Biological Assessment and Mri Monitoring of the Therapeutic Efficacy of a Monoclonal Anti-T Cd4 Antibody in Multiple Sclerosis Patients

An initial group of 21 patients plus a second group of 14 patients with active multiple sclerosis (MS) (18 progressive and 17 relapsing-remitting forms) were treated with a murine monoclonal anti-T CD4/BF5 antibody as part of a phase 1 open trial. Tolerance was relatively good: minor general side-effects occurred in 22 patients only upon the first mAb infusion. One year later, functional disability was stabilised in only six of the 35 patients and after 2 years in two patients only (among 21). One year after treatment, nine of the 17 relapsing-remitting patients were relapse-free. CD4 counts decreased dramatically 2 h after treatment These counts were back to baseline counts at 3 months. A transient increase was found in IL-6 and TNFα levels 2 h after treatment, which probably accounts for the observed side effects. Cell adhesion molecule levels were not modified. Serial MRI scans were performed in the second group of 14 patients. In all of these patients, lesion modifications were observed in the three scans performed prior to treatment Yet, no changes in the lesions were noted on the MRI scans performed over the following 3 months. These findings demonstrate the feasibility of this treatment insofar as it induced a marked CD4 lymphocyte depletion. However, it did not seem to stabilise the evolution of the disease – although one must be careful in drawing such conclusions in a phase 1 trial – or to curb the evolution of MRI-documented lesions.

Detection of late epilepsy by the texture analysis of MR brain images in the lithium-pilocarpine rat model

The aim of the study was to detect by texture analysis non easily visible anomalies of magnetic resonance (MR) images of piriform and entorhinal cortices relevant to the lithium-pilocarpine (Li-Pilo) model of temporal lobe epilepsy in rats. Status epilepticus was induced by Li-Pilo in twenty male rats 21 day-old. T(2)-weighted MR images of their brain, were obtained before injection of Li-Pilo and one day after status epilepticus. An hyperintense signal was found in the piriform and entorhinal cortices of six rats, which developed chronic epilepsy after a latent period of one to three months. Among the 14 other rats which displayed images similar to those obtained before injection, four remained healthy but 10 rats developed late epileptic symptoms, raising the problem of hidden cortical damage which may be too subtle to be detected by classic MRI examination. A numeric treatment of digital images was then undertaken by texture analysis, to derive image information from a purely computational point of view. The combined texture and discriminant analyses based on pixels pattern anomalies, selected 3 texture parameters derived from co-occurrence matrix which characterized structural abnormalities relevant to the hyperintense signal, not only in the modified images of 6 rats but also in images of 10 rats with apparently non modified images. These three texture's parameters allowed to classify the twenty rats of our experiment as follows: sixteen epileptic rats were effectively classified with cortical lesions, two non epileptic were correctly classified with healthy cortex, but two healthy rats were not correctly classified. This misclassification is discussed on the basis of the time dependence of the onset of seizure in the Li-Pilo model. These promising results suggest to apply this method to MRI examinations for an improvement of the early diagnostic of human epilepsy.

Existence of contralateral abnormalities revealed by texture analysis in unilateral intractable hippocampal epilepsy

We selected 23 patients with unilateral temporal lobe epilepsy characterized by ipsilateral hippocampal sclerosis and an apparently normal contralateral hippocampus on MR imaging. Images were acquired on a 0.28 T MR scanner using a conventional Carr-Purcell Meiboom Gill sequence in all patients and in 9 healthy subjects. Texture analysis was applied to axial MR images of the first and tenth echoes. Texture analysis detects macroscopic lesions and microscopic abnormalities that can not be observed visually. The presence of texture differences in the between normal (controls) and sclerotic hippocampi was ascertained by statistical discriminant analysis. The apparently normal contralateral hippocampi can be classified into three categories in terms of texture: 4 apparently healthy, 8 similar to sclerosis, and 11 different from either healthy or sclerosis. These findings are related to a certain degree of hippocampal alteration, which further investigation might help better characterize.

Distinct patterns of active and non-active plaques using texture analysis on brain NMR images in multiple sclerosis patients: preliminary results

The benefits of texture analysis of magnetic resonance images have been assessed in multiple sclerosis (MS) patients. Out of thirty-two lesions identified in eight MS patients, nine were considered active, judging from their gadolinium uptake. Texture analysis allowed to obtain forty-two characterizing parameters for each lesion. Using discriminant analysis as a statistical method allowed to classify the lesions into two groups: active or non-active. An attempt to classify their level of activity by using only co-occurrence matrices was unsuccessful. Alternately, the same type of analysis performed on runlength analysis criteria allowed the accurate classification of 88% of active lesions and 96% of non-active lesions. Using incremental discriminate analysis can reduce the number of useful parameters. This method showed that among the 42 parameters, 8 only were highly significant and permitted an accurate classification. Five of these parameters are runlength parameters, and three others are more directly related to the global distribution. The main interest of runlength parameters is that they allowed to demonstrate that the lesion structure was different in active and non-active plaques. This preliminary work suggests that using texture analysis could be of interest in the follow-up of MS patients because it provides an opportunity to identify active lesions without frequent gadolinium injections.

Technique for MRI of ocular motility

Our goal was to improve existing MR methods used in the assessment of ocular motility in the horizontal gaze direction, by using high resolution 20 s images and an experimental setup that prevents physiologically induced head motion in patients and eye convergence to the fixation point, thus improving the analysis of the relationships between the eyeball and the right muscle bellies in horizontal gaze exploration. The method has potential clinical applications for the diagnosis and/or follow-up of complex strabismus.

TO5 as a magnetization transfer contrast test object: characterization of the gels and determination of the real magnetization transfer

Following the work of the European concerted action, "Tissue characterization by magnetic resonance spectroscopy and imaging," sets of five test objects (TO) were designed, produced, and distributed among European laboratories. The TO were designed to control the image quality of clincial magnetic resonance imaging in an independent and uniform mode. The fifth test object (TO5) was devoted to relaxation measurements and composed of 18 agarose tubes, inserted in an holder filled with a CuSO4 solution. These gels are subject to magnetization transfer (MT). The purpose of this paper is to characterize their MT parameters. An individual study of each gel was performed in a spectrometer, and an individual fit, as well as a global fit, was done on the two-pool model. The MT parameters found in each case are in agreement with the known properties of the agarose gels and given below. The real MT (transfer of magnetization from water to macromolecules) was computed, taking into account the "bleeding over" (direct saturation of the water magnetization). The maximum real MT ranges from 15 to 35% and can be obtained with almost the same saturation pulse conditions for all the gels. However, the saturating field required to reach the maximum MT is very high (46 microT) and unserviceable on a clinical device.

Assessment of painful ureterohydronephrosis during pregnancy by MR urography

The purpose of this study was to assess the value of the fast imaging sequence called RARE (rapid acquisition with relaxation enhancement) MR urography (or RMU) in pregnant women with painful ureterohydronephrosis. A total of 17 pregnant women with an acute flank pain were examined with RMU. Results were compared with those of US, X-rays and the evolution of symptoms. The gold standard techniques used to evaluate the results of MR urography were US when it showed the entire dilated urinary tract and the nature of the obstruction (9 cases), limited intravenous urography (IVU) when performed (3 cases) or endoscopic procedure (5 cases). The accuracy of RMU in the detection of urinary tract dilatation and the localization of the level of obstruction was excellent (sensitivity 100% in our series). The determination of the type of obstruction, intrinsic vs extrinsic, was always exact. The RMU technique alone could not specify the exact nature of the obstruction. The RMU technique is able to differentiate a physiological from a pathological ureterohydronephrosis during pregnancy. It could be considered as the procedure of choice when US failed to establish the differential diagnosis.

Biological assessment and MRI monitoring of the therapeutic efficacy of a monoclonal anti-T CD4 antibody in multiple sclerosis patients

An initial group of 21 patients plus a second group of 14 patients with active multiple sclerosis (MS) (18 progressive and 17 relapsing-remitting forms) were treated with a murine monoclonal anti-T CD4/BF5 antibody as part of a phase I open trial. Tolerance was relatively good: minor general side-effects occurred in 22 patients only upon the first mAb infusion. One year later, functional disability was stabilised in only six of the 35 patients and after 2 years in two patients only (among 21). One year after treatment, nine of the 17 relapsing-remitting patients were relapse-free. CD4 counts decreased dramatically 2 h after treatment. These counts were back to baseline counts at 3 months. A transient increase was found in IL-6 and TNF alpha levels 2 h after treatment, which probably accounts for the observed side effects. Cell adhesion molecule levels were not modified. Serial MRI scans were performed in the second group of 14 patients. In all of these patients, lesion modifications were observed in the three scans performed prior to treatment. Yet, no changes in the lesions were noted on the MRI scans performed over the following 3 months. These findings demonstrate the feasibility of this treatment insofar as it induced a marked CD4 lymphocyte depletion. However, it did not seem to stabilise the evolution of the disease--although one must be careful in drawing such conclusions in a phase I trial--or to curb the evolution of MRI-documented lesions.

Susceptibility-based MRI contrast of the CSF by intravascular superparamagnetic nanoparticles

Endorem, a suspension of superparamagnetic iron oxide dextran nanoparticles (NP), have been injected intravenously to healthy anesthetized rats for the purpose of contrast enhancement of brain in gradient-echo imaging at 200 MHz. Not only gray and white matter but also particular regions of the cerebrospinal fluid (CSF) were contrasted in sagittal and transverse images, although samples of this fluid did not contain NP. The selected contrast in the CSF would result form the ability of dense vascular beds containing highly magnetized particles to induce a remote susceptibility effect far beyond the vascular walls into a large fraction of extravascular water.

NMR relaxation rates and blood oxygenation level

A linear relationship between the proton relaxation rates and the fraction of deoxyhemoglobin of circulating whole blood (fHb) has been established in vitro at 4.7 T. These results have been interpreted on the basis of the additivity of relaxation rates. The slope of the lines of transverse relaxation rates (R2) versus fHb was found to increase with interpulse delay in Carr-Purcell Meiboom-Gill (CPMG) experiments. The Luz-Meiboom relation applied to this interpulse delay dependence of R2 suggests a two-site chemical exchange rather than a diffusion mechanism. The 1-ms water proton exchange time derived from these observations has been interpreted in terms of exchange between exchangeable protons close to the paramagnetic center of hemoglobin and protons of bulk water.

Determination of free triiodothyronine by six different methods in patients with non-thyroidal illness and in patients treated with amiodarone

We performed a methodological comparison of free triiodothyronine (FT3) estimates in patients with liver cirrhosis and renal failure. Patients were classified in terms of severity of illness on the basis of their total triiodothyronine, total thyroxine and reverse triiodothyronine profiles. FT3 levels, measured in direct dialysis, microchromatography, labelled analogue and two-step immunoextraction assays were significantly (P < 0.01) lower than the control group in all patient categories. However, FT3 measured by a labelled antibody radioimmunoassay was significantly reduced only in the most severely ill sub-group of patients. In a further group of patients on long-term amiodarone therapy for cardiac disease all FT3 methods, with the exception of the labelled antibody radioimmunoassay and an analogue method, yielded significantly (P < 0.01) reduced levels. A significant negative association between FT3 and subject age was demonstrated for all methods except the labelled antibody radioimmunoassay, and a weak but significant negative correlation between log thyrotropin and FT3 was only seen with this assay. Three methods demonstrated a correlation (P < 0.02) with albumin levels in patients with the 'low T3 syndrome'. In this group, albumin had a predictive value (P < or = 0.02) for four out of six assays as determined by stepwise variable selection. Our findings suggest that users of FT3 assays should exercise caution in interpreting results in non-thyroidal illness and amiodarone treated patients, as there are method-related differences in the profiles obtained.

Dynamic nuclear polarization with nitroxides dissolved in biological fluids

The most widely used free radicals for dynamic nuclear polarization (DNP) experiments or related Overhauser imaging are nitroxides. The DNP parameters in biological fluids were measured in order to provide guidelines for the design of new nitroxides, adapted to the biological applications of DNP. Eighteen nitroxides were studied at a concentration of 1 mM. Extrapolation at complete electron paramagnetic resonance saturation and proton longitudinal-relaxation-time measurements enable calculation of the coupling factor between nitroxide free electrons and water protons. In deoxygenated phosphate-buffered solutions, the NMR signal enhancement by DNP ranged from -36.3 to -6.7, and the coupling factor ranged from 0.31 to 0.03. Nitroxides with a long side chain yield poor enhancement, although their relaxivity is far greater than that of nitroxides with small chains. In a 1 mM albumin solution, the loss in enhancement factor is mainly caused by the fact that proton relaxation occurs via interactions, not only with the dissolved free radicals but also with the albumin macromolecules. In serum, the enhancement factor is lower than that in an albumin solution, because of the higher protein concentration in serum. In red-blood-cell suspensions, the enhancement factor was further decreased. Two effects contribute to this decrease: first, the increased viscosity due to the presence of red blood cells, and second, the susceptibility effects of the paramagnetism of deoxyhemoglobin. The high sensitivity to oxygen of DNP in phosphate-buffered solution is also greatly reduced when nitroxides are dissolved in blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Fast imaging MR assessment of ureterohydronephrosis during pregnancy

PURPOSE

to assess the value of the fast imaging sequence called RARE-MR-Urography (RMU) for the diagnosis of pathologic ureterohydronephrosis during pregnancy.

MATERIALS AND METHODS

15 pregnant women with an acute flank pain were examined with RMU. Results were compared with those of ultrasonography (US), X-rays, and the evolution of symptoms.

RESULTS

the accuracy of RMU in the detection of urinary tract dilatation and the localization of the level of obstruction was excellent (100%). The determination of the type of obstruction, intrinsic vs. extrinsic, was always exact. RMU alone cannot specify the exact nature of the intrinsic obstruction. Ultrasonography gave less sensitive information in terms of level (60%) and type of obstruction (53%).

CONCLUSION

RMU is able to differentiate a physiological from a pathologic ureterohydronephrosis during pregnancy. It could be considered as a procedure of choice for special cases when US failed to establish this differential diagnosis.

Quality assessment in in vivo NMR spectroscopy: VI. Multicentre quantification of MRS test signals

In this paper the results are presented of a joint European quantitative data-analysis study on a series of in vivo NMR time-domain test signals. The purpose of this study was to investigate, whether the quantitative MRS results from the various European biomedical research-centres can be made more comparable and reproducible. From the results of the study it can be concluded that in case of heavily overlapping NMR lines the quantifications should be done by some form of model function fitting and that, whenever possible, prior knowledge on the quantitative parameters should be incorporated into the quantification algorithms.

Localized T2 measurements using an OSIRIS-CPMG method. Application to measurements of blood oxygenation and transverse relaxation free of diffusion effect

This work presents a new method allowing localized T2 measurements, based upon the OSIRIS scheme. A train of 180 degrees pulses is applied after the OSIRIS preparation cycle, recording directly the transverse magnetization decay. The method was verified for two nuclei, 1H and 19F, with phantoms and in vivo on rats. The accuracy of the T2 values is discussed, as well as possible applications of the OSIRIS-CPMG method to proton transverse spin relaxation measurements, free of diffusion effects, and to non-invasive in vivo blood oxygenation measurements, through the use of an emulsion of perfluorooctylbromide, a blood substitute containing fluorine.

[Magnetic Resonance Imaging study of the role of the blood-brain barrier in the pathogenesis of experimental allergic encephalomyelitis: application to multiple sclerosis]

Nuclear magnetic resonance imaging (MRI) proved to be, from the first, a very sensitive method, allowing the visualisation of multiple sclerosis lesions, yet which never permitted to establish a non equivocal relationship between the semeiology of such lesions and the clinical signs. The multifocal aspect of disseminated multiple sclerosis lesions is probably one of several factors accounting for this discrepancy. The study of an autoimmune disease, experimental allergic encephalomyelitis (EAE), regarded as a suitable model for multiple sclerosis in humans, has been performed using MRI in order to unravel the pathogenesis of the disease and apprehend the mechanisms responsible for the formation of multiple sclerosis lesions. The study focused on the part played by the blood-brain barrier (BBB) in the induction process of an autoimmune disease, since the central nervous system is normally screened from immunological supervision, by this barrier. Models both of acute EAE, induced by active or passive transfer of the antigen (myelin basic protein-MBP)--and chronic EAE, induced by passive transfer of MBP-specific T cells and myelin glycoproteins or MOG-specific monoclonal antibodies, have been reproduced, and their evolution followed up using high field MRI. Every time, the crucial role of the BBB was evidenced by the synchronism existing between the clinical signs, the appearance of lesions, preferentially in the most sensitive or permeable areas, and the BBB breakdown encouraged by the action of adjuvants. The physiopathological study of EAE using MRI is suggestive of the concept of systemic disease for multiple sclerosis, according to a two-step process, involving, in a first stage some primary viral or bacterial infection, causing T-cells to be sensitized to the host's own proteins by molecular mimicry, and in a second stage some bacterial infection or accidental circumstances which, resulting in a BBB breakdown, would provide immunocompetent cells with an opportunity to reach their target.

Hyperbaric oxygen treatment in acute experimental allergic encephalomyelitis. Contribution of magnetic resonance imaging study

Magnetic resonance imaging (MRI) has been performed to determine the efficacy of hyperbaric oxygen treatment (HBO) on experimental allergic encephalomyelitis (EAE) in Lewis rats. The animals were exposed for 2 x 3 h in a 24-h period at 2 ATA pure O2. Three HBO treatment protocols were used: a 10-day preventive treatment (beginning on the 1st day postimmunization), a 3-day preventive treatment (beginning on the 1st day postimmunization), and a 10-day symptomatic treatment (beginning on the 11th day postimmunization). Based on clinical and MRI observations, this study demonstrates: (i) that HBO treatment does not reduce the blood-brain barrier (BBB) disturbance and cerebral edema in EAE, (ii) that in an opposite way, it provokes reversible BBB breakdown, and (iii) that preventive HBO treatments results in modification of the course of EAE, possibly by immunosuppression effect during the initial sensitization step.

Magnetic resonance imaging of antibody-mediated demyelinating experimental allergic encephalomyelitis

Two models of demyelinating experimental allergic encephalomyelitis (EAE) were studied on Lewis rats in whom the disease was induced by injections of either (i) lentil-lectin binding myelin glycoproteins plus myelin basic protein (MBP)-specific T cells (36 rats), or (ii) myelin/oligodendrocyte glycoprotein-specific monoclonal antibody plus MBP-specific T cells (16 rats). In our 24 control rats, 20 received MBP-specific T cells only, and four received myelin glycoproteins plus purified protein derivative-specific T cells. The extent of the resulting blood-brain barrier (BBB) permeability, vasogenic oedema and/or demyelination was assessed in vivo using magnetic resonance imaging (MRI) techniques. The results show that in both demyelinating EAE models the disease appeared more quickly, progressed very rapidly and was more severe than when induced with a similar number of MBP-specific T cells alone. Almost all animals developed hyperacute EAE, with a very high mortality rate. MRI showed a very intense BBB breakdown and vasogenic oedema in all the normally 'leaky' areas of the central nervous system, and focal lesions corresponding to plaque formation in the brain stem or spinal cord near the 'leaky' areas. During the 40-day observation period, the rare survivors of this hyperacute form of EAE presented a chronic form of EAE with serious sequelae. Our results demonstrate that the synergistic effect observed between MBP-specific T cells and antibodies to myelin glycoproteins, especially to myelin/oligodendrocyte glycoprotein, does not only induce demyelinating lesions and chronic clinical signs, but is further responsible, via the normally 'leaky areas', for the fatal increase of the BBB breakdown and vasogenic oedema of which there are ample acute clinical signs.

Evaluation of RARE-MR urography in the assessment of ureterohydronephrosis

OBJECTIVE

The goal of this prospective study was to evaluate the value of the fast imaging sequence called RARE-MR urography (RMU) for the diagnosis of ureterohydronephrosis.

MATERIALS AND METHODS

Sixty-nine patients underwent this procedure. The results were compared with those obtained by intravenous urography (IVU) and ultrasonography (US).

RESULTS

The accuracy of RMU in the detection of urinary tract dilatation and the localization of the level of obstruction was excellent (100%). The determination of the type of obstruction, intrinsic versus extrinsic, was 80% by IVU and 60% for RMU. The RMU sequence alone could not specify the nature of the obstruction. Functional information about the obstructed collecting system could not be obtained.

CONCLUSION

The RMU technique may be considered in the following circumstances: contraindications to IVU (allergy to contrast medium, severe renal failure), impairment of renal excretion, and failure to locate the level of obstruction by US. The absence of ionizing radiations favors the promotion of this procedure to study ureterohydronephrosis during pregnancy.

Local administration of 7 beta-hydroxycholesteryl-3-oleate inhibits growth of experimental rat C6 glioblastoma

The effect of 7 beta-hydroxycholesteryl-3-oleate on rat brain C6 glioblastoma cells was studied. Three days after the inoculation of 2 x 10(5) C6 cells into the frontal cortex of 6-day-old Wistar rats, two types of liposomes [consisting of either phosphatidylcholine and monosialoganglioside (PG:GM1, 10:1 mol/mol) only, or containing 7 beta-hydroxycholesterol, 7 beta-hydroxycholesteryl-3-oleate, 7 alpha-hydroxycholesteryl-3-oleate, or 7-ketocholesteryl-3-oleate] were injected into the xenograft. Ten days later, the animals were sacrificed, the tumors were stained with cresyl violet or hematoxylin/eosin, their volumes determined by image analysis, and their development followed by magnetic resonance imaging. The mean (+/- SE) tumor volume was 4.4 +/- 1.0 mm3. The injection of liposomes without oxysterol had no effect on tumor growth, whereas injection of liposomes containing 7 beta-hydroxycholesteryl-3-oleate (36 nmol) gave rise to a marked decrease in tumor volume (from 4.4 +/- 1.0 to 0.7 +/- 0.4 mm3). Seven nmol had no effect on tumor growth, 72 nmol were as efficient as 36 nmol, and 144 nmol attenuated the tumor volume by 50% only. Liposomes containing 72 nmol of oleic acid enhanced the tumor volume 4-fold. These findings were confirmed by magnetic resonance imaging. Thus, following induction of tumors in both the right and left sides of the cortex and treatment of the right side, magnetic resonance imaging indicated a significant decrease in tumor volume on the right side only. When C6 cells and 7 beta-hydroxycholesteryl-3-oleate were simultaneously injected, tumors did not develop in 80% of the animals. The clearance of [3H]7 beta-hydroxycholesteryl-3-oleate, of which 75% was converted to cholesterol, reached 99% after 48 h. Other oxysterols did not affect the tumor volume except that 7-keto-cholesteryl-3-oleate decreased the tumor volume by 50%. Thus, the 3-fatty acyl ester and 7 beta-hydroxyl groups are apparently required for the antitumor growth effect. Taken together, these data suggest that 7 beta-hydroxycholesteryl-3-oleate might be useful for local glioblastoma chemotherapy.

The role of Mycobacterium tuberculosis in experimental allergic encephalomyelitis

Various detergents used in preparative membrane protein chemistry were added to a complete Freund's adjuvant/water emulsion in order to increase the solubility and/or immunologic availability of the Mycobacterium tuberculosis membrane and to explain its role in blood-brain barrier (BBB) permeability. Magnetic resonance imaging was used for in vivo determination of the BBB breakdown and cerebral edema. The results showed that with 1% 10 tridecyl ether, which increases emulsion stability, abundant BBB breakdown and cerebral edema were observed, similar to those encountered in experimental allergic encephalomyelitis (EAE). We suggest that the immunologic response triggered off by M. tuberculosis largely contributes to the BBB permeability changes observed during EAE, probably by an action on the endothelial cells of the cerebral blood vessels.

Localized T1 measurements using an inversion-recovery OSIRIS method

This work presents a new method for localized T1 measurements, based upon the OSIRIS scheme. It relies on the use of a non-selective 180 degrees pulse applied before the OSIRIS preparation cycle. The accuracy of the method has been verified with test tubes and in vivo for two nuclei, 1H and 19F. The accuracy of the T1 values is discussed, as well as possible applications of the inversion-recovery method to non-invasive in vivo pO2 measurements.

[Evaluation of sensitivity of an assay: application to a third-generation thyrotropin (TSH) assay]

The concentration-specific smallest detectable difference (D) between two concentrations (i.e., the sensitivity) was determined from the results of within-run and run-to-run reproducibility studies of a third-generation thyrotropin assay. Only low concentrations were considered (range 0-0.3 m U/l). Assays were performed in singlet or in duplicate. Findings confirmed the value of the assay: the analytic detection limit approximated 0.005 mU/l and the functional detection limit was around 0.01 mU/l. Expressed as a percentage of the concentration, D% was under 20% for levels of less than 0.02 mU/l in within-run studies or of less than 0.03 mU/l in run-to-run studies. With concentrations in excess of 0.05 mU/l, D% was under 10% in within-run studies and slightly above 10% in run-to-run studies. These new detection thresholds for this assay should be taken into account when interpreting clinical results from a single run (TRH test) or from several runs (hormone replacement therapy or suppression test).

Photoacoustic detection of photosensitized oxygenations in highly absorbing samples

A photoacoustic (PA) study of the relaxation processes of the excited states of photosensitizers in the presence of oxygen and chemical acceptors is described. It has been predicted theoretically that the ratio of PA amplitudes with and without acceptor depends on two parameters alpha and beta, related to the sensitizer and to the acceptor properties, respectively. Experimental studies were carried out on solutions of hematoporphyrin IX and methylene blue. The addition of an acceptor, specific to the singlet oxygen, like tetramethyl ethylene or furfuryl alcohol, appears to decrease significantly the photoacoustic signal amplitude within the band of absorption.

[Dynamic cartography of flow patterns by cine-MRI. Presentation of the technique and preliminary results for major vessels]

The authors report the principles, experimental evaluation and clinical approach of a method for dynamic imaging of flow patterns by NMRI, based upon the phase modulation technique. The imaging method is based upon gradient echo, functioning in "cine" and "flow compensated" mode. Modifications in this sequence enable attribution to the moving spins phase of a value which is considered to be proportional to the flow rate. A map of rates is then obtained from the phase image. Calibration of this sequence in vitro has shown excellent correlations between flow rate and the phase information thus obtained: r always > 0.98 for rates up to m/s. The first results obtained in vivo for the thoracic and abdominal aorta, in 11 control subjects, show that the technique is suitable for the study of pulsatile blood flow, providing very detailed information concerning the spatial distribution of flow rates. Mean flow in the suprarenal abdominal aorta (4.6 +/- 1.6 l/min) is 32% greater than that in the inferior vena cava (3.1 +/- 1 l/min), corresponding to an estimation of portal vein flow of 1.5 l/min. Practical limitations related to the use of a resistive magnet are nevertheless stressed and the authors list the technical aspects necessary for the better clinical utilisation of this non-invasive flowmetric technique. A review of the current literature forms the basis for an assessment of the potential importance of dynamic and quantitative NMRI of flow patterns in the cardiovascular area.

Blood-brain barrier breakdown in MBP-specific T cell induced experimental allergic encephalomyelitis. A quantitative in vivo MRI study

Blood--brain barrier permeability in myelin basic protein (MBP)-specific T cell induced experimental allergic encephalomyelitis (EAE) was studied by magnetic resonance imaging (MRI) in Lewis rats. Myelin basic protein-specific T cells of different specificity and/or purified protein derivative (PPD)-specific T cells were used. During the course of EAE, the volume of the lesions and the T1 and T2 relaxation times were recorded and evaluated with respect to the clinical signs. The results showed that the severity of abnormalities seen on MRI, corresponding to the blood--brain barrier breakdown and cerebral oedema depended on the following two factors: (i) the specificity of the MBP-specific T cells used; (ii) the number of MBP-specific T cells transferred. It was also shown that the more specific the cells were, the less severe the cerebral blood--brain barrier rupture. Moreover, the blood--brain barrier breakdown increased when the number of cells increased. Our results demonstrated that a synergy exists between MBP and PPD-specific T cells which seems to result in an increase in central nervous system inflammation. This helps to explain the role of Mycobacterium tuberculosis in the induction of EAE.

Quantitative cerebral magnetic resonance imaging during ACTH treatment of multiple sclerosis

Serial MR scans were performed with the 2DFT imaging method and the filtered backprojection imaging method on 12 patients with multiple sclerosis in acute phase, 4 in a relapsing/remitting form, and 8 in a progressive form, before, during and after ACTH treatment. Both T1 and T2mono relaxation times, obtained by fitting transverse magnetization decay curves with a monoexponential function within the apparently normal white matter and the areas of increased signal, were measured. With the backprojection method it was possible to fit the transverse magnetization decay curve with a biexponential function and obtain T2long and T2short relaxation times. The T2mono and T1 relaxation times of the apparently normal white matter were significantly different from those obtained for volunteers, but no significant differences were found before, during, or after treatment. The transverse magnetization decay curves of the areas of increased signal were better fitted by a biexponential function. No significant changes in these relaxation times were observed after ACTH treatment. These results argue against an anti-oedematous action of ACTH and may suggest that it has an immunosuppressant effect.

Oxygen imaging in perfused hearts by dynamic nuclear polarization

The feasibility of localized oximetry by dynamic nuclear polarization (DNP) imaging is demonstrated on perfused sheep hearts. DNPI is a magnetic, double resonance technique, in which the electron paramagnetic resonance (EPR) of a free radical dissolved in a perfusion medium is saturated, while the nuclear magnetic resonance (NMR) of water protons is used to perform conventional NMR imaging. The presence of oxygen reduces the enhancement of the NMR signal induced by DNP. The oxygen content of sheep heart tissues was detected by the subtraction of the DNP image of the heart, perfused with a nitrogen-equilibrated solution, from an image obtained when the heart was perfused with an oxygen-equilibrated solution. This result was obtained with extreme oxygen partial pressure, and the discussion presents physical and chemical means for improving the DNP imaging method. Physical means include field cycling, electron paramagnetic rotary saturation, and the use of a 180 degrees NMR pulse before EPR irradiation. The chemical means discussed are deuterium substitution in nitroxides and the potential use of solid, free radical probes. It is suggested to use the perfused heart model for comparing the numerous methods available to measure the oxygen content of tissues.

An evaluation of the significance of areas of intense signal in the MR brain images of patients with multiple sclerosis

This study evaluates the distribution of areas of intense signal (AIS) in 189 patients with multiple sclerosis (MS) and 83 patients presenting high-risk factors of cerebrovascular injuries. Two multivariate statistical analyses (multifactorial discriminant analysis and logistic regression analysis) with two AIS scores and several subpopulations of patients (according to age and/or the number of AIS) were tested. The results of these analyses were expressed with the usual screening test. The results obtained in this study even without the help of any clinical information are very promising, since they established that the specificity of MRI could be improved by using the distribution of the AIS in the various anatomical areas as a criterion. Five regions of the brain display were particularly significant in the discrimination between MS and non-MS patients: In decreasing order we found that the temporal, occipital, brain stem, and parietal regions were more specific with respect to the diagnosis of MS, while only the basal ganglia could account for non-MS patients. With multifactorial discriminant analysis and logistic regression analysis respectively, 78.9 (+/- 2.8)% and 85.1 (+/- 2.8)% of the patients were correctly classified by MRI. The results obtained on the main group were confirmed by a predictive test carried out on an other population of 40 patients, which produced similar results. The comparison between our method and Fazekas's imaging criteria showed a 20% improvement in favour of our approach and it is hoped that it will contribute to make the most of MRI as a tool for the diagnosis of MS.

Viscosity of water in hibernating and nonhibernating mammals estimated by proton NMR relaxation times

Longitudinal (T1) and transverse (T2) nuclear magnetic resonance relaxation times were measured in vitro at 37, 30, 25, 15, and 5 degrees C on serum, brain, liver, kidney, and heart samples from a hibernator, the European hamster, active in summer (SA), active in winter, or in the hibernating state in winter; from a less efficient hibernator, the golden hamster; and from a homeotherm, the rat. T1 and T2 relaxation times varied between species and in the European hamster between the active and hibernating subjects. Despite the major relaxation time differences between the organs, NMR relaxation time measurements showed a general trend to an increase in the viscosity of water for the European hamster in the active state. Although these modifications were not directly related to the process of hibernation itself, the relaxation times observed in the hibernating animals were closer to those seen in the rat. This evidenced that changes of physical properties of water reflect a better adaptation to low temperatures of the hamster, as compared to the nonhibernator, given that the low water viscosity of SA hamster allows the decrease of the viscosity with temperature during the hibernating state. These in vitro studies permit the study the viscosity which is an important physicochemical parameter involved in NMR longitudinal relaxation time of water proton. More detailed studies of other physiological parameters must be undertaken by further in vivo measurements.

Photoacoustic detection of triplet state and singlet oxygen in highly absorbing samples

A photoacoustic (PA) effect theory taking into account two heat sources corresponding to the radiationless relaxation processes of two states of different lifetimes and to the heat diffusion across the sample is herewith presented. Results obtained demonstrate that the amplitude and the phase of the PA signal depend on the sample's thermal properties, on its optical absorption coefficient, on the lifetime of the long-lived excited state, and on the ratio of the two heat sources. This ratio can be expressed as a function of the product of the energy of the excited state times the quantum yield of its production. Simulations of PA amplitude and phase variations vs light modulation frequency exhibit new features of the PA signal:phase inversion and fast decrease of the amplitude. Experimental verifications were carried out on solutions and gels. Fitting of the amplitude and phase variations allow us to measure the lifetime and conversion yield of the intermediate state which can be a triplet state or singlet oxygen, O2(1 delta g). The addition of an acceptor, specific to O2(1 delta g), induces changes in the amplitude of the PA signal which can be used to study the production and deactivation of this excited form of oxygen. This work demonstrates the usefulness of PA in the detection of metastable excited states such as the triplet state and singlet oxygen and in their quantitative analysis.

In vivo dynamic MR imaging of MBP-induced acute experimental allergic encephalomyelitis in Lewis rat

A dynamic in vivo study by MRI consisting of the measurement of relaxation times and in the visualization of the BBB permeability by Gd-DOTA was performed in an MBP-induced acute EAE model of Lewis rat. Fourteen rats were immunized with an MBP/CFA mixture, eight by CFA alone, and three control rats were used to test the harmless effect of repeatedly performed MRI examinations. Beginning on the 8th or 9th days and in parallel with the emergence of clinical signs, rats immunized by the MBP/CFA mixture showed slight increases of relaxation times and of the BBB permeability. These abnormalities, which always remain localized in the periventricular regions, become more pronounced toward the 10th and 11th days, just before (or at the same time) as paraplegia manifestations. After a plateau of a few days, they diminish with the clinical signs. This close correlation found in vivo establishes the essential role of BBB in the pathogenesis of clinical signs of this EAE model.

Changes in serum testosterone levels after myocardial infarction

To evaluate the effect of a severe non-endocrine disease on testosterone levels we determined the total testosterone (T), free testosterone (fT), myoglobin and myosin plasmatic levels in 18 men at the time of hospitalization for acute myocardial infarction (AMI), and 1, 3, 7 and 21 days later. Five different methods for determining fT were applied and compared; 1) radioimmunoassay after ultrafiltration, 2) direct analogue based radioimmunoassay (RIA), 3) calculation from total T, sex-hormone-binding globulin (SHBG) and albumin concentrations, 4) calculation from total T, SHBG concentrations with albuminemia fixed at 40 g/L, and 5) evaluation by the (total T)/(SHBG) ratio (fT index). After AMI the total T and fT decreased rapidly (minimum at day 1) and then increased until day 21. While a lower sensitivity in detecting small changes was noted for the direct analogue based fT RIA and for the calculation using a fixed albuminemia, the evolving pattern of the 5 different fT determinations was similar despite different absolute values. However, there was a wide scattering in the results from the different methods used to determine fT. Compared to ultrafiltration, the fT values were lower by direct analogue based assay and higher by calculation. There was a trend of correlation between changes in total T and the maximum myosin concentration (r = 0.557, p = 0.02), showing a relationship between the hormonal changes and the severity of the myocardial infarction.

Left ventricular ejection fraction in obstructive sleep apnea. Effects of long-term treatment with nasal continuous positive airway pressure

The effects of treatment with nasal continuous positive airway pressure (CPAP) on left ventricular ejection fraction (LVEF) were assessed in 29 patients with obstructive sleep apnea (OSA) in a prospective study using multiple gated equilibrium radionuclide angiocardiography. All patients were evaluated before CPAP treatment was initiated and were reevaluated after one year (mean +/- SE, 415 +/- 6 days), of home treatment with nasal CPAP. The mean LVEF increased from 59 +/- 1 percent to 63 +/- 1 percent (p less than 0.005). The degree of improvement in LVEF was correlated with baseline LVEF (r = 0.54; p less than 0.003), meaning that the lower the baseline value, the greater the increase with treatment. The changes were not different when subgroups of medicated and unmedicated patients were considered separately. These results show that long-term nasal CPAP treatment results in improved left ventricular function in OSA.

Nuclear magnetic resonance T2 relaxation times in multiple sclerosis

An original method was used to carry out the mathematical analysis of T2 transverse magnetization decay curves and the measure of T2 relaxation times on multiple sclerosis (MS) patients. The presumably normal white matter (WM) of these patients presented higher T2 relaxation times (98.6 msec), in comparison with that found in a population sample (88 msec). In this case, magnetization decay curves remain mostly monoexponential and are characterized by a single T2. On the other hand, areas of increased signal (AIS) curves are always better fitted by a biexponential function characterized by a short (82 msec) and a long (greater than 200 msec) T2. The spreading out of long T2 varies from one AIS to another in the same patient and among different patients; values of long T2 also vary with time, but without any correlation with the clinical state. In fact, no correlation was been established between relaxation times and clinical parameters. Quantitative MRI therefore enables a different approach to interpret MRI images; results suggest that several histobiochemical parameters play a role in the pathogenesis of an AIS and that MS is a dynamic and constantly evolving disease.

In vivo determination of multiexponential T2 relaxation in the brain of patients with multiple sclerosis

In vivo measurement of T2 relaxation times in multiple sclerosis (MS) lesions by magnetic resonance imaging (MRI) is potentially useful for the evaluation of the disease activity. Seven patients with definite MS were investigated over a period of three years (19 examinations), using a whole-body MRI scanner operating at 0.15 T with a specially designed high-power radio-frequency head coil. A modified CPMG sequence with a 180 degree pulse interval of TE = 6 msec and 128 echoes was used for the T2 relaxation measurement of the areas of increased signal (AIS) and white matter (WM). A biexponential T2 analysis of each pixel of the spin-echo images was computed. The T2 relaxation processes were found to be a monoexponential function in WM. The T2 relaxation times of apparently normal white matter in MS patients was significantly longer than in control subjects. The T2 relaxation curves of the AIS were found in most cases to fit a biexponential function characterized by a short and a long T2. T2 long relaxation times of AIS were spread out over a wide range (150-560 msec). The study of T2 long histograms shows that some AIS can be divided into two or three parts depending on the T2 long values. Each of these parts may correspond to a pathological process such as edema, demyelination and gliosis. Evolution of T2 relaxation times over a period of time cannot as yet be correlated with modifications in the clinical state.

In vitro and in vivo effects of increased concentrations of free fatty acids on free thyroxin measurements as determined by five assays

To compare in vitro and in vivo effects of increased concentrations of free fatty acids (FFA) on free thyroxin (FT4) values, we measured FT4 in three pooled sera supplemented with oleate and in serum from 18 euthyroid patients before and after an infusion of fat emulsion (Intralipid). We used five FT4 RIA kits: two two-step methods [Gammacoat, Baxter (GC); Ria-gnost, Behring (RG)], two analog RIAs [Amerlex-M, Amersham (AM); Coat-Ria, BioMérieux (CR)], and one kit with labeled antibodies [Amerlex-MAB*, Amersham (AA)]. In vitro, at the maximum oleate addition of 5 mmol/L, FT4 increased when measured by the GC and RG kits, decreased by the AM kit, and showed no significant change by the CR and AA kits. In vivo, post-Intralipid, FFA concentrations rose significantly and the FT4 changes agreed with the results of the in vitro experiments, except for the RG kit, for which FT4 increased in only nine patients. We conclude that in vitro oleate addition is useful to predict the in vivo effect of increased FFA on FT4 values; moreover, in serum from euthyroid subjects with high concentrations of FFA, FT4 analyzed with the CR or AA kits should better agree with normal results for thyrotropin than FT4 values measured with the other kits.

In vitro and in vivo effects of increased concentrations of free fatty acids on free thyroxin measurements as determined by five assays

To compare in vitro and in vivo effects of increased concentrations of free fatty acids (FFA) on free thyroxin (FT4) values, we measured FT4 in three pooled sera supplemented with oleate and in serum from 18 euthyroid patients before and after an infusion of fat emulsion (Intralipid). We used five FT4 RIA kits: two two-step methods [Gammacoat, Baxter (GC); Ria-gnost, Behring (RG)], two analog RIAs [Amerlex-M, Amersham (AM); Coat-Ria, BioMérieux (CR)], and one kit with labeled antibodies [Amerlex-MAB*, Amersham (AA)]. In vitro, at the maximum oleate addition of 5 mmol/L, FT4 increased when measured by the GC and RG kits, decreased by the AM kit, and showed no significant change by the CR and AA kits. In vivo, post-Intralipid, FFA concentrations rose significantly and the FT4 changes agreed with the results of the in vitro experiments, except for the RG kit, for which FT4 increased in only nine patients. We conclude that in vitro oleate addition is useful to predict the in vivo effect of increased FFA on FT4 values; moreover, in serum from euthyroid subjects with high concentrations of FFA, FT4 analyzed with the CR or AA kits should better agree with normal results for thyrotropin than FT4 values measured with the other kits.

Analytical and clinical evaluation of a new one-step non-analogue radioimmunoassay for serum-free thyroxine

We evaluated analytically and clinically the new one-step non-analogue free thyroxine (FT4) assay (Amerlex-MAB from Amersham), using a labelled monoclonal thyroxine-specific antibody as tracer, in comparison with the Gammacoat two-step FT4 kit (Baxter). Analytical performances of the new kit were excellent: within and between run coefficients of variation were less than 5% in the working range. Clinical sensitivities for hypo- and hyperthyroidism were comparable for both kits (FT4 Amerlex-MAB 95% confidence interval: 12-25 pM). When serum was supplemented with albumin we observed a slight decrease in FT4 values measured by both kits. When oleate was added to serum we noted a moderate increase with the Amerlex-MAB kit up to 10 mM oleate added and a much more marked increase with the two-step kit. Results obtained with patients from particular euthyroid populations, known to have low albumin or high free fatty acids concentrations or to have perturbed FT4 results when measured by an analogue-based method, agreed with those of the in vitro studies. With these patients the specificity of the Amerlex-MAB FT4 results was good but slightly decreased compared with the two-step FT4 method, except for heparin-treated patients who were all classified according to their euthyroidal status (17/17 instead of 13/17 with the two-step kit).

[Value of cine magnetic resonance imaging in the diagnosis and quantification of valvular regurgitation. Comparison with angiography and Doppler echocardiography]

Thirty-three patients presenting with regurgitation of the mitral valve (19 cases), tricuspid valve (14 cases) or aortic valve (11 cases) documented by angiography (n = 20) and/or doppler-echocardiography (n = 28) were examined by cine-MRI in order to test this method in valvular regurgitation. Sixteen ECG-synchronized cine-MRI images were acquired by the GRASS technique every 40 ms on appropriate projections, with a resistive 0.28 Tesla Bruker magnet. The semiology of normal and pathological blood flow images at cine-MRI is described. Valvular regurgitations present as "signal void" jets the chronology and spatial extension of which depend on the severity of the lesion. The differential diagnosis with physiological flows is discussed. The diagnostic sensitivity of the method was 29/29 when compared with angiography and 29/33 when compared with doppler-echocardiography (2 cases of 1/4 mitral regurgitation and 2 cases 1/4 tricuspid regurgitation were not visible at cine-MRI). The specificity of this method, as can be judged from 104 patients explored, also seems to be satisfactory. The severity of regurgitation was graded from 1 to 4 with the three methods, on the basis of strict criteria. The differences in grade evaluation exceeded +/- 1 point in only one case of mitral regurgitation which was greatly underestimated by the doppler method as compared with angiography and cine-MRI. Thus, cine-MRI is a reliable method to evaluate valvular regurgitations and their severity. It solves the practical problem raised by non-echogenic patients when catheterization is to be postponed or avoided.

Myocardial gated tomoscintigraphy with 99Tcm-methoxy-isobutyl-isonitrile (MIBI): regional and temporal activity curve analysis

Myocardial gated tomoscintigraphy with hexakis-(2 methoxy-isobutyl-isonitrile) labelled with 99Tcm, is more suitable to resolve precisely the size of myocardial infarct than nongated 201Tl tomoscintigraphy. Gated tomography gives short axis slices at eight points in the cardiac cycle. A quantitative method to analyse heart wall activity and its motion is proposed. In two groups of patients, one with inferior infarct and the other with anterior infarct, the time-activity curves show a maximum in systole for healthy regions and a flattened curve in akinetic regions. Gated tomoscintigraphy assesses more accurately the size of the injured regions because there is no averaging between systolic and diastolic activity as in 201Tl tomoscintigraphy. This method should permit a better follow-up of patients with myocardial infarct.

[Familial hyperthyroxinemia with dysalbuminemia: screening of 21,000 patients at the occasion of thyroid evaluation]

Serum samples from 21,342 patients undergoing evaluation of thyroid status were screened for familial dysalbuminemic hyperthyroxinemia (FDH) using a specific test based on the measure of charcoal uptake of 125I thyroxine (T4) from serum diluted 1:100 with addition of unlabelled 10(-6) M T4. We found 17 cases of FDH: a higher incidence (8:10,000) than previously reported in the general population (1:10,000). The results of thyroid function tests of patients with FDH are presented: total T4 concentration is increased in only 14 subjects; thyrotropin and free T4 measured by an immunoextraction method are the most useful assays to evaluate the clinical status of these patients.

[Comparison of the left ventricular stroke volume and fraction measured with MRI and contrast ventriculography]

27 patients who underwent a contrast ventriculography in right anterior oblique at 30 degrees (for various cardiopathies) were studied by MRI with a mean delay of 5.7 +/- 6.2 days. After location of the medio-ventricular area, a diastolic horizontal section (apex of the R wave) and a systolic section (descending portion of the T wave) are carried out using the spin ultrasound technique. The same calculations are used for MRI au X-Ray contours (modified area-length method) by two strictly independent operators. With MRI, the LVSF is under estimated (40.4 +/- 19%) as compared angiography (46.1 +/- 18%). The linear correlation is 0.79 and in half of the patients (13 in 27) the deviation of the LVSF exceeds 10 p. cent. The volumes also tend to be underestimated with MRI (97 +/- 50 and 64 +/- 51 ml for the diastole and systole respectively) compared with angiography (123 +/- 66 and 73 +/- 62 ml), but the difference is only significant for the diastole and the linear correlation coefficients are improved at 0.82 and 0.90. Underestimation of the parameters measured with MRI is the consequence of multiple factors including the imprecise determination of the true telesystole, the marked effect of the partial volume related to the thickness of the section, and especially the obliquity of the plane studied on MRI, compared with the long axis of the heart. The error made by using a calculation algorithm, conceived for projective methods showing the long axis of the modeled ellipsoid, also explains the underestimation of volumes obtained with MRI, tomographic method. The simple technique used here seems especially interesting in the analysis of segmental contraction. Finally, the development of cine-MRI will undoubtedly be extremely beneficial in the study of ventricular contraction and relaxation.