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The value of contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine for predicting decompensation and transplant-free survival in chronic liver disease. Eur Radiol 2023; 33:3425-3434. [PMID: 36897349 DOI: 10.1007/s00330-023-09489-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To investigate the value of contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine for predicting clinical outcomes in patients with chronic liver disease (CLD). METHODS Three hundred and fourteen CLD patients who underwent gadobenate dimeglumine-enhanced hepatic magnetic resonance imaging were stratified into three groups: nonadvanced CLD (n = 116), compensated advanced CLD (n = 120), and decompensated advanced CLD (n = 78) groups. The liver-to-portal vein contrast ratio (LPC) and liver-spleen contrast ratio (LSC) at the hepatobiliary phase were measured. The value of LPC for predicting hepatic decompensation and transplant-free survival was assessed using Cox regression analysis and Kaplan-Meier analysis. RESULTS The diagnostic performance of LPC was significantly better than LSC in evaluating the severity of CLD. During a median follow-up period of 53.0 months, the LPC was a significant predictor for hepatic decompensation (p < 0.001) in patients with compensated advanced CLD. The predictive performance of LPC was higher than that of the model for end-stage liver disease score (p = 0.006). With the optimal cut-off value, patients with LPC ≤ 0.98 had a higher cumulative incidence of hepatic decompensation than patients with LPC > 0.98 (p < 0.001). The LPC was also a significant predictive factor for transplant-free survival in patients with compensated advanced CLD (p = 0.007) and those with decompensated advanced CLD (p = 0.002). CONCLUSIONS Contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine is a valuable imaging biomarker for predicting hepatic decompensation and transplant-free survival in CLD patients. KEY POINTS • The liver-to-portal vein contrast ratio (LPC) significantly outperformed liver-spleen contrast ratio in evaluating the severity of chronic liver disease. • The LPC was a significant predictor for hepatic decompensation in patients with compensated advanced chronic liver disease. • The LPC was a significant predictor for transplant-free survival in patients with compensated and those with decompensated advanced chronic liver disease.
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Li X, Qi H, Cui W, Wang Z, Fu X, Li T, Ma H, Yang Y, Yu T. Recent advances in targeted delivery of non-coding RNA-based therapeutics for atherosclerosis. Mol Ther 2022; 30:3118-3132. [PMID: 35918894 PMCID: PMC9552813 DOI: 10.1016/j.ymthe.2022.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 10/16/2022] Open
Abstract
Cardiovascular disease (CVD) has overtaken infectious illnesses as the leading cause of mortality and disability worldwide. The pathology that underpins CVD is atherosclerosis, characterized by chronic inflammation caused by the accumulation of plaques in the arteries. As our knowledge about the microenvironment of blood vessel walls deepens, there is an opportunity to fine-tune treatments to target the mechanisms driving atherosclerosis more directly. The application of non-coding RNAs (ncRNAs) as biomarkers or intervention targets is increasing. Although these ncRNAs play an important role in driving atherosclerosis and vascular dysfunction, the cellular and extracellular environments pose a challenge for targeted transmission and therapeutic regulation of ncRNAs. Specificity, delivery, and tolerance have hampered the clinical translation of ncRNA-based therapeutics. Nanomedicine is an emerging field that uses nanotechnology for targeted drug delivery and advanced imaging. Recently, nanoscale carriers have shown promising results and have introduced new possibilities for nucleic acid targeted drug delivery, particularly for atherosclerosis. In this review, we discuss the latest developments in nanoparticles to aid ncRNA-based drug development, particularly miRNA, and we analyze the current challenges in ncRNA targeted delivery. In particular, we highlight the emergence of various kinds of nanotherapeutic approaches based on ncRNAs, which can improve treatment options for atherosclerosis.
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Affiliation(s)
- Xiaoxin Li
- Center for Regenerative Medicine, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, Qingdao 266021, People's Republic of China
| | - Hongzhao Qi
- Center for Regenerative Medicine, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, Qingdao 266021, People's Republic of China
| | - Weigang Cui
- Department of Cardiology, People's Hospital of Rizhao, No. 126 Taian Road, Rizhao 276827, People's Republic of China
| | - Zhibin Wang
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao 266000, China
| | - Xiuxiu Fu
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao 266000, China
| | - Tianxiang Li
- Center for Regenerative Medicine, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, Qingdao 266021, People's Republic of China
| | - Huibo Ma
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanyan Yang
- Department of Immunology, School of Basic Medicine, Qingdao University, Qingdao 266021, People's Republic of China.
| | - Tao Yu
- Center for Regenerative Medicine, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, Qingdao 266021, People's Republic of China; Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao 266000, China.
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Myrissa A, Braeuer S, Martinelli E, Willumeit-Römer R, Goessler W, Weinberg AM. Gadolinium accumulation in organs of Sprague-Dawley® rats after implantation of a biodegradable magnesium-gadolinium alloy. Acta Biomater 2017; 48:521-529. [PMID: 27845277 DOI: 10.1016/j.actbio.2016.11.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/28/2016] [Accepted: 11/10/2016] [Indexed: 12/23/2022]
Abstract
Biodegradable magnesium implants are under investigation because of their promising properties as medical devices. For enhancing the mechanical properties and the degradation resistance, rare earth elements are often used as alloying elements. In this study Mg10Gd pins were implanted into Sprague-Dawley® rats. The pin volume loss and a possible accumulation of magnesium and gadolinium in the rats' organs and blood were investigated in a long-term study over 36weeks. The results showed that Mg10Gd is a fast disintegrating material. Already 12weeks after implantation the alloy is fragmented to smaller particles, which can be found within the intramedullary cavity and the cortical bones. They disturbed the bone remodeling until the end of the study. The results concerning the elements' distribution in the animals' bodies were even more striking, since an accumulation of gadolinium could be observed in the investigated organs over the whole time span. The most affected tissue was the spleen, with up to 3240μgGd/kg wet mass, followed by the lung, liver and kidney (up to 1040, 685 and 207μgGd/kg). In the brain, muscle and heart, the gadolinium concentrations were much smaller (less than 20μg/kg), but an accumulation could still be detected. Interestingly, blood serum samples showed no accumulation of magnesium and gadolinium. This is the first time that an accumulation of gadolinium in animal organs was observed after the application of a gadolinium-containing degradable magnesium implant. These findings demonstrate the importance of future investigations concerning the distribution of the constituents of new biodegradable materials in the body, to ensure the patients' safety. STATEMENT OF SIGNIFICANCE In the last years, biodegradable Mg alloys are under investigation due to their promising properties as orthopaedic devices used for bone fracture stabilization. Gadolinium as Rare Earth Element enhances the mechanical properties of Mg-Gd alloys but its toxicity in humans is still questionable. Up to now, there is no study investigating the elements' metabolism of a REE-containing Magnesium alloy in an animal model. In this study, we examined the gadolinium distribution and accumulation in rat organs during the degradation of Mg10Gd. Our findings showed that Gd is accumulating in the animal organs, especially in spleen, liver and kidney. This study is of crucial benefit regarding a safe application of REE-containing Magnesium alloys in humans.
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Abstract
Peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM) exhibits broad clinical characteristics and various consequences and is known as one of the major macrovascular complications of T2DM. Atherosclerosis is recognized as the most direct and important cause of PAD, but acute or chronic limb ischemia may be the result of various risk factors. In light of the increasing number of patients who undergo peripheral vascular procedures, the number of subjects who are exposed to the risks for PAD and related complications is increasing. In this review, we will discuss the clinical and epidemiological characteristics of PAD, as well as the clinical significance of PAD in T2DM subjects.
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Affiliation(s)
- Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | - Young Seol Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
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Abstract
In acute ischemic stroke, the volume of threatened but potentially salvageable tissue, i.e. the ischemic penumbra, is critical to the success of all acute therapeutic interventions, most notably thrombolysis. Despite the availability of both CT and MRI based techniques to detect and assess the penumbra, advanced imaging of this type remains under-utilized. Although the optimal selection criteria are still being refined and technical improvements are ongoing, rapid imaging of the penumbra appears to be the most promising approach to expanding the acute thrombolysis population, as well as tailoring treatment based on specific pathophysiological findings. This second article in a two-part series reviews current evidence for penumbral-based treatment selection and discusses the barriers to implementation of these advanced imaging techniques in acute stroke management protocols.
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Doltra A, Skorin A, Hamdan A, Schnackenburg B, Gebker R, Klein C, Nagel E, Fleck E, Kelle S. Comparison of acquisition time and dose for late gadolinium enhancement imaging at 3.0 T in patients with chronic myocardial infarction using Gd-BOPTA. Eur Radiol 2014; 24:2192-200. [DOI: 10.1007/s00330-014-3213-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/13/2014] [Accepted: 04/30/2014] [Indexed: 01/15/2023]
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Bowering K, Embil JM. Soins des pieds. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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den Adel B, Bovens SM, Boekhorst BT, Strijkers GJ, Poelmann RE, van der Weerd L, Pasterkamp G. Histological validation of iron-oxide and gadolinium based MRI contrast agents in experimental atherosclerosis: The do's and don't's. Atherosclerosis 2012; 225:274-80. [DOI: 10.1016/j.atherosclerosis.2012.07.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/17/2012] [Accepted: 07/17/2012] [Indexed: 12/22/2022]
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Current problems and future opportunities of abdominal magnetic resonance imaging at higher field strengths. Top Magn Reson Imaging 2011; 21:141-8. [PMID: 21847033 DOI: 10.1097/rmr.0b013e3181e8f9b9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction of high-field-strength whole-body MR scanners to clinical routine made abdominal magnetic resonance (MR) imaging widely available. Higher field strength provides improved signal yield, but other issues such as shorter wavelength and increased power deposition of radiofrequency in tissue must also be taken into account. This review describes current problems and future opportunities of abdominal MR imaging at 3.0 T under special consideration of relevant physical properties and technical challenges: impact of higher field strength on signal-to-noise ratio, Larmor frequency, and chemical shift effects are elucidated in detail. Furthermore, changes in longitudinal and transverse relaxation times as well as increased susceptibility effects at 3.0 T are reported. General safety issues and limitations in radiofrequency power deposition are discussed. Subsequently, implications of the previously mentioned changed MR properties at 3.0 T on clinical abdominal examinations applying different sequence types are described.
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te Boekhorst BC, van Tilborg GA, Strijkers GJ, Nicolay K. Molecular MRI of Inflammation in Atherosclerosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011; 5:60-68. [PMID: 22308200 PMCID: PMC3261392 DOI: 10.1007/s12410-011-9114-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Inflammatory activity in atherosclerotic plaque is a risk factor for plaque rupture and atherothrombosis and may direct interventional therapy. Inflammatory activity can be evaluated at the (sub)cellular level using in vivo molecular MRI. This paper reviews recent progress in contrast-enhanced molecular MRI to visualize atherosclerotic plaque inflammation. Various MRI contrast agents, among others ultra-small particles of iron oxide, low-molecular-weight Gd-chelates, micelles, liposomes, and perfluorocarbon emulsions, have been used for in vivo visualization of various inflammation-related targets, such as macrophages, oxidized LDL, endothelial cell expression, plaque neovasculature, MMPs, apoptosis, and activated platelets/thrombus. An enzyme-activatable magnetic resonance contrast agent has been developed to study myeloperoxidase activity in inflamed plaques. Agents creating contrast based on the chemical exchange saturation transfer mechanism were used for thrombus imaging. Transfer of these molecular MRI techniques to the clinic will critically depend on the safety profiles of these newly developed magnetic resonance contrast agents.
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Affiliation(s)
- Bernard C. te Boekhorst
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - Geralda A. van Tilborg
- Biomedical MR Imaging and Spectroscopy Group, Image Sciences Institute, University Medical Center Utrecht, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Gustav J. Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
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Fujii S, Kaneda S, Kakite S, Kanasaki Y, Matsusue E, Harada T, Kaminou T, Ogawa T. Diffusion-weighted imaging findings of adnexal torsion: Initial results. Eur J Radiol 2011; 77:330-4. [DOI: 10.1016/j.ejrad.2009.07.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 06/10/2009] [Accepted: 07/31/2009] [Indexed: 11/26/2022]
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Briley-Saebo KC, Cho YS, Shaw PX, Ryu SK, Mani V, Dickson S, Izadmehr E, Green S, Fayad ZA, Tsimikas S. Targeted iron oxide particles for in vivo magnetic resonance detection of atherosclerotic lesions with antibodies directed to oxidation-specific epitopes. J Am Coll Cardiol 2011; 57:337-47. [PMID: 21106318 PMCID: PMC3095034 DOI: 10.1016/j.jacc.2010.09.023] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 09/21/2010] [Accepted: 09/22/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether iron oxide particles targeted to oxidation-specific epitopes image atherosclerotic lesions. BACKGROUND Oxidized low-density lipoprotein plays a major role in atherosclerotic plaque progression and destabilization. Prior studies indicate that gadolinium micelles labeled with oxidation-specific antibodies allow for in vivo detection of vulnerable plaques with magnetic resonance imaging (MRI). However, issues related to biotransformation/retention of gadolinium might limit clinical translation. Iron oxides are recognized as safe and effective contrast agents for MRI. Because the efficacy of passively targeted iron particles remains variable, it was hypothesized that iron particles targeted to oxidation-specific epitopes might increase the utility of this platform. METHODS Lipid-coated ultra-small superparamagnetic iron particles (LUSPIOs) (<20 nm) and superparamagnetic iron particles (<40 nm) were conjugated with antibodies targeted to either malondialdehyde-lysine or oxidized phospholipid epitopes. All formulations were characterized, and their in vivo efficacy evaluated in apolipoprotein E deficient mice 24 h after bolus administration of a 3.9-mg Fe/kg dose with MRI. In vivo imaging data were correlated with the presence of oxidation-specific epitopes with immunohistochemistry. RESULTS MRI of atherosclerotic lesions, as manifested by signal loss, was observed after administration of targeted LUSPIOs. Immunohistochemistry confirmed the presence of malondialdehyde-epitopes and iron particles. Limited signal attenuation was observed for untargeted LUSPIOs. Additionally, no significant arterial wall uptake was observed for targeted or untargeted lipid-coated superparamagnetic iron oxide particles, due to their limited ability to penetrate the vessel wall. CONCLUSIONS This study demonstrates that LUSPIOs targeted to oxidation-specific epitopes image atherosclerotic lesions and suggests a clinically translatable platform for the detection of atherosclerotic plaque.
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Affiliation(s)
- Karen C. Briley-Saebo
- Translational and Molecular Imaging Institute and Department of Radiology, Mount Sinai School of Medicine, New York, New York
| | - Young Seok Cho
- Seoul National University, Seoul, South Korea
- Vascular Medicine Program, University of California San Diego, La Jolla, California
| | - Peter X. Shaw
- Vascular Medicine Program, University of California San Diego, La Jolla, California
| | - Sung Kee Ryu
- Eulji University, Seoul, South Korea
- Vascular Medicine Program, University of California San Diego, La Jolla, California
| | - Venkatesh Mani
- Translational and Molecular Imaging Institute and Department of Radiology, Mount Sinai School of Medicine, New York, New York
| | - Stephen Dickson
- Translational and Molecular Imaging Institute and Department of Radiology, Mount Sinai School of Medicine, New York, New York
| | - Ehsan Izadmehr
- Translational and Molecular Imaging Institute and Department of Radiology, Mount Sinai School of Medicine, New York, New York
| | - Simone Green
- Vascular Medicine Program, University of California San Diego, La Jolla, California
| | - Zahi A. Fayad
- Translational and Molecular Imaging Institute and Department of Radiology, Mount Sinai School of Medicine, New York, New York
- Departments of Cardiology, Zena and Michael A. Weiner Cardiovascular Institute and Marie-Josee and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, New York
| | - Sotirios Tsimikas
- Vascular Medicine Program, University of California San Diego, La Jolla, California
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Briley-Saebo KC, Cho YS, Tsimikas S. Imaging of Oxidation-Specific Epitopes in Atherosclerosis and Macrophage-Rich Vulnerable Plaques. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010; 4:4-16. [PMID: 21297859 PMCID: PMC3018294 DOI: 10.1007/s12410-010-9060-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oxidative stress, and in particular oxidation of lipoproteins, is a hallmark of atherosclerosis. Upon entry of lipoproteins into the vessel wall, a cascade of pro-atherogenic pathways is initiated whereby the reaction of reactive oxygen species with substrates amenable to oxidation, such as polyunsaturated fatty acids, generates a variety of oxidation-specific epitopes on lipoproteins, proteins in the vessel wall, and apoptotic macrophages. Several of these oxidation-specific epitopes have been well characterized and specific murine and fully human antibodies have been generated in our laboratory to detect them in the vessel wall. We have developed radionuclide, gadolinium and iron oxide based MRI techniques to noninvasively image oxidation-specific epitopes in atherosclerotic lesions. These approaches quantitate plaque burden and also allow detection of atherosclerosis regression and plaque stabilization. In particular, gadolinium micelles or lipid-coated ultrasmall superparamagnetic iron oxide particles containing oxidation-specific antibodies accumulate within macrophages in the artery wall, suggesting they may image the most unstable plaques. Translation of these approaches to humans may allow a sensitive technique to image and monitor high-risk atherosclerotic lesions and may guide optimal therapeutic interventions.
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Lin G, Ho KC, Wang JJ, Ng KK, Wai YY, Chen YT, Chang CJ, Ng SH, Lai CH, Yen TC. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T. J Magn Reson Imaging 2008; 28:128-35. [PMID: 18581404 DOI: 10.1002/jmri.21412] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate diffusion-weighted imaging (DWI) for detection of pelvic lymph node metastasis in patients with cervical and uterine cancers. MATERIALS AND METHODS Fifty patients scheduled for pelvic lymph node dissection were enrolled for 3T magnetic resonance imaging (MRI) using a single-shot echo-planar DWI technique, body-phased array coil, b = 0, 1000 s/mm(2). We measured short/long-axis diameters, mean apparent diffusion coefficient (ADC) values of all identifiable nodes, relative ADC values between tumors and nodes, and utilized their cutoff values to validate the diagnostic accuracy internally. Histopathologic results served as the reference standard. RESULTS The relative ADC values between tumor and nodes were significantly lower in metastatic than in benign nodes (0.06 vs. 0.21 x 10(-3) mm(2)/s, P < 0.001; cutoff value 0.10 x 10(-3) mm(2)/s). Compared to conventional MRI, the method combining size and relative ADC values resulted in better sensitivity (25% vs. 83%) and similar specificity (98% vs. 99%). The smallest metastatic lymph node detected by this method measured 5 mm on its short axis. CONCLUSION The combination of size and relative ADC values was useful in detecting pelvic lymph node metastasis in patients with cervical and uterine cancers.
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Affiliation(s)
- Gigin Lin
- Department of Radiology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5 Fu Hsing Street, Kwei Shan Hsiang, Taoyuan, Taiwan
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Kelle S, Hamdan A, Schnackenburg B, Köhler U, Klein C, Nagel E, Fleck E. Dobutamine stress cardiovascular magnetic resonance at 3 Tesla. J Cardiovasc Magn Reson 2008; 10:44. [PMID: 18844984 PMCID: PMC2572055 DOI: 10.1186/1532-429x-10-44] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 10/09/2008] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The assessment of inducible wall motion abnormalities during high-dose dobutamine-stress cardiovascular magnetic resonance (DCMR) is well established for the identification of myocardial ischemia at 1.5 Tesla. Its feasibility at higher field strengths has not been reported. The present study was performed to prospectively determine the feasibility and diagnostic accuracy of DCMR at 3 Tesla for depicting hemodynamically significant coronary artery stenosis (> or = 50% diameter stenosis) in patients with suspected or known coronary artery disease (CAD). MATERIALS AND METHODS Thirty consecutive patients (6 women) (66 +/- 9.3 years) were scheduled for DCMR between January and May 2007 for detection of coronary artery disease. Patients were examined with a Philips Achieva 3 Tesla system (Philips Healthcare, Best, The Netherlands), using a spoiled gradient echo cine sequence. Technical parameters were: spatial resolution 2 x 2 x 8 mm3, 30 heart phases, spoiled gradient echo TR/TE: 4.5/2.6 msec, flip angle 15 degrees . Images were acquired at rest and stress in accordance with a standardized high-dose dobutamine-atropine protocol during short breath-holds in three short and three long-axis views. Dobutamine was administered using a standard protocol (10 microg increments every 3 minutes up to 40 microg dobutamine/kg body weight/minute plus atropine if required to reach target heart rate). The study protocol included administration of 0.1 mmol/kg/body weight Gd-DTPA before the cine images at rest were acquired to improve the image quality. The examination was terminated if new or worsening wall-motion abnormalities or chest pain occurred or when > 85% of age-predicted maximum heart rate was reached. Myocardial ischemia was defined as new onset of wall-motion abnormality in at least one segment. In addition, late gadolinium enhancement (LGE) was performed. Images were evaluated by two blinded readers. Diagnostic accuracy was determined with coronary angiography as the reference standard. Image quality and wall-motion at rest and maximum stress level were evaluated using a four-point scale. RESULTS In 27 patients DCMR was performed successfully, no patient had to be excluded due to insufficient image quality. Twenty-two patients were examined by coronary angiography, which depicted significant stenosis in 68.2% of the patients. Patient-based sensitivity and specificity were 80.0% and 85.7% respectively and accuracy was 81.8%. Interobserver variability for assessment of wall motion abnormalities was 88% (kappa = 0.760; p < 0.0001). Negative and positive predictive values were 66.7% and 92.3%, respectively. No significant differences in average image quality at rest versus stress for short or long-axis cine images were found. CONCLUSION High-dose DCMR at 3T is feasible and an accurate method to depict significant coronary artery stenosis in patients with suspected or known CAD.
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Affiliation(s)
- S Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Germany
- Department of Radiology, Johns Hopkins University, USA
| | - A Hamdan
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Germany
| | | | - U Köhler
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - C Klein
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - E Nagel
- Division of Imaging Sciences, King's College London, UK
| | - E Fleck
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Germany
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Dawson P. Nephrogenic systemic fibrosis: Possible mechanisms and imaging management strategies. J Magn Reson Imaging 2008; 28:797-804. [DOI: 10.1002/jmri.21521] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Brambilla S, Valaperta S, Graziani G, Montanelli A. Gadolinium and lanthanum: A iatrogenic transmetallation? Clin Biochem 2008; 41:1029-33. [DOI: 10.1016/j.clinbiochem.2008.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 05/09/2008] [Accepted: 05/13/2008] [Indexed: 10/22/2022]
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van der Molen AJ. Nephrogenic systemic fibrosis and the role of gadolinium contrast media. J Med Imaging Radiat Oncol 2008; 52:339-50. [DOI: 10.1111/j.1440-1673.2008.01965.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Lim RP, Hecht EM, Xu J, Babb JS, Oesingmann N, Wong S, Muhs BE, Gagne P, Lee VS. 3D nongadolinium-enhanced ECG-gated MRA of the distal lower extremities: Preliminary clinical experience. J Magn Reson Imaging 2008; 28:181-9. [DOI: 10.1002/jmri.21416] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Abstract
OBJECTIVE The purpose of this study was to determine the incidence of nephrogenic systemic fibrosis and its relation to renal failure and the administration of gadolinium-based contrast material at an academic medical center. MATERIALS AND METHODS A dermatopathology database was searched to identify patients in whom nephrogenic systemic fibrosis was diagnosed. The medical records of these patients were reviewed. Renal function concurrent with any administration of gadolinium-based contrast material was assessed, as was patient outcome. A database of patients undergoing long-term dialysis was reviewed separately to determine how many had received gadolinium and the frequency of nephrogenic systemic fibrosis among these patients. RESULTS Twenty-nine patients were found to have had nephrogenic systemic fibrosis between November 15, 1999, and December 31, 2006. It was known that gadolinium-based contrast material had been administered to 25 of these patients before diagnosis. All 29 patients had compromised renal function (27 had chronic renal failure, and two had acute renal failure). Determination of the temporal relation between gadolinium-based contrast administration and symptom onset often was difficult. Only eight patients had severe morbidity. Nephrogenic systemic fibrosis developed in 12 (2.9%) of 414 patients undergoing long-term dialysis who received gadolinium-based contrast material. CONCLUSION We confirm the strong association between nephrogenic systemic fibrosis and gadolinium-based contrast administration. Although the use of high doses of gadolinium and the occurrence of chronic renal failure have been implicated in other reports, several of our patients received standard doses of gadolinium, and two had transient acute renal failure before diagnosis. Most patients had mild or moderate symptoms. Nephrogenic systemic fibrosis developed in 2.9% of patients undergoing long-term dialysis who received gadolinium-based contrast material but in none of the long-term dialysis patients who did not receive gadolinium-based contrast material.
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Dawson P, Punwani S. NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis: Non-Gadolinium Options for the Imaging of CKD/ESRD Patients. Semin Dial 2008; 21:160-5. [DOI: 10.1111/j.1525-139x.2007.00401.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Otero HJ, Weissman BN, Rybicki FJ. System-based practice: proposal for a comprehensive curriculum. Acad Radiol 2008; 15:119-26. [PMID: 18078915 DOI: 10.1016/j.acra.2007.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Revised: 07/11/2007] [Accepted: 07/13/2007] [Indexed: 12/01/2022]
Affiliation(s)
- Hansel J Otero
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Wang T, Hossann M, Reinl HM, Peller M, Eibl H, Reiser M, Issels RD, Lindner LH. In vitro characterization of phosphatidylglyceroglycerol-based thermosensitive liposomes with encapsulated1H MRT1-shortening gadodiamide. CONTRAST MEDIA & MOLECULAR IMAGING 2008; 3:19-26. [DOI: 10.1002/cmmi.226] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Aneurysm Sac pressure measurement with minimally invasive implantable pressure sensors: an alternative to current surveillance regimes after EVAR? Cardiovasc Intervent Radiol 2007; 31:460-7. [PMID: 18087767 DOI: 10.1007/s00270-007-9245-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 10/30/2007] [Accepted: 11/08/2007] [Indexed: 10/22/2022]
Abstract
Current protocols for surveillance after endovascular repair (EVAR) of abdominal aortic aneurysms are mostly based on costly and time-consuming imaging procedures and aim to detect adverse events such as graft migration, endoleaks or aneurysm sac enlargement. These imaging procedures are either associated with radiation exposure to the patients or may be harmful to the patient due to the use of iodine- or gadolinium-containing contrast agents. Furthermore the advantages of EVAR in the short term might be negated by the necessity for endograft surveillance over years. Thus, alternative modalities for follow-up are being investigated. One of these technologies provides pressure information directly from the aneurysm sac. This noninvasive, telemetric pressure sensing was tested in vitro as well as in first clinical trials and was able to identify successful aneurysm exclusion after EVAR. The telemetric pressure sensors showed a promising efficacy and accuracy in detecting type I and type III endoleaks and will help to clarify the clinical relevance of type II endoleaks. This article provides an overview of the in vitro sensors investigated as well as the first clinical trials and the sensors' potential to change the current endograft surveillance regimes.
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Partain CL. On the potential causal relationship between gadolinium-containing MRI agents and nephrogenic systemic fibrosis. J Magn Reson Imaging 2007; 25:879-80. [PMID: 17457806 DOI: 10.1002/jmri.20982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Schneider G, Ballarati C, Grazioli L, Manfredi R, Thurnher S, Kroencke TJ, Taupitz M, Merlino B, Bonomo L, Shen N, Pirovano G, Kirchin MA, Spinazzi A. Gadobenate dimeglumine-enhanced MR angiography: Diagnostic performance of four doses for detection and grading of carotid, renal, and aorto-iliac stenoses compared to digital subtraction angiography. J Magn Reson Imaging 2007; 26:1020-32. [PMID: 17896354 DOI: 10.1002/jmri.21127] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine the diagnostic performance of contrast-enhanced MR angiography (CE-MRA) with four doses of gadobenate dimeglumine for detection of significant steno-occlusive disease of the carotid, renal, and pelvic vasculature. MATERIALS AND METHODS Eighty-four patients with suspected disease of the renal (n = 16), pelvic (n = 41), or carotid (n = 27) arteries underwent CE-MRA (3D-spoiled gradient-echo sequences) at 1.5T. CE-MRA was performed with gadobenate dimeglumine at 0.025, 0.05, 0.1, or 0.2 mmol/kg (23, 24, 19, and 18 patients, respectively) administered at 2 mL/sec. Accuracy, sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) for detection of significant disease (>50% stenosis or occlusion for renal/pelvic arteries; >70% stenosis or occlusion for carotid arteries) was determined by three fully blinded, independent radiologists using conventional digital subtraction angiography (DSA) as reference standard. All comparisons were tested statistically (ANOVA, chi-square, and Mantel-Haenszel tests as appropriate) and reader agreement (kappa) was assessed. RESULTS Values for accuracy, sensitivity, specificity, PPV, and NPV on CE-MRA were consistently higher for 0.1 mmol/kg gadobenate dimeglumine (accuracy = 95.2-97.3%, sensitivity = 84.2% (all readers), specificity = 96.9-99.2%, PPV = 80.0-94.1%, NPV = 97.6-97.7%). The greater accuracy of the 0.1 mmol/kg dose was significant (P < 0.01, all readers) compared to all other dose groups. Agreement between the three readers was good for all dose groups (kappa >/=0.58), with the highest percent agreement (85.7%) noted for the 0.1 mmol/kg dose. CONCLUSION Significantly better diagnostic performance on CE-MRA of the renal, pelvic, and carotid arteries is achieved with a gadobenate dimeglumine dose of 0.1 mmol/kg bodyweight.
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Affiliation(s)
- Günther Schneider
- Department of Diagnostic Radiology, University Hospital, Homburg/Saar, Germany
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