Gadolinium-DTPA-enhanced MRI of intraocular tumors

The value of gadolinium-enhanced MRI in 30 patients with intraocular lesions has been evaluated. Seventeen patients had a uveal melanoma, two a ciliary body melanoma, three had uveal metastases, one lymphoma, four had senile macula degenerations, and three uveal nevi. Twelve of 17 patients with melanoma were followed up by MRI after ruthenium plaque therapy on 2–4 occasions. Melanomas showed high precontrast signal intensities and only a slight enhancement after intravenous Gd-DTPA was given. After ruthenium plaque therapy precontrast signal intensities (SI) decreased while a moderate signal increase on postcontrast scans was noted. Scars or tumor residues were better delineated on enhanced images. All other tumors than melanotic melanomas showed low SI on precontrast scans and a high signal increase after Gd-DTPA administration. Small amelanotic tumors were better delineated on postcontrast scans. In addition Gd-DTPA-enhanced MRI allowed differentiation between tumor and hemorrhage. No signal increase after Gd-DTPA application was seen in subretinal or vitreous hemorrhages of varying ages.     

MRI in cerebral developmental malformations and epilepsy

Cerebral developmental malformations are increasingly recognized as a major cause of developmental delay and epilepsy. The incidence of these developmental malformations in patients with epilepsy is not known, but epilepsy surgery data suggest that this pathology is commonly seen in children who undergo epilepsy surgery for intractable epilepsy. These malformations can be diagnosed by a combination of clinical, neurophysiological, and imaging techniques. However, imaging techniques such as MRI have been able to provide in vivo recognition of many of these malformations and have contributed to the recognition of specific syndromes. These malformations can be classified on an anatomical basis either into diffuse, unilateral, or generalized. However, a combination of imaging data in conjunction with genetics and embryology may be more appropriate in the future. Further technical developments promise to increase the sensitivity of MRI in detecting these malformations and may help to delineate the possible biology of these disorders.     

Magnetic resonance imaging and computed tomography in Pelizaeus-Merzbacher disease

Six patients with the classical form of Pelizaeus-Merzbacher disease (PMD) were studied with computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. While final diagnosis of PMD should be made on the basis of histopathologic findings in the brain, findings in this group support the fact that MRI can be used for tentative early diagnosis when computer tomographic examination is normal or nondiagnostic. All patients had MRI findings reflecting a pattern of diffuse white matter disease that can be considered characteristic in the appropriate clinical setting.     

Signal-to-noise improvement in mid-field MRI surface coils: A degree in plumbing?

From a series of standard SE imaging sequences, performed on a Bruker 0.28 T imaging system, with the assistance of a healthy volunteer, the image signal-to-noise (S/N) ratio obtained from a 23-cm square surface coil has been shown to increase by up to 38% as the tube gauge is increased from 4 to 18 mm. The reason did not lie solely in the much improved Q factor of the unloaded coils. Despite a more than twofold increase in the unloaded Q factor, the loaded coil Q values only increased by 8%. It would appear, however, that the resistive, dielectric and inductive noise components are all reduced, and hence contribute to the observed improved S/N. The reduction in pure ohmic losses accounts for a quarter of the improved S/N, while the reduced inductive and dielectric losses provide the remaining three quarters. No independent quantification of the two latter noise sources was attempted, although a reduced dielectric contribution is confirmed qualitatively by a reduction in the negative frequency shift of the resonance frequency as a function of increasing coil gauge when the coil is loaded.     

In vivo boron-11 MRI and MRS using (B24H22S2)4- in the rat.

In vivo boron-11 magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) were performed on a rat that had been infused with a potential boron neutron capture therapy agent, Na₄B₂₄H₂₂S₂, using methods for detecting nuclei with a short T₂ relaxation time. MRI and MRS were also performed on a euthanized rat that had been similarly infused in vivo. Boron-11 spectral intensities decreased in the living rat over a 25-h period. The results demonstrate the capability of MRI and MRS to noninvasively monitor the distribution and excretion of boron agents in vivo.     

Increasing the yield from volumetric MRI in patients with epilepsy

Volumetric magnetic resonance imaging has become a routine investigation in the management of patients with chronic partial epilepsy. However, even with the use of reformatted images, an underlying cause for epileps can-not be found in many of these patients. We show that further processing of the data, including three-dimensional reconstruction and quantitative analysis of the volume and complexity of the images in three dimensions, reveals additional positive information in up to 75% of patients. This may be useful for surgical planning, prognostication, and understanding of the structure and development of the human brain.     

Clinical applications: MRI, SPECT, and PET

MRI, PET, and SPECT are all used to image abnormalities in the epileptic brain. Comparison of the techniques is difficult because they measure different aspects of the epileptic process—structure, metabolism, and perfusion. SPECT is the only one that can be systematically applied during seizures, while all three are used to image interictal abnormalities. Literature review suggests that of interictal techniques, PET has the highest diagnostic sensitivity in temporal lobe epilepsy (TLE) (84% vs. 66% for SPECT, 55% for qualitative MRI, 71% for quantitative MRI) while SPECT has the highest sensitivity in extratemporal epilepsy (ETE) (60% vs. 43% for MRI and 33% for PET). The highest diagnostic sensitivity and specificity were achieved by ictal imaging with SPECT (90% in TLE, 81% in ETE). The techniques, however, were not always redundant. One reason for the wide discrepancy of results in TLE and ETE might be the differing pathologic substrates. A literature review of imaging findings associated with mesial temporal sclerosis (MTS), developmental lesion or tumor as the underlying abnormality associated with epilepsy supports this explantion. PET and MRI are much more sensitive to MTS than SPECT (100%, 95% vs. 70%). On the other hand, in developmental lesions the three techniques are equally sensitive (88–92%) and in tumors, MRI was most sensitive (96%) and SPECT least (82%). A study at NIH explains the differing sensitivities: using PET to measure both blood flow and metabolism revealed discrepant findings in the same patients. Preliminary evidence also indicates that the distribution of hyperperfusion on ictal SPECT can differentiate subtypes of TLE. Combining the results of refined imaging techniques holds great promise in epilepsy localization and diagnosis.     

MRI hippocampal volume and neuropsychology in epilepsy surgery

A review is provided of recent findings on relationships between neurocognitive test data and magnetic resonance imaging (MRI)-determined hippocampal volumes in nonlesional temporal lobectomy patients. The difference between the right and left hippocampal volumes is correlated with postoperative verbal memory in left temporal lobectomy patients who do not have lesional pathology. MRI hippocampal volume data are not associated with measures of executive functioning or naming. Sex differences have been found for verbal memory outcome as women have better verbal memory following left temporal lobectomy. Sex differences have also been found in the relationships between verbal and visual memory, and hippocampal volume data. The systematic combination of MRI-acquired morphological data and neuropsychological test data may further our understanding of neurocognitive function, and provide clinically useful data for counseling epilepsy surgery patients. The current data are promising with regard to prediction of memory outcome following temporal lobectomy, but they do not yet allow for prediction of specific individual patient outcomes. Rather, the currently available data support counseling patients based on the memory outcome of others with similar characteristics.     

A novel editing technique for F MRI: Molecule-specific imaging

A novel technique is proposed to facilitate the selective imaging of specific molecules from a mixture. The application of the technique presented here demonstrates the ability to selectively produce ¹⁹F MR images of either trifluoroacetic acid or the perfluorocarbon emulsion Oxypherol-ET (perfluorotributylamine), when both molecules are present simultaneously. Selective detection is based on the presence of homonuclear J-modulation in one molecule and differential spin-spin relaxation time (T₂). Perfluorotributylamine, an A₃B₂ system, is subject to homonuclear J-modulation, which produces a null signal from the antiphase components of the triplet (A₃) when an echo time is used in a spin-echo image. At this echo time the second molecule, in this example trifluoroacetic acid, a non-coupled spin system, is selectively imaged. At longer echo times, e.g., TE = 1/J there is substantial recovery of the J-modulated signal, which may be solely observed due to T₂ decay of the trifluoroacetic acid signal. The method is demonstrated both using phantoms and in vivo.     

A simple approach to T2 imaging in MRI

A simple method for obtaining images whose contrast depends only on T₂ is described and tested both on phantoms and in vivo. The method works reliably and effectively under clinically realistic operating conditions using standard imaging protocols. It can result in a substantial reduction in imaging times for T₂ weighted images.     

Remotely detected high-field MRI of porous samples

Remote detection of NMR is a novel technique in which an NMR-active sensor surveys an environment of interest and retains memory of that environment to be recovered at a later time in a different location. The NMR or MRI information about the sensor nucleus is encoded and stored as spin polarization at the first location and subsequently moved to a different physical location for optimized detection. A dedicated probe incorporating two separate radio frequency (RF)-circuits was built for this purpose. The encoding solenoid coil was large enough to fit around the bulky sample matrix, while the smaller detection solenoid coil had not only a higher quality factor, but also an enhanced filling factor since the coil volume comprised purely the sensor nuclei. We obtained two-dimensional (2D) void space images of two model porous samples with resolution less than 1.4 mm2. The remotely reconstructed images demonstrate the ability to determine fine structure with image quality superior to their directly detected counterparts and show the great potential of NMR remote detection for imaging applications that suffer from low sensitivity due to low concentrations and filling factor.     

Clinical correlations: MRI and EEG

Main structural correlates of epileptogenesis include hippocampal sclerosis, cortical dysgenesis, foreign tissue lesions, gliosis, and dual pathology (a combination of any two). These structural abnormalities are now increasingly defined with MRI, enabling systematic EEG correlative analyses. Hippocampal atrophy (HA) and increased T₂ signal in medial temporal structures predict the presence of mesial temporal sclerosis with a high degree of sensitivity and specificity. In 50 patients with clinical evidence of temporal lobe epilepsy and isolated HA, ictal scalp EEG was concordant to the atrophic temporal lobe in 33, nonlateralizing in 12, obscured in 3, and bilateral in 2, but it was discordant in none. Earlier reports of higher levels of discordance may be ascribed to the presence of dual pathology or to differing MRI and EEG criteria for localization. In a more inclusive group of 101 patients with unilateral HA, ictal scalp EEG was obtained in 99. It was unlocalized in 53, localized elsewhere in 9, and localized to the atrophic temporal lobe in 38. Of those, 51 patients had intracranial EEG: 12 were unlocalized, 29 were localized to the atrophic hippocampus, and 9 were localized elsewhere. There is thus a rare but definite subgroup of patients with unilateral HA who have EEG localization elsewhere than the atrophy. The successful cure of seizures in half these patients after removal of the EEG focus confirms the importance of this observation and emphasizes the search for more dual pathology that has remained undetected on MRI. About 10% of the patients with HA have significant atrophy bilaterally, and several series have confirmed that surgical success is predicted by removal of the EEG identified seizure onset area, not the more or less atrophic hippocampus. In patients with other kinds of dual pathology, including HA and foreign tissue lesions or cortical dysgenesis, EEG is also paramount in predicting the site of epileptogenesis for surgical intervention. EEG correlates of cortical dysgenesis are heterogeneous, but EEG has potential to provide accurate localization of the site of epileptogenesis in foreign tissue lesions also. In a study of 59 lesional patients, a small number of patients with low grade astrocytomas and oligodendrogliomas consistently localized by EEG to an area elsewhere than the lesion, and failed seizure control when the lesion was removed. Although MRI can demonstrate the structural correlate of the epilepsy in many situations, rare patients, particularly with certain tumors, cortical dysgenesis, and dual pathology, require EEG for accurate localization.     

Primary lymphoma of the cervix: MRI findings with gadolinium

MRI evaluation of primary cervical lymphoma has not been reported. We report such a case of primary cervical lymphoma, a lesion well seen and well delineated from normal tissue by MRI. Although primary lymphoma of the cervix is a rare entity, the disease does exist and can be well demonstrated by MRI. We evaluated the MR appearance of this lesion with both nonenhanced and gadolinium-enhanced imaging.     

MRI of hepatic lymphoma

Thirteen patients with biopsy proven hepatic lymphoma (2 Hodgkin, 11 Non-Hodgkin) and a control group of 15 patients with hepatic metastases were analyzed quantitatively and qualitatively by MRI. Focal hepatic lymphoma was most reliably detected (eight of eight patients) and appeared hypointense relative to liver on T₁ weighted (CNR − 7.4 ± 2.3) and hyperintense on T₂ weighted (CNR + 8.4 ± 2.9) images. The mean T₁ and T₂ relaxation times of focal hepatic lymphoma (T₁ = 832 ± 234 msec, T₂ = 84 ± 16 ms) differed significantly from adjacent non-tumorous liver (T₁ = 420 ± 121 ms, T₂ = 51 ± 9 ms; p < 0.05), however CNR values and relaxation times were similar to those of hepatic metastases. Diffuse hepatic lymphoma (microscopic periportal infiltration) was undetectable by MRI in three patients by either morphologic features or quantitative criteria. A mixed pattern of hepatic lymphoma (focal lesions and diffuse infiltration) showed focal areas of slightly decreased signal intensity on T₁ weighted images (CNR = −1.7 ± 0.4) while T₂ weighted images revealed multiple regions of focal hyperintensity (CNR = +13.3 ± 8.4) superimposed on a diffusely hyperintense liver. Our experience demonstrates that either T₁ or T₂ weighted techniques are useful in detecting focal and that T₂ weighted techniques are useful in detecting mixed hepatic lymphoma. Conventional image derived relaxation time measurements and quantitative parameters were of no additional diagnostic value.     

Magnetic resonance imaging of soft-tissue tumors: Comparison with computed tomography

Twenty-seven patients with soft-tissue tumors were examined with a Picker 0.15-tesla resistive magnet and by computed tomography (CT). In all but one patient, MRI was better than or equal to CT in defining the anatomic extent of the tumor. We could determine whether major vascular structures were engulfed by the tumor in 80% of the MRI examinations but only in 62% of the CT scans. MRI and CT were equally effective in determining the presence or absence of bony invasion. The MRI images of all the tumors showed increased signal intensity relative to normal muscle when spin-echo (SE) sulse sequences with long repeat times were used (SE: echo time [TE], 60 ms; repetition time [TR], 2,000 ms). When T1 weighted pulse sequences were used (SE: TE, 30 ms; TR, 500 ms or inversion recovery: inversion time, 500 ms; TE, 40 ms; TR, 2,000 ms) the malignant tumors showed decreased signal intensity compared to normal muscle. Only lipomas showed high signal intensity on both T1 and T2 weighted pulse sequences.     

Varied MR appearance of autism: Fifty-three pediatric patients having the full autistic syndrome

Fifty-three autism patients ranging in age from 2 to 22 yr with a mean age of 9 yr were evaluated by MR imaging over a 3-yr study period. Sagittal, axial, and coronal spin-echo and short TI inversion recovery scans were performed on a 0.5 Tesla (Picker Inc., Cleveland, OH) system. Results were compared to 32 control patients age range 1 to 17 yr, mean 8.5 yr. MR scans were evaluated by three neuroradiologists. Measurements of midsagittal vermian height and AP diameter were performed. Subjective estimates were made of ventricular size, amygdala size, fourth ventricular size, and vermian shape. Results were correlated with clinical presentation, course, and lab analyses by a pediatric neurologist. MR findings did not present a single pattern capable of predicting the presence or severity of autism. The constellation of MR findings in this group of 53 patients was highly variable, thus we advise caution in the interpretation of MR images in autistic patients. Autism is a heterogeneous disease entity containing different clinical subgroups, which do not manifest similar radiologic pictures.     

Magnetic resonance imaging as an adjunct to sonography in the evaluation of the female pelvis

Magnetic resonance imaging (MRI) of the pelvis is generally considered to be most beneficial in those cases where the pelvic sonogram is limited or equivocal. All cases that underwent both sonographic and MRI examinations at our institution for the evaluation of the female pelvis in the past two years were retrospectively reviewed. We reviewed the sonographic and MRI reports and the subsequent clinical management in the 41 cases that had both studies to assess whether MRI contributed to the clinical management decision. Both studies were interpreted independently based upon the known clinical and laboratory data available at the time. MRI was obtained in 21 cases because the sonogram was suboptimal or inconclusive. In the other 20 cases it was obtained for additional information, even though the sonogram was diagnostic. Of the 21 inconclusive sonographic studies, MRI established or clarified the diagnosis in all cases. Of the 20 studies where MRI was obtained for additional information, MRI added useful data that helped contribute to the clinical management of 11 patients. MRI is an important adjunct to pelvic sonography. It established, clarified, or added significant data in 78% of cases.     

Hippocampal MRI volumetrics and temporal lobe substrates in medial temporal lobe epilepsy

Forty-nine consecutive patients undergoing anteromedial temporal lobe resection for medically intractable temporal lobe seizures, and averaging 2 yr (range 6 mo to 4 yr) postoperative follow-up, were selected for a retrospective study. This study correlated magnetic resonance imaging (MRI) derived hippocampal volumetrics, preoperative demographics, postoperative seizure control, and tissue analysis, including hippocampal CA (cornu ammonis) field neuronal, and glial cell counts, and immunohistochemistry (IHC) evidence for dentate sprouting and reorganization. These measures were compared in hippocampi with or without an adjacent presumptive epileptogenic temporal lobe mass. Mesial temporal sclerosis (MTS) was defined as >50% neuronal cell loss averaged across all CA fields with NPY (neuropeptide-y) and somatostatin reorganization. These patients may or may not include granule cell sprouting as determined by dynorphin staining. Patients were divided into two groups based on CA field neuronal cell counts, one averaging >50% cell loss and one averaging <50% cell loss. For the MTS group (N = 38), 89% had significant volumetric atrophy of the ipsilateral hippocampus, 74% had dentate reorganization, and complete seizure control was seen in 76% of these patients. In one subgroup of the <50% cell loss group, patients with medial temporal lobe epilepsy caused by a mass in the medial temporal lobe (mass group) (N = 6), 33% demonstrated significant volumetric atrophy of the hippocampus ipsilateral to the mass, 0% had dentate sprouting, and seizures were completely controlled in 67%. For the second subgroup of the <50% cell loss group, patients without mass lesions (N = 5) who were classified as the paradoxical medial temporal lobe epilepsy group (paradoxical group), 20% had ipsilateral hippocampal atrophy, 0% had dentate reorganization, and complete seizure control was seen in 60% of these patients. In conclusion, for the MTS group, hippocampal atrophy proven by MRI volumetrics was highly predictive of significant neuronal cell loss and an excellent indicator of success. However, in patients who had a foreign mass, hippocampal atrophy was not necessarily indicative of significant neuronal cell loss and MRI volumetrics was not a factor in the determination of a successful outcome. Furthermore, patients without mass lesions who have normal volumetrics but demonstrate hippocampal disease through invasive electrode monitoring, are likely to have paradoxical medial temporal lobe epilepsy, seizures beginning at a later age, and a lower, but not insignificant, success rate than the classical mesial temporal sclerosis group.     

Magnetic resonance imaging and epilepsy: Neurosurgical decision making

Advances in magnetic resonance imaging (MRI) techniques have had an important impact on the decision-making process leading to surgical resection for chronic seizures. The MRI is now obtained relatively early in the work-up, and, when it shows abnormality, it assumes a crucial role in the detection of specific surgically remediable syndromes. These syndromes, when diagnosed by MR and other confirmatory studies such as electroencephalography (EEG), positron emission tomography (PET), magnetoencephalography (MEG), and neuropsychological testing, define the essential part of the surgical plan; that is, removal of the disease substrate. The availability of a host of MR techniques enable us to investigate epilepsy not only as a structural pathology but as physiological pathology reflected in abnormal blood flow, metabolism, and synaptic transmission. The mainstay of surgical treatment is the removal of the anatomic pathology, but other MR techniques may be helpful in the delineation of dual pathology in lesional cases, in appreciation of the full extent of microscopic pathology in developmental lesions, and in the imposition of restrictions on the resection based upon functional mapping. Finally, functional and anatomic maps obtained preoperatively can be related directly to the spatial coordinates of the exposed brain in the operating room using MRI-based frameless stereotactic methods. The final outcome, then, is the removal of the disease substrate without injury to adjacent, functionally salient cortical regions.     

Cardiac lipoma: Six-year follow-up with MRI characteristics, and a review of the literature

A total of 63 cardiac lipomas have been reported to date. Although most of these rare tumors cause no symptoms, a few can have a detrimental effect on myocardial function as well as displacing and encasing the coronary arteries. This case of a cardiac lipoma was initially seen in 1982. The lipoma was found to be nonresectable at surgery due to involvement of the coronary arteries. This neoplasm was characterized with magnetic resonance imaging in 1989 on a follow-up visit. Magnetic resonance imaging is shown to be superior to computed tomography for identifying the relationship of the lipoma to the coronary arteries. This is a significant factor in determining resectability.