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At least 91 records · Page 5

MO-FG-CAMPUS-JeP2-01: 4D-MRI with 3D Radial Sampling and Self-Gating-Based K-Space Sorting: Image Quality Improvement by Slab-Selective Excitation

Purpose: A recent 4D MRI technique based on 3D radial sampling and self-gating-based K-space sorting has shown promising results in characterizing respiratory motion. However due to continuous acquisition and potentially drastic k-space undersampling resultant images could suffer from low blood-to-tissue contrast and streaking artifacts. In this study 3D radial sampling with slab-selective excitation (SS) was proposed in attempt to enhance blood-to-tissue contrast by exploiting the in-flow effect and to suppress the excess signal from the peripheral structures particularly in the superior-inferior direction. The feasibility of improving image quality by using this approach was investigated through a comparison with the previously developed non-selective excitation (NS) approach. Methods: Two excitation approaches SS and NS were compared in 5 cancer patients (1 lung 1 liver 2 pancreas and 1 esophagus) at 3Tesla. Image artifact was assessed in all patients on a 4-point scale (0: poor; 3: excellent). Signal-tonoise ratio (SNR) of the blood vessel (aorta) at the center of field-of-view and its nearby tissue were measured in 3 of the 5 patients (1 liver 2 pancreas) and blood-to-tissue contrast-to-noise ratio (CNR) were then determined. Results: Compared with NS the image quality of SS was visually improved with overall higher signal in all patients (2.6±0.55 vs. 3.4±0.55). SS showed an approximately 2-fold increase of SNR in the blood (aorta: 16.39±1.95 vs. 32.19±7.93) and slight increase in the surrounding tissue (liver/pancreas: 16.91±1.82 vs. 22.31±3.03). As a result the blood-totissue CNR was dramatically higher in the SS method (1.20±1.20 vs. 9.87±6.67). Conclusion: The proposed 3D radial sampling with slabselective excitation allows for reduced image artifact and improved blood SNR and blood-to-tissue CNR. The success of this technique could potentially benefit patients with cancerous tumors that have invaded the surrounding blood vessels where radiation therapy is needed to remove tumor from those regions prior to surgical resection. This work is partially supported by NIH R03CA173273; and CTSI core voucher award.

60 APPLIED LIFE SCIENCES↗

WE-AB-207B-01: Dose Tolerance for SBRT/SABR

Purpose: Stereotactic body radiation therapy (SBRT) / stereotactic ablative body radiotherapy (SABR) is gaining popularity, but quantitative dose tolerance has still been lacking. To improve this, the April 2016 issue of Seminars in Radiation Oncology will have normal tissue complication probability (NTCP) models for 10 critical structures: optic pathway, cochlea, oral mucosa, esophagus, chestwall, aorta, bronchi, duodenum, small bowel, and spinal cord. Methods: The project included more than 1500 treatments in 1–5 fractions using CyberKnife, Gamma Knife, or LINAC, with 60 authors from 15 institutions. NTCP models were constructed from the 97 grade 2–3 complications, predominantly scored using the common terminology criteria for adverse events (CTCAEv4). Dose volume histogram (DVH) data from each institutional dataset was loaded into the DVH Evaluator software (DiversiLabs, LLC, Huntingdon Valley, Pa) for modeling. The current state of the literature for the critical structures was depicted using DVH Risk Maps: comparative graphs of dose tolerance limits that can include estimated risk levels, reported complications, DVH data for study patients, as well as high- and low-risk dose tolerance limits. Results: For relatively acceptable toxicity like grade 1–3 rib fractures and chestwall pain, the high-risk limits have 50% risk and the low-risk limits have 5% risk. Emami et al (IJROBP 1991 May 15;21(1):109–22) used 50% and 5% risk levels for all structures, whereas this effort used clinically acceptable ranges for each: in structures like aorta or spinal cord where complications must be avoided, the high- and low-risk limits have about 3% and 1% risk, respectively, in this issue of Seminars. These statistically based guidelines can help ensure plan quality for each patient. Conclusion: NTCP for SBRT is now becoming available. Hypofractionated dose tolerance can be dramatically different than extrapolations of conventional fractionation so NTCP analysis of the SBRT/SBRT data is important to ensure safe clinical practice. Dr. Grimm, designed and holds intellectual property rights to the DVH Evaluator software tool which is an FDA-cleared product in commercial use, and was used to analyze the data.

60 APPLIED LIFE SCIENCES↗

Changes in mesenteric, renal, and aortic flows with +Gx acceleration

Previous studies in man and dogs have indicated that the splanchnic bed might contribute to the maintenance of arterial pressure during +Gx acceleration. Eight mongrel dogs were chronically instrumented with Doppler flow probes around the superior mesenteric (SMA) and renal arteries (RA) as well as the terminal aorta (TA). A solid-state pressure transducer was placed in the aorta distal to the flow probe. Using alpha-chloralose anesthesia following a 2-4 week recovery period, the animals were subjected to 120 sec at levels of 5, 10 and 15 +Gx acceleration on a 7.6-m radius centrifuge. The results indicate that both an active component and a mechanical component contribute to the maintenance of arterial pressure during +Gx acceleration.

Stone, H. L.↗

Content of lipids in blood and tissues of animals during hypodynamia

Experiments on 97 rats and 50 rabbits were undertaken to study the influence of hypodynamia on the lipid content in the blood, liver, heart, and in the aorta. Reduction of muscular activity contributed to the increase of cholesterol and beta lipoprotein levels in the blood and to accumulation of cholesterol in the liver and the heart. The total lipid content in these tissues decreased. In the aorta the total lipid content increased, while lecithin and cephalin figures went down. The character of biochemical changes in hypodynamia resembles in many ways the lipid metabolism changes in atherosclerosis.

Federov, I. V.↗

Effects of hypodynamia on the hemocoagulative properties of the vascular wall and myocardium

The hemocoagulative properties of the aorta (laminar), myocardium, hollow veins, and fibrinolytic capacity of tissues were studied in 14 rabbits subjected to 7 days of restricted mobility and compared to those of 10 control animals. Two tables of results show that, as a result of hypodynamia, the thromboplastic activity of the inner and middle layers of the aorta together with the destruction of endothelium increases the hemocoagulative potential and creates the threat of thrombogenesis. There is also an increase in fibrin-stabilizing activity for all tissues.

Inchina, V. I.↗

Noninvasive aortic bloodflow by Pulsed Doppler Echocardiography (PDE) compared to cardiac output by the direct Fick procedure

Left ventricular stroke volume was estimated from the systolic velocity integral in the ascending aorta by pulsed Doppler Echocardiography (PDE) and the cross sectional area of the aorta estimated by M mode echocardiography on 15 patients with coronary disease undergoing right catheterization for diagnostic purposes. Cardiac output was calculated from stroke volume and heart volume using the PDE method as well as the Fick procedure for comparison. The mean value for the cardiac output via the PDE method (4.42 L/min) was only 6% lower than for the cardiac output obtained from the Fick procedure (4.69 L/min) and the correlation between the two methods was excellent (r=0.967, p less than .01). The good agreement between the two methods demonstrates that the PDE technique offers a reliable noninvasive alternative for estimating cardiac output, requiring no active cooperation by the subject. It was concluded that the Doppler method is superior to the Fick method in that it provides beat by beat information on cardiac performance.

Source record↗

Beat by beat stroke volume assessment by PDE in upright and supine exercise

A 3.0 MHz pulse Doppler echocardiograph was used to estimate instantaneous stroke volume and cardiac output in 8 men during steady state supine and upright exercise at 300 kpm/min which were compared with other studies utilizing invasive procedures. The mean transients in heart rate and stroke volume and cardiac output for the first 20 sec of exercise in each posture were then determined. Centerline blood velocities were obtained in the ascending aorta with the transducer positioned manually in the suprasternal notch. Mean supine values for stroke volume and cardiac output at rest and exercise were 111 (6.4) and 112 ml (9.7 L/min), respectively, for supine. The corresponding results for upright were 76 (5.6) and 92 ml (8.4 L/min). These values compare favorably with prior studies. The transient response of cardiac output following the onset of upright was about twice as fast as in S because of the rapid and almost immediate upsurge in stroke volume. In supine, only heart rate served to augment cardiac output as stroke volume initially fell. The faster initial aortic flow in upright must represent the rapid mobilization of pooled venous blood from the leg veins which more than accounts for the additional volume (184 ml) of blood passing through the aorta during upright compared with supine in the first 20 sec.

Source record↗

Beat-by-beat stroke volume assessment by pulsed Doppler in upright and supine exercise

The instantaneous stroke volume (SV) and cardiac output (Q) in eight male subjects during steady-state supine (S) and upright (U) exercises at 300 kpm/min is assessed by a 3.0-MHz pulsed Doppler echocardiograph. The mean transients in heart rate (HR), SV, and Q for each posture were determined and the center-line blood velocities obtained in the ascending aorta. Results show that the mean supine values for SV and Q at rest and exercise were 111 ml and 6.4 l/min and 112 ml and 9.7 l/min, respectively. The corresponding results for U were 76 ml and 5.6 l/min and 92 ml and 8.4 l/min, respectively. The values compare favorably with previous studies utilizing invasive procedures. The transient response of Q following the onset of exercise in U was about twice as fast as in S because of the rapid and almost immediate upsurge in SV. The faster rise in aortic flow in U with exercise represented and additional volume (184 ml) of blood passing through the aorta compared with S in the first 20 exercises. It is suggested that the rapid mobilization of pooled venous blood from the leg veins during U was responsible for the increased blood flow.

Loeppky, J. A.↗

Effect of the Trendelenburg position on the distribution of arterial air emboli in dogs

The effect of Trendelenburg position (TP) on the distribution of arterial air emboli in dogs was examined in a two-part investigation. In the first part, the effects of the bubble size and the vessel angle on the bubble velocity and the direction of flow were investigated in vitro, using a simulated carotid artery preparation. It was found that larger bubbles increased in velocity in the same direction as the blood flow at 0-, 10-, and 30-deg vessel angles, and decreased when the vessel was positioned at 90 deg. Smaller bubbles did not change velocity from 0 to 30 deg, but acted to increase the velocity, in the same direction as the flood flow, at 90 deg. The second series of experiments examined the effect of 0 to 30 deg TP on carotid-artery distribution of gas bubbles injected into the left ventricle or ascending aorta of anesthetized dogs. It was found that, regardless of the degree of the TP, the bubbles passed into the carotid artery simultaneously with the passage into the abdominal aorta. It is concluded that the TP does not prevent arterial bubbles from reaching the brain.

Butler, Bruce D.↗

Effects of simulated microgravity on arterial nitric oxide synthase and nitrate and nitrite content

The aim of the present work was to investigate the alterations in nitric oxide synthase (NOS) expression and nitrate and nitrite (NOx) content of different arteries from simulated microgravity rats. Male Wistar rats were randomly assigned to either a control group or simulated microgravity group. For simulating microgravity, animals were subjected to hindlimb unweighting (HU) for 20 days. Different arterial tissues were removed for determination of NOS expression and NOx. Western blotting was used to measure endothelial NOS (eNOS) and inducible NOS (iNOS) protein content. Total concentrations of NOx, stable metabolites of nitric oxide, were determined by the chemiluminescence method. Compared with controls, isolated vessels from simulated microgravity rats showed a significant increase in both eNOS and iNOS expression in carotid arteries and thoracic aorta and a significant decrease in eNOS and iNOS expression of mesenteric arteries. The eNOS and iNOS content of cerebral arteries, as well as that of femoral arteries, showed no differences between the two groups. Concerning NOx, vessels from HU rats showed an increase in cerebral arteries, a decrease in mesenteric arteries, and no change in carotid artery, femoral artery and thoracic aorta. These data indicated that there were differential alterations in NOS expression and NOx of different arteries after hindlimb unweighting. We suggest that these changes might represent both localized adaptations to differential body fluid redistribution and other factors independent of hemodynamic shifts during simulated microgravity.

Non-NASA Center↗

Blood vessel adaptation to gravity in a semi-arboreal snake

The effects of vasoactive agonists on systemic blood vessels were examined with respect to anatomical location and gravity acclimation in the semi-arboreal snake, Elaphe Obsoleta. Major blood vessels were reactive to putative neurotransmitters, hormones or local factors in vessel specific patterns. Catecholamines, adenosine triphosphate, histamine and high potassium (80 mM) stimulated significantly greater tension per unit vessel mass in posterior than anterior arteries. Anterior vessels were significantly more sensitive to catecholamines than midbody and posterior vessels. Angiotensin II stimulated significantly greater tension in carotid artery than in midbody and posterior dorsal aorta. Arginine vasotocin strongly contracted the left and right aortic arches and anterior dorsal aorta. Veins were strongly contracted by catecholamines, high potassium and angiotensin II, but less so by adenosine triphosphate, arginine vasotocin and histamine. Precontracted vessel were relaxed by acetylcholine and sodium nitroprusside, but not by atrial natriuretic peptide or bradykinin. Chronic exposure of snakes to intermittent hypergravity stress ( + 1.5 Gz at tail) did not affect the majority of vessel responses. These data demonstrate that in vitro tension correlates with that catecholamines, as well as other agonists, are important in mediating vascular responses to gravitational stresses in snakes.

NASA Discipline Number 14-10↗

Lower energy levels and iodine-based material decomposition images increase pancreatic ductal adenocarcinoma conspicuity on rapid kV-switching dual-energy CT

Purpose: Multidetector computed tomography (MDCT) is used in the diagnosis of pancreatic ductal adenocarcinoma (PDAC), but it may be inadequate in some cases. Tumor detection can be improved using rapid kV-switching dual-energy CT (rsDECT) and iodine maps. Our aim this study is to evaluate tumor conspicuity in PDAC cases using rsDECT and iodine maps. Methods: Ninety cases with PDAC were evaluated rsDECT. Tumor contrast (HU) differences, tumor size, CNR (contrast-noise ratio), and noise were measured at 70 keV, individual CNR-energy level, and 45 keV, respectively. Quantitative differences in contrast gain ∆70-CNR and ∆CNR-45 were compared. On iodine maps, the iodine concentration measured in the tumor and parenchyma was normalized to the aorta as normalized iodine concentration (NIC) and compared. Results: The median optimized viewing energy level was 51 keV. The mean ± SD tumor contrast values were 62 ± 20, 115 ± 48, and 152 ± 48 HU (p < 0.001); the largest axial diameters were 36.6 ± 5.1, 37.9 ± 4.2, and 38.3 ± 3.7 mm (p = 0.015); the CNRs were 1.83 ± 0.72, 3.37 ± 0.93, and 2.36 ± 0.56; and the image noise levels were 23.7 ± 6.8, 39.3 ± 11.6, and 59.5 ± 17.2 (p < 0.001) (p < 0.001) for 70 keV, optimized energy level, and 45 keV, respectively. The mean ± SD contrast gain ∆70-CNR was 63 ± 12; and ∆CNR-45 was 31 ± 26 HU (p < 0.001). NIC{sub tumor} and NIC{sub parenchyma} values were 0.62 ± 0.03 and 1.36 ± 0.05 mg/mL, respectively (p = 0.004). Conclusion: The use of low energy levels on rsDECT and iodine maps improves tumor conspicuity. This situation may be help better detection of pancreatic tumors.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Superior mesenteric artery syndrome: a radiographic review

Purpose: To provide a review of the etiology, clinical presentation, and imaging findings of superior mesenteric artery (SMA) syndrome. Methods: A literature review of 24 relevant articles regarding SMA syndrome was performed. Results: Clinicians and radiologists with a high index of suspicion based on symptomatology may pursue radiologic investigation in the form of upper gastrointestinal (GI) series and contrast-enhanced abdominal computed tomography (CT). Magnetic resonance imaging (MRI) and ultrasound (US) are less commonly utilized modalities in the work-up of SMA syndrome, but provide imaging alternatives without the use of ionizing radiation. Imaging can assist in diagnosis by demonstrating characteristic findings of reduced aortomesenteric angle, reduced aortomesenteric distance, gastroduodenal distention, bowel caliber narrowing at the takeoff of the superior mesenteric artery from the aorta, as well as delayed gastric emptying or positional obstruction observed with real time with fluoroscopy. Conclusion: SMA syndrome is a rare disease that can go unrecognized and undiagnosed, exacerbating weight loss in an already significantly malnourished patient population. The diagnosis of SMA syndrome must be based on clinical symptomatology correlated with radiographic information. Once diagnosed, SMA syndrome can be safely treated by conservative measures although occasionally requires invasive intervention in the form of enteral tube placement, percutaneous jejunostomy tube placement, total parenteral nutrition, ligament of Treitz lysis, or duodenojejunostomy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Endovascular Treatment of Infrarenal Abdominal Aortic Lesions With or Without Common Iliac Artery Involvement

To evaluate the results of stent placement for obstructive atherosclerotic aortic disease with or without involvement of the common iliac artery. Forty patients had self-expanding stents primarily or after balloon dilatation in the abdominal aorta between January 2005 and May 2011. All patients had trouble walking. Follow-up examinations were performed with clinical visits; these included color Doppler ultrasonography and computed tomographic angiography. Technical, clinical, and hemodynamic success was achieved in all patients. None of the patients underwent reintervention during the follow-up period, which ranged from 3 months to 6 years (median 24 months). Nine complications occurred in six patients. Of the nine complications, four were distal thromboembolisms, which were successfully treated with catheter-directed thrombolysis or anticoagulation therapy. Endovascular treatment of the obstructive aortic disease using self-expanding stents was safe and effective, with high technical success and long-term patency. Thromboembolic complications were high even though direct stenting was considered protective for thromboembolism formation. Particularly for infrarenal aortic stenosis, it can be recommended as the first-line treatment option for patients with obstructive atherosclerotic aortic disease.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Image Fusion of Preprocedural CTA with Real-time Fluoroscopy to Guide Proper Hepatic Artery Catheterization During Transarterial Chemoembolization of Hepatocellular Carcinoma: A Feasibility Study

To assess feasibility of proper hepatic artery catheterization using a 3D model obtained from preprocedural computed tomographic angiography (CTA), fused with real-time fluoroscopy, during transarterial chemoembolization of hepatocellular carcinoma. Twenty consecutive cirrhotic patients with hepatocellular carcinoma undergoing transarterial chemoembolization were prospectively enrolled onto the study. The early arterial phase axial images of the preprocedural CTA were postprocessed on an independent workstation connected to the angiographic system (Innova 4100; GE Healthcare, Milwaukee, WI), obtaining a 3D volume rendering image (VR) that included abdominal aorta, splanchnic arteries, and first and second lumbar vertebrae. The VR image was manually registered to the real-time X-ray fluoroscopy, with the lumbar spine used as the reference. The VR image was then used as guidance to selectively catheterize the proper hepatic artery. The procedure was considered successful when performed with no need for intraarterial contrast injections or angiographic acquisitions. The procedure was successful in 19 (95 %) of 20 patients. In one patient, celiac trunk angiography was required for the presence of a significant ostial stenosis that was underestimated at computed tomography. Time for image reconstruction and registration was <10 min in all cases. The use of preprocedural CTA model with fluoroscopy enables confident and direct catheterization of the proper hepatic artery with no need for preliminary celiac trunk angiography, thus reducing radiation exposure and contrast media administration.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Endovascular Embolization of Bronchial Artery Originating from the Upper Portion of Aortic Arch in Patients with Massive Hemoptysis

Purpose: Our experience with endovascular embolization (EVE) of the bronchial artery (BA) originating from the upper portion of the aortic arch (AA) in six patients is described. Methods: Altogether, 818 patients with hemoptysis underwent multidetector row computed tomography angiography (MDCTA) before EVE or AA angiography during EVE. Aberrant BAs originating from the upper portion of the AA were the source of massive hemoptysis in six patients (0.73 %). MDCT angiograms and/or Digital subtraction angiograms were retrospectively reviewed. Selective catheterization and embolization were performed. Results: The ostia of the BAs were located on the superior surface of the AA between the brachiocephalic trunk and left common carotid artery in three patients, the junction of the aorta and medial surface of the left subclavian artery in two, and the posterior wall of the upper portion of the AA in one. The six BAs comprised two common trunks, three single right sides, and one single left side. The targeted vessels were successfully catheterized and embolized by a coaxial microcatheter system using polyvinyl alcohol particles. Other pathologic BAs and nonbronchial systemic arteries also were embolized. Bleeding was immediately controlled in all patients with no recurrence of hemoptysis. No procedure-related complications occurred. Conclusions: Application of EVE of anomalous origin of BAs in patients with hemoptysis is important, as demonstrated in the six reported patients. MDCTA before EVE or AA angiography during EVE is critical to avoid missing a rare aberrant BA originating from the upper portion of the AA.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A Migrated Aortic Stent Graft Causing Erosive Spondylopathy

We report about a patient presenting with back pain 4 months after an uneventful endovascular implantation of an aortic stent graft. Computed tomography scan revealed a migration of the stent with consecutive endoleakage, kink formation, and movement of the stent toward the spine, which caused destruction of the aortic wall as well as vertebral necrosis. Explantation of the stent and replacement of the native aorta relieved the patient of his symptoms.

62 RADIOLOGY AND NUCLEAR MEDICINE↗