Biomedical subjects

Bernd Kuehn

Publications and source records attributed to Bernd Kuehn.

4 recordsLinked to original sources

PubMed2005

Pulmonary arterial hypertension: diagnosis with fast perfusion MR imaging and high-spatial-resolution MR angiography--preliminary experience.

PURPOSE: To determine prospectively the accuracy of a magnetic resonance (MR) perfusion imaging and MR angiography protocol for differentiation of chronic thromboembolic pulmonary arterial hypertension (CTEPH) and primary pulmonary hypertension (PPH) by using parallel acquisition techniques. MATERIALS AND METHODS: The study was approved by the institution's internal review board, and all patients gave written consent prior to participation. A total of 29 patients (16 women; mean age, 54 years +/- 17 [+/- standard deviation]; 13 men; mean age, 57 years +/- 15) with known pulmonary hypertension were examined with a 1.5-T MR imager. MR perfusion imaging (temporal resolution, 1.1 seconds per phase) and MR angiography (matrix, 512; voxel size, 1.0 x 0.7 x 1.6 mm) were performed with parallel acquisition techniques. Dynamic perfusion images and reformatted three-dimensional MR angiograms were analyzed for occlusive and nonocclusive changes of the pulmonary arteries, including perfusion defects, caliber irregularities, and intravascular thrombi. MR perfusion imaging results were compared with those of radionuclide perfusion scintigraphy, and MR angiography results were compared with those of digital subtraction angiography (DSA) and/or contrast material-enhanced multi-detector row computed tomography (CT). Sensitivity, specificity, and diagnostic accuracy of MR perfusion imaging and MR angiography were calculated. Receiver operator characteristic analyses were performed to compare the diagnostic value of MR angiography, MR perfusion imaging, and both modalities combined. For MR angiography and MR perfusion imaging, kappa values were used to assess interobserver agreement. RESULTS: A correct diagnosis was made in 26 (90%) of 29 patients by using this comprehensive MR imaging protocol. Results of MR perfusion imaging demonstrated 79% agreement (ie, identical diagnosis on a per-patient basis) with those of perfusion scintigraphy, and results of MR angiography demonstrated 86% agreement with those of DSA and/or CT angiography. Interobserver agreement was good for both MR perfusion imaging and MR angiography (kappa = 0.63 and 0.70, respectively). CONCLUSION: The combination of fast MR perfusion imaging and high-spatial-resolution MR angiography with parallel acquisition techniques enables the differentiation of PPH from CTEPH with high accuracy.

Diagnosis, Differential↗

PubMed2005

Imaging of patellar cartilage with a 2D multiple-echo data image combination sequence.

OBJECTIVE: We sought to evaluate the diagnostic value of a 2D multiple-echo data image combination (MEDIC) MRI sequence in the detection of patellar cartilage defects. MATERIALS AND METHODS: Our study included 52 consecutive patients who had knee surgery within 4 months of undergoing an MRI examination including an axial 2D MEDIC (TR/TE, 884/26; flip angle, 30 degrees ) sequence. Cartilage was surgically graded on a 5-point scale: 0, normal; 1, softening or swelling; 2, partial thickness defect; 3, fissuring to the level of the subchondral bone; or 4, exposed subchondral bone. Cartilage was graded on MRI according to a scale that was almost identical to the surgical scale except that grade 1 lesions were defined as signal alteration or swelling of cartilage. Two blinded reviewers independently analyzed patellar cartilage. Sensitivity, specificity, accuracy, and weighted kappa values for interobserver variability were calculated. RESULTS: Low-grade cartilage lesions predominated in our study group. When grade 2 or higher was considered the threshold for relevance, the sensitivity, specificity, and accuracy for the MEDIC sequence was as high as 79%, 82%, and 81%, respectively. Increasing the threshold of relevance to grade 3 increased the sensitivity, specificity, and accuracy to as high as 83%, 91%, and 90%, respectively. Interobserver agreement for the MEDIC sequence was good (weighted kappa = 0.68). CONCLUSION: The 2D MEDIC sequence performs comparably to previously described sequences optimized for cartilage imaging such as the 3D double-echo steady-state or 3D spoiled gradient-recalled sequences with good interobserver agreement, high sensitivity, and excellent specificity for revealing low- to intermediate-degree cartilage defects.

Adult↗

PubMed2004

Quantification of pulmonary blood flow and volume in healthy volunteers by dynamic contrast-enhanced magnetic resonance imaging using a parallel imaging technique.

RATIONALE AND OBJECTIVES: We sought to optimize the dosage of a paramagnetic contrast medium (CM) for the quantification of pulmonary blood flow and volume by contrast-enhanced dynamic magnetic resonance imaging (MRI) using a parallel imaging technique and to prove the feasibility of the approach in healthy volunteers. METHODS: In a phantom study, the dependency of signal increase on different concentrations of the CM gadodiamide was evaluated by means of an ultra-fast MRI sequence with a generalized autocalibrating partially parallel acquisition technique (acceleration factor = 2). Using the same sequence, measurements were performed in a healthy volunteer after administration of different CM dosages for contrast dosage optimization in vivo. Finally, perfusion measurements were performed in 16 healthy volunteers after the administration of the optimal CM dose. Signal-time curves were evaluated from the pulmonary artery and from predefined regions of the lung. Pulmonary regional blood volume (RBV) and flow (RBF) were estimated using an open 1-compartment model. RESULTS: Phantom studies yielded a linear signal increase up to a concentration of 5.0 mmol/L gadodiamide. Results of contrast dosage optimization in vivo showed that the maximum CM dose providing a linear relationship between signal increase and CM concentration in the pulmonary artery of a healthy volunteer was approximately 0.05 mmol/kg-bw. Quantification of pulmonary blood volume and flow was reproducible in healthy volunteers, yielding mean values for the upper lung zones of 7.1 +/- 2.3 mL/100 mL for RBV and 197 +/- 97 mL/min/100 mL for RBF and for lower lung zones, 12.5 +/- 3.9 mL/100 mL for RBV and 382 +/- 111 mL/min/100 mL for RBF. CONCLUSIONS: If an adequate amount of gadodiamide and fast MR sequences are used, quantification of pulmonary blood flow and volume is feasible.

Adult↗

PubMed2004

MR arthrography of the hip: diagnostic performance of a dedicated water-excitation 3D double-echo steady-state sequence to detect cartilage lesions.

OBJECTIVE: The objective of our study was to compare the diagnostic performance of a dedicated cartilage MR sequence (water-excitation 3D double-echo steady-state) with a standard MR sequence (T1-weighted spin-echo) in detecting articular cartilage lesions of the hip after intraarticular injection of gadopentetate dimeglumine. MATERIALS AND METHODS: In 50 MR arthrograms of the hip joint obtained in 47 consecutive patients, a sagittal 3D double-echo steady-state sequence (TR/TE, 24/6.5; flip angle, 25 degrees ) was compared with a sagittal T1-weighted spin-echo sequence (350/14). Two musculoskeletal radiologists independently evaluated articular cartilage. Sensitivity and specificity for detecting cartilage defects were calculated for those hips that underwent open surgery (n = 21). Lesion conspicuity was retrospectively reviewed and graded between 1 (not visible) and 5 (well defined). RESULTS: At surgery, a total of 26 lesions of the acetabular (n = 20) and femoral (n = 6) cartilage were found. For the 3D double-echo steady-state and T1-weighted spin-echo sequences, sensitivities and specificities for cartilage lesion detection were 58% and 88% and 81% and 81% for reviewer 1 and 62% and 94% and 62% and 100% for reviewer 2, respectively. Lesion conspicuity was significantly superior (p = 0.036) for the 3D double-echo steady-state sequence (mean grade, 3.4) compared with the T1-weighted spin-echo sequence (mean grade, 3.0). The kappa value was fair for the 3D double-echo steady-state sequence (kappa = 0.40) and moderate for the T1-weighted spin-echo sequence (kappa = 0.55). CONCLUSION: The 3D double-echo steady-state sequence optimized for cartilage imaging improves lesion conspicuity but does not improve diagnostic performance.

Adult↗