Diffusion tensor imaging of oral carcinoma: Clinical evaluation and comparison with histopathological findings

PurposeThis study aims to assess the usefulness of diffusion tensor imaging (DTI) as a noninvasive method for the evaluation of histological grade and lymph node metastasis in patients with oral carcinoma (OC).Materials and methodsThirty-six consecutive patients with histologically confirmed OC underwent examination by 3-T MRI. DTI was performed using a single-shot echo-planar imaging sequence with b values of 0 and 1000 s/mm² and motion-probing gradients in 12 noncollinear directions. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) maps were compared with histopathological findings. The DTI parameters were correlated with the histological grade of the OCs based on the World Health Organization grading criteria and the presence or absence of lymph node metastasis.ResultsThe FA values (0.275 ± 0.058) of OC were significantly lower than those of normal tongue, muscle, and parotid glands (P < 0.001 for all), and the MD, AD, and RD values (1.220 ± 0.149, 1.434 ± 0.172, and 1.019 ± 0.165 × 10⁻³ mm²/s, respectively) were significantly higher than their respective normal values (P < 0.001 for all). Significant inverse correlations with histological grades were shown for FA, MD, AD, and RD values in OC patients (r = −0.862, r = −0.797, r = −0.747, and r = −0.844, respectively; P < 0.001 for all). In addition, there was a significant difference in the FA values of metastatic and nonmetastatic lymph nodes (0.186 vs. 0.276), MD (0.923 vs. 1.242 × 10⁻³ mm²/s), AD (1.246 vs. 1.621 × 10⁻³ mm²/s), and RD (0.792 vs. 1.100 × 10⁻³ mm²/s; P < 0.001 for all).ConclusionsDTI may be clinically useful for the noninvasive evaluation of histological grade and lymph node metastasis in OC patients.     

Region-Specific Susceptibilities to Cuprizone-Induced Demyelination of C57BL/6 Mouse: In vivo T2WI and DTI Studies at 7.0T

The cuprizone (CPZ) mouse model of demyelination was recognized and used to explore multiple sclerosis (MS)-like brain lesions. In this study, we assessed CPZ-treated mice using T₂-weighted imaging and diffusion tensor imaging (DTI). C57BL/6 mice treated with 2 weeks of 0.2 % CPZ-containing diet (n = 10) and regular chow diet (n = 10) were scanned with a 7.0 T MRI scanner (Agilent, USA), respectively, using fast spin-echo and fast spin-echo DTI sequences. The normalized T₂ signal intensity (normalized to the cerebrospinal fluid) was calculated and fractional anisotropy (FA value), mean diffusivity, axial diffusivity and radial diffusivity were measured in the brain region of the cerebral cortex (CTX), caudate putamen (CP), hippocampus (HP) and thalamus (TH). Compared with controls, increased normalized T₂ signal intensities and reduced FA values (p < 0.05) were observed in the CTX, HP and CP (p < 0.01), but not in TH in cuprizone-fed mice. In the regions of reduced FA values, an increase in mean diffusivity (p < 0.05) and radial diffusivity (p < 0.05) was also found. Significant decreased axial diffusivity was only observed in CTX (p < 0.05). DTI is sensitive to detecting cuprizone-induced demyelination of C57BL/6 mice. This study suggests that CTX, HP and CP are more susceptible to cuprizone-induced demyelination than TH. Our results also indicate that the decrease of FA value may be more likely due to increased radial diffusivity.     

Assessment of renal fibrosis in a rat model of unilateral ureteral obstruction with diffusion kurtosis imaging: Comparison with α-SMA expression and 18F-FDG PET

PurposeTo investigate the utility of diffusion kurtosis imaging (DKI) MRI for evaluation of renal fibrosis in rats with unilateral ureteral obstruction (UUO).MethodsTwenty-five rats had UUO, and ten rats were subjected to sham operation as control. DKI was performed on a 3.0 T MRI scanner on days 1, 3, 5, and 7 after ligation. All rats then underwent ¹⁸F-FDG dynamic PET to evaluate unilateral renal function, followed by histological analysis to examine α-smooth muscle actin (α-SMA) expression. DKI metrics were assessed among the time points and between two sides, and compared with maximum standardized uptake value (SUV_max), serum levels of creatinine and urea, and fibrosis marker α-SMA.ResultsMean kurtosis (MK) on day 7, axial kurtosis (Ka) on days 3 and 7, mean diffusivity (MD) on days 1, 3, 5, and 7, and fractional anisotropy (FA) on days 3, 5, and 7 of cortex and medulla between the UUO and contralateral sides were significantly different (all p < 0.05). Over the course of UUO progression, there were significant changes in Ka, MD and FA of medulla (all p < 0.05). FA of medulla was positively correlated with SUV_max (r = 0.641, p < 0.001), and MD of cortex was negatively correlated with urea (r = −0.534, p = 0.001). MD of cortex was negatively correlated with α-SMA on UUO sides (r = −0.710, p < 0.001).ConclusionsDKI shows the potential for noninvasive assessment of renal fibrosis and unilateral renal function induced by UUO.     

Diffusion Tensor Magnetic Resonance Imaging in Ring-Enhancing Cerebral Lesions

The objective of this study is to determine differential diagnostic value of diffusion tensor imaging (DTI) in high-grade brain astrocytomas, brain solitary metastases and brain abscesses. 53 patients with cerebral solitary lesions which showed ring enhancement on contrast-enhanced T ₁-weighted images were enrolled in this study. Brain tissues were examined pathologically from 49 patients to confirm the cerebral occupational diseases. Four patients have been diagnosed with primary cancer plus brain solitary metastasis. DTI measurements were obtained from regions of interest placed on central cavity, white matter of the immediate peritumoral region (IPR) and cerebral white matter of the normal side. The cavity of high-grade astrocytoma and brain metastases displayed hypointense signals; most of the brain abscess cavities displayed high signal intensity except for one case with uneven signal intensity. Mean diffusivity (MD) and fractional anisotropy (FA) values could be used for differentiation between tumor and abscess in brain. The brain abscess cavities showed restricted diffusion and anisotropy [MD = (0.604 ± 0.13) × 10⁻³ mm²/s, FA = 0.185 ± 0.03], whereas the central portion of high-grade astrocytoma [MD = (2.76 ± 0.26) × 10⁻³ mm²/s, FA = 0.069 ± 0.02] and solitary brain metastases [MD = (2.82 ± 0.29) × 10⁻³ mm²/s, FA = 0.064 ± 0.02] showed unrestricted diffusion and isotropy. Brain abscess could be differentiated by MD and FA values in their cavities from brain tumors (P < 0.01). The IPRs were all depicted as hyperintense or isointense signals on diffusion-weighted imaging. The difference between FA values in the IPR of high-grade brain astrocytomas and other groups was statistically significant (P < 0.01). In conclusion, our results suggested the potential role of the cavity MD and FA values in the differential diagnoses of brain tumors and brain abscesses; meanwhile, high-grade astrocytomas could be distinguished from solitary metastases and abscesses by evaluating their corresponding FA values in the IPR on brain magnetic resonance imaging (MRI). Combined with conventional MRI, DTI may help radiologists to facilitate the differential diagnosis of ring-enhancing cerebral lesions in clinical practice.     

Diffusion tensor magnetic resonance imaging of the normal breast

Purpose

The objective of this study was to evaluate diffusion anisotropy of the breast parenchyma and assess the range and repeatability of diffusion tensor imaging (DTI) parameters in normal breast tissue.

Materials and Methods

The study was approved by our institutional review board and included 12 healthy females (median age, 36 years). Diffusion tensor imaging was performed at 1.5 T using a diffusion-weighted echo planar imaging sequence. Diffusion tensor imaging parameters including tensor eigenvalues (λ₁, λ₂, λ₃), fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured for anterior, central and posterior breast regions.

Results

Mean normal breast DTI measures were λ₁=2.51×10⁻³ mm²/s, λ₂=1.89×10⁻³ mm²/s, λ₃=1.39×10⁻³ mm²/s, ADC=1.95±0.24×10⁻³ mm²/s and FA=0.29±0.05 for b=600 s/mm². Significant regional differences were observed for both FA and ADC (P<.05), with higher ADC in the central breast and higher FA in the posterior breast. Comparison of DTI values calculated using b=0, 600 s/mm² vs. b=0, 1000 s/mm², showed significant differences in ADC (P<.001), but not FA. Repeatability assessment produced within-subject coefficient of variations of 4.5% for ADC and 11.4% for FA measures.

Conclusion

This study demonstrates anisotropy of water diffusion in normal breast tissue and establishes a normative range of breast FA values. Attention to the influence of breast region and b value on breast DTI measurements may be important for clinical interpretation and standardization of techniques.     

Correlation between spinal cord diffusion tensor imaging and postural response latencies in persons with multiple sclerosis: A pilot study

PurposeLonger latency of postural response in multiple sclerosis (MS) may be linked to imbalance and increased likelihood of falls. It may be caused by the compromised microstructural integrity in the spinal cord, as evidenced by slowed somatosensory conduction in the spinal cord. Thus, the purpose of this study is to investigate the correlation between latency of postural responses and microstructural integrity of the cervical spinal cord, the region particularly related to the disease severity in MS, using diffusion tensor imaging (DTI) metrics.MethodsSeventeen persons with MS with mild-to-moderate disease severity were enrolled in this study. Postural response latencies of each patient were measured using electromyography of the tibialis anterior muscle (TA) and gastrocnemius muscle (GN) in response to surface perturbations. Cervical spinal cord DTI images were obtained from each patient. DTI mean, radial, axial diffusivity, and fractional anisotropy (FA) were measured between segments C4 and C6. Correlations of DTI metrics with postural response latencies, expanded disability status scale (EDSS) scores, and 25-foot walk (T25FW) were assessed using the Spearman's rank correlation coefficient at α = 0.05.ResultsLower FA was significantly correlated with longer latencies measured on right TA in response to forward postural perturbations (r = −0.51, p = .04). DTI metrics showed no significant correlations with EDSS scores (r = −0.06–0.09, p = .73–0.95) or T25FW (r = −0.1–0.14, p = .6–0.94). DTI metrics showed no significant differences between subjects with and without spinal cord lesions (p = .2–0.7).ConclusionsOur results showed a significant correlation between lower FA in the cervical spinal cord and longer latencies measured on right TA in response to forward postural perturbations in persons with MS, suggesting that impaired cervical spinal cord microstructure assessed by DTI may be associated with the delayed postural responses.     

DTI at 7 and 3 T: systematic comparison of SNR and its influence on quantitative metrics

Diffusion tensor imaging (DTI) and advanced related methods such as diffusion spectrum and kurtosis imaging are limited by low signal-to-noise ratio (SNR) at conventional field strengths. DTI at 7 T can provide increased SNR; however, B0 and B1 inhomogeneity and shorter T2? still pose formidable challenges. The purpose of this study was to quantify and compare SNR at 7 and 3 T for different parallel imaging reduction factors, R, and TE, and to evaluate SNRs influences on fractional anisotropy (FA) and apparent diffusion coefficient (ADC). We found that R>4 at 7 T and R≥2 at 3 T were needed to reduce geometric distortions due to B0 inhomogeneity. For these R at 7 T, SNR was 70-90 for b=0 s/mm² and 22-28 for b=1000s/mm² in central brain regions. SNR was lower at 3 T (40 for b=0 s/mm² and 15 for b=1000 s/mm²) and in lateral brain regions at 7 T due to B1 inhomogeneity. FA and ADC did not change with MRI field strength, SENSE factor or TE in the tested range. However, the coefficient of variation for FA increased for SNR <15 and for SNR <10 in ADC, consistent with published theoretical studies. Our study demonstrates that 7 T is advantageous for DTI and lays the groundwork for further development. Foremost, future work should further address challenges with B0 and B1 inhomogeneity to take full advantage for the increased SNR at 7 T.     

Voxelwise analysis of diffusion MRI of cervical spinal cord using tract-based spatial statistics

Robust voxelwise analysis using tract-based spatial statistics (TBSS) together with permutation statistical method is standardly used in analyzing diffusion tensor imaging (DTI) of brain. A similar analytical method could be useful when studying DTI of cervical spinal cord.Based on anatomical data of sixty-four healthy volunteers, white (WM) and gray matter (GM) masks were created and subsequently registered into DTI space. Using TBSS, two skeleton types were created (single line and dilated for WM as well as GM). From anatomical data, percentage rates of overlap were calculated for all skeletons in relation to WM and GM masks.Voxelwise analysis of fractional anisotropy values depending on age and sex was conducted. Correlation of fraction anisotropy values with age of subjects was also evaluated. The two WM skeleton types showed a high overlap rate with WM masks (~94%); GM skeletons showed lower rates (56% and 42%, respectively, for single line and dilated). WM and GM areas where fraction anisotropy values differ between sexes were identified (p < .05). Furthermore, using voxelwise analysis such WM voxels were identified where fraction anisotropy values differ depending on age (p < .05) and in these voxels linear dependence of fraction anisotropy and age (r = −0.57, p < .001) was confirmed by regression analysis. This dependence was not proven when using WM anatomical masks (r = −0.21, p = .10).The analytical approach presented shown to be useful for group analysis of DTI data for cervical spinal cord.     

High spatial and angular resolution diffusion-weighted imaging reveals forniceal damage related to memory impairment

Introduction

Diffusion tensor imaging (DTI) measures in patients with multiple sclerosis (MS), particularly those measures associated with a specific white matter pathway, have consistently shown correlations with function. This study sought to investigate correlations between DTI measures in the fornix and common cognitive deficits in MS patients, including episodic memory, working memory and attention.

Materials and Methods

Patients with MS and group age- and sex-matched controls underwent high-resolution diffusion scanning (1-mm isotropic voxels) and cognitive testing. Manually drawn forniceal regions of interest were applied to individual maps of tensor-derived measures, and mean values of transverse diffusivity (TD), mean diffusivity (MD), longitudinal diffusivity (LD) and fractional anisotropy (FA) were calculated.

Results

In 40 patients with MS [mean age±S.D.= 42.55±9.1 years; Expanded Disability Status Scale (EDSS)=2.0±1.2; Multiple Sclerosis Functional Composite (MSFC) score=0.38±0.46] and 20 healthy controls (mean age±S.D.= 41.35±9.7 years; EDSS=0.0±0; MSFC score=0.74±0.24), we found that FA, MD and TD values in the fornix were significantly different between groups (P< .03), and patient performance on the Brief Visuospatial Memory Test-Revised (BVMT-R) was correlated with DTI measures (P< .03).

Discussion

These results are consistent with findings of axonal degeneration in MS and support the use of DTI as an indicator of disease progression.     

Role of diffusion tensor imaging metrics and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of cystic intracranial mass lesions

The purpose of this study was to determine whether proton magnetic resonance spectroscopy (PMRS) and diffusion tensor imaging (DTI) indices, fractional anisotropy (FA) and mean diffusivity (MD) can be used to distinguish brain abscess from cystic brain tumors, which are difficult to distinguish by conventional magnetic resonance imaging (MRI). Fifty-three patients with intracranial cystic mass lesions and 10 normal controls were studied. Conventional MRI, PMRS and DTI of all the patients were performed on a 1.5-T GE scanner. Forty patients were with brain abscess and 13 with cystic tumors. Cytosolic amino acids (AAs) were present in 32 of 40 brain abscess patients. Out of 13 patients with cystic tumors, lactate and choline were seen in 3 and only lactate was present in 10 patients on PMRS. All 40 cases of abscess had high FA, while all 13 cases of tumor cysts had high MD values. We conclude that FA measurements are more sensitive in predicting the abscess, while PMRS and MD are more specific in differentiating abscess from cystic tumors. We suggest that PMRS should be combined with DTI rather than with diffusion-weighted imaging as FA can be used as an additional parameter for separation of abscess from other cystic intracranial mass lesions.     

White matter maturation in the brains of Long Evans shaker myelin mutant rats by ex-vivo QSI and DTI

The brains of Long Evans shaker (les) rats, a model of dysmyelination, and their age- matched controls were studied by ex-vivo q-space diffusion imaging (QSI) and diffusion tensor imaging (DTI). The QSI and DTI indices were computed from the same acquisition. The les and the control brains were studied at different stages of maturation and disease progression. The mean displacement, the probability for zero displacement and kurtosis were computed from QSI data while the fractional anisotropy (FA) and the eigenvalues were computed from DTI. It was found that all QSI indices detect the les pathology, at all stages of maturation, while only some of the DTI indices could detect the les pathology. The QSI mean displacement was larger in the les group as compared with their age-matched controls while the probability for zero displacement and the kurtosis were both lower all indicating higher degree of restriction in the control brains. Since all the DTI eigenvalues were higher in the les brains as compared to controls, the less efficient DTI measure for discerning the les pathology was found to be the FA. Clearly, the most sensitive DTI parameter to the les pathology is λ₃, i.e. the minimal diffusivity. Since the QSI and DTI data were obtained from the same acquisition, despite the somewhat higher SNR of the QSI data compared to the DTI data, it seems that the higher diagnostic capacity of the QSI data in this experimental model of dysmyelination, originates mainly from the higher diffusing weighting of the QSI data.     

Subject-specific changes in brain white matter on diffusion tensor imaging after sports-related concussion

Background and Purpose

Current approaches to diffusion tensor imaging (DTI) analysis do not permit identification of individual-level changes in DTI indices. We investigated the ability of wild bootstrapping analysis to detect subject-specific changes in brain white matter (WM) before and after sports-related concussion.

Materials and Methods

A prospective cohort study was performed in nine high school athletes engaged in hockey or football and six controls. Subjects underwent DTI pre- and postseason within a 3-month interval. One athlete was diagnosed with concussion (scanned within 72 h), and eight suffered between 26 and 399 subconcussive head blows. Fractional anisotropy (FA) and mean diffusivity (MD) were measured in each WM voxel. Bootstrap samples were generated, and a permuted t test was used to compare voxel-wise FA/MD changes in each subject pre- vs. postseason.

Results

The percentage of WM voxels with significant (p<.05) pre–post FA changes was highest for the concussion subject (3.2%), intermediary for those with subconcussive head blows (mean 1.05%±.15%) and lowest for controls (mean 0.28%±.01%). Similarly, the percentage of WM voxels with significant MD changes was highest for the concussion subject (3.44%), intermediary for those with subconcussive head blows (mean 1.48%±.17%) and lowest for controls (mean 0.48%±.05%). Significantly changed FA and MD voxels colocalized in the concussion subject to the right corona radiata and right inferior longitudinal fasciculus.

Conclusions

Wild bootstrap analysis detected significantly changed WM in a single concussed athlete. Athletes with multiple subconcussive head blows had significant changes in a percentage of their WM that was over three times higher than controls. Efforts to understand the significance of these WM changes and their relationship to head impact forces appear warranted.     

Diffusion abnormality in the posterior cingulum and hippocampal volume: correlation with disease progression in Alzheimer's disease

The purpose of this study was to determine correlations among disease progression, diffusion abnormalities in the posterior cingulum and hippocampal volume in patients with Alzheimer's disease (AD). We studied 25 AD patients by neuropsychological testing, including the Mini-Mental State Examination (MMSE), and by magnetic resonance imaging, including diffusion tensor imaging (DTI) and high-resolution three-dimensional T1-weighted imaging. The MMSE score was used as an indicator of disease progression. Diffusion tensor tractography of the posterior cingulum was generated from the DTI; mean diffusivity (MD) and fractional anisotropy (FA) were measured in co-registered voxels along the posterior cingulum. Hippocampal volume was measured using automated voxel-based morphometry. The relationships among MMSE score, hippocampal volume and MD and FA of the posterior cingulum were evaluated by bivariate correlation analysis. MD in the posterior cingulum correlated significantly with the MMSE score. No significant correlation was seen between FA and MMSE score and between hippocampal volume and MMSE score, FA or MD. Our results suggest that MD in the posterior cingulum is a more sensitive indicator of progression of AD than FA of the posterior cingulum and hippocampal volume.     

Keyhole and zero-padding approaches for reduced-encoding diffusion tensor imaging of the mouse brains

Keyhole diffusion tensor imaging (keyhole DTI) was previously proposed in cardiac imaging to reconstruct DTI maps from the reduced phase-encoding images. To evaluate the feasibility of keyhole DTI in brain imaging, keyhole and zero-padding DTI algorithms were employed on in vivo mouse brain. The reduced phase-encoding portion, also termed as the sharing rate, was varied from 50% to 90% of the full k-space. Our data showed that zero-padding DTI resulted in decreased fractional anisotropy (FA) and decreased mean apparent diffusion coefficient (mean ADC) in white matter (WM) regions. Keyhole DTI showed a better edge preservation on mean ADC maps but not on FA maps as compared to the zero-padding DTI. When increasing the sharing rate in keyhole approach, an underestimation of FA and an over- or underestimation of mean ADC were measured in WM depending on the selected reference image. The inconsistency of keyhole DTI may add a challenge for the wide use of this modality. However, with a carefully selected directive diffusion-weighted image to serve as the reference image in the keyhole approach, this study demonstrated that one may obtain DTI indices of reduced-encoding images with high consistency to those derived with full k-space DTI.     

Diffusion tensor imaging of the cervical spinal cord of patients with Neuromyelitis Optica

BackgroundPrevious studies have demonstrated a correlation between Expanded Disability Status Scale (EDSS) and Diffusion Tensor Imaging (DTI) metrics, but the conclusions were based on evaluations of the entire cervical spinal cord.ObjectivesThe purpose of this study was to quantify the FA and MD values in the spinal cord of NMO patients, separating the lesion sites from the preserved sites, which has not been previously preformed. In addition, we attempted to identify a correlation with EDSS.MethodsDTI was performed in 11 NMO patients and 11 healthy individuals using a 1.5-T MRI scanner. We measured the FA and MD at ROIs positioned along the cervical spinal cord. The mean values of FA and MD at lesion, preserved and spinal cord sites were compared with those of a control group. We tested the correlations between the mean FA and MD with EDSS.ResultsFA in NMO patients was significantly reduced in lesion sites (0.44 vs. 0.55, p = 0.0046), preserved sites (0.46 vs. 0.55, p = 0.0015), and all sites (0.45 vs 0.55, p = 0.0013) while MD increased only in lesion sites (1.03 × 10^− 3 mm²/s vs. 0.90 × 10^− 3 mm²/s, p = 0.009). The FA demonstrated the best correlation with EDSS (r = − 0.7603, p = 0.0086), particularly at lesion sites.ConclusionsThe results reinforce the importance of the FA index and confirm the hypothesis that NMO is a diffuse disease.     

R1ρ at high spin-lock frequency could be a complementary imaging biomarker for liver iron overload quantification

PurposeTo compare the correlations among the R1ρ, R2, and R2* relaxation rates with liver iron concentration (LIC) in the assessment of rat liver iron content and explore the application potential of R1ρ in assessing liver iron content.MethodsIron dextran (dosage of 0, 25, 50, 100, and 200 mg/kg body weight) was injected into 35 male rats to increase the amount of iron storage in the liver. After one week, all rats were euthanized with isoflurane. A portion of the largest hepatic lobe was extracted to quantify the LIC by inductively coupled plasma, and the remaining liver tissue was stored in 4% buffered paraformaldehyde for 24 h before MRI. Spin-lock preparation with a RARE (rapid acquisition with relaxation enhancement) readout (9 different spin-lock times and 7 different spin-lock frequencies (FSLs)) and multi-echo UTE (ultrashort TE) pulses were developed to quantify R1ρ and R2 * on a Bruker 11.7 T MR system. For comparisons with R1ρ and R2*, R2 was acquired using the CPMG sequence.ResultsMean R1ρ values displayed dispersion, with decrease in R1ρ at higher FSLs. Spearman's correlation analysis (two-tailed) indicated that the R1ρ values were significantly associated with LIC at FSL = 2000, 2500, and 3000 Hz (r = 0.365 and P = 0.031, r = 0.608 and P < 0.001, and r = 0.764 and P < 0.001, respectively), and were not significantly associated with LIC at FSL = 500, 1000, 1250, and 1500 Hz (all P > 0.05). R2 and R2* showed significant linear correlations with LIC (r = 0.787 and P < 0.001, and r = 0.859 and P < 0.001, respectively). Correlation analysis across R1ρ, R2, and R* also suggested that the correlation strength between R1ρ and R2 and between R1ρ and R* showed an increasing trend with increase in FSL.ConclusionIn this study, a strong association was observed between R1ρ and LIC at high FSLs further confirming previous findings. The results demonstrated that R1ρ at high FSL might serve as a complementary imaging biomarker for liver iron overload quantification.     

Elevations of diffusion anisotropy are associated with hyper-acute stroke: a serial imaging study

Diffusion tensor imaging (DTI) studies of human ischemic stroke within 24 h of symptom onset have reported variable findings of changes in diffusion anisotropy. Serial DTI within 24 h may clarify these heterogeneous results. We characterized longitudinal changes of diffusion anisotropy by analyzing discrete ischemic white matter (WM) and gray matter (GM) regions during the hyperacute (2.5-7 h) and acute (21.5-29 h) scanning phases of ischemic stroke onset in 13 patients. Mean diffusivity (MD), fractional anisotropy (FA) and T2-weighted signal intensity were measured for deep and subcortical WM and deep and cortical GM areas in lesions outlined by a > or =30% decrease in MD. Average reductions of approximately 40% in relative (r) MD were observed in all four brain regions during both the hyperacute and acute phases post stroke. Overall, 9 of 13 patients within 7 h post symptom onset showed elevated FA in at least one of the four tissues, and within the same cohort, 11 of 13 patients showed reduced FA in at least one of the ischemic WM and GM regions at 21.5-29 h after stroke. The fractional anisotropy in the lesion relative to the contralateral side (rFA, mean+/-S.D.) was significantly elevated in some patients in the deep WM (1.10+/-0.11, n=4), subcortical WM (1.13+/-0.14, n=4), deep GM (1.07+/-0.06, n=1) and cortical GM (1.22+/-0.13, n=5) hyperacutely (< or =7 h); however, reductions of rFA at approximately 24 h post stroke were more consistent (rFA= 0.85+/-0.12).     

Reproducibility and biases in high field brain diffusion MRI: An evaluation of acquisition and analysis variables

Diffusion tensor imaging (DTI) of in-vivo human brain provides insights into white matter anatomical connectivity, but little is known about measurement difference biases and reliability of data obtained with last generation high field scanners (> 3 T) as function of MRI acquisition and analyses variables. Here we assess the impact of acquisition (voxel size: 1.8 × 1.8 × 1.8, 2 × 2 × 2 and 2.5 × 2.5 × 2.5 mm³, b-value: 700, 1000 and 1300 s/mm²) and analysis variables (within-session averaging and co-registration methods) on biases and test-retest reproducibility of some common tensor derived quantities like fractional anisotropy (FA), mean diffusivity (MD), axial and radial diffusivity in a group of healthy subjects at 4 T in three regions: arcuate fasciculus, corpus callosum and cingulum. Averaging effects are also evaluated on a full-brain voxel based approach. The main results are: i) group FA and MD reproducibility errors across scan sessions are on average double of those found in within-session repetitions (≈ 1.3 %), regardless of acquisition protocol and region; ii) within-session averaging of two DTI acquisitions does not improve reproducibility of any of the quantities across sessions at the group level, regardless of acquisition protocol; iii) increasing voxel size biased MD, axial and radial diffusivities to higher values and FA to lower values; iv) increasing b-value biased all quantities to lower values, axial diffusivity showing the strongest effects; v) the two co-registration methods evaluated gave similar bias and reproducibility results. Altogether these results show that reproducibility of FA and MD is comparable to that found at lower fields, not significantly dependent on pre-processing and acquisition protocol manipulations, but that the specific choice of acquisition parameters can significantly bias the group measures of FA, MD, axial and radial diffusivities.     

Multiple sclerosis: Benefits of q-space imaging in evaluation of normal-appearing and periplaque white matter

Introduction

Diffusion tensor imaging (DTI) reveals white matter pathology in patients with multiple sclerosis (MS). A recent non-Gaussian diffusion imaging technique, q-space imaging (QSI), may provide several advantages over conventional MRI techniques in regard to in vivo evaluation of the disease process in patients with MS. The purpose of this study is to investigate the use of root mean square displacement (RMSD) derived from QSI data to characterize plaques, periplaque white matter (PWM), and normal-appearing white matter (NAWM) in patients with MS.

Methods

We generated apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps by using conventional DTI data from 21 MS patients; we generated RMSD maps by using QSI data from these patients. We used the Steel–Dwass test to compare the diffusion metrics of regions of interest in plaques, PWM, and NAWM.

Results

ADC differed (P < 0.05) between plaques and PWM and between plaques and NAWM. FA differed (P < 0.05) between plaques and NAWM. RMSD differed (P < 0.05) between plaques and PWM, plaques and NAWM, and PWM and NAWM.

Conclusion

RMSD values from QSI may reflect microstructural changes and white-matter damage in patients with MS with higher sensitivity than do conventional ADC and FA values.     

Evaluation of Disease Stage of Radiation-Induced Brain Injury: a DTI Study with Pathological Correlation

The aim of this study is to evaluate if diffusion tensor imaging (DTI) can distinguish the disease process of radiation-induced brain injury when combined with apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values. Twenty-one rabbits received irradiation of 100 Gy in the right brain hemisphere. Twelve rabbits were screened with magnetic resonance imaging (MRI) and DTI before radiation, and imaged at every week until week 9 following radiation. The rabbits that had MRI were euthanized at week 9 for histologic evaluation, while other nine rabbits without MRI were randomly killed for histologic evaluation at weeks 2, 4 and 6, respectively. From the DTI, the ADC and FA values were measured, and rADC and rFA were calculated. After radiation, the trend of the ADC value can be divided into three stages. In the first stage, the ADC value of the target tissues gradually decreased. In the second stage, the ADC value of white matter in the target tissues showed a recovery trend, back to the initial level similar to that in contralateral. In the third stage, the ADC value of white matter in the target tissue continues to increase over the ADC value of baseline and contralateral white matter. The FA value of radiation-targeted area showed continuous decreasing tendency. Pathological evaluation showed the different features in three stages. DTI can distinguish the different disease stages when combined with the ADC and FA values.