial metabolism during aerobic exercise by phosphorus-31 nuclear magnetic resonance spectroscopy

A few studies have been made in vivo on human myocardial energy metabolism. Hence, no discussion has taken place on metabolism during exercise or of training effects on metabolism. We examined human myocardial energy metabolism at rest and during exercise, and also training effects on the metabolism by phosphorus-31 nuclear magnetic resonance (31P NMR)-spectroscopy. Six sedentary male students (Cont) and six male long distance runners (Tr) were the subjects. Energy metabolism data were obtained from myocardium during rest and exercise by the region selection method using 31P NMR. Rotation of the legs while riding a bicycle, which was fitted with an ergometer we had made ourselves for NMR, imposed given exercise intensities. The heart rate was measured in a stationary phase during exercise. Although the heart rate at rest in the Tr group was significantly lower [Tr, 52.5 (SD 3.1) beat.min-1; Cont, 67.1 (SD 2.9) beat.min-1], no significant difference was observed in myocardial energy metabolism using the 31P NMR method [Tr, phosphocreatine/beta-adenosine 5'-triphosphate (PCr/beta-ATP); 1.51 (SD 0.02); Cont, 1.51 (SD 0.01)]. When NMR measurements were investigated at two different intensities of exercise, heart rates in the Cont group were significantly higher by about 20 beat.min-1 than those in the Tr group at both exercise intensities, while no difference in energy metabolism was observed between the groups or between rest and exercise [Tr, 75.9 (SD 3.6), 88.3 (SD 3.7) beat.min-1; PCr/beta-ATP 1.51 (SD 0.03), 1.51 (SD 0.03); Cont, 95.9 (SD 2.4), 115.1 (SD 3.5) beat.min-1, PCr/beta-ATP 1.51 (SD 0.01), 1.51 (SD 0.04)].(ABSTRACT TRUNCATED AT 250 WORDS)

Magnetization transfer contrast imaging of the cervical spine at 0.3 T

OBJECTIVE

We assessed the efficacy of magnetization transfer contrast (MTC) imaging of the cervical spine in conjunction with a gradient recalled echo (GRE) technique using a 0.3 T permanent magnet imager.

MATERIALS AND METHODS

Seventy patients were prospectively investigated. Multislice sagittal and axial images of the cervical spine with and without MTC were obtained using a GRE sequence (TR/TE/flip angle = 750 ms/23 ms/25 degrees). The contrast-to-noise ratios (C/Ns) for CSF versus cord or disk were calculated for quantitative analysis. Qualitative image analysis was also performed.

RESULTS

Both sagittal and axial MTC images had significantly higher C/N values than conventional GRE images. The MTC images showed better differentiation between the CSF and the cord or thecal sac as well as better delineation of the nerve roots. Furthermore, MTC images demonstrated syringomyelia more clearly than conventional images.

CONCLUSION

Magnetization transfer contrast images at 0.3 T are effective for diagnosing diseases of the cervical spine.

Muscle energetics in short-term training during hypoxia in elite combination skiers

Four well-trained combination skiers were studied through pre- and post-training for the effects of short-term intermittent training during hypoxia on muscle energetics during submaximal exercise as measured by Phosphorus-31 nuclear magnetic resonance and maximal aerobic power (VO2max). The hypoxia and training in the cold was conducted in a hypobaric chamber and comprised 60-min aerobic exercise (at an intensity equivalent to the blood lactate threshold), using a cycle ergometer or a treadmill twice a day for 4, consecutive days at 5 degrees C, in conditions equivalent to an altitude of 2000 m (593 mm Hg). No change in VO2max was observed over the training period, while in the muscle energetics during submaximal exercise, the values of phosphocreatine/(phosphocreatine+inorganic phosphate) and intracellular pH were found to be significantly increased by training during hypoxia. During recovery, the time constant of phosphocreatine was found to have been significantly reduced [pre, 27.9 (SD 6.7) s; post, 22.5 (SD 4.7) s, P < 0.01]. The observed inhibition of phosphocreatine as well as that of intracellular pH changes after training during hypoxia and quicker recovery of phosphocreatine in submaximal exercise tests, may indicate improved oxidative capacity (i.e. a high adenosine 5'-triphosphate formation rate) despite the short-term hypoxia training.

Focused radiation hepatitis after Bragg-peak proton therapy for hepatocellular carcinoma: CT findings

Radiation hepatitis is clearly demonstrated by noncontrast and contrast enhanced CT following radiotherapy for liver diseases. Radiation hepatitis is dependent on dose distribution and is usually demonstrated as a non-segmental bandlike lesion after photon therapy. We report a case of focused, oval-shaped radiation hepatitis that was induced by photon therapy. The attenuation difference was localized in a high-dose area caused by Bragg-peak proton therapy.

CT and MRI in detection of intrahepatic portosystemic shunts in patients with liver cirrhosis

OBJECTIVE

Our goal was to determine the prevalence and anatomic location of intrahepatic portosystemic shunts (IPSs) in patients with hepatic cirrhosis as shown by CT and MRI.

MATERIALS AND METHODS

We retrospectively reviewed CT and MR scans of 33 cirrhotic patients who had IPSs. In addition, two series of 100 consecutive CT or MR were reviewed to determine the prevalence of IPSs and the percentage of intrahepatic and extrahepatic paraumbilical veins.

RESULTS

Intrahepatic portosystemic shunts were divided into three groups according to the intrahepatic course: paraumbilical shunt between the left portal vein and the paraumbilical vein anterior to the liver (n = 29); inferior vena caval shunt between the posterior branch of the right portal vein and the inferior vena cava (n = 2); and miscellaneous (n = 2). Shunts of the paraumbilical type ran through the medial (n = 23), lateral (n = 3), or both medial and lateral (n = 3) segments of the left lobe of the liver. Twenty-five patients had one shunt, and four had more than one. Six cases were also associated with extrahepatic paraumbilical veins.

CONCLUSION

Intrahepatic portosystemic shunts, especially the paraumbilical type, were not infrequently visualized in patients with hepatic cirrhosis.

Peritoneal implants without ascites: preoperative CT diagnosis in colon carcinoma patients

We evaluated the preoperative CT findings in 10 patients with colon carcinoma in whom peritoneal metastases had been surgically confirmed. Seven patients lacked ascites. No CT findings suggestive of peritoneal metastasis were observed in two patients without ascites even by retrospective evaluation. A large mass was observed in the cul-de-sac in another. In the remaining four patients, small peritoneal metastases ranging from 8 to 11 mm in diameter were observed at the omentum in two, along the falciform ligament in one, and at both the omentum and the iliac fossa in one; three of these patients had received no prospective diagnosis of peritoneal metastasis prior to the surgery. In patients with advanced colon carcinoma with suspected serosal invasion, the entire peritoneal cavity should be carefully examined and interpreted using CT in order to detect small peritoneal implants even when ascites is absent.

[Usefulness of superparamagnetic iron oxide particle (AMI-25) enhanced MR imaging for the diagnosis of liver tumors: comparison with contrast enhanced CT]

The purpose of this study was to clarify the usefulness of SPIO-enhanced MRI in the diagnosis of liver tumors in comparison with contrast-enhanced CT. The subjects were forty patients with 154 nodules in the liver. We compared SPIO-enhanced MRI with contrast-enhanced CT in terms of tumor-liver contrast and detectability of liver tumors. In terms of tumor liver contrast, SPIO-enhanced MRI was equal or superior to contrast-enhanced CT in 82% of cases. In the detectability of liver tumor, SPIO-enhanced MRI detected more tumors than contrast-enhanced CT, especially small tumors. Tumors undetected by SPIO-enhanced MRI that were detected by contrast-enhanced CT and/or plain MRI were adenomatous hyperplasia and inflammatory pseudotumor according to fine needle biopsy. There were no severe complications of SPIO-enhanced MRI. In conclusion, SPIO-enhanced MRI will be more useful than contrast-enhanced CT in the diagnosis of liver tumors. SPIO-enhanced MRI may be a promising diagnostic method for the detection of hepatic tumors, especially small ones.

Improved detection of small insulinomas with intravenous dynamic CT

OBJECTIVE

To evaluate the usefulness of intravenous dynamic CT in demonstrating angiographically negative insulinomas.

MATERIALS AND METHODS

Two patients with endocrinologic evidence of insulinoma were examined with intravenous bolus-dynamic CT.

RESULTS

Angiographically negative insulinomas as small as 5-7 mm were demonstrated unequivocally as enhancing nodules.

CONCLUSION

Intravenous dynamic CT using larger amounts of contrast material can improve detection of small (< 1.0 cm) insulinomas.

[Spiral volumetric CT: detection and characterization of small hepatic cavernous hemangioma]

Twelve patients with 25 hepatic cavernous "hemangiomas of less than 2 cm in diameter received spiral volumetric CT (SVCT) examination using the special scanning programs named "double-phase return scan" or "triple-phase scan", which referred to arterial-, portal-dominant and/or late phases. Twenty-three lesions were not only detected, but characterized by applying these programs, although it has been difficult to detect such smaller lesions with the single level dynamic CT because of respiratory misregistration or multi-spreading lesions. SVCT made it possible to scan the whole liver during single breath-hold without any misregistrations. SVCT should become an indispensable procedure to assess subcentimeter lesions in the liver.

Tongue displacement: visualization with rapid tagged magnetization-prepared MR imaging

The authors describe a technique to depict tongue muscle displacement with tagged magnetization-prepared gradient-recalled echo magnetic resonance imaging. Three Japanese volunteers (three men, aged 31-36 years) were studied while they articulated specific sounds. Each image was obtained in less than 2 seconds without need for gating. Displacement and alteration of the tags within the tongue muscle during phonation were clearly visible. The technique may prove useful in the study of phoniatric pathophysiology.

Ovarian dysgerminoma: MR and CT appearance

OBJECTIVE

We determined the MR and CT appearance of ovarian dysgerminoma and correlated our findings with the pathologic features.

MATERIALS AND METHODS

CT and MR findings of three patients with ovarian dysgerminoma were retrospectively reviewed and compared with the pathologic findings.

RESULTS

The tumors were divided into lobules by septa that were hypointense or isointense on T2-weighted imaging and showed marked enhancement on Gd-diethylene triamine pentaacetic acid enhanced T1-weighted imaging and contrast-enhanced CT. These septa corresponded to fibrovascular bundles at histologic examination.

CONCLUSION

CT and MR findings characteristic of fibrovascular septa within solid ovarian masses should raise the possibility of dysgerminomas.

MRI of muscle strain injuries

OBJECTIVE

The purpose of our study was to evaluate (a) the characteristics of muscle strain injuries on MRI and (b) the potential of a frequency-selective fat suppression technique for diagnosing such injuries.

MATERIALS AND METHODS

Muscle strain injuries in seven athletes were examined by MRI. Spin echo sequences were obtained with and without fat suppression sequences. The absolute values of the contrast-to-noise (C/N) ratios for lesion versus muscle or fat were then compared for both types of images.

RESULTS

We obtained two types of characteristic findings for muscle strain. Lesions of the fascia and adjacent muscles showed a characteristic spray-like or fan-like appearance, extending longitudinally from a shared tendon to the muscle belly in five athletes. This finding was better displayed on coronal images. In contrast, lesions inside a muscle showed a diffuse and inhomogeneous appearance in two athletes. The absolute C/N ratios for lesion versus fat and lesion versus muscle were not significantly different for images with and without fat suppression according to the sign test. However, fat-suppressed images revealed subtle abnormalities that were not seen on conventional images.

CONCLUSION

Magnetic resonance can provide detailed information on muscle strain injuries, especially when coronal fat-suppressed images are obtained.

[Distribution and frequency of gastric cancer at the para-cardiac region and fornix]

To clarify the distribution and frequency of gastric cancer in the upper third of the stomach, especially in the para-cardiac region and fornix, we reviewed 634 lesions of all gastric cancers in any location in the University Hospital of Tsukuba University from April 1985 to March 1992. The para-cardiac region was defined as a circular area of 6 cm in diameter around the cardia. We found 56 lesions (8.8%) in the para-cardiac region, almost all of which were concentrated in the distal half of the para-cardiac region, and only three of which (0.47%) were in the fornix. Cancer in the upper third of the stomach tended to occur predominantly in aged male patients, and histologically most of them were classified as having differentiated adenocarcinoma. Since the percentage of advanced cancer at the para-cardiac region was much higher than at any other location, we should be careful to obtain double-contrast images of sufficient quality during the upper gastrointestinal examinations and not to overlook subtle changes in this region during the interpretation of films.

Hepatic peribiliary cysts: multiple tiny cysts within the larger portal tract, hepatic hilum, or both

PURPOSE

To describe characteristic imaging features of hepatic peribiliary cysts.

MATERIALS AND METHODS

Four patients with hepatic cysts in which the radiologic (n = 3) or histologic (n = 1) findings were consistent with peribiliary cysts of the liver (multiple small cysts seen exclusively in the larger portal tract, hepatic hilum, or both at gross examination and dilatations of extramural peribiliary gland at histologic examination) underwent computed tomography (CT) and ultrasound (US). In three patients, CT was performed after drip infusion of cholangiographic contrast material.

RESULTS

Contrast material-enhanced CT clearly depicted many tiny cysts along the larger portal veins up to the third- or fourth-order branch (n = 3). US depicted multiple cysts in the echogenic portal tract definitely (n = 2) or equivocally (n = 2). On cholangiographic contrast-enhanced CT scans, cystic areas were located adjacent to or surrounding the bile ducts, and the possibility of biliary dilatation, communication, or both was disproved.

CONCLUSION

Hepatic peribiliary cysts can be diagnosed with US and enhanced CT, especially with CT performed after administration of cholangiographic contrast material.

Metastatic tumors in irregular fatty liver mimicking focal sparing

Two cases of hepatic metastatic tumor occurring in irregular fatty liver are reported. These metastatic tumors appeared as irregularly shaped hyperdense areas and were difficult to distinguish from focally spared areas of irregular fatty liver. Even if areas of focal sparing are irregular in shape, hepatic tumors should be carefully ruled out in patients at high risk for liver tumors.

A study of chondroitin sulfate iron colloid as a liver specific MR contrast agent

Chondroitin sulfate iron colloid (CSIC) is a therapeutic agent for iron deficiency anemia. The potential of CSIC to decrease liver signal intensity at magnetic resonance (MR) imaging has already been tested. Enhanced detection of liver carcinoma by CSIC at MR imaging was studied in vivo. Our purpose was to determine the time period required to obtain the maximum contrast enhancement from CSIC at different dose levels. We performed MR imaging of eight rats with hepatic carcinoma before and after CSIC administration. For all dose groups it was found that on T2-weighted images the maximum contrast to noise ratio (C/N) was at 4-8 hours after the drug administration, while on proton density-weighted images the maximum C/N was at 2-8 hours.

[Clinical assessment of 99mTc-MAG3 scintigraphy for impaired renal function]

The renal scintigraphy and clearance of 99mTc-mercaptoacetyltriglycine (MAG3) and 123I-ortho-iodohippuric acid (OIH) were compared in 12 patients with impaired renal function. The patients were first studied with MAG3 and then reinvestigated with OIH two days later. The MAG3 renal scintigraphy gave better quality and functional information in comparison with OIH. The MAG3 and OIH renogram showed identical relative kidney uptake and Tmax, but T1/2 of MAG3 was longer (p < 0.001). The plasma clearance of MAG3 was lower than that of OIH, but they correlated significantly (r = 0.87, p < 0.005). Also, the plasma clearances of MAG3 and para-aminohippuric acid (calculated by the standard clearance technique) showed good correlation (r = 0.77, p < 0.05). The urinary excretion during the first 60 min after injection was the same for the two radiopharmaceuticals. We conclude that 99mTc-MAG3 is a suitable alternative to 123I-OIH in renal scintigraphy.

Radiation tolerance of the liver in relation to the preserved functional capacity

The radiation tolerance of the liver was investigated in 12 patients, 11 of them with liver cirrhosis, treated for hepatocellular carcinoma by partial liver irradiation with doses between 50 and 77 Gy. The tolerance was assessed by the complication probability (Lyman's model), which concerned the injured tissue itself, and by a prediction score used for postsurgical liver failure, which concerned the preserved functional capacity, assuming that the > or = 30 Gy volume was equivalent to the resected volume. The prediction score corresponded better with the observed risk of fatal liver failure than the complication probability. The liver volume after radiotherapy correlated largely with the untreated volume and the low-dose volume. Thus the preserved functional capacity gives a better expression of the radiation tolerance than direct measures of the extent of injured tissue.

Changes in magnetic resonance images in human skeletal muscle after eccentric exercise

To investigate the time-course of changes in transverse relaxation time (T2) and cross-sectional area (CSA) of the quadriceps muscle after a single session of eccentric exercise, magnetic resonance imaging was performed on six healthy male volunteers before and at 0, 7, 15, 20, 30 and 60 min and 12, 24, 36, 48, 72 and 168 h after exercise. Although there was almost no muscle soreness immediately after exercise, it started to increase 1 day after, peaking 1-2 days after the exercise (P < 0.01). Immediately after exercise, T2 increased significantly in the rectus femoris, vastus lateralis and intermedius muscles (P < 0.05) and decreased quickly continuing until 60 min after exercise. At and after the 12th h, a significant increase was perceived again in the T2 values of the vastus lateralis and intermedius muscles (P < 0.01) [maximum 9.3 (SEM 2.8)% and 10.9 (SEM 2.2)%, respectively]. The maximal values were exhibited at 24-36 h after exercise. In contrast, the rectus femoris muscle showed no delayed-stage increase. Also, in CSA, an increase after 12 h was observed in addition to the one immediately after exercise in the vastus lateralis, intermedius and medialis and quadriceps muscles as a whole (P < 0.01), reaching the maximal values at 12-24 h after exercise. The plasma creatine kinase activity remained unchanged up to 24 h after and then increased significantly 48 h after exercise (P < 0.05). Beginning 12 h after exercise, the subjects whose T2 and CSA increased less than the others displayed a faster decrease in muscle soreness.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute change of exercised muscle using magnetization transfer contrast MR imaging

We evaluated the acute changes in exercised muscle using magnetization transfer contrast (MTC) MR imaging with a short repetition time sequence. Ten volunteers performed supine ankle dorsiflexion exercise. MTC gradient-recalled echo (GRE) images were obtained before and after exercise at 1.5 T. The effect of MTC was assessed by dividing the signal intensity on MTC GRE images by that on conventional GRE images (M(s)/M0). The signal intensity, M(s)/M0 and cross-sectional area of exercised muscle were all greater at 1-2 min after exercise than immediately after exercise. We propose that this additional increase in these parameters after exercise was due to physiological reflow or hyperemia. Since the M(s)/M0 showed a good correlation with free water content in exercised muscle, this ratio may provide a quantitative variable for evaluating dynamic change of water-macromolecule interaction in skeletal muscle.

High spatial resolution CT with a synchrotron radiation system

OBJECTIVE

We describe a monochromatic X-ray CT system using synchrotron radiation, which has been constructed employing a vertical wiggler beam line at the National Laboratory for High-Energy Physics in Tsukuba, Japan. This CT system was produced to facilitate examination of the microstructures of material and biological specimens.

MATERIALS AND METHODS

The system provides excellent contrast and has a spatial resolution capacity ranging from 2 to 100 mm. In this preliminary experiment, the images of the rat were obtained at 36-mm slice thickness and 33.2-keV X-ray energy.

RESULTS

The nasal cartilage, skull, and teeth of a live rat were clearly demonstrated with 36-mm spatial resolution.

CONCLUSION

Using a monochromatic X-ray CT system with synchrotron radiation, detailed structures of rat skull were imaged clearly.

[The evaluation of lung cancers hidden by the mediastinal and hilar shadows on the plain chest film]

We retrospectively evaluated the plain chest frontal radiographs in four cases in which the lung cancers were quite difficult to observe prospectively on plain chest frontal radiographs in spite of the relatively large size of tumors (over 3 cm in diameter). Three of four cases were central-type lung cancers, two squamous cell carcinomas and one adenosquamous cell carcinoma. Since there was no associated atelectasis or obstructive pneumonia in these cases, wall thickening and indistinctness of the lumen of the central bronchi were the significant findings for diagnosis. One case proven to be adenocarcinoma was located in the periphery of S6. A focally increased radiopacity behind the descending pulmonary artery was the only finding to pointed out. Since tumors were not demonstrated directly in the aerated lungs, the condition of the central bronchi as well as the degree radiopacity of the pulmonary artery should be carefully interpreted.