B Kramann

Athlete's Heart Right and Left Ventricular Mass and Function in Male Endurance Athletes and Untrained Individuals Determined by Magnetic Resonance Imaging

OBJECTIVES Athletes heart represents a structural and functional adaptation to regular endurance exercise. BACKGROUND While left ventricular (LV) hypertrophy of the athletes heart has been examined in many studies, the extent of right ventricular (RV) hypertrophy is still uncertain because of its complex shape and trabecular structure. To examine RV hypertrophy, we used magnetic resonance imaging (MRI) and hypothesized that athletes heart is characterized by similar LV and RV hypertrophy. METHODS The LV and RV mass, volume, and function in 21 male endurance athletes (A) (27 +/- 4 years; 70 +/- 8 kg; 178 +/- 7 cm; maximal oxygen uptake [VO(2)max]: 68 +/- 5 ml/min per kg) and 21 pair-matched untrained control subjects (C) (26 +/- 3 years; 71 +/- 9 kg; 178 +/- 6 cm; VO(2)max: 42 +/- 6 ml/min per kg) were analyzed by MRI (Magnetom Vision 1.5T, Siemens, Erlangen, Germany). RESULTS Left ventricular masses: (A: 200 +/- 20 g; C: 148 +/- 17 g) and RV masses (A: 77 +/- 10 g; C: 56 +/- 8 g) differed significantly between the groups (p < 0.001). The LV and RV end-diastolic volumes (EDV) (LV-EDV 167 +/- 28 ml [A]; 125 +/- 16 ml [C]; RV-EDV 160 +/- 26 ml [A]; 128 +/- 10 ml [C]), and stroke volumes (SV) (LV-SV: 99 +/- 18 ml [A], 74 +/- 11 ml [C]; RV-SV: 102 +/- 18 ml [A], 79 +/- 8 ml [C]) were significantly different between the athletes and control subjects (p < 0.001), whereas ejection fractions (EF) (LV-EF: 59 +/- 3% [A]; 59 +/- 6% [C]; RV-EF: 63 +/- 3% [A], 62 +/- 3% [C]) and LV-to-RV ratios were similar for both groups (LV-to-RV mass: 2.6 +/- 0.2 [A], 2.6 +/- 0.3 [C]; LV-to-RV EDV: 1.05 +/- 0.14 [A], 0.99 +/- 0.14 [C]; LV-to-RV SV: 0.98 +/- 0.17 [A], 0.95 +/- 0.17 [C]; LV-to-RV EF: 0.93 +/- 0.07 [A], 0.96 +/- 0.10 [C]). CONCLUSIONS Regular and extensive endurance training results in similar changes in LV and RV mass, volume, and function in endurance athletes. This leads to the conclusion that the athletes heart is a balanced enlarged heart.

Lymphangioma of the pancreas and the duodenal wall: MR imaging findings

Abstract. Pancreatic lymphangiomas are rare benign tumours with a histogenesis not yet completely understood. Predominantly the cystic aspect of this lesion can complicate the differentiation from other neoplastic and non-neoplastic cystic tumours of the pancreas. We present a case of a middle-aged woman with a lymphangioma involving the duodenal wall and the pancreatic head. With special regard to MR imaging findings differential diagnosis is discussed.

Rare pseudotumors of the urinary bladder in childhood

Abstract We report two cases of inflammatory pseudotumors of the urinary bladder, one case of a chronic granulomatous pseudotumor (CGT) and one case of a pseudosarcomatous myofibroblastic (fibromyxoid) tumor (PMT). Both tumors resembled malignancies such as rhabdomyosarcomas regarding clinical appearance and imaging findings and represent rare urinary bladder tumors. The imaging findings on unenhanced and contrast-enhanced MRI as well as histological specimen are presented. Final diagnosis was made following elective surgery. Differential diagnosis of urinary bladder tumors as well as the imaging findings of these clinically comparable cases are discussed. Awareness of these benign lesions may prevent patients from inappropriate therapies such as chemotherapy or radiation therapy.

Littoral cell angioma of the spleen: CT and MR imaging appearance

Abstract. We report a case of littoral cell angioma (LCA) of the spleen, a recently described splenic pathology, which imaging characteristics and pathologic morphology have been discussed only by a few authors. The imaging findings in unenhanced and contrast-enhanced MRI and CT as well as histologic specimen are presented. Diagnosis was made after elective splenectomy. Differential diagnosis of splenic tumors as well as the imaging findings in this particular case are discussed.

Arterial embolization of a secondary aneurysmatic bone cyst of the thoracic spine prior to surgical excision in a 15-year-old girl

We report on a 15-year-old girl with a secondary aneurysmatic bone cyst of the thoracic spine with extension into the spinal canal on the basis of an osteoblastoma. Surgical treatment was facilitated by preoperative embolization of the highly-vascular tumor. Excision of the tumor was performed without extensive intraoperative blood loss. Following excision, transpedicular-stabilization of the spinal column was achieved using a fixateur intern. We conclude that superselective embolization of benign lesions of the spinal column constitutes a feasible means of reducing intraoperative bleeding complications, thus enhancing resectability.

Vergleich echokardiographischer Methoden zur linksventrikulären Muskelmassenbestimmung mit der MRT bei Ausdauerathleten mit Sportherz und Untrainierten

The echocardiographic determination of left ventricular mass (LVM) and volume is of importance for the interpretation of cardiac adaptions and risk-stratification. In pathologically hypertrophied hearts, conventional one- and two-dimensional echocardiographic methods tend to overestimate LVM. For the athlete’s heart, a comparison between different echocardiographic methods and magnetic resonance imaging (MRI) has not been performed so far. 23 healthy male endurance-athletes (28±4yr) with athlete’s heart (A) and 26 healthy untrained males (U; 26±4 yr) were examined by MRI and the following echocardiographic methods: ASE-Cube (ASE), Devereux (DEV), Troy (TRO), Teichholz (TEI), Reichek (REI) and Dickhuth (DIC). Indexed LVM were: MRI: 107±6g/m2 (A), 79±7g/m2 (U); ASE: 170±20g/m2 (A), 119±14 g/m2 (U); DEV: 134±16g/m2 (A), 95±11g/m2 (U); TRO: 134±16 g/m2 (A), 92±12g/m2 (U); TEI: 115±10g/m2 (A), 91±8g/m2 (U); REI: 114±14g/m2 (A), 89±11 g/m2 (U); DIC: 110±14g/m2 (A); 80±9g/m2 (U). In A and U, LVM is significantly overestimated by ASE, DEV, TRO, TEI, and REI compared to MRI (p<0.05), but not by DIC. Although coefficients of correlation were similar, only DIC revealed acceptable limits of agreement (ASE: +20 to +172g; DEV: –13 to +93g; TRO: –18 to +92g; TEI: –17 to +53g; REI: –25 to +57g; DIC: –37 to +45g). Depending on the used method, LVM upper limits range between 93 (MRT) and 146g/m2 (ASE) in U, and 119 (MRT) and 209g/m2 (ASE) in A. Conclusion Compared to MRI, DIC is the most accurate conventional echocardiographic method to determine LVM in U and A. For a correct interpretation of LVM, differences of the echocardiographic methods have to be considered. Die echokardiographische Bestimmung linksventrikulärer Muskelmassen (LVM) und Volumina ist zur Beurteilung kardialer Adaptationsmechanismen und Risikostratifizierung von wesentlicher Bedeutung. Allerdings neigen die üblicherweise angewandten ein- und zweidimensionalen Verfahren bei krankhaft hypertrophierten Herzen zur Überschätzung der LVM. Für physiologisch hypertrophierte Herzen liegt bisher noch keine vergleichende Untersuchung der unterschiedlichen echokardiographischen Bestimmungsmethoden mit der Referenzmethode Magnetresonanztomographie (MRT) vor. An 23 gesunden männlichen Ausdauerathleten mit Sportherz (A; 28±4 Jahre) sowie 26 gesunden männlichen Untrainierten (U; 26±4 Jahre) wurde die LVM mittels MRT und folgenden echokardiographischen Methoden bestimmt: ASE-Cube (ASE), Devereux (DEV), Troy (TRO) Teichholz (TEI), Reichek (REI) und Dickhuth (DIC). Die auf die Körperoberfläche bezogenen LVM betrugen: MRT: 107±6g/m2 (A), 79±7g/m2 (U); ASE: 170±20g/m2 (A), 119±14g/m2 (U); DEV: 134±16g/m2 (A), 95±11g/m2 (U); TRO: 134±16g/m2 (A), 92±12g/m2 (U); TEI: 115±10 g/m2 (A), 91±8g/m2 (U); REI: 114±14g/m2 (A), 89±11g/m2 (U); DIC: 110±14g/m2 (A); 80±9g/m2 (U). Bei A und U wird die kernspintomographische LVM durch ASE, DEV, TRO, TEI und REI im Gegensatz zu DIC signifikant überschätzt (p<0,05). Trotz ähnlicher Korrelationskoeffizienten liegen die Übereinstimmungsgrenzen der Analyse nach Bland und Altman nur für DIC in einem akzeptablen Bereich (ASE: +20 bis +172g; DEV: –13 bis +93g; TRO: –18 bis +92g; TEI: –17 bis +53g; REI: –25 bis +57g; DIC: –37 bis +45g). Die oberen Grenzwerte liegen je nach Methode für U zwischen 93 (MRT) und 146g/m2 (ASE), für A zwischen 119 (MRT) und 209g/m2 (ASE). Schlussfolgernd ist die Methode nach DIC, gemessen an der Referenzmethode MRT, bei U und A die genaueste konventionelle echokardiographische Methode zur LVM-Bestimmung. Um die LVM zuverlässig zu interpretieren, müssen die Werte stets im Kontext der jeweiligen echokardiographischen Methode betrachtet werden.

In vivo microscopic evaluation of the microvascular behavior of FITC-labeled macromolecular MR contrast agents in the hamster skinfold chamber.

Schneider G, Seidel R, Uder M, Wagner D, Weinmann HJ, Kramann B. In vivo microscopic evaluation of the microvascular behavior of FITC-labeled macromolecular MR contrast agents in the hamster skinfold chamber. Invest Radiol 2000;35:564–570. RATIONALE AND OBJECTIVES.The extravasation properties of two macromolecular MR imaging contrast media (CM) in relation to structural differences of the terminal vascular bed were investigated to determine whether differentiation between normal (physiological) and tumor (pathological) tissue can be achieved by means of extravasation characteristics. METHODS.Gd-DTPA-polylysine (50 kD, CM1) and Gd-DOTA cascade polymer (Gadomer 17; 20 kD, CM2) were labeled with fluorescein isothiocyanate (FITC) to enable in vivo fluorescence microscopy of the microcirculation. After implantation of a dorsal skinfold chamber and 7 days (range, 6–8) after induction of an amelanotic melanoma (A-Mel-3), 14 male hamsters weighing 85 g (range, 70–95 g) received 200 &mgr;mol/kg of CM1 by intravenous injection into the jugular vein. CM2 was similarly investigated after an interval of 24 hours. Fluorescence microscopy was performed in areas of subcutaneous tissue, striated muscle, and tumor tissue. Microscopic images were registered by a charge-coupled-device video camera and transferred to a video system. Distribution intensities of CM were evaluated on a digitally based measurement system. A control investigation was performed with FITC-dextran (150 kD). RESULTS.Gd-DTPA-polylysine showed no extravasation into physiological tissue for the first 10 minutes after injection. After this period, however, the first signs of leakage became apparent. Gd-DOTA cascade polymer was extravasated after 5 minutes into the tumor-free tissue. In tumor capillaries, Gd-DTPA-polylysine could be detected in the extravasal space as well as in physiological tissue after 15 minutes. After injection of Gd-DOTA cascade polymer, direct leakage from tumor capillaries was observed, with a contrast maximum between tumor and surrounding tissue occurring 3 to 5 minutes after CM injection. Good delineation of tumor vascularization from striated muscle and subcutaneous tissue was achieved. CONCLUSIONS.The CM studied showed different microvascular permeation properties. Faster leakage of Gd-DOTA cascade polymer was observed in areas with neoplastic tumor vessels, whereas extravasation in physiological tissue was detected after a period of 5 minutes. Gd-DTPA-polylysine demonstrated nonspecific leakage at later time points.

Inflammatory pseudotumor of the liver in a patient with congenital granulocytopenia and HCV infection.

Inflammatory pseudotumor (IPT) of the liver is a rare pathologic lesion. Although IPTs within the liver shows spontaneous regression, these lesions are frequently misdiagnosed as malignant on the basis of the clinical manifestation and the results of diagnostic imaging. With special regard to magnetic resonance imaging (MRI), differential diagnosis such as hepatocellular or cholangiocellular carcinoma (HCC/CCC) as well as regenerative liver lesions are discussed in a case of IPT with concomitant hepatitis C virus (HCV) infection and congenital granulocytopenia.

Nonionic contrast media iohexol and iomeprol decrease renal arterial tone. Comparative studies on human and porcine isolated vascular segments

Uder M, Humke U, Pahl M, et al. The nonionic contrast media iohexol and iomeprol decrease renal arterial tone: Comparative studies on human and porcine isolated vascular segments. Invest Radiol 2002;37:440–447. rationale and objectives. The vasoconstriction of the renal arteries is frequently considered as a crucial factor for radiocontrast-induced nephropathy. A direct effect of iodinated radiographic contrast medium (RCM) on vascular smooth muscle is supposed to be one component of the vascular response. We studied the effect of the nonionic RCM iomeprol and iohexol on the tonus of isolated human and porcine renal arteries in vitro. methods. In an organ bath renal arterial rings, uncontracted or precontracted by 10 &mgr;mol/L phenylephrine were incubated with increasing concentrations (15–103 mg iodine/mL) of iohexol, iomeprol, and mannitol solution isoosmolar to the contrast media. In a part of the preparations the endothelium was destroyed. Human vessels were obtained from tumor nephrectomy specimens of 10 patients. results. In human experiments iomeprol and iohexol (P < 0.05) relaxed renal arterial rings whereas mannitol produced concentration-dependent contractions. The relaxation by both contrast media was slightly attenuated upon increasing their concentration. The differences between mannitol solutions and RCM were statistically significant (P < 0.001) at concentrations of 57 mg iodine/mL and higher. Precontracted rings were significantly stronger relaxed by the RCM compared with mannitol (P < 0.001). The contrast medium induced relaxation did not depend on the presence of an intact endothelium (P > 0.05). Experiments with renal arterial segments prepared from swine showed similar results, with stronger relaxations than the human preparations. conclusion. Iomeprol and iohexol relaxed isolated renal arterial segments. These observations are in contradiction with the hypothesis that contrast media induce nephropathy by a direct vasoconstrictive effect on vascular smooth muscle. They do not exclude, however, a reduction of renal blood flow by other factors like liberation of hormones.

Enhanced Flow Velocity after Stenting of Renal Arteries Is Associated with Decreased Renal Function

Background: Atherosclerotic renal artery stenosis (RAS) is frequently treated by angioplasty and stent placement. Duplex sonography is an established noninvasive technique for patient follow-up. There is lack of evidence that routine monitoring of asymptomatic patients with stable blood pressure is needed. Methods: Renal duplex sonography was performed in 64 patients who had received percutaneous angioplasty and stenting of an atherosclerotic RAS. Duplex sonographic diagnosis was made by a combination of direct flow measurement in the renal artery and evaluation of intrarenal resistive indices. Renal function was determined by serum creatinine and calculated glomerular filtration rate (GFR). Results: With a mean follow-up of 28 months after angioplasty, a flow velocity of >2.0 m/s was detected within the stented arteries in 11/64 patients. While the initial blood pressure and GFR as well as the influence of angioplasty on these parameters were not different, the decrease in renal function over time was significantly higher in patients with flow enhancement (annual GFR decrease, 8.0 ml/min vs. 0.8 ml/min; p < 0.05). Conclusion: Follow-up duplex sonography in patients after renal artery stenting detected an unexpectedly high rate of in-stent restenosis associated with enhanced loss of renal function. Routine duplex sonographic follow-up may detect patients at risk of more rapidly declining renal function.