Christian Kremser

Tumor microcirculation and diffusion predict therapy outcome for primary rectal carcinoma

PURPOSE The aim of our study was to correlate perfusion indices and apparent diffusion coefficients with therapy outcome after chemoradiation. METHODS AND MATERIALS In 34 patients with primary rectal carcinoma (cT3) undergoing preoperative chemoradiation, pretherapeutic perfusion indices and apparent diffusion coefficients were obtained by dynamic or diffusion-weighted magnetic resonance imaging. Therapy response was defined if the pathologic observation revealed no invasion into the perirectal fat after chemoradiation. RESULTS In 18 patients, a response and in 16, no response was observed. Statistically significant differences were found for the mean perfusion index (p < 0.001; 7.5 +/- 1.5 mL/min/100 g vs. 10.7 +/- 2.7 mL/min/100 g) and for the intratumoral cumulative fraction of pixels with perfusion-indices > 12 mL/min/100 g (p < 0.001, 3.7 +/- 4.0% vs. 24.7 +/- 17.9%). A three-way ANOVA resulted in significant effects for therapy responder/nonresponder (p < 0.001) and for apparent diffusion coefficient and the individual patients. CONCLUSION Perfusion indices and apparent diffusion coefficients inside the tumor region seem to be of predictive value for therapy outcome of preoperative therapy in patients with primary rectal carcinoma. Higher parameter levels in the nonresponding group could be explained by increased shunt flow or increased angiogenic activity in aggressive tumor cell clusters resulting in reduced nutrients supply and higher fraction of intratumoral necrosis respectively.

Sex differences in brain activation pattern during a visuospatial cognitive task: a functional magnetic resonance imaging study in healthy volunteers

Sex differences in mental rotation tasks, favoring men, have been noted in behavioral studies and functional imaging studies. In the present study ten female and ten male volunteers underwent functional magnetic resonance imaging in a conventional block design. Regions of activation were detected after performance of a mental rotation task inside the scanner. In contrast to previous studies, confounding factors such as performance differences between genders or high error rates were excluded. Men showed significantly stronger parietal activation, while women showed significantly greater right frontal activation. Our results point to gender specific differences in the neuropsychological processes involved in mental rotation tasks.

Diffusion-weighted magnetic resonance imaging for monitoring diffusion changes in rectal carcinoma during combined, preoperative chemoradiation: preliminary results of a prospective study.

PURPOSE To evaluate the clinical value of diffusion-weighted magnetic resonance imaging (DW-MRI) to monitor response of primary carcinoma of the rectum to preoperative chemoradiation by measuring tumor apparent diffusion coefficient (ADC). MATERIALS AND METHODS Diffusion data of nine patients undergoing preoperative combined chemoradiation for clinical staged T3, N(0-2), M(0) carcinoma of the rectum were analyzed. Diffusion-weighted echo-planar MR images were obtained prior to and at specified intervals during chemoradiation and ADCs calculated from acquired tumor images. RESULTS Comparison of mean ADC and cumulative radiation dose showed a significant decrease of mean ADC at the 2nd (P = 0.028), 3rd (P = 0.012), and 4th (P = 0.008) weeks of treatment. Cytotoxic edema and fibrosis were considered as reasons for ADC decrease. CONCLUSION This study demonstrated tumor ADC changes via detection of therapy-induced alterations in tumor water mobility. Our results indicate that diffusion-weighted imaging may be a valuable clinical tool to diagnose the early stage of radiation-induced fibrosis.

Trace of diffusion tensor differentiates the Parkinson variant of multiple system atrophy and Parkinson's disease.

We have recently shown that diffusion-weighted magnetic resonance (MR) imaging (DWI) discriminates patients with the Parkinson variant of multiple system atrophy (MSA-P) from those with Parkinsons disease (PD) by regional apparent diffusion coefficients (rADC) in the putamen. Because rADCs measured in one direction may underestimate diffusion-related pathologic processes, we investigated the diffusivity in different brain areas by trace of diffusion tensor (Trace(D)) in a new cohort of patients with MSA-P and PD. We studied 11 MSA-P, 17 PD patients, and 10 healthy volunteers matched for age and disease duration. Regional ADCs in three orthogonal directions and Trace(D) values were determined in selected brain regions including the basal ganglia, gray matter, white matter, substantia nigra, and pons. MSA-P patients had significantly higher putaminal and pallidal rTrace(D) values as well as rADCs in y- and z-direction than both PD patients and healthy volunteers. Moreover, putaminal Trace(D) discriminated completely MSA-P from both PD and healthy volunteers. The rADCs in the y- and z-direction provided a complete or near complete separation. In conclusion, our study confirms the results of previous studies of our group that patients with MSA-P show an increased putaminal diffusivity due to neuronal loss and gliosis. Because rADCs in one direction are dependent on the slice orientation relative to the directions of fiber tracts, Trace(D) imaging appears to be more accurate in the separation of MSA-P from PD.

Model-based imaging of cardiac electrical excitation in humans

Activation time (AT) imaging from electrocardiographic (ECG) mapping data has been developing for several years. By coupling ECG mapping and three-dimensional (3-D) + time anatomical data, the electrical excitation sequence can be imaged completely noninvasively in the human heart. In this paper, a bidomain theory-based surface heart model AT imaging approach was applied to single-beat data of atrial and ventricular depolarization in two patients with structurally normal hearts. In both patients, the AT map was reconstructed from sinus and paced rhythm data. Pacing sites were the apex of the right ventricle and the coronary sinus (CS) ostium. For CS pacing, the reconstructed AT pattern on the endocardium of the right atrium was compared with the CARTO map in both patients. The localization errors of the origins of the initial endocardial breakthroughs were determined to be 6 and 12 mm. The sites of early activation and the areas with late activation were estimated with sufficient accuracy. The reconstructed sinus rhythm sequence was in good qualitative agreement with the pattern previously published for the isolated Langendorff-perfused human heart.

Imaging with a Terahertz quantum cascade laser.

We demonstrate bio-medical imaging using a Terahertz quantum cascade laser. This new optoelectronic source of coherent Terahertz radiation allows building a compact imaging system with a large dynamic range and high spatial resolution. We obtain images of a rat brain section at 3.4 THz. Distinct regions of brain tissue rich in fat, proteins, and fluid-filled cavities are resolved showing the high contrast of Terahertz radiation for biological tissue. These results suggest that continuous-wave Terahertz imaging with a carefully chosen wavelength can provide valuable data on samples of biological origin; these data appear complementary to those obtained from white-light images.

A developmental fMRI study of nonsymbolic numerical and spatial processing.

This functional magnetic resonance imaging (fMRI) study systematically investigates whether there is a neurofunctional overlap of nonsymbolic numerical and spatial cognition in (intra)parietal regions in children and adults. The study also explores the association between finger use and (nonsymbolic) number processing across development. Twenty-four healthy individuals (12 children, 12 adults) were asked to make nonsymbolic numerical and spatial (experimental tasks) as well as color discriminations (control task). Using identical stimulus material across the three tasks disentangled nonsymbolic number representations from general attentional mechanisms, visual-spatial processing and response selection requirements. In both age groups, behavioral distance effects were obtained upon processing numerical (but not spatial and/or color) stimuli. Baseline imaging effects revealed age-dependent, partly overlapping activations of nonsymbolic numerical and spatial processing in the right posterior superior parietal lobe (PSPL) in adults only. Interestingly, regions more activated in children relative to adults were centred on bilateral supramarginal gyrus (SMG) and lateral portions of the anterior intraparietal sulcus (IPS), further extending to adjacent right post- and precentral gyrus, the latter of which has been reported to support grasping previously (Simon et al., 2002). Overall, our results are first evidence for an age-dependent neurofunctional link between areas supporting finger use and nonsymbolic number processing and furthermore, might be suggestive of a special role of fingers for the development of number magnitude representations and early arithmetic.

Magnetic resonance imaging and cochlear implants: Compatibility and safety aspects†

With cochlear implants, magnetic resonance imaging (MRI) has until recently been contraindicated due to excessive magnetic and electromagnetic interference. The aim of this study was to determine the MRI compatibility of the Med‐El Combi 40/40+ cochlear implant, within a wide range of clinical MRI applications. In vitro experiments on a 1.5 T MR scanner were performed. Torque, force, demagnetization, artifacts, induced voltages, and temperature increase were measured in worst case scenarios for the implant. In addition, stabilization experiments were performed. It was shown that most of the electromagnetic interferences between the cochlear implant and the 1.5 T scanner remained within acceptable limits. One exception is the torque on the internal magnet, which represents a hazard for patients with these cochlear implants. Therefore, MRI examination should only be performed if there is a strong medical indication, and certainly some assessment of the relative risks involved versus the risk of not providing the diagnostic capabilities of MRI, will have to be made. Appropriate safety measures should be taken. J. Magn. Reson. Imaging 1999;9:26–38

Brain activation pattern during a verbal fluency test in healthy male and female volunteers: a functional magnetic resonance imaging study

Sex differences in executive speech tasks, favoring women, have been noted in behavioral studies and functional imaging studies. In the present study ten female and ten male volunteers underwent functional magnetic resonance imaging in a conventional block design. All subjects were selected on the basis of high performance on the verbal fluency task. Regions of activation were detected after performance of a covert lexical verbal fluency task inside the scanner. Men and women who did not differ significantly in verbal fluency task performance showed a very similar pattern of brain activation. Our data argue against genuine between-sex differences in cerebral activation patterns during lexical verbal fluency activities when confounding factors like performance differences are excluded.

Preliminary Results on the Influence of Chemoradiation on Apparent Diffusion Coefficients of Primary Rectal Carcinoma Measured by Magnetic Resonance Imaging

Purpose:To study changes of the apparent diffusion coefficient (ADC) measured by magnetic resonance imaging (MRI) in patients with primary rectal carcinoma during a course of combined chemoradiation.Patients and Methods:Diffusion-weighted echo-planar imaging at 1.5 T was performed in patients (n = 8) with primary rectal carcinoma (cT3) undergoing preoperative chemoradiation. Mean tumor ADC values and ADC histograms were determined and compared weekly during the course of therapy. Surgical resection of the tumors enabled a correlation of ADC values with the pathologic classification.Results:In four patients tumor T-downstaging (ypT0–2) was observed, and in four patients no downstaging (ypT3) was seen. In all patients, ADC values were higher before onset of chemoradiation therapy compared to the end of chemoradiation. Separating the patients into two groups, a significant increase in ADC value during week 1 of therapy, followed by a steady decrease, was found for the therapy-responder group. In the nonresponder group, no initial increase of ADC values was observed. After the 1st week of therapy, ADC values were significantly lower in the nonresponder group during the remaining duration of therapy.Conclusion:With these preliminary results it could be shown that MR diffusion imaging is able to detect individual changes of tumor ADC values during the course of combined chemoradiation reflecting biological changes within the tumor tissue. Further studies will be necessary to prove the possible value of totally noninvasive ADC imaging on predicting therapy outcome.Ziel:Untersuchung von Änderungen des mittels diffusionsgewichteter Magnetresonanztomographie (DMRT) gemessenen Diffusionskoeffizienten (ADC) in primären Rektumkarzinomen während kombinierter Radiochemotherapie.Patienten und Methodik:Diffusionsgewichtete echoplanare Bildgebung wurde an einem 1,5-T-MR-Gerät bei Patienten (n = 8) mit primären Rektumkarzinomen (cT3) während kombinierter Radiochemotherapie durchgeführt. Mittlere Tumor-ADC-Werte und ADC-Histogramme wurden im Verlauf der Therapie wöchentlich erfasst und verglichen. Die sich an die Therapie anschließende chirurgische Resektion des Tumors ermöglichte eine Korrelation der ADC-Werte mit der pathologischen Klassifikation.Ergebnisse:Bei vier Patienten wurde eine Verbesserung des Tumorstadiums (ypT0–2) beobachtet, und bei vier Patienten war keine Verbesserung des Tumorstadiums (ypT3) feststellbar. Zwischen Anfang und Ende der Therapie kam es bei allen Patienten zu einer signifikanten Abnahme der mittleren ADC-Werte. Für die Patientengruppe mit Verbesserung des Tumorstadiums wurde ein signifikanter Anstieg der ADC-Werte während der 1. Therapiewoche, gefolgt von einer stetigen Abnahme, beobachtet. Für die Patientengruppe ohne Verbesserung des Tumorstadiums wurde keine ADC-Zunahme während der 1. Therapiewoche festgestellt. Nach der 1. Therapiewoche waren die ADC-Werte für die Gruppe ohne Verbesserung des Tumorstadiums signifikant niedriger als für die Gruppe mit Verbesserung des Tumorstadiums.Schlussfolgerung:Diese vorläufigen Ergebnisse zeigen, dass die DMRT in der Lage ist, individuelle Änderungen der ADC-Werte, die biologische Veränderungen im Tumorgewebe widerspiegeln, während kombinierter Radiochemotherapie zu detektieren. Weitere Studien sind notwendig, um die mögliche Bedeutung der vollständig nichtinvasiven DMRT für die Vorhersage des Therapieergebnisses nachzuweisen.