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H J Schwarzmaier

Publications and source records attributed to H J Schwarzmaier.

16 recordsLinked to original sources

Optical properties of selected native and coagulated human brain tissues in vitro in the visible and near infrared spectral range.

Medical laser applications require knowledge about the optical properties of target tissue. In this study, the optical properties of selected native and coagulated human brain structures were determined in vitro in the spectral range between 360 and 1100 nm. The tissues investigated included white brain matter, grey brain matter, cerebellum and brainstem tissues (pons, thalamus). In addition, the optical properties of two human tumours (meningioma, astrocytoma WHO grade II) were determined. Diffuse reflectance, total transmittance and collimated transmittance of the samples were measured using an integrating-sphere technique. From these experimental data, the absorption coefficients, the scattering coefficients and the anisotropy factors of the samples were determined employing an inverse Monte Carlo technique. The tissues investigated differed from each other predominantly in their scattering properties. Thermal coagulation reduced the optical penetration depth substantially. The highest penetration depths for all tissues investigated were found in the wavelength range between 1000 and 1100 nm. A comparison with data from the literature revealed the importance of the employed tissue preparation technique and the impact of the theoretical model used to extract the optical coefficients from the measured quantities.

Brain↗

Laser-induced interstitial thermotherapy of liver metastases in an interventional 0.5 Tesla MRI system: technique and first clinical experiences.

Laser-induced interstitial thermotherapy (LITT) surveyed by magnetic resonance imaging (MRI) has been shown to be effective in various applications. The laser treatment of colorectal liver metastases usually requires a separate device (e.g., ultrasound or CT) to position the laser applicator. In this study, we used an interventional 0.5 T MRI system, allowing both the navigation to the target tissue and on-line thermometry. Laser irradiation was performed using a near-infrared laser source combined with a cooled laser light guide. We treated 20 patients exhibiting a total of 58 colorectal liver metastases. Clinically relevant complications did not occur. No residual tumor was observed after laser irradiation in all metastases with a diameter below 2 cm. Metastases with a mean diameter between 2 and 3 cm demonstrated total necrosis in 71%, while in larger tumors this proportion decreased to 46% (diameter, 3-4 cm) and 30% (diameter, >4 cm), respectively. We conclude that LITT, guided by the employed interventional MRI system, is feasible and safe. The results suggest a more aggressive treatment, especially for larger metastases. J. Magn. Reson. Imaging 2001;13:729-737.

Aged↗

Scattering delay time of Mie scatterers determined from steady-state and time-resolved optical spectroscopy.

We have determined the scattering delay time of Mie scatterers (r = 255 nm quartz spheres in polyester resin) from a combination of steady-state (integrating-sphere) and time-resolved (frequency-domain) measurements performed in the multiple-scattering regime. The effective transport velocity of light was derived from intensity and phase measurements at four different wavelengths by using the time-integrated microscopic Beer-Lambert law. We could demonstrate a systematic underestimation of the effective transport velocity compared with the phase velocity in the medium. Assuming that this discrepancy was caused entirely by the transient nature of a single-scattering process, the data presented resulted in time delays of between 18 fs (lambda = 678 nm) and 177 fs (lambda = 1,064 nm) per scattering event. For three out of four wavelengths investigated, the measured values are in excellent agreement with values predicted by a theoretical model for the scattering delay time based on Mie theory.

Light↗

[Interventional MR tomography. Current status and future perspectives].

The concept of MR guidance of invasive diagnostic and minimally invasive therapeutic procedures is based on the excellent morphologic and functional properties of MR imaging. Prerequisites are adequate patient monitoring and adherence to safety guidelines. Fast and ultrafast sequences, temperature quantification, visualization of intravascular devices, thermal stability of contrast media and thermosensitive contrast media are discussed. The spectrum of clinical applications includes biopsies, thermal ablation modalities, vascular applications, MR endoscopy and intraoperative MR imaging. The development of interventional MR imaging is still in its infancy. In the future, MR imaging may play an important role in interventional radiology and minimally invasive therapy.

Biopsy↗

Determination of laser-induced temperature distributions using echo-shifted TurboFLASH.

An echo-shifted TurboFLASH sequence implemented on a clinical whole body MR scanner was used to determine thermal changes in tissue. With this snapshot-like data acquisition, temperature-related phase shifts were measured with a temporal resolution of 1.3 s. For different types of tissue (postmortem porcine brain, liver, and muscle) the temperature coefficients of the proton chemical shift were recorded during uniform heating of the specimen in a water bath. The specific temperature-dependent frequency shifts appeared similar to the proton chemical shift of free water (-0.01 ppm/degrees C). With this method, laser-induced ablation in postmortem porcine brain was monitored by temperature mapping. Comparison of the induced temperature profiles measured with NiCrNi-thermocouples with the MR calculated profiles demonstrated excellent temperature sensitivity and accuracy for this method of MR thermometry, with a maximum deviation of the determined temperatures of only 1.8 degrees C. This investigation was designed as a feasibility study for this rapid version of the phase mapping method, and no in vivo studies were performed.

Animals↗

[MR tomographic temperature quantification at 1.5 T in vitro: a comparison of fast T1 maps and a phase-sensitive sequence].

PURPOSE: To determine the value of fast T1-maps and a phase-sensitive sequence for temperature quantification with MR imaging. MATERIAL AND METHODS: The experimental setup allowed both homogeneous heating as well as laser-induced interstitial thermotherapy (Nd:YAG, 1064 nm) of tissue specimens (pig brain, liver and muscle) in vitro. A total of 60 experiments were performed. T1-maps were calculated by means of a multi-point-turbo-FLASH sequence. Additionally, the temperature dependent phase shift was determined with a 2D-FLASH sequence. RESULTS: The T1-relaxation times of four different aqueous solutions of gadolinium-DTPA (0.125-1.0 mmol/l) varied by less than 5%. During homogeneous heating, the T1-maps revealed a linear correlation (r > 0.98) between temperature and T1-relaxation times. The temperature coefficients were 11.0 +/- 0.42 ms/degree C. Variations of the linear correlation were observed during laser irradiation. There was only slight variation of the temperature coefficients of the chemical shift during homogeneous heating of different tissues (brain: 0.0098 +/- 0.0002 ppm/degree C; muscle: 0.0109 +/- 0.0003 ppm/degree C; liver: 0.0093 +/- 0.0002 ppm/degree C). The temperatures calculated during laser therapy based on the phase shift correlated strongly (r = 0.99) to the measured temperatures. CONCLUSION: Due to the considerable tissue independence and high accuracy, the phase mapping method is superior to T1-maps for monitoring thermal therapy modalities at 1.5 T in vitro.

Animals↗

[Laser-induced interstitial induced hyperthermia of cerebral tumors with nuclear magnetic resonance tomography control].

PURPOSE: The purpose of our study was to determine the value of MRI in monitoring laser-induced interstitial thermotherapy (LITT) of cerebral neoplasms. MATERIALS AND METHODS: Sixteen patients with brain tumors were treated with LITT. The laser irradiation was performed within the MR unit and monitored with a temperature-sensitive T1-weighted 2D-FLASH sequence. RESULTS: During irradiation a gradually increasing central zone of high signal intensity was surrounded by an increasing area of reduced signal intensity. After therapy, the diameter of an enhancing rim at the outer border of the peripheral zone indicated total lesion size. On T2-weighted images the signal intensities were reversed. Total lesion size decreased during follow-up. CONCLUSION: MRI is suitable for monitoring LITT. However, the role of LITT in the treatment of brain tumors has still to be defined.

Adult↗

Mapping of the cortical motor hand area with functional MR imaging and MR imaging-guided laser-induced interstitial thermotherapy of brain tumors. Work in progress.

PURPOSE: To localize the cortical motor hand area with functional magnetic resonance (MR) imaging before and after MR imaging--guided laser-induced interstitial thermotherapy of tumors in the precentral brain region to control energy delivery and to improve safety. MATERIALS AND METHODS: Functional MR images were obtained in eight patients (five men, three women; aged 27-63 years) while they flexed their fingers. MR imaging--guided laser-induced interstitial thermotherapy was terminated when there was less than 8-12 mm between the border of the laser-induced lesion and the motor hand area anterior aspect. RESULTS: Seven patients had a statistically significant localized change in signal intensity in the central region of the contralateral hemisphere. This area was a spotlike circumscribed focus in three patients and scattered over a larger zone in four patients. Persistent deficits did not occur after thermotherapy in any patient. In three patients, onset of reversible perifocal edema in the motor hand area coincided with the development of hemiparesis, which completely resolved. No patient had activity within the tumor on functional MR images. CONCLUSION: Functional MR imaging findings can be used to prevent neurologic damage during MR imaging--guided laser-induced interstitial thermotherapy.

Adult↗

Optical properties of human articular tissue as implication for a selective laser application in arthroscopic surgery.

BACKGROUND AND OBJECTIVE: Optical density of normal and pathological hyaline cartilage, meniscus, and synovium is determined using native and laser-irradiated tissue samples in order to examine potentials for a selective laser ablation. STUDY DESIGN/MATERIALS AND METHODS: One hundred forty-four autopsy specimens were irradiated in a direct contact mode using a XeCl excimer laser (lambda = 308 nm; 20 ns; 40 Hz; 40 +/- 2.1 J/mm2; 800 microns fused silica fiber) and a continuous-wave Nd:YAG laser (lambda = 1,064 nm; 1 s; 124 +/- 5.4 W/mm2; 600 microns fused silica fiber). Transmission spectra were obtained by microspectrophotometry in a spectral range from 250 to 770 nm. RESULTS: In the ultraviolet spectrum analyzed, optical density (OD) is calculated to 0.81 +/- 0.05 for native hyaline cartilage, to 1.0 +/- 0.07 for meniscal tissue, and to 0.68 +/- 0.04 for synovium. With increasing wavelength the OD steadily decreases reaching mean values of 0.06 +/- 0.01, 0.13 +/- 0.03, and 0.15 +/- 0.04 at 750 nm. Compared to normal tissue degeneration of cartilage and meniscus lead to a significant increase in OD with a maximum relative OD of 4.39 and 1.26, respectively (P < .001 and P < .01). In synovitis the OD increases with a maximum ratio of 1.45:1 (P < .01). Following Nd:YAG laser exposition the OD of the coagulated zone exceeded the value of native tissue by a factor of 9.71 for cartilage, 4.71 for meniscus, and 3.04 for synovium (P < .001). Excimer irradiation leads to a 3.38-fold increase in OD for cartilage, 2.23-fold for meniscal tissue, and 1.6-fold for synovium (P < .01). CONCLUSION: The results presented indicate that a preferential ablation of pathological tissue structures in articular surgery is possible by selecting laser systems with an appropriate spectral emission range. However, thermal laser tissue interaction may lead to severe alterations in optical properties reducing potentials of a preferential or selective laser application.

Adult↗

Magnetic resonance imaging of microwave induced tissue heating.

MR-guided interstitial thermotherapy offers a minimally invasive treatment for localized tumors and tissue structures exhibiting functional abnormalities. In this study, microwaves (2.45 GHz) were used for tissue irradiation to overcome some limitations of the heating sources used so far. To this end, a microwave antenna was positioned in a specimen of porcine myocardium and irradiated for 10 min under MRI control using a T1-weighted FLASH sequence. The heating procedure resulted in a spherical tissue lesion of 26 mm in diameter. Thus, we could demonstrate the feasibility to monitor the microwave-induced coagulation process by MR-imaging in vitro.

Animals↗

Relation between ventricular late endocardial activity during intraoperative endocardial mapping and low-amplitude signals within the terminal QRS complex on the signal-averaged surface electrocardiogram.

Noninvasive recording of ventricular late potentials and intraoperative endocardial mapping at 36 sites were performed in 24 patients with left ventricular aneurysm and drug-resistant sustained ventricular tachycardia due to coronary artery disease. Their mean age was 55 +/- 8 years. Mean ejection fraction was 28 +/- 12%. For detection of late potentials on the signal-averaged QRS complex, 3 different algorithms were used. Late potentials were found in 54, 67 and 67% of the patients, respectively. In patients with a late potential on the signal-averaged electrocardiogram (ECG), delayed local activation (greater than 40 ms beyond the QRS complex on the intraoperative surface ECG) was recorded at 5.5, 5.5 and 5.6 endocardial sites. In patients without a late potential, this type of delayed local activation was detected at 2.4, 1.1 and 0.9 of 36 endocardial sites, respectively (p less than 0.05; p less than 0.01; p less than 0.002). The mean delay of local endocardial activity was 38, 35 and 37 ms in patients with a late potential on the body surface recording versus 20, 19 and 11 ms, respectively, in patients without a late potential (p less than 0.05; p less than 0.05; p less than 0.002). There was no correlation between the duration or amplitude of the late potential, if present, and the number of endocardial sites exhibiting delayed activity (r = -0.23, r = -0.05, r = 0.21; correlation not significant for each) or the mean duration of the endocardial delayed activity (r = -0.25, r = -0.14, r = -0.07; correlation not significant for each). These results indicate that the presence of late potentials on the signal-averaged surface ECG is related to the mean duration of endocardial late activity as well as to the number of endocardial sites exhibiting a given degree of delayed activation. Thus, it is dependent on the mass of slowly activated tissue. However, a direct conclusion from the duration or the amplitude of a late potential to the amount of delayed activation or the extent of endocardial time delay does not seem possible.

Algorithms↗

Preliminary experience with the application of gadolinium-DTPA before MR imaging-guided laser-induced interstitial thermotherapy of brain tumors.

The purpose of this study was to investigate the potential value of i.v. gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA) applied before MRI-guided laser-induced interstitial thermotherapy (LITT) of brain tumors without original enhancement, especially in defining total lesion size during therapy. MRI-guided LITT was performed on two patients with astrocytoma WHO II. For both patients, Gd-DTPA was administered intravenously after a first irradiation period and LITT was continued after pulling back the light guide to coagulate the upper parts of the tumor. In both patients, the whole irreversible damaged zone of the second irradiation period after Gd-DTPA showed an intense increase of signal intensity. The spatial expansion correlated with the diameter of an enhancing rim after Gd-DTPA on follow-up studies. Our preliminary results indicate that the application of Gd-DTPA before MRI-guided LITT may be of value in defining exactly the size of the irreversible damaged zone during therapy in nonenhancing brain tumors.

Adult↗

Treatment planning for MRI-guided laser-induced interstitial thermotherapy of brain tumors--the role of blood perfusion.

MR techniques have been demonstrated to allow a reliable monitoring of laser-induced interstitial thermotherapy (LITT). However, an adequate on-line control of this coagulation technique requires an exact therapy planning. The latter is mandatory to interpret the MR-monitoring data correctly to guarantee a precise laser irradiation. Moreover, it is a prerequisite for on-line decisions if modifications of the therapeutic regimen are required. In this work, we present a new simulation technique for LITT planning. The model accounts for the specific geometry of the treatment site, the exact configuration of the applicator, and the optical and thermal properties of the tissue, including changes during the heating process. The simulation results were compared with MR scans of laser-induced lesions in three patients with World Health Organization (WHO) grade II astrocytoma. Special interest was directed toward the role of blood perfusion, which was studied parametrically. Good agreement between the simulation results and the MR data was found if the appropriate blood perfusion rates were taken into account. Thus, the model can generate valid therapy plans allowing a precise on-line control of laser irradiation using MR techniques. Neglecting adequate perfusion parameters resulted in substantial errors with respect to the prediction of the final laser lesion.

Adult↗

In vivo MRI thermometry using a phase-sensitive sequence: preliminary experience during MRI-guided laser-induced interstitial thermotherapy of brain tumors.

The purpose of this study was the application of the proton-resonance-frequency method to monitor laser-induced interstitial thermotherapy (LITT) in a patient with an astrocytoma WHO II. A phase-sensitive two-dimensional (2D) fast low-angle shot (FLASH) sequence was used to determine the temperature-related phase shifts during LITT. Temperature maps were displayed during therapy with a temporal resolution of 20 seconds. Irradiation was discontinued as soon as the 60 to 65 degrees C isotherm reached the margin of the tumor. A contrast-enhanced MRI study performed immediately after therapy showed a good correlation of the size of an enhancing rim around the lesion with the 60 to 65 degrees C isotherm. The preliminary results of our study indicate that MRI guidance of LITT may be improved by temperature quantification based on the proton-resonance-frequency method.

Astrocytoma↗

MRI-guided laser-induced interstitial thermotherapy of cerebral neoplasms.

OBJECTIVE: Laser-induced interstitial thermotherapy (LITT) using a neodymium:yttrium aluminum garnet (Nd: YAG) laser is a new therapeutic approach in the treatment of brain tumors. The purpose of our study was to determine the value of MRI in monitoring LITT. MATERIALS AND METHODS: Eight patients with intracerebral tumors were treated with LITT. The light guide was inserted via an applicator sheath that was implanted stereotaxically with CT guidance. The laser irradiation was performed within the MR unit and monitored by repetitive measurements of a T1-weighted 2D-FLASH sequence. RESULTS: During therapy in all patients, typical changes of signal intensity were seen. A gradually increasing central zone of high signal intensity was surrounded by an increasing peripheral area of reduced signal intensity. The diameter of an enhancing rim at the outer border of the peripheral area after Gd-DTPA was considered as the total lesion size. The lesion size as determined on 2D-FLASH scans during LITT accounted for 88-100% (mean 93.5%) of total lesion size on T1-weighted images after Gd-DTPA acquired immediately after therapy. On T2-weighted images the signal intensities of the two zones were vice versa. Follow-up studies showed a decrease of total lesion size (15-87%). CONCLUSION: Our results demonstrate that MRI is feasible and effective in monitoring LITT. However, the role of LITT in the therapeutic workup of brain tumors still has to be defined in future clinical studies.

Adult↗

Laser-induced thermal lesions in the human brain: short- and long-term appearance on MRI.

PURPOSE: The purpose of our study was to investigate with MRI the development of thermal lesions in the human brain up to almost 4 years after laser-induced interstitial thermotherapy (LITT). METHOD: Eighteen patients with brain tumors who underwent LITT entered the study. RESULTS: In all patients the acute lesion comprised five concentric zones that showed reverse signal intensities on T1- versus T2-weighted images. Lesion development over time was uniform in 89% of the lesions. In two cases variations were observed. CONCLUSION: The results of our MR follow-up studies showed that post-LITT, laser-induced lesions will shrink exponentially after an initial expansion without any pseudocystic effects.

Adult↗