Memantine prevents hypoglycemia-induced decrements of the cerebral energy status in healthy subjects.

CONTEXT: The risk to develop dementia is significantly increased in diabetes mellitus. Memantine, an N-methyl-D-aspartate receptor antagonist, which is clinically applied in dementia, has been shown to exert neuroprotective effects under hypoglycemic conditions in rats. OBJECTIVE: We hypothesized that memantine may prevent hypoglycemia-induced decrements in the cerebral high-energy phosphate, i.e. ATP, metabolism to exert its neuroprotective action under these conditions. DESIGN AND PARTICIPANTS: In a randomized, double-blind crossover design, we applied memantine vs. placebo in 16 healthy male subjects and examined the cerebral high-energy phosphate metabolism by (31)phosphor magnetic resonance spectroscopy, hormonal counterregulation, and neurocognitive performance during hypoglycemic glucose clamp conditions. RESULTS: We found increments in hormonal counterregulation and reduced neurocognitive performance during hypoglycemia (P < 0.05). Cerebral ATP levels increased upon hypoglycemia in the memantine condition as compared with placebo (P = 0.006) and remained higher after renormalizing blood glucose concentrations (P = 0.018), which was confirmed by ATP to inorganic phosphate ratio (P = 0.046). Phosphocreatine levels and phosphocreatine to inorganic phosphate ratio remained stable throughout the experiments and did not differ between conditions (P > 0.1 for both). CONCLUSION: Our data demonstrate that memantine preserves the cerebral energy status during experimentally induced hypoglycemia in healthy subjects. An improved neuronal energy status may thus be involved in the neuroprotective effect under these conditions and may qualify memantine as potential future option to combat cognitive impairments and dementia in diabetes.

Development of a cryo-device for minimal-invasive application under MRI-control.

This paper describes the development of a cryo-device for the treatment of tumors. The probes are intended to form an iceball inside of an organ, e.g. the liver, to destroy degenerated cells. After successful preliminary tests and the development and construction of several probes, the emphasis is now being placed on the realization of a complete device prototype which will enable clinical studies to be carried out. Important for the functionality of the device is an integrated temperature sensor inside the probes. The device may also be used for cryo-analgesic purposes in pain treatment.

Activation of the cerebellum by sensory finger stimulation and by finger opposition movements. A functional magnetic resonance imaging study.

Activation of the ipsilateral anterior lobe of the cerebellum by means of hand movements by humans is a well-known phenomenon, but the cerebellar encoding of sensory information has not been well established. The authors delineated the representation of sensory stimulation of fingers in the anterior lobe of the cerebellum using functional magnetic resonance imaging sensitized to changes in blood oxygenation and compared these areas to the regions activated by means of finger opposition movements. Activation was determined by means of pixel-by-pixel correlation of the signal intensity time course with a reference waveform equivalent to the stimulus protocol. All subjects showed significant activation of the anterior lobe of the cerebellum, mainly located in the ipsilateral Larsell lobules IV-V and less consistent in the vermis in relation to sensory finger stimulation. Among some subjects the authors also found activation in the anterior lobe on the contralateral side. The finger movements activated regions that overlapped with the areas activated by sensory finger stimulation but showing a larger and more intense activation pattern.

Preoperative functional magnetic resonance imaging (fMRI) of the motor system in patients with tumours in the parietal lobe.

Intracranial lesions may compromise structures critical for motor performance, and mapping of the cortex, especially of the motor hand area, is important to reduce postoperative morbidity. We investigated nine patients with parietal lobe tumours and used functional MRI sensitized to changes in blood oxygenation to define the different motor areas, especially the primary sensorimotor cortex, in relation to the localization of the tumour. Activation was determined by pixel-by-pixel correlation of the signal intensity time course with a reference waveform equivalent to the stimulus protocol. All subjects showed significant activation of the primary sensorimotor cortex while performing a finger opposition task with the affected and unaffected side. In five patients the finger opposition task additionally activated the ipsilateral sensorimotor cortex and the supplementary motor area (SMA). Extension and flexion of the foot, additionally performed in two patients, also activated the sensorimotor cortex, in one case within the perifocal oedema of the tumour. Tumour localization near the central sulcus induced displacement of the sensorimotor cortex as compared to the unaffected side in all patients with a relevant mass effect. The results of our study demonstrate that functional MRI at 1.5 T with a clinically used tomograph can reproducibly localize critical brain regions in patients with intracranial lesions.

The total entropy for evaluating 31P-magnetic resonance spectra of the liver in healthy volunteers and patients with metastases.

RATIONALE AND OBJECTIVES: The authors describe the clinical status of liver tissue with only a single numerical quantity (total entropy) derived from spectroscopic data of 31P-magnetic resonance (MR) spectra. METHODS: Twenty-four patients with liver metastases and 20 volunteers were investigated with image-guided volume selective 31P-MR spectroscopy on a 1.5-T whole body scanner. From each in vivo 31P-MR spectrum, the ratios of phosphomonoester (PME)/beta-adenosine triphosphate (ATP), inorganic phosphate (Pi)/beta-ATP and phosphodiester (PDE)/ beta-ATP and the total entropy (H*) were calculated. Mean values and standard deviations were determined and significance of the differences were tested with Student's t test. RESULTS: For patients, the H* = 4.7 +/- 4.3, PME/beta-ATP 0.72 +/- 0.28, Pi/beta-ATP = 1.00 +/- 0.39, PDE/beta-ATP = 1.68 +/- 0.59. For the volunteers, H* = 7.6 +/- 2.5, PME/beta-ATP = 0.39 +/- 0.15, Pi/beta-ATP = 0.90 +/- 0.19, PDE/beta-ATP = 1.25 +/- 0.28. The total entropy of patients' spectra showed significantly lower values compared with those of volunteers. PME/beta-ATP and PDE/beta-ATP of the patients increased and differed significantly from volunteer data. CONCLUSIONS: It was demonstrated that the results of in vivo 31P-MR spectroscopy may be described with a single criterion by means of the total entropy.

Visualization of magnetic resonance-compatible needles at 1.5 and 0.2 Tesla.

PURPOSE: For two types of passively visualizable magnetic resonance (MR)-compatible needles, the size of susceptibility artifacts was investigated at 0.2 and 1.5 Tesla (T) and assessed regarding their suitability for needle visualization. METHODS: Phantom trials were performed using T1-weighted spin echo (SE), turbospin echo (TSE) and gradient echo (GE) sequences and different angles beta between the needles and the main magnetic field (B0). RESULTS: Depending on the needle angle beta and the applied pulse sequence, we found artifact diameters of 0-9.7 mm employing SE, of 1.7-9.4 mm employing TSE, and of 1.4-20.6 mm employing GE at 1.5 T. At 0.2 T, we found artifact diameters of 0-5.7 mm employing SE, of 0-6.3 mm employing TSE, and of 0-11.3 mm employing GE. CONCLUSION: Comparing artifact sizes at 1. 5 T and 0.2 T, low field strength is superior for passive visualization of the needles tested-especially if GE imaging is performed.

Influence of different fasting periods on P-31-MR-spectroscopy of the liver in normals and patients with liver metastases.

The purpose of this study was to determine the influence of different fasting periods on the in vivo P-31-MR spectroscopy of the healthy liver and patients with liver metastases. Image-guided localized P-31-MRS was performed in 24 patients with liver metastases and in 20 healthy volunteers. The spectra were obtained with a whole body scanner operating at 1.5 T using a surface coil. The P-31-MRS was performed after a fasting period of 3-5 h (group 1) and after overnight fasting (group 2). The PME/beta-NTP, PDE/beta-NTP and Pi/beta-NTP were calculated from P-31-MR spectra and were compared in relation to the nutrition status of the volunteers and patients. The PME/beta-NTP and PDE/beta-NTP were significantly increased in spectra of patients with metastases. There were no significant changes in the ratios of phosphorus metabolites in healthy liver tissue or in liver metastases after a fasting period of 3-5 h as compared with overnight fasting.

Cine MR imaging before and after realignment surgery for patellar maltracking -- comparison with axial radiographs.

OBJECTIVE: Comparison of motion-triggered cine magnetic resonance (MR) imaging and conventional radiographs for the assessment of operative results of patellar realignment. SUBJECTS AND METHODS: Fifteen patients with recurrent patellar dislocation or patellar subluxation were evaluated with conventional axial radiographs before and after realignment surgery by measuring the congruence angle (CA), lateral patellofemoral angle (LPFA), and lateral displacement (d). In eight patients the patellofemoral joint was additionally evaluated pre- and postoperatively with motion-triggered cine MR imaging by determining the bisect offset (BSO), lateral patellar displacement (LPD), and patellar tilt angle (PTA). RESULTS AND CONCLUSIONS: Significant differences between the pre- and postoperative measurements were found for all MR imaging parameters (BSO, LPD, PTA: p<0.01) but not for the conventional X-ray parameters (CA: p = 0.70, LPFA: p = 0.56; d: p = 0.04). Motion-triggered cine MR imaging was superior to conventional tangential radiographs for assessing the effectiveness of patellar realignment surgery.

Application of the maximum entropy method for evaluating phosphorus-31-magnetic resonance spectra in patients with liver metastases.

RATIONALE AND OBJECTIVES: The clinical feasibility and application of the maximum entropy method for data analysis from in vivo phosphorus-31-magnetic resonance (P-31-MR) spectra of the liver were determined. METHODS: Image-guided localized P-31-MR spectroscopy was performed in 24 patients with liver metastases and in 20 healthy volunteers. The spectra were obtained with a whole body scanner operating at 1.5 T using a surface coil. Phosphomonoester/beta-adenosine triphosphate (ATP), phosphodiester/beta-ATP, and inorganic phosphate/beta-ATP were calculated from the maximum entropy method-spectra and from spectra evaluated with standard data processing (Fourier transformation spectra). RESULTS: Phosphomonoester/beta-ATP and phosphodiester/beta-ATP were increased significantly with both methods in patients' spectra. Maximum entropy method spectra showed a distinct pattern with low noise. It was easier to determine peak borders and to attach resonances to the different metabolites using this method. CONCLUSIONS: Maximum entropy method is an alternative method for evaluation and quantification of P-31-MR spectra data and is preferred to standard data processing with Fourier transformation in cases of reduced signal-to-noise ratio of spectra.

In vivo P-31-MR-spectroscopy of focal hepatic lesions. Effectiveness of tumor detection in clinical practice and experimental studies of surface coil characteristics and localization technique.

RATIONALE AND OBJECTIVES: The influence of partial tumor sampling in a volume of interest (VOI) on the ratios of phosphorus metabolites was examined by localized phosphorus magnetic resonance spectroscopy (P-31-MRS). Experiments were performed to investigate the characteristics of the surface coil used and precession of spatial localization. METHODS: A total of 24 patients with liver metastases and 20 volunteers were studied by P-31-MRS. Patients were divided in two groups: VOI < 50% (n = 8) and VOI > 50% (n = 16) occupied by tumor. For evaluation of the surface coil and localization method (image selected in vivo spectroscopy), phantom studies were performed. RESULTS: Superficial focal liver tumors were detectable with a surface coil at a distance within the coil radius. The image selected in vivo spectroscopy permitted the study of phosphorus metabolism in a defined VOI, phosphomonoester/beta-adenosine triphosphate and phosphodiester/beta-adenosine triphosphate were elevated significantly in spectra of both patient groups. CONCLUSIONS: Detection of small tumor volumes within a VOI filled by less than 50% of the tumor is possible, with results statistically different from that in normal volunteers.

Evaluation of patellar tracking in patients with suspected patellar malalignment: cine MR imaging vs arthroscopy.

OBJECTIVE: The purpose of this study was to compare results of motion-triggered cine MR imaging of active extension of the knee with arthroscopic findings in cases of suspected femoropatellar malalignment. SUBJECTS AND METHODS: Twenty patients with clinically proved or suspected patellar subluxation or dislocation were examined prospectively with motion-triggered cine MR imaging to analyze patellar tracking from 30 degrees of flexion to full extension during active extension of the knee. The patellar tracking pattern was evaluated by measuring the following: bisect offset and lateral patellar displacement to assess lateralization of the patella and the patellar tilt angle to assess tilting of patella. The slopes of the linear regression lines of the MR findings vs the knee angle position, representing the patellar tracking, and the position of the patella at 30 degrees and 0 degrees of flexion were correlated with a semiquantitative arthroscopic classification of patellar tracking that had four categories ranging from normal to highly abnormal. RESULTS: The results showed a significant correlation between the semiquantitative arthroscopic findings of patellar tracking and the slopes of the linear regression lines of the bisect offset, lateral patellar displacement, and patellar tilt angle, as measured with cine MR imaging (p < .01). The arthroscopic findings also correlated significantly with the position of the patella when the knee was extended (p < .01), but not with the knee flexed 30 degrees. CONCLUSION: We conclude that motion-triggered cine MR imaging of active extension of the knee enables the dynamic evaluation of patellar bracing and is therefore suitable for noninvasive analysis of patellar tracking.

[31P-MR spectroscopy of liver diseases with reference to variable pulse recovery times]. / 31P-MR-Spektroskopie von Lebererkrankungen unter Berücksichtigung von unterschiedlichen Pulswiederholungszeiten.

The value of 31P-MRS for different types of liver disease and the effect of repetition time (TR) on measurements of relative phosphor metabolite concentrations was studied. Spectroscopy was performed on 26 patients with predominantly focal liver disease and on 14 normals, using a 1.5 Tesla clinical MR system. In all cases, (TR) of 2,400 ms was chosen and in 11 patients and 10 normals additionally shorter (TR) of 600 ms (with T1 weighted spectra) was chosen. The results show that PME/beta-ATP and PDE/beta-ATP are sensitive indicators of liver disease and differ widely from the findings in normal livers. In patients with liver metastases, the long (TR) of 2,400 ms (16 cases) showed an increase of PME/beta-ATP (0.96 +/- 0.32) and significant reduction of PDE/beta-ATP (1.89 +/- 0.47) as compared with normals (PME/beta-ATP = 0.75 +/- 0.26 and PDE/beta-ATP = 2.27 +/- 0.41), for a (TR) of 600 ms, PME/beta-ATP (0.87 +/- 0.47) and PDE/beta-ATP (1.82 +/- 0.67) are significantly increased. T1 weighted spectra showed more significant differences in phosphometabolites between patients and normals than density weighted spectra. The spectra in patients showed a significantly reduced signal to noise ratio independent of the (TR).

Patellar tracking patterns during active and passive knee extension: evaluation with motion-triggered cine MR imaging.

To evaluate the critical range of the patellofemoral joint motion from 30 degrees of knee flexion to full extension, motion-triggered cine magnetic resonance (MR) imaging was performed during active extension in 13 patients with confirmed patellar maltracking and 15 healthy subjects. Cine MR images were compared with static MR images obtained during incremental extension of the knee joint. To evaluate the patellar tracking pattern, the same imaging parameters (patellar tilt angle, bisect offset, and lateral patellar displacement) and section locations were used in the static and motion-triggered studies. Statistically significant differences between the passive and active knee motions were found in all three parameters in the group of patients and in the bisect offset in the control group. The comparison between patients and healthy subjects yielded statistically significant differences for all parameters in actively extended knees but not in passively extended knees. The results demonstrate the importance of dynamic patellar motion studies for diagnosis of patello-femoral maltracking.

[How tolerant are partial dose values? Some additional remarks on the concept of a tolerance dose]. / Wie tolerant sind Partialdosiswerte? Einige ergänzende Bemerkungen zu dem Konzept der Toleranzdosis.

By means of the NSD formula and its modifications (CRE, TDF) evaluated from radiotherapy experience by Ellis, it is possible to estimate the acceptance of applied radiotherapy and fractionation scheme. Because the parameters of the Ellis formula are calculated from patients data, they show a dispersion as usually in biological systems. These dispersions are considered as entrance error. In mathematical transformations errors are multiplied according to the principle of superposition of errors. Especially when judging tolerance values of organs of risk the dispersion is quite important. The problem of dispersion of resulting partial tolerance values is demonstrated by some examples of clinical cases.

[The femoropatellar gliding motion during active knee stretching. Imaging using motion-triggered MR tomography]. / Die femoropatellare Gleitbewegung während aktiver Kniestreckung. Darstellung mit bewegungsgetriggerter MR-Tomographie.

By means of motion-triggered MRT it has been possible for the first time to demonstrate movements in the patello-femoral joint by means of MRT. Patello-femoral movement was studied during active extension of the knee between 30 degrees flexion and complete extension. The knees of 5 normal females and 7 normal males were studied together with 2 women with recurrent lateral patellar luxation. In normal women there was an average 16 degrees (10 to 18 degrees), in men an average of 12 degrees (10 to 14 degrees) of lateralisation of the patella during complete extension of the knee. In 1 patient there was 10 degrees medial displacement of the patella before extension. In 2 knees with recurrent lateral subluxation there was a 20 and 24 degrees displacement of the patella.

[In vivo 31-phosphorus MR spectroscopy of the calf musculature in arterial occlusive diseases]. / In-vivo-31Phosphor-MR-Spektroskopie der Wadenmuskulatur bei arterieller Verschlusskrankheit.

Muscle metabolism was measured in 7 patients with arterial occlusive disease and symptoms of intermittent claudication both before and after percutaneous vascular neurolysis by means of dynamic 31P-MR spectroscopy. Phosphorus spectra of the involved calf muscles were determined before, during and after defined treadmill exercise. In addition to pH values the phosphocreatine content was measured during activity and recovery phases. There was close correlation in these patients between the increase in claudication distance and more rapid regeneration of phosphocreatine following neurolysis. However, none of the patients achieved normal values of phosphate metabolism. By means of the non-invasive 31P-MR spectroscopy it was possible for the first time to demonstrate the biochemical changes associated with neurolytic lumbar sympathetic blockade.

A study of T1-weighted 31phosphorus MR-spectroscopy from patients with focal and diffuse liver disease.

31P-MR-Spectroscopy was performed in 28 patients with focal (n = 23) and diffuse (n = 5) liver disease and in 18 healthy volunteers. The spectra were obtained with a whole body scanner operating at 1.5 T by using a surface coil. To get T1-weighted 31P-spectra a short TR of 600 msec was taken, because T1-weighted spectra of focal liver disease were more significantly different from spectra from healthy volunteers than density weighted ones. The VOI from patients with focal superficial alterations showed a mean volume of 172 ml, with diffuse liver disease 196 ml, and from volunteers 158 ml. Focal tumors filled up the VOI on an average of 70%. This investigation demonstrated that PME/beta-ATP- and PDE/beta-ATP-ratios were sensitive indicators for focal liver disease. As a result of this study we could establish a significant increase of PME/beta-ATP- (0.75 +/- 0.30) and PDE/beta-ATP-ratios (1.68 +/- 0.62) in patients with superficial focal liver metastases (n = 19) compared to the control group (PME/beta-ATP: 0.49 +/- 0.17, PDE/beta-ATP: 1.24 +/- 0.24; t-test: p < 0.02). Patients with a hemangioma (n = 1), liver infarction (n = 1), empyema of gallbladder (n = 1) and a hepatic involvement by a malignant lymphoma (n = 1) showed a similar increase of PME/beta-ATP and/or PDE/beta-ATP. Up to now spectral changes seemed to be non-specific. The ratios of 31P metabolites of the cirrhoses (n = 4) and the fatty liver (n = 1) did not show any characteristic changes versus the volunteers.

Motion-triggered cine MR imaging of active joint movement.

MRI cine studies of active physiological joint movement can provide additional functional information as a supplement to standard examinations. With the ankle joint as an example, it is shown that it is possible to measure kinematic MRI presentations of active joint movement. A pneumatic pressure transducer, a respiratory monitor, and an active differentiator transformed the skin muscle shifting of periodically performed joint movement to a pseudo-ECG, which finally triggered the MRI scanner as in cardiac cine MR imaging.