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N Lundbom

Publications and source records attributed to N Lundbom.

33 records · Page 2Linked to original sources

Tissue characterisation of intracranial tumours: the value of magnetisation transfer and conventional MRI.

We performed MRI on 85 patients with intracranial tumours to evaluate quantitative analysis in tumour characterisation. Signal intensities were measured on standard T2- and T1-weighted images, Gd-enhanced T1-weighted images and magnetisation transfer (MT) images. Statistically significant differences between tumour types were observed, but overlapping reduces their value. T2-weighted imaging was superior to T1-weighted imaging for tumour characterisation. Quantification of Gd enhancement was useful in the diagnosis of pituitary adenomas and haemangioblastomas, but of minor importance in other tumours, because of large nonspecific variation. The contribution of MT contrast to tumour characterisation resembled that of T2 contrast. However, MT imaging was superior to other sequences in the classification of intra-axial tumours. Low-grade astrocytomas, haemangioblastomas and craniopharyngiomas could be differentiated from other tumours on the basis of MT contrast. Reliable discrimination between meningiomas, high-grade astrocytomas and metastases was not possible by any of the methods.

Adenoma↗

MR classification of brain gliomas: value of magnetization transfer and conventional imaging.

We compared quantitative analysis of conventional MR and magnetization transfer (MT) images with visual morphologic assessment of standard images in the classification of gliomas. Thirty-two patients with gliomas were imaged preoperatively. Relative signal intensities on T2- and T1-weighted images, Gd-enhancement, signal heterogeneity on T2-weighted and Gd-enhanced T1-weighted images and MT ratios were measured. In 16 astrocytomas, the MT ratios were correlated with the volume fraction of tumor cell nuclei in histological sections. Among the conventional sequences T2-weighted images were most accurate for quantitative classification; signal heterogeneity was more accurate than relative signal intensity. MT ratios were superior to quantitative analysis of conventional images and equal to visual morphologic evaluation in discriminating between low-grade and high-grade gliomas and correlated with the volume fraction of nuclei in the tumor tissue (r = 0.71, p < .01). The results indicate that quantitative analysis is generally of minor value in the grading of gliomas. In spite of sensitivity to tissue changes associated with malignancy MT imaging cannot significantly improve MR classification of gliomas.

Astrocytoma↗

Magnetization transfer in protein solutions at 0.1 T: dependence on concentration, molecular weight, and structure.

RATIONALE AND OBJECTIVES: We observed the magnetization transfer rates in a variety of protein solutions at 0.1-T magnetic field and compared our results with previous investigations at high magnetic fields (> 0.5 T). The effects of protein concentration, size, pH, denaturation, cross linking, and fiber formation were investigated. METHODS: We used the saturation transfer technique to determine the transfer of magnetization in gamma globulin, fibronectin, collagen, fibrinogen, and albumin solutions. RESULTS: The observed transfer rate increased with increasing concentration and size of the protein. Protein degradation decreased the transfer rate. Cross linking and fiber formation each increased the transfer rate, whereas buffer pH had no effect. CONCLUSION: Protein denaturation, aggregation, and fiber formation are important determinants of magnetization transfer in vitro. The size, concentration, and cross linking of the proteins contribute strongly to the transfer of magnetization at low fields, and the effect seems to be at least as important as at the higher fields.

Hydrogen-Ion Concentration↗

T1 in subacute and chronic brain infarctions. Time-dependent development.

RATIONALE AND OBJECTIVES: Time-dependent behavior of T1 in brain infarcts and in brain tissue of the contralateral hemisphere was studied in the subacute and early chronic stages of stroke. METHODS: T1 was measured from magnetic resonance images (MRIs) of 29 patients as a function of infarct location and age. Another group of 11 patients was studied with consecutive MRI studies during the first 5 weeks after the onset of infarct, and the distribution of T1 in the infarctions was analyzed from T1 maps using a histographic method. RESULTS: During the first 2 months after a stroke, T1 was longer in the infarcted gray matter than in the infarcted white matter (P = .002), and prolonged linearly in both. The histographic analysis showed a component arising from tissue breakdown products that could be identified for up to 5 weeks. A transient lengthening in T1 of the contralateral hemisphere, reaching a maximum at 3 weeks, also was observed. CONCLUSIONS: These characteristics of recent infarctions differentiate them from older, gliotic lesions. The lengthening of T1 in the contralateral hemisphere may reflect remote flow and metabolic effects of brain infarctions.

Acute Disease↗

Determination of magnetization transfer contrast in tissue: an MR imaging study of brain tumors.

OBJECTIVE: In this study, the magnetization transfer contrast (MTC) on MR images of several brain tumors and the correlation between MTC and tumors' histologic features were investigated. MTC depends on the extent of magnetization transfer, or cross-relaxation, from tissue water protons to macromolecular protons. On the basis of the known increase of the cross-relaxation rate with increasing molecular weight of protein in protein solutions, the hypothesis that changes in MTC correlate directly with the macromolecular composition of various tumors was tested. SUBJECTS AND METHODS: Preoperative MR images were obtained with a 0.1-T MR system in 40 patients with brain tumors. MTC was correlated with the histologic features and the dry weight of the tumors. The tumors studied included astrocytomas (10), acoustic schwannomas (three), meningiomas (12), pituitary adenomas (10), craniopharyngiomas (two), and hemangioblastomas (three). RESULTS: MTC was 0.43 in normal white matter and 0.42 in normal gray matter, and varied from 0.11 to 0.37 in the tumors. The mean MTC in astrocytomas (0.21 +/- 0.09) was smaller than the mean MTC in the gray matter (p = .0001) or in the other solid tumors (0.34 +/- 0.07 to 0.37 +/- 0.09, p < .002). MTC was larger in high-grade than in low-grade astrocytomas (0.28 +/- 0.05 vs 0.14 +/- 0.04, p = .0005). In meningiomas, MTC correlated with the collagen content of the tumor tissue (r = .95, p = .01). The differences in contents of solids between the solid tumor groups were not significant (p > or = .1, NS). CONCLUSION: When the previously demonstrated correlations between solid content and 1/T1 of the types of tumors studied are taken into consideration, the present results suggest a larger relative contribution from hydrodynamic vs cross-relaxation effects in astrocytomas than in benign tumors or in gray matter. The twofold difference in MTC between low- and high-grade astrocytomas probably reflects the amount of nuclear material in the tumor cells. Collagen content determined the differences in MTC among meningiomas. These results indicate that the major determinant of differences in MTC within these tumor groups is the high-molecular-weight tissue macromolecules, suggesting higher specificity for MTC than for T1 in discriminating between tissues on MR images.

Brain↗

Relaxometry of brain: why white matter appears bright in MRI.

The remarkable success of magnetic resonance imaging of adult brain relates to the unusually large ratio of the longitudinal relaxation rates 1/T1 of white and gray matter, approximately 2:1 at physiological temperature and traditional imaging fields. Several investigators have conjectured that myelin is the source of the greater 1/T1 of white matter without, however, suggesting details of the molecular mechanisms responsible. From measurements of the magnetic field dependence of 1/T1 (NMRD profiles) of adult and neonatal gray and white matter at 5 and 35 degrees C, we find a thermally activated contribution to the NMRD profile of adult white matter that is not present in the profiles of either adult gray or neonatal gray and white matter. We attribute this contribution to myelin and develop a quantitative model that accounts for the unique relaxation behavior of myelinated white matter. We find that myelin water, 15% of the total, has a relatively short T1 that arises from an unexpectedly large interaction with myelin lipid; when cast in terms of an interaction over the entire myelin bilipid-water interface, it is sevenfold greater than the analogous protein-water interfacial interaction. Its magnitude remains to be accounted for, but cholesterol, known to alter the relaxation rates of lipid protons, may play an important role. The contribution of myelin to 1/T1 at physiological temperatures is attributed to thermally activated transmembrane diffusion of water and, hence, more rapid mixing of axonal and the rapidly relaxing myelin water molecules.

Adult↗

Magnetic field dependence of 1/T1 of human brain tumors. Correlations with histology.

The authors have measured the magnetic field dependence of 1/T1 (nuclear magnetic relaxation dispersion, or NMRD profiles) of water protons of histologically characterized samples of astrocytomas, meningiomas, and lymphomas. The goal was to elucidate the determinants of 1/T1 of brain tumors at the cellular level and, in particular, to search for a possible correlation of the profiles with neoplastic properties, including degree of malignancy. Because of the recently demonstrated contribution of myelin to 1/T1 of white matter, careful histologic analyses were performed to correct for its presence. The range of magnitude of the profiles of differing types and grades of tumors correlates with the range of water content of these tumors; the correlation of water content with cellularity (density of cell nuclei in a histologic preparation), in turn, produces correlations of 1/T1 with tumor type. For all the tumors studied, 1/T1 is proportional to solids content; the constant of proportionality is relatively insensitive to tumor type and, for astrocytomas, grade of malignancy; and is about the same as that of normal gray matter. For low- and intermediate-grade astrocytomas that contain myelin, the myelin-specific contribution to 1/T1 has to be considered to make manifest the underlying correlations, which are best demonstrated at low fields, where the background contribution of water and dissolved oxygen is minimal. At high fields, where most imaging is done, a change in oxygen partial pressure, as for example from ischemia in very malignant tumors, is sufficient to alter 1/T1 significantly, reducing the intrinsic correlation between histology and 1/T1.

Astrocytoma↗

Gadolinium-enhanced magnetization transfer contrast imaging of intracranial tumors.

The magnetization transfer contrast (MTC) technique was used in low-field-strength (0.1 T) magnetic resonance (MR) imaging of 28 patients with intracranial tumors. MTC images were generated with an off-resonance, low-power radio-frequency pulse applied during the interpulse delay period of a gradient-echo partial-saturation sequence (TR msec/TE msec = 200/20). Images in the presence and absence of the MTC pulse were concurrently acquired before and after injection of gadopentetate dimeglumine at a dose of 0.1 mmol/kg. The contrast agent enhanced 27 of 28 tumors. Application of the MTC pulse improved the contrast-to-noise ratio (C/N) between tumor and normal white matter in 26 of 28 cases on the preinjection images and in 25 of 28 cases on the postinjection images. On the gadolinium-enhanced images, the mean C/N was 2.6 +/- 1.7 without the MTC pulse and 3.2 +/- 1.9 with the MTC pulse. The greatest contrast improvement with the MTC technique was obtained in tumors showing the strongest paramagnetic enhancement. The results indicate that MTC can improve contrast between normal brain and some intracranial neoplasms. The use of gadopentetate dimeglumine generally intensified this effect.

Adenoma↗

Tissue characterization of intracranial tumors by magnetization transfer and spin-lattice relaxation parameters in vivo.

T1s and magnetization transfer (MT) parameters of 36 intracranial tumors were determined in vivo at 0.1 T to assess their use in tissue characterization. The mobile water relaxation times (T1w) did not differ between tumor groups, whereas the T1s, the apparent MT relaxation times (T1a), and the parameters MT contrast (MTC) differed significantly between several tumor types. The MT rates (Rwm) demonstrated the most significant differences; Rwm values could reliably separate high grade and low grade gliomas. T1ws of the tumors were commonly in the same range as that of normal gray matter, whereas other parameters differed from those of normal brain. The results indicate that MT rates are superior to other parameters in the characterization of intracranial tumors and may be also useful clinically in the grading of gliomas.

Adenoma↗

Ultrasonic guidance of lumbar sympathetic and celiac plexus block: a new technique.

BACKGROUND AND OBJECTIVES: Lumbar sympathetic and celiac plexus block are widely used to treat chronic pain of diverse etiologies. To avoid complications and confirm the correct position of the needle, fluoroscopy and computed tomography have been used to follow the procedure visually. Our objective was to examine whether ultrasonography could be used instead of these techniques. METHODS: Forty-eight neurolytic sympathectomies were performed using ultrasonographic guidance. The results were evaluated clinically and by color-doppler technique as applicable. RESULTS: This new technique was shown to provide excellent results in ensuring the safe passage of the needle and documenting the correct spread of neurolytic agent (phenol-glycerol). The correct position of the needle was achieved on the first attempt in all cases. CONCLUSIONS: The benefits of this technique are that it is inexpensive, there is no radiation, and the anatomy involved can be thoroughly examined before and after the procedure. Phenolglycerol may be the best choice as the neurolytic agent because it provides excellent contrast.

Autonomic Nerve Block↗