Comparison of delayed myocardial enhancement in the early and late phase after contrast injection: is it possible to reduce the examination time for myocardial viability study?

OBJECTIVES: We studied whether we can obtain a myocardial viability study immediately after contrast injection to reduce the whole cardiac MR examination time. MATERIALS AND METHODS: We examined 36 patients with cardiovascular abnormality on comprehensive cardiac MRI. T1-weighted images with inversion recovery (IR) were obtained 5 min after stress perfusion with 0.05 mmol/kg of gadodiamide and 15 min after the resting perfusion with the same dose. (The latter images were obtained 25 min after the initial administration.) We evaluated the existence, the number of sectors, and the degree of enhancement at each time. The contrast ratio was also calculated. The number of the enhanced sectors and the contrast ratio were statistically compared using Student's t test. RESULTS: All 17 cases of delayed myocardial enhancement at 25 min after contrast injection showed some enhancement at 5 min after contrast injection. However, the number of enhanced sectors was larger at 25 min after the initial injection in 11 cases, and it was statistically significant (P=.017). The degree of enhancement was stronger at 25 min in 14 cases. However, the contrast ratio at 5 and 25 min after contrast injection was not significantly different (P=.245). CONCLUSION: Myocardial viability study immediately after contrast injection is too early to evaluate the extent of myocardial injury.     

Equilibrium signal intensity mapping, an MRI method for fast mapping of longitudinal relaxation rates and for image enhancement

INTRODUCTION: Inhomogeneity of magnetic fields, both B(0) and B(1), has been a major challenge in magnetic resonance imaging (MRI). Field inhomogeneity leads to image artifacts and unreliability of signal intensity (SI) measurements. This work proposes and shows the feasibility of generating equilibrium signal intensity (SI(Eq)) maps that can be utilized either to speed up relaxation-rate measurement or to enhance image quality and relaxation-rate-based weighting in various applications. METHODS: A 1.5-T MRI scanner was used. In canines (n=4), myocardial infarction was induced, and 48 h after the administration of 0.05 mmol kg(-1) Gd(ABE-DTTA), a contrast agent with slow tissue kinetics, in vivo R(1) mapping was carried out using an inversion recovery (IR)-prepared, fast gradient-echo sequence with varying inversion times (TIs). To test the SI(Eq) mapping method without the confounding effects of motion and blood flow, we carried out ex vivo R(1) mapping after the administration of 0.2 mmol kg(-1) Gd(DTPA) using an IR-prepared, fast spin-echo sequence in another group of dogs (n=2). R(1,full) maps and SI(Eq) maps were generated from the data from both sequences by three-parameter nonlinear curve fitting of the SI versus TI dependence. R(1,full) maps served as the reference standard. Raw IR images were then divided by the SI(Eq) maps, yielding corrected SI maps (COSIMs). Additionally, R(1) values were calculated from each single-TI image separately, using the SI(Eq) value and a one-parameter curve-fitting procedure (R(1,single)). Voxelwise correlation analysis was carried out for the COSIMs and the R(1,single) maps, both versus the standard R(1,full) maps. Deviations of R(1,single) from R(1,full) were statistically evaluated. RESULTS: In vivo, COSIM versus R(1,full) showed significantly (P<.05) better correlation [correlation coefficient (CC)=0.95] than SI versus R(1,full) with a TI=700-800 ms, which is 200-300 ms longer than the tau(null) (500 ms) of viable myocardium. With such TIs, SI versus R(1,full) yielded CCs of 0.86-0.88. R(1,single) versus R(1,full) yielded a peak CC of 0.96 at TI=700-900 ms. Mean deviations of R(1,single) from R(1,full) were below 5% for TIs between 500 and 1000 ms. Ex vivo, where tau(null) was 300 ms, the advantage of correction with SI(Eq) was not in the improvement of linear correlation but more in the reduction of scatter. Peak CCs for SI versus R(1,full) and COSIM versus R(1,full) at TI=500 ms were 0.96 for both. The ex vivo CC for R(1,single) versus R(1,full) at TI=500 ms was 0.98. Mean deviations of R(1,single) from R(1,full) were below 5% for TIs between 400 and 700 ms. CONCLUSIONS: Once the corresponding SI(Eq) map is obtained from a control stack, R(1) can be obtained accurately, using only a single IR image and without the need for a stack of TI-varied images. This approach could be applied in various dynamic MRI studies where short measurement time, once the dynamics has started, is of essence. When using this method with IR-prepared T(1)-weighted images, it is essential that the single TI be chosen such that the longitudinal relaxation in all voxels of interest would have passed tau(null). SI(Eq) maps are also useful in eliminating confounders from MR images to allow obtaining SI values that reflect more faithfully the relaxation parameter (R(1)) sought.     

Quantification of gadolinium-dtpa concentrations for different inversion times using an ir-turbo flash pulse sequence: a study on optimizing multislice perfusion imaging

The purpose of this study was to optimize an inversion-recovery (IR) turbo fast low-angle shot (FLASH) for multislice imaging by evaluating the accuracy of calculated the relaxation-rate (R₁) for different inversion times (TI). This is important for tracer kinetic modeling because it requires a system responding linearly to input. R₁ are linearly related to changes in the concentration of gadolinium (Gd)-diethylenetriaminepentaacetic acid (DTPA), and R₁ is a parameter that can be derived from the magnetic resonance (MR) signal. The accuracy of calculated R₁ using an IR turbo fast low-angle shot was evaluated in phantoms and for increasing TIs using spectroscopically measured R₁ values as reference. Signal curves, obtained in vivo after a bolus injection of Gd-DTPA, were used in an analytical computer program to study the effect of different TI-values on accurate calculation of R₁. Results show that TI_eff should be <200 ms to measure the bolus-passage of Gd-DTPA in blood accurately, whereas the myocardial response can be measured correctly for TI_eff < 870 ms at 1.5 T. The initial slope of the myocardial signal enhancement curve becomes steeper for larger TI values, whereas the calculated R₁ curves were similar, indicating that these curves, rather than signal curves, are more suitable even for qualitative perfusion evaluation. It is concluded that the results can be incorporated in a multislice IR turbo fast low-angle shot using the first slice (with a short TI) for assessment of both the arterial input function and the tissue response and the second slice in another position for assessment of the tissue response alone.     

Partial angle inversion recovery (PAIR) MR imaging: spin-echo and snapshot implementation.

The effects of varying the inversion or excitation RF pulse flip angles on image contrast and imaging time have been investigated in IR imaging theoretically, with phantoms and with normal volunteers. Signal intensity in an IR pulse sequence as a function of excitation, inversion and refocusing pulse flip angles was calculated from the solution to the Bloch equations and was utilized to determine the contrast behavior of a lesion/liver model. Theoretical and experimental results were consistent with each other. With the TI chosen to suppress the fat signal, optimization of the excitation pulse flip angle results in an increase in lesion/liver contrast or allows reduction in imaging time which, in turn, can be traded for an increased number of averages. This, in normal volunteers, improved spleen/liver contrast-to-noise ratio (9.0 vs. 5.7, n = 8, p less than 0.01) and suppressed respiratory ghosts by 33% (p less than 0.01). Reducing or increasing the inversion pulse from 180 degrees results in shorter TI needed to null the signal from the tissue of interest. Although this decreases the contrast-to-noise ratio, it can substantially increase the number of sections which can be imaged per given TR in conventional IR imaging or during breathold in the snapshot IR (turboFLASH) technique. Thus, the optimization of RF pulses is useful in obtaining faster IR images, increasing the contrast and/or increasing the number of imaging planes.     

Superparamagnetic iron oxide particles and positive enhancement for myocardial perfusion studies assessed by subsecond T1-weighted MRI

Superparamagnetic iron oxide particles (SPIOs) are usually referred to as T₂ MR contrast agents, reducing signal intensity (SI) on T₂-weighted MR images (negative enhancement). This study reports the original use of SPIOs as T₁-enhancing contrast agents, primarily assessed in vitro, and then applied to an in vivo investigation of a myocardial perfusion defect. Using a strongly T₁-weighted subsecond MR sequence with SPIOs intravenous (IV) bolus injection, MR imaging of myocardial vascularization after reperfusion was performed, on a dog model of coronary occlusion followed by reperfusion. Immediately after the intravenous bolus injection of 20 μmol/kg of SPIOs, a positive signal intensity enhancement was observed respectively, in the right and left ventricular cavity and in the nonischemic left myocardium. Moreover, compared to normal myocardium, the remaining ischemic myocardial region (anterior wall of the left ventricle) appeared as a lower and delayed SI enhancing area (cold spot). Mean peak SIE in the nonischemic myocardium (posterior wall) was significantly higher than in the ischemic myocardium (anterior wall) (110 ± 23% vs. 74 ± 22%, Mann-Whitney test < 1%, n₁ = 6, n₂ − n₁ = 0, U > 2). In conclusion, the T₁ effect of SPIOs at low dose, during their first intravascular distribution, suggests their potential use as positive markers to investigate the regional myocardial blood flow and some perfusion defects such as the “no-reflow phenomenon”.     

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.     

Conventional high resolution versus fast T(2)-weighted MR imaging of the heart: assessment of reperfusion induced myocardial injury in an animal model

Cardiac image quality in terms of spatial resolution and signal contrast was assessed for conventional and newly developed T(2)-weighted fast spin-echo imaging with high k-space segmentation. The capability in revealing regional myocardial edema and cellular damage was examined by a porcine model using histopathologic correlation. Twelve porcine hearts were excised from slaughtered animals and instantly perfused with 1000 mL cold cardioplegic solution. After 4 h of cold ischemia the hearts were reperfused for one hour using a "Langendorff" perfusion model followed by MR imaging at 1.5 Tesla. Three additional pig hearts served as controls and were studied by MR directly after harvesting. Histopathological analysis of regional tissue changes was performed macro- and microscopically. Short axis T(2)-weighted (3000/45 and 90) high quality fast spin-echo (FSE) images were recorded without cardiac action and signal intensity was correlated with histology. These images also served as gold standard for evaluation of newly developed faster sequences allowing measuring times shorter than 20 s. Fast T(2)-weighted imaging comprised single-slice fast spin echo (moderate echo train length of 23 echoes, FSE(m)), and multi-slice single-shot half-Fourier fast spin-echo (71 echoes, FSE(HASTE)) sequences, supplemented by versions with inversion recovery preparation (FSE(m)IR and FSE(HASTE)IR). Systolic function after reperfusion was restored in 10 porcine hearts. Tissue alterations included myocardial edema and contraction band necrosis which was found to be most severe in myocardium with maximum T(2) SI. Especially FSE(m) and FSE(m)IR sequences allowed differentiation of all categories of tissue damage on a high level of significance. In contrast, single-shot FSE(HASTE) and FSE(HASTE)IR sequences did not provide sufficient image quality to discriminate moderate and severe myocardial damage (p > 0.05). Different degrees of myocardial injury after ischemia and reperfusion can be staged by MR imaging, especially using conventional high resolution T(2)-weighted FSE sequences. The animal study indicates that fast T(2)-weighted FSE(m) and FSE(m)IR sequences lead to superior image quality and diagnostic accuracy compared to FSE(HASTE) and FSE(HASTE)IR imaging.     

Tissue contrast enhancement: image reconstruction algorithm and selection of TI in inversion recovery MRI

It is clearly demonstrated that the proper application of the inversion recovery imaging pulse sequence is dependent on the method of image reconstruction and the selection of TI for optimum tissue contrast. There are two methods of 2DFT image reconstruction of IR sequence time-domain raw data. The first is a modulus-image reconstruction algorithm (contrast-obliterating option), and the second is a phase-correction routine for reconstructing "phase-sensitive" true IR-images. The second option generates proper "in-phase" images, retains proper scale of contrast, but can invert the algebraic sign of image-values under certain conditions. A series of "phase-sensitive" and "modulus" reconstructed brain images, obtained with conventional and optimized new IR pulse sequences, are shown to demonstrate these effects. They illustrate the considerable advantages gained, in practical clinical situations, if one generates "phase-sensitive" true IR-images from IR-sequence raw data at optimum TI for tissue contrast enhancement.     

Quantitative myocardial distribution volume from dynamic contrast-enhanced MRI

The objective of this study was to investigate if dynamic contrast-enhanced magnetic resonance imaging (MRI) can be used to quantitate the distribution volume (v_e) in regions of normal and infarcted myocardium. v_e reflects the volume of the extracellular, extravascular space within the myocardial tissue. In regions of the heart where an infarct has occurred, the loss of viable cardiac cells results in an elevated v_e compared to normal regions. A quantitative estimate of the magnitude and spatial distribution of v_e is significant because it may provide information complementary to delayed enhancement MRI alone.

Using a hybrid gradient echo–echoplanar imaging pulse sequence on a 1.5T MRI scanner, 12 normal subjects and four infarct patients were imaged dynamically, during the injection of a contrast agent, to measure the regional blood and tissue enhancement in the left ventricular (LV) myocardium. Seven of the normal subjects and all of the infarct patients were also imaged at steady-state contrast enhancement to estimate the steady-state ratio of contrast agent in the tissue and blood (Ct/Cb) — a validated measure of v_e. Normal and infarct regions of the LV were manually selected, and the blood and tissue enhancement curves were fit to a compartment model to estimate v_e. Also, the effect of the vascular blood signal on estimates of v_e was evaluated using simulations and in the dynamic and steady-state studies.

Aggregate estimates of v_e were 23.6±6.3% in normal myocardium and 45.7±3.4% in regions of infarct. These results were not significantly different from the reference standards of Ct/Cb (22.9±6.8% and 42.6±6.3%, P=.073). From the dynamic contrast-enhanced studies, approximately 1 min of scan time was necessary to estimate v_e in the normal myocardium to within 10% of the steady-state estimate. In regions of infarct, up to 3 min of dynamic data were required to estimate v_e to within 10% of the steady-state v_e value.

By measuring the kinetics of blood and tissue enhancement in the myocardium during an extended dynamic contrast enhanced MRI study, v_e may be estimated using compartment modeling.     

Quantification of myocardial viability distribution with Gd(DTPA) bolus-enhanced, signal intensity-based percent infarct mapping

Introduction

A substantial, common shortcoming of the currently used semiautomated techniques for the quantification of myocardial infarct with delayed enhancement magnetic resonance imaging is the assumption that the whole myocardial slab that corresponds to the hyperenhanced tomographic area is 100% nonviable. This assumption is, however, incorrect. To resolve this conflict, we have recently proposed the signal intensity percent-infarct mapping method and validated it in an ex vivo, canine experiment. The purpose of the current study has been the validation of the signal intensity percent-infarct mapping method in vivo, using a porcine model of reperfused myocardial infarct.

Methods

In swines (n=6), reperfused myocardial infarct was generated occluding for 90 min by an angioplasty balloon either the left anterior descending or the left circumflex coronary artery. To obtain DE images, Gd(DTPA) enhanced inversion-recovery fast gradient-echo acquisitions were carried out on day 28 after myocardial infarction. Scanning started 15 min after intravenous injection of 0.2 mmol/kg Gd(DTPA). At the end of the MRI session, the animal was sacrificed and 2,3,5-triphenyltetrazolium chloride staining was used to validate the existence and to determine the accurate size of the myocardial infarct. Tissue samples were taken and stained with hematoxylin-eosin and Masson's trichrome for histological assessment of the infarct and the periinfarct zone. The signal intensity percent-infarct mapping data were compared with corresponding data from the delayed enhancement images analyzed with SI_remote+2S.D. thresholding, and with corresponding triphenyltetrazolium-chloride staining data using Friedman's repeated measure analysis of variance on ranks.

Results

The infarct volume determined by the triphenyltetrazolium chloride, SI_remote+2S.D. and signal intensity percent-infarct mapping methods was 3.04 ml [2.74, 3.45], 13.62 ml [9.06, 18.45] and 4.27 ml [3.45, 6.33], respectively. Median infarct volume determined by SI_remote+2S.D. significantly differed from that determined by triphenyltetrazolium chloride (P<.05). The Bland-Altman overall bias was 12.49% of the volume of the left ventricle. Median infarct volume determined by signal intensity percent-infarct mapping, however, did not differ significantly (NS) from that obtained by triphenyltetrazolium chloride. Signal intensity percent-infarct mapping yielded only a 1.99% Bland-Altman overall bias of the left ventricular volume.

Conclusions

This in vivo study in the porcine reperfused myocardial infarct model demonstrates that signal intensity percent-infarct mapping is a highly accurate method for the determination of the extent of myocardial infarct. MRI images for signal intensity percent-infarct mapping are obtained with the pulse sequence of conventional delayed enhancement imaging and are acquired within clinically acceptable scanning time. This makes signal intensity percent-infarct mapping a practical method for clinical implementation.     

Assessment of acute myocardial infarction in man with magnetic resonance imaging and the use of a new paramagnetic contrast agent gadolinium-bopta

To assess the feasibility of and characterize the new paramagnetic contrast agent gadolinium-BOPTA/dimeglumine (Gd-BOPTA) to detect acute myocardial infarctions with MR imaging, 24 patients (53.3 ± 8.3 yr) were examined 9.3 ± 3.6 days after a first myocardial infarction. Short-axis T₁-weighted and T₂-weighted MR imaging was performed at three slice levels. T₁-weighted images were obtained before, immediately after, 15, 30, and 45 min after injection. Patients received either 0.05 or 0.1 mmol/kg body weight Gd-BOPTA. Images were qualitatively and quantitatively analyzed. Two patients showed no signs of infarction on T₂-weighted images as opposed to contrast-enhanced T₁-weighted images. Contrast-to-noise ratio was not affected by the dosage level. Signal intensity (SI) of normal to infarcted myocardium was significantly improved by both dosages (p < .0005) but a dosage of 0.05 mmol/kg produced significantly higher SI inf/norm (1.42 ± 0.07 vs. 1.34 ± 0.06, respectively, p = .015). SI of normal and infarcted myocardium enhanced immediately after administration of 0.05 mmol/kg (29.3 ± 5.1% and 53.8 ± 9.6% respectively), which decreased thereafter to 5.3 ± 4.8% and 40.2 ± 8.5% respectively, at 45 min (p < .002 for normal myocardium). SI enhancement immediately after 0.1 mmol/kg Gd-BOPTA showed no decrease within the first 45 min. Gd-BOPTA enables the detection of myocardial infarction. Optimal infarct delineation is achieved from 15 to 45 min after administration of 0.05 mmol/kg body weight Gd-BOPTA. Gd-BOPTA at 0.05 mmol/kg does improve image quality as measured by contrast-to-noise ratio and SI enhancement as compared to 0.10 mmol/kg.     

Magnetic resonance imaging with superparamagnetic iron oxide particles for the detection of myocardial reperfusion

The effect of superparamagnetic iron oxide particles on magnetic resonance myocardial signal intensity was examined in order to define the ability of this agent to identify normal, ischemic, and reperfused myocardium. Data were obtained from 6 normal rats (group 1) and from 6 heterotopic isogenic rat heart transplants (group 2) at 4.7 T with a multislice spin-echo sequence. Images were acquired in (a) normal rats before and after the infusion of 36 μmol Fe/kg of AMI-25 (group 1) and (b) rat heart transplants during control, global myocardial ischemia (before and after the injection of 72 μmol Fe/kg of AMI-25), and following reperfusion (group 2). Myocardial signal intensity decreased by 36 ± 4%, p < 0.001, following contrast infusion in normal hearts (group 1). The intensity remained constant in the rat heart transplants (group 2) during coronary occlusion, both before and after the infusion of AMI-25 and decreased by 61 ± 7%, p < 0.001, upon reperfusion. The larger effect of AMI-25 in reperfused as compared to normal myocardium suggests the presence of ischemia-induced hyperemia. There was no significant difference (analysis of variance) among intensities from different myocardial regions in either group at any stage of the experiment. We conclude that the use of AMI-25 permits identification of normal, ischemic, and reperfused myocardium and may therefore be helpful for the early detection of reperfusion following thrombolytic therapy for acute myocardial infarction.     

Simultaneous measurement of temperature and velocity maps by inversion recovery tagging method

A new method, called the inversion recovery (IR) tagging method, for simultaneous measurement of temperature and velocity maps of flowing fluid has been developed. The present method employs a set of tagging pulses which acts as an inversion pulse of the conventional IR method, based on the temperature dependence of the spin-lattice relaxation of water proton in a fluid, and has the advantage of being able to compensate the reduction of the NMR signal intensity due to flow motion and to reduce the total time to measure these maps. First, the accuracy of the temperature measurement of stagnant doped water in a differentially heated cell using the conventional IR method, as the basic sequence of the IR tagging method, has been evaluated. The accuracy was within 10% of the temperature difference DeltaT = 17.2 degrees C and the measurable temperature resolution was within +/-0.5 degrees C. Then temperature and velocity maps of the flowing doped-water through a cooled pipe were measured simultaneously by the IR tagging method, and the accuracy of temperature measurement was evaluated. The accuracy obtained using the present method was within 15% of the temperature difference DeltaT = 15 degrees C.     

Chemical shift artifact-free imaging: a new option in MRI?

A high-speed proton spectroscopic imaging method with high spatial resolution was used for obtaining water, fat, and chemical shift artifact-free images on a 1.5 T MR scanner. The technique is based on a fast radiofrequency (RF) spoiled gradient-echo sequence. The chemical shift information is encoded by incrementing the echo time in a series of image records. Suppression of water or fat signals is not used. The technique does not require a highly homogeneous magnetic field. Spectroscopic images of a human volunteer were compared with corresponding conventional images obtained using the short inversion time inversion recovery (STIR) and the selective partial inversion recovery (SPIR) methods. The results demonstrate that it is possible to produce images entirely free from chemical shift artifacts using only a few chemical shift encoding steps. The technique also produces pure water and fat images which are significantly better than those produced by using the conventional methods STIR and selective partial inversion recovery. The described method appears to be promising for routine clinical applications because it can be fully automated.     

Anisotropy of ultrasonic velocity and elastic properties in normal human myocardium.

Measurements of ultrasonic quasilongitudinal velocity were made in the muscle fiber plane of excised human myocardium. Multiple adjacent planes across the left ventricular wall were interrogated to assess the transmural dependence of velocity. For each measurement plane, data were obtained in 2-deg increments through the full 360 deg relative to the myofibers. An approximate 1.3% magnitude of anisotropy was observed with maximum velocity along the muscle fibers and minimum velocity perpendicular to the muscle fibers. The known transmural shift in myofiber orientation was evidenced in the anisotropy of velocity as angular shifts between plots obtained from adjacent transmural planes within the same specimen. Measured values of velocity and density were used to estimate the effective C33 and C11 elastic constants of a thin layer of normal myocardium.     

Serial magnetic resonance imaging in patients following acute myocardial infarction.

The detection of serial changes in magnetic resonance (MR) signal intensity of the heart following acute myocardial infarction may provide a useful method of characterizing tissue healing. Fourteen patients with acute Q-wave infarction underwent T2-weighted, spin-echo cardiac imaging during hospitalization, followed by one or more additional MR studies (total 31) over a 6- to 27-wk period (mean: 3 mo). Visual assessment of the images demonstrated a gradual reduction in signal intensity and localization of the bright signal to the subendocardium of the infarction region over the three-mo study period. A quantitative measurement of signal intensity (infarction/normal myocardium) fell from 1.81 +/- 0.42 on the initial study to 1.34 +/- 0.37 (p less than 0.05) at a mean of 14 wk. Two patients had an increase in signal intensity on the follow-up study and both patients had been readmitted with acute coronary syndromes. In summary, characterization of changes in signal intensity may provide a useful method of assessing myocardial healing following acute myocardial infarction. Further studies are indicated to determine the prognostic significance of these parameters.     

Tissue characterization by image processing subtraction: windowing of specific T1 values.

A method for windowing specific T₁ values is presented. A 1.0 T imager with two routine pulse sequences was employed: A T₁-weighted spin echo (SE) sequence and a short tau inversion recovery STIR sequence (fat-suppressed IR). A T₁ window for fat was obtained by subtracting the STIR image from the SE image. Negative values were coded black. The method was tested on a normal human thigh, on a human liver with confirmed fatty infiltration, and on the livers of four live burbots. The fat-containing tissues of the two human volunteers were well depicted. The differences in fat concentration among the burbot livers were also clearly shown. The fat intensity seen in the images correlated well with the chemically measured fat concentration. This subtraction method for windowing T₁ values proved feasible for fat. The method could be used for tissues with other short T₁ values as well.     

Magnetically Labeled Water Perfusion Imaging of the Uterine Arteries and of Normal and Malignant Cervical Tissue: Initial Experiences

Purpose: The aim of this pilot study was to evaluate a magnetically labeled water perfusion imaging technique as a non-contrast-enhanced approach to demonstrate the uterine artery, its branches, and to assess the cervical uterine blood flow in healthy volunteers and in patients with advanced uterine cervical carcinoma (FIGO IIB-IVA).Methods and Materials: Seven healthy volunteers (mean age, 29 years) and twenty-two patients (mean age, 52 years) with advanced cancer of the uterine cervix (FIGO IIB-IVA) were prospectively examined by magnetically labeled water perfusion imaging at different inversion delay times (300–900 ms). The magnetic resonance imaging (MRI) findings of all patients were matched to the findings of contrast-enhanced dynamic MRI and multiple biopsies (n = 5) and/or surgical whole mount specimens (n = 17), which were available in all patients.Results: The uterine artery was well visualized with short inversion delay times of 300–500 ms. It was characterized as single or multiple helical loops before dividing into its intracervical branches. The intracervical branching was observed at inversion delay times of 500–700 ms. With longer inversion delay times, arterial signal enhancement disappeared and cervical tissue enhancement was noted. Enhancement of benign tissue was observed at inversion delay times of 1100–1700 ms and in malignant tissue at shorter inversion delay times of 900–1300 ms. The maximum of this diffuse signal enhancement of benign tissue was seen at inversion delay times of 1500 ms (1100-1700 ms) in malignant tissue at significantly (p < 0.5) shorter inversion delay times of 1100 ms (900–1300 ms).Conclusion: Our preliminary results show that the vascular supply and blood flow of the normal uterine cervix and of advanced cervical cancer can be assessed by magnetically labeled water perfusion imaging and that malignant cervical tissue is earlier and stronger perfused than normal cervical tissue.     

NMR Proton 1/T1 Rates in Bile Fluid

1/TI rates in bile fluids from patients with gallstones in the gallbladder have been determined using a FT-NMR spectrometer operating at 60MHz. The inversion recovery pulse sequences (180°-τ-90°] were used for T1 measurements. Fluids from patients with non-obstructive, partially obstructive and complete obstructive gallstones have been studied. The mean 1/TI in bile fluids from patients with obstructive gallstones was highly significantly different than those from patients with non-obstructive and partial obstructive gallstones, while the 1/TI in the fluid of partially obstructive cases was significantly different than that of complete obstructive cases. This implies that in vivo MRI T1 measurements can be used for the clinical course of gallstone formation and for surgical decision about early intervention.     

partially saturated fluid attenuated inversion recovery (FLAIR) sequences in multiple sclerosis: Comparison with fully relaxed FLAIR and conventional spin-echo

Fluid attenuated inversion recovery (FLAIR) sequences produce selective cerebrospinal fluid (CSF) suppression by employing a very long inversion time (TI). We used the FLAIR sequence to study patients with multiple sclerosis (MS) at 0.6 T. So far, a very long TR (and long acquisition time) has been used in a fully relaxed (FR-FLAIR) system. To speed up the FLAIR sequences, we used a shorter TR, and demonstrated that complete CSF suppression can be maintained with partial saturation (PS-FLAIR) by reducing TI at the same time. The introduction of partial saturation, however, reduced the contrast between lesions and normal appearing white matter (NAWM). Suboptimal CSF suppression therefore had to be accepted to maintain sufficient lesion to NAWM contrast. Using a TE of 60 ms, the PS-FLAIR and FR-FLAIR performed equally well in the detection of MS-lesions, although the former provided poorer CSF suppression. Both FLAIR sequences, however, provided poorer contrast between lesions and NAWM compared to conventional spin-echo sequences. Although the long acquisition time of the FLAIR sequence can be reduced by using partial saturation, complete CSF suppression and good lesion to NAWM contrast are incompatible at short TRs. Using a TE of 60 ms, conventional spin-echo sequences detect more lesions and provide better contrast between lesions and NAWM than FLAIR sequences in MS patients.