L’insuffisance placentaire est une pathologie grave avec un diagnostic souvent trop tardif empêchant la mise en place de thérapeutiques efficaces. Le but de ce travail de Thèse est de développer chez la rate gestante et de transposer à l’Homme des outils d’IRM fonctionnelle (IRMf) placentaire qui permettrait une quantification de la perfusion placentaire en pratique clinique.Matériels et méthodes : Trois études en IRMf font partie de cette Thèse.Les deux premières ont été réalisées sur un modèle murin. Une séquence dynamique avec injection d’un agent de contraste (DCE) a été développée avec une particule de fer de type SPIO dans un modèle chirurgical d’hypoperfusion placentaire chronique, avec mesure de la perfusion placentaire f en ml/min/100ml et de la fraction volumique (Vb) en %. Une autre technique d’IRMf a été développée avec l’Arterial Spin Labeling (ASL) permettant d’estimer la perfusion placentaire en ml/min/100g sans injection de produit de contraste exogène. La dernière étude était une recherche translationnelle. Elle a consisté au développement de séquences de DCE avec injection de chélate de gadolinium, pour obtenir la perfusion f en ml/min/100ml et la fraction volumique en %. Nous avons également étudié, au décours de cette étude, la pharmacocinétique materno-fœtale du chélate de gadolinium.Résultats : Chez l’animal en DCE avec SPIO, notre étude nous a permis de montrer qu'il était possible d'utiliser l’effet T1 des SPIO pour caractériser la microcirculation placentaire par f=159,4 ml/min/100ml (+/- 54,6) et Vb =39,2% (+/- 11,9) pour 31 placentas « normaux ». En cas de RCIU, f diminue significativement pour les 23 placentas étudiés (f= 108,1 ml/min/100ml +/- 41, p=0,004), alors que la fraction volumique placentaire n'est pas modifiée (Vb=42,8% +/- 16,7, p=0,24). L’ASL nous a permis d’estimer la perfusion placentaire pour 47 placentas en condition physiologique, avec une perfusion estimée à 146,8 ml/min/100g (+/- 70,1).Chez l’Homme, 14 placentas ont été étudiés avec une perfusion placentaire globale estimée à 183 ml/min/100ml (+/-144) et nous avons également mis en évidence deux types de cinétique de rehaussement placentaire (précoce et intense et plus tardif et moins intense). La pharmacocinétique nous a permis d'étudier quantitativement le passage du chélate de gadolinium chez le fœtus. Ce passage est faible: par rapport à la concentration initiale du Dotarem®, la concentration sanguine fœtale correspond à 18,1x10-6 %, la concentration dans le liquide amniotique à 242,8 x10-6 % et 0,3 % de la dose initiale de Dotarem® est présente dans le placenta environ 70 heures après l’injection.Conclusion : Ce travail illustre la variété des techniques d'IRM fonctionnelle disponibles pour l'étude du placenta. La perfusion placentaire peut être quantifiée en DCE avec un agent particulaire à base de fer (SPIO) ou sans injection de produit de contraste en ASL chez le rat. L’étude de la perfusion placentaire chez l'Homme est possible en DCE avec les chélates de gadolinium.Mots clés : IRM, DCE, chélates de Gadolinium, ASL, perfusion placentaire, grossesse, placenta, retard de croissance intra-utérin. / Placental insufficiency is a serious medical condition with a diagnosis made usually too late to prevent introduction of effective therapies. The aim of this thesis is to develop, in pregnant rats and translate to humans, functional MRI (fMRI) tools allowing quantification of placental perfusion in clinical practice.Materials and Methods: Three studies using fMRI are part of this thesis. The first two were performed on a murine model. A dynamic sequence with injection of a contrast agent (DCE) has been developed with an iron oxide particle (SPIO) in a surgical model of chronic placental hypoperfusion with placental perfusion measurement (f) in ml / min / 100 ml and placental fractionnal volume (Vb) in %. Another technique of fMRI was developed with Arterial Spin Labeling (ASL) to estimate placental perfusion in ml / min / 100g without injection of contrast media.The latest study was a translational research. It consisted in the development of a dynamic sequence with injection of gadolinium chelate, in order to obtain perfusion (f) in ml / min / 100 ml and placental fractionnal volume (Vb) in %. We also studied maternal and fetal pharmacokinetics of gadolinium chelate.Results: In animals with SPIO DCE, our study allowed us to show that it is possible to use the T1 effect of SPIO to characterize the placental microcirculation by f = 159.4 ml / min / 100ml (+ / - 54.6) and Vb = 39.2% (11.9 +/-) for 31 « normal » placentas. In case of IUGR, f decreases significantly for the 23 examined placentas (f = 108.1 ml / min / 100ml +/- 41, p = 0.004), whereas the volume fraction placenta is not modified (Vb = 42 +/- 16.7 8 %, p = 0.24). ASL has allowed us to estimate placental perfusion for 47 placentas under physiological conditions, with an estimated perfusion of 146.8 ml / min / 100 g (70.1 +/-).In humans, 14 placentas were studied with an estimated perfusion of 183 ml / min / 100ml (+/- 144) and we also identified two types of placental kinetic enhancement (early and intense and later and less intense). Pharmacokinetics have allowed us to study quantitatively the transfer of gadolinium chelate in the fetus. This transfer is low compared to the initial concentration of Dotarem® : fetal blood concentration is 18.1x10-6%, concentration in amniotic fluid is 242.8 x10-6 % and 0.3% of the Dotarem® initial dose is present in the placenta approximately 70 hours after injection.Conclusion: This study illustrates the variety of functional MRI techniques available for placental study. Placental perfusion can be quantified by DCE with an iron oxide particle (SPIO) or without injection of contrast in ASL, in a rat model. The study of placental perfusion in humans is also possible in DCE with gadolinium chelates.

Para avaliar o efeito do gadolínio sobre os metabólitos Colina (CO), Creatina (CRE) e N-acetil-aspartato (NAA) foi realizada espectroscopia por ressonância magnética em 25 pacientes com tumores intracranianos antes e após a injeção venosa do meio de contraste. Foram quantificadas e comparadas as relações CO/CRE, CO/NAA e NAA/CRE bem como a largura a meia altura dos picos dos metabólitos CO, CRE e NAA nos espectros pré e pós-contraste. Verificou-se redução das relações CO/CRE e CO/NAA e da largura a meia altura do pico do NAA nos espectros pós-contraste / In order to evaluate the gadolinium effect on the metabolites choline (CHO), creatine (CRE) and N-acetyl-aspartate (NAA) we performed multivoxel spectroscopy in 25 patients with intracranial tumors before and after the injection of the contrast material. The metabolite ratios CHO/CRE, CHO/NAA and NAA/CRE and the peak width at half height of the metabolites were calculated and compared between the pre and post contrast spectra. Measurements showed reduction of the CO/CRE and CO/NAA ratios and of the NAA width after the administration of the contrast material

Polymerverkapselte magnetische Nanopartikel versprechen, in der Zukunft sehr erfolgreich bei Anwendungen in der Biologie und der Medizin eingesetzt werden zu können z. B. in der Krebstherapie und als Kontrastmittel bei der magnetischen Kernspinresonanztomographie. Diese Arbeit zeigt, dass durch die interdisziplinäre Kombination verschiedener Techniken Herstellungsverfahren und Eigenschaften solcher Partikel verbessert werden können. <br /> <br /> Unter Miniemulsionen versteht man wässrige Dispersionen relativ stabiler Öltröpfchen, zwischen 30 und 50 nm Größe. Ein Nanometer (nm) ist der 1.000.000.000ste Teil eines Meters. Ein Haar ist ungefähr 60.000 Nanometer breit.<br /> <br /> Hergestellt werden Miniemulsionen durch Scherung eines Systems bestehend aus Öl, Wasser, Tensid (Seife) und einer weiteren Komponente, dem Hydrophob, das die Tröpfchen stabilisieren soll. Die Polymerisation von Miniemulsionen ermöglicht die Verkapselung anorganischer Materialen z. B. magnetischer Teilchen oder Gadolinium-haltiger Komponenten. Zu Optimierung des Verkapselung, ist es notwendig, die richtige Menge eines geeigneten Tensids zu finden. <br /> <br /> Die magnetischen polymerverkapselten Nanopartikel, die in einer wässrigen Trägerflüssigkeit dispergiert sind, zeigen in Abhängigkeit von Partikelgröße, Zusammensetzung, elektronischer Beschaffenheit, etc. ein sogenanntes superpara- oder paramagnetisches Verhalten. Superpara- oder paramagnetisches Verhalten bedeutet, dass die Flüssigkeiten in Anwesenheit äußerer Magnetfeldern ihre Fließfähigkeit beibehalten. Wenn das Magnetfeld entfernt wird, haben sie keine Erinnerung mehr daran, unter dem Einfluss eines Magnetfeldes gestanden zu haben, d. h., dass sie nach Abschalten des Magnetfeldes selbst nicht mehr magnetisch sind. <br /> <br /> Die Vorteile des Miniemulsionsverfahrens sind der hohe Gehalt und die homogene Verteilung magnetischer Teilchen in den einzelnen Nanopartikeln. Außerdem ermöglicht dieses Verfahren nanostrukturierte Kompositpartikel herzustellen, wie z. B polymerverkapselte Nanopartikel mit Nanoschichten bestehend aus magnetischen Molekülen. / Combining the magnetic properties of a given material with the tremendous advantages of colloids can exponentially increase the advantages of both systems. This thesis deals with the field of magnetic nanotechnology. Thus, the design and characterization of new magnetic colloids with fascinating properties compared with the bulk materials is presented. <br /> <br /> Ferrofluids are referred to either as water or organic stable dispersions of superparamagnetic nanoparticles which respond to the application of an external magnetic field but lose their magnetization in the absence of a magnetic field. <br /> <br /> In the first part of this thesis, a three-step synthesis for the fabrication of a novel water-based ferrofluid is presented. The encapsulation of high amounts of magnetite into polystyrene particles can efficiently be achieved by a new process including two miniemulsion processes. The ferrofluids consist of novel magnetite polystyrene nanoparticles dispersed in water which are obtained by three-step process including coprecipitation of magnetite, its hydrophobization and further surfactant coating to enable the redispersion in water and the posterior encapsulation into polystyrene by miniemulsion polymerization. It is a desire to take advantage of a potential thermodynamic control for the design of nanoparticles, and the concept of &quot;nanoreactors&quot; where the essential ingredients for the formation of the nanoparticles are already in the beginning. The formulation and application of polymer particles and hybrid particles composed of polymeric and magnetic material is of high interest for biomedical applications. Ferrofluids can for instance be used in medicine for cancer therapy and magnetic resonance imaging.<br /> <br /> Superparamagnetic or paramagnetic colloids containing iron or gadolinium are also used as magnetic resonance imaging contrast agent, for example as a important tool in the diagnosis of cancer, since they enhance the relaxation of the water of the neighbouring zones. New nanostructured composites by the thermal decomposition of iron pentacarbonyl in the monomer phase and thereafter the formation of paramagnetic nanocomposites by miniemulsion polymerization are discussed in the second part of this thesis. In order to obtain the confined paramagnetic nanocomposites a two-step process was used. In the first step, the thermal decomposition of the iron pentacarbonyl was obtained in the monomer phase using oleic acid as stabilizer. In the second step, this iron-containing monomer dispersion was used for making a miniemulsion polymerization thereof. <br /> <br /> The addition of lanthanide complexes to ester-containing monomers such as butyl acrylate and subsequent polymerization leading to the spontaneous formation of highly organized layered nanocomposites is presented in the final part of this thesis. By an one-step miniemulsion process, the formation of a lamellar structure within the polymer nanoparticles is achieved. The magnetization and the NMR relaxation measurements have shown these new layered nanocomposites to be very apt for application as contrast agent in magnetic resonance imaging.

Developing radiation delivery systems for optimisation of absorbed dose to the target without normal tissue toxicity requires advanced calculations for transport of radiation. In this thesis absorbed dose and fluence in different radiotherapy applications were calculated by using Monte Carlo (MC) simulations. In paper I-III external neutron activation of gadolinium (Gd) for intravascular brachytherapy (GdNCB) and tumour therapy (GdNCT) was investigated. MC codes MCNP and GEANT4 were compared. MCNP was chosen for neutron capture reaction calculations. Gd neutron capture reaction includes both very short range (Auger electrons) and long range (IC electrons and gamma) products. In GdNCB the high-energetic gamma gives an almost flat absorbed dose delivery pattern, up to 4 mm around the stent. Dose distribution at the edges and inside the stent may prevent stent edge and in-stent restenosis. For GdNCT the absorbed dose from prompt gamma will dominate over the dose from IC and Auger electrons in an in vivo situation. The absorbed dose from IC electrons will enhance the total absorbed dose in the tumours and contribute to the cell killing. In paper IV a model for calculation of inter-cluster cross-fire radiation dose from β-emitting radionuclides in a breast cancer model was developed. GEANT4 was used for obtaining absorbed dose. The dose internally in cells binding the isotope (self-dose) increased with decreasing β-energy except for the radionuclides with substantial amounts of conversion electrons and Auger electrons. An effective therapy approach may be a combination of radionuclides where the high self-dose from nuclides with low β-energy should be combined with the inter-cell cluster cross-fire dose from high energy β-particles. In paper V MC simulations using correlated sampling together with importance sampling were used to calculate spectra perturbations in detector volumes caused by the detector silicon chip and its encapsulation. Penelope and EGSnrc were used and yielded similar results. The low energy part of the electron spectrum increased but to a less extent if the silicon detector was encapsulated in low z-materials.

Para avaliar o efeito do gadolínio sobre os metabólitos Colina (CO), Creatina (CRE) e N-acetil-aspartato (NAA) foi realizada espectroscopia por ressonância magnética em 25 pacientes com tumores intracranianos antes e após a injeção venosa do meio de contraste. Foram quantificadas e comparadas as relações CO/CRE, CO/NAA e NAA/CRE bem como a largura a meia altura dos picos dos metabólitos CO, CRE e NAA nos espectros pré e pós-contraste. Verificou-se redução das relações CO/CRE e CO/NAA e da largura a meia altura do pico do NAA nos espectros pós-contraste / In order to evaluate the gadolinium effect on the metabolites choline (CHO), creatine (CRE) and N-acetyl-aspartate (NAA) we performed multivoxel spectroscopy in 25 patients with intracranial tumors before and after the injection of the contrast material. The metabolite ratios CHO/CRE, CHO/NAA and NAA/CRE and the peak width at half height of the metabolites were calculated and compared between the pre and post contrast spectra. Measurements showed reduction of the CO/CRE and CO/NAA ratios and of the NAA width after the administration of the contrast material

Ce travail de thèse s’inscrit dans le domaine émergent du « théranostique » qui associe le diagnostic par l’imagerie à la thérapie au sein d’un même système. De nouveaux photosensibilisateurs (PS) pour la thérapie photodynamique (PDT) activables par un processus d’excitation biphotonique ont été synthétisés. Ils sont composés de porphyrines reliées à des unités dicétopyrrolopyrroles. Ces systèmes présentent d’importantes valeurs de sections efficaces d’absorption biphotonique dans le proche infra-rouge ainsi que de bons rendements quantiques de formation d’oxygène singulet. Deux PS ont ensuite été reliés à des complexes de Gd(III) permettant d’apporter la fonction d’imagerie par résonance magnétique (IRM). En plus de conserver de bonnes propriétés d’absorption biphotonique, ces systèmes présentent également de remarquables valeurs de relaxivité. Enfin, des études de phototoxicité in cellulo ont démontré l’activité d’un des agents théranostiques sous irradiation biphotonique. Ces résultats permettent de valider pour la première fois le concept d’un agent moléculaire unique pour la PDT par absorption biphotonique et pour l’IRM. / The work presented in this thesis belongs to the emerging field of « theranostic » whose aim is to combine a diagnostic and a therapeutic agent within the same system. New photosensitizers (PS) activated by a two-photon absorption process for Photodynamic Therapy (PDT) have been synthesised. These systems consist of porphyrins conjuguated to diketopyrrolopyrrole units. These compounds have significant high two-photon absorption cross-sections in the near infrared and good singlet oxygen quantum yields. Two PS have been linked to Gd(III) complexes in order to bring the magnetic resonance imaging (MRI) function. These systems still have good two-photon absorption properties and also show remarkable high relaxivity values. Finally, in cellulo phototoxicity studies have been performed for one of the theranostic agent and the two-photon PDT activity has been retained. These results validate, for the first time, a proof of concept of a single molecular agent for two-photon PDT and for MRI.

Hintergrund und Ziele: Gadolinium (Gd) wird seit 1988 als Kontrastmittel (KM) für Hirn-Magnetresonanztomographie (MRT)-Untersuchungen verwendet und gilt auch heute noch in vielen Kliniken zum Standard einer „lege artis“ durchgeführten pädiatrischen Hirnuntersuchung. Es galt lange Zeit als sehr nebenwirkungsarm, doch in den letzten Jahren wurden vermehrt Studien veröffentlicht, die von zum Teil schweren Folgen aufgrund der Gd-Applikation berichteten (Nephrotic systemic fibrosis, Gadolinium deposition disease). Ziel dieser Studie war es, den diagnostischen Zugewinn durch die generelle Gabe von Gd bei Kindern zu beurteilen, wenn initial im nativen Hirn-MRT kein pathologischer Befund zu finden war. Methodik: Für diese retrospektive Studie wurden 6.683 kraniale KM-MRT-Untersuchungen von Kindern im Alter von 0 bis 16 Jahren nochmals ausgewertet und daraufhin untersucht, ob die KM-Gabe zusätzliche relevante Informationen liefern konnte. Ergebnisse: In 8 von 3.003 (0,03 %) nativ unauffälligen Untersuchungen konnte durch KM-Gabe ein relevanter Zusatzbefund ermittelt werden. In allen 8 Fällen handelte es sich dabei um ein meningeales Enhancement. Dies entspricht einem negativen prädiktiven Wert (NPV) von 0,97. Von diesen relevanten Zusatzbefunden war das Enhancement nur bei einem Kind (0,03 %) richtungsweisend für die Diagnostik. Bei den nativ auffälligen Untersuchungen konnte in 297 von 3.680 (8,1 %) MRT´s ein relevanter Zusatzbefund gefunden werden. Schlussfolgerungen: Unsere Studie zeigte, dass eine KM-Gabe bei nativ unauffälligem Befund nur in einem Fall (0,03 %) eine richtungsweisende Diagnose mit Änderung der therapeutischen Strategie brachte. Stellt man diesem Ergebnis die Nachteile einer routinemäßigen Gd-Applikation gegenüber, ergibt sich eine zahlenmäßig begründete Evidenz, zukünftig routinemäßig auf die KM-Gabe bei nativ unauffälligen Befunden zu verzichten. In Einzelfällen kann von dieser Empfehlung abgewichen werden, wenn klinisch der Verdacht auf eine ZNS-Infektion besteht, oder wenn bei unklarer Symptomatik ein spreitender meningealer Tumor mit KM-Gabe ausgeschlossen werden soll. Bei pädiatrischen MRT-Untersuchungen des Gehirns, die schon vor KM-Gabe Auffälligkeiten zeigen, besteht weiterhin eine klare Indikation für die KM-Applikation. / Abstract Background: Brain imaging is the most common examination in pediatric magnetic resonance imaging (MRI), often combined with the use of a gadolinium-based contrast medium. The application of gadolinium-based contrast medium poses some risk. There is limited evidence of the benefits of contrast medium in pediatric brain imaging. Objective: To assess the diagnostic gain of contrast-enhanced sequences in brain MRI when the unenhanced sequences are normal. Materials and methods: We retrospectively assessed 6,683 brain MR examinations using contrast medium in children younger than 16 years in the pediatric radiology department of the University Hospital Leipzig to determine whether contrast-enhanced sequences delivered additional, clinically relevant information to pre-contrast sequences. All examinations were executed using a 1.5-T or a 3-T system. Results: In 8 of 3,003 (95% confidence interval 0.12-0.52%) unenhanced normal brain examinations, a relevant additional finding was detected when contrast medium was administered. Contrast enhancement led to a change in diagnosis in only one of these cases. Conclusion: Children with a normal pre-contrast brain MRI rarely benefit from contrast medium application. Comparing these results to the risks and disadvantages of a routine gadolinium application, there is substantiated numerical evidence for avoiding routine administration of gadolinium in a pre-contrast normal MRI examination.

published_or_final_version / Chemistry / Doctoral / Doctor of Philosophy

published_or_final_version / Chemistry / Doctoral / Doctor of Philosophy

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