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P Reimer

Publications and source records attributed to P Reimer.

136 records · Page 8Linked to original sources
PubMedDate not supplied

Dynamic gadolinium-enhanced echo-planar MR imaging of the liver: effect of pulse sequence and dose on enhancement.

To develop guidelines for clinical magnetic resonance imaging of the liver, the authors undertook an animal study to investigate the effect of dose and pulse sequence on liver signal intensity in gadopentetate dimeglumine-enhanced echo-planar imaging. Serial imaging of the liver was performed in anesthetized rats after intravenous administration of five different doses (0.01, 0.05, 0.1, 0.2, and 0.5 mmol/kg) of contrast agent, with six different pulse sequences. The results show that gadopentetate dimeglumine-enhanced echo-planar images obtained during the perfusion phase can yield either positive (due to increased T1 relaxation rates) or negative (due to susceptibility-induced increased T2 relaxation rates) liver enhancement depending on choice of pulse sequence and dose. At the current clinically recommended dose of 0.1 mmol/kg, maximal liver signal enhancement was seen with a T1-weighted inversion-recovery sequence, while maximal liver signal diminution was seen with a T2*-weighted gradient-echo sequence. The authors conclude that gadopentetate dimeglumine-enhanced echo-planar imaging can provide T1, T2, and T2* contrast that may be exploited for both lesion detection and lesion characterization.

Animals↗
PubMedDate not supplied

Assessment of reperfusion injury by means of MR contrast agents in rat liver.

The purpose of this study was to investigate whether extracellular MR contrast agents or intracellular liver-specific MR contrast agents may enable the assessment of liver reperfusion injury. Ischemia-related reperfusion was induced in 32 rats using Pringle's maneuver. Pringle's maneuver consisted of cross-clamping of the complete hepatoduodenal ligament for 45 minutes followed by 90 minutes of reperfusion. Two extracellular (gadopentetate dimeglumine and gadobutrol) and two intracellular gadoxetic acid and SH U 555 A) MR contrast agents were evaluated as model agents. Control animals and animals with liver ischemia were used to calculate changes in liver signal enhancement after Pringle's maneuver. Significant changes in liver signal after reperfusion injury were observed only with reticuloendothelial system (RES)-specific SH U 555 A. Liver signal enhancement after Pringle's maneuver with RES-specific SH U 555 A was decreased by 25.4% as compared with the control group. RES-specific contrast agents such as SH U 555 A seem to be more sensitive to ischemia-related dysfunction of the liver than hepatobiliary contrast agents such as gadoxetic acid or extracellular gadolinium chelates at different concentrations because Kupffer cells are more sensitive to liver ischemia than hepatocytes.

Analysis of Variance↗
PubMedDate not supplied

SPIO-enhanced 2D-TOF MR angiography of the portal venous system: results of an intraindividual comparison.

The purpose of this study was to investigate whether MR angiography (MRA) of the portal venous system may be improved by means of superparamagnetic iron oxides (SPIOs) during accumulation phase imaging and to study the underlying contrast mechanisms. MRA of the portal venous system was performed on 48 patients before and after intravenous injection of a new SPIO (Resovist, Schering AG, Berlin, Germany). Resovist, as a predominantly liver parenchymal darkening agent on T2-weighted MR images with uptake into the reticuloendothelial cell system, was administered intravenously by bolus injection of 8 to 12 micromol Fe/kg body weight. Patients were scanned with breath-hold coronal and axial two-dimensional (2D) time of flight (TOF) MRA (TR = 31.0 msec, TE = 9.8 msec, flip angle (FA) = 50 degrees, and 6.9-second acquisition time per section) sequences. Signal intensity values of liver parenchyma, the portal venous system, and background were obtained for quantitative analysis. The clinical relevance of additional plain and contrast-enhanced MRA studies for surgical planning was assessed by independent reading of three readers. Liver signal-to-noise ratio (SNR) significantly decreased following iv injection of Resovist; however, SNR values of the portal veins or hepatic veins did not change significantly. Visibility of the portal venous system improved significantly (tertiary branches visible: pre in 15.2% versus post in 87.0% of patients). Resovist-enhanced 2D-TOF MRA may improve planning of liver resections by better demonstrating the relationship of central liver lesions and vessels on source images. The decrease in liver SNR at a constant vessel SNR after iv injection of Resovist improves MRA of the liver. SPIO-enhanced 2D-TOF MRA scans are superior to plain 2D-TOF MRA studies and may be added for the workup of preoperative patients.

Contrast Media↗
PubMedDate not supplied

Preliminary clinical experience with laser-induced interstitial thermotherapy in patients with hepatocellular carcinoma.

The purpose of this preliminary study was to evaluate whether laser-induced interstitial thermotherapy (LITT) may be used for palliative treatment of localized hepatocellular carcinomas (HCC). We applied LITT to two patients suffering from unresectable localized hepatocellular carcinomas of different sizes (2.5 and 4 cm). LITT was performed with an Nd:YAG laser (1,064 nm) at 5 W laser power (15-20 minutes). Thermometry during LITT was performed by MRI using a temperature-sensitive T1-weighted fast low-angle shot (FLASH) sequence. Follow-up for local tumor control was performed by MRI and ultrasound. LITT was well tolerated and no adverse events occurred during or after LITT; no secondary liver lesions were seen in the follow-up (11 or 12 months, respectively). Only minimal tumor growth was observed in the larger HCC (from 4 to 5 cm), whereas the smaller HCC remained unchanged in size during 11 months of follow-up. We conclude that LITT might be an effective minimally invasive palliative treatment option for patients with small unresectable HCC.

Aged↗
PubMedDate not supplied

MR-monitored LITT as a palliative concept in patients with high grade gliomas: preliminary clinical experience.

The purpose of this study was to evaluate the clinical utility of laser-induced thermotherapy (LITT) as a palliative treatment for patients with high-grade gliomas. Four consenting patients with recurrent high grade III/IV gliomas near the primary language or motor areas were palliatively treated with LITT (2-5 W, 3-13 minutes; Neodym YAG Laser, Dornier, Friedrichshafen, Germany). Temperature monitoring was performed by T1-weighted turbo-fast low-angle shot (FLASH) imaging at 1.5 T (Siemens Magnetom SP 4000, Siemens, Erlangen, Germany). MRI studies before LITT included contrast-enhanced conventional scans and functional activation studies to localize the primary motor cortex or language areas using an echo-planar imaging (EPI) spin-echo (SE) sequence. Follow-up studies consisted of contrast-enhanced conventional scans as well as diffusion studies (contrast-enhanced Fourier-acquired steady-state technique and EPI-SE) and perfusion studies (EPI-SE with .2 mmol of gadolinium (Gd)/kg body weight) to differentiate post-therapeutic effects from residual or recurrent tumor growth. Local tumor control was achieved in areas with laser energy deposition with clinically stable conditions > or = 6 months. Conventional contrast-enhanced scans demonstrated strong enhancement surrounding ablated tumor components, which showed a reduction in CBV/CBF. Perfusion studies were useful to discriminate granulomatous tissue enhancement from residual or recurrent tumor growth. Careful application of LITT may evolve as an alternative palliative concept for patients with end-stage high-grade cerebral gliomas reducing clinical symptoms from circumscribed areas of pathology.

Adult↗
PubMedDate not supplied

Preclinical assessment of hepatocyte-targeted MR contrast agents in stable human liver cell cultures.

Much effort has been expended in the search for hepatocyte-specific MR contrast agents to improve the detection and characterization of liver tumors. The purpose of this study was to establish human hepatocyte cell cultures to preclinically assess hepatocyte-targeted magnetopharmaceuticals. Cultured human hepatocytes were sandwiched between two layers of collagen preserving both hepatocyte function and morphology over prolonged period of time. Cultures (n = 37) were subsequently used to test different fluorescinated MR contrast agents. Plain and rhodaminated monocrystalline iron oxide particles (MION and MION-rh) and asialoglycoprotein-receptor-specific rhodaminated asialofetuin coupled to MION (MION-ASF-rh) were prepared. Competition experiments of these agents were performed with D(+)-galactose to study the specificity of galactose-mediated cell uptake. To assess the impact of cell integrity on cell uptake, functional experiments with CCl4 were performed. Normal cell cultures showed significantly higher fluorescence light emission after incubation with hepatocyte-directed ASF-MION-rh than after incubation with MION-rh. Competition experiments of ASF-MION-rh with galactose showed a dose-dependent decrease of calibrated fluorescence light emission. Cell cultures treated with CCl4 demonstrated a dose-dependent significant reduction of calibrated fluorescence light emission, indicating reduced uptake of ASF-MION-rh. Our data demonstrate that stable human hepatocyte cell cultures can be used to preclinically assess novel magnetopharmaceuticals. Different contrast agents may be directly compared to each other and may accelerate their preclinical design. Because the assay can be applied to cells from any species, it may represent an ideal test system before clinical trials of new cell-directed MR contrast agents.

Asialoglycoprotein Receptor↗
PubMedDate not supplied

Hepatic MR imaging: comparison of RARE derived sequences with conventional sequences for detection and characterization of focal liver lesions.

BACKGROUND: We compared two T2-weighted turbo spin echo (TSE) sequences with a T2-weighted conventional SE (CSE) sequence to determine whether sequences derived from rapid acquisition with relaxation enhancement such as TSE could replace CSE for the detection and subsequent characterization of focal liver lesions. METHODS: A total of 55 consecutive patients with 107 liver lesions underwent magnetic resonance imaging examinations at 1.5 Tesla, with a constant imaging protocol. TSE pulse sequences were acquired with eight echo trains (repetition time [TR], 4718 ms; echo time [TE], 90 ms; acquisition time [TA], 4.03 min; and a symmetric k-space ordering scheme) and 11 echo trains (TR, 4200 ms; TE, 140 ms; TA, 4.40 min; and an asymmetric k-space ordering scheme) and compared with CSE (TR, 2300 ms; TE, 45/90 ms; TA, 9.53 min). Images were analyzed qualitatively by scoring image quality and artifacts and counting focal liver lesions by independent reading with consensus obtained for discrepancies. Quantitative analysis was performed by measuring signal-to-noise (S/N), contrast-to-noise (C/N), and tumor-liver signal intensity (T/L) ratios. RESULTS: T2-weighted TSE sequences provided better subjective image quality and reduced artifacts as compared with the T2-weighted CSE sequence. CSE and TSE sequences exhibited no statistically significant differences in liver S/N, lesion-liver C/N (CSE TE, 90 ms: 18.6 +/- 14.0; TSE TE, 90 ms: 16.5 +/- 12.9) and the detectability of focal liver lesions. Heavily T2-weighted TSE with a TE of 140 ms allowed correct characterization of focal liver lesions based on a T/L ratio of 3.0 in 84% of patients. CONCLUSIONS: T2-weighted TSE sequences are as suited as CSE for the detection (TE, 90 ms), and appear to be superior for the characterization (TE, 140 ms), of focal hepatic lesions. Whether a single sequence, such as a double-echo TSE or a single-echo TSE sequence with a TE between 110 and 120 ms, might perform both functions as well or better than CSE is unknown. However, because of time savings, TSE eventually may be preferred over CSE.

Artifacts↗
PubMedDate not supplied

Clinical application of abdominal echoplanar imaging (EPI): optimization using a retrofitted EPI system.

OBJECTIVE: Echoplanar MRI (EPI) with data acquisition times as short as 36 ms has been advocated for imaging body areas where gross physiologic motion degrades images. In this study we investigated the effect of various operator-defined parameters on image quality in EPI of the abdomen using a commercially available scanner. MATERIALS AND METHODS: Specifically, we assessed the effect of breathholding, slice thickness, k-space coverage (raw data size), and high resolution EPI in volunteers. The effect of these parameters on signal-to-noise ratio (SNR) and image quality of liver, spleen, kidney, and pancreas was evaluated to propose guidelines for clinical EPI of the abdomen. The requirements for contiguous imaging were analyzed in a phantom experiment. RESULTS: Our study suggests that optimum clinical EPI requires a minimum slice thickness of 7 mm. Breathhold single shot techniques are preferred to avoid spatial misregistrations and to optimize the signal yield for segmented techniques. Maximum k-space coverage at a given TE should be implemented. High resolution techniques (128 x 512) suffer from low SNR and are clinically not useful for routine EPI. Contiguous imaging requires a scan time of > 6 s to eliminate effects of cross-talk. CONCLUSION: The results suggest that clinical EPI requires careful attention to the choice of imaging parameters. The practical recommendations may help other investigators to optimize their clinical EPI studies.

Abdomen↗
PubMedDate not supplied

Brain imaging: reduced sensitivity of RARE-derived techniques to susceptibility effects.

OBJECTIVE: Our goal was to evaluate the decreased sensitivity of RARE-derived pulse sequences to susceptibility effects. MATERIALS AND METHODS: A variety of RARE-derived T2-weighted fast SE echo (FSE) sequences with echo trains from 6 to 16 were compared with conventional SE (CSE) sequences by means of MRI in phantoms (iron oxides), volunteers (n = 10), and patients (n = 13) with old hemorrhagic brain lesions. All experiments were performed on a 1.5 T clinical MR system (Magnetom SP 4000; Siemens AG, Erlangen, Germany) with constant imaging parameters. Contrast-to-noise ratios (CNRs) of tubes doped with iron oxides at different concentrations and brain areas with physiological iron deposition (red nucleus, substantia nigra) were calculated for CSE and FSE pulse sequences. Areas of old brain hemorrhage were analyzed for lesion conspicuity by blinded analysis with CSE as an internal standard. RESULTS: CNR of iron oxide tubes (TE 90 ms, CSE 45.0 +/- 3.5, FSE 16 echo trains 28.5 +/- 3.1; p < or = 0.01) and iron-containing brain areas decreased with increasing echo trains of FSE sequences. A significantly lower number of old hemorrhagic brain lesions was visible in patients scanned with FSE sequences (6 echo trains: n = 28; 16 echo trains; n = 26) than CSE (n = 40). CONCLUSION: Our results demonstrate that the sensitivity of RARE-derived techniques to susceptibility effects is significantly decreased compared with CSE. CSE sequences or GE sequences should still be preferred in patients with a history of seizures or intracranial hemorrhage.

Adult↗