Study of cerebrovascular reserve capacity by magnetic resonance perfusion weighted imaging and photoacoustic imaging

The aim of this work was to assess the feasibility of photoacoustic imaging (PAI) and MR imaging for evaluating the cerebrovascular reserve capacity (CVRC) in animal models. Wistar-Kyoto (WKY) rats and spontaneous hypertensive rats (SHR) were used for MRI. BALB/c mice were used for PAI. MR perfusion weighted imaging (PWI) was performed on a 1.5-T whole-body MR system before and after oral administration of acetazolamide (ACZ). The region of interest (ROI) was chosen in the bilateral frontal lobe for measuring regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) and mean transit time (MTT). The vessel diameters of the superficial layer of the cortex were measured by PAI in the resting and ACZ-activated mice. The results showed that there was a statistical difference between the resting and ACZ-activated animals in vessel diameter, rCBV and rCBF values. The increments in rCBV and rCBF of WKY rats between resting and ACZ test states were significantly higher than that of SHR. The pathological findings of small arterial walls and lumen of the brain were also different between WKY and SHR rats. The diameters of blood vessels in the superficial layer of the brain measured by PAI were enlarged after the ACZ tolerance test. This result was also observed in the MRI CBV map, where the signal of the vessel in the superficial layer of the cortex became redder after the ACZ stimulation, suggesting the increase of blood flow. It can be concluded that MR PWI and PAI combined with the ACZ test might be useful in evaluating the CVRC and revealing the pathologic changes in cerebral vessels.     

Conventional MR imaging with simultaneous measurements of cerebral blood volume and vascular permeability in ganglioglioma

The conventional MR imaging appearance of gangliogliomas is often variable and nonspecific. Conventional MR images, relative cerebral blood volume (rCBV) and vascular permeability (K(trans)) measurements were reviewed in 20 patients with pathologically proven grade 1 and 2 gangliogliomas (n = 20) and compared to a group of grade 2 low-grade gliomas (n = 30). The conventional MRI findings demonstrated an average lesion size of 4.1 cm, contrast enhancement (n = 19), variable degree of edema, variable mass effect, necrosis/cystic areas (n = 8), well defined (n = 12), signal heterogeneity (n = 9), calcification (n = 4). The mean rCBV was 3.66 +/- 2.20 (mean +/- std) for grade 1 and 2 gangliogliomas. The mean rCBV in a comparative group of low-grade gliomas (n = 30), was 2.14 +/- 1.67. p Value < 0.05 compared with grade 1 and 2 ganglioglioma. The mean K(trans) was 0.0018 +/- 0.0035. The mean K(trans) in a comparative group of low-grade gliomas (n = 30), was 0.0005 +/- 0.001. p Value = 0.14 compared with grade 1 and 2 ganglioglioma. The rCBV measurements of grade 1 and 2 gangliogliomas are elevated compared with other low-grade gliomas. The K(trans), however, did not demonstrate a significant difference. Gangliogliomas demonstrate higher cerebral blood volume compared with other low-grade gliomas, but the degree of vascular permeability in gangliogliomas is similar to other low-grade gliomas. Higher cerebral blood volume measurements can help differentiate gangliogliomas from other low-grade gliomas.     

Age dependency of the regional cerebral blood volume (rCBV) measured with dynamic susceptibility contrast MR imaging (DSC)

The changes of the regional cerebral blood volume (rCBV) with age were studied using dynamic susceptibility contrast MRI (DSC). We examined an unselected, random sample of 71 consecutive patients referred for work-up of suspected intracranial tumors (35 normal examinations, 36 tumors) with a standard 1.5 T clinical MR system. Determination of the rCBV was performed with a T₂¹-weighted simultaneous dual (SD) FLASH sequence (TR/TE1/TE2/α = 32/25/16/10°, 55 images) after bolus injection of Gd-DTPA. Absolute quantification of the rCBV was achieved by normalizing the measured tissue concentration-time curves with the integrated arterial input function (AIF), which was simultaneously measured in the brain feeding arteries. The rCBV (mean ± SD) was 8.4 ± 2.9 ml/100 g and 4.2 ± 1.7 ml/100 g in gray and white matter, respectively, with a decline of about 3% and 6% per decade for white and gray matter, respectively. We conclude that DSC using a SD FLASH sequence allows the simultaneous measurement of the AIF and the tissue concentration-time curve and thus an absolute quantification of the rCBV, which is the basis for interperson comparisons and follow-up studies.     

Improved T(1)-weighted dynamic contrast-enhanced MRI to probe microvascularity and heterogeneity of human glioma

Dynamic contrast-enhanced (DCE) T(1)-weighted magnetic resonance imaging (MRI) is a powerful tool capable of providing quantitative assessment of contrast uptake and characterization of microvascular structure in human gliomas. The kinetics of the bolus injection doped with increasing concentrations of gadopentate dimeglumine (Gd-DTPA) depends on tissue as well as pulse sequence parameters. A simple method is described that overcomes the limitation of relative signal increase measurement and may lead to improved accuracy in quantification of perfusion indices of glioma. Based on an analysis of the contrast behavior of spoiled gradient-recalled echo sequence; a parameter K with arbitrary unit 5.0 is introduced, which provides a better approximation to the differential T(1) relaxation rate. DCE-MRI measurements of relative cerebral blood volume (rCBV) and cerebral blood flow (rCBF) were calculated in 25 patients with brain tumors (15=high-grade glioma, 10=low-grade glioma). The mean rCBV was 6.46 +/- 2.45 in high-grade glioma and 2.89 +/- 1.47 in the low-grade glioma. The rCBF was 3.94 +/- 1.47 in high-grade glioma while 2.25 +/- 0.87 in low-grade glioma. A significant difference in rCBF and rCBV was found between high- and low-grade gliomas. This simple and robust technique reveals the complexity of tumor vasculature and heterogeneity that may aid in therapeutic management especially in nonenhancing high-grade gliomas. We conclude that the precontrast medium steady-state residue parameter K may be useful in improved quantification of perfusion indices in human glioma using T(1)-weighted DCE-MRI.     

Aspects on the accuracy of cerebral perfusion parameters obtained by dynamic susceptibility contrast MRI: a simulation study

Several studies have indicated that deconvolution based on singular value decomposition (SVD) is a robust concept for retrieval of cerebral blood flow in dynamic susceptibility contrast (DSC) MRI. However, the behavior of the technique under typical experimental conditions has not been completely investigated. In the present study, cerebral perfusion was simulated using different temporal resolutions, different signal-to-noise ratios (S/Ns), different shapes of the arterial input function (AIF), different signal drops, and different cut-off levels in the SVD deconvolution. Using Zierler's area-to-height relationship in combination with the central volume theorem, calculations of regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and regional mean transit time (rMTT) were accomplished, based on simulated DSC-MRI signal curves corresponding to artery, gray matter (GM), white matter (WM), and ischemic tissue. Gaussian noise was added to the noise-free signal curves to generate different S/Ns. We studied image time intervals of 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 s, as well as different degrees of signal decrease. The singular-value threshold in the SVD procedure and the shape of the AIF were also varied. Increased rCBF was seen when noise was added, especially for rCBF in WM at the larger image time intervals. The rCBF showed large standard deviations using a low threshold value. A prolonged time interval led to a lower absolute value of rCBF both in GM and WM, and a low/broad AIF also underestimated the rCBF. When a larger maximal signal decrease was assumed, smaller standard deviations were observed. No systematic change of the average rCBV was observed with increasing noise or with increasing image time interval. At S/N = 40, a low cut-off value resulted in an rCBF that was closer to the true value. Furthermore, at low S/N it was difficult to differentiate ischemic tissue from WM.     

Differentiation between intra-axial metastatic tumor progression and radiation injury following fractionated radiation therapy or stereotactic radiosurgery using MR spectroscopy, perfusion MR imaging or volume progression modeling

Objective

To determine the accuracy of magnetic resonance spectroscopy (MRS), perfusion MR imaging (MRP), or volume modeling in distinguishing tumor progression from radiation injury following radiotherapy for brain metastasis.

Methods

Twenty-six patients with 33 intra-axial metastatic lesions who underwent MRS (n=41) with or without MRP (n=32) after cranial irradiation were retrospectively studied. The final diagnosis was based on histopathology (n=4) or magnetic resonance imaging (MRI) follow-up with clinical correlation (n=29). Cho/Cr (choline/creatinine), Cho/NAA (choline/N-acetylaspartate), Cho/nCho (choline/contralateral normal brain choline) ratios were retrospectively calculated for the multi-voxel MRS. Relative cerebral blood volume (rCBV), relative peak height (rPH) and percentage of signal-intensity recovery (PSR) were also retrospectively derived for the MRPs. Tumor volumes were determined using manual segmentation method and analyzed using different volume progression modeling. Different ratios or models were tested and plotted on the receiver operating characteristic curve (ROC), with their performances quantified as area under the ROC curve (AUC). MRI follow-up time was calculated from the date of initial radiotherapy until the last MRI or the last MRI before surgical diagnosis.

Results

Median MRI follow-up was 16 months (range: 2-33). Thirty percent of lesions (n=10) were determined to be radiation injury; 70% (n=23) were determined to be tumor progression. For the MRS, Cho/nCho had the best performance (AUC of 0.612), and Cho/nCho >1.2 had 33% sensitivity and 100% specificity in predicting tumor progression. For the MRP, rCBV had the best performance (AUC of 0.802), and rCBV >2 had 56% sensitivity and 100% specificity. The best volume model was percent increase (AUC of 0.891); 65% tumor volume increase had 100% sensitivity and 80% specificity.

Conclusion

Cho/nCho of MRS, rCBV of MRP, and percent increase of MRI volume modeling provide the best discrimination of intra-axial metastatic tumor progression from radiation injury for their respective modalities. Cho/nCho and rCBV appear to have high specificities but low sensitivities. In contrast, percent volume increase of 65% can be a highly sensitive and moderately specific predictor for tumor progression after radiotherapy. Future incorporation of 65% volume increase as a pretest selection criterion may compensate for the low sensitivities of MRS and MRP.     

Hemodynamic investigation of peritumoral impaired blood oxygenation-level dependent cerebrovascular reactivity in patients with diffuse glioma

IntroductionThe presence of peritumorally impaired blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) has been unequivocally demonstrated in patients with diffuse glioma, and may have value to better identify tumor infiltration zone. Since BOLD-CVR does not measure hemodynamic changes directly, we performed additional MR perfusion studies to better characterize the peritumoral hemodynamic environment.MethodsSeventeen patients with WHO grade III and IV diffuse glioma underwent high resolution advanced hemodynamic MR imaging including BOLD-CVR and MR perfusion. The obtained multiparametric hemodynamic factors (i.e., regional cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit time (MTT), time-to-peak (TTP) and BOLD-CVR, were analyzed within 10 concentric expanding 3 mm volumes of interest (VOIs) up to 30 mm from the tumor tissue mask.ResultsBOLD-CVR impairment was found within the tumor tissue mask and the peritumoral VOIs up to 21 mm as compared to the contralateral flipped CVR analysis (p<0.05). In the affected hemisphere, we observed positive spatial correlations including all VOIs between BOLD-CVR and rCBV values (r=0.27; p<0.001), rCBF (r=0.42; p<0.001) and a negative correlation between BOLD-CVR and TTP (r=-0.47; p<0.001).ConclusionsPeritumorally impaired BOLD-CVR is associated with concomitant hemodynamic alterations with severity correlating to tumor volume. The distribution of these multiparametric hemodynamic MRI patterns may be considered for future studies characterizing the hemodynamic peritumoral environment, thereby better identifying the extent of tumor infiltration.     

平面波超声成像中的波束合成方法研究进展

平面波成像通过单次全孔径发射-接收即可获取整幅图像,将成像帧频显著地提升至1000帧/秒以上.然而,平面波成像过程中发射的非聚焦波束将导致回波信号信噪比降低,进而使图像的分辨率和对比度变差.通过多角度相干复合成像技术可以改善平面波成像的图像质量,但是会以牺牲帧频为代价.因此研究人员们开始将新型波束合成技术引入平面波成像...     

Analysis of tracer transit in rat brain after carotid artery and femoral vein administrations using linear system theory

Determination of tissue perfusion rates by MRI bolus tracking methods relies on the central volume principle which states that tissue blood flow is given by the tissue blood volume divided by the mean tracer transit time (MTT). Accurate determination of the MTT requires knowledge of the arterial input function which in MRI experiments is usually not known, especially when using small animals. The problem of unknown arterial input can be circumvented in animal experiments by directly injecting the contrast agent into a feeding artery of the tissue of interest. In the present article the passage of magnetite nanoparticles through the rat cerebral cortex is analyzed after injection into the internal carotid artery. The results are discussed in the framework of linear system theory using a one-compartment model for brain tissue and by using the well characterized γ-variate function to describe the tissue concentration profile of the contrast agent. The results obtained from the intra-arterial tracer administration experiments are then compared with the commonly used intra-venous injection of the contrast agent in order to estimate the contribution of the peripheral circulation to the MTT values in the latter case. The experiments were analyzed using a two-compartment model and the γ-variate function. As an application perfusion rates in normal and ischemic cerebral cortex of hypertensive rats were estimated in a model of focal cerebral ischemia. The results indicate that peripheral circulation has a significant influence on the MTT values and thus on the perfusion rates, which cannot be neglected.     

Effects of echo time variation on perfusion assessment using dynamic susceptibility contrast MR imaging at 3 tesla

The implications of changing the echo time of a gradient-echo echo planar imaging sequence applied to dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) for perfusion imaging at 3T were investigated. Four echo times in the range of 21 to 45 ms were examined in a total of 17 patients who received a dose of 0.1 mmol/kg bodyweight Gadobutrol (Gadovist, 1.0 mmol/ml). As the primary optimization parameter, the concentration-to-noise ratio (SNRc) was selected as it takes effects of variations in baseline as well as in signal drop into account. In an analysis of gray matter, white matter and arterial regions of interest, SNRc showed the highest values for the shortest applied echo time in all cases. Maps of regional cerebral blood volume (rCBV) and blood flow (rCBF) were calculated using deconvolution based on singular value decomposition. The quality of rCBF and rCBV images was judged to be good or excellent in all cases, independent of the echo time. Calculated gray matter/white matter ratios of rCBF and rCBV displayed no significant dependence on the applied echo time. Considering the better SNRc and arterial signal saturation aspects, we found that the shortest investigated echo time was the superior one. We thus suggest that short echo times should be applied, taking technical limitations and clinical demands into consideration.     

Quantitative assessment of intracranial tumor response to dexamethasone using diffusion, perfusion and permeability magnetic resonance imaging

There is increasing interest in obtaining quantitative imaging parameters to aid in the assessment of tumor responses to treatment. In this study, the feasibility of performing integrated diffusion, perfusion and permeability magnetic resonance imaging (MRI) for characterizing responses to dexamethasone in intracranial tumors was assessed. Eight patients with glioblastoma, five with meningioma and three with metastatic carcinoma underwent MRI prior to and 48-72 h following dexamethasone administration. The MRI protocol enabled quantification of the volume transfer constant (K(trans)), extracellular space volume fraction (nu(e)), plasma volume fraction (nu(p)), regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), longitudinal relaxation time (T(1)) and mean diffusivity (D(av)). All subjects successfully completed the imaging protocol for the presteroid and poststeroid scans. Significant reductions were observed after the treatment for K(trans), nu(e) and nu(p) in enhancing tumor as well as for T(1) and D(av) in the edematous brain in glioblastoma; on the other hand, for meningioma, significant differences were seen only in edematous brain T(1) and D(av). No significant difference was observed for any parameter in metastatic carcinoma, most likely due to the small sample size. In addition, no significant difference was observed for enhancing tumor rCBF and rCBV in any of the tumor types, although the general trend was for rCBV to be reduced and for rCBF to be more variable. The yielded parameters provide a wealth of physiologic information and contribute to the understanding of dexamethasone actions on different types of intracranial tumors.     

A phased array echoplanar imaging system for fMRI

A fully parallel, simultaneous sampling phased array receiver system for a clinical echoplanar imaging system is described and evaluated for BOLD activation and relative cerebral blood volume (rCBV) experiments. A 4-coil array curved around the occipital lobe improved SNR by factors of 1.5 in the visual cortex and 3.1 in the visual association cortex relative to a 13-cm diameter surface coil, improving the statistical significance and coverage of visual activation maps. A 4-coil bilateral array increased SNR throughout the head relative to a quadrature head coil by up to a factor of 5 in much of the cortex, with proportional improvement in the SNR of rCBV maps.     

Sevoflurane and nitrous oxide increase regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) in a drug-specific manner in human volunteers

Anesthesia for diagnostic procedures, e.g., MRI measurements, has increasingly used sevoflurane and nitrous oxide in recent years. Sevoflurane and nitrous oxide are known cerebrovasodilatators, however, which potentially interferes with MRI examination of cerebral hemodynamics. To compare the effects of relevant equianesthetic concentrations (0.4 MAC) of both drugs on regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) we used contrast-enhanced magnetic resonance imaging (MRI) perfusion measurement, which has the advantage of providing regional anatomic resolution.

Sevoflurane increased rCBF more than did nitrous oxide in all regions except in parietal and frontal gray matter. Nitrous oxide, by contrast, increased rCBV in most of the gray matter regions more than did sevoflurane. In summary we show that, in contrast to nitrous oxide, sevoflurane supratentorially reversed the anterior-posterior gradient in rCBF and typically redistributed rCBF to infratentorial gray matter. In contrast, nitrous oxide increased rCBV more than did sevoflurane. Both inhalational anesthetics had a drug-specific influence on cerebral hemodynamics, which is of importance when interpreting MRI studies of cerebral hemodynamics in anesthetized patients.     

Analysis of input functions from different arterial branches with gamma variate functions and cluster analysis for quantitative blood volume measurements

Regional cerebral blood volume (rCBV) provides valuable information about the nature and progress of diseases of the central nervous system. While relative rCBV maps can be derived directly from dynamic susceptibility contrast data, the arterial input function (AIF) has to be measured for absolute rCBV quantification. For determination of the AIF pixels located completely within a feeding artery must be selected. However, by using a region-of-interest (ROI) based selection some confounding effects can occur, especially if single shot echo planar imaging (EPI) with low spatial resolution is used. In this study we analyzed the influence of partial volume effects and spatial misregistration due to frequency shifts induced by paramagnetic contrast agents. We analyzed AIFs from the internal carotid artery (ICA), the vertebral artery (VA) and the middle cerebral artery (MCA) using gamma variate function based parameterization. The concentration time curves (CTC) of several pixels which were selected on the basis of strong signal drop appeared distorted during the bolus passage. Moreover, the amplitudes of input functions derived from the MCA were smaller by a factor of three as compared to those of the ICA and VA. Simulations revealed that these effects can be attributed to a spatial shift of the vessel along phase-encoding direction during the passage of the bolus. We therefore developed a procedure for a pixel selection based on cluster analysis which classifies pixels according to the parameters of the fitted gamma variate functions. This approach accounted for misregistration of the vessel and yielded very consistent results for a group of normal subjects.     

定量磁化率成像多回波相位拟合算法研究

定量磁化率成像(quantitative susceptibility mapping,QSM)技术大多采用多回波梯度回波序列采集相位数据,经加权最小二乘法(weighted linear least-square,WLS)拟合得到局部磁场分布.对于组织磁化率分布不均匀的区域,尤其是颅底部位,常规WLS算法拟合得到的局部磁场误差较大,导致相应部位磁化率分布图信噪比较低.针对常规WLS算法的这一不足,该文提出了一种截断WLS算法.对两种算法拟合得到的磁化率分布图对比研究发现,截断WLS算法可有效提高颅底部位定量磁化率分布图的图像质量,使其噪声明显下降.     

Linear-fitting-based similarity coefficient map for tissue dissimilarity analysis in T_2~*-w magnetic resonance imaging

Similarity coefficient mapping(SCM) aims to improve the morphological evaluation of T*2weighted magnetic resonance imaging(T*2-w MRI). However, how to interpret the generated SCM map is still pending. Moreover, is it probable to extract tissue dissimilarity messages based on the theory behind SCM? The primary purpose of this paper is to address these two questions. First, the theory of SCM was interpreted from the perspective of linear fitting. Then, a term was embedded for tissue dissimilarity information. Finally, our method was validated with sixteen human brain image series from multiecho T*2-w MRI. Generated maps were investigated from signal-to-noise ratio(SNR) and perceived visual quality, and then interpreted from intra- and inter-tissue intensity. Experimental results show that both perceptibility of anatomical structures and tissue contrast are improved. More importantly, tissue similarity or dissimilarity can be quantified and cross-validated from pixel intensity analysis. This method benefits image enhancement, tissue classification, malformation detection and morphological evaluation.     

Assessment of a combined spin- and gradient-echo (SAGE) DSC-MRI method for preclinical neuroimaging

The goal of this study was to optimize and validate a combined spin- and gradient-echo (SAGE) sequence for dynamic susceptibility-contrast magnetic resonance imaging to obtain hemodynamic parameters in a preclinical setting. The SAGE EPI sequence was applied in phantoms and in vivo rat brain (normal, tumor, and stroke tissue). Partial and full Fourier encoding schemes were implemented and characterized. Maps of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), vessel size index (VSI), volume transfer constant (K^trans), and volume fraction of the extravascular extracellular space (v_e) were obtained. Partial Fourier encoding provided shortened echo times with acceptable signal-to-noise ratio and temporal stability, thus enabling reliable characterization of T₂, T₂^? and T₁ in both phantoms and rat brain. The hemodynamic parameters CBV, CBF, and MTT for gradient-echo and spin-echo contrast were determined in tumor and stroke; VSI, K^trans, and v_e were also computed in tumor tissue. The SAGE EPI sequence allows the acquisition of multiple gradient- and spin-echoes, from which measures of perfusion, permeability, and vessel size can be obtained in a preclinical setting. Partial Fourier encoding can be used to minimize SAGE echo times and reliably quantify dynamic T₂ and T₂^? changes. This acquisition provides a more comprehensive assessment of hemodynamic status in brain tissue with vascular and perfusion abnormalities.     

Functional magnetic resonance imaging reference phantom

Functional magnetic resonance imaging (fMRI) is widely used to pinpoint active brain areas. Changes in neuronal activity modulate the local blood oxygenation level, and the associated modulation of the magnetic field homogeneity can be detected with magnetic resonance imaging. Thus, the blood oxygenation level-dependent (BOLD) fMRI indirectly measures neuronal activity. Similar modulation of magnetic field homogeneity was here elicited by other means to generate a BOLD-like change in a new phantom constructed to provide reference activations during fMRI. Magnetic inhomogeneities were produced by applying current to coils located near the phantom containing 1.5 ml of Gd-doped water. The signal-to-noise ratio of the images, produced by gradient-recalled echo-planar imaging, varied between 104 and 107 at a selected voxel when the field was and was not inhomogenized, respectively. The contrast of signals between homogeneous and inhomogeneous conditions was generally stable, except in 3% of time points. During the periods of greatest deviations an observable change would have been detected in a simultaneously measured BOLD signal. Such changes could result from the imaging method or occur through glitches in hardware or alterations in the measurement environment. With identical measurement setups, the phantom could allow comparing intersession or intersubject brain activations.     

Optimizing brain MRI protocols in the follow-up of patients with multiple sclerosis T2-weighted MRI of the brain after the administration of gadopentetate dimeglumine

The aim of our study was to determine whether T2-weighted (T2w) MRI of the brain could be performed immediately after the administration of gadopentetate dimeglumine (gadolinium DTPA) in patients with multiple sclerosis (MS) without a loss in image quality or diagnostic reliability. Sixteen patients with clinically diagnosed MS were included in the study. Twenty-four patients with various cerebral pathologies (14 patients with multiple lacunar lesions) were examined in order to exclude masking of T2 hyperintense lesions other than MS lesions. Images of 10 patients without pathological changes served as a control condition for the qualitative analysis. In these 50 patients, T1w and T2w MRI was performed before and after the administration of gadolinium DTPA. Signal intensities were measured within T2 hyperintense cerebral lesions, in T1-enhancing lesions and in normal appearing brain tissue on T2w turbo spin-echo (TSE) sequences. Both quantitative and qualitative analysis did not show significant differences between T2w pre- and postcontrast series. T2w MRI performed prior to and after the administration of gadolinium DTPA provides similar information in patients with MS. With a TR of 3.2 s, not a single lesion was obscured on T2w postcontrast series. Acquisition of T2w MR images immediately after the administration of gadolinium DTPA allows for shorter examination time and assures sufficient time for contrast enhancement in cerebral lesions with a disrupted blood-brain barrier.     

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

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