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R G Gonzalez

Publications and source records attributed to R G Gonzalez.

52 records · Page 3Linked to original sources
PubMed1997

MRI measurements of water diffusion and cerebral perfusion: their relationship in a rat model of focal cerebral ischemia.

The aim of this study was to examine the quantitative relationship between changes in apparent diffusion coefficient (ADC) and transverse relaxivity (delta R2*) measurements of relative perfusion deficits within the gradients of a focal ischemic insult. Sixty minutes after permanent occlusion of the middle cerebral artery, rats (n = 7) were subjected to spin echo diffusion-weighted scans followed by fast low-angle shot (FLASH) perfusion-sensitive scans. Diffusion-weighted images showed clear ischemic lesions in the affected basal ganglia and cortex. Ischemic deficits were demonstrated as a decrease in first-pass transit of injected boluses of gadodiamide. ADC maps were generated and regions of interest (ROIs) were obtained to span the range of ADC reductions from the lesion center or core to the periphery or penumbra. Corresponding ROIs from the bolus injection images were used to calculate perfusion indexes relative to contralateral levels as ratios of delta R2* integrals and ratios of delta R2* peak values. In all animals, the degree of ADC reductions was related to the degree of delta R2* perfusion deficits, ranging from severe ischemia in the core of the lesion to intermediate and moderate changes toward the lesion periphery. In the ischemic periphery, ADC reductions were linearly correlated with delta R2* peak ratios. However, no significant correlation was found between ADC reductions and delta R2* integral ratios. These data suggest that magnetic resonance measurements of ADC and delta R2* peak ratios can be used to quantitatively assess the variable gradients in focal ischemia, including potentiallyn critical areas at risk in the ischemic periphery.

Animals↗
PubMed1997

Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia.

BACKGROUND: The pathophysiology of eclampsia remains unclear. While the majority of patients develop reversible T2 hyperintense signal abnormalities on MR scans and reversible neurological deficits, some patients do develop infarctions (permanent T2 hyperintense abnormalities) and permanent neurological impairment. Routine MRI cannot prospectively differentiate between these two patient groups. Echo-planar diffusion-weighted imaging, however, is a new technique that clearly differentiates between cytotoxic and vasogenic edema. CASE DESCRIPTION: A 30-year-old woman developed symptoms consistent with eclampsia 24 hours after delivering premature twins. An MRI demonstrated extensive, diffuse T2 hyperintense signal abnormalities involving subcortical white matter and adjacent gray matter with a posterior predominance, consistent with either infarction or hypertensive ischemic encephalopathy. Diffusion-weighted images demonstrated increased diffusion, consistent with vasogenic edema and hypertensive ischemic encephalopathy. CONCLUSIONS: Unlike routine MRI, diffusion-weighted imaging reliably differentiates between vasogenic edema and cytotoxic edema. Consequently, in eclamptic patients diffusion-weighted imaging can afford clear differentiation between hypertensive ischemic encephalopathy and infarction, two very different entities with very different treatment protocols. Diffusion-weighted imaging should be performed in all eclamptic patients and should greatly affect their management.

Adult↗
PubMed1997

FDG hypermetabolism associated with inflammatory necrotic changes following radiation of meningioma.

PET with 18F-fluoro-2-deoxy-D-glucose (FDG) is currently the noninvasive gold standard for distinguishing brain tumor recurrence from radiation necrosis. We present a case report that appears to contradict this doctrine. The patient had a history of atypical meningioma and was treated with surgical resection and postoperative proton-beam radiation therapy. Approximately 16 mo after completion of therapy, MRI demonstrated two new regions of enhancement, and an FDG-PET study was performed to further characterize these lesions. FDG-PET demonstrated an area of intense hypermetabolism, and wide surgical resection was performed. Histological examination of the surgical specimen revealed reactive changes and areas of necrosis. There was no evidence of either recurrent or radiation-induced tumor.

Aged↗
PubMed1997

Functional imaging of the AIDS dementia complex and the metabolic pathology of the HIV-1-infected brain.

The AIDS-dementia complex remains one of the more common neurologic disorders associated with human immunodeficiency virus (HIV) infection. Despite several advances that have been made in elucidating some of its clinical and biological features, pathogenesis is not well understood, and effective treatments are scarce. This article reveals the results of these studies and discusses how these different approaches have already enabled clinicians to study further the effects of HIV infection on brain function and to explore the functional anatomy of this important clinical syndrome.

AIDS Dementia Complex↗
PubMed1996

Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging.

PURPOSE: To evaluate acute stroke with conventional, multisection diffusion-weighted (DW), and hemodynamically weighted (HW) magnetic resonance (MR) imaging. MATERIALS AND METHODS: The three MR imaging techniques were performed in 11 patients within 10 hours of the onset of acute hemiparesis. The volume of DW and HW abnormalities were compared with infarct volumes depicted at initial and/or follow-up MR or computed tomography (CT). RESULTS: Findings at DW and HW imaging were abnormal in nine of the 11 patients, despite normal findings at initial CT and/or MR. In all nine patients, infarcts were depicted at follow-up CT or MR. The DW abnormality was generally smaller and the HW abnormality was generally larger than the infarct volume determined at subsequent imaging. In the two patients with normal findings at DW and HW imaging, symptoms resolved completely within 1-48 hours. CONCLUSION: Different aspects of hyperacute cerebral ischemia are depicted at DW and HW imaging before infarction is depicted at conventional MR or CT. These techniques may improve stroke diagnosis and may contribute to advances in treatment.

Acute Disease↗
PubMed1996

Imaging of cerebral metastases.

MR imaging with intravenous gadolinium has greatly enhanced our ability to detect and delineate intracranial metastases as well as to differentiate them from other disease processes. Techniques such as magnetization transfer and triple dose gadolinium imaging have further improved lesion detection. Consideration of these radiologic techniques, including the issues and controversies of screening and cost effectiveness, suggests a reasonable approach to imaging patients with possible intracranial metastases. Newer modalities such as echo planar imaging, spectroscopy, PET, and SPECT, may in the future, prove to be very useful in the evaluation of patients with intracranial metastases. Proper imaging is also critical to appropriate diagnosis and management of meningeal metastases, calvarial metastases, and paraneoplastic disease.

Brain Neoplasms↗
PubMed1996

Quantitative in vivo 31P magnetic resonance spectroscopy of Alzheimer disease.

The purpose of this study was to determine whether, in Alzheimer disease (AD) patients, abnormalities in energy charge or phospholipid metabolism could be detected during life with quantitative phosphorus magnetic resonance spectroscopy (31P MRS). We performed in vivo 31P MRS in 16 patients with a clinical diagnosis of probable AD with mild to moderate dementia severity (mean Blessed Dementia Score = 17.5, range = 7-37) and in 8 healthy, nondemented, age-matched, control subjects. MR studies were performed on a commercial 1.5 T MR imager using a volume head coil. We acquired brain spectra by sampling a 6-cm-thick axial slice through the cerebrum (a region that includes approximately 900 ml of brain tissue); we measured beta-nucleoside triphosphate (beta-NTP), phosphocreatine (PCr), phosphomonoesters (PME), phosphodiesters (PDE), and inorganic phosphate (Pi) concentrations, then calculated ratios of these resonances. The beta-NTP, PCr, and Pi resonances in AD and control subjects were not significantly different. These data indicate that brain energy stores are not depleted in AD. No significant differences were detected in the absolute measurements of PME and PDE between the AD and control groups. However, among the calculated ratios, an increase in the PME/PDE ratio of approximately 50%, mostly due to a decrease in the PDE signal, was statistically significant (AD PME/PDE mean = 0.35, range 0.13-0.71; normal PME/PDE mean = 0.22, range 0.16-0.34). We speculate that the difference in PDE reflects changes in the biophysical state of membrane phospholipids in AD.

Aged↗
PubMed1995

Variability of brain lithium levels during maintenance treatment: a magnetic resonance spectroscopy study.

In vivo magnetic resonance spectroscopy (MRS) was used to determine the relationship between serum and brain lithium levels in bipolar patients (n=25). Over the broad range of serum lithium levels observed, the correlation (r=.68) with brain lithium levels was high. This correlation was much weaker (r=.39) when limited to only those patients with serum lithium levels in the range of 0.6-1.0 mmol/l. This variability may account for failure of lithium prophylaxis in some patients who have serum lithium levels in the therapeutic range.

Adult↗
PubMed1992

The human brain resonance of choline-containing compounds is similar in patients receiving lithium treatment and controls: an in vivo proton magnetic resonance spectroscopy study.

Lithium specifically and potentially inhibits membrane transport of choline. However, the effect of lithium on human neuronal choline content is unknown. This study was performed to determine if lithium alters the human brain choline concentration in vivo. In vivo proton magnetic resonance spectroscopy was used to compare the relative brain concentration of choline-containing compounds in seven lithium-treated patients and six lithium-free controls. No significant difference was observed in the mean relative choline resonance between the patient and control groups. Lithium treatment did not appear to alter the overall brain content of choline-containing compounds. It remains possible that a component of these compounds, particularly free choline, is elevated during lithium treatment.

Adult↗
PubMed1992

Accumulation of fluoxetine and norfluoxetine in human brain during therapeutic administration.

In vivo 19fluorine nuclear magnetic resonance spectroscopy was used to measure the brain concentration of fluoxetine and norfluoxetine in five patients with obsessive-compulsive disorder and three with major depression. The mean brain:plasma ratio of the parent drug plus the metabolite was significantly elevated to 2.6 (SD = 1.0) (95% confidence interval = 1.9-3.3). This accumulation may have implications for understanding both the therapeutic and the toxic effects of fluoxetine.

Adult↗
PubMed1986

In vitro 31P NMR spectroscopy detects altered phospholipid metabolism in Alzheimer's disease.

In order to study possible metabolic derangements in Alzheimer's disease (AD), we performed phosphorus 31 nuclear magnetic resonance (31P NMR) spectroscopy on brain samples obtained at autopsy from 7 patients with AD and 9 control subjects. Aqueous solutions of brain tissue contained well-defined peaks of intermediate compounds in phospholipid metabolism, including the phosphomonoesters phosphocholine and phosphoethanolamine, and the phosphodiesters glycerophosphorylcholine and glycerophosphorylethanolamine. 31P NMR spectra also displayed the inorganic phosphorus signal, which provides an index to the in vivo concentration of high-energy compounds. We found evidence for altered phospholipid metabolism in that relative levels of phosphomonoesters were decreased, and phosphodiesters increased, in frontal and parietal regions of patients with AD compared to control subjects. The inorganic phosphorus resonance peaks were similar in AD and control subjects, suggesting that energy stores are not diminished in AD. These preliminary data are consistent with the hypothesis that abnormalities in phospholipid metabolism contribute to possible neuronal membrane dysfunction and impaired cholinergic neurotransmission in AD.

Alzheimer Disease↗
PubMed1985

Study of vitreous liquifaction by NMR spectroscopy and imaging.

The vitreous gel is primarily composed of collagen, hyaluronic acid, and water (98-99%) and can break down into a liquid state devoid of collagen. The liquifaction of vitreous gel that occurs with age and in certain other disease states is believed to be important in the pathogenesis of retinal tears and detachments. The authors report measurements of water proton relaxation times and water proton nuclear magnetic resonance (NMR) imaging to study the process of vitreous liquifaction in extracted vitreous and in the intact bovine eye. A comparison is made between macroscopic viscosity, longitudinal (T1) and transverse (T2) relaxation times obtained on an NMR spectrometer and proton NMR images. Vitreous liquifaction as measured by a decrease in macroscopic viscosity resulted after treatment of vitreous with collagenase and to lesser degree with hyaluronidase. A shortening of relaxation times accompanied the drop in viscosity. An area of brightness or increased proton signal intensity corresponding to a focus of liquifaction was seen by NMR imaging only after injection with collagenase. The authors believe NMR imaging to be a useful new diagnostic modality by which vitreous liquifaction can be studied in the intact eye. The vitreous provides a new model for studying changes in proton relaxation times of protein solutions in biologic systems.

Animals↗
PubMedDate not supplied

CT angiography in the rapid triage of patients with hyperacute stroke to intraarterial thrombolysis: accuracy in the detection of large vessel thrombus.

PURPOSE: The purpose of this work was to evaluate the accuracy of CT angiography (CTA) for the detection of large vessel intracranial thrombus in clinically suspected hyperacute (<6 h) stroke patients. METHOD: Forty-four consecutive intraarterial thrombolysis candidates underwent noncontrast CT followed immediately by CTA. Axial source and two-dimensional collapsed maximum intensity projection reformatted CTA images were rated for the presence or absence of large vessel occlusion. Five hundred seventy-two circle-of-Willis vessels were reviewed; arteriographic correlation was available for 224 of these. RESULTS: Sensitivity and specificity for the detection of large vessel occlusion were 98.4 and 98.1%; accuracy, calculated using receiver operating characteristic analysis, was 99%. Mean time for acquisition, reconstruction, and analysis of CTA images was approximately 15 min. CONCLUSION: CTA is highly accurate for the detection and exclusion of large vessel intracranial occlusion and may therefore be valuable in the rapid triage of hyperacute stroke patients to intraarterial thrombolytic treatment.

Adult↗