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In this paper, we present an interactive high dynamic range volume visualization framework (HDR VolVis) for visualizing volumetric data with both high spatial and intensity resolutions. Volumes with high dynamic range values require high precision computing during the rendering process to preserve data precision. Furthermore, it is desirable to render high resolution volumes with low opacity values to reveal detailed internal structures, which also requires high precision compositing. High precision rendering will result in a high precision intermediate image (also known as high dynamic range image). Simply rounding up pixel values to regular display scales will result in loss of computed details. Our method performs high precision compositing followed by dynamic tone mapping to preserve details on regular display devices. Rendering high precision volume data requires corresponding resolution in the transfer function. To assist the users in designing a high resolution transfer function on a limited resolution display device, we propose a novel transfer function specification interface with nonlinear magnification of the density range and logarithmic scaling of the color/ opacity range. By leveraging modern commodity graphics hardware, multiresolution rendering techniques and out-of-core acceleration, our system can effectively produce an interactive visualization of large volume data, such as 2,048(3).

Purpose: The purpose of this study was to evaluate the outcomes of our 6-year experience with directional atherectomy used for treatment of stenoses in infrainguinal vein grafts., Methods: From March 1988 to April 1994, 52 directional atherectomy procedures were undertaken in 42 patients to treat 67 stenoses in 44 vein grafts. Follow-up consisted of periodic physical examinations and graft surveillance; ankle/brachial indexes, pulse volume recordings, and color-flow duplex ultrasonography. Follow-up angiography (n = 18) was performed for recurrent symptoms, reproducible drop in ankle/brachial index of greater than 0.15, a twofold to threefold focal increase in peak systolic velocity, or incidentally during evaluation of the opposite leg., Results: Forty-nine of 52 (94%) procedures were technically successful. In two the residual diameter stenosis was greater than 30%, and in one atherectomy could not be performed. Complications were minor in six (11%) and major in three (6%): two acute graft occlusions and one delayed pseudoaneurysm at the atherectomy site. There were no deaths at 30 days. With a mean follow-up of 21 +/- 18 months, 36 of 44 grafts (82%) remained patent without restenosis; 6 others were patent but considered "failed"--5 (11%) with restenosis, 1 with a pseudoaneurysm; and 2 grafts (5%) occluded. Clinically 33 of 44 extremities (75%) were asymptomatic during follow-up. Claudication improved in five, recurred in three, and was unchanged in one. There was one below-knee amputation. Life-table analysis including all 52 procedures reveals cumulative primary atherectomy patency rates for the 44 grafts of 82%, 78%, and 78%, respectively, at 1, 2, and 3 years after atherectomy, and 86%, 83%, and 83% for the 67 individual stenoses treated., Conclusions: Directional atherectomy of vein graft stenoses has high technical and clinical success rates, acceptably low morbidity rates, and offers better sustained patency rates than balloon angioplasty. Its long-term patency rate seems to approach that of surgical vein patch angioplasty.

Purpose: Noting a doubling in mortality soon after placement of filters in the inferior vena cava (IVC) from 1985 (7.8%) to 1992 (15.2%), the authors performed a study to define risk factors associated with death soon after IVC filter placement and to develop revised guidelines for filter placement., Patients and Methods: During a 4-year period, 141 IVC filters were placed in 137 patients. Patients were divided into two clinical risk groups: those with possible malignancy and those with possible suprainguinal venous thrombus. Survival was monitored for up to 3 weeks after hospital discharge., Results: Death occurred in 16 (26%) of 61 patients with malignancy (P = .0086, compared with patients without malignancy), seven (35%) of 20 patients with suprainguinal venous thrombus (P = .0422, compared with patients without suprainguinal venous thrombus), and six (46.2%) of 13 patients with malignancy and suprainguinal venous thrombus (P = .0091, compared with patients without malignancy or suprainguinal venous thrombus)., Conclusion: The data indicate that for some patients with malignancy or suprainguinal venous thrombus, insertion of an IVC filter gives little or no survival benefit. A reassessment of IVC filter use in these patients is warranted.

Background: Image-directed biopsies may be collected as histologic or cytologic specimens., Methods: In 34 patients, the results of aspiration cytologic examination were compared prospectively with core tissue biopsy findings obtained and diagnosed independently using the same image-guided procedure., Results: Cytologic examination disclosed 22 patients with positive or suspicious findings of malignancy; there was one false-suspicious result. Seventeen patients with such results were discovered by examining the core biopsy specimens. Cytologic findings also were more definitive in diagnosing malignancy. Those in whom an immediate interpretation could be done were more likely to have adequate cytologic specimens (88%) than those without (62%). One to five passes were done, but all 21 patients with definitive findings of either benign or malignant by cytologic examination underwent three or fewer passes. The three patients with positive biopsy results, but less definitive cytologic findings, all underwent only one cytologic pass., Conclusions: Therefore, it was concluded that cytologic examination is more sensitive and definitive than biopsy in diagnosing lesions using image guidance. Immediate interpretation and/or multiple passes increase the diagnostic yield. However, more than three aspiration cytologic passes appear to yield diminishing returns.

In this prospective blinded study of inferior vena caval (IVC) patency, 18 patients underwent 25 duplex ultrasound (US) and magnetic resonance (MR) angiography examinations over an eight-month period following Simon nitinol filter placement. Clinical examination for lower extremity venous stasis and plain abdominal radiography were also performed. Twenty-three of 24 MR examinations and 11 of 24 US examinations were judged technically adequate by the blinded observers. One technically adequate US exam was false positive for intraluminal caval thrombus. Thirteen technically inadequate US examinations missed 3 complete caval occlusions and 2 partial occlusions. MR identified all patients with complete or partial caval occlusion. The authors conclude that duplex US reliably confirms IVC patency only when strict criteria for technical adequacy and interpretation are met (good visualization of filter and IVC above and below filter). MR, although expensive, more reliably identifies nonoccluding intraluminal thrombus and caval occlusion. It should be the noninvasive study of choice in symptomatic patients with venous stasis and patients with recurrent pulmonary emboli.

Directional atherectomy alone or with supplemental percutaneous transluminal angioplasty was used to treat peripheral vascular lesions in 77 patients (85 procedures). Lesions involved 17 iliac arteries, 45 infrainguinal arteries, and 23 laser extremity vein bypass grafts. Technical success, defined as reduction of stenosis diameter to 30% or less of the normal vessel diameter, was achieved in 78 of 85 (92%) cases. The complication rate was 21% (18 of 85 procedures). Most complications were minor and were related to puncture sites. Patients underwent noninvasive follow-up studies, including measurement of ankle-brachial index and segmental pressures, plethysmography, and clinical examination. The mean follow-up period was 13.5 months. The probability of 1-, 2-, and 3-year patency for lesions treated with atherectomy alone was 92%, 84%, and 84%, respectively. Kaplan-Meier survival analysis revealed no difference in 2- to 3-year patency rate on the basis of lesion location or presence of calcification, eccentricity, or ulceration. Diabetic patients, however, had a higher restenosis rate than did patients who were not diabetic (P less than .03).

Of 13,203 transfemoral diagnostic and therapeutic cardiac catheterization procedures performed between January 1, 1980 and December 31, 1990, 73 (0.55%) were complicated by pseudoaneurysm (PA) formation, and 15 (0.11%) by arteriovenous fistulas (AVF). The rate of PA increased progressively from 0.44% (1980-1987), to 0.59% (1987-1989), to 0.92% (1990), with no corresponding change in the incidence of AVF. The rising incidence of PA complicating transfemoral cardiac catheterization was associated closely with the use of larger diameter catheters and aggressive antiocoagulation during coronary interventions, but findings during surgical repair suggested that puncture of the superficial femoral (SFA), rather than the common femoral artery (CFA), was an important avoidable cause of some PA and AVF. A technique for fluoroscopic localization of the puncture site to avoid inadvertent SFA puncture and the associated increased risk of complication is proposed.

Percutaneous transluminal angioplasty was performed on a right common iliac artery stenosis presumed to be causing renovascular hypertension in a patient with a renal allograft anastomosis to the right external iliac artery. This was complicated by an obstructive dissection resulting in acute threatening renal allograft ischemia. Renal blood flow was restored by means of a transluminal reperfusion catheter until corrective surgery could be performed. This case is reported because such catheters can be acutely helpful to the interventionalist, and they have not been described in the radiology literature.

This study describes a systematic comparison of intra-arterial digital subtraction angiography (DSA) of the main renal arteries with conventional angiography (CA), the currently accepted "gold standard" for the diagnosis of renal artery stenosis. Twenty-five patients scheduled for abdominal aortography for various indications underwent first DSA then CA. The DSA and CA images were evaluated for number of renal arteries, presence and grade of renal artery stenosis, presence of post-stenotic dilation or fibromuscular changes, and diagnostic and pictorial adequacy of the images. DSA was found to be diagnostically adequate in 92% of cases, compared with 96% for CA. In evaluating significant main renal artery stenosis, which the authors assumed to be any stenosis greater than 50%, there were 10 such stenoses seen by CA. DSA also detected 10 cases, but there was 1 false positive and 1 false negative, yielding a sensitivity of 90% and a specificity of 98%. There was also close correlation of DSA and CA for the few cases of post-stenotic dilatation and fibromuscular dysplasia encountered. The authors conclude that DSA is an acceptable substitute for CA in the evaluation of patients for main renal artery stenosis.

Symptomatic renal artery stenosis is a significant and treatable clinical problem. A reliable and accurate noninvasive method of screening for renal artery stenosis has not yet been found. We used magnetic resonance imaging to study 37 patients who had undergone recent renal angiography. Fourteen patients had normal renal arteries by angiography. In 23 patients either unilateral or bilateral stenosis or occlusion was present. The disease process in all patients appeared to be atherosclerosis. The average age of the 37 patients was 68 years. The magnetic resonance scans and angiograms were read independently by two different radiologists, each of whom was blinded to the clinical history and the results of the other study. Renal arterial stenoses found on angiogram and magnetic resonance scans were graded as absent (0% to 24%), mild (25% to 49%), moderate (50% to 74%), or severe (75% to 99%). The magnetic resonance imaging results concurred with the angiographic findings in 70 of 77 arteries (91%). Magnetic resonance imaging predicted the presence of a greater than 50% stenosis of the renal artery with a sensitivity of 100% and a specificity of 94%. Magnetic resonance imaging may prove to be the best noninvasive screening test for proximal atherosclerotic renal arterial stenosis.

Forty-two consecutive patients diagnosed with superficial phlebitis were seen during a 5-year period. Thirty-five of the 42 patients were outpatients. The diagnosis of superficial phlebitis was made by the presence of palpable subcutaneous cords in the course of the greater saphenous vein or its tributaries in association with tenderness, erythema, and edema. The presence of concurrent deep venous thrombosis (DVT) was assessed by impedance plethysmography in 37 patients, compression venous ultrasonography in 3 patients, and venography in 8 patients. Five of the 42 patients (12%) had DVT. Four of these five patients had a positive impedance plethysmographic or ultrasonographic test result followed by a confirmatory venogram. The fifth patient had a positive ultrasonographic test result, but no venogram was performed. Two of the five patients had clots that involved the popliteal or femoral veins. Four of 23 patients (17%) with superficial phlebitis at or above the knee had DVT. Only 1 of the 19 patients (5%) with superficial phlebitis below the knee had DVT. Three of the five patients with both superficial phlebitis and DVT had undergone surgery recently. All but 3 of the 42 patients (93%) had varicose veins. No patients had clinically apparent pulmonary emboli. DVT occurred in 17% of the patients with above-knee extension of the superficial phlebitis. In the clinical management of superficial lower-limb thrombophlebitis, noninvasive tests should be performed to guide therapy. When superficial phlebitis develops after recent surgery or the superficial phlebitis extends above the knee, diagnostic surveillance should be especially strict. When the noninvasive test results are equivocal, phlebography is indicated to rule out DVT.

A blinded, prospective study with magnetic resonance (MR) angiography was performed to study patients who had undergone abdominal aortography. In 55 renal arteries among 25 patients, MR angiography had a sensitivity of 100% for detecting renal artery stenosis of 50% or greater and a specificity of 92%. With MR angiography, the degree of renal artery stenosis was overgraded in four of 55 renal arteries: Mild stenosis was overgraded as moderate stenosis in two arteries and as a severe stenosis in one, and a moderate stenosis was overgraded as a severe stenosis in one. The number of renal arteries was correctly determined in all cases. The renal arteries could be well evaluated only in the proximal third of the vessel, precluding detection of more distal stenoses. Atherosclerotic plaque uniformly appeared dark on gradient-echo images and was easily differentiated from bright, flowing blood in the aortic lumen. MR angiography enabled correct grading of the presence of atherosclerotic plaque and stenoses of the abdominal aorta in 22 of 25 patients (88%). The authors conclude that MR angiography has the potential to be a useful screening technique for patients with suspected renal artery stenosis and disorders of the abdominal aorta, but further clinical studies are warranted.

Bovine skeletal muscle pyruvate kinase was covalently coupled to Sepharose that had previously been activated by low concentrations of cyanogen bromide. Reaction conditions were chosen such that essentially all tetrameric enzyme molecules were covalently bound via a single subunit. Denaturation of the immobilized enzyme with guanidine hydrochloride followed by removal of noncovalently bound subunits amd denaturant resulted in essentially no enzymatic activity remaining bound to the resin. Thus, single immobilized subunits of bovine pyruvate kinase were inactive. Sepharose-bound enzymatic activity could be recovered by adding soluble renaturing enzyme subunits to the immobilized monomers. The former combine noncovalently with the latter, presumably resulting in re-formation of bound tetramers, and an average recovery of 61% of the original matrix-bound activity was observed. While interactions with other enzyme subunits appear to be necessary for catalytic activity of bovine muscle pyruvate kinase, these subunit interactions apparently can be provided by chemically modified subunits. Soluble, renaturing subunits from enzyme that had been inactivated by treatment with trinitrobenzenesulfonic acid were able to interact with matrix-bound single subunits, thereby restoring the enzymatic activity of the latter.

Various complications have been reported after insertion of the Greenfield filter. This report describes an unusual complication after suprarenal placement of this filter: spreading of the filter struts, with perforation of the inferior vena cava, and penetration of the aorta and a vertebral body, followed by fracture of one of the struts.

The method of quantitating N,N-dimethylglycine involves cation-exchange high-performance liquid chromatography and detection of dimethylglycine with dimethylglycine dehydrogenase. Dimethylglycine was added to plasma and urine and samples were assayed for dimethylglycine. Plasma and urine to which no dimethylglycine was added were also assayed. Recoveries of added dimethylglycine were 99 to 104% with no endogenous dimethylglycine found in rat plasma or normal human urine. The human plasma used contained a small amount of endogenous dimethylglycine. The cation-exchange chromatography separates dimethylglycine from other compounds which can serve as substrates for dimethylglycine dehydrogenase. Repeatability of the assay is +/- 10%. Using this method we have identified dimethylglycine in the urine of a 1-month-old female human patient.

Bovine type M pyruvate kinase can be reversibly denatured by solutions of guanidine-HCl. Subsequent dilution of the enzyme into buffer containing 2-mercaptoethanol or dithiothreitol results in recovery of enzymatic activity with half-times that vary from 185 min at 0 degrees C to 4 min at 45 degrees C. In the temperature range 0-25 degrees C, 90% of the enzymatic activity is recovered. Above about 32 degrees C, the recovery drops off sharply, wih a yield of only 13% at 45 degrees C. Removal of inactive nonspecific aggregates and denatured monomer by gel filtration yields an enzyme with the same specific activity as the starting material. At enzyme concentrations below 3 microns/mL at 16 degrees C or below 25 micron/mL at 7.8 degrees C, the reactivation kinetics show a concentration dependence. At higher concentrations of protein and at temperatures of 16 degrees C or higher, no protein concentration dependence is seen, and the rate of reactivation is described by two first-order relaxations. The rate constants have apparent activation energies of 10.6 and 11.9 kcal/mol. Combinding the results presented here with earlier work from this laboratory [Cardenas, J. M., & Dyson, R. D. (1973) J. Biol. Chem. 248, 6938-6944; Cardenas, J. M., Hubbard, D. R., & Anderson, S. (1977) Biochemistry 16, 191-197] leads to the conclusion that a rapid, major folding produces two species which undergo transconformational steps. This is followed by subunit association which yields the native tetramer.

A rapid and convenient spectrophotometric assay has been devised to measure proteolysis. The assay is based on the reaction of o-phthalaldehyde (OPA) and 2-mercaptoethanol with amino groups released during proteolysis of a protein substrate. The reaction is specific for primary amines in amino acids, peptides, and proteins, approaches completion within 1 to 2 min at 25 degrees C (half-times of approx 10-15 s), and requires no preliminary heating or separation of the hydrolyzed products from the undegraded protein substrate prior to performing the assay. The OPA assay was relatively as successful as a 2,4,6-trinitrobenzenesulfonic acid (TNBS) procedure in predicting the extent of hydrolysis of a protein substrate. The utility of the OPA method was demonstrated by measuring the degree of proteolytic degradation caused by trypsin, subtilisin, Pronase, and chymotrypsin of various soluble protein substrates. Ethanethiol (instead of 2-mercaptoethanol) or 50% of dimethyl sulfoxide can be included in the assay solution to stabilize certain OPA-amine products. The present method approaches the sensitivity of ninhydrin and TNBS procedures, is more convenient and rapid, and could substitute for these reagents in most assay systems.

The Simon nitinol filter for percutaneous interruption of the vena cava to prevent pulmonary embolism is currently undergoing a multicenter clinical trial. Preliminary clinical results are reported as work in progress. The results in 44 patients at two centers are analyzed in detail, and major events are reported from 103 patients in 17 centers in the United States during a 10-month period. The filter was successfully inserted via the femoral or jugular route in all patients through a 9-F catheter. The placement procedure was easy and without significant complications. Follow-up studies included plain radiography, ultrasonography, magnetic resonance (MR) imaging, and clinical evaluation. No filter migration or perforation occurred among the 103 patients. Symptomatic occlusions occurred in 7%-9%, comparable to other series, and some asymptomatic occlusions were detected with MR imaging only. The implications of occlusion of the filter are discussed.

Intermittent prolapse of a jejunal loop into the gallbladder lumen was observed following cholecystojejunostomy in a patient with advanced carcinoma of the pancreas. This unusual complication was documented by cholangiography and sonography.

We describe a patient in whom thoracic aortography performed following blunt chest trauma revealed what appeared to be a traumatic tear of the proximal descending aorta. As the patient initially refused surgery, aortography was repeated 18 days later, confirming these findings. At thoracic aortotomy the aorta appeared normal; there was no hematoma or tear. We believe this to be the first reported case of false-positive aortography following blunt chest trauma (see Note added in proof).

Dimethylglycine dehydrogenase (EC 1.5.99.2) and sarcosine dehydrogenase (EC 1.5.99.1) are flavoproteins which catalyze the oxidative demethylation of dimethylglycine to sarcosine and sarcosine to glycine, respectively. During these reactions tightly bound tetrahydropteroylpentaglutamate (H4PteGlu5) is converted to 5,10-methylene tetrahydropteroylpentaglutamate (5,10-CH2-H4PteGlu5), although in the absence of H4PteGlu5, formaldehyde is produced. Single turnover studies using substrate levels of the enzyme (2.3 microM) showed pseudo-first-order kinetics, with apparent first-order rate constants of 0.084 and 0.14 s-1 at 23 and 48.3 microM dimethylglycine, respectively, for dimethylglycine dehydrogenase and 0.065 s-1 at 47.3 microM sarcosine for sarcosine dehydrogenase. The rates were identical in the absence or presence of bound tetrahydropteroylglutamate (H4PteGlu). Titration of the enzymes with substrate under anaerobic conditions did not disclose the presence of an intermediate semiquinone. The effect of dimethylglycine concentration upon the rate of the dimethylglycine dehydrogenase reaction under aerobic conditions showed nonsaturable kinetics suggesting a second low-affinity site for the substrate which increases the enzymatic rate. The Km for the high-affinity active site was 0.05 mM while direct binding for the low-affinity site could not be measured. Sarcosine and dimethylthetin are poor substrates for dimethylglycine dehydrogenase and methoxyacetic acid is a competitive inhibitor at low substrate concentrations. At high dimethylglycine concentrations, increasing the concentration of methoxyacetic acid produces an initial activation and then inhibition of dimethylglycine dehydrogenase activity. When these compounds were added in varying concentrations to the enzyme in the presence of dimethylglycine, their effects upon the rate of the reaction were consistent with the presence of a second low-affinity binding site on the enzyme which enhances the reaction rate. When sarcosine is used as the substrate for sarcosine dehydrogenase the kinetics are Michaelis-Menten with a Km of 0.5 mM for sarcosine. Also, methoxyacetic acid is a competitive inhibitor of sarcosine dehydrogenase with a Ki of 0.26 mM. In the absence of folate, substrate and product determinations indicated that 1 mol of formaldehyde and of sarcosine or glycine were produced for each mole of dimethylglycine or sarcosine consumed with the concomitant reduction of 1 mol of bound FAD.

The computed tomographic and angiographic findings of an isolated external iliac artery aneurysm secondary to cystic medial necrosis in a patient without Marfan's disease are demonstrated. A review of the differential diagnosis and surgical treatment of iliac artery aneurysms is presented. The dramatic surgical sequelae in this patient underscore the importance of preoperative consideration of this rare diagnosis.