In vivo MRSI of hyperpolarized [1-(13)C]pyruvate metabolism in rat hepatocellular carcinoma.

Hepatocellular carcinoma (HCC), the primary form of human adult liver malignancy, is a highly aggressive tumor with average survival rates that are currently less than 1 year following diagnosis. Most patients with HCC are diagnosed at an advanced stage, and no efficient marker exists for the prediction of prognosis and/or response(s) to therapy. We have reported previously a high level of [1-(13)C]alanine in an orthotopic HCC using single-voxel hyperpolarized [1-(13)C]pyruvate MRS. In the present study, we implemented a three-dimensional MRSI sequence to investigate this potential hallmark of cellular metabolism in rat livers bearing HCC (n = 7 buffalo rats). In addition, quantitative real-time polymerase chain reaction was used to determine the mRNA levels of lactate dehydrogenase A, nicotinamide adenine (phosphate) dinucleotide dehydrogenase quinone 1 and alanine transaminase. The enzyme levels were significantly higher in tumor than in normal liver tissues within each rat, and were associated with the in vivo MRSI signal of [1-(13)C]alanine and [1-(13)C]lactate after a bolus intravenous injection of [1-(13)C]pyruvate. Histopathological analysis of these tumors confirmed the successful growth of HCC as a nodule in buffalo rat livers, revealing malignancy and hypervascular architecture. More importantly, the results demonstrated that the metabolic fate of [1-(13)C]pyruvate conversion to [1-(13)C]alanine significantly superseded that of [1-(13)C]pyruvate conversion to [1-(13)C]lactate, potentially serving as a marker of HCC tumors.

Creating a patient-centered imaging service: determining what patients want.

OBJECTIVE: The purpose of this study is to determine patients' preferences for how, from whom, and how soon they receive imaging results. MATERIALS AND METHODS: Hard copies of our survey were randomly distributed to patients at an academic medical center outpatient imaging facility for 9 weeks, during August through October 2008, to collect data regarding patient preferences for how they received results ("Method"), from whom ("Person"), and how quickly ("Speed"). RESULTS: A total of 129 (23%) of 557 patients (47.4% male; median age, 55 years) undergoing CT (62%) and MRI (38%) completed the survey. According to survey responses, results needed to be communicated within a few hours for an "acceptable" rating from 95% of patients. Thirty-one percent preferred to receive normal results by the fastest method, whereas 35% preferred to receive abnormal results by telephone. Patients did not show an overwhelming preference regarding which physician communicates the results. More than 25% of patients were indifferent as to who was giving the results and cared only about the speed of delivery. For normal results, 12% chose from the radiologist, 41% from the referring physician, 14% from both, and 33% from whoever is faster (p < 0.0001). For abnormal results, 6% chose from the radiologist, 41% from the referring physician, 27% from both, and 26% from whoever is faster (p < 0.0002). CONCLUSION: Patients in our study wanted their results communicated much sooner than is currently practiced. Optimizing patient satisfaction may require a new communication model.

A strategy for blood biomarker amplification and localization using ultrasound.

Blood biomarkers have significant potential applications in early detection and management of various diseases, including cancer. Most biomarkers are present in low concentrations in blood and are difficult to discriminate from noise. Furthermore, blood measurements of a biomarker do not provide information about the location(s) where it is produced. We hypothesize a previously undescribed strategy to increase the concentration of biomarkers in blood as well as localize the source of biomarker signal using ultrasound energy directly applied to tumor cells. We test and validate our hypothesis in cell culture experiments and mouse tumor xenograft models using the human colon cancer cell line LS174T, while measuring the biomarker carcinoembryonic antigen (CEA) before and after the use of ultrasound to liberate the biomarker from the tumor cells. The results demonstrate that the application of low-frequency ultrasound to tumor cells causes a significant release of tumor biomarker, which can be measured in the blood. Furthermore, we establish that this release is specific to the direct application of the ultrasound to the tumor, enabling a method for localization of biomarker production. This work shows that it is possible to use ultrasound to amplify and localize the source of CEA levels in blood of tumor-bearing mice and will allow for a previously undescribed way to determine the presence and localization of disease more accurately using a relatively simple and noninvasive strategy.

Advancing radiology through informed leadership: summary of the proceedings of the Seventh Biannual Symposium of the International Society for Strategic Studies in Radiology (IS(3)R), 23-25 August 2007.

The International Society for Strategic Studies in Radiology (IS(3)R) brings together thought leaders from academia and industry from around the world to share ideas, points of view and new knowledge. This article summarizes the main concepts presented at the 2007 IS(3)R symposium, providing a window onto trends shaping the future of radiology. Topics addressed include new opportunities and challenges in the field of interventional radiology; emerging techniques for evaluating and improving quality and safety in radiology; and factors impeding progress in molecular imaging and nanotechnology and possible ways to overcome them. Regulatory hurdles to technical innovation and drug development are also discussed more broadly, along with proposals for addressing regulators' concerns and streamlining the regulatory process.

Practical approaches to the evaluation of signal-to-noise ratio performance with parallel imaging: application with cardiac imaging and a 32-channel cardiac coil.

In this work, two practical methods for the measurement of signal-to-noise-ratio (SNR) performance in parallel imaging are described. Phantoms and human studies were performed with a 32-channel cardiac coil in the context of ultrafast cardiac CINE imaging at 1.5 T using steady-state free precession (SSFP) and TSENSE. SNR and g-factor phantom measurements using a "multiple acquisition" method were compared to measurements from a "difference method". Excellent agreement was seen between the two methods, and the g-factor shows qualitative agreement with theoretical predictions from the literature. Examples of high temporal (42.6 ms) and spatial (2.1x2.1x8 mm3) resolution cardiac CINE SSFP images acquired from human volunteers using TSENSE are shown for acceleration factors up to 7. Image quality agrees qualitatively with phantom SNR measurements, suggesting an optimum acceleration of 4. With this acceleration, a cardiac function study consisting of 6 image planes (3 short-axis views, 3 long-axis views) was obtained in an 18-heartbeat breath-hold.