Janet E. Kuhlman

Evaluation of Structure-Function Relationships in Asthma using Multidetector CT and Hyperpolarized He-3 MRI

RATIONALE AND OBJECTIVESnAlthough multiple detector computed tomography (MDCT) and hyperpolarized gas magnetic resonance imaging (HP MRI) have demonstrated ability to detect structural and ventilation abnormalities in asthma, few studies have sought to exploit or cross-validate the regional information provided by these techniques. The purpose of this work is to assess regional disease in asthma by evaluating the association of sites of ventilation defect on HP MRI with other regional markers of airway disease, including air trapping on MDCT and inflammatory markers on bronchoscopy.nnnMATERIALS AND METHODSnBoth HP MRI using helium-3 and MDCT were acquired in the same patients. Supervised segmentation of the lung lobes on MRI and MDCT facilitated regional comparisons of ventilation abnormalities in the lung parenchyma. The percentage of spatial overlap was evaluated between regions of ventilation defect on HP MRI and hyperlucency on MDCT to determine associations between obstruction and likely regions of gas trapping. Similarly, lung lobes with high defect volume were compared to lobes with low defect volume for differences in inflammatory cell number and percentage using bronchoscopic assessment.nnnRESULTSnThere was significant overlap between sites of ventilation defect on HP MRI and hyperlucency on MDCT suggesting that sites of airway obstruction and air trapping are associated in asthma. The percent (r=0.68; P= .0039) and absolute (r=0.61; P= .0125) number of neutrophils on bronchoalveolar lavage for the sampled lung lobe also directly correlated with increased defect volume.nnnCONCLUSIONSnThese results show promise for using image guidance to assess specific regions of ventilation defect or air trapping in heterogeneous obstructive lung diseases such as asthma.

Imaging of lung ventilation and respiratory dynamics in a single ventilation cycle using hyperpolarized He‐3 MRI

To image respiratory dynamics and three‐dimensional (3D) ventilation during inhalation, breath‐hold, and exhalation for evaluation of obstructive lung disease using a single dose of hyperpolarized (HP) He‐3 during MRI.

A multisite phase iii study of the safety and efficacy of a new manganese chloride-based gastrointestinal contrast agent for mri of the abdomen and pelvis

The purpose of this study was to evaluate the safety and efficacy of a manganese chloride‐based oral magnetic resonance (MR) contrast agent during a Phase III multisite clinical trial. Two hundred seventeen patients were enrolled who were already scheduled for MRI of the abdomen and/or pelvis. In this group of patients, it was postulated that the use of an oral agent would better allow discrimination of pathology from bowel. Patients with known gastrointestinal pathology including peptic ulcer disease, inflammatory bowel disease, obstruction, or perforation were excluded to minimize confounding variables that could affect the safety assessment. Of these 217 patients, 18 received up to 900 mL of placebo, and 199 patients were given up to 900 mL of a manganese chloride‐based oral contrast agent, LumenHance® (Bracco Diagnostics, Inc.). Safety was determined by comparing pre‐ and post‐dose physical examinations, vital signs, and laboratory examinations and by documenting adverse events. Efficacy was assessed by unblinded site investigators and two blinded reviewers who compared pre‐ and post‐dose T1‐ and T2‐weighted MRI scans of the abdomen and/or pelvis. In 111 (57%) of the 195 cases evaluated for efficacy by site investigators (unblinded readers), MRI after LumenHance provided additional diagnostic information. Increased information was found by two blinded readers in 52% and 51% of patients, respectively. In 44/195 cases (23%) unblinded readers felt the additional information would have changed patient diagnosis and in 50 patients (26%), it would have changed management and/or therapy. Potential changes in patient diagnosis or management/therapy were seen by the two blinded readers in 8–20% of patients. No clinically significant post‐dose laboratory changes were seen. Forty‐eight patients (24%) receiving LumenHance and four patients (22%) receiving placebo experienced one or more adverse events. Gastrointestinal tract side effects were most common, seen in 29 (15%) of LumenHance patients and in 3 (17%) of the placebo patients. LumenHance is a safe and efficacious oral gastrointestinal contrast agent for MRI of the abdomen and pelvis.J. Magn. Reson. Imaging 1999;10:15–24.

Imaging pulmonary disease in AIDS: state of the Art

Abstract. The spectrum of pulmonary diseases in AIDS including infections and neoplasms that affect the lungs are reviewed. Characteristic plain film and CT findings are illustrated.

Bone metastasis from breast carcinoma with fluid-fluid level

A 75-year-old woman presented with pain and swelling of the right knee. She had a history of right breast carcinoma treated by radial mastectomy in 1981. Bone metastasis was diagnosed in 1986 at the proximal right humerus and distal right femur, for which external radiation was performed. The patient’s clinical course was uneventful for 7 years until her present admission. The physical examination found a palpable mass in the superior aspect of the right popliteal fossa. The results of all laboratory tests were normal. Bone scintigraphy revealed increased radiotracer uptake at the proximal right humerus and distal femur. Plain radiographs showed a lytic humeral lesion and a ‘‘bubbly’’ metaepiphyseal femoral tumor measuring 6×4×4 cm. The femoral lesion was characterized by internal septated trabeculation with expanded cortex. There was no mineralized matrix (Fig. 1). Earlier radiographs performed at an outside institution were unfortunately not available for comparison. Magnetic resonance (MR) imaging (Signa, General Electric, 189

Localized benign pleural mesothelioma arising in a radiation field

Localized benign pleural mesothelioma is a rare neoplasm representing less than 5% of all pleural tumors. Unlike the malignant diffuse pleural mesothelioma, there is no evidence of a relationship to asbestos exposure. Essentially, the cause of localized benign pleural mesotheliomas remains obscure. We propose that one mechanism of the development of this tumor is prior ionizing radiation to the tumor field. Ionizing radiation is a well-known human oncogen and leads to an increased incidence of benign tumors as well. A 65-year-old woman had a localized benign pleural mesothelioma of her left upper chest 22 years following adjuvant radiation therapy to the left breast and axillary region for a breast carcinoma.

Arterio-esophageal communication from a ruptured aberrant right subclavian artery aneurysm:Ct diagnosis

We report the computed tomography (CT) findings of an arterio-esophageal communication from an aberrant right subclavian artery aneurysm which had eroded into the esophagus. Pathologic correlation is provided. To our knowledge, this is the first CT demonstration of an aberrant right subclavian aneurysm causing a communication to the esophagus reported in the literature. Previously, one CT case of a left aberrant subclavian artery aneurysm that had ruptured into the esophagus, had been described. The characteristic location of the aberrant vessel with aneurysmal dilation and the presence of abnormal air identified within the wall of the aneurysm on CT, helped establish the diagnosis antemortem.