Einleitung: Obwohl pulmonale Erkrankungen in der Regel eine regional unterschiedliche Beteiligung des Lungenparenchyms aufweisen ist die Spirometrie als globale Messmethode immer noch der Goldstandard der Lungenfunktionsdiagnostik. Mit dynamischer MRT lässt sich die Lungenbewegung einzelner Lungenhälften mit einer zeitlichen Auflösung von bis zu 10 Bildern pro Sekunde erfassen. Eine Methode zur semiautomatischen Auswertung dieser Aufnahmen wird vorgestellt.

PURPOSE:Supplementing global spirometry with regional information could allow for earlier and more specific diagnosis of lung disease. Dynamic magnetic resonance imaging (dMRI) makes it possible to derive functional parameters from the visualization of the pulmonary motion of single lungs. The aim of this study was to compare high temporal resolution measurements of left and right thoracic diameters to simultaneously acquired spirometry.MATERIALS AND METHODS:10 healthy volunteers underwent 2-dimensional dMRI of both lungs at 1.5 T. Spirometry was performed simultaneously with an MRI-compatible spirometer. Thoracic diameters were measured semiautomatically and compared to simultaneously measured spirometric volumes. A dMRI surrogate for the Tiffeneau Index was compared to the spirometric Tiffeneau.RESULTS:The volume-time and flow-volume curves from dMRI were very similar to the spirometric curves. The semiautomatically measured diameters correlated well with the spirometric volumes (r > = 0.8, p < 10 - 15). Agreement between the methods at full temporal resolution was not as convincing (width of 95 % limits of agreement interval up to 56 %). Good agreement was found between the Tiffenau surrogate and spirometry (width of 95 % limits of agreement interval of 14.5 %).CONCLUSION:DMRI with semiautomatic measurement of thoracic diameters makes measurement of realistic volume-time and flow-volume curves from single lungs possible. The derived single lung Tiffeneau Index shows good agreement to spirometry and could be valuable to supplement global spirometric measurements with functional data from single lungs.

L’IRM dynamique 2D permet de déduire des paramètres fonctionnels pulmonaires régionaux qui pourraient supplémenter la spirométrie et son information globale. Etude réalisée sur 10 volontaires avec une séquence IRM-2D dynamique (8,5 images/sec.) en orientation sagittale sur le poumon droit. Les volumes respiratoires ont été mesurés simultanément avec un spiromètre compatible avec l’IRM. Le diamètre thoracique antéro-postérieur, la longueur crânio-caudale ainsi que l’aire pulmonaire ont été calculés semi-automatiquement par ordinateur. L’évolution de ces paramètres en fonction du temps a été comparée visuellement avec les courbes spirométriques. Par ailleurs, ces paramètres quantitatifs IRM ont été normalisés et comparés quantitativement avec les mesures du spiromètre. Enfin, un équivalent de l’index de Tiffeneau calculé avec les valeurs IRM a été évalué. Les courbes IRM sont visuellement concordantes avec la spirométrie. Une excellente corrélation est d’ailleurs observée (Pear-son: r = 0,94). La représentation de Bland-Altman montre néanmoins des différences quantitatives importantes (écart-type des différences = 13 %). Les différences sont moins importantes lorsqu’on compare l’aire pulmonaire et la spirométrie. L’index de Tiffeneau calculé avec l’IRM permet d’améliorer encore les résultats. L’aire pulmonaire mesurée par IRM-2D dynamique est bien corrélée avec la spirométrie et permet contrairement au spiromètre une évaluation fonctionnelle spécifique du poumon examiné.

Ziele: Quantifizierung von Lungenrundherdvolumina und Lungenrundherdrotation während des Atemzyklus unter Verwendung einer speziellen 3D MR Technik (dynamische MRT, dMRT) welche parallele Bildgebung mit Techniken des View Sharing kombiniert. Methode: Die dMRT wurde unter Verwendung einer speziellen 3D FLASH Sequenz durchgeführt, welche parallele Bildgebung (GRAPPA Algorithmus, Faktor 2) mit View Sharing kombiniert (TR/TE: 1.5/0.6 msek; 3.8×3.8×3.8 mm3; Scanzeit pro 3D Datensatz: 1 Sekunde). Zur Validierung wurden ebenfalls Phantome eingesetzt (Fleichbällchen: 130ml, 40ml, 12ml) und semiautomatisch segmentiert; 21verschiedene mathematische Rechenalgorithmen wurden untersucht um die Partialvolumeneffekte zu korrigieren und die berechneten Volumina wurden mit den tatsächlichen Volumina der Phantome, bestimmt durch deren Wasserverdrängung, verglichen. Die Techniken wurde bei 5 Patienten mit einem niedergradigen Bronchialkarzinom angewendet (4m/1 f) und mittels CT und Histologie verifiziert. Die Lungenrundherdrotation während der Atmung wurde quantifiziert unter Verwendung sogenannter Bounding-Box Techniken. Ergebnis: Der genaueste Algorithmus (r >0.9, p<0.01) zur Korrektur der Partialvolumeneffekte zeigte eine mittlere Standardabweichung von 14% gegenüber den tatsächlichen Volumina (errechnete Phantomvolumina 120.8±4.1ml, 36.1±3.98 ml und 13.1±1.5ml). Es zeigte sich kein signifikanter Unterschied zwischen MRT, CT und histologischem Volumina. Mit dieser Methode konnten deutliche volumetrische und rotatorische Veränderungen der Lungenrundherde während der Atmung nachgewiesen werden. Schlussfolgerung: 3D dMR Techniken ermöglichen eine nicht-invasive Quantifizierung von Lungenrundherdvolumina und –rotationen während des Atemzyklus.

Intraluminal mobile thrombus of the descending aorta are rare disorders. They are at high risk for peripheral embolism and therefore indication for treatment is mandatory. We report on a 54-year-old patient with peripheral arterial embolization who was treated by surgical thrombus removement by thoracotomy and staged peripheral bypass grafting. New diagnostic tools are presented, therapy and prognosis are discussed.

Purpose: To monitor lung motion in patients with malignant pleural mesothelioma (MPM) before and after chemotherapy (CHT) using 2-dimensional (2D) and 3-dimensional (3D) dynamic MRI (dMRI) in comparison with spirometry.Methods and Materials: Twenty-two patients with MPM were examined before CHT, as well as after 3 and 6 CHT cycles (3 months and 6 months) using 2D dMRI (trueFISP; 3 images/s) and 3D dMRI (FLASH 3D, I slab (52 slices)/s) using parallel imaging in combination with view-sharing technique. Maximum craniocaudal lung dimensions (2D) and lung volumes (3D) were monitored, separated into the tumor-bearing and nontumor-bearing hemithorax. Vital capacity (VC) was measured for comparison using spirometry.Results: Using 2D technique, there was a significant difference between the tumor-bearing and the nontumor-bearing hemithorax before CHT (P < 0.01) and after 3 CHT cycles (P < 0.05), whereas difference was not significant in the second control. In the tumor-bearing hemithorax, mobility increased significantly from the status before versus after 3 CHT cycles (4.1 +/- 1.1 cm vs. 4.8 +/- 1.4 cm, P < 0.05). Using 3D technique, at maximum inspiration, the volume of the tumor-bearing hemithorax was 0.6 +/- 0.4 L and of the nontumor-bearing hemithorax 1.25 +/- 0.4 L before CHT. In the follow-up exams, these volumes changed to 1.05 +/- 0.4 L (P < 0.05) and 1.4 +/- 0.5 L, respectively. Using spirometry, there was no significant change in VC (1.9 +/- 0.4 L vs. 2.2 +/- 0.7 L vs. 2.2 +/- 0.9 L).Conclusion: dMRI is capable of monitoring changes in lung, motion and volumetry in patients with MPM not detected by global spirornetry. Thus, dMRI is proposed for use as a further measure of therapy response.

Purpose: To develop a model for exactly reproducible respiration motion simulations of animal lung explants inside an MR-compatible chest phantom. Materials and Methods: The materials included a piston pump and a flexible silicone reconstruction of a porcine diaphragm and were used in combination with an established MR-compatible chest phantom for porcine heart-lung preparations. The rhythmic inflation and deflation of the diaphragm at the bottom of the artificial thorax with water (1 - 1.5 L) induced lung tissue displacement resembling diaphragmatic breathing. This system was tested on five porcine heart-lung preparations using 1.5T MRI with transverse and coronal 3D-GRE (TR/TE = 3.63/1.58, 256 x 256 matrix, 350 mm FOV, 4 mm slices) and half Fourier T2-FSE (TR/TE = 545/29, 256 x 192, 350 mm, 6 mm) as well as multiple row detector CT (16 x 1 mm collimation, pitch 1.5, FOV 400 mm, 120 mAs) acquired at five fixed inspiration levels. Dynamic CT scans and coronal MRI with dynamic 2D-GRE and 2D-SS-GRE sequences (image frequencies of 10/sec and 3/sec, respectively) were acquired during continuous "breathing" (7/minute). The position of the piston pump was visually correlated with the respiratory motion visible through the transparent wall of the phantom and with dynamic displays of CT and MR images. An elastic body splines analysis of the respiratory motion was performed using CT data. Results: Visual evaluation of MRI and CT showed three-dimensional movement of the lung tissue throughout the respiration cycle. Local tissue displacement inside the lung explants was documented with motion maps calculated from Cr. The maximum displacement at the top of the diaphragm (mean 26.26 [SD 1.9] mm on CT and 27.16 ISD 1.5] mm on MRI, respectively [p = 0.25; Wilcoxon test]) was in the range of tidal breathing in human patients. Conclusion: The chest phantom with a diaphragmatic pump is a promising platform for multi-modality imaging studies of the effects of respiratory lung motion.

(MD-CT) revealed a 5.0 4.0 2.7 cm tumor of soft tissue density, heterogeneous contrast medium enhancement derivation from the infrarenal vena cava and infiltrating the surrounding tissue. Panel A shows contrast-enhanced CT in the axial (a) and coronal (b) reconstructed view demonstrating an abdominal mass (arrow). A primary leiomyosarcoma of the vena cava inferior was assumed. Staging using CT thorax and bone scintigraphy presented no evidence of metastatic spread. Phlebography of the vena cava inferior confirmed an obstruction of lumen (Panel B, arrow) with prominent lumbar veins for collateral venous blood flow via azygos and hemiazygos veins. For surgical planning, multiphasic magnetic resonance angiography (CE-MRA) (Panel C, arrow) was performed to evaluate the degree of vascular involvement (local tumor infiltration and renal vessel involvement), but tumor involvement of renal venous vasculature was still uncertain. Therefore, computer-assisted surgical planning using the three-dimensional (3D) surface rendering technique was performed based on multiphasic CE-MRA raw data (Panel D). The virtual imaging techniques allowed an intra-luminal view and revealed left and right renal veins without direct tumor involvement (Panel D). Results of computer-assisted planning are as follows: vena cava (blue) and tumor (hatched) (Panel D, left) have been Vascular Medicine 2005; 10: 55–57

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not.The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Visualization of peripheral pulmonary artery stenosis using high-resolution multidetector computed tomography

RATIONALE AND OBJECTIVES:We sought to investigate lung volume and surface measurements during the breathing cycle using dynamic three-dimensional magnetic resonance imaging (3D MRI). MATERIALS AND METHODS:Breathing cycles of 20 healthy volunteers were examined using a 2D trueFISP sequence (3 images/second) in combination with a model and segmented 3D FLASH sequence (1 image/second) MR images using view sharing. Segmentation was performed semiautomatically using an interactive region growing technique. Vital capacity (VC) was calculated from MRI using the model (2D) and counting the voxels (3D) and was compared with spirometry. RESULTS:VC from spirometry was 4.9+/-0.9 L, 4.4+/-1.2 L from 2D MRI measurement, and 4.7+/-0.9 L for 3D MRI. Using the 3D technique, correlation to spirometry was higher than using the 2D technique (r>0.95 vs. r>0.83). Using the 3D technique, split lung volumes and lung surface could be calculated. There was a significant difference between the left and right lung volume in expiration (P<0.05). CONCLUSIONS:Dynamic 3D MRI is a noninvasive tool to evaluate split lung volumes and lung surfaces during the breathing cycle with a high correlation to spirometry.

HomeCirculationVol. 109, No. 14Cervical Origin of the Subclavian Artery Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBCervical Origin of the Subclavian ArteryImaging of a Rare but Clinically Relevant Anomaly Gerald F. Greil, MD, Axel Kuettner, MD, Ludger Sieverding, MD, Max Schoebinger, MSc, Hans-Peter Meinzer, PhD, Ralf Rauch, MD, Jürgen F. Schaefer, MD, Claus D. Claussen, MD and Michael Hofbeck, MD Gerald F. GreilGerald F. Greil From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Axel KuettnerAxel Kuettner From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Ludger SieverdingLudger Sieverding From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Max SchoebingerMax Schoebinger From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Hans-Peter MeinzerHans-Peter Meinzer From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Ralf RauchRalf Rauch From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Jürgen F. SchaeferJürgen F. Schaefer From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Claus D. ClaussenClaus D. Claussen From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author and Michael HofbeckMichael Hofbeck From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author Originally published13 Apr 2004https://doi.org/10.1161/01.CIR.0000121564.12555.8BCirculation. 2004;109:e177–e178A 4-year-old boy was referred to our hospital for further treatment of pulmonary atresia (Fallot type), multiple systemic to pulmonary collateral arteries, and hypoplastic central pulmonary arteries. Echocardiography revealed cervical origin of the right subclavian artery, which originated close to the bifurcation of the internal and external carotid arteries (Figure 1, Movie I, and Movie II). The anomaly of the subclavian artery was confirmed with cardiac catheterization (Figure 2A, Movie III). In addition, the boy had dysmorphic features of conotruncal anomaly facies syndrome, and monosomy 22q11 was confirmed by cytogenetic testing. To improve antegrade perfusion of the hypoplastic central pulmonary arteries, the patient underwent creation of a central aortopulmonary shunt followed by interventional coil occlusion of a large collateral artery from the descending aorta. The postoperative course was complicated by formation of a seroma of the polytetrafluoroethylene shunt, diagnosed by computed tomography (CT) of the thorax. Using a 16 detector CT scanner (Sensation 16, Siemens AG), a complete 3-dimensional data set of the neck, thorax, and upper abdomen was acquired in 10 seconds with nearly isotropic voxels (0.5×0.5×0.6 mm) using a single injection of 17 mL of contrast agent (Imeron 400) in a peripheral vein. The CT scan revealed the seroma, and 3-dimensional reconstruction demonstrated clearly the anomaly of the right subclavian artery (Figure 2B, Movie IV). After surgical revision of the seroma and balloon dilatation of a right pulmonary artery stenosis, the patient made an uneventful recovery. According to the literature, cervical origin of the subclavian artery is highly specific for 22q11 syndromes as demonstrated in this patient. Download figureDownload PowerPointFigure 1. Color-Doppler echocardiography (longitudinal section of the right neck) demonstrates cervical origin of the right subclavian artery (RSA) from the right common carotid artery (RCCA) in proximity to the bifurcation of the external (ECA) and internal (ICA) carotid arteries (A). A slightly inferior position of the transducer shows the parallel course of the RSA and RCCA in the lower neck (B). A indicates anterior; P, posterior; S, superior; and I, inferior.Download figureDownload PowerPointFigure 2. The angiogram (A) and a 3-dimensional surface reconstruction of the aorta with the great arteries based on a multidetector-row computed tomographic (16 detector) data set (B) are shown. The first right (RC) and left costa (LC) demonstrate in combination with the right (RCL) and left clavicle (LCL) the cervical origin of the right subclavian artery (arrow). Ao indicates aorta; LSA, left subclavian artery. Other abbreviations as in Figure 1.Movies I through IV are available in the online-only Data Supplement at http://www.circulationaha.org.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.The multidetector-row CT is partly supported by Siemens Medical Systems.FootnotesCorrespondence to Gerald F. Greil, MD, Department of Cardiology, Children’s Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Pandey N, Bhambri K and Kumar S (2020) Cervical origin of right subclavian artery associated with tetralogy of Fallot, Journal of Cardiac Surgery, 10.1111/jocs.14789, 35:8, (2037-2038), Online publication date: 1-Aug-2020. Machado R, Moubayed S, Khorsandi A and Urken M (2016) The importance of recognizing a cervical origin of the right subclavian artery, The Laryngoscope, 10.1002/lary.25991, 126:11, (2497-2499), Online publication date: 1-Nov-2016. Greil G, Wolf I, Kuettner A, Fenchel M, Miller S, Martirosian P, Schick F, Oppitz M, Meinzer H and Sieverding L (2007) Stereolithographic reproduction of complex cardiac morphology based on high spatial resolution imaging, Clinical Research in Cardiology, 10.1007/s00392-007-0482-3, 96:3, (176-185), Online publication date: 1-Mar-2007. Greil G, Schoebinger M, Kuettner A, Schaefer J, Dammann F, Claussen C, Hofbeck M, Meinzer H and Sieverding L (2006) Imaging of aortopulmonary collateral arteries with high-resolution multidetector CT, Pediatric Radiology, 10.1007/s00247-006-0143-0, 36:6, (502-509), Online publication date: 1-Jun-2006. April 13, 2004Vol 109, Issue 14 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000121564.12555.8BPMID: 15078807 Originally publishedApril 13, 2004 PDF download Advertisement