Assessment of the patellofemoral cartilage: Correlation of knee pain score with magnetic resonance cartilage grading and magnetization transfer ratio asymmetry of glycosaminoglycan chemical exchange saturation transfer

PurposeBiochemical imaging of glycosaminoglycan chemical exchange saturation transfer (gagCEST) could predict the depletion of glycosaminoglycans (GAG) in early osteoarthritis. The purpose of this study was to evaluate the relationship between the magnetization transfer ratio asymmetry (MTR_asym) of gagCEST images and visual analog scale (VAS) pain scores in the knee joint.Materials and methodsThis retrospective study was approved by the institutional review board. A phantom study was performed using hyaluronic acid to validate the MTR_asym values of gagCEST images. Knee magnetic resonance (MR) images of 22 patients (male, 9; female, 13; mean age, 50.3 years; age range; 25–79 years) with knee pain were included in this study. The MR imaging (MRI) protocol involved standard knee MRI as well as gagCEST imaging, which allowed region-of-interest analyses of the patellar facet and femoral trochlea. The MTR_asym at 1.0 ppm was calculated at each region. The cartilages of the patellar facets and femoral trochlea were graded according to the Outerbridge classification system. Data regarding the VAS scores of knee pain were collected from the electronic medical records of the patients. Statistical analysis was performed using Spearman's correlation.ResultsThe results of the phantom study revealed excellent correlation between the MTR_asym values and the concentration of GAGs (r = 0.961; p = 0.003). The cartilage grades on the MR images showed significant negative correlation with the MTR_asym values in the patellar facet and femoral trochlea (r = −0.460; p = 0.031 and r = −0.543; p = 0.009, respectively). The VAS pain scores showed significant negative correlation with the MTR_asym values in the patellar facet and femoral trochlea (r = −0.435; p = 0.043 and r = −0.671; p = 0.001, respectively).ConclusionThe pain scores were associated with the morphological and biochemical changes in articular cartilages visualized on knee MR images. The biochemical changes, visualized in terms of the MTR_asym values of the gagCEST images, exhibited greater correlation with the pain scores than the morphological changes visualized on conventional MR images; these results provide evidence supporting the theory regarding the association of patellofemoral osteoarthritis with knee pain scores.     

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.     

Magnetic resonance elastography of the pancreas: Measurement reproducibility and relationship with age

PurposeTo determine magnetic resonance elastography (MRE)-derived stiffness of pancreas in healthy volunteers with emphasis on: 1) short term and midterm repeatability; and 2) variance as a function of age.MethodsPancreatic MRE was performed on 22 healthy volunteers (age range:20–64 years) in a 3 T–scanner. For evaluation of reproducibility of stiffness estimates, the scans were repeated per volunteer on the same day (short term) and one month apart (midterm). MRE wave images were analyzed using 3D inversion to estimate the stiffness of overall pancreas and different anatomic regions (i.e., head, neck, body, and tail). Concordance and Spearman correlation tests were performed to determine reproducibility of stiffness measurements and relationship to age.ResultsA strong concordance correlation (ρ_c = 0.99; p-value < 0.001) was found between short term and midterm repeatability pancreatic stiffness measurements. Additionally, the pancreatic stiffness significantly increased with age with good Spearman correlation coefficient (all ρ > 0.81; p < 0.001). The older age group (> 45 yrs) had significantly higher stiffness compared to the younger group (≤ 45 yrs) (p < 0.001). No significant difference (p > 0.05) in stiffness measurements was observed between different anatomical regions of pancreas, except neck stiffness was slightly lower (p < 0.012) compared to head and overall pancreas at month 1.ConclusionMRE-derived pancreatic stiffness measurements are highly reproducible in the short and midterm and increase linearly with age in healthy volunteers. Further studies are needed to examine these effects in patients with various pancreatic diseases to understand potential clinical applications.     

High-intensity focused ultrasound (HIFU) for adenomyosis: Two-year follow-up results

ObjectiveTo evaluate the long-term improvement of clinical symptoms of adenomyosis after treatment with ultrasound-guided high intensity focused ultrasound (USgHIFU).MethodsFrom January 2010 to December 2011, 350 patients with adenomyosis were treated with USgHIFU. Among the 350 patients, 224 of them completed the two years follow-up. The patients were followed up at 3 months, 1 year, and 2 years after HIFU treatment. Adverse effects and complications were recorded.ResultsAll patients completed HIFU ablation without severe postoperative complications. 203 of the 224 patients who showed varying degrees of dysmenorrhea before treatment had the symptom scores decreased significantly after treatment (P < 0.001). The relief rate was 84.7%, 84.7%, and 82.3%, respectively at 3 months, 1 year, and 2 years after treatment. The menstrual volume in 109 patients with menorrhagia was significantly improved after treatment (P < 0.001) with a relief rate of 79.8%, 80.7%, and 78.9%, respectively at 3 months, 1 year, and 2 years after HIFU treatment.ConclusionWith its ability to sustain long-term clinical improvements, HIFU is a safe and effective treatment for adenomyosis.     

Quantification of myocardial oxygenation in heart failure using blood-oxygen-level-dependent T2* magnetic resonance imaging: Comparison with cardiopulmonary exercise test

PurposeQuantification of myocardial oxygenation (MO) in heart failure (HF) has been less than satisfactory. This has necessitated the use of invasive techniques to measure MO directly or to determine the oxygen demand during exercise using the cardiopulmonary exercise (CPX) test. We propose a new quantification method for MO using blood-oxygen-level-dependent (BOLD) myocardial T2* magnetic resonance imaging (M-T2* MRI), and investigate its correlation with CPX results.MethodsThirty patients with refractory HF who underwent cardiac MRI and CPX test for heart transplantation, and 24 healthy, age-matched volunteers as controls were enrolled. M-T2* imaging was performed using a 3-Tesla and multi-echo gradient-echo sequence. M-T2* was calculated by fitting the signal intensity data for the mid-left ventricular septum to a decay curve. M-T2* was measured under room-air (T2*-air) and after inhalation of oxygen for 10 min at a flow rate of 10 L/min (T2*-oxy). MO was defined as the difference between the two values (ΔT2*). Changes in M-T2* at the two conditions and ΔT2* between the two groups were compared. Correlation between ΔT2* and CPX results was analyzed using the Pearson coefficient.ResultsT2*-oxy was significantly greater than T2*-air in patients with HF (29.9 ± 7.3 ms vs. 26.7 ± 6.0 ms, p < 0.001), whereas no such difference was observed in controls (25.5 ± 4.0 ms vs. 25.4 ± 4.4 ms). ΔT2* was significantly greater for patients with HF than for controls (3.2 ± 4.5 ms vs. -0.1 ± 1.3 ms, p < 0.001). A significant correlation between ΔT2* and CPX results (peak VO₂, r = − 0.46, p < 0.05; O₂ pulse, r = − 0.54, p < 0.005) was observed.ConclusionΔT2* is increased T2*-oxy is greater in patients with HF, and is correlated with oxygen metabolism during exercise as measured by the CPX test. Hence, ΔT2* can be used as a surrogate marker of MO instead of CPX test.     

Monitoring of extra-axial brain tumor response to radiotherapy using pseudo-continuous arterial spin labeling images: Preliminary results

IntroductionTechnological developments have increased the ease of performing perfusion MRI by arterial spin labeling (ASL) in clinical settings. The objective of this study was to evaluate the effects of radiotherapy on extra-axial brain tumors by using MR perfusion images obtained using the pseudo-continuous arterial spin labeling (pcASL) method.Materials and MethodsSix consecutive patients (nine lesions) with extra-axial brain tumors treated only with radiotherapy were enrolled in this study. MR examinations, including pcASL imaging, were performed before and after radiotherapy. Cerebral blood flow, maximum tumor blood flow (mTBF), tumor volume and the ratio of signal enhancement by contrast material (enhancement ratio) were evaluated in serial examinations during the course of radiotherapy. Both the percentage change in mTBF (mTBF ratio) and the percentage change in volume (volume ratio) were calculated using values obtained before and after radiotherapy. The correlation between the volume ratio and the mTBF ratio was assessed using linear regression analysis and Spearman’s rank correlation coefficient (r_s).ResultsA strong correlation was demonstrated between the tumor volume ratio and the mTBF ratio before and after radiotherapy (r_s= 0.93, P< .01). However, no significant correlation was identified between changes in enhancement and volume ratio (r_s= 0.20) or between changes in enhancement and mTBF ratio (r_s= 0.30) before and after radiotherapy.ConclusionThe mTBF measured using pcASL may serve as an additive index for tumor volume when determining tumor response to radiotherapy even in the absence of contrast material.     

Dynamic contrast-enhanced MRI of gastric cancer: Correlations of the pharmacokinetic parameters with histological type,Lauren classification,and angiogenesis

PurposeTo compare the pharmacokinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in gastric cancers of different histological type and Lauren classification, and to investigate whether DCE-MRI parameters correlate with vascular endothelial growth factor (VEGF) expression levels in gastric cancer.MethodsIncluded were 32 patients with gastric cancer who underwent DCE-MRI of the upper abdomen before tumor resection. DCE-MRI parameters including the volume transfer coefficient (K^trans), reverse reflux rate constant (K_ep), and extracellular extravascular volume fraction (V_e) were calculated from the tumor region. Post-operative specimens were used for determination of histological differentiation (i.e., non-mucinous, mucinous, or signet-ring-cell adenocarcinoma) as well as Lauren classification (intestinal type or diffuse type). VEGF expression was examined for assessing angiogenesis. DCE-MRI parameters with different histological type and Lauren classification were compared using independent samples t-test and analysis of variance, respectively. Correlations between DCE-MRI parameters and VEGF expression grades were tested using Spearman correlation analysis.ResultsAmong gastric adenocarcinomas of three different histological types, mucinous adenocarcinomas showed a higher V_e and lower K^trans than the others (P < 0.01). Between the two Lauren classifications, the diffuse type showed a higher V_e than the intestinal type (P < 0.001). The mean K^trans showed a significantly positive correlation with VEGF (r = 0.762, P < 0.001).ConclusionDCE-MRI permits noninvasive prediction of tumor histological type and Lauren classification and estimation of tumor angiogenesis in gastric cancer. DCE-MRI parameters can be used as imaging biomarkers to predict the biologic aggressiveness of a tumor as well as patient prognosis.     

The effect of morphological and microstructural integrity of the corpus callosum on cognition,fatigue and depression in mildly disabled MS patients

AimTo assess the value of callosal morphological and microstructural integrity in assessing different cognitive domains, fatigue and depression in mildly disabled multiple sclerosis (MS) patients.Materials and methodsWe assessed 29 mildly disabled MS patients and 15 healthy controls using 3T magnetic resonance images (T1-weighted, FLAIR and DTI) and neuropsychological tests assessing different cognitive functions, depression and fatigue. We compared the added value of morphological measures (corpus callosum area corrected for total intracranial volume, index, circularity and the more detailed thickness profile) and diffusion features (fractional anisotropy and mean diffusivity) in multilinear models including standard clinical and whole-brain parameters in assessing neuropsychological scores.ResultsEven in mildly disabled MS patients, a significant reduction of the corpus callosum (p < 0.001) was observed in comparison to healthy controls. Callosal area, index and circularity were significantly (p < 0.002) related to whole-brain white matter volume, T2 lesion load and deep grey matter volume, but not with cortical grey matter.The combination of commonly used imaging and clinical parameters explained between 7% (Fatigue) and 50% (processing speed, verbal memory) of the adjusted variance. Inclusion of the mean diffusivity increased the adjusted R² significantly to 69% (p = 0.004) and 71% (p = 0.002) for visuospatial and verbal memory respectively.ConclusionOur results show that callosal features may be used as an alternative to measuring whole-brain volumes. Furthermore, the microstructural integrity of the corpus callosum can help to predict an MS patient's memory performance.     

The prognostic value of proton magnetic resonance spectroscopy in term newborns treated with therapeutic hypothermia following asphyxia

ObjectiveThe purpose of this study was to correlate brain metabolism assessed shortly after therapeutic hyperthermia by ¹H magnetic resonance spectroscopy (MRS), with neurodevelopmental outcome.MethodsAt the age of 6.0 ± 1.8 days, brain metabolites of 35 term asphyxiated newborns, treated with therapeutic hypothermia, were quantified by multivoxel proton MRS of a volume cranial to the corpus callosum, containing both gray and white matter. At the age of 30 months the Bayley Scale of Infant Development-III was performed.ResultsInfants that died had lower gray matter NAA levels than infants that survived (P = 0.005). In surviving infants (28 of 35) there was a trend of negative correlation between gray matter choline levels and gross motor outcome (r = − 0.45). In the white matter, choline correlated negatively with fine motor skills (r = − 0.40), and creatine positively with gross motor skills (r = 0.58, P = 0.02). There was no relationship between lactate levels and outcome.ConclusionMRS of asphyxiated neonates treated by therapeutic hypothermia can serve as predictor of outcome. Unlike previously reported associations in untreated asphyxiates, lactate levels had no relationship with outcome, which indicates that one of the working mechanisms of therapeutic hypothermia is reduction of the metabolic rate.     

Quantifying global-brain metabolite level changes with whole-head proton MR spectroscopy at 3 T

Background and purposeTo assess the sensitivity of non-localized, whole-head ¹H-MRS to an individual's serial changes in total-brain NAA, Glx, Cr and Cho concentrations — metabolite metrics often used as surrogate markers in neurological pathologies.Materials and methodsIn this prospective study, four back-to-back (single imaging session) and three serial (successive sessions) non-localizing, ~3 min ¹H-MRS (TE/TR/TI = 5/10⁴/940 ms) scans were performed on 18 healthy young volunteers: 9 women, 9 men: 29.9 ± 7.6 [mean ± standard deviation (SD)] years old. These were analyzed by calculating a within-subject coefficient of variation (CV = SD/mean) to assess intra- and inter-scan repeatability and prediction intervals. This study was Health Insurance Portability and Accountability Act compliant. All subjects gave institutional review board-approved written, informed consent.ResultsThe intra-scan CVs for the NAA, Glx, Cr and Cho were: 3.9 ± 1.8%, 7.3 ± 4.6%, 4.0 ± 3.4% and 2.5 ± 1.6%, and the corresponding inter-scan (longitudinal) values were: 7.0 ± 3.1%, 10.6 ± 5.6%, 7.6 ± 3.5% and 7.0 ± 3.9%. This method is shown to have 80% power to detect changes of 14%, 27%, 26% and 19% between two serial measurements in a given individual.ConclusionsSubject to the assumption that in neurological disorders NAA, Glx, Cr and Cho changes represent brain-only pathology and not muscles, bone marrow, adipose tissue or epithelial cells, this approach enables us to quantify them, thereby adding specificity to the assessment of the total disease load. This will facilitate monitoring diffuse pathologies with faster measurement, more extensive (~90% of the brain) spatial coverage and sensitivity than localized ¹H-MRS.     

Three-dimensional black-blood T2 mapping with compressed sensing and data-driven parallel imaging in the carotid artery

PurposeTo develop a 3D black-blood T₂ mapping sequence with a combination of compressed sensing (CS) and parallel imaging (PI) for carotid wall imaging.Materials and methodsA 3D black-blood fast-spin-echo (FSE) sequence for T₂ mapping with CS and PI was developed and validated. Phantom experiments were performed to assess T₂ accuracy using a Eurospin Test Object, with different combination of CS and PI acceleration factors. A 2D multi-echo FSE sequence was used as a reference to evaluate the accuracy. The concordance correlation coefficient and Bland-Altman statistics were calculated. Twelve volunteers were scanned twice to determine the repeatability of the sequence and the intraclass correlation coefficient (ICC) was reported. Wall-lumen sharpness was calculated for different CS and PI combinations. Six patients with carotid stenosis > 50% were scanned with optimised sequence. The T₂ maps were compared with multi-contrast images.ResultsPhantom scans showed good correlation in T₂ measurement between current and reference sequence (r = 0.991). No significant difference was found between different combination of CS and PI accelerations (p = 0.999). Volunteer scans showed good repeatability of T₂ measurement (ICC: 0.93, 95% CI 0.84–0.97). The mean T₂ of the healthy wall was 48.0 ± 9.5 ms. Overall plaque T₂ values from patients were 54.9 ± 12.2 ms. Recent intraplaque haemorrhage and fibrous tissue have higher T₂ values than the mean plaque T₂ values (88.1 ± 6.8 ms and 62.7 ± 9.3 ms, respectively).ConclusionThis study demonstrates the feasibility of combining CS and PI for accelerating 3D T₂ mapping in the carotid artery, with accurate T₂ measurements and good repeatability.     

Assessment of the link between quantitative biexponential diffusion-weighted imaging and contrast-enhanced MRI in the liver

PurposeTo investigate if intravoxel incoherent motion (IVIM) modeled diffusion-weighted imaging (DWI) can be linked to contrast-enhanced (CE-)MRI in liver parenchyma and liver lesions.MethodsTwenty-five patients underwent IVIM-DWI followed by multiphase CE-MRI using Gd-EOB-DTPA (n = 20) or Gd-DOTA (n = 5) concluded with IVIM-DWI. Diffusion (D_slow), microperfusion (D_fast), its fraction (f_fast), wash-in-rate (R_early) and late-enhancement-rate (R_late) of Gd-EOB-DTPA were calculated voxel-wise for the liver. Parenchyma and lesions were segmented. Pre-contrast IVIM was compared 1) between low, medium and high R_early for parenchyma 2) to post-contrast IVIM substantiated with simulations 3) between low and high R_late per lesion type.ResultsD_fast and f_fast increased (P < 0.001) with 25.6% and 33.8% between low and high R_early of Gd-EOB-DTPA. D_slow decreased (− 15.0%; P < 0.001) with increasing R_early. Gd-DOTA demonstrated similar observations. f_fast (+ 10%; P < 0.001) and D_fast (+ 6.6%; P < 0.001) increased after Gd-EOB-DTPA, while decreasing after Gd-DOTA (− 4.2% and − 5.7%, P < 0.001) and were confirmed by simulations. For focal nodular hyperplasia lesions (n = 5) D_fast and f_fast increased (P < 0.001) with increasing R_late, whereas for hepatocellular carcinoma (n = 4) and adenoma (n = 7) no differences were found.ConclusionMicroperfusion measured by IVIM reflects perfusion in a way resembling CE-MRI. Also IVIM separated intra- and extracellular MR contrast media. This underlines the potential of IVIM in quantitative liver imaging.     

Perfusion of the uterine junctional zone in nulliparous and primiparous women assessed by DCE-MRI,as a function of menstrual cycle and hormonal contraception

PurposeTo evaluate the perfusion parameters of inner and outer myometrium in healthy nulliparous and primiparous women who are and who are not currently using hormonal contraceptives by means of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Material and methodsWe performed pelvic 1.5 T DCE-MRI on 98 women: 18 nulliparous non-users, 30 nulliparous users, 12 primiparous non-users and 38 primiparous users of hormonal contraception (mean age respectively 26.4, 25.8, 30.23 and 28.18 years). The nulliparous non-users underwent DCE-MRI investigations during their follicular, ovulatory and luteal phase. Perfusion parameters (iAUC/volume, Ktrans, Kep and Ve) were assessed in the anterior and posterior junctional zone (JZ), outer myometrium and cervix.ResultsIn nulliparous non-users, the mean Ktrans and iAUC/volume showed a decrease from follicular to luteal phase (0.82 vs 0.55 min^− 1 for Ktrans, p = 0/027 and 1.28 vs 0.68 for iAUC/volume, p < 0.001). The anterior JZ demonstrated lower Ktrans (p = 0.050) and higher Kep (p = 0.012), in nulliparous non-users, lower Ktrans in nulliparous users (p < 0.001) and lower Ve in primiparous users (p = 0.012) than the anterior outer myometrium. Ktrans at the anterior and posterior JZ wall in nulliparous users was lower than in non-users (p = 0.001 and p = 0.013) and Ve at the anterior JZ wall in primiparous users was lower than in non-users (p = 0.044).ConclusionThis study provides data on normal perfusion parameters of inner and outer myometrium, which may be potentially useful in assisted reproductive therapy.     

Quantitative Dixon MRI sequences to relate muscle atrophy and fatty degeneration with range of motion and muscle force in brachial plexus injury

BackgroundAssessment of muscle atrophy and fatty degeneration in brachial plexus injury (BPI) could yield valuable insight into pathophysiology and could be used to predict clinical outcome. The objective of this study was to quantify and relate fat percentage and cross-sectional area (CSA) of the biceps to range of motion and muscle force of traumatic brachial plexus injury (BPI) patients.MethodsT1-weighted TSE sequence and three-point Dixon images of the affected and non-affected biceps brachii were acquired on a 3 Tesla magnetic resonance scanner to determine the fat percentage, total and contractile CSA of 20 adult BPI patients. Regions of interest were drawn by two independent investigators to determine the inter-observer reliability. Paired Students' t-test and multivariate analysis were used to relate fat percentage, total and contractile CSA to active flexion and biceps muscle force.ResultsThe mean fat percentage 12 ± 5.1% of affected biceps was higher than 6 ± 1.0% of the non-affected biceps (p < 0.001). The mean contractile CSA 8.1 ± 5.1 cm² of the affected biceps was lower than 19.4 ± 4.9 cm² of the non-affected biceps (p < 0.001). The inter-observer reliability was excellent (ICC 0.82 to 0.96). The contractile CSA contributed most to the reduction in active flexion and muscle force.ConclusionQuantitative measurement of fat percentage, total and contractile CSA using three-point Dixon sequences provides an excellent reliability and relates with active flexion and muscle force in BPI.     

A 32-channel coil system for MR vessel wall imaging of intracranial and extracranial arteries at 3T

PurposeTo develop a RF coil system for joint imaging of intracranial and extracranial arterial vessel wall at 3T.Materials and methodThe coil system consists of a 24-channel head coil combined with an 8-channel carotid coil. It is compared with a standard coil configuration (12-channel head coil + 4-channel neck coil + 8-channel carotid coil) for SNR and g-factors in phantoms and healthy volunteers. The clinical relevance of the proposed coil system is also evaluated in patients.ResultsIn phantom experiments, the SNR of the proposed coil system is 53% higher than the maximum SNR of the standard coil configuration at the center of the phantom which usually corresponds to the intracranial region of the head. The g-factors of the proposed coil system in the sagittal plane are lower than the standard coil configuration (by 10.8% and 26.6% for R = 2 and 4 respectively) in the same experiment. In healthy volunteer experiments, 55% of the pixels have SNR above 100 for the proposed coil system, which is 33% more than that of the standard coil configuration. The maximum g-factors in the standard configuration are higher than those from the new coil design by 12% at R = 2 and up to 36% at R = 4 in the sagittal plane. In patients, in-vivo intracranial and extracranial arterial wall images at an isotropic spatial resolution of 0.6 mm can be acquired using the proposed coil system. Plaques are well depicted from the images.ConclusionsThe performance of the proposed coil set is superior to the standard coil configuration, providing high SNR, low g-factor and good spatial coverage needed for simultaneous high resolution imaging of intracranial and extracranial arterial walls. Images acquired in 7.6 min using the proposed coil system can achieve an isotropic spatial resolution of 0.6 mm and can be used to depict plaques on the intracranial and extracranial arterial walls in patients.     

Alterations of the optic pathway between unilateral and bilateral optic nerve damage in multiple sclerosis as revealed by the combined use of advanced diffusion kurtosis imaging and visual evoked potentials

ObjectivesWe investigated changes in the optic tract and optic radiation in patients with multiple sclerosis (MS) by comparing unilateral and bilateral optic nerve damage assessed based on visual evoked potentials (VEPs) using advanced diffusion MR metrics.MethodsIn 21 MS patients, diffusion MRI was performed. Maps of fractional anisotropy, apparent diffusion coefficient (ADC), and mean kurtosis (MK) were computed. On the basis of the P100 latency in VEPs, the MS patients were divided into three groups: bilateral (n = 7), unilateral (n = 7), and no abnormality (n = 7). Their optic tracts and optic radiations were analyzed with diffusion MRI-based fiber tracking. We also investigated the correlations between diffusion parameters and VEPs (n = 21).ResultsIn the optic tract, the diffusion changes in each of the three groups showed step-like changes. The diffusion changes in the optic radiations of the unilateral group were similar to those in the normal VEP group. Only the bilateral group showed significantly higher ADC and lower MK relative to the other two groups (P < 0.05, Steel–Dwass multiple-comparison test). A significant positive correlation between VEP latency and ADC and a significant negative correlation between VEP latency and MK were observed (P < 0.01, Spearman's correction).ConclusionsWe first evaluated the relationship between VEPs and DKI and concluded that the lateral geniculate nucleus may compensate for unilateral damage in the pre-geniculate optic pathway via neural plasticity.     

R1ρ dispersion and sodium imaging in human calf muscle

PurposeTo evaluate the magnitude of chemical exchange effects and R_1ρ dispersion in muscle and their relationship to tissue sodium levels with aging.MethodsSeven healthy volunteers (aged 24 to 87 years, median age 47) underwent MRI to assess tissue sodium levels and water T_1ρ values at different spin-locking frequencies in calf muscles. T_1ρ values at each locking field were computed based on a three-parameter mono-exponential model to fit signals obtained at different locking times, and R_1ρ (= 1/T_1ρ) rates were compared at different locking fields. In particular, the dispersion of R_1ρ (ΔR_1ρ = R_1ρ(0 Hz) − R_1ρ(500 Hz)) was examined as a function of subject age. Muscle sodium content was calculated by comparing signal intensities between tissues and reference standards within the same image. The variations of ΔR_1ρ with age and sodium were analyzed by linear regression.ResultsT_1ρ values and sodium content both increased with age. R_1ρ dispersion also increased with age and showed a strong linear correlation (correlation coefficient r = 0.98, P = 0.000578) with sodium content.ConclusionΔR_1ρ reports on the contribution of labile protons such as hydroxyls which may be associated with macromolecule accumulation in the extracellular matrix (ECM). An increase of sodium signal suggests an enlarged ECM volume fraction and/or an increase in sodium concentration, which occurs during normal aging. The strong correlation between ΔR_1ρ and sodium is likely the consequence of increased ECM and density of total charged sites within the matrix from molecules such as collagens and proteoglycans. The results from this study show the potential use of R_1ρ dispersion and sodium imaging in the assessment of pathological changes in muscle such as fibrosis.     

Towards intrinsic R2* imaging in the prostate at 3 and 7 tesla

PurposeHypoxia is an important marker for resistance to therapy. In this study, we quantify the macroscopic effects of R2* mapping in prostate cancer patients incorporating susceptibility matching and field strengths effects.Materials and methods91 patients were scanned without endorectal coil (ERC) at 3 T. Only when rectal gas was absent, data was included for analysis. Another group of 10 patients was scanned using a susceptibility matched ERC. To assess the residual contamination of R2 and macroscopic field non-uniformities, a group of 10 patients underwent ultra-high resolution 7 T MRI.ResultsOf the patients scanned at 3 T 60% presented rectal gas and were excluded, due to susceptibility artifacts. At 3 T the tumor was significantly different (P < 0.01) from the healthy surrounding tissue in R2* values at intrapatient level. Using the measured median R2* value of 24.9 s^− 1 at 3 T and 43.2 s^− 1 at 7 T of the peripheral zone, the minimum contribution of macroscopic susceptibility effects is 15% at 3 T.ConclusionR2* imaging might be a promising tool for hypoxia imaging, particularly when minimizing macroscopic susceptibility effects contaminating intrinsic R2* of tissue, such as rectal gas. At 3 T macroscopic effects still contribute 15% in the R2* value, compared to ultra-high resolution R2* mapping at 7 T.     

MR visible localization device for radiographic-pathologic correlation of surgical specimens

PurposeThe detection of small parenchymal hepatic lesions identified by preoperative imaging remains a challenge for traditional pathologic methods in large specimens. We developed a magnetic resonance imaging (MRI) compatible localization device for imaging of surgical specimens aimed to improve identification and localization of hepatic lesions ex vivo.Materials and methodsThe device consists of two stationary and one removable MR-visible grids lined with silicone gel, creating an orthogonal 3D matrix for lesion localization. To test the device, five specimens of swine liver with a random number of lesions created by microwave ablation were imaged on a 3 T MR scanner. Two readers independently evaluated lesion coordinates and size, which were then correlated with sectioning guided by MR imaging.ResultsAll lesions (n = 38) were detected at/very close to the expected localization. Inter-reader agreement of lesion localization was almost perfect (0.92). The lesion size estimated by MRI matched macroscopic lesion size in cut specimen (± 2 mm) in 34 and 35, respectively, out of 38 lesions.ConclusionUse of this MR compatible device for ex vivo imaging proved feasible for detection and three-dimensional localization of liver lesions, and has potential to play an important role in the ex vivo examination of surgical specimens in which pathologic correlation is clinically important.     

Clinical feasibility of 3D-QALAS – Single breath-hold 3D myocardial T1- and T2-mapping

PurposeTo investigate the in-vivo precision and clinical feasibility of 3D-QALAS - a novel method for simultaneous three-dimensional myocardial T1- and T2-mapping.MethodsTen healthy subjects and 23 patients with different cardiac pathologies underwent cardiovascular 3 T MRI examinations including 3D-QALAS, MOLLI and T2-GraSE acquisitions. Precision was investigated in the healthy subjects between independent scans, between dependent scans and as standard deviation of consecutive scans. Clinical feasibility of 3D-QALAS was investigated for native and contrast enhanced myocardium in patients. Data were analyzed using mean value and 95% confidence interval, Pearson correlation, Paired t-tests, intraclass correlation and Bland-Altman analysis.ResultsAverage myocardial relaxation time values and SD from eight repeated acquisitions within the group of healthy subjects were 1178 ± 18.5 ms (1.6%) for T1 with 3D-QALAS, 52.7 ± 1.2 ms (2.3%) for T2 with 3D-QALAS, 1145 ± 10.0 ms (0.9%) for T1 with MOLLI and 49.2 ± 0.8 ms (1.6%) for T2 with GraSE.Myocardial T1 and T2 relaxation times obtained with 3D-QALAS correlated very well with reference methods; MOLLI for T1 (r = 0.994) and T2-GraSE for T2 (r = 0.818) in the 23 patients. Average native/post-contrast myocardial T1 values from the patients were 1166.2 ms/411.8 ms for 3D-QALAS and 1174.4 ms/438.9 ms for MOLLI. Average native myocardial T2 values from the patients were 53.2 ms for 3D-QALAS and 54.4 ms for T2-GraSE.ConclusionsRepeated independent and dependent scans together with the intra-scan repeatability, demonstrated all a very good precision for the 3D-QALAS method in healthy volunteers. This study shows that 3D T1 and T2 mapping in the left ventricle is feasible in one breath hold for patients with different cardiac pathologies using 3D-QALAS.