Ex vivo proton MR spectroscopy (1H-MRS) for evaluation of human gastric carcinoma

The present study was performed to determine the characteristics of the biochemical metabolites related to gastric cancer using ex vivo (1)H magnetic resonance spectroscopy (MRS), and to assess the clinical usefulness. A total of 35 gastric specimens resected during surgery for gastric cancer were used to compare MR spectra. A 1.5-T (64-MHz) clinical MR imager equipped with facilities for spectroscopy was used to obtain MR spectra from 33 gastric specimens. High-resolution (1)H nuclear magnetic resonance (NMR) spectra of the remains of two specimens were also examined with a 9.4-T (400-MHz) NMR spectrometer. Localized spectroscopic measurements were performed in two layers of gastric tissue, the proper muscle layer and the composite mucosa/submucosa layer. T(2) FSE and 3D SPGR images were used to determine the voxel size and the location for MRS data collection. MR spectra were obtained using the single-voxel PRESS technique with parameters of TR/TE = 2000/30 ms, NA = 256, and voxel size = 3 x 3 x 3 mm(3) (27 microL). Cancerous and noncancerous gastric tissues in the voxel were determined by histopathological analysis. On 9.4-T ex vivo NMR spectroscopy, the following metabolite peaks were found: lipids at 0.9 ppm (CH(3)) and 1.3 ppm (CH(2)); alanine (beta-CH(3)) at 1.58 ppm; N-Acetyl neuraminic acid (NANA: sialic acid) at 2.03 ppm; and glutathione at 2.25 ppm in normal gastric tissue layers. In the 1.5-T MR system, broad and featureless spectral peaks of the various metabolites in normal human gastric tissue were observed at 0.9 ppm, 1.3 ppm, 2.0 ppm, and 2.2 ppm regardless of gastric tissue layer. In specimens (Borrmann type III) with tubular adenocarcinoma, resonance peaks were observed at 1.26 ppm, 1.36 ppm (doublet of lactate), and 3.22 ppm (choline). Cancer lesions showed decreased levels of lipid peaks, showing the significant lactate doublet peaks, and increased intensity of the choline peak as compared with noncancerous gastric tissue. We found that decreased levels of lipids and increases in lactate and choline peaks in gastric tissue were markers for malignancy in gastric lesions. Information provided by ex vivo (1)H MRS, together with the development of in vivo (1)H MRS with high field strength and high resolution, may be very useful for the diagnosis of gastric cancer in clinical situation.     

Cystic intracranial mass lesions: Possible role of in vivo MR spectroscopy in its differential diagnosis

Thirty-four patients showing cystic intracranial mass lesions on MR imaging were evaluated by in vivo proton MR spectroscopy (MRS) with the aim of detecting lesion-specific spectral patterns that may assist imaging in better tissue characterization. In vivo spectroscopy was performed using stimulated echo acquisition mode with echo times 20 m and 270 m in all, and spin echo with echo time 135 m in 11 patients. All primary neoplasms (intra-as well as extra-axial) showed choline (3.22 ppm) resonance along with lipid and/or lactate (1.3 ppm). It was not possible to grade cystic gliomas based on N-acetyl asparate-to-choline ratio. High-grade gliomas (n = 8) showed lipid/lactate and low-grade gliomas (n = 6) showed only lactate. Seven patients with brain abscess showed resonances only from acetate (1.92 ppm), lactate (1.3 ppm) and alanine (1.5 ppm). Two cases of metastatic adenocarcinoma showed only lipid/lactate. In 7 patients with epidermoid cyst, lactate along with an unassigned resonance at 1.8 ppm was observed and could be easily differentiated from arachnoid cyst (n = 2), which showed only minimal lactate. A case of cystic meningioma could be differentiated from cystic schowannoma by the presence of alanine in the former. It is concluded that MR imaging, when combined with in vivo MRS, may help to better characterize intracranial cystic mass lesions.     

Prospective evaluation of in vivo proton MR spectroscopy in differentiation of similar appearing intracranial cystic lesions

Proton MR spectroscopy (PMRS) has been found to be useful in differentiating various cystic intracranial lesions. The purpose of the present study was to prospectively evaluate the spectral pattern of various cystic lesions of brain with similar imaging appearances and to determine the accuracy of this technique in the differential diagnosis of these lesions. Fifty-one patients with intracranial cystic lesions (21 abscesses, 20 gliomas, 3 hydatid cysts, 3 arachnoid cysts, 1 case each of glioependymal cyst, xanthogranuloma, infarction and acoustic neuroma) were evaluated with conventional MR imaging and in vivo PMRS. Ex vivo PMRS of the cystic contents aspirated at surgery in 31 cases was also done to confirm the in-vivo results. Preoperative diagnosis of the lesions was based on the results of in vivo PMRS. In vivo PMRS accurately predicted the pathology in 92% of the cases. We conclude that in-vivo PMRS complements imaging in better characterization of cystic intracranial mass lesions.     

Detection of rectal cancer and response to concurrent chemoradiotherapy by proton magnetic resonance spectroscopy

Introduction

To diagnose rectal cancer and monitor treatment response after preoperative concurrent chemoradiotherapy (CCRT) in rectal cancer patients using proton-1 magnetic resonance spectroscopy (¹H-MRS).

Materials and Methods

We enrolled 134 rectal cancer patients before treatment, of whom 34 underwent preoperative CCRT and follow-up MR spectroscopy before surgery. ¹H-MRS was performed using a six-channel phased-array coil at 3.0 T. We evaluated the presence of a choline peak at 3.2 ppm, and lipid peaks at 0.9 and 1.3 ppm, and glutamine and glutamate peaks at 2.1-2.3 and 2.7 ppm seen at two TEs (40 and 135 ms). We divided MR spectra patterns into two groups (A and B).

Results

A choline peak at 3.2 ppm seen in both TEs was characteristic for rectal cancer before treatment. Of 103 patients, 55 (53%) showed an elevated choline peak before treatment (type A). Type A spectra were seen in 68% of patients (23/34) before preoperative CCRT. After CCRT, the choline peak disappeared, resulting in only the lipid peak at 1.3 ppm (type B) in 97% of patients (33/34).

Discussion

We optimized a localized in vivo¹H-MRS method for detection of rectal adenocarcinoma and monitoring treatment response after preoperative CCRT. The method appears to be a promising and feasible noninvasive modality.     

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.     

1H magnetic resonance spectroscopy of the normal testis: preliminary findings

PURPOSE: The purpose of this study was to determine the pre- and postpubertal 1H magnetic resonance spectroscopic characteristics of the normal testis to establish baseline values for further clinical studies. MATERIALS AND METHODS: The subjects consisted of male volunteers, of whom 19 were prepubertal with ages between 7 and 13 years and 24 were postpubertal with ages between 19 and 39 years. Their testes were evaluated at 1.5 T with magnetic resonance spectroscopy; in addition, testis volumes were measured. Major metabolite peaks were identified and their ratios were calculated. Metabolite differences of testis between pre- and postpubertal age were analyzed. RESULTS: Major constituents of spectra were 3.21 ppm choline and 0.9-1.3 ppm lipid peaks. At the echo time (TE) spectrum of 31 ms, choline/lipid ratios ranged from 0.35 to 8.30 (mean=1.87) in postpubertal males and from 0.06 to 5.45 (mean=0.88) in prepubertal males (P<.013). At the TE spectrum of 136 ms, choline/lipid ratios ranged from 0.66 to 15.42 (mean=4.09) in postpubertal males and from 0.05 to 4.91 (mean=0.9) in prepubertal males (P<.016). CONCLUSIONS: Choline/lipid ratio was higher in the postpubertal period. The existence of higher choline peak in that age group should be due to the initiation of spermatogenesis. The decrease in the lipid peak may represent the effect of testosterone on testicular tissue or may be due to histochemical changes initiated by puberty. The significant decrease in choline/lipid ratio noted after puberty could represent the presence of spermatogenesis. This hypothesis should be evaluated by further studies on postpubertal subjects with impaired spermatogenesis.     

MnDPDP-enhanced magnetization transfer MR imaging: implications for effective liver imaging

The benefit of combining magnetization transfer (MT) MR imaging technique with liver-specific contrast agent manganese dipyridoxyldiphosphate (MnDPDP) was assessed in our experimental investigation. The study was accomplished by imaging a phantom containing serial concentrations of MnDPDP in cross-linked bovine serum albumin (BSA) with various protein concentrations. A 0.1T clinical MR imager with different parameters for MT and conventional MR sequences were used. The combination of an offset frequency of 8 kHz and an amplitude of 25 microT produced nearly maximal MT effect for all protein samples either without MnDPDP or with different MnDPDP concentrations. With long TRs (TR > 200 ms) MT dramatically improved CNR in conjunction with MnDPDP. With short TRs, the gain in CNR with MT was negligible. However, long TRs with increased number of images are beneficial in liver imaging. We conclude that MT like preparation pulse is useful when paramagnetic contrast agents such as MnDPDP are employed.     

Detection of muscle layer invasion with submillimeter pixel MR images: Staging of bladder carcinoma

Conventional magnetic resonance (MR) images used for the pelvic organs generally have a pixel size of 1.3 mm × 1.3 mm. We obtained images with a higher resolution than conventional images, and evaluated the usefulness of this type of image in staging urinary bladder carcinoma. Twenty-six patients having either transurethral resection of bladder tumor (TUR-BT) or cystectomy were retrospectively studied. T₂-weighted images of the bladder were acquired with a 20 cm field-of-view, a matrix size of 224 × 224 (pixel size: 0.9 mm × 0.9 mm), and a slice thickness of 7 mm using a 0.5 T system. MR appearances of the carcinoma were divided into the following five categories: no abnormality found on the inner surface of the bladder wall (0), high signal layer or protrusion without breakage of the wall (I), partial disruption of the wall (II), transmural disruption of the wall (III), and complete disruption with mass formations in the perivesicular region (IV). These findings were correlated with the TNM pathologic staging determined from each tissue specimen. A prediction for muscle layer invasion was calculated by selecting pathologic stage pT2 and MR category III as a boundary measure. The accuracy was 96.2%, the sensitivity 100.0%, and the specificity 91.7%. The results obtained indicate that submillimeter pixel MR imaging shows promise as a noninvasive method for the preoperative staging of bladder cancers.     

Phased array 3D MR spectroscopic imaging of the brain at 7 T

Ultra-high-field 7 T magnetic resonance (MR) scanners offer the potential for greatly improved MR spectroscopic imaging due to increased sensitivity and spectral resolution. Prior 7 T human single-voxel MR Spectroscopy (MRS) studies have shown significant increases in signal-to-noise ratio (SNR) and spectral resolution as compared to lower magnetic fields but have not demonstrated the increase in spatial resolution and multivoxel coverage possible with 7 T MR spectroscopic imaging. The goal of this study was to develop specialized radiofrequency (RF) pulses and sequences for three-dimensional (3D) MR spectroscopic imaging (MRSI) at 7 T to address the challenges of increased chemical shift misregistration, B1 power limitations, and increased spectral bandwidth. The new 7 T MRSI sequence was tested in volunteer studies and demonstrated the feasibility of obtaining high-SNR phased-array 3D MRSI from the human brain.     

Central neurocytoma: proton MR spectroscopy and diffusion weighted MR imaging findings

Purpose

To present proton magnetic resonance spectroscopy and diffusion-weighted imaging (DWI) findings of central neurocytoma (CN).

Methods and Materials

Imaging findings of seven patients with the histopathological diagnosis of CN (five male and two female; age range, 21–28 years of age) were evaluated retrospectively. In addition to conventional magnetic resonance imaging features, we also assessed the metabolite ratios and tumor normalized apparent diffusion coefficient (NADC), which was calculated by dividing the tumor apparent diffusion coefficient (ADC) values by normal ADC. Approval from our institutional review board was obtained for this review.

Results

The tumor choline/creatine ratios were 5.17±2.38, while N-acetyl aspartate/choline and N-acetyl aspartate/creatine ratios were 0.33±0.15 and 1.84±1.38, respectively. On DWI, tumors had heterogeneous hyperintense appearances when compared with the contralateral parietal lobe white matter and tumor NADC values were 0.63±0.05.

Conclusion

Significantly increased choline/creatine and decreased N-acetyl aspartate/choline ratios with lower NADC values in CN resemble high-grade gliomas and complicate the diagnosis. Familarity its physiologic features would help to presurgical diagnosis of ventricular and exraventricular CNs.     

Feasibility of fast MR imaging of the liver at 1.5 T

A phantom with T1 and T2 relaxation times encompassing normal liver and liver lesions was constructed to evaluate fast magnetic resonance pulse sequences using TR from 21-100 milliseconds, TE 12-60 milliseconds and flip angles from 5 degrees-90 degrees. Ten of these fast MR sequences were then selected and compared with conventional spin-echo sequences in normal volunteers (n = 3) and in patients with liver lesions (n = 6). Subjectively, the fast MR sequences eliminated motion artefacts. Objectively, 8 of 10 fast sequences had signal-to-noise ratios comparable to spin-echo imaging whereas only 2 of 10 had contrast-to-noise ratios that were similar to spin-echo imaging. This preliminary study, performed at 1.5 Tesla, does not show any clear-cut advantage of fast imaging over spin-echo imaging in the detection of liver lesions. The use of a liver tissue equivalent phantom provides a rapid, practical approach in evaluation of fast scans.     

Ovarian Brenner tumors: MR imaging characteristics

This study describes the appearance of Brenner tumors on MR imaging and compares quantitative signal intensity measurements of Brenner tumors with that of other ovarian tumors. A search of pathologic and MR records disclosed patients who had MRIs showing Brenner tumors prior to surgical excision. Patients (21) with other surgically proven ovarian masses were randomly selected for comparison. MR imaging was performed at 1.5 T with phased array multicoils and fast spin echo T2-weighted images. Region-of-interest measurements of signal intensity (SI) were made to calculate signal intensity ratios (SIR = mass SI/muscle SI). Brenner tumors showed significantly lower SIR than other tumors on T2-weighted images (p = 0 .004) and similar SIR on T1-weighted images. Brenner tumors show lower signal intensity on T2-weighted images than other non-fibrous ovarian tumors. This lower signal intensity may result from the extensive fibrous content of these tumors.     

Evaluation of STIR imaging as a complement to spin-echo MR and CT of the porta hepatis/hepatoduodenal ligament

Short TI inversion-recovery (STIR) imaging provides specific advantages over standard spin-echo (SE) MR sequences by producing additive effects of T1 and T2 brightening of pathology and suppression of the signal from surrounding fat. We retrospectively evaluated 12 patients with abnormalities, primarily neoplastic, of the porta hepatis/hepatoduodenal ligament (PH/HdL) with CT and MR imaging, including SE and STIR imaging. Masses on CT were of slightly decreased density compared to liver and seen in contrast to surrounding fat in the PH/HdL region. On MR, T1-weighted images provided comparable anatomic detail to CT, with masses clearly distinguished from surrounding fat due to the low signal intensity of masses as compared to fat. T2-weighted images clearly depicted intrahepatic lesions because of their high signal intensity relative to liver. Increased signal in extrahepatic lesions made them less distinctly seen from surrounding fat. STIR images best demonstrated tumor relative to fat. In six cases, CT was equivalent in demonstrating pathology to the best MR sequence. At least one MR sequence demonstrated pathology better than CT in 6 of 12 cases. In five of these six cases, the STIR sequence was better than CT. Thus, MR, particularly STIR imaging, provides a useful technique in imaging of PH/HdL pathology.     

Magnetization transfer and T2 quantitation in normal appearing cortical gray matter and white matter adjacent to focal abnormality in patients with traumatic brain injury

Traumatic brain injury (TBI) is one of the commonest causes of morbidity and mortality in the developed countries with posttraumatic epilepsy and functional disability being its major sequelae. The purpose of this study was to test the hypothesis whether the normal appearing adjacent gray and white matter regions on T2 and T1 weighted magnetization transfer (MT) weighted images show any abnormality on quantitative imaging in patients with TBI. A total of 51 patients with TBI and 10 normal subjects were included in this study. There were significant differences in T2 and MT ratio values of T2 weighted and T1 weighted MT normal appearing gray matter regions adjacent to focal image abnormality compared to normal gray matter regions in the normal individuals as corresponding contralateral regions of the TBI patient's group (p < 0.05). However the adjoining normal appearing white matter quantitative values did not show any significant change compared to the corresponding contralateral normal white matter values. We conclude that quantitative T2 and MT ratio values provide additional abnormality in patients with TBI that is not discernable on conventional T2 weighted and T1 weighted MT imaging especially in gray matter. This additional information may be of value in overall management of these patients with TBI.     

Recurrent hepatocellular carcinoma versus radiation-induced hepatic injury: differential diagnosis with MR imaging

The objective of this study was to assess the value of MR imaging in the differentiation between a recurrent hepatocellular carcinoma (HCC) and a radiation-induced hepatic injury. Nine male patients with suspected recurrence after radiotherapy for HCC underwent T(2)-, T(1)-weighted imaging and Gd-DTPA enhanced dynamic studies. T(2) relaxation times, signal intensity ratios in T(1)-weighted images (WI) and the relative enhancement of the dynamic study were calculated. Recurrent tumors and the irradiated area showed similar image characteristics: hypointense in T(1)-WI and hyperintense in T(2)-WI. T(2) values and signal intensity ratios in the T(1)-WI were not significantly different. In the gadolinium-enhanced dynamic study, a recurrent HCC showed early enhancement, followed by a rapid washout. However, the irradiated liver parenchyma showed hyperintensity from an early phase, and contrast enhancement tended to be more prominent and prolonged at the end of the dynamic studies. The characteristic findings of the dynamic MR study enable us to distinguish between a recurrent HCC and a radiation-induced hepatic injury.     

Improvement of image quality using BLADE sequences in brain MR imaging

The purpose of this study is to compare two types of sequences in brain magnetic resonance (MR) examinations of uncooperative and cooperative patients. For each group of patients, the pairs of sequences that were compared were two T2-weighted (T2-W) fluid attenuated inversion recovery sequences with different k-space trajectories (conventional Cartesian and BLADE) and two T2-TSE weighted with different k-space trajectories (conventional Cartesian and BLADE). Twenty-three consecutive uncooperative patients and 44 cooperative patients, who routinely underwent brain MR imaging examination, participated in the study. Both qualitative and quantitative analyses were performed based on the signal-to-noise ratio, contrast-to-noise ratio (CNR), and relative contrast (ReCon) measures of normal anatomic structures. The qualitative analysis was performed by experienced radiologists. Also, the presence of motion, other (e.g., Gibbs, susceptibility artifacts, phase encoding from vessels) artifacts and pulsatile flow artifacts was evaluated.     

Differentiation between intra-axial metastatic tumor progression and radiation injury following fractionated radiation therapy or stereotactic radiosurgery using MR spectroscopy, perfusion MR imaging or volume progression modeling

Objective

To determine the accuracy of magnetic resonance spectroscopy (MRS), perfusion MR imaging (MRP), or volume modeling in distinguishing tumor progression from radiation injury following radiotherapy for brain metastasis.

Methods

Twenty-six patients with 33 intra-axial metastatic lesions who underwent MRS (n=41) with or without MRP (n=32) after cranial irradiation were retrospectively studied. The final diagnosis was based on histopathology (n=4) or magnetic resonance imaging (MRI) follow-up with clinical correlation (n=29). Cho/Cr (choline/creatinine), Cho/NAA (choline/N-acetylaspartate), Cho/nCho (choline/contralateral normal brain choline) ratios were retrospectively calculated for the multi-voxel MRS. Relative cerebral blood volume (rCBV), relative peak height (rPH) and percentage of signal-intensity recovery (PSR) were also retrospectively derived for the MRPs. Tumor volumes were determined using manual segmentation method and analyzed using different volume progression modeling. Different ratios or models were tested and plotted on the receiver operating characteristic curve (ROC), with their performances quantified as area under the ROC curve (AUC). MRI follow-up time was calculated from the date of initial radiotherapy until the last MRI or the last MRI before surgical diagnosis.

Results

Median MRI follow-up was 16 months (range: 2-33). Thirty percent of lesions (n=10) were determined to be radiation injury; 70% (n=23) were determined to be tumor progression. For the MRS, Cho/nCho had the best performance (AUC of 0.612), and Cho/nCho >1.2 had 33% sensitivity and 100% specificity in predicting tumor progression. For the MRP, rCBV had the best performance (AUC of 0.802), and rCBV >2 had 56% sensitivity and 100% specificity. The best volume model was percent increase (AUC of 0.891); 65% tumor volume increase had 100% sensitivity and 80% specificity.

Conclusion

Cho/nCho of MRS, rCBV of MRP, and percent increase of MRI volume modeling provide the best discrimination of intra-axial metastatic tumor progression from radiation injury for their respective modalities. Cho/nCho and rCBV appear to have high specificities but low sensitivities. In contrast, percent volume increase of 65% can be a highly sensitive and moderately specific predictor for tumor progression after radiotherapy. Future incorporation of 65% volume increase as a pretest selection criterion may compensate for the low sensitivities of MRS and MRP.     

Development of a 1.0 T MR microscope using a Nd-Fe-B permanent magnet

A compact 1.0 T MR microscope was developed using a permanent magnet made of high performance Nd-Fe-B magnetic material and a compact MRI console (54 cm (W) x 77 cm (H) x 60 cm (D), 80 kg weight). Since the magnetic field of the permanent magnet had a large temperature coefficient (-1200 ppm/deg), an internal NMR locking technique was developed for the imaging sequences. The performance of the system was evaluated using several biological specimens. As a result, good SNR 3D images at (50 microm)(3)-(200 microm)(3) voxel dimensions were obtained in practical imaging times (0.5-7.5 hours). Thus we have concluded that the permanent-magnet compact MR microscope has great promise as a research or analytical tool.     

Proton MR spectroscopy of cerebellitis

Single voxel proton MR spectroscopy ((1)H-MRS) of the vermis was obtained in two patients with cerebellitis. In the acute phase (1)H-MRS revealed low N-acetyl-aspartate (NAA)/creatine (Cr) and NAA/choline (Cho) and normal Cho/Cr ratios. Decrease of the concentration of NAA was confirmed by quantitative analysis in one patient. The NAA/Cr and NAA/Cho ratios and NAA concentration were increased in (1)H-MRS examinations obtained 10 and 24 months after the acute episode. (1)H-MRS demonstrates reversible metabolite changes in cerebellitis.     

Metabolite ratios to assumed stable creatine level may confound the quantification of proton brain MR spectroscopy

In localized brain proton MR spectroscopy ((1)H-MRS), metabolites' levels are often expressed as ratios, rather than as absolute concentrations. Frequently, their denominator is the creatine [Cr], which level is explicitly assumed to be stable in normal as well as in many pathologic states. The rationale is that ratios self-correct for imager and localization method differences, gain instabilities, regional susceptibility variations and partial volume effects. The implicit assumption is that these benefits are worth their cost(w)-(w) propagation of the individual variation of each of the ratio's components. To test this hypothesis, absolute levels of N-acetylaspartate [NAA], choline [Cho] and [Cr] were quantified in various regions of the brains of 8 volunteers, using 3-dimensional (3D) (1)H-MRS at 1.5 T. The results show that in over 50% of approximately 2000 voxels examined, [NAA]/[Cr] and [Cho]/[Cr] exhibited higher coefficients of variations (CV) than [NAA] and [Cho] individually. Furthermore, in approximately 33% of these voxels, the ratios' CVs exceeded even the combined constituents' CVs. Consequently, basing metabolite quantification on ratios and assuming stable [Cr] introduces more variability into (1)H-MRS than it prevents. Therefore, its cost exceeds the benefit.