Follow-Up of Coiled Cerebral Aneurysms at 3T: Comparison of 3D Time-of-Flight MR Angiography and Contrast-Enhanced MR Angiography

BACKGROUND AND PURPOSE: Our aim was to compare contrast-enhanced MR angiography (CE-MRA) and 3D time-of-flight (TOF) MRA at 3T for follow-up of coiled cerebral aneurysms. MATERIALS AND METHODS: Fifty-two patients treated with Guglielmi detachable coils for 54 cerebral aneurysms were evaluated at 3T MRA. 3D TOF MRA (TR/TE = 23/3.5; SENSE factor = 2.5) and CE-MRA by using a 3D ultrafast gradient-echo sequence (TR/TE = 5.9/1.8; SENSE factor = 3) enhanced with 0.1-mmol/kg gadobenate dimeglumine were performed in the same session. Source images, 3D maximum intensity projection, 3D shaded surface display, and/or 3D volume-rendered reconstructions were evaluated in terms of aneurysm occlusion/patency and artifact presence. RESULTS: In terms of clinical classification, the 2 MRA sequences were equivalent for 53 of the 54 treated aneurysms: 21 were considered fully occluded, whereas 16 were considered to have a residual neck and 16 were considered residually patent at follow-up MRA. The remaining aneurysm appeared fully occluded at TOF MRA but had a residual patent neck at CE-MRA. Visualization of residual aneurysm patency was significantly ( P = .001) better with CE-MRA compared with TOF MRA for 10 (31.3%) of the 32 treated aneurysms considered residually patent with both sequences. Coil artifacts were present in 5 cases at TOF MRA but in none at CE-MRA. No relationship was apparent between the visualization of patency and either the size of the aneurysm or the interval between embolization and follow-up. CONCLUSION: At follow-up MRA at 3T, unenhanced TOF and CE-MRA sequences are similarly effective at classifying coiled aneurysms as occluded or residually patent. However, CE-MRA is superior to TOF MRA for visualization of residual patency and is associated with fewer artifacts

Evaluation of a novel time-efficient protocol for gadobenate dimeglumine (Gd-BOPTA)-enhanced liver magnetic resonance imaging

OBJECTIVE: We sought to evaluate gadobenate dimeglumine for the detection and characterization of focal liver lesions in the unenhanced and already pre-enhanced liver. MATERIALS AND METHODS: Sixty patients were evaluated prospectively. Unenhanced T1-weighted gradient echo (T1wGRE) and T2-weighted turbo spin echo (T2wTSE) images were acquired followed by contrast-enhanced T1wGRE images during the dynamic, equilibrium, and delayed phases after the bolus injection of 0.05 mmol/kg gadobenate dimeglumine. An identical series of dynamic images was then acquired after the delayed scan following a second 0.05 mmol/kg bolus of gadobenate dimeglumine. Images were evaluated randomly in 2 sessions by 3 independent blinded readers. Evaluated images in the first session comprised the unenhanced images, the first or second set of dynamic images, and the delayed images. The second session included the unenhanced images, the dynamic images not yet evaluated in the first session, and the delayed images. The 2 reading sessions were compared for lesion characterization and diagnosis, and kappa (kappa) values for interobserver agreement were determined. Quantitative evaluation of lesion contrast enhancement was also performed. RESULTS: The enhancement behavior in the second dynamic series was similar to that in the first series, although pre-enhancement of the normal liver resulted in reduced lesion-liver contrast-to-noise ratios and the visualization of some lesions only on arterial phase images. Typical imaging features for the lesions included in the study were visualized clearly in both series. Strong agreement (kappa=0.56-0.89; all evaluations) between the 2 images sets was noted by all readers for differentiation of benign from malignant lesions and for definition of specific diagnosis, and between readers for diagnoses established based on images acquired in the unenhanced and pre-enhanced liver. CONCLUSION: Dynamic imaging in the hepatobiliary phase gives similar information as dynamic imaging of the unenhanced liver. This might prove advantageous for screening protocols involving same session imaging of primary extrahepatic tumors and liver

Detection of malignant primary hepatic neoplasms with gadobenate dimeglumine (Gd-BOPTA) enhanced T1-weighted hepatocyte phase MR imaging: results of off-site blinded review in a phase-II multicenter trial

OBJECTIVE: To investigate the efficacy of gadobenate dimeglumine (Gd-BOPTA) enhanced MR imaging for the detection of liver lesions in patients with primary malignant hepatic neoplasms. MATERIALS AND METHODS: Thirty-one patients with histologically proven primary malignancy of the liver were evaluated before and after administration of Gd-BOPTA at dose 0.05 or 0.10 mmol/kg. T1-weighted spin echo (T1W-SE) and gradient echo (T1W-GRE) images were evaluated for lesion number, location, size and confidence by three off-site independent reviewers and the findings were compared to reference standard imaging (intraoperative ultrasound, computed tomography during arterial portography or lipiodol computed tomography). Results were analyzed for significance using a two-sided McNemar's test. RESULTS: More lesions were identified on Gd-BOPTA enhanced images than on unenhanced images and there was no significant difference in lesion detection between either concentration. The largest benefit was in detection of lesions under 1 cm in size (7 to 21, 9 to 15, 16 to 18 for reviewers A, B, C respectively). In 68% of the patients with more than one lesion, Gd-BOPTA increased the number of lesions detected. CONCLUSION: Liver MR imaging after Gd-BOPTA increases the detection of liver lesions in patients with primary malignant hepatic neoplasm

Multicenter, double-blind, randomized, intraindividual crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine for MR angiography of peripheral arteries

Purpose: To prospectively compare the image quality and diagnostic performance achieved with doses of gadobenate dimeglumine and gadopentetate dimeglumine of 0.1 mmol per kilogram of body weight in patients undergoing contrast material-enhanced magnetic resonance (MR) angiography of the pelvis, thigh, and lower-leg (excluding foot) for suspected or known peripheral arterial occlusive disease. Materials and Methods: Institutional review board approval was granted from each center and informed written consent was obtained from all patients. Between November 2006 and January 2008, 96 patients (62 men, 34 women;mean age, 63.7 years \ub1 10.4 [standard deviation];range, 39-86 years) underwent two identical examinations at 1.5 T by using three-dimensional spoiled gradient-echo sequences and randomized 0.1-mmol/kg doses of each agent. Images were evaluated on-site for technical adequacy and quality of vessel visualization and offsite by three independent blinded readers for anatomic delineation and detection/exclusion of pathologic features. Comparative diagnostic performance was determined in 31 patients who underwent digital subtraction angiography. Data were analyzed by using the Wilcoxon signed-rank, McNemar, and Wald tests. Interreader agreement was determined by using generalized \u3ba statistics. Differences in quantitative contrast enhancement were assessed and a safety evaluation was performed. Results: Ninety-two patients received both agents. Significantly better performance ( P > .0001; all evaluations) with gadobenate dimeglumine was noted on-site for technical adequacy and vessel visualization quality and offsite for anatomic delineation and detection/exclusion of pathologic features. Contrast enhancement(P 64 .0001) and detection of clinically relevant disease(P 64 .0028) were significantly improved with gadobenate dimeglumine. Interreader agreement for stenosis detection and grading was good to excellent (\u3ba = 0.749 and 0.805, respectively). Mild adverse events were reported for four (six events) and five (eight events) patients after gadobenate dimeglumine and gadopentetate dimeglumine, respectively. Conclusion: Higher-quality vessel visualization, greater contrast enhancement, fewer technical failures, and improved diagnostic performance are obtained with gadobenate dimeglumine, relative to gadopentetate dimeglumine, when compared intraindividually at 0.1-mmol/kg doses in patients undergoing contrast-enhanced MR angiography for suspected peripheral arterial occlusive disease

Renal artery stenosis evaluation: diagnostic performance of gadobenate dimeglumine-enhanced MR angiography--comparison with DSA

PURPOSE: To prospectively determine diagnostic performance and safety of contrast material-enhanced (CE) magnetic resonance (MR) angiography with 0.1 mmol per kilogram of body weight gadobenate dimeglumine for depiction of significant steno-occlusive disease (> or =51% stenosis) of renal arteries, with digital subtraction angiography (DSA) as reference standard. MATERIALS AND METHODS: This multicenter study was approved by local institutional review boards; all patients provided written informed consent. Patient enrollment and examination at centers in the United States complied with HIPAA. Two hundred ninety-three patients (154 men, 139 women; mean age, 61.0 years) with severe hypertension (82.2%), progressive renal failure (11.3%), and suspected renal artery stenosis (6.5%) underwent CE MR angiography with three-dimensional spoiled gradient-echo sequences after administration of 0.1 mmol/kg gadobenate dimeglumine at 2 mL/sec. Anteroposterior and oblique DSA was performed in 268 (91.5%) patients. Three independent blinded reviewers evaluated CE MR angiographic images. Sensitivity, specificity, and accuracy of CE MR angiography for detection of significant steno-occlusive disease (> or =51% vessel lumen narrowing) were determined at segment (main renal artery) and patient levels. Positive and negative predictive values and positive and negative likelihood ratios were determined. Interobserver agreement was analyzed with generalized kappa statistics. A safety evaluation (clinical examination, electrocardiogram, blood and urine analysis, monitoring for adverse events) was performed. RESULTS: Of 268 patients, 178 who were evaluated with MR angiography and DSA had significant steno-occlusive disease of renal arteries at DSA. Sensitivity, specificity, and accuracy of CE MR angiography for detection of 51% or greater stenosis or occlusion were 60.1%-84.1%, 89.4%-94.7%, and 80.4%-86.9%, respectively, at segment level. Similar values were obtained for predictive values and for patient-level analyses. Few CE MR angiographic examinations (1.9%-2.8%) were technically inadequate. Interobserver agreement for detection of significant steno-occlusive disease was good (79.9% agreement; kappa = 0.69). No safety concerns were noted. CONCLUSION: CE MR angiography performed with 0.1 mmol/kg gadobenate dimeglumine, compared with DSA, is safe and provides good sensitivity, specificity, and accuracy for detection of significant renal artery steno-occlusive disease

In vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction 192Ir high-dose-rate brachytherapy

<p>Abstract</p> <p>Background</p> <p>To assess brachytherapy catheter positioning accuracy and to evaluate the effects of prolonged irradiation time on the tolerance dose of normal liver parenchyma following single-fraction irradiation with ¹⁹²Ir.</p> <p>Materials and methods</p> <p>Fifty patients with 76 malignant liver tumors treated by computed tomography (CT)-guided high-dose-rate brachytherapy (HDR-BT) were included in the study. The prescribed radiation dose was delivered by 1 - 11 catheters with exposure times in the range of 844 - 4432 seconds. Magnetic resonance imaging (MRI) datasets for assessing irradiation effects on normal liver tissue, edema, and hepatocyte dysfunction, obtained 6 and 12 weeks after HDR-BT, were merged with 3D dosimetry data. The isodose of the treatment plan covering the same volume as the irradiation effect was taken as a surrogate for the liver tissue tolerance dose. Catheter positioning accuracy was assessed by calculating the shift between the 3D center coordinates of the irradiation effect volume and the tolerance dose volume for 38 irradiation effects in 30 patients induced by catheters implanted in nearly parallel arrangement. Effects of prolonged irradiation were assessed in areas where the irradiation effect volume and tolerance dose volume did not overlap (mismatch areas) by using a catheter contribution index. This index was calculated for 48 irradiation effects induced by at least two catheters in 44 patients.</p> <p>Results</p> <p>Positioning accuracy of the brachytherapy catheters was 5-6 mm. The orthogonal and axial shifts between the center coordinates of the irradiation effect volume and the tolerance dose volume in relation to the direction vector of catheter implantation were highly correlated and in first approximation identically in the T1-w and T2-w MRI sequences (<it>p </it>= 0.003 and <it>p </it>< 0.001, respectively), as were the shifts between 6 and 12 weeks examinations (<it>p </it>= 0.001 and <it>p </it>= 0.004, respectively). There was a significant shift of the irradiation effect towards the catheter entry site compared with the planned dose distribution (<it>p </it>< 0.005). Prolonged treatment time increases the normal tissue tolerance dose. Here, the catheter contribution indices indicated a lower tolerance dose of the liver parenchyma in areas with prolonged irradiation (<it>p </it>< 0.005).</p> <p>Conclusions</p> <p>Positioning accuracy of brachytherapy catheters is sufficient for clinical practice. Reduced tolerance dose in areas exposed to prolonged irradiation is contradictory to results published in the current literature. Effects of prolonged dose administration on the liver tolerance dose for treatment times of up to 60 minutes per HDR-BT session are not pronounced compared to effects of positioning accuracy of the brachytherapy catheters and are therefore of minor importance in treatment planning.</p

Cytochrome P-450 of the common mussel Mytilus edulus L.: partial purification and characterization.

Studies were carried out on microsomes of the digestive gland of the common mussel, Mytilus edulis L. Cytochrome P-450 specific content, and the specific contents or activities of other mixed-function oxidase (MFO) components, and the oxidative activities benzo[a]pyrene hydroxylase (BPH) and NADPH-independent 7-ethoxycoumarin O-deethylase (ECOD), all varied seasonally. To varying extents, correlations were seen between changes in these parameters, and changes in the mussel reproductive cycle and/or the seasonal variation in water temperature. The existence of P-450 isoenzymes was indicated by asynchrony in the seasonal changes in BPH and NADPH-independent ECOD activities relative to the changes in P-450 specific content, and by seasonal changes in cytochrome P-450 A max and the microsomal protein profile on SDS PAGE. Indications of P-450 isoenzymes were also obtained from purification studies, and from kinetic studies of NADPH-independent ECOD activity (multiphasic kinetics seen with 7-ethoxycoumarin concentration). The purification scheme essentially comprised sodium cholate solubilization, (NH4)2SO4-protein fractionation and affinity and ion-exchange column chromatographic steps. Two cytochrome P-450 peaks were obtained on DEAE-sephacel ion-exchange chromatography (KC1 elution), the overall purification for the major peak being x 20, with a yield of 5%. The final detergent-free P-450 preparation was largely in the low-spin state, and had a monomeric molecular weight of 53.0 Kd. Ligand-binding experiments were performed on partially-purified cytochrome P-450 preparations. Type II spectra were obtained with N-substituted imidazole compounds, metyrapone and pyridine, but with compounds giving type I spectra with mammalian cytochromes P-450 (testosterone, 7-ethoxycoumarin, a-naphthoflavone and SKF 525-A), reverse type I spectra were seen. In vitro MFO metabolic activity toward possible xenobiotic and endogenous substrates, was limited, and surprisingly, largely NADPH-independent. NADPH-independent ECOD activity was susceptable to modulators of mammalian MFO activity, and indicated to be cytochrome P-450-mediated. Mussel microsomal fraction and microsomal-extract were shown to inhibit rat MFO activities and hexobarbital binding to rat cytochrome P-450. These and other results are discussed in terms of a possible "endogenous blocking" of the substrate-binding site of the mussel P-450, and in terms of possible mechanisms of cytochrome P-450 catalytic action in addition to monooxygenation, such as peroxidation. Mussel cytochrome P-450 specific content was relatively unaffected by a variety of mammalian model P-450 inducers, with the exception of a small elevation with exposure to 3-methylcholanthrene (3MC). In contrast, NADPH-cytochrome c (P-450) reductase activity was slightly more responsive. An increase in NADPH-independent ECOD activity with 3MC-exposure was seen at one time of the year, but not at other times

Gadobenate dimeglumine-enhanced MR imaging breast vascular maps: association between invasive cancer and ipsilateral increased vascularity

Purpose: To retrospectively compare three doses of Gd-BOPTA with a standard dose of Gd-DTPA for MR evaluation of breast vessels and to evaluate the accuracy of one-side increased vascularity as an indicator of ipsilateral breast cancer on Gd-BOPTA-enhanced MR images. Methods and Materials: Ninety-five patients with known or suspected breast cancer were randomized to four groups to receive Gd-BOPTA at doses of .05 (n=24), .1 (n=24), or .2 (n=24) mmol/kg or Gd-DTPA at a dose of .1 mmol/kg (n=23). T1-weighted gradient echo images were acquired before and at 2 minutes after intravenous contrast injection. Subtracted images were used to obtain maximum intensity projections (MIPs). A score between 0 (poor) and 3 (extensive) was assigned to the bilateral MIPs of all groups based on vessel number, length and conspicuity. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of one-side increased vascularity in association with ipsilateral malignancy was determined for 69 histologically-confirmed lesions (reference standard) after Gd-BOPTA. Results: Significantly higher mean scores were assigned to the combined Gd-BOPTA groups than to the Gd-DTPA group (P < .044). In patients studied with Gd-BOPTA, histology revealed malignant lesions in 52 patients (invasive ductal, n=45; invasive lobular, n=4; invasive ductal/lobular, n=3) and benign lesions in 17 patients. Two cases of bilateral invasive cancer with symmetric breast vascular maps were excluded to give overall values for sensitivity, specificity, accuracy, PPV and NPV of 88% (44/50), 82% (14/17), 87% (58/67), 94% (44/47) and 70% (14/20), respectively, for one-side increased vascularity as a finding associated with ipsilateral malignancy. Conclusion: Gd-BOPTA is effective for MR evaluation of breast vessels at doses as low as .05 mmol/kg. One-side increased vascularity is an MR finding frequently associated with ipsilateral invasive breast cancer

Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine-enhanced MR imaging: prospective study

PURPOSE: To prospectively determine the accuracy of differentiating benign focal nodular hyperplasia (FNH) from hepatic adenoma (HA) and liver adenomatosis (LA) by using gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging. MATERIALS AND METHODS: The ethics committee at each center approved the study, and all patients provided informed consent. Seventy-three patients with confirmed FNH and 35 patients with confirmed HA (n = 27) or LA (n = 8) underwent MR imaging before (T2-weighted half-Fourier rapid acquisition with relaxation enhancement or T2-weighted fast spin-echo and T1-weighted gradient-echo [GRE] sequences) and at 25-30 seconds (arterial phase), 70-90 seconds (portal venous phase), 3-5 minutes (equilibrium phase), and 1-3 hours (delayed phase) after (T1-weighted GRE sequences only, with or without fat suppression) bolus administration of 0.1 mmol per kilogram of body weight gadobenate dimeglumine. The enhancement of 235 lesions (128 FNH, 32 HA, and 75 LA lesions) relative to the normal liver parenchyma was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for the differentiation of FNH from HA and LA were determined. RESULTS: Hyper- and isointensity on T2-weighted and iso- and hypointensity on T1-weighted GRE images were noted for 177 (88.9%) of 199 lesions visible on unenhanced images. On dynamic phase images after contrast material administration, 231 (98.3%) of 235 lesions showed rapid strong enhancement during the arterial phase and appeared hyper- to isointense during portal venous and equilibrium phases. Accurate differentiation of FNH from HA and LA was not possible on the basis of precontrast or dynamic phase images alone. At 1-3 hours after contrast material enhancement, 124 (96.9%) of 128 FNHs appeared hyper- or isointense, while 107 (100%) HA and LA lesions appeared hypointense. The sensitivity, specificity, PPV, NPV, and overall accuracy for the differentiation of FNH from HA and LA were 96.9%, 100%, 100%, 96.4%, and 98.3%, respectively. CONCLUSION: Accurate differentiation of FNH from HA and LA is achievable on delayed T1-weighted GRE images after administration of gadobenat