Showing papers in "Journal of Magnetic Resonance Imaging in 1997"

Modeling tracer kinetics in dynamic Gd-DTPA MR imaging

Abstract: Three major models (from Tofts, Larsson, and Brix) for collecting and analyzing dynamic MRI gadolinium-diethylene-triamine penta-acetic acid (Gd-DTPA) data are examined. All models use compartments representing the blood plasma and the abnormal extravascular extracellular space (EES), and they are intercompatible. All measure combinations of three parameters; (1) kPSp is the influx volume transfer constant (min-1), or permeability surface area product per unit volume of tissue, between plasma and EES; (2) ve is the volume of EES space per unit volume of tissue (0 < ve < 1); and (3) K(ep), the efflux rate constant (min-1), is the ratio of the first two parameters (k(ep) = kPSp/ve). The ratio K(ep) is the simplest to measure, requiring only signal linearity with Gd tracer concentration or, alternatively, a measurement of T1 before injection of Gd (T10). To measure the physiologic parameters kPSp and ve separately requires knowledge of T10 and of the tissue relaxivity R1 (approximately in vitro value).

Magnetically labeled cells can be detected by MR imaging

Abstract: To determine the feasibility of MR imaging of magnetically labeled cells, different cell lines were labeled with monocrystalline iron oxide (MION) particles. Phantoms containing MION labeled cells were then assembled and imaged by MR at 1.5 T using T1-weighted and T2-weighted pulse sequences. MION uptake ranged from 8.5 x 10(4) to 2.9 x 10(5) particles/cell for tumor cells (9L and LX1, respectively) to 1.5 x 10(6) to 4.8 x 10(8) particles/cell for "professional phagocytes" (J774 and peritoneal macrophages, respectively). On the T1-weighted images, cell-internalized MION appeared hyperintense relative to agar and similar to MION in aqueous solution. On T2-weighted images, signal intensity varied according to concentration of MION within cells. Cell-internalized MION caused similar MR signal changes of cells as did free MION; however, at a dose that was an order of magnitude lower, depending on the pulse sequence used. The detectability of MION within cells was approximately 2 ng Fe, which corresponded to 10(5) tumor cells/well or 5 x 10(3) macrophages/well. We conclude that a variety of cells can be efficiently labeled with MION by simple incubation. Intracellular labeling may be used for MR imaging of in vivo cell tracking.

Brain atrophy progression measured from registered serial MRI: Validation and application to Alzheimer's disease

Abstract: In this paper, we validate the brain boundary shift integral (BBSI) as a measure of brain atrophy and demonstrate its application in Alzheimer's disease (AD). Nineteen normal subjects and nine patients with AD underwent serial three-dimensional MRI (6- to 30-month scan intervals). Repeat studies were registered to the baseline studies. The accuracy of the BBSI was assessed by comparison with simulated atrophy and with segmentation; it was also tested for reproducibility, linearity, and its ability to discriminate patients with AD from healthy controls. The BBSI correlated closely with simulated volumes of atrophy (r = 1.000). The mean absolute difference between repeat measures was 1.51 ml or .13% of mean brain volume. Rates of atrophy from all 18 AD scan pairs were widely separated from those of all 31 control pairs. In matched subgroups, the mean (SD) annual rate of brain atrophy in nine controls was .24% (.32%), compared with 2.78% (.92%) in nine patients with AD. We conclude that the BBSI is a linear and highly reproducible measure of atrophy with potential uses in the early diagnosis and measurement of progression in Alzheimer's disease.

Theory and application of static field inhomogeneity effects in gradient‐echo imaging

Abstract: The influence of local static magnetic field inhomogeneities on gradient-echo imaging is discussed and the underlying theoretical aspects are reviewed. A high-resolution approach is suggested to suppress image distortion and restore signal loss due to spin dephasing. Acquisition of three-dimensional data sets not only overcomes part of the limitations associated with gradient echoes but also makes it possible to extract local information about the strength or direction of background gradients and relative susceptibility changes between different tissues. Applications of the suggested approach in the human brain for anatomical imaging as well as for extraction of physical and physiological parameters are presented and discussed.

Uptake of dextran‐coated monocrystalline iron oxides in tumor cells and macrophages

Abstract: Although several dextran-coated iron oxide preparations are in preclinical and clinical use, little is known about the mechanism of uptake into cells. As these particles have been shown to accumulate in macrophages and tumor cells, we performed cellular uptake and inhibition studies with a prototypical monocrystalline iron oxide nanoparticle (MION). MION particles were labeled with fluorescein isothiocyanate or radioiodinated and purified by gel permeation chromatography. Two preparations of MION particles were used in cell experiments: nontreated MION and plasma-opsonized MION purified by gradient density purification. As determined by immunoblotting, opsonization resulted in C3, vitro-nectin, and fibronectin association with MION. Incubation of cells with fluorescent MION showed active uptake of particles in macrophages both before and after opsonization. In C6 tumor cells, however, intracellular MION was only detectable in dividing cells. Quantitatively, 125I-labeled MION was internalized into cells with uptake values ranging from 17 ng (in 9L gliosarcoma) to 970 ng iron per million cells for peritoneal macrophages. Opsonization increased MION uptake into macrophages sixfold, whereas it increased the uptake in C6 tumor cells only twofold. Results from uptake inhibition assay suggest that cellular uptake of nonopsonized (dextran-coated) MION particles is mediated by fluid-phase endocytosis, whereas receptor-mediated endocytosis is presumably responsible for the uptake of opsonized (protein-coated) particles.

Assessing tumor angiogenesis using macromolecular MR imaging contrast media.

Abstract: MRI enhanced with a macromolecular contrast medium (MMCM) has previously been shown to estimate tumor microvascular characteristics that correlate closely with histologic microvascular density, an established surrogate of tumor angiogenesis. A similar MMCM-enhanced MRI technique has now been used to investigate the acute tumor microvascular effects of antibody-mediated inhibition of vascular endothelial growth factor (VEGF), a well-studied and potent angiogenesis stimulator. Athymic rats xenografted with a human breast carcinoma (MDA-MB-435) were imaged after administration of albumin-gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA30) using a heavily T1-weighted three dimensional-spoiled gradient-refocused acquisition in a steady-state pulse sequence before and 24 hours after treatment with anti-VEGF antibody (single dose of 1 mg). Changes in longitudinal relaxivity (delta R1) were analyzed using a bidirectional two-compartment kinetic model to estimate tumor fractional blood volume (fBV) and permeability surface area product (PS). Data showed a significant decrease (P < 0.05) of tumor PS with respect to macromolecular contrast medium at 24 hours after treatment with anti-VEGF antibody. No significant change was observed in fBV. Suppression of tumor microvascular permeability induced by anti-VEGF antibody can be detected and quantified by MMCM-enhanced MRI. MRI grading of tumor angiogenesis and monitoring of anti-angiogenesis interventions could find wide clinical application.

Water diffusion and exchange as they influence contrast enhancement.

Abstract: The contrast-enhanced magnetic resonance imaging (MRI) signal is rarely a direct measure of contrast concentration; rather it depends on the effect that the contrast agent has on the tissue water magnetization. To correctly interpret such studies, an understanding of the effects of water movement on the magnetic resonance (MR) signal is critical. In this review, we discuss how water diffusion within biological compartments and water exchange between these compartments affect MR signal enhancement and therefore our ability to extract physiologic information. The two primary ways by which contrast agents affect water magnetization are discussed: (1) direct relaxivity and (2) indirect susceptibility effects. For relaxivity agents, for which T1 effects usually dominate, the theory of relaxation enhancement is presented, along with a review of the relevant physiologic time constants for water movement affecting this relaxation enhancement. Experimental issues that impact accurate measurement of the relaxation enhancement are discussed. Finally, the impact of these effects on extracting physiologic information is presented. Susceptibility effects depend on the size and shape of the contrast agent, the size and shape of the compartment in which it resides, as well as the characteristics of the water movement through the resulting magnetic field inhomogeneity. Therefore, modeling of this effect is complex and is the subject of active study. However, since susceptibility effects can be much stronger than relaxivity effects in certain situations, they may be useful even without full quantitation.

Probing tumor microvascularity by measurement, analysis and display of contrast agent uptake kinetics.

Abstract: This paper describes a measurement protocol for acquiring quantitative dynamic MRI data and novel analysis and display software (Magnetic Resonance Imaging Workbench (MRIW)). Proton density-weighted and T1-weighted two-dimensional gradient echo images are used to quantify tissue contrast agent concentration. The dynamic studies last approximately 7 minutes, with 10-second temporal resolution. Analyses of signal and concentration changes with time are performed, allowing capillary permeability-surface area product, tissue leakage space, enhancement onset time, mean enhancement gradient and maximum enhancement level to be mapped as false-color parametric overlays registered with anatomic images. Quantification of permeability and leakage space provides a method for comparing physiology in patients between visits or for intersite comparisons.

Imaging of the lungs using 3He MRI: preliminary clinical experience in 18 patients with and without lung disease.

Abstract: The purpose of this study was to describe the 3He MRI findings of normal pulmonary ventilation in healthy volunteers and to evaluate abnormalities in patients with different lung diseases. Hyperpolarized 3He gas (300 ml, 3 x 10(5) Pa, polarized to 35-45% by optical pumping, provided in special glass cells) was inhaled by 8 healthy volunteers and 10 patients with different lung diseases. Imaging was performed with a three-dimensional fast low-angle shot (FLASH) sequence (TR = 11.8 msec; TE = 5 msec; transmitter amplitude, 5-8 V; corresponding flip angle, < 5 degrees) in a single breath-hold (22-42 seconds). Clinical and radiological examinations were available for correlation. The studies were performed successfully in eight of eight volunteers and in 8 of 10 patients. The lung parenchyma of volunteers with normal ventilatory function exhibited rather homogeneous intermediate to high signal, whereas patients with chronic obstructive lung disease or bronchiectasis presented with severe signal inhomogeneities with patchy or wedge-shaped defects. The mass effect of bronchogenic carcinoma, chronic empyema, lymphadenopathy, or pleural effusion caused large signal defects, representing the lesion and adjacent hypoventilation, the extent of which had not been presumed from chest x-ray or CT. 3He MRI is a promising new modality for the assessment of pulmonary ventilation and its abnormalities. Additional studies are needed to determine its potential clinical role.

MR navigator-echo monitoring of temporal changes in diaphragm position: implications for MR coronary angiography.

Abstract: Temporal changes in respiration could influence navigator-echo (NE)-gated MR coronary angiography (MRCA), but systematic investigation of the effects of such variations and how to limit them has not been performed. We addressed these issues by studying the influence of time in the magnet on diaphragm position and respiratory patterns using NE diaphragm monitoring in volunteers and a phantom model. NE diaphragm monitoring was performed at .5 T in 10 subjects over a total period of 35 minutes. The end-expiratory position was sustained for longer (1.1 vs .4 seconds, P < .001) and with greater position stability (SD 1.9 vs 5.9 mm, P = .01) than the end-inspiratory position. Drift of the end-expiratory position occurred over time, causing a fall in scan efficiency (44-28%, P = .01). Up-drift of the end-expiratory position was most common. Loss of scan efficiency was worse with up-drift because of loss of the end-expiratory pause from the NE window (up-drift 10% mm-1, down-drift 7% mm-1, both P = .03). Scan efficiency also was reduced during sleep (to a nadir of 0%), secondary to loss of the end-expiratory pause, periodic breathing with oscillating end-expiratory position, and periods of apnea. The phantom model used actual diaphragm traces to evaluate the artifact resulting from diaphragm motion during acquisition. Artifact was considerably reduced by NE adaptive motion correction compared with NE gating alone (ghosting ratio 2.0 vs 2.8, P < .01). Artifact also was significantly reduced with up-drift if scan efficiency was maintained above 35% (P = .05). For optimal NE-gated MRCA, the following features are important: the NE window should be placed around the end-expiratory position; subjects should not sleep; scan efficiency should be monitored and the NE window should be repositioned if scan efficiency falls below 35%; and adaptive motion correction should be used.

Effect of oxygen inhalation on relaxation times in various tissues

Abstract: The effect of the oxygen inhalation on relaxation times was evaluated in various tissues, including the myocardium, liver, spleen, skeletal muscle, subcutaneous fat, bone marrow, and arterial blood, with a [1H]MR system. Statistically significant decrease of T1 relaxation times was observed in the myocardium, spleen, and arterial blood after inhalation of 100% oxygen, whereas no significant change was observed in liver, skeletal muscle, subcutaneous fat, or bone marrow. The T2 relaxation time of these tissues did not differ significantly between before and after inhalation of the oxygen. These results indicate that [1H]MRI can be used to evaluate changes with oxygen inhalation and that the effect of the oxygen inhalation on T1 relaxation time is different among various tissues.

Microvessel density in invasive breast cancer assessed by dynamic gd-dtpa enhanced MRI

Abstract: It has been postulated that the rapid enhancement demonstrated by breast carcinomas after administration of contrast media is a direct result of tumor angiogenesis. However, to date, little quantitative data have been published to support this view. A retrospective study has been undertaken to compare dynamic contrast-enhanced data obtained from 40 patients with microvessel density (MVD) evaluated in specimens immunohistochemically stained with a factor VIII related antigen. The dynamic data were analyzed quantitatively using both simple indices of enhancement and a two-compartment kinetic model. A moderate but significant correlation was demonstrated between initial enhancement and MVD, and this correlation strengthened when node-positive tumors were considered in isolation (r = .77, P < .0005). However, the data showed considerable variability. The enhancement characteristics of the tumors could not be explained solely by their MVD; therefore, MRI cannot be used to predict MVD in vivo. Further work is required to address the exact relationship between contrast-enhanced MRI and tumor angiogenesis.

Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia

Abstract: The purpose of this study was to evaluate accuracy of dynamic gadolinium-enhanced MR angiography (MRA) of the celiac, superior, and inferior mesenteric arteries in patients with suspected mesenteric ischemia compared with catheter angiography or surgery. Sixty-five patients with suspected mesenteric ischemia underwent three-dimensional spoiled gradient-recalled acquisition in the steady state (GRASS) gadolinium-enhanced MRA. Correlative studies were performed on 14 patients, catheter angiography alone was performed on 12 patients, and surgery alone was performed on two patients. Six patients had mesenteric ischemia. In all patients, the celiac artery (CA) and superior mesenteric artery (SMA) were seen well enough to evaluate; however, the inferior mesenteric artery (IMA) could be evaluated in only 9 of the 14 patients. MRA showed severe stenosis (> 75%) or occlusion of the celiac axis in seven patients, of the SMA in six patients, and of the IMA in four patients. The overall sensitivity and specificity were 100% and 95%, respectively, compared with catheter angiography and surgery. The two errors were caused by overgrading the severity of IMA disease. Three-dimensional gadolinium-enhanced MRA can accurately demonstrate the origins of the CA and SMA and is useful in evaluation of patients with suspected mesenteric ischemia.

Optimization of contrast timing for breath-hold three-dimensional MR angiography.

Abstract: The purpose of this study was to determine the influence of various factors (age, weight, breathing, saline flush) on the contrast kinetics of a test bolus injection for the purpose of calculating the scan delay for optimized contrast-enhanced three-dimensional MR angiography. Initially, the test bolus administration was optimized by evaluating the influence of breathing (breathing versus breath-hold) and the administration of a saline flush after the contrast injection (no flush versus flush) on the kinetics of a 4-ml Gd-DTPA test bolus injection in three healthy volunteers. Subsequently, in 33 patients referred for three-dimensional MR angiography of the renal arteries, test bolus kinetics were correlated to age, weight, and heart rate. In addition, the image quality of the three-dimensional MR angiograms was assessed on a four-point scale with regard to vessel visibility. The administration of a saline flush after the contrast injection significantly shortened the first appearance time (14 versus 16 seconds, P < .05), as well as the time to maximal signal intensity (SI) (6 versus 10 seconds, P < .05) and increased both maximum (67 versus 151 seconds, P < .05) and the SI slope (6.4 versus 20.5 seconds, P < .05). Breath-holding was shown to have no significant affect on the test bolus kinetics. No correlation was found between physiologic parameters and test bolus kinetics in the patient group. Image quality was graded as sufficient for diagnostic purposes in 32 of 33 patients. The contrast travel time from injection site to the vascular system under consideration cannot be predicted based on physiologic parameters. This time interval can be reliably and accurately determined by a test bolus injection of a small volume of contrast agent followed by a saline flush during normal breathing.

Origin of cartilage laminae in MRI

Abstract: To understand the origin of the laminated appearance of cartilage in MRI (the magic angle effect), microscopic MRI (mu MRI) experiments were performed at 14-microns pixel resolution on normal canine articular cartilage from the shoulder joints. Two-dimensional images of the spin-spin relaxation time (T2) of the cartilage-bone plug at two angles (0 degree and 55 degrees) were calculated quantitatively. A distinct T2 anisotropy was observed as a function of the cartilage tissue depth. The surface and the deep regions exhibit strong orientational dependence of T2, whereas the upper-middle region exhibits little orientational dependence of T2. These three mu MRI regions correspond approximately to the three histologic zones in cartilage tissue. The results from the bulk T2 measurements agreed with these mu MRI results. Our studies show that the laminated appearance of cartilage in MRI is caused by T2 anisotropy of the tissue. We further suggest that the molecular origin of the T2 anisotropy is the nuclear dipolar interaction. The structure of the cartilage tissue indicates that the collagen meshwork defines this T2 anisotropy. The results show that the T2 anisotropy provides an indirect but sensitive indicator for the orientation of macromolecular structures in cartilage. The clinical implications of this anisotropy are discussed.

Understanding pulsed magnetization transfer.

Abstract: Using a two-pool exchange model of magnetization transfer (MT), numeric simulations were developed to predict the time dependence of longitudinal magnetization in both semisolid and liquid pools for arbitrary pulsed radiofrequency (RF) irradiation. Whereas RF excitation of the liquid pool was modeled using the time-dependent Bloch equations, RF saturation of the semi-solid pool was described by a time-dependent rate proportional to both the absorption lineshape of the semisolid pool and the square of the RF pulse amplitude. Simulations show good agreement with experimental results for a 4% agar gel aqueous system in which the two-pool kinetics have been well studied previously. These simulations provide a method for interpreting pulsed MT effects, are easily extended to biologic tissues, and provide a basis for optimizing clinical imaging applications that exploit MT contrast.

MR angiography with an ultrasmall superparamagnetic iron oxide blood pool agent

Abstract: The purpose of the study was to investigate the use of a dextran-coated ultrasmall superparamagnetic iron oxide (USPIO) as a blood pool contrast agent for thoracic and abdominal MR angiography. Abdominal and thoracic MR angiography was performed in six healthy volunteers using two-dimensional and three-dimensional spoiled gradient echo (SPGR) sequences before and after intravenous administration of USPIO. Doses ranged from 1.1 to 2.6 mg Fe/kg. Flip angle was varied from 20 to 60 degrees. Subjective image quality, analysis of signal-to-noise ratio (SNR), and blood T1 relaxation times were measured. USPIO significantly lowered the T1 of blood (from 1,210 ms precontrast to 159 ms postcontrast at a dose of 2.6 mg Fe/kg) (P < .01). Image quality on coronal fast three-dimensional breath-hold SPGR images of the abdomen increased with increasing dose and was maximum at the highest dose, producing an aortic SNR of 9.6 compared to 1.8 precontrast. Axial two-dimensional time-of-flight (TOF) aortic SNR was reduced significantly from 13 on precontrast to 6 on the postcontrast images at the highest dose (P < .05) due to T2* shortening effects. There was little flip angle dependence on image quality. Due to the T1 shortening effect and long intravascular half-life, USPIO improved visualization of vascular anatomy using three-dimensional fast SPGR imaging. The echo time must be minimized to minimize signal loss from T2* shortening effects. The blood pool distribution of USPIO is useful for equilibrium-phase MR angiography.

Proximal coronary artery stenosis: Three‐dimensional MRI with fat saturation and navigator echo

Abstract: The purpose of this study was to compare the diagnostic value of MR angiography (MRA) with conventional contrast angiography in coronary artery disease. Thirty-five patients underwent MRA and coronary angiography within 4 hours. Of these, three patients were investigated twice: once before and once after balloon angioplasty. The pulse sequence was a cardiac-triggered, single-slab, three-dimensional gradient-echo sequence, employing a spin-echo navigator echo measurement to track the variation of the diaphragm during the scan. The following segments of the coronary arteries were included in this prospective study: left main coronary artery, proximal and middle left anterior descending, proximal and middle left circumflex, proximal and middle right coronary artery, and intermediate branch, if present. In total, 176 segments were classified as normal or having a stenosis of less than 50% and as having a stenosis of more than 50%. Five patients were excluded because of lack of cooperation. Over all, 45 of 54 stenoses were detected and interpretable by MRA. Sensitivity, specificity, and positive and negative predictive values of MRA for detecting significant stenoses were 83%, 94%, 87%, and 93%, respectively. MRA identified significant stenoses within the major coronary arteries with a high degree of accuracy. Sensitivity and specificity are higher compared with exercise tests or scintigraphy or top of the precise localization.

Physiologic measurements by contrast‐enhanced MR imaging: Expectations and limitations

Abstract: Contrast-enhanced magnetic resonance imaging (MRI) offers the opportunity to quantitatively assess physiologic properties of tissue, such as perfusion, blood volume, and capillary permeability. Use of such quantitation potentially allows tissues to be characterized in terms of pathophysiology and to be monitored over time, during the course of therapeutic intervention. The degree to which such quantitation is applicable relies heavily on simplified model descriptions of the tissue space and assumptions relating the signal intensity observed to the contrast agent concentration. This article presents a perspective on the use of quantitative contrast-enhanced MRI, analysis of the accuracy of derived physiologic parameters, and recommendations for pulse sequence choice.

Fuzzy clustering of gradient-echo functional MRI in the human visual cortex. Part I: reproducibility.

Abstract: Reproducibility of human functional MRI (fMRI) studies is essential for clinical and neuroresearch applications of this new human brain mapping method. Based on a recently presented study on reproducibility of gradient-echo fMRI in the human visual cortex (Moser et al. Magn Reson Imaging 1996; 14:567-579), comparing the performance of three different threshold strategies for correlation analysis, we demonstrate that (a) fuzzy clustering is a robust, model-independent method to extract functional information in time and space; (b) intertrial reproducibility of cortical activation is significantly improved by the capability of fuzzy clustering to separate signal contributions from larger vessels, running perpendicular to the slice orientation, from activation apparently close to the primary visual cortex; and (c) for repeated single subject studies, SDs of <20% for signal enhancement in approximately 80% of the studies and SDs of <30% for activated area size in approximately 65% of the studies are obtained. This, however, depends also on signal-to-noise ratio, (motion) artifacts, and subject cooperation.

Peripheral nerve stimulation during MRI: effects of high gradient amplitudes and switching rates.

Abstract: The application of high gradient amplitudes and switching rates for MRI and spectroscopy, resulting in short rise times for the gradient field and high changes of the magnetic flux density in the patient, is known to possibly evoke peripheral nerve stimulation (PNS) in patients. These effects have been studied on 20 volunteers under different experimental circumstances. The results of these measurements are partially in line with earlier findings reported in the literature. New information is found for the dependence of the PNS threshold level as a function of the rise time of the gradient waveform. The PNS threshold level, expressed in terms of dB/dt, is found to be proportional with t-0.5, where t is the switch time for the gradients. Indications are found that magnitude of B, the modulus of the gradient vector field, is more closely related to the PNS threshold level than Bx, the imaging component of the gradient field. From the experiments, it is furthermore concluded that only for the imaging protocols characterized by the application of long bipolar repetitive gradient pulse trains, such as echoplanar imaging, PNS is expected at the reported threshold levels. For the protocols based on spin echo, turbo spin echo, inversion recovery, fast field echo, etc., characterized by shorter gradient pulse trains, the threshold levels are expected to be much higher.

MR imaging contrast agents — what's in a name?

Abstract: The purpose of this brief review is to reduce the confusion surrounding the nomenclature of MRI contrast agents. There are several different categories of contrast agents for potential use in human diagnosis and several alternative names for each contrast agent, an array of choices that actually changes over time. This review describes the general process by which these various agents are named, presents one general categorization by which these agents can be considered, and provides a concise table to which readers can refer to identify the proper name to use for each of the agents that has thus far been administered to humans.

Assessment of tumor microcirculation: a new role of dynamic contrast MR imaging.

Abstract: With the advances in MR techniques, information related to tumor microcirculation now can be obtained in the clinical setting. This information can be valuable in the assessment of tumor blood supply/oxygenation status and tumor response to therapy. In this article, we review the tracer-kinetic modeling for tumor microcirculatory parameters derived from dynamic contrast MR imaging and report several preliminary results from both an animal model and early experience with human tumors. Despite the application of different MR protocols and tracer-kinetic models, the initial results of these pioneer studies consistently support the role of MR-derived microcirculatory tumor parameters, in providing prognostic information to assess and predict the response of cancers to cytotoxic therapy.

Fuzzy clustering of gradient‐echo functional MRI in the human visual cortex. Part II: Quantification

Abstract: Fuzzy cluster analysis (FCA) is a new exploratory method for analyzing fMRI data. Using simulated functional MRI (fMRI) data, the performance of FCA, as implemented in the software package Evident, was tested and a quantitative comparison with correlation analysis is presented. Furthermore, the fMRI model fit allows separation and quantification of flow and blood oxygen level dependent (BOLD) contributions in the human visual cortex. In gradient-recalled echo fMRI at 1.5 T (TR = 60 ms, TE = 42 ms, radiofrequency excitation flip angle [theta] = 10 degrees-60 degrees) total signal enhancement in the human visual cortex, ie, flow-enhanced BOLD plus inflow contributions, on average varies from 5% to 10% in or close to the visual cortex (average cerebral blood volume [CBV] = 4%) and from 100% to 20% in areas containing medium-sized vessels (ie, average CBV = 12% per voxel), respectively. Inflow enhancement, however, is restricted to intravascular space (= CBV) and increases with increasing radiofrequency (RF) flip angle, whereas BOLD contributions may be obtained from a region up to three times larger and, applying an unspoiled gradient-echo (GRE) sequence, also show a flip angle dependency with a minimum at approximately 30 degrees. This result suggests that a localized hemodynamic response from the microvasculature at 1.5 T may be extracted via fuzzy clustering. In summary, fuzzy clustering of fMRI data, as realized in the Evident software, is a robust and efficient method to (a) separate functional brain activation from noise or other sources resulting in time-dependent signal changes as proven by simulated fMRI data analysis and in vivo data from the visual cortex, and (b) allows separation of different levels of activation even if the temporal pattern is indistinguishable. Combining fuzzy cluster separation of brain activation with appropriate model calculations allows quantification of flow and (flow-enhanced) BOLD contributions in areas with different vascularization.

Contrast agents in functional MR imaging

Abstract: Contrast agents have greatly expanded the role of MR imaging (MRI) to allow assessment of physiologic, or "functional," parameters. Although activation mapping generally does not require contrast agents, other forms of functional MRI, including mapping of cerebral hemodynamics (eg, perfusion imaging), are best done with the use of contrast agents. Serial echo planar images are obtained after bolus injection of lanthanide chelates. Application of susceptibility contrast physics and standard tracer kinetic principles permits generation of relative cerebral blood volume maps. Deconvolution of cerebral blood flow and mean transit time parameters is also possible within technical limitations. By using diffusion and perfusion pulse sequences, an imaging correlate to the ischemic penumbra can be identified. Functional MRI perfusion imaging of intraaxial tumors is analogous to positron emission tomography for delineation of metabolic activity, yet may be even more sensitive to neovascularity and possesses improved image quality. Clinical applications include biopsy site selection and postirradiation follow-up. Further improvements in data analysis and map generation techniques may improve diagnostic accuracy and utility.

Ovarian fibromas and cystadenofibromas: MRI features of the fibrous component

Abstract: Ovarian fibromas and cystadenofibromas are neoplasms that share a similar distinctive tissue component of dense fibrous tissue. We sought to describe the MRI features of these neoplasms and to determine if the fibrous component shows distinctive characteristics. Fourteen patients in whom MR images performed with multicoil and fast-spin-echo images and who subsequently underwent surgery for resection of ovarian fibromas or cystadenofibromas were identified from two institutions. Five patients had ovarian fibromas, and nine patients had fourteen cystadenofibromas. 1.5-T MR studies used T1-weighted spin echo and multiplanar T2-weighted fast-spin-echo images, with fat saturation gadolinium-enhanced fast multiplanar gradient-echo images in seven patients. Studies were reviewed for findings of low (approximately equal to skeletal muscle) signal intensity solid components on T2-weighted images, characteristics of gadolinium enhancement, and associated endometrial findings. Images were obtained ex vivo from three adnexal surgical specimens with an 8-cm field of view and correlated with histology. All five of the fibromas showed predominantly very low signal intensity, similar to skeletal muscle, on T2-weighted images. Two of five fibromas were in patients with endometrial polyps and increased amounts of fluid in the pelvis. Thirteen cystadenofibromas were multicystic masses with bands of very low signal intensity ranging from 2 to 20 mm in the wall of the mass, and one was predominantly solid fibrous tissue. Pathologic correlation with specimen images showed that the low signal intensity material was the subepithelial fibrous component of the cystadenofibromas. Fibrous components of ovarian fibromas and cystadenofibromas are demonstrable by MR as solid components representing fibrous tissue of very low signal intensity on T2-weighted images.

Multifeature analysis of Gd-enhanced MR images of breast lesions.

Abstract: The objective of this study was to determine whether linear discriminant analysis of different independent features of MR images of breast lesions can increase the sensitivity and specificity of this technique. For MR images of 23 benign and 20 malignant breast lesions, three independent classes of features, including characteristics of Gd-DTPA-uptake curve, boundary, and texture were evaluated. The three classes included five, four and eight features each, respectively. Discriminant analysis was applied both within and across the three classes, to find the best combination of features yielding the highest classification accuracy. The highest specificity and sensitivity of the different classes considered independently were as follows: Gd-up-take curves, 83% and 70%; boundary features, 86% and 70%; and texture, 70% and 75%, respectively. A combination of one feature each from the first two classes and age yielded a specificity of 79% and sensitivity of 90%, whereas highest figures of 93% and 95%, respectively, were obtained when a total of 10 features were combined across different classes. Statistical analysis of different independent classes of features in MR images of breast lesions can improve the classification accuracy of this technique significantly.

MRI acoustic noise: Sound pressure and frequency analysis

Abstract: The large gradient coils used in MRI generate, simultaneously with the pulsed radiofrequency (RF) wave, acoustic noise of high intensity that has raised concern regarding hearing safety. The sound pressure levels (SPLs) and power spectra of MRI acoustic noise were measured at the position of the human head in the isocenter of five MRI systems and with 10 different pulse sequences used in clinical MR scanning. Each protocol, including magnetization-prepared rapid gradient echo (MP-RAGE; 113 dB SPL linear), fast gradient echo turbo (114 dB SPL linear), and spin echo T1/2 mm (117 dB SPL linear), was found to have the high SPLs, rapid pulse rates, amplitude-modulated pulse envelopes, and multipeaked spectra. Since thickness and SPL were inversely related, the T1-weighted images generated more intense acoustic noise than the proton-dense T2-weighted measures. The unfiltered linear peak values provided more accurate measurements of the SPL and spectral content of the MRI acoustic noise than the commonly used dB A-weighted scale, which filters out the predominant low frequency components. Fourier analysis revealed predominantly low frequency energy peaks ranging from .05 to approximately 1 kHz, with a steep high frequency cutoff for each pulse sequence. Ear protectors of known attenuation ratings are recommended for all patients during MRI testing.

Triangular fibrocartilage and intercarpal ligaments of the wrist: Does MR arthrography improve standard MRI?

Abstract: The objective of this study was to assess the value of adding MR arthrography to standard MRI for patients with chronic wrist disorders. Thirty consecutive patients (age range, 19-73 years; mean, 36.2 years) were included in the investigation. The images were evaluated blindly and separately by two radiologists with regard to lesions of the scapholunate (SL) and lunotriquetral (LT) ligaments and the triangular fibrocartilage (TFC). Conventional two- or three-compartment arthrography was used as the standard of reference. For TFC lesions, standard MR images had a sensitivity of 92.3% (reader 1) and 84.6% (reader 2) and a specificity of 41.2% (reader 1) and 52.9% (reader 2). For MR arthrography, sensitivity was 84.6% (reader 1) and 84.6% (reader 2) and specificity was 88.2% (reader 1) and 100% (reader 2). For SL ligament tears, standard MRI had a sensitivity of 33.3% (reader 1) and 11.1% (reader 2) and a specificity of 47.6% (reader 1) and 57.1% (reader 2). For MR arthrography, sensitivity was 66.7% (reader 1) and 55.6% (reader 2) and specificity was 52.4% (reader 1) and 81.0% (reader 2). For LT ligament tears, standard MRI had a sensitivity of 28.6% (reader 1) and 35.7% (reader 2) and a specificity of 93.8% (reader 1) and 81.3% (reader 2). For MR arthrography, sensitivity was 35.7% (reader 1) and 23.1% (reader 2) and specificity was 93.8% (reader 1) and 94.1% (reader 2). In conclusion, the diagnostic performance of MRI in suspected lesions of the TFC and the SL and LT ligaments is improved by adding MR arthrography to the standard examination.

Useful internal standards for distinguishing infiltrative marrow pathology from hematopoietic marrow at MRI

Abstract: The objective of this study was to establish internal standards on MRI differentiating infiltrative marrow pathology from hematopoietic marrow. The T1-weighted images of 74 patients (51 biopsy-proven; 23 clinical follow-up) were reviewed retrospectively. The relative signal intensity of bone marrow was compared to adjacent skeletal muscle (n = 65) and/or nondegenerated intervertebral disk (n = 53). Twenty foci were hyperintense compared to muscle, of which 17 (85%) cases represented normal red marrow (P < .0001); 45 were isointense or hypointense compared to muscle, of which 44 (98%) represented infiltrative marrow processes (P < .0001). Twelve were hyperintense compared to disk, of which 12 (100%) represented normal red marrow (P < .0001); 41 were isointense or hypointense compared to disk, of which 40 (98%) represented infiltrative marrow processes (P < .0001). On T1-weighted spin-echo MRI, skeletal muscle and intervertebral disk may serve as internal standards for differentiating infiltrative pathology from normal hematopoietic marrow. Marrow lesions that are relatively isointense or hypointense to muscle and/or disk should not be considered normal hematopoietic marrow.