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Wednesday, December 03, 2008

nejm central pontine mylinolysis

A 26-year-old man with a history of chronic alcohol abuse presented with dysarthria, lethargy, and horizontal nystagmus. Results of a clinical examination and blood tests were otherwise normal, including a serum sodium level of 137 mmol per liter and serum osmolality of 287 mOsm per kilogram. Over the next 5 days, spastic quadriparesis and pseudobulbar palsy developed. full story….

Please read my other post on central pontine myelinolysis

See MRI images here


Wednesday, September 17, 2008

NEW MRI Searchable Database

There is a new service available for hospitals and clincs that can determine the mri safety of implanted devices . check out there website.

The MRI safety status of medical implant devices can be difficult to track because many manufacturers 1.) Change their names; 2) Sell their medical devices to other companies; 3.) Go out of business; 4) Discontinue manufacturing of certain devices; 5.) Merge with other companies; or holding companies move medical device ownership from company to company. Dozens of these transactions transpire annually, bringing confusion and obfuscation to MRI technologists, who need to be certain of an implanted device’s safety status before scanning. After seven or eight years of this merger and acquisition activity, the status of many implants can become impossible to find.

MRI technologists, too often given the sketchiest of information, can spend hours looking for safety status, or materials of construction, to determine if a scan is safe. Even if the search is successful, most sites have no method to ultimately store the data or retrieve it for use later. An MRI site’s source of implant safety information can quickly degrade to a paperback book and an unmanageable manila folder of faxes.

Compounding the problem, are new safety definition standards; more powerful scanners and implants from overseas. Faced with an “MR Conditional” device, technologists must account for the static field strength, spatial gradient field, SAR and time duration of the scan. According to a recent JCAHO Sentinel Event: “All implants should be checked against product labeling or manufacturer literature specific to that implant, or peer-reviewed published data regarding the device or implant in question. Technologists should be provided with ready access to this information.” What JCAHO did not state is where this information is supposed to come from!

A searchable database to store MRI specific information with multiple search options to retrieve manufacturer’s information and published data, would be an invaluable tool to free up technologist’s time and eliminate duplicate research for implant safety information!

MagResource LLC has developed a searchable database to track the MRI safety status of medical implants through this whirlwind of economic and technological turmoil. The Internet database features daily rather than yearly updates to provide site-users with instant access to the latest information. User sites enter the Online Database without login or password. When a device is not found in the database, MagResource will endeavor to find it. Free trials and in-service for MRI sites at:

Saturday, September 13, 2008

Top 13 Reasons to Date an X-ray Tech

1. We do our best work in the dark

2. We can see through your clothes
3. We know all the positions
4. We are well developed
5. The chemistry is always right
6. We know what buttons to push
7. We have all the right techniques
8. We know how to warm up a tube
9. We know how to get the best penetration
10. When you need it now, we make it wet.1
1. Human anatomy is common knowledge.
12. We do it on the table and sometimes we slip it in the bucky.
13. Radiation physics: Hard Beam + Tight Collimation = Adequate penetration

Bayer and Epix to part ways over vasovist.

Bayer Schering Pharma will transfer the worldwide commercial rights for the novel blood pool magnetic resonance angiography (MRA) agent, Vasovist(R) (gadofosveset trisodium) to EPIX. Thecollaboration agreementbetween the two parties will terminate effectiveMarch 1, 2009; until that time, Bayer Schering Pharma will continue to provide continued supply of Vasovist in the 19 countries where it is currently marketed.
"We are pleased to regain complete worldwide commercial rights for Vasovist which has a PDUFA date of December 31, 2008," said Elkan Gamzu, Ph.D., interim chief executive officer of EPIX. "Pending FDA approval, Vasovist is positioned to become the first MRA contrast agent approved in the United States and it could be launched in 2009. Our goal remains to maximize the commercial value of Vasovist and we are committed to executing our monetization strategy which includes finding a marketing and commercialization partner for Vasovist."
"Vasovist is a first-in-class blood specific MRA contrast agent with several distinctive characteristics that we believe may allow it to become a market leader in the United States," added Chen Schor, chief business officer of EPIX. "Vasovist has demonstrated good resolution angiography, a high signal per dose, a long imaging window timeframe and single-dose imaging of multiple vessel beds. We believe these characteristics coupled with a streamlined commercial rights profile should make this an appealing opportunity for a company interested in building or strengthening its competitive position in the MRA market."

Wednesday, August 27, 2008

Parrish Medical Centers Diamondback 360 System

The Diamondback 360° System uses the principle of centrifugal force. As crown rotation increases, centrifugal force presses the eccentrically mounted, diamond-coated crown against the stenotic lesion, removing a thin layer of plaque. The increasing crown orbit creates a larger lumen — minimizing procedure time and expense of catheter upsizing.

Additional benefits of the orbiting motion include:
Removing plaque while minimizing the potential for stress or injury to the media layer, and reducing the risk of barotrauma.
The use of a 6 French introducer sheath

Doctors Ravi Rao, MD, interventional cardiologist and Joseph Flynn, DO, interventional radiologist at Parrish Medical Center are among the first in Central Florida to offer a newly FDA approved treatment option to people with Peripheral Arterial Disease (PAD)—the Diamondback 360’™ Orbital Atherectomy System.The device removes plaque blockages in the legs (peripherals) and restores blood flow

To learn more about Parrish Medical Center’s services and physicians, visit For a free Peripheral Arterial Disease (PAD) screening, call 268-6574 to make your appointment. PMC’s radiology department can be reached at 268-6140.
For more information please visit

Tuesday, August 26, 2008

BlackBerry Bold

We've been waiting to get our smudgy digits on RIM's BlackBerry Bold seemingly since before the Earth's crust finished cooling, and finally, Canada's Rogers Wireless lent us a hand. In a few words, the screen is striking, size is actually pretty comfy to hang on to, the keys are fairly easy to use, and we're kinda digging it. As a quick refresher, the Bold has tri-band HSDPA, quad-band EDGE, WiFi, Bluetooth, GPS, 1GB of onboard memory, and a 2-megapixel cam that can take advantage of the GPS for a bit of geotagging tomfoolery. The integrated media player seems to get the job done with a pile of supported formats -- including DivX, some support for XviD, H.264, MP3, WMA, and a bunch more -- the OS 4.6 looks slick, and have we mentioned the frickin' screen? We'll be back right quick with a deeper dive into the Bold's capabilities, but for now, enjoy the pics.

vasovist mri contrast blood pool agents

Epix Pharmaceuticals Inc., an Israeli firm that has developed Vasovist (gadofosveset trisodium), a novel MRI contrast agent, has announced that its product "has achieved positive results from the blinded, independent re-read of images of its novel blood pool magnetic resonance angiographic (MRA) agent, Vasovist. In the re-read of images obtained from previous phase 3 studies, EPIX met all pre-specified endpoints prospectively agreed to with the U.S. Food and Drug Administration (FDA). EPIX plans to resubmit a New Drug Application (NDA) to the FDA for Vasovist in mid-2008. Vasovist is currently approved for marketing in 33 countries." And that includes the European Union, where the device (as it is classified) has been marketed (in collaboration with Schering AG) since 2005.
Here's how the agent is described:
Vasovist® is an injectable intravascular contrast agent discovered internally at EPIX and is designed to provide improved imaging of the vascular system using magnetic resonance angiography (MRA). EPIX's initial target indication for Vasovist is for use in MRA imaging of peripheral vascular disease, providing a breakthrough in the physician's ability to visualize the human vascular system and improve disease diagnosis and treatment.
Vasovist reversibly binds to the human blood protein albumin, allowing imaging of the blood vessels for approximately an hour after administration. With a single injection, Vasovist enables clear three-dimensional images of arteries and veins throughout the body. Vasovist may make it possible for physicians to detect vascular disease earlier and less invasively than with X-ray angiography, and provide an improved evaluation of potential therapeutic options including percutaneous intervention and vascular surgery.

diffusion spectrum imaging

At the Massachusetts General Hospital in Boston researchers are using an MRI technique called diffusion spectrum imaging to create three dimensional models of the brains of animals and humans.
MIT Technology Review describes this promising imaging modality:
It uses magnetic resonance signals to track the movement of water molecules in the brain: water diffuses along the length of neural wires, called axons. Scientists can use these diffusion measurements to map the wires, creating a detailed blueprint of the brain's connectivity.
On the medical side, radiologists are beginning to use the technology to map the brain prior to surgery, for example, to avoid important fiber tracts when removing a brain tumor. Wedeen and others are now using diffusion imaging to better understand the structures that underlie our ability to see, to speak, and to remember. Scientists also hope that the techniques will grant new insight into diseases linked to abnormal wiring, such as schizophrenia and autism

Zecotek making hybrid mri/pet machines

Photonics magazine is profiling photodetectors made by Zecotek Photonics, a firm out of Singapore, that work well within strong magnetic fields, allowing engineers to make hybrid PET/MRI machines.
Zecotek is leading a collaborative research program with the University of Washington to develop a proprietary PET-MRI detector as the core technology of a new generation of medical imaging systems. The major barrier to a combined PET and MRI scanning device is the strong magnetic fields of MRI which destroy the photodetection capabilities of current PET scanning devices. Unlike the vacuum tube-based PMT, Zecotek's MAPD photodetectors can operate in highly magnetic environment of the MRI making the LFS scintillation crystals and MAPD photodetectors critical enabling technologies for a successful fusion of PET and MRI into one scanning device. This new generation device will offer both higher resolution and faster patient throughput which in turn improves patient diagnostics and reduces costs to the medical system, Zecotek said.
Zecotek announced in mid-April that it successfully completed preproduction testing of the MAPD, which will be initially produced in an 8 by 8 format, with 64 individual MAPDs each measuring 3 by 3 mm, and scalable to larger dimensions. First run production has been slated for evaluation by select industry partners.

A protien called Otx 2

August 7, 2008

Researchers have long sought a factor that can trigger the brain's ability to learn - and perhaps recapture the "sponge-like" quality of childhood. In the August 8 issue of the journal Cell, neuroscientists at Children's Hospital Boston report that they've identified such a factor, a protein called Otx 2.
Otx2 helps a key type of cell in the cortex to mature, initiating a critical period--a window of heightened brain plasticity, when the brain can readily make new connections.

Takao Hensch, PhD, of the Neurobiology Program and Department of Neurology at Children's, the study's senior investigator, speculates that there may be similar factors from the auditory, olfactory and other sensory systems that help time critical periods. Timing is important, because the brain needs to rewire itself at the right moment--when it's getting the optimal sensory input.

Hensch, who last fall won the highly competitive NIH Director's Pioneer Award, is also interested in the transport mechanism that propagates Otx2 from the retina to the cortex. He speculates that Otx2 itself could be a carrier for factors you'd want to deliver to the brain, envisioning eye drops for brain disorders such as schizophrenia, in which parvalbumin cells don't properly mature.

Monday, August 25, 2008

MRI through astonomy

Astronomers from the University of Edinburgh are collaborating with clinicians in trying to apply their expertise in fuzzy image processing to improve the output of MRI machines. The algorithmic techniques, though not specified, are probably based on speckle imaging methods that, thanks to modern computers, have been used in astronomy for a couple decades.
MRI scanning can record images of any part of the body from several angles and is used to examine organs or tissue. Patients who undergo scans may have to lie still for half-an-hour or more, while the scanner records successive layered images of their body, much like a slow-exposure photograph. If the patient moves, the images become distorted.
The astronomy algorithm corrects distortions caused by movement or caused by the scanner. This makes the technique especially suitable for use with children or seriously ill patients, and avoids patients having to undergo repeat scans to get accurate results.
Once an MRI scan is complete, it currently takes a long time to analyse the results fully, whereas the new algorithm can deliver results instantly - without an expensive supercomputer.
Presently many scans are useless because of distortion errors and have to be repeated, so this technology could save time and allow more patients to have faster access to appointments. It could also deliver substantial savings for healthcare providers.
Professor Alan Heavens, of the University of Edinburgh's School of Physics, said: “It was clear that we had the solution to a general problem - how to compress vast amounts of data into manageable, meaningful results - and we wanted to find applications for it. We estimate that in two or three years this technology, derived from pure astronomy research, will be bringing benefits to patients.”

digital light box

BrainLAB AG, out of Feldkirchen, Germany has recently installed its first Digital Lightbox radiology system in a Munich hospital. Designed to be installed in radiology departments, clinical floors, and operating rooms, the system behaves like a giant iPhone, simultaneously displaying volumetric images from various imaging modalities along with patient information.
Digital Lightbox replaces the conventional light box used to observe analog x-ray images. Connected to the hospital PACS, the new digital platform can be installed both in meeting rooms and in operating rooms, where clinicians can then access, manipulate, and utilize data for surgery planning. By displaying the human body in 3D, Digital Lightbox helps clinicians to more clearly demonstrate to patients what effects a disease can have and which procedures may be necessary.
Digital Lightbox enables clinicians to select the most valuable images from large amounts of existing medical data. Ergonomic touchscreen technology with zoom functionality makes working with data easy and effective.
Clinicians can intuitively navigate within pictures and between settings. Image scrolling can be performed with one finger; zooming in and out of images with two. Images from different sources can also be fused easily. A measure functionality enables clinicians to set size and other dimensions.
By integrating the communication platform iPlan® Net from BrainLAB, clinicians can perform treatment planning with Digital Lightbox or any PC connected to the hospital network. This eliminates bottlenecks, as busy planning stations are rendered obsolete. iPlan Net helps to simplify the clinical workflow and save costs, as well as strengthen and simplify interdisciplinary collaboration between neurosurgery, nuclear medicine and radiology departments.
Digital Lightbox can be installed in any hospital environment and is compatible with all established image formats, such as DICOM, jpg, bmp, tif, png, avi, wmv. Planning data can be transferred directly from Digital Lightbox to surgical navigation systems designed for precise and minimally invasive procedures.

MRI tracks stem cells in the heart.

Now for the first time, researchers have tracked the stem cells in mice using magnetic resonance imaging (MRI) from their bone marrow origin to the injured site. This opens up the possibility of finding some therapeutic treatment to direct these cells after a heart attack.

Mesenchymal stem cells, or MSCs, are found in the bone marrow and can differentiate into certain cell types. They have been detected around heart injuries following a myocardial infarction (heart attack), but whether they come to regenerate heart tissue or to promote healing is still under debate.

Using a series of MRI scans, Tom Hu and colleagues at the Medical College of Georgia in Augusta, GA, have tracked MS’s in a sample of mice. The researchers first transplanted into the bone marrow a few hundred thousand MSCs that had been labeled with both iron-oxide (a molecule that essentially shades out the MRI signal) and a special protein that fluoresces when exposed to blue light. The team then operated on all of the mice, inducing a heart attack in one group. Over the following days, MRI scans showed a gradual darkening around the site of injury in the heart attack group, which was presumably due to the arrival of the labeled MSCs. The researchers validated this migration with fluorescent microscopy.

The goal now is to devise a way to attach an MRI-sensitive marker to MS’s in humans who have suffered a heart attack. This would allow doctors to more closely study these cells, and perhaps devise treatments that can control their migration.

For more information:

Source: American Association of Physicists in Medicine

New MRI contrast agents

Berlin, July 8, 2008 –The U.S. Food and Drug Administration (FDA) has approved Bayer Schering Pharma’s magnetic resonance imaging (MRI) contrast agent Primovist® (gadoxetate disodium) for the detection and characterization of liver lesions in adults with known or suspected focal liver disease. The product will be marketed in the United States under the name EOVIST®; it is currently marketed as Primovist outside the U.S. and as EOB Primovist in Japan. It is the first organ-specific MRI contrast agent to be approved in the U.S. for over a decade. Bayer plans to make EOVIST available to customers in the U.S. in the summer of 2008.
“Primovist not only offers the unique benefit of being able to simultaneously detect, locate and distinguish various types of liver lesions, but also helps to guide and follow-up on treatment decisions, as it enables radiologists to identify even tiny pathological liver lesions,” said Dr. Gunnar Riemann, Member of the Board of Management of Bayer Schering Pharma AG, responsible for the company’s Business Units. “Bayer is now in the unique position of offering Primovist for diagnosing patients with liver cancer and Nexavar for treating hepatocellular carcinoma – the most common form of liver cancer.”

More info here

Wednesday, July 30, 2008

Eovist Bayers new contrast for MRI

Berlin, July 8, 2008 –The U.S. Food and Drug Administration (FDA) has approved Bayer Schering Pharma’s magnetic resonance imaging (MRI) contrast agent Primovist® (gadoxetate disodium) for the detection and characterization of liver lesions in adults with known or suspected focal liver disease. The product will be marketed in the United States under the name EOVIST®; it is currently marketed as Primovist outside the U.S. and as EOB Primovist in Japan. It is the first organ-specific MRI contrast agent to be approved in the U.S. for over a decade. Bayer plans to make EOVIST available to customers in the U.S. in the summer of 2008.
“Primovist not only offers the unique benefit of being able to simultaneously detect, locate and distinguish various types of liver lesions, but also helps to guide and follow-up on treatment decisions, as it enables radiologists to identify even tiny pathological liver lesions,” said Dr. Gunnar Riemann, Member of the Board of Management of Bayer Schering Pharma AG, responsible for the company’s Business Units. “Bayer is now in the unique position of offering Primovist for diagnosing patients with liver cancer and Nexavar for treating hepatocellular carcinoma – the most common form of liver cancer.”
More info here
Doreen SchröderTelefon: +49 30 468-11399Fax: +49 30 468-16710 (berlin)

Update Current MRI of the Liver study with Eovist.

First Received: September 28, 2010 Last Updated: October 5, 2010 History of Changes
Sponsor:Fred Hutchinson Cancer Research Center
Collaborators:Bayer Healthcare Pharmaceuticals, Inc./Bayer Schering Pharma
University of Washington
Information provided by:Fred Hutchinson Cancer Research Center Identifier:NCT01215838

The purpose of this study is to determine if a new magnetic resonance (MR) protocol is better at diagnosing liver lesions.

Hepatocellular Carcinoma

Study Type:Observational
Study Design:Observational Model: Cohort
Time Perspective: Prospective
Official Title:Dynamic Contrast Evaluation of the Liver Using Gadoxetate Disodium (Eovist®) for Hepatocellular Carcinoma (HCC)

Further study details as provided by Fred Hutchinson Cancer Research Center:

Primary Outcome Measures:
  • Accuracy of a new MR protocol in diagnosing HCC and other liver lesions. [ Time Frame: One day: participants will have one MRI of the liver. ] [ Designated as safety issue: No ]

Estimated Enrollment:200
Study Start Date:August 2010
Estimated Study Completion Date:December 2013
Estimated Primary Completion Date:December 2013 (Final data collection date for primary outcome measure)
Detailed Description:

Hepatocellular carcinoma (HCC), a form of liver cancer, is the seventh most common cause of cancer mortality in the US. The incidence rate of HCC is increasing along with the incidence of Hepatitis B and C which are known to promote HCC. Patients have a better prognosis (survival outlook) if HCC is found and treated at an early stage. MRI is the best imaging modality for diagnosing HCC.

This study will compare standard MRIs and MRIs performed with a newly developed MR protocol to determine if it is possible to more confidently diagnose HCC.

Contacts and Locations

Please refer to this study by its identifier: NCT01215838

Sponsors and Collaborators
Fred Hutchinson Cancer Research Center
Bayer Healthcare Pharmaceuticals, Inc./Bayer Schering Pharma
University of Washington
Principal Investigator:Orpheus Kolokythas, MDUniversity of Washington

words of wisdom

The hours of folly are measured by the clock; but of wisdom, no clock can measure. - William Blake

vasovist a new contrast for MRI

LEXINGTON, Mass.–(BUSINESS WIRE)–July 1, 2008–EPIX Pharmaceuticals, Inc. (NASDAQ:EPIX), a biopharmaceutical company focused on discovering and developing novel therapeutics through the use of its proprietary and highly efficient in silico drug discovery platform, announced today that the New Drug Application (NDA) for its novel blood pool magnetic resonance angiography (MRA) agent, Vasovist (gadofosveset trisodium) was resubmitted to the U.S. Food and Drug Administration (FDA) on June 30, 2008.
If approved, Vasovist will be the first contrast agent approved for marketing in the United States for use with MRA, a non-invasive modality for imaging blood vessels. In 2007, there were approximately 1.3 million MRA procedures performed in the United States using contrast agents.
We look forward to continuing to work with the FDA to bring Vasovist to market in the United States, said Michael G. Kauffman, M.D., Ph.D., chief executive officer of EPIX. Throughout the appeal process for Vasovist, we worked closely with the FDA and the resubmission is a culmination of the work done by our team at EPIX. We remain hopeful that we will achieve approval for Vasovist by the end of 2008 and are focused on executing our strategy to monetize our interest in this valuable asset.
About Vasovist(R)
Vasovist is an injectable intravascular contrast agent designed to provide improved imaging of the vascular system through magnetic resonance angiography imaging (MRA). Vasovist has been approved for marketing in 33 countries, including all 27 member states of the European Union, Switzerland, Turkey, Australia and Canada. The marketing rights to Vasovist are held by Bayer Schering Pharma in Europe and by Bayer HealthCare Pharmaceuticals in the United States and Canada. Both companies are part of Bayer AG. Vasovist is currently marketed in Canada and 18 European countries, including Germany, the Netherlands, Italy, all Nordic countries, the United Kingdom and Switzerland

Wednesday, July 23, 2008

Thank you to The Beatles for the First CAT Scan machine

As a direct result of The Beatles’ success, Dr Timmis claimed, the scanner’s inventor, Sir Godfrey Hounsfield, was able to devote about four years developing the scanner from its 1968 prototype, to something that could be used in a clinical setting. His work was done in the Central Research Laboratory, a facility near Heathrow airport that was part of the EMI Group. Having sold 200 million of the Fab Four’s singles, (at seven inches, almost enough vinyl to stretch the length of the equator) the Beatles’ record company, EMI, was able to fund Hounsfield to do his research and the CT scanner was ready be used in hospitals in the 1970’s.
Look how far we have come Aquillion 320 slice CT scanner

Check out out my friends at Mind Hacks where I first read about this story

Sunday, June 22, 2008

10 penny nail found pre mri

You ever have one of thoose days that you just wanted to put a 10 penny nail into your bladder? What? I know this sounds crazy but that is exactly what this woman did. The pt came into the ER with slurred speech. The CT scan from the night before had revealed a hypodense area in her brain therefore an MRI was ordered. Before the MRI could be performed the patient had to be Xrayed to find out if she did have a nail in her body. The patient reported it was in her Uterous but upon Ultrasound localization it was found to be in her bladder. (source NEJM). ……
Read more here to find out why?

Sunday, May 04, 2008

Gastric Tumors

Gastric tumors may be classified as benign or malignant on the basis of their biologic behavior; epithelial and mesenchymal tumors may be similarly classified on the basis of their origin. More than 95% of malignant tumors of the stomach are adenocarcinomas . The remaining malignant tumors include lymphoma, sarcoma (eg, malignant gastrointestinal stromal tumor), carcinoid tumor, metastasis, and so on. Between 85% and 90% of gastric tumors are benign . About half of these benign tumors are mucosal lesions (mostly hyperplastic or adenomatous polyps) and about half are mesenchymal tumors .
Mesenchymal tumors of the gastrointestinal tract are divided into two broad groups. The first group consists of tumors that are identical to those arising in the somatic soft tissue. These include smooth muscle tumors (eg, leiomyoma, leiomyosarcoma), neural tumors (eg, schwannoma, neurofibroma, plexosarcoma), lipocytic tumors (eg, lipoma, liposarcoma), tumors originating from vascular and perivascular tissues (eg, glomus tumor, hemangioma, lymphangioma), and other tumors . The benign neoplasms in this first group are composed of well-differentiated mesenchymal cells. The second group is far larger and more important and consists primarily of spindle cells or epithelioid cells, which are different from typical somatic soft-tissue tumors and are unique to the gastrointestinal tract. These lesions are called gastrointestinal stromal tumors and constitute the largest category of primary nonepithelial neoplasms of the stomach . Previously, many lesions in this group were erroneously referred to as leiomyoma or leiomyosarcoma .
Although these lesions demonstrate different histologic findings, the overlap of radiologic findings in many gastric tumors makes differentiation difficult. Clinical manifestations also overlap and can vary from severe abdominal pain and acute abdomen to vague signs such as weight loss and anemia. Therefore, some gastric tumors cause diagnostic confusion, which may result in unnecessary surgery or inappropriate follow-up. However, some unusual gastric tumors have characteristic radiologic features that may suggest a specific diagnosis.
Computed tomographic (CT) and barium imaging is often used to diagnose unusual gastric tumors including lipoma, schwannoma, glomus tumor, lymphangioma, Brunner gland hamartoma, carcinoid tumor, and lymphoma. In the CT evaluation of gastric lesions, water is often used as a negative oral contrast agent. Water is particularly well-suited for use as a gastric contrast agent because it has a relatively low attenuation (0–10 HU), which optimizes visualization of the enhancing gastric wall at CT and results in good gastric distention . Adequate gastric distention can be achieved with about 500–1000 mL of water . Find many examples of these tumors at
Abdominal imaging has come a long way for MRI. These images are some that I took of a patient with a tumor in the stomach. We have been able to shorten our scan time to make it possible to aquire nice abdominal images in one breath hold.

thoracic aorta disection

Aortic dissection is the most common catastrophe affecting the aorta. The aorta is the largest artery of the body through which blood leaves the heart to deliver oxygenated blood to the rest of the body. It occurs in about 24 people per million each year in the U.S. It is caused when the inner layer of the aortic wall tears and then peels or separates away from the next layer of the aorta. This creates two channels; the original aortic channel for blood flow (the true lumen) is still present while the peeling away of the outer layer in the dissection creates a new additional flow channel (the false lumen).

Symptoms of Aortic Dissection
Location of Pain:
Chest pain
Back pain
Flank pain
Abdominal pain
Leg pain

Quality of Pain
Pain that is tearing or sharp
Abrupt onset of pain
Pain that migrates or radiates
Neurological Deficits
Coma/Altered consciousness
Extremity numbness
Difficulty with speaking or slurred speech
Difficulty breathing/shortness of breath

There are three primary tests used to diagnose aortic dissection. Aortic dissection can be diagnosed with a CAT scan of the aorta or an MRI scan. A transesophageal echo (TEE) may also be performed. A TEE is a special type of ultrasound test during which a small ultrasound probe is passed through the mouth and into the stomach and esophagus to take very detailed pictures of the heart and aorta. Currently there are no blood tests that can accurately diagnose aortic dissection.

In all cases, the first treatment for patients with aortic dissection is aggressive control of blood pressure with medications, usually given through an intravenous line (IV). Patients with aortic dissection are generally monitored in the intensive care unit. A team of experts cares for patients with aortic dissection, including emergency medicine physicians, cardiac and vascular surgeons, cardiologists, radiologists, and internal medicine specialists. The treatment of aortic dissection depends upon a number of factors, including the location of the tear in the aortic wall, how much of the aorta is involved, the effects of the dissection on the branch vessels of the aorta and the perfusion of the organs, and the patient’s symptoms. For patients with aortic dissection who require invasive treatment, surgery to repair the dissected portio of the aorta is generally the recommended treatment. In some cases, minimally invasive stenting procedures can be used to treat aortic dissection.
For all patients who have an aortic dissection long-term follow-up with a physician is a very important part of treatment. Blood pressure and heart rate need to be carefully monitored and controlled with medications. For many patients, CAT scans or MRI scans will be repeated at regular intervals (such as every 6 months or every year) to monitor the size of the aorta and the status of the dissection.

Magnetic resonance imaging (MRI) is currently the gold standard test for the detection and assessment of aortic dissection, with a sensitivity of 98% and a specificity of 98%. An MRI examination of the aorta will produce a three-dimensional reconstruction of the aorta, allowing the physician to determine the location of the intimal tear, the involvement of branch vessels, and locate any secondary tears. It is a non-invasive test, does not require the use of iodinated contrast material, and can detect and quantitate the degree of aortic insufficiency.
The disadvantage of the MRI scan in the face of aortic dissection is that it has limited availability and is often located only in the larger hospitals, and the scan is relatively time consuming. Due to the high intensity of the magnetic waves used during MRI, an MRI scan is contraindicated in individuals with metallic implants. In addition, many individuals experience claustrophobia while in the MRI scanning tube.

Aortic dissection is associated with hypertension (high blood pressure) and many connective tissue disorders. Vasculitis (inflammation of an artery) is rarely associated with aortic dissection. It can also be the result of chest trauma. 72 to 80% of individuals who present with an aortic dissection have a previous history of hypertension.
The highest incidence of aortic dissection is in individuals who are 50 to 70 years old. The incidence is twice as high in males as in females (male-to-female ratio is 2:1). Half of dissections in females before age 40 occur during pregnancy (typically in the 3rd trimester or early postpartum period).
A bicuspid aortic valve (a type of congenital heart disease involving the aortic valve) is found in 7-14% of individuals who have an aortic dissection. These individuals are prone to dissection in the ascending aorta. The risk of dissection in individuals with bicuspid aortic valve is not associated with the degree of stenosis of the valve.
Marfan syndrome is noted in 5-9% of individuals who suffer from aortic dissection. In this subset, there is an increased incidence in young individuals. Individuals with Marfan syndrome tend to have aneurysms of the aorta and are more prone to proximal dissections of the aorta.
Turner syndrome also increases the risk of aortic dissection, by aortic root dilatation[4].
Chest trauma leading to aortic dissection can be divided into two groups based on etiology: blunt chest trauma (commonly seen in car accidents) and iatrogenic. Iatrogenic causes include trauma during cardiac catheterization or due to an intra-aortic balloon pump.
Aortic dissection may be a late sequalae of cardiac surgery. 18% of individuals who present with an acute aortic dissection have a history of open heart surgery. Individuals who have undergone aortic valve replacement for aortic insufficiency are at particularly high risk. This is because aortic insufficiency causes increased blood flow in the ascending aorta. This can cause dilatation and weakening of the walls of the ascending aorta.

The long term follow-up in individuals who survive aortic dissection involves strict blood pressure control. The relative risk of late rupture of an aortic aneurysm is 10 times higher in individuals who have uncontrolled hypertension, compared to individuals with a systolic pressure below 130 mmHg.
The risk of death is highest in the first two years after the acute event, and individuals should be followed closely during this time period. 29% of late deaths following surgery are due to rupture of either the dissecting aneurysm or another aneurysm. In addition, there is a 17% to 25% incidence of new aneurysm formation. This is typically due to dilatation of the residual false lumen. These new aneurysms are more likely to rupture, due to their thinner walls.
Serial imaging of the aorta is suggested, with MRI being the preferred imaging technique.

Tuesday, April 01, 2008

abccess of lower leg on MRI « Coolmristuff

This abcces was not what I expected when I first saw it. The entire lower leg was red and extremley sore to the touch. there was an open wound where the abccess had been drained the night before but it was small compared to the amount of involvement of the entire lower leg. This patient is diabetic and therefore at risk for infection or a non-healing wound.
t1 cor & sag

This is a Stir axial image of the lower leg

t1 ax pre and post contrast.(multihance)

April 1, 2008 - Posted by turbospinecho 1 ,
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Friday, March 07, 2008

Stewart-Treves syndrome is a rare, deadly cutaneous angiosarcoma…………..

I scanned a patient with the diagnosis of angiosarcoma. I was not familiar with the disease and had to do a little research before we did the procedure. She had a history of lymphedema for 13 years after her breast surgery for cancer. Her entire right arm was swollen. Her doctor had done a biopsy on two lesions on her arm and confirmed angiosacroma. She had a CT of the Chest and A MRI of the Forearm and Humerus. Here is some background info on Angiosacroma.
this is not the patient I scanned it is only an example in angiosarcoma
Stewart-Treves syndrome is a rare, deadly cutaneous angiosarcoma that develops in long-standing chronic lymphedema. Most commonly, this tumor is a result of lymphedema induced by radical mastectomy to treat breast cancer. Unfortunately, although the breast cancer may be cured with such radical surgery, this second primary cancer may be responsible for the patient’s worsening course. The term Stewart-Treves syndrome is broadly applied to an angiosarcoma that arises in a chronically lymphedematous region due to any cause, including congenital lymphedema and other causes of secondary lymphedema unassociated with mastectomy. As reported by Durr et al in 2004, this lymphangiosarcoma occurs as a rare complication. Lymphangiosarcoma is a misnomer because this malignancy seems to arise from blood vessels instead of lymphatic vessels. A more appropriate name is hemangiosarcoma.
In 1906, Lowenstein first described angiosarcoma in a patient’s arm that had been affected by severe posttraumatic lymphedema for 5 years. In 1948, Stewart and Treves reported this rare secondary malignancy in 6 cases of angiosarcoma in postmastectomy lymphedema. They recognized that an edematous arm after radical mastectomy for breast cancer may suggest recurrent breast cancer, but that long-standing chronic edema without recurrent cancer may occasionally produce “a heretofore unrecognized and unreported sequel … long after the malignant breast neoplasm has apparently been arrested … a new specific tumor.” Stewart and Treves suggested that these angiosarcomas were probably not observed previously because they were mistaken for recurrent, inoperable, cutaneous manifestations of breast cancer.
Internationally: Currently, approximately 400 cases are reported in the world literature. In 1962, Schirger calculated that the incidence of this disease is 0.45% in patients who survive at least 5 years after radical mastectomy. Others have noted a much lower incidence of 0.07% in patients after mastectomy.
Lymphangiosarcomas are extremely aggressive tumors with a high local recurrence rate and a tendency to metastasize early to many areas
Metastatic angiosarcoma to the lungs and chest wall are the most common cause of death in patients with Stewart-Treves syndrome.
Metastases to the liver and bones can also occur.
Lymphangiomas are associated with a high rate of local recurrence and metastasis, even after aggressive surgical treatment

Sunday, February 03, 2008

Cardiac CTA visualizes cardiovascular disease as well as interventional heart catheterization.

January 30, 2008
Last night I had the privilege to listen to David Bush MD from John Hopkins speak at Parrish Medical Center. He was very informative about the topic of heart disease and Cardiac CTA. With all of the talk of cut backs on Medicare reimbursements in this area I find it hard to believe that this exam should be considered. CTAs of the Heart are becoming the industry standard for patients that are not experience acute MI symptoms. Those patients will always needs immediate action taken by a cardiologist in a Cathlab setting.

The results the cardiovascular CT imaging community has been waiting for two years are in: Sixty-four-slice CT meets cardiac catheterization in the primary diagnosis of cardiovascular disease and disorders in all populations, according to results of the CorE 64 study announced Monday by Julie Miller, MD, lead investigator of the study and assistant professor of medicine at Johns Hopkins Hospital, Johns Hopkins University in Baltimore, Md. The study also showed that early detection with 64-slice is a good predictor of who will need angioplasty or coronary bypass surgery.The coronary artery evaluation using 64-row multidetector CT angiography (CorE 64) trial findings were presented at the American Heart Association’s Scientific Sessions in Orlando, Fla. The study marks the first time an imaging study was presented on AHA’s late-breaking clinical trials agenda. Toshiba and Bracco sponsored the nine-center, seven-country multi-center study. (source)

Wednesday, January 23, 2008

Thomas Laupstad and I’m a photographer from Northern Norway

Thomas Laupstad from Northern Norway

Prints of his work can be bought over at Imagekind. Just a few of his photos are available, but all photos seen on this site can be printed upon request.

Sunset picture from winter afternoon in Northern Norway - The sun has come back
January 22nd, 2008 · 8 Comments
Taken with Olympus E500 digital camera January 21st 2008. Click image for larger view.The sun has finally come back here in Northern Norway, but because of clouds I have yet to actually see it. Later in the afternoon I got to see this spectacular winter sunset and because of the warm, still weather it felt like spring time. Had to take some pictures to share the sunset with you.
Take a look at these great pictures !!!

Tuesday, January 22, 2008

Come take a look at my brand new MRI Group on Facebook leave me a message.
I hope to hear from all of you.

Monday, January 21, 2008

NIH Normal Brain study

Below are some images from our gallery. Please click for full view. Image A) Images of T1W, T2W, DTI Fiber Orientations, Fractional Anisotropy at various stages of development. Image B) Animation of a T1W image from 3 months to 11 months. C) Cortical thickness output

Click here


I found this cool place called Radrounds after going to Neuroraz webpage. This is set up alot like Facebook for radiologist. It is a place to meet with others from around the world and post intresting cases. take a look.

Sumers Radiology site nominated as Best medical blog

Check out Sumers site It is full of great content.

Sumer’s Radiology Site gets nominated as one of the finalist in Best Clinical Sciences Blog Category
Dear friends
It gives me great pleasure to share with you that my website- Sumer’s Radiology Site has been nominated into the finalists for the best clinical sciences blog on Medgadget Journal.

Here is one intresting case on cerebral vasculitis

3d medical record

The idea is to have a rendered 3D representation of the anatomy of the patient, and to use that as a basis for the record. This is reported in IEEE Spectrum.
Visualizing Electronic Health Records With “Google-Earth for the Body” By Robert N. CharetteJanuary 2008
Andre Elisseeff leads a research team at IBM’s Zurich Research Lab that in September demonstrated a prototype system that will allow doctors to view their patients’ electronic health record (eHR) using three-dimensional images of the human body. Called the Anatomic and Symbolic Mapper Engine, the system maps the information in a patient’s eHR to a 3-D image of the human body. A doctor first clicks the computer mouse on a particular part of the image, which triggers a search of the patient’s eHR to retrieve the relevant information. The patient’s information corresponding to that part of the image is then displayed, including text entries, lab results, and medical images, such as magnetic resource imaging.
Elisseeff hopes that by “opening the computer screen to the patient, better communication between doctor and patient can occur.” He also believes that by changing the computer’s role from a physical barrier to a conversation starter that the acceptance of eHRs will increase.
One of the barriers to the adoption of EMR is that there are many different systems, and they all require training to use to maximum effect. If the interface is too complex, it will be difficult for it to become widely used.
This could be a usefull tool for comunication between medical profesionals. being able to see where the patients tumor is in a 3d space is very important in aspects like biopsys. We use MRI, CT, and ultrasound for that but this could prove an aditional benifit if it was easy to access in the patients EMR. It would give the doctors a quick look into history and show areas with pathology. I can see some usefullness to this program.

Laser infared energy for stroke treatment

Laser Light for Stroke Treatment
Filed under: Neurology
PhotoThera, a company out of Carlsbad, California, is currently conducting clinical trials of their experimental laser system for the treatment of strokes. Using a near-infrared laser that is capable of reaching the brain through the scalp, it is thought that the light can help reinvigorate cells in the ischemic milieu.
To prevent Quire's [Linda Quire, stroke patient at University of Wisconsin Hospital in Madison --ed.] penumbra from going over to the dark side, two things had to occur.
First, the laser treatment would have to work. Although animal studies and limited human research suggest it might be effective, the treatment still is in the experimental stage and its value has yet to be proved.
Second, Quire would have to get the actual laser treatment. Under the protocol of the clinical trial, half the patients get the treatment and half get a sham treatment. Neither the doctor nor the patients know who is getting treated.
Essentially, Quire had a 50-50 chance of receiving an iffy treatment.
Still, there is reason to believe the laser treatment, which can be given up to 24 hours after the onset of symptoms, might be beneficial.
An earlier trial involving 120 patients found that 70% who got the laser treatment had a successful outcome, such as complete recovery from their stroke, compared with 51% for those who got a sham treatment.
"The prospects are very good," said Harry Whelan, a neurologist who practices at Children's Hospital of Wisconsin and Froedtert Hospital.
Whelan, who has done extensive research on so-called photo therapy, said that when infrared laser light reaches brain cells, it improves energy metabolism in those cells, which can be starved of glucose and other energy sources when the blood supply is inhibited. The laser light activates an enzyme that controls production of an energy source known as ATP.
"There is a large area (of brain cells) fighting for survival," said Whelan, a professor of neurology at the Medical College of Wisconsin who was not a part of the study.
Indeed, using laser light might be beneficial in other neurological disorders, said Whelan, who is researching whether it might help in the treatment of Parkinson's disease and diabetic retinopathy.
More at the Milwaukee Journal Sentinel...
Company page with few details: PhotoThera

very low field MRI may be better for tumors.

HEAD SHOTS: Four slices of researcher Vadim Zotev’s head are the first medical images made with low-magnetic-field MRI.
Researchers at Los Alamos National Laboratory have made what they say are the first images of a human brain using magnetic fields a hundred-thousandth the strength of conventional magnetic resonance imaging (MRI), paving the way for lower cost medical images that might be better at detecting tumors.
Though the resolution is much lower than that in conventional MRIs, the images “show we have a potential for pretty good results,” says Vadim Zotev, a researcher in Los Alamos’s applied modern physics group. (That’s his head in the images.)
MRI works by ­subjecting the human body to a strong magnetic field, which causes the ­proton in the nucleus of each hydrogen atom in the body to line up along the magnetic field’s lines of force. An RF pulse briefly knocks the ­protons out of alignment. As they snap back into position, the ­protons emit an RF signal that can be used to construct a three-dimensional image. Most MRI machines have a magnetic field of about 1.5 teslas, strong enough to yank metal objects out of the hands of the unwary.
Zotev’s machine, however, generates a magnetic field of only 46 microteslas, roughly the same strength as the Earth’s magnetic field. Few protons align at this lower strength, so he must first apply a 1-­second prepolarization pulse—at 30 milli­teslas, it’s about as strong as a small bar magnet—which primes the protons to respond to the microtesla field. To detect the weaker signals, he uses an array of seven super­sensitive magnetometers called superconducting quantum interference devices, or SQUIDs. In a SQUID, ­electrons are in an odd ­quantum state that allows individual ­electrons to move in two directions at once and interfere with themselves. The amount of interference depends on the strength of an external magnetic field and translates into a measurable resistance to the flow of current in the SQUID.
A weak magnetic field MRI machine might cost as little as US $100 000 compared with $1 million or more for a standard MRI system
Because it needs fewer costly magnets, a weak­magnetic-field MRI machine might cost as little as US $100 000, compared with $1 million or more for a standard MRI system, says Zotev. But perhaps the most exciting thing about low-field imagers is that they can also perform another imaging technique, magneto­encephalography (MEG), which, conveniently, also relies on SQUIDs. MEG measures the magnetic fields produced by brain activity and is used to study seizures. Putting the two imaging modes together could mean matching images of brain activity from MEG with images of brain structure from MRI, and it might make for more precise brain surgery.
Low-field MRI has other advantages, says John Clarke, a physicist at the University of California, Berkeley, who uses a single-SQUID MRI device to image tissue samples. “I’m personally quite excited about the idea of imaging tumors” with low-field MRI, he says. The difference between cancerous and noncancerous tissue is subtle, particularly in breast and prostate tumors, and the high-field strengths used in conventional MRI can drown out the signal. But low-field MRI will be able to detect the differences, Clarke predicts. A low-field MRI might also allow for scans during surgical procedures such as biopsies, because the weaker magnetic field would not heat up or pull at the metal biopsy needle.
Groups in Europe and Japan are also developing low-field MRI, both for identifying tumors and for matching with MEG. Zotev is working on improving the image quality, perhaps by increasing the strength of the prepolarization field, and studying what signals might be read in low-field MRI that conventional MRI might miss. He says that, with enough focus on the engineering issues, practical devices might be ready for clinical trials within a ­couple of years.



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