Vessel size imaging in humans

The relation of contrast-enhanced transverse relaxation rates R2* and R2 provides in vivo mapping of the mean caliber of cerebral vessels. This technique is referred to as vessel size imaging (VSI). Here a quantitative assessment of the vessel caliber in brain tumor patients is presented. The obtained mean vessel size shows sensitivity to the tumor type. A theoretical analysis is given to elucidate the morphological information content of VSI in the context of vessel architecture. The simplification of the theory underlying the data processing results in a systematic overestimation of the vessel caliber. An increase in the magnetic susceptibility of the contrast agent allows for quantitatively more accurate measurements. Quantitative VSI must include measurements of the regional diffusion coefficient and absolute determination of the regional cerebral blood volume.

Point spread function mapping with parallel imaging techniques and high acceleration factors: fast, robust, and flexible method for echo-planar imaging distortion correction

Echo-planar imaging (EPI) is an ultrafast magnetic resonance (MR) imaging technique prone to geometric distortions. Various correction techniques have been developed to remedy these distortions. Here improvements of the point spread function (PSF) mapping approach are presented, which enable reliable and fully automated distortion correction of echo-planar images at high field strengths. The novel method is fully compatible with EPI acquisitions using parallel imaging. The applicability of parallel imaging to further accelerate PSF acquisition is shown. The possibility of collecting PSF data sets with total acceleration factors higher than the number of coil elements is demonstrated. Additionally, a new approach to visualize and interpret distortions in the context of various imaging and reconstruction methods based on the PSF is proposed. The reliable performance of the PSF mapping technique is demonstrated on phantom and volunteer scans at field strengths of up to 4 T.

Fast 31P chemical shift imaging using SSFP methods

Steady-state free precession (SSFP) methods have been very successful due to their high signal and short imaging times. These properties make them good candidates for applications that intrinsically suffer from low signal such as low gamma nuclei imaging. A new chemical shift imaging (CSI) technique based on the SSFP signal formation has been implemented and applied to (31)P. The signal properties of the SSFP CSI method have been evaluated and the steady-state signal of (31)P has been measured in human muscles. Due to the T(2) and T(1) signal dependence of SSFP, the steady-state signal mainly consists of phosphocreatine (PCr). The technique allows fast CSI acquisitions with high SNR of the PCr signal. The SNR gain for PCr over a FLASH-based CSI method is approx. 4-5. Fast in vivo CSI of human muscle with subcentimeter resolution and high SNR is demonstrated at 2 T.

Decoupling of the short-term hemodynamic response and the blood oxygen concentration

Neuronal activation leads to an increase in the local cortical perfusion. The exact regulatory mechanisms leading to these changes are still unknown. To elucidate the role of oxygen in the initial hemodynamic regulation, a disactivation paradigm was performed with fMRI. A stimulus was applied following a previous extended activation in order to evoke physiological variations of the local oxygen concentration. The results demonstrate that the initial hemodynamic response time is independent of the local blood oxygen concentration.

Motion correction of parametric fMRI data from multi-slice single-shot multi-echo acquisitions

Fast parametric imaging using multi-echo techniques has been proven to yield quantitative parameter maps with high stability for functional MRI (fMRI). Due to the different contrasts and signal-to-noise ratios (SNRs) in the various images, motion correction of the echo images or the resulting parameter maps is not a straightforward process. 3D motion correction of parametric imaging data has not yet been examined thoroughly. However, motion correction is an essential step in fMRI data processing. In this study several possible motion detection methods were tested and compared. Motion parameters can be estimated from the different echo images as well as from the parameter maps. The accuracy of the different methods was examined in simulations and in in vivo experiments. Motion parameters should be estimated from the I(0)-parameter maps and subsequently applied to the T(*)(2)-parameter maps.

Neural correlates of attention and working memory deficits in HIV patients

OBJECTIVES

To evaluate the neural correlates of attention and working memory deficits in patients with HIV-1.

METHOD

fMRI was used to evaluate brain activity in 11 patients with HIV and 11 age-, sex-, education-, and handedness-matched seronegative subjects, while performing a battery of tasks that required different levels of attention for working memory.

RESULTS

Patients with HIV showed greater brain activation (blood oxygenation level dependent signal changes) in some regions compared with control subjects while performing the same tasks. For the simpler tasks, patients with HIV showed greater activation in the parietal regions. However, with more difficult tasks, patients with HIV showed greater activation additionally in the frontal lobes. Reaction times during these tasks were slower but accuracy was similar in the patients with HIV compared with control subjects.

CONCLUSION

Injury to the neural substrate caused by HIV infection may necessitate greater attentional modulation of the neural circuits, hence a greater use of the brain reserve; additional activation of the frontal lobes is required to perform the more complex tasks. The task-dependent increased frontal activation in patients with HIV suggests that the neural correlate of attentional deficits may be excessive attentional modulation as a result of frontostriatal brain injury.

Biexponential modeling of multigradient-echo MRI data of the brain

Functional MRI (fMRI) using fast multigradient-echo acquisition methods allows the quantitative determination of the relevant parameter T2*. Previously, the TE-dependent signal decay has been modeled with a monoexponential function despite the complex composition of the brain. In this study, biexponential modeling was used to evaluate the relaxation of brain parenchyma and blood separate from that of cerebrospinal fluid. Single-shot multigradient-echo data acquired with spiral or EPI techniques were analyzed. In phantom experiments the biexponential method proved to be accurate. Compared to the biexponential procedure, the monoexponential model overestimated T2* (72.2 msec vs. 65.3 msec) and underestimated DeltaT2* (2.96 msec vs. 3.19 msec) during visual stimulation. The biexponential method may allow intrinsic correction for partial volume effects due to cerebrospinal fluid. The activation-induced parameter changes are detected with a sensitivity equal to that of a monoexponential method. The resulting T2* and DeltaT2* values describe the experimental data more accurately.

Separation and quantification of perfusion and BOLD effects by simultaneous acquisition of functional I(0)- and T2(*)-parameter maps

The nature of the coupling between neuronal activity and the hemodynamic response is the subject of intensive research. As a means to simultaneously measure parametric changes of T2(*), initial intensity (I(0)) and perfusion with high temporal resolution, a multi-image EPI technique with slice-selective inversion recovery (ssIR) for arterial spin labeling was developed and implemented. Comparative measurements with and without the preceding slice-selective inversion pulse were performed. I(0) and R2(*) changes induced by primary visual stimulation were separated. For ssIR-multi-image EPI the average change of I(0) over all 12 subjects was 3.4%, corresponding to a perfusion change of 40 ml/min/100 g, whereas only minor I(0) changes were observed without inversion. On average, the R2(*) of the activated pixels changed by -0.62 sec(-1) without inversion, while a significantly reduced average R2(*) change of -0.46 sec(-1) was calculated for ssIR-multi-image EPI due to a decreased BOLD effect contribution of the intravascular compartment.

HIV-2 infection with cerebral toxoplasmosis and lymphomatoid granulomatosis

A Nigerian man had acute onset of headache and vertigo due to a cerebellar mass. A brain biopsy of the mass revealed toxoplasmosis despite repeated negative HIV-1 serology. The presence of an opportunistic infection and his country of origin raised the suspicion for HIV-2; this was confirmed by positive HIV-2 serology. Despite his preliminary pathological diagnosis, results of physiological magnetic resonance imaging (MRI) (perfusion MRI and proton magnetic resonance spectroscopy) were not typical for toxoplasmosis. The lesion showed a biochemical and perfusion pattern that was intermediate for infectious and neoplastic processes. Further neuropathology confirmed a secondary diagnosis of lymphomatoid granulomatosis.

Comparison of the hemodynamic response to different visual stimuli in single-event and block stimulation fMRI experiments

Experiments with three different types of basic visual stimulation were performed to compare cortical activation in single-event and block trials. Independent of the stimulation paradigm, the single-event presentation leads to highly consistent signal responses regarding both the activated cortical areas and the dynamics of the signal time course. In contrast, signal time courses during block paradigms depend on the stimulus applied and are a complex and nonlinear function of the single-event responses. Additionally, the initial dip during the first 2 seconds after stimulus onset is consistently observed. However, the small amplitude change (-0.1% to -0.3%) requires signal averaging to establish statistical significance of the effect. Furthermore, different patterns of activation were observed within the primary visual cortex. In an anterior part of the primary visual cortex, activation was only observed at the onset and at the cessation of stimulation involving luminance changes.

Perfusion MRI of the human brain with dynamic susceptibility contrast: gradient-echo versus spin-echo techniques

In this study, spin-echo and gradient-echo-based perfusion magnetic resonance imaging (MRI) techniques are systematically compared with respect to their application in the human brain. Six healthy subjects were evaluated with both techniques consecutively and injected twice with a gadolinium-based contrast agent. In accordance with theoretical predictions and with previous animal experiments, the spin-echo-based technique shows a markedly reduced appearance of large vessels. The intersubject standard deviations of the two methods are similar but smaller for the spin-echo technique in small regions adjacent to large vessels. Therefore, the sensitivity of the two acquisition methods for evaluating pathologic abnormalities may be similar despite the higher contrast-to-noise ratio of the gradient-echo-based technique. The gray-to-white matter ratio of the regional cerebral blood flow of the spin-echo method is closer to previous nuclear medicine measurements than that of the gradient-echo method. Our measurements indicate that spin-echo-based perfusion MRI is more representative of capillary perfusion than gradient-echo measurements. J. Magn. Reson. Imaging 2000;12:381-387.

Cerebral perfusion abnormalities in abstinent cocaine abusers: a perfusion MRI and SPECT study

Nuclear medicine studies found decreased regional cerebral blood flow (rCBF) in the cortex and deep gray matter of cocaine users. Perfusion magnetic resonance imaging (MRI), a non-radioactive technique, has not been applied to evaluate persistent rCBF abnormalities. Twenty-five abstinent cocaine users and 15 healthy subjects without a history of drug use were examined with perfusion MRI, using dynamic bolus-tracking, and single photon emission computed tomography (SPECT), using 133Xe-calibrated 99mTc-HMPAO. After coregistration of SPECT with MRI, the relative rCBF (from perfusion MRI and SPECT) and absolute rCBF (from SPECT) were determined in 10 brain regions in each hemisphere. There was a statistically significant interaction between drug use and brain region on SPECT alone (relative and absolute rCBF), and on SPECT and perfusion MRI combined, but not on perfusion MRI alone. There also was a significant interaction among gender, drug use, and brain region. Compared to the control subjects, cocaine users showed increased rCBF in the frontal white matter (+8.6%, P=0.02) and in the globus pallidus (+6.3%, P=0.05), and decreased rCBF in the putamen (-3.9%, P=0.04) and the temporal cortex (-2.4%, P=0.02). SPECT and perfusion MRI detect a regional pattern of rCBF abnormalities in cocaine users that is consistent across the two methods. The hypoperfusion in the cortex and deep gray matter of the cocaine users is consistent with previous results. The increased rCBF in the white matter of cocaine users may be due to the presence of reactive glia.

Gender differences in the functional organization of the brain for working memory

Gender differences in brain activation during working memory tasks were examined with fMRI. Seventeen right-handed subjects (nine males, eight females) were studied with four different verbal working memory tasks of varying difficulty using whole brain echo-planar fMRI. Consistent with prior studies, we observed activation of the lateral prefrontal cortices (LPFC), the parietal cortices (PC), and additionally, caudate activation in both sexes. The volume of activated brain tissue increased with increasing task difficulty. For all four tasks, the male subjects showed bilateral activation or right-sided dominance (LPFC, PC and caudate), whereas females showed activation predominantly in the left hemisphere. The task performance data demonstrated higher accuracy and slightly slower reaction times for the female subjects. Our results show a highly significant (p < 0.001) gender differences in the functional organization of the brain for working memory. These gender-specific differences in functional organization of the brain may be due to gender-differences in problem solving strategies or the neurodevelopment. Therefore, gender matching or stratification is required for studies of brain function using imaging techniques.

Evidence for long-term neurotoxicity associated with methamphetamine abuse: A 1H MRS study

OBJECTIVE

To determine whether proton MRS (1H MRS) can detect long-term metabolite abnormalities in abstinent methamphetamine users.

BACKGROUND

Methamphetamine is toxic to dopaminergic and serotonergic neurons in rodents; however, little data are available on the toxic effects of methamphetamine on the human brain.

METHODS

1H MRS was performed in 26 abstinent methamphetamine abusers with a history of methamphetamine dependence (median total cumulative lifetime exposure, 3,640 g; median recency of last methamphetamine use, 4.25 months) and 24 healthy subjects without a history of drug abuse. Cerebral metabolite concentrations on 1H MRS were measured in the frontal cortex, frontal white matter, and basal ganglia.

RESULTS

The concentration of N-acetylaspartate ([NA]), a neuronal marker, was reduced significantly (-5 to -6%) in the basal ganglia and frontal white matter of methamphetamine users compared with control subjects. The frontal white matter [NA] correlated inversely with the logarithm of the lifetime methamphetamine use. The methamphetamine users also showed significantly reduced total creatine in the basal ganglia (-8%), and increased choline-containing compounds ([CHO], +13%) and myo-inositol ([MI], +11%) in the frontal grey matter.

CONCLUSIONS

The reduced [NA] on 1H MRS provides evidence for long-term neuronal damage in abstinent methamphetamine users.

Perfusion MRI detects rCBF abnormalities in early stages of HIV-cognitive motor complex

OBJECTIVE

To evaluate patients with early HIV-cognitive motor complex (HIV-CMC) for possible regional cerebral blood flow (rCBF) abnormalities on perfusion MRI (pMRI).

BACKGROUND

Nuclear medicine techniques have demonstrated global and focal cerebral perfusion abnormalities in patients with HIV dementia. Ultrafast pMRI enables the measurement of rCBF throughout the brain without the need to apply radioactive tracers or ionizing radiation.

METHODS

pMRI was used to measure the rCBF in 19 patients with early stages of HIV-CMC and 15 healthy seronegative control subjects. The rCBF maps were registered to high-resolution anatomic MRI scans and transformed into Talairach space. Statistical analysis of the rCBF maps was performed with SPM96.

RESULTS

Compared with the control subjects, the patients with HIV had statistically significantly decreased rCBF bilaterally in the inferior lateral frontal cortices (right: -15%, p < 0.002; left: -12%, p < 0.005) and in the inferior medial parietal brain region (-15%, p < 0.0009). In contrast, rCBF was increased bilaterally in the posterior inferior parietal white matter (right: +19%, p < 0.0001; left: + 17%, p < 0.001). Furthermore, rCBF abnormalities correlated significantly with clinical disease severity as measured by CD4 count, plasma viral load, Karnofsky score, and HIV dementia scale.

DISCUSSION

Our results are consistent with previous findings from PET and SPECT studies. Furthermore, pMRI can detect rCBF abnormalities that correlate with disease severity in HIV-CMC. Because pMRI is more cost-effective, faster, and safer than nuclear medicine techniques for monitoring rCBF changes, pMRI may be more feasible for monitoring the effects of therapy for HIV-CMC.

Highly active antiretroviral therapy reverses brain metabolite abnormalities in mild HIV dementia

OBJECTIVE

To determine whether cerebral metabolite abnormalities normalize with highly active antiretroviral therapy (HAART).

BACKGROUND

Patients with HIV-cognitive motor complex (HIV-CMC) show cerebral metabolite abnormalities in the early stages of dementia.

METHODS

Sixteen patients with HIV-CMC were evaluated before and after HAART, and compared with 15 HIV-negative healthy volunteers. Cerebral metabolite ratios and concentrations in the frontal lobe and basal ganglia were measured using proton MRS (1H MRS).

RESULTS

In 14 of 16 patients who tolerated HAART, CD4 count increased by 133+/-101 cells/mm3 (p = 0.0003), HIV Dementia Scale score increased by 1.8+/-2.4 points (p = 0.02), and AIDS dementia complex (ADC) stage decreased by 0.54+/-0.54 points (p = 0.003). The initially increased choline/creatine (CHO/CR) reversed in the midfrontal cortex (-8.0%; p = 0.02) and in the basal ganglia (-14.7%; p = 0.01). The initially elevated myoinositol (MI)/CR and myoinositol concentration [MI] in the basal ganglia also decreased (MI/CR: -14.1%; p = 0.005; [MI]: 11.8%; p = 0.02), along with normalization of [MI] in the frontal white matter (11.4%; p = 0.05). Furthermore, the change in [MI] in the frontal white matter correlated with the change in CD4 count (r = -0.67, p = 0.03) and with the change in ADC stage (p = 0.04).

CONCLUSIONS

HAART improves HIV-CMC in addition to systemic measures of HIV infection. 1H MRS detects improvement of brain injury measured by cerebral metabolites, particularly the glial marker [MI], in patients with early HIV-CMC after HAART. In addition, the degree of improvement in clinical severity of HIV-CMC is related to the degree of recovery with [MI].

Simultaneous correction for interscan patient motion and geometric distortions in echoplanar imaging

A method is presented for simultaneous correction of linear geometric distortions and interscan patient motion in echoplanar imaging (EPI). The technique does not require the acquisition of specialized scans other than high-resolution magnetic resonance images. The method is based on a generalized surface-based coregistration algorithm, which accounts for a complete 3-dimensional affine transformation, i.e., rotations, translations, scaling, and shearing, between two volumetric image data sets. Any minimally distorted high-resolution scan may serve as a reference data set, to which the EPI data set is matched. The algorithmic accuracy was assessed using simulated data sets with known affine distortions. The deviation of the parameters determined by the coregistration program from the true values typically was 1% or less. Precise alignment of functional and anatomic information will be important for many future clinical applications.

Comparison of static and dynamic MRI techniques for the measurement of regional cerebral blood volume

Two different acquisition and processing strategies to determine the regional cerebral blood volume (rCBV) with magnetic resonance imaging (MRI) are compared. The first method is based on the acquisition of the signal time course during a bolus administration of a contrast agent (dynamic method). The second method evaluates signal changes before and after the contrast agent injection (static method), assuming the contrast agent remains primarily intravascular in the brain after the first pass. Both methods were applied to the same data sets, acquired with either echoplanar imaging (EPI, n = 18) or fast low-angle shot (FLASH, n = 28) techniques. A voxel-by-voxel correlation between the static and dynamic method yielded a correlation coefficient of 0.76 +/- 0.06 for the EPI and 0.71 +/- 0.10 for the FLASH measurements. The static method was less sensitive and showed higher standard deviations for rCBV than the dynamic method. With the development of truly intravascular contrast agents, the static perfusion MRI method, which can be performed with higher signal-to-noise ratio and higher spatial resolution, may become an alternative to ultra-fast MRI for measuring rCBV.

Correlation of regional cerebral blood flow from perfusion MRI and spect in normal subjects

The objective of this study was to determine the relationship in regional cerebral blood flow (rCBF) as measured with perfusion magnetic resonance imaging (pMRI) and single photon emission computer tomography (SPECT). rCBF was determined in 26 healthy subjects with pMRI and SPECT. After co-registration of pMRI with SPECT, rCBF was determined in 10 brain regions relative to the whole slice value. pMRI was evaluated with and without elimination of large vessels. rCBF from pMRI correlates significantly with rCBF from SPECT (r = 0.69 with and r = 0.59 without elimination of large vessels; p < 0.0001 for both). Elimination of large vessels reduced the interindividual variance of the pMRI measurements in most regions. rCBF from pMRI shows good correlation with rCBF from SPECT. Because pMRI is sensitive to flow in large vessels while SPECT is not, elimination of large vessels in pMRI reduces the interindividual variability of pMRI and improves the-correlation between the two methods. pMRI is a reliable noninvasive method for rCBF measurements.

Functional imaging by I0- and T2*-parameter mapping using multi-image EPI

A new functional imaging method has been developed and used to measure T2*- and initial intensity (I0)-parameter maps of multiple slices during activation of the cortex with high temporal resolution. Multiple echo-planar images (EPIs) are read out after a single excitation of the spin system, leading to several images with increasing effective echo times. Changes induced by primary visual stimulation in T2* and I0 were measured in eight subjects. Although stimulation-induced increases in I0 only occurred at short repetition times, T2* increased from 57.3 to 60.9 ms on average. The method combines the high stability of a single shot EPI experiment with the high information content of a multiecho acquisition. In addition, stimulation-induced changes in inflow can be easily separated from true blood oxygenation level dependent (BOLD) signal changes.

1H-magnetic resonance spectroscopy in obsessive-compulsive disorder: evidence for neuronal loss in the cingulate gyrus and the right striatum

We compared 12 patients with obsessive-compulsive disorder (OCD) and six control subjects by 1H-magnetic resonance spectroscopy. Significantly lower relative N-acetyl-aspartate (NAA) levels were found in the right striatum of OCD patients, as well as a decrease of anterior cingulate NAA that correlated with severity of illness. Age and sex were correlated to striatal NAA levels.

Improved sensitivity to overlapping multiplet signals in in vivo proton spectroscopy using a multiecho volume selective (CPRESS) experiment

A method for volume selective proton spectroscopy is presented based on a multiecho sequence with short refocusing interval tcp. It is demonstrated, that by appropriate choice of tcp on the order of 4-6 ms, signals from overlapping multiplets like the glutamine and glutamate (Glu/Gln) resonances in spectra of the human brain are considerably increased compared with a conventional PRESS volume selection scheme. Thus proton spectra from J-coupled multiplet signals can be acquired with TE on the order of 20-30 ms avoiding the baseline problems arising at shorter echo times due to broad resonances. This allows to selectively acquire spectra from substances with longer T2 without the confounding effects from J-coupling occurring in conventional volume selection techniques.

Time-resolved measurements of brain activation after a short visual stimulus: new results on the physiological mechanisms of the cortical response

This paper presents examinations of the time course of the signal from the visual cortex following a brief (2 s) light stimulus. Signal was generated from a 2 x 2 x 2 ml voxel using a modified point-resolved spectroscopy experiment. In accordance with previous studies a triphasic time course was observed. The results indicate that the observable signal contains contributions from non blood oxygen level dependent signal changes occurring immediately after the onset of stimulation. The response to multiple stimuli could be fitted with a response model which is linear with respect to the BOLD-phase of the response. This suggests that the experiments using a very weak stimulus were performed below the limit of the arterial reserve. This is in marked contrast to other studies performed by functional magnetic resonance imaging as well as optical imaging. First results using echo planar imaging confirm the common origin of the signals in the activated cortical areas.

Grading and therapy monitoring of astrocytomas with 1H-spectroscopy: preliminary study

We examined 11 patients (9 male and 2 female, age 41 +/- 13) presenting astrocytomas of different malignancy grade (WHO) with single voxel (PRESS) and double voxel (STABLE) spectroscopy techniques. The content of choline in the tumors was determined as a function of their grade of malignity and a significant correlation was found. The measurements were repeated after interstitial radiosurgery. Observed spectra changes induced by this stereotactic treatment with 125I-seed demonstrated the possibility of therapy monitoring.

[Principles of functional magnetic resonance tomography]

The basic principles of brain activation studies by MRI and functional spectroscopy are presented. The paper introduces the underlying mechanisms, followed by a discussion of the possibilities and limitations of current and new measuring techniques. Functional MRI has already proven to be a useful tool in neurocognitive research. Initial clinical applications have especially been demonstrated in neurosurgical operation planning.

[Functional spectroscopy: the limits and potentials of a new method for the study of brain activation with MR tomography]

The possibility of examining brain activity by means of localised spectroscopy was studied in relation to its neurological basis. Measurements on 18 normals during optical stimulation showed an improvement in signal to noise ratio compared with functional imaging of almost one order of magnitude. Time dependent measurements during stimulation by a 500 ms light impulse showed definite delay of increased blood flow when compared with oxygen utilisation. The excellent signal to noise ratio and the inherent stability of the method permits reliable detection of weak effects such as are caused by finger tapping or electrical stimulation.

Detection of brain activation using oxygenation sensitive functional spectroscopy

A nonwater-suppressed localized spectroscopy experiment using the PRESS-sequence has been used to study the signal changes of the water resonance during cortical activation. Significant effects with an effect-to-noise ratio up to 50:1 for a single shot experiment have been observed upon photic stimulation. The exceedingly high signal-to-noise ratio of the experiment was used to demonstrate signal changes as low as 0.1% after electrical stimulation of the median nerve.

[Early education of disabled children seen from the angle of regionalization and inter-disciplinary work (author's transl)]

Early education of disabled children is presented as a specific and indispensable yet integrated part of a complex task which can be mastered solely by inter-disciplinary co-operation and interchange between educational, psychological, medical and clinical services. The author submits a concept - developed and put to the test at federal state level - of a regional and closely knit network of educationally-oriented education services. Statistical data obtained from 103 early education facilities in Bavaria give an insight into the work of such institutions.