Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

Anisotropic water diffusion in neural fibres such as nerve, white matter in spinal cord, or white matter in brain forms the basis for the utilization of diffusion tensor imaging (DTI) to track fibre pathways. The fact that water diffusion is sensitive to the underlying tissue microstructure provides a unique method of assessing the orientation and integrity of these neural fibres, which may be useful in assessing a number of neurological disorders. The purpose of this review is to characterize the relationship of nuclear magnetic resonance measurements of water diffusion and its anisotropy (i.e. directional dependence) with the underlying microstructure of neural fibres. The emphasis of the review will be on model neurological systems both in vitro and in vivo. A systematic discussion of the possible sources of anisotropy and their evaluation will be presented followed by an overview of various studies of restricted diffusion and compartmentation as they relate to anisotropy. Pertinent pathological models, developmental studies and theoretical analyses provide further insight into the basis of anisotropic diffusion and its potential utility in the nervous system.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/nbm.782

The basis of anisotropic water diffusion in the nervous system – a technical review

The success of diffusion magnetic resonance imaging (MRI) is deeply rooted in the powerful concept that during their random, diffusion-driven displacements molecules probe tissue structure at a microscopic scale well beyond the usual image resolution. As diffusion is truly a three-dimensional process, molecular mobility in tissues may be anisotropic, as in brain white matter. With diffusion tensor imaging (DTI), diffusion anisotropy effects can be fully extracted, characterized, and exploited, providing even more exquisite details on tissue microstructure. The most advanced application is certainly that of fiber tracking in the brain, which, in combination with functional MRI, might open a window on the important issue of connectivity. DTI has also been used to demonstrate subtle abnormalities in a variety of diseases (including stroke, multiple sclerosis, dyslexia, and schizophrenia) and is currently becoming part of many routine clinical protocols. The aim of this article is to review the concepts behind DTI and to present potential applications.

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Diffusion tensor imaging: Concepts and applications

PURPOSE
To assess intrinsic properties of water diffusion in normal human brain by using quantitative parameters derived from the diffusion tensor, D, which are insensitive to patient orientation.


MATERIALS AND METHODS
Maps of the principal diffusivities of D, of Trace(D), and of diffusion anisotropy indices were calculated in eight healthy adults from 31 multisection, interleaved echo-planar diffusion-weighted images acquired in about 25 minutes.


RESULTS
No statistically significant differences in Trace(D) (approximately 2,100 x 10(-6) mm2/sec) were found within normal brain parenchyma, except in the cortex, where Trace(D) was higher. Diffusion anisotropy varied widely among different white matter regions, reflecting differences in fiber-tract architecture. In the corpus callosum and pyramidal tracts, the ratio of parallel to perpendicular diffusivities was approximately threefold higher than previously reported, and diffusion appeared cylindrically symmetric. However, in other white matter regions, particularly in the centrum semiovale, diffusion anisotropy was low, and cylindrical symmetry was not observed. Maps of parameters derived from D were also used to segment tissues based on their diffusion properties.


CONCLUSION
A quantitative characterization of water diffusion in anisotropic, heterogeneously oriented tissues is clinically feasible. This should improve the neuroradiologic assessment of a variety of gray and white matter disorders.

Diffusion Tensor MR Imaging ofthe Human Brain

Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term "stroke" is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.

An Updated Definition of Stroke for the 21st Century A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Diffusional anisotropy of human brain was investigated clinically in six adult volunteers, eight premature neonates, and three infants aged 5-10 months. Diffusion-weighted magnetic resonance imaging was performed with gradient b of 450 sec/mm2. The direction of diffusion-sensitive gradients was changed among x, y, and z axes according to the orientation of neurofibers in white matter. T1- and T2-weighted images also were obtained for evaluation of myelination. Diffusional anisotropy was demonstrated in white matter in the adults. Extensive signal attenuation was observed when gradients were parallel to white matter fibers. Conversely, in neonates, diffusional anisotropy of white matter, in which no myelination was shown on T1- and T2-weighted images, was weak. Diffusional anisotropy was more distinct after brain maturation, as observed in adult white matter. Detection of diffusional anisotropy is useful in evaluating neonatal brain development and various white matter disorders.

Adult and neonatal human brain : Diffusional anisotropy and myelination with diffusion-weighted MR imaging

PURPOSE: To determine the accuracy of first-pass contrast material–enhanced stress myocardial magnetic resonance (MR) imaging for depiction of myocardial ischemia in patients without myocardial infarction. MATERIALS AND METHODS: First-pass contrast-enhanced MR images of the entire left ventricle were acquired in 104 patients at rest and during dipyridamole-induced stress by using an interleaved notched saturation technique. Coronary angiography was performed in all patients, and stress perfusion single photon emission computed tomography (SPECT) was performed in 69 patients. Receiver operating characteristic curve analysis was performed to compare the diagnostic accuracies of first-pass contrast-enhanced stress MR imaging and stress SPECT, with coronary angiography as the reference standard. RESULTS: The overall sensitivity of MR imaging for depicting at least one coronary artery with significant stenosis was 90% (69 of 77 patients). The sensitivities of MR imaging for depiction of single-, double-, and t...

Noninfarcted Myocardium: Correlation between Dynamic First-Pass Contrast-enhanced Myocardial MR Imaging and Quantitative Coronary Angiography

This study had institutional review board approval, and all patients gave informed consent. The purpose of this study was to prospectively evaluate the use of whole-heart three-dimensional (3D) coronary magnetic resonance (MR) angiography in patients suspected of having coronary artery disease. Whole-heart coronary MR angiography was performed in 39 patients (30 men and nine women; mean age, 63.9 years +/- 15.6 [standard deviation]) by using a steady-state free precession sequence with free breathing. Twenty patients (16 men and four women; mean age, 64.9 years +/- 11.7) also underwent conventional coronary angiography. MR angiography was successfully completed in 34 of 39 patients (87%); the average imaging time was 13.8 minutes +/- 3.8. Sensitivity and specificity of MR angiography for detecting significant stenosis were 82% (14 of 17 arteries) and 91% (39 of 43 arteries), respectively. Whole-heart coronary MR angiography with a navigator-gated steady-state sequence can enable reliable 3D visualization of the coronary arteries in patients suspected of having coronary artery disease.

Kan Takeda

Papers

Adult and neonatal human brain : Diffusional anisotropy and myelination with diffusion-weighted MR imaging

Noninfarcted Myocardium: Correlation between Dynamic First-Pass Contrast-enhanced Myocardial MR Imaging and Quantitative Coronary Angiography

Assessment of coronary arteries with total study time of less than 30 minutes by using whole-heart coronary MR angiography.

Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate.

Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: treatment response based on tumor size and morphology.