Turning on the red phosphorescence of a [Ru(tpy)(bpy)(Cl)]Cl complex by amide substitution: self-aggregation, toxicity, and cellular localization of an emissive ruthenium-based amphiphile

Dodecylamide functionalization of [Ru(tpy)(bpy)Cl]Cl led to an emissive, self-assembling, and cytotoxic complex targeting membranes.

An in vitro cell irradiation protocol for testing photopharmaceuticals and the effect of blue, green, and red light on human cancer cell lines

Traditionally, ultraviolet light (100-400 nm) is considered an exogenous carcinogen while visible light (400-780 nm) is deemed harmless. In this work, a LED irradiation system for in vitro photocytotoxicity testing is described. The LED irradiation system was developed for testing photopharmaceutical drugs, but was used here to determine the basal level response of human cancer cell lines to visible light of different wavelengths, without any photo(chemo)therapeutic. The effects of blue (455 nm, 10.5 mW cm(-2)), green (520 nm, 20.9 mW cm(-2)), and red light (630 nm, 34.4 mW cm(-2)) irradiation was measured for A375 (human malignant melanoma), A431 (human epidermoid carcinoma), A549 (human lung carcinoma), MCF7 (human mammary gland adenocarcinoma), MDA-MB-231 (human mammary gland adenocarcinoma), and U-87 MG (human glioblastoma-grade IV) cell lines. In response to a blue light dose of 19 J cm(-2), three cell lines exhibited a minimal (20%, MDA-MB-231) to moderate (30%, A549 and 60%, A375) reduction in cell viability, compared to dark controls. The other cell lines were not affected. Effective blue light doses that produce a therapeutic response in 50% of the cell population (ED50) compared to dark conditions were found to be 10.9 and 30.5 J cm(-2) for A375 and A549 cells, respectively. No adverse effects were observed in any of the six cell lines irradiated with a 19 J cm(-2) dose of 520 nm (green) or 630 nm (red) light. The results demonstrate that blue light irradiation can have an effect on the viability of certain human cancer cell types and controls should be used in photopharmaceutical testing, which uses high-energy (blue or violet) visible light activation.

An in vitro cell irradiation protocol for testing photopharmaceuticals and the effect of blue, green, and red light on human cancer cell lines

Traditionally, ultraviolet light (100-400 nm) is considered an exogenous carcinogen while visible light (400-780 nm) is deemed harmless. In this work, a LED irradiation system for in vitro photocytotoxicity testing is described. The LED irradiation system was developed for testing photopharmaceutical drugs, but was used here to determine the basal level response of human cancer cell lines to visible light of different wavelengths, without any photo(chemo)therapeutic. The effects of blue (455 nm, 10.5 mW cm(-2)), green (520 nm, 20.9 mW cm(-2)), and red light (630 nm, 34.4 mW cm(-2)) irradiation was measured for A375 (human malignant melanoma), A431 (human epidermoid carcinoma), A549 (human lung carcinoma), MCF7 (human mammary gland adenocarcinoma), MDA-MB-231 (human mammary gland adenocarcinoma), and U-87 MG (human glioblastoma-grade IV) cell lines. In response to a blue light dose of 19 J cm(-2), three cell lines exhibited a minimal (20%, MDA-MB-231) to moderate (30%, A549 and 60%, A375) reduction in cell viability, compared to dark controls. The other cell lines were not affected. Effective blue light doses that produce a therapeutic response in 50% of the cell population (ED50) compared to dark conditions were found to be 10.9 and 30.5 J cm(-2) for A375 and A549 cells, respectively. No adverse effects were observed in any of the six cell lines irradiated with a 19 J cm(-2) dose of 520 nm (green) or 630 nm (red) light. The results demonstrate that blue light irradiation can have an effect on the viability of certain human cancer cell types and controls should be used in photopharmaceutical testing, which uses high-energy (blue or violet) visible light activation.

Green light-induced apoptosis in cancer cells by a tetrapyridyl ruthenium prodrug offering two trans coordination sites

In this work, two new photopharmacological ruthenium prodrugs are described that can be activated by green light. Cell death occurs via apoptosis; it is not a consequence of singlet oxygen generation, but of light-induced photosubstitution reactions.

In this work, two new photopharmacological ruthenium prodrugs are described that can be activated by green light. They are based on the tetrapyridyl biqbpy ligand (6,6′-bis[N-(isoquinolyl)-1-amino]-2,2′-bipyridine), which coordinates to the basal plane of the metal centre and leaves two trans coordination sites for the binding of monodentate sulphur ligands. Due to the distortion of the coordination sphere these trans ligands are photosubstituted by water upon green light irradiation. In vitro cytotoxicity data on A431 and A549 cancer cell lines shows an up to 22-fold increase in cytotoxicity after green light irradiation (520 nm, 75 J cm^–2), compared to the dark control. Optical microscopy cell imaging and flow cytometry indicate that the cancer cells die via apoptosis. Meanwhile, very low singlet oxygen quantum yields (∼1–2%) and cell-free DNA binding studies conclude that light-induced cell death is not caused by a photodynamic effect, but instead by the changes induced in the coordination sphere of the metal by light, which modifies how the metal complexes bind to biomolecules.

ACRIN 6664: Patient acceptance and preferance of CT colonography compared to optical colonoscopy for colon cancer screening

4034

Background: Colorectal cancer screening must be repeated on a regular basis. Understanding patient perceptions and willingness to be rescreened will help to determine future compliance rates. The purpose of this study was to compare National CT Colonography Trial (NCTCT) screening participant experiences with CT colonography (CTC) and optical colonoscopy (OC), willingness to return for each procedure, and procedure preference. Methods: NCTCT participants underwent a single bowel preparation (BP). Participants were scheduled to receive CTC, followed by sedation and OC. Participants were asked to complete a questionnaire two weeks post-exam on physical discomfort and embarrassment during BP, CTC and OC and willingness to repeat CTC and OC (with or without BP) at different time intervals. McNemar's Test and logistic regression were used for statistical analysis. Results: 2310 of 2600 patients (89%) responded (1224 women, 1086 men). Mean age was 58.39 years (range 50–86). The participant population was 85% Caucasian, 11% African American and 4% other. Severe discomfort was reported by 7.1% participants with BP, 6.3% with CTC, and 2.2% with OC. Severe embarrassment was reported by 1.6% participants with BP, 1.3% with CTC, and 0.7% with OC. Forty-six percent of participants preferred CTC, 27.4% reported no preference, and 24.9% preferred OC (p<0.001). Repeat screening with CTC is currently recommended every 5 years and with OC every 10 years. 80.5% of the participants were willing to be screened again with CTC in 5 years and 97.5 % were willing to be screened again with OC in 10 years (p<0.001). If the screening interval for CTC were extended to ten years, 93.7% of participants were willing to return for screening (p<0.001). If BP were unnecessary, 91.0% were willing to be rescreened with CTC in 5 years and 97.5% were willing to be rescreened with OC in 10 years (p<0.001). Conclusions: NCTCT participants preferred CTC to OC, but their willingness to undergo repeat CTC was limited by the shorter interval between screenings currently recommended for CTC as opposed to OC. Improvements in technology that would eliminate the need for bowel preparation or extend the recommended screening interval would likely improve adherence to recommended repeat screening.

[Table: see text]

CT findings in runner’s colitis

A spectrum of lower gastrointestinal tract symptoms occurs in marathon runners. Although most symptoms are transient, reversible ischemic colitis is a rare complication that typically responds to supportive therapy. Because computed tomographic features have not been previously described to our knowledge, we describe abdominal computed tomographic manifestations of reversible ischemic colitis in three marathon runners. On computed tomography, reversible ischemic colitis involves the cecum, with varying involvement of the proximal colon.

[Calcification of the falx cerebri. A pathognomonic symptom of Gorlin-Goltz syndrome]

BACKGROUND

Gorlin-Goltz syndrome is an autosomal dominant disorder with variable penetration characterized primarily by keratocysts of the jaws, multiple basal cell carcinomas, skeletal abnormalities and intracranial calcifications.

METHOD

In this study, 4787 radiographs with occipitomental x-rays from the hospital archives for oral and maxillofacial surgery of the Christian Albrechts University Kiel were examined for calcifications in the area of the falx cerebri.

RESULTS

Four characteristic alterations in the falx cerebri could be assigned to four groups of structures. Those in group 4 could be found only within Gorlin-Goltz syndrome patients, and differed significantly in form and extent from the remaining three groups.

CONCLUSION

The plurilamellar appearance of this group could be rated as a pathognomonic symptom of the Gorlin-Goltz syndrome.

Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas

OBJECTIVE

Our objective was to investigate whether a tethered, teardrop-shaped superior mesenteric vein (SMV) is a reliable CT indicator of unresectable adenocarcinoma of the head of the pancreas.

MATERIALS AND METHODS

CT scans of 92 patients with high suspicion for pancreatic head adenocarcinoma were retrospectively reviewed by two radiologists who were unfamiliar with the patients' outcomes. The reviewers were asked to assess whether the teardrop SMV sign was present or not; agreement was reached by consensus. Teardrop SMV was considered absent in patients with an obstructed vessel.

RESULTS

Of 92 patients, 30 had a normal pancreas without a teardrop SMV. A mass in the head of the pancreas was seen in all 62 patients with cancer. Of these 62 patients, 30 (seven with teardrop SMV) were deemed to have inoperable disease by standard CT or clinical criteria. The remaining 32 patients underwent surgery; only 15 of these 32 had successful pancreatoduodenectomies. No patient with resectable tumor had an unequivocal teardrop SMV sign. In 17 patients (13 with teardrop SMV), resection of the tumor could not be accomplished because of vascular encasement (n = 12) or metastasis (n = 5). Added to conventional signs, teardrop SMV significantly increased CT's sensitivity (from 60% to 91%) and accuracy (from 79% to 95%) without significantly changing its specificity (from 100% to 98%) for resectability of pancreatic head cancer.

CONCLUSION

The teardrop SMV is a reliable sign for predicting unresectability of adenocarcinoma of the head of the pancreas and can significantly contribute to preoperative planning.

The ischemic penumbra: operationally defined by diffusion and perfusion MRI

BACKGROUND

Identifying tissue at risk for infarction is important in deciding which patients would benefit most from potentially harmful therapies and provides a way to evaluate newer therapies with regard to the amount of ischemic tissue salvaged.

OBJECTIVE

To operationally define and characterize cerebral tissue at risk for stroke progression.

METHODS

We retrospectively selected 25 patients with an acute onset of a hemispheric stroke from our database who had undergone a combination of two diffusion-weighted MRI studies and a perfusion-weighted MRI study. We applied a logistic regression model using maps of the relative mean transit time and relative cerebral blood flow (rCBF) as well as three different maps of the relative cerebral blood volume (rCBV) to predict an operationally defined penumbra (region of mismatch between the diffusion lesion on day 1 and its extension 24 to 72 hours later).

RESULTS

Maps of the rCBF and initial rCBV were significant predictors for identifying penumbral tissue. Our operationally defined penumbral region was characterized by a reduction in the initial rCBV (47% of contralateral control region [CCR]), an increase (163% of CCR) in the total rCBV, and a reduction (37% of CCR) in the rCBF, whereas the operationally defined ischemic core showed a more severe reduction in the rCBF (12% of CCR) and in the initial rCBV (19% of CCR).

CONCLUSION

These MR indexes may allow the identification and quantification of viable but ischemically threatened cerebral tissue amenable to therapeutic interventions in the hyperacute care of stroke patients.

Sonographic appearance of early complete molar pregnancies

Since our anecdotal experience indicates that the classically described "snowstorm" appearance on ultrasonography of early molar pregnancies is often not present and that theca-lutein cysts are also rare, we examined the ultrasonographic appearance of early complete molar pregnancies. We reviewed the ultrasonographic reports and clinical data of 21 cases of histologically diagnosed complete molar pregnancies with a mean gestational age at sonography of 10.5 weeks (range, 4 to 18 weeks). The diagnosis of molar pregnancy was made on ultrasonography in 12 (57%) cases, was second in the differential diagnosis of one (4.8%) case, and was not considered in eight (38%) cases. No theca-lutein cysts were identified. Five of five (100%) molar pregnancies of 13 weeks or over were diagnosed prospectively, while only eight of 16 (50%) earlier pregnancies were correctly diagnosed prospectively. In a retrospective review of the available images of 16 patients, only nine of 16 (56%) images demonstrated the classic appearance, and no theca-lutein cysts were seen. We conclude that the classic appearance of complete moles on ultrasonography is seen in less than two thirds of cases and even less commonly in the first trimester. The prevalence of theca-lutein cysts is very low.

Echoplanar MR imaging for ultrafast detection of brain lesions

OBJECTIVE

We retrospectively evaluated the use of echo-planar imaging for ultrafast detection of brain lesions.

MATERIALS AND METHODS

In our retrospective study, 61 patients were imaged with the following echo-planar sequences: single-shot proton density-weighted, single-shot T2-weighted, single-shot T2-weighted high-resolution, multishot proton density-weighted, and multishot T2-weighted. Lesions revealed in these patients ranged from 0.5 to 12.0 cm (mean, 3.7 cm) and were the result of tumor (n = 16), stroke (n = 21), demyelination (n = 18), and toxoplasmosis (n = 2). Four patients had scans with normal findings. Two neuroradiologists who were unaware of pertinent clinical data reviewed the images. The images were retrospectively compared with conventional spin-echo images for diagnosis, sensitivity of lesion detection, and qualitative criteria: subjective image quality, gray and white matter differentiation, lesion conspicuity, delineation of lesion borders, and artifacts. (Artifacts included those caused by motion, susceptibility, pulsation, and ghosting.) Quantitative criteria, including signal-to-noise and signal difference-to-noise measurements, were also evaluated in 40 lesions.

RESULTS

Sensitivity for lesion detection was 97% for single-shot echo-planar T2-weighted MR images and 100% for multishot echo-planar T2-weighted MR images. Single-shot echo-planar proton density-weighted MR images had the highest signal-to-noise ratio (91.2+/-19.3). Echo-planar T2-weighted MR images had the highest signal difference-to-noise (33.8+/-22.9). Echo-planar sequences were superior to spin-echo sequences regarding motion and pulsation artifacts. Spin-echo sequences lacked susceptibility and ghosting artifacts, and were superior in lesion conspicuity and delineation of lesion borders.

CONCLUSION

In this study, echo-planar sequences were as sensitive as conventional spin-echo imaging for the diagnostic assessment of lesions. Echo-planar sequences had a strikingly shorter acquisition time and substantially reduced motion and pulsation artifacts. Echo-planar sequences may be a useful diagnostic tool for use in claustrophobic and unstable patients.

A general kinetic model for quantitative perfusion imaging with arterial spin labeling

Recently, several implementations of arterial spin labeling (ASL) techniques have been developed for producing MRI images sensitive to local tissue perfusion. For quantitation of perfusion, both pulsed and continuous labeling methods potentially suffer from a number of systematic errors. In this study, a general kinetic model for the ASL signal is described that can be used to assess these errors. With appropriate assumptions, the general model reduces to models that have been used previously to analyze ASL data, but the general model also provides a way to analyze the errors that result if these assumptions are not accurate. The model was used for an initial assessment of systematic errors due to the effects of variable transit delays from the tagging band to the imaging voxel, the effects of capillary/tissue exchange of water on the relaxation of the tag, and the effects of incomplete water extraction. In preliminary experiments with a human subject, the model provided a good description of pulsed ASL data during a simple sensorimotor activation task.

STAR-HASTE: perfusion imaging without magnetic susceptibility artifact

A novel magnetic resonance imaging technique (STAR-HASTE) based on pulsed arterial spin labeling using a single shot acquisition method is described for perfusion imaging. The method is similar to EPISTAR in using STAR (Signal Targeting with Alternating Radiofrequency) technique for pulsed radiofrequency labeling of inflowing blood, but uses a half-Fourier single shot turbo spin-echo (HASTE) sequence for data acquisition instead of echo-planar imaging (EPI). Our preliminary studies show that STAR-HASTE permits perfusion imaging to be performed without many of the artifacts encountered with other imaging methods based on EPI acquisition. The novel method not only provides similar perfusion information to that obtained by EPISTAR, as demonstrated in the functional brain imaging study, but also eliminates magnetic susceptibility artifacts and image distortion commonly observed in EPI images. Furthermore, this technique can be readily implemented in MR systems without EPI capability.

Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome

Diffusion-weighted magnetic resonance imaging detects ischemic injury within minutes after onset, and has been used to demonstrate drug efficacy in animal models of stroke. In 50 patients diagnosed with acute ischemic stroke (<24-hour duration) within the middle cerebral artery territory, lesion volume was measured by diffusion-weighted imaging. Thirty-four patients also had volumes measured by T2-weighted imaging chronically (median time, 7.5 weeks; mean, 15.9 weeks). Clinical severity was measured by the National Institutes of Health Stroke Scale Score and the Barthel index. Acute lesion volumes correlated with the acute stroke scale score (r = 0.56), the chronic stroke scale score (r = 0.63), and chronic lesion volumes (r = 0.84). Chronic volumes correlated with the chronic stroke scale score (r = 0.86) and the Barthel index (r = -0.60). When only cortically based lesions were considered, the correlations relating acute lesion volume measured by diffusion-weighted imaging (r = 0.61) and chronic lesion volume measured by T2-weighted imaging (r = 0.90) to the chronic stroke scale score were higher. These results provide evidence that lesion volumes determined by diffusion-weighted imaging acutely may be predictive of clinical severity and outcome, and may support a role for diffusion-weighted imaging in the assessment of acute stroke therapies in clinical trials.

Time course of the apparent diffusion coefficient (ADC) abnormality in human stroke

Diffusion-weighted MRI can rapidly detect acute cerebral ischemic injury as hyperintense signal changes, reflecting a decline in the apparent diffusion coefficient (ADC) of water through brain parenchyma, whereas ADC is elevated in the chronic stage because of increased extracellular water content. To determine the time course of these ADC changes, we analyzed 157 diffusion-weighted MRI studies performed at varying time points from the initial ischemic event from 101 patients. Data were expressed as the relative ADC (rADC), the ratio of lesion to control regions of interest. We observed two phases in the time course of rADC changes in acute human stroke: a significant (p < 0.005) reduction in rADC lasting for at least 96 hours from stroke onset (mean, 58.3% of control; SEM, 1.47) and an increasing trend from reduction to pseudonormalization to elevation of rADC values at later subacute to chronic time points (> or = 7 days). We suggest that the persistent reduction of rADC within the first four days may reflect ongoing or progressive cytotoxic edema to a greater degree than extracellular edema and cell lysis.

STAR MR angiography for rapid detection of vascular abnormalities in patients with acute cerebrovascular disease

BACKGROUND AND PURPOSE

We undertook to investigate the usefulness of signal targeting with alternating radiofrequency magnetic resonance angiography (STAR MRA) in the diagnosis of acute cerebrovascular disease. The potential advantage of the technique is that angiographic images can be acquired in less than 1 minute.

METHODS

We studied 19 patients (11 men and 8 women, ranging in age from 36 to 84 years [mean age, 66 years]) presenting with signs and symptoms of acute stroke. Patients underwent STAR MRA and three-dimensional fast imaging with steady-state precession (3D FISP) MRA. The MRAs were analyzed as to image quality and vascular abnormalities in the vascular territory of stroke as defined by diffusion-weighted imaging abnormalities and compared using a Wilcoxon signed-rank test.

RESULTS

STAR MRAs had slightly inferior image quality compared with 3D FISP MRA (P < .05). STAR MRA and 3D FISP MRA agreed in 18 of 19 cases regarding vascular abnormalities in the territory of the infarct (occlusion, n = 8; stenosis, n = 4; no abnormality, n = 6). In one patient, the techniques disagreed, when 3D FISP MRA was normal and STAR MRA demonstrated a vessel occlusion in the vascular territory of a stroke as defined by diffusion-weighted imaging abnormalities (P > .05).

CONCLUSIONS

Despite slightly inferior image quality compared with 3D FISP MRA, STAR MRA is comparable with 3D FISP MRA in depicting abnormalities in the proximal parts of the cerebral arteries corresponding to ischemic regions on diffusion-weighted imaging, in a strikingly shorter acquisition time. Further studies are necessary to confirm that the smaller branches are better shown by using longer inversion times.

Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging

We aimed to determine the frequency and time course of the enlargement of ischemic cerebral lesions following human stroke and to study the effect of the state of perfusion on lesion enlargement. Acute lesion volumes were measured on diffusion-weighted magnetic resonance images and compared with lesion volumes measured on T2-weighted images at 7 days or later. Forty-four measurements were performed between 2 and 53 hours after stroke onset in 28 patients. Thirteen patients also had magnetic resonance perfusion imaging performed. In 12 (43%) of 28 patients the initial lesion volume increased by 20% or more. The number of studies showing enlargement of the ischemic lesion volume ranged from 12 (43%) of 28 at or after 2 hours to 10 (38%) of 26 at or after 6 hours, 5 (33%) of 15 at or after 24 hours, and 2 (33%) of 6 at or after 48 hours. In 7 of the 10 patients in whom the hypoperfusion volume acutely exceeded the volume of the abnormality on diffusion-weighted images, lesion volume increased by 20% or more. This study provided evidence that substantial enlargement of human cerebral ischemic lesion volumes can occur beyond the first 6, 12, or 24 hours after onset. A mismatch acutely between the region of hypoperfusion (larger) and the region of diffusion abnormality (smaller) may be predictive of ischemic lesion enlargement.

Comparison of EPISTAR and T2*-weighted gadolinium-enhanced perfusion imaging in patients with acute cerebral ischemia

PURPOSE

To compare echo-planar imaging with signal targeting and alternating radiofrequency (EPISTAR), an arterial spin-labeling technique, to a T2*-weighted gadolinium-enhanced (T2*-WGE) MR perfusion technique for the evaluation of acute cerebrovascular disease.

METHOD

Twenty-one EPISTAR and T2*-WGE perfusion studies were performed on 18 patients with the clinical diagnosis of acute stroke (12 men, 6 women, age range 34 to 89 years, mean age 68 years). For qualitative analysis, perfusion studies of both techniques were grouped into categories (hyperperfusion, normal perfusion, delayed perfusion, or absent perfusion) and compared with a Wilcoxon signed rank test. Quantitative analysis was performed using signal intensity measurements in a region of interest that was defined by diffusion-weighted imaging abnormalities. These signal intensity measurements were compared with a mirror region in the contralateral unaffected hemisphere. Signal intensity ratios (infarcted region versus the unaffected contralateral region) were calculated and compared using a paired t test.

RESULTS

Qualitative analysis demonstrated agreement between the two techniques in 17 of 21 studies (hyperfusion, n = 3 patients; normal perfusion, n = 3; delayed perfusion, n = 4; and absent perfusion, n = 7). In four studies, the two techniques disagreed when EPISTAR demonstrated absent and T2*-WGE perfusion demonstrated delayed perfusion (p > 0.05). Quantitative analysis revealed a mean signal intensity ratio of 0.73 +/- 0.79 for the T2*-WGE perfusion technique and 0.69 +/- 0.68 for the EPISTAR technique (p > 0.05).

CONCLUSION

The noninvasive EPISTAR technique can assess perfusion abnormalities similarly to the T2*-WGE perfusion technique and may provide a valuable alternative in the diagnosis of acute stroke patients. Differences between the two techniques can be explained by the applied inflow times in the EPISTAR technique.

Prefrontal cortex fMRI signal changes are correlated with working memory load

We investigated whether a nonspatial working memory (WM) task would activate dorsolateral prefrontal cortex (DLPFC) and whether activation would be correlated with WM load. Using functional magnetic resonance imaging we measured regional brain signal changes in 12 normal subjects performing a continuous performance, choice reaction time task that requires WM. A high WM load condition was compared with a non-WM choice reaction time control condition (WM effect) and a low WM load condition (load effect). Significant changes in signal intensity occurred in the DLPFC, frontal motor regions and the intraparietal sulcus (IPS) in both comparisons. These findings support the role of DLPFC and IPS in WM and suggest that signal changes in DLPFC correlate with WM load.

Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery

OBJECTIVE

The purpose of this study was to evaluate the effect of CT on the diagnosis and management of acute abdominal pain in patients who did not undergo surgery and to determine what population of patients would profit most from CT examination.

MATERIALS AND METHODS

Clinical data and CT reports of 91 patients with acute abdomen (41 men and 50 women, 22-96 years old) were analyzed retrospectively. The accuracies of clinical evaluation and CT in revealing the cause of acute abdomen were compared, and the effect of CT on patient management was assessed. Analysis included the entire population of patients and these subgroups: (1) patients who had symptoms for fewer than 24 hr versus patients who had symptoms for 24 hr or more and (2) patients who had a history of abdominal diseases versus patients who had no such history.

RESULTS

Twenty-nine patients had signs or symptoms for fewer than 24 hr, and 62 patients had signs or symptoms for 24 hr or more. Fifty-nine patients had a history of abdominal disease, and 32 had no history of abdominal disease. In the entire population of patients, CT was superior to clinical evaluation for diagnosing the cause of acute abdomen (sensitivity was 90% for CT and 76% for clinical evaluation, p < .0005). Management was changed after CT in 25 patients (p < .0005). Similar differences were observed in the subgroups of patients with signs and symptoms for fewer than 24 hr, patients with signs and symptoms for 24 hr or more, and patients with no history of abdominal disease (p < .05). In the subgroup of patients with a history of abdominal disease, the differences between clinical evaluation and CT were not statistically significant.

CONCLUSION

CT is an excellent examination technique for patients with acute abdomen, regardless of the duration of signs and symptoms. CT is particularly useful in defining the cause and therapeutic strategy in patients with acute abdomen who have no history of abdominal disease.

Comparison of the BOLD- and EPISTAR-technique for functional brain imaging by using signal detection theory

Two magnetic resonance imaging techniques, BOLD (blood oxygenation level dependent) and EPISTAR (echo-planar imaging and signal targeting with alternating radio-frequency), were compared for functional brain imaging. Ten volunteers were imaged performing a sequential finger to thumb opposition task alternating with no movement conditions. Techniques were compared using variance maps and signal detection theory (ROC analysis). True positive activation in regions of interest with expected task-dependent signal changes were computed versus false activation rates in regions in which no activation was expected. D-prime coefficients were calculated for each comparison and statistically compared using a paired t test. Activation in the perirolandic region was seen in all volunteers with both techniques. There was no significant difference for the d-prime between BOLD and EPISTAR. These results indicate that based on a different physiologic principle, EPISTAR is an alternative to BOLD to perform fMRI with similar results.

Brain lesions in patients with multiple sclerosis: detection with echo-planar imaging

PURPOSE

To evaluate the detection of brain lesions with echo-planar imaging relative to conventional spin-echo (SE) imaging.

MATERIALS AND METHODS

In 17 patients (three men, 14 women; mean age, 31 years) with multiple sclerosis, the following were compared: single-shot proton-density- and T2-weighted and thin-section T2-weighted echo-planar, proton-density- and T2-weighted multishot echo-planar, and conventional SE sequences. Quantitative and qualitative criteria as well as lesion detectability were evaluated. The proton-density-weighted SE sequence was used as the standard of reference.

RESULTS

Multishot sequences were superior to single-shot sequences in image quality and lesion detectability. With the multishot proton-density-weighted sequence, 53 of 54 large lesions and 23 of 30 small lesions were detected; with the single-shot proton-density-weighted sequence, 38 of 54 large lesions and five of 30 small lesions were detected.

CONCLUSION

With multishot echo-planar sequences, detectability of large lesions is similar to that with conventional SE imaging. Susceptibility artifact is diminished in comparison to single-shot echo-planar sequences.

Diffusion and perfusion imaging techniques

Diffusion imaging techniques including the Stejskal-Tanner and the stimulated emission of amplitude echoes (STEAM) pulse sequences are discussed. The calculation of apparent diffusion coefficient (ADC) maps is reviewed. The perfusion imaging techniques of blood oxygen level dependent (BOLD) and first pass bolus perfusion techniques as well as the newer technique of echo-planar imaging with signal targeting and altering radiofrequency (EPISTAR) are also discussed. Finally, the theory of intravoxel incoherent motion (IVIM) and its relationship to both diffusion and perfusion phenomena is examined.

Stroke and ischemia

With the introduction of diffusion imaging the diagnosis and acute stroke can be made within minutes of clinical onset. In combination with perfusion imaging, tissue viability can be assessed. The etiology of ischemia can in most cases be investigated by MR angiography. The current applications of these techniques are reviewed, and pitfalls as well as problems in the diagnosis of acute stroke are discussed. With the availability of these techniques, patients can almost instantaneously be approved for pharmacotherapy and monitored and thus clinical outcome potentially can be improved tremendously.

Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging

Our purpose was to use whole brain echo planar magnetic resonance imaging (MRI) to identify and characterize diffusion abnormalities in acute cerebral ischemia. We studied 40 patients as early as 3 hours after onset of signs and symptoms of cerebral ischemia. Diffusion-weighted imaging (DWI) of the entire brain could be completed in 3 seconds or, using seven different diffusion sensitivities (maximum b = 1,271 sec/mm2), in 48 seconds. Measurements and synthetic maps were made of apparent diffusion coefficients (ADC), a physiological parameter that characterizes the self-diffusion of water in tissue. Early ischemic lesions were identified with DWI as hyperintense regions of decreased ADC in all patients who subsequently developed infarction, before changes were evident on conventional MRI in cases studied earlier than 6 hours after onset of ischemic symptoms. Lesions as small as 4 mm in diameter were identified. The extent of lesions within white matter was best defined by controlling for the anisotropic effect of axonal orientation. The mean ADC (+/- SD) for control regions in the 36 patients was 9.15 (+/- 2.91) x 10(-4) mm2/sec. Mean ADC of ischemic regions was 56% of control values at 6 hours or less and stayed significantly reduced for 3 to 4 days after onset of ischemia. The relative ADC increased progressively over time to be pseudonormalized at 5 to 10 days and elevated in the chronic state, making the distinction of acute lesions adjacent to chronic infarcts readily apparent. DWI with echo planar imaging measures a unique physiological parameter that is sensitive to ischemic changes before conventional MRI. Its potential role in the quantitative study of human stroke pathophysiology and therapeutics is the subject of further investigation.

CT of the acute abdomen: findings and impact on diagnosis and treatment

An acute abdomen is a clinical condition characterized by severe abdominal pain that develops suddenly over several hours or less [1]. Abdominal tenderness and rigidity, either generalized or localized, usually are severe and indicate an urgent need for prompt diagnosis and treatment. The underlying cause of acute abdomen varies, and some cases require immediate surgical treatment, whereas for others, surgery is unnecessary or contraindicated. This need for prompt diagnosis and treatment should not preclude an appropriate investigation to establish the precise diagnosis before undertaking surgery [1, 2].

Fast MR imaging of the liver: quantitative comparison of techniques

PURPOSE

To compare several techniques for fast magnetic resonance (MR) imaging of focal liver lesions.

MATERIALS AND METHODS

Ninety patients (37 men and 53 women, aged 19-92 years [mean, 54 years]) with 137 focal liver lesions (56 metastases, 13 hepatocellular carcinomas, 52 hemangiomas, 16 cysts) underwent MR imaging with rapid acquisition spin-echo (RASE), T1-weighted fast low-angle shot (FLASH), turboFLASH, segmented turboFLASH, and T2-weighted conventional and turbo spin echo (SE). Images were analyzed for spleen-to-liver and lesion-to-liver signal difference-to-noise ratios (SD/Ns).

RESULTS

Turbo SE T2-weighted imaging had the highest SD/N for spleen-to-liver (P < .01) and for lesion-to-liver (P < .02) contrast. Segmented T1-weighted turboFLASH imaging had the second highest SD/N for spleen-to-liver (P < .001) contrast and was better overall than other T1-weighted sequences for depicting liver lesions (P < .01). Results at segmented turboFLASH imaging were second best for hemangiomas (P < .01). For metastases, no significant difference was found for results with the T1-weighted sequences.

CONCLUSION

Segmented T1-weighted turboFLASH and turbo SE T2-weighted imaging hae advantages over conventional techniques for liver imaging.

[The in-vivo diffusion measurements of the liver, kidneys, spleen and m. erector with an echo-planar imaging system in normal subjects]

A diffusion sensitive pulse sequence using a stimulated echo (STEAM) type excitation and echo-planar (EPI) readout was developed on a 1.5 T echo-planar MR imaging system. Using this sequence the authors measured the apparent diffusion coefficients (ADC) of water in normal human liver, spleen, muscle and kidney in 12 volunteers. ADCs measured in normal volunteers were: liver, 1.39 +/- 0.16 x 10(-3) mm2/s, spleen, 0.95 +/- 0.15 x 10(-3) mm2/s, muscle, 1.99 +/- 0.16 x 10(-3) mm2/s, kidney, 3.54 +/- 0.47 x 10(-3) mm2/s. A large scatter of the ADCs in the kidneys was found in the different degrees of hydration status among the volunteers and also due to inter-subject variability. With further clinical experience, in vivo diffusion measurements of the abdominal organs may prove helpful in the identification and classification of abdominal disease by MRI.

Qualitative mapping of cerebral blood flow and functional localization with echo-planar MR imaging and signal targeting with alternating radio frequency

PURPOSE

To create qualitative maps of cerebral blood flow (CBF) with the EPISTAR (echo-planar imaging and signal targeting with alternating radio frequency) technique.

MATERIALS AND METHODS

The EPISTAR technique was performed in a pig model of hypercapnia and then tested in 26 volunteers by using various paradigms for cortical activation. Echo-planar images were acquired with and without use of a radio-frequency inversion pulse applied to inflowing arterial spins. A qualitative map of CBF was then created by subtracting the image obtained without the radio-frequency pulse from that obtained with the radio-frequency pulse.

RESULTS

Progressively more distal portions of the tagged vessels were seen as the inflow time was lengthened until cortical enhancement was seen for inflow times of approximately 1 second or longer. Signal intensity increases from rest to sensorimotor activation ranged from 13% to 193%. CBF changes in the motor strip, primary visual cortex, and the motor area for eye movements were well localized to the cortical gray matter ribbon.

CONCLUSION

The EPISTAR technique is a rapid, noninvasive means for creating qualitative maps of CBF.

[The role of magnetic resonance angiography prior to the transjugular placement of a portosystemic stent shunt (TIPS)]

The authors employed magnetic resonance angiography (MRA) to guide catheter placement for transjugular intrahepatic portosystemic stent shunt (TIPS) procedures in 14 of 24 patients, and compared the results to the 10 patients who did not have prior planning based on MRA. Two-dimensional time-of-flight venography was performed during breath holding, and projection venograms were formatted in sagittal, coronal and axial planes. MRA defined venous anatomy sufficiently well to shorten the procedure and helped to minimize invasiveness. With MRA guidance, intrahepatic needle punctures were significantly fewer (without MRA guidance: mean 12.1; with MRA guidance: mean 3.5, p < 0.001) and associated complications were absent (without MRA guidance: failed placement, N = 1; bleeding requiring blood transfusions, N = 2; death complicating intraperitoneal haemorrhage with haemobilia, N = 1, and hepatic capsular perforation, N = 1). The average time for the procedure was 2.8 hours without MRA guidance and 1.8 hours with MRA guidance (p < 0.0005). The authors conclude that MR angiography is a useful technique to define portal and hepatic venous anatomy prior to TIPS, and planning based on MRA may decrease the difficulty and length of the procedure.

MR angiographic guidance for transjugular intrahepatic portosystemic shunt procedures

The authors used magnetic resonance (MR) angiography to guide catheter placement in transjugular intrahepatic portosystemic shunt (TIPS) procedures in nine of 18 patients and compared the results with those of the nine patients for whom prior planning based on MR angiography was not done. Two-dimensional time-of-flight MR venography was performed during breath hold, and projection venograms were formatted in sagittal, coronal, and axial planes. MR angiography defined venous anatomy sufficiently to shorten the procedure and help minimize invasiveness. With MR angiographic guidance, intrahepatic needle punctures were significantly fewer (without MR guidance: mean, 12.1; with MR guidance: mean, 3.6; P < .001) and associated complications were absent (without MR guidance: failed placement, n = 1; bleeding requiring blood transfusions, n = 1; death due to intraperitoneal hemorrhage with hemobilia, n = 1; and death due to hepatic capsular perforation, n = 1). The average time for the procedure was 2.9 hours without MR angiographic guidance and 1.8 hours with MR angiographic guidance (P < .001). The authors conclude that MR angiography is a useful technique for defining portal and hepatic venous anatomy before the TIPS procedure and that planning based on MR angiography may decrease the difficulty and length of the procedure.

[The value of MR tomography after transsphenoidal hypophyseal resection. A retrospective comparison between endocrinology, operation and MRT]

Postoperative magnetic resonance images of 40 patients after transsphenoidal surgery for pituitary adenoma were evaluated retrospectively. The signal intensities of packing material and residual tumour were analysed. T1-weighted spin-echo sequences were obtained in coronal and sagittal views with and without intravenous injection of contrast media. Residual tumour demonstrated homogeneous or inhomogeneous signal intensity on the native scan with homogeneous or inhomogeneous enhancement. Packing material demonstrated a homogeneous signal intensity on the images obtained without injection of contrast media with a peripheral enhancement or alternate layers of low and intermediate signal intensity with alternate enhancement after injection of contrast media. In 5 of 54 examinations different results were found in MRI, endocrinology and surgery (two false negative and one false positive MRI in correlation with endocrinology; two residual tumours on MRI where surgery was supposed to be complete). Application of intravenous contrast media facilitates the interpretation of postoperative examination of the pituitary gland as well as comparison with preoperative examinations and the knowledge of the intraoperative procedure.

Signal targeting with alternating radiofrequency (STAR) sequences: application to MR angiography

We describe a time of flight subtraction method for cine MR angiography that provides nearly perfect suppression of background signal intensity with excellent flow contrast. The method consists of a preparation phase, during which the longitudinal magnetization of the target tissue is inverted on alternate acquisitions and the background tissue is presaturated, followed by a readout phase using a cine segmented turboFLASH sequence with a shared echo modification to improve temporal resolution. With appropriate alternation of the phases of the radiofrequency excitation pulses, there is cancellation of the background signal intensity but flow signal is optimized. By using a thick section (up to 25 mm), substantial portions of the vascular territory are encompassed in a single plane. This permits rapid, dynamic assessment of flow patterns in areas such as the circle of Willis, carotid bifurcation, or renal arteries. Applications of the method for bright and dark blood cine MR angiography are demonstrated.

Abdominal diffusion mapping with use of a whole-body echo-planar system

PURPOSE

To measure apparent diffusion coefficients (ADCs) of water in liver, spleen, kidney, and muscle.

MATERIALS AND METHODS

Ten volunteers (seven women and three men, aged 19-31 years [mean, 24 years]) and nine patients (five women and four men, aged 49-70 years [mean, 62 years]) (liver cyst, n = 3; liver hemangioma, n = 3; liver cirrhosis, n = 2; hepatocellular carcinoma, n = 1; and liver metastasis, n = 1) underwent magnetic resonance (MR) imaging. A stimulated-echo acquisition mode (STEAM)-type excitation and echo-planar imaging (EPI) readout was used in a 1.5-T echo-planar MR imaging system.

RESULTS

ADCs measured in volunteers were liver, 1.39 x 10(-3) mm2/sec +/- 0.16; spleen, 0.95 x 10(-3) mm2/sec +/- 0.15; muscle, 1.99 x 10(-3) mm2/sec +/- 0.16; and kidney, 3.54 x 10(-3) mm2/sec +/- 0.47 (mean +/- standard deviation). Distinctive ADC values were found in organs with abnormalities. ADCs in patients with hepatic disease included liver cysts, 3.9-5.3; liver hemangiomas, 2.0-2.8; liver metastases from an islet cell tumor, 1.2; hepatocellular carcinoma, 1.7; and liver cirrhosis, 0.9-1.2 x 10(-3) mm2/sec.

CONCLUSION

In vivo diffusion measurements of abdominal organs obtained with MR imaging may prove helpful in the identification and classification of abdominal disease.

Portal magnetic resonance angiography

MR angiography has shown definite clinical use in the portal venous system. Methods have been developed for noninvasive assessment of portal venous anatomy and blood flow using a variety of techniques. Time-of-flight techniques for portal angiography and both time-of-flight and phase-contrast techniques for flow measurement are reviewed.

[Differentiating between tumor and implant material in the postoperative sella using MRT]

MRT criteria have been developed to distinguish between tumour and implant material following examination of 50 patients who had transsphenoidal hypophysectomies for tumours. Judgements were based on the postoperative hormonal status and the operation notes. Following contrast injection of Gd-DTPA and using T1 weighted spin-echo sequences, implant material appeared as sandwich-like, linear or circular structures. Residual recurrent tumour produced homogenous or non-homogenous aspects without marginal enhancement in 84% of cases. Postoperative displacement of the infundibulum to the opposite side was observed in 73% of patients with tumour remnants. Sensitivity of MRT was 70%, specificity 95%. There was a positive predictive value of 94% and a negative predictive value of 72% with an accuracy of 81%. This provides assistance in differentiating between tumour remnants and implant material. MRT is recommended as a method of examination for hypophyseal tumours to evaluate the success of surgery and where there is clinical doubt concerning residual or recurrent tumour.

Plasma concentrations of S-verapamil after single doses of two different galenic formulations of racemic verapamil

The results of enantioselective analysis of verapamil (CAS 52-53-9) in plasma samples obtained at tmax after single dose applications of a 80 mg fast dissoluting (IR) tablet, a controlled release (CR) formulation (240 mg) and an intravenous injection of 5 mg verapamil are reported. The mean fraction of S-verapamil obtained in samples containing the Cmax of racemic verapamil was somewhat smaller after application of the IR-form than observed with the CR formulation. (IR = 15.8 +/- 3.8%; CR = 18.8 +/- 2.0%; p < 0.01), after the intravenous application the mean S-fraction was 32.8 +/- 1.4%. In vitro dissolution tests of the two oral preparations prove that the isomers were released as racemate.

[MR venography in deep venous thromboses of the leg and pelvis. A comparison of 2D single layer images and 3D MIP reconstructions with phlebography]

A total of 22 MR venograms were performed in 7 volunteers and 15 patients suspected of deep vein thrombosis of the lower limb and pelvis. MR findings were compared to conventional venography in all patients. MR venography is a reliable method for the exclusion of thrombosis proximal to the popliteal vein. In the calf veins, diagnosis of thrombosis is not yet reliable. For MR venography 2D-time-of-flight-inflow-technique and secondary 3D-MIP reconstructions were used and compared to each other. With both methods there were no false negative results in comparison to conventional venography. 2D single slice MR venography showed two false positive results in iliac and one in popliteal vein. MIP 3D reconstructions led to seven false positive results (three iliac, two femoral, two popliteal). The exclusive interpretation of MIP-3D reconstruction is not reliable for decision-making in deep venous thrombosis.

[Spontaneous necrosis of the femoral condyle--new findings in T2-weighted spin-echo sequences and gradient-echo studies]

The spontaneous necrosis of the femur condyles might cause diagnostic problems because clinical symptoms precede the radiologic changes on conventional x-ray. MRI offers an early detection of the necrosis of the femur condyle like bone necrosis of other localisation. Nine patients were examined by T1- and T2-weighted spin echo- and by T2*-weighted gradient echo sequences. All patients had reduced signal intensity in the subchondral bone marrow on T1-w SE sequences. In three patients new findings were observed on T2-w SE and gradient echoes respectively. These findings allow better understanding in the underlying pathologic-anatomical changes.

[Effects of the PAF antagonist WEB 2086 on hypoxia and angiotensin II-induced pulmonary vasoconstriction in the isolated perfused rat lung]

Using isolated blood-perfused lung preparations of rats, we tested the influence of the PAF antagonist WEB 2086 on vasoconstriction triggered by hypoxia or angiotensin II (A II). If a constant flow was pre-set, changes in the prepulmonarily measured pressure were directly related to the changes of resistance in the pulmonary flow. WEB 2086 reduced the hypoxically conditioned vasoconstriction (HPV) when using blood as perfusion medium, the effect being dependent on the dose (ED50 = 127.3 +/- 21.1 mg/l). HPV was lowered on the average by 82% if the full pharmacologic dose of 800 mg/l WEB 2086 was added to the perfusate. The A II response was weakened to a lesser degree (by 45%). If plasma was used as perfusate, the pressure increase in response to hypoxic stimulation or A II was less marked. However, the relative effect of the PAF antagonist was analogous (attenuation by 83% or 53%, respectively). In chronically hypoxic animals (3 weeks at 10% O2) the relative pressure drop in the lesser circulation after application of WEB 2086 (400 mg/l; HPV; blood as perfusate) was definitely more pronounced (p less than 0.001). The fact that WEB partly antagonises the pulmonary vasoconstriction triggered both by alveolar hypoxy and by angiotensin II, seems to indicate that in both constrictive stimuli PAF participates in the complex mediator mechanism or that WEB 2086 exercises a non-specific vasodilatory effect on the pulmonary flow.

[Left hemispheric site of EEG findings in patients with schizophrenic psychoses]

It was the aim of our study to examine the interhemispherical and extrahemispherical integration that is possibly disturbed in patients suffering from schizophrenic psychoses, using an easy method of EEG performance spectral analysis. For this purpose, the EEG at rest and the functional EEG were determined in 69 schizophrenic patients (ICD) and 22 healthy subjects and the EEG reactivity was calculated. Differences especially in alpha-2 reactivity were seen both intrahemispherically and interhemispherically. This supports the concept of left hemispheric dysfunction in patients suffering from schizophrenic psychoses.

[A pseudosarcoma of the duodenum]

Pseudosarcoma is a rare malignant neoplasm composed of both carcinomatous and sarcomatous elements. It occurs most frequently in the uterus. When located in the gastrointestinal tract the lethality is almost 100% one year after the diagnosis. Clinical observations and radiological findings in a 52-year old patient with pseudosarcoma of the duodenum are presented in this report.

[Acute purulent parotitis as a sequela of alkylphosphate (E 605) poisoning]

Acute suppurative parotitis is a possible consequence of poisoning by organophosphates (E 605). The endogenous accumulation of acetylcholine results--as in the acute pancreatitis caused by poisoning with organophosphates--in massive hyperemia and an increased secretory activity with leakage of saliva into the tissue, in an activation of the kallikrein-kinin system, the phospholipase A2, and, ultimately, in toxic tissue lesions caused by lysolecithin and the superoxide-radical anion. In spite of antibiotic therapy this is followed by bacterial inflammation. Treatment consists in the administration of aprotinin (Trasylol) and corticosteroids. In the case of abscess formation surgical drainage is necessary.