First-pass Imaging Research Articles

First-pass images of musculoskeletal lesions: A new and useful diagnostic application of dynamic contrast-enhanced MRI

The purpose of this study was to evaluate the diagnostic value of parametric images which display the first-pass of Gd-DTPA after intravenous bolus injection. Single slice dynamic contrast-enhanced MRI (Turbo-FLASH) with a temporal resolution of 2.41 s was performed in 40 benign and malignant musculoskeletal lesions. Parametric ‘first-pass’ images were obtained by using a new postprocessing technique, derived from a home written computer program, which calculated the steepest slope of the time-intensity curve pixel by pixel. First-pass images provided qualitative and quantitative information, which was useful for diagnosis and therapy. Demonstration of the areas with the highest vascularization was very helpful in planning the best biopsy site in 6 patients and to delineate tumor from peritumoral muscle edema in 4 patients. In 10 patients the first-pass images provided additional information, which was not visible on the conventional spin-echo images. The most promising application was the ability to evaluate the response to preoperative chemotherapy in a patient with Ewing's sarcoma. Although a highly statistically significant difference ( p<0.001) was found between the first-pass slope values of benign and malignant lesions, the sensitivity (77%) and specificity (71%) of this method were too low to permit a definite differentiation of highly vascular benign from malignant lesions. Pathologic examination of 17 lesions, performed in the plane of the first-pass image, showed a good correlation between the first-pass slope values and the vascularization of the tissues. While in lesions with a nonuniform enhancement pattern, the single slice technique is subject to sampling error, first-pass images provide useful qualitative and quantitative information for the evaluation of musculoskeletal lesions, which is often not visible on the spin-echo images.

Surface and Volume Three-Dimensional Displays of Tc-99m HMPAO Brain SPECT Images in Stroke Patients by a Three-Headed Gamma Camera

Twenty patients with strokes were studied to evaluate volume and surface three-dimensional (3D) displays in Tc-99m HMPAO brain SPECT imaging using a triple-head gamma camera interfaced with a 64-bit super computer. In each patient, after an intravenous injection of 20 to 30 mCi of Tc-99m HMPAO, a first-pass cerebral flow study and brain SPECT images at 30 to 60 minutes were obtained. Although the cerebral lesion was more clearly delineated with surface 3D and volume 3D, crossed cerebellar diaschisis in seven patients was more clearly exhibited by volume 3D rather than surface 3D imaging. Volume and surface 3D displays enhance continuity of structures and understanding of spatial relationships; these displays view the brain from all angles, and thus the location and extension of lesion(s) in the brain are much easier to appreciate. It is concluded that 1) both surface and volume 3D displays equally enhance SPECT interpretation; and 2) volume 3D display enhances demonstration of crossed cerebellar diaschisis, but surface 3D display does not.

Wire chambers revisited

Detectors used for radioisotope imaging have, historically, been based on scintillating crystal/photomultiplier combinations in various forms. From the rectilinear scanner through to modern gamma cameras and positron cameras, the basic technology has remained much the same. Efforts to overcome the limitations of this form of technology have foundered on the inability to reproduce the required sensitivity, spatial resolution and sensitive area at acceptable cost. Multiwire proportional chambers (MWPCs) have long been used as position-sensitive charged particle detectors in nuclear and high-energy physics. MWPCs are large-area gas-filled ionisation chambers in which large arrays of fine wires are used to measure the position of ionisation produced in the gas by the passage of charged particles. The important properties of MWPCs are high-spatial-resolution, large-area, high-count-rate performance at low cost. For research applications, detectors several metres square have been built and small-area detectors have a charged particle resolution of 0.4 mm at a count rate of several million per second. Modification is required to MWPCs for nuclear medicine imaging. As gamma rays or X-rays cannot be detected directly, they must be converted into photo- or Compton scatter electrons. Photon-electron conversion requires the use of high atomic number materials in the body of the chamber. Pressurised xenon is the most useful form of "gas only" photon-electron convertor and has been used successfully in a gamma camera for the detection of gamma rays at energies below 100 keV. This camera has been developed specifically for high-count-rate first-pass cardiac imaging. This high-pressure xenon gas MWPC is the key to a highly competitive system which can outperform scintillator-based systems. The count rate performance is close to a million counts per second and the intrinsic spatial resolution is better than the best scintillator-based camera. The MWPC camera produces quantitative ejection fraction information of the highest quality. The detection of higher energy gamma rays has proved more problematical, needing a solid photon-electron convertor to be incorporated into the chamber. Several groups have been working on this problem with modest success so far. The only clinical detectors have been developed for positron emission tomography, where thin lead or lead-glass can provide an acceptable convertor for 511 keV photons. Two MWPC positron cameras have been evaluated clinically and one is now in routine use in clinical oncology. The problems of detection efficiency have not been solved by these detectors although reliability and large-area PET imaging have been proven.(ABSTRACT TRUNCATED AT 400 WORDS)

Assessment of intracardiac shunts with gadolinium-enhanced ultrafast MR imaging.

Dye dilutional techniques are widely accepted for the assessment of intracardiac shunts, but current techniques require arterial access or radioisotope injection. Ultrafast (less than 500 msec) magnetic resonance (MR) imaging is ideally suited for the evaluation of an indicator during passage through the heart. Twenty patients were studied, including 13 with shunts. Four-chamber, T1-weighted images were obtained during bolus injection of gadopentetate dimeglumine. A single image was obtained in 420 msec, with repetitive images acquired after each QRS complex. After the contrast material was injected, there was pronounced signal intensity enhancement in the right atrium, followed by the right ventricular cavity, left atrium, left ventricular cavity, and descending aorta. Patients with substantial intracardiac shunts demonstrated early recirculation. First-pass contrast material-enhanced MR imaging is a promising new technique for the rapid assessment of intracardiac shunts. Combined with anatomic and functional MR imaging techniques, it can help provide a comprehensive noninvasive evaluation of suspected intracardiac shunts or provide follow-up in patients with known shunts.

Quantification of left ventricular performance during transient coronary occlusion at various anatomic sites in humans: A study using tantalum-178 and a multiwire gamma camera

To study the functional significance or transient coronary occlusion on systolic and diastolic left ventricular function relative to the anatomic site of occlusion, first-pass radionuclide angiography with a mobile multiwire gamma camera using tantalum-178 (dose activity ≤84 mCi/elution) was performed in 46 patients undergoing balloon coronary angioplasty. First-pass images were acquired immediately before angioplasty and during the last 30 s of a 60-s balloon inflation in 23 left anterior descending arteries, 18 right coronary arteries, 8 circumflex arteries and 5 diagonal coronary arteries.Occlusion of the left anterior descending artery resulted in significant decreases in left ventricular ejection fraction (54.6 ± 12.7% to 32.3 ± 10.6%, p = 0.0001) and peak filling rate (2.48 ± 0.68 to 1.75 ± 0.64 end-diastolic volumes/s, p = 0.0001), accompanied by severe abnormalities in regional function and left ventricular dilation. Right coronary artery occlusion caused inferior hypokinesia, but did not significantly change left ventricular ejection fraction (48.5 ± 12.4% vs. 45.8 ± 12.5%, p = NS) or peak filling rate (2.05 ± 0.81 vs. 2.09 ± 0.81 end-diastolic volumes/s, p = NS). Circumflex artery occlusion resulted in mild wall motion deterioration and a borderline decrease in ejection fraction (54.7 ± 11.4% to 50.5 ± 12%, p = 0.057). Diagonal artery occlusion did not cause significant changes in left ventricular ejection fraction or filling rate. The decrease in left ventricular ejection fraction during coronary occlusion was 9 ± 25% and 27 ± 22%, respectively, in those arteries with and without collateral supply (p = 0.052).These data provide strong evidence for the critical importance of the left anterior descending artery and the secondary role of the other coronary arteries in maintaining global systolic and diastolic left ventricular function and suggest a protective role of collateral vessels during coronary occlusion.

Technetium-99m sestamibi myocardial imaging at rest for assessment of myocardial infarction and first-pass ejection fraction

The ability of technetium (Tc)-99m sestamibi myocardial perfusion imaging at rest to evaluate myocardial infarction and first-pass ejection fraction was studied in a trial involving 18 institutions. Protocol I compared regional perfusion with occurrence of infarction by Q wave or by gated blood pool scan wall motion abnormality in 146 patients. Protocol II assessed first-pass right and left ventricular ejection fraction in 85 patients. In protocol I, Tc-99m sestamibi images were abnormal in 104 of 111 patients (94%) with both a Q wave and a gated scan wall motion abnormality and was normal in 23 of 25 patients (92%) in whom both were normal. Therefore, concordance existed in 105 (94%) patients. Of 115 patients with a Q wave, 107 (93%) had an abnormal Tc-99m sestamibi study. Of 115 patients with a gated scan wall motion abnormality, 108 (94%) had an abnormal Tc-99m sestamibi study. Tc-99m sestamibi imaging showed corresponding perfusion abnormalities in 81% of 69 anterior Q-wave infarcts, 73% of 55 inferior Q-wave infarcts and 88% of 8 posterior infarcts. Specificity in normal regions on electrocardiography and wall motion was 91, 100 and 100%, respectively, for anterior, inferior and posterior regions, respectively, between wall motion and perfusion. Of 17 myocardial segments per patient, there was concordance in 74% of patients. First pass Tc-99m sestamibi imaging of ejection fraction agreed well with conventional first-pass imaging for the right and left ventricle. It is concluded that Tc-99m sestamibi myocardial imaging at rest reliably diagnoses and localizes infarction and assesses ejection fraction by first-pass imaging.

First-pass nuclear magnetic resonance imaging studies using gadolinium-DTPA in patients with coronary artery disease

Nuclear magnetic resonance (NMR) imaging has been shown to accurately portray cardiac anatomy and function. To investigate the potential of NMR imaging for the assessment of coronary stenosis in patients with chest pain, ultrafast NMR imaging in conjunction with a T1(longitudinal relaxation time) contrast agent was performed in 17 patients with chest pain who had undergone cardiac catheterization. These included 12 patients with significant coronary artery stenoses and 4 who underwent repeat NMR study after myocardial revascularization. Cardiac images at rest were obtained during rapid intravenous injection of gadolinium-DTPA (0.04 mM/kg). Electrocardiographic-gated images were acquired over 380 ms, with repetitive images obtained every 3 to 4 s.After contrast injection, there was pronounced signal enhancement in the right ventricular cavity, followed by enhancement in the left ventricular cavity and myocardium. Regional myocardium perfused by a diseased vessel demonstrated a lower peak signal intensity (p = 0.001) and lower rate of signal increase (p = 0.001) than did myocardium perfused by coronary arteries without stenosis. Repeat NMR study after revascularization showed an increase in peak signal intensity (p < 0.002).These results demonstrate the clinical potential of dynamic gadolinium-DTPA-enhanced NMR imaging for the assessment of coronary artery disease in patients with chest pain. In combination with anatomic and functional NMR imaging, this technique has the potential to provide a comprehensive noninvasive cardiac evaluation of patients with suspected coronary artery disease.

A perception experiment to assess the clinical accuracy of various methods of obtaining cardiac phase images

Five methods of obtaining cardiac phase (and phase-like) images are compared. These are single-harmonic Fourier phase imaging; time-to-minimum using a two-harmonic fit to each dixel; time-to-minimum using four weighted harmonics; composite factorial phase imaging; and individual factorial phase imaging. Polaroid prints of phase images for both gated equilibrium studies (using all methods) and first-pass studies (first and last methods only) were shown to observers who were asked to rate the images according to their confidence of an abnormality presenting. A receiver operating characteristic (ROC) analysis was performed. For gated studies composite factorial phase imaging appears to be best, while all methods are significantly better than single-harmonic Fourier phase imaging. For first-pass studies individual factorial phase imaging appears to be superior to single-harmonic Fourier phase imaging.