Sympathetic activation by lower body negative pressure decreases kidney perfusion without inducing hypoxia in healthy humans

Purpose There is ample evidence that systemic sympathetic neural activity contributes to the progression of chronic kidney disease, possibly by limiting renal blood flow and thereby inducing renal hypoxia. Up to now there have been no direct observations of this mechanism in humans. We studied the effects of systemic sympathetic activation elicited by a lower body negative pressure (LBNP) on renal blood flow (RBF) and renal oxygenation in healthy humans. Methods Eight healthy volunteers (age 19-31 years) were subjected to progressive LBNP at - 15 and - 30 mmHg, 15 min per level. Brachial artery blood pressure was monitored intermittently. RBF was measured by phase-contrast MRI in the proximal renal artery. Renal vascular resistance was calculated as the MAP divided by the RBF. Renal oxygenation (R2*) was measured for the cortex and medulla by blood oxygen level dependent (BOLD) MRI, using a monoexponential fit. Results With a LBNP of - 30 mmHg, pulse pressure decreased from 50 +/- 10 to 43 +/- 7 mmHg; MAP did not change. RBF decreased from 1152 +/- 80 to 1038 +/- 83 mL/min to 950 +/- 67 mL/min at - 30 mmHg LBNP (p = 0.013). Heart rate and renal vascular resistance increased by 38 +/- 15% and 23 +/- 8% (p = 0.04) at - 30 mmHg LBNP, respectively. There was no change in cortical or medullary R2* (20.3 +/- 1.2 s(-1) vs 19.8 +/- 0.43 s(-1); 28.6 +/- 1.1 s(-1) vs 28.0 +/- 1.3 s(-1)). Conclusion The results suggest that an increase in sympathetic vasoconstrictor drive decreases kidney perfusion without a parallel reduction in oxygenation in healthy humans. This in turn indicates that sympathetic activation suppresses renal oxygen demand and supply equally, thus allowing adequate tissue oxygenation to be maintained.Cardiovascular Aspects of Radiolog

MRI of pancreatic cancer for radiotherapy

Tijdens radiotherapie worden tumoren bestraald met ioniserende straling. Deze straling is schadelijk voor tumorcellen, maar ook voor gezonde cellen. Daarom is het doel van radiotherapie om een zo hoog mogelijke stralingsdosis te geven aan de tumor, met een beperkte stralingsdosis in gezond weefsel. In dit proefschrift is onderzocht hoe MRI kan worden ingezet bij alvleesklierkankerpatiënten om onnodige bestraling van gezond weefsel te voorkomen en zo radiotherapie te bevorderen. In het eerste deel van het proefschrift wordt besproken hoe MRI kan helpen tijdens het definiëren van de te bestralen doelgebieden. In het tweede deel wordt diffusie gewogen MRI geoptimaliseerd. Deze beeldvormende techniek maakt het meten van bepaalde weefseleigenschappen mogelijk zoals de mate van diffusie en perfusie. Dit kan helpen om de reactie van de tumor op radiotherapie te bestuderen en daarmee de effectiviteit van radiotherapie te bepalen. Potentieel kan de effectiviteit van radiotherapie zelfs voor de behandeling al worden voorspeld aan de hand van de weefseleigenschappen. In beide gevallen kan onnodige bestraling worden voorkomen

Image Distortions on a Plastic Interstitial Computed Tomography/Magnetic Resonance Brachytherapy Applicator at 3 Tesla Magnetic Resonance Imaging and Their Dosimetric Impact

Purpose: To quantify magnetic resonance imaging (MRI)distortions on a plastic intracavitary/interstitial applicator with plastic needles at a field strength of 3 T and to determine the dosimetric impact, using patient data.Methods and Materials: For 11 cervical cancer patients, our clinical MRI protocol was extended with 3 scans. From the first scan, a multi-echo acquisition, a map of the magnetic field (B-0) was calculated and used to quantify the field inhomogeneity. The expected displacements of the applicator were quantified for the clinical sequence using the measured field inhomogeneity and the clinical sequence's bandwidth. The second and third scan were our routine clinical sequence (duration: <5 minutes each), acquired consecutively using opposing readout directions. The displacement of the applicator between these scans is approximately twice the displacement due to B0 inhomogeneity. The impact of the displacement on the dose was determined by reconstructing the applicator on both scans. The applicator was then shifted and rotated the same distance as the observed displacement to create a worst-case scenario (ie, twice the actual displacement due to B0 inhomogeneity). Next, the dose to 98%/90% (D98/D90) of the clinical target volume at high risk, as well as the dose to the most irradiated 2 cm 3 for bladder and rectum, were calculated for the original plan as well as the shifted plan.Results: For a volume of interest containing the intrauterine device and the ovoids the 95th percentile of the absolute displacement ranged between 0.2 and 0.75 mm, over all patients. For all patients, the difference in D98/D90 in the opposing readout scans with the original plan was at most 4.7%/ 4.3%. For the dose to the most irradiated 2 cm 3 of bladder/rectum, the difference was at most 6.0%/ 6.3%.Conclusions: The dosimetric impact of distortions on this plastic applicator with plastic needles is limited. Applicator reconstruction for brachytherapy planning purposes is feasible at 3 T MRI. (C) 2017 Elsevier Inc. All rights reserved.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Addition of MRI for CT-based pancreatic tumor delineation: a feasibility study

Contains fulltext : 175066.pdf (publisher's version ) (Open Access)PURPOSE: To assess the effect of additional magnetic resonance imaging (MRI) alongside the planning computed tomography (CT) scan on target volume delineation in pancreatic cancer patients. MATERIAL AND METHODS: Eight observers (radiation oncologists) from six institutions delineated the gross tumor volume (GTV) on 3DCT, and internal GTV (iGTV) on 4DCT of four pancreatic cancer patients, while MRI was available in a second window (CT + MRI). Variations in volume, generalized conformity index (CIgen), and overall observer variation, expressed as standard deviation (SD) of the distances between delineated surfaces, were analyzed. CIgen is a measure of overlap of the delineated iGTVs (1 = full overlap, 0 = no overlap). Results were compared with those from an earlier study that assessed the interobserver variation by the same observers on the same patients on CT without MRI (CT-only). RESULTS: The maximum ratios between delineated volumes within a patient were 6.1 and 22.4 for the GTV (3DCT) and iGTV (4DCT), respectively. The average (root-mean-square) overall observer variations were SD = 0.41 cm (GTV) and SD = 0.73 cm (iGTV). The mean CIgen was 0.36 for GTV and 0.37 for iGTV. When compared to the iGTV delineated on CT-only, the mean volumes of the iGTV on CT + MRI were significantly smaller (32%, Wilcoxon signed-rank, p < .0005). The median volumes of the iGTV on CT + MRI were included for 97% and 92% in the median volumes of the iGTV on CT. Furthermore, CT + MRI showed smaller overall observer variations (root-mean-square SD = 0.59 cm) in six out of eight delineated structures compared to CT-only (root-mean-square SD = 0.72 cm). However, large local observer variations remained close to biliary stents and pathological lymph nodes, indicating issues with instructions and instruction compliance. CONCLUSIONS: The availability of MRI images during target delineation of pancreatic cancer on 3DCT and 4DCT resulted in smaller target volumes and reduced the interobserver variation in six out of eight delineated structures

Feasibility and accuracy of quantitative imaging on a 1.5 T MR-linear accelerator

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

The ISMRM Open Science Initiative for Perfusion Imaging (OSIPI): Results from the OSIPI–Dynamic Contrast-Enhanced challenge

Purpose: K trans has often been proposed as a quantitative imaging biomarker for diagnosis,prognosis,andtreatmentresponseassessmentforvarioustumors.Noneofthe many software tools for K trans quantification are standardized. The ISMRM OpenScience Initiative for Perfusion Imaging–Dynamic Contrast-Enhanced (OSIPI-DCE)challenge was designed to benchmark methods to better help the efforts to standardize K trans measurement. Methods: A framework was created to evaluate K trans values produced by DCE-MRI analysis pipelines to enable benchmarking. The perfusion MRI community was invited to apply their pipelines for K trans quantification in glioblastoma from clinical and synthetic patients. Submissions were required to include the entrants’ K trans values, the applied software, and a standard operating procedure. These were evaluated using the proposed OSIPIgold score defined with accuracy, repeatability, and reproducibility components. Results: Across the 10 received submissions, the OSIPIgold score ranged from28% to 78% with a 59% median. The accuracy, repeatability, and reproducibility scores ranged from 0.54 to 0.92, 0.64 to 0.86, and 0.65 to 1.00, respectively(0–1=lowest–highest). Manual arterial input function selection markedly affected the reproducibility and showed greater variability in K trans analysis than automated methods. Furthermore, provision of a detailed standard operating procedure was critical for higher reproducibility. Conclusions: This study reports results from the OSIPI-DCE challenge and high-lights the high inter-software variability within K trans estimation, providing a framework for ongoing benchmarking against the scores presented. Through this challenge, the participating teams were ranked based on the performance of their software tools in the particular setting of this challenge. In a real-world clinical setting, many of these tools may perform differently with different benchmarking methodology