The effect of morphological and microstructural integrity of the corpus callosum on cognition,fatigue and depression in mildly disabled MS patients

AimTo assess the value of callosal morphological and microstructural integrity in assessing different cognitive domains, fatigue and depression in mildly disabled multiple sclerosis (MS) patients.Materials and methodsWe assessed 29 mildly disabled MS patients and 15 healthy controls using 3T magnetic resonance images (T1-weighted, FLAIR and DTI) and neuropsychological tests assessing different cognitive functions, depression and fatigue. We compared the added value of morphological measures (corpus callosum area corrected for total intracranial volume, index, circularity and the more detailed thickness profile) and diffusion features (fractional anisotropy and mean diffusivity) in multilinear models including standard clinical and whole-brain parameters in assessing neuropsychological scores.ResultsEven in mildly disabled MS patients, a significant reduction of the corpus callosum (p < 0.001) was observed in comparison to healthy controls. Callosal area, index and circularity were significantly (p < 0.002) related to whole-brain white matter volume, T2 lesion load and deep grey matter volume, but not with cortical grey matter.The combination of commonly used imaging and clinical parameters explained between 7% (Fatigue) and 50% (processing speed, verbal memory) of the adjusted variance. Inclusion of the mean diffusivity increased the adjusted R² significantly to 69% (p = 0.004) and 71% (p = 0.002) for visuospatial and verbal memory respectively.ConclusionOur results show that callosal features may be used as an alternative to measuring whole-brain volumes. Furthermore, the microstructural integrity of the corpus callosum can help to predict an MS patient's memory performance.     

Magnetic resonance elastography of the pancreas: Measurement reproducibility and relationship with age

PurposeTo determine magnetic resonance elastography (MRE)-derived stiffness of pancreas in healthy volunteers with emphasis on: 1) short term and midterm repeatability; and 2) variance as a function of age.MethodsPancreatic MRE was performed on 22 healthy volunteers (age range:20–64 years) in a 3 T–scanner. For evaluation of reproducibility of stiffness estimates, the scans were repeated per volunteer on the same day (short term) and one month apart (midterm). MRE wave images were analyzed using 3D inversion to estimate the stiffness of overall pancreas and different anatomic regions (i.e., head, neck, body, and tail). Concordance and Spearman correlation tests were performed to determine reproducibility of stiffness measurements and relationship to age.ResultsA strong concordance correlation (ρ_c = 0.99; p-value < 0.001) was found between short term and midterm repeatability pancreatic stiffness measurements. Additionally, the pancreatic stiffness significantly increased with age with good Spearman correlation coefficient (all ρ > 0.81; p < 0.001). The older age group (> 45 yrs) had significantly higher stiffness compared to the younger group (≤ 45 yrs) (p < 0.001). No significant difference (p > 0.05) in stiffness measurements was observed between different anatomical regions of pancreas, except neck stiffness was slightly lower (p < 0.012) compared to head and overall pancreas at month 1.ConclusionMRE-derived pancreatic stiffness measurements are highly reproducible in the short and midterm and increase linearly with age in healthy volunteers. Further studies are needed to examine these effects in patients with various pancreatic diseases to understand potential clinical applications.     

Digital differentiation of non-small cell carcinomas of the lung by the fractal dimension of their epithelial architecture

IntroductionIn recent years, differences have emerged in the treatment of squamous and non-squamous non-small cell lung carcinomas (NSCLCs). This highlights the importance of accurate histopathologic classification. However, there remains inter-observer disagreement when making diagnoses based on histology. Fractal dimension (FD) is a mathematical measure of irregularity and complexity of shape. We hypothesize that the FD of carcinoma epithelial architecture can assist in differentiating adenocarcinoma (ADC) from squamous cell carcinoma (SCC) of the lung.Methods134 resected (88 ADC and 46 SCC) cases of resected early-stage NSCLC were analyzed. Tissue micro arrays were generated from formalin-fixed paraffin-embedded tissue, stained with pan-cytokeratin, and digitally imaged and the FD of the epithelial structure calculated. Mean FD of ADC and SCC were compared using the independent t-test, partial correlations, and receiver operating characteristic (ROC) analyses.ResultsA statistically significant difference (p < 0.001) between the mean FD of ADC (M = 1.70, SD = 0.07) and SCC (M = 1.78, SD = 0.07) was found. Significance remained (p < 0.001) when controlling for several possible confounders. ROC analysis demonstrated an area-under-the-curve of 0.81 (p < 0.001).ConclusionsThe epithelial structure FD of NSCLC has potential as a reproducible and automated measure to help subtype NSCLCs into ADC and SCC. With further image analysis algorithm improvements, fractal analysis may be a component in computerized histomorphological assessments of lung cancer and may provide an adjunct test in differentiating NSCLCs.     

Perfusion of the uterine junctional zone in nulliparous and primiparous women assessed by DCE-MRI,as a function of menstrual cycle and hormonal contraception

PurposeTo evaluate the perfusion parameters of inner and outer myometrium in healthy nulliparous and primiparous women who are and who are not currently using hormonal contraceptives by means of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Material and methodsWe performed pelvic 1.5 T DCE-MRI on 98 women: 18 nulliparous non-users, 30 nulliparous users, 12 primiparous non-users and 38 primiparous users of hormonal contraception (mean age respectively 26.4, 25.8, 30.23 and 28.18 years). The nulliparous non-users underwent DCE-MRI investigations during their follicular, ovulatory and luteal phase. Perfusion parameters (iAUC/volume, Ktrans, Kep and Ve) were assessed in the anterior and posterior junctional zone (JZ), outer myometrium and cervix.ResultsIn nulliparous non-users, the mean Ktrans and iAUC/volume showed a decrease from follicular to luteal phase (0.82 vs 0.55 min^− 1 for Ktrans, p = 0/027 and 1.28 vs 0.68 for iAUC/volume, p < 0.001). The anterior JZ demonstrated lower Ktrans (p = 0.050) and higher Kep (p = 0.012), in nulliparous non-users, lower Ktrans in nulliparous users (p < 0.001) and lower Ve in primiparous users (p = 0.012) than the anterior outer myometrium. Ktrans at the anterior and posterior JZ wall in nulliparous users was lower than in non-users (p = 0.001 and p = 0.013) and Ve at the anterior JZ wall in primiparous users was lower than in non-users (p = 0.044).ConclusionThis study provides data on normal perfusion parameters of inner and outer myometrium, which may be potentially useful in assisted reproductive therapy.     

Quantitative Dixon MRI sequences to relate muscle atrophy and fatty degeneration with range of motion and muscle force in brachial plexus injury

BackgroundAssessment of muscle atrophy and fatty degeneration in brachial plexus injury (BPI) could yield valuable insight into pathophysiology and could be used to predict clinical outcome. The objective of this study was to quantify and relate fat percentage and cross-sectional area (CSA) of the biceps to range of motion and muscle force of traumatic brachial plexus injury (BPI) patients.MethodsT1-weighted TSE sequence and three-point Dixon images of the affected and non-affected biceps brachii were acquired on a 3 Tesla magnetic resonance scanner to determine the fat percentage, total and contractile CSA of 20 adult BPI patients. Regions of interest were drawn by two independent investigators to determine the inter-observer reliability. Paired Students' t-test and multivariate analysis were used to relate fat percentage, total and contractile CSA to active flexion and biceps muscle force.ResultsThe mean fat percentage 12 ± 5.1% of affected biceps was higher than 6 ± 1.0% of the non-affected biceps (p < 0.001). The mean contractile CSA 8.1 ± 5.1 cm² of the affected biceps was lower than 19.4 ± 4.9 cm² of the non-affected biceps (p < 0.001). The inter-observer reliability was excellent (ICC 0.82 to 0.96). The contractile CSA contributed most to the reduction in active flexion and muscle force.ConclusionQuantitative measurement of fat percentage, total and contractile CSA using three-point Dixon sequences provides an excellent reliability and relates with active flexion and muscle force in BPI.     

Quantitative susceptibility mapping using principles of echo shifting with a train of observations sequence on 1.5 T MRI

PurposeTo evaluate the accuracy of susceptibility estimated from the principles of echo shifting with a train of observations (PRESTO) sequence using a 1.5 T MRI system, we conducted experiments on the human brain using the PRESTO sequence and compared our results with the susceptibility obtained from spoiled gradient-recalled echo (GRE) sequence with flow compensation using quantitative susceptibility mapping (QSM) reconstruction.Materials and methodsExperiments on the human brain were conducted on 12 healthy volunteers (27 ± 4 years) using PRESTO and spoiled GRE sequences on a 1.5 T scanner. The PRESTO sequence is an echo-shifted gradient echo sequence that allows high susceptibility sensitivity and rapid acquisition because of TE > TR compared with the spoiled GRE sequence. QSM analysis was performed on the obtained phase images using the iLSQR method. Estimated susceptibility maps were used for region of interest analyses and estimation of line profiles through iron-rich tissue and major vessels.ResultsOur results demonstrated that susceptibility maps were accurately estimated, without error, by QSM analysis of PRESTO and spoiled GRE sequences. Acquisition time in the PRESTO sequence was reduced by 43% compared with that in the spoiled GRE sequence. Differences did exist between susceptibility maps in PRESTO and spoiled GRE sequences for visualization and quantitative values of major blood vessels and the areas around themConclusionThe PRESTO sequence enables correct estimation of tissue susceptibility with rapid acquisition and may be useful for QSM analysis of clinical use of 1.5 T scanners.     

Reproducibility of cine displacement encoding with stimulated echoes (DENSE) in human subjects

ObjectivesTo test the hypothesis that two-dimensional (2D) displacement encoding via stimulated echoes (DENSE) is a reproducible technique for the depiction of segmental myocardial motion in human subjects.Materials and methodsFollowing the approval of the institutional review board (IRB), 17 healthy volunteers without documented history of cardiovascular disease were recruited. For each participant, 2D DENSE were performed twice (at different days) and the images were obtained at basal, midventricular and apical levels of the left ventricle (LV) with a short-axis view. The radial thickening strain (Err), circumferential strain (Ecc), twist and torsion were calculated. The intra-, inter-observer and inter-study variations of DENSE-derived myocardial motion indices were evaluated using coefficient of variation (CoV) and intra-class correlation coefficient (ICC).ResultsIn total, there are 272 pairs of myocardial segments (data points) for comparison. There is good intra- and inter-observer reproducibility for all DENSE-derived measures in 17 participants. There is good inter-study reproducibility for peak Ecc (CoV = 19.64%, ICC = 0.8896, p < 0.001), twist (CoV = 33.11%, ICC = 0.9135, p < 0.001) and torsion (CoV = 13.96%, ICC = 0.8684, p < 0.001). There is moderate inter-study reproducibility for Err (CoV = 38.89%, ICC = 0.7022, p < 0.001).ConclusionDENSE is a reproducible technique for characterizing LV regional systolic myocardial motion on a per-segment basis in healthy volunteers.     

Assessment of the link between quantitative biexponential diffusion-weighted imaging and contrast-enhanced MRI in the liver

PurposeTo investigate if intravoxel incoherent motion (IVIM) modeled diffusion-weighted imaging (DWI) can be linked to contrast-enhanced (CE-)MRI in liver parenchyma and liver lesions.MethodsTwenty-five patients underwent IVIM-DWI followed by multiphase CE-MRI using Gd-EOB-DTPA (n = 20) or Gd-DOTA (n = 5) concluded with IVIM-DWI. Diffusion (D_slow), microperfusion (D_fast), its fraction (f_fast), wash-in-rate (R_early) and late-enhancement-rate (R_late) of Gd-EOB-DTPA were calculated voxel-wise for the liver. Parenchyma and lesions were segmented. Pre-contrast IVIM was compared 1) between low, medium and high R_early for parenchyma 2) to post-contrast IVIM substantiated with simulations 3) between low and high R_late per lesion type.ResultsD_fast and f_fast increased (P < 0.001) with 25.6% and 33.8% between low and high R_early of Gd-EOB-DTPA. D_slow decreased (− 15.0%; P < 0.001) with increasing R_early. Gd-DOTA demonstrated similar observations. f_fast (+ 10%; P < 0.001) and D_fast (+ 6.6%; P < 0.001) increased after Gd-EOB-DTPA, while decreasing after Gd-DOTA (− 4.2% and − 5.7%, P < 0.001) and were confirmed by simulations. For focal nodular hyperplasia lesions (n = 5) D_fast and f_fast increased (P < 0.001) with increasing R_late, whereas for hepatocellular carcinoma (n = 4) and adenoma (n = 7) no differences were found.ConclusionMicroperfusion measured by IVIM reflects perfusion in a way resembling CE-MRI. Also IVIM separated intra- and extracellular MR contrast media. This underlines the potential of IVIM in quantitative liver imaging.     

Flow versus permeability weighting in estimating the forward volumetric transfer constant (Ktrans) obtained by DCE-MRI with contrast agents of differing molecular sizes

PurposeTo quantify the differential plasma flow- (F_p-) and permeability surface area product per unit mass of tissue- (PS-) weighting in forward volumetric transfer constant (K^trans) estimates by using a low molecular (Gd-DTPA) versus high molecular (Gadomer) weight contrast agent in dynamic contrast enhanced (DCE) MRI.Materials and methodsDCE MRI was performed using a 7T animal scanner in 14 C57BL/6J mice syngeneic for TRAMP tumors, by administering Gd-DTPA (0.9 kD) in eight mice and Gadomer (35 kD) in the remainder. The acquisition time was 10 min with a sampling rate of one image every 2 s. Pharmacokinetic modeling was performed to obtain K^trans by using Extended Tofts model (ETM). In addition, the adiabatic approximation to the tissue homogeneity (AATH) model was employed to obtain the relative contributions of F_p and PS.ResultsThe K^trans values derived from DCE-MRI with Gd-DTPA showed significant correlations with both PS (r² = 0.64, p = 0.009) and F_p (r² = 0.57, p = 0.016), whereas those with Gadomer were found only significantly correlated with PS (r² = 0.96, p = 0.0003) but not with F_p (r² = 0.34, p = 0.111). A voxel-based analysis showed that K^trans approximated PS (< 30% difference) in 78.3% of perfused tumor volume for Gadomer, but only 37.3% for Gd-DTPA.ConclusionsThe differential contributions of F_p and PS in estimating K^trans values vary with the molecular weight of the contrast agent used. The macromolecular contrast agent resulted in K^trans values that were much less dependent on flow. These findings support the use of macromolecular contrast agents for estimating tumor vessel permeability with DCE-MRI.     

Towards intrinsic R2* imaging in the prostate at 3 and 7 tesla

PurposeHypoxia is an important marker for resistance to therapy. In this study, we quantify the macroscopic effects of R2* mapping in prostate cancer patients incorporating susceptibility matching and field strengths effects.Materials and methods91 patients were scanned without endorectal coil (ERC) at 3 T. Only when rectal gas was absent, data was included for analysis. Another group of 10 patients was scanned using a susceptibility matched ERC. To assess the residual contamination of R2 and macroscopic field non-uniformities, a group of 10 patients underwent ultra-high resolution 7 T MRI.ResultsOf the patients scanned at 3 T 60% presented rectal gas and were excluded, due to susceptibility artifacts. At 3 T the tumor was significantly different (P < 0.01) from the healthy surrounding tissue in R2* values at intrapatient level. Using the measured median R2* value of 24.9 s^− 1 at 3 T and 43.2 s^− 1 at 7 T of the peripheral zone, the minimum contribution of macroscopic susceptibility effects is 15% at 3 T.ConclusionR2* imaging might be a promising tool for hypoxia imaging, particularly when minimizing macroscopic susceptibility effects contaminating intrinsic R2* of tissue, such as rectal gas. At 3 T macroscopic effects still contribute 15% in the R2* value, compared to ultra-high resolution R2* mapping at 7 T.     

Quantification of myocardial oxygenation in heart failure using blood-oxygen-level-dependent T2* magnetic resonance imaging: Comparison with cardiopulmonary exercise test

PurposeQuantification of myocardial oxygenation (MO) in heart failure (HF) has been less than satisfactory. This has necessitated the use of invasive techniques to measure MO directly or to determine the oxygen demand during exercise using the cardiopulmonary exercise (CPX) test. We propose a new quantification method for MO using blood-oxygen-level-dependent (BOLD) myocardial T2* magnetic resonance imaging (M-T2* MRI), and investigate its correlation with CPX results.MethodsThirty patients with refractory HF who underwent cardiac MRI and CPX test for heart transplantation, and 24 healthy, age-matched volunteers as controls were enrolled. M-T2* imaging was performed using a 3-Tesla and multi-echo gradient-echo sequence. M-T2* was calculated by fitting the signal intensity data for the mid-left ventricular septum to a decay curve. M-T2* was measured under room-air (T2*-air) and after inhalation of oxygen for 10 min at a flow rate of 10 L/min (T2*-oxy). MO was defined as the difference between the two values (ΔT2*). Changes in M-T2* at the two conditions and ΔT2* between the two groups were compared. Correlation between ΔT2* and CPX results was analyzed using the Pearson coefficient.ResultsT2*-oxy was significantly greater than T2*-air in patients with HF (29.9 ± 7.3 ms vs. 26.7 ± 6.0 ms, p < 0.001), whereas no such difference was observed in controls (25.5 ± 4.0 ms vs. 25.4 ± 4.4 ms). ΔT2* was significantly greater for patients with HF than for controls (3.2 ± 4.5 ms vs. -0.1 ± 1.3 ms, p < 0.001). A significant correlation between ΔT2* and CPX results (peak VO₂, r = − 0.46, p < 0.05; O₂ pulse, r = − 0.54, p < 0.005) was observed.ConclusionΔT2* is increased T2*-oxy is greater in patients with HF, and is correlated with oxygen metabolism during exercise as measured by the CPX test. Hence, ΔT2* can be used as a surrogate marker of MO instead of CPX test.     

Selective microvascular muscle perfusion imaging in the shoulder with intravoxel incoherent motion (IVIM)

The evaluation of local muscle recruitment during a specific movement can be done indirectly by measuring changes in local blood flow. Intravoxel incoherent motion perfusion imaging exploits some properties of the magnetic resonance to measure locally microvascular perfusion, and seems ideally suited for this task. We studied the selectivity of the increase in intravoxel incoherent motion blood flow related parameter fD* in the muscles of 24 shoulders after two physical exam maneuvers, Jobe and Lift-off test (test order reversed in half of the volunteers) each held 2 min against resistance. After a lift-off, IVIM blood flow-related fD* was increased in the subscapularis (in 10⁻³ mm² s⁻¹, 3.24 ± 0.86 vs. rest 1.37 ± 0.58, p < 0.001) and the posterior bundle of deltoid (2.62 ± 1.34 vs. rest 0.77 ± 0.32, p < 0.001). Those increases were selective when compared with other rotator cuff muscles and deltoid bundles respectively. After a Jobe test, increase in fD* was scattered within the rotator cuff muscles, but was selective for the lateral deltoid compared to the other deltoid bundles (anterior, p < 0.001; posterior, p < 0.05). Those results were similar when the testing order was reversed. In conclusion, this study demonstrated a selective increase in local microvascular perfusion after specific muscle testing of the shoulder muscles with IVIM. This technique has the potential to non-invasively characterize perfusion-related musculoskeletal physiological as well as pathological processes.     

Diagnostic accuracy of automatic normalization of CBV in glioma grading using T1- weighted DCE-MRI

PurposeAim of this retrospective study was to compare diagnostic accuracy of proposed automatic normalization method to quantify the relative cerebral blood volume (rCBV) with existing contra-lateral region of interest (ROI) based CBV normalization method for glioma grading using T1-weighted dynamic contrast enhanced MRI (DCE-MRI).Material and methodsSixty patients with histologically confirmed gliomas were included in this study retrospectively. CBV maps were generated using T1-weighted DCE-MRI and are normalized by contralateral ROI based method (rCBV_contra), unaffected white matter (rCBV_WM) and unaffected gray matter (rCBV_GM), the latter two of these were generated automatically. An expert radiologist with > 10 years of experience in DCE-MRI and a non-expert with one year experience were used independently to measure rCBVs. Cutoff values for glioma grading were decided from ROC analysis. Agreement of histology with rCBV_WM, rCBV_GM and rCBV_contra respectively was studied using Kappa statistics and intra-class correlation coefficient (ICC).ResultThe diagnostic accuracy of glioma grading using the measured rCBV_contra by expert radiologist was found to be high (sensitivity = 1.00, specificity = 0.96, p < 0.001) compared to the non-expert user (sensitivity = 0.65, specificity = 0.78, p < 0.001). On the other hand, both the expert and non-expert user showed similar diagnostic accuracy for automatic rCBV_WM (sensitivity = 0.89, specificity = 0.87, p = 0.001) and rCBV_GM (sensitivity = 0.81, specificity = 0.78, p = 0.001) measures. Further, it was also observed that, contralateral based method by expert user showed highest agreement with histological grading of tumor (kappa = 0.96, agreement 98.33%, p < 0.001), however; automatic normalization method showed same percentage of agreement for both expert and non-expert user. rCBV_WM showed an agreement of 88.33% (kappa = 0.76,p < 0.001) with histopathological grading.ConclusionIt was inferred from this study that, in the absence of expert user, automated normalization of CBV using the proposed method could provide better diagnostic accuracy compared to the manual contralateral based approach.     

Reduced distortion artifact whole brain CBF mapping using blip-reversed non-segmented 3D echo planar imaging with pseudo-continuous arterial spin labeling

PurposeTo implement and evaluate interleaved blip-up, blip-down, non-segmented 3D echo planar imaging (EPI) with pseudo-continuous arterial spin labeling (pCASL) and post-processing for reduced susceptibility artifact cerebral blood flow (CBF) maps.Materials and methods3D EPI non-segmented acquisition with a pCASL labeling sequence was modified to include alternating k-space coverage along phase encoding direction (referred to as “blip-reversed”) for alternating dynamic acquisitions of control and label pairs. Eight volunteers were imaged on a 3T scanner. Images were corrected for distortion using spatial shifting transformation of the underlying field map. CBF maps were calculated and compared with maps obtained without blip reversal using matching gray matter (GM) images from a high resolution 3D scan. Additional benefit of using the correction for alternating blip-up and blip-down acquisitions was assessed by comparing to corrected blip-up only and corrected blip-down only CBF maps. Matched Student t-test of overlapping voxels for the eight volunteers was done to ascertain statistical improvement in distortion.ResultsMean CBF value in GM for the eight volunteers from distortion corrected CBF maps was 50.8 ± 9.9 ml/min/100 gm tissue. Corrected CBF maps had 6.3% and 4.1% more voxels in GM when compared with uncorrected blip up (BU) and blip down (BD) images, respectively. Student t-test showed significant reduction in distortion when compared with blip-up images and blip-down images (p < 0.001). When compared with corrected BU and corrected BD only CBF maps, BU and BD corrected maps had 2.3% and 1% more voxels (p = 0.006 and 0.04, respectively).ConclusionPseudo-continuous arterial spin labeling with non-segmented 3D EPI acquisition using alternating blip-reversed k-space traversal and distortion correction provided significantly better matching GM CBF maps. In addition, employing alternating blip-reversed acquisitions during pCASL acquisition resulted in statistically significant improvement over corrected blip-up and blip-down CBF maps.     

High-resolution,three-dimensional diffusion-weighted breast imaging using DESS

PurposeTo evaluate the use of the double-echo steady-state (DESS) sequence for acquiring high-resolution breast images with diffusion and T2 weighting.Materials and MethodsPhantom scans were used to verify the T2 and diffusion weighting of the DESS sequence. Image distortion was evaluated in volunteers by comparing DESS images and conventional diffusion-weighted images (DWI) to spoiled gradient-echo images. The DESS sequence was added to a standard clinical protocol, and the resulting patient images were used to evaluate overall image quality and image contrast in lesions.ResultsThe diffusion weighting of the DESS sequence can be easily modulated by changing the spoiler gradient area and flip angle. Radiologists rated DESS images as having higher resolution and less distortion than conventional DWI. Lesion-to-tissue contrast ratios are strongly correlated between DWI and DESS images (R = 0.83) and between T2-weighted fast spin-echo and DESS images (R = 0.80).ConclusionThe DESS sequence is able to acquire high-resolution 3D diffusion- and T2-weighted images in short scan times, with image quality that facilitates morphological assessment of lesions.     

Alterations of the optic pathway between unilateral and bilateral optic nerve damage in multiple sclerosis as revealed by the combined use of advanced diffusion kurtosis imaging and visual evoked potentials

ObjectivesWe investigated changes in the optic tract and optic radiation in patients with multiple sclerosis (MS) by comparing unilateral and bilateral optic nerve damage assessed based on visual evoked potentials (VEPs) using advanced diffusion MR metrics.MethodsIn 21 MS patients, diffusion MRI was performed. Maps of fractional anisotropy, apparent diffusion coefficient (ADC), and mean kurtosis (MK) were computed. On the basis of the P100 latency in VEPs, the MS patients were divided into three groups: bilateral (n = 7), unilateral (n = 7), and no abnormality (n = 7). Their optic tracts and optic radiations were analyzed with diffusion MRI-based fiber tracking. We also investigated the correlations between diffusion parameters and VEPs (n = 21).ResultsIn the optic tract, the diffusion changes in each of the three groups showed step-like changes. The diffusion changes in the optic radiations of the unilateral group were similar to those in the normal VEP group. Only the bilateral group showed significantly higher ADC and lower MK relative to the other two groups (P < 0.05, Steel–Dwass multiple-comparison test). A significant positive correlation between VEP latency and ADC and a significant negative correlation between VEP latency and MK were observed (P < 0.01, Spearman's correction).ConclusionsWe first evaluated the relationship between VEPs and DKI and concluded that the lateral geniculate nucleus may compensate for unilateral damage in the pre-geniculate optic pathway via neural plasticity.     

A non-contrast CMR index for assessing myocardial fibrosis

PurposeSafe, sensitive, and non-invasive imaging methods to assess the presence, extent, and turnover of myocardial fibrosis are needed for early stratification of risk in patients who might develop heart failure after myocardial infarction. We describe a non-contrast cardiac magnetic resonance (CMR) approach for sensitive detection of myocardial fibrosis using a canine model of myocardial infarction and reperfusion.MethodsSeven dogs had coronary thrombotic occlusion of the left anterior descending coronary arteries followed by fibrinolytic reperfusion. CMR studies were performed at 7 days after reperfusion. A CMR spin-locking T₁ρ mapping sequence was used to acquire T₁ρ dispersion data with spin-lock frequencies of 0 and 511 Hz. A fibrosis index map was derived on a pixel-by-pixel basis. CMR native T₁ mapping, first-pass myocardial perfusion imaging, and post-contrast late gadolinium enhancement imaging were also performed for assessing myocardial ischemia and fibrosis. Hearts were dissected after CMR for histopathological staining and two myocardial tissue segments from the septal regions of adjacent left ventricular slices were qualitatively assessed to grade the extent of myocardial fibrosis.ResultsHistopathology of 14 myocardial tissue segments from septal regions was graded as grade 1 (fibrosis area, < 20% of a low power field, n = 9), grade 2 (fibrosis area, 20–50% of field, n = 4), or grade 3 (fibrosis area, > 50% of field, n = 1). A dramatic difference in fibrosis index (183%, P < 0.001) was observed by CMR from grade 1 to 2, whereas differences were much smaller for T₁ρ (9%, P = 0.14), native T₁ (5.5%, P = 0.12), and perfusion (− 21%, P = 0.05).ConclusionA non-contrast CMR index based on T₁ρ dispersion contrast was shown in preliminary studies to detect and correlate with the extent of myocardial fibrosis identified histopathologically. A non-contrast approach may have important implications for managing cardiac patients with heart failure, particularly in the presence of impaired renal function.     

MRI ductography of contrast agent distribution and leakage in normal mouse mammary ducts and ducts with in situ cancer

High resolution 3D MRI was used to study contrast agent distribution and leakage in normal mouse mammary glands and glands containing in situ cancer after intra-ductal injection. Five female FVB/N mice (~ 19 weeks old) with no detectable mammary cancer and eight C3(1) SV40 Tag virgin female mice (~ 15 weeks old) with extensive in situ cancer were studied. A 34G, 45° tip Hamilton needle with a 25μL Hamilton syringe was inserted into the tip of the nipple and approximately 15 μL of a Gadodiamide was injected slowly over 1 min into the nipple and throughout the duct on one side of the inguinal gland. Following injection, the mouse was placed in a 9.4 T MRI scanner, and a series of high resolution 3D T1-weighted images was acquired with a temporal resolution of 9.1 min to follow contrast agent leakage from the ducts. The first image was acquired at about 12 min after injection. Ductal enhancement regions detected in images acquired between 12 and 21 min after contrast agent injection was five times smaller in SV40 mouse mammary ducts (p < 0.001) than in non-cancerous FVB/N mouse mammary ducts, perhaps due to rapid washout of contrast agent from the SV40 ducts. The contrast agent washout rate measured between 12 min and 90 min after injection was ~ 20% faster (p < 0.004) in SV40 mammary ducts than in FVB/N mammary ducts. These results may be due to higher permeability of the SV40 ducts, likely due to the presence of in situ cancers. Therefore, increased permeability of ducts may indicate early stage breast cancers.     

Evaluation of correlation between chemical dosimetry and subharmonic spectrum analysis to examine the acoustic cavitation

Currently several therapeutic applications of ultrasound in cancer treatment are under progress which uses cavitation phenomena to deliver their effects. There are several methods to evaluate cavitation activity such as chemical dosimetry and measurement of subharmonic signals. In this study, the cavitation activity induced by the ultrasound irradiation on exposure parameters has been measured by terephthalic acid chemical dosimetry and subharmonic analysis. Experiments were performed in the near 1 MHz fields in the progressive wave mode and effect of duty cycles changes with 2 W/cm² intensity (I_SATA) and acoustic intensity changes in continuous mode on both fluorescence intensity and subharmonic intensity were measured. The dependence between fluorescence intensity of terephthalic acid chemical dosimetry and subharmonic intensity analysis were analyzed by Pearson correlation (p-value < 0.05). It has been shown that the subharmonic intensity and the fluorescence intensity for continuous mode is higher than for pulsing mode (p-value < 0.05). Also results show that there is a significant difference between the subharmonic intensity and the fluorescence intensity with sonication intensity (p-value < 0.05). A significant correlation between the fluorescence intensity and subharmonic intensity at different duty cycles (R = 0.997, p-value < 0.05) and different intensities (R = 0.985, p-value < 0.05) were shown. The subharmonic intensity (μW/cm²) significantly correlated with the fluorescence intensity (count) (R = 0.901; p < 0.05) and the fluorescence intensity due to chemical dosimetry could be estimated with subharmonic intensity due to subharmonic spectrum analysis. It is concluded that there is dependence between terephthalic acid chemical dosimetry and subharmonic spectrum analysis to examine the acoustic cavitation activity.     

High-intensity focused ultrasound (HIFU) for adenomyosis: Two-year follow-up results

ObjectiveTo evaluate the long-term improvement of clinical symptoms of adenomyosis after treatment with ultrasound-guided high intensity focused ultrasound (USgHIFU).MethodsFrom January 2010 to December 2011, 350 patients with adenomyosis were treated with USgHIFU. Among the 350 patients, 224 of them completed the two years follow-up. The patients were followed up at 3 months, 1 year, and 2 years after HIFU treatment. Adverse effects and complications were recorded.ResultsAll patients completed HIFU ablation without severe postoperative complications. 203 of the 224 patients who showed varying degrees of dysmenorrhea before treatment had the symptom scores decreased significantly after treatment (P < 0.001). The relief rate was 84.7%, 84.7%, and 82.3%, respectively at 3 months, 1 year, and 2 years after treatment. The menstrual volume in 109 patients with menorrhagia was significantly improved after treatment (P < 0.001) with a relief rate of 79.8%, 80.7%, and 78.9%, respectively at 3 months, 1 year, and 2 years after HIFU treatment.ConclusionWith its ability to sustain long-term clinical improvements, HIFU is a safe and effective treatment for adenomyosis.