T1 and proton density at 7 T in patients with multiple sclerosis: an initial study

Magnetic resonance imaging of cortical lesions due to multiple sclerosis (MS) has been hampered by the lesions' small size and low contrast to adjacent, normal-appearing tissue. Knowing cortical lesion T1 and proton density (PD) would be highly beneficial for the process of developing and optimizing dedicated magnetic resonance (MR) sequences through computer modeling of MR tissue responses. Eight patients and seven healthy control subjects were scanned at 7 T using a series of inversion recovery turbo field echo scans with varying inversion times. Regions of interest were drawn in white matter, gray matter, cortical lesions, white matter lesions and cerebrospinal fluid. White matter and gray matter T1s were significantly higher in MS patients than in controls. Cortical and white matter lesion T1 and PD are also presented for the first time. The advantages of ultrahigh field MR imaging will be important for future investigations in MS research and sequence optimization for the detection of cortical lesions.     

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

Introduction

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

Methods

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

Results

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

Conclusion

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

低场MRI系统中线扫描扩散张量成像方法的研究

磁共振扩散张量成像(DTI)是在扩散加权成像(DWI)基础上发展起来的一种新型技术,可以无创伤显示脑白质纤维,诊断脑白质病变. 但是由于各种原因,DTI一般只在超导高场磁共振成像(MRI)仪器上进行,这就限制了这一重要诊断手段临床应用的广泛性. 本文在低场磁共振成像系统上应用线扫描实现了扩散张量成像,并测量了健康志愿者大脑内主要解剖结构的表观扩散系数(ADC)和各项异性分数(FA),得到的数据与高场仪器上的相关数据比较是吻合的. 因此临床上使用在低场强上得到的DTI图像评价脑白质是可行的,而且通常在临床上这也是足够的.     

Diffusion-weighted EPI with magnetization transfer contrast

Capabilities of diffusion-weighted (DW) and magnetization transfer (MT) imaging are well established for tissue characterization in various pathologies individually. However, the effect of suppression of macromolecules on applying MT pulse on signals associated with DW imaging and resulting change in the apparent diffusion coefficient (ADC) of water molecules has not been demonstrated previously. In the present study, we have performed DW echo planar imaging (EPI) with and without MT preparation pulse to see the effect of macromolecular signal suppression on ADC. A total of 10 normal volunteers and 20 patients with different intracranial cystic lesions [abscesses (n=10), cystic tumors (n=5), arachnoid cysts (n=5)] were subjected to DW imaging (b=0 and 1000 s/mm(2)) with and without MT saturation pulse. Analysis of region of interest (ROI) from different areas of white matter in normal volunteers and in the wall and cavity of cystic lesions in patients was carried out for calculating the ADC values. We found a significant increase (P<.05) in the ADC values in brain parenchyma and cavity of those intracranial cystic lesions having considerable amount of proteins after the application of MT preparation pulse except for arachnoid cysts. This is due to the size of the macromolecules present in the normal and abnormal tissue. Our studies suggest that this technique is likely to give a novel image contrast and may be of value in improving the tissue specificity in pathologies associated with variable macromolecular size.     

Short-term evolution of individual enhancing MS lesions studied with magnetization transfer imaging.

We performed serial monthly magnetization transfer (MT) imaging to evaluate the prevalence and evolution of structural changes in individual enhancing lesions from patients with multiple sclerosis (MS). Every 4 weeks for 3 months, we obtained dual echo, magnetization transfer (MT) imaging and, 5 min after SD (0.1 mmol/kg) gadolinium-DTPA injection, T1-weighted scans from 10 patients with early relapsing-remitting MS. We measured the MT ratio (MTR) of enhancing lesions seen on the entry scans on co-registered quantitative MTR images at entry and during the follow up. Fourty-two enhancing lesions were identified on the entry scans. According to the "maximal random fluctuation" detected for the normal-appearing white matter MTR values, 16 (38%) lesions were classified as "increasing MTR" lesions, 21 (50%) as "stable MTR" lesions, and 5 (12%) as "decreasing MTR" lesions. The classification of the lesions after the first month of follow up strongly predicted the classification at the end of the follow up (chi squared = 20.35, p = 0.0004). These results indicate that the enhancing lesion population in MS is heterogeneous, and that reparative mechanisms occurring after blood-brain barrier opening are not efficient in only a minority of the enhancing lesions from patients with early relapsing-remitting MS.     

Differentiation of recurrent brain tumor versus radiation injury using diffusion tensor imaging in patients with new contrast-enhancing lesions

BACKGROUND AND PURPOSE: The purpose of this study was to assess the use of diffusion tensor imaging (DTI) in the evaluation of new contrast-enhancing lesions and perilesional edema in patients previously treated for brain neoplasm in the differentiation of recurrent neoplasm from treatment-related injury. METHODS: Twenty-eight patients with new contrast-enhancing lesions and perilesional edema at the site of previously treated brain neoplasms were retrospectively reviewed. Nine directional echoplanar DTIs with b=1000 s/mm(2) were obtained using a single-shot spin-echo echoplanar imaging. Standardized regions of interest were manually drawn in several regions. Mean apparent diffusion coefficient (ADC), fractional anisotropy (FA) and eigenvalue indices (lambda( parallel) and lambda( perpendicular)) and their ratios relative to the contralateral side were compared in patients with recurrent neoplasm versus patients with radiation injury, as established by histological examination or by clinical course, including long-term imaging studies and magnetic resonance spectroscopy. RESULTS: The ADC values in the contrast-enhancing lesions were significantly higher (P=.01) for the recurrence group (range=1.01 x 10(-3) to 1.66 x 10(-3) mm(2)/s; mean+/-S.D.=1.27+/-0.15) than for the nonrecurrence group (range=0.9 x 10(-3) to 1.31 x 10(-3) mm(2)/s; mean+/-S.D.=1.12+/-0.14). The ADC ratios in the white matter tracts in perilesional edema trended higher (P=.09) in treatment-related injury than in recurrent neoplasm (mean+/-S.D.=1.85+/-0.30 vs. 1.60+/-0.27, respectively). FA ratios were significantly higher in normal-appearing white matter (NAWM) tracts adjacent to the edema in the nonrecurrence group (mean+/-S.D.=0.89+/-0.15) than in those in the recurrence group (mean+/-S.D.=0.74+/-0.14; P=.03). Both eigenvalue indices lambda( parallel) and lambda( perpendicular) were significantly higher in contrast-enhancing lesions in the recurrence group than in those in the nonrecurrence group (P=.02). As well, both eigenvalue indices lambda( parallel) and lambda( perpendicular) were significantly higher in perilesional edema than in normal white matter (P<.01 and P<.001, respectively) in both groups. CONCLUSION: The assessment of diffusion properties, especially ADC values and ADC ratios, in contrast-enhancing lesions, perilesional edema and NAWM adjacent to the edema in the follow-up of new contrast-enhancing lesions at the site of previously treated brain neoplasms may add to the information obtained by other imaging techniques in the differentiation of radiation injury from tumor recurrence.     

Inversion recovery ultrashort echo time magnetic resonance imaging: A method for simultaneous direct detection of myelin and high signal demonstration of iron deposition in the brain – A feasibility study

Multiple sclerosis (MS) causes demyelinating lesions in the white matter and increased iron deposition in the subcortical gray matter. Myelin protons have an extremely short T2* (< 1 ms) and are not directly detected with conventional clinical magnetic resonance (MR) imaging sequences. Iron deposition also reduces T2*, leading to reduced signal on clinical sequences. In this study we tested the hypothesis that the inversion recovery ultrashort echo time (IR-UTE) pulse sequence can directly and simultaneously image myelin and iron deposition using a clinical 3 T scanner. The technique was first validated on a synthetic myelin phantom (myelin powder in D₂O) and a Feridex iron phantom. This was followed by studies of cadaveric MS specimens, healthy volunteers and MS patients. UTE imaging of the synthetic myelin phantom showed an excellent bi-component signal decay with two populations of protons, one with a T2* of 1.2 ms (residual water protons) and the other with a T2* of 290 μs (myelin protons). IR-UTE imaging shows sensitivity to a wide range of iron concentrations from 0.5 to ~ 30 mM. The IR-UTE signal from white matter of the brain of healthy volunteers shows a rapid signal decay with a short T2* of ~ 300 μs, consistent with the T2* values of myelin protons in the synthetic myelin phantom. IR-UTE imaging in MS brain specimens and patients showed multiple white matter lesions as well as areas of high signal in subcortical gray matter. This in specimens corresponded in position to Perl's diaminobenzide staining results, consistent with increased iron deposition. IR-UTE imaging simultaneously detects lesions with myelin loss in the white matter and iron deposition in the gray matter.     

Study on the variations of the apparent diffusion coefficient in areas of solid tumor in high grade gliomas

Present knowledge suggests that in glioblastoma multiforme the value of the apparent diffusion coefficient (ADC) is elevated in the solid part and hyperintense in T1, in spite of the elevated cellularity, and also in areas where peritumoral vasogenic edema is present. The purpose of our study has been to verify in vivo if the ADC increases in areas of solid tumor because of an increased presence of edema, like it happens in areas surrounding the tumor. Sixteen patients with histologically verified glioblastoma multiforme underwent a magnetic resonance (MR) examination with sequences: T1-weighted pre and post contrast, diffusion-weighted at b = 0 and b = 1000 s/mm(2), perfusion-weighted. One hundred sixty-five regions of interest (ROI) have been obtained for all set of patients. In each ROI we have estimated 4 parameters: ADC, intensity of T2-signal normalised to the white matter (SI(T2W)(n)), regional cerebral blood volume (rCBV), T1-signal enhancement (E%). With the SI(T2W)(n) the presence of edema was estimated. For each pair of measured parameters a statistical test of linear regression on the set of all ROI was made. A directed linear correlation between: ADC and SI(T2W)(n) (p 相似文献   

Susac syndrome: serial diffusion-weighted MR imaging

Susac syndrome (SS) is a clinical triad of hearing loss, retinal artery occlusion and encephalopathy. The typical MR imaging findings of multiple focal lesions in the corpus callosum and subcortical white matter can be easily misdiagnosed as multiple sclerosis. On diffusion-weighted (DW) MR imaging, new lesions were hyperintense, with reduced apparent diffusion coefficient (ADC). These lesions later became less prominent or hypointense on subsequent DW MR imaging. Serial DW imaging and ADC maps may be useful in differentiating SS from demyelinating diseases.     

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

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

Increased differentiation of intracranial white matter lesions by multispectral 3D-tissue segmentation: preliminary results

MRI is a very sensitive imaging modality, however with relatively low specificity. The aim of this work was to determine the potential of image post-processing using 3D-tissue segmentation technique for identification and quantitative characterization of intracranial lesions primarily in the white matter. Forty subjects participated in this study: 28 patients with brain multiple sclerosis (MS), 6 patients with subcortical ischemic vascular dementia (SIVD), and 6 patients with lacunar white matter infarcts (LI). In routine MR imaging these pathologies may be almost indistinguishable. The 3D-tissue segmentation technique used in this study was based on three input MR images (T(1), T(2)-weighted, and proton density). A modified k-Nearest-Neighbor (k-NN) algorithm optimized for maximum computation speed and high quality segmentation was utilized. In MS lesions, two very distinct subsets were classified using this procedure. Based on the results of segmentation one subset probably represent gliosis, and the other edema and demyelination. In SIVD, the segmented images demonstrated homogeneity, which differentiates SIVD from the heterogeneity observed in MS. This homogeneity was in agreement with the general histological findings. The LI changes pathophysiologically from subacute to chronic. The segmented images closely correlated with these changes, showing a central area of necrosis with cyst formation surrounded by an area that appears like reactive gliosis. In the chronic state, the cyst intensity was similar to that of CSF, while in the subacute stage, the peripheral rim was more prominent. Regional brain lesion load were also obtained on one MS patient to demonstrate the potential use of this technique for lesion load measurements. The majority of lesions were identified in the parietal and occipital lobes. The follow-up study showed qualitatively and quantitatively that the calculated MS load increase was associated with brain atrophy represented by an increase in CSF volume as well as decrease in "normal" brain tissue volumes. Importantly, these results were consistent with the patient's clinical evolution of the disease after a six-month period. In conclusion, these results show there is a potential application for a 3D tissue segmentation technique to characterize white matter lesions with similar intensities on T(2)-weighted MR images. The proposed methodology warrants further clinical investigation and evaluation in a large patient population.     

Diffusion-weighted imaging with a rapid repeated hole-burning sequence

Diffusion-weighted imaging in the presence of extremely short T2-relaxation time is generally not feasible with a standard PGSE experiment due to the superposed signal decays caused primarily by T2-relaxation and secondarily by diffusion. Here, we present a new method for diffusion-weighted imaging achieved by a nearly T2-independent pre-experiment where a DANTE-pulse train is repeated rapidly.     

Differentiation of high-grade and low-grade intra-axial brain tumors by time-dependent diffusion MRI

IntroductionOscillating gradient spin-echo (OGSE) sequences enable acquisitions with shorter diffusion times. There is growing interest in the effect of diffusion time on apparent diffusion coefficient (ADC) values in patients with cancer. However, little evidence exists regarding its usefulness for differentiating between high-grade and low-grade brain tumors. The purpose of this study is to investigate the utility of changes in the ADC value between short and long diffusion times in distinguishing low-grade and high-grade brain tumors.Material and methodsEleven patients with high-grade brain tumors and ten patients with low-grade brain tumors were scanned using a 3 T magnetic resonance imaging with diffusion-weighted imaging (DWI) using OGSE and PGSE (effective diffusion time [Δ_eff]: 6.5 ms and 35.2 ms) and b-values of 0 and 1000 s/mm². Using a region of interest (ROI) analysis of the brain tumors, we measured the ADC for two Δeff (ADC_Δeff) values and computed the subtraction ADC (ΔADC = ADC_{6.5 ms} − ADC_{35.2 ms}) and the relative ADC (ΔADC = (ADC_{6.5 ms} − ADC_{35.2 ms}) / ADC_{35.2 ms} × 100). The maximum values for the subtraction ADC (ΔADC_max) and the relative ADC (rADC_max) on the ROI were compared between low-grade and high-grade tumors using the Wilcoxon rank-sum test. A P-value <.05 was considered significant. The ROIs were also placed in the normal white matter of patients with high- and low-grade brain tumors, and ΔADC_max values were determined.ResultsHigh-grade tumors had significantly higher ΔADC_max and rADC_max than low-grade tumors. The ΔADC_max values of the normal white matter were lower than the ΔADC_max of high- and low-grade brain tumors.ConclusionThe dependence of ADC values on diffusion time between 6.5 ms and 35.2 ms was stronger in high-grade tumors than in low-grade tumors, suggesting differences in internal tissue structure. This finding highlights the importance of reporting diffusion times in ADC evaluations and might contribute to the grading of brain tumors using DWI.     

Effect of cerebrovascular changes on brain DTI quantitation: a hypercapnia study

Quantitative diffusion tensor imaging (DTI) offers a valuable tool to probe the microstructural changes in neural tissues in vivo, where absolute quantitation accuracy and reproducibility are essential. It has been long recognized that measurement of apparent diffusion coefficient (ADC) using DTI could be influenced by the presence of water molecules in cerebrovasculature. However, little is known about to what extent such blood signal affects DTI quantitation. In this study, we quantitatively examined the effect of cerebral hemodynamic change on DTI indices by using a standard multislice echo planar imaging (EPI) spin echo (SE) DTI acquisition protocol and a rat model of hypercapnia. In response to 5% CO(2) challenge, mean, radial and axial diffusivities measured with diffusion factor (b-value) of b=1.0 ms/μm(2) were found to increase in whole brain (1.52%±0.22%, 1.66%±0.16% and 1.35%±0.37%, respectively), gray matter (1.56%±0.23%, 1.63%±0.14% and 1.47%±0.45%, respectively) and white matter regions (1.45%±0.28%, 1.88%±0.33% and 1.10%±0.26%, respectively). Fractional anisotropy (FA) was found to decrease by 1.67%±0.38%, 1.91%±0.59% and 1.46%±0.30% in whole brain, gray matter and white matter regions, respectively. In addition, these diffusivity increases and FA decreases became more pronounced at a lower b-value (b=0.3 ms/μm(2)). The results indicated that in vivo DTI quantitation in brain can be contaminated by vascular factors on the order of few percentages. Consequently, alterations in cerebrovasculature and hemodynamics can affect the DTI quantitation and its efficacy in characterizing the neural tissue microstructures in normal and diseased states. Caution should be taken in designing and interpreting quantitative DTI studies as all DTI indices can be potentially confounded by physiologic conditions and by cerebrovascular and hemodynamic characteristics.     

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

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

Evaluation of cystic ovarian lesions using apparent diffusion coefficient calculated from reordered turboflash MR images.

Reordered snapshot fast low-angle shot images with, and without, diffusion-perfusion gradients were used for the evaluation of contents of cystic ovarian lesions. Sonographically detected 51 cystic ovarian lesions (13 endometrial cysts, 17 ovarian cysts, 7 serous cystadenomas, 6 mucinous cystadenomas, 8 malignant cystic ovarian tumors) were studied. T1- and T2-weighted images, reordered snapshot fast low-angle shot images with and without diffusion-perfusion gradients (b = 106 and 0 s/mm2, respectively) were obtained. Using these images, apparent diffusion coefficients (ADCs) were calculated in the cystic contents of these lesions. Endometrial cysts and malignant cystic ovarian tumors showed lower ADC values than ovarian cysts, serous cystadenomas and mucinous cystadenomas (p < 0.02). There was no distinct ADC difference among ovarian cysts, serous cystadenomas, mucinous cystadenomas (p > 0.2). In conclusion, diffusion-weighted magnetic resonance imaging is possible to be useful to evaluate cystic contents of ovarian lesions.     

Detecting cortical lesions in multiple sclerosis at 7 T using white matter signal attenuation

Cortical lesions have recently been a focus of multiple sclerosis (MS) MR research. In this study, we present a white matter signal attenuating sequence optimized for cortical lesion detection at 7 T. The feasibility of white matter attenuation (WHAT) for cortical lesion detection was determined by scanning eight patients (four relapsing/remitting MS, four secondary progressive MS) at 7 T. WHAT showed excellent gray matter-white matter contrast, and cortical lesions were hyperintense to the surrounding cortical gray matter, The sequence was then optimized for cortical lesion detection by determining the set of sequence parameters that produced the best gray matter-cortical lesion contrast in a 10-min scan. Despite the B1 inhomogeneities common at ultra-high field strengths, WHAT with an adiabatic inversion pulse showed good cortical lesion detection and would be a valuable component of clinical MS imaging protocols.     

Bi-exponential diffusion signal decay in normal appearing white matter of multiple sclerosis

Purpose

Our aim was to characterize bi-exponential diffusion signal changes in normal appearing white matter of multiple sclerosis (MS) patients.

Methods

Diffusion parameters were measured using mono-exponential (0–1000 s/mm²) and bi-exponential (0–5000 s/mm²) approaches from 14 relapsing-remitting subtype of MS patients and 14 age- and sex-matched controls after acquiring diffusion-weighted images on a 3T MRI system. The results were analyzed using parametric or nonparametric tests and multiple linear regression models.

Results

Mono-exponential apparent diffusion coefficient (ADC) slightly increased in controls (P=.09), but decreased significantly in MS as a function of age, nonetheless an elevated ADC was observed with increasing lesion number in patients. Bi-exponential analyses showed that the increased ADC is the result of decreased relative volume fraction of slow diffusing component (f_s). However, the fast and slow diffusion components (ADC_f, ADC_s) did not change as a function of either age in controls or lesion number and age in MS patients.

Conclusions

These data demonstrated that the myelin content of the white matter affects diffusion in relapsing-remitting subtype of multiple sclerosis that is possibly a consequence of the shift between different water fractions.     

Spin lock and magnetization transfer MR imaging of focal liver lesions

The present study was designed to evaluate tissue contrast characteristics obtained with the spin-lock (SL) technique by comparing the results with those generated with a magnetization transfer(MT)-weighted gradient echo [GRE, echo-time (TE) = 40 ms] sequence. Twenty-eight patients with hepatic hemangiomas (n = 14), or metastatic liver lesions (n = 14) were imaged at 0.1 T by using identical imaging parameters. Gradient echo, single–slice off-resonance MT, and multiple-slice SL sequences were obtained. SL and MT-effects were measured from the focal liver lesions and from normal liver parenchyma. In addition, tissue contrast values for the liver lesions were determined. Statistically significant difference between the SL-effects of the hemangiomas and metastases, and also between the MT-effects of the lesions was observed (p < 0.02). Tissue contrast values for the lesions proved to be quite similar between the SL and MT techniques. Our results indicate that at 0.1 T multiple-slice SL imaging provides MT based tissue contrast characteristics in tissues rich in protein with good imaging efficiency and wide anatomical coverage, and with reduced motion and susceptibility artifacts.