Faculty Bibliography

OBJECTIVE: To compare the 2-dimensional time of flight, the 3-dimensional time-resolved contrast-enhanced magnetic resonance (MR) angiography, and the 3-dimensional 3-station bolus chase contrast-enhanced MR angiography in assessing distal station atherosclerosis. METHODS: Two-dimensional time of flight, 3-dimensional time-resolved contrast-enhanced MR angiography, and 3-dimensional bolus chase contrast-enhanced MR angiography were performed from the knees to the metatarsal heads of 40 patients. Blinded to the patients' identity, 2 readers independently reviewed the 3 sequences in random order; differences were resolved by consensus. Anterior tibial, peroneal, and posterior tibial arterial lengths to the talar dome were scored as follows: 1, greater than 50% of the length of a normal artery; 2, less than 50%; and 3, total occlusion. Stenoses were scored as follows: 1, less than 50%; and 2, greater than 50%. The pedal vessels (dorsalis pedis, posterior tibial, and plantar pedal arch arteries) were scored as follows: 1, less than 50% stenosis; and 2, greater than 50% stenosis. The reference standard was a combined interpretation of all 3 sequences by both readers in consensus. RESULTS: For the 240 calf segments scored for length, concordance with reference assessment was poorer for the time of flight than for either the bolus chase or time-resolved angiography (P = 0.0021 and P = 0.0082, respectively), and the latter two were statistically indistinguishable. For stenosis grading of the 461 calf and pedal segments, the time-resolved and bolus chase methods were superior to the time of flight (P = <0.0001 and P = 0.0041, respectively), and the contrast-enhanced methods were statistically indistinguishable. CONCLUSIONS: Both contrast-enhanced time-resolved and bolus chase MR angiography are superior to the time of flight in diagnosing distal station peripheral vascular disease

PURPOSE: To determine the dependence of absolute computed tomographic (CT) attenuation values on multi-detector row CT scanner type, convolution kernel, and tube current by using an anthropomorphic phantom. MATERIALS AND METHODS: A customized phantom was designed with tissue-equivalent materials to simulate contrast material-enhanced liver, spleen, pancreas, aorta, kidney, 0- and 50-HU cylindric renal cysts, muscle, and fat. The phantom was scanned with five multi-detector row CT scanners (LightSpeed QXi, GE Healthcare, Milwaukee, Wis; MX8000, Philips Medical Systems, Best, the Netherlands; and Volume Zoom, Sensation 16 and Sensation 64, Siemens Medical Solutions, Forchheim, Germany) on five separate occasions with 120 kVp, low and high tube current settings, 3.00-3.75-mm section thickness, 50% overlap, and standard and high-spatial-resolution kernels. Standardized regions of interest (ROIs) were used to obtain 3510 attenuation measurements. Attenuation dependence on scanner, kernel, and tube current was evaluated by using F tests derived with mixed-model regression. Within the mixed-model framework, the Tukey honestly significant difference procedure and a Bonferroni multiple comparison correction were used to assess differences among imaging regimens and tube current settings, respectively, in terms of tissue attenuation and ROI standard deviation. RESULTS: Tube current had no significant effect (P>.4) on observed tissue attenuation. Significant (P<.0001) differences were observed between imaging regimens with respect to mean attenuation for each tissue type. Convolution kernel modification had an inconsistent effect on tissue attenuation, depending on the scanner. All multi-detector row CT scanners displayed intrascanner variability in tissue attenuation (minimum range: 8.4 HU for fat tissue with the Sensation 16; maximum range: 63.4 HU for liver tissue with the Sensation 64). The scanners behaved differently at the lower range of the CT number scale, where 0-HU cyst attenuation ranged from -15.7 to 23.9 HU and one vendor's equipment showed significantly lower mean attenuation values. CONCLUSION: CT attenuation values vary significantly between different manufacturers' multi-detector row CT scanners, among different generations of multi-detector row CT scanning equipment, and with individual combinations of scanner and convolution kernel. Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/242/1/109/DC1

Background/Aims: Subjective memory complaint (SMC) in normal individuals may predict future cognitive decline. The goal of this study was to examine whether the probability of decline increases with growing intensity of complaint. Methods: Normal subjects over the age of 50 years were included in a longitudinal retrospective study (mean follow-up time = 8 years). All subjects (n = 230) underwent cognitive and medical examination at baseline. The presence of SMC was determined based on Global Deterioration Scale staging. A subgroup of 83 participants also received baseline assessment for the intensity of SMC. Logistic regression was used to predict outcome from baseline variables. Three outcome groups were established at the final visit: nondeclining, declining and diagnostically unstable (i.e. the diagnosis changed over time: from normal to mild cognitive impairment, then back to normal). Results: The presence of SMC was a predictor of future decline but also increased the likelihood of the unstable diagnosis. Increasing intensity of SMC did not further raise the risk for decline. High intensity of complaints and more pronounced affective symptoms predicted the unstable clinical diagnosis. Conclusions: The presence of SMC contributes to the risk of future decline, however, the increasing intensity of the perceived impairment does not further enhance the risk.

PURPOSE: To retrospectively determine if arterial phase computed tomographic (CT) imaging is necessary for follow-up imaging of patients who have undergone endovascular stent-graft therapy for abdominal aortic aneurysm. MATERIALS AND METHODS: This HIPAA-compliant study was exempt from institutional review board approval; informed patient consent was waived. Eighty-five patients (66 men, 19 women; mean age, 66 years; range, 45-81 years) underwent 110 multidetector CT examinations after endovascular repair of abdominal aortic aneurysms. Nonenhanced CT images were obtained. Intravenous contrast material was then injected at 4 mL/sec, and arterial and venous phase (60 seconds) CT images were obtained. The nonenhanced and venous phase images were evaluated to determine if an endoleak was present. Subsequently, arterial phase images were analyzed. The effective dose was calculated. Ninety-five percent confidence intervals as indicators of how often arterial phase imaging would contribute to the diagnosis of endoleak were determined. RESULTS: Twenty-eight type II endoleaks were detected by using combined nonenhanced and venous phase acquisitions. Twenty-five of the 28 endoleaks were also visualized during the arterial phase. Three type II endoleaks were seen only during the venous phase. The arterial phase images depicted no additional endoleaks. Seventy-eight CT examinations performed in 67 patients revealed no endoleak during the venous phase. The arterial phase images also depicted no endoleaks at these examinations. Thus, for no more than 3.1% of all examinations, there was 95% confidence that arterial phase imaging would depict an endoleak missed at venous phase imaging. Arterial phase imaging contributed to a mean of 36.5% of the effective dose delivered. CONCLUSION: Study results indicate that arterial phase imaging may not be necessary for the routine detection of endoleaks. Radiation exposure can be decreased by eliminating this phase

This study aimed to determine regional pattern of tissue perfusion in the normal-appearing white matter (NAWM) of patients with primary-progressive (PP), relapsing-remitting (RR) multiple sclerosis (MS) and healthy controls, and to investigate the association between perfusion abnormalities and clinical disability. Using dynamic susceptibility contrast (DSC) perfusion MRI at 3 T, we studied 22 patients with clinically definite MS, 11 with PP-MS and 11 with RR-MS and 11 age- and gender-matched healthy volunteers. The MRI protocol included axial dual-echo, dynamic susceptibility contrast enhanced (DSC) T2*-weighted and post-contrast T1-weighted images. Absolute cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the periventricular, frontal, occipital NAWM and in the splenium of the corpus callosum. Compared to controls, CBF and CBV were significantly lower in all NAWM regions in both PP-MS patients (p values from <0.0001 to 0.001) and RR-MS (p values from <0.0001 to 0.020). Compared to RR-MS, PP-MS patients showed significantly lower CBF in the periventricular NAWM (p=0.002) and lower CBV in the periventricular and frontal NAWM (p values: 0.0029 and 0.022). EDSS was significantly correlated with the periventricular CBF (r=-0.48, p=0.0016) and with the periventricular and frontal CBV (r=-0.42, p=0.015; r=-0.35, p=0.038, respectively). This study suggests that the hemodynamic abnormalities of NAWM have clinical relevance in patients with MS. DSC perfusion MRI might provide a relevant objective measure of disease activity and treatment efficacy

OBJECTIVE: The aim of this study was to compare the quality of images obtained with fast 3D T2-weighted turbo spin-echo (TSE) MR cholangiopancreatography (MRCP) sequences and 1-mm isotropic voxels with the quality of conventional 2D MRCP images. SUBJECTS AND METHODS: Thirty consecutively registered patients (14 women, 16 men; average age, 60.2 years; age range, 32-87 years) underwent imaging at 1.5 T with a 6-element body array coil. All imaging was performed with three MRCP techniques: free-breathing 3D T2-weighted TSE (TR/TE, 1,300/680; flip angle, 180 degrees; field of view, 250-300 mm; matrix size, 256 x 256; slice thickness, 1 mm; parallel acquisition technique factor, 2); breath-hold 3D T2-weighted TSE (same parameters as the free-breathing 3D technique); breath-hold coronal and oblique coronal thick-slab 2D TSE without parallel acquisition technique (2,800/1,100; flip angle, 150-180 degrees). Quantitative measures of image signal and contrast were evaluated by analysis of variance and paired Student's t tests. A 5-point scale (1, nondiagnostic, to 5, high diagnostic confidence) was used to compare the 3D and 2D data sets for image quality and definition of biliary and pancreatic ductal anatomic features. Friedman's nonparametric and Wilcoxon's rank sum tests were performed for statistical analysis of the qualitative assessments. RESULTS: Quantitative results showed free-breathing and breath-hold 3D TSE images had significantly higher relative signal intensity and contrast than 2D TSE images (p < 0.0001). The qualitative findings showed that both free-breathing and breath-hold 3D TSE techniques gave better delineation of biliary anatomy (p < 0.0001) than the 2D technique. The overall quality of 3D images was better than that of 2D images, and 3D imaging was better at depicting pancreatic ducts, although the difference did not reach statistical significance. CONCLUSION: Three-dimensional volumetric MRCP images are of superior quality and give better delineation of pancreaticobiliary anatomy than conventional 2D images and have the added advantage of multiplanar and postprocessing capabilities

BACKGROUND AND PURPOSE: Numerous different parameters measured by perfusion MR imaging can be used for characterizing gliomas. Parameters derived from 3 different analyses were correlated with histopathologically confirmed grade in gliomas to determine which parameters best predict tumor grade. METHODS: Seventy-four patients with gliomas underwent dynamic susceptibility contrast-enhanced MR imaging (DSC MR imaging). Data were analyzed by 3 different algorithms. Analysis 1 estimated relative cerebral blood volume (rCBV) by using a single compartment model. Analysis 2 estimated fractional plasma volume (V(p)) and vascular transfer constant (K(trans)) by using a 2-compartment pharmacokinetic model. Analysis 3 estimated absolute cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) by using a single compartment model and an automated arterial input function. The Mann-Whitney U test was used make pairwise comparisons. Binary logistic regression was used to assess whether rCBV, V(p), K(trans), CBV, CBF, and MTT can discriminate high- from low-grade tumors. RESULTS: rCBV was the best discriminator of tumor grade ype, followed by CBF, CBV, and K(trans). Spearman rank correlation factors were the following: rCBV = 0.812 (P < .0001), CBF = 0.677 (P < .0001), CBV = 0.604 (P < .0001), K(trans) = 0.457 (P < .0001), V(p) = 0.301 (P =.009), and MTT = 0.089 (P = .448). rCBV was the best single predictor, and K(trans) with rCBV was the best set of predictors of high-grade glioma. CONCLUSION: rCBV, CBF, CBV K(trans), and V(p) measurements correlated well with histopathologic grade. rCBV was the best predictor of glioma grade, and the combination of rCBV with K(trans) was the best set of metrics to predict glioma grade