EEG-fMRI mapping of asymmetrical delta activity in a patient with refractory epilepsy is concordant with the epileptogenic region determined by intracranial EEG

We studied a patient with refractory focal epilepsy using continuous EEG-correlated fMRI. Seizures were characterized by head turning to the left and clonic jerking of the left arm, suggesting a right frontal epileptogenic region. Interictal EEG showed occasional runs of independent nonlateralized slow activity in the delta band with right frontocentral dominance and had no lateralizing value. Ictal scalp EEG had no lateralizing value. Ictal scalp EEG suggested right-sided central slow activity preceding some seizures. Structural 3-T MRI showed no abnormality. There was no clear epileptiform abnormality during simultaneous EEG-fMRI. We therefore modeled asymmetrical EEG delta activity at 1-3 Hz near frontocentral electrode positions. Significant blood oxygen level-dependent (BOLD) signal changes in the right superior frontal gyrus correlated with right frontal oscillations at 1-3 Hz but not at 4-7 Hz and with neither of the two frequency bands when derived from contralateral or posterior electrode positions, which served as controls. Motor fMRI activations with a finger-tapping paradigm were asymmetrical: they were more anterior for the left hand compared with the right and were near the aforementioned EEG-correlated signal changes. A right frontocentral perirolandic seizure onset was identified with a subdural grid recording, and electric stimulation of the adjacent contact produced motor responses in the left arm and after discharges. The fMRI localization of the left hand motor and the detected BOLD activation associated with modeled slow activity suggest a role for localization of the epileptogenic region with EEG-fMRI even in the absence of clear interictal discharges.     

Hemodynamic response (BOLD/fMRI) in focal epilepsy with reference to benzodiazepine effect

We studied a new procedure of BOLD/fMRI acquisition in epilepsy. They use the benzodiazepine effect to achieve a more reliable baseline for statistical analysis. The method works only in the MR domain without EEG correlation. It compares the EPI images during interictal epileptic discharges and the images “inactivated” by benzodiazepine.

The results in five out of eight patients show that this procedure in comparison with the EEG/fMRI method gives a net improvement of spatial definition of BOLD areas. These preliminary results seem to confirm the hypothesis that the better BOLD/fMRI procedure in epilepsy is to make use of physical features of MR that, unlike EEG, is not influenced by the distance of intercerebral sources and consequently allows a more complete and undistorted display of BOLD areas.     

Changes in cerebral activity after decreased upper-limb hypertonus: an EMG-fMRI study

Objective

Whereas several studies have used functional magnetic resonance imaging (fMRI) to investigate motor recovery, whether therapy to decrease post-stroke hypertonus alters central motor patterns remains unclear. In this study, we used continuous electromyography (EMG)-fMRI to investigate possible changes in movement-related brain activation in patients receiving Botulinum toxin (BoNT-A) for hand-muscle hypertonus after chronic stroke.

Methods

We studied eight stroke patients all of whom had hemiparesis and associated upper-limb hypertonus. All patients underwent an fMRI-EMG recording and clinical-neurological assessment before BoNT-A and 5 weeks thereafter. The handgrip motor task during imaging was fixed across both patients and controls. The movements were metronome paced, movement amplitude and force were controlled with a plastic orthosis, dynamometer and EMG recording. An age-matched control group was recruited from among healthy volunteers underwent the same fMRI-EMG recording.

Results

Before BoNT-A, while patients moved the paretic hand, fMRI detected wide bilateral activation in the sensorymotor areas (SM1), in the supplementary motor area (SMA) and cerebellum. After BoNT-A blood oxygenation level-dependent (BOLD) activation decreased in ipsilateral and contralateral motor areas and became more lateralized. BOLD activation decreased also in ipsilateral cerebellar regions and in the SMA.

Conclusion

Changes in peripheral upper-limb hypertonus after BoNT-A were associated to an improvement in active movements and more lateralized and focalized activation of motor areas. The clinical and EMG-fMRI coregistration technique we used to study hand-muscle hypertonus in patients receiving BoNT-A after chronic stroke should be useful in future studies seeking improved strategies for post-stroke neurorehabilitation.     

An empirical investigation of motion effects in eMRI of interictal epileptiform spikes

We recently developed a functional neuroimaging technique called encephalographic magnetic resonance imaging (eMRI). Our method acquires rapid single-shot gradient-echo echo-planar MRI (repetition time=47 ms); it attempts to measure an MR signal more directly linked to neuronal electromagnetic activity than existing methods. To increase the likelihood of detecting such an MR signal, we recorded concurrent MRI and scalp electroencephalography (EEG) during fast (20-200 ms), localized, high-amplitude (>50 μV on EEG) cortical discharges in a cohort of focal epilepsy patients. Seen on EEG as interictal spikes, these discharges occur in between seizures and induced easily detectable MR magnitude and phase changes concurrent with the spikes with a lag of milliseconds to tens of milliseconds. Due to the time scale of the responses, localized changes in blood flow or hemoglobin oxygenation are unlikely to cause the MR signal changes that we observed. While the precise underlying mechanisms are unclear, in this study, we empirically investigate one potentially important confounding variable — motion. Head motion in the scanner affects both EEG and MR recording. It can produce brief “spike-like” artifacts on EEG and induce large MR signal changes similar to our interictal spike-related signal changes. In order to explore the possibility that interictal spikes were associated with head motions (although such an association had never been reported), we had previously tracked head position in epilepsy patients during interictal spikes and explicitly demonstrated a lack of associated head motion. However, that study was performed outside the MR scanner, and the root-mean-square error in the head position measurement was 0.7 mm. The large inaccuracy in this measurement therefore did not definitively rule out motion as a possible signal generator. In this study, we instructed healthy subjects to make deliberate brief (<500 ms) head motions inside the MR scanner and imaged these head motions with concurrent EEG and MRI. We compared these artifactual MR and EEG data to genuine interictal spikes. While per-voxel MR and per-electrode EEG time courses for the motion case can mimic the corresponding time courses associated with a genuine interictal spike, head motion can be unambiguously differentiated from interictal spikes via scalp EEG potential maps. Motion induces widespread changes in scalp potential, whereas interictal spikes are localized and have a regional fall-off in amplitude. These findings make bulk head motion an unlikely generator of the large spike-related MR signal changes that we had observed. Further work is required to precisely identify the underlying mechanisms.     

Depression recognition using resting-state and event-related fMRI signals

Purpose

This paper aimed to develop a method for depression detection using blood-oxygen-level-dependent (BOLD) response estimated from event-related signals and resting-state functional magnetic resonance imaging (fMRI) signals together.

Materials and Methods

Thirteen patients with unipolar depression and matched healthy subjects were recruited. Resting state data of each subject were collected. Thereafter, event-related paradigm was undertaken using sad facial stimuli. The resting-state fMRI signal was deemed as the baseline of each subject's activity. Coefficient marks were designed to sort and select temporal independent components of event-related signals. Thereafter, stimulus-evoked BOLD response components inside event-related signal were extracted and taken as features to discriminate depressive patients from healthy controls.

Results

Accuracy rate for depression recognition was 77.27% with P value of .017 for whole-brain analysis and 81.82% with P value of .009 for region-of-interest analysis. The effectiveness and the superiority of the proposed method for disease recognition were demonstrated via the performance comparison with three other typical methods.

Conclusions

The proposed model was effective in depression recognition.     

Fractional amplitude of low-frequency fluctuation changes in monkeys with spinal cord injury: A resting-state fMRI study

Purpose

Although functional magnetic resonance imaging (fMRI) has revealed that spinal cord injury (SCI) causes anomalous changes in task-induced brain activation, its effect during the resting state remains unclear. The aim of this study is to explore the changes of the brain resting-state function in non-human primates with unilateral SCI.

Materials and methods

Eleven adult female rhesus monkeys were subjected to resting-state fMRI: five with unilateral thoracic SCI and six healthy monkeys, to obtain the fractional amplitude of low-frequency fluctuations (fALFF) of the blood oxygenation level-dependent (BOLD) contrast signal to determine the influence of SCI on the cerebral resting-state function.

Results

The SCI-induced fALFF vary significantly in several encephalic regions, including the left cerebellum, the left thalamus, the right lateral geniculate nucleus, the right superior parietal lobule, and the posterior cingulate gyrus.

Conclusion

Analysis of the resting-state fMRI provides evidence of abnormal spontaneous brain activations in primates with SCI, which may help us understand the pathophysiologic mechanisms underlying the changes in neural plasticity in the central nervous system after SCI.     

EEG topography-specific BOLD changes: a continuous EEG-fMRI study in a patient with focal epilepsy

Blood oxygenation level dependent (BOLD) response related to interictal activity was evaluated in a patient with post-traumatic focal epilepsy at repeated continuous electroencephalogram (EEG)-functional magnetic resonance imaging examinations. Lateralized interictal EEG activity induced a main cluster of activation co-localized with the anatomical lesion. Spreading of EEG interictal activity to both frontal lobes evoked bilateral clusters of activation indicating that topography of BOLD response might depend on the spatial distribution of epileptiform activity.     

Mapping of spikes, slow waves, and motor tasks in a patient with malformation of cortical development using simultaneous EEG and fMRI

We report on the simultaneous and continuous acquisition of EEG and functional MRI data in a patient with a left hemiparesis and focal epilepsy secondary to malformation of cortical development in the right hemisphere. EEG-triggered fMRI localization was previously demonstrated in this patient. In the experiments reported here, 322 spikes maximum at electrode C4 and 126 focal slow waves were identified offline. A hierarchy of models was explored in order to assess the relative contributions of each type of EEG event. Modeling the BOLD response to C4 spikes alone showed an area of activation within the large malformation, adjacent to the area of infolding cortex. However, also modeling slow-waves gave rise to a broader and stronger activation, suggesting that the generators overlap. Motor mapping of the right hand showed activation in the left sensorimotor cortex; left-hand tapping led to a more diffuse area of activation, displaced superiorly into the superior frontal gyrus, and a small area of activation within the lesion. In conclusion, continuous EEG-fMRI is useful to compare the functional mapping of epileptiform activity and eloquent cortices in individual patients.     

EEG quality during simultaneous functional MRI of interictal epileptiform discharges

This article concerns the evaluation of the quality of interictal epileptiform EEG discharges recorded throughout simultaneous echo planar imaging (EPI). BOLD (blood oxygen level dependent) functional MRI (fMRI) images were acquired continuously on a patient with intractable epilepsy. EEG was sampled simultaneously, during and after imaging, with removal of pulse and imaging artifacts by subtraction of channel-specific running averages. Contiguous EEG epochs recorded with and without fMRI (fMRI+ve vs. fMRI−ve) were next randomized and presented to two blinded observers. Epileptiform discharges were identified retrospectively, and comparison was made in terms of the number of identified events, their amplitude, and spatiotemporal distribution. A spectral analysis was also performed on the EEG. In the randomized comparison of EEG segments, 80 (fMRI+ve) vs. 69 (fMRI−ve) discharges were noted with good interobserver agreement (69%). There were no significant differences in amplitude or spatio-temporal distribution. Comparison of the events detected and measured by two expert observers demonstrated that the Interictal Epileptiform Discharge (IED) characteristics were indistinguishable with and without scanning. We review briefly the existing literature on EEG recording quality for combined EEG/fMRI.     

Assessment of data acquisition parameters,and analysis techniques for noise reduction in spinal cord fMRI data

Purpose

The purpose of this work is to characterize the noise in spinal cord functional MRI, assess current methods aimed at reducing noise, and optimize imaging parameters.

Methods

Functional MRI data were acquired at multiple echo times and the contrast-to-noise ratio (CNR) was calculated. Independently, the repetition time was systematically varied with and without parallel imaging, to maximize BOLD sensitivity and minimize type I errors. Noise in the images was characterized by examining the frequency spectrum, and investigating whether autocorrelations exist. The efficacy of several physiological noise reduction methods in both null (no stimuli) and task (thermal pain paradigm) data was also assessed. Finally, our previous normalization methods were extended.

Results

The echo time with the highest functional CNR at 3 Tesla is at roughly 75 msec. Parallel imaging reduced the variance and the presence of autocorrelations, however the BOLD response in task data was more robust in data acquired without parallel imaging. Model-free based approaches further increased the detection of active voxels in the task data. Finally, inter-subject registration was improved.

Conclusions

Results from this study provide a rigorous characterization of the properties of the noise and assessment of data acquisition and analysis methods for spinal cord and brainstem fMRI.     

White matter abnormalities in children and adolescents with temporal lobe epilepsy

Background and Purpose

The widespread propagation of synchronized neuronal firing in seizure disorders may affect cortical and subcortical brain regions. Diffusion tensor imaging (DTI) can noninvasively quantify white matter integrity. The purpose of this study was to investigate the abnormal changes of white matter in children and adolescents with focal temporal lobe epilepsy (TLE) using DTI.

Materials and Methods

Eight patients with clinically diagnosed TLE and eight age- and sex-matched healthy controls were studied. DTI images were obtained with a 3-T magnetic resonance imaging scanner. The epileptic foci were localized with magnetoencephalography. Fractional anisotropy (FA), mean diffusivity (MD), parallel (λ_||) and perpendicular (λ_⊥) diffusivities in the genu of the corpus callosum, splenium of the corpus callosum (SCC), external capsule (EC), anterior limbs of the internal capsule (AIC), and the posterior limbs of the internal capsule (PIC) were calculated. The DTI parameters between patients and controls were statistically compared. Correlations of these DTI parameters of each selected structure with age of seizure onset and duration of epilepsy were analysed.

Results

In comparison to controls, both patients' seizure ipsilateral and contralateral had significantly lower FA in the AIC; PIC and SCC and higher MD, λ_|| and λ_⊥ in the EC, AIC, PIC and SCC. The MD, λ_|| and λ_⊥ were significantly correlated with age of seizure onset in the EC and PIC. λ_|| was significantly correlated with the duration of epilepsy in the EC and PIC.

Conclusion

The results of the present study indicate that children and adolescents with TLE had significant abnormalities in the white matter in the hemisphere with seizure foci. Furthermore, these abnormalities may extend to the other brain hemisphere. The age of seizure onset and duration of epilepsy may be important factors in determining the extent of influence of children and adolescents TLE on white matter.     

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.     

A preliminary study of blood-oxygen-level-dependent MRI in patients with chronic kidney disease

Background

Blood-oxygen-level-dependent (BOLD) magnetic resonance imaging (MRI) can provide regional measurements of oxygen content using deoxyhemoglobin paramagnetic characteristics. The apparent relaxation rate or R2*(=1/T2*) can be determined from the slope of log (intensity) versus echo time and is directly proportional to the tissue content of deoxyhemoglobin. Thus, as the level of deoxyhemoglobin increases, T2* will decrease, leading to an increase in R2*. Chronic kidney disease (CKD) can affect oxygenation levels in renal parenchyma, which influences the clinical course of the disease. The goal of this study was to detect and assess renal oxygenation levels in CKD using BOLD MRI.

Methods

Fifteen healthy subjects and 11 patients with CKD underwent a renal scan using multigradient-recalled-echo sequence with eight echoes. R2* (1/s) of the renal cortex and medulla was measured on BOLD images. Of the 11 patients, nine had biopsy-proven chronic glomerulonephritis, and two had a similar diagnosis based on clinical symptoms and investigations.

Results

Mean medullary R2* (MR2*) and cortex R2* (CR2*) levels were significantly higher in patients (22 kidneys, MR2*=24.79±4.84 s⁻¹, CR2*=18.97±2.72 s⁻¹) than in controls (30 kidneys, MR2*=19.98±1.19 s⁻¹, CR2*=16.03±1.23 s⁻¹) (P<.01), and MR2* was increased more than CR2*. Medullary to cortical R2* ratios (MCR2*) of patients were significantly increased when compared with those of controls (P<.01). In the patient group, estimated glomerular filtration rate levels were greater than or equal to 60 ml/min/1.73 m² in six patients (12 kidneys), whose MR2* and CR2* were also significantly higher than those of controls (P<.01). Serum creatinine levels were normal in seven patients (14 kidneys), whose MR2*, CR2* and MCR2* were also higher than those of controls (P<.01).

Conclusions

BOLD MRI can be used to evaluate changes in renal oxygenation in CKD, suggesting that it has the potential to be an excellent noninvasive tool for the evaluation of renal function.     

Unfolding the long-term pathophysiological processes following an acute inflammatory demyelinating lesion of multiple sclerosis

Background

Acute symptomatic inflammation is a main feature of multiple sclerosis but pathophysiological processes underlying total or partial recovery are poorly understood.

Objective

To characterize in vivo these processes at molecular, structural and functional levels using multimodal MR methods.

Methods

A neuroimaging 3-year follow-up (Weeks 0, 3, 11, 29, 59 and 169) was conducted on a 41-year-old woman presenting at baseline with a large acute demyelinating lesion of multiple sclerosis. Conventional magnetic resonance imaging (MRI), magnetization transfer imaging, diffusion-weighted imaging, functional MRI and magnetic resonance spectroscopy were conducted at 1.5 T.

Results

Patient presenting with subacute left hemiplegia recovered progressively (expended disability status scale 7 to 5.5). The MR exploration demonstrated structural functional and metabolic impairments at baseline. Despite restoration of the blood brain barrier integrity, high lactate levels persisted for several weeks concomitant with glial activation. Slow and progressive structural and metabolic restorations occurred from baseline to W169 (lesion volume −64%; apparent diffusion coefficient −14.7%, magnetization transfer ratio +14%, choline −51%, lipids −78%, N-acetylaspartate +77%) while functionality of the motor system recovered.

Conclusions

Multimodal MRI/MRS evidenced long-term dynamics recovery processes involving tissue repair, glial activation, recovery of neuronal function and functional systems. This may impact on customized rehabilitation strategies generally focused on the first months following the onset of symptoms.     

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.     

MR T1ρ quantification of cartilage focal lesions in acutely injured knees: correlation with arthroscopic evaluation

Objective

Quantitative T₁ρ MRI has been suggested as a promising tool to detect changes in cartilage composition that are characteristic of cartilage damage and degeneration. The objective of this study was to evaluate the capability of MR T₁ρ to detect cartilage lesions as evaluated by arthroscopy in acutely ACL-injured knees and to compare with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) using clinical standard MRI.

Method

Ten healthy controls (mean age 35) with no ACL injury or history of osteoarthritis (OA) and 10 patients with acute ACL injuries (mean age 39) were scanned at 3 Tesla (3 T). ACL patients underwent ACL reconstruction, where focal lesions were graded according to an Outerbridge grading system during arthroscopic evaluation. Normalized MR T₁ρ values (T₁ρ z-scores normalized to control values in matched regions) in full thickness, and superficial and deep layers of cartilage were compared between defined sub-compartments with and without focal lesions. Intraclass (ICC) correlation and the root mean square coefficient of variation (RMS-CV) were performed to evaluate the inter-observer reproducibility of T₁ρ quantification. Sub-compartments of cartilage were also evaluated using WORMS scoring and compared to their Outerbridge score respectively.

Results

The inter-observer ICC and the RMS-CV of the sub-compartment T₁ρ quantification were 0.961 and 3.9%, respectively. The average T₁ρ z-scores were significantly increased in sub-compartments with focal lesions compared to those without focal lesions and to the control cohort (p < 0.05).

Conclusion

Our results indicate that T₁ρ provided a better diagnostic capability than clinical standard MRI grading in detecting focal cartilage abnormalities after acute injuries. Quantitative MRI may have great potential in detecting cartilage abnormalities and degeneration non-invasively, which are occult with standard morphological MRI.     

Detection of focal liver lesions in unenhanced and ferucarbotran-enhanced magnetic resonance imaging: a comparison of T2-weighted breath-hold and respiratory-triggered sequences

Purpose

To investigate the image quality and detection rate of focal liver lesions by comparing a T2-weighted breath-hold single-shot sequence and a T2-weighted high spatial resolution fast spin-echo sequence with respiratory triggering via unenhanced and superparamagnetic iron oxide (SPIO)-enhanced liver imaging.

Materials and Methods

The study was approved by the local ethical review board; informed consent was waived. Liver-lesion contrast was measured and a qualitative consensus evaluation of image quality and lesion detection was performed in 42 consecutive patients using a 1.5-T MR system.

Results

The liver-lesion contrast was significantly higher (P<.05) for the respiratory-triggered sequence compared to the breath-hold sequence regarding unenhanced and SPIO-enhanced imaging. The respiratory-triggered sequences revealed significantly higher image quality scores as well as higher numbers of detected liver lesions compared to the breath-hold sequence on unenhanced and SPIO-enhanced imaging. The SPIO contrast did not significantly improve the number of detected lesions on the respective sequences (P>.05).

Conclusion

We find that respiratory-triggered fast spin-echo sequences produce a higher image quality and a more precise liver-lesion detection rate thereby justifying the increased acquisition time necessary for this method.     

MR findings of focal eosinophilic liver disease using gadoxetic acid

Purpose

The purpose of this study was to describe magnetic resonance (MR) findings of focal eosinophilic liver disease using gadoxetic acid (Gd-EOB-DTPA).

Materials and Methods

Nineteen patients (M:F=14:5; age range, 26–66 years; mean age, 50 years) with 35 focal eosinophilic liver lesions were included after reviewing the medical records of 482 patients who underwent Gd-EOB-DTPA-enhanced MR imaging (MRI) on a 3.0-T unit between April 2008 and June 2009. The diagnosis of focal eosinophilic liver disease was established by means of percutaneous liver biopsy or surgery and consistent clinical findings. Two radiologists retrospectively reviewed MR images with consensus. Margin, shape and distribution of the lesions were analyzed. We also evaluated signal intensity of focal hepatic lesions on T₁- and T₂-weighted images and patterns of enhancement in dynamic contrast study.

Results

The mean diameter of the lesions was 1.7 cm (range, 0.7–6.1 cm). Most of the focal eosinophilic liver lesions [n=31/35 (88.6%)] had poorly defined margins. They were usually isointense or slightly hypointense [n=34/35 (97.2%)] on T₁-weighted images and hyperintense [n=32/35 (91.4%)] on T₂-weighted images. Dynamic study showed enhancement (rim or homogeneous) on the arterial phase [n=21/35 (60%)] and hypointensity on the late venous phase [n=31/35 (88.6%)]. All the lesions were hypointense on the hepatobiliary phase images.

Conclusion

Focal eosinophilic liver lesions tend to be hyperintense on the arterial phase and hypointense on the late venous phase during dynamic study of Gd-EOB-DTPA-enhanced MRI. Although these findings mimic other focal hepatic lesions, poorly defined margins of the lesions and peripheral eosinophilia might help distinguish focal eosinophilic liver disease from other hepatic lesions.     

Histopathologically confirmed focal nodular hyperplasia of the liver: Gadoxetic acid-enhanced MRI characteristics

Purpose

The purpose of this study was to evaluate enhancement characteristics of histopathologically confirmed focal nodular hyperplasia (FNHs) with gadoxetic acid-enhanced MRI.

Materials and Methods

Twenty-seven patients with all histopathologically proven FNHs were retrospectively identified. MRI consisted of T₁- and T₂-weighted (w) sequences with and without fat saturation (FS), multiphase dynamic T₁-w images, and FS T₁-w images during the hepatobiliary phase. Standard of reference was surgical resection (n = 24) or biopsy (n = 3). Images were analyzed for morphology and contrast behavior including signal intensity (SI) measurement on T₁-w images normalized to the pre-contrast base line.

Results

In total 36 FNHs were evaluated. All FNHs showed enhancement in the arterial phase, significant reduction contrast enhancement (“wash-out”) in the late dynamic phases was not present. In the hepatobiliary phase, all FNHs (100%) showed enhancement (overall SI increase, 118% (± 91%), P < 0.001) with at least partial hyperintensity to the liver. Upon visual comparison, 3 of 36 FNHs appeared with heterogeneous/partial enhancement (8%) and 7 (19%) showed rim-accentuated enhancement.

Conclusion

The typical enhancement pattern of FNH with gadoxetic acid consists of arterial hyperperfusion, no wash-out during the venous phase, and at least partial hyperintensity compared to the liver in the hepatobiliary phase. Partial hypointensity or rim-accentuated enhancement rarely occurs.