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Frenzel Free PDF d0wnl0ad, audio books, books to read, good books to read, cheap books, good books, online books, books online, book reviews epub, read books online, books to read online, online library, greatbooks to read, PDF best books to read, top books to read Management of Information Technology 4th edition by Carroll W. Introduction of a time-resolved sequence in , using view sharing with oversampling of the center of k-space, provided additional temporal information on blood flow dynamics, while maintaining the excellent delineation of vessels provided by the breath-hold technique, and reducing the flow-related artifacts that were sometimes seen [ ].
It was further realized, in , that correct GBCA bolus timing could approximately double SNR in the aorta and portal vein [ ], and this subsequently led to the development of a number of semi-automated bolus detection tools for optimization of CE-MRA acquisition.
Today, CE-MRA is widely used for imaging the vascular anatomy in patients with known or suspected peripheral arterial occlusive or aneurysmal disease, as well as various less commonly encountered conditions that affect the non-coronary vasculature [ ]. Through advances in technology and the availability of suitable contrast agents, CE-MRA has evolved into a real-time imaging technique that is a highly valuable alternative to CT angiography and intra-arterial DSA [ ], with the advantages of avoiding ionizing radiation, iodinated contrast agents, and the need for arterial puncture or manipulation as required for DSA , making MRA particularly useful in patients requiring repeated imaging.
Cardiac Imaging Gadolinium-based contrast agent wash-in and wash-out characteristics were initially described to differentiate infarcted and normal myocardial tissue in a rabbit model in , with marked differences in contrast kinetics between normal tissue, infarct rim and infarct core regions, which correlated with the severity of microvascular damage [ ].
Various studies have found LGE imaging to be a fast, robust, and highly valuable method to determine myocardial viability in patients with left ventricular dysfunction [ ]. Kim et al. LGE has also proved to be an accurate measure to detect myocardial scars, myocardial fibrosis, and myocarditis [ ]. The superiority of combined LGE and perfusion cardiac imaging over SPECT for the diagnosis of coronary artery disease has also recently been established in a large, prospective multicenter trial [ ].
Today, cardiac MRI has the capability to visualize cardiac function and morphology, and has become a standard imaging modality in a range of clinical applications including assessment of valvular disease, myocarditis and cardiomyopathies, and congenital heart disease [ , ].
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Abdomen The first CE-MRI examination of the liver was performed in , as part of a case series investigating the efficacy and safety of gadopentetate dimeglumine-enhanced MRI [ 22 ]. Assessment of the dynamic CE-MRI enhancement pattern has become key for the differentiation of benign and malignant lesions in the liver, pancreas and kidneys, as well as elsewhere in the body [ ].
Major advances in this field were the introduction of fast breath-hold techniques and effective respiratory triggering, which reduced respiratory- and motion-induced artifacts while improving the sensitivity of imaging [ , , ]. Another major advance was the advent of hepato-specific contrast agents. The first liver-specific CE-MRI results were published in , describing manganese dipyridoxal diphosphate enhancement of the liver parenchyma and clearance into the gallbladder this agent has currently limited worldwide availability [ ].
A seminal manuscript by Weinmann, published in , described the preclinical results for gadoxetic acid, highlighting its protein binding properties, low toxicity and uptake properties in rat hepatocytes, predicting gadoxetic acid to play a future role as a hepatobiliary contrast agent for MRI in clinical practice [ ].
The clinical trials in humans that followed established the value of gadoxetic acid for liver MRI, and more specifically for the detection and differentiation of focal liver lesions in the cirrhotic and noncirrhotic liver Fig. Reflecting the value of gadoxetic acid-enhanced MRI, this imaging method was included in the guidelines of the Japan Society of Hepatology for the diagnosis of hepatocellular carcinoma in chronic liver disease [ ]. More recently, further applications of gadoxetic acid-enhanced MRI have been investigated, including for cholangiopancreatography and biliary imaging [ , ].
The potential utility of gadoxetic acid-enhanced MRI has also been suggested for the assessment of the liver pre- and post-treatment surgery or locoregional therapy , including the quantitative and regional assessment of liver function [ , , , ].
A lesion in segment VII of the liver demonstrates hyperintensity on pre-contrast T2-weighted image, and hypointensity on T1. Post-contrast, the mass has peripheral puddling of contrast in the arterial phase c which progressively coalesce d, e. In the hepatocyte phase f , the mass is hypointense to the liver with similar signal intensity to blood vessels.
Imaging features are characteristic of haemangioma [ ]. Reprinted from Cruite et al. CE-MR enterography for imaging the small bowel provides similar spatial resolution and improved contrast resolution compared to CT for investigation of gastrointestinal tumors and inflammatory bowel disease [ ], and it shows promise for the future in terms of differentiating active from chronic bowel disease and non-invasive monitoring of response to therapy [ ].
The advantage of eliminating ionizing radiation with CE-MRI compared with CT is particularly important in young patients with inflammatory bowel disease who require numerous repeated examinations over many years. Contrast-enhanced magnetic resonance imaging is becoming a standard modality to image malignancies in the pelvis, with analysis of dynamic contrast kinetics able to aid visualization of tumor vascularization and differentiation of benign from malignant prostate and ovarian tumors [ , ].
For such tumors, improved diagnostic confidence in assessment of lesion type, extension and response to therapy has been demonstrated for multiparametric MRI techniques combining DCE with other functional parameters, particularly diffusion-weighted imaging DWI [ , , ]. Breast Contrast-enhanced magnetic resonance imaging of breast lesions was reported in a preliminary study in , and was shown to be more accurate than X-ray mammography and unenhanced MRI [ ].
In the following years, various technical developments were described [ , ]. CE-MRI has since been demonstrated to detect more ductal carcinoma in situ than mammography, and in particular more high-grade disease, suggesting that CE-MRI is superior to mammography for diagnosis of the most clinically relevant, potentially invasive tumors [ , ].
An explanation for the difference in performance between these modalities is that mammography demonstrates microcalcifications due to apoptosis of slowly growing cancers, whereas MRI detects changes in the local microvasculature indicative of aggressively growing cancers [ ]. CE-MRI has also been shown to be highly sensitive for the detection of cancer foci in the contralateral breast of women diagnosed with unilateral disease [ ].
Furthermore, neither mammography nor ultrasound could improve the cancer yield provided by CE-MRI alone when screening women at risk [ ]. DCE enhancement kinetics have shown value for the evaluation of mass-like breast tumors, especially for morphologically equivocal lesions, with characteristic signal time—intensity curves able to differentiate benign from malignant tumors [ ].
Musculoskeletal System Magnetic resonance imaging has been used to image the musculoskeletal system since the early days of the modality, as MRI demonstrated good soft tissue contrast, spatial resolution and multi-planar capabilities, and sequences could be adapted for optimal contrast between muscle, bone marrow and abnormal tissue [ ].
The indications for musculoskeletal MRI fall into three main categories: tumors, infectious diseases and joint damage [ ]. CE-MRI is employed to gain additional information in cases of complicated osseous and soft-tissue infection especially when extent and necrosis are of concern , and for the evaluation of articular injuries and post-operative joint status [ ].
For joint assessment, MR arthrography has become a useful alternative to conventional MRI, with GBCA administration performed intravenously indirect arthrography or into the target joint direct arthrography [ ]. Higher magnetic field strength, specialized coils, and improvements in pulse sequences and post-processing have led to increased SNR and soft tissue contrast.
Nonetheless, more recent technological advances have furthered the capabilities of musculoskeletal MRI, including kinematic imaging of joint motion, MR spectroscopy and cartilage mapping [ ].
Current Technological Trends and Clinical Challenges Contrast-enhanced magnetic resonance imaging has become accepted as a valuable non-invasive, efficient and safe diagnostic imaging modality that is utilized in radiology departments worldwide.
Current trends in the use of existing MR technologies are toward a greater standardization—and simplification—of protocols across centers, with the benefits of uniform performance and interpretation of imaging studies.
Continuing research is also extending the applications of current contrast agents, so that individual agents can now be used to image an increasing number of body regions in a single examination.
Multiparametric imaging has enabled more accurate assessment of normal and disease-associated tissue characteristics in terms of cellularity diffusion restriction , vascularization DSC , permeability DCE , fibrosis and metabolite levels, leading to greater certainty of diagnosis and improved patient outcome.
Multiparametric MRI is advancing imaging capabilities in many fields, with a special focus on indications where anatomical imaging alone has in the past been associated with limited accuracy, such as breast and prostate cancer imaging [ ].
The fast pace of technological innovation in MR is in itself a challenge for clinical practitioners. CE-MRI acquisition techniques are continually changing, and the modern radiologist must keep abreast of the latest developments while ensuring that others on the clinical team nurses, technicians, etc. As the reported applications of MRI continue to grow in the literature, there is a related need for expert recommendations to provide guidance on the optimal parameters and protocols, interpretation and reporting of the imaging results.
For example, as described previously, dynamic CE-MRI perfusion parameters can aid in grading and predicting the progression of brain tumors [ 99 , ] and show promise as markers to monitor response to therapy [ ]; however, the variations in practice observed between centers indicate a need for a greater standardization of protocols and the utilization of the latest diagnostic algorithms [ ].
The role of CE-MRI in disease screening programs is an ongoing topic of discussion, with both health-economic and clinical repercussions. CE-MRI has demonstrated high sensitivity and specificity for the detection of liver cancer [ ] and, as discussed above, CE-MRI of the breast provides a high cancer yield and is recommended for screening women at high risk [ , ].
With only FDA guidance available, mHealth technology has yet to be subjected to stringent assessment before use. With a trend in clinical research toward targeted patient populations, conventional methods of recruitment can be insufficient as many clinical trials fail to meet recruitment goals.
The study included a prospective collection of longitudinal and multidimensional data to analyze reports of asthma symptoms in regions affected by heat, pollen, or wildfires, as well as research challenges associated with the use of mHealth. Once patients are enrolled, however, barriers exist that can affect retention. A digital health study evaluating factors associated with dropout during recruitment of an mHealth-based randomized controlled trial reported lack of following interest in the trial, motivation to use mobile technology-based interventions, and lack of capacity patients expressed inability to use mobile phones or text messaging as factors affecting the attrition rate.
25 Years of Contrast-Enhanced MRI: Developments, Current Challenges and Future Perspectives
Whereas perceived stigma and patient illness have been identified in previous studies as barriers to recruitment, age and gender were the major factors in uencing recruitment and refusal.
Collection of Reliable Health Data There is considerable opportunity for clinicians to receive urgent information and act outside of the hospital setting. Data collection is facilitated by mHealth technology that is designed to take place in real time and can be more comprehensive and efficient compared with established methodologies. This approach allows for increased clinical observations for each patient to optimize data and improve outcomes. The traditional periodic patient visit has the potential to be combined with more frequent, continuous digital communication for more effective care.
This increased communication has the potential to complement the classic approach and encourage patients to better understand their health and become active participants in their care. A fully implemented mHealth system may result in fewer physician visits, better symptom management, and decreased healthcare. Study results have shown time-intensive tasks being replaced through mHealth technology, although more evidence is needed. Patients have more opportunities to report and log adverse effects AEs from medications, receive notifications and reminders to promote adherence, follow up on appointments, and manage disease.
There is a growing body of evidence that even simple interventions, such as text message reminders, improves adherence in a variety of chronic diseases.
Triggered e-mail alerts based on an algorithm assessing specific changes in symptoms were sent to the physician to confirm the need for anticipated visits or supportive care options. The median survival of patients utilizing the application was 19 months compared with 12 months for those who received standard follow-up care.
The Web-based application provided a continuous feedback mechanism for patients between visits to their oncologist, which resulted in early detection of complications and signs of relapse for earlier care. Thus, approaches that included monitoring of emerging toxicity prompting the healthcare team to conduct proactive symptom management would be expected to provide value in improving medication adherence in oncology.
Another randomized controlled trial demonstrated higher compliance with using internet follow-up for patients with esophageal cancer. By allowing patients to evaluate their adverse effects on a continual basis, mHealth provides the opportunity to identify and manage toxicities earlier. Throughout all phases of oncology drug development, the reporting of symptomatic AEs is a crucial component of understanding the efficacy and quality of potential treatments and their impact on patients.
The current method of collecting AEs in oncology clinical trials is based on physician reporting using the Common Terminology Criteria for Adverse Events. Clinicians report AEs from oncology treatment on a scale of can range from 0 to 5, each number representing severity levels of none, mild, moderate, severe, life-threatening, or death, respectively.
An IRB review of mHealth research must address challenges such as the lack of face-to-face interaction, minor consent, responsibility of data integrity, privacy, security, confidentiality, and the collection of unrelated study data eg, geographical location, personal contacts, Internet searches. Currently, systematic reviews and novel methods are being investigated to assess medical apps for clinical safety.
Conclusion As patients advocate for their place in the healthcare system, mHealth provides opportunities and resources for patients and providers to collaborate on healthcare and promote shared decision making for improved health and health outcomes.
Management of information technology
However, adoption of this technology requires that patients, providers, and informatics systems align despite the inherent challenges in mHealth adoption, EHR integration, or privacy, security, and condidentiality.
As a disruptive technology, mHealth offers an opportunity to improve on the quality and safety of healthcare. Health-related smartphone apps: status update for hem-onc practitioners. The Hematologist. HIMSS website.
Published February 23, Accessed May 1, World Health Organization website. Published Moumtzoglou A. M-health Innovations for patient-centered care. IGI Global. Activating racial and ethnic minorities to engage in preventive health: patient preferences for health reminders.
J Participat Med.This increased communication has the potential to complement the classic approach and encourage patients to better understand their health and become active participants in their care.
One such experimental agent is EPR, a molecule containing four Gd-complexes that binds with good specificity to fibrin, where it demonstrates a relaxivity per molecule approximately 25 times higher than a conventional GBCA at 1.
Image formation by induced local interactions: examples employing nuclear magnetic resonance. Activating racial and ethnic minorities to engage in preventive health: patient preferences for health reminders. CE-MRI has also been shown to be highly sensitive for the detection of cancer foci in the contralateral breast of women diagnosed with unilateral disease [ ]. Frenzel Free PDF d0wnl0ad, audio books, books to read, good books to read, cheap books, good books, online books, books online, book reviews epub, read books online, books to read online, online library, greatbooks to read, PDF best books to read, top books to read Management of Information Technology 4th edition by Carroll W.