Effects on food intake of Gammarus spp. after exposure to PFBA in very low concentrations

Per- and polyfluoroalkyl substances (PFAS) are a group of thousands of highly persistent anthropogenic chemicals widely used in many industries. Therefore, they are, ubiquitously present in various types of environments. Despite their omnipresence, ecotoxicological studies of most PFAS are scarce, and those available often assess the effects of long chain PFAS. In this study, we present the results of an exposure experiment in which wild aquatic amphipod Gammarus spp. was exposed to the short chain perfluorinated substance perfluorobutanoic acid (PFBA) at very low and environmentally relevant concentrations of 0, 10 and 100 ng/L. The exposure lasted for 12 days, and food intake and non-reproductive behavior were analyzed. Exposure to 10 and 100 ng/L PFBA resulted in a lower consumption of food during exposure but no effect on behavior was found.

Persistence of norfluoxetine in marine mussels

The concentration of pharmaceuticals in coastal waters is tending towards increasing due to a shift of the human population into coastal zones. In parallel, the number of prescriptions of antidepressants, mainly selective serotonin reuptake inhibitors (SSRI), is constantly growing. Most of the SSRI is metabolised into active compounds; for instance, norfluoxetine (NFLU) is the main active metabolite of fluoxetine. In this study, we tested the bioaccumulation and depuration of NFLU in Mytilus trossulus at two environmentally relevant concentrations (100 and 500 ng/L, after six days of exposure and five days of depuration at 10 °C). The concentration of NFLU in the mussels' tissue seems not to be directly proportional to the exposure concentration. The levels of NFLU in the mussels' tissues after the depuration period were comparable to the levels detected at the end of exposure. This indicates that NFLU is not efficiently removed by the mussels and points to a potential risk for consumers of such marine organisms.

Somatic evolution of marine transmissible leukemias in the common cockle, Cerastoderma edule

Transmissible cancers are malignant cell lineages that spread clonally between individuals. Several such cancers, termed bivalve transmissible neoplasia (BTN), induce leukemia-like disease in marine bivalves. This is the case of BTN lineages affecting the common cockle, Cerastoderma edule, which inhabits the Atlantic coasts of Europe and northwest Africa. To investigate the evolution of cockle BTN, we collected 6,854 cockles, diagnosed 390 BTN tumors, generated a reference genome and assessed genomic variation across 61 tumors. Our analyses confirmed the existence of two BTN lineages with hemocytic origins. Mitochondrial variation revealed mitochondrial capture and host co-infection events. Mutational analyses identified lineage-specific signatures, one of which likely reflects DNA alkylation. Cytogenetic and copy number analyses uncovered pervasive genomic instability, with whole-genome duplication, oncogene amplification and alkylation-repair suppression as likely drivers. Satellite DNA distributions suggested ancient clonal origins. Our study illuminates long-term cancer evolution under the sea and reveals tolerance of extreme instability in neoplastic genomes.

Oxytetracycline-induced inflammatory process without oxidative stress in blue mussels Mytilus trossulus

Potentially harmful compounds including pharmaceuticals are commonly found in marine waters and sediments. Amongst those, antibiotics and their metabolites are detected worldwide in various abiotic (at concentrations as high as µg/L) and biotic matrices at ng/gram of tissue, posing a risk to non-target species exposed to them such as blue mussels. Amongst those, oxytetracycline (OTC) belongs to the most detected antibiotics in the marine environment. In this work, we concentrated on studying the potential induction of oxidative stress, activation of cellular detoxification processes (including Phase I and Phase II xenobiotic biotransformation enzymes) and multixenobiotic resistance pumps (Phase III) as well as changes in the aromatisation efficiency in Mytilus trossulus exposed to 100 μg/L OTC. Our results show that 100 µg/L OTC concentration did not provoke cellular oxidative stress and did not affect the expression of genes involved in detoxification processes in our model. Moreover, no effect of OTC on aromatisation efficiency was found. Instead, phenoloxidase activity measured in haemolymph was significantly higher in OTC exposed mussels than in those from the control (30.95 ± 3.33 U/L and 17.95 ± 2.75 U/L, respectively). OTC exposed mussels were also characterised by a tissue-dependant activation of major vault protein (MVP) gene expression (1.5 times higher in gills and 2.4 times higher in the digestive system) and a decreased expression of the nuclear factor kappa B-a (NF-κB) gene (3.4 times lower in the digestive system) when compared to those from the control. Additionally, an elevated number of regressive changes and inflammatory responses in tissues such as gills, digestive system and mantle (gonads) was observed underlining the worsening of bivalves' general health. Therefore, instead of a free-radical effect of OTC, we for the first time describe the occurrence of typical changes resulting from antibiotic therapy in non-target organisms like M. trossulus exposed to antibiotics such as OTC.

A multi-biomarker approach to assess toxicity of diclofenac and 4-OH diclofenac in Mytilus trossulus mussels - First evidence of diclofenac metabolite impact on molluscs

Although the presence of pharmaceuticals in the environment is an issue widely addressed in research over the past two decades, still little is known about their transformation products. However, there are indications that some of these chemicals may be equally or even more harmful than parent compounds. Diclofenac (DCF) is among the most commonly detected pharmaceuticals in the aquatic environment, but the potential effects of its metabolites on organisms are poorly understood. Therefore, the present study aimed to evaluate and compare the toxicity of DCF and its metabolite, 4-hydroxy diclofenac (4-OH DCF), in mussels using a multi-biomarker approach. Mytilus trossulus mussels were exposed to DCF and 4-OH DCF at 68.22 and 20.85 μg/L (measured concentrations at day 0), respectively, for 7 days. In our work, we showed that both tested compounds have no effect on most of the enzymatic biomarkers tested. However, it has been shown that their action can affect the protein content in gills and also be reflected through histological markers. ENVIRONMENTAL IMPLICATION: Studies in recent years clearly prove that pharmaceuticals can negatively affect aquatic organisms. In addition to parent compounds, metabolites of pharmaceuticals can also be a significant environmental problem. In the present work, the effects of diclofenac and its main metabolite, 4-hydroxy diclofenac, on marine mussels were evaluated. Both compounds showed negative effects on mussels, which was primarily observed through histological changes. The present study therefore confirms that not only diclofenac, but also its main metabolite can have negative effects on aquatic organisms.

Long-term stability of diclofenac and 4-hydroxydiclofenac in the seawater and sediment microenvironments: Evaluation of biotic and abiotic factors

Studies in recent years have shown that significant amounts of diclofenac (DCF) and its metabolites are present in marine coastal waters. Their continuous flow into the environment may be associated with numerous negative effects on both fauna and flora. Although more and more is known about the effects of pharmaceuticals on marine ecosystems, there are still many issues that have not received enough attention, but are essential for risk assessment, such as long term stability. Furthermore, interaction of pharmaceuticals with sediments, which are inhabited by rich microbial, meiofaunal and macrobenthic communities need investigation. Therefore, we undertook an analysis of the stability of DCF and its metabolite, 4-hydroxy diclofenac, in seawater and sediment collected from the brackish environment of Puck Bay. Our 29-day experiment was designed to gain a better understanding of the fate of these compounds under experimental conditions same as near the seafloor. Diclofenac concentration decreased by 31.5% and 20.4% in the tanks with sediment and autoclaved sediment, respectively during 29-day long experiment. In contrast, the concentration of 4-OH diclofenac decreased by 76.5% and 90.2% in sediment and autoclaved sediment, respectively. The concentration decrease of both compounds in the sediment tanks resulted from their sorption in the sediment and biodegradation. Obtained results show that marine sediments favour DCF and 4-OH DCF removal from the water column.

Presence of pharmaceuticals and their metabolites in wild-living aquatic organisms - Current state of knowledge

In the last decades an increasing number of studies has been published concerning contamination of aquatic ecosystems with pharmaceuticals. Yet, the distribution of these chemical compounds in aquatic environments raises many questions and uncertainties. Data on the presence of selected pharmaceuticals in the same water bodies varies significantly between different studies. Therefore, since early 1990 s, wild organisms have been used in research on environmental contamination with pharmaceuticals. Indeed, pharmaceutical levels measured in biological matrices may better reflect their overall presence in the aquatic environments as such levels include not only direct exposure of a given organisms to a specific pollutant but also processes such as bioaccumulation and biomagnification. In the present paper, data concerning occurrence of pharmaceuticals in aquatic biota was reviewed. So far, pharmaceuticals have been studied mainly in fish and molluscs, with only a few papers available on crustaceans and macroalgae. The most commonly found pharmaceuticals both in freshwater and marine organisms are antibiotics, antidepressants and NSAIDS while there is no information about the presence of anticancer drugs in aquatic organisms. Furthermore, only single studies were conducted in Africa and Australia. Hence, systematization of up-to-date knowledge, the main aim of this review, is needed for further research targeting.

Cellular level response of the bivalve Limecola balthica to seawater acidification due to potential CO2 leakage from a sub-seabed storage site in the southern Baltic Sea: TiTank experiment at representative hydrostatic pressure

Understanding of biological responses of marine fauna to seawater acidification due to potential CO₂ leakage from sub-seabed storage sites has improved recently, providing support to CCS environmental risk assessment. Physiological responses of benthic organisms to ambient hypercapnia have been previously investigated but rarely at the cellular level, particularly in areas of less common geochemical and ecological conditions such as brackish water and/or reduced oxygen levels. In this study, CO₂-related responses of oxygen-dependent, antioxidant and detoxification systems as well as markers of neurotoxicity and acid-base balance in the Baltic clam Limecola balthica from the Baltic Sea were quantified in 50-day experiments. Experimental conditions included CO₂ addition producing pH levels of 7.7, 7.0 and 6.3, respectively and hydrostatic pressure 900 kPa, simulating realistic seawater acidities following a CO₂ seepage accident at the potential CO₂-storage site in the Baltic. Reduced pH interfered with most biomarkers studied, and modifications to lactate dehydrogenase and malate dehydrogenase indicate that aerobiosis was a dominant energy production pathway. Hypercapnic stress was most evident in bivalves exposed to moderately acidic seawater environment (pH 7.0), showing a decrease of glutathione peroxidase activity, activation of catalase and suppression of glutathione S-transferase activity likely in response to enhanced free radical production. The clams subjected to pH 7.0 also demonstrated acetylcholinesterase activation that might be linked to prolonged impact of contaminants released from sediment. The most acidified conditions (pH 6.3) stimulated glutathione and malondialdehyde concentration in the bivalve tissue suggesting potential cell damage. Temporal variations of most biomarkers imply that after a 10-to-15-day initial phase of an acute disturbance, the metabolic and antioxidant defence systems recovered their capacities.

Exposure of Mytilus trossulus to diclofenac and 4'-hydroxydiclofenac: Uptake, bioconcentration and mass balance for the evaluation of their environmental fate

Diclofenac (DIC) is one of the most widely consumed drugs in the world, and its presence in the environment as well as potential effects on organisms are the subject of numerous recent scientific works. However, it is becoming clear that the risk posed by pharmaceuticals in the environment needs to be viewed more broadly and their numerous derivatives should also be considered. In fact, already published results confirm that the transformation products of NSAIDs including DIC may cause a variety of potentially negative effects on marine organisms, sometimes showing increased biological activity. To date, however, little is known about bioconcentration of DIC and DIC metabolites and the role of sex in this process. Therefore, the present study for the first time evaluates sex-related differences in DIC bioconcentration and estimates bioconcentration potential of DIC metabolite, 4-OH DIC, in the Mytilus trossulus tissues. In the experiment lasting 7 days, mussels were exposed to DIC and 4-OH DIC at concentrations 68.22 and 20.85 μg/L, respectively. Our study confirms that DIC can be taken up by organisms not only in its native form, but also as a metabolite, and metabolised further. Furthermore, in the present work, mass balance was performed and the stability of both studied compounds under experimental conditions was analysed. Obtained results suggest that DIC is more stable than its derivative under the tested conditions, but further analyses of the environmental fate of these compounds are necessary.

Bioaccumulation of phenolic endocrine disruptors in the clam Rangia cuneata: Storage in shells and influence of size and sex

This study aimed to investigate the sequestration of phenolic endocrine disrupting compounds (EDCs) such as bisphenol A (BPA), 4-t-octylphenol (4-t-OP), and 4-nonylphenol (4-NP) in the shells of the mature clam Rangia cuneata from the Vistula Lagoon (southern Baltic Sea) and to determine the influence of sex and shell length on bioaccumulation of these contaminants. Even though there is broad interest in EDCs influences on aquatic organisms, these basic parameters are poorly understood, yet necessary for assessing environmental risks for clams. Average proportions of the total body burden (ng/individual) deposited in shells of R. cuneata were more than 70% for BPA and 4-NP and up to 32% for 4-t-OP. These results indicate that shell storage can be an important route for elimination of specific EDCs. Relationships between EDCs concentrations and the size and sex of R. cuneata indicate that females and large individuals experience greater exposures to the adverse effects of these pollutants than males and smaller clams. This effect could have significant impacts on population ecology and ultimately affect the entire ecosystem, in which bivalves play an important role. In the context of using clams to assess water pollution, the co-variation of EDCs concentrations with the size and sex of bivalves could influence the quality of monitoring data, unless accounted for in sampling design and data analysis.

Toxic effects of NSAIDs in non-target species: A review from the perspective of the aquatic environment

The presence of pharmaceuticals in the aquatic environment, both in marine and freshwater reservoirs, is a major concern of global environmental protection. Among the drugs that are most commonly used, NSAIDs tend to dominate. Currently, being aware of the problem caused by drug contamination, it is extremely important to evaluate the scale and the full spectrum of its consequences, from short-term to long-term effects. The influence on non-target aquatic animals can take place at many levels, and the effects can be seen both in behaviour and physiology, but also in genetic alterations or reproduction disorders, affecting the development of entire populations. This review summarises all the advances made to estimate the impact of NSAIDs on aquatic animals. Multicellular animals from all trophic levels, inhabiting both inland waters, seas and oceans, have been considered. Particular attention has been paid to chronic studies, conducted at low, environmentally-relevant concentrations, to estimate the real effects of the present pollution. The number of such studies has indeed increased in recent years, allowing for a better insight into the possible consequences of pharmaceutical pollution. It should be stressed, however, that our knowledge is still limited to a few model species, while there are many groups of organisms completely unexplored regarding the effects of drugs. Therefore, the main aim of this paper was to summarise the current state of knowledge on the toxicity of NSAIDs in aquatic animals, also identifying important gaps and major issues requiring further analysis.

Effects of environmentally relevant concentrations of diclofenac in Mytilus trossulus

The presence of pharmaceuticals in the marine environment is a growing problem of global importance. Although awareness of the significance of this issue is increasing, many questions related to the ecotoxicology of pharmaceuticals remain unclear. Diclofenac is one of the drugs most commonly detected in the marine environment and its potential toxicity has been previously highlighted, thus its impact on organisms deserves a special attention. Therefore, in this study, a thorough analysis of the effects of diclofenac on a condition and tissue level of a model representative of marine invertebrates - Mytilus trossulus - was performed. During the 25-day experiment, divided into exposure and depuration phases, bivalves were exposed to two environmentally relevant drug concentrations of 4 and 40 μg/L. The study showed that mussels absorb diclofenac in their tissues and the highest recorded concentration was 1.692 μg/g dw on day 8. Moreover, the content of diclofenac metabolites (4-OH and 5-OH diclofenac) was also examined, but they were not detected either in water or in tissues. Although exposure to low diclofenac concentrations did not significantly affect the condition index of organisms, changes in numerous histopathological parameters were noted. Performed histological examination provided additional valuable information on the influence of drugs on the functioning of invertebrates. Nevertheless, applicability of histopathological techniques in ecotoxicology of drugs requires additional evaluation in future studies.

Mytilidae as model organisms in the marine ecotoxicology of pharmaceuticals - A review

Growing production and consumption of pharmaceuticals is a global problem. Due to insufficient data on the concentration and distribution of pharmaceuticals in the marine environment, there are no appropriate legal regulations concerning their emission. In order to understand all aspects of the fate of pharmaceuticals in the marine environment and their effect on marine biota, it is necessary to find the most appropriate model organism for this purpose. This paper presents an overview of the ecotoxicological studies of pharmaceuticals, regarding the assessment of Mytilidae as suitable organisms for biomonitoring programs and toxicity tests. The use of mussels in the monitoring of pharmaceuticals allows the observation of changes in the concentration and distribution of these compounds. This in turn gives valuable information on the amount of pharmaceutical pollutants released into the environment in different areas. In this context, information necessary for the assessment of risks related to pharmaceuticals in the marine environment are provided based on what effective management procedures can be developed. However, the accumulation capacity of individual Mytilidae species, the bioavailability of pharmaceuticals and their biological effects should be further scrutinized.

Aromatisation of steroids in the bivalve Mytilus trossulus

In this study, we demonstrated the presence of the enzymatic complex able to perform aromatization (estrogen synthesis) in both, the microsomal and mitochondrial fractions of gills and gonads from Mytilus trossulus. Based on in vitro experiments, we highlighted the importance of temperature as the limiting factor of aromatisation efficiency (AE) in mussels. After testing range of temperatures (4–23 °C), the highest AE was found during incubation at 8 °C and pH 7.6 (41.66 pmol/h/mg protein in gills and 58.37 pmol/h/mg protein in gonads). The results were confirmed during field studies where the most efficient aromatisation occurred in bivalves collected in spring while the least effective in those collected in winter. During in vitro studies, AE turned out to be more intensive in female gonads than in male gonads. The process was also more intensive in mitochondrial fraction than in microsomal one (62.97 pmol/h/mg protein in male gills and 73.94 pmol/h/mg protein in female gonads). Enzymatic complex (aromatase-like enzyme) catalysing aromatisation in mussels was found to be insensitive to inhibitory effect of selective inhibitors of mammalian aromatase such as letrozole and anastrazole, suggesting its different structure from vertebrate aromatase. Further in vivo studies using ¹³C-labeled steroids at 8 °C temperature window confirmed that bivalves are able to uptake testosterone and androstenedione from the ambient environment and metabolise them to estrone and 17β-estradiol thus confirming endogenous estrogen’ synthesis.

Multi biomarker analysis of pollution effect on resident populations of blue mussels from the Baltic Sea

Anthropogenic pollution including metals, petroleum, toxins, nutrients and many others is a growing problem in the marine environment. These are important factors altering the environment and by that the fate of many local populations of marine organisms. The aim of this study was to assess the impact of selected point pollution sources on resident populations of the blue mussel (Mytilus edulis trossulus) in the Baltic Sea using multiple biomarker approach. The study used a nested sampling scheme in which sites from reference (REF) habitats are geographically paired with selected sites from sewage treatment plants (STP) and harbors (HAR). The results showed that mussels from harbors had a higher frequency of histological abnormalities in the digestive gland compared to mussels from sewage effluent affected areas and reference sites. However these mussels together with mussels from STPs had higher lipid content, body mass index (BMI) and gonado-somatic index (GSI) compared to mussels from reference sites. A marked spatial variability was found with a stronger toxicity of ambient environment affecting resident mussel populations in the Gulf of Gdańsk area, while an opposite pattern was found in Tvärminne area. Yet the blue mussels sampled in the Gulf of Gdańsk were characterized by the highest GSI and BMI values compared to Askö and Tvärminne populations. No differences in analyzed biomarker response related to species identity, measured by a species-specific genetic marker, were found indicative of strong genetic introgression in the Baltic Proper.

Changes in steroid profiles of the blue mussel Mytilus trossulus as a function of season, stage of gametogenesis, sex, tissue and mussel bed depth

This paper describes changes in the content of free steroid hormones e.g. testosterone (T), estradiol-17β (E2), estrone (E1) and estriol (E3) of Mytilus trossulus from the southern Baltic Sea as a function of season, stage of gametogenesis, sex, tissue (gonadal and somatic) and depth. The highest levels of T, E2, E1 and E3 were found in mussels sampled in spring and summer while the lowest levels were found in winter. This pattern was stable and was seen in both sexes and tissues in mussels from both mussel beds. The spring and summer peaks in steroid levels (SL) coincided with advanced levels of gametogenesis (the highest gonadal index, GI) of our model species. But, the lowest GI (autumn) and the lowest steroids content (winter) did not overlap. Instead, water temperature increase was followed by increase of SL and vice versa. This suggests that steroids may not be actively involved in the early stages of gamete development and does not preclude them from potentially being involved as endogenous modulators in the final stages of reproduction (e.g. spawning). Hence, observed fluctuations in SL in our model species are unlikely to be caused by reproductive cycle but are rather of unknown nature, likely linked with environmental conditions. Sex-related differences in steroid content included estrogen domination in females and androgen domination in males. A trend towards higher level of steroids in gills than in gonads was found, supporting the hypothesis about an exogenous origin of steroids in bivalves. However, based on the present results, we cannot exclude the possibility that these steroids have both an endogenous and exogenous origin.

Kernspintomographie zum Metastasen-Screening? Ein prospektiver Vergleich mit der Skelettszintigraphie

Bei 102 Patienten mit Tumoren mit häufiger Skelettmetastasierung, wurde im Vergleich zur Skelettszintigraphie (SkSz) der Stellenwert der Kernspintomographie (KST) von Wirbelsäule, Becken, Femora und proximalen Tibiae zum Metastasen-Screening geprüft. Alle Patienten hatten in der SkSz keinen Metastasen-Hinweis, 96 (94%) auch bei der KST. Nur bei 6% der Patienten fanden sich mit KST im Knochenmark Herdbefunde. Dies bedeutet, daß eine 94%ige Wahrscheinlichkeit auf Metastasenfreiheit gegeben ist, wenn die SkSz normal ausfällt, weshalb sie nach wie vor die Methode der Wahl zum Screening nach ossären Metastasen ist. Trotz hoher Sensitivität und Spezifität kann die KST mit der momentanen Routinetechnik die SkSz derzeit wegen längerer Untersuchungszeiten, höherer Kosten und fehlender Ganzkörperaufnahme noch nicht ersetzen, erscheint aber bei radiologisch negativen fraglichen Befunden der SkSz indiziert.

Elevated gonadal atresia as biomarker of endocrine disruptors: Field and experimental studies using Mytilus trossulus (L.) and 17-alpha ethinylestradiol (EE2)

In the present work we compared the type and frequency of gonadal abnormalities among Mytilus trossulus populations from the Gulf of Gdańsk, Baltic Sea. Observed histopathologies were grouped as regressive changes (RC, gonadal atresia (GA) and regression (GR)), progressive changes (PC, gonadal tumors) and intersex. Sex-based and spatial differences in frequency of RC were found, with the highest frequency of RC and PC found in mussels from polluted station B followed by mussels from station A located near a purification plant outlet. Bivalves from the reference area had the lowest frequency of RC. In order to confirm biomarker applicability of RC, an exposure experiment with model xenoestrogen 17α-ethinylestradiol (EE2) was performed. The exposure of M. trossulus to 50 and 500ngdL^-1 of EE2 resulted in an increased frequency of gonadal regression and atresia, including melanized hemocytes infiltration in seminiferous tubules. We thus suggest that these changes can serve as biomarkers of endocrine disrupting compounds in biomonitoring studies.

Sewage treatment plant associated genetic differentiation in the blue mussel from the Baltic Sea and Swedish west coast

Human-derived environmental pollutants and nutrients that reach the aquatic environment through sewage effluents, agricultural and industrial processes are constantly contributing to environmental changes that serve as drivers for adaptive responses and evolutionary changes in many taxa. In this study, we examined how two types of point sources of aquatic environmental pollution, harbors and sewage treatment plants, affect gene diversity and genetic differentiation in the blue mussel in the Baltic Sea area and off the Swedish west coast (Skagerrak). Reference sites (REF) were geographically paired with sites from sewage treatments plant (STP) and harbors (HAR) with a nested sampling scheme, and genetic differentiation was evaluated using a high-resolution marker amplified fragment length polymorphism (AFLP). This study showed that genetic composition in the Baltic Sea blue mussel was associated with exposure to sewage treatment plant effluents. In addition, mussel populations from harbors were genetically divergent, in contrast to the sewage treatment plant populations, suggesting that there is an effect of pollution from harbors but that the direction is divergent and site specific, while the pollution effect from sewage treatment plants on the genetic composition of blue mussel populations acts in the same direction in the investigated sites.

Bioindicative potential of shell abnormalities occurring in the clam Macoma balthica (L.) from the Baltic Sea

This study reports the occurrence of shell deformities in the Baltic clam Macoma balthica from the Northern Baltic Sea (Trösa Archipelago, Sweden). The functional significance and the bioindicative potential of observed exoskeleton' anomalies was assessed using a suite of physiological and morphological biomarkers. Analyzed shell deformations (SD) included damages of the dorsal margin visible as shell excavations, destruction of the beak, umbo and hinge ligament and decreased shell' transparency. Deformed clams exhibited worse physiological conditions and increased frequency of micronuclei. Skewed sex ratio towards male domination was observed in all studied populations. Spatial differences in the occurrence of deformed clams are reported, with more than 50% of deformed clams inhabiting polluted locations and 8% the reference station. These results are encouraging for the use of described SDs as initial and cost effective indicators of environmental health.

The future of Baltic Sea populations: local extinction or evolutionary rescue?

Environmental change challenges local and global survival of populations and species. In a species-poor environment like the Baltic Sea this is particularly critical as major ecosystem functions may be upheld by single species. A complex interplay between demographic and genetic characteristics of species and populations determines risks of local extinction, chances of re-establishment of lost populations, and tolerance to environmental changes by evolution of new adaptations. Recent studies show that Baltic populations of dominant marine species are locally adapted, have lost genetic variation and are relatively isolated. In addition, some have evolved unusually high degrees of clonality and others are representatives of endemic (unique) evolutionary lineages. We here suggest that a consequence of local adaptation, isolation and genetic endemism is an increased risk of failure in restoring extinct Baltic populations. Additionally, restricted availability of genetic variation owing to lost variation and isolation may negatively impact the potential for evolutionary rescue following environmental change.

Long-term toxicity of hexabromocyclododecane (HBCDD) to the benthic clam Macoma balthica (L.) from the Baltic Sea

The world's largest brackish water sea area, the Baltic Sea, is considered to be one of the most polluted seas of the world. Many new pollutants are constantly entering the environment, such as brominated flame-retardants (BFRs). BFRs represent a group of compounds that structurally resemble hydrophobic organic contaminants, but only scarce data about their toxicity to marine organism exist. Thus, the purpose of this study was to analyze long-term in vivo cytotoxicity and genotoxicity of hexabromocyclodododecane (HBCDD) to exposed marine invertebrates using a suite of cytogenetic biomarkers. This included a set of nuclear and nucleolar characteristics and the micronucleus test. The use of those parameters reflects different mechanisms of nuclear activity regulation in cells (as a parameter of cytotoxicity) and measures subcellular processes. The induction of nuclear abnormalities (like the formation of micronuclei) was also employed here as a parameter of genotoxicity. In order to reflect the proliferative and metabolic activity of the cells the number of argylophillic nucleolar organiser regions (NORs) in interphase cells was scored. Over a period of 50 days an in vivo exposure experiment with a clam Macoma balthica and different concentrations of HBCDD (nominal concentrations of 0, 100 and 250microg/l) with three replicates each was performed. Gill cells were used as "sentinel systems" considering specificity in metabolism, repair mechanisms, adaptative response and cell proliferation. A significant increase in nuclear and nucleolar abnormalities and in the frequency of dead cells was observed during the duration of the experiment with the highest peak occurring 10 days after exposure for nuclear abnormalities and 20-30 days after exposure for malfunction of ribosomal genes (NORs) (GLM analyses and Spearman correlation, p<0.05). Thus, the induction of micronuclei and other nuclear abnormalities reflected the toxic potential of HBCDD to marine invertebrates while an increase in the number of NOR may also reflect adaptive responses of the system as enhanced induction of proliferative regeneration of the gill tissue.

First record of the occurrence of "gill disease" in Mytilus edulis trossulus from the Gulf of Gdańsk (Baltic Sea, Poland)

We are presenting the first report of the occurrence of "gill disease" in Mytilus edulis trossulus from the southern Baltic Sea, Gulf of Gdańsk (Poland). The disease preliminary diagnosis was based on the presence of white and yellow "spots" causing deep indentations in the gills with degeneration, destruction and necrosis of gill filaments. Average prevalence of gill erosion in the blue mussels population was 15.8%. According to other authors, gill erosion may affect over 80% of the bivalve population resulting in mortality rates of up to 40%. The origin of the gill erosion remains unknown, but viruses are most likely involved in the etiology of these pathological conditions. The disease as such may indicate a decrease in the immunological resistance of organisms to infections and inflammations directly or indirectly caused by harmful factors in the ambient environment. Furthermore, the occurrence of numerous pathologies in bivalves is a particular problem in the Gulf of Gdańsk being a low biodiversity ecosystem. Pathologies reduce bilvalves' reproduction ability, worsen their physiological condition and increase their mortality rate. Those factors may also pose a significant ecological danger and lead to negative alterations of the ecosystem.

Ultrastructural study of neoplastic cells in Macoma balthica (Bivalvia) from the Gulf of Gdansk (Poland)

In the Baltic clam Macoma balthica from the Gulf of Gdansk, neoplasia is considered as a serious epizootic linked to bad environmental conditions and high levels of pollutants. Previous research was focused on the diagnosis, prevalence, seasonality and histopathological characteristic of the cancer. This study is focused on electron microscopy analyses describing cell ultrastructure abnormalities related to neoplasia. Examinations using the electron microscopy highlighted changes confined to anatomic ultrastructures, shapes and functions of neoplastic cells. The lobulated appearance of the nucleus, changes in cellular matrix and the occurrence of large granular cells with hyperchromatic nuclei, atypical Golgi structures and deterioration of rough endoplasmic reticulum manifested the disease. The presence of atypical mitochondria, free ribosomes and hypertrophic nuclei suggests the adaptation of neoplastic cells to increased mitotic activity, while the observed modification of cellular membranes may reflect functional changes connected to increased pinocytotic activity or intercellular transport. The cancer cells were found to appear in two types, abnormal round-shaped cells and spindle-shaped cells, both with increased frequencies of cell division. Round-shaped cells typical for disseminated neoplasia were observed in all affected bivalves, in a few cases co-occurring with abnormal spherical cells. Spindle-shaped cells containing some intracytoplasmic filaments, and with a tendency of the nuclei to be orientated as in a palisade were interpreted as myofibroblasts-like cells and were observed in five out of eleven clams diagnosed as neoplastic. This finding represents the first demonstration of phenotypic differences in the cell types co-occurring in animals diagnosed as neoplastic and by that suggests coexistence of two types of bivalve cancer, disseminated neoplasia and probable fibrosarcoma.

Survey for neoplasia in Macoma balthica from the Gulf of Gdansk by flow cytometry

Using flow cytometry, 234 Macoma balthica were examined during a survey to determine frequency of neoplasia in the Gulf of Gdansk (Poland). Clams were collected in 4 locations and DNA content in gill tissue cells was determined by flow cytometry using propidium iodide staining. Cell permeabilization was induced by osmotic shock. Prevalence of neoplasia ranged from 9.6 to 26.7% depending on location. DNA content in aneuploid cells was higher than in normal dividing cells. The fluorescence value for aneuploid cells corresponded to tetraploid/pentaploid cells. Three stages of neoplasia were defined, based on the percentage of aneuploid cells determined by flow cytometry. Histopathological and cytogenetic analyses were also carried out on the same clams for comparative study. Proportions of normal and affected clams detected using flow cytometry were similar to those identified using both methods. In the present study, no clear relationship was demonstrated between prevalence of neoplasia and pollutant detection in the different sampling sites.

Neoplasia detection in Macoma balthica from the Gulf of Gdansk: comparison of flow cytometry, histology and chromosome analysis

A flow cytometry protocol was applied for the detection of neoplasia in Macoma balthica L. from the Gulf of Gdansk (Baltic Sea, Poland). A simple method, based on an osmotic shock, was used to permeabilise gill cells. The cytometric pattern of normal clams consisted of 2 peaks, a major peak B and a smaller peak C. The cytometric pattern of affected clams consisted of 2 peaks named B' and C'. Two parameters were used to define the stages of abnormalities in M. balthica clams based on the percentage of cells in peaks B, C, B' and C' and on the ratio between the fluorescence value of peaks B, C, B' and C' in all individuals. Three stages of neoplasia were clearly distinguished by flow cytometry considering peak C'. Stage 1 was characterised by a major population of cells in peak B' and more than 10% of cells in the C' peak. Stage 2 consisted of a lower percentage of cells in peak B' and more than 25% of cells in peak C'. Stage 3 of the neoplasia was characterised by a further reduction in peak B' and more than 40% of cells in peak C'. Flow cytometry allowed for objective detection of neoplasia and provided a rapid method for measuring the DNA content of thousands of cells per individual. The accuracy of flow cytometry was assessed by comparing with standard histological techniques, used here as a reference technique for the detection of neoplasia, and with chromosome analysis. All individuals were analysed in parallel using the 3 techniques. The proportion of normal and affected individuals diagnosed using flow cytometry was comparable to the proportion determined by histology and chromosome analysis.

Argyrophilic nucleolar organizer regions (AgNORs) in interphases and metaphases of normal and neoplastic gill cells of Macoma balthica (Bivalvia: Tellinidae) from the Gulf of Gdansk, Baltic Sea

Chromosome analysis of gill cells of different populations of Macoma balthica (L.) from the Bay of Gdansk (Baltic Sea) revealed 2 clam categories, 1 with neoplastic features and 1 without. Silver-staining was performed on interphase and metaphase cells of both categories. The mean argyrophilic nucleolar organizer region (AgNOR) count per abnormal interphase cell was significantly higher than in normal interphase cells. Normal silver-stained metaphases had 3 nucleolar organizer region (NOR) chromosome phenotypes. The location of the NORs in the most frequent phenotype (55.6% in 54 metaphases scored) was interstitial on the largest metacentric chromosome pair, Pair No. 1. Abnormal silver-stained metaphases had a higher number of active NOR sites. Different phenotypes were observed (frequency greater than 10% for 67 metaphases scored); 2 were similar to those in normal metaphases and 5 were ectopic. The higher activity of AgNORs observed in abnormal cells confirmed the diagnosis of malignant neoplasia.

Identification of hemodynamically significant restenosis after percutaneous transluminal coronary angioplasty in acute myocardial infarction by transesophageal dobutamine stress echocardiography and comparison with myocardial single photon emission computed tomography

BACKGROUND

Beside thrombolysis, percutaneous transluminal coronary angioplasty (PTCA) has become a well-established treatment for acute myocardial infarction. However, restenosis occurs in approximately 15%-40% of patients. Despite a frequently occurring infarct-related regional systolic dysfunction at rest, the identification of hemodynamically relevant restenosis seems important in terms of risk stratification, adequate treatment, and possible improvement of prognosis in these patients. This study was designed to assess the role of transesophageal dobutamine stress echocardiography and myocardial scintigraphy for identification of hemodynamically significant restenosis after PTCA for acute myocardial infarction.

METHODS

Multiplane transesophageal stress echocardiography (dobutamine 5, 10, 20, 30, and 40 micrograms/kg per min) studies and myocardial single photon emission computed tomography (SPECT) studies were performed in 40 patients, all of whom underwent PTCA in the setting of acute myocardial infarction > or = 4 months prior to the test. Repeated coronary angiography was performed in all study patients who showed stress-induced perfusion defects or wall-motion abnormalities, or both.

RESULTS

Significant restenosis (> or = 50%) was angiographically found in 15 (37.5%) of 40 patients. Of these 15 patients, transesophageal dobutamine stress echocardiography identified restenosis in 12 (80%) and myocardial SPECT in 14 (93%), yielding diagnostic agreement in 70% of patients. Echocardiographic detection of restenosis was based mainly on a biphasic response to increasing doses of dobutamine. Sensitivity and specificity for identification of hemodynamically relevant restenosis in individual patients was 80% and 92%, respectively for dobutamine stress echocardiography versus 93% and 68% for myocardial SPECT.

CONCLUSIONS

Both transesophageal dobutamine stress echocardiography and myocardial SPECT were highly sensitive in identifying significant restenosis after PTCA for acute myocardial infarction. Therefore, either test, as a single diagnostic tool or especially if performed together, are clinically valuable alternatives to coronary angiography for the detection of restenosis after PTCA for acute myocardial infarction.

Hypothyroidism after therapy for larynx and pharynx carcinoma

Early detection of local and regional recurrence is the main goal during follow-up of patients with larynx and pharynx cancer. Hypothyroidism occurring in those patients stays frequently undiagnosed as screening for hypothyroidism is not part of the routine follow-up. This study was performed to assess the prevalence of hypothyroidism in these patients. We included 120 patients (106 male, 14 female) with larynx or pharynx cancer treated more than 2 months earlier (mean = 41 months) in the study. Cancer treatment consisted of either surgery (n = 44), radiotherapy (n = 15), or surgery combined with postoperative radiotherapy (n = 61). In all patients, thyroid function studies (thyrotropin [TSH], free triiodothyronine [FT3], and free thyroxine [FT4]) were performed. Twenty-six of all patients (22%) were hypothyroid; in two patients hypothyroidism was diagnosed postoperatively and these two patients were on replacement therapy with thyroid hormones. The highest rate of hypothyroidism (34%) was present in patients treated with surgery combined with radiotherapy, whereas among patients treated with surgery only 7% were hypothyroid (p < 0.001). There was no difference in the duration of follow-up between therapy and inclusion in the study between those two groups. Two of 15 patients treated only with radiotherapy were diagnosed hypothyroid, but in this group the latency was shorter (p < 0.05). The results indicate that thyroid function studies should be routinely performed in the follow-up of head and neck cancer patients, especially if radiotherapy was part of the treatment.

Positron emission tomography using 18F-fluorodeoxyglucose in advanced stages of malignant melanoma: a comparison of ultrasonographic and radiological methods of diagnosis

The diagnostic and therapeutic impact and the cost-effectiveness of positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) will depend on the role for which the tests are used. In 68 patients with advanced malignant melanoma, original sets of FDG-PET images from various institutes were compared with findings obtained by ultrasonography, conventional radiology, computed tomography (CT) and magnetic resonance imaging. In 22 patients, all examinations were undertaken within 2 weeks and strategies of staging were analysed. In 46 patients, only some of these examinations were performed within this time period, and comparison of methods was restricted to the examined organs. The occurrence of metastasis, without specifying the number of foci, was detected by either conventional staging with CT or by PET in 20 of 22 patients. None of these patients were up- or down-staged by FDG-PET compared with CT staging. In the 68 patients as a whole, FDG-PET detected fewer pulmonary and hepatic metastases and fewer cerebral foci, but more lymph node and bone metastases than conventional radiology or CT. For the detection of lymph node or skeletal metastases, false-positive FDG-PET findings were taken into account when compared with follow-up data. In advanced melanoma, FDG-PET did not influence the pattern of subsequent diagnostic testing. Thus, indications for FDG-PET include pre-metastatic melanoma, localized lymph node metastases and monitoring of the response to treatment.

[Influence of disease prognosis and age on the radiation risk from diagnostic nuclear medicine (bone scintigraphy as an example)]

AIM

Of the study was to assess the influence of the patient age and the survival of patients undergoing bone scintigraphy on the calculations of the theoretical lifetime loss.

PATIENTS AND METHODS

The evaluated data set included 216 patients undergoing a bone scan for the first time in 1980. From 182 patients a study end point (either the date of death, or existing registration in the German resident office on the 31.12.1995) was obtained. The theoretical life time loss was based on the formalism previously presented by Schicha und Wellner (13).

RESULTS

In 74% of the examined patients a malignant disease was present. 28% of the patients had died within one year of the examination. At the end of the follow-up period, of at least 15 years, 58% of the patients were deceased. The theoretical lifetime loss due to radiation exposure within this specified patient group was estimated to be 0.152 d/mSv. Assuming an age distribution of the general population and statistically derived life expectancy, this value should be 0.437 d/mSv.

CONCLUSION

The estimates regarding the risk of diagnostic procedures using ionizing radiation should take into account the limited life expectancy of patients in hospitals.

[Simultaneous occurrence of Graves' ophthalmopathy and autonomous thyroid nodules]

Estimations regarding the simultaneous occurrence of Graves' ophthalmopathy and autonomously functioning thyroid nodules expect frequencies of 0.05-0.2%. Contrary to these estimated numbers, only 3 patients with these simultaneous manifestations were identified in an out patient thyroid clinic within a period of 10 years. The possible protection by the autonomous thyroid nodules against the manifestations of Graves' disease is discussed.

[Magnetic resonance imaging in screening for bone metastasis? A prospective comparison with bone scintigraphy]

To define the value of magnetic resonance imaging (MRI) in screening for bone metastases (BM) compared to bone scintigraphy (BSc) 102 patients with tumours with frequent BM were examined also by MRI of spine, pelvis, femora, and proximal tibiae. All patients had normal BSc and 96 (94%) normal MRI. Only 6% of the patients had focal abnormalities within the bone marrow. This indicates that there is a 94% probability of absence of BM if BSc is normal. Therefore, BSc should currently remain the method of choice for screening for BM. Despite MRI is sensitive and specific, with the common technique up to now it should not be used instead of BSc in screening because of costs, duration, and lack of whole body examination. MRI is a valuable adjunct in equivocal findings in BSc with negative results on radiographs.

Regional 99mTc-methoxyisobutyl-isonitrile-uptake at rest in patients with myocardial infarcts: comparison with morphological and functional parameters obtained from gradient-echo magnetic resonance imaging

It is not yet clear whether 99mTc-methoxyisobutyl-isonitrile (MIBI)-uptake is a reliable indicator of myocardial viability, and a threshold value, differentiating viable from scarred myocardium, in comparison to a morphological and functional standard of reference has not been defined. MIBI-uptake was quantified in 800 segments from 55 patients with angiographically proven coronary artery disease with and without a history of myocardial infarction. Viable myocardium was defined from gradient-echo magnetic resonance images (MRI) as regions with systolic wall thickening or an end-diastolic wall thickness above the mean value -2.5 SD of a healthy control group (n = 21). Scar was defined as end-diastolic wall thickness > 2.5 SD below the normal mean value and absent systolic wall thickening or wall thinning. Mean MIBI-uptake of viable (n = 676; 79 +/- 14%) and scar segments by MRI (n = 124; 31 +/- 16%) was significantly different (P < 0.001). Segmental MIBI-uptake vs end-diastolic wall thickness (r = 0.7) and systolic wall thickening (r = 0.71) yielded a fair correlation. The highest values as regards sensitivity and specificity of MIBI-uptake in predicting the presence of scar were 89% and 96% respectively for MIBI-uptake < or = 50%. However, of the 136 segments with MIBI-uptake < or = 50%, 26 (19%) were viable by MRI, resulting in a positive predictive accuracy for scar tissue of 81%. Of the 26 segments diagnosed as scarred by MIBI-SPECT but viable by MRI, 25 (96%) were located in the inferoseptal region. MIBI-SPECT seems useful in the detection of viable myocardium after anterior myocardial infarcts, but over-estimates scar in the inferoseptal regions. Perfusion defects in these regions could be confirmed or denied by additional evaluation of myocardial morphology and function by MRI or tissue metabolism by positron emission tomography (PET).

[Dobutamine versus dipyridamole magnetic resonance tomography: safety and sensitivity in the detection of coronary stenoses]

Safety and sensitivity of gradient-echo magnetic resonance imaging (MRI) for the identification of significant coronary artery stenoses using pharmacologic stress testing was assessed in 61 patients with > or = 70% stenosis of a major coronary artery and a normal left ventricle. After MRI at rest 28 patients underwent dobutamine-MRI during steady-state dobutamine infusion (5, 10, 15 and 20 micrograms/kg/min) and 33 patients had dipyridamole-MRI after high-dose dipyridamole infusion (0.75 mg/kg over 10 min). All patients additionally performed standard ECG exercise stress testing (EST). Segmental wall motion analysis was performed in basal and midventricular short axis tomograms by two observers. A segment was graded pathologic if transient dobutamine or dipyridamole induced wall motion abnormalities could be detected. For comparison to coronary angiography findings, each segment was assigned to one of the coronary artery perfusion territories. There were no serious side-effects during dobutamine and dipyridamole infusion leading to termination of the study protocol. Peak double product during dobutamine infusion was significantly higher (p < 0.001) than after dipyridamole infusion (18.493 +/- 4.311 versus 12.799 +/- 2.694 mm Hg/min). Overall sensitivity of dobutamine and dipyridamole-MRI for coronary artery disease (CAD) was 85% and 84%. Regional asynergy by dobutamine and dipyridamole-MRI was observed in 73% versus 79% patients with single- and 100% versus 92% with multi-vessel disease. Individual coronary artery stenoses were correctly identified by segmental wall motion abnormalities in 87% versus 81% for left anterior descending, 62% versus 86% for left circumflex and 78% versus 92% for right coronary artery stenoses. In conclusion, dobutamine and dipyridamole-MRI are well tolerated and safe non-exercise dependent tests for detection and localization of hemodynamically significant coronary artery stenoses with a similar diagnostic accuracy but with a better control of stress intensity and duration provided by dobutamine.

Identification of hemodynamically significant coronary artery stenoses by dipyridamole-magnetic resonance imaging and 99mTc-methoxyisobutyl-isonitrile-SPECT

Magnetic resonance imaging (MRI) has been used in conjunction with dipyridamole induced wall motion abnormalities for the noninvasive detection of coronary artery disease (CAD). To assess the clinical usefulness of dipyridamole-MRI for the localization of CAD and to evaluate the relation between dipyridamole induced wall motion abnormalities and myocardial perfusion 33 patients with severe CAD (> 70% diameter reduction) underwent MRI at rest and after dipyridamole infusion (0.75 mg dipyridamole/kg over a period of 10 minutes). All patients performed exercise stress testing and 20 patients of the study group additionally had rest and exercise stress 99mTc-methoxyisobutyl-isonitrile-SPECT (MIBI-SPECT). Two patients (6%) could not be evaluated due to severe motion artifacts during dipyridamole MRI. Segmental wall motion and perfusion of corresponding short axis planes were related to the major coronary arteries using a standardized segmental coronary artery perfusion pattern. Detection of wall motion abnormalities or perfusion defects by 2 blinded observers in consensus was the criterion for grading a segment normal or pathologic. For localization of CAD, segmental gradings were related to the presumed coronary artery territories. Stress-ECG was pathologic in 19/31 patients yielding a sensitivity of 61% and dipyridamole induced angina was present in 68% (21/31) of patients. Dipyridamole-MRI detected coronary artery disease with a sensitivity of 84% (26/31 patients) and all patients with new wall motion abnormalities also had dipyridamole induced angina. For the subgroup of 20 patients with MIBI-SPECT images, CAD was detected by both MIBI-SPECT and Dipyridamole-MRI in 90% (18/20) of patients. Dipyridamole-MRI and MIBI-SPECT gradings agreed in 55/60 (92%) coronary artery perfusion territories. There were no significant differences with respect to the sensitivities of Dipyridamole-MRI/MIBI-SPECT for the localization of individual coronary artery stenoses yielding 81%/78% for left anterior descending, 80%/80% for left circumflex and 92%/89% for right coronary artery stenoses. However, specificity of Dipyridamole-MRI (89%) for the detection of RCA stenoses was slightly better than for MIBI-SPECT (80%).

[Effort-induced myocardial wall motion abnormalities in the magnetic resonance tomogram: a comparison with effort MIBI SPECT]

In 20 patients with an angiographically documented coronary artery stenosis of > or = 70% and normal LV function at rest MRI was performed before and after dipyridamole infusion (0.75 mg/kg BW). In all patients MIBI-SPECT was obtained at rest and after dynamic symptom-limited exercise. In 18 patients MIBI-SPECT showed ischemia and in 18 patients dipyridamole MRI showed a wall motion impairment. In the segments representing the 29 stenosed vessels ischemia in MIBI-SPECT was diagnosed correctly in 24 instances (sensitivity 83%, specificity 90%) and a wall motion abnormality was present in MRI in 23 instances (sensitivity 79%, specificity 90%). Dipyridamole GE-MRI is not superior to MIBI-SPECT in the diagnosis of ischemia.

[Magnetic resonance tomography image of transmural myocardial infarct in comparison with 99mTc-methoxyisobutylisonitrile SPECT]

To assess the ability of magnetic resonance imaging (MRI) to identify morphologic and functional abnormalities associated with transmural anterior and inferior myocardial infarction, 18 patients with anterior myocardial infarcts and 11 patients with inferior myocardial infarcts confirmed by ECG and cine-ventriculography underwent gradient-echo MRI of transverse and short-axis imaging planes. Myocardial perfusion of corresponding imaging planes was measured by 99mTc-methoxyisobutyl-isonitrile single-photon emission computed tomography (MIBI-SPECT). Transmural scar by MRI was defined as diastolic wall thickness 2.5 SD below corresponding normal values of a healthy control group (n = 21). MIBI-SPECT scar was defined as a MIBI uptake less than 2.5 SD below mean values of a healthy control group (n = 11). By MIBI-SPECT, 231 segments contained normal tissue and 161 contained scarred myocardium. In 352/392 (90%) segments gradings based on diastolic wall thickness and MIBI-SPECT gradings were identical. Diastolic wall thickness was significantly higher in normal than in scarred MIBI-SPECT segments (10.3 +/- 1.5 vs 5.2 +/- 2 mm, p less than 0.0001). Additionally, normal segments by MIBI-SPECT showed significantly higher systolic wall thickening than scar segments (5.5 +/- 1.5 vs 0.6 +/- 1.6 mm, p less than 0.0001). The correlation between MRI and MIBI-SPECT assessed infarct size was r = 0.91 for anterior and r = 0.77 for inferior myocardial infarcts. The agreement between MIBI-SPECT perfusion defect size and regions with reduced diastolic wall thickness on MRI tomograms was significantly better for anterior myocardial infarcts than for inferior myocardial infarcts.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assessment with magnetic resonance tomography of anatomy and ventricular function after Mustard correction of transposition of the great arteries]

In order to evaluate postoperative sequelae and ventricular function after Mustard-operation in patients with transposition of the great arteries (TGA), 30 patients were assessed by magnetic resonance imaging in EKG-triggered spin-echo (SE) and gradient-echo (GE) technique. Twenty-three patients, aged 4.7 to 15.8 years, had transposition of the great arteries with intact ventricular septum with or without left-ventricular outflow tract obstruction (TGA+IVS +/- SPS). Seven patients aged 9.5 to 21.7 years had transposition of the great arteries with ventricular septal defect (TGA+VSD). Five patients showed a residual baffle leak, one had a pulmonary venous obstruction, five an obstruction at the caval veins, 13 a left-ventricular outflow tract obstruction, and 14 a tricuspid regurgitation. Right-ventricular enddiastolic volume in patients with TGA+VSD (77.0 +/- 25.5 ml/m2) was significantly higher than in patients with TGA+IVS +/- SPS (61.2 +/- 12.0 ml/m2). In TGA+VSD right-ventricular ejection fraction (47.6 +/- 13.0%) was significantly lower than in patients with TGA+IVS +/- SPS (56.7 +/- 10.7%). The ratio of muscle masses of right to left ventricle was 1.8:1 in patients with TGA+IVS +/- SPS and 2.5:1 in patients with TGA+VSD. In conclusion, after Mustard-operation in patients with transposition of the great arteries (TGA) magnetic resonance imaging provides a comprehensive and noninvasive assessment of postoperative sequelae, residuae, and ventricular function and will, therefore, become the method of choice for postoperative evaluation.

Chronic myocardial infarction: assessment of morphology, function, and perfusion by gradient echo magnetic resonance imaging and 99mTc-methoxyisobutyl-isonitrile SPECT

To assess the ability of magnetic resonance imaging (MRI) to identify the anatomic and functional abnormalities associated with completely scarred myocardium, 20 patients with chronic transmural myocardial infarction confirmed by electrocardiography and cineventriculography were examined by gradient echo MRI. Myocardial perfusion at rest was assessed in corresponding transverse sections using 99mTc-methoxyisobutyl-isonitrile single-photon emission computed tomography (MIBI-SPECT). MRI scar was defined as diastolic wall thickness (DWT) 2.5 SD below corresponding normal values or systolic wall thickening (delta WT) less than or equal to 1 mm. For MIBI-SPECT images, scar was defined as a MIBI uptake less than 2.5 SD below normal values. By MIBI-SPECT, 152 segments contained normal tissue and 88 contained scarred myocardium. In 226 of 240 (94%) segments, MRI gradings by DWT and MIBI-SPECT gradings were identical. DWT by MRI was higher in normal than in scarred MIBI-SPECT segments (10 +/- 1 versus 4 +/- 2 mm, p less than 0.001). In 230 of 240 (96%) segments, MRI gradings by delta WT and MIBI-SPECT gradings were identical. Segments graded normal by MIBI-SPECT showed higher delta WT by MRI than scar segments (5 +/- 1 versus 0.3 +/- 1 mm, p less than 0.001). MIBI-SPECT perfusion defect size and regions with reduced DWT on MRI tomograms correlated well (r = 0.85). This study indicates that myocardial regions fulfilling electrocardiographic and ventriculographic criteria for transmural myocardial scar are clearly depicted by regional diastolic wall thinning and delta WT less than or equal to 1 mm on gradient echo MR images.(ABSTRACT TRUNCATED AT 250 WORDS)

Feasibility of high-dose dipyridamole-magnetic resonance imaging for detection of coronary artery disease and comparison with coronary angiography

To assess the feasibility, safety and usefulness of gradient-echo magnetic resonance imaging (MRI) combined with pharmacologic stress testing for the detection of coronary artery disease, 23 patients without previous myocardial infarction but with significant stenosis (greater than 70% diameter stenosis) of greater than or equal to 1 major coronary artery were selected for dipyridamole-MRI stress testing. Each patient underwent MRI at rest, and high-dose dipyridamole-MRI (0.75 mg/kg over 10 minutes) of corresponding basal and midventricular short-axis tomograms. Additionally, these patients performed symptom-limited exercise stress tests. All short-axis tomograms were evaluated on a standardized segmental basis by grading each segment as normal, hypokinetic, akinetic or dyskinetic. Dipyridamole-MRI was considered pathologic if segmental wall motion deteriorated by greater than or equal to 1 grade after dipyridamole. For comparison with coronary angiography, segmental wall motion gradings were related to the respective coronary artery territories in the short-axis plane. Pathologic dipyridamole-MRI was obtained in 18 of 23 (78%) patients. For 1- and 2-vessel diseases, sensitivity was 69 and 90%, respectively. Exercise stress tests were pathologic in 14 of 23 (66%) patients. For 1- and 2-vessel diseases, sensitivity of exercise stress test was 58% (7 of 12 patients) and 77% (7 of 9), respectively. Sensitivity/specificity of dipyridamole-MRI for the localization of the stenosed coronary artery was 78/100% for left anterior descending, 73/100% for left circumflex, and 88/87% for right coronary artery stenoses. It is concluded that dipyridamole-MRI is a feasible nonexercise-dependent test for detection and localization of functionally significant coronary artery disease.

[Retrosternal lymph node metastases in breast cancer: lymphoscintigraphy and magnetic resonance tomography]

In 21 patients with breast cancer (pT1-4, N0, M0) internal mammary lymphoscintigraphy and magnetic resonance imaging (MRI) were performed to evaluate retrosternal lymph node metastases. In 6 patients normal findings of lymphoscintigraphy were confirmed by MRI. In the 15 patients with focal defects seen by lymphoscintigraphy no lymph nodes were found by MRI in 5 in the corresponding area, 5 showed normal-sized lymph nodes (less than 1 cm) and 5 enlarged lymph nodes indicating metastatic infiltration. In addition to internal mammary lymphoscintigraphy MRI may offer the possibility to improve TNM staging in patients with breast cancer.

[The early diagnosis of Perthes disease: the value of bone scintigraphy and magnetic resonance imaging in comparison with x-ray findings]

The value of conventional radiology, bone scintigraphy and magnetic resonance imaging (MRI) in the early diagnosis of Legg-Calvé-Perthes disease (LCPD) was assessed. The initial results were compared with the clinical and radiological findings of long-term follow-up in 43 children. Radiological and scintigraphic examination resulted in a relatively high number of equivocal findings (16% and 10%, respectively). MRI findings were less equivocal (3%). Depending on whether such findings were classified as normal or as pathological, the diagnostic accuracy ranged as follows: radiography 88-93%, bone scintigraphy 88-91%, and MRI 97-99%. Therefore, MRI by itself seems to be sufficient to detect or exclude LCPD. The results of this study and the radiation exposure associated with radiography and scintigraphy raise the question whether MRI should be the diagnostic method of choice in patients with suspected LCPD.

[Bone marrow changes in patients with thyroid carcinoma]

In 62 patients with thyroid carcinoma 79 MRI bone marrow examinations and 48 bone marrow scintigraphies were recorded before or following radioiodine therapy, to study the extent of bone marrow expansion. The results of both methods were the same. In 34/79 investigations normal findings were seen, in 18 the bone marrow expanded to the middle third and in 26 to the distal third of the femur. One patient showed bone marrow expansion to the tibia. These results were compared with the following data: histology of tumor, TNM-staging, time passed since thyroidectomy, accumulated doses of radioiodine therapy, results of 131I scintigraphy, hematological changes, thyroglobulin level, age and sex. No significant correlations were found between these and the bone marrow imaging results. Bone marrow changes in patients before radioiodine therapy were similar to those in patients treated with up to 48 GBq 131I. Blind biopsy of the posterior iliac crest in five patients showed slightly pathological reactive changes. In only 2/17 follow-up studies an increase of bone marrow expansion was seen. In 8 patients localized findings indicating malignant infiltration were observed. In 4/8 patients metastases of thyroid carcinoma were known or confirmed by pathological radioiodine uptake and in 2/8 metastatic involvement was assumed because of an increased thyroglobulin level.

Magnetic resonance imaging of cardiac function and morphology in patients with transposition of the great arteries following Mustard procedure

In order to assess the diagnostic possibilities of magnetic resonance imaging (MRI), 30 children (mean age 11.5 years) with d-transposition of the great arteries (TGA) corrected by the Mustard procedure were studied. Patient values were compared to those of 10 healthy volunteers. The most important postoperative abnormalities such as baffle leaks, systemic or pulmonary venous obstructions, left ventricular outflow tract (LVOT) stenosis and tricuspid regurgitation were assessed. Cardiac volumes and muscle mass were measured. Baffle leaks were found in 5 and obstruction of the baffle limbs in 6 patients. On gradient echo images 13 patients showed signs of LVOT stenosis and 12 tricuspid incompetence. Right ventricular end diastolic volumes in patients were significantly higher than the left ventricular volumes, but slightly lower than right ventricular volumes in the normals. In patients with TGA and ventricular septal defect (VSD) (n = 7) right ventricular (RV) volumes were found to be higher than in patients with intact ventricular septum (n = 23) and in normals. In contrast to the normal RV function of patients after Mustard surgery only patients with previous VSD showed a diminished RV ejection fraction. The muscular mass in TGA patients showed a ratio of 1.9:1 between right and left ventricles. In normals the ratio was 1:1.5. Magnetic resonance imaging allows a quantitative insight into the ventricular function and the morphology of the heart after inflow correction. Thus, it supplements the noninvasive evaluation of TGA patients.

[Diagnosis and classification of tricuspid valve insufficiency with dynamic magnetic resonance tomography: comparison with right ventricular angiography]

To evaluate the diagnostic potential of magnetic resonance imaging (MRI) to diagnose and evaluate tricuspid incompetence (TI), right ventricular angiography (RVA) and MRI were compared in 51 patients. For angiographic semi-quantification a 4-grade modified Sellers classification was used. Several MRI-parameters (jet volume, jet area, number of slices with visible jet, duration of the regurgitation and volume of the right atrium) were examined concerning their validity to evaluate TI and compared to the angiographic data. Limits for MRI jet areas and volumes for each angiographic group were defined to obtain the best agreement with angiographic results. Thirty of 34 patients with angiographically visible TI (sensitivity = 88%) were diagnosed correctly with MRI. The 4 remaining patients also showed a small regurgitant jet which was, however, interpreted as physiologic. One of the 17 patients without angiographic TI was diagnosed as mild TI by MRI (specificity = 94%). MRI classification using jet volume (46/51 = 90% correct classifications) was not significantly better than the easier and faster MRI classification using jet area (43/51 = 84%). The other parameters (number of slices, duration of regurgitation and volume of the right atrium) showed considerable overlap between angiographic groups and did therefore not allow a classification into 4 grades. However, simple classification into hemodynamic relevant and irrelevant TI was possible. Thus MRI is able to diagnose TI with good sensitivity and specificity. Classifications based on jet volume and jet area showed good agreement with angiographic results. However, both parameters depend on the magnet and the pulse sequence used and must therefore be specifically determined for each imaging routine.