Effects of blood ΔR2* non-linearity on absolute perfusion quantification using DSC-MRI: Comparison with Xe-133 SPECT

Purpose

To evaluate whether a non-linear blood ΔR₂*-versus-concentration relationship improves quantitative cerebral blood flow (CBF) estimates obtained by dynamic susceptibility contrast (DSC) MRI in a comparison with Xe-133 SPECT CBF in healthy volunteers.

Material and Methods

Linear as well as non-linear relationships between ΔR₂* and contrast agent concentration in blood were applied to the arterial input function (AIF) and the venous output function (VOF) from DSC-MRI. To reduce partial volume effects in the AIF, the arterial time integral was rescaled using a corrected VOF scheme.

Results

Under the assumption of proportionality between the two modalities, the relationship CBF(MRI) = 0.58CBF(SPECT) (r = 0.64) was observed using the linear relationship and CBF(MRI) = 0.51CBF(SPECT) (r = 0.71) using the non-linear relationship.

Discussion

A smaller ratio of the VOF time integral to the AIF time integral and a somewhat better correlation between global DSC-MRI and Xe-133 SPECT CBF estimates were observed using the non-linear relationship. The results did not, however, confirm the superiority of one model over the other, potentially because realistic AIF signal data may well originate from a combination of blood and surrounding tissue.     

Spin labeling artery method perfusion MRI study of SPG4 and SCA3/MJD

Background

Spinocerebellar ataxia type 3 (SCA3) and Machado–Joseph disease (MJD) are similar diseases that are often referred to jointly as SCA3/MJD. As the most common autosomal-dominantly inherited subtype of hereditary spastic paraplegia (HSP), HSP4 (or SPG4) has overlapping symptoms with SCA3/MJD, which hinders their diagnoses. Arterial spin labeling (ASL) is a noninvasive, contrast-agent free, magnetic resonance perfusion imaging method used to obtain maps of the cerebral blood flow (CBF). Here, we investigated the diagnostic value of ASL in SCA3/MJD and SPG4 patients.

Methods

A total of 13 SPG4 cases, 38 SCA3/MJD cases (22 onset patients and 16 genetic abnormality-only patients), and 27 healthy volunteers were examined by ASL. Data were processed to obtain the regional CBF (rCBF) and comparatively studied.

Results

In the pons, cerebellar dentate nucleus, and cerebellar cortex, rCBF of the onset SCA3/MJD group was significantly lower than that of the normal control group. In the cerebellar dentate nucleus and cerebellar cortex, the rCBF of the non-onset SCA3/MJD group was significantly lower than that of the control group. In the pons and cerebellar cortex, the rCBF of the onset SCA3/MJD group was significantly lower than that of the SPG4 group.

Conclusions

SCA3/MJD lesions are mainly located in the cerebellum and brainstem. Gray matter and white matter were both involved, although the deep cerebellar nuclei may be the earliest involved region. Cerebellar and brainstem lesions of SCA3/MJD were more severe than those of SPG4. ASL can aid the diagnosis of SCA3/MJD and SPG4.     

Hepatocellular lesions with increased iron uptake on superparamagnetic iron oxide-enhanced magnetic resonance imaging in cirrhosis or chronic hepatitis: comparison of four magnetic resonance sequences for lesion conspicuity

Purpose

The aim of this study was to determine the adequate MR sequence for the lesion conspicuity of hepatocellular lesions with increased iron uptake on superparamagnetic iron oxide (SPIO)-enhanced MRI.

Materials and Methods

SPIO-enhanced MRI was performed using a 1.5-T system. Among 25 patients with hypovascular hepatocellular nodules on contrast-enhanced dynamic CT (no early enhancement at arterial phase and hypoattenuation at equilibrium phase), 39 lesions with increased iron uptake on SPIO-enhanced MRI were evaluated. SPIO-enhanced MRI included (1) T1-weighted in-phase gradient recalled echo (GRE) images, (2) T2-weighted fast spin echo (FSE) images, (3) T2*-weighted GRE with moderate TE (7 ms) and (4) long TE (12 ms). The lesion-to-liver contrast-to-noise ratios of the hepatocellular nodule and the signal-to-noise ratio (SNR) of the hepatic parenchyma were calculated by one radiologist for a quantitative assessment. MR images were reviewed retrospectively by two independent radiologists to compare the subjective lesion conspicuity in each image set based on a four-point rating scale.

Result

The mean lesion-to-liver contrast-to-noise ratios with T2*-weighted GRE with moderate TE (7 ms) was highest (5.79±3.71) and was significantly higher than those with T1-weighted, in-phase images (3.79±3.23, P<.01), T2-weighted images (2.72±1.52, P<.001) and T2*-weighted GRE with long TE (12 ms) (3.93±2.69, P<.05). The subjective rating of lesion conspicuity was best on the T2*-weighted GRE with moderate TE (7 ms), followed by that on the T2*-weighted GRE with moderate TE (7 ms; P<.05).

Conclusion

T2*-weighted GRE sequence with moderate TE (7 ms) showed high lesion-to-liver contrast-to-noise ratios in hepatocellular lesions with increased iron uptake on SPIO-enhanced MRI, indicating better lesion conspicuity of hypointense hepatocellular nodules in cirrhosis or chronic hepatitis.     

Application of FT-based MMSE deconvolution method for cerebral blood flow measurement in patients with leukoaraiosis

Introduction

The bolus-tracking (BT) technique is the most popular perfusion-weighted (PW) dynamic susceptibility contrast MRI method used for estimating cerebral blood flow (CBF), cerebral blood volume and mean transit time. The BT technique uses a convolution model that establishes the input–output relationship between blood flow and the vascular tracer concentration. Singular value decomposition (SVD)- and Fourier transform (FT)-based deconvolution methods are popular and widely used for estimating PW MRI parameters. However, from the published literature, it appears that SVD is more widely accepted than other methods. In a previous article, an FT-based minimum mean-squared error (MMSE) technique was proposed and simulation experiments were performed to compare it with the well-established circular SVD (oSVD) method. In this study, the FT-based MMSE method has been used to estimate relative CBF (rCBF) in 13 patients with white matter lesions (WMLs) (leukoaraiosis), and results are compared with the widely used oSVD method.

Materials and Methods

Thirteen patients with leukoaraiosis were imaged on a 1.5-T Siemens whole-body scanner. After acquiring the localizer and structural scans consisting of FLAIR (fluid attenuated with inversion recovery), T₁-weighted and T₂-weighted images, perfusion study was implemented as part of the MRI protocol. For each patient and method, two values were calculated: (a) rCBF for normal white matter (NWM) ROI, obtained by dividing the average CBF value in NWM ROI with average CBF in gray matter (GM) ROI, and (b) rCBF for WML ROI, obtained by dividing the average CBF value in WML ROI with average CBF in GM ROI. Results for the two deconvolution methods were computed.

Results and Discussion

A significant (P<.05) decrease in estimated rCBF was observed in the WML in all the patients using the MMSE method, while for the oSVD method, the decrease was observed in all but one patient. Initial results suggest that the MMSE method is comparable to the oSVD method for estimating rCBF in NMW while it may be better than oSVD for estimating rCBF in lesions of low flow. Studies involving a larger patient population may be required to further validate the findings of this work.     

Identification of efferent flow in the superior vena cava and azygos vein confluence using cine phase-contrast MRI: speculation of the role of the azygos arch valves

Purpose

We aimed to evaluate flow patterns in the superior vena cava (SVC) and azygos vein confluence with cine phase-contrast magnetic resonance imaging with consideration for the role played by the azygos arch valves.

Materials and Methods

Two-dimensional cine phase-contrast magnetic resonance images of the SVC and azygos vein confluence were prospectively acquired in 10 healthy volunteers. Flow directions during the cardiac cycle were evaluated quantitatively using sequential flow profile graphs obtained from each orthogonal image and affirmed visually by two radiologists from the oblique sagittal cine images.

Results

Although the blood in the SVC and azygos vein confluence had an afferent flow during the systolic phase, a slight temporal efferent flow during the diastolic phase was quantitatively observed in all cases. Flow in the SVC can also be confirmed visually. The average velocity, average maximum afferent velocity during the systolic phase and average maximum efferent velocity during the diastolic phase of the SVC were 8.7±2.4, 19.9±3.7 and −1.0±3.2 cm/s, respectively; for the azygos vein confluence, these values were 2.2±1.5, 7.1±2.6 and −1.5±1.1 cm/s, respectively.

Conclusion

We verified that a slight temporal efferent flow exists in the SVC and azygos vein confluence during the diastolic phase, which suggests that the usual role of the azygos arch valves is to prevent this physiological retrograde flow.     

A general dual-bolus approach for quantitative DCE-MRI

Purpose

To present a dual-bolus technique for quantitative dynamic contrast-enhanced MRI (DCE-MRI) and show that it can give an arterial input function (AIF) measurement equivalent to that from a single-bolus protocol.

Methods

Five rabbits were imaged using a dual-bolus technique applicable for high-resolution DCE-MRI, incorporating a time resolved imaging of contrast kinetics (TRICKS) sequence for rapid temporal sampling. AIFs were measured from both the low-dose prebolus and the high-dose main bolus in the abdominal aorta. In one animal, TRICKS and fast spoiled gradient echo (FSPGR) acquisitions were compared.

Results

The scaled prebolus AIF was shown to match the main bolus AIF, with 95% confidence intervals overlapping for fits of gamma-variate functions to the first pass and linear fits to the washout phase, with the exception of one case. The AIFs measured using TRICKS and FSPGR were shown to be equivalent in one animal.

Conclusion

The proposed technique can capture even the rapid circulation kinetics in the rabbit aorta, and the scaled prebolus AIF is equivalent to the AIF from a high-dose injection. This allows separate measurements of the AIF and tissue uptake curves, meaning that each curve can then be acquired using a protocol tailored to its specific requirements.     

Model-free arterial spin labelling for cerebral blood flow quantification: introduction of regional arterial input functions identified by factor analysis

PURPOSE: To identify regional arterial input functions (AIFs) using factor analysis of dynamic studies (FADS) when quantification of perfusion is performed using model-free arterial spin labelling. MATERIAL AND METHODS: Five healthy volunteers and one patient were examined on a 3-T Philips unit using quantitative STAR labelling of arterial regions (QUASAR). Two sets of images were retrieved, one where the arterial signal had been crushed and another where it was retained. FADS was applied to the arterial signal curves to acquire the AIFs. Perfusion maps were obtained using block-circulant SVD deconvolution and regional AIFs obtained by FADS. In the volunteers, the ASL experiment was repeated within 24 h. The patient was also examined using dynamic susceptibility contrast MRI. RESULTS: In the healthy volunteers, CBF was 64+/-10 ml/[min 100 g] (mean+/-S.D.) in GM and 24+/-4 ml/[min 100 g] in WM, while the mean aBV was 0.94% in GM and 0.25% in WM. DISCUSSION: Good CBF image quality and reasonable quantitative CBF values were obtained using the combined QUASAR/FADS technique. We conclude that FADS may be a useful supplement in the evaluation of ASL data using QUASAR.     

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.     

Time-resolved and high-resolution MRA in a rabbit model of pulmonary embolism at 7 T: preliminary results

Purpose

Evaluate feasibility of using time-resolved and high-resolution, contrast-enhanced magnetic resonance angiography (MRA) at 7 T for characterization of an animal model of pulmonary embolism.

Methods

MRAs were performed in five rabbits using a 7-T MR scanner. Preceding the MR studies, each rabbit underwent a pulmonary artery catheterization with balloon placement. Two doses of gadodiamide were injected: first during a time-resolved MRA, immediately followed by a high-resolution acquisition. Balloon was then deflated, permitting reperfusion for 5 min. A second dose was then injected and another high-resolution MRA acquired. Measurements of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and vessel cross-sections down to fourth-order branches were made, among other parameters.

Results

Occlusion was detected in all rabbits. Despite a TE of 0.58 ms for the time-resolved MRA, regions of nonuniform enhancement attributed to susceptibility effects at the 7-T field were observed in perfused lung. Mean SNR=7.5±3.3 and 134.2±46.5 for the lung and aorta, respectively, and mean CNR=126.7±46.4 for aorta versus lung were obtained. Diameters of vessels in lung that was never occluded were not statistically different from those in reperfused lung.

Conclusion

Results show that time-resolved and high-resolution MRA of the lung are feasible at 7 T and provide high SNR, CNR and resolution, but TEs smaller than 0.58 ms are required to avoid susceptibility artifacts in time-resolved MRAs.     

High spatial and angular resolution diffusion-weighted imaging reveals forniceal damage related to memory impairment

Introduction

Diffusion tensor imaging (DTI) measures in patients with multiple sclerosis (MS), particularly those measures associated with a specific white matter pathway, have consistently shown correlations with function. This study sought to investigate correlations between DTI measures in the fornix and common cognitive deficits in MS patients, including episodic memory, working memory and attention.

Materials and Methods

Patients with MS and group age- and sex-matched controls underwent high-resolution diffusion scanning (1-mm isotropic voxels) and cognitive testing. Manually drawn forniceal regions of interest were applied to individual maps of tensor-derived measures, and mean values of transverse diffusivity (TD), mean diffusivity (MD), longitudinal diffusivity (LD) and fractional anisotropy (FA) were calculated.

Results

In 40 patients with MS [mean age±S.D.= 42.55±9.1 years; Expanded Disability Status Scale (EDSS)=2.0±1.2; Multiple Sclerosis Functional Composite (MSFC) score=0.38±0.46] and 20 healthy controls (mean age±S.D.= 41.35±9.7 years; EDSS=0.0±0; MSFC score=0.74±0.24), we found that FA, MD and TD values in the fornix were significantly different between groups (P< .03), and patient performance on the Brief Visuospatial Memory Test-Revised (BVMT-R) was correlated with DTI measures (P< .03).

Discussion

These results are consistent with findings of axonal degeneration in MS and support the use of DTI as an indicator of disease progression.     

Correlations between microstructural alterations and severity of cognitive deficiency in Alzheimer's disease and mild cognitive impairment: a diffusional kurtosis imaging study

Object

Diffusional kurtosis imaging (DKI), a natural extension of diffusion tensor imaging (DTI), can characterize non-Gaussian diffusion in the brain. We investigated the capability of DKI parameters for detecting microstructural changes in both gray matter (GM) and white matter (WM) in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) and sought to determine whether these DKI parameters could serve as imaging biomarkers to indicate the severity of cognitive deficiency.

Materials and Methods

DKI was performed on 18 AD patients and 12 MCI patients. Fractional anisotropy, kurtosis and diffusivity parameters in the temporal, parietal, frontal and occipital lobes were compared between the two groups using Mann–Whitney U test. The correlations between regional DKI parameters and mini-mental state examination (MMSE) score were tested using Pearson's correlation.

Results

In ADs, significantly increased diffusivity and decreased kurtosis parameters were observed in both the GM and WM of the parietal and occipital lobes as compared to MCIs. Significantly decreased fractional anisotropy was also observed in the WM of these lobes in ADs. With the exception of fractional anisotropy and radial kurtosis, all the five other DKI parameters exhibited significant correlations with MMSE score in both GM and WM.

Conclusion

Bearing additional information, the DKI model can provide sensitive imaging biomarkers for assessing the severity of cognitive deficiency in reference to MMSE score and potentially improve early detection and progression monitoring of AD based on characterizing microstructures in both the WM and especially the GM.     

Imaging features of small (≤ 3 cm) pancreatic solid tumors on gadoxetic-acid-enhanced MR imaging and diffusion-weighted imaging: an initial experience

Objective

The objective was to determine imaging features that distinguish small (≤3cm) solid pancreatic adenocarcinoma, neuroendocrine tumor (NET) and solid pseudopapillary tumor (SPT) on gadoxetic-acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighed imaging (DWI).

Materials and methods

Twenty-four adenocarcinomas, 10 NETs and 8 SPTs were retrospectively included. Two radiologists analyzed morphologic features, signal intensity of the tumors on MR images including DWI (b=800) and dynamic enhancement pattern with consensus. Tumor-to-parenchyma ratio and tumor apparent diffusion coefficients (ADCs) were quantitatively assessed.

Results

All adenocarcinomas had an ill-defined margin and irregular shape, and more frequently had pancreatic duct dilatation compared with other tumors (P<.05). All SPTs and all but one of the adenocarcinomas (95.8%) had no arterial enhancement with progressively increased enhancement, whereas seven NETs (70%) had arterial enhancement with progressively decreased enhancement (P<.01). The mean value of tumor-to-parenchyma ratio on arterial and portal phases was significantly higher for NETs, and the mean value of tumor ADCs was significantly lower for SPTs than for other tumors (P<.05).

Conclusions

Gadoxetic-acid-enhanced MRI may aid in differentiation between small adenocarcinomas, NETs and SPTs based on morphologic features with dynamic enhancement pattern in adenocarcinomas, dynamic enhancement pattern with tumor-to-parenchyma ration on arterial and portal phases in NETs, and dynamic enhancement pattern with lower ADC value in SPTs.     

Highly accelerated aortic 4D flow MR imaging with variable-density random undersampling

Purpose

To investigate an effective time-resolved variable-density random undersampling scheme combined with an efficient parallel image reconstruction method for highly accelerated aortic 4D flow MR imaging with high reconstruction accuracy.

Materials and Methods

Variable-density Poisson-disk sampling (vPDS) was applied in both the phase-slice encoding plane and the temporal domain to accelerate the time-resolved 3D Cartesian acquisition of flow imaging. In order to generate an improved initial solution for the iterative self-consistent parallel imaging method (SPIRiT), a sample-selective view sharing reconstruction for time-resolved random undersampling (STIRRUP) was introduced. The performance of different undersampling and image reconstruction schemes were evaluated by retrospectively applying those to fully sampled data sets obtained from three healthy subjects and a flow phantom.

Results

Undersampling pattern based on the combination of time-resolved vPDS, the temporal sharing scheme STIRRUP, and parallel imaging SPIRiT, were able to achieve 6-fold accelerated 4D flow MRI with high accuracy using a small number of coils (N = 5). The normalized root mean square error between aorta flow waveforms obtained with the acceleration method and the fully sampled data in three healthy subjects was 0.04 ± 0.02, and the difference in peak-systolic mean velocity was − 0.29 ± 2.56 cm/s.

Conclusion

Qualitative and quantitative evaluation of our preliminary results demonstrate that time-resolved variable-density random sampling is efficient for highly accelerating 4D flow imaging while maintaining image reconstruction accuracy.     

Altered hemispheric symmetry found in left-sided mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE/HS) but not found in right-sided MTLE/HS

Purpose

The purpose was to investigate the altered hemispheric asymmetry in patients with mesial temporal lobe epilepsy with unilateral hippocampus sclerosis (MTLE/HS).

Materials and methods

This study examined the hemispheric asymmetry of regional gray matter (GM) and white matter (WM) volume among a group of 13 patients with left-sided MTLE/HS, a group of 10 patients with right-sided MTLE/HS and a group of 21 age- and gender- matched healthy controls by optimized voxel-based morphometry (VBM) based on magnetic resonance imaging.

Results

Compared to healthy controls, abnormal asymmetries were detected in the left-sided MTLE/HS patients. The left-sided MTLE/HS patients had more GM asymmetries (L<R) in the temporal lobes, including the inferior temporal gyrus, middle temporal gyrus and parahippocampal gyrus. There was significant asymmetry (L<R) in subcortical WM of the mesial temporal lobe in left-sided MTLE/HS patients. However, no significant difference was detected in terms of GM and WM asymmetry between the group with right-sided MTLE/HS and normal controls.

Conclusion

We should approach hemispheric asymmetry in left- and right-sided MTLE/HS patients differently. The study also demonstrates potential future use of VBM in detecting hemispheric asymmetries and lateralization of brain functions.     

Study of normal breast tissue by in vivo volume localized proton MR Spectroscopy: variation of Water–Fat ratio in relation to the heterogeneity of the breast and the menstrual cycle

Purpose

To investigate the alterations in water–fat (W-F) ratio of the normal breast tissue of female volunteers as a function of the histological phases of the menstrual cycle.

Methods

Image-guided volume localized in vivo proton (¹H) magnetic resonance spectroscopy (MRS) at 1.5 T was carried out in the para-areolar region and the upper and lower quadrants of the normal breast tissue of volunteers (n=29; mean age 33.7±6 years) during five histological phases of the menstrual cycle.

Results

A W-F value of 0.90±0.41 was observed for the para-areolar region during the proliferative phase, which reduced to 0.46±0.21 and 0.45±0.25 during follicular and luteal phases, respectively. The value increased to 0.76±0.61 during secretory and to 0.87±0.37 during menstrual phases. No significant difference was observed in the W-F value for the upper and the lower quadrants of the breast during various phases of the menstrual cycle. However, the W-F ratio of the para-areolar region was significantly higher compared to the upper and the lower quadrants during all phases. This reflects the dependence of W-F value on the amount of glandular and adipose tissues and the heterogeneous nature of the breast.

Conclusions

Our results indicate that changes in the normal breast tissue characteristics occur due to physiological factors like menstrual cycle that strongly influences the W-F value especially the para-areolar region in a cyclic manner. Thus any assessment of breast pathology using W-F values should be carried out carefully taking into consideration the location of the tumor within the breast as well as the time of menstruation.     

Quantitative assessment of regional systolic and diastolic functions and temporal heterogeneity of myocardial contraction in patients with myocardial infarction using cine magnetic resonance imaging and Fourier fitting

Purpose

The objective of this study is to determine regional left ventricle (LV) function and temporal heterogeneity of LV wall contraction by analyzing regional time–volume curve (TVC) after Fourier fitting and to assess altered systolic and diastolic functions and temporal indices of myocardial contraction in infarcted segments in comparison with noninfarcted myocardium in patients with myocardial infarction (MI).

Methods

Steady-state cine magnetic resonance (MR) and late gadolinium-enhanced (LGE) MR images were acquired using a 1.5-T MR system in 60 patients with MI. Regional LV function was determined by analyzing regional TVC in 16 segments. The fitted regional TVC was generated by Fourier curve fitting with five harmonics. Regional LV ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR), time to end-systole and time to peak filling (TPF) were determined from TVC and the first derivative curve.

Results

On LGE MR imaging (MRI), MI was observed in 307 of 960 segments (32.0%). Regional EF and PER averaged in LGE segments were 49.3±14.5% and 2.83±0.65 end-diastolic volume (EDV)/s, significantly lower than those in normal segments (66.7±11.9% and 3.63±0.60 EDV/s, P<.001 and P<.01, respectively). In addition, regional PFR, an index of diastolic function, was significantly reduced in LGE segments (1.94±0.54 vs. 2.86±0.68 EDV/s, P<.01). Time to end-systole and TPF were significantly greater in LGE segments (380.2±57.6 and 169.3±45.4 ms) than in normal segments (300.9±55.1 and 132.3±43.0 ms, P<.01 and P<.01, respectively).

Conclusions

Analysis of regional TVC on cine MRI after Fourier fitting allows quantitative assessment of regional systolic and diastolic LV functions and temporal heterogeneity of LV wall contraction in patients with MI.     

Feasibility of coronary artery wall thickening assessment in asymptomatic coronary artery disease using phase-sensitive dual-inversion recovery MRI at 3 T

Objectives

The purpose of this study was to (a) investigate the image quality of phase-sensitive dual-inversion recovery (PS-DIR) coronary wall imaging in healthy subjects and in subjects with known coronary artery disease (CAD) and to (b) investigate the utilization of PS-DIR at 3 T in the assessment of coronary artery thickening in subjects with asymptomatic but variable degrees of CAD.

Materials and Methods

A total of 37 subjects participated in this institutional review board-approved and HIPAA-compliant study. These included 21 subjects with known CAD as identified on multidetector computed tomography angiography (MDCT). Sixteen healthy subjects without known history of CAD were included. All subjects were scanned using free-breathing PS-DIR magnetic resonance imaging (MRI) for the assessment of coronary wall thickness at 3 T. Lumen–tissue contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and quantitative vessel parameters including lumen area and wall thickness were measured. Statistical analyses were performed.

Results

PS-DIR was successfully completed in 76% of patients and in 88% of the healthy subjects. Phase-sensitive signed-magnitude reconstruction, compared to modulus-magnitude images, significantly improved lumen–tissue CNR in healthy subjects (26.73 ± 11.95 vs. 14.65 ± 9.57, P < .001) and in patients (21.45 ± 7.61 vs. 16.65 ± 5.85, P < .001). There was no difference in image CNR and SNR between groups. In arterial segments free of plaques, coronary wall was thicker in patients in comparison to healthy subjects (1.74 ± 0.27 mm vs. 1.17 ± 0.14 mm, P < .001), without a change in lumen area (4.51 ± 2.42 mm² vs. 5.71 ± 3.11 mm², P = .25).

Conclusions

This is the first study to demonstrate the feasibility of successfully obtaining vessel wall images at 3 T using PS-DIR in asymptomatic patients with known variable degrees of CAD as detected by MDCT. This was achieved with a fixed subject-invariant planning of blood signal nulling. With that limitation alleviated, PS-DIR coronary wall MRI is capable of detecting arterial thickening and positive arterial remodeling at 3 T in asymptomatic CAD.     

Feasibility of post-gadolinium three-dimensional gradient-echo sequence to evaluate the pulmonary arterial vasculature

Purpose

To determine the feasibility of post-gadolinium three-dimensional gradient-echo (3D-GE) sequence for the evaluation of the pulmonary arterial vasculature in patients with suspected pulmonary embolism (PE) and in patients with a variety of other disease processes.

Materials and Methods

Twenty-six consecutive patients (18 females, 8 males; mean age±S.D., 46.6±21.1 years) who underwent chest magnetic resonance imaging (MRI) including post-gadolinium 3D-GE sequence for the evaluation of PE (Group A, n=13) and a variety of other disease processes (Group B, n=13) were included in the study. Post-gadolinium 3D-GE MR sequences were retrospectively, independently and blindly evaluated by two reviewers for the image quality of pulmonary arterial vasculature, and findings of PE and other disease processes. Clinical and imaging follow-up data for all patients were obtained. Interobserver agreement was calculated by kappa statistics.

Results

All central and lobar pulmonary arteries, 71.4–89.6% of segmental arteries and 46.7–52.7% of subsegmental arterial units in both groups were visualized with sufficient diagnostic image quality on post-gadolinium 3D-GE sequences. PE involving lobar and segmental arteries was diagnosed in two patients in each group. Other disease processes including pneumonia, lung nodules, superior vena cava stenosis, lung metastases, chronic lymphocytic leukemia and aortic aneurysm were detected in 10 of 26 patients. There was good to excellent interobserver agreement (0.73 to 1.00) for all findings.

Conclusion

Post-gadolinium 3D-GE sequence may be an alternative technique for the visualization of central, lobar and segmental arteries, and may diagnose PE and other pathologies involving the chest in different patient populations.     

White matter hyperintensities and dynamics of postural control

Background

White matter hyperintensities (WMHs) on MRI have been associated with age, cardiovascular risk factors and falls in the elderly. This study evaluated the relationship between WMHs and dynamics of postural control in older adults without history of falls.

Methods

We studied 76 community-living subjects without history of falls (age 64.5±7.3 years). Brain and WMH volume calculations and clinical rating were done on fluid-attenuation inversion recovery (FLAIR) and MP-RAGE MR images on 3 T. Balance was assessed from the center of pressure displacement using the force platform during 3 min of quiet standing using traditional and dynamic measures (using stabilogram-diffusion analysis). Gait speed was measured from 12-min walk.

Results

Age-adjusted periventricular and focal WMHs were associated with changes in certain dynamic balance measures, including reduced range of postural sway in anteroposterior direction (fronto-temporal WMHs, P=.045; parieto-occipital WMHs, P=.009) and more irregular long-term mediolateral fluctuations (P=.046). Normal walking speed was not affected by WMHs.

Conclusions

Periventricular and focal WMHs affect long-term dynamics of postural control, which requires engagement of feedback mechanisms, and may contribute to mobility decline in the elderly.     

Cervical spondylosis: Evaluation of microstructural changes in spinal cord white matter and gray matter by diffusional kurtosis imaging

Introduction

We investigated microstructural changes in the spinal cord, separately for white matter and gray matter, in patients with cervical spondylosis by using diffusional kurtosis imaging (DKI).

Methods

We studied 13 consecutive patients with cervical myelopathy (15 affected sides and 11 unaffected sides). After conventional magnetic resonance (MR) imaging, DKI data were acquired by using a 3 T MR imaging scanner. Values for fractional anisotropy (FA), apparent diffusion coefficient (ADC), and mean diffusional kurtosis (MK) were calculated and compared between unaffected and affected spinal cords, separately for white matter and gray matter.

Results

Tract-specific analysis of white matter in the lateral funiculus showed no statistical differences between the affected and unaffected sides. In gray matter, only MK was significantly lower in the affected spinal cords than in unaffected spinal cords (0.60 ± 0.18 vs. 0.73 ± 0.13, P = 0.0005, Wilcoxon’s signed rank test).

Conclusions

MK values in the spinal cord may reflect microstructural changes and gray matter damage and can potentially provide more information beyond that obtained with conventional diffusion metrics.