Applications of magnetic resonance imaging in diseases of the pediatric central nervous system

Magnetic resonance imaging (MRI) is rapidly becoming the initial diagnostic step in the evaluation of gross abnormalities involving the brain or spinal cord in the pediatric patient. Control of patient motion and support of vital functions are critical if future utilization of MRI is to progress beyond its current outpatient diagnostic role. Currently, MRI's noninvasiveness, sensitivity and multiplanar graphic depiction of the disease process are supplanting the more traditional diagnostic modalities of CT, metrizamide CT, and myelography.     

Biliary cystadenocarcinoma: seven year follow-up and the role of MRI and MRCP.

Biliary cystadenomas and their malignant counterparts, biliary cystadenocarcinomas, are rare cystic tumors that arise from hepatobiliary epithelium. Ultrasound (US) and computed tomography (CT) are the initial imaging modalities used for the evaluation of biliary cystic tumors, but are not specific. MRI and MRCP, because of increased contrast and spatial resolution, may be a more specific imaging modality in the detection of biliary cystic neoplasms. We present a case of biliary cystadenocarcinoma imaged by MRI and MRCP in a 65 year-old man managed conservatively for 7 years.     

Primary left atrial angiosarcoma: follow-up by magnetic resonance imaging

We report the case of a primary left atrial angiosarcoma followed by MRI over a period of 1 year. The tumor was lobulated, with an initial central hyperintensity on T1-weighted images which disappeared after radiotherapy. Compared with other imaging modalities, MRI offered the most accurate information about the location, extent, and outcome under treatment.     

Abdominal imaging studies: comparison of diagnostic accuracies resulting from ultrasound, computed tomography, and magnetic resonance imaging in the same individual

We retrospectively compared the diagnostic accuracy of abdominal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) studies performed on the same individual to determine the relative performance of these modalities in the evaluation of disease processes, arising from different intra-abdominal organ systems. We retrospectively reviewed all procedure codes accrued by our abdominal imaging section during a 1-year period to determine how many patients underwent all three imaging procedures in our institution within a 2-week interval. These cases were then further evaluated to determine: (1) the primary organ system of disease involvement, (2) the final diagnosis, and (3) the imaging modality that provided the most accurate information upon which appropriate medical management was based. Imaging findings were determined by review of diagnostic reports, and medical management was determined by chart review. Two thousand six hundred-ninety five patients underwent ultrasound, 4,394 patients underwent CT, and 872 patients underwent MRI for the investigation of abdominal disease. Among these 5,126 patients, 26 underwent sequential US, CT, and MRI evaluation within a two-week interval. Appropriate clinical management was based on the US findings in 12/26 cases (46%; 95% CI: 27-67%), CT findings in 16/26 cases (62%; 95% CI: 41-80%), and MRI findings in 24 cases (92%; 95% CI: 75-99%). Significant differences in directing appropriate clinical management were found when comparing the relative diagnostic accuracies of MRI to US (p = 0.0003) and MRI to CT (p = 0.009). However, differences were not significant when comparing CT to US (p = 0.27). All final diagnoses in a given patient were accurately determined by US in 7/26 cases (27%), by CT in 10/26 cases (38%), and by MRI in 23/26 cases (88%). When analyzed according to individual diagnoses (61 total), US detected 33 of 61 (54%) abnormalities, CT detected 41 (67%) abnormalities, and MRI detected 51 (84%) abnormalities. US correctly characterized 32 (52%) abnormalities, CT correctly characterized 36 (59%) abnormalities, and MRI correctly characterized 49 (80%) abnormalities. Ultrasound, CT, and MR imaging correctly diagnosed the disease process in 3 of 12 (25%), 3 of 12 (25%), and 10 of 12 (83%) patients, respectively, with liver disease; 2 of 9 (22%), 6 of 9 (66%), and 9 of 9 (100%) patients, respectively, with pancreatic disease; 17 of 17 (100%), 8 of 17 (47%), and 10 of 17 (58%) patients, respectively, with gallbladder and biliary disease; 2 of 8 (25%), 5 of 8 (63%), and 5 of 8 (63%) patients, respectively, with renal disease; 0 of 3 (0%), 2 of 3 (66%), and 3 of 3 (100%) patients, respectively, with adrenal disease; and 8 of 12 (75%), 12 of 12 (100%), and 12 of 12 (100%) patients with free intraperitoneal fluid. Our results provide new information, regarding the relative benefits of ultrasound, CT, and MRI for the investigation of abdominal diseases at our institution. This initial data suggests that ultrasound provides the most accurate diagnoses in the investigation of gallbladder disease; MRI provides the most accurate diagnoses in the investigation of hepatic, adrenal, and pancreatic disease; and either CT or MRI may be the most appropriate first imaging study for the detection of renal disease.     

High-performance low field MRI enables visualization of persistent pulmonary damage after COVID-19

The outbreak of coronavirus disease 2019 (COVID-19) with the origin of the spread assumed to be located in Wuhan, China, began in December 2019, and is continuing until now. With the COVID-19 pandemic showing a progressive spread throughout the countries of the world, there is emerging interest for the potential long-term consequences of suffering from a COVID-19 pneumonia. Imaging plays a central role in the diagnosis and management of COVID-19 pneumonia, with chest X-ray examinations and computed tomography (CT) being undoubtedly the modalities most widely used, allowing for a fast and sensitive detection of infiltration patterns associated with COVID-19 pneumonia. For a better understanding of underlying pathomechanisms of pulmonary damage, longitudinal imaging series are warranted, for which CT is of limited usability due to repeated exposure of X-rays. Recent advances in MRI suggested that high-performance low-field MRI might represent a valuable method for pulmonary imaging without the need of radiation exposure. However, so far, low-field MRI has not been applied to study pulmonary damage after COVID-19 pneumonia. We present a case report of a patient who suffered from COVID-19 pneumonia using 0.55 T MRI for follow-up examinations three months after initial infection. Low-field MRI enables a precise visualization of persistent pulmonary changes including ground-glass opacities, which are consistent with CT performed on the same day. Low-field MRI seems to be feasible in the detection of pulmonary involvement in patients with COVID-19 pneumonia and may have the potential for repetitive lung examinations in monitoring the reconvalescence after pulmonary infections.     

Osteomyelitis: Sensitivity of 0.064 T MRI, three-phase bone scanning and indium scanning with biopsy proof

We compared the ability of magnetic resonance imaging (MRI) using a 0.064 T permanent magnet, three-phase bone scanning, and indium-labeled white blood cell (¹¹¹In-WBC) scanning, to diagnose osteomyelitis. Twenty-three patients underwent biopsy. All patients were examined at presentation with all three modalities. Sensitivities for each modality were calculated using biopsy as a gold standard. The results were 72% for MRI, 68% for bone scan, and 45% for ¹¹¹In-WBC. Specificities were not calculated because of lack of negative biopsies. MRI was as sensitive as bone scanning in the diagnosis of osteomyelitis. All modalities had lower than previously reported sensitivities for imaging osteomyelitis.     

MR imaging of excessively obese patients: the use of an open permanent magnet

Excessive obesity can pose a limitation to both clinical and radiographic evaluation. Although CT and MR have revolutionized head and body imaging, patients with weights above 300 lb present a restriction of these imaging modalities. Magnetic resonance imaging (MRI) is well suited for imaging excessively obese patients, because the RF used does not have difficulty in penetrating large amounts of adipose tissue as ionizing radiation or sound waves does. The limitations of conventional MR imaging in these obese patients are the gantry size and the table weight limit. The recent development of a new low field MR imager with a larger gantry size and greater weight capacity, has the potential for imaging obese patients that cannot be evaluated by standard CT or MR. In this paper, we report our experience in imaging nine excessively obese patients with weights between 350 and 490 lb using a permanent magnet operating at 0.064 T.     

Monitoring redox-sensitive paramagnetic contrast agent by EPRI, OMRI and MRI

A comparative study of tissue redox-status imaging using commonly used redox sensitive nitroxides has been carried out using electron paramagnetic resonance imaging (EPRI), Overhauser magnetic resonance imaging (OMRI) and conventional T(1)-weighted magnetic resonance imaging, MRI. Imaging studies using phantoms of different nitroxides at different concentration levels showed that EPRI and OMRI sensitivities were found to be linearly dependent on line width of nitroxides up to 2 mM, and the enhancement in MRI intensity was linear up to 5 mM. The sensitivity and resolution of EPRI and OMRI images depended significantly on the line width of the nitroxides whereas the MRI images were almost independent of EPR line width. Reduction of the paramagnetic 3-carbamoyl-2,2,5,5-tetramethylpyrrolidine-1-oxyl (3CP) by ascorbic acid (AsA) to the diamagnetic by hydroxylamine was monitored from a sequence of temporal images, acquired using the three imaging modalities. The decay rates determined by all the three modalities were found to be similar. However the results suggest that T(1)-weighted MRI can monitor the redox status, in addition to providing detailed anatomical structure in a short time. Therefore, a combination of MRI with nitroxides as metabolically responsive contrast agents can be a useful technique for the in vivo imaging probing tissue redox status.     

Real-time imaging with radial GRAPPA: Implementation on a heterogeneous architecture for low-latency reconstructions

Combination of non-Cartesian trajectories with parallel MRI permits to attain unmatched acceleration rates when compared to traditional Cartesian MRI during real-time imaging. However, computationally demanding reconstructions of such imaging techniques, such as k-space domain radial generalized auto-calibrating partially parallel acquisitions (radial GRAPPA) and image domain conjugate gradient sensitivity encoding (CG-SENSE), lead to longer reconstruction times and unacceptable latency for online real-time MRI on conventional computational hardware. Though CG-SENSE has been shown to work with low-latency using a general purpose graphics processing unit (GPU), to the best of our knowledge, no such effort has been made for radial GRAPPA. Radial GRAPPA reconstruction, which is robust even with highly undersampled acquisitions, is not iterative, requiring only significant computation during initial calibration while achieving good image quality for low-latency imaging applications. In this work, we present a very fast, low-latency, reconstruction framework based on a heterogeneous system using multi-core CPUs and GPUs. We demonstrate an implementation of radial GRAPPA that permits reconstruction times on par with or faster than acquisition of highly accelerated datasets in both cardiac and dynamic musculoskeletal imaging scenarios. Acquisition and reconstruction times are reported.     

MR imaging of surgical complications of systemic-to-pulmonary artery shunts

Patients with a systemic-to-pulmonary artery shunt and positive findings on traditional imaging modalities such as chest X-ray, echocardiography, or cardiac angiography often can benefit from additional noninvasive imaging with magnetic resonance imaging (MRI). Diagnostic dilemmas encountered include: pseudoaneurysms, contained fluid collection (seroma) surrounding a shunt, and stenosis of the shunt anastomoses. MRI studies using traditional cardiac-triggered spin-echo (SE) imaging and the newer breathhold MRI studies with k-space segmented gradient-recalled echo (GRE) imaging can greatly help resolve diagnostic dilemmas. By combining different MR imaging techniques it becomes possible to clearly distinguish between pseudoaneurysms and seroma, to exclude an active leak and to sometimes visualize the distal anastomosis with more precision than conventional angiography. MRI is often able to add information needed for clinical decision making prior to surgical repair.     

Cardiac calcifications: difficult MRI diagnosis

Magnetic resonance imaging (MRI) and computed tomography (CT) were performed in 40 patients with a variety of cardiovascular diseases. These imaging modalities were compared to investigate their relative value in the assessment of cardiovascular diseases. Of these 40 patients, 7 were found by CT to have detectable cardiovascular calcifications. These patients included one calcified mitral stenosis, one calcified coronary artery, one calcified type B aortic dissection, two calcified myocardial infarctions, and two patients with calcific pericarditis. In several cases, MRI was misleading because of difficulty in detecting calcifications. We present a series of cases illustrating a limitation of MRI in identifying diagnostically and clinically important cardiovascular calcifications.     

Comparison of diffusion tensor,dynamic susceptibility contrast MRI and Tc-Tetrofosmin brain SPECT for the detection of recurrent high-grade glioma

Introduction

Treatment induced necrosis is a relatively frequent finding in patients treated for high-grade glioma. Differentiation by imaging modalities between glioma recurrence and treatment induced necrosis is not always straightforward. This is a comparative study of diffusion tensor imaging (DTI), dynamic susceptibility contrast MRI and ^99mTc-Tetrofosmin brain single-photon emission computed tomography (SPECT) for differentiation of recurrent glioma from treatment induced necrosis.

Methods

A prospective study was made of 30 patients treated for high-grade glioma who had suspected recurrent tumor on follow-up MRI. All had been treated by surgical resection of the tumor followed by standard postoperative radiotherapy with chemotherapy. No residual tumor had been found on brain imaging immediately after the initial treatment. All the patients were studied with dynamic susceptibility contrast brain MRI and, within a week, ^99mTc-Tetrofosmin brain SPECT.

Results

Both ^99mTc-Tetrofosmin brain SPECT and dynamic susceptibility contrast MRI could discriminate between tumor recurrence and treatment induced necrosis with 100% sensitivity and 100% specificity. An apparent diffusion coefficient (ADC) ratio cut-off value of 1.27 could differentiate recurrence from treatment induced necrosis with 65% sensitivity and 100% specificity and a fractional anisotropy (FA) ratio cut-off value of 0.47 could differentiate recurrence from treatment induced necrosis with 57% sensitivity and 100% specificity. A significant correlation was demonstrated between ^99mTc-Tetrofosmin uptake ratio and rCBV (P = 0.003).

Conclusions

Dynamic susceptibility contrast MRI and brain SPECT with ^99mTc-Tetrofosmin had the same accuracy and may be used to detect recurrent tumor following treatment for glioma. DTI also showed promise for the detection of recurrent tumor, but was inferior to both dynamic susceptibility contrast MRI and brain SPECT.     

Feasibility study of myocardial perfusion and oxygenation by noncontrast MRI: comparison with PET study in a canine model

The purpose of this study was to examine the feasibility of quantifying myocardial blood flow (MBF) and rate of myocardial oxygen consumption (MVO(2)) during pharmacologically induced stress without using a contrast agent. The former was measured by the arterial spin labeling (ASL) method and the latter was obtained by measuring the oxygen extraction fraction (OEF) with the magnetic resonance imaging (MRI) blood oxygenation level-dependent effect and Fick's law. The MRI results were compared with the established positron emission tomography (PET) methods. Six mongrel dogs with induced acute moderate left coronary artery stenosis were scanned using a clinical PET and a 1.5-T MRI system, in the same day. Regional MBF, myocardial OEF and MVO(2) were measured with both imaging modalities. Correlation coefficients (R(2)) of the three myocardial indexes (MBF, OEF and MVO(2)) between MRI and PET methods ranged from 0.70 to 0.93. Bland-Altman statistics demonstrated that the estimated precision of the limits of agreement between MRI and PET measurements varied from 18% (OEF) to 37% (MBF) and 45% (MVO(2)). The detected changes in these indexes, at rest and during dobutamine stress, were similar between two image modalities. The proposed noncontrast MRI technique is a promising method to quantitatively assess myocardial perfusion and oxygenation.     

糖尿病脑病的磁共振研究

糖尿病是由胰岛素分泌不足（T1DM）或胰岛素抵抗（T2DM）而引发的慢性代谢疾病,严重影响人们的生活质量. 中枢神经系统是糖尿病并发症的易感部位. 临床研究和流行病学调查结果显示,糖尿病会引发脑白质损伤、脑萎缩和认知功能障碍,并会增加脑卒中的风险. 磁共振成像和活体磁共振波谱可提供大脑解剖结构、功能及代谢等多方面的信息. 近年来,随着人们对糖尿病脑病关注度的不断增加和认识的不断加深,磁共振成像和活体波谱开始并越来越多地被应用于该疾病的研究. 该文综述磁共振成像与活体波谱技术在糖尿病脑病研究中的应用及最新进展.     

Magnetic resonance in the era of molecular imaging of cancer

Magnetic resonance imaging (MRI) has played an important role in the diagnosis and management of cancer since it was first developed, but other modalities also continue to advance and provide complementary information on the status of tumors. In the future, there will be a major continuing role for noninvasive imaging in order to obtain information on the location and extent of cancer, as well as assessments of tissue characteristics that can monitor and predict treatment response and guide patient management. Developments are currently being undertaken that aim to provide improved imaging methods for the detection and evaluation of tumors, for identifying important characteristics of tumors such as the expression levels of cell surface receptors that may dictate what types of therapy will be effective and for evaluating their response to treatments. Molecular imaging techniques based mainly on radionuclide imaging can depict numerous, specific, cellular and molecular markers of disease and have unique potential to address important clinical and research challenges. In this review, we consider what continuing and evolving roles will be played by MRI in this era of molecular imaging. We discuss some of the challenges for MRI of detecting imaging agents that report on molecular events, but highlight also the ability of MRI to assess other features such as cell density, blood flow and metabolism which are not specific hallmarks of cancer but which reflect molecular changes. We discuss the future role of MRI in cancer and describe the use of selected quantitative imaging techniques for characterizing tumors that can be translated to clinical applications, particularly in the context of evaluating novel treatments.     

Microtesla MRI of the human brain combined with MEG

One of the challenges in functional brain imaging is integration of complementary imaging modalities, such as magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI). MEG, which uses highly sensitive superconducting quantum interference devices (SQUIDs) to directly measure magnetic fields of neuronal currents, cannot be combined with conventional high-field MRI in a single instrument. Indirect matching of MEG and MRI data leads to significant co-registration errors. A recently proposed imaging method--SQUID-based microtesla MRI--can be naturally combined with MEG in the same system to directly provide structural maps for MEG-localized sources. It enables easy and accurate integration of MEG and MRI/fMRI, because microtesla MR images can be precisely matched to structural images provided by high-field MRI and other techniques. Here we report the first images of the human brain by microtesla MRI, together with auditory MEG (functional) data, recorded using the same seven-channel SQUID system during the same imaging session. The images were acquired at 46 microT measurement field with pre-polarization at 30 mT. We also estimated transverse relaxation times for different tissues at microtesla fields. Our results demonstrate feasibility and potential of human brain imaging by microtesla MRI. They also show that two new types of imaging equipment--low-cost systems for anatomical MRI of the human brain at microtesla fields, and more advanced instruments for combined functional (MEG) and structural (microtesla MRI) brain imaging--are practical.     

Prediction of early response to concurrent chemoradiotherapy in cervical cancer: Value of multi-parameter MRI combined with clinical prognostic factors

PurposeThis study aimed to investigate the prediction of early response to concurrent chemoradiotherapy (CCRT) through a combination of pretreatment multi-parametric magnetic resonance imaging (MRI) with clinical prognostic factors (CPF) in cervical cancer patients.MethodsEighty-five patients with pathologically confirmed cervical cancer underwent conventional MRI, intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI), and dynamic contrast-enhanced MRI (DCE-MRI) before CCRT. The patients were divided into non- and residual tumor groups according to post-treatment MRI. Univariable and multivariable analyses were performed to pretreatment MRI parameters and CPF between the two groups, and optimal thresholds and predictive performance for post-treatment residual tumor occurrence were estimated by drawing the receiver operating characteristic (ROC) curve.ResultsThere were 52 patients in non- and 33 in residual group. The residual group showed a lower perfusion fraction (f) value and volume transfer constant (K^trans) value, a higher apparent diffusion coefficient (ADC) value, diffusion coefficient (D) value and volume fraction of extravascular extracellular space (V_e) value, and a higher stage than the non-residual tumor group (all P < .05). D, K^trans, V_e and stage were independent prognostic factors. The combination of D, K^trans and V_e improved the diagnostic performance compared with individual MRI parameters. A further combination of these three MRI parameters with stage exhibited the highest predictive performance.ConclusionsPretreatment D, K^trans, V_e and stage were independent prognostic factors for cervical cancer. The predictive capacity of multi-parametric MRI was superior to individual MRI parameters. The combination of multi-parametric MRI with CPF further improved the predictive performance.     

Magnetic resonance imaging (MRI) studies of knee joint under mechanical loading: Review

Osteoarthritis (OA) is a very common disease that affects the human knee joint, particularly the articular cartilage and meniscus components which are regularly under compressive mechanical loads. Early-stage OA diagnosis is essential as it allows for timely intervention. The primary non-invasive approaches currently available for OA diagnosis include magnetic resonance imaging (MRI), which provides excellent soft tissue contrast at high spatial resolution. MRI-based knee investigation is usually performed on joints at rest or in a non-weight-bearing condition that does not mimic the actual physiological condition of the joint. This discrepancy may lead to missed detections of early-stage OA or of minor lesions. The mechanical properties of degenerated musculoskeletal (MSK) tissues may vary markedly before any significant morphological or structural changes detectable by MRI. Recognizing distinct deformation characteristics of these tissues under known mechanical loads may reveal crucial joint lesions or mechanical malfunctions which result from early-stage OA. This review article summarizes the large number of MRI-based investigations on knee joints under mechanical loading which have been reported in the literature including the corresponding MRI measures, the MRI-compatible devices employed, and potential challenges due to the limitations of clinical MRI sequences.     

Amyotrophic lateral sclerosis with predominant pyramidal signs -- early diagnosis by magnetic resonance imaging

OBJECTIVE: To evaluate the role of magnetic resonance imaging (MRI) in the early diagnosis of amyotrophic lateral sclerosis (ALS) with predominant upper motor neuron (UMN) signs in the initial stage of the disease. PATIENTS AND METHOD: Two patients with ALS were found to have spastic quadriparesis with no wasting or fasciculation in the limbs in the early stage of the disease. Both were subjected to MRI of the head and cervical spine to look for any specific diagnostic feature. Both of them were followed with clinical evaluation and electroneuromyography (ENMG) for the definitive diagnosis of ALS. RESULTS: Magnetic resonance imaging showed selective degeneration of the pyramidal tracts in the contiguous axial cuts from subcortical white matter to cerebral peduncles. The finding was more visible in the coronal section. In addition, there was T1 hyperintensity visible along the anterior aspect of the spinal cord in the cervical region. These findings were suggestive of ALS, the diagnosis that was subsequently confirmed by serial clinical follow-up and ENMG. CONCLUSION: It is difficult to diagnose ALS in the early stage of the disease especially if the pyramidal signs predominate over the lower motor neuron (LMN) signs; MRI might be useful in such cases.     

MRI-guided biopsy in inflammatory myopathy: Initial results

The purpose of this report is to describe our initial experience with techniques employing magnetic resonance imaging (MRI) to guide the choice of muscle to be biopsied in patients suspected of having inflammatory myopathy. Five patients with a clinical diagnosis of inflammatory myopathy (IM) were studied. Four were imaged prior to biopsy. Four had repeated examinations, either immediately following biopsy or to evaluate disease progression. Use of MRI to localize muscle lesions was associated with abnormal pathologic findings in all cases, including histopathologic demonstration of lymphocyte infiltration in three cases of idiopathic polymyositis; nonspecific myopathic changes were seen in one patient with probable dermatomyositis and in one patient with chronic inflammatory polyneuropathy and high serum creatine kinase levels (>45,000 IU/ml). The precise location of the area sampled by biopsy was visible in only one of four postbiopsy images. MRI shows promise in identifying pathologic muscle in patients suspected of having one of the inflammatory myopathies; however, further refinement of localization techniques may be needed to optimize histopathologic diagnoses.