Injection Of Gadolinium-diethylenetriamine Pentaacetic Acid Research Articles

Dexamethasone does not affect endolymphatic hydrops (EH) in patients with Meniere's disease within 24 h, and intratympanic administration of gadolinium plus dexamethasone simplifies high-quality imaging of EH using a novel protocol of 7 min

BackgroundIntratympanic administration of gadolinium chelate allows for a better visualization of endolymphatic hydrops (EH) using MRI than intravenous injection and was recently further improved to facilitate high-quality imaging of EH in 7 min. The aim of the present study was to simplify the intratympanic administration protocol by mixing gadolinium chelate with therapeutic dexamethasone and to evaluate the effects of this mixture on the visualization of EH in MRI. Materials and methodsIn an in vitro study, the potential impact of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) on the stability of dexamethasone was evaluated by analyzing dynamic changes in dexamethasone with high-performance liquid chromatography (HPLC) after mixing with Gd-DTPA. Ten patients with definite Meniere's disease (MD) were recruited to study the potential interference of dexamethasone on MRI visualization of EH, and 49 patients with MD were recruited to evaluate the effect of intratympanic injection of Gd-DTPA mixed with dexamethasone on MRI of EH using a 3T MR machine and a novel heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed using a magnitude plus zero-filled interpolation (hT2FLAIR-MZFI) sequence. ResultsThe retention times and peak area of dexamethasone in HPLC were not modified by the addition of Gd-DTPA. EH grading in the cochlea and vestibule was not influenced in any ear by intratympanic injection of dexamethasone. Excellent inner ear images were obtained from all patients, and EHs with various grades were displayed. There were significant correlations between diagnosis and cochlear EH (p < 0.01, Spearman's Rho), between diagnosis and vestibular EH (p < 0.01, Spearman's Rho), and between cochlear and vestibular EH (p < 0.01, Spearman's Rho). The distribution of Gd-DTPA plus dexamethasone negatively correlated with the grade of vestibular EH. Injury of the endolymph-perilymph barrier was detected in one cochlea and three vestibules of 59 inner ears with MD. ConclusionsIntratympanic administration of Gd-DTPA plus dexamethasone yielded high-quality MRI images of EH in patients with MD using a novel 7-min protocol and simplified the clinical application. Intratympanic administration of Gd-DTPA plus dexamethasone might be used to test its therapeutic effect in future work. Level of evidence3.

Magnetic resonance colonography with intestine-absorbable nanoparticle contrast agents in evaluation of colorectal inflammation

ObjectivesTo develop a nanoparticle-based MRI protocol based on transrectal administration of intestine-absorbable nanoparticle contrast agents to evaluate ulcerative colitis (UC).MethodsSolid lipid nanoparticles (SLNs) were synthesized by loading gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) and octadecylamine-fluorescein isothiocyanate to produce Gd-FITC-SLNs as T1 contrast agents. Twenty mice with acute UC were divided into four groups: enema with Gd-FITC-SLNs, intravenous injection of Gd-FITC-SLNs, enema with Gd-DTPA, and intravenous injection of Gd-DTPA. Five mice with chronic UC and five mice without UC underwent enema with Gd-FITC-SLNs. Axial T1- and T2-weighted MR images were obtained before and 20, 40, 60, 80,100, and 120 min after enema or intravenous injection of the contrast agent. The signal-to-noise ratios (SNRs) of the colorectal wall were measured in both groups. The MRI findings were correlated with subsequent histological confirmation.ResultsAt 20 min after enema with Gd-FITC-SLNs, MRI showed the following contrast enhancement pattern: acute UC > normal intestinal wall > chronic UC. A continuous enhancement effect was observed in mice with acute UC, whereas a slight continuous enhancement of the colorectal wall was observed in mice with chronic UC. The normal intestinal wall rapidly metabolized the contrast agent, and the enhancement decreased on sequential scans. There was no significant difference between the SNRs of the intestinal wall at 20 min after intravenous Gd-DTPA and transrectal Gd-FITC-SLN administration.ConclusionsEnema with Gd-FITC-SLNs may be helpful for the diagnosis and differential diagnosis of acute and chronic UC and can confer the same or better results than with intravenous Gd-DTPA.Key Points• Enema with Gd-FITC-SLNs may be helpful for the diagnosis and differential diagnosis of acute and chronic UC.• Enema with Gd-FITC-SLNs can achieve the same or better result than that with intravenous Gd-DTPA.• SLN-based MR colonography enhances the colorectal wall inflammation, based on the colonic absorption of the nanoparticle contrast agents.

Gadolinium-Loaded Solid Lipid Nanoparticles for Colorectal Tumor in MR Colonography.

The current study aims to investigate the possibility of using solid lipid nanoparticles (SLNs)-enhanced magnetic resonance (MR) colonography to diagnose colorectal cancer. Gd-FITC-SLNs were synthesized by loading gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) and fluorescein isothiocyanate (FITC) simultaneously. Twenty mice received azoxymethane/dextran sulfate sodium (AOM/DSS) to induce adenocarcinoma of the colon and were divided into 4 groups, and 5 in per group. MR colonography were performed at different time periods before and after enema or intravenous injection of Gd-FITC-SLNs or Gd-DTPA. The results demonstrated SNR (signal-to-noise ratio) significantly increased from 1.56- to 1.76-fold within the colorectal tumors after the enema of Gd-FITC-SLNs (p < 0.001). No differences in SNR were observed after the enema of Gd-DTPA (p > 0.05). Besides, SNR increased from 1.54- to 1.72-fold within the colorectal tumors after the intravenous injection of Gd-FITC-SLNs (p < 0.001) while SNR increased from 1.39to 1.57-fold within the colorectal tumors after the injection of Gd-DTPA (p < 0.001). In addition, SNR within colorectal tumors significantly increased ranging from 20th to 140th min, and lasted for about 120 min (p < 0.05) after the enema of Gd-FITC-SLNs and SNR within colorectal tumors also significantly increased ranging from 0th hour to 8th hour, lasted for about 8 hour (p < 0.05) after the injection of Gd-FITC-SLNs. However, after the injection of Gd-DTPA, SNR within colorectal tumors significantly increased only ranging from 0th min to 20th min after administration (p < 0.01). Furthermore, hematoxylin and eosin (H&E) staining revealed that all mice developed adenocarcinoma of the colon. In summary, it is feasible by using Gd-FITC-SLNs in MR colonography to diagnose colorectal cancer. Enema of Gd-FITC-SLNs can provide marked enhancement of colorectal tumors quickly, and safer while intravenous injection of Gd-FITC-SLNs can provide a long-lasting enhancement of colorectal tumors in MR colonography. These findings present a potential clinical application of Gd-FITC-SLNs on MR colonography.

Magnetic resonance elastography of liver: influence of intravenous gadolinium administration on measured liver stiffness.

To evaluate the effect of intravenous gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA) on estimation of liver stiffness using magnetic resonance elastography (MRE) for detection of liver fibrosis. Liver MRI with MRE was performed in 210 subjects on a single 1.5 Tesla clinical MRI scanner. Liver MRE was performed before intravenous Gd-DTPA injection (NC-MRE) and 5 minutes post injection (PC-MRE) using a modified phase-contrast gradient-echo sequence (TR/TE=100/27 ms, FOV = 30-46 cm, 4 x 10 mm slices, gap 5 mm) which automatically generated stiffness maps. Two readers' blinded to clinical details independently performed liver stiffness measurements (LSM) by drawing 2 or more regions of interest (ROI) on the stiffness maps on each of the four slices of NC-MRE and PC-MRE obtained for each patient. The mean LSM in kilopascals (kPa) for NC-MRE and PC-MRE was calculated. The correlation between NC-MRE and PC-MRE LSM was evaluated with a paired t test and Pearson's correlation analysis, and the inter-observer correlation was evaluated using intra class coefficient (ICC) analysis. A receiver operating curve analysis (ROC) was performed to compare accuracies for detection and staging of liver fibrosis in a subgroup of 72 subjects with histological confirmation of liver fibrosis. There was an excellent correlation between NC-MRE and PC-MRE LSM (R(2)=0.98, p<0.001) with no significant differences. The interobserver agreement was also excellent (ICC, 0.94-0.99). There were no significant differences in the cut-off LSM value/accuracy/sensitivity/specificity for detection of significant liver fibrosis with NC-MRE and PC-MRE (2.98 kPa/98.5%/100%/88%, p<0.001 and 3.1 kPa/98.2%/98%/88%, p<0.001 respectively). Intravenous Gd-DTPA had no significant influence on LSM with MRE and does not significantly affect the diagnostic performance of MRE for fibrosis detection.

DYNAMIC CONTRAST-ENHANCED MAGNETIC RESONANCE ANGIOGRAPHY OF Gd-TTDA-BOM COMPARED WITH Gd-DTPA IN NORMAL RAT AT 3T

Dynamic contrast-enhanced magnetic resonance angiography (DCE-MRA) is a good modality for the diagnosis of vascular diseases. Contrast agents that produce higher and longer enhancement in vessels are highly valued. The complex of gadolinium with (R,S)-4-carboxy-5,9,12-tris(carboxymethyl)-l-phenyl-2-oxa-5,9,12-triazatridecan-14-oic acid (Gd-TTDA-BOM) possesses a benzyloxymethyl group in the ligand TTDA-BOM with the capability of raising lipophilicity. The Gd-TTDA-BOM complex expresses higher and longer enhancement in mouse liver than that of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) because of its faster water exchange rate, higher reorientation time, and higher lipophilicity. Phantom studies have shown that Gd-TTDA-BOM has expressed with higher affinity to human serum albumin (HSA) than Gd-DTPA. In general, these characteristics might provide an advantage for vascular imaging. To verify this in vivo, a 3T MR scanner was used to investigate the signal enhancement in the aorta of normal rats by DCE-MRA after the bolus injection of Gd-TTDA-BOM and compared this with the injection of Gd-DTPA. Gd-TTDA-BOM expressed higher and longer signal enhancement in the aorta than Gd-DTPA. These results suggest that Gd-TTDA-BOM could provide better image quality than Gd-DTPA as an enhancement agent in DCE-MRA.

Transferrin-Coated Gadolinium Nanoparticles as MRI Contrast Agent

In this study, the contrasting properties of human serum albumin nanoparticles (HSA-NPs) loaded with gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) and coated with transferrin in MRI in mice are evaluated. HSA-NPs were conjugated with Gd-DTPA (Gd-HSA-NPs) and coupled with transferrin (Gd-HSA-NP-Tf). Mice underwent MRI before or after injection of Gd-DTPA, Gd-HSA-NP, or Gd-HSA-NP-Tf. All the studied contrast agents provided a contrast enhancement (CE) in the blood, heart muscle, and liver. Compared to Gd-DTPA, CE with HSA-NP was achieved at lower Gd doses. Gd-HSA-NP-Tf yielded significantly higher CE than Gd-HSA-NP in the skeletal muscle, blood, cardiac muscle, and liver (p < 0.05). Gd-HSA-NP-Tf achieved a significantly higher CE than Gd-HSA-NP and Gd-DTPA in the blood, cardiac muscle, and liver (p < 0.05). In the brain, only Gd-HSA-NP-Tf was found to cause a significant CE (p < 0.05). The Gd-HSA nanoparticles have potential as MRI contrast agents. In particular, Gd-HSA-NP-Tf has a potential as a specific contrast agent for the brain, while the blood-brain barrier is still intact, as well as in the heart, liver, and skeletal muscle.

Cell Swelling Contributes to Thickening of Low-Dose N-methyl-D-Aspartate–Induced Retinal Edema

The contribution of cell swelling versus vascular leakage in retinal edema remains largely undefined. The objective of this study was to use in vivo magnetic resonance imaging (MRI) to assess retinal cell swelling in the edematous mouse retina. Inner retinal edema was induced by intravitreal injection of 2.5 nmol N-methyl-D-aspartate (NMDA). To assess retinal cell swelling, diffusion MRI was performed at baseline, 3-hours, 1 day, 3 days, and 7 days (n ≥ 5 at each time point) after NMDA injection. To detect retinal vascular leakage, gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) enhanced MRI was performed at baseline, 3 hours and 1 day (n = 5 for each group) after NMDA injection. Upon the completion of MRI, mouse eyes were enucleated, cryosectioned, and stained for assessing retinal layer thickness and cell death. Inner retinal cell swelling was hyperintense on diffusion-weighted images at 3 hours and 1 day after NMDA injection. The thickened inner retina was also seen in anatomic MRI and histology. Quantitatively, inner retinal apparent diffusion coefficient (ADC) decreased approximately 20% at 3 hours and 1 day after NMDA injection (P < 0.05 compared with baseline), suggesting cell swelling. Systematic injection of paramagnetic Gd-DTPA did not alter vitreous longitudinal relaxation time (T1) at baseline or at 3 hours after NMDA injection. In contrast, vitreous T1 in mice decreased 16 ± 6% (P < 0.05), reflecting retinal vascular leakage at 1 day after NMDA injection. Noninvasive diffusion MRI was performed to detect retinal cell swelling in vivo. Our results demonstrated that retinal cell swelling could directly lead to retinal thickening independent of vascular leakage.

Assessment of peripheral tissue perfusion disorder in streptozotocin-induced diabetic rats using dynamic contrast-enhanced MRI

Purpose To assess peripheral tissue perfusion disorder in streptozotocin (STZ)-induced diabetic rats by using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Materials and Methods A rat diabetes model was produced by intravenous injection of STZ. Diabetic rats were sustainably treated with either saline or insulin using an Alzet osmotic pump. Hind paw tissue perfusion was measured by signal intensity (SI) enhancement after gadolinium diethylenetriaminepentaacetic acid injection in DCE-MRI study and quantified using the initial area under the SI-time curve (IAUC). Peripheral tissue uptake of [ 14C]iodoantipyrine (IAP) was also determined as a marker of tissue blood flow for comparison with the IAUC value indicating tissue perfusion. Results STZ caused hyperglycemia at 1 and 2 weeks after injection. Treatment with insulin significantly alleviated hyperglycemia. At 2 weeks after STZ injection, peripheral tissue perfusion was clearly reduced in the diabetic rats and its reduction was significantly improved in the insulin-treated diabetic rats. Tissue perfusion evaluated by DCE-MRI was similar to the tissue blood flow measured by [ 14C]IAP uptake. Conclusion Our findings demonstrated that DCE-MRI can assess peripheral tissue perfusion disorder in diabetes. DCE-MRI could be suitable for noninvasive evaluation of peripheral tissue perfusion in both preclinical and clinical studies. It may also be useful for developing novel drugs to protect against diabetic vascular complications.

Gadolinium-loaded polymeric nanoparticles modified with Anti-VEGF as multifunctional MRI contrast agents for the diagnosis of liver cancer

Molecular imaging is essential to increase the sensitivity and selectivity of cancer diagnosis especially in the early stage of tumor. Here, we designed a novel multifunctional polymeric nanoparticle contrast agent (Anti-VEGF PLA-PEG-PLL-Gd NP) simultaneously modified with Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) and anti-vascular endothelial growth factor (VEGF) antibody to deliver Gd-DTPA to the tumor area and achieve the early diagnosis of hepatocellular carcinoma (HCC). The Anti-VEGF PLA-PEG-PLL-Gd NPs exhibited high T 1 relaxivity and no obvious cytotoxicity under the experimental concentrations in human hepatocellular carcinoma (HepG2) cells. The results of in vitro cell uptake experiments demonstrated that the uptake process of NPs was both concentration and time depended. Compared with non-targeted NPs, the Anti-VEGF antibody modified NPs showed much higher cell uptake in the HepG2 cells. During in vivo studies, the targeted NPs showed significantly signal intensity enhancement at the tumor site (mouse hepatocarcinoma tumor, H22) compared with non-targeted NPs and Gd-DTPA injection in tumor-bearing mice and the imaging time was significantly prolonged from less than an hour (Gd-DTPA injection group) to 12 h. These results demonstrated that this novel MRI contrast agent Anti-VEGF PLA-PEG-PLL-Gd NPs showed great potential in the early diagnosis of liver tumors.

Effects of Contrast Agent on Water Suppression and Shimming of Kidney Single-Volume Proton MR Spectroscopy at 3.0T

The aim of this study was to determine whether the administration of gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) significantly affects shimming and water suppression on kidney magnetic resonance spectroscopic prescanning and whether the impact of shimming and water suppression is changed with time after intravenous administration on a 3.0-T system. Forty patients (two patients were excluded from analysis because of motion) were examined before and after the administration of Gd-DTPA (the interval between the right and left kidneys was approximately 40 seconds). Regions of interest were carefully positioned in the region of the corresponding location of both kidneys separately. Line widths (full width at half maximum) and water suppression were obtained. A paired t test for comparison of means was used. In addition, repeat measurements with a shorter time interval (obtained 120-130 seconds after the injection) and a longer time interval (obtained 150-160 seconds after the injection) were performed in five patients in the same regions of interest of the right kidney. Sequential ¹H magnetic resonance spectroscopic prescanning in the same region of interest was performed in one patient. The left kidney had slightly better shimming and water suppression effects than the right kidney after contrast agent administration (all P values < .01). The limiting resolution of both shimming and water suppression effects was decreased on enhanced images in both kidneys (all P values < .01). The longer time interval group had better shimming and water suppression effects than the shorter time interval group (all P values < .01). After the administration of Gd-DTPA in one patient, sequential values of shimming and water suppression in the right and left kidneys, respectively, were 13 Hz and 97% and 12 Hz and 97% prior to the examination, 34 Hz and 86% and 30 Hz and 88% at 5 minutes, 32 Hz and 89% and 27 Hz and 90% at 10 minutes, 28 Hz and 91% and 24 Hz and 91% at 15 minutes, and 24 Hz and 92% and 20 Hz and 92% at 25 minutes. Gd-DTPA exerts adverse effects on water suppression and shimming, both of which show a trend of becoming well gradually with time extension after the injection of Gd-DTPA. This phenomenon limits the diagnostic use of kidney magnetic resonance spectroscopy performed immediately after contrast-enhanced magnetic resonance imaging.

MR Imaging of the Cochlear Modiolus after Intratympanic Administration of Gd-DTPA

We evaluated whether enhancement of the cochlear modiolus could be visualized 24 hours after intratympanic injection of gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) using a 3-dimensional real inversion recovery sequence combined with a 32-channel head coil at 3 tesla. Intratympanic injection of Gd-DTPA has been reported for visualizing endolymphatic hydrops in Meniere's disease, and its use has shown communication between the cochlear perilymph and cerebrospinal fluid in the internal auditory canal. Although the cochlear modiolus has been considered the route for this communication, this has not been confirmed through direct visualization of its enhancement. We qualitatively and quantitatively evaluated the presence of contrast enhancement in the modiolus in 19 patients with clinically suspected endolymphatic hydrops or hearing loss who underwent imaging as described above. The contrast ratio (CR) between the cochlear modiolus and cerebellar white matter on the injected side was 1.09+/-1.23, and that on the non-injected side was -0.48+/-0.38 (P<0.01). In all subjects, the CR value was larger on the injected than non-injected side, and enhancement of the cochlear modiolus was also recognized visually. Intratympanic Gd-DTPA can be administered to visualize enhancement of the cochlear modiolus and may thereby reveal its functional anatomy.

Noninvasive detection of temozolomide in brain tumor xenografts by magnetic resonance spectroscopy.

Poor drug delivery to brain tumors caused by aberrant tumor vasculature and a partly intact blood-brain barrier (BBB) and blood-brain tumor barrier (BTB) can significantly impair the efficacy of chemotherapy. Determining drug delivery to brain tumors is a challenging problem, and the noninvasive detection of drug directly in the tumor can be critically important for accessing, predicting, and eventually improving effectiveness of therapy. In this study, in vivo magnetic resonance spectroscopy (MRS) was used to detect an anticancer agent, temozolomide (TMZ), in vivo in murine xenotransplants of U87MG human brain cancer. Dynamic magnetic resonance imaging (MRI) with the low-molecular-weight contrast agent, gadolinium diethylenetriaminepentaacetic acid (GdDTPA), was used to evaluate tumor vascular parameters. Carbon-13-labeled TMZ ([(13)C]TMZ, 99%) was intraperitoneally administered at a dose of approximately 140 mg/kg (450 mg/m(2), well within the maximal clinical dose of 1000 mg/m(2) used in humans) during the course of in vivo MRS experiments. Heteronuclear multiple-quantum coherence (HMQC) MRS of brain tumors was performed before and after i.p. administration of [(13)C]TMZ. Dynamic MRI experiments demonstrated slower recovery of MRI signal following an intravenous bolus injection of GdDTPA, higher vascular flow and volume obtained by T*(2)-weighted MRI, as well as enhanced uptake of the contrast agent in the brain tumor compared with normal brain detected by T(1)-weighted MRI. These data demonstrate partial breakdown of the BBB/BTB and good vascularization in U87MG xenografts. A [(13)C]TMZ peak was detected at 3.9 ppm by HMQC from a selected volume of about 0.15 cm(3) within the brain tumor with HMQC pulse sequences. This study clearly demonstrates the noninvasive detection of [(13)C]TMZ in xenografted U87MG brain tumors with MRS. Noninvasive tracking of antineoplastic agents using MRS can have a significant impact on brain tumor chemotherapy.

REAL-TIME MONITORING OF GADOLINIUM DIETHYLENETRIAMINE PENTA-ACETIC ACID DURING OSMOTIC BLOOD-BRAIN BARRIER DISRUPTION USING MAGNETIC RESONANCE IMAGING IN NORMAL WISTAR RATS

Treatment of malignant gliomas is hampered by several factors, one of which is the blood-brain barrier (BBB). Thus, innovative strategies to cross the BBB have been developed, such as the BBB disruption procedure. Although it has been studied extensively, details regarding the physiology of the procedure remain obscure. This study was undertaken to clarify these issues. Forty Wistar rats were imaged with a 7T animal magnetic resonance imaging scanner in dynamic acquisitions during BBB disruption. Gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) was injected to visualize and characterize the permeability of the BBB at different time points after disruption. The concentration of Gd-DTPA in the brain parenchyma was determined as a function of time after injection. A typical pattern of signal change as a function of time was observed in the treated hemisphere of all animals. Initially, a slight signal decrease was observed in T1-weighted images followed by a strong increase corresponding to the injection of Gd-DTPA. Two different mechanisms seemed responsible for the distribution of Gd-DTPA within the parenchyma: 1) a direct diffuse increase in capillary permeability, and 2) a diffusion process in the interstitial compartment. Initial results showed that the barrier opens immediately after the procedure and for at least 30 minutes. The methodology described in this article allows monitoring of the dynamics of the BBB disruption process and characterization of its physiology in vivo, and represents a marked advantage over postmortem static studies.

Effect of intravenous gadolinium-DTPA on diffusion tensor MR imaging for the evaluation of brain tumors

The aim of this study was to investigate whether indices of diffusion tensor MRI (DT-MRI) are altered after contrast medium injection in patients with brain tumors. DT-MRIs at a 3-T unit before and 6 min after gadolinium-diethylenetriamine penta-acetic acid injection were obtained in nine patients (five women, four men) with histologically confirmed brain tumors (four metastases, one glioblastoma multiforme, three meningiomas, and one lymphoma). Fractional anisotropy (FA), trace and mean raw DT-MRI data without (DT_b0, b value = 0 s/mm(2)) and with (DT_b800, b value = 800 s/mm(2)) diffusion-encoded gradients were calculated. Regions of interest (ROIs) were placed in the tumor, peritumoral edema, and normal-appearing symmetric contralateral brain tissue for each patient. The Kruskal-Wallis rank sum test was used to determine the effects of contrast medium and ROI for all of the maps, and the Wilcoxon signed-rank test was performed for either paired t test between pre- and post-contrast values of DTI indices for the ROIs or the post hoc test. Statistically significant differences between pre-contrast and post-contrast DT-MRI are shown in the trace value of the peritumoral edema area (p = 0.0195) and the FA value of the tumor area (p = 0.0273). Trace and FA values of the other areas show no statistically significant differences between pre- and post-contrast (p > 0.05). In addition, we find a significant ROI effect for both FA (chi (2) = 26.514, df = 2, p = 0.0001) and trace (chi (2) = 21.218, df = 2, p = 0.0001). DT-MRI obtained after contrast medium injection of 6 min results in significant changes in diffusion isotropic and anisotropic values. Therefore, clinical applications of DT-MRI after administrating a contrast medium require caution in interpretation.

The blood–brain barrier is intact after levodopa-induced dyskinesias in parkinsonian primates—Evidence from in vivo neuroimaging studies

It has been suggested, based on rodent studies, that levodopa ( l-dopa) induced dyskinesia is associated with a disrupted blood–brain barrier (BBB). We have investigated BBB integrity with in vivo neuroimaging techniques in six 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) lesioned primates exhibiting l-dopa-induced dyskinesia. Magnetic resonance imaging (MRI) performed before and after injection of Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) revealed an intact BBB in the basal ganglia showing that l-dopa-induced dyskinesia is not associated with a disrupted BBB in this model.

Image evaluation of endolymphatic space in fluctuating hearing loss without vertigo

The objective of the present study was to investigate endolymphatic space images in patients with fluctuating hearing loss without vertigo, and to elucidate its underlying pathophysiology. Eight patients with fluctuating hearing loss without vertigo were included in this study. 3T MRI was taken, 24 h after intratympanic injection of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Electrocochleography and VEMP tests were performed to evaluate cochlear and vestibular functions. Endolymphatic hydrops were observed both in the cochlea and in the vestibule of all eight patients. Three patients out of six whose summating potential/action potential (SP/AP) ratio was recordable showed an elevation of SP/AP ratio. In the two patients with remarkable endolymphatic hydrops in the vestibule, VEMP was absent from the affected ear. In conclusion, 3T MRI after intratympanic injection of Gd-DTPA revealed endolymphatic hydrops both in the cochlea and in the vestibule in the patients with fluctuating hearing loss without vertigo.

Communication between cochlear perilymph and cerebrospinal fluid through the cochlear modiolus visualized after intratympanic administration of Gd-DTPA

Intratympanic injection of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) has been reported as a procedure to visualize endolymphatic hydrops of Meniere's disease. We frequently noted that cerebrospinal fluid (CSF) in the internal auditory canal (IAC) was also enhanced after this procedure. The purpose of this study was to evaluate how frequently this occurs and to investigate the specific features of patients who lack this communication. A total of 25 patients with clinically suspected endolymphatic hydrops underwent the procedure. After 24 h, three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and 3D constructive interference in steady state (3D-CISS) were performed. The presence of contrast enhancement in the CSF space of the fundus of the IAC was evaluated. The contrast ratio between CSF of the IAC fundus and cerebellar white matter on the injected side was 1.49 +/- 0.65, and that of the noninjected side was 0.32 +/- 0.16 (P < 0.01). Enhancement of the CSF space in the IAC fundus was seen in all but two subjects: one had enlarged endolymphatic duct and sac syndrome (EEDS), and the other had cochlear nerve agenesis. In these two patients, the cochlear modiolus seemed to be normal. Intratympanic Gd-DTPA administration can reveal permeability of the modiolus and might facilitate evaluation of functional abnormalities of the modiolus not detected by conventional imaging tests.

Coronary Collaterals in Full Effect

A 59-year-old man with no relevant medical history was referred to our clinic for analysis of exertional chest pain. He had noticed slowly progressive symptoms approximately 6 months before referral, although they did not prohibit his daily 12-mile cycling exercise routine. During diagnostic 99m-technetium-sestamibi single photon emission computed tomography treadmill stress testing, the ECG showed pathological ST-segment depression, and the patient had anginal chest pain. Three-dimensional reconstructed scintigraphic perfusion images (Figure 1) displayed a substantial reversible defect in the anterolateral myocardium with only a mild resting perfusion defect in the distal segment of the anterior wall, which coincided with a small area of subendocardial fibrosis visualized …

Physiologic changes in breast magnetic resonance imaging during the menstrual cycle: perfusion imaging, signal enhancement, and influence of the T1 relaxation time of breast tissue

This study was undertaken to determine the best time during the menstrual cycle to perform dynamic breast magnetic resonance imaging (MRI). Fifty premenopausal women with contralateral “normal” breast (mean age, 40.4±6.4 years; range, 30-52 years) were enrolled in a protocol designed to correlate an ipsilateral suspicious breast lesion with pathology. The contralateral breast in each patient was examined with palpation and mammography prior to MRI on a 1.5-T scanner using gradient echo and dynamic contrast-enhanced echo-planar without and following gadolinium diethylenetriaminepentaacetic acid injection. Precontrast T1 relaxation times were measured before calculating extraction flow product (EFP) maps using a multicompartmental model. T1, EFP, and enhancement were measured in the control breast on four slices centered around the nipple and recorded as a function of the phases of the menstrual cycle. Lesions or areas with focal enhancement were excluded. Analysis of variance and Fisher's tests were performed. The cyclic changes in T1 relaxation time were not significant (P>.2). Extraction flow product and enhancement varied significantly during the cycle (P<.003 and P<.004, respectively), with low values during the first half of the cycle and high values during the second half. The lowest values of EFP and enhancement (5.5±2.9 ml per 100 g/min and 26±17%) were observed during the proliferative phase (days 3-7), and the highest values (17±10.2 ml/100 g/min and 104±28%) were observed during the secretory phase (days 21-27) (P<.0006 and P<.0008, respectively). Dynamic breast MRI should be performed during the first half of the menstrual cycle (days 3-14) in order to minimize interpretative difficulties related to the uptake of gadolinium in normal breast tissue due to hormonal fluctuations during the menstrual cycle.

Reduced myocardial perfusion reserve and transmural perfusiongradient in heart transplant arteriopathyassessed by magnetic resonance imaging

ObjectivesThe goal of this study was to detect transplant arteriopathy (Tx-CHD) by a reduced myocardial perfusion reserve (MPR) and resting endomyocardial/epimyocardial perfusion ratio (Endo/Epi ratio). BackgroundTransplant arteriopathy often lacks clinical symptoms and is the reason for frequent surveillance angiography in heart transplant (Tx) recipients. Magnetic resonance perfusion imaging (MRPI) allows noninvasive assessment of transmural and selective endomyocardial and epimyocardial perfusion. MethodsFifteen healthy volunteers (controls) and three groups (A, B, C) of Tx recipients were included. In controls and patients, MPR (hyperemic/resting perfusion) and Endo/Epi ratio were determined with MRPI after injection of gadolinium-diethylenetriamine pentaacetic acid at rest and during hyperemia (intravenous adenosine). Group A (n = 10) had no left ventricular (LV) hypertrophy and/or prior rejection, while patients in group B (n = 10) had at least one of these characteristics. Patients in group A and B had a normal coronary angiogram and a coronary flow reserve (CFR) of ≥2.5 (CFR = hyperemic/resting blood flow). Group C (n = 7) had Tx-CHD diagnosed by angiography and a reduced CFR (<2.5). ResultsIn group C, MPR (1.7 ± 0.5) and Endo/Epi ratio (1.1 ± 0.2) were significantly reduced compared with controls (4.2 ± 0.7 and 1.6 ± 0.3; both p < 0.0001), group A (3.6 ± 0.7 and 1.6 ± 0.2; both p < 0.0001) and B (2.7 ± 0.9, p < 0.01 and 1.4 ± 0.1, p < 0.04). Transplant arteriopathy can be excluded by an MPR of >2.3 with sensitivity and specificity of 100% and 85%. If LV hypertrophy and prior rejection are excluded, Tx-CHD can be excluded by an Endo/Epi ratio of >1.3 with 100% and 80%. ConclusionsMagnetic resonance perfusion imaging detects Tx-CHD by a decreased MPR. After exclusion of LV hypertrophy and prior rejection, resting Endo/Epi ratio alone might be sufficient to indicate Tx-CHD.