Naoaki Yamada

A Pitfall in Ultrafast CT Scanning for the Detection of Left Atrial Thrombi

We studied 41 patients with mitral stenosis by ultrafast CT (UFCT) and transesophageal echocardiography to detect left atrial thrombi. Cardiac UFCT was performed twice after contrast medium injection to obtain early (during injection lasting 40-60 s) and late (approximately 5 min after beginning injection) phase images. There were 10 patients (24%) in whom a filling defect detected in the early phase disappeared in the late phase. The site of filling defects was the left atrial appendage in nine patients and the left atrium in one patient. All of the filling defects were in the ventral side of the left atrium. Furthermore, all of those patients had chronic atrial fibrillation. Transesophageal echocardiography revealed no thrombus in the area of the filling defect in the early phase. We believe that blood stasis existed in those patients. This finding leads to a false-positive result when only early phase images are obtained. The diagnosis of thrombi should be made only when a filling defect is observed in both phases. Late phase scanning is necessary in the diagnosis of left atrial thrombi.

Evaluation of the susceptibility effect on gradient echo phase images in vivo: a sequential study of intracerebral hematoma.

Susceptibility effect of intracerebral hematoma was estimated on the phase images of gradient echo (GrE). Thirty-five hematomas were studied 3 hr to 5 yr after the onset, a total of 72 times with use of phase and magnitude images of GrE, as well as T1-, T2-, and density-weighted spin-echo (SE) images at 1.5 T. On the basis of the theory of electromagnetism, phase shift to hematoma was calculated for simplified models with concentric distribution of paramagnetic susceptibility. All hematomas were well visualized by the phase images, the pattern of which changed sequentially. The distribution of paramagnetic susceptibility could be estimated by correlating the observed phase shifts with the calculated one. SE images were necessary to presume the type of magnetic substances. A probable hypothesis of the evolution of intracerebral hematoma is proposed.

Sequential MR signal change of the thrombus in the false lumen of thrombosed aortic dissection

The evolution of thrombus in the false lumen was investigated in 14 patients with thrombosed aortic dissection, by reviewing the findings acquired at a total of 21 magnetic resonance imaging (MRI) examinations performed between 2 and 146 days after the onset. On electrocardiographic gated 1.5-Tesla MRI, T1-(TR/TE = 860 +/- 190 ms/17-40 ms) and T2-(TR/TE = 1620 +/- 240 ms/70-80 ms) weighted spin echo and gradient echo images were obtained, and the signal intensity of the thrombus on these images was evaluated independently by two observers. The density of the thrombus was also evaluated using computed tomography (CT) images obtained at a total of 54 examinations. On both T1- and T2-weighted images, the thrombus showed signal iso- or hypointensity compared to that of skeletal muscle during the first several days after the onset and, thereafter, showed signal intensity similar to that of fat tissue. It is suggested that the low signal intensity of the thrombus observed during the initial period after the onset was caused by the presence of deoxyhemoglobin and the high intensity observed thereafter was caused by methemoglobin. Focal discrepancy of the signal intensities within two parts of the lumen on spin echo images was observed in 7 patients, and a low-intensity layer on the surface of the thrombus inside the false lumen was observed on gradient echo images in 5 of these 7 patients. This characteristic MR signal change of the thrombus in the false lumen of thrombosed aortic dissection provides useful information concerning the age of the thrombus and in the differential diagnosis of the thrombus from a mural thrombus of aortic aneurysm.

Magnetic resonance imaging of pericardial malignant mesothelioma

Magnetic resonance imaging of pericardial malignant mesothelioma in two patients is reported. Magnetic resonance imaging clearly depicted the tumor location and expansion, and was useful in delineating the anatomic extent of pericardial malignant mesothelioma.

Method for determining resolution power or discrimination capacity of an NMR imaging apparatus

A phantom for diagnosis by nuclear magnetic resonance imaging comprises a container made of a synthetic resin and a hydrogel sealingly contained in the container. The container has at least one opening into which a sample material is inserted. The hydrogel is prepared by charging an aqueous solution of a polyvinyl alcohol into the container, cooling the aqueous solution to minus 10°C. or lower to obtain a cooled frozen mass and thawing the cooled frozen mass. Also disclosed is a method for determining resolution power or discrimination capacity of an NMR imaging apparatus.