641 Left ventricular non-compaction as a distinct cardiomyopathy or a phenotypic feature: a case report

A 71-year-old male with no cardiovascular risk factors and a history of two uninvestigated episodes of loss of consciousness one year before, presented in our department to undergo a treadmill exercise stress test in relation to inverted T waves in V5-V6 on his basal ECG and frequent ventricular extrasystoles (PVCs). The stress test was positive for inducible ischemia, with a significant depression of the ST-segment in the lateral lead. A transthoracic echocardiography revealed normal thicknesses and volumes of the left ventricle (LV) with a dyskinesia of the lateral wall and a mildly reduced ejection fraction (EF) up to 46%. Epicardial surface was unremarkable. Next, a coronary angiography showed no critical obstruction in the epicardial coronary arteries. In order to further investigate the frequent PVCs and the reduction of the LV systolic function, a cardiac magnetic resonance (CMR) with paramagnetic contrast agent was performed. The images outlined the presence of non-compaction in the distal lateral wall and apex with a late gadolinium enhancement (LGE) in the epicardial portion of the lateral wall (Figure 1). Moreover, the CMR showed an adipose infiltration of the interventricular septum and thickened right ventricular trabeculae, suggesting an overlap with arrhythmogenic left ventricular dysplasia. During the subsequent follow-up, the patient was implanted with an implantable cardiac defibrillator (ICD), after two reported episodes of loss of consciousness and an electrophysiology study (EPS) resulting in the induction of a symptomatic ventricular tachycardia. Non-compaction cardiomyopathy is a rare and still relatively novel nosological entity, which can sometimes be observed in the same patient with other forms of cardiomyopathy. In the context of an unexplained reduction of LVEF and frequent PVCs, the accuracy of CMR in describing cardiac morphology and myocardial layer remains an indispensable tool to detect otherwise underdiagnosed potentially fatal cardiomyopathies.

Possibilities of MR-mammography in Diagnosis of Breast Reconstruction following Complex Cancer Treatment (Literature Review with Own Clinical Observations)

Magnetic resonance imaging (MRI) is the most effective method of diagnosing breast pathology due to its high resolution in the study of soft tissues and high sensitivity based on the contrast effect. There is still no consensus on the choice of the optimal method of examination of patients after mastectomy and breast reconstruction. Changes in breast tissue that are associated with surgery and radiation therapy cause difficulties in interpreting mammographic and ultrasound images. MRI using a high-field tomograph (> 1 T), a specialized coil and a paramagnetic contrast agent is highly informative in the detection and differential diagnosis of recurrent formations against the background of infiltrative and scarring changes.

Cardiovascular Magnetic Resonance as Pathophysiologic Tool in Diabetes Mellitus

Diabetes mellitus can independently contribute to cardiovascular disease and represents a severe risk factor for premature development of cardiovascular disease. A three-fold higher mortality than the general population has been observed in type 1 diabetes mellitus whereas a two- to four-fold increased probability to develop cardiovascular disease has been observed in type 2 diabetes mellitus. Cardiovascular magnetic resonance, a non-radiative modality, is superior to all other modalities in detecting myocardial infarction. The main cardiovascular magnetic resonance sequences used include a) balanced steady-state free precession (bSSFP) for function evaluation; b) T2-W for oedema detection; c) T1 W for ischemia detection during adenosine stress; and d) late gadolinium enhanced T1-W images (LGE), evaluated 15 min after injection of paramagnetic contrast agent gadolinium, which permit the diagnosis of replacement fibrosis, which appears white in the middle of suppressed, nulled myocardium. Although LGE is the technique of choice for diagnosis of replacement fibrosis, it cannot assess diffuse myocardial fibrosis. The application of T1 mapping (native or pre contrast and post contrast) allows identification of diffuse myocardial fibrosis, which is not detectable my other means. Native T1 and Contrast-enhanced T1 mapping are involved in the extracellular volume fraction (ECV) calculation. Recently, 1H-cardiovascular magnetic resonance spectroscopy has been applied to calculate the amount of myocardial triglycerides, but at the moment it is not part of the routine assessment of diabetes mellitus. The multifaceted nature of cardiovascular magnetic resonance has the great potential of concurrent evaluation of function and myocardial ischemia/fibrosis in the same examination and represents an indispensable tool for accurate diagnosis of cardiovascular disease in diabetes mellitus.

Importance of Veins for Neurosurgery as Landmarks Against Brain Shifting Phenomenon: An Anatomical and 3D-MPRAGE MR Reconstruction of Superficial Cortical Veins

Modern neurosurgery uses preoperative imaging daily. Three-dimensional reconstruction of the cortical anatomy and of the superficial veins helps the surgeons plan and perform neurosurgical procedures much more safely. The target is always to give the patient maximum benefit in terms of outcome and minimize intraoperative and postoperative complications. This study aims to develop a method for the combined representation of the cerebral cortex anatomy and the superficial cerebral veins, whose integration is beneficial in daily practice. Only those patients who underwent surgical procedures with craniotomy and a large opening of the dura mater were included in this study, for a total of 23 patients, 13 females (56.5%) and 10 males (43.5%). The average age was 50.1 years. We used a magnetic resonance tomograph Magnetom Vision® 1.5T (Siemens AG). Two sequences were applied: a strongly T1-weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence to visualize cerebral anatomical structures, and a FLASH-2D-TOF angiography sequence to visualize the venous vessels on the cortical surface after the administration of a paramagnetic contrast agent. The two data sets were superimposed manually, co-registered in an interactive process, and merged to create a combined data set, segmented and visualized as a three-dimensional reconstruction. Furthermore, we present our method for visualizing superficial veins, which helps manage brain shift (BS). We also performed anatomical observations on the reconstructions. The reconstructions of the cortical and venous anatomy proved to be a valuable tool in surgical planning and positively influenced the surgical procedure. Due to the good correlation with the existing surgical site, this method should be validated on a larger cohort or in a multicentric study.

Imaging the Transmembrane and Transendothelial Sodium Gradients in Gliomas

ABSTRACTHigh sodium (Na+) in extracellular (Na+e) and blood (Na+b) compartments and low Na+ in intracellular milieu (Na+i) produce strong transmembrane (ΔNa+mem) and weak transendothelial (ΔNa+end) gradients respectively, which reflect cell membrane potential (Vm) and blood-brain barrier (BBB) integrity. We developed a sodium (23Na) magnetic resonance spectroscopic imaging (MRSI) method using an intravenously-administered paramagnetic contrast agent to measure ΔNa+mem and ΔNa+end. In vitro23Na-MRSI established that the 23Na signal is strongly shifted by the agent compared to biological factors. In vivo23Na-MRSI showed Na+i remained unshifted and Na+b was more shifted than Na+e, and these together created weakened ΔNa+mem and enhanced ΔNa+end in rat gliomas. Specifically, RG2 and U87 tumors maintained weakened ΔNa+mem (i.e., depolarized Vm) implying an aggressive state for proliferation, and RG2 tumors displayed elevated ΔNa+end suggesting altered BBB integrity. 23Na-MRSI will allow explorations of perturbed Na+ homeostasis in vivo for the tumor neurovascular unit.

Diagnostic accuracy of perfusion weighted MRI in differentiating neoplastic and non-neoplastic brain lesions using histopathology as Gold standard.

Objectives: Perfusion-weighted imaging may be performed as a complementary examination to conventional MRI techniques. The clinical applications of PWI in the evaluation of focal brain lesions include the differentiation between neoplastic and non-neoplastic brain lesions, primary tumors and solitary metastasis and, in the post-treatment follow up, the differentiation of tumoral recurrence and radio necrosis. To determine the diagnostic accuracy of perfusion weighted MRI in differentiating. Neoplastic and non-neoplastic brain lesions keeping histopathology as gold standard. Study Design: Cross sectional (validation) study. Setting: The study was conducted in Radiology department of Allied Hospital Faisalabad. Period: Six months from 25-March-2016 to 24-Sep-2016. Material and Methods: Permission for this study was taken from the hospital ethical review committee. A total of 125 patients were included and MRI examination was performed with the patients in supine position using a 1.5-T Philips MRI unit and a body phased-array coil. A preload of paramagnetic contrast agent (gadolinium) was administered 30 seconds before acquisition of dynamic images, followed by a standard dose 10 seconds after starting imaging acquisitions. Results: Patients ranged between 15-65 years of age. Mean age of the patients was 47.6±10.6 years. There were 65 males (52%) and 60 females (48%). PW MRI showed sensitivity 81.67%, specificity 81.54%, positive predictive value 80.33%, negative predictive value 82.81% and diagnostic accuracy 81.60%. ROC and likelihood ratio was measured for age and gender. For age (15-40 years) likelihood ratio was 7.187 and for age 41-65 likelihood ratio was 48.665. For males likelihood ratio was 31.759 while for females 16.188. Conclusion: In conclusion, our results suggest a promising role for perfusion MR imaging in the distinction between neoplastic and non-neoplastic lesions.

Synthesis, quantum chemistry analysis and pre-clinical in vivo evalution of magnetic resonance imaging abilities of paramagnetic manganese complex with 2,3-dimercaptosuccinate (succimang)

Aim of the study. We have carried out the synthesis of complex of Manganese(II) with dimercaptosuccinic acid (DMSA), applied the quantum chemistry analysis for evaluation of most stable form of the Mn- DMSA complex and studied it’s uptake and imaging properties in normal and tumoral tissues in veterinary patients (cats with tumors)Material and methods. The synthesis of the 2.3-dimercaptosuccinic acid (COOH-CHSH-CHSH-COOH) has been carried out using modified technique proposed by A.I. Busev [Busev A.I. 1972]. Using phantoms filled in with 0.05 mM – 16 mM solutions of the agent we quantified the R1 relaxivity. Imaging properties of the 0.5 M solution of the Mn-(DMSA)2 were evaluated when performing the contrastenhanced studies in veterinary patients (cats with adenofibrous tumors and angiofibromas, nine animals) using T1-w spin-echo mode.Results. As result of quantum chemistry analysis it was shown that the most stable complex of Mn(II) with DMSA is the molecule Mn-(DMSA)2. The R1 relaxivity of the Mn-(DMSA)2 complex in the water solution was as high as 3.2 1/(mM*s). In normal control animals the Mn-(DMSA)2 provided highly intensive enhancement of renal parenchyma and mild enhancement of liver, spleen and bone marrow. In animals with tumors the Mn-(DMSA)2 enhanced the T1-w spin-echo images of angiofibromas and fibroadenomas in both peripheral (index of enhancement = 1.87 ± 0.09, p < 0.01) and central (index of enhancement = 1.59 ± 0.07, p < 0.01) parts of the tumor.Conclusion. The imaging properties of the Mn-(DMSA)2 make an argue for real possibility of production of new non-Gadolinium paramagnetic contrast agents specific to tumors. Further study of the Mn-(DMSA)2 complex as paramagnetic contrast agent is of interest and useul.

THE ORETICAL BASIS AND EXPERIMENTAL STUDY OF COMPLEX OF MANGANESE (II) WITH HEXAMETHYL- PROPILENAMIN-OXIME AS PARAMAGNETIC CONTRAST AGENT FOR MR-IMAGING OF MALIGNANT TUMORS

Aim of the study. We attempted to obtain the Mn-HMPAO complex (Mangoxim) and to evaluate the possibility to apply as a paramagnetic contrast agent for enhancement of tumors at MRI. Materials and methods. The synthesis of HMPAO was carried out by using R. D. Neirinckx — J. Pijarowska-Kruszyna technique (2017), without separation of enantiomers. The Mn-HMPAO was obtained by mixing Manganese(II) carbonate with HMPAO, pH 6,2–6,5, 0,5 M. Also the quantum chemistry calculations were carried out on the structure of Mn-HMPAO using method of functional of density DFT rb3lyp/6–31+g(d,p) for isolated molecules and for water solutions (CPCM). MRI study of Mn-HMPAO uptake carried out in twelve laboratory mouses with transplanted Lewis sarcoma, in T1-w. SE mode, TR=500 ms, TE=15 ms, 256×256 matrix, FOV 15×15 cm, 3 mm thin slice. MRI acquired in 15–17 min and 60–90 min after intravenous injection of the Mn-HMPAO. The uptake was quantified as index of enhancement: IE=(Int. T1-w.MRI)Mn-HMPAO/(Int. T1- w.MRI)pre-contrast. Results. The N,N-Mn-dioxim is more stable than O,O-Mn-dioxim for 50,5 KCal/mol, so in the nature only N,N-Mn-dioxim exists. R1 of Mn-HMPAO was 3,35 1/(mM•s), below R1 of gadopentetate=3,96 1/(mM•s). The highest value of early IE was over the tumor (3,36±0,31) and over lungs (3,07±0,43). At 60 min the IE over tumor decreased to 1,58±0,14, remaining far over IE values over any other location. Conclusion. The Mn-HMPAO complex demonstrates paramagnetic properties for the application as the contrast MRI agent and probably will improve the selective enhancement of tumors.

Imaging of Human Insulin Secreting Cells with Gd-DOTA-P88, a Paramagnetic Contrast Agent Targeting the Beta Cell Biomarker FXYD2γa

Non-invasive imaging and quantification of human beta cell mass remains a major challenge. We performed pre-clinical in vivo validation of a peptide previously discovered by our group, namely, P88 that targets a beta cell specific biomarker, FXYD2γa. We conjugated P88 with DOTA and then complexed it with GdCl3 to obtain the MRI (magnetic resonance imaging) contrast agent (CA) Gd-DOTA-P88. A scrambled peptide was used as a negative control CA, namely Gd-DOTA-Scramble. The CAs were injected in immunodeficient mice implanted with EndoC-βH1 cells, a human beta cell line that expresses FXYD2γa similarly to primary human beta cells. The xenograft-bearing mice were analyzed by MRI. At the end, the mice were euthanized and the CA biodistribution was evaluated on the excised tissues by measuring the Gd concentration with inductively coupled plasma mass spectrometry (ICP-MS). The MRI and biodistribution studies indicated that Gd-DOTA-P88 accumulates in EndoC-βH1 xenografts above the level observed in the background tissue, and that its uptake is significantly higher than that observed for Gd-DOTA-Scramble. In addition, the Gd-DOTA-P88 showed good xenograft-to-muscle and xenograft-to-liver uptake ratios, two potential sites of human islets transplantation. The CA shows good potential for future use to non-invasively image implanted human beta cells.