Abdominal MRI using a negative contrast agent

A dose of 0.5 g of a negative oral contrast agent for labelling the bowel, was given to 40 patients in a clinical trial. Oral magnetic particles (OMP) consist of crystals of iron oxide with superparamagnetic properties, and are administered in 800 ml of a viscous suspension in order to obtain a uniform distribution. The aim of the study was to identify any adverse effects up to 1 week following ingestion, as well as the contrast distribution and effect, together with the induction of artifacts. A comparison of diagnostic value of the pre and postcontrast ingestion series was also performed. Vomiting followed ingestion in a single patient already nauseated and was the only adverse effect. Good contrast distribution and effect with no artifacts were present. The diagnostic information was greatly improved after OMP ingestion, and the diagnosis would not have been possible without the use of the contrast agent in 41% of the examinations.

Contribution of oral magnetic particles in MR imaging of the abdomen with spin-echo and gradient-echo sequences

An open phase III clinical trial of the oral contrast agent OMP (oral magnetic particles) was performed in 35 patients undergoing abdominal magnetic resonance (MR) imaging at 1.5 T with axial spin-echo and gradient-echo sequences. The diagnostic efficacy of OMP was examined by comparing pre-and postcontrast images. Bowel loops and abdominal organs were more easily recognizable after OMP ingestion, and the general quality of the images was improved because of fewer bowel-related artifacts. The diagnostic value of the postcontrast abdominal MR examination was superior or equal to that of the precontrast study, and additional information was obtained in 44% of the cases. Postcontrast gradient-echo sequences increased confidence in the MR examination in 18% of cases. OMP was well tolerated and increased the quality and amount of diagnostic information acquired during the examination. Gradient-echo imaging was found to be a useful complement, but the need for a reduction in susceptibility artifacts was apparent and indicates that a decrease in TE or the use of rapid spin-echo sequences might be advantageous.

Oral Superparamagnetic Particles for Magnetic Resonance Imaging

As a potential gastrointestinal MR contrast medium magnetic particles have been evaluated in preclinical studies as well as in healthy volunteers. The main problem was to achieve an even distribution of the aqueous suspension of magnetic particles in the entire intestine. To improve the distribution of the contrast medium, a viscosity-increasing agent was added to the preparation. In the plain aqueous suspension the magnetic particles sedimented rapidly and caused artifacts, whereas no such sedimentation occurred in the viscous preparation. The contrast effect, as well as the presence of artifacts, increased with particle concentration. The general contrast effect was good in all 5 volunteers, and the contrast medium was well distributed in the small intestine, including the duodenum. There were no artifacts observed, and the contrast medium was well tolerated. The viscosity-increasing agent will thus be introduced in further clinical studies.

Cervical myelography with iohexol

An open study with iohexol (Omnipaque) in cervical myelography has been performed in 20 patients to evaluate the properties and neurotoxicity of this new water soluble contrast medium. The image quality was good (30%) or excellent (70%) in all cases. The frequency of headache was 25%. No EEG changes were severe and the total frequency was 20%. We conclude that this study supports other reports of iohexol having a low neurotoxicity and is well suited for intrathecal use.

Superparamagnetic iron oxide for liver imaging. Comparison among three different preparations

OBJECTIVES

The effects of differently sized superparamagnetic iron oxide (SPIO) particles as liver contrast agents were evaluated by relaxation analysis and magnetic resonance imaging in normal rabbits.

METHODS

We performed relaxivity measurements in agarose gels; T1 was measured by saturation recovery. Rabbits were injected with SPIO particles to evaluate hepatocellular localization and magnetic resonance appearance.

RESULTS

Small (30 nm), medium (300 nm) and large SPIO particles (3,500 nm) reduced the T2 of liver by 50%, 40% and 15%, respectively, and the T2 of spleen by approximately 60%, 65%, and 25%, respectively, at 1 mg Fe/kg intravenous injection. Both small and medium SPIO particles decreased the T1 of spleen by approximately 35%, with no effect on liver T1. Magnetic resonance imaging showed decreased signal intensity ratios (SIliver/SImuscle) by approximately 80% and 60% for small and medium SPIO particles, respectively. Iron oxide (positive Perls blue staining) was observed in Kupffer cells after injection of medium and large SPIO particles, and also in hepatocytes after injection of small SPIO particles.

CONCLUSION

The liver contrast effect seemed to be related to cellular distribution; the widely distributed small SPIO particles were most effective.

Combination of Gadolinium and Dysprosium Chelates as a Cellular Integrity Marker in MR Imaging

A combination of gadolinium (Gd) and dysprosium (Dy) chelates was investigated as a potential marker of cell-membrane integrity by means of a double-contrast effect in MR imaging. Blood samples with varying hematocrit (Hct) levels containing intact or lysed cells were used as model systems. With intact cells, the agents were assumed to be distributed solely extracellularly and the highest Hct studied (69%) was assumed to mimic the ratio of extracellular to intracellular water in tissue. The combined effect on image intensity of Gd (in a concentration corresponding to 0.2 mmol/kg b.w. in humans) and Dy (0.6 mmol/kg b.w.) applied simultaneously was a marked difference in signal intensity between samples with intact and lysed cells in both the T1- and T2-weighted spin-echo images with a corresponding increase in the contrast-to-noise ratio. This was the result of a T1 reduction caused by Gd with a negligible Dy susceptibility effect in areas with lysed cells. On the other hand, the Dy susceptibility effect (i.e. reduced apparent T2) dominated in areas with intact cells. Thus, the combination of Gd and Dy may serve as a marker of cell-membrane integrity in MR examinations.

Gadolinium-enhanced MR imaging of normal renal transplants. An evaluation of a T1-weighted dynamic echo-planar sequence

PURPOSE

To evaluate the potential usefulness of dynamic MR with echoplanar imaging (EPI) in assessing the renal function in patients with renal allografts.

MATERIAL AND METHODS

Using a T1-weighted sequence, EPI was performed after injection of a Gd-chelate in 17 patients with normally functioning renal allografts. Time-intensity curves were plotted from the signal intensity (SI) measurements of the cortex and the medulla.

RESULTS

The pattern of corticomedullar differentiation (CMD) observed after contrast enhancement was divided into four phases using the T1-EPI. After a rapid decrease in the SI of cortical structures, and a subsequent return to precontrast levels, a gradual fall in the SI of the medulla was observed. The average time between the two periods of signal loss was 60 s.

CONCLUSION

This study illustrated the potential use of dynamic T1-EPI to demonstrate contrast-induced CMD in renal allografts.

Effect of Superparamagnetic Particles as Oral Contrast Medium at Magnetic Resonance Imaging

Non-biodegradable superparamagnetic particles were used as an oral contrast medium in different concentrations, and evaluated in 25 human volunteers. The aim of the study was to determine the most appropriate concentration of the contrast medium, and to evaluate the effect, distribution, safety and tolerance. With the concentration of 1.0 g/l a substantial reduction of the signal intensity in the bowel was achieved in both T1 and T2 weighted images. The intraabdominal structures were well differentiated from the bowels containing contrast medium. ‘Metal’ artifacts and blurring of adjacent structures, probably due to an increased local concentration, were observed at higher dosages. The distribution of the preparation in the gastrointestinal tract varied between individuals. As a rule a good contrast effect was achieved in the small bowel with the exception of the duodenum. The contrast medium was well accepted and did not cause any side effects of clinical importance. The results suggest that the preparation is well tolerated by humans and may be a useful contrast medium for abdominal MR imaging.

Synergistic effects of relaxation and susceptibility in differentiation between compartmentalized and noncompartmentalized tissues

RATIONALE AND OBJECTIVES

This study illustrates the synergistic effects of relaxation- and susceptibility-based contrast enhancement. Using a combination of gadolinium (Gd) and dysprosium (Dy) complexes and a sequence capable of taking advantage of the particular relaxation behavior of this combination, the difference between compartmentalized and noncompartmentalized regions was significantly enhanced.

METHODS

Magnetic resonance imaging of the rat kidney was performed before and immediately after the administration of a combination of Gd and Dy chelates (Gd-DTPA-BMA and Dy-DTPA-BMA).

RESULTS

The signal intensity (SI) of the renal parenchyma was reduced by 85%, whereas the collecting tubes had a 100% increase of their SI as demonstrated by a short repetition time (600 msec), long echo time (50 msec), and spin-echo sequence.

CONCLUSIONS

The high R2* effect, specific to the compartmentalized tissues, associated with the moderately high R1 and R2 developed in the remaining areas, results in an important improvement in tissue differentiation, which potentially is useful for the evaluation of pathological changes as in tubular necrosis.

Delineation of liver necrosis using double contrast-enhanced MRI

The purpose of this study was to demonstrate the potential usefulness of the combination of gadolinium and dysprosium to enhance the different between normal and necrotic liver tissue. Small regions of acute necrosis were induced by injecting 200-300 microliters of 95% alcohol into the liver of 26 rats. MRI was performed 24 hours after necrosis induction, before and immediately after injection of one or both contrast agents. Using a mixed T1/T2-weighted sequence, the signal intensity of (SI) of the normal liver was reduced by 70%, whereas the necrotic regions had more than a 50% increase in SI after double contrast. The region that was enhanced corresponded largely with the region of necrosis as observed postmortem. The lesion size, when identified, was largely underestimated using either of the agents along, albeit using the common pulse sequences. The double contrast effect of simultaneous administration of gadolinium and dysprosium allows accurate delineation of liver necrosis.

Superparamagnetic Particles as Oral Contrast Medium in MR Imaging of Malignant Lymphoma

Non-biodegradable superparamagnetic particles, in plain and viscous aqueous suspensions, were used as an oral contrast medium in 34 patients with known or suspected malignant lymphoma. The contrast effect, the occurrence of artifacts, and the distribution were evaluated in the plain and the viscous aqueous suspensions, and the diagnostic information received from abdominal MR examinations performed without bowel contrast medium was compared with that of post-contrast examinations. Magnetic particles in the concentration of 0.5 g/l displayed a good contrast effect at 0.5 T, and helped in differentiating the intestine from adjacent tissues, resulting in increased diagnostic information in abdominal MR imaging. In the patients given the viscous aqueous suspension the occurrence of artifacts caused by the magnetic particles decreased considerably, and the distribution was homogeneous and improved compared with that in patients given the plain aqueous suspension.

Lumbar myelography with Omnipaque (iohexol)

Lumbar myelography with iohexol (Omnipaque) was performed in 103 consecutive adult patients with low back pain or sciatica. The patients were observed for 48 h with registration of possible adverse reactions. Mild or moderate transient side effects were recorded in 24 patients. No serious adverse reactions were noted, and EEG recorded in 25 patients showed no changes.

Contrast-enhanced MR imaging of experimental acute tubular necrosis

Purpose: To demonstrate the involvement of the various renal structures in acute tubular necrosis (ATN).

Material and Methods: In 15 rats, using a T1-/T2-weighted sequence, either gadodiamide alone, or gadodiamide in combination with sprodiamide (a susceptibility agent) were used to enhance the various anatomical substrates of the kidney. The results were compared to those of pathological verification.

Results: Experimentally induced ATN of the rat kidney causes profound changes in the medulla, leaving the cortex largely intact. The difference between the normal cortex and the partially necrotic outer medulla, on the one hand, and the papillary region, was significantly enhanced with the combination, whereas a larger region composed of the inner and outer medulla was enhanced after the gadolinium chelate alone.

Conclusion: The results varied considerably between the two procedures; the double contrast demonstrated a clear difference between the inner and outer medulla, and the gadolinium chelate alone demonstrated a clear difference between the medulla and the cortex. These results demonstrated a clear difference in the compartmentalization between the inner and outer medullary regions, providing complementary information about the pathological condition of the kidney.

Superparamagnetic Particles as Gastrointestinal Contrast Agent in Magnetic Resonance Imaging of Lower Abdomen

Negative gastrointestinal contrast enhancement can be achieved by oral administration of superparamagnetic particles. Their feasibility for the MR imaging of the female pelvis and lower abdomen was evaluated in studies on 32 follow-up patients with treated gynaecologic cancer. All the applied doses (0.2–1.0 mg particles/ml given in a volume of 600–800 ml) of contrast medium decreased the intraluminal signal. However, there was unpredictable individual variation in segmental distribution, and in some cases only a limited contrast effect was obtained. Image distortion was detected when the applied particle concentration exceeded 0.5 mg/ml, especially of the sagittal sections.

Hepatocyte-mediated transport to the bile of AMI-HS, a particulate contrast agent

RATIONALE AND OBJECTIVES

The elimination of hepatocyte-directed particulate contrast agents has not been studied in the same detail as particles eliminated mainly by the mononuclear phagocyte system. The aim of the present study was to elucidate the fate of these particles by a multidisciplinary approach.

METHODS

After intravenous injection of AMI-HS particles directed to the hepatocytes, rats were killed and cytological studies, by both electron microscopy and histochemistry, and spectroscopic studies of the bile were performed. The data were compared with a dynamic magnetic resonance study of the heart and liver.

RESULTS

The particles were rapidly cleared from the blood by Kupffer cells and hepatocytes and then found first in the vascular and later in the biliary pole of the hepatocytes. After 24 hours, a relaxometric characterization of the bile showed the presence of unchanged particles in the bile.

CONCLUSIONS

These results show the capacity of the liver to excrete unchanged AMI-HS particles directly into the bile.

Mr Imaging of the Pancreas AT 0.3 T Using a Super-Paramagnetic Oral Contrast Medium

Twenty patients with carcinoma of the pancreas identified with ultrasonography and/or CT and confirmed by histology, were examined with MR before and after administration of an oral superparamagnetic contrast medium. Ten patients were examined after administration of the contrast medium through a duodenal tube. Ten patients drank the contrast medium mixed with a viscosity-increasing agent. Organ delineation and diagnostic information were improved in the postcontrast scans in both groups and the viscous contrast suspension yielded better delineation and diagnostic information than the aqueous suspension. The viscous contrast suspension also showed better tolerance, contrast distribution and less artifacts than the aqueous suspension.