Contrast-enhancement cardiac magnetic resonance imaging beyond the scope of viability

The clinical applications of cardiovascular magnetic resonance imaging with contrast enhancement are expanding. Besides the direct visualisation of viable and non-viable myocardium, this technique is increasingly used in a variety of cardiac disorders to determine the exact aetiology, guide proper treatment, and predict outcome and prognosis. In this review, we discuss the value of cardiovascular magnetic resonance imaging with contrast enhancement in a range of cardiac disorders, in which this technique may provide insights beyond the scope of myocardial viability.     

Nuclear cardiac imaging for the assessment of myocardial viability

An important aspect of the diagnostic and prognostic work-up of patients with ischaemic cardiomyopathy is the assessment of myocardial viability. Patients with left ventricular dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischaemia but at the same time benefit most from revascularisation. It is important to identify viable myocardium in these patients, and radionuclide myocardial scintigraphy is an excellent tool for this. Single-photon emission computed tomography perfusion scintigraphy (SPECT), whether using ²⁰¹thallium, ^99mTc-sestamibi, or ^99mTc- tetrofosmin, in stress and/or rest protocols, has consistently been shown to be an effective modality for identifying myocardial viability and guiding appropriate management.Metabolic and perfusion imaging with positron emission tomography radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularisation. New techniques in the nuclear cardiology field, such as attenuation corrected SPECT, dual isotope simultaneous acquisition (DISA) SPECT and gated FDG PET are promising and will further improve the detection of myocardial viability. Also the combination of multislice computed tomography scanners with PET opens possibilities of adding coronary calcium scoring and noninvasive coronary angiography to myocardial perfusion imaging and quantification.     

Application of magnetic resonance imaging technique in determining canine muscle and human free-flap viability

Magnetic resonance imaging technique is an exciting, new, safe clinical tool that provides a noninvasive way to monitor free-tissue transfers. Magnetic resonance imaging (MRI) produces a cross-sectional tomographic image at higher resolution than conventional CAT scans and provides a dynamic and physiologic assessment of transferred tissue. We first studied ischemic muscle in the beagle hindlimb gracilis muscles and found an incremental and definitive increase in signal strength both over time and in comparing complete devascularization to partial devascularization. In the right hindlimb (partially devascularized), there was an average increase in T2 (measured in milliseconds) of 2.5 percent at 1 hour, 16.72 percent at 3 hours, and 16.45 percent at 12 hours as compared to normal undisturbed muscle. Similarly, the left hindlimb (completely devascularized) measurements increased from 10.97 percent at 1 hour to 24.02 percent at 3 hours to 47.75 percent at 12 hours. Possible explanations for T2 increases include an increase in intercellular and intracellular water, a change in pH, and possible protein metabolism changes. Clinical studies in seven patients with free flaps have shown "normal" T2 values in healthy tissue comparable to undisturbed canine gracilis muscle and the change in contour and composition of tissue over time. The clinical usefulness of these data is apparent.     

Paramagnetic pharmaceuticals for magnetic resonance imaging

Complexes of paramagnetic ions that are tissue-, organ- or tumor-specific will supplement routine magnetic resonance imaging, help assess organ perfusion, and in some cases assess specific organ function. Studies are described in animals and man and the results suggest that dilute iron solutions may be useful for contrast-enhancement of the gastrointestinal tract; that ferrioxamine B, a stable ferric iron complex, appears to permit identification of focal blood-brain-barrier defects and to assess renal excretory function; and that gadolinium-DTPA can produce contrast-enhancement of a variety of lesions. In addition, gadolinium-DTPA can detect a breakdown in the blood-brain-barrier and can delineate functioning myocardium in the setting of acute ischemia.     

Yield stress of pretreated corn stover suspensions using magnetic resonance imaging

Cellulose fibers in water form networks that give rise to an apparent yield stress, especially at high solids contents. Measuring the yield stress and correlating it with fiber concentration is important for the biomass and pulp industries. Understanding how the yield stress behaves at high solids concentrations is critical to optimize enzymatic hydrolysis of biomass in the production of biofuels. Rheological studies on pretreated corn stover and various pulp fibers have shown that yield stress values correlate with fiber mass concentration through a power‐law relationship. We use magnetic resonance imaging (MRI) as an in‐line rheometer to measure velocity profiles during pipe flow. If coupled with pressure drop measurements, these allow yield stress values to be determined. We compare our results with literature values and discuss the accuracy and precision of the rheo‐MRI measurement, along with the effects of fiber characteristics on the power‐law coefficients. Biotechnol. Bioeng. 2011;108: 2312–2319. © 2011 Wiley Periodicals, Inc.     

Cardiac functional stress imaging: A sequential approach with stress echo and cardiovascular magnetic resonance

Background

An adequate placental perfusion is crucial for the normal growth and well being of the fetus and newborn. The blood flow through the placenta can be compromised in a variety of clinical situations, always causing important damage to the gestation. Our objective is to identify significant predictors for adverse neonatal outcome in severe fetal compromise.

Methods

Consecutive premature fetuses at between 25 and 32 weeks with severe placental insufficiency were examined prospectively. Inclusion criteria were: (i) singletons (ii) normal anatomy; (iii) abnormal umbilical artery Doppler pulsatility index (PI); (iv) abnormal cerebroplacental ratio; (v) middle cerebral artery (MCA) PI < - 2SD ("brain sparing"); (vi) last Doppler examination performed within 24 hours prior to delivery. All 46 patients that met criteria and started the study were followed to the end. We considered as independent potential predicting variables: absent or reversed end diastolic flow in umbilical artery, abnormal ductus venosus S/A ratio, absent or reversed flow during atrial contraction in the ductus venosus and birth weight Z score. Outcome parameters were: neonatal mortality and severe neonatal morbidity.

Results

Backward stepwise logistic regression analysis was used to determine the optimal model for the prediction of neonatal mortality and severe neonatal morbidity. In this analysis birth weight Z score index showed the strongest association OR = 1,87 [1,17-2,99] with all neonatal outcome, all other independent variables were excluded for the optimal model. There was no mortality for the group with normal birth weight Z score.

Conclusion

Our study suggests that birth weight Z score is the strongest predictor of adverse neonatal outcome in severe placental insufficiencies. Such use of Z scores, allowing to get rid of gestational age or sex covariates could be extended to estimated fetal weight and might help in making important decisions in the management of compromised pregnancies.     

Contrast agents for nuclear magnetic resonance imaging

Nuclear magnetic resonance imaging relies upon differences in relaxation times for much of its ability to resolve anatomical structures and to detect changes in tissue. The natural differences can be changed by the administration of paramagnetic substances, such as metal complexes and stable organic free radicals, and ferromagnetic materials, such as small particles of magnetite. Detailed studies of the chemistry and biophysics of such substances in the body are required if they are to become safe and effective contrast agents for use in medical NMR imaging.     

Principles of magnetic resonance imaging

This article aims to provide an educational document of magnetic resonance imaging principles for applied biomedical users of the technology. Basic principles are illustrated using simple experimental models on a preclinical imaging system.     

Targeted contrast agents for magnetic resonance imaging and ultrasound

The development of contrast agents that can be localized to a particular tissue or cellular epitope will potentially allow the noninvasive visualization and characterization of a variety of disease states. Recent advances have been made in the field of molecular imaging with magnetic resonance imaging and ultrasound and varied approaches have been devised to overcome the high background tissue signal. The types of agents and applications developed include gadolinium-conjugated targeting molecules for imaging of fibrin, superparamagnetic iron oxide particles for stem-cell tracking, multimodal perfluorocarbon nanoparticles for visualization of angiogenesis, liposomes for targeting atheroma components, and microbubbles for imaging transplant rejection.     

Iron oxide particles for molecular magnetic resonance imaging cause transient oxidative stress in rat macrophages

Iron oxide particles are a promising marker in molecular magnetic resonance imaging. They are used to label distinct cell populations either in vitro or in vivo. We investigated for the first time whether small citrate-coated very small superparamagnetic iron oxide particles (VSOPs) can lead to an increase in cellular oxidative stress. We incubated rat macrophages (RAW) in vitro with iron oxide particles. We observed a massive uptake of VSOPs measured both with atomic absorption spectroscopy and with NMR, which could be visualized by confocal laser scanning microscopy. After incubation, cells were lysed and the levels of malonyldialdehyde (MDA) and protein carbonyls were determined. We found a significant increase in both MDA and protein carbonyl levels after incubation with the particles. Surprisingly, 24 h after incubation, a significant indication of oxidative stress could no longer be observed. The increase in oxidative stress seems to be transient and closely linked to the incubation procedure. The iron chelator desferal and the intracellular spin trap PBN caused a significant reduction in oxidative stress to almost control levels. This indicates that the augmentation of oxidative stress is closely linked to the free iron during incubation. Proliferation assays showed that incorporation of VSOPs did not lead to long-term cytotoxic effects even though the iron oxide particles remained in the cell. Magnetic labeling of cells with VSOPs seems to cause transient oxidative conditions not affecting cellular viability and seems to be a usable approach for molecular magnetic resonance imaging.     

Cardiovascular applications of magnetic resonance imaging

Magnetic resonance (MR) imaging is a unique imaging modality that is gaining rapid acceptance for a variety of medical indications. Diagnostic information is obtained noninvasively, without the potential hazards of ionizing radiation. The spatial resolution and anatomic detail of MR imaging rival those of other currently available imaging methods. By gating to an electrocardiographic signal cardiac imaging is possible. Since March 1983 the authors have had experience with cardiac MR imaging in both animals and humans. Cardiac anatomy is well shown by this technique, which allows detection and characterization of intracardiac masses, congenital heart disease and anomalies of the great vessels. Myocardial infarction has been detected in both animals and humans without the use of contrast agents, and acute cardiac transplant rejection has been visualized in an animal model. Limitations of MR imaging primarily have been lengthy imaging times and the sensitivity of the images to motion. With further investigation and experience this technique may become useful for studying a wide variety of cardiovascular disorders.     

Dobutamine stress echocardiography assessment of myocardial contusion due to blunt impact in dogs

We sought to investigate the role of two-dimensional stress echocardiography in the early assessment of myocardial contusion. For this purpose, 12 dogs, weighing 11.36 ± 1.50 kg, were selected and the myocardial contusion was experimentally induced. Two-dimensional dobutamine stress echocardiography (DSE) was used to detect abnormal myocardial motions segments at time phases of baseline and 0.5, 2, 4, and 8 h post-wounding. Finally, the above results were compared with pathological findings. The data show that after the dogs were induced to have severe myocardial contusion, 122 segments were found with abnormal myocardial wall motions at 0.5 h post-wounding, 133 segments at 2 h post-wounding, and 142 segments, each, at 4 h and 8 h post-wounding. The wall motion score (WMS) and wall motion score index (WMSI) increased (P < 0.001) as compared with the pre-impaction values. Considering the left ventricular axis view as the standard section, in the 60 segments examined by echocardiography, 54 segments were found to have wall motion abnormalities. Comparing with the results of pathological TTC staining, the sensitivity and specificity were found to be 100 and 66.6%, respectively. It was, therefore, concluded that two-dimensional DSE was a valuable technique in the early diagnosis of myocardial contusion due to its better sensitivity and specificity.     

Molecular aspects of magnetic resonance imaging and spectroscopy

Magnetic resonance imaging (MRI) is a well known diagnostic tool in radiology that produces unsurpassed images of the human body, in particular of soft tissue. However, the medical community is often not aware that MRI is an important yet limited segment of magnetic resonance (MR) or nuclear magnetic resonance (NMR) as this method is called in basic science. The tremendous morphological information of MR images sometimes conceal the fact that MR signals in general contain much more information, especially on processes on the molecular level. NMR is successfully used in physics, chemistry, and biology to explore and characterize chemical reactions, molecular conformations, biochemical pathways, solid state material, and many other applications that elucidate invisible characteristics of matter and tissue. In medical applications, knowledge of the molecular background of MRI and in particular MR spectroscopy (MRS) is an inevitable basis to understand molecular phenomenon leading to macroscopic effects visible in diagnostic images or spectra. This review shall provide the necessary background to comprehend molecular aspects of magnetic resonance applications in medicine. An introduction into the physical basics aims at an understanding of some of the molecular mechanisms without extended mathematical treatment. The MR typical terminology is explained such that reading of original MR publications could be facilitated for non-MR experts. Applications in MRI and MRS are intended to illustrate the consequences of molecular effects on images and spectra.