Thesis (Ph. D.)--University of Technology, Sydney, 2004. / Bibliography: leaves 238-269.

Background: Idiopathic parkinsonism is a neurodegenerative syndrome of unknown cause and includes Parkinson’s disease (PD) and atypical parkinsonian disorders. The atypical parkinsonian disorders are: Multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). The incidence rates of these diseases in Sweden are largely unknown. The diagnosis of each disease relies mainly on clinical examination although several imaging and laboratory parameters may show changes. A diagnosis based on clinical examination is especially difficult early in the course of each disease; diagnosis is easier later on when disease-charactersistic signs have evolved and become more prominent. However, even in later stages it is not uncommon that patients are misdiagnosed. PD can be divided into subgroups based on the main clinical symptoms, i. e. tremor dominant, postural instability and gait difficulty (PIGD), and indeterminate. The PIGD subtype has worse prognosis including higher risk of dementia. The aims were to study the incidence of idiopathic parkinsonism and the different specific parkinsonian disorders in the Umeåregion and to investigate the patients early in the course of the disease with brainmagnetic resonance tomography (MRI), external anal sphincterelectromyography (EAS-EMG) and oculomotor examination. Can these methods improve the differential diagnostic work-up and/or differentiate between the subtypes of PD? Methods: We examined all patients in our catchment area (142,000 inhabitants) who were referred to us due to a suspected parkinsonian syndrome. Our clinic is the only clinic in the area receiving referrals regarding movement disorders. During the period (January 1, 2004 through April 30,2009) 190 patients fulfilled the inclusion criteria and were included in the study. Healthy volunteers served as controls.  Results: Incidence: We found the highest incidences reported in the literature: PD (22.5/100,000/year), MSA(2.4/100,000/year), and PSP (1.2/100,000/year). No CBD patients were encountered. Brain MRI: Degenerative changes were common both in controls and PD. There were no differences between the PD subtypes. EAS-EMG: Pathological changes in EAS-EMG examination were common in PD, MSA and PSP. It was not possible to separate PD, MSA and PSP by the EAS-EMG examination. Oculomotor examination: Pathological results were common in all diagnosis groups compared to controls. It was not possible to separate PD, MSA and PSP or the PD subtypes with the help of oculomotor examination. Conclusions: The incidences of idiopathic parkinsonism, PD, MSA and PSP were higher than previously reported in the literature. It is not clear weather this is due to a true higher incidence in the Umeå region or a more effective casefinding than in other studies. MRI, EAS-EMG and oculomotor examination could not contribute to the differential diagnostic work-up between PD, MSA and PSP nor differentiate between PD subtypes early in the course of the disease.

Titel: Magnetfältstyrkans betydelse för personer med multipel skleros eller kliniskt isolerat syndrom - en litteraturstudie Bakgrund: Multipel skleros (MS) är en demyeliniserande autoimmun sjukdom i centrala nervsystemet som debuterar främst hos unga vuxna. MS diagnostiseras utifrån kliniska och radiologiska fynd enligt McDonaldkriterierna där inga krav ställs på vilken fältstyrka som bör användas. Magnetkameror med högre fältstyrkor blir dock vanligare. Syfte: Att undersöka om högre fältstyrka (Tesla, T) gav bättre detektion av lesioner vid magnetresonanstomografiundersökningar av personer med multipel skleros eller kliniskt isolerat syndrom. Metod: I denna litteraturstudie gjordes sökningarna i databaserna PubMed, Web of Science och Scopus mellan 8 och 11 mars 2016. Tio kvantitativa artiklar kvalitetsgranskades och analyserades för att slutligen sammanställas i resultatet. Resultat: Resultatet presenteras under fyra huvudrubriker och totalt tolv underrubriker. Huvudrubrikerna är skillnad mellan fältstyrkor, fältstyrkor och anatomiska regioner, fältstyrkor och pulssekvenser samt artefakter och bildkvalitet. Konklusion: 3T och 7T är bättre än 1,5T och att 7T ofta är bättre än 3T på att detektera lesioner. Dock måste andra aspekter tas i beaktning då det är många parametrar som spelar in vid en magnetresonanstomografiundersökning. Ytterligare studier gällande bland annat optimering av pulssekvenser samt patienters upplevelser av ultrahöga fältstyrkor rekommenderas. / Title: The importance of magnetic field strength for people with multiple sclerosis or clinically isolated syndrome - a literature study. Background: Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system debuting mostly in young adults. MS is diagnosed based on clinical and radiological findings according to the McDonald criteria where no requirements are placed on which field strength that should be used. Magnetic resonance imaging (MRI) scanners with higher field strengths are however becoming more common. Objective: To investigate whether higher field strength (Tesla, T) gave better detection of lesions at MRI examinations of people with MS or clinically isolated syndrome. Methods: In this literature study searches were made in the databases PubMed, Web of Science and Scopus between the 8th and 11th of March 2016. Ten quantitative articles were examined and analyzed to finally be compiled under the results. Results: The results are presented under four main headings and twelve sub- headings. The main headings are the differences between field strengths, field strength and anatomical regions, field strength and pulse sequences and artifacts and image quality. Conclusion: 3T and 7T are better than 1,5T and 7T is usually better than 3T at detecting lesions. However other aspects need to be taken into account because many parameters come into play during MRI examinations. Further studies regarding optimization of pulse sequences and field strength and patients’ experiences of ultrahigh field strength are recommended, among others.

Este trabalho descreve o projeto, a construção e a avaliação de um digitalizador de sinais controlado por microprocessador, desenvolvido para ser utilizado em Tomografia por Ressonância Magnética Nuclear, TORM. O digitalizador apresenta dois canais de entrada com digitalização simultânea em 256, 512 ou 1024 palavras por canal e com taxa de amostragem máxima de 22,7 Khz. A resolução é de 12 bits com conversão analógico/digital por aproximação sucessiva. Não há controles manuais o que exige um computador hospedeiro para o ajuste de parâmetros via interface de comunicação paralela destinada para este fim. Opcionalmente pode-se utilizar uma interface serial do tipo RS232C-EIA operando com velocidade máxima de 9600 bauds. O equipamento efetua o processamento local da média acumulativa do sinal, técnica empregada para melhorar a relação sinal/ruído no caso de ruído aleatório. Um circuito dedicado à monitoração permite que se visualize em monitor X-Y tanto o sinal como a sua média. No caso da média, por ela ser acumulativa, há um ajuste automático de escala / This work describes the design, construction and evaluation of a microprocessor controlled digitizer developed to be used in Magnetic Resonance Tomography or Imaging, MRI. The digitizer presents two input channels with simultaneous digitalization in 256, 512 or 1024 words per channel with a sample rate up to 22.7 Khz. A resolution of 12 bits is obtained with successive approximation A/D conversion. There are no manual controls. So a host computer is needed to adjust the parameters through a parallel communication interface available for this purpose. Optionally, a RS232-EIA type serial interface may be used, operating at speeds up to 9600 bauds. Signal average can be processed locally by the equipment. This technique is used to improve the signal to noise ratio in case of random noise. A dedicated circuit permits the visualization of the signal and or its average on an x-y monitor. To monitor cumulative averaged data an automatic scale adjustment is provided

Este trabalho descreve o projeto, a construção e a avaliação de um digitalizador de sinais controlado por microprocessador, desenvolvido para ser utilizado em Tomografia por Ressonância Magnética Nuclear, TORM. O digitalizador apresenta dois canais de entrada com digitalização simultânea em 256, 512 ou 1024 palavras por canal e com taxa de amostragem máxima de 22,7 Khz. A resolução é de 12 bits com conversão analógico/digital por aproximação sucessiva. Não há controles manuais o que exige um computador hospedeiro para o ajuste de parâmetros via interface de comunicação paralela destinada para este fim. Opcionalmente pode-se utilizar uma interface serial do tipo RS232C-EIA operando com velocidade máxima de 9600 bauds. O equipamento efetua o processamento local da média acumulativa do sinal, técnica empregada para melhorar a relação sinal/ruído no caso de ruído aleatório. Um circuito dedicado à monitoração permite que se visualize em monitor X-Y tanto o sinal como a sua média. No caso da média, por ela ser acumulativa, há um ajuste automático de escala / This work describes the design, construction and evaluation of a microprocessor controlled digitizer developed to be used in Magnetic Resonance Tomography or Imaging, MRI. The digitizer presents two input channels with simultaneous digitalization in 256, 512 or 1024 words per channel with a sample rate up to 22.7 Khz. A resolution of 12 bits is obtained with successive approximation A/D conversion. There are no manual controls. So a host computer is needed to adjust the parameters through a parallel communication interface available for this purpose. Optionally, a RS232-EIA type serial interface may be used, operating at speeds up to 9600 bauds. Signal average can be processed locally by the equipment. This technique is used to improve the signal to noise ratio in case of random noise. A dedicated circuit permits the visualization of the signal and or its average on an x-y monitor. To monitor cumulative averaged data an automatic scale adjustment is provided

No description available.

Thermoablationsverfahren werden in der klinischen Routine zur Therapie bei Patienten mit primären Lebertumoren und Lebermetastasen eingesetzt, bei denen von einer Operation abgesehen wird. Die laserinduzierte Thermotherapie (LITT) ist ein minimal invasives radiologisches Verfahren zur perkutanen Tumorablation. Mit der Magnetresonanztomographie (MRT) am Hochfeldtomographen (1.5 Tesla) steht eine radiologische Methode mit der Option einer präzisen Prozesskontrolle der Thermoablation und einer suffizienten Erfolgskontrolle zur Verfügung. Ziel dieser Arbeit war es, im Tierexperiment die Anwendung der LITT zur Ablation von Pankreasgewebe zu erproben, das Potenzial der MRT für die Prozesskontrolle der LITT am Pankreas zu bestimmen und neue MRT-Sequenzen mit neuen Kontrastmitteln für die Optimierung der Erfolgskontrolle zu erforschen. Die LITT am Pankreas im Rahmen einer Pilotstudie an 15 Läuferschweinen war perkutan komplikationsarm durchführbar, generalisierte Pankreatitiden oder Blutungen traten nicht auf. Die qualitative Prozessbeobachtung mittels thermosensitiver Sequenzen zeigte eine hohe Übereinstimmung zwischen magnetresonanztomographisch dokumentierten Thermoeffekten und histopathologisch verifizierten thermisch induzierten Nekrosen. Die Untersuchung und invasive Kalibrierung verschiedener Messmethoden in vivo zur quantitativen MRT-Thermometrie ergab Vorteile für den Einsatz der Protonenresonanzfrequenz-Methode. Zur Optimierung der Erfolgskontrolle nach LITT von Lebergewebe im Tierexperiment sowie klinisch bei Lebermetastasen wurden die MRT-Kontrastmittel Gadomesoporphyrin, Eisenoxid und Gadobutrol erprobt. Mittels Spätaufnahmen 6 - 18 h post injectionem wurden mit Gadobutrol thermisch induzierte Nekrosen präzise visualisiert. / Thermoablation of primary liver tumors and liver metastases is widely used in patients without surgical options. The laser-induced thermotherapy (LITT) is a minimal invasive radiologic procedure for percutaneous tumor ablation. With high field magnetic resonance imaging at 1.5, monitoring of thermoablation and visualization of thermal induced ablation zones can be performed precisely. Aim of this work was to investigate the feasibility of MR-guided LITT of pancreatic tissue and to optimise the contrast between thermal induced lesions, residual tumor and normal tissue after LITT procedure. MR-guided LITT was feasible in 15 female pigs, generalized pancreatitis or bleeding did not occur. MR monitoring by thermosensitive sequences precisely visualized thermal induced ablation zones verified by histopathologic examination. Best results of MR thermometry (thermo-mapping) were obtained by proton resonance frequency method. Gadolinum- mesoporphyrine, superparamagnetic iron oxides (SPIO) and gadobutrol were used to optimise ablation control. Late enhanced imaging 6 - 18 hours after injection of gadobutrol precisely visualized thermal induced necrosis. In conclusion, percutaneous MR guided LITT of pancreatic tissue of female pigs was feasible and monitoring of thermoablation could be performed accurately. In contrast to other imaging methods, MR using new contrast agents enables accurate visualization of thermal induced necrosis.

Die Bestrahlungstherapie von Aderhautmelanomen mit der Protonentherapie stellt ein sehr präzises Behandlungsverfahren dar, welches hohe Ansprüche an die zugrundliegende Bildgebung stellt. Die Magnetresonanztomographie (MRT) und Computertomographie (CT) scheinen prinzipiell in der Lage, mit geeigneten Oberflächenspulen bzw. angepaßter Untersuchungstechnik diese Ansprüche zu erfüllen. Ziel der Arbeit ist die Bereitstellung und Überprüfung eines bildgebenden Systems, das einerseits die diagnostischen und differentialdiagnostischen Aufgaben für die Differenzierung und das Staging von Aderhautmelanomen erfüllt und andererseits als Grundlage der Bestrahlungsplanung dienen kann. Erstrebenswert ist dabei die Erstellung von Schnittbildern bestehend aus isotropen Voxeln, d.h. Voxeln mit identischer Kantenlänge, mit der Magnetresonanztomographie (MRT) und der Computertomographie (CT). Zur Differenzierung der unterschiedlichen Tumorentitäten wurden verschiedene Untersuchungen mit zum Teil großen Patientenkollektiven durchgeführt und histologisch und klinisch korreliert bzw. verifiziert. Dabei konnte das MR-morphologische Erscheinungsbild der relevanten Erkrankungen studiert werden. Die Genauigkeit der MR-gestützten Tumorvolumetrie wurde in vitro im Tierversuch und in vivo am Patientenauge überprüft. Zur Überprüfung der Genauigkeit der MR-Bildgebung mit isotropen Voxeln wurden unterschiedliche Spulen getestet und verschiedene Phantomuntersuchungen durchgeführt. Entsprechend wurde auch die CT evaluiert. Mit der digitalen Bildfusion wurden die MRT- und die CT-Daten in einen gemeinsamen Datensatz überführt, der sowohl zur Bestimmung der Genauigkeit beider Verfashren als auch als Basis zur Bestrahlungsplanung verwendet werden konnte. Mit einer optimierten Untersuchungstechnik konnten Schnittbilder auf der Basis von CT und MRT zur Verfügung gestellt werden, die eine präzise Planung der Protonenbestrahlung beim Aderhautmelanom ermöglichen. / The radiation therapy of uveal melanomas using proton therapy is a very precise therapy procedure, that makes high demands on the underlying imaging modalities. In general magnetic resonance imaging (MRI) and computed tomography (CT) have the potential to fulfill these criteria using suited surface coils and optimized imaging techniques, respectively. Purpose of the investigations was the preparation and evaluation of an imaging system, that allows diagnosis and differetial diagnosis of uveal melanomas including staging on the one hand. On the other hand it should be the base for high precision radiation therapy planning. The preparation of images with isotropic voxels, i.e. the edges of the voxels have identical size, is desirable with both magnetic resonance imaging (MRI) and computed tomography (CT). Several examinations on large patient groups were performed for the differentiation of different tumor entities and compared with clinical and histopathological outcome. The precision of the MR-based tumor volumetry was evaluated with animal studies in vitro and patient eyes in vivo. The MR-imaging with isotropic voxels was evaluated using several surface coils and phantom examinations. Comparable examinations were performed regarding CT. Digital image fusion of CT and MRI data sets was used to evaluate the precision of both modalities and for planning of radiation therapy. Using optimized examination techniques both CT and especially MRI are suitable for a precise proton therapy planning of uveal melanoma.

Die grundlegenden neurobiologischen Mechanismen für das Zusammenwirken eines pathologisch erhöhten Körpergewichts und der gewichts-assoziierten emotionalen Belastung sind bisher noch wenig erforscht. Die vorliegende Arbeit untersucht gezielt Abweichungen der regionalen Transporter-Verfügbarkeiten mittels Positronen-Emissions-Tomographie (PET) mit hochselektiven Marker für den Noradrenalin- (NET) sowie den Serotonin-(5-Hydroxytryptamin-)transporter (5-HTT) und funktioneller Magnetresonanztomographie (fMRT) sowie damit verbundene Alterationen der neuronalen Ruhe-(resting-state-)Aktivität konnektierter Hirnregionen. Die Ergebnisse der kombinierten PET/fMRT Analyse wurden mit zwei neuropsychologischen Scores zur Erfassung allgemeiner und gewichtsabhängiger emotionaler Veränderungen korreliert. Insgesamt 48 Teilnehmer (Body-Mass-Index [BMI]: 19 - 50 kg/m2) erhielten eine fMRT und eine PET mittels NET-selektivem [11C]MRB (n = 20) beziehungsweise 5-HTT-selektivem [11C]DASB (n = 28). Die PET ergab im Hypothalamus eine tendentielle, BMI-abhängig verminderte Verfügbarkeit des NET, nicht jedoch des 5-HTT. Zusätzlich fand sich bei steigendem BMI innerhalb beider Neurotransmitternetzwerke in Abhängigkeit zur jeweiligen Transporter-Verfügbarkeit eine teils geschlechtsspezifisch verstärkte funktionelle Konnektivität zwischen dem Hypothalamus und Hirnregionen der Verarbeitung und Bewertung von Nahrungsreizen. Korrelationen der lokalen resting-state Aktivitäten mit den neuropsychologischen Scores lassen vermuten, dass diese Regionen zudem auch mit langfristigen, negativen Veränderungen des gewichtsabhängigen emotionalen Wohlbefindens assoziiert sind. Insgesamt spielen diese beiden zentralen Neurotransmitter-Systeme eine wichtige Rolle in der Modulation von Netzwerken zur Regulation des gewichtsabhängigen emotionalen Wohlbefindens und könnten somit wichtige Anhaltspunkte für neue pharmakologische Ansätze bereitstellen.