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Biomedical subjects

M D Rifkin

Publications and source records attributed to M D Rifkin.

At least 19 recordsLinked to original sources

Partial angle inversion recovery (PAIR) MR imaging: spin-echo and snapshot implementation.

The effects of varying the inversion or excitation RF pulse flip angles on image contrast and imaging time have been investigated in IR imaging theoretically, with phantoms and with normal volunteers. Signal intensity in an IR pulse sequence as a function of excitation, inversion and refocusing pulse flip angles was calculated from the solution to the Bloch equations and was utilized to determine the contrast behavior of a lesion/liver model. Theoretical and experimental results were consistent with each other. With the TI chosen to suppress the fat signal, optimization of the excitation pulse flip angle results in an increase in lesion/liver contrast or allows reduction in imaging time which, in turn, can be traded for an increased number of averages. This, in normal volunteers, improved spleen/liver contrast-to-noise ratio (9.0 vs. 5.7, n = 8, p less than 0.01) and suppressed respiratory ghosts by 33% (p less than 0.01). Reducing or increasing the inversion pulse from 180 degrees results in shorter TI needed to null the signal from the tissue of interest. Although this decreases the contrast-to-noise ratio, it can substantially increase the number of sections which can be imaged per given TR in conventional IR imaging or during breathold in the snapshot IR (turboFLASH) technique. Thus, the optimization of RF pulses is useful in obtaining faster IR images, increasing the contrast and/or increasing the number of imaging planes.

Abdomen

Polycythemia vera and myelofibrosis: correlation of MR imaging, clinical, and laboratory findings.

Magnetic resonance (MR) imaging was performed in 14 patients with biopsy-proved polycythemia vera (n = 4) or myelofibrosis (n = 10) to determine whether MR imaging findings can be correlated with the clinicopathologic diagnosis and established clinical parameters of severity (serum lactate dehydrogenase [LDH] and cholesterol levels) and chronicity (spleen size). Evaluation of marrow in the proximal femurs showed that patients could be categorized into three distinct groups based on anatomic patterns of normal fatty and abnormal low-signal-intensity (non-fatty) marrow in the femoral capital epiphysis (FCE) and greater trochanter (GT). Patients with nonfatty marrow in both the FCE and GT (n = 8) had significantly higher serum LDH (P less than .02) and lower serum cholesterol (P less than .02) levels than patients with fatty marrow in at least the GT (n = 6). Splenic volume, as measured from MR images, was significantly greater in the myelofibrosis group than in the polycythemia vera group (P less than .001). MR imaging provided a better understanding of these hematologic disorders and novel parameters for classification that are different from conventional histologic and laboratory data.

Adult

MR imaging in adenocarcinoma of the prostate: interobserver variation and efficacy for determining stage C disease.

Patients with adenocarcinoma of the prostate confined to the gland (stage B) are candidates for a potentially curative surgical procedure (radical retropubic prostatectomy). However, patients with adenocarcinoma that penetrates the capsule or invades the seminal vesicles (stage C) are no longer considered good candidates for surgical cure of their disease. The purpose of this study was to compare the ability of four radiologists to detect stage C disease on MR images and to evaluate interobserver variability. One hundred consecutive MR studies of the prostate were reviewed independently by four radiologists to determine whether the cancer was stage C (capsule penetration or seminal vesicle invasion by tumor). A radical prostatectomy was performed in each case, and careful histologic assessment was made of the prostatic capsule and seminal vesicles for any evidence of stage C disease. The sensitivity, specificity, and accuracy (true-positive + true-negative/100 patients) in detecting stage C disease were calculated for each of the four readers. Four receiver-operating-characteristic curves were generated and compared by means of the univariate z score. Percentage agreement was calculated for five specific areas of the prostate on MR images, and observations made by the best reader were compared with the other three to help determine interreader variability. The results showed that the sensitivity and specificity of MR imaging in detecting stage C disease ranged from .24 to .61 (mean, .48) and .49 to .79 (mean, .66), respectively. The accuracy of MR imaging ranged from .47 to .61 (mean, .55). The univariate z score test showed that one of the readers significantly differed from the other three. The average percentage agreement between that reader and the other three was 70% for the five separate anatomic regions. This study shows that considerable interobserver variation exists in the interpretation of MR images for staging cancer of the prostate. The average accuracy among four radiologists in determining the presence of stage C adenocarcinoma of the prostate from MR images was only slightly above a chance guess at .55.

Adenocarcinoma

Testicular microlithiasis: sonographic and clinical features.

Eleven cases of bilateral diffuse microlithiasis of the testes were evaluated sonographically. The presence of testicular microlithiasis was coincidental to the presence of testicular neoplasms (n = 2), nontesticular malignant lesion in the abdomen or chest (n = 2), subfertility (n = 2), varicocele (n = 1), epididymitis (n = 1), testicular maldescent (n = 1), scrotal trauma (n = 1), and transient scrotal pain (n = 1). Clinical follow-up suggested that testicular microlithiasis is an asymptomatic nonprogressive condition. Sonographic examination of testicular microlithiasis shows diffuse hyperechoic nonshadowing foci measuring 1-2 mm in diameter throughout both testes. The diagnosis of testicular microlithiasis was pathologically proved in five cases. In six cases, the diagnosis was made on the basis of the sonographic appearance (n = 6), clinical information and follow-up (n = 6), and radiologic demonstration of testicular microcalcifications (n = 3). The sonographic appearance of testicular microlithiasis is specific, and we believe that biopsy or orchiectomy in these cases is unnecessary.

Adult

Ultrasound of the prostate--applications and indications.

Endorectal prostate ultrasound has become a clinically useful application. This paper describes the necessary understanding of the newer concepts of anatomy, origins of disease and indications for prostate ultrasound. These indications include: (1) an abnormal digital rectal examination, (2) biopsy guidance, (3) evaluation of the patient with known prostate cancer, (4) follow-up of patients with prostate cancer, (5) certain cases of infertility, (6) prostatic inflammation, (7) voiding studies, and (8) evaluation of prostate in selected patients without previously suspected pathology.

Algorithms

Magnetic resonance chemical shift imaging and spectroscopy of atherosclerotic plaque.

An in vivo magnetic resonance imaging (MRI) technique for identification and characterization of atherosclerotic plaque was assessed in animal and human models. Atherosclerosis was induced in the abdominal aorta of four rabbits by a combination of balloon denudation and a high cholesterol diet. In vivo conventional spin-echo and fat/water suppressed images of the rabbit aortae were obtained at 1.5 T. Chemical shift imaging (CSI) was achieved using a hybridization of selective excitation and modified Dixon techniques. These techniques were then used to obtain images of atherosclerotic lesions in the carotid arteries of four patients prior to endarterectomy. The MRI results were corroborated by histologic and high-resolution proton MR spectroscopic (8.5 T) analysis of rabbit aorta, human carotid endarterectomy, and six additional human superficial femoral and iliac atherectomy specimens. All animal and human lesions were classified as either fatty streaks or fibrotic plaque. When compared to conventional spin-echo images, fat suppression by CSI substantially improved the measured contrast-to-noise ratio between plaque and vessel lumen, and enhanced its discrimination from periadventitial fat. In contrast, water suppression eliminated visualization of plaque due to the negligible amount of isotropic (liquid-like) signal from the immobilized lesion lipids. Magnetic resonance spectroscopy corroborated the CSI results by demonstrating broad, ill-defined fat resonances characteristic of nonmobile lipids in both human and rabbit atherosclerotic lesions. These findings indicate that in vivo MRI of plaque is technically feasible and can be markedly improved using chemical shift imaging.

Animals

Hepatocellular carcinoma within siderotic regenerative nodules: appearance as a nodule within a nodule on MR images.

Large regenerative nodules in cirrhotic livers may accumulate iron and develop internal iron-poor foci of hyperplasia or malignancy. Magnetic resonance examinations were performed on 23 patients with biopsy-proved cirrhosis. A "nodule-within-nodule" appearance was noted in two patients. This appearance consisted of markedly low intensity of a large nodule on gradient-echo images, with one or two internal foci that were isointense to the liver. Each of the large nodules was 2 cm in diameter, and each of the internal foci was less than 1 cm. Serum alpha-fetoprotein levels were normal in both patients. Aspiration biopsy performed in one patient failed to show malignancy, but histologic confirmation of hepatocellular carcinoma was obtained eventually in both cases. The nodule-within-nodule sign, which reflects the unique histopathology of hepatocellular carcinoma in large siderotic regenerative nodules, is strongly suggestive of early hepatocellular carcinoma, even if serologic markers and biopsy results do not support this diagnosis.

Biopsy

Liver and pancreas: improved spin-echo T1 contrast by shorter echo time and fat suppression at 1.5 T.

T1-weighted spin-echo magnetic resonance (MR) images have had limited soft-tissue contrast at 1.5 T. The authors investigated the effects of echo-time (TE) minimization and fat suppression on MR images of the liver and pancreas. Two sets of MR images were obtained with identical repetition times and other parameters. In 10 subjects with seven liver lesions, images with TEs of 20 and 12 msec were compared. In 18 additional subjects with seven liver lesions and five pancreatic carcinomas, images with identical TEs but with and without fat suppression were compared. Contrast-to-noise ratios (CNRs) were greater with a TE of 12 msec than with a TE of 20 msec for liver versus spleen (7.6 vs 4.9, P = .014) and liver versus lesion (6.9 vs 3.9, P = .031). In patients without fatty liver, CNR for six lesions versus liver was greater (9.5 vs 6.0, P = .014) with fat suppression. CNR between glandular pancreas and cancer was most conspicuous with fat suppression, but fat planes were less distinct. Minimization of TE improves T1-weighted images significantly. Fat suppression also improves CNR, but the disadvantages of fat suppression do not allow elimination of conventional T1-weighted images.

Fatty Liver

Palpable masses in the prostate: superior accuracy of US-guided biopsy compared with accuracy of digitally guided biopsy.

The accuracies of digitally guided biopsy versus ultrasound (US)-guided biopsy of the prostate were compared in 112 consecutive men with palpable prostatic lesions who had previously undergone conventional digitally guided biopsy and in which the results were negative for carcinoma. US-guided biopsies were performed with either the transperineal (n = 51) or transrectal (n = 61) approach, by means of previously described methods. All US-guided biopsies were performed within 3 months after the most recent conventional biopsy. In 44 patients (39.3%) with negative results of conventional biopsies, the results of US-guided biopsy revealed cancer. The transrectal and transperineal digitally guided biopsies were equally inaccurate, and the transrectal and transperineal US-guided biopsies showed no statistically significant differences in accuracy. The patients accepted and tolerated both US techniques equally well; neither technique was associated with significant complications. It is concluded that all patients with a palpable nodule should undergo US-guided biopsy if the result of conventional digitally guided biopsy is negative for cancer and the diagnostic US scan suggests an abnormality.

Biopsy, Needle

Parenchymal versus reticuloendothelial iron overload in the liver: distinction with MR imaging.

Parenchymal iron deposition occurs in hemochromatosis, while iron is deposited in reticuloendothelial (RE) cells after blood transfusions or rhabdomyolysis. Magnetic resonance images of patients with decreased liver signal intensity on T2-weighted images at 1.5 T were blindly compared in an effort to distinguish these conditions. In each of five patients with hemochromatosis, the pancreas had low signal intensity, but splenic signal intensity was decreased in only one. In contrast, only three of the 16 patients with RE iron overload had low pancreatic signal intensity, while all of these patients either had low splenic signal intensity (n = 14) or previously underwent splenectomy (n = 2). Distinction among these causes of iron deposition is clinically important because parenchymal iron overload from hemochromatosis may produce significant tissue damage, while the RE iron of transfusions and rhabdomyolysis is of little clinical consequence.

Adolescent

Comparison of Kaopectate with barium for negative and positive enteric contrast at MR imaging.

In an evaluation of safe, inexpensive, orally administered contrast agents for use at magnetic resonance imaging, different concentrations of the clay agents kaolin-pectate and attapulgite were compared in an in vitro phantom by performing spin-echo imaging with variable echo times to estimate T2 relaxation time. Additional phantoms containing from 0% to 100% attapulgite or barium preparations were compared by using spin-echo and spoiled-gradient-echo techniques to estimate T1, T2, and T2* relaxation times. In vivo spin-echo and gradient-echo images were obtained of 10 healthy volunteers and of five patients with pancreatic disease after oral administration of 12-16 oz of attapulgite preparation. T1 and T2 relaxation times obtained with use of attapulgite were slightly lower than those obtained with kaolin-pectate at both 50% and 25% concentrations. Compared with barium, attapulgite had shorter T1, T2, and T2* relaxation times, and concentration-dependent relaxivity was greater by nearly an order of magnitude. All subjects were able to drink the attapulgite, and the only complaints were of bad taste and mildly loose stools.

Barium Sulfate

Color Doppler as an adjunct to prostate ultrasound.

Endorectal ultrasound of the prostate with color Doppler is a new technique to identify internal vasculature and flow. In a period of one year more than 500 men have been examined with this technique. The normal prostate will demonstrate flow within the surrounding vasculature; there is no distinguishing flow among the various zones. In prostate cancer there is an increased flow within or surrounding the lesion. Diffuse prostatitis exhibits a diffusely abnormal flow; in focal prostatitis the flow is not significantly different from cancer. In benign prostatic hyperplasia a significant abnormal flow was seen, usually in the inner gland, and flow was frequently identified in the area of the surgical capsule. Color Doppler can provide additional physiologic information for prostate ultrasound and may increase the specificity and sensitivity of the examination in the evaluation of potential prostatic malignancy.

Humans

Fatty liver. Chemical shift phase-difference and suppression magnetic resonance imaging techniques in animals, phantoms, and humans.

In vitro animal and human models were used to evaluate the potential of chemical shift magnetic resonance imaging (MRI) for assessing fatty liver. Phantoms of varying fat content were created from mayonnaise-agar preparations. Fatty liver was induced in eight rats by feeding them ethanol for three to six weeks (36% of total calories), whereas eight control rats were fed a normal diet. T1-weighted in-phase and opposed-phase MR images were obtained of the phantoms animals, and 28 human subjects. Additional images obtained in animals included long TR images with in-phase and opposed-phase technique, and hybrid chemical shift water and fat suppression. The rats were killed and histologic status was graded blindly by a hepatopathologist as normal, mild, moderate, or severe fatty change, for correlation with MR grading. Quantitative analysis of MR images included fat signal fraction for animals, and relative signal decrease between in-phase and opposed-phase images for phantom and human data. Phantom in-phase signal increased linearly with respect to fat content, whereas opposed-phase signal decreased linearly. MRI and histologic grading of rat livers were highly correlated, especially when based on water suppression images (r = 0.91, P = .0001). Opposed-phase images were also highly correlated, while fat suppression images were less effective. There was no overlap between MR-derived fat fractions for control (2.6%-5.7%) versus ethanol-fed rats (7.7%-17.9%, P = .0002). Human liver considered to be fatty by visual inspection (n = 8) had higher relative signal decrease than nonfatty liver (n = 22) (P less than .001). Phantom, animal, and human data demonstrate that comparison of T1-weighted in-phase and opposed-phase images is both practical and sensitive in the detection and grading of fatty liver.

Adult

Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer. Results of a multi-institutional cooperative trial.

BACKGROUND: In 1987, a cooperative study group consisting of five institutions was formed to determine the relative benefits of magnetic resonance imaging (MRI) and endorectal (transrectal) ultrasonography in evaluating patients with clinically localized prostate cancer (stage Ta or Tb). METHODS: Over a period of 15 months, 230 patients were entered into the study and evaluated with identical imaging techniques. We compared imaging results with information obtained at the time of surgery and on pathological analysis. RESULTS: MRI correctly staged 77 percent of cases of advanced disease and 57 percent of cases of localized disease; the corresponding figures for ultrasonography were 66 and 46 percent (P not significant). These figures did not vary significantly between readers; moreover, simultaneous interpretation of MRI and ultrasound scans did not improve accuracy. In terms of detecting and localizing lesions, MRI identified only 60 percent of all malignant tumors measuring more than 5 mm on pathological analysis and ultrasonography identified only 59 percent. CONCLUSIONS: The MRI and ultrasonography equipment that is currently available is not highly accurate in staging early prostate cancer, mainly because neither technique has the ability to identify microscopic spread of disease. Further evaluation with improved equipment may improve the accuracy of these techniques.

Adult

MRI of aggressive fibromatosis: frequent appearance of high signal intensity on T2-weighted images.

Magnetic resonance imaging of seven patients with eight pathologically proven desmoid tumor tumors was performed and retrospectively reviewed. On T2-weighted images, all but one lesion demonstrated increased signal intensity relative to muscle, and had signal intensity similar to that of fat. The signal was heterogenous in six of these seven lesions. In a patient with synchronous multicentric lesions, light microscopy correlation revealed increased cellularity in one lesion with increased signal intensity and dense collagenous elements in a second lesion, with decreased signal intensity. High signal intensity appears to be typical but nonspecific, and in following these patients could indicate recurrent tumor, superimposed inflammatory process or granulation tissue.

Abdominal Neoplasms

Bone marrow findings on magnetic resonance images of the knee: accentuation by fat suppression.

Long TR/double spin-echo magnetic resonance images of the knee were obtained with and without the use of fat suppression techniques in seven patients with high signal intramedullary lesions. Comparison between images was performed qualitatively and quantitatively. Contrast-to-noise ratios between focal defects and surrounding fatty marrow were higher with fat suppression in all cases. The mean contrast-to-noise ratio for images obtained with fat suppression was 53.6, while for images obtained without fat suppression the mean contrast-to-noise ratio was 17.3 (p less than 0.01).

Adipose Tissue

Variable flip angle imaging and fat suppression in combined gradient and spin-echo (GREASE) techniques.

Conventional "proton density" and "T2-weighted" spin-echo images are susceptible to motion induced artifact, which is exacerbated by lipid signals. Gradient moment nulling can reduce motion artifact but lengthens the minimum TE, degrading the "proton density" contrast. We designed a pulse sequence capable of optimizing proton density and T2-weighted contrast while suppressing lipid signals and motion induced artifacts. Proton density weighting was obtained by rapid readout gradient reversal immediately after the excitation RF pulse, within a conventional spin-echo sequence. By analyzing the behavior of the macroscopic magnetization and optimizing excitation flip angle, we suppressed T1 contribution to the image, thereby enhancing proton density and T2-weighted contrast with a two- to four-fold reduction of repetition time. This permitted an increased number of averages to be used, reducing motion induced artifacts. Fat suppression in the presence of motion was investigated in two groups of 8 volunteers each by (i) modified Dixon technique, (ii) selective excitation, and (iii) hybrid of both. Elimination of fat signal by the first technique was relatively uniform across the field of view, but it did not fully suppress the ghosts originating from fat motion. Selective excitation, while sensitive to the main field inhomogeneity, largely eliminated the ghosts (0.21 +/- 0.05 vs. 0.29 +/- 0.06, p less than 0.01). The hybrid of both techniques combined with bandwidth optimization, however, showed the best results (0.17 +/- 0.04, p less than 0.001). Variable flip-angle imaging allows optimization of image contrast which, along with averaging and effective fat suppression, significantly improves gradient- and spin-echo imaging, particularly in the presence of motion.

Adipose Tissue