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This study attempted to assess the accuracy and potential of lung magnetic resonance (MR) perfusion imaging compared with perfusion scintigraphy in the evaluation of patients with suspected lung perfusion defects. The technique, which uses an inversion recovery turbo-FLASH sequence with ultra-short TE (1.4 msec), was tested in 24 patients suspected clinically of having acute pulmonary embolism (n 5 19) and in patients with severe pulmonary emphysema (n 5 5). Perfusion lung scintigraphy was performed within 48 hours prior to the MRI examination in both groups of patients. The dynamic study was acquired in the coronal plane and consisted of 10 images of 6 slices (a total of 60 images per series). Gadopentetate dimeglumine (0.1 mmol/kg) was manually injected as a compact bolus during the acquisition of the first image. Three senior radiologists reviewed all unprocessed two-dimensional coronal sections. They were blinded to clinical data and other imaging modalities. For the three observers, the average sensitivity and specificity of MR were 69% and 91%, respectively. The overall agreement between MR and scintigraphy appears to be good, with a good correlation between the two modalities (kappa 5 0.63). However, the data showed variability depending on the location of the perfusion defect, with higher accuracy in the upper lobes. The agreement between MR perfusion and scintigraphy appears to be moderate in the left inferior lobe (kappa 5 0.48). The data showed an overall good interobsever agreement (kappa 5 0.66). MR perfusion of the lung is a promising technique in detecting lung perfusion defects. J. Magn. Reson. Imaging 1999;9:61‐68. r 1999 Wiley-Liss, Inc.

Background and Purpose —Although new, large, double-blind, randomized studies are needed to establish the efficiency of intravenous thrombolysis, open trials of sufficient size may also provide novel data concerning specific outcomes after thrombolysis. Methods —An open study of intravenous rtPA in 100 patients with internal carotid artery (ICA) territory strokes between 20 and 81 years of age, with a baseline Scandinavian Stroke Scale (SSS) score of Results —At day 90, 45 patients (45%) had a good result, defined as complete regression or slight neurological sequelae (mRS score of 0–1), 18 patients had a moderate outcome (mRS 2–3), and 31 patients had serious neurological sequelae (mRS 4–5). Six patients died, 2 with intracerebral hematoma after immediate heparin. Five of 11 patients (45.5%) treated between 6 and 7 hours had a good result. The overall intracerebral hematoma rate was 7%. Higher values of fibrin degradation products at 2 hours were observed in the subgroup with intracerebral hematomas. Significant predictors of poor outcome on multivariate logistic regression analysis were baseline SSS score of P =0.04), indistinction between white and gray matter on CT scan (OR, 6.59; 95% CI, 2.19 to 19.79; P =0.0008), and proximal internal carotid thrombosis (OR, 3.29; 95% CI, 0.99 to 10.95; P =0.05). Conclusions —Our study confirms the safety of intravenous rtPA at a dose of 0.8 mg/kg and suggests efficacy for this drug even within 7 hours. Outcome and hematoma rates were at least as favorable as for trials of therapy with a 3-hour time window. Subgroups with a poor prognosis include low baseline neurological score, baseline CT changes, and proximal ICA thrombosis. However, approximately 30% of patients with each of these characteristics show a good outcome, so their inclusion in future routine rtPA protocols is still justified.

The acetazolamide (ACZ) test is performed to evaluate the decrease in cerebral perfusion pressure (CPP) by investigation of vasomotor reactivity (VMR). Our aim was to study cerebral blood flow and blood volume changes induced by the ACZ test in healthy control subjects using dynamic susceptibility contrast-enhanced gradient-echo MRI (DSC-MRI). A FLASH sequence was used to produce susceptibility-weighted images during an intravenous injection of 0.1 mmol/kg gadopentetate dimeglumine (Gd-DTPA). After the first dynamic study, 1 g acetazolamide was given intravenously and 10 min later a second bolus of Gd-DTPA was injected. Using the indicator-dilution theory, relative cerebral blood volume and relative cerebral blood flow were estimated. In healthy subjects the ACZ test induced a significant increase in relative blood volume (from 80.5 +/- 10.7 to 113.4 +/- 11.9) and relative blood flow (from 5.73 +/- 0.96 to 7.5 +/- 0.97), symmetrically in the cerebral hemispheres. This approach might be promising in the understanding of cerebral haemodynamics in patients with vascular disorders.

In patients with cerebrovascular disease the acetazolamide (ACZ) test is performed to evaluate the decrease in cerebral perfusion pressure (CPP) through the investigation of the vasomotor reactivity (VMR). This latter is currently assessed with ACZ with several methods. Recently, magnetic resonance imaging (MRI) techniques have been developed that are sensitive to stimulus-induced changes in blood flow. Dynamic susceptibility contrast material-enhanced gradient-echo MRI techniques (DSC-MRI) might be an attractive tool to assess VMR. We aimed to test the ability of DSC-MRI in the assessment of VMR. Relative hemodynamic parameters rCBV, MTT, and rCBF were evaluated at baseline after the first injection of gadopentetate dimeglumine and 10 min after the intravenous administration of ACZ (1 g) with a second bolus of contrast agent. Assessment of hemodynamic parameters was performed over the whole hemisphere and also within regions of interest. The significances of the mean differences, before and after ACZ, were assessed with repeated-measures ANOVA with two within factors: laterality (right-left) and ACZ. DSC-MRI with ACZ test was performed in ten healthy controls (aged 51.4+/-16.2 years). The cerebral hemispheric ratio for the three parameters (cerebral blood volume (CBV), mean transit time (MTT), and cerebral blood flow (CBF)) ranged between 1.01 and 1.03. The mean gray matter-to-white matter ratio for CBV, CBF and MTT were 2.44, 2.41 and 1.05, respectively. As the laterality effect was not significant, left and right hemispheric values were averaged. A significant increase of all hemodynamic parameters was observed after ACZ (P

The authors detect activation in the auditory cortex during cochlear electrical stimulation in deaf patients using functional magnetic resonance (MR) imaging.Stimulating electrode was inserted gently under local anesthesia close to the round window membrane of the cochlea in seven cochlear implant candidates. These patients suffered from postlingual-acquired deafness. Four patients were stimulated above the electrical perception threshold and three below the electrical discomfort threshold. Functional scans (fast low-angle shot 91 mseconds/60 mseconds) were acquired in an oblique axial plane running parallel to the sylvian fissure. Four consecutive series of six images were obtained in 6 minutes. The acquisition time of each image was 15 seconds.During electrical cochlear stimulation below the discomfort threshold, the three patients described "auditory" sensations with activation of the superior temporal regions. In two patients with electrical stimulation of the left ear, the maximum signal intensity increased by 8.42% in the right auditory cortex and 5.69% in the left. In one patient with a right electrical stimulation only the left cortex was activated. Electrical cochlear stimulation above the perception threshold induces no significant activation in the auditory cortex.Functioning MR imaging can detect activation in the auditory cortex during cochlear electrical stimulation in deaf patients using a conventional 1.5-tesla system in a routine hospital environment. Further studies are needed to investigate its usefulness in clinical practice.

The potential to define liver tumors at magnetic resonance (MR) imaging was compared with a positive and a negative contrast agent (gadoxetic acid disodium, or gadolinium EOB-DTPA [a hepatocyte-directed agent], and ferumoxides, or superpara-magnetic iron oxide particles [a Kupffer cell-directed agent], respectively) in normal rats and in rats with induced acute hepatitis, fatty liver, or cirrhosis.Rats with implanted liver adenocarcinomas were divided into four groups: no diffuse liver disease ("normal" [n = 6]) and diffuse liver diseases (induced acute hepatitis [n = 6], fatty liver [n = 6], or cirrhosis [n = 6]). Rats first received gadoxetic acid disodium (50 mumol/kg) and then, 45 minutes later, ferumoxides (10 mumol/kg). Liver signal intensity enhancement and tumor-to-liver contrast-to-noise ratio (C/N) were measured in each group.Mean liver signal intensity enhancement values with gadoxetic acid disodium and ferumoxides were excellent in the normal liver model (176% and -62%, respectively; P.01) but were significantly reduced in the acute hepatitis model (82% and -36%, respectively). In the fatty livers compared with the normal livers, enhancement with gadoxetic acid disodium was reduced (57%) but with ferumoxides was excellent (-55%). In the cirrhotic livers compared with the normal livers, enhancement with gadoxetic acid disodium (174%) was virtually the same but was impaired with ferumoxides (-43%).Hepatic enhancement and tumor-to-liver C/N with either positive or negative liver-enhancing agents can be impaired by the presence of underlying liver disease. Prior knowledge of the type of diffuse liver disease may influence the choice of contrast agent for tumor detection.

Susceptibility-weighted sequences may improve our understanding of the pathophysiology of acute cerebral ischemia.1–4 At the acute stage of ischemic stroke, a signal loss, attributed to intravascular deoxygenation, has been identified with T2*-weighted gradient echo (GRE) MRI along the course of leptomeningeal vessels.5 We sought to detect any difference between clinical and MRI parameters according to the presence of this imaging feature. Consecutive patients with acute (

Background and Purpose Pilot studies using early thrombolytic therapy in stroke have suggested that recombinant tissue plasminogen activator (rTPA) might be effective. While large, double-blind, randomized studies are needed, open trials could generate hypotheses concerning (1) the clinical correlations of outcome, (2) the significance of CT scan data during the first week, and (3) the use of adjunctive therapies. Methods We performed an open trial of intravenous rTPA on patients referred to our emergency service with all types of ischemic stroke in the carotid territory. All patients between 20 and 81 years hospitalized during 1994 with completed stroke in the internal carotid artery territory and a baseline Scandinavian Stroke Scale score lower than 48, even with severe disturbances of consciousness, were included. The inclusion time was within 7 hours after stroke onset. A 0.8-mg/kg dose of rTPA was infused for 90 minutes. Intravenous heparin was given either immediately at efficient dosage or after 24 hours. Mannitol was used in patients with severe presentation. The Scandinavian Stroke Scale evaluation was done at baseline, 3 hours, and 1, 7, 30, and 90 days. The CT scan was performed before the treatment and at days 1 (24±6 hours) and 7. Results Forty-three consecutive patients met the criteria of the protocol. The mean age at inclusion was 65±10.4 years, and the mean interval to treatment was 232±79 minutes. At day 90, 25 patients (58.1%) exhibited a complete regression of symptoms, and 3 had moderate neurological sequelae. Thirteen patients had severe neurological sequelae, 11 with infarcts and 2 with secondary parenchymal hematomas. Two patients died (4.6%), 1 with hematoma. The overall hematoma rate was 6.9%. Excellent outcome at day 90 was significantly correlated with major neurological improvement at day 1. Intravenous immediate heparin versus delayed heparin after 24 hours improved the ischemic outcome but not the overall outcome. Reinfarction syndromes after major neurological improvement, likely to be rethrombosis syndromes, were observed in 3 patients (6.9%). For the day 1 CT scan, poor outcome was associated with the presence of structured and homogeneous hypodensities likely to represent classic infarcts, as confirmed by day 7 CT scan. Conversely, total recovery was significantly associated with the absence of any image or with unstructured hypodensities, a particular type of image characterized by its heterogeneous darkness and often polylobar shape. This type of image disappeared at day 7 in 17.6% of the cases and is likely to represent reperfusion images and/or incomplete ischemic damage. Conclusions The results obtained in this open, small study suggest safety and effectiveness of rTPA thrombolysis at the dose of 0.8 mg/kg within 7 hours in acute strokes of the carotid territory, including highly serious baseline neurological presentations, until age 81 years and under special therapeutic conditions. Complete recovery is significantly associated with major neurological improvement during the first 24 hours and the presence of a particular type of image at day 1 CT scan characterized by an unstructured hypodensity, often polylobar and heterogeneous, which is likely to correspond to reperfusion images.

Injection of thrombin into the middle cerebral artery (MCA) of mice has been proposed as a new model of thromboembolic stroke. The present study used sequential multiparametric Magnetic Resonance Imaging (MRI), including Magnetic Resonance Angiography (MRA), Diffusion-Weighted Imaging (DWI) and Perfusion-Weighted Imaging (PWI), to document MCA occlusion, PWI-DWI mismatch, and lesion development. In the first experiment, complete MCA occlusion and reproducible hypoperfusion were obtained in 85% of animals during the first hour after stroke onset. In the second experiment, 80% of animals showed partial to complete reperfusion during a three-hour follow-up. Spontaneous reperfusion thus contributed to the variability in ischemic volume in this model. The study confirmed the value of the model for evaluating new thrombolytic treatments, but calls for extended MRI follow-up at the acute stage in therapeutic studies.

An animal model of oxygen-induced pulmonary injury was used to assess the potential of contrast-enhanced MRI to identify and quantify abnormal capillary permeability. Sprague-Dawley rats were exposed to 100% oxygen for 48 h (n = 5) or 60 h (n = 9). Axial spin-echo MR images were acquired in intubated, anesthetized rats with ECG-gating (TR 400; TE 6) immediately or 7 days after the cessation of oxygen exposure. Polylysine-Gd-DTPA, a macromolecular paramagnetic blood-pool marker, was then given intravenously and the lungs were serially imaged for 42 to 47 min to monitor changes in signal intensity. Pulmonary enhancement was stable in rats exposed to 48 h of oxygen, and in rats exposed to 60 h of oxygen and given 7 days to recover. However, animals exposed to 100% oxygen for 60 h without a period of recovery showed a progressive increase in lung signal intensity for 15 min after polylysine-Gd-DTPA. Pleural effusions also showed progressively increasing signal, reflecting a capillary endothelial leak. A two compartment model describing the kinetics of polylysine-Gd-DTPA in the plasma and interstitial water of the lung was consistent with the dynamic MRI data and allowed estimation of the fractional leak rate (0.235 min-1) of the contrast agent from plasma to interstitial water. Given the assumption of our kinetic model, MRI following intravenous administration of polylysine-Gd-DTPA can be used to quantitate changes in capillary integrity induced by hyperoxia, including acute capillary leakiness and return to normal endothelial integrity with recovery from hyperoxic injury.

RATIONALE AND OBJECTIVES Gadolinium-ethoxybenzyl-DTPA (Gd-EOB-DTPA) is a recently introduced experimental magnetic resonance (MR) contrast agent for hepatic imaging. Although liver enhancement has been investigated in a number of animal models, tolerance evaluations of Gd-EOB-DTPA injection have been limited. METHODS The authors investigated acute hepatotoxicity in an isolated perfused rat liver model, cardiovascular effects in the anesthetized rat, and potential immunogenicity of Gd-EOB-DTPA using detection of specific antibodies. RESULTS Using perfused rat liver model, no significant deviation could be observed for functional parameters, liver enzymes, or potassium release, comparing Gd-EOB-DTPA to a control, but there was a significant choleresis (+250% bile flow). Hemodynamic effects of Gd-EOB-DTPA were observed after femoral bolus injection, but only with relatively high dosages (0.3-0.5 mmol/kg, 10-fold the likely clinical dose in humans). Experimental conditions, idealized for antibody induction, failed to cause an IgG immune response to Gd-EOB-DTPA in the intact rat. CONCLUSIONS The results further support preliminary conclusions that Gd-EOB-DTPA is a well-tolerated MR contrast agent.

A new hepatobiliary contrast agent for magnetic resonance (MR) imaging, gadolinium-ethoxybenzyl (EOB)-diethylemetriaminepentaacetic acid (DTPA), was compared with Gd-DTPA to define the potential for improving tumor-liver contrast in a rodent liver adenocarcinoma model. With a T1-weighted spin-echo sequence, the contrast-to-noise ratio (C/N) for tumor before contrast agent administration was 5 (arbitrary units), the tumor appearing slightly hypo-intense with respect to liver parenchyma. After Gd-DTPA injection (0.1 mmol/kg), tumor enhanced more strongly than liver, resulting in an equalization of tumor and liver signal intensities and a decline in C/N to zero at 3 minutes after injection. After Gd-EOB-DTPA injection (0.1 mmol/kg), liver enhanced more strongly than tumor. Five minutes after injection, C/N increased from 5 to 25 and remained above 17 for 50 minutes. The data indicate that Gd-EOB-DTPA yields higher and more prolonged tumor-liver contrast than Gd-DTPA on T1-weighted spin-echo images. The high liver-tumor contrast after Gd-EOB-DTPA administration should prove clinically advantageous for MR imaging detection of focal hepatic masses.

RATIONALE AND OBJECTIVES Adenosine is a potent vasodilator used clinically in nuclear scintigraphy to assess coronary artery reserves. The potential to identify this vasodilating effect of adenosine using magnetic resonance imaging (MRI), which is superior in spatial resolution to nuclear scintigraphy, combined with a blood-pool MRI contrast agent, was investigated in normal rats. METHODS Groups of Sprague-Dawley rats received successive infusions of either adenosine (3 mg/kg/minute; n = 7) or dipyridamole (negative control; up to 1.0 mg/kg/minute; n = 9), both before and after contrast enhancement, with a macromolecular blood-pool MRI contrast agent, albumin-gadolinium-DTPA35 (Gd-DTPA35) (4.0 mumol Gd per kilogram). Electrocardiographically (ECG) gated MRIs (2.0 Tesla), acquired serially before and after contrast enhancement, and with and without either adenosine or dipyridamole infusions, to monitor potential pharmacologic responses. RESULTS During repeated infusions of adenosine, the postcontrast myocardial enhancement, reflecting blood volume, increased significantly (P < .05), up to 150%, compared with pre-adenosine enhancement. Infusions of dipyridamole, pharmacologically inactive in rats, produced no change in myocardial enhancement. CONCLUSIONS The increased myocardial signal intensity observed during adenosine infusions after enhancement of the blood pool can be attributed to increased blood volume accompanying coronary vasodilatation. The method, which does not require a continuous infusion of contrast agent, has potential for the clinical evaluations of coronary artery reserves.

RATIONALE AND OBJECTIVES. This study was designed to evaluate the potential of a blood–pool magnetic resonance (MR) contrast agent, polylysine–gadolinium-DTPA4O (polylysine–G-DTPA40) for detecting pulmonary perfusion defects. MATERIALS AND METHODS. Pulmonary emboli were induced in 10 rats by venous injection of 0.2 mL of air. Axial spin-echo images were acquired (TR = 800 mseconds; TE = 6 mseconds) before and after air injection and serially after the administration of polylysine–Gd-DTPA40. The embolism model was confirmed by scintigraphy using 99mTc-macroaggregated albumin. RESULTS. Signal intensity differences between normal and embolized lungs before and after the air injection were less than 25%. After polylysine–Gd-DTPA40 administration, signal intensity of the perfused lung increased more than 200%, whereas the embolized lung increased by only 25%. Signal intensities of the perfused lung remained stable for 1 hour, whereas signal intensities of the embolized lung gradually increased for 20 minutes as the air embolus dissolved. CONCLUSION. Magnetic resonance imaging (MRI) enhanced with a macromolecular blood–pool contrast agent can be used to detect acute pulmonary embolism in a confirmed animal model.

The potential of magnetic resonance (MR) imaging enhanced with albumin-(gadolinium diethylenetri-aminepentaacetic acid [DTPA])35, a macromolecular blood pool marker, for detection of focal changes in renal perfusion was studied in a myoglobinuric acute renal failure (ARF) model in the rat. T1-weighted spin-echo postcontrast images of injured kidneys at 3 hours after glycerol injection showed three distinct zones: a strongly enhanced outer cortex, a low-intensity inner cortex, and a strongly enhanced medulla. The distinct band of low intensity in the inner cortex indicated zonal decreased blood volume, corresponding to published microsphere data showing zonal low perfusion in the inner cortex. Contrast differences between parenchymal zones were significant for at least 30 minutes. No focal ischemic changes could be delineated on nonenhanced images. Enhanced and nonenhanced images of injured kidneys obtained at 24 hours after glycerol injection revealed no zonal differentiation. Contrast-enhanced MR imaging data in this ARF model correlated well with pathologic data and microsphere perfusion results. Contrast-enhanced characterization of the ischemic phase of renal injury with MR imaging may improve specificity for the diagnosis of ARF and may serve as a marker for therapeutic intervention.

Objectifs pedagogiques Connaitre la semiologie des maladies de la microcirculation hepatique. Savoir evoquer la peliose hepatique ou la maladie veineuse occlusive. Connaitre les examens complementaires pour confirmer le diagnostic. Connaitre la prise en charge et le suivi radiologique adaptes. Messages a retenir La maladie veino-occlusive et la peliose hepatique sont liees a l’atteinte de la microcirculation hepatique, se traduisant par une dilatation sinusoidale et des troubles perfusionnels au sein du parenchyme. Ces pathologies sont revelees par une hypertension portale, le bilan echographique se revelant souvent negatif. Le diagnostic repose sur l’imagerie en coupes (IRM ou TDM), eventuellement les mesures de pression veineuse hepatique mais egalement sur l’anatomopathologie et doit egalement rechercher des atteintes associees. Le traitement est celui des complications de l’hypertension portale avec un suivi annuel.

Objectifs Valider l’IRM corps entier comme une alternative aux differents examens irradiants usuels (TEP-scan et scanner) dans le bilan d’extension et de suivi des melanomes malins. Materiels et methodes Vingt patients ont ete explores de la tete aux pieds par IRM corps entier (Siemens, Avento, 1,5T) combinant l’etude en sequences de diffusion, en sequences VIBE apres injection de gadolinium (Multihance, Bracco) et en T1 SE sur le crâne. L’interpretation a ete effectuee sur les images natives et sur les images obtenues apres fusion des donnees de diffusion et des donnees post-gadolinium. Le gold-standard etait represente par l’association d’un scanner thoraco-abdomino-pelvien et cerebral, d’un TEP-scan et d’une echographie ganglionnaire. Resultats L’analyse combinee de toutes les donnees de l’IRM corps entier permet un bilan exhaustif des lesions metastatiques chez l’ensemble de nos patients. Cette technique presente les avantages de l’excellente resolution en contraste des sequences de diffusion, associes aux avantages de la bonne resolution morphologique de la sequence VIBE et de la fusion d’images. Conclusion Les resultats obtenus permettent d’ores et deja d’envisager une alternative aux bilans d’extension et de suivi usuels des melanomes malins. On peut ainsi concevoir, chez ces sujets souvents jeunes, de substituer a ce bilan associant des examens irradiants, un bilan par IRM corps entier.

Objectifs pedagogiques Connaitre les causes extra-biliaires d’epaississement vesiculaire. Connaitre les criteres diagnostiques d’une cholecystite aigue et savoir reconnaitre ses formes graves ou compliquees necessitant une prise en charge en urgence. Savoir reconnaitre les elements semiologiques evocateurs de malignite. Savoir discuter les diagnostics differentiels et reconnaitre une adeno-myomatose, une cholesterolose et un adenome vesiculaire. Messages a retenir Un epaississement vesiculaire peut etre la consequence de pathologies tres variees. Tout epaississement vesiculaire febrile n’est pas une cholecystite. L’adenocarcinome vesiculaire, du fait de sa gravite, doit rester constamment a l’esprit, mais il est necessaire de savoir reconnaitre les lesions benignes et si necessaire, proposer une surveillance adaptee. En presence d’un cholangiocarcinome de la vesicule biliaire, le radiologue doit savoir evaluer son degre d’extension et orienter la prise en charge therapeutique. L’echographie reste l’examen de premiere intention, mais le scanner et l’IRM prennent une place preponderante, aussi bien diagnostique que pronostique.

Pulmonary arteriovenous fistula are an uncommon disorder, and are most frequently congenital, usually then associated with hereditary hemorrhagic telangectasia (Rendu-Osler-Weber disease). We present, to our knowledge, the first case of a pulmonary arteriovenous fistula detected by gadolinium-enhanced pulmonary magnetic resonance angiography and confirmed by digital subtraction pulmonary angiography in a patient where the CT scan was unremarkable.

Objectifs Etude IRM de la dynamique de la neuro-inflammation post-ischemique chez la souris apres injection de nanoparticules de fer (USPIO). Materiels et methodes Un modele d’ischemie cerebrale focale par electrocoagulation a ete realise chez douze souris. Huit ont recu une injection intraveineuse d’USPIO (2mmolFe/kg) 5h post-ischemie. Les quatre autres souris operees ont constitue les temoins. Trois souris non-operees ont recu des USPIO. Les souris injectees ont ete imagees avant puis apres contraste a 6,12 et 24 ou 48h et 72h. Sequences utilisees a 7 Tesla : T2 multi-echo, Echo de gradient, diffusion (ADC). Les cerveaux ont ete etudies histologiquement a 72h avec coloration de Peris et immunomarquage des cellules macrophagiques (F4/80). Resultats Il existe chez les souris operees avec USPIO un hyposignal localise a la peripherie du foyer lesionnel dans les 12 premieres heures post-ischemie, puis dans la region ipsilaterale du striatum et dans le corps calleux s’etendant jusqu’a l’hemisphere controlateral. Les controles histologiques retrouvent dans les memes regions la presence de cellules macrophagiques activees avec du fer (USPIO) en situation intracellulaire. Conclusion L’IRM avec injection intraveineuse d’USPIO permet de caracteriser la neuro-inflammation, avec pour la premiere fois en imagerie in vivo la demonstration du caractere global de l’inflammation induite par une ischemie cerebrale focale.

Objectifs Evaluer la faisabilite et les complications de la biopsie hepatique par voie percutanee avec embolisation du trajet de ponction (PBHET) chez une population a risque hemorragique. Materiels et methodes Etude retrospective sur 134 PBHET sous controle echographique chez 116 patients (54 patients transplantes) classes en 4 groupes a faible (Gr.l = 23), moyen (Gr.2 = 59) et haut risque hemorragique (Gr.3 = 33) ou presentant des tumeurs hypervas-culaires (Gr.4 = 19). La longueur, la fragmentation et le nombre d’espaces portes ont ete analyses ainsi que les complications du geste. Resultats La qualite du prelevement a ete jugee bonne ou moyenne dans 86 %, de mauvaise qualite (3 a 5 espaces portes) dans 11,5 % ou inadequate (moins de 3 espaces portes) dans 2,5 %. La longueur moyenne du prelevement etait de 13 mm. Quatre complications severes ont ete rapportees : 1 hematome hepatique (conduisant au deces), 1 hemoperitoine et 2 hemothorax (groupes 3 et 4). Conclusion La PBHET est une technique simple, efficace et rapide pouvant dans la majorite des cas remplacer la PBH par voie transjugulaire.

Objectifs Comparer les donnees de l’echo-Doppler et de l’echographie avec injection de produit de contraste (EC) (Sonovue) chez les patients porteurs d’un TIPSS. Materiels et methodes Pendant 12 mois, 15 patients porteurs d’un TIPSS ont ete surveilles tous les 4 mois par echo-Doppler avec mesure de la vitesse dans le tronc porte, dans la prothese, evaluation du sens de circulation du systeme porte intra-hepatique et EC avec analyse de la qualite de remplissage de la prothese ; pour chaque suspicion de dysfonctionnement du TIPSS, un controle angiographique a ete realise. Resultats L’EC ne montrait aucun defect dans la prothese pour tous les patients avec un echo-Doppler normal, hormis 1 cas avec doppler normal et un thrombus detecte en EC et confirme par l’analyse de la piece d’hepatectomie totale. Chez tous les patients (3 cas) pour lesquels un dysfonctionnement en doppler du TIPSS etait suspecte, une thrombose murale dans la prothese etait confirmee en EC et lors de la revision par voie angiographique du TIPSS. Conclusion L’EC permet une analyse endoluminale du TIPSS, confirmant la localisation precise et le diagnostic de thrombose lorsque celle-ci et suspectee selon les criteres habituels de l’echo-Doppler.

Objectifs Evaluation de l’effet de l’exposition aigue et subaigue a l’ozone en IRM. Materiels et methodes Dix-huit rats âges de 5 mois sont utilises. Les animaux sont maintenus dans une enceinte en plexiglas balayee par un flux d’air continu filtre. L’ozone est produit a partir d’une lampe UV placee sur le circuit d’air a l’entree de l’enceinte. Quatre groupes d’animaux sont soumis a une exposition d’ozone de 0,5 ppm en continue ou intermittente (12 h par jour) pendant 2 ou 6 jours. Trois rats controles sont soumis a flux d’air exclusif. Juste apres l’exposition (moins de 3 heures) les animaux sont images sur une IRM 2T apres inhalation de 6 ml d’Helium 3 a un debit de 2ml/s. Resultats Tous les animaux exposes a 6 jours d’ozone presentaient de larges troubles de ventilation predominant au niveau des apex pulmonaires. Les animaux exposes a 2 jours d’ozone et les controles ne presentaient pas de trouble de ventilation. Conclusion Le rat represente un bon modele pour l’etude des effets physiopathologiques de l’ozone car sa sensibilite a l’ozone est voisine de celle observee chez l’homme. La dose de 0,5 ppm chez le rat est equivalente a une dose de 0,1 ppm chez l’homme. Cette dose de 0,1 ppm est souvent depassee dans les pays industrialises en ete.

International audience; Rationale & aim: Various types of cell therapies are currently under investigation for the treatment of ischemic stroke patients. To bridge the gap between cell administration and therapeutic outcome, there is a need for non-invasive monitoring of these innovative therapeutic approaches. Spectral photon counting computed tomography (SPCCT) is a new imaging modality that may be suitable for cell tracking. SPCCT is the next generation of clinical CT that allows the selective visualization and quantification of multiple contrast agents. The aims of this study are: (i) to demonstrate the feasibility of using SPCCT to longitudinally monitor and quantify therapeutic cells, i.e. bone marrow-derived M2-polarized macrophages transplanted in rats with brain damage; and (ii) to evaluate the potential of this approach to discriminate M2-polarized macrophages from their encapsulating scaffold. Methods: Twenty one rats received an intralesional transplantation of bone marrow-derived M2-polarized macrophages. In the first set of experiments, cells were labeled with gold nanoparticles and tracked for up to two weeks post-injection in a monocolor study via gold K-edge imaging. In the second set of experiments, the same protocol was repeated for a bicolor study, in which the labeled cells are embedded in iodine nanoparticle-labeled scaffold. The amount of gold in the brain was longitudinally quantified using gold K-edge images reconstructed from SPCCT acquisition. Animals were sacrificed at different time points post-injection, and ICP-OES was used to validate the accuracy of gold quantification from SPCCT imaging. Results: The feasibility of therapeutic cell tracking was successfully demonstrated in brain-damaged rats with SPCCT imaging. The imaging modality enabled cell monitoring for up to 2 weeks post-injection, in a specific and quantitative manner. Differentiation of labeled cells and their embedding scaffold was also feasible with SPCCT imaging, with a detection limit as low as 5,000 cells in a voxel of 250 × 250 × 250 µm in dimension in vivo. Conclusion: Multicolor SPCCT is an innovative translational imaging tool that allows monitoring and quantification of therapeutic cells and their encapsulating scaffold transplanted in the damaged rat brain.

Purpose: To evaluate complicated aortoiliac and lower extremity arterial bypass grafts with contrast-enhanced subtraction magnetic resonance angiography (MRA). Methods: Twenty-three patients with 40 vascular grafts with either clinical symptoms or abnormal duplex findings were selected. They were examined using a fast T1-weighted gradient-echo sequence. Twelve to 19 coronal sections of 5 to 8 mm were acquired before and after an intravenous bolus injection of gadolinium (0.1 mmol/kg) in 25 to 40 seconds. Final images were created by subtracting each precontrast section from its corresponding postcontrast section. The MRA was obtained after subtraction and maximum intensity projection. Results: MRA detected 38 grafts (95%) with 28 abnormalities. Two stenoses were overestimated. MRA had a sensitivity of 91% and a specificity of 92% for diagnosis of graft stenoses and occlusions. MRA brought out more information in five cases by demonstrating four nonthrombotic ectasias that were unseen by duplex sonography and one thrombotic ectasia that was unseen by x-ray angiography. Conclusions: MRA seems to compare favorably with x-ray angiography for the diagnosis of arterial bypass graft complications. A multicenter trial will be necessary to validate these preliminary results and to assess the exact role of MRA compared with the other established techniques. (J Vasc Surg 1997;26:1036-42.)

RATIONALE AND OBJECTIVES The authors evaluate the use of magnetic resonance (MR) to image pulmonary perfusion in healthy controls and to detect pulmonary defects in patients with unilateral lung transplantation, using dynamic images after contrast administration. METHODS Five patients with right lung transplantation and nine healthy volunteers underwent MR imaging. Twenty-five subsecond contrast-enhanced MR images (turbo-fast low-angle shot [FLASH]) were obtained at the level of the pulmonary arteries after a single injection of gadopentetate dimeglumine (0.1 mmol/kg) in an antecubital vein. Perfusion lung scintigraphy was done within 24 hours after the MR imaging examination in the transplanted patients. RESULTS Before administration of contrast material, MR images showed both lungs to be homogeneous and of low signal intensity in healthy controls and in patients with lung transplantation. After contrast administration in controls, the mean signal intensity of the dependent lung increased markedly to 171 +/- 24% above baseline, whereas the nondependent signal intensity lung increased by only 105 +/- 17%; these changes were significantly different. In all patients with lung transplantation, a clear perfusion defect was demonstrated in the native lung. This defect was confirmed in all cases by perfusion nuclear scintigraphy, which showed that the majority of lung perfusion is directed to the transplanted allograft, compared with the native contralateral lung. CONCLUSIONS Our results suggest that dynamic contrast-enhanced MR imaging is a potential method for detecting pulmonary perfusion defects in patients with lung transplantation.

Prediction of hemorrhagic transformation (HT) in patients treated by intravenous recombinant tissue-type plasminogen activator (rt-PA) is a challenging issue in acute stroke management. HT may be correlated with severe hypoperfusion. Signal changes may be observed at susceptibility-weighted magnetic resonance imaging (MRI) within large perfusion defects. A signal drop within cerebral veins at T2∗-weighted gradient-echo MRI may be expected in severe ischemia, and may indicate subsequent risk of HT. The authors prospectively searched for an abnormal visibility of transcerebral veins (AVV) within the ischemic area in patients with hemispheric ischemic stroke, before they were treated with intravenous rt-PA therapy. Any correlation between AVV and baseline clinical or MRI findings, or further HT, was noted. An AVV was present in 23 of 49 patients (obvious, n = 8; moderate, n = 15), and was supported by severe hemodynamic changes at baseline MRI. The AVV was correlated with the occurrence of parenchymal hematoma type 2 at computed tomography during the first week ( r = 0.44, P = 0.002). Five of six type 2 parenchymal hematomas occurred in association with obvious AVV. At multiple regression analysis, two baseline MRI factors had an independent predictive value for HT risk during the first week: the AVV and the cerebral blood volume ratio (Nagelkerke R2 = 0.48).

Objectives Gadolinium-ethoxybenzyl-DTPA (Gd-EOB-DTPA) is a new hepatobiliary magnetic resonance imaging (MRI) contrast agent with a dual elimination: 70% via the liver and bile and 30% via the kidney in normal rats. The abdominal enhancement patterns of this new compound and the uptake mechanism by the liver were studied in rats using tissue relaxometry and MRI. Methods Twelve normal rats, 33 rats treated with agents designed to inhibit biliary excretion of the agent, and 6 rats with surgically ligated common bile ducts received Gd-EOB-DTPA intravenously. Distribution and excretion were measured by MR relaxometry. MR signal intensity was measured over time for liver, kidney, and bowel. Results In normal animals, 0.1 mmol/kg Gd-EOB-DTPA induced a significantly greater (200%) and more prolonged liver signal enhancement (100% at 30 minutes) than Gd-DTPA at the same dose. Either hyperbilirubinemia, induced by common bile duct ligation, or bromosulfophtalein (BSP) infusion inhibited liver uptake of Gd-EOB-DTPA, resulting in a preferential elimination via the kidney. Taurocholate (TC), an inhibitor of the bile acid transporter, was unable to block the liver uptake of Gd-EOB-DTPA. Blood half-lives of Gd-EOB-DTPA in rats were 2.4 minutes for the first component and 8.2 minutes for the second. Conclusions Data indicate that transport of Gd-EOB-DTPA through the liver into bile is driven by the organic anion transporter. The relation between enhancement of liver and kidney may be diagnostically useful to indirectly evaluate liver excretory function. Yet, persistent enhancement of liver, even in the presence of severe hyperbilirubinemia, should be sufficient to identify focal mass lesions.

BACKGROUND After radiochemotherapy, 20% to 30% of patients with early worsening MRI experience pseudoprogression (Psp) which is not distinguishable from early progression (EP). We aimed to assess the diagnostic performance and survival predictive ability of radiomics in patients with suspected EP or Psp. MATERIAL AND METHODS Radiomics features (RF) of 76 patients (53 EP and 23 Psp) retrospectively identified were extracted from conventional MRI based on four volumes-of-interest. Subjects were randomly assigned into training and validation groups. Classification model (EP versus Psp) consisted of a random forest algorithm after univariate filtering. Overall (OS) and progression-free survivals (PFS) were predicted using a semi-supervised principal component analysis and, forecasts were evaluated using C index and integrated Brier scores (IBS). RESULTS Using 11 RFs, radiomics classified patients with 75.0% and 76.0% accuracy, 81.6% and 94.1% sensitivity, 50.0% and 37.5% specificity, respectively in training and validation phases. Addition of MGMT promoter status improved accuracy to 83% and 79.2% and, specificity to 63.6% and 75%. OS model included 14 RFs and stratified low- and high-risk patients both in the training (hazard ratio (HR), 3.63, p=0.002) and the validation (HR, 3.76, p=0.001) phases. Similarly, PFS model stratified patients during training (HR, 2.58, p=0.005) and validation (HR, 3.58, p=0.004) phases using 5 RF. OS and PFS forecasts had C index of 0.65 and 0.69 and IBS of 0.122 and 0.147, respectively. CONCLUSION Conventional MRI radiomics has promising diagnostic value, especially when combined with MGMT promoter status, but specificity remains moderate. In addition, our results suggest a potential for predicting OS and PFS.

Acute ischemic stroke treatments (intravenous thrombolysis, mechanical thrombectomy) aim to restore an affective brain perfusion in order to improve neurological outcome. We first evaluated the predictive value of susceptibility vessel sign (SVS) on T2* MRI sequence after intravenous thrombolysis and studied course of SVS using sequential MRI assessment. We confirm that SVS is a strong predictor of no recanalisation, and underline discrepancies between MR angiography and T2* data. In the second part, we assessed the usefulness of near-infrared spectroscopy (NIRS) to monitor recanalisation during mechanical thrombectomy. NIRS is a reliable tool, but still suffer of challenging limitations; A la phase aigüe des accidents ischémiques cérébraux, l'objectif thérapeutique principal est l'obtention d'une recanalisation de l'artère occluse et d'une reperfusion de la zone de pénombre ischémique. L'identification de facteurs prédictifs d'une recanalisation et le développement de nouveaux outils de surveillance est d'un intérêt majeur lors de la mise en oeuvre de ces thérapeutiques. Dans la première partie de notre travail, nous avons étudié la valeur pronostique de la visibilité initiale du thrombus sur les séquences IRM en T2* et son évolution lors d'acquisitions séquentielles chez les patients traités par thrombolyse intraveineuse. Nous avons confirmé la valeur péjorative cette visibilité initiale, et souligné les discordances entre les données de l'angioIRM et de la séquence T2* lors de l'analyse séquentielle. Dans la seconde partie du travail, nous avons évalué l'intérêt de la spectroscopie de proche infrarouge comme méthode permettant d'évaluer le bénéfice de la recanalisation chez les patients traités par thrombectomie mécanique. Cette technologie semble intéressante, mais présente cependant des limites discutées dans ce travail

The benefit of recombinant tissue plasminogen activator (rtPA) treatment in stroke is well known with serious side effects requiring the evaluation of alternative strategies. Injection of thrombin in the middle cerebral artery of mice has been proposed as a new model of thromboembolic stroke. In the first study, we used multiparametric Magnetic Resonance Imaging (MRI), performed immediately after thrombin injection, to document occlusion and area at risk in this model. Despite similar MCA occlusion and marked hypoperfusion, half of animals showed a cortical lesion on DWI, while the other half demonstrated no or very limited lesion. Therefore, MRI measurement of basal lesion size is required to use this animal model in therapeutic studies. The second study compared efficacy between TAFI inhibitor alone and TAFI inhibitor in combination with low-dose rtPA. In conclusion, we showed that the combination of TAFI-I with low-dose rtPA is not as effective as the standard dose of rtPA, with a positive trend, while TAFI inhibition alone is not effective at all. The present thromboembolic model is of particular interest in assessing strategies rtPA association to improve thrombolysis, especially when coupled with longitudinal MRI assessment, L'efficacité du rtPA dans le traitement de l’ischémie aigue est bien reconnue avec des effets secondaires graves nécessitant l’évaluation d’autres stratégies. Un modèle d’ischémie cérébrale focale a été décrit, réalisé par injection in situ de thrombine. Dans notre première étude, nous avons utilisé l’imagerie par résonance magnétique multimodale pour documenter les lésions et les zones de pénombre dans ce modèle. Malgré une occlusion de l’artère reproductible et une hypoperfusion marquée chez tous les sujets, une reperfusion spontanée est constatée dans 38% des cas, rendant l’IRM incontournable dans l’évaluation de ce modèle. La deuxième étude a comparé l'efficacité d’un TAFI inhibiteur seul ou en combinaison avec le rtPA à faible dose. Nous avons montré que la combinaison du TAFI inhibiteur avec le rtPA à faible dose n'est pas aussi efficace que la dose standard de rtPA, avec une tendance positive, tandis que le TAFI inhibiteur seul n'est pas efficace du tout. Le modèle thromboembolique présente un intérêt particulier dans l'évaluation des stratégies thérapeutiques associées au rtPA pour améliorer la thrombolyse, surtout lorsqu'il est évalué par un suivi longitudinal en IRM

The benefit of recombinant tissue plasminogen activator (rtPA) treatment in stroke is well known with serious side effects requiring the evaluation of alternative strategies. Injection of thrombin in the middle cerebral artery of mice has been proposed as a new model of thromboembolic stroke. In the first study, we used multiparametric Magnetic Resonance Imaging (MRI), performed immediately after thrombin injection, to document occlusion and area at risk in this model. Despite similar MCA occlusion and marked hypoperfusion, half of animals showed a cortical lesion on DWI, while the other half demonstrated no or very limited lesion. Therefore, MRI measurement of basal lesion size is required to use this animal model in therapeutic studies. The second study compared efficacy between TAFI inhibitor alone and TAFI inhibitor in combination with low-dose rtPA. In conclusion, we showed that the combination of TAFI-I with low-dose rtPA is not as effective as the standard dose of rtPA, with a positive trend, while TAFI inhibition alone is not effective at all. The present thromboembolic model is of particular interest in assessing strategies rtPA association to improve thrombolysis, especially when coupled with longitudinal MRI assessment; L'efficacité du rtPA dans le traitement de l’ischémie aigue est bien reconnue avec des effets secondaires graves nécessitant l’évaluation d’autres stratégies. Un modèle d’ischémie cérébrale focale a été décrit, réalisé par injection in situ de thrombine. Dans notre première étude, nous avons utilisé l’imagerie par résonance magnétique multimodale pour documenter les lésions et les zones de pénombre dans ce modèle. Malgré une occlusion de l’artère reproductible et une hypoperfusion marquée chez tous les sujets, une reperfusion spontanée est constatée dans 38% des cas, rendant l’IRM incontournable dans l’évaluation de ce modèle. La deuxième étude a comparé l'efficacité d’un TAFI inhibiteur seul ou en combinaison avec le rtPA à faible dose. Nous avons montré que la combinaison du TAFI inhibiteur avec le rtPA à faible dose n'est pas aussi efficace que la dose standard de rtPA, avec une tendance positive, tandis que le TAFI inhibiteur seul n'est pas efficace du tout. Le modèle thromboembolique présente un intérêt particulier dans l'évaluation des stratégies thérapeutiques associées au rtPA pour améliorer la thrombolyse, surtout lorsqu'il est évalué par un suivi longitudinal en IRM

Several studies on small animals have shown that MRI enhanced with nanoparticles of iron oxide (USPIO) is able to detect the neuroinflammation. However, to our knowledge, no team had yet investigated the potential of this approach for monitoring an anti-inflammatory treatment. In this context, we have demonstrated the feasibility of this approach to monitor the effects of minocycline after cerebral ischemia in mice. MRI is a very sensitive technique for the detection of iron, but the precise location of USPIO as well as their quantification is difficult. We therefore propsed to complete the MRI approach by a new technique to our knowledge in the field of USPIO imaging in the brain : Synchrotron radiation tomography. We here present the first results showing the feasibility of this approach and a comparative study of the sensitivity of two techniques used for the detection of USPIO in the brain. In the last part of our work, we report our results on the biotransformation of USPIOs in the spleen of the mouse during the first 40 days after intravenous injection obtained by transmission electron microscopy (TEM).; Plusieurs études menées chez le petit animal ont montré que l'IRM réhaussé avec les nanoparticules d'oxyde de fer (USPIO) permettait de détecter la neuroinflammation. Cependant, à notre connaissance, aucune équipe n'avait à ce jour étudié le potentiel de cette approche pour le suivi d'un traitement anti-inflammatoire. Dans ce contexte, nous avons démontré la faisabilité de cette approche pour monitorer les effets de la minocycline suite à une ischémie cérébrale chez la souris. L'IRM est une technique très sensible pour la détection du fer, mais la localisation précise des USPIO tout comme leur quantification est difficile. Nous avons donc proposé de compléter l'approche IRM par une technique inédite à notre connaissance dans le domaine de l'imagerie cérébrale des USPIO : la tomographie par rayonnement Synchrotron. Nous présentons ici les tous premiers résultats montrant la faisabilité de l'approche, ainsi qu'une étude comparée de la sensibilité, des deux techniques pour la détection des USPIO dans le cerveau. Dans la première partioe de notre travail , nous apportons nos résultats concernant la biotransformation des USPIOs dans la rate de la souris dans les 40 premiers jours suivant leur injection intraveineuse obtenus en microscopie électronique par transmission (MET).