Intravenous Administration Of Gadolinium Research Articles

Usefulness of dynamic contrast-enhanced magnetic resonance images for distinguishing between pyogenic spondylitis and tuberculous spondylitis.

Dynamic contrast-enhanced (DCE)-MRI is used for examining the features of malignant tumours in radiology, and we can obtain more information in terms of the diffusion of the media over the course of time. The purpose of this study was to clarify the usefulness of DCE-MRI for distinguishing pyogenic spondylitis (PS) and tuberculous spondylitis (TB). Forty-five consecutive patients diagnosed with PS (68.6 ± 11.1years old, males 30 and females 15) and 14 with TB (73.9 ± 9.1years old, males 6 and females 8) were involved. DCE-MRI consisted of serial six sagittal images which were taken every 20s after intravenous gadolinium administration. Degree of enhancement, presence of epidural abscess, presence of necrosis in vertebra, presence of enhancement in disc lesion, pattern of diffusion, and maximum contrast index were examined and compared between PS and TB. Degree of enhancement, percentage of epidural abscess, and percentage of necrosis in vertebra were 2.1 ± 0.5 and 1.8 ± 0.8, 60.7% and 100%, 50.0% and 66.7% for PS and TB, respectively, without statistical difference. Maximum contrast index, percentage of the diffusion pattern from the disc, and percentage of enhanced disc were 108.1 ± 22.3 and 78.2 ± 35.6s, 89.3% and 0%, and 53.6% and 0% for PS and TB, respectively, with statistical significance. This study indicated that longer maximum contrast index, higher likelihood of diffusion pattern from the disc, and higher likelihood of enhanced disc are more specific to PS than TB. This less invasive imaging technique is useful for more accurate diagnosis of PS and TB. These slides can be retrieved under Electronic Supplementary Material.

Comprehensive comparison of MR image quality between intratympanic and intravenous gadolinium injection using 3D real IR sequences

Background: Intratympanic and intravenous gadolinium administration is used to visualise endolymphatic hydrops.Aims/objectives: The goal of this study was to compare the image quality between intratympanic (IT-method) and intravenous (IV-method) gadolinium administration using three-dimensional inversion recovery with real reconstruction (3D real IR) sequences.Materials and methods: A number of 152 patients with Meniere’s disease were included. The 3D real IR sequence was performed 24 h after IT administration or 4 h after IV administration. The detection rate of endolymphatic hydrops, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the two methods were compared. Specifically, the average image scores of the two methods were evaluated by two radiologists.Results: The SNRROI and CNRs of the IT-method were higher than those of the IV-method, whereas no significant difference between the IT-method and IV-method with regard to the SNRB was found. The average image scores were 3.49 ± 0.12 and 3.30 ± 0.12 for the IT-method and IV-method, respectively (p = .229). No statistically significant difference was found between two methods in terms of the detection rate of endolymphatic hydrops.Conclusions and significance: IT-method images can display endolymphatic hydrops more precisely than IV-method images. The IV-method can be used as an alternative to the IT-method in clinical applications to some extent.

Imaging of Ménière Disease.

Visualization of the morphologic substrate of Ménière disease, the endolymphatic hydrops, can be performed using noncontrast or contrast-enhanced MR imaging techniques. Noncontrast MR imaging uses a heavily T2-weighted sequence; however, its reproducibility remains to be confirmed. Contrast-enhanced MR imaging techniques mainly use a 3-dimensional fluid-attenuated inversion recovery sequence after intratympanic gadolinium administration or after a 4-hour delayed intravenous gadolinium administration. The latter technique is most frequently used and is able to detect and grade Ménière disease. It is a reliable technique with a high diagnostic accuracy, enabling visualization of endolymphatic hydrops.

Quantitative evaluation of endolymphatic hydrops with MRI through intravenous gadolinium administration and VEMP in unilateral definite Meniere's disease.

To help clinicians to further understand the significance of vestibular-evoked myogenic potential (VEMP) examinations to diagnose MD and the quantitative relationship between VEMP and MRI in assessing the location and degree of endolymphatic hydrops (EH) in definite Meniere's disease (MD) patients. Fifty-six patients with unilateral definite MD participated in this study, which used MRIs through intravenous gadolinium administration (IV-Gd), audiometry, caloric tests and VEMP tests. The VEMP results of 26 healthy volunteers were used as a normal reference value. The participants were found through MRI to have differing degrees of vestibular and cochlear EH. Quantitative comparison of MRI and VEMP results found that the response rates of oVEMP decreased with cochlear EH increasing; the asymmetry ratio (AR) of oVEMP can be used to find whether cochlear EH or not, and the P1-N1 amplitude was lower in the extreme cochlear EH group (P < 0.01). The AR of cVEMP was larger in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.01). The correlation between the degree of cochlear EH and the mean PTA threshold was statistically significant (P < 0.05). The duration of MD correlated positively with vestibular EH (P < 0.05). The abnormal rate of caloric tests was higher in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.05). The advantages of MRIs by IV-Gd administration were obvious in assessing the location and degree of EH. oVEMP and PTA can be indirectly used to evaluate the extent of cochlear EH, cVEMP and caloric tests can be used to assess the extent of vestibular EH on the condition of absent MRIs.

Vestibular atelectasis: Myth or reality?

Because delayed post-contrast three-dimensional fluid-attenuated inversion recovery imaging sequences enable the distinction between the utricle and the saccule, we raised the hypothesis that patients with vestibular atelectasis (VA) could show unilateral collapse of the utricle and the ampullas on imaging. Retrospective case series. We retrospectively reviewed 200 patients who underwent 3 T magnetic resonance imaging (MRI) after intravenous administration of gadolinium. MRI scans were assessed for the presence of VA. The endolymphatic space was considered as collapsed when the utricle and at least two ampullas were not visible or were barely visible. We reported four patients with VA on MRI responsible for atypical clinical presentations of acute vestibular deficit. All patients presented a specific involvement of the pars superior sensory captors (utricle, ampullas), preserving the pars inferior sensory captors (cochlea and saccule). This was confirmed both clinically and on MRI. Our study is the first to describe in vivo unilateral collapse of the pars superior on delayed postcontrast MRI in patients with a clinical unilateral vestibular loss. 4 Laryngoscope, 129:1689-1695, 2019.

Peyronie disease: How can I see the non calcified plaque?

Teaching points 1. To describe the main clinical aspects of Peyronie disease; 2. To point out the main findings in X ray, ultrasound (US), Elastography and MRI; 3. Which complications can occur lately? Content Peyronie´s disease is an uncommon disorder that develops a fibrous plaque in the sheaths covering the penis corpora cavernosa. During the erection the penis usually bend towards the inelastic fibrous plaque. Erectile dysfunction may be related to pain, veno-occlusive dysfunction, or bending of the penis. After a time the plaque can calcifies. Soft tissue radiography of the penis can detect calcified plaques. Penile sonography is the first choice for identification of small lesions, but soft plaques are very difficult to detect. US and MRI detects the number of plaques, their size, and the exact position of the lesions in the penis. Nowadays elastography imaging may be very usefull for detecting those non calcified plaques as the hard plaque can be seen as a hard area in the elastogram. MR imaging of Peyronie disease shows a focal thickening of the tunica albuginea and is best seen on T2-weighted images. An inflammed Peyronie plaque enhances after an intravenous administration of gadolinium and can be detected by Doppler US.

MRI in Menière’s Disease

The visualization of the morphologic substrate of Meniere’s disease -the endolymphatic hydrops – can be performed using non-contrast as well as contrast-enhanced magnetic resonance imaging techniques. The non-contrast magnetic resonance imaging technique uses a heavily T2-weighted sequence; however, the reproducibility of this technique remains to be confirmed. The contrast-enhanced techniques most frequently use a 3-dimensional fluid-attenuated inversion recovery sequence or a real 3-dimensional inversion recovery sequence either after intratympanic gadolinium administration either 4 hours after intravenous gadolinium administration. The latter is the most frequently used technique and is able to detect definite Meniere’s disease with a high sensitivity and specificity. It has been proven to be a reliable technique with a high diagnostic accuracy, enabling the visualization of endolymphatic hydrops.

Endolymphatic hydrops severity in magnetic resonance imaging evidences disparate vestibular test results

ObjectivesIt has been suggested that in Ménière’s disease (MD) a dissociated result in the caloric test (abnormal result) and video head-impulse test (normal result) probably indicates that hydrops affects the membranous labyrinth in the horizontal semicircular canal (HSC). The hypothesis in this study is that based on endolymphatic hydrops’ cochleocentric progression, hydrops should also be more severe in the vestibule of these patients than in those for whom both tests are normal. Methods22 consecutive patients with unilateral definite MD were included and classified as NN if both tests were normal or AN if the caloric test was abnormal. MRI evaluation of endolymphatic hydrops was carried out with a T2-FLAIR sequence performed 4h after intravenous gadolinium administration. The laterality and degree of vestibular endolymphatic hydrops and the presence or absence of cochlear endolymphatic hydrops were recorded. Demographic data, audiometric and vestibular evoked myogenic potentials were collected, and video head-impulse and caloric tests were performed. ResultsPatients in both groups (NN and AN) were similar in terms of demographic data and hearing loss. The interaural asymmetry ratio was significantly higher for ocular and cervical VEMP in patients in the AN group. There was a significantly higher degree of hydrops in the vestibule of the affected ear of AN patients (χ2; p=0.028). ConclusionSignificant canal paresis in the caloric test is associated with more severe endolymphatic hydrops in the vestibule as detected with gadolinium-enhanced MRI and with a more severe vestibular deficit.Level of evidence: 2a

New cross-sectional imaging in IBD.

Cross-sectional imaging, namely ultrasound, CT and MR enterography, complements clinical and endoscopic monitoring of activity and complications in IBD, and emerging new radiological technologies may have clinical applications in the near future. This review offers an update on the potential role of these new imaging methods in the management of IBD. Specific MR techniques [diffusion-weighted imaging (DWI), diffusion kurtosis imaging (DKI) and magnetization transfer] allow accurate detection of inflammation (DWI and maybe DKI) and fibrosis (magnetization transfer) in Crohn's disease, without the need of intravenous gadolinium administration. ultrasonography developments (elastography, contrast-enhanced ultrasonography, small intestine contrast ultrasonography and multispectral optoacoustic tomography) are promising techniques for evaluation of fibrosis (elastography) and inflammation (contrast ultrasonography). Dose-reduction techniques in CT allow similar quality imaging and diagnostic accuracy with lower radiation exposure. Hybrid imaging (PET/MR and PET/CT) hold promise for grading inflammation in Crohn's disease. The potential benefits of new cross-sectional imaging techniques in IBD include better inflammation grading, such as identification of mild degree of activity, which may be relevant whenever assessing response to treatment and, of uttermost importance, accurate preoperative detection and grading of fibrosis in stricturing Crohn's disease, facilitating surgical vs. medical therapeutic decisions.

Improved 3D-real Inversion Recovery: A Robust Imaging Technique for Endolymphatic Hydrops after Intravenous Administration of Gadolinium.

Improved 3D-real Inversion Recovery: A Robust Imaging Technique for Endolymphatic Hydrops after Intravenous Administration of Gadolinium.

Abstract WP46: Objective Collateral Assessment to Identify Patients Suffering From Distal Middle Cerebral Artery Occlusion Refractory to Intravenous Tissue Plasminogen Activator Therapy

Introduction: It remains unknown who requires endovascular therapy in case of distal middle cerebral artery (MCA) occlusion. Hypothesis: Objective collateral assessment can identify acute ischemic stroke (AIS) patients with distal MCA occlusion refractory to intravenous tissue plasminogen (iv-tPA) alone. Methods: We Included patients 1) who were admitted to our institution from July 2009 to March 2017 within 4.5 hours of onset and diagnosed as AIS in the territory of the MCA, and 2) who underwent iv-tPA alone (0.6mg/kg). We assessed collateral status with time-intensity curves (TIC) produced by intravenous administration of gadolinium in bilateral MCA territories. We excluded patients with proximal MCA occlusion within 5 mm in length from the origin. According to the time to peak (TP) and the peak value (PV) of TIC comparing the affected side (a) with the contralateral side (c), we defined collateral status as following; Poor was defined as TP(a) minus TP(c) (TP delay) of 2 seconds or more and PV(a) divided by PV(c) (PV ratio) of less than 0.25, Moderate as TP delay of 2 seconds or more and PV ratio of 0.25 or more and of less than 0.75, Good as TP delay of less than 2 seconds or PV ratio of 0.75 or more. We evaluated association of collateral status with modified Rankin scale (mRS) scores at 3 months. We defined mRS score of 0 to 2 as favorable. Results: Sixty-six patients matched our criteria. A median NIHSS score was 12.5. Two patients had Poor collateral, 36 patients had Moderate and 28 patients had Good. Clinical outcome was favorable in none (0%) with Poor, in 19 (52.8%) with Moderate and in 18 (64.3%) with Good. Clinical outcome of all 5 patients with occlusion of opercular or cortical branches was favorable. Except for the 5 patients, among 34 patients with Moderate, outcome was favorable in 1 (50%) of 2 with NIHSS score of less than 5 and in 16 (50%) of 32 with NIHSS score of 5 or more, and among 25 patients with Good, outcome was favorable in all (100%) of 4 with NIHSS of less than 5 and in 11 (52%) of 21 with NIHSS of 5 or more. Conclusion: All patients with Poor collateral, half of the patients with Moderate collateral, about half of the patients with Good collateral coupled with NIHSS score of 5 or more are refractory to iv-tPA alone for distal MCA occlusion except opercular or cortical branches.

Differences in Signal Intensity and Enhancement on MR Images of the Perivascular Spaces in the Basal Ganglia versus Those in White Matter

Purpose:To elucidate differences between the perivascular space (PVS) in the basal ganglia (BG) versus that found in white matter (WM) using heavily T2-weighted FLAIR (hT2-FL) in terms of 1) signal intensity on non-contrast enhanced images, and 2) the degree of contrast enhancement by intravenous single dose administration of gadolinium based contrast agent (IV-SD-GBCA).Materials and Methods:Eight healthy men and 13 patients with suspected endolymphatic hydrops were included. No subjects had renal insufficiency. All subjects received IV-SD-GBCA. MR cisternography (MRC) and hT2-FL images were obtained prior to and 4 h after IV-SD-GBCA. The signal intensity of the PVS in the BG, subinsular WM, and the cerebrospinal fluid (CSF) in Ambient cistern (CSFAC) and CSF in Sylvian fissure (CSFSyl) was measured as well as that of the thalamus. The signal intensity ratio (SIR) was calculated by dividing the intensity by that of the thalamus. We used 5% as a threshold to determine the significance of the statistical test.Results:In the pre-contrast scan, the SIR of the PVS in WM (Mean ± standard deviation, 1.83 ± 0.46) was significantly higher than that of the PVS in the BG (1.05 ± 0.154), CSFSyl (1.03 ± 0.15) and the CSFAC (0.97 ± 0.29). There was no significant difference between the SIR of the PVS in the BG compared to the CSFAC and CSFSyl. For the evaluation of the contrast enhancement effect, significant enhancement was observed in the PVS in the BG, the CSFAC and the CSFSyl compared to the pre-contrast scan. No significant contrast enhancement was observed in the PVS in WM.Conclusion:The signal intensity difference between the PVS in the BG versus WM on pre-contrast images suggests that the fluid composition might be different between these PVSs. The difference in the contrast enhancement between the PVSs in the BG versus WM suggests a difference in drainage function.

Classic Tuberculous Meningoencephalitis manifestations, without lumbar puncture

A 28-year-old man who was hospitalized with decreased consciousness.Consciousness decreased slowly since one week before being admitted to our hospital. He had headache since two months ago but became worse since two weeks ago. There were frequent nausea and vomiting for the last two months (approximately four times daily). He was often confused, had abnormal personal behaviour, and had double vision since two months ago.He often had fever, night sweat, and weight losssince two months ago. He had chronic cough since two months ago. His appetite was decreased. There was no history of head trauma, hypertension, diabetes, high blood cholesterol level, stroke and heart disease. Family history of chronic cough or tuberculosis treatment was denied. Based on physical and neurological examination, he was sub-febrile (his temperature was 37.5oC) with Glasgow Coma Scale (GCS) score total of 11(E3M5V3). Nuchal rigidity and Kernig’s sign were positive. Movement and strength were unclear lateralization at first, but then we found that there was decreased movement and strenght at the right side of the body, tone and physiological reflexes were normal. Pathological reflexes were negative. Routine and chemistry blood examination demonstrated White Blood Cell (WBC): 13.940/mm3; Red Blood Cell (RBC): 4.55x106/mm3; Hemoglobin (Hb): 13.3g/dl; Haematocrit (HCT): 38.1%; Platelet (PLT): 323x103/mm3; Blood Random Glucose: 90 mg/dl; Ureum 18 mg/dl; Creatinine: 0.52 mg/dl; SGOT: 40 mg/dl; SGPT: 79 mg/dl; Sodium: 126 mmol/L; Potassium: 4,1 mmol/L; Chloride: 90 mmol/L; HIV Rapid Test non reactive; HIV Antigen 0.03 (non reactive); and HIV Antibody 0.04 (non reactive). Axial head CT-scans of both non-contrast and contrast to the administration of intravenous gadolinium (Gd-DOTA) were performed and showed left thalamus infarct that was not enhanced by contrast injection and hypertensive hydrocephalus (obstuctive) (Figure 1A and B). A contrast head CT-Scan examination showed basal enhancing exudate

Tolosa-Hunt Syndrome - Cranial Neuroimaging Findings.

The etiology of Tolosa-Hunt Syndrome (THS) is still unknown. The initial standard magnetic resonance imaging (MRI) may not be sufficient for diagnosis, so dynamic contrast-enhanced MRI may be necessary to demonstrate the presence of lesions. Seven patients diagnosed with THS according to the International Headache Society criteria (beta version) were included into the study. Patients were assessed in terms of type, age, symptoms and findings, accompanying disease, localization of the determined lesion, response to treatment, and clinical progress. The "Tolosa-Hunt protocol" was applied in all patients, and the cavernous sinuses, orbital apices, and orbits were evaluated. The parameters used for the patients were as follows: Turbospin echo T1 and T2 weighted sequences on the axial plane, turbospin echo fat-saturated T2 weighted sequence on the coronal plane, turbospin echo T2 weighted sequence on the sagittal plane, spin echo fat-saturated T1 sequences repeated on the axial and coronal planes followed by intravenous administration of gadolinium. In all sequences the slice thickness was 3 mm. Four of seven cases diagnosed with THS were males, and the average age of the patients was 45.7±18.1 years (range 25-69 years). A follow-up MRI in patient 5 after three months showed decreased signal intensity and enhancement of the affected cavernous sinus. Conventional MRI may be insufficient to show the granulomatous inflammation, and an MRI method referred to as the Tolosa-Hunt protocol should be applied to those who are thought to have THS.

Application of Texture Analysis to Study Small Vessel Disease and Blood-Brain Barrier Integrity.

We evaluate the alternative use of texture analysis for evaluating the role of blood-brain barrier (BBB) in small vessel disease (SVD). We used brain magnetic resonance imaging from 204 stroke patients, acquired before and 20 min after intravenous gadolinium administration. We segmented tissues, white matter hyperintensities (WMH) and applied validated visual scores. We measured textural features in all tissues pre- and post-contrast and used ANCOVA to evaluate the effect of SVD indicators on the pre-/post-contrast change, Kruskal-Wallis for significance between patient groups and linear mixed models for pre-/post-contrast variations in cerebrospinal fluid (CSF) with Fazekas scores. Textural "homogeneity" increase in normal tissues with higher presence of SVD indicators was consistently more overt than in abnormal tissues. Textural "homogeneity" increased with age, basal ganglia perivascular spaces scores (p < 0.01) and SVD scores (p < 0.05) and was significantly higher in hypertensive patients (p < 0.002) and lacunar stroke (p = 0.04). Hypertension (74% patients), WMH load (median = 1.5 ± 1.6% of intracranial volume), and age (mean = 65.6 years, SD = 11.3) predicted the pre/post-contrast change in normal white matter, WMH, and index stroke lesion. CSF signal increased with increasing SVD post-contrast. A consistent general pattern of increasing textural "homogeneity" with increasing SVD and post-contrast change in CSF with increasing WMH suggest that texture analysis may be useful for the study of BBB integrity.

Contralateral type of delayed endolymphatic hydrops may consist of two phenotypes based on a magnetic resonance imaging preliminary study

Objective: This study was performed to determine the volume distribution of EH in contralateral DEH.Patients and methods: Five contralateral DEH patients (age range = 21–77 years) and one ipsilateral DEH patient. Visualization of in vivo EH using 3T magnetic resonance (MR) imaging was performed by intravenous administration of gadolinium. The EH volume was determined quantitatively by adding the area of EH in consecutive MR images.Results: The total EH volume of the patients with contralateral DEH varied from 24.2 to 56.6 μL in the first ear and 20.2 to 35.7 μL in the contralateral ear. EH was dominantly developed in the first ear for Patient no. 3 and 4, and not dominantly developed in the first ear for Patient no. 1, 2, and 5.Conclusions: The volume distribution of endolymphatic hydrops (EH) in contralateral delayed endolymphatic hydrops (DEH) was classified into two phenotypes. This suggests that contralateral DEH may consist of two etiologies.

Optimized Multistable Stochastic Resonance for the Enhancement of Pituitary Microadenoma in MRI.

Magnetic resonance imaging (MRI) is the modality of choice as far as imaging diagnosis of pathologies in the pituitary gland is concerned. Furthermore, the advent of dynamic contrast enhanced (DCE) has enhanced the capability of this modality in detecting minute benign but endocrinologically significant tumors called microadenoma. These lesions are visible with difficulty and a low confidence level in routine MRI sequences, even after administration of intravenous gadolinium. Techniques to enhance the visualization of such foci would be an asset in improving the overall accuracy of DCE-MRI for detection of pituitary microadenomas. The present study proposes an algorithm for postprocessing DCE-MRI data using multistable stochastic resonance (MSSR) technique. Multiobjective ant lion optimization optimizes the contrast enhancement factor (CEF) and anisotropy of an image by varying the parameters associated with the dynamics of MSSR. The marked regions of interest (ROIs) are labeled as normal and microadenoma of pituitary obtained with increased level of accuracy and confidence using proposed algorithm. The increased difference between the mean intensity curves obtained using these ROIs validated the obtained subjective results. Furthermore, the proposed MSSR-based algorithm has been evaluated on standard T1 and T2 weighted BrainWeb dataset images and quantified in terms of CEF, peak signal to noise ratio (PSNR), structure similarity index measure (SSIM), and universal quality index (UQI). The obtained mean values of CEF 1.22, PSNR 27.68, SSIM 0.75, UQI 0.83 for twenty dataset images were highest among considered contrast enhancement algorithms for the comparison.

Gadolinium based contrast agents (GBCA): Safety overview after 3 decades of clinical experience

In the past three decades, we have learned much about the potential short-term and long-term safety issues associated with the intravenous administration of gadolinium based contrast agents (GBCAs). Yet, surprisingly, the past few years and even months have been accompanied by new discoveries in this field. This manuscript focuses predominantly on what we have learned – and are continuing to learn – about the long-term potential MR safety issues associated with the administration of the various GBCAs available today and will highlight areas in which they appear to differ from each other at least in a quantitative fashion, if not qualitatively.

Abstract TP91: Vessel Wall Imaging Demonstrates Aneurysm Wall Enhancement in Unruptured Posterior Communicating Artery Aneurysms With Oculomotor Nerve Palsy

Background: In ruptured aneurysms, vessel wall imaging (VWI) shows aneurysm wall enhancement, which may be caused by inflammation of the aneurysm wall. However, whether this inflammation is the cause or the result of aneurysm rupture remains unknown. In this study, we analyzed high-resolution VWI on posterior communicating artery (PComA) aneurysms, seeking to better understand aneurysm wall inflammation. Hypothesis: Oculomotor nerve palsy (ONP) is a warning sign of PComA aneurysm rupture. ONP results from compression of the oculomotor nerve and indicates aneurysm enlargement. Thus, PComA aneurysms with ONP are about to rupture, which makes them perfect cases to research aneurysm wall inflammation. If the inflammation of the aneurysm wall is the cause of aneurysm rupture, VWI may capture images of aneurysm wall enhancement before it ruptures. Methods: PComA aneurysm patients with ONP were examined using a Verio 3.0T scanner with a 12-channel head coil (Siemens Healthcare, Erlangen, Germany). Time-of-flight MRI angiography was performed to localize the aneurysm site. Then, a high-resolution T1-weighted black blood vessel wall sequence was obtained before and after intravenous administration of gadolinium. Each sequence was performed in the axial planes. Additional coronal planes or other planes were obtained if necessary. Patients with ruptured PComA aneurysms were also examined as a positive control, and patients with unruptured PComA aneurysms without ONP were examined as a negative control. Results: Ten patients with PComA aneurysm were examined. VWI of 3 patients with ONP showed aneurysm wall enhancement. Of these 3 patients, 2 were with post-orbital pain, and VWI showed complete enhancement of the aneurysm wall. VWI showed partial enhancement of the aneurysm wall in the other one patient without post-orbital pain. In the positive control group, complete wall enhancement was seen in all 3 ruptured PComA aneurysms (2 with ONP, 1 without ONP). In the negative control group of 4 cases, no aneurysm wall enhancement was seen. Conclusion: VWI demonstrated aneurysm wall enhancement in PComA aneurysms with ONP, which indicates that wall inflammation may occur before aneurysm rupture.

Utility of cardiac MRI in the assessment of myocardial viability: Evaluating its role using 3-T machine in correlation with SPECT

BackgroundAssessment of viable myocardium has important prognostic value in patients with coronary artery disease (CAD). The aim of this study was to compare 3T cardiac magnetic resonance (CMR) with single-photon emission computed tomography (SPECT). MethodsThirty-three patients with coronary artery disease were involved in this study. All patients were examined using coronary angiography to determine the degree of the coronary artery disease. Then, they underwent 3T CMR examination, after administration of intravenous gadolinium and the segmental extent of myocardial enhancement was determined, followed by SPECT evaluation. Comparison of myocardial viability was performed in 99 coronary territories. ResultsAgreement between two modalities was obtained in 88 segments (88.9%), resulting in a kappa value of 0.725. In 99 segments, we had eleven discordant results. Eleven SPECT viable segments were non-viable according to CMR. ConclusionSPECT was comparable to 3T CMR for myocardial viability assessment, C-MRI detected more non-viable segments with high definition to the thickness of the myocardial scar tissue than the SPECT.