E. William Akins

Assessment of left ventricular wall thickness in healed myocardial infarction by magnetic resonance imaging

The ability of magnetic resonance imaging (MRI) to detect and localize healed myocardial infarction (MI) was assessed. Seventeen consecutive patients with healed MI assessed by biplane contrast ventriculography underwent MRI using oblique imaging planes. Seven normal subjects underwent MRI as controls. In each patient, ventriculography identified regional wall motion abnormalities. MRI, performed with a 0.15-Tesla resistive magnet and oblique imaging planes relating to the left ventricle, detected zones of regional wall thinning conforming to the wall motion abnormalities localized by ventriculography in 16 patients. In these patients, adjacent areas of intact myocardium were identified in areas shown by ventriculography to be normal. The left ventricular wall thickness at the site of MI was significantly less than adjacent noninfarcted myocardium (p less than 0.001) and normal hearts (p less than 10(-6)). The ratio of the thickness of the infarct to adjacent normal wall averaged 0.40 (range 0.22 to 0.62). MRI could differentiate healed MI from adjacent noninfarcted myocardium and normal hearts.

Short-term Effects of Selective Renal Arterial Carbon Dioxide Administration on the Dog Kidney

PURPOSE The authors examined the nephrotoxicity of carbon dioxide injected directly into the renal arteries as an arterial contrast agent. MATERIALS AND METHODS Fourteen anesthetized dogs received selective renal infusions of CO2 ranging from a normal dose of 7 cm3/kg to high doses of 11-54 cm3/kg. Two dogs received conventional iodinated contrast media. The effects on renal function and histologic appearance were evaluated by means of radionuclide studies (iodine-131 iodohippurate sodium and technetium-99m dimercaptosuccinate) and histopathologic examination (light, transmission, and scanning electron microscopy). RESULTS Although there was a mean decrease in renal blood flow of 11.86% (standard error [SE], 7.1) immediately after the injection of CO2, flow had returned to baseline (0.17%; SE, 5.27) after 24 hours. Although the sample size was small, there was no dose-dependent effect of CO2 on renal function and histologic appearance. Mild histologic changes and one case of moderate acute tubular necrosis were seen only in cases in which the kidney was positioned vertically rather than laterally. CONCLUSION Although formal studies in patients are required, the results of this investigation suggest that CO2 may be a safe contrast agent and less nephrotoxic than existing contrast agents, providing care is taken to ensure that CO2 is not trapped in a vertically positioned kidney, as might occur in renal transplant recipients.

Importance of imaging plane for magnetic resonance imaging of the normal left ventricle

Visualization of the left ventricle by magnetic resonance imaging (MRI) is largely a function of imaging planes. The best depiction of the myocardium is possible when the imaging plane is perpendicular to the region of interest. The effect of imaging plane on the visualization of the left ventricle has not been fully described. To assess this effect, 10 normal adults underwent electrocardiogram-gated multiplanar cardiac MRI. The imaging planes being evaluated were standard planes, transverse, sagittal and coronal, and modified planes relating to the left ventricular (LV) long axis: coronal long axis parallel to the ventricular septum (VS), sagittal long axis perpendicular to the VS and transverse short axis perpendicular to the VS and long axis. The myocardium was separated into 9 segments. Using each plane, the LV segments were evaluated for quality of LV depiction. The planes based on the LV long axis were superior to standard planes in depicting the LV segments.

Evaluation of an aortic annular pseudoaneurysm by MRI: Comparison with echocardiography, angiography and surgery

Nuclear magnetic resonance imaging (MRI) was clinically useful in a case of aortic annular pseudoaneurysm complicating bacterial endocarditis. The MRI findings were proven by angiography and surgery. Although surgical correction was attempted, the aneurysm recurred and has been followed by MRI and two-dimensional echocardiography. In addition to two-dimensional echocardiography, MRI represents a useful noninvasive imaging method for diagnosis and follow up of aortic annular pseudoaneurysm.

Preoperative Evaluation of the Thoracic Aorta Using MRI and Angiography

The ability of ECG-gated magnetic resonance imaging (MRI) to evaluate disease of the thoracic aorta compared with angiography was prospectively assessed in 28 patients. MRI identified abnormalities in all patients, with confirmation at operation in 22 (79%) and by angiography alone in all 28. In 20 of the patients, MRI correctly diagnosed 20 of 21 aneurysms of the thoracic aorta (6 dissecting, 4 saccular, 10 fusiform), but 1 surgically proven fusiform aneurysm was categorized as an enlarged aortic dissection based on both MRI and angiographic findings. One dissection and 1 fusiform aneurysm were shown by MRI only. Coarctation of the aorta was identified in 4 patients. Ascending aortic enlargement and left ventricular hypertrophy were identified by MRI in 4 patients with aortic stenosis. In 7 patients (25%), MRI provided additional important information not shown by angiography and in 1 patient, the MRI findings resulted in a change in the surgical approach. In 14 of 28 patients (50%), angiography was necessary for definitive preoperative evaluation of the aortic valve, the coronary arteries, or the brachiocephalic vessels. MRI was a useful noninvasive supplement to angiography for the preoperative assessment of thoracic aortic disease.

Carbon dioxide as an angioscopic medium. Comparison to various methods of saline delivery.

The limitations of angiography, when it is used as the sole method of vascular assessment, are increasingly apparent as vascular intervention becomes more sophisticated. Angioscopy could be an adjunctive diagnostic modality by differentiating among thrombus, dissection, and atheroma, and by monitoring the response to therapy. However, angioscopy requires a blood-free field for adequate visibility, and this may be difficult to obtain. The feasibility of carbon dioxide (CO2) and various saline delivery methods for clarifying the viewing field for percutaneous angioscopy was investigated. Angioscopy of femoral and iliac arteries on nine dogs was performed. Saline was infused by hand injection, pressure bag infusion, or mechanical power injection, and CO2 gas was injected using a special gas injector. The clarity of the viewing field was graded for each medium and method. Excellent quality antegrade femoral angioscopy was obtained with CO2. The superiority of CO2 injection in comparison with power-injected saline approached statistical significance (P = .06). Power-injected CO2 and power saline were superior to hand-injected or pressure bag-injected saline for maintaining sufficient visibility. Retrograde iliac angioscopy was possible without inflow occlusion, but required high flow rates (only possible with power-injected saline or CO2). CO2 injected under controlled circumstances holds promise as a medium to improve angioscopic visibility.

Cross-coupled double loop receiver coil for NMR imaging of cardiac and thoraco-abdominal regions of the human body

An RF receiver coil structure for NMR imaging of cardiac and thoraco-abdominal regions of a human body. The coil structure includes a coil of generally solenoidal geometry having two turns separated by an inter-element gap. The inter-element gap is sufficiently large to accommodate an average human torso at the chest level (e.g. 25 cm). The turns are cross coupled by a pair of crossed diagonal elements. The coil is formed of a tubular conductor, having a tubular diameter (outside diameter) of approximately 1/2 inch. The coil has terminal ends in one of its diagonal elements, and the coil structure further includes a component unit located where the diagonal elements cross. The component unit includes a capacitor electrically connected to the coil to form a parallel resonant circuit. The same geometry may be employed in a multi-turn structure, where preferably one-half of the total number of turns are positioned above the patient, and the other half below the patient.

Button self-retaining drainage catheter

To help improve patient acceptance of long-term internal/external catheter access to the biliary tract in those with benign biliary obstruction, a simple design allows the catheter end to remain flush with the skin. It consists of a clothes button affixed to the drainage catheter with a wood screw after the catheter has been cut off at the skin exit. This button/screw device has been used successfully in 22 patients over the last 10 years; catheter exchanges were easily accomplished.

Magnetic resonance imaging late after tricuspid valvectomy

Abstract Triscupid valvectomy without replacement is the treatment of choice in patients with antibiotic-resistant bacterial endocarditis involving the tricuspid valve. 1 Removal of this valve causes hemodynamic changes that may result in massive venous distention and right-sided cardiac dilation. The case described herein shows the ability of magnetic resonance imaging (MRI) to accurately depict these changes in cardiovascular anatomy quantitatively.