Purpose: The purpose of this study was to evaluate the diagnostic performance of non-contrast-enhanced magnetic resonance angiography with time-spatial labeling inversion pulse (time-SLIP MRA) in the assessment of pulmonary arteriovenous malformation (PAVM). Methods: Eleven consecutive patients with 38 documented PAVMs underwent time-SLIP MRA with a 3-tesla unit. Eight patients with 25 lesions were examined twice, once before and once after embolotherapy. The lesions were divided into two groups—initial diagnosis (n = 35) and follow-up (n = 28)—corresponding to untreated and treated lesions, respectively, and were evaluated separately. To evaluate the initial diagnosis group, two reviewers assessed image quality for visualization of PAVMs by using a qualitative 4-point scale (1 = not assessable to 4 = excellent). The location and classification of PAVMs were also evaluated. The results were compared with those from digital subtraction angiography. For evaluation of the follow-up group, the reviewers assessed the status of treated PAVMs. Reperfusion and occlusion were defined respectively as visualization or disappearance of the aneurysmal sac. The diagnostic accuracy of time-SLIP MRA was assessed and compared with standard reference images. Interobserver agreement was evaluated with the κ statistic. Results: In the initial diagnosis group, time-SLIP MRA correctly determined the PAVMs in all but one patient with one lesion who had image degradation due to irregular breath. Image quality was considered excellent (median = 4) and the κ coefficient was 0.85. Additionally, both readers could correctly localize and classify the PAVMs on time-SLIP MRA images with both κ coefficient of 1.00. In the follow-up group, the sensitivity and specificity of time-SLIP MRA for reperfusion of PAVMs were both 100%, and the κ coefficient was 1.00. Conclusion: Time-SLIP MRA is technically and clinically feasible and represents a promising technique for noninvasive pre- and post-treatment assessment of PAVMs.
Purpose: Multi-slice ungated double inversion recovery has been proposed as an alternative time-efficient and effective sequence for black-blood carotid imaging. The purpose of this study is to evaluate the comparative repeatability of this multi-contrast sequence with respect to a single slice double inversion recovery prepared gated sequence.
Materials and Methods: Ten healthy volunteers and three patients with Doppler ultrasound defined carotid artery stenosis >30% were recruited. T1-weighted (T1W) and T2W fast spin-echo (FSE) images were acquired centered at the carotid bifurcation with and without cardiac gating. Repeat imaging was performed without patient repositioning to determine the variations in vessel wall measurement and signal intensity due to gating, while negating variations as a result of slice misalignment and anatomical displacement relative to the receiver coil. The distributions and the repeatability of lumen area, vessel wall area, signal and contrast-to-noise ratio (SNR/CNR) of the vessel wall and adjacent muscle were reported.
Results: The T1W ungated sequence generally had comparable wall SNR/CNR with respect to the gated sequence, however the muscle SNR was lower (P = 0.013). The T2W ungated multi-slice sequence had lower SNR/CNR than the gated single slice sequence (P < 0.001), but with equivalent effective wall CNR (P = 0.735). Vessel area measurements using the gated/ungated sequences were equivalent. Ungated sequences had better repeatability in SNR/CNR than the gated sequences with borderline and statistically significant differences. The repeatability of T2W wall area measurement was better using the ungated sequences (P = 0.02), and the repeatability of the remaining vessel area measurements were equivalent.
Conclusions: Ungated sequences can achieve comparable SNR/CNR and equivalent carotid vessel area measurements than gated sequences with improved repeatability of SNR/CNR. Ungated sequences are good alternatives of gated sequences for vessel area measurement and plaque composition quantification.
Purpose: Stepping motions have been often used as gait-like patterns in functional magnetic resonance imaging (fMRI) to understand gait control. However, it is still very difficult to stabilize the task-related head motion. Our main purpose is to provide characteristics of the task-related head motion during stepping to develop robust restraints toward fMRI.
Methods: Multidirectional head and knee position during stepping were acquired using a motion capture system outside MRI room in 13 healthy participants. Six phases in a stepping motion were defined by reference to the left knee angles and the mean of superior-inferior head velocity (Vmean) in each phase was investigated. Furthermore, the correlation between the standard deviation of the knee angle (θsd) and the maximum of the head velocity (Vmax) was evaluated.
Results: The standard deviation of each superior-inferior head position and pitch were significantly larger than the other measurements. Vmean showed a characteristic repeating pattern associated with the knee angle. Additionally, there were significant correlations between θsd and Vmax.
Conclusions: This is the first report to reveal the characteristics of the task-related head motion during stepping. Our findings are an essential step in the development of robust restraint toward fMRI during stepping task.
Purpose: To measure T1 and T2 values of hepatic postmortem magnetic resonance (PMMR) imaging. Materials and Methods: We performed hepatic PMMR imaging of 22 deceased adults (16 men, 6 women; mean age, 56.3 years) whose deaths were for reasons other than liver injury or disease at a mean of 27.7 hours after death. Before imaging, the bodies were kept in cold storage at 4°C (mean rectal temperature, 17.6°C). We measured T1 and T2 values in the liver at two sites (the anterior segment of the right lobe and the lateral segment of the left lobe). We also investigated the influence of the body temperature and postmortem interval on T1 and T2 values. Results: In the anterior segment of the right lobe and the lateral segment of the left lobe, T1 values of PMMR imaging were 524 ± 112 ms and 472 ± 104 ms (mean ± standard deviation), respectively; while T2 values were 42 ± 6 ms and 43 ± 8 ms, respectively. T1 and T2 values did not differ significantly between the two sites (P ≧ 0.05). Regarding temperature, the T2 values of hepatic PMMR imaging were linearly correlated with the body temperature, but the T1 values were not. The T1 and T2 values of the two sites in the liver did not correlate with the postmortem interval. Conclusion: Reduction in body temperature after death is considered to induce T1 and T2 value changes in the liver on PMMR imaging.
Purpose: We present a sequence for T1 relaxation-time mapping that enables a rapid and accurate measuring. The sequence is based on the Look-Locker method by employing turbo-field echo-planar imaging (TFEPI) acquisitions and time to free relaxation after constant application of the radiofrequency (RF) pulses. We optimized the sequence, and then evaluated the accuracy of the method in imaging of head and neck. Materials and Methods: The method was implemented on a standard clinical scanner, and the accuracy of the T1 value was evaluated against that with the two-dimensional (2D) inversion recovery method. Results: The percentage errors of the T1 value, as validated by phantom imaging measurements, were 3.1% for slow-relaxing compartments (T1 = 2736 msec) and 1.1% for fast-relaxing compartments (T1 = 264.2 msec). Conclusion: We demonstrated a fast 3D sequence to obtain multiple slices, based on the Look-Locker method for T1 measurement, which provided a rapid and accurate way of measuring the spin-lattice relaxation time. An acquisition time of approximately 5 min was achieved for T1 mapping; in principle, this can provide head and neck coverage with 15 slices.
Background: Carmustine (BCNU) wafer (Gliadel® Wafer) implantation after tumor resection is an approved treatment for high-grade glioma (HGG). These wafers change various characteristics on early postoperative magnetic resonance imaging (ep-MRI) including slight expansion of high-intensity areas on T2-weighted imaging (ep-T2-HIAs) into adjacent parenchyma without restricted diffusivity. We assessed the frequency of the ep-T2-HIAs after BCNU wafer implantation in HGG patients. Moreover, we focused on ep-T2-HIA expansion and its relation to delayed cerebral edema. Methods: Twenty-five consecutive HGG patients who underwent BCNU wafer implantation were assessed. First, patients were divided into ep-T2-HIA and non-ep-T2-HIA groups, and the incidence of delayed adverse effects was compared between the two groups. Subsequently, the patients were divided into delayed edema and non-delayed edema groups, and pre-, intra-, and postoperative data were compared between the two groups. Results: The ep-T2-HIA expansion and the delayed edema were evident in 9 cases (36%) and 12 cases (48%), respectively. In comparison of the ep-T2-HIA and non-ep-T2-HIA groups, delayed edema was the only delayed adverse effect associated with ep-T2-HIA expansion (P = 0.004). Univariate analysis showed a significantly higher ratio of delayed edema in the subgroups with maximal diameter of removed cavity ≤40 mm (P = 0.047) and the ep-T2-HIA expansion in comparison of the delayed edema and non-delayed edema groups. Multivariate analysis showed that the ep-T2-HIA expansion was the only independent factor associated with delayed edema (P = 0.021). Conclusion: In BCNU wafer implantation cases, ep-T2-HIA expansion was a predictive factor for delayed cerebral edema.
Purpose: Increased cochlear lymph fluid signals on three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) images obtained several minutes after intravenous administration of a single dose of gadolinium-based contrast agent (IV-SD-GBCA) in a patient with severe retrofenestral type otosclerosis had been reported. This increase was thought to represent breakdown of the blood-labyrinthine barrier. The purpose of this study was to evaluate cochlear lymph signal on heavily T2-weighted 3D-FLAIR (HF) images obtained 4 hours after IV-SD-GBCA in patients with otosclerosis, Ménière’s disease, and healthy subjects. Materials and Methods: Twenty-two ears from 12 patients with otosclerotic plaques determined by computed tomography (CT), 16 ears from 8 healthy volunteers, and 10 ears from 9 Ménière’s disease patients with significant endolymphatic hydrops on magnetic resonance (MR) images were retrospectively analyzed. Images were obtained 4 hours after IV-SD-GBCA. Patients and healthy volunteers underwent MR cisternography (MRC) for anatomical reference of the fluid space and HF at 3T. The region of interest (ROI) was manually drawn on MRC images around the scala tympani in the basal cochlear turn. The reference ROI was set in the cerebellum. ROIs were copied onto HF images and the signal intensity ratio (SIR) of cochlear perilymph to cerebellum was measured. Differences in the SIR on HF images among the three groups were tested by one-way analysis of variance (ANOVA). Results: The mean SIR was 24.0 ± 10.1 in otosclerosis patients, 7.9 ± 1.5 in volunteers, and 11.6 ± 3.9 in Ménière’s disease patients. The mean SIR was significantly higher in the otosclerosis group than in the other groups (P < 0.001). In the otosclerosis group, there was a significant difference in the SIR between the retrofenestral type and the fenestral type (P = 0.033). Conclusions: In patients with otosclerosis, the SIR was higher than in Ménière’s disease patients or in healthy volunteers. The SIR was higher in the retrofenestral type than in the fenestral type.
Purpose: Diffusional kurtosis imaging (DKI) is an emerging technique that describes diffusion of water molecules in terms of deviation from Gaussian distribution. This study investigated correlations between DKI metrics and cognitive function in patients with idiopathic normal pressure hydrocephalus (iNPH). Materials and Methods: DKI was performed in 29 iNPH patients and 14 age-matched controls. Mini-mental state examination (MMSE), frontal assessment battery (FAB), and trail making test A (TMT-A) were used as cognitive measures. Tract-based spatial statistics (TBSS) analyses were performed to investigate the between-group differences and correlations with the cognitive measures of the diffusion metrics, including mean kurtosis (MK), fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD). Results: In iNPH patients, FA and MK identified positive correlations with cognitive function in similar regions, predominantly in the frontal lobes (P < 0.05, corrected for multiple comparisons). The frontoparietal subcortical white matter showed significant correlations with FAB and TMT-A across more extensive areas in MK analyses than in FA. ADC, AD, and RD analyses showed no significant correlations with MMSE and FAB, while negative correlation with TMT-A was observed in the limited portion of the frontal deep white matter. Conclusion: Both FA and MK correlated well with cognitive impairment in iNPH. The observed differences between FA and MK results suggest DKI may play a complementary role to conventional FA and ADC analyses, especially for evaluation of the subcortical white matter.
Purpose: To develop a novel probe for chemical exchange saturation transfer magnetic resonance imaging (CEST MRI) based on thermosensitive liposomes (lipoCEST) for theranostics, in which diagnostics and therapy are integrated into a single platform. Methods: We developed two kinds of lipoCEST agents. The first kind encapsulated dysprosium (Dy)-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-Na·3NaCl, terbium-DOTA-Na·3NaCl, or thulium-DOTA-Na·3NaCl into the inner cavity of thermosensitive liposomes, while the second kind encapsulated Dy-DOTA-Na and incorporated amphiphilic metal complex [thulium-diethylenetriamine pentaacetic acid-bis (stearylamide) (Tm-DTPA-BSA)] as a membrane constituent. The nuclear magnetic resonance (NMR)- and Z-spectra of these lipoCEST agents were acquired at various temperatures on a 9.4T MRI scanner. To investigate their applicability to the drug release induced by hyperthermia, we also encapsulated a fluorescent dye (calcein) into the inner cavity of liposomes and measured calcein release after warming them. Results: The intra- and extraliposomal water signals could be differentiated in all agents from their NMR- and Z-spectra. The agent incorporating Tm-DTPA-BSA showed the largest chemical shift (approximately 15 ppm) derived from the intraliposomal water protons. The calcein retained in this agent was successfully released at 44°C. The agent incorporating 30 mol% of Tm-DTPA-BSA in its membrane released more calcein at 42–44ºC than that of the agent incorporating 10 mol%. Conclusion: We developed novel thermosensitive lipoCEST agents and characterized them. Our preliminary results suggest that they are useful and can be applied to theranostics.
Contrast inherent inflow-enhanced multi-phase angiography combining multiple-phase flow-alternating inversion-recovery (CINEMA-FAIR) is an arterial-spin-labeling-based four-dimensional magnetic resonance angiography (4D-MRA) technique. Two neuroradiologists independently evaluated the depiction of the intracranial vasculatures in healthy subjects with 3T 4D-MRA using CINEMA-FAIR. Our results indicated that this technique can provide good visualization of the cerebral arteries with a high spatial and temporal resolution. It appears to have sufficient resolution for identifying flow difference in the anterior and posterior circulation in healthy subjects.
We propose a simple but novel data acquisition technique for whole-heart coronary magnetic resonance angiography (CMRA). In this technique, the breath-hold chasing MRA, data are collected during breath-hold intervals, with the navigation window manually adjusted to the diaphragmatic level. Compared with the conventional free breathing MRA, this method provided 33% reduction of acquisition time and improved visibility of right coronary artery in 18 normal subjects without any additional software or hardware requirements.