Biomedical subjects

O Smedby

Publications and source records attributed to O Smedby.

At least 19 recordsLinked to original sources

PubMed2001

Allergic reactions at repeat femoral angiography with ioxaglate.

PURPOSE: To study the occurrence of allergy-like reactions at angiography, repeated several times, and, secondly, to evaluate the effect of prophylactic treatment in individuals who had earlier experienced such reactions. MATERIAL AND METHODS: One hundred and fifty-seven patients with hypercholesterolaemia, participating in the Probucol Quantitative Regression Swedish Trial (PQRST), underwent aortofemoral angiography with ioxaglate (Hexabrix) repeated annually for 3 years. Allergic reactions to the contrast medium were recorded. At the following angiographies, all patients who had earlier experienced such reactions were treated prophylactically with steroids and antihistamine. RESULTS: Allergic reactions were observed in 35 patients. Twelve reacted only year 0, 3 only year 1, 5 only year 2 and 6 only year 3. Eight patients had at least one reaction also when treated prophylactically. It was significantly (p<0.05) more common to react at year 0 but not at year 1 than to react at year 1 but not at year 0. At years 1, 2 and 3 the frequency of reactions was significantly greater in the group given prophylactic treatment than in the group without any earlier reaction at all: 8/20 versus 3/137, 4/23 versus 6/134, and 6/29 versus 6/128, respectively. CONCLUSION: Some individuals had an increased risk of an allergy-like reaction to the contrast agent. Prophylactic treatment reduced the risk of renewed reactions, but not to the same level as for those without earlier reaction. Nevertheless, individuals who have had earlier reactions can be investigated in the future, with prophylactic treatment.

Adult↗

PubMed2000

MRI-guided celiac plexus block.

Celiac plexus block is used as a palliative procedure in cases of severe upper abdominal pain caused by pancreatitis or tumors of the pancreas. It can be guided by bony landmarks, fluoroscopy, ultrasound (US), or computed tomography (CT). To avoid severe complications, methods visualizing soft tissue, like CT and magnetic resonance (MR) imaging, are preferable. We describe celiac plexus blocks carried out in an open MR scanner, offering needle guidance with an optical tracking system and near real-time image acquisition. Eight patients with severe chronic abdominal pain were included. In these, 14 celiac blocks were carried out. Good or total pain relief was achieved in 8 of the 14 blocks (57%), a moderate effect in 5 blocks (36%), and no effect in 1 block (7%). The placement of the needle was easily guided with MR in all cases. The MR technique ensures good visualization of soft tissue, direct monitoring of needle movement and avoids exposure to ionizing radiation. Celiac plexus block can safely be carried out in an open MR scanner.

Abdominal Pain↗

PubMed2000

Functional imaging of the thoracic outlet syndrome in an open MR scanner.

Symptoms due to thoracic outlet syndrome may present only in abduction, a position that cannot be investigated in conventional MR scanners. Therefore, this study was initiated to test MRI in an open magnet as a method for diagnosis of thoracic outlet syndrome. Ten volunteers and 7 patients with a clinical suspicion of thoracic outlet syndrome were investigated at 0.5 T in an open MR scanner. Sagittal 3D SPGR acquisitions were made in 0 and 90 degrees abduction. In the patients, a similar data set was also obtained in maximal abduction. To assess compression, the minimum distance between the first rib and the clavicle, measured in a sagittal plane, was determined. In the neutral position, no significant difference was found between patients and controls. In 90 degrees abduction, the patients had significantly smaller distance between rib and clavicle than the controls (14 vs 29 mm; p < 0.01). On coronal reformatted images, the compression of the brachial plexus could often be visualised in abduction. Functional MR examination seems to be a useful diagnostic tool in thoracic outlet syndrome. Examination in abduction, which is feasible in an open scanner, is essential for the diagnosis.

Adult↗

PubMed2000

Gadolinium-enhanced magnetic resonance angiography, digital subtraction angiography and duplex of the iliac arteries compared with intra-arterial pressure gradient measurements.

PURPOSE: to compare gadolinium-enhanced magnetic resonance angiography (Gd-MRA), digital subtraction angiography (DSA) and duplex of the iliac arteries with intra-arterial pressure gradient measurement as the reference method. MATERIALS AND METHODS: Gd-MRA, DSA and duplex examinations of the iliac arteries were performed in 30 patients (60 arteries) with lower-limb arterial occlusive disease. In 29 arteries, pressure measurements were made (n=25) or the artery was found to be occluded on catheterisation (n=4). An aortofemoral peak systolic pressure gradient of 20 mmHg or more was regarded as haemodynamically significant. Stenoses with a diameter reduction of 50% or more on MRA or DSA, or an increase in peak systolic velocity greater than 150% (duplex) were considered significant. MRA examinations were evaluated by means of maximum intensity projections (MRA-MIP) and using source images and curved multiplanar reconstruction (MRA-MPR). RESULTS: the sensitivity (specificity) for a significant iliac artery stenosis were 81% (75%) for MRA-MIP, 76% (75%) for MRA-MPR, 86% (88%) for DSA, and 72% (88%) for duplex. CONCLUSION: with intra-arterial pressure measurements as the reference method, similar results were achieved with Gd-MRA, DSA and duplex concerning the detection of haemodynamically significant iliac artery stenoses. The use of source images and multiplanar reconstructions resulted in higher accuracy for the detection of occlusions.

Aged↗

PubMed1999

Characterization of human head vasculature by percolation parameters.

A data reduction procedure, originally proposed for characterization of fractals and random percolation clusters, has been used to evaluate the vascular system of the human head. The motivation behind this study arose from the wish to study empirically transport properties of vascular systems and to find a suitable formalism for their description. MR angiographic data acquired by a standard 3D inflow method were used. The evaluated parameters refer to the backbone fractal dimensionality and the correlation length. The fractal dimensionality of the backbone was found to be 1.71 for the human head vasculature. This value fits the theoretical range of random percolation networks. It is concluded that concepts of percolation theory might have some value for characterizing the structure and transport properties of the vascular system.

Brain↗

PubMed1999

Quantitation of atherosclerosis by magnetic resonance imaging and 3-D morphology operators.

The objective was to ascertain whether MRI and image processing can be used to quantify atherosclerosis by measuring wall thickness in rabbit aorta. The abdominal aortas of 2 healthy and 5 atherosclerotic rabbits were examined with a gradient-echo inflow angiography sequence (2DI) and a proton density weighted turbo-spin-echo sequence (PDW). Using thresholding by four observers and 3D morphology operators, segmentation of the artery and vein lumina was performed from the 2DI sequence, and of surrounding fat and muscle from the PDW sequence. Remaining voxels adjacent to the aortic lumen were classified as vessel wall. By measuring the vessel wall volume and the lumen volume, the wall percentage was calculated. The values were significantly higher for the diseased animals than for unaffected individuals (p < 0.01). It is concluded that aortic wall thickening in atherosclerotic rabbits can be measured quantitatively by using MRI combined with 3D morphology image processing operators.

Animals↗

PubMed1999

Timing adjustment in gadolinium MR angiography by raw data recombination. Technical note.

To solve the problem of injection timing in gadolinium MR angiography, a simple procedure is proposed which allows the acquisition interval to be chosen after injection. Starting simultaneously with the injection, several consecutive acquisitions are made, after which raw data acquired in a contiguous interval with a variable starting time are recombined to one data set, which is then used for delayed image reconstruction.

Aged↗

PubMed1998

2D inflow MR angiography in severe chronic leg ischemia.

PURPOSE: The aim of this study was to compare 2D inflow MR angiography (MRA) with selective X-ray angiography (XRA) in patients with severe chronic leg ischemia. MATERIAL AND METHODS: In a blinded prospective study, 2D inflow MRA and XRA were compared with regard to evaluation of the arteries distal to the knee in 24 patients (median age 72 years) with severe ischemia; 23 of them had either rest pain or tissue loss. Statistics were calculated with XRA as the reference method. RESULTS: The interpretations of 2D inflow MRA and XRA showed moderate agreement in the calf arteries but poor agreement in the foot arteries. Of the discrepancies, two-thirds were observer-related and only one-third method-related. Of all the comparable arteries, 9% showed method-related differences between the two methods. An assessment of MRA using only maximum intensity projections (MIP) resulted in 19% of findings being judged inconclusive whereas all the arteries could be classified when the cross-sectional images were studied on the viewing console. CONCLUSION: The agreement between MRA and XRA was good in the calf but questionable in the foot.

Adult↗

PubMed1997

Magnetic resonance angiography in the resectability assessment of suspected pancreatic tumours.

The aim of this prospective study was to evaluate MRI, including MR angiography (MRA), in the preoperative assessment of the resectability of suspected malignancy of the pancreas. A total of 17 patients with suspected pancreatic carcinoma and planned surgery were investigated with conventional angiography, ultrasonography with Doppler technique, MRI and MRA. The MRA protocol included both 2D inflow angiography and 3D phase-contrast angiography. Surgery was carried out in 13 patients. The image quality of MRA was judged satisfactory in all cases. The findings with respect to vascular involvement agreed between the radiological methods in all but 3 cases. When the findings were correlated with the final diagnosis, one false-negative case was found for each of the three methods. The results suggest that MRI with MRA, including both the phase-contrast and inflow techniques, has a similar diagnostic value to that of conventional angiography and ultrasonography in the preoperative assessment of the portal venous system in patients with pancreatic carcinoma. Further studies are needed to establish the optimal diagnostic procedure.

Biopsy↗

PubMed1997

Do plaques grow upstream or downstream?: an angiographic study in the femoral artery.

Although the distribution of atherosclerosis has been described, little is known about the direction of growth of plaques. In this study, 237 patients with slight or moderate atherosclerosis underwent femoral angiography twice at a 3-year interval, and the films were studied with computerized image analysis. First, atherosclerosis was measured as edge roughness, and the change in roughness of each 1-cm segment over the 3-year period was related to the edge roughness of the segments immediately upstream and downstream. On the medial side of the artery, the change in edge roughness was found to be more strongly related to the roughness values upstream than to those downstream of the segment studied. This suggests that growth in the downstream direction is more common than growth in the upstream direction. On the lateral side, more equivocal results were obtained. Atherosclerosis was also assessed by study of the cross-sectional area of the artery as a function of distance along the vessel. A mathematical model of plaque growth was formulated as a nonlinear filtering of this curve. Growth in the downstream direction was significantly (P<.001) more frequent than growth in the upstream direction. The findings are compatible with an atherogenic effect of fluid mechanical disturbances, such as flow separation, that may occur downstream of a stenosis.

Adult↗

PubMed1996

Development of femoral atherosclerosis in relation to flow disturbances.

Angiography and post-mortem studies have indicated that disturbed blood flow may promote atherogenesis. Our aim was to demonstrate flow disturbances in vivo and correlate them to the subsequent development of atherosclerosis. The femoral arteries of 17 patients with early atherosclerosis were studied with cineangiography. The films are digitized and analyzed with an image analysis computer. From the time-intensity curves, the arrival time of the contrast medium at each pixel was calculated. In the resulting parametric images, the computer identified zones of delayed contrast filling, (ZDF) which have been shown to correspond to disturbed flow. The progression or regression of atherosclerosis was followed with another angiography 3 years later by computing changes in edge roughness. Arterial segments without flow disturbances (defined as ZDF) showed a more marked decrease in edge roughness than those with flow disturbances (p < 0.05). In addition, the edge roughness tended to increase more in segments with larger ZDF area. Angiographic studies of fluid mechanics and atherogenesis are feasible, but larger patient materials are needed.

Adult↗

PubMed1996

Anatomical variations of the human vestibular aqueduct. Part I. A radioanatomical study.

Variations in the size and shape of the human vestibular aqueduct were evaluated in 118 plastic casts of unselected specimens of human temporal bones. They were examined by conventional radiography and by high resolution CT. The degree of the mastoid and perilabyrinthine pneumatization was defined and classified into 3 types. The dimensions of the peripheral portion of the aqueduct were found to be related to the extent of the perilabyrinthine pneumatization.

Humans↗

PubMed1996

Anatomical variations of the human vestibular aqueduct. Part II. A radioanatomical study.

The human vestibular aqueducts are classified into 3 types and into the types hyper-, normo- and hypoplastic. The types correspond with each other up to over 85%. For a better understanding of the radioanatomy and for the proper interpretation of radiograms, we describe the presence of a flat recess-like widening of the peripheral portion of the aqueduct, as well as other findings.

Humans↗

PubMed1996

Anatomical variations of the tympanic and mastoid portions of the facial nerve canal. A radioanatomical investigation.

PURPOSE: To obtain information on the morphology of the tympanic and mastoid portions of the facial nerve canal, and on the appearance of unusual vascular channels and anomalies such as dehiscences. MATERIAL AND METHODS: One hundred and two temporal bone preparations were examined by conventional radiography to evaluate mastoid pneumatization. Of these, 73 were examined by high resolution CT in order to test the ability of the method to detect dehiscences in the bony wall of the tympanic portion of the canal and the accompanying channels along its mastoid portion. Subsequently produced plastic preparations were used to measure the length and width of these 2 portions of the facial canal. RESULTS: Our study reports observations on the three-dimensional morphology of the canal in the plastic casts. The study shows variations in the course and dehiscences of the tympanic portion. Additional bony channels along the mastoid portion are described. These results supplement those in previous investigations. CONCLUSION: The measurement results agree with those of previous investigations. The course of the tympanic portion is S-shaped and has an impression on its upper surface. High resolution CT reproduces dehiscences of the bony canal in a percentage similar to that of microscopical methods and in relevant sites. Pneumatization does not influence the dimensions of the 2 portions.

Ear, Middle↗

PubMed1995

Predilection of atherosclerosis for the inner curvature in the femoral artery. A digitized angiography study.

The degree of atherosclerosis in the inner and outer curvature of the femoral artery was studied by using digitized angiography and edge-roughness calculations in 301 hyperlipidemic patients. When the two edges of the vessel were compared no significant difference was seen, but when the local curvature was taken into account, inner curves were found to be more atherosclerotic than outer curves, and both inner and outer curves were more affected than straight segments. The same pattern was encountered in subpopulations defined by clinical or blood lipid criteria. The suggested explanation is that flow disturbances such as low shear rates or separated flow, which tend to arise along the inner curvature, promote the development of atherosclerosis.

Adult↗

PubMed1993

Flow disturbances in early femoral atherosclerosis--an in vivo study with digitized cineangiography.

Disturbances in arterial flow are believed to influence the localization and development of atherosclerotic plaques. The femoral arteries of 26 patients were studied with cineangiography, after which the films were digitized and analyzed with an image analysis computer. The image sequence was converted to a set of time-intensity curves, from which time parameters were calculated, representing the arrival time of the contrast medium at each pixel. In the resulting parametric images, zones of delayed contrast filling (ZDF) were identified by an adaptive thresholding, which identifies lighter regions within the vessel, excluding the smallest ones. The ZDF, which have been shown, in a model study, to correspond to disturbed flow, were more frequent in the inner curvature than in the outer curvature of the curved vessels. Accordingly, they were more frequent along the lateral wall than along the medial wall of the artery. Several ZDF were also found in the vicinity of bifurcations. Most of the findings tally closely with fluid mechanical theory. In future studies, flow disturbances are to be correlated with the progression of atherosclerotic lesions.

Adult↗

PubMed1992

Angiographic methods for the study of fluid mechanical factors in atherogenesis.

The purpose of this thesis is to investigate the feasibility of using angiographic methods to study, in vivo, fluid mechanical phenomena believed to influence the development and localization of atherosclerotic lesions, in particular, separated flow. This involved developing a method to recognize separated flow by digital analysis of cineangiography films, testing this method both with model measurements and in a clinical material, and a detailed analysis of certain methodological problems. In addition, methods have been developed to measure the tortuosity of arteries, a phenomenon which may, according to fluid mechanical theory, promote the occurrence of separated flow. In a glass model of an arterial bifurcation, a pump generated a pulsatile flow resembling that in large arteries. Using LDV (laser Doppler velocimetry) as a reference method, three velocity profiles in the symmetry plane of the model were recorded. During diastole, extensive separated flow was demonstrated in the larger branch of the bifurcation. The flow was then cineradiographed during injection of contrast medium, and the image sequence was transferred to an image analysis workstation. Treating the image sequence as a set of time-intensity curves, time parameters representing the arrival time of the contrast agent were computed. In the resulting parametric images, zones of delayed filling were identified and found to correspond to the separated flow. Viscosity was measured for seven radiographic contrast media and, as expected, the highest values were found for the largest molecules. For iohexol and ioxaglate, which were studied in detail, a linear relation to temperature and a quadratic relation to concentration were found. Whole-blood viscosity was measured for 5 healthy volunteers at high and low shear rates, before and after mixing with contrast agents in varying proportions. At low shear, viscosity decreased, while at high shear, it increased with increasing contrast concentration. The conclusion was that modern contrast media, despite their higher viscosity, seem to affect blood rheology less than older agents. In a study of the imaging characteristics of the digitization equipment for cinefilms, the resolution proved comparable to that of an entirely digital system, while the noise level was higher. Algorithms for the correction of variations in exposure and geometric distortion are also presented. The method for analysis of cinefilms, tried in the model study, was applied, with slight modifications, to a material of 26 patients with hyperlipidemia and slight or moderate atherosclerosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1992

Viscosity of some contemporary contrast media before and after mixing with whole blood.

The viscosity of 7 contrast media was measured using a rotational viscometer. When solutions with similar iodine concentrations were compared, the highest viscosities were found for the nonionic dimers iodixanol and iotrolan, the lowest for diatrizoate, iopamidol, and iopromide, and intermediate values for iohexol and ioxaglate. The viscosity of iohexol and ioxaglate was found to vary linearly with temperature and quadratically with concentration. Whole-blood viscosity was measured for 5 subjects at high and low shear rates before and after mixing with contrast media in various proportions. Low-shear viscosity was found to decrease and high-shear viscosity to increase with contrast medium concentration. It is concluded that the contrast media currently used may affect blood rheology less than previous agents, despite their higher viscosity.

Adult↗