MRI evaluation of AIDS-related encephalopathy: toxoplasmosis vs. lymphoma

The spectrum of cranial MRI findings was evaluated in 113 patients with the acquired immunodeficiency syndrome, assessing lesion number, size, location, and configuration in association with the autopsy and/or biopsy results. Correlation of cranial MRI and CT was performed in 32 patients. MRI was shown to be superior in sensitivity of lesion detection demonstrating more lesions than CT in 14 studies (44%) and equivalent information in 18 studies (56%). In no case did CT demonstrate lesions not detected on MRI. We conclude that MRI should be the study of choice in evaluating AIDS-related encephalopathy. Multiple lesions that involve both deep gray matter and white matter suggest the possibility of CNS lymphoma. The "target" appearance on MRI is not helpful in distinguishing toxoplasmosis from lymphoma.     

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.     

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 Evaluation of diabetic muscle infarction

Diabetic muscle infarction (DMI) is a painful and potentially serious complication in patients with poorly controlled diabetes mellitus. The incidence of DMI is likely much greater than reports in the literature suggest, perhaps secondary to the difficulty in making the diagnosis and excluding other more serious etiologies. This paper describes the role of MRI in the evaluation of a diabetic patient with a painful, swollen limb. Early application of MRI can more accurately classify the disease process and focus the differential diagnosis, thus avoiding the hazards of medical therapy associated with other etiologies such as deep venous thrombosis, cellulitis, or osteomyelitis. This paper describes the evaluation and diagnostic pitfalls encountered in two patients. MRI techniques and applications are presented with a discussion of clinical and radiological differential diagnoses.     

Quantitative assessment of skeletal muscle activation using muscle functional MRI

The purpose of the present study is to determine whether muscle functional MRI (mfMRI) can be used to obtain three-dimensional (3-D) images useful for evaluating muscle activity, and if so, to measure the distribution of muscle activity within a medial gastrocnemius (MG) muscle. Seven men performed 5 sets of 10 repetitions of a calf-raise exercise with additional 15% of body-weight load. Magnetic resonance images were obtained before and immediately after the exercise. To threshold images, only those pixels showing transverse relaxation time (T2) greater than the mean+1 S.D. of the entire regions of interest (ROIs) in the preexercise image and T2 lower than the mean+1 S.D. of the entire ROIs in the postexercise image were identified. The survived pixels showing T2 are defined as active muscle. Those thresholded images were 3-D reconstructed, and this was used to determine area of active muscle along transverse, longitudinal and vertical axes. At the exercise level used in the present study, the percentage volume of activated muscle in the MG was 62.8+/-4.5%. There was a significant correlation between percentage volume of activated muscle and integrated electromyography (r=.78, P<.05). Percentage areas of activated muscle were significantly larger in the medial than in the lateral region, in the anterior than in the posterior region and in the distal than in the proximal region (P<.05). These results suggest that mfMRI can be used to evaluate the muscle activity and to determine intramuscular variations of activity within skeletal muscle.     

Intrauterine devices and uterine peristalsis: evaluation with MRI

Intrauterine devices (IUDs) have been viewed as an effective form of contraception. However, the mechanism by which IUDs disturb fertility remains controversial. This study aimed to evaluate the effects of IUDs on uterine contractility using cine MR. Eleven healthy female volunteers of reproductive age bearing IUDs and 12 women not bearing IUDs were evaluated during the periovulatory phase. MR images were obtained with a 1.5-T magnet, acquiring 60 serial images every 3 s via half-Fourier acquisition single-shot turbo spin echo to be displayed on cine mode. Assessments were based on (a) the presence of peristaltic waves, (b) the frequency and direction of peristaltic waves and (c) the extent of peristaltic waves. Static images were evaluated for thickness of the junctional zone (JZ) and myometrium. A fundo-cervical (FC)-directed peristaltic wave was identified in 4 of 11 IUD-bearing subjects and in only 1 of 12 subjects from the control group. FC waves extended through more than half of the thickness of the myometrium. Peristaltic frequency in IUD users (5.0/3 min) was less than that of the control group (6.5/3 min). The JZ and myometrium were significantly thicker in IUD users. FC-directed waves were more often observed in IUD-bearing subjects, which might explain the inhibition of active sperm transport.     

Granulomatous hepatitis: MRI findings.

The purpose of this study was to describe the magnetic resonance imaging findings of granulomatous hepatitis on T1-weighted, T2-weighted and postgadolinium images. Eight patients with histopathological diagnosis of granulomatous hepatitis were evaluated in this study. MRI examinations included precontrast T1-weighted breath-hold spoiled gradient echo, breathing independent STIR sequences, and T1-weighted breath-hold spoiled gradient-echo sequence following after i.v. gadolinium administration in arterial, intermediate and late phases. Diffuse nodular liver involvement was visualized in all patients. Nodules were consistent with granulomas and were 0.5-4.5 cm in diameter. Caseating granulomas were intermediate and high signal on T2-weighted, low signal on T1-weighted images. They revealed no enhancement in two patients, and enhanced in one patient. Noncaseating granulomas revealed intermediate signal on T1, and T2-weighted images and increased enhancement on arterial phase images with persisting enhancement in late phase images. Portal lymph nodes were visible in five patients. Splenomegaly was present in five patients. Granulomatous hepatitis has spectrum of MRI features, to be considered in differential diagnosis with other diffuse nodular liver pathologies.     

Skeletal muscle contraction in protecting joints and bones by absorbing mechanical impacts

We have previously hypothesized that the dissipation of mechanical energy of external impact is a fundamental function of skeletal muscle in addition to its primary function to convert chemical energy into mechanical energy. In this paper, a mathematical justification of this hypothesis is presented. First, a simple mechanical model, in which the muscle is considered as a simple Hookean spring, is considered. This analysis serves as an introduction to the consideration of a biomechanical model taking into account the molecular mechanism of muscle contraction, kinetics of myosin bridges, sarcomere dynamics, and tension of muscle fibers. It is shown that a muscle behaves like a nonlinear and adaptive spring tempering the force of impact and increasing the duration of the collision. The temporal profiles of muscle reaction to the impact as functions of the levels of muscle contraction, durations of the impact front, and the time constants of myosin bridges closing, are obtained. The absorption of mechanical shock energy is achieved due to the increased viscoelasticity of the contracting skeletal muscle. Controlling the contraction level allows for the optimization of the stiffness and viscosity of the muscle necessary for the protection of the joints and bones.     

Skeletal muscle metabolism in Duchenne muscular dystrophy (DMD): an in-vitro proton NMR spectroscopy study

The metabolic differences in the skeletal muscle of patients with Duchenne muscular dystrophy (DMD) and normal subjects (controls) were investigated using in-vitro high-resolution proton NMR spectroscopy. In all, 56 metabolites were unambiguously identified in the perchloric acid extract of muscle tissue using one- and two-dimensional NMR. The concentrations of glycolytic substrate glucose (Glc; p < 0.05), gluconeogenic amino acids such as glutamine (Gln; p < 0.05) and alanine (Ala; p < 0.05) and the glycolytic product lactate (Lac; p < 0.05) were statistically significantly lower in DMD patients as compared to controls. A significant reduction in the concentrations of total creatine (TCr; p < 0.05), glycerophosphoryl choline + phosphoryl choline + carnitine (GPC/PC/Car; p < 0.05), choline (Cho; p < 0.05) and acetate (Ace; p < 0.05) was also observed in these patients. Decrease in the level of glucose may be attributed to the reduction in the concentrations of gluconeogenic substrates or membrane abnormalities in degenerated muscle of DMD patients. Lower levels of choline containing compounds indicate membrane abnormalities. Decrease in the concentration of lactate in the muscle of DMD patients may be due to the reduction in anaerobic glycolytic activity or lower substrate concentration. The decrease in the concentration of acetate may reflect reduced transport of fatty acids into mitochondria due to decreased concentration of carnitine in DMD patients. Kreb's cycle intermediate alpha-ketoglutarate was observed only in the diseased muscle, which is suggestive of predominant oxidative metabolism for energy generation.     

Three dimensional texture analysis in MRI: a preliminary evaluation in gliomas

The discrimination of tumor boundaries from normal tissue, as well as the evaluation of tissue heterogeneity and tumor grading often continue to pose a challenge in MRI. Although yielding promising results in various fields of medical imaging, two- dimensional (2D) texture analysis in MRI has, until now, demonstrated a lack of specificity in brain tumor classification. A new three-dimensional (3D) approach using Cooccurrence Matrix analysis is proposed to increase the sensitivity and specificity of brain tumor characterization. A preliminary comparative evaluation of 2D and 3D texture analysis was performed on T(1)-weighted MRI of seven gliomas for characterization of solid tumor, necrosis, edema and surrounding white matter. With 3D compared to 2D method, a better discrimination is obtained between necrosis and solid tumor as well as between edema and solid tumor. Using both methods, peritumoral white matter overlaps with edema, but is completely separated from far homo-lateral matter. This latter shows a complete overlapping with contra-lateral matter. The 3D texture analysis approach could provide a new tool for tumor grading and treatment follow-up, as well as for surgery or radiation therapy planning.     

Mapping of muscle deformation during heating: in situ dynamic MRI and nonlinear registration

We present developments in dynamic magnetic resonance imaging that allow internal structural muscle markers to be followed during heating. This monitoring is based on quantitative characterization of the experimental conditions and their temperature time course. A nonlinear image registration technique was optimized and applied to consecutively acquired images to measure the deformation fields in the muscle. A model coupling local deformation and temperature was obtained, which for the first time takes into account the variations of deformation and temperature in the sample. This modeling opens the way to a better understanding of the mechanisms responsible for mass loss and degradation of the textural properties of muscle during heating.     

3.0-T MRI evaluation of patients with chronic liver diseases: initial observations

PURPOSE: To describe the use of 3.0-T magnetic resonance imaging (MRI) for the evaluation of chronic liver diseases. MATERIALS AND METHODS: Two groups of patients who had chronic liver diseases and underwent 3.0-T MRI for evaluation of the liver were included in the study. The first group of patients included 66 consecutive patients (33 male, 33 female; mean age+/-standard deviation, 56+/-11). The second group of patients included 30 consecutive patients (18 males, 12 females; mean age+/-standard deviation, 53+/-10) in whom Variable-Rate Selective Excitation (VERSE) pulses and improved adjustments procedure were used during the acquisitions. Imaging findings of chronic liver diseases, predetermined artifacts and image quality of all individual sequences in the first group and predetermined artifacts and image quality of T2-weighted sequences in the second group were reviewed retrospectively and independently by two reviewers. chi-Square tests were used to compare the findings between two groups of patients and individual sequences. Kappa statistics were used to determine the extent of agreement between the reviewers. RESULTS: Fifteen dysplastic nodules in 6 of 66 (9%) patients and 12 hepatocellular carcinomas in 11 of 66 (17%) patients were detected. Excluding motion artifacts, three-dimensional (3D) T1-weighted gradient-echo (GE) sequence was the least affected sequence by the artifacts. Image quality of T1-weighted 3D-GE sequences was excellent in 43 of 66 (65%) patients. In-phase and out-of-phase T1-weighted spoiled GE (SGE) images were fair in 62 of 66 (94%) and 61 of 66 (92%) patients, respectively. The image quality of short tau inversion recovery (STIR) and half-Fourier rapid acquisition with relaxation enhancement (RARE) sequences were fair in 31 of 66 (47%) and 53 of 66 (80%) patients. STIR and half-Fourier RARE sequences in the second group demonstrated significantly better image quality (P=.03 and P<.0001). CONCLUSION: 3.0-T MRI allows the acquisition of very high quality postgadolinium 3D-GE sequence, which permitted the detection and characterization of lesions in the setting of chronic liver diseases. The use of VERSE pulses and improved adjustments procedure improved the image quality of T2-weighted sequences. In-phase/out-of-phase SGE sequences are at present of fair quality.     

Automatic assessment of cardiac function from short-axis MRI: procedure and clinical evaluation

Cardiac magnetic resonance imaging (MRI) provides a wealth of morphological and physiological information. Automatic extraction of this information is possible by implementing various image processing techniques. However, existing procedures mostly rely on extensive human interaction and are seldom evaluated on a clinical scale. In this study, a nearly automatic process that extracts physiological parameters from cardiac MR images has been both developed and clinically evaluated. Raw images were obtained in the short-axis view and acquired by a gradient-cho (GE) protocol. In images selected to be analyzed, the only manual step required is the indication of a point in the center of the left ventricle (LV). From a set of such images, the process extracts endocardial and epicardial contours and calculates left ventricular volumes, mass and ejection fraction (EF). The process implements novel approaches to image processing techniques such as thresholding and shape extraction and can be adapted to other acquisition protocols. The process has demonstrated a clear potential for accurate extraction of the endocardial contour but a lower one with respect to the epicardial contour as a result of the low contrast between myocardium and some surrounding tissues, generated by the gradient-echo protocol. The ability of the process to asses physiological parameters has been subjected to a systematic clinical evaluation, which compared parameters, derived manually and automatically, in 10 healthy subjects and 10 patients. The evaluation has indicated that although individual volumes and mass were not accurately assessed, the automatic process has shown high potential for assessing the ejection fraction with relatively high accuracy and reliability.     

Spectroscopic MRI: a tool for the evaluation of systemic lipid storage disease

Spectroscopic MR imaging allows to measure the lipid content of a region inside the human body. This technique has been applied to the case of a woman with a severe multisystemic triglyceride storage disease. Lipid contents of liver, pancreas, kidneys, left ventricle, skeletal muscles (calves, thighs, arms) were measured by using the Dixon spectroscopic imaging sequence. In some heterogeneous muscles, localized proton spectra were recorded. Results agreed with clinical findings (muscle weakness, normal renal and cardiac function, diabetes). These techniques could help to quantify the severity of the disease and to follow up its evolution under therapy.     

Post-pneumonectomy evaluation of the chest: a prospective comparative study of MRI with CT

A comparative study of 11 pneumonectomized patients was undertaken in order to evaluate the respective advantages and drawbacks of MRI and CT in post-operative follow-up. Nine patients were healthy at the time of the study and two presented with tumor recurrence. MR examination included 500/40 ms axial, and frontal 800/40-80 ms or 1300/60-120 ms nongated spin echo sequences. MRI was slightly more efficient in identifying vascular stump and main nodal stations, and detected better than CT tumoral and metastatic spread in cancer recurrences. It was as informative as CT in evaluating postpneumonectomy space and bronchial stump. It was noncontributory in the detection of calcifications. Although clips were visible with MRI, their location was less definite than with CT, a potential pitfall when radiotherapy is planned.     

Spatial heterogeneity in the muscle functional MRI signal intensity time course: effect of exercise intensity

It has previously been observed that during isometric dorsiflexion exercise, the time course of T2-weighted signal intensity (SI) changes is spatially heterogeneous. The purpose of this study was to test the hypothesis that this spatial heterogeneity would increase at higher contraction intensities. Eight subjects performed 90-s isometric dorsiflexion contractions at 30% and 60% of maximum voluntary contraction (MVC) while T2-weighted (repetition time/echo time=4000/35 ms) images were acquired. SI was measured before, during and after the contractions in regions of interest (ROIs) in the extensor digitorum longus (EDL) muscle and the deep and superficial compartments of the tibialis anterior (D-TA and S-TA, respectively). For all ROIs at 30% MVC, SI changes were similar. The maximum postcontraction SI was greater than the SI during exercise. At 60% MVC, SI changes during contraction were greater in the S-TA than in the D-TA and EDL. For the EDL and D-TA, the maximum postcontraction SI was greater than those during exercise. For the S-TA, the maximum postcontraction change was greater than the changes at t=8, 20 and 56 s but not the end-exercise value. We conclude that spatial heterogeneity increases during more intense dorsiflexion contractions, possibly reflecting regional differences in perfusion or neural activation of the muscle.     

Geometric distortion in clinical MRI systems Part I: evaluation using a 3D phantom

Recently, a 3D phantom that can provide a comprehensive and accurate measurement of the geometric distortion in MRI has been developed. Using this phantom, a full assessment of the geometric distortion in a number of clinical MRI systems (GE and Siemens) has been carried out and detailed results are presented in this paper. As expected, the main source of geometric distortion in modern superconducting MRI systems arises from the gradient field nonlinearity. Significantly large distortions with maximum absolute geometric errors ranged between 10 and 25 mm within a volume of 240 x 240 x 240 mm(3) were observed when imaging with the new generation of gradient systems that employs shorter coils. By comparison, the geometric distortion was much less in the older-generation gradient systems. With the vendor's correction method, the geometric distortion measured was significantly reduced but only within the plane in which these 2D correction methods were applied. Distortion along the axis normal to the plane was, as expected, virtually unchanged. Two-dimensional correction methods are a convenient approach and in principle they are the only methods that can be applied to correct geometric distortion in a single slice or in multiple noncontiguous slices. However, these methods only provide an incomplete solution to the problem and their value can be significantly reduced if the distortion along the normal of the correction plane is not small.     

Isointense model for the evaluation of tumor-specific MRI contrast agents

An isointense model has been developed to evaluate the applicability of putative tumor-specific MRI contrast agents. Data for tissue relaxation measurements in the presence of Mn(III)TPPS4 are used to illustrate the model. The concentration of contrast agent in tumor tissue required for a tumor/normal tissue signal difference-to-noise ratio of 5 (delta SNR = 5) is determined for a T1 weighted pulse sequence and several hypothetical tumor/normal tissue pairs. The impact of various contrast agent characteristics including initial tumor/normal tissue relaxation values, differential uptake of contrast agent, and in vivo relaxivity are considered. Isointense tumor/normal tissue with longer initial relaxation times are shown to be more affected by the presence of contrast agent. In addition those with initially longer relaxation times have less rigorous requirements for tumor specificity. Typically, a normal tissue/tumor uptake ratio of 1:2 increases the concentration required for delta SNR = 5 by a factor of two compared to that of exclusive uptake in tumor. For the T1 weighted pulse sequence employed, the concentration required for delta SNR = 5 is shown to be linear with the inverse of in vivo relaxivity for the hypothetical tissues considered. The isointense model is also extended to predict the field dependence of tumor-specific contrast enhancement by Mn(III)TPPS4.     

An evaluation of reconstructed ACL impingement on PCL using MRI

Using magnetic resonance imaging (MRI), we evaluated 42 reconstructed anterior cruciate ligaments (ACLs) for impingement on corresponding posterior cruciate ligaments (PCLs) in the knee-extended position. Thirty-one single-bundle ACL reconstructions and 11 double-bundle ACL reconstructions were performed. MR examinations were performed at 3 and 12 months after arthroscopic ACL reconstructions. Using oblique axial MRIs of reconstructed ACLs, we evaluated the shape of the PCL and divided them into two groups: an impingement-positive group and an impingement-negative group. Using sagittal images, we measured the PCL index (Liu's method) and examined the correlation between the degree of impingement and the index. At 3 months after surgery, 14 of 31 single-bundle ACL reconstructions and 5 of 11 double-bundle ACL reconstructions were regarded as positive impingement on PCLs. At 12 months after surgery, 17 of 31 single-bundle ACL reconstructions and 5 of 11 double-bundle ACL reconstructions were regarded as positive impingement on PCLs. At 3 months in single-bundle reconstructions and at 3 and 12 months in all reconstructions, the PCL index of the impingement-positive group was significantly lower than that of the negative group. This study indicated that reconstructed ACLs in the impingement-positive group pressed the PCLs more posteriorly than did the impingement-negative group.