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Evaluation of brain lesions using magnetic resonance imaging (MRI) provides information that is critical for accurate diagnosis, prognosis, therapeutic intervention and monitoring response. Conventional contrast-enhanced MR neuroimaging using gadolinium (Gd) contrast agents primarily depicts disruption of the blood-brain barrier, demonstrating location and extent of disease, and also the morphological details at the lesion site. However, conventional imaging results do not always accurately predict tumour aggressiveness. Advanced functional MRI techniques such as dynamic contrast-enhanced perfusion-weighted imaging utilise contrast agents to convey physiological information regarding the haemodynamics and neoangiogenic status of the lesion that is often complementary to anatomical information obtained through conventional imaging. Most of the Gd contrast agents available have similar T1 and T2 relaxivities, and thus their contrast-enhancing capabilities are comparable. Exceptions are gadobenate-dimeglumine, Gd-EOB-DTPA, Gadobutrol and gadofosveset, which, owing to their transient-protein-binding capability, possess almost twice (and more) the T1 and T2 relaxivities as other agents at all magnetic field strengths. Numerous comparative studies have demonstrated the advantages of the increased relaxivity in terms of enhanced image contrast, image quality and diagnostic confidence. Here we summarise the benefits of higher relaxivity for the most common neuroimaging applications including MRI, perfusion-weighted imaging and MRA for evaluation of brain tumours, cerebrovascular disease and other CNS lesions. [ABSTRACT FROM AUTHOR]

Background: Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are noninvasive alternatives for therapy monitoring of cerebral arteriovenous malformation (AVM). Purpose: To evaluate if CTA is able to detect residual AVM in the long-term follow-up after radiotherapy when time-of-flight (TOF) MRA could no longer detect a remaining nidus. Material and Methods: 18 patients with intracranial AVM were included between November 2005 and August 2007 who were scheduled for CTA (16-slice CT, 1-mm slice thickness, 90 ml iomeprol 400 mg I/ml, 4 ml/s) in the follow-up of radiotherapy. In these patients, MRA (3D-TOF, and bolus tagging at 1.5 T) could no longer detect a remaining nidus. Results: The previously performed MRA (median time between CTA and MRA, 2.5 months) described total obliterations in 14 and subtotal obliterations in two AVM cases. Two MRA diagnoses were inconclusive due to artifacts. CTA (median time after therapy, 28 months; range, 5-66 months) could provide a diagnosis in all cases, but confirmed the MRA diagnosis only in 50% of the cases. A residual nidus was shown in an additional six cases, and subtotal obliteration in another three cases. The interval between radiotherapy and the follow-up examination was significantly different (P<0.05) between false- and true-negative MRA examinations (median, 18 vs. 30 months). Conclusion: High-contrast CTA is a sensitive tool in the detection of AVM and is able to identify residual AVM after radiotherapy even if previously performed TOF MRA at 1.5 T shows total obliteration. [ABSTRACT FROM AUTHOR]

This article presents a new way of teaching by integrating both anatomy and radiology using three-dimensional image post-processing tools. One preclinical and one clinical module were developed for integrated teaching of anatomy and radiology. Potential benefits were assessed by anonymous evaluation among the 176 participating students. The students highly appreciated the new approach, especially the high degree of interactivity with the post-processing software and the possibility to correlate the real dissection with the virtual dissection. Students agreed that three-dimensional imaging and postprocessing improved their understanding of difficult anatomical topics and topographical relations. We consider the new approach to provide great additional benefits for participating students regarding preparation for everyday clinical practice. In particular, it imparts familiarity with imaging and image post-processing techniques and may improve anatomical understanding, radiological diagnostic skills and three-dimensional appreciation. [ABSTRACT FROM AUTHOR]

Therapy monitoring in oncological patient care requires accurate and reliable imaging and post-processing methods. RECIST criteria are the current standard, with inherent disadvantages. The aim of this study was to investigate the feasibility of semi-automated volumetric analysis of lymph node metastases in patients with malignant melanoma compared to manual volumetric analysis and RECIST. Multislice CT was performed in 47 patients, covering the chest, abdomen and pelvis. In total, 227 suspicious, enlarged lymph nodes were evaluated retrospectively by two radiologists regarding diameters (RECIST), manually measured volume by placement of ROIs and semi-automated volumetric analysis. Volume (ml), quality of segmentation (++/--) and time effort (s) were evaluated in the study. The semi-automated volumetric analysis software tool was rated acceptable to excellent in 81% of all cases (reader 1) and 79% (reader 2). Median time for the entire segmentation process and necessary corrections was shorter with the semi-automated software than by manual segmentation. Bland-Altman plots showed a significantly lower interobserver variability for semi-automated volumetric than for RECIST measurements. The study demonstrated feasibility of volumetric analysis of lymph node metastases. The software allows a fast and robust segmentation in up to 80% of all cases. Ease of use and time needed are acceptable for application in the clinical routine. Variability and interuser bias were reduced to about one third of the values found for RECIST measurements. [ABSTRACT FROM AUTHOR]

Purpose: To study the visualization of spinal cord feeding arteries in patients with complex thoracic aortic pathology undergoing endovascular aortic repair (EVAR) using an optimized protocol for multislice computed tomographic angiography (MSCTA). Methods: Eighteen consecutive patients (13 men; mean age 63 years, range 45-79) with aortic type B dissections (n=5), chronic expanding aortic dissections (n=5), thoracic aortic aneurysms (n=6), or penetrating aortic ulcers (n=2) underwent 16-slice CTA before and after (mean interval 9 days) EVAR. Pulse rate and neurological status were documented. Quantitative density measurements were taken at regions of interest (ROI) in the ascending thoracic aorta and at the level of the diaphragm. Two experienced radiologists qualitatively assessed the posterior intercostal arteries (PIA; fully visible, partially visible, non-visible), dorsal branches (DB; visible/non-visible), and artery of Adamkiewicz (AKA; visible/non-visible) on multiplanar reformations and maximum intensity projection reconstructions. Results: MSCTA was performed successfully in 17/18 patients before and after EVAR (1 patient was excluded after EVAR owing to rising creatinine levels). Before EVAR, MSCTA revealed 197/203 PIAs within the stented area, of which 179 were fully and 18 partially visible. No significant (p=0.37) difference was noted for overall PIA detection within the stented area on post-EVAR MSCTA (185/203 PIA), although only 124 were fully and 61 partially visible. Similar results were obtained for DB visualization. The AKA were seen in 10/17 patients pre EVAR and 9/17 post EVAR. In 2 patients, the AKA was localized within the stented aortic segment. ROI analysis revealed contrast densities of 427+/-89 HU and 398+/-84 HU on pre- and post-EVAR MSCTA, respectively. No neurological events were observed. Conclusion: The majority of posterior intercostal arteries and dorsal branches remain open after EVAR due to retrograde perfusion. High-resolution MSCTA permits accurate pre- and post-EVAR visualization of spinal cord feeding arteries in patients with thoracic aortic pathology. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE: Dynamic contrast-enhanced MRI (DCE-MRI) followed by pharmacokinetic analysis has been successfully used in a variety of solid tumors. The aims of this study were to evaluate the feasibility of DCE-MRI in malignant pleural mesothelioma (MPM), to differentiate benign from pathologic tissue and compare pharmacokinetic with clinical parameters and survival in order to map out its microcirculation; and to compare pharmacokinetic with clinical parameter and survival in order to improve our understanding of the in vivo biology of this malignancy. METHODS: Nineteen patients with a diagnosis of MPM who were scheduled to receive chemotherapy with gemcitabine were enrolled in the study. DCE-MRI was performed before treatment (n = 19) and after the third cycle (n = 12) and sixth cycle (n = 7) of chemotherapy. An established pharmacokinetic two-compartment model was used to analyze DCE-MRI. Tumor regions were characterized by the pharmacokinetic parameters amplitude (Amp), redistribution rate constant (kep), and elimination rate constant (kel). Kinetic parameters of tumor tissue and normal tissue were compared using the Student t test. Patients were classified as clinical responders or nonresponders according to clinical outcome, and these groups were compared with the pharmacokinetic parameters derived from DCE-MRI. RESULTS: Normal and tumor tissue could be distinguished by the pharmacokinetic parameters Amp and kel (p