Investigative Radiology Journal Impact Factor & Information

Publisher: Association of University Radiologists, Lippincott, Williams & Wilkins

Journal description

Investigative Radiology publishes original, peer-reviewed reports on clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, and related modalities. Emphasis is on early and timely publication. Primarily research-oriented, the journal also includes a wide variety of features of interest to clinical radiologists.

Current impact factor: 4.45

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 4.453
2012 Impact Factor 5.46
2011 Impact Factor 4.593
2010 Impact Factor 4.665
2009 Impact Factor 4.85
2008 Impact Factor 5.289
2007 Impact Factor 4.234
2006 Impact Factor 3.398
2005 Impact Factor 3.173
2004 Impact Factor 2.32
2003 Impact Factor 1.99
2002 Impact Factor 2.67
2001 Impact Factor 2.298
2000 Impact Factor 1.41
1999 Impact Factor 1.757
1998 Impact Factor 0.922
1997 Impact Factor 0.915
1996 Impact Factor 0.89
1995 Impact Factor 0.712
1994 Impact Factor 0.841
1993 Impact Factor 0.776
1992 Impact Factor 0.658

Impact factor over time

Impact factor

Additional details

5-year impact 4.44
Cited half-life 6.40
Immediacy index 1.39
Eigenfactor 0.01
Article influence 1.31
Website Investigative Radiology website
Other titles Investigative radiology
ISSN 0020-9996
OCLC 1753822
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details

Lippincott, Williams & Wilkins

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Some journals have separate policies, please check with each journal directly
    • Pre-print must be removed upon acceptance for publication
    • Post-print may be deposited in personal website or institutional repository
    • Publisher's version/PDF cannot be used
    • Must include statement that it is not the final published version
    • Published source must be acknowledged with full citation
    • Set statement to accompany deposit
    • Must link to publisher version
    • NIH authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 12 months embargo (see policy for details)
    • Wellcome Trust and HHMI authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 6 months embargo (see policy for details)
    • Publisher last reviewed on 19/03/2015
  • Classification
    ​ yellow

Publications in this journal

  • Mami Iima, Kojiro Yano, Masako Kataoka, Masaki Umehana, Katsutoshi Murata, Shotaro Kanao, Kaori Togashi, Denis Le Bihan
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    ABSTRACT: Objectives: The purpose of this study was to explore the potential of non-Gaussian diffusion and perfusion magnetic resonance imaging (MRI) using intravoxel incoherent motion (IVIM) MRI for the diagnosis of breast lesions. Materials and Methods: This study included 26 women with breast lesions. Diffusion-weighted images were acquired using 16 b values up to 2500 s/mm(2) and analyzed using a kurtosis diffusion model (apparent diffusion coefficient [ADC(0)] and kurtosis [K]) for the diffusion component and IVIM model (perfusion fraction [fIVIM] and pseudodiffusion coefficient [D*]) for the perfusion component. Diagnostic performance of diffusion and perfusion parameters was evaluated from receiver operating characteristic analyses. Results: The ADC(0) in malignant lesions was significantly lower than that in benign lesions and normal tissue (P < 0.001, P < 0.001), whereas K was significantly higher (P < 0.05, P < 0.001), as well as fIVIM (P < 0.05, P < 0.01). No significant difference was found in D*. The receiver operating characteristic analysis gave high area under the curve values for ADC(0), K, and fIVIM for distinguishing malignant from benign lesions (0.99, 0.85, and 0.82, respectively). The ADC(0) allowed benign tumors to be identified with 100% negative predictive value and malignant tumors with 100% sensitivity. The malignant/benign diagnosis thresholds were 1.4 +/- 10(-3) mm(2)/s as well as 0.6 and 7%, respectively, for ADC(0), K, and fIVIM. Conclusions: With a proper methodological framework, IVIM MRI can provide valuable information on tissue structure and microvasculature beneficial for the diagnosis of breast cancer lesions.
    Investigative Radiology 04/2015; 50(4):205-211.
  • Investigative Radiology 04/2015; 50(4):187. DOI:10.1097/RLI.0000000000000139
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    ABSTRACT: Patients with hepatic metastases who are candidates for Y90-radioembolization (Y90-RE) usually have advanced tumor stages with involvement of both liver lobes. Per current guidelines, these patients have usually undergone several cycles of potentially hepatotoxic systemic chemotherapy before Y90-RE is at all considered, requiring split (lobar) treatment sessions to reduce hepatic toxicity. Assessing response to Y90-RE early, that is, already after the first lobar session, would be helpful to avoid an ineffective and potentially hepatotoxic second lobar treatment. We investigated the accuracy with which diffusion- weighted magnetic resonance imaging (DWI-MRI) and positron emission tomography/computed tomography (PET/CT) can provide this information. An institutional review board-approved prospective intraindividual comparison trial on 35 patients who underwent fluorodeoxyglucose PET/CT and DWI-MRI within 6 weeks before and 6 weeks after Y90-RE to treat secondary-progressive liver metastases from solid cancers (20 colorectal, 13 breast, 2 other) was performed. An increase of minimal apparent diffusion coefficient (ADCmin) or decrease of maximum standard uptake value (SUVmax) by at least 30% was regarded as positive response. Long-term clinical and imaging follow-up was used to distinguish true- from false-response classifications. On the basis of long-term follow-up, 23 (66%) of 35 patients responded to the Y90 treatment. No significant changes of metastases size or contrast enhancement were observable on pretreatment versus posttreatment CT or magnetic resonance images. However, overall SUVmax decreased from 8.0 ± 3.9 to 5.5 ± 2.2 (P < 0.0001), and ADCmin increased from 0.53 ± 0.13 × 10 mm/s to 0.77 ± 0.26 × 10 mm/s (P < 0.0001). Pretherapeutic versus posttherapeutic changes of ADCmin and SUVmax correlated moderately (r = -0.53). In 4 of the 35 patients (11%), metastases were fluorodeoxyglucose-negative such that no response assessment was possible by PET. In 25 (71%) of the 35 patients, response classification by PET and DWI-MRI was concordant; in 6 (17%) of the 35, it was discordant. In 5 of the 6 patients with discordant classifications, follow-up confirmed diagnoses made by DWI. The positive predictive value to predict response was 22 (96%) of 23 for MRI and 15 (88%) of 17 for PET. The negative predictive value to predict absence was 11 (92%) of 12 for MRI and 10 (56%) of 18 for PET. Sensitivity for detecting response was significantly higher for MRI (96%; 22/23) than for PET (65%; 15/23) (P < 0.02). Diffusion-weighted magnetic resonance imaging appears superior to PET/CT for early response assessment in patients with hepatic metastases of common solid tumors. It may be used in between lobar treatment sessions to guide further management of patients who undergo Y90-RE for hepatic metastases.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    Investigative Radiology 03/2015; 50(6). DOI:10.1097/RLI.0000000000000144
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    ABSTRACT: The aim of this study was to evaluate the suitability of in vivo x-ray dark-field radiography for early-stage diagnosis of pulmonary emphysema in mice. Furthermore, we aimed to analyze how the dark-field signal correlates with morphological changes of lung architecture at distinct stages of emphysema. Female 8- to 10-week-old C57Bl/6N mice were used throughout all experiments. Pulmonary emphysema was induced by orotracheal injection of porcine pancreatic elastase (80-U/kg body weight) (n = 30). Control mice (n = 11) received orotracheal injection of phosphate-buffered saline. To monitor the temporal patterns of emphysema development over time, the mice were imaged 7, 14, or 21 days after the application of elastase or phosphate-buffered saline. X-ray transmission and dark-field images were acquired with a prototype grating-based small-animal scanner. In vivo pulmonary function tests were performed before killing the animals. In addition, lungs were obtained for detailed histopathological analysis, including mean cord length (MCL) quantification as a parameter for the assessment of emphysema. Three blinded readers, all of them experienced radiologists and familiar with dark-field imaging, were asked to grade the severity of emphysema for both dark-field and transmission images. Histopathology and MCL quantification confirmed the introduction of different stages of emphysema, which could be clearly visualized and differentiated on the dark-field radiograms, whereas early stages were not detected on transmission images. The correlation between MCL and dark-field signal intensities (r = 0.85) was significantly higher than the correlation between MCL and transmission signal intensities (r = 0.37). The readers' visual ratings for dark-field images correlated significantly better with MCL (r = 0.85) than visual ratings for transmission images (r = 0.36). Interreader agreement and the diagnostic accuracy of both quantitative and visual assessment were significantly higher for dark-field imaging than those for conventional transmission images. X-ray dark-field radiography can reliably visualize different stages of emphysema in vivo and demonstrates significantly higher diagnostic accuracy for early stages of emphysema than conventional attenuation-based radiography.
    Investigative Radiology 03/2015; DOI:10.1097/RLI.0000000000000147
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    ABSTRACT: The objective of this study was to assess the risk of gadoxetate disodium in liver imaging for the development of nephrogenic systemic fibrosis (NSF) in patients with moderate to severe renal impairment. We performed a prospective, multicenter, nonrandomized, open-label phase 4 study in 35 centers from May 2009 to July 2013. The study population consisted of patients with moderate to severe renal impairment scheduled for liver imaging with gadoxetate disodium. All patients received a single intravenous bolus injection of 0.025-mmol/kg body weight of liver-specific gadoxetate disodium. The primary target variable was the number of patients who develop NSF within a 2-year follow-up period. A total of 357 patients were included, with 85 patients with severe and 193 patients with moderate renal impairment, which were the clinically most relevant groups. The mean time period from diagnosis of renal disease to liver magnetic resonance imaging (MRI) was 1.53 and 5.46 years in the moderate and severe renal impairment cohort, respectively. Overall, 101 patients (28%) underwent additional contrast-enhanced MRI with other gadolinium-based MRI contrast agents within 12 months before the start of the study or in the follow-up. No patient developed symptoms conclusive of NSF within the 2-year follow-up. Gadoxetate disodium in patients with moderate to severe renal impairment did not raise any clinically significant safety concern. No NSF cases were observed.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    Investigative Radiology 03/2015; 50(6). DOI:10.1097/RLI.0000000000000145
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    ABSTRACT: This study aimed to describe and evaluate the influence of time-of-flight (TOF) information on metal artifact reduction in positron emission tomography (PET) image quality in clinical simultaneous PET/magnetic resonance (MR) scanning. A total of 7 patients with various malignant tumors were included and underwent a PET/MR examination after standard PET/computed tomography. Baseline TOF and non-TOF PET images were reconstructed. Next, the TOF and non-TOF PET reconstructions were repeated after the introduction of artificial signal voids in the attenuation map to simulate metal artifacts of various sizes in a range of locations. Three different sizes of signal voids were inserted in the attenuation maps for each location of interest: over the maxilla, humeral head, chest, sternum, thoracic and lumbar spine, as well as the femoral head to replicate clinically relevant metal artifacts. The reconstructed images with the artifacts were then compared with the baseline reconstructed images. The mean percentage error in a region of interest surrounding the simulated artifact was used to compare between TOF and non-TOF images. Further comparison between TOF and non-TOF images was performed using histogram analysis. In all cases, the mean percentage error in a region of interest surrounding the simulated artifact was reduced when TOF information was included in the reconstruction. The inclusion of TOF also changes the distribution of smaller errors away from the origin of the artifact. In some anatomical regions, an increase in the number of small errors was noted with TOF, although the differences with non-TOF were minimal. Positron emission tomographic imaging benefits from the integration of TOF information in simultaneous PET/MR. The inclusion of TOF information in simultaneous PET/MR imaging reduces errors related to metal artifacts at the site of the artifact.
    Investigative Radiology 03/2015; DOI:10.1097/rli.0000000000000146
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    ABSTRACT: From a surgeon's point of view, meshes implanted for inguinal hernia repair should overlap the defect by 3 cm or more during implantation to avoid hernia recurrence secondary to mesh shrinkage. The use of magnetic resonance imaging (MRI)-visible meshes now offers the opportunity to noninvasively monitor whether a hernia is still covered sufficiently in the living patient. The purpose of this study was therefore to evaluate the efficacy of hernia repair after mesh implantation based on MRI findings (mesh coverage, visibility of hernia structures) and based on the patient's postoperative symptoms. In this prospective study approved by the ethics committee, 13 MRI-visible meshes were implanted in 10 patients (3 bilaterally) for inguinal hernia repair between March 2012 and January 2013. Senior visceral surgeons (>7 years of experience) implanted the meshes via laparoscopic transabdominal preperitoneal procedure. Magnetic resonance imaging was performed within 1 week and at 3 months after surgery at a 1.5-T system. Mesh position, deformation, and coverage of the hernia were visually assessed in consensus and rated on a 4-point semiquantitative scoring system. Distances of hernia center point to the mesh borders (overlap) were measured. Mesh position and hernia coverage postoperatively and at 3 months after implantation were correlated with the respective patients' clinical symptoms. Statistical analysis was performed using the Wilcoxon signed rank test. Two of the 13 meshes presented with an atypical mesh configuration along the course of psoas muscle with a short medial overlap of less than 2 cm. Eleven of the 13 meshes exhibited a typical mesh configuration with lateral folding and initial overlap of more than 2 cm. Between baseline and 3 months' follow-up, average overlap decreased in the medial direction by -10% (3.75 cm vs 3.36 cm, P = 0.22), in the lateral direction by -20% (3.55 cm vs 2.82 cm, P = 0.01), in the superior direction by -2% (5.82 cm vs 5.72 cm, P = 0.55), and in the posterior direction by -19% (4.11 cm vs 3.34 cm, P = 0.01). Between baseline and 3 months' follow-up, mesh folding increased mildly in the medial direction, whereas no change was found in the other directions. Individual folds of the mesh were flexible over time, whereas the gross visual configuration and location of meshes did not change. Four of the 13 former hernia sites were mildly painful at follow-up, whereas 9 of the 13 were completely asymptomatic. No correlation between clinical symptoms and mesh position or hernia coverage was found. Our results suggest that the actual postoperative mesh position after release of laparoscopic pneumoperitoneum may deviate from its position during surgery. Gross mesh position and configuration differed between patients but did not change within a given patient over the observation period of 3 months after surgery. We did not find a correlation between clinical symptoms and mesh configuration or position. Shrinkage of meshes does occur, yet not as concentric process, but regionally variable, leading to a reduced hernia coverage of up to -20% in the lateral and posterior directions.
    Investigative Radiology 03/2015; DOI:10.1097/RLI.0000000000000148
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    ABSTRACT: The dentate nucleus of the cerebellum may appear as hyperintense on unenhanced T1 magnetic resonance images (MRIs) of the brain. Recently, T1 signal hyperintensity has received attention owing to data on the association of this finding with the history of multiple injections of gadolinium-based contrast agents, specifically gadodiamide, in patients with multiple sclerosis and brain metastases. We conducted a retrospective study on patients with a meningioma who had routinely undergone follow-up enhanced MRI scans with gadodiamide. Across a time interval of 18 months (from January 2013 to July 2014), we identified 102 consecutive patients eligible for this study. A significant increase in T1 hyperintensity of the dentate nuclei of the cerebellum on nonenhanced scans was observed between the first and the last MRI in the group of patients with a history of at least 6 enhanced MRI scans (P < 0.01), whereas no differences were observed in the group with 1 to 5 enhanced MRI scans (P = 0.74). Further research is necessary to shed light on the mechanism of the T1 hyperintensity as well as on the histological and microstructural appearance of the dentate nucleus after multiple intravenous injections of gadodiamide. The finding raises the question of substantial dechelation of this agent in patients with normal renal function.
    Investigative Radiology 03/2015; DOI:10.1097/RLI.0000000000000154
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    ABSTRACT: The objective of this study was to evaluate the influence of short- and long-term hypoxia on the depiction of cerebral veins in the susceptibility-weighted angiography (SWAN) sequence. In the context of a study on brain adaptation mechanisms to hypoxia, 16 healthy men (aged 20-28 years) were studied through magnetic resonance imaging (MRI) under room air conditions, short-term-hypoxia (7 minutes before and during the MRI scan), and long-term hypoxia (8.5 hours before and during the MRI scan). Oxygen saturation was continuously measured using a finger-mounted pulse oximeter. Two independent blinded readers compared the 3 scans of each participant and graded the SWAN source images and minimum intensity projections according to the size, number, and signal intensity of the cerebral veins. Signal intensities of deep cerebral veins were measured, and signal intensity proportions of deep cerebral veins to different parenchymal brain regions were calculated. Nine subjects could be included in the study. In all of them, both readers correctly distinguished the 2 hypoxia scans from the baseline scan, grading the SWAN images acquired under hypoxic conditions as visualizing cerebral veins more prominently. Signal intensities of the deep cerebral veins and signal intensity proportions were significantly lower in the hypoxia scans. No significant differences between short-term and long-term hypoxia were found on visual inspections and signal intensity measurements. This correlated with the results of the pulse oximetry: mean O2 saturation values were 97.9% ± 1.2% (baseline), 84.1% ± 3.8% (short-term hypoxia), and 82.8% ± 4.4% (long-term hypoxia), respectively. Hypoxia leads to visible and measurable changes in cerebral veins as depicted through SWAN. Possible clinical implications of this finding include stroke and tumor imaging and need further investigation.
    Investigative Radiology 02/2015; DOI:10.1097/RLI.0000000000000143
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    ABSTRACT: The objective of this study was to demonstrate experimentally that radiofrequency ablation (RFA) of ferucarbotran-accumulated healthy liver tissues causes excess iron deposition in the ablated liver tissues on postablation days and produces sustained T2*-weighted low signals indicative of ablative margins surrounding hepatic tumors. We conducted 3 experiments using 30 rats. In experiment 1, we administered either ferucarbotran (n = 6) or saline (n = 4), acquired T2*-weighted images (T2*-WIs) of the liver by using a 3-T magnetic resonance scanner, and subsequently performed RFA of healthy liver lobes. We acquired follow-up T2*-WIs up to day 7 and histologically analyzed the liver specimens. In another 4 rats, we performed sham operation, instead of RFA, in ferucarbotran-accumulated liver lobes, followed by the same image acquisition and histological analysis. In experiment 2, we administered Fe-labeled ferucarbotran, subsequently performed either RFA (n = 4) or sham operation (n = 4) in the liver, and acquired autoradiograms of the liver specimens on day 7. In experiment 3, we conducted RFA treatment for 8 rats bearing orthotopic hepatic tumors after ferucarbotran administration and monitored tumor growth by using serial T2*-WIs. On days 4 and 7 of the experiment 1, T2*-WIs of 6 rats with systemic ferucarbotran administration and subsequent hepatic RFA showed low-signal regions indicative of ablated liver tissues, whereas high-signal areas were seen in 4 saline-administered rats. Neither high nor low signal areas were detected in 4 sham-operated rats. Histologically, larger amounts of iron were observed in the RFA-induced necrotic liver tissues in the ferucarbotran-administered rats than in the saline-administered-rats. The Fe autoradiography of the rats in experiment 2 revealed accumulation of ferucarbotran-derived iron in necrotic liver tissues. Among 6 hepatic tumors grown in 6 rats of the experiment 3, a total of 4 tumors were stable in size, but the other 2 increased markedly on day 7. Retrospectively, T2*-WIs showed the former tumor sites surrounded completely by low-signal areas on day 4. The RFA of ferucarbotran-accumulated healthy liver tissues in the rats caused excess iron deposition in the ablated liver tissues and produced sustained T2*-weighted hypointense regions. Similar hypointense regions surrounding hepatic tumors were indicative of ablative margins.
    Investigative Radiology 02/2015; 50(6). DOI:10.1097/RLI.0000000000000137
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    ABSTRACT: Calculation of accurate T1 relaxivity (r1) values for gadolinium-based magnetic resonance contrast agents (GBCAs) is a complex process. As such, often referenced r1 values for the GBCAs at 1.5 T, 3 T, and 7 T are based on measurements obtained in media that are not clinically relevant, derived from only a small number of concentrations, or available for only a limited number of GBCAs. This study derives the r1 values of the 8 commercially available GBCAs in human whole blood at 1.5 T, 3 T, and 7 T. Eight GBCAs were serially diluted in human whole blood, at 7 concentrations from 0.0625 to 4 mM. A custom-built phantom held the dilutions in air-tight cylindrical tubes maintained at 37 ± 0.5°C by a heat-circulating system. Images were acquired using inversion recovery sequences with inversion times from 30 milliseconds to 10 seconds at 1.5 T and 3 T as well as 60 milliseconds to 5 seconds at 7 T. A custom MATLAB program was used to automate signal intensity measurements from the images acquired of the phantom. SigmaPlot was used to calculate T1 relaxation times and, finally, r1. Measured r1 values in units of s[BULLET OPERATOR]mM at 1.5 T (3 T/7 T) were 3.9 ± 0.2 (3.4 ± 0.4/2.8 ± 0.4) for Gd-DOTA, 4.6 ± 0.2 (4.5 ± 0.3/4.2 ± 0.3) for Gd-DO3A-butrol, 4.3 ± 0.4 (3.8 ± 0.2/3.1 ± 0.4) for Gd-DTPA, 6.2 ± 0.5 (5.4 ± 0.3/4.7 ± 0.1) for Gd-BOPTA, 4.5 ± 0.1 (3.9 ± 0.2/3.7 ± 0.2) for Gd-DTPA-BMA, 4.4 ± 0.2 (4.2 ± 0.2/4.3 ± 0.2) for Gd-DTPA-BMEA, 7.2 ± 0.2 (5.5 ± 0.3/4.9 ± 0.1) for Gd-EOB-DTPA, and 4.4 ± 0.6 (3.5 ± 0.6/3.4 ± 0.1) for Gd-HP-DO3A. The agents can be stratified by relaxivity, with a significant additional dependency on field strength. This report quantifies, for the first time, T1 relaxivity for all 8 gadolinium chelates in common clinical use worldwide, at current relevant field strengths, in human whole blood at physiological temperature (37°C). The measured r1 values differ to a small degree from previously published values, where such comparisons exist, with the current r1 measurements being that most relevant to clinical practice. The macrocyclic agents, with the exception of Gd-DO3A-butrol, have slightly lower r1 values when compared with the 2 much less stable linear agents, Gd-DTPA-BMA and Gd-DTPA-BMEA. The 2 agents with hepatobiliary excretion, Gd-EOB-DTPA and Gd-BOPTA, have, at 1.5 and 3 T, substantially higher r1 values than all other agents.
    Investigative Radiology 02/2015; 50(5). DOI:10.1097/RLI.0000000000000132
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    ABSTRACT: Cardiac C-arm computed tomography (CT) uses a standard C-arm fluoroscopy system rotating around the patient to provide CT-like images during interventional procedures without moving the patient to a conventional CT scanner. We hypothesized that C-arm CT can be used to visualize and quantify the size of perfusion defects and late enhancement resulting from a myocardial infarction (MI) using contrast-enhanced techniques similar to previous CT and magnetic resonance imaging studies. A balloon occlusion followed by reperfusion in a coronary artery was used to study acute and subacute MI in 12 swine. Electrocardiographically gated C-arm CT images were acquired the day of infarct creation (n = 6) or 4 weeks after infarct creation (n = 6). The images were acquired immediately after contrast injection, then at 1 minute, and every 5 minutes up to 30 minutes with no additional contrast. The volume of the infarct as measured on C-arm CT was compared against pathology. The volume of acute MI, visualized as a combined region of hyperenhancement with a hypoenhanced core, correlated well with pathologic staining (concordance correlation, 0.89; P < 0.0001; mean [SD] difference, 0.67 [2.98] cm). The volume of subacute MI, visualized as a region of hyperenhancement, correlated well with pathologic staining at imaging times 5 to 15 minutes after contrast injection (concordance correlation, 0.82; P < 0.001; mean difference, -0.64 [1.94] cm). C-arm CT visualization of acute and subacute MI is possible in a porcine model, but improvement in the imaging technique is important before clinical use. Visualization of MI in the catheterization laboratory may be possible and could provide 3-dimensional images for guidance during interventional procedures.
    Investigative Radiology 01/2015; 50(6). DOI:10.1097/RLI.0000000000000138
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    ABSTRACT: This study is designed to examine the feasibility of diffusion-sensitized multishot split-echo rapid acquisition with relaxation enhancement (RARE) for diffusion-weighted ophthalmic imaging free of geometric distortions at 3.0 and 7.0 T in healthy volunteers and patients with intraocular masses. A diffusion-sensitized multishot split-echo RARE (ms-RARE) variant is proposed as an alternative imaging strategy for diffusion-weighted imaging. It is compared with standard single-shot echo planar imaging (EPI) and readout-segmented EPI in terms of geometric distortions in a structure phantom as well as in vivo at 3.0 and 7.0 T. To quantify geometric distortions, center of gravity analysis was carried out. Apparent diffusion coefficient (ADC) mapping in a diffusion phantom was performed to verify the diffusion sensitization within ms-RARE. An in vivo feasibility study in healthy volunteers (n = 10; mean age, 31 ± 7 years; mean body mass index, 22.6 ± 1.7 kg/m) was conducted at 3.0 and 7.0 T to evaluate clinical feasibility of ms-RARE. As a precursor to a broader clinical study, patients (n = 6; mean age, 55 ± 12 years; mean body mass index, 27.5 ± 4.7 kg/m) with an uveal melanoma and/or retinal detachment were examined at 3.0 and 7.0 T. In 1 case, the diseased eye was enucleated as part of the therapy and imaged afterward with magnetic resonance microscopy at 9.4 T. Macrophotography and histological investigation was carried out. For qualitative assessment of the image distortion, 3 independent readers reviewed and scored ms-RARE in vivo images for all subjects in a blinded reading session. Statistical significance in the difference of the scores (a) obtained for the pooled ms-RARE data with b = 0 and 300 s/mm and (b) for the 3 readers was analyzed using the nonparametric Mann-Whitney test. The assessment of geometric integrity in phantom imaging revealed the ability of ms-RARE to produce distortion-free images. Unlike ms-RARE, modest displacements (2.3 ± 1.4 pixels) from the fast low angle shot imaging reference were observed for readout-segmented EPI, which were aggravated for single-shot EPI (8.3 ± 5.7 pixels). These observations were confirmed in the in vivo feasibility study including distortion-free diffusion-weighted ophthalmic images with a 0.5 × 0.5 × 5 mm spatial resolution at 3.0 T and as good as 0.2 × 0.2 × 2 mm at 7.0 T. The latter represents a factor of 40 enhancement in spatial resolution versus clinical protocols recently reported for diffusion-weighted imaging of the eye at 1.5 T. Mean ADC values within the vitreous body were (2.91 ± 0.14) × 10 mm/s at 3.0 T and (2.93 ± 0.41) × 10 mm/s at 7.0 T. Patient data showed severe retinal detachment in the anatomical images. Whereas the tumor remained undetected in T1-weighted and T2-weighted imaging at 3.0/7.0 T, in vivo ADC mapping using ms-RARE revealed the presence of a uveal melanoma with a significant contrast versus the surrounding subretinal hemorrhage. This observation was confirmed by high-resolution ex vivo magnetic resonance microscopy and histology. Qualitative analysis of image distortion in ms-RARE images obtained for all subjects yielded a mean ± SD image quality score of 1.06 ± 0.25 for b = 0 s/mm and of 1.17 ± 0.49 for b = 300 s/mm. No significant interreader differences were observed for ms-RARE with a diffusion sensitization of b = 0 s/mm and 300 s/mm. This work demonstrates the capability of diffusion-sensitized ms-RARE to acquire high-contrast, high-spatial resolution, distortion-free images of the eye and the orbit at 3.0 and 7.0 T. Geometric distortions that are observed for EPI-based imaging approaches even at lower field strengths are offset by fast spin-echo-based imaging techniques. The benefits of this improvement can be translated into the assessment of spatial arrangements of the eye segments and their masses with the ultimate goal to provide guidance during diagnostic treatment of ophthalmological diseases.
    Investigative Radiology 01/2015; 50(5). DOI:10.1097/RLI.0000000000000129
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    ABSTRACT: The purpose of this study was to investigate the correlation between hepatic venous pressure gradient (HVPG) and in vivo viscoelasticity of the liver and spleen before and after transjugular intrahepatic portosystemic shunt (TIPS) implantation. Ten patients with portal hypertension were examined twice by 3-dimensional multifrequency magnetic resonance elastography as well as prior and subsequent TIPS intervention; HVPG was also measured during TIPS placement. Five harmonic vibrations (25-60 Hz) were transferred to the abdominal region and recorded for the reconstruction of 2 viscoelastic constants, |G | and φ, corresponding to the magnitude and the phase angle of the complex shear modulus G of the liver and spleen. All patients had cirrhosis, yielding high |G*| values in the liver (8.34 ± 2.18 kPa) and spleen (8.44 ± 1.36kPa). In both organs, a decrease of |G*| after TIPS placement was observed (liver: 8.34 ± 2.18kPa vs 7.02 ± 1.46 kPa, P = 0.01; spleen: 8.44 ± 1.36 kPa vs 7.06 ± 1.32 kPa, P = 0.01), whereas φ was insensitive to TIPS. Relative changes in |G*| of the spleen were correlated with the relative change of HVPG (R = 0.659, P = 0.013). The observed linear correlation between spleen viscoelasticity HVPG raises the prospect of an image-based noninvasive assessment of portal pressure by magnetic resonance elastography in the follow-up of TIPS placements.
    Investigative Radiology 01/2015; 50(5). DOI:10.1097/RLI.0000000000000136
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    ABSTRACT: The purpose of this study was to develop a new method of displaying dynamic cerebral computed tomographic (CT) angiography (CTA) data sets in which the time delay to maximum enhancement (Tdelay) is displayed in a range of colors (color-coded CT angiography [cCTA]). This institutional review board-approved study included multiparametric CT data sets from 16 patients with different types of supra-aortic large vessel occlusions. Color-coded CT angiography was reconstructed from CT perfusion raw data sets. All voxel enhancement curves were fitted to f(t) = α · AIFmtt(t - Δt), with AIFmtt(t), indicating enhancement of AIF dilated by convolution with boxcar function (with mean transit time [mtt]); α, scaling factor; and Δt, transition along the time. The time delay to maximum enhancement was defined as Tdelay = Δt +0.5 · mtt. Values of Tdelay were color-coded and superimposed on temporal maximum intensity projections CTA resulting in colored angiographic composite images. For a pilot clinical evaluation, diagnostic confidence in determining the pathology, quality of the visualization of leptomeningeal collaterals, and additional diagnostic information were assessed. The reconstruction of cCTA was technically feasible in all 16 patients. Both diagnostic confidence (P < 0.01) and the quality of the visualization of collaterals (P < 0.0001) were significantly higher when using the combination of single-phase CTA and cCTA compared with single-phase CTA alone. Additional diagnostic information was obtained with cCTA regarding occlusion type (reader 1: 5 cases and reader 2: 4 cases), differentiation between arteries and veins (11/13), differentiation between antegrade and retrograde filling (12/13), as well as leptomeningeal collateralization (13/14). Color-coded CT angiography is a technically feasible technique that provides additional information on cerebral hemodynamics in ischemic stroke patients.
    Investigative Radiology 01/2015; DOI:10.1097/RLI.0000000000000134
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    ABSTRACT: The objective of this study was to evaluate the radiation dose and image quality performance of thoracoabdominal examinations with an automated tube voltage selection (tube voltage adaptation), tube current modulation, and high pitch using a third-generation dual-source computed tomography (CT) compared intraindividually with 120-kV examinations with tube current modulation with special attention on clinically relevant lesions in the liver, the lungs, and extrahepatic soft tissues. This study was approved by the institutional review board. Computed tomography of the body was performed using a third-generation dual-source system in 95 patients (mean body mass index, 25 kg/m; range, 18-35 kg/m). For 49 of these patients, all calculated tube settings and resulting dose values were recorded for each of the 12 gradual contrast weightings of the tube voltage adaptation algorithm. Spiral CT was performed for all patients with an intermediate weighting (grade 7) in a portal venous phase at 120 reference kV, 180 reference mAs, and pitch of 1.55. Objective image quality was assessed on the basis of contrast-to-noise ratio. Subjective image quality was assessed on the basis of clarity and sharpness of anatomical and pathological structures as well as interfering beam hardening and spiral and motion artifacts (heart, lungs, diaphragm). Previous examinations on a 64-slice scanner served as reference. All examinations were rated good or excellent for clinical diagnosis. Automated tube voltage selection resulted in significantly lower effective radiation dose (9.5 mSv) compared with the reference (12.0 mSv; P < 0.01). Contrast-to-noise ratio and image quality of soft tissue lesions were significantly increased (P < 0.01). Motion artifacts were significantly reduced (P < 0.01). Automated tube voltage adaptation combined with high-pitch protocols allows for a substantial radiation dose reduction while substantially increasing the image quality, even at large-volume exposure.
    Investigative Radiology 01/2015; 50(5). DOI:10.1097/RLI.0000000000000133
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    ABSTRACT: The objective of this study was to evaluate the frequency and characteristics of artifacts in segmentation-based attenuation correction maps (μ-maps) of positron emission tomography/magnetic resonance (PET/MR) and their impact on PET interpretation and the standardized uptake value (SUV) quantification in normal tissue and lesions. The study was approved by the local institutional review board. Attenuation maps of 100 patients with PET/MR and preceding PET/computed tomography examination were retrospectively inspected for artifacts (tracers: 2-deoxy-2-[F]fluoro-D-glucose (F-FDG), C-Choline, Ga-DOTATOC, Ga-DOTATATE, C-Methionine). The artifacts were subdivided into 9 different groups on the basis of their localization and appearance. The impact of μ-map artifacts in normal tissue and lesions on PET interpretation was evaluated qualitatively via visual analysis in synopsis with the non-attenuation-corrected (NAC) PET as well as quantitatively by comparing the SUV in artifact regions to reference regions. Attenuation map artifacts were found in 72% of the head/neck data sets, 61% of the thoracic data sets, 25% of the upper abdominal data sets, and 26% of the pelvic data sets. The most frequent localizations of the overall 276 artifacts were around metal implants (16%), in the lungs (19%), and outer body contours (31%). Twenty-one percent of all PET-avid lesions (38 of 184 lesions) were affected by artifacts in the majority without further consequences for visual PET interpretation. However, 9 PET-avid lung lesions were masked owing to μ-map artifacts and, thus, were only detectable on the NAC PET or additional MR imaging sequences. Quantitatively, μ-map artifacts led to significant SUV changes in areas with erroneous assignment of air instead of soft tissue (ie, metal artifacts) and of soft tissue instead of lung. Nevertheless, no change in diagnosis would have been caused by μ-map artifacts. Attenuation map artifacts that occur in a considerable percentage of PET/MR data sets have the potential to falsify PET quantification and visual PET interpretation. Nevertheless, on the basis of the present data, in the clinical interpretation setup, no changes in diagnosis due to μ-map artifacts may occur, especially when the μ-maps are checked for artifacts and PET/MR is read in synopsis with the NAC PET, if artifacts are present.
    Investigative Radiology 01/2015; 50(5). DOI:10.1097/RLI.0000000000000131
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    ABSTRACT: We sought to assess the feasibility and reproducibility of 3-dimensional ultrasound molecular imaging (USMI) of vascular endothelial growth factor receptor 2 (VEGFR2) expression in tumor angiogenesis using a clinical matrix array transducer and a clinical grade VEGFR2-targeted contrast agent in a murine model of human colon cancer. Animal studies were approved by the Institutional Administrative Panel on Laboratory Animal Care. Mice with human colon cancer xenografts (n = 33) were imaged with a clinical ultrasound system and transducer (Philips iU22; X6-1) after intravenous injection of either clinical grade VEGFR2-targeted microbubbles or nontargeted control microbubbles. Nineteen mice were scanned twice to assess imaging reproducibility. Fourteen mice were scanned both before and 24 hours after treatment with either bevacizumab (n = 7) or saline only (n = 7). Three-dimensional USMI data sets were retrospectively reconstructed into multiple consecutive 1-mm-thick USMI data sets to simulate 2-dimensional imaging. Vascular VEGFR2 expression was assessed ex vivo using immunofluorescence. Three-dimensional USMI was highly reproducible using both VEGFR2-targeted microbubbles and nontargeted control microbubbles (intraclass correlation coefficient, 0.83). The VEGFR2-targeted USMI signal significantly (P = 0.02) decreased by 57% after antiangiogenic treatment compared with the control group, which correlated well with ex vivo VEGFR2 expression on immunofluorescence (ρ = 0.93, P = 0.003). If only central 1-mm tumor planes were analyzed to assess antiangiogenic treatment response, the USMI signal change was significantly (P = 0.006) overestimated by an average of 27% (range, 2%-73%) compared with 3-dimensional USMI. Three-dimensional USMI is feasible and highly reproducible and allows accurate assessment and monitoring of VEGFR2 expression in tumor angiogenesis in a murine model of human colon cancer.
    Investigative Radiology 01/2015; 50(5). DOI:10.1097/RLI.0000000000000128