Mapping of left ventricle wall thickness in mice using 11.7-T magnetic resonance imaging

BackgroundThe left ventricle (LV) wall thickness is an important and routinely measured cardiologic parameter. Here we introduce three-dimensional (3D) mapping of LV wall thickness and function using a self-gated magnetic resonance (MR) sequence for ultra-high-field 11.7-T MR cine imaging of mouse hearts.Methods and resultsSix male C57BL/6-j mice were subjected to 11.7-T MR imaging (MRI). Three standard views—short axis, long axis four-chamber, and long axis two-chamber—and eight consecutive short axis scans from the apex to base were performed for each mouse. The resulting 11 self-gated cine images were used for fast low-angle shot analysis with a navigator echo over an observation period of approximately 35 min. The right ventricle (RV) and LV were identified in the short axis and four-chamber views. On 3D color-coded maps, the interventricular septum wall (diastole: 0.94 ± 0.05 mm, systole: 1.20 ± 0.09 mm) and LV free wall (diastole: 1.07 ± 0.15 mm, systole: 1.79 ± 0.11 mm) thicknesses were measured.ConclusionThis 3D wall thickness mapping technique can be used to observe regional wall thickness at the end-diastole and end-systole. Self-gated cine imaging based on ultra-high-field MRI can be used to accurately and easily measure cardiac function and wall thickness in normal mouse hearts. As in the preclinical study, this versatile and simple method will be clinically useful for the high-field-MRI evaluation of cardiac function and wall thickness.     

Cardiac magnetic resonance tissue tracking in right ventricle: Feasibility and normal values

PurposeTo investigate right ventricular (RV) strain in patients without identified cardiac pathology using cardiac magnetic resonance tissue tracking (CMR TT).MethodsA total of 50 consecutive patients with no identified cardiac pathology were analyzed. RV longitudinal and circumferential strain was assessed by CMR TT. The age range was 4–81 years with a median of 32 years (interquartile range, 15 to 56 years).ResultsAnalysis time per patient was < 5 min. The peak longitudinal strain (E_ll) was − 22.11 ± 3.51%. The peak circumferential strains (E_cc) for global, basal, mid-cavity and apical segments were as follows: − 11.69 ± 2.25%, − 11.00 ± 2.45%, − 11.17 ± 3.36%, − 12.90 ± 3.34%. There were significant gender differences in peak E_cc at the base (P = 0.04) and the mid-cavity (P = 0.03) with greater deformation in females than in males. On Bland-Altman analysis, peak E_ll (mean bias, 0.22 ± 1.67; 95% CI − 3.05 to 3.49) and mid-cavity E_cc (mean bias, 0.036 ± 1.75; 95% CI, − 3.39 to 3.47) had the best intra-observer agreement and inter-observer agreement, respectively.ConclusionsRV longitudinal and circumferential strains can be quickly assessed with good intra-observer and inter-observer variability using TT.     

3D late gadolinium enhanced cardiovascular MR with CENTRA-PLUS profile/view ordering: Feasibility of right ventricular myocardial damage assessment using a swine animal model

AimsTo develop a high-resolution, 3D late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (MRI) technique for improved assessment of myocardial scars, and evaluate its performance against 2D breath-held (BH) LGE MRI using a surgically implanted animal scar model in the right ventricle (RV).Methods and resultsA k-space segmented 3D LGE acquisition using CENTRA-PLUS (Contrast ENhanced Timing Robust Acquisition with Preparation of LongitUdinal Signal; or CP) ordering is proposed. 8 pigs were surgically prepared with cardiac patch implantation in the RV, followed in 60 days by 1.5 T MRI. LGE with Phase-Sensitive Inversion Recovery (PSIR) were performed as follows: 1) 2DBH using pneumatic control, and 2) navigator-gated, 3D free-breathing (3DFB)-CP-LGE with slice-tracking. The animal heart was excised immediately after cardiac MR for scar volume quantification. RV scar volumes were also delineated from the 2DBH and 3DFB-CP-LGE images for comparison against the surgical standard. Apparent scar/normal tissue signal-to-noise ratio (aSNR) and contrast-to-noise ratio (aCNR) were also calculated.3DFB-CP-LGE technique was successfully performed in all animals. No difference in aCNR was noted, but aSNR was significantly higher using the 3D technique (p < 0.05). Against the surgical reference volume, the 3DFB-CP-LGE-derived delineation yielded significantly less volume quantification error compared to 2DBH-derived volumes (15 ± 10% vs 55 ± 33%; p < 0.05).ConclusionCompared to conventional 2DBH-LGE, 3DFB-LGE acquisition using CENTRA-PLUS provided superior scar volume quantification and improved aSNR.     

Clinical feasibility of 3D-QALAS – Single breath-hold 3D myocardial T1- and T2-mapping

PurposeTo investigate the in-vivo precision and clinical feasibility of 3D-QALAS - a novel method for simultaneous three-dimensional myocardial T1- and T2-mapping.MethodsTen healthy subjects and 23 patients with different cardiac pathologies underwent cardiovascular 3 T MRI examinations including 3D-QALAS, MOLLI and T2-GraSE acquisitions. Precision was investigated in the healthy subjects between independent scans, between dependent scans and as standard deviation of consecutive scans. Clinical feasibility of 3D-QALAS was investigated for native and contrast enhanced myocardium in patients. Data were analyzed using mean value and 95% confidence interval, Pearson correlation, Paired t-tests, intraclass correlation and Bland-Altman analysis.ResultsAverage myocardial relaxation time values and SD from eight repeated acquisitions within the group of healthy subjects were 1178 ± 18.5 ms (1.6%) for T1 with 3D-QALAS, 52.7 ± 1.2 ms (2.3%) for T2 with 3D-QALAS, 1145 ± 10.0 ms (0.9%) for T1 with MOLLI and 49.2 ± 0.8 ms (1.6%) for T2 with GraSE.Myocardial T1 and T2 relaxation times obtained with 3D-QALAS correlated very well with reference methods; MOLLI for T1 (r = 0.994) and T2-GraSE for T2 (r = 0.818) in the 23 patients. Average native/post-contrast myocardial T1 values from the patients were 1166.2 ms/411.8 ms for 3D-QALAS and 1174.4 ms/438.9 ms for MOLLI. Average native myocardial T2 values from the patients were 53.2 ms for 3D-QALAS and 54.4 ms for T2-GraSE.ConclusionsRepeated independent and dependent scans together with the intra-scan repeatability, demonstrated all a very good precision for the 3D-QALAS method in healthy volunteers. This study shows that 3D T1 and T2 mapping in the left ventricle is feasible in one breath hold for patients with different cardiac pathologies using 3D-QALAS.     

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.     

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.     

The prognostic value of proton magnetic resonance spectroscopy in term newborns treated with therapeutic hypothermia following asphyxia

ObjectiveThe purpose of this study was to correlate brain metabolism assessed shortly after therapeutic hyperthermia by ¹H magnetic resonance spectroscopy (MRS), with neurodevelopmental outcome.MethodsAt the age of 6.0 ± 1.8 days, brain metabolites of 35 term asphyxiated newborns, treated with therapeutic hypothermia, were quantified by multivoxel proton MRS of a volume cranial to the corpus callosum, containing both gray and white matter. At the age of 30 months the Bayley Scale of Infant Development-III was performed.ResultsInfants that died had lower gray matter NAA levels than infants that survived (P = 0.005). In surviving infants (28 of 35) there was a trend of negative correlation between gray matter choline levels and gross motor outcome (r = − 0.45). In the white matter, choline correlated negatively with fine motor skills (r = − 0.40), and creatine positively with gross motor skills (r = 0.58, P = 0.02). There was no relationship between lactate levels and outcome.ConclusionMRS of asphyxiated neonates treated by therapeutic hypothermia can serve as predictor of outcome. Unlike previously reported associations in untreated asphyxiates, lactate levels had no relationship with outcome, which indicates that one of the working mechanisms of therapeutic hypothermia is reduction of the metabolic rate.     

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.     

Intravoxel incoherent motion and diffusion tensor imaging of early renal fibrosis induced in a murine model of streptozotocin induced diabetes

IntroductionTo assess if parameters in intravoxel incoherent motion (IVIM) and diffusion tensor imaging (DTI) can be used to evaluate early renal fibrosis in a mouse model of diabetic nephropathy.Materials & methodsIn a population of 38 male CD1 mice (8 weeks old, 20–30 g), streptozotocin induced diabetes was created in 20 mice via a single intraperitoneal injection of streptozotocin at 150 mg/kg, while 18 mice served as control group. IVIM parameters were acquired at 0, 12 and 24 weeks after injection of streptozotocin using a range of b values from 0 to 1200 s/mm². DTI parameters were obtained using 12 diffusion directions and lower b values of 0, 100 and 400 s/mm². DTI and IVIM parameters were obtained using region of interests drawn over the renal parenchyma. Histopathological analysis of the right kidney was performed in all mice. Results were analyzed using an unpaired t-test with P < 0.05 considered statistically significant.ResultsRenal cortex fractional anisotropy (FA) was significantly lower in the diabetes group at week 12 as compared with the control group. Renal cortex apparent diffusion coefficient and tissue diffusivity were significantly higher in the diabetes group at week 12 compared with the control group at 12 weeks. Blood flow was significantly decreased at the renal medulla at 24 weeks. Histopathological analysis confirmed fibrosis in the diabetes group at 24 weeks.ConclusionFA is significantly reduced in diabetic nephropathy. FA might serve a potential role in the detection and therapy monitoring of early diabetic nephropathy.     

MR elastography of hepatocellular carcinoma: Correlation of tumor stiffness with histopathology features—Preliminary findings

PurposeTo determine if tumor stiffness by MR Elastography (MRE) is associated with hepatocellular carcinoma (HCC) pathologic features.Material and methodsA retrospective review was undertaken of all patients with pathologically confirmed HCC who underwent MRE prior to loco-regional therapy, surgical resection or transplant between 1/1/2007 to 12/31/2015. An independent observer measured tumor stiffness (kilopascals, kPa) by drawing regions of interest (ROI) covering the HCC and in the case of HCCs with non-enhancing/necrotic components, only the solid portion was included in the ROI. HCC tumor grade (WHO criteria), vascular invasion and tumor encapsulation were assessed from retrievable pathology specimens by an expert hepatobiliary pathologist. Tumor stiffness was compared by tumor grade, size, presence of capsule and vascular invasion using Student's t-test (or Exact Mann-Whitney test).Results21 patients were identified who had pathologically confirmed HCCs and tumor MRE data. 17 patients (81.0%) had underlying chronic liver disease. The mean ± SD tumor size (cm) was 5.3 ± 3.9 cm. The mean ± SD tumor stiffness was 5.9 ± 1.4 kPa. Tumors were graded as well differentiated (N = 2), moderately differentiated (N = 11) and poorly differentiated (N = 8). There was a trend toward increased tumor stiffness in well/moderately differentiated HCCs (6.5 ± 1.2 kPa; N = 13) compared to poorly differentiated HCCs (4.9 ± 1.2 kPa; N = 8) (p < 0.01). There was no significant correlation between tumor stiffness and liver stiffness or tumor size. There was no significant difference in tumor stiffness by presence or etiology of chronic liver disease, vascular invasion or tumor encapsulation.ConclusionPreliminary data suggest that tumor stiffness by MRE may be able to differentiate HCC tumor grade.     

Free breathing whole-heart 3D CINE MRI with self-gated Cartesian trajectory

PurposeTo present a method that uses a novel free-running self-gated acquisition to achieve isotropic resolution in whole heart 3D Cartesian cardiac CINE MRI.Material and methods3D cardiac CINE MRI using navigator gating results in long acquisition times. Recently, several frameworks based on self-gated non-Cartesian trajectories have been proposed to accelerate this acquisition. However, non-Cartesian reconstructions are computationally expensive due to gridding, particularly in 3D. In this work, we propose a novel highly efficient self-gated Cartesian approach for 3D cardiac CINE MRI. Acquisition is performed using CArtesian trajectory with Spiral PRofile ordering and Tiny golden angle step for eddy current reduction (so called here CASPR-Tiger). Data is acquired continuously under free breathing (retrospective ECG gating, no preparation pulses interruption) for 4–5 min and 4D whole-heart volumes (3D + cardiac phases) with isotropic spatial resolution are reconstructed from all available data using a soft gating technique combined with temporal total variation (TV) constrained iterative SENSE reconstruction.ResultsFor data acquired on eight healthy subjects and three patients, the reconstructed images using the proposed method had good contrast and spatio-temporal variations, correctly recovering diastolic and systolic cardiac phases. Non-significant differences (P > 0.05) were observed in cardiac functional measurements obtained with proposed 3D approach and gold standard 2D multi-slice breath-hold acquisition.ConclusionThe proposed approach enables isotropic 3D whole heart Cartesian cardiac CINE MRI in 4 to 5 min free breathing acquisition.     

R1ρ dispersion and sodium imaging in human calf muscle

PurposeTo evaluate the magnitude of chemical exchange effects and R_1ρ dispersion in muscle and their relationship to tissue sodium levels with aging.MethodsSeven healthy volunteers (aged 24 to 87 years, median age 47) underwent MRI to assess tissue sodium levels and water T_1ρ values at different spin-locking frequencies in calf muscles. T_1ρ values at each locking field were computed based on a three-parameter mono-exponential model to fit signals obtained at different locking times, and R_1ρ (= 1/T_1ρ) rates were compared at different locking fields. In particular, the dispersion of R_1ρ (ΔR_1ρ = R_1ρ(0 Hz) − R_1ρ(500 Hz)) was examined as a function of subject age. Muscle sodium content was calculated by comparing signal intensities between tissues and reference standards within the same image. The variations of ΔR_1ρ with age and sodium were analyzed by linear regression.ResultsT_1ρ values and sodium content both increased with age. R_1ρ dispersion also increased with age and showed a strong linear correlation (correlation coefficient r = 0.98, P = 0.000578) with sodium content.ConclusionΔR_1ρ reports on the contribution of labile protons such as hydroxyls which may be associated with macromolecule accumulation in the extracellular matrix (ECM). An increase of sodium signal suggests an enlarged ECM volume fraction and/or an increase in sodium concentration, which occurs during normal aging. The strong correlation between ΔR_1ρ and sodium is likely the consequence of increased ECM and density of total charged sites within the matrix from molecules such as collagens and proteoglycans. The results from this study show the potential use of R_1ρ dispersion and sodium imaging in the assessment of pathological changes in muscle such as fibrosis.     

Tissue gadolinium deposition in renally impaired rats exposed to different gadolinium-based MRI contrast agents: Evaluation with inductively coupled plasma mass spectrometry (ICP-MS)

ObjectivesTo quantify tissue gadolinium (Gd) deposition in renally impaired rats exposed to Gd-EOB-DTPA and other Gd-based MRI contrast agents by means of inductively coupled plasma mass spectrometry (ICP-MS), and to compare the differences in distribution among major organs as possible triggers for nephrogenic systemic fibrosis (NSF).MethodsA total of 15 renally impaired rats were injected with Gd-EOB-DTPA, Gd-DTPA-BMA and Gd-HP-DO3A. Gd contents of skin, liver, kidney, lung, heart, spleen, diaphragm and femoral muscle were measured by inductively coupled plasma mass spectrometry (ICP-MS). Histological assessment was also conducted.ResultsTissue Gd deposition in all organs was significantly higher (P = 0.005 ~ 0.009) in the Gd-DTPA-BMA group than in the Gd-HP-DO3A and Gd-EOB-DTPA groups. In the Gd-DTPA-BMA group, Gd was predominantly deposited in kidney (1306 ± 605.7 μg/g), followed by skin, liver, lung, spleen, femoral muscle, diaphragm and heart. Comparing Gd-HP-DO3A and Gd-EOB-DTPA groups, Gd depositions in the kidney, liver and lung were significantly lower (P = 0.009 ~ 0.011) in the Gd-EOB-DTPA group than in the Gd-HP-DO3A group although no significant differences were seen for any other organs.ConclusionsGd-EOB-DTPA is a stable and safe Gd-based contrast agent (GBCA) showing lower Gd deposition in major organs in renally impaired rats, compared with other GBCAs. This fact suggests that the risk of NSF onset would be low in the use of Gd-EOB-DTPA.     

Abnormal lipid metabolism in skeletal muscle tissue of patients with muscular dystrophy: In vitro,high-resolution NMR spectroscopy based observation in early phase of the disease

PurposeQualitative (assignment of lipid components) and quantitative (quantification of lipid components) analysis of lipid components were performed in skeletal muscle tissue of patients with muscular dystrophy in early phase of the disease as compared to control/normal subjects.MethodsProton nuclear magnetic resonance (NMR) spectroscopy based experiment was performed on the lipid extract of skeletal muscle tissue of patients with muscular dystrophy in early phase of the disease and normal individuals for the analysis of lipid components [triglycerides, phospholipids, total cholesterol and unsaturated fatty acids (arachidonic, linolenic and linoleic acid)]. Specimens of muscle tissue were obtained from patients with Duchenne muscular dystrophy (DMD) [n = 11; Age, Mean ± SD; 9.2 ± 1.4 years; all were males], Becker muscular dystrophy (BMD) [n = 12; Age, Mean ± SD; 21.4 ± 5.0 years; all were males], facioscapulohumeral muscular dystrophy (FSHD) [n = 11; Age, Mean ± SD; 23.7 ± 7.5 years; all were males] and limb girdle muscular dystrophy-2B (LGMD-2B) [n = 18; Age, Mean ± SD; 24.2 ± 4.1 years; all were males]. Muscle specimens were also obtained from [n = 30; Mean age ± SD 23.1 ± 6.0 years; all were males] normal/control subjects.ResultsAssigned lipid components in skeletal muscle tissue were triglycerides (TG), phospholipids (PL), total cholesterol (CHOL) and unsaturated fatty acids (arachidonic, linolenic and linoleic acid)]. Quantity of lipid components was observed in skeletal muscle tissue of DMD, BMD, FSHD and LGMD-2B patients as compared to control/normal subjects. TG was significantly elevated in muscle tissue of DMD, BMD and LGMD-2B patients. Increase level of CHOL was found only in muscle of DMD patients. Level of PL was found insignificant for DMD, BMD and LGMD-2B patients. Quantity of TG, PL and CHOL was unaltered in the muscle of patients with FSHD as compared to control/normal subjects. Linoleic acids were significantly reduced in muscle tissue of DMD, BMD, FSHD and LGMD-2B as compared to normal/control individuals.ConclusionsResults clearly indicate alteration of lipid metabolism in patients with muscular dystrophy in early phase of the disease. Moreover, further evaluation is required to understand whether these changes are primary or secondary to muscular dystrophy. In future, these findings may prove an additional and improved approach for the diagnosis of different forms of muscular dystrophy.     

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.     

Relationship between shoulder pain and skin temperature measured by infrared thermography in a wheelchair propulsion test

IntroductionWheelchair Users (WCUs) depend on their upper extremities for their daily living. Therefore, it is not unusual to find that shoulder pain (SP) is a problem for WCUs and reduces their participation in sport and leisure activities.ObjectivesThe aims of this study were 1 – to analyse skin temperature measured by infrared thermography (IRT) before (pre-test), one minute after (post-test) and 10 min after (post-10) the kinematic wheelchair propulsion test (T-CIDIF) of athletic wheelchair users; 2 – to evaluate the relationship between shoulder pain (SP) and Skin Temperature Asymmetry (ΔT_sk) before and after (pre-test, post-test, post-10) the T-CIDIF, and to relate the SP with the kinematic variables of the T-CIDIF.Participants & interventions/procedureA volunteer sample of 12 wheelchair athletes completed an exercise test (T-CIDIF) in their own wheelchair. It consisted in a 30-s maximum test performed on two rollers. Two linear transducers connected to the rollers registered the number of propulsions, maximum and mean velocity and power of each arm. SP was assessed with the Wheelchair Users Shoulder Pain Index (WUSPI). Skin temperature (T_sk) of the anterior and posterior upper body was measured before and after the T-CIDIF by using an infrared camera. A total of 26 ROIs were evaluated with respect to the opposite side of the body to identify significant (ΔT_sk).Results/main outcome measure(s)Significant differences were observed between the T_sk of the post-10 and pre-test in 12 ROIs, and between the post-10 and the post-test in most of the ROIs. These differences are attenuated when the ΔT_sk is compared before and after exercise. T_sk tends to initially decrease immediately after the test and then significantly increase after 10 min of completing the T-CIDIF. The ΔT_sk vs SP analysis yielded significant inverse relationships (from r = −0.58 to r = −0.71, p < 0.05) in 5 of the 26 ROI. No significant correlations between propulsion variables and SP questionnaire were found. All T-CIDIF variables were significantly correlated with the temperature asymmetries in multiple ROIs (from r = −0.86 to r = −0.58, from p < 0.05 to p < 0.001).ConclusionsThese results present indications that high performance wheelchair athletes exhibit similar capacity of heat production than able-bodied. The thermographic data inversely correlates with the SP and the kinematic variables, but the last is not related to SP. This work contributes to improve the understanding about temperature changes in wheelchair athletes during exercise, and could be used to assess the efficacy of various sports and rehabilitation programs.     

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.     

Diffusion tensor imaging of the cervical spinal cord of patients with Neuromyelitis Optica

BackgroundPrevious studies have demonstrated a correlation between Expanded Disability Status Scale (EDSS) and Diffusion Tensor Imaging (DTI) metrics, but the conclusions were based on evaluations of the entire cervical spinal cord.ObjectivesThe purpose of this study was to quantify the FA and MD values in the spinal cord of NMO patients, separating the lesion sites from the preserved sites, which has not been previously preformed. In addition, we attempted to identify a correlation with EDSS.MethodsDTI was performed in 11 NMO patients and 11 healthy individuals using a 1.5-T MRI scanner. We measured the FA and MD at ROIs positioned along the cervical spinal cord. The mean values of FA and MD at lesion, preserved and spinal cord sites were compared with those of a control group. We tested the correlations between the mean FA and MD with EDSS.ResultsFA in NMO patients was significantly reduced in lesion sites (0.44 vs. 0.55, p = 0.0046), preserved sites (0.46 vs. 0.55, p = 0.0015), and all sites (0.45 vs 0.55, p = 0.0013) while MD increased only in lesion sites (1.03 × 10^− 3 mm²/s vs. 0.90 × 10^− 3 mm²/s, p = 0.009). The FA demonstrated the best correlation with EDSS (r = − 0.7603, p = 0.0086), particularly at lesion sites.ConclusionsThe results reinforce the importance of the FA index and confirm the hypothesis that NMO is a diffuse disease.     

The value of ESWAN in diagnosis and differential diagnosis of prostate cancer: Preliminary study

ObjectiveTo evaluate the value of enhanced T2 star-weighted angiography (ESWAN) in diagnosis and differential diagnosis of prostate cancer by comparing the multiple indices of ESWAN in benign prostatic hyperplasia (BPH), prostate cancer (PCa) and the normal peripheral zone (PZ).MethodsTraditional MRI and ESWAN were performed on forty-nine clinically-diagnosed PCa patients, sixty BPH patients, and forty-six normal adult males. The ESWAN indices (magnitude value, phase value, R2* value and T2* value) measured on different regions of interest (ROIs) were analyzed. Additionally, receiver operating characteristic (ROC) analysis was performed to obtain the area under the curve (AUC), sensitivity, specificity, and optimal cut-off points of PCa and BPH, PCa and PZ respectively.ResultsThe magnitude value, phase value, R2* value and T2* value of PZ were 1529.43 ± 254.43, 0.0689 ± 0.1619, 16.57 ± 8.11, 82.75 ± 53.87, respectively; the magnitude value, phase value, R2* value, and T2* value of PCa were 1540.18 ± 338.62, − 0.0176 ± 0.0919, 26.93 ± 11.31, and 45.99 ± 17.43, respectively; the magnitude value, phase value, R2* value, and T2* value of BPH were 1579.49 ± 285.28, 0.0209 ± 0.0839, 20.69 ± 3.95, and 51.56 ± 8.90, respectively. Compared with normal PZ, phase value of PCa was lower (t = − 3.302, P = 0.001), R2* value higher (t = 5.326, P = 0.000), and T2* value lower (t = − 4.570, P = 0.000); compared with BPH, phase value of PCa was lower (t = − 2.261, P = 0.026), R2* value higher (t = 3.988, P = 0.000), and T2* value lower (t = − 2.155, P = 0.033). When PCa and PZ were distinguished, the AUC of magnitude value, phase value, R2* value, and T2* value were respectively 0.539 (P = 0.510), 0.679 (P = 0.0007), 0.811 (P < 0.0001), and 0.762 (P < 0.0001); the diagnosis efficiency of R2* value was higher than that of T2* value (P = 0.037), while the diagnosis efficiency of T2* value was equivalent to phase value (P = 0.256). When PCa was differentiated from BPH, the AUC of magnitude value, phase value, R2* value, and T2* value were 0.518 (P = 0.752), 0.612 (P = 0.039), 0.705 (P = 0.0001), and 0.685 (P = 0.0006), respectively; there was no statistical difference in the diagnostic efficiency of phase value, R2* value, and T2* value.ConclusionsThe phase value, R2* value and T2* value can distinguish PCa and normal PZ, PCa and BPH, so they are valuable for the diagnosis and differential diagnosis of PCa, moreover, the diagnostic efficiency of R2* value is better than other indices.     

Water and lipid diffusion MRI using chemical shift displacement-based separation of lipid tissue (SPLIT)

PurposeTo obtain water and lipid diffusion-weighted images (DWIs) simultaneously, we devised a novel method utilizing chemical shift displacement-based separation of lipid tissue (SPLIT) imaging.Materials and methodsSingle-shot diffusion echo-planar imaging without fat suppression was used and the imaging parameters were optimized to separate water and lipid DWIs by chemical shift displacement of the lipid signals along the phase-encoding direction. Using the optimized conditions, transverse DWIs at the maximum diameter of the right calf were scanned with multiple b-values in five healthy subjects. Then, apparent diffusion coefficients (ADCs) were calculated in the tibialis anterior muscle (TA), tibialis bone marrow (TB), and subcutaneous fat (SF), as well as restricted and perfusion-related diffusion coefficients (D and D*, respectively) and the fraction of the perfusion-related diffusion component (F) for TA.ResultsWater and lipid DWIs were separated adequately. The mean ADCs of the TA, TB, and SF were 1.56 ± 0.03 mm²/s, 0.01 ± 0.01 mm²/s, and 0.06 ± 0.02 mm²/s, respectively. The mean D*, D, and F of the TA were 13.7 ± 4.3 mm²/s, 1.48 ± 0.05 mm²/s, and 4.3 ± 1.6%, respectively.ConclusionSPLIT imaging makes it possible to simply and simultaneously obtain water and lipid DWIs without special pulse sequence and increases the amount of diffusion information of water and lipid tissue.