Multislice spiral computed tomography allows for the assessment of acute MI. Late-enhancement MSCT appears to be as reliable as delayed contrast-enhanced MRI in assessing infarct size and myocardial viability in acute MI.

Background-The advent of fibrin-binding molecular magnetic resonance (MR) contrast agents and advances in coronary MRI techniques offers the potential for direct imaging of coronary thrombosis. We tested the feasibility of this approach using a gadolinium (Gd)-based fibrin-binding contrast agent, EP-2104R (EPIX Medical Inc), in a swine model of coronary thrombus and in-stent thrombosis. Methods and Results-Ex vivo and in vivo sensitivity of coronary MR thrombus imaging was tested by use of intracoronarily delivered Gd-DTPA-labeled fibrinogen thrombi (nϭ6). After successful demonstration, in-stent coronary thrombosis was induced by x-ray-guided placement of thrombogenic-coated, MR-lucent stents (nϭ5). After stent placement, 60 mol of EP-2104R was injected via the left main coronary artery. Free-breathing, navigator-gated 3D coronary MR angiography and thrombus imaging were performed (1) before and after stent placement and (2) before and after EP-2104R. Thrombi were confirmed by x-ray angiography and autopsy. Fibrinogen thrombi: 5 of 6 intracoronarily delivered Gd-labeled fibrinogen clots (Ϸ250 mol/L Gd) were visible on MRI and subsequently confirmed by x-ray angiography. In-stent thrombi: in-stent thrombosis was observed in all stents after EP-2104R. Four of 5 thrombi were confirmed by x-ray angiography. Chemical analysis of 2 thrombi demonstrated 99 to 147 mol/L Gd. Conclusions-We demonstrate the feasibility of MRI of coronary thrombus and in-stent thrombosis using a novel fibrin-binding molecular MR contrast agent. Potential applications include detection of coronary in-stent thrombosis or thrombus burden in patients with acute coronary syndromes.

This study was an initial phase II trial in humans of molecular magnetic resonance (MR) imaging for improved visualization of thrombi in vessel territories potentially responsible for stroke using a new fibrin-specific contrast agent (EP-2104R). Eleven patients with thrombus in the left ventricle (n = 2), left or right atrium (n = 4), thoracic aorta (n = 4) or carotid artery (n = 1) as verified by an index examination (ultrasound, computed tomograpy, or conventional MR) were enrolled. All MR imaging was performed on 1.5 T whole-body MR-system using an inversion-recovery black-blood gradient-echo sequence. The same sequence was performed before and 2-6 h after low-dose intravenous administration of 4 mumol/kg EP-2104R. Two investigators assessed image quality and signal amplification. Furthermore, contrast-to-noise ratios (CNR) between the clot and the blood pool/surrounding soft tissue before and after administration of the contrast agent were compared using Student's t-test. MR imaging and data analysis were successfully completed in 10 patients. No major adverse effects occurred. On enhanced images, thrombi demonstrated high signal amplification, typically at the clot surface, with a significantly increased contrast in comparison to the surrounding blood pool and soft tissue (CNR for clot vs. blood pool, unenhanced and enhanced: 6 +/- 8 and 29 +/- 14; CNR for clot vs. soft tissue, unenhanced and enhanced: 0 +/- 4 and 21 +/- 13; P < 0.01 for both comparisons). EP-2104R allows for molecular MR imaging of thrombi potentially responsible for stroke. High contrast between thrombus and surrounding blood and soft tissues can be achieved with enhanced imaging.

Background-The differential diagnosis of acute chest pain is challenging, especially in patients with normal ECG findings, and may include coronary thrombosis or pulmonary emboli. The aim of this study was to investigate the novel fibrin-specific contrast agent EP-2104R for molecular targeted MR imaging of coronary thrombosis and pulmonary emboli. Methods and Results-Fresh clots were engineered ex vivo from human blood and delivered in the lungs and coronary arteries of 7 swine. Subsequent molecular MR imaging was performed with a navigator-gated free-breathing and cardiac-triggered 3D inversion-recovery black-blood gradient-echo sequence before and after systemic administration of 7.5 mol/kg EP-2104R. Two swine served as the control group. MR images were analyzed by 2 investigators, and contrast-to-noise ratio and gadolinium concentration in the clots were assessed. Before contrast media application, no thrombi were visible. After contrast administration, all 32 pulmonary emboli, 3 emboli in the right heart, and 5 coronary thrombi were selectively visualized as white spots with a mean contrast-to-noise ratio of 32Ϯ19. The average gadolinium concentration from all 3 types of thrombi was 144Ϯ79 mol/L. Conclusions-Molecular MR imaging with the fibrin-targeted contrast-agent EP-2104R allows selective visualization of acute coronary, cardiac, and pulmonary thrombi.

Mucins of the gastroduodenal junction are secreted by the mucous surface and mucusproducing glandular cells in the stomach, and by goblet cells and Brunner's glands in the duodenum. Developmental studies have demonstrated that Brunner's glands can arise from undifferentiated gastric epithelium and/or intestinal epithelium in the proximal duodenum. The aim of this study was to investigate the carbohydrate composition of mucins from this region and compare it with that of mucins from Brunner's glands to evaluate the probable evolution of mucins from these glands. Toward that end, paraffin sections from 13 mammalian species were stained by classic carbohydrate histochemistry and treated with 13 lectins. In general, the mucous surface cells of the stomach, pyloric glands, duodenal goblet cells, and Brunner's glands secretory epithelium had different lectin-binding patterns. However, the lectin-binding profile of the secretory epithelium of Brunner's glands resembled that of pyloric glands more closely than that of duodenal goblet cells and mucous surface cells of the stomach. Mucins from Brunner's glands and pyloric glands showed a greater terminal carbohydrate residue diversity than those of gastric mucous surface cells or duodenal goblet cells. The lectin-binding profile argues for the evolution of similar mucins from the epithelia of Brunner's glands and pyloric glands. The greater diversity of carbohydrate residues in mucins secreted by Brunner's glands suggests that their mucus is more adaptable. This may explain why Brunner's glands metaplasia rather than goblet cell metaplasia is seen in the mucosa adjacent to chronic intestinal ulcers. Anat Rec Part A 278A:540 -550, 2004. Key words: Brunner's glands; carbohydrate histochemistry; comparative anatomy; gastroduodenal junction; histogenesis; lectin; mucinThe epithelial cells that line the gastrointestinal tract of mammals are protected in part from the somewhat harsh environment of acid, proteolytic enzymes, and abrasives in the lumen by a mucus layer. In the stomach the mucus layer, which is several microns thick, is secreted by both the epithelium lining the gastric mucosa and mucus-producing cells of the gastric glands, while in the duodenum it is secreted by goblet cells and Brunner's glands, which are located in the submucosa. Mucus is a highly hydrated gel that consists of about 95% water, 5% mucins, and minor components, such as electrolytes (Allen, 1981;Neutra and Forstner, 1987). Mucins are high-molecularweight glycoproteins that have gel-forming properties which are highly glycosylated and which in turn are responsible for their protective function.A particular morphological feature of the duodenal submucosa is the presence of Brunner's glands. Brunner's glands are specific to mammals and have been observed in all mammals examined to date (Krause, 1988). They are

Slab-selective inversion-prepared 3D SSFP MR angiography had high sensitivity, specificity, accuracy, and NPV for RAS detection, without the need for contrast material. However, RAS severity was overestimated in some patients.

The aim of this study was to assess global left ventricular (LV) function and regional wall motion using retrospectively ECG-gated 16-slice computed tomography (CT) in comparison with magnetic resonance imaging (MRI). Twenty-one patients (18 male, 65.5+/-8.6 years) with acute myocardial infarction underwent multislice spiral CT (MSCT) and MRI. From manually drawn endo- and epicardial contours, LV volumes including myocardial mass, peak filling rate (PFR), peak ejection rate (PER), time to PER (TPER) and time from end-systole to PFR (TPFR) were calculated. Regional wall motion was assessed from cine loops using a 16-segment model of the left ventricle. LV function was analyzed using the Bland-Altman method, Pearson's correlation coefficient, multivariate analysis and post hoc t tests. Regional wall motion was evaluated with weighted kappa-statistics. Multivariate analysis revealed significant differences for global LV function as determined by MSCT and MRI. Post hoc t-tests showed significant differences for end-diastolic volume (EDV), PFR and TPER (P<0.05), while there was a good agreement for the LV volumes with an ejection fraction of 46.9+/-8.4% for MSCT and 46.9+/-8.9% for MRI. PER, PFR, TPER and TPFR presented a poor correlation and a wide range of scattering between MSCT and MRI. Regional wall motion scores showed a good agreement with kappa=0.791. Sixteen-slice spiral CT allows for reliable assessment of LV volumes, but is not yet suited for the evaluation of all functional parameters. Assessment of regional wall motion at rest is feasible.

The fibrin-specific MR contrast agent EP-2104R allows for selective and high-contrast visualization of left atrial clots by means of molecular targeted MRI.