Improved image contrast with mangafodipir trisodium (MnDPDP) during MR-guided percutaneous cryosurgery of the liver

The present study was undertaken to measure the gain observed in the liver-to-tumor contrast of perioperative images when using mangafodipir trisodium, a liver-specific contrast agent, during percutaneous cryosurgery of the liver performed under the guidance of magnetic resonance images. Retrospective quantitative analyses of MR images were performed on eleven patients having a total of 30 liver tumors treated by MR-guided percutaneous cryosurgery. An initial group of four patients were treated with no contrast agent, and was compared with a second group of 7 patients who received an intravenous injection of 5 microM/kg of mangafodipir for their cryosurgery. The percutaneous cryosurgery was monitored under the near-real-time-imaging mode of a 0.5T open-configuration MRI system using a T(1)-weighted Gradient-recalled echo pulse sequence. A significant improvement in the liver-to-tumor contrast-to-noise ratio was observed with mangafodipir (p < 0.05, paired t test) in 0.5T preoperative images. Along with the stability of the mangafodipir contrast enhancement during the entire cryosurgical procedure, the resulting gain in contrast allowed for better visualizing the presence of residual untreated tumor margins at the periphery of the cryosurgery iceball directly from perioperative images acquired with patients under narcosis. Consequently, it not only became easier for the interventionalist to determine the need for an additional cryoprobe to increase the size of the iceball during the procedure, but also to decide on the appropriate end point of the cryosurgery.     

Numerical simulation of tissue freezing by liquid nitrogen based cryoprobe

A model is presented to simulate the cooling processes during tumor cryosurgery with different kinds of flows through the cryoprobe. The heat flux between the cryoprobe wall and the tumor, the heat transfer coefficient under different inflow conditions are obtained numerically. The impact of the inlet mass flow rate, gas volume fraction on these parameters is investigated. It is found that the heat transfer coefficient decreased significantly when inflow changed from two-phase annular flow to droplet flow, and to gas flow. The inlet gas volume fraction and flow velocity only significantly affect the freezing ability of the probe when the inflow is gas or in droplet phase. Simulation of the tumor temperature profiles under different flow conditions show that the heat transfer coefficient is a crucial parameter in temperature prediction during cryosurgery. Results indicate that when the cryoprobe wall is assumed at a constant temperature conventionally, the cooling effect could be overestimated. It would be more reasonable to use the constant wall heat transfer coefficient to simulate the cooling progress under a specific flow.     

The thermal effect of urethral warming during cryosurgery

The heating effect of urethral warming during cryosurgery has been investigated theoretically, via heat transfer simulations. Two warmer configurations have been considered: (i). the clinically available urethral warmer, which has a configuration of a counter flow fluid heat exchanger; (ii). a newly designed urethral warmer, based on a temperature controlled electrical heater, termed a "cryoheater". A dramatic effect of thermal resistance to heat transfer through the heat exchanger wall has been identified, which is absent in the cryoheater. It follows that the cryoheater is expected to be more efficient in generating an unfrozen region around the urethra. It is shown that the conventional heat exchanger may fail to prevent freezing around the urethra in a significant number of prostate cases, depending on the layout of cryoprobes around the urethra. On the other hand, clinical reports exist which suggest that the heat exchanger improves in many cases the outcome of cryosurgery, in terms of long term complications. It is speculated in the current report that the cryoheater can further improve the outcome of cryosurgery, by providing protection from freezing in a wider range of cases. It is suggested that a future study be conducted to examine the correlation between the layout of cryoprobes and surgical outcome.     

Experimental and computational analyses of the effects of slice distortion from a metallic sphere in an MRI phantom

Susceptibility artifacts due to metallic prostheses are a major problem in clinical magnetic resonance imaging. We theoretically and experimentally analyze slice distortion arising from susceptibility differences in a phantom consisting of a stainless steel ball bearing embedded in agarose gel. To relate the observed image artifacts to slice distortion, we simulate images produced by 2D and 3D spin-echo (SE) and a view angle tilting (VAT) sequence. Two-dimensional SE sequences suffer from extreme slice distortion when a metal prosthesis is present, unlike 3D SE sequences for which--since slices are phase-encoded--distortion of the slice profile is minimized, provided the selected slab is larger than the region of interest. In a VAT sequence, artifacts are reduced by the application of a gradient along the slice direction during readout. However, VAT does not correct for the excitation slice profile, which results in the excitation of spins outside the desired slice location and can lead to incorrect anatomical information in MR images. We propose that the best sequences for imaging in the presence of a metal prosthesis utilize 3D acquisition, with phase encoding replacing slice selection to minimize slice distortion, combined with excitation and readout gradient strengths at their maximum values.     

MRI-monitored cryosurgery in the rabbit brain

The inability to observe the transient, irregular shape of the frozen region that develops during cryosurgery has inhibited the application of this surgical technique to the treatment of tumors in the brain and deep in visceral organs. We used proton NMR spin-echo and spoiled gradient-echo imaging to monitor the development of frozen lesions during cryosurgery in the rabbit brain and the resulting postervosurgical changes up to 4 hr after freezing. Spoiled gradient-echo images (TE = 14 ms; TR = 50 ms) were acquired during freezing and thawing at a rate of 15 s/slice. Although the frozen region itself is invisible in MR images, its presence is distinguished easily from the surrounding unfrozen soft tissue because of the large contrast difference between frozen and unfrozen regions. T₂-weighted spin-echo images (TE = 100 ms, TR = 2 s) obtained after thawing suggest that edema forms first at the margin of the region that was frozen (cryolesion) and then moves into the region's core. Histological examination showed complete necrosis in the cryolesion and a sharp transition to undamaged tissue at the margin of the lesion and its image. Blood-brain barrier (BBB) damage was investigated using gadolinium-DTPA. The region of edema in the T₂-weighted spin-echo images was coincident with the area of BBB damage in the Gd-DTPA-enhanced T₁-weighted spin-echo images (TE = 33 ms, TR = 400 ms) and both were distinguishable as areas of high signal relative to the surrounding normal tissue. The results of these experiments indicate that MR can both effectively monitor the cryosurgical freezing and thawing cycle and characterize the postcryosurgical changes in tissue during follow-up.     

模拟生物组织冻结过程实验与分析

冷冻外科中组织冻结过程的分析对手术实施十分重要。本文建立了低温冷刀实验台,在模拟生物组织中进行冷冻实验,测量了冰球内某点的温度变化;并用有限元方法求解了建立在治法基础上的模拟生物组织冻结过程多维数学模型,计算结果与实验值符合较好;用该模型和方法计算了实验条件下冰球内的温度梯度变化和冷刀所需理论冷量;分析了不同的冷刀直径对冻结过程的影响。     

考虑冷热刀刀头温度响应对制定肿瘤治疗计划的影响

本文对冷热联合治疗肿瘤过程中在体生物组织的温度响应进行了深入的数值研究。组织被当作非理想材料,在一定的温度范围内冷冻和融化,并且考虑了未冻结组织和未损伤组织区域的血液灌注及代谢产热的影响。对比考虑和不考虑冷热刀刀头温度响应两种情形的计算结果表明,拟定治疗计划中若不考虑刀头温度响应,则有可能会造成冷热剂量的不足,从而无法彻底杀灭肿瘤。     

前列腺低温微创治疗及器件的研究

利用低温冷冻破坏前列腺增生或肿瘤组织治疗疾病具有许多的优点,如出血少、痛苦小,有时甚至不需要麻醉。前列腺冷冻术可采用两种方法,即穿刺式和接触式。穿刺式就是将探针直接插入病灶组织中心,予以冷冻,主要用于较小的病灶;接触式就是将探针冷冻区接触病灶组织表面予以冷冻,主要用于较小的前列腺增生或不规则的肿瘤等,有时也可将二者结合使用。冷冻术最大的优点还在于可防止肿瘤细胞的扩散。文中详细介绍前列腺冷冻治疗的机理、冷冻探针的结构特点及临床应用效果。     

Analysis of machine-dependent and object-induced geometric distortion in 2DFT MR imaging.

Geometric distortion in MR imaging predominantly arises from the inhomogeneity of the static field and the nonlinearity of the gradients. It is the purpose of this paper to analyse the object and machine related contributions to geometric distortion in order to determine which corrections are necessary for attaining a specified precision. System related imperfections were measured by systematic variation of the strength, direction, and polarity of the read-out gradient in imaging experiments on a grid of cylindrical sample tubes. For the 1.5-T system used in this study, static field related errors up to 7 mm and gradient related errors up to 4 mm were observed (midcoronal plane, FOV 400-mm, G-read between 0.5 and 3.0 mT/m). Field related errors were shown to be inversely proportional to gradient strength, whereas gradient related errors turned out to be virtually independent of gradient strength. It therefore seems recommendable to always apply the strongest available selection and read-out gradients when geometric fidelity is given preference to signal-to-noise considerations. Correction of system related geometric distortions in MR images can readily be performed by table lookup. Object-induced distortions of the gradient fields were studied by experiments on a grid of sample tubes immersed into a cylindrical water bath of variable saline concentration. These experiments revealed a negligible influence of the object on the gradient error distribution, and lead to the conclusion that correction for the nonlinearity of the gradients only requires the application of system dependent correction factors. Object-related distortions of B0 were studied by conventional SE and fat-suppressed IR experiments on phantoms and human subjects. In these experiments the polarity of the read-out gradient was reversed. Subtraction images showed significant object-induced inhomogeneities of the static field at tissue-air interfaces and in the immediate vicinity of the object being imaged. A first attempt to correct for object related B0 inhomogeneities was made by contour analysis of the source images. At present this correction still has to be done manually.     

Magnetic resonance spectroscopic imaging for visualization and correction of distortions in MRI: high precision applications in neurosurgery

We present a method for the quantification and correction of geometrical/intensity distortions of magnetic resonance images predominantly caused by bulk magnetic susceptibility shifts due to susceptibility heterogeneities of measured biologic tissues and shape of the object under investigation. The method includes precise and fast measurements of the static magnetic-field distribution inside the measured object and automated data processing. Magnetic-field deviations in the range −2.4; 2.6 ppm were found in the human brain at B₀ = 1.5 T. For routinely used imaging parameters, with a read gradient strength of about 1 mT/m, the magnetic-field perturbations in the human brain can cause geometrical distortions up to ±4 mm and intensity changes up to ±50%. MR images corrected by the described method are suitable for planning high precision applications in neurosurgery.     

Keyhole acceleration for magnetic resonance acoustic radiation force imaging (MR ARFI)

MR ARFI measures the displacement induced by the ultrasonic radiation force and provides the location of the focal spot without significant heating effects. Displacements maps obtained with MR ARFI provide an indirect estimation of the acoustic beam intensity at the target. This measure is essential for dose estimation prior to focused ultrasound treatments (FUS) and adaptive focusing procedures of MR-guided transcranial and transribs FUS. In the latter case, the beam correction is achieved by maximizing the displacement at focus. A significant number of serial MR ARFI images are required and thus, a partial k-space updating method, such as keyhole appears as a method of choice. The purpose of this work is to demonstrate via simulations and experiments the efficiency of the keyhole technique combined with a two-dimensional spin-echo MR ARFI pulse sequence. The method was implemented in an ex vivo calf brain taking advantage of the a priori knowledge of the focal spot profile. The coincidence of the phase-encoding axis with the longest axis of the focal spot makes the best use of the technique. Our approach rapidly provides the focal spot localization with accuracy, and with a substantial increase to the signal-to-noise ratio, while reducing ultrasound energy needed during MR-guided adaptive focusing procedures.     

Single-shot fast spin-echo diffusion tensor imaging of the brain and spine with head and phased array coils at 1.5 T and 3.0 T

In this study, we investigated the use of a single-shot fast spin-echo-based sequence to perform diffusion tensor imaging (DTI) with improved anatomic fidelity through the entire brain and the cervical spine. Traditionally, diffusion tensor images have been acquired by single-shot echo-planar imaging (EPI) methods in which large distortions result from magnetic susceptibility effects, especially near air-tissue interfaces. These distortions can be problematic, especially in anterior and inferior portions of the brain, and they also can severely limit applications in the spine. At higher magnetic fields these magnetic susceptibility artifacts are increased. The single-shot fast spin-echo (SSFSE) method used in this study utilizes radiofrequency rephasing in the transverse plane and thus provides diffusion images with negligible distortion even at 3 Tesla. In addition, the SSFSE sequence does not require multiple fast-receivers, which are not available on many magnetic resonance (MR) systems. Phased array coils were used to increase the signal-to-noise ratio of the images, offering a major inherent advantage in diffusion tensor imaging of the spine and brain. The mean diffusion measurements obtained with the SSFSE acquisition were not statistically different (p > 0.05) from EPI-based acquisitions. Compared to routine T(2)-weighted MR images, the DTI-EPI sequence showed up to 20% in elongation of the brain in the anterior-posterior direction on a sagittal image due to magnetic susceptibility distortions, whereas in the DTI-SSFSE, the image distortions were negligible. The diffusion tensor SSFSE method was also able to assess diffusion abnormalities in a brain stem hemorrhage, unaffected by the spatial distortions that limited conventional EPI acquisition.     

Multicontrast multiecho FLASH MRI for targeting the subthalamic nucleus

The subthalamic nucleus (STN) is one of the most common stimulation targets for treating Parkinson's disease using deep brain stimulation (DBS). This procedure requires precise placement of the stimulating electrode. Common practice of DBS implantation utilizes microelectrode recording to locate the sites with the correct electrical response after an initial location estimate based on a universal human brain atlas that is linearly scaled to the patient's anatomy as seen on the preoperative images. However, this often results in prolonged surgical time and possible surgical complications since the small-sized STN is difficult to visualize on conventional magnetic resonance (MR) images and its intersubject variability is not sufficiently considered in the atlas customization. This paper proposes a multicontrast, multiecho MR imaging (MRI) method that directly delineates the STN and other basal ganglia structures through five co-registered image contrasts (T1-weighted navigation image, R2 map, susceptibility-weighted imaging (phase, magnitude and fusion image)) obtained within a clinically acceptable time. The image protocol was optimized through both simulation and in vivo experiments to obtain the best image quality. Taking advantage of the multiple echoes and high readout bandwidths, no interimage registration is required since all images are produced in one acquisition, and image distortion and chemical shift are reduced. This MRI protocol is expected to mitigate some of the shortcomings of the state-of-the-art DBS implantation methods.     

A quantitative comparison of two methods to correct eddy current-induced distortions in DT-MRI

Eddy current-induced geometric distortions of single-shot, diffusion-weighted, echo-planar (DW-EP) images are a major confounding factor to the accurate determination of water diffusion parameters in diffusion tensor MRI (DT-MRI). Previously, it has been suggested that these geometric distortions can be removed from brain DW-EP images using affine transformations determined from phantom calibration experiments using iterative cross-correlation (ICC). Since this approach was first described, a number of image-based registration methods have become available that can also correct eddy current-induced distortions in DW-EP images. However, as yet no study has investigated whether separate eddy current calibration or image-based registration provides the most accurate way of removing these artefacts from DT-MRI data. Here we compare how ICC phantom calibration and affine FLIRT (http://www.fmrib.ox.ac.uk), a popular image-based multi-modal registration method that can correct both eddy current-induced distortions and bulk subject motion, perform when registering DW-EP images acquired with different slice thicknesses (2.8 and 5 mm) and b-values (1000 and 3000 s/mm(2)). With the use of consistency testing, it was found that ICC was a more robust algorithm for correcting eddy current-induced distortions than affine FLIRT, especially at high b-value and small slice thickness. In addition, principal component analysis demonstrated that the combination of ICC phantom calibration (to remove eddy current-induced distortions) with rigid body FLIRT (to remove bulk subject motion) provided a more accurate registration of DT-MRI data than that achieved by affine FLIRT.     

Exophytic benign tumors of the liver: appearance on MRI.

The purpose of our study was to determine the MR imaging appearance of exophytic benign liver tumors on precontrast and postgadolinium images. We reviewed our 9.5 year experience with MRI of the liver with dynamic gadolinium enhanced imaging to identify four patients with five histologically proven exophytic benign liver tumors. The histological diagnoses were cavernous hemangioma (2), focal nodular hyperplasia (FNH) (1), and hepatocellular adenoma (HCA) (2 exophytic adenomas in a patient with adenomatosis of the liver). All MRI studies were performed at 1.5 T and included: in-phase and out-of-phase T1-weighted spoiled gradient echo (SGE), T2-weighted fat-suppressed echo train spin echo, single shot T2-weighted sequences, and serial postgadolinium T1-weighted SGE sequences without and with fat-suppression. Prospective interpretations were reviewed and retrospective consensus readings of all MR images were performed assessing location, size, origin, morphology, visibility of the connection to the liver, signal characteristics on precontrast T1-weighted and T2-weighted images, and enhancement patterns on serial postgadolinium images. Three of the five tumors were pedunculated and connected to the liver by a thin stalk, which was prospectively identified in one patient. On precontrast and serial postgadolinium images, all exophytic tumors showed signal characteristics comparable to imaging features of standard intraparenchymal benign liver tumors. Our findings illustrate that the characteristic T1, T2, and postgadolinium imaging findings of these tumors permit correct identification of their liver origin despite their exophytic location, even if their connection with liver is not visualized.     

低温外科设备治疗探针高频钎焊研究

治疗探针是低温外科设备的关键器件.在临床手术过程中,治疗探针的探杆部分(非冷冻区)通常需与人体正常组织紧密接触.为不伤及这些非冷冻组织,对于这种细直径探杆狭小隔层空间的绝热,只能采用高真空加以实现.为获得并维持探杆隔层空间的高真空,必须保证冷冻探针金属组件焊接的质量.文中详细介绍了冷冻探针金属组件的材料处理和高频钎焊技...     

临床低温外科装置

低温冷冻在临床上可用来杀死各类肿瘤组织,冷冻治疗具有许多优越性,如手术过程出血少、痛苦小.文中介绍低温外科装置的工作过程及装置结构,分析冷冻探头的传热过程.最后根据临床应用,对装置的工作压力、冷冻速率、复温速率等重要参数进行讨论.     

Methods for the systematic investigation of gastrointestinal contrast media for MRI: evaluation of intestinal distribution by radiographic monitoring

Comparison of the effectiveness of various gastrointestinal (GI) contrast agents for magnetic resonance (MR) imaging is often complicated by varying amounts intraluminal filling with the orally administered agents. To achieve more uniform and reproducible imaging results with GI contrast agents for MR imaging (GICMR), we evaluated a radiographic method for monitoring intraluminal filling and distribution. Solutions of Mn-DPDP (2 mM), to which a small amount of barium sulfate (6 wt/vol%) was added, were administered orally to dogs. Gastric emptying and small bowel transit were monitored fluoroscopically. MR imaging was performed either 1) at a fixed time after administration of the contrast agent or 2) at a variable interval when the contrast agent was observed fluoroscopically to be in the terminal ileum. When initiation of MR imaging was guided by fluoroscopic monitoring of intestinal contrast distribution, uniform and reproducible intestinal contrast enhancement by GICMR was achieved. However, when MR imaging was performed at a fixed time interval after oral administration, non-uniform and variable GI visualization was obtained, and this corresponded to the variable intestinal distribution observed fluoroscopically. We conclude that reproducible intestinal filling with orally administered contrast agents can be accomplished with a radiographic monitoring technique, and this promotes more consistent GI visualization on MR images. Such standardized and reproducible methods are necessary for studies in which the effectiveness of GI contrast media for MR imaging is evaluated and compared.     

Vessel boundary extraction based on a global and local deformable physical model with variable stiffness

Reliable and efficient vessel cross-sectional boundary extraction is very important for many medical magnetic resonance (MR) image studies. General purpose edge detection algorithms often fail for medical MR images processing due to fuzzy boundaries, inconsistent image contrast, missing edge features, and the complicated background of MR images. In this regard, we present a vessel cross-sectional boundary extraction algorithm based on a global and local deformable model with variable stiffness. With the global model, the algorithm can handle relatively large vessel position shifts and size changes. The local deformation with variable stiffness parameters enable the model to stay right on edge points at the location where edge features are strong and at the same time, fit a smooth contour at the location where edge features are missing. Directional gradient information is used to help the model to pick correct edge segments. The algorithm was used to process MR cine phase-contrast images of the aorta from 20 volunteers (over 500 images) with excellent results.     

Small hyperintense hepatic lesions on T1-weighted images in patients with cirrhosis: evaluation with serial MRI and imaging features for clinical benignity

PURPOSE: The aim of this study was to evaluate the frequency and magnetic resonance imaging (MRI) features of clinically benign, small (<2 cm) hyperintense hepatic lesions in the cirrhotic liver on T1-weighted MR images seen at serial MRI. MATERIALS AND METHODS: This study included 189 patients with cirrhosis, who underwent hepatic MRI more than twice with an interval of at least 12 months. The initial MR images were reviewed for the presence of small hyperintense lesions on T1-weighted images. The size, location and signal intensity on T2-weighted images as well as enhancement patterns of the corresponding lesions were recorded. RESULTS: On the initial T1-weighted MR images, 43 small hyperintense hepatic lesions were detected in 23 (12%) of 189 patients. Twelve (28%) of 43 lesions showed early enhancement and were pathologically diagnosed as hepatocellular carcinoma (HCC) during the follow-up period. Thirty-one (72%) of 43 lesions showed no early enhancement with various signal intensity on T2-weighted images (hyperintensity=4, isointensity=20, hypointensity=7). Among these 31 lesions, 12 showed no interval change, while 11 disappeared (n=10) or decreased in size (n=1). In the remaining eight lesions, seven were diagnosed as HCC on the basis of pathologic confirmation or the interval growth. CONCLUSION: Small hyperintense hepatic lesions on T1-weighted magnetic resonance (MR) images without early enhancement on the arterial-phase contrast-enhanced dynamic studies in patients with cirrhosis usually showed no interval growth or disappeared during the serial MRI. These lesions with additional findings of iso- or hypointensity on the T2-weighted MR images without "washout effect" on the contrast-enhanced equilibrium-phase images may more frequently be clinically benign or hyperplastic nodules than HCCs.