Biomedical subjects

David Maintz

Publications and source records attributed to David Maintz.

24 records · Page 2Linked to original sources

PubMed2003

Thoracic aortic stent graft: comparison of contrast-enhanced MR angiography and CT angiography in the follow-up: initial results.

The objective of this study was to compare contrast-enhanced magnetic resonance angiography (CE MRA) and multislice computed tomographic angiography (MS CTA) in the follow-up of thoracic stent-graft placement. The CE MRA and MS CTA were performed following nitinol stent-graft treatment due to thoracic aneurysm ( n=4), intramural bleeding ( n=2) and type-B aortic dissection ( n=5). Corresponding evaluation of arterial-phase imaging characteristics focused on the stent-graft morphology and leakage assessment. Stent-graft and aneurysm extensions were comparable between both techniques. Complete exclusion (aneurysm, n=4; dissection, n=2) was assessed with high confidence with CE MRA and MS CTA. Incomplete exclusion (intramural bleeding, n=2; dissection, n=3) was assigned to lower confidence scores on CE MRA compared with MS CTA. On CE MRA the stent-graft lumen demonstrated an inhomogeneous signal, the stent struts could not be assessed. The CE MRA can be used as alternative non-invasive imaging for follow-up of nitinol stent grafts. Arterial-phase leak assessment can be less evident in CE MRA compared with MS CTA studies; therefore, the use of late-phase imaging seems to be necessary. The diagnostic gap of stent-graft fracture evaluation using MRA may be filled with plain radiographs.

Aged↗

PubMed2003

Improved coronary artery stent visualization and in-stent stenosis detection using 16-slice computed-tomography and dedicated image reconstruction technique.

OBJECTIVE: The aim of this study was to compare the visualization of different coronary artery stents and the detectability of in-stent stenoses during 4-slice and 16-slice computed tomography (CT) angiography in a vessel phantom. MATERIAL AND METHODS: Ten coronary stents were introduced in a coronary artery vessel phantom (plastic tubes with an inner diameter of 3 mm, filled with iodinated contrast material diluted to 220 Hounsfiled Units [HU], surrounded by oil [60 HU]). CT scans were obtained perpendicular to the stent axes on a 4-slice scanner (detector collimation 4x1 mm; table feed 1.5 mm/rotation, mAs 300, kV 120, medium-smooth kernel) and a 16-slice scanner (detector collimation 12x0.75 mm; table feed 2.8 mm/rotation, mAs 370, kV 120, reconstruction with a standard and an optimized sharp kernel). Longitudinal multiplanar reformations were evaluated regarding visible lumen diameters and intraluminal attenuation values. Additionally, the stents were scanned with the same parameters after implantation of 60% stenoses (HU 30). RESULTS: Using the same medium-smooth kernel reconstruction with 4-slice and 16-slice CT, there was a slight increase in the average visible lumen area (26% versus 31%) and less increase of average intraluminal attenuation values (380 HU versus 349 HU). Significant improvement of lumen visualization (54%, P<0.01) and attenuation values (250, P<0.01) was observed for the 16-slice scans using the sharp kernel reconstruction. In-stent stenoses could be more reliably identified (or ruled out) by 16-slice CT and sharp reconstruction kernel when compared with the other 2 methods. CONCLUSION: 16-slice CT using a dedicated sharp kernel for image reconstruction facilitates improved visualization of coronary artery stent lumen and detection of in-stent stenoses.

Coronary Angiography↗

PubMed2002

Imaging of coronary artery stents using multislice computed tomography: in vitro evaluation.

The aim of this study was to evaluate imaging features of different coronary artery stents during multislice CT Angiography (MSCTA). Nineteen stents made of varying material (steel, nitinol, tantalum) and of varying stent design were implanted in plastic tubes with an inner diameter of 3 mm to simulate a coronary artery. The tubes were filled with iodinated contrast material diluted to 200 Hounsfield units (HU), closed at both ends and positioned in a plastic container filled with oil (-70 HU). The MSCT scans were obtained perpendicular to the stent axes (detector collimation 4x1 mm, table feed 2 mm/rotation, 300 mAs, 120 kV). Axial images and multiplanar reformations were evaluated regarding artifact size, lumen visibility, and intraluminal attenuation values. Artifacts characterized by artifactual thickening of the stent struts leading to apparent reduction in the lumen diameter and increased intraluminal attenuation values were observed in all cases. The stent lumen was totally obscured in the Wiktor stent, the Wallgraft stent, and the Nir Royal stent. Partial residual of the stent lumen could be visualized in all other utilized stent products (artificial lumen reductions ranged from 62% in the V-Flex stent to 94% in the Bx Velocity stent). Parts of the stent lumen can be visualized in most coronary artery stents; however, detectability of in-stent stenoses remains to be evaluated for each stent type.

Artifacts↗

PubMed2002

Phosphorus-31 MR spectroscopy of normal adult human brain and brain tumours.

Localized phosphorus-31 MR spectra were obtained in vivo in a large series of normal human brain tissue specimens of healthy volunteers (n=36) and various brain tumours (n=52). Tumour types examined included grade II and grade III gliomas (n=15 and n=1, respectively), glioblastomas (n=16) and meningeomas (n=12). An additional eight tumours were analysed during chemo- or radiotherapy. Spectra were acquired using a modified ISIS pulse sequence with a repetition time of 3 s. Voxel sizes ranged from 56 to 129 ml. The spectra were evaluated using a least-square variable projection (VARPRO) fitting procedure in the time domain, which allows semi-quantitative determination of relative metabolite concentrations. The measurements in normal cerebrum of healthy volunteers revealed the following results of metabolite signal intensity ratios: pH 7.04 (+/- 0.01), PCr/alpha-ATP 0.51 (+/- 0.03), P(i)/alpha-ATP 0.17 (+/-0.02), PCr/P(i) 2.09 (+/-0.12), PDE/alpha-ATP 3.65 (+/-0.13) and PME/alpha-ATP 0.41 (+/-0.04). Meningiomas showed the most obvious changes when compared with normal brain tissue. They are characterized by an alkaline environment (pH 7.16 +/- 0.03; p<0.005), a decrease in the phosphocreatine peak (p<0.0001) and significantly decreased phosphodiesters (p<0.0001). Glioblastomas also showed alkalization (pH 7.12 +/- 0.02; p<0.001) and a decrease in PDE/alpha-NTP (p<0.05), but no significant changes in PCr/alpha-NTP or PCr/Pi. In gliomas with low malignancy, less distinct changes could be detected with slight alkalization (pH 7.09 +/- 0.02; p<0.05) and more than a two-fold reduction in the PDE/alpha-NTP ratio (p<0.05). The spectra of brain tumours during chemo- and radiotherapy indicated clear but inconsistent influence of the therapy.

Adolescent↗

PubMed2002

Coronary magnetic resonance angiography for assessment of the stent lumen: a phantom study.

PURPOSE: To evaluate the feasibility of visualizing the stent lumen using coronary magnetic resonance angiography in vitro. MATERIAL AND METHODS: Nineteen different coronary stents were implanted in plastic tubes with an inner diameter of 3 mm. The tubes were positioned in a plastic container filled with gel and included in a closed flow circuit (constant flow 18 cm/sec). The magnetic resonance images were obtained with a dual inversion fast spin-echo sequence. For intraluminal stent imaging, subtraction images were calculated from scans with and without flow. Subsequently, intraluminal signal properties were objectively assessed and compared. RESULTS: As a function of the stent type, various degrees of in-stent signal attenuation were observed. Tantalum stents demonstrated minimal intraluminal signal attenuation. For nitinol stents, the stent lumen could be identified, but the intraluminal signal was markedly reduced. Steel stents resulted in the most pronounced intraluminal signal voids. CONCLUSIONS: With the present technique, radiofrequency penetration into the stents is strongly influenced by the stent material. Thesefindings may have important implicationsforfuture stent design and stent imaging strategies.

Blood Vessel Prosthesis Implantation↗

PubMed2002

Revealing in-stent stenoses of the iliac arteries: comparison of multidetector CT with MR angiography and digital radiographic angiography in a Phantom model.

OBJECTIVE: Our objective was to evaluate the detectability of in-stent stenoses in iliac artery stents using multidetector CT angiography in comparison with MR angiography and digital radiographic angiography. MATERIALS AND METHODS: Ten different metallic stents (made of steel, nitinol, tantalum, or cobalt) were implanted in plastic tubes (8 mm). The stent lumina were partially obstructed by wax (CT density, -30 H) resulting in 50-60% in-stent stenoses. The tubes were filled with diluted contrast material (25 mmol/L of gadopentetate dimeglumine or 6 mg I/mL of iodinated contrast material) and placed in a plastic container filled with oil or water, respectively. CT angiography was performed on a four-detector CT scanner (detector collimation, 4 x 1 mm; slice thickness, 1.25 mm; table feed, 4 mm per rotation). MR angiography was performed on a 1.5-T system with a three-dimensional gradient-echo sequence (TR/TE, 4.6/1.8; flip angle, 30 degrees; slice thickness, 1.88 mm). Axial and longitudinal reformations of CT and MR imaging data were evaluated regarding the in-stent attenuation and signal intensity, the visible lumen diameter inside the stent, and the delineation of the stenoses. For comparison, digital radiographic angiography was performed as the gold standard. RESULTS: The degree and character of stent-related artifacts differed in CT angiography and MR angiography. In CT angiography, only the tantalum stent caused artifacts that obscured the stenosis; in all other cases, the stenoses were visible. In MR angiography, depiction of stenoses was impaired in two steel stents but possible in the tantalum and most nitinol stents. CONCLUSION: CT angiography is suited for detection of relevant stenoses in steel, cobalt-based, and nitinol stents. MR angiography is superior only in tantalum products.

Angiography↗