Pre-donation assessment of kidneys by magnetic resonance angiography and venography: accuracy and impact on outcomes.

Reports on the accuracy of magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) in evaluating living donor renovasculature employ few patients or omit the consequences of inaccurate scans. We retrospectively compared intraoperative findings to MRA/MRV scans in 146 donor-recipient pairs. For detecting accessory arteries and early branching, MRA sensitivity was 57.6%, specificity 96.5%, false positive rate 3.5%, false negative rate 42.4%, positive predictive value 82.6%, negative predictive value 88.6% and overall accuracy 87.7%. By excluding clinically inconsequential accessory arteries, MRA sensitivity rose to 73.1%, specificity to 96.7% and overall accuracy to 92.5%. For MRVs, sensitivity was 56.2%, specificity 99%, false positive rate 1%, false negative rate 43.8%, positive predictive value 90%, negative predictive value 94.8% and accuracy 94.5%. Inaccurate scans were associated with prolonged donor and recipient operations and more frequently reconstructed arteries, but did not affect clinical outcomes. Because most missed accessory arteries are inconsequential, MRA is a useful, less invasive method for defining donor renovascular anatomy.

Regional differences in right ventricular systolic function as determined by cine magnetic resonance imaging after infundibulotomy.

The right ventricle of subjects after infundibulotomy (n = 20) and of subjects free of right ventricular disease (n = 19) was partitioned into the infundibular and sinus segments to examine the relative size and function of each. Excellent agreement was found between observers for measuring regional volume and ejection fraction. Although the surgical subjects had lower infundibular ejection fraction and higher indexed volumes, most had preserved sinus ejection fraction.

Quantification of pulmonary blood flow and volume in healthy volunteers by dynamic contrast-enhanced magnetic resonance imaging using a parallel imaging technique.

RATIONALE AND OBJECTIVES: We sought to optimize the dosage of a paramagnetic contrast medium (CM) for the quantification of pulmonary blood flow and volume by contrast-enhanced dynamic magnetic resonance imaging (MRI) using a parallel imaging technique and to prove the feasibility of the approach in healthy volunteers. METHODS: In a phantom study, the dependency of signal increase on different concentrations of the CM gadodiamide was evaluated by means of an ultra-fast MRI sequence with a generalized autocalibrating partially parallel acquisition technique (acceleration factor = 2). Using the same sequence, measurements were performed in a healthy volunteer after administration of different CM dosages for contrast dosage optimization in vivo. Finally, perfusion measurements were performed in 16 healthy volunteers after the administration of the optimal CM dose. Signal-time curves were evaluated from the pulmonary artery and from predefined regions of the lung. Pulmonary regional blood volume (RBV) and flow (RBF) were estimated using an open 1-compartment model. RESULTS: Phantom studies yielded a linear signal increase up to a concentration of 5.0 mmol/L gadodiamide. Results of contrast dosage optimization in vivo showed that the maximum CM dose providing a linear relationship between signal increase and CM concentration in the pulmonary artery of a healthy volunteer was approximately 0.05 mmol/kg-bw. Quantification of pulmonary blood volume and flow was reproducible in healthy volunteers, yielding mean values for the upper lung zones of 7.1 +/- 2.3 mL/100 mL for RBV and 197 +/- 97 mL/min/100 mL for RBF and for lower lung zones, 12.5 +/- 3.9 mL/100 mL for RBV and 382 +/- 111 mL/min/100 mL for RBF. CONCLUSIONS: If an adequate amount of gadodiamide and fast MR sequences are used, quantification of pulmonary blood flow and volume is feasible.

Prediction of neurocognitive outcome in adult brain tumor patients.

PURPOSE: To determine the relative contributions of patient, disease and therapy specific factors on neurocognitive outcome of brain tumor patients. PATIENTS AND METHODS: Seventy-nine patients (mean age = 41.1 years; range: 17-75 years; 54% male, 46% female) with glioblastoma multiforme (37%), anaplastic astrocytoma (17%), low grade astrocytoma (13%), and oligodendroglioma (10%) predominantly in the frontal regions (45%) were evaluated in an outpatient neuro-oncology clinic. A neuropsychological test battery emphasized elements of attention/concentration. Multiple regression analyses determined relationships between functional outcomes and demographic and clinical predictors. RESULTS: Key predictors of neurocognitive functioning included age of the patient (36-59 years, p < 0.01; >/= 60 years, p < 0.05) and frontal region tumor location (p < 0.01). As expected, older patients did not perform as well as younger patients in absolute terms on neuropsychological tests; decrements persisted when comparisons were based on age-standardized versions of neurocognitive outcomes. Major depressive disorder was marginally associated with outcomes, while surgical interventions and radiotherapy did not show strong associations with test performances. CONCLUSIONS: Primary malignant brain disease was found to be less negative on neurocognitive outcomes for younger than for either middle-aged or older patients. Treatments were not as predictive of neurocognitive outcomes as age. No single test outcome measure was as sensitive to neurocognitive status as the empirically derived index of attention and concentration.

Anatomic variations in right liver living donors.

BACKGROUND: Anatomic knowledge is crucial in right liver living donor transplantation. STUDY DESIGN: We reviewed radiologic and surgical findings in right liver donors. Arterial and portal anatomy was assessed in 96 donors, biliary anatomy in 77, and hepatic venous anatomy in 65. RESULTS: Portal vein (PV): 86.4% had classic anatomy; 6.3% had a trifurcated PV; 7.3% had a right anterior PV taken off the left PV. Hepatic artery (HA): 70.8% had classic anatomy; 12.5% had a left HA arising from the left gastric artery; 13.5% had a right HA arising from the superior mesenteric artery; 2.1% had a double replaced left HA and right HA; and in 1.0% the common HA arose from the superior mesenteric artery. Biliary tree: 55.8% had normal anatomy; 14.3% had a trifurcated biliary anatomy; in 5.2% the right anterior bile duct and in 15.6% the right posterior bile duct opened into the left bile duct; in 2.6% the right anterior and in 6.5% the right posterior ducts opened into the common bile duct. Hepatic veins: S5 and S8 accessory hepatic veins had incidences of 43% and 49%, respectively. The incidence of S6 or S7 short hepatic vein was 38%. CONCLUSIONS: Anatomic variations are common but do not contraindicate donation; surgeons should be prepared to recognize and manage them.

Time-resolved magnetic resonance angiography as a noninvasive method to characterize endoleaks: initial results compared with conventional angiography.

PURPOSE: Several types of endoleaks have been described, each with different methods of treatment. Conventional arteriography is widely regarded as the gold standard for the classification of endoleaks. Recently, faster magnetic resonance gradients have allowed for rapid data acquisition and review of vascular studies as a real-time continuous angiogram (time resolved magnetic resonance angiography [TR-MRA]). This study was performed to compare the findings of TR-MRA with conventional angiography for the characterization of endoleaks. METHODS: Between June 2002 and June 2003, 12 patients with documented endoleaks following endovascular repair of aortic aneurysms (10 abdominal and two thoracic) underwent TR-MRA to identify and characterize the endoleak. All patients had nitinol-based aortic stent grafts. MRA was performed on a 1.5-Tesla magnet (Sonata class; Siemens Medical Systems, Iselin, NJ). The TR-MRA studies were reviewed under continuous observation as a "cine MR angiogram." These MRA data sets were used to classify the endoleaks into types 1 through 3. The patients underwent conventional angiography following the MRA to confirm the findings and to plan treatment. The MRA findings were compared with the findings made at conventional arteriography. RESULTS: TR-MRA identified seven patients with type 1 leaks, including four proximal and three distal. Four patients had type 2 leaks, including two arising from the inferior mesenteric artery and two from an iliolumbar artery. One patient had a type 3 leak. Conventional angiography confirmed the type of endoleak in all 12 patients. CONCLUSION: These initial results demonstrate TR-MRA to be an effective noninvasive method for classifying endoleaks. This technique may allow for screening of patients with endoleaks to identify those requiring urgent repair.

New techniques and applications for magnetic resonance angiography.

Recent technological advances in magnetic resonance imaging have transformed the field of magnetic resonance angiography (MRA) from a research tool into an important clinical examination that is gaining acceptance as the screening modality of choice in evaluation of vascular disease. This article describes some of the new techniques and applications of MRA in clinical practice today.

Endovascular aortic biopsy in the diagnosis of takayasu arteritis.

PURPOSE: To use a minimally invasive approach to obtain biopsy specimens of the aorta to confirm the diagnosis of Takayasu arteritis and formulate a therapeutic plan. CASE REPORT: A 17-year-old woman with lower extremity claudication and a normal erythrocyte sedimentation rate had magnetic resonance angiography, which suggested stenotic lesions of the infrarenal aorta and left renal artery. An endovascular biopsy of the aortic lesion was performed under local anesthesia, retrieving sufficient tissue to make the diagnosis of Takayasu arteritis. The patient was discharged the same day. CONCLUSIONS: Endovascular aortic biopsy may be useful in diagnosing Takayasu arteritis and guiding the clinician toward the proper mode of treatment.

Predicting major depression in brain tumor patients.

Very few studies have been performed utilizing DSM criteria to diagnose major depressive disorder (MDD) in adult brain tumor patients. This study aimed to diagnose MDD in this population using DSM-IV criteria.Eighty-nine adult brain tumor patients were examined in an ambulatory neuro-oncology clinic setting using a structured psychiatric interview which followed current DSM-IV diagnostic criteria for MDD. This sample was interviewed and evaluated on a one-time basis. The patients were referred for evaluation on a consecutive basis. Multiple regression was used to model critical independent variables to predict MDD.Twenty-eight percent of the sample (N=89) were found to have major depressive disorder using DSM-IV criteria. Key predictors of MDD included frontal region of tumor location (p=0.001), combined sadness and lack of motivation symptoms (p=0.0001), and family psychiatric history (p=0.006). The multiple regression models account for 37% of variance in predicting MDD (R(2)=0.37).A substantially higher incidence of MDD was found in this sample of adult brain tumor patients compared with other adult, ambulatory cancer patients previously evaluated with DSM criteria. The incidence of MDD was about triple that found in other published studies using DSM criteria.

Severe aplastic anaemia and Grave's disease in a paediatric patient.

Severe aplastic anaemia (SAA) is considered to be an autoimmune disorder affecting the haematopoietic cells and most often is idiopathic. An association between SAA and other autoimmune diseases is rare and has been described in adults for eosinophilic fasciitis, thymomas, systemic lupus erythematosus and thyroid disorders. We describe the first paediatric patient with chronic relapsing SAA and Grave's disease. We discuss the difficulty in diagnosis of Grave's disease, the possibility of its manifestation due to withdrawal of immunosuppressants, and issues to consider in the treatment of this disease in the setting of bone marrow failure.