A technique for flow-enhanced magnetic resonance angiography of the lower extremities

A two-dimensional, flow-enhanced gradient echo pulse sequence for nuclear magnetic resonance angiography is described. It employs interleaved, presaturated slices to acquire data efficiently on imagers which favor interleaved acquisition over sequential acquisition for multislice imaging. It is useful on any imager when the effective TR is extended to enhance the sensitivity to slow flow. The technique was applied to the region from aortic bifurcation to the iliac bifurcations of three normal volunteers. The right and left common iliac arteries and veins, the separation of the external and internal iliac arteries, and secondary branches were clearly depicted.     

MRI angiography of the carotid artery

Spin echo images of the carotid arteries in longitudinal view have been obtained by selection of oblique imaging planes. Blood flow within the lumen in the region of the carotid bifurcation has been visualized through the use of cardiac gating during end diastole. Using a surface coil placed about the mandible, high resolution images [(0.75 mm)² per pixel) were obtained with scan times typically equal to 9 min and image data matrix equal to 256 × 256. Images obtained with this technique of MRI carotid angiography demonstrate blood flow phenomenon as well as vascular anatomy.     

Clinical applications: MRI, SPECT, and PET

MRI, PET, and SPECT are all used to image abnormalities in the epileptic brain. Comparison of the techniques is difficult because they measure different aspects of the epileptic process—structure, metabolism, and perfusion. SPECT is the only one that can be systematically applied during seizures, while all three are used to image interictal abnormalities. Literature review suggests that of interictal techniques, PET has the highest diagnostic sensitivity in temporal lobe epilepsy (TLE) (84% vs. 66% for SPECT, 55% for qualitative MRI, 71% for quantitative MRI) while SPECT has the highest sensitivity in extratemporal epilepsy (ETE) (60% vs. 43% for MRI and 33% for PET). The highest diagnostic sensitivity and specificity were achieved by ictal imaging with SPECT (90% in TLE, 81% in ETE). The techniques, however, were not always redundant. One reason for the wide discrepancy of results in TLE and ETE might be the differing pathologic substrates. A literature review of imaging findings associated with mesial temporal sclerosis (MTS), developmental lesion or tumor as the underlying abnormality associated with epilepsy supports this explantion. PET and MRI are much more sensitive to MTS than SPECT (100%, 95% vs. 70%). On the other hand, in developmental lesions the three techniques are equally sensitive (88–92%) and in tumors, MRI was most sensitive (96%) and SPECT least (82%). A study at NIH explains the differing sensitivities: using PET to measure both blood flow and metabolism revealed discrepant findings in the same patients. Preliminary evidence also indicates that the distribution of hyperperfusion on ictal SPECT can differentiate subtypes of TLE. Combining the results of refined imaging techniques holds great promise in epilepsy localization and diagnosis.     

A novel editing technique for F MRI: Molecule-specific imaging

A novel technique is proposed to facilitate the selective imaging of specific molecules from a mixture. The application of the technique presented here demonstrates the ability to selectively produce ¹⁹F MR images of either trifluoroacetic acid or the perfluorocarbon emulsion Oxypherol-ET (perfluorotributylamine), when both molecules are present simultaneously. Selective detection is based on the presence of homonuclear J-modulation in one molecule and differential spin-spin relaxation time (T₂). Perfluorotributylamine, an A₃B₂ system, is subject to homonuclear J-modulation, which produces a null signal from the antiphase components of the triplet (A₃) when an echo time is used in a spin-echo image. At this echo time the second molecule, in this example trifluoroacetic acid, a non-coupled spin system, is selectively imaged. At longer echo times, e.g., TE = 1/J there is substantial recovery of the J-modulated signal, which may be solely observed due to T₂ decay of the trifluoroacetic acid signal. The method is demonstrated both using phantoms and in vivo.     

Susceptibility, field inhomogeneity, and chemical shift-corrected NMR microscopy: Application to the human finger in vivo

Spectroscopic proton image data recorded with the aid of a gradient-echo spectroscopic imaging pulse sequence are reported. A postdetection processing method is suggested which permits correction of artifacts due to inhomogeneity, susceptibility, and chemical-shift resonance offsets. That is, apart from the spectral information available in this way, better spatial resolutions can be achieved. The method is demonstrated by resonance-offset corrected images of the human finger in vivo. Moreover, resonance-line selective and spectroscopically resolved diffusion-weighted images and diffusivity maps rendered with the aid of the same postdetection procedure are shown.     

The oral administration of MnCl2: A potential alternative to IV injection for tissue contrast enhancement in magnetic resonance imaging

Mn⁺² (as MnCl₂) was administered to rabbits intravenously and orally (a route of administration which based upon our previous experiments in rats⁷ promises to give selective hepatobiliary enhancement with less systemic toxicity). Nuclear magnetic relaxation dispersion or T₁ (NMRD) was performed on selected tissues (heart, liver, kidney, serum, and bile) in both animal groups to examine possible qualitative and semiquantitative differences in T₁ relaxation at equivalent sacrifice times. One animal was given an oral dose of MnCl₂ (620 micromoles/kg) and imaged sequentially (T₁ weighted sequence, .12T) for 30 minutes. The NMRD curves for organ tissues show an increase in relaxation efficacy in the 10–20MHz range characteristic of Mn-macromolecular complexes and are similar irrespective of the route of administration. The lack of increased relaxation enhancement for bile in this frequency range reflects cleavage of this complex upon excretion. Decreased overall relaxation in the liver is observed when oral Mn⁺² is compared to IV Mn⁺² due to the small fraction of administered dose that is absorbed. However, the images document a significant increase in the intensity of liver signal after the oral dose. We suspect this dose may ultimately be adjusted downward to give selective hepatobiliary effects.     

A next-generation,flow-diverting implant used to treat brain aneurysms: in vitro evaluation of magnetic field interactions,heating and artifacts at 3-T

Background and Purpose

Fine-mesh braided, stent-like structures (flow diverters) have been proposed for treatment of brain aneurysms. To date, the safety of performing magnetic resonance imaging (MRI) in patients with these implants is unknown. Therefore, the purpose of this study was to evaluate MRI issues at 3-T for a new flow-diverting implant used to treat brain aneurysms.

Methods

The Surpass NeuroEndoGraft (Surpass Medical, Ltd., Tel Aviv, Israel) underwent evaluation for magnetic field interactions, MRI-related heating and artifacts using standardized techniques. Magnetic field interactions were assessed for this implant with regard to translational attraction (i.e., using the deflection angle technique) and torque (qualitative assessment method). MRI-related heating was evaluated by placing the implant in a gelled-saline-filled, head/torso phantom and performing MRI using a transmit/receive radiofrequency body coil at a whole-body-averaged specific absorption rate of 2.9 W/kg for 15 min. Artifacts were characterized using T1-weighted, spin echo (SE) and gradient echo (GRE) pulse sequences.

Results

The Surpass NeuroEndoGraft exhibited minor magnetic field interactions (21° deflection angle and no torque), which were acceptable from a safety consideration. Heating was not substantial, with the highest temperature change being 2.3°C (background temperature rise without the implant was 1.5°C). Artifacts may create issues if the area of interest is in the same area or close to this implant.

Conclusions

The findings demonstrated that it would be acceptable for patients with this next-generation, flow-diverting implant to undergo MRI at 3-T or less.     

External laryngeal frame function in voice production revisited: A review

Reserch indicates significant contribution of extrinsic laryngeal mechanisms to voice production. This article reviews the major theories of the role of the external laryngeal factors in voice production and relevant experimental data. The review suggests that partly neglected external factors and possibly even misinterpretation of some of the recently documented individual variation in physiological data may have unnecessarily complicated the issues pertaining to the interplay between the physiological mechanisms of the larynx. The implications of contemporary findings and documentation in the modeling of the extrinsic factors are discussed and a synthesis of empirical data into two simple models of the extrinsic forces of pitch control is presented. Also suggested by the review, a basic principle, probably underlying the laryngeal control of phonation, is put forward.