Treatment-related central nervous system toxicity: MR imaging evaluation with CT and clinical correlation

Thirteen patients with abnormal brain MR scans attributable to treatment-induced injury were retrospectively reviewed. All patients were treated with radiation therapy and 62% received chemotherapy. Five patients were graded as having severe white matter (WM) changes, four had moderate WM changes, and four had mild WM changes. CT was generally equivalent to MR in evaluation of severe and moderate WM abnormalities, whereas MR was superior to CT in detection of mild WM abnormalities. In general, the severity of changes depicted by MR/CT correlated with the extent of neurologic dysfunction. The most severe changes were seen in those patients treated with combination irradiation and chemotherapy.     

Alteration of diffusion tensor parameters in postmortem brain

In autopsy of humans, there is usually an interval of hours to days between death and tissue fixation, during which the cadaver is stored below room temperature to retard tissue autolysis. We have attempted to model this process and evaluate the alteration in diffusion indices of the postmortem brain in pigs, which were kept at 4°C. The pigs were scanned prior to death and at 3, 6, 9, 12, 18, 24, 30, 36, 42, 48 and 72 h postmortem. Regions of interest were placed in the corpus callosum, internal capsule, periventricular and subcortical white matter anteriorly and posteriorly. There was a slight increase in fractional anisotropy (FA) in the first 3 h postmortem. The FA remained stable up to 72 h postmortem. There was a marked decrease in trace, eigenmajor (λmajor), eigenmedium (λmedium) and eigenminor (λminor), particularly in the first 3 h following death. This study supports the utility of measuring diffusion anisotropy if the time elapsed between death and tissue fixation is within 3 days. However, trace and eigenvalues decreased markedly within the first few hours postmortem. Therefore trace and eigenvalues obtained from ex vivo studies cannot be extrapolated to in vivo studies.     

Quantum cognition: The possibility of processing with nuclear spins in the brain

The possibility that quantum processing with nuclear spins might be operative in the brain is explored. Phosphorus is identified as the unique biological element with a nuclear spin that can serve as a qubit for such putative quantum processing–a neural qubit–while the phosphate ion is the only possible qubit-transporter  . We identify the “Posner molecule”, Ca₉(PO₄)₆${\text{Ca}}_9{\left({\text{PO}}_4\right)}_6$, as the unique molecule that can protect the neural qubits on very long times and thereby serve as a (working) quantum-memory. A central requirement for quantum-processing is quantum entanglement. It is argued that the enzyme catalyzed chemical reaction which breaks a pyrophosphate ion into two phosphate ions can quantum entangle pairs of qubits. Posner molecules, formed by binding such phosphate pairs with extracellular calcium ions, will inherit the nuclear spin entanglement. A mechanism for transporting Posner molecules into presynaptic neurons during vesicle endocytosis is proposed. Quantum measurements can occur when a pair of Posner molecules chemically bind and subsequently melt, releasing a shower of intra-cellular calcium ions that can trigger further neurotransmitter release and enhance the probability of post-synaptic neuron firing. Multiple entangled Posner molecules, triggering non-local quantum correlations of neuron firing rates, would provide the key mechanism for neural quantum processing. Implications, both in vitro and in vivo, are briefly mentioned.     

Accuracy of image registration between MRI and light microscopy in the ex vivo brain

A multistep procedure was developed to register magnetic resonance imaging (MRI) and histological data from the same sample in the light microscopy image space, with the ultimate goal of allowing quantitative comparisons of the two datasets. The fixed brain of an owl monkey was used to develop and test the procedure. In addition to the MRI and histological data, photographic images of the brain tissue block acquired during sectioning were assembled into a blockface volume to provide an intermediate step for the overall registration process. The MR volume was first registered to the blockface volume using a combination of linear and nonlinear registration, and two dimensional (2D) blockface sections were registered to corresponding myelin-stained sections using a combination of linear and nonlinear registration. Before this 2D registration, two major types of tissue distortions were corrected: tissue tearing and independent movement of different parts of the brain, both introduced during histological processing of the sections. The correction procedure utilized a 2D method to close tissue tears and a multiple iterative closest point (ICP) algorithm to reposition separate pieces of tissue in the image. The accuracy of the overall MR to micrograph registration procedure was assessed by measuring the distance between registered landmarks chosen in the MR image space and the corresponding landmarks chosen in the micrograph space. The average error distance of the MR data registered to micrograph data was 0.324±0.277 mm, only 8% larger than the width of the MRI voxel (0.3 mm).     

Chaos and generalised multistability in a mesoscopic model of the electroencephalogram

We present evidence for chaos and generalised multistability in a mesoscopic model of the electroencephalogram (EEG). Two limit cycle attractors and one chaotic attractor were found to coexist in a two-dimensional plane of the ten-dimensional volume of initial conditions. The chaotic attractor was found to have a moderate value of the largest Lyapunov exponent (3.4 s⁻¹ base e) with an associated Kaplan-Yorke (Lyapunov) dimension of 2.086. There are two different limit cycles appearing in conjunction with this particular chaotic attractor: one multiperiodic low amplitude limit cycle whose largest spectral peak is within the alpha band (8-13 Hz) of the EEG; and another multiperiodic large-amplitude limit cycle which may correspond to epilepsy. The cause of the coexistence of these structures is explained with a one-parameter bifurcation analysis. Each attractor has a basin of differing complexity: the large-amplitude limit cycle has a basin relatively uncomplicated in its structure while the small-amplitude limit cycle and chaotic attractor each have much more finely structured basins of attraction, but none of the basin boundaries appear to be fractal. The basins of attraction for the chaotic and small-amplitude limit cycle dynamics apparently reside within each other. We briefly discuss the implications of these findings in the context of theoretical attempts to understand the dynamics of brain function and behaviour.     

Modeling brain tissue volumes over the lifespan: quantitative analysis of postmortem weights and in vivo MR images

Normative measurements of brain gray matter and white matter tissue volumes across the lifespan have not yet been established. The purpose of this article was to use mathematical modeling and analytical functions to demonstrate the growth trajectory of gray matter and white matter from age 0 to age 90. For each gender, brain weight functions were generated by utilizing existing autopsy data from 4400 subjects. Brain gray matter, white matter and lateral ventricular volumes were measured from 39 MR volumes of normal individuals. These were converted to weight by multiplying the tissue volumes by the specific gravity of that tissue. White matter volumes were described by a saturating exponential function, and the gray matter volume function was calculated by subtracting the white matter weight function from the brain weight function. For each gender, equations were generated for white matter and gray matter volumes as a function of age over the lifespan.     

Regional distribution of manganese found in the brain after injection of a single dose of manganese-based contrast agents

Manganese (Mn) complexes are unstable and dissociate in vivo. Because of the release of this metal, there exists some concern about the potential long-term neurotoxicity associated with the use of Mn-based contrast agents. This latter problem arises because manganese is known to accumulate in specific regions of the brain of people intoxicated by this metal. It was previously demonstrated that Mn can accumulate in the mice brain after administration of 5 μmol/kg of MnCl₂, Mn-diethylenetriaminepentaacetate (Mn-DTPA), or Mn-dipyridoxal diphosphate (Mn-DPDP). In order to better characterize the behavior of Mn complexes after administration, this study assesses the regional distribution of Mn in the brain after i.v. injection of a single dose of MnCl₂ or Mn-DTPA. Male Wistar rats received an i.v. injection of 5 μmol/kg of ⁵⁴Mn as MnCl₂ or Mn-DTPA. The rats were killed at one and two weeks post exposure. The distribution of the radioactivity in the slices was monitored by autoradiography. For both MnCl₂ or Mn-DTPA, we observed that the radioactivity was dispersed in the entire brain, but the radioactivity was higher in several regions. No difference was observed between MnCl₂ or Mn-DTPA in the regional distribution of Mn, and no difference was observed between the two times of exposure (1 week or 2 weeks). The uptake of Mn was minimal in corpus callosum. Maximal Mn concentration was observed in the hippocampal region, thalamus, colliculi, amygdala, olfactory nuclei, and cerebellum.     

Artifacts in magnetic resonance imaging after surgical resection of brain tumors

Background

Since the advent of magnetic resonance imaging, metal artifacts have posed an important diagnostic problem in different fields of medicine. However, this has not been systematically studied in patients undergoing surgery for brain tumors.

Objective

This study was planned to assess whether metal artifacts can occur in patients undergoing brain surgery without metallic implants.

Methods

Of 40 individuals who could be included because of having a pre- and postoperative MRI and a postoperative computed tomography (CT) scan or a conventional skull X-ray for the detection of metallic artifacts, 26 patients agreed to participate in this study and gave informed consent.

Results

Twenty-six subjects, 12 males and 14 females, with an age range of 12 to 54 years, were included in the study. Four patients were found to have gross metal particles in their postoperative brain CTs and were excluded. Of the remaining 22 subjects, 7 patients (31.8%) had metallic artifacts.

Conclusion

Our study showed that simple bone drilling or chiseling during surgical manipulation of skull bones may result in separation of very tiny metal particles which can remain in the surgical site and cause artifacts in postoperative MRIs. This finding appeared to be independent of factors such as age, sex, tumor/incision site, tumor size, pathologic tumor type, total radiation dose, operation–MRI time interval and sequence of MRI.     

Progress and problems in the application of focused ultrasound for blood-brain barrier disruption

Advances in neuroscience have resulted in the development of new diagnostic and therapeutic agents for potential use in the central nervous system (CNS). However, the ability to deliver the majority of these agents to the brain is limited by the blood-brain barrier (BBB), a specialized structure of the blood vessel wall that hampers transport and diffusion from the blood to the brain. Many CNS disorders could be treated with drugs, enzymes, genes, or large-molecule biotechnological products such as recombinant proteins, if they could cross the BBB. This article reviews the problems of the BBB presence in treating the vast majority of CNS diseases and the efforts to circumvent the BBB through the design of new drugs and the development of more sophisticated delivery methods. Recent advances in the development of noninvasive, targeted drug delivery by MRI-guided ultrasound-induced BBB disruption are also summarized.     

Diffusion-weighted imaging features of brain in obesity

PURPOSE: Obesity is characterized by an altered distribution of body fluid. However, distribution of fluid (extracellular/intracellular) in brain tissues has not been studied in obese subjects yet. The purpose of this study was to detect possible brain diffusion changes especially in satiety and hunger related centers in obese subjects by diffusion weighted imaging (DWI). METHODS: Conventional MRI and DWI of the brain was obtained from 81 obese patients (obese=68, morbid obese=13) and 29 age-matched, nonobese. The apparent diffusion coefficient (ADC) values were calculated in hypothalamus; amygdala; hippocampal gyrus; thalamus; insula; cingulate gyrus; orbitofrontal, dorsomedial and dorsolateral frontal, middle temporal and occipital cortex; cerebellum; midbrain and corpus striatum. RESULTS: The ADC values of hypothalamus, hippocampal gyrus, amygdala, insula, cerebellum and midbrain were significantly increased in patients (n:81) when compared to nonobese subjects. The ADC values of thalamus, hippocampal gyrus, amygdala, orbitofrontal, occipital, dorsolateral and middle temporal cortex, insula and midbrain were significantly increased in morbid obese when compared to nonobese subjects. The ADC values of orbitofrontal and occipital cortex were significantly higher in morbid obese than the values in the obese. The body mass index positively correlated with ADC values of amygdala, insula, orbitofrontal and middle temporal cortex. CONCLUSION: We observed increased ADC values of distinct locations related to satiety and hunger that suggest altered fluid distribution and/or vasogenic edema in obese subjects. Awareness of this abnormalities in brain tissue composition/function in obesity may contribute to better understanding of the underlying mechanisms.     

H MR spectroscopy monitoring of changes in choline peak area and line shape after Gd-contrast administration

Fifteen percent loss in the peak area of choline containing compounds (Cho) was recently observed in ¹H MR spectra of contrast-enhancing tumor at 5–10 min after Gd-contrast administration [Magn. Reson. Med. 37:222–225, 1997]. In this study, chemical shift imaging (CSI, 1500/135 ms PRESS) was used to assess the spectral changes in 47 Gd-enhancing glial brain tumors and metastatic brain tumors measured at 0–5, 5–10, and/or 10–15 min after administration of Gd-contrast. Percent Cho peak area losses measured at these times, 3 ± 3, 12 ± 2, and 14 ± 3 SEM, respectively, coincided with trends of line narrowing and up-field shift of the Cho peak. Significant changes in creatine and N-acetyl acetate signals were not observed. It is concluded that the Gd-induced loss of tumor Cho signal measured after 5 min, typically required for post contrast-MRI and the positioning of the CSI volume on tumor, shows little further change with time, if any.     

Evaluation of atlas-based segmentation of hippocampi in healthy humans

Introduction and aim

Region of interest (ROI)-based functional magnetic resonance imaging (fMRI) data analysis relies on extracting signals from a specific area which is presumed to be involved in the brain activity being studied. The hippocampus is of interest in many functional connectivity studies for example in epilepsy as it plays an important role in epileptogenesis. In this context, ROI may be defined using different techniques. Our study aims at evaluating the spatial correspondence of hippocampal ROIs obtained using three brain atlases with hippocampal ROI obtained using an automatic segmentation algorithm dedicated to the hippocampus.

Material and methods

High-resolution volumetric T1-weighted MR images of 18 healthy volunteers (five females) were acquired on a 3T scanner. Individual ROIs for both hippocampi of each subject were segmented from the MR images using an automatic hippocampus and amygdala segmentation software called SACHA providing the gold standard ROI for comparison with the atlas-derived results. For each subject, hippocampal ROIs were also obtained using three brain atlases: PickAtlas available as a commonly used software toolbox; automated anatomical labeling (AAL) atlas included as a subset of ROI into PickAtlas toolbox and a frequency-based brain atlas by Hammers et al. The levels of agreement between the SACHA results and those obtained using the atlases were assessed based on quantitative indices measuring volume differences and spatial overlap. The comparison was performed in standard Montreal Neurological Institute space, the registration being obtained with SPM5 (http://www.fil.ion.ucl.ac.uk/spm/).

Results

The mean volumetric error across all subjects was 73% for hippocampal ROIs derived from AAL atlas; 20% in case of ROIs derived from the Hammers atlas and 107% for ROIs derived from PickAtlas. The mean false-positive and false-negative classification rates were 60% and 10% respectively for the AAL atlas; 16% and 32% for the Hammers atlas and 6% and 72% for the PickAtlas.

Conclusion

Though atlas-based ROI definition may be convenient, the resulting ROIs may be poor representations of the hippocampus in some studies critical to under- or oversampling. Performance of the AAL atlas was inferior to that of the Hammers atlas. Hippocampal ROIs derived from PickAtlas are highly significantly smaller, and this results in the worst performance out of three atlases. It is advisable that the defined ROIs should be verified with knowledge of neuroanatomy before using it for further data analysis.     

Multimodal approach for diagnosis of bacterial etiology in brain abscess

Background and purpose

Proton magnetic resonance spectroscopy (PMRS) has high sensitivity and specificity for the detection of pyogenic brain abscess and the categorization of bacteria. But the metabolite patterns failed to evaluate the etiology of disease when the culture results are sterile. The aim of the present study is to compare the multimodality techniques viz., conventional culture, MR spectroscopy and 16S rRNA PCR and sequencing for rapid diagnosis of etiology in brain abscess and evaluate the PMRS in culture sterile samples and also demonstrate the sensitivity and specificity of these techniques.

Methods

Thirty five patients underwent MRI on a 3 T MRI and in-vivo PMRS for the diagnosis and evaluation of various resonances of metabolites such as lipid (LIP), lactate (LAC), acetate (AC), amino acid (AC), succinate (SUC). Pus was collected for identification of etiologic agents by culture and molecular method.

Results

In 35 samples, metabolite patterns were as follows: LIP/LAC/AA, n = 17, LIP/LAC/AA/SUC with or without AC, n = 17 and LIP/LAC/AA/AC, n = 1. Culture showed bacterial growth in 22 samples (18 aerobic/facultative anaerobic, 9 anaerobic) whereas molecular method was detected 26 aerobic/facultative anaerobic, 13 anaerobic, 4 microaerophilic bacteria. Among the 13 sterile samples, molecular method detected 16 microorganisms along with 3 mixed infections and PMRS recognized metabolite patterns as LIP/LAC/AA, n = 5 and LIP/LAC/AA/SUC with or without AC, n = 8. The sensitivity of in-vivo PMRS in sterile samples was 100% and 75%, and specificity was 75% and 100% for aerobic and anaerobic organisms respectively.

Conclusion

Based on metabolite resonances, PMRS can detect slow growing and fastidious organisms and classify them into aerobic and anaerobic bacteria which are difficult to culture by conventional method. It can categorize microorganisms even in culture sterile samples with rational sensitivity and specificity which may allow early choice of targeted therapy.     

Critical brain networks

Highly correlated brain dynamics produces synchronized states with no behavioral value, while weakly correlated dynamics prevents information flow. We discuss the idea put forward by Per Bak that the working brain stays at an intermediate (critical) regime characterized by power-law correlations.     

Estimation and application of spatially variable noise fields in diffusion tensor imaging

Optimal interpretation of magnetic resonance image content often requires an estimate of the underlying image noise, which is typically realized as a spatially invariant estimate of the noise distribution. This is not an ideal practice in diffusion tensor imaging because the noise distribution is usually spatially varying due to the use of fast imaging and noise suppression techniques. A new estimation approach for spatially varying noise fields (NFs) is proposed in this article. The approach is based on a noise invariance property in scenarios in which more than one image, each with potentially different signal levels, is acquired on each slice, as in diffusion-weighted MRI. This technique leads to improved NF estimates in simulations, phantom experiments and in vivo studies when compared to traditional NF estimators that use regional variability or background intensity histograms. The proposed method reduces the NF estimation error by a factor of 100 in simulations, shows a strong linear correlation (R²=0.99) between theoretical and estimated noise changes in phantoms and demonstrates consistent (<5% variability) NF estimates in vivo. The advantages of spatially varying NF estimation are demonstrated for power analysis, outlier detection and tensor estimation.     

Statistical methods for detecting activated regions in functional MRI of the brain

Two statistical tests for detecting activated pixels in functional MRI (fMRI) data are presented. The first test (t-test) is the optimal solution to the problem of detecting a known activation signal in Gaussian white noise. The results of this test are shown to be equivalent to the cross-correlation method that is widely used for activation detection in fMRI. The second test (F test) is the optimal solution when the measured data are modeled to consist of an unknown activation signal that lies in a known lower dimensional subspace of the measurement space with added Gaussian white noise. A model for the signal subspace based on a truncated trigonometric Fourier series is proposed for periodic activation–baseline imaging paradigms. The advantage of the second method is that it does not assume any information about the shape or delay of the activation signal, except that it is periodic with the same period as the activation–baseline pattern. The two models are applied to experimental echo-planar fMRI data sets and the results are compared.     

Proton nuclear magnetic resonance spectroscopy of normal and edematous brain tissue in vitro: Changes in relaxation during tissue storage

Proton nuclear magnetic resonance relaxation times, T₁ and T₂, of water in unfixed gray and white matter from normal and edematous rabbit brain tissues were measured in vitro at 23°C and 100 MHz to evaluate the effects of the temperature (?25°C to 37°C) and duration (0 to 96 h) of tissue storage on relaxation times. T₁ and T₂ tended to decrease during storage, probably from slow dehydration of the tissue. This effect was greatest in tissues stored at 37°C and least in those stored at 4 and ?25°C; decreases in T₁ and T₂ were greater in white matter than in gray matter. Freezing brain tissue to ?25°C caused a sudden decrease in the T₂ of normal white matter. Relaxation times were constant for 5 h in tissues stored at 23°C and for 40 h at 4°C. These results correlated well with corresponding tissue water loss.     

An approach for computer-aided detection of brain metastases in post-Gd T1-W MRI

Purpose

To develop an approach for computer-aided detection (CAD) of small brain metastases in post-Gd T1-weighted magnetic resonance imaging (MRI).

Method

A set of unevenly spaced 3D spherical shell templates was optimized to localize brain metastatic lesions by cross-correlation analysis with MRI. Theoretical and simulation analyses of effects of lesion size and shape heterogeneity were performed to optimize the number and size of the templates and the cross-correlation thresholds. Also, effects of image factors of noise and intensity variation on the performance of the CAD system were investigated. A nodule enhancement strategy to improve sensitivity of the system and a set of criteria based upon the size, shape and brightness of lesions were used to reduce false positives. An optimal set of parameters from the FROC curves was selected from a training dataset, and then the system was evaluated on a testing dataset including 186 lesions from 2753 MRI slices. Reading results from two radiologists are also included.

Results

Overall, a 93.5% sensitivity with 0.024 of intra-cranial false positive rate (IC-FPR) was achieved in the testing dataset. Our investigation indicated that nodule enhancement was very effective in improving both sensitivity and specificity. The size and shape criteria reduced the IC-FPR from 0.075 to 0.021, and the brightness criterion decreases the extra-cranial FPR from 0.477 to 0.083 in the training dataset. Readings from the two radiologists had sensitivities of 60% and 67% in the training dataset and 70% and 80% in the testing dataset for the metastatic lesions <5 mm in diameter.

Conclusion

Our proposed CAD system has high sensitivity and fairly low FPR for detection of the small brain metastatic lesions in MRI compared to the previous work and readings of neuroradiologists. The potential of this method for assisting clinical decision- making warrants further evaluation and improvements.     

Magnetic resonance imaging and computed tomography in Pelizaeus-Merzbacher disease

Six patients with the classical form of Pelizaeus-Merzbacher disease (PMD) were studied with computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. While final diagnosis of PMD should be made on the basis of histopathologic findings in the brain, findings in this group support the fact that MRI can be used for tentative early diagnosis when computer tomographic examination is normal or nondiagnostic. All patients had MRI findings reflecting a pattern of diffuse white matter disease that can be considered characteristic in the appropriate clinical setting.