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Biomedical subjects

Daniel T Boll

Publications and source records attributed to Daniel T Boll.

At least 19 recordsLinked to original sources

Synergy of MDCT and cine MRI for the evaluation of cardiac motility.

OBJECTIVE: The objective of our study was to validate the feasibility of the synergistic use of cardiac MR and CT data sets for ventricular motility analysis and to correlate measurement variability with underlying heart rate. SUBJECTS AND METHODS: Twenty patients underwent concurrent ECG-gated MDCT and MRI for evaluation of ventricular motility, expressed as ventricular wall thickening and motion. Initially, individual measurement repetition series were analyzed by determining intraobserver variability and detecting intraobserver bias related to heart rates. Subsequently, absolute measurement differences of CT or MR data were statistically evaluated. Finally, absolute measurement differences were correlated with underlying heart rates by curve estimation regression. RESULTS: Analysis of measurement reproducibility proved that data variability was dependent on only the anatomic localization of the analyzed ventricular segment, not on the imaging technique used or underlying heart rate, in normofrequent patients. Comparing MR and CT image data sets, no statistically significant differences were identified when ventricular motility was evaluated based on data sets of either imaging technique in normofrequent patients. Tachycardic frequencies, above 100 beats per minute, led to exponential error propagation due to insufficient temporal resolution of the current CT technology. CONCLUSION: This study proved that cardiac motility assessment based on ECG-gated CT and MR data sets resulted in comparable ventricular function results for normofrequent patients; however, the high spatial resolution of cardiac MDCT cannot compensate for the lack of temporal resolution in patients with tachycardia, thus emphasizing the necessity of reporting ventricular motility analysis results in combination with heart rate to allow consideration of this possible cause for measurement variation.

Adolescent↗

MDCT angiography of the spinal vasculature and the artery of Adamkiewicz.

OBJECTIVE: The purpose of our study was to prospectively assess 40-MDCT technology in combination with adapted brain reconstruction algorithms to visualize the spinal vasculature, in particular the artery of Adamkiewicz and its anatomic variants. SUBJECTS AND METHODS: One hundred patients underwent contrast-enhanced MDCT of the thoracolumbar junction with collimation of 40 x 0.625 mm. The adapted brain algorithm reconstructed the spinal canal with a field of view of 90 mm at 0.6-mm slice thickness. Curved multiplanar reformations identified the artery of Adamkiewicz as a continuous vascular tract extending from the aortic orifices of the intercostal or lumbar arteries via the anterior radiculomedullary artery to the anterior spinal artery. Segment of origin and length were noted. Diameter and contrast-to-noise ratio (CNR) were evaluated along the posterior branch, the radiculomedullary artery, the artery of Adamkiewicz, and the anterior spinal artery. Univariate general linear model analysis with Bonferroni post hoc corrections evaluated whether laterality, segment of origin, and length of the artery of Adamkiewicz showed a sex-specific propensity. Multivariate general linear model analysis assessed whether spinal vascular diameters and intraluminal CNR showed correlations with sex, laterality, and segment of origin. Finally, the luminal diameters of the feeding posterior branches were statistically compared with those of the ipsilateral and contralateral adjacent posterior branches. RESULTS: Successful depiction of the artery of Adamkiewicz was achieved in all patients; longitudinally the artery measured 40.1 +/- 13.51 mm. In 63% of patients it originated from the left side of the body, and in 74% it originated from the level of the 10th-12th thoracic vertebrae. Duplications were found in 5% of patients. Segmental distribution, laterality, and length did not show significant sex-specific differences (p > 0.05). The vascular diameter and luminal contrast did not show significant differences caused by sex, laterality, or segment of origin (p > 0.05). The diameter of the posterior branches (2.8 +/- 0.71 mm) arising in the segments of origin showed a significantly wider lumen than any of the other posterior branches (contralateral, 1.9 +/- 0.32 mm; upper ipsilateral, 2.0 +/- 0.47 mm; lower ipsilateral, 1.9 +/- 0.39 mm) (p < 0.0001). CONCLUSION: Contrast-enhanced 40-MDCT technology, in combination with an adapted brain reconstruction algorithm, can depict the artery of Adamkiewicz and its anatomic variants.

Adult↗

Automatic determination of minimal cardiac motion phases for computed tomography imaging: initial experience.

Low motion phases for cardiac computed tomography reconstructions are currently detected manually in a user-dependent selection process which is often time consuming and suboptimal. The concept of motion maps was recently introduced to achieve automatic phase selection. This pilot study compared the accuracy of motion-map phase selection to that with manual iterative selection. The study included 20 patients, consisting of one group with low and one with high heart rate. The technique automatically derives a motion strength function between multiple low-resolution reconstructions through the cardiac cycle, with periods of lowest difference between neighboring phases indicating minimal cardiac motion. A high level of agreement was found for phase selection achieved with the motion map approach compared with the manual iterative selection process. The motion maps allowed automated quiescent phase detection of the cardiac cycle in 85% of cases, with best results at low heart rates and for the left coronary artery. They can also provide additional information such as the presence of breathing artifacts. Motion maps show promise as a rapid off-line tool to automatically detect quiescent cardiac phases in a variety of patients.

Adult↗

Perfusion abnormalities in congenital and neoplastic pulmonary disease: comparison of MR perfusion and multislice CT imaging.

The aim of this work was to assess magnetic resonance (MR) perfusion patterns of chronic, non-embolic pulmonary diseases of congenital and neoplastic origin and to compare the findings with results obtained with pulmonary, contrast-enhanced multislice computed tomography (CT) imaging to prove that congenital and neoplastic pulmonary conditions require MR imaging over the pulmonary perfusion cycle to successfully and directly detect changes in lung perfusion patterns. Twenty-five patients underwent concurrent CT and MR evaluation of chronic pulmonary diseases of congenital (n=15) or neoplastic (n=10) origin. Analysis of MR perfusion and contrast-enhanced CT datasets was realized by defining pulmonary and vascular regions of interest in corresponding positions. MR perfusion calculated time-to-peak enhancement, maximal enhancement and the area under the perfusion curve. CT datasets provided pulmonary signal-to-noise ratio measurements. Vessel center-lines of bronchial arteries were determined. Underlying perfusion type, such as pulmonary arterial or systemic arterial supply, as well as regions with significant variations in perfusion were determined statistically. Analysis of the pulmonary perfusion pattern detected pulmonary arterial supply in 19 patients; six patients showed systemic arterial supply. In pulmonary arterial perfusion, MR and multislice CT imaging consistently detected the perfusion type and regions with altered perfusion patterns. In bronchial arterial supply, MR perfusion and CT imaging showed significant perfusion differences. Patients with bronchial arterial supply had bronchial arteries ranging from 2.0 to 3.6 mm compared with submillimeter diameters in pulmonary arterial perfusion. Dynamic MR imaging of congenital and neoplastic pulmonary conditions allowed characterization of the pulmonary perfusion type. CT imaging suggested the presence of systemic arterial perfusion by visualizing hypertrophied bronchial arteries.

Adolescent↗

Functional cardiac CT and MR: effects of heart rate and software applications on measurement validity.

This study sought to validate different software applications for cardiac function analysis using ECG-gated CT and MR datasets in correlation with underlying heart rate. Ten patients and a set of ventricular phantoms underwent concurrent multislice-CT and cine-MR imaging for evaluation of cardiac function. Datasets from both imaging modalities were evaluated utilizing 2 volumetric analysis tools to determine left ventricular volume and mass. Initially, intraobserver measurement variability was assessed. Detected measurement variability was correlated with underlying absolute magnitude of cardiac volumes and masses. Subsequently, results were statistically evaluated by determining significant data variability depending on imaging modality and choice of evaluation software. Finally, the data variability was correlated with underlying heart rates. This study showed that all analyzed datasets uniformly presented intraobserver variations below 2%, and variability was not related to the magnitude of measurement. Significant measurement accuracy was proven in all calculated parameters obtained from the cardiac phantoms. Acquired patient datasets and calculated functional parameters showed significant data homogeneity, with measurement variability coefficients ranging from 0.935-0.955. CT datasets showed maximal data variability at heart rates below 60 BpM. MR datasets showed maximal data variability at heart rates above 90 BpM. In conclusion, CT and MR datasets allowed an interchangeable utilization of volumetric analysis tools. However, reliable volumetric analysis was limited to an optimal range of cardiac rates for each modality, thus emphasizing the necessity of reporting volumetric measurement results in combination with heart rate to allow for consideration of this possible cause for measurement variation.

Adolescent↗

Assessment of parallel acquisition techniques in adrenal magnetic resonance imaging: does increased temporal resolution significantly improve visualization of adrenal lesions?

RATIONALE AND OBJECTIVES: To compare conventional radiofrequency coil reception techniques with parallel coil array acquisition methods in adrenal tissue visualization and to evaluate the dependence of temporal resolution on image quality in adrenal magnetic resonance magnetic resonance (MR) imaging. MATERIAL AND METHODS: Using a 1.5 T MR imager, conventional and parallel sampled sequences were acquired in 10 healthy volunteers and 10 patients with adrenal lesions. The imaging protocol consisted of: conventional (TR/TE 4,730/125 ms; FA 150 degrees; NA 1; AT 25 s), and two parallel imaging SMASH techniques (TR/TE 4,090/125 ms; FA 150 degrees; NA 1 resulting in an AT of 12 s, as well as NA 2 resulting in an AT of 24 s) with generalized autocalibration T(2)-weighted turbo spin echo sequences with 5 mm slice thickness, 1.6 mm in-plane resolution, and an acceleration factor 2. Severity of breathing motion and aliasing artifact and overall image quality were rated on five-point scales and evaluated with student's t test; a differential receiver operating characteristic (DROC) analysis was performed. RESULTS: Adrenal gland findings included adenomas, metastases, and hemorrhages. Acceleration of conventional turbo spin echo sequence with one signal average led to an increase in diagnostic power (DROC 0.362) as well as significant improvement in overall image quality (P(Volunteers) =.017; P(Patients) =.042) and reduction of breathing motion artifact in patients (P(Patients) =.012) while improving the temporal resolution. Parallel imaging with two signal averages resulted in further improvement of image quality over conventional imaging (DROC 0.303), (P(Volunteers) =.045; P(Patients) =.022), in the same acquisition time as the conventional method. CONCLUSION: Parallel acceleration of sequences used for adrenal tissue visualization leads to a significant increase in diagnostic quality by significantly reducing breathing motion artifacts without sacrificing contrast indispensable for adrenal lesion characterization.

Adenoma↗

Comparison of MR imaging sequences for liver and head and neck interventions: is there a single optimal sequence for all purposes?

RATIONALE AND OBJECTIVES: To compare the appropriate pulse sequences for interventional device guidance during magnetic resonance (MR) imaging at 0.2 T and to evaluate the dependence of sequence selection on the anatomic region of the procedure. MATERIALS AND METHODS: Using a C-arm 0.2 T system, four interventional MR sequences were applied in 23 liver cases and during MR-guided neck interventions in 13 patients. The imaging protocol consisted of: multislice turbo spin echo (TSE) T2w, sequential-slice fast imaging with steady precession (FISP), a time-reversed version of FISP (PSIF), and FISP with balanced gradients in all spatial directions (True-FISP) sequences. Vessel conspicuity was rated and contrast-to-noise ratio (CNR) was calculated for each sequence and a differential receiver operating characteristic was performed. RESULTS: Liver findings were detected in 96% using the TSE sequence. PSIF, FISP, and True-FISP imaging showed lesions in 91%, 61%, and 65%, respectively. The TSE sequence offered the best CNR, followed by PSIF imaging. Differential receiver operating characteristic analysis also rated TSE and PSIF to be the superior sequences. Lesions in the head and neck were detected in all cases by TSE and FISP, in 92% using True-FISP, and in 84% using PSIF. True-FISP offered the best CNR, followed by TSE imaging. Vessels appeared bright on FISP and True-FISP imaging and dark on the other sequences. CONCLUSION: In interventional MR imaging, no single sequence fits all purposes. Image guidance for interventional MR during liver procedures is best achieved by PSIF or TSE, whereas biopsies in the head and neck are best performed using FISP or True-FISP sequences.

Adult↗

Comparison of ECG-gated rectilinear vs. real-time radial K-space sampling schemes in cine True-FISP cardiac MRI.

PURPOSE: To compare three k-space sampling schemes in cine True-FISP cardiac magnetic resonance imaging and to evaluate changes in calculated quantitative functional cardiac parameters as a function of underlying k-space sampling techniques. MATERIAL AND METHODS: Using a 1.5 T MR imaging system (Magnetom Sonata, Siemens Medical Solutions, Erlangen, Germany), three k-space data-sampling schemes: rectilinear (2.96 ms/1.58 ms/70 degrees /12 s TR/TE/FA/AcquisitionTime), and two radial k-space acquisitions, with filtered back-projection (RADIAL) (2.45 ms/1.25 ms/ 50 degrees /3.3 s TR/TE/FA/AT), and steady-state projection imaging with dynamic echotrain readout (SPIDER) (3.39 ms/1.62 ms/55 degrees /1.8 s TR/TE/FA/AT) of a True-FISP sequence were applied in 10 healthy volunteers. Long- and short-axis breath-hold series were acquired and signal-to-noise ratios (SNR) for blood and myocardium were determined, as was contrast-to-noise ratios (CNR). Quantitative cardiac functional analysis included: determination of end-systolic/end-diastolic volumes, ejection fraction, and left ventricular mass. Functional analysis was performed by two independent readers three times for each volunteer and k-space sampling strategy. Statistical analysis evaluated the accuracy of the measurements obtained from each of the three sampling techniques and the intra- and interobserver reliability. RESULTS: Intraobserver and interobserver reliability measures of functional data were homogeneous without statistically significant differences. Intraobserver correlation coefficients ranged from 0.94-0.99; interobserver correlation coefficients ranged from 0.97-0.99. Direct comparison of SPIDER- and RADIAL-sampled True-FISP sequences showed no statistically significant differences in measured functional parameters with interstudy correlation coefficients from 0.88-0.98. RADIAL and SPIDER images had better temporal resolution and were qualitatively judged to provide superior wall/blood border definition. Statistically significant differences were identified in each volumetric functional parameter when results from the rectilinear sampling acquisitions were compared with either radial or SPIDER sampling techniques. RADIAL and SPIDER results were consistently higher than volumetric measures obtained from the rectilinear data set. CONCLUSION: Employing faster sampling schemes led to enhanced signal homogeneity while maintaining the necessary CNR for estimation of functional cardiac parameters. Enhanced signal homogeneity and maintained CNR will most likely improve the accuracy of the cardiac functional parameter determination.

Adult↗

Low-flow vascular malformations: MR-guided percutaneous sclerotherapy in qualitative and quantitative assessment of therapy and outcome.

PURPOSE: To prospectively assess the therapeutic procedure and outcome of magnetic resonance (MR)-guided percutaneous sclerotherapy in patients with low-flow vascular malformations. MATERIALS AND METHODS: Seventy-six percutaneous sclerotherapy treatments were performed by one radiologist with real-time MR guidance in 15 patients (six female patients; mean age, 54.4 years +/- 11.1; nine male patients; mean age, 32.9 years +/- 14.1) with vascular malformations in the head and neck (n = 64), spine (n = 5), and extremities (n = 7). Qualitative assessment was used to analyze (a) individual success of therapy, (b) occurrence of complications, (c) time required for minimally invasive MR-guided sclerotherapy in regression analysis, (d) ability of MR imaging to depict postinterventional perfusion changes within the vascular malformation with calculation of changes in contrast-to-noise ratios, and (e) detection of volume changes at follow-up examinations with volumetric analysis. RESULTS: Percutaneous sclerotherapy was performed successfully and without complications by filling targeted vascular malformations with sclerosing agent. Induced vascular sclerosis was used to successfully treat individual predominant symptoms, such as hemorrhage, pain, cosmetic disfigurement, and functional impairment. Quantitative analysis focusing on the actual interventional length of time presented an acceleration over the 5-year time period, matching a cubic function in regression curve fit and taking 31 minutes 50 seconds +/- 14 minutes. Induced vascular thrombosis was identified in all treated portions on postinterventional images by the statistically significant changes in contrast-to-noise ratio (P < .05) compared with preinterventional imaging. On follow-up images (ie, those obtained after 12 weeks +/- 6), shrinkage was observed in targeted portions (67.2% +/- 18.9). CONCLUSION: MR imaging allows safe guidance and monitoring of minimally invasive sclerotherapy and permits verification of therapeutic success postinterventionally and during follow-up examinations.

Adolescent↗

Multidetector CT angiography of arterial inflow and runoff in the lower extremities: a challenge in data acquisition and evaluation.

PURPOSE: To show the feasibility of acquiring homogenous 3-dimensional datasets with high temporal and spatial resolution from computed tomographic angiographic (CTA) scans of the lower extremities and to assess automated vessel-tracking techniques for vascular evaluation. METHODS: Eighteen men (mean age 67.0 years, range 43-83) with aneurysmal or occlusive vascular diseases underwent contrast-enhanced CTA of the lower limb arteries utilizing a 16-row CT imager. Curved multiplanar reformations were generated by manual selection of vessel centerlines in the infrarenal aorta and the arterial vasculature in the pelvis, thigh, and calf based on volume-rendering techniques. For each vessel, opacification and depiction were quantitatively evaluated. The manually segmented images were compared to datasets processed with automated vessel-tracking strategies by 5 radiologists, who evaluated diagnostic reliability and image quality. A Differential Receiver Operating Characteristic (DROC) analysis was performed. RESULTS: An increase in the temporal and spatial resolution led to acquisition of high quality CTA datasets. Significant homogeneity of the vascular contrast-to-noise ratios was achieved in the pelvic (coefficient of variance 1.5% to 10.1%), thigh (0.1% to 9.4%), and calf (3.3% to 19.2%) vessels. The assessment of vascular delineation revealed full-width-at-half-maximum contrast values of 96.4%, 95.5%, and 111.3% in the pelvis, thigh, and calf, respectively. Observers were not able to distinguish between manual and automated vascular segmentation, as represented by a 0.56 value for the area under the DROC curve. CONCLUSIONS: High-resolution CTA lower extremity datasets were acquired successfully, presenting vascular signal intensities of high homogeneity suitable for automated vessel-tracking techniques. Automated 3D visualization tools produced reliable, reproducible, and time-efficient centerline extractions that were comparable to manually defined centerlines.

Adult↗

Volumetric assessment of pulmonary nodules with ECG-gated MDCT.

OBJECTIVE: The objective of our study was to assess physiologic lung deformation and compression originating from cardiovascular motion and their subsequent impact on determining the volume of small pulmonary nodules throughout the cardiac cycle on ECG-gated MDCT. SUBJECTS AND METHODS: Seventy-three small noncalcified pulmonary nodules were identified in 30 patients who underwent ECG-gated MDCT. The volume of each nodule was assessed throughout the cardiac cycle using computer-aided automatic segmentation algorithms, and the assessment was repeated three times. To ensure the validity of the subtle changes in volume that were detected, we determined the volume and signal attenuation in phantom data sets and patient nodules without temporal or spatial differentiation. Subsequently, nodules were assigned to pulmonary segments, and volume changes were correlated to cardiac phases, nodular location, and mean nodular size. Statistical multivariate tests were performed to evaluate significant patterns. RESULTS: The validity of significant measurements was proven in evaluated phantom data sets with a general tendency toward overestimating nodular volume (p = 0.492). Statistical evaluation of nodular signal attenuation confirmed true deformation and compression of nodules rather than partial volume effects as the reason for volume variations (p = 0.874). Differentiating pulmonary nodules in cardiac phases, pulmonary locations, and mean nodular volumes, we found that one single effect did not determine the amount of cardiovascular motion conveyed to pulmonary parenchyma and subsequently led to nodule deformation. Multivariate testing revealed statistically significant measures identifying patterns correlating variation in nodular volume with cardiac phase (p < 0.001), nodular location (p = 0.007), and mean nodular size (p < 0.001). CONCLUSION: Cardiovascular motion was disproportionately conveyed to various pulmonary segments and led to changes in the volume of pulmonary nodules, especially in small pulmonary nodules. A precise volumetric assessment was therefore possible only by identifying the underlying cardiac phase.

Adult↗

Differentiating a chronic hyperplastic mass from pancreatic cancer: a challenge remaining in multidetector CT of the pancreas.

A multitude of clinical symptoms originate from pancreatic inflammatory or neoplastic processes due to their highly complex composition, function, and anatomic relationships to adjacent organs as well as the heterogeneous patterns of vascular perfusion and neural innervation of the pancreatic gland which complicate an early and precise diagnosis. Whereas early assessment of inflammatory or neoplastic pancreatic processes is a prerequisite for a successful curative approach, the classical radiologic signs of chronic pancreatitis and pancreatic carcinoma show significant similarities. This article provides an overview of the pathogenesis and imaging findings in chronic pancreatitis and pancreatic cancer, including some new approaches for visualizing the subtle but distinct differences between these two entities.

Adenocarcinoma↗

Multislice helical CT of the pancreas and spleen.

Multislice helical CT (MSCT) with its multidetector technology and faster rotation times, has led to new dimensions in spatial and temporal resolution in CT imaging. In contrast to single-slice CT, smaller slice collimations can be applied that lead to almost isotropic voxels and allow high quality multiplanar and 3-D image reconstructions. The high speed of multislice CT can be used to reduce the time needed to cover a given volume, to increase the spatial resolution along the z-axis by applying thinner slice collimations, and to cover longer anatomic volumes. The speed of MSCT allows organ imaging in clearly defined perfusion phases, e.g. the arterial, parenchymal, and portal venous perfusion phases. Contrast agents with higher iodine concentrations (400 mg iodine per ml compared with 300 mg iodine per ml) lead to higher contrast enhancement of the pancreas (arterial+portal venous phases), the kidneys (arterial+portal venous phases), the spleen (arterial phase), the wall of the small intestine (arterial+portal venous phases), the larger and smaller arteries (arterial phase), and the portal vein (portal venous phase). All of these advancements lead to improved visualization of small structures and of various pathologies, such as pancreatic tumors, liver metastases, vessel infiltration, and vascular diseases.

Humans↗

Intraoperative MR imaging.

Intraoperative MR imaging has become a safe and effective technology that has revolutionized the way neurosurgery is performed. Benefits include the ability to update data sets for navigational systems, to monitor tumor resections, to adjust the approach to intracranial lesions, and to guide functional and drug or cell delivery procedures. Use of this technique can help avoid inadvertent injury of important anatomic and vascular structures. In addition, complications such as ischemia or hemorrhage can be detected early. Intraoperative MR imaging is particularly useful for ensuring that brain biopsies yield diagnostic tissue and for assessing the completeness of tumor resection. As is true for any new technology, the benefits of intraoperative MR imaging must be examined carefully to guarantee appropriate use. Many neurosurgical procedures do not require real-time image guidance and can be performed safely using current surgical techniques, including microsurgical methods and frameless and frame-based stereotaxy. Other tumor resections, tumor biopsies, and surgical and interventional procedures distinctly benefit from the sophisticated information provided by intraoperative imaging techniques. In surgery for low-grade gliomas, intraoperative MR imaging has found general acceptance, whereas its usefulness to monitor the resection of high-grade gliomas remains controversial. The economic issues related to intraoperative MR imaging cannot be overlooked. The acquisition of an intraoperative MR imaging system is associated with considerable expense, and its performance increases the cost of equipment and the operating time. Despite these additional expenses, intraoperative MR imaging can lead to a potential overall cost reduction in the treatment of certain patients if long-term cure can be achieved, repeat resection can be avoided, or procedure-associated morbidity can be reduced. Although intraoperative MR imaging techniques hold tremendous potential, the definition of their appropriate role in the delivery of successful and cost-effective medical care awaits further study.

Brain↗

Slice-to-volume registration and its potential application to interventional MRI-guided radio-frequency thermal ablation of prostate cancer.

In this study, we registered live-time interventional magnetic resonance imaging (iMRI) slices with a previously obtained high-resolution MRI volume that in turn can be registered with a variety of functional images, e.g., PET, SPECT, for tumor targeting. We created and evaluated a slice-to-volume (SV) registration algorithm with special features for its potential use in iMRI-guided radio-frequency (RF) thermal ablation of prostate cancer. The algorithm features included a multiresolution approach, two similarity measures, and automatic restarting to avoid local minima. Imaging experiments were performed on volunteers using a conventional 1.5-T MR scanner and a clinical 0.2-T C-arm iMRI system under realistic conditions. Both high-resolution MR volumes and actual iMRI image slices were acquired from the same volunteers. Actual and simulated iMRI images were used to test the dependence of SV registration on image noise, receive coil inhomogeneity, and RF needle artifacts. To quantitatively assess registration, we calculated the mean voxel displacement over a volume of interest between SV registration and volume-to-volume registration, which was previously shown to be quite accurate. More than 800 registration experiments were performed. For transverse image slices covering the prostate, the SV registration algorithm was 100% successful with an error of <2 mm, and the average and standard deviation was only 0.4 mm +/- 0.2 mm. Visualizations such as combined sector display and contour overlay showed excellent registration of the prostate and other organs throughout the pelvis. Error was greater when an image slice was obtained at other orientations and positions, mostly because of inconsistent image content such as that from variable rectal and bladder filling. These preliminary experiments indicate that MR SV registration is sufficiently accurate to aid image-guided therapy.

Algorithms↗

Do surgical clips interfere with radiofrequency thermal ablation?

OBJECTIVE: This study sought to evaluate whether surgical clips affect tissue conductivity and thereby alter the induction of radiofrequency ablation lesions and to determine whether therapy is safe after previous placement of clips in the liver. MATERIALS AND METHODS: An ex vivo porcine hepatic model was used. Three clips were placed around a radiofrequency electrode at 10, 20, and 30 mm from the point of insertion. Clips were arranged in a plane either perpendicular or parallel to the electrode track. After placement of the liver specimen on a grounding pad, radiofrequency energy was applied in a standardized manner for 5 min. Lesion growth and morphology were documented for each minute. RESULTS: Radiofrequency lesions appeared circular and homogeneous after 5 min. Lesion diameter perpendicular to the radiofrequency electrode averaged 30 mm. However, lesion formation was irregular during the early phase of the radiofrequency ablation. The lesion extended irregularly toward the 1-cm clip after 60 sec of ablation. During the second minute, a distinct lesion was observed around the clip 1 cm from the electrode; the primary lesion had not yet reached the clip. During the final 3 min, the primary lesion reached the 1-cm clip and ultimately incorporated the satellite lesion. No lesions were detected surrounding the more distant clips. CONCLUSION: Our data suggest that with the parameters applied in our study, radiofrequency ablation can be safely performed in patients with implanted clips. No aberrant conduction is observed around surgical clips that are located 20 mm and further from the radiofrequency electrode.

Animals↗

Magnetic resonance imaging versus multislice computed tomography of thoracic aortic endografts.

PURPOSE: To compare the potential of magnetic resonance imaging (MRI) to multislice computed tomography (CT) for evaluating stent-graft placement in the thoracic aorta. METHODS: Susceptibility artifacts in 2 different stent-graft systems (Talent and Excluder) were evaluated in vitro in 2 angulations (straight and 33 degrees curved) using 3 different MRI gradient echo sequences (True FISP, 2-dimensional FLASH, and 3-dimensional Turbo FLASH). The size of the stent-related artifact was measured, and the relative stent lumen was calculated. In vivo stent demarcation, stent patency, and additional findings were determined in 13 patients (3 Talent, 9 Excluder, and 1 combined) and compared to CT findings. RESULTS: In vitro, both endograft systems proved to be MR compatible, with the relative stent lumen value ranging from 82% to 100% in the straight configuration; in a curved model, the relative stent lumen value ranged from 56% to 92% with the 3D Turbo FLASH sequence, which provided the smallest susceptibility artifacts. The Excluder endoprosthesis caused significant signal inhomogeneity within the stent in a curved configuration. In vivo, MRI and multislice CT showed similar results, with CT imaging slightly superior in stent demarcation and MRI better in demonstrating thrombus. CT beam hardening artifacts were pronounced in the Talent system, while the Excluder device caused significant signal inhomogeneity within the stent on magnetic resonance angiography. CONCLUSIONS: Multislice CT and contrast-enhanced MRI are fast, reliable means of providing all relevant information for surveillance of fully MR-compatible stent-grafts in the thoracic aorta.

Aorta, Thoracic↗