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Background: Although the measurement of turbulence kinetic energy (TKE) by using magnetic resonance imaging (MRI) has been introduced as an alternative index for quantifying energy loss through the cardiac valve, experimental verification and clinical application of this parameter are still required., Objectives: The goal of this study is to verify MRI measurements of TKE by using a phantom stenosis with particle image velocimetry (PIV) as the reference standard. In addition, the feasibility of measuring TKE with MRI is explored., Methods: MRI measurements of TKE through a phantom stenosis was performed by using clinical 3T MRI scanner. The MRI measurements were verified experimentally by using PIV as the reference standard. In vivo application of MRI-driven TKE was explored in seven patients with aortic valve disease and one healthy volunteer. Transvalvular gradients measured by MRI and echocardiography were compared., Results: MRI and PIV measurements of TKE are consistent for turbulent flow (0.666 < R2 < 0.738) with a mean difference of -11.13 J/m3 (SD = 4.34 J/m3). Results of MRI and PIV measurements differ by 2.76 ± 0.82 cm/s (velocity) and -11.13 ± 4.34 J/m3 (TKE) for turbulent flow (Re > 400). The turbulence pressure drop correlates strongly with total TKE (R2 = 0.986). However, in vivo measurements of TKE are not consistent with the transvalvular pressure gradient estimated by echocardiography., Conclusions: These results suggest that TKE measurement via MRI may provide a potential benefit as an energy-loss index to characterize blood flow through the aortic valve. However, further clinical studies are necessary to reach definitive conclusions regarding this technique.

Objective: To define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques., Materials and Methods: Eighteen patients (mean age, 58 ± 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group., Results: All patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non-ASM group (2.1±5.3 mm vs. 14.9±4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8±4.5 mm vs. 2.1±5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89±5.41 vs. -15.41±3.7, p < 0.05), Conclusion: Abnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium.

To assess the signal pattern in T2-weighted images (T2WI) and determine its relation to persistent microvascular obstruction (PMO) and intramyocardial hemorrhage in a porcine model with reperfused acute myocardial infarction. Left anterior descending artery was occluded (90 or 180 min) and reperfused (90 min). T2WI and delayed-enhanced magnetic resonance images (DE-MRI) were acquired. The T2WI signal pattern, T2WI contrast ratio, PMO, and intramyocardial hemorrhage were evaluated, and their interrelationships were analyzed. The infarct area on T2WI was recorded as a homogeneous high-intensity signal or as low- or iso-intensity signals. The contrast ratio of the T2WI in the cases with PMO was significantly lower than that in those without PMO (1.38 +/- 0.25 vs. 1.89 +/- 0.31, P < 0.05), and it showed significant inverse correlation with the extent of PMO observed in DE-MRI images (r =-0.8, P < 0.05). The extent of PMO correlated strongly with that of intramyocardial hemorrhage (r = 0.97, P < 0.05). The abnormal signal area in the T2WI was larger than the infarct area in the DE-MRI images (47.0 +/- 9.9% vs. 37.8 +/- 9.9%, P < 0.05) and the infarct area observed after TTC staining (47.0 +/- 9.9% vs. 37.4 +/- 8.4%, P < 0.05). We observed variable T2WI signal patterns for the infarcted myocardium. Lower T2WI contrast ratios significantly correlated with the extent of PMO in DE-MRI and intramyocardial hemorrhage in the gross specimen.

Purpose: To evaluate the feasibility of magnetic resonance (MR) imaging in depicting in vivo recruitment of iron oxide-labeled macrophages in experimentally induced soft-tissue infection., Materials and Methods: The study was performed according to the guidelines of the U.S. National Institutes of Health and recommendations of the committee on animal research. The protocol was approved by the local institutional review committee on animal care. Experimental soft-tissue infection in 12 mice was induced by inoculation with a 5 x 10(7) colony-forming units of Staphylococcus aureus into the left calf. Peritoneal macrophages were harvested from thioglycollate-treated mice, cultured, and labeled with iron oxide in vitro. The iron oxide-labeled macrophage (macrophage group, n = 6) or iron oxide solution (control group, n = 6) was administered through the tail vein. The left calf of the mice was imaged on days 2 and 3 with a 4.7-T MR unit. Changes in relative signal intensity (SI) and pattern of contrast material enhancement (macrophage distribution) were analyzed and compared with histopathologic findings. Statistical analysis was performed with the Wilcoxon matched-pairs signed rank test., Results: On MR images obtained 24 hours after administration of macrophage labeled with iron oxide, a band-shaped lower SI zone was noted in the abscess wall, which corresponded to the distribution of the iron oxide-labeled macrophages at histopathologic examination. The relative SI of the abscess wall significantly decreased after injection of iron oxide-labeled macrophages (median, 0.42) compared with that before injection (median, 1.23) (P = .031). In the control group, the SI change after administration of iron oxide solution was not significant (P = .688)., Conclusion: Homing of intravenously administered iron oxide-labeled macrophages can be monitored with MR imaging and may provide a tool to investigate interactions between macrophages and the invading pathogens., ((c) RSNA, 2006.)

Rationale and Objectives: To investigate the capacity of manganese dipyridoxyl diphosphate (MnDPDP)-enhanced magnetic resonance imaging (MRI) to discriminate the injured myocardium from the normal myocardium in a cat model., Materials and Methods: Fourteen cats were prepared for acute myocardial infarction with 90-minute occlusion followed by 120-minute reperfusion. Inversion recovery gradient-recalled echo (IR-GRE) MR images were obtained at 60-minute intervals for 4 hours after the injection of MnDPDP, and ex vivo after the cats were killed. We evaluated the differences between the unenhanced area on the in vivo and ex vivo MR images and the unstained area on triphenyl tetrazolium chloride (TTC) staining., Results: The unenhanced area on the in vivo MR images was well correlated with that on the ex vivo MR images. The unenhanced area on the ex vivo MR images was significantly larger than the unstained area on TTC staining., Conclusions: This study suggests that the MnDPDP-unenhanced area on the MR images includes not only the infarcted myocardium but also the stunned myocardium.

Rationale and Objectives: To compare manganese dipyridoxyl diphosphate (MnDPDP)-enhanced magnetic resonance imaging (MRI) with cine MRI for distinguishing the dysfunctional myocardium from the normal myocardium., Materials and Methods: Seventeen cats were prepared for acute myocardial infarction with 90 minutes of occlusion followed by 120 minutes of reperfusion. In vivo inversion-recovery gradient-recalled echo MRI and cine MRI were performed. Two radiologists independently analyzed the MR images and recorded the size of the unenhanced area on the MnDPDP-enhanced MR images as well as that of the dysfunctional area on the cine MR images. Agreement between these abnormal areas was evaluated using Bland-Altman analysis. Interobserver agreement was assessed using Bland-Altman analysis., Results: The sizes of the unenhanced area on the MnDPDP-enhanced MR images and the dysfunctional area on the cine MR images showed good agreement on Bland-Altman analysis (the limits of agreement: observer 1= 1.8% +/- 11.6, observer 2 = 0.1% +/- 9.9). The abnormal segments on both types of MR imaging showed a good interobserver agreement (the limits of agreement: MnDPDP-enhanced MRI = 0.3% +/- 7.6, cine MRI = -1.4% +/- 10.9)., Conclusion: The size of the dysfunctional area on the cine MR images was well correlated with that of the unenhanced area on the MnDPDP-enhanced MR images.

Objective: To assess the usefulness of magnetic resonance (MR) imaging for detecting bowel ischemia with strangulation compared with histopathologic findings in an experimental cat model., Materials and Methods: Fourteen cats were assigned to the normal control group (n = 3), acute ischemic group (induced by ligation of superior mesenteric vessels for 3 hours, n = 7), and subacute ischemic group (induced by ligation of superior mesenteric vessels for 10 hours, n = 4). Using a 4.7-T MR scanner, contrast-enhanced T1-weighted images were obtained at 0, 10, 20, 30, and 60 minutes after bolus injection of contrast media. T1- and T2-weighted images were obtained from the extracted bowel wall and compared with histopathologic findings., Results: On contrast-enhanced MR images, the target-like bowel wall layers were clearly demonstrated and the submucosal layer showed the most prominent enhancement. At 10 minutes after administration of contrast media, the subacute ischemic group showed significantly lower enhancement of the submucosal layer than the normal or acute ischemic group (P <0.05). On T1-weighted images, there were not significant differences between the normal and ischemic bowel groups (P >0.05). On T2-weighted images, the signal intensity of all layers of acute ischemic bowel wall was significantly higher than that of the normal control or subacute ischemic group (P <0.05)., Conclusion: Delayed contrast-enhanced MR images and T2-weighted images were helpful for detecting subacute and acute bowel ischemia with strangulation, respectively.

Purpose: To compare T2-weighted and Gadomer-17- and bis-gadolinium mesoporphyrins-enhanced magnetic resonance (MR) images for distinguishing reversibly from irreversibly damaged myocardium in a cat model of reperfused myocardial infarction., Materials and Methods: Twelve cats underwent 90 minutes of occlusion and 90 minutes of reperfusion of the left anterior descending coronary artery. After baseline T1- and T2-weighted MR images were obtained, Gadomer-17-enhanced and bis-gadolinium mesoporphyrins-enhanced T1-weighted images were sequentially obtained for 6 hours and 2 hours, respectively. After MR imaging, all cats were sacrificed for 2,3,5-triphenyltetrazolium chloride (TTC) histochemical tissue staining. Areas of abnormal signal intensity on T2-weighted and Gadomer-17-enhanced and bis-gadolinium mesoporphyrins-enhanced T1-weighted MR images were compared with the areas of infarction seen at TTC histochemical staining by using repeated-measures two-way analysis of variance, linear regression analysis, and Bland-Altman analysis., Results: Mean areas of abnormally high signal intensity on T2-weighted and Gadomer-17-enhanced T1-weighted MR images (43.9% of the left ventricular surface area +/- 11.9 [SD] and 37.7% +/- 10.1, respectively) were significantly larger than the mean area of myocardial infarction at TTC staining (25.7% +/- 12.5) (P <.001). However, there was excellent correlation between the size of an enhancing area on bis-gadolinium mesoporphyrins-enhanced T1-weighted MR images and that of myocardial infarction at TTC staining (r = 0.916, P <.001)., Conclusion: bis-Gadolinium mesoporphyrins-enhanced T1-weighted MR images accurately reflect the area of infarction, whereas the size of infarction is overestimated on T2-weighted and Gadomer-17-enhanced T1-weighted MR images, which seem to depict the periinfarct area as well as the infarct area.

Objective: To determine whether the size of a perfusion defect seen at myocardial perfusion MR imaging represents the extent of irreversibly damaged myocardium in acute reperfused myocardial infarction., Materials and Methods: In nine cats, reperfused myocardial infarction was induced by occlusion of the left anterior descending coronary artery for 90 minutes and subsequent reperfusion for 90 minutes. At single-slice myocardial perfusion MR imaging at the midventricular level using a turbo-FLASH sequence, 60 short-axis images were sequentially obtained with every heart beat after bolus injection of gadomer-17. The size of the perfusion defect was measured and compared with both the corresponding unstained area seen at triphenyl tetrazolium chloride (TTC) staining and the hyperenhanced area seen at gadophrin-2- enhanced MR imaging performed in the same cat six hours after myocardial perfusion MR imaging., Results: The sizes of perfusion defects seen at gadomer-17-enhanced perfusion MR imaging, unstained areas at TTC staining, and hyperenhanced areas at gadophrin-2-enhanced MR imaging were 20.4+/-4.3%, 29.0+/-9.7%, and 30.7+/- 10.6% of the left ventricular myocardium, respectively. The perfusion defects seen at myocardial perfusion MR imaging were significantly smaller than the unstained areas at TTC staining and hyperenhanced areas at gadophrin-2- enhanced MR imaging (p < .01). The sizes of both the perfusion defect at myocardial perfusion MR imaging and the hyperenhanced area at gadophrin-2- enhanced MR imaging correlated well with the sizes of unstained areas at TTC staining (r = .64, p = .062 and r = .70, p = .035, respectively)., Conclusion: In this cat model, the perfusion defect revealed by myocardial perfusion MR imaging underestimated the true size of acute reperfused myocardial infarction. The defect may represent a more severely damaged area of infarction and probably has prognostic significance.

Purpose: To test whether bis-gadolinium mesoporphyrins-enhanced magnetic resonance (MR) imaging can accurately depict irreversibly damaged myocardium in occlusive myocardial infarction., Materials and Methods: Ten cats were subjected to 90 minutes of occlusion of the left anterior descending coronary artery. Bis-gadolinium mesoporphyrins-enhanced T1-weighted MR imaging was performed in the cats for 6 hours. Histopathologic examinations with 2'3'5-triphenyl tetrazolium chloride (TTC) staining and electron microscopy were performed on the resected specimens. The time course and pattern of signal intensity enhancement were evaluated. The size of the infarcted myocardium was estimated on the MR images by measuring the size of the signal intensity-enhanced area., Results: In eight of 10 cats, it was impossible to distinguish infarcted myocardium from normal myocardium at visual inspection of T1-weighted MR images. The contrast ratio between infarcted and normal myocardium did not increase significantly over time. In one of the two remaining cats, a doughnut pattern of signal intensity enhancement was noted. The other cat showed intensely homogeneous enhancement of infarcted myocardium at MR imaging. The size of the area of signal intensity enhancement at MR imaging in these two cats was accurately mapped to that of the infarction on the TTC-stained specimens., Conclusion: Occlusive myocardial infarction cannot be accurately detected at bis-gadolinium mesoporphyrins-enhanced MR imaging.

Objective: To identify and evaluate the lateral border zone by comparing the size and distribution of the abnormal signal area demonstrated by MR imaging with the infarct area revealed by pathological examination in a reperfused myocardial infarction cat model., Materials and Methods: In eight cats, the left anterior descending coronary artery was occluded for 90 minutes, and this was followed by 90 minutes of reperfusion. ECG-triggered breath-hold turbo spin-echo T2-weighted MR images were initially obtained along the short axis of the heart before the administration of contrast media. After the injection of Gadomer-17 and Gadophrin-2, contrast-enhanced T1-weighted MR images were obtained for three hours. The size of the abnormal signal area seen on each image was compared with that of the infarct area after TTC staining. To assess ultrastructural changes in the myocardium at the infarct area, lateral border zone and normal myocardium, electron microscopic examination was performed., Results: The high signal area seen on T2-weighted images and the enhanced area seen on Gadomer-17-enhanced T1WI were larger than the enhanced area on Gadophrin-2-enhanced T1WI and the infarct area revealed by TTC staining; the difference was expressed as a percentage of the size of the total left ventricle mass (T2= 39.2 %; Gadomer-17 =37.25 % vs Gadophrin-2 = 29.6 %; TTC staining = 28.2 %; p < 0.05). The ultrastructural changes seen at the lateral border zone were compatible with reversible myocardial damage., Conclusion: In a reperfused myocardial infarction cat model, the presence and size of the lateral border zone can be determined by means of Gadomer-17- and Gadophrin-2-enhanced MR imaging.

Purpose: To investigate the capability of a necrosis-avid magnetic resonance (MR) contrast agent, bis-gadolinium mesoporphyrins, for assessment of irreversibly damaged myocardium and to evaluate the time course of signal enhancement in the reperfused myocardium., Materials and Methods: Nine cats were subjected to 90 minutes of occlusion of the left anterior descending coronary artery followed by 90 minutes of reperfusion. Contrast material-enhanced T1-weighted spin-echo images were obtained for 12 hours in five cats and 6 hours in four cats. Pathologic examinations of the resected specimens were performed with 2'3'5-triphenyl tetrazolium chloride (TTC) histochemical staining and electron microscopy. The size of enhanced area on MR images was compared with that of irreversibly damaged myocardium with TTC staining. The time course of signal enhancement was evaluated., Results: The size of enhanced area on MR images was well correlated with that of irreversibly damaged myocardium with TTC staining. Maximum enhancement occurred 1-3 hours after administration of the contrast material, with mean enhancement of 171% that of normal myocardium. Electron microscopic examinations showed severe myocardial damage in the irreversibly damaged myocardium but only mild edematous changes in the reversibly damaged myocardium., Conclusion: MR images enhanced with bis-gadolinium mesoporphyrins provide accurate sizing of irreversibly damaged myocardium with a strong and persistent signal enhancement in the reperfused myocardium.

The purpose of this study was to correlate the abnormal signal area on various magnetic resonance (MR) images to the infarct area on pathologic examination and to assess the myocardial viability on the basis of MR images. T2-weighted, first-pass perfusion, and delayed gadolinium-enhanced T1-weighted images were used as "one-stop examinations" in a pig model of reperfused myocardial infarction. The results of each MR image were compared with those of 2,3, 5-triphenyltetrazolium chloride (TTC) staining. The abnormal signal areas on T2-weighted and Gd-enhanced T1-weighted images were larger than the infarct areas on TTC staining (34.7% and 32.3% vs. 28.3%; P< 0.05), whereas the nonperfused areas on perfusion images were correlated (25.6% vs, 28.3%; P = 0.139). Electron microscopic examination showed severely distorted ultrastructures in the infarct areas and mildly damaged ultrastructures in the peri-infarct areas. Perfusion images probably reflected the infarct areas, whereas T2-weighted and Gd-enhanced T1-weighted images seemed to include peri-infarct as well as infarct areas., (Copyright 2000 Wiley-Liss, Inc.)

With the advances in magnetic resonance imaging (MRI) technology that have occurred in recent years, it is possible to examine the myocardial status with high spatial and temporal resolutions in the evaluation of ischemic heart disease. The purpose of this article is to review the current status and the role of MRI for the evaluation of myocardial infarction. We discuss the pathophysiology of myocardial infarction, MRI techniques for the evaluation of myocardial status, and the pathophysiological significance of MR signal changes observed in various MRI techniques. We conclude that, with further development of MR techniques and contrast agents, MRI will play an increasing role in the diagnosis of ischemic heart disease. J. Magn. Reson. Imaging 1999;10:686-693., (Copyright 1999 Wiley-Liss, Inc.)

Objectives: Using proton magnetic resonance spectroscopy, we investigated cerebral metabolism and its determinants in congestive heart failure (CHF), and the effects of cardiac transplantation on these measurements., Background: Few data are available about cerebral metabolism in CHF., Methods: Fifty patients with CHF (ejection fraction < or = 35%) and 20 healthy volunteers were included for this study. Of the patients, 10 patients underwent heart transplantation. All subjects performed symptom-limited bicycle exercise test. Proton magnetic resonance spectroscopy (1H MRS) was obtained from localized regions (8 to 10 ml) of occipital gray matter (OGM) and parietal white matter (PWM). Absolute levels of the metabolites (N-acetylaspartate, creatine, choline, myo-inositol) were calculated., Results: In PWM only creatine level was significantly lower in CHF than in control subjects, but in OGM all four metabolite levels were decreased in CHF. The creatine level was independently correlated with half-recovery time and duration of heart failure symptoms in PWM (r = -0.56, p < 0.05), and with peak oxygen consumption and serum sodium concentration in OGM (r = 0.58, p < 0.05). Cerebral metabolic abnormalities were improved after successful cardiac transplantation., Conclusions: This study shows that cerebral metabolism is abnormally deranged in advanced CHF and it may serve as a potential marker of the disease severity.

Background and Purpose: Functional reorganization of the brain can result from congenital brain disorders as well as from brain infarction. The purpose of our study was to use functional MR imaging to determine whether reorganization of brain function occurs in patients with schizencephaly., Methods: Four patients with schizencephaly (three right-handed, one ambidextrous) presented with seizures. Associated lesions included agenesis of the corpus callosum (n = 1) and absence of the septum pellucidum (n = 1). Functional MR imaging was performed in each patient using a single-section fast low-angle shot (FLASH) blood oxygen level-dependent (BOLD) technique at 1.5 T in a standard head coil. The motor cortex was initially identified on an axial T1-weighted anatomic image. Thirty consecutive images were obtained during a motor task consisting of repetitive finger-to-thumb opposition. The percentage of change in increased signal intensity was calculated for the primary motor area. An ipsilateral activation index was used to compare the affected with the unaffected hemisphere., Results: The percentage of change in increased signal intensity in the area of activation ranged from 4.8% +/- 0.9 to 9.2% +/- 1.2 (mean, 5.6% +/- 1.5). The ipsilateral activation index in the affected hemisphere was 0.00 to 0.38, whereas that in the unaffected hemisphere was 15.4 to infinity. The difference in the ipsilateral activation index between each hemisphere was considered significant., Conclusion: Our results showed increased activation in the unaffected hemisphere in patients with schizencephaly, which may reflect functional reorganization of the motor area in patients with this congenital disorder.

Magnetic resonance (MR) imaging is considered the gold standard for soft-tissue disease. The traditional MR imaging series uses axial and sagittal views. The purpose of this study was to demonstrate that oblique MR imaging provides valuable information about the cervical foramen not available from the conventional MR imaging technique. Ten asymptomatic individuals volunteered for MR imaging. Measurements were taken of height, width, and area for the nerves and foramen at the entrance and mid zones. Nerves were graded as normal, contacted, or deformed. Normal foraminal morphology in asymptomatic individuals and characteristics that compromise the space available for the nerve root were identified. Nerves with minimal or no contact had significantly greater foraminal widths than nerves with significant contact. Although there was a correlation between nerve contact and foraminal width, regression analysis did not demonstrate a correlation between disc height and foraminal size.

To assess the clinical utility of the breath-hold turbo spin-echo T2-weighted MRI in patients with acute myocardial infarction, the results of MRI were compared with those of electrocardiography, coronary angiography, and thallium-201 single photon emission tomography (SPECT) in 23 patients and 5 healthy volunteers. To compare MRI and thallium-SPECT, the left ventricle was divided into five segments, and the presence of myocardial infarction was determined in each segment. MRI demonstrated an abnormally bright signal in 49 of 140 segments (five segments each from 23 patients and 5 volunteers); thallium-SPECT showed a fixed perfusion defect in 52 segments, for an 85% diagnostic concordance rate. The size of the myocardial infarction measured on MRI corresponded well to that measured on thallium-SPECT (r = .70, P < .01). Breath-hold turbo spin-echo T2 MRI can be used for detection of acute myocardial infarction in conjunction with thallium-SPECT, especially when accurate localization of lesion, increased spatial resolution, and anatomic landmarks are needed.

Rationale and Objectives: To correlate magnetic resonance (MR) signal enhancement with pathophysiologic changes occurring during ischemia and reperfusion in evaluation of myocardial infarction in cats., Methods: Seven cats were subjected to 150 minutes of occlusion of the left anterior descending coronary artery followed by 90 minutes of reperfusion. Gadolinium (Gd) diethylenetriaminepentaacetic acid-polylysine (molecular weight [mw] = 40 to 50 kd, DP230) contrast-enhanced MR images were acquired with coinjection of poly-L-lysine-fluorescein isothiocyanate (mW = 40 to 50 kd, DP219) as a fluorescent tracer molecule of the contrast agent. Signal intensities on the MR images and fluorescence activities on the resected cardiac specimens were measured. Pathologic examinations by electron and light microscopes and 2,3,5-triphenyltetrazolium chloride histochemical staining were performed on the specimens., Results: Magnetic resonance signal intensity was lower in the center (3.49 +/- 0.36) than in the periphery (4.71 +/- 0.89) of the enhanced area. Fluorescence activities were absent in the normal myocardium; they were scant as nonspecific discrete dots in the center and numerous as specific interstitial distribution in the periphery of the ischemic myocardium. Electron and light microscopic examinations showed severely damaged ultrastructures of the center and moderately distorted ultrastructures of the periphery., Conclusions: The center of the MR signal-enhanced area is the infarct center with severe ultrastructural damages, which also might be an area of little or absent of blood reflow. Conversely, the peripheral-enhanced area is the infarct periphery with moderate myocardial damages.

Purpose: To study the effects of formalin fixation, signal intensity characteristics of the stomach-wall layers, and findings suggestive of cancerous invasion to the stomach wall in vitro with magnetic resonance (MR) imaging in humans., Materials and Methods: MR images of nine specimens of stomach cancer and 29 normal specimens were obtained at 4.7 T; 26 of the normal specimens were fixed in 10% formalin for 2 hours to 187 days before imaging. The field gradient was 10 G/cm; the spatial resolution, 0.1 mm., Results: The mucosal, submucosal, and proper-muscle layers were clearly identifiable. The submucosa of the fresh specimens had the lowest signal intensity of all specimens on both T1- and T2-weighted images (P < .01). No statistical correlation existed between signal intensity and duration of fixation. Tumor invasion was detected in seven of eight specimens with mucosal invasion, all eight specimens with submucosal invasion, and three of six specimens with muscle invasion., Conclusion: In vitro MR imaging enabled differentiation of all three layers of the stomach wall, detection of the cancer, and measurement of the depth of invasion.

Purpose: To assess the capability of gadolinium polylysine-enhanced cardiac magnetic resonance (MR) imaging in depicting normal and ischemic myocardium during occlusion and reperfusion of the left anterior descending artery., Materials and Methods: Contrast-enhanced MR images were obtained in 18 cats during 90 minutes each of occlusion and reperfusion. The change in signal intensity (SI) was compared among normal myocardium and central and peripheral ischemic zones. Results were compared with those of 2,3,5-triphenyltetrazolium chloride staining., Results: During occlusion, the ischemic zone lacked enhancement while normal myocardium had gradual enhancement. During reperfusion, the ischemic zone had strong enhancement. In cats with large infarction, the central and peripheral ischemic zones had intermediate and high SI, respectively; in cats with focal or no infarction, the entire ischemic zone had high SI., Conclusion: Occlusive and reperfused myocardial infarction can be detected at gadolinium polylysine-enhanced MR imaging by means of differential SI changes in normal myocardium and central and peripheral ischemic zones.

The "crisscross" heart and the heart with "superoinferior ventricles" are closely related congenital cardiac malformations that are characterized by twisted atrioventricular connections. The authors studied the morphologic characteristics of three hearts with twisted atrioventricular connections as seen on magnetic resonance (MR) images. The most important clue to the diagnosis was the distorted atrioventricular connections that were demonstrated on serial images. The axes of the atrioventricular connections through the atrioventricular valves were not parallel to each other. The presence of unusual recesses in the cardiac chambers, the angulated or curved configuration of the atrial and ventricular septa, and the unexpected great arterial relationship for the given combination of segmental connections supported the findings of twisted atrioventricular connections. MR imaging facilitated the precise morphologic diagnosis of these hearts.

A new angiography technique using the susceptibility effect is proposed. Blood containing deoxyhemoglobin is more paramagnetic than surrounding tissue and thereby produces a susceptibility effect at blood-tissue interfaces. By use of a specially tailored RF pulse, signals from normal tissues are suppressed while the signals from blood interfaces, where strong susceptibility-induced fields are created, are enhanced. The design and characteristic behavior of the tailored RF pulse are discussed and experimental results obtained using both a phantom and a human volunteer with a 2.0-T whole-body NMR system are also presented.

Surgical treatment of patients with double-outlet right ventricle (DORV) depends on the spatial relation between the associated ventricular septal defect (VSD) and the arterial valves. This study was performed to refine the magnetic resonance (MR) imaging characteristics of VSD in DORV. Ten patients with DORV underwent MR imaging. Coronal, transverse, and oblique images were obtained with an electrocardiographic-gated multiple-section spin-echo technique. The transverse plane was the most valuable in defining the spatial relation of the VSD to the arterial valves. The site of fusion of the outlet septum with the VSD margin was diagnostically the most important feature in differentiating subaortic from subpulmonary VSD. The outlet septum fused with the anterior margin in subaortic VSD and the posterior margin in subpulmonary VSD; it was absent in doubly committed VSD. This study suggests that MR imaging can demonstrate the pertinent features of VSD and may be an indispensable adjunct to echocardiography in the preoperative evaluation of patients with DORV.

MR imaging in the oblique coronal plane can provide an en face image of ventricular septal defects by visualizing the entire circumference of the defect. This pictorial essay illustrates various types of ventricular septal defects as seen on these images.

The current study used cine magnetic resonance imaging to determine the effect of increasing severity of valvular regurgitation on systolic wall stress and to demonstrate that wall stress was disproportionately increased in relation to the severity of regurgitation in patients with myocardial disease. A total of 39 patients with predominantly mitral (n = 22) or aortic (n = 17) regurgitation with (n = 13) and without (n = 26) myocardial disease and 10 normal volunteers were examined with cine magnetic resonance imaging (MRI) at 1.5 T. Left ventricular (LV) cardiac output (CO) and peak systolic (PS) wall stress (WS) and end-systolic (ES) WS were calculated from blood pressure recordings, carotid pulse tracings, and wall thickness (h) and diameter (D) measurements obtained from cine MRI. Patients were classified into three degrees of severity according to their LV regurgitant volume (RV). Myocardial disease was defined by an ejection fraction (EF) of less than 40%. Mean LV EF was 61 +/- 3% in normal volunteers, 64 +/- 3% in patients with regurgitation, and 25 +/- 2% in patients with myocardial disease. LV CO was directly related to RV in patients without myocardial disease, whereas it was disproportionately low in relation to RV in patients with myocardial disease. PS WS was significantly higher in severe mitral and/or aortic regurgitation compared with moderate, mild, and no mitral and/or aortic regurgitation. Compared with the degree of regurgitation, PS WS was disproportionately higher in patients with myocardial disease. Thus LV CO and WS rise progressively with increasing severity of regurgitation. Disproportionately high systolic WS relative to RV indicates the presence of myocardial disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Anomalous blood flow caused by valvular regurgitation can be visualized as a narrowly defined area of signal loss in contrast to the high intensity of the blood pool on repetitive gradient refocused magnetic resonance (MRI) (cine MRI) views. In order to assess the accuracy of identification and measurements of the signal void in the evaluation of mitral (MR) and aortic regurgitation (AR), the cine MRI studies of 62 patients with regurgitation and of 20 normal volunteers were retrospectively analyzed in a blinded study of three independent reviewers. Accuracy for detection of MR was greater than 0.96 and for AR was greater than 0.91 for all three reviewers. The total volume of the signal void associated with regurgitation was measured on cine MRI images of 58 patients by two independent observers. The patients were divided into three groups of severity based upon assessment of severity of regurgitation by two-dimensional echocardiography and/or angiography. The total volume of signal loss was 9.0 ml (+/- 0.94 SEE; n = 18) for mild MR, 30.7 ml (+/- 5.3 SEE; n = 11) for moderate MR, and 83.4 ml (+/- 17.4 SEE; n = 5) for severe MR. In patients with AR, the calculated signal void was 27.3 ml (+/- 3.2 SEE; n = 24) in mild, 49.7 ml (+/- 2.9 SEE; n = 7) in moderate, and 75.8 ml (+/- 5.7; n = 6) in severe cases. The differences in the volume of the signal void were significant among the three groups of severity (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

A wide variety of MRI techniques is available for vascular imaging, each exploiting a different property of flowing blood to achieve contrast. These include spin-echo, which has been used for the diagnosis of aortic dissection and of great vessel anomalies, as well as for the evaluation of pulmonary flow in patients with pulmonary hypertension and pulmonary embolism. Spin echo excels in detecting infection and hematoma in the tissues around grafts and vessels. Phase display imaging has proven useful in differentiating signal of slow flow from that of intravascular thrombus. Imaging of peripheral vessels can be achieved with gradient refocused sequences, which provide bright intravascular signal over a wide range of flow velocities. These sequences may be combined with subtraction strategies to eliminate the signal from stationary tissues in order to generate an angiographic image. The advent of three-dimensional MR angiographic imaging techniques provides an effective way to display peripheral vessels. Early experience implies that MR angiography will play an important role in vascular imaging in the future, provided that the signal loss from turbulent flow can be minimized.