The WCC Note

Your Weekly Guide to Harmonizing Clinical Trial Imaging

Archive for the ‘Cardiovascular’ Category

MRI: Catheter Guidance & Stroke and HGF: Emphysema – Vol. 2, Number 21

Tuesday, August 12th, 2008

MRI: CATHETER GUIDANCE

In Vivo Real-Time MRI Catheter Guidance Proves Feasible
In the setting of heart rhythm dysfunction, it is sometimes necessary to map out, assess, and treat the electrical pathways in the heart.  Electrophysiological studies of the heart achieve this and entail directing catheters to specific locations within the heart.  Currently, physicians employ conventional fluoroscopy to guide the catheters.  However, MRI affords superior soft-tissue visualization compared to fluoroscopy and lacks fluoroscopy’s radiation.  Thus it would be advantageous to place catheters under MRI guidance, rather than the conventionally used fluoroscopy.  Potential barriers to electrophysiological studies are the magnetic force and electromagnetic interference inherent in MRI.  Reporting in Circulation, researchers at Johns Hopkins University achieved successful intracardiac positioning of catheters in dogs, and performed electrograms and pacing with the catheters.  No evidence of thermal injury occurred.  Subsequently, the researchers achieved two human real-time, MRI-guided catheter mapping studies.

Conclusion: Real-time, MRI-guided electrophysiology studies prove feasible – and afford better soft-tissue visualization and lack radiation compared to conventional fluoroscopy.

HGF: EMPHYSEMA

Intranasal HGF Reverses Lung Emphysema in Mice
Chronic respiratory disease is the fourth leading cause of death in the United States and 4.1 million adults have been diagnosed with emphysema.  Hepatocyte growth factor (HGF) affects multiple factors, including stem cells, epithelial proliferation, and wound healing.  A recent study from Japan evaluated the intranasal administration of HGF on mine with elastase-induced emphysema.  The HGF inhalation occurred twice a week for one to four weeks.  Published in Molecular Therapy, the results revealed significant amelioration of airspace enlargement and alveolar destruction.  Within two weeks, elevated static lung compliance returned to control levels.  The authors report: “… intranasal treatment with HGF reverses both the physiological and morphometric changes of lung emphysema, possibly through stem-cell mobilization and alveolar regeneration.”

Conclusion:  Intranasal human growth factor reverses induced emphysema in mice.

MRI: STROKE

Imaging of In Vivo Single Neurons Shows Cells Take on New Roles After Stroke
Stroke ranks third (behind heart disease and cancer) as a leading U.S. cause of death, killing 150,074 people in 2004 alone.  The process of stroke recovery is thought to be accomplished by living brain cells assuming the tasks of injured ones.  To assess whether single neurons perform new functions at the expense of their original ones, versus acquiring multiple roles, researchers at the University of British Columbia performed in vivo two-photon calcium imaging.  Using an adult mice role model, neurons and glia were studied over two eight weeks after ischemic damage.  As published in the Journal of Neuroscience, the single-cell calcium imaging showed that surviving neurons that normally process information for a single contralateral limb instead processed information for multiple limbs.  This peaked at one month after injury; at two months neurons became more selective for a preferred limb.

Conclusion:  Imaging of in vivo single neurons after stroke shows surviving cells initially process information for multiple new sites, then become more selective.

MRI: Stroke, Hepatitis & Asthma
Vol. 2, Number 19

Wednesday, July 23rd, 2008

MRI: STROKE

Silent Midlife Cerebral Infarcts Detected by MRI Studied in Large Cohort
The prevalence of silent cerebral infarction (SCI) and its associated risk factors were reported recently in Stroke.  The study cohort consisted of 2,040 “Framingham offspring” who came to the sixth examination (1996-1998), were imaged with brain MRI between 1999 and 2005, and were negative for clinical stroke at MRI.  The group consisted of 53% females and had a mean age of 62.  Led by researchers at Boston University, the results showed at least 10.7% of the cohort had at least one SCI.  The infarction occurred most often in the basal ganglia (52%), followed by other subcortical areas (35%) and cortical areas (11%).  Associated findings were stage 1 hypertension, high plasma homocysteine, atrial fibrillation, carotid senosis of more than 25%, and increased carotid intimal-medial thickness.

Conclusion:  Silent midlife cerebral infarcts occur with 11% prevalence and are associated with risk factors for clinical stroke.

MRI: HEPATITIS

MRI Diffusion Imaging Helps Diagnose Fibrosis, Inflammation in Chronic Hepatitis
The inflammation of chronic hepatitis can lead to fibrosis and subsequent cirrhosis.  To assess the presence of fibrosis and inflammation, a recent study measured the apparent diffusion coefficient (ADC) with both conventional diffusion-weighted imaging (CDI) and diffusion tensor imaging (DTI).  As reported in the Journal of Magnetic Resonance Imaging, researchers led by New York University studied 31 patients with breath-hold, single-shot, echo-planar imaging with CDI and DTI.  The patients underwent subsequent liver biopsies, with all samples scored for fibrosis and inflammation.  The ADC proved significantly lower in patients with liver fibrosis and inflammation than in those without fibrosis or inflammation.  CDI also outperformed DTI.

Conclusion:  Diffusion imaging can portend liver fibrosis and inflammation in chronic hepatitis.

MRI: ASTHMA

Hyperpolarized 3Helium Diffusion MRI Depicts Microstructure Changes in Asthma
A recent study in the Journal of Magnetic Resonance Imaging investigated 3helium (3He) diffusion at short and long time scales in teh lungs of asthmatics.  The authors depicted the lung changes by evaluating 14 asthmatics, 9 chronic obstructive pulmonary disease patients, and 14 healthy controls.  Led by researchers from the University of Virginia, the results found increased mean apparent diffusion coefficients (ADCs) over the short- and long-time-scale group (9% and 27%, respectively) in asthmatics compared to the healthy cohort.  The group-mean % ADC – abnormal showed 107% and 272% increases, respectively.  The COPD patients displayed much greater elevations.

Conclusion:  Increased diffusion of hyperpolarized 3He occurs in asthmatic patients, reflecting small airway changes in lung microstructure.