Spatial heterogeneity in the muscle functional MRI signal intensity time course: effect of exercise intensity

It has previously been observed that during isometric dorsiflexion exercise, the time course of T2-weighted signal intensity (SI) changes is spatially heterogeneous. The purpose of this study was to test the hypothesis that this spatial heterogeneity would increase at higher contraction intensities. Eight subjects performed 90-s isometric dorsiflexion contractions at 30% and 60% of maximum voluntary contraction (MVC) while T2-weighted (repetition time/echo time=4000/35 ms) images were acquired. SI was measured before, during and after the contractions in regions of interest (ROIs) in the extensor digitorum longus (EDL) muscle and the deep and superficial compartments of the tibialis anterior (D-TA and S-TA, respectively). For all ROIs at 30% MVC, SI changes were similar. The maximum postcontraction SI was greater than the SI during exercise. At 60% MVC, SI changes during contraction were greater in the S-TA than in the D-TA and EDL. For the EDL and D-TA, the maximum postcontraction SI was greater than those during exercise. For the S-TA, the maximum postcontraction change was greater than the changes at t=8, 20 and 56 s but not the end-exercise value. We conclude that spatial heterogeneity increases during more intense dorsiflexion contractions, possibly reflecting regional differences in perfusion or neural activation of the muscle.     

Comparison of FAIR technique with different inversion times and post contrast dynamic perfusion MRI in chronic occlusive cerebrovascular disease

The purpose of this study was to examine the signal change occurring with different inversion times (TIs) of the flow-sensitive alternating inversion recovery (FAIR) technique and to compare with the perfusion image obtained with Gd-DTPA injection. The subjects were 11 patients with unilateral occlusive cerebrovascular disease. Two FAIR images with different TIs (800 ms and 1600 ms) were measured for each patient and dynamic perfusion MRI was performed to produce four kinds of parameter maps: mean transit time (MTT), time to peak (TTP), relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV) maps. Asymmetry ratios (ARs) between the affected and contra-lateral vascular sides were measured in both FAIR images and the four dynamic parameter maps. The AR of the MTT map of the four parameters showed the highest correlation with that of the FAIR images, especially with that of TI = 1600 ms (r = 0.829), and the AR of the rCBV map revealed the worst correlation with the FAIR images. The AR of the FAIR image with TI = 800 ms was less correlated with that of MTT than that with TI = 1600 ms. These results suggested that the signal intensity of the FAIR image was influenced by flow transition time and the change in TI could be used to select the flow with a different transition time. Our study suggested that a longer TI in the FAIR technique might be more useful than a shorter TI for evaluating chronic occlusive cerebrovascular disease in the clinical setting.     

Correcting saturation effects of the arterial input function in dynamic susceptibility contrast-enhanced MRI: a Monte Carlo simulation

To prevent systematic errors in quantitative brain perfusion studies using dynamic susceptibility contrast-enhanced magnetic resonance imaging (DSC-MRI), a reliable determination of the arterial input function (AIF) is essential. We propose a novel algorithm for correcting distortions of the AIF caused by saturation of the peak amplitude and discuss its relevance for longitudinal studies. The algorithm is based on the assumption that the AIF can be separated into a reliable part at low contrast agent concentrations and an unreliable part at high concentrations. This unreliable part is reconstructed, applying a theoretical framework based on a transport-diffusion theory and using the bolus-shape in the tissue. A validation of the correction scheme is tested by a Monte Carlo simulation. The input of the simulation was a wide range of perfusion, and the main aim was to compare this input to the determined perfusion parameters. Another input of the simulation was an AIF template derived from in vivo measurements. The distortions of this template was modeled via a Rician distribution for image intensities. As for a real DSC-MRI experiment, the simulation returned the AIF and the tracer concentration-dependent signal in the tissue. The novel correction scheme was tested by deriving perfusion parameters from the simulated data for the corrected and the uncorrected case. For this analysis, a common truncated singular value decomposition approach was applied. We find that the saturation effect caused by Rician-distributed noise leads to an overestimation of regional cerebral blood flow and regional cerebral blood volume, as compared to the input parameter. The aberration can be amplified by a decreasing signal-to-noise ratio (SNR) or an increasing tracer concentration. We also find that the overestimation can be successfully eliminated by the proposed saturation-correction scheme. In summary, the correction scheme will allow DSC-MRI to be expanded towards higher tracer concentrations and lower SNR and will help to increase the measurement to measurement reproducibility for longitudinal studies.     

MRI Evaluation of diabetic muscle infarction

Diabetic muscle infarction (DMI) is a painful and potentially serious complication in patients with poorly controlled diabetes mellitus. The incidence of DMI is likely much greater than reports in the literature suggest, perhaps secondary to the difficulty in making the diagnosis and excluding other more serious etiologies. This paper describes the role of MRI in the evaluation of a diabetic patient with a painful, swollen limb. Early application of MRI can more accurately classify the disease process and focus the differential diagnosis, thus avoiding the hazards of medical therapy associated with other etiologies such as deep venous thrombosis, cellulitis, or osteomyelitis. This paper describes the evaluation and diagnostic pitfalls encountered in two patients. MRI techniques and applications are presented with a discussion of clinical and radiological differential diagnoses.     

Quantitative assessment of skeletal muscle activation using muscle functional MRI

The purpose of the present study is to determine whether muscle functional MRI (mfMRI) can be used to obtain three-dimensional (3-D) images useful for evaluating muscle activity, and if so, to measure the distribution of muscle activity within a medial gastrocnemius (MG) muscle. Seven men performed 5 sets of 10 repetitions of a calf-raise exercise with additional 15% of body-weight load. Magnetic resonance images were obtained before and immediately after the exercise. To threshold images, only those pixels showing transverse relaxation time (T2) greater than the mean+1 S.D. of the entire regions of interest (ROIs) in the preexercise image and T2 lower than the mean+1 S.D. of the entire ROIs in the postexercise image were identified. The survived pixels showing T2 are defined as active muscle. Those thresholded images were 3-D reconstructed, and this was used to determine area of active muscle along transverse, longitudinal and vertical axes. At the exercise level used in the present study, the percentage volume of activated muscle in the MG was 62.8+/-4.5%. There was a significant correlation between percentage volume of activated muscle and integrated electromyography (r=.78, P<.05). Percentage areas of activated muscle were significantly larger in the medial than in the lateral region, in the anterior than in the posterior region and in the distal than in the proximal region (P<.05). These results suggest that mfMRI can be used to evaluate the muscle activity and to determine intramuscular variations of activity within skeletal muscle.     

Observation of rat hind limb skeletal muscle during arterial occlusion and reperfusion by 31P MRS and 1H MRI

31P NMR spectra and 1H MR T1- and T2-weighted spin-echo images were concurrently observed in rat hind limb during arterial occlusion and following reperfusion. With arterial occlusion, phosphocreatine level decreased and inorganic phosphate (Pi) level increased in 31P NMR spectra. Intracellular pH's dropped as a function of time. Beta-ATP started to decrease in three hours. In six hours after the occlusion, any peaks other than Pi were scarcely detected. The signal intensities in the 1H MR images increased homogeneously in both T1- and T2-weighted conditions, but the changes were more profound with T2-weighted images. After the release of the arterial occlusion, the 31P NMR spectra recovered to the preischemic state in several hours. The 1H MR images during reperfusion showed characteristic heterogenous pattern. The signal intensities in the anterior tibial muscle and the gastrocnemius muscle remained high in T1-weighted condition and the intensities further increased in T2-weighted condition, while those in other parts returned to the preischemic level. These changes were found to be irreversible even 12 hr after the release. The high signal intensities suggested the increase of water in the extracellular compartment induced by so-called reperfusion injury. Multinuclear analysis using in vivo NMR was valuable to consecutively detect time-dependent and location-specific response in skeletal muscle during ischemia and reperfusion.     

Effects of arterial input function selection on kinetic parameters in brain dynamic contrast-enhanced MRI

PurposeKinetic parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) were suggested as a possible instrument for multi-parametric lesion characterization, but have not found their way into clinical practice yet due to inconsistent results. The quantification is heavily influenced by the definition of an appropriate arterial input functions (AIF). Regarding brain tumor DCE-MRI, there are currently several co-existing methods to determine the AIF frequently including different brain vessels as sources. This study quantitatively and qualitatively analyzes the impact of AIF source selection on kinetic parameters derived from commonly selected AIF source vessels compared to a population-based AIF model.Material and methods74 patients with brain lesions underwent 3D DCE-MRI. Kinetic parameters [transfer constants of contrast agent efflux and reflux K^trans and k_ep and, their ratio, v_e, that is used to measure extravascular-extracellular volume fraction and plasma volume fraction v_p] were determined using extended Tofts model in 821 ROI from 4 AIF sources [the internal carotid artery (ICA), the closest artery to the lesion, the superior sagittal sinus (SSS), the population-based Parker model]. The effect of AIF source alteration on kinetic parameters was evaluated by tissue type selective intra-class correlation (ICC) and capacity to differentiate gliomas by WHO grade [area under the curve analysis (AUC)].ResultsArterial AIF more often led to implausible v_e > 100% values (p < 0.0001). AIF source alteration rendered different absolute kinetic parameters (p < 0.0001), except for k_ep. ICC between kinetic parameters of different AIF sources and tissues were variable (0.08–0.87) and only consistent > 0.5 between arterial AIF derived kinetic parameters. Differentiation between WHO III and II glioma was exclusively possible with v_p derived from an AIF in the SSS (p = 0.03; AUC 0.74).ConclusionThe AIF source has a significant impact on absolute kinetic parameters in DCE-MRI, which limits the comparability of kinetic parameters derived from different AIF sources. The effect is also tissue-dependent. The SSS appears to be the best choice for AIF source vessel selection in brain tumor DCE-MRI as it exclusively allowed for WHO grades II/III and III/IV glioma distinction (by v_p) and showed the least number of implausible v_e values.     

Biexponential analysis of intravoxel incoherent motion in calf muscle before and after exercise: Comparisons with arterial spin labeling perfusion and T2

PurposeThis study aimed to clarify exercise-induced changes in intravoxel incoherent motion (IVIM) parameters obtained from diffusion-weighted imaging (DWI) of the calf muscle, as well as the relationships between IVIM parameters, perfusion, and water content in muscle tissue.Materials and methodsThirteen healthy volunteers underwent IVIM-DWI, arterial spin labeling (ASL), and multi-echo spin-echo T₂ mapping of the right calf on a 3.0-T magnetic resonance imaging scanner before and after performing dorsiflexion exercise. From the data, we derived the perfusion-related diffusion coefficient (D^⁎), perfusion component fraction (F), blood flow parameter (FD^⁎), and restricted diffusion coefficient (D) in the tibialis anterior muscle. The muscle blood flow (MBF) and transverse relaxation time (T₂) were also calculated from the ASL and multi-echo spin-echo data, respectively. We compared the parameters measured before and after exercise and assessed the relationship of each IVIM-derived perfusion parameter (D^⁎, F, and FD^⁎) with MBF and each diffusion parameter (D and ADC) or F with T₂.ResultsNotably, all these parameters were significantly increased after exercise. Before exercise, the FD^⁎ exhibited a significant positive correlation with the MBF, whereas no significant correlation was observed between D^⁎ or F and MBF. After exercise, both D^⁎ and FD^⁎ exhibited significant positive correlations with MBF, whereas F was not significantly correlated with MBF. Additionally, D was significantly correlated with T₂ after exercise, but not before exercise. No significant correlations were found between ADC and T₂ either before or after exercise.ConclusionsThe IVIM analyses before and after exercise enable the simultaneous evaluation of exercise-induced changes in perfusion and water diffusion in the muscle and increases the body of information on muscle physiology.     

Correcting the effects of background microcirculation in the measurement of arterial input functions using dynamic susceptibility contrast MRI of the brain

In dynamic susceptibility contrast MRI, the shape of the arterial input function (AIF) is commonly obtained in the near vicinity of the middle cerebral artery (MCA). However, the tissue regions where the AIF is sampled also have significant perfusion, which contributes to T(2)* changes. We investigate whether correction of this effect will introduce significant changes in the measurement of the AIF and, subsequently, the assessment of the mean transit time (MTT). Clinical dynamic susceptibility data from 13 patients with brain tumors were analyzed. Patients received either single or double doses of Magnevist followed by a saline flush through a power injector. In the correction procedure, DeltaR(2)* was sampled in a region of gray matter approximately 1-2 cm away from the MCA and then subtracted from the DeltaR(2)* sampled in the immediate vicinity of the MCA. We demonstrate that in the brain, this correction of DeltaR(2)* due to tissue perfusion leads to a narrower width of the AIF curve obtained with DeltaR(2)* (mean+/-S.D.=7.3+/-2.0 and 6.4+/-1.7 s, before and after correction, respectively, P<.001 using a two-tailed paired t-test). Furthermore, the peak of the AIF also moved to a slightly earlier time relative to the time of arrival (mean+/-S.D.=4.7+/-0.9 and 4.3+/-0.8 s, before and after correction, with P<.001). With the use of the corrected AIF, the measured MTT had increased values in areas of both gray and white matter.     

Flow effects in long-range dipolar field MRI

Incoherent spin motion, such as diffusion, can lead to significant signal loss in multiple spin echoes (MSE) experiments, sometimes to its complete extinction. Coherent spin motion, such as laminar flow, can also modify the magnetization in MSE imaging and yield additional contrast. Our experimental results indicate that MSE is flow-sensitive. Our theoretical analysis and experimental results show how the effect of the distant dipolar field can be annihilated by flow. This effect can be quantified by directly solving the nonlinear Bloch equation, taking into account the deformation of the dipolar field by motion. Unexpected results have been observed, such as a recovery of the dipolar interaction due to flow in the "magic angle" condition.     

Magnetic resonance measurement of blood flow in peripheral vessels after acute exercise

Velocity-encoded Cine magnetic resonance imaging (MRI) was used to measure blood flow in the anterior tibial artery (AT), posterior tibial artery (PT), and popliteal artery of adult human subjects (mean age 29 yr) before and after 90 s of ankle dorsiflexion exercise. Before exercise, mean flow, peak systolic velocity, and end-diastolic velocity in AT were 8.1 ± 1.6 (SE, n = 6) ml/min, 26.9 ± 2.6 cm/s, and −0.6 ± 0.4 cm/s, respectively. After exercise, mean flow and peak systolic velocity in AT increased by 19-fold and 3-fold, respectively, and end-diastolic velocity increased to 8.7 ± 1.1 cm/s. Flow in popliteal artery above its bifurcation was similar to the sum of flows in AT and PT, both before and after exercise. Flow in AT declined exponentially after exercise with a mean half-time of 4 min. The results demonstrate the utility of MR phase-encoded flow-velocity measurements for physiological studies of peripheral vascular dynamics after exercise.     

Sampling time effects on signal-to-noise and contrast-to-noise ratios in spin-echo MRI

This work discusses the effect of sampling time on noise, signal-to-noise and contrast-to-noise ratios in magnetic resonance imaging. A simple imaging experiment is performed to demonstrate the effect of sampling time on noise, confirming theoretical expectations that doubling the sampling time while decreasing the read gradient strength by a factor of two reduces statistical noise to 1/square root 2 of its original level. This result suggests that sampling time should be maximized within the constraints of the pulse sequence: namely, that sampling time should be increased and read gradient strength decreased as TE is increased. Revised expressions for signal-to-noise and contrast-to-noise ratios are presented based on the assumption that sampling time increases linearly with echo delay time above a certain minimum TE value. The revised expressions are then used to derive new predictions of the interpulse delay times that maximize signal-to-noise and contrast-to-noise ratios in spin-echo imaging. It is demonstrated that sampling times are critical in determining whether T1-weighted or T2-weighted sequences produce superior tissue contrast in spin-echo imaging.     

Aberrant resting-state cerebral blood flow and its connectivity in primary dysmenorrhea on arterial spin labeling MRI

PurposeThis study aimed to clarify the resting-state cerebral blood flow alteration patterns induced by primary dysmenorrhea, investigate the relationships between cerebral blood flow alterations and clinical parameters of patients with primary dysmenorrhea, and explore whether brain regions with abnormal cerebral blood flow also feature functional connectivity changes.MethodsArterial spin labeling imaging and clinical parameters were acquired in 42 patients with primary dysmenorrhea and 41 healthy controls during their menstrual phases. Differences in cerebral blood flow were compared between the two groups, and the clusters with significant group differences were selected as the regions of interest for further statistical analyses.ResultsCompared to healthy controls, patients with primary dysmenorrhea exhibited increased cerebral blood flow in the bilateral precuneus, left posterior cingulate cortex, and right rolandic operculum. Among patients with primary dysmenorrhea, we identified a negative correlation between the cerebral blood flow in the right rolandic operculum and the visual analogue score for anxiety, and greater correlation between the functional connectivity in the precuneus/posterior cingulate cortex and the right middle cingulate cortex, and between the right rolandic operculum and the left inferior parietal lobule and the bilateral postcentral gyrus.DiscussionCerebral blood flow abnormalities associated with primary dysmenorrhea were mainly concentrated in the areas comprising the default mode network in primary dysmenorrhea patients, which could be involved in the central mechanism of primary dysmenorrhea. Cerebral blood flow alteration in the rolandic operculum may underlie an anxiety-induced compulsive tendency in patients with primary dysmenorrhea. Investigating the enhanced connectivity among various pain-related brain regions could improve understanding of the onset and development of primary dysmenorrhea.     

Partial volume effects in MRI studies of multiple sclerosis

We have estimated the accuracy of volume measurements of multiple sclerosis (MS) lesions made using magnetic resonance imaging (MRI) for lesions of comparable diameter to the image slice thickness. We used a phantom containing objects of known volume and obtained images using a range of slice thicknesses. Measurements on the phantom were used to assess a theoretical model, which was then employed to investigate the effects of image dimensions and geometry upon volume measurement accuracy. We observed measured volume to be dependent upon slice thickness. Thin slices gave the most accurate estimate of volume. As slice thickness increased relative to object diameter, the error in the volume measurement increased (to as much as 100%), the volume measured being dependent on the position of the object relative to the slice center. Using a signal intensity threshold value of 50% to outline objects gave results closest to the actual volume. As expected, a lower threshold value tended to give higher volume estimates (up to 100% larger), as did a semi-automated local edge detection technique. For accurate volume measurement, the slice thickness should be no more than a fifth of anticipated object diameter. For typical MS lesions (7 mm in diameter), this implies using a 1.5-mm slice thickness. For serial studies, a repositioning error of 1 mm could lead to differences in the volume measurement of individual lesions of up to 12% between studies for lesions of typical MS size and 5-mm slice thickness. These results emphasize the need for accurate patient repositioning, relatively thin slices, for regular quality assurance checks to ensure that pixel size and slice position are correct and stable over time, and that lesion outlining is performed in a consistent fashion. We would recommend the use of a 3D sequence with 1 mm cubic voxels for accurate measurements of MS lesions.     

Noninvasive diffusion MRI to determine the severity of peripheral nerve injury

ObjectivePrimary repair of peripheral nerves is recommended following transection; however, patient management following repair is challenged by a lack of biomarkers to nerve regeneration. Previous studies have demonstrated that diffusion magnetic resonance imaging (MRI) may provide viable biomarkers of nerve regeneration in injury models; though, these methods have not been systematically evaluated in graded partial transections and repairs.MethodsEx vivo diffusion MRI was performed in fixed rat sciatic nerve samples 4 or 12 weeks following partial nerve transection and repair (25% cut = 12, 50% cut = 12 and 75% cut = 11), crush injuries (n = 12), and sham surgeries (n = 9). Behavioral testing and histologic evaluation were performed in the same animals and nerve samples for comparison.ResultsDiffusion tractography provided visual characterizations of nerve damage and recovery consistent with the expected degree of injury within each cohort. In addition, quantitative indices from diffusion MRI correlated with both histological and behavioral evaluations, the latter of indicated full recovery for sham and crush nerves and limited recovery in all partially transected/repaired nerves. Nerve recovery between 4 and 12 weeks was statistically significant in partial transections 50% and 75% depth cuts (p = 0.043 and p = 0.022) but not for 25% transections.InterpretationOur findings suggest that DTI can i) distinguish different degrees of partial nerve transection following surgical repair and ii) map spatially heterogeneous nerve recovery (e.g., due to collateral sprouting) from 4 to 12 weeks in partially transected nerves.     

Effect of exercise on the creatine resonances in 1H MR spectra of human skeletal muscle

1H MR spectra of human muscles were recorded before, during, and after fatiguing exercise. In contrast to expectations, it was found that the spectral contributions of creatine/phosphocreatine (Cr/PCr) were subject to change as a function of exercise. In particular, the dipolar-coupled methylene protons of Cr/PCr were found to be reduced in intensity in proportion to the co-registered PCr levels. Recovery after exercise and behavior under ischemic conditions provide further evidence to suggest that the contributions of the CH2 protons of Cr/PCr to 1H MR spectra of human muscle in vivo reflect PCr rather than Cr levels. Variation of experimental parameters showed that this effect is not due to a trivial change in relaxation times. At present it can only be speculated about why the Cr resonances have reduced NMR visibility. If temporary binding to macromolecules should be involved, the free Cr concentration-important for equilibrium calculations of the creatine kinase reaction-might be different from what was previously assumed.     

Study on the effects of gadolinium-based MRI contrast medium on X-ray scanning

Gadolinium has a higher atomic mass (64) than iodine (53). The K-edge absorption energy of gadolinium is 50.2 keV, which is in the absorbed wavelength range of the X-rays used by a CT scanner, suggesting that it has a high X-ray absorption ability. This study examined the effects of a gadolinium-based MRI contrast medium on the quality (mAs) and the quality (kVp) of radiation during a X-ray scan. A contrast medium phantom was manufactured after diluting the contrast medium to various concentrations. A CT scanner (Siemens, Somatom Senation 64, Germany) was used to obtain images by changing the quality of radiation from 80 kVp to 100, 120, and 140 kVp. At a constant quality of radiation of 120 kVp, the mAs was changed from 100 mAs to 200 and 300 mAs and images were obtained under each condition. The Hounsfield units (HUs) in a test tube were measured for analysis and comparison. The contrast enhancement by the contrast medium for CT scanning was 100% at a tube voltage of 80 kVp. The contrast enhancements at 100 kVp, 120 kVp, and 140 kVp were 93.8%, 87.7%, and 69.5%, respectively. In addition, although the quantity increased a fixed tube voltage, the HU of the test tube remained relatively constant, indicating that the absorption of the contrast medium had little association with the quantity of X-rays but had some correlation with the quality of radiation. A tube voltage of 80 kVp or lower is recommended when a MRI contrast medium is used CT scanning. When MRI scanning and X-ray scanning are conducted together, X-ray scanning should be performed first or after sufficient gadolinium contrast medium has been excreted.